Leadbitter v. Keystone Anesthesia Consultants, Ltd., 19 WAP 2020

• Court: United States State Supreme Court of Pennsylvania
• Writing for the Court: SAYLOR, JUSTICE.
• Parties: JAMES E. LEADBITTER AND TAMMY M. LEADBITTER, HIS WIFE v. KEYSTONE ANESTHESIA CONSULTANTS, LTD., A CORPORATION, CHRISTOPHER MERCK, D.O., AJOY KATARI, M.D., JOHN P. WELDON, M.D., LAURA V. MCNEILL, M.D., AND ST. CLAIR HOSPITAL v. CARMEN PETRAGLIA, M.D. AND SOUTH HILLS ORTHOPAEDIC SURGERY ASSOCIATES, A CORPORATION APPEAL OF: ST. CLAIR HOSPITAL
• Docket Number: 19 WAP 2020,J-7-2021
• Decision Date: 17 August 2021

JAMES E. LEADBITTER AND TAMMY M. LEADBITTER, HIS WIFE
v.
KEYSTONE ANESTHESIA CONSULTANTS, LTD., A CORPORATION, CHRISTOPHER MERCK, D.O., AJOY KATARI, M.D., JOHN P. WELDON, M.D., LAURA V. MCNEILL, M.D., AND ST. CLAIR HOSPITAL
v.
CARMEN PETRAGLIA, M.D. AND SOUTH HILLS ORTHOPAEDIC SURGERY ASSOCIATES, A CORPORATION

APPEAL OF: ST. CLAIR HOSPITAL

No. 19 WAP 2020

No. J-7-2021

Supreme Court of Pennsylvania

August 17, 2021

ARGUED: March 9, 2021

Appeal from the Order of Superior Court entered on 2/12/20 at No. 1414 WDA 2018 affirming the order of the Court of Common Pleas of Allegheny County entered 9/17/18 at No. G.D. 16-10700

OPINION

SAYLOR, JUSTICE.

This discretionary appeal concerns discovery in a medical negligence lawsuit in which the patient suffered complications following surgery at a hospital. The issue is whether certain portions of the hospital's credentialing file for the doctor who performed the surgery are protected from discovery. The hospital claims protection under the Peer Review Protection Act and the federal Health Care Quality Improvement Act.

I. Background

In mid-2014, Carmen Petraglia, M.D., applied to be appointed to the medical staff of Appellant St. Clair Hospital (the "Hospital"). He also applied for orthopedic surgery clinical privileges. In considering these applications, the Hospital's credentials committee reviewed a variety of information and documentation, and it ultimately recommended that these requests be granted. In September 2014, Dr. Petraglia accepted appointment to the Hospital's medical staff with delineated clinical privileges in the Department of Surgery, Section of Orthopedic Surgery.^[1]

During the next few months, Dr. Petraglia examined plaintiff James Leadbitter and recommended spinal surgery. He performed the surgery during a two-day period at the Hospital in mid-January 2015. Shortly thereafter, Leadbitter suffered a series of strokes, resulting in numerous impairments including permanent brain damage.

Leadbitter and his wife ("Plaintiffs") filed a complaint raising, inter alia, claims of negligence against multiple defendants, including the Hospital, and vicarious liability and corporate negligence against the Hospital. In the latter claim, Plaintiffs alleged the Hospital's credentialing and privileging process was inadequate, and that it knew or should have known Dr. Petraglia lacked the expertise to be authorized to perform the surgery in question. See First Amended Complaint at ¶76, reprinted in RR. 88a-92a.

In March 2017, Plaintiffs served on the Hospital a first set of interrogatories and request for documents seeking the complete credentialing and/or privileging file for Dr. Petraglia. The Hospital responded by supplying much of the requested file, but it withheld or redacted several documents. After this Court decided Reginelli v. Boggs, 645 Pa. 470, 181 A.3d 293 (2018) - which held, among other things, that the evidentiary privilege set forth in Pennsylvania's Peer Review Protection Act (the "PRPA")^[2] applies to the documents of a "review committee" but not to the documents of all "review organizations," see id. at 490, 181 A.3d at 305-06 - Plaintiffs asked the Hospital to produce the complete, unredacted file. In the event of incomplete production, Plaintiffs asked the Hospital to include with its response a privilege log identifying any documents withheld, the reasons they were withheld, and the reasons for any redactions appearing in the documents supplied. The Hospital responded by providing additional portions of the file, together with a privilege log.

According to the privilege log, the Hospital believed that five documents in Dr. Petraglia's file were non-discoverable: an OPPE (Ongoing Professional Practice Evaluation) Summary Report; a Professional Peer Review Reference and Competency Evaluation, which contained evaluations prepared by other physicians of Dr. Petraglia's performance; and three documents described as "National Data Bank Practitioner Query Response," based on queries submitted to the National Practitioner Data Bank (the "NPDB") in July 2014, December 2014, and January 2017. See Contents of Non-Discoverable Portions of Credentials File of Carmen Petraglia, M.D., reprinted in RR. 337a; see also Response in Opposition to Plaintiff's [sic] Motion to Compel Discovery, at ¶9, reprinted in RR. 360a. In addition to withholding these documents, the Hospital redacted from three documents that it provided to Plaintiffs information which the Hospital characterizes as professional opinions relating to Dr. Petraglia's competence. See Brief for Appellant at 14.

