Royal Women's Hospital v Medical Practitioners Board
[2005] VSC 225
•29 June 2005
| IN THE SUPREME COURT OF VICTORIA | Not Restricted | |
AT MELBOURNE
COMMON LAW DIVISION
No. 8917 of 2004
| ROYAL WOMEN'S HOSPITAL | Appellant |
| v | |
| MEDICAL PRACTITIONERS BOARD OF VICTORIA | Respondent |
---
JUDGE: | GILLARD J. | |
WHERE HELD: | MELBOURNE | |
DATE OF HEARING: | 28 and 29 April 2005 | |
DATE OF JUDGMENT: | 29 June 2005 | |
CASE MAY BE CITED AS: | Royal Women's Hospital v Medical Practitioners Board | |
MEDIUM NEUTRAL CITATION: | [2005] VSC 225 | |
---
Complaints against Medical Practitioners – Investigation by Medical Practitioners Board – Search warrant to seize hospital and medical records – Objection to production of documents seized – Relied on grounds of privilege under s.28(2) Evidence Act 1958, a right to refuse under s.141(2) Health Services Act 1988 and public interest immunity based on class of documents – Section 28(2) Evidence Act only applies to curial proceedings and investigation under Accident Compensation Act – No basis for refusal under Health Services Act – Immunity does not apply – Public interest immunity of proper investigation on all evidence outweighs public interest in hospital maintaining confidential relationship.
---
APPEARANCES: | Counsel | Solicitors |
| For the Appellant | Mr P. Lacava, S.C. with Dr S. McNicol | Middletons |
| For the Respondent | Mr T. Ginnane, S.C. with Dr S. Donaghue | Minter Ellison |
HIS HONOUR:
This is an appeal from orders made by a Magistrate that documents which had been seized pursuant to a search warrant be handed to the entity which had obtained the search warrant. The learned Magistrate in reaching the decision and making the orders held that there was no basis for refusing the request to examine the documents.
Parties
The appellant, Royal Women’s Hospital (“the Hospital”) is a body corporate operating a public health service within the meaning of the Health Services Act 1988.[1] It operates a public hospital in Carlton, specialising in maternity cases and health of women. It enjoys a reputation as a centre of excellence in the health care of women.
[1]See s.31.
The respondent, the Medical Practitioners Board of Victoria (“the Board”) was established by the Medical Practice Act 1994 (“the Act”), is a body corporate and has, inter alia, functions of regulating the standards of medical practice in the public interest and investigating the professional conduct, performance and ability to practise of registered medical practitioners.[2]
[2]See ss.65 and 66 of the Medical Practice Act.
In addition to the named parties, there are other persons who were involved in the circumstances which led to the application before the Magistrates’ Court. Senator Julian McGauran is a Senator for the State of Victoria who in May 2001 made a complaint to the Board.
Mrs X is a person who underwent a termination of a 32 week old foetus at the Hospital in February 2000. There are a number of registered medical practitioners who were on the staff of the Hospital at the relevant time and whose conduct is the subject of the complaint made to the Board. On 8 December 2004 Master Wheeler made an order pursuant to s.18 of the Supreme Court Act 1986 suppressing the publication of the names of Mrs X and any treating medical practitioners involved in the complaint to the Board made by Senator McGauran. By reason of the order made I will refer to the patient as Mrs X, the doctors the subject of the complaint collectively as “the doctors”, and any non‑medical staff as “staff of the hospital”.
Basic Facts
In late January 2000, Mrs X attended the hospital emergency department requesting the termination of her pregnancy. She had been informed as a result of a recent ultrasound that her foetus, which was approximately 32 weeks old, may have skeletal dysplasia, commonly known as dwarfism. She was referred for counselling. A further ultrasound taken some days later confirmed the skeletal dysplasia. Mrs X became hysterical and suicidal and demanded that her pregnancy be terminated. She was referred to a psychiatrist for counselling and assessment and it appears that the psychiatrist some days later recommended termination of the pregnancy to preserve the psychiatric health and life of Mrs X. Various medical practitioners within the hospital were consulted and after consultation they concurred with the recommendation and in early February 2000 a foetal reduction procedure was undertaken and Mrs X delivered a female by stillbirth.
On or about 8 May 2001, Senator McGauran made a complaint concerning the termination. On 13 March 2002, Senator McGauran delivered a speech to the Senate in which he raised questions of the propriety of the termination. In the course of that speech, the Senator said:
“There was a misdiagnosis of the child’s disability of dwarfism. The baby did not have dwarfism but was found to be normal on delivery.”
In April 2002 the Board determined to conduct a preliminary investigation into the matters and delegated its power to conduct a preliminary investigation to a sub-committee. It was made clear by Mrs X and her solicitors that she did not wish to have any involvement in the investigation and she declined to waive her right to refuse access to her medical records.
The sub-committee carried out a preliminary investigation but was hampered by the lack of medical records concerning the treatment provided to Mrs X. On 26 June 2003 the Board obtained from the Magistrates’ Court a search warrant which was executed and the documents seized from the Hospital were lodged with the Court. The Hospital made an application seeking an order that the documents seized be returned and on 31 July 2003 an order was made by consent that the documents be returned.
On 28 October 2003 the Board applied for a further search warrant which was declined but eventually on 13 November 2003 the Magistrates’ Court issued a search warrant which was executed on 18 November 2003. The documents seized by the Board were lodged with the Court to be “dealt with according to law”.[3]
[3]See s.93A(2)(c) of the Act.
On 18 November 2003 the Hospital made application to the Court seeking an order that the documents seized be returned to the Hospital. Thereafter orders were made for directions and the application eventually came on for hearing before a Magistrate on 15 March 2004. The matter was heard, concluding on 19 March 2004. Senior and junior counsel appeared for the Hospital and the Board before the learned Magistrate. A number of issues were raised by the hospital, including issues relating to the validity of the search warrant. In a reserved judgment delivered on 8 October 2004, the Magistrate published her reasons, dealt with the issues raised concerning the search warrant and its execution, and considered and determined the issues raised by the Hospital relating to privilege and public interest immunity. The learned Magistrate found against the Hospital in respect to all issues raised and ordered that the Hospital’s application be refused and that the documents seized pursuant to the search warrant issued on 13 November 2003, with the exception of those which attracted legal‑professional privilege, be released to the Board. The Hospital was ordered to pay the Board’s costs of the application. A stay of 30 days was granted.
Issues raised before the Magistrate
In light of the grounds relied on in this appeal, it is unnecessary to consider the reasons of the learned Magistrate in relation to all issues decided by her. It is necessary to consider the three grounds relied upon by the Hospital for an order excluding the production of the documents to the Board.
The Hospital submitted that the documents should not be delivered to the Board because –
(i)s.28(2) of the Evidence Act 1958 precluded the divulging of any information acquired by a medical practitioner in attending the patient without the consent of the patient;
(ii)the provisions of s.141(2) of the Health Services Act 1988 precluded the handing over of any information concerning a patient except in certain circumstances, and the exceptions did not apply to the documents seized pursuant to the warrant;
(iii)the handing over of the documents would be contrary to the public interest and a public interest immunity existed in relation to the records and documents held by the Hospital in relation to Mrs X and accordingly they were immune from production.
The learned Magistrate held that the grounds relied upon by the Hospital were not established and made the orders referred to above.
Appeal
On 4 November 2004 the Hospital filed an application to appeal to this Court pursuant to s.109 of the Magistrates’ Court Act 1989. The appeal was instituted pursuant to Rule 58.07 of the Rules of Court by filing a notice of appeal. The notice of appeal raised the following questions of law, namely:
(i)whether the documents the subject of the search warrant were subject to the protection of s.28(2) of the Evidence Act 1958;
(ii)whether the documents the subject of the search warrant were subject to the protection of s.141(2) of the Health Services Act 1988; and
(iii)whether the principle of public interest immunity applied to the documents the subject of the search warrant as a class of documents, resulting in those documents not being required to be produced.
The grounds of appeal were that the learned Magistrate was in error in failing to determine that the documents were subject to the protection of s.28(2) of the Evidence Act and s.141(2) of the Health Services Act 1988 and was also in error in failing to find that the documents were excluded from production by the principle of public interest immunity.
The documents
The documents seized comprised the hospital file which contained a variety of documents relating to Mrs X, prepared and/or endorsed by members of the medical profession and also nurses who attended Mrs X. In addition, there were documents relating to an investigation carried out internally by the Hospital in relation to the treatment of Mrs X.
An appeal under s.109 of the Magistrates’ Court Act is an appeal on a question of law. It follows that in order to succeed in the appeal the appellant must establish an error of law by the Magistrate and persuade this Court that if the error of law had not occurred the appellant would have been successful in the proceeding in the Magistrates’ Court.
Doctor-patient privilege
There are a number of well established principles of law concerning the doctor-patient relationship. They are the background to the enactment in 1857 by the Parliament of the Colony of Victoria of a statutory privilege applying in certain circumstances where there was a doctor-patient relationship.
·At common law there is no privilege attaching to information ascertained in a doctor-patient relationship which precludes its disclosure to others. This has been the law for many years.[4]
·The relationship of doctor-patient is a confidential one and equity precludes a party to the relationship from disclosing any information without the consent of the other party. This is the general rule and courts may grant an injunction to restrain the disclosure of the information.
·The law has recognised a need to break a confidence in a doctor‑patient relationship in the interests of the public and accordingly the general rule applies “save in very exceptional circumstances”.[5]
[4]Duchess of Kingston’s case (1776) 20 Stat Tr 355 at 572-3; Russell v Jackson (1851) 9 Hare 387 at 391-2; 68 ER 558 at 559-60.
[5]Hunter v Mann [1974] QB 767 at 772; A v Hayden (1984) 156 CLR 532.
The confidential relationship however will not withstand the law compelling disclosure such as the obligation to give evidence as a witness, the production of documents pursuant to discovery or subpoena or the reach of a search warrant.[6] The confidential relationship must give way to compulsion imposed by law to give evidence or to provide documents.
[6]Baker v Campbell (1983) 153 CLR 52 at 66, 75, 94 and 128, and D v National Society for the Prevention of Cruelty to Children [1978] AC 171 at 218, 230 and 237.
