Vanderbilt University Medical Center faces a class action lawsuit and investigation into a rights violation after they released the records of transgender patients to the state attorney general.
Tennessee has passed increasingly hostile laws toward the transgender community in the last few years, and former Vanderbilt patients say their names and other information should have been protected before the records were passed on.
Vanderbilt University Medical Center in Nashville, Tennesee, is at the center of controversy after releasing the medical records of over 100 transgender patients to the Tennesee attorney general, Jonathan Skrmetti, at the end of 2022.
Patients whose information was provided to Skrmetti were not informed until June of this year, prompting alarm from those patients and their families. Concern has been heightened due to the political climate in Tennessee and the state’s recent passage of laws such as a bill banning gender-affirming care for minors.
Skrmetti’s office has said the files are needed for a routine investigation into potential insurance fraud. Under Tennessee law, disclosure of patient information is permitted if the disclosure is related to payment. However, Skrmetti’s stated reason has been met with doubt by some lawmakers and advocates because of his political record. He vocally supported the state’s ban on gender-affirming care for minors.
Additionally, he joined a group of Republican attorney generals in opposing a proposed federal rule limiting how states could collect medical records of residents who fled their states for gender-affirming or abortion care. Further doubt has been cast due to the timing of the request for records; Skmetti’s office requested the records from Vanderbilt University Medical Center following inflammatory claims about practices at the Vanderbilt Transgender Health clinic from conservative political commenter Matt Walsh. Insurance fraud was not among Walsh’s claims.
Two of the patients involved in disclosing records have brought a lawsuit against Vanderbilt University Medical Center. The patients have claimed that, especially given the current positions taken by many in the Tennessee government toward the transgender community, Vanderbilt should have removed their names and other personally identifying information from the records before passing them over to the attorney general’s office. The suit also claims that Vanderbilt provided more information than was requested, such as providing the attorney general’s office with the names of people who only visited the transgender health center once for information sessions and never became patients.
On top of the suit from affected patients, the US Department of Health and Human Services is looking into the incident as a federal violation of civil rights.
Patient information and malpractice
The lawsuit filed against Vanderbilt University Medical Center is a class action suit, not a medical malpractice suit.
Often, instances involving the disclosure of patient information are HIPPA violations and separate from malpractice claims. However, there are cases when the improper disclosure of patient information can overlap with malpractice and can lead to a malpractice suit. For instance, if it can be shown that the disclosure of information led to patient harm and was caused by negligence or a violation of medical standards, that disclosure could be considered malpractice.
Of course, shifting laws surrounding both abortion and gender-affirming care in states throughout the country could make some instances very complex for medical providers to navigate. Vanderbilt’s transgender health center, the clinic at the center of the lawsuit at Health and Human Services investigation, is no longer operating. It closed in June 2023, in response to Tennessee’s new ban on gender-affirming care for minors. Laws in several states have changed quickly and might continue to change, leaving healthcare providers in difficult situations. These changes could open more scenarios, such as the one in Tennessee, where patient information could be requested, but sharing that information could result in heightened patient harm. For instance, in some states, patient information stating someone has received an abortion or sought gender-affirming care could have consequences it did not even a year or two ago.
Does that make disclosing this information malpractice? Right now, it’s hard to say for sure. Certain types of medical information already have extra privacy protection regulations because of the potential for discrimination and harm to patients if the information is shared. This widely includes substance abuse and mental health treatment information, with some states having stricter standers for other categories as well. However, if patient records are required for legal purposes, passing them on without patient authorization isn’t typically a HIPAA violation. In fact, providers are generally obligated to provide information to law enforcement and other legal authorities, as long as the information requested is within the scope of a given investigation.
Richard Cahill, JD, who serves as Vice President and Associate General Counsel for The Doctors Company, a medical malpractice company, says it’s crucial for healthcare providers to only pass along the exact patient information that is needed.
“The key with patient information disclosures is that the covered entity or healthcare provider must provide the minimum necessary to comply with the request,” he says. “Going beyond that would be inappropriate and would be considered a breach.”
Over the next few years, complicated situations might come up in states where these new laws have been passed. Unfortunately, laws that restrict medical care leave physicians in situations that are in violation of medical standards. That’s why major associations, including the American Medical Association, have repeatedly spoken out in opposition to bills restricting abortion and gender-affirming care. It’s also why providers might find themselves in situations where what’s best for patients and the law in their state don’t align. What that will mean for malpractice cases if and when these scenarios play out is yet to be seen, but it seems certain that the political climate in the country will continue to have a significant effect on physicians.