Opinion ID: 2402252
Heading Depth: 2
Heading Rank: 1

Heading: The Psychotherapist/Psychologist-Patient Privilege

Text: While not specifically privileged under the common law, communications between a patient and his or her psychotherapist or psychologist are now statutorily privileged. The privilege was created by the legislature and is codified in C.J. § 9-109, which states: Unless otherwise provided, in all judicial, legislative, or administrative proceedings, a patient or the patient's authorized representative has a privilege to refuse to disclose, and to prevent a witness from disclosing: (1) Communications relating to diagnosis or treatment of the patient; or (2) Any information that by its nature would show the existence of a medical record of the diagnosis or treatment. C.J. § 9-109(b) (emphasis added). Petitioner contends that he is a patient as contemplated under the aforesaid subsection (a)(3), which states: `Patient' means a person who communicates or receives services regarding the diagnosis or treatment of his mental or emotional disorder from a psychiatrist, licensed psychologist, or any other person participating directly or vitally with either in rendering those services in consultation with or under direct supervision of a psychiatrist or psychologist. C.J. § 9-109(a)(3). In petitioner's view, the communications made to Ms. Sargeant as a part of the intake medical screening at the time of the prior proceeding on April 9, 2001, were made for diagnosis or treatment and nurse Sargeant qualified as any other person participating directly or vitally in petitioner's diagnosis or treatment. As a consequence of what he deems his status as a patient at the prior intake screening, petitioner argues that his comments to the nurse at that time were privileged and that the court erred in allowing the State to elicit those statements during the subsequent trial for the present offenses for which he was convicted. Petitioner's initial argument is not based upon a reading of C.J. § 9-109, but upon a general overview of Maryland's public policy of providing mental healthcare services to inmates. Petitioner points to the thousands of inmates and parolees who are in need of mental healthcare. He contends that as a result of such a great number of people in need of attention, the State has adopted a policy of providing mental healthcare services for all inmates who need it. This policy, petitioner posits, had its origin in the case of Estelle v. Gamble, 429 U.S. 97, 97 S.Ct. 285, 50 L.Ed.2d 251 (1976); where the Supreme Court of the United States held that the government has an obligation to provide medical care for those whom it is punishing by incarceration. Id. at 103, 97 S.Ct. at 290, 50 L.Ed.2d 251. Furthermore, the United States Court of Appeals for the Fourth Circuit has held that the medical treatment to which inmates are entitled includes mental healthcare services. Bowring v. Godwin, 551 F.2d 44, 47 (1977). Based upon the public policy he proffers exists, petitioner reasons that the communications between an inmate and any nurse or other person interviewing a potential inmate as to health conditions, during all intake screenings must be privileged. He alleges support exists in Maryland Code (1999), § 11-203 of the Correctional Services Article (C.S.), which requires local correctional facilities to provide for the safety, health, and welfare of inmates. The statute requires the local facility to provide (i) food and board, and (ii) any article of comfort that is considered necessary for a sick inmate by the physician attending the inmate. C.S. § 11-203(a). Petitioner also points to COMAR 12.14.04.02(15), which requires local facility managers to have a written policy that includes, inter alia, the identification, housing, treatment, supervision, and referral of a mentally ill inmate. Finally, petitioner states that Montgomery County Code Part 2 § 13-9, which requires the correctional facility to provide a medical examination and access to daily medical or sick call facilities, brings the intake screening within the scope of C.J. § 9-109. The State does not dispute that public policy requires correctional facilities to provide mental healthcare services to inmates. It argues, however, that the intake screening process is not part of the mental health treatment provided by these institutions. We first turn to the meaning of the word patient in C.J. § 9-109. The statute itself provides the definition of patient and, therefore, as we stated earlier, we need not go beyond that language in order to determine petitioner's status. Gilmer, 389 Md. at 667, 887 A.2d at 556. Section 9-109(a)(3), provides the definition of patient as stated supra, and for the purpose of this case, it can be reduced to two specific requirements: First, there must be a communication regarding the diagnosis or treatment of the person's mental or emotional disorder; second, the communication must be with a psychiatrist, licensed psychologist or any other person participating directly or vitally with either in rendering those services in consultation with or under direct supervision of a psychiatrist or psychologist. (Emphasis added.) Our inquiry focuses on the purpose of the communication: Is the exchange between the inmate and the screener regarding diagnosis or treatment? In order to answer this question we look to the purpose of the intake screening. Petitioner argues that the intake screening is an integral part of the inmate's treatment. He relies on the National Commission on Correctional Health Care (NCCHC) Standards for Health in Jails (2003). [5] Montgomery County follows the NCCHC standards. Both petitioner and the State rely on these standards in support of their respective positions. One of the requirements for NCCHC accreditation, which Montgomery County Correctional Facilities has achieved, is that the institution must provide mental healthcare services for all inmates who require them. NCCHC standard J-G-04. NCCHC has also provided guidance on what is required for providing mental healthcare services to inmates. In 1992, it issued a Position Statement, Mental Health Services in Correctional Settings. The statement provided that based upon the decision in Ruiz v. Estelle, 503 F.Supp. 1265, 1339 (S.D.Tex. 1980), rev'd in part, 679 F.2d 1115 (5th Cir.1982), cert. denied, 460 U.S. 1042, 103 S.Ct. 1438, 75 L.Ed.2d 795 (1983), the minimum requirements for mental health services in correctional settings must include:  screening and evaluation to identify those needing mental health care;  a treatment plan for identified problems;  qualified mental health staff sufficient to treat the population;  a health records system;  a suicide prevention and treatment program; and,  the appropriate use of behavior-altering medications. The position letter further provided a standard for mental health evaluations that is very similar to Montgomery County Code Part 2 § 13-9. It requires an inmate examination within fourteen days of admission for evaluation of that inmate's mental healthcare needs. Petitioner asserts that NCCHC standard J-H-02 requires that health records and information must be kept in confidence and that staff must be trained to maintain the confidentiality of inmates' records and information. Furthermore, petitioner contends, NCCHC standard J-A-09 requires that all clinical encounters be conducted in private and must encourage the inmate to participate in subsequent healthcare services. In petitioner's view, the entire process, including the intake screening, is for the purpose of providing mental healthcare services to the inmate and that any communication relating to that process is for the diagnosis or treatment of the inmate. Hence, he asserts, it must be privileged. The State also relies on the NCCHC standards, but it gives them a narrower reading. It points to NCCHC J-E-02 entitled RECEIVING SCREENING, which provides: