Opinion ID: 2283325
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Heading Rank: 4

Heading: Missouri Law on the Issue of ex parte Communications

Text: Missouri common law historically provides that a litigant patient in a personal injury lawsuit could not be compelled by court order to sign medical authorizations consenting to ex parte communications with treating physicians. State ex rel. Woytus v. Ryan, 776 S.W.2d 389, 395 (Mo. banc 1989). In Woytus, this Court expressed numerous policy statements that mirror the privacy policies of HIPAA, and it is worth noting a number of these statements in analyzing the relationship of HIPAA, Missouri law, and the case presently before us. For illustrative purposes: Although the patient is deemed to have waived the statutory privilege with regard to certain information, the ongoing confidential and fiduciary relationship between physician and patient continues to require protection from conduct that might jeopardize the sanctity of that relationship.... A physician occupies a position of trust and confidence as regards his patienta fiduciary position. It is his duty to act with the utmost good faith. This duty of the physician flows from the relationship with his patient and is fixed by law.... Id. at 393 (citation omitted). The Court refused to compel a patient to sign a medical authorization order consenting to ex parte communications because the [Missouri Rules of Court] do not expressly forbid ex parte discussion, [or] expressly authorize such discussion as a method of discovery. Id. at 392. This Court refused to add a non-enumerated discovery method to the rules because of the potential risks to the physician-patient privilege: [T]his Court will not require that a nonenumerated discovery method be added to those already available under the [Missouri Rules of Court]. Information or evidence that can be obtained legitimately through ex parte discussion [with treating physicians] can also be obtained through the methods of discovery listed in the [Missouri Rules of Court]. Any burdens caused defendants by being restricted to the specially enumerated discovery procedures are outweighed by the potential risks to the physician-patient relationship in deviating from those procedures. Id. at 395. These risks include the possibility (or, some would argue, probability) that: An unauthorized ex parte interview could disintegrate into a discussion of the impact of a jury's award upon a physician's professional reputation, the rising cost of malpractice insurance premiums, the notion that the treating physician might be the next person to be sued, and other topics which might influence the treating physician's views. Id. Subsequently, this Court issued a pair of companion opinions addressing voluntary and informal ex parte communications between plaintiff's treating physician and defendant or defendant's representatives in a medical malpractice case. Brandt v. Pelican, 856 S.W.2d 658 (Mo. banc 1993) ( Brandt I ); Brandt v. Med. Def. Assocs., 856 S.W.2d 667 (Mo. banc 1993) ( Brandt II ). In Brandt I, the issue presented was whether voluntary and informal ex parte communications between defense counsel and plaintiff's treating physician (without plaintiff's consent) were prohibited during the discovery period of litigation. 856 S.W.2d at 661. The Court focused on Missouri's physician-patient testimonial privilege statute, § 491.060(5), RSMo Supp. 1992, and answered the question by concluding that there was nothing in this statute that expressly prohibited [3] informal and voluntary ex parte communications with plaintiff's physician. Id. Lacking a statutory or common law testimonial preclusion for this informal discovery measure, this Court refused to sanction the defendant for the voluntary and informal ex parte communication with the plaintiff's treating physician. Id. at 662. Notably, though, this Court reaffirmed its previous holding in Woytus that a plaintiff cannot be compelled to execute a medical authorization authorizing his treating physicians to engage in ex parte communications with the defendant nor could plaintiff's treating physician be compelled to engage in informal ex parte discussions with the defense. Id. Likewise, this Court commented that it was correct to observe that  Woytus `shows a judicial philosophy that discourages ex parte conversations with plaintiff's doctor.' Id. at 661 (citation omitted). In Brandt II, this Court's starting point of discussion was a reminder that, in Brandt I, the Court had concluded that there was no statutory basis in Missouri for concluding that voluntary ex parte communications between defense counsel and plaintiff's treating physician were prohibited. 856 S.W.2d at 669. With no statutory basis to prohibit Missouri personal injury litigants from engaging in informal discovery via ex parte voluntary discussion with plaintiff's treating physicians, this Court in Brandt II shifted its analysis to whether such voluntary ex parte communications by the plaintiff's treating physician violated the physician's common law fiduciary duty of confidentiality. Id. This Court decided the case based upon the doctrine of waiver, concluding that once a patient/physician privilege waiver occurs in the filing of a personal injury lawsuit in which the plaintiff's medical condition is placed at issue, the plaintiff has waived both the physician's testimonial privilege and the physician's fiduciary duty of confidentiality, including voluntary ex parte conferences with the plaintiff's treating physician within the limited scope of the waiver. Id. at 674. Notably, though, this Court in Brandt II reiterated its warning in Brandt I that nothing in either of these opinions is designed to create any right to compel the plaintiff or his treating physicians to authorize, or participate in, such ex parte communications. Id. at 674-75. [4]