Opinion ID: 774034
Heading Depth: 2
Heading Rank: 2

Heading: a prisoner's right to privacy in medical records

Text: 24 Section 1983 imposes civil liability upon any person who, acting under the color of state law, deprives another individual of any rights, privileges or immunities secured by the Constitution or laws of the United States. 42 U.S.C. S 1983. This section does not create any new substantive rights, but it provides a remedy for the violation of a federal constitutional or statutory right conferred elsewhere. Baker v. McCollan, 443 U.S. 137, 144 n.3 (1979). 25 When the defendant in a S 1983 action claims qualified immunity, a court must first determine if the plaintiff 's allegations are sufficient to establish the violation of a federal constitutional or statutory right. Wilson v. Layne, 526 U.S. 603, 609 (1999), citing Conn v. Gabbert , 526 U.S. 286, 290 (1999). 4 If the plaintiff 's allegations meet this threshold, a court must next determine whether the right that the defendant's conduct allegedly violated was a clearly established one, about which a reasonable person would have known. Id. If the plaintiff 's allegations fail to satisfy either inquiry, then a defendant is entitled to qualified immunity and dismissal of the case. Deciding this purely legal question permits courts expeditiously to weed out suits which fail the test without requiring a defendant who rightly claims qualified immunity to engage in expensive and time consuming preparation to defend the suit on its merits. Siegert v. Gilley, 500 U.S. 226, 232 (1991). 26 With this framework in mind, we must determine whether an HIV-positive inmate has a right to privacy in his medical information. If so, we must determine whether that right was clearly established in 1995.
27 An individual has a constitutional right to privacy which protects the individual interest in avoiding disclosure of personal matters. Whalen v. Roe, 429 U.S. 589, 599 (1977). We have long recognized the right to privacy in one's medical information: There can be no question that . . . medical records, which may contain intimate facts of a personal nature, are well within the ambit of materials entitled to privacy protection. United States v. Westinghouse Elec. Corp. 638 F.2d 570, 577 (3d Cir. 1980). The right to privacy in one's medical information extends to prescription records. Doe v. Southeastern Pa. Transp. Auth., 72 F.3d 1133, 1138 (3d Cir. 1995), cert. denied 519 U.S. 808 (1996) [hereinafter Doe v. SEPT A]. In Doe v. SEPTA, we acknowledged that the privacy interest in information regarding one's HIV status is particularly strong because of the stigma, potential for harassment, and risk of much harm from non-consensual dissemination of the information. Id. at 1140. 28 The District Court recognized Doe's right to privacy in his medical information, but concluded that such a right does not exist in prison. We disagree. As the Supreme Court has noted, prison inmates do not shed all fundamental protections of the Constitution at the prison gates. Wolff v. McDonnell, 418 U.S. 539, 555 (1974). Inmates retain those rights that are not inconsistent with their status as prisoners or with the legitimate penological objectives of the corrections system. Pell v. Procunier, 417 U.S. 817, 822 (1974). 29 For example, prisoners retain rights afforded by the First Amendment. O'Lone v. Shabazz, 482 U.S. 342, 348 (1987). They retain the protection of due process, Wolff, 418 U.S. at 555, 94 S.Ct. 2963, and the protection against racial discrimination. Lee v. Washington, 390 U.S. 333, 334 (1968) (per curiam). Of course, prisoners retain the Eighth Amendment's protection against cruel and unusual punishment. Wilson v. Seiter, 501 U.S. 294, 297 (1991). While many rights survive incarceration, however, it is clear that some rights retained by free citizens are necessarily extinguished by imprisonment. 30 The defendants correctly assert that prisoners do not have a Fourth Amendment right to privacy in their cells. Hudson v. Palmer, 468 U.S. 517, 529 (1984). The Supreme Court has concluded that the Fourth Amendment right to privacy, to be free from unreasonable searches, is fundamentally inconsistent with incarceration. Id. at 527. Mindful that internal security is a chief concern in prisons, the Court recognized that it would be impossible to prevent the introduction of weapons, drugs and other contraband into the premises if prisoners maintained a right of privacy in their cells. Id. Therefore, the Fourth Amendment has no applicability to a prison cell. Id. at 536. 