Salmonella Outbreak – Medical Records Needed

Whoa, that pesky salmonella.  Striking again.  This time the harmful strain can be attributed to conditions at a Foster Farms poultry plant in California.

Salmonella is a thorn in the chicken industry’s side: the salmonella bacteria is actually quite common in the poultry industry and can be detected in most chickens, often from birth.  Since the salmonella bacteria can be killed through cooking, government officials allow some levels of the contaminant to be present in poultry factories.  The largest concern over the recent outbreak, however, is the particular strain of salmonella: Salmonella Heidelberg.  Salmonella Heidelberg has become resistant to some common antibiotics and over 40% of the recent illnesses have resulted in hospitalizations, twice the normal rate associated with most salmonella outbreaks.

Currently, 362 people have reportedly been infected across 21 states.  No deaths have been reported.  Recalls have been issued at several grocery store chains, including the Costco in San Francisco, CA.  Nevertheless, the salmonella tainted chicken may still be in circulation in grocery stores around the country as the USDA’s Food Safety and Inspection Service, F.S.I.S., did not actually order Foster Farms or any grocery store to recall the tainted chicken.  The current solution to the outbreak: handle your chicken carefully, and cook it well.

This is not the first salmonella outbreak, nor will it be the last.  MEDRECS is constantly monitoring the CDC and other sources for information on outbreaks and other consumer issues.  We have been intimately involved in the rapid gathering and processing of medical records for patients affected by past salmonella outbreaks related to peanut butter and other tainted food products.  The speedy retrieval and vetting of medical records is critical both to law firms and the patients they represent in order to ensure a complete understanding of the outbreak and subsequent illnesses, and to ensure impartial and transparent access to the primary evidence: the medical records.

If your law firm finds itself representing a party in a food-bourne illness matter, you can count on MEDRECS as your medical records partner. Our experience and success on large volume high-profile cases is unmatched and our turnaround time for production of records is industry best.

For any questions you have for MEDRECS, please contact us at


2014 Changes to RCW 70.02.010

Interesting news flash: it looks like the transition to electronic medical records is beginning to pay off, monetarily.

Effective 07/01/2014, “reasonable fees” will be lowered to $0.65 pp for the first 30 pages and to $0.50 pp for any pages thereafter.  (note – this new rate is down from $1.04 pp for the first 30 pages, and $0.79 pp for all pages thereafter.)  Additionally, the maximum clerical fee a provider may charge will be reduced from $23.00 to $15.00.

“These amounts shall be adjusted biennially in accordance with changes in the consumer price index, all consumers, for Seattle-Tacoma metropolitan statistical area as determined by the secretary of health.”

To see the new bill, click here:

Subpoena v. Subpoena Duces Tecum

The other day a couple paralegals and I sat together at happy hour discussing subpoenas.  Several questions arose as we tossed around the general term subpoena and the more regal sounding Latin trinomial, subpoena duces tecum.  At first, we simply argued over how to pronounce the latter.  Then we turned to a deliberation over the difference between the two terms, and if indeed there was any significant difference?  Are the terms interchangeable?  If the terms refer to distinct legal commands, then when should each be invoked, and for what purpose?  In the end, like good legal professionals, we agreed to disagree on what constitutes a subpoena duces tecum versus a standard “subpoena.

In light of this dispute, I decided to dig deeper and I uncovered some answers:

To begin, we must define “subpoena:  a subpoena is a writ issued by a government agency, often a court, or by an attorney of record in the action who is thereby endowed with legal authority to act as an officer of the court.

There are two types of subpoenas – subpoena ad testificandum and subpoena duces tecum - which serve three common purposes:  (1) to compel testimony before the court, (2) to compel presence at a deposition, or (3) to compel the production of tangible evidence.  The subpoena ad testificandum is used for number (1) and (2) above, while the subpoena duces tecum is used for number (3).  

