ASH Patient Medical Records: Wherein the issue of any patient at The Arizona State Hospital's desire to access and review their own personal ASH medical records is brought to the table in order to clarify a thing or two about yet one more aspect of ASH's substandard conditions. 

RULE: (Hospital Information Portability and Protection Act, 2006) $164.524 Access of individuals to protected health information.

     (1) Individuals request for access. The covered entity must permit an individual access to inspect or to obtain a copy of the protected health information about the individual that is designated in a record set.

NUTSHELL TO THE FOLLOWING: Patient' access to their own records may only be restricted if the records are psychotherapy notes, or notes/information that LIKELY poses a clear threat of harm to anyone, be it the patient themselves, others, and so on. That's it, no exceptions. Your records are YOURS, and in no other circumstances may ASH staff restrict said access. Also, should ASH staff or administrators deny said access for any reason at all, they must provide the client-patient with a clear explanation in writing. If ASH staff fail to meet these strict requirements, they are doing so in violation of the The Hospital Information Portability and Protection Act, which is an exclusive and paramount federal law, which direct applicability to health care policy under law. Period. I know from experience that ASH staff, including senior clinicians and administrators, will deny such access to any patients's records if the access poses any likelihood that staff wrongdoing will be exposed. ASH patient records as a whole contain a wide range of information about any patient's flow of treatment, and as such, often do offer the opportunity for patient or patient representative access to evidence in support of claims about staff misconduct, and for this reason, ASH administrators are more than reluctant to grant patients their lawfully rightful access to records for this very reason. Standard practice at ASH, in other words, and one more distinct aspect of how and why the senior clinical staff at ASH continually get away with providing their patients with grossly substandard care, in direct complicity with ASH administrators. 

The following outlines the underlying law specific to this reality, albeit in torturous legalese. 

GENERAL

Word has come to me of late, that the administrators and senior clinicians at The Arizona State Hospital are engaged in ongoing denials of any ASH patient's fundamental right to access and review their own ASH medical records. This is an issue that I know for a fact contributes to  unabated criminality specific to the clinical practices at ASH, for any ASH patient's  records will include supplemental notes are taken by all levels/forms of ASH staff, such as the nurses, technicians, recreational staff, even the librarian, and as such, represent a diverse variety of data in the context of records, and none of which are psychotherapy notes. The fact is that, if many/most patients/patient representatives were made aware of the full records compiled by various ASH staff who are directly involved in any patient's treatment, the patient (etc.) would be provided a reasonable opportunity to review a range of details underlying how ASH staff in general interpret the patient's needs, behaviors, and related status specific to their given diagnosis, as well as in terms of the patient's overall flow of treatment. But the fact is, ASH senior clinical staff do not want most patients to see these records, because that would also provide ASH patients with a much clearer idea of just how deceitful and/or unethical their primary care physicians are, this in the sense that such senior staff unethically CONTROL the flow of patients' treatment by restricting (access to), distorting, or otherwise manipulating the information in such notes. Thus, this article is an overview of the current standards applicable to this specific topic, and I am hopeful that it will be of use to anyone seeking these specifics in relation to their own treatment at ASH, or there treatment of their loved ones, and so on. 

I know for a fact how critical this issue is in terms of any patients ability to exercise their right(s) to report potentially unlawful issues that arise in specific relation their flow of treatment at ASH, because I was personally subjected to this specific violation of my rights and related protections on more than one occasion.

