LANDAY v. RITE AID OF PENNSYLVANIA, INC.

OPINION

Justice TODD.

In this discretionary appeal, we consider whether the Medical Records Act ("MRA" or "the Act"), 42 Pa.C.S.A. §§ 6151-6160, applies to the reproduction of records by pharmacies, and, if so, whether, and under what circumstances, pharmacies may charge customers a flat fee for the reproduction of records. For the reasons that follow, we hold that the Act does not apply to pharmacies, and, as a result, we need not address the flat fee issue. In light of our conclusions, we reverse the decision of the Superior Court.

Briefly, and by way of background, the MRA was enacted in 1986. The Act, as described by this Court,

Chiurazzi Law Inc. v. MRO Corp., ___ Pa. ___, 97 A.3d 275, 276 (2014).

Notably, when first enacted, the Act referred only to subpoenas for records served upon employees of "health care facilities." Further, the Act did not contain statutory caps on the amount that could be charged for the reproduction of records. In 1998, however, the Act was amended in several respects pertinent to this appeal. First, Section 6152(a)(1) was expanded to include subpoenas served upon a "health care provider":

42 Pa.C.S.A. § 6152(a)(1) (as amended in 1998) (emphasis added to indicate amendments).

In addition, the 1998 amendments limited the amount a health care provider or health care facility could charge for the reproduction of medical charts or records by adding the following subsection:

42 Pa.C.S.A. § 6152(a)(2)(i) (as amended in 1998).1

Finally, Section 6155(b) of the Act was amended to allow a patient's designee, including his attorney, the right to obtain copies of medical charts and records upon request, without a subpoena, for an amount not in excess of that set forth above in Section 6152(a)(2)(i):

42 Pa.C.S.A. § 6155(b)(1) (as amended in 1998).2 With these relevant sections of the MRA in mind, we turn to the facts of the instant case.

Appellant Rite Aid of Pennsylvania, Inc. ("Rite Aid") is a Pennsylvania corporation that operates pharmacies throughout the Commonwealth. In or around December 2008, Attorney David A. Landay submitted to Rite Aid an "authorization" on behalf of an individual, requesting copies of the individual's pharmacy records. Around the same time, the law firm of Patberg Carmody & Ging ("PC & G") also submitted an authorization to Rite Aid requesting copies of pharmacy records for an individual.3 In response to the requests, Rite Aid sent invoices for $50 to both Landay and PC & G (collectively, "Appellees"); both invoices contained the following language:

Rite Aid Invoices, 12/4/08 and 12/3/08. Appellees paid the invoices, and Rite Aid provided the requested copies of the pharmacy records.

On March 24, 2010, Appellees filed a class action against Rite Aid. In Count I of the complaint, Appellees claimed that Rite Aid breached an implied agreement between the parties and Rite Aid that Rite Aid would provide copies of its records to its customers in a manner consistent with Pennsylvania law, limiting the amount that may be charged to the estimated actual and reasonable expenses incurred in connection with the reproduction of the requested records. Specifically, Appellees maintained that Rite Aid's act of charging a flat fee for the reproduction of records violates Section 6152(a)(2)(i) of the MRA. In Count II of their complaint, Appellees requested a declaratory judgment that the MRA prohibits Rite Aid from charging more than the reasonable expenses it incurred to reproduce the requested records, and, further, precludes Rite Aid from charging a flat fee.

Rite Aid filed preliminary objections in the nature of a demurrer, asserting the MRA does not apply to the reproduction of pharmacy records because a pharmacy is neither a health care facility nor a health care provider under the Act. Rite Aid alternatively claimed that, even if the MRA does apply to pharmacies, Appellees' voluntary payment of Rite Aid's invoices defeated their claims.

