On March 18, 2026, the Minnesota Supreme Court decided State of Minnesota vs. Smeby. The decision is important because it limits the scope of Minnesota’s physician-patient privilege statute (Minn. Stat. § 595.02, subd 1(d)) to generally exclude communications between patients and paramedics—paving the way for admissions in medical records that can be used to defend against frivolous claims.
As a matter of first impression, the Supreme Court also held that statements made by a patient to a third party are not automatically protected by the nurse-patient privilege statute (Minn. Stat. § 595.02, subd. 1(g)) when the third party conveys those statements to a nurse.
Physician-patient privilege does not have a basis in common law. It is typically established by state statute. The Minnesota Supreme Court’s decision in Smeby may therefore provide a persuasive framework for other courts addressing whether physician-patient communications are privileged under the terms of the legislative enactments in other states. Moreover, if a manufacturer’s product allegedly results in a personal injury and corresponding court proceeding in Minnesota, then application of the Minnesota physician-patient statutory privilege will likely apply—regardless of where the manufacture is located. Accordingly, the interpretation of Minnesota’s physician-patient statutory privilege may be of broad interest to manufacturers who could find themselves subject to personal injury claims in Minnesota.
Although the Smeby case arises in the context of a criminal proceeding, it impacts civil proceedings and may provide significant assistance in defending cases involving personal injuries—unless the Minnesota Legislature expands the scope of the physician-patient privilege by expressly extending it to include communications with paramedics.
Background Facts
In 2021, Richard Smeby was involved in a three-car accident. A police officer arriving on the scene found Smeby unconscious behind the wheel of his vehicle and administered two doses of Narcan. Smeby regained consciousness.
As he was transported to the hospital for treatment, Smeby told a paramedic he had been using “too much” heroin. At the hospital, Smeby told his girlfriend he had taken heroin, and the girlfriend shared Smeby’s statement with a nurse.
The hospital released Smeby’s medical records, including the “ambulance run sheet,” pursuant to a warrant. Those medical records included notes about Smeby’s statement to the paramedic, as well as the statement Smeby made to his girlfriend, which was then shared with the nurse. Smeby was charged with driving under the influence.
Smeby sought to suppress the medical records and ambulance run sheets during an omnibus hearing arguing the records were privileged. The trial court concluded that neither the physician-patient privilege nor the nurse-patient privilege applied to protected Smeby’s statement to the paramedic or to his girlfriend, or any statement made by his girlfriend to the nurse. A jury then convicted Smeby.
The Court of Appeals affirmed Smeby’s conviction, concluding paramedics are categorically excluded from the physician-patient privilege statute, and the physician-patient privilege statute did not protect Smeby’s statements to his girlfriend (which she then shared with a nurse).
The Supreme Court’s Decision
A. The Physician-Patient Privilege Held Inapplicable.
When considering Smeby’s appeal to Minnesota’s Supreme Court three points controlled the decision: (i) the physician-patient privilege is “solely a creature of statute,” not the common law; (ii) the physician-patient privilege statute is generally construed narrowly; and (iii) the statute does not expressly include “paramedics.”
The Supreme Court rejected the Court of Appeals’ categorical exclusion. Unlike the Court of Appeals that relied solely on the plain language of the statute and its failure to list paramedics, the Supreme Court considered an exception. The Supreme Court explained the physician-patient statutory privilege may be extended to communications between paramedics and patients if a paramedic is acting “under the direction” of a treating physician such that there is an agency relationship with the physician.
The Supreme Court allocated to the patient the burden of establishing whether a paramedic is “acting under the direction of [a] physician” within the context of an agency relationship. Smeby, however, provided insufficient evidence to establish such a relationship.
Accordingly, because the physician-patient privilege statute does not expressly include communications with “paramedics” within its scope, and because the paramedic assisting Smeby was not acting under the direction of an Emergency Room physician, the Supreme Court determined Smeby’s communications with the paramedic were not shielded by the physician-patient privilege under Minn. Stat. § 595.02, subd 1(d).
