LIU, J. —
The Center for Investigative Reporting (the Center) is a news organization investigating mistreatment of mentally ill and developmentally disabled individuals in state-owned long-term health care facilities. It filed a California Public Records Act (Public Records Act; Gov. Code, § 6250 et seq.) request for copies of all the citations issued by the State Department
The Long-Term Care, Health, Safety, and Security Act of 1973 (the Long-Term Care Act; Health & Saf. Code, § 1417 et seq.) lays out in detail the information that must be included in citations issued by DPH and expressly states that the citations are public records, but that the names of the affected patients or residents must be redacted from the publicly available version of the citation. (See Health & Saf. Code, §§ 1423, 1424, 1429, 1439.) Yet DPH disclosed heavily redacted copies of the citations it had issued to the facilities in question, citing its obligation under another statute not to release confidential information obtained "in the course of providing services" to mentally ill and developmentally disabled individuals. (Welf. & Inst. Code, § 5328; all subsequent statutory references are to the Welfare and Institutions Code unless otherwise indicated.)
The trial court determined that the Long-Term Care Act was the more specific and later-enacted statute and thus trumped section 5328. DPH sought writ relief, and the Court of Appeal issued a writ directing the trial court to vacate its judgment. In so doing, the Court of Appeal agreed with DPH, but only in part. It concluded that because both statutes are remedial statutes designed to protect the same vulnerable population, the two statutory schemes could be harmonized. The Court of Appeal did so by ordering DPH to disclose such information as the Court of Appeal deemed consistent with the common purpose of both statutes while permitting DPH to redact such information as the Court of Appeal deemed inconsistent with that common purpose.
We reverse and remand with instructions for the Court of Appeal to deny the petition. The trial court was correct: The Long-Term Care Act's provisions are the later-enacted provisions, and they announce with detail and specificity the information that must be included in DPH citations in the public record. Because it is both the more specific and the later-enacted statute, the Long-Term Care Act is properly construed as a limited exception to section 5328's general rule of patient and resident confidentiality. Accordingly, DPH citations issued under the Long-Term Care Act are public records and must be disclosed to the Center subject only to the specific redactions mandated by the Long-Term Care Act.
The Center is a nonprofit news organization involved in investigating and reporting on patient abuse in state-owned long-term care facilities operated by
In May of 2011, while investigating these matters, a staff reporter employed by the Center filed a written request, pursuant to the Public Records Act (Gov. Code, § 6250 et seq.), requesting copies of all citations issued by DPH since 2002 to the seven largest state-owned and state-operated treatment facilities. DPH issues such citations pursuant to a detailed statutory scheme set out in the Long-Term Care Act.
DPH's response was twofold. First, it informed the Center that DPH was required to maintain citations for only four years. Second, DPH told the Center that any recent responsive records would be "examined and redacted before release in accordance with Welfare and Institutions Code section 5328," which governs patient confidentiality at facilities providing designated services to developmentally disabled and mentally ill patients and residents. As explained in more detail below, section 5328 is part of the Lanterman-Petris-Short Act (§ 500 et seq.); a parallel provision is included in the Lanterman Developmental Disabilities Services Act (§ 4500 et seq.). (See § 4514.) Like the parties and the Court of Appeal, we refer to both acts collectively as the Lanterman Act. When we refer to section 5328, the reference applies equally to section 4514.
A month later, DPH produced 55 citations from the years 2007 through 2011. In DPH's own words, the records were "aggressively" redacted. In fact, the redacted citations contained scant information about the violations giving rise to each citation. A representative example is citation No. 15-1040-0003490-S. The citation is classified as an "AA" citation, meaning that the patient died as a direct and proximate result of the facility's offense. (Health & Saf. Code, § 1424, subd. (c).) The citation lists two general regulations that were violated: California Code of Regulations, title 22, section 76315, subdivision (a)(4), which requires each patient or resident to have an individual program plan, and California Code of Regulations, title 22, section 76525, subdivision (a)(20), which assures patients and residents the right "[t]o be free from harm, including unnecessary physical restraint or isolation, excessive medication, abuse or neglect." But the substance of the violation is then described as follows: "The facility failed to keep Client 1 free from harm by ...." The remainder of the citation, comprising two and a half pages of text, is completely redacted.