It follows that at common law a doctor could not refuse to answer questions in court because of any obligation of confidentiality. Equally a doctor could not refuse to comply with the demands of a search warrant to produce documents on the ground of confidentiality.
In 1857, the legislature of the Colony of Victoria passed an Act which gave a measure of protection to a patient, restricting a medical practitioner from divulging any information obtained for the purposes of treatment in a “civil suit action or proceeding”. The enactment has been amended and re-enacted from time to time. Today it is found in s.28(2) of the Evidence Act 1958. It provides:
“(2)No physician or surgeon shall without the consent of his patient divulge in any civil suit action or proceeding or an investigation by a Complaints Investigator under the Accident Compensation Act 1985 any information which he has acquired in attending the patient and which was necessary to enable him to prescribe or act for the patient.”
The Hospital relies upon s.28(2) and submits that the protection given to the patient pursuant to that sub-section precludes the handing over of the hospital records to the Board’s Investigating Committee. It submits that the Court must give effect to each word in s.28(2) and that the phrase “civil suit action or proceeding” is not confined to court proceedings but is wider; that the word “proceeding” is sufficiently wide to cover an investigation which is inextricably bound up with the hearing of a complaint against a medical practitioner by the Board.
The Board
It is necessary at this stage to briefly outline the Board’s jurisdiction, powers and obligations under the Act. The Board was created by the Act and accordingly its jurisdiction, powers, authority and obligations are to be found within the four corners of the Act which created it. In addition to the express powers set out in the Act, there would be implied powers such as the implied power to do all things necessary to give effect to the exercise of its jurisdiction or authority under the Act.
The following summarises the Board’s jurisdiction, authority and obligations under the Act with particular reference to it investigating, considering and determining a complaint against a medical practitioner:
· The Board is a body corporate created by the Act.[7]
[7]See s.65.
· It has a number of functions including a function to regulate the standards of medical practise in the public interest.[8]
[8]See s.66(1)(ab).
· It has power to investigate the professional conduct of registered medical practitioners, to hold hearings into a complaint and to impose a punishment where appropriate.[9]
[9]See s.66(1)(c) and Part 3 of the Act.
· The Board must investigate a complaint if it concerns the professional conduct of a registered medical practitioner, provided the complaint has not been dealt with by the Health Services Commission and the Board has not determined the complaint to be frivolous or vexatious.[10] It is pursuant to this authority and obligation that the Board has commenced the investigation in the present matter.
[10]See ss.22 and 25(1).
· The Board must conduct a preliminary examination into the complaint in order to determine whether or not to conduct a hearing into the complaint.[11] The Board does in fact have power of its own motion to conduct a hearing without conducting a preliminary investigation.[12] The Board has commenced an investigation in the present matter.
[11]See s.24(2).
[12]See s.26.
· The Board may delegate its power to conduct a preliminary examination.[13] It has done so in the present matter and has appointed a sub-committee of the Board comprising three members of the Board to carry out the preliminary investigation.[14]
[13]See s.24(3).
[14]See s.24(3)(c).
· There are no express provisions in the Act dealing with the preliminary investigation into a complaint of unprofessional conduct. However, the purpose of the preliminary investigation is to consider the complaint and decide whether to make a recommendation to the Board under s.38K. By way of example, that the complaint not be investigated further or that a hearing be held into the complaint.
· On completion of the investigation, the body conducting it is authorised to make one of four recommendations.[15] The Board must then determine whether or not to act on the recommendation.[16]
[15]See s.38K(1).
[16]See s.25.
· The Board having made a determination under s.38K(2) that a hearing take place, if it is an informal hearing the Board must appoint a panel to hold the hearing, give notice to the practitioner and the complainant and fix a time and place for the hearing.[17]
[17]See s.39.
· The Act does not expressly define the difference between the requirement to have an informal or a formal hearing but it can be gathered from Division 3A of Part 3 that an informal hearing is one where the alleged unprofessional conduct is not of a serious nature.[18]
[18]See ss.42 and 43.
· However an informal hearing may be converted into a formal hearing if before the end of it, the practitioner fails to attend or he or she requests that a formal hearing be held or the panel is of the opinion that a formal hearing should be held. In those circumstances the matter is then referred to a formal hearing.[19]
[19]See s.44.
· Divisions 3A and B of Part 3 deal with the establishment and conduct of formal and informal hearings.
· A formal hearing which takes place in relation to a serious charge of unprofessional conduct is to be open to the public unless the panel determines it should be closed.[20]
· The range of penalties in relation to the outcome of an informal hearing are significantly less severe[21] than the range of penalties open to the panel where an adverse finding is made against the registered medical practitioner.[22]
[20]See s.49(d).
[21]See s.43(2).
[22]See s.45A.
The complaint made in the present proceeding is the subject of a preliminary investigation. The Act empowers the Board through a person appointed for the purpose, to apply to a Magistrate for the issue of a search warrant.[23] One of the bases for applying for the issue of a search warrant is that it is necessary for the purpose of investigating a complaint made under the Act, “which, if substantiated, may provide grounds for the suspension or cancellation of registration of a medical practitioner”.[24] The section gives jurisdiction to a Magistrate to issue a search warrant.[25] A search warrant was issued on 13 November 2003 and it was executed on 18 November 2003 on the Hospital. The search warrant must be issued in accordance with the Magistrates’ Court Act 1989 and the rules with respect to search warrants stated in that Act extend and apply to warrants under the Medical Practice Act 1994. The warrants when issued require the person who seized anything named or described in the warrant to bring the thing before the court “so that the matter may be dealt with according to law”.[26] This occurred, the Hospital objected to the documents seized being handed over to the Board, and the learned Magistrate ordered that the documents be released to the Board.
Interpretation of s.28(2) of the Evidence Act 1958
[23]See s.93A(1).
[24]See s.93A(1)(d).
[25]S.93A(2).
[26]See 93A(2)(c).
It was submitted by the Hospital, that s.28(2) of the Evidence Act precluded the Hospital handing over the documents without the consent of the patient, Mrs X. She had declined to give her permission. It was submitted that on a proper construction of the sub‑section, the phrase “any civil suit action or proceeding” covered an investigation under the Act. Alternatively, the phrase covered any hearing that may result from an investigation and since the investigation was inextricably bound up with the hearing, it must have been the intention of Parliament that the privilege should extend to the investigation. It was submitted that the natural and ordinary meaning of the words in the phrase must be given effect to, and that a court in construing a statutory provision must give effect to each and every word used. It was submitted that the sub-section was not confined to a hearing or proceeding in a court. The Board submitted that when the provision was first enacted in 1857, it was clear that the phrase “any civil suit action or proceeding” referred to a court proceeding, that the courts had so construed the provision, and when it was re‑enacted in 1890, 1915, 1928 and 1958, Parliament re-enacted the provision with the knowledge that the phrase had been confined to court‑type proceedings. The Board further submitted that an amendment to the provision in 1987 which added the words “or an investigation by a Complaints Investigator under the Accident Compensation Act 1985” is cogent evidence that Parliament had proceeded on the understanding which was in accordance with the authorities that the sub-section only applied to court proceedings.
Section 28(2) was first enacted in 1857 by Act No. VIII called an Act to consolidate and amend the Law of Evidence known as the Law of Evidence Consolidation Act. Before considering the provision, it is necessary to briefly state the historical setting. The English Parliament in 1850 passed an Act called an Act for the Better Government of Her Majesty’s Australian Colonies which received the royal assent on 5 August 1850. It reached the colony on 11 January 1851, was proclaimed on 13 January, and in accordance with s.37 it came into operation. The Act created a new colony of Victoria and provided for constitutional government and the administration of justice. On 13 January 1851 the Colony of Victoria became a self‑governing body. The existing Legislative Council continued in office and was obliged to prepare a new constitution. Up until January 1851, the statutory laws that applied in the Colony of Port Phillip were those enacted by the Imperial Parliament and the Legislature of the Colony of New South Wales. A number of laws had been passed concerning evidence and they are conveniently identified in the first schedule to the Law of Evidence Consolidation Act of 1857. The Imperial Act of 1850 contemplated the establishment of the Supreme Court of Victoria by letters patent. However, things moved quickly in the colony and by a local Act No. 10 of 1852, the Supreme Court of Victoria was established.[27]
[27]An Act to make provision for the better administration of justice in the Colony of Victoria.
The new Constitution for the Colony of Victoria was duly proclaimed on 21 May 1855. It established the Legislative Assembly. The Law of Evidence Consolidation Act of 1857 was passed by the Legislative Council and the Assembly.
Section XVIII provided:
“XVIII No clergyman of any church or religious denomination shall without the consent of the person making the confession divulge in any suit action or proceeding whether civil or criminal any confession made to him in his professional character according to the usage of the church or religious denomination to which he belongs and no physician or surgeon shall without the consent of his patient divulge in any civil suit action or proceeding unless the sanity of the patient be the matter in dispute any information which he may have acquired in attending the patient and which was necessary to enable him to prescribe or act for the patient.”
There is no argument that “physician or surgeon” covers any medical practitioner and is not confined to a specialist. In a modern setting, it may be argued with some substance, that the word “proceeding” has a wider meaning than a proceeding in a court. But in my opinion that was not the position in 1857.
In construing an Act of Parliament, the cardinal rule is that the words must be construed to give effect to the intention of the Parliament which passed the Act. The primary source of the intention of Parliament is the words themselves, to be construed in their ordinary and natural meaning taking into account the context, the Act as a whole and the evident purpose of the legislation. The words declare the intention of Parliament.
In construing the language used by the Parliament in its natural and ordinary sense, it is necessary to consider the sense in which the words were used at the time when the statute was passed. The rule as to contemporaneous exposition was first stated by Lord Coke in Inst ed. Thomas, p.2.n.(1), as follows when speaking of the Magna Charta:
“This and the like were the forms of ancient Acts and grants and the ancient Acts and grants must be construed and taken as the law was holden at the time when they were made.”
Some centuries later Lord Cranworth said:
“It has often been held and not unwisely or improperly, that the construction of very ancient statutes may be elucidated by what in the language of the courts is called contemporanea exposito; that is, seeing how they were understood at the time they were passed.”[28]
[28]See Montrose Peerage Claim (1853) 1 Macq H.L(Sc) 401 at 406.
