Case Title: Ex parte Freudenberger

Citation: 

Docket Number: 1190159

State: alabama

Court: Alabama Supreme Court

Date: 2020-06-30T00:00:00Z

Document:
Rel: June 30, 2020
Notice: This opinion is subject to formal revision before publication in the advance
sheets of Southern Reporter.  Readers are requested to notify the Reporter of Decisions,
Alabama Appellate Courts, 300 Dexter Avenue, Montgomery, Alabama 36104-3741 ((334) 229-
0649), of any typographical or other errors, in order that corrections may be made before
the opinion is printed in Southern Reporter.
SUPREME COURT OF ALABAMA
OCTOBER TERM, 2019-2020
____________________
1190159
____________________
Ex parte Curt Freudenberger, M.D., and Sportsmed Orthopedic
Surgery & Spine Center, P.C.
PETITION FOR WRIT OF MANDAMUS
(In re: Rhonda Brewer and Charlie Brewer
v.
Crestwood Medical Center, LLC; Curt Freudenberger, M.D.; and
Sportsmed Orthopedic Surgery & Spine Center, P.C.)
(Madison Circuit Court, CV-19-901640)
SELLERS, Justice.
1190159
 
Two of the defendants below, Curt Freudenberger, M.D.,
and Sportsmed Orthopedic Surgery & Spine Center, P.C.
("Sportsmed Orthopedic"),1 petition this Court for a writ of
mandamus directing the Madison Circuit Court to vacate its
October 10, 2019, protective order to the extent it imposes
conditions upon ex parte interviews defense counsel intends to
conduct with physicians who treated one of the plaintiffs,
Rhonda Brewer, in connection with her injuries.  We grant the
petition and issue the writ. 
I.  Facts and Procedural History
 
In August 2019, Rhonda and her husband, Charlie, sued Dr.
Freudenberger and Sportsmed Orthopedic (hereinafter sometimes
collectively referred to as "the defendants"), asserting
claims of medical malpractice based on injuries Rhonda
allegedly suffered during the course of a surgical procedure
performed by Dr. Freudenberger.  Charlie also asserted a claim
of loss of consortium. Before discovery, the defendants moved
for the entry of a "qualified protective order," pursuant to
the Health Insurance Portability and Accountability Act of
1The Brewers also named Crestwood Medical Center, LLC, as
a defendant; Crestwood is not a party to this petition.  
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1996 ("HIPAA"), and filed a proposed order with their motion.
Among other things, the defendants' proposed order allowed the
parties' attorneys to request ex parte interviews with
Rhonda's treating physicians, who could either grant or deny
such request;2 it prohibited the parties from using or
disclosing protected health information for any purpose other
than the subject litigation; and it required the return or
destruction of that information at the end of the litigation.
The Brewers objected to the proposed order, arguing that
defense counsel's ex parte interviews with Rhonda's treating
physicians would violate both HIPAA and the Alabama Rules of
Civil Procedure.  
The trial court thereafter entered a qualified protective
order authorizing the disclosure of Rhonda's protected health
information; the order, however, imposed the following
2The defendants' proposed order states, in relevant part,
that "[t]he attorneys for the parties to the lawsuit may
request an interview with any healthcare providers ... in
connection with [Rhonda's protected health information]. ... 
Such healthcare provider ... may grant or deny a request for
an interview."  We interpret the proposed order as meaning
that the attorneys may request interviews with only those
physicians with whom Rhonda consulted in connection with her
injuries. 
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conditions upon defense counsel's contacts with her treating
physicians: 
"No ex parte interviews will be conducted by
[defense counsel] with [Rhonda's] prescribing and
treating physicians unless and until [defense
counsel] provides [Rhonda's counsel] with at least
ten (10) days written notice of the time and place
of the interview and the opportunity to attend."
The defendants moved the trial court to reconsider its
order, arguing that its limitations, if not elimination, of a
valid discovery tool was without any basis in Alabama law or
HIPAA. They specifically contended that Alabama law allowed ex
parte interviews with treating physicians, that HIPAA did not
prohibit ex parte interviews with treating physicians, and
that the restrictions imposed effectively deprived them from
conducting ex parte interviews. The trial court denied the
motion to reconsider. This mandamus petition followed. 
