Case Title: St. Luke Institute v. Jones

Citation: 

Docket Number: 62/19

State: maryland

Court: Maryland Supreme Court

Date: 2020-11-20T00:00:00Z

Document:
Saint Luke Institute, Inc. v. Andre Jones, No. 62, September Term, 2019, Opinion by 
Booth, J. 
 
Discovery of Mental Health Records Under the Maryland Confidentiality of Medical 
Records Act, Health General (“HG”) §§ 4-301 Through 309 (“Confidentiality Act”) 
– Where mental health records are requested by a private party litigant in a civil case in 
which the patient has not authorized disclosure, the Confidentiality Act, the Maryland 
discovery rules, and our case law establish the following process for disclosure.  The party 
seeking discovery should file a motion seeking or compelling the disclosure and requesting 
a court order under HG § 4-307.  The movant must establish a “need to inspect”—in other 
words, a reasonable possibility that review of the records would result in discovery of 
usable evidence.  In considering whether the movant has a need for access to the records, 
the court should consider the nature of the underlying litigation, the relationship between 
the records and any claim or defense, and the likelihood that review of the records would 
result in the discovery of relevant information.  
 
Once the movant makes a threshold proffer sufficient to enable the court to 
determine that there is a “need to inspect,” the court should undertake an in camera review 
of the documents sought to be disclosed to ensure that the records sought are relevant, and 
to ensure that disclosure is limited to only those records that may be relevant.  If the court 
determines that the records are relevant, it should enter an order under Maryland Rule 2-
403(b) authorizing the disclosure with adequate provisions or restrictions to protect the 
patient’s privacy interests as it determines are appropriate on a case-by-case basis.  Such 
conditions or restrictions should include a provision prohibiting redisclosure and requiring 
the return of original records and the return or destruction of any copies made, at the 
conclusion of the litigation.   
 
Health Care Provider’s Standing to Raise Patient’s Objections to Disclosure – Under 
the plain language of the Confidentiality Act, HG § 4-307(k)(6), where a litigant is seeking 
discovery of mental health records, the health care provider or custodian has standing to 
raise a patient’s “constitutional right or other legal authority in opposition to disclosure.” 
 
Circuit Court for Prince George’s County 
Case No.:  CAL18-40657 
Argued: September 10, 2020 
 
IN THE COURT OF APPEALS 
OF MARYLAND 
 
 
 
 
 
 
 
 
No. 62 
September Term, 2019 
 
 
 
 
 
 
 
 
SAINT LUKE INSTITUTE, INC. 
v. 
ANDRE JONES 
 
 
 
 
 
 
 
 
 
 
Barbera, C.J. 
McDonald 
Watts 
Hotten 
Getty 
Booth 
Biran, 
 
JJ. 
 
 
 
 
 
 
 
 
 
 
Opinion by Booth, J. 
 
 
 
 
 
 
 
 
 
 
Filed: November 20, 2020 
 
 
Pursuant to Maryland Uniform Electronic Legal Materials Act  
(§§ 10-1601 et seq. of the State Government Article) this document 
is authentic.
Suzanne C. Johnson, Clerk  
Suzanne Johnson
2020-11-20 10:19-05:00
In this case, we are asked to determine the legal standard to be applied under the 
Maryland Confidentiality of Medical Records Act, Maryland Code (2000, 2019 Repl. 
Vol.), Health General (“HG”) §§ 4-301 through 309 (“Confidentiality Act”), when a 
private party in a civil case seeks discovery of a patient’s mental health records where 
the patient has not authorized the disclosure.  We are also asked to determine whether the 
custodian of the records has standing to raise the patient’s privacy rights or other legal 
opposition to disclosure on the patient’s behalf.  These questions arise in the context of a 
civil case filed in Massachusetts in which the plaintiffs allege that they were sexually 
abused by a brother or member of a religious order while they were minor children 
residing in a children’s group home that employed the brother.  The Massachusetts 
plaintiffs filed a proceeding in Maryland seeking discovery of the brother’s mental health 
records that they believe are in the custody of Saint Luke Institute, Inc. (“SLI”), a facility 
located in Maryland.  After considering the plaintiffs’ motion for a court order to produce 
the records and SLI’s opposition to disclosure, the Circuit Court for Prince George’s 
County entered an order directing that SLI produce the brother’s mental health records 
under seal to a Massachusetts court.  Prior to ordering the disclosure of the records, the 
circuit court did not review the pleadings in the Massachusetts case, nor did the court 
conduct an in camera review of the records.  SLI appealed the order to the Court of 
Special Appeals, which reversed the judgment and remanded the case for further 
proceedings.   
 
For the reasons more fully set forth in this opinion, we affirm the judgment of the 
Court of Special Appeals and remand this proceeding to the circuit court for that court to 
2 
 
undertake an in camera review of the mental health records and to determine what portion 
of the records are relevant in accordance with its statutory obligation under HG § 4-307, 
and to enter an order transferring the portion of the records determined to be relevant under 
seal to the Massachusetts court for that court’s determination as to what should be released 
to counsel.   
I. 
Background  
A. Massachusetts Action  
This case arises from a discovery motion related to a civil lawsuit pending in the 
Massachusetts Superior Court involving four consolidated cases alleging negligent hiring 
and supervision of Brother Edward Anthony Holmes, who was a member of the 
Congregation of Sacred Hearts (“CSH”), and who is now deceased.  In 2017, Petitioner, 
Andre Jones, the lead plaintiff, filed a lawsuit in the Massachusetts Superior Court, Trial 
Division in Suffolk County (“Massachusetts Court”), naming as defendants the Roman 
Catholic Archbishop of Boston and the CSH (“Massachusetts Action”).1  Although the 
Massachusetts complaint is not included in the record of the proceedings in this case, 
according to proffers made by counsel for Mr. Jones, the suit alleges that Mr. Jones was 
sexually assaulted by Brother Holmes when he was a minor, while he was placed in his 
 
1 The pleadings in the Massachusetts Action were not presented to the circuit court 
in connection with the discovery motion, nor are they included in the record on appeal.  
The only Massachusetts pleading filed in this case is the Letters Rogatory issued by the 
Massachusetts Court.  For purposes of this appeal, our description of the Massachusetts 
Action is based upon the proffers of counsel for Mr. Jones in his various pleadings filed in 
Maryland.   
3 
 
care at the Nazareth Child Care Center in Jamaica Plain, Massachusetts (“Nazareth”).  
According to Mr. Jones, the complaint in the Massachusetts Action includes counts 
alleging negligent hiring and negligent supervision of Brother Holmes by the defendants.2 
Mr. Jones asserts that documents produced by the defendant CSH in discovery in 
the Massachusetts Action noted that Brother Holmes underwent psychotherapy at SLI in 
the early 1990s.  SLI, located in Maryland, is a “Catholic organization with 40 years of 
experience treating Catholic clergy” and “offers a full range of psychological screening, 
treatment and educational services for Catholic clergy.”  Mr. Jones alleges that, according 
to the documents produced by the CSH, two psychiatric evaluation reports on Brother 
Holmes were written by SLI employees, dated June 28, 1991 and November 8, 1993. 
The produced documents highlighted and summarized a “caution” contained in the 
1993 report generated by SLI, stating, “[t]here are no reported signs that [Brother Holmes] 
has been sexually inappropriate.  However, we would caution [] [Brother Holmes] and his 
order: there are many signs of risk that should not lightly be dismissed.”  The report also 
noted that Brother Holmes had “not worked through his experience of being molested as a 
child.”   
After Mr. Jones learned of the existence of the 1991 and 1993 reports, he requested 
that the reports and associated records be produced by the defendants in the 
 
2 Mr. Jones’ case was consolidated with three other companion cases by the 
Massachusetts Court.  The Letters Rogatory reflects that the cases of Andre Jones, 
Lawrence Gay, John Doe SV, and John Doe RJ were consolidated.  According to Mr. Jones, 
each plaintiff alleges similar child sexual assault and abuse perpetrated upon them by 
Brother Holmes while each was a minor and resident of Nazareth.   
4 
 
Massachusetts Action.  Mr. Jones was informed that the mental health evaluation reports 
had been destroyed by the Roman Catholic Archbishop of Boston and the CSH in the 
early 2000s.  
Unable to obtain the mental health evaluation reports directly from the defendants, 
Mr. Jones and the other plaintiffs sought production of the records from SLI by filing a 
Motion for the Issuance of Letters of Rogatory and a Commission3 to Take the Deposition 
of a Non-Resident Witness Custodian of Records.  The Massachusetts Court entered an 
order granting the motion and issued a Commission and Letters Rogatory. 
The Letters Rogatory requests “as a matter of comity” that an appropriate 
Maryland Court “issue process to compel [t]he [c]ustodian of [r]ecords for St. Luke 
Institute . . . to appear” for a deposition in Maryland and to produce documents.  The 
Letters Rogatory acknowledges that SLI is located out of state and is therefore not subject 
to the jurisdiction of the Massachusetts Court, and that its appearance “can be compelled 
only by process issued by the appropriate authority in the State of Maryland.”  The Letters 
Rogatory explained that “the production of documents and things for copying and 
inspection are left entirely to your Court’s procedure.”  (Emphasis added).  The Letters 
 
3 A letter rogatory is a letter from a Massachusetts court requesting that the 
appropriate authority in another jurisdiction assist in obtaining discovery within that state’s 
borders for use in Massachusetts litigation.  The authority to issue a letter rogatory is set 
forth in Mass. Gen. Laws ch. 223A, § 10 (2020), which provides that an in-state litigant 
may take “[a] deposition to obtain testimony or documents or other things in an action 
pending in [Massachusetts] . . . outside [Massachusetts] . . . pursuant to a letter rogatory 
issued by the court.”  Id. § 10(a), (a)(3).  Section 10(b) sets forth the process by which a 
party may request a Massachusetts court to issue a letter rogatory.  Specifically, § 10(b) 
provides that “a letter rogatory shall be issued after notice and application to the court, and 
on terms that are just and appropriate.”  Id. § 10(b).   
5 
 
Rogatory reflect that the documents to be produced are “all documents related to Brother 
Edward Anthony Holmes, including but not limited to, psychotherapy examinations/risk 
assessments that were conducted on June 28, 1991 and November 8, 1993 at St. Luke 
Institute.”   
B. Maryland Circuit Court Proceeding 
After the Letters Rogatory was issued by the Massachusetts Court, Mr. Jones sought 
a subpoena from the Circuit Court for Prince George’s County requesting that SLI produce 
Brother Holmes’ mental health records.  SLI filed a motion to quash the subpoena, arguing 
that under HG § 4-307, mental health records may only be disclosed to a private party in 
litigation by a court order, not through a subpoena.  
 
