Prove Letter 1

March 4, 1998

Robert D. Crider, Jr., M.S., M.P.A.,
Director, Immunization Division
1100 West 49th Street
Austin, TX 78756
(512) 458-7284

Bob.Crider@TDH.STATE.TX.US

Subject: Comments on the proposed rules for House Bill 3054 pertaining to the Statewide Immunization Registry as published in the Texas Register.

As a parent who is concerned about the confidentiality of my child’s medical records, I would like to make my concerns about the proposed rules for the Immunization Tracking System a part of public record during this comment period.

I OBJECT TO THE BURDEN OF ACTION BEING PLACED ON THE PARENTS TO DECLINE CONSENT.

Parents not wishing to have their child included in the registry should not have to do anything.

The law only requires consent to release the data, not a written statement to prohibit it.

Section 161.008 pertaining to the immunization record states that "the department, only with the consent of a child’s parent, managing conservator, or guardian may: 1) obtain the data constituting an immunization record for the child from a public health district, a local health department, or a physician to the child."

Requiring parents to write and mail a separate form to TDH

  1. is redundant. Doctors already have consent forms. Anyone who hasn’t already signed a consent form obviously has not given consent
  2. allows TDH to maintain a separate database on parents not wishing to be included in the registry – apart from the registry – to be used for whatever purposes that are unregulated since it is not a part of the registry
  3. is deviant from the spirit of the intent of Jerry Patterson’s amendment to HB 3054 maintaining full confidentiality for parents not wanting to be included in the registry or any other TDH files regarding the immunization status of their child.

I OBJECT TO A DOCTOR, HEALTH CARE PROVIDER, OR INSURANCE COMPANY RELEASING ANY INFORMATION TO TDH FOR A CHILD WHOSE PARENT HAS NOT GIVEN CONSENT.

The way the rules are written, it allows for the doctor or insurance company to forward all immunization data en masse, including the records of children whose parents don’t want their records going to TDH. TDH states that these records will not be included "in the registry", but they still have them to put anywhere else, including, but not limited to, a file of parents declining consent. In the rules in section 100.3, TDH tries to give insurance companies the right to "assume consent" to release data to TDH even if no consent is given. As a parent concerned about the confidentiality of my child’s medical records, I don’t want TDH to have my child’s records at all if I have not given consent . This intent of the law is to protect confidentiality and honor consent. The rules circumvent that intent.

Section 161.007 section c) states that "An insurance company, health maintenance organization, or other organization is not required to provide an immunization history to the department under this subsection for a person for whom consent has not been obtained in accordance with the guidelines adopted under Subsection (a) or for whom consent has been withdrawn."

And

Section 161.007 section d) states that "A health care provider is not required to provide an immunization history to the department under this subsection for a person for whom consent has not been obtained in accordance with the guidelines adopted under Subsection (a) or for whom consent has been withdrawn."

I OBJECT TO TDH MAINTAINING ANY FILES ON A CHILD PERTAINING TO THEIR IMMUNIZATION HISTORY OR CONSENT FOR A PARENT WHO HAS WITHDRAWN CONSENT.

Since consent is no longer granted, then section 161.008 should also apply here. TDH no longer has consent, so according to the law, they no longer have the authority to obtain the data. Therefore, all data previously obtained needs to be deleted not just from the registry, but all other files.

Section 161.008 pertaining to the immunization record states that "the department, only with the consent of a child’s parent, managing conservator, or guardian may: 1) obtain the data constituting an immunization record for the child from a public health district, a local health department, or a physician to the child."

In addition, in the rules it states that "The Bureau of Vital Statistics will provide the option for parental consent for inclusion in the registry on the birth certificate. The consent will be valid for life unless the parent notifies the department that consent has been withdrawn." I request that on the birth certificate and anywhere else consent for inclusion is given, that full disclosure of withdrawal procedures are included for parents who change their mind

I OBJECT TO THE HIGHLY PERSONAL DATA OF MY CHILD’S SOCIAL SECURITY NUMBER, THE FAMILY’S PERSONAL HOME ADDRESS, THE MOTHER’S MAIDEN NAME, AND THE CHILD’S SEX BEING INCLUDED IN THE REGISTRY.

Section 161.008 b) defines an immunization record in the registry to contain:

    1. the name and date of birth of the person immunized;
    2. dates of immunization;
    3. types of immunization administered;
    4. the name and address of the health care provider administering the immunization.

Here again, the Texas Department of Health is trying to sidestep the legislation and obtain more information than they are allowed as defined in the law. Given that this information will be transmitted electronically, even though there are penalties for misuse of this information, it does not prevent the potential harm to the family for this information getting in the wrong hands.

I OBJECT TO THE "TRANSMISSION OF RECORDS TO OTHER STATE AND NATIONAL REGISTRIES."

Section 161.008 (c) (2) pertaining to the immunization record states that "the department, only with the consent of a child’s parent, managing conservator, or guardian may: 2) release the data constituting an immunization record for the child to a public health district, a local health department, a physician to the child, or a school or child care facility in which the child is enrolled."

The law does not provide for release of this information to other state or national registries, or anywhere else under any circumstances. Since TDH has no jurisdiction over the confidentiality procedures for other state and national registries, they should not be allowed to make this data available.

I OBJECT TO THE ABSENCE OF RECORDING MEDICAL AND RELIGIOUS EXEMPTION DATA IN THE REGISTRY.

TDH has given itself, doctors, and insurance providers the authority to provide notices "by mail, telephone, personal contact, or other means" of "overdue" immunizations to parents. This subjects parents with legal medical and religious exemptions to vaccinations to unnecessary harassment. In addition, without a place to record exemptions, when a health care provider other than the primary is treating a child and sees that an immunization is overdue according to the recommended schedule, this places the child with a medical contraindication (e.g. allergy to an ingredient in the vaccine or past neurological damage triggered by a vaccine, etc.) at high risk for being vaccinated with potentially devastating medical consequences.

I OBJECT TO THE TEXAS DEPARTMENT OF HEALTH DEFINING ALL PROVIDERS AS AGENTS FOR THE TEXAS DEPARTMENT OF HEALTH FOR THE PURPOSES OF THE IMMUNIZATION REGISTRY.

Again, according to the statute quoted above, providers are not required to provide any of this information without consent. By defining providers as agents, that could potentially release them from their obligation to maintain doctor/patient confidentiality. TDH is using this definition to attempt to obtain non-consented data in a manner inconsistent with the law.

I OBJECT TO THE QUALITY ASSURANCE SECTION OF THE RULES (100.6) ALLOWING TDH THE ABILITY TO INSPECT THE CHILD’S MEDICAL RECORDS.

This section of the rules tries to rationalize quality assurance, but there is no way to protect and maintain confidentiality of other sensitive private medical record entries if TDH has access to the child’s medical file.

I look forward to seeing these concerns addressed. I have also forwarded my comments to my Texas State Senator, my Texas State Representative, and Senators Jerry Patterson and Chris Harris.

Sincerely,
Dawn Richardson

Edited:
  01/16/99