New York Law Review

Tag: medical records

  • People v. Ortega, 15 N.Y.3d 610 (2010): Admissibility of Medical Records Under Business Records Exception

    15 N.Y.3d 610 (2010)

    Statements in medical records are admissible under the business records exception to the hearsay rule if they are relevant to diagnosis and treatment; however, statements not related to these purposes are inadmissible.

    Summary

    The New York Court of Appeals addressed whether certain statements in medical records were properly admitted under the business records exception to the hearsay rule. In People v. Benston, the complainant’s medical records included references to “domestic violence” and a “safety plan.” In People v. Ortega, the complainant stated he was “forced to” smoke crack cocaine. The Court held that the references to domestic violence and a safety plan were admissible as relevant to diagnosis and treatment of a domestic violence victim, while the reference to the weapon’s color was harmless error. The statement in Ortega was also admissible, as it related to the treatment of a patient who was the victim of coercion. The Court affirmed both convictions.

    Facts

    People v. Benston: The complainant, who allowed the defendant to live in her apartment, was assaulted and choked by him after she asked him to move out. At the hospital, she reported being strangled by an old boyfriend with a black leather belt, and was diagnosed with “domestic violence [and] asphyxiation.”

    People v. Ortega: The complainant claimed the defendant forced him at gunpoint to smoke crack cocaine and withdraw money from ATMs. He was taken to the hospital, where he reported he “was forced to smoke [a] white substance from [a] pipe.” The defendant testified that the complainant voluntarily smoked crack and handed over his personal property.

    Procedural History

    People v. Benston: The defendant was convicted of assault and other charges. The Appellate Division affirmed. The Court of Appeals affirmed.

    People v. Ortega: The defendant was convicted of criminal possession of stolen property. The Appellate Division affirmed. The Court of Appeals affirmed.

    Issue(s)

    1. Whether references to “domestic violence” and a “safety plan” in a victim’s medical records are admissible under the business records exception to the hearsay rule.

    2. Whether a complainant’s statement that he was “forced to” smoke crack cocaine is admissible under the business records exception.

    Holding

    1. Yes, because with all that has been learned about the scourge of domestic violence in recent decades, we now recognize that it differs materially, both as an offense and a diagnosis, from other types of assault in its effect on the victim and in the resulting treatment.

    2. Yes, because treatment of a patient who is the victim of coercion may differ from a patient who has intentionally taken drugs.

    Court’s Reasoning

    The Court relied on CPLR 4518(a), which allows admission of records made in the regular course of business if made at the time of the event or within a reasonable time thereafter. Hospital records are considered trustworthy because they are relied upon in matters of life and death and reflect the patient’s motivation to report accurately.

    The Court distinguished Williams v. Alexander, where a statement about how an accident occurred was deemed inadmissible because it was irrelevant to diagnosis or treatment. The Court noted, however, that in some situations, how an injury occurred may be helpful to medical understanding.

    In Benston, the Court found the relationship between the parties clearly one subject to classification as involving domestic violence. “In this context, it is relevant for purposes of diagnosis and treatment that complainant’s assault was at the hands of a former boyfriend.” The Court emphasized that domestic violence differs materially from other assaults, requiring consideration of psychological and trauma issues. Developing a safety plan and providing information about social services are important parts of treatment.

    In Ortega, the statement that the complainant was “forced to” smoke crack was relevant, as the amount and nature of the substance ingested, and the fact that it was coerced, can impact treatment.

    Judge Smith concurred, arguing that the business records exception alone is insufficient to admit the statements, as it does not address hearsay within hearsay. He proposed adopting a medical diagnosis and treatment exception to the hearsay rule, justifying it by the intrinsic reliability of statements to one’s own doctor.

    Judge Pigott concurred in the result only, arguing that the content of medical records should be subject to redaction of irrelevant information. The “diagnosis” of domestic violence and references to a “safety plan” should not have been admitted because “whether complainant was strangled by a former intimate partner or by a stranger was irrelevant to the type of treatment she received for her physical injuries.”

  • Mantica v. New York State Department of Health, 94 N.Y.2d 58 (1999): Patient Access to Medical Records Under FOIL

    Mantica v. New York State Department of Health, 94 N.Y.2d 58 (1999)

    A patient may obtain their own medical records from a state agency under New York’s Freedom of Information Law (FOIL), even with Public Health Law § 18(6)’s restrictions on third-party redisclosure, unless those records contain information that could cause substantial harm to the patient or others, or contain privileged doctor’s notes.

