Opinion ID: 4570664
Heading Depth: 4
Heading Rank: 1

Heading: identifies the individual; or

Text: (ii) with respect to which there is a reasonable basis to believe that the information can be used to identify the individual. 42 U.S.C.S. § 1320d(6). By definition, unidentified health information is not confidential. [¶44] Similarly, under the Maine statute, section 1711-C(1)(E), defines health care information as “information that directly identifies the individual and that relates to an individual’s physical, mental or behavioral condition, personal or family medical history or medical treatment or the health care provided to that individual.” See 22 M.R.S. § 1711-C(1)(E) (emphasis added). It specifically states that “‘[h]ealth care information’ does not include 33 information that protects the anonymity of the individual by means of encryption or encoding of individual identifiers . . . .” Id.19 [¶45] Pursuant to both the federal and state statutes, health care information that does not identify the patient is not confidential. See 42 U.S.C.S. § 1320d-6; 22 M.R.S § 1711-C(1)(E). Therefore, there is no need to refer to the sections allowing disclosure pursuant to court order. The corresponding exceptions dealing with court orders permit the court to order the disclosure of protected health care information—information that is identifiable and therefore confidential. See 22 M.R.S § 1711-C(6)(F-1); 45 C.F.R. 164.512(e). In this case, the medical information does not fit the definition of “individually identifiable health information,” see 42 U.S.C.S. § 1320d(6), nor does it “directly identify the individual,” 22 M.R.S. § 1711-C(1)(E). The requested health care information in this case is by definition not confidential, and therefore there is no need to obtain a court order pursuant to section 1711-C(6)(F-1). See 22 M.R.S. § 1711-C(1)(E),(2), (6). 19 Section 1711-C(1)(E) directs the Maine Health Data Organization (MHDO) to adopt rules to define what constitutes “identifying information.” 22 M.R.S. § 1711-C (1)(E)(2020). The MHDO rules specify twenty-five items as identifying information. See 90-590 C.M.R. ch. 125 (effective Feb. 17, 2009). None of these identifiers would be present in the redacted operative notes at issue pursuant to the court order. 34 B. Privilege [¶46] I also disagree with the Court’s holding that Maine Rule of Evidence 503(b) protects the health care information in this case because I believe that we should adopt the same approach as the federal and state confidentiality laws (HIPPA & the Maine statute)—if the individual is not identifiable then the rule does not apply. 42 U.S.C.S. § 1320d-6; 22 M.R.S § 1711-C(1)(E), (2). [¶47] Based upon the recognition that the confidentiality of the physician-patient relationship is paramount to medical care, the Maine statute prohibits the unauthorized disclosure of identifiable information obtained in the context of that relationship. See 22 M.R.S. § 1711-C; P.L. 1997, ch. 793; see also An Act to Provide for Confidentiality of Healthcare Information and An Act Regarding Access to Medical Information: Hearing on L.D. 1737 & L.D. 1779 Before the J. Standing Comm. on Health & Human Servs., 118th Legis. (1997). Thus, section 1711-C “establishes safeguards for maintaining the confidentiality, security and integrity” of an individual’s identifiable health information. L.D. 1737, Enacted Law Summary (118th Legis. 1998). [¶48] The physician-patient privilege in Maine arises from our own evidentiary rules.20 Maine Rule of Evidence 503(b) protects from disclosure The since-repealed statutory privilege cited by the Court “could not give assurance to the 20 patient that what the patient said would not be disclosed.” Field & Murray, Maine Evidence § 503.1 35 “confidential communications made for the purpose of diagnosing or treating the patient’s physical, mental, or emotional condition.” Like other evidentiary privileges, the physician-patient privilege exists to serve the public interest by encouraging complete and honest discourse between a patient and their doctor. See Jaffee v. Redmond, 518 U.S. 1, 11 (1996); Lewin v. Jackson, 492 P.2d 406, 410 (Ariz. 1972). The physician-patient privilege facilitates this interest by “secur[ing] the patient from disclosure in court of potentially embarrassing private details concerning health and bodily condition.” 