Since subpoena ad testificandum is such a mouthful, it is often simply referred to as a “subpoena”; so, the general term “subpoena” refers to a writ summoning an individual to the court or to a deposition, whereas, the specific term “subpoena duces tecum” refers to a writ summoning the production of evidence pertinent to the case.

The term subpoena duces tecum is literally Latin for “bring with you under penalty of punishment”.  Not to confound matters further, but, in many states a subpoena duces tecum is referred to as a “subpoena for the production of evidence”.  (Note – several states are attempting to reduce the usage of non-English words in court terminology.  Furthermore, the legal lexicon is not employed uniformly from state to state.  What may be referred to as a “subpoena duces tecum” in one state may be referred to as a regular ol’ “subpoena” in another.)

The main difference between a “subpoena” (subpoena ad testificandum) and a subpoena duces tecum is that the subpoena duces tecum does not require the subject to give oral testimony.  The subpoena duces tecum only commands the subject to produce the items named in the document.  In the past, it was far more common for the subject to bring the items with her/him to the court; however, nowadays it is normal for the subject to mail or deliver the items to the attorney’s office or to the office of a record retrieval company such as MEDRECS.

It should now be clear that in our world of personal injury and other medical related litigation, we almost always deal with subpoena duces tecum.  Medical related litigation relies heavily upon the acquisition of medical records and other information from healthcare entities such as hospitals and doctors’ offices.  Such information provides the evidence which constitutes the crux of many cases.  Therefore, it is very common for a subpoena duces tecum to be used to compel the production of vital material such as medical records, billing records, x-rays, pharmacy records, billing codes, pathology material, employment records, labor and industries records, and the list goes on.

During the process of discovery, requests for records are typically sent to healthcare providers which seek the production of medical records and other key documents.  It is not uncommon, however, for insufficient or incomplete information to be produced by the healthcare facility, or, in some cases, no information is produced at all.  For this reason, the subpoena duces tecum is an effective way to compel healthcare providers to produce complete and accurate evidence, which is specifically outlined in the subpoena.  Failure to produce the information listed in a subpoena may open the healthcare provider to penalty.

If you have any questions about the subpoena service process, whether a subpoena is appropriate or necessary, or if you seek assistance in the preparation and service of a subpoena, please feel free to contact MEDRECS.


Hop on the HIPAA Omnibus

In the world of HIPAA we have a dizzying array of acronyms to keep straight:  HITECH, NPP, PHI, GINA, AFEHCT and on and on… Now, the HIPAA regulators at the U.S. Department of Health and Human Services (HHS) have coined a catchy term for the new HIPAA compliance laws that went into effect this Monday, September 23, 2013:  The HIPAA Omnibus Rule

The HIPAA Omnibus Rule is a more stringent set of standards and regulations which provides stronger privacy rights for patients.  The privacy rights are outlined in a new Notice of Privacy Practices (NPP) document which medical providers must give to new patients as of September 23, 2013.  New patient rights include the following: 

  • Patients now have a right to tell their provider to not share information with their health insurer about treatment paid for out of pocket.  According to practice management consultant Mary Pat Whaley, these private payments are often for psychiatric or mental health treatment, which patients do not want their insurance plans to know about. 
  • Stronger regulations are also in place regarding how patient health information may be used and disclosed for marketing and fundraising purposes.  
  • Privacy regulations now extend to business associates of medical providers, including outsourced billing companies.  As a result, we expect third party billing services to become even more cautious and strict regarding the release of patient information in the weeks and months ahead.  

As all of us in the world of litigation know, obtaining complete medical records is one of the more difficult and pain-staking aspects of working up the case.  We will keep our fingers on the pulse of these developments in the months ahead and we will keep the legal world apprised of any changing requirements regarding authorized access to patient medical and billing records.  

