Court Opinion

ID: 9786456
Source: CourtListenerOpinion
Date Created: 2023-08-30 23:55:50.034779+00
Date Added: 2024-06-11T07:36:45.316979
License: Public Domain

WATT, J.
dissenting.
T1 The majority holds that the certified nurse aide's photocopying and dissemination of a patient's records for her own purposes will not support a finding of misappropriation of a resident's property sufficient to require her name to be placed on the Oklahoma Nurse Aide Registry. It does so although the aide's actions violated federal and state law and the patient's statutorily guaranteed privacy rights.1 Furthermore, it is undisputed that the aide made no attempt to obtain the permission of the patient or the patient's personal representative and disseminated the records without redacting the patient's name.
2 The majority opinion ignores the Oklahoma Legislature's acquiescence in agency rules specifically providing for disciplinary proceedings against nurse aides who wrongfully disseminate a patient's medical records. The majority begins its analysis by focusing on a single word, "belongings," located in the legislative definition of misappropriation of property. In so doing, it applies an unnecessarily narrow definition to the term which strips patients of a protected property right. The majority's interpretation of Oklahoma statutory authority does not comply with the interpretive rule requiring that a statute should be considered in its entirety when legislative intent is questioned.2 Finally, the *1071majority ignores Oklahoma's legislatively guaranteed right of privacy in medical records and concludes that an individual may avoid the confidentiality protections of Oklahoma law and the Health Insurance Portability and Accountability Act of 1996 (HIPPA) by merely disclosing a copy of a patient's medical records without consent when disclosure of the original would result in violation of HIPPA provisions. This is clearly a glaring distinction without even a minuscule difference. In both instances the identical information is being revealed. Information which the patient has every right and expectation to be kept private.
8 I cannot agree with the majority's interpretation or its analysis. Therefore, I dissent.
4 a. Legislative response to requirements for Nurse Aide Registry and acquiescence in agency rules providing for discipline for the removal of medical records from the employment setting.
5 Under Federal law, a state must establish and maintain a registry of nurse aides.3 Pursuant to federal regulations, a finding on the registry of abuse, neglect, mistreatment of residents, or misappropriation of their property bars future employment in facilities receiving Medicare or Medicaid funds.4 The Oklahoma Legislature enacted identical constraints in 63 O.S8. Supp.2006 § 1-1951(D)(7) 5. specifically including a provision for notice of ineligibility to work as a nurse aide where clear and convincing evidence establishes a charge of misappropriation of property.
T6 In accordance with the Administrative Procedures Act, 75 0.98.2001 § 250 et seq., the Legislature delegated the duty and the power to establish a registry for nurse aides and trainees to the Department of Health (Department). In so doing, the Department was charged with the duty to promulgate appropriate rules for the implementation of the same.6 Administrative rules are valid expressions of lawmaking powers having the foree and effect of law.7 Administrative rules, like statutes are given a sensible construction bearing in mind the evils intended *1072to be avoided.8 If an administrative rule is clear and unambiguous, there is no need to resort to rules of construction to ascertain its meaning.9
T7 In connection with its duty to promulgate rules and procedures related to the registry, the Department established the grounds for certification actions against certified nurse aides. The Department specifically outlined "[rlemoving medical records or other documentation pertaining to resident care from the employment setting without authorization" as a ground for certification action.10 The rule's language is so clear, plain and unmistakable that it is not subject to interpretation and is to be accorded the meaning accorded by the Department.11
18 If the Legislature disagrees with an agency interpretation, it may: 1) delay, suspend, veto or amend any rule or proposed rule under review by joint resolution;12 2) disapprove a permanent or emergency rule at any time if it determines the rule to be inconsistent with legislative intent;13 or 3) make emergency rules ineffective through its disapproval.14 Such legislative action has not been implemented. Furthermore, at least two Legislatures have convened and recessed since the rule allowing discipline was instituted in 2006 without rejecting the same. The Legislature's silence is proof of the lawmakers' consent15 and its adoption of the administrative construction16. specifically allowing the instigation of disciplinary proceedings for the precise situation presented here, a nurse aide's unauthorized dissemination of medical records.
*1073T9 b. "Belongings" as encompassed within controlling federal authority includes a person's private medical records in which the patient has a personal property interest and a legislatively recognized right of privacy.
