Doe v. Guthrie Clinic, CoA

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    =================================================================Thi s opi ni on i s uncor r ect ed and subj ect t o r evi si on bef or epubl i cat i on i n the New Yor k Repor t s.- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -No. 224J ohn Doe, Appel l ant , v.Gut hr i e Cl i ni c, Lt d. , et al . , Respondent s.

    T. Andr ew Brown, f or appel l ant .Mar t ha B. St ol l ey, f or r espondent s.

    PI GOTT, J . :

    The Uni t ed St at es Cour t of Appeal s f or t he Second

    Ci r cui t has cer t i f i ed t he f ol l owi ng quest i on f or our

    consi derat i on: "Whether , under New Yor k l aw, t he common l aw

    r i ght of act i on f or br each of t he f i duci ar y dut y of

    conf i dent i al i t y f or t he unaut hor i zed di scl osur e of medi cal

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    i nf or mat i on may r un di r ect l y agai nst medi cal cor por at i ons, even

    when t he empl oyee r esponsi bl e f or t he br each i s not a physi ci an

    and act s outsi de t he scope of her empl oyment ?" We answer t he

    quest i on i n t he negat i ve.

    On J ul y 1, 2010, " J ohn Doe" was bei ng t r eated f or a

    sexual l y t r ansmi t t ed di sease ( STD) at t he Gut hr i e Cl i ni c St euben,

    a pr i vat e medi cal f aci l i t y. A nur se empl oyed by t he Cl i ni c

    r ecogni zed Doe as t he boyf r i end of her s i st er - i n- l aw. The nur se

    accessed Doe' s medi cal r ecor ds and l ear ned t hat he was bei ng

    t r eat ed f or t he STD. Whi l e Doe was st i l l awai t i ng t r eat ment , she

    sent t ext messages t o her si st er - i n- l aw i nf or mi ng her of Doe' s

    condi t i on. The si st er - i n- l aw i mmedi at el y f or war ded t he messages

    t o Doe; accor di ng t o Doe, t he messages suggest ed t hat st af f

    member s were maki ng f un of hi s medi cal condi t i on.

    Fi ve days af t er hi s vi si t t o t he Cl i ni c, Doe cal l ed t o

    compl ai n of t he nur se' s behavi or . He met wi t h an admi ni st r ator

    of t he Cl i ni c, and t he nur se was f i r ed. Ther eaf t er , t he

    Pr esi dent and CEO of Gut hr i e Cl i ni c, Lt d. sent a l et t er t o Doe

    conf i r mi ng t hat t her e had been an unaut hor i zed di scl osur e of

    Doe' s conf i dent i al heal t h i nf or mat i on, t hat appr opr i at e

    di sci pl i nar y act i ons had been car r i ed out , and t hat st eps had

    been t aken t o pr event such a br each f r om occur r i ng i n t he f ut ur e.

    Doe subsequent l y f i l ed t hi s act i on i n f eder al cour t

    agai nst def endant s, var i ous af f i l i at ed ent i t i es t hat al l egedl y

    "owned, possessed, oper at ed, st af f ed and/ or ot her wi se cont r ol l ed"

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    t he cl i ni c. I n hi s compl ai nt , Doe asser t ed ei ght causes of

    act i on: ( 1) common l aw br each of f i duci ar y dut y t o mai nt ai n t he

    conf i dent i al i t y of per sonal heal t h i nf or mat i on, ( 2) br each of

    cont r act, ( 3) negl i gent hi r i ng, t r ai ni ng, r et ent i on and/ or

    super vi si on of empl oyees, ( 4) negl i gent i nf l i ct i on of emot i onal

    di str ess, ( 5) i nt ent i onal i nf l i ct i on of emot i onal di str ess, ( 6)

    br each of dut y to mai nt ai n t he conf i dent i al i t y of per sonal heal t h

    i nf ormat i on under New Yor k CPLR 4504, ( 7) br each of dut y t o

    mai nt ai n t he conf i dent i al i t y of per sonal heal t h i nf or mat i on under

    New Yor k Publ i c Heal t h Law 4410, and ( 8) br each of dut y t o

    mai nt ai n t he conf i dent i al i t y of per sonal heal t h i nf or mat i on under

    New Yor k Publ i c Heal t h Law 2803c.

    The Uni t ed St at es Di st r i ct Cour t f or t he West er n

    Di st r i ct of New Yor k gr ant ed t he def endant s' mot i on t o di smi ss

    al l ei ght cl ai ms ( 2012 WL 531026, 2012 US Di st LEXI S 20507 [ US

    Di st Ct , WD NY Febr uary 17, 2012] ) .