For any questions regarding access to medical records under the new HIPAA Omnibus Rule, please feel free to contact MEDRECS, Inc

In light of these new HIPAA regulations, we suggest that any office or firm that stores or accesses patient medical records provide HIPAA compliance training to staff and personnel on a regular basis.  The laws are constantly being updated and the penalties for HIPAA violations continue to become more serious.  Links to helpful websites are below. 



HHS Website:

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HIPAA tightens its grip…

In the ever-stricter world of protected health information (PHI) and HIPAA compliance, nothing can be left to chance.  Healthcare facilities are no longer interested in inferring anything from the authorizing documents.  All requests must be explicit and direct.   Interpretation is out of the question: if there is even the slightest ambiguity on the stipulation, authorization, or subpoena nowadays, the request will likely result in a rejection.  This level of scrutiny is vastly more stringent than it was even one or two years ago.  Here are a couple important tips to remember:

If you require billing records from a particular organization, you must (1) determine where the billing is done and (2) include the specific billing department’s name and location on the stipulation/authorization.  Many hospital billing departments are now off-site and/or outsourced.  This is true for hospitals such as University of Washington and Harborview Medical Center.  In the past, it was sufficient to state on the stipulation that you require medical records and billing records from University of Washington Medical Center, or Harborview Medical Center.  Now, if you require billings in addition to the medical records, you must list the billing departments separately from the medical records departments.  So for Harborview, you must indicate “Association of University Physicians” billings (and include the address), as well as “Hospital Collections” billings.  Furthermore, you must indicate whether you seek billings generated by a UWMC Doctor or department, or a Harborview Doctor.  Yes, this is much more detailed than it was a year ago.  But it is useful to be aware of these nuances in advance as requests will be processed more quickly and achieve a higher level of success if copious information is provided at the outset.  If you have any questions about this, please contact MEDRECS.  If you are unsure of the exact wording or address for a billing facility, please contact MEDRECS.  Note – citing incorrect address, name, or facility information on a stipulation may result in a rejection from the facility.  Therefore, it is advisable to cross-check all information with MEDRECS before proceeding.

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Hello MEDRECS friends!  Springtime litigation is heating up and there is a regular need for record retrieval from the Washington State Department of Labor & Industries.  Please take notice: Washington State L&I has been cracking down lately on their acceptance of patient signed authorizations to comply with the State RCW 51.28.070.  In order to authorize the release of L&I records, the Stipulation or authorization form must specifically indicate it intends “to release Labor and Industries records” or “to release workers’ compensation records.” The Department of L&I has informed us that wording such as “any and all medical records” will compel the release of “medical records” from L&I, but not the entire L&I file.

Electronic Health Records at the “click-of-a-button”? Not so fast…

Electronic health records (EHR) have been hailed as a huge technological breakthrough in Health Information Management sciences.  And while EHR brings many benefits, there is still a long way to go before electronic records are available to us at the “push of a button”.  In fact, the idea that EHR has solved everything for us, and that medical records are now easily available from the Provider, is a common misconception.  Healthcare providers have a lot of work to do before we will begin to see seamless and efficient methods for EHR storage and delivery.


Last week I met with Erin Ussery, a leader in the Health Information Management industry, to try to get to the bottom of what is going on with electronic health records.  In particular, if electronic records are supposed to be such a huge breakthrough in efficiency and cost-savings, then why is it still so difficult to pry records out of hospitals and why are records still so expensive?  What I learned was quite revealing, and a couple of brief examples illustrate the challenges that healthcare facilities continue to face while they try to “go electronic.”

In the early-to-mid 2000’s the electronic health record industry was “hot”, resulting in a blitz to develop and sell EHR systems as quickly as possible.  The healthcare industry became saturated with EHR possibilities which resulted in different EHR systems being installed within one single hospital.  This inevitably led to incompatibility issues. Take the Swedish Edmonds Campus, for example.  Swedish Medical Center is an advanced healthcare facility but their electronic medical record system will make your head spin.  According to Erin, “the records custodian at Swedish Edmonds has more than 5 different EHR systems to search through in order to find records pursuant to a request.  In addition, the custodian must search the hard copy storage of records maintained off-site by Iron Mountain, as well as entertain the possibility of older records stored on an ancient microfilm system.  Billing records are also stored in two different locations depending upon their history:  billing records created more than 4 years ago will be maintained off-site in paper storage.”  Needless to say, tracking down patient records at this facility is not a quick and easy task.

