Case Title: HOLMES v. NIGHTINGALE

Citation: 

Docket Number: 103762

State: oklahoma

Court: Oklahoma Supreme Court

Date: 2007-03-20T00:00:00Z

Document:
HOLMES v. NIGHTINGALE  HOLMES v. NIGHTINGALE 2007 OK 15 158 P.3d 1039 Case Number: 103762 Decided: 03/20/2007 As Corrected: May 30, 2007 THE SUPREME COURT OF THE STATE OF OKLAHOMA MARGIE L. HOLMES, ADMINISTRATOR OF THE ESTATE OF TERESA LEE ELAM, Petitioner, v. HONORABLE REBECCA BRETT NIGHTINGALE, District Judge, Respondent. APPLICATION TO ASSUME ORIGINAL JURISDICTION AND PETITION FOR WRIT OF PROHIBITION ¶0 The petitioner, Margie L. Holmes (Holmes/administrator), represents the estate of Teresa Lee Elam (Elam/patient) in a medical malpractice suit related to Elam's death. The real parties in interest are St. John Medical Center, Inc. (St. John/hospital) and Interim Healthcare of Tulsa, Inc. (Interim/collectively, health care providers). Holmes seeks to enjoin the respondent, Honorable Rebecca Brett Nightingale (trial judge), from enforcing an order authorizing the release of protected health information. We determine that a court order permitting, rather than mandating, oral communication with health care providers entered as a result of an individual clearly placing mental or physical conditions in issue by filing suit does not contravene HIPAA's confidentiality requirements. Nevertheless, the order presented does not: a) conform with the statutory requirements of ORIGINAL JURISDICTION ASSUMED; WRIT GRANTED; CAUSE REMANDED. Steven R. Hickman, FRASIER, FRASIER & HICKMAN, LLP, Tulsa, Oklahoma, for Petitioner, Karen L. Callahan, Leslie C. Weeks, Beth S. Reynolds, RODOLF & TODD, Tulsa, Oklahoma, for Real Party in Interest, St. John Medical Center, Inc., Jeffrey A. Glendening, James A. Higgins, Tara P. Goodnight, THE GLENDENING LAW FIRM, P.L.L.C., Tulsa, Oklahoma, for Real Party in Interest, Interim Healthcare of Tulsa, Inc. WATT, J.: ¶1 We assume original jurisdiction to decide an issue not addressed in a published opinion ¶2 We hold that a court order permitting, rather than mandating, oral communication with health care providers entered as a result of an individual clearly placing mental or physical conditions in issue by filing suit does not contravene HIPAA's confidentiality requirements. Our determination is supported by: 1) 45 CF.R. §164.512(e)(1) governing the procedural requirements and safeguards imposed by HIPAA which clearly anticipates disclosures of protected health information pursuant to a court order; ¶3 Our favorable resolution of the issue regarding ex parte communications requires us to examine the order issued for compliance with ¶4 Although the order refers to the statutory requirements of FACTS ¶5 On October 14, 2005, Theresa Lee Elam (Elam/patient/decedent) was injured in an automobile accident. Elam died on February 23, 2006, while under the care of Interim Healthcare of Tulsa and St. John Health System, Inc. On April 11, 2006, Holmes filed suit on behalf of Elam's estate asserting claims of medical negligence against the health care providers. The following week, an amended petition was filed identifying St. John Medical Center, Inc. as a defendant and medical provider. ¶6 Following Holmes' failure to execute allegedly HIPAA-compliant medical authorizations provided by St. John, the hospital filed a motion to dismiss or in the alternative an application for release of protected health information on May 19, 2006. Interim filed a notification of intent to obtain protected health care information on June 27, 2006. In an order signed on that date and filed on July 5, 2006, the trial court ordered the release of Elam's protected health care information "pursuant to ¶7 Holmes filed an application to assume original jurisdiction and petition for writ of prohibition on September 13, 2006. The health care providers filed their responses on September 29th. ¶8 A COURT ORDER PERMITTING, RATHER THAN MANDATING, ORAL COMMUNICATION WITH HEALTH CARE PROVIDERS ENTERED AS A RESULT OF AN INDIVIDUAL CLEARLY PLACING MENTAL OR PHYSICAL CONDITIONS IN ISSUE BY FILING SUIT DOES NOT CONTRAVENE HIPAA'S CONFIDENTIALITY REQUIREMENTS. ¶9 Holmes argues that the trial court's order allowing ex parte oral communications with Elam's health care providers violates HIPAA's confidentiality requirements. Nevertheless, she recognizes that HIPAA allows the disclosure of protected health information pursuant to court order. ¶10 a) Federal regulations governing the procedural requirements and safeguards imposed by HIPAA clearly anticipate disclosures of protected health information pursuant to a court order. ¶11 Congress enacted HIPAA in 1996 entrusting the Secretary of the Department of Health and Human Services (Secretary) with the task of the creation of national standards to ensure the integrity and confidentiality of individually identifiable health information. ". . . (1) Permitted disclosures. A covered entity may disclose protected health information in the course of any judicial or administrative proceeding: (i) In response to an order of a court or administrative tribunal, provided that the covered entity discloses only the protected health information expressly authorized by such order; or (ii) In response to a subpoena, discovery request, or other lawful process . . ." [Emphasis supplied.] The clear language of the regulation anticipates not only that there may be disclosures pursuant to the filing of a lawsuit but that the disclosures may be allowed where a court order so provides. Here, the first condition is met -- the court order clearly allows such disclosures. ¶12 The defendant and the medical provider argue essentially that, as long as there is an order signed by a judge, there is no limit