REVISITING THE CONFIDENTIALITY OF MEDICAL REPORTS PRINCIPLE: A CASE ANALYSIS OF MR. X v. HOSPITAL Z
Mr. X, the plaintiff, completed his MBBS in 1987 and was recruited by the Nagaland State Medical and Health Service as Assistant Surgeon Grade in 1990.i Later on, he joined the MD Pharmacology Course and paused his services at the Nagaland State Medical and Health Service on the note that he would join back once his course was completed. Accordingly, he resumed his services in August 1993 as Assistant Surgeon Grade I.[i]
Meanwhile, a man named Itokhu Yepthomi was diagnosed with Aortic Aneurism and was directed to get treatment from Hospital Z, located in Madras. Mr. X was asked by the Government of Nagaland to accompany the ailing man. The hospital revealed that Mr. Yepthomi needed blood to undergo the required surgery. Mr. X and Mr. Yepthomi’s driver were asked to donate blood and accordingly, their samples were preserved.[ii]
In the meantime, Mr. X proposed Ms. Y for marriage, which was duly accepted by her. However, the marriage was later called off after the hospital revealed to the family, including Ms. Y, that Mr. X was HIV (+). Since the marriage had been subsequently called off, most of the people along with the community members got to know about Mr. X’s medical condition. Consequently, he had to face a lot of criticism and was even expelled from his community.[iii] His wedding was called off and he left Nagaland to permanently shift to Madras.
Eventually, Mr. X filed a plea before the National Consumer Disputes Redressal Commission against Hospital Z, on the grounds that there exists a privileged relationship between a doctor and his patient and the same had been violated by the respondents.[iv] The hospital had breached their medical ethics by revealing information related to Mr. X’s HIV status, making them liable to pay damages. The NCDRC dismissed the petition and accordingly, an appeal was filed.[v]
Issues Discussed By The Court
Three main issues were identified from the grounds of challenge put forth by the appellant, viz.:
1. Whether the hospital had a duty to maintain the confidentiality of the appellant’s medical reports and whether such duty was violated?
2. Whether the disclosure of the appellant’s HIV status amounted to a violation of the right to privacy, making the hospital liable to pay damages?
3. Whether the appellant’s right to marry was affected by the violation of his privacy?
In its judgment, the court held that even though the relationship between a doctor and his patient is a privileged one, however, such privilege is not absolute. There are exceptions to this, that is when a person does have a right to privileged information but the other person (in this case the Doctor) has no correlative duty or has a bigger duty than that right initially, such as in the case of Mr. X. In the instant case, the right to privileged information involved a threat to the life of another person i.e. Ms. Y. The provisions in the Code of Medical Ethics provide for such exceptions concerning the maintenance of confidentiality.[vi] Therefore, it is safe to assume that such information which concerns public interest or which may harm the public at large must be disclosed.
Hence, the appellant’s argument stating that the Hospital had breached its duty of care towards him by revealing the information regarding his HIV status is not acceptable. Mr. X’s HIV status was bound to cause health risks to his partner. Even if Mr. X’s medical condition had been disclosed later, Ms. Y would still have had an open ground to seek divorce.[vii]
The court held that there had been no violation of the Right to privacy as the disclosure had been made in good faith and under public interest. On a completely unrelated note, the court went on to state that HIV patients do not have a right to marry but a duty to prevent this condition from spreading. Any person who conceals such information from their spouse could be penalized under Sections 269 and 270 of the IPC, 1860.[viii]
Accordingly, the Court struck down Mr. X’s plea.[ix]
Analysis Of The Court’s Stance
The aforementioned case marks an important development in the jurisprudence of both Article 21 as well as the rights of HIV patients in India. The case garnered both positive and negative outlook to the conversation around HIV awareness at the time. In the instant case, the court was required to resolve the clash between the right to privacy of a HIV patient and the right to health of his spouse. The judgment unequivocally determines both the right to privacy and the right to health as fundamental rights under Article 21 while at the same time accepting that these rights under right to life are not absolute but subject to public interest and morality.[x] The court was correct to note that in a scenario where there is a clash of two fundamental rights, one that advances public morality and public interest must be advanced. One’s right to privacy cannot come at the cost of another person’s health. In reaching its decision, the court referred to the guidelines on HIV and AIDS issued by the General Medical Council of Great Britain.[xi] It came to the conclusion that contrary to a doctor’s obligation to not divulge information about his patient, a doctor may feel the need to inform any sexual partners of such medical condition, if the circumstances require so.[xii] The court clarified that public interest would override the duty to maintain confidentiality, especially when there is an immediate risk to another person.[xiii] The spouse of any person suffering from a disease capable of being transmitted has the right to be fully aware of the risks and hence, such disclosure does not amount to a violation of privacy. It is significant to note that the instant judgment, though pronounced much before the landmark Justice K.S Puttaswamy[xiv] verdict, recognized the right to privacy as a fundamental right falling within the ambit of Article 21.
The judgement was also heavily criticized after the court observed that HIV patients did not have the right to marry. A person’s right to marry is very much a fundamental right under his right to life or Article 21. However, the court went on to say that a failure to disclose such information might attract criminal sanctions upon such patients, and therefore, a duty was created upon such people ‘not to marry.’[xv] In its concluding remarks, the court stated that “AIDS is the product of indisciplined sexual impulse. The impulse being the notorious human failing if not disciplined…”[xvi] The obiter of the court came as a shock, especially in the HIV community. It was opined by many that the court had overstepped its authority in determining a question of public policy beyond the facts of the case.[xvii]
In a second petition asking for clarification, the Supreme Court [xviii] went on to state that while the verdict regarding the liability of Hospital Z stands as it is, the additional remarks of the court on the marriageability of HIV patients were “unnecessary” and “uncalled for”. However, what is important to note is that the clarification issued by the apex court did not either affirm or negate these determinations. As a result, the instant case cannot be said to have been overturned on this issue, and doctrinally, in the absence of a clear ruling, HIV patients’ right to marry remains ambiguous.
The foregoing analysis of this case makes it clear that the apex court delivered a crucial opinion with respect to the rights of HIV patients, capable of having far reaching consequences in the future. The court was progressive in regarding the Right to Privacy as a Fundamental Right. By holding that public interest overrides one’s right to privacy, the Supreme Court attempted to settle a clash between two opposing Fundamental Rights. Not only does the judgment mark an important addition to the Article 21 and HIV jurisprudence in India, but it certainly goes a long way in providing the means to resolve such future clashes between two or more basic human rights.
[i] 1998 Supp(1) SCR 723, p 1. [ii] Id. [iii] Id. [iv] Id at p 2. [v] Id. [vi] Id at p 3. [vii] Id at pp 5-6. [viii] Id at p 6. [ix] Id at p 7. [x] 1998 Supp(1) SCR 723, p 7. [xi] Id at pp 3-4. [xii] Id at pp 5-6. [xiii] Id at p 7. [xiv] Justice K.S Puttaswamy v Union of India, (2017) 10 SCC 1 [xv]1998 Supp(1) SCR 723, p 6. [xvi] Id at p 7. [xvii] Jayanth K. Krishnan, The Rights of the New Untouchables: A Constitutional Analysis of HIV Jurisprudence in India, 25 Human Rights Quarterly, 809, (2003). [xviii] Mr. X v Hospital Z, AIR 2003 SC 664
This article has been written by Navneeta Shankar and Jhanvi Gupta. Navneeta is a fourth year law student at Maharashtra National Law University, Mumbai and Jhanvi is a second-year law student at Dharmashastra National Law University, Jabalpur.