It is well settled that the rule only applies to statutes which have been passed many years ago. Lord Watson, speaking in 1883, said:
“Such usages as has in this case been termed contemporanea exposito is of no value in construing a British statute of the year 1858. When there are ambiguous expressions in an Act passed one or two centuries ago, it may be legitimate to refer to the construction put upon these expressions throughout a long course of years, by the unanimous consent of all persons interested, as evidencing what must presumably have been the intention of the legislature at that remote period.”[29]
[29]See Trustees of Clyde Navigation v Laird (1883) 8 App Cas 658 at 673.
The application of the contemporaneous exposition principle to the construction of an Act must be used with care because the general approach is to construe an Act in accordance with its current meaning, especially when the provision has been re‑enacted. The courts have in the past construed provisions in Acts of Parliament which could not have literally applied to the circumstances at the time of the passing of the enactment because the present circumstances could never have been contemplated at the time. Nevertheless the courts have moved with the times and held, for example, that a radio broadcast could breach the Copyright Act 1912 even though radio had not been invented at the time the Act was passed.[30] The reason is that if matters which were not known at the time when the Act was passed on a fair construction of it falls within the words then the Act does apply to the new situation.
[30]See Chappell and Co Ltd v Associated Radio Co of Australia Ltd [1925] VLR 350.
But that is not the position in the present matter. In my view the contemporaneous exposition rule applies to the construction of language found in an old statute. [31]
[31]See Campbell College, Belfast (Governor’s) v Commissioner of Valuation (North Ireland) [1964] 1 WLR 912 at 941.
Whilst it is noted that caution must be exercised in applying the rule, and that as a general rule the principles should only be applied to ancient statutes where there is some doubt as to the meaning of the words used, in my opinion it is a useful principle where the Court by reference to contemporaneous knowledge is able to conclude that the words in question had a settled meaning.
In the Campbell College, Belfast case[32] Lord Upjohn said:
“As to contemporanea expositio, this doctrine is I believe truly confined to the construction of ambiguous language used in very old statutes where indeed the language itself may have had a rather different meaning in those days. As Martin B said in Morgan v Crawshay, in delivering the opinion of the judges to your Lordships’ House: ‘In construing old statutes it has been usual to pay great regard to the construction put on them by the judges who lived at or soon after the time when they were made because they were best able to judge of the intention of the makers at the time.’ He was referring to the original poor law statute 43 Eliz. 1, c.2. In such circumstances the construction put on ambiguous expressions throughout a long course of years by the unanimous consent of all parties interested may be evidence of what must presumably have been the intention of the legislature at that remote period. See per Lord Watson in Clyde Navigation Trustee v Laird.”
[32]Supra at 941.
In Babaniaris v Lutony Fashions Pty Ltd[33] Wilson and Dawson JJ said:
“The reluctance of courts to depart from long-standing decisions of lower courts appears to be derived in part from the principle of contemporaneous exposition. The principle – contemporanea expositio est optima et fortissima in lege – has a use confined to the construction of ambiguous language in statutes which are sufficiently old for the words to have had a previous different meaning: Campbell College, Belfast (Governors) v Northern Ireland Valuation Commissioner per Lord Upjohn. This origin of the wider doctrine serves to demonstrates its limits. Some ambiguity or doubt must attend the construction of the statute before the doctrine can have any application.”
[33](1987) 163 CLR 1 at 23.
Brennan J in Corporate Affairs Commission (NSW) v Yuill[34] did not confine the application of the principle in a restrictive way. His Honour said:[35]
“The alteration of the law which Baker v Campbell prescribes evokes an application of the rule contemporanea expositio est optima et fortissama in lege – the best and surest mode of construing an instrument is to read it in the sense which would have been applied when it was drawn up: Broom’s Legal Maxims, 10th ed. (1939) p.463. And so, the answer to our first question is that the Code should be construed in the light of the law as it stood when the Code came into force – that is, the law as it stood before Baker v Campbell was decided – unless there be something in the Code which is inconsistent with the operation that would thus be attributed to the Code.”
[34](1991) 172 CLR 319.
[35]At 322.
His Honour referred with approval to what Lord Simon of Glaisdale said in Black‑Clawson Ltd v Papierwerke A.G.[36] where his Lordship said:
“… if the draftsman uses the tools of his trade correctly, the meaning of his words should actually represent what the promulgator meant to say. And the court of construction, retracing the same path in the opposite direction, should arrive, via the meaning of what was said, and what the promulgator meant to say … In order to understand the meaning of the words which the draftsman has used to convey what Parliament meant to say, the Court must so far retrace the path of the draftsman as actually to put itself in his position and that of Parliament. The expositio must be both contemporanea and eodem loco.”
[36][1975] AC 591 at 645.
I respectfully agree. It is the tracing process which may provide cogent evidence of what the intention of Parliament was at the relevant time, namely, the true meaning of the words used.
In my opinion, a consideration of provisions of various Acts passed at the beginning of the Victorian Legislature leads to the conclusion that the Parliament intended the words to refer to a proceeding in a court of law and not otherwise.
The starting point is the Act which established the Supreme Court of Victoria.
As earlier stated, the Supreme Court of Victoria was established by an Act to make provision for the better Administration of Justice in the Colony of Victoria which was assented to on 6 January 1852. It was Act No. X of 1852. It was enacted by Lieutenant Governor La Trobe with the advice and consent of the Legislative Council of the Colony. It must be remembered that the law was administered in various divisions within the Court and this was the position in England at the time. That Act established a jurisdiction at common law,[37] a criminal jurisdiction,[38] an equitable jurisdiction,[39] and an ecclesiastical jurisdiction.[40]
[37]See s.X.
[38]See s.XI.
[39]See s.XIV.
[40]See ss.XV and XVI.
Section II provided:
“That from and after the commencement of this Act a Court shall be holden in and for the Colony of Victoria and its dependencies which shall be styled ‘The Supreme Court of the Colony of Victoria’ Provided however it be enacted that no Action Suit or other proceeding at Law or in Equity or any matter or thing whether civil or criminal or relating to affairs Ecclesiastical or of any other description whatsoever which shall then be depending in the several departments of the Supreme Court of New South Wales for the District of Port Phillip shall abate … “.
(Emphasis added).
It is clear from the context that the phrase “no Action Suit or other proceeding at Law or in Equity” concerned any process then pending in “the several departments of the Supreme Court of New South Wales for the District of Port Phillip”. The phrase in my opinion was intended to embrace all process in the Court. It was a phrase used to cover the process in the various jurisdictions.
Going further back in time, it is clear that the phrase “any Suit Action or proceeding” was a phrase used by the Legislature of the Colony of New South Wales to cover any process or proceeding in a court. In an Act for improving the Law of Evidence, 26 June 1844 – 8 Vic No. 1, s.I provided:
“That no person offered as a witness, shall hereafter be excluded by reason of incapacity … from giving evidence, either in person or by deposition, according to the practice of the Court, on the trial of any issue joined or of any matter or question, or on any enquiry arising in any suit, action or proceeding, civil or criminal, in any court or before any judge jury sheriff coroner Magistrate officer or person having by law or by the consent of the parties authority to hear, receive and examine evidence in the Colony of New South Wales … “.
(Emphasis added).
It is noted that the Legislature expressly extended the operation of the provision to proceedings other than in a court but nevertheless used the phrase to cover all proceedings in the court.
The same observations may be made with respect to an Act to amend the Law of Evidence 17.9.1852 – 16 Victoria No. 9, an Act passed by the Legislative bodies of the Colony of Victoria where it is noted in s.I the following:
“Whenever any action suit or legal proceeding shall henceforth be pending in any Court in the said Colony, such Court … “.
I refer also to the use of the phrase by the Victorian Legislature in an Act to amend further the Law of Evidence 14.3.1854 – 17 Victoria No.11 – s.II. This dealt with the competence and compellability of witnesses and the section applied “in any action suit or other proceeding in any court of justice or before any person having by law or by consent of the parties authority to hear receive and examine evidence the parties thereto and the persons in whose behalf … “.
The Legislature has used the phrase to cover the process in a Court.
In 1857 the Legislature in the Colony of Victoria, which by this time comprised the Legislative Council and the Legislative Assembly, passed the Law of Evidence Consolidation Act. This brought together the statutory law of evidence in the Colony and various previous acts relating to evidence were repealed. Section III commenced:
“On the trial of any issue joined or of any matter or question or on an enquiry arising in any suit action or proceeding in any court or before any person having by law or by consent of the parties authority to hear receive and examine evidence any person who may happen to be present and who by virtue of this act is competent to give evidence … may be called and required to give evidence.”
(Emphasis added).
In my opinion, the historical survey shows that the Legislatures of New South Wales and Victoria at the time used the phrase “suit action or proceeding” to cover any process in a court of law. Where the Legislature intended that the particular provision should have application beyond a court of law, it expressly stated so.
It was by s.XVIII that the privilege now under consideration was first enacted. I have set it out above.[41]
[41]See paragraph 30.
When it was enacted in 1857, the section covered both confessions to clergymen and medical practitioners. It was divided into two parts in the 1890 consolidation and more recently has been divided into two sub-sections. In construing a statute, it is necessary to consider the provisions in context and taking into account the statute as a whole. In its original form, it is clear in the first part of the section that the phrase “any suit action or proceeding” relates to court proceedings by reason of the words that followed the phrase, namely, “whether civil or criminal”. The section follows on from the first part of the section and the phrase in context relates to proceedings in a court. However, it is noted that the phrase is “civil suit action or proceeding” which confines it to a civil proceeding and does not preclude the divulging of the information in a criminal proceeding. In my opinion, the wording of s.XVIII makes that clear. This conclusion is reinforced by the earlier legislation to which I have referred where it is clear that “any civil suit action or proceeding” was a composite phrase to cover any proceeding or process in a court of law. Where the Legislature intended to cover a proceeding before a person having by law or by consent authority to hear and examine any evidence then the Legislature made that clear.[42] If the Legislature intended that the prohibition on disclosure of the information was to extend to a proceeding other than in a court of law, it could easily have done so. In my opinion, when enacted it was the intention of the Legislature to confine the doctor‑patient privilege to a process or proceeding in a court of law.
