From "Pennsylvania Psychiatrist - Newsletter of the Pennsylvania Psychiatric Society"
July 2001

Pennsylvania psychiatrist takes Magellan to court over confidentiality of records

MEMBER IN THE NEWS

Daniel S. Shrager, MD, a member of the Pennsylvania Psychiatric Society practicing in Pittsburgh, has been granted a non-jury trial in the Allegheny County Court of Common Pleas in his fight to preserve patient confidentiality and his credentialed status in the Magellan network. The trial will take place some time after mid-August.

The Pennsylvania Psychiatric Society has been actively involved in providing resources to Dr. Shrager and his attorney. As reported in the October 2000 issue of Pennsylvania Psychiatrist, the underlying issue of dispute is the extent to which a managed care organization has the right to view patient records, in particular for site reviews. According to Lawrence A. Real, MD, President of the Pennsylvania Psychiatric Society, resolution of this issue is important to psychiatrists throughout the state. The Society believes that every effort must be made to preserve the confidentiality of patient records and the patient’s right to provide truly informed consent.

Magellan first decredentialed Dr. Shrager after he failed to set up a site visit, as requested, for Magellan to see patient records in order to review his record-keeping practices. He had asked Magellan to reconsider, citing the need for a signed, informed consent from the patient and the negative effect which loss of confidentiality has on patient care.

The Court subsequently ordered Magellan and Highmark to reinstate Dr. Shrager to its provider panel, the day after he filed an emergency preliminary injunction requiring reinstatement. The Court also ordered Magellan to provide Dr. Shrager with his internal administrative appeal. Dr. Shrager’s complaint alleged that he had been improperly decredentialed, without the due process to which he is entitled, and that Magellan’s demand to review confidential patient records during a site review is contrary to Pennsylvania law and the terms of Dr. Shrager’s contract with the defendants.

Since that time Magellan has reasserted its belief that no special consent is needed for its agents to access the entire record, since general authorizations were previously supplied to the underlying insurance plan. Nevertheless, Magellan offered to allow Dr. Shrager to provide redacted records, which he also declined to do absent contemporaneous, specific consent. Magellan contends it is Dr. Shrager’s responsibility to procure a consent from the patient if he disagrees with its position.

Dr. Shrager, on the other hand, believes that consent is required even for redacted records, that it would be unethical for him to request consent for the purpose at hand (his own re-credentialing), and that the release of information might be harmful to the patient and the treatment and therefore contrary to both his contractual and professional obligations.

When Magellan’s appeals panels reaffirmed the decision to decredential, Dr. Shrager asked that the matter be decided through a non-jury trial, instead of the arbitration required by his contract with Magellan. Both the judge and Magellan agreed to that option. At issue are matters of federal and state law, the public interest in providing the level of confidentiality necessary for effective treatment, and professional ethical standards. State law requires providers to adhere to professional ethical standards.

Magellan and Dr. Shrager have different interpretations of the ethical standards and the applicable laws. A ruling by the Court may not only settle the issue between them, but may also clarify the law for other Pennsylvania psychiatrists who believe that insurers and managed care organizations insist on more information than they are entitled to receive.