Case Title: State ex rel. Wallace v. State Med. Bd. of Ohio

Citation: 2000-Ohio-213

Docket Number: 19991385

State: ohio

Court: Ohio Supreme Court

Date: 2000-08-16T00:00:00Z

Document:
[Cite as State ex rel. Wallace v. State Med. Bd. of Ohio, 89 Ohio St.3d 431, 2000-
Ohio-213.] 
 
 
THE STATE EX REL. WALLACE ET AL., APPELLEES, v. STATE MEDICAL BOARD OF 
OHIO ET AL., APPELLANTS. 
[Cite as State ex rel. Wallace v. State Med. Bd. of Ohio (2000), 89 Ohio St.3d 
431.] 
Public records — State Medical Board of Ohio’s investigative records are not 
public records — Waiver of right to confidentiality — Determining 
whether State Department of Insurance fraud investigatory records are 
exempt from disclosure under R.C. 149.43(A)(2). 
(No. 99-1385 — Submitted April 11, 2000 — Decided August 16, 2000.) 
APPEAL from the Court of Appeals for Hamilton County, No. C-980557. 
 
Relator-appellee Alvin Wallace is a surgical assistant and president of 
relator-appellee Surgical Skills, Inc., a business that provides hospitals with 
surgical assistants.  Surgical assistants perform tasks such as preparing and laying 
out the necessary surgical instruments. 
 
In 1994, respondent-appellant State Medical Board of Ohio and 
respondent-appellant State Department of Insurance began independent 
investigations of the relators. 
 
On September 7, 1994, Patricia Ellis, an investigator employed by the 
Medical Board, began investigating relators for alleged violations of R.C. Chapter 
4731, including the unlicensed practice of medicine. 
 
In January 1995, Richard Wilson, an investigator employed by Anthem 
Blue Cross and Blue Shield (“Anthem”), began investigating insurance claims 
submitted to Anthem by the relators. 
 
Also in January 1995, Robert J. Kaising, an investigator with the 
Insurance Department, was assigned to investigate a complaint, made by a third-
party payor other than Anthem, that alleged that relators were committing 
 
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insurance fraud.  In June 1995, Kaising learned that Anthem was also conducting 
an investigation of the relators. 
 
Wilson’s 
investigation 
commenced 
after 
Anthem 
received 
a 
communication from the National Health Care Anti-Fraud Association.  The 
communication was authored by FBI agent Cynthia Cronin and stated that the 
relators were suspected of submitting fraudulent claims to insurance companies.  
The concern was that the relators, surgical assistants, were using billing codes 
employed by the medical profession to bill insurance companies for services 
rendered by surgeons. 
 
The scope of Wilson’s investigation was limited to determining whether 
Wallace was a physician and whether services that relators provided to Anthem 
subscribers were reimbursable, as Anthem’s administrative guidelines did not 
allow services performed by nonphysician surgical assistants to be reimbursed. In 
the beginning of April or May 1995, Wilson, believing that he was under a duty to 
do so, contacted the Insurance Department to discuss information he had gathered 
regarding the relators.  At that time, he also contacted the Medical Board. 
 
During their investigations, Wilson was present on several occasions when 
Ellis and Kaising interviewed physicians and when they inquired about 
arrangements between the relators and medical providers. 
 
In December 1995, relators contacted the Medical Board and Insurance 
Department and requested permission to inspect and copy all of the documents 
these agencies had in their possession relating to Wallace and Surgical Skills, Inc.  
These requests were made pursuant to the Public Records Act, R.C. 149.43 et seq.  
The Medical Board and Insurance Department refused to release their 
investigatory records to the relators. 
 
In May 1996, relators filed a mandamus action in the Hamilton County 
Court of Common Pleas to compel the respondents to release their investigatory 
records relating to relators under R.C. 149.43.  Respondents, the Medical Board 
 
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and Insurance Department, claimed that the records were confidential and 
exempted from release under R.C. 149.43.  On June 3, 1998, the trial court 
granted respondents’ motion for summary judgment. 
 
