FIG1 A Maryland court has
vindicated former APA President Harold Eist, M.D., in his suit against a state
Harold Eist, M.D.: "We have won a battle, but the war
Courtesy of Harold Eist, M.D.
The suit centered on the state board's right to obtain the medical records
of a mother and her children whom Eist was treating and its punishment of him
for not complying with its demand in what it determined was an appropriate
On March 7 Judge Durke Thompson of Montgomery County (Md.) Circuit Court
ordered the reprimand of Eist levied by the Maryland Board of Physicians
rescinded and all charges dismissed.
This was the third time a court ruled in Eist's favor in the four years
since the actions that prompted the case began to unfold (Psychiatric
News, November 4, 2005; April 18, 2003).
The judge said he wondered if the physician board's unfair actions against
the psychiatrist signified that they were "out to get Dr. Eist."
The board pursued the sanctions because, it claimed, Eist did not cooperate in
an investigation of charges filed against him with the board.
The charges, which involved failure to meet the standard of care, were
filed by the husband in a couple mired in a bitter divorce and child-custody
proceeding. After the filing, the board demanded that Eist, who was treating
the wife and her two children, turn over her treatment records and those of
the children, so they could investigate the husband's charges that his wife
and children were being overmedicated by Eist. Both the wife and the
children's legal representative in the proceedings would not agree to do so.
Without their permission, Eist maintained that complying with the board's
demand to have their records forwarded posed a serious ethical dilemma for
Eist asked for the physician board's guidance on how he should proceed in
light of his ethical concerns about complying with its demand, but seven
months later its only response was to impose sanctions.
The board fined Eist $5,000 for noncompliance and issued a reprimand.
Eist eventually released the records to the board after the wife and the
children's legal representative withdrew their opposition. In 2003 an
administrative law judge ruled in Eist's favor regarding the initial
reluctance to breach patient confidentiality and issued a strong rebuke to the
board over its actions and refusal to drop its pursuit of the case.
The Montgomery County Circuit Court then got the case and upheld the ruling
of the administrative law judge, but again the board would not drop it. Eist
appealed the board's refusal to cancel the sanctions to that court, and last
month learned that his appeal had succeeded, with the judge emphasizing the
importance of confidentiality in psychiatric treatment.
Eist's lawyer, Alfred Belcuore, said he was "delighted that Judge
Thompson saw the case for what it has been—an effort to overcome the
privacy that patients deserve if their mental health care is to be
effective." The judge sent the unambiguous message, he added, that the
Maryland board "exceeded its authority in prosecuting Dr. Eist."
He noted that despite the "unequivocal" nature of the judge's
ruling against the board, it may still appeal the decision.
Tom Keech, the general counsel for the physician board, told
Psychiatric News in mid March that the board had not met since
Thompson's decision and thus had not made a decision about whether to appeal.
The system the judge expects the board to follow in handling investigations of
complaints against physicians, Keech said, is "unworkable."
Eist's case has also had an impact on Maryland legislators. In February the
state Senate passed a bill (SB 142) that stemmed from the case and specifies
when a physician or other provider must disclose certain patient records
without authorization to the state medical board. In cases in which a third
party files a complaint that requires access to medical records, it would give
the patient 30 days in which to go to court to try to have the subpoena for
medical records quashed. Only if the court disagreed with the patient's
request would the treating physician have to turn over the records. The bill
was introduced by three state senators after discussions with representatives
of the Washington Psychiatric Society. At press time, the bill, which is also
being supported by the Maryland Psychiatric Society and Maryland State Medical
Society, was before the House Health and Government Affairs Committee.
In an e-mail to his supporters soon after the March ruling, Eist, who spent
approximately $300,000 of his own money in the case, said that "fighting
for and preserving our ethics is hard and costly but is something we must do..
.if we are to provide the high-quality care patients deserve and require. We
have won a battle, but the war continues." ▪