Title: Fairfax Hospital v. Curtis
Citation: N/A
Docket Number: 962068
State: Virginia
Issuer: Virginia Supreme Court
Date: October 31, 1997

Present:  Carrico, C.J., Compton, Lacy, Hassell, Keenan, and 
Kinser, JJ., and Whiting, Senior Justice 
 
FAIRFAX HOSPITAL, BY AND THROUGH 
INOVA HEALTH SYSTEM HOSPITALS, INC. 
 
 
OPINION BY JUSTICE LEROY R. HASSELL, SR. 
v.   Record No. 962068         October 31, 1997 
 
PATRICIA CURTIS 
 
 
FROM THE CIRCUIT COURT OF FAIRFAX COUNTY 
 
David T. Stitt, Judge 
 
 
I. 
 
In this appeal we consider, among other things, whether 
a patient has a cause of action against a health care 
provider which voluntarily disseminated the patient's 
medical records to third parties without the patient's 
authorization. 
 
II. 
 
Seeking compensatory and punitive damages, Patricia 
Curtis filed a motion for judgment against INOVA Health 
System Foundation, Inc., Linda Beckett, and Nancy Perrelli 
and another motion for judgment against INOVA Health System 
Hospitals, Inc., which owns and operates Fairfax Hospital.  
Both motions for judgment were consolidated by order of the 
trial court.  As relevant to this appeal, the plaintiff 
alleged in her motions for judgment that the defendants 
improperly disseminated her "private and confidential 
medical records and treatment information" to third persons. 
 
The defendants asserted in a demurrer and plea in bar 
that:  the plaintiff waived any privilege of confidentiality 
in her medical records by filing a medical malpractice 
claim; the plaintiff had not alleged a cause of action 
because she sought damages solely for emotional distress; 
and the plaintiff's claims were barred by the applicable 
statute of limitations.  Overruling the demurrer, the court 
held that the plaintiff had a cause of action against the 
defendants for the unauthorized dissemination of her medical 
records without her consent.  The court also denied the 
defendants' special plea of the statute of limitations.   
 
The litigants stipulated the relevant facts underlying 
this dispute, but disagreed about the application of the 
law.  Consequently, the litigants submitted factual 
statements with exhibits to the trial court and stipulated 
damages.  The trial court entered a judgment on behalf of 
the plaintiff for the amount of the stipulated damages, 
$100,000, and the defendants appeal. 
 
III. 
 
Plaintiff received prenatal care at Fairfax Hospital 
beginning in July 1988.  She was admitted to Fairfax 
Hospital in January 1989, and gave birth to a child, Jessie 
Curtis, on February 13, 1989.  During the course of such 
treatment, she communicated personal information, including 
her medical history, to Fairfax Hospital's employees.   
Jessie later suffered a cardiopulmonary arrest and died. 
 
In March 1990, Patricia Curtis, in her capacity as 
administrator of the estate of Jessie Curtis, filed a notice 
of claim against Fairfax Hospital System, Linda Beckett, and 
others, pursuant to the Virginia Medical Malpractice Act.
1  
Beckett was a nurse in the Hospital's neonatal intensive 
care unit at the time of Jessie's birth.   
 
Following receipt of the notice of claim, Nancy 
Perrelli, INOVA Health System Foundation's Director of Legal 
Affairs, requested that the Hospital provide a complete copy 
of Patricia Curtis' medical records to Gerald R. Walsh, an 
attorney for the Hospital.  Subsequently, Walsh directed 
"that a copy of the medical records be provided to Nurse 
Beckett."  Perrelli complied with Walsh's directive. 
 
The plaintiff's counsel learned during a discovery 
deposition of Beckett that she "had possession of, and had 
reviewed three to four days before the deposition, the 
medical records obtained from Perrelli, pursuant to the 
direction of defense counsel Walsh.  Beckett brought a copy 
of the medical records to the deposition."  The medical 
records contained very personal information about 
plaintiff's medical history before and after her pregnancy 
with Jessie Curtis.   
 
IV. 
 
A. 
 