31 However, Doe's asserted right to privacy in his medical information is completely different than the right extinguished in Hudson. See, e.g., Powell v. Schriver, 175 F.3d 107, 112 n.3 (2d Cir. 1999) (noting right to confidentiality of medical information is distinct from right of privacy implicated in Hudson); Anderson v. Romero, 72 F.3d 518, 522 (7th Cir. 1995) (same). The Hudson court confirmed that a Fourth Amendment right to be free from unreasonable searches and seizures is inconsistent with incarceration. In the instant case, Doe is asserting his Fourteenth Amendment right to privacy in his medical information. The right to nondisclosure of one's medical information emanates from a different source 5 and protects different interests than the right to be free from unreasonable searches and seizures. Compare Whalen, 429 U.S. at 598-99 97 S.Ct. 869 with Hudson, 468 U.S. at 525. 32 It is beyond question that information about one's HIV- positive status is information of the most personal kind and that an individual has an interest in protecting against the dissemination of such information. See Doe v. SEPTA, 72 F.3d at 1140; Westinghouse, 638 F.2d at 577. Moreover, a prisoner's right to privacy in this medical information is not fundamentally inconsistent with incarceration. Therefore, we join the Second Circuit in recognizing that the constitutional right to privacy in one's medical information exists in prison. See Powell, 175 F.3d at 112. 33 We acknowledge, however, that a prisoner does not enjoy a right of privacy in his medical information to the same extent as a free citizen. We do not suggest that Doe has a right to conceal this diagnosed medical condition from everyone in the corrections system. Doe's constitutional right is subject to substantial restrictions and limitations in order for correctional officials to achieve legitimate correctional goals and maintain institutional security. 34 Specifically, an inmate's constitutional right may be curtailed by a policy or regulation that is shown to be reasonably related to legitimate penological interests. Turner v. Safley, 482 U.S. 78, 89 (1987). Courts must respect the administrative concerns underlying a prison regulation, without requiring proof that the regulation is the least restrictive means of addressing those concerns. We have summarized the analysis as follows: 35 [Turner] directs courts to assess the overall reasonableness of such regulations by weighing four factors. First, there must be a valid, rational connection between the prison regulation and the legitimate governmental interest put forward to justify it, and this connection must not be so remote as to render the policy arbitrary or irrational. Second, a court must consider whether inmates retain alternative means of exercising the circumscribed right. Third, a court must take into account the costs that accommodating the right would impose on other inmates, guards, and prison resources generally. And fourth, a court must consider whether there are alternatives to the regulation that fully accommodate the prisoner's rights at de minimis cost to valid penological interests. 36 Dehart v. Horn, 227 F.3d 47, 51 (3d Cir. 2000) (en banc) (internal quotations omitted). 37 Appellant alleges that his constitutional right to privacy in his medical information was violated by three practices: the open-door examination room policy, the disclosure of his medical condition to corrections officer escorts, and the loud announcement of the names of his medications. Doe concedes that the open door examination room policy could conceivably be justified by a legitimate security interest but contends that no such interest has been advanced here. In addition, Doe maintains that the other disclosures are unrelated to any legitimate penological interests, and thus violated his right to privacy. 38 Given the disposition of the case by the District Court, defendants did not have the opportunity to come forward with any evidence of legitimate penological interests, costs of accommodating Doe's privacy interest, or availability of alternatives to the disclosures made here. Based on this undeveloped record, we are unable to assess any of the Turner factors. Rather than speculating about these factors, we ordinarily would remand for consideration by the trial court on those issues. However, we need not decide those issues in this case because of our disposition of the second prong of the qualified immunity analysis.
