in-re-robert-l-williams-individually-and-on-behalf-of-the-estate-of ( 2009 )


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  •                                   IN THE
    TENTH COURT OF APPEALS
    No. 10-08-00364-CV
    IN RE ROBERT L. WILLIAMS, INDIVIDUALLY AND ON BEHALF OF
    THE ESTATE OF ALBERTA SUE WILLIAMS, DECEASED AND ON
    BEHALF OF WRONGFUL DEATH BENEFICIARIES ROBERT L.
    WILLIAMS AND DUSTIN STROM
    Original Proceeding
    MEMORANDUM OPINION
    Robert L. Williams, individually and on behalf of the Estate of Alberta “Sue”
    Williams, deceased, and on behalf of wrongful death beneficiaries Robert L. Williams
    and Dustin Strom, seeks a writ of mandamus directing Respondent, the Honorable
    Steve Smith, judge of the 361st Judicial District Court of Brazos County, to vacate an
    order compelling the production of Dustin’s mental health records. We conditionally
    grant the relief requested.
    FACTUAL BACKGROUND
    Sue, a tractor-trailer driver, sustained injuries in an accident with another tractor
    trailer. As a result, she suffered from chronic pain and depression. Her pain was
    controlled by medication. While her husband Robert, also a truck driver, was out of
    town working, Sue fell and was unable to get up. She went without food and water for
    approximately two days. Robert contacted authorities when he was unable to reach
    Sue. Sue was taken to College Station Medical Center. She suffered from dehydration,
    renal failure, and rhabdomyolysis.          Physicians Wendell Lobb, M.D. and Steven
    Opersteny, M.D. treated her. After her discharge, Sue received home health care from
    Healthwise Home Health Care Agency. Approximately two and a half weeks later, Sue
    was found dead in her home.
    At the time of Sue’s death, her fifteen-year old son Dustin resided in New York
    with his father and stepmother. Sue and Dustin’s father were in the midst of a custody
    battle. Dustin and Sue had not been getting along. Dustin was not invited to Sue’s and
    Robert’s wedding, and he had not spoken to Sue in several months or visited her in
    Texas.     In March 2004, Dustin began meeting with a counselor.              These sessions
    continued until January 2005, approximately two months after Sue’s death. Dustin
    subsequently dropped out of high school for missing too many days. He missed school
    because he lost approximately sixty pounds, which lowered his immune system and
    caused him to be ill more often. He opined that his weight loss may have resulted from
    the depression he suffered as a result of Sue’s death.
    In re Williams                                                                          Page 2
    Robert sued the Medical Center, Dr. Lobb, Dr. Opersteny, and Healthwise (“Real
    Parties in Interest”), alleging negligence and seeking mental anguish damages. At his
    deposition, Dustin declined to answer questions regarding his mental healthcare
    provider. Dr. Lobb and Dr. Opersteny filed a motion to compel production of Dustin’s
    mental health records. The Medical Center and Healthwise filed a joint motion to
    compel. Robert informed Respondent that the only available medical or mental health
    records were those created during Dustin’s counseling sessions. After an in camera
    inspection, Respondent ordered production of the records.
    MANDAMUS REQUIREMENTS
    Generally, privileged matters are not discoverable. In re Fort Worth Children’s
    Hosp., 
    100 S.W.3d 582
    , 587 (Tex. App.—Fort Worth 2003, orig. proceeding); see In re
    Nance, 
    143 S.W.3d 506
    , 510 (Tex. App.—Austin 2004, orig. proceeding). A discovery
    order is improper if it compromises a person’s right to possible claims of privilege or
    mandates the disclosure of privileged information that exceeds the scope of discovery.
    Fort Worth Children’s 
    Hosp., 100 S.W.3d at 587
    . Mandamus is the appropriate remedy
    when the trial court has erroneously granted discovery of privileged documents. 
    Id. Remedy by
    appeal in that case is ineffective because, once revealed, the documents
    cannot be protected. 
    Id. The party
    claiming privilege has the burden to establish the
    privilege. Id; see also TEX. R. CIV. P. 193.4(a).
    ISSUES PRESENTED
    Robert contends that Respondent abused his discretion by compelling
    production of Dustin’s mental health records because they are protected by the mental
    In re Williams                                                                   Page 3
    health information privilege.    Real Parties in Interest contend that the records are
    discoverable because: (1) the mental health information privilege was waived; (2) the
    patient-litigant exception applies; and (3) the offensive-use doctrine applies.
