The 21st Century Cures Act passed by Congress in December will boost funding for medical research and experimental treatments, but U.S. Rep. Tim Murphy doesn’t think the law goes far enough to help people with mental health issues.
The law earmarks billions of dollars for cancer research, studies into brain disorders and preventative measures to fight the opioid epidemic sweeping across the nation. It received overwhelming bipartisan support in both chambers of Congress in an otherwise polarized political climate.
While the law also aims to improve the mental health system and creates another pathway for states to offer more treatment to those who need it, Murphy too many “gray areas” on privacy restrictions remain within the 20-year-old Health Insurance Portability and Accountability Act, or HIPAA.
Murphy and other House members wanted a “compassionate communication allowance” for doctors to be able to notify families of those suffering from mental illness about medical issues rather than being forced to wait until the patient might be in imminent danger to himself or others.
“The doctor is no longer able to share information, and we think that’s preposterous,” Murphy said. “Give the doctor the discretion to make the informed decision to make that call.”
Murphy, an eight-term Republican lawmaker from Upper St. Clair, spoke to the Observer-Reporter last week to discuss HIPAA’s privacy rules and how he believes the stringent regulations hurt people suffering from mental illness rather than help protect them.
Doctors and nurses are bound to keep a patient’s medical records confidential unless allowed for by the patient or if there is “imminent danger.” Murphy, a child psychologist, argues that some patients might be too incapacitated to make a decision, leaving them alone to deal with medical or psychological issues while family members are unaware there is a problem.
“For the patient themselves, we know that when a family member is engaged and involved, the success rate is very, very high,” Murphy said. “When a family member is not involved, it declines considerably, so it’s good for someone’s health.”
When HIPAA was passed by Congress in August 1996, it centered around the portability of health care coverage. But it also required Congress to form provisions for privacy rules within three years, or those regulations would be created by the Department of Health and Human Services. Congress failed to pass privacy provisions, leaving it to HHS under the Bush Administration, which finalized the rules in 2002.
The new privacy rules governing “protected health information” went into effect for most health providers in 2003, although some were permitted to wait until the following year.
Murphy said while the privacy rules are important, they can adversely impact the health of those with serious mental illness who might need other medical care for diseases, such as diabetes.
“That patient does not get care because they are not competent enough to get care,” Murphy said. “Sometimes they don’t understand the existence of their mental illness or the severeness of their mental illness.”
It also can put hospitals in awkward positions about what doctors and nurses can tell police or law enforcement, Murphy said.
“We’re training them on what they can’t do,” Murphy said. “Doctors and nurses are around to listen.”
Murphy thinks there should be a more transparent discharge plan in place for when people with mental illness are leaving the hospital from a voluntary or involuntary commitment.
HIPAA’s privacy constraints can have tragic outcomes.
On Dec. 3, Christopher Griedel was arrested after arguing with relatives and threatening to harm himself before he assaulted Cumberland Township police officers as they took him into custody. Cumberland officers originally transported Griedel to the Greene County jail, according to court documents, but the officers and jail staff decided he should be “checked out” at WHS-Greene hospital near Waynesburg for a mental health evaluation.
“We got Christopher inside the hospital, and the doctor told us that he is going to keep Christopher,” Cumberland police Officer John Lingo wrote in court documents to support charges being filed against Griedel, which included felony aggravated assault on a police officer.
What happened next is unknown, and sources close to the investigation have declined to speak publicly.
It is not known when Griedel was released from WHS-Greene or if he was transferred elsewhere. It also is unclear if hospital staff had any contact with Cumberland police during his commitment and before his release due to the arrest warrant on the pending charges.
Less than four weeks after the incident, Griedel died after being shot once by his brother, Ryan, during an argument at the family’s home in Clarksville. Search warrants filed by state police indicate Christopher Griedel was attacking his mother with a golf club and assaulted his brother before Ryan shot him with a pistol Dec. 29 in what he and witnesses claim was an act of self defense.
Christopher Griedel, 30, died at the scene. State police have not said whether they plan to file charges against Ryan Griedel.
State police executed a search warrant Jan. 11 to retrieve an 11-page medical record from WHS-Greene for Griedel’s “mental health commitments and evaluations,” according to documents filed at the Greene County Courthouse. However, investigators with state police and Cumberland Township have declined to discuss what happened in the days between Griedel’s release from the hospital and the fatal shooting.
Washington Health System spokeswoman Stephanie Wagoner said the hospital follows HIPAA privacy regulations and should not discuss the details of the Griedel case.
Greg Hook, the solicitor for Greene County Human Services, did not know details about the case and is not affiliated with WHS-Greene, but said HIPAA regulations are clear when it comes to patient information.
“It would be in violation for a hospital to notify (police),” Hook said. “It’s not a prison. The hospital is in charge. The hospital doesn’t have an obligation to say, ‘John Doe is ready for discharge. Come get him.’”
He added that it would be up to the doctor to make a decision whether to break that confidentiality, which is a “gray area” in the law that centers around imminent danger.
“It’s such a difficult area. Even if (patients) have mental health issues, they still have rights. If they’re getting treatment and they’re ready to be discharged, as a society, how much do we want to limit their rights?”
Human Services Director Karen Bennett agreed that it is a difficult situation and goes beyond HIPAA to state regulations and county policies. She often sees similar situations involving drug and alcohol cases and Children and Youth Services.
“They can refuse to take their medication at any time. And it happens all the time,” Bennett said. “What’s the threshold of when you’re telling the family?”
That’s why Murphy thinks there should be clearer regulations on what doctors and licensed counselors can release. He hopes Tom Price, an orthopedic surgeon and President Donald Trump’s nominee to head HHS, will issue new guidelines to ease those privacy rules.
“Families may know the person is in treatment and they are desperately calling for help,” Murphy said. “The family is aware there are problems, but there is poor or no communication.”
As a child psychologist, Murphy himself has been faced with difficult situations. He pointed to Pennsylvania state laws that allow a person 14 and older to demand a physician keep confidential information from his or her parents.
Murphy said he’s had to make “critical judgments” for patients that have fallen in those HIPAA gray areas, which is something he does not take lightly.
“The idea we’re protecting someone’s confidentially, it actually harms them,” Murphy said. “I would rather be facing a family in a courtroom than face a family in a funeral home.”