WASHINGTON, March 21 — The Bush administration today proposed dropping a requirement at the heart of federal rules that protect the privacy of medical records. It said doctors and hospitals should not have to obtain consent from patients before using or disclosing medical information for the purpose of treatment or reimbursement.
The proposal, favored by the health care industry, was announced by Tommy G. Thompson, the secretary of health and human services, who said the process of obtaining consent could have "serious unintended consequences" and could impair access to quality health care.
The sweeping privacy rules were issued by President Bill Clinton in December 2000. When Mr. Bush allowed them to take effect last April, consumer advocates cheered, while much of the health care industry expressed dismay.
Today's proposal would repeal a provision widely viewed as the core of the Clinton rules: a requirement that doctors, hospitals and other health care providers obtain written consent from patients before using or disclosing medical information for treatment, the payment of claims or any of a long list of "health care operations," like setting insurance premiums and measuring the competence of doctors.
The proposal is to be published in the Federal Register next week, with 30 days for public comment. The government will consider the comments and then issue a final rule, with the force of law.
Secretary Thompson said he wanted to remove the consent requirements because he believed they could delay care.
Pharmacists and hospitals had expressed the same concern. Drugstores said they could not fill prescriptions phoned in by a doctor for pick-up by a patient's relative or neighbor. Hospitals said they could not schedule medical procedures until the patient had read a privacy notice and signed a consent form.
Hospitals and insurance companies praised today's proposal as a victory for common sense, but consumer advocates and Democratic members of Congress denounced it as a threat to privacy.
"In general, this is great for the health care industry," said Elisabeth Belmont, corporate counsel for Maine Health, which operates seven hospitals, a nursing home and a home health agency in Maine. Mary R. Grealy, president of the Health Care Leadership Council, which represents drug makers, drugstores, insurers and hospitals, said: "The new proposal strikes an appropriate balance. It's a workable compromise."
But Janlori Goldman, coordinator of the Consumer Coalition for Health Privacy, an alliance of more than 100 groups favoring patients' rights, said the administration was proposing "a destructive change."
Representative Edward J. Markey, Democrat of Massachusetts, said: "By stripping the consent requirement from the health privacy rule, the Bush administration strips patients of the fundamental right to give their consent before their health information is used or disclosed. The administration's proposal throws the baby away with the bath water."
Senator Edward M. Kennedy, Democrat of Massachusetts, said he was "very concerned" because he believed that "an individual should have to give permission before medical information is disclosed."
The Bush administration denied that it was eviscerating privacy protections. "The president believes strongly in the need for federal protections to ensure patient privacy, and the changes we are proposing today will allow us to deliver strong protections for personal medical information while improving access to care," Mr. Thompson said.
Under the rules, doctors and other health care providers would still have to notify patients of their rights and the providers' disclosure policies. Patients would be asked to acknowledge in writing that they had received such notice, but could receive care without the acknowledgment.
Ms. Goldman, director of the Health Privacy Project at Georgetown University, said: "It's absurd to suggest that a notice serves the same purpose as consent. Signing the consent makes it more likely that people will understand their rights."
Some parts of the Clinton rules would survive the changes proposed by the Bush administration. Patients would, for example, have a federal right to inspect and copy their records and could propose corrections.
Congress could try to set privacy standards by law, overriding decisions by the Bush administration. But that appears unlikely. Under a 1996 law, Congress instructed the secretary of health and human services to issue rules on medical privacy in the absence of action by Congress, and lawmakers have never been able to agree on standards.
In its proposal today, the Bush administration tries to ensure that parents have "appropriate access" to medical records of their children, including information about mental health, abortion and treatment for drug and alcohol abuse. The Clinton rules "may have unintentionally limited parents' access to their child's medical records," the Bush administration said. The proposal makes clear that state law governs disclosures to parents.
The Bush proposal would also relax some consent requirements that medical researchers saw as particularly onerous.
The rules, the first comprehensive federal standards for medical privacy, affect virtually every doctor, patient, hospital, pharmacy and health plan in the United States.
Health care providers and insurers must comply by April 14, 2003. Anyone who violates the rules after that date will be subject to civil and criminal penalties, including a $250,000 fine and 10 years in prison for the most serious violations.
When Mr. Clinton issued the rules in December 2000, he described them as "the most sweeping privacy protections ever written." Mr. Bush took political credit for accepting those rules last April. White House officials said Mr. Bush would back a wide range of privacy protections for consumers, even if he had to defy his usual business allies.
The White House wanted to avoid the political embarrassment Mr. Bush suffered when he altered Clinton policies on arsenic levels in drinking water, global warming, ergonomic rules and the contamination of school lunch meat with salmonella. But after studying the medical privacy rules and listening to the concerns of companies in the health care industry, the administration concluded that major provisions of the Clinton rules were unworkable.
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