Privacy Rights Stymie Searches of Psychiatrists’ Medicaid Files

Privacy Rights Stymie Searches of Psychiatrists’ Medicaid Files

Summary and Analysis

The United States LAW WEEK
A National Survey of Current Law The Bureau of National Affairs, Inc., Washington D.C.

HONOLULU – The numerous interests protected by the multi-faceted constitutional right to privacy have yet to be fully catalogued. However, the U.S. District Court for Hawaii adds one more item to the list, as it recognizes a privacy right in deciding to seek psychiatric treatment. Based on this “autonomy” strand of the right to privacy, as well as a “confidentiality” strand, the court preliminary enjoins enforcement of a Hawaii statute that authorizes administrative warrants to search psychiatrists’ confidential Medicaid patient files. (Hawaii Psychiatric Society v. Ariyoshi, 10/22/79)

Pursuant to the statute, state officials seized from a psychiatrist’s office various records concerning Medicaid patients, including therapeutic notes, patient history forms, and medical records. The possibility that intimate thoughts and emotions could be disclosed, either to state officials or the public, is an infringement of the privacy-based right to seek treatment. Such infringement, the court says, warrants scrutiny under the compelling state interest standard.

There is a substantial probability, the court finds, that the statute fails this constitutional test. Even if such searches were necessary to uncover fraud, the details of a patient’s problems are not necessary to determine whether psychiatric services are being rendered as claimed. Further, the state has no more interest in ensuring the quality of care to Medicaid patients or making their records available for emergencies than it does for patients who pay for treatment.

The second strand of the right to privacy, confidentiality, requires a different constitutional test. Disclosure of confidences arising from the psychiatrist-patient relationship can be obtained, the court says, only when a compelling state interest outweighs the individual’s confidentiality right. Since the disclosure of the highly personal information in the manner provided by statute is not necessary to the state’s pursuit of its interests, the court concludes that the statute most likely fails on this score too. (Page 2344)

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