Paramedic Communications Are Privileged Only If the Paramedic Acts Under a Treating Physician’s Direction; Nonprivileged Medical-Record Content Remains Nonprivileged; Privilege Does Not Bar Particularized Warrants for Accident-Day Records

I. Introduction

In State of Minnesota v. Anthony Richard Smeby (Minn. Mar. 18, 2026), the Minnesota Supreme Court addressed the intersection of statutory medical privileges and criminal investigation tools after a traffic crash led to a DWI-controlled-substance prosecution. The State obtained a search warrant for Smeby’s “medical records and ambulance run sheets” for the date of the collision; those records included notes that Smeby admitted heroin use to a paramedic and that Smeby’s girlfriend relayed a heroin-use admission to a nurse.

The core issues were:

• When, if ever, Minn. Stat. § 595.02, subd. 1(d) (2024) (physician-patient privilege) covers patient communications with paramedics;
• Whether Minn. Stat. § 595.02, subd. 1(g) (2024) (nurse-patient privilege) protects patient statements made to a third party (the girlfriend) who then speaks to a nurse;
• Whether nonprivileged content becomes privileged merely by being transmitted to or recorded by healthcare providers;
• Whether the physician-patient privilege statute prohibits issuance of a particularized search warrant for accident-day medical records.

The parties were the State of Minnesota (Respondent) and Anthony Richard Smeby (Appellant). The Supreme Court affirmed the conviction, while correcting portions of the court of appeals’ reasoning.

II. Summary of the Opinion

The court affirmed and announced (and clarified) four main rules:

1. No categorical exclusion of paramedics: Communications with paramedics can fall within Minn. Stat. § 595.02, subd. 1(d) if the paramedic is acting “under the direction” of the treating physician (an agency relationship), consistent with State v. Staat. Smeby, however, failed to prove direction/agency on this record.
2. Third-party presence/participation matters: Statements made to (or through) a third party who is not a “necessary and customary participant” in consultation or treatment are not protected; Smeby’s girlfriend was not necessary to his treatment while he was conscious and able to communicate.
3. Privilege does not “attach by transmission”: Nonprivileged information does not become privileged merely because it appears in medical records or is acquired by a healthcare provider.
4. Privilege does not bar a particularized warrant: The physician-patient privilege statute does not prohibit a district court from issuing a warrant authorizing a particularized search of a criminal suspect’s medical records for the date of a traffic accident; privileged material may be suppressed later, but the warrant itself is not forbidden by the privilege statute.

The court also held the warrant sufficiently particular because it was temporally limited to the date of the crash, and a more precise description was not feasible under the circumstances.

III. Analysis

A. Precedents Cited

1. Privilege framework and narrow construction

• State v. Zais, 805 N.W.2d 32 (Minn. 2011) and State v. Expose, 872 N.W.2d 252 (Minn. 2015): The court relied on these cases for the standard of review: privilege applicability is reviewed de novo, while evidentiary rulings are otherwise reviewed for abuse of discretion. That framing positioned the Supreme Court to correct the court of appeals’ “categorical” interpretation of the statute.
• State v. Atwood, 925 N.W.2d 626 (Minn. 2019): The court used Atwood for two related ideas: (i) the physician-patient privilege is purely statutory and has “no constitutional underpinnings,” and (ii) privileges are generally construed narrowly to avoid “blind and sweeping” suppression of nonprivileged evidence. Atwood also supported the court’s treatment of medical records as often privileged because they typically memorialize privileged patient-to-physician communications—yet not automatically privileged in all parts.
• State v. Garding, 12 N.W.3d 697 (Minn. 2024): Cited to limit the record on review to what was before the district court at the pretrial suppression hearing; the Supreme Court declined to rely on trial testimony offered later to establish paramedic-physician “direction.”

2. Extending (and limiting) privilege to non-physicians: agency and “under the direction”

• State v. Staat, 192 N.W.2d 192 (Minn. 1971): This is the opinion’s central interpretive anchor. Staat held the privilege may extend “by implication” to “nurses or attendants” who are “employees or acting under the direction” of the treating physician—i.e., an agency relationship. Critically, Staat emphasized the claimant bears the burden to prove all facts necessary to invoke privilege, and it refused to presume agency merely because a physician gave instructions that duplicated routine duties (rejecting an automatic “borrowed-servant” inference). In Smeby, the Supreme Court used Staat to reject the court of appeals’ categorical exclusion of paramedics while still denying privilege on the facts due to lack of proof of direction/control.
• Morris v. State, 765 N.W.2d 78 (Minn. 2009) and People v. Mirque, 758 N.Y.S.2d 471 (N.Y. Crim. Ct. 2003): These authorities appear in the court’s policy aside. The court acknowledged plausible policy reasons to protect paramedic communications, but—invoking the general separation-of-powers caution reflected in Morris—left any categorical statutory expansion (e.g., expressly adding paramedics to § 595.02, subd. 1(d)) to the Legislature.

