Tag: medical information

‘Vilified’ doctor cannot publish patient’s private information

Posted on | by Robin Hopkins
In the Matter of C (A Child) (Application by Dr X and Y) [2015] EWFC 79 involved, in the words of Munby J, an unusual and indeed unprecedented application. It pitted the right to defend one’s reputation against the privacy and confidentiality rights of others. In this case, the latter won.
Dr X had treated C and C’s mother; he had also been an expert witness in the family court care proceedings concerning C. C’s mother was unhappy about the treatment given by Dr X. She complained about him to the GMC, whose Fitness to Practise panel in due course found the allegations against Dr X to be unproven. C’s mother also criticised Dr X publicly in the media.
Dr X felt that his “otherwise unblemished reputation … has been cataclysmically damaged … through inaccurate reporting and internet postings” and that he has been “unfairly and unjustly pilloried by the mother and, through her, by the press” (his skeleton argument, cited at para 10 of Munby J’s judgment).
Dr X wanted to be able to put his side of the story, and to have the original source documents – from the family court proceedings and the Fitness to Practice proceedings – available, to quote from (while respecting anonymity) if his public statements were challenged. He sought disclosure of documents from those proceedings.
One difficulty he faced was that the law restricts the use to which documents from family proceedings could be put. The court had a discretion to allow disclosure, but generally subject to restrictions on the use to which documents could be put.
A further major difficulty was that he was bound by doctor-patient confidentiality, both as a matter of legal duty and professional confidentiality. That duty permits of exceptions – for example, to allow a doctor who is being unfairly vilified by a patient to defend himself – but even then any departure from confidentiality obligations must be proportionate.
The same applies to interference with patients’ privacy under Article 8 ECHR; privacy rights were particularly acute here, because what was sought (for disclosure, and for deployment in public statements) was “a mass of medical materials relating to the mother’s mental health” (Munby J at paragraph 42). Disclosure of those materials, even in redacted form, would have major implications for the privacy of the child, C.
Those difficulties were fatal to the application. Munby J said that “the remedy being sought by Dr X – permission to put the mother’s medical records and related documents into the public domain, at a time and in circumstances of his own choosing and without any of the safeguards usually imposed – is wholly disproportionate to anything which he can legitimately or reasonably demand”.
In relation to the documents filed in the Fitness to Practise proceedings but which were not part of the documentation filed in the care proceedings, the court had no jurisdiction to grant an application for disclosure. In any event, disclosure of the confidential material Dr X sought for deployment in the public domain would again be wholly disproportionate.
Heather Emmerson of 11KBW appeared for the GMC.​
Robin Hopkins @hopkinsrobin

Confidentiality of medical information after patient’s death: two new Upper Tribunal decisions

Posted on | by Robin Hopkins

The absolute exemption at section 41 extends to information obtained by the public authority the disclosure of which would give to an actionable breach of confidence. Does the obligation of confidence survive the death of the confider? If so, would a breach of that obligation be actionable, even if it is not clear exactly who could bring such an action? These issues arise most notably in the context of medical records. The Upper Tribunal has had something to say on this in two recent decisions.

In Webber v IC and Nottinghamshire Healthcare NHS Trust (GIA/4090/2012), the appellant had made a FOIA request for information (including hospital records) about the death of her son in 1999 when he was compulsorily resident at Rampton hospital. This was refused on section 41 grounds. The Commissioner upheld the refusal, as did the First-Tier Tribunal. In doing so, it somewhat unusually did not see the withheld information for itself, since it had not been asked to by anyone.

Mrs Webber’s appeal to the Upper Tribunal has also been dismissed. Judge Williams considered that the Tribunal could not be faulted for not differentiating between different categories of withheld information (which it obviously could not do, as it had not seen the information): “it is the task of the tribunal to decide the case before it unless it sees reason to investigate further” (paragraph 30).

He also confirmed the well-established principle that what matters under FOIA is information rather than documents: though the records were created by the NHS Trust, the information contained in those records came from the patient. In the section 41 context, “obtained” simply means “come to have”, which can be active or passive (paragraph 38).

Judge Williams confirmed a further touchstone of FOIA, namely that whatever the particular interests of the requester, this “remained an application to put the information into the public domain” (paragraph 37), that being the effect of disclosure under FOIA.

Disclosure would entail a breach of confidence which was actionable after the patient’s death, notwithstanding the argument that, in this case, the only person who could sue would be the personal representative (who was likely to have been the requester: thus it was submitted that she would in effect have been suing herself).

Judge Williams also found that there would not have been a public interest defence to the breach of confidence. Here he gave weight to the fact that some of the information sought would or could come into the public domain or be obtained in another way: a coroners’ inquest, or through an application under the Access to Health Records Act 1990 (now largely supplanted by FOIA, but not as regards deceased persons) which allows for requests for access to information to be made by (inter alia) patients’ personal representatives. Such an application was outside the Upper Tribunal’s jurisdiction but it was “relevant to note that it exists as a specific if limited remedy for some aspects of the application made for the appellant in this case” (see paragraphs 23-24).

In M v IC and Medicines and Health Products Regulatory Authority (GIA/3017/2010), Upper Tribunal Judge Lloyd-Davies allowed the requester’s appeal for information in a report held by the public information concerning a pharmaceutical trial of a drug developed by Pfizer. That information had again been withheld under section 41, with the Commissioner and First-Tier Tribunal agreeing – regardless of whether the participants in the trial were dead or alive at the time of the request.

The appeal was allowed because of a procedural error – the Tribunal had authorised more extensive redactions than were in fact being put to it.

The remitted hearing is to include questions of identifiability of patients in the context of anonymised drug trial data. The line of authorities on statistical information (Common Services Agency, Department of Health) will no doubt be considered.

The decision contained this obiter observation on actionable breaches of confidence in the case of deceased patients: “where the confidence arises in the context of a patient/healthcare professional relationship, I am minded to conclude that the obiter observations of Mr Justice Foskett in R (Lewis) v Secretary of State for Health [2008] EWHC 2196 (QB) are correct”.

I acted for the Commissioner in the M case; my colleague Joe Barrett acted for the appellant in Webber.

Robin Hopkins @hopkinsrobin