Apparently realizing the error in attempting to obtain the records by subpoena as 
opposed to a court order, Mr. Jones filed a cross-motion for a court order to produce the 
mental health records.  In connection with the motion for a court order, counsel for Mr. 
Jones filed a memorandum in which counsel described the underlying Massachusetts 
Action, including the allegations of sexual abuse, and represented that the litigation 
included counts for negligent hiring and negligent supervision.  In the memorandum, Mr. 
Jones alleged that he was sexually assaulted by Brother Holmes after being removed from 
the custody of his parents and placed at Nazareth.  The memorandum stated that three other 
individuals had made similar allegations of sexual assault by Brother Holmes while the 
plaintiffs were residents of Nazareth, and that those cases had been consolidated with Mr. 
Jones’ case in the Massachusetts Action.  Mr. Jones described the discovery that had been 
undertaken by the parties, explaining that defendant CSH had produced written documents 
6 
 
consisting of handwritten and typed notes from SLI, which referenced two psychiatric 
evaluations that were performed on Brother Holmes, dated June 28, 1991 and November 
8, 1993.  Counsel for Mr. Jones attached to the motion copies of the handwritten and typed 
notes that had been produced by CSH.  Mr. Jones argued that the “relevance of these 
psychiatric evaluations and mental health records to the underlying case [were] self-
evident.”  Specifically, Mr. Jones contended that “[w]hat was known about Holmes’ 
propensity to sexually abuse minors in his care and when that was known is a central issue 
in the case.”  Counsel proffered that Mr. Jones had requested that CSH produce the 
underlying records or reports but was informed that the mental health reports had been 
destroyed by CSH in the early 2000s.   
In the memorandum, Mr. Jones asserted that Brother Holmes’ sexual abuse of 
minors at Nazareth was “public knowledge,” and attached as exhibits copies of three 
articles from Boston newspapers,4 which reported that Brother Holmes pleaded guilty in 
2006 to repeatedly raping and assaulting two boys in the 1970s and 1980s and that he 
was sentenced to five years and one day for the crimes.  The articles recite that Brother 
Holmes was a member of CSH and had been assigned to work at Nazareth, which was 
run by the Archdiocese of Boston.  The sex crimes occurred while the children were 
 
4 According to Mr. Jones, the articles, which appeared in the Boston Globe, 
TheBostonChannel.com, and the Jamaica Plain Gazette, had been produced by the 
defendant Roman Catholic Archdiocese of Boston in discovery in the Massachusetts 
Action.  The victims of Brother Holmes’ crimes who were described in the articles are not 
the plaintiffs in the Massachusetts Action.   
7 
 
living at the Nazareth facility.  Mr. Jones also pointed out that Brother Holmes died in 
August 2011. 
SLI filed a memorandum in opposition, arguing that the circuit court would need 
to examine pleadings in the Massachusetts Action to properly determine whether Brother 
Holmes’ mental condition had been raised and whether such evidence was relevant.   
 
In a memorandum opinion and order dated January 23, 2019, the circuit court 
granted Mr. Jones’ cross-motion for an order to produce Brother Holmes’ mental health 
records and ordered that any responsive records “shall be filed under seal to the Superior 
Court of the Commonwealth of Massachusetts.”  In its memorandum opinion, the circuit 
court determined that “records already in possession of [Mr. Jones] from [SLI] do suggest 
that more records would be directly relevant to the [Massachusetts Action], which involve 
negligent hiring and negligent supervision of Brother Holmes.”  In rejecting SLI’s 
argument that the circuit court must examine the pleadings in the Massachusetts Action 
to properly determine whether Brother Holmes’ mental condition has been raised and 
whether such evidence is relevant, the circuit court stated that it did “not believe that two 
separate courts are required to review what are likely extensive pleadings in order to 
adjudicate this discovery request.  To do so is contrary to the interests of judicial 
economy, especially as the trial court can and will be the ultimate gatekeeper of evidence 
at trial.”   
 
The circuit court judge proceeded to apply a balancing test that is undertaken when 
a governmental agency seeks discovery of confidential medical records in connection 
with a government investigation, which was first outlined in United States v. 
8 
 
Westinghouse Electric Corp., 638 F.2d 570, 578 (3d Cir. 1980), and was adopted by the 
Court of Special Appeals, in Dr. K. v. State Board of Physician Quality Assurance, 98 
Md. App. 103, 113–15, cert. denied, 334 Md. 18, cert. denied, 513 U.S. 817 (1994) and 
later adopted by this Court in Doe v. Maryland Board of Social Work Examiners, 384 
Md. 161, 186 (2004).5  Applying the Westinghouse balancing analysis, the circuit court 
concluded that “there is a compelling state interest in aiding the Plaintiff [to] obtain the 
requested records.”  The circuit court reasoned that “[t]his case is one of the predatory 
sexual assault of minors, and there are multiple alleged victims, at least one of whom was 
sent to this institution by the state itself.”  The circuit court stated that the “[p]laintiff in 
this instance case was taken from the custody of his parents by the Commonwealth of 
 
5 The Westinghouse analytical framework, first adopted by the Court of Special 
Appeals in Dr. K, and later adopted by this Court in Doe, applies in circumstances in which 
a government agency is seeking medical records of a third party, and requires the balancing 
of several factors when weighing an individual’s right to privacy in his or her medical 
records against the government’s competing interest in obtaining access to those records.  
See United States v. Westinghouse Elec. Corp., 638 F.2d 570, 578 (3d Cir. 1980); Dr. K. 
v. State Bd. of Physician Quality Assurance, 98 Md. App. 103, 113–15, cert. denied, 334 
Md. 18, cert. denied, 513 U.S. 817 (1994); Doe v. Maryland Bd. of Soc. Work Exam’rs, 
384 Md. 161, 184 (2004).  Specifically, when a government actor seeks disclosure of an 
individual’s medical records, the Westinghouse balancing framework requires that the 
court consider  
 
the type of record requested, the information it contains, the 
potential for harm in subsequent nonconsensual disclosure, the 
injury in disclosure to the relationship for which the record was 
generated, the adequacy of safeguards to prevent unauthorized 
disclosure, the government’s need for access, and whether 
there is an express statutory mandate, articulate public policy, 
or other public interest militating towards access. 
 
Doe, 384 Md. at 184–85 (quoting Dr. K, 98 Md. App. at 114–15 (citing Westinghouse, 638 
F.2d at 578)) (emphasis added).   
9 
 
Massachusetts, and place[d] in the care of Brother Holmes.”  The circuit court balanced 
what it considered to be the “compelling state interest” in disclosure against any 
intrusions into Brother Holmes’ privacy interest in the records, by concluding that “the 
records requested do not at this time injure or embarrass Brother Holmes, who is now 
deceased and who previously admitted to rape and sexual assault of minors.”  
Accordingly, the circuit court determined that there were “compelling factors towards 
ordering the release of this requested information, with the [Massachusetts] trial court as 
the gatekeeper and safeguard for the Defendants.”  Based upon this analysis, the circuit 
court entered an order directing that SLI produce, under seal, Brother Holmes’ mental 
health records to the Massachusetts Court.   
 
After the circuit court denied SLI’s motion for reconsideration and request to vacate 
the order, SLI filed a timely appeal to the Court of Special Appeals, and a motion to stay 
the production of the mental health records.  The motion to stay was granted by the Court 
of Special Appeals. 
C. Court of Special Appeals  
 
The Court of Special Appeals reversed the decision of the circuit court and 
remanded the case for additional proceedings.  St. Luke Inst., Inc. v. Jones, 242 Md. App. 
617, 631 (2019).  The Court of Special Appeals determined that the circuit court had the 
authority to order SLI to produce Brother Holmes’ confidential medical records under the 
Confidentiality Act.  Id. at 625.  However, the intermediate appellate court pointed out that 
under our case law, where the information sought to be discovered is confidential, before 
disclosure of the materials in discovery, the “moving party must show, usually at a hearing, 
10 
 
some connection between the records sought, the issue before the court, and the likelihood 
that information relevant to the trial would be discovered.”  Id. at 626 (quoting Goldsmith 
v. State, 337 Md. 112, 127–28 (1995) (quoting Zaal v. State, 326 Md. 54, 83 (1992))) 
(emphasis omitted).   
Based upon the pleadings filed by Mr. Jones in connection with his motion to 
compel, the Court of Special Appeals concluded that “[Mr.] Jones met his burden in 
establishing the need for pre-trial disclosure of Brother Holmes’ mental health records.”  
Id. at 626.  The intermediate appellate court explained that “[a]s we see it, the circuit court 
did not abuse its discretion in finding that, based on the two reports and averments made 
by Jones, Holmes’ mental health records with SLI were likely relevant to the Massachusetts 
Action and subject to discovery.”  Id. at 627.  
Believing that SLI was asserting Brother Holmes’ patient-therapist privilege,6 the 
Court of Special Appeals rejected any assertion that the records could not be disclosed 
based upon privilege.  Id. at 628.  The intermediate appellate court explained that, although 
Maryland recognizes a patient-therapist privilege, “[t]he privilege belongs to the patient to 
assert, not to the psychiatrist or psychologist.”  Id. (cleaned up).  The intermediate appellate 
court declined to address SLI’s arguments with respect to Brother Holmes’ privacy interest 
in the mental health records because the court concluded that SLI lacked the requisite 
standing to advance the argument on Brother Holmes’ behalf.  Id. at 628 n.6.   
 
