Question For Patients

[Dr. Bob]

Recently the status of the physician certification and patient application packet for medical marijuana has been questioned in a court case. As patients, what do you consider 'medical records', are these documents private to you, and who should retain them- the physician who saw you or the people that held the 'clinic event' and why? Just want to get the general feelings of the community.

 

My thought is that if a physician sees a patient professionally, evaluates their condition, and makes recommendations the record of that visit is a 'medical record' to be retained by the physician. The physician needs to have those records on hand to defend the certification in court and before the medical board if questions arise. I also feel they have the same privacy needs of any other medical record. The law requires the doctor to maintain those records for a period of 7 years because of the possibility of having to refer back to them in a court or board hearing. Do you agree or disagree and why?

[Restorium2]

Thcf held records and left the state. When I wanted to see the same doctor again he didn't have the records, THCF did. I believe the doctor should have the records not the clinic. I think this is a no brainer after what some clinics have done. Doctors have ethical standards they must follow, clinics, not so much. Doctors need to run the show, not clinics.

Thanks for bringing this up, there definitely is room for improvement.

[ilynnboy]

It is or was my understanding that the doctor is Responsible for safekeeping and storage of personal medical records.

Isn't it the doctors license at stake if they cannot produce the necessary documents to substantiate their recommendations?

Is there no legal requirement?

I am going to research this as to legality and or responsibility.

I will be back, going to check the state medical licensing authority.

 

 

[Dr. Bob]

But the question is 'are the application documents and physician certification form medical records and why?' A recent court ruling, at the request of non-physicians who run 'certification clinic events', says they are not. Similar situation to what was described concerning THCF leaving the state (see above), though they were not the 'clinic' involved.

 

Dr. Bob

[Restorium2]

It may hinge on the fact that some clinics use more than one doctor so they can show a need to keep the records for the use of their other doctors if a patient decides to stay with a certain clinic and not specifically the same doctor.

Edited April 24, 2012 by Restorium2

[Morhawk]

You mean the form with the Name, SSN, and diagnosis on it? If that's not a medical record, then I do not know what is..

[semicaregiver]

In our little niche the answer seems clear cut that the doc should retain the records, but is that how it happens in the larger world?

 

For example, the internist that I see annually works out of what I might describe as a clinic, others might describe it as a group practice. Either way, the office door has the name Beaumont on it. When I went there the first time I had recently gotten a good insurance policy that paid for an annual physical. This office was close by and I was of course familiar with the hospital name associated with the group.

Since my original visit, I have seen the same internist for my last three visits and I feel comfortable with him to the point that if he went off on his own or to another medical group I would probably seek him out and continue with him.

 

Where I am going with this is, I would expect that he has some sort of non-compete clause in his employment contract and if he left, the records would not go with him. On the flipside, I fully expect that I could request Beaumont to transfer my records to him and they would do so.

 

In the world of mmj clinics things are not so clear cut. As we know, many are from out of state and they have little financial investment here in Michigan that would preclude them from just leaving their patients high and dry. Recognizing this, it would be ideal if both the doc and the clinic retained the records. My thinking here is that it is just as likely that the doc may decide that doing mmj rec'c is not his or her thing and leave the patient out to dry as well.

[SparklyBuds]

I think any documents with information on our diagnosis and/or treatment, including history / physical exam, progress notes, lab, XRay or other tests, and prescription (or in this case, recommendation). Any of that is Medical, not business, records.

 

Doctor should retain the records, since the relationship is between the Doctor and Patient; the clinic is just hosting the event.

Edited April 24, 2012 by SparklyBuds

[Dr. Bob]

If the doctor decided to stop doing certifications, would he not still have to defend those certifications he did? If so, with what would he defend them. We are not discussing what other types of practices do, showing someone else does a 'worse' job does not make us look 'better'. Personally, when recommending a schedule 1 narcotic, illegal on the federal level, and the target of the state AG, I think we need to hold ourselves to a higher standard at times. So let's not look at bad examples of what is being done elsewhere, let's look at what should be done.

 

The issue here is that the certification documents were considered 'business records' not medical records in the local ruling, and the ruling was requested by the attorney for a group of non-physicians that runs 'certification clinic events' with 'hired doctors' to review and sign the certification forms. It is not a physician owned business, nor is it a medical clinic. It is claiming all the application material, medical records from outside Primary Care doctors, etc are only 'business records' and not considered medical records.

