Case Title: Rogers v. State

Citation: 127 Nev. Adv. Op. No. 25

Docket Number: 

State: nevada

Court: Nevada Supreme Court

Date: 2011-06-02T00:00:00Z

Document:
0

 

427 Nev., Advance Opinion 25
IN THE SUPREME COURT OF THE STATE OF NEVADA

DAVID M. ROGERS, No. 54913

Appellant, FI L E D

THE STATE OF NEVADA,
Respondent. JUN 022011

wy,

Appeal from a judgment of conviction, pursuant to a jury
verdict, of driving under the influence of a controlled substance and/or
with an amount of a prohibited controlled substance in the blood causing
substantial bodily harm. First Judicial District Court, Carson City; James
‘Todd Russell, Judge.

Affirmed.
Diane R. Crow, State Public Defender, and James P. Logan, Chief Deputy

Public Defender, Carson City,
for Appellant.

Catherine Cortez Masto, Attorney General, Carson City; Neil A.
Rombardo, District Attorney, and Gerald J. Gardner, Assistant Distriet
Attorney, Carson City,

for Respondent.

 

BEFORE DOUGLAS, C.J., PICKERING and HARDESTY, JJ.

OPINION
By the Court, PICKERING, J.:

 
David M, Rogers was convicted by a jury of driving under the
influence of a controlled substance (marijuana) causing substantial bodily
harm, for which he was sentenced to serve 24 to 60 months in prison. Part
of the evidence the jury heard came from a paramedic who took Rogers by
ambulance to the hospital. The paramedic testified that Rogers confided
that he had smoked marijuana before the accident. On appeal Rogers
argues, as he did in the district court, that his statement to the paramedic
was inadmissible because it was protected by Nevada's doctor-patient
priviloge.t We disagree and affirm.

L

‘As it happens, Rogers w:

 

already en route to the hospital
when the traffic accident occurred. He had been mountain biking, fallen,
and suffered a cut on his thigh near the femoral artery. Alone and
wanting medical care, Rogers decided to drive himself to the hospital.
Upon reaching Carson City, Rogers drove into a busy

intersection without braking, causing a seven-car pileup. The driver

’Rogers also argues that errors in the jury instructions (concerning
impairment and proximate cause) and prosecutorial misconduct (closing
argument to the effect that repeating a story doesn't make it true) require
reversal. Rogers did not preserve these issues by timely trial objection,
and he fails to establish them as plain error on appeal. Berry v, State, 125
Nev. _, __, 212 P.3d 1085, 1097 (2009) (unobjected-to jury instructions
are reviewed for plain error), abrogated on other grounds by State v.
Castaneda, 126 Nev. __, 245 P.3d 550 (2010); Valdez v. State, 124 Nev.
1172, 1190, 196 P.3d 465, 477 (2008) (unobjected-to prosecutorial
misconduct claim is reviewed for plain error). His cumulative error claim
thus fails too. Valdez, 124 Nev. at 1195, 196 P.3d at 481.

 

     

 
 

whose car Rogers hit first suffered serious injuries. When the police
arrived, they found Rogers sitting on his car's tailgate applying a compress
to his cut leg. He said he could not remember the collision and thought he
had blacked out.? His car’s airbags had deployed.

 

Among the first responders was firofighter/paramedic Joff
Friedlander. After speaking to Friedlander at the scene, Rogers went on
to the hospital by ambulance with Friedlander attending him. During the
trip, Friedlander asked Rogers if he had used drugs or alcohol that day.
Rogers said “something to the effect of ...‘T burned a joint on the trail,
mountain biking.” As an emergency medical technician (EMT),
Friedlander routinely asks ambulance transport patients such questions,
He testified that he did so in this case, not at the direction of the hospital
or any doctor Rogers might see, but as normal triage for an independent
EMT.

At the hospital Rogers consented to a blood test, which came
back positive for marijuana. Earlier, Rogers had asked Friedlander not to
tell the police about his marijuana use. ‘Torn between his conflicting
duties to Rogers and to the public, Friedlander sought advice from another
EMT, who advised Friedlander to pass the information along to the
Highway Patrol officer investigating the accident, which Friedlander did.

"The State disputes Rogers’ veracity and account of the accident. It
maintains Rogers’ marijuana use impaired his driving and depth
perception and caused the accident.