6 As discussed infra, it does not appear from our review of the record that SLI was 
asserting patient-therapist privilege on Brother Holmes’ behalf—as opposed to Brother 
Holmes’ privacy rights under the Confidentiality Act or the Constitution—either before the 
trial court or on appeal. 
11 
 
Although the Court of Special Appeals determined that Mr. Jones had made a 
sufficient proffer establishing a need for pre-trial disclosure of Brother Holmes’ mental 
health records, and that the records were not barred from disclosure under a statutory 
privilege or the Confidentiality Act, the court agreed with SLI that the circuit court erred 
in ordering that Brother Holmes’ entire mental health file be transferred to the 
Massachusetts Court without examining the file for relevancy.  Id. at 629.  The intermediate 
appellate court explained that, pursuant to HG § 4-307(c), the circuit court was only 
authorized to permit release of records that are determined to be relevant to the 
Massachusetts Action.  Id.  The Court of Special Appeals also agreed with SLI that the 
appropriate manner for the circuit court to undertake its statutory review was an in camera 
review of Brother Holmes’ mental health records to determine what portion was relevant 
to the Massachusetts Action, and therefore, should be produced in discovery.  Id. at 630.  
Relying on this Court’s analysis in Zaal v. State, 326 Md. 54, 58 (1992), the Court of 
Special Appeals stated that it was “appropriate that the circuit court order the portion of 
Brother Holmes’ mental health records deemed relevant to the Massachusetts Action be 
produced under seal to the Massachusetts Court for that court’s determination as to what 
should be released to counsel.”  Id. at 631. 
SLI petitioned for a writ of certiorari, asserting, among other things, that the Court 
of Special Appeals erred by analyzing the discovery request under a privilege statute, and 
by holding that SLI had no standing to raise Brother Holmes’ privacy interests in the mental 
12 
 
health records.  We granted certiorari to consider the following questions, which we have 
consolidated and rephrased as follows7: 
1. Did the circuit court apply the correct legal standard for the 
disclosure of mental health records when requested by a 
private party litigant where the patient has not authorized 
disclosure?  
 
2. Does a health care provider in custody of a patient’s mental 
health records have standing under the Confidentiality Act, 
§ HG 4-307(k)(6) to raise the patient’s objections to 
disclosure? 
 
For the reasons set forth below, we answer the first question in the negative.  The 
circuit court did not apply the correct legal standard when considering whether to order the 
 
7 The questions presented in the writ of certiorari were:  
 
1. Does SLI have standing to raise the constitutional right of 
privacy on behalf of a mental health patient?  
 
2. If SLI has the requisite standing, must the court first determine 
whether the constitutional right of privacy of the person whose 
records are sought has been superseded prior to any release of 
mental health records or can the court immediately proceed to 
the question of release without first determining that the right 
of privacy has been superseded?  
 
3. If the constitutional right of privacy is required to be ruled upon 
by the court to determine if it has been superseded, then what 
are the standards to be applied by the court when a private party 
litigant rather than a state agency is making the request?  
 
4. If the determination is made that records may be released, does 
the party requesting the release of mental health records have 
the burden of identifying to the court the nature of the 
information being sought for release from the mental health 
records prior to the court undertaking its in camera review?  
 
13 
 
release of confidential mental health records.  Concerning the second question, we hold 
that a health care provider has standing to raise a patient’s objections to disclosure under 
the Confidentiality Act, HG § 4-307(k)(6).  We affirm the judgment of the Court of Special 
Appeals and remand this case to the Circuit Court for Prince George’s County for further 
proceedings consistent with this opinion.  
II.   
Standard of Review 
This case involves an attempt by Massachusetts litigants to obtain records from a 
Maryland institution pursuant to a Maryland court order for use in the Massachusetts 
Action.  Although this matter is not a traditional Maryland discovery dispute, the same 
principles that govern Maryland discovery matters also apply here.  With respect to the 
application of discovery rules, “it is long settled that the trial judges are vested with a 
reasonable, sound discretion in applying them, which discretion will not be disturbed in 
the absence of a showing of its abuse.”  Ehrlich v. Grove, 396 Md. 550, 560 (2007) (internal 
quotations and citations omitted).  Although we generally review discovery disputes under 
an abuse of discretion standard, the dispute in this case involves a civil litigant’s right to 
obtain mental health records that are ordinarily protected from disclosure by statute and 
may only be obtained in accordance with the express statutory provisions authorizing such 
disclosure.  When a trial court’s order involves an interpretation and application of 
statutory and case law, we must determine whether the lower court’s conclusions are 
14 
 
legally correct under a de novo standard of review.  Nesbit v. Gov’t Emps. Ins. Co., 382 
Md. 65, 72 (2004).   
III.  
Discussion  
A. Parties’ Contentions  
SLI contends that under the Confidentiality Act, the circuit court erred by ordering 
the release of all of Brother Holmes’ mental health records to the Massachusetts Court 
without first conducting an in camera review and making a relevancy determination.  SLI 
points out that under HG § 4-307(c), a private party litigant may obtain disclosure of only 
the portions of the mental health records that are relevant.  SLI asserts that the 
Confidentiality Act requires that the circuit court review the records and make the 
relevancy determination, and that the circuit court is not permitted to abdicate its 
responsibilities by releasing the entire contents of the records to the Massachusetts Court 
without first undertaking its own review.  SLI notes that this Court described the in 
camera review process to be undertaken by a court when a private party litigant seeks 
discovery of confidential records in Baltimore City Department of Social Services v. 
Stein, 328 Md. 1, 14 (1992).  SLI posits that the circuit court should have applied the 
same in camera review process in this instance.  In connection with the court’s statutory 
obligation under the Confidentiality Act to review the records for relevancy, SLI contends 
that the circuit court erred by accepting Mr. Jones’ representations concerning the 
Massachusetts Action without reviewing the complaint or related pleadings to determine 
the relevance of the mental health records to the allegations asserted in that case.  SLI 
15 
 
does not contend that the circuit court was required to review all the pleadings in the 
Massachusetts Action.  Rather, SLI asserts that the burden was on the movant to establish 
the relevancy of the mental health records by focusing the court’s attention on specific 
issues alleged in the Massachusetts Action.  SLI also contends that the circuit court 
incorrectly applied the Westinghouse factors as part of its analysis, pointing out that the 
Westinghouse balancing analysis applies when a governmental agency is seeking medical 
records, not when a private party litigant is seeking records from a health care provider.  
Although SLI recognizes that the Westinghouse balancing test does not apply because 
there is no state action that would require balancing a “compelling state interest” in 
disclosure against the individual’s privacy rights in the records, SLI argues that this Court 
should adopt a “compelling need” standard when a private litigant seeks discovery of 
confidential records in the context of civil discovery, which SLI asserts should be 
determined on a case-by-case basis.  To demonstrate a “compelling need,” SLI contends 
that the private party litigant must do more than simply represent that the litigant needs 
the records to prove its case.   
Finally, SLI contends that the Court of Special Appeals erred in analyzing “the 
issues in this case under the doctrine of privilege,” because SLI did not assert any privilege.  
SLI also argues that the Court of Special Appeals erred when it failed to consider SLI’s 
standing to raise Brother Holmes’ privacy rights under HG § 4-307(k)(6).  SLI asserts that 
16 
 
under the plain language of that subsection, SLI has standing to raise Brother Holmes’ 
privacy rights.8   
In response, Mr. Jones argues that the Court of Special Appeals’ holding, which 
remands the case to the circuit court for an in camera review of the records, is reasonable 
and appropriate and provides an “exceeding level of scrutiny” prior to any subsequent 
review by the Massachusetts Court or the litigants.  Mr. Jones contends that, to the extent 
that records are ultimately produced to the parties in the underlying action, they will only 
be produced under a protective order prohibiting public disclosure/dissemination.  With 
respect to Brother Holmes’ right to privacy, Mr. Jones asserts that there is no “right to 
privacy in public facts,” and given Brother Holmes’ admission of sexual assault and 
related convictions, matters pertaining to Brother Holmes’ mental health records and to 
his risk of being a child predator are “public knowledge.”  Mr. Jones also asserts that the 
fact that Brother Holmes is now deceased is certainly a relevant factor in determining 
what right to privacy, if any, exists over SLI’s records.  In any event, Mr. Jones contends 
that SLI has no standing to assert Brother Holmes’ right to privacy because that right is 
a “personal one” and argues that HG § 4-307(k)(6) only gives the patient or “person in 
 
8 Although SLI asserts in its brief that the circuit court erred in failing to conduct a 
hearing under Maryland Rule 2-311(f), it did not raise this issue in its petition for writ of 
certiorari.  It is well-settled that this Court “ordinarily do[es] not . . . consider an issue not 
raised in a petition for certiorari.”  Renbaum v. Custom Holding, Inc., 386 Md. 28, 33 n.2 
(2005).  In the rare circumstances where this Court addresses an issue not raised in a 
petition for certiorari, it is generally because the issue is “implicitly contained within the 
question on which we granted certiorari.”  State v. Roshchin, 446 Md. 128, 147 (2016).  
We determine that there is no basis to consider the propriety of the trial court’s decision to 
rule on SLI’s and Mr. Jones’ motions without a hearing, as the issue was neither explicitly 
nor implicitly raised in the petition for writ of certiorari.  
17 
 
interest” the right to assert a “constitutional right.”  Assuming the statute confers standing 
on SLI to object to the disclosure on Brother Holmes’ behalf, Mr. Jones contends that 
Brother Holmes waived his right to privacy in the records.  With respect to the circuit 
court’s application of the Westinghouse factors, Mr. Jones contends that he has 
demonstrated a “compelling state interest” in the disclosure of the records.  
B. Disclosure of Mental Health Records in Private Civil Litigation—The 
“Balancing Framework” Established by Applicable Rules, Statutes, and Case 
Law  
In this case, we are being asked to determine the legal standard to be applied under 
the Confidentiality Act when a private party in civil litigation seeks discovery of a third 
party’s mental health records where the patient has not authorized the disclosure.9  
Although the specific request at issue in this case involves an additional procedural 
complication—namely, that the records are being sought in connection with litigation 
pending in another state—our analysis and consideration of the threshold determination of 
whether these records are discoverable, and the parameters for disclosure, is the same 
regardless of whether the litigation was initiated in Maryland or elsewhere.  
 
