Opinion ID: 887039
Heading Depth: 1
Heading Rank: 3

Heading: Medical and Mental Health Records

Text: ¶ 35 The District Court has inherent discretionary power to control discovery based on its authority to control trial administration. Anderson v. Werner Enterprises, Inc., 1998 MT 333, ¶ 13, 292 Mont. 284, ¶ 13, 972 P.2d 806, ¶ 13. We review a district court's rulings on discovery motions for an abuse of discretion. Anderson, ¶ 13. The party claiming error in the district court's discovery rulings must show prejudice. Anderson, ¶ 13. We will reverse these discretionary rulings only when the court's judgment may materially affect the substantial rights of the complaining party and allow the possibility of a miscarriage of justice. Anderson, ¶ 13. ¶ 36 Medical records are private and deserve the utmost constitutional protection. State v. Nelson (1997), 283 Mont. 231, 242, 941 P.2d 441, 448. Article II, Section 10, of the Montana Constitution guarantees informational privacy in the sanctity of one's medical records. Nelson, 283 Mont. at 242, 941 P.2d at 448. However, [w]hen a party claims damages for physical or mental injury, he or she places the extent of that physical or mental injury at issue and waives his or her statutory right to confidentiality to the extent that it is necessary for a defendant to discover whether plaintiff's current medical or physical condition is the result of some other cause. State ex rel. Mapes v. District Court (1991), 250 Mont. 524, 530, 822 P.2d 91, 94. Nonetheless, the waiver is not unlimited; the defendant may only discover records related to prior physical or mental conditions if they relate to currently claimed damages. The plaintiff's right to confidentiality is balanced against the defendant's right to defend itself in an informed manner. State ex rel. Mapes, 250 Mont. at 530, 822 P.2d at 94. A defendant is not entitled to unnecessarily invade plaintiff's privacy by exploring totally unrelated or irrelevant matters. State ex rel. Mapes, 250 Mont. at 530, 822 P.2d at 95. ¶ 37 The District Court denied the State's motion to compel production of all Kristin's health care records (including medical and counseling records) from before and after Hunter's fall and granted a protective order on the basis that the records were constitutionally protected, irrelevant to the issues in this case, and therefore not discoverable. The court conducted an in camera review of Kristin's medical records. An in camera review is often used at various stages throughout discovery and trial to balance the privacy interests of the parties and the need to know. The in camera procedure can effectively offer protection to both parties by avoiding needless exposure of potentially harmful information. State v. Burns (1992), 253 Mont. 37, 39, 830 P.2d 1318, 1319-20. The court can preview potentially damaging information before it is released, Burns, 253 Mont. at 39, 830 P.2d at 1320, and decide what information is properly discoverable, In re Lacy (1989), 239 Mont. 321, 326, 780 P.2d 186, 189. ¶ 38 A defendant is not allowed unfettered access to all medical records he believes may help his defense. In State v. Mix , the trial court refused access to records because the subject matter was irrelevant and too remote to the case. State v. Mix (1989), 239 Mont. 351, 360, 781 P.2d 751, 756. In that case, a defendant charged with deliberate homicide sought medical records regarding the victim's asthma condition. Mix, 239 Mont. at 360, 781 P.2d at 756. ¶ 39 In the present case, Kristin commenced an action for damages for her personal injuries which placed in issue her mental and physical condition arising from the accident. Jaap v. District Court (1981), 191 Mont. 319, 322, 623 P.2d 1389, 1391; State ex rel. Mapes, 250 Mont. at 530, 822 P.2d at 94. In doing this, she waived any physician-patient privilege as to a mental or physical condition in controversy. Jaap, 191 Mont. at 322, 623 P.2d at 1391; Rule 35(b)(2), M.R.Civ.P. This includes testimony her physicians may have provided concerning her prior mental condition. Kristin did not produce records from before Hunter's accident because the records were sensitive and personal. She did produce redacted medical records for the period after Hunter's accident which she determined were relevant. The State did view the redacted portion of Kristin's medical records. However, the State sought all Kristin's mental and medical health records from ten years before Hunter's accident (1985) through time of trial. ¶ 40 Kristin claims that because she provided her doctors with complete copies of the disputed medical records, and her doctors stated the records showed no causal correlation between any previous injury or condition and her current injuries, this ends the inquiry into the medical records. Kristin argues that the State should be denied access to the records because it did not present any expert medical opinion that her alleged injuries were more probably than not caused by some factor other than witnessing Hunter's fall. The fallacy in this argument is that there was no way that the State could have provided this opinion because it was denied access to the very records which would have enabled it to make this determination. The court's denial of these records only allowed for one-sided review of the medical records by Kristin's physicians. ¶ 