Kates, W., et ux. v. Doylestown Hosp. ( 2014 )

J-A15039-14
NON-PRECEDENTIAL DECISION - SEE SUPERIOR COURT I.O.P. 65.37
WILLIAM KATES AND BEVERLY KATES, IN THE SUPERIOR COURT OF
PENNSYLVANIA
Appellees
v.
DOYLESTOWN HOSPITAL, ET AL.,
Appellant No. 2718 EDA 2013
Appeal from the Order Entered August 15, 2013
In the Court of Common Pleas of Bucks County
Civil Division at No(s): 2011-02516
BEFORE: PANELLA, LAZARUS AND JENKINS, JJ.
MEMORANDUM BY JENKINS, J. FILED AUGUST 22, 2014
August 15, 2013 directing the Hospital to provide various records to
eges
that the documents are privileged under the Peer Review Protection Act
affirm.
The Kates allege in this action that various medical defendants,
including the Hospital, failed to
During discovery, the Kates demanded that the Hospital produce documents
Benner, reviewed in preparation for her
ee,
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compliance with accreditation by the Joint Commission on Accreditation of
On April 11, 2013, the Kates filed a motion to compel the Hospital to
produce the documents in dispute. In response, the Hospital submitted the
following documents under seal to the court for in camera review:
spital personnel had
completed the American Stroke Association's NI1-1 Stroke Scale
program.
made to the night hawk program (which deals with off hours x-ray
review).
nda of the Critical Care Quality Sub-
Committee of the Patient Safety Committee.
Stroke Committee's Minutes, which deal with the procedures to be
used for the operation of the stroke program.
-mail chains between
Stroke Committee members concerning practices and procedures the
hospital will use in the operation of its stroke program.
deals with
stroke and disabled patients at the hospital.
-mail chains between Stroke Committee
members and a Jefferson University administrator exchanging the
transfer agreement (which cannot be seen) between the two hospitals.
Documents 24-26 are email chains regarding the procedures used
requests by one doctor to another asking for their input on the
treatment of a patient).
etting forth the topics (procedures and
practices) the Stroke Committee will need to be prepared to discuss in
an upcoming phone call.
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Trial Court Opinion, pp. 3-41.
compel. On August 15, 2013, the court ordered the Hospital to produce the
above list of documents. The Hospital filed a timely appeal from the portions
the portions of the order that permitted the Hospital to withhold several
documents from production.
The Hospital has the right to take an interlocutory appeal of this
discovery order pursuant to the collateral order doctrine embodied in
Pa.R.A.P. 313. Gillard v. AIG Ins. Co., 15 A.3d 44, 56 (Pa.2011)
(collateral order doctrine permits appeal from discovery order requiring
disclosure over assertion of privilege). Our standard of review over appeals
from orders interpreting the PRPA is plenary. Dodson v. DeLeo, 872 A.2d
1237, 1241 (Pa.Super.2005).
The lone issue on appeal is whether PRPA shields from production the
documents that the trial court ordered the Hospital to produce.
quality of care, reduce mortality and keep healthcare costs within reasonable
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To eliminate confusion, we do not list the documents that the court found
were not subject to production.
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bounds. Trial Court Opinion, p. 6. To achieve these goals, there must be
honest and sometimes critical internal review of medical providers by their
peers. Id. The PRPA deems many internal review documents privileged to
facilitate accurate and comprehensive internal evaluations of medical
providers.
The trial court observed, however, that the PRPA has two important
limitations. The first limitation is that
review committee
committee engaged in peer review, including...gather[ing] and review[ing]
any hospital board, committee or individual reviewing the
professional qualifications or activities of its medical staff or applicants for
admission thereto Id. Peer review, in turn, is defined in pertinent part as
the procedure for evaluation by professional health
care providers of the quality and efficiency of
services ordered or performed by other professional
health care providers,... and the compliance of a
hospital, nursing home or convalescent home or
other health care facility operated by a professional
health care provider with the standards set by an
association of health care providers and with
applicable laws, rules and regulations.
