New York Law Review

Tag: physician-patient privilege

  • Camperlengo v. Blum, 56 N.Y.2d 254 (1982): Physician-Patient Privilege and Medicaid Fraud Investigations

    Camperlengo v. Blum, 56 N.Y.2d 254 (1982)

    The physician-patient privilege does not provide absolute protection to a doctor’s treatment records of Medicaid patients when those records are subpoenaed by the State Department of Social Services during a billing practices investigation.

    Summary

    This case addresses the conflict between physician-patient privilege and the state’s need to investigate potential Medicaid fraud. A psychiatrist, Camperlengo, faced a subpoena for patient records due to unusual billing patterns. He argued the records were protected by physician-patient privilege. The court held that while the privilege exists, it is abrogated to the extent necessary for effective Medicaid oversight. This exception is narrowly tailored to ensure funds are properly used and patient confidentiality is maintained as much as possible. The ruling balances patient privacy with the public interest in preventing Medicaid fraud, allowing access to records directly relevant to administering the program.

    Facts

    A psychiatrist, Camperlengo, treated Medicaid recipients. The State Department of Social Services noticed consecutive billing dates for some patients, which they considered unusual. The Department requested access to the psychiatrist’s records to check for unnecessary treatment or fraudulent billing. The psychiatrist’s initial cooperation was insufficient, leading the Department to issue a subpoena duces tecum for records of 35 Medicaid patients. The subpoena sought treatment plans, evaluations, diagnostic records, and payment records from third parties.

    Procedural History

    The psychiatrist moved to quash the subpoena in the Supreme Court. The Supreme Court denied the motion. The Appellate Division affirmed the Supreme Court’s decision.

    Issue(s)

    Whether the physician-patient privilege under CPLR 4504(a) protects a psychiatrist’s treatment records of Medicaid patients from a subpoena issued by the State Department of Social Services during an investigation of billing practices.

    Holding

    No, because the Federal and State record-keeping and reporting requirements of the Medicaid program demonstrate a clear intention to abrogate the physician-patient privilege to the extent necessary to ensure proper application of Medicaid funds.

    Court’s Reasoning

    The court acknowledged the physician-patient privilege, a statutory creation designed to protect patient confidentiality and encourage open communication with doctors. The court stated, “to protect those who are required to consult physicians from the disclosure of secrets imparted to them; to protect the relationship of patient and physician and to prevent physicians from disclosing information which might result in humiliation, embarrassment, or disgrace to patients”. However, the court also noted that the legislature has, in some instances, abrogated this privilege to effectuate other public policies, such as preventing child abuse or treating narcotic addiction.

    The court then examined the Medicaid program, which uses public funds and requires accountability. Federal regulations (42 U.S.C. § 1396a(a)(27)) mandate that states participating in Medicaid have agreements with service providers to keep records fully disclosing the services provided and to furnish the state agency with information regarding payments claimed. New York regulations (18 NYCRR 540.7(a)(8)) also require providers to keep such information available for at least six years after payment.

    While there is no explicit statutory exception to the physician-patient privilege for Medicaid records, the court found that the federal and state record-keeping requirements demonstrate a clear intention to abrogate the privilege to the extent necessary for effective Medicaid oversight. The court emphasized that this exception is limited to ensuring Medicaid funds are properly applied. Confidentiality is maintained through restrictions on the use of the information, limiting its use to purposes directly connected with administering the Medicaid program. As the court explained, “the public must be assured that the funds which have been set aside for this worthy purpose will not be fraudulently diverted into the hands of an untrustworthy provider of services”.

  • People v. Edney, 39 N.Y.2d 620 (1976): Waiver of Privilege When Raising Insanity Defense

    People v. Edney, 39 N.Y.2d 620 (1976)

    When a defendant raises an insanity defense and presents psychiatric evidence to support that defense, both the physician-patient and attorney-client privileges are waived, allowing the prosecution to call psychiatric experts, including those initially consulted by the defense, to testify regarding the defendant’s sanity.

