Doe v. Institute of Living, Inc.

• Decision Date: 02 May 1978
• Court: Connecticut Supreme Court
• Parties: Jane DOE v. INSTITUTE OF LIVING, INC., et al.

Page 491

392 A.2d 491

175 Conn. 49

Jane DOE v. INSTITUTE OF LIVING, INC., et al.

Supreme Court of Connecticut.

Argued Dec. 7, 1977.

Decided May 2, 1978.

Stephen Wizner, New Haven, with whom were Mary F. Keller, New Haven, and, on the brief, Dennis E. Curtis, New Haven, for plaintiff.

Edward F. Hennessey, III, Hartford, with whom was James A. Wade, Hartford, for defendants.

Before HOUSE, C. J., and LOISELLE, BOGDANSKI, LONGO and SPEZIALE, JJ.

LOISELLE, Associate Justice.

This case comes to the court on reservation upon stipulation from the Superior Court in Hartford County. ¹ The material facts stipulated to may be summarized as follows: The Institute of Living is a private, nonprofit institution for the care and treatment of mentally ill persons. Founded by the Connecticut Medical Society, it was given its charter in 1822 by the General Assembly and received its first patients in 1824 under the name of the Connecticut Retreat for the Insane. In 1943, the charter was amended to change the facility's name to the Institute of Living. Currently, the Institute's operating income is derived from the payment received from patients, including payment by the welfare department for services rendered indigent patients, ² gifts, funds for its outreach program in the division of child psychiatric services derived from a joint, annual fund-raising effort made by the Institute and several local hospitals, federal funds providing stipends for the training of some of the residents, and the income derived from its endowment. In addition, the Institute receives reimbursement from various governmental authorities for services rendered by its physicians. ³

For over one hundred years the Institute has functioned without the benefit of state appropriations granted by the General Assembly. At the time of its inception, in 1822, the act of incorporation chartering the Institute authorized a conditional appropriation of $5000 provided the Institute raised an additional $15,000 privately. This appropriation was received in 1824. In 1845, 1853 and 1855, the General Assembly authorized payments to the Institute of $5000, $8000 and $6000, respectively, for building purposes. Additional payments were made by the General Assembly as fees for services rendered to enable the Institute to take care of the indigent insane until the establishment of the first state hospital in Middletown in 1868. The Institute has neither applied for appropriations made by the General Assembly for payment to psychiatric hospitals, nor does it receive any state or federal assistance for the care of its patients other than fees for services rendered to those patients. The Institute claims that an affirmative decision was made not to apply for state grants and appropriations on the basis of several factors including awareness of the provisions of General Statutes § 4-104 pertaining to the production of patient records by hospitals receiving state aid. As a matter of psychiatric practice, the Institute preferred not to expose itself to the operation of this statute. ⁴ The plaintiff concedes that she has no way of determining the accuracy of the Institute's claimed rationale for not seeking appropriations, but she does not contest them.

The taxability of the Institute by the city of Hartford has been a continuing subject of negotiation and litigation. As early as 1877, the city imposed a tax of $7000 on the Institute for certain sewers and other services which was continued yearly. See Braceland, The Institute of Living, 1822-1972, p. 111. Then, in 1887, the Hartford assessors imposed the so-called Washington School tax which was continued at least through 1896. Id., 131. This tax was later removed but it was restored again in 1901 and the Institute paid property taxes up through 1927. Id., 175.

Revoked in 1927 for a decade, the tax was again revived and in 1938 there began a struggle between the Institute and the tax assessors for the city of Hartford. In that year this court ruled that the Institute was a charitable institution. While the question of tax exemption was not at issue, it was held that the retreat was "operated for the public welfare without profit to itself or any individual." Boardman v. Burlingame, 123 Conn. 646, 653-54, 197 A. 761, 765. In 1943 the Hartford board of tax review voted to tax the Institute anew commencing in 1944. The Institute brought suit in the Court of Common Pleas, where the decision of the board of tax review was reversed in 1945; Institute of Living v. Board of Tax Review, 13 Conn.Supp. 372; and again the Institute was held tax exempt. The city of Hartford appealed this ruling to this court which reversed the lower court. In Institute of Living v. Hartford, 133 Conn. 258, 260, 50 A.2d 822, 827, the court held that the Institute was not tax exempt because it was not "supported wholly or in part by state appropriations."

