Disclosure of patient records approved in doctor discipline case

A ruling by the Missouri Court of Appeals Western District could offer some clarity to doctors who face requests over patient records during investigations by state licensing boards. 

The court’s Dec. 7 ruling involves the State Board of Registration for the Healing Arts’ attempt to discipline the medical license of Dr. John L. Putnam related to alleged improper care and treatment of five patients. Putnam objected when the board asked him to produce the medical records associated with those patients. 

The Western District said most of the information the board sought could be lawfully produced. Although both Missouri law and the federal Health Insurance Portability and Accountability Act, or HIPAA, generally require physicians to keep patient records private, the court said both make specific exceptions for license disciplinary proceedings. 

Putnam also pointed to a 1993 ruling, Brandt v. Medical Defense Associates, in which the Missouri Supreme Court said doctors who violate their fiduciary duty of confidentiality to their patients can be sued. 

However, the Western District said the Brandt opinion itself said that duty “must give way if there is a stronger countervailing societal interest,” such as the statutory exceptions for disciplinary proceedings. 

The Western District did say that a portion of what the board sought was protected as attorney work product and shouldn’t be disclosed. Some of the board’s interrogatories asked for “the substance” of statements from the relevant patients, which the court said aren’t patient records.

Putnam’s attorney, David F. Barrett, a Jefferson City-based attorney who specializes in professional licensing cases, said the opinion will help doctors and their attorneys know when they can produce records and when they can’t. The state’s discovery rules were primarily written before patient privacy laws became prevalent, and it was unclear, particularly to non-specialists, that doctors could produce them to professional licensing boards to justify their actions. 

“What I see a lot of time when general practitioners become involved in these cases initially, there’s sometimes a tendency to assume that the records should be produced, which isn’t always the right answer,” he said.

Lori Croy, a spokeswoman for the Missouri Department of Commerce & Insurance, declined to comment on the ruling. The board was represented in the appeal by Adam G. Grayson of Grayson & Grayson in Jefferson City.

The case is State ex rel. Putnam v. State Board of Registration for The Healing Arts, WD84394.