Source: s3://data.kl3m.ai/documents/govinfo/USCOURTS/USCOURTS-azd-2_15-cv-00236/USCOURTS-azd-2_15-cv-00236-0/pdf.json

Nature of Suit Code: 362
Nature of Suit: Medical Malpractice
Cause of Action: 28:2671 Federal Tort Claims Act

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 WO

IN THE UNITED STATES DISTRICT COURT

FOR THE DISTRICT OF ARIZONA

Lawrence N. Cherry, et al.,

 Plaintiffs,

vs.

United States of America,

 Defendant.

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No. CV-15-00236-PHX-PGR 

 ORDER

 

 

Pending before the Court is the United States’ Motion for Protective Order

Precluding Disclosure of the Treatment Records Mailed to the Court by St. Luke’s

Behavior Health Center (Doc. 107). Having considered the parties’ memoranda, the

Court finds that the motion should be granted pursuant to Fed.R.Civ.P. 26(c)(1)(A).

This is a medical malpractice action filed against the United States pursuant

to the Federal Tort Claims stemming from treatment plaintiff Lawrence Cherry

received through the Department of Veterans Affairs. Non-party Steven Carbonniere

is a physician assistant employed by the VA who was involved in the plaintiff’s

treatment between January 13, 2010 and February 11, 2011. During his deposition

on August 28, 2015, Mr. Carbonniere testified that he had undergone a five-day

inpatient detoxification program at St. Luke’s Behavior Health Center (“St. Luke’s”)

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The subpoena stated that the produced records should include:

• Copies of complete chart, progress notes and interview notes,

discharge summaries, counseling records, patient substance

abuse history, medication logs, orders, mental health treatment

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in September 2011 for opioid dependence stemming from his chronic back pain. He

further testified that he had been abusing narcotics for maybe six or eight months

prior to September 2011, but that it didn’t become a complusive problem until the

summer of 2011, that he had written narcotic prescriptions for himself using fictitious

names somewhere in the area of January or March 2011 through the late summer

of 2011, and that he was taking oxycodone on a daily basis for probably four or five

months prior to entering the St. Luke’s program. In a declaration, Mr. Carbonniere

stated while at St. Luke’s he underwent a medically assisted detoxification using

methadone and participated in counseling involving both individual and group

sessions.

During Mr. Carbonniere’s deposition, the plaintiffs’ counsel asked him to

release his St. Luke’s medical records and he refused. Three months later, on

November 24, 2015, the plaintiffs’ counsel sent a medical authorization form for Mr.

Carbonniere’s St. Luke’s records to the United States Attorney’s Office, which that

office forwarded to Mr. Carbonniere on November 30, 2015. In a declaration, Mr.

Carbonniere stated that he did not sign the release form because he wanted to

maintain the confidentiality of his St. Luke’s records. Seven month later, on June 22,

2016, the plaintiffs’ counsel, without notice to Mr. Carbonniere, sent a subpoena to

St. Luke’s for “all records concerning the treatment” of Mr. Carbonniere by St. Luke’s

“and any other professionals to whom your facility referred him or from whom you

received records.”1

 The plaintiffs’ counsel gave St. Luke’s until July 13, 2016 in

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records, substance abuse treatment, and/or videotaped

interviews, written documents submitted by patient, laboratory

tests, etc., whether in electronic or other format;

• Billing records and Explanation of Benefits including list of all

healthcare provider and all other related billing/payment

records[.]

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which to produce Mr. Carbonniere’s medical records. Rather than producing the

records to the plaintiffs’ counsel, St. Luke’s, without notifying Mr. Carbonniere, sent

the records directly to the undersigned Judge, with the notation that it had informed

counsel for both sides that it was doing so because “Pt auth not available.” In its

cover letter, dated July 12, 2016, St. Luke’s stated that Mr. Carbonniere’s records

were being sent to the undersigned Judge under seal “as we have not received

authorization from the patient, nor a court order to disclose them to the court.”