[42]See, for example, s.III of the Law of Evidence Consolidation Act.
The 1857 Act was repealed and re-enacted in the Evidence Act of 1864. Section XVIII was re-enacted in exactly the same form in s.47. The 1864 Act was repealed by the Evidence Act of 1890 and again the same words were used in the new Act concerning confessions to clergymen and disclosures to medical men. Now the section was divided into two parts. See s.55. The Evidence Act of 1890 was repealed and re-enacted by the Evidence Act 1915. Section 28 is in exactly the same terms as s.55 of the 1890 Act. The 1915 Act was repealed and re-enacted in the Evidence Act 1928 and s.28 is in exactly the same terms as the same section in the 1915 Act. The 1928 Act was repealed and re-enacted in 1958. Section 28 is in the same terms save that it was amended by the Evidence Act 1946 where the words “or testamentary capacity” were inserted after the word “sanity” in s.28.
The question arises that when the Parliament re-enacted the Evidence Act in 1958 was it the intention of Parliament that the phrase in s.28, which was enacted in separate parts to cover confessions to clergymen and disclosures to medical practitioners, provided a protection against production in a proceeding in a court of law only? Going back in time, s.43 of the Evidence Act 1864 was concerned with parties and the issue of husbands and wives being competent and compellable witnesses “in any suit action or proceeding in any court”. The section went on to provide that the provision applied in any proceeding “before any person having by law or by consent of parties authority to hear receive and examine evidence.” This provision has been re-enacted in every Evidence Act since and is now found in s.24 of the Evidence Act 1958. Counsel for the Hospital have drawn attention to the words “in any court” which follow the phrase, and submit that this is in stark contrast to the wording of s.28(2). It was submitted that the absence of the words “in any court” in s.28(2) meant that it was not confined to a court proceeding. I do not accept this submission. It is clear why it was phrased in that way as early as 1864, because the provision was intended to extend beyond a court proceeding and to cover any proceeding before a person having by law or consent of the parties authority to hear, receive and examine evidence. Rather than counter the submission that the phrase is confined to a court proceeding, in my view it reinforces that conclusion because the Legislature expressly provided for a situation other than a court of law. It did not do so in the original provision, and the amendment of 1987 inserting the words “or an investigation by a complaints investigator under the Accident Compensation Act 1985” is cogent evidence that the Parliament proceeded on the basis that s.28(2) was confined to a court proceeding.
This conclusion is reinforced by a consideration of the cases which have discussed the construction of s.28(2). These cases have decided or proceeded on the assumption that the phrase is confined to a court proceeding. There is controversy concerning the rule relating to the construction of a provision in a statute after it has been re-enacted following a judicial decision as to its meaning. The most frequently cited statement of the rule is the dicta of James LJ in Ex parte Campbell[43] which was approved by the House of Lords in Barras v Aberdeen Steam Trawling and Fishing Co Ltd.[44] His Lordship said:
“Where once certain words in an Act of Parliament have received a judicial construction in one of the Superior Courts, and the Legislature has repeated them without any alteration in a subsequent statute, I conceive that the Legislature must be taken to have used them according to the meaning which a court of competent jurisdiction has given them.”
[43](1870) LR 5 Ch App 703 at 706.
[44][1933] AC 402 at 412.
That principle has been quoted with approval and applied in a number of Australian cases. The seven members of the High Court in Re Alcan Australia Ltd & Ors; ex parte Federation of Industrial, Manufacturing and Engineering Employees[45] said:
“There is abundant authority for the proposition that where the Parliament repeats words which have been judicially construed, it is taken to have intended the words to bear the meaning already ‘judicially attributed to (them)’, although the validity of that proposition has been questioned. But the presumption is considerably strengthened in the present case by the legislative history of the Act.”
[45](1994) 181 CLR 96 at 106.
The questioning of the rule has emerged where the provisions have been re‑enacted in consolidating acts. Doubts have been cast upon the value of the rule. See Salvation Army (Vic) Property Trust v Ferntree Gully Corp[46] and more recently Flaherty v Girgis.[47] Although doubts about the rule have been expressed, and in my opinion it is clear that if a court came to the view that previous interpretations were wrong, the rule should not apply, the fact is that the rule has force when one considers the history of the legislation and the decisions considering the interpretation of the provision.
[46](1952) 85 CLR 159.
[47](1987) 162 CLR 575 at 594.
Cases in the past have construed the provision as relating only to curial proceedings, that is, proceedings in a court of law.
Whether the rule should apply will depend upon the particular circumstances, and the history of the provision in this case leads very strongly to the conclusion that the principle does apply to s.28(2).
In Warnecke v The Equitable Life Assurance Society of the United States[48] the Full Court held that the word “information” in the provision included not only communications made by the patient but knowledge acquired by the medico in the course of his professional relationship with the patient. This decision was approved by the High Court in National Mutual Life Association of Australasia Limited v Godrich.[49] In neither case was the issue of the provision’s application to a court of law or any other body considered. Nevertheless there are observations made by judges in the High Court which support the conclusion that the provision only applies to proceedings in a court of law. Isaacs J[50] said:
“The purpose of the legislature is manifest on the face of the enactment. It was to prevent, within certain limits, any public tribunal being made the instrument to violate the confidence which a patient has reposed in a physician or surgeon as his medical adviser. Parliament has not thought fit to enact a general prohibition of disclosure of professional secrets. Outside the walls of the Court a medical man is left to the dictates of his honour, the ethics or rules of his profession, or the force of any compact he may have made with the person who confided in him. And even within the Court itself, where crime is charged, the interests of the public at large are still for obvious reasons thought sufficient to outweigh considerations of medical confidence. But, where individual rights only are in controversy, unless the patient’s sanity is the matter in dispute, the State, setting private obligation against private obligation, refuses to be a participant in the breach of a personal trust, probably the result of physical suffering or the fear of death. So much is clear; the evil to be cured is unmistakable, and within the limitations which the legislature has itself marked out, the remedy should be advanced: Heydon’s case.
The enactment works no abridgement of any substantive right, no invasion of liberty or property, nothing but a regulation of curial procedure to effect the desired reform in the law of evidence for the maintenance of good faith.”
(Emphases added).
[48][1906] VLR 482.
[49](1909) 10 CLR 1.
[50]At 33.
The word “curial” means pertaining to a court.[51] What his Honour said of course was not essential to his decision because the issue in the case did arise out of a court proceeding. However, what his Honour said accords with the historical consideration of the section. One thing is clear, the Legislature intended to provide a privilege but the privilege was to be confined in accordance with the provisions of the section. It did not apply in all circumstances. The privilege was not intended to cover all situations.
[51]See The Shorter Oxford English Dictionary.
In Andasteel Constructions Pty Ltd v Taylor,[52] Gillard J considered the section where a proceeding was brought by an employer to recover money under the Workers Compensation Act from the negligent defendant, such money having being paid to the deceased worker’s widow. The employer called the doctor who examined the employee after the accident. Objection was taken by the defendant that the doctor was precluded from giving evidence of statements made by the deceased during his examination. Gillard J held that the medical evidence was inadmissible. The question did arise as to who could waive the privilege. Since the employee was deceased, there was nobody in the proceeding to waive the privilege. In reaching his conclusion, the learned judge referred to three matters and the second was expressed in this way:
“(b)Secondly, the privilege is a curial one only to be exercised in a court, and having no analogy to a propriety right existing at large against the world.”
[52][1964] VR 112.
What his Honour said concerning the privilege being a curial one only to be exercised in a court was not necessary for his decision. His Honour was dealing with a matter in the Court and the only question was who could give the consent after the death of the patient. Nevertheless other judges have accepted the observation and applied it.
Reference has been made to the Andasteel case by a number of judges of this Court without criticism. In Carusi v Housing Commission[53] Lush J referred to the decision without any criticism. He noted that Gillard J had “stressed that the privilege or exemption conferred by s.28(2) was a curial matter exercised in court and that the consent referred to must be consent to the giving of evidence in court.” The proceeding before Lush J was a proceeding in court. He held that although consent had been given by the deceased in a document to disclose information, s.28(2) precluded it from being given in a court.
[53][1973] VR 215.
In Harey v Riley and anor,[54] Norris J was concerned with a claim for privilege where a widow sued a medical practitioner for negligently causing the death of her husband. The cause of action concerned treatment for mental instability and the question arose whether the defendant could object to producing certain documents by reason of the privilege in s.28(2) of the Evidence Act. His Honour referred to what Gillard J said in Andasteel. However, his Honour did not have to consider the issue. No criticism was made of what Gillard J had said.
[54][1974] VR 577.
In Elbourne v Troon Pty Ltd,[55] Jenkinson J was concerned with the objections taken by medical practitioners to production of documents. They had been sued by an employer seeking contribution in a proceeding brought by a plaintiff for damages for personal injuries suffered in his employment. His Honour said:[56]
“I accept, with respect, the characterisation by Gillard J of the privilege conferred by s.28(2) as ‘a curial one only to be exercised in a court, and having no analogy to a proprietary right existing at large against the world’.”
[55][1978] VR 171.
[56]At 175.
The conclusion that the provision is confined to a Court proceeding is further reinforced by a consideration of the amendments made to s.28(2) since it was re-enacted in 1958.
The judgment in the Andasteel Constructions case was delivered on 23 September 1963. His Honour considered what Sholl J had held in Pacyna v Grima.[57] His Honour distinguished that case. Sholl J had held in the previous year that consent under the provision to divulge the information could be given by the personal representative of a deceased patient in an action brought by the personal representative under s.17 of the Wrongs Act 1958 for the benefit of the relatives of the deceased or under s.29 of the Administration and Probate Act 1958 for the benefit of the estate. Gillard J held in Andasteel that the consent could not be given by the personal representative if such personal representative was not a party to the litigation. These two decisions raised some interesting questions about who could consent to waiving the privilege and in early 1966 the Parliament of Victoria passed the Evidence (Medical Evidence) Act 1966. It added the following provision to s.28:
“(3)Sub-section (2) shall cease to have any application in –
(a)an action brought under Part III of the Wrongs Act 1958 to recover damages for the death of a patient; or
(b)proceedings brought under the Workers Compensation Act 1958 to recover compensation for the death of a patient –
if the person bringing or continuing the action or proceedings calls as a witness any physician or surgeon who has attended the patient.”