    Summary

    James Mantica sought his medical records from the New York State Department of Health (DOH) under FOIL after receiving allegedly deficient medical care. DOH denied the request, citing Public Health Law § 18(6), which restricts third-party redisclosure of patient information. The New York Court of Appeals held that Mantica was entitled to his records because the intent of Public Health Law § 18(6) was not to prevent patients from accessing their own medical records, but rather to prevent disclosure to other third parties. The Court emphasized that FOIL mandates broad disclosure unless a specific statutory exemption applies and the agency demonstrates that the material qualifies for exemption.

    Facts

    James Mantica received allegedly deficient medical care at St. Peter’s Hospital, leading to the amputation of his legs. His wife filed a complaint with the DOH. Subsequently, the Manticas commenced a medical malpractice action against several physicians and the hospital. They requested Mantica’s medical records from DOH, who provided redacted versions of some documents. When a second, more detailed request invoking FOIL was denied, the Manticas initiated a CPLR article 78 proceeding to compel disclosure.

    Procedural History

    The Supreme Court initially ordered disclosure, except for quality assurance review activities. The Appellate Division affirmed, stating that denying a patient their own health information was illogical. The New York Court of Appeals granted DOH leave to appeal, limiting the scope to the production of Mantica’s medical records.

    Issue(s)

    Whether a patient can obtain their own medical records from a state agency under FOIL, notwithstanding Public Health Law § 18(6)’s prohibition against redisclosure of patient information by third parties.

    Holding

    Yes, because the legislative intent of Public Health Law § 18(6) was to protect patient privacy by preventing disclosure to third parties, not to deny patients access to their own medical information. Public Health Law § 18(3) and (4) might provide a specific statutory exception to FOIL, and the patient might be required to obtain the records directly from the health care provider pursuant to section 18, if the records contain information that could cause substantial harm to the patient or others, or contain privileged doctor’s notes.

    Court’s Reasoning

    The Court of Appeals reasoned that FOIL imposes a broad standard of open disclosure on government agencies, and documents are presumptively discoverable unless a specific statutory exemption applies. The burden rests on the agency to demonstrate that the requested material qualifies for exemption. DOH argued that Public Health Law § 18(6) provided such an exemption. However, the court determined that the intent of § 18(6) was to prevent disclosure of confidential medical records to third parties, not to patients themselves. The Court cited the legislative record, including a DOH memorandum recommending approval of the bill, which stated, “There is no legitimate reason to withhold information related to a person’s physical health from that person particularly when insurers, government agencies and employers are routinely granted access.” The Court clarified that a patient’s right to access their records is not absolute; Public Health Law § 18(3) allows denial of access if the information could cause “substantial and identifiable harm” or contains privileged doctors’ notes, with a detailed mechanism for administrative and judicial review. However, since there was no allegation of harmful information or privileged notes in this case, § 18(3) and (4) did not provide an exemption to FOIL. The Court emphasized that the patient’s right to obtain the records under FOIL is not diminished by the possibility of obtaining them directly from the hospital under § 18. The Court stated, “Information so disclosed should be kept confidential by the party receiving such information and the limitations on such disclosure in this section shall apply to such party.”

  • Matter of Grand Jury Investigation in Onondaga County, 59 N.Y.2d 130 (1983): Physician-Patient Privilege and Grand Jury Subpoenas

    Matter of Grand Jury Investigation in Onondaga County, 59 N.Y.2d 130 (1983)

    A grand jury subpoena seeking the names and addresses of hospital patients treated for stab wounds, even when limited to a specific timeframe, is impermissible as it violates the physician-patient privilege because compliance would necessarily reveal privileged information about diagnosis and treatment.

    Summary

    The Onondaga County District Attorney issued a grand jury subpoena to a hospital, seeking medical records of patients treated for stab wounds within a specific timeframe, believing a homicide victim may have stabbed her assailant. After the hospital moved to quash the subpoena, the DA narrowed the request to just names and addresses. The New York Court of Appeals held that even the limited subpoena violated the physician-patient privilege. The court reasoned that providing names and addresses would inherently disclose privileged information regarding the patient’s diagnosis and treatment, thus undermining the purpose of the privilege. The court also emphasized that any exceptions to the privilege are the responsibility of the legislature and that the public interest does not automatically override statutory protections.