3. Third-party involvement and loss of confidentiality

• State v. Gillespie, 710 N.W.2d 289 (Minn. App. 2006), review denied (Minn. May 16, 2006): The Supreme Court found persuasive the court of appeals’ rule that a third party’s presence renders patient statements nonprivileged unless the third party is a “necessary and customary participant” in consultation or treatment. Smeby effectively adopts that logic for the nurse-patient privilege context presented here: the girlfriend’s involvement was not necessary because Smeby was conscious and able to speak.

4. Warrants: particularity and scope

• State v. Bradford, 618 N.W.2d 782 (Minn. 2000) and State v. Hannuksela, 452 N.W.2d 668 (Minn. 1990): The court cited these cases for the constitutional prohibition on “general or exploratory searches” and “exploratory rummaging,” grounding its particularity analysis under the Fourth Amendment and Minnesota’s analog.
• State v. Miller, 666 N.W.2d 703 (Minn. 2003) and State v. Poole, 499 N.W.2d 31 (Minn. 1993): These decisions support the flexible, circumstance-dependent particularity inquiry, considering the nature of the crime and whether more precision is feasible.
• State v. Sardina-Padilla, 7 N.W.3d 585 (Minn. 2024): Used for the specific proposition that a temporal limitation can make an otherwise broad warrant sufficiently particular—directly supporting the “date of 08/04/21” limitation here.

5. Distinguishing absolute-record privileges from information-based privileges

• In re Hope Coalition, 977 N.W.2d 651 (Minn. 2022): Smeby argued this case barred warrant-based access to medical records. The Supreme Court distinguished it: the sexual assault counselor privilege in Minn. Stat. § 595.02, subd. 1(k) protects the entirety of counselor records from disclosure even for in camera review without consent, whereas the physician-patient privilege in subd. 1(d) is narrower—protecting only certain information acquired by the professional in attending the patient and necessary to professional action. The distinction enabled the court to allow warrants that may capture mixed privileged and nonprivileged content.
• State v. Evans, 756 N.W.2d 854 (Minn. 2008): The court cited Evans to emphasize that medical privilege sometimes yields to confrontation rights, with in camera review as a balancing safeguard—supporting the broader thesis that medical records are not invariably immune from compelled disclosure mechanisms.

6. Concurrence authorities: procedural safeguards and privilege harm upon disclosure

• State v. Bartylla, 755 N.W.2d 8 (Minn. 2008) and Illinois v. Gates, 462 U.S. 213 (1983): Justice Hennesy used these to underscore that the warrant process is designed to test probable cause—not to screen for privilege—supporting the concurrence’s call for separate, privilege-protective procedures.
• In re C.T., 999 A.2d 210 (N.H. 2010): Cited by the concurrence for a model requiring in camera review and patient notice/opportunity to object when medical records are sought, reinforcing the concurrence’s proposed safeguards.
• State v. McNeilly, 6 N.W.3d 161 (Minn. 2024) and Kaur v. Maryland, 141 S. Ct. 5 (2020) (statement Sotomayor, J., respecting denial of certiorari): Used by the concurrence to argue that privilege is compromised by “mere disclosure” to police and potentially worsened by disclosure to prosecutors, motivating pre-disclosure neutral review.
• State v. Wiggins, 4 N.W.3d 138 (Minn. 2024): Invoked in the concurrence’s cautionary note that probable cause can justify broad record searches even where the patient is not known to be a suspect.
• State v. Heaney, 689 N.W.2d 168 (Minn. 2004): Cited by the concurrence for the conceptual role of privileges as substantive protections of socially valuable relationships.
• Brown v. Saint Paul City Ry. Co., 62 N.W.2d 688 (Minn. 1954) and State v. Lender, 124 N.W.2d 355 (Minn. 1963): The concurrence relied on these to highlight that privilege determinations are fact-bound and may not be apparent on a document’s face—supporting the need for notice and an adversarial opportunity to assert privilege before disclosure.

B. Legal Reasoning

1. Paramedics and the physician-patient privilege: rejecting categorical exclusion, requiring proof of agency

The Supreme Court’s key move was to treat Minn. Stat. § 595.02, subd. 1(d) as an information-based privilege that can reach beyond physicians when a third party is acting as the physician’s agent, as recognized in State v. Staat. The court of appeals had reasoned from statutory text (“paramedics are not among the listed professionals”) to a categorical exclusion. The Supreme Court deemed that too rigid because Staat already allows “by implication” coverage for non-listed actors (nurses/attendants) when acting “under the direction” of the treating physician.

But the court then applied Staat’s burden rule against Smeby: to obtain suppression, he needed evidence establishing the required agency/control relationship. The court rejected reliance on trial testimony not presented at the pretrial omnibus hearing (State v. Garding). Even if considered, generalized teamwork and trust did not establish “direction” or control, and there was no evidence of direct physician-paramedic communication. Thus, the doctrinal door to privilege coverage was opened, but Smeby could not walk through it on these facts.

