Opinion ID: 1860963
Heading Depth: 1
Heading Rank: 2

Heading: constitutional grounds for injunctive relief

Text: Appellants assert that collection and disclosure of data relating to abortions is constitutionally suspect, and may be sustained only upon a showing that it will be held in confidence and that it will not restrict the physicians' right to exercise of medical judgment or otherwise interfere with a pregnant woman's right to obtain an abortion prior to viability of the embryo. This statement is overly broad and does not correctly state the holding of the court's decision in Planned Parenthood of Central Missouri v. Danforth, 428 U.S. 52, 96 S.Ct. 2831, 49 L.Ed.2d 788 (1976). The amicus brief of the Minnesota Civil Liberties Union provides a better statement of the constitutional issues. The M.C.L.U. contends that disclosure of the names of physicians who performed abortions on medical assistance patients would infringe the privacy rights of both the patients and the physicians.
In Roe v. Wade, 410 U.S. 113, 93 S.Ct. 705, 35 L.Ed.2d 147 (1973), the court held that a woman has a right of personal privacy that encompasses the decision whether or not to terminate her pregnancy. This right is not absolute, but is subject to the states' compelling interests in the protection of maternal health, medical standards, and prenatal life. The states' interests in maternal health, however, do not become compelling until the second trimester, and their interests in prenatal life do not become compelling until the fetus is viable. Thus, a state may not interfere with the patients' and physicians' decision to abort during the first trimester and, during the second trimester, may regulate abortions only in ways reasonably related to the health of the mother. 410 U.S. 164, 93 S.Ct. 732, 35 L.Ed.2d 183. In Planned Parenthood of Central Missouri v. Danforth, 428 U.S. 52, 96 S.Ct. 2831, 49 L.Ed.2d 788 (1976), the court upheld a provision of a Missouri statute that required doctors to make and keep records on all abortions for the use of local, state, and national public health officers. The records were to be confidential and used only for statistical purposes to enhance medical knowledge for the preservation of maternal health. The recordkeeping requirement was challenged on the ground that it constituted an unconstitutional restriction on the patients' abortion decision during the first trimester. The court, however, found that the records served the state's interest in protecting the health of its female citizens and that, because the records were confidential, there was no legally significant impact or consequence on the abortion decision or on the physician-patient relationship. 428 U.S. 81, 96 S.Ct. 2846, 49 L.Ed.2d 812. Amicus M.C.L.U. contends that the proposed disclosure of the names of physicians who performed abortions will have the legally significant impact not found in Danforth. First, there is the danger that patients' names will be accidentally disclosed. Second, any disclosure will have a chilling effect in that women may be prevented from obtaining an abortion by the fear that their names might be accidentally disclosed. Third, a woman may be deterred from seeking an abortion from the doctor named because people might correctly infer the reason she saw that doctor. Fourth, disclosure may cause some doctors to discontinue performing abortions, thus making it more difficult for women to find a willing doctor and infringing their freedom of choice in the selection of a physician. M.C.L.U. also notes that the confidentiality of the physician-patient relationship is protected under state law. Nevertheless, the M.C.L.U.'s speculations on the possible effects of the disclosure of the doctors' names on women seeking abortions are not sufficient grounds for injunctive relief. Whenever the state acquires confidential information, the possibility of accidental disclosure exists. That possibility is not sufficient to preclude the state from acquiring the information, Whalen v. Roe, 429 U.S. 589, 97 S.Ct. 869, 51 L.Ed.2d 64 (1977), and should also not be sufficient to deprive the public of access to other, nonconfidential information. Beyond simply presenting the possibility of accidental disclosure of patients' names, amicus offers nothing to show that the procedures followed by the department in this case are insufficient to protect patient anonymity. Similarly there is no evidence to support the speculation that the mere possibility of disclosure of patient identities, however slight, will be a significant factor in a medical assistance patient's decision not to seek an abortion. The guilt-by-association argument is also without evidentiary support and appears even less reasonable. The validity of that