39 As stated earlier, the qualified immunity doctrine shields public officials from actions for damages unless their conduct was unreasonable in light of clearly established law. Harlow v. Fitzgerald, 457 U.S. 800, 818 (1982). We have recognized that qualified immunity applies if reasonable officials in the defendants' position at the relevant time could have believed, in light of what was in the decided case law, that their conduct would be lawful. Good v. Dauphin County Social Servs. for Child en & Youth, 891 F.2d 1087, 1092 (3d Cir. 1989). 40 Thus, having determined that Doe has alleged a violation of a constitutional right, we must determine whether Doe's right to privacy was clearly established in a particularized sense. Anderson v. Creighton, 483 U.S. 635, 640 (1987). The contours of the right must be sufficiently clear that a reasonable official would understand that what he is doing violates that right. Id. We do not require precise factual correspondence between the right asserted and prior case law. Good, 891 F.2d at 1092. Whether an official may be protected by qualified immunity turns on the objective legal reasonableness of the action, assessed in light of the legal rules that were clearly established at the time it was taken. Wilson v. Layne, 526 U.S. 603, 614 (1999) (internal quotes omitted). The issue is whether, given the established law and the information available to Defendants, reasonable prison officials in Defendants' positions could have believed that their conduct was lawful. See Paff v. Kaltenback, 204 F.3d 425, 431 (3d Cir. 2000). 41 Appellant makes three arguments in support of his contention that his right to privacy in his medical information was clearly established in 1995. First, Doe argues that a Pennsylvania statute both creates a right and serves to inform defendants of the existence of that right. Second, Doe argues that, by 1995, a growing consensus of other courts had held that inmates possess a right to privacy in their medical records. Finally, Doe argues that the class action settlement in Austin v. Pennsylvania Dept. of Corrections, 876 F. Supp. 1437 (E.D.Pa. 1995), put defendants on specific notice of the existence of a prisoner's constitutional right to privacy in his medical information. We address each argument in turn. 42 The Pennsylvania Confidentiality of HIV-Related Information Act, 35 P.S. S 7603, became effective March 1, 1991. Under the Act, any person who obtains confidential HIV-related information in the course of providing health or social services, or pursuant to consent, may not disclose the information, except by consent, or to certain designated persons. 35 P.S. S 7607. The state right is enforceable in a private cause of action for damages. 35 P.S.S 7610. Doe contends that he consented to the HIV test but did not consent to the various disclosures made by defendants. While Doe concedes that the state statute cannot be the basis for his federal action, he argues that prison officials could not have been acting reasonably when they were in direct violation of a clear state statute; they thus lost the protections of qualified immunity. 43 This argument misinterprets the effect of a state law on a federal constitutional claim. The Supreme Court has held that officials do not forfeit qualified immunity from suit for violation of a federal constitutional right because they failed to comply with a clear state statute. Davis v. Scherer, 468 U.S. 183, 195 (1984); see also D.R. by L.R. v. Middle Bucks Area Vocat'l Tech. School, 972 F.2d 1364, 1375-76 (3d Cir. 1992) (en banc) ([I]llegality under the state statute can neither add to nor subtract from the constitutional validity of a state's actions.) (internal quotes and citation omitted). To overcome qualified immunity, Doe's clearly established right must be the federal right on which the claim for relief is based. 6 Claims for violations of the Pennsylvania Confidentiality of HIV-Related Information Act can be vindicated in state courts, or, as Doe did here, as a supplemental claim. But the state statute cannot clearly establish the federal right for qualified immunity purposes. 