41 The State was prejudiced when it was denied the right to defend itself in an informed manner. It had the right to discover evidence related to prior physical or mental conditions possibly connected to Kristin's current damages. State ex rel. Mapes, 250 Mont. at 530, 822 P.2d at 94. The State is not entitled to unnecessarily invade Kristin's privacy by exploring totally unrelated or irrelevant matters. State ex rel. Mapes, 250 Mont. at 530, 822 P.2d at 95. However, because Kristin presented her entire medical records file to her treating physicians and asked for their expert medical opinions, which were at least in part based on the records which were denied to the defense, she waived her statutory right to confidentiality but only to the extent that it is necessary for the State to discover for itself whether Kristin's current medical or physical condition is the result of some other cause. State ex rel. Mapes, 250 Mont. at 530, 822 P.2d at 94. The State thus has a right to review Kristin's medical records to determine whether her present condition is attributable to some preexisting cause. ¶ 42 The similarity between Kristin's present claims and those for which she was previously treated shows the possible correlation between her pre-accident records and her present claims. Kristin's claims involve emotional distress, loss of consortium, and post-traumatic stress disorder (PTSD). The record indicates that prior to Hunter's accident, she was taking medications which can be used to treat depression, headaches, sleep disorders, and anxiety. The connection between Kristin's present claims and her past conditions is not attenuated as it was in Mix where access to records was denied. Mix, 239 Mont. at 360, 781 P.2d at 756. Accordingly, we reverse the District Court's denial of the State's motion to compel production of the medical records. Financial Documents, School Transcripts, and Personnel Records ¶ 43 The District Court granted an order protecting Kristin's financial documents, school transcript, and personnel records. The State sought to have these records produced in an effort to quantify Kristin's damages. However, the court ruled that Kristin's statement of damages was sufficient and the documents were not likely to lead to discovery of any relevant information. ¶ 44 Because the State is the party alleging error in the District Court's discovery rulings, the State must show how it was prejudiced by the trial court's ruling. Anderson, ¶ 13. Kristin does not claim lost earnings or lost earning capacity; rather her mental and emotional states are at issue. The requested documents have no bearing on these legitimate issues. The State fails to show that the denial of the requested documents substantially prejudiced it or impaired its ability to present a defense. We find no abuse of discretion. We affirm. ¶ 45 Issue 4: Whether the District Court erred in not allowing the State to depose Hunter or to call him as a witness? ¶ 46 We review a grant or denial of a motion in limine for an abuse of discretion. Bramble v. State, 1999 MT 132, ¶ 16, 294 Mont. 501, ¶ 16, 982 P.2d 464, ¶ 16. We will not overturn a district court's ruling on discovery unless the party alleging error proves an abuse of discretion and resulting prejudice. Anderson, ¶ 13. Rule 26(c), M.R.Civ.P., allows a court to make any order which justice requires to protect a party or person from annoyance, embarrassment, oppression, or undue burden ... including... that the discovery not be had[.] There is no minimum age requirement with regard to child testimony. State v. Eiler (1988), 234 Mont. 38, 42, 762 P.2d 210, 213 (testimony from four-year-old and five-year-old children allowed). However, child witnesses need protection against the potential emotional and psychological injuries that may occur with regular litigation procedures. State v. Sor-Lokken (1991), 247 Mont. 343, 349, 805 P.2d 1367, 1372. Furthermore, needlessly cumulative evidence may be excluded. Rule 403, M.R.Evid. ¶ 47 The District Court issued a protective order precluding a deposition of Hunter and reaffirmed this decision when it granted a motion in limine to exclude Hunter as a witness. The court reasoned that because Hunter was only three years old at the time of the accident, and only nine years old at the time of the trial, little probative information could be gained by forcing him to testify regarding the stress his mother suffers because of his head injury. The court also stated that such testimony would be traumatic and unduly burdensome to Hunter. Additionally, any information Hunter could have provided was available from other witnesses, such as physicians and school teachers, and thus would be cumulative. Rule 403, M.R.Evid. ¶ 48 The State has failed to show prejudice resulting from the exclusion of Hunter's testimony. Due to his young age, Hunter does not remember the accident or his mother's condition before the accident. He could not testify as to how the accident changed her life. The State had the opportunity to question Kristin and other adult witnesses regarding her condition before and after Hunter's accident. ¶ 49 Furthermore, because the State had the opportunity to use expert witness testimony regarding Hunter's condition, it did not need Hunter to testify regarding the effects the accident had on him. The State listed