Source: http://jaffee-redmond.org/briefs/bierenbaumbrief.htm
Timestamp: 2019-04-24 10:08:50+00:00

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NEW YORK STATE PSYCHIATRIC ASSOCIATION, INC.
This brief is submitted by the proposed amici New York State Psychiatric Association, Inc. and American Psychoanalytic Association with regard to two questions apparently raised in this proceeding that involve the confidentiality of medical records pertaining to defendant Robert Bierenbaum and statements made by the defendant to psychiatrists Michael Stone, M.D., Stanley Bone, M.D., and Carl Kleban, M.D., during treatment and consultation sessions with those psychiatrists.
1) Was the psychotherapist-patient privilege under CPLR Section 4504 barring disclosure of all medical records and statements made by the defendant to Drs. Stone, Bone and Kleban in their professional relationships waived for any and all purposes because the defendant discussed his marital problems, medical care and/or marital counseling with third parties?
2) Was the psychotherapist-patient privilege under CPLR Section 4504 barring disclosure of all medical records and statements made by the defendant to Drs. Stone, Bone and Kleban in their professional relationships waived or otherwise overriden for any and all purposes because Dr. Stone gave warnings to the defendant's wife and parents during or after his treatment and consultation with the defendant?
The American Psychoanalytic Association (APsaA) is a national professional organization of psychoanalysts practicing in the United States. ApsaA is comprised of 40 affiliate societies and 29 psychoanalytic training institutes and has approximately 3,000 members. ApsaA is also a regional association of the International Psychoanalytic Association. ApsaA has participated as an amicus curiae in Jaffee v. Redmond, 518 U.S. 1 (1996), the landmark case regarding the psychotherapist-patient privilege.
The issues involved are of considerable interest to psychiatrists and psychoanalysts since these issues directly affect the duty of confidentiality and the expectation of patients that confidences related to psychiatrists and psychoanalysts in their professional capacity will remain confidential and privileged except in certain narrow and limited circumstances.
The issues discussed in this brief are framed by positions taken by the District Attorney in previous proceedings.
Previously, the District Attorney issued a subpoena requiring Stanley Bone, M.D., the defendant's psychiatrist, to testify before the Grand Jury and produce certain records pertaining to his treatment of the defendant. Dr. Bone sought to quash the subpoena. In response to Dr. Bone's motion, the District Attorney argued that the defendant had waived his psychotherapist-patient privilege with Dr. Bone because the defendant had discussed his marital difficulties and marital counseling with third parties.(1) See Affirmation of Assistant District Attorney Daniel L. Bibb, dated September 1, 1999.
Consequently, NYSPA and APsaA, as amici curiae, submit this brief on the issues outlined above. In summary, it is the position of the amici that the defendant's communications with third parties about his marital difficulties and marital counseling do not constitute a waiver of his psychotherapist-patient privilege and that Dr. Stone's warnings given 17 years ago do not waive or abrogate the defendant's physician-patient privilege at all, much less on all communications with all physicians for all time, where there is no current threat of imminent harm.
DEFENDANT DID NOT WAIVE HIS PSYCHOTHERAPIST-PATIENT PRIVILEGE BY DISCUSSING HIS MARITAL DIFFICULTIES WITH THIRD PARTIES.
The psychotherapist-patient privilege precludes a physician from revealing "any information which he acquired in attending a patient in a professional capacity, and which was necessary to enable him to act in that capacity." CPLR Section 4504(a); see People v. Sinski, 88 N.Y.2d 487, 491 (1996). It protects both communications and medical records. Williams v. Roosevelt Hospital, 66 N.Y.2d 391 (1985). The privilege is personal to the patient but may be asserted by the treating physician or custodian of the patient's records in the absence of a waiver by the patient. Cynthia B. v. New Rochelle Hosp. Med. Ctr., 60 N.Y.2d 452 (1983).
The rationale of the privilege is to encourage uninhibited communications between physicians and their patients for the purpose of securing appropriate treatment. In the Matter of a Grand Jury Investigation of Onondaga County, 59 N.Y.2d 130 (1983). By guaranteeing confidentiality, the privilege shields patients from humiliation, embarrassment and disgrace. Farrow v. Allen, 194 A.D.2d 40, 43 (1st Dept. 1993). Medical treatment rendered by mental health professionals particularly requires confidentiality "because the very nature of psychiatric treatment renders privacy essential." Id.