The Center's legal counsel wrote a letter to DPH arguing that the redactions were not legally justified. DPH responded with an e-mail maintaining that the redactions were required by sections 4514 and 5328.15. The Center responded by filing a petition for writ of mandate in the superior court seeking an order that DPH disclose the redacted material pursuant to the Public Records Act.
The trial court said it was "called upon in this case to resolve an apparent conflict between the Lanterman Act's prohibition against disclosure of records obtained in the course of providing mental health or developmental services, and the Long-Term Care Act's requirement that citations issued to long-term health care facilities be open to public inspection." It concluded that the two statutes could not be reconciled and that the Long-Term Care Act's mandate that DPH citations be made public with minimal redaction trumped the Lanterman Act's confidentiality provisions because the Long-Term Care Act was the more specific statute. DPH filed a petition for writ of extraordinary mandate.
The Court of Appeal acknowledged a conflict between the Long-Term Care Act and the Lanterman Act, but determined that the statutes could be harmonized. It observed that "the Lanterman Act and the Long-Term Care Act apply to the same population and seek the same purpose — to promote and protect the health and safety of mental health patients. But the two acts effectuate this common purpose from opposite directions. The Lanterman Act effectuates this purpose by ensuring the confidentiality of mental health records — this encourages persons with mental problems to seek, accept and undergo treatment and to be open and candid in treatment. The Long-Term Care Act effectuates this purpose, as relevant here, by making citations for violations of patient care standards publicly accessible, so the public can oversee what is happening in these facilities." The "congruence of population and purpose, and this effectuation of purpose from opposite directions, creates a complementarity of method to effectuate the common purpose for this common population. In this way, these confidentiality and public accessibility provisions can be harmonized."
Justice Hoch dissented. She would have concluded that the two statutes were in irreconcilable conflict as to what information in a DPH citation can or must be released to the public. She would have resolved the conflict by concluding that the Long-Term Care Act prevailed because its relevant provisions are more specific and later enacted than section 5328. We granted review.
We begin by describing the two statutory schemes at issue.
The Long-Term Care Act was enacted in 1973 with the purpose of "establish[ing] (1) a citation system for the imposition of prompt and effective civil sanctions against long-term health care facilities in violation of the laws and regulations of this state, and the federal laws and regulations as applicable to nursing facilities as defined in subdivision (k) of Section 1250, relating to patient care; (2) an inspection and reporting system to ensure that long-term health care facilities are in compliance with state statutes and regulations pertaining to patient care; and (3) a provisional licensing mechanism to ensure that full-term licenses are issued only to those long-term health care facilities that meet state standards relating to patient care." (Health
The term "long-term health care facility" is defined as any of eight types of licensed care facilities. (Health & Saf. Code, § 1418, subd. (a); see § 1760.) Four of the eight categories of long-term care facilities — "[i]ntermediate care facility/developmentally disabled," "[i]ntermediate care facility/developmentally disabled habilitative," "[i]ntermediate care facility/developmentally disabled — nursing," and "[i]ntermediate care facility/developmentally disabled — continuous nursing" (id., § 1418, subd. (a)(3)-(5), (8)) — serve only developmentally disabled persons.
Before the Long-Term Care Act was enacted, the only significant sanctions available against a long-term health care facility were misdemeanor criminal charges, injunctions, or suspension or revocation of the facility's license. (Sen. Com. on Health & Welfare, Analysis of Assem. Bill No. 1600 (1973-1974 Reg. Sess.) as amended June 21, 1973, p. 1.) This system was "criticized as too rigid, lacking in intermediate sanctions, and ineffective in producing compliance with standards." (Ibid.; see Joint Com. on Aging, Analysis of Assembly Bill 1600 (1973-1974 Reg. Sess.) p. 4; Report of Joint Committee on Aging, Regarding Assembly Bill 1600, 5 Assem. J. (1973-1974 Reg. Sess.) p. 8786 (Joint Committee Report) [describing the available remedies as "either too weak or too severe in nature"].) The Long-Term Care Act also specifically sought to combat the problem that "[t]he Department's reports on nursing homes and their relative compliance with patient health and safety standards were all centralized in Sacramento and, therefore, practically inaccessible to nursing home consumers ...." (Joint Com. Rep., at p. 8786.)
