The Order of Judge Richard Smoak in a recent Federal District Court case (Opis Management, LLC, et. al. v. Dudek, No. 4:11-cv-400/RS-WCS (N.D. Fla., Tallahassee Division)) (the “Opis Order”) reminds us of the attention that must be paid to the interaction and potential conflicts or dual applicability of state law with HIPAA compliance. While the Opis Order dealt with a relatively narrow issue that did not involve a data security breach, as will be hereinafter discussed, its focus highlights the broader concern about conflicts or dual law coverage involving  HIPAA and state law.

The Opis Order itself dealt with the concern of plaintiffs that compliance with a Florida law would violate federal law under HIPAA, and compliance with federal law under HIPAA would violate state law.As a result, plaintiffs argued that the Florida law was invalid. More specifically they argued that


Florida law requires nursing homes to “furnish to the spouse, guardian, surrogate, proxy, or attorney in fact . . . of a former resident . . . a copy of that resident’s records which are in the possession of the facility.” Further, the law provides that “copies of such records shall not be considered part of the deceased resident’s estate and may be made available prior to the administration of an estate, upon request, to the spouse, guardian, surrogate, proxy, or attorney in fact.” FLA. STAT. § 400.145 . . . Plaintiffs claim that their non-compliance is excusable because Section 400.145 is preempted by the Health Insurance Portability and Accountability Act of 1996 (“HIPPA”). They seek a declaratory judgment that Section 400.145 is invalid and injunctive relief prohibiting its enforcement. [For whatever reason, the Opus Order uses the definition “HIPPA” rather than the much more widely-used acronym “HIPAA.” Except in quotations taken directly from the OPIS Order, this posting will use the more prevalent “HIPAA.”] 


Under HIPAA, a more stringent state law preempts HIPAA as to a particular matter. HIPAA defines more stringent as meaning “with respect to a use or disclosure, the [state] law prohibits or restricts a use or disclosure in circumstances under which such use or disclosure otherwise would be permitted.” In granting plaintiff’s declaratory judgment petition, the Court found that, rather than being more stringent than HIPAA, Florida provision Section 400.145 actually afforded less protection of protected health information (“PHI”) than HIPAA.  The Opis Order concluded as follows:


Section 400.145 is preempted because it is contrary to HIPPA. It affords a patient far less protection than the heightened privacy requirements imposed by the federal requirement and is, therefore, not more stringent than HIPPA. For this reason, Section 400.145 “stands as an obstacle to the accomplishment and execution of the full purposes and objectives of [HIPPA].” 45 C.F.R. § 160.202.


The Opis Order serves as a case in point of the need to analyze state law whenever considering compliance issues involving HIPAA. However, the Opis Order is only one example of potential conflicts, overlapping or inconsistencies that can exist between HIPAA and state law relative to the same or similar subject matter. A proper analysis requires a comparison of HIPAA and state law definitions of terms, scope of applicability and procedural requirements. Moreover, it must be remembered that, to the extent a HIPAA item is not “contrary to” a state law provision, both HIPAA and state law provisions must be followed. For example, some areas where differences between HIPAA and state law may surface in connection with notification of security breaches include the following:


• To what persons does the law apply? – HIPAA applies to covered entities and business associates/state law may apply to different persons, e.g., all businesses and/or public entities.


• What type of information is covered? – HIPAA applies to PHI, a very broad range of information/state law may apply to more limited information primarily associated with potential identity theft, such as credit card numbers, social security numbers and dates of birth.


 In what medium is the information contained? –  HIPAA covers PHI in electronic, paper and oral format/state law may only cover one or two of these formats.


• What constitutes a security breach? – HIPAA and state law may diverge greatly.


• In what cases, who, how and when must regulatory authorities be notified of a data security breach? – HIPAA and state law may have provisions that differ greatly and may conflict with each other, overlap or have dual applicability, while not conflicting.


In summary, while HIPAA requires careful compliance in the event of a security breach, state law provisions must also be considered and analyzed as well.


Happy New Year and thank you to each of our readers.