The District Attorney is seeking medical records and testimony from psychiatrists relating to their consultations with and treatment of the defendant. The sole purpose of these communications was to enable the psychiatrists to render effective medical treatment to the defendant, or to determine what treatment (if any) was needed and from whom it most appropriately could be received. Because there is no evidence that the defendant has effected a waiver, the medical records and testimony sought by the District Attorney are privileged.
The District Attorney has taken the position that the defendant waived his physician-patient privilege because he allegedly informed several third parties of his marital difficulties and that he was seeking therapy related to his marital problems. That position is supported in neither reason nor precedent. The fact that defendant was receiving treatment is not privileged in the first place, so its disclosure to third parties cannot waive anything. And the disclosure to third parties of the general reason for the physician visits - marital issues - cannot possibly waive the privilege as to the detailed communications during those visits.
It is well settled that the fact of treatment, i.e., the fact that a certain physician provided medical care to a certain patient, is not privileged. Klein v. Levin, 242 A.D.2d 682 (2d Dept. 1997). Therefore, the disclosure by a patient to third parties of the fact of treatment does not constitute a waiver of the physician-patient privilege.
Importantly, this is not a case where a patient is trying to use the privilege not as a shield but to sharpen his own sword. That situation arises when a patient makes a selective disclosure for his own advantage and then tries to bar the more complete disclosure that is necessary in order to ensure that his selection of information is not misleading. In other words, there is no basis in this case for finding waiver in the need to ensure fairness and completeness after a partial disclosure is made.
With no such justification present, a finding of waiver here would have ludicrously broad and unjustified consequences. Individuals who see physicians or other therapists for marital problems, and do not hide from friends or relatives the fact that they are doing so, would lose the protection of the privilege as to all the details disclosed in the therapy. More generally, individuals who see physicians or therapists and mention the general reason to some friend or relative - work related problems, family problems, etc. - would suddenly lose the cloak of secrecy surrounding all the details of those problems. The difference between disclosing general topics (e.g., marital problems) and disclosing details of communications (e.g., adultery, impotence, etc.) is gargantuan. With fewer and fewer individuals ashamed to admit (to friends or relatives) the fact of therapy and even some general reason, there would be few cases where any privilege would survive under the District Attorney's rule.
DR. STONE'S WARNINGS TO THE DEFENDANT'S WIFE AND PARENTS DID NOT CONSTITUTE A WAIVER OR ABROGATION OF ALL COMMUNICATIONS BETWEEN THE DEFENDANT AND HIS PHYSICIANS FOR ANY AND ALL PURPOSES.
The District Attorney appears to argue that Dr. Stone's 1983 warnings to the defendant's wife and parents after his treatment and consultations with the defendant waived or overrode, for any and all purposes the defendant's psychotherapist-patient privilege under CPLR Section 4504. That section states the New York legislature's rule barring disclosure of all medical records and statements made by the defendant to any physician in a professional relationship. Amici submit that the privilege survives in this case for undisclosed communications. First, the privilege applies to "consultations" as well as "treatment." Second, Dr. Stone's actions, which logically cannot be a waiver (the privilege is not his to waive), do not justify an abrogation of the statutory privilege: the danger that justified Dr. Stone's limited 1983 disclosure has ceased, and with no present danger, the current disclosure of psychiatrist-patient communications serves no beneficial purpose and can only serve to discourage patients from seeking assistance from psychiatrists and communicating their problems. Third, there does not appear to be a basis for finding that defendant, to whom the privilege belongs and who is not making unfair use of selective disclosures, has waived it. Therefore, as the disclosure of the defendant's physician-patient communications serves no salutary purpose at this time, this Court should honor the defendant's right to privacy of his physician-patient communications and records and preclude disclosure of those communications and records during the upcoming trial.
The District Attorney appears to argue that even if communications in the course of treatment are privileged, communications in the course of "consultations" that do not involve treatment are not privileged. There is no case law to support that view, and the Court of Appeals has held that "in determining whether or not information necessary for treatment is privileged, the question as to whether or not actual treatment is undertaken is not decisive." People v. Decina, 2 N.Y.2d 133, 142 (1956). See also, Oregon v. Miller, 709 P.2d 225, 234 (1985) (discussions between psychotherapist and patient during consultation privileged).
In general, a physician's voluntary disclosures of records and communications obtained during the physician-patient relationship cannot constitute a waiver making otherwise privileged statements admissible. Prink v. Rockefeller Center, Inc., 48 N.Y.2d 309, 314-15 (1979). After all, the privilege belongs to the patient, not to the physician, and only the patient can waive it. Thus, statements made by Dr. Stone about the defendant to third parties cannot waive the defendant's physician-patient privilege as only the defendant had the right to waive that privilege.
