Dallas ASOs win fight to keep client info off Web

DSHS wanted patient notes added to secure online server to help in audits; agencies say risk to confidentiality was too great

DAVID TAFFET  |  Staff Writer taffet@dallasvoice.com

Raeline Nobles
LEADING THE FIGHT | Raeline Nobles, executive director of AIDS Arms Inc., took the lead in negotiating with DSHS to keep AIDS service organizations from being forced to put confidential client information on an online server.

Local AIDS agencies have prevailed over a Department of State Health Services mandate to post all confidential client notes on an Internet database.

The agencies began battling the mandate after state officials claimed that ARIES, the new database, would be secure but could not provide a list of who would have access to the system to the agencies.

“That hit me like a brick,” said Don Maison, executive director of AIDS Services Dallas.

He said immigration status, incidents of domestic violence and other personal information would all become public. He sent his staff for training on the system but instructed agency employees not to enter any information.

Bret Camp, associate executive director of health and medical services at Nelson Tebedo Clinic, said, “We have information available for review. We will not be entering information in ARIES.”

Dallas County sided with local AIDS service providers. After almost a year of negotiations, the state compromised and will allow agencies to provide the data needed by the state without posting confidential notes on line.

The only objections to using the system came from Dallas.

Raeline Nobles, executive director of AIDS Arms, said all agencies funded by Ryan White Part B money in Texas would be affected.

Houston doesn’t receive this type of funding. Agencies in other parts of the state told Nobles they were too small to fight the new mandate.

That left Dallas organizations to lead the fight to protect personal information from being compromised on line.

“We were successful,” said Nobles, who led the opposition and negotiated with the state on behalf of the county and Dallas AIDS service providers.

“DSHS has come back and decided to negotiate a fair and equitable deal,” she said. “Austin has done the right thing on behalf of clients and agencies.”

The state agency told both Nobles and Maison that it needed all of the client notes to audit the agencies. They said allowing state officials to examine the agencies without traveling to the various locations across the state would save money. The state, however, pays the county to review agency records.

Greg Beets, DSHS public information coordinator for HIV/STD programs, said that the reason behind ARIES is to codify and evaluate HIV services across the state. He said confidentiality was the state’s biggest concern as well.

“The data helps provide a snapshot of what services are being provided and identify unmet service needs,” Beets said.

Beets said that the system met standards developed at a national level and a series of measures would ensure security. Those measures included limited access to the information on a need-to-know basis, security at the building in which the computer was housed and encrypted information.

Those assurances did not satisfy Dallas AIDS agencies. Nobles pointed out that from time to time information is compromised from financial institutions that spent quite a bit of money on their technology.

“If information ever got out to the public, we’d be liable,” Nobles said.

Several years ago, the state required AIDS organizations to invest millions in new computer record keeping systems. She said all of the information is currently kept on a secure computer database within the agency. That computer system is not Internet-based.

Nobles’ agency raised several hundred thousand dollars to satisfy the unfunded mandate to build their database, and, she said, Parkland spent more than $1 million on their system.

To move the information to the new state computer system would be a complete waste of that money the state required her to raise from local donors, Nobles said.

She explained she feared moving the information off the database to a state system would compromise her credibility with her agency’s donors.

“But privacy is the number one issue,” Nobles said. “We can’t build a reliable relationship with clients if they don’t believe it’s confidential.”

Maison was even more adamant.

“This agency would be in court,” Maison said. “It wouldn’t take a rocket scientist to see what this policy does to make people run from care.”

Maison said people with HIV who use public services give up quite a bit of their privacy, “But to invite the government into your daily life is not acceptable.”

Nobles said she was never arguing about the state’s right to see AIDS Arms’ records. “Any time a government public health funder needs to audit, they can do so,” she said. She said that the information the state needs is statistical information.

But, Nobles added, she couldn’t imagine what use the client notes would have been.

The state will maintain the ARIES system. Nobles said smaller agencies, especially in rural areas that could not afford their own database, might want to use it.

Maison was happy with the outcome.

“I don’t recall being on the same side as the county before,” said Maison, who has headed ASD for more than 20 years.

Camp was also pleased with the outcome. “I’m very pleased Dallas County understood the importance of client confidentiality and backed the service providers,” he said.

This article appeared in the Dallas Voice print edition August 13, 2010.

—  Kevin Thomas

Did the Rainbow Lounge raid prompt TABC to stop arresting people for public intoxication?

In fiscal year 2009, Texas Alcoholic Beverage Commission agents made 761 arrests for public intoxication — a figure that includes a few high-profile ones you may have heard about at the Rainbow Lounge in Fort Worth.

In fiscal year 2010, which began one month after the Rainbow Lounge raid, TABC has made just 81 arrests for public intoxication, The Austin American-Statesman reported over the weekend.

Based on these numbers, one might deduce that the highly controversial raid — which resulted in three agents being fired — also prompted TABC to abruptly change its enforcement practices. But according to the agency, this is only partly true.

TABC officials say the changes really began in fiscal year 2007, two years before the raid. Consider that in fiscal year 2006, TABC agents made a whopping 3,100 public intoxication arrests.

But in response to a long series of controversies — the Rainbow Lounge raid being just one of the latest — TABC began shifting its focus from petty criminal enforcement back to its mandate of regulating the businesses that sell alcohol.

Carolyn Beck, a spokeswoman for TABC who also now serves as its liaison to the LGBT community, told Instant Tea on Monday that’s it’s “impossible to calculate” how much of a factor the Rainbow Lounge raid has been.

“If you look at the decreasing numbers of criminal citations issued by our agents, and the increasing number of hours spent on investigations, it’s clear that we have been moving in this direction since FY 2007,” Beck said. “But you can also see a significant jump forward this fiscal year which started 9/1/09. It’s impossible to calculate how much of that push was in response to the Rainbow Lounge, but certainly incidents like the Rainbow Lounge and the shooting in Austin resulted in our agency direction changing at a faster pace.”

—  John Wright