There is also a recent pattern of conglomeration taking place in the healthcare industry: large hospital systems acquire smaller clinics and bring them under their umbrella.  Take for example, a large healthcare system in Yakima with numerous affiliated clinics: pain clinic, cancer center, rehab center, 2 radiology departments, etc..  Nearly each clinic has a different EHR system and several still have records stored on microfilm.  Moreover, in order for the hospital to produce billing statements, the custodian must navigate through 2 separate systems: the first system reveals the account number associated with the particular date of service (DOS) and the second system is where you must enter the account number to find the bill associated with the DOS.  Sound cumbersome enough?  Well, it gets better:  this same process must be performed for each DOS.  So if the custodian must produce billing statements for 15 dates of service, this same process must be repeated 15 times since there is a different tracking number associated with each DOS visit.  The billing statements must then be converted to PDF (15 PDFs) and the multiple PDFs must be merged and excess/blank pages that result from the conversion must be deleted.

Then there is the common concern of excess pages and/or nearly blank pages found in abundance in many sets of electronic medical records.  This occurrence may turn what would normally be a 50 page chart into a 200 page chart, which not only increases the work involved to produce the chart, but also increases the cost.  Why is this so?  Erin states, “One of the most popular and widely used EHR systems is programmed such that each entry made creates a separate document within the electronic record.  So there may be 100 pages of records with each page containing nothing more than one or two lines of content at the top of the page.  When the record custodian goes to produce this record to the requesting party, each page must be selected, QA’d (“Quality Assured”), and then downloaded separately.  It is not uncommon for a 200 page chart to take one whole day for a person to download and QA.”

Speaking of QA (which is really the most important part of this whole process) we haven’t even mentioned the HIPAA disclosure requirements.  There are 14 requirements for an authorization form to be HIPAA compliant.  Furthermore, the records custodian at the healthcare facility must QA every single page of the electronic record prior to release to ensure cogency between the authorization and the information being released.

What we have found is that the process for releasing electronic records is far more involved than just a “click of a button”.  In fact, who would actually want their healthcare information sent around if the only thing the custodian had to do was “click a button.”  These HIPAA protections and strict QA and review of records are important safeguards for patient privacy.

Despite these bumps in the road and the current labyrinthine nature of EHR systems, EHR is the wave of the future and holds great promise as the industry moves forward and irons out the kinks in the current systems.  According to Erin, electronic records currently take longer to find, prepare, review/QA, and release than paper records.  However, we are already seeing many benefits of the electronic health record revolution:  “E-records are more secure than paper records, and are redundantly backed up on proxy servers at secondary locations in the event of disaster.  E-records can also be securely transferred online much more quickly than snail mail.  And new compatibility systems are being developed that allow for the ease of sharing and access among doctors at various clinics/hospitals.”  And of course, e-records are phasing out the need for paper and are thereby saving trees.  Still, for many people electronic records are difficult to read, navigate, search through, annotate, and so on.  Fortunately, MEDRECS is actively creating solutions for these issues such as OCR/keyword searchable PDFs, organized and hyperlinked index within the records, chronologically sorted records and medical record summaries.  While the advent of EHR has yet to speed up the release of information process on the provider side, there is huge upside potential and room for innovation in the EHR world while we work to make EHR more accessible and actionable for all parties involved.

