## Facts

- SEPTA, a self-insured public transportation authority, was contractually required to provide a prescription drug benefit to employees.
- To control costs and monitor misuse, SEPTA contracted with Rite Aid as the sole prescription provider and received periodic utilization reports.
- Under the reporting arrangement, SEPTA’s Chief Administrative Officer, Judith Pierce, received reports listing employee names alongside the drugs dispensed.
- John Doe, a SEPTA employee receiving AIDS-related medications, had disclosed his HIV/AIDS status to SEPTA’s medical director, who indicated prescription monitoring generally did not link names to specific drugs.
- Pierce inferred Doe’s HIV/AIDS status from the reports and discussed the information with SEPTA’s benefits director in connection with administering and reviewing the prescription program.
- Doe alleged the internal disclosure caused emotional distress and workplace ostracism.
- Doe sued under 42 U.S.C. § 1983, asserting violation of constitutional informational privacy (and also raised Fourth Amendment and procedural due process theories).
- After trial, a jury awarded Doe $125,000 in compensatory damages; the district court denied defendants’ post-trial motions.

## Issues

1. Whether the Constitution protects an individual’s interest in keeping prescription drug records and HIV/AIDS status confidential.
2. If so, whether SEPTA’s access to and limited internal sharing of identified prescription information for administration of a self-insured prescription plan violated that right.
3. Whether defendants were entitled to judgment as a matter of law notwithstanding the jury verdict.

## Decision

- The Third Circuit reversed and directed entry of judgment for SEPTA and Pierce.
- The court recognized a constitutionally protected privacy interest in medical information, including prescription records and HIV status.
- Applying a balancing test, the court held SEPTA’s administrative and financial need to audit and monitor its self-insured prescription program outweighed Doe’s confidentiality interest on these facts.
- The court concluded the conduct was an impingement on privacy but not a constitutional violation; the jury’s verdict and damages award were set aside.

## Legal Principles

- The Constitution protects an interest in avoiding disclosure of personal medical matters, including prescription drug information and HIV/AIDS status.
- The protection is conditional and requires balancing the individual’s privacy interest against the government employer’s asserted need for access.
- Relevant balancing considerations include: the type and sensitivity of the record; the information contained; risk and harm from nonconsensual disclosure; effects on the relationship in which the record arose; safeguards against unauthorized disclosure; the degree of need for access; and statutory mandate or public policy supporting access.
- A government employer administering a self-insured health benefit may access identified prescription utilization information for cost control, fraud detection, and plan administration when internal dissemination is limited to personnel with a need to know; such a limited intrusion may be insufficient to establish a constitutional violation under § 1983.

## Conclusion

The Third Circuit held that although prescription and HIV-related information implicates constitutional informational privacy, SEPTA’s limited access to and internal use of identified prescription data for auditing and administering its self-insured plan was justified by legitimate administrative need and therefore did not violate the Constitution.


Doe v. Se. Pa. Transp. Auth., 72 F.3d 1133 (3d Cir. 1995)