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Doe v. Group Health Cooperative of Puget Sound Inc.

March 3, 1997

JOHN DOE, APPELLANT,
v.
GROUP HEALTH COOPERATIVE OF PUGET SOUND, INC., RESPONDENT.



Appeal from Superior Court of King County. Docket No: 94-2-03583-5. Date filed: 10/13/95. Judge signing: Hon. Carol Schapira.

Authored by Mary K. Becker. Concurring: Walter E. Webster, Ann L. Ellington.

The opinion of the court was delivered by: Becker

BECKER, J. -- Group Health used John Doe's name and consumer number, without his authorization, to illustrate a training exercise on how to process mental health claims. Doe sued Group Health, claiming damages under the Uniform Health Care Information Act. Granting a motion for summary judgment, the trial court dismissed this claim. We reverse. Whether the trainer disclosed "health care information", and whether the disclosure met the "need to know" test, are factual issues warranting trial.

Since 1979 Doe has been a highly-placed employee at Group Health. Doe succeeded in his career despite having a bipolar disorder, a form of depression. Doe took steps to avoid having his mental health treatment history become known within Group Health because he feared it would stigmatize him among his fellow employees. He used an alias when receiving in-patient services at a Group Health hospital. He specially designated his medical file at Group Health as "confidential". He went outside of Group Health for some mental health services. He prohibited his therapist from sending detailed notes to Group Health without his permission. And he declined Group Health reimbursement for medications and laboratory work so that others within Group Health would not learn of his mental condition.

In 1991 an employee in Group Health's billing and claims administration department held a routine training session for at least four staff members from Group Health's mental health department. The purpose of the training program was to teach the trainees how to use the claim-processing system. The trainer devised an exercise that called for trainees to access specific patient information from the computer and to use that information to practice filling out a claim form. The trainer compiled a training manual for use at this particular session. For the manual the trainer selected the actual names and consumer numbers of several Group Health patients who had obtained mental health services from other providers. The trainer made an effort to exclude Group Health employees from the examples, but she inadvertently included Doe. His name and consumer number appeared in the training materials under the heading:

CLAIMS ADMINISTRATION TRAINING PROGRAM

Mental Health/King Street

HISTORY INQUIRY

Under Doe's name and consumer number was a full page of practice questions that the trainees were to answer regarding claim history once they had accessed Doe's computer file. Seeing Doe's name in the manual, one of the trainees exclaimed that her boss was included in the manual. The trainer then had the trainees remove and discard the objectionable pages without accessing Doe's patient information in the computer. One of the trainees later discussed the disclosure with someone, who told someone else, who told Doe.

Doe filed suit against Group Health alleging unauthorized disclosure of health care information in violation of RCW 70.02, the Uniform Health Care Information Act. Upon cross-motions for summary judgment, the court concluded that Group Health disclosed no "health care information" as defined by that statute, and dismissed the claim.

"HEALTH CARE INFORMATION"

The Uniform Health Care Information Act, enacted in this state in 1991, *fn1 regulates the disclosure of health care information. The Act allows a private right of action against health care providers who do not comply. *fn2

Doe claims that Group Health violated the Act's prohibition against disclosure of "health care information" without the patient's authorization:

Except as authorized in RCW 70.02.050, a health care provider, an individual who assists a health care provider in the delivery of health care, or an agent and employee of a health care provider may not disclose health care information about a patient to ...


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