M.A.K. v. Rush-Presbyterian-St. Luke's Medical Center

764 N.E.2d 1, 198 Ill. 2d 249, 261 Ill. Dec. 710, 2001 Ill. LEXIS 1784

• Court: Illinois Supreme Court
• Decided: December 20, 2001
• Docket: 90527
• Status: Published

Opinions

JUSTICE GARMAN

delivered the opinion of the court:

Plaintiff, M.A.K., filed a complaint in the circuit court of Will County against defendants, Rush-Presbyterian-St. Luke’s Medical Center (Rush) and Royal Maccabees Life Insurance Company (Royal), alleging that Rush had improperly released certain medical records to Royal, pursuant to a written consent signed by plaintiff. The circuit court granted judgment on the pleadings to Rush. Thereafter, plaintiff voluntarily dismissed his action as to Royal and appealed the circuit court’s order. The appellate court reversed and remanded (316 Ill. App. 3d 156). We granted Rush’s petition for leave to appeal (177 Ill. 2d R. 315) and we now reverse the judgment of the appellate court.

BACKGROUND

In count I of his second amended complaint, plaintiff alleged that Rush had breached the physician-patient relationship by releasing his records without first advising plaintiff of its intention to do so and obtaining his approval. In count II, for invasion of privacy, plaintiff alleged that Rush had wrongfully released his medical records without his prior authorization or consultation. Count III alleged negligent infliction of emotional distress.

The allegations of the complaint show that on January 13, 1995, plaintiff was admitted to Rush’s Behavioral Health Center — Du Page (Behavioral Health Center) for alcohol dependence. He was discharged on March 2, 1995. In October 1994, plaintiff had applied to Royal for a disability income insurance policy. Royal issued the policy. While receiving treatment at Rush, plaintiff contacted his insurance agent about filing a claim for benefits under the policy. After receiving a claim form from Royal, plaintiff notified Royal in February 1995 that he would not be filing a claim. In April 1995, Rush received from Royal a written consent signed by plaintiff, dated October 12, 1994, to release plaintiffs medical and nonmedical information to Royal. The records that Rush released to Royal included plaintiffs records of alcohol-dependence treatment. After receiving plaintiff’s medical records from Rush, Royal cancelled plaintiffs disability policy.

The written consent signed by plaintiff was entitled “AUTHORIZATION AND ACKNOWLEDGEMENT” (hereafter authorization) and stated in pertinent part as follows:

“I AUTHORIZE any physician, medical practitioner, hospital, clinic, health care facility, [or] other medical or medically related facility[ ] *** having information available as to diagnosis, treatment and prognosis with respect to any physical or mental condition and/or treatment of me *** and any other non-medical information of me *** to give to Royal *** any and all such information.

I UNDERSTAND the purpose of this authorization is to allow Royal *** to determine eligibility for life or health insurance or a claim for benefits under a life or health policy. ***

I UNDERSTAND THAT my *** medical records may be protected by certain Federal Regulations, especially as they apply to any drug or alcohol abuse data. I understand that I *** may revoke this authorization at any time as it pertains to any such drug or alcohol abuse data by written notification ***.

*** I AGREE this Authorization shall be valid for two and one half years from [October 12, 1994].”

In the circuit court, Rush filed a motion for judgment on the pleadings (735 ILCS 5/2—615(e) (West 1998)), arguing that plaintiffs executed authorization expressly permitted Rush to release his medical and nonmedical records to Royal and was therefore facially valid. Plaintiff argued that the authorization was not a valid waiver of his right to confidentiality of his medical records that were not in existence at the time he signed the authorization and that Rush should have notified plaintiff that Royal had submitted a request for his medical records. Plaintiff also filed a reply to Rush’s reply brief in support of its motion for judgment on the pleadings in which plaintiff included an affidavit of his attorney, who stated that, during a meeting with Paul Feldman, the medical director of the Behavioral Health Center, Feldman admitted that plaintiffs records should not have been released to Royal. On December 11, 1997, the circuit court granted Rush’s motion.