Dr. Bach as an expert witness for Kristin's trial to present testimony based on his examination of Hunter and also to report on Hunter's past and present condition. Since the State could have used Dr. Bach's testimony but chose not to, it was not prejudiced by the inability to call Hunter as a witness. The court did not act arbitrarily without conscientious judgment and did not abuse its discretion. We affirm the order of the court protecting Hunter from having to testify at deposition or at trial. ¶ 50 Issue 5: Whether the District Court erred in prohibiting the State from conducting an IME and in excluding the State's expert witness? ¶ 51 We review a district court's rulings on discovery motions for an abuse of discretion. Anderson, ¶ 13. Rule 35, M.R.Civ.P., recognizes an independent medical examination (IME) as a form of discovery. This Court has recognized an IME as a valid tool to determine if and to what extent a defendant suffers from an alleged injury. Winslow v. Montana Rail Link, 2001 MT 269, ¶ 16, 307 Mont. 269, ¶ 16, 38 P.3d 148, ¶ 16. A plaintiff in a negligence action who asserts mental or physical injury places that mental or physical injury clearly in controversy and provides the defendant with good cause for an examination to determine the existence and extent of such asserted injury. Winslow, ¶ 9 (citation and internal citation omitted). Thus if a plaintiff alleges mental or physical injury, he or she puts the existence of that injury at issue and provides the defendant with good cause to request that an IME be conducted. Winslow, ¶ 9. ¶ 52 In this case, the court issued a scheduling order that required exchange of all expert witnesses (including a comprehensive statement of the proposed expert's opinions and the grounds for the opinions) by November 15, 2001. The discovery deadline was December 15, 2001. The court amended the deadline for taking depositions to January 25, 2002. ¶ 53 As early as September 23, 1997, and numerous times thereafter, the State had access to records that indicated Kristin suffered from emotional distress resulting from her son's injuries. However, it was not until October 22, 2001, that Kristin used, for the first time, the term on-going post traumatic stress in a supplemental discovery response. Kristin's November 15, 2001, expert witness disclosure stated that Dr. Erin Bigler believed Kristin suffered from PTSD. On this same day, the State disclosed Dr. Price as an expert witness, and reserved the right to conduct an IME of Kristin. The State disclosed Dr. Price's general opinion without details because he had not yet performed the IME. On November 30, 2001, the State requested Kristin submit to an IME. Kristin did not make herself available for this examination. ¶ 54 On December 6, 2001, the State moved the court to order Kristin to submit to an emergency IME because it had not been previously informed Kristin suffered from PTSD. This motion, made before the discovery deadline, was initially granted. However, the IME was later denied because, after reconsideration, the court determined that since the State knew of Kristin's PTSD since September 1997, the request for the IME came too late in the proceedings. We are not so persuaded. ¶ 55 Kristin claims the State had four years to conduct an IME because she provided the State with her mental health records from 1997 which contained the PTSD diagnosis. Nonetheless, the mere existence of the record is insufficient notice that she was planning to use this diagnosis as a basis for damages in the present lawsuit. The State did not know that fact until the supplemental discovery response from October of 2001. Upon learning this, the State timely filed its motions to have Kristin undergo an IME so that the State could adequately prepare its defense. If Kristin had earlier revealed the fact that she was going to use the PTSD diagnosis as a basis for damages, the State would not have been forced to run so close to the ever-looming discovery deadline. As it was, the State complied with the court's discovery deadlines. We reverse the court's denial of the State's request for an IME. ¶ 56 Now we examine the fact that Dr. Price was precluded from testifying as a witness. The State disclosed Dr. Price as an expert witness within the time-limit imposed by the scheduling order. The State twice provided the required supplementation regarding his testimony, to the extent possible given the limited amount of information with which he had to work. The court, however, barred Dr. Price from testifying as a witness because he had not conducted an IME as a basis for his testimony. Although much of the information necessary to provide a comprehensive report was not available to him because Kristin's complete medical records and the IME were denied, Dr. Price still could have testified based on his medical knowledge and the redacted medical records available to him. ¶ 57 The underlying policies of Rule 26, M.R.Civ.P., are to eliminate surprise and to promote effective cross-examination of expert witnesses. Hawkins v. Harney, 2003 MT 58, ¶ 21, 314 Mont. 384, ¶ 21, 66 P.3d 305, ¶ 21. In Scott v. E.I. Dupont De Nemours & Co. (1989), 240 Mont. 282, 286-87, 783 P.2d 938, 941, we stated that although discovery answers regarding an expert witness were very brief, the expert was not a surprise witness and refusing to