Tuesday Night Open Thread

Rough day at the dentist today. When I left with a prescription for pain medication, it came with a separate notice from the dentist, addressed to me, at my home address, advising me that when I fill the prescription, it will be entered in a state database accessible to law enforcement and doctors. 37 states are now enrolled in the prescription monitoring program. They are even working on an interstate version, having states share the information about your prescriptions with other states.

There's something wrong with this picture. Why should the private, personal medical information of millions of people be subjected to state surveillance and made accessible to law enforcement and thousands of pharmacists and health care providers, just so the Government can stop a few lawbreakers?

What if the database is breached or hacked, as happened in Virginia, exposing the medical information of 5 million people? The hackers demanded a $10 million ransom to return the information.

This is an open thread, all topics welcome.

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    Black History month start tomorrow (5.00 / 2) (#4)
    by loveed on Tue Jan 31, 2012 at 10:38:49 PM EST
    Here is an article from Yahoo homepage.
     I really don't know what to make of it. But I hope this month we can all have a frank discussion about race. But not tonight have to work in the morning.


    I've read that letter before (5.00 / 1) (#7)
    by Peter G on Tue Jan 31, 2012 at 11:28:17 PM EST
    but it was great to be invited to read it again.  Thanks for the pointer, Loveed.

    Thank you for that (none / 0) (#8)
    by sj on Wed Feb 01, 2012 at 12:28:06 AM EST
    Unlike Peter, I had never seen it before.  And I'm glad I have now.

    Loveed, please put your urls (none / 0) (#10)
    by Jeralyn on Wed Feb 01, 2012 at 01:06:58 AM EST
    in html format. Long urls skew the site and I have to delete the comment.

    happy Black History Month to everyone (none / 0) (#12)
    by The Addams Family on Wed Feb 01, 2012 at 02:00:25 AM EST
    loveed, i wonder what you would say in, as you call it, "a frank discussion about race"

    three good books:

    How the Irish Became White, by Noel Ignatiev

    Working Toward Whiteness: How America's Immigrants Became White: The Strange Journey from Ellis Island to the Suburbs, by David R. Roediger

    How Jews Became White Folks and What That Says About Race in America, by Karen Brodkin


    Interesting that the link leaves out (none / 0) (#13)
    by Towanda on Wed Feb 01, 2012 at 03:20:00 AM EST
    the paragraph below; this father did not just have hopes for the son.

    And interesting that recent research is telling us much more about freedwomen, long left out of too much African American history -- as recent research also is telling us much more about these daughters' daughters, the women who would lead the Great Migration northward to escape the anger toward them from postwar Southern whites:

    In answering this letter, please state if there would be any safety for my Milly and Jane, who are now grown up, and both good-looking girls. You know how it was with poor Matilda and Catherine. I would rather stay here and starve--and die, if it come to that--than have my girls brought to shame by the violence and wickedness of their young masters. You will also please state if there has been any schools opened for the colored children in your neighborhood. The great desire of my life now is to give my children an education, and have them form virtuous habits.

    I know, right? (none / 0) (#34)
    by sj on Wed Feb 01, 2012 at 02:37:05 PM EST
    I thought that was strange also.  They quoted most of the letter and left that out.  In fact, I found the paragraph particularly pointed and the article just diminished the content entirely.  The letter did say that his children were happy and being educated, but the thrust of it was that his DAUGHTERS were SAFE.

    PS.  And I am missing access to comment attributes.  I don't what's up with Firefox.


    I've read recent research (5.00 / 1) (#40)
    by Towanda on Thu Feb 02, 2012 at 08:46:05 PM EST
    on reasons for the Great Migration of African Americans, from a new perspective -- that of women.  Turns out that they tended to be the first in their families, since women could get work first (as maids).  And so much of the focus has been on lynchings of men as motivation to move north -- but for the first to come north, the motivation was escape from rape.

    History looks so different when women are not, as in that excerpting, left out of the story. . . .


    When Piers Morgan talks about (5.00 / 1) (#6)
    by Militarytracy on Tue Jan 31, 2012 at 11:15:50 PM EST
    Mittens throwing the kitchen sink at Newt and beating Newt into submission, it just sounds wrong.

    Which is worse? (none / 0) (#1)
    by Peter G on Tue Jan 31, 2012 at 09:12:39 PM EST
    An awful, Big Brother-ish, penal-minded law, or dental pain? That's a tough one.

    Big D Decline (none / 0) (#2)
    by koshembos on Tue Jan 31, 2012 at 09:51:34 PM EST
    McCarty wants to know whether you or your friends take percocet. Remember Dante!

