Staley v. Jolles, 20080492.

• Decision Date: 26 March 2010
• Docket Number: No. 20080492.,20080492.
• Citation: 230 P.3d 1007,2010 UT 19
• Parties: Denise STALEY, Plaintiff and Respondent,v.Christopher Jolles, M.D.; and NORTHERN UTAH HEALTHCARE CORPORATION dba ST. MARK'S HOSPITAL, Defendants and PETITIONERS.
• Court: Utah Supreme Court

230 P.3d 1007

2010 UT 19

Denise STALEY, Plaintiff and Respondent,v.Christopher Jolles, M.D.; and NORTHERN UTAH HEALTHCARE CORPORATION dba ST. MARK'S HOSPITAL, Defendants and PETITIONERS.

No. 20080492.

Supreme Court of Utah.

March 26, 2010.

David A. Cutt, Jordan P. Kendell, Salt Lake City, for plaintiff.

Jennifer Ries-Buntain, Eric P. Schoonveld, Mark A. Riekhof, Hugh C. Griffin, Salt Lake City, for defendants.

NEHRING, Justice:

INTRODUCTION

¶ 1 This interlocutory appeal requires us to decide whether redacted medical information, which may only be reviewed by a limited number of people, offends the policies of the physician-patient privilege outlined in Utah Rule of Evidence 506. We hold that it does not and affirm the district court's ruling.

FACTS AND PROCEDURAL HISTORY

¶ 2 On April 10, 2003, appellee Denise Staley underwent a hysterectomy at St. Mark's Hospital, a facility located in Salt Lake City, Utah, and owned by appellant Northern Utah Healthcare Corporation. Following surgery, Ms. Staley was sent to floor Four West for postoperative recovery. During the evening of April 11, and while on floor Four West, Ms. Staley was cared for by registered nurse Angela Stallings. Ms. Stallings had an additional six patients assigned to her during that same evening.

¶ 3 St. Mark's nursing guidelines suggest a minimum of six registered nurses be on duty if there are thirty-four patients to a floor. These guidelines also provide that if a patient's systolic blood pressure drops below 90 points, the patient's assigned nurse should report that drop to the patient's physician. Four West was staffed with only five registered nurses and had a total of thirty-four patients from the evening of April 11, at 11:00 p.m., until April 12, at 7:00 a.m. During the same evening, Ms. Staley's systolic blood pressure dropped from 132 to 86 points between the hours of 6:15 p.m. and 2:00 a.m. Ms. Staley's physician was never notified.

¶ 4 Ms. Staley claims Ms. Stallings was negligent and that St. Mark's knowingly and recklessly understaffed floor Four West. Ms. Staley claims that because of this understaffing Ms. Stallings was unable to adequately monitor and prevent permanent damage to Ms. Staley's kidneys, which resulted from the low blood pressure. To support her negligent staffing claim, Ms. Staley requested documentation reflecting the acuity of the other patients assigned to Ms. Stallings during the evening following Ms. Staley's surgery. Patient acuity refers to the amount of nursing care a patient requires. After a series of discovery motions, St. Mark's was ordered to produce either a chart reflecting the acuity of Ms. Stallings' patients or a statement discussing how patient acuity is assessed and communicated on floor Four West. St. Mark's chose the latter.

¶ 5 In response to the order, St. Mark's produced an affidavit of registered nurse How-Su Chen, the nursing manager for floor Four West. Ms. Chen explained in her affidavit that patient acuity involves multiple factors including the patient's medical diagnosis and multiple patient needs that change from shift to shift. Ms. Chen also indicated that she had personally reviewed the six patient charts assigned to Ms. Stallings during the evening of April 11, and that in her opinion, Ms. Stallings' assignment was an appropriate staffing decision.

¶ 6 Ms. Staley then requested the six patient charts. Ms. Staley argued that it would be unfair and contrary to discovery for Ms. Chen to have access to the six patient charts without providing Ms. Staley an opportunity to review the records herself. St. Mark's refused to produce the six patient charts, arguing that they fall under the physician-patient privilege found in Utah Rule of Evidence 506(b). To overcome this physician-patient privilege, Ms. Staley has stipulated to redaction of all personal identifying information from the six patient charts as well as limiting review of the records to only attorneys and experts. St. Mark's rejected this stipulation, which resulted in a discovery hearing before the district court.

¶ 7 The district court noted that the question of redaction in the context of a physician-patient privilege is one of first impression in Utah. After analyzing the policies underlying the physician-patient privilege, and following the review of sister jurisdictions' treatment of the issue, the district court ordered St. Mark's to produce the six patient charts for redaction and limited review, holding that such a course would take the medical information out of the privilege altogether.