    WAIVER
    A party should not object to a request for written discovery on the grounds that
    it calls for production of material or information that is privileged but should instead
    comply with Rule 193.3. TEX. R. CIV. P. 193.2(f). A party who objects to production of
    privileged material or information does not waive the privilege but must comply with
    Rule 193.3 when the error is pointed out. 
    Id. A party
    who claims that material or
    information responsive to written discovery is privileged may withhold the privileged
    material or information from the response. TEX. R. CIV. P. 193.3(a). The party must
    state--in the response (or an amended or supplemental response) or in a separate
    document--that: (1) information or material responsive to the request has been withheld
    (2) the request to which the information or material relates, and (3) the privilege or
    privileges asserted. 
    Id. Real Parties
    in Interest contend that Robert waived the mental health information
    privilege by failing to assert it in response to discovery requests.        Specifically, in
    response to an interrogatory seeking the identities of all medical providers that “have or
    are presently treating Dustin Strom for injuries he alleges were caused by the events in
    question,” Dustin stated that he was “treated by a counselor in New York after his
    mother’s death whose name will be provided in supplement to this answer.” This
    answer was later supplemented: “Upon further investigation, Plaintiff has discovered
    In re Williams                                                                        Page 4
    that Dustin has not been treated for any injuries related to the events in question.” In
    response to a request for “all medical records relating to any injury you allegedly
    suffered as a result of the alleged incident,” Robert objected on the basis of Rules of
    Civil Procedure 192.3, 194.1, 176.7, and 192.4.
    Although Robert did not assert the mental health information privilege in
    response to these requests, he argues that Dustin’s mental health records were not
    responsive to these requests. Moreover, he asserted the privilege in response to a
    request for production specifically seeking “All medical reports and medical records
    pertaining to Dustin Strom”:
    Plaintiff further objects to this request as violating and invading Dustin
    Strom’s physician-patient privilege set forth in T.R.E. 509 and 510, to the
    extent it seeks medical information beyond that relevant to an issue of the
    physical, mental or emotional condition of decedent on which any party
    relies as a part of their claim or defense.1
    Moreover, during Dustin’s deposition, counsel instructed him not to answer any
    questions regarding whether he has seen any counselors, stating that such information
    is “not discoverable” and is “privileged.”             Robert further asserted the privilege in
    response to the motion to compel production of Dustin’s mental health records.
    Rule 193.3 makes clear that privileges need not be asserted in the response to
    discovery requests, but may be asserted in supplemental or amended responses or a
    separate document. See TEX. R. CIV. P. 193.3(a). Nor is there a time limit within which
    to assert such a privilege. See In re Graco Children’s Prods., 
    173 S.W.3d 600
    , 605 (Tex.
    1       The response further stated, “An executed authorization of relevant medical records of Dustin
    Strom will be provided if and when it is determined that Dustin Strom has suffered from injuries that are
    or were treated by a health care provider.”
    In re Williams                                                                                    Page 5
    App.—Corpus Christi 2005, orig. proceeding) (“Although the time limit for objecting to
    written discovery is 30 days from the date of service, no objection needs to be made to
    preserve a privilege and the rules set no time-limit for asserting a privilege.”); see also
    TEX. R. CIV. P. 193.2(f), 193.3(a).         The record demonstrates that the mental health
    information privilege was raised in the trial court when applicable. 2 See In re BP Prods.
    N. Am. Inc., 
    263 S.W.3d 106
    , 111-12 (Tex. App.—Houston [1st Dist.] 2006, orig.
    proceeding) (“[T]he party seeking to resist discovery bears the burden of pleading and
    proving an applicable privilege.”); see 
    Nance, 143 S.W.3d at 510
    (mental health
    information privilege was waived by virtue of failure to assert it in the trial court).
    Robert did not waive the right to assert the mental health information privilege.
