Missouri judge ruled HIPAA restricts access to trans patient data. Both sides are unhappy

Since March 2023, Missouri Attorney General Andrew Bailey has been trying to obtain information on medical and billing practices related to transgender care for minors from clinics around the state, including Planned Parenthood of St. Louis Region and Southwest Missouri.

Despite a St. Louis judge allowing part of that information to be obtained, both the attorney general and the Planned Parenthood organization are trying to change that. A jury trial is scheduled for 9 a.m. Aug. 26 in St. Louis.

What is the AG investigating? When did it start?

Last year, a whistleblower at Washington University in St. Louis alleged that its pediatric transgender clinic was not following best practices. Attorney General Andrew Bailey launched an investigation into that clinic as well as others in the state of Missouri, including Planned Parenthood of the St. Louis Region and Southwest Missouri. Bailey issued Planned Parenthood a civil investigative demand — an administrative subpoena that does not need court approval — seeking information related to that investigation, specifically medical and billing practices.

The attorney general has stated that he has the ability to investigate medical and billing practices due to the Missouri Merchandising Practices Act, which protects consumers from fraudulent business practices.

Planned Parenthood of the St. Louis Region and Southwest Missouri filed a petition to have that subpoena blocked on the grounds that it is "unauthorized and vague" and fails to show how PPSLR is directly involved in the Washington University investigation.

More: Missouri AG requests termination of emergency rule restricting gender-affirming care

What did the court decide?

In April 2024, St. Louis judge Michael F. Stelzer ruled that the subpoena is within the attorney general's abilities, and that he should receive some of the documents. However, Stelzer also ruled that despite those abilities, the attorney general cannot receive access to federally protected documents and that the circuit court does not have the ability to override federal law.

To put it plainly, he ruled that the attorney general should receive all documents that are not protected by the federal Health Insurance Portability and Privacy Act and that he should not receive documents protected by HIPAA. Stelzer said in his April 11 ruling that the only way the attorney general can obtain those files is for each individual patient to waive their HIPAA rights.

PPSLR has appealed this decision and the attorney general has filed a motion to amend the judgement.

What does HIPAA have to do with this?

The 1995 law protects information health care providers put in a patient's medical record, conversations the patient's provider has about their care or treatment with nurses and others, information about the patient in their health insurer's computer system, billing information about the patient at their clinic and most other health information about patients held by entities subject to HIPAA, according to a U.S. Department of Health and Human Services page explaining patients' privacy rights.

Planned Parenthood has argued that allowing the attorney general access to its files would violate HIPAA, which allows patients to set limits on who accesses specific health information about them, among other things.

“Planned Parenthood stands firmly against this latest attempt to invade and exploit patients’ privacy. Make no mistake: we will continue to do all we can to protect our patients’ health care and rights in court,” said Richard Muinz, interim president and CEO for PPSLR, in a statement.

In all of the attorney general's cases so far where they request patient information, exhibits with patient information have been kept under seal to protect patient privacy, according to Madeline Sieren, spokesperson for the attorney general's office.

"Attorney General Bailey is committed to getting to the bottom of what happened here while still protecting patient privacy," Sieren said. "In addition, the Missouri Merchandising Practices Act requires by statute that any documents our office receives from these investigations are kept confidential."

From 2023: In wake of AG's emergency rule, trans Ozarkers fear for safety, access to care

What is PPSLR asking for in its appeal?

In its April 19 appeal, Planned Parenthood of the St. Louis Region and Southwest Missouri says the court erred in its ruling, misconstrued evidence and abused its discretion.

Planned Parenthood wants the whole subpoena blocked, not just parts where HIPAA is a concern.

What is the attorney general asking for?

On April 23, the attorney general filed a motion to amend the judgement. The attorney general is asking the state to change its judgment so that the CID applies to all relevant documents, including ones that fall under HIPAA.

In the motion, Bailey argues that individual patient waivers are not the only way to obtain HIPAA-protected documents. Federal regulations make provisions for judicial and administrative proceedings, stating that the individual's permission is not needed when the information is requested as part of a court order.

"There is no more important fight than to ensure Missouri is the safest state in the nation for children. No stone will be left unturned in these investigations," Bailey said in a statement.

This article originally appeared on Springfield News-Leader: Missouri AG, Planned Parenthood continue battle over patient info