Title: Sylvia M. Crawford v. Care Concepts, Inc.

State: wisconsin

Issuer: Wisconsin Supreme Court

Document:

2001 WI 45 
 
SUPREME COURT OF WISCONSIN 
 
 
Case No.: 
99-0863 
 
 
Complete Title 
of Case: 
 
Sylvia M. Crawford, by June E. Goodyear, her 
guardian,  
 
Plaintiff-Respondent, 
 
v. 
Care Concepts, Inc., d/b/a Premier Care and St. 
Paul Fire & Marine Insurance Company,  
 
Defendants-Appellants-Petitioners, 
Donna Shalala, Secretary of the United States 
Department of Health & Human services,  
 
Defendant.  
 
 
REVIEW OF A DECISION OF THE COURT OF APPEALS 
2000 WI App 59 
Reported at:  233 Wis. 2d 609, 608 N.W.2d 694 
(Published) 
 
 
Opinion Filed: 
May 15, 2001 
Submitted on Briefs: 
      
Oral Argument: 
November 6, 2000 
 
 
Source of APPEAL 
 
COURT: 
Circuit 
 
COUNTY: 
Rock 
 
JUDGE: 
Edwin C. Dahlberg 
 
 
JUSTICES: 
 
Concurred: 
      
 
Dissented: 
      
 
Not Participating:       
 
 
ATTORNEYS: 
For the defendants-appellants-petitioners there 
were briefs by Michael J. Hogan, R. Scott Ritter and Hogan, 
Ritter, Minix & Pasholk, Milwaukee, and oral argument by Michael 
J. Hogan. 
 
 
2 
 
For the plaintiff-respondent there was a brief by 
Philip R. Schomber and O’Neal, Forbeck, Elliott & Monahan, S.C., 
Beloit, and oral argument by Philip R. Schomber. 
 
2001 WI 45 
 
NOTICE 
This opinion is subject to further editing and 
modification.  The final version will appear 
in the bound volume of the official reports. 
 
 
No. 99-0863 
 
STATE OF WISCONSIN                    :  
  IN SUPREME COURT 
 
 
Sylvia M. Crawford, by June E. Goodyear, 
her guardian, 
 
 
Plaintiff-Respondent, 
 
 
v. 
 
Care Concepts, Inc., d/b/a/ Premier Care 
and St. Paul Fire & Marine Insurance Co., 
 
 
Defendants-Appellants-Petitioners, 
 
Donna Shalala, Secretary of the United 
States Department of Health & Human 
Services, 
 
 
Defendant. 
 
 
REVIEW of a decision of the Court of Appeals.  Affirmed and 
cause remanded to the circuit court. 
 
¶1 
WILLIAM A. BABLITCH, J.   Care Concepts, the owner of 
a nursing home in Beloit, Wisconsin, petitions this court to 
review a decision of the court of appeals.1  The court of appeals 
held that information, including records and reports, relating 
                     
1 Crawford v. Care Concepts, Inc., 2000 WI App 59, 233 
Wis. 2d 609, 608 N.W.2d 694.  
FILED 
 
MAY 15, 2001 
 
Cornelia G. Clark 
Clerk of Supreme Court 
Madison, WI 
 
 
 
 
 
No. 
99-0863 
 
 
2 
to a nonparty's assaultive or disruptive conduct was not 
protected 
by 
the 
physician-patient 
privilege, 
Wis. 
Stat. 
§ 905.04(1997-98).2  We agree.  Information concerning assaultive 
or disruptive behavior by a patient and contained in medical 
records is not confidential, as that term is defined in the 
statutes.  As a result, the privilege does not bar Care Concepts 
from responding to Crawford's discovery requests. 
¶2 
The court of appeals further concluded that Wis. Stat. 
§ 146.82 does not prohibit Care Concepts from responding to 
Crawford's discovery demands.  Section 146.82 generally bars the 
release of patient health care records to unauthorized persons 
without the patient's consent; information may be released 
without 
informed 
consent 
pursuant 
to 
certain 
statutorily 
enumerated circumstances.  One of these statutorily enumerated 
circumstances permits records to be released under a lawful 
order of a court.  The court of appeals held that nonprivileged 
information could be released by order of the court.  We agree 
and therefore affirm the court of appeals' decision on this 
issue as well. 
Facts and Procedural History 
¶3 
Sylvia Crawford was a patient at a Care Concepts' 
nursing home in Beloit.  In October 1997 another nursing home 
resident, 
D.D., 
allegedly 
attacked 
and 
injured 
Crawford.  
Crawford brought a claim for damages against Care Concepts and 
                     