    Facts

    On June 16, 1982, a woman was found murdered. The District Attorney of Onondaga County suspected the victim may have stabbed her assailant before her death.
    In an effort to identify the potential assailant, the District Attorney issued a grand jury subpoena to a local hospital on June 17, 1982.
    The initial subpoena demanded “any and all medical records pertaining to treatment of any person with stab wounds or other wounds caused by a knife, from June 15, 1982 to the present time.”
    Subsequently, the District Attorney limited the subpoena via letter to the “[n]ames and addresses of those treated for stab wounds or other wounds caused by a knife from June 15, 1982 through June 17, 1982”.

    Procedural History

    The hospital moved to quash the original subpoena, arguing it violated the physician-patient privilege and the constitutional right to privacy.
    County Court denied the motion to quash but stayed enforcement pending appeal.
    The Appellate Division reversed the County Court’s order, granted the motion to quash, and quashed the subpoena.
    The District Attorney appealed to the New York Court of Appeals.

    Issue(s)

    Whether a grand jury subpoena requesting the names and addresses of patients treated for stab wounds, even when limited to a specific time frame, violates the physician-patient privilege.
    Whether the public interest in investigating a homicide overrides the physician-patient privilege.

    Holding

    Yes, because revealing the names and addresses of patients treated for stab wounds would necessarily disclose privileged information regarding their diagnosis and treatment.
    No, because the legislature has created specific exceptions to the physician-patient privilege, and the courts should not create additional exceptions based on public policy concerns without legislative guidance. “Those exceptions to the privilege make clear the legislative concept that exceptions to the statutorily enacted physician-patient privilege are for the Legislature to declare.”

    Court’s Reasoning

    The Court of Appeals emphasized that the physician-patient privilege is statutory and must be construed broadly to encourage full disclosure by patients to their physicians. CPLR 4504(a) prohibits the disclosure of information acquired by a physician or hospital in attending a patient in a professional capacity, where such information was necessary to enable the physician to act in that capacity. While facts plain to observation without expert knowledge are not privileged, the act of seeking treatment for a stab wound and its associated diagnosis and treatment are inherently confidential.
    The court distinguished cases where only the names and addresses of a doctor’s patients or photographs of patients meeting a description were sought, noting those did not necessarily reveal privileged information.
    The court acknowledged that while the privilege belongs to the patient, a hospital may assert it on behalf of a patient who has not waived it, even if the patient is suspected of a crime.
    The court rejected the District Attorney’s argument that the public interest in investigating a homicide overrides the privilege, stating that exceptions to the privilege are for the legislature to declare. The court noted the legislature had created specific exceptions, such as for child abuse and certain firearm-related injuries, implying a deliberate choice not to create a broad exception for all violent crimes. The court noted, “specific exceptions to the physician-patient privilege have been enacted by the Legislature…Those exceptions to the privilege make clear the legislative concept that exceptions to the statutorily enacted physician-patient privilege are for the Legislature to declare.”

  • Matter of Levin v. State Bd. for Professional Medical Conduct, 59 N.Y.2d 35 (1983): Threshold for Subpoenaing Medical Records

    Matter of Levin v. State Bd. for Professional Medical Conduct, 59 N.Y.2d 35 (1983)

    To sustain a subpoena for medical records issued by the State Board for Professional Medical Conduct based on a third-party complaint, a minimal threshold showing of the complaint’s authenticity and sufficient substance to warrant investigation is required.

    Summary

    This case concerns the authority of the State Board for Professional Medical Conduct to subpoena a physician’s patient records based on third-party complaints. The Court of Appeals held that while the Board has the power to issue such subpoenas, a minimal showing of the authenticity and substance of the triggering complaint is required to justify the intrusion. The Court emphasized that this threshold protects physicians from unwarranted investigations while allowing the Board to fulfill its duty to investigate legitimate complaints. The court reversed the Appellate Division’s order in Levin and affirmed the order in McGrath, quashing the subpoenas due to the Board’s failure to demonstrate the authenticity of the underlying complaints.

