No Per Se Piercing of Medical/Therapy Privileges for RSA 135:17-a, V Involuntary-Admission Evaluations; “Standard of Care” Alone Is Not a Compelling Justification

1. Introduction

State of New Hampshire v. John Doyle (N.H. May 14, 2026) returns to the Supreme Court of New Hampshire after a remand in State v. Doyle, 176 N.H. 594 (2024), 2024 N.H. 25 (Doyle I). The case arises from a criminal prosecution in which the defendant was found not competent to stand trial and not restorable. After the superior court found the defendant posed a danger to others, it ordered an evaluation for the appropriateness of involuntary admission under RSA 135:17-a, V, applying the civil-commitment framework in RSA 135-C:34 and related provisions.

The dispute on this appeal is narrow but consequential: whether the State may obtain the defendant’s privileged medical and mental health records (held by a State entity, the Office of the Forensic Examiner) for a State-designated physician to prepare an involuntary-admission certificate, by “piercing” the statutory physician-patient and therapist-patient privileges (RSA 329:26; RSA 330-A:32) and the defendant’s constitutional privacy interests (N.H. CONST. pt. I, art. 2-b).

2. Summary of the Opinion

The court reversed the superior court’s order authorizing disclosure and remanded. Although the parties agreed (and the court assumed without deciding) that the essential need standard governs, the Supreme Court held that the State failed to establish the first prong—a compelling justification—because the superior court relied on general “standard of care” testimony rather than case-specific circumstances.

The court warned that the trial court’s reasoning effectively created an impermissible per se rule that privilege must yield whenever records would make an involuntary-admission evaluation “more accurate.” New Hampshire law instead requires a fact-sensitive balancing in each case. The case was remanded for the limited purpose of determining whether the defendant waived the privileges.

3. Analysis

3.1. Precedents Cited

  • State v. Doyle, 176 N.H. 594 (2024), 2024 N.H. 25 (Doyle I)
    Role: Doyle I rejected the trial court’s earlier conclusion that records sought for an RSA 135:17-a, V evaluation were statutorily exempt from the physician- and therapist-patient privileges. It established the remand framework: the records could be disclosed only if (1) the defendant waived the privilege, or (2) the court pierced the privilege upon a proper showing that disclosure is “essential.” Influence here: This order enforces the Doyle I directive by scrutinizing whether the trial court properly applied privilege-piercing doctrine, and by returning the case to the waiver question once piercing fails.
  • State v. Zarella, 177 N.H. 328 (2025), 2025 N.H. 20
    Role: Zarella articulated the modern essential need test for obtaining in camera review and subsequent disclosure of privileged records: the moving party must prove (1) a compelling justification and (2) that the targeted information is unavailable from another source. Influence here: The parties agreed this test controlled, and the court applied Zarella’s two-prong structure—ultimately reversing because the compelling-justification prong lacked an objective record basis.
  • State v. Stewart, 178 N.H. ___, 2026 N.H. 14
    Role: Stewart supplied both the appellate standard of review for discovery management (unsustainable exercise of discretion) and the substantive point that New Hampshire rejects categorical “compelling justification” rules (e.g., felony prosecution is not, by itself, per se compelling). Influence here: The court used Stewart to invalidate the trial court’s near-categorical logic and to emphasize that compelling justification depends on the facts and circumstances of each case and requires an objective basis in the record.
  • In re Kathleen M., 126 N.H. 379 (1985)
    Role: Kathleen M. applied an essential-need analysis in the involuntary admission context and declined to adopt a per se exception to the psychiatrist-patient privilege for involuntary admission hearings. Influence here: The court relied on Kathleen M. to reinforce that commitment-related public safety concerns do not automatically override privilege; courts must instead engage in case-specific balancing.
  • In re Grand Jury Subpoena (Medical Records of Payne), 150 N.H. 436 (2004)
    Role: Payne is referenced through Stewart as a prior decision whose reach the court has limited—illustrating the court’s resistance to broad, categorical justifications for breaching medical confidentiality. Influence here: It supports the court’s insistence that “compelling justification” is not satisfied by generalized governmental interests.
  • Desclos v. S. N.H. Med. Ctr., 153 N.H. 607 (2006)
    Role: Desclos is cited for the proposition that privilege-piercing and the public-interest countervailing analysis are circumstance-dependent. Influence here: It anchors the court’s demand for a concrete, record-based balancing rather than abstract “accuracy” assertions.

