Amaral v. Saint Cloud Hosp.

Decision Date12 August 1999
Docket NumberNo. CX-98-784.,CX-98-784.
Citation598 N.W.2d 379
PartiesMichael A. AMARAL, et al., petitioners, Appellants, v. The SAINT CLOUD HOSPITAL, Respondent.
CourtMinnesota Supreme Court

Mary R. Vasaly, Richard A. Kempf, Susan E. Oliphant, Maslon Edelman Borman & Brand, L.L.P., Minneapolis, for appellants.

Kevin J. Hughes, Kevin M. O'Driscoll, Hughes, Mathews & Didier, P.A., St. Cloud, for respondent.

Heard, considered, and decided by the court en banc.



This case requires us to examine the scope of Minn.Stat. § 145.64, subd. 2 (1998), the provider data exception to the privilege provision of Minnesota's review organizations statute, Minn.Stat. §§ 145.61-.67 (1998). Appellants, Dr. Michael A. Amaral and Dr. Dan E. Miulli, are physicians with staff privileges at respondent, The Saint Cloud Hospital. The two physicians requested information about themselves from certain of the hospital's medical peer review organizations. The hospital refused their request, stating that the information sought was confidential under the privilege provision of the statute, Minn.Stat. § 145.64, subd. 1 (1998). The hospital further asserted that under the provider data exception, the information sought was only discoverable in a court action challenging an adverse determination concerning the physicians' staff privileges or participation status. Both physicians then commenced an action in district court for declaratory and injunctive relief. They sought judgment declaring that they had a right to the requested information and that the hospital violated Minn.Stat. § 145.64, subd. 2. They also sought an injunction enjoining and restraining the hospital from violating the statute or from interfering with their access to the requested information. The hospital moved for summary judgment and the court awarded summary judgment to the hospital based on the plain language of the statute. The court of appeals affirmed, basing its affirmance on the purposes underlying the statute. We affirm.

On April 18, 1997, Dr. Michael A. Amaral and Dr. Dan E. Miulli each sent a letter to The Saint Cloud Hospital requesting records, information, and data relating to themselves from the following of the hospital's medical review organizations: Credentials Committee, Critical Care Committee, Medical Care Review Committee, and Executive Committee. Both physicians practice at the hospital and have staff privileges there; therefore, they are subject to the hospital's peer review process. Citing Minn.Stat. § 145.64, subd. 2, the provider data exception to the review organizations statute, Amaral requested the following information for the time frame of September 1995 to the date of the letters:

Records and documents that refer or relate to reviews, evaluations, grants, denials, or recommendations regarding [my] staff privileges or status;
Minutes of meetings where [I][was] discussed;
Complaints, criticisms, reports, recommendations, requests for review, requests for investigation, or any inquiries directed to [the committee or the committee head or representative] referring or relating to [me]; and
Any records or documents [the committee or the committee head or representative] received, reviewed or considered in reviewing or reaching any decision about [me], [my] staff privileges or status.

Miulli requested the same information regarding himself for the time frame of July 1995 to April 1997. In addition, Miulli requested "any records or documents referring or relating in any way to the grant, suspension, denial, or withdrawal of my staff privilege or opportunity to do steratactic surgery or procedures."

The hospital responded, citing the privilege provision of the statute, Minn.Stat. § 145.64, subd. 1, and stating that the information the physicians sought could only be obtained through the discovery process and was "only discoverable if the physician has received an adverse determination and challenges that determination in court." The hospital asserted that, because the physicians had received no adverse determination regarding their privileges or participation status and thus had commenced no legal action based on such an adverse determination, the requested information was privileged and could not be disclosed.

The physicians again wrote to the hospital, requesting that the hospital provide "the authority upon which the hospital's position [was] based." The hospital responded by directing the physicians to the text of the privilege provision. In addition, the hospital attached a letter from its attorney, which stated in essence the same information the hospital had conveyed to the physicians in its previous letter.

