New York Law Review

Tag: physician-patient privilege

  • Chanko v. American Broadcasting Companies, Inc., 27 N.Y.3d 46 (2016): Breach of Physician-Patient Confidentiality and Intentional Infliction of Emotional Distress

    27 N.Y.3d 46 (2016)

    A physician’s duty to maintain patient confidentiality, established by statute, is breached when confidential information is disclosed to those not involved in the patient’s care, and is not dependent on the sensitivity or embarrassment associated with the information; claims for intentional infliction of emotional distress require conduct that is extreme and outrageous, exceeding all bounds of decency.

    Summary

    The New York Court of Appeals addressed a case involving the filming of a patient’s medical treatment and death in a hospital emergency room for a television documentary. The court held that the hospital and treating physician could be liable for breach of physician-patient confidentiality due to unauthorized disclosure, but that the conduct did not rise to the level of “extreme and outrageous” required for intentional infliction of emotional distress. The court emphasized the breadth of the physician-patient privilege and the high standard for intentional infliction of emotional distress claims, distinguishing this case from prior rulings.

    Facts

    Mark Chanko was treated at New York-Presbyterian Hospital after being hit by a car. While he was being treated, an ABC News crew filmed a documentary series, with the hospital’s permission, but without Chanko’s or his family’s knowledge or consent. After Chanko’s death, the filming continued, and the events were included in an episode of the documentary series, 16 months later his widow, Anita Chanko, and other family members saw the footage, leading to distress. The family sued the hospital, the physician, and ABC, alleging breach of confidentiality and intentional infliction of emotional distress.

    Procedural History

    The trial court dismissed most claims but allowed breach of physician-patient confidentiality against the hospital and physician, and intentional infliction of emotional distress against all defendants, to proceed. The Appellate Division reversed, dismissing the entire complaint. The Court of Appeals granted the plaintiffs leave to appeal, addressing the viability of these claims.

    Issue(s)

    1. Whether the complaint sufficiently states a cause of action against the hospital and physician for breach of physician-patient confidentiality.

    2. Whether the conduct of the defendants was sufficiently “extreme and outrageous” to support a claim for intentional infliction of emotional distress.

    Holding

    1. Yes, because the complaint alleged an unauthorized disclosure of confidential medical information, and the physician-patient privilege should be construed broadly.

    2. No, because the defendants’ conduct, while potentially insensitive, did not meet the high threshold of “extreme and outrageous” behavior required for this tort.

    Court’s Reasoning

    The court found the breach of physician-patient confidentiality claim was adequately stated. The physician-patient privilege, codified in CPLR 4504, aims to encourage open communication between patients and providers by protecting patient privacy. The privilege covers all information acquired during treatment and is not limited to embarrassing information. Here, the hospital and doctor allowed the filming and disclosure to the film crew without the patient’s consent. The court noted that a lack of consent could be inferred from the allegations of the complaint.

    Regarding intentional infliction of emotional distress, the court found the defendants’ actions were not sufficiently outrageous. The court emphasized that this tort requires conduct “so outrageous in character, and so extreme in degree, as to go beyond all possible bounds of decency, and to be regarded as atrocious, and utterly intolerable in a civilized community.” The court cited prior cases where the behavior was not found outrageous enough to satisfy this standard. The fact that the footage shown was edited to include less than three minutes of content was a significant factor in the court’s decision. Therefore, the court held that the defendants’ conduct, while reprehensible, did not meet the stringent standard required to support this claim.

    Practical Implications

    This case clarifies the scope of the physician-patient privilege in New York, emphasizing its broad protection of medical information. It serves as a reminder that any disclosure of such information to unauthorized parties can form the basis of a breach of confidentiality claim. It also underscores the high bar for establishing intentional infliction of emotional distress. Attorneys should carefully assess whether the conduct alleged is truly “extreme and outrageous” and, if not, should consider other causes of action.