The Long-Term Care Act details the information that must be included in every citation, and it specifies that citations are public records. It also specifies that the patient's or resident's name must be redacted and is not part of the public record. Health and Safety Code section 1423 provides that "[e]ach citation shall be in writing and shall describe with particularity the nature of the violation, including a reference to the statutory provision, standard, rule, or regulation alleged to have been violated, the particular place or area of the facility in which it occurred, as well as the amount of any proposed assessment of a civil penalty. The name of any patient jeopardized by the alleged violation shall not be specified in the citation in order to protect the privacy of the patient. However, at the time the licensee is served with the citation, the licensee shall also be served with a written list of each of the names of the patients alleged to have been jeopardized by the violation, that shall not be subject to disclosure as a public record." (Health & Saf. Code, § 1423, subd. (a)(2).)
Finally, the Long-Term Care Act says, "Any writing received, owned, used, or retained by [DPH] in connection with the provisions of this chapter is a public record within the meaning of subdivision (d) of Section 6252 of the Government Code, and, as such, is open to public inspection pursuant to the provision of Section 6253, 6256, 6257, and 6258 of the Government Code." (Health & Saf. Code, § 1439.) Again, the statute emphasizes that the patients' and residents' names must be redacted but does not mention any other redaction. (Ibid. ["[T]he names of any persons contained in such records, except the names of duly authorized officers, employees, or agents of the state department conducting an investigation or inspection in response to a complaint filed pursuant to this chapter, shall not be open to public inspection and copies of such records provided for public inspection shall have such names deleted."].)
The Lanterman-Petris-Short Act was enacted in 1967. (Stats. 1967, ch. 1667, § 36, p. 4074.) Its stated purposes include "provid[ing] prompt evaluation and treatment of persons with mental health disorders or impaired by chronic alcoholism" (§ 5001, subd. (b)), "encourag[ing] the full use of all existing agencies, professional personnel, and public funds to accomplish these objectives" (id., subd. (f)), and "protect[ing] persons with mental health disorders and developmental disabilities from criminal acts" (id., subd. (g)).
The relevant provisions here are sections 5328 and 4514. Section 5328 provides that "[a]ll information and records obtained in the course of providing services under" enumerated statutory divisions addressing services provided to mentally ill individuals "to either voluntary or involuntary recipients of services shall be confidential...." It further provides that "[i]nformation and records shall be disclosed only in any of the following cases ..." and then enumerates 25 specific exceptions. (Ibid.) The exceptions
As originally enacted, section 5328 contained a much shorter list of exceptions. (See Stats. 1967, ch. 1667, § 36, pp. 4074, 4092-4093.) It was reenacted and amended in 1972 (Stats. 1972, ch. 1058, § 2, pp. 1960-1961) and has subsequently been amended several times to expand the list of exceptions. As discussed in more detail below, the Legislature enacted additional exceptions to section 5328's confidentiality rule in 1980, which were codified at section 5328.15. (Stats. 1980, ch. 695, § 1, p. 2095.) Section 5328.15 has been amended several times. The most relevant amendment occurred in 2012, when the Legislature authorized disclosure of confidential information, including "unredacted citation report[s]," to any "protection and advocacy agency established pursuant to [Welfare and Institutions Code] Section 4901." (§ 5328.15, subd. (c)(2); see Stats. 2012, ch. 664, § 3.)
Section 5328's confidentiality protections are designed "to encourage persons with mental or alcoholic problems to seek treatment on a voluntary basis." (County of Riverside v. Superior Court (1974) 42 Cal.App.3d 478, 481 [116 Cal.Rptr. 886]; see Sorenson v. Superior Court (2013) 219 Cal.App.4th 409, 447 [161 Cal.Rptr.3d 794] (Sorenson); In re S.W. (1978) 79 Cal.App.3d 719, 721 [145 Cal.Rptr. 143] [§ 5328 seeks to protect patients from the
Before considering the merits of the Court of Appeal's effort to harmonize the Long-Term Care Act and the Lanterman Act, we must first address a threshold argument. The Center contends that section 5328 does not apply to Long-Term Care Act citations because such citations are not "obtained in the course of providing services" (§ 5328) to developmentally disabled or mentally ill persons. The Center says that an investigation and the resulting citation do not involve providing services, so their content is not governed by section 5328's confidentiality guarantee.
