Opinion ID: 2351723
Heading Depth: 2
Heading Rank: 3

Heading: ) Constitutional Privacy Interest in Preventing Disclosure

Text: Petitioners next argue that the Court of Special Appeals erred in accepting the finding by the circuit court that the Board's interest in obtaining petitioners' therapy records outweighed petitioners' constitutional privacy interest in preventing disclosure. For the reasons that follow, we do not agree. This Court has stated that the right to privacy is protected by the federal constitution and ... where the right is applicable, regulation limiting it must be justified by a `compelling state interest.' Montgomery County v. Walsh, 274 Md. 502, 512, 336 A.2d 97, 104-05 (1975), appeal dismissed, 424 U.S. 901, 96 S.Ct. 1091, 47 L.Ed.2d 306 (1976); see also Doe v. Commander, Wheaton Police Dep't., 273 Md. 262, 272, 329 A.2d 35, 41 (1974) (stating that regulation limiting [the right of privacy] must be justified by a `compelling state interest') (alteration added). The United States Supreme Court has recognized that cases ... characterized as protecting `privacy' have in fact involved at least two different kinds of interests. One is the individual interest in avoiding disclosure of personal matters, and another is the interest in independence in making certain kinds of important decisions. Whalen v. Roe, 429 U.S. 589, 599-600, 97 S.Ct. 869, 876, 51 L.Ed.2d 64 (1977) (emphasis added) (footnotes omitted). Medical records fall within the protections of this right to privacy. See In re Search Warrant (Sealed), 810 F.2d 67, 71 (3d Cir.1987), cert. denied, 483 U.S. 1007, 107 S.Ct. 3233, 97 L.Ed.2d 739 (1987) (stating that medical records are clearly within this constitutionally protected sphere); see also United States v. Westinghouse Electric Corp., 638 F.2d 570, 577 (3d Cir.1980) (stating that [t]here can be no question that ... medical records, which may contain intimate facts of a personal nature, are well within the ambit of materials entitled to privacy protection). In the case sub judice, petitioners assert their privacy interest in nondisclosure of their 1998 treatment records. Therefore, the Board, a State agency, must show a compelling state interest before it will be allowed to infringe on petitioners' privacy rights regarding their treatment records. In the case of Dr. K v. State Board of Physician Quality Assurance, 98 Md.App. 103, 632 A.2d 453 (1993), cert. denied, 334 Md. 18, 637 A.2d 1191, cert. denied, 513 U.S. 817, 115 S.Ct. 75, 130 L.Ed.2d 29 (1994), after receiving formal written complaints that a psychiatrist and his former patient were having a romantic relationship and that the psychiatrist was depressed and abusing alcohol, the State Board of Physician Quality Assurance [15] initiated an investigation and subpoenaed the psychiatrist's records relating to the patient's treatment. Akin to petitioners in the case sub judice, in Dr. K the patient claimed on appeal to the intermediate appellate court that her constitutional right to privacy barred the disclosure of her mental health records to the Board of Physician Quality Assurance. [16] See id. at 107, 632 A.2d at 455. The Court of Special Appeals, after finding that the patient had a right to privacy in her medical records, proceeded to analyze whether or not this individual privacy interest trumped the State's competing interest in obtaining the medical records under the standard described in United States v. Westinghouse Electric Corp., 638 F.2d 570 (3d Cir.1980). In explaining the analytical framework of Westinghouse, which the intermediate appellate court adopted in its analysis, the court stated: In those cases where a court has allowed intrusion into the privacy right in medical records, `it has usually done so only after finding that the societal interest in disclosure outweighs the privacy interest on the specific facts of the case.' ... [T]he [ Westinghouse ] court specified several factors to consider in the `delicate task' of weighing the government's competing interest. Those factors are: the type of record requested, the information it contains, the potential for harm in subsequent nonconsensual disclosure, the injury in disclosure to the relationship for which the record was generated, the adequacy of safeguards to prevent unauthorized disclosure, the government's need for access, and whether there is an express statutory mandate, articulate public policy, or other public interest militating towards access. Dr. K, 98 Md.App. at 114-15, 632 A.2d at 459 (alteration added) (citing Westinghouse, 638 F.2d 570, 578 (3d Cir.1980)). After weighing all of the pertinent factors mentioned in Westinghouse, the Court of Special Appeals held that: the State's interest outweighs patient A's privacy right in this instance. To give a patient, in effect, a veto over the Board's power to regulate licensed physicians would be to eviscerate the Board's ability to protect the larger public interest. This is especially true in a case such as this  where the patient may not object to, or may even support, the physician's allegedly unprofessional or unethical behavior. A decision in favor of patient A would allow those physicians who are unscrupulous and in a position to exert influence over their patients to stop a preliminary investigation by the Board in its tracks. Dr. K, 98 Md.App. at 120, 632 A.2d at 461-62 (some emphasis added). Although the Dr. K case dealt with the wrongdoings of a physician