 

 
——-

Neither side argues that Friedlander sharing Rogers’ admission with the
Highway Patrol prompted the blood test.

Rogers filed a protrial motion in limine to keep his statement
to Friedlander out of evidence based on the doctor-patient privilege. The
district court denied the motion by written order in which it concluded
“that an EMT paramedic does not fall within the Doctor-Patient Privilege”
because the definition of “doctor” in NRS 49.215 “does not include a
paramedic” and, further, that there was no “evidence to support that Mr.
Friedlander was working under the direction of a doctor” in examining
Rogers. After a two-day trial, the jury convicted Rogers of driving under
the influence of a controlled substance causing substantial bodily harm,

IL

Rogers bases his EMT- or paramediec-patient privilege claim
on the doctor-patient privilege. The doctor-patient privilege did not exist
at common law. 2 C. Mueller & L. Kirkpatrick, Federal Evidence § 5.42
(3d ed. 2010) (discussing Lord Mansfield’s comments, in Duchess of
Kingston's Trial, 20 Howell’s State Trials 955, 573 (HLL. 1776), that a

physician committed no indiscretion when he revealed communications

 

between himself and his patient “in a court of justice”). Its existence and

SNRS 629.065 provides that health care records relating to a blood,
breath, or urine test shall, upon request, be made available to a law
enforcement agency or district attorney if the patient is suspected of
having violated the laws against driving under the influence and that they
are admissible as evidence in any related criminal proceeding.

 

 
scope depend on statute. Id, In Nevada, the doctor-patient privilege is

codified at NRS 49.215-.245,

 

NRS 49.226 states the general rule of doctor-patient privilege,
as follows:

A patient has a privilege to refuse to disclose and
to prevent any other person from disclosing
confidential communications among the patient,
the patient's doctor or persons who are
participating in the diagnosis or treatment under
the direction of the doctor, including members of
the patient's family.

Each of the privilege statute's key terms—‘doctor,” “patient,” and

 

“confidential” communication—has a specific, given definition. “Doctor”
means a person licensed to practice medicine, dentistry or osteopathic
medicine in any state or nation, or a person who is reasonably believed by
the patient to be so licensed, and in addition includes a person
employed . .. as a psychiatric social worker.” NRS 49.215(2). “Patient” is
defined as “a person who consults or is examined or interviewed by a
doctor for purposes of diagnosis or treatment.” NRS 49.215(3). And a
communication is “confidential” if “it is not intended to be disclosed to
[unnecessary] third persons,” e.,, persons who are not “present to further
the interest of the patient,” “reasonably necessary for the transmission of
the communication,” or “participating in the diagnosis and treatment
under the direction of the doctor, including members of the patient's
family.” NRS 49.215(1)(a)-().

There is little doubt that Rogers meant his statement to
Friedlander about smoking marijuana to be “confidential.” ‘The problem is
that “doctor,” as defined in NRS 49.215(2), does not include EMTs or

 

 
os

paramedics, while “patient” is defined in NRS 49.215(8) with reference to
the defined term “doctor.” Reading NRS 49.225 literally, the “doctor-
patient” relationship required for the privilege to attach did not arise
simply by virtue of Rogers, a person en route by ambulance to a hospital,
speaking to Friedlander, an EMT/paramedic, in confidence.

‘The doctor-patient privilege is “intended to inspire confidence
in the patient” and encourage candor in making a full disclosure go the
best possible medical care can be given. Hetter v, District Court, 110 Nev.
518, 516, 874 P.2d 762, 763 (1994). Rogers argues that the same need for
candor and trust that justify the doctor-patient privilege exists in the first
responder and ambulance transport settings. But see Daniel M. Roche,
Comment, Don't Ask, Don't Tell: HIPAA’s Effect. on Informal Discovery in
Products Liability and Personal Injury Cases, 2006 BYU L. Rev. 1075,

1077 (2006) (noting that “the policy implications of the physician-patient

 

privilege are weakened in an emergency response context [because] EMTs
and paramedics do not usually have a continuing relationship with
patients, nor are they particularly sought out or chosen by patients”),
However, testimonial privileges like the doctor-patient privilege come at a
price. They “are in derogation of the search for truth,” United States v.
Nixon, 418 U.S. 683, 710 (1974), cited in Ashokan v, State, Dep't of Ins.,
109 Nev. 662, 668, 856 P.2d 244, 247 (1993), “contraven{e] ... the
fundamental principle that ‘the public... has the right to every man’s
evidence,” Jaffee v, Redmond, 518 U.S. 1, 19 (1996) (Scalia, J., dissenting)
(quoting Trammel_v, United States, 445 U.S. 40, 50 (1980)), and often
their “benefits are, at best, ‘indirect and speculative.” Whitehead v.
Comm’n on Jud, Discipline, 110 Nev. 380, 415, 873 P.2d 946, 968 (1994)

