Court Opinion

ID: 9943111
Source: CourtListenerOpinion
Date Created: 2024-02-22 18:10:53.448982+00
Date Added: 2024-06-11T13:46:05.171987
License: Public Domain

[Cite as Loparo v. Univ. Hosps. Health Sys., Inc., 2024-Ohio-663.]

                               COURT OF APPEALS OF OHIO

                              EIGHTH APPELLATE DISTRICT
                                 COUNTY OF CUYAHOGA

TERRY LOPARO,                                           :

                 Plaintiff-Appellee,                    :
                                                                     No. 112765
                 v.                                     :

UNIVERSITY HOSPITALS HEALTH                             :
SYSTEM, INC., ET AL.,

                 Defendants-Appellants.                 :

                                JOURNAL ENTRY AND OPINION

                 JUDGMENT: AFFIRMED IN PART, REVERSED IN PART,
                            AND REMANDED
                 RELEASED AND JOURNALIZED: February 22, 2024

            Civil Appeal from the Cuyahoga County Court of Common Pleas
                                Case No. CV-22-961541

                                             Appearances:

                 Gioffre, Schroeder & Jansky Co., LPA, and Michael S.
                 Schroeder, and David J. Jansky, for appellee.

                 Hanna, Campbell & Powell, LLP, and Gregory T. Rossi,
                 and Rocco D. Potenza, for appellants.

EMANUELLA D. GROVES, J.:

                Defendants-appellants, University Hospitals Health System, Inc., and

University Hospitals Lake West Medical Center (“Appellants”), appeal the trial

court’s judgment ordering them to produce interrogatory responses to plaintiff-
appellee Terry Loparo (“Appellee”). For the reasons that follow, we affirm in part

and reverse in part and remand the judgment of the trial court.

Procedural History and Factual Background

              Appellee initiated this wrongful death action against Appellants arising

from the death of Phillip Loparo (“Loparo”) on October 1, 2021. Loparo arrived at

the University Hospitals Lake West Medical Center’s emergency department on

September 28, 2021, complaining of shortness of breath. Loparo was administered

two COVID-19 tests, which were both negative. After waiting more than five hours

to be treated, Loparo suffered respiratory arrest and subsequently died. Appellee’s

wrongful death and negligence claims are based on Appellants’ alleged failure to

treat Loparo timely. Appellants responded to the complaint with a motion for

judgment on the pleadings, raising an affirmative immunity defense under H.B.

606.

              In their motion for judgment on the pleadings, Appellants argued that

immunity was proper because patients with more severe COVID-19 symptoms

needed to be seen before Loparo. (See University Hospitals, et al., Appellants’

motion for judgment on the pleadings ¶ 9, October 31, 2022). The trial court denied

the motion.

              Appellee propounded discovery, including interrogatories upon

Appellants. These interrogatories requested information for every patient in the

emergency department at University Hospitals Lake West Medical Center from 8:00

p.m., on September 28, 2021, through 2:00 a.m., on September 29, 2021.
Interrogatory 22 requested information from the registration forms for each

patient’s age, sex, race, reason for visit/chief complaint, encounter start date and

time, and encounter stop date and time. Interrogatory 23 requested information

from the tracking board visit form for their arrival date and time, discharge date and

time, patient complaint, treating complaint, disposition diagnosis, disposition, and

dispositioning provider. Interrogatory 24 requested the patient’s triage start time,

triage end time, person who performed triage, and triage level.

            Appellants objected to interrogatories 22, 23, and 24. Their response

to each of these interrogatories was:

      Objection: This Interrogatory is vague, ambiguous, and unclear. It is
      also overly broad, unduly burdensome and is not proportional to the
      needs of the case. The Interrogatory seeks information that is not
      relevant and not reasonably calculated to lead to the discovery of
      admissible evidence. It also seeks information that is protected by
      HIPAA and the physician-patient privilege.