9 As noted in our discussion of the parties’ contentions, SLI asserts that the Court of 
Special Appeals erred when it discussed the patient-therapist privilege, codified in Md. 
Code Ann., Cts. & Jud. Proc. § 9-109(b)(1)–(2) (2020).  The Court of Special Appeals 
addressed the patient-therapist privilege because the court believed that SLI was raising 
the privilege as a basis for non-disclosure.  St. Luke Inst., Inc. v. Jones, 242 Md. App. 617, 
627 (2019).  Based upon our review of the record and the briefs, it does not appear that SLI 
was asserting a privilege.  Rather, SLI’s position was that the circuit court failed to comply 
with the mental health records disclosure provisions under the Confidentiality Act, HG § 
4-307.  Regardless of whether privilege was raised below, SLI is not asserting any privilege 
in connection with this Court’s review.  Accordingly, we do not address any privilege as 
part of this opinion and our discussion and holding is limited to the disclosure provisions 
under the Confidentiality Act.   
18 
 
As described more fully below, the Maryland discovery rules, the Confidentiality 
Act, and our case law establish the framework for a trial court to apply when balancing the 
civil litigant’s need to obtain relevant, discoverable information against the patient’s 
privacy interests in the confidential mental health records. 
1. Maryland Discovery Rules Generally 
Maryland’s discovery rules, governed by Chapter 400 of Title 2 of the Maryland 
Rules, “were deliberately designed to be broad and comprehensive in scope.”  Ehrlich v. 
Grove, 396 Md. 550, 560 (2007) (internal quotations omitted).  Maryland Rule 2-402(a) 
permits, in pertinent part, a party to obtain discovery “regarding any matter that is not 
privileged . . . if the matter sought is relevant to the subject matter involved in the action, 
whether it relates to the claim or defense of the party seeking discovery or to the claim or 
defense of any other party.”  As we have stated on numerous occasions, “Maryland’s 
discovery rules are to be liberally construed.”  Ehrlich, 396 Md. at 560 (first citing Kelch 
v. Mass Transit Admin., 287 Md. 223, 229 (1980); then citing Klein v. Weiss, 284 Md. 36, 
55 (1978)).  There are limitations, however, on the general proposition that discovery rules 
are to be liberally construed.   
2. Statutory Provisions Governing Disclosure of Mental Health Records 
Under the Confidentiality Act   
 
In this case, the limitation comes in the form of the pertinent statutory provisions 
governing the confidentiality and disclosure by health care providers of medical records, 
including mental health medical records that are set forth in the Confidentiality Act, HG 
§§ 4-301 through 4-309.  The Confidentiality Act addresses the confidentiality of medical 
19 
 
records in general.  HG § 4-302(a) requires health care providers to keep medical records 
confidential, and allows disclosure only as provided by Maryland law.10   
 
10 Medical records, including mental health records, are also subject to the 
confidentiality provisions of the Health Insurance and Portability Accountability Act 
(“HIPAA”), 42 U.S.C. § 1320d et seq.  HIPAA provides for the confidentiality of 
individually identifiable health information and establishes the Department of Health and 
Human Services’ (“HHS”) authority to regulate the disclosure of medical and mental health 
records.  45 C.F.R. § 160.203(b) establishes federal preemption of state laws unless the 
state regulation is more protective of protected health information.  
 
For purposes of this case, our focus is solely on the Confidentiality Act, HG §§ 4-
401 through 4-309.  SLI did not raise any objection to the disclosure of the records under 
HIPAA.  SLI acknowledges in its pleadings that the Confidentiality Act contains more 
restrictive provisions for the disclosure of mental health records than its federal 
counterpart, and therefore is controlling.  Comparing the applicable provisions of the 
Confidentiality Act with the applicable HIPAA provisions, we agree that, although the 
provisions are similar, the Maryland statute provides greater protections with respect to 
disclosure of mental health records.   
 
45 C.F.R. § 164.512 sets forth the circumstances in which a covered health care 
provider “may use or disclose protected health information without the written 
authorization” of an individual.  Subsection (e) of that regulation governs unauthorized 
disclosure of protected health information in the course of a judicial or administrative 
proceeding.  45 C.F.R. § 164.512(e).  Under that subsection, health care providers and other 
covered entities are permitted to disclose protected health information without the patient’s 
consent: (1) in response to a court order, provided only the information specified in the 
court order is disclosed; or (2) in response to a subpoena or discovery request if the health 
care provider receives adequate assurance that the individual whose records are requested 
has been given sufficient notice of the request, or if reasonable efforts have been made to 
secure a protective order.  45 C.F.R. § 164.512(e)(1)(i), (ii).  Protective orders must (1) 
prohibit use of the protected health information outside the litigation process; and (2) 
require the return or destruction of the records, including copies made, at the conclusion of 
the litigation.  45 C.F.R. § 164.512(e)(1)(v).   
 
In contrast to the federal regulations, the Confidentiality Act distinguishes between 
mental health records and medical records, affording greater protections against the 
unauthorized disclosure of mental health records by (1) requiring a court order prior to their 
disclosure, see HG § 4-307(k)(1)(iv), and further requiring that (2) only the information in 
the record relevant to the purpose for which disclosure is sought may be released. See HG § 
4-307(c).  Additionally, the Confidentiality Act restricts “redisclosure” of medical records—
20 
 
Where the records sought to be disclosed consist of medical records developed in 
connection with the provision of mental health services,11 the General Assembly has 
imposed additional limitations, which are set forth in HG § 4-307.12  First, unlike other 
types of medical records that may be disclosed to a third party by subpoena, a court order 
is required where the disclosure of mental health records is sought by a private litigant in 
a civil proceeding in which the person in interest has not authorized the disclosure.  As it 
pertains to this case, HG § 4-307(k)(1) requires a health care provider to disclose a 
medical record to a court or a party to a court proceeding “in accordance with a court 
order[.]”13  Second, the Confidentiality Act provides that “[w]hen a medical record 
 
a restriction not contained in HIPAA.  See 88 Opinions of the Attorney General 205, 216 
(2003) available at [https://perma.cc/H2T7-K7C2].  
 
11 Under the Confidentiality Act, “mental health services” are defined as “health 
care rendered to a recipient primarily in connection with the diagnosis, evaluation, 
treatment, case management, or rehabilitation of any mental disorder.”  HG § 4-
301(k)(1).  
 
12 See HG § 4-307(b), which provides that “[t]he disclosure of a medical record 
developed in connection with the provision of mental health services shall be governed by 
the provisions of this section in addition to the other provisions of this subtitle.”   
 
13 HG § 4-307(k) provides that:  
 
(1) A health care provider shall disclose a medical record 
without the authorization of a person in interest:  
 
*  *  * 
 
(iv) in accordance with a court order, other than compulsory 
process compelling disclosure, as permitted under § 9-109(d), § 9-
109.1(d) or § 9-121(d) of the Courts and Judicial Proceedings 
Article, or as otherwise provided by law, to:  
 
21 
 
developed in connection with the provision of mental health services is disclosed without 
the authorization of a person in interest, only the information in the record relevant to the 
purpose for which disclosure is sought may be released.”  HG § 4-307(c).14  If medical 
records are authorized to be disclosed, the Act also prohibits redisclosure of the records.15  
Additionally, disclosing a medical record in violation of the subtitle subjects the violator 
to a possible criminal fine and to actual damages in a civil suit.  See HG § 4-309.  
Taken together, where a private party litigant seeks the disclosure of mental health 
records and the person in interest has not authorized the disclosure, given the conditions 
and limitations imposed by the General Assembly in HG § 4-307: (1) the party seeking 
 
1. A court;  
2. An administrative law judge; 
3. A health claims arbitrator; or  
4. A party to a court, administrative, or arbitration proceeding.  
 
The compulsory process provisions described in subsection (iv) are not applicable here. 
 
14 The Confidentiality Act contains protections similar to HIPAA.  45 C.F.R. 
§ 164.512(e)(1)(i) permits a health care provider to disclose only the protected health 
information expressly authorized by court order.  
 
15 HG § 4-302(d) provides in part:  
 
Redisclosure.—A person to whom a medical record is 
disclosed may not redisclose the medical record to any other 
person unless: 
 
(1) The redisclosure is: 
(i) Authorized by the person in interest;  
(ii) Otherwise permitted by this subtitle; . . .  
 
There is no other provision in the subtitle that would permit redisclosure of Brother 
Holmes’ mental health records. 
22 
 
their disclosure must file a motion requesting a court order compelling their disclosure; and 
(2) prior to the court authorizing the disclosure pursuant to a court order, the court must 
undertake an examination of the documents sought to be disclosed and any other necessary 
information in order to make a relevancy determination and to ensure that it limits 
disclosure only to the information that may be relevant. 
In response to a motion seeking a court order compelling or authorizing the 
disclosure of mental health records, the Confidentiality Act also provides a health care 
provider, recipient, or person in interest with the right to object to the disclosure.  See HG 
§ 4-307(k)(6) (“This subsection may not preclude a health care provider, a recipient, or a 
person in interest from asserting in a motion to quash or a motion for a protective order any 
constitutional right or other legal authority in opposition to disclosure.”).  By its plain 
terms, HG § 4-307(k)(6) authorizes a health care provider to assert, in a motion, a 
“constitutional right . . . in opposition to disclosure.”  In Maryland State Board of 
Physicians v. Eist, 417 Md. 545, 564 (2011), we stated that this provision of the Act “grants 
standing to the health care provider, as well as others opposed to disclosure, to raise the 
patient’s constitutional rights or other grounds for nondisclosure, by filing in court a motion 
to quash or a motion for a protective order.”   
By establishing a process whereby a private party litigant may only obtain 
disclosure of mental health records by a court order, and granting standing to the health 
care provider or other authorized person to object to the disclosure by filing a motion in 
opposition, the provisions of the Confidentiality Act dovetail with the court’s broad 
discretion to enter a protective order under Maryland Rule 2-403.  In Eist, we recognized 
23 
 
that where medical records were sought in connection with a licensing investigation, filing 
a motion to quash a subpoena under Maryland Rule 2-510 or motion for a protective order 
under Maryland Rule 2-403 was the “route chosen by the General Assembly for the 
resolution of constitutional or other objections to the subpoena[,]” id. at 565, or in this case, 
a motion requesting a court order.16  The process necessarily requires a balancing of the 
relevance of the records and the movant’s need for disclosure on the one hand, and the 
patient’s privacy interests implicated by the disclosure on the other.   
3. Protective Orders 
Maryland Rule 2-403(a) governs the application for protective orders.  It states:  
On motion of a party, a person from whom discovery is sought, 
. . . and for good cause shown, the court may enter any order 
that justice requires to protect a party or person from 
annoyance, embarrassment, oppression, or undue burden or 
expense, including one or more of the following: (1) that the 
discovery not be had, . . . (3) that the discovery may be had 
only on specified terms and conditions, . . . (6) that discovery 
be conducted with no one present except persons designated by 
the court . . . . 
 
