Opinion ID: 1281880
Heading Depth: 3
Heading Rank: 1

Heading: Statements to Psychiatrist.

Text: The rule only protects from disclosure a confidential communication, defined as a communication not intended to be disclosed to third persons. OEC 504(1)(a). The identical language in FRE 504 has been construed to focus on the patient's intent. See, e.g., Lora v. Bd. of Ed. of City of New York, 74 F.R.D. 565 (E.D.N.Y. 1977), where the privilege was held not to apply to diagnostic and referral files of emotionally handicapped students because it was unlikely that the students or their families expected privacy, and third parties had access to the data. [I]f a patient makes a communication expecting it to be disclosed, the privilege ceases. 2 Weinstein & Berger, Weinstein's Evidence, § 504[05], 504-21 (1985). [4] Whether there is an intent to avoid disclosure may be inferred from the circumstances. For example, a communication made in public or intended to be relayed to outsiders would not be considered confidential. [5] The communication must also be made for the purposes of diagnosis or treatment. OEC 504(2). The purpose of the communication may be inferred from the surrounding circumstances. A patient's reasonable belief that the communication is being made for the purposes of diagnosis or treatment will suffice. This point is more fully discussed infra. The definition of a psychotherapist in OEC 504(1)(c) has two parts. The person must be both lawfully authorized to engage in diagnosis or treatment of the patient's mental or emotional condition (or reasonably believed by the patient so to be) and be so engaged when the communication which is intended to be kept confidential is made. The trial court and four judges on the Court of Appeals seem to have concluded that defendant could not be a patient and invoke the privilege until a psychotherapist-patient relationship had been established that had been agreed upon by both sides. They considered controlling the fact that defendant had not previously been a patient at the hospital, that the psychiatrist did not anticipate an ongoing psychotherapist-patient relationship to develop, and that she testified she was not actually diagnosing or treating defendant, but only keeping him on the telephone line until the police arrived. A previously established psychotherapist-patient relationship is not required before the privilege can be invoked. In State v. O'Neill, 274 Or. 59, 545 P.2d 97 (1976), for example, this court held that the physician-patient privilege was applicable where the defendant was brought for the first time to a hospital crisis unit for observation and treatment. The evidence of a privileged relationship was in one sense even weaker than in this case because in O'Neill the defendant was forcibly taken into custody by the police at the request of his mother and brought to the hospital. He did not voluntarily seek treatment or intend to enter into a privileged relationship, as was apparently done here. Nothing in the legislative history of OEC 504 or proposed FRE 504 suggests that the phrase while so engaged should be limited to a contractual or employment relationship. It is likely that the requirement that a psychotherapist be engaged in diagnosis or treatment was intended to exclude communications to licensed mental health professionals engaged in non-clinical work, such as scientific research or teaching. The Legislative Commentary to OEC 504 states: The definition of `patient' in Rule 504 and 504-1 does not include a person submitting to examination for scientific purposes. This limitation agrees with the current Oregon requirement that a physician be consulted for treatment in order that the physician-patient privilege attach. State v. O'Neill, 274 Or 59, 545 P.2d 97 (1976). Kirkpatrick, supra, at 156. (Emphasis supplied.) Similarly, proposed FRE 504 does not [apply] when a person consults a psychologist engaged in advertising, market research and the like. 2 Weinstein & Berger, supra, at 504-21. [6] In light of the policy behind the rule and its similarity to the attorney-client privilege, we conclude that the psychotherapist-patient privilege protects communications made in an initial conference for the purpose of establishing a psychotherapist-patient relationship, even if such a relationship is never actually formed. The psychotherapist-patient privilege necessarily includes communications made in the course of diagnostic interviews and examinations which might reasonably lead to psychotherapy. Allred v. State, 554 P.2d 411, 420 (Alaska 1976). This is required to encourage patients to discuss frankly and freely their mental or emotional problems so that the professional can accurately determine whether he or she is qualified to treat them. If information revealed during the initial conference indicates to either party that an ongoing professional relationship should not be formed, the confidences revealed in the initial consultation are protected nevertheless. This is not to say, however, that a prospective patient who meets a person known to be a psychotherapist in a supermarket and immediately makes an unsolicited confession can claim the privilege solely because the patient intends the communication to be confidential and hopes to receive diagnosis or treatment. In order for statements made in an initial encounter to be covered by the privilege, the psychotherapist and patient must agree, or at least reasonably appear to agree, that they intend to establish a psychotherapist-patient relationship. There must be some indication from the psychotherapist that he or she is willing to embark upon such a relationship. An indication of this intent may be inferred from the circumstances. It might come from the setting alone. For example, if a prospective patient talks to a licensed psychotherapist in a professional practice setting, such as a mental health clinic or a private practice office, the patient could fairly infer that the psychotherapist has indicated a willingness to enter into a confidential relationship. The requisite willingness could also be shown by the psychotherapist's behavior, apart from the setting. If the prospective client in the above-stated supermarket example is assured by the psychotherapist