Physician-Patient Privilege Outweighs Need for Testimony

New York State’s highest court on May 5 reaffirmed the physician-patient privilege in a child abuse case that drew the attention of APA and the New York State Psychiatric Association.

Although physicians by law must report a patient’s admission of child abuse to child protection authorities, the court ruled that the same statement cannot be admitted as evidence in a criminal trial because it is covered by the privilege.

“The decision represents a strong affirmation of the reason for physician-patient privilege: to encourage disclosure in the context of diagnosis and treatment,” former APA President Paul Appelbaum, M.D., the Dollard Professor of Psychiatry, Medicine, and Law at Columbia University College of Physicians and Surgeons, told Psychiatric News.

“Sometimes the real story is what didn’t happen, and I think that’s the case here,” he said. “This was a major threat to the integrity of the physician-patient privilege, and that threat was pushed aside by the New York Court of Appeals, which saw the state’s policy of protecting patient-physician communications as an important interest deserving protection.”

The defendant, David Rivera, sought treatment from a psychiatrist and told her that he had sexually abused an 11-year-old relative. Rivera was eventually charged with “predatory sexual assault against a child,” and at trial, prosecutors sought testimony from Rivera’s psychiatrist, who reported that the defendant admitted to the abuse. The defendant then denied committing the sexual abuse.

Rivera was convicted, but an appeals court reversed the decision on the grounds that the trial judge should not have permitted the psychiatrist’s testimony. The prosecution then appealed that ruling.

(The psychiatrist involved in the case was asked to comment on the proceedings but declined.)

The Court of Appeals held that while the state legislature had created exceptions to privilege, those laws narrowly addressed specific subjects and were not blanket exemptions.

“[I]t is one thing to allow the introduction of statements or admissions in child protection proceedings, whose aim is the protection of children, and quite another to allow the introduction of those same statements, through a defendant’s psychiatrist, at a criminal proceeding, where the People seek to punish the defendant and potentially deprive him of his liberty,” wrote Judge Eugene F. Pigott Jr., J.D., in the unanimous opinion.

The New York case is definitive for that state, but it does not set a precedent for other states.

The New York State Psychiatric Association filed an amicus curiae brief in support of Rivera’s appeal with input from APA’s Committee on Judicial Action. APA also provided some financial support for the preparation of the brief.

A contrary decision might have opened the door to any number of exceptions in psychiatry and in medicine in general, said Appelbaum. For instance, information routinely given to insurers relating to diagnosis, treatment, frequency of office visits, and more might have no expectation of privacy either.

The ruling should reassure psychiatrists and patients about the continued confidentiality of their discussions.

“Patients accused of child abuse can nevertheless participate in psychiatric treatment without worrying that what they reveal to their psychiatrist will be revealed in court,” said Appelbaum. “It is good public policy for these people to get treatment, and that would have been impeded by a contrary decision.” ■