Maryland Rule 2-403(b) provides that “[i]f the motion for a protective order is denied in 
whole or in part, the court may, on such terms and conditions as are just, order that any 
party or person provide or permit discovery.”  As applicable here, the plain language of the 
 
16 In explaining the General Assembly’s “chosen route” for objecting to a discovery 
request seeking medical records, we further noted that “the General Assembly did not 
provide that the health care provider could refuse to comply with the subpoena, fail to file 
a motion to quash or a motion for a protective order, and later, in a disciplinary action 
[against the physician for failing to comply with a subpoena], defend on the ground that 
the patient’s privacy rights were infringed by the subpoena.”  Maryland State Bd. of 
Physicians v. Eist, 417 Md. 545, 565 (2011) (footnote omitted).  
24 
 
rule provides the trial court with broad discretion to fashion a protective order in a manner 
that balances the movant’s interest in obtaining relevant discovery with the patient’s 
privacy interests.  Although the rule confers considerable discretion on the trial court, as 
the Court of Special Appeals has previously observed, there are few Maryland appellate 
decisions describing or interpreting this rule.  Tanis v. Crocker, 110 Md. App. 559, 574 
(1996).  The lack of case law discussing protective orders arises from the fact that “[i]t is 
well settled in Maryland that discovery orders usually are not immediately appealable.”  
Baltimore City Dep’t of Soc. Servs. v. Stein, 328 Md. 1, 14 (1992) (citation omitted).17  The 
 
17 This principle is subject to limited exceptions.  For example, in Baltimore City 
Department of Social Services v. Stein, 328 Md. 1, 20–21 (1992), we held that “a discovery 
order directed to a governmental agency, a non-party to the underlying action, requiring 
the disclosure of files which contain information which, by statute, is confidential except 
when disclosed by the agency or by court order, is immediately appealable by the agency.”  
In Ehrlich v. Grove, 396 Md. 550, 564 (2007), we held that the collateral order doctrine 
applied to a discovery order entered by a trial court for records where the Governor of the 
State of Maryland had asserted executive privilege with respect to certain documents 
sought in discovery because “separation of powers principles are implicated[.]”  Although 
we granted review in that case, we pointed out that “the collateral order doctrine is a limited 
exception to the principle that only final judgments are appealable and it may only be 
invoked in extraordinary circumstances when the conjunctive four-part test is met.”  Id. at 
563–64.  Ehrlich discusses in detail the collateral order doctrine, and its four requirements, 
which “are very strictly applied.”  Id. at 561–65.  In St. Joseph Medical Center, Inc. v. 
Cardiac Surgery Associates, P.A., 392 Md. 75, 91 (2006), we held that a hospital was 
entitled to appeal a circuit court’s order authorizing the disclosure of records which the 
hospital contended were protected by statutory privilege despite the fact that the discovery 
order was not a final judgment and was not appealable under the collateral order doctrine.  
We held that  
 
[i]n situations where the aggrieved appellant, challenging a 
trial court discovery or similar order, is not a party to the 
underlying litigation in the trial court, or where there is no 
underlying action in the trial court but may be an underlying 
administrative or investigatory proceeding, Maryland law 
25 
 
discovery dispute in this case is somewhat atypical as the dispute arises from a discovery 
request originating in another jurisdiction, which results in a final disposition of the 
Maryland proceeding upon the entry of an order. 
Although there is little Maryland case law providing guidance to trial courts on 
protective orders in connection with civil discovery matters, we note that Maryland Rule 
2-403(a) is based in large part on Federal Rule of Civil Procedure 26(c).18  We agree with 
our colleagues on the Court of Special Appeals that “when interpreting a Maryland Rule 
that is similar to a Federal Rule of Civil Procedure this Court may look for guidance to 
federal decisions construing the corresponding federal rule[.]”  Tanis, 110 Md. App. at 574 
(citations omitted).  It is particularly instructive to look to the federal courts’ application of 
Federal Rule 26(c) in the context of protective orders involving the disclosure of medical 
records protected by confidentiality provisions under the Health Insurance and Portability 
Accountability Act (“HIPAA”), 42 U.S.C. § 1320d et. seq. or other state and federal 
statutory confidentiality provisions or privileges.  See, e.g., In re Sealed Case (Medical 
 
permits the aggrieved appellant to appeal the order because, 
analytically, it is a final judgment with respect to that appellant. 
   
Id. at 90 (citations omitted).   
 
18 The language of Federal Rule of Civil Procedure 26(c) is virtually identical to 
Maryland Rule 2-403.  Rule 26(c) authorizes a court: 
 
 
[F]or good cause, [to] issue an order to protect a party or person 
from annoyance, embarrassment, oppression, or undue burden 
or expense, including one or more of the following: . . . (D) 
forbidding inquiry into certain matters, or limiting the scope of 
disclosure or discovery to certain matters . . . . 
26 
 
Records), 381 F.3d 1205, 1218 (D.C. Cir. 2004) (vacating a court order requiring 
production of all of the appellant group home residents’ mental health records because the 
court failed to “weigh[] the appellant’s privacy interests against the . . . evidentiary need” 
for the records). 
4. Our Jurisprudence Concerning Discovery Requests for Confidential 
Records 
Finally, we examine our jurisprudence involving discovery requests for confidential 
records in other contexts.  As the Court of Special Appeals aptly observed, our case law 
requires that the litigant undertake an “additional hurdle” when the information sought to 
be discovered is confidential.  St. Luke Inst., 242 Md. App. at 626.  Although these cases 
do not involve mental health records, they are nonetheless instructive because they address 
requests for discovery of confidential records protected by other statutes.  See Zaal, 326 
Md. 54; Stein, 328 Md. 1.  
 
In Zaal, we considered a criminal defendant’s right to access his victim’s 
confidential school records.  326 Md. at 61.  Although Zaal is a criminal case, it is 
nonetheless instructive.  Mr. Zaal was charged with sexually abusing his granddaughter, 
which he denied.  Id.  In an effort to develop evidence with which to impeach her, he 
subpoenaed her school records.  Id. at 62.  The Board of Education (“Board”) sought a 
protective order to prevent their disclosure.  Id.  At a hearing on the Board’s motion, Mr. 
Zaal contended that the records were relevant because he was aware that the victim had an 
emotional disability requiring special education.  Id.  He asserted that the victim was in a 
“special classroom” as a result of an “emotional disturbance” which he contended would 
27 
 
bear on whether there was “a physical basis that would relate to her capacity to observe 
and relate” or “a mental deficiency leading to an inability to control actions.”  Id. at 62–63 
(internal quotations omitted).   
 
Rather than allowing Mr. Zaal, through his attorney, to review the records, the trial 
court conducted an in camera review, after which it granted the Board’s motion for 
protective order and quashed the subpoena.  Id. at 63.  Concluding that “‘there is really 
nothing I can see that in any significant way would relate to truth telling to this or any other 
occasion’ and certainly, nothing ‘show[ing] an inveterate tendency to lie[,]’” the court 
explained that to allow discovery could significantly compromise the child’s educational 
future.  Id.  After the Court of Special Appeals affirmed the trial court, we reversed and 
remanded for further proceedings consistent with our opinion.  Id. at 88–89.  Our analysis 
involved balancing Mr. Zaal’s “need to inspect” against the child’s privacy interest in her 
school records.  Id. at 81.   
 
We equated Mr. Zaal’s “need to inspect” with relevance and the existence of “a 
reasonable possibility that review of the records would result in discovery of usable 
evidence.”  Id. (internal quotations omitted).  We also noted that the defendant’s need to 
have access to the records in that case required consideration of several factors—the nature 
of the charges brought against the defendant, the relationship between charges and the 
information sought, and the likelihood that review of the records would result in the 
discovery of relevant information.  Id. at 81–82.  We explained that the circumstances will 
determine whether a sufficient relationship exists to require disclosure and, of course, that 
will in turn depend on the “proffer of relevance that the defendant makes.”  Id. at 82.  We 
28 
 
recognized that “[t]he specificity of the proffer of what is sought necessarily depends on 
the nature of the issue, rather than the extent of the defendant’s knowledge of the contents 
of the records.”  Id.  We cautioned that when a trial court reviews the records alone,  
it must approach its task cognizant of the fact that it is not an 
advocate and, in most instances, will not, and, indeed, cannot 
be expected, to discern all the nuances or subtleties which may 
render an innocuous bit of information relevant to the defense.  
Thus the court’s review is not to determine whether, and, if so, 
what, is “directly admissible,” rather, it is to exclude from the 
parties’ review material that could not, in anyone’s 
imagination, properly be used in defense or lead to the 
discovery of usable evidence.  Only when the records are not 
even arguably relevant and usable should the court deny the 
defendant total access to the records.  In other words, except as 
to information, which, without regard to the perspective of the 
person conducting the review, has absolutely no possible 
relevance to the case, the trial court’s in camera review should 
not be conducted with preclusive intent.   
 
Id. at 87–88 (footnote omitted).  
 
In Stein, we considered whether the Department of Social Services (“Department”) 
was required to produce confidential records of a minor child and his parents to the 
defendant, Mr. Stein, in a personal injury action alleging lead paint poisoning.  328 Md. 1.  
Like the mental health records at issue in this case, under Md. Code Ann., Article 88A, § 
6 (recodified 2007),19 the records in the Department’s possession were “confidential” and 
could only be released pursuant to a court order.  Id. at 5–6.  After Mr. Stein served a 
subpoena for the records, the Department filed a motion for a protective order asserting 
that the records were confidential and could only be released pursuant to a court order, and 
 
19 In 2007, Article 88A, § 6 was recodified without substantive revision in Maryland 
Code, Human Services § 1-201.  2007 Md. Laws 14.  
29 
 
further asserting that the records were privileged.  Id. at 4–5.  Mr. Stein filed a motion to 
compel.  Id. at 5.  In the motion, Mr. Stein did not proffer precisely what evidence he 
believed the Department’s file would reveal regarding the minor plaintiff relevant to his 
defense of the lead paint suit.  Id. at 6.  “He simply asserted that evidence that shows the 
social circumstances under which the minor plaintiff was raised was relevant.”  Id.  The 
trial court denied the Department’s motion for a protective order and granted Mr. Stein’s 
motion to compel.  Id. at 7.  
 