    Summary

    Edney was convicted of manslaughter and kidnapping after killing his former girlfriend’s daughter. His defense was insanity. The prosecution called Dr. Schwartz, a psychiatrist who initially examined Edney at the request of his attorney, to rebut the defense’s insanity claim. The New York Court of Appeals held that Edney waived both the physician-patient and attorney-client privileges by raising the insanity defense and presenting psychiatric testimony. The court reasoned that allowing the defense to selectively use psychiatric testimony would obstruct justice and that no harm accrues to the defense as the underlying facts would be revealed to the prosecution in any event.

    Facts

    Defendant Edney was charged with kidnapping and killing the eight-year-old daughter of his former girlfriend. The prosecution presented evidence that Edney abducted the victim, made a threatening phone call to the victim’s aunt, and was seen with the victim shortly before her death. The victim’s body was found with multiple stab wounds. Edney made incriminating statements to the police and his father. Edney testified that he consumed large amounts of alcohol and marijuana on the day of the crime and might have killed the victim but was unsure.

    Procedural History

    The jury found Edney guilty of manslaughter and kidnapping. The Appellate Division unanimously affirmed the conviction. The New York Court of Appeals granted review to determine the admissibility of Dr. Schwartz’s testimony over claims of privilege.

    Issue(s)

    Whether the testimony of a psychiatrist, who examined the defendant at the request of his attorney prior to trial, is admissible when the defendant raises an insanity defense, despite objections based on physician-patient and attorney-client privileges.

    Holding

    Yes, because a plea of innocence by reason of insanity constitutes a complete and effective waiver of any claim of privilege, both physician-patient and attorney-client privileges.

    Court’s Reasoning

    The Court of Appeals relied on its prior decision in People v. Al-Kanani, which held that when a defendant offers evidence tending to show insanity, a complete waiver of the physician-patient privilege is effected, allowing the prosecution to call psychiatric experts to testify regarding the defendant’s sanity. The court reasoned that the defendant, by disclosing evidence of their affliction, gives the public the full details of their case, thus waiving the privilege. Quoting People v. Bloom, the court stated that “when a secret is out it is out for all time and cannot be caught again like a bird and put back in its cage…The legislature did not intend to continue the privilege when there was no reason for its continuance and it would simply be an obstruction to public justice”.

    The court rejected the defendant’s reliance on cases from other jurisdictions that excluded such testimony based on the attorney-client privilege. The court found the Al-Kanani rule more persuasive, stating that a defendant who puts their sanity in issue should not be permitted to thwart the introduction of testimony from a material witness by invoking the attorney-client privilege. The court emphasized that a defendant who seeks to introduce psychiatric testimony in support of an insanity plea may be required to disclose the underlying basis of their alleged affliction to a prosecution psychiatrist, per Matter of Lee v. County Court of Erie County. Thus, no harm accrues to the defense from seeking pretrial psychiatric advice where an insanity plea is actually entered, because the underlying factual basis will be revealed to the prosecution psychiatrist in any event.

    The court clarified that an attorney can still consult a psychiatrist to obtain advice without fear of later courtroom disclosure, as the product of such a consultation is protected by the work product doctrine. However, this doctrine only protects facts and observations disclosed *by the attorney*, not other disclosed information. The court also noted that the underlying purpose of the attorney-client privilege – encouraging persons needing professional advice to disclose freely the facts – is not harmed by the admission of the psychiatrist’s testimony, as the information would be available to the prosecution in any event.

  • People v. Al-Kanani, 317 N.E.2d 263 (N.Y. 1974): Physician-Patient Privilege Waiver When Insanity is Raised as a Defense

    People v. Al-Kanani, 317 N.E.2d 263 (N.Y. 1974)

    When a defendant asserts an insanity defense and introduces psychiatric evidence to support that defense, they waive the physician-patient privilege, allowing the prosecution to introduce psychiatric testimony, even from doctors who previously treated the defendant, to rebut the insanity claim.

