Opinion ID: 2615193
Heading Depth: 1
Heading Rank: 2

Heading: The Psychotherapist-Patient Privilege and the Child Abuse Reporting Act.

Text: Defendant first contends that Dr. Walker's testimony regarding the consultation of July 29 was erroneously admitted at trial in violation of the psychotherapist-patient privilege, a relationship subsumed in the right to privacy and defined by statutory provision. On the facts of this case, we agree that the doctor's testimony should have been excluded. Evidence Code section 1014 provides in part that the patient, whether or not a party, has a privilege to refuse to disclose, and to prevent another from disclosing, a confidential communication between patient and psychotherapist.... We acknowledged in In re Lifschutz (1970) 2 Cal.3d 415, 421 [85 Cal. Rptr. 829, 467 P.2d 557, 44 A.L.R.3d 1], the growing importance of the psychiatric profession in our modern, ultracomplex society. (1) Thus for reasons of policy the psychotherapist-patient privilege has been broadly construed in favor of the patient. ( Roberts v. Superior Court (1973) 9 Cal.3d 330 [107 Cal. Rptr. 309, 508 P.2d 309]; Grosslight v. Superior Court (1977) 72 Cal. App.3d 502 [140 Cal. Rptr. 278].) Confidential communications between psychotherapist and patient are protected in order to encourage those who may pose a threat to themselves or to others, because of some mental or emotional disturbance, to seek professional assistance. ( Grosslight v. Superior Court, supra, 72 Cal. App.3d at pp. 507-508.) (2) The psychotherapist-patient privilege has been recognized as an aspect of the patient's constitutional right to privacy. (Cal. Const., art. I, § 1; In re Lifschutz, supra, 2 Cal.3d at pp. 431-432, citing Griswold v. Connecticut (1965) 381 U.S. 479, 484 [14 L.Ed.2d 510, 514-515, 85 S.Ct. 1678]; Ceasar v. Mountanos (9th Cir.1976) 542 F.2d 1064, 1070.) It is also well established, however, that the right to privacy is not absolute, but may yield in the furtherance of compelling state interests. ( Britt v. Superior Court (1978) 20 Cal.3d 844, 855 [143 Cal. Rptr. 695, 574 P.2d 766]; Jones v. Superior Court (1981) 119 Cal. App.3d 534, 550 [174 Cal. Rptr. 148]; Board of Medical Quality Assurance v. Gherardini (1979) 93 Cal. App.3d 669, 680 [156 Cal. Rptr. 55].) Thus in Lifschutz we held that the patient-litigant exception to the psychotherapist-patient privilege (Evid. Code, § 1016), if narrowly drawn, does not impermissibly invade the patient's right to privacy: Even though a patient's interest in the confidentiality of the psychotherapist-patient relationship rests, in part, on constitutional underpinnings, all state `interference' with such confidentiality is not prohibited. ( In re Lifschutz, supra, 2 Cal.3d at p. 432.) Similarly in Jones v. Superior Court, supra, 119 Cal. App.3d at page 550, the court concluded that The constitutional right is by no means absolute. The state's interest in facilitating the ascertainment of truth in connection with legal proceedings is substantial enough to compel disclosure of a great variety of confidential material, including even communications between a psychotherapist and his patient. To determine whether the psychotherapist-patient privilege embraced by the right to privacy has impermissibly been violated, we begin by considering the state's competing interest. Here that interest is the detection and prevention of child abuse, and is expressed in the recently enacted Child Abuse Reporting Act. (Pen. Code, § 11165 et seq.) Section 11166, subdivision (a), of the act provides in part that any child care custodian, medical practitioner, nonmedical practitioner, or employee of a child protective agency who has knowledge of or observes a child in his or her professional capacity or within the scope of his or her employment whom he or she knows or reasonably suspects has been the victim of child abuse shall report the known or suspected instance of child abuse to a child protective agency immediately or as soon as practically possible by telephone and shall prepare and send a written report thereof within 36 hours of receiving the information concerning the incident. Section 11165 of the act provides the following: subdivision (g) defines child abuse to include the sexual assault of a child ...; subdivision (i) defines medical practitioner to include licensed psychiatrists and psychologists; and subdivision (k) defines child protective agency to include a police or sheriff's department and a county welfare department. The scope and substance of the reporting requirement are set out in section 11167. Subdivision (a) thereof states that A telephone report of a known or suspected instance of child abuse shall include the name of the person making the report, the name of the child, the present location of the child, the nature and extent of the injury, and any other information, including information that led such person to suspect child abuse, requested by the child protective agency. Subdivision (b) further provides that Information relevant to the incident of child abuse may also be given to an investigator from a child protective agency who is investigating the known or suspected case of child abuse. (3) Together these provisions impose on psychotherapists the affirmative duty to report to a child protective agency all known and suspected instances of child abuse. Lest there be any doubt that the Legislature intended the child abuse reporting obligation to take precedence over the physician-patient or psychotherapist-patient privilege, section 11171, subdivision (b), explicitly provides an exception to these very privileges: Neither the physician-patient privilege nor the psychotherapist-patient privilege applies to information reported pursuant to this article in any court proceeding or administrative hearing. The Legislature obviously intended to provide specific exception to the general