Pettus v. Cole (49 Cal. App. 4th 402, 1996)

Opinion

PHELAN, J.

In the first of these consolidated cases, appellant Louis Pettus (Pettus) timely appeals from a final judgment entered in favor of two psychiatrists, respondents Dr. Kathleen Bell Unger and Dr. Alan Cole, as to his claims of unauthorized release of medical information in violation of the Confidentiality of Medical Information Act (Civ. Code, § 56 et seq. (hereinafter the CMIA or the Act)), and invasion of his constitutional right of privacy (Cal. Const., art. I, § l). At the close of Pettus’s case-in-chief in a bench trial, the court granted Drs. Unger’s and Cole’s motions for judgment pursuant to Code of Civil Procedure section 631.8.

In the second case, Pettus seeks review of the court’s judgment in favor of his employer, respondent E.I. du Pont de Nemours & Company, Inc. (hereinafter Du Pont), on claims of breach of contract, wrongful termination in violation of public policy, unauthorized use of medical information, and invasion of his constitutional right of privacy. The court denied Du Font’s motion pursuant to Code of Civil Procedure section 631.8 at the close of plaintiff’s evidence, but found against plaintiff on all claims following Du Font’s presentation of its case-in-chief.

The issues presented in these consolidated appeals include: (1) Whether and to what extent medical information compiled during the psychiatric examination of an employee may be disclosed to the employer by a psychiatrist without employee authorization or consent, where the employee has requested leave from work because of a stress-related disability, the examination is required under the employer’s short-term disability policy, and the examination has been arranged and paid for by the employer; and (2) Whether discharging the same employee for refusal to comply with his employer’s demand that he enroll in an inpatient alcohol rehabilitation program constitutes a violation of the employee’s state constitutional right to privacy (Cal. Const., art. I, § 1) and/or wrongful termination in violation of public policy.

We conclude as a matter of law that Drs. Cole and Unger violated the CMIA by providing Du Pont a detailed report of their psychiatric examinations of Pettus without a specific written authorization for such disclosure. As to his claim under article I, section 1 of the California Constitution, we conclude that Pettus made a prima facie showing of invasion of privacy by the psychiatrists but, based on evidence presented by Du Pont in its defense case, there is a serious question whether Pettus waived this claim by voluntarily disclosing to his supervisors at Du Pont much of the sensitive personal information that was subsequently transmitted in the psychiatrists’ reports. We will, therefore, remand for further evidentiary proceedings so that Drs. Cole and Unger may have an opportunity to present a defense to that claim.

As to Pettus’s claims against his former employer, we conclude that Du Pont violated both the CMIA and Pettus’s state constitutional rights to autonomy and informational privacy when it terminated his employment because of his refusal to comply with its demand that he enroll in an inpatient alcohol treatment program. Accordingly, we will reverse the judgment of the trial court as to all respondents and remand for further proceedings consistent with this opinion.

I. Factual and Procedural Background

A. Introduction.

The material facts of this case are essentially undisputed. Appellant Pettus had been working for Du Pont for 22 years when, in June 1988, he sought to take time off from work because he was suffering from a disabling stress-related condition. Before requesting disability leave, Pettus sought medical help for his stress condition from his personal physician and from an outpatient psychological counseling program at the Sierra Clinic. Both recommended to Du Pont that Pettus’s stress condition warranted a disability leave.

Under Du Font’s short-term disability leave policy, Pettus was required to submit to examination by a Du Pont-selected doctor for verification of his need for disability leave. The policy provided for up to six months’ leave, with pay, for nonoccupational illnesses or injuries. Du Pont was “self-insured” for purposes of its short-term disability leave policy.

In the course of having his disability verified, Pettus submitted to three medical examinations arranged and paid for by Du Pont. The first examination was with Dr. Collins, a physician under contract with Du Pont to provide general medical services for Du Pont employees. Dr. Collins verified Pettus’s stress condition, and his need for time off, but believed a psychiatric evaluation was necessary. She recommended to Du Pont that Pettus should see Dr. Cole. The second examination was a psychiatric evaluation conducted by Dr. Cole. Dr. Cole verified appellant’s stress condition and agreed that appellant had a legitimate medical need for time off work. Finally, Pettus underwent another psychiatric evaluation by Dr. Unger. Du Pont arranged for Pettus to see Dr. Unger after Dr. Cole reported that Pettus’s stress condition might be linked to an alcohol abuse problem. Dr. Cole recommended Dr. Unger to Du Pont because she is a specialist in chemical dependency cases.

