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From Health Law Daily, September 27, 2017

Mandamus petition to compel medical records production denied

By Robert B. Barnett Jr., J.D.

An individual who obtained an order from the Office of Open Records (OOR) allowing him access to medical records under the Pennsylvania Right-to-Know Law does not have the right to enforce that order while the appeal of the OOR order is pending, a Pennsylvania court has ruled. In a case of first impression, the court ruled that a petition asking a federal court to review the administrative order had the same effect as other appeals, which was to preclude the right to immediate relief pending the appeal (Baron v. Commonwealth Department of Human Services, September 21, 2017, Simpson, R.).

Background. An individual submitted a Right-to-Know Law request to the Pennsylvania Commonwealth Department of Human Services (DHS) for rates paid to nursing home by managed care organizations (MCOs) that participated in the Medical Assistance Program called HealthChoices. DHS, which said that it did not have possession of those records, requested the information from the MCOs. When the MCOs refused, claiming exemptions, DHS denied the individual’s request. He then appealed the decision to the OOR. The OOR ruled that he had the right to the records, and it ordered DHS (but not the MCOs) to provide the records to the individual. The MCOs (but not DHS) filed petitions in federal court for review of the order. The individual filed a cross-petition asking for enforcement of the OOR’s order. The court consolidated the appeals. The individual then filed a separate petition for a writ of mandamus against DHS and Health Partners, one of the MCOs, asking the court to compel the production of the documents while the consolidated appeals were pending. It argued that the order remained enforceable because neither DHS nor Health Partners appealed the order (notwithstanding the consolidated appeals) and neither had requested a stay.

Mandamus. The common law writ of mandamus exists to compel the performance of a ministerial act or mandatory duty. Health Partners raised three objections. First, it argued that mandamus is not available against a private party. Second, it argued that the OOR order mandated action only by DHS. Third, it argued that the consolidated appeals triggered the automatic stay provisions of the Right-to-Know Law. The court agreed with all three arguments and denied the individual’s motion for mandamus as it applied to Health Partners. The next question was whether mandamus could be applied to DHS. The court concluded that it could not, once the OOR’s order was challenged in the consolidated appeals. The fact that DHS never appealed the OOR’s order did not impair the MCOs’ appeal rights. Because the order was subject to reversal or modification on appellate review, the individual had no immediate right to relief. The court also concluded that DHS was protected by the Right-to-Know Law’s automatic stay.

The court, therefore, sustained Health Partners’ demurrer and dismissed the individual’s mandamus petition with prejudice.

The case is No. 503 M.D. 2016.

Attorneys: Bruce Gaynor Baron (Capozzi & Associates, PC) for Bruce G. Baron. Marisa Lynn Cohan for Pennsylvania Commonwealth Department of Human Services. James J. Rodgers (Dilworth Paxson, LLP) for Health Partners Plans, Inc.

Companies: Pennsylvania Commonwealth Department of Human Services; Health Partners Plans, Inc.

MainStory: TopStory CaseDecisions CMSNews BillingNews ManagedCareNews PennsylvaniaNews

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