    Sorry to hear about (none / 0) (#3)
    by fishcamp on Tue Jan 31, 2012 at 10:17:18 PM EST
    your toothache and pi$$ed off that big brother has yet another avenue into our privacy.  Who tells them to set up state databases to monitor prescriptions?  Vodka and Vicodin has always helped me with toothaches...now they'll know...

    Violation of HIPPA? (none / 0) (#5)
    by CrappyAirBags on Tue Jan 31, 2012 at 10:43:39 PM EST
    This seems like a clear violation of HIPPA, a federal statute.  You guys are the lawyers not me,  what gives?  Lawsuit for HIPPA violation?

    No (none / 0) (#14)
    by jbindc on Wed Feb 01, 2012 at 06:30:07 AM EST
    States can get funding from the federal government for these dstabases.

    The funding is not the issue (none / 0) (#19)
    by vicndabx on Wed Feb 01, 2012 at 09:21:28 AM EST
    How the stage agency or contractor functions is the issue - it determines whether the entity is what's known as a "covered entity."

    Insurers get funding from the federal gov't to process claims and return payment to care providers, thus making them covered entities.

    In this instance VA DHP is a state agency that is using the data for trend analysis, thus they are not a covered entity and not subject to HIPAA privacy laws.


    It's the Best Day in February (none / 0) (#9)
    by CoralGables on Wed Feb 01, 2012 at 01:06:42 AM EST
    Far superior to Valentine's Day.
    It's National Signing Day.
    Go Gators!

    Totally agree (none / 0) (#15)
    by jimakaPPJ on Wed Feb 01, 2012 at 07:04:31 AM EST
    What we need is a catch and kill of these killers.  

    No, a free market solution is best, by (5.00 / 1) (#16)
    by observed on Wed Feb 01, 2012 at 07:21:05 AM EST

    Perhaps a $100 bounty (none / 0) (#18)
    by Abdul Abulbul Amir on Wed Feb 01, 2012 at 08:22:25 AM EST

    for each head turned in might help.

    Let us pray (none / 0) (#37)
    by Abdul Abulbul Amir on Thu Feb 02, 2012 at 08:29:34 AM EST

    that no one finds some endangered worm that needs boa or python poop to survive.



    Let us pray that the worm which has (none / 0) (#38)
    by observed on Thu Feb 02, 2012 at 09:08:13 AM EST
    obviously begun eating away at your brain, to judge from this ridiculous comment, does not completely consome your grey matter. We do appreciate the laughs.

    I am surprised (none / 0) (#39)
    by Abdul Abulbul Amir on Thu Feb 02, 2012 at 11:16:07 AM EST

    that you seem to think that the Endangered Species Act does not apply to worms.

    Please see comment above (none / 0) (#21)
    by vicndabx on Wed Feb 01, 2012 at 09:29:58 AM EST
    the state and the databases are not required to do anything of the sort, i.e. "comply with HIPAA."

    The care providers (pharmacy, doctor, etc.) are the ones that must comply.

    If I know your meds I know your conditions (none / 0) (#23)
    by CrappyAirBags on Wed Feb 01, 2012 at 10:31:35 AM EST
    It seems like they tried to limit the scope of data to protect the privacy of the patient by only including medications.  BUT...If you show me someone's med list I can pretty much tell you if they have HIV/AIDS. (or other conditions).  I was unaware of entire state based program.  Its very distrubing.

    Does anyone know if as a patient,  I get notification when someone views my identifiable data in these state based repositories?

    Also,  If they are using this for trending why isnt the information "de-identified"?  Anyone know?


    Notification of data rules (none / 0) (#25)
    by jbindc on Wed Feb 01, 2012 at 11:08:59 AM EST

    The HIPAA Privacy Rule carves out many exceptions to your ability to authorize release of your "protected health information," including details that identify you . As discussed earlier, you don't have the right to consent or object when your information is used for treatment, payment, or operations, including disclosures to business associates of your health care provider or plan. Each of these exceptions places conditions on the covered entity that makes the decision to disclose. But, you are out of the loop.

    The flow of your medical information is beyond your control when the disclosure is made by a covered entity to or in connection with:

    *Any disclosure required by federal, state, or local regulation, regardless of the scope of the disclosure or the purpose of the disclosure.
    *Public health authorities.
    *A person subject to the jurisdiction of the federal Food and Drug Administration.
    *A person who may have been exposed to a communicable disease.
    *An employer to (1) conduct workplace medical surveillance or (2) to evaluate whether you have a work-related illness or injury.
    *Victims of abuse, neglect or domestic violence.
    *A health oversight agency for audits and investigations.
    *Court or administrative proceedings in response to a court order, subpoena, or discovery request.
    *A collection agency for unpaid medical bills.
    *Coroners and medical examiners.
    *Funeral directors.
    *Organ procurement organizations.
    *A medical researcher with institutional review board approval.
    *A threat to public safety or public health.
    *U.S. and foreign military commanders.
    *U.S. Department of Veterans Affairs to determine eligibility for benefits.
    *Federal government national security and intelligence officials.
    *U.S. Department of State to verify health fitness of employees and their families for foreign duty.
    *Correctional institutions involved in health care of inmates.
    *Workers compensation uses authorized by state law.
    Further . . .