Pettus was terminated from his job at Du Pont on September 21, 1988, because he refused to enter a 30-day inpatient alcohol rehabilitation program that Du Pont required as a condition of continued employment. Pettus’s alcohol consumption became a matter of concern to Du Pont when Drs. Cole and Unger disclosed to Du Pont in their disability evaluation reports that his stress condition might be caused or exacerbated by misuse of alcohol. However, the trial court specifically found that, “From all the evidence it is undisputed that plaintiff was not at any time an alcoholic, nor perhaps even an alcohol abuser in the more common lay use of the word.” Drs. Unger and Cole also disclosed in their reports to Du Pont that Pettus believed his employers were racist, and that he had violent thoughts regarding a coworker. Pettus contends that he did not authorize the doctors to disclose the full contents of their evaluations to Du Pont, and that the unauthorized release of such information to his supervisors, and the subsequent use of that information as the basis for terminating his employment, violated the CMIA and his state constitutional right to privacy.

B. Pettus’s Employment History With Du Pont.

Pettus is a 52-year-old African-American who began employment with Du Pont in a South San Francisco plant as a laborer in 1966. Between 1966 and 1976, he rose through the ranks and became a first-line supervisor in various departments at the plant. When this plant was closed in 1982, Pettus was transferred to another in Flint, Michigan, where he retained his position as a supervisor. Shortly after arriving in Flint in November 1982, Pettus began to perceive that he was being harassed and discriminated against by his supervisor, Norman Conn. Pettus believed this was the result of his dating a White woman in whom Mr. Conn, who was White, also had a romantic interest. Pettus developed symptoms of severe emotional distress as a result of this perceived racially based harassment, including a rash for which he sought medical treatment.

In April 1984, Mr. Conn informed Pettus that he would be fired. There was conflicting testimony about Pettus’s performance at Flint. Pettus testified that to his knowledge he had performed well. Other evidence presented at trial indicated that he had received “generally favorable” performance evaluations during his first year in Flint. However, there was also testimony that Pettus’s shift had received several customer complaints during the last three or four months of his employment at the Flint plant, and that Pettus was criticized for failure to prepare an incident report, for miscommunication of shift changes, for poor preparation of meeting notes, and for time card errors. To avoid termination, Pettus transferred to a position as a warehouse operator in a Du Pont warehouse in Los Angeles, incurring a 50 percent reduction in salary.

Pettus believed that upon transferring to Los Angeles he would be given a position comparable to the one he held in Flint, and he became increasingly frustrated when this opportunity did not materialize. He continued to be bothered by the poor treatment he believed he had received in Flint. His physical and emotional problems returned: stress, skin rash and—for the first time—high blood pressure.

In July 1987, at his request, Pettus transferred to a Du Pont automotive finishing plant in Hayward, California. He was initially employed as a warehouse worker, but in December 1987 he was given the chance to move up to a position as a sales assistant. The position never became permanent because he was not able to master the computer skills required for the job in the time allotted. During this time, Pettus continued to be bothered by the events in Flint, believing they contributed to his lack of career advancement with Du Pont.

In the fall of 1987 Pettus felt his anxiety return and his rash worsened. He sought medical attention from his personal physician who referred him to a psychiatrist, Dr. Walter Shervington. Pettus consulted with Dr. Shervington five to seven times in 1987.

During this time, Pettus was especially troubled by an incident relating to his failure to secure the sales assistant position. He had asked for help in learning the necessary computer skills from a colleague, Judy Mendonca, a White woman who had also trained for the position. Mendonca reported to Du Pont management that she was uncomfortable with Pettus’s inquiries, and he was subsequently instructed not to speak to her for any reason. Pettus believed Ms. Mendonca’s unwillingness to help him was motivated by racism. After the incident, he had stress reactions upon seeing her at work that caused him to get headaches and to become angry to the point where he sometimes felt like striking her.

C. Pettus’s Initial Requests for Time off of Work.

At a routine company physical examination on May 5, 1988, Pettus complained of his stress and skin rash to Dr. Carol Collins, a physician under contract with Du Pont to provide medical evaluation, physicals and treatment for Du Pont employees. Dr. Collins recommended that Pettus see a specialist dealing in stress conditions.

Soon thereafter, on or around May 24, 1988, Pettus sought stress counseling at the Sierra Clinic. On June 2, at the suggestion of a Sierra Clinic doctor, Pettus called his supervisor, Bill Taylor, to ask for a 90-day leave. Taylor told him he could not have a 90-day leave without the concurrence of a Du Pont physician in accordance with the company policy regarding requests for disability benefits. However, Bob Rotter, the division manager at the Hayward plant, became concerned about stress levels in the warehouse and worried that other employees might be experiencing problems similar to Pettus’s. Accordingly, Rotter asked Dr. Collins to arrange an appointment for Pettus with Dr. Dominick Fisichella, a dermatologist, in order to determine the cause of Pettus’s skin rash. Dr. Fisichella examined appellant on June 3, 1988, and determined that appellant’s skin condition was not work related and was not disabling. Based on the dermatologist’s findings, Rotter ordered Pettus to return to work on the following Monday, June 6.

