Sanderson v. Frank S. Bryan, M.D., Ltd.

• Decision Date: 23 March 1987
• Citation: 361 Pa.Super. 491,522 A.2d 1138
• Parties: , 55 USLW 2545 Robert L. SANDERSON and Nola Sanderson, his wife v. FRANK S. BRYAN, M.D., LTD. and Carlisle Hospital, Appellants.
• Court: Pennsylvania Superior Court

Page 1138

522 A.2d 1138

361 Pa.Super. 491, 55 USLW 2545

Robert L. SANDERSON and Nola Sanderson, his wife v. FRANK S. BRYAN, M.D., LTD. and Carlisle Hospital, Appellants.

Superior Court of Pennsylvania.

Argued Oct. 2, 1986.

Filed March 23, 1987.

[361 Pa.Super. 492] Daniel K. Deardorff, Carlisle, for appellants.

Daniel P. Altland, Harrisburg, for appellee.

Before WICKERSHAM ^*, ROWLEY and TAMILIA, JJ.

OPINION OF THE COURT

ROWLEY, Judge:

These are consolidated appeals, specially allowed, ¹ from a certified, interlocutory discovery order in a medical malpractice action. The issue presented has not been addressed by the appellate courts of this Commonwealth. That issue is whether the Peer Review Protection Act, Act of July 20, 1974, P.L. 564, No. 193, as amended 1978, October 5, P.L. 1121, No. 262, Pa. Stat. Ann. tit. 63 § 425.1 et seq. (Purdon Supp.1986) ("the Act"), is violated by an order which gives a plaintiff access through the discovery process to peer review information that is not directly related to his or her case.

Plaintiffs Robert and Nola Sanderson instituted this action against Frank S. Bryan, M.D., LTD. and Carlisle Hospital alleging that Mr. Sanderson was admitted to Carlisle Hospital where he was treated by Dr Bryan for radicular back pain. The Sandersons aver that Dr. Bryan was negligent in performing surgical procedures which resulted in exacerbating Mr. Sanderson's physical problems. They further contend that Carlisle Hospital was negligent in allowing Dr. Bryan to perform surgical procedures beyond the scope of his privileges and in failing to supervise and monitor those surgical procedures.

During discovery, plaintiffs filed a Request for Production of Documents directed to Carlisle Hospital requesting all documents and recordings, other than those relating to their cause of action, maintained by any review organization within the hospital involving the evaluation and review of Dr. Bryan. Carlisle Hospital filed objections to this request, believing such information to be privileged from discovery under the Act. Dr. Bryan filed a petition for a protective order. The trial court denied in part the objections and petition and ordered Carlisle Hospital to produce certain requested documents, i.e., complaints, findings and recommendations. It further ordered that the names and addresses of the patients in any disclosed materials be deleted. Both Carlisle Hospital and Dr. Bryan have appealed from this order contending that the purpose of the Act is to promote peer review activity by protecting the confidential nature of such proceedings, and that this purpose is emasculated by the trial court's decision. Briefs in support of defendants' position have been filed by amici curiae Pennsylvania Medical Society Liability Insurance Company, Pennsylvania Medical Society, and Hospital Association of Pennsylvania.

These appeals involve the interpretation of the Act, particularly section four, entitled "Confidentiality of review organization's records," which provides in part as follows:

The proceedings and records of a review committee shall be held in confidence and shall not be subject to discovery or introduction into evidence in any civil action against a professional health care provider arising out of the matters which are the subject of evaluation and review by such committee and no person who was in attendance at a meeting of such committee shall be permitted or required to testify in any such civil action as to any evidence or other matters produced or presented during the proceedings of such committee or as to any findings, recommendations, evaluations, opinions or other actions of such committee or any members thereof....

§ 425.4.

The trial court found that the words "... civil action against a professional health care provider arising out of the matters which are the subject of evaluation and review by such committee ..." limit the scope of the privilege, ² and held that peer review material concerning the treatment of persons other than the plaintiff are discoverable. We disagree with this interpretation of the Act.

