Opinion ID: 1414591
Heading Depth: 1
Heading Rank: 2

Heading: The Medical Histories

Text: Plaintiffs object to a trial court order, claiming that it is harassing and abusive, because it required them to list the dates and nature of their prior physical injuries and the nature and duration of treatment received for emotional disturbances. In my opinion the trial court acted well within its discretion and in accordance with correct discovery practice in ordering such disclosure. It must be noted that the order in question did not require plaintiffs to furnish any medical records or physicians' reports. Rather, they are ordered only to provide defendant with a description of prior physical injuries for which medical treatment was received along with a general description of each incident, the nature and duration of treatment therefor, and the nature and duration of any treatment for mental or emotional injury or illness. Such a discovery order, given plaintiffs' general allegations of injuries, cannot be fairly described as harassing. The information defendant seeks is directly relevant to its defense. As previously noted, plaintiffs' claims of injury are broad and sweeping, as shown by their allegations that as a result of airport noise plaintiffs have been injured in their health, strength, and activity, have sustained bodily injuries and shock and injury to the nervous system, emotional upset, irritability and loss of hearing, all of which causes physical and mental pain and suffering and which impairs plaintiffs' work and functioning. The complaint, now in its third amended form, does not, of course, specifically identify the precise nature of the mental or physical injury sustained by each of the 936 plaintiffs. This is not a class action. The very generality of the claimed injuries underscores the primary importance of discovery in seeking to ascertain the degree, if any, to which particular plaintiffs' alleged mental and physical injuries can properly be attributed to causes other than the noise, smoke, and fumes generated at Lindbergh Field. The majority, in considering the request for medical histories, commits a serious analytical error. It characterizes sections 990 and following, and 1010 and following, of the Evidence Code, relating to the physician- and psychotherapist-patient relationship, as the relevant statutory provisions. Noting the existence of a privilege of confidentiality in communications with the patient extending to medical histories and that sections 996 and 1016 constitute exceptions, the majority concludes that The resolution of the instant case turns on the proper interpretation of the scope of these statutory exceptions. ( Ante, p. 863.) However, both sections 996 and 1016 are concerned with privileged communication, a term which is specifically defined in sections 992 and 1012 as information, including information obtained by an examination of the patient, transmitted between a patient and a physician [or psychotherapist] in the course of that relationship.... (Italics added.) A cursory examination of the interrogatories in question (see ante, p. 850) quickly discloses that much of the information requested, such as the mere fact of the existence of prior injury or medical treatment, cannot be deemed communication in any form within the definition of the cited sections. The majority's conclusion that none of the requested information is the proper object of discovery appears to ignore the basic legal concept, set forth in Greyhound v. Superior Court, supra , that The trial courts in exercising their discretion should keep in mind that the Legislature has suggested that, where possible, the courts should impose partial limitations rather than outright denial of discovery;... (56 Cal.2d at p. 383, italics added.) The majority would have demonstrated greater adherence to this principle by directing the trial court to review the interrogatories with a view to a possible limitation, given the claim of privileged communication, rather than by denial of discovery altogether. Having laid a shaky statutory foundation, the majority constructs its argument from carefully selected quotations contained in cases which, on close inspection, underscore the weakness of the majority theses. Heavy reliance is placed, for example, on our expressions in In re Lifschutz (1970) 2 Cal.3d 415 [85 Cal. Rptr. 829, 467 P.2d 557, 44 A.L.R.3d 1], and Roberts v. Superior Court (1973) 9 Cal.3d 330 [107 Cal. Rptr. 309, 508 P.2d 309]. I suggest that neither case supports the majority's conclusion that the requested material was either privileged or irrelevant and therefore not discoverable. In Lifschutz we dealt with a substantially similar issue and our holding seems to me to be entirely contrary to the position urged by the majority. In that action for damages from an alleged assault, a psychiatrist was imprisoned for contempt for refusing to obey an order of the trial court which had instructed him to answer deposition questions and to produce records relating to communications with a former patient. The complaint alleged physical injuries, pain and suffering, and severe emotional distress. During the course of his deposition plaintiff admitted that he had received treatment from psychiatrist Lifschutz approximately 10 years earlier. The majority's lengthy quotation from Lifschutz serves only to reaffirm a point not in dispute, namely, that the scope of the inquiry permitted depends upon the nature of the injuries which the patient-litigant himself has brought before the court. (2 Cal.3d at p. 435.) Had the majority elected, however, to extend the quotation it would have reaffirmed our expression which has much greater significance to the matter before us, for we immediately continued, In some situations, the patient's pleadings may clearly demonstrate that his entire mental condition is being placed in issue and that records of past psychotherapy will clearly be relevant.  ( Ibid., italics added.) We further noted: In other cases, however, the determination of the specific `mental condition' in issue may present more complex problems. The difficulties involved in analyzing the applicability of the exception in the instant case may be illustrative. The plaintiff's complaint, containing the typical allegations of `mental and emotional distress' arising out of a physical assault, does not specifically identify the nature of the `mental or emotional condition' at issue.... The generality of the claim ... does create the possibility that some feature of plaintiff's psychological history will be directly relevant to the determination of whether his emotional or mental distress can be properly attributed to the alleged assault. ... [W]e cannot determine from the present state of the record whether plaintiff's `mental and emotional' distress is merely the `normal' distress experienced as a result of physical assault or whether it includes unusual or particularly serious elements upon which prior history may be directly relevant. (P. 436, italics added.) As noted, in our instant case plaintiffs allege shock and injury to the nervous system, emotional upset, irritability ... which causes mental pain and suffering. The majority ignores the true and clear analogy between Lifschutz and the instant case. With more than 900 plaintiffs making complaints which reflect a wide variety of mental and physical conditions, it is impossible for us to determine from the state of the record whether and to what extent the prior history of any particular plaintiff could or could not lead to the discovery of evidence relevant to his complaint. Acknowledging that the evidence may have contained relevant material, in Lifschutz we held that the petitioner-psychiatrist had no right to refuse to produce the records in question even though the records were 10 years old. Furthermore, we held that ... the burden rests upon the patient initially to submit some showing that a given confidential communication is not directly related to the issue he has tendered to the court. ( Ibid. ) Plaintiffs have declined to delimit the areas of emotional and physical injury for which they seek recovery. Rather, they make only the most generalized assertions in this regard. Surely, in fairness, defendant is entitled to attempt to show in this civil action that there were independent causes, other than airport noise, for any emotional and physical conditions of which plaintiffs complain. It is self-evident that the human body is an integrated system; various conditions and injuries are not capable of being neatly categorized and catalogued into clearly separable functions and conditions by medical experts; there is a physiological interrelationship. This is particularly true in an area so fraught with uncertain etiology as emotional upset and mental pain and suffering. The defendant should be permitted to develop facts, if it is able to do so, showing that some or all of the injuries claimed by plaintiffs in fact resulted from sources other than the airport. The interrogatories objected to by plaintiffs are the first logical step in accomplishing that objective. In Roberts v. Superior Court, supra, 9 Cal.3d 330, we reaffirmed Lifschutz' narrow interpretation of the scope of the patient-physician exception, but nothing that we said in Roberts supports plaintiffs' contention that the discovery order in the instant case is impermissibly overbroad. Plaintiff in Roberts claimed no damages for emotional distress or mental suffering. She sought only redress for pain in her neck, back, and legs. She had been asked questions concerning, and had described, previous illnesses and institutional confinement. She had, in fact, delivered to defendant various reports of the physicians who had treated her both before and after the collision from which the suit arose. Plaintiff objected to discovery only when defendants subpoenaed all of her medical records in the custody of the various physicians who had treated her, including those of her psychotherapist. In Roberts, holding that the requested discovery exceeded permissible boundaries, we noted, A fortiori, in a case such as this where there is no specific mental condition of the patient at issue, and discovery of the privileged communications is sought merely upon speculation that there may be a `connection' between the patient's past psychiatric treatment and some `mental component' of his present injury, those communications should remain protected by the privilege of section 1014. ( Id., at p. 339, italics added.) In sharp contrast, as I have noted, the present plaintiffs have made a specific complaint that the noise level at the