Elizabeth Lawson v. Patricia Halpern-Reiss and Central Vermont Medical Center
2019 VT 38, 212 A.3d 1213 (2019)
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Rule of Law:
The Vermont Supreme Court recognized a common-law private right of action for damages against a medical provider for unjustified disclosure of patient information but held that such disclosures are protected if made in subjective good faith to prevent a serious and imminent threat to health or safety, with the burden on the plaintiff to rebut a presumption of good faith.
Facts:
- In the early morning hours of May 10, 2014, Elizabeth Lawson drove herself to the Central Vermont Medical Center (CVMC) emergency room after lacerating her arm.
- A CVMC charge nurse detected a heavy odor of alcohol on Lawson's breath and determined she had been drinking.
- Lawson underwent an alco-sensor test, which revealed a breath-alcohol concentration of .215.
- The charge nurse understood that Lawson did not have a ride home and intended to drive herself home after being discharged.
- Shortly before Lawson's discharge, the charge nurse informed an onsite police officer that Lawson was "blatantly intoxicated," had driven herself to the hospital, and was about to drive home.
- Following this information and communication with Lawson, the officer arrested her on suspicion of driving while intoxicated.
- The resulting criminal charge against Lawson was later dismissed by the prosecutor.
Procedural Posture:
- Elizabeth Lawson filed a complaint against the charge nurse and Central Vermont Medical Center (CVMC) in the Washington Unit, Civil Division of the Superior Court, alleging negligent disclosure of medical information and inadequate training/policies by CVMC.
- The charge nurse was dismissed from the case by stipulation of the parties.
- CVMC moved for summary judgment.
- The trial court granted summary judgment to CVMC, concluding there was no record basis to infer the nurse's disclosure was for any reason other than good-faith concern for public safety, and thus found no negligence.
- Lawson appealed the trial court's grant of summary judgment to the Supreme Court of Vermont.
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Issue:
Does Vermont common law recognize a private right of action for damages against a medical provider for the unjustified disclosure of patient information, and if so, was the disclosure in this case justified under an exception for preventing an imminent and serious threat to health or safety?
Opinions:
Majority - Eaton, J.
Yes, Vermont recognizes a common-law private right of action for damages arising from a medical provider’s unauthorized disclosure of patient information, but in this case, the disclosure was justified under the "serious and imminent threat" exception because Lawson failed to rebut the presumption of the nurse's good faith. The Court formally adopted a common-law private right of action for breach of a medical provider's duty of confidentiality, aligning Vermont with the majority of jurisdictions. It reasoned that while HIPAA does not create a private right of action, it does not preempt state common law claims and can "inform the standard of care" for such claims. The decision underscored that confidentiality is essential for patient trust and effective medical treatment, citing public policy evidenced in the Hippocratic Oath, physician licensing statutes, evidentiary privileges, and common law principles of trust. The Court noted various Vermont statutes that protect patient confidentiality (e.g., 18 V.S.A. § 1852, 12 V.S.A. § 1612, 18 V.S.A. § 1881) while also acknowledging statutes that compel disclosure in certain circumstances for public safety (e.g., communicable diseases, gunshot wounds). To define the limits of this duty, the Court integrated the HIPAA regulation 45 C.F.R. § 164.512(j), which permits disclosures made in good faith to prevent a "serious and imminent threat to the health or safety of a person or the public." Critically, the Court adopted a subjective good-faith standard for this exception, focusing on the medical provider's actual belief and intent rather than objective reasonableness. Under this standard, a covered entity is presumed to have acted in good faith (per 45 C.F.R. § 164.512(j)(4)), shifting the burden of production to the plaintiff to show otherwise. Applying this, the Court found that Lawson failed to offer any evidence to suggest the nurse had an ulterior motive beyond preventing Lawson from driving drunk and endangering herself and others. Even if the detail about Lawson driving to the hospital was arguably superfluous, it was not sufficient to rebut the presumption of subjective good faith without a proffer of improper motive.
Analysis:
This case represents a significant development in Vermont common law by formally recognizing a private right of action for breach of medical confidentiality, bringing the state into alignment with the majority of other jurisdictions. The Court's decision to incorporate HIPAA regulations as the "standard of care" provides a clear, nationally recognized framework for evaluating such claims, ensuring consistency for medical providers. By adopting a subjective good-faith standard for the "serious and imminent threat" exception, the Court strikes a balance between patient privacy and public safety, offering substantial protection to medical professionals making discretionary disclosures in urgent, high-stakes situations. This places a considerable burden on plaintiffs to demonstrate that a provider's motive for disclosure was not genuinely aimed at preventing harm, which could make it challenging for future plaintiffs to succeed if the provider's actions appear to fall within the ambit of public safety.