The trial court, by the Honorable R. Stanton Wettick, Jr., granted Rite Aid's preliminary objections and dismissed its complaint. In concluding the MRA does not apply to pharmacies, or the reproduction of pharmacy records, Judge Wettick observed that Section 6155(b)(1), from the time it was enacted in 1986, has used the term "patient," and that, generally, "persons describe themselves as patients of the physician who wrote the prescription and customers of the pharmacy that filled the prescription. Persons describe themselves as patients of a hospital but persons do not describe themselves as patients of a pharmacy." Trial Court Opinion, 5/5/11, at 5. Judge Wettick reasoned that, "by using the term patient, the Legislature was focusing on problems concerning access to the records of hospitals and physicians. I have no reason to believe the same problems existed with respect to records of pharmacies." Id. at 6 (emphasis original).

In a unanimous published opinion, the Superior Court reversed the trial court's order granting Rite Aid's preliminary objections, and remanded for further proceedings. Landay v. Rite Aid, 40 A.3d 1280 (Pa.Super.2012). In doing so, the court first stated that it "fail[s] to see any ambiguity in the term `patient.'" Id. at 1284.4 The court continued:

Id.

In support of its interpretation, the Superior Court relied on the Pharmacy Act, 63 P.S. §§ 390-1 et seq., which defines the practice of pharmacy as "the provision of health care services by a pharmacist," including, inter alia, "patient counseling." See Landay, 40 A.3d at 1284 (quoting 63 P.S. § 390-2(11)). The court specifically noted that, "as part of their health care duties, pharmacists are authorized to administer injectable medications, biologicals and immunizations.... Thus, the practice of pharmacy is not limited to filling prescriptions." Id. at 1285.

In addition, the Superior Court quoted at length from the Pennsylvania Code, which sets forth the specific duties owed by pharmacists to their patients, see 49 Pa.Code § 27.19 (adopted March 4, 1994), and observed:

Id. at 1287-88.

With regard to Rite Aid's assertion that, even if the MRA applies to pharmacies, the parties were free to negotiate their own terms with respect to the charges for the reproduced pharmacy records pursuant to Section 6152(a)(2)(i) of the MRA, the court rejected Rite Aid's contention that Appellees' payment of Rite Aid's invoices vitiated Appellees' right to challenge the fees under the voluntary payment doctrine. Specifically, the court opined that, because there were no terms or itemization on the invoices, it was unable to conclude that Appellees had "full knowledge of the facts," as required for the voluntary payment doctrine to apply. Id. at 1288-89.

Rite Aid filed a petition for allowance of appeal with this Court, which we granted as to the following issues:

Landay v. Rite Aid, 621 Pa. 108, 73 A.3d 577 (2013) (order). As these issues raise questions of law, our standard of review is de novo and our scope of review is plenary. Dechert LLP v. Commonwealth, 606 Pa. 334, 998 A.2d 575, 579 (2010).

Rite Aid first contends that the MRA does not apply to pharmacies, or requests for pharmacy records, because the MRA applies only to record requests from health care facilities, and pharmacies are not health care facilities. In support of its position, Rite Aid cites Section 6151 of the Act, titled "Use of certified copies," which provides:

42 Pa.C.S.A. § 6151 (as enacted 1986) (emphasis added). According to Rite Aid, the language of Section 6151, which was not revised during the 1998 amendments, "makes clear that the Act applies only to the medical charts or records of a `health care facility licensed under the laws of this Commonwealth.'" Appellant's Brief at 13.

In arguing that a pharmacy is not a health care facility under the MRA, Rite Aid acknowledges that the term "health care facility" is not defined in the MRA, but asserts that its meaning is evident when considered in pari materia with the Health Care Facilities Act ("HCFA"), 35 P.S. § 448.101 et seq. (enacted July 19, 1979), which defines "health care facility" as follows:

35 P.S. § 448.802a. Rite Aid contends that, under the doctrine of ejusdem generis, pharmacies "bear no resemblance to the listed facilities," and, thus, are not health care facilities. Appellant's Brief at 14.5

