Opinion ID: 2328477
Heading Depth: 1
Heading Rank: 2

Heading: Confidential Physician-Patient Relationship

Text: The tort of breach of the confidential physician-patient relationship was first recognized in this jurisdiction in the leading case of Vassiliades v. Garfinckel's, Brooks Bros., Miller & Rhoades, Inc., 492 A.2d 580, 591-92 (D.C.1985). The tort reflects the strong public policy in the District of Columbia to encourage candor by patients and confidentiality by physicians. Id. at 591 (noting that such a public policy is reflected in the District's statutory privilege that prevents physicians from testifying about their patients' medical conditions without their consent as well as certain licensing statutes). [1] To be actionable, a claim for breach of the confidential physician-patient relationship requires the unconsented, unprivileged disclosure to a third party of nonpublic information that the defendant has learned within a confidential relationship. Doe v. Medlantic Health Care Group, Inc., 814 A.2d 939, 950-51 (D.C.2003) (citing Vassiliades, 492 A.2d at 591). [2] The critical question in this appeal, then, is whether Dr. Caceres's disclosure to a fellow physician in his office in the course of dealing with a matter related to the operation of that office was an unconsented, unprivileged disclosure to a third party. We hold that it was not. We have not been cited to, nor ourselves found, any case in this jurisdiction, or else-where, that squarely addresses the question whether communications between two physicians within the same medical office concerning a patient of that office can constitute a breach of the confidential physician-patient relationship. Cases dealing with invocation of the testimonial privilege, however, support the expectation that there will be interaction among related health care personnel. It is widely acknowledged that the nurse who attends a physician during a consultation or examination, or the technician who makes tests under the doctor's direction, are bound by the privilege. See, e.g., Shultz v. State, 417 N.E.2d 1127, 1134 (Ind.App.1981) (technician drawing blood); Ostrowski v. Mockridge, 242 Minn. 265, 65 N.W.2d 185, 190-91 (1954) (nurse assisting doctor at examination); Branch v. Wilkinson, 198 Neb. 649, 256 N.W.2d 307, 312-13 (1977) (extending privilege to physician's agents); In re Kathleen M., 126 N.H. 379, 493 A.2d 472, 477 (1985) (privilege applies to members of treatment team). [3] These decisions simply reflect the reality of medical practice, where many individuals may work in concert. Cf. Washington Hosp. Ctr. v. District of Columbia Dep't of Employment. Servs., 789 A.2d 1261, 1263-65 (D.C. 2002) (observing, in the chosen physician context, that frequent, successive referrals are commonplace in modern medical practice). [4] A similar recognition of the extent and necessity of communication within a professional entity is reflected in available authority [5] relating to the attorney-client privilege as applied to intra-firm communications. [6] See United States v. Rowe, 96 F.3d 1294, 1296 (9th Cir.1996) (finding that communications between lawyers in the same firm remain privileged by analogizing such communications to the corporate privilege); Bank Brussels Lambert v. Credit Lyonnais (Suisse), S.A., 220 F.Supp.2d 283, 286-87 (S.D.N.Y.2002) (citing cases); In re Sunrise Sec. Litig., 130 F.R.D. 560, 595 (E.D.Pa.1989) (acknowledging that a derivative protection applies to communications that reveal the substance of prior confidential communications from a client to members of the same law firm). [7] Commentators, similarly, have noted that the privilege should apply to communications between attorneys. The District of Columbia Rules of Professional Conduct too support the proposition that client information shared among attorneys within a firm is to be expected and remains confidential, an opinion that, in turn, informs our view that communications among physicians in the same medical office enjoy a similar protected status. [8] Rule 1.6, cmt. 10, which concerns the confidentiality of information, states [u]nless the client otherwise directs, a lawyer may disclose the affairs of the client to partners or associates of the lawyer's firm. Analogously, Rule 1.10, cmt. 6, which discusses imputed disqualification, notes [t]he rule of imputed disqualification ... gives effect to the principle of loyalty to the client as it applies to lawyers who practice in a law firm. Such situations can be considered from the premise that a firm of lawyers is essentially one lawyer for purposes of the rules governing loyalty to the client, or from the premise that each lawyer is vicariously bound by the obligation of loyalty owed by each lawyer with whom the lawyer is associated. Moreover, Rule 1.10, cmt. 14, highlights that [p]reserving confidentiality is a question of access to information.... A lawyer may have general access to files of all clients of a law firm and may regularly participate in discussions of their affairs; it should be inferred that such a lawyer in fact is privy to all information about all the firm's clients. We are mindful that the case before us concerns the