If Dr. Stone's 1983 warnings are relevant, therefore, it could only be because they somehow justify an abrogation, or override, of the statutory privilege that plainly covers the still-secret communications made within the relationship with defendant. But no such abrogation can be found, for two reasons. Even without any weighing or balancing, the dispositive fact is that the rationale justifying the 1983 warnings simply does not extend to further disclosures today. And, in any event, any override could not be justified given the well-recognized strength of the need for the privilege.
1. Necessarily starting from the premise that the 1983 warnings were justified (if not, the unjustified disclosures could hardly justify still further disclosures), the District Attorney presumably views the justification for those warnings as being the overriding need to protect known individuals from imminent danger. That justification presumably supplied a defense for Dr. Stone if defendant had tried to enforce Dr. Stone's duty of confidentiality towards him. Cf. Jaffee v. Redmond, 518 U.S. 1, 18, n. 19 (1996). Conceivably, that justification would support not only Dr. Stone's right, but even a duty on his part to have given the warnings. (See, Tarasoff v. Board of Regents, 529 P.2d 553 (Cal. 1974) and 551 P.2d 334 (Cal. 1976)), though the existence of such a duty has not been settled in New York law. Cf. MacDonald v. Clinger, 84 A.D.2d 482 (4th Dept. 1982).(3) What that justification does not do, however, is justify disclosures that cannot any longer serve the purpose of protecting known individuals from imminent dangers.
Disclosure of the long-ago communications at issue in this case cannot today provide that protection and, thus, is simply outside the rationale that must justify the original 1983 warnings. (The District Attorney does not allege or show facts demonstrating that the defendant poses any threat of imminent harm to anyone at this time.) Even if this were a case of pure common law, therefore, this would be a classic case for application of the common law maxim that a rule (here permitted disclosure by the physician to warn of imminent danger to identifiable individuals) extends no further than the reason which supports it. See Lockhard v. Fretwell, 506 U.S. 364, 373 (1993); Dewitt v. Barley and Schoonmaker, 9 N.Y. 371, 375 (1853) ("Cessante ratione legis, cessat et ipsa lex"). That principle is all the stronger in this case. Any abrogation of the privilege in this case is an overriding of an otherwise-clear statutory command.
2. Refusing to broaden the effect of the 1983 warnings beyond its rationale is hardly a matter of formalism. It is necessary to respect the strong policies behind the privilege. The purpose of the physician-patient privilege, as discussed above, is to encourage uninhibited communications between physicians and their patients for the purpose of securing appropriate treatment and to shield patients from humiliation, embarrassment and disgrace. In the Matter of a Grand Jury Investigation of Onondaga County, 59 N.Y.2d 130 (1983).
"Its purpose is to protect those who are required to consult physicians from the disclosure of secrets imparted to them, to protect the relationship of patient and physician, and to prevent physicians from disclosing information which might result in humiliation, embarrassment, or disgrace to patients."
unthinkable, the repressed. To speak of such things to another human being requires an atmosphere of unusual trust, confidence and tolerance. Patients can be helped only if they can form a trusting relationship with a psychiatrist."
"Many physical ailments might be treated with some degree of effectiveness by a doctor whom the patient did not trust, but a psychiatrist must have his patient's confidence or he cannot help him. The psychiatric patient confides more utterly than anyone else in the world. He exposes to the therapist not only what his words directly express; he lays bare his entire self, his dreams, his fantasies, his sins and his shame. Most patients who undergo psychotherapy know that this is what is expected of them, and they cannot get help except on that condition.... It would be too much to expect them to do so if they knew that all they say- all that the psychiatrists learns from what they say- may be revealed to the whole world from the witness stand."
"Among physicians, the psychiatrist has a special need to maintain confidentiality. His capacity to help his patients is completely dependent upon their willingness and ability to talk freely. This makes it difficult if not impossible for him to function without being able to assure his patient of confidentiality and, indeed, privileged communication. Where there may be exceptions to this general rule..., there is wide agreement that confidentiality is the sine qua non for successful psychiatric treatment. The relationship may well be likened to that of the priest-penitent or the lawyer-client. Psychiatrists not only explore the very depths of their patients' conscious, but their unconscious feeling and attitudes as well. . . . A threat to secrecy blocks successful treatment.
Advisory Committee's Notes to Proposed Rules, 56 F.R.D. 183, 242 (1972) (quoting Group for Advancement of Psychiatry, Report No. 45, Confidentiality and Privileged Communication in the Practice of Psychiatry 92 (June 1960))."
