Doe v. SEPTA

The Appellant, Doe, was an HIV-positive employee of Respondent SEPTA. Doe brought this constitutional challenge after SEPTA reviewed his prescription drug records for the purpose of monitoring its employee prescription plan. Doe claimed that SEPTA infringed his right to privacy implicit in the right to due process in the Fourteenth Amendment to the Constitution.

Doe had informed the head of SEPTA’s medical department (Dr. Press), the staff physician (Dr. Van de Beek), his acting supervisor, and his administrative assistant that he was living with HIV/AIDS. In doing so, he trusted each of them to keep his condition confidential; he did not want other co-workers to know of his condition. Before Doe filled his prescription through his employee health insurance plan, Doe asked Dr. Press if he or anyone else reviewed employee names in association with the drugs they were taking. In response, Dr. Press assured Doe that he only reviewed names on prescriptions in cases of suspected narcotics abuse and he knew of no other review that included employee names.

However, Pierce, the employee in charge of monitoring the costs of SEPTA’s prescription drug program, reviewed prescription drug reports for signs of fraud and drug abuse. SEPTA’s drug supplier issued the reports and each line included the name of the employee or dependant, the name of the drug, and the total cost. Pierce disclosed the reports to Aufschauer, another employee who also reviewed the reports. When neither recognized a drug name they would call the staff physician, Dr. Van de Beek, to inquire into the nature of the drug.

In this instance, Pierce called Dr. Van de Beek to determine the nature of Doe’s medications. Dr. Van de Beek indicated that they were for the treatment of HIV/AIDS. Pierce did not mention Doe by name, but Dr. Van de Beek deduced that she was asking about Doe. Dr. Van de Beek informed Doe of Pierce’s questions and that Pierce had likely discovered that Doe was HIV-positive. After the incident, Doe made no claim of personal discrimination or economic deprivation. However, he testified that he felt as though he was treated differently, that he required antidepressants to treat subsequent depression, and that he grew fearful of Pierce.

The District Court decided in favor of Doe, and awarded compensatory damages for his emotional distress. SEPTA appealed.

The Court reversed the lower court’s decision and held that individuals have a constitutionally protected right to privacy in their HIV status and their medical records, including prescription drug records. However, the court held that this right was not absolute.

Applying Whalen v. Roe, 429 US 589 (1977), the court noted that medical records fell within an individual’s “interest in avoiding disclosure of personal information.” Applying United States v. Westinghouse, 638 F.2d 570 (1980), the court held that there was “no question that an employee’s medical records . . . [were] well within the ambit of materials entitled to [constitutional] privacy protection.” In Westinghouse, the court held that records of prescription medications were entitled to the same protection as medical test results.

Applying Whalen, the court emphasised that “the right of privacy in one’s prescription records must be balanced against important competing interests.” In determining whether there had been a violation of the right to privacy in the disclosure of information, the court explained that seven factors, as put forth in Westinghouse, must be weighed: (1) the type of record requested; (2) the information it does or might contain; (3) the potential for harm in any subsequent non-consensual disclosure; (4) the injury from disclosure to the relationship in which the record was generated; (5) the adequacy of safeguards to prevent unauthorized disclosure; (6) the degree of need for access; and (7) whether there is an express statutory mandate, articulated in public policy, or other recognizable public interest favoring access.

Weighing these factors, the court found that SEPTA did not infringe on Doe’s constitutional right to privacy. It held that “a self-insured employer’s need for access to employee prescription records under its health insurance plan, when the information disclosed [was] only for the purpose of monitoring the plans by those with a need to know, outweigh[ed] an employee’s interest in keeping his prescription drug purchases confidential.” The following factors contributed to the court’s holding: the lack of economic loss, discrimination, or harassment actually suffered by Doe; the fact that SEPTA requested that the drug supplier no longer include confidential information in its reports, which the court believed established an adequate safeguard against the recurrence of unnecessary disclosure; and the fact that SEPTA had a public “duty” to monitor costs, fraud and abuse, as it was substantially publicly funded.

The court held that a separate disclosure was made every time a new person was told about an employee’s HIV status, regardless of the working relationship of the people to whom disclosure was made. However, it explained that Pierce had a “genuine, legitimate and compelling need” for the report and that she had “inadvertently” learned about Doe’s condition in the course of her work. The court added that the disclosure to Aufschauer was also based on a “legitimate need.” Pierce’s disclosure to Dr. Press was also found to be permissible because Dr. Press had previously been informed of the same information directly from Doe, and thus he did not learn of any new information as a result of Pierce’s actions.

“When the underlying claim is one of invasion of privacy, the complaint must be ‘limited to those [rights of privacy] which are `fundamental' or `implicit in the concept of ordered liberty' ...’ . . . Medical records fall within this scope.” 72 F.3d, p. 1137.

“It is now possible from looking at an individual's prescription records to determine that person's illnesses, or even to ascertain such private facts as whether a woman is attempting to conceive a child through the use of fertility drugs. This information is precisely the sort intended to be protected by penumbras of privacy.” 72 F.3d, p. 1138.

“An individual using prescription drugs has a right to expect that such information will customarily remain private.” 72 F.3d, p. 1138.

“[D]isclosures of private medical information to doctors, to hospital personnel, to insurance companies, and to public health agencies are often an essential part of modern medical practice even when the disclosure may reflect unfavorably on the character of the patient.” 72 F.3d, p. 1138.

“A disclosure occurs in the workplace each time private information is communicated to a new person, regardless of the relationship between the co-workers sharing that information . . . Therefore, we hold that each person who learned of Doe's condition constitutes a separate disclosure for the purposes of Doe's invasion of privacy action.”  72 F.3d, p. 1139.