Author: Joseph L. Fink III, BSPharm, JD
A divorce proceeding in which a husband obtains his wife's prescription history from a pharmacy without her consent calls into question the nature of the pharmacist-patient relationship.
ISSUE OF THE CASE
When one spouse gains unauthorized access to the other’s medication profile information in a pharmacy’s database of patient records, may the individual whose records were unlawfully reviewed maintain a legal claim against the pharmacy?
FACTS OF THE CASE
During a contentious divorce battle between 2 physicians, the husband was somehow able to gain access to the wife’s medication records from a chain pharmacy database, and relayed that information to the court-appointed attorney who was representing the interests of the children in the matter. The trial court records did not report how this unauthorized access was achieved, and the parties to the subsequent lawsuit—the wife and pharmacy— had different views on the matter.
The pharmacy did not dispute that it disclosed the information in question, but did argue in court filings that the husband engaged in “unlawful acquisition” of his wife’s prescription profile. The wife argued that the pharmacy disclosed to her husband her “confidential mental health prescription records.” Under applicable law, the court regarded as true the allegation that the pharmacy had made the disclosure.
The records obtained by the husband, designated by the pharmacy as a “Confidential Patient Information Prescription Profile,” included prescription numbers, names and quantities of medications prescribed, initials of the pharmacist who dispensed the medication, the name of the prescriber, insurance plan information, dates of transaction, and price information. Based on the medication records, which indicated that the wife was being treated with sertraline hydrochloride (Zoloft) and clonazepam (Klonopin), the husband informed the attorney representing the interests of the children that, in his opinion, the wife had “serious psychiatric problems.” He also told the attorney that his wife had “a drug abuse problem” that had “too many similarities” to a recent case in the area where a woman married to a physician had murdered their 3 children while divorce proceedings were pending.
Despite these allegations by the husband, the trial court awarded custody of the children to the wife. The wife subsequently filed a claim against the pharmacy for releasing the records, arguing that her privacy rights under a state statute entitled the Mental Health and Developmental Disabilities Confidentiality Act were violated. The pharmacy chain moved for dismissal at the trial court level and that motion was granted. The wife appealed to the state Court of Appeals, alleging that an error had been made by the trial court judge in dismissing her claim.
THE COURT’S RULING
The appellate court affirmed the dismissal of the claim by the trial court judge.
THE COURT’S REASONING
The court reviewed the wording of the Mental Health and Developmental Disabilities Confidentiality Act, which directed that “all records…shall not be disclosed except as provided in this Act.” Looking further, the court found that the term “record” had been defined by the legislature for purposes of this statute as “any record kept by a therapist or by an agency in the course of providing mental health or developmental disability services to a recipient concerning the recipient and the services provided.”
The wife advanced the argument that regardless of whether the pharmacy chain is itself a “therapist” or “an agency,” the records it maintains are subject to the Act, which prohibits their disclosure. To address this, the court pointed out that the primary rule of statutory construction is to give effect to the intent of the legislature. Moreover, the statutory language must be given its plain and ordinary meaning.
The court focused on the stated goal of the legislation to “ensure the confidentiality of therapeutic relationships.” Consequently, the court ruled that the reach of the statute includes “only those persons entering into a therapeutic relationship with the clients.”
Citing an earlier case in which a pharmacist had obtained mental health treatment information from a patient and later, encountering her in a tavern, discussed it with her in front of others, the court concluded that the role of pharmacist and the nature of the pharmacist’s relationship with a patient is different from that of a therapist’s. The ruling in the earlier case had been that dispensing medication to a patient was not a “provision of mental health services” as used in the statute.
While this claim was dismissed, it should serve to remind pharmacists that all sources of patient medication information should be safeguarded to prohibit disclosure to unauthorized individuals, thereby forestalling legal entanglements. PT
Dr. Fink is professor of pharmacy law and policy at the University of Kentucky College of Pharmacy, Lexington.