2 All subsequent references to the Wisconsin Statutes are to 
the 1997-98 version, unless otherwise indicated.  
No. 
99-0863 
 
 
3 
its insurer, asserting that the injuries she sustained in the 
attack were caused by the negligence of the nursing home staff. 
¶4 
The litigation proceeded to the discovery stage. 
Crawford served upon Care Concepts interrogatories and a request 
for the production of documents.  Care Concepts refused to 
answer a number of these interrogatories.  Those disputed 
interrogatories that are the subject of this review stated:  
 
INTERROGATORY NO. 4:  State whether or not resident, 
D.D., ever engaged in conduct towards an employee, of 
defendant, 
Care 
Concepts, 
Inc., 
a 
resident 
of 
defendant, Care Concepts Inc., or any other person 
which caused or reasonably could have been expected to 
cause physical pain or injury, illness, or other 
physical impairment. 
 
INTERROGATORY NO. 5:  If the answer to Interrogatory 
No. 4 is in the affirmative, for each such incident 
please provide the following information: 
 
A.  The date such incident occurred. 
 
B.  The name and current address of any 
person against whom such action was taken. 
 
C.  State whether or not any records or 
reports of the incidents were prepared by 
defendant, Care Concepts, Inc., or on its 
behalf. 
 
D.  Describe in detail the nature of the 
incident. 
 
INTERROGATORY NO. 6:  State whether or not, in 
addition to any incident described in the answers to 
Interrogatories Nos. 4 and 5, D.D. ever engaged in any 
conduct the nature of which has a tendency to cause a 
disturbance. 
 
INTERROGATORY NO. 7:  If the answer to Interrogatory 
No. 6 is in the affirmative, for each such incident 
please provide the following information: 
No. 
99-0863 
 
 
4 
A.  The date such incident occurred. 
 
B.  State whether or not any records or 
reports of the incident were prepared by 
defendant, Care Concepts, Inc., or on its 
behalf. 
 
C.  Describe in detail the nature of such 
incident. 
¶5 
Crawford 
also 
requested 
the 
production 
of 
all 
documents referred to or relied upon by Care Concepts in 
preparing its answers to these interrogatories. 
¶6 
Care Concepts argued that the information demanded by 
Crawford was confidential under Wis. Stat. § 146.82(1), and 
privileged under Wis. Stat. § 905.04(2).  Crawford filed a 
motion in the circuit court to compel an answer.  Rock County 
Circuit Court Judge Edwin C. Dahlberg granted Crawford's motion. 
¶7 
Subsequently, Care Concepts petitioned the court of 
appeals for leave to appeal from the circuit court's order.  The 
petition was granted.  The court of appeals affirmed in part and 
reversed in part the order of the circuit court.  Crawford v. 
Care Concepts, Inc., 2000 WI App 59, 233 Wis. 2d 609, 608 N.W.2d 
694.  The court of appeals affirmed the circuit court order as 
to Interrogatories Nos. 4 and 5, finding that these questions 
sought information regarding what it characterized as assaultive 
conduct, and that the privilege in Wis. Stat. § 905.04(2) did 
not protect this type of information.  Id. at ¶¶8-10.   
¶8 
The 
court 
of 
appeals 
next 
concluded 
that 
Interrogatories Nos. 6 and 7 may reach privileged matters.  As a 
result, the court ordered that the circuit court conduct an in 
No. 
99-0863 
 
