In Biddle v. Warren General Hospital, the Ohio Appeals Court had to determine whether a hospital could be sued for violating its patients’ right to confidentiality after it released copies of their medical records to a group of attorneys it hired to assist with collecting outstanding bills.  The hospital hired a law firm to screen the medical records of its patients to determine whether any of their patients might be eligible for Supplemental Security Income reimbursement.  In order to perform this assessment, the law firm was given copies of the hospital’s patient registration forms.  The patient registration forms contained the patient’s name, address, date of birth, employment status, and their admitting diagnosis.

                One of the attorneys employed by the law firm who was assigned to review the hospital’s patient registration forms discovered that the law firm was planning to terminate her.  In an effort to retaliate against her employer, this attorney released copies of the patient registration forms to a local television station in Ohio.  The television station prepared an investigative report regarding a patient’s right of confidentiality based upon the information they received from the attorney.  Two of the patients whose registration forms were released, Cheryl and Robert Biddle, participated in the televised news report. 

                As a result of the investigation, the Biddles filed a complaint against the hospital.  The numerous counts in the complaint included breach of confidentiality, invasion of privacy, intentional infliction of emotional distress, negligence, breach of contract, and statutory violations concerning patient confidentiality.  The Biddles also brought claims against the law firm including inducement of breach of confidentiality.  The defendants filed a motion for summary judgment asking the Court to dismiss the Biddles’ claims against them.  After the trial court entered judgment in the defendants’ favor, the Biddles filed an appeal. 

                In order to support a claim for breach of confidentiality, the Appeals Court held that the Biddles must demonstrate an “uncontested, unprivileged disclosure to a third party of nonpublic information that the [hospital] has learned within a confidential relationship.”  The Appeals Court explained that the duty of confidentiality that a hospital owes a patient is derived from several sources including the statutory physician-patient privilege, the Hippocratic Oath, and their license to practice medicine. The Court pointed out that a hospital has a privilege to disclose nonpublic information only when public policy mandates such disclosure.  Such public policy concerns include the diagnosis of occupational or contagious diseases, suspected child abuse, or evidence of criminal conduct.  Since none of these public policy concerns applied to this case, the Court found that the Biddles’ registration sheets contained nonpublic information. 

                The hospital argued that even though the documents at issue contained non-public information, the Biddles consented to the release of the information.  In support of this argument, the hospital presented a copy of a signed release.  After reviewing the release, the Court determined that it only permitted the disclosure of medical records to the patient’s insurance company or to a third party payor, such as a governmental agency.  The form did not directly or indirectly permit the disclosure of any confidential medical information to the hospital’s law firm. 

                The hospital also argued that it did not breach its duty of confidentiality by releasing the records because the law firm had a duty to keep them confidential.  The Court rejected this argument, stating that the disclosure of confidential information to a third party is all that is required to show breach.  The Court pointed out that if the hospital wished to release patient records to the law firm in the future, they could avoid liability by obtaining the patient’s express consent for this type of release.  

                The Appeals Court also determined that the law firm could be sued for inducing the hospital to release confidential information about its patients.  Adopting the standard set forth by state of Massachusetts, the Appeals Court held that Biddles must show that the law firm either knew or should have known of the existence of a physician-patient relationship, the law firm intended to induce the hospital to disclose patient information, and the law firm did not reasonably believe that the hospital could disclose the information without violating its duty of confidentiality.  Since the law firm needed to ascertain each patient’s medical condition in order to assess eligibility for SSI, the Appeals Court found there were issues of fact to support a claim for inducement of breach of confidentiality against the law firm. 

                The Appeals Court upheld the dismissal of the Biddles’ invasion of privacy claim.  To support this claim, the Biddles had to show that the confidential information was released to the public at large or to so many persons that it was substantially certain to become public knowledge.  Since the registration forms were provided to the law firm as part of an attorney-client relationship, there was no evidence to show that the information contained within the registration forms was certain to become public knowledge.  With regard to this claim, the Court did not believe that it was foreseeable that the attorney would breach the attorney-client privilege with the Hospital by releasing the records to the television station. 

                Whenever a hospital is faced with the issue of releasing confidential medical information about a patient, they must first determine whether they have a statutory privilege to do so.  If not, to protect themselves from liability for improperly releasing confidential medical information, hospitals should seek a patient’s express consent before releasing medical information to a third party.  In situations when it is unclear whether the hospital has a privilege to release the medical information, the hospital should refrain from releasing a patient’s records unless they have the patient’s express consent.


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    Inadequate Release Forms and Disclosure to 3rd Parties

    by Attorney Frank E. Reardon

    April 1999

    Healthcare Law, Litigation & Public Policy   Medical Licensure & Discipline ♦ Employment Board of Registration