Opinion ID: 2524957
Heading Depth: 1
Heading Rank: 7

Heading: Constitutional Right to Privacy

Text: Petitioners argue that mandamus is warranted because Judge Anderson's order fails to protect the subject patients' constitutional rights to privacy. The attorney general asserts that the patients' rights are adequately protected by Judge Anderson's order. We discern the possibility for infringement of three federal constitutional privacy interests. The first is the right to maintain the privacy of certain information. See Whalen v. Roe, 429 U.S. 589, 599 n.25, 51 L. Ed. 2d 64, 97 S. Ct. 869 (1977) (right to be let alone is most valued); Eastwood v. Dept. of Corrections of State of Okl., 846 F.2d 627, 631 (10th Cir. 1988) (information regarding personal sexual matters); see also A.L.A. v. West Valley City, 26 F.3d 989, 990 (10th Cir. 1994) (confidential medical information is entitled to constitutional privacy protection); Aid for Women v. Foulston, 2006 WL 218185 (10th Cir.) (minors' right to informational privacy). A second, perhaps related, federal constitutional right to obtain confidential health care has been recognized explicitly by at least the Sixth Circuit. See Gutierrez v. Lynch, 826 F.2d 1534, 1539 (6th Cir. 1987); In re Zuniga, 714 F.2d 632, 642 (6th Cir.), cert. denied Zuniga v. United States, 464 U.S. 983 (1983); see also Mann v. University of Cincinnati, 824 F. Supp. 1190, 1199 (S.D. Ohio 1993) (patients' interest in making decisions vital to their health care may be impaired by unwarranted disclosures). And, as noted in the Mann case out of the Southern District of Ohio, other federal district courts have echoed the Sixth Circuit position. Mann, 824 F. Supp. at 1196 n.2, citing Inmates of New York State with Human Immune Deficiency Virus v. Cuomo, No. 90-CV-252, 1991 WL 16032 (N.D.N.Y. Feb. 7, 1991); Rodriguez v. Coughlin, No. CIV-87-1577E, 1989 WL 59607 (W.D.N.Y. June 5, 1989); Doe v. Meachum, 126 F.R.D. 452 (D. Conn. 1989); Plowman v. United States Dep't of Army, 698 F. Supp. 627, 633 and n.22 (E.D. Va. 1988); Doe v. Coughlin, 697 F. Supp. 1234, 1237 (N.D.N.Y. 1988); Woods v. White, 689 F. Supp. 874, 876 (W.D. Wis. 1988), aff'd 899 F.2d 17 (7th Cir. 1990). See Doe v. City of New York, 15 F.3d 264, 267 (2d Cir. 1994). Compare Borucki v. Ryan, 827 F.2d 836, 840 (1st Cir. 1987) (discussing confidentiality and autonomy aspects of federal constitutional right to privacy: the individual interest in avoiding disclosure of personal matters and the interest in independence in making certain kinds of important decisions); Pesce v. J. Sterling Morton High Sch. Dist., 830 F.2d 789, 796 (7th Cir. 1987) (same); In re Search Warrant, 810 F.2d 67, 71-72 (3d Cir. 1987) (balancing patients' rights to privacy in medical records against government intrusion through warrant directed to physician under investigation for insurance fraud). But see Sherman v. Jones, 258 F. Supp. 2d 440, 442-43 (E.D. Va. 2003) (citing Whalen v. Roe and Fourth Circuit precedent to conclude individual's confidential medical information outside constitutionally protected zone of privacy). The third federal constitutional right at stake, long recognized and protected by the United States Supreme Court, is the fundamental right of a pregnant woman to obtain a lawful abortion without government imposition of an undue burden on that right. See, e.g., Planned Parenthood of Southeastern Pa. v. Casey, 505 U.S. 833, 874-78, 120 L. Ed. 2d 674, 112 S. Ct. 2791 (1992). If inquisition subpoenas for documents related to abortions are not handled sensitively, the fundamental rights of women who may seek abortions in the future could be substantially impaired or the assertion of those rights prevented. We have not previously recognized  and need not recognize in this case despite petitioners' invitation to do so  that such rights also exist under the Kansas Constitution. But we customarily interpret its provisions to echo federal standards. See, e.g., State v. Morris, 255 Kan. 964, 979-81, 880 P.2d 1244 (1994) (double jeopardy provisions of federal, Kansas constitutions co-equal); State v. Schultz, 252 Kan. 819, 824, 850 P.2d 818 (1993) (Section 15 of Kansas Constitution's Bill of Rights identical in scope to Fourth Amendment of federal Constitution); State ex rel. Tomasic v. Kansas City, Kansas Port Authority, 230 Kan. 404, 426, 636 P.2d 760 (1981) (Section 1 of Kansas Constitution's Bill of Rights given same effect as Equal Protection Clause of Fourteenth Amendment of federal Constitution). Regarding petitioners' standing to assert their patients' rights, the United States Supreme Court has held that abortion providers can take such action. Singleton v. Wulff, 428 U.S. 106, 117, 49 L. Ed. 2d 826, 96 S. Ct. 2868 (1976) (physician had standing to assert rights of patients seeking abortions; patient may be chilled