and not those of a social worker, the substance of the intermediate appellate court's reasons for its decision as to why privacy interests may at times be overcome by the interests of a state licensing and disciplinary board are compelling. The importance of an investigation by a state agency into the alleged improper conduct of its professional licensees was further stated by the United State District Court for the District of Maryland in Patients of Dr. Barbara Solomon v. Board of Physician Quality Assurance, 85 F.Supp.2d 545 (D.Md.1999): It is beyond doubt that society has a deep interest in ensuring, through its government agencies, that practicing physicians meet moral and professional standards. Investigations are necessary and may involve the subpoenas of medical records. As the [Court of Special Appeals of Maryland] noted in Dr. K, allowing individual patients to block Board investigations  as the Patients seek to do here  would hinder the Board's ability to protect public health. Id. at 548 (alteration added). We agree with the intermediate appellate court that the balancing test framework described in Westinghouse, and applied in Dr. K, is the correct standard to use when balancing individual privacy interests in medical records against competing state interests in those records. See Dr. Solomon, 85 F.Supp.2d at 548 (stating that, [a]lthough Dr. K is not binding on this Court, it is clearly in line with relevant federal case law) (citing Schachter v. Whalen, 581 F.2d 35 (2d Cir.1978) (patients' constitutional rights not infringed where state board for professional medical conduct subpoenaed medical records in the course of a disciplinary investigation) and In re Search Warrant (Sealed), 810 F.2d 67 (3d Cir.1987) (state's interest in investigating physician for health care fraud outweighed patients' privacy in medical records)). Whether a compelling state interest can be shown in order to override an individual's privacy interest is to be determined on a case-by-case basis. Therefore, we shall proceed to examine whether the intermediate appellate court was correct in finding that the Board's interest in obtaining petitioners' treatment records did in fact outweigh petitioners' right to keep those records private, i.e., nondisclosed. In regard to the first Westinghouse factor, concerning the type of record requested and the information it contains, Chief Judge Murphy of the Court of Special Appeals, writing for that court, stated that because  [t]he subpoena in this case directed a social worker to deliver `the complete patient file' for Jane and John Doe `for the calendar year 1998,' petitioners' treatment records contain information of a highly private nature. Doe, 154 Md.App. at 537, 840 A.2d at 754. We agree with the intermediate appellate court in regard to this first factor. As stated, supra, petitioners' treatment records at issue are to be considered medical records for the purposes of the Confidentiality of Medical Records Act, §§ 4-301 et seq. of the Health  General Article, and private by their very nature. Turning next to the potential for harm in subsequent nonconsensual disclosure, the Court of Special Appeals stated that: Even though Mr. Doe has been convicted of criminal charges, the records at issue are potentially harmful to the Does. Because of the nature of the charges being investigated, and the potential for embarrassment if the records were subsequently disclosed, without the consent of the interested parties, the `potential for harm' is present. Doe, 154 Md.App. at 537, 840 A.2d at 754-55. Obviously, because the treatment records may apparently provide evidence that generational child abuse was occurring in petitioners' household, we find no fault with the intermediate appellate court's assessment of the potential for harm to petitioners if the treatment records are disclosed to the Board. This is merely one factor to consider in the balancing framework, however, and must be balanced against the Board's interests in obtaining the records. In regard to the adequacy of safeguards to prevent unauthorized disclosure we find, for the identical reasons stated, supra, that §§ 4-302(d) and 4-309 of the Health  General Article provide adequate safeguards under the law to prevent further disclosure of petitioners' treatment records. The intermediate appellate court also found that adequate safeguards to prevent unauthorized disclosure existed for substantially the same reasons. See Doe, 154 Md.App. at 538, 840 A.2d at 755 (stating that [a]lthough these safeguards may not be fail-proof, security precautions that are substantial but `not foolproof' are constitutionally adequate) (quoting Schachter v. Whalen, 581 F.2d 35, 37 n. 2 (2nd Cir.1978)); see also Dr. Solomon, 85 F.Supp.2d at 547 (United States District Court for the District of Maryland stating that Maryland statutes provide an adequate safeguard against unauthorized disclosure [of medical records] ...) (alteration added). Moving next to whether there exists an express statutory mandate, articulate public policy, or other public interest militating towards access, Dr. K, 98 Md.App. at 115, 632 A.2d at 459, we agree with the intermediate appellate court that the Board's interests in obtaining Ms. F's treatment records of petitioners are clearly compelling. Of great importance is the fact that the Board itself was established by the Legislature 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 