Advantage Behavioral Health Systems v. Eric Cleveland, as Administrator of the Estate of Nicholas Cleveland
Advantage Behavioral Health Systems v. Eric Cleveland, as Administrator of the Estate of Nicholas Cleveland
Opinion
Upon being discharged from a mental health care facility operated by Advantage *765 Behavioral Health Systems ("Advantage"), Nicholas Cleveland committed suicide. Cleveland's parents then filed this negligence and wrongful death action against Advantage, and Advantage filed a motion for a protective order, seeking to have portions of its records on Cleveland declared privileged. The trial court issued an order ruling that only some of the records were privileged and that Advantage lacked standing to assert the mental health privilege to exclude otherwise relevant evidence at trial. For the following reasons, we affirm the trial court's ruling as to which records were privileged, but we reverse its ruling that Advantage lacked standing to assert the mental health privilege.
The record shows that on March 29, 2016, Cleveland presented at Athens Regional Medical Center with complaints and/or a history of suicidal thoughts, bipolar disorder, severe depression, hallucinations, and alcohol use disorder. Cleveland was examined by Dr. Edward Green, a member of the hospital's emergency department, who completed a Form 1013 ordering that Cleveland be involuntarily committed to Vantage Point, a mental health care facility operated by Advantage. 1 Cleveland received treatment at Vantage Point for two days until his discharge on April 1, 2016, and he committed suicide a few hours later.
In May 2016, Cleveland's parents requested a copy of his medical records from Advantage, and Advantage produced all the records without redaction. In October 2016, Cleveland's parents' attorneys requested a certified copy of the medical records from Advantage, and Advantage again produced the records without redaction. In June 2017, Cleveland's parents filed the instant action against Advantage, 2 raising claims of wrongful death and professional negligence based on the allegation that Advantage failed to properly evaluate and treat Cleveland's suicide risk and improperly discharged him given that risk.
Advantage filed a motion for a protective order, seeking rulings that certain disputed portions of the medical records be declared privileged 3 under the mental health privilege provided for in OCGA § 24-5-501 (a) and that further disclosure of any privileged records be precluded. Advantage argued that, in addition to communications between Cleveland and mental health care providers and communications between the providers themselves, records of assessment, diagnosis, and treatment were privileged and therefore inadmissible as evidence at trial.
The plaintiffs opposed the motion, arguing that the disputed portions of the records, which they described as "diagnoses, medications, prescriptions, goals, plan[s] of treatment, orders, observations, assessments and non-mental health records," were not privileged. The plaintiffs asserted that under OCGA § 24-5-501 (a) only portions of the records reflecting communications between Cleveland and certain mental health care providers were privileged. The plaintiffs also argued that it appeared some of the records were not created by providers subject to the mental health privilege.
The trial court issued an order ruling that (1) only certain portions of the disputed records contained privileged information, and (2) Advantage did not have standing to assert the mental health privilege on behalf of Cleveland to exclude otherwise relevant evidence at trial. 4 Regarding which portions of *766 the records were privileged, the trial court found that the diagnoses, medications, and prescriptions were not privileged. Noting that OCGA § 24-5-501 (a) applies the mental health privilege to communications only, the trial court declined to construe the privilege against disclosure of confidential communications so broadly as to encompass diagnoses and medications prescribed, because doing so would render meaningless OCGA § 37-3-166 (a) (8.1), which provides that the non-privileged portions of mental health records may be released to the legal representative of a deceased person's estate.
Regarding what it characterized as goals, observation orders/levels, objectives, and plans of treatment, the trial court found that many of these records were not privileged because they could not be characterized as confidential communications. Instead, the trial court found that they were expectations of staff and were not particularized to Cleveland as a result of any communications from him. Among these records were those indicating (1) that the facility had goals that Cleveland not be a danger to himself, take medications as prescribed, and decrease alcohol withdrawal symptoms; (2) that he would be encouraged to attend group therapy; and (3) how often staff members were checking on him. The trial court found that records indicating Cleveland's stress level and his own comments on his stress level were privileged, reasoning that the records came from patient communication.
Regarding what it characterized as observations, the trial court stated that it determined whether the observations were the result of communication with Cleveland. The trial court found that several observations were privileged because they came from communications by Cleveland, arose immediately out of his communications, or were communicative in nature. Such records included indications of whether Cleveland had suicidal thoughts, how he slept, how much alcohol he drank, and his living and employment situation. The trial court found that other observations were not privileged because they were treatment-directed, were by the treatment providers, or reflected goals of treatment and conclusions of the providers. Such records indicated that Cleveland met with a social worker, had an appropriate appearance, was interacting well with others, watched television, was cooperative, and was in a detoxification program. The trial court found that a record summarizing a discussion between Cleveland and a treatment provider was privileged, and records indicating Cleveland's description of his mood and whether he accepted or declined rehab were also privileged, but a record indicating he attended group therapy was not privileged.
