Court Opinion

ID: 9587553
Source: CourtListenerOpinion
Date Created: 2023-08-21 23:23:38.887058+00
Date Added: 2024-06-11T18:00:19.507844
License: Public Domain

MOSK, J. ,Concurring and Dissenting.—
I
The majority assert that the Confidentiality of Medical Information Act (Civ. Code, § 56 et seq.; hereafter the Act)1 permits a doctor to disclose a patient’s medical records, without any authorization from the patient, to a malpractice insurer if the doctor fears he or she “may incur” malpractice liability. I am not persuaded.
The purpose of the Act is to provide reasonable protection for the confidentiality of patient’s medical records. (Stats. 1981, ch. 782, § 1, p. 3040.) “It is the intention of the Legislature in enacting this act, to provide for the confidentiality of individually identifiable medical information, while permitting certain reasonable and limited uses of that information.” {Ibid.)
The basic scheme of the Act is that a medical provider must not disclose medical information without a written authorization from the patient. There are exceptions. Thus, section 56.10 provides that “[n]o provider of health care shall disclose medical information regarding a patient of the provider without first obtaining an authorization, except as provided in subdivision (b) or (c).”
Before I examine the exceptions, it is important to consider what sort of authorization the Legislature requires pursuant to its basic rule. The Legislature has been quite demanding. An authorization is valid if it is handwritten or typed in legible type on a separate piece of paper and is properly signed and dated by the patient or enumerated substitutes. (§ 56.11, subds. (a), (b) & (c).) The authorization must state “. . . the specific uses and limitations on the types of medical information to be disclosed ...[,] ['ll] ... the name or functions of the provider of health care that may disclose the medical information ...[,] HD .. . the name or functions of the persons or entities authorized to receive the medical information ...[,] *47[1 . . . the specific uses and limitations on the use of the medical information by the persons or entities authorized to receive the medical information ...[,] [HD ... a specific date after which the provider of health care is no longer authorized to disclose the medical information,” and that the person signing the authorization has been advised of the right to receive a copy of the authorization. (§ 56.11, subds. (d)-(i).)
These provisions demonstrate an interest in assuring that medical information be disclosed only for a narrowly defined purpose, to an identified party, for a limited period of time.
The authorization is not a mere formality that may be overlooked, but is, under normal circumstances, a sine qua non. We can see this because sometimes the patient is required to provide an authorization. (§ 56.105.) In a section that is highly relevant to this case, the Legislature has required the patient to supply an authorization when, prior to filing a complaint, he or she serves a demand letter or offer of compromise in a claim for professional negligence. (Ibid.) The section covers the problem of informal discovery (formal discovery is treated in § 56.10, subd. (b)), and specifies that “[t]he authorization shall be in accordance with Section 56.11 and shall authorize disclosure of that information that is necessary to investigate issues of liability and extent of potential damages in evaluating the merits of the demand for settlement or offer to compromise.” (§ 56.105.)
The disclosure in this case was not made pursuant to any authorization, nor does there appear any claim that plaintiff should have provided an authorization under section 56.105.
The question remains whether any of the statutory exceptions to the authorization requirement apply.
The Act provides that disclosure is required even in the absence of an authorization when compelled by court order, subpoena, or search warrant or “otherwise specifically required by law.” (§56.10, subd. (b)(l)-(7).) It is undisputed that these provisions do not apply here.
The Act also provides that disclosure is permissible without an authorization in several types of situations. Disclosure is permissible to other health care providers “for purposes of diagnosis or treatment of the patient.” (§ 56.10, subd. (c)(1).) Disclosure is permissible to an entity responsible for paying a medical bill (and to billing services) “to the extent necessary to allow responsibility for payment to be determined and payment to be made.” (§ 56.10, subd. (c)(2) & (3).)
*48Disclosure is permissible to groups performing peer review “or to persons or organizations insuring, responsible for, or defending professional liability which a provider may incur,” if the groups or persons “are engaged in reviewing the competence or qualifications of health care professionals or in reviewing health care services with respect to medical necessity, level of care, quality of care, or justification of charges.” (§ 56.10, subd. (c)(4).)