In my own case, during the summer months of 2011, I sought nurses' notes  specific to my own flow of treatment due to the fact that my primary ASH doctor at the time (Dr. Pervaiz Ahkter, who became my 2nd PC doctor after my falling out with ASH's current Chief medical Officer, Laxman P. Patel, a falling out that occurred in relation to Patel's disagreement with my ongoing willingness to report ASH staff misconduct whenever I was aware of its occurrence, as described in my April 4, 2013 article, Fundamental Fact #2) had informed me that nursing staff had allegedly documented a range of (my own) alleged "misbehavior" that I knew to be patently untrue; at that time, Ahkter was "citing" such records in order to threaten my status as a patient granted full privileges there at ASH (which provide the patient access to ASH's various day to say therapeutic and recreational activities, etc.), and I effectively called him on it by requesting access to those records. In this context, it is important to note that in all truth, I accrued no history at all of engaging in any form of actual "misbehavior" during the entirety of my time at ASH (but for one or two very specific occasions, each of which occurred under very unusual circumstances); and at no point whatsoever in my 8 months of treatment prior to ASH, while in Tucson area hospitals. At ASH, I attest that it is common practice for senior clinical staff, including the attending Chief Medical Officer, to mischaracterize any patients' behavior in order to manipulate that patients' due flow of treatment, which is a gross abuse of their given authority and flies in the face of the Hippocratic Oath; in my case, this physician sought to intimidate me in this fashion in clear retaliation for my willingness to report staff misconduct, and I contend that his goal was to either intimidate me into submission (and stop reporting staff misconduct), or to use the invalid data in order to restrict my access to day to day activities there, including therapeutic sessions, recreational activities, and so on. In either case, Ahkter's intent was in clear violation of various patient rights and protections, and I have no idea if he even has the capacity to realize that fact, for much like ASH's current Chief Medical Officer, Laxman P. Patel, Akhter came to the United States from one of the most horrifically out of control regions of the world today, Pakistan, a nation known as anything but a bastion of human rights and democratic values specific to human interaction. This, the face of ASH today. It really is that bad.   

The standards applicable to any patient's right to access their own health care records is well established today, and are very clearly defined, as such, by state and federal law in every part of the United States. Thus, anytime ASH staff choose to deny such access, they must adhere to very strict provisions of these laws, lest they be held accountable as per equally defined penalties, which are most significantly spelled out by applicable federal law and policy. Specifically, the Hospital Information Portability and Protection Act (HIPPA) covers any American citizen's rights in this context, and it's primary purpose is to ensure that hospitals and health providers don't engage in unlawful management of any individual's given needs. The HIPPA document itself was congressionally enacted due the critical nature of this subject, and as such, very clearly supersedes the authority of involved health care providers; as such, if and when health care providers fail to adhere to HIPPA or act in violation of the privileges and protections created to individuals receiving medical service, there are very serious consequences which are to be implemented by state and federal oversight. I attest to the fact that ASH's senior clinical staff, as well as ASH's administrators, unlawfully manipulate the presence of the HIPPA document as a matter of challenging patient requests to access their own ASH medical records, taking grossly unfair advantage, in effect, of most any patients' inability to refer to HIPPA, and related lack of awarenesses to their rights context. 

The HIPPA document is anything but short and to the point, and no person unfamiliar/uncomfortable with legal terminology is going to have an easy time finding their way through the thing, much less so persons affected by debilitating forms of mental illness; and the one's running ASH flagrantly exploit this fundamental dynamic to the fullest extent possible, in graphic defiance of HIPPA itself, in sickening contradiction to the very purpose of HIPPA, and 100% out of line with established codes of decency in this specific context. The following is a statement that I recently submitted to one specific media outlet that I am currently working with, and is designed to give the investigative staff of that source an idea of the legal dynamics underlying this matter. As such, it is fairly technical and not entirely well done (I comfortably admit to this likelihood, but hey, I do what I can), but I hope that it is in some way useful to any person's interest in this matter as it stands today. 

NUTSHELL TO THE FOLLOWING: Patient access to their own records may only be restricted if the records are psychotherapy notes, or notes/information that LIKELY poses a clear threat of harm to anyone, be it the patient themselves, others, and so on. That's it, no exceptions. Your records are YOURS, and in no other circumstances may ASH staff restrict said access. The following outlines this, albeit in torturous legalese. 

I UTILIZED A VERY BASIC APPROACH TO STRUCTURING THIS DOCUMENT, REFERRED TO AS THE "IRAC" METHOD, WHICH RELIES UPON NOTHING MORE COMPLEX THAN:

                   ISSUE-RULE(LAW)-ANALYSIS-CONCLUSION

ISSUE: Do patients have a right to access their own personal medical records from hospital staff, and if so, what are the terms of such access, including circumstances whereby hospital staff can lawfully restrict such access?

