Not so long ago, in a simpler world, patients needing a copy of their medical records could ask their doctor for them.
But these days, it is not so easy.
Increasingly, medical records are being kept by managed care companies and non-physicians who own medical practices, though state law requires that physicians control the records. A patient seeking records could find they were left with an HMO that has been sold three times.
"There are thousands of situations that go on in Florida every year where physicians that work for group practices, HMOs and prisons who take care of patients, then they (the doctors) leave and go somewhere else and they rely on the institution to take care of their medical records," Tallahassee attorney Wilson Jerry Foster said.
Foster spoke Wednesday at a meeting of a Board of Medicine committee trying to determine what to do about the problem. The issue is so complex that the group left the question of a solution for another meeting.
Who controls medical records is important not only for patients, but also for regulators trying to investigate complaints and doctors trying to defend themselves against charges.
A Board of Medicine rule requires that licensed doctors "maintain the full and total responsibility for and control of all files relating to his patients and his medical practice."
In reality, that is becoming rare. Increasingly, doctors are employed by large companies that maintain the records. Many times, a contract bars doctors from taking their patient records if they leave the company.
"In the real world, probably the majority of physicians practice in a setting in which someone else claims the responsibility, the duty and the right to not only have access to those records, but to control them," said Allen Grossman, the medical board's attorney.
Board members are especially concerned about medical records kept by people or companies not licensed by the state.
The state could pursue administrative action against a licensed doctor, hospital or managed care company that mishandles records, but it would have no recourse against an unlicensed clinic owner.
Finding a workable solution is likely to be difficult and almost certainly will involve the need for new state laws.
The only thing decided Wednesday was the need for more discussion.