Opinion ID: 2351723
Heading Depth: 2
Heading Rank: 2

Heading: ) Supervisory and Subpoena Power of the Board over Licensed Social Workers

Text: Title 19 of the Health Occupations Article regulates the social work profession as it exists in this State and provides that [t]he General Assembly finds that the profession of social work profoundly affects the lives, health, safety, and welfare of the people of this State, and that the purpose of the title is to protect the public by: (1) Setting minimum qualification, education, training, and experience standards for the licensing of individuals to practice social work; and (2) Promoting and maintaining high professional standards for the practice of social work. Section 19-102 of the Health Occupation Article. The Board exists as the State regulatory agency that is legislatively empowered to license and regulate social workers in Maryland. Inherent in the power to regulate the licensees is the power to investigate licensees for alleged improper conduct as it relates to their duties as social workers and to discipline any licensee that violates any of his or her statutory duties. See McDonnell v. Commission on Medical Discipline, 301 Md. 426, 436, 483 A.2d 76, 81 (1984) (stating that  [t]he purpose of disciplinary proceedings against licensed professionals is not to punish the offender but rather as a catharsis for the profession and a prophylactic for the public). Of special importance to the case sub judice is § 19-311 of the Health Occupation Article, which provides in part: § 19-311. Denials, reprimands, suspensions, and revocations  Grounds. Subject to the hearing provisions of § 19-312 of this subtitle, the Board may deny a license to any applicant, fine a licensee, reprimand any licensee, place any licensee on probation, or suspend or revoke a license if the applicant or licensee: ... (15) Knowingly fails to report suspected child abuse in violation of § 5-704 of the Family Law Article.  [Emphasis added.] Pursuant to an investigation under any of the grounds listed in § 19-311, including an investigation into whether a social worker did, in fact, knowingly fail[ ] to report suspected child abuse, the Legislature has specifically granted the Board, under § 19-312(c) of the Health Occupations Article, the power to issue subpoenas. The statute states: (c) Subpoenas and oaths.  Over the signature of an officer or the administrator of the Board, the Board may issue subpoenas and administer oaths in connection with any investigation under this title and any hearings or proceedings before it. [Emphasis added.] As stated, the Board initiated an investigation into the actions (or lack thereof) by Ms. F in relation to her counseling of petitioners after a complaint arose concerning acts of child abuse by John Doe that were not reported by Ms. F. It is apparent from the record, particularly the Consent Order, that substantial evidence was acquired by the Board which showed that Ms. F had acted in her professional capacity as a licensed social worker in such a way as to be subject to discipline by the Board under § 19-311 of the Health Occupations Article. [9] A subpoena was thereafter issued by the Board for the treatment records of petitioners that were made by Ms. F while she was acting in her capacity as petitioners' social worker. This subpoena was issued for the sole purpose of gathering any information as to whether Ms. F was in violation of Title 19 of the Health Occupations Article and subject to discipline by the Board. The social worker's treatment records relating to petitioners would be one logical, potential source of such information, if it existed. Other statutes further express the power of the Board to subpoena records such as those sought in the case before us. In regard to the ability of a health professional licensing or disciplinary board to subpoena medical records in order to further an investigation of a licensee, § 4-306(b)(2) of the Health  General Article states that: (b) Permitted disclosures.  A health care provider shall disclose a medical record without the authorization of a person in interest: ... (2) Subject to the additional limitations for a medical record developed primarily in connection with the provision of mental health services in § 4-307 of this subtitle, to health professional licensing and disciplinary boards, [ [10] ] in accordance with a subpoena for medical records for the sole purpose of an investigation regarding: (i) Licensure, certification, or discipline of a health professional; or (ii) The improper practice of a health profession. [Emphasis added.] [Footnote added.] Moreover, § 4-307 of the Health  General Article, which deals specifically with the disclosure of mental health records, [11] states, in pertinent part: § 4-307. Disclosure of mental health records. ... (k) Transfer of recipient; protection and advocacy system; commitment proceedings; court orders, subpoenas, etc.; death of recipient. -(1) A health care provider shall disclose a medical record without the authorization of a person in interest: ... (vi) In accordance with a subpoena for medical records on specific recipients: 1. To health professional licensing and disciplinary boards for the sole purpose of an investigation regarding licensure, certification, or discipline of a health professional or the