Terre Haute Regional Hosp., Inc. v. Trueblood

Decision Date21 October 1992
Docket NumberNo. 61S04-9210-CV-847,61S04-9210-CV-847
PartiesTERRE HAUTE REGIONAL HOSPITAL, INC. and Hospital Corporation of America, Appellants (Defendants Below), v. Linda S. TRUEBLOOD, Appellee (Plaintiff Below).
CourtIndiana Supreme Court

KRAHULIK, Justice.

We grant transfer to decide whether the trial court may compel the production of the medical records of non-party patients who have not waived the physician-patient privilege. We hold that when all the information regarding the identities of these non-party patients has been redacted from the records, production of the medical records will not violate the physician-patient privilege.

Linda S. Trueblood (Plaintiff-Appellee below) seeks transfer after the Court of Appeals decided that Terre Haute Regional Hospital and Hospital Corporation of America, its parent corporation, (Defendant-Appellants below), (collectively "the hospital") were able to assert the physician-patient privilege to preclude the production of the non-party medical records even if the patient identification information is redacted from the records. Terre Haute Regional Hosp., Inc. v. Trueblood (1991), Ind.App., 579 N.E.2d 1342.

Facts

Trueblood brought this action against the hospital alleging that Manuel Cacdac, M.D., a staff physician at the hospital, performed two unnecessary surgeries on her neck and back in 1980 and 1981. Trueblood alleges that the hospital was negligent in supervising and monitoring Dr. Cacdac's performance and that the hospital's negligence was the cause of her injuries.

During discovery, Trueblood served a Request for Production of Documents and Entry on Land for Inspection, pursuant to which she sought to inspect and copy hospital charts and radiographs of Dr. Cadcac's patients who underwent surgery for their neck or back during the calendar years of 1979, 1980 and 1981 at the hospital. The hospital asserted multiple objections to the request including that the documents are privileged and confidential. Subsequently, Trueblood filed a motion to compel. The trial court issued an order, later supplemented, which permitted Trueblood's attorney and expert to inspect the medical records in an unredacted form. The order, however, also required Trueblood's attorney and expert to sign a confidential protective order stating they would never disclose the name of any patient, that copies of the records could only be obtained through leave of court and that these copies would not contain patient identification information. The hospital took an interlocutory appeal pursuant to Ind. Appellate Rule 4(B)(6) challenging the discoverability of the non-party medical records.

The Court of Appeals held that the trial court's order compelling discovery of the non-party medical records constitutes an abuse of discretion because the medical records of non-party patients are protected by the physician-patient privilege and are outside the scope of discovery even if the patient identification information is redacted from the records. 579 N.E.2d at 1346. Consequently, the Court of Appeals vacated the discovery order and remanded the action to the trial court to proceed consistent with the decision. We conclude that the non-party patient medical records are discoverable where there are adequate safeguards to protect the identity of the non-party patient. 1

Physician-Patient Privilege

In Indiana, discovery rules are designed "to allow liberal discovery with a minimum of court involvement in the process." Chustak v. Northern Ind. Pub. Serv. Co. (1972), 259 Ind. 390, 395, 288 N.E.2d 149, 152-3. Indiana Trial Rule 26(B)(1) requires that the information sought be relevant, admissible, or reasonably calculated to lead to the discovery of admissible evidence, and not privileged. The instant case requires the Court to balance the competing interests of this scope of discovery and the physician-patient privilege.

Indiana generally recognizes that privileges are statutory in nature and that it is within the power of the legislature to create them. DeMoss Rexall Drugs v. Dobson (1989), Ind.App., 540 N.E.2d 655, 657; Scroggins v. Uniden Corp. of America (1987), Ind.App., 506 N.E.2d 83, 86. Most privileges were unknown at common law and, as a result, are to be strictly construed to limit their application. Scroggins, 506 N.E.2d at 86.

The physician-patient privilege did not exist at common law, but was statutorily created to extend to this relationship the same rule of public policy which protected the professional confidence between an attorney and client. Canfield v. Sandock (1990), Ind., 563 N.E.2d 526, 528. The two privileges are codified in the same statute, Ind.Code Sec. 34-1-14-5, and provide similar protection in each relationship. The physician-patient privilege

has been justified on the basis that its recognition encourages free communication and frank disclosure between patient and physician which, in turn, provide assistance in proper diagnosis and appropriate treatment. To deny the privilege, it was thought, would destroy the confidential nature of the physician-patient relationship and possibly cause one suffering from a particular ailment to withhold pertinent information of an embarrassing or otherwise confidential nature for fear of being publicly disclosed.

