OPINION OF THE COURT
This action for an injunction and for damages for breach of privacy is a matter of first impression in this State, and so far as I am able to ascertain, a matter of first impression in the United States. It arises out of the publication, verbatim, by a psychiatrist of a patient’s disclosures during the course of a lengthy psychoanalysis. I have made and filed detailed findings of fact which are briefly summarized here.
Dr. Joan Roe is a physician who has practiced psychiatry for more than 50 years. Her husband, Peter Poe, has been a psychologist for some 25 years. The plaintiff and her late, former husband were each patients of Dr. Roe for many years. The defendants, eight years after the termination of treatment, published a book which reported verbatim and extensively the patients’ thoughts, feelings, and emotions, their sexual and other fantasies and biographies, their most intimate personal relationships and the disintegration of their marriage. Interspersed among the footnotes are Roe’s diagnosis of what purport to be the illnesses suffered by the patients and one of their children.
The defendants allege that the plaintiff consented to this publication. This defense is without substance. Consent was sought while the plaintiff was in therapy. It was never obtained in writing. In Dr. Roe’s own words consent "was there one day and not there another day. That was the nature of the illness I was treating, unreliable.” I need not deal with the value of an oral waiver of confidentiality given by a patient to a psychiatrist during the course of treatment. It is sufficient to
The plaintiff seeks to prevail on any or all of four theories: that violation of CPLR 4504 (subd [a]) gives rise to a cause of action;
The defendants contend not only that there was no unlawful disclosure, the patient’s identity having been fully concealed, but that no right of action exists even if the plaintiff is recognizable in this volume. The defendants assert that neither the "evidentiary privilege” contained in CPLR 4504 (subd [a]) nor the regulations of the Commissioner of Education, by their history, are intended to give rise to a cause of action for their violation; that the only cause of action for invasion of privacy recognized in the State of New York is the statutory
The few New York cases dealing with a physician’s unauthorized disclosure of a patient’s confidences usually turn on other issues, restrict themselves for the most part to a discussion of the effect of the current evidentiary statute (CPLR 4504, subd [a]) or its predecessor (Civ Prac Act, § 352) and in their dicta reach contradictory conclusions. In Munzer v Blaisdell (
In Clark v Geraci (
The most frequently cited cases arising in other jurisdictions suffer from the same limitations. Although in Smith v Driscoll (94 Wash 441, 442) the court said that "for so palpable a wrong, the law provides a remedy,” the case turned on a question of pleading. A dictum in Simonsen v Swenson (104 Neb 224) suggests the availability of a remedy for violation of the duty of secrecy, but the issue involved what the court held to be a limited right of disclosure of the existence of a communicable disease. The court in Berry v Moench (
In Hague v Williams (37 NJ 328, 336) the court states that despite the absence of a common-law physician-patient privilege (cf. Matter of City Council of City of N. Y. v Goldwater,
None of the post Civil Practice Act cases had considered the effect of the repeal of section 354 of the Civil Practice Act. Section 352 of the Civil Practice Act which prohibited disclosure, was carried forward verbatim into the new statute (CPLR 4504, subd [a]). Section 354 of the Civil Practice Act limited the application of section 352 providing in part that it applied "to any examination of a person as a witness,” but this language was excluded from the new statute leaving only the broad prohibition without limitation that "a person duly authorized to practice medicine * * * shall not be allowed to disclose any information which he acquired in attending a patient in a professional capacity, and which was necessary to enable him to act in that capacity”.
