Lead Opinion
OPINION
In this appeal, we are asked to consider whether appellants waived the mental health records privilege provided under the Mental Health Procedures Act (MHPA), 50 P.S. § 7111,
Because the state police concluded James was attempting to commit suicide, appellees sought discovery information regarding his mental health history and access to his mental health records, which Susan refused to provide. Appellees filed a motion for leave to access and copy sealed files pertaining to James’s involuntary commitments pursuant to the MHPA and a motion to compel the execution of authorizations pertaining to his mental health and involuntary commitment records and full and complete answers to Interrogatory No. 63.
Appellees appealed to the Commonwealth Court, contending the trial court erred when it denied them access to James’s mental health records and involuntary commitment records. Specifically, appellees argued the MHPA’s confidentiality provisions were waived by Susan because she placed James’s mental health at issue by filing the complaint. In defense to the underlying negligence claim, appel-lees asserted James intentionally caused his own injuries by throwing himself under Walker’s vehicle in an unsuccessful suicide attempt. Denying them access to the requested information, appellees argued, “would be manifestly unfair, grossly prejudicial and an affront to the truth-seeking function of the courts as Susan Octave should not be permitted to bring suit against [appellees] while depriving them of information which could totally absolve them of liability.” Octave ex rel. Octave v. Walker,
The Commonwealth Court reversed and remanded, finding “Susan Octave directly put James Octave’s mental history, especially as it pertains to his previous suicide attempts, or considerations or contempla
Susan Octave must provide a full and complete answer to Interrogatory No. 63 and provide all medical records requested by DOT and Walker ... to the trial court for an in camera review, so that the trial court may identify those records which pertain or relate, in any manner, to James Octave’s history of suicidal attempts and/or contemplations, or desires or attempts to harm himself.
Octave, at 610..
Senior Judge Kelley dissented, concluding since the amended complaint sought damages only for physical, not mental, injury, “it cannot be said that [Susan] directly placed her husband’s mental condition at issue as the plaintiffs had in Kraus and Gormley.” Id., at 613 (Kelley, S.J., dissenting) (citing Premack v. J.C.J. Ogar, Inc.,
We granted allocatur to address the following issue:
Given the [petitioners] do not explicitly waive the protections of 50 P.S. § 7111, given the [petitioners’] Amended Complaint does not allege injuries to mental health, given the [respondents] raise the question of mental health and seek the [petitioner’s] pre-collision mental health records, and given the [respondents’] claim of mental health relies exclusively on the conclusions of a-third party, did the [petitioners] put mental health at issue and impliedly waive the protections of 50 P.S. § 7111 though [sic] the act of filing the within lawsuit?
Octave ex rel. Octave v. Walker,
The primary goal of statutory interpretation is ascertaining and effectuating the General Assembly’s intent. 1 Pa.C.S. § 1921(a). When attempting to determine such intent, this Court must presume the General Assembly did not intend an absurd or unreasonable result. Id., § 1922(1). The practical results of a particular interpretation may also be considered. Id., § 1921(c)(4), (6).
Appellants contend, since the amended complaint does not seek damages for mental injury, they have not put James’s mental health at issue and, thus, have not impliedly waived the MHPA’s confidentiality protections. By holding such records are discoverable, appellants argue, the Commonwealth Court failed to follow this Court’s clear mandate in Zane v. Friends Hospital,
While appellees do not dispute that James’s mental health is not at issue in the damages realm, they highlight such is certainly at issue regarding causation, which is at the heart of appellants’ negligence claim. “Whether a plaintiffs mental state bears upon the issue of damages, as in Gormley and Kraus, or on the issue of causation instead, as in this case, [DOT asserts,] surely has no bearing on the basic sense of fairness and justice which underlies those decisions.” Brief for Appellee, Department of Transportation, at 19 (internal quotation marks omitted). Indeed, DOT claims, “If anything, a case such as this one ... presents a stronger argument for disclosure than did Gormley or Kraus ..., [in which] the evidence at issue served merely to limit the damages to which the plaintiff might be entitled, whereas in this case it could serve to defeat the [appel-lee]s’ liability altogether.” Id., at 20 (emphasis in original). Appellees argue appellants should not be permitted to “wield the confidentiality provisions of the [MHPA] as a sword in order to exploit them for the sake of gaining advantage in the ensuing litigationf, which] is both unfair and outside of the statute’s protective, nondiscriminatory purpose.” Id., at 11-12; see also Brief for Appellee, David Walker, at 20. As to appellants’ reliance on Zane, appel-lees note that case is factually distinguish-’ able and did not address the question at issue in this case.