Relators appealed, asserting five assignments of error.  On June 11, 1999, 
the Court of Appeals for Hamilton County reversed the trial court’s judgment in 
part and remanded the case to the trial court for further proceedings in accordance 
with its disposition of the case. 
 
The court of appeals determined that by allowing Wilson to be present 
during witness interviews the Medical Board violated the duty to keep its 
investigatory records confidential; however, the court concluded, “R.C. 4731.22 
provides a privilege for information in the Medical Board’s investigatory records.  
Without a valid waiver from all persons whose privacy rights are implicated, 
these records may not be disclosed under the Public Records Act.”  The court 
further noted that Dr. Semertzides, one of the physicians who was interviewed in 
Wilson’s presence, authorized the release of all information gathered during his 
interview.  With regard to this information, the court of appeals directed the trial 
court to conduct an in camera inspection and withhold any information that 
implicated the privacy rights of anyone other than Semertzides.  Additionally, the 
court of appeals concluded that the trial court had a duty to conduct an in camera 
inspection of the Insurance Department’s records in order to ascertain whether the 
information contained therein was exempted from release. 
 
In addressing relators’ other assignments of error, the court held that the 
investigations conducted by the Medical Board and the Insurance Department 
were legitimate and therefore not ultra vires and that the denial of records did not 
violate Wallace’s equal protection rights. 
 
The cause is now before this court upon the allowance of a discretionary 
appeal. 
__________________ 
 
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Robert Armand Perez, Sr., for appellees. 
 
Betty D. Montgomery, Attorney General, Scott Myers and Lisa Wu Fate, 
Assistant Attorneys General, and Mark R. Weaver, Special Counsel to the 
Attorney General, for appellants. 
__________________ 
 
ALICE ROBIE RESNICK, J. 
 
This case, which the court of appeals characterized as a “complex case 
involving the interplay of the Public Records Act, the confidentiality provisions of 
the State Medical Board of Ohio, and similar, but not identical provisions 
governing the State Department of Insurance” (footnote omitted), raises two 
separate yet interrelated issues for our consideration.  First, we must determine 
whether the records in question are “public records” within the meaning of R.C. 
149.43.  If these records are not public records but rather are confidential 
investigatory materials, then we must determine whether the presence of a 
nonagent, third party during witness interviews constitutes a waiver of 
confidentiality in the otherwise privileged material. 
I.  Confidentiality of Investigatory Records 
 
Ohio’s Public Records Act is codified in R.C. 149.43 et seq.  The statute 
defines “[p]ublic record” as “any record that is kept by any public office.”  R.C. 
149.43(A)(1).  The term “public office” includes “any state agency * * * 
established by the laws of this state for the exercise of any function of 
government.”  R.C. 149.011(A).  R.C. 149.43 must be construed liberally in favor 
of broad access to records kept by public offices, and any doubt is to be resolved 
in favor of disclosure of the records.  State ex rel. Gannett Satellite Info. Network, 
Inc. v. Petro (1997), 80 Ohio St.3d 261, 264, 685 N.E.2d 1223, 1227, citing State 
ex rel. Gannett Satellite Info. Network, Inc. v. Shirey (1997), 78 Ohio St.3d 400, 
401, 678 N.E.2d 557, 559.  Additionally, mandamus is the appropriate remedy to 
compel compliance with R.C. 149.43.  R.C. 149.43(C); see, also, State ex rel. 
 
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Multimedia, Inc. v. Snowden (1995), 72 Ohio St.3d 141, 142, 647 N.E.2d 1374, 
1377, citing State ex rel. Steckman v. Jackson (1994), 70 Ohio St.3d 420, 426, 
639 N.E.2d 83, 88-89.  With these standards in mind, we now proceed. 
A.  Medical Board Records 
 
The Medical Board is a “public office” for the purposes of R.C. 149.43. 
Former R.C. 4731.22(C)(1), the applicable provision governing Medical Board 
investigations, stated, “Information received by the board pursuant to an 
investigation shall be confidential and not subject to discovery in any civil 
action.”  146 Ohio Laws, Part V, 8765.  (The current version is codified at R.C. 
4731.22[F][5] and is virtually the same.) 
 
