Opinion ID: 1922462
Heading Depth: 1
Heading Rank: 4

Heading: Health Record Privacy Statute

Text: The General Assembly's intention to protect the privacy of Delaware's citizens is reflected, in part, in the statutes that provide confidentiality for investigatory files, [12] autopsy reports [13] and death certificates. [14] Those privacy concerns were ratified, reinforced and enhanced with the 2002 passage of Delaware's Health Record Privacy Statute. At the time of its enactment, that legislation was described as creating Delaware's first health record privacy statute, ensuring that health information gathered by the state about Delawareans will not be used or disclosed improperly. [15] In her signing message, Governor Ruth Ann Minner stated [t]he bill also gives Delaware residents the most privacy protection of any state in the country for their health information that is in the hands of the state. [16] Section 1232 of the Health Record Privacy Statute provides that [p]rotected health information is not public information... and may not be disclosed without the informed consent of the individual ( or the individual's lawful representative ) who is the subject of the information except as expressly provided by statute. [17] In relevant part, title 16, section § 1230(4) of the Delaware Code defines protected health information as: any information, whether oral, written, electronic, visual, pictorial, physical or any other form, that relates to an individual's past, present or future physical or mental health status, condition, treatment, service, products purchased, or provision of care and that reveals the identity of the individual whose health care is the subject of the information.... [18] This unambiguous language protects the information contained in an autopsy report from public disclosure. In fact, the State defendants acknowledge in their Answering Brief: It is undisputed that the medical information in Mr. Duane Lawson's autopsy report is protected health information under 16 Del. C. § 1230(4). The Court of Chancery determined, however, that the language of section 1232(e) exempts what would otherwise be confidential health information from the scope of section 1232 when that information is contained in an autopsy report, death certificate or `related documents.' Section 1232(e) provides: (e) Deceased individuals. Nothing in this subchapter shall prohibit the disclosure of protected health information: (1) In a certificate of death, autopsy report or related documents prepared under applicable laws or regulations; (2) For the purposes of identifying a deceased individual; (3) For the purposes of determining a deceased individual's manner of death by a medical examiner; or (4) To provide necessary information about a deceased individual who is a donor or prospective donor of an anatomical gift. [19] Mrs. Lawson, as Mr. Lawson's lawful representative, argues that section 1232(e) means that information that would otherwise be unavailable as protected health information can be released for the purpose of creating the death certificate or autopsy report but that the information contained in a death certificate or autopsy report, once created, otherwise remains protected. We agree. Sections 1232(e)(1) and (3) only permit disclosure of public health information in a death certificate or an autopsy report and only [f]or the purposes of determining a deceased individual's manner of death by a medical examiner. [20] Nothing in section 1232(e) changes the mandate of section 1232(a) that protected health information is not public information. Given the comprehensive restrictions of section 1232(a), without the statutory authority provided in section 1232(e) allowing disclosure of this information in a death certificate and autopsy report, such disclosure would be prohibited. Therefore, section 1232(e) is not only consistent with the other provisions of section 1232, but also is required in order to allow a Medical Examiner or attending physician to state a cause and manner of death in a death certificate and/or an autopsy report. The limited scope, and plain meaning, of section 1232(e) is further reflected in section 1232(g), entitled Secondary disclosures, which prohibits the secondary disclosure of protected health information. [21] Section 1232(g) provides: No person to whom protected health information has been disclosed pursuant to this subchapter shall disclose the information to another person except as authorized by this subchapter. This section shall not apply to: (1) The individual who is the subject of the information; (2) The individual's parents, legal guardians or other persons lawfully authorized to make health care decisions for the individual where the individual who is the subject of the information is unable to give legal consent pursuant to subsection (f) of this section; or (3) Any person who is specifically required by federal or state law to disclose the information. [22] Section 1232(g) reaffirms the comprehensive restrictions imposed on the disclosure of protected health information and makes clear that protected health information can only be disclosed in the manner expressly provided by section 1232. Accordingly, we hold that under the circumstances of Mr. Lawson's death, section 1232(g) prohibits the public disclosure of any Autopsy Information by a person to whom [that] protected health care information has been disclosed. [23] That prohibition applies to the defendants in this proceeding.