For the reasons set out in the preamble, 38 CFR part 1 is
proposed to be amended as follows:
PART GENERAL
1. New center headings and Sections 1.460 through 1.499 are
added as follows:
Release of Information From Department of Veterans Affairs (VA)
Records Relating to Drug Abuse, Alcoholism or Alcohol Abuse,
Infection With the Human Immunodeficiency Virus (HIV), or Sickle
Call Anemia.
Sec.
1.460 Definitions
1.461 Applicability.
1.462 Confidentiality restrictions.
1.463 Criminal penalty for violation
1.464 Minor patients
1.465 Incompetent and deceased patients
1.466 Security for records.
1.467 Restrictions on the use of identification cards and public signs.
1.468 Relationship to Federal statutes protecting research subjects against compulsory disclosure of their identity.
1.469 Patient access and restrictions on use.
1.470-1.474 (Reserved)
Disclosures with Patient's Consent
1.475 Form of written consent
1.476 Prohibition on redisclosure.
1.477 Disclosures Permitted with written Consent.
1.478 Disclosures to prevent multiple enrollments in detoxification and maintenance treatment programs not
applicable to records relating to sickle cell anemia or
infection with the human immunodeficiency virus.
1.479 Disclosures to elements of the criminal justice system which have refereed patients.
1.4801.484 (Reserved)
Disclosures Without Patient Consent
1.485 Medical emergencies
1.486 Disclosure of information related to infection with the human immunodeficiency virus to public health authorities.
1.487 Disclosure of Information related to Infection with the human immunodeficiency virus to the spouse or sexual
partner of the patient
1.488 Research activities
1.489 Audit and evaluation activities.
Court Orders Authorizing Disclosure, and Use
1.490 Legal effect of order.
1.491 Order not applicable to records disclosed without consent to researchers, auditors and evaluators.
1.492 Procedures and criteria for orders authorizing disclosures ∞
for noncriminal purposes.
Sec.
1.493 Procedures end Criteria for orders authorizing disclosure end use of records to criminally invite or prosecute patients.
1.494 Procedures and criteria for orders authorizing disclosure and use of records to investigate or prosecute VA or employees
of VA
1.495 Orders authorizing the use of undercover agents end informants to criminally Investigate employees or agents of
VA
1.496-1.499 [Reserved]
Release of Information From Department of Veterans Affairs
Records Relating to Drug Abuse, Alcoholism or Alcohol Abuse,
Infection With the Human Immunodeficiency Virus (HIV), or Sickle
Cell Anemia.
Note: Sections 1.460 through 1.499 of this part concern the
confidentiality of information relating to drug abuse, alcoholism
or alcohol abuse, infection with the human immunodeficiency
virus, or sickle cell anemia in VA records and are applicable in
combination with other regulations pertaining to the release of
information from VA records. Sections 1.500 through 1.527, Title
38, Code of Federal Regulations, implement the provisions of 38
U.S.C 5701 and 5702. Sections 1.550 through 1.559 implement the
provisions of 5 U.S.C 552 (The Freedom of Information Act).
Sections 1.575 through 1.584 implement the provisions of 5 U.S.C'
552a (The Privacy Act of 1974).
Authority: The provisions of 1.460 through 1.499 of this
pertain to any program or activity, including education,
treatment, rehabilitation or research, which relates to drug
abuse, alcoholism or alcohol abuse, infection with the human
immunodeficiency virus, or sickle cell anemia. The statutory
authority for the drug abuse provisions an alcoholism or alcohol
abuse provisions of 1.460 through 1.499 is sec. 111 of Pub. L.
94-581, the Veterans Omnibus Health Care Act of 1976 (38 U.S.C.
7331 through 7334), the authority for the human immunodeficiency
virus provisions is Sec. 121 of Pub. L. 100-322, the Veterans
Benefits and Services Act of 1988(38 U.S.C 7332); the authority
for the sickle cell anemia provisions is sec. 109 of Pub. L.
