The British Columbia Human Rights Tribunal has ordered provincial health authorities to disclose specific data from the Patient Records and Outcome Management Information System, known as PROMIS, to the Union of BC Indian Chiefs1. This decision comes as part of an ongoing class complaint alleging systemic discrimination against Indigenous patients within the province’s liver transplant system. The ruling, delivered by Tribunal Member Shannon Beckett on August 22, 2025, navigates the complex intersection of patient privacy rights, the administrative burden of legal discovery, and the necessity of statistical evidence in proving claims of systemic bias. While the Tribunal granted access to the electronic data, it notably refused to order a manual review of individual patient charts or the production of province-wide health records that fall outside the health authorities’ direct control.
The underlying case involves a class complaint brought by the Union of BC Indian Chiefs against the Provincial Health Services Authority, Vancouver Coastal Health Authority, and the British Columbia Transplant Society. The complaint alleges that the criteria used to determine eligibility for liver transplants discriminate against Indigenous persons based on race, ancestry, and physical disability. Specifically, the Union represents two distinct classes of individuals. The first is the “Abstinence Class,” comprised of Indigenous persons adversely impacted by a policy requiring six months of abstinence from alcohol before becoming eligible for a transplant. The second is the “MELD-Na Class,” which refers to Indigenous persons with Primary Biliary Cirrhosis who have been adversely impacted by the use of specific medical scoring systems to determine their access to life-saving surgery.
To support these allegations, the Union of BC Indian Chiefs sought to introduce expert testimony from Dr. Stephen Hart. The Union argued that to determine if there is a statistically linked adverse effect on Indigenous patients, their expert required a broad dataset covering all patients referred to the BC Liver Transplant Program between February 11, 2019, and February 10, 2025. This request was not limited to Indigenous patients but sought information on the entire population of referrals to establish a comparator group. The Union sought four main categories of documents. These included dates of referral and evaluation, detailed clinical histories regarding liver disease and substance use, clinical outcomes such as transplant success or death, and a broad request for province-wide data concerning liver diagnoses across the general population.
The Respondents, who manage liver transplant delivery in British Columbia, opposed the application. They argued that the request amounted to a “fishing expedition” that exceeded the scope of reasonable disclosure. Through an affidavit from Eric Lun, the Executive Director of the BC Transplant Society, the health authorities explained the logistical realities of their record-keeping. Mr. Lun detailed that during the relevant six-year period, 1,621 people were referred to the program. He clarified that while some data is centralized in the PROMIS database, much of the granular clinical information requested by the Union exists only in individual patient charts or is not tracked by the transplant program at all.
A central point of contention was the request for province-wide data concerning the diagnosis of all liver-related problems and substance use issues for the full population of British Columbia. The Union argued that this information was necessary to understand the full scope of potential discrimination. However, the Respondents submitted that they do not possess or control data for the entire province, as much of that information resides in the private offices of general practitioners and specialists. Tribunal Member Beckett accepted the evidence provided by the Respondents on this issue. She noted that the Union had failed to explain how the health authorities could possibly identify or collect diagnosis dates for every person in the province with liver issues. Consequently, the Tribunal dismissed this portion of the application, finding that the Respondents could not be ordered to produce documents they did not possess and that the request was disproportionate given the unknown volume of records involved.
The Tribunal then turned its attention to the data concerning the 1,621 patients specifically referred to the Liver Transplant Program. The Union sought detailed information including MELD-Na scores, classifications of hepatic encephalopathy, and assessments of social functioning. The Respondents argued that disclosing this information would breach patient confidentiality. They pointed to a previous decision in the same proceedings where the Tribunal had denied the Union access to the redacted medical records of class members who had not consented to the release. The health authorities contended that even without names, the unique medical timelines and histories could lead to the identification of patients, thereby invading their privacy.
Tribunal Member Beckett drew a distinction between the previous request for full medical records and the current request for data points. In the earlier decision, the Tribunal found that a full medical file contains a patient’s unique life story, which is difficult to redact effectively. However, the current application sought high-level, de-identified data such as dates of diagnosis, specific liver function scores, and clinical outcomes. Member Beckett concluded that this limited data did not carry the same risk of identifying individuals. She found that the privacy interests of the patients were sufficiently protected by the de-identification of the data and that the potential probative value of the statistical evidence outweighed the minimal risk to privacy. The Tribunal recognized that proving systemic discrimination often requires comparing the treatment of a specific group against a larger population, making the data on non-Indigenous patients arguably relevant.
The question of proportionality played a significant role in the final decision. The Respondents provided evidence that much of the requested information, such as specific clinical criteria scores and detailed substance use history, was not tracked in the PROMIS database. To retrieve this information, staff would need to request access to individual charts from various health authorities and manually search through 1,621 files. Mr. Lun estimated that this process would take between three to six hours per patient, resulting in years of work.
Member Beckett found that requiring a manual review of over sixteen hundred patient charts would be disproportionate, particularly given the stage of the proceedings. The complaint, originally filed in June 2020, is approaching a scheduled hearing in November 2025. The Tribunal emphasized the importance of moving the case toward a resolution after five years of litigation. Ordering a manual review of charts would necessitate a lengthy adjournment of the hearing, which the Tribunal deemed unacceptable. As a result, the Tribunal denied the request for any information that would require manual extraction from individual patient files.
However, the Tribunal reached a different conclusion regarding the data already housed within the PROMIS database. The Respondents confirmed that PROMIS tracks dates of decision for listing patients, dates of ineligibility, transplant outcomes, and certain liver function scores at the time of referral. It also records patient ethnicity once a patient is placed on the transplant list. Member Beckett reasoned that producing data from an existing database does not impose an undue burden. The Tribunal rejected the argument that generating a report from a database equates to “creating” new documents, which is generally not required under disclosure rules. Instead, the Tribunal found that extracting stored information is a standard part of modern discovery obligations.
The Tribunal also addressed the timing of the Union’s application. The Respondents argued that the request came too late in the process, noting that the deadline for expert reports was fast approaching. They contended that allowing the data release now would prejudice their ability to prepare for the hearing and potentially require them to retain a rebuttal expert on short notice. While Member Beckett acknowledged that the Union had not explained the delay in seeking the data, she determined that there was still sufficient time to manage the disclosure without derailing the schedule. The order anticipates that the PROMIS data can be generated quickly and that the Union’s expert can produce a report within a short timeframe, allowing the Respondents the statutory thirty days to respond before the hearing.
Ultimately, the Tribunal ordered the Respondents to produce the subset of data confirmed to be in the PROMIS database. This includes dates regarding referral, evaluation, and listing decisions, as well as specific liver function scores available in the system and clinical outcomes. Crucially, the order includes the disclosure of recorded ethnicity data, which is vital for the Union’s analysis of racial discrimination. The Respondents are required to provide this data for the period covering February 11, 2019, to February 10, 2025.
The decision represents a procedural compromise that grants the Union of BC Indian Chiefs access to potential statistical evidence while protecting the health authorities from an unmanageable administrative workload on the eve of a trial. The Respondents have been given a deadline of September 1, 2025, to provide the data. The case is set to proceed to a hearing later in the year, where the Tribunal will consider the substantive allegations regarding the fairness of the liver transplant eligibility criteria.
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