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St. Luke Institute v. Jones: New Maryland Mental Health Discovery Opinion

Defense lawyers are often obsessed with getting the victim’s mental health records.  They rarely bear the juicy fruit they seek.  But this does not deter them.

In St. Luke Institute Inc. v. Jones (No. 62, Sept. Term 2019), the Maryland Court of Appeals laid out a step-by-step roadmap for when and how litigants can get confidential mental health records in civil discovery.

The process for getting confidential mental health records in civil discovery are now as follows:

  • File a motion to compel disclosure and requesting a court order under Code Ann., Health Gen. § 4-307(k)(1)(iv)
  • Movant must demonstrate a “need to inspect” by showing that the confidential records will yield useable, relevant evidence
  • If movant establishes “need to inspect,” the court should review confidential records in camera to confirm relevance
  • If relevancy is confirmed, court will enter order under Md. Rule 2-403(b) allowing disclosure of the records with appropriate privacy restrictions

Facts of St. Luke Institute v. Jones

In St. Luke Institute Inc. v. Jones, the Maryland Court of Appeals was tasked with defining the appropriate legal standard and process to apply when a party in a civil case seeks discovery of confidential mental health records. The issue arose in the context of a sexual abuse lawsuit filed in Massachusetts against the Catholic Archbishop of Boston (the “MA Lawsuit”). The plaintiffs in the MA Lawsuit alleged that they were sexually abused by a catholic priest, Brother Edward Holmes, when they were children living in a group home run by the church.

The MA Lawsuit asserted claims of negligent hiring and negligent supervision against the defendants. Specifically, the claims alleged that the defendants were aware that Brother Holmes was a sexual predator and did nothing to stop him. During discovery in the MA Lawsuit, the plaintiffs learned that in the early 1990s the defendants sent Brother Holmes (deceased since 2017) to St. Luke Institute (“SLI”) in Maryland for “psychotherapy” treatment.

SLI is a Catholic mental health treatment facility that specializes in treated troubled members of the Catholic clergy. Some of the documents produced in discovery indicated that SLI employees had done 2 separate psychiatric evaluation reports on Brother Holmes. Plaintiffs in the MA Lawsuits got a Commission and Letters Rogatory the court in Massachusetts and then initiated an action in the Circuit Court for Prince George’s County to get a subpoena for SLI’s mental health records on Brother Holmes.

SLI filed a motion to quash the subpoena on the grounds that the records were confidential and protected under Maryland’s Confidentiality Act (Md. Code Ann., Health Gen. §§ 4-301 et seq.). The plaintiffs responded with a cross-motion asking for a court order directing SLI to produce Brother Holmes’ records. The P.G. County Circuit Court granted this motion and directed SLI to produce the records.

SLI immediately appealed this decision to the Court of Special Appeals (the “COSA”). The COSA reversed the lower court’s decision for somewhat confusing reasons that we won’t bother to address. The Court of Appeals granted certiorari to weigh in on the topic.

Legal Analysis and Holding of St. Luke’s v. Jones

The Maryland Court of Appeals decision, in this case, began with a discussion of the Confidential Act. Maryland’s Confidentiality Act requires health care providers to keep medical records confidential and prohibits disclosure except as “provided by law” (e.g., in response to a subpoena). The Confidentiality Act provides an additional level of protection for mental health records. Mental health records can ONLY be produced in response to a court order and even then only the relevant portions of the records are fair game.

After outlining the parameters of the Confidentiality Act, the Court went on to discuss the relevant aspects of the Maryland discovery rules and applicable case law. Based on these various parts of Maryland law, the Court articulated a clear legal standard and step-by-step procedural process for when and how civil litigants can obtain confidential mental health records. Each of these steps is outlined below.

  • File a Motion to Compel

Under the Confidentiality Act, mental health records can ONLY be disclosed in response to a clear court order. Therefore, the court found that the first step in the process of obtaining mental health records is to file a motion to compel. The motion to compel should ask the court to enter an order specifically directing the health care provider to disclose the confidential records.

  • Establish a “Need to Inspect”

The party seeking disclosure of the records must establish a “need to inspect” by demonstrating to the court “a reasonable possibility” that the confidential records will yield relevant, useable evidence. The Court of Appeals explains that in evaluating whether there is a valid “need to inspect,” the trial court should consider:

The nature of the underlying litigation, the relationship between the records and any claim or defense, and the likelihood that review of the records would result in the discovery of relevant information.

citing Baltimore City Dept. of Soc. Servs. v. Stein, 328 Md. 1, 14 (1992)).

  • In Camera Review

If the moving party makes a sufficient “proffer of relevance” to establish a “need to inspect” the records, the next step requires the trial court to undertake its own in camera review of the confidential records. The purpose of this in camera review is for the court to confirm the “proffer of relevance.” In other words, the trial court is supposed to look through the records and determine their relevance to the claims and defenses in the case. The Maryalnd Court of Appeals explains that the goal of this in camera review is not to determine whether the records are admissible, but whether they could lead to useable, admissible evidence.

  • Order Allowing Discovery with Appropriate Limitations

If the trial court completes the in camera review and finds that the records are potentially relevant, it should enter an order authorizing disclosure along with a protective order under Md. Rule 2-403. The protective order should impose appropriate restrictions and limitations to protect the confidentiality of the mental health records. At a minimum, the conditions in the protective order must incorporate the rules prohibiting redisclosure in § 4-302(d) of the Confidentiality Act.

Notes and Comments on St. Luke’s v. Jones

I get it.  The plaintiff is often putting her mental health at issue when she argues that her depression/anxiety/mental pain and suffering were the result of the crash.

But there should be, and are, limits.  The need for those limits are compounded by many orders of magnitude in clergy sex abuse case.   The decision from the Maryland Court of Appeals is helpful. The court gives both litigants and circuit court judges some much-needed legal clarity on discovery requests for mental health records in civil cases.

First, the court establishes the substantive “need to inspect” standard for when litigants are entitled to discovery of mental health records. This is well articulated and easy to understand and apply. Moreover, the court lays out a clear procedural roadmap to handle and decide motions for discovery of confidential information.

  • Which states have expanded the statute of limitations in sex abuse cases
  • Pretty good law review article on the subject of discovery of mental health records.  On page 41, they look at sex abuse cases specifically. You have to remember there is a difference — or should be a difference – in the scope in criminal cases versus civil cases.
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