Opinion ID: 2582260
Heading Depth: 3
Heading Rank: 3

Heading: The State Rebutted Burns's Presumed Authority to Claim the Physician-Patient Privilege

Text: ¶ 19 Although there is no blanket exception to the physician-patient privilege for suspected insurance fraud, evidence of such fraud has bearing on a physician's presumed authority to claim the privilege on behalf of the patient. The plain language of rule 506 gives a treating physician presumptive authority to claim the privilege, not absolute authority. We interpret court rules, like statutes and administrative rules, according to their plain language. See State v. Robertson, 932 P.2d 1219, 1228 (Utah 1997), overruled on other grounds by State v. Weeks, 2002 UT 98, 61 P.3d 1000, and State v. Reyes, 2005 UT 33, 116 P.3d 305; Archer v. Bd. of State Lands & Forestry, 907 P.2d 1142, 1145 (Utah 1995). In our inquiry, we seek to give effect to the intent of the body that promulgated the rule. See Wilcox v. CSX Corp., 2003 UT 21, ¶ 8, 70 P.3d 85. Rule 506(c) states that [t]he privilege may be claimed by the patient, or the guardian or conservator of the patient. The person who was the physician or mental health therapist at the time of the communication is presumed to have authority during the life of the patient to claim the privilege on behalf of the patient. Utah R. Evid. 506(c) (emphasis added). Under this rule, the patient, the guardian, and the conservator have unequivocal rights to claim the privilege. See id. The physician, however, is only presumed to have the authority to claim the privilege on behalf of the patient. Id. The rule's use of the word presumed denotes that there are instances outside the recognized exceptions where a physician lacks authority to claim the privilege. Or, in other words, the presumption is rebuttable. Otherwise, there would have been no reason for the drafters of the rule to include the word presumed. See C.T. v. Johnson, 1999 UT 35, ¶ 9, 977 P.2d 479 (We presume that the legislature used each word advisedly and give effect to each term according to its ordinary and accepted meaning. (internal quotation marks omitted)). ¶ 20 Under the Utah Rules of Evidence, a presumption is an evidentiary mechanism where proof of certain basic facts will serve as proof of some presumed fact unless the presumption is rebutted. Kimball & Boyce, supra ¶ 12, at 3-51. To rebut a presumption, the party against whom it is directed [bears] the burden of proving that the nonexistence of the presumed fact is more probable than its existence. Utah R. Evid. 301(a). [7] Thus, to determine whether the State effectively rebutted the rule 506(c) presumption, we must first determine what basic and presumed facts are contemplated by that rule, and then determine whether the State met its burden in rebutting the presumed fact. ¶ 21 The basic facts necessary to trigger the rule 506(c) presumption are the same facts as those necessary for a patient to personally claim the privilege. Specifically, to trigger the presumption, a treating physician must prove that the information at issue was (1) communicated in confidence, (2) to or from a physician or mental health therapist, and (3) for the purpose of diagnosing or treating the patient. Id. 506(b). The presumed fact, however, is less clear. The rule states that the treating physician is presumed to have authority ... to claim the privilege. Id. Yet presuming authority would appear to presume a legal effect rather than a fact. In actuality, since a physician must prove all the basic facts to trigger the presumption that a patient would need to prove to claim the privilege, the only remaining fact for a physician to prove is that he is, in fact, claiming the privilege on behalf of the patient and not for his own benefit. See id. In sum, the presumed fact under rule 506(c) is that the physician is claiming the privilege on behalf of the patient. [8] Thus, to defeat a physician's ability to claim a privilege once the physician has proven all the basic facts, a party needs to prove that the nonexistence of [a physician's intent to claim the privilege for the patient's benefit] is more probable than its existence. Id. 301(a). In other words, to rebut the physician's authority, the challenging party must show that it is more likely than not that a physician is claiming the privilege in his own self-interest. The State has met that burden in this case. ¶ 22 We assume for purposes of our analysis that Burns adequately proved the basic facts as described above and focus our inquiry on Burns's intent in claiming the privilege. The State has consistently argued that Burns is claiming the privilege not to protect his patients, but rather, to shield himself from the criminal investigation. The record supports this conclusion. The only person who stood to benefit from quashing the subpoena was Burns because the secrecy order was in place to protect the patients. In fact, the most compelling evidence against Burns's presumed selfless intent is that he has consistently attacked the secrecy orderthe main barrier preventing public disclosure of the patient information already in the record. The facts in this case are similar to those in Brillantes, where the California Court of Appeals noted that an attempt by a physician accused of [insurance] fraud to invoke this privilege on behalf of his patients, would serve to benefit only the physician, to the patient's detriment. 