The defendants, relying upon Pierce v. Caday, 244 Va. 
285, 422 S.E.2d 371 (1992), argue that Virginia does not 
                     
    
1Patricia Curtis, administrator of the estate of Jessie 
Curtis, subsequently filed a motion for judgment against 
Fairfax Hospital and recovered a judgment which was affirmed 
by this Court.  See Fairfax Hosp. Sys., Inc. v. Curtis, 249 
Va. 531, 457 S.E.2d 66 (1995). 
recognize a cause of action against a health care provider 
for the unauthorized disclosure of a patient's medical 
records.  The plaintiff asserts, however, that she does have 
a cause of action against the defendants for the voluntary 
disclosure of her confidential medical records without her 
authorization.  We agree with the plaintiff. 
 
In Pierce v. Caday, a patient filed an action against 
her physician for the physician's alleged failure to assure 
nondisclosure of the patient's confidential information.  
The patient alleged that, even though her physician had 
assured her that certain matters she had discussed with him 
would remain confidential, the physician's employees had 
discussed the confidential information with others.  The 
trial court dismissed the patient's action because, inter 
alia, she had failed to give the physician written notice of 
the claim prior to filing suit, as required by former Code 
§ 8.01-581.2(A) of the Virginia Medical Malpractice Act, and 
her motion for judgment was insufficient in law because it 
failed to state a cause of action. 
 
Declining to decide whether Virginia recognizes a cause 
of action against a health care provider for the wrongful 
disclosure of the patient's medical records and information 
because such issue was not dispositive of our decision in 
Pierce, we stated: 
 
 
"Some courts in other jurisdictions . . . 
have recognized the nonstatutory right of a 
patient to recover damages from a physician for 
unauthorized disclosure of confidential 
communications concerning the patient; other 
courts have refused to create such a cause of 
action. . . .   
 
 
In view of the General Assembly's repeated 
recognition of the privilege, we easily could 
adopt the view that a civil remedy lies in favor 
of a patient against a physician if the physician, 
or anyone under the physician's control, without 
the patient's consent makes an extra-judicial 
disclosure of confidential information obtained in 
the course of the physician-patient 
relationship. . . .   
 
 
But it is unnecessary for us today to 
recognize expressly the existence of such a cause 
of action in Virginia in order to decide this 
case.  Indeed, the issue has not been raised or 
debated, the parties presuming that such a cause 
of action is available.  Therefore, we will assume 
without deciding that such an action will lie." 
 
244 Va. at 290-91, 422 S.E.2d at 373-74 (citations omitted). 
 
In our jurisprudence, a health care provider owes a 
duty of reasonable care to the patient.  Included within 
that duty is the health care provider's obligation to 
preserve the confidentiality of information about the 
patient which was communicated to the health care provider 
or discovered by the health care provider during the course 
of treatment.  Indeed, confidentiality is an integral aspect 
of the relationship between a health care provider and a 
patient and, often, to give the health care provider the 
necessary information to provide proper treatment, the 
patient must reveal the most intimate aspects of his or her 
life to the health care provider during the course of 
treatment.  
 
We hold that in the absence of a statutory command to 
the contrary, or absent a serious danger to the patient or 
others, a health care provider owes a duty to the patient 
not to disclose information gained from the patient during 
the course of treatment without the patient's authorization, 
and that violation of this duty gives rise to an action in 
tort.  We observe that our holding today is consistent with 
decisions of most jurisdictions which have considered this 
issue.  See Horne v. Patton, 287 So.2d 824, 830 (Ala. 1974); 
Alberts v. Devine, 479 N.E.2d 113, 119 (Mass.), cert. 
denied, 474 U.S. 1013 (1985); Simonsen v. Swenson, 177 N.W. 
831, 832 (Neb. 1920); MacDonald v. Clinger, 446 N.Y.S.2d 
801, 804 (N.Y. App. Div. 1982); Humphers v. First Interstate 
Bank, 696 P.2d 527, 535 (Or. 1985); but see Quarles v. 
Sutherland, 389 S.W.2d 249, 252 (Tenn. 1965) (rejecting a 
cause of action in tort for health care provider's 
dissemination of patient's confidential information). 
 
B. 
 