In State Med. Bd. of Ohio v. Murray (1993), 66 Ohio St.3d 527, 536, 613 
N.E.2d 636, 642-643, we held that information contained in the Medical Board’s 
records “is to be kept confidential at all times and is not, under any circumstances, 
* * * discoverable in a civil action.”  Based on the plain language employed in 
R.C. 4731.22, language that we previously deemed a “clear legislative directive,” 
we hold that the Medical Board’s investigative records are not public records.  Id. 
at 536, 613 N.E.2d at 642. 
 
R.C. 149.43(A)(1) defines “public record” and enumerates exceptions 
from the definition of “public record” for purposes of the Public Records Act.  
“Records the release of which is prohibited by state or federal law” are not public 
records.  R.C. 149.43(A)(1)(q), formerly R.C. 149.43(A)(1)(p), 146 Ohio Laws, 
Part I, 134.  In enacting former R.C. 4731.22(C)(1), the General Assembly 
specifically exempted the Medical Board’s investigative records from disclosure 
under R.C. 149.43. 
 
Having determined that the Medical Board’s investigative records are not 
public records within the meaning of R.C. 149.43, we must now determine 
whether the Medical Board waived its right to confidentiality by allowing Wilson, 
a third party, to attend witness interviews. 
 
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Former R.C. 4731.22(C)(1) mandated that the board “conduct all 
investigations and proceedings in such a manner as to protect patient 
confidentiality.  The board shall not make public names or other identifying 
information about patients unless proper consent is given or a waiver of the 
patient privilege exists” under R.C. 2317.02(B).  146 Ohio Laws, Part V, 8766. 
(This mandate remains unchanged in the current version of R.C. 4731.22.  See 
R.C. 4731.22[F][5].  Moreover, this current version requires the board to protect 
confidentiality not only of patients but also of persons who file complaints with 
the board.)  This provision contains safeguards designed to protect patient 
confidentiality in the same manner that the physician-patient privilege protects 
patient confidences.  State Med. Bd. of Ohio v. Miller (1989), 44 Ohio St.3d 136, 
138, 541 N.E.2d 602, 604.  The court of appeals correctly recognized that by 
allowing Wilson to attend witness interviews, the Medical Board violated its duty 
to maintain the confidentiality in the information it gathered.  We agree that it was 
improper for the Medical Board to give a private third party access to this 
information.  Thus, the issue remains whether the Medical Board’s breach of 
confidentiality constitutes a waiver. 
 
One physician, Dr. Semertzides, authorized the release of information 
gathered at an interview attended by Wilson.  The court of appeals determined 
that by signing the release Semertzides waived his privilege of confidentiality 
with regard to information gathered at his interview.  Consequently, the court of 
appeals directed the trial court to release the records pertaining to Semertzides and 
to withhold any information concerning anyone else whose privacy rights were 
implicated.  The court ordered that all other records should remain confidential 
because “[w]ithout a valid waiver from all persons whose privacy rights are 
implicated, these records may not be disclosed under the Public Records Act.” 
 
“Waiver” is defined as a voluntary relinquishment of a known right.  See 
Chubb v. Ohio Bur. of Workers’ Comp. (1998), 81 Ohio St.3d 275, 278, 690 
 
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N.E.2d 1267, 1269, citing State ex rel. Athens Cty. Bd. of Commrs. v. Gallia, 
Jackson, Meigs, Vinton Joint Solid Waste Mgt. Dist. Bd. of Directors (1996), 75 
Ohio St.3d 611, 616, 665 N.E.2d 202, 207.  Persons may either expressly or 
impliedly waive statutory provisions intended for their own benefit, but statutory 
provisions cannot be waived when they are intended for the benefit of others.  See 
Brannock v. Brannock (1986), 104 N.M. 385, 386, 722 P.2d 636, 637; see, also, 
State v. Ventura (1999), 101 Ohio Misc.2d 15, 19, 720 N.E.2d 1024, 1027.  
Moreover, it is a well-settled general principle that no party has the power to 
waive matters that affect third parties, because the holder of the privilege is the 
only one who has the power to relinquish it.  Id. 
 
