Clinics Chafe Under City's Scrutiny

By: Paul F. CuadrosThe Chicago Department of Health may be violating Illinois confidentiality laws by requiring its neighborhood mental health clinics to turn over their patients' names and other personal information to the department's central office, The Chicago Reporter has found.

The policy, initiated in 1989, affects thousands of patients, including city workers. Clinic therapists oppose the practice because they can be sued by patients whose privacy is compromised. About 40 percent of the patients are low income.

When told of the practice, Ald. Joseph Moore (49th) said, "A chilling effect is placed on someone who feels his name is going to be compromised."

"If word ever got out that the names and discreet information was going downtown, people might not want to go to the clinics," added Patricia Quirk, chairwoman of the Chicago Community Mental Health Board, which advises the health department.

City therapists are required to record client information on forms, which are entered into health department computers at the Richard J. Daley Center. City officials said the data allows the state to track Medicaid payments and guard against fraudulent reimbursements.

Deputy Commissioner Richard H. Sewell sees no problem with the practice. "We need the names inside our system to bill Medicaid," he said. "This department is like a big family and the information has to go to the head of the household."

The Illinois Department of Mental Health and Developmental Disabilities requests service hours and the number of patients and staff, but no names, said spokeswoman Donna Johnson.

Critics also question why city health officials have required personal client information like religious preference and educational and marital status.

"Mental health records are especially sensitive because people won't see a therapist unless the client's statements are confidential," said Benjamin S. Wolf, an attorney for the American Civil Liberties Union of Illinois.

The ACLU got involved in the issue when therapists produced earlier drafts of the city's form, which asked for the patient's ward and legislative district, Wolf said. The city decided not to include the information in the final version of the form, and recently eliminated the religious preference category.

Mental health workers also ask patients to sign a consent form that allows the bureau to correct the personal information for funding purposes. But if they refuse, the bureau still sends the data downtown, Sewell said.

The consent form is deceiving, said DePaul University law professor Donald H. J. Hermann, who is also director of the school's Health Law Institute. The city is "trying to give themselves additional protection," he said. "They've created an expectation that there's a possibility you can deny consent."

No Consent
At issue is whether the transfer of information from a health clinic to administrative offices constitutes disclosure of personal information. State law provides that therapists can only disclose, without consent, a client's name, address or other identifying information to their supervisors, co-workers, a record keeper or someone under their supervision.

The law also permits disclosure without consent to a state or federal agency or an accrediting body if "the personally identifiable information is necessary to accomplish" an audit or site review.

"We do expect to be able to retrieve personal data, but we don't require them for normal funding purposes," said Johnson. "Names are unreliable anyway in a large city like Chicago."

"It's not a release to move that information from the center offices to our office," Sewell said. "The information is not outside the institutional walls."

But Wolf disagrees, and said the policy creates a disclosure "whenever a therapist gives the information to anybody."

In 1992, the city's 18 mental health clinics served 11,899 clients, health department records show. The clinics, which now number 17, are open to everyone, including city workers.

The city gets about $6 million in grants for psychiatric services from the state mental health department, Johnson said.

The money pays for out-patient treatment at city clinics for people discharged from state institutions and for people seeking treatment at home. The therapists include psychiatrists, psychologists, licensed social workers and others who provide counseling.

The state also reimburses the city for $150,000 to $200,000 in annual fees for Medicaid patients, she said. About 40 percent of clinic patients are covered by Medicaid, health department records show.

Black Bag
Every weekday, the city health department sends a messenger to the Lakeview Mental Health Clinic, 2847 N. Clark St., to pick up client information forms.

The messenger puts the forms into a black bag, locks it and takes the bag to the Daley Center.

Sewell said the department needs the data for Medicaid reimbursements, but he also requires therapists to provide the information for clients who pay their own way. About 39 percent of the patients pay for services.

"For anybody who is not on Medicaid, I believe it's a violation of the law," Wolf said. "The city needs a reason to do this."

"They certainly shouldn't need the information for non-Medicaid patients," added Jonathan Tomes, a visiting associate professor at IIT Chicago-Kent College of Law, who has written about confidentiality issues. "The patients could sue the therapist or the city for improper disclosure of information."

But Dr. Ronald Davidson, director of public policy for the Mental Health Association of Illinois, argued that under state law, "the records belong to the institution, not the therapists," he said. "These are institutional records, not private notes."

Sewell said the health department needs the patient information so it can review its therapists. "We have to identify who the patient is to make sure the standards of care are being met," he said.

Health care systems typically share information, Davidson said. "There isn't a mental health system in the country without an exchange of information between its satellites and central office."

Disclosure can be made "as long as you have a good reason and respect the patient's rights," Wolf said.

In 1989, the American Federation of State County and Municipal Employees Union Local 505, which represents the therapists, filed a grievance with the city and asked for written assurance that the city Department of Law would defend therapists in a confidentiality lawsuit.

The therapists never received a response; in July, the union filed another grievance, asking that the policy be dropped. "They are an administrative body and do not and should not have client contact," said one therapist who asked not to be identified.

In 1989, city Department of Personnel Commissioner Glenn E. Carr requested the social security numbers of city employees who had participated in the drug and alcohol abuse program, according to a memo obtained by the Reporter. The assistance program is available to employees seeking help for drug and alcohol problems.

Michael McMillan, who coordinated the program, refused to turn over the information, arguing that he would be violating state and federal law. McMillan, who was laid off in 1991, is suing the city, claiming that his dismissal was politically motivated.

Carr backed off, but said he was trying to determine how many city employees were using the substance abuse program. "We didn't want names, that breached confidentiality and created problems," he said. "We found another way to get the information."

Carr said he eventually asked McMillan to give him statistics about the program, including the number of city employees and the services provided to them. "We simply went with the numbers that he gave us with the understanding that we would use a random sample without using identification markers."

The mental health clinics should be handled the same way, therapists said. "They should give us client ID numbers so we can block out identifying information and then they can conduct their reviews," the therapist said. "We shouldn't identify clients for the downtown office."

Interns Kendall Allen and Clara Jeffery helped research this article.