 
5 
camera examination of the requested materials and determine if 
any information was privileged.  Id. at ¶¶10-11.  
¶9 
Finally, the court of appeals concluded that Wis. 
Stat. § 146.82 did not bar the release of this information.  The 
court held that although § 146.82 prohibits the release of 
patient health care records to unauthorized persons without the 
patient's consent, the statute permits such records to be 
released under a lawful order of a court.  Id. at ¶12 n. 4.  The 
court of appeals therefore concluded that nonprivileged material 
could be released by order of the circuit court. 
¶10 Care Concepts subsequently sought review by this 
court.  We granted its petition and now affirm the decision of 
the court of appeals. 
Standard of Review 
¶11 Rulings of the circuit court on issues of discovery 
are discretionary and will be upheld if they are "'consistent 
with the facts of record and established legal principles.'"  
Ranft v. Lyons, 163 Wis. 2d 282, 290, 471 N.W.2d 254 (Ct. App. 
1991)(quoting Lievrouw v. Roth, 157 Wis. 2d 332, 358-59, 459 
N.W.2d 850 (Ct. App. 1990)).  Resolution of the issue before the 
court in this case requires an interpretation of Wis. Stats. 
§ 905.04 and § 146.82.  Statutory interpretation is a question 
of law, which this court reviews independently.  Steinberg v. 
Jensen, 194 Wis. 2d 439, 458, 534 N.W.2d 361 (1995).   
Analysis 
I 
No. 
99-0863 
 
 
6 
¶12 Care Concepts asserts that two statutes prohibit it 
from responding to Crawford's interrogatories and request for 
production of documents: Wis. Stats. § 146.82 and § 905.04.  We 
begin our analysis with consideration of § 905.04, relating to 
the evidentiary privilege to not have disclosed confidential 
communications that occur between a patient and certain health 
care professionals. 
¶13 The applicability of Wis. Stat. § 905.04 arose while 
the parties engaged in pretrial discovery pursuant to the 
procedures set forth in Wis. Stat. ch. 804.  The scope of 
pretrial discovery permitted under ch. 804 is broad, and 
discovery is not limited to admissible information.  Wis. Stat. 
§ 804.01(2).  The requested information need only appear 
"reasonably calculated to lead to the discovery of admissible 
evidence."  Wis. Stat. § 804.01(2)(a).3  This breadth is 
essential because the purpose of discovery is identical to the 
purpose of our trial system - the ascertainment of truth.  State 
ex rel. Dudek v. Circuit Court, 34 Wis. 2d 559, 576, 150 N.W.2d 
387 (1967).   
¶14 The 
broad 
discovery 
rules 
encourage 
thorough 
investigation by the parties and foster the "revelation of the 
objective truth."  Id.  In our adversary system, pretrial 
discovery is "designed to formulate, define and narrow the 
issues to be tried, increase the chances for settlement, and 
                     
3 We note that Care Concepts does not dispute the relevance 
of the information sought by Crawford.  
No. 
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7 
give each party opportunity to fully inform himself [or herself] 
of the facts of the case and the evidence which may come out at 
trial."  Id.  Privileged matter presents a limited exception to 
the broad scope of discovery.  Wis. Stat. § 804.01(2)(a).  The 
privilege relied upon by Care Concepts in this case is the 
physician-patient4 privilege. "[E]xceptions to the demand for 
every man's [and woman's] evidence are not lightly created nor 
expansively construed, for they are in derogation of the search 
for truth."  United States v. Nixon, 418 U.S. 683, 710 (1974).  
Accordingly, statutory privileges are construed strictly and 
narrowly.  Steinberg, 194 Wis. 2d at 464 (citing Franzen v. 
Children's Hosp., 169 Wis. 2d 366, 386, 485 N.W.2d 603 (1992)). 
¶15 In applying Wis. Stat. § 905.04 to the facts of this 
case, we are mindful that this privilege must coexist in a 
judicial system seeking to find the truth, serve the interests 
of justice, and have all relevant information available for 
consideration by the fact-finder.  Within this framework, we 
turn to consider the requirements of § 905.04.   
¶16 Wisconsin Stat. § 905.04(2) provides: 
 
GENERAL RULE OF PRIVILEGE.  A patient has a 
privilege to refuse to disclose and to prevent any 
other 
person 
from 
disclosing 
confidential 
communications 
made 
or 
information 
obtained 
or 
disseminated for purposes of diagnosis or treatment of 
                     
4 The privilege set forth in Wis. Stat. § 905.04(2)(a) 
protects communications between a patient and a variety of 
professionals, 
including 
registered 
nurses, 
psychologists, 
marriage and family therapists and others.  In this opinion, the 
privilege 
will 
be 
referred 
to 
as 
the 
physician-patient 
privilege, as it is widely known.   
No. 
99-0863 
 