II.  Standard of Review
"Discovery matters are within the trial court's
sound discretion, and this Court will not reverse a
trial court's ruling on a discovery issue unless the
trial court has clearly exceeded its discretion.
Home Ins. Co. v. Rice, 585 So. 2d 859, 862 (Ala.
1991). Accordingly, mandamus will issue to reverse
a trial court's ruling on a discovery issue only (1)
where there is a showing that the trial court
clearly exceeded its discretion, and (2) where the
aggrieved party does not have an adequate remedy by
ordinary appeal. The petitioner has an affirmative
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burden to prove the existence of each of these
conditions."
Ex parte Ocwen Federal Bank, FSB, 872 So. 2d 810, 813 (Ala.
2003). "Generally, an appeal of a discovery order is an
adequate remedy .... In certain exceptional cases, however,
review by appeal of a discovery order may be inadequate, for
example, ... when a privilege is disregarded ...."  Ex parte
Ocwen, 872 So. 2d at 813. 
III.  Analysis  
1.  Mandamus Review
 
Mandamus review is appropriate in this case because the
trial court's protective order involves a disregard of the
work-product privilege. Ex parte Stephens, 676 So. 2d 1307,
1310 (Ala. 1996), overruled on other grounds, Ex parte Henry,
770 So. 2d 76 (Ala. 2000). As the defendants point out, the
trial court's order allows the Brewers' counsel to peer into
defense 
counsel's 
mental 
impressions 
and 
effectively 
discloses
defense strategies. Rule 26(b)(4), Ala. R. Civ. P., expressly
states that "the trial court shall protect against disclosure
of the mental impressions, conclusions, opinions, or legal
theories of an attorney or other representative of a party
concerning the ligation."  See also Hickman v. Taylor, 329
5
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U.S. 495, 510 (1947)(explaining that a lawyer's work product
is reflected in many intangible ways, including interviews,
and that "it is essential that a lawyer work with a certain
degree of privacy, free from unnecessary intrusion by 
opposing
parties and their counsel").   
2.  The Role of HIPAA in Regulating Ex Parte Interviews
 
In 1996, the United States Congress enacted, and the
President signed into law, HIPAA. (Pub. L. No. 104-191, 110
Stat. 1936 (1996)).3 Congress enacted HIPAA, in part, to
protect the privacy of an individual's health information.4 
The Department of Health and Human Services subsequently
proposed and adopted the "Privacy Rule," which consists of a
series 
of 
regulations governing 
permitted 
uses 
and 
disclosures
of protected health information.5 The Privacy Rule prohibits
3HIPAA, as amended, is codified in various sections of
Titles 18, 26, 29, and 42 of the United States Code.
4See 
45 
C.F.R. 
§ 
160.103 
(1997)(defining 
"protected 
health
information" and its subset "individually identifiable health
information").
5The Privacy Rule is codified at parts 160 and 164 of
Title 45 of the Code of Federal Regulations (45 C.F.R. pt.
160, 164 (2018)).
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a "covered entity"6 such as a health-care provider from using
or disclosing protected health information without written
authorization, unless the use or disclosure of that
information is specifically permitted or required by the
Privacy Rule. 45 C.F.R. §§ 164.502, 164.506, 164.508, 164.510,
164.512 (2018).
Relevant to medical-malpractice cases in general and to
this dispute in particular, the Privacy Rule permits a health-
care provider to disclose protected health information "in 
the
course 
of 
any 
judicial 
or 
administrative proceeding," 
pursuant
to a court order; in such situation, written authorization is
not required. 45 C.F.R. § 164.512(e)(2018).  This permissive
disclosure is known as the "judicial exception" to the Privacy
Rule.  Under the Privacy Rule, a "qualified protective order"
is an order of  a court or administrative tribunal or a
stipulation by the parties that (1) prohibits the use or
disclosure of protected health information "for any purpose
other than the litigation or proceeding for which such
information was requested" and (2) requires the return or
6A "covered entity" is defined to include health plans,
health-care 
clearinghouses, 
and 
health-care 
providers, 
such 
as
physicians and hospitals. 