Disclosure is also permissible for the purpose of licensing or accrediting a provider of health care (§ 56.10, subd. (c)(5)); for the purpose of a coroner’s investigation (§ 56.10, subd. (c)(6)); for bona fide medical research (§ 56.10, subd. (c)(7)); for certain employment-related claims relevant to an employee’s lawsuit against an employer (§ 56.10, subd. (c)(8)); in connection with certain coverage claims (§ 56.10, subd. (c)(9)); to a group practice plan for the purpose of administering the group practice plan (§ 56.10, subd. (c)(10)); to insurance agents in compliance with certain Insurance Code provisions (§56.10, subd. (c)(ll)); to a probate court investigator under specified circumstances (§ 56.10, subd. (c)(12)); to a tissue bank under specified circumstances (§ 56.10, subd. (c)(13)), and when the disclosure “is otherwise specifically authorized by law.” (§ 56.10, subd. (c)(14).)
The majority hold that the exception described in section 56.10, subdivision (c)(4) covers the circumstances of this case. I disagree. The majority fail to examine the entire subdivision and to read the applicable language in pari materia.
Section 56.10, subdivision (c)(4) permits disclosure “to organized committees and agents of professional societies or of medical staffs of licensed hospitals, or to licensed health care service plans, or to professional standards review organizations, or to utilization and quality control peer review organizations as established by Congress in Public Law 97-248 in 1982, or to persons or organizations insuring, responsible for, or defending professional liability which a provider may incur, if the committees, agents, plans, organizations, or persons are engaged in reviewing the competence or qualifications of health care professionals or in reviewing health care services with respect to medical necessity, level of care, quality of care, or justification of charges.”
The majority assert that because Dr. Yamaguchi was in danger of medical malpractice exposure as the associate of a doctor whom his patient was already suing, Dr. Yamaguchi came under section 56.10, subdivision (c)(4) as a provider who “may incur” malpractice liability. (Maj. opn., ante, p. 39.)
The interpretation is ungrammatical. The term “professional liability which a provider may incur” is part of an entire adjectival clause that *49modifies the term “persons or organizations.” (§ 56.10, subd. (c)(4).) The clause describes persons or organizations to whom information may be disclosed, not, as the majority suggest, persons who may disclose information.
The phrase specifies that the persons or organizations to whom medical information may be disclosed must be those that are insuring or are responsible for or are defending malpractice liability. It does not describe under what circumstances the disclosure may be made, but merely describes the recipient. The language describing under what circumstances the disclosure may be made comes later in the paragraph, starting with the word “if.”
Thus the phrase upon which the majority rely does not mean that a doctor who is afraid he or she—or an employee—“may incur” malpractice liability may disclose patient’s records to the insurer. Nor does it mean that a doctor would be a “person defending professional liability,” because throughout the Act, doctors are referred to as “providers.” And, as I have noted, the section describes persons and organizations to whom information may be disclosed. This description does not refer to the doctor who possesses the records. In any case, there is certainly no evidence that Dr. Yamaguchi was defending his professional liability when he made the disclosures—nor am I aware of any evidence in the record before us establishing that Dr. Yamaguchi actually “might incur” malpractice liability at the time he made the disclosure.
The majority also claim that the term “quality of care” includes the question of malpractice liability, so that an insurer defending a malpractice claim would be a proper recipient of disclosure under section 56.10, subdivision (c)(4). (Maj. opn., ante, p. 39.)
Such an interpretation is inconsistent with the general purpose of the Act to restrict disclosure of medical records except as specifically provided by the Act, and renders the particular provision of the Act regarding informal discovery in malpractice actions meaningless surplusage. It is also inconsistent with the general purpose of the subdivision. Finally, it would interpret the phrase “quality of care” as referring to malpractice liability, though a different term has been used in the statute that applies specifically to malpractice actions.
We should not interpret isolated phrases in section 56.10, subdivision (c)(4), but should interpret the whole paragraph in order to ascertain and carry out the Legislature’s intent. It is a principle of statutory construction that the meaning of a word may be determined by reference to other terms *50that are associated with it in the same statute. (People v. Rogers (1971) 5 Cal.3d 129, 142 [95 Cal.Rptr. 601, 486 P.2d 129] (conc, and dis. opn. of Mosk, J.) [discussing doctrine of noscitur a sociis].) “[W]hen a statute contains a list or catalogue of items, a court should determine the meaning of each by reference to the others, giving preference to an interpretation that uniformly treats items similar in nature and scope. ... In accordance with this principle of construction, a court will adopt a restrictive meaning of a listed item if acceptance of a more expansive meaning . . . would otherwise make the item markedly dissimilar to the other items in the list.” (Moore v. California State Bd. of Accountancy (1992) 2 Cal.4th 999, 1011-1012 [9 Cal.Rptr.2d 358, 831 P.2d 798].) The majority opinion fails to follow this directive, instead choosing to interpret isolated phrases without reference to the whole.