58 Cal.Rptr.2d at 778. While it is true that insurance companies are the primary victim of fraudulent billing practices, allowing a physician to shield those practices by claiming the physician-patient privilege injures the patients and the population at large by potentially causing an increase in insurance premiums. Cf. Eaquinta v. Allstate Ins. Co., 2005 UT 78, ¶ 13, 125 P.3d 901 (recognizing that increasing an insurance company's expenditures can cause premiums to increase). Moreover, allowing physicians to shield their fraud through the privilege relegates the patients to tools in perpetuating the fraud. Ultimately, the benefit of allowing Burns to claim the privilege protecting patient records from public disclosurecan be achieved through other methods. The detriment to the patients remains, however, so long as Burns can use the privilege to hinder the investigation. Therefore, where it is clear from the record that Burns is claiming the privilege to shield himself from investigation rather than to protect his patients' interests, the State has met its rebuttal burden, and Burns lacks authority to claim the physician-patient privilege under rule 506. ¶ 23 In holding that Burns lacks authority to claim the physician-patient privilege, we do not leave the patients' privacy interests unprotected. Initially, it is doubtful that patients have any expectation that the privilege would shield their records from law enforcement officials in a case like this. See Reynaud v. Superior Court, 138 Cal.App.3d 1, 187 Cal.Rptr. 660, 666-67 (Ct.App.1982). Patients generally expect that an insurance company has access to patient records to protect its interests. Furthermore, if there is suspected fraud, patients would expect that their insurance company could assist law enforcement to respond to that activity, and, in fact, Utah Code section 31A-31-104(1)(b) (2005) requires an insurer to do so. ¶ 24 While patients likely do not expect their records to remain confidential from authorities in investigations of fraud, they do expect their records to remain confidential from the general public. The physician-patient privilege is perhaps the first line of defense in keeping patient records out of the public eye, but it is by no means the only defense. A secrecy order, such as the one in this case, represents one possible protection against public disclosure. ¶ 25 Burns focuses, however, only on the first line of defense and argues that we must uphold the privilege in his case because he is ethically bound to withhold his patient records from the State. Burns thus argues that Judge Boyden's order puts him in a catch-22 situation, in that he violates the law whether or not he complies with the subpoena. Burns misapprehends his professional duty under Utah Code section 58-73-501(12) (2002). That section provides that willfully betraying or disclosing a professional confidence or violation of a privileged communication can be punished as [u]nprofessional conduct. Id. § 58-73-501. But there is an exception to this rule when disclosure is required by law. Id. § 58-73-501(12)(a). In this case, the court-approved subpoena served on Burns has the force of law, so compliance with the subpoena would be excepted from the definition of unprofessional conduct under section 58-73-501. ¶ 26 Nevertheless, our opinion in this case should not dissuade physicians from zealously guarding their patients' confidences. Rather, we merely recognize that, in instances where a physician seeks to claim the physician-patient privilege to serve his or her own interest rather than the patient's, a court may find that the physician lacks authority to do so. In those cases, the burden of protecting private medical records from public disclosure falls on the district court and law enforcement officials. The district court, in particular, should not order a physician to disclose confidential medical records without first taking measures to protect the records from public disclosure. In this case, the district court entered a secrecy order to protect against public disclosure. ¶ 27 In sum, we deny Burns's petition for extraordinary relief because Judge Boyden properly denied Burns's motion to quash the subpoena. The State rebutted Burns's presumed authority to claim the physician-patient privilege by showing that it was more likely than not that Burns claimed the privilege for his own benefit rather than on behalf of his patients. Moreover, there remains adequate protection from public disclosure of Burns's patient records. Having determined that Burns lacks authority to claim the privilege in this case, we now discuss the constitutionality of the secrecy order.