             Due to Appellants’ response, Appellee filed a motion to compel

responses to discovery. The trial court ordered Appellants to produce responses to

the interrogatories under seal for the court to conduct an in camera inspection of the

records. On April 20, 2023, Appellants produced three spreadsheets related to

Appellee’s interrogatory Nos. 22, 23, and 24 for the court’s in camera review. In

their notice of submission of documents for in camera inspection, Appellants noted

they were not waiving any objections to producing the personal health information

of nonparty patients, which was protected by the physician-patient privilege and

HIPAA. Appellants also produced the affidavit of Suzanne Clemente (“Clemente”),
which stated that 65 other patients were in the emergency department during the

relevant time. Clemente also stated:

      “No document existed within UH Lake West that listed this data in its
      entirety as requested by Plaintiff;” in order to provide the responses to
      these Interrogatories, it was necessary for me to access the protected
      health information/medical charts of the patients who were present in
      the ED during this timeframe” and “I manually entered the data into
      the spreadsheet.”

(Quoting Clemente Affidavit at ¶ 4-7.)

            The trial court granted Appellee’s motion to compel discovery on April

23, 2023. The court stated in its journal entry:

      Upon a review of the answers, the claim of privilege is overruled,
      primarily because the information is not traceable to any particular
      patient other than the plaintiff’s decedent, where applicable.

(J.E. Apr. 23, 2023.)

             Appellants appeal, raising one assignment of error for review.

                              Assignment of Error

      The trial court erred in granting the plaintiff’s motion to compel the
      defendants to produce personal medical information of nonparty
      patients as this order violates R.C. 2317.02(B)(1), Ohio’s physician-
      patient privilege.

Standard of Review

            The party seeking to exclude evidence as privileged bears the burden of

establishing that requested information is protected from disclosure. Pietrangelo v.

Hudson, 2019-Ohio-1988, 136 N.E.3d 867, ¶ 15 (8th Dist.). A discovery dispute is

generally reviewed for abuse of discretion; however, whether the information sought

in discovery is a confidential communication and privileged is a question of law that
is reviewed de novo. Id. See also Hance v. Cleveland Clinic, 2021-Ohio-1493, 172

N.E.3d 478, ¶ 25 (8th Dist.). When the trial court’s order concerning privileged

information would result in the disclosure of the disputed discovery, it is treated as

a final appealable order. Humphry v. Riverside Methodist Hosp., 22 Ohio St.3d 94,

97, 488 N.E.2d 877 (1986); Grove v. Northeast Ohio Nephrology Assocs., 164 Ohio

App.3d 829, 2005-Ohio-6914, 844 N.E.2d 400, ¶ 9 (9th Dist.); Burnham v.

Cleveland Clinic, 151 Ohio St.3d 356, 2016-Ohio-8000, 89 N.E.3d 536, ¶ 24.

Law and Analysis

              Appellants argue that the requested information is exempt from

disclosure as privileged physician-patient records under R.C. 2317.02(B).

Moreover, Appellants contend the trial court’s decision is inconsistent with the Ohio

Supreme Court’s interpretation of R.C. 2317.02 in Roe v. Planned Parenthood

Southwest Ohio Region, 122 Ohio St.3d 399, 2009-Ohio-2973, 912 N.E.2d 61, and

the provisions of the Health Insurance Portability and Accountability Act

(“HIPAA”).    Appellants assert that their interrogatory responses required the

production of nonparty privileged patient communications and medical records.

             Further, Appellants’ immunity claim is based on the number of

nonparty COVID-19 patients treated in the emergency department with more severe

symptoms than Loparo. Appellee requested evidence relevant to this defense in

interrogatories 22, 23, and 24.

              Appellee alleges that Appellants failed to establish that all of the

interrogatory responses they produced were communications between the provider
and patient “necessary to enable a physician to diagnose, treat, prescribe, or act for

a patient.” R.C. 2317.02. We find Appellants’ argument persuasive, in part, where

interrogatory     responses    would    reveal   privileged   communications       under

R.C. 2317.02. On the other hand, we find Appellee’s argument persuasive regarding

the remaining interrogatory requests.