Were this case to turn exclusively on the application of CPLR 4504 (subd [a]) it might be argued that had the Legislature intended, on adoption of the Civil Practice Law and Rules, to create a new cause of action where none existed before (cf. Matter of City Council of City of N. Y. v Goldwater, supra), it would have said so explicitly. Obviously, this case does not depend on so limited an approach; but I am of the opinion that the Legislature, in excluding from the new statute the opening words of section 354 of the Civil Practice Act (quoted supra), intended to reinforce the public policy of this State expressed in numerous statutes and regulations (cf. CPLR 4504, subd [a]; 4507, 4508; Education Law, §§ 6509-6511; Mental Hygiene Law, § 15.13, subds [c], [d]; § 35.11; Public Health Law, § 2803-c, subd 3, par f; § 2805-e, subd 3; § 3371; 8 NYCRR 60.1 [d] [3]) prohibiting physicians, persons in allied fields and medical institutions from disclosing without authorization of the patient, information discovered in attending the patient. I believe it clear, from the statutory and regulatory schemes set forth above that the Legislature did not intend to confine the prohibition to trials and other formal hearings whose proceedings are governed by a practice act (cf. Matter of City Council of City of N. Y. v Goldwater, supra) but intended that " 'the statute [CPLR 4504, subd (a)] have a broad and liberal construction to carry out its policy’” (Matter of City Council of City of N. Y v Goldwater, supra, p 301, citing Buffalo Loan, Trust & Safe Deposit Co. v Knights Templar & Masonic Mut. Aid Assn., supra).
As hereafter indicated there are theories on which liability
Horne v Patton (supra) was a case of first impression in Alabama, a State without a testimonial privilege statute, but which had a licensing statute (Ala Code, tit 46, § 257 [21]; now Ala Code, § 34-24-35, subd 14) which, like our own statute (Education Law, § 6509 et seq.) and regulations (8 NYCRR 60.1 [d] [3]) permitted revocation of the physician’s license for "[w]ilful betrayal of a professional secret”. The court (p 830) sustained the complaint seeking an injunction and damages and recognized the "right of a person to be free from unwarranted publicity or unwarranted appropriation or exploitation of one’s personality, publicization of one’s private affairs with
I too find that a physician, who enters into an agreement with a patient to provide medical attention, impliedly covenants to keep in confidence all disclosures made by the patient concerning the patient’s physical or mental condition as well as all matters discovered by the physician in the course of examination or treatment. This is particularly and necessarily true of the psychiatric relationship, for in the dynamics of psychotherapy "[t]he patient is called upon to discuss in a candid and frank manner personal material of the most intimate and disturbing nature * * * He is expected to bring up all manner of socially unacceptable instincts and urges, immature wishes, perverse sexual thoughts — in short, the unspeakable, the unthinkable, the repressed. To speak of such things to another human requires an atmosphere of unusual trust, confidence and tolerance. * * * Patients will be helped only if they can form a trusting relationship with the psychiatrist.” (Heller, Some Comments to Lawyers on the Practice of Psychiatry, 30 Temple L Rev 401, 405-406.)
There can be little doubt that under the law of the State of New York and in a proper case, the contract of private parties to retain in confidence matter which should be kept in confidence will be enforced by injunction and compensated in
The contract between the plaintiff and Dr. Roe is such a contract. The contention that such enforcement of a private agreement not to disclose information received in confidence somehow offends the United States Constitution would seem to be disputed by implication in Kewanee Oil Co. v Bicron Corp. (
The complaint alleges a cause of action for breach of privacy under sections 50 and 51 of the Civil Rights Law. These statutes have not been violated for the defendants did not use the plaintiff’s "name, portrait or picture” in their book. We are not, of course, limited to the theory set forth in the complaint, but may consider any cause of action revealed by the pleadings and proof (Diemer v Diemer,
The expression "right of privacy” is not without confusion and has been applied to varying rights and causes of action. Among the cases cited by the plaintiff in support of its contention are Roe v Wade (
In Nader v General Motors Corp. (
Ever since Roberson v Rochester Folding Box. Co. (
Every patient, and particularly every patient undergoing psychoanalysis, has such a right of privacy. Under what circumstances can a person be expected to reveal sexual fantasies, infantile memories, passions of hate and love, one’s most intimate relationship with one’s spouse and others except upon the inferential agreement that such confessions will be forever entombed in the psychiatrist’s memory, never to be revealed during the psychiatrist’s lifetime or thereafter? The very needs of the profession itself require that confidentiality exist and be enforced. As pointed out in Matter of Lifschutz (2 Cal 3d 415, 421) "a large segment of the psychiatric profession concurs in Dr. Lifschutz’s strongly held belief that an absolute privilege of confidentiality is essential to the effective practice of psychotherapy” (cf. Ann., 20 ALR3d 1109-1112). Despite the fact that in no New York case has such a wrong been remedied due, most likely, to the fact that so few physicians violate this fundamental obligation, it is time that the obligation not only be recognized but that the right of redress be recognized as well.