The Center relies on Sorenson, supra, 219 Cal.App.4th 409, Tarasoff v. Regents of University of California (1976) 17 Cal.3d 425, 443 [131 Cal.Rptr. 14, 551 P.2d 334] (Tarasoff), and Devereaux v. Latham & Watkins (1995) 32 Cal.App.4th 1571, 1585 [38 Cal.Rptr.2d 849] (Devereaux) in support of its argument that the information in DPH citations is not "obtained in the course of providing services." But none of these cases stands for the proposition that confidential information obtained during a DPH investigation becomes public when an investigator reviews or reproduces it.
Tarasoff and Devereaux are even further afield. Neither case involved a patient or resident who was alleged to have been receiving treatment under the Lanterman Act at the time the record in question was generated. (See Tarasoff, supra, 17 Cal.3d at p. 443 ["[t]he pleadings ... state no facts showing that the psychotherapy provided to [the patient] by [the hospital] falls under any of [the] programs" enumerated in § 5328]; Devereaux, supra, 32 Cal.App.4th at p. 1585 [the patient "failed to allege with any specificity the nature of [the] records so as to bring them within the purview of ... section 5328"].) They therefore have little relevance here.
We now turn to the primary question that occupied the Court of Appeal: whether the Long-Term Care Act and the Lanterman Act can be harmonized, or whether one must prevail over the other.
The Court of Appeal misapplied the harmonization rule here. It did not interpret either the Lanterman Act or the Long-Term Care Act in a way that rendered the text of the two acts consistent. Instead, its harmonization analysis began by considering the "common purpose" of the two acts, i.e., "to promote and protect the health and safety of mental health patients." It then harmonized the statutes by considering, in its own independent judgment, whether disclosure of the various types of information listed as public records in the Long-Term Care Act would serve this common purpose. This approach was well intentioned but erroneous.
The Long-Term Care Act states not only that DPH citations are public records, but that "AA" and "A" citations must be publicly posted at the facility in question. (Health & Saf. Code, §§ 1424, subd. (b), 1429, subds. (a) & (b), 1439.) Section 1424, subdivision (a) specifically states the factors DPH must consider when choosing the appropriate fine for a violation. Those factors include "[t]he patient's or resident's medical condition," "his or her
In two separate statutory provisions, the Long-Term Care Act also mandates the precise redactions that should occur before making a citation public. Health and Safety Code section 1423 states that "[t]he name of any patient jeopardized by the alleged violation shall not be specified in the citation in order to protect the privacy of the patient." (Health & Saf. Code, § 1423, subd. (a)(2).) Although patient names must be made available to the sanctioned facility itself, they "shall not be subject to disclosure as a public record." (Ibid.) Similarly, Health and Safety Code section 1439 states that "[a]ny writing ... retained by the state department in connection with the provisions of this chapter is a public record ... and, as such, is open to public inspection pursuant to the provisions of [the Public Records Act]. However, the names of any persons contained in such records, except the names of duly authorized officers, employees, or agents of the state department conducting an investigation or inspection ... shall not be open to public inspection and copies of such records provided for public inspection shall have such names deleted."
By contrast, the Lanterman Act's express terms would render most of the information included in a DPH citation confidential and therefore not subject
It is thus evident that the two statutory schemes conflict. On one hand, the Long-Term Care Act, which expressly applies to facilities that provide the types of services enumerated in section 5328 (see Health & Saf. Code, § 1418), requires publication of all information contained in DPH-issued citations except for the names of patients or residents (or information that constitutes the constructive equivalent of the patients' or residents' names). Failure to publicly post the citations in the manner required by the Long-Term Care Act is a class "B" violation of the Long-Term Care Act resulting in a $1,000 civil penalty. (Health & Saf. Code, § 1429, subd. (c).) On the other hand, section 5328 provides that all information obtained in the course of providing enumerated services to patients or residents is confidential and thus not subject to disclosure. As such, the Lanterman Act would require extensive redaction of citations before they could be made public. The knowing disclosure of such confidential information exposes the discloser to a minimum of $10,000 in civil liability; negligent disclosure exposes the discloser to a minimum of $1,000 in civil liability. (§ 5330.) In sum, the Lanterman Act prohibits disclosure of information that the Long-Term Care Act deems public.
