OWNERSHIP
OF X-RAYS
There are three types of
law that govern the practice of any health care profession in any state:
1.
Statute
This
is law that results from the introduction of a bill into the state
legislature, passes the state House and Senate (or whatever form the state
legislature takes) after committee hearings, much debate, and probable
amendments, and is finally signed by the governor.
Statutes are not changed very frequently.
In
Washington state, these statutes are called RCWs (Revised Code of Washington).
2.
Administrative
Rules
In each state, various state governmental departments, agencies,
commissions, and Boards are authorized to pass administrative rules.
These various entities propose a rule and must hold open hearings
for testimony by all interested “stakeholders,” according to proper
provisions of administrative law. When
finally adopted by the entity, these administrative rules have equal
effect (are as binding) as statutes.
Chiropractic and medical licensing and disciplining agencies are
two examples of many agencies that are authorized to adopt administrative
rules. Administrative rules
further define matters of law that are not addressed – or are addressed
only generally – in statute. Administrative
rules are more easily changed than statutes, because they involve only the
affected stakeholders, thus being more adaptable and responsive to various
reasons for change.
In
Washington state, these administrative
rules are called WACs
(Washington Administrative Code).
3.
Case
Law
This
third body of law, applicable to health care practices in all states, is
often underappreciated by doctors, but it definitely has a major impact on
health care practice. Decisions
in litigated cases at Appellate and higher court levels create precedent
that may be cited in subsequent cases.
Certain legal trends, therefore, guide how doctors practice.
Doctors are apprised of these trends in their continuing education,
in their professional publications, and by their state and national
professional associations.
A
state could possibly pass a law that specified who owns x-rays, but most
states (including
Washington) do
not have such a law. Ownership
of x-rays is therefore almost always a matter of case law.
In the absence of any such law (which is typical), courts have
consistently held that x-rays belong to the doctor/facility that produced
them. The rationale is as
follows:
·
The
information is indispensable to the doctor as a part of his/her diagnostic
information
·
The
diagnostic information derived from the x-ray is relatively meaningless to
the typical patient
·
The
law requires a case record to be maintained by the doctor and specifies
certain retention periods
·
In the state of Washington, the Department of Labor and
Industries specifies that x-rays must be retained by the doctor for 10
years. WAC 296-20-121
·
In Washington state chiropractic offices, the Chiropractic
Quality Assurance Commission has specified that records and x-rays must be
kept in “an orderly, accessible file” and may be “loaned” to
another doctor. WAC
246-808-650
·
Note
that it is not illegal to give x-rays to a patient.
If for some reason the patient would be better served by archiving
the x-rays at another doctor’s office, this will meet the film retention
requirements. Make sure the
destination of the x-rays is noted in the patient’s chart, along with
the patient’s signature.
The patient does not pay for the physical possession
of the actual radiographs, but rather for:
·
the
costs of the equipment used
·
the
time for acquiring the images
·
staffing
·
the
professional expertise of the doctor in interpreting the images
·
the
information which the doctor derives from the study.
o
This
information derived from the x-rays must
be provided to the patient, whether by oral remarks or by a written
report.
Patients do have a right to see all
their medical records, and they may obtain copies of them, at their
own expense. (In Washington state WAC
246-808-650[2] covers this issue).