44 Second, a review of decisions which had addressed the issue by 1995 reveals that no court of appeals had held that prisoners retained a constitutional right to the privacy of their medical information. In fact, only a handful of district court opinions had done so. 45 The earliest circuit opinion addressing the issue analyzed a prison policy of segregating HIV-positive inmates from the general prison population. Harris v. Thigpen, 941 F.2d 1495, 1515-1521 (11th Cir. 1991). In Harris, the Eleventh Circuit stated that the precise nature and scope of the privacy right at issue in this case is rather ill-defined. Id. at 1513. Nevertheless, the court assumed, arguendo, that HIV-positive inmates had a constitutionally-protected privacy interest in nondisclosure of their medical information. The court acknowledged that the scope of such a right, however, is far from settled, and we need not divine its precise parameters here, Id. at 1513 n. 26, because it found that the Department of Corrections' decision to segregate such inmates from the general prison population served a legitimate penological interest in reducing the transmission of HIV and reducing the threat of violence. Id. at 1521. 46 Prior to 1995, other courts of appeals likewise upheld the segregation of HIV-positive inmates from the general population. See, e.g. Camarillo v. McCarthy, 998 F.2d 638, 640 n.2 (9th Cir. 1993) (reserving question of whether HIV segregation policy is constitutional but holding officers entitled to qualified immunity); Moore v. Mabus, 976 F.2d 268, 271 (5th Cir. 1992) (finding HIV segregation policy reasonably related to legitimate penological interests). 7 Of course, the nature of the disclosures in HIV housing segregation cases is different than the disclosures Doe challenges here. 47 In 1995, the Seventh Circuit considered disclosures that are closer to the ones that occurred in the present case. Anderson v. Romero, 72 F.3d 518 (7th Cir. 1995). In Anderson, the prison superintendent told a guard, in the presence of another guard, to make sure inmate Anderson was in a cell by himself because he was HIV-positive. The information was repeated to at least one other guard. The Anderson court recognized a qualified constitutional right to confidentiality of medical records and medical communications outside of prison, but concluded that it was an open question as to whether the right applied in the prison setting. Id. at 522. The court rejected two district court opinions which had found that nonsystematic disclosures of HIV status had violated HIV -positive inmates' right to privacy and instead relied on the fact no appellate court had yet recognized the right. Id. at 523-25 (discussing Woods v. White, 689 F. Supp. 874 (W.D.Wis. 1988) aff'd 899 F.2d 17 (7th Cir. 1990) (table) and Rodriguez v. Coughlin, 1989 WL 59607 (W.D.N.Y. 1989). The Anderson court concluded that the officials were entitled to qualified immunity because, if such a right existed, it was not clearly established in 1992 nor in 1995. 8 Id. at 524. 48 We note that Doe has cited several district court cases which concluded, by 1995, that inmates have a right to privacy in their medical information. See Austin v. Pennsylvania Dept. of Corrections, 876 F . Supp. 1437 (E.D.Pa. 1995) (approving class action settlement including policies regarding treatment of HIV positive inmates); Clarkson v. Coughlin, 898 F. Supp. 1019 (S.D.N.Y. 1995) (failure to provide qualified interpreters violated deaf inmates' right to privacy); Faison v. Parker, 823 F. Supp. 1198 (E.D. Pa. 1993) (disclosure of inmate's medical conditions in presentence report did not violate right to privacy); Nolley v. County of Erie, 776 F . Supp. 715 (W.D.N.Y. 1991) (HIV-positive inmate's right to privacy violated by involuntary segregation and placing red stickers on his documents); Doe v. Coughlin, 697 F . Supp. 1234, 1238 (N.D.N.Y. 1988) (granting preliminary injunction to halt involuntary segregation of HIV-positive inmates); Woods v. White, 689 F. Supp. 874, 876 (W.D. Wis. 1988), aff'd 899 F.2d 17 (7th Cir . 1990) (table) (gratuitous disclosure of HIV-positive status to guards and inmates violated constitutional right to privacy). 49 Of course, all of these opinions are factually and legally distinguishable from the present case. Both Nolley and Doe v. Coughlin are HIV-positive inmate segregation cases. These cases conflict with the subsequent appellate HIV segregation cases, which upheld the practice. 9 See Camarillo, 998 F.2d at 640; Moore, 976 F.2d at 271; Harris, 941 F.2d at 1515-21. Likewise, the district court decision in White v. Woods was specifically considered and rejected by the Seventh Circuit's opinion in Anderson v. Romero. 72 F.3d at 525 (holding prisoners had no clearly established right to privacy in medical records in 1995). In Faison, the district court found that disclosure of an inmate's medical conditions in a court-ordered presentence report did not violate the inmate's right to privacy. 823 F . Supp. at 1205. And Clarkson v. Coughlin addressed deaf inmates, not HIV- positive ones. 898 F. Supp. at 1024. 