Section 56.10, subdivision (c)(4) should be interpreted so that the term “quality of care” means something similar for each entity described by the paragraph. What each entity has in common is its function in reviewing quality of care for the purpose of determining whether the physician is good enough to receive the imprimatur of the group requesting the information, whether it be for peer recognition or rating services, extending group practice or hospital staff privileges or providing insurance coverage. An insurer deciding whether to offer or continue malpractice insurance to a provider stands in need of patient records for substantially the same reason as the various other entities enumerated in the paragraph. I would conclude that the statute should be interpreted to permit providers to disclose patient information to insurers, without any patient authorization, only for such a purpose.
My interpretation is supported by legislative history. When this subdivision was first enacted, it was labeled “For peer review of physicians.” (Former § 56.15, subd. (c)(2)(A); Stats. 1979, ch. 773, § 1, p. 2648.) The subdivision permitted disclosure to “organized committees of professional societies, including components or subsidiaries thereof, or of medical staffs of licensed hospitals, or to professional standards review organizations organized in a manner which makes available professional competence to review professional competence or qualifications or health care services with respect to medical necessity, quality of care, or economic justification of charges or level of care.” (Ibid., italics added.)
In 1981, the Act was revised, adding section 56.10, subdivision (c)(4) in substantially the same form as it now appears. The new subdivision added the reference to insurers upon which the majority rely, but retained the qualification that the persons or organizations to whom disclosure is made *51must be engaged in reviewing professional competence or qualifications or in reviewing medical necessity, level of care, quality of care, or justification of charges. (Stats. 1981, ch. 782, § 1, p. 3042, italics added.)
We should infer that “quality of care” means basically the same term it meant in 1979, that is, that the information is to be disclosed only if the organizations or persons seeking disclosure are engaged in determining whether a provider is adequately qualified to receive the organization or person’s approval, membership or services.
Defending a malpractice action does not meet this qualification. In such circumstances, the issues are liability and damages, not competence or qualification. When the Legislature has wished to describe the function of a malpractice carrier in defending a claim for malpractice, it has described that function in quite different terms than are used in section 56.10, subdivision (c)(4). Thus, section 56.105 requires the patient to authorize disclosure of “that information that is necessary to investigate issues of liability and extent of potential damages.” (Italics added.)
We must read sections 56.105 and 56.10, subdivision (c)(4) in pari materia. They are part of the same act and should be harmonized to carry out the intent of the Legislature and give effect to both provisions. (City of Huntington Beach v. Board of Administration (1992) 4 Cal.4th 462, 468 [14 Cal.Rptr.2d 514, 841 P.2d 1034]; Dyna-Med v. Fair Employment & Housing Com. (1987) 43 Cal.3d 1379, 1387 [241 Cal.Rptr. 67, 743 P.2d 1323].) An interpretation of section 56.10, subdivision (c)(4) that permits a doctor to disclose medical information because a malpractice insurer is investigating a malpractice claim would make section 56.105 meaningless, and would fail to give it any effect.
I cannot understand the majority’s claim that section 56.105 supports its interpretation. (Maj. opn., ante, p. 40.) Section 56.105 was enacted after section 56.10, subdivision (c)(4). The Legislature, when it enacted section 56.105, thought it necessary to provide for precomplaint disclosure of medical information in malpractice actions. It would not have done so had it considered that section 56.10, subdivision (c)(4) already permitted such disclosure. The Legislative Counsel’s Digest upon which the majority rely for a contrary conclusion does not define the nature of the disclosure that could be made to malpractice insurers under existing law, and, in any event, *52the Legislature’s own action is far more probative of its intent than a broad, general statement of the Legislative Counsel.2
The majority claim that its interpretation is necessary to serve the goal of reasonable, informal pretrial discovery in order to promote settlement. But this goal is already served by section 56.105. Nor should we overlook the fact that formal discovery itself is intended to promote settlement. (See, e.g., Province v. Center for Women’s Health & Family Birth (1993) 20 Cal.App.4th 1673, 1683-1684 [25 Cal.Rptr.2d 667].) Unlimited ex parte disclosure on the part of any doctor who fears he or she “may incur” malpractice liability is unnecessary and inconsistent with the purpose of the Act.