    MENTAL HEALTH INFORMATION PRIVILEGE
    The mental health information privilege protects the following from disclosure in
    civil cases: (1) communications between a patient and a professional; and (2) records of
    the identity, diagnosis, evaluation, or treatment of a patient which are created or
    maintained by a professional. TEX. R. EVID. 510(b)(1), (2). The patient-litigant exception
    allows for disclosure of a “communication or record relevant to an issue of the physical,
    mental or emotional condition of a patient in any proceeding in which any party relies
    upon the condition as a part of the party’s claim or defense.” TEX. R. EVID. 510(d)(5).
    The exception applies when the records are “relevant to the condition at issue” and the
    “condition is relied upon as a part of a party’s claim or defense, meaning that the
    2       Real Parties in Interest cite Kavanaugh v. Perkins, 
    838 S.W.2d 616
    (Tex. App.—Dallas 1992, orig.
    proceeding), in support of their contention that the mental health information privilege has been waived.
    In Kavanaugh, the privilege was raised for the first time in the petition for mandamus. See 
    Kavanaugh, 838 S.W.2d at 620
    . Here, the privilege was raised in the trial court; thus, Kavanaugh is inapplicable.
    In re Williams                                                                                     Page 6
    condition itself is a fact that carries some legal significance.” R.K. v. Ramirez, 
    887 S.W.2d 836
    , 843 (Tex. 1994) (orig. proceeding). A condition is “‘part’ of a claim or defense if the
    pleadings indicate that the jury must make a factual determination concerning the
    condition itself.” 
    Id. Even then,
    “patient records should be revealed only to the extent necessary to
    provide relevant evidence relating to the condition alleged.” 
    Id. “[C]ourts reviewing
    claims of privilege and inspecting records in camera should be sure that the request for
    records and the records disclosed are closely related in time and scope to the claims
    made so as to avoid any unnecessary incursion into private affairs.” 
    Id. If a
    record
    “includes some information meeting this standard, any information not meeting this
    standard remains privileged and must be redacted or otherwise protected.” 
    Id. Analysis Whether
    Respondent abused his discretion depends on whether Dustin’s records
    are “relevant to the condition at issue” and whether the condition itself is of legal
    consequence to a claim or defense. 
    R.K., 887 S.W.2d at 843
    . Real Parties in Interest
    argue that: (1) Dustin placed his mental health in issue by claiming that he suffered
    depression and weight loss and dropped out of school after Sue’s death; (2) “[s]hould a
    jury find negligence against a Defendant in this case, it will then make a factual
    determination concerning Plaintiff Dustin Strom’s mental condition, injury thereto, and
    award a dollar amount to compensate him”; and (3) the records “relate to treatment
    [Dustin] received at the time his injuries for mental anguish incurred.” They rely on
    Wimberly Resorts Prop., Inc. v. Pfeuffer, 
    691 S.W.2d 27
    (Tex. App.—Austin 1985, orig.
    In re Williams                                                                         Page 7
    proceeding) and Easter v. McDonald, 
    903 S.W.2d 887
    (Tex. App.—Waco 1995, orig.
    proceeding) to support their position.
    In Wimberly, Donald Dibble sued Wimberly, seeking damages for emotional
    trauma resulting from a scuba diving accident on Wimberly’s property. See 
    Wimberly, 691 S.W.2d at 28
    . Wimberly attempted to take a deposition by written questions of the
    custodian of records of Dibble’s psychiatrist as evidence of Dibble’s physical, mental,
    and emotional condition prior and subsequent to the accident. 
    Id. Dibble sought
    a
    protective order based on privilege, which the trial court granted. 
    Id. The Austin
    Court
    instructed the trial court to set aside the order:
    Because the psychiatrist is a professional under Rule 510(a)(1), Dibble is a
    patient under Rule 510 (a)(2), and the communication was in the nature of
    consultation for the diagnosis, examination, evaluation, or treatment of an
    emotional or mental condition, the information is within the rule’s
    privilege of confidentiality. Because Dibble has placed his mental or
    emotional condition in issue by his suit, the information is within the
    exception of Rule 510(d)(5).
    
    Id. at 29-30.
    In Easter, Stanley Turner sued Easter, his ex-wife Cecelia, and counselor John
    Wise, alleging that Easter sexually assaulted his daughter Amy during Easter’s
    marriage to Cecelia. See 
    Easter, 903 S.W.2d at 889
    . Between marriages, Easter, Cecelia,
    and Amy had met with Wise. 
    Id. Easter and
    Cecelia re-married. 
