APA President Daniel Borenstein, M.D., was recently invited to discuss medical record privacy and confidentiality issues with Vice President and Democratic presidential candidate Al Gore.

Borenstein was part of a small discussion group that consisted of several California state politicians, two psychologists, a social worker, a former patient whose medical-record confidentiality had been breached, and Sharon Davis, wife of California Governor Gray Davis.

Paramount among the issues the group spotlighted for Gore, said Borenstein, was the alarming number of people with psychiatric symptoms who refuse to take advantage of their insurance benefits because they fear the consequences should the intimate details of their illness and their life be leaked by employers or others with access to their records.

The meeting, which was held September 19 at New Horizons, a rehabilitation facility in the San Fernando Valley north of Los Angeles, occurred just before an invitation-only "town hall meeting" that Gore’s staff had arranged.

Reflecting on the vice president’s level of knowledge and interest in the topic, Borenstein told Psychiatric News that "it was clear Gore had some facts on confidentiality, but seemed to want to learn more from the small group, including examples of breaches of medical confidentiality."

Borenstein said that while Gore’s wife, Tipper, President Bill Clinton’s advisor on mental health issues, has been out front on the issue of medical record privacy and other crucial mental health concerns, this was "an important opportunity to educate" the vice president on the damage that confidentialty breaches can wreak in patients’ lives.

At one point during the town-hall forum that followed the small-group meeting, Gore unexpectedly handed the microphone to Borenstein so the APA president could repeat an example of a serious confidentiality violation he earlier used to illustrate the dimensions of the problem for Gore.

"I had earlier given him the example of a banker who had looked at clients’ health records and then called in the loans of those who had cancer," Borenstein said, "and of a letter from a [pharmacy] benefits manager indicating that two patients, who were named in the letter, are receiving antidepressant medication and asking the treating psychiatrist if he had thought of trying a different product, which had recently begun to be marketed." Gore called on Borenstein to repeat the banker illustration for the town-hall audience.

Borenstein noted that he turned the meeting with Gore into an opportunity to write to the Republican nominee, Texas Governor George W. Bush, describing the vice president’s interest in medical-record privacy concerns and to ask Bush where he stands on this issue.

Writing on behalf of APA, Borenstein cited in particular his concern—one he hoped Bush would share—about the substantial number of patients who need mental health care but refuse to use their insurance benefits out of fear about "invasions of their privacy."

He tried to impress on Bush that as a presidential candidate, his "thoughts, interests, and initiatives will have a strong impact on the evolution of medical record privacy in the information age."