Transparency doesn't work in isolation. If there's a problem where the release of 450,000 pages of patient information is so difficult that it can't be done, then there's a fundamental process fuckup that should be corrected. For example, if everything's on paper, then the process failure is in a lack of transcription. If it's because private information is typed in a form, that form should be broken up in a way so that the important private information is typed into another field. Generally there are ways to make sure these issues don't happen -- from the beginning. Keep in mind, these people are aware of the existence of FOIA and the possibility that these records would be subject to FOIA. These processes should be built with that in-mind, especially considering the importance of the information.
It's such a big deal that in states like Illinois, the law disallows the use of the unduly burdensome exemption if the gov agency doesn't respond within the time limits of the statute. Takes 10k hours? Big deal, shoulda responded in time.
A lot of these issues stem from the fact that in so many cases, the agency's estimates are either beyond any possible worst case scenario (ie, unrealistic), or an intentionally naive estimate in order to urge the requester to go away. If we take these public agencies at face value that something would take forever without litigation, then they can easily just make it a routine process to call something unduly burdensome, so it's important to call them out on their shit. See: https://mchap.io/that-time-the-city-of-seattle-accidentally-...