The issue addressed by the appellate court was whether the authorization complied with the requirement of section 2.31(a)(1) of the Confidentiality of Alcohol and Drug Abuse Patient Records regulations (hereafter regulation). Confidentiality of Alcohol and Drug Abuse Patient Records, 42 C.F.R. § 2.31(a)(1) (2000). The regulation requires that a written consent for release of alcohol and drug treatment records give the “specific name or general designation” of the person or program authorized to make the disclosure of such records. In reversing the circuit court, the appellate court relied upon the “plain language” of the authorization and concluded that the term “general designation” required something more specific than the phrase “any physician, medical practitioner, hospital, clinic, health care facility or other medical or medically related facility.” The court described the language of the authorization as “at best imprecise and far too generic to be considered a general designation as that term is commonly understood and as is required by the regulations.” 316 Ill. App. 3d at 160.

ANALYSIS

I. Standard of Review

Judgment on the pleadings is proper only where no genuine issue of material fact exists and the moving party is entitled to judgment as a matter of law. Chicago Title & Trust Co. v. Steinitz, 288 Ill. App. 3d 926, 934 (1997). In ruling on a motion for judgment on the pleadings, only those facts apparent from the face of the pleadings, matters subject to judicial notice, and judicial admissions in the record may be considered. All well-pleaded facts and all reasonable inferences from those facts are taken as-true. Mt. Zion State Bank & Trust v. Consolidated Communications, Inc., 169 Ill. 2d 110, 115 (1995). Our review is de novo. Board of Trustees of the University of Illinois v. City of Chicago, 317 Ill. App. 3d 569, 571 (2000).

II. Compliance With the Regulation

The regulation implements section 543 of the Public Health Service Act (Public Health Act) (42 U.S.C. § 290dd—2 (1994)). That section mandates the confidentiality of alcohol and drug abuse patient records and prescribes the conditions and manner of release of such records. It states in pertinent part as follows:

“(a) Requirement

Records of the identity, diagnosis, prognosis, or treatment of any patient which are maintained in connection with the performance of any program or activity relating to substance abuse education, prevention, training, treatment, rehabilitation, or research, which is conducted, regulated, or directly or indirectly assisted by any department or agency of the United States shall, except as provided in subsection (e) of this section, be confidential and be disclosed only for the purposes and under the circumstances expressly authorized under subsection (b) of this section.

(b) Permitted disclosure

(1) Consent

The content of any record referred to in subsection (a) of this section may be disclosed in accordance with the prior written consent of the patient with respect to whom such record is maintained, but only to such extent, under such circumstances, and for such purposes as may be allowed under regulations prescribed pursuant to subsection (g) of this section.” 42 U.S.C. §§ 290dd—2(a), (b) (1994).

Subsection (g) grants authority to the Department of Health and Human Services (Department) to promulgate regulations to implement the purposes of the law. 42 U.S.C. § 290dd—2(g) (1994). The regulation sets forth the requirements of a written consent authorizing disclosure of a patient’s alcohol or drug abuse treatment records. That section provides in pertinent part:

“(a) Required elements. A written consent to a disclosure under these regulations must include:

(1) The specific name or general designation of the program or person permitted to make the disclosure.

(2) The name or title of the individual or the name of the organization to which disclosure is to be made.

(3) The name of the patient.

(4) The purpose of the disclosure.

(5) How much and what kind of information is to be disclosed.

(6) The signature of the patient ***.

(7) The date on which the consent is signed.

(8) A statement that the consent is subject to revocation at any time except to the extent that the program or person which is to make the disclosure has already acted in reliance on it. ***

(9) The date, event, or condition upon which the consent will expire if not revoked before. This date, event, or condition must insure that the consent will last no longer than reasonably necessary to serve the purpose for which it is given.” 42 C.F.R. § 2.31(a) (2000).

Familiar principles of statutory construction apply to the interpretation of regulations of an administrative agency. See Tivoli Enterprises, Inc. v. Zehnder, 297 Ill. App. 3d 125, 132 (1998). The primary rule of statutory construction is to give effect to the intent of the legislature. Paris v. Feder, 179 Ill. 2d 173, 177 (1997). The best evidence of legislative intent is the language used in the statute itself and that language must be given its plain and ordinary meaning. Paris, 179 Ill. 2d at 177. The statute should be construed as a whole and, if possible, in a manner such that no term is rendered meaningless or superfluous. Texaco-Cities Service Pipeline Co. v. McGaw, 182 Ill. 2d 262, 270 (1998). Where the meaning of a statute is unclear from a reading of its language, courts may look beyond the language of the statute and consider the purpose of the law, the evils it was intended to remedy, and the legislative history behind it. In re B.C., 176 Ill. 2d 536, 542-43 (1997).