Further, appellees assert, in filing this negligence action, appellants knew or reasonably should have known James’s mental health would be put directly at issue given the state police’s conclusion James attempted to commit suicide; thus, the filing of the complaint was “the functional equivalent of the ‘written consent’ that is required by the MHPA in order to waive its confidentiality protections[.]” Brief for Appellee, Department of Transportation, at 13 (quoting 50 P.S. § 7111(a)); see also Brief for Appellee, David Walker, at 17. DOT highlights § 7111 “does not require
Initially, we note appellants’ reliance on Zane is misplaced. In Zane, this Court held § 7111 barred the plaintiff access to the defendant-patient’s mental health records in a negligence suit, despite such records being necessary to establish the plaintiffs case.
The MHPA, 50 P.S. § 7101 et seq., establishes the rights and procedures for inpatient psychiatric treatment and involuntary outpatient care with the purpose of assuring availability of adequate treatment to mentally ill persons. The confidentiality protections for mental health records afforded by § 7111 exist to enable effective treatment “by encouraging patients to offer information about themselves freely and without suffering from fear of disclosure of one’s most intimate expressions to others and the mistrust that the possibility of disclosure would engender.” Zane, at 33 (citations omitted). To this end, § 7111(a) requires a patient’s “written consent” before his mental health records are released or disclosed, except under certain limited circumstances inapplicable here. 50 P.S. § 7111(a). The Superior Court has held this statutory protection can be “waived,” however, if the patient places his mental health at issue in a case. See Kraus, at 1145.
In Kraus, the Superior Court held the plaintiff impliedly waived the MHPA’s and Judicial Code’s confidentiality protections for his drug and alcohol treatment records by filing a personal injury lawsuit seeking damages for permanent injury, thereby placing his life expectancy at issue in the case. The court reasoned, “[ajllowing [the plaintiff] to pursue a claim for permanent injury, while simultaneously barring [the defendants] from access to [the plaintiff]’s long history of drug and alcohol abuse, ‘would be manifestly unfair and grossly prejudicial.’ ” Id. (quoting O’Boyle v. Jensen,
We cannot believe that the Pennsylvania General Assembly intended to allow a plaintiff to file a lawsuit and then deny a defendant relevant evidence, at plaintiffs ready disposal, which mitigates defendant’s liability. See generally 1 Pa. C.S. § 1922(1) (in ascertaining legislative intent, courts are to presume that the General Assembly did not intend an unreasonable result). Rather[,] the General Assembly must have intended the privileges to yield before the state’s compelling interest in seeing that truth is ascertained in legal proceedings and fairness in the adversary process.
Id. (citation and internal quotation marks omitted). Accordingly, the court concluded the plaintiffs treatment records were not privileged and it was within the trial
The question of whether and under what circumstances the MHPA’s and Judicial Code’s confidentiality protections may be waived has also been addressed by our federal courts applying state law. In O’Boyle, the decedent was found unconscious in his cell after being arrested for public drunkenness; he died several hours later. The plaintiff alleged the decedent’s death resulted from injuries inflicted by the police and by their failure to provide the decedent with proper medical attention. The defendants sought access to the decedent’s drug and alcohol treatment records; such records are confidential and can only be disclosed with the patient’s consent and only to enumerated individuals.