[57][1963] VR 421.
In Pacyna v Grima,[58] Sholl J had raised but not answered the question whether, in an action brought under s.18 of the Wrongs Act where there was no personal representative, consent could be given. The amendment, in my opinion, put at rest the query raised by Scholl J and reversed the effect of the Andasteel Constructions case. What is pertinent is that no attempt was made by the Parliament to alter the reach of the privilege to something other than a curial proceeding. Further amendments were made in the Evidence (Amendment) Act 1984. Sub-section (3) was repealed and the following was substituted:
“(3)Where a patient has died, no physician or surgeon shall without the consent of the legal personal representative or spouse of the deceased patient or a child of the deceased patient divulge in any civil suit action or proceeding any information which the physician or surgeon has acquired in attending the patient and which was necessary to enable the physician or surgeon to prescribe or act for the patient.”
(Emphasis added).
[58]Supra.
Sub-section (4) was added and it provided:
“(4)Sub-section (3) shall cease to have any application to or in relation to any civil suit action or proceeding at and from the time at which there is no legal personal representative spouse or child of a deceased patient.”
A new sub-section (5) excluded the application of sub‑ss.(2) and (3) to any action brought under Part 3 of the Wrongs Act 1958, to proceedings brought under the Workers Compensation Act or in civil suit action or proceeding in which the sanity or testamentary capacity of a patient is the matter in dispute.
No attempt was made by the Legislature to amend the provision to extend its application to a non-curial proceeding. Further, the Legislature repeated the phrase “in any civil suit action or proceeding“ which had been accepted in the cases as referring to curial proceedings only and in a context where the phrase was referring to a court proceeding.
Finally, there was a further amendment made to s.28(2) by the Accident Compensation (Amendment) Act 1987. After the word “proceeding” the amendment added the words, “or an investigation by a complaints investigator under the Accident Compensation Act 1985”. This amendment provides support for the view that Parliament accepted that the provision did not apply to anything other than a curial proceeding. The amendment also provides some support for the opinion that Parliament accepted that the original provision passed in 1857 referred to curial proceedings only and that was the meaning today.
In my opinion, s.28(2) of the Evidence Act 1958 confines the privilege to a curial proceeding, that is, a proceeding pertaining to a court and by reason of the recent amendment an investigation by a complaints investigator under the Accident Compensation Act 1985. In my opinion it does not apply to an investigation under the Medical Practice Act 1994, nor in my opinion would it apply to a hearing conducted by the Board or a panel of it, in respect of a complaint made against a registered medical practitioner. The history of the legislation supports those conclusions, as does the context of the provision when read with other provisions in the Evidence Act, the statement of Gillard J in Andasteel which has not been the subject of any criticism and finally, the amendments since 1958. Parliament has in the past where appropriate extended the operation of a provision to a proceeding outside the courts. It has expressly so provided after using the phrase and qualifying it by adding the words “in any court”. In using the qualifying words it was seeking to distinguish between a court proceeding and another proceeding. It has not done so in s.28(2) save for the recent amendment to cover an investigation under the Accident Compensation Act 1985. If Parliament intended the provision to cover other proceedings it has had a number of opportunities to extend its operation and has not.
The only decision which seems to be against my conclusion is the decision of Hampel J in Wartski v Medical Practitioners Board and ors.[59] His Honour was concerned with a judicial review where it was assumed by the parties that s.28(2) applied to the formal hearing before the Board and that objection could be taken to production of documents. In my opinion, the case is no authority for the proposition that s.28(2) did or did not apply to a proceeding before the Medical Practitioners Board.
[59][1999] VSC 385.
I requested counsel to ascertain whether there were any cases dealing with the New Zealand legislation which had some degree of similarity to s.28(2). Reference was made to Lucena v The National Mutual Life Association of Australasia;[60] In Re the St Helen’s Hospital;[61] and Pallin v Department of Social Welfare.[62] I have not been assisted by these authorities. The relevant legislation qualified the word “proceeding” by the word “civil”. In addition, in the earlier Act of 1908, the term “proceeding” was in fact defined. These cases and in particular In Re the St Helen’s Hospital discussed the type of proceedings, but it is clear that the courts were dealing with different legislation. Those cases do not provide any assistance on the issue raised in this appeal.
[60](1911) 31 NZLR 481.
[61](1913) 32 NZLR 682.
[62][1983] NZLR 266.
In my opinion, the Hospital cannot object to the production of the documents to the Board for the purposes of the investigation relying upon s.28(2) of the Evidence Act 1958. The learned Magistrate’s conclusion was correct.
Health Services Act 1988
It was the contention of counsel for the Hospital that s.141 of the Health Services Act 1988 precluded the production of the documents to the Board. Section 141 deals with confidentiality. Sub-section (2) provides:
“(2)A relevant person must not, except to the extent necessary –
(a)to carry out functions under this or any other Act; or
(b)to exercise powers under this or any other Act in relation to a relevant health service; or
(c)to give any information he or she is expressly authorised, permitted or required to give under this or any other Act –
give to any other person, whether directly or indirectly, any information acquired by reason of being a relevant person if a person who is or has been a patient in, or has received health services from a relevant health service, could be identified from that information.
Penalty: 50 penalty units.”
“Relevant person” is defined by s.141(1) and means, inter alia, “a relevant health service or the board of a relevant health service”. “Relevant health service” means according to the sub-section “a public hospital or denominational hospital”. There is no doubt that the Hospital is a relevant person being a public hospital. Initially it was argued that the sub-section could not apply because the documents were to be given to “any other person” and the Board was not a person. However by reason of s.38 of the Interpretation of Legislation Act 1984, the word “person” in any legislation includes “a body politic or corporate as well as an individual”.
Counsel on behalf of the Board put a number of submissions. First of all it was submitted that the exception in (c) applied, namely, that they were required to give the information by reason of the issue and execution of the search warrant under s.93A of the Medical Practice Act 1994 and hence it was necessary to give the information. The second submission was that the requirement to hand over the documents pursuant to a search warrant does not amount to a breach of the sub‑section because the Hospital was not “giving to any other person” whether directly or indirectly any information because the Hospital was required as a matter of law to hand over the documents. Reference was made to the decision of Royal Melbourne Hospital v Mathews[63] where Beach J held that the giving of information pursuant to a search warrant is “not giving information to the police officer within the meaning of sub-s.(2c) of s.141 of the Act”. I agree with Beach J’s decision. The production of documents under compulsion of law could hardly be described as giving to a person information.
[63][1993] 1 VR 665.
In any event, in my opinion s.141(2)(c) provides an exception to the prohibition because the Hospital was bound under an Act to deliver up the documents. The search warrant was validly issued and executed under an Act of Parliament and required the production of the documents.
Section 141(2) is a provision of the law which makes it a criminal offence to give the information to another person, but if the information was given under compulsion of law, I cannot see how the person giving the information would be guilty of an offence. It could hardly be said that the actus reus of the offence was a voluntary act on the part of the person giving the information.
In my opinion s.141(2) does not preclude the handing over of the documents which have been validly seized under the search warrant. The Magistrate’s conclusion was correct.
Public Interest Immunity
The Hospital submits that the doctrine of public interest immunity applies and as a result the Board is prevented from obtaining access to the records seized under the search warrant. Where public interest immunity is claimed, it is essential for the party or body claiming the immunity to identify with a degree of precision the class of documents which it would not be in the interests of the public to produce. It is apparent from the learned Magistrate’s reasons that some difficulty was experienced by counsel on behalf of the Hospital defining the class of documents. The learned Magistrate said in her reasons:
“During the course of the hearing, and in particular in referring to the documents for which he argued for public interest immunity to be attached, counsel for the applicant described them variously as ‘hospital records’, ‘medical records’ and ‘hospital and medical records’. It was only on the last day of the hearing that the description of the ‘class’ for which the applicant claimed public interest immunity was clarified as being ‘all medical records of public hospitals should be immune from production’.
In the circumstances I have taken that that statement accurately reflects the applicant’s claim.”
(Emphasis added).
It is clear that the Hospital claimed that there was a “class” of documents which were protected by the public interest immunity and the class was defined. However on this appeal counsel for the Hospital re-defined the “class”. Counsel identified the class of documents as the medical records of “women patients in public hospitals seeking advice and treatment concerning reproductive matters including obstetrics and gynaecological care”. It is noted that this is a more restricted definition of the class.
Counsel for the Board opposed the re-formulation of the class. It was submitted that this was an appeal from a Magistrate on a question of law. As the appeal, like all appeals, is a creature of statute, it was necessary for the Hospital as the appellant, to establish an error of law by the Magistrate. It was submitted that it could not be said that the learned Magistrate had made an error of law if she had not considered the submission that was now being put to this Court.
Counsel for the Hospital sought to counter this submission by relying upon a principle that it was open for an appellate court to consider a matter that was not considered below if it did not involve any consideration of a factual matter, was confined to a question of law and justice dictated that the appellant should be permitted to argue the question on appeal. That principle is well established.
However, I am concerned with a statutory appellate jurisdiction which requires an appellant to establish to the satisfaction of this Court on appeal that the learned Magistrate reaching the decision made an error of law and the error of law was involved in the final order.
The nature of an appeal under s.109 was considered by the Court of Appeal in Constant Tsai Shi Wong v C. Carter and ors.[64] Tadgell JA with whom the other members of the Court agreed said:[65]
“Section 109(1) of the Magistrates’ Court Act 1989 confers on a party to a civil proceeding in the Magistrates’ Court a right of appeal to the Supreme Court, on a question of law, from a final order of the Magistrates’ Court in that proceeding. The nature of an appeal of that character was considered in Transport Accident Commission v Hoffman [1989] VR 197 at 199. The Full Court there decided that the right of appeal conferred by s.52 of the Administrative Appeals Tribunal Act 1984 (now repealed) ‘on a question of law, from a decision of’ the Administrative Appeals Tribunal was to be construed as granting a right of appeal ‘on a question of law which is involved in’ the decision. The appeal authorized by s.109 of the Magistrates’ Court Act (and by s.92 in criminal cases) is to be similarly construed. … An appeal to the Supreme Court is not authorised by the Magistrates’ Court Act unless it is brought on a question of law which is involved in the final order from which the appeal is brought. The existence of a question of law is not only a precondition to the right of appeal but also the subject of the appeal itself; and it follows that the appeal does not operate as a re-hearing of the whole dispute or matter.”
