Milton S. Hershey Medical Center of Pennsylvania State University, Application of
| Decision Date | 04 November 1993 |
| Citation | 535 Pa. 9,634 A.2d 159 |
| Parties | , 62 USLW 2371, 87 Ed. Law Rep. 926 In re Application of the MILTON S. HERSHEY MEDICAL CENTER OF the PENNSYLVANIA STATE UNIVERSITY. In re Application of the HARRISBURG HOSPITAL. Appeal of JOHN DOE, M.D. |
| Court | Pennsylvania Supreme Court |
Bruce E. Cooper, Harrisburg, for appellants.
Delbert J. McQuaide, R. Mark Faulkner, State College, Thomas B. Schmidt, III, Donna L. Fisher, Harrisburg, for appellees.
Before NIX, C.J., LARSEN, FLAHERTY, ZAPPALA, PAPADAKOS, CAPPY, and MONTEMURO, JJ.
This is an appeal, by allowance, from an order of the Superior Court, 407 Pa.Super. 565, 595 A.2d 1290, which affirmed an order of the Court of Common Pleas of Dauphin County authorizing two hospitals to disclose that a physician on their medical staffs tested positive for Human Immunodeficiency Virus (HIV).
The physician in question, John Doe, M.D. (a pseudonym), was a resident in the obstetrics and gynecology departments of the Milton S. Hershey Medical Center of the Pennsylvania State University (Hershey Medical Center) and the Harrisburg Hospital. Dr. Doe served in this capacity for approximately two years before the events giving rise to this case.
In 1991, while assisting another physician in a surgical procedure, Dr. Doe was accidentally cut with a scalpel. Although it was unlikely that blood was transferred between the patient and Dr. Doe, because the cut did not occur above the patient's incision, it was impossible to be certain that no blood transfer took place. The next day, Dr. Doe voluntarily had his blood tested for HIV. The result was positive, so Dr. Doe withdrew from participation in further surgical procedures. A subsequent blood test confirmed the presence of HIV. Dr. Doe informed hospital officials of his condition and took a leave of absence. The manner in which Dr. Doe contracted HIV and the date when he became HIV-positive were not determinable.
Investigations were conducted by the Hershey Medical Center and the Harrisburg Hospital to determine which patients at those facilities had been placed at risk of contact with Dr. Doe's blood via surgical or obstetrical procedures in which Dr. Doe held or was likely to have held sharp instruments, i.e., procedures in which Dr. Doe might conceivably have sustained cuts that would have allowed his blood to come in contact with the blood of patients. The Hershey Medical Center determined that 279 of its patients fell into this category. The Harrisburg Hospital found that 168 of its patients were similarly situated.
Hospital records do not reflect each instance in which a surgeon sustains a cut. Nor do they particularize the exact roles taken by surgeons during operative procedures. Nevertheless, the determinations made by the two hospitals were in recognition of the fact that, in a small but nevertheless significant percentage of surgical procedures, surgeons suffer cuts that result in possible transfers of blood to patients.
The Hershey Medical Center and the Harrisburg Hospital filed petitions in the Court of Common Pleas of Dauphin County alleging that there was, under the Confidentiality of HIV-Related Information Act (HIV Act), 35 P.S. § 7608(a)(2), a "compelling need" to disclose information regarding Dr. Doe's condition to the patients potentially affected thereby as well as to certain physicians on the medical staffs. Both hospitals contended that disclosure to the patients was necessary to prevent the spread of HIV and to provide treatment, testing, and counseling. The hospitals asserted too that disclosure to certain physicians was necessary so that the physicians could contact their patients in the event that Dr. Doe had assisted in their surgical procedures. In opposition to the hospitals' petitions, Dr. Doe asserted that there was no compelling need for disclosure of his HIV-related information and that he was entitled to confidentiality under the Act.
After hearing arguments on the petitions, the trial court issued an order providing for partial disclosure. The order, which allowed a very selective and limited disclosure of Dr. Doe's identity and HIV-related information, read as follows:
AND NOW, this 14th day of June, 1991, Petitioners are hereby authorized to disclose the identity of Dr. Doe, M.D. as follows and only as thus authorized:
1. By providing the name of Dr. Doe to the physicians in the Obstetrics and Gynecology Departments including the physicians in the residency program.
2. By providing the name of Dr. Doe to a physician authorized in writing by a patient for whom Dr. Doe participated in a surgical procedure or obstetrical care.
3. By describing Dr. Doe in letters to patients and in media releases as "a physician in our joint Obstetrics and Gynecology residency program" and by setting forth the relevant period of such service.
Each physician to whom the name of Dr. Doe is provided under 1. and 2. above shall be reminded that the Act prohibits further disclosure of such information.
The issue presented for our review is whether the trial court, in concluding that the hospitals met their burden of showing a compelling need for disclosure under the HIV Act, committed an abuse of discretion. 1 See generally John M. v. Paula T., 524 Pa. 306, 311-12, 571 A.2d 1380, 1382-83 (1990) (), cert. denied, 498 U.S. 850, 111 S.Ct. 140, 112 L.Ed.2d 107 (1990). Where the discretion exercised by the trial court is challenged on appeal, the party bringing the challenge bears a heavy burden. As stated in Echon v. Pennsylvania Railroad Co., 365 Pa. 529, 534, 76 A.2d 175, 178 (1950) (quoting Garrett's Estate, 335 Pa. 287, 292-93, 6 A.2d 858, 860 (1939)),
When the court has come to a conclusion by the exercise of its discretion, the party complaining of it on appeal has a heavy burden; it is not sufficient to persuade the appellate court that it might have reached a different conclusion if, in the first place, charged with the duty imposed on the court below; it is necessary to go further and show an abuse of the discretionary power. "An abuse of discretion is not merely an error of judgment, but if in reaching a conclusion the law is overridden or misapplied, or the judgment exercised is manifestly unreasonable, or the result of partiality, prejudice, bias or ill-will, as shown by the evidence or the record, discretion is abused." Mielcuszny et ux. v. Rosol, 317 Pa. 91, 93, 94, 176 A. 236.
Accord Commonwealth v. Powell, 527 Pa. 288, 297 n. 8, 590 A.2d 1240, 1244 n. 8 (1991) ().
The trial court, after weighing the interest of Dr. Doe in maintaining his privacy against the interest of the hospitals and their patients in permitting disclosure, determined that a limited form of disclosure was warranted. We perceive no abuse of discretion.
The HIV Act was promulgated to promote voluntary blood testing to limit the spread of HIV. 35 P.S. § 7602. HIV causes the fatal disease known as Acquired Immune Deficiency Syndrome (AIDS). Confidential testing was viewed by the legislature as a means of encouraging persons who believe they may have been exposed to HIV to obtain testing and counseling, thereby protecting the public health. Id.
The HIV Act imposes strict limits upon the dissemination of information pertaining to an individual's HIV status. 35 P.S. § 7607. It is undisputed that Dr. Doe's status as a carrier of HIV is encompassed by the Act's definition of confidential information, and that, as such, the information falls within the Act's general proscription on disclosure. The proscription is, however, subject to numerous exceptions set forth in the Act. Id. The exception under which HIV-related information was disclosed in the present case is set forth in 35 P.S. § 7607(a)(10), which provides that courts can order disclosure in accordance with 35 P.S. § 7608.
The latter section provides that disclosure can be ordered if a compelling need therefor has been shown:
(a) Order to disclose.--No court may issue an order to allow access to confidential HIV-related information unless the court finds, upon application, that one of the following conditions exists:
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