Individual states have differing requirements for the length of time patient records must be retained by the facility which produced them. Each doctor is responsible for this knowledge and for the retention of the records for the required length of time.
General Recommendations
Many states have no actual retention time specified in law; rather, retention time is a nebulous amount of time in which the x-rays might be needed for comparison to subsequent x-rays or for use in a possible malpractice case. Since the statute of limitation for malpractice varies widely among various states, there is much confusion as to retention times. Obviously, the space requirements and expense of storage create a desire to purge records when it is safe to do so.
Balancing this, many authorities recommend retaining x-rays for 10 years, although other authorities recommend keeping them almost indefinitely.
In many states, radiographs of children should be retained until the child reaches adulthood (actual age varies in different states).
In Washington state it seems quite safe to discard records, including x-rays, after 10 years. Chiropractors in Washington state may discard records after five years according to WAC 246-808-650(1) (see below); however, the Washington state Department of Labor and Industries requires doctors of all specialties to store x-rays on injured workers for 10 years (see below).
Ultimately, the doctor must decide the length of time to store x-rays and other case records. Most doctors feel that there is very little need to store records beyond 10 years. A doctor generally would not be faulted if he could not come up with x-rays that were produced over 10 years previously; however, if you have room, you might as well keep them.
Any stored x-rays should be kept in a safe location under adequate conditions of temperature and humidity.
Specific Washington State Laws
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Applicable |
WAC 246-808-650 “RECORDS AND X-RAYS AND WITHDRAWAL FROM PRACTICE” — MAINTENANCE AND (1) Any chiropractor who treats patients in the state of Washington shall maintain all treatment records regarding patients treated. These records may include, but shall not be limited to treatment plans, patient charts, patient histories, correspondence, financial data, and billing. These records shall be retained by the chiropractor for five years in an orderly, accessible file and shall be readily available for inspection by the chiropractic disciplinary board or its authorized representative: PROVIDED, that x-rays or copies of records may be forwarded pursuant to a licensed agent’s written request. Also, office records shall state the date on which the records were released, method forwarded and to whom, and the reason for the release. A reasonable fee may be charged the patient to cover mailing and clerical costs. (2) A chiropractor shall honor within fifteen days a written request from an adult patient or their legal representative or that of a minor child to release original x-rays on a loan basis to other licensed health care providers or the A chiropractor who has received original x-rays on a loan basis shall return them to the loaning chiropractor within sixty days unless other arrangements are made. |
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L&I Regs: Applicable |
WAC 296-20-121: X-rays. Recognizing the greatest need for access to x-rays lies with the attending doctor, the department or self-insurer requires only submission of x-ray findings and does not require submission of the actual films except upon specific request when needed for purposes of permanent disability rating, other administrative or legal decisions, or in litigation cases. The department or self-insurer requires the attending doctor retain x-rays for a period of not less than ten years. In transfer cases, the x-rays in the possession of the current attending doctor must be made available to the new attending doctor. When requesting consultation, the attending doctor should make any x-rays in his possession available to the consultant. When a special exam has been arranged for the worker by the department or self-insurer, the worker’s existing x-rays should be provided to the special examiner. The worker may carry such x-rays to the exam. When the doctor’s office is closed because of death, retirement, or leaving the state, arrangements must be made with the department or self-insurer regarding custody of x-rays to ensure availability on request. |
How to dispose of x-rays
Films to be discarded are not thrown away but are recycled for silver reclamation. Commercial silver reclaimers will buy used film by the pound if there is a particularly large amount; otherwise, call the nearest large x-ray facility that is still using film and see if they collect film for recycling. To find a source for film recycling, first ask your film supplier. If they do not offer the service, you may be able to find silver reclaimers by googling “Film Scrap” or “Silver Salvage” or “Metal Refineries.” You do not need to cut the patient ID off the x-rays, as commercial film recyclers have usually prepared HIPAA Business Associate agreements. Even if they have not, they are accustomed to handling medical images, and they handle all film using bulk methods that never involve staff persons looking at individual films before they are incinerated.