Pacific Radiation Oncology, LLC v. Queen's Medical Center
47 F. Supp. 3d 1069
D. Haw.2014Background
- PRO (Pacific Radiation Oncology) physicians alleged Queen’s adopted a closed-facility (employment) model to exclude competing physicians and filed a multi‑claim suit including Hawai‘i constitutional and Hawai‘i Revised Stat. ch. 480 claims. Plaintiffs moved for a TRO or preliminary injunction to stop Queen’s use/disclosure of PRO patients’ medical records.
- Queen’s administrators compiled a list of ~132 PRO patients who consulted at Queen’s but received treatment elsewhere; that list (containing patient names and diagnoses) was attached as an exhibit to a subpoena and publicly filed inadvertently.
- The court’s Amended Stipulated Protective Order defined such patient information as Protected Health Information and required redaction/leave to file under seal. The court found the public filing violated the Protective Order.
- Plaintiffs sought injunctive relief under HIPAA and the Hawai‘i Constitution; the court concluded the Amended Complaint did not plead a HIPAA/state‑privacy claim and therefore denied the TRO/preliminary injunction requests.
- The court found the disclosure was a willful violation of the Protective Order (though not shown to be in bad faith) and imposed sanctions limited to awarding Plaintiffs reasonable attorneys’ fees and costs related to the public filing; parties were ordered to brief the amount. The court also directed the parties to meet with the magistrate judge to address discovery and HIPAA/state‑law issues.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether TRO/PI should issue to stop Defendants’ review/use/disclosure of PRO patients’ records | TRO/P.I. needed because public disclosure and review caused/created risk of irreparable harm to patients and to physician‑patient relationships | No entitlement to preliminary relief; Plaintiffs lack a pleaded HIPAA/state‑privacy claim in the complaint | Denied — Plaintiffs unlikely to succeed on merits because the Amended Complaint did not assert the claimed HIPAA/state‑privacy violation; TRO/PI not granted |
| Whether public filing of the patient list violated the Protective Order and whether violation was willful | Protective Order protects such PHI; public filing improper and warrants strong sanction | Filing was inadvertent; counsel took some remedial steps; sanction should be modest if any | Found violated Protective Order and was willful (deliberate staff filing due to inadequate precautions); sanctions warranted |
| Appropriate sanction for Protective Order violation | Sought broad remedies: mandatory patient notices, broad prohibition on further access, withdrawal of discovery requests, identification/destruction of all copies, etc. | Requested a small monetary sanction (no more than $1,000) | Limited monetary‑remedial sanction: award of Plaintiffs’ reasonable attorneys’ fees and costs related to responding to the public filing; parties to brief amount; broader discovery/remedial requests denied as beyond scope |
| Whether HIPAA preempts Hawai‘i constitutional privacy claims and how discovery of PHI should proceed | State constitutional privacy may provide more stringent protection; parties should resolve via discovery rules and Hawaii law may govern if more protective | HIPAA governs and permits the relevant disclosures; federal preemption arguments apply | Court: HIPAA establishes a federal floor; more‑stringent state privacy protections may apply; discovery/disputes to be addressed before the magistrate judge under HIPAA and Hawai‘i constitutional guidance (no substantive discovery ruling made) |
Key Cases Cited
- Winter v. Natural Res. Def. Council, Inc., 555 U.S. 7 (Sup. Ct.) (establishes the standard for preliminary injunctions requiring likelihood of success and irreparable harm)
- Alliance for the Wild Rockies v. Cottrell, 632 F.3d 1127 (9th Cir.) (preserves the Ninth Circuit's "serious questions" sliding‑scale formulation for preliminary injunctions alongside Winter)
- Evon v. Law Offices of Sidney Mickell, 688 F.3d 1015 (9th Cir.) (district courts may impose sanctions for willful or deliberate violations of protective orders)
- Cohan v. Ayabe, [citation="132 Hawai'i 408, 322 P.3d 948"] (Haw. 2014) (Hawai‘i Supreme Court: HIPAA sets a federal floor; state constitutional informational‑privacy protections can be more stringent)
- Brende v. Hara, [citation="113 Hawai'i 424, 153 P.3d 1109"] (Haw. 2007) (holding medical‑information protective orders must, at minimum, provide HIPAA protections)