Tommy Lynn Lawson v. Knoxville Dermatology Group, P.C.Tommy Lynn Lawson v. Knoxville Dermatology Group, P.C.
The plaintiffs
Tenn. R. App. P. 3 Appeal as of Right; Judgment of the Circuit Court Affirmed; Case Remanded
THOMAS R. FRIERSON, II, J., delivered the opinion of the court, in which CHARLES D. SUSANO, JR., and ARNOLD B. GOLDIN, JJ., joined.
Timothy L. Baldridge, Knoxville, Tennessee, for the appellants, Tommy Lynn Lawson and Katrina Lawson.
James H. London, Carrie S. O‘Rear, and Jeremey R. Goolsby, Knoxville, Tennessee, for the appellees, Knoxville Dermatology Group, P.C., and Katie Hageman, PA-C.
OPINION
I. Factual and Procedural Background
The plaintiffs, Tommy Lynn Lawson and Katrina Lawson, filed a complaint against the defendants, Knoxville Dermatology Group (“KDG“) and Katie Hageman, Certified Physician‘s Assistant, (collectively, “Defendants“), on August 23, 2016. The complaint involved the events that transpired on April 29, 2015, when Mr. Lawson sought treatment with KDG for a Methicillin-resistant Staphlococcus aureus (“MRSA“) infection on his left ear. The Lawsons alleged that during the visit, Mr. Lawson was injured by the negligence of KDG and Ms. Hageman, specifically their alleged failure to properly secure the examination table, which purportedly flipped over as Mr. Lawson was attempting to lift himself onto it, resulting in alleged injury when he “f[e]ll straight down onto the stool with his left leg underneath him.” Ms. Lawson joined in the complaint as a plaintiff, seeking recovery for loss of consortium.
On October 3, 2016, KDG and Ms. Hageman filed separate motions to dismiss for failure to comply with provisions of
Following a hearing, the trial court granted the motions to dismiss in an order entered on December 16, 2016, dismissing all claims without prejudice. The Lawsons timely appealed, limiting the issue raised on appeal to the dismissal of the health care liability claim against KDG. The Lawsons have not appealed the dismissal of Ms. Hageman as a defendant or the dismissal of Ms. Lawson‘s claims for loss of consortium.1
II. Issue Presented
The Lawsons present one issue on appeal, which we have restated slightly as follows:
Whether the trial court erred by finding that the medical authorization included in the Lawsons’ pre-suit notice to KDG did not substantially satisfy the requirements of
Tennessee Code Annotated § 29-26-121(a)(2)(E) .
III. Standard of Review
Our Supreme Court has elucidated the following regarding the standard of review applicable to a motion to dismiss a health care liability action based upon the plaintiff‘s noncompliance with
The proper way for a defendant to challenge a complaint‘s compliance with
Tennessee Code Annotated section 29-26-121 andTennessee Code Annotated section 29-26-122 is to file a Tennessee Rule of Procedure 12.02 motion to dismiss. In the motion, the defendant should state how the plaintiff has failed to comply with the statutory requirements by referencing specific omissions in the complaint and/or by submitting affidavits or other proof. Once the defendant makes a properly supported motion under this rule, the burden shifts to the plaintiff to show either that it complied with the statutes or that it had extraordinary cause for failing to do so. Based on the complaint and any other relevant evidence submitted by the parties, the trial court must determine whether the plaintiff has complied with the statutes. If the trial court determines that the plaintiff has not complied with the statutes, then the trial court may consider whether the plaintiff has demonstrated extraordinary cause for its noncompliance. If the defendant prevails and the complaint is dismissed, the plaintiff is entitled to an appeal of right under Tennessee Rule of Appellate Procedure 3 using the standards of review in Tennessee Rule of Appellate Procedure 13. If the plaintiff prevails, the defendant may pursue an interlocutory appeal under either Tennessee Rule of Appellate Procedure 9 or 10 using the same standards.