(Emphasis added).
[64]Unreported, delivered 19 April 2000.
[65]At para 43.
Whether there is a question of law involved in the final order will depend upon the particular circumstances of each appeal. In some cases where an appellant seeks to argue a matter not argued below there may not be a question of law involved in the final order. However, in this appeal the Hospital wishes to re‑define the class attracting the public interest immunity. The Hospital has submitted that the learned Magistrate misdirected herself on the law and erred in her consideration of the issues. It was submitted that this error was manifest and the attack upon her decision did not involve the definition of the class of documents. It was submitted that if the Court was satisfied that the learned Magistrate did err in her consideration of the issue of public interest immunity which did not depend on the definition of the class of documents, an error of law was established, and the decision should be set aside. In my opinion that is correct. Nevertheless, the parties did inform the Court that if the Court came to that conclusion, the parties wished the Court to consider the question in accordance with the law. It would be at that point that the re-classification would be relevant. In those circumstances, because it is a question of law and there is no suggestion that further evidence should be placed before the Court on the question, in my opinion justice would be served in the interests of both parties if the Court did consider the new definition of the class at that point. In reaching that point, the Court would have concluded that there was a question of law involved in the final order and that error had been demonstrated.
It is necessary at the outset to identify the documents which are said to be protected from production.
The documents are identified as the patient Ms X’s medical records, together with any documents in respect of an internal review of the case by the Hospital and any other documents relating to the termination of the pregnancy.
Mr Lacava SC who appeared with Dr S. McNicol on behalf of the Hospital submitted that the Magistrate misdirected herself on the law resulting in failing to consider the issue in accordance with the law. Hence her decision was vitiated by error. Of course if the Magistrate did err in her approach, it is still open to the Board as a successful party to demonstrate that in the result her decision was correct. Mr Lacava referred to the Magistrate’s decision in which she quoted what Spigelman CJ said in R v Young.[66] His Honour discussed various principles under the heading “Public interest immunity”.[67] His Honour discussed further principles[68] under the heading “Privilege”. It was submitted that the Magistrate relied upon statements made by the Chief Justice which concerned the question of the creation of a new head of privilege. This was not an issue before the Magistrate.
[66](1999) 46 NSWLR 681.
[67]At 693.
[68]At 696.
Although public interest immunity was formerly known as Crown privilege it does in fact differ from the categories of privilege recognised by law. Public interest immunity applies for the benefit of the public interest and does not operate for any particular private relationship or private interest. It differs from what I might call pure privilege because the privilege is claimed in the interests of the public, it cannot be waived, nor can copies of documents protected by the public interest immunity be disclosed. In his judgment in R v Young, Spigelman CJ considered whether the public interest immunity precluded the production of statements to a person accused of sexual offences made by the victim of the sexual assaults. The majority of the Court which included the learned Chief Justice was of the opinion that the common law public interest immunity did not apply. However, it was argued on behalf of the respondents to the appeal that the Court should recognise a new category of privilege. This involved the application of principles which were separate and distinct from the common law public interest immunity. A close reading of what his Honour said makes it clear that all that followed after the heading “Privilege” was concerned with this very question. It was in that context where his Honour made observations criticising the paucity of material presented to the Court and that a court would need to be satisfied that there was evidence which established the need for a new category of privilege.[69] His Honour said:[70]
“However, before the Court establishes a new category of privilege it needs to be satisfied that some form of systematic attempt to marshal relevant evidence has occurred. Nothing of that character was done in the present case.”
[69]See paras 116-17.
[70]At p.704.
The learned Magistrate’s reasoning can be summarised as follows:
· That public interest immunity arises in order to safeguard the proper functioning of the executive arm of government and of the public service and that in the circumstances she was satisfied that there was a link between government and public health and this satisfied the first criterion of the public interest immunity.
· That in order to recognise what the learned Magistrate described as a new category of privilege it was necessary to have evidence of a review of expert literature or a review of an expert body of opinion and in this regard the Magistrate relied upon what Spigelman CJ said at paragraph 115 of his judgment.
· She concluded as follows:
“Unless it is clear that there are distinctive features which lift such documents into an identifiable, recognisable class, I believe that I am bound to exercise constraint in developing the common law by ‘creating’ a new ‘class’ of documents which would attract public interest immunity.
Without the requisite body of evidence or the clearly discernible features of the documents (e.g. the mental health records of a prisoner in a particular coercive set of circumstances as in Clifford’s case), I find that the applicant has failed to discharge its burden of establishing that the medical records of a public hospital, or of the Royal Women’s Hospital, form a recognisable and distinctive class of documents of such public interest that all documents in such a class should be immune from production.
In light of that finding, it is not necessary for me to consider the nature and extent of the public interest in the production of the seized documents to the Board or to engage in a balancing of the competing public interest.”
In my opinion, the learned Magistrate’s approach was wrong. The reference to what Spigelman CJ said at paragraph 114 was in relation to the creation of a new category of privilege. The common law over the years has created new categories of privilege. If a court was to consider such an issue, it would be necessary, as Spigelman CJ said, to have extensive evidence as to the necessity of the recognition of a new category of privilege. His Honour’s comments were not concerned with the question of public interest immunity. In addition, the Magistrate was wrong in failing to perform the balancing exercise. The balancing exercise requires the Court to weigh the harm to public interest that would be done by the production of documents as against the public interest which is vital to the proper investigation of a complaint against a medical practitioner, pursuant to a statutory obligation. The Court must perform the balancing exercise and decide which public interest must predominate.
I am satisfied that the learned Magistrate erred in her approach and accordingly her decision is vitiated because of the error. However, that is not the end of the exercise. Counsel for the Board submitted that the decision reached by the Magistrate was correct in that on a proper application of the principles the Hospital had failed to establish public interest immunity. That is, that on a proper balancing of the interests, the interests of the public in a proper investigation predominated over any public interest alleged by the Hospital.
It is necessary at this stage to briefly state the principles of the law concerning public interest immunity. This form of privilege grew out of the well established and longstanding principles exempting the obligation to disclose documents known as Crown privilege. But as has been stated, it is misleading to describe it as a privilege. In R v Lewes,JJ ex p. Home Secretary[71] Lord Reid said:
“The ground put forward has been said to be Crown privilege. I think that that expression is wrong and may be misleading. There is no question of any privilege in the ordinary sense of the word. The real question is whether the public interest requires that the letter shall not be produced and whether that public interest is so strong as to override the ordinary right and interest of the litigant that he shall be able to lay before a court of justice all relevant evidence.”
[71][1973] AC 388 at 400.
That case was concerned with criminal libel. An application had been made for a certificate to conduct a bingo club. The application was refused. The Gaming Board sought and received information from a chief constable of the county. Two witness summonses were directed to the chief constable and the secretary of the Board to give evidence and produce certain letters. The House of Lords held that the public interest required that the letters should not be produced since if the information given to the Board was liable to be disclosed, it might be withheld and the Board would thereby be hampered in the discharge of the duty imposed on it by statute to identify and exclude persons of dubious character and reputation from the privilege of obtaining a licence to conduct a bingo club.
“A plea of public interest immunity is a plea to be exempted from an obligation to discover or produce documents or to have admissible evidence excluded in curial proceedings.” - per Brennan J in Jacobsen v Rogers.[72]
[72](1995) 182 CLR 572 at 597.
The principles were stated by Gibbs ACJ in Sankey v Whitlam.[73] His Honour said:
“The general rule is that the court will not order the production of a document, although relevant and otherwise admissible, if it would be injurious to the public interest to disclose it. However the public interest has two aspects which may conflict. These were described by Lord Reid in Conway v Rimmer as follows:
‘There is the public interest that harm shall not be done to the nation or the public service by disclosure of certain documents, and there is the public interest that the administration of justice shall not be frustrated by the withholding of documents which must be produced if justice is to be done.’
It is in all cases the duty of the court, and not the privilege of the executive government, to decide whether a document will be produced or may be withheld. The court must decide which aspect of the public interest predominates, or in other words whether the public interest which requires that the document should not be produced outweighs the public interest that a court of justice in performing its functions should not be denied access to relevant evidence. In some cases, therefore, the court must weigh the one competing aspect of the public interest against the other, and decide where the balance lies.”
[73](1978) 142 CLR 1 at 38 et seq.
As his Honour went on to observe, however there may be cases where the nature of the injury to the nation or the public service is so obvious that the court does not have to go through the balancing process but declines an order for production.[74]
[74]See p.39.
Where the claim to public interest immunity concerns the production of documents, the documents may be divided into two separate categories. First, there are those documents which are identified as a class of documents such as government papers, Cabinet submissions and Cabinet papers. The other category concerns the contents of particular documents which are damaging to the interests of the public. An example of the first category of documents can be seen in the cases of Sankey v Whitlam[75] and Commonwealth v Northern Land Council.[76] Examples of the second category are found in Conway v Rimmer[77] and Australian National Airlines Commission v Commonwealth.[78] The distinction was emphasised by what Gibbs ACJ said in the Sankey case when he said:[79]
“An objection may be made to the production of a document because it would be against the public interest to disclose its contents, or because it belongs to a class of documents which in the public interest ought not to be produced, whether or not it would be harmful to disclose the contents of the particular document.”
[75]Supra.
[76](1993) 176 CLR 604.
[77][1968] AC 910.
[78](1975) 132 CLR 582.
[79]At p.39.
But in relation to both categories the Court is required to perform the balancing exercise. The Magistrate did not carry out the exercise. It is the contention of the Hospital that the documents belong to a class of documents. Gibbs ACJ went on to state how the court should approach such an objection when he said:[80]
“Speaking generally, such a claim will be upheld only if it is really necessary for the proper functioning of the public service to withhold documents of that class from production. However it has been repeatedly asserted that there are certain documents which by their nature fall in a class which ought not to be disclosed no matter what the documents individually contain; in other words that the law recognizes that there is a class of documents which in the public interest should be immune from disclosure.”