On June 6, 1988, Pettus met with Rotter in his office. During that meeting, Pettus told Rotter that the stress he was suffering stemmed from the Flint incident and that he was angry at “members of management,” a group in which Rotter believed himself to be included, and that the mere sight of Du Pont products could trigger his anger. Pettus also told Rotter he felt anger toward Judy Mendonca, such that “he could hit her.”

On June 10,1988, Dr. Ephrom of the Sierra Clinic wrote a letter to Taylor recommending that Pettus be given a 90-day leave of absence due to stress. Dr. Ephrom asserted that Pettus was suffering from an adjustment disorder that had been “brought on by a chronic job stress situation.” Taylor told appellant he would forward the request for disability leave to Rotter. Rotter denied appellant’s request for disability leave. According to Pettus, Rotter denied the request because he “didn’t see anything on the job that was causing me to have any problems.”

Pettus continued to work, but his stress and its physical manifestations persisted. He again sought medical treatment from his personal physician, Dr. Coleman. Dr. Coleman found that appellant’s blood pressure was elevated and also detected a slight heart murmur. On June 14, 1988, he wrote a letter recommending that Pettus “remain off work for the next thirty days . . . because of his medical condition.” Pettus submitted this letter to Taylor, who denied the request for leave because Dr. Coleman was not Du Font’s doctor.

Pettus was instructed to see the company physician, Dr. Collins, on June 16, 1988, to have his request for disability leave evaluated. Dr. Collins performed a repeat physical exam and also discussed with appellant some of his personal stresses and his difficulty sleeping. Dr. Collins reported her conclusions in a June 17, 1988, letter to Rotter, her sole contact at Du Pont. In that letter, Dr. Collins noted appellant’s elevated blood pressure, heart murmur and rash, and concluded that these physical problems would not prevent him from performing his job. Nevertheless, she recommended that Pettus not return to work because of the high level of mental stress he was

experiencing. She reported that Pettus’s stress seemed related to frustration over employment circumstances which began when he was working in Michigan, but stated that she could not tell what proportion of his stress was due to work or other personal difficulties. Dr. Collins recommended that Pettus be given at least 30 days’ leave in order to pursue intensive psychotherapy and personality assessment. At the end of that time, if further leave was required, Dr. Collins recommended that Pettus be reassessed by his therapist. Pursuant to Dr. Collins’s evaluation, Pettus was immediately granted a 30-day paid disability leave.

Dr. Collins suggested to Rotter that appellant consult with Dr. Cole to obtain a psychiatric evaluation. Dr. Collins set up an appointment with Dr. Cole for Pettus. She wrote Dr. Cole a letter informing him that Pettus was a Du Pont employee being referred by the company for psychiatric assessment in connection with a “disability case” he had “filed against the company.” For background information, Dr. Collins also forwarded to Dr. Cole her June 17, 1988, letter to Rotter, in which she had reported her findings from the June 16, 1988, physical examination.

D. Pettus’s Consultation With Dr. Cole.

Rotter informed Pettus of the appointment with Dr. Cole, which was scheduled for June 23, 1988. Pettus believed this appointment was necessary to secure disability leave. He understood that the purpose of the visit was to verify the physical and emotional problems he was having in order to qualify for disability leave under the company policy. Pettus knew the visit was not entirely confidential. He understood that Dr. Cole would report back to Du Pont a conclusion about whether his stress condition warranted disability leave, but believed any such communication would be limited to this conclusionary purpose. It is undisputed that Dr. Cole never obtained written authorization from appellant to release medical information to Du Pont.

During the examination, Pettus disclosed detailed information about his family history; his drinking habits in Flint; the incidents in Flint and in Hayward where he felt he was the victim of racial discrimination; his belief that Du Pont and its management were racist; his thoughts that he was beginning not to like White people, and that this bothered him; and his reoccurring skin rash.

Approximately an hour after the examination, Dr. Cole spoke with Rotter on the telephone and discussed the contents of his interview of Pettus. Dr. Cole discussed in detail appellant’s medical and emotional condition, telling Rotter that he thought appellant had an alcohol problem, that this could potentially be his most serious problem, and that appellant had a great deal of frustration and emotional difficulty. Dr. Cole opined that Pettus was disabled by work-related stress, and recommended that Pettus be given leave. Prior to this phone conversation, Dr. Cole had had no direct contact with anyone connected to Du Pont. At the time of the call he was not aware of Rotter’s position at Du Pont or of his relationship to Pettus, that of a second-line supervisor.