The defendants suggest that even if the plaintiff has a 
cause of action for the wrongful disclosure of her medical 
records, she is not entitled to recover against them because 
she placed her medical condition "at issue" when she filed 
the notice of medical malpractice against the Hospital and 
others to recover damages for the death of her daughter.  
The plaintiff responds that she did not waive her right to 
the confidentiality of her medical records by preparing to 
file, and by later filing, an action against the Hospital 
and others in her capacity as administrator for her deceased 
daughter's estate. 
 
Code § 8.01-399, in effect when the wrongful 
disclosures were made, and which we have described as 
"merely a rule of evidence," Pierce v. Caday, 244 Va. at 
290, 422 S.E.2d at 373, stated: 
 
 
"Except at the request of, or with the 
consent of, the patient, no duly licensed 
practitioner of any branch of the healing arts 
shall be required to testify in any civil action, 
respecting any information which he may have 
acquired in attending, examining or treating the 
patient in a professional capacity if such 
information was necessary to enable him to furnish 
professional care to the patient; provided, 
however, that when the physical or mental 
condition of the patient is at issue in such 
action . . . no fact communicated to, or otherwise 
learned by, such practitioner in connection with 
such attendance, examination or treatment shall be 
privileged and disclosure may be required."  
(Emphasis added). 
 
 
Code § 8.01-399, before amendment in 1993, permitted 
disclosure of information that a patient had conveyed to a 
health care provider when that patient's physical or mental 
condition was at issue in a civil action in certain 
circumstances.  Additionally, the express words contained in 
the aforementioned version of Code § 8.01-399 state that 
"disclosure may be required." 
 
This statute did not automatically compel disclosure of 
a patient's confidential medical information in all 
instances, but permitted a court, in the exercise of its 
discretion, to require disclosure of such information.  We 
hold that if the patient did not manifestly place his or her 
medical condition at issue in a civil proceeding, then the 
statute required a determination by a judicial officer 
whether the patient's condition was at issue in the civil 
action before the health care provider was entitled to 
disseminate the patient's confidential communications to 
third persons. 
 
The notice of claim that the plaintiff forwarded to the 
Hospital and others, in her capacity as administrator of her 
daughter's estate, simply did not manifestly place Curtis' 
medical condition at issue.  Thus, before disseminating such 
information, the Hospital was required, in accordance with 
the aforementioned version of Code § 8.01-399, to obtain 
permission from either a court or the patient.  The 
defendants concede that they unilaterally disseminated the 
plaintiff's confidential medical records to an attorney and 
a nurse without the requisite consent from the patient or 
determination from a judicial officer.
2  
                     
    
2Code § 8.01-399 has been subsequently amended and 
currently states in relevant part: 
 
 
 
"A. Except at the request or with the consent 
of the patient, no duly licensed practitioner of 
any branch of the healing arts shall be required to 
testify in any civil action, respecting any 
information which he may have acquired in 
attending, examining or treating the patient in a 
professional capacity. 
 
 
B.  Notwithstanding subsection A, when the 
physical or mental condition of the patient is at 
issue in a civil action, facts communicated to, or 
otherwise learned by, such practitioner in 
connection with such attendance, examination or 
treatment shall be disclosed but only in discovery 
pursuant to the Rules of Court or through testimony 
at the trial of the action.  In addition, 
disclosure may be ordered when a court, in the 
exercise of sound discretion, deems it necessary to 
the proper administration of justice.  However, no 
disclosure of facts communicated to, or otherwise 
learned by, such practitioner shall occur if the 
court determines, upon the request of the patient, 
that such facts are not relevant to the subject 
matter involved in the pending action or do not 
appear to be reasonably calculated to lead to the 
 
 
C. 
 
The defendants point out that during the subsequent 
medical malpractice panel proceedings, the chairman of the 
panel granted Beckett's motion to depose Curtis over her 
objections because "Patricia Curtis' health is at issue in 
this action, [and] the privilege may not be asserted."  The 
defendants also note that in the civil action styled 
Patricia Curtis, as Administrator for the Estate of Jessie 
Curtis, et al. v. Fairfax Hospital Systems, Inc., the trial 
court ruled that the defendants were entitled to obtain 
Patricia Curtis' medical records from other health care 
providers covering a period of two years before and one year 
after the birth of the deceased infant.  Continuing, the 
defendants assert that these rulings demonstrate that the 
                                                             
discovery of admissible evidence. 
 