that his statements will be kept confidential and is questioned about his problem, then the therapist has reasonably indicated a willingness to enter into a psychotherapist-patient relationship, and the privilege attaches when the first words are spoken. Where a psychotherapist has given reasonable assurances to the patient that they are embarking upon a privileged relationship, an ulterior motive or purpose on the part of the psychotherapist will not prevent the patient from claiming the privilege. We agree with Judge Richardson's dissent in the Court of Appeals:    [T]he relevant point is not why she [the psychiatrist] spoke with him, but whether the substance of the conversation came within the privilege defined by OEC 504. This was not a situation in which the psychiatrist told defendant that she did not understand their conversation to be related to her professional role, or one in which she listened in silence while defendant spoke, or even one in which she simply engaged in polite chatter and offered comforting reassurances. She spoke with defendant in the basic way she would speak with a patient in a diagnostic or treating situation. State v. Miller, supra, 67 Or. App. at 651, 680 P.2d 676. (Emphasis in original.) Some courts facing similar situations have held that the physician-patient relationship is created by implication, for purposes of the privilege, when a physician attempts to testify as to information acquired from the patient on the ground that he never actually treated the patient, but only examined the patient for another purpose of which the patient was not aware. For example, in Ballard v. Yellow Cab Co., 20 Wash.2d 67, 145 P.2d 1019 (1944), a person was injured by a taxicab and taken to a public hospital, where she submitted to an examination by a physician without knowing that the examination was being made for the taxicab company. The Washington Supreme Court said that the injured woman, by submitting to the examination, to all intents and purposes became his patient and could claim the privilege. That court said: It is not necessary in order to create the relation of physician and patient that he should actually treat the patient. If he makes an examination of the patient, with her knowledge and consent, she believing that the examination is being made for the purpose of treating her, then the relation is created by implication, and it is wholly immaterial what the secret object or purpose of the physician was in making it;    if such a thing as that could be done, then the privilege accorded the patient could be taken from her by trick or fraud.  20 Wash.2d at 72, 145 P.2d 1019, quoting from Smart v. Kansas City, 208 Mo. 162, 192, 105 S.W. 709 (1907). (Emphasis supplied.) See also Arizona & N.M. Ry. Co. v. Clark, 207 Fed. 817 (9th Cir.1913); State v. Steelman, 120 Ariz. 1213, 585 P.2d 1213 (1978) (stating that where a patient is examined believing the purpose to be treatment, the patient has a right to rely upon the confidence imposed in the physician); People v. Decina, 2 N.Y.2d 133, 157 N.Y.S.2d 558, 138 N.E.2d 799 (1956) (stating that whether or not a physician-patient relationship exists does not depend upon whether actual treatment was undertaken; it exists when a patient could reasonably have regarded the physician as acting in a professional capacity). Thus, where a patient consults a psychotherapist for professional assistance for a mental or emotional problem and reasonably believes that the psychotherapist is willing to embark upon a professional relationship, the fact that the psychotherapist has a secret ulterior purpose for the interview or examination will not prevent the patient from claiming the privilege as to confidential communications. To hold otherwise would effectively transfer the privilege from the patient (who holds it under OEC 504(3)) to the psychotherapist. Such a shift is not supported by the language of the rule, its underlying policy, or caselaw. Turning to the facts of this case, defendant herein specifically requested, and was assured of, confidentiality. Only then did he divulge his true name. This is a clear indication that defendant intended his conversation with the psychiatrist to be confidential. At his brother's suggestion, defendant telephoned Dammasch State Hospital and asked to speak to a doctor. He was described as distraught and depressed. No one has disputed that he was seeking professional assistance for his emotional condition. He talked to a psychiatrist for 10 or 15 minutes, until the conversation was interrupted by the police officer removing him from the telephone booth. During this conversation the psychiatrist did not engage in small talk or idle chatter. She testified that she spoke to defendant and questioned him in much the same way she would have in a psychiatric interview. Based upon these facts, the only reasonable conclusion is that defendant reasonably believed that the communication was made for the purposes of diagnosis or treatment. We also conclude that, if Dr. Saville was a psychotherapist within the meaning of the rule, then defendant was a patient under OEC 504(1)(b), because he both consulted and was interviewed by her. Dr. Saville was a licensed psychiatrist, authorized by statute to engage in the diagnosis or treatment of a mental or emotional condition. The only dispute concerns whether she was so engaged while she was talking to defendant by telephone. She was the psychiatrist on duty at Dammasch State Hospital, a professional practice setting. [7] She assured defendant of confidentiality and questioned him about his problem in the usual way that clinical interviews, as necessary precursors to diagnosis and treatment, are conducted. Although they had no prior psychotherapist-patient relationship and she testified that she did not anticipate forming one, it was not disputed that she led defendant reasonably to believe that she was willing to embark upon such a relationship. The fact that she had an ulterior purpose (keeping defendant on the telephone line until the police came) does not prevent him from claiming the privilege. We thus hold that defendant's statements to Dr. Saville were covered by the psychotherapist-patient privilege and should not have been admitted into evidence.