    This case affects how hospitals, physicians, and media companies must act in their relationships with patients, especially in situations involving filming or recording. It also highlights the need for healthcare providers to balance their need to give information, the privacy concerns of patients, and the need to obtain informed consent before filming medical treatments and sharing patient information with external parties. The standard the court applied for intentional infliction of emotional distress continues to be a major hurdle for plaintiffs seeking damages on this basis.

  • People v. Williams, 24 N.Y.3d 256 (2014): Physician-Patient Privilege and Confidentiality in Criminal Proceedings

    People v. Williams, 24 N.Y.3d 256 (2014)

    The physician-patient privilege, codified in CPLR 4504(a), protects confidential communications made by a patient to a physician during treatment, even if the physician is required to report certain information to authorities.

    Summary

    A defendant was convicted of sexual abuse based in part on testimony from his psychiatrist, who revealed the defendant’s admission of abuse during a therapy session. The court held that the admission of the psychiatrist’s testimony violated the physician-patient privilege. Even though the psychiatrist was obligated to report the suspected abuse to authorities, the court found that the privilege was not waived, and the testimony was inadmissible in a criminal trial, emphasizing the need for clear legislative intent to abrogate the privilege, especially when it concerns the use of information in criminal proceedings. The court reversed the conviction, holding that the evidence was not harmless error.

    Facts

    The defendant was admitted to a psychiatric emergency room, complaining of depression and suicidal ideation. During treatment, he admitted to his psychiatrist that he had sexually abused an 11-year-old relative. The psychiatrist subsequently reported the abuse to the Administration for Children’s Services (ACS). The defendant was later arrested and charged with predatory sexual assault. At trial, the prosecution sought to introduce the psychiatrist’s testimony about the admission. The trial court permitted the psychiatrist to testify about the admission, but the Appellate Division reversed the conviction, finding the testimony inadmissible due to the physician-patient privilege.

    Procedural History

    The trial court admitted the psychiatrist’s testimony. The Appellate Division reversed the conviction, holding that the testimony was inadmissible. The New York Court of Appeals granted leave to appeal.

    Issue(s)

    1. Whether the admission of a psychiatrist’s testimony, concerning a defendant’s confession of sexual abuse made during treatment, violated the physician-patient privilege under CPLR 4504(a).

    Holding

    1. Yes, because the physician-patient privilege protected the defendant’s confidential communication, and no exception applied to permit the introduction of the testimony in a criminal trial.

    Court’s Reasoning

    The court emphasized that the physician-patient privilege, codified in CPLR 4504(a), protects confidential communications made in the course of treatment. The court found that the defendant’s admission to his psychiatrist was subject to this privilege. The court recognized that while the psychiatrist had a duty to report the abuse, this reporting did not automatically abrogate the privilege in the context of a criminal trial. The court contrasted the ethical requirement of confidentiality in psychiatric treatment with the evidentiary physician-patient privilege, emphasizing that the latter is a rule of evidence protecting communications. The court noted that while the legislature has created specific exceptions to the privilege, it has done so through explicit legislation. The court observed that the legislature did not create an exception allowing a psychiatrist to testify against a defendant in a criminal proceeding, even when the psychiatrist was required to report the abuse. The court explicitly stated, “Evidentiary standards are necessarily lower in the former proceedings [child protective] than in the latter [criminal] because the interests involved are different.”.

    Practical Implications

    This case reinforces the strong protection afforded by the physician-patient privilege in New York. It clarifies that even when a physician is required to report certain information, the privilege is not automatically waived in a criminal proceeding. Defense attorneys should vigorously object to the introduction of privileged communications, arguing that such evidence is inadmissible. Prosecutors must be aware of the limits on using information obtained from mental health professionals in criminal cases. The ruling underscores that any exceptions to the privilege must be clearly established by statute. Mental health professionals should be aware of these limitations when working with patients who may be involved in criminal investigations.

  • New York City Health & Hospitals Corp. v. New York State Commission of Correction, 18 N.Y.3d 241 (2011): Implied Exception to Physician-Patient Privilege for Inmate Death Investigations

    New York City Health & Hospitals Corp. v. New York State Commission of Correction, 18 N.Y.3d 241 (2011)

    When a state commission is statutorily mandated to investigate the death of an inmate, an implied exception to the physician-patient privilege exists, allowing access to the inmate’s medical records, even if the inmate received treatment at a non-correctional facility, to ensure a thorough investigation.

