Court Opinion

ID: 9731851
Source: CourtListenerOpinion
Date Created: 2023-08-26 16:00:00.352968+00
Date Added: 2024-06-11T18:26:21.600889
License: Public Domain

HARRIS, Justice
(dissenting).
Because of one clearly established fact and one settled rule of law I think the trial court should be reversed and the case remanded for a new trial. The fact is that Dr. Taylor was selected to attend the defendant after her arrest for the very reason that he had been and would continue to be her treating physician. The rule is that under j;hese circumstances the physician-patient privilege was not waived. It was reversible error under section 622.10, The Code 1979, to admit Dr. Taylor’s testimony.
The defendant admittedly shot and killed her former husband. Her defense is only and simply that she was not herself when she did so. Given the brutality of her act such a defense is apt to meet with considerable skepticism. Claims of diminished responsibility are rarely attractive. But under Iowa R.Cr.P. 10(10)(b) and 21(8) we recognize such a defense and we should accord this defendant a full opportunity to try to claim it.
The order by which the magistrate committed defendant to the hospital was obtained through the joint efforts of the defendant’s counsel and the assistant county attorney. Counsel sought this order for reasons which were in part similar and in part differing. Defendant’s counsel’s motives were custodial. There was an overriding concern for the defendant’s emotional and mental state, especially her suicidal tendencies. The prosecutor then assigned to the case was certainly, and quite properly, sympathetic to these concerns. Because custodial care under the circumstances is *41not easily come by, the procedure employed seemed then to be consistent with the interests of both the defendant and the State. It was then already clear that diminished responsibility would be the fighting issue in any future trial. The magistrate expected an evaluation and report but recognized that counsel’s concern and the magistrate’s own primary concern was to submit defendant to hospital care. Any evaluation of defendant was of secondary concern.
The psychiatrist selected in the court order was of defendant’s own choosing and her reason for choosing him was and is of crucial importance. Defendant had been under his private care and Dr. Taylor was named in the order of commitment for evaluation for that very reason. The doctor’s two professional roles, first as defendant’s treating physician, and also under the magistrate’s order, led to a hotly controverted claim of doctor-patient privilege under section 622.10.
I. There is obvious tension between the statutory privilege and the purpose stated in the magistrate’s order submitting the defendant for psychiatric and physical examination and evaluation. The defendant has consistently taken the position that the magistrate’s order, notwithstanding the language used or the form in which it was drawn, was not for the purpose of evaluation but rather was because of her suicidal tendencies and consequent need to have her psychiatrist attend her. The State first urges that, because of the order, especially in Anew of its form and language, no doctor-patient privilege arose.
This strikes me as absolutely contrary to our prior holdings. In State v. Mayhew, 170 N.W.2d 608, 615 (Iowa 1969), and again in State v. Nowlin, 244 N.W.2d 596, 602 (Iowa 1976), we subscribed to a “sole purpose” rule. We said:
The physician-patient privilege does not arise where on order of the court a defendant is examined to determine his mental or physical condition. [Authorities.]
The cited cases distinguish between an examination of a defendant solely to ascertain his mental and physical condition as opposed to diagnosis and treatment. Only in the former situation is the privilege unavailable, in the latter situation the defendant still can invoke the privilege.
Mayhew, 170 N.W.2d at 615 (emphasis added).
The majority should not apply the quoted general rule without observing the quoted exception. The majority’s rationale, as I understand it, is that the magistrate’s order committing defendant to Dr. Taylor is absolute and clear on its face so we should ignore the clear record made on the order’s purpose. But our cases heretofore have not indicated that a court order or decree should give rise to an unintended result by inadvertent language. Dairyland, Inc. v. Jenison, 207 N.W.2d 753, 754-55 (Iowa 1973). The circumstances surrounding its entry are relevant to show its meaning. Id. at 755. Both the State and defendant offered testimony regarding the circumstances surrounding the entry of the order and its intent and purpose.
The factual dispute is so limited as to be unimportant. As noted, the defendant believes the order was only for defendant’s custody and protection. The State and the magistrate himself take the position that the order had a dual purpose. Defendant would receive hospital care and there would be the evaluation of defendant’s condition and a report to the court. Although the defendant does not agree that the order’s purpose included the evaluation and report, the disagreement can remain unresolved or even be resolved in favor of the State. Either way the sole purpose rule contemplated in Mayhew and Nowlin was not satisfied.