. . . .   
 
 
D.  Neither a lawyer, nor anyone acting on the 
lawyer's behalf, shall obtain, in connection with 
pending or threatened litigation, information from 
a practitioner of any branch of the healing arts 
without the consent of the patient except through 
discovery pursuant to the Rules of the Court as 
herein provided. 
 
. . . .   
 
 
F.  Nothing herein shall prevent a duly 
licensed practitioner of the healing arts from 
disclosing any information which he may have 
acquired in attending, examining or treating a 
patient in a professional capacity where such 
disclosure is necessary in connection with the care 
of the patient, the protection or enforcement of 
the practitioner's legal rights including such 
rights with respect to medical malpractice actions, 
or the operations of a health care facility or 
health maintenance organization or in order to 
comply with state or federal law. 
plaintiff's medical condition was at issue and, hence, she 
had no privilege in the disseminated medical records.   
 
The defendants' contentions are not persuasive.  The 
defendants disseminated the plaintiff's medical records 
before the aforementioned rulings of the medical malpractice 
panel and the trial court in the subsequent civil action.  
And, as we have already noted, an independent judicial 
officer, not the Hospital or the director of legal affairs 
for the Hospital's parent company, was the appropriate 
person to make the determination whether Curtis' physical 
condition was at issue. 
 
D. 
 
The defendants contend that a health care provider who 
discloses medical confidences without the patient's consent 
should only be subjected to liability if such disclosure was 
made in a "non-judicial" context.  The defendants say that 
"[i]n Pierce v. Caday, this Court carefully noted that if it 
were to recognize a theory of tort liability against a 
physician for the unauthorized disclosure of medical 
confidences, such an action would be limited to 'extra-
judicial' disclosures."   
 
As we have already demonstrated, the defendants' 
assertion is without merit because in Pierce we did not 
consider whether we would recognize a cause of action for 
the wrongful dissemination of a patient's medical 
information; nor did we articulate what limitations, if any, 
we would place upon such cause of action.  Furthermore, the 
disclosure of the plaintiff's confidential information in 
this case did constitute an "extra-judicial disclosure."  
Here, the Hospital's director of legal affairs made a 
unilateral decision to disseminate the plaintiff's medical 
records to the Hospital's attorney and a nurse without a 
judicial determination that the plaintiff's physical 
condition was at issue and without the determination that 
disclosure of those records was required. 
 
V. 
 
The defendants assert that the trial court erred by 
ruling that the plaintiff was entitled to recover for 
emotional distress caused by the defendants' negligent acts. 
 We disagree.   
 
As a general rule, in tort cases, absent accompanying 
physical harm or wanton and willful conduct, emotional 
distress damages are not recoverable.  Carstensen v. 
Chrisland Corp., 247 Va. 433, 446, 442 S.E.2d 660, 668 
(1994)
3; Sea-Land Serv., Inc. v. O'Neal, 224 Va. 343, 354, 
297 S.E.2d 647, 653 (1982); Womack v. Eldridge, 215 Va. 338, 
340, 210 S.E.2d 145, 147 (1974).  However, as we noted in 
                     
    
3Contrary to the defendants' assertions, the plaintiff's 
claim is unlike the claims we considered in Carstensen v. 
Chrisland Corp.  There, the plaintiffs alleged, among other 
things, that they experienced humiliation, embarrassment, 
anger, frustration, and emotional distress because of a title 
insurance company's breach of its alleged fiduciary duty to 
them.  Approving the trial court's judgment which dismissed 
the plaintiffs' claims, we held that the plaintiffs failed to 
identify an exception to the general rule which would have 
permitted them to recover emotional distress damages.  247 
Va. at 445-46, 442 S.E.2d at 667-68. 
Sea-Land, there are exceptions to this general rule:  "[W]e 
have approved the recovery of damages for humiliation, 
embarrassment, and similar harm to feelings, although 
unaccompanied by actual physical injury, where a cause of 
action existed independently of such harm."  224 Va. at 354, 
297 S.E.2d at 653.   
 
