PRACTICE MASTERY QUESTION #23

QUESTION:  Do patient records belong to the practice or the patient and how long do they need to be kept after the patient ceases to be active?

ANSWER:  Patient records belong to you, the practitioner.  Statutes of limitations in the various states vary, but the maximum time they need to be kept after the patient terminates care is seven years.

The practitioner is the owner of all patient records and has control over their disposition.   Patients may request copies and in most instances you have an obligation to provide those copies, including copies of x-rays.  You also may have the ability to charge for those copies.  You should always maintain a full record of who has received copies or summaries of those records and any such information should always be consistent down to the smallest detail with what is in your master file. Many state laws and regulations make state-specific provisions regarding records.  Your state board is the final word on all records-related issues and they will be happy to provide you with written direction on what your obligations are.   Federal regulations also now require much greater control over the storage and distribution of information in patient records.  The new HIPAA law (Health Insurance Portability and Accountability Act of 1996) established very detailed requirements in this area.  For an update on HIPAA, see a new federal document available on-line at http://www.hhs.gov/ocr/hipaa/privacy.html.

The length of time you need to maintain inactive patient files relates both to the likelihood that any such patient may need or request those records, and your obligations under the law.  There are many instances where, decades later, a patient or insurance company, relative or attorney will be looking for old information.  You will need to determine the practicality of maintaining old files for such great lengths of time.  There is no danger in not having those records after such a long period, even though in very rare instances, those former patients or those acting on their behalf would be pleased to obtain that information.  Some states make specific provisions on how long such records must be kept.  Other states address this question under the general statute of limitations.  Statutes of limitations are legislative provisions that limit the time period in which legal action for damages and other complaints may be filed.  A good general rule is after 7 years, nearly all jurisdictions prohibit legal action.  This limitation is an important protection for you and your practice. 

There are two exceptions to the general rule on statutes of limitations.  Those concern "minors" and persons determined under the law to be "incompetent' and unable to act on their own behalf.  In most states, the law on the statute of limitations starts the limitation clock after a minor becomes an adult.  On minor patients' records, you will want to check to see if your jurisdiction has any specific provision for minors, and what the details of that provision might be.  Regarding those who might be determined to be incompetent, check in each instance where this might apply to a patient under your care.  Once again, you will always want to inquire for the record of your state board before you dispose of any records.  Always keep a copy of your inquiry and their response in your files to use in addressing any questions about your actions to dispose of old files. 

Record keeping is an area that is often not given the attention it should receive because of the tedious nature of that activity, the inclination to postpone such work, and  competing demands for the doctor's time.  You will always be well served, however, by making good records a priority, both current and old files, since they are the basis on which you will need to rely to explain and perhaps defend all of your care decisions.