The Kennedy-Kassebaum Act, otherwise known as the Health Insurance Portability and Accountability Act (HIPAA), was passed by Congress and signed in 1996 by then-President Bill Clinton. It is a law with many good features; for example, it protects health insurance coverage for workers and their families when a breadwinner changes jobs or loses a job.

But it is also a many-headed beast, and has been both lauded and vilified almost since the day it became law.

One ongoing conundrum is its treatment of patient privacy. HIPAA establishes national standards for “covered entities” (think: providers and their agents) regarding the security of “protected health information” (think: medical records). These standards cover not only collection and storage, but also all subsequent transactions involving protected information. With very few statutory exceptions – court-ordered searches for missing persons or criminal investigations of child abuse are two – this information cannot be released by a covered entity without the written consent of the subject.

On the surface, that sounds good in an age in which privacy is eroding daily, Big Brother is watching, and identity theft is an ever-increasing problem.

But the pendulum always seems to swing too far.

*Recently, I accompanied a family member – who shares the same surname – to a doctor’s office, with the plan that I would go shopping and return later for pick-up. When I asked at the desk – the same desk at which I had stood less than 90 minutes previously – I was told that not only could the staff not tell me when my relative would be done, but they couldn’t even confirm that my relative was, in fact, in the office at all, “because it would be a HIPAA violation.”

*On one maximum security (locked) psychiatric unit that I once supervised, all of the patient charts were kept in a rolling cart at the nurses’ station for easy access of clinical staff. The cart was often turned toward those seated at the station’s desk, meaning that, if one had really good eyesight or even cared, the names on the charts could be seen by a person standing at the station’s window. Keep in mind that this was a locked unit, and the only people present were staff, committed patients, and the occasional escorted visitor. Still, we were told that we could be cited for a HIPAA violation if the cart remained facing the window where visitors could potentially see the names.

I mention these scenarios because it’s easy to lament how ridiculous rules and regulations have become… until one remembers what it was like in the past.

My maternal grandparents were married at the turn of the 20th century and then lived in the tiny hamlet of Appley, in far western Somersetshire, England. I’m not even sure how large is Appley today, mainly because I can’t find it in any recent census roster. Having visited once, I’m certain, though, that there are no more than a few dozen full time residents, if that many. In 1890 it must have been even smaller.

In good English form, though, there is a pub in town called the Globe Inn, which is still in business after more than a century. Appley is so small that the Globe is the only landmark that shows when the village is searched on Google Maps.


Apparently in the late 1890s, there was also a physician who called Appley home. I don’t know his name or anything about his practice, except that my grandmother talked about going to see him when she was a young woman.

If any of the locals had a perceived medical problem, they would have to walk to the doctor’s house and wait outside, rain or shine, until 9:00 a.m. At that time, a woman would emerge from the house and begin to interview the crowd that had gathered. This was not done in private. It was done on the sidewalk. The woman would listen, and then either tell the potential patient, “go home,” or else, “come inside.” Those admitted to the house would wait in the parlor until the doctor was able to see them.

So who was the woman screener? A nurse? A midwife? Someone in medical training? No, it was the doctor’s housekeeper, a resident of town with no formal education or experience who was making triage decisions as to who needed help and who didn’t!

I’m sure that much gossip started from those sidewalk screenings, and then traveled like wildfire in the confines of small-town Somerset. And that makes me think that HIPAA, properly implemented, ain’t such a bad thing after all.

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