Shaare Zedek Hospital.
(photo credit: MARC ISRAEL SELLEM/THE JERUSALEM POST)
The Association for Civil Rights in Israel (ACRI) objected on Sunday to a Health Ministry directive that sensitive medical information about psychiatric patients can be transferred to the four health funds without asking their written permission, unlike the permission required from non-psychiatric patients.
The need to transfer medical files will be necessary on July 1, when the ministry is due to transfer responsibility for psychiatric care from state psychiatric clinics and hospitals to the public health funds. The reform was first recommended around three decades ago, but less than five years ago, the ministry agreed to the change, and it has taken until now for the Treasury and the health funds to reach an agreement about implementing the reform.
ACRI said that failing to get explicit permission from psychiatric patients to provide the health funds with medical information harms the rights of patients to privacy about their conditions and is “illegal,” violating the Patients’ Rights Law. The reason for its refusal, the ministry explained, “is that to do so, it would place an unreasonable burden on the health system.”
ACRI protested when the ministry instructed psychiatrists at state-owned outpatient clinics to transfer sensitive records of their patients – including names, diagnoses, and treatment they had already received – to their health funds.
Asked to comment, ministry spokeswoman Einav Shimron-Greenboim said: “The information will be transferred only after the patient has been informed about it and the reform process and its significance. The patient must express his permission and if he refuses, the data will not be transferred. Written explanations have been provided in three languages.”
When asked whether the patient’s permission would be given orally or in writing, the spokeswoman said: “orally.”
She added that medical information is “minimal in order to ensure the continuation of treatment and prevent patients from having to deal with bureaucracy; it includes a laconic description of the diagnosis and details of continued treatment and not beyond this. Most patients in mental health clinics in any case already receive their medications from their health fund doctor, and the psychiatric system has always worked in full cooperation with other factors who give treatment... Whoever does not want to receive [psychiatric treatment] at his health fund will not have to,” she concluded.
ACRI said that following its first complaint over the issue, the ministry issued a new directive that medical information about a psychiatric patient cannot be transferred if the patient opposes this. But the ministry declared that “there is no need to get written permission from the patient” as required by law. Instead, said ACRI, it “made do with arrangements liable to expose the patients’ medical data before they have a chance to refuse. The ministry did not give details on how the data would be transferred and who in each health fund would be allowed to read the information,” said ACRI, which warned the ministry it is breaking the law.
The ministry responded that it had considered getting explicit permission from each psychiatric patient for the transfer of data to health funds, but turned it down because such a procedure would be “too cumbersome.” ACRI was told by ministry officials that patients would logically agree to the transfer “because it was for their own good,” as then they could receive psychiatric care in health fund clinics.
“By turning to the public health system, a patient gives his or her agreement in advance to all the procedures used there, in the present and the future, and this includes the transfer of medical data,” the ministry said.
ACRI lawyer Tal Hassin said that mental health personnel “are under unfounded pressures and threats because they are unwilling to hand over patients’ medical information without their explicit permission. From the ministry’s reaction, one can get the wrong impression that there is a conflict between efficient preparation for the reform and patients’ rights to privacy and honor. But the opposite is true: protecting privacy of patients is a basic element in the relationship of trust between the patients and those who treat them and a necessary condition to protect their rights and welfare.”
ACRI contacted a deputy attorney-general to find out whether the office would defend the ministry’s policy in court or order the ministry to freeze the transfer of medical data. The ministry spokeswoman concluded that if ACRI was not happy with the ministry decision, it “could go to the High Court of Justice if it wishes.”