Discussion

A. The Subpoena was Untimely

The Court concludes that the United States’ motion should be granted

because the plaintiffs’ subpoena to St. Luke’s was untimely. Pursuant to the Court’s

amendment (Doc. 63), entered on November 17, 2015, to the Scheduling Order

(Doc. 37), the deadline to complete all fact discovery was July 1, 2016. The

Scheduling Order provided in relevant part that “[d]iscovery which cannot be timely

responded to prior to the discovery deadline will be met with disfavor, and could

result in denial of an extension, exclusion of evidence, or the imposition of other

sanctions.” Notwithstanding that the plaintiffs’ counsel knew about Mr.

Carbonniere’s treatment at St. Luke’s no later than August 28, 2015, the plaintiffs’

subpoena to St. Luke’s for his medical records was not issued until June 24, 2016,

just six days before the fact discovery deadline, and had a return date of July 13,

2016, which was twelve days after the discovery deadline. The plaintiffs did not

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seek an extension of the fact discovery deadline and have not provided any

explanation as to why they could not have timely sought the St. Luke’s records.

B. The Subpoena Violates Federal Law

The Court further, and more importantly, concludes that the United States’

motion should be granted because the plaintiff’s subpoena to St. Luke’s was not

sought or issued in compliance with the Health Insurance Portability and

Accountability Act (“HIPAA”), 42 U.S.C. § 1320d et seq., and the pertinent

regulations promulgated pursuant to HIPAA. 

HIPAA governs the dissemination of protected health information, and its

regulations place strict limitations on the ability of heath care providers to release a

patient’s medical records or discuss the patient’s medical history without the express

consent of the patient. The relevant regulation, 45 C.F.R. § 164.512(e), which

provides for disclosures during judicial and administrative procedures, applies to

medical information sought during discovery. Briefly stated, this regulation provides

in relevant part that, in the absence of a court order authorizing the disclosure or the

submission to the court of a request for a qualified protective order covering the

disclosure, neither of which is present here, a patient’s records can only be disclosed

by a healthcare provider in response to a subpoena or discovery request when (1)

that request is accompanied by a written statement by the requesting party

satisfactorily assuring the provider that the requesting party has made a good faith

attempt to provide written notice to the patient, that the notice included sufficient

information about the litigation underlying the request to permit the patient to raise

an objection to the court, that the time for the patient to raise an objection to the

court has elapsed, and that no objection was filed or that any filed objection had

been resolved by the court and the records being sought are consistent with the

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Section 290dd-2(a) provides that

[r]ecords of the identity, diagnosis, prognosis, or treatment of any

patient which are maintained in connection with the performance of

any program or activity relating to substance abuse education,

prevention, training, treatment, rehabilitation, or research, which is

conducted, regulated, or directly or indirectly assisted by any

department or agency of the United States shall, except as provided in

subsection (e) of this section, be confidential and be disclosed only for

the purposes and under the circumstances expressly authorized under

subsection (b) of this section.

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court’s resolution, § 164.512(e)(ii-iii), or (2) in the absence of the receipt of a

satisfactory assurance from the requesting party, that the medical care provider has

made the required reasonable effort to notify the patient about the discovery request

or has sought to obtain a qualified protective order. § 164.512(e)(vi). A review of the

subpoena-related documents submitted to the Court by St. Luke’s and the parties,

which include St. Luke’s cover letter to the Court confirming that it had not received

any authorization from Mr. Carbonniere for the disclosure of his records nor any

court order authorizing their disclosure, and Mr. Carbonniere’s declaration stating

that neither the plaintiffs’ counsel nor St. Luke’s contacted him to indicate that his

records were being sought via subpoena or that they were going to be released to

the Court, persuade the Court that Mr. Carbonniere’s records cannot be disclosed

to the plaintiffs because the regulatory requirements of § 164.512(e) were not met.

 The United States argues for the first time in its reply that Mr. Carbonniere’s

substance abuse treatment records are also protected from disclosure under the

Public Health Service Act “(PHSA”), 42 U.S.C. § 290dd-2(a) and its accompanying

regulations.2

 The United States asserts that St. Luke’s is a “federally assisted

program” for purposes of the PHSA pursuant to 42 C.F.R. § 2.11 because it

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conducts methadone maintenance treatment programs, and pursuant to 42 C.F.R.

