Legal and Ethical Implications of Medical Record Confidentiality

This report delves into the critical intersection of medical laws and ethics, specifically focusing on the confidentiality of patient information, disclosure protocols, and access to medical records within the Indian legal framework. It begins by emphasizing the significance of medical records as both essential tools for patient care and crucial evidence in legal proceedings. The report then examines the legal boundaries surrounding medical information, including the complexities of informed consent, the impact of the Right to Information Act, and the ethical dilemmas faced by healthcare professionals regarding disclosure. It analyzes the role of medical records as evidence in various legal contexts, such as malpractice claims and ethical breaches. The report highlights the importance of adhering to ethical codes, such as those mandated by the Medical Council of India, while acknowledging existing gaps in data protection and the challenges posed by cross-border information flow. The conclusion underscores the need for continued efforts to protect patient confidentiality and preserve the integrity of medical records.

Running head: MEDICAL LAWS AND ETHICS
MEDICAL LAWS AND ETHICS
Name of the Student
Name of the university
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Topic- Legal and Ethical implications on confidentiality disclosure and access to medical
records
Introduction
A patient's medical record normally consists of a legal document that records decisions
and events for helping the health practitioner to manage the patient care. The medical record may
also act as evidence for applying any tort law against any clinical mal practice; hence it is
important to preserve the medical records of patients1. Furthermore it is mandatory for the health
care professionals not to disclose the health care information of a patient to anyone. This report
focuses on the various laws and the acts in India supporting the maintenance of the medical
record confidentiality.
Objectives
 To understand the importance of medical records
Medical records are central to the health care activities of the patient and they also form a
part of the ethical and statutory duty of the doctor for providing a patient care. Medical
records can also act as the sole evidence against any fowl play and hence should be preserved
with utmost safety1. Medical records are useful documents that explain every detail about the
patient's history, diagnostic test results, clinical findings, pre and post operative care, patient's
1 Solove, Daniel J., and Paul Schwartz. Information privacy law. Wolters Kluwer Law & Business, 2014.

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medications and heath status. It is one of the most important evidence on the basis of which
almost all medico-legal battle can be fought2.
It is recommended that more efforts should be made for the institutional management and the
preservation of the clinical evidence. There are certain objectives of maintaining the medical
records such as monitoring of the actual patient, taking care while altering of the medical
records, people are accessing to the medical records and proper release of the records2.
 To understand the legal boundaries
The concept of informed consent in medical field is still alien to many medical
practitioners and researchers and to the Indian population. In India the therapeutic relationship
between the doctor and the patient is mainly governed by trust and the doctor is considered as the
ultimate authority. The Indian penal code is almost indifferent about the legal validity of the
consent given by people between 12 and 18 years of age3.
'The Right to Information Act' can be viewed as a crucial and historic development in the
democracy of India. The act gives right to the citizen of India to inspect any medical records or
documents held by the public authorities4. This provision has raised an ethical dilemma among
2 Davis Giardina, Traber, et al. "Patient access to medical records and healthcare outcomes: a systematic review."
Journal of the American Medical Informatics Association 21.4 (2013): 737-741.
3 "Medical Council Of India." Mciindia.Org, 2018,
https://www.mciindia.org/ActivitiWebClient/rulesnregulations/codeofMedicalEthicsRegulations2002.
"Right To Information." Rti.Gov.In, 2018, http://rti.gov.in/.
4 "Right To Information." Rti.Gov.In, 2018, http://rti.gov.in/.

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the doctors whether to conceal or disclose the medical records to the patient. It has to be noted
that not complying with the laws would evoke penalty. All the registered health care
practitioners in India are bound to the codes of ethics4.
According to the RTI Act, section 8.1, there are certain conditions that have been
exempted from the disclosure, if it endangers the life of a certain person or if the disclosure will
affect any ongoing prosecution or investigation 4. According to the section 2.2 of the RTI act, a
physician must respect the confidentiality of the patient and should until requested by any law 4.
High administrative costs for data processing have led to the increase of the outsourcing of the
information of the patient, in order to reduce the costs. Cross border flow of the information can
lead to disclosure of the patient's information5. The government has enacted the Information
Technology (Reasonable security Practices and procedures and sensitive Personal Data or
Information) Rules, 2011 (IT rules)5. These have to some extent strengthened the data protection
law in India.
Contrary to the strong rules about disclosure in US and UK, the Supreme Court has
chosen to follow the cases by case approach for the interpretation of the privacy rules6. Although
in most of the cases the hospital chooses to maintain the confidentiality of the patient
information, there had been cases where the hospital has been allowed by the court to disclose
5 "Rules For Information Technology Act 2000 | Ministry Of Electronics And Information Technology,
Government Of India." Meity.Gov.In, 2018, http://meity.gov.in/content/rules-information-technology-act-2000.
6 "The Medical And Health Sector - Data Protection ...." https://www.dataprotection.ie/docs/The-Medical-and-
Health-Sector/m/245.htm.

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the HIV status of the patient to his future spouse3. The reason for these types of disclosure has
been the public welfare argument, in order to stop the spreading of the disease.
 To determine the value of the medical records as the evidence
Medical records of a patient contains numerous information acquired from various sources, such
as the patients clinical history, symptoms , pains, ongoing medications, treatment regimen
applied1. It acts as a single most evidence for the clinical practitioners in lawsuits, inquests or
hearings. The medical records can act as relevant information against any medical malpractice or
an ordinary negligent action. Any tort law can be applied in the basis of these medical records.
Medical records can be presented as any evidence to support or defeat a person's claim2. It has
also been found that medical records can act as evidence for claims against any professional
ethics breaches or billing frauds6.
Conclusion
The codes of ethics by the Medical Council of India have compelled the doctors to
maintain the confidentiality and the electronic preservation of the health care records1. Despite of
the IT rules, there are several loops and gaps still to be addressed. The Medical council has also
mandated that patient’s information should not be disclosed by any health care professionals
unless compelled by law or for the welfare of the public.

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References
"Medical Council Of India." Mciindia.Org, 2018,
https://www.mciindia.org/ActivitiWebClient/rulesnregulations/codeofMedicalEthicsRegulations
2002.
"Right To Information." Rti.Gov.In, 2018, http://rti.gov.in/.
"Rules For Information Technology Act 2000 | Ministry Of Electronics And Information
Technology, Government Of India." Meity.Gov.In, 2018, http://meity.gov.in/content/rules-
information-technology-act-2000.
"The Medical And Health Sector - Data Protection ...." https://www.dataprotection.ie/docs/The-
Medical-and-Health-Sector/m/245.htm.
Davis Giardina, Traber, et al. "Patient access to medical records and healthcare outcomes: a
systematic review." Journal of the American Medical Informatics Association 21.4 (2013): 737-
741.
Goldzweig, Caroline Lubick, et al. "Electronic patient portals: evidence on health outcomes,
satisfaction, efficiency, and attitudes: a systematic review." Annals of internal medicine159.10
(2013): 677-687.
Grace, Jamie, and Mark J. Taylor. "Disclosure of confidential patient information and the duty to
consult: The role of the health and social care information centre." Medical law review21.3
(2013): 415-447.

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Solove, Daniel J., and Paul Schwartz. Information privacy law. Wolters Kluwer Law &
Business, 2014.