improper practice of a health profession.... [Emphasis added.] As petitioners correctly note, however, § 4-307(k)(6) of the Health  General Article states that: This subsection may not preclude a health care provider, a recipient, or person in interest from asserting in a motion to quash or a motion for a protective order any constitutional right or other legal authority in opposition to disclosure. Petitioners, in their brief, claim that this provision demonstrates the explicit legislative intent not to abrogate other provisions of law through § 4-307 of the Health  General Article. Hence, the exceptions to the confidentiality of medical records contained in § 4-307 of the Health  General Article have no bearing on the privilege[ ] created in ... [§ 9-121(b) of the Courts and Judicial Proceedings Article] (alteration added). We do not agree. Petitioners' main contention relating to their claim that the § 4-307 exceptions have no bearing on the social worker  client privilege existing under § 9-121(b) is that several enumerated exceptions exist under § 9-121(d)  (e), which petitioners claim is an exhaustive list of exceptions not to be expanded upon by any of the language found in §§ 4-306 and 4-307 of the Health  General Article. Section 9-121(d)  (e) states the exceptions to the social worker  client privilege as follows: (d) Privilege inapplicable in certain circumstances.  There is no privilege if: (1) A disclosure is necessary for the purpose of placing the client in a facility for mental illness; (2) A judge finds that the client, after being informed there will be no privilege, makes communications in the course of an examination ordered by the court; (3) In a civil or criminal proceeding: (i) The client introduces the client's mental condition as an element of the claim or defense; or (ii) After the client's death, the client's mental condition is introduced by any party claiming or defending through or as a beneficiary of the client; (4) The client or the personal representative of the client makes a claim against the licensed certified social worker for malpractice; or (5) The client expressly consents to waive the privilege, or in the case of death or disability, the client's personal representative waives the privilege for purpose of making a claim or bringing suit on a policy of insurance on life, health, or physical condition. (e) Privilege inapplicable in certain proceedings.  There is no privilege in: (1) Any administrative or judicial nondelinquent juvenile proceeding; (2) Any guardianship and adoption proceeding initiated by a child placement agency; (3) Any guardianship and protective services proceeding concerning disabled persons; or (4) Any criminal or delinquency proceeding in which there is a charge of child abuse or neglect or which arises out of an investigation of suspected child abuse or neglect. As stated, petitioners assert that this statutory listing of the inapplicability of the social worker  client privilege in certain circumstances and proceedings is exhaustive and that the General Assembly was free to add an additional, tenth exception to the legislative scheme, but it chose not to. Petitioners fail, however, to acknowledge the ultimate authority found in the language of § 9-121(b), which allows for the existence of the privilege in the first place. The language establishing the privilege is preceded by  Unless otherwise provided ... (emphasis added). What it does not say is unless otherwise provided in this subtitle or the like. Therefore, the exceptions to the social worker  client privilege found in § 9-121(d)  (e) of the Court and Judicial Proceedings Article are not meant to be exhaustive insofar as they would exclude an exemption to the privilege based on an investigation by the Board of one of its social workers not fulfilling her statutorily mandated duties under § 5-704(a) of the Family Law Article. The statute establishing a social worker  client privilege and its exceptions does not exist in a vacuum but can be, and is, affected by other statutes which further limit the scope of the privilege. Our conclusion is bolstered by the fact that several other exceptions to the social worker  client privilege that are not enumerated in § 9-121(d)  (e) are recognized by law, e.g., the requirement that social workers report suspected child abuse (§ 5-704(a) of the Family Law Article); the requirement that social workers report the abuse, neglect, self-neglect, or exploitation of an alleged vulnerable adult (§ 14-302(a) of the Family Law Article); the duty of mental health care providers to warn their patients' intended victims (§ 5-609 of the Courts and Judicial Proceedings Article); and permission to disclose exculpatory information. See Goldsmith v. State, 337 Md. 112, 133-34, 651 A.2d 866, 877 (1995) (where showing is made that there is a reasonable likelihood that privileged records contain exculpatory information necessary for a proper defense, the privilege may be abrogated). It is readily apparent, therefore, that there exist exceptions to the social worker  client privilege that are not specifically enumerated in § 9-121(d)  (e) of the Courts and Judicial Proceedings Article, but that nevertheless limit successful assertion of the privilege. As this Court has stated, the paramount rule of statutory construction is to