§ 2.12(b) because it is licensed to dispense controlled substances as part of its

treatment programs as established by its DEA registration number as a Narcotic

Treatment Program. Assuming that St. Luke’s falls within the purview of the PHSA,

which appears to be the case, then in the absence of Mr. Carbonniere’s consent,

the disclosure of his medical records to the plaintiffs is only permissible “[i]f

authorized by an appropriate order of a court of competent jurisdiction granted after

application showing good cause therefor, including the need to advert a substantial

risk of death or serious bodily harm.” § 290dd-2(b)(2)(C). Nothing in the record of

this action establishes that the plaintiffs made any effort to comply with the PHSA,

or its relevant regulation governing the application for a court order of disclosure, 42

C.F.R. § 2.64, before sending its subpoena to St. Luke’s.

C. Psychotherapist-Patient Privilege

The United States primarily argues that the involuntary disclosure of Mr.

Carbonniere’s medical records from St. Luke’s is barred by the federal

psychotherapist-patient privilege. The Court agrees with the United States that this

privilege constitutes yet another reason to grant its Rule 26(c) motion.

First, the Court is unpersuaded by the plaintiffs’ contention that the United

States does not have standing to assert the privilege on behalf of Mr. Carbonniere.

As a party to this action, the United States has the right to move for a protective

order pursuant to Rule 26(c)(1) on the ground that the medical records sought by the

plaintiffs are privileged and thus outside the scope of discovery permitted by Rule

26(b)(1).

Second, the Court disagrees with the plaintiffs’ contention that Mr.

Carbonniere’s records do not fall within the scope of the privilege. The Supreme

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As the Supreme Court noted in Jaffe, Arizona has a similar statutory

privilege barring the disclosure of confidential communications made to a licensed

“behavior health professional” absent the waiver of the privilege by the client. A.R.S.

§ 32-3283.

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Court has recognized an absolute psychotherapist-patient privilege for confidential

communications made to licensed psychiatrists, psychologists, and social workers

in the course of psychotherapy diagnosis and treatment. Jaffee v. Redmond, 518

U.S.1, 15 (1996).3

 The Ninth Circuit has expanded this privilege to cover confidential

communications made to unlicensed counselors and representatives involved in

psychotherapeutic treatment undertaken through employee assistance programs.

Oleszko v. State Compensation Insurance Fund, 243 F.3d 1154, 1158-59 (9th Cir.

2001). Mr. Carbonniere has stated in a declaration that his treatment at St. Luke’s

included participation in individual and group counseling for his addiction, and the

Court’s in camera review of the medical records confirm that Mr. Carbonniere

underwent psychotherapy-related treatment at St. Luke’s.

Third, the Court also disagrees with the plaintiffs’ contention that Mr.

Carbonniere waived his psychotherapist-patient privilege by testifying at his

deposition that he had undergone a detoxification program at St. Luke’s for his

opiate addiction. No legally sufficient waiver has been established by the plaintiffs

since nothing in the submitted portions of Mr. Carbonniere’s deposition show that he

testified about any confidential communications he had with St. Luke’s personnel

that were made during the course of his treatment at St. Luke’s. 

Although the Court agrees with the United States that Mr. Carbonniere’s

medical records from St. Luke’s cannot be produced to the plaintiffs, or to anyone

else, the Court cannot agree with the United States’ request in its motion that the

records either be returned to St. Luke’s or be destroyed by the Court. Since the

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undersigned Judge has reviewed the records in camera, the Court must retain the

records for any future appellate review. To that end, the Court will place the records

in a sealed envelope and will have the Clerk of the Court file that envelope under

seal. The actual medical records will not be viewed by any Clerk’s Office personnel.

Therefore,

IT IS ORDERED that the United States’ Motion for Protective Order

Precluding Disclosure of the Treatment Records Mailed to the Court by St. Luke’s

Behavior Health Center (Doc. 107) is granted pursuant to Fed.R.Civ.P. 26(c)(1)(A)

and that the Court forbids the disclosure of the medical records of non-party Steven

Carbonniere submitted to the Court by St. Luke’s Behavior Health Center pursuant

to the plaintiffs’ subpoena duces tecum.

IT IS FURTHER ORDERED that the medical records of non-party Steven

Carbonniere submitted to the Court by St. Luke’s Behavior Health Center are to be

placed in a sealed envelope and that envelope, which is not to be opened for

docketing purposes, shall be filed by the Clerk of the Court UNDER SEAL.

DATED this 31st day of August, 2016.

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