Canfield, 563 N.E.2d at 529 quoting Collins v. Bair (1971), 256 Ind. 230, 236, 268 N.E.2d 95, 98.

Despite the apparent prohibitory language of the physician-patient privilege statute, it does not create an absolute incompetency, but rather a privilege for the benefit of the patient. Goodwin v. State (1991), Ind.App., 573 N.E.2d 895, 897, trans. den. The statute, however, is intended to foreclose disclosure of patient information where the method of treatment is associated closely with the nature of the ailment so that the disclosure itself will reveal the ailment. See State v. Jaggers (1987), Ind.App., 506 N.E.2d 832, 835.

It is in this context that the hospital asserts that the physician-patient privilege precludes discovery of the non-party medical records. Trueblood asserts that where adequate safeguards are established to protect the patient's confidentiality, there is no breach of the physician-patient privilege. 2 The issue is one of first impression in Indiana and as part of our review, the law of other jurisdictions is considered.

The rule that the physician-patient privilege is not violated by the review of non-party medical records where adequate safeguards exist is followed in several jurisdictions: Ziegler v. Superior Ct. (1982), 134 Ariz. 390, 656 P.2d 1251; Rudnick v. Superior Ct. (1974), 11 Cal.3d 924, 114 Cal.Rptr. 603, 523 P.2d 643; Community Hosp. Ass'n. v. District Ct. (1977), 194 Colo. 98, 570 P.2d 243; Amisub (Northridge Hosp.), Inc. v. Kemper (1989), Fla.App., 543 So.2d 470; State ex rel Benoit v. Randall (1968), Mo., 431 S.W.2d 107; Ventimiglia v. Moffitt (1986), Fla.App., 502 So.2d 14; Osterman v. Ehrenworth (1969), 106 N.J.Super. 515, 256 A.2d 123. But see contra, Parkson v. Central DuPage Hosp. (1982), 105 Ill.App.3d 850, 61 Ill.Dec. 651, 435 N.E.2d 140.

Similar to Indiana's purpose for the privilege, the Arizona Supreme Court in Ziegler recognized that the purpose of the privilege "is to insure that the patient will receive the best medical treatment by encouraging full and frank disclosure of medical history and symptoms by a patient to his doctor." Ziegler, 656 P.2d at 1255. As a doctor and patient need full disclosure in order for the doctor to "best" diagnose his patient, the court seeks full disclosure to "best" ascertain the truth. The Missouri Supreme Court in State v. Randall explained,

The ultimate object of every judicial inquiry is to get at the truth. Therefore no rule of law standing in the way of getting at the truth should be loosely or me[c]hanically applied. The application of such law must be with discrimination, so that it may have the legislative effect intended for it, and yet the investigation of truth be not unnecessarily thwarted.

431 S.W.2d 107, 110. By providing adequate safeguards to protect the identity of the non-party patients, a court may give effect to the intent of the statute and the physician-patient privilege is not violated. See Ziegler, 656 P.2d at 1255; Randall, 431 S.W.2d at 110.

The California Supreme Court examined the issue in Rudnick v. Superior Court of Kern Co., 114 Cal.Rptr. 603, 610-11, 523 P.2d 643, 650-51. In Rudnick, the trial court denied discovery on the ground that production would violate the physician-patient privilege. The California Supreme Court reversed, stating in footnote 13 of its opinion:

Because the record indicates sporadic and unclear concern by the parties as to the discoverability of patients' names in the context of the physician-patient privilege, we note the following for the guidance of the trial court should it determine to exercise its discretion to protect an absentee holder of the privilege. The whole purpose of the privilege is to preclude the humiliation of the patient that might follow disclosure of his ailments. Therefore if the disclosure of the patient's name reveals nothing of any communication concerning the patient's ailments, disclosure of the patient's name does not violate the privilege. If, however, disclosure of the patient's name inevitably in the context of such disclosure reveals the confidential information, namely the ailments, then such disclosure violates the privilege. Conversely if the disclosure reveals the ailments but not the patient's identity, then such disclosure would appear not to violate the privilege.

Id. at 610-11, 523 P.2d at 650-51. (Citations omitted.) (Emphasis added.)

Rudnick recognized that the trial court acted as the protector of the absentee...

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