Rite Aid acknowledges that the legislature added the term "health care provider" to specific sections of the MRA, including Sections 6152(a) and (c), 6152.1,6 and 6155(b), as part of the 1998 amendments to the Act. However, Rite Aid observes that subsections 6152(b) and (d) were not modified at that time, and still refer only to health care facilities.7 Id. at 20. Rite Aid also emphasizes that no revisions were made to Sections 6151, 6153,8 6154,9 6155(a),10 or 615711 of the Act, all of which still reference only health care facilities. Thus, Rite Aid contends that the addition of the term "health care provider" to limited sections of the MRA should not be viewed as an expansion of the entire scope of the MRA to entities other than health care facilities. Instead, Rite Aid suggests that the addition of the phrase "health care provider" to certain sections of the MRA merely was intended to bring operators of health care facilities within the category of persons or entities from whom records may be obtained using subpoenas and patient requests. Appellant's Brief at 22; Appellant's Reply Brief at 10. According to Rite Aid, when read as a whole,

Appellant's Brief at 21.

Rite Aid further argues that, to the extent the term "health care provider" may be construed more broadly than the term "health care facility," the existence of an alternative or expanded definition renders the MRA ambiguous, see, e.g., Delaware Cty. v. First Union Corp., 605 Pa. 547, 992 A.2d 112, 118 (2010) (a statute is ambiguous when there are at least two reasonable interpretations), thereby requiring further resort to statutory construction tools to determine whether the legislature intended the MRA to apply to entities other than health care facilities. Rite Aid asserts that such an analysis demonstrates that the legislature, in amending the MRA, did not intend to expand application of the Act to entities other than health care facilities, but, rather, intended to address concerns about the amount hospitals were charging for the reproduction of medical records. Appellant's Brief at 28.

Finally, Rite Aid contends that, even if this Court concludes the MRA does apply to health care providers, a pharmacy cannot be considered a health care provider because the traditional practice of pharmacy, which includes preparing and dispensing drugs to a consumer, is distinct from the practice of medicine. Rite Aid argues the Superior Court erred in concluding pharmacies constitute health care providers under the MRA on the basis of changes in the law that occurred after the 1998 amendments to the Act. Specifically, Rite Aid notes that, at the time of the 1998 amendments, a pharmacist's main function was to dispense drugs, and it was not until 2002 that pharmacists became authorized to administer injectable medications and vaccines, and not until 2010 that pharmacists became eligible to engage in collaborative drug therapy management12 with physicians pursuant to 63 P.S. §§ 390-9.2 and 390-9.3. Rite-Aid also suggests that the considerations underlying application of the MRA to hospital records do not "readily apply to other types of health care entities, such as pharmacies," Appellant's Brief at 34, and submits that the term "medical records," as contained in Section 6155(b), is a term of art which is not used when referring to records of prescriptions kept by pharmacies. Appellant's Brief at 40-41.13

In response to Rite Aid's arguments, Appellees maintain that the legislature's addition of the term "health care provider" to certain sections of the MRA in 1998, and its use of the term "or" in Section 6155(b)(1), as well as Section 6152(a)(1), demonstrate its intent that the terms "health care provider" and "health care facility" have different meanings, and application of the MRA not be limited to health care facilities.

Appellees further assert that the terms "health care provider or facility," "patient," and "medical records or charts," as contained in Section 6155(b)(1), are unambiguous and "readily susceptible to definition according to common and approved usage." Appellees' Brief at 12. In this regard, they contend: (1) a "patient" is "one who is undergoing medical care and treatment"; (2) the term "health care" is defined as "efforts to maintain or restore health, especially by trained and licensed professionals"; (3) the term "provider" means "one that provides health care"; and (4) "the common and approved definition of the term `health care provider' is a trained and licensed professional who provides or undertakes efforts to maintain or restore health." Id. at 12-13. Appellees further offer that the term "medical record" is commonly understood as "a record of a patient's medical information (as medical history, care or treatments received, test results, diagnoses, and medications taken)." Id. at 14.