By 1951, the city property tax had risen to over $100,000. The superintendent of the Institute and its counsel appeared before the 1953 session of the General Assembly to attempt to obtain an exemption from local property taxes. Section 854c of the 1953 supplement to the General Statutes granted a property tax exemption to any "hospital society or corporation" which was on May 1, 1953, "supported wholly or in part by state appropriations." The General Assembly declined to remove the language limiting tax exemptions to state-supported hospitals. In 1955, however, the legislature enacted Public Act No. 130 which deleted the requirement of state support and extended exemption from local property taxes to all hospital societies and corporations. It is under this act, now General Statutes § 12-81(16), that the Institute receives its current exemption from local property taxes.

The Institute retains psychiatric records on all of its patients. Such records, which contain both observed objective data and subjective data obtained by the treating psychiatrist from a variety of sources, are maintained under conditions of strict confidentiality. Stored and locked in the medical records section, the records are accessible only to designated authorities immediately involved in a patient's treatment. ⁵ The information contained in the records is imparted to others only with the express written consent of the patient and then only on a need-to-know basis, such as when a patient is under the treatment of another psychiatrist or when the patient is involved in litigation in which the mental records are relevant. In the event that such information is given to the patient's attorney, it is done so only upon the representation that it will be maintained in confidentiality.

The plaintiff, a resident of the town of New Haven, was a patient at the Institute during the period of January 22, 1969, to April 25, 1970. Following her discharge, the plaintiff, upon written application, sought the Institute's permission to examine and copy the records maintained on her during the period of her confinement. The applications were denied and the plaintiff brought this action seeking an order, pursuant to General Statutes §§ 4-104 and 4-105, directing the defendants to produce such records.

General Statutes § 4-104 in part requires that "(e)ach private hospital, public hospital society or corporation receiving state aid shall, upon the demand of any patient who has been treated in such hospital and after his discharge therefrom, permit such patient or his physician or authorized attorney to examine the hospital record." The first question reserved to this court is whether the Institute of Living is a "private hospital, public hospital society or corporation" within the meaning of § 4-104. The second question is whether the Institute is receiving "state aid" within the meaning of the same statute. If either of these questions is answered in the negative, then the Institute does not fall within the mandate of the statute. For the purposes of this opinion, we will assume that the Institute is a hospital within the meaning of §§ 4-104 and 4-105 and first address the issue of whether the Institute is the recipient of "state aid" within the meaning of the records inspection provisions.

The plaintiff claims that the Institute receives "state aid" in that it receives (a) a property tax exemption pursuant to General Statutes § 12-81(16), (b) direct payments from the state pursuant to various contractual relations with a number of state offices and agencies, and (c) reimbursements from the state for services rendered to indigent patients, again pursuant to contractual arrangements with specific state agencies. The Institute, on the other hand, contends that the term "state aid" within General Statutes §§ 4-104 and 4-105, the record inspection provisions, refers specifically and solely to appropriations by the General Assembly for capital projects.

An interpretation of the language of a legislative enactment involves the question of "the expressed intention, that is, the intention of the legislative body 'as found from the words employed to make it manifest.' " Dana-Robin Corporation v. Common Council, 166 Conn. 207, 221, 348 A.2d 560, 567; Park Regional Corporation v. Town Plan & Zoning Commission, 144 Conn. 677, 682, 136 A.2d 785. Legislative intent is to be found not in what the legislature meant to say, but in the meaning of what it did say. Lee v. Lee, 145 Conn. 355, 358, 143 A.2d 154. As a general principle, a statutory term is to be given the meaning it has "according to the commonly approved usage of the language." General Statutes § 1-1(a); International Business Machines Corporation v. Brown, 167 Conn. 123, 134, 355 A.2d 236; Southington v. Southington Water Co., 80 Conn. 646, 658, 69 A. 1023. As this court has conceded, however, "(s)uch guidance is often of little help . . . since words seldom have precise and unvarying meanings." Jacques v. H. O. Penn Machinery Co., 166 Conn. 352, 359n, 349 A.2d 847, 851. Indeed, "...