allow him to testify because full and complete discovery answers were not provided was an extreme sanction. ¶ 58 In this case, the District Court sanctioned the State by preventing Dr. Price from testifying. We have identified the following criteria to determine whether a sanction is an abuse of discretion or too severe: 1) whether the consequences imposed by the sanctions relate to the extent and nature of the actual discovery abuse; 2) the extent of the prejudice to the opposing party which resulted from the discovery abuse; and 3) whether the court expressly warned the abusing party of the consequences. Maloney v. Home & Investment Center, Inc., 2000 MT 34, ¶ 35, 298 Mont. 213, ¶ 35, 994 P.2d 1124, ¶ 35. ¶ 59 Applying the above criteria, we determine that the court sanction was too severe. The discovery abuse committed by the State, if any, was a tardy request for an IME which was, nonetheless, still within the court-mandated time. An IME need not be conducted by the date set for expert disclosures. The State provided a list of expert witnesses, including Dr. Price, by the court-imposed deadline. The information provided regarding Dr. Price's testimony was sufficient to satisfy the Rule 26 requirements. The State provided the subject matter, the factual substance, and a summary of the grounds for Dr. Price's opinion. The State also supplemented Dr. Price's testimony by the deadline for all discovery to be completed. The State supplemented Dr. Price's testimony a second time, after the deadline for discovery passed but before the extended January 25, 2002, deadline for the taking of depositions. Ideally, the State would have provided all supplementation by the discovery deadline. However, the State was attempting to provide as complete a picture as possible regarding Dr. Price's testimony. If his testimony was not comprehensively described in answers to interrogatories, that was in large part due to the District Court's rulings precluding an IME and excluding full access to Kristin's medical records. ¶ 60 In addition, Dr. Price's disclosures were provided before the deadline for all depositions had passed. Any prejudice suffered by Kristin was minimal because she was well-aware Dr. Price was listed as an expert witness and she had ample time to depose him. No surprise is alleged and none occurred. In its scheduling order, the court generally warned that noncompliance with the order's provisions could result in the imposition of sanctions. However, no more specific warning was ever given. ¶ 61 Having reviewed the court's ruling in the context of the three Maloney criteria, we conclude that the court abused its discretion in not allowing Dr. Price to testify. The facts here are distinguishable from Seal v. Woodrows Pharmacy, 1999 MT 247, 296 Mont. 197, 988 P.2d 1230. In that case, we upheld a trial court's prohibition of a doctor's testimony because of continual and blatant discovery abuses when Seal refused to provide the required Rule 26 information even after being afforded numerous opportunities to do so. Seal, ¶ 25. In this case, the State did not engage in continual and blatant discovery abuses. The court should have, at a minimum, allowed Dr. Price to testify based on his review of Kristin's redacted medical records. We reverse the District Court's decision not to allow Dr. Price to testify as an expert witness. ¶ 62 Issue 6: Whether the District Court erred in excluding evidence of (1) stressors in Kristin's life unrelated to the accident and counseling services Kristin received prior to Hunter's accident; and (2) a prior fall at the MSU library? ¶ 63 We review a grant or denial of a motion in limine for an abuse of discretion. Bramble, ¶ 16. The trial court has the inherent power to deny or grant a motion in limine to ensure that a fair trial is afforded to all parties. Bramble, ¶ 16. Litigants must establish a causal connection more probable than not connecting any possible cause of a plaintiff's injuries before alternate causation testimony is allowed at trial; mere speculation is not sufficient and not admissible. Newville v. State, Dept. of Family Svcs. (1994), 267 Mont. 237, 260, 883 P.2d 793, 807. ¶ 64 A district court has broad discretion to determine whether evidence is relevant and admissible, and we will not overturn the district court's decision absent an abuse of discretion. Kissock v. Butte Convalescent Center, 1999 MT 322, ¶ 10, 297 Mont. 307, ¶ 10, 992 P.2d 1271, ¶ 10. A court may exclude relevant evidence if its probative value is substantially outweighed by the danger of unfair prejudice, confusion of the issues, needless presentation of cumulative evidence, waste of time, undue delay, or misleading the jury. Rule 403, M.R.Evid. ¶ 65 In Kimes v. Herrin (1985), 217 Mont. 330, 333, 705 P.2d 108, 110, we stated that it was an abuse of discretion for a trial court to allow testimony suggesting that a plaintiff's home environment may have caused the plaintiff's symptoms because no medical connection was established between the home environment and the appellant's symptoms. ¶ 66 The question of what caused Kristin's symptoms is critical to the issue of her damages. If any information has a tendency to make the alleged cause of the symptoms more or less probable, it would be relevant and admissible, unless otherwise provided by law. Rules 401 and 402, M.R.Evid.