It is enacted by the General Assembly as follows:

SECTION 1. The title of Chapter 5-37.3 of the General Laws is hereby amended to read as follows:

SECTION 2. Sections 5-37.3-3, 5-37.3-4, and 5-37.3-6 of the General Laws in Chapter 5-37.3 entitled "Confidentiality of Health Care Information Act" are hereby amended to read as follows:

5-37.3-3. Definitions. -- As used in this chapter:

(1) "Authorized representative" means:

(i) A person empowered by the patient/client to assert or to waive the confidentiality, or to disclose or consent to the disclosure of confidential information, as established by this chapter. That person shall not, except by explicit authorization, be empowered to waive confidentiality or to disclose or consent to the disclosure of confidential information;

(ii) A guardian or conservator, if the person whose right to confidentiality is protected under this chapter is incompetent to assert or waive that right; or

(iii) If the patient/client is deceased, his or her personal representative or, in the absence of that representative, his or her heirs-at-law.

(2) "Board of medical licensure and discipline" means the board created under chapter 37 of this title, as amended.

{ADD (3)(a) "Confidential health care communication" means a communication of health care information by an individual to a health care provider, including a transcription of any such information, not intended to be disclosed to third persons except if those persons are: (i) present to further the interest of the patient in the consultation, examination or interview; (ii) reasonably necessary for the transmission of the communication; or (iii) participating in the diagnosis and treatment under the direction of the health care provider, including members of the patient's family. ADD}

(3){ADD (b) ADD} "Confidential health care information" means all information relating to a patient's health care history, diagnosis, condition, treatment or evaluation obtained from a health care provider who has treated the patient.

(4) "Health care provider" means any person licensed by this state to provide or otherwise lawfully providing health care services, including but not limited to, a physician, hospital, intermediate care facility or other health care facility, dentist, nurse, optometrist, podiatrist, physical therapist, psychiatric social worker, or psychologist, and any officer, employee or agent of that provider acting in the course and scope of his or her employment or agency related to or supportive of health services.

(5) "Health care services" means acts of diagnosis, treatment, medical evaluation or counselling or such other acts as may be permissible under the health care licensing statutes of this state.

(6) "Medical peer review board" means a peer review board under chapter 37 of this title, as amended.

(7) "Nurse" means a registered nurse or licensed practical nurse licensed to practice nursing in the state.

(8) "Patient" means a person who receives health care services from a health care provider.

(9) "Personally identifiable confidential health care information" means confidential health care information which explicitly or by implication identifies a particular patient.

(10) "Physician" means a person registered or licensed to practice allopathic or osteopathic medicine in this state under Rhode Island general laws.

(11) "Psychiatric social worker" means a person holding a Master's or further advanced degree from a school of social work accredited by the council of social work education.

(12) "Psychologist" means a certified psychologist under chapter 44 of this title, as amended.

(13) "Qualified personnel" means persons whose training and experience are appropriate to the nature and level of the work in which they are engaged and who, when working as part of an organization, are performing that work with published and adequate administrative safeguards against disclosure unauthorized under this article.

(14) "Third party" means a person other than the patient to whom the confidential health care information relates and other than a health care provider.

5-37.3-4. Limitations on and permitted disclosures. -- (a) Except as provided in subsection (b) or as otherwise specifically provided by the law, a patient's confidential health care information shall not be released or transferred without the written consent of that patient or his or her authorized representative, on a consent form meeting the requirements of subsection (d), a copy of any notice used pursuant to subsection (d), and of any signed consent shall upon request be provided to the patient prior to his or her signing a consent form.

