Sarasota Sheriff Wants Doctors To Have Patients Sign Away Their Rights

Doctors who prescribe pain medications sometimes find themselves in a tough spot: they may want to report suspicious or clearly illegal behavior by patients, but they are prevented from doing so by the sweeping federal medical privacy law known as HIPPA.

Administrators with the Sarasota County Sheriff's Office, which is fighting a prescription drug epidemic that led to 113 overdose deaths in Sarasota and Manatee counties during 2010, thought they had found an easy way to learn more about medical patients who might be breaking the law to get pills.

Their solution? Provide doctors with a form patients could sign that would waive their privacy rights and allow detectives to examine an individual's records without getting permission from a judge, an approach that other jurisdictions in Florida are now considering.

The medical information waivers — which did not carry any indication that they were written by a law enforcement agency — were handed out last year to about 30 local pain doctors, who were asked to have patients sign them. But the measure never gained traction with doctors, and, so far, none has submitted a form signed by a patient.

Moreover, the move has drawn sharp criticism from some in the Sarasota County medical community and from defense lawyers who call it a sly way to violate a patient's constitutional privacy rights and protections under the federal Health Insurance Portability and Accountability Act, the so-called HIPPA law.

Normally, police would have to apply for a search warrant or obtain a subpoena for the records, said Assistant Public Defender Mark Adams.

“The waivers are a blatant violation of the Constitution, and they're doing an end-run around the search warrant requirements and HIPPA,” Adams said. “Some of the most confidential records we have are our medical records. The waivers serve no medical purpose. Shame on any doctor who's having patients sign them.”

Patrick Duggan, assistant general counsel for the sheriff's office, points out that the waivers — titled “Authorization for Release of Protected Health Information” — would only be signed voluntarily.

Duggan and Sgt. Debra Kaspar, who runs the sheriff's Pharmaceutical Diversion Unit, said they came up with the idea for the waivers because doctors were “constantly” calling to report illegal activity such as doctor shopping. They became concerned that by talking to the doctors about specific patients, the doctors were violating their patient's privacy rights and could open themselves up to legal problems.

“We want to make good cases. We don't want anyone's rights violated,” Duggan said. “We drafted the form to give the doctors a mechanism to contact us. It was really designed more as a safeguard to protect people's rights than anything else.”

Kaspar and Duggan have no explanation for why doctors are not turning in any waivers.

But Dr. William Cole, of Sarasota's Orthomed Pain and Sports Medicine clinic, says he already is in “survival mode” because of strict regulations imposed by the county and the sheriff's office that hamper filling legitimate pain pill prescriptions. Cole, who said he has refused to ask any patients to sign the form, questioned the sheriff's office use of “voluntary” to describe the waivers.

“They have to protect themselves from undue scrutiny,” Cole said. “My patients are sick, generally with multiple disorders. Would you ask a cancer patient to sign the form? It's not acceptable.”

Sheriff's office spokeswoman Wendy Rose said that when the waivers were delivered to the physicians, informational meetings were held in advance.

“We also explained the nature of the meeting will be to educate them on the ordinance,” Rose said in an email. “The meetings were not just law enforcement personnel but included Health Department staff as well. The insinuation that we applied pressure is a complete mischaracterization.”

But Cole maintains that the county has gone too far in its zeal to close down pill mills.

“They don't understand long-term chronic pain,” he said. “They think all pain clinics are pill mills.”

Sarasota County, Cole said, already has some of the strictest rules in the state. Anyone writing more than 20 prescriptions per day has to register as a pain clinic. “They are focusing on people who are just trying to make a difference in people's lives,” he said.

Dr. Susan Aull, who runs a physical medicine and rehabilitation practice in Sarasota, does not include the word “pain” in any of her advertisements or imply that she will assist a patient with their pain. If Aull did, she says she would fall under the county's pain clinic regulations.

“That's how stringent Sarasota County is,” Aull said. “You can't even try to educate a patient without using the word pain. It's ridiculous.”

Like Cole, Aull said she has never asked a patient to sign a privacy waiver.

Paul Sloan, who is not a doctor and has owned two pain clinics in Sarasota County since 2007, wrote much of the county's pain clinic ordinance. Sloan is blunt about what he will do to a patient suspected of breaking the law.

“All my patients sign a contract — and they have since day one — the most comprehensive contract ever seen,” Sloan said. “It does state they are waiving their rights if we are approached by an investigator, that we'll turn over information to the sheriff's office.”

So far, 17 of Sloan's patients have been taken out of his clinics in handcuffs. “I understand HIPPA and am a firm believer in their rights, but if they're doing something illegal, they're jeopardizing my license,” he said.

But even with his willingness to cooperate with law enforcement, there are documents that Sloan is unwilling to turn over, such as a patient's actual medical records. “I would never turn over medical records — never,” he said.

Rose, the sheriff's spokeswoman, says that no medical records would be turned over to detectives just because a waiver is signed. “If doctor contacted us, the consent would cover the doctor giving us the patient name and maybe a brief synopsis of their concerns over the phone.”

The Florida Department of Law Enforcement does not use a rights waiver during its drug investigations, said FDLE spokeswoman Gretl Plessinger, but Pinellas County's Strategic Diversion Task Force is creating a form similar to Sarasota County's, says Sgt. Dan Zsido.

Like his Sarasota County colleagues, Zsido said he believes physicians could violate HIPPA or their patients' rights by reporting misconduct without a signed waiver.

“It's ludicrous they can't report a crime to us,” said Zsido, adding that his unit also does not intend to seek actual medical records.

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