9382, the Veterans Health tree Expansion Act of 1973 (38 U.S.C.
1751-1754, formerly 651854).
11.460 Definitions.
For purposes of 1.460 through 1.499 of this part, the
following definitions apply:
(a) Alcohol abuse. The term "alcohol abuse" means the use of an alcoholic beverage which impairs the physical, mental, emotional,
or social well-being of the user.
(b)Contractor. The term "contractor" means a person who provides
services to VA such as data processing; dosage. preparation,
laboratory analyses or medical or other professional services.
Each contractor all be required to enter into a written
agreement subjecting such contractor to the provisions of 1.460 ∞
through 1.499 of this pert: 38 U.S.C. 5701 an 7332; and 5
U.S.C. 552a and 38 CFR 1.576(g).
(c) Diagnosis. The term "diagnosis" means any reference to an individual's alcohol or drug abuse or to a condition which is
identified as having been caused by that abuse or any reference
to sickle cell anemia or infection with the humanimmunodeficiency
virus which is made for the purpose of treatment or referral for
treatment. A diagnosis prepared for the purpose of treatment or
referral for treatment but which is not so used is covered by
1.460 through 1.499 of this part. These regulations do
no diagnosis of drug alcohol intoxication which clearly shows that the individual involved is not an alcohol or drug abuser
(e.g., involuntary ingestion of alcohol or drugs or reaction to a
prescribed dosage of one or more drugs).
(d)Disclose or disclosure. The term "disclose" or "disclosure"
means a communication of patient identifying information, the
affirmative verification of another person's communication of
patient Identifying information, or the communication of any
information from the record of a patient who has been identified.
(e)Drug Abuse. The term "drug abuse means the use of a
psychoactive substance for other than medicinal purposes which
Impairs the physical, mental, emotional, or social well-being of
the user.
(f)Infection with the human immunodeficiency virus (HIV). The
term "infection with the human immunodeficiency virus (HIV)"
means the presence of laboratory evidence for human
immunodeficiency virus infection. For the purposes of 1.460
through 1.499 of this part, the term includes the
testing of an individual for the presence of the Virus or
antibodies to the virus and information related to such testing
(including tests with negative results).
(g) Informant. The term "informant" means an individual who is a
patient or employee or who becomes a patient or employee at the
request of a law enforcement agency or official and who the
request of a law enforcement agency or official observes one or
more patients or employees for the purpose of reporting the
information obtained to the law enforcement agency or official
(h) Patient The term "patient" means any individual or subject
who has applied for or been given a diagnosis or treatment for
drug abuse, alcoholism or alcohol abuse, infection with the human
immunodeficiency virus, or sickle cell anemia and includes any
individual who, after arrest on a criminal charge, is interviewed
and/or tested in connection with drug abuse, alcoholism or
alcohol abuse, infection with the human immunodeficiency virus, or sickle cell anemia in order to determine that individual's eligibility to participate in a treatment or rehabilitation program. The term patient includes an individual who has been diagnosed or treated for alcoholism, drug abuse, HIV infection, or sickle cell anemia for purposes of participation in a VA program or activity relating to those four conditions, including a program or activity consisting of treatment, rehabilitation, education, training, evaluation, or research. The term "patient" for the purpose of infection with the human immunodeficiency virus or sickle cell anemia, includes one tested for the disease.
(I) Patient identifying information. The term "patient identifying information" means the name, address, social security
number, fingerprints, photograph, or similar information by which
the Identity of a patient can be determined with reasonable
accuracy and speed either directly or by reference to other
publicly available information. The term does not include a
number assigned to a patient by a treatment program, if that
number does not consist of, or contain numbers (such as social
security, or driver's license number) which could be used to
Identify a patient with reasonable accuracy speed from sources
external to the treatment program.
(j) Person. The term "person" means an individual, partnership,
corporation, Federal, State or local government agent or any
other legal entity.