Here, we are of opinion that the plaintiff's cause of 
action falls within the exception to the general rule 
because her cause of action is independent of the 
humiliation, embarrassment, and harm to feelings that she 
suffered.  Without question, a patient, whose intimate 
personal medical information is wrongfully disseminated to 
third parties, will experience some degree of humiliation, 
embarrassment, and hurt.  Under these circumstances, we 
perceive no logical reason to refuse recovery of emotional 
distress damages. 
 
VI. 
 
The defendants argue that the trial court erred by 
failing to grant their motion for summary judgment which 
asserted that the plaintiff's claims are barred by the two-
year statute of limitations contained in Code § 8.01-
243(A).
4  The defendants state that the trial court 
"concluded that the claims were subject to a two-year 
                     
    
4Code § 8.01-243(A) states in relevant part:  "Unless 
otherwise provided in this section or by other statute, every 
action for personal injuries, whatever the theory of recovery 
. . . shall be brought within two years after the cause of 
action accrues." 
limitations period which accrued on March 7, 1990. . . .  
Since the case at bar was not filed until February 4, 1994, 
Plaintiff's claims would be barred by limitations, but for 
the Court's conclusion that the filing of the wrongful death 
claim in November 1991 tolled the statute until the entry of 
a final order, which followed commencement of the instant 
actions."  Responding, the plaintiff argues that the 
defendants are precluded from raising this issue on appeal 
because they failed to raise it in the trial court.  We 
agree with the plaintiff. 
 
As we have already stated, the plaintiff filed two 
separate motions for judgment against the defendant, and, 
the second motion, styled Patricia Curtis, Plaintiff v. 
Fairfax Hospital, by and through INOVA Health System 
Hospitals, Inc., contained a count captioned "Count I:  
Medical Malpractice."  The plaintiff alleged in that count 
that the defendant, Fairfax Hospital, breached the 
applicable standard of care owed to her by disseminating her 
medical records without her authorization.   
 
The defendants filed a motion for summary judgment 
raising the statute of limitations defense.  The defendants 
stated in their motion:  "[d]efendants, Inova Health System 
Foundation, Inc., Nancy Perrelli, and Fairfax Hospital by 
and through Inova Health System Hospitals, Inc., . . . move 
this Court . . . for entry of Summary Judgment with respect 
to Count III (Conspiracy to Commit Malpractice) and Count V 
(Punitive Damages)."  The defendants' "Memorandum of Points 
and Authorities in Support of Motion for Summary Judgment" 
asserted that the plaintiff's claims of conspiracy were 
barred by the two-year statute of limitations contained in 
Code § 8.01-243(A). 
 
The trial court's opinion letter, which explained the 
court's rationale for denying the defendants' motion for 
summary judgment states:  "[t]he defendants move now for 
summary judgment as to Count III (conspiracy to commit 
malpractice) and Count V (punitive damages), in support of 
which they claim that the statute of limitations bars the 
action. . . ."  The trial court's order, denying the motion 
for judgment, incorporated its opinion letter by reference. 
 The defendants filed a motion for reconsideration which 
stated:  "[d]efendants, Inova Health System Foundation, 
Inc., Nancy Perrelli, and Fairfax Hospital . . . 
respectfully move this Court for reconsideration of its 
Order denying defendants' Motion for Summary Judgment with 
respect to Count III (Conspiracy to Commit Malpractice) and 
Count V (Punitive Damages)."   
 
The defendants did not request, and the trial court did 
not make, a ruling on the issue whether the plaintiff's 
cause of action for negligence in Count I of her motion for 
judgment was barred by the statute of limitations.  And, on 
the morning of trial, the plaintiff took a voluntary non-
suit of her purported claim of conspiracy to commit 
malpractice.  The defendants' statute of limitations defense 
was limited to the plaintiff's claim of conspiracy to commit 
malpractice, and the statute of limitations defense was not 
asserted against the plaintiff's negligence claim.  Hence, 
the defendants may not, for the first time on appeal, assert 
the statute of limitations defense to bar the plaintiff's 
negligence action.  Rule 5:25.   
 
VII. 
 
In view of the foregoing, we will affirm the judgment 
of the trial court. 
 
Affirmed.