(b) No consent for release or transfer of confidential health care information is required in the following situations:

(1) To a physician, dentist, or other medical personnel who believes in good faith that the information is necessary for diagnosis or treatment of that individual in a medical or dental emergency; or

(2) To medical peer review board or the board of medical licensure and discipline; or

(3) To qualified personnel for the purpose of conducting scientific research, management audits, financial audits, program evaluations, actuarial, insurance underwriting, or similar studies, provided that personnel shall not identify, directly or indirectly, any individual patient in any report of that research, audit, or evaluation, or otherwise disclose patient identities in any manner; or

(4) By a health care provider to appropriate law enforcement personnel, or to a person if the health care provider believes that person or his or her family to be in danger from a patient, or to appropriate law enforcement personnel if the patient has or is attempting to obtain narcotic drugs from the health care provider illegally, or to appropriate law enforcement personnel or appropriate child protective agencies if the patient is a minor child who the health care provider believes, after providing health care services to such patient, to have been physically or psychologically abused or to law enforcement personnel in the case of a gunshot wound reportable under section 11-47-48; or

(5) Between or among qualified personnel and health care providers within the health care system for purposes of coordination of health care services given to the patient and for purposes of education and training within the same health care facility; or

(6) To third party health insurers for the purpose of adjudicating health insurance claims ; {ADD including to utilization review agents as provided by section 23-17.12-9(k) ADD} ; or

(7) To a malpractice insurance carrier or lawyer if the health care provider has reason to anticipate a medical liability action; or

(8) To a court or lawyer or medical liability insurance carrier if a patient brings a medical liability action against a health care provider; or

(9) To public health authorities in order to carry out their functions as described in this title and titles 21 and 23 promulgated thereunder. These functions include, but are not restricted to, investigations into the causes of disease, the control of public health hazards, enforcement of sanitary laws, investigations of reportable diseases, certification and licensure of health professionals and facilities, review of health care such as that as required by the federal government and other governmental agencies; or

(10) To the state medical examiner in the event of a fatality that comes under his or her jurisdiction; or

(11) In relation to information that is directly related to current claim for workers' compensation benefits or to any proceeding before the workers' compensation commission or before any court proceeding relating to workers' compensation; or

(12) To the attorneys for a health care provider whenever that provider considers that release of information to be necessary in order to receive adequate legal representation; or

(13) By a health care provider to appropriate school authorities of disease, health screening and/or immunization information required by the school; or when a school age child transfers from one school or school district to another school or school district; or

(14) To a law enforcement authority to protect the legal interests of an insurance institution agent or insurance-support organization in preventing and prosecuting the perpetration of fraud upon them; or

(15) To a grand jury or to a court of competent jurisdiction pursuant to a subpoena or subpoena duces tecum when that information is required for the investigation or prosecution of criminal wrongdoing by a health care provider relating to his or her or its provisions of health care services and that information is unavailable from any other source; provided however, that any information so obtained shall not be admissible in any criminal proceeding against the patient to whom that information pertains; or

(16) To the state board of elections pursuant to a subpoena or subpoena duces tecum when that information is required to determine the eligibility of a person to vote by mail ballot and/or the legitimacy of a certification by a physician attesting to a voter's illness or disability; or

(17) To certify, pursuant to chapter 17-20 of the general laws, the nature and permanency of a person's illness or disability, the date when that person was last examined and that it would be an undue hardship for the person to vote at the polls so that the person may obtain a mail ballot; or

(18) To the central cancer registry; or

(19) To the Medicaid Fraud Control Unit of the Attorney General's Office for the investigation or prosecution of criminal or civil wrongdoing by a health care provider relating to his or her or its provision of health care services to then Medicaid eligible recipients or patients, residents or former patients or residents of long term residential care facilities. Provided, however, that any information so obtained shall not be admissible in any criminal proceeding against the patient to whom said information pertains.

(20) To the state department of children, youth and families pertaining to the disclosure of health care records of children in the custody of the department.

(21) To the foster parent or parents pertaining to the disclosure of health care records of children in the custody of the foster parent or parents, provided that the foster parent or parents receive appropriate training and have ongoing availability of supervisory assistance in the use of sensitive information that may be the source of distress to such children.

(22) A hospital may release the fact of a patient's admission and a general description of a patient's condition to persons representing themselves as relatives or friends of the patient or as a representative of the news media. The access to confidential health care information to persons in accredited educational programs under appropriate provider supervision shall not be deemed subject to release or transfer of that information under subsection (a). The release or transfer of confidential health care information under any of the above exceptions shall not be the basis for any legal liability, civil or criminal, nor considered a violation of this chapter.