50 In short, none of these decisions, individually or collectively, makes it sufficiently clear to reasonable officials that their conduct violated a prisoner's federal constitutional right. District court opinions may be relevant to the determination of when a right was clearly established for qualified immunity analysis. 10 However, in this case, the absence of binding precedent in this circuit, 11 the doubts expressed by the most analogous appellate holding, together with the conflict among a handful of district court opinions, undermines any claim that the right was clearly established in 1995. 51 Finally, we address Doe's argument regarding the settlement in Austin v. Pennsylvania Dept. of Corrections, 876 F. Supp. 1437 (E.D.Pa. 1995). In Austin, the district court accepted a negotiated settlement between a class of inmates and the Pennsylvania Department of Corrections over numerous prison conditions, including medical care. As part of the settlement, the DOC agreed to keep inmates' medical information regarding their HIV status confidential and to advocate a universal precautions policy instead of a notification policy in future union negotiations. Id. at 1453. Doe argues that, in light of the Austin settlement, prison officials could not reasonably believe that non-consensual disclosures of an inmate's HIV status were lawful. 52 We agree that, in some ways, the Austin settlement is more persuasive than the scattered district court opinions previously discussed. Austin has significant factual correspondence to Doe's case. In addition, the opinion documents the participation of the DOC in lengthy negotiations regarding treatment of HIV-positive inmates to settle the class action. Cf. Buckley v. Rogerson , 133 F.3d 1125, 1130-31 (8th Cir. 1998) (district court class action judgment against Missouri state prison system clearly established right for Iowa state prisoner to over come qualified immunity defense). 53 Nevertheless, Austin is also less persuasive than other district court opinions. Rather than providing a decision on the legal merits of the claims, the Austin court merely approved a settlement. As the Austin court itself noted, it only evaluate[ed] the probable outcome of the litigation and [was] not required to weigh and decide each contention. Austin, 876 F. Supp. at 1464 n.16. The Austin court's statement about the constitutionality of disclosing an inmate's medical information was in response to proposed, and rejected, courses of conduct. 12 The legal conclusion regarding the constitutional right to privacy was dictum. It was not binding on the parties and it certainly did not clearly establish a constitutional right. 54 Nor can the fact that the DOC agreed to settle a case clearly establish a federal constitutional right. The law favors settlement, particularly in class actions and other complex cases, to conserve judicial resources and reduce parties' costs. See In Re General Motors Corp. Pick-Up Truck Fuel Tank Litig., 55 F.3d 768, 784 (3d Cir.) cert. denied, General Motors v. French, 516 U.S. 824 (1995). Where, as in Austin, the factual and legal issues were numerous, broad and complex, the decision to settle a case cannot be elevated to the recognition of a constitutional right. 55 Based on the foregoing, we cannot conclude that the cited authorities, individually or in combination, clearly established an inmate's constitutional right to privacy in his medical information. Government officials must stay abreast of constitutional developments, but they are not expected to predict the future course of constitutional law. Wilson v. Layne, 526 U.S. at 617. We conclude that the contours of defendants' legal obligations under the Constitution were not sufficiently clear in 1995 that a reasonable prison official would understand that the non- consensual disclosure of a prisoner's HIV status violates the Constitution. Accordingly, we will affirm the District Court order granting Defendants qualified immunity from Plaintiff 's claims. 13
56 Although the exact boundaries of such a right have yet to be established, we hold today that prison inmates retain a Fourteenth Amendment substantive due process right to privacy in their medical information. The exact parameters of a prisoner's right to privacy in that information will have to be determined in a later case on a more complete record, where the Turner factors can be fully considered in the context of the penological interests concerned. Moreover, because we are granting qualified immunity to the defendants, we also do not go on to the issue of the standard that is utilized to determine whether a prisoner's right to privacy in his medical information has been violated. That determination too will have to wait for another day.