Court Opinion

ID: 9758165
Source: CourtListenerOpinion
Date Created: 2023-08-28 23:13:27.637926+00
Date Added: 2024-06-11T07:28:47.040852
License: Public Domain

DORSEY, Justice,
dissenting.
I dissent from the majority’s particular holding in this case, and also disagree with the broad language and multiple bases used to justify its position.
The issue is whether the trial judge clearly abused his discretion in requiring the hospital, after deleting all material that could identify the patients, to reveal a particular delivery room nurse’s notes as to whether the physician was in the delivery room at the time of an infant’s birth, and when the physician arrived.
The suit involves an alleged injury to an infant, where the plaintiff claims that an instrument was wrongly used on the infant during birth. Who used the tool and injured the child is critical to the plaintiffs case. The defendant physical, although denying negligence, admits to delivering the child and being present during the critical time when the injury allegedly occurred. However, the mother, a plaintiff, has testified in discovery that while her child was being born and had partially emerged from her body, she saw the physical walk into the delivery room for the first time. If the mother is correct, and the physician had first entered the delivery room after the injury to her child had occurred, someone else was aiding in the delivery without authority and injured the child.
What is sought here are the noted this particular delivery room nurse made on other births when she was present over a several month period, looking solely to whether she noted when the physician arrived or was present. The habit or practice of this nurse to record this data is the subject of the disputed discovery. Did the nurse regularly record this information in her notes?
The order complained of requires the hospital to shield the identity of the patients whose records are to be examined and copied. The issue is not whether the trial court allowed sufficient protection to protect the identity of patients, as the hospital is directed to take such measures as are necessary to protect identity, which could include omission not only of the name and identifying characteristics of the mother/patient, but also the date of the birth, the sex of the child, and whatever *804else is necessary to provide anonymity to the patient.
I would hold that such redaction of the hospital’s records makes them fall outside the scope of the physician-patient privilege. That privilege is found in three locations in the law of Texas: the rules of evidence, the occupations code, and in the health and safety code. Tex.Occ.Code Ann. § 159.002(b) (Vernon Supp.2001); Tex.Health & Safety Code Ann. § 241.151(2), 241.152 (Vernon Supp.2001); Tex.R.Evid. 509(c)(2). The language of the specific provisions shows that the order at issue does not violate the physician-patient privilege.
Protection of the identity of the patients clearly makes these records fall outside the scope of the version of the privilege codified in the health and safety code. See Tex.Health & Safety Code Ann. § 241.152(a). In that statute, except in certain circumstances, “a hospital or an agent or employee of a hospital may not disclose health care information about a patient to any person other than the patient or the patient’s legally authorized representative.” Id. (emphasis added). “Health care information” is information that “identifies a patient and relates to the history, diagnosis, treatment, or prognosis of a patient.” Id. at § 241.151(a) (emphasis added). Thus, if the information does not both identify the patient and relate to his “history, diagnosis, treatment, or prognosis,” it is not “health care information” under the statute. Accordingly, I would hold that the proposed redaction adequately addresses the concerns expressed by the majority. The information sought from those records does not concern the patient’s history, treatment, diagnosis, or prognosis, but concerns the presence of a particular nurse during the delivery of the patient. I believe this information could be safely revealed without infringing on the confidentiality concerns addressed by the statute.
The version of the privilege contained in the occupations code protects the confidentiality of both communications between a physician and a patient and of certain “records.” Tex.Occ.Code Ann. § 159.002(a)-(b). The records that are protected are records “of the identity, diagnosis, evaluation, or treatment of a patient by a physician that is created or maintained by a physician.” Id. at § 159.002(b). The next section of the chapter carves out numerous exceptions to this general rule in the context of “court or administrative proceedings.” Id. at § 159.003(a). One notable exception exists when the record or communication is produced “to a court or a party to an action under a court order or court subpoena.” Id. at § 159.003(a)(12). I would interpret that provision to include a situation where the trial court has determined that the confidentiality concerns of the patient are adequately protected, such as the one presented in this case.
Finally, the version of the privilege contained in the rule of evidence sets forth the “general rule of privilege” in civil proceedings. Tex.R.Evid. 509(c). Rule 509(c) states that both confidential communications between physician and patient, and “records of the identity, diagnosis, evaluation, or treatment of a patient by a physician that are created or maintained by physician are confidential and privileged and may not be disclosed.” Id. However, redacting all information that identities the patient would render the remaining information anonymous. Thus, I fail to see how a particular patient’s confidentiality privilege could be violated. I would hold that redaction of the patient’s identification and of all other information reasonably necessary to conceal the patient’s identification would make these records fall outside the scope of the privilege.
*805Moreover, I find a meaningful distinction between the cases involving redaction of information contained in an attorney’s records and redaction of information contained in medical records. The majority contends that we should apply the reasoning of the court in Pittsburgh Corning Corp. v. Caldwell, 861 S.W.2d 428 (Tex.App. — Houston [14 Dist.] 1993, orig. proceeding). That court held that documents protected by the attorney-client privilege may not be safely redacted so as to be capable of being produced, in part, but protected, in part. Id. at 425. However, that court’s concerns are not applicable to the situation at hand.
The Pittsburgh Coming court stated: The ... document in dispute is ... a portion of a memorandum authored by ... a claims director for Travelers ... which concerns [his] trial strategy and ... thoughts on how certain facts might affect an asbestos lawsuit. This information falls squarely within the language of [the attorney-client] privilege, and is clearly privileged and not subject to production.