    Facts

    Dr. Levin received a subpoena to produce records for three named patients based on a complaint alleging professional misconduct in treatment methods. Dr. McGrath received a subpoena to produce records for all patients treated during a specific afternoon, later modified to female patients and one male patient, based on a complaint regarding dangerous drug treatment methods. Both doctors moved to quash the subpoenas, arguing insufficient basis and relevance.

    Procedural History

    In Levin, the Supreme Court granted the motion to quash the subpoena, but the Appellate Division reversed. The Court of Appeals then heard Dr. Levin’s appeal as of right. In McGrath, Special Term denied the motion to quash, but the Appellate Division reversed. The State Board appealed to the Court of Appeals as of right.

    Issue(s)

    Whether the State Board for Professional Medical Conduct must establish a minimal threshold showing of the authenticity and substance of a third-party complaint to justify the issuance of a subpoena for medical records in an investigation of a physician.

    Holding

    Yes, because to warrant the issuance of a subpoena in furtherance of an investigation, undertaken in consequence of receipt of a complaint or otherwise, there must be a showing that there exists “some basis for inquisitorial action.”

    Court’s Reasoning

    The Court recognized the State’s police power to regulate medicine and the Board’s authority to investigate professional misconduct. However, it emphasized the need to balance this authority against the privacy of patient records and the potential for abuse. The Court held that a bare recital of receiving a complaint, without identifying or authenticating details, is insufficient to justify a subpoena. The Court emphasized that while the Board must investigate all complaints, it can verify their authenticity without resorting to subpoenas at the outset. The court quoted A’Hearn, stating, “There must be authority, relevancy, and some basis for inquisitorial action.” The court clarified that the required showing relates to the authenticity of the complaint, not a full substantiation of the charges, and suggested that details like the complainant’s reliability, basis for knowledge, or specific details within the complaint could suffice. The court observed that, absent such a threshold showing, governmental agencies could launch intrusive investigations against individuals without minimal warrant.

  • In re Grand Jury Subpoena Duces Tecum, 45 N.Y.2d 677 (1978): Required Records Exception to Fifth Amendment Privilege

    In re Grand Jury Subpoena Duces Tecum, 45 N.Y.2d 677 (1978)

    The Fifth Amendment privilege against self-incrimination does not apply to records that are required by law to be kept and are subject to governmental regulation and inspection.

    Summary

    This case addresses whether physicians can invoke the Fifth Amendment privilege against self-incrimination to avoid producing records subpoenaed by a grand jury. The New York Court of Appeals held that the “required records exception” to the Fifth Amendment privilege applies because the physicians were legally obligated to maintain the records, which were subject to governmental inspection. This exception ensures that regulatory laws are enforceable by preventing individuals from using the Fifth Amendment to shield required records.

    Facts

    A Grand Jury issued a subpoena duces tecum to physician appellants, demanding the production of certain medical and billing records. These records related to patient treatments and financial transactions. The physicians refused to produce the records, asserting their Fifth Amendment privilege against self-incrimination, arguing that the records could potentially incriminate them.

    Procedural History

    The lower courts ordered the physicians to produce the subpoenaed records. The physicians appealed, arguing that the subpoena violated their Fifth Amendment rights. The Appellate Division affirmed the lower court’s decision. The New York Court of Appeals then reviewed the case.

    Issue(s)

    1. Whether the Fifth Amendment privilege against self-incrimination protects physicians from being compelled to produce medical and billing records that they are required by law to maintain and are subject to governmental inspection.
    2. Whether the demand for billing records exceeded the scope of disclosure permitted under Section 17 of the Public Health Law.

    Holding

    1. No, because the required records exception to the Fifth Amendment privilege applies to records that are required by law to be kept and are subject to governmental regulation and inspection.
    2. The court did not rule on this issue because of its holding regarding the required records exception rendering the issue moot.

    Court’s Reasoning

    The Court of Appeals reasoned that the Fifth Amendment privilege, which typically protects private papers from compelled disclosure, does not extend to records required to be kept by law and subject to governmental regulation. The court relied on the “required records exception,” citing Shapiro v. United States, Davis v. United States, Wilson v. United States, Matter of Cappetta, and Matter of Sigety v. Hynes. These cases establish the principle that allowing the Fifth Amendment privilege to protect such records would undermine the enforcement of state and federal laws.

    The court emphasized that physicians were legally obligated to maintain the subpoenaed records under 8 NYCRR 29.2(3) and, under certain circumstances, to make them available for governmental inspection as per Public Health Law § 230(10)(k). Therefore, the court held that the physicians’ personal privilege against self-incrimination did not apply to the records sought.

