## Facts

- The Medical Board of California investigated Dr. Alwin Carl Lewis’s prescribing practices involving Schedule II–IV controlled substances used in a very low-calorie diet regimen.
- During the investigation, the Board obtained patients’ prescription information from California’s Controlled Substance Utilization Review and Evaluation System (CURES) without a warrant or a subpoena supported by good cause.
- Following administrative proceedings, the Board disciplined Lewis for gross negligence and repeated negligent acts in prescribing.
- Lewis sought writ relief in superior court, arguing (among other points) that obtaining CURES data violated patients’ privacy rights under article I, section 1 of the California Constitution.
- The superior court denied relief and upheld the discipline; the Court of Appeal affirmed.
- The California Supreme Court granted review to decide whether the Board’s warrantless, subpoena-less access to CURES data violated patients’ state constitutional privacy rights in the context of a physician-discipline investigation.

## Issues

1. Whether patients have a legally protected privacy interest and reasonable expectation of privacy in CURES prescription records sufficient to trigger article I, section 1 protections.
2. Whether the Medical Board’s access to CURES records without a warrant or subpoena constitutes a serious invasion of privacy.
3. If there is a serious invasion, whether the intrusion is justified and appropriately limited given the state’s interests and the safeguards governing CURES access.

## Decision

- The California Supreme Court affirmed the Court of Appeal and left the Board’s discipline in place.
- The Court assumed, without deciding definitively, that patients have a legally protected privacy interest in CURES data and that access could be a serious intrusion.
- The Court held that any such intrusion was justified by the state’s compelling interests in preventing diversion and abuse of controlled substances and protecting patients from negligent or incompetent prescribing.
- The Court declined to require, as a constitutional matter, a warrant or subpoena supported by good cause before the Board may access CURES in a specific disciplinary investigation.

## Legal Principles

- Article I, section 1 privacy claims are evaluated by asking whether there is (1) a legally protected privacy interest, (2) a reasonable expectation of privacy, and (3) a serious invasion; if so, courts balance countervailing interests and consider whether the intrusion is justified and adequately limited.
- Medical and prescription information can fall within informational privacy protections, but government acquisition of such information is not per se unconstitutional.
- Statutory reporting requirements and regulated, purpose-limited disclosure can diminish reasonable expectations of privacy in the reported data relative to other medical information.
- Access to a limited-access regulatory database may be constitutionally permissible when used for a case-specific investigation, constrained to relevant records, and subject to confidentiality and use restrictions.
- The state constitutional privacy analysis does not automatically impose a Fourth Amendment-style warrant requirement; the question is justification and tailoring in context.

## Conclusion

The court held that the Medical Board’s access to patients’ CURES prescription records without a warrant or subpoena, undertaken for a targeted physician-discipline investigation and subject to statutory confidentiality and use limits, did not violate the California Constitution’s privacy clause because the intrusion was justified by compelling public safety and patient protection interests.


Lewis v. Superior Court, 3 Cal. 5th 561 (Cal. 2017)