63 P.S
under 63 P.S. § 425.4, which provides:
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Provided, however, that information, documents or
records otherwise available from original sources are
not to be construed as immune from discovery or
use in any such civil action merely because they
were presented during proceedings of such
committee, nor should any person who testifies
before such committee or who is a member of such
committee be prevented from testifying as to
matters within his knowledge, but the said witness
cannot be asked about his testimony before such a
committee or opinions formed by him as a result of
said committee hearings.
Id. (emphasis added). Under this limitation, a hospital may not shield a
document from production merely by giving it to a peer review committee.
A document not derived from nor part of an evaluation or review by a peer
review committee is not privileged. Dodson, supra, 872 A.2d at 1244.
Read together, the trial court reasoned, the two limitations provide
Court Opinion, p. 8.
The trial court held that the documents that it ordered the Hospital to
produce do not relate to peer review. Instead, the court said, the Hospital
simply labeled them privileged without good reason:
Peer review necessarily involves evaluating the
quality of care provided by medical professionals or
evaluating the qualifications of medical care
providers. Except for those portions that we held
could be redacted, the documents/communications
at issue were not used or made for the
determination of staff privileges or for credentialing
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purposes. These documents/communications were
not used exclusively for quality assurance purposes
by the Stroke Committee and are not incorporated
exclusively within a physician's credentialing file.
See Dodson, supra. Furthermore, Doylestown
Hospital cannot point to a definitive action initiating
the peer review process prior to the time these
documents were created. See Mazzucca [v.
Methodist Hospital], 47 D. & C. 3d [55,] 60
[(Phila. Cty. 1985)]. Quite simply, the emails,
agenda and minutes we ordered discoverable are
non-peer review business records and
communications that are neither used, nor generated
by the Stroke Committee for peer review purposes.
Id., pp. 8-
procedures for the operations of its stroke program or monitoring changes
with the Joint Commission's standards [does not] constitute[] a peer review
process. . . especially if those procedures relate to discussing the Joint
Id., pp. 9,
11.
The court continued:
[T]he Kates' Motion for Production of Documents
does not request any reports, documents or
recommendations produced by the Joint Commission
or exchanged between the Joint Commission and
Doylestown Hospital: (1) The Motion requests
minutes of the Stroke Committee in 2009 (2) The
motion requests documents reviewed by Benner
prior to the deposition, and (3) The Motion requests
emails between Benner and the Stroke Committee.
Furthermore, our Order explicitly exempts any
documents, communications or evaluations produced
by the Joint Commission or exchanged between the
Joint Commission and Doylestown Hospital.
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Id., p. 10.
The court concluded:
peer review procedures may overlap with the Stroke
rate or related peer review
procedures. For instance, our in camera review of
the disputed documents helped us identify and
protect from discovery certain portions of the Stroke
Committee minutes that involved actual peer review.
Document 8, item 2.a, and Document 10, item 2,
both are minutes that detail the Stroke Committee's
report and discussions on problems regarding the
efficiency and quality of care provided by medical
personnel. We allowed those portions to be redacted.
We are reluctant, however, to extend this same
exemption to other information relating to the Stroke
Committee's function of setting up the Stroke
Program's policies and procedures[,] especially if
those procedures relate to discussing the Joint
Commission's publically published standards of
accreditation.
[The] Hospital would like the PRPA's confidentiality
provision to extend to all communications of the
Stroke Committee as well as every document derived
by the Stroke Committee. Permitting such a broad
request would be a clear misuse of the PRPA's
confidentiality provision because it would allow
hospitals to insulate their policy making decisions
under the guise of peer review. It is beyond the
PRPA's plain meaning.
Therefore, [the] Hospital did not meet its burden of
establishing t
confidentiality provision extends to the documents
and communications our order requires it to disclose.
Id., p. 11.
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We have carefully reviewed the record, the briefs of both parties, and
the documents that are the subject of this appeal. We agree with Judge
Order affirmed.
Judgment Entered.
Joseph D. Seletyn, Esq.
Prothonotary
Date: 8/22/2014
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