The California Court of Appeal recently held that the release of an index identifying hospital patients did not constitute the release of medical information under California’s Confidentiality of Medical Information Act (CMIA), Civ. Code, § 56 et seq., because the index contained only demographic information and nothing “regarding a patient’s medical history, mental or physical condition, or treatment.”Eisenhower Medical Center v. Superior Court (Malanche), Case No. E058378 (Cal. Ct. App. May 21, 2014). The Court held that “a health care provider cannot be held liable under the relevant portions of the CMIA for the release of an individual’s personal identifying information that is not coupled with that individual’s medical history, mental or physical condition, or treatment.”
The case arose when a computer stolen from the Eisenhower Medical Center (EMC) contained an index identifying over 500,000 persons who had been assigned record numbers at EMC going back to the 1980s. The information was password-protected but not encrypted. The index contained “demographic” information, listing each person’s name, medical record number, age, date of birth, and last four digits of the person’s Social Security number (SSN). When EMC gave the required notice of the theft, a number of the listed individuals brought a class action seeking “nominal” damages of $1,000 for each class member under the CMIA—which could have totaled more than half a billion dollars based upon the number of records—and asserting other related claims.
EMC moved for summary adjudication on the grounds that the computer theft did not result in a disclosure of “medical information” of any of the listed persons and sought appellate review when the motion was denied. EMC argued that the CMIA requires a disclosure not only of “individually identifiable information” (which was concededly contained on the index) but also information “regarding a patient’s medical history, mental or physical condition, or treatment.” The Court agreed.
There was no dispute that the index contained no information of a specifically medical nature. The plaintiffs’ primary argument was that inclusion of a person’s name on the index, standing alone, constituted a release of medical history because it disclosed that he or she was a patient. In rejecting this contention, the Court found the mere disclosure that a person may once have been a patient was insufficient to establish liability. Medical information is something more than “any patient-related information” held by a provider. Under the CMIA, a prohibited release by a health care provider must reveal both “individually identifiable information” and “also include ‘a patient’s medical history, mental or physical condition, or treatment.’ This definition does not encompass demographic or numeric information that does not reveal medical history, diagnosis, or care.” The Court observed that the plaintiffs’ argument would render the clause “regarding a patient’s medical history, mental or physical condition, or treatment” entirely meaningless. The Court also noted that Civil Code Section 56.16 of the CMIA expressly authorizes hospitals to release certain categories of medical information about a patient upon request, including a general description of the reasons for treatment, the general nature of any injury, and the patient’s general condition.
Eisenhower adds to the growing body of law interpreting and generally narrowing the scope of liability under the CMIA. Eisenhower’s holding that patient identity and other personal information such as age does not constitute medical information under the CMIA is an important clarification of the statutory scheme, as was the recent ruling in Regents of University of California v. Superior Court, 220 Cal.App.4th 549 (2013). In the Regents case, the court ruled that no claim can be asserted under the CMIA unless confidential medical information actually has been viewed by some unauthorized person.
The Eisenhower Court expressly limited the reach of its opinion to its facts; a footnote mentions that the decision does not address situations involving disclosure of an individual’s status as a patient of a specialized health care provider, such as an AIDS clinic—which by itself could reveal more about that person’s medical condition, history, or treatment than the fact that the person was assigned a medical record number. In such a situation, it might be difficult for a defendant provider to argue persuasively that no medical information was disclosed. Like many recent privacy cases, Eisenhower highlights the value of encrypting patient data, whatever its content.