II
Although I would find that the disclosure plaintiff complains of was not permitted by the Act, nonetheless I would hold that the litigation privilege of section 47, subdivision (b) (hereafter section 47(b)) immunized Dr. Yamaguchi from liability because his disclosures occurred in connection with the ongoing litigation against Dr. Geis.
Section 47(b) immunizes publications “(1) made in judicial or quasi-judicial proceedings; (2) by litigants or other participants authorized by law; (3) to achieve the objects of the litigation; and (4) that have some connection or logical relation to the action.” (Silberg v. Anderson (1990) 50 Cal.3d 205, 212 [266 Cal.Rptr. 638, 786 P.2d 365].) The privilege is absolute and immunizes persons for liability for all torts. The only exception is in an action for malicious prosecution. (Id., at pp. 215-216.) The privilege also applies to prelitigation communications that have some relation to anticipated lawsuits. (Rubin v. Green (1993) 4 Cal.4th 1187, 1194 [17 Cal.Rptr.2d 828, 847 P.2d 1044].)
As it is undisputed that the communication at issue here between Dr. Yamaguchi and the insurer had a clear relationship to the lawsuit against Dr. Geis, it seems clear on the face of the matter that the litigation privilege should apply.
The Court of Appeal found otherwise, concluding that conduct, rather than communication, was at issue.
*53It is true that in Ribas v. Clark (1985) 38 Cal.3d 355 [212 Cal.Rptr. 143, 696 P.2d 637, 49 A.L.R.4th 417] and Kimmel v. Goland (1990) 51 Cal.3d 202 [271 Cal.Rptr. 191, 793 P.2d 524], we pointed out that when it is noncommunicative conduct, such as eavesdropping or surreptitious taping, rather than communication for the purpose of litigation that causes an injury, the litigation privilege does not apply. In Ribas v. Clark, supra, 38 Cal.3d 355, an attorney’s violation of a statute in taping the conversation between his client and the opposing party caused an injury at the moment it occurred—the injury did not arise from a communication for the purpose of litigation. We concluded that although the taping itself was actionable, the testimonial use of the contents of the overheard conversation was privileged. (Id., at p. 364; see also Rubin v. Green, supra, 4 Cal.4th at p. 1195.) Similarly, in Kimmel v. Goland, supra, 51 Cal.3d 202, the conduct of secretly taping a telephone conversation caused an actionable injury that was not related to any publication of the information contained in the telephone conversation. (Id., at p. 209.) We distinguished “injury allegedly arising from communicative acts . . . and injury resulting from noncommunicative conduct, i.e., the invasion of privacy resulting from the attorney’s eavesdropping.” (Id., at p. 211.) Thus we carefully distinguished immunized communicative acts related to litigation and injuries arising from illegal conduct unrelated to any judicial proceeding.
We recently made this distinction even more clearly in Rubin v. Green, supra, 4 Cal.4th 1187. There we held that an attorney’s solicitation of business in possible violation of the Business and Professions Code was essentially communicative, and therefore privileged under section 47(b). That the defendant’s communication necessarily also involved related conduct did not destroy the privilege. (4 Cal.4th at p. 1195.) We held that “plaintiff’s claims, however styled, are founded essentially upon alleged misrepresentations made by the law firm (and Green) to [park residents] in the course of discussions over park conditions and the possibility of being retained to prosecute the failure-to-maintain action, and the subsequent filing of pleadings in the lawsuit itself. Whether these acts amounted to wrongful attorney solicitation or not, they were communicative in their essential nature and therefore within the privilege of section 47(b).” (Id., at p. 1196.)
Thus the defendant’s violation of the Act in this case, like the possible violation of the Business and Professions Code in Rubin v. Green, supra, 4 Cal.4th 1187, does not by itself strip him of the protection of the litigation privilege. The relevant question is not whether defendant violated a statute, but whether defendant injured plaintiff through conduct or through communication.