On June 23, 1988, Dr. Cole prepared a written report about his examination of Pettus, which was addressed to Rotter with a copy to Dr. Collins. Dr. Cole’s report contained details of Pettus’s work and family history, his drinking habits, his problems in Flint, and his thoughts of violence towards Ms. Mendonca, as well as his current psychiatric symptoms. More specifically, Dr. Cole reported that Pettus was “extremely angry, particularly at one of his coworkers, and [was] having a hard time controlling these feelings.” Dr. Cole reported Pettus’s comments about Judy Mendonca, as follows: . . Every time I see her in particular, I get awful, awful upset.’ . . . ‘That’s where the headaches come from. When I see her in the office, I look at her and just get angry. Du [P]ont has never been fair with minorities. I have been able to cope with racism all my life. I’ve begun to dislike white people, which is bothering me. I guess it’s just harder to cope with it now that I’m getting older.’ ” Dr. Cole also reported Pettus’s statement that he began “drinking excessively” three months before he was discharged from the Flint plant in 1984. In response to Dr. Cole’s question as to whether he had any guilt feelings, appellant said, “ T really regret that I didn’t hurt the guy in Flint. He ruined my whole life and I let him get away with it. I think if I saw him again, I would really try to kill him. I need to get over that.’ ”

In his written report, Dr. Cole concluded that appellant was genuinely disabled, and that it would not be in appellant’s best interests to return to work. Accordingly, on June 24,1988, Rotter called Pettus at home to inform him that Du Pont was granting him a 90-day disability leave. Dr. Cole further concluded that there was a “distinct possibility” that Pettus was suffering from “a primary alcohol problem.” Thus, Dr. Cole recommended that appellant be examined by a specialist in substance abuse cases. Following this suggestion, Dr. Collins referred Rotter to Dr. Unger, a psychiatrist with expertise in chemical dependency. Rotter arranged for Dr. Unger to meet with Pettus on July 6, 1988.

E. Pettus’s Consultation With Dr. Unger.

About a week before appellant’s appointment with Dr. Unger, Rotter sent a cover letter to Dr. Unger along with Pettus’s medical file, which contained the reports from Drs. Collins and Cole. In the letter, Rotter informed Dr. Unger that he had told Pettus of the appointment and that Pettus “appeared willing and cooperative.” Rotter also specifically requested that Dr. Unger: (1) determine Pettus’s mental condition and whether it would affect his ability to perform his duties as a warehouseman; (2) determine how deeply rooted his feelings of anger toward his fellow employees were; (3) determine whether he had an alcohol and/or other substance abuse problem, and, if so, how it affected his working relationships in Hayward; and (4) make recommendations for further treatment and how to proceed. In addition to the letter, Rotter communicated with Dr. Unger prior to Pettus’s evaluation in a telephone call he placed to set up the appointment. In that conversation, Rotter told Dr. Unger that there was an urgent need for the interview to take place as soon as possible because he was concerned about the potential for Pettus to commit some violent act as a result of his hostile feeling toward Du Pont and Judy Mendonca.

Dr. Unger met with Pettus on July 6, 1988. Pettus testified that the meeting lasted no more than 30 minutes. Dr. Unger maintained it was about two hours long. Pettus understood the purpose of the interview with Dr. Unger to be to the same as that of the examinations by Drs. Collins and Cole, to evaluate his request for stress-related disability leave. He was not aware of Rotter’s written request to Dr. Unger for specific information, or that Rotter intended the interview to be in part an evaluation of the likelihood he might commit some violent act. He believed that Dr. Unger’s communication with Du Pont would be limited to a conclusion about whether he was, in fact, suffering a stress-related disability. It is undisputed that Dr. Unger never obtained written authorization from Pettus to disclose medical information to Du Pont.

Based on her discussion with appellant, the reports of Drs. Collins and Cole, and a telephone conversation prior to the meeting with Rotter, Dr. Unger prepared a written report addressed to Rotter, which contained information about appellant’s family and work histories, his drinking habits, and his emotional condition. Specifically, Dr. Unger reported that Pettus suffered from deep-rooted and long-standing anger toward Du Pont, and was currently stressed beyond his ability to cope. She did not diagnose Pettus to be an alcoholic, but concluded that he was “using alcohol adversely,” and that his use of alcohol was having an impact on his emotional problems and his life generally. In answer to Rotter’s fear that Pettus might physically harm someone, Dr. Unger reported that appellant’s anger had recently focused on Ms. Mendonca, but that he was not a threat to anyone in the workplace. Dr. Unger explained that Pettus’s hostile feelings were normal and could even be therapeutic.

The first of her nine recommendations, which were listed in order of importance, was that appellant abstain for three months from alcohol use, a suggestion which appellant had come up with on his own and was willing to try. The last was that Pettus be terminated by Du Pont. Dr. Unger’s other recommendations included experimenting with different medication, and establishing an exercise and nutritional program oriented toward weight loss.