airport caused them to suffer emotional distress. Plaintiffs have placed the subject in issue and, unlike Roberts, the inquiries of defendant as to the mere fact of past medical treatments of plaintiffs are thus directly relevant to a specific mental condition voluntarily and expressly raised in the present litigation and initiated by plaintiffs. It will be observed that discovery in this matter, a massive undertaking at best, can occur in one of two ways: Defendant can conduct oral depositions of the 936 plaintiffs. If three depositions a day are conducted five days per week, approximately one year and two months will be consumed. Doubtless the cost on either side will be extremely high. The alternative is through use of written interrogatories, attempting thereby to identify the more serious claims and to focus on them. This apparently is what defendant seeks, and it should be permitted to do so. The majority's statutory and legal analysis fails to survive close scrutiny. However, my concern with the majority's misreading of precedent is overshadowed by what I view as its substantial reassignment of roles in the matter of pretrial discovery. I had thought it generally accepted that the tasks of determining what material is discoverable, what is relevant, and what is privileged, were primarily functions of the trial court. The majority, unaccountably, has determined that this duty can best be discharged by plaintiffs themselves. The majority commends plaintiffs because they are completely willing to provide defendant with medical information which relates in any way to the physical or emotional injuries for which they seek recovery. ( Ante, p. 862 italics added.) But the vital, unanswered question is, who decides what information relates to the claimed injuries? The majority concludes that [t]he trial court thus obviously erred in ordering plaintiffs to disclose to defendant their entire lifetime medical histories ( ante, p. 864), and that plaintiffs are entitled to retain the confidentiality of all unrelated medical or psychotherapeutic treatment they may have undergone in the past. ( Ibid., italics added.) It is clear that the majority intends that the plaintiffs are to determine what is unrelated. The majority fails to comment, as we did in Lifschutz, on the obvious important relationship between plaintiffs' medical history and their present health. This is most strange. The majority's formulation permits plaintiffs to serve as their own medical experts, picking and choosing between various injuries and diseases and deciding for themselves which are, or are not, relevant to the injuries which they presently claim. A particular plaintiff thereby becomes his own judge, thus depriving defendant of any opportunity to contest plaintiffs' determination of relevancy. Such a result is unthinkable, for it contravenes every sound principle of fair and open discovery. It permits a plaintiff carefully, selectively, and conveniently to draw a curtain around those portions of his medical background which he elects not to disclose. Moreover, medical histories have their primary value and significance when subjected to medical not lay evaluation and review. An injury or disease which, to a litigant, may seem wholly irrelevant, may be clinically significant to a physician. The power to determine relevance in the discovery area should remain where it properly has been, with the trial court empowered to issue the discovery orders. If in the proper pursuit of relevant probative evidence defendant's inquiries constitute harassment, Code of Civil Procedure section 2019, subdivision (b)(1), offers a remedy. It permits the court to make any other order which justice requires to protect the party or witness from annoyance, embarassment or oppression. As we noted in Lifschutz, when inquiry into the confidential relationship takes place before trial during discovery ... the patient ... may apply to the trial court for a protective order to limit the scope of the inquiry or to regulate the procedure of the inquiry so as to best preserve the rights of the patient. (2 Cal.3d at p. 437.) The availability of these protective orders remains as security against abuse. In Bakman v. Superior Court, supra, 63 Cal. App.3d 306, the court observed that, The issue narrows to whether real party's statutory right to pursue legitimate discovery procedures and the state's compelling interest in the enforcement of such procedures outweighs the deterring effect the disclosure sought has upon the First Amendment right to freedom of association of the persons whose identities real party is seeking to discover, so that it can be said, fairly, that under the facts of this case the qualified constitutional privilege must yield to a more compelling state purpose. We have concluded that the answer to this question is in the affirmative. (P. 315, italics in original.) In the matter before us the requested medical histories were not privileged information and were clearly relevant to the defense which defendant sought to prepare and establish. The request for such discovery was a reasonable and necessary request, and the trial court acted properly within its discretion in permitting such discovery. As with the unanimous Courts of Appeal, both in Bakman and herein, I would affirm the trial court's order of discovery.