The phrase “general designation” is not defined in the regulation. The word “general” means “involving, applicable to, or affecting the whole,” “involving, relating to, or applicable to every member of a class, kind, or group,” and “concerned or dealing with universal rather than particular aspects”. Merriam-Webster’s Collegiate Dictionary 484 (10th ed. 1996). “[Designation” is defined as “the act of indicating or identifying,” and “a distinguishing name, sign, or title.” Merriam-Webster’s Collegiate Dictionary 313 (10th ed. 1996).

Rush argues that the phrase “general designation” is properly construed to mean “a broad and comprehensive classification of the programs and persons permitted to make disclosure” of the patient’s confidential records. Since the terms “physician, medical practitioner, hospital, clinic, health care facility, and other medical or medically related facility” constitute such a classification, their use in the authorization complied with the regulation. Plaintiff, on the other hand, argues that the phrase requires the authorization to contain a reference to records of treatment in an alcohol abuse program.

As the appellate court recognized, this is an issue of first impression. We have been unable to locate any case that has addressed the question before us.

On its face, the phrase “general designation” appears to be vague. The word “general” refers to a broad classification. The word “designation” refers to either the act of identifying or a distinguishing name or title. It is unclear how to reconcile these words. We will therefore look beyond the language of the regulation to determine the meaning of the phrase “general designation.”

The original authority for the regulation derives from section 333 of the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act of 1970 (Alcohol Abuse Act) (42 U.S.C. § 4582 (1982)). That section is now section 543 of the Public Health Act (42 U.S.C. § 290dd—3 (1994)). Congress recognized that, without guarantees of confidentiality, many individuals would hesitate to seek treatment in alcohol and drug abuse programs. Whyte v. Connecticut Mutual Life Insurance Co., 818 F.2d 1005, 1010 (1st Cir. 1987). The purpose of enacting the Alcohol Abuse Act was to facilitate the work of alcohol and drug treatment centers by assuring the confidentiality of patient records. United States v. Eide, 875 F.2d 1429, 1436 (9th Cir. 1989). The regulation was originally promulgated in 1975. 40 Fed. Reg. 27802 (1975). Until 1987, the regulation provided that a written consent to a disclosure of a patient’s alcohol or drug treatment records must include the name of the program which was to make the disclosure. 42 C.F.R. § 2.31(a)(1) (2000). The regulation was amended in 1987 to its current form. In its comments explaining the 1987 amendments the Department noted that:

“The Final Rule retains all elements previously required for written consent, though in one instance it will permit a more general description of the required information. The first of the required elements of written consent in both the existing and proposed rule ([section] 2.31(a) (1)) asks for the name of the program which is to make the disclosure. The Final Rule will amend that element by calling for ‘(1) The specific name or general designation of the program or person permitted to make the disclosure.’ This change will permit a patient to consent to disclosure from a category of facilities or from a single specified program. For example, a patient who chooses to authorize disclosure of all his or her records without the necessity of completing multiple consent forms or individually designating each program on a single consent form would consent to disclosure from all programs in which the patient has been enrolled as an alcohol or drug abuse patient. Or, a patient might narrow the scope of his or her consent to disclosure by permitting disclosure from all programs located in a specified city, from all programs operated by a named organization, or as now, the patient might limit consent to disclosure from a single named facility. (In this connection, the Department interprets the existing written consent requirements to permit consent to disclosure of information from many programs in one consent form by listing specifically each of those programs on the form.)

This change generalizes the consent form with respect to only one element without diminishing the potential for a patient’s making an informed consent to disclose patient identifying information. The patient is in [a] position to be informed of any programs in which he or she was previously enrolled and from which he or she is willing to have information disclosed.” Confidentiality of Alcohol and Drug Abuse Patient Records, 52 Fed. Reg. 21,796, 21,799 (June 9, 1987).

After careful consideration, we conclude that the authorization signed by plaintiff in this case complies with section 2.31(a)(1) of the regulation. Prior to the 1987 amendments, the regulation required a written consent to give the specific name of the program or person permitted to make the disclosure. The intent of the amendments was to broaden the permissible wording of a written consent to disclosure of alcohol and drug treatment records. The amended regulation permits a more general description of the person or program to make the disclosure. This relaxed requirement serves the amendments’ stated purpose of relieving patients of the necessity of executing multiple consent forms or specifically naming each and every program or person entitled to make disclosure of alcohol or drug treatment records. The appellate court’s interpretation of the phrase “general designation” gives too much emphasis to the word “designation.” In doing so, the court essentially read the word “general” out of the phrase. Construing the regulation in this manner undermines the intent of the 1987 amendments. The authorization here gives a general classification of the types of entities that are entitled to disclose plaintiff’s medical and nonmedical information. That is all the regulation requires.