 
8 
the patient's physical, mental or emotional condition, 
among 
the 
patient, 
the 
patient's 
physician, the 
patient's 
registered 
nurse, 
the 
patient's 
chiropractor, 
the 
patient's 
psychologist, 
the 
patient's social worker, the patient's marriage and 
family therapist, the patient's professional counselor 
or persons, including members of the patient's family, 
who are participating in the diagnosis or treatment 
under the direction of the physician, registered 
nurse, 
chiropractor, 
psychologist, 
social 
worker, 
marriage 
and 
family 
therapist 
or 
professional 
counselor.    
¶17 The legislature has provided specific definitions for 
two terms employed in Wis. Stat. § 905.04(2) and relevant to our 
analysis in this case.  First, "confidential" is defined in 
§ 905.04(1)(b) as follows: 
 
A communication or information is "confidential" 
if not intended to be disclosed to 3rd persons other 
than those present to further the interest of the 
patient 
in 
the 
consultation, 
examination, 
or 
interview, or persons reasonably necessary for the 
transmission of the communication or information or 
persons who are participating in the diagnosis and 
treatment 
under the 
direction 
of 
the 
physician, 
registered nurse, chiropractor, psychologist, social 
worker, marriage and family therapist or professional 
counselor, including the members of the patient's 
family.  
 
¶18 The court of appeals concluded, and we agree, that the 
word "confidential" in Wis. Stat. § 905.04(2) modifies both 
"communications 
made" 
and 
"information 
obtained 
or 
disseminated."  Crawford, 2000 WI App. 59 at ¶7.   
¶19 Second, the word "patient" is defined in Wis. Stat. 
§ 905.04(1)(c) as an "individual . . . who consults with or is 
examined or interviewed by a physician . . ." or one of the 
other enumerated health care professionals.  For the purposes of 
No. 
99-0863 
 
 
9 
this analysis, we will assume that at all relevant times D.D. 
was a patient as defined by the statute. 
¶20 The plain language of subsection (2) extends the 
physician-patient privilege to either "communications made or 
information 
obtained 
or 
disseminated" 
during 
professional 
contacts.5  Care Concepts focuses upon the portion of Wis. Stat. 
§ 906.04(2) 
which 
provides 
that 
"information" 
that 
is 
"obtained . . . for purposes of diagnosis or treatment" is 
privileged.  Noting that in this case D.D. suffers from 
Alzhiemer's disease, Care Concepts contends that a health care 
provider's written observation or treatment notes regarding an 
Alzheimer patient's violent behavior is information obtained by 
or disseminated by the provider for purposes of the patient's 
diagnosis and treatment.  As a result, Care Concepts argues that 
such information is privileged.    
¶21 We disagree with Care Concepts' conclusion because in 
this case the required elements of Wis. Stat. § 905.04 are not 
satisfied.  Pursuant to that statute, the privilege is available 
when there is: 
                     
5 Commentators agree with this conclusion.   
[The privileges in Wis. Stat. § 950.04] are broader 
than 
other 
privileges 
that 
are 
restricted 
to 
"communications," since they also extend a protective 
cover to "information obtained or disseminated" during 
the professional contacts.  The communications or 
information 
must 
have 
been 
made, 
obtained 
or 
disseminated for purposes of diagnosing or treating 
the patient's physical, mental or emotional condition. 
7 Daniel D. Blinka, Wisconsin Practice § 504.2, p. 212 (1991). 
No. 
99-0863 
 
