Physician "gag clause" and hydraulic fracturing in Pennsylvania

In February 2012, Pennsylvania enacted Act 13 which created an impact fee for unconventional gas drilling "fracking", set boundaries where gas drilling could be permitted, limited the power of local townships to set zoning limits on gas drilling and created a non disclosure requirement for physicians treating a patient with exposure to "fracking" fluid. Physicians must request in writing the name of any proprietary chemical used in the fracking process if they suspect it is necessary to properly treat an exposed patient. The proprietary chemical may not be further disclosed. Interpretations of further disclosure remains unclear at this point. For example, disclosure may or may not be shared with specialists, occupational medicine doctors, patients or public health officials. Writing the name of chemical in a patient chart may be subject to prosecution.

The Medical Society has chosen not to object to this restriction on physician autonomy citing a letter from the Secretary of Health that physicians are free to share this information with others. Subsequently, the Secretary of Health was fired.

The gas industry has cited the Pennsylvania law as a model to be used in other states. As of this writing, no lawsuits have been filed to test this law. However, there are significant legal, ethical, and public health issues raised by the non disclosure agreements which limit what doctors may do in treating patients and limit the ability to create the evidence needed to assess the impact of fracking on health. This paper will discuss these issues.