Does Tennessee's law requiring courts to report mental commitments to the FBI background check system violate patient privacy?

Plain-English summary

A Nashville circuit judge asked whether Tennessee's then-new statute requiring courts to report mental commitments and "mental defective" adjudications to the federal background check system conflicted with patient privacy laws. The reporting statute, Tenn. Code Ann. § 16-10-213, took effect January 1, 2010, and was enacted to comply with the federal NICS Improvement Amendments Act of 2007. Federal law (18 U.S.C. § 922(d)(4) and (g)(4)) bars firearm sales to and possession by people committed to a mental institution or adjudicated as a mental defective, and the reporting statute fed those determinations into the FBI's background check system.

AG Robert E. Cooper, Jr. concluded there was no conflict with either Tennessee's mental health confidentiality regime (Title 33) or HIPAA. Title 33 generally bars disclosure of mental health records, but Tenn. Code Ann. § 33-3-115 contains an explicit carve-out that requires court clerks holding records of involuntary commitment or "mental defective" adjudications to disclose the information specified in § 16-10-213(c) to the FBI. As for HIPAA, the federal privacy rule applies only to "covered entities" (health plans, health care clearinghouses, and certain health care providers). Tennessee circuit and criminal courts are not covered entities, so HIPAA does not regulate the information they hold from court proceedings.

Currency note

This opinion was issued in 2010. Subsequent statutory amendments, court decisions, or later AG opinions may have changed the analysis. Treat this page as historical context, not current legal advice. Verify current law before relying on any specific rule, deadline, or remedy mentioned here.

Common questions

Q: What information do courts have to report?
A: Per § 16-10-213(c), the clerk reports the person's full name (including aliases), date of birth (if known), the case or docket number, the date of the commitment or adjudication, and the name of the private or state hospital or treatment resource where the person was committed. The reports go to the FBI's NICS index and the Tennessee Department of Safety.

Q: Who triggers a reportable event?
A: A person who has been "judicially committed" to a mental institution under Tennessee Code Title 33, Chapter 6 or 7, or who has been "adjudicated as a mental defective." Voluntary admissions are not on the list. The reporting obligation arises from the court's formal order, not from the underlying clinical care.

Q: Why doesn't this violate Title 33's confidentiality rule?
A: Title 33 starts with broad confidentiality (§ 33-3-103) but then carves out specific disclosure exceptions. Section 33-3-115(a) is one of those exceptions: it specifically requires court clerks holding the relevant records to send them to the FBI and to the Tennessee Department of Safety to support the firearm prohibitions in §§ 39-17-1316, 39-17-1351, and 39-17-1352, and the federal NICS Improvement Amendments Act.

Q: Why isn't this a HIPAA violation?
A: Because HIPAA only governs "covered entities," meaning health plans, health care clearinghouses, and health care providers that transmit certain health information electronically (45 C.F.R. § 160.103). Courts are not covered entities. Information that flows into a court file from a commitment proceeding belongs to the court, and the court can disclose it under whatever rules apply to court records.

Q: What about clinical records held by the hospital?
A: That's a different question, the opinion did not address clinical records held by the treating hospital. HIPAA would still apply to the hospital, and the court reporting statute does not authorize hospitals to disclose anything beyond what they would already disclose under the existing exceptions to Title 33 or HIPAA.

Q: What courts have to report?
A: All Tennessee courts that hear commitment or adjudication matters. Section 16-10-213 covers circuit and criminal courts. Section 16-10-206 imposes the same duty on chancery courts; § 16-16-120 covers county or probate courts; § 16-15-303 covers general sessions courts. The opinion specifically rejected any argument that one court's reporting was permitted while another's was not.

Background and statutory framework

The constitutional baseline is that a state may legislate disclosures of information held by government agencies, including courts, subject to constitutional limits. Tennessee's mental health confidentiality regime in Title 33 is structured the same way HIPAA is: a broad confidentiality rule followed by enumerated exceptions. Section 33-3-115(a) is the exception relevant here, and it does not carve out a discretionary disclosure, it requires clerks to disclose the information specified in § 16-10-213(c) to the FBI and Department of Safety.

The federal trigger came in 2007 when Congress passed the NICS Improvement Amendments Act (P.L. 110-180) in response to the 2007 Virginia Tech shooting, where the shooter had been adjudicated mentally ill but not entered into NICS. The Act created strong incentives for states to feed mental adjudication data into the federal background check system. Tennessee's response was Tenn. Code Ann. § 16-10-213 and its Title 33 counterpart in § 33-3-115.

HIPAA's privacy rule, 45 C.F.R. Parts 160 and 164, was enacted in 2000 under the Health Insurance Portability and Accountability Act of 1996. It applies only to "covered entities," a defined term that does not include courts. The opinion's HIPAA analysis follows directly from the regulatory definition: no covered entity, no HIPAA preemption issue.