In principle, hospital patients and medical clients in general are granted full access to their personal health information and related treatment records except for in a very narrow area of conditions. This is as fundamental to contemporary health care practice as you might find, and as such, is common knowledge to most people today. 

RULE: (Hospital Information Portability and Protection Act, 2006) $164.524 Access of individuals to protected health information.

(a) Standard: Access to protected health information.

(1) Right of access. Except as otherwise provided in paragraph (a)(2) or (a)(3) of this section, an individual has a right of access to insect an obtain a copy of protected health information about the individual in a designated record set, for as long as the protected information is maintained in the designated record set, except for:

   (i) Psychotherapy notes: (these are notes very specifically compiled in actual psychotherapy sessions, with no exception outside of such conditions; a psychotherapy session is understood to be one wherein a licensed psychotherapist engages in regulated cognitive therapy with at least one protected individual, again, with no outside exceptions). IT IS IMPORTANT TO DISTINGUISH THE IRREFUTABLE FACT THAT PSYCHOTHERAPY NOTES ARE VERY NARROWLY DEFINED AS COMMUNICATIONS THAT OCCUR DURING FORMALLY REGULATED THERAPY SESSIONS BETWEEN THE PATIENT AND A LICENSED PSYCHOTHERAPIST. MEDICAL NOTES NOT COMPILED UNDER THIS NARROW DEFINITION ARE GENERALLY ACCESSIBLE TO ANY PATIENT WHO REQUESTS SUCH ACCESS. AT ASH, SENIOR CLINICIANS LIKE TO LUMP ALL FORMS OF MEDICAL RECORDS AND NOTES UNDER PARAMETERS ONLY APPLICABLE TO PSYCHOTHERAPY, AND THEY DO THIS IN GROSS VIOLATION OF LAW.

(2) Unreviewable grounds for denial. A covered entity may deny an individual access to without providing the individual an opportunity for review, in the following circumstances.

    Summary i-v: None of the above terms "(2)" apply at ASH outside of psychotherapy notes (which strictly apply as I have already defined above, with no exceptions), but do apply as follows, to: (ii) correctional facilities (ASH is not a correctional facility); (iii) research facilities ("" "" "" "" "" ""); (iv) Privacy Act 5 USC 552a (not applicable to hospital patients in public facilities); (v) outside information not compiled by the entity (not applicable to in-hospital records).

(3) Reviewable grounds for denial.

    (i) In cases where access is likely to endanger the life or physical safety of the individual or another person;

   (ii) In cases where access is likely to cause substantial harm to such other person(s)

  (iv) In cases where someone other than the individual has requested access and such access is determined to likely pose substantial harm to the individual or another person.

(4) Review of  a denial of access. If access is denied on a ground permitted (above) the individual has a right to have the denial reviewed by a licensed health care professional designated by the covered entity and who did not participate in the original denial.

   

(b) Implementation specifications: Requests for access and timely action.

(1) Individuals request for access. The covered entity must permit an individual access to inspect or to obtain a copy of the protected health information about the individual that is designated in a record set. AGAIN: "MUST PERMIT ACCESS." AND SO ON.

ALSO, PLEASE UNDERSTAND THAT THE WRITING OF THE STATUTE SHOWN ABOVE BEGINS BY LAYING OUT THE CIRCUMSTANCES WHEREIN A MEDICAL PROVIDER MAY BE GRANTED TO OPTION TO DENY ACCESS TO ONE'S OWN MEDICAL RECORDS, BEFORE IT THEN CUTS TO THE MEAT OF THE STANDARD, WHICH IS SIMPLY STATED JUST ABOVE. THEREIN, ONE THE MORE FRUSTRATING ASPECTS OF HOW THIS STATUTE IS WRITTEN. 