    Summary

    The New York State Commission of Correction (Commission) subpoenaed Elmhurst Hospital, operated by New York City Health and Hospitals Corporation (HHC), for the medical records of Carlos Frazier, an inmate who died after being transferred to the hospital. HHC refused, citing physician-patient privilege. The Court of Appeals held that an implied exception to the privilege exists, compelled by the Commission’s statutory duty to investigate inmate deaths. The court reasoned that the legislature intended the Commission’s investigations to be thorough, irrespective of where the inmate received medical treatment, and that the limited disclosure would not undermine the policies underlying the privilege.

    Facts

    Carlos Frazier, an inmate, was transferred from a New York City correctional facility to Elmhurst Hospital and then to Bellevue Hospital, where he died. The Commission, responsible for overseeing correctional facilities, initiated an investigation into Frazier’s death through its Medical Review Board. As part of the investigation, the Commission subpoenaed Frazier’s medical records from Elmhurst Hospital. HHC, representing Elmhurst Hospital, refused to provide the records, asserting physician-patient privilege.

    Procedural History

    HHC filed a motion to quash the Commission’s subpoena. Supreme Court granted the motion, holding that HIPAA permitted, but did not require, disclosure absent authorization from Frazier’s representative, and that the physician-patient privilege applied. The Appellate Division affirmed, stating that any exceptions to the privilege should be made by the Legislature. The Court of Appeals granted the Commission permission to appeal.

    Issue(s)

    Whether an implied exception exists to the physician-patient privilege that permits the New York State Commission of Correction to subpoena an inmate’s medical records from a non-correctional hospital as part of its investigation into the inmate’s death.

    Holding

    Yes, because the Legislature intended for the Commission’s Medical Review Board to have plenary authority to investigate the death of any inmate of a correctional facility, and this authority would be undermined if the thoroughness of the Board’s inquiry varied depending on the site of the inmate’s premortem medical care.

    Court’s Reasoning

    The Court of Appeals recognized that the physician-patient privilege exists to protect communication, record-keeping, and privacy. However, the privilege is a legislative creation that can be limited when it conflicts with other legislatively sanctioned policies. Citing Matter of Camperlengo v Blum, 56 NY2d 251 (1982), the court noted prior precedent where it implied an exception to the physician-patient privilege in the context of a Medicaid fraud investigation. The court distinguished this case from others where a general public interest exception was claimed. Here, the Commission claimed a specific, narrow exception necessary to fulfill its mandate, as expressed in Correction Law § 47 (1) (a), to investigate the cause of death of any inmate of a correctional facility. The court reasoned that allowing the privilege to block access to records from non-prison medical facilities would create an “obviously unintended and unreasonable disparity” in the Board’s investigative power, and this would not serve any justifying purpose of the privilege. The court noted, “In granting this authority, the Legislature cannot be supposed to have allowed that the thoroughness of the Board’s inquiry would vary with the site of an inmate’s premortem medical care.” Furthermore, the court found that HIPAA did not prohibit the disclosure, as 45 CFR 164.512(a) allows disclosures “required by law,” including those pursuant to subpoenas issued by an administrative body.

  • People v. Elysee, 11 N.Y.3d 100 (2008): Overcoming Physician-Patient Privilege for Blood Samples in DWI Cases

    People v. Elysee, 11 N.Y.3d 100 (2008)

    In cases involving driving while intoxicated (DWI) resulting in death or serious injury, a court order issued under Vehicle and Traffic Law § 1194(3) compelling a blood test overcomes the physician-patient privilege that might otherwise protect previously drawn blood samples taken for medical purposes.

