POOLER, Circuit Judge
BACKGROUND
I. Factual Background
Troy, New York is home to both Samaritan Hospital and Rensselaer County Jail. Samaritan serves as the primary healthcare provider for most of the Jail's detainees and many of its employees. Appellants are among those employees who have seen doctors at Samaritan.
The Jail does not rely entirely on Samaritan for healthcare services; it also employs its own medical staff. That staff included Elaine Young, a registered nurse. To facilitate continuity of care, Samaritan provided Young with electronic access to Samaritan's medical records on three computers at the Jail through a password-protected system. Logging in with this password provided unlimited access to Samaritan's entire medical records system.
Before she was granted access to Samaritan's record system, Young signed a one-page clearly worded agreement stating that she would only use the system in a way that preserved patient confidentiality. This consent form cautioned that "Federal law and regulations strictly limit the purposes for which patient information may be accessed and used." App'x at 1679. Its terms then restricted use for the purposes of "providing medical treatment to the patient," "securing payment for treatment of the patient," and "quality assurance activities, professional competence review activities and health care fraud or abuse detection."Id. Accessing Samaritan's system for "other purposes" was only permitted with "signed authorization of the patient" or "approval of the [Samaritan] Privacy Officer."
Young had apparently been unable to obtain passwords for other nurses to use, so she taped her login information inside a drawer at the nurse's desk at the Jail. Any person who knew where the password was kept and had access to that desk could thus view any of Samaritan's medical records.
In late 2011, Samaritan learned that "health information relating to a patient of Samaritan Hospital may have been accessed for an improper purpose by an employee" of the Jail. App'x at 35, 41, 47.
Mahar appointed Corrections Lieutenant James Karam to conduct the investigation. Karam did so until August 2012, when he resigned due to medical issues and the pressure that Mahar allegedly placed on him. According to Karam, Mahar had attempted to convince Karam to delay the investigation to prevent at least one employee from being notified that his medical records had been accessed. No one was ever criminally prosecuted for accessing Samaritan's medical records.
In March 2013, Samaritan sent letters to patients whose records its internal investigations found had been viewed without their permission. The letters detailed when and for how long each patient's medical records had been accessed via Young's account.
Confronted with this information, a number of patients sued the County of Rensselaer and several of its employees. Some of these lawsuits have been settled; some continue at the district court level. E.g. , Pasinella v. County of Rensselaer , No. 13-cv-00607, consent order (N.D.N.Y. Sept. 23, 2014); Colantonio v. County of Rensselaer , No. 14-cv-00107, judgment dismissing by reason of settlement (N.D.N.Y. Apr. 24, 2015); Karam v. County of Rensselaer , No. 13-cv-01018, order and stipulation of discontinuance (N.D.N.Y. Sept. 6, 2016); Snyder v. County of Rensselaer , No. 14-cv-00242, order and stipulation of dismissal (N.D.N.Y. Sept. 26, 2014); Rogers v. Mahar , No. 14-cv-01162, order and stipulation of dismissal (N.D.N.Y. Jan. 25, 2016); Momrow v. County of Rensselaer , No. 15-cv-00521, complaint filed (N.D.N.Y. Apr. 29, 2015).
Appellants are among those who received the letter from Samaritan and subsequently sued. Relying on the preliminary results of Karam's investigation and on a number of depositions taken across many of these cases, they allege that their records were accessed as part of Mahar's campaign to rein in Jail employees' use of sick leave. It is undisputed that Mahar enforced a sick leave policy that penalized employees deemed to be taking "excessive" sick leave. Appellants note that access of their medical records took place during or soon after instances in which they had taken "extended or unexpected" sick leave. Appellants' Br. at 9. They allege that Mahar or somebody acting under Mahar's direction either used Young's password or directed Young to do so in order to determine whether Appellants had been using sick leave in accordance with the policy Mahar was enforcing. Appellees offer no alternative explanation or justification for the unauthorized access of Appellants' medical records.