    *Law enforcement access is authorized in a number of ways under HIPAA. In some cases information may be disclosed without a warrant or court order.

    As Jeralyn notes (none / 0) (#30)
    by vicndabx on Wed Feb 01, 2012 at 11:59:15 AM EST
    the data is not just used for trending.  My point w/that statement is that the state agency isn't doing any billing w/your data.

    A good site for info on the law and your rights as a consumer is here.

    The key thing to remember however, is whether or not the entity that has and may be sharing your data is a covered entity.


    You are correct (none / 0) (#24)
    by jbindc on Wed Feb 01, 2012 at 11:06:33 AM EST
    Bad choice of words.  Each state gets to determine who and what gets access to the records. Many states have rules that are more stringent than HIPAA. And federal law would trump state law in the case that the state law did not go far enough.

    State Prescription Drug Monitoring Program Information.


    Your link goes to the DEA (none / 0) (#27)
    by Jeralyn on Wed Feb 01, 2012 at 11:25:52 AM EST
    The DEA is not involved with the administration of any state PDMP. A better place for information on the programs is the Alliance of States with Prescription Monitoring Programs. Here is the current map showing the states enrolled as of Jan. 27, 2012. This page has links to every state program where you can check the rules in your state.

    my site (none / 0) (#33)
    by jbindc on Wed Feb 01, 2012 at 02:00:01 PM EST
    Answers questions and also leads to the same site.

    the comment you are replying to has (none / 0) (#26)
    by Jeralyn on Wed Feb 01, 2012 at 11:13:49 AM EST
    been deleted for containing false information. Law enforcement does not need "probable cause" to access the prescription databases. Each state makes its own laws and in Colorado, for example, the information is accessible to law enforcement by either a court order or a subpoena.

    Patients may receive their own personal data by contracting the PDMP.  Law Enforcement may contact the PDMP to obtain prescriber or patient data.  A court order or subpoena is required for such release

    Here is the form (none / 0) (#28)
    by Jeralyn on Wed Feb 01, 2012 at 11:29:42 AM EST
    Law enforcement submits to get the patient data in Colorado. All it says is that the officer is currently investigating the patient. Nothing about probable cause.

    Well, whoever said Mittens is (none / 0) (#22)
    by KeysDan on Wed Feb 01, 2012 at 09:31:51 AM EST
    not doing his share is off base.  He was seen strapping a very large, wiggling bag to the roof of his car heading out of Florida toward  the ferry for the Caymans.  It was either an anaconda or Newt--but a snake for sure.   Not to worry, it was airtight.

    one other thing (none / 0) (#29)
    by Jeralyn on Wed Feb 01, 2012 at 11:36:49 AM EST
    those with access don't just get to look up a prescription. They can search your entire history.

    For instance, if a patient is taking OxyContin, the prescriber would be able to review when the patient was first prescribed the drug, how many providers have prescribed for the patient, how often, and from what pharmacies the patient has received controlled drugs. The prescriber would determine whether the patient is taking the medication appropriately or making other uses of it.

    You can get a copy of your own data that has been submitted, at least in Colorado.

    Well then HIPPA seems useless (none / 0) (#35)
    by CrappyAirBags on Wed Feb 01, 2012 at 07:37:29 PM EST
    I see MAJOR HIPPA Violations everyday (production databases restored for engineers to debug etc.)  in combination with what you have outlined above, HIPPA seems like a toothless/useless regulation.

    Daughter who worked in oncology (none / 0) (#41)
    by Towanda on Thu Feb 02, 2012 at 08:47:36 PM EST
    as a receptionist said the same.  She hewed to HIPPA religiously but saw so many co-workers not doing so that she got quite discouraged about it.  (She has a health condition herself, much misunderstood, that some fools still use against employment.)

    How do you "return" digital data ... (none / 0) (#36)
    by cymro on Wed Feb 01, 2012 at 10:48:40 PM EST
    ... unless you walk off with the physical media? In which case the crime would be theft, not hacking. Hacking just gets you a copy, which itself can be copied, ad infinitum.