    Summary

    Elysee was involved in a fatal car accident and taken to the hospital, where blood samples were drawn for treatment (5:30 a.m. samples). Later, pursuant to a court order, a second set of samples was drawn for a blood alcohol test (2:50 p.m. samples). A search warrant was then issued to seize the 5:30 a.m. samples from the hospital. Elysee argued that seizing the 5:30 a.m. samples violated the physician-patient privilege. The New York Court of Appeals held that even if the samples were privileged, the privilege was overcome by the court order issued under Vehicle and Traffic Law § 1194(3), which authorizes chemical tests in DWI cases involving death or serious injury.

    Facts

    On December 25, 2003, Elysee was involved in a four-vehicle car accident resulting in a fatality and injuries. At 5:30 a.m., he was taken to the hospital, where blood samples were drawn for treatment purposes. At 1:50 p.m., a court order compelled him to submit to a blood alcohol test, resulting in a second blood draw at 2:50 p.m. A search warrant was issued and executed on December 29, 2003, to seize the 5:30 a.m. samples from the hospital.

    Procedural History

    Elysee moved to controvert the search warrant and suppress the results of the blood alcohol test performed on the 5:30 a.m. samples, arguing a violation of the physician-patient privilege. The trial court denied the motion. At trial, both sets of blood samples were tested. The jury convicted Elysee of manslaughter, assault, and driving while intoxicated. The Appellate Division affirmed, and the Court of Appeals affirmed that decision.

    Issue(s)

    1. Whether the seizure of blood samples drawn for medical purposes, pursuant to a search warrant issued after a court order compelling a blood alcohol test under Vehicle and Traffic Law § 1194(3), violates the physician-patient privilege defined by CPLR 4504.

    2. Whether the trial court erred in refusing to charge criminally negligent homicide as a lesser included offense of second-degree manslaughter.

    Holding

    1. No, because even if the blood samples were privileged, the privilege was overcome by the court order issued pursuant to Vehicle and Traffic Law § 1194(3).

    2. No, because given the overwhelming evidence of Elysee’s intoxication, there was no reasonable view of the evidence that would support a finding of criminally negligent homicide.

    Court’s Reasoning

    The Court reasoned that Vehicle and Traffic Law § 1194(2)(a) establishes implied consent to chemical tests for drivers in the state. Further, § 1194(3) allows for court-ordered chemical tests when a person is involved in an accident causing death or serious injury, operates the vehicle while intoxicated, is lawfully arrested, and refuses or is unable to consent to a chemical test. The Court stated, “Here, it is illogical to conclude that a blood sample taken at 5:30 a.m. cannot be seized pursuant to a properly issued court order, merely because the order issued after the blood was actually drawn by an authorized person.” The seizure of the earlier blood sample was in accord with the statute, as the Vehicle and Traffic Law authorized a chemical test under the circumstances. Regarding the lesser-included offense, the court held that a person who fails to perceive a substantial and unjustifiable risk by reason of his intoxication acts recklessly, not with criminal negligence. The court cited People v. Donohue, 123 AD2d 77, 81 (3d Dept 1987) and People v. Van Dusen, 89 AD2d 649 (3d Dept 1982).

  • Arons v. Jutkowitz, 9 N.Y.3d 393 (2007): Permissibility of Ex Parte Interviews with Treating Physicians After HIPAA

    Arons v. Jutkowitz, 9 N.Y.3d 393 (2007)

    An attorney may conduct ex parte interviews with an adverse party’s treating physician when the party has placed their medical condition in controversy, subject to HIPAA’s procedural prerequisites.

    Summary

    This case addresses whether an attorney can privately interview an opposing party’s treating physician in a medical malpractice case. The New York Court of Appeals held that such interviews are permissible, provided the attorney adheres to the requirements of the Health Insurance Portability and Accountability Act (HIPAA). By placing their medical condition at issue in a lawsuit, a plaintiff waives the physician-patient privilege. HIPAA does not prohibit these interviews but requires either a valid authorization from the patient or a court order to ensure compliance with privacy regulations. This decision clarifies the interaction between informal discovery practices and federal patient privacy laws.

    Facts

    In three separate medical malpractice cases consolidated for appeal, plaintiffs refused to provide HIPAA-compliant authorizations allowing defense counsel to interview their treating physicians. The plaintiffs argued that defense counsel were limited to formal discovery methods under the CPLR. The defendant physicians sought these interviews to gather information relevant to the medical conditions placed at issue by the lawsuits.

