Protection & Advocacy v. Mental Health & Addiction

• Decision Date: 05 May 2006
• Docket Number: Docket No. 05-1457-CV.
• Parties: PROTECTION & ADVOCACY FOR PERSONS WITH DISABILITIES, STATE OF CT, Plaintiff-Appellee, v. MENTAL HEALTH & ADDICTION SERVICES, Thomas A. Kirk /o Comm, Defendant-Appellant, Connecticut Hospital Association, Inc. and National Association of Protection and Advocacy Systems, Amicus Curiaes.
• Court: U.S. Court of Appeals — Second Circuit

448 F.3d 119

PROTECTION & ADVOCACY FOR PERSONS WITH DISABILITIES, STATE OF CT, Plaintiff-Appellee, v. MENTAL HEALTH & ADDICTION SERVICES, Thomas A. Kirk /o Comm, Defendant-Appellant Connecticut Hospital Association, Inc. and National Association of Protection and Advocacy Systems, Amicus Curiaes.

Docket No. 05-1457-CV.

United States Court of Appeals, Second Circuit.

Argued: February 28, 2006.

Decided: May 5, 2006.

Rosemary M. McGovern, Assistant Attorney General (Richard Blumenthal, Attorney

General of the State of Connecticut, Richard J. Lynch and Thomas J. Ring, Assistant Attorneys General, on the brief), Hartford, Connecticut, for Defendant-Appellant.

Nancy B. Alisberg, Managing Attorney, Office of Protection & Advocacy for Persons with Disabilities, Hartford, Connecticut, for Plaintiff-Appellee.

Jennifer A. Osowiecki, Cox & Osowiecki, LLC, Hartford, Connecticut, for Amicus Curiae Connecticut Hospital Association, Inc.

Kenneth Pasquale, Stroock & Stroock & Lavan LLP, New York, New York, for Amicus Curiae National Disability Rights Network, formerly known as National Association of Protection and Advocacy Systems.

Before: SOTOMAYOR and RAGGI, Circuit Judges, and CEDARBAUM, District Judge.^*

SOTOMAYOR, Circuit Judge.

This case raises the question whether the Protection and Advocacy for Individuals with Mental Illness Act ("PAIMI"),¹ 42 U.S.C. §§ 10801-10851 (2000), requires defendant-appellant the Connecticut Department of Mental Health and Addiction Services, through its commissioner, Thomas A. Kirk, ("the Department") to disclose peer review records to plaintiff-appellee the Connecticut Office of Protection and Advocacy for Persons with Disabilities ("OPA"). For the reasons that follow, we hold that PAIMI unambiguously grants OPA access to peer review records and affirm the district court's entry of a declaration and injunction requiring the Department to disclose to OPA the peer review records at issue.

BACKGROUND

The parties have stipulated to the relevant facts. OPA is a state-created agency that is authorized to represent and investigate suspected abuse of individuals with disabilities or mental illness residing in facilities in Connecticut. See Conn. Gen. Stat. §§ 46a-10 to 46a-11 (2003). OPA serves as the protection and advocacy ("P & A") system for Connecticut pursuant to PAIMI, 42 U.S.C. § 10801(b)(2). Enacted in the wake of disturbing reports about the treatment of institutionalized persons with disabilities, see S.Rep. No. 99-109, at 2-3 (1985), reprinted in 1986 U.S.C.C.A.N. 1361, 1362-63, PAIMI provides federal funds for states, such as Connecticut, that have qualifying P & A systems that monitor the care of individuals with disabilities and mental illness in facilities providing care and treatment. See 42 U.S.C. § 10801.

On January 21, 2000, Rose Marie Cinami, a patient at the Cedarcrest Hospital who was diagnosed with schizophrenia, died after choking on her breakfast. OPA subsequently opened an investigation into her death. The administrator of Cinami's estate authorized OPA to access her records and OPA requested all of Cedarcrest Hospital's records relating to her care. Cedarcrest Hospital, which is administered by the Department, disclosed all of its records relating to Cinami's care except for its peer review records. Peer review records are those created by or for the peer review committee at Cedarcrest Hospital. The hospital peer review committee is a "committee of Cedarcrest Hospital" comprised of healthcare staff at the hospital that "engage[s] in the evaluation . . . of the quality and efficiency of services ordered or performed by other health care professionals."

On April 3, 2002, James Bell, a patient at the Whiting Forensic Institute division of the Connecticut Valley Hospital, died while being transported in restraints. OPA opened an investigation into his death and requested all records relating to his case, including the peer review records. Because Bell had died and OPA made a probable cause determination that he had been subject to abuse or neglect, it did not need consent to obtain the files. See 42 U.S.C. § 10805(a)(4)(B). The Whiting Forensic Institute, which is also administered by the Department, released to OPA all of Bell's records except for its peer review records. The Department withheld both sets of peer review records on the ground that peer review documents are privileged under Connecticut law.