We note that plaintiff does not argue that he failed to understand that alcohol treatment records could be disclosed pursuant to the authorization. Indeed, language in the authorization specifically refers to alcohol and drug abuse treatment records, advising plaintiff that such records may be protected by federal regulations and that he may revoke the authorization at any time as it pertains to such records. We therefore conclude that the appellate court erred in finding the authorization invalid under section 2.31(a)(1) of the regulation.

III. Issues Raised by Plaintiff

In his appellee brief, plaintiff raises additional arguments in support of the appellate court’s decision. He argues that the authorization failed to comply with two additional elements of the regulation. The regulation requires a written consent for release of alcohol or drug treatment records to state how much and what kind of information is to be disclosed. 42 C.F.R. § 2.31(a)(5) (2000). It also requires a written consent to state “[t]he date, event, or condition upon which the consent will expire if not revoked before. This date, event, or condition must insure that the consent will last no longer than reasonably necessary to serve the purpose for which it is given.” 42 C.F.R. § 2.31(a)(9) (2000). The authorization states that “any and all” of plaintiff’s medical and nonmedical information may be released. It also states . that the consent to disclosure will expire 21k years from October 12, 1994.

Plaintiff also argues that, even should we decide that the authorization is valid, this cause should be remanded to the circuit court to resolve issues of fact concerning whether Rush violated its own policies and procedures in releasing plaintiffs records. In this argument, plaintiff relies on the alleged statement by Paul Feldman, the Behavioral Health Center’s medical director, that Rush should not have released plaintiffs records.

Finally, plaintiff argues that, as a matter of law, the authorization was not applicable to medical records not in existence at the time he signed it.

Rush contends that plaintiff did not raise these arguments in the circuit or appellate courts. It is not clear from the record that all of these arguments are waived. After concluding that the authorization failed to comply with the “general designation” requirement of the regulation, the appellate court chose not to address other arguments of the parties. The opinion does not indicate what those arguments were. In addition, we note that plaintiff argued in the circuit court that the authorization did not waive his right to confidentiality of his medical records generated after he signed the authorization. Regardless, the waiver rule is a limitation on the parties and not the jurisdiction of this court. Michigan Avenue National Bank v. County of Cook, 191 Ill. 2d 493, 518 (2000). Under the circumstances, we choose to address plaintiffs arguments.

A. Other Requirements of the Regulation

Plaintiff argues that the authorization fails to specify how much and what kind of information is to be disclosed, as required by the regulation. The authorization states that it applies to “any and all such information,” i.e., all medical and nonmedical information possessed by the entities to make the disclosure. Plaintiff apparently complains that the authorization’s description of this information is too broad. He cites, as his sole authority for this argument, a publication entitled, “Checklist for Monitoring Alcohol and Other Drug Confidentiality Compliance.” Department of Health and Human Services Publication No. 18 (SMA) 96—3083 (1996). This publication was published pursuant to a contract from the Center for Substance Abuse Treatment (Center) of the Substance Abuse and Mental Health Services Administration, an agency of the Department, as part of its Technical Assistance Publication Series. The publication that plaintiff refers to is Technical Assistance Publication 18 and it purports to provide a checklist to assist alcohol and other drug programs and state and other governmental monitoring agencies in determining whether a breach of patient confidentiality has occurred under federal law and regulations governing patient confidentiality.

With regard to section 2.31(a)(5) of the regulation, this publication states that the information to be released “should be described as exactly and narrowly as possible in light of the purpose of the release. Releases for ‘any and all pertinent information’ are not valid.” Department of Health and Human Services Publication No. 18 (SMA) 96—3083, Checklist, pt. A(III)(A), Summary of the Rule.

Plaintiffs reliance on this publication is misplaced, because it explicitly states that “[t]he opinions expressed herein are the views of the authors and do not necessarily reflect the official position of [the Center] or any other part of the [Department].” Department of Health and Human Services Publication No. 18 (SMA) 96—3083, Introduction. Thus, it provides no authority for plaintiffs contention that the authorization’s description of the kind and amount of information to be released violates the regulation. There is no indication in the regulation or in the Department’s comments to the 1987 amendments that a broad description of the information to be released is impermissible.