    Procedural History

    In Arons v. Jutkowitz, the Supreme Court granted the defendant’s motion to compel the plaintiff to provide authorizations. The Appellate Division reversed, holding that ex parte interviews were not authorized by the CPLR. In Webb v. New York Methodist Hospital, the Supreme Court granted a similar motion, but the Appellate Division reversed based on its decision in Arons. In Kish v. Graham, the Supreme Court granted the motion to compel authorizations, but the Appellate Division reversed, again relying on Arons. The Court of Appeals granted leave to appeal in all three cases to resolve the issue.

    Issue(s)

    Whether an attorney may interview an adverse party’s treating physician privately when the adverse party has affirmatively placed his or her medical condition in controversy, subject to HIPAA’s procedural prerequisites.

    Holding

    Yes, because by bringing a lawsuit that places their medical condition at issue, a plaintiff waives the physician-patient privilege, and HIPAA does not prohibit ex parte interviews but imposes procedural requirements for obtaining protected health information.

    Court’s Reasoning

    The Court of Appeals relied on the principles established in Niesig v. Team I and Muriel Siebert & Co., Inc. v. Intuit Inc., which emphasized the importance of informal discovery practices in litigation. The court reasoned that a litigant waives the physician-patient privilege when bringing a personal injury action by affirmatively placing their mental or physical condition in issue. “[A] party should not be permitted to affirmatively assert a medical condition in seeking damages or in defending against liability while simultaneously relying on the confidential physician-patient relationship as a sword to thwart the opposition in its efforts to uncover facts critical to disputing the party’s claim” (Dillenbeck v Hess, 73 NY2d 278, 287 [1989]). The court rejected the argument that the absence of express authorization for ex parte interviews in CPLR Article 31 prohibited the practice. The court emphasized that attorneys have always sought to interview potential witnesses as part of trial preparation. HIPAA does not preempt state law on ex parte interviews; instead, it imposes procedural prerequisites. To conduct an interview, an attorney must obtain a valid HIPAA authorization, a court order, or a subpoena with satisfactory assurances regarding notification or a qualified protective order. The court noted the long-standing practice of New York trial attorneys engaging in ex parte interviews with treating physicians, particularly in malpractice actions after the note of issue was filed. Finally, the court reversed the lower courts’ orders requiring defense counsel to disclose all materials obtained during the interviews, finding those stipulations inconsistent with Niesig and Siebert.

  • People v. Berrios, 28 N.Y.3d 278 (2006): Evidence Admissible Despite Physician-Patient Privilege Violation

    People v. Berrios, 6 N.Y.3d 278 (2006)

    Evidence obtained as a result of a violation of the physician-patient privilege need not be suppressed at a criminal trial unless the statute’s primary purpose is to protect a constitutional right.

    Summary

    The New York Court of Appeals held that evidence obtained following a hospital’s disclosure of a patient’s information to police, even if violating the physician-patient privilege, is admissible in a criminal trial. Anthony Berrios was killed. Detective Elliott learned the shooter was slashed in the face days before. A hospital administrator gave Elliott the defendant’s name and address. This led to an eyewitness identification of the defendant and his subsequent conviction for manslaughter. The Court reasoned that because the physician-patient privilege is statutory, not constitutional, and doesn’t primarily protect against government misconduct, suppression of evidence is not the appropriate remedy for its violation. The focus is on the doctor’s conduct, not the state’s, when the privilege is breached. Therefore, the evidence was admissible.

    Facts

    Anthony Berrios was fatally shot on October 16, 2001. Detective Michael Elliott investigated and learned the shooting stemmed from a fight on October 13 where a man was slashed in the face. Elliott inquired at a hospital about individuals treated for facial slash wounds on that date. The hospital administrator provided defendant Berrios’s name and address. Using this information, Elliott obtained Berrios’s arrest record and photo. A witness identified Berrios’s photo as the shooter, leading to further evidence and his conviction.