general duty of a physician to maintain the confidentiality of a patient's medical condition, and not the distinct, albeit related, statutory testimonial privilege, which in general prohibits a physician from testifying as to any confidential information acquired in attending a client in a professional capacity. See D.C.Code § 14-307(a); Richbow v. District of Columbia, 600 A.2d 1063, 1068 (D.C.1991). The two are not necessarily co-extensive, since the testimonial privilege of the speaker to remain silent is derivative of the patient's interest while the general confidentiality principle may at times also involve consideration of the propriety of a physician's defensive invocation of a right to communicate free of liability. But the interrelation between the two, both bottomed in the end on client candor and effective medical practice, is sufficient to justify reference to testimonial privilege doctrine in our analysis, as casting some light on the extent to which communications retain their confidential nature, on who may legitimately be considered a third party, and on what general expectations of confidentiality can be expected by a patient. It is true that, in the case before us, the communication was not made in connection with the immediate on-going treatment of a common patient. Nonetheless, the communication was related to and arose as a consequence of such medical treatment and was made in the course of the business of administering the mutual medical practice. Doctors within the same medical office should be allowed to work together with some latitude of freedom of communication not only to treat patients, but also to respond to patient administrative requests and, as here, patient complaints. Both doctors, moreover, already knew of appellant's HIV-positive status as a result of their treatment of appellant. Appellant argues that Muller was not aware of the NIH report of the decline in appellant's T-cell count from 700 to 600, suggesting a worsening of his condition, [9] and communication of that fact was not directly related to his complaint. We do not think that the content of a communication between two doctors in a common medical practice about a matter involving the operation of that practice should be subjected to such a taxing sentence-by-sentence analysis, especially where the challenged statement is itself medical information acquired as part of the firm's practice. [10] Too exacting an approach, requiring the most guarded attention and analysis of the content of each professional exchange, could well hinder the free flow of information within a given medical practice and work ultimately to the detriment of the medical care of the patients of the firm as a whole. Moreover, when the information relating to a patient's medical record is contained in communications between physicians in the same office relating to that mutual patient, present or past, there can be no doubt that the cloak of confidentiality with respect to that record encompasses both physicians, even when the communication does not directly relate to immediate medical treatment. Cf. PAUL R. RICE, ATTORNEY-CLIENT PRIVILEGE IN THE UNITED STATES, § 6:31 (2d ed.1999) (noting in the attorney-client context: [W]hen the client communication is generally addressed to the law firm, or to the corporation's internal legal department, the fact that lawyers other than the ones working on the particular matter may read it is inconsequential because all attorneys within the firm or legal department would be bound by the privilege not to divulge its contents. Therefore, confidentiality would be presumed for the latter type of communications.). [11] In summation, Suesbury was a patient of Caceres' medical office. Muller was a treating physician in that office and had been informed that Suesbury was HIV-positive. Muller normally would be expected to have access to Suesbury's medical information, presumably including the NIH report about Suesbury's T-cell count, at least where he did so for the purposes of treatment, payment, or health care operations. [12] Suesbury complained to Caceres about Muller's actions and, without objection by Suesbury, Caceres said he would investigate. In the course of doing so, he naturally communicated with Muller and, in the process, happened to mention one piece of medical information new to Muller, the decrease in the T-cell count. Caceres' communication related to important practice-related concerns that a patient of the medical practice had voiced. In this setting, the single medical statement of a T-cell count contained in a communication relating to firm operations by one physician to another, made within the bounds of a common professional enterprise and a mutual obligation of confidentiality, simply was not the unconsented, unprivileged communication with a third party required to underpin the tort. [13] Suesbury thus failed to establish an essential element of his cause of action in tort for breach of the confidential physician-patient relationship. The trial court correctly granted summary judgment against him on that count, as well as the related count for intentional infliction of emotional distress. [14] Affirmed.