    Doe appeal ed t he di smi ssal of t he f i r st f i ve of t he

    ei ght causes of act i on. The Uni t ed St at es Cour t of Appeal s f or

    t he Second Ci r cui t af f i r med t he di smi ssal of f our of t he

    r emai ni ng f i ve causes of act i on, r eser vi ng deci si on on hi s cl ai m

    of br each of f i duci ar y dut y, whi ch i s t he onl y subj ect of t hi s

    cer t i f i ed quest i on ( 519 Fed Appx 719 [ 2d Ci r 2013] ) .

    I n a separ at e opi ni on ( 710 F3d 492 [ 2d Ci r 2013] ) , t he

    Second Ci r cui t f ound t hat t he nur se' s act i ons wer e not

    f or eseeabl e t o def endant s, nor wer e her act i ons t aken wi t hi n t he

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    scope of her empl oyment ( i d. at 495) . The cour t expl ai ned t hat

    i n hi s compl ai nt Doe hi msel f al l eged t hat t he nur se was mot i vat ed

    by pur el y per sonal r easons and " t hose r easons had ' nothi ng t o do

    wi t h [ Doe' s] t r eat ment and car e' " ( i d. , ci t i ng Doe compl ai nt at

    25) . "As such, " t he cour t hel d, t he nur se' s "act i ons cannot be

    i mput ed t o t he def endant s on t he basi s of respondeat superior"

    ( i d. at 496) . The cour t cer t i f i ed t he quest i on t o t hi s Cour t ,

    however , whet her Doe may asser t a speci f i c and l egal l y di st i nct

    cause of act i on agai nst def endant , f or br each of t he f i duci ar y

    dut y of conf i dent i al i t y, even when respondeat superior l i abi l i t y

    i s absent ( i d. at 498) .

    Gener al l y, a hospi t al or medi cal cor por at i on may be

    hel d vi car i ousl y l i abl e f or t he wr ongf ul act s of i t s empl oyees

    ( see e. g. Hi l l v St . Cl ar e' s Hospi t al , 67 NY2d 72, 79 [ 1986] ) .

    However , " [ u] nder t he doct r i ne of r espondeat super i or , an

    empl oyer may be vi car i ousl y l i abl e f or t he t or t i ous act s of i t s

    empl oyees onl y i f t hose act s wer e commi t t ed i n f ur t her ance of t he

    empl oyer ' s busi ness and wi t hi n t he scope of empl oyment " ( N. X. v

    Cabr i ni Medi cal Cent er , 97 NY2d 247, 252- 253 [ 2002] ) . Thus, a

    medi cal cor por at i on i s gener al l y not l i abl e f or a t or t of an

    empl oyee when such an act i on i s not wi t hi n t he scope of

    empl oyment .

    We have, i n ot her ci r cumst ances, decl i ned to hol d a

    medi cal corporat i on t o a "hei ght ened dut y" f or an empl oyee' s

    mi sconduct . For i nst ance, i n N. X. v Cabr i ni Med. Ct r . , wher e a

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    physi ci an empl oyed by t he def endant hospi t al commi t t ed a sexual

    assaul t on a sedat ed pat i ent , t hi s Cour t r ej ect ed t he at t empt t o

    hol d t he hospi t al st r i ct l y l i abl e. We decl i ned t o r ecogni ze a

    hei ght ened dut y on t he par t of t he hospi t al , expl ai ni ng:

    "A hospi t al has a dut y to saf eguar d t hewel f ar e of i t s pat i ent s, even f r om har mi nf l i ct ed by thi r d per sons, measur ed by thecapaci t y of t he pat i ent t o pr ovi de f or hi s orher own saf et y . . . . Thi s sl i di ng scal e ofdut y i s l i mi t ed, however ; i t does not r endera hospi t al an i nsur er of pat i ent saf et y orr equi r e i t t o keep each pat i ent underconst ant sur vei l l ance . . . . As wi t h any

    l i abi l i t y i n t or t , t he scope of a hospi t al ' sdut y i s ci r cumscr i bed by t hose r i sks whi char e reasonabl y f or eseeabl e" ( i d. at 252253) .

    Si nce t he sexual assaul t commi t t ed by t he hospi t al empl oyee was

    "not i n f ur t her ance of hospi t al busi ness" and was " a cl ear

    depar t ur e f r om t he scope of empl oyment , havi ng been commi t t ed f or

    whol l y per sonal mot i ves, " we concl uded t hat t he hospi t al coul d

    not be hel d vi car i ousl y l i abl e.