* * *
The leading rule governing our construction of any statute is to ascertain and give effect to the legislature‘s intent. Walker v. Sunrise Pontiac-GMC Truck, Inc., 249 S.W.3d 301, 309 (Tenn. 2008). To that end, we start with an examination of the statute‘s language, Curtis v. G.E. Capital Modular Space, 155 S.W.3d 877, 881 (Tenn. 2005), presuming that the legislature intended that each word be given full effect. Lanier v. Rains, 229 S.W.3d 656, 661 (Tenn. 2007). When the import of a statute is unambiguous, we discern legislative intent “from the natural and ordinary meaning of the statutory language within the context of the entire statute without any forced or subtle construction that would extend or limit the statute‘s meaning.” State v. Flemming, 19 S.W.3d 195, 197 (Tenn. 2000); see also In re Adoption of A.M.H., 215 S.W.3d 793, 808 (Tenn. 2007) (“Where the statutory language is not ambiguous . . . the plain and ordinary meaning of the statute must be given effect.“) (citing Calaway ex rel. Calaway v. Schucker, 193 S.W.3d 509, 516 (Tenn. 2005)). The construction of a statute is also a question of law which we review de novo without any presumption of correctness. Lind, 356 S.W.3d at 895.
Myers v. AMISUB (SFH), Inc., 382 S.W.3d 300, 307-08 (Tenn. 2012).
In Arden v. Kozawa, 466 S.W.3d 758, 763 (Tenn. 2015), our Supreme Court clarified:
The content and affidavit requirements of
Tennessee Code Annotated sections 29-26-121(a)(2) ,(a)(3) , and(a)(4) are not mandatory, but directory, and can be achieved through substantial compliance. See Thurmond v. Mid-Cumberland Infectious Disease Consultants, PLC, 433 S.W.3d 512, 520 (Tenn. 2014) (allowing substantial compliance with the affidavit requirement underTennessee Code Annotated sections 29-26-121(a)(3)(B) and(a)(4) ); Stevens ex rel. Stevens v. Hickman Comm. Health Care Servs., Inc., 418 S.W.3d 547, 555 (Tenn. 2013) (allowing substantial compliance with the HIPAA form requirement underTennessee Code Annotated section 29-26-121(a)(2)(E) ). “[U]nless strict compliance with a notice content requirement ‘is essential to avoid prejudicingan opposing litigant,’ substantial compliance with a content requirement will suffice.” Thurmond, 433 S.W.3d at 520 (quoting Stevens, 418 S.W.3d at 555).
IV. Requirements Concerning HIPAA-Compliant Medical Authorization
The Lawsons contend that the trial court erred by finding that they had failed to provide a medical authorization that was substantially compliant with HIPAA regulations. KDG asserts that the trial court properly dismissed the claim because the medical authorization provided by the Lawsons was insufficient to allow KDG to access relevant medical records to mount a defense. Upon careful review of the record and applicable authorities, we agree with KDG.
The requirements of
(a)(1) Any person, or that person‘s authorized agent, asserting a potential claim for health care liability shall give written notice of the potential claim to each health care provider that will be a named defendant at least sixty (60) days before the filing of a complaint based upon health care liability in any court of this state. (Emphasis added.)
(2) The notice shall include:
(A) The full name and date of birth of the patient whose treatment is at issue;
(B) The name and address of the claimant authorizing the notice and the relationship to the patient, if the notice is not sent by the patient;
(C) The name and address of the attorney sending the notice, if applicable;
(D) A list of the name and address of all providers being sent a notice; and
(E) A HIPAA compliant medical authorization permitting the provider receiving the notice to obtain complete medical records from each other provider being sent a notice.
KDG asserts that the trial court properly found that the Lawsons did not substantially comply with
(c)(1) Core elements. A valid authorization under this section must contain at least the following elements:
(i) A description of the information to be used or disclosed that identifies the information in a specific and meaningful fashion.
(ii) The name or other specific identification of the person(s), or class of persons, authorized to make the requested use or disclosure.
(iii) The name or other specific identification of the person(s), or class of persons, to whom the covered entity may make the requested use or disclosure.
(iv) A description of each purpose of the requested use or disclosure. . . .
(v) An expiration date or an expiration event that relates to the individual or the purpose of the use or disclosure. . . .