Following their receipt of the hospital's second letter, the physicians commenced an action in Stearns County District Court requesting: (1) a declaratory judgment that they had a right to examine the requested information, (2) a declaratory judgment that the hospital had violated the review organizations statute, specifically the provider data exception, and (3) an injunction enjoining and restraining the hospital from further violating the provider data exception. The physicians then served discovery requests on the hospital, seeking the same information they had requested in their April 18 letters. The hospital moved for summary judgment and a protective order. Together with its motion for summary judgment, the hospital submitted all correspondence between the parties up to that point and an affidavit from Dr. Daniel J. Whitlock, the hospital's Vice President of Medical Affairs. In his affidavit, Dr. Whitlock stated that confidentiality of review organization information "is essential to the effective functioning of physician review of physician performance and conduct in the Hospital." He further stated that "[t]he extent to which such review [of review organization information] is available to scrutiny beyond the process itself affects the extent, nature, and effect of that process, in that the desired open, candid, honest, and critical evaluation of physician practice and conduct, as it affects patient care in the [h]ospital, will be adversely affected." The physicians then filed a motion to compel the production of the information sought in their discovery requests.

The district court awarded summary judgment in favor of the hospital. The summary judgment was based on the court's conclusion that the language of the provider data exception was unambiguous. The provider data exception allows limited access to review organization information for "professionals requesting or seeking through discovery data, information, or records relating to their medical staff privileges, membership, or participation status." Minn.Stat. § 145.64, subd. 2. The court concluded that the word "or" as used in the phrase "requesting or seeking through discovery" should be read as "a conjunction of two essentially similar words, `requests' and `seeks through discovery.'"

The court went on to conclude that reading the word "or" as disjunctive would not be a reasonable construction of the statute for two reasons. First, citing to a thesaurus, the court determined that the word "`[s]eek' is synonymous with `request.'" The court also concluded that "discovery is essentially comprised of requests by each party" and that "[t]he rules governing discovery are replete with references to `requests' in almost every instance." Second, reading the word "or" as disjunctive would be at odds with the policy underlying the privilege provision, which provision grants confidentiality to the proceedings and records of medical review organizations, protecting such information from discovery or introduction into evidence in civil actions against a professional health care provider; see Minn.Stat. § 145.64, subd. 1. The court stated that the privilege provision encourages "free and uninhibited discussion among members of peer review [organizations] without fear of retaliation or of legal action brought by professionals subject to the peer review process." The court then concluded that this policy "would be defeated if a request by a professional at any time would mandate the turning over of documents that are otherwise protected by [the privilege provision]."

The court of appeals affirmed on different grounds. See Amaral v. Saint Cloud Hosp., 586 N.W.2d 141, 143-44 (Minn. App.1998). Specifically, the court declined to engage in an analysis of the plain language of the statute, relying instead on legislative intent. See id. at 143. In dismissing any plain language analysis, the court stated that "the legislative intent of the statute is clear, even though the language itself is not." Id. The court, in examining the legislative intent, relied on two decisions of our court to ascertain the purpose behind the privilege provision—Kalish v. Mount Sinai Hosp., 270 N.W.2d 783 (Minn.1978), and Campbell v. St. Mary's Hosp., 312 Minn. 379, 252 N.W.2d 581 (1977). See Amaral, 586 N.W.2d at 143-44. In those cases, we concluded that the statutes providing for confidentiality and immunity for peer review organizations and persons involved in the peer review process reflect a legislative intent both to improve the quality of health care by providing for confidentiality of review organization information and to encourage self-monitoring in the medical profession. See Kalish, 270 N.W.2d at 785; Campbell, 312 Minn. at 389, 252 N.W.2d at 587. On the basis of our statements in Kalish and Campbell, the court of appeals concluded that

[t]he extent to which peer review materials are available to outside sources could well affect the nature and result of the monitoring process. The practice of medicine involves referrals, collegiality, and cooperation. Confidentiality of physician files is essential to ensure the highest quality medical practice. If physicians could access all peer review materials at any time, even without any adverse decision affecting their status or

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