FIG1 Former APA President Harold
Eist, M.D., will receive financial assistance from the Association to help in
his battle with the Maryland Board of Physicians over patient confidentiality
rights. The physician board has fined and reprimanded him for "failure
to cooperate" with its demand that he turn over patient records.
Harold Eist, M.D., expects that his appeal will be heard by the end of
Eist had been treating a woman who was involved in a divorce proceeding and
her children (Psychiatric News, April 18, 2003).
Her husband filed a suit to gain custody and insisted that his family's
psychiatric records needed to be made available as part of that suit. When
Eist did not comply, he filed a complaint with the Board of Physicians
charging that Eist was overmedicating his wife and children, leaving the wife"
overly psychotic" and the children deteriorating emotionally.
When the board informed him that it wanted the records in question, Eist
contacted the woman and the children's lawyer, both of whom would not consent
to the demand. He told the board of the objections from the mother and the
children's lawyer, but the board would not reconsider its demand.
Despite a request by Eist for guidance from the board, the board, after
seven months of silence, informed Eist of its medical-misconduct complaint
against him without addressing the ethical concerns he raised. After the
mother and the children's attorney told Eist they no longer objected to his
turning the records over to the board, he did so.
An administrative law judge in Maryland heard the case and ruled in Eist's
favor, declaring, "I am convinced that [Eist] followed the only ethical
course of action available to him under the circumstances." Nonetheless,
the medical board refused to end the proceedings against Eist, maintaining
that it had a right to all of the records it demanded, when it demanded them,
and without apparently conducting an evaluation of the need for them.
The case then went to a county circuit court, which ruled that the state's
medical privacy law required the board to provide a more detailed and
comprehensive justification before it was entitled to medical records in this
type of case. APA had filed an amicus brief on Eist's behalf in 2003,
concerned about imposition of arbitrary limits on patients' rights to control
their medical records.
The court then remanded the case to the administrative law judge who again
backed Eist, and again the board declined to accede to the judge's ruling,
maintaining that without the records it couldn't investigate the charges
against Eist. It also maintained that its responsibility to investigate
complaints against physicians represents a compelling state interest that
overrides privacy protections.
It reprimanded him, fined him $5,000, and reported him to the National
Practitioner Data Bank.
Eist's lawyer has filed an appeal with the Circuit Court of Montgomery
County (Md.). APA has given Eist $5,000 toward the cost of the litigation and
is considering joining another amicus brief in the case. Eist expects that the
appeal will be heard by the end of this year.
The Washington Psychiatric Society, of which Eist is a member, has also
been involved, writing letters of protest to Maryland's governor, lieutenant
governor, attorney general, and each member of the Board of Physicians
charging that Eist is being "persecuted" for his stance on behalf
of confidentiality rights.
Eist told Psychiatric News that "if not addressed
forcefully, cases such as this, one case at a time, will become a cancer
attacking the credibility of our treatments and profession. This is the most
important psychiatric standard-of-care issue for patients, even children
patients." In deciding to financially support the case, he added, the
APA Board is backing an issue "of national importance."
In 2003 Eist won a Profile of Courage Award from the APA Assembly for his
stance in this case. ▪