    Id. Turner alleged
    that the abuse continued during this second marriage. 
    Id. Turner sought
    Easter’s
    medical records. 
    Id. Wise asserted
    the mental health information privilege. 
    Id. Turner sought
    to compel production of the records.          
    Id. The trial
    court ordered Wise to
    produce the records. 
    Id. In a
    second order, the trial court found that Amy’s records
    In re Williams                                                                         Page 8
    were discoverable, but references to Cecelia in Easter’s or Amy’s records should be
    deleted. 
    Id. Easter requested
    an in-camera inspection. 
    Id. After the
    inspection, the trial
    court sustained Easter’s objection. 
    Id. Turner amended
    his petition and requested
    reconsideration of the ruling. 
    Id. The trial
    court ordered disclosure of Amy’s and
    Easer’s records with deletion of any references to Cecelia. 
    Id. We held
    that the trial court did not abuse its discretion by applying the patient-
    litigant exception because Turner had alleged that Wise was “negligent in his diagnosis
    of Easter and in representing to Turner that Easter’s condition was no threat to Amy.”
    
    Id. at 891.
    “Although the factfinder may not be asked about Easter’s condition, it will
    necessarily have to determine his condition to decide if Wise was negligent.” 
    Id. Easter is
    distinguishable from the present case. Whether Wise was negligent
    depended on Easter’s condition; thus, the jury was required to “make a factual
    determination concerning the condition itself.” 
    R.K., 887 S.W.2d at 843
    . Here, for
    reasons discussed below, the jury need not decide Dustin’s mental condition before
    awarding damages for mental anguish that he suffered as a result of Sue’s death.
    Since Wimberly, the Texas Supreme Court rendered its decision in R.K. Courts
    applying R.K. have found that a plaintiff’s past mental problems are “distinct from the
    mental anguish associated with a personal injury or loss; a tortfeasor takes a plaintiff as
    he finds him or her.” 
    Nance, 143 S.W.3d at 512
    ; see In re Pennington, No. 2-08-00233-CV,
    2008 Tex. App. LEXIS 5359, at *9 (Tex. App.—Fort Worth July 16, 2008, orig.
    proceeding) (mem. op.); see also In re Chambers, No. 03-02-00180-CV, 2002 Tex. App.
    LEXIS 4567, at *11-12 (Tex. App.—Austin June 27, 2002, orig. proceeding) (not
    In re Williams                                                                       Page 9
    designated for publication) (Plaintiff’s petition alleged nothing more than a “routine
    mental anguish claim”). A claim for mental anguish or emotional distress will not,
    standing alone, make a plaintiff’s mental or emotional condition a part of the plaintiff’s
    claim. In re Toyota Motor Corp., 
    191 S.W.3d 498
    , 502 (Tex. App.—Waco 2006, orig.
    proceeding).
    A routine allegation of mental anguish or emotional distress does not
    place the party’s mental condition in controversy. The plaintiff must
    assert mental injury that exceeds the common emotional reaction to an
    injury or loss.
    Coates v. Whittington, 
    758 S.W.2d 749
    , 753 (Tex. 1988);3 see 
    Nance, 143 S.W.3d at 512
    ; see
    also In re Doe, 
    22 S.W.3d 601
    , 610 (Tex. App.—Austin 2000, orig. proceeding); Chambers,
    2002 Tex. App. LEXIS 4567, at *11-12.
    In Pennington, which involved a traffic accident, the trial court ordered
    Pennington to (1) sign a medical release as to any records relating to her mental health
    history; and (2) supplement discovery to provide the names of her mental health care
    providers. See Pennington, 2008 Tex. App. LEXIS 5359, at *1. Pennington had asserted
    the mental health information privilege. 
    Id. at *1-2.
    Medical records addressing the
    3        Coates did not address the mental health information privilege, but created a test for compelling a
    party to submit to a mental examination. See Coates v. Whittington, 
    758 S.W.2d 749
    , 751 (Tex. 1988)
    (addressing former Rule of Civil Procedure 167a, now Rule 204.1 (physical and mental examination)). As
    part of that test, the “movant must show that the party’s mental condition is ‘in controversy’”, which is
    not accomplished by a “routine allegation of mental anguish or emotional distress.” 