O’Boyle died for unexplained reasons. The possibility cannot be ruled out at this stage that he died as a result of a medical condition related to or brought on by a history of alcohol problems. Barring defendants from exploring that possibility in preparing their defense to plaintiffs allegations would be manifestly unfair and grossly prejudicial. Plaintiff cannot pursue a claim against defendants for O’Boyle’s death while denying them all access to medical/treatment records potentially relevant to the key issue of causation.
Id. (citations omitted).
Courts in other jurisdictions have applied a similar analysis in determining privileges are waived when one places confidential information at issue in a lawsuit. See, e.g., D.C. v. S.A.,
It must be emphasized that eviden-tiary privileges have been viewed by this Court to be in derogation of the search for truth, and are generally disfavored for this reason. See Commonwealth, Department of Transportation v. Taylor,
We utilize our authority in this area carefully and urge courts to use great caution in accepting this form of implicit waiver. The importance of the confidentiality protections afforded by the MHPA cannot be overemphasized, and those protections must not be ignored in deciding whether a patient impliedly waived the privilege. However, under the facts of the instant case, barring appellees access to James’s mental health records would be manifestly unfair and grossly prejudicial. To allow appellants to pursue a negligence action while hiding behind a statutory privilege claim — essentially wielding the legislature’s intended shield as a sword — would offend the most basic understanding of fairness and justice. As such a result would be unreasonable, it cannot be what the General Assembly intended. See 1 Pa.C.S. § 1922(1). Rather, it “must have intended the privileges to yield before the state’s compelling interest in seeing that truth is ascertained in legal proceedings
Moreover, under the Commonwealth Court’s holding, such records are subject only to in camera review,
Order affirmed. Jurisdiction relinquished.
Former Justice McCAFFERY did not participate in the decision of this case.
Chief Justice CASTILLE and Justices BAER and STEVENS join the opinion.
Justice SAYLOR files a dissenting opinion.
Justice TODD files a dissenting opinion.
Notes
.Section 7111 provides, in pertinent part:
(a) All documents concerning persons in treatment shall be kept confidential and, without the person's written consent, may not be released or their contents disclosed to anyone except [in situations inapplicable here.]
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In no event, however, shall privileged communications, whether written or oral, be disclosed to anyone without such written consent.
l'd., § 7111(a).
. Although James survived the incident, he later died as a result of his injuries. Neither party asserts his death affects the privilege.
. By order dated September 24, 2009, the trial court granted the preliminary objections of these additional defendants, and they were dismissed from the case.
. Interrogatory No. 63 provided:
63. Did Plaintiff at any time throughout his entire lifetime suffer from mental illness, or seek treatment regarding his mental health? If so, please answer the following:
a. Any and all official diagnosis' [sic] given to Plaintiff by a medical physician/institution regarding his mental health;
b. The length of time that Plaintiff suffered from mental/psychological issues;
c. List all facilities that Plaintiff treated [sic] throughout his lifetime for his mental/psychological issues;
d. List all physician[s] with whom Plaintiff treated [sic] throughout his lifetime for his mental/psychological issues;
e. Was Plaintiff treating [sic] for his mental health issues at the time of the incident giving rise to this litigation;
f. Has Plaintiff ever attempted suicide at any time throughout his life and if so, when;
g. Has Plaintiff ever spoken about committing suicide or terminating his life to anyone, throughout his lifetime;
h. Has Plaintiff ever been involuntarily committed to a mental health facility and if so, please provide the dates and names of the facilities;
i. Has Plaintiff ever voluntarily checked into a mental health facility and if so, please provide the dates;
j. Has Plaintiff ever lost a job, or had to resign from a job as a result of his mental illness and;
k. How did Plaintiff’s mental illness affect his day to day activities.
Interrogatories Directed to James Octave, at 24-25.
. This Court affirmed the grant of summary judgment based on the absence of these records.