ascertain and effectuate the intent of the legislature. Gillespie v. State, 370 Md. 219, 221, 804 A.2d 426, 427 (2002). Furthermore, when the Legislature acts, it `is presumed to be aware of its own enactments.' Maryland State Highway Admin. v. Kim, 353 Md. 313, 324, 726 A.2d 238, 244 (1999) (quoting State v. Hernandez, 344 Md. 721, 727, 690 A.2d 526, 529 (1997)). With this in mind, we do not accept petitioners' argument that the social worker  client privilege established under § 9-121(b) automatically prohibits the Board from subpoenaing petitioners' 1998 treatment records for the purpose of investigating one of its licensed social workers for professional violations, especially those involving allegations that a licensed social worker has knowingly failed to report child abuse. As the intermediate appellate court rightfully stated in its opinion below, it would create an absurd result to mandate that a social worker report child abuse, while at the same time, permit the abuser and/or the social worker to prevent the Board from investigating a complaint of failure to report the suspected abuse. Doe, 154 Md.App. at 541, 840 A.2d at 757. We agree with the intermediate appellate court's assessment. It is obvious that the Board is statutorily permitted to investigate allegations that a licensed social worker has knowingly failed to report suspected child abuse. See § 19-311(15) of the Health Occupations Article. If a social worker, in this case Ms. F, knowingly fails to report incidents of child abuse, this is something in which the Board would understandably take an interest and seek to remedy accordingly, presumably through its disciplinary powers subsequent to an investigation into the matter. The social worker  client privilege cannot be allowed to create an impenetrable wall to investigations of such importance. Section 5-704 of the Family Law Article requires social workers to notify the appropriate department or law enforcement agency, notwithstanding any law on privileged communications, if there is a reason to believe that a child has been subjected to abuse. If the Legislature has provided that the privilege does not prevent a social worker from reporting the abuse, [12] it follows that the privilege must not prevent the investigation of a social worker who is suspected of knowingly not reporting such abuse. Other courts have held that a statutorily-enacted privilege does not automatically work to prevent investigatory boards from obtaining confidential records under similar circumstances as those existing in the case sub judice. In State Medical Board of Ohio v. Miller, 44 Ohio St.3d 136, 541 N.E.2d 602 (1989), a physician who was the subject of an investigation by the state medical board for improperly prescribing controlled substances moved to quash an investigative subpoena duces tecum that sought the physician's  patient records for a number of his patients. Id. at 136, 541 N.E.2d at 602-03. The physician asserted that the physician  patient privilege, as set forth by a state statute, precluded the disclosure of the requested records. On appeal, the Supreme Court of Ohio framed the issue before it as follows: This case presents the question of how a statute, designed to permit investigation of the suspected wrongdoing of physicians, is impacted by the physician  patient privilege. Id. at 138, 541 N.E.2d at 603-04. In holding that the physician  patient privilege did not prevent the state medical board from compelling production of confidential patient records, the state supreme court stated that [w]hile we are cognizant of the laudable purpose and goal to be achieved by the physician  patient privilege, we are likewise cognizant that the privilege may not be invoked automatically in all circumstances.  Id. at 140, 541 N.E.2d at 605 (emphasis added). The court first noted that, because there existed no physician  patient privilege at common law ... the privilege is in derogation of the common law [and] must be strictly construed against the party seeking to assert it. Id. Next, the court observed that the opportunity to practice medicine is not an unqualified right. All physicians must be licensed to practice pursuant to [the state licensing statute]. Id. (alteration added). Thirdly, the court stated that in certain circumstances, the policy considerations underlying the physician  patient privilege are outweighed by other factors.... We feel that the interest of the public at large, served here through the board's investigation of possible wrongdoing by a licensed physician, outweighs the interests to be served by invocation of the physician  patient privilege. Miller, 44 Ohio St.3d at 140-41, 541 N.E.2d at 606 (emphasis added). Lastly, the court gave weight to the fact that the state medical board was required by statute to maintain the confidentiality of patient records reviewed during an investigation. The statute itself stated that [t]he board shall conduct all investigations and proceedings in such a manner as to protect patient confidentiality. The board shall not make public names or other identifying information about patients unless proper consent is given. Id. at 141, 541 N.E.2d at 606. Similarly, in the case of In re Board of Medical Review Investigation, 463 A.2d 1373 (R.I.1983), a physician petitioned to quash a subpoena duces tecum ordering