 

 
——s

(quoting In_re Grand Jury Investigations, 599 F.2d 1224, 1236 (8d Cir.
1979). For these reasons, this court has consistently held that statutory
privileges should be construed narrowly, according to the “plain meaning
of [their] words.” Ashokan, 109 Nev. at 670, 856 P.2d at 249 (hospital peer
review privilege construed narrowly); MeNair v, District Court, 110 Nev.
1285, 1288, 885 P.2d 576, 578 (1994) (accountant-client privilege
construed narrowly); Whitehead, 110 Nev. at 414-15, 873 P.2d at 968
(attorney-client and work product privileges construed narrowly); see
State v. Fouquette, 67 Nev. 505, 586-37, 221 P.2d 404, 420-21 (1950)
(construing a predecessor version of NRS 49.225 narrowly; holding that

 

 

the physician-patient privilege provided in Nevada Compiled Laws § 8974
(1949) wi
medicine in Nevada).

 

limited to physicians or surgeons actually licensed to practice

‘The Legislature recognizes and regulates EMTs as
fety of
the people of Nevada.” NRS 450B.015; see NRS Chapter 450B. Over the
years, the Legislature has expanded the definition of “doctor” for purposes

professionals whose services are “necessary for the health and

 

of the doctor-patient privilege from the narrow Nevada-licensed “physician
or surgeon” definition set forth in Fouguette, 67 Nev. at 536-37, 221 P.2d
‘at 420-21, to encompass any person licensed or reasonably believed to be
licensed under the laws of any state or nation to practice medicine,
dentistry, or osteopathy, or who is employed as a psychiatric social worker.
NRS 49.215(2). Despite this expansion, the Legislature has not included
EMTs or paramedics in NRS 49.215(2)'s definition of “doctor.” As first
responders, EMTs see and hear things that later witnesses can only

surmise or reconstruct. Applying the narrow construction conventional to

 
 

this court's interpretation of testimonial privilege statutes, we conclude
that the doctor-patient privilege in NRS 49,225 does not apply to
communications between an EMT or paramedic and patient when those
‘communications do not occur in the presence, or at the direction, of a
doctor, as defined in NRS 49.215(2). Accord Med-Expreas, Inc. v. Tarpley,
629 So. 2d 331, 332 (La. 1993) (because “ambulance technicians [are] not
‘physician[s]’ as [defined by statute], there is no privilege”); State v,
LaRoche, 442 A.2d 602, 603 (N.H. 1982) ("[t}he statute ... by its terms,
applies only to physicians

 

nd surgeons and those working under their
supervision{; sJince EMT's are not physicians or surgeons, and there was
no evidence that the EMT's were working under the supervision of a
physician or surgeon, the privilege cannot protect the defendant's
admission in the ambulance”); State v. Ross, 947 P.2d 1290, 1292 (Wash.
Ct. App. 1997) (a privilege statute covering statements “to physicians,
surgeons, or osteopathic physicians or surgeons” does cover
communications to a “responding paramedic’).«

Accepting arguendo that “doctor” as defined in NRS 49.215(2)
does not include EMTs, Rogers makes a further argument: His statement
to Friedlander is privileged under NRS 49,225, he claims, because that

statute protects as privileged all communications “among the patient, the

“Other courts have reached the same conclusion in unpublished
dispositions. State v. Gates, No. 09-1241, 2010 WL 2598334, at *5 (owa
Ct. App. Jun. 30, 2010) (publication decision pending); State v. Barrett,
No. CA2003-10-261, 2004 WL 2340658, at *8 (Ohio Ct. App. Oct. 18, 2004),

 

 
ee

patient's doctor or persons who are participating in the diagnosis or
treatment under the direction of the doctor, including members of the
patient's family.” (Emphasis added.) By law, EMTs are regulated by the
State or District Board of Health. NRS 450B.120. As an EMT,
Friedlander worked under the auspices of a medical director who
established the protocols to be followed in the field. NAC 450B,505(2)-(3).
From this Rogers concludes that Friedlander was acting “under the
direction of a doctor"—the medical director under whose auspices he
worked as an EMT/paramedic/firefighter—thereby qualifying his
statement as privileged under NRS 49.225.