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destruction of that information at the end of the litigation
or proceeding. 45 C.F.R. § 164.512(e)(1)(v)(A). 
In this case, the parties dispute whether the judicial
exception is applicable to ex parte interviews with treating
physicians such that HIPAA requirements would supersede
longstanding Alabama law by severely limiting ex parte
interviews. It is undisputed that the Privacy Rule does not
expressly mention ex parte interviews between counsel and
treating physicians. However, the definition in the Privacy
Rule of "health information" includes oral information; thus,
it is widely accepted that, by its terms, HIPAA covers oral
interviews.  See 45 C.F.R. § 160.103(e) (2016). The Brewers
argue that ex parte interviews do not fall within the judicial
exception because, they say, the nature of the interviews
renders them outside the course of any judicial proceeding. 
The Brewers rely on State ex rel. Proctor v. Messina, 320
S.W.3d 145 (Mo. 2010), in which the Missouri Supreme Court
interpreted the language "in the course of a judicial ...
proceeding," as precluding ex parte communications because,
the Court reasoned, such communications were not "under the
supervisory authority of the court either through discovery or
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through other formal court procedures."  320 S.W.3d at 156. 
The Missouri Supreme Court noted that, because the Missouri
Rules of Civil Procedure did not provide a mechanism for
courts to oversee ex parte communications, a meeting where 
those communications occurred was not a judicial proceeding. 
Id. at 157. Taken to its logical conclusion, the adoption of
such a rule would require trial courts to directly participate
in discovery matters where the health information of a
plaintiff was relevant.
The defendants, on the other hand, argue that the Privacy
Rule does not prohibit ex parte interviews with treating
physicians; rather, they say, it merely imposes procedural
prerequisites to authorize and protect the disclosure of
private health information. The defendants cite Arons v.
Jutkowitz, 9 N.Y.3d 393, 415, 850 N.Y.S.2d 345, 356, 880
N.E.2d 831, 842 (2007), in which the New York Court of Appeals
concluded that New York law permitting ex parte interviews and
HIPAA could 
coexist because, the court reasoned, HIPAA "merely
superimposes procedural requirements" onto state law: 
"[T]he Privacy Rule does not prevent this informal
discovery from going forward, it merely superimposes
procedural prerequisites.  As a practical matter,
this means that the attorney who wishes to contact
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an adverse party's treating physician must first
obtain a valid HIPAA authorization or a court or
administrative order; or must issue a subpoena,
discovery request or other lawful process with
satisfactory 
assurances 
relating 
to 
either
notification or a qualified protective order."
(Emphasis added.)
 Although ex parte interviews are not under the direct
supervision of a court, they proceed alongside a pending
lawsuit and, in that respect, are considered to be "in the
course" of a judicial proceeding. To this extent, we agree
with the Arons court's analysis, and find it to be the more
persuasive, as well as an appropriate and practical
interpretation of the Privacy Rule.  We conclude that the
federal Privacy Rule does not negate long-standing Alabama law
allowing 
ex 
parte 
interviews with 
treating 
physicians; 
rather,
it merely superimposes procedural prerequisites by requiring
defense counsel to obtain a valid HIPAA authorization or, in
this case, a court order complying with the provisions of 45
C.F.R. § 164.512(e). See also, e.g.,  Murphy v. Dulay, 768
F.3d 1360, 1377 (11th Cir. 2014)("Once a plaintiff executes a
valid HIPAA authorization [or obtains a qualified protective
order] as part of his presuit obligations, his physician can,
consistent with HIPAA, convey relevant health information
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about the plaintiff to the defendant. A medical provider can
simultaneously comply with state and federal requirements.")
Ex parte interviews are allowed under Alabama common law7 and
nothing in HIPAA specifically precludes them. Accordingly,
Alabama law permitting ex parte interviews and HIPAA can
coexist so long as the procedural requirements of 45 C.F.R. §
164.512(e) are met. 
