People who believe their personal information is safe on the Internet or in electronic databases should think again. Private citizens, detectives, and APA Vice President Paul Appelbaum, M.D., testified before a congressional subcommittee last month about the price they or others have paid when personal information was disclosed without their knowledge or consent.

With millions of financial, health care, and other records kept in electronic databases, the Web has become a virtual storehouse of information.

However, entrepreneurs and criminals are exploiting that information. Robert Douglas, a private investigator, told the House Subcommittee on Government Management, Information, and Technology about the techniques Web detectives and even thieves use to track down personal information online.

For example, the Web site <www. docusearch.com> offers to locate anyone for a fee. It will search for a person’s driver’s license number, property rented or owned, telephone numbers including unlisted ones, bank account and investment information, and Social Security number.

Docusearch sleuths mine celebrity secrets, spy on business rivals, and track down hidden assets, secret lovers, and "deadbeat dads," according to an article in the November 29, 1999, Forbes Magazine. It was Docusearch that provided information about Amy Boyer to the person who stalked and killed her.

Once someone has a person’s Social Security number, it would take only a few more clicks of a mouse to find a medical claim.

"The loss of privacy is indeed serious," Appelbaum testified on behalf of APA. "Privacy and medical records privacy issues are one of the key public policy issues faced by federal and state governments today. We live with a 21st century health care delivery system, but patients are forced to live with privacy protections designed for the 1960s."

He mentioned several concerns about privacy violations to illustrate what one panel of experts dubbed "a health privacy crisis."

A recent study by professors at Harvard and Stanford medical schools revealed more than 200 cases where patients were harmed by disclosures of medical record information. The San Diego Tribune reported recently that a pharmacy inappropriately disclosed a man’s HIV status to his ex-wife, who used that information in a custody dispute.

To avoid such disclosures, some patients will not seek medical care or they drop out of treatment, said Appelbaum. "I treated a skilled tradesman for two and a half years who worked overtime to pay for his treatment rather than use his insurance coverage. He didn’t want his union, which was administering his insurance, to know he was receiving psychiatric treatment."

Appelbaum emphasized that confidentiality is essential to effective mental illness treatment. He urged the subcommittee chaired by Rep. Stephen Horn (R-Calif.) to add more protections for medical records to privacy bills introduced in Congress and regulations proposed by the Department of Health and Human Services (HHS). He called on committee members to contact HHS and conduct hearings on the final regulations.

Appelbaum also expressed APA’s support for the bill (HR 4049) introduced by Reps. James Moran (D-Va.) and Asa Hutchinson (R-Ark.) in March. The bill calls for the creation of the 17-member Commission for the Comprehensive Study of Privacy Protection.

Appelbaum added that APA is concerned about a provision that would prevent states from preserving or enacting privacy laws that are more stringent than the federal law.

The commission would examine information trends in health care, financial services, and the Internet; conduct town hall meetings; and report its findings to Congress within 18 months, added Hutchinson.

He recommended that the proposed privacy commission increase public awareness about the need for additional voluntary, legislative, and regulatory protections for privacy. He also recommended that the membership of the proposed privacy commission represent a balance between the consumer, patient, financial, and medical communities.—C.L.