[80]At 39.
His Honour then went on to identify documents which included Cabinet minutes, discussions between heads of departments and any documents relating to government policy at a high level.
It is accepted that the categories of public interest are not closed.[81] Further, the immunity is not tied to government information and government documents. The public interest immunity is wider. In D v National Society for the Prevention of Cruelty to Children,[82] Lord Diplock said:
“I see no reason and I know of no authority for confining public interest as a ground for non-disclosure of documents or information to the effective functioning of departments or organs of central government. In Conway v Rimmer [1968] AC 910 the public interest to be protected was the effective functioning of a county police force; in Re D (Infants) [1970] 1 WLR 599 the interest to be protected was the effective functioning of a local authority in relation to the welfare of boarded‑out children. In the instant case the public interest to be protected is the effective functioning of an organisation authorised under an Act of Parliament to bring legal proceedings for the welfare of children.”
[81]See D v National Society for the Prevention of Cruelty to Children [1978] AC 171.
[82]At 220.
The courts have been slow however to recognise public interest immunity with respect to documents in cases other than involving departments or organs of central government. Where the courts have extended the public interest immunity they have done so by analogy with an established public interest category. Hence in D v NSPCC[83] the Court was prepared to establish a new category of immunity in a case where information about child abuse was provided by persons to an organisation concerned with the protection of children and it was held that this category was a proper extension of the immunity already given to police informers. The immunity is not confined to government matters. The immunity was discussed in cases involving confidential reports given by referees to prospective employers. See Bell v University of Auckland[84] and the House of Lords decision of Science Research Council v Masse.[85] In the latter case Lord Salmon quoted with approval what Browne LJ said in the Court of Appeal in that case:
“I am most impressed by the disadvantages of the disclosure of such confidential information … but I have come to the conclusion that I cannot hold that the disclosure of this information is prohibited by ‘public interest privilege’. It is now established that this ‘privilege’ is not confined to government departments or other organs of the central government, but it has so far been confined to bodies exercising statutory duties or functions. Further it has so far been confined to cases analogous to the ‘police informer’ immunity: … if it extends to the present cases, it would mean that an employer who wishes to rely on some such confidential report (presumably with the consent of the author) would not be able to do so.”[86]
(Emphasis added).
[83]Supra.
[84](1969) NZLR 1029.
[85][1980] AC 1028.
[86]See Public Interest Immunity – a matter of prime judicial responsibility by A.A.S. Zuckerman (1994) 47 MLR 703 at 709 et seq.
It is trite to observe that the court is bound to balance the competing elements of the public interest and this will depend upon the facts in each case. Where the person or body objecting is seeking to establish a claim of immunity from production in circumstances where the claim has not been recognised before, the affidavit in support of the claim should state the ground or grounds relied upon so that the court may evaluate the competing interests.[87] The burden resting upon the party seeking the immunity is a heavy one where the immunity is not based upon central government or public service issues and does not fall into a category that has been recognised in the past. In those circumstances the party seeking protection would have to establish by analogy with a recognised category, the requirement of protection.
[87]See Sankey v Whitlam, supra, at 44 and 48-49.
The High Court in the Commonwealth of Australia v Northern Land Council and anor[88] stated the principles which the court applies when considering the issue of public interest immunity.
[88](1993) 176 CLR 604.
· The classification of claims for public interest immunity into “class” claims and “contents” claims serves to differentiate between those documents the discovery of which would be injurious to the public interest whatever be the contents from those which ought not to be discovered because of particular content.
· Some classes of documents have in the past been classified as falling within a class of documents which are immune from production – e.g. the deliberations of Cabinet.
· The fact that the class of documents is a category recognised as being immune from production is not an absolute or inflexible classification. It could be described as a prima facie rule which recognises immunity for documents falling within that class.
· The court must weigh the prima facie rule of non-production against the competing public interest consideration which in most cases is the proper administration of justice, namely, the fundamental importance in a court proceeding that the parties have access to all relevant and other admissible evidence – this is the balancing process.
· If necessary the court may consider a document and inspect it, if necessary, to determine whether in fact it falls within a class which attracts immunity.
· Documents which have been recognised as a class which attracts the immunity results in an acceptance that the documents must not be produced for inspection and the court “will lean initially against ordering disclosure”.[89] The weight to be attached to this prima facie rule depends to a large extent upon the nature of the class. For example, Cabinet documents.
· Despite the prima facie rule the court must perform the balancing process. “The process of determining whether an order for disclosure of documents in that class should be made remains one of weighing the public interest in the maintenance of confidentiality against the public interest in the due administration of justice, but the degree of protection against disclosure which is called for by the nature of that class will dictate the paramountcy of the claim for immunity in all but quite exceptional situations.”[90]
[89]See p.618.
[90]See p.618.
As the High Court pointed out in respect of records of Cabinet deliberations which remain current or controversial, the Court doubted whether disclosure would ever be warranted in civil proceedings. But clearly as it is so often said, each case must depend upon its own particular circumstances. There are classes of documents and there are classes of documents. It is now clear that the class of documents is not confined to documents or information concerning the functioning of departments or organs of the central government. However, the immunity grew out of a privilege from production concerning such documents or information and where documents do relate to government departments or organs of the central government, it is most likely that the prima facie rule would apply. In other words, there would be a prima facie rule against production and it would take weighty matters of public interest to overcome the pre-disposition to refuse production.
It follows that the court is obliged to consider the question in a step by step process as follows:
· Is the claim of immunity based on a class of documents or the contents of particular documents?
· Identify the documents to be protected – their nature and likely content.
· What is the public interest claim for non-production? This of course will depend upon evidence but as the High Court has made clear, a mere assertion by a servant of the Crown does not preclude the court from fully considering the question.
· What is the competing public interest for their production?
· If necessary the court may examine the documents to determine their nature and importance with particular reference to whether they deal with any present or controversial topic.
· Do the protected documents fall within a class which has been accepted by the authorities and on principle as warranting protection from production?
· If the documents do fall within a recognised class of documents immune from production, what weight should in the circumstances be attached to the pre‑disposition not to produce the documents, in the balancing process?
· Perform the balancing process.
In the present case, it appears that the Magistrate was of the opinion that the public interest immunity principle only applied to matters of government or the public service. But in my view it has not been so confined.
The Magistrate held that it is only “when the link between government and the entity which is claiming immunity from production of its records is established or accepted by the court, that it is appropriate for the court to consider the nature and extent of the public interest in the non-production of that entity’s records and the nature and extent of the public interest in the production of such records. It is when that has been done that it is appropriate for the court to weigh one public interest against the other.”
It was submitted on behalf of the Hospital that it was a hospital carrying out health services in Victoria, funded by the government, and that one of the functions of government is the preservation, promotion and enhancement of public health. The Magistrate held that there was a link between government and the public hospital. It was contended on this appeal by the Board that the public interest immunity cannot be claimed by the Hospital because it does not perform government functions. Reference was made to R v Young where Spigelman CJ appeared to confine the public interest immunity to the proper functions of the arms of government and the public service.[91]
[91]See, supra, at pp.693-96.
I have doubts that the Hospital in performing its operations and providing health care to members of the public is performing services of a government character or that any documents and records kept by the Hospital containing patient treatment details are concerned with the effective functioning of the government or the departments of government. Nonetheless, in my opinion, it is not essential to the application of public interest immunity to establish that the documents concern the functioning of government, its organs or departments.
The Magistrate having come to the conclusion that there was a link between the services provided by the Hospital and government matters, noted that no case had gone as far as recognising the immunity applying to medical records kept by a hospital. In Mok v NSW Crime Commission,[92] the New South Wales Court of Appeal acknowledged that “medical confidences involving non-incarcerated patients do not form a class of public interest immunity.”[93] The only case where a form of medical privilege was upheld under the public interest immunity exemption was Clifford v Victorian Institute of Forensic Mental Health.[94] However that case was an example of a person who was compelled by law to submit to medical tests against his will. In that case an accused person was arrested and was then certified under the Mental Health Act 1986 that he appeared to be mentally ill and he was coercively transferred to a psychiatric hospital. The investigating police officer applied for a search warrant to obtain the psychiatric hospital file which the officer believed recorded an admission by the accused. The learned Magistrate upheld the claim on behalf of the Victorian Institute of Forensic Mental Health that it was not obliged to produce the file on the ground of public interest immunity. The policeman made application for a judicial review to the Supreme Court. It was clear that under the Corrections Act 1986 an accused, upon reception into prison, may be coercively medically examined and under the Mental Health Act such a person may be coercively placed in a psychiatric hospital. There is no doubt that when examined by a doctor the relationship was one of confidentiality, and further, the accused person was not cautioned concerning any information they may provide to the staff. Cummins J held that the public interest immunity precluded the production of the medical records. He based his conclusions on the fact that the accused person was bound under law to undergo a medical investigation and that it was entirely appropriate that he should undergo such medical investigation for the welfare of the accused and other persons in the prison system. As his Honour said:[95]
“The therapeutic and protective regime established by the Mental Health Act 1986 and related legislation exists for the benefit of both prisoner and community. Its effective operation should be preserved. It is significantly in the public interest that that be so.”
[92][2002] NSWCA 53.
[93]Supra at para 31.
[94][1999] VSC 359.
[95]At para 25.
His Honour performed the balancing exercise and stated his reasons why the public interest immunity required refusal. He said: “First, the accused was a prisoner in custody. Second, he had been charged with murder. Third, he had already been interviewed twice by the police. Fourth, he was not (normally) entitled to bail. Fifth, he was subject to coercive medical procedures. Sixth, he was not warned that he did not have to give a history or answers to the doctor (probably the contrary). Seventh, he was mentally ill and certified as such. The existence and confluence of those factors affirmatively requires the upholding of the public interest immunity.”
