GloucesterTimes.com, Gloucester, MA

July 3, 2008

Mayor: Pregnancy numbers may violate privacy

By Patrick Anderson

Disturbed by the international spotlight focused on pregnancies at Gloucester High School, Mayor Carolyn Kirk said yesterday she is investigating whether staffers at the school-based health clinic violated patient confidentiality laws when they discussed the issue with faculty and members of the press.

Kirk said she has sent a letter to Stephen Laverty, the president of Northeast Health System — the company that runs Addison Gilbert and Beverly hospitals and administers the high school health center — and has asked him to describe what information the company considers confidential, how it deals with requests for information, and what consequences employees face if they reveal protected information.

The letter, received by Northeast on June 27 and made available to the Times by the mayor in response to a public records request, stops short of alleging a violation of federal medical privacy laws, but expresses regret that news of the spike in pregnancies at the high school has exposed students to scrutiny and leaves open the possibility of wrongdoing.

"I hope you and your organization are as distressed as I am over the public discourse which has revealed far too much information about Gloucester students than is necessary or appropriate," the letter says.

Yesterday, Kirk said she was not immediately charging Northeast, school or clinic staff with a violation of privacy laws, but reiterated that the city needs to conduct a "review into whether there are violations and by whom."

"One of the biggest complaints that I am getting, is that the breaches of confidentiality have devastated the families," Kirk said. "The press was able to hunt these girls down and find them. That was what the (privacy laws) were designed to prevent."

Specific requests of Northeast made in the letter include how information inquiries from the press, parents and School Department are handled. The letter also asks whether the company considers confidential the number of pregnancy tests given at the clinic, the number of confirmed pregnancies at the school and behavior of students upon hearing the results of the tests.

Heather Jones, a spokeswoman for Northeast, said yesterday that the company planned to respond formally to the mayor's request "as soon as possible," but would not comment on the matter until that time.

Dr. Brian Orr, the former medical director of the clinic who resigned at the end of the academic year in protest against Northeast's reluctance to recommend offering confidential access to contraceptives at the high school, could not be reached yesterday.

The privacy law in question — the Health Insurance Portability and Accountability Act (HIPAA) of 1996 — sets rules for how medical information can be released by health care providers and insurance companies.

In response to suggestions made by the mayor earlier in the year about possible confidentiality violations, staff at the clinic said revealing the total number of students involved does not break HIPAA laws because it does not provide information that could be used to identify any individuals.

But Kirk this week said her reading of the confidentiality laws indicated that aggregate medical data could not be released under HIPAA if it referred to a group of patients smaller geographically than a state.

"When you talk about 17 pregnant teens at the high school, that has not been de-identified," Kirk said.

Kirk said the reporting of teen births, conducted annually on the municipal level by the state, does not violate the law because birth is not a medical condition. She said yesterday she had consulted acting city legal counsel Suzanne Egan before issuing the letter to Northeast.

Representatives from state Attorney General Martha Coakley's office and the Massachusetts Division of Insurance would not comment on Kirk's reading of the law.

The Times first reported that school officials were concerned about an increase in teen pregnancies at the high school, at that time 10, after conversations with Principal Joseph Sullivan, district health coordinator Ann-Marie Jordan and clinic nurse practitioner Kim Daly.

In May, a health clinic advisory board that included hospital, clinic and school district representatives completed a policy paper that broke down 15 confirmed pregnancies by grade level. Later that month, Orr said 17 girls had received positive tests, a number accepted by school officials. Orr has since raised the total to 18.

Kirk said on Tuesday that the city's review of the issue would include the actions of school district employees.

"We will get to the bottom of it," Kirk said. "We need to see that the safeguards are in place to make sure that it never happens again."

Patrick Anderson can be reached at panderson@gloucestertimes.com.