On the morning following her evaluation of appellant, Dr. Unger spoke by telephone with Rotter and discussed the meeting and her recommendations with him in detail. During the time she was in communication with Rotter about Pettus, she knew him to be appellant’s supervisor and a manager at the Hayward plant.

F. Termination of Pettus’s Employment With Du Pont.

The written reports of Drs. Collins, Cole and Unger were sent to Joseph Montovino, Du Pont employee relations manager in Wilmington, Delaware. Mr. Montovino’s task was to coordinate a review of Pettus’s situation with Du Font’s medical and substance abuse groups. To that end, Mr. Montovino forwarded the reports to Dr. Alan J. Hay of Du Font’s corporate medical department, and to Walter Beam, the director of Du Font’s substance abuse program for its 140,000 employees worldwide. Based on their review of the reports and consultations between themselves and with Dr. Hay, Mr. Montovino and Dr. Beam decided that Pettus would be required to enter a 30-day, inpatient alcohol treatment program as a condition to his return to work. It was Dr. Beam’s opinion that such a program would provide the best chance for Pettus to return to work.

On August 1, 1988, Montovino and Rotter met with appellant to discuss his future with the company. Also in attendance at that meeting was Stephen Howard, regional manager for Du Pont. Pettus was told that in order to continue his employment with Du Pont, he would be required to enroll in an inpatient alcohol treatment program, possibly followed by a psychiatric program. If he was unwilling to attend such a program, then he had the alternatives of resigning and taking early permanent retirement, or seeking a disability retirement. Pettus expressed his desire to get his own physician’s opinion as to whether he was an alcoholic, which Du Pont allowed him to do.

Appellant tried to obtain an independent evaluation from his own psychiatrist, Dr. Shervington, but was unsuccessful in that attempt. Du Pont, for its part, tried to contact Dr. Shervington on numerous occasions between September 1 and September 15, but was also unsuccessful. Apparently, Dr. Shervington had met with Pettus on August 17, 1988, and informed him that he could not comply with his request for an opinion whether he needed treatment for alcohol abuse because he did not have enough information. However, Pettus did not tell Du Pont that he would not be able to provide an opinion from Dr. Shervington.

On September 21, 1988, Pettus received a letter from Rotter stating that he had to respond to Du Font’s demand that he enter the alcohol treatment program by September 26. Appellant’s employment was terminated on September 23, 1988, after he told Taylor that he would not agree to enter the alcohol rehabilitation program. At that point, Pettus discussed his dilemma with Dr. Shervington, who urged him to enroll in the alcohol treatment program, if only to demonstrate to Du Pont that he was not an alcoholic. Pettus then contacted Taylor to say he had changed his mind, but Taylor told him it was too late.

n. The Appeal From Judgment in Favor of Drs. Cole and Unger

A. Standard of Review.

As a threshold matter, we establish the standard of review for the judgment in favor of Drs. Cole and Unger. In granting that judgment, the trial court proceeded under Code of Civil Procedure section 631.8 which, in relevant part, provides: “After a party has completed his presentation of evidence in a trial by the court, the other party . . . may move for a judgment. The court as trier of the facts shall weigh the evidence and may render a judgment in favor of the moving party . . . .” (Id., subd. (a).) The purpose of Code of Civil Procedure section 631.8 is to enable the court, when it finds at the completion of plaintiff’s case that the evidence does not justify requiring the defense to produce evidence, to weigh evidence and make findings of fact. (Connolley v. Bull (1968) 258 Cal.App.2d 183 [65 Cal.Rptr. 689].)

The standard of review after a trial court issues judgment pursuant to Code of Civil Procedure section 631.8 is the same as if the court had rendered judgment after a completed trial—that is, in reviewing the questions of fact decided by the trial court, the substantial evidence rule applies. An appellate court must view the evidence most favorably to the respondents and uphold the judgment if there is any substantial evidence to support it. (Rodriguez v. North American Rockwell Corp. (1972) 28 Cal.App.3d 441, 447 [104 Cal.Rptr. 678]; Miller v. Dussault (1972) 26 Cal.App.3d 311, 316 [103 Cal.Rptr. 147].) However where, as here, we are called upon to review a conclusion of law based on undisputed facts, we are not bound by the trial court’s decision and are free to draw our own conclusions of law. (Torrey Pines Bank v. Hoffman (1991) 231 Cal.App.3d 308, 317 [282 Cal.Rptr. 354].)

B. Pettus’s Claim Under Section 56.10.

Pettus first contends that, as a matter of law, Drs. Unger and Cole violated the CMIA when they disclosed to his supervisors at Du Pont the detailed reports of his psychiatric evaluations. For reasons we will elaborate, we agree.