    Id. at 751,
    753. The
    new Rule has changed this test to some extent. See In re Transwestern Publ’g Relators Co., 
    96 S.W.3d 501
    ,
    507 n.1. (Tex. App.—Fort Worth 2002, orig. proceeding) (“[R]ule 204.1(c) has made the showing of ‘in
    controversy’ unnecessary under both prongs of the Coates test when the party moving for a mental
    examination relies on rule 204.1(c)(2).”). Courts have cited Coates in the context of Rules of Evidence 509
    and 510. See In re Pennington, No. 2-08-00233-CV, 2008 Tex. App. LEXIS 5359, at *7 (Tex. App.—Fort
    Worth July 16, 2008, orig. proceeding) (mem. op.); see also In re Toyota Motor Corp., 
    191 S.W.3d 498
    , 502
    (Tex. App.—Waco 2006, orig. proceeding); In re Nance, 
    143 S.W.3d 506
    , 512-13 (Tex. App.—Austin 2004,
    orig. proceeding); In re Doe, 
    22 S.W.3d 601
    , 610 (Tex. App.—Austin 2000, orig. proceeding).
    In re Williams                                                                                      Page 10
    injuries she allegedly sustained in the accident showed that Pennington was taking
    antidepressant and antianxiety medication at the time of the accident. 
    Id. at *2.
    The
    defendants alleged that Pennington’s “injuries, damages and/or liabilities” resulted
    from “pre-existing mental, emotional, and/or physical conditions and disabilities.” 
    Id. at *2-4.
    The Fort Worth Court found that the trial court abused its discretion:
    The fact that a plaintiff has had past mental problems is distinct from the
    mental anguish associated with a personal injury or loss; a tortfeasor takes
    a plaintiff as he finds her. Defensive claims that a plaintiff’s damages and
    injuries were caused by pre-existing conditions do not involve the
    resolution of ultimate issues of fact that have legal significance standing
    alone. Instead, these types of defensive assertions are in the nature of
    inferential rebuttal claims and, thus, are not sufficient to put a plaintiff’s
    mental condition at issue so as to make medical records about that
    condition discoverable.
    
    Id. at *9-10
    (internal citations and footnotes omitted).
    In Doe, the Austin Court found that the plaintiff’s mental health records were not
    relevant because the plaintiff had not “alleged any ‘severe emotional condition’ that would
    place her mental condition in issue so as to trigger the litigation exception and waive
    her privilege regarding her mental health records”:
    To hold otherwise would suggest that every time a plaintiff raises a claim
    for past and future mental anguish damages her mental condition would
    be in issue and thereby all mental health records would be discoverable.
    This proposition is contrary to the express holding of the Texas Supreme
    Court in Coates.
    
    Doe, 22 S.W.3d at 610
    (emphasis added).
    In Nance, the Austin Court found that the decedent’s “mental health history
    [was] not a ‘part’ of either the Nances’ claims or the defendants’ defenses”. 
    Nance, 143 S.W.3d at 512
    .     The plaintiffs’ pleadings merely alleged “facts and circumstances
    In re Williams                                                                           Page 11
    surrounding Ms. Nance’s 2002 hospitalization, surgery, follow-up care, and the
    damages suffered as a result of her death.”       
    Id. The pleadings
    did not place the
    decedent’s mental health history in dispute. See 
    id. Real Parties
    in Interest contend that, unlike Nance and Doe, the present case does
    not involve a tenuous relationship between the “records sought and the claims or
    defenses asserted,” the records were not sought early in the discovery process, and
    Respondent reviewed the records in camera. See 
    Nance, 143 S.W.3d at 512
    -13; see also
    
    Doe, 22 S.W.3d at 210
    . Despite these factual differences, the question is still the same:
    whether the records are relevant to a condition at issue that is of legal consequence to a
    claim or defense. See 
    R.K., 887 S.W.2d at 839
    , 844 (trial court had conducted an in camera
    inspection; trial court’s order was overly broad, as some of the information in the
    defendant’s mental health records was “not relevant to the condition at issue”).
    Applying R.K., we hold that Dustin’s mental health records are not “relevant to
    the condition at issue” and the condition itself is not of legal consequence to a claim or
    defense. 