The Court of Appeal's harmonization effort results in a disclosure scheme that is inconsistent with the requirements of either statute. By permitting DPH to disclose "what was the harm [to the patient or resident], what was the abuse, what was the lack of respect or dignity afforded, and what was the action that the facility did or failed to do" (italics omitted), the Court of Appeal did not give full effect to section 5328's mandate that such information is the type of medical information that must be maintained as confidential to protect patients and residents from embarrassment. And by requiring redaction of information that the Long-Term Care Act expressly requires to be included in the public record, including "[t]he patient's or resident's mental, physical, and medical conditions, history of mental disability or disorder, as well as the risk the violation presents to that mental and physical condition," the Court of Appeal did not give full effect to that act's purpose of preventing future violations by making facilities' past violations publicly known with a high degree of specificity. As Justice Hoch put it, "under the guise of bringing harmony, the majority opinion does violence to two
Even if the Court of Appeal's methodology had been sound, it is not clear that the balance it struck was logical. The Court of Appeal's decision required the redaction of information, including information on "the risk the violation presents to [the patient's or resident's] mental and physical condition," that is highly significant to understanding how and why the DPH selected a particular penalty as the appropriate punishment for a particular violation. At the same time, the Court of Appeal's compromise leaves in the public record enough facts for a patient or resident who was the victim of the misconduct to know that he or she is the subject of the citation. It is hard to see how such results would protect patients from the embarrassment of seeing their suffering disclosed in the public record or advance the Long-Term Care Act's goal of specifically and publicly identifying the full scope of a facility's misconduct.
In addition, the Court of Appeal's harmonization requires facilities to walk a tightrope when balancing their obligations to protect confidentiality and to make citations public. The slightest misstep in either direction exposes facilities to significant civil liability. (See Health & Saf. Code, § 1429, subd. (c); Welf. & Inst. Code, § 5330, subds. (a) & (b).) It is unclear whether a risk-averse facility would react by overredacting or underredacting. What is clear is that facilities would be exposed to a dilemma that the Legislature in all likelihood did not intend to create.
We also reject DPH's argument that the statutes can be harmonized by reading Health & Safety Code section 1439 as authorizing the extensive redaction of citations permitted by the Court of Appeal. Section 1439 requires disclosure of citations "pursuant to the provision of" the Public Records Act. In turn, the Public Records Act provides that "public records exempt from disclosure by express provisions of law" need not be disclosed. (Gov. Code, § 6253, subd. (b).) According to DPH, section 5328 is such an "express provision of law," thus creating an exemption from the Public Records Act's general rule favoring disclosure of governmental records. But interpreting section 5328 to define the information subject to disclosure under the Long-Term Care Act would mean section 1439 has little if any practical effect as to mentally ill and developmentally disabled individuals in state-owned long-term health care facilities, who constitute a significant portion of the individuals section 5328 encompasses. It is hard to fathom why the Legislature would have expressly stated in section 1439 that "the names of any persons contained in such records ... shall not be open to public
We now address the dispositive question: whether the Lanterman Act must be treated as an exception to the Long-Term Care Act's general rule that DPH citations must be made public with only minimal redactions, or whether the Long-Term Care Act must be treated as an exception to the Lanterman Act's general rule that all information obtained in the course of treating mentally ill and developmentally disabled patients and residents is confidential.