                It is well settled that “parties may obtain discovery regarding any

matter, not privileged, which is relevant to the subject matter involved in the

pending action, whether it relates to the claim or defense of the party seeking

discovery.” Civ.R. 26(B)(1). However, physician-patient communications are

generally privileged and subject to R.C. 2317.02. Leopold v. Ace Doran Hauling &

Rigging Co., 136 Ohio St.3d 257, 2013-Ohio-3107, 994 N.E.2d 431, ¶ 18.

                R.C. 2317.02 states that the physician-patient privilege applies to:

      (B)(1) A physician or a dentist concerning a communication made to
      the physician or dentist by a patient in that relation or the physician’s
      or dentist’s advice to a patient, except as otherwise provided in this
      division, division (B)(2), and division (B)(3) of this section, and except
      that, if the patient is deemed by section 2151.421 of the Revised Code to
      have waived any testimonial privilege under this division, the physician
      may be compelled to testify on the same subject.

      ***
      (5) (a) As used in divisions (B)(1) to (4) of this section,
      “communication” means acquiring, recording, or transmitting any
      information, in any manner, concerning any facts, opinions, or
      statements necessary to enable a physician or dentist to diagnose, treat,
      prescribe, or act for a patient. A “communication” * * * may include,
      but is not limited to, any medical or dental, office, or hospital
      communication such as a record, chart, letter, memorandum,
      laboratory test and results, x-ray, photograph, financial statement,
      diagnosis, or prognosis.

R.C. 2317.02
             When parties cannot resolve a discovery issue concerning a claim of

physician-privilege, we review the challenged documents in light of HIPAA and

R.C. 2317.02. HIPAA’s patient privacy rules attempt to balance the interests of

individuals in maintaining the privacy of their protected health information with the

interests of society in obtaining, using, and disclosing health information to carry

out various public and private activities. Menorah Park Ctr. for Senior Living v.

Rolston, 164 Ohio St.3d 400, 2020-Ohio-6658, 173 N.E.3d 432, ¶ 19.               The

conclusion that protected health information is privileged depends on two factors:

firstly, whether the information is a communication between a patient and their

healthcare provider, and secondly, whether the purpose of the communication was

for diagnosis or treatment. Ward v. Summa Health Sys., 128 Ohio St.3d 212, 2010-

Ohio-6275, 943 N.E.2d 514, ¶ 25.

              Both state and federal laws are intended to ensure the privacy of

confidential health information. See Med. Mut. of Ohio v. Schlotterer, 122 Ohio

St.3d 181, 2009-Ohio-2496, 909 N.E.2d 1237, ¶ 14, citing Hageman v. Southwest

Gen. Health Ctr., 119 Ohio St.3d 185, 2008-Ohio-3343, 893 N.E.2d 153, ¶ 9.

             As a preliminary matter, a discussion of the terminology and relevant

rules regarding the disclosure of health information is in order.             Under

R.C. 3798.01(B), Ohio’s HIPAA statute, the terms “covered entity,” “disclosure,”

“health care provider,” “health information,” “individually identifiable health

information,” and “protected health information” have the same meanings as in the

federal HIPAA privacy rules under 45 C.F.R. 160.103.
       “Health information” means any information, including genetic
       information, whether oral or recorded in any form or medium, that:

       (1) Is created or received by a health care provider, health plan, public
           health authority, employer, life insurer, school or university, or
           health care clearinghouse; and

       (2) Relates to the past, present, or future physical or mental health or
          condition of an individual; the provision of health care to an
          individual; or the past, present, or future payment for the provision
          of health care to an individual.

