There are three types of law that govern the practice of any health care profession in any state:
- Statute
- Administrative Rules
- Case Law
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).
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).
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:
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- 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
- 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).