What label we affix to this wrong is unimportant (although the category of wrong could, under certain circumstances— such as determining the applicable Statute of Limitations — be significant). " Tt is generally accepted that "There is no necessity whatever that a tort must have a name. New and nameless torts are being recognized constantly”. (Prosser, Torts [2d ed.], p. 3.) What is important is that there must be the infliction of intentional harm, resulting in damage, without legal excuses or justification. (See Aikens v. Wisconsin,
It is not disputed that under our public policy the right of confidentiality is less than absolute. The evidentiary statute itself (CPLR 4504, subd [a]) contains its own exceptions. Despite the duty of confidentiality courts have recognized the duty of a psychiatrist to give warning where a patient clearly presents a danger to others (Tarasoff v Regents of Univ. of Cal.,
Nor is the argument available that by enjoining the further distribution of this book the court will be engaging in a "prior restraint” on publication. The Supreme Court long ago recognized that "liberty of speech, and of the press, is
There is no prior restraint in the case at bar. The book has been published and it does offend against the plaintiff’s right of privacy, contractual and otherwise, not to have her innermost thoughts offered to all for the price of this book. There is no prior restraint and, therefore, no censorship within constitutional meaning.
As I have indicated in the separately filed findings of facts, the defense of laches is groundless. Publication occurred 10 years after Dr. Roe last discussed the book with the plaintiff, eight years after treatment stopped. As soon as the plaintiff heard of the impending publication, she protested, orally through a mutual friend and in writing through her attorney. Dr. Roe’s evasive and misleading answer to the attorney should serve to still any claim of laches.
The liability of Dr. Roe to respond in damages is clear; and Mr. Poe’s liability is equally clear. True, he and the plaintiff were not involved in a physician-patient relationship and he certainly had no contractual relationship to her. But, the conclusion is unassailable that Poe, like anyone else with access to the book, knew that its source was the patient’s production in psychoanalysis. He knew as well as, and perhaps better than Roe, of the absence of consent, of the failure
The plaintiff seeks punitive damages and suggests that a proper measure of those damages, in addition to compensatory damage, is approximately $50,000, the sum plaintiff has thus far expended on and incurred for attorneys’ fees. (Given the history of this action with appeals to the United States Supreme Court, it is reasonable to assume that she shall continue to incur expenses.) Under the English rule, an allowance of costs to the prevailing party includes attorneys’ fees assessed by the court. Early in the judicial history of the United States, this country and nearly all if not all, jurisdictions within it, determined that except for extraordinary circumstances, attorneys’ fees were not a proper element of costs unless provided for by statute. It has been held that in the Federal courts where jurisdiction is attained other than by diversity of citizenship, attorneys’ fees may be awarded under general Federal equity jurisdiction where a losing litigant has acted "in bad faith, vexatiously, wantonly, or for oppressive reasons” (Hall v Cole,
In order to warrant an award of punitive damages, it must have been affirmatively demonstrated that the wrong committed was willful and malicious, that the act complained of was "morally culpable or * * * actuated by evil and reprehensible motives not only to punish the defendant but to deter him as well as others” (Walker v Sheldon,
On turning to compensatory damages, we are confronted by the defendants’ contention that the information concerning the book acquired by the plaintiff’s university students and colleagues be excluded from consideration. They argue that these people acquired their information as a consequence of newspapers reporting the filing of this suit. They say, inferentially, that had plaintiff not brought this action she would have been spared that particular embarrassment, and therefore, having brought the action, she must bear its consequences.