Unsatisfied with the Hospital's response, Plaintiffs filed a motion to compel, seeking the entire, unredacted file. In its responsive pleading, the Hospital alleged it had withheld or redacted materials that were privileged or did not pertain to the time period encompassed by the request. The Hospital claimed such materials were protected from disclosure under the PRPA or, in the case of the NPDB query responses, by the federal Health Care Quality Improvement Act of 1986 (the "HCQIA").^[3]

After oral argument on the motion, the county court granted it, expressly relying on Reginelli, and directing the Hospital to produce Dr. Petraglia's credentialing file in full and without redactions. In its Rule 1925(a) opinion, see Pa.R.A.P. 1925(a), the court stated that, per its reading of Reginelli, files relating to a doctor's membership or continued membership on a hospital's medical staff constitute credential-review files (as opposed to peer-review files) and, as such, are not protected by the PRPA. It also concluded that, because the information requested from the NPDB was part of that same file, it too was unprotected. See Leadbitter v. Keystone Anesthesia Consultants, Ltd., No. GD 16-10700, slip op. at 2-3 (C.P. Allegheny Nov. 26, 2018).

The Hospital filed an interlocutory appeal, arguing that the trial court erred in finding that PRPA does not protect from disclosure the professional opinions and performance evaluations that the credentials committee reviewed, reasoning that the materials constitute peer-review documents subject to PRPA's protection. The Hospital also asserted that the court mistakenly compelled it to produce the NPDB query responses notwithstanding HCQIA's protections.

The Superior Court affirmed in a published decision. See Leadbitter v. Keystone Anesthesia Consultants, Ltd., 229 A.3d 292 (Pa. Super. 2020). The court indicated that the documents at issue constituted professional evaluations that the committee considered before granting Dr. Petraglia surgery privileges - and, as such, that they fit the PRPA's definition of peer-review documents. See id. at 296 (citing 63 P.S. §425.2). However, the court understood Reginelli as holding that only documents of a "review committee" enjoyed the statutory protection, and not documents kept by a "review organization," regardless of the nature of such documents. Thus, the court found that, as the credentials committee was a review organization, the PRPA did not shield any portion of its file on Dr. Petraglia from discovery. See id. It added that this Court may wish to grant review to address the propriety of its analysis on this point because, in the Superior Court's view, Reginelli "assumed that documents in a credentialing file are not peer review documents." Id. at 297 n.7.

As for the NPDB information, the court largely tracked the reasoning of the common pleas court, stating that because no aspect of the committee's file was protected under the PRPA, the NPDB documents were similarly unprotected under the HCQIA. In reaching this holding, the Superior Court relied on a provision of the HCQIA which indicates that nothing in its conferral of confidentiality is meant to prevent disclosure, by a party which is otherwise authorized under state law to make such disclosure, of information reported pursuant to the HCQIA. See id. at 297-98 (quoting 42 U.S.C. §11137(b)(1); 45 C.F.R. §60.20(a)).

This Court allowed further review to consider the following issues as framed by the Hospital:

(1) Whether the Superior Court's holding directly conflicts with the Pennsylvania Peer Review Protection Act 69 P.S. §§ 425.1, et seq., and misapplies Reginelli v. Boggs, 645 Pa. 470, 181 A.3d 293 (2018), by ordering the production of acknowledged "peer review documents" solely because they were maintained in a physician's credentialing file

(2) Whether the Superior Court's holding directly conflicts with the Federal Healthcare Quality Improvement Act, 42 U.S.C. § 11137(B)(1), and federal regulations which protect from disclosure, responses to statutorily-required inquiries of the national practitioner data bank, by ordering the production of such documents solely because they were maintained in physician's credentialing file

Leadbitter v. Keystone Anesthesia Consultants, Ltd., ___ Pa. ___, ___, 239 A.3d 11, 12 (2020) (per curiam).

II. The PRPA

Before discussing the reasons the Hospital believes the Superior Court erred, it is helpful to review certain aspects of the PRPA and the Reginelli decision.

The purpose underlying the PRPA has been articulated in prior decisions. Briefly, the enactment stems from the dual observations that: the practice of medicine is highly complex and, as such, the medical profession is in the best position to police itself, see Reginelli, 645 Pa. at 481, 181 A.3d at 300; and, the profession's self-regulation is accomplished, at least in part, through a peer-review mechanism undertaken to determine whether a particular physician should be given clinical privileges to perform a certain type of medical activity at a hospital, see Cooper v. Del. Valley Med. Ctr., 539 Pa. 620, 628, 654 A.2d 547, 551 (1995); see also id. ("The purpose of this privilege system is to improve the quality of health care . . .. Thus, it is beyond question that...