    Procedural History

    The Supreme Court denied Berrios’s motion to suppress the evidence, holding that a violation of the physician-patient privilege does not require suppression. The Appellate Division affirmed, reasoning both that there was no breach of privilege and that, even if there was, suppression was not required. The New York Court of Appeals granted leave to appeal and affirmed based on the second ground: suppression was not required even if a privilege was breached.

    Issue(s)

    1. Whether the hospital’s disclosure of Berrios’s name and address to Detective Elliott violated the physician-patient privilege under CPLR 4504(a)?
    2. Whether evidence obtained as a result of a violation of the physician-patient privilege must be suppressed in a criminal trial?

    Holding

    1. The Court did not decide whether the privilege was violated.
    2. No, because the physician-patient privilege is statutory, not constitutional, and its violation does not automatically warrant suppression of evidence.

    Court’s Reasoning

    The Court of Appeals affirmed, focusing on the suppression issue. It acknowledged that CPLR 4504(a) protects patient information disclosed to medical professionals. However, the Court emphasized that statutory violations do not automatically mandate evidence suppression, citing People v. Patterson. An exception exists when a statute’s primary purpose is to safeguard constitutional rights, as seen in People v. Taylor and People v. Gallina, which involved statutes protecting Fourth Amendment rights. The Court distinguished the present case, stating, “There is no constitutional right to privacy in physician-patient communications.” The Court noted the legislature has created exceptions to the privilege, such as mandatory reporting of gunshot wounds. The Court found the privilege primarily regulates a private relationship, not governmental conduct. It stated, “To suppress evidence resulting from a violation of section 4504 would be to punish the State for a doctor’s or hospital’s misconduct—a punishment unlikely to deter doctors and hospitals, who have little interest in whether criminal prosecutions succeed or not.” Therefore, suppression was not warranted.

  • People v. Sinski, 88 N.Y.2d 487 (1996): Physician-Patient Privilege and Statutory Exceptions in Criminal Cases

    People v. Sinski, 88 N.Y.2d 487 (1996)

    The physician-patient privilege protects confidential communications between a patient and their healthcare provider, and exceptions to this privilege are narrowly construed, particularly in the context of criminal investigations.

    Summary

    Defendant, a police officer, was convicted of crimes based on evidence that he unlawfully obtained drug prescriptions. The prosecution argued that Public Health Law § 3373 eliminated the physician-patient privilege, allowing the admission of the evidence. The New York Court of Appeals reversed the conviction, holding that § 3373 does not permit the release of confidential medical information to law enforcement for criminal proceedings absent judicial process. The court emphasized the importance of patient confidentiality to encourage open communication with doctors and narrowly interpreted the statutory exception.

    Facts

    Defendant, a police officer, experienced dental and back problems requiring pain medication. The Internal Affairs Bureau suspected excessive drug use based on insurance claims filed by the defendant and initiated an investigation. Investigators interviewed the defendant’s physicians and dentists, obtaining written statements and reviewing patient records. The Grand Jury subsequently charged the defendant with criminal possession of a forged instrument, falsifying a business record, and violating Public Health Law provisions related to obtaining prescriptions.

    Procedural History

    The trial court convicted the defendant on all four counts. The Appellate Division affirmed the conviction, finding the evidence admissible under Public Health Law § 3373. The New York Court of Appeals reversed the Appellate Division’s order and remanded the case for a new trial, concluding that the physician-patient privilege had been violated.

    Issue(s)

    Whether the exception to the physician-patient privilege contained in section 3373 of the Public Health Law extends to the investigation and criminal prosecution of the defendant in this case, allowing the admission of confidential medical information obtained from his physicians and dentists.

    Holding

    No, because Section 3373 of the Public Health Law does not authorize treating physicians to release confidential information to police authorities for criminal proceedings absent judicial process; the legislative intent is to maintain patient confidentiality, and the exception to the privilege is narrowly tailored to the specific duties arising under Article 33 of the Public Health Law.

