Opinion ID: 1708068
Heading Depth: 1
Heading Rank: 4

Heading: Would Disclosure Violate Marsha's Right of Privacy?

Text: Marsha argues here, as she did in the district court, that she has a constitutional right of privacy that would be violated unless she is allowed to keep her communications with Susan privileged and private. In short, she urges that Iowa Code section 258A.6 is unconstitutional as applied to her. A. The right of privacy interest. We have recognized on two occasions that an individual has an interest in avoiding disclosure of personal matters. See Head v. Colloton, 331 N.W.2d 870, 876 (Iowa 1983); accord Chidester, 353 N.W.2d at 853. The interest is referred to as a right of privacy and is constitutionally protected. Colloton, 331 N.W.2d at 876; accord Chidester, 353 N.W.2d at 853. The United States Supreme Court described the components of the privacy interest this way: The cases sometimes characterized as protecting privacy have in fact involved at least two different kinds of interests. One is the individual interest in avoiding disclosure of personal matters, and another is the interest in independence in making certain kinds of important decisions. Whalen v. Roe, 429 U.S. 589, 599-600, 97 S.Ct. 869, 876, 51 L.Ed.2d 64, 73 (1977) (footnotes omitted). The right of privacy is implicit in the Fourteenth Amendment's concept of personal liberty and as such restricts state action. Id. at 599, n. 23, 97 S.Ct. at 876, n. 23, 51 L.Ed.2d at 73, n. 23. B. Extending the right of privacy to professional records of mental health professionals. Though not all courts agree, the majority of them hold that the right of privacy should extend to the patient records of mental health professionals. See In re Zuniga, 714 F.2d 632, 638-39 and n. 3 at 639 (6th Cir.) (citing state and federal jurisdictions that do and do not extend privilege), cert. denied, 464 U.S. 983, 104 S.Ct. 426, 78 L.Ed.2d 361 (1983). We join those courts that extend constitutional protection to such records. Our reasons for doing so are eloquently expressed in the following passage: Psychotherapy probes the core of the patient's personality. The patient's most intimate thoughts and emotions are exposed during the course of the treatment. The psychiatric patient confides [in his therapist] more utterly than anyone else in the world.... [H]e lays bare his entire self, his dreams, his fantasies, his sin, and his shame. The patient's innermost thoughts may be so frightening, embarrassing, shameful or morbid that the patient in therapy will struggle to remain sick, rather than to reveal those thoughts even to himself. The possibility that the psychotherapist could be compelled to reveal those communications to anyone ... can deter persons from seeking needed treatment and destroy treatment in progress. Hawaii Psychiatric Soc'y v. Ariyoshi, 481 F.Supp. 1028, 1039 (D.Haw.1979) (citations omitted) (licensed clinical psychologist and nonprofit corporation made up of 115 psychiatrists sued Hawaii state officials to enjoin enforcement of Hawaii statute authorizing issuance of administrative inspection warrants to search offices and records of Medicaid providers for investigation and prosecution of Medicaid fraud; held that statute was subject to scrutiny under compelling state interests standard). We think both prongs of the right of privacy interest extend to the records of the mental health professional. A patient has an interest in avoiding disclosure of these records because of the obvious personal and intimate information contained in them. The patient also has an interest in keeping independent the patient's choice to seek the help of mental health professionals. This is so because in some circles a social stigma still attaches to anyone who merely seeks the help of such professionals. If the patient cannot be assured that the choice to seek help will be kept confidential, that choice is severely limited. The constitutional privacy interest is not, however, absolute. At most it is a qualified rather than an absolute privilege. Chidester, 353 N.W.2d at 853. In determining whether the privilege attaches, we apply a balancing test: The privacy interest must always be weighed against such public interests as the societal need for information, and a compelling need for information may override the privacy interest. Id. The public interest in this case is the board's statutory obligation to police the mental health professions. See generally Iowa Code chs. 147 (regulating professions generally), 154B (regulating practice of psychology), 258A (empowering licensing boards to sanction licensees for improper conduct). C. Necessary showing. Procedurally, we impose the burden on the board to establish the need for intrusion on a person's right of privacy. We have no hesitancy in doing so for two reasons. First, the right is constitutionally protected. Second, we think the statute imposes such a burden. See Iowa Code § 258A.6(3) (Upon proper showing, the district court shall order the person to obey the subpoena....). What showing should the board make to justify intrusion? First, the board should make a minimal showing that the complaint reasonably justifies the issuance of a subpoena in furtherance of the investigation. As one court explained, such a showing will necessarily vary from case to case. It may relate to the reliability of the complainant; it may be shown by the substance of the complaint. Specific detail as to identification of the complainant, some evidence of [the complainant's] good faith or reliability, disclosure of the basis for [the complainant's] knowledge of the substance of the complaint, with dates to establish its currency, and some revelation of the substance of the complaint will normally suffice, but all or most of this data may not be necessary. Sufficient authenticating detail may be found in the complaint itself; if not, it must be independently supplied. Levin v. Murawski, 59 N.Y.2d 35, 42, 449 N.E.2d 730, 733-34, 462 N.Y.S.2d 836, 840 (1983) (recital that state medical board had received a third-party complaint alleging professional misconduct, with no identifying or authenticating detail, was insufficient basis for issuing official subpoena for production of medical records). Second, the board should establish that the records are necessary as