(c) Third parties receiving and retaining a patient's confidential health care information must establish at least the following security procedures:

(1) Limit authorized access to personally identifiable confidential health care information to persons having a "need to know" that information; additional employees or agents may have access to that information which does not contain information from which an individual can be identified;

(2) Identify an individual or individuals who have responsibility for maintaining security procedures for confidential health care information;

(3) Provide a written statement to each employee or agent as to the necessity of maintaining the security and confidentiality of confidential health care information, and of the penalties provided for in this chapter for the unauthorized release, use, or disclosure of such information. The receipt of that statement shall be acknowledged by the employee or agent, who shall sign and return the statement to his or her employer or principal, who shall retain the signed original. The employee or agent shall be furnished with a copy of the signed statement;

(4) Take no disciplinary or punitive action against any employee or agent solely for bringing evidence of violation of this chapter to the attention of any person.

(d) Consent forms for the release or transfer of confidential health care information shall contain, or in the course of an application or claim for insurance be accompanied by a notice containing, the following information in a clear and conspicuous manner:

(1) A statement of the need for and proposed uses of that information;

(2) A statement that all information is to be released or clearly indicating the extent of the information to be released; and

(3) A statement that the consent for release or transfer of information may be withdrawn at any future time and is subject to revocation, except where an authorization is executed in connection with an application for a life or health insurance policy in which case the authorization shall expire two (2) years from the issue date of the insurance policy and when signed in connection with a claim for benefits under any insurance policy the authorization shall be valid during the pendency of that claim. Any revocation shall be transmitted in writing.

(e) Except as otherwise specifically provided by law, an individual's confidential health care information shall not be given, sold, transferred, or in any way relayed to any other person not specified in the consent form or notice meeting the requirements of subsection (d) without first obtaining the individual's additional written consent on a form stating the need for the proposed new use of such information or the need for its transfer to another person.

{ADD (f) Nothing contained in this chapter shall be construed to limit the permitted disclosure of confidential health care information and communications set forth in subsection (b) of this section. ADD}

5-37.3-6. Legal process -- Court proceedings. -- (a) Except as provided in subsection (b), confidential health care information {ADD communications ADD} shall not be subject to compulsory legal process in any type of {ADD judicial ADD} proceeding, including, but not limited to, any civil or criminal case or legislative or administrative proceedings or in any pre-trial or other preliminary proceedings, and a patient or his or her authorized representative shall have the right to refuse to disclose, and to prevent a witness from disclosing, his or her confidential health care information {ADD communications ADD} in any such proceedings.

(b) The exemption from compulsory legal process and the privilege provided in subsection (a) shall not apply:

(1) When an individual introduces his or her physical or mental condition, including, but not limited to, any allegation of mental anguish, mental suffering or similar condition, as an element of his or her claim or defense, provided, however, that a claim for damages or other relief for "pain and suffering" based solely on one's physical condition shall not be deemed to constitute the introduction of one's mental condition into issue and the exemption and privilege shall apply in that situation only to those portions of one's confidential health care information relating to mental condition;

(2) When, in a civil or criminal commitment proceeding, a physician, in the course of diagnosis, treatment, or medical evaluation of an individual, determines that an individual is in need of care and treatment in a hospital or any other health care facility which is deemed by the individual's physician to be appropriate for mental illness;

(3) When a court finds that an individual, after having been informed that the communications would not be privileged, has made communications to a psychiatrist in the course of a psychiatric examination ordered by the court, provided that the communications shall be admissible only on issues involving the individual's mental condition;

(4) When, in any court proceeding, including an ex parte hearing, it is demonstrated on a prima facie basis to the court that the individual's physical or mental condition is of an imminent and serious danger to the physical or mental health of another person;

(5) When, in any action by a person pursuant to section 5-37.3-5(d), or in any policy action brought by an individual against his or her insurance carrier, or by the carrier against an insured, it is demonstrated to the court that the confidential health care information is relevant and material, that court may issue in its discretion an order compelling production of such information;