(vi) Signature of the individual and date. If the authorization is signed by a personal representative of the individual, a description of such representative‘s authority to act for the individual must also be provided.
Our Supreme Court has described the purpose of
[T]he purpose of
Tenn. Code Ann. § 29-26-121(a)(2)(E) is not to provide defendants with notice of a potential claim. Instead,Tenn. Code Ann. § 29-26-121(a)(2)(E) serves to equip defendants with the actual means to evaluate the substantive merits of a plaintiff‘s claim by enabling early access to a plaintiff‘s medical records. Because HIPAA itself prohibits medical providers from using or disclosing a plaintiff‘s medical records without a fully compliant authorization form, it is a threshold requirement of the statute that the plaintiff‘s medical authorization must be sufficient to enable defendants to obtain and review a plaintiff‘s relevant medical records. See45 C.F.R. § 164.508(a)(1) (“a covered entity may not use or disclose protected health information without an authorization that is valid under this section“).Tenn. Code Ann. § 29-26-121(d)(1) creates a statutory entitlement to the records governed by§ 29-26-121(a)(2)(E) . SeeTenn. Code Ann. § 29-26-121(d)(1) (“All parties in an action covered by this section shall be entitled to obtain complete copies of the claimant‘s medical records from any other provider receiving notice . . .“) (emphasis added).
Stevens, 418 S.W.3d at 555 (footnote omitted).
It is well established in Tennessee that the purpose of
Myers and Stevens thus instruct that: (1) providing potential defendants pre-suit notice of health care liability claims is the “essence” and “fundamental” purpose of the pre-suit notice requirement, Myers, 382 S.W.3d at 309; and (2) unless strict compliance with a notice content requirement “is essential to avoid prejudicing an opposing litigant,” substantial compliance with a content requirement will suffice, Stevens, 418 S.W.3d at 555.
Thurmond v. Mid-Cumberland Infectious Disease Consultants, PLC, 433 S.W.3d 512, 520 (Tenn. 2014). “Defendants are clearly prejudiced when unable, due to a form procedural error, to obtain medical records needed for their legal defense.” Hamilton v. Abercrombie Radiological Consultants, Inc., 487 S.W.3d 114, 120 (Tenn. Ct. App. 2014), perm. app. denied (Tenn. May 15, 2015).
In support of their assertion that they substantially complied with pre-suit notice content requirements, the Lawsons argue that the element missing from their medical authorization, designation of who was authorized to make the requested use or disclosure, was not necessary to KDG‘s ability to mount a defense because (1) KDG already had access to the medical record it generated when Mr. Lawson underwent treatment there on April 29, 2013; (2) it was one missing element, rather than several; (3) the document entitled “LIST OF HEALTH CARE PROVIDERS,” which had been attached to the pre-suit notice, supplemented the HIPAA authorization to satisfy the missing element; (4) and the April 29, 2013 medical record did not document the incident or injury at issue. We will address each argument in turn.
First, the Lawsons argue that KDG was not prejudiced because it was already in possession of the only medical record relevant to the case at bar. However, “[i]n Roberts, this Court rejected the argument that because the pertinent medical records were already in the defendants’ possession, this fact should result in a holding excusing full compliance with the statutory requirements.” See Hamilton, 487 S.W.3d at 122 (citing Roberts v. Prill, No. E2013-02202-COA-R3-CV, 2014 WL 2921930, at *5 (Tenn. Ct. App. June 26, 2014)). Although “[i]n limited circumstances, HIPAA provides for the use or disclosure of medical records without specific authorization ‘by the covered entity to defend itself in a legal action,‘” “HIPAA generally provides that a covered entity may not ‘use or disclose protected health information without’ valid authorization.” Roberts v. Prill, No. E2013-02202-COA-R3-CV, 2014 WL 2921930, at *6 (Tenn. Ct. App. June 26, 2014) (quoting
The Lawsons in their complaint named two health care providers as defendants, KDG and Ms. Hageman. In a case involving one defendant to a health care liability action, our Supreme Court has recently held:
[B]ased on the clear and unambiguous language of
section 29-26-121(a)(2)(E) , a plaintiff need not provide a HIPAA-compliant authorization when a single healthcare provider is given pre-suit notice of a healthcare liability claim. The authorization only allows a potential defendant to obtain the prospective plaintiff‘s medical records from any other healthcare provider also given notice and identified as a potential defendant in the pre-suit notice. This authorization requirement is consistent withsection 29-26-121(d)(1) , which specifies that all parties to a healthcare suit “shall be entitled to obtain complete copies of the claimant‘s medical records from any other provider receiving notice” and that the claimant complies with this requirement by providing a HIPAA-compliant medical authorization with pre-suit notice.Id. § 29-26-121(d)(1) .