evidence in connection with the disciplinary proceeding. This requirement comes right from the statute. See Iowa Code § 258A.6(3) (A subpoena issued under the authority of a licensing board may compel ... the production of professional records ... which are deemed necessary as evidence in connection with a disciplinary proceeding. ) (emphasis added). To make this determination, the district court will necessarily have to review the medical records in camera and determine whether the records are essential to establishing the allegations of the complaint. Relevancy becomes a critical issue here. If the district court determines there is no relationship between the records sought and the allegations of the complaint, that should end the matter. See In re A-85-04-38, 138 Misc.2d 786, 788, 525 N.Y.S.2d 479, 481 (1988) (patient's records held by subsequent treating psychiatrist were insufficiently relevant to investigation of another psychiatrist for professional misconduct and could not be subpoenaed by medical board investigating complaint not initiated by patient; basis for subpoena included no allegations remotely involving records). If the court determines there is such a relationship, it should allow the board access to only those portions of the record that are deemed relevant. In addition, the party subpoenaed should redact from the patient's records all identifying information about the patient before submitting such records to the district court. This requirement is consistent with the statutory provision regarding confidentiality as to a person whose privilege has been involuntarily waived. See Iowa Code § 258A.6(4) (Notwithstanding the provisions of section 17A.19 subsection 6 [requirement that agency transmit original record to district court on appeal of agency decision], if a waiver of privilege has been involuntary and evidence has been received at a disciplinary hearing, the court shall order withheld the identity of the individual whose privilege was waived.). Third, the board should establish that it notified the patient and attempted to obtain an authorization from the patient for release of the records before issuing the subpoena. See Wood v. Superior Court, 166 Cal.App.3d 1138, 1147-48, 212 Cal.Rptr. 811, 820-21 (1985) (in investigating medical propriety of prescribing drugs, medical board must take reasonable steps to notify patient of its proposed examination of patient records and attempt to secure authorization to release records). Fourth, the board should establish that there are adequate safeguards to prevent unauthorized disclosure. See United States v. Westinghouse Elec. Corp., 638 F.2d 570, 578 (3rd Cir.1980) (listing factors to consider in determining whether intrusion into an individual's privacy is justified). Last, the board should establish whether there is an express statutory mandate, articulated public policy, or other recognizable public interest militating toward access. Id. D. The showing here. In fairness to the board and the district court, neither had the benefit of the foregoing analysis. Consequently, the record lacks a substantial showing for the need to enforce the subpoena and intrude on Marsha's right of privacy. For example, there was no showing of the authenticity of the complaint. Nor was there any showing beyond conclusory statements that the records are necessary. In this respect one of the board members testified: Q. In regard to the records sought by the subpoena, did you determinewhy did you determine that those were necessary? A. We have other sources of information that have pointed to the significance of those records in investigating this particular case. .... Q. Are these records relevant to [the contested case pending in regard to ... Todd Hines]? A. I think so, yes. .... Q. In what way are your records relevant to your investigation to your knowledge, your personal knowledge? A. I believe the records are relevant in terms of the time frame that they cover. I believe they're relevant to conclusions that may be drawn about the other psychologist's conduct. .... Q. In what way do those records support the conclusions which you have drawn concerning the conduct of this psychologist? A. I don't know that they support it. I believe that they have information relevant. Q. But you don't know that? A. I don't know that they support it. Q. You don't know what those records relate to? A. I don't know. I haven't seen them. In this connection, the district court made no in camera inspection of Marsha's records to establish their relevancy. The board made no attempt to secure Marsha's authorization for release of the records. Nor did the board attempt to notify her of its intent to subpoena the records. As it turned out, this was not significant because Marsha knew what was happening and was able to resist the board's efforts in court. Iowa Code section 258A.6(4) does provide confidentiality safeguards to prevent public disclosure of the information in Marsha's records. See Iowa Code § 258A.6(4) (statutory language broad enough to prevent disclosure of medical records). Such safeguards, however, are only one factor for a court to consider in the balancing process and should not be controlling. This is so because of the unique personal nature of the records. Mental health practitioner's records may include the patient's most intimate thoughts and emotions, as well as descriptions of conduct that may be embarrassing or illegal. The possibility that those records could be disclosed to anyone, whether it be state officials or the public, is sufficient to constitute an intrusion into the right of privacy.... Hawaii Psychiatric Soc'y, 481 F.Supp. at 1041 (emphasis added). Finally, we acknowledge that there is a recognizable public interest favoring access. As we said, the board has a statutory obligation to police the mental health professions. Apparently, the board is proceeding against Todd because of some alleged conduct between him and Marsha while she was his patient. However, we have no inkling from the record what that alleged conduct was. We can only speculate that the conduct involved a breach of mental health professional ethics. If that is the case, the public interest is the need for the board to have Marsha's records to carry out its statutory duty to police the mental health professions.