Several groups have a privilege of confidentiality in the Medical Board’s 
investigative files.  In re Kralik (1995), 101 Ohio App.3d 232, 236, 655 N.E.2d 
273, 275.  These groups include patients, physicians who are under investigation, 
investigation witnesses, and any other persons whose confidentiality right is 
implicated by a Medical Board investigation.  Id.  The holder of the 
confidentiality privilege is the one who must waive it before the contents of the 
Medical Board’s investigative files relating to that person may be divulged.  Id.  
Hence, when someone who is not authorized to waive the privilege discloses 
privileged information, the information remains privileged. State v. Shipley 
(1994), 94 Ohio App.3d 771, 775, 641 N.E.2d 822, 825, citing Powers v. Chicago 
Transit Auth. (C.A.7, 1989), 890 F.2d 1355, 1357-1359. 
 
By permitting Wilson to attend Medical Board interviews with witnesses, 
the Medical Board waived its own confidentiality privilege; however, the Medical 
Board cannot unilaterally waive others’ privileges to confidentiality, because the 
Medical Board is not the holder of those privileges. 
 
The court of appeals properly ordered an in camera review of records 
pertaining to the interview with Semertzides and the release of those records after 
 
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they are redacted to protect the confidentiality of anyone else who has not waived 
the privilege. 
B.  Insurance Department Records 
 
The State Department of Insurance is a “public office” for purposes of 
R.C. 149.43.  At issue is R.C. 3901.44, which relates to insurance fraud 
investigatory records. 
 
Former R.C. 3901.44(A) stated:  “All papers, documents, reports, and 
evidence in the possession of the division of insurance fraud of the department of 
insurance that pertain to an investigation conducted or authorized by the division 
are confidential law enforcement investigatory records under section 149.43 of 
the Revised Code.  Notwithstanding such section, the division shall not prohibit 
public inspection of such records that pertain to an investigation after the 
expiration of all federal and state statutes of limitations applicable to the particular 
offense to which the papers, documents, reports, and evidence relate.”  142 Ohio 
Laws, Part III, 4579.  (The current version, codified at R.C. 3901.44[B], is 
substantially the same.) 
 
Former R.C. 3901.44(A)’s explicit reference to R.C. 149.43 requires that 
the two sections be read in conjunction.  “Confidential law enforcement 
investigatory records” are not public records for purposes of R.C. 149.43.  Former 
R.C. 149.43(A)(1), now R.C. 149.43(A)(1)(h).  However, this is not the end of the 
inquiry.  R.C. 149.43(A)(2) defines “confidential law enforcement investigatory 
records” as “any record that pertains to a law enforcement matter of criminal, 
quasi-criminal, civil, or administrative nature, but only to the extent that the 
release of the record would create a high probability of disclosure of any of the 
following: 
 
“(a) The identity of a suspect who has not been charged with the offense to 
which the record pertains, or of an information source or witness to whom 
confidentiality has been reasonably promised; 
 
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“(b) Information provided by an information source or witness to whom 
confidentiality has been reasonably promised, which information would 
reasonably tend to disclose the source’s or witness’s identity; 
 
“(c) Specific confidential investigatory techniques or procedures or 
specific investigatory work product; 
 
“(d) Information that would endanger the life or physical safety of law 
enforcement personnel, a crime victim, a witness, or a confidential information 
source.”  (Emphasis added.) 
 
The Insurance Department invites this court to hold that analysis pursuant 
to R.C. 149.43 is unnecessary because the plain language of R.C. 3901.44 
specifically deems insurance fraud investigatory records “confidential law 
enforcement investigatory records” under R.C. 149.43.  We decline to adopt this 
interpretation. 
 
A two-step analysis is required when exempting records from release 
under R.C. 149.43(A)(2).  State ex rel. Multimedia, Inc. v. Snowden (1995), 72 
Ohio St.3d 141, 142, 647 N.E.2d 1374, 1377.  The first inquiry is whether the 
record in question is a confidential law enforcement record.  The second inquiry is 
whether releasing the record would create a high probability of disclosure of any 
of the four categories of information specified in R.C. 149.43(A)(2). 
 