The trial court found without discussion or explanation that the Form 1013 from Dr. Green was not privileged. The trial court found that a record showing that Cleveland had a "service class" of "psychiatric treatment" was not privileged because it simply concerned the fact of treatment. The trial court found that certain assessments reflected Cleveland's answers to questions, and certain treatment goals were clearly developed as a result of communications with him, rendering both privileged. The trial court found that certain plans of care, including records indicating the future discussions a treatment provider planned to have with Cleveland and records consisting of general treatment goals and diagnostic information, were not privileged.
Next, however, the trial court ruled that Advantage did not have standing to assert the mental health privilege on behalf of Cleveland at trial, reasoning that Advantage was a stranger to the privileged communications between Cleveland and his individual mental health care professionals. The trial court stated that it "ma[de] no determination as to the testimony of any individual mental health care professional." 5 We granted Advantage's application for interlocutory appeal, and this appeal followed.
1. First, we address the plaintiffs' argument that Advantage's appeal should be dismissed due to its failure to file an enumeration of errors. We conclude that although Advantage has not filed or included in its *767 appellant's brief an enumeration of errors, it is apparent from the notice of appeal, the record, and the brief what errors Advantage asserts, and we decline to dismiss this appeal.
OCGA § 5-6-48 (f) provides:
Where it is apparent from the notice of appeal, the record, the enumeration of errors, or any combination of the foregoing, what judgment or judgments were appealed from or what errors are sought to be asserted upon appeal, the appeal shall be considered in accordance therewith notwithstanding that the notice of appeal fails to specify definitely the judgment appealed from or that the enumeration of errors fails to enumerate clearly the errors sought to be reviewed. ...
"The legislature, in enacting OCGA § 5-6-48 (f), has imposed on the appellate courts a statutory duty to discern what errors an appellant is attempting to articulate." (Punctuation omitted.)
Felix v. State
,
No appeal shall be dismissed or its validity affected for any cause nor shall consideration of any enumerated error be refused, except:
(1) For failure to file notice of appeal within the time required as provided in this article or within any extension of time granted hereunder;
(2) Where the decision or judgment is not then appealable; or
(3) Where the questions presented have become moot.
In several recent cases, this Court has considered appeals despite the appellant's failure to file an enumeration of errors where we could discern the errors asserted on appeal. See
State v. Martinez-Palomino
,
However, in
Complete Wiring Sols., LLC v. Astra Group, Inc.
,
In other cases, this Court and the Supreme Court of Georgia have dismissed appeals based on the absence of an enumeration of errors, but those cases (1) did not address whether the errors asserted on appeal could be discerned from other documents, and/or (2) were decided at a time when appellate court rules required the enumeration to be filed separately from the appellant's brief. See
Lowery v. Smith
,
In a case decided this year,
State v. Freeman
,
In light of the statutory mandates favoring consideration of this appeal, our duty to construe the APA forgivingly, and the apparent tension in the case law, we are not persuaded that the failure to title a section of an appellant's brief as an "Enumeration of Errors" necessarily requires dismissal of the appeal. Here, in the "Argument" section of its brief, Advantage argues that (1) "[t]he trial court erred in concluding that the mental health privilege does not apply to the diagnoses, medications, prescriptions, goals, observations, and treatment plans in Cleveland's mental health records," and (2) "[t]he trial court incorrectly held that Advantage lacks standing to assert the mental health privilege." Thus, we can clearly ascertain the two rulings Advantage asserts were erroneous, and we decline to dismiss this appeal. See
Felix , supra,
2. Next, we must resolve the parties' dispute over the proper standard of review to apply to the trial court's order. Advantage asserts that the order is subject to de novo review, while the plaintiffs assert that we should review it for an abuse of discretion. As shown in Division 3 below, whether Advantage has standing to assert the mental health privilege in the circumstances presented does not involve any factual determinations and only presents a question of law. As "the standard of review for a question of law on appeal is de novo,"
Ga. Transmission Corp. v. Worley
,
We will, however, review the trial court's ultimate rulings regarding whether certain records were privileged for an abuse of discretion, while reviewing any factual determinations underlying those rulings for clear error. In
Cooksey v. Landry
,
*769
(Citation omitted.)