T10 The majority acknowledges that federal regulations relating to the Medicare and Medicaid programs define misappropriation of resident property as "the deliberate misplacement, exploitation, or wrongful, temporary or permanent use of a resident's belongings or money without the resident's consent." 17 It then goes on to define the term "belongings" narrowly as a "movable item, not an intangible property right." The interpretation ignores patients' property interests and legislatively recognized rights of privacy in medical records. It makes light of one's most precious possession, their state of health, and the records pertaining thereto. One's health is personal and precious to an individual and only to that individual, exponentially more so than any "moveable item" like cash or jewelry which the majority holds so dear.
11 I would define the term "belongings" as at least two courts have done in unpublished opinions as inclusive of medical ree-ords. The Los Angeles County Superior Court referred to belongings as including all of an individual's medical records.18 The United States District Court of the Northern District of Illinois has done the same.19
112 In Hayter v. Kuttler, 185 Cal.App.2d 189, 8 Cal.Rptr. 160 (1960), the California Court rejected an argument that the term "my belongings" should be restricted to tangible personal property. Instead, it determined that "belongings" should be given a broader definition and be considered inclusive of personal property of every nature, both real and intangible. Most certainly, the Hayter court would have included medical records within the definition of "belongings" as intangible personal property.
{13 The majority's characterization of medical records as not being the property of the patient simply cannot be sustained. In Pyramid Life Ins. Co. v. Masonic Hosp. Ass'n of Payne County, 191 F.Supp. 51 (W.D.Ok1a.1961), the federal court recognized that a keeper of medical records is only the custodian of such records. The keeper may own the medium upon which the information is stored. Nevertheless, the court determined the facility holding such records did not have the right to possess and use the information to the exelusion of the patient, the patient's representative, or those standing in the patient's shoes. Furthermore, the court acknowledged that there were restrictions on the release of the medical records when the patient had not given permission for the same. Finally, the opinion specifically provides that "[tThe patient has a property right in the information appearing or portrayed on the records ...".
14 The term "belongings" as utilized in federal regulations intended to protect patient's rights is sufficiently broad to include an individual's private medical records in which the patient has a personal property right. It should not be construed so narrowly as to degrade a patient's property rights associated with the information contained in medical records.
4 15 c. When 63 0.8. Supp.2006 § 1-1951 is considered in its entirety, it is clear that a nurse aide who misappropriates a resident's or client's property is intended to be included on the registry as ineligible for employment.
1 16 The majority relies on a portion of 63 0.8. Supp.2006 § 1-1951(D) for the proposition that misappropriation of a patient's or client's property was not intended to support inclusion of a nurse aide's name on the registry. The portion of the statute relied upon is *107463 O0.S. Supp.2006 § 1-1951(D)(8)(a)(d4) providing in pertinent part:
"... The registry shall include, but not be limited to, the following information on each certified nurse aide or nurse aide trainee:
... (4) information on any finding of the Department of abuse, neglect, or exploitation by the certified nurse aide or nurse aide trainee ..." [Emphasis provided.]
The majority does not consider subsection 7 of the same statutory provision providing:
"If the Department after notice and opportunity for hearing determines with clear and convincing evidence that abuse, neglect or exploitation, or misappropriation of resident or client property has occurred and the alleged perpetrator is the person who committed the prohibited act, notice of the findings shall be sent to the nurse aide and to the district attorney for the county where the abuse, neglect or exploitation, or misappropriation of resident or client property occurred and to the Medicaid Fraud Control Unit of the Attorney General's Office. Notice of ineligibility to work as a nurse aide in a long-term care facility, a residential care facility, assisted living facility, day care facility, or any entity that requires certification of nurse aides, and notice of any further appeal rights shall also be sent to the nurse aide." |
Clearly and unmistakably,20 this subsection makes it plain that where clear and convine-ing evidence has established the "misappropriation of resident or client property" it is required that notice of ineligibility to work shall be given.
117 d. An individual may not avoid the confidentiality protections in medical records established by Oklahoma legislative provisions and of HIPPA by merely disclosing a copy of a patient's medical records without consent when disclosure of the original would result in violation of HIPPA provisions.