3.  Preemption
Finally, there is no federal preemption issue in this
case.  Although the Privacy Rule expressly preempts any
"contrary" state law, there is no preemption when privacy
protections afforded by a state are more stringent than
HIPAA's regulations. 45 C.F.R. § 160.203. A state law is
"contrary" to HIPAA only if a health-care provider would find
it impossible to comply with both the state and federal
7Before the enactment of HIPAA, it was common practice in
Alabama for defense counsel to conduct informal ex parte
interviews with a plaintiff's treating physicians. As this
Court has noted, "when a party files a lawsuit that makes an
issue of his physical condition, he waives his privacy rights
in favor of the public's interest in full disclosure."  Ex
parte Dumas, 778 So. 2d 798, 801 (Ala. 2000). See also Romine
v. Medicenters of America, Inc., 476 So. 2d 51, 55 (Ala.
1985)(discussing ex parte interviews); and Zaden v. 
Elkus, 881
So. 2d 993 (Ala. 2003)(same). 
11
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requirements or if the state law stands as an obstacle to the
accomplishment of HIPAA's purposes.  45 C.F.R. § 160.202
(2016). The Privacy Rule defines "State law" as "a
constitution, statute, regulation, rule, common law, or other
State action having the force and effect of law."  45 C.F.R.
§ 160.202(6)(2016). Under these definitions, no laws in
Alabama could be deemed "contrary" to HIPAA. 
In fact, in Alabama, there is no statutory law or Rule of
Civil Procedure prohibiting a litigant's ability to conduct ex
parte 
interviews 
with 
the 
opposing 
party's 
treating
physicians. Thus, Alabama law allowing such ex parte
interviews cannot be "contrary" to HIPAA, and no preemption
issue is presented.  See Arons, 9 N.Y.3d at 415,  850 N.Y.S.2d
at 356, 880 N.E.2d at 842 ("[W]here 'there is a State
provision and no comparable or 
analogous federal provision, or
the converse is the case,' there is no possibility of
preemption because in the absence of anything to compare
'there cannot be ... a "contrary" requirement' ....") (citing
Standards for Privacy of Individually Identifiable Health
Information, 64 Fed. Reg. 59,918, 59,995) (Nov. 3, 1999)).   
IV.  Conclusion 
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Based on the foregoing, we conclude that nothing in
Alabama law prohibits defense counsel from seeking ex parte
interviews with a plaintiff's treating physicians. We
similarly conclude that HIPAA does not prohibit ex parte
interviews with treating physicians as a means of informal
discovery.  A physician's ability to disclose private health
information in an ex parte correspondence is regulated by
HIPAA, so disclosure of that information may be permitted
pursuant to  a qualified protective order that satisfies 45
C.F.R. 164.512(e). To this extent, we hold that the trial
court exceeded its discretion by requiring the Brewers'
counsel to receive notice of, and have an opportunity to
attend, ex parte interviews that defense counsel intended to
conduct with Rhonda's treating physicians. The defendants
sought a protective order satisfying the requirements of 45
C.F.R. 164.512(e). Accordingly, the additional conditions
imposed by the trial court were not justified based on the
Brewers' objection that ex parte communications would violate
HIPAA and the Alabama Rules of Civil Procedure. We emphasize
that trial courts remain gatekeepers of discovery, and there
may be special or exceptional circumstances, if good cause is
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shown, justifying the imposition of conditions and/or
restrictions upon ex parte interviews with a litigant's
treating physicians. However, in 
this case, the Brewers failed
to demonstrate the existence of any circumstances warranting
limitations on ex parte communications with Rhonda's treating
physicians.  Therefore, we direct the trial court to vacate
its order to the extent it imposes conditions upon defense
counsel's 
ex 
parte 
interviews 
with 
Rhonda's 
treating
physicians.
PETITION GRANTED; WRIT ISSUED.
Bolin, J., concurs.
Mendheim and Mitchell, JJ., concur specially.
Shaw,8 Wise, Bryan, and Stewart, JJ., concur in the
result.
Parker, C.J., dissents.
8Although Justice Shaw was not present at the oral
argument in this case, he has reviewed a recording of that
oral argument.  
