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Tuesday, July 4, 2000

Medical privacy law
may need changes

Bullet The issue: A state law assuring patients the right to privacy of their medical records has gone into effect, but changes are forecast.

Bullet Our view: Legislators in the next session should be careful about further altering the law before knowing its full effect on privacy concerns.

DOCTORS are worried that a new state law protecting the privacy of patients' medical records could hamper efforts to share information important for treatment. While that concern seems unfounded, authors of the new safeguards acknowledge they may need changes if problems become apparent between now and the next state legislative session.

Governor Cayetano signed the restrictions into law last year. They are aimed at protecting personal health information from unauthorized use, allowing review of medical information to improve health care, prevent fraud and abuse, and aid medical research. Members of a health-care task force that drafted the rules agree they are complex and may need fixing.

The state rules are broader than proposed federal regulations, scheduled for enforcement in 2002 but affecting only electronic medical records; most medical records continue to be on paper. The state law, which took effect Saturday, may need further review as paper records are shifted to electronic transactions, says Moya T. Davenport Gray, director of the state Office of Information Practices.

Under the law, authorization to release medical information must include a description of what it is about, who is making the disclosure, and to whom and for what purpose it is being disclosed. Consent is not needed for disclosure of information for treatment, payment or qualified health-care operations. The law obviously will add paperwork in health-care operations.

A patient's medical information can be denied to relatives, florists and the news media unless the patient consents. The Society of Professional Journalists' Hawaii chapter had urged that the bill be vetoed, arguing that it will deter reporting on serious crimes and accidents. That is a valid concern and one that should be monitored in the coming months.

Since no agency is in charge of administering the law -- enforcement is patient-driven through court action -- recommendations will come from those affected by it. In considering observations of patients, journalists and health-care professionals, legislators will have the formidable task of maintaining aggressive privacy standards balanced with public-policy needs.

Democracy in Mexico

Bullet The issue: Mexico's ruling party for the past seven decades was toppled for the first time in presidential elections.

Bullet Our view: Vicente Fox's victory is an encouraging sign for a vibrant democracy in Mexico as it enters the new century.

LEADERS of Mexico's ruling party for the past 71 years realized months ago they were in danger of losing control. The Institutional Revolutionary Party (PRI) in November conducted its first primary election for president to pump new life into the party, but the trend had been set. Dressed like an American cowboy, rancher Vicente Fox Quesada rode to victory carrying the banner of the conservative National Action Party, or PAN, ending his country's lengthy political monopoly.

"Mexicans have truly never had the chance to throw the bums out," political analyst Denise Dresser remarked before Sunday's votes were cast. "Tasting that experience would be extraordinarily empowering. It would inject a whole new fresh air into the process."

That seems to be the consensus about what has occurred, rather than expectation of any significant ideological shift in Mexico's government. The PRI, born in 1929 as a vehicle of compromise among victorious factions of the 1910 Mexican revolution, never has been known for its policy leanings. At various times, it has been socialist or capitalist or a mixture of the two.

The PRI became recognized more for its top-down power, patronage and reliably obeisant legislature. If that combination had resulted in a prosperous and balanced economy, the party might have won its 14th consecutive presidential election. However, Mexico suffers from rampant crime, government corruption and widespread poverty, in contrast to its northern neighbor's current prosperity.

PRI candidate Francisco Labastida Ochoa enlisted the campaign help of PRI state governors and leaders associated with illicit fortunes and election fraud. They dispensed taxpayer-financed giveaways to poor voters, often in exchange for vote pledges. The tactic may have played into the hands of Fox, whose core support came from the educated and middle classes.

Mexico's first peaceful transition of power from one party to another was notable also because of Zedillo's humble congratulations to the winner, and Fox's conciliatory response: "It was a very combative process, and I open my arms to him."

MEXICAN leadership naturally is important to the United States because of proximity. Of particular concern are the smuggling of illegal aliens and illegal drugs across the border, although trade flourishes under the North American Free Trade Agreement. "We are not only neighbors and partners, but we have a common destiny," said Fox, who once was Coca-Cola's chief executive officer in Mexico. "I want to work intensely with the United States."

The Mexico election was a bold assertion of democracy into a system that had become autocratic. Above all, it was a long overdue victory for what was called "la alternancia" -- the idea of parties alternating power.

Published by Liberty Newspapers Limited Partnership

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John M. Flanagan, Editor & Publisher

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Diane Yukihiro Chang, Senior Editor & Editorial Page Editor

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A.A. Smyser, Contributing Editor

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