 

I disagree, and think the medical board will as well, but I am curious as to what the folks that are giving private health information to these people think.

 

Dr. Bob

[Willy]

Seems to me that as blanks there not medical records, but as soon as the doctor fills out the forms, or you populate the information , then its a medical record. I believe that its the doctors responsiblility to maintain these records for a give time frame, as someone stated its 7 years.

[Dr. Bob]

I should note as well, the implication is far reaching. 'Medical Records' are protected by health privacy laws, 'Business Records' are not. When you went to a certification clinic, were you expecting your records to be treated as medical or business records? If so, why?

 

Dr. Bob

[Morhawk]

If the doctor decided to stop doing certifications, would he not still have to defend those certifications he did? If so, with what would he defend them. We are not discussing what other types of practices do, showing someone else does a 'worse' job does not make us look 'better'. Personally, when recommending a schedule 1 narcotic, illegal on the federal level, and the target of the state AG, I think we need to hold ourselves to a higher standard at times. So let's not look at bad examples of what is being done elsewhere, let's look at what should be done.

 

The issue here is that the certification documents were considered 'business records' not medical records in the local ruling, and the ruling was requested by the attorney for a group of non-physicians that runs 'certification clinic events' with 'hired doctors' to review and sign the certification forms. It is not a physician owned business, nor is it a medical clinic. It is claiming all the application material, medical records from outside Primary Care doctors, etc are only 'business records' and not considered medical records.

 

I disagree, and think the medical board will as well, but I am curious as to what the folks that are giving private health information to these people think.

 

Dr. Bob

 

Now what if said "Clinic operators" (cashiers basicly) are not HIPAA certified and/or trained and you willingly hand your record to them. Does that create a release of medical information, or......

Edited April 24, 2012 by Morhawk

[Dr. Bob]

Seems to me that as blanks there not medical records, but as soon as the doctor fills out the forms, or you populate the information , then its a medical record. I believe that its the doctors responsiblility to maintain these records for a give time frame, as someone stated its 7 years.

Seems to me that as blanks there not medical records, but as soon as the doctor fills out the forms, or you populate the information , then its a medical record. I believe that its the doctors responsiblility to maintain these records for a give time frame, as someone stated its 7 years.

 

That was my argument. I felt a blank form was a blank form, and that once a physician saw the patient in a medical professional setting, evaluated the patient and recorded findings, and made recommendations for medical therapy they became confidential medical records. The non-physicians running the 'certification clinic event' felt they were just filled out state forms and business records.

 

But I want to hear what the patients have to say about it, and what THEY consider them to be and how they expected them to be protected and by whom.

 

Dr. Bob

[Dr. Bob]

Good question about the 'cashiers'. Is a physician expected to literally carry around all patient records on their person? Or is it acceptable to keep them at the office. Does the receptionist who files them in the chart room own the records? Or does the physician. If they are business records and not subjected to privacy, I would assume no special instruction or handling would be required. If they are and basic instructions to keep them confidential are given, are they not protected?

 

Dr. Bob

[cristinew]

the dr and patient keep the records not the clinic

[Dr. Bob]

Here let's just cut to the chase. I run a legitimate, physician owned, medical practice. There are other similar, physician owned clinics in the state. As physicians, I don't think that ANY of us view the patient information on the certification forms as anything other than a confidential medical record. There are other representatives of certification clinics in here, and this is a good time for them to pipe in and state how they view the records entrusted with them.

 

I am very curious as to the effect it would have on the confidence of medical marijuana certification in the MMJ community if the records were viewed as anything other than medical records. Let's get some other opinions from those involved and patients.

 

Dr. Bob

[Morhawk]

Well, as far as carrying them around: Normally, the person operating the desk would be a medical assistant/medical receptionist, possibly a nurse in some cases. They are usually trained and compliant with this type of law. The person I refer to is JimBob the Hydro store/dispensary owner that was a bricklayer before opening said store. I can't see how this could be considered a business record once you check that little box that says cancer or chronic pain, I would think instantly it becomes medical. Of course, this is common sense thinking, so I could be wrong.

[Morhawk]

Not to try and open a can of worms, but your same thinking goes for LARA also. How do they store our records??? Should they even be seeing them?