    Her e, Doe ur ges us t o i mpose absol ut e l i abi l i t y on t he

    medi cal cor por at i on f or an empl oyee' s di ssemi nat i on of a

    pat i ent ' s conf i dent i al medi cal i nf or mat i on. We decl i ne t o do so,

    and, t o t he ext ent t hat t hi s r at i onal e may have been empl oyed i n

    Doe v Communi t y Heal t h Pl an- Kai ser Cor p. ( 268 AD2d 183 [ 3d Dept

    2000] ) , we r ej ect t hat deci si on. For t he same r easons st at ed i n

    Cabr i ni , a medi cal cor por at i on' s dut y of saf ekeepi ng a pat i ent ' s

    conf i dent i al medi cal i nf or mat i on i s l i mi t ed t o t hose r i sks t hat

    ar e reasonabl y f or eseeabl e and t o act i ons wi t hi n the scope of

    empl oyment .

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    The di ssent , i n accept i ng Doe' s ar gument woul d i mpose

    str i ct l i abi l i t y on medi cal cor por at i ons f or any di scl osur e by an

    empl oyee, an appr oach t hat i s unnecessary and agai nst pr ecedent .1

    I n cases wher e an i nj ur ed pl ai nt i f f ' s cause of act i on f ai l s

    because t he empl oyee i s act i ng out si de t he scope of empl oyment , a

    di r ect cause of act i on agai nst t he medi cal cor por at i on f or i t s

    own conduct , be i t negl i gent hi r i ng, super vi si on or ot her

    negl i gence may st i l l be mai nt ai ned ( see J udi t h M. v Si st er s of

    Char i t y Hosp. , 93 NY2d 932, 934 [ 1999] ) . A medi cal corporat i on

    may al so be l i abl e i n t or t f or f ai l i ng t o est abl i sh adequat e

    pol i ci es and pr ocedur es t o saf eguar d t he conf i dent i al i t y of

    pat i ent i nf or mat i on or t o t r ai n t hei r empl oyees t o pr oper l y

    di schar ge t hei r dut i es under t hose pol i ci es and pr ocedur es.

    These pot ent i al cl ai ms provi de t he r equi si t e i ncent i ve f or

    medi cal pr ovi der s t o put i n pl ace appr opr i at e saf eguar ds t o

    1 Subj ect i ng hospi t al s and ot her heal t h car e ent i t i es t ost r i ct l i abi l i t y f or t he act s of an empl oyee t hat wer e not onl yunaut hor i zed, but mot i vat ed ent i r el y by per sonal r easons i scont r ar y t o wel l - est abl i shed pr ecedent ( see N. X. v Cabr i niMedi cal Cent er , 97 NY2d 247, 252- 253 [2002] ; Cornel l v St ate ofNew Yor k, 46 NY2d 1032 [ 1979] ) . Whi l e t he di ssent f i nds ourhol di ng t oo "nar r ow" ( see di ssent i ng op at 1) , t he di ssent ' sr easoni ng i s f l awed f or t he opposi t e r eason; i t i s t oo br oad. I ft he di ssent ' s vi ew i s t aken t o i t s l ogi cal concl usi on, a medi cal

    pr ovi der may be hel d l i abl e i n negl i gence f or any i nadver t entdi scl osur e by an empl oyee. As an exampl e, i f a r ecept i oni st of apr i vat e physi ci an di scl oses at a cockt ai l par t y t hat a pat i entwas i n t o see t he doct or f or a par t i cul ar ai l ment , per hapsunbeknownst t o t he pat i ent ' s f ami l y because he di d not want t owor r y t hem, under t he di ssent ' s r ul e, t he medi cal cor por at i onwoul d be requi r ed t o respond i n damages f or t hat di scl osur e.

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    ensur e pr ot ect i on of a pat i ent ' s conf i dent i al i nf or mat i on. Those

    causes of act i on i n t he pr esent case have al r eady been r esol ved

    by t he f ederal cour t s and we theref ore do not address t hem.

    Accor di ngl y, t he cer t i f i ed quest i on shoul d be answer ed

    i n t he negat i ve.

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    Doe v Gut hr i e Cl i ni c, Ltd. , et al .