In holding that when the complaint is against a single health care provider, a HIPAA-compliant authorization is not needed, the Bray Court specifically distinguished such a situation from that in Roberts, 2014 WL 2921930, a health care liability action involving two named defendants. As the Bray Court explained in relevant part:
In Roberts, the plaintiff filed a healthcare liability suit against the decedent‘s treating oncologist and the specialty healthcare group that employed the oncologist.
. . . While Roberts and the case at bar are both healthcare liability suits concerning incomplete medical authorizations, they are factually distinguishable on a critical point: Roberts involved two defendants, whereas this case involves a single defendant.
Bray, ___ S.W.3d at ___, 2017 WL 2856697, at *3.
We determine the instant action to be on point with Roberts and therefore conclude that the one-defendant exception articulated in Bray does not apply in this action. The Lawsons were required to include a HIPAA-compliant medical authorization with their pre-suit notice to the original two Defendants. Moreover, because KDG‘s possession of the medical record from the date of the alleged injury did not operate as an authorization for KDG to disclose the record, we further determine the Lawsons’ argument that KDG needed no such authorization to be unavailing.
Second, the Lawsons rely in part on our Supreme Court‘s decision in Stevens, noting that the Court affirmed the dismissal of the plaintiff‘s action in Stevens when the plaintiff omitted from her medical authorization “at least three of the six compliance requirements.” See Stevens, 418 S.W.3d 547 at 556. The Lawsons argue that their situation is distinguishable because they omitted only one element. However, substantial compliance, as it is used in the context of pre-suit notice, does not refer solely to the number of satisfied elements, but rather to a degree of compliance that provides the defendant with the ability to access and use the medical records for the purpose of mounting a defense. See id. at 555 (“Because HIPAA itself prohibits medical providers from using or disclosing a plaintiff‘s medical records without a fully compliant authorization form, it is a threshold requirement of the statute that the plaintiff‘s medical authorization must be sufficient to enable defendants to obtain and review a plaintiff‘s relevant medical records.“). The relevant inquiry, therefore, is whether the Lawsons failed to meet this threshold requirement, rather than how many core elements of the authorization were omitted.
The Lawsons argue that the instant action is comparable to the factual situation in Hamilton, 487 S.W.3d at 122, wherein this Court reversed the trial court‘s dismissal of the plaintiff‘s health care liability claim upon the determination that the plaintiffs’ pre-suit medical authorization substantially complied with HIPAA regulations despite the omission of one core element, the expiration date or event relating to the individual or the purpose of the use or disclosure. See
We read the Roberts holding in light of the particular shortcomings in the Roberts HIPAA form, which, as discussed above, were more substantive and substantial than the omitted date on the HIPAA form in the instant case. The relatively minor omission on Appellant‘s HIPAA form, coupled with the lack of evidence that Appellees were prejudiced or otherwise denied access to medical records as a result of the missing date, leads us to conclude that the trial court applied the Stevens holding too harshly in this case. While we concede that it is not good practice to omit any of the C.F.R. criteria from a HIPAA form, we conclude that the relatively minor shortcoming in the HIPAA form here is not fatal to the Appellant‘s cause of action. The Appellant substantially complied with
§ 29-26-121(a)(2)(E) because sheprovided Appellees sufficient notice to obtain the relevant medical records.
Hamilton, 487 S.W.3d at 122 (citing Roberts, 2014 WL 2921930, at *5) (additional internal citations omitted).