(k)Records.The term "records" means any information received,
obtained or maintained, whether recorded or not, by an employee
or contractor of VA, for the purpose of seeking or performing VA
program or activity functions relating to drug abuse, alcoholism,
tests for or infection with the human immunodeficiency virus, or
sickle cell anemia regarding an identifiable patient. A program
or activity function relating to drug abuse, alcoholism,
infection with the human immunodeficiency virus, or sickle cell
anemia includes evaluation, treatment, education, training,
rehabilitation, research, or referral for one of these condition
Sections 1.460 through 1.499 of this part apply to a primary or
other diagnosis, or other information which identities, or could
reasonably be expected to identify, a patient as having drug or
alcohol abuse condition, infection with the human
immunodeficiency virus, or sickle cell anemia (e.g., alcoholic
psychosis, drug dependence), but only if such diagnosis or
information is received, obtained or maintained
for the purpose of seeking or performing one of a above program
or activity functions. Sections 1.460 through 1.499 of this part
do not apply if such diagnosis or other information is not
received, obtained or maintained for the purpose of seeking or
performing a function or activity relating to drug abuse,
alcoholism, infection with the human immunodeficiency virus, or
sickle cell anemia for the patient In question. Whenever such
diagnosis or other information, not originally received or
obtained for the purpose of obtaining or providing one of the
above program or activity functions, is subsequently used in
connection with such program or activity functions, those
original entries become a "record" and 1.460 through 1.499 of
this part thereafter apply to those entries. Segregability: These
regulations do not apply to records or information contained
therein, the disclosure of which (the circumstances surrounding
the disclosure having been considered) could not reasonably be
expected to disclose the fact that a patient has been connected
with a VA program or activity function relating to drug abuse,
alcoholism, infection with the human immunodeficiency virus, or
sickle cell anemia.
(1) The following are examples of in stances whereby records or information related to alcoholism or drug abuse are covered by
the provisions of 1.460 through 1.499 of this part:
(i) A patient with alcoholic delirium tremens is admitted for detoxification. The patient is offered treatment in a VA alcohol
rehabilitation program which he declines.
(ii) A patient who is diagnosed as a drug abuser applies for and is provided VA drug rehabilitation treatment.
(iii) While undergoing treatment for an unrelated medical condition, a patient discusses with the physician his use and
abuse of alcohol. The physician offers VA alcohol rehabilitation
treatment which is declined by the patient.
(2) The following are examples of instances whereby records or information related to alcoholism or drug abuse are not
covered by the provisions of 1.460 through 1.499 of this part:
(I) A patient with alcoholic delirium tremens is admitted for detoxification, treated and released with no counseling
or treatment for the underlying condition of alcoholism.
(ii) While undergoing treatment for an unrelated medical
condition, a patient informs the physician of a history of drug
abuse fifteen years earlier with no ingestion of drugs since. The
history and diagnosis drug abuse is documented in the hospital
summary and no treatment is sought by the patient or offered or
provided by VA during the current period of treatment.
(iii) While undergoing treatment for injuries sustained in an accident, a patient's medical record is documented to support the
judgment of the physician to prescribe certain alternate
medications in order to avoid possible drug interactions in view
of the patient's enrollment and treatment in a non-VA methadone
maintenance program. The patient states that continued treatment
and follow-up will be obtained from private physicians and VA
treatment for the drug abuse is not sought by the patient nor
provided or offered by the staff.
(1)Third party payer. The term "third party payer" means a
person who pays~ or agrees to pay, for diagnosis or treatment
furnished to a patient on the basis of a contractual relationship
with the patient or a member of his or her family or on the basis
of the patient's eligibility for Federal, State, or local
governmental benefits.
(m) Treatment The term "treatment" means the management and
care of a patient for drug abuse, alcoholism or alcohol abuse,
infection with the human immunodeficiency virus, or sickle cell
anemia, or a condition which is identified as having been caused
by one or more of these conditions, in order to reduce or
eliminate the adverse effects upon the patient. The term includes
testing for the human immunodeficiency virus or sickle cell
anemia.