[Dr. Bob]

They are required by law to maintain the database and records, therefore they can. Physicians are required by law to maintain MEDICAL records for 7 years. Business records, I guess that is handled under IRS requirements for financial documentation.

 

Dr. Bob

[AKenewell]

Good question about the 'cashiers'. Is a physician expected to literally carry around all patient records on their person? Or is it acceptable to keep them at the office. Does the receptionist who files them in the chart room own the records? Or does the physician. If they are business records and not subjected to privacy, I would assume no special instruction or handling would be required. If they are and basic instructions to keep them confidential are given, are they not protected?

 

Dr. Bob

 

In a true Dr. office setting..which is where I think all Certs should be done and it seems the state agree's as they have said no Dr. should be strictly doing Medical Marijuana certifications in there recent ruling. I disagree with any clinics run outside an office setting in this legal environment, it is not the right choice. Any receptionist/office assistant should be trained in hippa law's. The patient and the Dr. own the records..and any release of records should only be done with a signed consent by the patient. With all guidelines met it would be hard for the records not to be protected, it would require wrongdoing on the part of the Dr, if a Dr. comes under investigation his records become accessible to the medical board and LEO. They should be kept at the office in the chart room..accesible only by the physician and the trained staff. This is how I see it..Would you agree Dr. Bob?

[Morhawk]

http://biotech.law.lsu.edu/Books/lbb/x71.htm

 

Medical records are business records for the purpose of the hearsay rule. Medical record-keeping procedures must fulfill the legal requirements of the business records exception if a medical record is to be admissible in court. This exception to the hearsay rule requires that the record meet four basic tests:

1. The record was made in the regular course of the business.

2. The entry in the record was made by an employee or representative of that business who had personal knowledge of the act, event, or condition that is being recorded in the record.

3. The record was made at or near the time that the recorded act, event, or condition occurred or reasonably soon thereafter.

4. The records were kept in a consistent manner, according to a set procedure.

[bobandtorey]

i have be trying to get my records for about 5 mouths or longer i have sent him letters and have even went and spook to him and still have not gotten them and i had to use my medical records from the V.A i know they are supported to give them to me but they won't instead he gave me a letter that say's he is OK with me using mmj

[Dr. Bob]

Well, as far as carrying them around: Normally, the person operating the desk would be a medical assistant/medical receptionist, possibly a nurse in some cases. They are usually trained and compliant with this type of law. The person I refer to is JimBob the Hydro store/dispensary owner that was a bricklayer before opening said store. I can't see how this could be considered a business record once you check that little box that says cancer or chronic pain, I would think instantly it becomes medical. Of course, this is common sense thinking, so I could be wrong.

Well, as far as carrying them around: Normally, the person operating the desk would be a medical assistant/medical receptionist, possibly a nurse in some cases. They are usually trained and compliant with this type of law. The person I refer to is JimBob the Hydro store/dispensary owner that was a bricklayer before opening said store. I can't see how this could be considered a business record once you check that little box that says cancer or chronic pain, I would think instantly it becomes medical. Of course, this is common sense thinking, so I could be wrong.

 

I think this needs some clarification. I can only speak for how I do things, but I strongly suspect other legitimate clinics operate in a similar fashion. At my offices, I have staff that help with paperwork. They are clearly instructed that anything they see, or anyone they see in the setting of the clinic is not to be discussed and treated as confidential medical information. The records are reviewed by me, the staff copies records for the patient and the chart and if ALLOWED by the patient will review the application packet to make sure it is complete, has the appropriate documentation for the reduced fee, etc. They don't review the medical documentation other than making sure the boxes are checked, and only with the permission of the patient. I leave with the records and store them at my secured office, though they used to be stored off site when I first started.

 

At outreach clinics with local staff, they are generally part of the local MMJ community and are instructed on privacy issues. Again, the review of ANY medical records (ie the check for completeness) is done primarily by me at the time of certification. The patients again have the option to have the local staff review the forms for completeness and copies, but putting the medical records from the primary into the feeder, hitting the button, handing the originals back to the patient, and putting the copies in the chart for my review does not me 'HydroJoe' is going over your medical history or private details. That is my job as the doctor, and you are protected by my training and medical ethics. Just as with any other doctors office.

