State v. State Medical Board, Unpublished Decision (6-11-1999)
State v. State Medical Board, Unpublished Decision (6-11-1999)
Opinion of the Court
OPINION
This is a complex case involving the interplay among the Public Records Act,1 the confidentiality provisions of the State Medical Board of Ohio, and similar, but not identical, provisions governing the State Department of Insurance.2 With sparse precedent to guide us, we have attempted to negotiate the rather tortuous path created by these provisions — a path made all the more Byzantine by the strange facts of this case.Relator-appellant Alvin Wallace is a surgical assistant and the president of relator-appellant Surgical Skills, Inc., a business that provides surgical assistants to hospitals. In 1995, Richard A. Wilson, an investigator for Anthem Blue Cross and Blue Shield, began an investigation of the billing practices of Wallace and Surgical Skills.
Wilson's investigation coincided with an investigation by respondent-appellee State Medical Board of Ohio (Medical Board), which was looking into allegations that Wallace and Surgical Skills were engaged in the unauthorized practice of medicine. The investigation also coincided with one by respondent-appellee State Department of Insurance (Insurance Department), which was investigating Wallace for alleged insurance fraud. Both the Medical Board and the Insurance Department conducted interviews of various witnesses as part of their investigations. At several of these interviews, some of which were conducted jointly by the Medical Board and the Insurance Department, Wilson was also present.
In May 1996, Wallace and Surgical Skills (collectively, Wallace) filed a mandamus action in the Hamilton County Court of Common Pleas, seeking the records of the Medical Board's and the Insurance Department's investigations. Wallace claimed that he was entitled to these records under the Public Records Act, R.C.
Wallace now appeals. He asserts five assignments of error.
R.C.
We follow the case law and conclude that R.C.
For the Medical Board's records pertaining to all interviews except Dr. Semertzides's, we hold that those records should remain confidential. Although the Medical Board may have violated its duty to keep that information confidential, there is no evidence that any other parties waived their confidentiality privileges. Thus, those records are not subject to disclosure, and the trial court is not required to do an in camera inspection of them.
For the records that Dr. Semertzides authorized to be released, we cannot tell from the record exactly whose privacy rights were implicated. We remand this case to the trial court to conduct an in camera inspection. The court shall release records that pertain to the Medical Board and Dr. Semertizides. But the court shall redact information pertaining to anyone else whose privacy rights are implicated, such as patients.
All papers documents, reports, and evidence in the possession of the superintendent [of insurance] or the superintendent's designee that pertain to an insurance fraud investigation are confidential law enforcement investigatory records under section
149.43 of the Revised Code.10
We have been unable to find any relevant case law or other materials interpreting R.C.
Regarding the statute's reference to the Insurance Department's records being "confidential law enforcement investigatory records under section
(a) The identity of a suspect who has not been charged with the offense to which the record pertains, or of an information source or witness to whom confidentiality has been reasonably promised;
(b) Information provided by an information source or witness to whom confidentiality has been reasonably promised, which information would reasonably tend to disclose the source's or witness's identity;
(c) Specific confidential investigatory techniques or procedures or specific investigatory work product;
(d) Information that would endanger the life or physical safety of law enforcement personnel, a crime victim, a witness, or a confidential information source.13
When a public body, such as the Insurance Department, asserts that records are not subject to disclosure because they are confidential law enforcement investigatory records, a court "must make an individualized scrutiny of the records in question" if the person requesting the records challenges the public body's assertion.14 The best way for the court to scrutinize the records is to conduct an in camera inspection.15 Only by scrutinizing the records can the court adequately determine which records contain information that falls under any of the above four categories.
Here, when the Insurance Department asserted that its records were not subject to disclosure, the court erred by accepting that assertion without looking at the records. We hold that the court had a duty to conduct an in camera inspection to determine if the records "would create a high probability of disclosure" of the information listed in any of the above four categories. Thus, we remand this case for the trial court to conduct an in camera inspection. If the records do not create a high probability of disclosure of any information in the four categories, the court shall order the records to be released. If a record partially contains confidential information, the court shall release that record with the confidential information redacted.
