## Facts

- Jane Doe was a longtime psychoanalytic patient of psychiatrist Dr. Joan Roe; Doe’s late husband was also Roe’s patient.
- Roe’s husband, Peter Poe, was a psychologist; Roe and Poe co-authored and published a book.
- About eight years after Doe’s treatment ended, the book reproduced Doe’s psychoanalytic disclosures extensively and verbatim, including intimate details about her thoughts, emotions, sexual fantasies, relationships, and marital breakdown.
- The book included psychiatric diagnoses of Doe, her husband, and one of their children, including in footnotes.
- Defendants asserted Doe consented, but any claimed consent was oral, allegedly obtained while Doe was still in therapy, and described by Roe as fluctuating due to the condition being treated.
- The court found defendants did not obtain valid consent and knew they lacked it.
- After publication, people in Doe’s personal and professional circles read the book; Doe became reclusive, her emotional condition worsened, and she incurred psychotherapy expenses and lost wages.
- The court used pseudonyms and sealed the file due to the sensitive nature of the disclosures.

## Issues

1. Whether unauthorized publication of a patient’s confidential psychoanalytic communications can support civil liability under New York law.
2. Whether New York’s physician-patient privilege (CPLR 4504(a)) and professional misconduct rules (including Education Law § 6509 and related regulations) supply a basis for a civil remedy.
3. Whether the physician-patient relationship includes an implied contractual duty of confidentiality enforceable in damages and injunctive relief.
4. Whether New York recognizes a common-law privacy claim for public disclosure of private facts notwithstanding the limits of Civil Rights Law §§ 50–51.
5. Whether an asserted patient consent or the First Amendment bars liability for publishing confidential therapeutic communications.
6. What compensatory, punitive, and injunctive remedies are available for such disclosures.

## Decision

- The court held defendants civilly liable for publishing Doe’s confidential psychoanalytic disclosures without valid consent.
- The court rejected the consent defense as factually and legally insufficient under the circumstances.
- The court recognized liability on multiple grounds, including statutory-policy, professional-duty, implied-contract, and common-law privacy theories.
- The court held the First Amendment did not shield defendants from liability for breaching psychiatric confidentiality in this manner.
- The court granted injunctive relief against further dissemination and awarded compensatory damages; it also awarded punitive damages to punish and deter the conduct.

## Legal Principles

- Confidentiality is a core duty in psychiatric treatment; unauthorized publication of therapeutic communications can constitute a legally cognizable wrong.
- CPLR 4504(a), though framed as an evidentiary privilege, reflects a strong policy against physician disclosure of patient information absent waiver; that policy may support civil redress for egregious breaches.
- Professional discipline statutes and regulations defining unauthorized disclosure as misconduct may inform the standard of conduct and support recognition of a tort remedy when the protected policy is violated.
- The physician-patient relationship may be treated as contractual, with an implied promise of confidentiality consistent with professional norms; breach supports contract-based relief.
- New York may recognize a common-law privacy claim for unreasonable publicity of private medical facts, even when statutory privacy remedies are limited to use of name or likeness.
- Purported consent obtained orally during ongoing therapy, especially where the patient’s condition is cited as affecting reliability, may be ineffective to waive confidentiality for later commercial publication.
- Free speech interests do not immunize a clinician’s verbatim disclosure of identifiable patient confidences made in treatment.

## Conclusion

The court imposed injunctive and monetary remedies after finding that a psychiatrist and co-author spouse unlawfully disclosed a former patient’s confidential psychoanalytic communications in a book without valid consent, and that neither asserted consent nor the First Amendment excused the breach of professional and legal duties of confidentiality.


Doe v. Roe, 93 Misc. 2d 201, 400 N.Y.S.2d 668 (Sup. Ct. N.Y. Cnty. 1977)