The Supreme Court recognized its decision implicated public policy issues. It justified its narrow application of the physician-patient statute explaining:
“[A]lthough courts must be alert to safeguard the purpose of evidentiary privileges, they must be equally alert to see that these privileges are not enforced in such a blind and sweeping manner that they unnecessarily become vehicles for the suppression of evidence which is not privileged.
Even so, in a footnote, the Supreme Court admitted “there are strong arguments for why the Legislature should expressly add paramedics to the persons listed in the physician-patient privilege statute.” But whether to amend the statute to include paramedics was expressly “left to the Legislature to decide.”
B. The Nurse-Patient Privilege Held Inapplicable.
As a matter of first impression the Supreme Court addressed whether statements made by a third-party about a conscious adult’s medical condition were privileged. Because Smeby’s girlfriend was not necessary to Smeby’s treatment—for example, because Smeby was conscious and interacting with hospital staff—the Supreme Court concluded the statement Smeby made to his girlfriend, who then shared the statement with a nurse, is not protected by the nurse-patient privilege under Minn. Stat. § 595.02, subd. 1(g). If Smeby wanted his heroin use to remain confidential, the Supreme Court explained, he should have communicated it directly to the nurse.
C. The General Privilege Extended to Medical Records Did Not Apply.
Smeby erroneously claimed his statements about heroin use to the paramedic and his girlfriend became privileged as soon as they were transmitted to, or acquired by, a healthcare provider and put into his medical records.
The Supreme Court rejected Smeby’s argument that attempted to create a derivative privilege. It held that the status of a communication does not change simply because it is documented in a privileged record.
This holding will prevent patients from shielding otherwise admissible evidence simply because it is contained in an otherwise privileged document.
The Supreme Court reiterated its previous conclusions that the statements were not privileged when made. Therefore, it determined the general rule that written medical records are covered by the physician-patient privilege did not apply here.
The Significance of the Smeby Decision
The Smeby decision is significant for several reasons.
First, in defending against personal injury claims, there is no longer a categorical privilege (at least in Minnesota) for statements made to paramedics. This is important because paramedics often are the first on the scene of an injury and receive key information from the injured party. Those statements are often closer to the truth than subsequent refined statements, which are often offered after injured parties retain legal counsel to pursue damages claims. If medical records are withheld based on a claim of physician-patient or nursing-patient privilege, those claims of privilege may be subject to valid challenges.
Second, the Supreme Court sent a clarion call to the Minnesota Legislature. If that call is received, the physician-patient privilege statute may soon be legislatively expanded to expressly protect communications with “paramedics.” If the Legislature acts on this, then it must carefully craft privilege protections that do not terminate the specific waiver of medical privilege already provided with respect to communications concerning “the same physical, mental, or blood condition” voluntarily placed at issue in civil litigation by a party (see Minn. R. Civ. P. 35.03)—although the Legislature could clarify that any broadened or clarified statute applies to communications that are not voluntarily placed at issue by a party.
Third, the Minnesota Supreme Court refused to impose a “categorical rule” limiting the physician-patient statutory privilege to the plain language of the statute. Instead, it recognized a limited exception to the statute through which an agency theory could potentially be used to circumvent otherwise harsh applications of the physician-patient statutory privilege. Having recognized this exception to the plain language reading of the statute, it may be just a matter of time until this exception is asserted (perhaps even successfully) to avoid the application of other statutes based on their plain language.
Fourth, the Supreme Court’s decision manifests a policy of not allowing individuals to shield statements that could undermine public safety. The Court placed public safety over confidentiality concerns.
Fifth, the Minnesota Supreme Court sent a clear message that statements made by third parties incidental to treatment that could have been made by the patient may not be protected by the physician-patient or nurse-patient privilege.