. All patient records and all information contained therein relating to drug or alcohol abuse or drug or alcohol dependence prepared or obtained by a private practitioner, hospital, clinic, drug rehabilitation or drug treatment center shall remain confidential and may be disclosed only with the patient's consent and only (i) to medical personnel exclusively for purposes of diagnosis and treatment of the patient or (ii) to government or other officials exclusively for
the purpose of obtaining benefits due the patient as a result of his drug or alcohol abuse or drug or alcohol dependence except that in emergency medical situations where the patient’s life is in immediate jeopardy, patient records may be released without the patient’s consent to proper medical authorities solely for the purpose of providing medical treatment to the patient.
71 P.S. § 1690.108(c).
. One justice dissented in part, stating the majority’s decision forced the plaintiff to make a Hobson's choice — reveal spousal confidences or forego the right to seek redress for a grievous wrong. Id.,
. However, we do not subscribe to a standard as relaxed as that applied in some of these cases, i.e., a plaintiff implicitly waives confidentiality protections by filing a lawsuit in which his mental health records could be “potentially relevant” to the disputed legal issue. Allowing a defendant to initiate a fishing expedition into a plaintiff's mental health records to explore whether any information may be potentially relevant or contradictory to the subject of the action would destroy the purpose of the MHPA’s privilege and its confidentiality protections. As discussed below, we instead employ a more limited approach for finding implicit waiver.
.As this Court finds appellants have impliedly waived the MHPA's confidentiality protections by filing the instant negligence suit, we do not reach the issue of whether their complaint constitutes "written consent” for purposes of § 7111. We also do not reach appellants’ argument that the evidence sought
. Appellants argue, since appellees can contest liability through less intrusive means, e.g., an accident reconstruction or eyewitness testimony, discovery of James’s mental health records should be precluded. However, this argument is based upon a faulty understanding of the less-intrusive-means analysis, which only applies when there are other, less intrusive methods of obtaining the same type of information, not simply other available means of proving one’s case. See, e.g., Cooper v. Schoffstall,
. Appellants did not raise allegations of mental injuries in their amended complaint. Their complaint differs from the Kraus and Gormley complaints, which expressly included allegations of mental injuries, thereby placing mental health directly at issue as to damages. Notwithstanding, because there was objective evidence suggesting suicide, appellants knew that by commencing suit and alleging James’s physical injuries were caused by appellees' negligence, they were placing his mental health directly at issue as to causation.
. We encourage trial courts to proceed with caution in conducting in camera review in these matters, as the statutory privilege is only waived as to the particular information directly related to the subject of the litigation. Taking such a balanced approach safeguards the patient's confidentiality protections and ensures fairness and integrity within the judicial system.
Dissenting Opinion
dissenting.
The Mental Health Procedures Act (MHPA) contains a proviso that “[i]n no event” may privileged communications be disclosed without “written consent.” 50 P.S. § 7111(a). As Madame Justice Todd observes, this appears to foreclose the possibility that, consistent with legislative intent, a non-written waiver may be implied from the circumstances. See Dissenting Opinion, at 1265. Accordingly, I cannot join the Court’s present holding that Appellants “have impliedly waived the MHPA’s confidentiality protections by filing the instant negligence suit[.]” Majority Opinion, at 1262 n. 9.
With that said, I also think that, where there is an objective basis in the record to believe that the plaintiffs mental-health records are relevant to liability (in this case, for example, records that reflect past suicide attempts), it may be fundamentally unfair to the defendant to deny access to such information — at least subject to the screening process of an in camera inspection so as to prevent unwarranted disclosures. Indeed, as Appellees emphasize, lack of access could allow Appellants to conceal evidence that might absolve them of liability. Hence, it seems that, in such a scenario, the act’s confidentiality provision, as applied, can potentially violate due process. See Fox v. Ward,
However, the issue raised on appeal to the intermediate court was framed solely in terms of implied waiver, see Octave v. Walker, No. 532 & 540 C.D.2011, Brief for Appellants, at 4; that tribunal disposed of the appeal on such terms, see Octave v. Walker,
Accordingly, I would reverse the order of the Commonwealth Court and remand to the common pleas court to determine whether a due process challenge is pending in that court and, if so, which records (if any) must be provided to avoid a constitutional violation.