OPA filed this action pursuant to 42 U.S.C. § 1983 and PAIMI in the United States District Court for the District of Connecticut, seeking a declaration that it is entitled to the peer review records relating to Bell and Cinami under PAIMI and an injunction requiring the Department to release the records. OPA's motion for a preliminary injunction was denied without prejudice to its arguments being raised on a motion for summary judgment. Both parties then moved for summary judgment on the basis of stipulated facts. OPA argued that it was entitled to the peer review records because § 10805(a)(4) of PAIMI authorizes it to have access "to all records of . . . any individual" who has consented to OPA access or whom OPA has probable cause to believe has been abused, and because § 10806(b)(3)(A) defines "records" to include "reports prepared by any staff of a facility rendering care and treatment." 42 U.S.C. § 10806(b)(3)(A).

The Department argued that the term "all records of . . . any individual" is ambiguous and that the district court therefore had to defer to the regulatory interpretation promulgated by the United States Department of Health and Human Services ("HHS"), which provides that a P & A system may receive all records, including peer review reports, "except that nothing in this section is intended to preempt State law protecting records produced by medical care evaluation or peer review committees." 42 C.F.R. § 51.41(c)(4). Pursuant to this regulation, the Department asserted, PAIMI did not preempt Connecticut's peer review privilege law and thus did not require release of the peer review records.

The District Court for the District of Connecticut (Dominic J. Squatrito, Judge) granted OPA's motion for summary judgment. Following the reasoning of the Third and Tenth Circuits in their treatment of this issue, the district court concluded that the grant of access in § 10805(a)(4) to "all records of . . . any individual" unambiguously includes peer review records relating to a particular individual's care. Conn. Office of Prot. & Advocacy for Persons with Disabilities v. Kirk, 354 F.Supp.2d 196, 201-02 (D.Conn. 2005). Accordingly, the court did not defer to the regulatory interpretation promulgated by HHS. Finally, the court held that PAIMI preempts Connecticut's law governing the use of peer review records in civil actions. Id. at 202. The district court then entered an injunction requiring the Department to provide OPA with the peer review records relating to Cinami's and Bell's care on or before March 11, 2005. Id. at 202-03. That order was stayed pending this timely appeal.

On appeal, the Department argues that the district court erred in concluding that § 10805(a)(4) unambiguously requires it to disclose peer review records to OPA. It asserts that §§ 10805-06 do not expressly provide access to peer review records and that the statutory language is ambiguous. Accordingly, it contends, this Court must defer to HHS's reasonable interpretation of the statute.

DISCUSSION

This Court reviews a district court's grant of summary judgment de novo. Peck v. Baldwinsville Cent. Sch. Dist., 426 F.3d 617, 625 (2d Cir.2005). Moreover, questions of statutory interpretation and "the appropriate level of deference to accord agency regulations [are] . . . purely of law, subject to de novo review." Kruse v. Wells Fargo Home Mortgage, Inc., 383 F.3d 49, 54 (2d Cir.2004) (citation and internal quotation marks omitted).

I

Two PAIMI provisions granting OPA access to patient records are at issue here. Section 10805(a) provides that a P & A system such as OPA:

shall . . . (4) in accordance with section 10806 of this title, have access to all records of—

(A) any individual who is a client of the system if such individual, or the legal guardian, conservator, or other legal representative of such individual, has authorized the system to have such access;

(B) any individual (including an individual who has died or whose whereabouts are unknown)—(i) who by reason of the mental or physical condition of such individual is unable to authorize the system to have such access; (ii) who does not have a legal guardian, conservator, or other legal representative, or for whom the legal guardian is the State; and (iii) with respect to whom a complaint has been received by the system or . . . there is probable cause to believe that such individual has been subject to abuse or neglect; and

(C) any individual with a mental illness, who has a legal guardian, conservator, or other legal representative, with respect to whom a complaint has been received by the system or with respect to whom there is probable cause to believe the health or safety of the individual is in serious and immediate jeopardy . . . .

42 U.S.C. § 10805(a) (emphasis added). Section 10806 then provides:

As used in this section, the term "records" includes reports prepared by any staff of a facility rendering care and treatment or reports prepared by an agency charged with investigating reports of incidents of abuse, neglect, and injury occurring at such facility that describe incidents of abuse, neglect, and injury occurring at such facility and the steps taken to investigate such incidents, and discharge planning records.

Id. § 10806(b)(3)(A). The other subsections of § 10806 govern when the P & A system must maintain the records in confidence and when disclosure to the subject of the records, i.e., the patient at the hospital or facility, is prohibited. See id. § 10806(a)-(b)(2).

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