In contrast to the omitted date at issue in Hamilton, the case at bar presents a situation in which the name or other specific identification of the person(s) or class of persons authorized to make the requested use or disclosure is missing from the Lawsons’ pre-suit medical authorization. As KDG notes on appeal, health care providers presented with a medical authorization missing the identification of those authorized to release information would have no way of knowing that they were the providers for which the authorization was intended or that they were allowed to release medical records. Here, the authorization form provided by the Lawsons to KDG does not specify KDG as a provider allowed to release Mr. Lawson‘s medical records. Although the omission in this case includes only one of the omitted items at issue in Roberts, we determine that it is a necessary element to Defendants’ legal authorization to use the pertinent medical records to mount a defense. See Roberts, 2014 WL 2921930, at *5.
The Lawsons also rely on this Court‘s decision in Hughes v. Henry Cty. Med. Ctr., No. W2014-01973-COA-R3-CV, 2015 WL 3562733 (Tenn. Ct. App. June 9, 2015). In Hughes, the pre-suit authorization provided to the defendant medical facility did not allow the facility to obtain and utilize records from the other defendant, a physician employed by the facility. Id. at *1. This Court reversed the trial court‘s dismissal of the health care liability action in Hughes upon determining that the defendant physician had only treated the decedent at the defendant facility and possessed no medical records separate from the facility. Id. at *5 (concluding that the goal of providing the defendant with the means necessary to evaluate the substantive merits of the plaintiff‘s claim was satisfied because the defendant facility “was authorized to use all of the patient‘s relevant medical records“). The Lawsons draw a parallel between Hughes and this case because of the employer-employee relationship between Defendants. However, unlike in Hughes, the defendant medical practice in this action, KDG, was not provided with authorization to utilize Mr. Lawson‘s medical records because the space on the authorization form for those entitled to disclose the records was left entirely blank. We therefore find the Lawsons’ reliance on Hughes to be unavailing.
Third, the Lawsons assert that the document attached to their pre-suit notice, titled, “LIST OF HEALTH CARE PROVIDERS,” can supplement the HIPAA authorization to satisfy the requirement provided in
A one-page medical record concerning Mr. Lawson‘s April 29, 2015 visit to KDG is in the record on appeal as an exhibit attached to the Lawsons’ response to Defendants’ motion to dismiss. It is undisputed that this one-page record does not reference the incident involving the examination table. However, we have no way of knowing, nor did the trial court, how the medical record before us, which includes a description of Mr. Lawson‘s presenting his condition requiring dermatology treatment subsequent to suffering his purported injury allegedly caused by the table malfunction, would be evaluated by an expert witness or consultant. Moreover, because the medical authorization provided by the Lawsons failed to designate who would be authorized to make use of the medical record, KDG was foreclosed by HIPAA regulations from consulting with anyone to determine whether the record could aid in mounting a defense. See Stevens, 418 S.W.3d 547 at 555; Roberts, 2014 WL 2921930, at *5.
Upon thorough review, we conclude that KDG was prejudiced by the inadequacy of the Lawsons’ pre-suit medical authorization because KDG would not be allowed to use Mr. Lawson‘s medical records to mount a defense. The trial court did not err in dismissing the Lawsons’ health care liability action against KDG without prejudice based on the Lawsons’ failure to provide medical authorization with their pre-suit notice that was substantially compliant with HIPAA regulations.
We note that inasmuch as the Lawsons failed to comply with pre-suit notice requirements, they did not obtain the 120-day extension of the statute of limitations when they filed their complaint. See
V. Conclusion
For the foregoing reasons, we affirm the trial court‘s judgment dismissing the Lawsons’ health care liability claim against KDG without prejudice. We acknowledge, however, that any future claims filed by the Lawsons in this matter would be time-barred. This case is remanded to the trial court, pursuant to applicable law, for enforcement of the trial court‘s judgment and collection of costs below. The costs on appeal are assessed against the appellants, Tommy Lynn Lawson and Katrina Lawson.
THOMAS R. FRIERSON, II, JUDGE