Hands Off My Medical History
A woman seeking reproductive health care usually starts by filling out a questionnaire detailing her complete medical history including whether she is sexually active, past illnesses, number of pregnancies, number of live births, contraceptive use, marital status, gender of her sexual partner, occupation, address and more.
Yet, as the legal battles over reproductive rights continue to increase in number and intensity, more and more women have become reluctant to be open and frank.
And after last week--when an Indiana judge on May 30 denied the request of Planned Parenthood of Indiana to stop the state's Attorney General Steve Carter from accessing the medical records of its young clients--it may be even harder for doctors to gather an accurate health history from women and teens.
Planned Parenthood of Indiana filed its lawsuit in March after the state attorney general's office implemented the state Medicaid Fraud Control Unit, which apparently overrides federal health privacy laws, to investigate whether more than forty Planned Parenthood affiliates are properly reporting cases of rape and molestation involving girls under 14. The lawsuit also asked the Superior Court judge to require the return of records already taken by the attorney general's office. Following the judge's denial, Planned Parenthood requested a stay in the case and has vowed to appeal to the Indiana Court of Appeals if necessary.
"I think it's very disturbing and frightening," says Dorothy Greene, a New York City writer who had an abortion years ago but chooses not to share that information with her doctors. "I don't know anymore where these records end up or who sees them. I don't want to feel that the personal private records of mine will be open to scrutiny by someone who has no business looking at them except for their personal ideological reasons."
Indiana is the second state in a matter of months in which prosecutors have sought full access to medical records held by reproductive health clinics.
In February, Kansas Attorney General Phill Kline served subpoenas on two Kansas reproductive health clinics seeking access to the medical records of at least 90 women who had used its abortion services.
Attorneys for the two clinics--Comprehensive Health, a Planned Parenthood clinic located in the suburbs of Kansas City and Women's Health Care Services, located in Wichita--filed an appeal on March 16 with the Kansas Supreme Court to block Kline's access to the unedited files, which include the patient's name, medical history, psychological profile and sexual history.
"We made a commitment to our patients that their records are confidential and private," says Peter Brownlie, president and CEO of Planned Parenthood of Kansas and Mid-Missouri, which, along with Women's Health Care Services, has not released any files to date.
The decision on whether to uphold Kline's injunction is pending review by the seven-member Kansas Supreme Court and may not be issued for months.
The Kansas women whose medical records were subpoenaed have expressed outrage at what they see as an incursion into their privacy, says Julie Burkhardt, executive director of ProKanDo, a pro-choice political action committee that she founded along with Dr. George Tiller, medical director of Women's Health Care Services. "They're very concerned that a non-medical official was going to be searching through their medical records."
Both clinics cited in the subpoenas offer legal second-trimester abortion services.
Kline says that he's investigating possible violations of a state law limiting late-term abortions and another that requires the mandatory reporting of suspected child rape.
"This is a fishing expedition," retorts Brownlie of Planned Parenthood of Kansas and Mid-Missouri, noting that Kline is poised to run next year for either a second term as attorney general or for the governorship. "We fully comply with Kansas' laws."
Whitney Watson, spokesperson for Kansas Attorney General Kline, refused to discuss any potential evidence, saying only that the District Court judge who signed the subpoenas had determined that probable cause existed.
Critics say Kline is pushing an anti-choice agenda.
"He has been very clear throughout his political career that he is out to get abortion providers," Burkhardt says. "When this inquisition broke back in February, he repeatedly said that this is about protecting children from child rapists."
But she says that Kline has subpoenaed the records of all women--not just the very young--who had abortions at or after 22 weeks of pregnancy during 2003.
She says if Kline's motive was to uncover possible instances of child sexual abuse he'd also be looking at the records of family physicians, psychologists, social workers and others.
When asked about that, Watson responded, "You don't know that we're not."
A spokesperson for the Indiana attorney general's office also says that it is pursuing its legal obligation to investigate potential wrongdoing involving minors.
Signs of Intimidation
Although Planned Parenthood declines to say exactly how much activity it lost at the Kansas clinic, it contends that the empty places in its appointment books indicate that Kline's actions were intimidating women who would normally be seeking its health care services.
"We are concerned about the chilling effect," says Brownlie. "We had phone calls from patients wanting to know if their privacy was at risk."
Concealing their medical histories can put patients' health at risk, says Katharine O'Connell, a professor of obstetrics and gynecology at Columbia University.
For instance, says O'Connell, many teens today take the acne drug Accutane. If they do not reveal to their doctors that they are pregnant, they might continue taking the drug, which can cause serious birth defects.
"Doctors trust that patients will be open to them," says O'Connell.
Health workers, however, say patients often feel there is a bigger risk in sharing their information.
"What people leave out are the things they're ashamed of or perceive others to have judgment about," says Leslie Rottenberg, senior director of social services for Planned Parenthood of New York. She cited sexually transmitted diseases, drugs and abortions as likely omissions.
Rottenberg adds women most often omit their abortion history, worrying that somehow their employers might find out and that minors, in particular, are concerned about insurance information reaching their parents.
"There is definite concern about where that information goes and who will know and who will have access to it," she says.
Carole Joffe, a professor of sociology at the University of California, Davis, believes even more women would conceal their abortion history if they knew what was going on in Kansas and Indiana.
"When young women in society see headline after headline that says the attorney general is seeking abortion records, it just adds to the sense that abortion is stigmatized. And that your records may be subpoenaed."
This stigma surrounding abortion, she says, compels many women to reach for their pocketbook rather than use their health insurance to cover the procedure.
"They're afraid to let their insurance company know or have it become part of their permanent medical record."
Both state cases follow a failed attempt in 2003 by former U.S. Attorney General John Ashcroft to gain access to women's medical records across the nation as part of litigation to defend an anti-choice law passed by Congress which would have banned abortions after the 12th week of pregnancy.
In addition, in 2002, after the discovery of a dismembered infant in Iowa, local law enforcement officials subpoenaed approximately 1,000 positive pregnancy test results from a Planned Parenthood affiliate there in attempts to locate the mother. Months later they withdrew the subpoena after lawyers for Planned Parenthood of Iowa successfully appealed to the state Supreme Court to block and review the lower court order. Iowa Attorney General Tom Miller cited a deficit of time and resources as his reason for backing off from that intrusion into women's privacy.