Delores Combs, Inland Valley Daily Bulletin (Ontario, CA)

Do you realize that if you call 911 and reveal to a dispatcher some private medical information about yourself that you could hear it replayed tomorrow on the news?

This sums up the concern of California Assemblywoman Norma Torres, which prompted her proposed legislation (Assembly Bill 1275) to address the problem of a patient’s right to privacy as it relates to sensitive medical information that could be made public when calling 911 for emergency aid.

A.B. 1275 would limit public access to 911 calls that contain medical information. However, it is not as easy as the text of the bill would suggest. There are two complications that indicate there is still a need to fine-tune the proposed bill.

Complication No. 1: Some people say Torres’ bill is redundant in that the Health Insurance Portability and Accountability Act (HIPAA) already protects privacy.

This is not clear. HIPPA applies to billable medical care, such as doctors, hospitals, and pharmacies or more generally, a “treatment team.”

As 911 calls are not directly billed to a caller, an argument goes that those calls are not covered by HIPPA. On the other hand, Dr. Deborah Peel of Patient Privacy Rights believes that the release of 911 tapes should be considered “a HIPAA violation.” She argues that 911 dispatchers are “in effect, working on behalf of hospitals and emergency centers as part of the patient’s treatment team.”

At the very least, the HIPAA issue is debatable, and one that requires further legislation or a legal decision to be clarified.

Complication No. 2: There is tension between the need for transparency in government and the duty to protect a caller at their most vulnerable.

The duty to protect a caller’s privacy is in Torres’ bill, but it does not directly balance this tension; it only addresses the caller. What about the other side? Is there a place that the balance can be achieved?

Consider the 1985 case of a Dallas, Texas, 911 call. A nurse screener employed by the Dallas Fire Department was recorded arguing with a man begging for an ambulance for his mother, which was refused. The patient subsequently died. Had that call not been recorded, the public would not have felt the impact and its implications for 911 dispatch training. As a result of this call being made public, sweeping changes were made in Dallas 911 protocol.

Another case occurred in Los Angeles in 1987. A fire department dispatcher misdiagnosed a 45-year- old woman as having hyperventilation. A second call to 911 regarding the same woman was diagnosed as food poisoning. Upon the third call, an ambulance was finally dispatched. But it was too late.

The woman was actually suffering from an anoxic seizure and she suffered cardiac arrest while getting into her car, having given up on the ambulance. She died. That case – which was widely publicized, including CBS’ “60 Minutes” – resulted in Mayor Tom Bradley ordering a complete overhaul of the city’s 911 dispatching procedural system, now based on a standardized system for evaluating and conducting calls.

Had that 911 call not been publicized, the public would have been left in the dark, “60 Minutes” would not have covered it, and perhaps it would not have been brought to the attention of Bradley to make changes in the 911 dispatch system.

The right to public access of 911 calls, as these two cases point out, led to changes that directly and dramatically improved the 911 caller’s experience and has put systems in place to provide them with better care.

If privacy had been achieved at the expense for transparency, patients would be worse off in the long run.

The issue that Torres seeks to resolve isn’t as easy as the text of the bill would imply. A better bill would address these difficulties.

Delores Abdella Combs is studying for her masters in social work at USC. She lives in the Inland Empire.

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