 
10
(1)  A patient, as defined by Wis. Stat. § 905.04(1)(c).  
(2) Information that is obtained or disseminated for 
purposes of diagnosis or treatment. 
(3) Information that is confidential, as defined by Wis. 
Stat. § 905.04(1)(b). 
(4) 
Information 
obtained 
or 
disseminated 
among 
the 
individuals enumerated in the statute. 
¶22 The dispositive issue in this case is whether the 
information 
is 
confidential 
as 
defined 
by 
Wis. 
Stat. 
§ 905.04(1)(b).  This section sets forth the relationships that 
comprise the privilege. Therefore, to analyze whether this 
element is met, we must consider what information was sought by 
the interrogatories.  Crawford's Interrogatories Nos. 4 and 5 
requested 
information 
regarding 
whether 
D.D. 
engaged 
in 
assaultive conduct towards three classes of individuals:  (1) "a 
resident of Care Concepts"; (2) "an employee, of defendant, Care 
Concepts"; or (3) "any other person."  As to the first group, 
residents of Care Concepts, we find that the privilege does not 
protect information or records concerning assaults by D.D. 
against residents because that information is not confidential 
under the statute.  Residents of the nursing home fall outside 
the network of relationships set forth in the privilege.  
Residents are third persons: 
 
other than those present to further the interest of 
the patient in the consultation, examination, or 
interview, or persons reasonably necessary for the 
transmission of the communication or information or 
persons who are participating in the diagnosis and 
No. 
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11
treatment under the direction of [enumerated health 
care professionals]. . . . 
Wis. Stat. § 905.04(1)(b).  Thus, any assault made by D.D. 
against another resident was not confidential at its inception. 
Therefore, even if a health care professional documented this 
assaultive conduct in D.D.'s medical record for the purpose of 
diagnosis or treatment, the information is not privileged.  
¶23 As to the next two classes of individuals addressed in 
Interrogatories Nos. 4 and 5, employees or other individuals, we 
again conclude that the definition of confidential in Wis. Stat. 
§ 905.04(1)(b) is not satisfied.  Individuals falling within 
these two groups could potentially fall within the statutorily 
enumerated 
list 
of 
individuals 
among 
whom 
confidential 
information may flow. However, § 905.04(1)(b) also provides that 
information is "confidential" only if it is not intended to be 
disclosed to third persons.  We conclude that an attack upon an 
employee or other person could not be undertaken with the intent 
that the act remain confidential under § 905.04. 6   
¶24 Care Concepts argues that the statute does not define 
whose intent governs, the patient or the health care provider 
who documents observations of the patient's conduct.  In its 
view, the statute permits the recorded impressions of a health 
care provider to be privileged based upon the provider's 
                     
6 Conceivably, there may be a situation where a nursing home 
resident is encompassed within the class of individuals outlined 
in Wis. Stat. § 905.04(1)(b).  Our analysis here includes this 
situation. 
No. 
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12
intention that it not be disclosed to third persons.7  We 
conclude 
that 
the 
statute 
is 
ambiguous 
on 
this 
point.  
Therefore, we may consider the public policy purpose supporting 
the statute as a guide to discerning legislative intent.  
¶25 The public policy purpose of the statute is to 
facilitate communication between a patient and his or her health 
care providers.  Steinberg, 194 Wis. 2d at 459.  Applying the 
privilege to information concerning assaultive behavior observed 
at a residential facility by the health care provider does not 
advance candid communication between patient and health care 
provider.  Plainly, the information may serve other purposes. 
The observation of violent or aggressive behavior by Alzheimer's 
patients such as D.D. may be information that is used in forming 
medical 
opinions 
and 
developing 
a 
course 
of 
treatment.  
Additionally, nursing homes are required to document the 
resident's 
condition 
pursuant 
to 
Wis. 
Admin. 
Code 
HFS 
§ 132.45(5)(c) (Oct. 2000).  However, we conclude that where a 
patient engages in assaultive conduct, such conduct is not 
intended 
to 
be 
confidential 
for 
the 
purposes 
of 
candid 
discussion of medical concerns, which is the purpose of the 
physician-patient privilege.   
                     