On appeal, we noted that although Article 88A, § 6 made the unauthorized 
disclosure of the records a criminal offense, but permitted the disclosure by court order, 
the statute provided “precious little guidance as to when a court order should issue.”  Id. at 
23–24.  We observed that the “issue presented . . . is one of first impression: whether, and 
to what extent, a state’s interest in the confidentiality of its social services record[s] must 
yield to a civil defendant’s right to discover favorable evidence bearing on his threatened 
loss of property.”  Id. at 24.  The Department argued that the purpose of the statute was the 
promotion of “full and frank communication between those needing social services and 
those providing that assistance by protecting the confidentiality of both discussions and 
correspondence.”  Id. at 24–25 (internal quotations omitted).  The Department asserted that 
Mr. Stein’s proffer was insufficient to establish that the records would be relevant, and that 
confidentiality provisions could not be circumvented on a “mere possibility that it might 
possess records which may be relevant or may lead to the discovery of the admissible 
evidence in a case involving a personal injury accident or . . . lead paint poisoning.”  Id. at 
25 (emphasis in original).  Finally, the Department argued that the trial court erred in 
30 
 
entering an order authorizing the blanket disclosure of all records in the Department’s 
possession without first reviewing the records for “potentially relevant information[,]” 
which “disregards entirely the privacy rights of the plaintiffs[.]”  Id. 
 
In juxtaposition to the Department’s arguments, Mr. Stein contended that his 
property interest entitled him to due process.  Id. at 25–26.  He asserted that because the 
plaintiffs alleged physical, mental, and emotional injury as a result of the housing he 
provided, neither the Department nor the plaintiffs should be permitted to suppress 
information contained in the records that may be necessary to rebut the allegations.  Id. at 
26.  Mr. Stein contended that “denying him the discovery necessary to present an available 
defense den[ied] him due process of law.”  Id.   
 
In assessing the countervailing arguments presented by each party, we started our 
analysis with a discussion of Zaal, which we found to be instructive.  Id.  We acknowledged 
that, although Zaal involved a criminal case, we provided guidance on in camera 
proceedings where the discovery sought contained confidential information.  Id. at 26–29.  
Applying the principles outlined in Zaal, we noted that although Stein was a civil case, “the 
stakes involved are high.”  Id. at 29.  We explained that the records sought by Mr. Stein 
could potentially rebut the allegations that the plaintiffs must make and successfully prove 
in a lead poisoning case.  Id. at 30.  We stated that “[t]o the extent that the records contain 
information bearing on the child’s behavior, particularly during the relevant period, the 
trier of fact will be able to assess whether that behavior was caused by lead poisoning or 
something else.”  Id.  We determined that Mr. Stein had “alleged a potential and plausible 
relationship between the records and the plaintiffs’ causes of action.”  Id.  We concluded 
31 
 
that, like the defendant in Zaal, Mr. Stein had “proffered, given the circumstances, a ‘need 
to inspect,’ that is, ‘a reasonable possibility that review of the records would result in 
discovery of usable evidence.’”  Id. (quoting Zaal, 326 Md. at 81). 
 
We recognized that Mr. Stein’s “proffer is not overly specific[,]” which “is to be  
expected,” since Mr. Stein had “not seen the records and cannot possibly know what is in 
them.”  Id.  We concluded that Mr. Stein’s proffer created a scenario that was “quite similar 
to credibility.  As with credibility, whether information will be useful in rebutting the 
plaintiff’s case or impeaching the plaintiff ‘depends upon the circumstances, including 
context, and, to a large extent, the perception of the person interpreting it.’”  Id.  (quoting 
Zaal, 326 Md. at 82). 
 
Reaching the same conclusion as in Zaal, we determined that Mr. Stein’s proffer 
was “not frivolous, and, indeed, ‘placed before the court [his] legitimate concerns and gave 
plausibility to his stated need to review the records for relevant information.’”  Id. at 31 
(quoting Zaal, 326 Md. at 83).  In other words, we determined that Mr. Stein had “crossed 
the need to inspect threshold.”  Id. (quotations omitted).  
 
Although we concluded that Mr. Stein had “crossed the need to inspect threshold[,]” 
we also pointed out that the plaintiff’s “privacy concerns are . . . protected by [statute].”  
Id.  Accordingly, we stated that “there should be no greater disclosure allowed than is 
necessary to meet the ‘need to inspect’ shown by [Mr. Stein].  That extent can only be 
determined upon a review of the records.  In that regard[,] the options we identified in Zaal 
[pertaining to in camera review] are available . . . .”  Id.  We concluded that the trial court 
erred and reversed the judgment granting “unrestricted disclosure” of the plaintiff’s files 
32 
 
and remanded the case for “further proceedings, consistent with the principles enunciated 
in . . . Zaal, 326 Md. at 81–87.”  Id.   
Our jurisprudence in Zaal and Stein establish the process for a circuit court to 
undertake an in camera review where the discovery sought involves confidential records.  
We see no reason to deviate from the procedures established by these cases where the 
records are protected by the Confidentiality Act.   
5. Putting all the Pieces Together—A Synthesis of the Applicable Law 
 
In summary, where mental health records are requested by a private party litigant in 
a civil case, the Confidentiality Act, the Maryland discovery rules, and our case law 
establish the following process for disclosure.  First, as noted above, where the discovery 
involves disclosure of mental health records without authorization of a person in interest, 
the Confidentiality Act only permits disclosure in accordance with a court order.  HG § 4-
307(k)(1).  The party seeking discovery must file a motion for a court order compelling the 
disclosure.  The party seeking disclosure of the records must establish a “need to inspect”—
in other words, “a reasonable possibility that review of the records would result in 
discovery of usable evidence.”  Stein, 328 Md. at 27 (quoting Zaal, 326 Md. at 81) (internal 
quotations omitted).20  In considering whether the party seeking the records has a need for 
 
20 SLI argues that the Court adopt a standard requiring the litigant to demonstrate a 
“compelling need” prior to the disclosure of records.  We decline to add language or 
additional requirements to the balancing framework established by Zaal and Stein.  Where 
records are confidential and protected by statute, the party seeking disclosure of the records 
must establish a “need to inspect”—in other words, “a reasonable possibility that review 
of the records would result in discovery of usable evidence.”  Stein, 328 Md. at 27 (quoting 
Zaal, 326 Md. at 81) (internal quotations omitted).  The “need to inspect” standard 
established in Zaal and Stein, combined with the statutory requirement that the circuit court 
33 
 
access to the records, the court should consider the nature of the underlying litigation, the 
relationship between the records and any claim or defense, and the likelihood that review 
of the records would result in the discovery of relevant information.  See Stein, 328 Md. at 
27; Zaal, 326 Md. at 81–82.  “[T]he circumstances will determine whether a sufficient 
relationship exists to require disclosure[,]” which will depend upon the “proffer of 
relevance” that the party seeking disclosure makes.  Stein, 328 Md. at 27–28; Zaal, 326 
Md. at 82.  
When considering the moving party’s proffer of relevance, the court should consider 
the request through the lens of the nature of the issue, rather than the specificity of the 
proffer.  Stein, 328 Md. at 28.  Where the records sought are confidential, the party seeking 
their disclosure may have little or no knowledge of their contents, but the records might, 
nonetheless, be relevant to the party’s claim or defense.  See id.; Zaal, 326 Md. at 82.   
Once the movant makes a threshold proffer sufficient to enable the court to 
determine that there is a “need to inspect,” the court must undertake an examination of the 
documents sought to be disclosed to ensure that the records sought are, in fact, relevant, 
and that the court limits disclosure only to the information that may be relevant.  See HG 
§ 4-307(c).  
As part of the proceeding, a health care provider custodian or person in interest may 
object to the disclosure by filing a motion for protective order.  In the motion, the health 
 
only permit disclosure of those portions of the record that are relevant, strikes the 
appropriate balance between the need for disclosure on the one hand, and privacy interests 
on the other.   
34 
 
care provider or person in interest may raise any applicable “constitutional right or other 
legal authority in opposition to disclosure.”  HG § 4-307(k)(6); Eist, 417 Md. at 564.   
With the relevancy proffer and any objections presented to the court, the court 
should undertake an in camera review of the records to determine their relevance to the 
moving party’s claim or defense.  When undertaking the relevancy determination as part 
of its in camera review, the court should be mindful of our direction given in Zaal.  326 
Md. at 87–88.  The court’s role is not to determine whether the records are admissible, but 
rather, could the records lead the movant to the discovery of usable evidence.  Id. at 88.  
“In other words, except as to information, which, without regard to the perspective of the 
person conducting the review, has absolutely no possible relevance to the case, the trial 
court’s in camera review should not be conducted with preclusive intent.”  Id. at 88 
(footnote omitted).   
If the court determines that the records are relevant, it should enter an order 
authorizing the disclosure of those records it determines are relevant.21  In connection with 
the entry of the order, the court has the discretion under Rule 2-403(b) to impose terms and 
conditions that it determines are appropriate on a case-by-case basis.  Given the 
confidential nature of the records, the court should place conditions or restrictions on the 
disclosure to protect the privacy interests in the disclosed records.  Such conditions should 
 
21 In undertaking its in camera review and relevancy analysis, we do not mean to 
suggest that the trial court needs to undertake the review on a line-by-line basis and redact 
accordingly.  If the trial court determines that the records have any possible relevance to 
any claim or defense, they should be disclosed pursuant to an order with appropriate 
protections.   
35 
 
include a provision incorporating the language set forth in HG § 4-302(d) prohibiting 
redisclosure, and a provision requiring the return of any original records and the return or 
destruction of any copies made, at the conclusion of the litigation.  Indeed, given the 
overlapping and preemptive force of HIPAA where the federal law provides greater 
protections, the protective order should incorporate the same conditions as would be 
required under HIPAA.22  The order should also note or reference the protections of the 
Confidentiality Act that are more restrictive than HIPAA.  See HG §4-302(d) (prohibiting 
redisclosure) and HG § 4-309 (establishing possible criminal fines and civil damages for 
the unauthorized disclosure or redisclosure of the records.). 
C. SLI’s Standing to Raise Brother Holmes’ Privacy Interests 
Before we apply these principles to Mr. Jones’ motion to compel, we address 
whether SLI has standing to assert any privacy interest that Brother Holmes, now deceased, 
 
22 Under HIPAA regulations,  
 
a qualified protective order means . . . an order of a court or a 
of an administrative tribunal or a stipulation by the parties to 
the litigation or administrative proceeding that:  
 
(A) 
 Prohibits the parties from using or disclosing the 
protected health information for any purpose other 
than the litigation or proceeding for which such 
information was requested; and  
 
(B) 
 Requires the return to the covered entity or 
destruction of the protected health information 
(including all copies made) at the end of the 
litigation or proceeding.  
 