(n)Undercover agent. The term "undercover agent" means an
officer of any Federal, State, or local law enforcement agency
who becomes a patient or employee for the purpose of
investigating a suspected violation of law or who pursues that
purpose after becoming a patient or becoming employed for
other purposes.
(Authority: 38 U.S.C. 7334)
1.461 Applicability.
(a)General (1) Restrictions on disclosure. The restrictions on
disclosure in these regulations apply to any information whether
or not recorded, which:
(i) Would Identify a patient as an alcohol or drug abuser, an individual tested for or infected with the human
Immunodeficiency virus (HIV), hereafter referred to as HIV, or an
individual with sickle cell anemia, either directly, by reference to other publicly available information, or through verification of such an identification by another person; and
(ii) Is provided or obtained for the purpose of treating
alcohol or drug abuse, infection with the HIV or sickle call anemia, making a diagnosis for that treatment, or making a
referral for that treatment as well as for education, training,
evaluation, rehabilitation and research program or activity
purposes.
(2) Restriction on use. The restriction on use of information to initiate or substantiate any criminal charges against a
patient or to conduct any criminal investigation of a patient
applies to any information, whether or not recorded, which is
maintained for the purpose of treating drug abuse, alcoholism or
alcohol abuse, infection with the HIV, or sickle cell anemia,
making a diagnosis for that treatment, or making a referral for
that treatment as well as for education, training, evaluation,
rehabilitation, and research pro am or activity purposes
(b) Period covered as affecting applicability. The provisions of
1.460 through 1.499 of this part apply to records of identity,
diagnosis, prognosis, or treatment pertaining to any given
individual maintained over any period of time which,
irrespective of when it begins, does not end before March 21,
1972, in the case of diagnosis or treatment for drug abuse; or
before May 14, 1974, in the case of diagnosis or treatment for
alcoholism or alcohol abuse; or before September 1, 1973, in the
case of testing, diagnosis or treatment of sickle cell anemia; or
before May 20,1988, in the case of testing, diagnosis or
treatment for an infection with the HIV.
(c) Exceptions. (1) Department of Veterans Affairs and Armed
Forces. The restrictions on disclosure in 1.460 through 1.499
of this art do not apply to communications of information between
or among those components of VA who have a need for the
information in connection with their duties in the provision of
health care, adjudication of benefits, or in carrying out
administrative responsibilities related to those functions,
including personnel of the Office of the Inspector General who
are conducting audits or evaluations, or between such components
and the Armed Forces, of records Pertaining to a person relating
to a period when such person is or was subject to the Uniform
Code of Military Justice. Similarly, the restrictions on
disclosure in 1.460 through 1.499 of this part do not apply
to communications of information to the Department of Justice or
U.S. Attorneys who are providing support in litigation or possible litigation involving VA
(2) Contractor. The restrictions on disclosure in 1.460 through 1.499 of this part do not apply to communications between
VA and a contractor of information needed by the contractor to
provide his or her services.
(3) Crimes on VA premises or against VA personnel. The restrictions on disclosure and use in 1.480 through
1.499 of this part do not apply to communications from VA
personnel to law enforcement officers which-
(i) Are directly related to a patient's commission of a crime on the premises of the facility or against personnel of VA or to
a threat to commit such a crime; and
(ii) Are limited to the circumstances of the incident, including the patient status of the individual committing or
threatening to commit the crime, that individual's name and address to the extent authorized by 38 U.S.C 5701(f)(2), and that
individual's last known whereabouts.
(4) Undercover agents and informants. (i) Except as specifically authorized by a court order granted under 1.495 of this part,
VA may not knowingly employ, or admit as a patient, any
undercover agent or informant in any VA drug abuse, alcoholism or
alcohol abuse, HIV infection, or sickle cell anemia treatment
program.