    The court quoted United States v. White, stating that to allow the privilege to cloak such records would make enforcement of State and Federal laws impossible.

    The court found it unnecessary to rule on the appellants’ claim that the demand for billing records exceeded the scope of disclosure pursuant to section 17 of the Public Health Law, noting that CPL 190.40(1) requires witnesses in Grand Jury proceedings to provide “any evidence legally requested”. The Court disposed of the appeal based on the “required records exception”.

  • Short v. Board of Managers, 57 N.Y.2d 399 (1982): Limits on Deletion of Identifying Details Under Freedom of Information Law

    Short v. Board of Managers, 57 N.Y.2d 399 (1982)

    The statutory authority to delete identifying details to facilitate disclosure under the Freedom of Information Law (FOIL) is limited to records where disclosure would constitute an unwarranted invasion of personal privacy and does not extend to records specifically exempted from disclosure by state or federal statute.

    Summary

    John Short sought access to medical records related to Medicaid reimbursements for abortions. The New York Court of Appeals addressed whether a state agency could be compelled to disclose records otherwise exempt from disclosure under FOIL after deleting identifying details. The Court held that the deletion of identifying details only applies to records whose disclosure would constitute an unwarranted invasion of privacy, but not to records exempted by other statutes. Therefore, the medical records, protected by state statutes ensuring patient confidentiality, remained exempt even after the proposed deletion of identifying information. The memorandum was subject to in camera review to determine if statistical or factual data existed.

    Facts

    John Short requested copies of 29 medical records from the Nassau County Medical Center related to Medicaid reimbursement claims for abortions performed between February and April 1972. He also sought a copy of a memorandum from the medical center to a Deputy County Attorney regarding medically related abortions at the center during 1972. The medical center denied the request based on statutory exemptions. Short then initiated a legal action to compel the medical center to release the records.

    Procedural History

    The Supreme Court directed disclosure of the 29 medical records after deletion of personal identifying details, with the medical center determining the extent of deletion. The court denied disclosure of the July 1972 memorandum. The medical center appealed the order to disclose the medical records, while Short cross-appealed the denial of access to the memorandum. The Appellate Division affirmed the Supreme Court’s judgment. Both parties then appealed to the New York Court of Appeals.

    Issue(s)

    1. Whether the Freedom of Information Law requires disclosure of medical records, otherwise exempt under state statutes protecting patient confidentiality, if personal identifying details are deleted?

    2. Whether an interagency memorandum is entirely exempt from disclosure under FOIL, even if it contains statistical or factual data?

    Holding

    1. No, because the authority to delete identifying details applies only to records whose disclosure would constitute an unwarranted invasion of personal privacy, not to records already exempted from disclosure by other statutes like those protecting patient confidentiality.

    2. No, because statistical or factual tabulations or data within an interagency memorandum are subject to disclosure, requiring an in-camera inspection to determine if such data exists.

    Court’s Reasoning

    The Court of Appeals reasoned that the Freedom of Information Law allows agencies to deny access to records specifically exempted from disclosure by state or federal statute, as outlined in Public Officers Law § 87(2)(a). The medical records in question were protected by Public Health Law §§ 2803-c and 2805-g, and Social Services Law § 369, which ensure patient privacy and confidentiality of medical records. The court emphasized that the provision for deleting identifying details, found in Public Officers Law § 89(2), applies only to records whose disclosure would constitute an unwarranted invasion of personal privacy. This provision does not extend to records exempted by other statutes. The court stated, “What is intended and accomplished by subdivision 2 of section 89 is provision of a means by which the single obstacle to disclosure — the invasion of personal privacy — may be overcome, i.e., by deleting identifying details.” Since the medical records were not “otherwise available” due to statutory exemptions, the deletion provision was inapplicable. Regarding the memorandum, the Court acknowledged its general exemption as “inter-agency or intra-agency materials” under § 87(2)(g), but noted the exception for “statistical or factual tabulations or data.” Thus, the case was remanded for an in-camera inspection to determine if such data existed within the memorandum. Chief Judge Cooke dissented in part, arguing that the court has discretionary power to order disclosure of patient records with identifying information deleted to promote public accountability. The majority rejected this argument, holding the statute does not permit such judicial revision.