¶ 8 St. Mark's timely filed this interlocutory appeal pursuant to rule 5 of the Utah Rules of Appellate Procedure. We have jurisdiction pursuant to Utah Code section 78A-3-102(3)(j).

STANDARD OF REVIEW

¶ 9 “The existence of a privilege is a question of law for the court, which we review for correctness, giving no deference to the trial court's determination.” Moler v. CW Mgmt. Corp., 2008 UT 46, ¶ 7, 190 P.3d 1250 (internal quotation marks omitted).

ANALYSIS

¶ 10 Stripped to their essence, St. Mark's contentions on appeal are: (1) that the physician-patient privilege found in rule 506 of the Utah Rules of Evidence permits neither redaction nor restricted review of medical files; (2) that even if redaction were allowed, the patient files would be only marginally relevant to Ms. Staley's negligent staffing claim and therefore would not overcome St. Mark's interest in protecting patient privacy; and (3) that Ms. Staley's negligent staffing claim has no independent viability and is merely a reformulation of her negligence claim.

¶ 11 Ms. Staley counters by pointing to the plain language and policy of rule 506, which, in her view, permits redaction and restricted access to medical records like that approved by the district court. Next, Ms. Staley asserts the medical records are very relevant, bearing directly on her claim that too few nurses were assigned to her floor on the night she suffered kidney damage.

I. THE PHYSICIAN-PATIENT PRIVILEGE IS NOT IMPLICATED IF THE RECORDS ARE ADEQUATELY REDACTED

¶ 12 The first issue before us is whether the physician-patient privilege applies to the medical records requested by Ms. Staley. Ms. Staley argues that when the documents sought were scrubbed of information that might identify the patient, and when access to the redacted documents was restricted, the physician-patient privilege no longer applied. In the alternative, Ms. Staley argues that the exception found in rule 506(d)(1) should include medical conditions of non-litigants.

¶ 13 St. Mark's reasons that since the text of rule 506 says nothing about redaction, and moreover, the enumerated exceptions to rule 506(b) are to be strictly construed, any redaction cannot change the privileged character of the records. St. Mark's also argues that rule 506(d)(1), excepting from the privilege physician-patient communications when a patient's “condition is an element of any claim or defense,” applies only to patients who are parties and not to a condition of a non-litigant.

¶ 14 “We interpret court rules, like statutes and administrative rules, according to their plain language.” Burns v. Boyden, 2006 UT 14, ¶ 19, 133 P.3d 370. “Parties may obtain discovery regarding any matter not privileged, which is relevant to the subject matter involved in the pending action, whether it relates to the claim or defense of the party seeking discovery or to the claim or defense of any other party....” Utah R. Civ. P. 26(b)(1) (emphasis added). Rule 506 of the Utah Rules of Evidence creates the physician-patient privilege. It states, in part:

If the information is communicated in confidence and for the purpose of diagnosing or treating the patient, a patient has a privilege, during the patient's life, to refuse to disclose and to prevent any other person from disclosing (1) diagnoses made, treatment provided, or advice given, by a physician or mental health therapist, (2) information obtained by examination of the patient, and (3) information transmitted among a patient, a physician or mental health therapist, and persons who are participating in the diagnosis or treatment under the direction of the physician or mental health therapist....

Utah R. Evid. 506(b). Certain exceptions to the privilege exist under rule 506(d). Otherwise privileged communications will become discoverable in three specifically enumerated situations: (1) when a patient's condition is “an element of any claim or defense”; (2) when “proceedings to hospitalize the patient for mental illness” are being conducted; or (3) when communications of a “physical, mental, or emotional condition of a patient” are “made in the course of” and are “pertinent to the purpose of a court-ordered examination.” Utah R. Evid. 506(d)(1)-(3).

¶ 15 On appeal, the parties have focused their arguments on how the exceptions to the physician-patient rule have been interpreted and applied. We find, however, that this appeal is best resolved by examining the general meaning, scope, and intent of rule 506. See State v. Rothlisberger, 2006 UT 49, ¶ 15, 147 P.3d 1176 (“Our objective in interpreting a court rule is to give effect to the intent of the body that promulgated it.”)

¶ 16 Rule 506 shields from disclosure certain information communicated between a physician or a mental health therapist and a patient, so long as the information “is communicated in confidence” and for the purpose of diagnosis and treatment of the patient. Utah R. Evid. 506(b). Under rule 506, communicating information contemplates an exchange of information between a physician and a patient. In short, to be operative, rule 506 requires two actors-a patient and a physician, and an exchange of confidential information concerning a particular subject matter-diagnosis and treatment. All of these elements must be present for the privilege to be activated; mere descriptions of diagnoses and treatments that make no reference to a patient are ineligible for...