This Court and the Supreme Court of Georgia generally review the grant or denial of a motion for protective order using the abuse of discretion standard of review.
Alexander Properties Group Inc. v. Doe
,
Here, in contrast to
Cooksey
, the trial court carefully reviewed the disputed records and based most of its privilege rulings on specific factual determinations regarding whether the records arose from patient communications. Accordingly, we determine that the trial court's ultimate privilege rulings should be reviewed for an abuse of discretion, and we will accept the trial court's specific factual findings underlying those rulings unless they are clearly erroneous. "[I]n various contexts, we accept factual findings unless they are clearly erroneous and review a trial court's ultimate decision on the particular issue for abuse of discretion." (Citation omitted.)
Reed v. State
,
3. Turning to the merits, we agree with Advantage that the trial court erred in ruling it lacks standing to assert the mental health privilege.
"Georgia law provides several privileges related to mental health, which, collectively, are referred to as the mental health privilege."
Brown
, supra,
There are certain admissions and communications excluded from evidence on grounds of public policy, including, but not limited to, the following:
...
(5) Communications between psychiatrist and patient;
(6) Communications between licensed psychologist and patient as provided in Code Section 43-39-16 ;
(7) Communications between a licensed clinical social worker, clinical nurse specialist in psychiatric/mental health, licensed marriage and family therapist, or licensed professional counselor and patient; [and]
(8) Communications between or among any psychiatrist, psychologist, licensed clinical social worker, clinical nurse specialist in psychiatric/mental health, licensed marriage and family therapist, and licensed professional counselor who are rendering psychotherapy or have rendered psychotherapy to a patient, regarding that patient's communications which are otherwise privileged by paragraph (5), (6), or (7) of this subsection ....
OCGA § 43-39-16 provides that "[t]he confidential relations and communications between a licensed psychologist and client are placed upon the same basis as those provided by law between attorney and client; and nothing in this chapter shall be construed to require any such privileged communication to be disclosed."
"The primary purpose of the [mental health] privilege is to encourage the patient to talk freely without fear of disclosure and embarrassment, thus enabling the psychiatrist to render effective treatment of the patient's emotional or mental disorders."
*770
(Citation and punctuation omitted.)
Cooksey , supra,
Here, we conclude that the trial court erred in ruling that Advantage does not have standing to seek to exclude otherwise relevant evidence by asserting the mental health privilege on behalf of Cleveland at trial. In the absence of a waiver by the patient, 6 privileged material is neither discoverable nor admissible at trial, and nothing precludes Advantage from asserting the privilege.
In
Cooksey , supra,
The Supreme Court further explained in
Cooksey , supra,
[c]onsistent with the protections afforded psychiatrist-patient communications even after a patient's death, our legislature has determined that a deceased patient's representative cannot waive the psychiatrist-patient privilege. See OCGA § 31-33-4 (providing that statutes authorizing the release of health records to a deceased patient's representative "shall not apply to psychiatric, psychological, or other mental health records of a patient"); OCGA § 37-3-166 (a) (8.1) (authorizing mental health facilities to release a deceased patient's mental health records "to the legal representative of [the] deceased patient's estate, except for matters privileged under the laws of this state.").
The Supreme Court framed the privilege as a nearly absolute one, emphasizing that "the
patient
is the holder of the psychiatrist-patient privilege and absent waiver
by the patient
, privileged communications may not be disclosed." (Emphasis in original.)
*771
Other cases support the concept that the mental health privilege applies in the absence of a waiver by the patient and regardless of who raises the issue, whether it be an individual mental health professional, a mental health care facility, or another entity. In
Annandale at Suwanee, Inc. v. Weatherly
,
In
Freeman v. State
,
By way of contrast, in
Johnson v. State
,
Moreover, a rule that a facility in possession of privileged information may not assert the mental health privilege - whether to prevent disclosure of such information during discovery or to prevent admission of such information at trial - would contravene the privilege's purpose of encouraging free communications between patients and mental health providers. See
Herendeen , supra,
We recognize that the mental health privilege and the attorney-client privilege are largely coextensive, see OCGA § 43-39-16, and that the rule providing that communications between attorney and client are privileged cannot be invoked for the benefit of persons who are strangers to the attorney-client relationship. See
White v. Regions Bank
,
We also acknowledge that "it is no small matter for a court, given its focus on the pursuit of truth and justice, to hold that potentially relevant evidence is shielded from [admission at trial],"
Cooksey , supra,
4. In arguing that "[t]he trial court erred in concluding that the mental health privilege does not apply to the diagnoses, medications, prescriptions, goals, observations, and treatment plans in Cleveland's mental health records," Advantage challenges the trial court's privilege rulings in toto without analyzing or challenging any specific rulings. Advantage broadly asserts that the mental health privilege applies not just to actual communications between patients and mental health professionals, but also to information with origins in such communications. It argues that diagnoses, medications, prescriptions, goals, observations, and treatment plans necessarily originate from communications, as the only way mental health professionals can diagnose patients, determine what medications to prescribe, collect observations, or devise treatment plans is by communicating with them, and the mental health privilege must be applied here in order to advance the privilege's purpose.
