HB 5169, An Act Requiring The Establishment Of An Alert In The State-Wide Health Information Exchange Regarding Patients With A History Of Violence Or Combative Behavior Toward A Health Care Provider

TESTIMONY OF THE CONNECTICUT HOSPITAL ASSOCIATION
SUBMITTED TO THE PUBLIC HEALTH COMMITTEE

Wednesday, February 18, 2026

The Connecticut Hospital Association (CHA) appreciates this opportunity to submit testimony concerning HB 5169, An Act Requiring The Establishment Of An Alert In The State-Wide Health Information Exchange Regarding Patients With A History Of Violence Or Combative Behavior Toward A Health Care Provider.  CHA has concerns about the bill, as drafted.

Connecticut hospitals make our state stronger by delivering nationally recognized, world-class care, supporting jobs and economic growth, and serving communities across Connecticut.  Every day, hospitals improve access, affordability, and health equity — providing care to all patients regardless of ability to pay.  At the same time, hospitals invest in their workforce and local communities, even as they navigate significant financial and federal challenges.

HB 5169 seeks to have the Department of Public Health (DPH) develop a statewide reporting and notification system that would require all healthcare providers that are capable of connecting with the statewide Health Information Exchange (HIE), Connie, to send patient-specific reports for the purposes of identifying any and all patients involved in “any incidence of violence or combative behavior that a patient directs at the health care provider or that the health care provider witnesses the patient direct at another health care provider.”

At the outset it is important to state that CHA fully embraces the need to create and maintain safe working environments for healthcare workers and is supportive of analyzing every possible solution to ensure the well-being of the healthcare workforce.  Connecticut hospitals prioritize employee well-being and safe care environments.

HB 5169 is a unique approach to addressing patient-on-worker violence that, while certainly well-intentioned, is likely unworkable in practice unless a variety of legal and operational challenges are addressed. 

If HB 5169 moves forward, we urge that the bill be revised to expressly include important considerations that DPH would be required to review as threshold issues before determining whether this type of reporting system is feasible.  Those issues include the following.

DPH should be required to explore how the bill aligns with all state and federal rules governing patient records and patient privacy rights.

  • HB 5169 is too vague and subjective to meet the “required by law” privacy exception in the HIPAA Privacy Rule (See 45 CFR 164.512). Because federal law requires precision in “required by law” exceptions to patient privacy rights, the reporting threshold would almost certainly need to be statutory and could not be merely outlined in later guidance or DPH policies

  • HIPAA allows patients to amend incorrect information in their records. Under this proposal, it is unclear how this requirement would be addressed. (See 45 CFR 164.526)  

  • DPH should explore whether patient access to information would be required and what challenges that presents. If the identification of the patient as violent or combative becomes part of the medical record kept by Connie, then a patient has a right to access that information without interference or additional steps (under HIPAA and pursuant to federal information blocking rules under the Cures Act) 

  • The information, if made part of the patient’s record, would be difficult (nearly impossible) to remove once entered, even if later determined to be unfounded, unwarranted, or due to a misapprehension or misunderstanding. Per federal rules, the information would also need to be included in every release of the full designated record set (putting it in the hands of all types of recipients)

DPH should be required to explore whether this system creates a new type of record.

  • If the report is not part of the medical record, what is it, and what rules apply for privacy, security, breach, and patient’s/other’s access?

  • If the information is not part of the medical record, does HIPAA cease to apply?

  • What notice would patients be given about the information?

  • What controls would be placed on sharing the information, and how would that work? Could the (potentially uncorroborated) information be used in court against a patient?

  • How could providers have the information in their medical record systems but not apply HIPAA rights and protections?

  • Would the information be shared with prospective employers, law enforcement, and subject to subpoena?

  • If the records are not protected by HIPAA, how can Connie accept them as part of the statewide HIE?

DPH should be required to explore the scope applicable to the reporting thresholds.

  • How does a provider determine what threshold needs to be crossed to trigger a mandatory report?

  • The plain language of the bill draws no distinction between (1) a patient who, in a moment of frustration, uses profanity and is very rude to a physician at the checkout desk because, under the bill, that would be reportable “combative behavior” versus (2) a patient who uses a knife to stab an emergency department staff member.  Under the bill, both instances would have to be reported.  The definitions and reporting requirements must be made extraordinarily clear

    • Does the setting in which the violence or combative behavior occur matter? The bill does not indicate that the setting must be a healthcare setting

    • Would online behavior that is combative meet the reporting threshold?

    • Would medical events potentially causing the behavior be exempt? The plain language of the bill would include all violent or combative patient behavior.  For example, if a patient were sedated and had no knowledge of their combative outburst, does that trigger a mandatory report?  Or a person in labor?  Or a person in detox?

    • Does the reporting apply to all ages of patients?

    • Does 42 CFR Part 2 block reporting of certain patients by substance use disorder (SUD) programs?

    • What should be reported if multiple healthcare providers witness the same incident but have opposing opinions of whether a patient was violent or combative? Is a report required?

DPH should be required to explore how to ensure providers are not unfairly sued for mandatory reporting and determine how insurance would be required to apply.

  • Providers would need to be held harmless and made immune from civil or criminal prosecution in connection with any good faith reports (or good faith non-reports)

  • If claims are made, will insurance be required to defend the provider from the unwarranted or unfair suit or claim?

  • Do state-based providers need additional liability protections?

  • Does Connie need additional liability protections?

DPH should be required to explore whether Connie can be used for a new purpose.

  • Would Connie’s enabling laws need to be changed to allow for this use? Connie’s statutory purposes do not easily lend themselves to this type of reporting or notification.  The statewide HIE is not generally used for policing patient actions

  • How would Connie ingest reports from individual providers when most of the technical connections are with facilities, not with individuals?

  • What role would the Connie board play in this system? (Connie is a unique entity that is not synonymous with a state agency)

DPH should be required to explore how the inclusion of this information could impact patient care.

  • Could healthcare providers use this information to refuse to provide care to certain patients?

  • If the information is used by certain providers in the community to deny care to patients, how might that exacerbate hospital throughput issues?

Thank you for your consideration of our position.  For additional information, contact CHA Government Relations at (203) 294-7301.