(6) When, in any court proceeding, civil or criminal, the issue arises as to the ingestion by an individual of intoxicating liquor, toluene or any controlled substance as defined in chapter 28 of title 21, upon motion by any party to that proceeding, and it is demonstrated to the court that the confidential health care information is relevant and material, that court may issue, in its discretion, an order compelling production of that information, if any, which demonstrates the presence of alcohol in a concentration of one tenth of one percent (.1%) or more by weight on the presence of a controlled substance in that individual, as shown by a chemical analysis of a blood, breath or urine sample, if said test was originally performed at the direction of a law enforcement official in accordance with section 31-27-2.

SECTION 3. Chapter 5-37.3 of the General Laws entitled "Confidentiality of Health Care Information Act" is hereby amended by adding thereto the following sections:

{ADD 5-37.3-6.1. Court proceedings -- Confidential health care information. -- (a) Except as otherwise provided in section 5-37.3-6, a health care provider or custodian of health care information may disclose confidential health care information in a judicial proceeding if the disclosure is pursuant to a subpoena and the provider or custodian is provided written certification by the party issuing the subpoena that:

(1) A copy of the subpoena has been served by the party on the individual whose records are being sought on or before the date the subpoena was served, together with a notice of the individual's right to challenge the subpoena; or, if the individual cannot be located within this jurisdiction, that an affidavit of that fact be provided; and

(2) Twenty (20) days have passed from the date of service on the individual and within that time period the individual has not initiated a challenge; or

(3) Disclosure is ordered by a court after challenge.

(b) Within twenty (20) days after the date of service of a subpoena, an individual or his/her authorized representative may file a motion to quash the subpoena in the court in which the case is pending or, if no case is pending, in superior court. A copy of the motion to quash shall be served by the movant upon the party issuing the subpoena in accordance with the rules of civil procedure.

(c) The party issuing the subpoena may file with the court such papers, including affidavits and other sworn documents, as to sustain the validity of the subpoena. The movant may file with the court reply papers in response to the issuing party's filing. The court, upon receipt of these papers may proceed in camera. The court may conduct such proceedings as it deems appropriate to rule on the motion, but shall endeavor to expedite its determination.

(d) The court shall grant a motion to quash unless the requesting party can demonstrate that there is reasonable ground to believe the information being sought is relevant to the proceedings, and the need for the information clearly outweighs the privacy interest of the individual.

(e) In determining whether the need for information clearly outweighs the privacy of the individual, the court shall consider:

(1) The particular purpose for which the information was collected;

(2) The individual's reasonable expectation of privacy in the information;

(3) The degree to which disclosure of the information would embarrass, injure, or invade the privacy of the individual;

(4) The effect of the disclosure on the individual's future health care;

(5) The importance of the information to the lawsuit or proceeding; and

(6) Whether the information is available from another source, including rule 35 of the rules of civil procedure.

(f) If the court determines that a subpoena should issue, the information shall not be disclosed for any other purpose except as otherwise authorized by this chapter.

(g) Nothing contained herein shall be construed to bar a health care provider or custodian of health care information from filing a motion to quash a subpoena for such information in accordance with the rules of civil procedure. ADD}

{ADD 5-37.3-6.2. Legislative or administrative proceedings. -- Except as provided in section 5-37.3-6(b), confidential health care information and confidential health care communications shall not be subject to compulsory legal process in any legislative or administrative proceedings, and a patient or his or her authorized representative shall have the right to refuse to disclose, and to prevent a witness from disclosing, his or her confidential health care information in any such proceedings. ADD}

{ADD 5-37.3-6.3. Exceptions. -- (a) Nothing in this chapter shall be construed to interfere with the rights to confrontation and compulsory process secured to a defendant in a criminal prosecution pursuant to the state and federal constitutions.

(b) This chapter shall not be construed to interfere with any federal laws or regulations which provide more extensive protection than provided herein for the confidentiality of health care information. ADD}

SECTION 4. This act shall take effect upon passage.