from such assertion by a desire to protect the very privacy of her decision from the publicity of a court suit). The Seventh Circuit has followed suit. See Northwest Memorial Hosp. v. Ashcroft, 362 F.3d 923, 928 (7th Cir. 2004) (Department of Justice acknowledgment that hospital-custodian of medical records of women's abortions is appropriate representative of patient's privacy interests). And a panel of the Tenth Circuit has concluded that providers of family planning services have third-party standing to assert their patients' informational privacy rights. Aid for Women v. Foulston, 2006 WL 218185 (10th Cir.). Having identified specific constitutional privacy interests and confirmed petitioners' standing to champion them, we next examine the extent of the State's interest in invading patient privacy. It is beyond dispute that the State has a compelling interest in pursuing criminal investigations. See Branzburg v. Hayes, 408 U.S. 665, 699-701, 33 L. Ed. 2d 626, 92 S. Ct. 2646 (1972). And an individual's right to informational privacy is not necessarily absolute; rather, it is a conditional right which may be infringed upon a showing of proper governmental interest. Planned Parenthood of Southern Arizona v. Lawall, 307 F.3d 783, 790 (9th Cir. 2002) (citing In re Crawford, 194 F.3d 954, 959 [9th Cir. 1999]). Also, the fundamental right to obtain a lawful abortion may be regulated as long as the regulation does not constitute an undue burden. See Casey, 505 U.S. 874-78. Our evaluation necessarily involves weighing of these competing interests, including the type of information requested, the potential harm in disclosure, the adequacy of safeguards to prevent unauthorized disclosure, the need for access, and statutory mandates or public policy considerations. See Lawall, 307 F.3d at 790 (citing United States v. Westinghouse Elec. Corp., 638 F.2d 570, 578 [3rd Cir. 1980]); see also Sheets v. Salt Lake County, 45 F.3d 1383, 1387 (10th Cir. 1995) (disclosure of diary must advance compelling state interest in least intrusive manner). Petitioners contend the attorney general has not shown a compelling need for unredacted patient files. Kline now takes the position that the patients' identifying information may be redacted. Petitioners further assert that it is inconceivable the disclosure of entire patient files would be the least intrusive way to meet a compelling state interest in uncovering noncompliance with the criminal abortion and mandatory child abuse reporting statutes. Petitioners have pointed to the example of the many details of each patient's sexual and contraceptive history that the files are likely to contain but that are equally likely to be irrelevant to the factors required to be considered and documented under the criminal abortion statute. With regard to the child abuse reporting statute, we expect that nearly all information except the identity and age of the male who impregnated the minor patient, his relationship to the minor patient, the circumstances surrounding the sexual intercourse that produced the pregnancy, and compliance or noncompliance with reporting requirements is likely to be irrelevant to Kline's inquiry. The type of information sought by the State here could hardly be more sensitive, or the potential harm to patient privacy posed by disclosure more substantial. Judge Anderson's order does not do all it can to narrow the information gathered or to safeguard that information from unauthorized disclosure once it is in the district court's hands. Although the criminal inquisition statutes do not speak to the need for such narrowing and safeguards, the constitutional dimensions of this case compel them. Under the circumstances of this case, Judge Anderson was correct to hold a closed hearing to allow the parties to address appropriate limitations on disclosure  limitations that strike the necessary balance between patient privacy and government investigation. His order simply failed to incorporate all that the hearing had revealed. We discern three specific errors: First, the judge misstated a critical provision of the criminal abortion statute. The two physicians who must agree that an abortion at 22 weeks' gestational age or later is necessary must do so on the basis that the life of the pregnant woman is endangered or on the basis that continuation of the pregnancy would cause a substantial and irreversible impairment of a major bodily function of the pregnant woman. K.S.A. 65-6703(a). Judge Anderson joined these two bases by the conjunction and rather than the disjunctive or. This misstatement of the law must be corrected lest the attorney general be misled as to the limits of his authority to prosecute. Second, Judge Anderson also stated that presumed flaws in the attorney general's interpretation of the criminal abortion or mandatory