7  In support of this contention Care Concepts cites State 
v. Locke, 177 Wis. 2d 590, 604, 502 N.W.2d 891 (Ct. App. 1993), 
in which the court of appeals wrote: "The patient's objectively 
reasonable perceptions and expectations of the medical provider 
are the proper gauge of the scope of the sec. 905.04 privilege." 
The Locke decision does not resolve the issues in this case. 
No. 
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13
¶26 Care Concepts believes that permitting disclosure of 
the requested information will have a chilling effect on free 
discussion between patients and health care providers, in part 
because the disclosure would be made without notice to the 
patient or an opportunity for the patient to object.  However, a 
health care provider is authorized by Wis. Stat. § 905.04(3) to 
invoke the physician-patient privilege on behalf of the patient, 
and obligated by professional responsibility to do so.8  As a 
result, a nonparty's interest in asserting the privilege may be 
advanced, as it has been in this case.  Accordingly, we hold 
that the information sought by Crawford in Interrogatories Nos. 
4 and 5 is not protected by the physician-patient privilege.   
¶27 Crawford's Interrogatories Nos. 6 and 7 ask for 
information concerning whether D.D. ever engaged in conduct that 
had a tendency to cause a disturbance.  For the reasons 
previously stated, we also conclude that the information sought 
by these questions is not confidential information pursuant to 
Wis. Stat. § 905.03(1)(b).  As with assaultive conduct, creating 
a disturbance is not a communication intended to remain 
confidential 
within 
the 
policy 
of 
the 
physician-patient 
privilege.  Accordingly, information concerning the creation of 
a disturbance is not privileged. 
¶28 Further, as to Interrogatories Nos. 6 and 7, we agree 
with the court of appeals' conclusion that the information 
                     
8 Under Wis. Admin. Code MED § 10.02(1)(n) (Dec. 1999) it is 
unprofessional conduct for a physician to willfully divulge a 
privileged communication or confidence.   
No. 
99-0863 
 
 
14
sought by these interrogatories is framed using fairly general 
language, raising the possibility that by answering these 
questions 
privileged 
information 
may 
be 
reached. 
 
We 
specifically adopt the court's conclusions at Crawford, 2000 WI 
App 59, ¶¶10-12, remanding this matter to the circuit court and 
allowing the court to order in camera production of the 
requested material and to make a determination of whether any 
information 
produced 
by 
Care 
Concepts 
reaches 
privileged 
matters. 
II 
¶29 The second statute relied upon by Care Concepts in its 
contention that it cannot answer Crawford's discovery demands is 
Wis. Stat. § 146.82(1).  Section 146.82(1) provides in relevant 
part that "[a]ll patient health care records shall remain 
confidential.  Patient health care records may be released only 
to the persons designated in this section or to other persons 
with the informed consent of the patient or of a person 
authorized by the patient."  A "patient health care record" is 
defined in § 146.81(4) as records "related to the health of a 
patient prepared by or under the supervision of a health care 
provider . . . ."  Crawford does not dispute that § 146.82 
applies to the documentation by the nursing home of any 
aggressive conduct on the part of D.D.  Therefore, for the 
purposes of this analysis, we will assume that § 146.82(1) 
applies. 
¶30 The statute providing for the confidentiality of 
patient health care records is not an absolute bar to the 
No. 
99-0863 
 
 
15
release of information without the informed consent of the 
patient.  Wisconsin Stat. § 146.82(2) provides for numerous 
exceptions from the rule set forth in subsection (1).  The 
parties raise only one of these exceptions as applicable to the 
case at hand, § 146.82(2)(a)4.  This provision states that under 
a lawful order of a court of record, patient health care records 
shall be released without informed consent.  
¶31 Care 
Concepts 
contends 
that 
this 
court 
should 
interpret the "lawful order of a court" exception in Wis. Stat. 
§ 146.82(2)(a)4 using the same method of analysis as applied in 
In re Mental Condition of Billy Jo W., 182 Wis. 2d 616, 514 
N.W.2d 707 (1994).  Billy Jo W. was civilly committed pursuant 
to the provisions of Wis. Stat. ch. 51, the mental health act.  
Wisconsin Stat. § 51.30(3) (1991-92) provided that records of 
court proceedings under ch. 51 are closed.  The statute provided 
several exceptions to this closed record rule, including that 
"'records may be released . . . pursuant to lawful order of the 
court which maintains the records.'"  Billy Jo W., 182 Wis. 2d 
at 626-27 n.1.   
¶32 The phrase "pursuant to lawful order of the court" was 
undefined in Wis. Stat. § 51.30(3), and therefore in Billy Jo W. 
we examined § 51.30(4) for guidance in determining the meaning 
of this phrase because it appeared in both sections, "because 
the purpose of limiting access to treatment records and court 
records is similar, and because in sec. 51.30(4)(b) the 
legislature has enumerated 22 situations under which treatment 
records may be released."  Billy Jo W., 182 Wis. 2d at 635.  We 
No. 
99-0863 
 
