Michigan law trumps HIPAA in patient privacy case

Legal experts say a Michigan court ruling over disclosing patient names places tighter restrictions on what information physicians can release during legal proceedings.

The decision also could impact peer review and lead to a rise in lawsuits against health care professionals over patient-privacy violations, they said.

The case stems from a 2009 lawsuit filed by Howell, Mich.-based podiatrist Isidore Steiner, DPM, of Family Foot Center against podiatrist Marc Bonanni, DPM, alleging that Bonanni "stole" patients in violation of an employee agreement, court records show. His contract prohibited him from soliciting patients if he left the practice.

During discovery, the center requested that Bonanni disclose the names, addresses and telephone numbers of all patients treated at his new practice since he left the center. Bonanni objected, arguing that the disclosure was protected by state and federal patient privacy laws.

The center filed a motion asking the court to force Bonanni to produce the information. It said the Health Insurance Portability and Accountability Act should be applied to the case. HIPAA allows certain patient disclosures during legal proceedings.

But Bonanni argued that Michigan's patient privacy law, which prevents such disclosures, should be applied.

A trial court ruled in favor of Bonanni. Steiner appealed. The appellate court ruled that the plaintiffs were not entitled to the patient information because Michigan law preempts HIPAA. The court said HIPAA applies only if there is not a more stringent state law related to patient privacy.

"There are not exceptions under Michigan law for providing random patient information related to any lawsuit," the court said. "The purpose of the physician-patient privilege is to protect the confidential nature of the physician-patient relationship. ... These principles are particularly important in a context, as here, wherein plaintiff seeks the names, addresses and telephone numbers of nonparty patients, many of whom are unlikely to know this lawsuit is pending."

Elizabeth Favaro, the attorney for Bonanni, was pleased with the court's decision and its potential impact on disclosure-related cases. "[The opinion] provides greater guidance about [how best] to protect patient information when doctors start fighting about the practice," she said.

Ruling raises questions

The court's interpretation of Michigan law raises concerns about what information is subject to disclosure in various circumstances, including peer review, said Elizabeth Callahan-Morris, a Michigan-based attorney. Callahan-Morris focuses on patient privacy laws and advises hospitals and doctors on compliance issues and how to respond to legal requests.

The sharing of information between medical professionals and health organizations is generally protected by peer review rules, she said. With the Bonanni ruling, Callahan-Morris said there may be problems involving requests of patient information without a waiver from each patient. The ruling also may create more lawsuits against health care professionals by patients claiming that their information was released in violation of Michigan law.

"When entities do not want to disclose information, they're going to use this case as their response. I expect to see this case used as both a sword and a shield," she said.

Defending and prosecuting cases that require patient information also may become more difficult, said David Honig, a health care attorney in Michigan.

"In the trenches as a litigator, what is this going to mean? All kinds of records are relevant in all kinds of cases," he said. "It's going to raise a lot of questions."