    R.K., 887 S.W.2d at 843
    . Any mental health problems from which Dustin
    suffered before Sue’s death are distinct from the mental anguish associated with the loss
    of Sue. See 
    Nance, 143 S.W.3d at 512
    ; see also Pennington, 2008 Tex. App. LEXIS 5359, at
    *9; Chambers, 2002 Tex. App. LEXIS 4567, at *11-12. Dustin’s testimony that his weight
    loss “could have had something to do with the depression” resulting from Sue’s death
    is insufficient to place his mental health in issue. Dustin also testified that he was not
    sure what had caused the weight loss and he had never obtained any “official advice”
    as to the cause. In fact, Dustin was fifteen years of age when Sue died, but did not drop
    In re Williams                                                                     Page 12
    out of school until April of his senior year in high school. Dustin’s testimony merely
    raises routine allegations of mental anguish resulting from his mother’s death and does
    not address a mental injury exceeding a common emotional reaction to such a loss. See
    
    Nance, 143 S.W.3d at 512
    ; see also 
    Doe, 22 S.W.3d at 607
    ; Chambers, 2002 Tex. App. LEXIS
    4567, at *11-12; 
    Coates, 758 S.W.2d at 753
    .
    Moreover, the time in which the records were created does not place Dustin’s
    mental health in issue. See Chambers, 2002 Tex. App. LEXIS 4567, at *13 (“Mental health
    records are not ‘in issue’ simply because they were generated at a time corresponding to
    the events giving rise to a lawsuit.”). Nor is an allegation that Dustin’s damages and
    injuries were caused by a pre-existing condition sufficient to do so.4 Such an allegation
    amounts to an inferential rebuttal claim that does not place a “mental condition at issue
    so as to make medical records about that condition discoverable.” Pennington, 2008 Tex.
    App. LEXIS 5359, at *9-10; see 
    Nance, 143 S.W.3d at 512
    -13.
    For these reasons, we hold that the patient-litigation exception to the mental
    health information privilege does not apply. Because the mental health information
    privilege does apply, Respondent abused his discretion by compelling production of
    Dustin’s mental health records.
    OFFENSIVE-USE DOCTRINE
    A plaintiff seeking affirmative relief cannot “maintain the action, and at the same
    time maintain evidentiary privileges that protect from discovery outcome determinative
    4
    Dr. Lobb and Dr. Opersteny alleged, “any injuries, damages or liability complained of by the
    Plaintiffs are the result, in whole or in part, of pre-existing conditions and disabilities and are not the
    result of any act or omission on the part of the Defendants.” The Medical Center also alleged, “Plaintiffs’
    alleged damages are the result of a pre-existing condition…”
    In re Williams                                                                                     Page 13
    information not otherwise available to the defendant.” Texas Dep’t of Pub. Safety Officers
    Ass’n v. Denton, 
    897 S.W.2d 757
    , 761 (Tex. 1995) (citing Ginsberg v. Fifth Court of Appeals,
    
    686 S.W.2d 105
    , 107 (Tex. 1985) (orig. proceeding)). This doctrine consists of three
    elements: (1) a party must be seeking affirmative relief; (2) the party is using a privilege
    to protect outcome determinative information; and (3) the protected information is not
    otherwise available to the defendant. 
    Id. (citing Republic
    Ins. v. Davis, 
    856 S.W.2d 158
    (Tex. 1993)). “[T]he offensive use doctrine is independent from and unrelated to the
    privilege exception for patient-litigants stated in Rules 509(d)(4) and 510(d)(5).” 
    R.K., 887 S.W.2d at 841
    .
    Real Parties in Interest maintain that “Dustin [] was treated for his mental
    condition after the death of [Sue], as he was already in treatment for emotional injury
    stemming from his relationship with [Sue].” They contend that Dustin’s records “relate
    directly to his ‘ordinary mental anguish’ claim”; thus, withholding evidence that “could
    materially weaken or defeat his claims, [would] unjustly impair[] [their] right and
    ability to evaluate and defend against such claims.” They do not attempt to establish
    the elements of the offensive-use doctrine, but rely on Midkiff v. Shaver, 
    788 S.W.2d 399
    (Tex. App.—Amarillo 1990, orig. proceeding).
    In Midkiff, the trial court found that the plaintiffs’ medical records were
    discoverable because they sought mental anguish damages. See 
    Midkiff, 788 S.W.2d at 400
    . The plaintiffs alleged ordinary mental anguish, but one plaintiff had been treated
    for some symptoms of mental anguish. 