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MEDRECS Tips for Record Retrieval – VA Hospital / Madigan Army Hospital

The Department of Veteran Affairs and Madigan Army Hospital receive a huge volume of requests for medical records.  Naturally, processing time may be delayed in some cases, and for this reason it is critical to provide as much information as possible at the outset of the request.  Today’s “MEDRECS tip” concerns spouses of servicemen/servicewomen:

If the spouse of a serviceman or servicewoman gets injured, they may be treated at the VA or Madigan Hospital under their spouse’s military insurance. i.e., the husband is in the military, his wife gets injured and taken to Madigan.  When medical records are requested from Madigan under these circumstances, it is important to have the “sponsor”, or servicemember’s social security number in order to obtain the records.  If the records are requested using only the wife’s SSN, for example, Madigan may state that there are no records for this patient, when in fact they do have the records, but the records are filed under the husband’s SSN.

As a service to the legal community, MEDRECS provides periodic medical record retrieval tips and pointers that we believe will help to make everyone’s lives easier.  We understand the pressures of litigation, and that’s why we do everything we can to provide knowledge and expertise that helps law firms streamline the record retrieval process.  To download VA and Madigan authorization forms, please visit our Resources page.

Veterans Affairs medallion - Dakota Sisterhood...

Veterans Affairs medallion

MEDRECS – Group Health Authorization Form

In the interest of thoroughness and stringent commitment to the confidentiality of patient health information, Group Health all but requires the use of their own particular authorization form in order to release protected health information (PHI).  If you attempt to request records from Group Health with something other than the Group Health Legal Release Form, your chances of gaining compliance to your request are rare indeed.  For this reason, it is highly recommended that you utilize the Group Health Legal Release Form for any medical records requests made to Group Health.  The Group Health form is updated periodically and MEDRECS keeps a keen eye out for any updates to the form to ensure that the forms we provide access to contain all the most recent verbiage.  The most recent Group Health form includes authorization language for sensitive information.  This form, and dozens of other facility-specific authorization forms, can be found in a reliable and up-to-date format on MEDRECS website.

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MEDRECS update on fungal meningitis outbreak

MEDRECS is monitoring the recent outbreak of fungal meningitis which has been linked to tainted lots of Methylprednisolone Acetate (PF), an injectable steroid mixed and distributed by the New England Compounding Center in Massachusetts.  It appears that most of the victims received spinal injections of the steroid to treat chronic back pain, and a few victims received injections of the steroid in other joint locations. As of this writing, there are over 370 confirmed cases of fungal meningitis and 29 reported deaths across 19 states (according to the Center for Disease Control), with the largest number of cases being reported in Tennessee, Michigan, Virginia, and Indiana.

This terrible outbreak is not the first of its kind, unfortunately. We are reminded of past outbreaks of disease related to tainted food/medicine, most recently the salmonella outbreak of 2009 linked to contaminated peanut butter produced by the Peanut Corporation of America in its Georgia, Texas, and Virginia plants. That outbreak prompted one of the largest recalls of a food product in US history, sickening more than 700 and killing 9 people across 46 states. 

During the 2009 peanut butter litigation, attorneys across the country were mired in the daunting task of retrieving voluminous sets of medical and billing records within a strict time frame with very limited resources (on average, a paralegal can spend 30 hours retrieving medical and billing records for a single patient). Many of these firms turned to MEDRECS for help retrieving records. “I remember working with one attorney who had so many medical records to retrieve, her paralegal just sent us an Excel spreadsheet and we took it from there,” explains one MEDRECS account representative. Another MEDRECS team member also remembers working on the peanut butter cases: “It was satisfying to me to spend my day working on these cases, then read the latest news at night and think ‘at least I’m doing something to help.’”

Our hearts go out to the victims of this fungal meningitis outbreak. We wish a speedy recovery to those who have fallen ill, and we offer our sincere condolences to the family members who have lost loved ones.

(Infographic courtesy of Buckfire Law.)

UPDATE (November 9, 2012)

The total number of confirmed cases of fungal meningitis tied to this outbreak is now 424 with 31 deaths. Our thoughts are with the victims and their families.

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