Health Administration Responsibility Project

Scheme for getting patient medical records from
recalcitrant HMOs


1. Patient (Pt) delivers written request and authorization to records clerk. (HSC §123110)
   a. HMO must let Pt see records within 5 business days
   b.HMO must deliver copies within 15 days, for 25 cents/page (++)

2. If HMO doesn't comply, switch to EC §1158

3. Pt hires pro bono attorney (atty)
   a. Atty names an agent for purposes of this caper, via agency agreement
   b. Atty prepares request for records
   c. Pt signs authorization for record release

4. Agent delivers above documents to HMO record clerk, noting clerk's name. Records must be made available in 5 days. (business days?)
Gets a receipt for the request, or at least the clerk's date stamp on a copy.
Agent signs affidavit of delivery.

5. Option 1:
   Provider must make copies available within 5 days for 10 cents/page + $16/hr for clerk.

6. Option 2:
   Pt hires Licensed Photocopier (BPC §22450) for much money, to make the copies

7. Option 3: - Obviously the cheapest and easiest
   a. Atty names Pt (or a friend or family member) as atty's agent, to do the copying (BPC §22451(b))
   b. Pt rents portable copier and agent makes copies
   c. Provider charges pt $15 max.

8. If HMO doesn't comply, switch to CCP §1985.7

9. Pt puts up costs for atty to apply to local superior court for an Order to Show Cause (see CRC §3.1150)

An OSC is a way to get a Preliminary Injunction when the other party hasn't appeared in a case.
Notice sets a hearing date for Dft to give excuse for violating the law, or be fined

File the verified complaint first.
Take a file-stamped copy to the judge.
Judge will hear the Application
The OSC describes the injunction to be sought at the hearing.
A proposed OSC should contain blanks for time and manner of service, date on which proof of service must be delivered to court, briefing schedule

OSC presented to judge for signing within 1 day after granting the application.
Judge signs the proposed order. A deposit may be required??

Serve it like a summons and complaint.
   a. It must be answered by HMO within 20 days.
   b. If need is urgent, judge can shorten time for answer.

10. Pt gets someone (family, friend) to serve it on the HMO. (doc 6,7)

11. When HMO answers or delivers the documents, atty asks for fees and costs of enforcement. (doc8)

12. Atty reimburses Pt for costs of OSC.

13. Atty buys a glass of wine with the profits from his fee award.



PATIENT'S REQUEST FOR RECORDS

   I, ______________________, am or have been a patient at ______________________ HMO, and I hereby authorize and, pursuant to California Health & Safety Code §123110, request that the HMO make available ALL of my records in its possession or control, 5 calendar days from this date, i.e., on ______________________, at 10AM, for copying by me and/or my agent.

   This request covers all records within your system, wherever stored, including paper, electronic, telephone, fax, medical, administrative, billing, active, stored, and from all areas, including, without limitation, inpatient, outpatient, emergency room, radiology, laboratory, pathology, pharmacy, cardiology, physical therapy, neurology, etc.., including any sent to you by doctors outside your system.

   Any records withheld, on the putative grounds that they may be psychologically harmful to the patient, shall be identified by date, type, and author, with the name, medical license number, and board qualifications of the physician making that determination, and mailed to my physician:

__________________________________M.D.

____________________________________[Address].

   If you choose not to provide them to me, you may mail the ORIGINALS of x-rays, EKGs, EEGs, etc. to the physician identified above.

   In addition I will appear at your records room 15 calendar days from this date, as mandated by California Health & Safety Code §123110, to pick up copies of all of the records identified above which you have not forwarded to my physician. At that time I will reimburse you for your actual copying expenses, not to exceed 25 cents/page, plus your actual retrieval cost. Please have verification of your costs available at that time.

   Please note that your failure to comply with this request will trigger penalties under California Health & Safety Code §§123110(f) and 123120.

   Thank you for your compliance.

Signed____________________________ Date___________________________

Patient Identification Number __________________________________________



AGENCY AGREEMENT

   I, ______________, am an attorney admitted to the California Bar, Bar #_______.