    Id. at 402.
    Thus, a connection existed “between
    her mental anguish complaint and the medical attention she sought.” 
    Id. The Amarillo
    In re Williams                                                                       Page 14
    Court held that, as long as the plaintiffs relied on symptoms of mental anguish for
    which they received treatment, they could not: (1) “invoke[] privileges as a shield to
    prevent discovery of medical and mental health records related to [] asserted emotional
    condition[s]”; or (2) “refuse to answer questions pertaining to medical attention sought
    in connection with those claims.” 
    Id. at 402-03.
    Discovery should have been limited to
    those records “related to the medical attention sought for the symptoms of the
    respective mental anguish claims.” 
    Id. at 403.
    Unlike in Midkiff, there is no connection between Dustin’s mental anguish
    complaint arising out of Sue’s death and the medical attention he sought before Sue’s
    death. Those records are not related to the emotional conditions that form the basis of
    Dustin’s mental anguish claim.
    Moreover, Midkiff does not address the elements of the offensive-use doctrine.
    Robert contends that the second element cannot be met because Dustin’s records are not
    outcome determinative: (1) Real Parties in Interest must take Dustin as they found him
    and “compensate him for the amount of mental anguish he suffered,” regardless of his
    mental state at the time of Sue’s death; and (2) Dustin’s strained relationship with Sue
    does not defeat his mental anguish claim. Robert further argues that the third element
    cannot be met because evidence of a strained relationship between Sue and Dustin is
    available from other sources. We agree.
    To be outcome determinative, a “confidential communication must go to the
    very heart of the affirmative relief sought.” 
    Davis, 856 S.W.2d at 163
    . “Mere relevance
    is insufficient.” 
    Id. “A contradiction
    in position without more is insufficient.” 
    Id. We In
    re Williams                                                                   Page 15
    have already determined that Dustin’s mental state at the time of Sue’s death is distinct
    from the mental anguish he suffered as the result of her death. Moreover, the record
    contains other evidence besides Dustin’s medical records that reveal a strained
    relationship between Sue and Dustin. Robert testified that Sue had instructed him that
    Dustin was not to know in the event she died and that Dustin was to inherit nothing.
    The record also contains documents from the local sheriff’s department regarding a
    prior suicide attempt by Sue. These records contain a suicide note stating that Dustin is
    not to “get anything I have”, “I am tired of waiting on people who s--- on me,” Dustin is
    a “bastard[]”, and “when I am dead Dustin will get more money, but I will haunt you to
    your grave[]”…”promise”.
    If any one of the three elements of the offense-use doctrine is lacking, the
    privilege must be upheld. See 
    Davis, 856 S.W.2d at 163
    . Neither elements two nor three
    have been established in this case. Accordingly, the mental health information privilege
    is not waived by the offense use doctrine.
    CONCLUSION
    Having found that Dustin’s mental health records are protected by the mental
    health information privilege and that the offensive-use doctrine does not apply, we
    conclude that Robert has no adequate remedy by appeal. See Fort Worth Children’s
    
    Hosp., 100 S.W.3d at 587
    ; see also 
    Nance, 143 S.W.3d at 510
    . We, therefore, conditionally
    grant the writ. The writ will issue only if Respondent fails to advise this Court in
    writing within fourteen days after the date of this opinion that he has vacated his order
    compelling production of Dustin’s mental health records.
    In re Williams                                                                    Page 16
    FELIPE REYNA
    Justice
    Before Chief Justice Gray
    Justice Reyna, and
    Justice Davis
    (Chief Justice Gray dissenting with note)*
    Writ conditionally granted
    Opinion delivered and filed March 4, 2009
    [OT06]
    *       (Chief Justice Gray dissents. A separate opinion will not issue. He notes,
    however, that while he generally agrees with the legal discussion he disagrees with its
    application to the facts of this proceeding. He notes that because mental anguish is part
    of the damages sought and that the proximate cause, which is not only an element of
    the plaintiff’s case necessary to prove his claim, but is also an issue contested by and
    thus constitutes part of the defendant’s defense to that claim, he is of the opinion that
    the trial court’s decision was not an abuse of discretion and would, therefore, deny the
    petition for writ of mandamus.)
    In re Williams                                                                    Page 17