II. Procedural History
Appellants filed their initial complaint on September 20, 2013, alleging violations of their rights to privacy implied by the Due Process Clause of the Fourteenth Amendment and of their rights under the CFAA. On September 24, 2014, the district court granted Appellees' motion to dismiss with respect to the claims under the CFAA, determining that Appellants had failed to allege the damages required by that statute. It denied the motion with respect to the civil rights claim.
On February 10, 2015, Appellants filed an amended complaint alleging only the civil rights cause of action. After more
Relying heavily on its interpretation of our previous decision in Matson v. Board of Education of City School District of N.Y. ,
Final judgment was filed in favor of Appellees on August 8, 2016. This appeal of both the dismissal and the grant of summary judgment was filed on August 17.
DISCUSSION
I. CFAA Claims
A. Standard of Review
Although "[i]t is well settled that an amended pleading ordinarily supersedes the original and renders it of no legal effect," we do not require futile repleading of a claim that has been dismissed with prejudice. In re Crysen/Montenay Energy Co. ,
"We review de novo a district court's decision to dismiss a complaint pursuant to [Federal] Rule [of Civil Procedure] 12(b)(6), accepting all factual allegations as true and drawing all reasonable inferences in the plaintiff's favor." Crawford v. Cuomo ,
B. Discussion
Congress originally enacted the CFAA in 1984 to criminalize the then-novel problem of hacking. Ten years later, it added a private right of action. See Violent Crime Control and Law Enforcement Act of 1994, Pub. L. No. 103-322, § 290001(d),
Subclause (I) covers "loss to 1 or more persons during any 1-year period ... aggregating at least $5,000 in value."
Economic damages have not been pled. Appellants argue instead that Subclause (I) on its face applies broadly and point to a non-precedential summary order from this Court holding that the 2001
Subclause (II) refers to damages based on "the modification or impairment, or potential modification or impairment, of the medical examination, diagnosis, treatment, or care of 1 or more individuals."
II. Fourteenth Amendment Claims
A. Standard of Review
"We review a district court's grant of summary judgment de novo. " Marvel Characters, Inc. v. Kirby ,
B. Discussion
Appellants sue under
1. The Right to Privacy in Medical Records
To determine whether a constitutional violation has occurred, we must first identify the right at stake. See O'Connor v. Pierson ,
The Due Process Clause of the Fourteenth Amendment requires states to operate in accordance with the "fundamental principles of liberty and justice which lie at the base of all our civil and political institutions." Duncan v. Louisiana ,
The Supreme Court has long implied that the zone of privacy protects "the individual interest in avoiding disclosure of personal matters." Whalen v. Roe ,
2. Weighing Interests in the Privacy of Medical Records
Although it is fundamental, the constitutional right to privacy is not absolute. In various situations the government has a legitimate interest in accessing and even publicizing medical records. See Doe ,
How we weigh these interests depends on whether a government acts in its legislative or executive capacity.
Before discussing the balancing in this case in more detail, we note that most situations in which a government actor accesses an individual's personal information will not require the application of a balancing test to determine whether a due process violation has occurred. For instance, when an individual gives informed consent to the access or publication of certain information and an official has acted within the scope of that consent, there is no ground for constitutional challenge. A government actor cannot invade the zone of privacy if they have been invited in. As well, if a breach of privacy takes a form courts have previously approved-whether because it is pursuant to a legislative scheme that has passed constitutional muster or because it fits the pattern of case law-there will be no need for case-by-case balancing. Conversely, we can summarily condemn invasions of privacy that take a form that has already been found to violate due process.
But Appellants have not consented to the access of their medical records, and that access does not take a form that has been previously adjudicated. So a context-specific balancing is necessary. In front of us are executive actions, and Appellants are not prisoners. So the invasions of privacy here should be evaluated according to a shocks-the-conscience standard.