4 18 The majority recognizes that "federal HIPPA regulations prohibit the use and disclosure of medical information by a covered entity except under certain cireumstances." Additionally, it acknowledges that the aide disclosed resident medical information but nonsensically determines that there was no "transfer" of the patient's property as only a copy of the protected medical information was transmitted to the EEOC.
T 19 The majority's analysis fails to recognize that the Oklahoma Legislature has specifically provided patients with protection from the wrongful dissemination of medical records. Title 12 0.8. Supp.2004 § 2508 provides that "[a]) patient has a privilege to refuse to disclose and to prevent any other person from disclosing confidential" medical information. The guaranteed protection does not end with the loss of life, but extends to the patient's personal representative.21
20 Furthermore, the majority's reasoning simply cannot be supported by HIPAA and its provisions. Under HIPAA, a person who discloses individually identifiable health information to another person "shall" be punished by a fine not to exceed $50,000, imprisonment of not more than a year, or both.22 The aide made such a disclosure. Furthermore, she did not dispute the fact that she had violated HIPAA standards in a cause brought in the federal district court based on the identical facts presented here.
*10751 21 In Vaughn v. Villa, 2006 WL 2987728 (W.D.Okla.) [Summary judgment in favor of the employer affirmed in Vaughn v. Epworth Villa, 537 F.3d 1147 (10th Cir.2008),23 the district court notes:
*... It is undisputed that plaintiff's disclosure of the confidential health information of one of defendant's patients violated defendant's policies, its employee conduct and work rules and HIPAA regulations...."
In the appellate decision, the 10th Cireuit stated the following:
*... In addition to violating Epworth Villa's policies and procedures, and perhaps Oklahoma law, it also appears that Vaughn's conduct may have violated federal law. Under the terms of the federal Health Insurance Portability Accountability Act (HIPAA), '[al covered entity may not use or disclose protected health information, except as permitted or required by this subpart' 45 CFR. § 164.502(@). 'Protected health information' includes "individually identifiable health information' that is '[tlransmitted or maintained in any ... form or medium./' 45 CER. § 160.103. Individually identifiable health information,' meanwhile, '[i}s created or received by a health care provider ...; and ... [rJelates to the past, present, or future physical or mental health or condition of an individual ... and ... identifies the individual ..." Id.
Vaughn does not appear to dispute that the medical information she transmitted to the EEOC was 'protected health information' or that Epworth Villa is a 'covered entity.' Instead, Vaughn contends that her conduct was excepted from HIPAA under 45 C.F.R. $ 164.502(j), the whistle-blower exception. This argument in [sic] unavailable for several reasons. Most basically, however, the whistleblower exception only applies to disclosures made to a 'health oversight agency or public health authority," or '[aln attorney retained by or on behalf of the' whistleblower, none of which is the EEOC. Id." [Emphasis provided.]
As the Tenth Cireuit makes clear, federal regulations govern "transmitted" medical records, precisely the situation presented here when the nurse provided copies of the patient's medical records to the EEOC.
{22 Whether a copy or an original, the information sent to the EEOC by the aide was unquestionably a criminal act under HI-PAA which would support a fine of up to $50,000 and a year in jail. It was also confidential information protected by Oklahoma law.24
CONCLUSION
1 23 In its zeal to protect a nurse aide who may be subject to criminal proceedings for her actions, the majority ignores Department rules in which the Legislature has acquiesced and which clearly, plainly, and unmistakably contemplate that a nurse aide who wrongfully disseminates a patient's medical records will be disciplined. It utilizes a tortured statutory analysis of a single term, "belongings," to conclude that there is nothing which would support a finding that the aide misappropriated a resident's property by photocopying the resident's medication record and providing the same to the EEOC. In order to reach its result, the majority ignores statutory rules of construction providing for the consideration of all relevant statutory provisions as a whole; and it turns it's back on both state and federal statutorily protected rights of privacy in medical records.
24 It is clear from agency rules, in which the Oklahoma Legislature has acquiesced, that nurse aides are intended to be disciplined for the unauthorized dissemination of a patient's medical records. It is also apparent that the term "belongings" as utilized in *1076state and federal regulations is sufficiently broad to include an individual's private medical records in which the patient has a personal property right. Furthermore, both the federal and state governments have recognized a patient's right of privacy in such records and provided for protection of the same. The majority does not extend the patient these statutorily guaranteed rights. Therefore, I dissent.

