HIPAA, Hillary and Hype

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By Marilyn M. Singleton, M.D., J.D.

In watching Hillary Clinton campaign I’m reminded of a poem I
learned in ninth grade: humorist Arthur Guiterman’s
“On the Vanity of Earthly Greatness”:

The tusks that clashed in mighty brawls
Of mastodons, are billiard balls.
The sword of Charlemagne the Just
Is ferric oxide, known as rust.
The grizzly bear whose potent hug
Was feared by all, is now a rug.
Great Caesar’s bust is on my shelf,
And I don’t feel so well myself.

We came into this election cycle hearing that Hillary Clinton was going to be coronated the Democratic nominee for president. The queen is not to be defied. Worse yet, she actually believes the hype.

First, we have the Hillary is a trailblazer meme. Of course, the true trailblazer was Victoria Woodhull, the first female stockbroker on Wall Street, who ran for U.S. president in the Equal Rights Party in 1872 – well-before women could vote. And Senator Margaret Chase Smith ran in 1964, the first year in which any woman’s name was on the ballot as a candidate for President. (In the 19th century, voters cast tickets prepared by the parties rather than state-printed ballots). Smith was first woman to have her name be placed in nomination for the presidency at a major political party’s convention. There have been some 40 bold women who have launched presidential runs without the benefit of a political “machine” and a famous husband.

Then we have the demeaning battle cry that women should vote for Clinton merely because of her gender. Clinton grinned and vigorously applauded as Madeleine Albright said “there is a special place in hell for women who do not help other women.” Does this include Imelda Marcos or Isabel Perón? I suppose Hillary has assured her eternal damnation by not helping Michelle Bachman or Carly Fiorina.

Then there’s Clinton’s supporter, Georgia civil rights activist John Lewis’ rather convenient recollection from the 1960s. He said he never saw Bernie Sanders at freedom marches in the 1960s but he “met” the Clintons. Curious indeed, since according to Clinton herself, during high school (1963-65) she was a “Goldwater Girl,” and in college interned for Gerald Ford and worked for Nelson Rockefeller in his presidential nomination bid at the 1968 Republican convention. On the other hand, Bernie Sanders before his 1964 graduation from University of Chicago was the protest organizer for the Congress of Racial Equality (CORE) and the Student Nonviolent Coordinating Committee (SNCC). In 1963 Sanders was convicted of resisting arrest during a demonstration against segregation in Chicago’s public schools.

And of course we have the infamous emails on the private server that was wiped clean. Clearly Clinton’s emails with sensitive diplomatic activity would be a target – particularly as she traveled throughout a sometimes hostile world. The intelligence community believes that dozens of Clinton’s emails contained classified material, including “top secret/SAP (special access program)” materials. Government computer breaches are not merely theoretical. The Office of Personnel Management and Department of Homeland Security hacks exposed sensitive data on thousands of federal workers.

Personal email servers generally are not covered by enterprise-grade data backup, archiving, and network security. Moreover, a personal server is outside the reach of Freedom of Information Act (FOIA) disclosure requirements. The State Department Foreign Affairs Manual requires that custodians must keep “records that document the formulation and execution of basic policies and decisions and the taking of necessary actions; records that document important meetings; records that facilitate action by agency officials and their successors in office.”

As physicians, we value privacy and are held to high ethical and legal standards. The Health Insurance Portability and Accountability Act’s HIPAA Security Rule requires that all electronic personal health information (ePHI) must be properly secured from unauthorized access, whether the data is at rest or in transit. Custodians as well as their business associates must perform yearly risk analyses for vulnerabilities in the administrative, physical, and technical safeguards. Stiff penalties await violators of HIPAA rules. Penalties range from up to $50,000 per violation for “reasonable cause” to a maximum of $1,500,000 per year and criminal charges which could result in jail time for “willful neglect.” Criminal prosecutions have occurred (for example, here, here, and here).

At the very least Clinton violated the Federal Records Act that prohibits willful concealment, removal, or destruction of government records, punishable by up to three years imprisonment.

If Hillary Clinton were a physician she’d be in prison. I hear the facility in Allenwood, Pennsylvania is particularly pleasant in the Spring.

To blindly jump on the Hillary inevitability bandwagon would prove that “the world is grown so bad that wrens make prey where eagles dare not perch.” I’d rather heed Margaret Chase Smith’s caution: “Honor is to be earned, not bought.”


Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and Board member of the Association of American Physicians and Surgeons. She graduated from Stanford and earned her MD at UCSF Medical School. Dr. Singleton completed 2 years of Surgery residency at University of California at San Francisco Medical Center, then her Anesthesia residency at Harvard’s Beth Israel Hospital. She was on the faculty at Johns Hopkins Hospital in Baltimore, Maryland before returning to California for private practice at Cedars-Sinai Medical Center in Los Angeles and Alta Bates Medical Center in Berkeley. While still working in the operating room, she attended UC Berkeley Law School. She interned at the National Health Law Project, and practiced insurance and health law. In addition to providing pain management, Dr. Singleton runs a wellness clinic in association with her county food bank and is in Oakland’s Medical Reserve Corps. Along with delivering medical and educational supplies, she started two make-shift medical clinics in two rural villages in El Salvador.

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  • Elliot J. Stamler

    I stumbled on to an article by Dr. Jane Orient and decided just out of curiosity to check her out which in turn led me to your site.
    I am a patient (i.e. civilian.) I live in NYC where I was born but lived for 18 years in S. Calif. Like most senior citizens which I now am, I’ve seen my share of physicians the vast majority of whom have been excellent but in the course of my life I encountered two who were incompetent and two others who were unethical.
    I must tell you I don’t think I ever had a physician like the bunch of you in this anti-AMA extremist organization of hard-core Republican conservatives and if I had the misfortune to encounter one I’d promptly find another doctor. I know of course there are doctors like you — one can only see the conservative Republican representatives and senators in Washington who are M.D.s. I am just grateful we do not have many like them and you here in New York.
    Quite frankly I do not know how you people ever became physicians or why you did; the lot of you strike me as having as much compassion, concern for humanity, appreciation of economic realities for Americans (other than the super rich),as the doctors who worked for Hitler had. I don’t know why you didn’t go into business (as I did with an Ivy League MBA) where the perfectly acceptable ethos is profit maximization (ethically) and personal enrichment.
    All of you in your organization not only revolt me but I think would revolt all of the physicians I am treated by a number of whom hold high academic positions as well as clinical practices.
    You are nothing but the Tea Party with medical degrees. Or worse.

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