Esta ley enmienda la Ley Núm. 194 de 25 de agosto de 2000, conocida como la "Carta de Derechos y Responsabilidades del Paciente", para garantizar el derecho del paciente a recibir su récord médico al finalizar la relación médico-paciente, de forma gratuita y en un plazo no mayor de cinco días laborables. También establece el derecho a obtener copia del récord médico pagando un costo razonable que no exceda los .75 centavos por página, con un máximo de $25 por récord, en un plazo no mayor de cinco días laborables. La existencia de deuda no impedirá la entrega del récord.
(Approved December 25, 2002)
To amend subsection
(e) of Section 11 of Act No. 194 of August 25, 2000, as amended, known as the "Bill of Rights and Responsibilities of the Patient," so that once the physician-patient relationship ends, the physician shall hand his/her medical record to the patient; and to provide that the patient has the right to receive a copy of his/her medical record in within a period that shall not exceed five (5) working days, through the payment of a reasonable fee, which shall not exceed seventy-five (.75) cents per page, up to a maximum of twenty-five (25) dollars for each medical record.
In order to protect the health and welfare of the population, the Legislature of Puerto Rico approved Act No. 194 of August 25, 2000, known as the "Bill of Rights and Responsibilities of the Patient." Said Act No. 194, supra, provides that "It is important for the users and consumers of such health services to be aware, not only of their rights but also of their responsibilities, financial and otherwise, under the various options of health services and treatment available to them." It also provides that "The promulgation of this Act shall visibly contribute to form a better informed, more aware, and responsible, and probably, healthier population," Act No. 194 of August 25, 2000.
Said principle of information and participation of the patient is patent when the Code of Professional Ethics, the medical class of Puerto Rico
regulates the nature of the medical record of the patient. Rule six (6) of this Code of Professional Ethics provides the following: "The record which the physician creates in his/her private office, or that is created by a group of physicians organized to provide ambulatory medical services, is property of the patient, except as otherwise provided by the Act. The physician shall be the custodian of said record. When any of the parties ends the physician-patient relationship, said record must be handed to the patient, father, mother, or custodian free of charge within a term that shall not exceed five (5) working days. The physician may keep copy of the same for his/her records. If the patient, father, mother, custodian or legal representative requests a copy of the original record, it shall be furnished for a reasonable cost, which shall not exceed seventy five (.75) cents per page, up to a maximum of twenty-five dollars for each medical record, within a term that shall not exceed five (5) working-days. The fact that there is an outstanding debt between the physician and the patient shall not be an impediment for the patient to obtain his/her medical record." Code of Professional Ethics Rule 6.
In spite of this specific provision of the Code of Professional Ethics of the medical class of the Island, the citizenry has made a claim regarding the refusal of some physicians to furnish the medical record to the patients who end the physician-patient relationship, or when the physician ends it, or because there is an outstanding debt between the patient and the physician. Said practice is contrary to what is established in Rule 6 of the code of medical ethics and contrary to the principle of good faith that should prevail in every professional relationship.
Similarly, in the practice of law, the Supreme Court of Puerto Rico has firmly established that the legal record is the property of the client and that it
must be handed to him/her once the attorney-client relationship ends. Even if the client owes money to the lawyer, the latter shall not withhold the client's record until the client settles the debt; the lawyer is always bound to hand the record to the client.
Continuing the legislative intent set forth in Act No. 194, supra, and enacting the provisions of Rule number six (6) of the Code of Professional Ethics into law, this bill has the purpose of guaranteeing all patients that, once the physician-patient relationship comes to an end, the patient be furnished his/her medical record, free of charge, within a term of not more than five (5) working-days. Furthermore, if the patient, father, mother, custodian or legal representative requests copy of the original record, the same shall be furnished for a reasonable cost, which shall not exceed seventy five (.75) cents each page, up to a maximum of twenty-five dollars for the medical record, within a term that shall not exceed five (5) working days. The fact that there is any indebtedness between the physician and the patient shall not be an impediment for the patient to obtain his/her medical record.
Since the direct effect of this measure is the effective continuity of the medical services offered to the patient and those received by him/her, and by providing that the medical record shall be handed to the patient once the physician-patient relationship concludes, the patient can seek quality medical services with another physician as soon as possible without endangering his/her health. On the other hand, the patient shall be able to avoid opening a new medical record with the physician who will subsequently attend him/her which represents a savings for the patient in terms of money, time, and efforts in procuring the best quality medical services.
Section 1.- Subsection
(e) of Section 11 of Act No. 194 of August 25, 2000, as amended, known as the "Bill of Rights and Responsibilities of the Patient," is hereby amended to read as follows: "Section 11.- Rights Concerning the Confidentiality of Medical Records and Information.-
(a) ...
(b) ...
(c) ...
(d) ...
(e) Every provider, medical-hospital institution, and every insurer shall provide every patient a speedy access to their files and records. A Patient is entitled to receive a copy of his/her medical record within a term which shall not exceed five (5) days, in those cases that the medical record is requested from a medical hospital institution, it shall be furnished within a term of not more than fifteen (15) working days, through the payment of a reasonable cost, which shall not exceed seventy-five (.75) cents a page, up to a maximum of twenty-five (25) dollars for the medical record.
Whenever any of the parties, to wit the medical services provider or the patient, concludes the physician-patient relationship, said medical record shall be furnished to the patient, father, mother, or custodian free of charge, within a term that shall not exceed five (5) working days. The fact that an outstanding debt exists
between the physician and the patient shall not be an impediment for the patient to obtain his/her medical record."
Section 2.- Effectiveness This Act shall take effect thirty (30) days after its approval.
I hereby certify to the Secretary of State that the following Act No. 309 (H.B. 2341) of the $4^{ ext {th }}$ Session of the $14^{ ext {th }}$ Legislature of Puerto Rico:
AN ACT to amend subsection
(e) of Section 11 of Act No. 194 of August 25, 2000, as amended, known as the "Bill of Rights and Responsibilities of the Patient," so that once the physician-patient relationship ends, the physician shall hand his/her medical record to the patient; and to provide that the patient has the right to receive a copy of his/her medical record in within a period that shall not exceed five (5) working days, through the payment of a reasonable fee, which shall not exceed seventy-five (.75) cents per page, up to a maximum of twenty-five (25) dollars for each medical record, has been translated from Spanish to English and that the English version is correct.
In San Juan, Puerto Rico, today $23^{ ext {rd }}$ of November of 2004.
Elba Rosa Rodríguez-Fuentes Director