45 C.F.R. § 164.512(e)(1)(v). 
36 
 
may have in his mental health records.  SLI contends that the Court of Special Appeals 
erred in failing to consider its standing to raise Brother Holmes’ privacy interests.  Given 
the express statutory provision conferring standing under the Confidentiality Act, we 
agree.23   
Mr. Jones argues that SLI does not have standing to raise Brother Holmes’ privacy 
interest in his mental health records.  Mr. Jones contends that the right to privacy is a 
personal right that cannot be raised by another.24  Mr. Jones also argues that the 
 
23 The Court of Special Appeals declined to consider SLI’s arguments related to 
Brother Holmes’ privacy interests in the medical records because neither Brother Holmes 
nor his personal representative had raised the patient-therapist privilege under CJ § 9-
109(b)(1)-(2).  St. Luke Inst., 242 Md. App. at 628 n.6.  The court appears to confuse a 
patient’s statutory privilege (which was not raised by either Brother Holmes or SLI), with 
a patient’s privacy interest in his or her medical records, which is protected by the 
Confidentiality Act.  The intermediate appellate court reasoned that, because Brother 
Holmes had not asserted a privilege, “no party with the requisite standing” was present to 
advance such an argument related to a constitutional right to privacy.  Id. (citations 
omitted).  The court further determined that, because the case “can properly be disposed of 
on a non-constitutional ground[,]” it would not consider arguments related to Brother 
Holmes’ privacy interests in the mental health records.  Id. (citations omitted).  We disagree 
with this analysis.  First, SLI’s arguments related to Brother Holmes’ privacy interests arise 
in the context of the Confidentiality Act and have no relation to any argument that Brother 
Holmes may have been entitled to raise under a privilege statute.  Second, the 
Confidentiality Act expressly confers standing on the health care provider to raise the 
patient’s “constitutional right or other legal authority in opposition to disclosure.”  HG § 
4-307(k)(6); see also Eist, 417 Md. at 564.  Finally, the principle that a court will not 
address a constitutional issue when the case can be otherwise disposed of on a non-
constitutional ground has no application here.  In this case, the issue is whether the statute 
permits disclosure.  Any constitutional or other legal argument arising from Brother 
Holmes’ privacy interests would militate against disclosure.  In other words, if we 
determine that a statute permits disclosure, it does not follow that we would not consider a 
constitutional issue that might preclude or limit disclosure.   
 
24 Mr. Jones relies upon California law and a federal case from the Seventh Circuit 
for the proposition that the right of privacy is personal and cannot be asserted by anyone 
other than the person whose privacy interest has been invaded.  See Lugosi v. Universal 
37 
 
Confidentiality Act only gives the health care provider standing to assert its constitutional 
rights or legal authority in opposition to disclosure, not the patient’s constitutional right.  
We disagree with Mr. Jones’ interpretation.   
As noted above, the Confidentiality Act, HG § 4-307(k)(6) expressly confers 
standing in these circumstances.  Where a third party is seeking a patient’s confidential 
mental health records in the possession of a third party health care provider, the General 
Assembly has expressly granted standing to the “health care provider, a recipient, or person 
in interest” to “assert[] in a motion to quash or a motion for a protective order any 
constitutional right or other legal authority in opposition to disclosure.”  HG § 4-307(k)(6).  
In Eist, we explained that “the statute grants standing to the health care provider, as well 
as others opposed to disclosure, to raise the patient’s constitutional rights or other grounds 
for nondisclosure, by filing in court a motion to quash [in the case of a subpoena] or a 
motion for a protective order.”  417 Md. at 564.   
We reject Mr. Jones’ argument that the plain language of the statute only permits a 
health care provider to raise its constitutional right.  Such an interpretation is illogical and 
is also inconsistent with the common law standing principles that have been established by 
 
Pictures, 25 Cal. 3d 813, 821–22 (Cal. 1979); Maritote v. Desilu Prods., Inc., 345 F.2d 
418, 419 (7th Cir. 1965).  These cases, which address whether an individual can bring a 
common law right of privacy action on behalf of another, are inapposite to the very 
different facts of this case.  Here, we must address whether a health care provider who is 
in custody of confidential records of a patient, may assert, on the patient’s behalf, by motion 
for protective order, a constitutional right or other legal authority in opposition to 
disclosure.  
38 
 
the United States Supreme Court and this Court.25  Although as a general rule, a person 
may not assert the constitutional rights of others, there are exceptions to that rule.  Turner 
v. State, 299 Md. 565, 571 (1984).  Notably, “[w]hen a relationship between a litigant and 
a third person is such that the enjoyment of the third person’s rights are ‘inextricably bound 
up with the activity the litigant wishes to pursue’; the litigant is ‘very nearly, as effective a 
proponent of the right’ as the third person; and the rights of the third person are likely to 
be ‘diluted or adversely affected,’ the general rule does not apply.”  Id. at 572 (quoting 
Singleton v. Wulff, 428 U.S. 106, 115–16 (1976) (holding that physicians were permitted 
to assert patients’ constitutional rights)). 
Our plain reading of the statute is consistent with federal courts’ standing 
jurisprudence on matters involving a custodian filing a motion for a protective order under 
Fed. R. Civ. P. 26(c) on behalf of a non-party where the custodian is in possession of 
confidential records.  See In re Search Warrant (Sealed), 810 F.2d 67, 69 (3d Cir. 1987) 
 
25 To support the position that SLI lacks standing to assert Brother Holmes’ privacy 
interest in his mental health records, Mr. Jones and the Court of Special Appeals cite Lujan 
v. Defenders of Wildlife, 504 U.S. 555, 560 (1992).  St. Luke Inst., 242 Md. App. at 628 
n.6.  In Lujan, the United States Supreme Court held that an environmental group lacked 
standing to challenge a governmental agency’s alleged unlawful environmental regulations 
because the group did not demonstrate that they suffered or will suffer an ‘“injury in fact’—
an invasion of a legally protected interest which is (a) concrete and particularized; and (b) 
actual or imminent, not conjectural or hypothetical[.]”  504 U.S. at 560 (some quotations 
omitted) (internal citations omitted).  We determine that Lujan has no application to our 
standing analysis in this case.  As noted above, HG § 4-307(k)(6), by its express terms, 
confers standing in such instances.  Moreover, even in the absence of a statute, in the 
context of disclosure of medical records, the United States Supreme Court and other federal 
courts have held that the custodian of the medical records has the right to assert the privacy 
interests of the patient.  See Singleton v. Wulff, 428 U.S. 106, 115–17 (1976); In re Search 
Warrant (Sealed), 810 F.2d 67, 69 (3d Cir. 1987).  
39 
 
(holding that physician, as the custodian of records, had the right to assert his patients’ 
privacy interest when medical records were seized as part of a fraud insurance 
investigation); Westinghouse, 638 F.2d at 574 (holding that an employer has standing to 
assert its employees’ privacy interests where the subpoena issued by the National Institute 
for Occupational Safety and Health sought discovery of the employees’ medical records).   
Where a court order is sought compelling the disclosure of mental health records 
from a custodian, the custodian’s interests and the patient’s interests are inextricably 
intertwined.  As we explained in Eist, any objections to the disclosure are required to be 
raised in a motion for a protective order.  417 Md. at 564–65.  If an order authorizing the 
records is entered, a failure to comply could subject the health care provider or custodian 
to a motion for contempt.  Moreover, there may be instances where, given the patient’s 
mental or physical condition, he or she is not able to file a motion for a protective order 
within the time period established by the Maryland Rules.  By granting standing to the 
health care provider to assert the patient’s “constitutional rights or legal authority in 
opposition to disclosure[,]” the statute ensures that the patient’s rights are protected even 
if the patient is unable to assert the right.  HG § 4-307(k)(6).  For these reasons, we hold 
that SLI has the authority to raise Brother Holmes’ privacy interests in connection with its 
opposition to disclosure. 
D. In this Case, there is no State Action that Precipitates a Constitutional 
Analysis  
Although we hold that SLI would have standing to assert any constitutional right 
that Brother Holmes would have against disclosure of his mental health records, here, the 
40 
 
party seeking discovery of the mental health records is a private party, instead of a 
government agency, and Brother Holmes’ privacy interests are subject to a statutory 
balancing test, not a constitutional “compelling state interest” balancing test.   
It is undisputed that medical records fall within an individual’s privacy interests and 
are protected by the statutory confidentiality provisions under HIPAA and the 
Confidentiality Act.  In addition, medical records fall within the penumbra of privacy rights 
protected by the Constitution.  See Doe, 384 Md. at 183–84 (citing Whalen v. Roe, 429 
U.S. 589, 599–600 (1997)) (Supreme Court recognizing that “cases . . . characterized as 
protecting ‘privacy’ have in fact involved at least two kinds of interests.  One is the 
individual interest in avoiding disclosure of personal matters, and another is the interest in 
independence in making certain kinds of important decisions.”) (footnotes omitted).  
Because the patient’s right to privacy in his or her medical records falls within the 
sphere of privacy rights entitled to constitutional protection, where a government agency 
is seeking disclosure of medical records that fall within the constitutional right to privacy, 
we have held that the “state agency[] must show a ‘compelling state interest’ before it will 
be allowed to infringe on petitioners’ privacy rights regarding their treatment records.”  Id. 
at 183–84 (holding that Board of Social Work Examiners investigating accusation of 
failure of a licensed social worker to report sexual abuse of a minor must demonstrate a 
compelling state interest before the state agency could subpoena medical records); see also 
Dr. K., 98 Md. App. at 111 (holding that the State Board of Physician Quality Assurance 
demonstrated a compelling state interest in the investigation of a psychiatrist who was 
alleged to be abusing alcohol and having a romantic relationship with a former patient, 
41 
 
which outweighed the patient’s privacy right in her treatment records).  Accordingly, we 
have held that “the balancing test framework described in Westinghouse, and applied in 
Dr. K, is the correct standard to use when balancing individual privacy interests in medical 
records against competing state interests in those records.”  Doe, 384 Md. at 186 (emphasis 
added) (citations omitted).   
 