45 C.F.R. 160.103

       {¶ 18} “HIPAA regulates how ‘covered entities’ can use or disclose

individually identifiable health (medical) information (in whatever form)

concerning an individual.” OhioHealth Corp. v. Ryan, 10th Dist. Franklin No. 10

AP-937, 2012-Ohio-60, ¶ 14, quoting Stigall v. Univ. of Kentucky Hosp., E.D. Ky.

No. 5:09-CV-00224-KSF, 2009 U.S. Dist. LEXIS 103757, ¶ 2 (Nov. 6, 2009). See

also 45 C.F.R. 160 and 164. Under 45 C.F.R. 160.103, covered entities include

hospitals, healthcare providers, and public agencies.

       {¶ 19} R.C. 2317.02 provides an additional layer of protection by prohibiting

the disclosure of protected health information that is also privileged communication

between physician and patient in relation to treatment or diagnosis. State privacy

laws generally preempt HIPAA provisions if the state law is more stringent1 than

       1 “HIPAA contains a preemption provision found in 45 C.F.R. 160.203 that states

in pertinent part: “A standard, requirement, or implementation specification adopted
under this subchapter that is contrary to a provision of state law preempts the provision
of state law. This general rule applies, except if one or more of the following conditions is
met: * * * (b) The provision of state law relates to the privacy of individually identifiable
health information and is more stringent than a standard, requirement, or
implementation specification adopted under subpart E of part 164 of this subchapter.” 45
HIPAA 45 C.F.R. 160.202. The overriding purpose of HIPAA privacy rules is to

prevent covered entities from disclosing protected health information absent

specific circumstances. Covered entities include public agencies and healthcare

providers. Under Ohio law, protected health information has the same meaning

defined in HIPAA 45 C.F.R. 160.103. R.C. 3798.01.

      “Protected health information” is defined as information, in any form,
      including oral, written, electronic, visual, pictorial, or physical, that
      describes an individual’s past, present, or future physical or mental
      health status or condition, receipt of treatment or care, or purchase of
      health products, if either of the following applies:

      (a) The information reveals the identity of the individual who is the
      subject of the information.

      (b) The information could be used to reveal the identity of the
      individual who is the subject of the information, either by using the
      information alone or with other information that is available to
      predictable recipients of the information.

HIPAA 45 C.F.R.160.103.

      {¶ 20} Health information is not protected if it does not reveal or cannot be

used to disclose the individual’s identity. Protected health information subsequently

de-identified and compiled in summary, aggregate, or statistical form is

not protected under HIPAA 45 C.F.R. 164.502. HIPAA privacy rules provide the

standards for de-identifying individually identifiable health information. 45 C.F.R.

164.502.

C.F.R.160.203(b). May v. N. Health Facilities, Inc., 11th Dist. Portage No. 2008-P-0054,
2009-Ohio-1442, ¶ 10.
      (d) Standard: Uses and disclosures of de-identified protected health
      information.

      (1) Uses and disclosures to create de-identified information. A covered
      entity may use protected health information to create information that
      is not individually identifiable health information or disclose protected
      health information only to a business associate for such purpose,
      whether or not the de-identified information is to be used by the
      covered entity.

      (2) Uses and disclosures of de-identified information.         Health
      information that meets the standard and implementation
      specifications for de-identification under 164.514(a) and (b) is
      considered not to be individually identifiable health information, i.e.,
      de-identified. The requirements of this subpart do not apply to
      information that has been de-identified in accordance with the
      applicable requirements of 164.514, provided that:

      (i) Disclosure of a code or other means of record identification designed
      to enable coded or otherwise de-identified information to be re-
      identified constitutes disclosure of protected health information; and

      (ii) If de-identified information is re-identified, a covered entity may
      use or disclose such re-identified information only as permitted or
      required by this subpart.

