Opinion ID: 4570664
Heading Depth: 2
Heading Rank: 2

Heading: State and Federal Statutory Prohibitions

Text: [¶16] MCH argues that the nonparty operative notes are protected from discovery by the Maine statute providing for confidentiality of health care information, 22 M.R.S. § 1711-C(2), and the federal Health Insurance Portability and Accountability Act (HIPAA), 42 U.S.C.S. § 1320d-6. We review de novo whether either statute prevents disclosure of the nonparty operative notes. See SAD 3 Educ. Ass’n v. RSU 3 Bd. of Dirs., 2018 ME 29, ¶ 14, 180 A.3d 125. [¶17] In general, both the Maine statute and HIPAA prohibit the disclosure of individually identifiable health care information;7 however, each Even if the notes from these later procedures were relevant or reasonably calculated to lead to 6 the discovery of admissible evidence, they would be protected from disclosure for the same reasons, discussed below, that the notes from the surgeries preceding Kennelly’s were privileged and therefore not discoverable. 7 The health care information protected by Maine’s statute and HIPAA is, specifically, information that identifies the patient. See 22 M.R.S. § 1711-C(1)(E), (2) (2020); 42 U.S.C.S. § 1320d-6 (LEXIS through Pub. L. No. 116-91); see also 45 C.F.R. § 164.514(a) (2020) (“Health information that does not identify an individual and with respect to which there is no reasonable basis to believe that the information can be used to identify an individual is not individually identifiable health information.”). 11 statute also contains an exception permitting disclosure of health care information pursuant to a court order.8 See 22 M.R.S. § 1711-C(6)(F-1); 45 C.F.R. § 164.512(e) (2020). Thus, the trial court correctly determined that, despite substantial protection under state and federal laws, “neither the [Maine statute] nor HIPAA absolutely bars the disclosure of medical records” because each permits disclosure by the custodian of the records if they do not identify the patient or if disclosure is directed by a court order. [¶18] However, neither the Maine statute nor HIPAA addresses the circumstances under which a court may order the disclosure of a nonparty patient’s operative notes. These statutes speak in terms of confidentiality rather than privileges that protect records from disclosure through discovery pursuant to Rule 26(b)(1). Absent provisions specifically declaring an individual’s health care information privileged, the statutes do not directly 8 The regulations implementing HIPAA plainly contemplate that confidential medical records may be disclosed pursuant to a court order in the context of litigation. For example, “[a] covered entity may disclose protected health information in the course of any judicial or administrative proceeding . . . in response to an order of a court,” 45 C.F.R. § 164.512(e) (2020) (emphasis added), without violating HIPAA’s confidentiality protections and without leading to the penalties created in 42 U.S.C.S. § 1320d-6. Title 22 M.R.S. § 1171-C similarly provides that “[a]n individual’s health care information is confidential and may not be disclosed other than to the individual by the health care practitioner or facility except as provided in subsection 3, 3-A, 3-B, 6 or 11.” 22 M.R.S. § 1711-C(2). Subsection 6 lays out a list of exceptions to that general rule, one of which is that a health care practitioner or facility covered by section 1171-C may disclose confidential health care information “[a]s directed by order of a court or as authorized or required by statute.” 22 M.R.S. § 1711-C(6)(F-1) (2020). 12 address the judicial analysis of privilege in the context of discovery or the trial court’s authority to order the disclosure of nonparty medical records. See M.R. Evid. 503 (physician-patient privilege); M.R. Civ. P. 26(b)(1) (permitting discovery of materials “not privileged”); see also Pinkham, 2016 ME 74, ¶¶ 10, 13, 139 A.3d 904 (distinguishing confidentiality and privilege); Burka v. U.S. Dep’t of Health & Human Servs., 87 F.3d 508, 518 (D.C. Cir. 1996) (stating that privileged information is “presumptively not discoverable”). [¶19] Thus, we turn to the question of whether the operative notes sought in this case are categorically protected by the physician-patient privilege such that a court may not order their disclosure without a waiver of the privilege by the nonparty patient, or whether they may be redacted to an extent that the privilege no longer applies.