    Court’s Reasoning

    The court emphasized that the physician-patient privilege, codified in CPLR 4504(a), promotes open communication between patients and physicians. While the privilege has exceptions, it is to be broadly construed. Public Health Law § 3373, enacted to prevent drug diversion, was not intended to generally abrogate the privilege for criminal prosecution. The statute’s language and legislative history reveal a concern for patient confidentiality, limiting disclosure to reports required by the statute. The court distinguished Matter of Camperlengo v. Blum, noting that case involved Medicaid billing requirements that implied an exception to the privilege. The court rejected the argument that a crime-fraud exception should apply, finding that the prosecution had not argued that the defendant visited doctors solely to obtain drugs. As the court noted, “The People’s suggestion that the Legislature intended section 3373 to generally abrogate the physician-patient privilege for the purpose of criminal prosecution is not only contrary to the rationale behind the physician-patient privilege — to encourage complete candor in order to secure appropriate treatment — but it is also contradicted by the language of the statute and the Legislature’s demonstrated concern over confidentiality in this area.”

  • Williams v. Roosevelt Hospital, 66 N.Y.2d 391 (1985): Scope of Physician-Patient Privilege in Discovery

    Williams v. Roosevelt Hospital, 66 N.Y.2d 391 (1985)

    A witness in a medical malpractice action may invoke the physician-patient privilege to avoid disclosing confidential communications made to her physician, but must testify to relevant medical facts or incidents concerning herself or her children.

    Summary

    In a medical malpractice suit, the New York Court of Appeals addressed the scope of the physician-patient privilege during pre-trial discovery. The Court held that while the privilege protects confidential communications between a patient and physician, it does not shield a witness from disclosing relevant factual medical information about themselves or their children. This distinction ensures both patient privacy and access to information crucial for a fair legal process. The case clarifies that the privilege aims to protect the confidentiality of doctor-patient communications, not to block the discovery of underlying facts.

    Facts

    The infant plaintiff, Rashan Williams, allegedly suffered brain damage due to negligent obstetrical care during his birth in 1979. During a pre-trial examination, the infant’s mother, a non-party witness, was questioned about her medical history, the births and conditions of her other children, and related medical events. Plaintiffs’ counsel objected to several questions, instructing the witness not to answer based on physician-patient privilege.

    Procedural History

    Defendants moved for an order compelling the infant’s mother to appear for further examination and answer questions about her prior health history and the birth and physical condition of her other children. Special Term denied the motion based on a prior Second Department decision. The Appellate Division reversed, granting the motion for further examination, reasoning that the privilege applies to confidential information given to the physician, not to the mere facts of what happened. The New York Court of Appeals granted leave to appeal.

    Issue(s)

    Whether the physician-patient privilege (CPLR 4504) allows a witness at a pre-trial examination in a medical malpractice action to refuse to answer questions about her own medical history and the birth and physical condition of her other children.

    Holding

    No, because the physician-patient privilege protects confidential communications, not the underlying facts and incidents of a person’s medical history. The witness can assert the privilege to protect specific communications, but she must answer questions about relevant medical facts.

    Court’s Reasoning

    The Court acknowledged New York’s liberal discovery rules (CPLR 3101[a]), balanced against the protection of privileged matter (CPLR 3101[b]). The physician-patient privilege (CPLR 4504) protects against the disclosure of information acquired by a medical professional while attending a patient in a professional capacity, when the information was necessary to enable them to act in that capacity. The court emphasized that while the privilege aims to protect confidential communications to foster open doctor-patient relationships, it does not extend to shielding the underlying facts of a person’s medical history. Citing Upjohn Co. v. United States, the Court analogized the physician-patient privilege to the attorney-client privilege, stating that “the protection of the privilege extends only to communications and not to facts.” The court reasoned that allowing a witness to conceal facts merely because they relate to medical care would undermine the discovery process. The burden to establish the applicability of the privilege rests on the party asserting it. The Court remanded the case for the trial court to determine the relevance of the information sought, emphasizing the policy favoring broad pretrial discovery. The court determined that the Appellate Division had the power to allow further examination of the witness because the physician-patient privilege does not provide a basis to refuse to reveal the information sought.