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MENDHEIM, Justice (concurring specially).
I agree with the main opinion's conclusion that the
Health Insurance Portability and Accountability Act of 1996
("HIPAA") allows the defendants, Dr. Curt Freudenberger and
Sportsmed Orthopedic Surgery & Spine Center, P.C., to conduct
ex parte interviews with Rhonda Brewer's treating physicians
provided the defendants first obtain a "qualified protective
order" that places safeguards on the use and dissemination of
the 
plaintiff's 
private 
medical 
information. 
See 
generally, 45
C.F.R. § 164.512(e).  I write separately to express my view
regarding the main opinion's final observation that "trial
courts remain gatekeepers of discovery, and there may be
special or exceptional circumstances, if good cause is shown,
justifying the imposition of conditions and/or restrictions
upon ex parte interviews with a litigant's treating
physicians." ___ So. 3d at ___.
This Court has continually emphasized that "[w]hen a
dispute arises over discovery matters, the resolution of the
dispute is left to the sound discretion of the trial court."
Ex parte Henry, 770 So. 2d 76, 79 (Ala. 2000).  "The Alabama
Rules of Civil Procedure permit very broad discovery; however,
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Rule 26(c)[, Ala. R. Civ. P.,] recognizes that this right to
discovery is not unlimited and accordingly vests the trial
court with broad discretionary power to control the use of the
process and prevent its abuse by any party."  Ex parte Mack,
461 So. 2d 799, 801 (Ala. 1984).  Thus, we intervene in the
discovery process only when "the trial court has clearly
exceeded its discretion."  Ex parte Ocwen Fed. Bank, FSB, 872
So. 2d 810, 813 (Ala. 2003).
The main opinion correctly observes that, before the
enactment of HIPAA, ex parte interviews of the plaintiff's
treating physicians conducted by the defendant were permitted
in Alabama medical-malpractice cases.  See, e.g., Romine v.
Medicenters of America, Inc., 476 So. 2d 51, 55 (Ala. 1985)
(quoting with approval Doe v. Eli Lilly & Co., 99 F.R.D. 126,
128 (D. D.C. 1983), for the proposition that "While the
Federal Rules of Civil Procedure have provided certain
specific 
formal 
methods 
of 
acquiring 
evidence 
from
recalcitrant sources by compulsion, they have never been
thought to preclude the use of such venerable, if informal,
discovery techniques as the ex parte interview of a witness
who is willing to speak.").  However, because of the broad
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discretion trial courts are afforded concerning discovery,
trial courts could also restrict or even prohibit such
interviews if the particular circumstances warranted such
measures.  See, e.g., Zaden v. Elkus, 881 So. 2d 993, 999 n.7,
1011 (Ala. 2003) (describing an order in Ballew v. Eagan,
CV-00-6528, in which the circuit court disallowed "any
ex parte communications between defense counsel or insurance
investigators and the treating physicians of the deceased
patient" as the "circuit judge's exercise of discretion
concerning discovery matters").
HIPAA did not change the fact that such ex parte
interviews are allowed in Alabama or a trial court's
discretion 
in 
overseeing 
such 
discovery issues; 
instead, 
HIPAA
added procedural prerequisites to obtaining the plaintiff's
health-care information in order to safeguard the plaintiff's
medical privacy.  In addition to providing some general
privacy safeguards, HIPAA's requirement that the defendant
seek a qualified protective order that places specified
restrictions on any "protected health information" the
defendant obtains through such informal discovery also exists
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so that a plaintiff is able to offer any objections he or she
has to that method of disclosure.  45 C.F.R. § 164.512(e)(1).
"Of course, qualified protective orders for
ex parte interviews do not issue automatically, and
HIPAA does not require a court to issue them. 'If a
plaintiff shows a specific reason for restricting
access to her or his treating physicians, such as
sensitive medical history irrelevant to the lawsuit,
a court may restrict ex parte interviews and
disclosure of medical records.' Pratt v. Petelin,
09–2252–CM–GLR (D. Kan. Feb. 4, 2010) [(not selected
for publication in F. Supp.)]."
Thomas v. 1156729 Ontario Inc., 979 F. Supp. 2d 780, 784 (E.D.