Citations and references

Federal law:

• 18 U.S.C. § 922(d)(4) and (g)(4) (firearm prohibitions tied to mental commitments)
• NICS Improvement Amendments Act of 2007, P.L. 110-180
• 45 C.F.R. §§ 160.103, 164.500 (HIPAA covered entity definitions)

State statutes:

• Tenn. Code Ann. § 16-10-213 (circuit and criminal court reporting)
• Tenn. Code Ann. § 16-10-206 (chancery court)
• Tenn. Code Ann. § 16-15-303 (general sessions)
• Tenn. Code Ann. § 16-16-120 (county/probate)
• Tenn. Code Ann. § 33-3-103 (general confidentiality)
• Tenn. Code Ann. § 33-3-115 (NICS disclosure exception)
• Tenn. Code Ann. § 39-17-1316, 39-17-1351, 39-17-1352 (firearm prohibitions)

Source

• Landing page: https://www.tn.gov/attorneygeneral/opinions.html
• Original PDF: https://www.tn.gov/content/dam/tn/attorneygeneral/documents/ops/2010/op10-056.pdf

Original opinion text

April 26, 2010

Opinion No. 10-56

Patient's Right to Privacy

QUESTION

Does Tenn. Code Ann. § 16-10-213 conflict with a patient's right to privacy?

OPINION

No. Tennessee Code Annotated § 16-10-213 does not conflict with the patient privacy protections of either Tenn. Code Ann. Title 33 or the Health Insurance Portability and Accountability Act ("HIPAA") privacy provisions.

ANALYSIS

Tennessee Code Annotated § 16-10-213 requires the circuit and criminal courts in Tennessee that order persons committed to a mental institution pursuant to Tenn. Code Ann. Title 33, Chapters 6 or 7, or that adjudicate a person as a "mental defective," to enter a standing and continuing order instructing the court clerk to collect and periodically report certain information to the Federal Bureau of Investigation-NCJS Index and the Tennessee Department of Safety for the purpose of complying with the NICS Improvement Amendments Act of 2007, P.L. 110-180. The NICS Improvement Amendments Act of 2007 prohibits the possession of a firearm by and the sale of a firearm to persons "adjudicated as a mental defective or committed to any mental institution." 18 U.S.C. § 922(d)(4) and (g)(4). Pursuant to Tenn. Code Ann. § 16-10-213(c), the court order would require the court clerk to collect and report the complete name, including all aliases, and the date of birth, if known, of every person judicially committed or adjudicated as a mental defective; the case or docket number and the date of the judicial commitment or adjudication as a mental defective; and the private or state hospital or treatment resource to which the person was judicially committed. Tennessee Code Annotated § 16-10-213 was enacted in 2009 and became effective January 1, 2010. You ask whether Tenn. Code Ann. § 16-10-213 conflicts with a patient's right to privacy.

Tennessee Code Annotated §§ 16-10-206 and 16-16-120 place the same requirements on the chancery courts and the county or probate courts in Tennessee, respectively. Clerks of the general sessions courts in Tennessee must also provide the same information pursuant to Tenn. Code Ann. § 16-15-303.

Tennessee Code Annotated Title 33 provides the statutory protections for patient privacy pertaining to mental health information under Tennessee law. Tennessee Code Annotated § 33-3-103 makes confidential and prohibits disclosure "except in compliance with this part" of "[a]ll applications, certificates, records, reports, legal documents, and pleadings made and all information provided or received in connection with services applied for, provided under, or regulated" under Title 33 that directly or indirectly identify a present or former service recipient. However, Tenn. Code Ann. § 33-3-115 creates a pertinent exception to these confidentiality requirements. Tennessee Code Annotated § 33-3-115(a) requires any clerk of court that maintains records of an adjudication as a mental defective or a judicial commitment to a mental institution pursuant to Chapter 6 or 7 to disclose the information listed in Tenn. Code Ann. § 16-10-213(c) to the Federal Bureau of Investigation-NCJS Index and the Tennessee Department of Safety in accordance with the procedures outlined in Tenn. Code Ann. Title 16 for the purpose of complying with Tenn. Code Ann. §§ 39-17-1316, 39-17-1351, and 39-17-1352, and the NICS Improvement Amendments Act of 2007. Based on this exception, Tenn. Code Ann. § 16-10-213 does not conflict with the patient privacy protections of Title 33.

Tennessee Code Annotated § 39-17-1316 prohibits the sale of firearms to persons who have been judicially committed to a mental institution pursuant to Title 33 or adjudicated as a mental defective. Tennessee Code Annotated § 39-17-1351 requires persons applying for a handgun carry permit to disclose any such judicial commitment or adjudication. Tennessee Code Annotated § 39-17-1352 requires the suspension or revocation of the handgun permit of a person judicially committed to a mental institution pursuant to Title 33 or adjudicated as a mental defective.

The Health Insurance Portability and Accountability Act ("HIPAA") privacy provisions also protect individually identifiable health information from disclosure. 45 C.F.R. Parts 160 and 164. However, only a "covered entity" is subject to HIPAA. 45 C.F.R. § 164.500. A "covered entity" includes a health plan, a health care clearinghouse, and a health care provider who transmits any health information in electronic form in connection with a transaction covered by HIPAA. 45 C.F.R. § 160.103. Tennessee circuit and criminal courts are not covered entities subject to HIPAA.

Therefore, HIPAA does not govern information obtained by the court in the course of proceedings before the court, and Tenn. Code Ann. § 16-10-213 does not conflict with HIPAA.

ROBERT E. COOPER, JR.
Attorney General and Reporter

MICHAEL E. MOORE
Solicitor General

PAMELA A. HAYDEN-WOOD
Senior Counsel

Requested by:
Honorable Hamilton V. Gayden, Jr.
Judge, First Circuit Court
1 Public Square
502 Metropolitan Courthouse
Nashville, TN 37201