    No. 224

    RI VERA, J . ( di ssent i ng) :

    Pat i ent s, who have l i t t l e say i n t he mat t er , di scl ose

    t hei r per sonal i nf or mat i on t o medi cal cor por at i ons t r ust i ng t hat

    i t wi l l be kept pr i vat e. I n answer i ng t he cer t i f i ed quest i on i n

    t he negat i ve, t he maj or i t y l i mi t s a pat i ent ' s r emedy even i n

    cases wher e a cor por at i on has f ai l ed i n i t s dut y to pr ot ect

    conf i dent i al i nf or mat i on. I bel i eve t hat a medi cal cor por at i on' s

    dut y ext ends beyond an empl oyee' s conduct wi t hi n the scope of

    empl oyment , and I woul d answer t he cer t i f i ed quest i on i n t he

    af f i r mat i ve.

    The maj or i t y' s nar r ow concept i on of a medi cal

    cor por at i on' s dut y under mi nes New Yor k' s publ i c pol i cy t o pr ot ect

    t he conf i dent i al i t y of pat i ent s' medi cal r ecor ds ( see Publ i c

    Heal t h Law 2803- c [ 1] [ 3] [ f ] ) . The ease wi t h whi ch

    conf i dent i al pat i ent i nf or mat i on can now spr ead t hr ough per sonal

    di gi t al devi ces and acr oss soci al net wor ks demands a st r ong l egal

    r egi me t o pr ot ect a pat i ent ' s conf i dent i al i t y. A cause of act i on

    di r ect l y agai nst a medi cal cor por at i on, unhamper ed by quest i ons

    as t o whet her an empl oyee' s conduct occur r ed wi t hi n the scope of

    empl oyment , ensur es t he f ul l est pr ot ect i ons f or pat i ent s and best

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    addr esses t he cur r ent r eal i t i es of medi cal ser vi ce del i ver y.

    Compr ehensi ve medi cal r ecords are cr uci al t o ensur i ng

    pr oper medi cal car e. Medi cal pr ovi der s, i ncl udi ng cor por at e

    medi cal pr ovi der s, r equi r e pr i vat e medi cal dat a f r om pat i ent s t o

    ensur e pr oper t r eat ment . A pat i ent r eveal s per sonal dat a f or

    pur poses of r ecei vi ng medi cal servi ces, wi t h t he under st andi ng

    t hat t he pat i ent r et ai ns a r i ght t o conf i dent i al i t y i n such

    i nf or mat i on. Technol ogi cal advances have made i t possi bl e t o

    col l ect and house pat i ent dat a i n ways easi l y accessi bl e t o a

    pat i ent ' s doct or and ot her heal t h car e pr ovi der s t af f . Comput er s

    and cel l ul ar devi ces have t r ansf ormed medi cal r ecord keepi ng and

    heal t h car e servi ce pr ovi si on, maki ng access t o such dat a f ast

    and easy. Whi l e such access surel y benef i t s bot h t he pat i ent and

    t he pr ovi der , i t al so i ncreases t he pot ent i al f or i nst ant aneous

    and ext ensi ve unaut hor i zed di scl osur e of conf i dent i al pat i ent

    i nf or mat i on by a r ange of st af f per sonnel . Soci et al i nt er est i n

    mai nt ai ni ng pat i ent pr i vacy i n medi cal r ecor ds i s ser ved t hr ough

    a robust t or t syst em, r esponsi ve t o the r eal i t i es of t he ease of

    di scl osur e.

    I n some ci r cumst ances, we have l i mi t ed a medi cal

    cor por at i on' s l i abi l i t y f or t he negl i gence of i t s empl oyees under

    a theor y of r espondeat super i or ( see, e. g. , N. X. v Cabr i ni Med.

    Ct r . , 97 NY2d 247, 251- 252 [ 2002] ; J udi t h M. v Si st er s of Char i t y

    Hosp. , 93 NY2d 932, 933- 934 [ 1999] ; Hi l l v St . Cl ar e' s Hospi t al ,

    67 NY2d 72, 79 [ 1986] ; Suar ez v Bakal chuk, 66 AD3d 419, 419 [ 1st

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    Dept 2009] ; Doe v West f al l Heal t h Care Ct r . , 303 AD3d 102, 110

    [ 4t h Dept 2002] . See al so maj or i t y op, at 3- 4) . Respondeat

    super i or i s a t heory of vi car i ous l i abi l i t y t hat or i gi nal l y

    devel oped under t he assumpt i on t hat a mast er coul d cont r ol t he

    conduct of an agent ( see Mot t v Consumers' I ce Co. , 73 NY 543,

    546- 547 [ 1878] ; Rest at ement [ Second] of Agency 219, Comment a) .