Mich. 2013).  Thus, as was the case before the enactment of
HIPAA, a plaintiff may establish a reasonable privacy concern
other than just tactical litigation strategy that warrants
further restrictions than those listed in 45 C.F.R.
§ 164.512(e)(1)(v) or that justifies prohibiting such
interviews altogether.  Such privacy concerns could include
the involvement of a minor, an independent confidentiality
issue, 
sexual 
issues, 
unnecessary embarrassment, and 
so 
forth. 
The Thomas court noted that one requirement federal district
courts sometimes add in qualified protective orders that
address ex parte interviews is "'clear and explicit' notice to
the plaintiff's physician about the purpose of the interview
and that the physician is not required to speak to defense
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counsel."  979 F. Supp. 2d at 785–86 (quoting Croskey v. BMW
of North America, No. 02-73747, Nov. 10, 2005 (E.D. Mich.
2005) (not selected for publication in F. Supp.)).  Other
courts have suggested "affording plaintiff's counsel the
opportunity to communicate with the physician, if necessary,
in order to express any appropriate concerns as to the proper
scope of the interview and the extent to which plaintiff
continues to assert the patient-physician privilege."  Smith
v. American Home Prods. Corp. Wyeth-Ayerst Pharm., 372 N.J.
Super. 105, 133, 855 A.2d 608, 625 (2003). Generally speaking,
I believe regulations such as these could be deemed
appropriate as "standard language" in a HIPAA qualified
protective order.
In my opinion, the trial court's error in this case was
issuing a "blanket" prohibition on ex parte interviews by
Dr. Freudenberger's lawyers of Rhonda Brewer's medical
providers without any other considerations.  The trial court
should have considered the specific facts and issues of the
case, balanced the competing positions of the litigants
regarding ex parte interviews, and then issued an appropriate
qualified protective order.  The starting point for a trial
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court's analysis in this type of case should be that ex parte
interviews are allowed, and it should then consider specific
exceptions or regulations from the plaintiff that could be
incorporated into the qualified protective order.  If the
plaintiff has presented sound reasons other than tactical
litigation strategy for the exceptions or regulations, then I
believe this Court should uphold the trial court's ruling as
consistent with the trial court's broad authority to oversee
discovery.
In sum, because HIPAA already places some restrictions on
a defendant's use and dissemination of a plaintiff's medical
information to safeguard the plaintiff's privacy, to warrant
further restrictions the plaintiff must establish that
specific circumstances exist in his or her situation that
justify the additional restrictions.  If a plaintiff
demonstrates that such circumstances exist, trial courts
maintain the discretion to place additional restrictions and
regulations upon ex parte interviews with treating physicians
or even to prohibit such interviews altogether.  "A general
argument, 
however, 
that 
ex 
parte 
communications would 
conflict
with public policy does not suffice to warrant restriction of
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such communications."  Pratt v. Petelin, No. 09-2252-CM-GLR,
Feb. 4, 2010 (D. Kan. 2010) (not selected for publication in
F. Supp.).  In this case, the Brewers offered no patient-
specific reason why any restrictions beyond those listed in 45
C.F.R. 
§ 
164.512(e)(1)(v) 
should 
be 
placed 
upon
Dr. Freudenberger's ex parte interviews of Rhonda's treating
physicians.  Accordingly, as the main opinion concluded, the
trial court in this case exceeded its discretion by requiring
additional restrictions without sufficient justification of
privacy concerns from the Brewers.  On return of the case to
the trial court, I believe that the Brewers would have the
opportunity to present specific arguments to the trial court
consistent with the parameters discussed herein.
Mitchell, J., concurs.
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SHAW, Justice (concurring in the result).
I do not believe that the Health Insurance Portability
and Accountability Act of 1996 ("HIPAA") requires the specific
conditions imposed by the trial court in this case on the
defendants' ability to conduct ex parte witness interviews,
which are otherwise allowed by law.  With the specific
considerations of HIPAA resolved and certain other issues of
medical confidentiality waived by law or not applicable, I see
nothing providing the trial court the discretion to restrict,
with no exception or limitation, only one party's ability to
conduct witness interviews in the fashion found in this case. 
