Diane H. Schetky, M.D.
Four years ago, I wrote a column on the retention of medical records. Following my retirement from 35 years of practice last spring, I have had to revisit the issue. I decided to share my reflections and reacquaint readers with the salient issues. I was faced with the problem of what to do with all of the patient records I had accrued over 21 years of private practice in Maine. My files had been aging like fine wines passing their prime in a storage room to which I would soon no longer have access. My practice had encompassed consults to schools, therapists, pediatricians, the Department of Human Services, and insurance companies, as well as treatment cases that I carried over many years. In addition, large banker boxes swelled with binders of discovery material on civil and criminal forensic evaluations of children and adults.
I was faced with two issues: Which files might I safely destroy? What was the best means of disposal? The latter was the easiest one to answer, as the town dump was clearly out of the question for reasons of confidentiality and I couldn't be bothered getting a permit for a bonfire. Having had good experience in the past with Shredding on Site, a company of good repute that services my local bank and hospital, I once again called upon them. The reasons for retaining patient records after termination of treatment or closing a practice are to promote continuity of care should the patient transfer to another physician or facility; to preserve documentation of medical care for purposes of employment, insurance, or litigation; and to protect the physician in the event that a malpractice claim is filed.
Physicians physically own patients’ medical records, but in most states patients have a statutory right to access their records. The majority of states permit physicians to deny patients access to records if access would be detrimental to their mental or physical health. It is common for physicians to place a notice in newspapers upon retirement, notifying patients that they may request their records. I did not think this was appropriate for psychiatric records, particularly those involving minors. In addition, my handwritten notes were not particularly legible and former patients might choose to read into them anything they wanted to. I had, for the most part, addressed the issue of transfer of medical records for ongoing therapy cases when I phased out my private practice a few years ago to work part time for the State Forensic Service. I had prepared treatment summaries, which I had shared with patients, and sent on to therapists of those who required transfer.
In deciding which files I might part with, I first revisited Maine’s Statute of Limitations (SOLs). A SOL is a statute that originated in Common Law setting for the period of time, after a certain event, in which legal proceedings based on the event might begin. SOLs begin to run from the time the cause of action occurred or from the time the wrong was discovered (e.g., the sponge left in the abdomen or injuries due to toxic substances). SOLs have become part of civil and criminal codes and vary by state and country. For instance, in some states in the United States, a charge of misdemeanor must be brought within two years of the offense, whereas in Canada it is within ten years of the date of the offense. SOLs vary by the type of offense, and many states have eliminated statute of limitations altogether for sexual assault. In Maine, the SOL is six years for negligence, personal injury, or fraud, and two years for wrongful death. For medical malpractice, the SOL is three years. However, for minors it is six years from the cause of action or three years after they have reached the age of majority. Sometimes, the SOL may be tolled by mental illness or disability.
It should be noted that records of Medicaid and Medicare patients must be kept at least five years. In addition, there is no statute of limitations regarding ethics procedures or disciplinary actions by state licensing boards.
Armed with this information, I began to tackle over a thousand files with the intent of saving: 1) Forensic cases they had not yet gone to trial or were awaiting an appeal, 2) Files of minors I had treated or evaluated who still fell within the SOL, and 3) Files of persons I knew to be litigious. Sometimes yellowing paper, an old office address on my letterhead, or a primitive font was a giveaway that the file was a throwaway. It was easy discarding files on patients I had only evaluated and could barely remember. Treatment cases were another matter. I paused to wonder what had become of children I’d seen with oppositional defiant disorder, how a child with autism was now functioning as an adult, and whether an angry seven-year old had stopped setting fires. I some- times get follow-ups in my local paper and find former patients in the police blotter or, on a good day, in announcements of honor rolls, college graduations, or weddings.
My purging of files was slowed down by sadness over memories of a four-year old patient who’d been murdered by her mother and several adolescent patients who became traffic fatalities. I reminisced over reams of records on Munchausen by Proxy cases and wondered how scarred these now adult children might be. These discursions were slowing my progress and I forced myself to move on to the next box and make my way through the alphabet. I felt humbled by the thought that as vivid as my memories were of many of the children I had treated that most of them probably had little recollection of their play therapy with me. I wondered what impact, if any, I’d had on their lives.
After two weeks of sporadically pruning my records, I had whittled them down to three boxes to be saved and pondered what to do with hundreds of hanging files. A monstrous Green Bean Biofueled Shredding on Site truck arrived, and for $67.50, it gobbled up documentation of 21 years of my professional work in ten minutes. Shredded histories, diagnoses, and progress notes were recycled to a pulp mill where they lie in anonymity awaiting new life as recycled paper, perhaps to be used by another generation of psychiatrists. I feel purged but wistful.
In the new era of electronic records, the shredding of copious paper records is no longer such an issue. I was reassured to learn that shredding companies also shred hard drives, CDs, floppies, and videos. The pulp mill at the other end is able to separate shredded paper from shredded clips and other metal. My cumbersome salvage system seems to have worked, and I have already received a request from Disability Services for files on an adolescent whose records I kept. However, I recommend that child and adolescent psychiatrists develop a filing system by date and patient birth date that permits easier disposal of dated records than the tedious process I encountered. In addition, become conversant with the SOLs in the state in which you practice.
Dr. Schetky performs forensic examinations for the Maine State Forensic Service.