    Summary

    Al-Kanani was convicted of murdering his wife. At trial, he pleaded not guilty by reason of insanity and presented psychiatric testimony from Central Islip State Hospital supporting his claim. The prosecution then called Dr. Lanzkron, a psychiatrist who treated Al-Kanani at Matteawan, to testify that Al-Kanani was sane at the time of the murder. Al-Kanani argued that this violated his physician-patient privilege. The New York Court of Appeals held that by introducing psychiatric evidence to support his insanity defense, Al-Kanani waived his physician-patient privilege, allowing the prosecution to present psychiatric testimony to rebut his claim of insanity. This decision balances the need to protect patient confidentiality with the pursuit of justice when a defendant uses a mental health condition as a legal defense.

    Facts

    Al-Kanani murdered his wife by striking her with a fireplace poker and stabbing her with a meat fork in April 1964.

    He was initially found mentally unfit to stand trial and committed to Matteawan State Hospital.

    After being certified as capable of conducting his defense, he pleaded not guilty by reason of insanity.

    At trial, the defense presented psychiatric testimony from Central Islip State Hospital asserting Al-Kanani was insane at the time of the crime.

    The prosecution called Dr. Lanzkron, a psychiatrist who treated Al-Kanani at Matteawan, to testify that he was sane, over defense objection.

    Procedural History

    Al-Kanani was initially convicted, but the conviction was reversed due to improper testimony from a prosecution-retained doctor (31 A.D.2d 838, aff’d 26 N.Y.2d 473).

    He was convicted again in a second trial, and the Appellate Division affirmed this conviction.

    The case then went to the New York Court of Appeals by permission.

    Issue(s)

    Whether a defendant waives his physician-patient privilege when he asserts an insanity defense and introduces psychiatric evidence to support that defense, thus allowing the prosecution to call psychiatric experts to testify regarding his sanity, even if they have previously treated the defendant.

    Holding

    Yes, because when a defendant introduces psychiatric evidence to support an insanity defense, they waive the physician-patient privilege, allowing the prosecution to present psychiatric testimony to rebut the insanity claim.

    Court’s Reasoning

    The court reasoned that the physician-patient privilege, codified in CPLR 4504 and CPL 60.10, aims to protect patients from the disclosure of sensitive information that could cause humiliation, embarrassment, or disgrace. Citing Steinberg v. New York Life Ins. Co., 263 N.Y. 45, 48-49, the court noted that the privilege is meant “to protect those who are required to consult physicians from the disclosure of secrets imparted to them”. However, the court found that this protection is waived when the patient affirmatively puts their mental state at issue by asserting an insanity defense and presenting psychiatric evidence.

    The court emphasized that by disclosing evidence of his mental state, the defendant “has given the public the full details of his case, thereby disclosing the secrets which the statute was designed to protect”. This waiver removes the information from the statute’s protection, as “when a secret is out it is out for all time and cannot be caught again like a bird and put back in its cage”. Citing People v. Bloom, 193 N.Y. 1, 10, the court stated, “The legislature did not intend to continue the privilege when there was no reason for its continuance and it would simply be an obstruction to public justice”.

    The court further stated that once the defendant opens the door by presenting psychiatric evidence, the prosecution is entitled to present its own evidence to rebut the defendant’s claim, even if that evidence comes from psychiatrists who previously treated the defendant. The court noted the waiver is complete and the prosecution is allowed to call psychiatric experts to testify regarding his sanity (cf. People v. Carfora, 25 Y 2d 972).

    The court found the defendant’s remaining contentions insubstantial. It noted the claimed error in the receipt of testimony of a fellow convict, was precipitated by defendant’s own questioning. Further, there was no substance to the claim that the court coerced the jury into reaching a verdict (cf. People v. Randall, 9 Y 2d 413, 426).