 
16
concluded that in enacting Wis. Stat. ch. 51, it was the intent 
of the legislature to allow the scope of access to civil 
commitment court records to be analogous to the scope of access 
to treatment records.  Id.   Accordingly, we concluded that 
"'pursuant to lawful order of the court' in sec. 51.30(4)(b)4 
allows access in situations distinct from but substantially 
similar to those contained in the enumerated exceptions."  Id. 
at 637.   
¶33 Our method of analysis of Wis. Stat. § 51.30 in Billy 
Jo W. is not applicable to Wis. Stat. § 146.82.  Section 51.30 
is a specific statute relating to access to registration and 
treatment records for individuals committed pursuant to the 
provisions of Wis. Stat. ch. 51, while  § 146.82 is a general 
statute governing patient health care records.  Section 51.30 is 
part of ch. 51, which was created to "assure the provision of a 
full range of treatment and rehabilitation services in the state 
for all mental disorders and developmental disabilities and for 
mental illness, alcoholism and other drug abuse."  Wis. Stat. 
§ 51.001.  As we noted in Billy Jo W., there remains a stigma 
associated to mental illness and commitment to a mental 
institution and individuals are entitled to privacy about these 
matters.  Billy Jo W., 182 Wis. 2d at 632.  D.D.'s privacy 
interest in care and treatment for Alzheimer's disease while she 
is a resident of a nursing home is also important, but 
distinguishable from the potential stigmatization that may occur 
as a result of a civil commitment under ch. 51.  While 
§ 51.30(4)(b)4 had to be read within the context of ch. 51, we 
No. 
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17
need not apply the same analysis to § 146.82(2)(a)4. The 
reasoning of Billy Jo W., therefore, is inapplicable in our 
analysis of § 146.82(2)(a)4.  Consequently, for the exception in 
§ 146.82(2)(a)4 to apply we need only determine whether the 
circuit court's order in this case was a "lawful order."  
¶34 Care Concepts asserts that the circuit court's order 
compelling it to answer Crawford's interrogatories is not lawful 
because D.D. is not a party to this action, and she has not 
waived her right of privacy in her health care records.  In 
support of its argument, Care Concepts points to the reasoning 
by the court of appeals in Ambrose v. General Casualty Co., 156 
Wis. 2d 306, 456 N.W.2d 642 (Ct. App. 1990).   
¶35 In Ambrose the court of appeals interpreted Wis. Stat. 
§ 146.82(2) (1987-88) and the medical records discovery rule, 
Wis. Stat. § 804.10(2) (1987-88).  The medical records discovery 
rule in § 804.10(2) provided that the circuit court may order a 
claimant to give his or her consent and the right to inspect and 
copy hospital, medical or other records and reports concerning 
the injuries claimed and the treatment thereof.  Ambrose, 156 
Wis. 2d at 309 n.1. 
¶36 In Ambrose, plaintiff Patricia Ambrose brought a 
personal injury claim against the operator of a vehicle that had 
collided 
with 
Ambrose's 
vehicle. 
 
During 
the 
course 
of 
conducting discovery, the defendants learned that Ambrose had a 
pre-existing dormant condition.  The defendants then sought an 
order from the circuit court to examine records relating to 
No. 
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18
Ambrose's health before and after the accident that was the 
subject of the underlying litigation.  Id. at 310. 
¶37 The circuit court granted the defendants' motion and 
ordered the plaintiff to sign a release authorizing disclosure 
to the defendants' attorneys all health care records and 
reports, including records and reports that may have been 
subject to Ambrose's physician-patient privilege.  Id. at 309.  
On appeal, Ambrose argued that the circuit court exceeded its 
discretion under the medical records discovery rule when it 
ordered her to "give carte blanche consent to [the defendants] 
to inspect and copy all of her health care records and reports, 
regardless of their confidential nature and regardless of the 
existence of a physician-patient privilege as to any of the 
records or reports."  Id. at 311.   
¶38 In a nonparty brief filed in support of the Ambrose 
defendants, the Civil Trial Counsel of Wisconsin, Inc. argued 
that 
the 
circuit 
court's 
order 
conformed 
to 
Wis. 
Stat. 
§ 146.82(2)(a)4, the "lawful order of a court" exception also at 
issue in the case at hand.  Ambrose did not dispute that Wis. 
Stat. § 804.10(2) provided an exception to the confidentiality 
of patient health care records set forth in § 146.82(1).  Id. at 
316.  However, the court of appeals determined that the circuit 
court's order was not "lawful" because it was beyond the court's 
discretionary authority under § 804.10(2).  The court of appeals 
concluded that the circuit court had exceeded its discretion 
because the scope of the order would extinguish Ambrose's 
physician-patient privilege as to all health care records.  As a 
No. 
99-0863 
 