(ii) No information obtained by an undercover agent or informant, whether or not that undercover agent or informant is
placed in a VA drug abuse, alcoholism or alcohol abuse, HIV
infection, or sickle cell anemia treatment program pursuant to an
authorizing court order, may be used to criminally investigate or
prosecute any patient unless authorized pursuant to the,
provisions of 1.493 of this part,
(iii) The enrollment of an undercover agent or informant in a treatment unit shall not be deemed a violation of this section.
If the enrollment is solely for the purpose of enabling the
individual to obtain treatment for drug or alcohol abuse, HIV
infection, or sickle cell anemia
(d) Applicability to recipients of information.-(1) Restriction on use of information. In the absence of a proper 1.493 court
order, the restriction on the use of any information subject to
1.460 through 1A99 of this part to initiate or substantiate any
criminal charges against a patient or to conduct any criminal
investigation of a patient applies to any person who obtain that
information from VA, regardless of the status of the person
obtaining the in formation or of whether the information was
obtained in accordance with 1.460 through 1.499 of this part.
This restriction on use bars, among other things, the
introduction of that information as evidence in a criminal
proceeding and any other use of this information to investigate
or prosecute a patient with respect to a suspected crime.
Information obtained by undercover agents or informants (see
paragraph (c) of this section) or through patient access (see
1.469 of this part) is subject to the restriction on use.
(2)Restrictions on disclosure-- third party payers and others.
The restrictions on disclosure in 1.460 through 1.499 of this
part apply to third-party payers and persons who, pursuant to a
consent, receive patient records directly from VA and who are
notified of the restrictions on redisclosure of the records in
accordance with 1.476 of this part (Authority: 38 U.S.& 7332(e)
and 7334)
1.462 Confidentiality restrictions
(a) General. The patient records to which 1.460 through
1.499 of this part apply may be disclosed or used only as
permitted by these regulations and may not otherwise be disclosed
or used in any civil, criminal administrative, or legislative
proceedings conducted by any Federal, State, or local authority.
Any disclosure made under these regulations must be limited to
that information which Is necessary to carry out the purpose of
the disclosure.
(b) Unconditional compliance required. The restrictions on disclosure and use in 1.460 through 1.499 of this part apply
whether the person seeking the information already has it, has other means of obtaining it, is a law enforcement or other
official, has obtained a subpoena, or asserts any other
justification for a disclosure or use which is not permitted by
1.460 through 1.499 of this part. These provisions do not
prohibit VA from acting accordingly when there is no disclosure
of information.
(c) Acknowledging the presence of patients: responding to requests. (1) The presence of an identified-patient in a VA
facility for the treatment or other VA program activity relating
to drug abuse, alcoholism or alcohol abuse, infection with the
HIV, or sickle cell anemia may be acknowledged only if the
patient's written consent is obtained in accordance with 1.475
of this part or if an authorizing court order is entered in
according with 1.490 through 1.499 of this part.
Acknowledgement of the presence of an identified patient in a
facility is permitted if the acknowledgement does not reveal that
the patient is being treated for or is otherwise involving a VA
program or activity concerning drug abuse, alcoholism or alcohol
abuse, infection with the HIV, or sickle cell anemia.
(2) Any answer to a request for a disclosure of patient
records which is not permissible under 1.480 through 1.499
of this part must be made in away that will not affirmatively
reveal that an identified individual has been, or is being
diagnosed or treated for drug abuse, alcoholism or alcohol
abuse, infection with the HIV, or sickle cell anemia. These
regulations do not restrict a disclosure that an identified
individual is not and never has been a patient,
(Authority: 38 U.S.C. 7334)
1.463 Criminal penalties for violations.
Under 38 U.S.C. 7332(g), any person who violates any provision
of this statute or 1.460 through 1.499 of this part shall be
fined not more than $5,000 in the case of a first offense, and