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Medical Records Debate Re-Emerges

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
Douglas R. Clifford
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

Nearly 15 years after Florida voters approved a constitutional amendment about access to records in medical-malpractice cases, a Jacksonville hospital has launched a federal lawsuit arguing it should be shielded from being required to turn over documents to a patient.

The lawsuit, filed this month in federal court in Jacksonville, is the latest in a series of legal disputes about whether hospitals need to disclose records about patient care as part of malpractice litigation under the 2004 constitutional amendment. The Florida Supreme Court in 2017 issued rulings that broadly interpreted the constitutional amendment to require records to be turned over.

In the new case, however, attorneys for UF Health Jacksonville are asking a U.S. district judge to declare that the disputed records are shielded under a federal law that “preempts” the state constitutional amendment. Also, the hospital contends that it could face federal penalties if it is required to turn over the information because of the constitutional amendment. It asks for an injunction against such penalties.

The federal law, known as the Patient Safety and Quality Improvement Act, or PSQIA, passed in 2005 and allows hospitals to voluntarily submit information about medical errors to "patient safety organizations" --- and offers certain confidentiality protections. The law was aimed, at least in part, at encouraging health providers to submit information that could be analyzed and used to prevent future medical errors.

UF Health Jacksonville, which also goes by the name Shands Jacksonville Medical Center, did not spell out all of the underlying details in the case. But it said it received a letter in February requesting all “adverse medical incident documents” related to the care of Nada Caro, a patient from June 2018.

“Shands is subject to a patient request for this information pursuant to the Florida Constitution,” the lawsuit said. “The information, however, is both privileged and confidential under the PSQIA. The Florida Supreme Court, in recent decisions interpreting the relevant Florida constitutional provision, appears to mandate disclosure of the information. If Shands complies with the patient’s request, the Secretary (of the U.S. Department of Health and Human Services) has authority to impose a significant civil monetary penalty against Shands for violating the PSQIA’s nodisclosure requirements.”

The 2004 constitutional amendment, which appeared on the ballot as Amendment 7, was passed amid legal and political battles between health-care providers and plaintiffs’ attorneys about medical-malpractice laws. The amendment was intended to provide access for patients and their attorneys to adverse medical incident reports, which can play an important role in malpractice cases.

The UF Health Jacksonville lawsuit names U.S. Health and Human Services Secretary Alex Azar as the defendant. As of mid-day Thursday, the federal government had not filed a response.

But in one 2017 ruling, the Florida Supreme Court rejected the notion that the federal law trumps the state constitutional amendment.

"The federal act was intended by Congress to improve the overall health care in this system, not to act as a shield to providers, thereby dismantling an important right afforded to Florida citizens through Amendment 7," said the majority opinion in a case involving another Jacksonville hospital system. "Moreover, health care providers should not be able to unilaterally decide which documents will be discoverable and which will not in medical malpractice cases."