Written by Ann Haley Fromholz
In a victory for California healthcare providers, the California Court of Appeal recently held that a health care provider is not liable under California’s Confidentiality of Medical Information Act (CMIA) (Cal. Civ. Code, § 56 et seq.) when the health care provider releases an individual’s personal identifying information, but the information does not include the person’s medical history, mental or physical condition, or treatment. The case was a win for the health care provider and, more importantly, provided critical clarity about the definition of “medical information” under the CMIA.
In Eisenhower Medical Center v. Superior Court of Riverside County, plaintiffs sued on behalf of a putative class whose information was disclosed by EMC when a computer with information about over 500,000 people was stolen from EMC. The information included each person’s name, medical record number, age, date of birth, and last four digits of the person’s Social Security number. The information was password protected but was not encrypted.
The CMIA makes it unlawful for a health care provider to disclose or release medical information regarding a patient of the provider without first obtaining authorization. An individual can recover $1,000 in damages for the improper release of information, and need not show actual damage to recover the $1,000.
The CMIA defines “medical information” as:
any individually identifiable information, in electronic or physical form, in possession of or derived from a provider of health care, health care service plan, pharmaceutical company, or contractor regarding a patient’s medical history, mental or physical condition, or treatment. ‘Individually identifiable’ means that the medical information includes or contains any element of personal identifying information sufficient to allow identification of the individual, such as the patient’s name, address, electronic mail address, telephone number, or social security number, or other information that, alone or in combination with other publicly available information, reveals the individual’s identity.
In addition, the CMIA permits acute care hospitals to disclose certain patient information upon demand and without authorization from the patient. Section 56.16 of the CMIA allows hospitals to reveal medical information regarding the general description of the reason for the treatment, the general nature of the injury, and the general condition of the patient, as well as nonmedical information. The court reasoned that, although section 56.16 applies only when there is a demand for information, it does show that information solely identifying a person as a patient (and nothing more) is not given the same protection as more specific information about the person’s medical history.
EMC argued that the theft of the computer did not result in a disclosure of “medical information,” as defined in the CMIA, of any of the people at issue. The computer did not contain information about their medical history, condition, or treatment; instead, that information is saved only on EMC’s servers, which are located in its data center. While EMC conceded that the index on the computer contained “individually identifiable information,” EMC maintained that the index did not include information “regarding a patient’s medical history, mental or physical condition, or treatment,” which is required to find a violation of the CMIA.
The court agreed, reasoning that a release of information is prohibited by the CMIA only when it includes information relating to medical history, mental or physical condition, or treatment of the individual. The court explained that medical information does not include all patient-related information held by a healthcare provider, but must be “individually identifiable information” and also include “a patient’s medical history, mental or physical condition, or treatment.” This definition of medical information does not encompass demographic or other information that does not reveal a patient’s medical history, diagnosis, or care. Therefore, “medical information” as defined under the CMIA is individually identifiable information combined with substantive information regarding a patient’s medical condition or history. When the computer was stolen from EMC, there was a release of “individually identifiable information,” but not of medical information.
In the wake of Eisenhower Regional Medical Center, medical providers should examine what information they store about patients, how that information is protected, and if information that constitutes “medical information” is segregated from mere individually identifiable information. The provider here was saved because it kept medical information about its patients only on secure servers. That information was not transferred to the index on a computer, which eventually was stolen. Medical providers should consider taking similar steps to protect medical information and, in fact, would be safer if they encrypt all data about patients that is transferred to computers, especially about large groups of patients. Although the provider prevailed here, no medical provider wants to face a similar challenge.