Health department, psychiatrist lock horns over sharing of private medical information

The Yukon government says it does not require complete patient charts from physicians for billing purposes, following claims from a local psychiatrist that he’s being asked to give over sensitive information in order to be paid.

The Yukon government says it does not require complete patient charts from physicians for billing purposes, following claims from a local psychiatrist that he’s being asked to give over sensitive information in order to be paid.

But Dr. Armando Heredia insists he has nearly 300 outstanding requests — he calls them yellow sheets — from the insured health office asking for medical records that include “full notes, full assessments, full charts,” with more coming in all the time. He said the problem ramped up about five years ago.

Heredia said he has refused to share complete medical records with the government, and is therefore not being paid for many of the services he provides. He said he’s now owed more than $100,000.

“Patients have no idea that their doctors are being put under pressure to provide private medical information to make a living,” he said. “Why do you need to know somebody’s most intimate secrets, most intimate feelings, in order to get the doctor paid?”

Shauna Demers, director of insured health with the Department of Health and Social Services, said that when physicians bill the government, they must provide the patient’s health-care number, a code corresponding to the patient’s diagnosis and a fee code indicating how much they should be paid for different services.

They must also provide referral letters from general practitioners, though Demers said treatments, conditions and specific concerns about a patient’s health should be redacted from those letters.

But if information is missing from billing claims, or if there is anything unusual about them, the government can suspend the claims until the physician submits additional information.

That’s where Heredia and Demers disagree about what insured health requires.

Demers said the government generally wants evidence that a patient was referred to a consulting physician, like a psychiatrist. That could include a written report from the consultant to the referring physician, with sensitive information deleted.

“It’s just confirmation that they were seen by the one provider and referred to another,” she said. “We have never requested entire patient charts.”

But Heredia disputes that, saying there is no indication in the requests from insured health that certain information should be redacted. He said that even if physicians are allowed to redact sensitive information, they’re not being told how.

“Have they actually sent something out to the doctors about how you’re supposed to do it?” he said. “The answer would be no, because I’m probably the one they would send it to first.”

Health department spokesperson Pat Living confirmed that it is physicians’ responsibility to redact private information.

“It’s up to the physician to ensure that they’re only providing us with the information we need,” she said.

Insured health can also conduct audits of physicians’ records. Demers said all physicians will be audited from time to time, especially when they’re new to the territory, to make sure they understand how the system works.

But they will also be audited if there are “anomalies” in their billing claims, she said — for instance, if a physician is billing especially high fee codes compared to others that provide similar services.

Heredia said he was audited twice soon after he arrived in the territory, around 2003. Last year, he received another audit request, but he said it was cancelled before it happened. He claims he would have refused to allow government officials to look through his records.

But he said there’s nothing unusual about his billing. He believes he’s being targeted because he has refused to turn over complete medical records to the government.

“In the end, I’ve accumulated so many (yellow sheets) because I don’t comply, and more than likely I receive more than most because I don’t comply,” he said.

He said other physicians have told him they avoid billing certain codes altogether, for fear they will produce yellow sheets.

“I think the system has caused the physicians to modify what they bill in order to get paid,” he said.

Dr. Alison Freeman, president of the Yukon Medical Association, which represents local physicians, told the News in a statement that the confidentiality of patients’ health information is “paramount and fundamental to the doctor-patient relationship.”

“The YMA will continue to advocate for the appropriate balance between the confidentiality of medical records and the information required by government to ensure fiscal responsibility.”

Still, Demers insists that the Yukon government’s practices are compliant with Yukon’s Health Information Privacy and Management Act (HIPMA), which came into force in August 2016.

HIPMA states that a physician can disclose a patient’s personal health information to the government without the patient’s consent “to the extent necessary for payment for health care or other related goods, services or benefits provided to the individual.”

Demers said the Yukon legislation is “not unlike other jurisdictions in Canada.”

A spokesperson for B.C.’s Ministry of Health explained by email that “In most cases, patient charts are not required for billing — however, they may be required if there is an audit of a physician’s billing.”

Diane McLeod-McKay, the Yukon’s information and privacy commissioner, said HIPMA is complicated, but it does lay out very specific instances in which personal information can be shared without a patient’s consent.

“It’s supposed to maximize privacy protection,” she said. “But it also has to be balanced against the system’s need to have information.”