1 Robert P. Mosteller, McCormick on Evidence § 98 at 692 (8th ed. 2020). [¶49] Here we are not interpreting a statutory confidentiality provision, but considering our own evidentiary rule and setting policy based on that rule. Although we are not bound by the Maine statute’s definition of confidentiality in interpreting Rule 503, we should be wary of adopting a policy that is incongruous with that of the Maine Legislature. Rule 503 and the Maine statute both seek to facilitate effective health care services by protecting the confidentiality of the physician-patient relationship. See M.R. Evid. 503 Advisers’ Note to former M.R. Evid. 503 (Feb. 2, 1976). We should not interpret at 225; see 32 M.R.S.A. § 3295 (Supp. 1973), repealed by P.L. 1977, ch. 564, § 123 (effective July 23, 1977). 36 Rule 503 as preventing disclosure of nonidentifiable health information because such an interpretation conflicts with the Legislature’s policy, which does not prevent disclosure of nonidentifiable health care information. See 22 M.R.S. § 1711-C(1)(E), (2). In this case, pursuant to HIPPA and the Maine statute, the hospital could produce these records (properly redacted) to the estate, or to anyone that requests them, but under the Court’s holding these same records could not be produced to the litigants because Rule 503 prohibits disclosure. [¶50] When any and all information that could potentially identify a patient is redacted prior to the disclosure of a relevant medical record, the privilege should not be applicable. In the absence of identifying information, there is no “patient” for the privilege to protect and the information contained within the redacted medical records becomes “nothing more than medical terminology.” Staley v. Jolles, 230 P.3d 1007, 1011 (Utah 2010); see also Wipf v. Alstiel, 888 N.W.2d 790, 794 (S.D. 2016) (“This type of anonymous, nonidentifying information is not protected by the physician-patient privilege because there is no patient once the information is redacted.”) Likewise, the purpose that the privilege exists to serve is no longer served because “[i]t is unlikely that a patient would be inhibited from confiding in his physician where 37 there is no risk of humiliation and embarrassment, and no invasion of the patient’s privacy.” Terre Haute Reg’l Hosp., Inc. v. Trueblood, 600 N.E.2d 1358, 1361 (Ind. 1992). [¶51] A substantial majority of other jurisdictions follows the approach of allowing for the discovery of relevant medical records when information that could identify a nonparty patient has been redacted. See, e.g., Wipf, 888 N.W.2d at 793 (collecting cases); Staley, 230 P.3d at 1011; Baptist Mem’l Hosp.-Union Cnty. v. Johnson, 754 So. 2d 1165, 1169-71 (Miss. 2000); State ex rel. Wilfong v. Schaeperkoetter, 933 S.W.2d 407, 409-10 (Mo. 1996); Amente v. Newman, 653 So. 2d 1030, 1033 (Fla. 1995); Terre Haute Reg’l Hosp., 600 N.E.2d at 1361-62; Cmty. Hosp. Ass’n v. Dist. Ct., 570 P.2d 243, 244-45 (Colo. 1977); Rudnick v. Superior Ct., 523 P.2d 643, 650 n.13 (Cal. 1974); Snibbe v. Superior Ct., 168 Cal. Rptr. 3d 548, 556-57 (Cal. App. Ct. 2014); Bennet v. Fieser, 152 F.R.D. 641, 643-44 (D. Kan. 1994); Todd v. S. Jersey Hosp. Sys., 152 F.R.D. 676, 684-87 (D.N.J. 1993). [¶52] To protect the anonymity of nonparty patients, courts following the majority approach have taken a variety of steps to ensure that any and all identifying information has been redacted from the medical records, including not just patient names, but any other information that could reasonably lead to 38 the identification of a patient—e.g., dates of birth, locations and dates of treatment, family and medical histories, or any other information deemed necessary. See, e.g., Wipf, 888 N.W.2d at 795; Cmty. Hosp., 570 P.2d at 244. [¶53] In Wipf v. Altstiel, the South Dakota Supreme Court held that “[i]n accordance with the rationale of . . . the almost unanimous view of other courts, we too hold that anonymous, nonidentifying medical information is not privileged per se.” Wipf, 888 N.W.2d at 794. In Wipf and other similar cases, the courts have ordered procedural steps to protect the information provided within the medical records, such as issuing protective orders requiring leave of court to copy records, and limiting who the redacted records may be disclosed to for the purposes of litigation. See Wipf, 888 N.W.2d at 795; Terre Haute, 600 N.E.2d at 1362. [¶54] In this case, the trial court took significant steps to protect the identity of any nonparty patients and to ensure that the request was