In my view the doctor-patient privilege did arise. It clearly existed prior to the court order. It persisted thereafter because of the dual purpose of Dr. Taylor’s professional involvement after the order was entered. The error in admitting his testimony was further demonstrated by his testimony that his professional views concerning the defendant arose from the professional rela*42tionship both before and after the order. The observations had become merged in his own mind so that he could not separate them into periods before and after the order.
II. In division 1(B) of the majority opinion it is suggested, though apparently not held, that defendant may have waived the privilege. The State advances two alternative theories in support of its position that the doctor-patient privilege was waived. As the first alternative the State urges that all doctor-patient privilege is waived whenever insanity or diminished responsibility is raised as a defense. I do not subscribe to the view that a waiver is effected when insanity or diminished responsibility is raised as a defense. There would be no need or reason for a sole purpose rule under such a waiver rule. We would never reach the question of sole purpose because the waiver would wipe out any reason to inquire into the purpose of the commitment.
I think the waiver rule the State urges is at odds with the better reasoned conception of the policy behind the physician-patient privilege. The authorities supporting the waiver rule proceed from the view that the privilege is grounded in the right of privacy:
The whole reason for the privilege is the patient’s supposed unwillingness that the ailment should be disclosed to the world at large; hence the bringing of a suit in which the very declaration, and much more the proof, discloses the ailment to the world at large, is of itself an indication that the supposed repugnancy to disclosure does not exist.
8 Wigmore, Evidence, § 2389 at 855.'
Other policy considerations beyond the mere right of privacy also support the rule. There is a strong social interest in fostering full and complete disclosure by patients to doctors. This is quite aside from any fears that the public or one’s neighbors may learn of a mental affliction. Even if the affliction becomes public knowledge there remains an advantage, which translates into public interest, when a patient can make a full disclosure to a physician without fearing some repercussion at trial. Collins v. Auger, 428 F.Supp. 1079, 1082-84 (S.D. Iowa 1977), vacated on other grounds in Collins v. Auger, 577 F.2d 1107 (8th Cir.1978).
The State alternatively argues that the defendant waived the doctor-patient privilege by participating in and submitting to the court order for evaluation under these circumstances. Once again I must disagree on the basis of the sole purpose doctrine. The court-ordered evaluation and report was not the sole purpose for defendant’s commitment to Dr. Taylor.
The State next points to the express waiver by defendant’s counsel to the procedure employed by the magistrate at the time of the order. But I believe the waiver by defendant’s counsel went only to the magistrate’s lack of authority and did not reach defendant’s privilege. Under section 748.2, The Code 1977, the magistrate had only “power to hear complaints, or preliminary informations, issue warrants, order arrests, require security to keep the peace, make commitments, and take bail, as provided by law.” See § 602.60, The Code 1979. This statutory enumeration must be read strictly. State v. Iverson, 272 N.W.2d 1, 3 (Iowa 1978). So there was considerable doubt in the magistrate’s mind and in those of counsel that the magistrate held authority to enter the order of commitment. He was urged to do so by defendant’s counsel who expressly waived any objection to his lack of authority. There was nothing, however, in that express waiver which even remotely approached a waiver of doctor-patient privilege. There was nothing to suggest that the waiver indeed went any further than defendant’s counsel admits. Defendant abided by the waiver. There has been no objection at any time to the magistrate’s authority to commit defendant at the time, under the circumstances, and for the purposes intended. This, under the defendant’s view of the record, was limited to custodial care and treatment for the defendant and to prevent a suicide. This, under the State’s view of the record, was for the dual purpose of care and treatment *43coupled with evaluation. But it is not right to attach the State’s intent at the time as a ground for the defendant’s waiver.
III. Therefore I believe we should reject both of the State’s alternative theories of waiver. The general theory of waiver should be rejected on the basis of the better reasoned cases. The argument that a waiver was effected by the special facts here ignores defendant’s dilemma. She needed hospitalization and care. The magistrate lacked jurisdiction to order it but did so when objection to the lack was waived. The effect is that defendant’s privilege was lost unknowingly and the loss is required of her, under the majority holding, as a price for the hospitalization. I think it is not accurate to justify this result as the majority attempts to do on the basis of fairness.
The majority seems to suggest that Dr. Taylor’s professional care of the defendant, when she was placed in hospital custody for fear of suicidal tendencies, was not treatment. I reject any such view. It seems manifest that commitment and care for such a patient by a psychiatrist is treatment within the meaning of the privilege.
It is unnecessary to extend this dissent by discussion of the other assignments. In view of the affirmance by the majority it is enough for me to say that on the foregoing ground I believe the judgment of the trial court should be reversed.
REES and ALLBEE, JJ., join this dissent.