child abuse reporting statutes would not prevent production of the files called for in the subpoenas. In essence, this statement adopted senior assistant attorney general Maxwell's position that any error in the attorney general's interpretation was irrelevant. We disagree. To hold otherwise could permit exactly the abuse of prosecutorial power the courts must be vigilant to prevent. To the extent the inquisition rests on the attorney general's ignorance, disregard, or misinterpretation of precedent from the United States Supreme Court, subpoenas pursuant to the inquisition cannot be allowed. For example, the United States Supreme Court has long held, and continues to hold that, in order to be constitutional, state restrictions on abortions must include exceptions to preserve both the life and health of the pregnant woman. See Casey, 505 U.S. at 846 (emphasizing this rule as part of the essential holding of Roe v. Wade, 410 U.S. 113, 35 L. Ed. 2d 147, 93 S. Ct. 705, reh. denied 410 U.S. 959 [1973]); see also Ayotte v. Planned Parenthood of Northern New England, ___ U.S. ___, 2006 WL 119149 (January 18, 2006). Moreover, health has been interpreted by the United States Supreme Court to include the mental or psychological health of the pregnant woman. See Doe v. Bolton, 410 U.S. 179, 191-92, 35 L. Ed. 2d 201, 93 S. Ct. 739 (1973); United States v. Vuitch, 402 U.S. 62, 71-72, 28 L. Ed. 2d 601, 91 S. Ct. 1294 (1971). The attorney general has said he disagrees with requiring an exception to preserve the pregnant woman's mental health. Until the United States Supreme Court or the federal Constitution says otherwise, however, the mental health of the pregnant woman remains a consideration necessary to assure the constitutionality of the Kansas criminal abortion statute. Judge Anderson was not free to decide the subpoenas should issue in the first place or whether the petitioners' motion to quash should be denied without considering the soundness of any legal interpretations on which the attorney general depends. This is true of any district judge who passes on an inquisition application or associated subpoenas. Third, Judge Anderson erred in refusing to allow redaction of patient-identifying information from the files. This information must be redacted by petitioners before the files are turned over to the court. Should patient-identifying information later be required, the district judge may approve appropriate subpoenas for that information at that time. As noted above, Judge Anderson's order also permitted the attorney general to select the physician or physicians who would participate in the initial in camera review of the records. At oral argument, Rucker stated that the attorney general was unwilling to trust doctors employed by or associated with petitioners to participate in this segment of the process. Understandably, petitioners are equally reluctant to have a physician or physicians selected by the attorney general do so. Kline's Motion to Clarify eliminates this issue, however. The attorney general has now explicitly stated that he does not oppose Judge Anderson's appointment of the physician or physicians to be trusted with this task. In sum, Judge Anderson must withdraw his order and first evaluate the inquisition and subpoenas in light of what the attorney general has told him regarding his interpretation of the criminal statutes at issue. If the judge requires additional information in order to perform this evaluation, he should seek it from the attorney general in the inquisition proceeding. As targets of the investigation, petitioners need not be included in any hearing or other communication to enable this evaluation. Only if Judge Anderson is satisfied that the attorney general is on firm legal ground should he permit the inquisition to continue and some version of the subpoenas to remain in effect. Then he also must enter a protective order that sets forth at least the following safeguards: (1) Petitioners' counsel must redact patient-identifying information from the files before they are delivered to the judge under seal; (2) the documents should be reviewed initially in camera by a lawyer and a physician or physicians appointed by the court, who can then advise the court if further redactions should be made to eliminate information unrelated to the legitimate purposes of the inquisition. This review should also determine whether any of the files demonstrate nothing more than the existence of a reasonable medical debate about some aspect of the application of the criminal abortion and/or mandatory child abuse reporting statutes, which the attorney general's office has already acknowledged would not constitute a crime. If so, those files should be returned to petitioners; and (3) any remaining redacted files should be turned over to the attorney general.