not a fishing expedition. The trial court first determined that the requested information was relevant. The trial court stated, “Here, because the standard relied upon by the parties requires some assessment of the physician’s usual practice, the procedure the physician has used in other surgeries has some tendency to make it more or less probable that she breached the standard of 39 care.” After making this finding of relevance for purposes of discovery, the trial court ordered the production of twenty-five redacted notes on operations performed by Dr. Marietta before the surgery on Kennelly and twenty-five on operations performed after it.21 The trial court ordered that all information except “the year of the surgery, the name of the surgeon (Dr. Marietta), the name of the procedure, and a portion of the section labeled ‘operative procedure’” be redacted. To the extent there is any identifying information, (e.g., name, date of birth, age, sex, race) in the ‘operative procedure’ section, such information shall also be redacted.” Further still, the trial court subjected the already highly-redacted information to a protective order, stating that “[p]laintiff’s counsel shall not attempt to identify persons whose identities have been redacted and shall not provide copies to anyone, other than expert witnesses in the case . . . .” [¶55] This is not to say that redactions in all cases make the protections of the physician-patient privilege inapplicable. The physician-patient privilege, although broad, should not be a blunt impediment to the discovery of highly 21 Because I agree with the trial court that the procedure used by Dr. Marietta in the twenty-five surgeries before Kennelly’s and the twenty-five surgeries after Kennelly’s has some tendency to make it more or less probable that she breached the standard of care, I would hold that the trial court properly concluded that the requested operative notes from the twenty-five surgeries that took place after Kennelly’s are relevant for purposes of discovery. 40 relevant medical records when there is a sufficient guarantee of anonymity through the use of redactions or other procedural protections. “Whether and under what circumstances redaction can make good on its promise of anonymity depends on the circumstances of each case.” Staley, 230 P.3d at 1012. In this vein, a recent dissent in McCain v. Vanadia raised the issue of whether, even with substantial redactions, the identities of patients could be protected in “smaller Maine communities where only a few treatments may be provided per year.” 2018 ME 118, ¶ 27, 191 A.3d 1174 (Alexander, J., dissenting). This, and other similar concerns, however, would properly be considered by the court on a case-by-case basis prior to issuing an order compelling the production of medical records. See Wipf, 888 N.W.2d at 795 (noting that, on remand, the court should consider when the small population would make identification of patients likely); Staley, 230 P.3d at 1013 (noting that a large population served by multiple hospitals increased the likelihood that anonymity would be preserved). If “the prospect of preserving anonymity through redaction [is] too uncertain,” Staley, 230 P.3d at 1013, then the court, in its discretion, could deny the request for records, even with substantial redactions. 41 C. Conclusion [¶56] It does not make sense to hold that HIPPA and the Maine statute provide less protection to a patient’s confidential record than a court created rule of evidence pertaining to the same records. [¶57] In this case, I believe that the trial court took sufficient steps to protect the identity of the nonparty patients whose medical records are at issue. I would affirm the trial court’s order compelling the production of the operative notes along with the safeguards ordered by the court. Philip M. Coffin III, Esq., and Abigail C. Varga, Esq. (orally), Lambert Coffin, Portland, for appellant Mid Coast Hospital Travis M. Brennan, Esq. (orally), and Taylor A. Asen, Esq., Berman & Simmons, P.A., Lewiston, for appellee Estate of Carol A. Kennelly Karen Frink Wolf, Esq., and Rachel M. Wertheimer, Esq., Verrill Dana LLP, Portland, for amici curiae Maine Hospital Association and Maine Medical Association Thomas L. Douglas, Esq., Douglas, McDaniel & Campo LLC, PA, Westbrook, for amicus curiae Maine Trial Lawyers Association Cumberland County Superior Court docket number CV-2016-471 FOR CLERK REFERENCE ONLY