  • 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.”

  • In the Matter of the Grand Jury Investigation of Onondaga County, 59 N.Y.2d 350 (1983): Hospital Cannot Assert Patient Privilege to Block Grand Jury Investigation

    In the Matter of the Grand Jury Investigation of Onondaga County, 59 N.Y.2d 350 (1983)

    A hospital under investigation by a grand jury for potential crimes against its patients cannot assert physician-patient privilege, social worker-client privilege, or patient privacy rights to resist a subpoena for patient records, nor can it invoke the litigation preparation exception to discovery.

    Summary

    A hospital, facing a grand jury investigation into potential criminal activity related to patient deaths (specifically, alleged “no coding” practices), attempted to quash subpoenas for patient records, citing physician-patient privilege, social worker-client privilege, patient privacy rights, and the protection for materials prepared for litigation. The New York Court of Appeals held that the hospital could not assert these privileges or protections to shield the records from the grand jury. The Court reasoned that the purpose of these privileges is to protect patients and encourage open communication, not to shield potential criminal activity by the hospital itself. Additionally, it found that the protection for litigation preparation does not apply to grand jury subpoenas.

    Facts

    The Deputy Attorney-General for Medicaid Fraud Control issued grand jury subpoenas to a hospital and its executive vice-president, seeking records related to two deceased patients, Maria M. and Daisy S. The investigation stemmed from suspicions of “no coding,” a practice of selectively denying life-saving measures to certain patients. The hospital moved to quash the subpoenas.

    Procedural History

    Special Term denied the hospital’s motion to quash the subpoenas related to Maria M., and the Appellate Division affirmed. Subsequently, the grand jury issued a subpoena regarding Daisy S., which was also challenged and upheld in the lower courts. The appeals concerning both subpoenas were consolidated before the New York Court of Appeals.

    Issue(s)

    1. Whether a hospital under grand jury investigation can assert the physician-patient privilege to prevent disclosure of patient records relevant to the investigation.
    2. Whether the hospital can assert the social worker-client privilege to prevent disclosure of patient records.
    3. Whether the hospital can assert a patient’s constitutional right to privacy to prevent disclosure of patient records.
    4. Whether the conditional bar to discovery of material prepared for litigation under CPLR 3101(d) applies to a grand jury subpoena duces tecum.

    Holding

    1. No, because the privilege is designed to protect the patient, not to shield the hospital from potential criminal liability.
    2. No, because the purpose of the social worker-client privilege is to encourage uninhibited disclosure by the individual seeking assistance, not to protect a hospital potentially involved in crimes against patients.
    3. No, because in this context, the hospital lacks standing to assert the constitutional rights of its deceased patients.
    4. No, because the legislative intent of CPLR 3101(d) was not to impede legitimate grand jury investigations.

    Court’s Reasoning

    The Court of Appeals emphasized the broad latitude traditionally afforded to grand juries in investigating potential criminal activity. While evidentiary privileges generally apply to grand jury proceedings, their application is limited when it does not further their legitimate purpose. The physician-patient and social worker-client privileges are intended to encourage full disclosure by patients and clients to secure appropriate treatment and assistance. The Court reasoned that allowing a hospital to assert these privileges to shield itself from investigation would undermine, not serve, the purpose of these privileges.

    Quoting from People v. Lay, the court emphasized that “the purpose of the privilege is to protect the patient, not to shield the criminal.” The Court extended this principle to the grand jury context. It further reasoned that the confidentiality of grand jury proceedings mitigates concerns that compelling disclosure would inhibit future communications between patients and their physicians or social workers.

    The Court found that the hospital lacked standing to assert the deceased patients’ right to privacy. Regarding the material prepared for litigation, the Court stated that CPLR 3101(d)’s conditional privilege was not intended to impede legitimate grand jury investigations. The court reasoned that the legislature did not intend for the conditions imposed on the discovery of material prepared for litigation to apply to grand jury subpoenas. The Court emphasized the relevance of the subpoenaed documents to the grand jury’s legitimate investigation.