The parties rely on dueling cases to demonstrate which statute is more specific. The Center cites cases to demonstrate that the relevant provisions of the Long-Term Care Act are more specific because they deal with a more specific subject matter — i.e., DPH citations — than does section 5328, part of the Lanterman Act. (See, e.g., Marsh v. Edward Theatres Circuit, Inc. (1976) 64 Cal.App.3d 881, 890 [134 Cal.Rptr. 844] ["A special statute dealing expressly with a particular subject controls and takes precedence over a more general statute covering the same subject."].) On the other hand, DPH argues that the Lanterman Act is more specific because it applies to a narrower group of individuals. (See In re Ward (1964) 227 Cal.App.2d 369, 374-375 [38 Cal.Rptr. 650].)
The Legislature has amended section 5328 several times since 1972 to update statutory cross-references and to expand the list of exceptions. In 1982, the Legislature enacted section 4514, which is substantively identical to section 5328 but pertains exclusively to developmentally disabled individuals. These changes left intact the key language of section 5328: the requirement that "[a]ll information and records obtained in the course of providing services ... to either voluntary or involuntary recipients of services shall be confidential." (§ 5328; see Gov. Code, § 9605 ["Where a section or part of a statute is amended .... [t]he portions which are not altered are to be considered as having been the law from the time when they were enacted ...."].)
Moreover, the Legislature has continued to view the Long-Term Care Act as demanding specific and detailed disclosure of DPH citations. Health and Safety Code section 1424's statement that "[r]elevant facts considered by [DPH] in determining the amount of the civil penalty [for a citation] shall be documented by [DPH] on an attachment to the citation and available in the public record" was added by the Legislature in 1998. (Health & Saf. Code, § 1424, subd. (b), as amended by Stats. 1998, ch. 650, § 3, p. 4249.) Thus, more than 25 years after the original enactment of the Long-Term Care Act, the Legislature reaffirmed the importance of publicly releasing the detailed information contained in the attachments to a DPH citation, and it did so without suggesting that § 5328 limited the scope of disclosure. (Cf. Albertson v. Superior Court (2001) 25 Cal.4th 796, 804-807 [107 Cal.Rptr.2d 381, 23 P.3d 611] [relying on legislative history showing that the Legislature had enacted a statute requiring disclosure of confidential records of sex offenders to the district attorney despite the fact that no such exemption was added to § 5328].)
Contrary to DPH's argument, the 2012 enactments do not provide protection and advocacy agencies with merely the same access to DPH citations that the general public has under the Long-Term Care Act. The statutes, by their terms, provide for disclosures of unredacted citations, i.e., citations that include the names that sections 1423 and 1439 of the Health and Safety Code require to be redacted. Thus, the recent enactments at most prove that the Legislature in 2012 sought to ensure greater access to citations for the protection and advocacy agency than the degree of access to which the general public is entitled. This is hardly surprising given that the protection and advocacy agency needs to know who was actually harmed by a facility's misconduct in order to fulfill the agency's statutory mandate of "protecting and advocating for the rights of people with disabilities," including by "[p]ursu[ing] administrative, legal, and other appropriate remedies or approaches." (§ 4902, subd. (a)(2).) The 2012 enactments also operate in a different procedural context: whereas a member of the general public must file a Public Records Act request for a copy of the citation with redactions to remove patient names, the protection and advocacy agency gains direct access to unredacted records within three days of making a request. (§ 4903, subd. (e)(1).)
DPH's argument that section 5328.15, subdivision (a) evinces the Legislature's intent to limit the scope of public disclosure of DPH citations is similarly flawed. That provision permits the disclosure of any and all information that is confidential under section 5328 to DPH licensing personnel. It does not refer specifically to DPH citations imposed under the Long-Term Care Act, nor does it prove by implication that the Legislature sought to repeal that statute's explicit provisions governing the disclosure of such citations.
On this record, we do not know whether the 55 citations at issue will be devoid of personally identifying information once redacted to remove patient and resident names. Accordingly, we have no occasion to consider whether unusually detailed citations that clearly identify particular patients or residents without expressly naming them might require redaction under the Long-Term Care Act.
For the reasons above, we reverse and remand this case to the Court of Appeal with instructions to deny DPH's petition for writ of mandate. We also deny DPH's motion to take additional evidence.
Cantil-Sakauye, C. J., Werdegar, J., Chin, J., Corrigan, J., Baxter, J.,