She said the act is a good piece of legislation, but “there’s still a lot of work to be done to improve the level of compliance in the Yukon.”

McLeod-McKay is currently investigating complaints about the collection of medical information by insured health, and she’s urging others with concerns to contact her office.

“I think my biggest concern here right now is I would be very concerned if people suddenly became afraid to go to their doctor,” she said.

But Heredia lays that responsibility at the government’s doorstep.

“Fix the system so people can be comfortable seeing their doctor.”

Contact Maura Forrest at

Get local stories you won't find anywhere else right to your inbox.
Sign up here

Just Posted

Children’s performer Claire Ness poses for a photo for the upcoming annual Pivot Festival. “Claire Ness Morning” will be a kid-friendly performance streamed on the morning of Jan. 30. (Photo courtesy Erik Pinkerton Photography)
Pivot Festival provides ‘delight and light’ to a pandemic January

The festival runs Jan. 20 to 30 with virtual and physically distant events

The Boulevard of Hope was launched by the Yukon T1D Support Network and will be lit up throughout January. It is aimed at raising awareness about Yukoners living with Type 1 diabetes. (Stephanie Waddell/Yukon News)
Boulevard of Hope sheds light on Type 1 diabetes

Organizers hope to make it an annual event

City of Whitehorse city council meeting in Whitehorse on Oct. 5, 2020. An updated council procedures bylaw was proposed at Whitehorse city council’s Jan. 18 meeting that would see a few changes to council meetings and how council handles certain matters like civil emergencies. (Crystal Schick/Yukon News file)
Whitehorse procedures bylaw comes forward

New measures proposed for how council could deal with emergencies

A Yukon survey querying transportation between communities has already seen hundreds of participants and is the latest review highlighting the territory’s gap in accessibility. (Crystal Schick/Yukon News file)
Multiple reports, survey decry lack of transportation between Yukon communities

A Community Travel survey is the latest in a slew of initiatives pointing to poor accessibility

Mobile vaccine team Team Balto practises vaccine clinic set-up and teardown at Vanier Catholic Secondary School. Mobile vaccine teams are heading out this week to the communities in order to begin Moderna vaccinations. (Haley Ritchie/Yukon News)
Mobile vaccine teams begin community vaccinations

“It’s an all-of-government approach”

A file photo of grizzly bear along the highway outside Dawson City. Yukon conservation officers euthanized a grizzly bear Jan. 15 that was originally sighted near Braeburn. (Alistair Maitland/Yukon News file)
Male grizzly euthanized near Braeburn

Yukon conservation officers have euthanized a grizzly bear that was originally sighted… Continue reading

Mayor Dan Curtis listens to a councillor on the phone during a city council meeting in Whitehorse on April 14, 2020. Curtis announced Jan. 14 that he intends to seek nomination to be the Yukon Liberal candidate for Whitehorse Centre in the 2021 territorial election. (Crystal Schick/Yukon News)
Whitehorse mayor seeking nomination for territorial election

Whitehorse mayor Dan Curtis is preparing for a run in the upcoming… Continue reading

Gerard Redinger was charged under the <em>Civil Emergency Measures Act</em> with failing to self-isolate and failing to transit through the Yukon in under 24 hours. (Joel Krahn/Yukon News file)
Man ticketed $1,150 at Wolf Creek campground for failing to self-isolate

Gerard Redinger signed a 24-hour transit declaration, ticketed 13 days later

Yukon Energy, Solvest Inc. and Chu Níikwän Development Corporation are calling on the city for a meeting to look at possibilities for separate tax rates or incentives for renewable energy projects. (Crystal Schick/Yukon News file)
Tax changes sought for Whitehorse energy projects

Delegates call for separate property tax category for renewable energy projects

Yukon University has added seven members to its board of governors in recent months. (Crystal Schick/Yukon News file)
New members named to Yukon U’s board of governors

Required number of board members now up to 17

Yukonomist Keith Halliday
Yukonomist: Your Northern regulatory adventure awaits!

“Your Northern adventure awaits!” blared the headline on a recent YESAB assessment… Continue reading

Yukoner Shirley Chua-Tan is taking on the role of vice-chair of the social inclusion working group with the Canadian Academy of Health Sciences’ oversight panel and working groups for the autism assessment. (Submitted)
Canadian Academy of Health Sciences names Yukoner to panel

Shirley Chua-Tan is well-known for a number of roles she plays in… Continue reading

Most Read