on the scope of disclosure of protected health information under section 19(B) or HIPAA. They argue that, because the HIPAA regulations provide for disclosure "in response to an order of a court" under section 164.512(e)(1)(i), no restriction on the scope of disclosure applies. That argument, however, ignores the rest of the sentence which requires the "covered entity [to disclose] only the protected health information expressly authorized by such order." ¶13 b) Although there is little federal jurisprudence on the issue of ex parte communications under HIPAA, the existing case law supports a finding that such contact should be allowed when, as here, a court order exists allowing the communication. ¶14 Holmes relies on two cases -- Law v. Zuckerman, 307 F. Supp. 2d 705 (D.Md. 2004) and Crenshaw v. MONY Life Ins. Co., 318 F. Supp. 2d 1015 (S.D.Cal. 2004) -- for the proposition that ex parte contacts are prohibited under HIPPA and that protected medical information may only be released pursuant to formal discovery procedures. The reliance is misplaced. ¶15 The Law court determined that Maryland law, which did not prohibit ex parte communications between a lawyer and the treating physician of an adverse party, was not as stringent as HIPAA. Therefore, the federal law was found to preempt the Maryland statute. Nevertheless, the federal court recognized that disclosures should be allowed when strict compliance with HIPAA occurred. Finally, the Law court determined that: 1) defense counsel had exercised reasonable diligence in attempting to guarantee that physician contacts did not violate HIPAA; 2) the Secretary-promulgated rules restrict the ability of health care providers to divulge patient medical records without express consent of the patient or pursuant to a court order; and 3) a court order allowing either party to speak with the plaintiff's physician about issues set forth in the party's medical records effectively remedied any potential HIPAA violation. ¶16 In Crenshaw, the court held that defense counsel's ex parte communications with the opposing party's personal physicians fell beyond HIPAA's requirement that confidential medical information be disclosed pursuant to a court order, subpoena or discovery request. The federal court's determination rested on a finding that all such disclosures must be accompanied by assurances to the healthcare provider that reasonable efforts had been made by the party to secure a qualified protective order. Because no protective order had issued, the Crenshaw Court determined that HIPAA's disclosure requirements were violated. ¶17 Both Law and Crenshaw were analyzed in Bayne v. Provost, 359 F. Supp. 2d 234, 329 (N.D.N.Y. 2005). The federal court determined that the true import of the two causes was that there is no bright line HIPAA rule barring all ex parte discussions. Rather, that such contacts are appropriate once the protections required by HIPAA are met. ¶18 c) A court order allowing, rather than mandating, disclosure of protected healthcare information through ex parte communications conforms with the pre-HIPAA determinations in Seaberg v. Lockard and Johnson v. District Court of Oklahoma County holding that where there has been a waiver of the physician/patient privilege pursuant to ¶19 Our analysis here is limited to the issue of whether ex parte communications are allowed under Oklahoma jurisprudence. Johnson v. District Court of Oklahoma County, 1987 OK 47, 738 P.2d 151 involved a medical malpractice action. The trial court issued an order finding the privilege involving protected healthcare information waived and requiring discovery by ex parte communication. The Johnson Court issued a writ of prohibition to prevent enforcement of the order. The Court held that it was beyond the district court's authority to compel discovery by ex parte communication. ¶20 Following the teachings of Johnson, the memorandum opinion in Seaberg v. Lockard, 1990 OK 40, 800 P.2d 230 held that §19's14 waiver of the physician/patient privilege in a personal injury action did not authorize the district court's pretrial declaration that no privilege existed. Although the Seaberg Court determined that the law sanctioned voluntary ex parte communications with physicians and other healthcare providers where no legal privilege existed, it held that judicial authority could not be exercised to facilitate or to impede such informal communications. ¶21 THE ORDER PRESENTED IS OVERLY BROAD. IT DOES NOT CONFORM WITH THE STATUTORY REQUIREMENTS OF ¶22 While we agree with the health care providers that a court order permitting, rather than mandating, oral communication with health care providers entered as a result of an individual clearly placing mental or physical conditions in issue by filing suit does not contravene HIPAA's confidentiality requirements, we must now determine whether the order presented conforms with the statutory requirements of 76 O.S. Supp. 2005 §1915 and 12 O.S. Supp. 2004 §2503(D)(3).16 Furthermore, we examine the order's language in light of the risks physicians face when disclosing protected health care information. ¶23 a) The court order does not conform with the statutory requirements of ¶24 We have determined that 45 C.F.R. §164.512 clearly anticipates the issuance of court orders allowing ex parte communications with physicians. The same regulation limits the information to be disclosed to that "expressly authorized by such order."17 Here, the order allows access inclusive of, but not limited to, "all examinations, treatment, radiographic imagining films, emergency room records, outpatient records, hospital charts, billing statements, or results of any diagnostic study" and to "any record of any