1. An Overview of the CMIA.

The CMIA was originally enacted as Senate Bill No. 480 in 1979. (See Stats. 1979, ch. 773, § 1, p. 2645.) Senate Bill No. 480 was heavily criticized for being organizationally unsound, ambiguous and practically impossible to implement, and was subject to a series of moratoria which prevented it from ever taking effect. (Sen. Com. on Judiciary, Background Information to Sen. Bill No. 889; see also Heller v. Norcal Mutual Ins. Co. (1994) 8 Cal.4th 30, 38 [32 Cal.Rptr.2d 200, 876 P.2d 999].) In 1981, Senate Bill No. 480 was repealed by Senate Bill No. 889, and the CMIA was reenacted as amended. (Stats. 1981, ch. 782, §§ 1.5, 2, p. 3040.) One major criticism of the original version of the CMIA was that it left unclear whether certain medical information could be released without an authorization. (Letter from California Hospital Association to Governor Edmund G. Brown, Sept. 21,1981.) Unfortunately, this shortcoming was not completely resolved when the Act was amended to its present form. (See Heller v. Norcal Mutual Ins. Co., supra, 8 Cal.4th at pp. 38-42.)

The basic scheme of the CMIA, as amended in 1981, is that a provider of health care must not disclose medical information without a written authorization from the patient. Section 56.10, subdivision (a), provides that: “No provider of health care shall disclose medical information regarding a patient of the provider without first obtaining an authorization, except as provided in subdivision (b) or (c).” As our Supreme Court has observed, “Considered together, the statutory provisions require a health care provider to hold confidential a patient’s medical information unless the information falls under one of several exceptions to the act.” (Heller v. Norcal Mutual Ins. Co., supra, 8 Cal.4th at p. 38.)

The “authorization” requirements, which are found in section 56.11, are detailed and demanding, reflecting the Legislature’s interest in assuring that medical information may be disclosed only for a narrowly defined purpose, to an identified party, for a limited period of time. For an authorization to be valid it must be handwritten or typed, in language clearly separate from any other language on the same page, and properly signed and dated by the patient or one of the permissible substitutes enumerated under the Act. The signature must serve no other purpose than to execute the authorization. (§56.11 subds. (a), (b) & (c).) The authorization must state “the specific uses and limitations on the types of medical information to be disclosed!,] HD . . . the name or functions of the provider of health care that may disclose the information!,] [H • • • the name or functions of the persons or entities authorized to receive the medical information!,] [H • • • the specific uses and limitations on the use of the medical information by the persons or entities authorized to receive the medical information!,] [Ü . . . a specific date after which the provider of health care is no longer authorized to disclose the medical information!,]" and that the person signing the authorization has been advised of the right to receive a copy of the authorization. (§ 56.11, subds. (d)-(i).)

Under normal circumstances, where there is no valid authorization there can be no disclosure. (§ 56.10, subd. (a).) However, a provider who has made an unauthorized disclosure is relieved from liability if it can show that the disclosure is excepted either by the mandatory (id., subd. (b)) or permissive (id., subd. (c)) provisions of the act, allowing disclosure of medical information without prior authorization under specified circumstances. In this case, there is no question that the disclosures were not made pursuant to a section 56.11 authorization.

The Act provides that disclosure is mandatory even in the absence of an authorization when compelled by court order, subpoena, or search warrant or “otherwise specifically required by law.” (§ 56.10, subd. (b)(l)-(7).) These mandatory disclosure provisions do not apply here.

The Act also provides that disclosure is permissible without an authorization in several types of situations. The dispute in this case is over which of these permissive disclosure provisions, if any, applies to the facts at hand and whether the disclosures made by Drs. Unger and Cole violated the applicable provision.

It is important to note that even the permissive disclosure exceptions do not always allow full disclosure of all medical information. The exceptions recognize that in some circumstances a legitimate need for access to medical information may conflict with an individual’s interest in keeping that information confidential, and attempt to strike a balance. Thus, under some of the exceptions described in section 56.10, subdivision (c)(1) through (14) the Legislature established parameters within which disclosure is permissible and allowed disclosure of only that information which is necessary to achieve the legitimate purpose addressed by the particular exception.

The list of permissive exceptions is lengthy, and some are difficult to rationalize. To discern which of the exceptions the Legislature intended to apply to the circumstances of this case, it is useful to look at the range of situations contemplated by the exceptions. Disclosure to other health care providers is permissible “for purposes of diagnosis or treatment of the patient.” (§ 56.10, subd. (c)(1).) Disclosure is permissible to an entity responsible for paying a medical bill (and to billing services) “to the extent necessary to allow responsibility for payment to be determined and payment to be made.” (Id.., subd. (c)(2), (3).) Disclosure is permissible to groups performing peer review “or to persons or organizations insuring, responsible for, or defending professional liability which a provider may incur,” if the groups or persons “are engaged in reviewing the competence or qualifications of health care professionals or in reviewing health care services with respect to medical necessity, level of care, quality of care, or justification of charges.” (Id., subd. (c)(4).) Disclosure is permissible for the purpose of licensing or accrediting a provider of health care (id., subd. (c)(5)); for the purpose of a coroner’s investigation (id., subd. (c)(6)); and for bona fide medical research, provided that no information so disclosed should be further disclosed by the recipient in any way which would permit identification of the patient (id., subd. (c)(7)).