Occupations Article. As the Court of Special Appeals stated in this regard:  To deny the Board access to patient files is to deny it the ability to carry out its legislative mandate. If the Social Worker Board receives a complaint that a social worker failed to notify the appropriate agency of his/her reason to believe that a child had been subjected to abuse, a lack of access to the worker's records would `effectively foreclose any meaningful investigation into that conduct and any basis for disciplinary action.' Doe, 154 Md.App. at 539, 840 A.2d at 755 (emphasis added) (quoting Dr. K, 98 Md.App. at 118, 632 A.2d at 461). It does not follow that a State entity charged with the licensing and oversight of the State's licensed social workers could be prevented from making any investigations into the conduct of one of its licensees through the use of the social worker's client treatment records at the first instance a person in interest (here, petitioners) alleges that his or her privacy interests in those records inhibit that investigation. There is clearly an important public interest supporting the creation of an entity to oversee the licensing, regulation, and discipline of this State's licensed social workers. There likewise exists a compelling state interest in seeing that Board investigations of social workers who allegedly have improperly conducted themselves in any of the ways listed in § 19-311 of the Health Occupations Article are fully carried out and the social worker dealt with accordingly. [17] Petitioners also claim that, because Ms. F has already been subjected to Board discipline and that a Consent Order between the Board and Ms. F precludes any further action by the Board against Ms. F pertaining to her actions of not reporting suspected child abuse, there cannot be said to be a viable need for the Board to examine petitioners' treatment records. We disagree. The Consent Order, filed on October 10, 2003 and signed by both Ms. F as respondent and Mary C. Burke, Chairperson of the Board, consists of a Procedural Background, Findings of Fact, Conclusions of Law and Order. The agreed-to findings were that Ms. F engaged in a course of conduct that is inconsistent with generally accepted standards in the practice of social work, that she knowingly failed to report suspected child abuse and that she failed to maintain adequate patient records. For these transgressions, Ms. F was suspended from the practice of social work for one year, ordered to complete varying courses dealing with sexual abuse and documentation and also was subjected to a probationary period of two years. Petitioners point to a specific paragraph in the Order to bolster their assertion that the Board's need for their treatment records has been diminished as a result of this Consent Order. The specific passage states: AGREED that [Ms. F's] conduct as stated in the Charges of June 12, 2002, the Amended Charges of August 8, 2003, and the Findings of Fact, Conclusions of Law and Order as stated in this Consent Order, will not be used in the future as the basis for any further action involving [Ms. F's] license, including renewal or non-renewal of [Ms. F's] license.... [Alterations added.] What petitioners' do not point out, however, is the importance of the paragraph immediately following that part of the Order and its effect on the ability of the Board to discipline Ms. F further if, after an examination of Ms. F's client treatment records as to the petitioners, additional discipline is warranted. It states: ACKNOWLEDGED by the parties that an appeal filed by [petitioners] is pending regarding the Board's access to the treatment records of [petitioners], and if the Board is able to obtain those records, the Board will not be precluded from taking further action involving [Ms. F's] license if [petitioners'] records provide probable cause to support violations in addition to those investigated and pursued in these proceedings .... [Alterations added.] [Emphasis added.] Because the Board has not yet been provided with petitioners' treatment records, there may yet be other serious issues relating to Ms. F's conduct as a social worker. We therefore agree with the Court of Special Appeals' assessment, which stated that the case ... is not moot merely because Ms. F faces no additional discipline for her failure to report her former client's abuse. Doe, 154 Md.App. at 541, 840 A.2d at 757. As the Consent Order states, there may exist other violations in addition to those investigated and pursued by the Board. The Board's desire for these records is not merely a fishing expedition, as petitioners' deem it to be, but an understandable need by the Board to have all the relevant facts regarding Ms. F's conduct as a licensed social worker before it so that it can best decide if additional discipline is proper and to fulfill its legislative mandate that it  protect the public by ... [p]romoting and maintaining high professional standards for the practice of social work. Section 19-103 of the Health Occupations Article (emphasis added). We agree with Chief Judge Murphy's analysis for the intermediate appellate court and find that the Board has shown, under those factors as described in Westinghouse, that there exists a compelling state interest in obtaining petitioners' treatment records via its statutorily enacted subpoena power. This compelling state interest overcomes petitioners' privacy rights in the records.