Any concerns that ex parte interviews might be abused could be
remedied by a more narrowly tailored and equitable order.  I
therefore agree that the writ should be issued, and I concur
in the result.  
Bryan, J., concurs.
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STEWART, Justice (concurring in the result).
I agree with the main opinion insofar as it concludes
that defense counsel's ex parte interviews of a plaintiff's
treating physicians are authorized under Alabama law. I also
agree that the defendant's right to conduct such interviews is
not prohibited by HIPAA. As the main opinion notes, the
disclosure of the plaintiff's health information can be
authorized pursuant to the issuance of a qualified protective
order under 45 C.F.R. 164.512(e).  In addition, ex parte
interviews of treating physicians provide a vital and
efficient information-gathering tool that comports with the
purpose of discovery, which is "to allow a broad search for
facts, the names of witnesses, or any other matters which may
aid a party in the presentation of his case." Committee
Comments on 1973 Adoption of Rule 26, Ala. R. Civ. P. As the
Delaware Supreme Court has stated:
"This Court will not condone the use of the formal
discovery rules as a shield against defense
counsel's informal access to a witness when these
rules were intended to simplify trials by expediting
the flow of litigation ... and to encourage the
production of evidence ...."
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Green v. Bloodsworth, 501 A.2d 1257, 1258-59 (Del. Super. Ct.
1985). 
Equally important to the right of the defendant in a
medical-malpractice action to prepare a defense with work-
product-privilege protection is the privacy right of the
plaintiff to his or her medical information, especially
medical information that is not relevant to the claims or
defenses raised in the litigation. This Court has held that
"when a party files a lawsuit that makes an issue of his
physical condition, he waives his privacy rights in favor of
the public's interest in full disclosure." Ex parte Dumas, 778
So. 2d 798, 801 (Ala. 2000). A party filing such a lawsuit,
however, cannot be said to have consented to the disclosure
and discovery of his or her entire medical history, in
particular if medical information is not relevant to the
lawsuit. In such situations, the Alabama Rules of Civil
Procedure provide an avenue for a party to seek judicial
intervention 
to 
protect 
the disclosure 
of 
privileged
information.  Indeed, this Court in Ex parte Dumas went on to
say:
"The Alabama Rules of Civil Procedure allow broad
and liberal discovery. Ex parte O'Neal, 713 So. 2d
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956, 959 (Ala. 1998). Rule 26(b)(1), Ala. R. Civ.
P., 
allows 
'[p]arties 
[to] 
obtain 
discovery
regarding any matter, not privileged, which is
relevant to the subject matter involved in the
pending action' and which is 'reasonably calculated
to lead to the discovery of admissible evidence.'
This Court has written: 'A trial judge, who has
broad discretion in this area, should nevertheless
incline toward permitting the broadest discovery and
utilize his discretion to issue protective orders to
protect 
the 
interests 
of 
parties 
opposing
discovery.' Ex parte AMI West Alabama Gen. Hosp.,
582 So. 2d 484, 486 (Ala. 1991). In fact, this Court
has suggested that it issues more writs of mandamus
to correct orders improperly restricting discovery
than it issues to correct orders permitting too much
discovery. Id. A party subject to discovery can
prevent the disclosure of confidential matters not
subject to discovery by securing a protective order
pursuant to Rule 26(c), Ala. R. Civ. P."
778 So. 2d at 801. Accordingly, a plaintiff seeking to limit
the scope of an ex parte interview with a treating physician
is authorized under the Alabama Rules of Civil Procedure to
seek a protective order to prevent the disclosure of medical
information that is irrelevant to the disposition of a claim
or defense raised in the action.
Of further importance in the context of ex parte
interviews are the interests of the treating physician. 
Informal interviews provide an efficient mechanism for
information-gathering from the treating physician, whereas
depositions can be timely and costly.  In addition,
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establishing parameters could aid in the prevention of
inadvertent disclosure of nonrelevant medical information.