. Some state legislatures have statutorily incorporated the waiver concept in the form of a patient-litigation exception. See, e.g., Cal. Evid.Code § 1016; 740 Ill. Comp. Stat. 110/10(a). Our Legislature has codified a similar exception with regard to physician-patient confidentiality. See 42 Pa.C.S. § 5929; Ferrell v. Glen-Gery Brick,
. Whether a due process challenge was raised before the common pleas court would be a question to be addressed by that court in the first instance. Here, I simply note that Appel-lees argued that denying them access to evidence of the plaintiff’s suicidal tendencies or past instances of self-inflicted harm would violate their right to a fair trial and would be manifestly unfair, grossly prejudicial, and amount to a miscarriage of justice. See Octave. v. Walker, Civil No. 4128 of 2009, Defendants' Brief in Support of Motion for Leave to Access and Copy Sealed Files Pertaining to Plaintiff’s Involuntary Psychological Treatments, at 5-7; see also id., Defendants’ Brief in Support of Motion to Compel Medical Authorizations Pertaining to Plaintiff's Mental Health Treatment and/or Involuntary Psychiatric Commitments, at 4-5. Thus, on the present state of the record, I cannot foreclose the possibility that Appellees have, in effect, forwarded a due-process challenge to application of Section 7111(a) in the circumstances.
Dissenting Opinion
dissenting.
The language in Section 7111 of the Mental Health Procedures Act that is central to this appeal states: “All documents concerning persons in treatment shall be kept confidential and, without the person’s written consent, may not be released or their contents disclosed to anyone,” subject to certain exceptions not relevant herein. 50 P.S. § 7111(a). I would be hard-pressed to conceive of a more emphatic directive from our General Assembly. Indeed, this Court, in addressing Section 7111, has deemed it “unambiguous,” “unmistakable,” and “mandatory,” concluding:
The release of the documents is contingent upon the person’s written consent and the documents may not be released “to anyone ” without such consent. The terms of the provision are eminently clear and unmistakable and the core meaning of this confidentiality section of the Mental Health Procedures Act is without doubt — there shall be no disclosure of the treatment documents to anyone.
Zane v. Friends Hosp.,
Nevertheless, I recognize the inequity that drives the majority’s analysis: it is untenable for a plaintiff to sue for relief where matters otherwise protected by Section 7111 are critical to the defense of that action, but, at the same time, expect those matters to remain confidential and expect to proceed with the suit. However, instead of running afoul of a statutory mandate in an effort to avoid such an unjust result, I would encourage that such matters be addressed in the context of discovery, in a manner such as that initiated by Appellees below.
Here, Appellees filed interrogatories and sought access to information pertaining to Appellant James Octave’s mental health treatment; when Appellants objected, Appellees filed a motion to compel Appellants to provide written consent pursuant to Section 7111, detailing in the motion the relevance of that information to their defense. See Motion to Compel, 2/25/10 (R.R. at 73). The trial court was then in a position to assess the significance of the information to the defense, and, had it deemed the information sufficiently material, issue an order compelling the authorizations be executed.
Discovery matters are vested in the trial court’s sound discretion. Rae v. Pennsylvania Funeral Directors Ass’n,
Accordingly, I disagree with the majority’s decision to affirm the Commonwealth Court’s extra-statutory determination that Section 7111 protections may be implicitly waived, and so would reverse that decision. However, because I agree with the majority that the requested information was material to Appellee’s defense, I would remand the matter to the trial court to grant Appellee’s motion to compel the execution of Section 7111 consent. Should Appellants refuse, I would leave the appropriate sanction to the trial court’s discretion, pursuant to the considerations set forth in City of Philadelphia, supra.
Accordingly, I dissent.
. The trial court denied Appellees’ motion, concluding that, after Appellants amended their complaint, James Octave's mental health treatment records were no longer relevant. I agree with the majority's implicit conclusion that this determination was in error.
. Of course, these determinations are then subject to appellate review for an abuse of discretion.