Under section 56.10, subdivision (c)(8), a “provider of health care that has created medical information as a result of employment-related health care services to an employee conducted at the specific prior written request and expense of the employer may disclose to the employee’s employer that part of the information which: [H (A) Is relevant in a law suit, arbitration, grievance, or other claim or challenge to which the employer and the employee are parties and in which the patient has placed in issue his or her medical history, mental or physical condition, or treatment, provided it may only be used or disclosed in connection with that proceeding. [<]D (B) Describes functional limitations of the patient that may entitle the patient to leave from work for medical reasons or limit the patient’s fitness to perform his or her present employment, provided that no statement of medical cause is included in the information disclosed.”

Section 56.10, subdivision (c)(9), provides: “Unless the provider is notified in writing of an agreement by the sponsor, insurer, or administrator to the contrary, the [medical] information may be disclosed to a sponsor, insurer, or administrator of a group or individual insured or uninsured plan or policy which the patient seeks coverage by or benefits from, if the information was created by the provider of health care as the result of services conducted at the specific prior written request and expense of the sponsor, insurer, or administrator for the purpose of evaluating the application for coverage or benefits.”

Disclosure is also permissible to a group practice plan for the purpose of administering the group practice plan (§56.10, subd. (c)(10)); to insurance agents in compliance with certain Insurance Code provisions (id., subd. (c)(ll)); to a probate court investigator under certain circumstances (id., subd. (c)(12)); to a tissue bank, under specified circumstances (id., subd. (c)(13)); and when the disclosure is “otherwise specifically authorized by law” (id., subd. (c)(14)).

Most of these permissive disclosure exceptions can be easily eliminated as inapplicable to the fact situation here. Respondents Unger and Cole argue that section 56.10, subdivision (c)(8)(A) and (9) both apply, and that the disclosures made in this case were permitted under both subparagraphs. Appellant argues that subdivision (c)(8)(B) is the applicable provision and that the disclosures were not protected under it. Adhering to the fundamental canon of statutory interpretation to “give meaning to every word and phrase in the statute to accomplish a result consistent with the legislative purpose” (Harris v. Capital Growth Investors XIV (1991) 52 Cal.3d 1142, 1159 [278 Cal.Rptr. 614, 805 P.2d 873]), we read each exception listed in subdivision (c)(1) through (14) in pari materia. Doing so, we conclude that subdivision (c)(8)(B) is the provision most apposite to the facts at hand and that it therefore governs this case. We further conclude that the disclosures made by Drs. Unger and Cole exceeded the parameters established in subdivision (c)(8)(B), which limit the permissible disclosure to a description of any “functional limitations” and explicitly prohibit disclosure of “medical cause” of the limitation.

2. Pettus was a “Patient” of Drs. Cole and Unger for Purposes of the CMIA.

Before turning to the merits of appellant’s claim under the CMIA, we must dispose of Dr. Cole’s threshold argument that Pettus is not protected by section 56.10 because he does not qualify as a “patient” within the meaning of the statute. We disagree with Dr. Cole’s interpretation, and find it contrary to both the letter and spirit of the statute. Under the CMIA, a patient is “any natural person, whether or not still living, who received health care services from a provider of health care and to whom medical information pertains.” (§ 56.05, subd. (c).) Another pertinent definition is that of “medical information,” which means “any individually identifiable information in possession of or derived from a provider of health care regarding a patient’s medical history, mental or physical condition, or treatment.” (§ 56.05, subd. (b).)

Dr. Cole contends that no health care services were provided to or received by Pettus, and that, therefore, he was not a “patient” under section 56.10. In support of this contention Dr. Cole claims that the psychiatric evaluation he performed was for the sole purpose of advising Pettus’s employer of his findings with respect to appellant’s disability claim, not to advise Pettus. Though his report made explicit recommendations for treatment, he argues these recommendations were generated for Du Font’s information. He further contends that Pettus was not a “patient” because he saw Pettus on a single occasion, no care or treatment was contemplated, and no doctor/patient relationship existed between them.

