How Quickly Should Medical Records Be Provided to Families?

Many of you have followed the Jahi McMath tragedy which unfolded over the holiday season.  It was (and still continues to be) a red-hot story. Lots of accusations lobbed back and forth, including comments from the family and their attorney that the hospital would not share Jahi's medical records with them.  Then, a few days later, the media reported that the hospital finally shared the records with the family. The issue of providing medical records to upset or angry family members is not unique to this case; Jahi's story merely highlighted a sore subject for many consumer and patient safety advocates.  How quickly should hospitals and medical practices turn over "the chart?"

At Sorry Works!, we teach hospitals, medical practices, and insurers to turn over the records as quickly as possible if family members are truly entitled to the records.  Be pro-active.  Don't play games or hide the football, especially with something the family will eventually get any way.  I always make a point of talking about this issue during my presentations and training seminars because hospitals and practices often do have "policy" that states records are available after, say, 30 days, and only if the physician has completed the record, you have to go downtown to get the records, and the copying fee is $5 for the first page, $1 for every page thereafter, blah, blah, blah.  I teach my hospitals, doctors, and nurses that the more bureaucratic road blocks that are put up and the longer facility keeps control of the record, the more the consumer thinks you are cooking the books.  It's a sure fire way to lose the family's trust and stoke the anger that leads to litigation, calls to regulatory officials, e-mails to news reporters, and blasting your organization on social media.  Don't do it!

So, the story of Jahi's records allegedly being withheld led me to ask the following question to the National Patient Safety Foundation listserv group: "Is there ever a good reason for a hospital or doctor's office to withhold records from a family?"  The question generated some very interesting responses:

"My son died due to medical error following a tonsillectomy.  About two weeks later I went to the hospital to get his medical record. I was told that it would take 6-8 weeks and I answered “okay” and sat down in the waiting area. When they asked what I was doing I said I could wait. Understanding that the mind of a newly bereaved parent is far from rational, I really did plan to wait there for 6-8 weeks. They were able to copy and give me his record within the hour. In my opinion there is no reason to delay giving families the records even if some of the summaries are not yet done. The impression that records are changed, “lost” etc. is very strong among families that have been harmed. If we truly want to partner with patients then this is an easy way to show that partnership and dispel this impression, Tanya Lord PhD, MPH"

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"Most physicians have 30 days to get their case summaries and discharge notes into the record and finalized.  This is why hospitals don’t want to send them out – they are often incomplete. Lori Rizzo, RN BSN MBA, Staff Specialist, Perioperative Services, White 406D , Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, Phone:  617-724-0150"

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"I am in strong agreement with Doug.  Although it is true that a thirty-day turn around on a closed record is fairly standard, it seems to me that it adds insult to injury to signal a family – overtly or otherwise – that their loved one’s posthumous record is being managed “routinely.”   If I were the surgeon, I would have my Operative Note and Final Summary on the record ASAP for a host of reasons. Michael B Grosso, MD, FAAP, Sr. Vice President for Medical Affairs, Huntington Hospital – NSLIJ, Assistant Professor of Pediatrics, Hofstra – NSLIJ School of Medicine."

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"The Beth Israel Deaconess Medical Center in Boston, Massachusetts, the Geisinger Health System in Danville, Pennsylvania, and the Harborview Medical Center in Seattle, Washington allow patients see doctor notes through tool called "OpenNotes" funded by Robert Wood Johnson Foundation.  With this tool, patients have complete access to one part of their medical records, as well as all the notes that doctors wrote about them. Within days of seeing their doctors, patients receive an email inviting them to read the doctor’s signed notes on a secure patient Web site. Patients/families are allowed to communicate with doctors if they do not understand the notes or if they want clarification. Dev Raheja, MS,CSP, Author - Safer Hospital Care (Taylor & Francis), Patient System Safety, 9811 Mallard Drive, Suite 213, Laurel, MD  20708, Tel: (301) 604-0144"

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"I so agree with you and applaud the work you are doing to help healthcare move forward since your tragedy, communication is still a top issue in most serious events.  I always get the record for the family or patient as soon as they request it without a charge for copying, sometimes I even ask them do you want a copy of your record or the patient record now?  I have it labeled as incomplete as some of the physicians may not have completed all of the summaries or the final labs may not be in the record.  I also offer to explain to the patient/family how the record is set up so they can see the sections from physician orders, physician progress notes nursing notes lab etc.  Most families who do not have medical knowledge have no idea how a record is set up and how to navigate through it.  I also let them know that if they have trouble understanding something in the record they can call me and I will attempt to help navigate them to who would be able to discuss that with them.  I have found anytime I have been forced to not provide the record immediately that the patient/family becomes distrustful of us (all healthcare).  Better to just provide the record and assist them than to hold back on it whatever is in the record will have to be addressed at some point.  Joyce Lahue, BSN, MS, RN, CPHRM, Director Risk Management, Baptist Health System, 730 North Main Suite 424, San Antonio, TX 78205, P: 210-297-8261"

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What do you think?  This is an important issue for the disclosure and patient safety movements.

Other tip: When asked for the chart, instead of getting defensive and bureaucratic, calmly ask, "What are you looking for in the chart?"  It might not be a big deal.

I look forward to hearing your thoughts and reactions.