2. Third-party statements to nurses: confidentiality depends on necessity for treatment

The court treated confidentiality as fragile when the patient chooses to route information through a third party. Borrowing the “necessary and customary participant” logic from State v. Gillespie, it concluded the girlfriend was not necessary because Smeby was conscious and able to communicate with the nurse directly. The result is a practical rule: privilege does not protect a patient’s statements made to non-essential third parties, even if the information later reaches a nurse.

3. No “privilege by inclusion” in medical records

The court drew a sharp line between (a) medical records as a common vessel for privileged communications and (b) a theory that anything written in a medical chart becomes privileged. Citing State v. Atwood, it acknowledged that written medical records are “generally covered” because they record privileged patient-to-provider communications and resultant medical opinions. But the privilege only protects what the statute protects. Nonprivileged content (e.g., statements to non-agents; statements from non-essential third parties) remains nonprivileged even after being copied into the record.

4. Warrants for medical records: particularity satisfied; privilege statute not a categorical bar

On the Fourth Amendment/Minnesota analog question, the court applied the particularity precedents (Bradford, Hannuksela, Miller, Poole, Sardina-Padilla) and held the warrant sufficiently particular because it was limited to records and run sheets for the date of the accident, and more precision was not feasible.

On the statutory-privilege-as-bar argument, the court distinguished In re Hope Coalition: unlike sexual assault counselor records (protected in their entirety), medical records can contain both privileged and nonprivileged material. The court accepted the State’s approach that records may be seized pursuant to a properly particularized warrant, and privileged content can be suppressed later. In short, privilege affects admissibility (and possibly disclosure in some contexts), but it does not categorically disable the warrant process here.

C. Impact

• Paramedic privilege claims become fact-intensive: Defendants (and privilege claimants) now have a clear doctrinal route to argue that paramedic communications are privileged, but only with evidence establishing “under the direction” agency—likely requiring testimony or documentation about medical control, protocols, direct physician instruction, or supervisory relationships.
• Limits on “caregiver” or companion intermediation: Parties should expect courts to scrutinize whether a companion’s participation was actually necessary for treatment. For conscious adults able to speak, third-party relays to nurses are at high risk of being deemed nonprivileged.
• Medical-record warrants likely to increase in DWI/drug cases: By holding that the privilege statute does not prohibit issuing a particularized warrant for accident-day records, the court lowers an asserted categorical barrier. Future litigation will likely focus less on “can a warrant issue?” and more on “what is sufficiently particular?” and “what must be suppressed?”
• Procedural safeguard debate remains open: Justice Hennesy’s concurrence (joined by Justices Thissen and Procaccini) flags a significant unresolved question: whether courts should require in camera review, notice, and an opportunity to object before law enforcement reviews seized medical records. Footnote 7 expressly leaves this for another day.

IV. Complex Concepts Simplified

• Physician-patient privilege (Minn. Stat. § 595.02, subd. 1(d)): A rule that (in court proceedings) generally prevents a physician from disclosing certain patient information obtained while treating the patient, when that information was necessary for treatment. It is statutory, not constitutional.
• Nurse-patient privilege (Minn. Stat. § 595.02, subd. 1(g)): A similar rule limiting disclosure by certain professionals (including registered nurses) of information acquired in a professional capacity and necessary to act in that capacity.
• “Under the direction” / agency: A relationship where a physician has sufficient control over another person (e.g., a nurse, attendant, or potentially a paramedic) such that the other person is effectively acting as the physician’s agent. Mere cooperation, teamwork, or general trust is not enough; the question is functional control tied to diagnosis/treatment work.
• Third-party “necessary and customary participant”: If someone who is not needed for treatment is brought into the conversation, that can break confidentiality for privilege purposes. Necessary participants might include an interpreter or a guardian in appropriate circumstances; a companion is not automatically necessary.
• In camera review: A judge privately reviews records to decide what is privileged or must be disclosed, without exposing the full content to parties (or, in some contexts, to law enforcement) first. The majority did not require it here for warrant-executed seizures; the concurrence would.
• Particularity (warrants): Warrants must specify what is to be searched/seized closely enough to prevent “general rummaging.” A tight time limit (here, the accident date) can help satisfy that requirement.

V. Conclusion

State v. Smeby reshapes Minnesota privilege-and-records practice in four ways: it rejects a categorical exclusion of paramedics while requiring proof they acted under a physician’s direction; it denies privilege protection for patient-related statements routed through non-essential third parties; it holds that nonprivileged facts do not become privileged simply by being charted; and it confirms that the physician-patient privilege statute does not bar a court from issuing a sufficiently particular warrant for accident-day medical records, even if the records contain mixed privileged and nonprivileged material.

At the same time, the concurrence highlights a looming procedural question—whether courts should require pre-disclosure judicial screening (and patient notice) when warrants seize medical records—suggesting that future cases may address safeguards to prevent privilege being effectively lost by disclosure itself.