    The moder n t heor y of r espondeat super i or gi ves t he i nj ured

    pl ai nt i f f a means t o r ecover a r emedy f r om wel l - i nsur ed empl oyer s

    and pr ovi des i ncent i ves f or empl oyer s t o hi r e car ef ul empl oyees

    ( see Ri vi el l o v Wal dr on, 47 NY2d 297, 302 [ 1979] ; Rest at ement

    [ Thi r d] of Agency 2. 04, Comment a) . Nonet hel ess, t he l aw l i mi t s

    t he empl oyer ' s l i abi l i t y t o act s "done whi l e t he ser vant was

    doi ng hi s mast er ' s wor k, no mat t er how i r r egul ar l y, or wi t h what

    di sr egar d f or i nst r uct i ons": act s done wi t hi n t he scope of

    empl oyment ( Ri vi el l o, 47 NY2d at 302 [ ci t at i ons omi t t ed] ) . Thi s

    l i mi t at i on r el i eves an empl oyer f r om l i abi l i t y f or an empl oyee' s

    t or t s when t he empl oyer nei t her benef i t s f r om t he t or t i ous

    conduct nor has t he means t o cont r ol t he empl oyee' s behavi or .

    Such l i mi t at i ons have no pl ace i n a negl i gence act i on

    agai nst a medi cal cor por at i on f or di scl osur e of conf i dent i al

    medi cal r ecor ds. As t he maj or i t y not es, i t i s t he medi cal

    cor por at i on i t sel f , not mer el y i t s empl oyees, whi ch owes t he dut y

    of conf i dent i al i t y t o t he pat i ent ( see maj or i t y op, at 5) . New

    Yor k' s publ i c pol i cy woul d be f ur t hered by permi t t i ng a cause of

    act i on f or br each of medi cal conf i dent i al i t y, even i n cases wher e

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    an empl oyee has act ed out si de the scope of empl oyment , because

    pat i ent s must r eveal medi cal dat a i n or der t o obt ai n car e f r om

    t he medi cal cor por at i on and t he pat i ent has no way of pr ot ect i ng

    agai nst i t s unaut hor i zed di scl osur e or means of cont r ol l i ng who

    has access t o i t . 1

    Our deci si on i n N. X. v. Cabr i ni Med. Ct r . ( 97 NY2d 247

    [ 2002] ) r ecogni zed t hat a hospi t al owes a dut y t o keep pat i ent s

    saf e, even f r om t hi r d par t i es and empl oyees act i ng out si de t he

    scope of empl oyment . I n t hat case, a sur gi cal r esi dent sexual l y

    assaul t ed t he pl ai nt i f f ( i d. at 249) . We hel d t hat t he hospi t al

    coul d not be hel d vi car i ousl y l i abl e f or t he r esi dent ' s

    wr ongdoi ng because he was act i ng out si de the scope of hi s

    empl oyment ( i d. at 251- 252) . However , t hat di d not end t he

    i nqui r y. We al so hel d t hat " [ a] hospi t al has a dut y t o saf eguar d

    t he wel f ar e of i t s pat i ent s, even f r om har m i nf l i cted by t hi r d

    per sons measur ed by the capaci t y of t he pat i ent t o pr ovi de f or

    hi s or her own saf et y" ( i d. at 252) and l i mi t ed "by t hose r i sks

    1 The maj or i t y bel i eves t hat cl ai ms based on vi car i ousl i abi l i t y and soundi ng i n negl i gence l i mi t ed t o conduct wi t hi nt he scope of empl oyment pr ovi de suf f i ci ent r el i ef f or a pat i entwhose pr i vat e i nf or mat i on i s wr ongf ul l y di scl osed ( maj or i t y op,at 6) . As t he i nst ant case wel l i l l ust r at es, t hose causes ofact i on al one ar e i nadequate t o remedy a br each of t he dut y t omai nt ai n t he conf i dent i al i t y of per sonal dat a, and t hey pr ovi de

    col d comf or t t o a pat i ent whose per sonal dat a i s di scl osed due t ot he st at us of t he empl oyee and r egar dl ess of t he act i ons of t heempl oyer t hat f aci l i t at ed di scl osur e. Our l egal syst em must ber esponsi ve t o a heal t h car e ser vi ce syst em wi t h i t s at t endantcompr ehensi ve dat a col l ect i on, suppor t ed by t echnol ogi caladvances t hat are vul ner abl e t o access .