privileges set out in the Evidence Code (Evid. Code, §§ 994, 1014) so that incidents of child abuse might be promptly investigated and prosecuted. Defendant neither challenges the constitutionality of the child-abuse reporting exception to the psychotherapist-patient privilege, nor argues that the state's interest in protecting children is less than compelling. (4a) Rather, he contends that on the particular facts of his case the exception provided in Penal Code section 11171, subdivision (b), was unnecessarily and therefore erroneously applied to his confidential communications with Dr. Walker. We agree. (5) We begin by recognizing our obligation to construe narrowly any exception to the psychotherapist-patient privilege: we must apply such an exception only when the patient's case falls squarely within its ambit. ( In re Lifschutz, supra, 2 Cal.3d at p. 435.) We therefore examine in detail the sequence of events in this case. The record reveals that Dr. Walker contacted the welfare agency immediately after his consultation with Sarah on July 28, before he met with defendant. When Deputy Buttell first telephoned to investigate this report Dr. Walker elaborated in detail on Sarah's revelations. As defendant concedes, Sarah's communications were not privileged because Evidence Code section 1027 provides an exception when, as here, the patient is under 16 years of age and the psychotherapist has reason to believe that the patient has been the victim of a crime and that disclosure of the communication is in the best interest of the child. (Fn. 1, ante. ) After Dr. Walker had seen defendant on July 29, Deputy Buttell called again and asked the psychotherapist to disclose the substance of defendant's communications. Although Buttell persuaded him that the act overrode the privilege and thus elicited the therapist's response, under the circumstances the doctor was not legally obligated to discuss Sarah's case with him again. It is clear from the record that in his own therapeutic consultation defendant gave Dr. Walker no reason to suspect any additional criminal activity, beyond the incidents described by Sarah earlier and already reported. In his first tape-recorded conversation with the deputy Dr. Walker indicated that Sarah had been uncertain how many fondling incidents had occurred but, in response to his questioning, had said she thought there might have been 10 or more. He also related that Sarah had denied there had been oral copulation or sexual intercourse. In his trial testimony Dr. Walker stated that defendant had told him there had been approximately six fondling incidents and, again, no oral copulation or sexual intercourse. Thus defendant at most only confirmed what the doctor had already reported to Deputy Buttell in their first conversation, following Sarah's consultation. (4b) Dr. Walker was under no statutory obligation to make a second report concerning the same activity. Had he learned from defendant of possible further child abuse  whether additional incidents involving Sarah, or other incidents with another child  he would, of course, have been required to report these new suspicions. Or, if Dr. Walker had first learned of the fondling incidents from defendant himself, he would have been bound to report that information as provided in the act. However, on the facts of this case, we conclude that Dr. Walker satisfied his statutory reporting obligation when he divulged Sarah's revelations; he was not required to reiterate his suspicion following consultation with defendant. The exception to the psychotherapist-patient privilege set out in the Child Abuse Reporting Act applies only to information reported pursuant to this article.... (Pen. Code, § 11171, subd. (b).) In this case, Dr. Walker reported his suspicion of child abuse following his consultation with Sarah, pursuant to section 11167, subdivision (a), of the act. He was not then required to make a second report of the same incidents, based on defendant's subsequent redundant communications. Although section 11167, subdivision (b), provides that a psychotherapist may report information relevant to the incident of child abuse beyond the fact of the incident itself, it would be highly inappropriate to apply subdivision (b) in this case. The record makes clear that although Dr. Walker voluntarily reported Sarah's disclosure of her sexual relations with her stepfather, he did not want to disclose defendant's confidential communications on the identical subject. He did so only at the behest of deputy Buttell, who misled him into believing he was required to do so by law. It was therefore error to admit Dr. Walker's testimony concerning his consultation with defendant. We have recognized the contemporary value of the psychiatric profession, and its potential for the relief of emotional disturbances and of the inevitable tensions produced in our modern, complex society. (See, e.g., In re Lifschutz, supra, 2 Cal.3d 415, 421; Tarasoff v. Regents of University of California (1976) 17 Cal.3d 425, 440-441 [131 Cal. Rptr. 14, 551 P.2d 334, 83 A.L.R.3d 1166].) That value is bottomed on a confidential relationship; but the doctor can be of assistance only if the patient may freely relate his thoughts and actions, his fears and fantasies, his strengths and weaknesses, in a completely uninhibited manner. If the psychiatrist is compelled to go beyond an initial report to authorities regarding a suspected child abuse and must thereafter repeat details given to him by the adult patient in subsequent sessions, candor and integrity would require the doctor to advise the patient at the outset that he will violate his confidence and will inform law enforcement of their discussions. Under such circumstances it is impossible to conceive of any meaningful therapy. Ironically, in this case medical help was initially what this distraught family sought as a result of these tragic events.