Pacific Radiation Oncology, LLC v. The Queen's Medical Center., 375 P.3d 1252

Plaintiffs (Pacific Radiation Oncology and individual radiation oncologists) sued Queens’ Medical Center (QMC) alleging wrongful termination of clinical privileges and related anticompetitive and tort claims; QMC counterclaimed that some doctors steered patients to a competitor (TCCH).
QMC’s counsel publicly filed an exhibit listing 132 cancer patients (names, QMC IDs, treating PRO doctors) as part of discovery/subpoena materials; the filing was later sealed. QMC had accessed electronic medical records to investigate alleged patient diversion.
Nineteen affected patients intervened solely to assert privacy rights and to prohibit use/production of their medical records; over 100 non-party patients are implicated.
The federal magistrate ordered the 132 patient records de-identified and produced for discovery; the district court certified two Hawaii-law questions to the Hawaii Supreme Court after the plaintiffs and intervenors challenged that order.
The Hawaii Supreme Court limited its analysis to article I, § 6 of the Hawaii Constitution (right to privacy) and HIPAA-related technical de-identification issues only to the extent state constitutional privacy law is implicated.

Issue	Plaintiff's Argument	Defendant's Argument	Held
May a party in lawful possession use or be compelled to produce a patient’s confidential medical records in litigation where the patient is not a party?	PRO: non-party patients’ records should be protected by privacy and not used beyond discovery absent consent.	QMC: records are discoverable; de-identification under HIPAA renders them usable; state law aligns with HIPAA.	No. Under article I, § 6 the parties cannot use or be compelled to produce non-party patients’ confidential medical records in litigation absent a compelling state interest.
Is de-identification sufficient to protect patient privacy where agents previously accessed records and some information was publicly disclosed?	PRO/intervenors: de-identification does not cure the privacy invasion, especially after an egregious breach; de-identified use still invades privacy.	QMC: HIPAA de-identification (and state statutes harmonized with HIPAA) permits disclosure of de-identified data; state law should not bar it.	No. Court declines to resolve HIPAA preemption questions but holds under the Hawaii Constitution that use/production of even sufficiently de-identified records of non-parties violates article I, § 6 absent a compelling state interest.

Brende v. Hara, [citation="113 Hawai'i 424"] (Haw. 2007) (recognizing health information as highly personal and protected by article I, § 6)
Naipo v. Border, [citation="125 Hawai'i 31"] (Haw. 2011) (held non-party medical records protected by state constitutional privacy; subpoena quashed)
Cohan v. Ayabe, [citation="132 Hawai'i 408"] (Haw. 2014) (held de-identified party medical information may not be used outside litigation absent compelling state interest)
State of Hawai'i Org. of Police Officers v. Soc’y of Prof’l Journalists, [citation="83 Hawai'i 378"] (Haw. 1996) (state constitutional privacy includes informational privacy and common-law privacy principles)
Nw. Mem’l Hosp. v. Ashcroft, 362 F.3d 923 (7th Cir. 2004) (once de-identified under HIPAA criteria, records are not ‘‘individually identifiable health information’’ for preemption purposes)
In re Zyprexa Prods. Liab. Litig., 254 F.R.D. 50 (E.D.N.Y. 2008) (concluded state privilege laws do not bar discovery of properly de-identified records)