Are There Any Restrictions on the Info that Must Be Produced in a Medical Report in an Auto Accident Case?

Are There Any Restrictions on the Info that Must Be Produced in a Medical Report in an Auto Accident Case?

In companion appeals arising out of a discovery dispute in a personal injury case, two non-parties, an orthopedic medical practice and its claims manager, challenged the trial court’s order compelling them to produce an expansive database report and other documents to the defendants.

Background

An injured motorist sued a trucking company and its insurance company for damages stemming from an automobile accident. As part of her damages, the plaintiff sought to recover her past and future medical expenses, and she relied on medical treatment and bills she received from different providers, including an orthopedic medical practice (the “physicians”). Her medical bills for treatment she received from the physicians was about $18,000.

The defendants served the physicians and its claims manager with requests for production of records and database materials. Pertinent to those requests, the physicians and its claims manager used two software databases: eClinicalWorks, which was a medical billing and records software program, and Salesforce, which included information about law firms associated with a patient. Among other materials, the defendants sought the following:

  1. Communications between the physicians, the plaintiff’s attorneys, and any litigation funding companies involved in the case, including communications logged into eClinicalWorks and/or Salesforce;
  2. All applicable contracts between the physicians, the plaintiff, her attorneys, and any litigation funding companies involved in the case;
  3. HIPAA audit logs reflecting who’d accessed the plaintiff’s medical files and any changes made to those files; and
  4. A database report revealing the physicians /the claims manager’s billed charges or rates, as well as any adjustments made to those rates charges or rates, “categorized by associated law firm referral partner.

Additionally, the defendants requested that the physicians and/or its claims manager generate an eClinicalWorks Report entitled, “Financial Analysis at CPT Level (with Everything),” which was a spreadsheet that would list, for every physicians patient:

  • The amount billed for each visit or procedure at every physician’s location, categorized by CPT (Current Procedural Terminology ) code;
  • The amount written-off, adjusted, or accepted in satisfaction for each bill;
  • The payor of each bill; and
  • Information about who referred each patient to the physicians (the “Database Report” or “Report”).

The defendants requested that the Report include information for the past three years, and further advised that all “HIPAA-protected personal identifying information,” such as patient names and addresses, could be redacted.

When the physicians and the claims manager failed to produce all of the requested materials, including the Database Report, the defendants filed a motion to compel their production. The defendants argued that the Report was discoverable because it would reveal data as to the reasonableness and necessity of the physicians’ medical bills issued for the plaintiff’s treatment and would show information pertaining to the scope of its relationship with personal injury law firms generally and the plaintiff’s attorneys in particular. This, the physicians claimed, would be relevant to issues of bias, intent, and motive. The defendants specified that the names of any patients and other personal identifying information should be redacted from the Database Report, and the instructions provided by a software program expert explained how to generate a report with that information blacked out.

In addition, the defendants submitted a sealed brief and two sealed exhibits to the trial court as part of their motion to compel. These were attorney referral ledgers created by clinics that allegedly were analogous to the physicians and that the defendants contended could serve as examples of the type of information that was sought in this case. The defendants also argued that the ledgers showed that the plaintiff’s attorneys had extensive referral relationships with other, similar Atlanta physicians clinics.

The physicians filed a response in opposition to the motion to compel and a motion for protective order, asserting, among other things, that:

  • The Database Report wasn’t relevant to the issues of physician bias or the reasonableness and necessity of medical treatment;
  • It included confidential financial data, trade secrets, and collateral source information that weren’t discoverable; and
  • It was overly broad, unduly burdensome, and disproportionate to the needs of the case.

In support of its position, the physicians submitted the affidavit of its CEO detailing the confidential nature of the extensive medical and billing data contained in the Report. The claims manager also filed a response in opposition to the motion to compel, raising arguments similar to those of the physicians but also contending that it didn’t have possession of the documents and database materials sought by the defendants.

The trial court held a hearing on the competing motions. After the hearing, the trial court granted the defendants’ motion to compel production of the Report and other requested materials, finding that “these specific materials are reasonably calculated to lead to admissible evidence,” and that “these materials are uniquely in the possession of the physicians and the claims manager and thus good cause exists to compel their production according to O.C.G.A. § 9-11-34(c)(2).”

In conjunction with this, the trial court entered a protective order requiring the physicians and the claims manager redact personal health information of patients from the Database Report and other requested materials in accordance with HIPAA. The protective order also specified that the Report should include data “for the three years prior to the date of [the defendants’ requests for production made to the physicians and the claims manager] through and including the date of production.” As a result, based on the date of the protective order, the physicians and the claims manager were required to produce approximately four years of financial data. The protective order didn’t otherwise place any restrictions on the use, dissemination, or confidentiality of the produced materials requested by the defendants. The appeals by the physicians and the claims manager followed.

Was the Trial Court’s Protective Order Too Broad?

The physicians contended that the trial court abused its discretion by entering a protective order that failed to shield it from producing the Report. It argued that the Database Report was overly broad and requiring it to create and produce the Report to the defendants constituted an unreasonable invasion of its privacy rights and was manifestly unjust and oppressive.