production of certain patient-treatment records, which were sought by the state's Board of Medical Review Investigation to determine whether the physician was guilty of unprofessional conduct. [13] The state supreme court framed the issue before it as follows: The issue before us is whether or not the [statutory physician  patient privilege][ [14] ] should be construed to prevent the subpoenaing of a physician's records of patient treatment during an investigation by the Board of Medical Review of alleged unprofessional conduct. Id. at 1373-74 (alteration added) (footnote added). The Supreme Court of Rhode Island first noted that [t]he Legislature created the Board of Medical Review and empowered it `to investigate all complaints and charges of unprofessional conduct against any licensed physician and to hold hearings to determine whether such charges are substantiated.' In furtherance of this statutory directive the board has the authority to issue subpoenas `to compel the production of documents or other written records....' Id. at 1374 (citations omitted). The state supreme court then found that the purpose of the [physician  patient privilege] is not violated by the board's subpoenaing a physician's records of his patients during a board investigation of alleged unprofessional conduct... because the ... investigations are confidential.... [T]he patient-physician privilege shall not prevent the board from carrying out its investigation.... Id. at 1376 (alteration added). The court concluded its reasoning for holding that the asserted privilege did not prevent an investigation by the medical review board by stating: By establishing the Board of Medical Review and authorizing it to investigate charges of unprofessional conduct against physicians, the Legislature manifested a desire to improve the quality of health-care services rendered in this state and to maintain a standard of professional ethics. By enacting the [statutory physician  patient privilege], the Legislature has sought to encourage open disclosure of information from patient to physician so as to aid in the effective treatment of the patient. However, when a physician is under investigation for unprofessional conduct and the physician attempts to invoke the patient-physician privilege and to prevent the investigatory committee from obtaining records necessary to its investigation, it seems apparent that the injury to society's interest in probity within the medical profession is much greater than the injury done to the patient's interest in the privacy of his medical records.  In re Board, 463 A.2d at 1376 (alteration added) (emphasis added). We find the reasons behind these courts' actions of holding that a statutory privilege cannot automatically prevent an investigatory board's effort to subpoena relevant medical records to be persuasive. Although the cases discussed dealt with the physician  patient privilege as it existed in those states, the thrust of both holdings as to why a statutory privilege should not always prove insurmountable to a legitimate and specific board investigation is undoubtedly relevant to the sphere of social worker  client privileges. A state investigatory board that is statutorily charged with regulating and disciplining its licensees should not be barred, generally, from conducting a thorough investigation into allegations of the unprofessional conduct of a licensee, especially when the Legislature has specifically provided that the state investigatory board has the power to subpoena records pursuant to an investigation. As with both the Supreme Court of Ohio and the Supreme Court of Rhode Island, we are persuaded that our holding is further warranted due to the fact that Maryland law, like the laws of those two states, provides adequate safeguards to prevent the disclosure of petitioners' treatment records. As stated, supra, § 4-302(a) of the Health  General Article requires health care providers to keep medical records confidential and allows disclosure only as provided by Maryland law. When confidential records are disclosed under Maryland law, however, § 4-302(d) of the Health  General Article expressly prohibits the redisclosure of those disclosed records: (d) Redisclosure.  A person to whom a medical record is disclosed may not redisclose the medical record to any other person unless the redisclosure is: (1) Authorized by the person in interest; (2) Otherwise permitted by this subtitle.... There is no other provision in this subtitle permitting the redisclosure of treatment records by the Board. In fact, § 4-309 of the Health  General Article provides that a health care provider or any other person  (emphasis added) who discloses a medical record in violation of the subtitle shall be subjected to a possible criminal fine and to civil damages. The Board is statutorily required by this subtitle to keep confidential those records which it seeks to examine pursuant to its investigation of Ms. F. We find that the Legislature has provided adequate safeguards against the disclosure by the Board of any information that it seeks to obtain through its statutorily-enacted subpoena power. Petitioners' social worker  client privilege in regard to their 1998 treatment records does not prevent the Board from subpoenaing those records pursuant to its investigation of Ms. F.