health care providers care and treatment of Teresa Lee Elam."18 [Emphasis supplied.] The permitted disclosure is too broad. ¶25 Information which may be released once a party places its medical condition in issue is limited by 76 O.S. Supp. 2005 §19 and 12 O.S. Supp. 2004 §2503(D)(3) along with causes interpreting the statutory scheme. Our jurisprudence makes it clear that these statutes preclude the general disclosure of all of a party's medical records and restrict discovery to materials relevant to any issue in the malpractice action or to the injury or death in litigation. ¶26 We consider the limitations placed on ex parte communications under the same causes which anticipate such disclosures. Johnson v. District Court, 1987 OK 47, ¶4, 738 P. 21d 151 provides that "[t]he scope of discovery under section 19(B) includes any material relevant to any issue in the malpractice action." Seaberg v. Lockard, 1990 OK 40, ¶3, 800 P.2d 230 reaffirmed Johnson, holding that "[a]lthough the law sanctions voluntary ex parte communications with physicians and other health providers where no legal privilege is deemed to exist, judicial authority may not be exercised to facilitate or impede such information communications." [Emphasis in original.] Seaberg went on to explain that the waiver of privilege in section 19(B) "is to be viewed as self-executing" and that section 19(B) "does not contemplate a judicial order directing or authorizing physicians or other health care providers to make themselves available for ex parte interviews by the legal representatives of a defendant." Further, the Seaberg Court recognized that the waiver of patient privilege found in section 19(B) "is imposed by force of law and stands restricted to the injury or death in litigation." ¶27 In Higgenbotham v. Jackson, 1994 OK 8, ¶1, 869 P.2d 319 , we recognized that no statutory discovery method required a plaintiff in a personal injury lawsuit to execute, in favor of the defendant, a general medical authorization entitling the defendant to obtain all of the plaintiff's medical records. In considering the breadth of §2503(D)(3), the Court stated "12 O.S. §2503(D)(3) qualifies the physician/patient privilege 'to the extent that an adverse party in said proceeding may obtain relevant information regarding said condition by statutory discovery.'" Higgenbotham conforms with the teachings of Johnson that "[t]he scope of discovery under section 2503(D)(3) is limited to the issue of the condition raised as an element of the claim or defense." ¶28 The challenged order is deficient under both 76 O.S. Supp. 2005 §1919 and 12 O.S. Supp. 2004 §2503(D)(3).20 It places no limit on the scope of the medical information to be disclosed. It is not confined to "material relevant to any issue in the malpractice action" as required by Johnson, nor is it "restricted to the injury or death in litigation" as required by Seaberg. Furthermore, it is too broad under Higgenbotham, allowing the health care providers access to "any record of any health care providers care and treatment of Teresa Lee Elam"21 rather than limiting it to the condition alleged to have caused the patient's injury and resulting death. ¶29 b) An order allowing ex parte physician communications should clearly provide that no physician may be compelled to participate in oral ex parte communications. ¶30 Pursuant to 42 U.S.C. §1320d-6 a physician disclosing protected health care information under HIPAA is subject to severe penalties ranging from $50,000 to $250,000 in fines and/or imprisonment running from less than a year to a maximum of not more than 10 years.22 In light of the exposure, any physician should be advised by the Court's order allowing ex parte communication that such correspondence is "purely voluntary and may not be compelled by any party." Although the order here contains permissive language regarding any physician's participation, it does not clearly delineate that such communications may not be compelled. CONCLUSION ¶31 HIPAA does not expressly bar ex parte communications but does require certain procedures. One measure by which such information may be sought is pursuant to a court order specifying the substance of the information to be released.23 We hold that an order, entered as a result of an individual placing mental or physical conditions in issue by filing suit and containing clearly permissive language in relation to ex parte communications, does not contravene HIPAA's confidentiality requirements.24 The determination is consistent with: procedural requirements and safeguards imposed by HIPAA;25 extant federal jurisprudence; and this Court's pre-HIPAA determinations in Johnson v. District Court of Oklahoma County, 1987 OK 47, 738 P.2d 151 and Seaberg v. Lockard, 1990 OK 40, 800 P.2d 230 . ¶32 The language of the challenged order does not conform with the requirements of 76 O.S. Supp. 2005 §19(B)(1)26 and 12 O.S. Supp. 2004 §2503(D)(3).27 It does not limit disclosure to a mental or emotional condition of the patient that is relevant to the claims or defenses asserted in the malpractice action. The order has the potential to allow defense counsel in the malpractice action to obtain all medical and psychological health information of the patient, even information that has nothing to do with the malpractice action. Although the order contains permissive language regarding the participation of any physician in ex parte communications, it does not clearly advise doctors that such exchanges may not be compelled. Therefore, we assume jurisdiction, grant the writ and remand the cause for entry of an order consistent with this opinion.28 ORIGINAL JURISDICTION ASSUMED; WRIT GRANTED; CAUSE REMANDED. ALL JUSTICES CONCUR. FOOT