The scope of discovery under the Civil Practice Act is broad, and Presiding Judge Anne Elizabeth Barnes of the Georgia Court of Appeals explained:

Under O.C.G.A. § 9-11-26(b)(1), parties may obtain discovery regarding any matter, not privileged, which is relevant to the subject matter involved in the pending action, whether it relates to the claim or defense of the party seeking discovery or to the claim or defense of any other party. Pursuant to O.C.G.A. § 9-11-34 (a) (1), a party may request that another party produce documents containing matter discoverable within the scope of O.C.G.A. § 9-11-26(b), and O.C.G.A. § 9-11-34(c)(1) establishes that the discovery of … [such] documents also applies to nonparties.

Quoting a Georgia Supreme Court decision, Judge Barnes wrote that “in the discovery context, courts should and ordinarily do interpret ‘relevant’ very broadly to mean matter that is relevant to anything that is or may become an issue in the litigation.” Further, it’s not ground for objection that the information sought would be inadmissible at the trial if the information sought appears reasonably calculated to lead to the discovery of admissible evidence.

Nevertheless, Judge Barnes found that the fact that certain records are nonprivileged and relevant doesn’t automatically mean that they’re discoverable. Under general discovery rules applicable to all parties, not only must a trial court determine whether the requested discovery is relevant and material, but when parties seek discovery of unprivileged but sensitive materials, the trial court must balance the requesting party’s specific need for the material against the harm that would result by its disclosure. A trial court is obligated to apply this balancing test to determine whether discovery of the requested sensitive materials would subject the producing party to “annoyance, embarrassment, oppression, or undue burden or expense,” the judge opined, quoting O.C.G.A. § 9-11-26(c). And when a party’s request for information is overly broad, the request should be denied. Moreover, where pre-trial discovery of the producing party’s financial resources is authorized, the scope of this should be limited to the extent necessary to prevent an unreasonable intrusion into the party’s privacy.

The judge went on to explain that a trial court may grant a protective order and prohibit or limit certain requested discovery for “good cause shown” under O.C.G.A. § 9-11-26(c), and the movant bears the burden of showing his or her entitlement to such an order. Here, the defendants argued that the Report was discoverable because it was reasonably calculated to lead to the discovery of admissible evidence regarding the reasonableness and necessity of the medical expenses incurred by the plaintiff at the physicians and regarding the bias of her treating physicians there.

Judge Barnes pointed out that to recover medical expenses in a personal injury action, a plaintiff must show that the expenses arose from the injury sustained and were reasonable and necessary. And the amount that the physicians charged, wrote-off, adjusted, or accepted as payment in full from other patients for the same types of treatment at the same medical facility during the same general time period as the plaintiff may have some relevance—“particularly in the broad discovery sense”—to the reasonableness and necessity of the charges for the plaintiff’s care and thus be discoverable.

Moreover, a treating physician’s financial interest in the outcome of the case is highly relevant to the issue of his credibility and potential bias, and evidence that the plaintiff’s counsel has a close relationship with and a history of making referrals to the plaintiff’s treating physician can be relevant to show the bias of that physician. As a result, Judge Barnes and the Court held that documents reasonably calculated to lead to this type of financial information concerning a treating physician’s bias would be discoverable.

However, the information in the Report that the defendants sought to have the physicians create would be far more extensive in scope, the judge found. The Report would include detailed financial information about each of the physicians ‘s patients, regardless of the type of treatment received, the clinic location where the treatment occurred, or the physician providing the treatment. It would also include all CPT Codes for every visit and every treatment of every patient, the name of a payor on an account if other than the patient, and the names of all sources of patient referrals. Plus, the Report, as ordered by the trial court, would include all of this financial data for more than four years.

Judge Barnes concluded that given the extensive breadth of sensitive financial information that would be contained in the Report, the request wasn’t reasonably calculated to lead to discovery of admissible evidence and was so overly broad that the trial court abused its discretion in denying the physicians ‘s request for a protective order prohibiting its production to the defendants.

What’s more, the trial court didn’t place any restrictions on the use, dissemination, or confidentiality of the sensitive financial data that would be contained in the Report, despite the fact that at the hearing on the matter, defense counsel didn’t oppose the imposition of at least some restrictions on the use and dissemination of the database data. The trial court had an obligation to enter an order that would “provide reasonable protection for the physicians’ legitimate proprietary concerns regarding its financial information, and it abused its discretion in failing to impose any restrictions with respect to the use and dissemination of the data.

The Court of Appeals vacated the protective order to the extent that it required the physicians to produce the Report to the defendants and remanded the case to the trial court to see if a more limited report could be generated. Medernix, LLC v. Snowden, 2024 Ga. App. LEXIS 243, 2024 WL 3082057 (Ga. App. June 21, 2024).

Contact Us

Understanding what materials are discoverable in an auto or truck accident case is critical to an accident victim’s success. That’s why you need an experienced Atlanta personal injury attorney representing you. Having a knowledgeable attorney whom Atlanta residents trust and who has experience handling motor vehicle accident cases does matter. Whoever you hire as your personal injury car accident lawyer needs to know the law and how to apply the law. We’re happy to answer your questions. We offer free consultations to all prospective clients.

Contact an Atlanta personal injury attorney at Tobin Injury Law 24 hours a day, 7 days a week by calling 404-JUSTICE (404-587-8423).