Plaintiff also argues that the authorization does not comply with section 2.31(a)(9) of the regulation, governing the terms under which a written consent to disclosure is to expire. Plaintiff asserts that the authorization’s statement that it is valid for 2V2 years from October 12, 1994, goes “substantially” beyond the time reasonably necessary to serve the purpose for which the authorization was given. In support of this argument, plaintiff cites a footnote in another Technical Assistance Publication, entitled, “Confidentiality of Patient Records for Alcohol and Other Drug Treatment,” which notes that some states have statutes that provide for the automatic expiration of written consents after 60 or 90 days. Department of Health and Human Services Publication No. 13 (SMA) 95—3018 (1994), ch. 1 n.11. As with the prior publication cited by plaintiff, this latter publication expressly represents only the views of its author. It provides no support for plaintiffs argument. The authorization here complied with the regulation by stating the date upon which it would cease to be valid. The stated purpose for the authorization was to enable Royal to determine plaintiff’s eligibility for insurance and to evaluate any claims made by plaintiff under his insurance policy. We cannot say as a matter of law that a period of 2V2 years for the purpose of evaluating any claims plaintiff might make under the insurance policy is invalid.

B. Alleged Violation of Rush’s Policies in Disclosing Records

Plaintiff argues that this cause should be remanded for a determination of whether Rush violated its own policies and procedures in disclosing plaintiffs records. Plaintiff relies on an affidavit of his attorney referring to comments made by Feldman during a meeting, stating that Rush should not have released the records. Plaintiff notes that Rush did not challenge the affidavit, which was attached to a reply to Rush’s reply to plaintiffs response to Rush’s motion for judgment on the pleadings.

Plaintiffs reliance on this affidavit is misplaced. In ruling upon a motion for judgment on the pleadings, a court may consider only (1) facts apparent from the face of the pleadings, (2) matters subject to judicial notice, and (3) judicial admissions in the record. Mt. Zion State Bank & Trust, 169 Ill. 2d at 115. Extrinsic evidence may not be considered. Romano v. Village of Glenview, 277 Ill. App. 3d 406, 413 (1995). Accordingly, the affidavit of plaintiffs attorney is irrelevant.

C. Validity of Authorization as to Subsequently Generated Records

Plaintiff argues that, as a matter of Illinois law, the authorization was not valid to waive his right to confidentiality of his medical records that were not in existence on the date he signed it. In support, he cites section 8—2001 of the Code (735 ILCS 5/8—2001 (West 1998)), which requires hospitals to permit patients, after their discharge from the hospital, to examine and copy their records. Plaintiff argues that the fact that the right under this statute to examine and copy records accrues after discharge from a hospital implies that a consent for release of hospital records applies only to records in existence at the time the patient signs the consent. Plaintiff cites no authority supporting his interpretation of this statute. Section 8—2001 of the Code merely allows patients access to their- hospital records upon discharge. Nothing in the statute implies that patients may not authorize disclosure of treatment records that may be generated in the future.

Plaintiff next argues that, since he did not know at the time he signed the authorization that he would be hospitalized in the future for alcohol abuse treatment, he could not, by signing the authorization, have waived his right to nondisclosure of his records. Thus, without notice from Rush to plaintiff of Royal’s request for his records, he could not have exercised his right to revoke the authorization. In support of his argument, plaintiff cites an Arizona case, Danielson v. Superior Court, 157 Ariz. 41, 754 P.2d 1145 (App. 1987). That case, however, is inapposite, as it involved a situation in which a physician disclosed his alcohol treatment records to a state investigatory agency and later sought to prevent disclosure of those records in a medical malpractice lawsuit. The appellate court held that the physician had no right to withhold the records from the agency and that, in such cases, a voluntary disclosure cannot be considered a waiver of the right to invoke the confidentiality privilege in the future. Danielson, 157 Ariz. at 48, 754 P.2d at 1152. In the instant case, plaintiff had the right not to sign the authorization and he maintained the right to revoke it at any time. Plaintiff points to no authority for the proposition that he could not waive his confidentiality privilege as to subsequently generated medical records and we reject his argument.

CONCLUSION

We hold that the circuit court did not err in entering judgment on the pleadings in favor of Rush. We therefore reverse the appellate court’s judgment and affirm that of the circuit court.

Appellate court judgment reversed; circuit court judgment affirmed.