I hereby appoint _______________________ as my agent for the sole purpose of obtaining the medical records of _________________________ from ______________________ pursuant to California Evidence Code §1158, and pursuant to the "attorney's agent" exception of California Business & Professions Code §22451(b), and authorize him/her to copy said records.

Signed__________________________ Date_____________________



AUTHORIZATION FOR RELEASE OF MEDICAL RECORDS

   I, ________________________, am or have been a patient at ______________________ HMO, and I hereby authorize and direct them to make all of my medical records in their possesion or control available for inspection and copying by the agent _________________________ , of my attorney __________________________ , as authorized by California Evidence Code §1158.

Signed______________________________ Date_________________________________



ATTORNEY'S REQUEST FOR RECORDS

   I, ______________________, attorney for ________________________, pursuant to the accompanying AUTHORIZATION FOR RELEASE OF MEDICAL RECORDS and AGENCY AGREEMENT, and to California Evidence Code §1158, hereby request that ___________________________ HMO make available ALL of the records of your enrollee _________________________ in your possession or control, 5 calendar days from this date, i.e., on ______________________, at 10AM, for copying by my agent ______________________.

   This request covers all records within your system, wherever stored, including paper, electronic, telephone, fax, medical, administrative, billing, active, stored, and from all areas, including, without limitation, inpatient, outpatient, emergency room, radiology, laboratory, pathology, pharmacy, cardiology, physical therapy, neurology, etc., including any sent to you by doctors outside your system. At that time my agent will tender the $15 statutory fee.

   Note that the withholding of records, on the putative grounds that they may be psychologically harmful to the patient, is not allowed under §1158, but such records may be so marked.

   Please note that failure to comply will trigger penalties under California Code of Civil Procedure §1985.7, including costs of enforcement and attorney's fees.

Signed____________________________ Date___________________________



AFFIDAVIT OF DELIVERY OF RECORD REQUEST

   I, _____________________, hereby declare under penalty of perjury under the laws of the state of California that I delivered copies of the attached Agency Agreement, Authorization for Release of Records, and Request for Records to:

________________________ [person delivered to]

at __________________________ [HMO name]

at ____________________________________ [HMO Address]

at ________[time] on _____________[date].

Signed_________________________ Date_______________________

Place____________________



================================================================================

ORDER GRANTING PRELIMINARY INJUNCTION

[Name of Attorney] [State Bar Number]
[Address Of Attorney]
[Phone Number]
Attorney for [Name of Plaintiff]

 

 

 

SUPERIOR COURT OF THE STATE OF CALIFORNIA

COUNTY OF ________

[PLAINTIFF(S) NAMES] ) CASE NO: _______
Plaintiffs, )  
v. ) ORDER GRANTING PRELIMINARY INJUNCTION
[DEFENDANT(S) NAMES] )  
Defendants )  
________________________________ )  

Date: ______
Time: ______
Place: ______
Trial Date: _____

 

The motion of plaintiff for a preliminary injunction to enjoin defendant to perform certain acts came on regularly before me today for hearing pursuant to an order to show cause entered on __________ [date].

__________ [name] appeared as counsel for the plaintiff and __________ [name] appeared as counsel for the defendant.

The Court being fully advised, and good cause appearing:

IT IS HEREBY ORDERED that a preliminary injunction be granted as follows:

Within five (5) business days from the date of this order, defendant shall make available to plaintiff, in a place convenient to plaintiff, all of plaintiff's medical records in the possession or control of defendant, its subsidiary departments, or bailors.

This order covers all records within defendant's system, wherever stored, including paper, electronic, telephone, fax, medical, administrative, billing, active, and archived, and from all areas, including, without limitation, inpatient, outpatient, emergency room, radiology, laboratory, pathology, pharmacy, cardiology, physical therapy, neurology, etc.., including any sent to defendant by providers outside its system.

Defendant shall provide a convenient location and allow plaintiff or plaintiff's agent to make copies of any or all of those records.

Fifteen dollars ($15) plus provable costs of collecting the records shall be deducted from the costs of enforcement accruing to plaintiff.

If defendant has not complied with this order within seven (7) business days after the date of this order, it shall be fined One Hundred Dollars ($100) per day, payable to this court, from that date until it complies.

Dated __________.

 

______________________________

[Signature of judge]



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