[The parties seeking the records] claim that [the trial judge] was attempting to “follow the winds of judicial change” by attempting to shield potions of these disputed documents from discovery through redaction of the privileged information, while allowing the production of the remainder of the document. Basically, plaintiffs argue that redaction f privileged information from a document is not an abuse of discretion because the rule of privilege extends only to shelter mental processes, conclusions, and legal theories, and does not extend to facts an attorney might acquire. See Owens-Corning Fiberglas Corp. v. Caldwell, 818 S.W.2d 749, 750 (Tex.1991). We agree that the relevant facts of a case may not be hidden under the guides of privilege. However, those facts are discoverable through other proper means of discovery, without forcing the production of a privileged document which may also contain that factual information....
Once it is established that a document contains a confidential communication, the privilege extends to the entire document, and not merely the specific portions relating to legal advice, opinions, or mental analysis. Id. It is inconceivable that an attorney could give sound legal advice on a client’s case if he or she did not include an application of the law or opinion to the specific facts of that case. If we were to hold that all or part of a document containing privileged information should be disclosed because it also included facts patient to the lawsuit, the purpose of the attorney - client and work-product privileges would be annihilated. The ultimate effect of such a holding would be that clients would be reluctant to give their attorneys any factual information for fear that it would be subject to discovery. ... And no attorney could even begin to prepare a case for tirl, or be able to give sound advice for lack of those facts. Such a chilling intervention into the attorney-client relationship under the guides of “looking for facts, ” pierces the core of a critical privilege to carve out limited and usually superfluous morsels of discovery otherwise obtainable. In our opinion, the cost is too great.
Id. at 424-25 (emphasis added).
I do not believe the concerns at issue in this case are so grave. Certainly, no one would argue that revelation of the redacted records requested would destroy a physician’s ability to render medical treatment. The concerns with an attorney’s notes are different than the concerns with *806a physician’s notes. While the stated purposes of the two privileges are similar, I do not believe the potential harm incumbent with allowing discovery of redacted medical records is comparable to allowing discovery of redacted attorney’s notes.
The majority has cited no case holding that medical records may not be redacted so that they fall outside the scope of the privilege of such records. I belive that they can.
I agree with my colleagues that rule 196.1(c) is merely a notice requirement and does not alter the substantive law regarding privilege of physician-patient records. See, Tex.R.Civ.P. 196.1. That rule states that where discovery of nonparty records is sought in a manner where “the identity of the nonparty whose records are sought will not directly or indirectly be disclosed by production of the records,” the nonparty is not required to be served with the request for the records. Id. While I concede that the rule does not authorize production of redacted nonparty medical records, its existence would seem to imply that such an action is not unprecedented.
This is a mandamus action, in which the real question here is whether the trial judge clearly abused his discretion in ordering the records to be produced after redaction. The question of abuse of discretion goes to whether the judge acted without guiding rules and principles in making the decision complained of. Downer v. Aquamarine Operators, Inc., 701 S.W.2d 238, 241-42 (Tex.1985). The guiding rules and principles to be applied are the applicable Texas statutes and rules discussed earlier: the health and safety code, the occupations code, and the rules of evidence. A general rule of statutory construction is that the more specific and particular be applied before the more general. See Horizon/CMS Healthcare Corporation v. Auld, 34 S.W.2d 887, 200 Tex.LEXIS 88, at *37-38 (Tex. Aug. 24, 2000). My construction is that none of the cited Texas statutes or rules prohibit the trial judge’s order. The majority finds the disclose violates both Texas statutes as well as a “constitutional right or privacy.” Having found protection in the statutes, seeking additional justification in the constitution would seem to be dicta and gratuitous. However, because this constitutional right is given as an additional reason for the trial judge’s abusing his discretion, I must address it.
The United States Supreme Court is the ultímate interpreter of the United States Constitution, but not the sole one. The United States Supreme Court has found a right of privacy in reproductive matters only, and has not expanded it to include other activities within the “right of privacy.”
The first case holding there was a right of privacy in the United States Construction was Griswold v. Connecticut, in which Justice William O. Douglas wrote for the Court “that specific guarantees of the Bill of Rights have penumbras, formed by emanations from those guarantees that help give them life and substance.” Griwold, 381 U.S. 479, 486, 85 S.Ct. 1678, 14 L.Ed.2d 510 (1965). The Court held that a right of privacy was in this penumbra of the Bill of Rights. Id. at 483, 85 S.Ct. 1678. At issue was a conviction for disseminating birth control information to married couples. Justice Goldberg stated it as a matter of martial privacy, and quoted Justice Brandéis in his dissent in Olm-stead v. United States, “They conferred, as against the Government, the right to be let alone — the most comprehensive of rights and the most valued by civiilzed men.” Olmstead, 277 U.S. 438, 478, 48 S.Ct. 564, 72 L.Ed. 944 (1928) (Brandeis, J., dissenting).
*807The only other instances in which the United States Supreme Court has applied a constitutional right of privacy has been in the abortion cases. In Roe v. Wade, the court said that although “[t]he Constitution does not explicitly mention any right of privacy,” certain zones of personal privacy were fundamental. Roe, 410 U.S. 113, 152, 93 S.Ct. 705, 35 L.Ed.2d 147 (1973). The court has been seemingly reluctant to expand this right of privacy beyond reproductive rights.
Given that very limited guidance from the United States Supreme Court, I am not sure a patient’s interest in the confidentially of his medical records rises to such a fundamental right to require constitutional protection. But if it should, the State of Texas has adopted seemingly reasonable rules defining the physician patient privilege, limiting it, creating exceptions, etc. I am not prepared to hold that those limitations are so unreasonable so as to violate the patient’s constitutional right of privacy absent comprehensive briefing and having the matter squarely presented to the trial judge.
I would not grant mandamus. The trial judge did not clearly abuse his discretion. Accordingly, I respectfully dissent.
ROBERT J. SEERDEN, Senior Justice (Assigned), joins in this dissent.