This argument must be rejected for the same reason we reject the demand for attorneys’ fees. An underlying principle of American law is that a person having a cognizable claim is entitled or even encouraged to pursue that claim in the courts and that which discourages a person from seeking redress, such as the imposition of substantial costs as a penalty for losing his suit, is rejected. (Cf. Alyeska Pipeline Co. v Wilderness Soc.,
The plaintiff has suffered damage as a consequence of this publication. She suffered acute embarrassment on learning the extent to which friends, colleagues, employer, students and others, had read or read of the book. Her livelihood, as indicated in the findings, was threatened; but fortunately, the actual cash loss was only some $1,500. Medical attention,
Damages, of course, do not provide an adequate remedy; for should the book circulate further, beyond the 220 copies already sold, the damage must accrue anew. The plaintiff is entitled to a judgment permanently enjoining the defendants, their heirs, successors and assigns from further violating the plaintiff’s right to privacy whether by circulating this book or by otherwise disclosing any of the matters revealed by the plaintiff to Dr. Roe in the course of psychotherapy. On settlement of the judgment suggestions will be entertained concerning the disposition of any remaining volumes or parts thereof.
Notes
. By prior order this file has been sealed from indiscriminate viewing and pseudonyms have been used in the title of the action and in the other documents. I see every reason to continue that arrangement (cf. Munzer v Blaisdell,
. CPLR 4504 (subd [a]) provides in part: "Unless the patient waives the privilege, a person authorized to practice medicine * * * shall not be allowed to disclose any information which he acquired in attending a patient in a professional capacity, and which was necessary to enable him to act in that capacity.”
. Subdivision (9) of section 6509 of the Education Law provides: "Each of the following is professional misconduct: * * * (9) Committing unprofessional conduct, as defined by the board of regents in its rules or by the commissioner in regulations approved by the board of regents.”
8 NYCRR 60.1 (d) (3) provides in part, "Unprofessional conduct in the practise of medicine shall include * * * the revealing of facts, data or information obtained in a professional capacity relating to a patient or his records without first obtaining the consent of the patient”.
. Every physician is presumed to have taken the oath of Hippocrates [460? — 377? B. C.] which states in part, "I will abstain [in treating patients] * * * from whatever is deleterious and mischievous. * * * Whatever, in connection with my professional practise, or not in connection with it, I may see or hear in the lives of men which ought not to be spoken abroad I will not divulge, as reckoning that all such should be kept secret.”
. "[w]hen a course of conduct is cruel or shocking to the average man’k conception of justice, such course of conduct must be held to be obviously contrary to public policy, though such policy has never been so written in the bond, whether it be Constitution, statute, or decree of court” (p 796).
. "[ajlmost every member of the public is aware of the promise of discretion contained in the Hippocratic Oath, and every patient has a right to rely upon this warranty of silence. The promise of secrecy is as much an express warranty as the advertisement of a commercial entrepreneur” (p 801).
. "A physician may not reveal the confidences entrusted to him in the course of medical attendance, or the deficiencies he may observe in the character of patients, unless he is required to do so by law or unless it becomes necessary in order to protect the welfare of the individual or of the community.” (American Med Assn., Principles of Medical Ethics, 1957, § 9.)
. It has been predicted (Galella v Onassis, 487 F2d 986, 995) that the New York Court of Appeals, when again faced with the issue, will abandon Roberson v Rochester Folding Box Co. (supra), but this case need not turn on such prediction.
, It is interesting to observe that a leading professional organization, The Group for the Advancement of Psychiatry, in its Report No. 45 [New York, NY, 1960] concurs in the conclusion that conflicts between ethical obligations and scientific advance must be resolved in favor of the ethical consideration. It said,
"When the psychiatrist describes the details of the life history of his patient, his job problems, et cetera, the possibility of recognition is very high.
"For this reason clinical data may have to be disguised with consequent impairment of the objective scientific value. Sometimes material may be so impossible to camouflage that it should not be published at all, in spite of its scientific value.
"Such ethical requirements take priority over research objectives.”