. Title 12 O.S. Supp.2004 § 2503 providing in pertinent part:
"A. As used in this section:
. 4. A communication is 'confidential' if not intended to be disclosed to third persons, except persons present to further the interest of the patient in the consultation examination or interview, persons reasonably necessary for the transmission of the communication, or persons who are participating in the diagnosis and treatment under the direction of the physician or psychotherapist, including members of the patient's family.
B. A patient has a privilege to refuse to disclose and to prevent any other person from disclosing confidential communications made for the purpose of diagnosis or treatment of the patient's physical, mental or emotional condition, including alcohol or drug addiction, among the patient, the patient's physician or psychotherapist, and persons who are participating in the diagnosis or treatment under the direction of the physician or psychotherapist, including members of the patient's family.
C. The privilege may be claimed by the patient, the patient's guardian or conservator or the personal representative of a deceased patient. The person who was the physician or psychotherapist at the time of the communication is presumed to have authority to claim the privilege but only on behalf of the patient...."

. Relevant portions of a statute and related enactments will be considered together to give force and effect to the whole. Matter of M.B., *10712006 OK 63, fn. 24, 145 P.3d 1040; Cox v. State ex rel. Dept. of Human Servs., 2004 OK 17, ¶ 19, 87 P.3d 607; Independent School Dist. No. 1-20 of Muskogee County v. Oklahoma State Dept. of Educ., 2003 OK 18, ¶ 13, 65 P.3d 612; Clifton v. Clifton, 1990 OK 88, ¶ 7, 801 P.2d 693.

. 42 C.F.R. § 482.156(a) (2006) providing in pertinent part:
"(a) Establishment of registry. The State must establish and maintain a registry of nurse aides that meets the requirement of this section...."

. 42 C.F.R. § 483.13 (2006) providing in pertinent part:
"... (c) Staff treatment of residents. The facility must develop and implement written policies and procedures that prohibit mistreatment, neglect, and abuse of residents and misappropriation of resident property....
(ii) Not employ individuals who have been-
... (B) Have had a finding entered into the State nurse aide registry concerning abuse, neglect, mistreatment of residents or misappropriation of their property ..."
Allen v. Department of Health & Human Servs., 155 N.C.App. 77, 573 S.E.2d 565 (2002), review denied, 357 N.C. 163, 580 S.E.2d 358 (2003).

. Title 63 O.S. Supp.2006 § 1-1951 providing in pertinent part:
"A. The State Department of Health shall have the power and duty to:
. 4. Establish and maintain a registry for certified nurse aides and for nurse aide trainees ...
B. The State Board of Health shall promulgate rules to implement the provisions of this section ...
D.... 7. If the Department after notice and opportunity for hearing determines with clear and convincing evidence that abuse, neglect or exploitation, or misappropriation of resident or client property has occurred and the alleged perpetrator is the person who committed the prohibited act, notice of the findings shall be sent to the nurse aide and to the district attorney for the county where the abuse, neglect or exploitation, or misappropriation of resident or client property occurred and to the Medicaid Fraud Control Unit of the Attorney General's Office. Notice of ineligibility to work as a nurse aide in a long-term care facility, a residential care facility, assisted living facility, day care facility, or any entity that requires certification of nurse aides, and notice of any further appeal rights shall also be sent to the nurse aide."

. Id.

. McClure v. ConocoPhillips Co., 2006 OK 42, ¶ 17, 142 P.3d 390.

. Walker v. Group Health Serv., Inc., 2001 OK. 2, ¶ 27, 37 P.3d 749; Oklahoma Alcoholic Beverage Control Bd. v. Burris, 1980 OK. 58, ¶ 13, 626 P.2d 1316, 20 A.L.R.4th 593.

. Coppola v. Fulton, 1991 OK 18, ¶ 12, 809 P.2d 1291; Mayfield v. H.B. Oil & Gas, 1987 OK 106, ¶ 9, 745 P.2d 732.

. OAC 310:677-5-5 (2007) providing in pertinent part:
"(a) Grounds for certification action against a certified nurse aide may include:
... (4) Removing medical records or other documentation pertaining to resident care from the employment setting without authorization ..."