The medical profession exercises self-regulation. The most common form of such regulation in the health care industry is the peer review organization. Hospital peer review organizations are usually composed of physicians who review and evaluate other physicians' credentials and medical practices. Generally, hospital peer review findings and records are protected from public scrutiny either legislatively, or by court decision. The purpose for such protection is to encourage increased peer review activity which will result, it is hoped, in improved health care. See Cuneo Disclosure v. Confidentiality of Hospital Peer Review Committee Reports, Med. Trial Tech. Q., 172 (1985); Comment, Medical Peer Review Protection in the Health Care Industry, 52 Temp. L.Q. 552 (1979). That there are strong policies favoring peer review protection is evidenced by the fact that forty-six states have enacted some type of statutory limitation on the disclosure and use of peer review materials. ³ Though the protection provided differs in degree among the states, typically the privilege extends to peer review committee reports, records, proceedings and testimony. See Note, The Missouri Rule: Hospital Peer Review is Discoverable in Medical Malpractice Cases, 50 Mo. L.R. 459, 475-76 (1985).

The Pennsylvania legislature first created protection for peer review organizations in 1974. Unfortunately, minimal legislative history regarding the Act was recorded and, since then, legislative and judicial activity concerning the Act has been limited to the 1978 amendment to include professional health care providers within the Act's protection, and a few conflicting trial court decisions interpreting the Act. ⁴ Our efforts to interpret the Act, however, are not entirely thwarted by a lack of history or authority. A major concern of the legislature when it created the Act was confidentiality. "The purpose of the bill is to provide protection to those persons who give testimony to peer review organizations." Hearing on H.B. No. 1729, 158 Pa. Legis. J.--House at 4438 (1974) (statement of Representative Wells). The words prefacing the Act also provide evidence of legislative intent: "Providing for the increased use of peer review groups by giving protection to individuals and data who report to any review group." H.B. 1729, Act of July 20, 1974, P.L. 564, No. 193. More recently, this Court held that "[t]hrough these immunity and confidentiality provisions [§§ 425.3, 425.4] ... the Legislature has sought to foster free and frank discussion by review organizations." Steel v. Weisberg, 347 Pa.Super. 106, 110, 500 A.2d 428, 430 (1985).

We are bound to ascertain the intent of the legislature in enacting the Peer Review Protection Act as we find the confidentiality section at issue in this appeal to be unclear. Habecker v. Nationwide Ins. Co., 299 Pa.Super. 463, 445 A.2d 1222 (1982). The rules of statutory construction provide that "[t]he object of all interpretation and construction of statutes is to ascertain and effectuate the intention of the General Assembly." 1 Pa.C.S.A. § 1921(a) (Purdon Supp.1985). Each provision of the statute must be given full effect, if possible. Id. When the words of the statute are not explicit, however, the intent of the General Assembly may be ascertained. Id. § 1921(c).

In its brief, appellant Carlisle Hospital argues that the portion of the Act at issue can only be read to "disallow discovery of any materials relating to the committee's purposes." (Brief at 9) (emphasis in the original). The committee's purposes are enunciated in the definition of "Review Organization," i.e., to (1) evaluate and improve the quality of health care; (2) reduce morbidity or morality; (3) establish and enforce guidelines designed to keep the cost of health care within reasonable bounds. § 425.2. Appellant Dr. Bryan urges this Court to adopt the reasoning of other jurisdictions with peer review statutes substantially similar to Pennsylvania's which interpret the statute to provide protection for peer review materials concerning plaintiff as well as other patients. ⁵ Both appellants place great weight on the words "[t]he proceedings and records of a review committee shall be held in confidence and shall not be subject to discovery...." § 425.4. The Sandersons and the trial court contend that this privilege is limited by the words "... in any civil action ... arising out of the matters which are the subject of evaluation and review by such committee...." Id. The trial court specifically found that the protection is limited to matters reasonably associated with plaintiff's cause of action. Therefore, all other proceedings, records, etc. of the peer review organization concerning patients other than plaintiff are not protected and thus, are discoverable.

We find that, as applied, this interpretation leads to an unreasonable and impractical result. Ultimately, depending upon the identity of the plaintiff, all records of all peer review proceedings would be discoverable. What would not be discoverable by one plaintiff, i.e., peer review materials reasonably associated with his or her cause of action, would be discoverable by another plaintiff. Hence, the confidential nature of the peer review proceedings would be obliterated. This result flies in the face of legislative intent and renders the Act senseless.

Moreover, the trial court has misapplied its own interpretation. According to the trial court, peer review matters reasonably associated with plaintiff's cause of action are privileged. In the case sub judice, plaintiffs maintain a cause of action against Carlisle Hospital alleging that the hospital was negligent in allowing Dr. Bryan to perform surgical procedures when it knew or had reason to know of Dr. Bryan's failure to exercise proper care and judgement. Under the trial court's...