ANALYSIS: Individuals do in fact posses the implicit right to access all/any health care records specific to their treatment in entities covered by the terms of HIPPA. There are very limited exceptions to this right, and specific to ASH, the nature of psychotherapy notes very well may arise, depending on the specific circumstances (the nature of which is described above). Nurses' notes and other like data do not fall under the specific exceptions provided by HIPPA. It is also of note that anytime a health care provider chooses to deny any individuals access to protected health care information, they must provide the individual with written explanation/justification for such a denial (this is also laid out in HIPPA, but I did not include such details at this time as a matter of expedience.) Likewise, at ASH, there may be cases where an individuals access to their own health care records might pose danger to their own safety or the safety of others, but as described above in the HIPPA document itself, denials on this basis must adhere to strict consideration wherein it's determined that the access will likely pose such danger in this context. 

CONCLUSION: I attest to the fact that my request to access nurses's notes was reasonably based upon my need to review information specific to my behavior at ASH, and as such, had nothing at all to do with psychotherapy notes, and posed no form of danger whatsoever, either to myself or anybody else. I was aware of my right to access these records, and I went so far as to share my awareness of this fact with my doctor at the time that he cited nurses notes in direct relation to my alleged misbehavior (as I have already described). The doctor responded by stating: "I  am not going to provide you with those notes because I do not want you to nitpick about the conduct of staff."  There was no other justification for the the denial than this, and I was never provided with any form of written explanation/justification in this context.  As such, the denial of my right to access these records by my primary doctor at ASH (Ahkter) was in clear violation of HIPPA, and in spite of the fact that immediately filed a grievance report to the ASH patient advocate, there was no lawfully required response, and later, when I shared the details of this issue with representatives of the ADHS Office of Greivances and Appeals, they too rejected the merits of my concerns, and as such, engaged in furthering the violations specific to this matter as it stood at the time. I of course have all records of the history of this process as it played out in 2011, while I was at ASH.

IN CLOSING: I have already stated my knowledge specific to the willingness of senior clinical staff at The Arizona State Hospital to unlawfully manipulate the Hospital Information Portability and Protection Act as a matter of challenging patient requests to access their own ASH medical records, taking grossly unfair advantage, in effect, of most any patients' inability to refer to HIPPA, and related lack of awarenesses to their rights context. It is also critical to realize that the administrators at ASH similarly distort the intent and application of HIPPA in order to engage in gross violations of the public trust. This is an issue clearly illustrated by ASH supervisor Cory "crazycorycorner" Nelson's repeated denials of his staff's direct involvement in the tragic murder of April Mott in late August, 2011, denials that he made in various media inquiries specific to why ASH allegedly could not publicize escaped ASH patient Jesus Rincon Murietta's presence in the greater Phoenix metropolitan area, this in spite of the fact that Murietta had very clear and recent history of graphically violent behavior, including the very manner in which he escaped ASH. As such, Nelson is hiding behind the HIPPA document in order to cloak the factual causes underlying Ms. Mott's untimely death, and I contend that his conduct in this case is prosecutable under federal law. At a minimum, it is just as atrociously in contradiction to the intent and design of HIPPA as one might possibly come upon in today's societal affairs, and this is unacceptable in all senses.    

There is no reason for any of you, my readers, to hold back on doing whatever you can to defend the rights of Arizona's most seriously mentally ill citizens. The patient abuse in the The Arizona State Hospital is ongoing, and the complicity of the Hospitals' highest ranking administrators and senior clinicians has yet to be meaningfully addressed. ASH is the sole long term public mental health facility to the state of Arizona, and it is operating at a level of substandard mental-medical care and practice, and they are getting away away with it, lock-stock-and barrel. This is unacceptable. Patient abuse is sickening to the conscience of any reasonable moral human being, and the abuse of Arizona's most vulnerable adults at ASH needs to stop. PLEASE SEE MY "RESOURCE IDEAS" ARTICLE AND DETERMINE HOW YOU CAN BEST DEFEND THE RIGHTS AND CARE NEEDS OF THE PATIENTS AT ASH.

paoloreed@gmail.com