Doctors reluctant to reveal own data
By Alice Keesing
Advertiser Health Writer
The state commerce department next week will take up the controversial issue of whether doctors have to reveal their personal medical histories in order to remain part of Hawai'i's biggest health insurer.
The Hawai'i Medical Service Association calls it a matter of patient safety, saying national statistics suggest Hawai'i is not doing a good job of policing its physicians.
It wants all doctors to sign a blanket consent form authorizing access to their personal medical records. Officials say they would review only the records in rare cases such as when drug addiction or mental illness could lead to a doctor's harming patients. Such review would be conducted only after a doctor has signed a second release.
But doctors who refuse to sign either form will be terminated from HMSA plans. Opponents of the new rule say HMSA is using the muscle of its monopoly to coerce doctors. The move, they say, also could drive doctors with addictions or other conditions underground where they would not seek help.
"It's a witch-hunt that I think gives them free rein to use the medical records for whatever they want to," said Dr. Gerald McKenna, president of the Hawai'i Medical Association. "But I think the main thing that it does is that it's a way of intimidating doctors."
HMSA argues it should be able to look into private records because national statistics show that Hawai'i has consistently been lax in enforcing licensing laws against impaired physicians.
A survey by Public Citizen, a national nonprofit public interest organization, found that Hawai'i ranked last among states in enforcement efforts in 2001, taking 0.8 serious actions for every 1,000 doctors.
In comparison, the American Medical Association has estimated that as many as 10 percent of practicing physicians are impaired.
"These data again raise serious questions about the extent to which patients in many states with poorer records of serious doctor discipline are being protected from physicians who might well be barred from practice in states with boards that are doing a better job of disciplining physicians," the Public Citizen report said.
HMSA says only a handful of the approximately 1,000 doctors who have been sent the consent form have protested. But Dr. Arlene Meyers, president of the Hawai'i Coalition for Health, said doctors are outraged.
The coalition has asked the insurance division of the state Department of Commerce and Consumer Affairs to strike down HMSA's new requirement. It will begin hearing the case Tuesday.
The Hawai'i Psychiatric Association is considering joining the coalition's case. The medical association, which represents 1,600 doctors, also is exploring legal action. And the Hawai'i Independent Physicians Association, representing more than 400 doctors, plans to ask HMSA's board to get rid of the form.
The argument is part of the ongoing tension between HMSA and doctors, who believe that the insurance company has used its monopoly to push through rules that some doctors believe restrict their ability to adequately care for patients. HMSA covers about 96 percent of Hawai'i physicians.
All doctors are being asked to sign a general consent form allowing HMSA to inspect personal and professional information as part of its credentialing process, which is repeated every two years. If the initial information given by the doctor raises more questions, the doctor may be asked to sign a second form allowing access to records on their physical or mental conditions.
Dr. Christopher Tortora joined the coalition's case after HMSA sent him a termination notice because he had not signed the first form as part of his recredentialing. Neither Tortora nor any of the other doctors involved in the case against HMSA is suspected of improper behavior.
Tortora said he objects to what he sees as an invasion of privacy. But he eventually signed the form.
"It was a sense of being coerced" because of the prospect of termination, Tortora said. "If you don't participate with HMSA and 60 percent of your practice revenue is from HMSA, then it basically puts you out of business."
HMSA said it is bound by state law, accrediting agencies and its members to ensure its doctors are credentialed and fit to work with patients.
"One very small piece of it is that should the physician credentialing committee get to the point where they're unsure of a certain physician's background — and it would be a very unusual case — they wanted the right to ask for medical records," said HMSA senior vice president Cliff Cisco.
HMSA's medical director, Dr. Richard Chung, who heads the organization's credentialing committee, said he can recall only one or two times since 1996 that a doctor's records were requested.
"If someone is intoxicated while they're doing their diagnoses or treatment, that may be a danger," he said. "If they have a drug addiction, they may use their prescriptive powers or misuse their relationship with their patient. When I first moved here ... , there was a guy apparently who was giving nitrous oxide to his patients and having his way with them."
Chung said there is no hard data demonstrating that impaired doctors are escaping notice in Hawai'i. Doctors say the lower discipline numbers could be a result of Hawai'i's small community, which makes it harder to hide when something is wrong.
Chung said he has been surprised by the opposition to the consent form because HMSA has always required that doctors make records available if the need arises.
But Meyers, a longtime adversary of HMSA, said doctors have never before had to sign a blanket authorization up front. She and other doctors say they have no problem with such a request from a regulatory agency when there is cause to believe that a doctor is in trouble. But they say HMSA is overstepping its role when it requires more than 2,000 doctors to give their consent up front as a condition of their participation.
"Are they saying, then, that they're going to become the disciplinary group for physicians in Hawai'i and they'll take that power away from (the Regulated Industries Complaints Office) and the board of medical examiners?" McKenna said. "I don't think that our system in the state works perfectly, or even very well, but I think that's beside the point. I don't think HMSA should take it on themselves to say, 'OK, we're going to do the investigations now.' If they want to make changes, if they think the system isn't working, then they should work with other groups who are actually trying to change the system so there is more accountability."
Reach Alice Keesing at akeesing@honoluluadvertiser.com or 525-8014.