Rogers’ argument misreads NRS 49.225 by substituting “a” for
“the” in its reference to “the patient, the patient's doctor or persons who
are participating in the diagnosis or treatment under the direction of the
doctor .” The relationship the statute fosters is that between the
patient and the patient

 

doctor. Communications among the patient, the
patient's doctor, or persons acting “under the direction of the doctor” are
privileged but only when the third person is participating “under the
direction” of the patient's doctor. While “patients who are being treated by
physician should be entitled to trust someone who works under the close

 

supervision of the physician to the same degree that they can trust the
physician,” such as a doctor's on-staff nurse, the statutory privilege does
not by its terms extend to third persons not working under the doctor's
close supervision, such as an independent EMT. Darnell v. State, 674
N.E.2d 19, 21-22 (Ind. Ct. App. 1996); see State v, Gubitosi, 886 A.2d 1029,
1041-42 (N.H. 2005) (the statutory physician-patient privilege is construed
“quite strictly” and does not apply “to emergency medical technicians

 

 
ei

because they do not work under the supervision of a physician or surgeon
as required by the statute” (quotation omitted)); Edward J. Imwinkelried,
‘The New Wigmore: A Treatise on Evidence: Evidentiary Privileges § 6.9.1
(2d ed. 2010) (alithough on balance the definitions under the medical
privileges are expansive, they are not boundless” and do not apply “in
most jurisdictions...to paramedics acting independently of any
physician’).

Here, as the district court found, Friedlander was acting as an
independent EMT. There was no doctor present at the scene and
Friedlander was not acting under the supervision or direction of a doctor
in a doctor-patient relationship with Rogers. Accepting Rogers’ argument
that, because an EMT is required by law to report to a medical director,
this makes communications between an injured person and an EMT
privileged would in effect expand the doctor-patient relationship to cover
all EMT-patient communications and ignore the plain language in NRS
49.225, We recognize that a policy argument can be made that people who
receive EMT services should enjoy the protections of the doctor-patient
See
People v. Mirque, 768 N-Y.S.2d 471, 477 (Crim. Ct. 2003) (“A patient
bound for the hospital by ambulance should not be required to master the

 

privilege for communications between them and the first responder:

rules of agency before speaking freely”; extending New York's physician-
patient privilege to reach a patient's statement to an EMT); contra People
vAckerson, 566 N.Y.S.2d 833, 834 (County Ct. 1991). However, we
cannot ignore the substantial competing concern with availability of

10

 

 
evidence, particularly in the first-responder setting.’ It is for “the
Legislature, not the court, . . . to extend the literal language of the [doctor-
patient] privilege [statute] to include paramedics.” Ross, 947 P.2d at 1293;
Darnell, 674 N.E.2¢ at 22 (‘were we to recognize that all communications
between [emergency responders] and patients were privileged, we would
be limiting the amount of testimony which could be offered at trial and,
thereby, impeding the search for truth,” a “policy decision{ best left] to the
legislature”); see_also NRS 49.015(1) (providing that there are no
testimonial privileges other than those required by the United States or
‘Nevada Constitutions or provided by statute)

‘As the proponent of the privilege, Rogers bore the burden of
establishing it. McNair, 110 Nev. at 1289, 885 P.2d at 579. He failed to

"Many of the cases addressing EMT-privilege or paramedic-privilege
claims have arisen in the context of prosecutions for driving under the
influence of drugs or alcohol. State v. Gates, No. 09-1241, 2010 WL
2598334 (Iowa Ct. App. Jun. 30, 2010); People v. Mirque, 758 N.Y.S.2d 471
(Crim. Ct. 2003); State v. Barrett, No. CA2003-10-261, 2004 WL 2340658
(Ohio Ct. App. Oct. 18, 2004); State v. Ross, 947 P.2d 1290 (Wash. Ct. App.
1997).

 

 
  
    

meet that burden, and his other assignments of error also fail, supra

Gti

note 1, We therefore affirm,

Cd.

  

phn heh, J.

Hardesty

12