In this case, the party seeking disclosure of Brother Holmes’ mental health records 
is not a state actor—disclosure is sought in connection with private civil litigation.  
Accordingly, Brother Holmes’ privacy interests are considered within the balancing 
framework established by the Confidentiality Act, instead of the constitutional balancing 
framework applicable to governmental requests for disclosure.  See, e.g., Citizens for 
Health v. Leavitt, 428 F.3d 167, 177 (3d Cir. 2005) (holding that a “violation of a citizen’s 
right to medical privacy rises to the level of a constitutional claim only when that violation 
can properly be ascribed to the government.  The Constitution protects against state 
interference with fundamental rights.”) (emphasis in original).26 
Although there is no state or governmental action that would trigger a constitutional 
balancing test under the Westinghouse framework, we determine that the patient’s privacy 
rights are nonetheless afforded equivalent protections—those protections simply arise 
under the balancing framework outlined in the Confidentiality Act.  Comparing the privacy 
protections discussed in Part III.B.5 of this opinion, and the Westinghouse factors outlined 
 
26 SLI acknowledges that this Court has never applied a “compelling governmental 
interest” test where the individual seeking the records was not a government agency, and 
acknowledges that in Stein, this Court did not apply a constitutional analysis where the 
party seeking disclosure of confidential records was a private litigant.  328 Md. 1.  
42 
 
in footnote 5, supra, we conclude that the patient’s privacy interests are similarly and 
appropriately protected under either balancing analysis.27  As described in Part III.B.5, 
when a court considers a litigant’s request for discovery of confidential mental health 
records, the court must undertake a relevancy analysis in connection with an in camera 
review and is only authorized to order disclosure of those portions of the records that are 
relevant.  Moreover, as part of the entry of a protective order, the court has discretion to 
establish protective parameters for disclosure.  Instead of balancing a “compelling state 
interest” in disclosure against the privacy interest, the balancing test involves a relevance 
inquiry and a court order permitting disclosure of only relevant records with additional 
protections established by a protective order on a case-by-case basis. 
Although we hold that there is no constitutional analysis of privacy interests in the 
context of the discovery sought in this instance, as noted above, SLI has standing to raise 
any statutory objections to disclosure that Brother Holmes would have been permitted to 
raise.  See HG § 4-307(k)(6) (granting standing to raise any applicable “constitutional right 
or other legal authority in opposition to disclosure.”) (Emphasis added).  Accordingly, 
although Brother Holmes’ constitutional rights are not implicated by the discovery request, 
to the extent that his privacy rights are protected by statute, SLI would have standing to 
 
27 It is also worth noting that, where a constitutional right is implicated because of 
governmental action, the constitutional right to privacy is not absolute.  In many instances, 
the court determines that a compelling state interest overrides the individual’s privacy 
interest.  See Doe, 384 Md. at 192–93; Dr. K, 98 Md. App. at 120–22.  
43 
 
ensure that the statutory provisions concerning disclosure, and the protections afforded by 
the Confidentiality Act, are followed.28 
E. 
Application of the Balancing Framework to Mr. Jones’ Request for 
Brother Holmes’ Mental Health Records  
In this case, Mr. Jones filed a motion seeking to compel disclosure of Brother 
Holmes’ mental health records and requesting a court order compelling the disclosure, 
consistent with the process required by HG § 4-307(k)(1).  Mr. Jones attached to his motion 
a memorandum containing his proffer of relevance.  The proffer included a summary of 
the Massachusetts Action alleging negligent hiring and negligent supervision of Brother 
Holmes.  Mr. Jones attached the handwritten and typewritten documents that had been 
produced by CSH in discovery that reflected that SLI had prepared two psychiatric 
evaluation reports.  Mr. Jones explained the potential relevance of these psychiatric 
evaluations and mental health records to the Massachusetts Action, reasoning that “[w]hat 
was known about Holmes[’] propensity to sexually abuse minors in his care and when that 
 
28 We disagree with Mr. Jones’ contention that Brother Holmes has no privacy 
interest in his mental health records because he is deceased.  We also disagree, based upon 
the record before us, that any privacy interest was waived.  One cannot infer waiver based 
simply upon the fact that CSH had handwritten and typed notes referencing the psychiatric 
evaluations in its possession.  Nor do we conclude that Brother Holmes had no privacy 
right in his mental health records given his guilty plea and convictions pertaining to sexual 
abuse of other individuals.  Although Brother Holmes’ convictions are “public facts,” his 
mental health records are not.  To be sure, the circuit court may consider these factors when 
balancing Brother Holmes’ privacy interest against the plaintiffs’ interest in disclosure.  
However, we are not persuaded that Brother Holmes has no privacy interest whatsoever in 
the mental health records arising from his death, convictions in other matters, or under 
principles of waiver.  If we were to determine that Brother Holmes had no privacy interest 
in his mental health records, there would be no need to apply any balancing test under HG 
§ 4-307 and the plaintiffs would be entitled to unfettered access to all of Brother Holmes’ 
mental health records in SLI’s possession.   
44 
 
was known is a central issue in the case.”  Mr. Jones also attached copies of newspaper 
articles reflecting that Brother Holmes pled guilty to 17 counts of sexual abuse of minors 
while they were residents at Nazareth—the same facility where Mr. Jones alleged that he 
was sexually abused.  Mr. Jones asserted that the newspaper articles are evidence that 
Brother Holmes’ sexual abuse of minors is public knowledge.  Finally, Mr. Jones proffered 
that Brother Holmes died in April 2011.   
 
Based upon the record before us, the proffer made by Mr. Jones in his 
memorandum appears to be sufficient to demonstrate a “need to inspect” or in other 
words, “a reasonable possibility that review of the records would result in discovery of 
usable evidence.”  Stein, 328 Md. at 27 (quotations and citation omitted).  However, given 
the balancing of interests that the circuit court is required to make, and the statutory 
requirement that the court may only permit disclosure of information that is “relevant to 
the purpose for which disclosure is sought[,]” see HG § 4-307(c), we conclude that the 
trial court should examine the complaint filed in the Massachusetts Action as part of its 
relevancy inquiry.29  
 
When undertaking its in camera review, the court’s role is not to determine whether 
the records are admissible, but whether the records could lead the movant to the discovery 
 
29 SLI does not contend that the trial court is required to review all the pleadings 
filed in the Massachusetts Action.  We agree.  As part of its in camera review, the trial 
court could simply review the complaint and the mental health records sought by Mr. 
Jones to determine whether the records are relevant to his claims.  Of course, this does 
not mean that the circuit court’s review is limited to reviewing only the complaint.  We 
simply note that under the facts of this case and the proffer by Mr. Jones’ counsel, a 
review of the complaint should be sufficient to enable the circuit court to carry out its 
duties under HG § 4-307(c). 
45 
 
of usable evidence.  Zaal, 326 Md. at 88.  In accordance with HG § 4-307(c), the court 
should permit the disclosure of records or information that may be relevant to the claims 
asserted by the plaintiffs in the Massachusetts Action.  This does not mean that the trial 
court must undertake a line-by-line analysis of the mental health records, nor should the 
court undertake its review with a preclusive intent.  The court should review the claims 
asserted by the plaintiffs in the Massachusetts Action and determine whether the mental 
health records may lead to the discovery of usable evidence.  Assuming that the trial court 
finds that the records are relevant, in furtherance of the balancing of interests between 
disclosure and protecting the privacy interests protected by the Confidentiality Act, we 
agree with the Court of Special Appeals that it is appropriate for the circuit court to order 
the portion of Brother Holmes’ mental health records deemed relevant to the Massachusetts 
Action to be produced under seal to the Massachusetts Court for that court’s determination 
as to what should be released to counsel.   
IV.   
Conclusion 
 
For the reasons set forth above, we hold:  
(1) 
Where mental health records are requested by a private litigant in a civil case, 
the Confidentiality Act, the Maryland discovery rules, and our case law addressing 
discovery of confidential records establish the process to be undertaken by the trial court 
prior to disclosure of the records, which is outlined in Part III.B.5 of this opinion.  
(2) 
Under the plain language of the Confidentiality Act, HG § 4-307(k)(6), 
where a litigant is seeking discovery of mental health records, the health care provider or 
46 
 
custodian has standing to raise a patient’s “constitutional right or other legal authority in 
opposition to disclosure.”   
(3) 
The circuit court erred by failing to conduct the necessary statutory relevancy 
analysis required by HG 4-307(c).  Remand is appropriate for the court to review the 
complaint filed in the Massachusetts Action, and to conduct an in camera review of the 
mental health records.  Assuming the court determines that the records are relevant, it 
should enter an appropriate order transferring the relevant portions of the records under 
seal to the Massachusetts Court for further proceedings.   
JUDGMENT OF THE COURT OF 
SPECIAL APPEALS IS AFFIRMED; 
AND THE CASE IS REMANDED TO 
THE CIRCUIT COURT FOR PRINCE 
GEORGE’S COUNTY FOR FURTHER 
PROCEEDINGS 
IN 
ACCORDANCE 
WITH THIS OPINION; COSTS IN THIS 
COURT AND IN THE COURT OF 
SPECIAL APPEALS TO BE PAID BY 
RESPONDENT.