Teresa Scassa - Blog

The Supreme Court of Canada has just granted leave to appeal a decision of the British Columbia Court of Appeal in a case involving evidentiary issues in the province’s law suit to recover health care costs from the tobacco industry. The law suit was brought under the Tobacco Damages and Health Care Costs Recovery Act – a law passed specifically for the purpose of recovering health care costs from the industry. The case raises interesting issues regarding the balance between privacy rights and fairness in litigation; it also touches on issues or re-identification risk in aggregate health care data.

Under the B.C. statute, the province has two options for recovering health care costs. It can recover actual costs for particular identified individuals, or it can recover costs on an aggregate basis “for a population of insured persons as a result of exposure to a type of tobacco product.” (s. 2(1)) The province chose the second option. Under s. 2(5) of the Act, if this route is chosen, the province is not required to identify specific individuals or to establish tobacco-related illnesses with respect to those individuals. Further, the health records of specific individuals need not be provided as part of the litigation. However, if aggregate data is relied upon, the court retains the right to “order discovery of a statistically meaningful sample” of the records, and can issue “directions concerning the nature, level of detail and type of information to be disclosed.” The court must nevertheless ensure that the identities of the specific individuals to whom the data pertain are not disclosed.

The province generated aggregate statistical data regarding costs from its databases of health care services provided to insured persons, and indicated its intention to rely upon this data to prove its case. The defendant tobacco companies sought access to the data relied upon by the province. The province declined to provide the data directly. Instead it arranged for a limited form of access through third party intermediaries, which included Statistics Canada employees. Although some of the defendants accepted this approach, Philip Morris International (PMI) did not. It argued that it was entitled to access the data itself in order to assess the reliability and accuracy of the province’s analyses. Both the court at first instance and the B.C. Court of Appeal ultimately sided with PMI.

The B.C. Information and Privacy Commissioner, who intervened in the appeal before the B.C. Court, argued that “the interpretation of a statutory provision aimed at protecting personal privacy must be approached in light of the importance of protection of privacy as a fundamental value in Canadian society” (at para 25 of the BCCA decision). He maintained that the court should rely upon the Freedom of Information and Protection of Privacy Act (FIPPA) in interpreting the Tobacco Act, and that FIPPA required the terms “personal information” and “record” to be given a broad interpretation. The Court of Appeal summarily rejected this argument, stating that “FIPPA does not limit the information available by law to a party to a proceeding (s. 3(2)) and has no role in the interpretation of s. 2(5)(b).” (at para 25)

The Court of Appeal noted that the Tobacco Act provided two routes for the province to establish damages, one that required consideration of individual health records and one that did not. It chose the second route, which means that in general terms, individual health records are not compellable. The province argued that their decision to choose this route was motivated by a desire to protect the privacy of affected individuals. The Information and Privacy Commissioner argued that a requirement to disclose the aggregate data “has privacy implications for millions of insured persons who are not involved as litigants in the underlying action.” (at para 28) The Court of Appeal noted, however, that the legislation established the ‘playing field’ on which the litigation would take place and that there was no indication that this playing field was not intended to be even. It observed that the legislation does not make privacy a “paramount concern” (at para 31) since it did provide the province with the option to choose a route that would involve consideration of thousands of specific records. Had this route been chosen, the Court noted, “all of the individualized persons’ health care records would be subject to discovery and disclosure notwithstanding any privacy concerns that such disclosure might raise.” (at para 31)

With an aggregate action, the focus is not on individualized health care records. Section 2(5)(b) protects the privacy of individuals if such a route is chosen, and prevents “the aggregate action from becoming bogged down with “individual forms of discovery” in which the defendants could demand voluminous records of thousands or millions of people.” (at para 34) However, the Court noted that in following this route, the province will rely upon the data generated from its databases to establish both causation and damage. This makes the databases highly relevant to the litigation. The Court noted that s. 2(5)(b) “is not intended to block the discovery of the cumulative data contained in the databases, which data is essential to prove causation and damages.” (at para 35)

The Court ruled that the anonymized data on which the province would base its analyses would pose “no realistic threat to personal privacy.” (at para 36) Further, the defendants would be bound not to disclose the information provided to them as part of the litigation-related implied undertaking. The Court also observed that the identity of the specific individuals would be of no interest to the defendants, making it highly unlikely any attempts at re-identification would be made.

The Court of Appeal was particularly concerned about the unfairness that might result if “The only data available to the defendants would be the data the Province offers up on restrictive terms, or the data the Province’s testifying experts eventually choose to rely on in their reports.” (at para 37) It found that fairness required that the databases be produced.

It should be noted that in reaching its decision, the B.C. Court of Appeal declined to follow a judgment from the New Brunswick Supreme Court in a very similar case under nearly identical legislation. In Her Majesty the Queen in Right of the Province of New Brunswick v. Rothmans Inc., the judge had dismissed an application by the defendant tobacco companies for the production of anonymized health care data in the same circumstances. The judge in that case had access to the decision of the B.C. Supreme Court which had ordered production of the databases, but had declined to follow that decision on the basis that the anonymization of the data would not be sufficient to protect privacy, and that the database was “a document containing information that relates to the provision of health care benefits for “particular individuals””. (BCCA decision at para 20) In declining to follow the New Brunswick decision, the B.C. Court of Appeal observed that the New Brunswick judge had relied entirely on the privacy provisions and “did not attempt to read the provisions in the New Brunswick Act as a harmonious whole.” (at para 39) The New Brunswick Court of Appeal declined leave to appeal. With two conflicting decisions from two different provinces, the matter is now heading to the Supreme Court of Canada.

 

 

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