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    whi ch ar e r easonabl y f or eseeabl e" ( i d. at 253) . I n Cabr i ni , t he

    hospi t al had an i ndependent dut y t o pr event t he empl oyee who

    acted out si de t he scope of hi s empl oyment f r om harmi ng t he

    pl ai nt i f f . Thus, t he hospi t al coul d be l i abl e f or t he br each of

    i t s dut y t hr ough t he i nact i on of i t s nur si ng st af f i n t he f ace of

    obvi ous r i sks ( see i d. at 253- 254) . When a pat i ent l ays hel pl ess

    i n a hospi t al bed, ent r ust i ng hi s or her car e t o t he hospi t al ,

    t he hospi t al has an i ndependent dut y to ensur e hi s or her saf et y.

    Si mi l ar l y, a pat i ent ent r ust s pr i vat e medi cal

    i nf or mat i on t o t he car e of t he medi cal cor por at i on and i t s

    empl oyees, over whom t he pat i ent has no cont r ol . The pat i ent ' s

    onl y sur ef i r e means t o pr event acci dent al di scl osure woul d be t o

    f or ego t ur ni ng over t he conf i dent i al i nf or mat i on i n t he f i r st

    pl ace. Thi s i s not a r eal i st i c opt i on because a pat i ent cannot

    expect del i ver y of medi cal ser vi ces wi t hout di scl osi ng such dat a.

    I ndeed, t he medi cal pr of essi on encour ages f ul l di scl osur e by the

    pat i ent of a comprehensi ve medi cal hi st ory ( see AMA Code of Med

    Et hi cs Op. 10. 02 [ 2] ) . I n or der t o r ecei ve t r eat ment , a pat i ent

    must r eveal per sonal i nf or mat i on; a pat i ent wi t hhol ds such dat a

    at hi s or her per i l . Havi ng t ur ned over pr i vat e i nf or mat i on t o

    ensure pr oper and adequate t r eatment , t he pat i ent i s at t he mer cy

    of t he medi cal cor por at i on' s abi l i t y t o pr ot ect i t s

    conf i dent i al i t y. A hospi t al shoul d owe a dut y t o keep a

    pat i ent ' s heal t h i nf or mat i on conf i dent i al , and a hospi t al shoul d

    be di r ect l y l i abl e f or i t s own f ai l ur e t o pr event br eaches of

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    conf i dent i al i t y by empl oyees who act out si de t he scope of t hei r

    empl oyment .

    I n or der t o pr ot ect t he pat i ent ' s pr i vacy i nt er est s

    gi ven t he compet i ng need t o di scl ose, such a cause of act i on

    woul d pr ovi de a power f ul i ncent i ve t o medi cal cor por at i ons t o

    i mpl ement pr ot ect i ons agai nst di scl osur es. Gi ven t he hi ghl y

    per sonal nat ur e of medi cal dat a at r i sk of di scl osur e, t he har m

    associ at ed wi t h di ssemi nat i on of such sensi t i ve pr i vat e

    i nf ormat i on, t he ease wi t h whi ch empl oyees of a medi cal

    cor por at i on may access conf i dent i al dat a di ssemi nat e i t t hr ough

    t he use of a commonl y hel d and i nexpensi ve devi ce, a cel l ul ar

    t el ephone, and t he i nabi l i t y of pat i ent s t o pr ot ect t hemsel ves

    f r om empl oyee mi sconduct , such an i ncent i ve f ur t her s t he St at e' s

    publ i c pol i cy i n pr ot ect i ng t he conf i dent i al i t y of medi cal

    r ecor ds.

    The cer t i f i ed quest i on shoul d be answer ed i n t he

    af f i r mat i ve.

    * * * * * * * * * * * * * * * * *

    Fol l owi ng cer t i f i cat i on of a quest i on by t he Uni t ed St at es Cour tof Appeal s f or t he Second Ci r cui t and accept ance of t he quest i onby t hi s Cour t pur suant t o sect i on 500. 27 of t hi s Cour t ' s Rul es ofPr act i ce, and af t er hear i ng ar gument by counsel f or t he par t i esand consi der at i on of t he br i ef s and r ecor d submi t t ed, cer t i f i edquest i on answer ed i n t he negat i ve. Opi ni on by J udge Pi got t .Chi ef J udge Li ppman and J udges Gr af f eo, Read, Smi t h and Abdus-

    Sal aam concur . J udge Ri ver a di ssent s and vot es t o answer t hecer t i f i ed quest i on i n t he af f i r mat i ve i n an opi ni on.

    Deci ded J anuary 9, 2014

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