45 C.F.R. 164.502.

              HIPAA privacy rules define de-identified health information,

      When the following identifiers of the individual or of relatives,
      employers, or household members of the individual, are removed:

      (A) Names;

      (B) All geographic subdivisions smaller than a state, including street
      address, city, county, precinct, zip code, and their equivalent geocodes,
      except for the initial three digits of a zip code if, according to the current
      publicly available data from the Bureau of the Census[.]

45 C.F.R. 164.514.
      {¶ 22} To the extent that de-identified health information is provided in

summary, statistical, or aggregate form and cannot be used to identify an individual,

it is not protected health information. A trial court does not err in granting a motion

to compel discovery when a party claiming privilege fails to demonstrate that the

requested health information is a communication between a provider and patient

for   diagnosis   or   treatment    or   otherwise    protected    from    disclosure.

Morawski v. Davis, 8th Dist. Cuyahoga No. 112033, 2023-Ohio-1898, ¶ 16. Zimpfer

v. Roach, 3d Dist. Shelby No. 17-16-03, 2016-Ohio-5176, ¶ 27.

      {¶ 23} However, absent more stringent state protections, hospitals must

comply with the privacy rules outlined in HIPAA when the discovery at issue is

protected health information, as defined by 45 C.F.R. 160.103. OhioHealth Corp

¶ 16. See 45 C.F.R. 160.203.

      {¶ 24} Notably, Ohio’s privacy laws are stricter than HIPAA concerning

protected health information. May v. N. Health Facilities, Inc., 11th Dist. Portage

No. 2008-P-0054, 2009-Ohio-1442, ¶ 12. The HIPAA privacy regulations found in

45 C.F.R. 164.512 permit the disclosure of protected health information during

judicial or administrative proceedings in response to a court order, whether through

subpoena, discovery request, or other lawful processes. Grove v. Northeast Ohio

Nephrology Assocs. Inc., 164 Ohio App.3d 829.

      {¶ 25} In contrast, R.C. 2317.02 imposes more stringent restrictions by

prohibiting disclosure of protected health information that is also privileged, even
in situations where such disclosure would be permitted under HIPAA. Id. Section

45 C.F.R. 164.103.

      {¶ 26} We will now discuss the Appellants’ argument that all the

interrogatory responses are privileged and prohibited from disclosure, absent an

exception. Appellants rely on Roe v. Planned Parenthood, 122 Ohio St. 399, to

support their claim that the requested records are privileged. Roe is inapposite to

the facts presented here. In Roe, the parties stipulated that the disputed discovery

included privileged communications within nonparty medical records.               The

plaintiffs sought patients’ actual medical records with the protected health

information redacted. “Medical record” means data in any form pertaining to a

patient’s medical history, diagnosis, prognosis, or medical condition generated and

maintained by a health care provider in the process of the patient’s health care

treatment. R.C. 3798.01 and 45 C.F.R. 160.103. Redaction cannot overcome a

privilege protection; only a statutory exception can. Roe at ¶ 53.

      {¶ 27} A broad request for the entire medical record includes protected

communications and is, therefore, privileged and subject to exceptions in

R.C. 2317.02. Sullivan v. Smith, 11th Dist. Lake No. 2008-L-107, 2009-Ohio-289,

¶ 29. However, “the fact that the requested information is retrieved from medical

records does not, in itself, attach privilege.” Medina v. Medina Gen. Hosp., 8th Dist.

Cuyahoga No. 96171, 2011-Ohio-3990 ¶ 14. Because the discovery request in Roe

was for patients’ actual medical records, the Ohio Supreme Court determined that
no exception applied under R.C. 2317.02 and declined to create one not authorized

by statute.

      {¶ 28} In this case, Appellee specifically requested interrogatory responses,

not medical records. The disputed discovery for patient complaint, demographic,

and diagnosis information will be addressed first. The responses to these preceding

interrogatory requests are communications between the patient and provider for the

purpose of diagnosis, treatment, prescribing, or acting for the patient. Therefore,

this information is privileged. Appellants have claimed no applicable exception

under R.C. 2317.02, regarding the interrogatory responses concerning sex, race,

reason for visit/chief complaint, patient complaint, treating complaint, diagnosis,

and disposition, which are privileged and prohibited from disclosure. Accordingly,

Appellants’ assignment of error is sustained in part.