When the definition of patient is construed in relation to the other statutory definitions and in view of the statute’s purpose, respondent Cole’s position is patently untenable. It is undisputed that Dr. Cole’s meeting with Pettus generated highly sensitive medical information which was subsequently reported to Du Pont. According to statutory definitions, “medical information” is information “derived from a provider of health care" and a patient is someone who has received health care services from a provider of health care and to whom medical information pertains. (§ 56.05, subds. (b), (c).) Unfortunately, the term “health care services” is not defined by the Act. However, logic dictates that in order for a health care provider to gather medical information about a person, the provider must have dealt with the person at some level and performed professional services of some type. By failing to include the term “health care services” in the list of definitions, the drafters failed to define the precise level of interaction between the provider and the subject necessary to constitute “health care services.” It is, however, appropriate to construe the term in a manner which effectuates the purpose of the statute. (Harris v. Capital Growth Investors XIV, supra, 52 Cal.3d at p. 1159.) Doing so, we find that Pettus is a “patient” for purposes of section 56.10. The Legislature clearly intended for the statute to afford employees in Pettus’s situation—i.e., where the employer has requested and paid for a medical examination to determine the validity of a claim for medical leave benefits—some protection by imposing a duty on health care providers involved in the procedure a duty to maintain, at least to a limited degree, the confidentiality of the employee’s medical information. (See § 56.10, subd. (c)(8)(B).) Indeed, subdivision (c)(8)(B) expressly refers to an employee who is examined by a health care provider, at the employer’s request and expense, as a “patient.”

We do agree, however, that the traditional doctor/patient relationship, with the host of concomitant duties created by such a relationship, was not established between appellant and the respondent psychiatrists. This is the proposition for which both cases cited by Dr. Cole in his opening brief stand. In Felton v. Shaeffer (1991) 229 Cal.App.3d 229 [279 Cal.Rptr. 713], the defendant physician performed a preemployment physical on plaintiff and made an erroneous conclusion about the plaintiff’s fitness which caused him to be rejected by the employer. The court held against the plaintiff in subsequent actions against the physician for negligence and medical malpractice, finding that defendant’s sole function was to provide information to the prospective employer, that no doctor/patient relationship was created, and that, therefore, defendant owed no duty of care to the plaintiff. In Keene v. Wiggins (1977) 69 Cal.App.3d 308 [138 Cal.Rptr. 3], plaintiff was a worker sent to defendant doctor by his workers’ compensation carrier for examination following an industrial accident. The doctor wrote a letter to the insurance carrier opining no treatment was necessary. Plaintiff received a copy of the report and allegedly relied on it to his detriment. The court held the doctor was not liable to the plaintiff for negligence or medical malpractice in making the report since the doctor conducted the examination only for the purpose of rating the plaintiff’s injury for the insurance carrier. The court further held that there was no doctor/patient relationship of the sort giving rise to a duty of care owed to the plaintiff in connection with the medical report.

In the case before us, plaintiff is similarly situated in that he is bringing an action against a doctor who examined him at the request of a third party, his employer, Du Pont. If Pettus brought a professional negligence claim against Dr. Cole or Dr. Unger, he would likely be defeated under the authority of Keene and Felton. Pettus, however, does not rely on common law theories of negligence or medical malpractice. Rather, he is seeking to enforce a duty of confidentiality codified in the CMIA. For purposes of that statute he is, clearly, a “patient.”

3. Section 56.10, subdivision (c)(8)(B) Governs the Type of Disclosure at Issue in This Case.

It is not clear from either the trial court’s reasons for decision or its comments at trial under which portion of section 56.10 the court rejected Pettus’s CMIA claim against Drs. Cole and Unger. In granting the nonsuit to the psychiatrists, the court concluded that Du Pont was entitled to “full and complete information,” stating: “It is the court’s opinion that doctors Unger and Cole both gave a report fully within the authorization of section 56.10, that there was nothing inappropriate, that the employer was indeed entitled to secure full and complete information. That was what they were doing. [cJfl First they sent him to a general doctor, and the general doctor said it has got some psychiatric overlay and underlay. [*]Q And the psychiatrist said I can’t tell if it is engendered from ingestion of a substance, whether overuse of sugar, or thyroid, or something else, or alcohol, or whether it is purely a psychiatric chemical problem within the mind. I don’t know. I think you need to talk to somebody that specializes in that area. [U And they did. And the doctor responded to the questions. [‘JQ I’m going to grant the non-suit as to the doctors.” When plaintiff’s counsel asked the court to clarify whether it made “a specific ruling on what exception to section 56.10[, subdivision] (a) applied,” the court replied, “No. 56.10. I’m not going to go further than that.”

In its reasons for decision, the trial court utterly failed to deal with the specific terms of the statute. The court prefaced its short discussion about the disclosure with its conclusion that Du Pont had the right to request and receive the information the psychiatrists disclosed: “Defendant [Du Pont] was entitled under the law generally and specifically under published company policy to verify through their own employed or retained doctors any asserted or claimed medical disability to work. [