Opinion ID: 2402231
Heading Depth: 1
Heading Rank: 14

Heading: Confidential Health-Care Information

Text: Similarly, further explanation by the motion justice is needed concerning whether the privilege created by the Confidentiality of Health Care Information Act insulates any of the 750 pages of documents. This Court has had occasion to delimit the application of the act in judicial proceedings. In Bartlett v. Danti, 503 A.2d 515 (R.I. 1986), this Court declared § 5-37.3-6 unconstitutional because it rendered confidential health-care information not subject to compulsory legal process in any judicial proceedings. Bartlett, 503 A.2d at 517. We held that this prohibition intruded upon the judicial power and violated the separation of powers guarantee of the Rhode Island Constitution because it remove[d] from the court's discretion the determination of admissibility of otherwise relevant evidence. Id. We later declared unconstitutional a similar statute enacted a few months subsequent to our decision in Bartlett in an obvious attempt to avoid our declaration of unconstitutionality   . Almonte, 644 A.2d at 298. In doing so, this Court could not allow the Legislature to create such a sweeping privilege with regard to health-care information as to cripple the ability of the Judiciary to try and determine a wide range of civil and criminal cases. Id. We since have described Almonte as holding that the Legislature was not precluded from legislating in this area, but could not enact a statute that unequivocally impinge[d] upon the power of the Judiciary in carrying out its fact finding function. In re Doe Grand Jury Proceedings, 717 A.2d 1129, 1132 (R.I.1998). The Legislature responded to our holding in Almonte by enacting § 5-37.3-6.1, a third attempt to harmonize the need to protect confidential health-care information with the exclusive authority of the Judiciary to decide the admissibility of evidence in its tribunals. See Washburn v. Rite Aid Corp., 695 A.2d 495, 498 n. 5 (R.I.1997). Section 5-37.3-6.1 sets forth a statutory procedure for the disclosure of confidential health-care information in connection with judicial proceedings. Section 5-37.3-6.1 provides, in relevant part: (a) Except as provided in § 5-37.3-6, a health care provider or custodian of health care information may disclose confidential health care information in a judicial proceeding if the disclosure is pursuant to a subpoena and the provider or custodian is provided written certification by the party issuing the subpoena that: (1) A copy of the subpoena has been served by the party on the individual whose records are being sought on or before the date the subpoena was served, together with a notice of the individual's right to challenge the subpoena; or, if the individual cannot be located within this jurisdiction, that an affidavit of that fact is provided; and (2) Twenty (20) days have passed from the date of service on the individual and within that time period the individual has not initiated a challenge; or (3) Disclosure is ordered by a court after challenge.   . (Emphasis added.) This Court, in In re Doe Grand Jury Proceedings, 717 A.2d at 1132, noted that the Confidentiality of Health Care Information Act was intended `to establish safeguards for maintaining the integrity of confidential health-care information that relates to an individual. ' Id. (quoting In re Grand Jury Investigation, 441 A.2d 525, 528 (R.I.1982)) (emphasis added). We concluded that § 5-37.3-6.1 struck a permissible balance between a party's interest in maintaining the confidentiality of his or her personal health care records and the court's need to access relevant information. Doe, 717 A.2d at 1133. Thus, at least with respect to known, personally identifiable health-care records, § 5-37.3-6.1 sets forth a procedure by which the person whose records are sought is provided notice and an opportunity to contest their production or seek to limit their disclosure or use. That is not the situation with which we currently are faced. The plaintiff in this case has not sought health-care records personally identifiable to a particular patient. Rather, plaintiff requested information that was reviewed by the hospital in the course of its credentialing decisions. Thus, because the individuals whose records defendants assert are privileged have not been identified to plaintiff, compliance with § 5-37.3-6.1 is impossible. The plaintiff cannot be expected to serve a copy of a subpoena on an unknown putative patient or to obtain his or her acquiescence to access an as-yet-unidentified document. Moreover, plaintiff is attempting to prove that the hospital negligently credentialed Dr. Samson, a claim that can be proved without the need to identify a particular individual. In response to the hospital's claim that some documents were protected by the Confidentiality of Health Care Information Act, plaintiff requested and was granted an in camera review of the records. The motion justice ordered the disclosure of all documents without identifying any confidential health-care records, although she ordered that some records be redacted. The Confidentiality of Health Care Information Act is not a shield behind which a medical provider may hide to avoid liability for medical negligence or for any other purpose. Cf. In re Grand Jury Investigation, 441 A.2d at 531-32 (holding that the Confidentiality of Health Care Information Act cannot be used to prevent the subpoenaing of a physician's records of a patient's treatment during a criminal investigation of alleged Medicaid fraud, and the privilege must give way to fraud investigations). This Court has declared that privileges do not aid the quest for truth, the core function of the adversary process, see Almonte, 644 A.2d at 298, and, therefore, privileges should narrowly be construed, see von Bulow, 475 A.2d at 1006 (Because the attorney-client privilege limits the full disclosure of the truth, it must be narrowly construed.); see also University of Pennsylvania v. Equal Employment Opportunity Commission, 493 U.S. 182, 189, 110 S.Ct. 577, 107 L.Ed.2d 571 (1990) (We are especially reluctant to recognize a privilege in an area where it appears that Congress has considered the relevant competing concerns but has not provided the privilege itself.). Accordingly, we are of the opinion that in camera review and redaction of personally identifying patient information is an appropriate procedure to decide whether the documents should be produced. However, the trial justice failed to make a record finding about which documents, if any, met the definition of personally identifiable confidential health-care information as set forth in § 5-37.3-3(13), and, if so, whether the records could be produced after they were redacted. We remand this case for that determination. 3