Balancing the interests of the parties and the physician
witnesses, I would reject any notion that ex parte interviews
cannot be conducted without the presence of the plaintiff or
the plaintiff's counsel.  Likewise, I would reject any notion
that defense counsel's work-product privilege outweighs the
plaintiff's privacy rights at all costs.  Instead, I would
adhere to this Court's long-held sentiment that trial courts
are 
afforded 
broad 
discretion in 
matters 
concerning 
discovery,
and a trial court's ruling on discovery matters will not be
reversed unless the trial court exceeds its discretion. Ex
parte Wal–Mart, Inc., 809 So. 2d 818, 822 (Ala. 2001). The
trial court is in the best position to craft, on a case-by-
case basis,  a protective order specific to the facts of the
case setting forth the precise parameters within which ex
parte interviews of treating physicians may be conducted. I
would adopt the reasoning of the Georgia Supreme Court in
Baker v. Wellstar Health System, Inc., 288 Ga. 336, 339, 703
S.E.2d 601, 605 (2010), in which the Georgia Supreme Court
"exhort[ed] trial 
courts, 
in 
authorizing 
[ex 
parte] 
interviews
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[of treating physicians], to fashion their orders carefully
and with specificity as to scope" and in which that court
developed a framework for trial courts in that state to follow
when issuing such orders:
"[I]n 
issuing 
orders 
authorizing 
ex 
parte
interviews, 
trial 
courts 
should 
state 
with
particularity: (1) the name(s) of the health care
provider(s) who may be interviewed; (2) the medical
condition(s) at issue in the litigation regarding
which 
the 
health 
care 
provider(s) 
may 
be
interviewed; (3) the fact that the interview is at
the 
request 
of 
the 
defendant, 
not 
the
patient-plaintiff, and is for the purpose of
assisting defense counsel in the litigation; and (4)
the 
fact 
that 
the 
health 
care 
provider's
participation in the interview is voluntary. See,
e.g., Arons v. Jutkowitz, 9 N.Y.3d 393, 850 N.Y.S.2d
345, 880 N.E.2d 831, 843, n. 6 (II)(B) (2007). See
also Angela T. Burnette & D'Andrea J. Morning, HIPAA
and Ex Parte Interviews—The Beginning of the End?,
1 J. Health & Life Sci. L. 73, 104–105 (April 2008).
In addition, when issuing or modifying such orders,
trial 
courts 
should 
consider 
whether 
the
circumstances--including any evidence indicating
that ex parte interviews have or are expected to
stray beyond their proper bounds--warrant requiring
defense counsel to provide the patient-plaintiff
with prior notice of, and the opportunity to appear
at, 
scheduled 
interviews 
or, 
alternatively,
requiring the transcription of the interview by a
court reporter at the patient-plaintiff's request.
See Wayne M. Purdom, Ga. Civil Discovery, § 5.10
(6th ed.); Burnette, supra at 104.
"In sum, the use of carefully crafted orders
specifying precise parameters within which ex parte
interviews may be conducted will serve to enforce
the privacy protections afforded under state law and
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advance HIPAA's purposes while at the same time
preserving a mode of informal discovery that may be
helpful in streamlining litigation in this State."
Baker, 288 Ga. at 339–40, 703 S.E.2d at 605. Although the
Baker court concluded that HIPAA preempted Georgia law, the
standards provided therein to be included in a protective
order authorizing ex parte interviews of treating physicians
provide a balanced approach that seeks to protect the
interests of the parties and the witnesses.  
In the present case, the qualified protective order
entered by the Madison Circuit Court ("the trial court")
required counsel for Curt Freudenberger, M.D., and Sportsmed
Orthopedic Surgery & Spine Center, P.C., to provide notice of
the ex parte interview to counsel for Rhonda and Charlie
Brewer and to allow the Brewers' counsel to attend the
interview.  Nothing in the materials presented to this Court
indicate that the proposed depositions would stray beyond the
bounds of 
information relevant to the discovery of information
pertinent to the claims and defenses raised by the parties in
the case.  Accordingly, I would issue the writ, but with
direction to the trial court to conduct a hearing to allow the
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parties to present evidence in conjunction with the
aforementioned parameters.
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