The case was considered in the Mok decision.[96] In that case the NSW Crime Commission had brought a proceeding against Mok for confiscation of certain property arising out of criminal activity. It was common ground that the proceeding would turn essentially upon the evidence of a man named Cheung. A substantial part of a conversation involving him was recorded by a hidden listening device. Mr Mok issued a subpoena to the officer in charge of the Department of Human Resources in Victoria to produce certain documents and objection was made on the basis of public interest immunity. In Mok Mason P stated the following:[97]
“I incline to the view that the common law of Australia would uphold a claim of public interest immunity in the factual situation addressed in Clifford, including (in particular) any clearly established situation involving compulsion to submit to medical tests under s.29 of the Corrections Act 1986 (Vic) or any interstate counterpart. But Clifford involved the unique concatenation of facts (see para 26 of the extract from the judgment of Cummins J) and the situation is (to me) much less clear once one moves away from them.
To the extent that the common law insists upon the presence of a governmental interest (NB Young), that interest is present in such a context because the medical and psychiatric assessment of a prisoner upon reception into the prison system is a vital step in proper prison administration. It goes well beyond the private interest of the prisoner. Likewise with medical tests directed by the principal medical officer.
But it is not nearly so clear in relation to the voluntary ongoing medical treatment of a serving prisoner or to the result of a psychiatric assessment initiated by the prisoner for his or her own purposes. The affidavit that grounded the decision in Clifford and the affidavit read in the present application show a tenable basis for a public interest in confidentiality, but it is far from clear that such interest outweighs the public interest in getting at the truth in litigation. Medical confidences involving non‑incarcerated patients do not form a class of public interest immunity (see Young at 699 [89]) and it is difficult to see why the patient’s status as a prisoner should alter this in the general run of cases.”
[96]Supra.
[97]At paras 29 et seq.
The Court set aside the public interest immunity finding precluding production made by the judge at first instance and remitted the matter back for further hearing.
I respectfully agree with the observations of Mason P that the Clifford case should be confined to its own particular facts; in particular that the medical investigation of the accused person was done under compulsion of law. That is not the case here.
No case has recognised a class of documents which are immune from production answering the description of the documents now defined on this appeal. It follows that there is no prima facie pre‑disposition to refuse production to assist the Hospital. The claim is based on a class of documents. The class is defined as “records of women patients in public hospitals seeking advice and treatment concerning reproductive matters including obstetrics and gynaecological care”. The interest claimed by the Hospital is the maintenance of the confidential relationship between patient and Hospital and doctors to ensure that the Hospital can effectively function. The competing interest is obvious; the necessity in the public interest of a complete and proper investigation of a complaint concerning a doctor made to the Board which is charged by statute to carry out the investigation, if necessary hold a hearing and impose a punishment on a medical practitioner where appropriate. The public has an interest in medical practitioners performing their services in a professional, lawful and careful manner. The Board is charged by statute to regulate the standards of medical practice in the public interest.[98]
[98]See s.66(1)(ab) of the Medical Practice Act 1994.
I now turn to the balancing exercise. It is necessary to consider in more detail the nature of the public interests claimed by the Board and the Hospital. The Magistrate was critical of the Hospital’s evidence or as she put it, the lack thereof. I do not share her criticism. The evidence discloses the nature and content of the public interest claimed.
The issue for the court is to answer the question – does the public interest in the proper investigation and determination of complaints made against registered medical practitioners outweigh the public interest in the confidentiality of the documents identified as a class, namely the medical records of women patients in public hospitals seeking advice and treatment about women’s health and reproduction, and in particular obstetrics and gynaecological advice?
Some of the documents seized do not fall within the defined class in that there are documents generated by the Hospital as part of an investigation into the circumstances leading to the termination of the pregnancy. However, in my view, one should not separate out the documents because such documents would be inextricably bound up with the class of documents defined by the Hospital. Accordingly, I propose to approach the determination of this appeal on that basis.
The public interest in respect of the proper investigation of any complaint which was not frivolous or vexatious, against a registered medical practitioner, is manifest. If it is alleged against a practitioner that he engaged in conduct proscribed by the relevant provisions of the Medical Practice Act 1994 it is essential that the investigation and determination of the complaint should be fully and carefully performed considering all relevant evidence. The public do have a substantial interest in the activities of registered medical practitioners. The registered medical practitioners perform services for members of the community which are partially remunerated by government funds. The public must have confidence that the doings of medical practitioners are professional, within the law and performed carefully. The Board is bound by statute to investigate a complaint. It is in the public interest that it discharges its statutory functions and duty properly and in accordance with the law. The Board is also bound by statute to regulate the standards of practice in the public interest. As against this the Hospital says that the class of documents identified by the Hospital fall within a class of documents which if disclosed would be detrimental to the public interest.
It is necessary to consider the affidavit of Dr Christine Margaret Bayly who is the Associate Director of the Royal Women’s Hospital, a gynaecologist and a member of the senior management team at the Hospital responsible for overseeing obstetric and gynaecological care.
Dr Bayly’s affidavit deals with the concerns of women patients not approaching the Royal Women’s Hospital or misleading the Hospital in respect to sensitive matters relating to their health dealing with pregnancy and termination. The affidavit does not refer to what may occur in respect of other public hospitals in this State but in my opinion her statements of concern about disclosure of the various documents would apply to all public hospitals in this State dealing with the care of pregnant women and termination of pregnancy. I will so treat her affidavit. She identifies the following matters relevant to non-disclosure in the public interest –
·Public hospitals provide services to women patients of a gynaecological and obstetric nature which because of expense cannot always be performed in the private health system.
·The provision of good health care for pregnant women depends upon a relationship of trust between patient and the provider of the health services.
·Trust requires non-disclosure of personal information and treatment and the maintenance of the confidential relationship.
·The patient knows of the privacy obligations and relies upon them.
·The provision of proper and accurate information by a patient is necessary for the health professional to know to determine and carry out the necessary treatment.
·The prospect of disclosure may discourage patients from seeking care or going from hospital to hospital or withholding information which is relevant to the treatment or giving misleading information resulting in delayed or adverse outcomes.
·The withholding or misrepresentation of information may delay health services resulting in further and unnecessary expense.
·Loss of trust could adversely affect the whole public health system because of the reluctance of pregnant women to seek treatment or failure to reveal accurately or at all, all relevant information.
·Women patients expect privacy in sensitive areas relating to relationships, sexual behaviour, contraception, fertility, sexually transmitted diseases, and reproductive health and if a woman patient knows such information could be disclosed by compulsion of law, it could lead to non-disclosure of, or misleading, information.
·Pregnancy termination is a major health issue and history prior to the Menhennitt ruling in 1969 shows that desperate pregnant women sometimes took desperate measures which are health and life threatening. There is a concern that this could happen again if confidence was not maintained.
·The fear of disclosure may discourage women from seeking safe care in a timely way in respect to termination of a pregnancy.
When analysed, the factors highlight the necessity of maintaining the confidential relationship between patient and the health services provider to ensure that patients will not be discouraged from seeking treatment, and providing full information and to ensure that the hospitals can perform their statutory duties in the interest of the public. The law recognises that the relationship is one of confidentiality and as a general rule the confidentiality should be maintained and if necessary enforced. On the other hand, the law has always recognised that a confidential relationship cannot stand in the way of disclosure of documents or information by compulsion of the law but there are exceptions to that rule. In D v National Society for the Prevention of Cruelty to Children,[99] Lord Diplock said:
“The fact that information has been communicated by one person to another in confidence, however, is not of itself a sufficient ground for protecting from disclosure in a court of law the nature of the information or the identity of the informant if either of these matters would assist the court to ascertain facts which are relevant to an issue upon which it is adjudicating: Alfred Crompton Amusement v Customs and Excise (No. 2) [1974] AC at p.433-4. The private promise of confidentiality must yield to the general public interest that in the administration of justice truth will out, unless by reason of the character of the information or the relationship of the recipient of the information to the informant a more important public interest is served by protecting the information or the identity of the informant from disclosure in a court of law.”
(Emphasis added).
[99]Supra at 218.
The Hospital’s submission is that the breakdown of the confidential relationship will have adverse effects upon pregnant women approaching public hospitals or they will fail to look after their own interests when obtaining treatment from a public hospital because of non‑disclosure of, or providing misleading, information. I have difficulty in accepting that proposition. Pregnant women will seek treatment if it becomes necessary, they will approach a public hospital if necessary, and will reveal all that is necessary to enable their treatment to be properly and carefully performed. The exigencies of the occasion will ensure this is so. Further, I am not persuaded that the disclosure of confidential information by the Hospital will adversely affect, hinder or interfere with the Hospital or any other hospital performing its functions whether statutory or otherwise. The matters that influenced the judges in D v National Society for the Prevention of Cruelty to Children and in R v Lewes JJ, ex parte Home Security[100] are not present. In both those cases the disclosure threatened the existence of the body objecting and seriously interfered with its statutory functions and ability to perform its statutory duty. In my opinion, the demand that truth will out is a matter of weighty public interest when the Board carries out its statutory obligation to investigate and if necessary deal with a complaint concerning a registered medical practitioner. It is performing a statutory duty which is there for the protection of the public. The public interest is manifest in ensuring that the investigation and the subsequent dealing with the complaint if necessary is carried out with all relevant information before the investigating body and the complaint hearing body. In my opinion, a strong case has been established for the production of the documents to the Board to enable the investigation to be properly and carefully performed. In my view, after weighing up the various factors relevant to the public interest of both the Hospital and like bodies and the Board, disclosure of the documents in the circumstances would not be detrimental to the public interest in maintaining a confidential relationship between patient and the provider of medical services or interfere with the Hospital performing its statutory functions and duties properly, carefully and in the interests of the public. In my opinion, the documents should be produced. I am satisfied that the decision of the Magistrate was correct.
[100]Supra.
Conclusion
The Hospital has objected to the production of the documents claiming a privilege under s.28(2) of the Evidence Act 1958, a statutory right to refuse under s.141(2) of the Health Services Act 1988, and public interest immunity. In my opinion, the Hospital has failed to establish any of the alleged bases for refusal of production. Accordingly it has failed to establish that the Magistrate erred as a matter of law in her decision not to refuse production.
Subject to any submissions by counsel I propose to make the following orders:
(i)That the appeal against the orders made by Her Honour A.J. Maugham, M. on 8 October 2004 be dismissed.
(ii)That the Royal Women’s Hospital pay the costs of the Medical Practitioners Board of Victoria of the appeal including any reserved costs.
---
22
6
0