The language employed by the General Assembly in former R.C. 
3901.44(A), now (B), answers the first query in the affirmative.  In essence, what 
R.C. 3901.44 does is classify insurance fraud investigatory records as 
“confidential law enforcement investigatory records” under R.C. 149.43.  Thus, 
the next step is to ascertain whether any of the exemptions in R.C. 149.43(A)(2) 
apply. 
 
“[E]xceptions to disclosure must be strictly construed against the 
custodian of the public records, and the burden to establish an exception is on the 
custodian.”  Multimedia, 72 Ohio St.3d at 142, 647 N.E.2d at 1377, citing State ex 
 
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rel. James v. Ohio State Univ. (1994), 70 Ohio St.3d 168, 169, 637 N.E.2d 911, 
912; see, also, State ex rel. Gannett Satellite Info. Network, Inc. v. Petro (1997), 
80 Ohio St.3d 261, 266, 685 N.E.2d 1223, 1228; State ex rel. McCleary v. Roberts 
(2000), 88 Ohio St.3d 365, 370, 725 N.E.2d 1144, 1148-1149.  Our duty requires 
us to strictly construe confidential law enforcement investigatory records and 
“resolve any doubts in favor of disclosure.”  Multimedia, 72 Ohio St.3d at 143, 
647 N.E.2d at 1378.  Generally, in the absence of evidence that the custodian of 
the records disclosed their contents to the public, the exemptions are fully 
applicable.  Petro, 80 Ohio St.3d at 265, 685 N.E.2d at 1227; see, also, State ex 
rel. WLWT-TV5 v. Leis (1997), 77 Ohio St.3d 357, 361, 673 N.E.2d 1365, 1369-
1370. 
 
Application of a statutory exemption to a particular document is best 
accomplished by an in camera inspection.  See Henneman v. Toledo (1988), 35 
Ohio St.3d 241, 243, 520 N.E.2d 207, 210.  Based on the limited record before us, 
we are unable to discern the nature of the records at issue.  Consequently, the trial 
court is the tribunal best equipped to inspect these documents in camera, to 
determine whether their release “would create a high probability of disclosure” of 
any of the material specified in R.C. 149.43(A)(2), and to withhold any 
information that falls within a statutory exemption.  After examination of the 
investigatory files, material that does not fall within an exemption must be 
disclosed upon a request made pursuant to R.C. 149.43, and any exempted 
information should be withheld.  See Franklin Cty. Sheriff’s Dept. v. State Emp. 
Relations Bd. (1992), 63 Ohio St.3d 498, 589 N.E.2d 24, paragraph one of the 
syllabus. 
 
Having concluded that a two-part inquiry is required in order to determine 
whether insurance fraud investigatory records, which R.C. 3901.44 designates 
“confidential law enforcement investigatory records” for purposes of R.C. 149.43, 
 
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are exempted from release, we now turn to the question of whether the Insurance 
Department waived its right to rely on any applicable exemptions. 
 
R.C. 149.43’s exemptions are “usually fully applicable absent evidence 
that the public office having custody of the records disclosed the records to the 
public.”  Petro, 80 Ohio St.3d at 265, 685 N.E.2d at 1227.  Wilson, an 
investigator employed by Anthem, was present at several witness interviews 
conducted by Kaising.  During the investigation of the appellees, Wilson attended 
these interviews as a representative of Anthem and brought with him a working 
knowledge of the insurance industry and his employer.  At no time during his 
investigation of the appellees did Kaising share or disclose the contents of the 
Insurance Department’s investigatory file with Wilson.  Investigations into 
insurance fraud are not conducted in a vacuum.  Investigators working for private 
insurance companies may have occasion to interact with investigators from the 
Insurance Department.  As a matter of fact, R.C. 3999.42, which went into effect 
in March 1998, requires that insurers having a “reasonable belief that a person is 
perpetrating or facilitating an insurance fraud * * * notify the department of 
insurance.”  Although Wilson is a member of the public, his presence at witness 
interviews conducted by the Insurance Department is not tantamount to a public 
disclosure and does not effectuate a waiver of any applicable statutory 
exemptions. 
 