Appellees observe that the term "pharmacist" is defined under the Statutory Construction Act as "[a]n individual licensed under the laws of this Commonwealth to practice as a pharmacist." Id. at 14 (quoting 1 Pa.C.S.A. § 1991). Appellees further note that "pharmacy" is defined in the dictionary as "the art, practice or profession of preparing, preserving, compounding and dispensing medical drugs." Id. (quoting Merriam-Webster's Collegiate Dictionary, at 928 (11th ed.2003)). Appellees thus conclude:

Id. at 14-15.

Based on the above, Appellees contend the language of the MRA is plain, and, therefore, that it was unnecessary and improper for the Superior Court to engage in further statutory interpretation to determine whether pharmacies are health care providers. Nevertheless, Appellees contend that the Superior Court's ultimate determination that pharmacists are health care providers for purposes of the MRA was correct. In so arguing, Appellees first note that the basic role of pharmacists in health care has been recognized in Pennsylvania since at least 1961, and that, since 1992, pharmacists have been required to perform a Prospective Drug Review ("PDR") prior to filling a prescription. Id. at 16-18. Appellees further highlight that, since 2002, pharmacists have been permitted to administer injectable medications, and, since at least 2010, pharmacists have been permitted to engage in collaborative drug therapy management. Id. at 20-21. Appellees also offer that the term "patient" is consistently used to refer to customers of pharmacies in both the Pharmacy Act and the Pennsylvania Code, and that the prescription profiles and patient profiles that pharmacies are required to maintain in connection with dispensed medications constitute "medical charts and records" under the MRA.

Finally, Appellees aver that Rite Aid's proposed construction of the MRA is erroneous because: it ignores the principle that a change of language in subsequent statutes on the same matter indicates a change of legislative intent; the principle of in pari materia does not apply because there is no ambiguity; and the HCFA and the MRA serve different purposes and address different subject matter, i.e., the safety of on-site premises (the HCFA) compared to the reproduction of medical records (the MRA). Appellees suggest that Rite Aid's more restrictive construction of the MRA will undermine the Act's purpose of providing individuals with broad access to their medical records, not only from pharmacies, but also from doctors. They also suggest Rite Aid's construction will "destroy established privacy protections of patients," because "[a] right of access to one's own personal information is considered a basic part of the right to privacy." Appellees' Brief at 44.14

With these arguments in mind, we begin our analysis. Pursuant to the Statutory Construction Act, 1 Pa.C.S.A. §§ 1501 et seq., "[t]he object of all interpretation and construction of statutes is to ascertain and effectuate the intention of the General Assembly." Id. § 1921(a). The best indication of the General Assembly's intent in enacting a statute may be found in its plain language. Martin v. Com., Dep't of Transp., Bureau of Driver Licensing, 588 Pa. 429, 905 A.2d 438, 443 (2006). When interpreting a statute, sections of the statute should be read together and construed to give effect to all of the statute's provisions. Id. § 1921(a). Words and phrases "shall be construed according to rules of grammar and according to their common and approved usage." Id. § 1903(a). Further, we should not interpret statutory words in isolation, but must read them with reference to the context in which they appear. Mishoe v. Erie Ins. Co., 573 Pa. 267, 824 A.2d 1153, 1155 (2003).

Applying these principles, we first address Rite Aid's contention that the MRA applies only to health care facilities. It is well settled that we "are not permitted to ignore the language of a statute, nor may we deem any language to be superfluous." Chiurazzi, 97 A.3d at 292 (citation omitted). Thus, although Rite Aid attempts to minimize the import of the legislature's addition of the term "health care provider" to Sections 6152(a) and (c), 6152.1, and 6155(b) of the MRA by noting that the same language was not added to Sections 6151, 6152(b) or (d), 6153, 6154, 6155(a), and 6157, all of which still refer only to health care facility, the fact that the legislature added that language in 1998 demonstrates that it envisioned some distinction between health care facilities and health care providers.