argument must rest on the assumption that once a doctor is known to have performed abortions, it may be inferred that all, or at least the majority, of his female patients employ him to perform abortions. Only if the doctor provides almost no services except abortions, does such an assumption have merit. In such a case, it is likely that the nature of the doctor's practice would be known even without disclosure of the department's information. Thus, it is improbable that disclosure will have any significant effect on the inferences that can be drawn from the fact that a woman visits a particular physician. A radical restriction in the number of Minnesota physicians willing to perform abortions resulting from disclosure would present a more difficult problem than the more direct effect on women themselves. Amicus contends that such a reduction would infringe on a woman's right to make an independent abortion decision by making abortions less available. Here again, however, there is no evidence that such a reduction will occur. Robert G. Randle, director of the Medical assistance division of the state Medicaid program, states in his deposition that disclosure of physicians' names could have some kind of an impact on participation of medical providers in the medical assistance program. He goes on to state, however, that his primary concern was the relationship between the providers and the program. Nowhere does he forecast a radical restriction in the number of participating providers. The affidavit of plaintiff Dr. Chester Anderson states that disclosure of the names of physicians and the nature of the treatments they provided would also discourage physicians and other medical providers from providing treatment covered by the Medical Assistance program to patients eligible for Medical Assistance and discourage physicians and other medical providers from performing necessary medical procedures which are controversial from a nonmedical point of view. He does not allege any significant reduction in the number of doctors willing to participate in the medical assistance program. Neither Randle nor Anderson offers any support for his speculations. Moreover, it seems unlikely that mere disclosure of the fact that a doctor has performed abortions will cause him to stop providing that service. Once that fact is known, the doctor has little reason to stop. In fact, disclosure could aid women seeking abortions to find a doctor willing to provide the service. Of course, disclosure may also permit those who oppose abortions to focus pressure on the named doctors to convince them that it would be in their best interests to cease providing the service. The propriety of such action, however, is not before this court, which is concerned on this appeal only with the effect of the disclosure itself. The United States Supreme Court has indicated that any state action that interferes with a woman's right to make an independent abortion decision or with her physician's exercise of medical judgment constitutes an invasion of her right to privacy, at least during the first trimester of pregnancy. See, Planned Parenthood of Central Missouri v. Danforth, 428 U.S. 52, 81, 96 S.Ct. 2831, 2846, 49 L.Ed.2d 788, 812, where the court stated:    We naturally assume, furthermore, that these recordkeeping and record-maintaining provisions will be interpreted and enforced by Missouri's Division of Health in the light of our decision with respect to the Act's other provisions, and that, of course, they will not be utilized in such a way as to accomplish, through the sheer burden of recordkeeping detail, what we have held to be an otherwise unconstitutional restriction.  (Italics supplied.) The disclosure sought to be prevented in this case would not constitute such an otherwise unconstitutional restriction. Disclosure places no burden on the doctor, does not destroy the confidentiality of his relationship with patients, and does not restrict his freedom to exercise his medical judgment. Disclosure itself does not have any effect on the moral or ethical considerations that affect his decision whether or not to perform abortions. If antiabortion factions of the public convince him to stop performing abortions, his decision will be the result of private, not state, actions. Therefore, even if the ultimate consequence of disclosure is a reduction in the number of physicians willing to perform abortions, that reduction will not constitute an unconstitutional infringement of women's rights of privacy. Plaintiffs thus have failed to establish that failure to grant the requested injunction will result in a deprivation of female medical assistance patients' rights to privacy in making an independent decision to seek termination of pregnancy.