Thus, the court of appeals properly remanded this cause so that the trial 
court could conduct an in camera inspection of the records in question. 
II.  Conclusion 
 
The Public Records Act serves a laudable purpose by ensuring that 
governmental functions are not conducted behind a shroud of secrecy.  However, 
even in a society where an open government is considered essential to 
maintaining a properly functioning democracy, not every iota of information is 
subject to public scrutiny.  Certain safeguards are necessary.  Accordingly, we 
 
12 
affirm the court of appeals and remand this cause to the trial court for further 
proceedings not inconsistent with this opinion. 
Judgment affirmed 
and cause remanded. 
 
MOYER, C.J., DOUGLAS, F.E. SWEENEY and PFEIFER, JJ., concur. 
 
COOK and LUNDBERG STRATTON, JJ., concur in part and dissent in part. 
__________________ 
 
COOK, J., concurring in part and dissenting in part.  I agree that the 
Medical Board’s investigative records are not public records and that the Medical 
Board waived its own—and only its own—confidentiality privilege with respect 
to the Medical Board records discussed in Part IA of the majority opinion. 
 
I respectfully dissent, however, from the majority’s judgment that the 
insurance department records discussed in Part IB might be subject to public 
disclosure under the Public Records Act.  Former R.C. 3901.44 explicitly 
categorizes the insurance department documents at issue as “confidential law 
enforcement investigatory records [and thereby excepted from public disclosure 
as ‘public records’] under section 149.43,” which precludes the judiciary from 
reaching a contrary result.  The majority analyzes the applicability of the 
“confidential law enforcement investigatory records” exception and concludes 
that it does not apply, when the statute plainly states otherwise. 
 
We are not privileged to ignore the plain and unambiguous language of a 
statute.  State v. Krutz (1986), 28 Ohio St.3d 36, 38, 28 OBR 96, 97, 502 N.E.2d 
210, 211.  To hold as the majority does is to do just that. 
 
LUNDBERG STRATTON, J., concurs in the foregoing opinion. 
__________________ 
 
LUNDBERG STRATTON, J., concurring in part and dissenting in part.  I 
dissent with respect to whether the presence of a third party at witness interviews 
constituted a waiver of the State Medical Board’s privilege of confidentiality.  I 
 
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also join Justice Cook’s dissent and would find that insurance department records 
are not subject to disclosure under the Public Records Act.  I concur as to the 
remainder of the majority opinion. 
 
Under Part IB of the majority’s opinion, “Insurance Department Records,” 
the majority concludes that the presence of Anthem’s investigator did not 
constitute a waiver of the Department of Insurance’s privilege of confidentiality.  
I would apply the same rationale to Part IA and find that the investigator’s 
presence also did not constitute a waiver of the Medical Board’s privilege.  There 
is no reason to distinguish between the two. 
 
An insurance fraud investigator is integral to the work of both the 
Department of Insurance and the Medical Board to uncover fraud or handle 
allegations of unauthorized medical practice.  The investigator possesses the 
expertise, knowledge, and investigative background that enable the Medical 
Board and Department of Insurance to determine the direction of their own 
investigations.  At times, there were joint investigations that involved the 
investigator for the State Medical Board, Patricia Elliss, the Department of 
Insurance investigator, Robert Kaising, and Anthem’s investigator, Richard 
Wilson.  They worked together to gather evidence and interview witnesses. 
 
The allegations being investigated involved issues of fraudulent billing, 
with complex billing codes and methods.  The use of experts, such as Anthem’s 
investigator, is crucial in helping the Medical Board to effectively conduct its 
investigation.  The majority recognizes this importance to the Department of 
Insurance yet somehow excludes the Medical Board from obtaining the same 
benefits. 
 
The majority does not address the effect of its decision upon the presence 
of other third parties; however, the logical extension is that victims and other 
parties who wish to have a trusted advisor, family member, or friend present at 
 
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their interview will now waive the confidentiality of their statements.  This could 
affect a victim’s willingness to report wrongdoing. 
 
We should hold that the presence of an insurance investigator who is an 
active participant in the investigation of the wrongdoing at a witness interview 
does not result in a waiver of the confidentiality of the Medical Board’s 
investigative records. 
 
Therefore, I respectfully dissent.