New Law Alert
No. 9 
May 2001
California edition

California Legislature amends Confidentiality of Medical Information Act again...

• Patient addenda to records
• Disclosure to coroner's office
• Clarification: Licensed lay midwives disclosure required
• To reach MIEC

Existing confidentiality laws allow for an adult patient to inspect his or her records upon request to the health care provider. Newly enacted Health & Safe Code §123111 authorizes an adult patient to write an addendum to his/her records which a physician is required to attach to the medical record.

Civil Code §56.10 (b)(8) has been amended delineating when medical information must be provided to the coroner's office, and when the physician as the option to withhold information.

Patient addenda to records

Section 123111, added to the Health & Safety Code this year, allows any adult patient to inspect his/her record (or review a physician's summary of the patient's care and treatment) and “to provide to the health care provider a written addendum with respect to any item or statement in his or her records that the patient believes to be incomplete or incorrect.”  The addendum is limited to 250 words per alleged incomplete or incorrect item in the patient's record, and it must clearly indicate in writing that the patient wants the addendum to be part of the medical chart. 

The physician must attach the addendum to the patient's chart and include it whenever the health care provider “makes a disclosure of the allegedly incomplete or incorrect portion of the patient's records to any third party.”

Physicians are protected from liability under this code section for any “defamatory or 
otherwise unlawful language” written in the addendum and subsequently included in the medical record.

Disclosure to coroner's office

Effective as of January 1, 2001, physicians must provide confidential medical information even in the absence of authorization from a deceased patient's representative when “compelled” to do so by the coroner's office under certain circumstances. Civil Code §56.10 (b)(8) compels the release of records:

“...when requested in the course of an investigation by the coroner's office for the purpose of identifying the decedent or locating next of kin, or when investigating deaths that may involve public health concerns, organ or tissue donation, child abuse, elder abuse, suicides, poisonings, accidents, sudden infant death, suspicious deaths, unknown deaths, or criminal deaths, or when otherwise authorized by the decedent's representative. Medical information requested by the coroner under this paragraph shall be limited to information regarding the patient who is the decedent and who is the subject of the investigation and shall be disclosed to the coroner without delay upon requests.”

Physicians may disclose information to the county coroner in the course of an investigation related to “all purposes not included in paragraph (8) of subdivision (b).”

Clarification: Licensed lay midwives disclosure required 

Revised Business & Professions [B&P] Code §2508 requires that a licensed lay midwife must disclose orally and in writing to a prospective patient all of the following:

• (1) The provisions of B&P Code §2507, which include:

  (a) a [licensed lay] midwife is supervised by a physician/surgeon and licensed to attend normal births, and provide prenatal, intrapartum, and post-partum care;

  (b) all complications arising during a normal childbirth must be referred immediately to a physician;

  (c) the practice of midwifery “does not include the assisting of childbirth by an 
  artificial, forcible, or mechanical means...;”

  (d) the [licensed lay] midwife's supervising physician is not required to be physically 
  present during a delivery; 

  (e) the ratio of midwives to supervising physician cannot exceed 4:1; and

  (f) a midwife is not authorized to practice medicine or surgery;
  

• (2) whether or not the midwife has professional liability coverage;
  
• (3) “. . .the specific arrangements for the transfer of care during the intrapartum and post-partum periods, and access to appropriate emergency medical services for mother and baby if necessary;” and
  
• (4) the procedure for reporting complaints to the Medical Board of California.

The disclosure must be signed by both the patient and the midwife, and a copy must be put in the patient's chart. 

This section of the B&P Code does not pertain to certified registered nurse midwives, who are regulated by the Board of Nursing and its Nursing Practice Act

To reach MIEC