 

Dr. Bob

[restlesslegs]

Recently the status of the physician certification and patient application packet for medical marijuana has been questioned in a court case. As patients, what do you consider 'medical records', are these documents private to you, and who should retain them- the physician who saw you or the people that held the 'clinic event' and why? Just want to get the general feelings of the community.

 

Medical records state what my conditions are and should not be seen by anyone but the doctor. Isn't that our right as patients to expect our records to be confidential? I would not want staff reading my "chart", I do not know them and may never meet them, I put my trust in the doctor to keep my records safe and do not want the clinic to keep them.

 

My thought is that if a physician sees a patient professionally, evaluates their condition, and makes recommendations the record of that visit is a 'medical record' to be retained by the physician. The physician needs to have those records on hand to defend the certification in court and before the medical board if questions arise. I also feel they have the same privacy needs of any other medical record. The law requires the doctor to maintain those records for a period of 7 years because of the possibility of having to refer back to them in a court or board hearing. Do you agree or disagree and why?

 

I agree and there is no reason to state why because I agree with what you have written.

[Dr. Bob]

In a true Dr. office setting..which is where I think all Certs should be done and it seems the state agree's as they have said no Dr. should be strictly doing Medical Marijuana certifications in there recent ruling. I disagree with any clinics run outside an office setting in this legal environment, it is not the right choice. Any receptionist/office assistant should be trained in hippa law's. The patient and the Dr. own the records..and any release of records should only be done with a signed consent by the patient. With all guidelines met it would be hard for the records not to be protected, it would require wrongdoing on the part of the Dr, if a Dr. comes under investigation his records become accessible to the medical board and LEO. They should be kept at the office in the chart room..accesible only by the physician and the trained staff. This is how I see it..Would you agree Dr. Bob?

In a true Dr. office setting..which is where I think all Certs should be done and it seems the state agree's as they have said no Dr. should be strictly doing Medical Marijuana certifications in there recent ruling. I disagree with any clinics run outside an office setting in this legal environment, it is not the right choice. Any receptionist/office assistant should be trained in hippa law's. The patient and the Dr. own the records..and any release of records should only be done with a signed consent by the patient. With all guidelines met it would be hard for the records not to be protected, it would require wrongdoing on the part of the Dr, if a Dr. comes under investigation his records become accessible to the medical board and LEO. They should be kept at the office in the chart room..accesible only by the physician and the trained staff. This is how I see it..Would you agree Dr. Bob?

 

I agree with much of what you are saying but you didn't address the core question clearly. Are certification documents treated as medical or business records by your practice? Does your doctor own the records or the administrative/non-medical staff? Obviously I know the answer but I want to see it clearly stated by the folks involved.

 

As for practice models, I feel that brick a mortar offices are clearly indicated to provide a place for the patients to go for follow up, the records should be stored and accessible to the physician, good medical practices should be followed, and the standards should remain the same whether the visit is conducted at the office or at an outreach clinic. Much of the area I serve for example is very rural and cannot support a local certification clinic full time. Outreach clinics meet the need NOT being met by local physicians with their patients, though I would just as soon not do them until the local docs start carrying their load and caring for their own patients, someone like me has to certify them.

 

The point you raised about doing the majority of practice in certifications is valid. The medical board did put out guidelines, which contained two distinct parts. One is a desired practice model (primary care) for certifications, which is what you are referring to. The other is actual standards for a certification (face to face visit, records, follow up, etc). Until we have the participation of local physicians, we aren't going to have the practice model they want- though many of us (including me) do things other than certification in our practices, have fixed clinics, etc, we do what is in the best interests of our patients given the hands we are dealt. Hence dedicated certification clinics still exist. The challenge for us now is to stay as close to BOTH sets of guidelines as we can, and take steps to justify ANY deviation we make from them before the board if we are ever questioned.

 

As explained to me when I asked the enforcement division of the medical board, back when the guidelines were released in Feb, so long as I stayed within the guidelines, there would be no question. If I deviated from the guidelines for good medical reason, it would be evaluated if a question was raised and my thought process and decision making would need to be explained. If it was a valid reason for deviation, it would be fine. He ended up by saying there were enough blatant violations going on elsewhere to keep them busy, they are NOT worried about a good, standards based, practice that had to occasionally set out of the guidelines in the best interest of a patient in a given situation. Especially when dealing with things that are well accepted elsewhere in medicine.

 

Dr. Bob