Because Advantage only provides argument challenging the trial court's privilege rulings as a whole and at least some of these rulings were not erroneous, this enumeration of error fails. The trial court did not rule that the "diagnoses, medications, prescriptions, goals, observations, and treatment plans" in the records were categorically not privileged. Instead, at least as to the goals, observations, and treatment plans, the trial court analyzed the records and ruled that some records were privileged and some were not, depending on whether they arose from patient communications.
It is well-settled that the mental health privilege applies to "communications" and "admissions" between patients and covered mental health providers, as well as communications between such providers regarding patient communications. See OCGA § 24-5-501 (a) ;
Cooksey , supra,
*773
Mrozinski v. Pogue
,
Here, the trial court did not abuse its discretion in ruling that at least some of the disputed records were not privileged, based on its factual findings that these records did not have their origins in patient-mental health professional communications. One disputed record indicates that Cleveland was receiving psychiatric treatment, and the mental health privilege does not apply to the fact of treatment. Other disputed records simply show that Cleveland participated in certain activities, such as meeting with a social worker, attending group therapy, and watching television, or show that his appearance was appropriate. The trial court did not clearly err in finding that these records did not have their origins in patient communications.
While it is arguable that some portions of the records which the trial court deemed non-privileged actually had their origins in patient communications,
8
we do not resolve that issue in this appeal because it is not presented to us. Advantage broadly challenges the trial court's privilege rulings as a whole, and at least some of these rulings were not erroneous. Advantage, as the appellant, bears the burden to show error affirmatively by argument and by citation to the record. See Court of Appeals Rule 25 (c) (2). As Advantage's challenge to the entirety of the trial court's privilege rulings fails, we will not manufacture or analyze more specific enumerations of error or arguments not asserted by Advantage.
9
See
Hess Oil & Chemical Corp. v. Nash
,
In conclusion, we reverse the trial court's ruling that Advantage lacks standing to exclude privileged material at trial by asserting the mental health privilege. However, we affirm the trial court's rulings regarding whether disputed portions of Advantage's records were privileged.
Judgment affirmed in part and reversed in part.
Rickman and Reese, JJ., concur.
Advantage is a state community service board which operates programs and provides treatment and support services regarding mental health, developmental disabilities, and addictive diseases. See OCGA § 37-2-6 (a). Vantage Point offers short-term residential services for individuals with psychiatric and substance abuse disorders, and its staff includes a psychiatrist, a nurse practitioner, nurses, clinicians, technicians, and operational support staff.
The plaintiffs also named as a defendant the Georgia Department of Behavioral Health and Developmental Disabilities, but they subsequently dismissed this defendant without prejudice.
The parties agreed that certain portions of the records were privileged and highlighted these portions in orange. Advantage highlighted the disputed portions of the records and submitted all of the records to the trial court for an in camera review.
The trial court also ruled that the prior release of the records by Advantage did not constitute a waiver of Cleveland's mental health privilege. This ruling is not contested on appeal. The trial court did not address whether the records were created by professionals subject to the mental health privilege.
Because Advantage is a state entity, the plaintiffs could not name the individual mental health care professionals as defendants in this action. See OCGA § 50-21-25.
There is no contention that Cleveland waived the privilege.
Prior to
Cooksey
, in
Sims v. State
,
For instance, while the trial court ruled that the diagnoses were not privileged, in
Freeman , supra,
We also note that, as the plaintiffs point out, it is not apparent from the record on appeal whether some of the disputed records involve communications between Cleveland and covered mental health providers or agents thereof under OCGA § 24-5-501 (a). "In order to invoke the statutory mental health privilege in Georgia, the requisite relationship of mental health provider and patient must have existed." (Punctuation omitted.)
Herendeen , supra,
Case-law data current through December 31, 2025. Source: CourtListener bulk data.