What limitations exist, if any, on a defendant’s ability to obtain a plaintiff’s complete medical history, both pre and post incident?

In the District of Columbia, a party “may obtain discovery regarding any nonprivileged matter that is relevant to any party’s claim or defense and proportional to the needs of the case, considering the importance of the issues at stake in the action, the amount in controversy, the parties’ relative access to relevant information, the parties’ resources, the importance of the discovery in resolving the issues, and whether the burden or expense of the proposed discovery outweighs its likely benefit. Information within this scope of discovery need not be admissible in evidence to be discoverable.”  D.C. R. R.C.P. 26(b)(1).[1]  This includes a plaintiff’s relevant medical history.

The District of Columbia recognizes the physician-patient privilege.  Section 14-307 of the D.C. Code provides that a physician, surgeon, or mental health professional is not permitted, without the consent of the client or his legal representative, to disclose the patient’s confidential health information.  See D.C. Code § 14-307(a).  This privilege is evidentiary in nature only and “extends no further than the courtroom door.”  Richbow v. District of Columbia, 600 A.2d 1063, 1068 (1991).  Thus, the District of Columbia Court of Appeals has concluded that “ex parte interviews with a treating physician are a permissible means of informal discovery when the plaintiff has put the medical condition of that physician’s patient at issue by filing a lawsuit.”  Street v. Hedgepath, 607 A.2d 1238, 1247 (D.C. App. 1992).

A plaintiff waives the privilege against disclosure of relevant medical evidence by placing his or her physical condition in issue in the lawsuit.  Street, 607 A.2d at 1246.  Further, “[a] patient-litigant may not authorize disclosure of only those portions of the medical records favorable to that party’s position, while withholding other relevant portions which are unfavorable.” Nelson v. U.S., 649 A.2d 301, 308 (1994).  A plaintiff who waives the physician-patient privilege may not subsequently preclude the physician from offering expert opinion ground on the same.  Richbow v. District of Columbia, 600 A.2d 1063, 1070 (1991).  Additionally, “[a]n authorization for release of medical information contained in a contract of insurance has been equated with the waiver of the physician-patient privilege where pertinent to a suit for recovery under the policy.”  Nelson, 649 A.2d at 308.  The waiver is not unlimited in scope, however, and it “extends only to medical information relevant to the . . . claim.”  Street, 607 A.2d at 1246.

The District of Columbia Rules also provide model interrogatories that relate to a plaintiff’s bodily injury and medical history, indicating that the discovery of certain medical and health information is discoverable.  See D.C. Super. Ct. R. Civ., Model Interrogatories, Section F (containing interrogatories related to a plaintiff’s bodily injuries), Section H (interrogatories on a plaintiff’s medical history).

Medical bills, paid or unpaid, can form the basis of a plaintiff’s special damages and serve as evidence of damages.  See Worjloh v. Stephens, 835 A.2d 1093, 1095 (D.C. 2003); Hawthorne v. Canavan, 756 A.2d 397, 399–400 (D.C. 2000).  Where a plaintiff testified that she had received medical treatment for injuries resulting from an assault, a medical bill for this treatment was properly admitted into evidence even though no doctor had testified to its authenticity.  Montgomery v. Dennis, 411 A.2d 61, 62 (D.C. 1980).  Further, “medical bills may be admitted into evidence without direct testimony establishing their reasonableness.”  Montgomery, 411 A.2d at 62 n. 5.  A jury may not simply discount a plaintiff’s damages to zero when evidence of treatment and medical bills are admitted without objection.  Worjloh, 835 A.2d at 1095.

The District of Columbia recognizes the “collateral source rule,” which provides “that when a tort plaintiff’s items of damage are reimbursed by a third-party who is independent of the wrongdoer, the plaintiff may still seek full compensation from the tortfeasor even though the effect may be a double recovery.”  Caglioti v. District Hosp. Partners, LP, 933 A.2d 800, 815 (D.C. 2007); see also Bushong v. Park, 837 A.2d 49, 57 (2003) (“The collateral source rule provides, as a general proposition, that an injured party may recover full compensatory damages from a tortfeasor regardless of the payment of any amount of those damages by an independent party (a ‘collateral source’), such as an insurance carrier.”).  The rule applies when “(1) a payment to the injured party came from a source wholly independent of the tortfeasor, or (2) ‘when the plaintiff may be said to have contracted for the prospect of a double recovery.’”  Hardi v. Mezzanotte, 818 A.2d 974, 984 (D.C. 2003) (quoting District of Columbia v. Jackson, 451 A.2d 867, 873 (D.C. 1982)).  Accordingly, there are no offsets or reductions in damages awarded based upon whether particular bills are paid.  See Hardi, 818 A.2d at 985.