*54It cannot be gainsaid that plaintiff alleges in her seventh, eighth and twelfth causes of action that Dr. Yamaguchi injured her because he “disclosed . . . confidential medical information” to Norcal. The general allegations of her complaint allege that Dr. Yamaguchi disclosed the information for the purpose of aiding the defense of the ongoing litigation against Dr. Geis. It follows that her complaint arises from a communication connected with litigation, one that our case law clearly establishes is immunized by section 47(b).
Ill
Plaintiff has alleged that defendant’s disclosure of confidential information about her medical condition was a violation of her constitutional right to privacy under article I, section 1 of the California Constitution. I would conclude that because it was foreseeable that the disclosure was within established limits of the litigation privilege, plaintiff cannot make out a claim for violation of privacy under the majority opinion in Hill v. National Collegiate Athletic Assn. (1994) 7 Cal.4th 1 [26 Cal.Rptr.2d 834, 865 P.2d 633] (Hill).
In Hill, supra, 7 Cal.4th 1, we held that “a plaintiff alleging an invasion of privacy in violation of the state constitutional right to privacy must establish each of the following: (1) a legally protected privacy interest; (2) a reasonable expectation of privacy in the circumstances; and (3) conduct by defendant constituting a serious invasion of privacy.” (Id., at pp. 39-40.) Although I disagree with this standard (id., at p. 73 et seq. (dis. opn. of Mosk, J.)), it is the law.
A plaintiff who brings a malpractice action has a limited expectation of privacy in his or her medical records. Although I would find the particular disclosure inappropriate under the Act, a plaintiff bringing such an action is required to make substantial disclosures regarding medical history during formal and informal discovery. (§§ 56.10, subd. (b), 56.105.) The patient, in fact, may not be able to assert the physician-patient privilege as to matters put in issue by the allegations of the complaint. (Evid. Code, § 996; see, e.g., People v. Mickle (1991) 54 Cal.3d 140, 189 [284 Cal.Rptr. 511, 814 P.2d 290]; see also In re Lifschutz (1970) 2 Cal.3d 415 [85 Cal.Rptr. 829, 467 P.2d 557, 44 A.L.R.3d 1].) Indeed, a patient’s treating physician who, like Dr. Yamaguchi, is not the subject of a lawsuit, may testify on behalf of the defense in a malpractice action against another doctor. (See Torres v. Superior Court (1990) 221 Cal.App.3d 181, 186-188 [270 Cal.Rptr. 401]; see also Province v. Center for Women’s Health & Family Birth, supra. 20 Cal.App.4th 1673, 1685.) Accordingly, plaintiff had a relatively lir .(ted *55privacy interest in information regarding her “current and past medical condition” during treatment for the condition caused by Dr. Geis’s negligence.
Finally, defendant’s disclosures do not represent the serious invasion of privacy that we said should be actionable in Hill, supra, 7 Cal.4th 1. Rather, defendant’s disclosures, though painful as far as plaintiff was concerned, actually may have served another right of constitutional magnitude, that is, the right of free access to the courts. (See Pacific Gas & Electric Co. v. Bear Stearns & Co. (1990) 50 Cal.3d 1118, 1133 [270 Cal.Rptr. 1, 791 P.2d 587].) As we said in Rubin v. Green, supra, 4 Cal.4th 1187, “[u]ndergirding the immunity conferred by section 47(b) is the broadly applicable policy of assuring litigants ‘the utmost freedom of access to the courts to secure and defend their rights . . . .’” (Id., at p. 1194, italics added.)
Accordingly, I would conclude that plaintiff has failed to make out a claim for violation of the constitutional right to privacy under article I, section 1 of the California Constitution.
IV
I dissent from the conclusion of the majority that plaintiff failed to state a cause of action for violation of section 56 et seq. I concur, however, in the disposition of the majority because I would find the claim barred by the litigation privilege, and I would find no violation of constitutional rights under Hill, supra, 7 Cal.4th 1.

All statutory references are to the Civil Code unless otherwise indicated.

The majority’s reference to section 56.16 is also unpersuasive. Plaintiff’s claim that Dr. Yamaguchi disclosed her present and past medical condition goes far beyond the limited disclosure authorized by that section. If the section authorized the disclosure plaintiff complains of, the restrictions of the rest of the Act would be unenforceable.