Northwestern Memorial Hospital v. John Ashcroft, Attorney General of the United States

362 F.3d 923, 64 Fed. R. Serv. 334, 58 Fed. R. Serv. 3d 173, 2004 U.S. App. LEXIS 5724, 2004 WL 601652
CourtCourt of Appeals for the Seventh Circuit
DecidedMarch 26, 2004
Docket04-1379
StatusPublished
Cited by163 cases

This text of 362 F.3d 923 (Northwestern Memorial Hospital v. John Ashcroft, Attorney General of the United States) is published on Counsel Stack Legal Research, covering Court of Appeals for the Seventh Circuit primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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Northwestern Memorial Hospital v. John Ashcroft, Attorney General of the United States, 362 F.3d 923, 64 Fed. R. Serv. 334, 58 Fed. R. Serv. 3d 173, 2004 U.S. App. LEXIS 5724, 2004 WL 601652 (7th Cir. 2004).

Opinions

POSNER, Circuit Judge!

The government appeals from an order by the district court quashing a subpoena commanding Northwestern Memorial Hospital in Chicago to produce the medical records of certain patients on whom Dr. Cassing Hammond had performed late-term abortions at the hospital using the controversial method known variously as “D & X” (dilation and extraction) and “intact D & E” (dilation and evacuation). We accelerated briefing and argument, and now accelerate our decision, in view of the pressures of time discussed later in the opinion.

The subpoenaed records, apparently some 45 in number, are sought for use'in the forthcoming trial in the Southern District of New York of a suit challenging the constitutionality of the Partial-Birth Abortion Ban Act of 2003, Pub.L. No. 108-105, 117 Stat. 1201, 18 U.S.C. § 1531. See National Abortion Federation v. Ashcroft, 2004 WL 540470 (S.D.N.Y. Mar.17, 2004) (order denying summary judgment for plaintiffs). Dr. Hammond is one of the plaintiffs in that suit and will also be testifying as an expert witness. The district court held that the production of the records is barred by regulations issued under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Pub.L. 104-191, 110 Stat. 1936, and let us begin there.

Section 264 of HIPAA, 42 U.S.C. § 1320d-2 Note, directs the Secretary of Health and Human Services to promulgate regulations to protect the privacy of medical records, but provides in subsection (c)(2) that such a regulation “shall not supercede a contrary provision of State law, if the provision of State law imposes requirements, standards, or implementation specifications that are more stringent than the requirements, standards, or implementation specifications imposed under the regulation.” See also 45 C.F.R. § 160.203(b). A standard is “more stringent” if it “provides greater privacy protection for the individual who is the subject of the individually identifiable health information” than the standard in the regulation. § 160.202(6).

The particular focus of the appeal is an HHS regulation entitled “Standard: Disclosures for Judicial and Administrative [925]*925Proceedings,” § 164.512(e), which authorizes a “covered entity” (such as Northwestern Memorial Hospital) to disclose private health information in judicial or administrative proceedings “in response to an order of a court.” § 164.512(e)(1)(f). The regulation also allows the disclosure of such information in those proceedings “in response to a subpoena, discovery request, or other lawful process,” § 164.512(e)(l)(ii), if the party seeking the information either notifies the patient (or at least makes a good faith effort to do so) or makes a “reasonable effort” to secure a qualified protective order, that is, an order that prohibits the use or disclosure of the information outside the litigation and requires the return or destruction of the information at the end of the litigation. 45 C.F.R. § 164.512(e)(l)(v).

The district judge presiding over the case in New York issued an order authorizing, although not directing, the hospital to provide the records to the government after redaction to remove information identifying the patients. The parties agree that his order is an “order” within the meaning of the “in response” provision. It hardly matters; the government didn’t need such an order because it had obtained a protective order, thus qualifying under the alternative procedure for disclosure of medical records. But under Illinois law, even redacted medical records are not to be disclosed in judicial proceedings, with immaterial exceptions. 735 ILCS 5/8-802; Department of Professional Regulation v. Manos, 326 Ill.App.3d 698, 260 Ill.Dec. 364, 761 N.E.2d 208, 216-17 (2001); Parkson v. Central DuPage Hospital, 105 Ill.App.3d 850, 61 Ill.Dec. 651, 435 N.E.2d 140, 143-44 (1982). The district court in our case ruled that the Illinois law, because it sets a “more stringent” standard for disclosure than- the HI-PAA regulation, trumps that regulation by virtue of HIPAA’s supersession provision. So he quashed the subpoena, precipitating this appeal.

Although the issue is not free from doubt, we agree with the government that the HIPAA regulations do not impose state evidentiary privileges on suits to enforce federal law. Illinois is free to enforce its more stringent medical-records privilege (there is no comparable federal privilege) in suits in state court to enforce state law and, by virtue of an express provision in Fed.R.Evid. 501, in suits in federal court (mainly diversity suits) as well in which state law supplies the rule of decision. But the Illinois privilege does not govern in federal-question suits, such as the suit in the Southern District of New York. The enforcement of federal law might be hamstrung if state-law privileges more stringent than any federal privilege regarding medical records were applicable to all federal cases. We say “might” not “would” because some federal statutes authorize subpoenas in terms that would override the HIPAA regulations. See, e.g., 18 U.S.C. § 3486; In re Subpoena Duces Tecum, 228 F.3d 341 (4th Cir.2000). But almost certainly there are gaps; and we think it improbable that HHS intended to open such a can of worms when it set forth a procedure for disclosure of medical records in litigation — intended, that is, to be regulating, actually or potentially (depending on other statutory provisions regulating subpoenas), the litigation of federal employment discrimination cases, social security disability cases, ERISA cases, Medicare and Medicaid fraud cases, Food and Drug Administration cases; and the numerous other classes of federal case in which medical records whether of the parties or of nonparties would not be privileged under federal evidence law.

All- that 45 C.F.R. § 164.512(e) should be understood to do, therefore, is to [926]*926create a procedure for obtaining authority to use medical records in litigation. Whether the records are actually admissible in evidence will depend among other things on whether they are privileged. And the evidentiary privileges that are applicable to federal-question suits are given not by state law but by federal law, Fed.R.Evid. 501, which does not recognize a physician-patient (or hospital-patient) privilege. Rule 501 in terms makes federal common law the source of any privileges in federal-question suits unless an Act of Congress provides otherwise. We do not think HIPAA is rightly understood as an Act of Congress that creates a privilege.

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362 F.3d 923, 64 Fed. R. Serv. 334, 58 Fed. R. Serv. 3d 173, 2004 U.S. App. LEXIS 5724, 2004 WL 601652, Counsel Stack Legal Research, https://law.counselstack.com/opinion/northwestern-memorial-hospital-v-john-ashcroft-attorney-general-of-the-ca7-2004.