. Tyler v. Shelter Mut. Ins. Co., see note 20, infra; Wylie v. Chesser, see note 20, infra; Wilson v. Catoosa Public Schools, see note 20, infra.

. Title 75 0.$.2001 § 250.2(B)(4) providing:
"B. In creating agencies and designating their functions and purposes, the Legislature may delegate rule making authority to these agencies to facilitate administration of legislative policy. The delegation of rule making authority is intended to eliminate the necessity of establishing every administrative aspect of general public policy by legislation. In so doing, however, the Legislature reserves to itself: (4) The right to approve, delay, suspend, veto, or amend the implementation of any rule or proposed rule while under review by the Legislature by joint resolution."

. Title 75 O.S. 201 § 250.2(B)(5) providing in pertinent part:
"B =... [the Legislature reserves to itself:
5. The rights to disapprove a proposed rule or amendment to a rule during the legislative review period independent of any action by the Governor by a concurrent resolution."

. Title 75 0.$.2001 § 250.2(B)(6) providing in pertinent part:
"B _... [the Legislature reserves to itself:
6. The right to disapprove a permanent or emergency rule at any time if the Legislature determines such rule to be an imminent harm to the health, safety or welfare of the public or the state or if the Legislature determines that a rule is not consistent with legislative intent."
Title 75 0.$.2001 § 253(H)(2) (2001) providing:
2. Any promulgated emergency rule shall be made ineffective if;
a. disapproved by the Legislature;
b. superseded by the promulgation of permanent rules;
c. any adopted rules based upon such emergency rules are subsequently disapproved pursuant to Section 308 of this title, or
d. an earlier expiration date is specified by the agency in the rules."

. McClure v. ConocoPhillips Co., see note 7, supra; Walker v. Group Health Servs., Inc., see note 8, supra; First of McAlester Corp. v. Oklahoma Tax Comm'n, 1985 OK 52, ¶ 14, 709 P.2d 1026; Peterson v. Oklahoma Tax Comm'n, 1964 OK 78, ¶ 16, 395 P.2d 388.

. Branch Trucking Co. v. State ex rel. Oklahoma Tax Comm'n, 1990 OK 41, ¶ 6, 801 P.2d 686; Oral Roberts Univ. v. Oklahoma Tax Comm'n, 1985 OK 97, ¶ 17, 714 P.2d 1013.

. 42 CFR. § 488.301 (2003) providing in pertinent part:
"... Misappropriation of resident property means the deliberate misplacement, exploitation, or wrongful, temporary or permanent use of a resident's belongings or money without the resident's consent...."

. Huang v. LTM Total Care, Inc., 2007 WL 3054207 (Cal.App. 2 Dist.).

. Clark v. Stahl, 2000 WL 631306 (N.D.Ill.)

. If a statute is plain and unambiguous and its meaning clear, no occasion exists for the rules of construction. Rather, the statute will be accorded the meaning expressed by the legislative language utilized. Tyler v. Shelter Mut. Ins. Co., 2008 OK 9, fn. 1, 184 P.3d 496; Wylie v. Chesser, 2007 OK 81, ¶ 19, 173 P.3d 64; Wilson v. Catoosa Public Schools, 2007 OK 20, ¶ 11, 157 P.3d 1149.

. Title 12 O.S. Supp.2004 § 2503, see note 1, supra.

. Title 42 U.S.C. § 1320d-6 (2009) providing in pertinent part:
"... (a) Offense
A person who knowingly and in violation of this part-
... (3) discloses individually identifiable health information to another person ...
(b) Penalties
A person described in subsection (a) of this section shall--
(1) be fined not ore than $500,000, imprisoned not more than 1 year, or both ..."

. See, also, Gratton v. United Parcel Serv., Inc., 2008 WL 4934056 (E.D.N.Y.) holding that a treatment summary relating to a social worker's treatment of an employee, who brought an action against her employer alleging gender discrimination, and the portion of the social worker's deposition transcript discussing the summary contained protected health information that was barred from disclosure by the Health Insurance Portability and Accountability Act of 1996 (HI-PAA).

. Title 12 O.S. Supp.2004 § 2503, see note 1, supra.