Determining the legislature's intent as to the meaning of "health care provider" proves to be a more difficult task. Regrettably, the MRA defines neither the term "health care facility," nor the term "health care provider."15 Further, as the trial court recognized, there is little legislative history with respect to the 1998 amendments to the MRA. See Trial Court Opinion, 5/5/11, at 5. However, observing that Section 6152(a)(1) refers to "any health care provider or an employee of any health care facility licensed under the laws of this Commonwealth," 42 Pa.C.S.A. § 6152(a)(1), Rite Aid suggests the MRA should be construed in pari materia with the HCFA, as both statutes relate "to the same persons or things or to the same class of persons or things" — namely, records of health care facilities licensed under the laws of Pennsylvania. Appellant's Brief at 23; see 1 Pa.C.S.A. § 1932. In this regard, Rite Aid contends that the term "health care provider," as contained in the MRA, should be construed in the same manner as the term "health care provider" is defined in the HCFA: "An individual, a trust or estate, a partnership, a corporation (including associations, joint stock companies and insurance companies), the Commonwealth, or a political subdivision or instrumentality (including a municipal corporation or authority) thereof, that operates a health care facility." 35 P.S. § 448.103 (as amended in 1992) (emphasis added).

When construing a statute, we must ascertain the intent of our legislature based on the law at the time the statute was enacted or amended. HSP Gaming, L.P. v. City of Phila., 598 Pa. 118, 954 A.2d 1156, 1182 (2008). At the time of the 1998 amendments to the MRA, several statutes contained definitions of the term "health care provider." As discussed above, pharmacies were not included under the definition of "health care provider" in the HCFA. Pharmacies also were not included under the definition of "health care provider" under 40 P.S. § 991.1201 (Uniform Health Insurance Claim Form).16 Conversely, at the time of the 1998 amendments, pharmacists were included under the definition of "Professional health care provider" contained in the Peer Review Protection Act, 63 P.S. § 425.2,17 and under the definition of "health care provider" in the Workers' Compensation Act, 77 P.S. § 29.18

For the following reasons, we agree with Rite Aid that it is appropriate to construe the MRA in pari materia to the HCFA. Pursuant to Section 1932 of the Statutory Construction Act, "[s]tatutes or parts of statutes are in pari materia when they relate to the same persons or things or to the same class of persons or things," and "shall be construed together, if possible, as one statute." 1 Pa.C.S.A. § 1932.

As Rite Aid emphasizes, Section 6152(a)(1) refers to "any health care provider or an employee of any health care facility licensed under the laws of this Commonwealth," 42 Pa.C.S.A. § 6152(a)(1) (emphasis added), and it is the Department of Health, under the HCFA, which is responsible for issuing licenses. See 35 P.S. § 448.806(a) ("No person shall maintain or operate or hold itself out to be a health care facility without first having obtained a license therefor issued by the department. No health care facility can be a provider of medical assistance services unless it is licensed by the department and certified as a medical assistance provider.").

Moreover, the MRA provides specific limits on what a health care provider or facility may charge for the reproduction of medical records, see Chiurazzi,19 and one of the duties of the Department of Health under the HCFA is to promote cost efficiency and access in the area of health care. See, e.g., 35 P.S. § 448.202;20 Rehab Hosp. Services Corp. v. Health Systems Agency of Southwestern Pa., 82 Pa. Cmwlth. 147, 475 A.2d 883, 887 (1984) (noting that, in enacting the HCFA, the legislature clearly was concerned with rising health care costs). Thus, at least one of the goals of both the MRA and the HCFA relates to cost containment in the area of health care.