The same principles would also hold true in criminal proceedings. In People v. Stritzinger, 34 Cal.3d 505, 521 (1983), Judge Kaus said that "there is obviously something revolting about the spectacle of a psychotherapist testifying to a patient's confidences in a criminal action in which the patient is a defendant."
3. Given the express statutory protection of the privilege, and the strong public policy favoring protection of the confidentiality of statements made by patients to psychotherapists, long-ago warnings cannot justify abrogating the privilege covering still-confidential communications when there is no longer an imminent danger to avert by further disclosure. Relevant precedent supports this straightforward conclusion.
"Although it would be premature to speculate about most future developments in the federal psychotherapist privilege, we do not doubt that there are situations in which the privilege must give way, for example, if a serious threat of harm to the patient or to others can be averted only by means of a disclosure by the therapist."
"The public interest to be served by notifying the police, in most cases, could be achieved by divulging only that information needed to show why a clear and immediate danger is believed to exist. It would rarely justify the full disclosure of the patient's confidences to the police, and never justify a full disclosure of the patient's confidences in open court, long after any possible danger has passed."
There is no apparent basis for finding that defendant actually waived his privilege by (as assumed here) consenting to the warnings given by Dr. Stone in 1983. That consent is irrelevant if, as the District Attorney maintains, the warnings were justified by basic public policy regardless of defendant's consent- so that Dr. Stone had a right or perhaps even a duty, to give them. Certainly, to agree to a disclosure that could not be prevented anyway, as defendant could reasonably assume respecting the 1983 warnings, in no way suggests consent to disclosure of additional communications that can be kept confidential. Moreover, as already, noted, this is not a case of implied waiver. Defendant is not affirmatively making and exploiting a selective disclosure that requires additional disclosure to ensure against unfair and misleading incompleteness.
THIS COURT SHOULD EXCLUDE FROM CONSIDERATION THE MEDICAL RECORDS OF THE DEFENDANT AND STATEMENTS MADE BY THE DEFENDANTS TO HIS PSYCHIATRISTS DURING THE COURSE OF HIS PROFESSIONAL RELATIONSHIPS.
1. The District Attorney has since subpoenaed the records of Carl Kleban, M.D., another psychiatrist who treated the defendant and also seeks Dr. Kleban's appearance at court proceedings. Dr. Kleban has moved to quash the subpoena, and the District Attorney has not yet answered that motion.
confidentiality to a patient not to reveal any information about the treatment of a patient, including non-privileged information such as fact of treatment on a certain date; privileged information such as the course of treatment of the patient; and even privileged information where the patient waived the privilege. The duty of confidentiality is not affected by whether the physician may be compelled to testify on the witness stand about the treatment of his patient.
3. Mental Hygiene Law Section 33.16(c)(6) states, with regard to facilities operated or licensed by the New York State Office of Mental Health, that "nothing in this paragraph shall be construed to impose an obligation upon a treating psychiatrist... to release information about a client who presents a serious or imminent danger to an individual."
5. This strong enunciation of the importance of confidentiality in psychiatric care was cited favorably by the Appellate Division, Fourth Department in MacDonald v. Clinger, 84 A.D.2d 482, 486 (4th Dept. 1982) upholding a patient's right to pursue a cause of action for the unauthorized release of confidential medical information to the patient's wife.
6. Professor Harris in his article noted that the Judicial Advisory Committee that drafted the report relied upon by the United States Supreme Court in Jaffee "deliberately chose not to write a 'future crime' exception into the bill. Its members were persuaded that, as a class, patients willing to express to psychiatrists their intention to commit crime are not ordinarily likely to carry out their intentions. Instead, they are making a plea for help. The very making of these pleas affords the psychiatrist his unique opportunity to work with patients in an attempt to resolve their problems. Such resolutions would be impeded if patients were unable to speak freely for fear of possible disclosure at a later date in a legal proceeding." 74 Wash. L. Rev. at 37.
the contrary, the New York statute is broadly protective. Indeed, when the New York State Legislature has enacted exceptions to privileges or has required mandatory reporting, it has spoken with specific language. See Social Services Law Section 415 (mandatory reporting required in cases of child abuse or maltreatment); Family Court Act Section 1046(a)(vii) (physician-patient privilege does not apply in child protective proceedings.) In contrast, while Mental Hygiene Law Section 33.13(c)(6) states that a psychiatrist in a facility licensed or operated by New York State Office of Mental Health may give a warning to an endangered individual, that statute does not require a psychiatrist to give a warning nor state that there is no privilege attached to the statements that trigger a warning if a psychiatrist chooses to give a warning as in California.

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