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PHYSICAL ACCESS TO RECORDS

The OSHA rules provide that employees and their designated representatives have access to their medical records and the allowable conditions on that access. Although these rules were drafted for employer-based medical departments, they also apply to private physicians' offices and clinics. The rules can be problematic for private physicians and clinics since some of their requirements differ from customary private medical practice. The most fundamental of these differences is that OSHA grants the employee or representative the right to examine the original medical record.

This right differs from the usual practice of limiting the patient to a copy of his or her original medical record. This practice reflects state laws that are concerned with ensuring patients access to their medical information rather than the record itself. The state laws assume that physicians maintain records in a proper manner. The OSHA rule allowing inspection of the original record arises from the suspicion that company physicians may try to cover up occupationally related health conditions. OSHA does allow the medical records custodian to "delete from requested medical records the identity of a family member, personal friend, or fellow employee who has provided confidential information concerning an employee's health status." In the absence of specific authorization by the patient, however, this provision does not give medical care providers the right to discuss the patient's medical condition with third parties.

A demand to examine the original record should not disrupt office routines in the individual case, but it can become a problem when a designated representative requests access to the records of all the employees of a company. The physician or clinic is required to provide proper facilities for reviewing the records, which can take weeks or months, or to loan the records to the requesting organization. In either case, the physician or clinic may find it necessary to make and retain a copy of the records to provide ongoing care for the employees during the period when the records are unavailable. This can be very expensive and should be addressed in the contract between a company and a contract provider of occupational medical services.

Whenever an employee or designated representative requests a copy of a record, the employer (or contracting occupational medicine provider) must provide a copy of the record without charge, provide free access to a copying machine, or loan the record to the requesting employee or representative for a reasonable period of time to allow copying. "In the case of an original X-ray, the employer may restrict access to on-site examination or make other suitable arrangements for the temporary loan of the X-ray." If the record has been previously provided without cost to an employee or designated representative, the employer may charge reasonable, nondiscriminatory administrative costs (search and copying expenses but not including overhead expenses) for additional copies of the record. The employer shall not charge for an initial request for a copy of information that has been added to a record since it was previously provided.

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