The Medical Board has the authority to investigate "evidence that appears to show that a person has violated any provision" of Chapter 4731 of the Revised Code, which governs physicians and limited practitioners.17 One section of Chapter 4731 prevents the unauthorized practice of medicine.18 Here, the Medical Board was investigating allegations that Wallace was engaged in the unauthorized practice of medicine. As part of that investigation, the Medical Board may have looked at Wallace's contractual relationship with Anthem. But the evidence in the record shows that the investigation of the contractual relationship was merely done in the context of the broader investigation of the allegations of the unauthorized practice of medicine. There is no evidence that shows that the purpose of the Medical Board's investigation was merely to help Anthem in its private dispute with Wallace.
As for the Insurance Department's investigation, the Insurance Department has broad power to investigate alleged insurance fraud.19 We have found no evidence to suggest that the Insurance Department was looking into anything other than insurance fraud when it investigated Wallace. Besides Kaising's reference to Wilson being a "point man" — an isolated, ambiguous reference without any context — there is no evidence in the record to even suggest that the purpose of the Insurance Department's investigation was merely to help Anthem in its private dispute with Wallace. In fact, Kaising explained in his deposition that Wilson was present because he brought to the investigations a general expertise of health insurance as well as a specific knowledge of Anthem. Also, the record reveals that the Insurance Department began its investigation before Anthem began its investigation.
Therefore, we hold that neither the Medical Board's investigation nor the Insurance Department's investigation was ultra vires. No genuine issues of material fact remain to be litigated in this respect.20 We reject Wallace's second assignment.
In Wallace's fourth assignment, he asserts that the trial court's failure to conduct an in camera review of the Medical Board's and the Insurance Department's records violated the constitutional principle of separation of powers. He argues that there should have been some judicial review, in the form of an incamera review, when the two entities declared their records to be confidential. Basically, he asserts that any determination by governmental entities that records are confidential must be subject to judicial review, a proposition that has validity.
Here, though, we have already held that the trial court must conduct an in camera review of the Insurance Department's records and of the Medical Board's records pertaining to Dr. Semertzides's interview. Thus, the fourth assignment is moot for those records. As for the Medical Board's remaining records, Wallace has already had two opportunities for judicial review of the Medical Board's denial of his request for those records: first in his mandamus action in the trial court, and now on appeal. The trial court and this court have had the opportunity to review the language of R.C.
In Wallace's fifth assignment, he asserts that his equal-protection rights were violated when the Medical Board and the Insurance Department denied him access to their records. He argues that, by allowing Wilson to be present at interviews, the Medical Board and the Insurance Department favored Wilson over him. In his words, the Medical Board's and the Insurance Department's actions created "an unconstitutional preference or separate class of persons."
Under the Equal Protection Clause in the United States and Ohio Constitutions,22 if government action does not involve a suspect class of persons or a fundamental right, then the action will be upheld unless it is shown that the action is not rationally related to a legitimate government interest.23 That rational-basis test applies here. First, Wallace is not a member of a suspect class, which generally involves race, national origin, religion, or sex.24 Second, the Medical Board's and the Insurance Department's refusal to release their reports does not involve a fundamental right, as there is no fundamental right for an individual to receive confidential material.
Applying the rational-basis test, we hold that there was no equal-protection violation. The governmental interests involved here were the Medical Board's interest in preventing the unauthorized practice of medicine and the Insurance Department's interest in preventing insurance fraud. Considering that the Revised Code grants the Medical Board broad power to investigate the unauthorized practice of medicine and the Insurance Department broad investigatory powers for insurance fraud, we hold that the governmental interests were legitimate.
We also conclude that Wilson's presence at the witness interviews was rationally related to the Medical Board's and the Insurance Department's interests. As we have already explained, there is no evidence in the record that the Medical Board and the Insurance Department allowed Wilson to be present because they were merely helping him investigate Wallace. Rather, the evidence in the record shows that Wilson was present because he brought to the investigations a general expertise of health insurance and a specific expertise of Anthem. In other words, the evidence shows that Wilson's purpose was to aid the Medical Board and the Insurance Department in their investigations, a rational reason for having Wilson present. Thus, Wilson's fifth assignment is overruled.
Please Note:
The court recorded its own entry on the date of the release of this Opinion.
Case-law data current through December 31, 2025. Source: CourtListener bulk data.