Opinion ID: 3066860
Heading Depth: 2
Heading Rank: 1

Heading: Constitutional Privacy Rights

Text: In support of its position that the lower court’s order improperly requires unfettered disclosure of patient records to the patient advocates, the DHHR maintains that the Fourteenth Amendment has been recognized to protect an individual’s right to privacy with regard to avoiding disclosure of personal matters. See Whalen v. Roe, 429 U.S. 589, 599 (1977); accord Doe v. City of New York, 15 F.3d 264, 267 (2d Cir. 1994) (“Extension of the right to confidentiality to personal medical information recognizes there are few matters that are quite so personal as the status of one’s health, and few matters the dissemination of which one would prefer to maintain greater control over.”). Because the trial court failed to employ a balancing test to assess the reasonableness of the privacy 15 Cf. Syl. Pt. 5, Riffe v. Armstrong, 197 W.Va. 626, 477 S.E.2d 535 (1996). 8 intrusion that flows from the sweeping access mandated by the order at issue, the DHHR argues that the constitutional rights of patients at Sharpe and Bateman outweigh Legal Aid’s interest in accessing patient files. See Nixon v. Adm’r of Gen’l Servs., 433 U.S. 425, 458-60 (1977) (utilizing balancing test to measure privacy intrusion against reasonableness of governmental actions). Emphasizing the enhanced need to conduct this inquiry when a realistic probability of public disclosure exists as in this case, the DHHR posits that the circuit court erred by failing to consider the applicability of constitutionally-based protections for the health information contained in the patient records. Legal Aid contends that the DHHR improperly seeks to inject constitutional error into this matter with an issue never addressed by the circuit court.16 Not only does Legal Aid concur with the tenets of privacy law articulated by the DHHR, but it fully agrees with the petitioners’ statement that “the Fourteenth Amendment’s right to informational privacy forbids the indiscriminate disclosure of state psychiatric records.” Legal Aid emphasizes that the patient advocates neither seek the indiscriminate disclosure of patient records nor do they conduct their advocacy services in a manner inconsistent with the 16 Legal Aid asserts that the DHHR did not raise the issue of constitutional error at the August 1, 2014, hearing. In response, the DHHR states that the evidentiary proceeding was not the forum in which to assert legal error. The record demonstrates that the DHHR advanced the issue of constitutional error in its response to Legal Aid’s Motion for Emergency Relief. Citing Griswold v. Connecticut, 381 U.S. 479 (1965), the DHHR asserted that unlimited access to patient records absent patient consent is a violation of the right to privacy judicially deemed to arise under the First Amendment. 9 patients’ privacy rights. Dismissing the need for an extended discourse about the existence of privacy rights, Legal Aid states that the issue presented is simply whether the disclosure of patient records pursuant to state and federal laws enacted to protect patient rights runs afoul of those acknowledged rights. Or stated in the converse, do provisions of federal and/or state law permit the disclosure of patient records to the patient advocates under contract with DHHR to provide advocacy services at Bateman and Sharpe. At the outset, we observe that the constitutional concerns raised by the DHHR are confined to the previous longstanding practice of permitting the advocates to review patient records for purposes of assessing overall hospital conditions.17 The DHHR does not raise the possibility of constitutionally-based privacy violations with regard to individual grievances or complaints of abuse and neglect.18 What the DHHR challenges is the circuit court’s directive that allows the advocates to have access to patient files unrelated to specific complaints or grievances. This access was authorized, consistent with past practice and the agreement of the parties, for purposes of discerning systemic issues related to the patient 17 It is difficult for this Court to avoid the conclusion that, while seeking to prevent access to the patient advocates under the guise of privacy concerns, the DHHR’s true objective is to make the discovery of systemic problems more difficult for the advocates to identify. 18 Legal Aid asserts that the new policy implemented by the DHHR prevents Legal Aid from complying with the time constraints pertaining to the investigation of abuse and neglect complaints under state law. See 64 C.S.R. § 59-20.2.9 (requiring submission of written report by patient advocate “[w]ithin the next eight (8) regular working hours” of receipt of abuse or neglect grievance). 10 rights established by state regulation.19 See 64 C.S.R. §§ 59-1 to -20. Pursuant to the governing Grant Agreement that outlines the duties the DHHR requires of the patient advocates, an annual report reflecting the results of the systemic review is required to be tendered to the circuit court judge, court monitor, the DHHR, and Mountain State Justice.20 Inherent in the DHHR’s argument is a presumption that the systemic review of patients’ records necessarily results in the wrongful disclosure of medical information. Given that the first and only complaint concerning an alleged violation of HIPAA was filed in 2014 by the DHHR–almost twenty years after the federal act became law–it is clear that inappropriate disclosure of patient information has not been taking place as implied by the DHHR. Not only have there been no complaints filed until the DHHR instituted one,21 but the state privacy officers whose responsibility it is to oversee these matters have failed to 19 These periodic reviews, required by the 2009 Agreed Order, have been performed by the patient advocates. Additionally, as noted by the trial court in both its August 18 and 27, 2014, rulings, the “Respondents [DHHR] agreed to the Formal Recommendations [of the Court Monitor], which set forth that systemic advocacy will be pursued by LAWV [Legal Aid], without objection, thereby allowing them to take on the force of Court Order.” 20 During the evidentiary hearing held in this matter on August 1, 2014, the DHHR’s privacy officer, Lindsey McIntosh, was questioned as to how the patient advocates were going to do the systemic audits “without access to records or patients or have conversations with staff without individual releases specifying specific grievances.” She answered the query by stating, “I don’t know how you’re going to conduct audits if you have to do that.” 21 Finding it to be baseless, the trial court ordered the DHHR to dismiss its complaint. A review of the complaint demonstrates that even the DHHR was dubious about the violation given its statement in the complaint that the “level of harm”was unclear. 11 either independently identify or confirm the existence of any issues concerning the level of access historically afforded to the patient advocates. In seeking to convince this Court that the provision of advocacy services over the past two decades has just recently become a matter of constitutional significance, the DHHR ignores the annual HIPAA training, the executed confidentiality agreements, and state law provisions all designed for the purpose of, and apparently successful at, imposing a high level of confidentiality upon the patient advocates with regard to their review of sensitive health information. As Legal Aid explained, the review undertaken by the patient advocates is conducted in confidence without public disclosure of any protected health information. Critically, there has never been any complaint filed by a Bateman or Sharpe patient, or the patient’s representative, associated with the wrongful dissemination of confidential health information.22 Because the record in this case wholly fails to demonstrate the indiscriminate disclosure of confidential information by the patient advocates–let alone any disclosure of protected health information, we are not persuaded that a meritorious issue exists with regard to Legal Aid’s dissemination of confidential health information.23 22 In contrast, there have been patient-initiated complaints since the DHHR imposed the new, limited access provisions. According to Legal Aid, the patients were frustrated by their inability to gain immediate access to the advocates, who were no longer permitted to freely roam the facilities where patients could easily seek them out when needed. 23 As Legal Aid observes, there is no greater risk posed by the patient advocates than by any of the Hospital employees who have access to patient records. 12 Accordingly, we reject the DHHR’s contention that the trial court erred in failing to address whether the access afforded to Legal Aid violates the constitutionally-based rights of privacy of patients at Sharpe and Bateman.