 
19
result, the court of appeals determined it would not affirm the 
order of the circuit court based upon § 146.82(2)(a)4.  
¶39 Here, 
the 
circuit 
court 
has 
not 
exceeded 
its 
discretionary 
authority. 
 
We 
have 
determined 
that 
the 
information regarding any assaultive conduct by D.D. is not 
protected 
by 
the 
physician-patient 
privilege. 
 
The 
interrogatories and related request for the production of 
documents at issue in this case do not demand the production of 
more than this unprivileged material.  While it is correct that 
D.D. is not a party to this action, she is not immune from 
providing information that will resolve the controversy.  "The 
well-accepted legal principle, a fundamental tenet of our modern 
legal system, is that the public has a right to every person's 
evidence except for those persons protected by a constitutional, 
common-law, or statutory privilege.  This principle applies to 
all of us——even to the President of the United States."  State 
v. Gilbert, 109 Wis. 2d 501, 505, 326 N.W.2d 744 (1982) (citing 
United States v. Nixon, 418 U.S. 683 (1974); Unites States v. 
Fromme, 405 F.Supp. 578 (E.D. Cal. 1975)) (footnote omitted).   
¶40 Other rules reflect the principle cited in Gilbert.  
For example, pursuant to Wis. Stat. § 804.05(3)(b)4, "[a] 
nonparty deponent may be compelled by subpoena served within 
this state to give a deposition . . . ."  In addition, Wis. 
Stat. § 905.01 states: 
 
Except as provided by or inherent or implicit in 
statute or in rules adopted by the supreme court or 
required by the constitution of the United States or 
Wisconsin, no person has a privilege to: 
No. 
99-0863 
 
 
20
 
(1) Refuse to be a witness; or 
 
(2) Refuse to disclose any matter; or 
 
(3) Refuse to produce any object or writing; 
or 
 
(4) Prevent another from being a witness or 
disclosing 
any 
matter 
or 
producing 
any 
object or writing. 
Further, Wis. Stat. § 804.09, relating to the production of 
documents and things and entry upon land for inspection and 
other purposes, provides:  "(3) Persons not parties. This rule 
does not preclude an independent action against a person not a 
party for production of documents and things and permission to 
enter upon land." 
¶41 These statutory provisions illustrate that a nonparty 
may be required to provide or produce evidence.  In the present 
case, we find that because the information sought by Crawford is 
not privileged, the court's order granting Crawford's motion to 
compel was a lawful order under Wis. Stat. § 146.82(2)(a)4.  
¶42 Finally, we are concerned, as was the court of 
appeals, that the nonparty's privacy rights be protected to the 
extent fully provided by law.  Accordingly, in this case we 
order that all records produced by Care Concepts regarding D.D. 
in response to the interrogatories be initially examined in 
camera by the circuit court for a determination of whether any 
privileged information is potentially at risk of exposure.   
¶43 We conclude that the circuit court properly issued its 
order compelling Care Concepts to answer the interrogatories 
No. 
99-0863 
 
 
21
filed by Crawford.  The information sought pertaining to 
aggressive or assaultive behavior by D.D. is not protected by 
the physician-patient privilege.  Additionally, the order of the 
circuit court on this matter was a lawful order under Wis. Stat. 
§ 146.82(2)(a)4.   
By the Court.—The decision of the court of appeals is 
affirmed, and the cause remanded to the circuit court. 
 
 
 
 
 
 
 
 
 
 
No. 
99-0863 
 
 
1