In defining the privacy interest in various medical conditions, we "proceed on a case-by-case basis," examining all of the relevant factors. Matson ,
The strength of a privacy interest is relevant to the due process inquiry, but only in service of determining how strong the government's interest must be in order to override it. Appellees and the district court correctly point out that we have repeatedly found that determining the strength of this interest requires taking into account the seriousness of the condition and the stigma associated with it. Matson ,
And the inquiry cannot be overly individualized. An interest in medical privacy derives not just from a desire to keep one's medical conditions to oneself but also from the collectively enjoyed benefit of being able to expect confidentiality from those we depend on to care for the most intimate aspects of our lives. A slow drip of exceptions would erode that protection beyond recognition. As such, the interest in preserving the integrity of the doctor-patient relationship deserves its own consideration independent of the idiosyncrasies of the privacy invasion. The baseline individual interest in privacy is thus substantially greater than whatever the least abashed individual would allow.
Some clarification of Matson is apparently in order. That case dealt with a school that had publicly disclosed the fibromyalgia of its music teacher as part of a report on her alleged abuse of the school's sick leave policy. Matson ,
Before Matson , we had suggested that the strength of the privacy interest mattered, but we had never actually been confronted with a weak privacy interest. So we had not had the opportunity to articulate how it might affect the analysis. See , e.g., Doe ,
Accepting the district court's alternative reading of Matson would leave us with an illogical doctrine that implicitly abrogates our previous decisions. If the right to privacy were to depend exclusively on the seriousness of the condition one seeks to keep private, medical records would not truly be protected from arbitrary government intrusion. It would be as if the First Amendment allowed a particular person to speak only if they could show they have something worth saying, or if the Fourth Amendment required individuals to obtain warrants to prevent the government from searching their effects.
Our decisions before Matson avoided these absurdities by making clear that we apply a balancing test to the government's collection or publication of all medical records. Doe ,
All of which is to say that identifying the strength of the individual interest in privacy never ends the analysis. A court applying a shocks-the-conscience test must always examine the executive branch's interest in breaching that privacy. The stronger the individual interest, the more compelling the government actor's reasons must be. But even the weakest privacy interests cannot be overridden by totally arbitrary or outright malicious government action. How to judge the government action depends on context. Government actors with specific duties of confidentiality or care unreasonably invade privacy even if they do so as a result of "deliberate indifference." See O'Connor ,
Because the district court treated the seriousness and stigma of each of Appellants' diagnoses as a threshold inquiry without considering other aspects of the individual privacy interest or the government's intent, we vacate this aspect of its judgment and remand it for reconsideration.
While stigma is not the only consideration, it can still be relevant to the analysis. It is neither necessary nor appropriate for us to determine at this stage in the proceeding whether any condition in Appellants' medical records is in fact stigmatizing. However, during the course of its reconsideration, the district court should re-examine whether it might have set the threshold too high in evaluating Appellants' conditions.
It is at least as important for the district court to consider the fact that Appellees offer no reasons, as far as we can tell, for the breaches of confidentiality. It seems clear that the breaches did not result from inattention, but beyond that it is a disputed issue of fact why they occurred. If Appellants' proffered explanation that Mahar maliciously looked at the records to aid in his enforcement of sick leave policies or to gain leverage over his employees is correct, that would likely shock our consciences. It would do so regardless of the contents of Appellants' medical records. It is exactly this type of abuse of state power that protecting the zone of privacy is meant to guard against.
C. Qualified Immunity
Because the district court found that Appellants did not have claims under the Fourteenth Amendment, it did not have to pass on whether the individual Appellees were entitled to qualified immunity from those claims. In remanding the case, we instruct the court to determine whether Mahar, Hetman, and/or Young are entitled to it.
CONCLUSION
Because we find that the district court improperly balanced the interests in this
Notes
This is a functional differentiation. Some types of executive actions, such as regulations, are more akin to legislative action.
When dealing with the lessened privacy interests of a prison inmate, we give decisive weight to whether a privacy invasion was "reasonably related to legitimate penological interests." Powell ,
Several district court decisions after Matson have found the seriousness and stigma associated with the medical conditions contained in the records in front of them to be dispositive in finding against Appellants who were claiming privacy violations. It may be worth clarifying how our opinion affects two of them, which we think are representative. In Miron v. Town of Stratford ,
Appellees Mahar and Hetman raise qualified immunity in their brief, but Young does not. Because we do not rule on the question here for any of the Appellees, we do not treat Young's claim to qualified immunity as waived.