Amicus M.C.L.U. asserts that disclosure will deprive physicians of their rights to both privacy and property. The property right claimed is to practice medicine according to his or her best judgment and without undue interference by the state. Whether physicians have the property right claimed, independent of their patients' rights to receive the services involved, has not been decided. Singleton v. Wulff, 428 U.S. 106, 113, 96 S.Ct. 2868, 2874, 49 L.Ed.2d 826, 833 (1976). Even if such a right exists, as is noted in the preceding section, disclosure itself does not constitute interference by the state. Thus, the physician's right to privacy is the only right not derived from the patients that can serve as a ground for injunctive relief. In Roe v. Wade, 410 U.S. 113, 152, 93 S.Ct. 705, 726, 35 L.Ed.2d 147, 176 (1973), the court stated: The Constitution does not explicitly mention any right of privacy. In a line of decisions, however, going back perhaps as far as Union Pacific R. Co. v. Botsford, 141 U.S. 250, 251, 11 S.Ct. 1000, 35 L.Ed. 734 (1891), the Court has recognized that a right of personal privacy, or a guarantee of certain areas or zones of privacy, does exist under the Constitution.   These decisions make it clear that only personal rights that can be deemed `fundamental' or `implicit in the concept of ordered liberty,' Palko v. Connecticut, 302 U.S. 319, 325, 58 S.Ct. 149, 82 L.Ed. 288 (1937), are included in this guarantee of personal privacy. Thus, the question presented by the assertion of the physicians' right of privacy is whether the personal right claimed  that is, the right of medical assistance providers to keep the details of their dealings with the department of public welfare from becoming public knowledge  is fundamental or implicit in the concept of ordered liberty. The right claimed is not, as amicus argues, the right not to have all their professional and business dealings made public. The department does not propose to disclose all their professional and business dealings. Only services that are paid for with public funds are involved. The providers contracted with the department to provide medical care to medical assistance patients and were paid by the department for services rendered pursuant to the agreement. The intervenors seek disclosure of information concerning only those services and payments. Viewed in this manner, the contention that disclosure would infringe the physicians' personal rights of privacy loses much of its force. The public has a right to know about the workings of government. The United States Supreme Court stated in Cox Broadcasting Corp. v. Cohn, 420 U.S. 469, 491, 95 S.Ct. 1029, 1044, 43 L.Ed.2d 328, 347 (1975):    [I]n a society in which each individual has but limited time and resources with which to observe at first hand the operations of his government, he relies necessarily upon the press to bring to him in convenient form the facts of those operations. Great responsibility is accordingly placed upon the news media to report fully and accurately the proceedings of government, and official records and documents open to the public are the basic data of governmental operations. Without the information provided by the press most of us and many of our representatives would be unable to vote intelligently or to register opinions on the administration of government generally. In opposition to the public's need for information in this case is the doctors' asserted right to prevent public disclosure of their names. In Paul v. Davis, 424 U.S. 693, 713, 96 S.Ct. 1155, 1166, 47 L.Ed.2d 405, 421 (1976), the court held that no personal right of privacy was infringed when a police department distributed a flyer identifying the plaintiff as an Active Shoplifter to local businesses. The court stated:    In Roe the Court pointed out that the personal rights found in this guarantee of personal privacy must be limited to those which are `fundamental' or `implicit in the concept of ordered liberty' as described in Palko v. Connecticut, 302 U.S. 319, 325, 58 S.Ct. 149, 152, 82 L.Ed. 288, 292 (1937). The activities detailed as being within this definition were ones very different from that for which respondent claims constitutional protection  matters relating to marriage, procreation, contraception, family relationships, and child rearing and education. In these areas it has been held that there are limitations on the States' power to substantively regulate conduct. Respondent's claim is far afield from this line of decisions. He claims constitutional protection against the disclosure of the fact of his arrest on a shoplifting charge. His claim is based, not upon any challenge to the State's ability to restrict his freedom of action in a sphere contended to be `private,' but instead on a claim that the State may not publicize a record of an official act such as an arrest. None of our substantive privacy decisions hold this or anything like this, and we decline to enlarge them in this manner. The instant case, like Paul v. Davis , involves the disclosure of records of official acts. As previously noted, that disclosure does not restrict the doctors' freedom of action in a private sphere. Moreover, the information to be disclosed cannot be characterized as purely personal since it concerns the expenditure of public funds. In Nixon v. Administrator of General Services, 433 U.S. 425, 459, 97 S.Ct. 2777, 2798, 53 L.Ed.2d 867, 901 (1977), the court distinguished between the former president's personal matters for example, `extremely private communications between him and, among others, his wife, his daughters, his physician, lawyer and clergyman, and his close friends as well as personal diary dictabelts and his wife's personal files.' 408 F.Supp., at 359. and matters relating to acts done in his public capacity. The same distinction can be made between a doctor's private records and the records of the department of public welfare's payments to him. The latter records are not extremely private communications. It must, therefore, be concluded that disclosure of the information sought here will not infringe physicians' constitutional rights of privacy. Appellants have failed to establish that they have any statutory or constitutional right to prevent disclosure of the requested information. Since disclosure will not violate appellants' rights, the district court did not abuse its discretion in denying their plea for injunctive relief and its decision is affirmed. Affirmed.