In contrast, the Peer Review Protection Act pertains to, inter alia, the procedure for evaluating "the quality and efficiency of services ordered or performed by other professional health care providers," including individual pharmacists. 63 P.S. § 425.2. Further, as this Court has explained, the Worker's Compensation Act was designed, inter alia, to "compensate claimants for earnings loss occasioned by work-related injuries," and "to provide recompense commensurate with the damage from accidental injury, as a fair exchange for relinquishing every other right of action against the employer." Tooey v. AK Steel Corp., ___ Pa. ___, 81 A.3d 851, 857 (2013) (citations omitted). These statutes are designed to insure the quality of health care services, and to compensate injured individuals, respectively; the focus is not on limiting health care costs.

Thus, upon review of the subjects of the statutes that, in 1998, contained a definition of the term "health care provider," we agree with Rite Aid that the MRA should be construed in pari materia with the HCFA. As a result, we interpret the term "health care provider," as contained in the MRA, according to the definition of "health care provider" set forth in the HCFA. Interpreting the MRA's use of the term "health care provider" in this manner, we conclude that pharmacies are not health care providers under the MRA, as they are not entities that operate a health care facility. See 35 P.S. § 448.103.

We recognize, as Appellees argue, that many statutes that concern the release of medical information now specifically include pharmacies within the definition of "health care provider." See, e.g., Pennsylvania eHealth Information Technology Act, 35 P.S. § 510.101 (enacted July 5, 2012) (concerning "consent and confidentiality of health information; and establishing civil immunity under certain circumstances," and expressly including a pharmacy under the definition of "Health Care Provider"); Anatomic Pathology Service Disclosure Act, 63 P.S. § 426.2 (enacted Nov. 23, 2010) (defining "Health care provider" as including, inter alia, a physician, hospital, health care facility, and pharmacist). However, these statutes were enacted subsequent to the 1998 amendments to the MRA, and, therefore, may not alter our conclusion as to the legislature's intent in 1998.

For similar reasons, we conclude that, even if Appellees are correct that the term "health care provider" means more than just a health care facility or operator thereof, pharmacies do not constitute health care providers under the MRA. As discussed above, in support of their position that pharmacies constitute health care providers, Appellees rely, in great part, on the fact that pharmacists currently are permitted to administer injectable medications and engage in collaborative drug therapy management. The Superior Court also recognized these services provided by pharmacies, and further noted that, based on the language used to define the practice of pharmacy under the Pharmacy Act, a pharmacy customer is considered a patient.

It is beyond dispute that there has been a substantial increase in the scope of services offered by pharmacies since the 1998 amendments to the MRA. However, at the time of the amendments, pharmacists were not authorized to perform the types of health care services identified by Appellees and the court below. Indeed, it was not until 2002 that pharmacists became authorized to administer injectable medications and vaccines, and it was not until 2010 that pharmacists were permitted to engage in collaborative drug therapy management with licensed physicians in a setting other than an institutional setting.

Additionally, prior to 1998, the "practice of pharmacy" was defined in the Pharmacy Act as follows:

63 P.S. § 390-2 (1985) (emphasis added). Thus, at the time of the 1998 amendments to the MRA, a consumer of a pharmacy was not referred to as a patient of the pharmacy, and the definition of the practice of pharmacy under the Pharmacy Act did not include "the provision of health care services" or patient counseling. Rather, a pharmacist's duties were limited to the preparation, compounding, dispensing, storage, and distribution of drugs, record maintenance, and the provision of information related to drugs and devices.21

As noted above, when construing a statute, we must ascertain the intent of our legislature based on the law at the time the statute was enacted or amended. HSP Gaming, supra. Thus, even under Appellees' proposed construction of the term "health care provider," at the time of the 1998 amendments, pharmacies did not constitute "health care providers" for purposes of the MRA. Accordingly, we reverse the decision of the Superior Court.22

Order reversed. Jurisdiction relinquished.

Former Justice McCAFFERY did not participate in the decision of this case.

Chief Justice CASTILLE and Justices SAYLOR, EAKIN, BAER and STEVENS join the opinion.