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Bush Baffles Med-Privacy Pundits
by Jeffrey Benner

2:00 a.m. Apr. 13, 2001 PDT

 The Bush Administration baffled pundits and defied predictions on Thursday
when it decided to allow sweeping privacy regulations drafted under the
Clinton Administration to take effect this Saturday.

Once they become law on Saturday, the new regulations (PDF file) will grant
patients more control over their medical records. Any time medical
information changes hands, it will require consent from the patient --
something the health care industry claims will be cumbersome and expensive to
do.

The new administration has repeatedly declared its opposition to new
government regulations that make it harder to do business. And from repealing
ergonomics legislation to arsenic rules, it's proven itself willing to side
with business, even in hot-button political issues.

The smart money said the same thing would happen to the medical privacy
rules. It was wrong, and now medical privacy pundits are wondering why.

"I'm surprised they didn't pull the rules," said Bob Gelman, a consultant who
has worked on the medical privacy issue for over 20 years. "Everyone I talked
to thought they would. It's a little bizarre."

Gelman is not the only one confused. Health care industry organizations like
the American Hospital Association (AHA) pushed hard to loosen the new rule,
claiming it would be too difficult and expensive to implement.

When Secretary of Health Tommy Thompson reopened the new rules to public
comment last February, it appeared the AHA's message was getting through, and
the administration would make good on its reputation as a friend of business
and foe of government regulation.

Melinda Hatton, an AHA lawyer, struggled to explain what had happened.

"I don't know," she said. "I wish I knew. It was a profound disappointment to
us. We wanted them to extend the effective date and fix the rule."

Joy Pitts, who is senior counsel for Georgetown University's Health Privacy
Project and a supporter of the new regulations, didn't expect the victory.

"It is a surprise," she said. "Especially considering the intense pressure
from the industry. They really put out an all-out attack."

Despite the rule taking effect, the battle isn't over. Critics of the rule,
like the AHA's Hatton, plan to hold Bush and Thompson to their puzzling
promises to modify the rule after it goes into effect.

In the same Thursday statement that announced the rule would become law, Bush
acknowledged that some complaints about it were legitimate, and "asked
Secretary Thompson to recommend appropriate modifications to the rule to
address these concerns."

In a separate statement, Thompson promised to publish "guidelines" that "will
allow us to clarify some of the confusion regarding the impact this rule
might have on health care delivery and access. And we will consider any
necessary modifications that will ensure the quality of care does not suffer
inadvertently from this rule."

Why would the administration implement a new rule and then promise to change
it all in one breath? Larry Gostin, a professor of Law and Public Health at
Georgetown, thinks the administration may have had no choice but to let the
rule stand.

"The legal wiggle room was minuscule," Gostin said. "They're in a box and
they can't get out of it."









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