3.2. Legal Reasoning

  1. Privileges and privacy protections apply. The parties agreed that the records are protected by the statutory physician-patient and therapist-patient privileges (RSA 329:26; RSA 330-A:32) and implicate “private or personal information” protected by Part I, Article 2-b.
  2. Waiver was not decided below and could have mooted piercing. The trial court did not reach waiver because it ordered disclosure on “essential need.” The Supreme Court noted waiver should be considered first because, if found, it could eliminate the need to pierce.
  3. Assuming Zarella applies, the State must prove both prongs. The court assumed (without deciding) that Zarella’s essential-need test governs even though the request involves State-held records and disclosure to a State-designated evaluator, noting Zarella’s discussion of different contexts and citing In re Kathleen M..
  4. The compelling-justification prong failed because the justification was generic. The trial court found a compelling justification because the evaluation would be “less accurate” without the records, potentially jeopardizing public and defendant safety, supported by testimony that reviewing “reasonably available records” is the “standard of care.” The Supreme Court held this reasoning effectively becomes a per se rule: whenever records might improve accuracy, privilege yields. New Hampshire law rejects that approach; a compelling justification exists only when a sufficiently important public interest countervails the societal benefit advanced by the privilege, and that countervailing determination must be grounded in the case’s specific facts.
  5. Prior competency-related disclosure did not supply the missing case-specific showing. The State argued the same records were “needed” for prior competency/restorability evaluations. The court rejected the inference that prior access for competency (under RSA 135:17) automatically establishes compelling justification for involuntary admission evaluation (under RSA 135:17-a, V and RSA 135-C:34), emphasizing these are distinct statutory purposes.
  6. Result: reversal without reaching the second prong. Because both prongs are required and the first prong failed, the disclosure order could not stand. The case was remanded solely to address waiver.

3.3. Impact

  • Reinforces a case-specific threshold for breaching medical and therapy confidentiality. Courts cannot treat “improved accuracy” or “standard of care” as an automatic override of statutory privileges in the RSA 135:17-a, V pathway. The State must articulate why this defendant’s records are necessary in this case—not merely why records are helpful in general.
  • Constrains governmental record-sharing within State entities. Even when the records are already in the hands of a State entity (OFE) and the recipient is another State-designated professional, privilege and constitutional privacy remain meaningful barriers absent waiver or a properly supported essential-need finding.
  • Encourages disciplined litigation sequencing: waiver first. By remanding to consider waiver, the court signals that trial courts should address waiver as a potentially dispositive issue before undertaking the heavier constitutional and privilege-piercing analysis.
  • Likely increases the need for tailored evidentiary showings. Future motions will need affidavits or testimony identifying concrete, defendant-specific reasons the evaluator cannot reliably answer the statutory involuntary-admission criteria without particular privileged materials, rather than generalized references to professional norms.

4. Complex Concepts Simplified

Physician-patient / therapist-patient privilege (RSA 329:26; RSA 330-A:32)
Legal rules that generally prevent disclosure of confidential communications and treatment information obtained in medical and therapy relationships, unless an exception applies, the privilege is waived, or a court orders limited disclosure under a stringent standard.
Waiver
Loss of privilege protection because the privilege-holder’s conduct (for example, placing a condition at issue, or consenting to disclosure) permits disclosure. The Supreme Court did not decide waiver here and directed the trial court to consider it on remand.
Piercing the privilege / “essential need” (State v. Zarella)
A narrow pathway for disclosure even without waiver. The moving party must prove: (1) a compelling justification (a sufficiently important public interest that outweighs the societal value of confidentiality in the case), and (2) that the relevant information cannot be obtained elsewhere.
Compelling justification (case-specific, not categorical)
Not “this would be useful” or “this is best practice.” It requires a concrete showing, tied to the case, that disclosure is necessary to protect or vindicate a public interest that outweighs the reasons the privilege exists (candor in treatment, privacy, trust in healthcare).
In camera review
A judge’s private review of records before deciding whether, and how much, may be disclosed. The trial court did not conduct in camera review here; the Supreme Court reversed on the threshold “compelling justification” failure and therefore did not use this case to define when in camera review is mandatory.

5. Conclusion

The decision’s core rule is that the State may not pierce a defendant’s medical and mental health privileges for an RSA 135:17-a, V involuntary-admission evaluation based on generalized assertions that reviewing records is the professional “standard of care” and would improve accuracy. Compelling justification must be grounded in case-specific facts showing that the public interest truly outweighs the societal benefits of confidentiality. Because that showing was absent, the disclosure order was reversed, and the case was remanded to decide whether the defendant waived the privileges.