      {¶ 29} Having identified those responses that are privileged, we now turn to

the remaining discovery responses. Notably, the Ohio Supreme Court stated, “We

have never held that the physician-patient privilege provides absolute protection

against the disclosure of medical information.” Ward at ¶ 29. Under Ohio’s

physician-patient privilege statute, a treating physician is only prohibited from

disclosing matters communicated between the patient and physician in relation to

treating, acting for, prescribing, or diagnosing the patient. State Med. Bd. of Ohio

v. Miller, 44 Ohio St.3d 136, 140, 541 N.E.2d 602 (1989). Harris v. Belvoir Energy,

Inc., 8th Dist. Cuyahoga No. 103460, 2017-Ohio-2851, ¶ 10. The physician-patient

“privilege must be strictly construed against the party seeking to assert it and may
be applied only to those circumstances specifically named in the statute.” Ward at

¶ 15.

        {¶ 30} Courts have consistently held that health information, such as

provider names, triage priority data, and time data (ex., triage times, discharge

times, and treatment times), are not privileged because they do not involve

communications as defined in R.C. 2317.02. Heimberger v. Heimberger, 11th Dist.

Lake No. 2019-L-139, 2020-Ohio-3853, ¶ 31. See also In re Jones, 99 Ohio St.3d

203, 2003-Ohio-3182, ¶ 13, 790 N.E.2d 321 (psychotherapy notes created for

forensic analysis were not privileged communications under R.C. 2317.02, but

psychotherapy    records   created   for   case   plan   services     were   privileged

communications for diagnosis and treatment). See Turk v. Oiler, 732 F.Supp.2d 758

(N.D. Ohio 2010), Medina at ¶ 13, citing Ingram v. Adena Health Sys., 149 Ohio

App.3d 447, 2002-Ohio-4878, 777 N.E.2d 901 (4th Dist.) (identity of the health care

provider(s) that treated the patient is not protected information).

        {¶ 31} In this case, the requested time, triage, and provider data are

comparable to the requested information (or discovery) sought in Medina. There

the court found that the appellee’s requests for interrogatory responses regarding

the intervals and number of times the defendant charted end-tidal CO2 in nonparty

care were not privileged. The court found that the records charting intervals of

unidentified, nonparty patients were “time data” and not protected health

information when provided as interrogatory responses. Id. at ¶ 16. Likewise in this

case, the remaining responses include triage time data and provider names. These
are not protected health information nor privileged communications.              These

responses are not communications between the provider and patient in relation to

treatment or diagnosis.     Consequently, the following time data is subject to

disclosure: encounter start date and time, encounter stop date and time, arrival date

and time, discharge date and time, triage start time, and triage end time.

      {¶ 32} In summary, Appellants’ assignment of error regarding interrogatory

requests for the following data is sustained: sex, race, reason for visit/chief

complaint, patient complaint, treating complaint, diagnosis, and disposition. We

overrule the Appellants’ assignment of error regarding provider names, and the

following time data: encounter start date and time, encounter stop date and time,

arrival date and time, discharge date and time, triage start time, and triage end time.

      {¶ 33} Judgment is reversed in part, affirmed in part, and remanded for

further proceedings.

      It is ordered that appellee and appellants share the costs herein taxed.

      The court finds there were reasonable grounds for this appeal.

      It is ordered that a special mandate issue out of this court directing the

common pleas court to carry this judgment into execution.
      A certified copy of this entry shall constitute the mandate pursuant to Rule 27

of the Rules of Appellate Procedure.

_________________________
EMANUELLA D. GROVES, JUDGE

EILEEN T. GALLAGHER, P.J., and
MICHAEL JOHN RYAN, J., CONCUR