Case Title: Harston v. Campbell County Memorial Hosp.

Citation: 

Docket Number: 95-90

State: wyoming

Court: Wyoming Supreme Court

Date: 1996-04-02T00:00:00Z

Document:
Harston v. Campbell County Memorial Hosp.1996 WY 50913 P.2d 870Case Number: 95-90Decided: 04/02/1996Supreme Court of Wyoming

CARMA CHRISTENSEN HARSTON; DANE HARSTON, by CARMA 
CHRISTENSEN HARSTON, her Mother and Next Friend; and PAUL C. HARSTON, by CARMA 
CHRISTENSEN HARSTON, his Mother and Next Friend,  

Appellants (Plaintiffs), 

 

v. 

 

CAMPBELL COUNTY MEMORIAL HOSPITAL,  

Appellee (Defendant).

 

Appeal 
from the District Court of Campbell County 

The 
Honorable Terrence L. O'Brien, Judge.

 

Representing 
Appellants: 

Walter Urbigkit of Frontier Law Center, 
Cheyenne.

 

Representing 
Appellee: 

John A. Sundahl and John Coppede of Sundahl, Powers, 
Kapp & Martin, Cheyenne. 

J. Kent Rutledge of Lathrop & Rutledge, P.C., 
Cheyenne, for Amicus Curiae The Wyoming Hospital Association. 

Richard Rideout of Herschler, Freudenthal, Salzburg, 
Bonds & Rideout, P.C., Cheyenne, for Amicus Curiae Wyoming Medical 
Society.

 

THOMAS, 
Justice. 

[¶1]      The essential 
issue in this case addresses the scope of discovery of hospital information, 
documents, or other records in an action against a hospital for independent 
negligence in credentialing and reviewing the staff privileges of a physician, 
as well as the responsibility of the hospital for patient injuries. The district 
court limited Carma Christensen Harston's (Harston) efforts to obtain discovery 
with respect to incident reports relating to her care and materials relating to 
the appointment, reappointment, credentialing, and privileges of her treating 
physician. The district court then granted a summary judgment in favor of 
Campbell County Memorial Hospital (CCMH) after ruling that Harston, in both her 
individual and representative capacities, had failed to meet her burden to 
demonstrate any genuine issue of material fact in response to a motion for 
summary judgment. In resolving these issues, we revisit Greenwood v. Wierdsma, 741 P.2d 1079 
(Wyo. 1987), and hold that the trial court erred in limiting discovery. We 
cannot know how the information sought by the discovery would have benefited 
Harston in countering the motion for summary judgment but, since Harston never 
had the opportunity to utilize information that should have been made available, 
the Order Granting Summary Judgment for Campbell County Memorial Hospital must 
be reversed. The case is remanded for further proceedings in accordance with 
this opinion.

 

[¶2]      In the Brief of 
Appellants, filed on behalf of Harston in both her individual and representative 
capacities, the issues are articulated in this way:

 

A. The Court erroneously denied Plaintiffs' discovery 
efforts by sustaining objections and granting protective orders limiting or 
foreclosing access by interrogatories, document production and deposition 
interrogation directed to obtain information, documents and testimony of 
witnesses from Campbell County Memorial Hospital and its employees and 
representatives.

B. Waiver of privilege or confidentiality should have 
been applied if, following Campbell County Memorial Hospital's objection to 
document production and interrogatories for witness testimony for which 
confidentiality could have properly existed, the document or information which 
was subjected to the objection was then used by CCMH as the underlying factual 
basis for tendered expert witness testimony or for stated opinions in affidavits 
filed to support the CCMH Motion for Summary Judgment.

C. Summary Judgment was improperly granted to 
Defendant, Campbell County Memorial Hospital.

1. Whether the district court properly granted 
summary judgment in favor of the Appellee in this alleged medical malpractice 
action where after having discharged its summary judgment burden, the Appellants 
failed to offer competent expert testimony refuting the facts established by the 
experts of the Appellee.

2. Whether the district court abused its discretion 
in denying the Appellants access to documents that were statutorily privileged 
from discovery, related to the credentialling, peer review and quality 
management functions of the hospital. In any event, assuming the district court 
abused its discretion, whether the denial of said discovery constituted harmless 
error where the Appellants failed to designate an expert witness on these 
issues.

3. Whether the district court lacked subject matter 
jurisdiction over this action because of the Appellants' failure to submit a 
sufficient notice of claim in compliance with the Wyoming Governmental Claims 
Act.

4. Whether this Court has appellate jurisdiction over 
this appeal where prior to filing their notice of appeal the Plaintiffs entered 
into a release of all claims that included this Appellee.

 

[¶3]      In its Amicus 
Curiae Brief in Support of Appellee Campbell County Memorial Hospital, the 
Wyoming Medical Society offers this Statement of the 
Issue:

 

The issue presented here, as stated by the Appellee, 
Campbell County Memorial Hospital, is whether the district court properly 
sustained the Hospital's objections to the Plaintiff/Appellant's broad discovery 
requests which sought to obtain credentialing, peer review, and quality 
assurance documents and information regarding one of its staff physician's [sic] 
as well as from the Hospital itself. Amicus accepts this statement of the issue 
presented for review.

 

In a Brief of Amicus Curiae, 
The Wyoming Hospital Association, no separate statement of the issues appears. 
The Wyoming Hospital Association, after articulating its composition and 
interest in high quality medical care, sets forth its concerns about this case. 
It argues that the application of our statutes protecting peer review and 
quality management is important to it and its members, and limiting the 
application of those statutes, as Harston seeks to do, would have an adverse 
impact on its members.

 

[¶4]      Harston brought 
her action against CCMH seeking recovery for injuries attributable to medical 
treatments in the hospital and asserting the failure to develop and provide 
adequate protocols for emergencies during surgery; failure to develop adequately 
and provide requirements for competency of surgeons in surgical treatment in the 
event that emergencies during surgery develop; failure to require appropriate 
pre-surgical testing; failure to manage, maintain, and require adequate 
maintenance of medical records documenting the events occurring during medical 
care at the hospital; and responsibility for the negligence of its employees, 
agents, representatives, and persons provided staff privileges. CCMH sought 
dismissal of Harston's claims against it because of insufficient notice under 
the Wyoming Governmental Claims Act, WYO. STAT. §§ 1-39-101 to -120 (1988) (as 
amended June 1995 Supp.), but the district court denied that motion. No appeal 
was taken by CCMH from that ruling. There followed extensive discovery on the 
part of all parties. A number of the claims against various parties were 
disposed of by summary judgment or settled by February 28, 1995. These events 
left the focus of the lawsuit on the claims by Harston against 
CCMH.

 

[¶5]      The discovery 
dispute between these parties commenced with Plaintiffs' Request for Production. 
In particular, Request No. 19 asked for:

 

Minutes and records except for information regarding 
any deliberation relating to consideration, decision and actions of the Campbell 
County Memorial Hospital Credentials Committee in considering the original 
accreditation of [treating physician] and any periodic extensions of hospital 
privileges since the original accreditation and granting of hospital privileges 
in Campbell County Memorial Hospital as a hospital license under the laws of the 
State of Wyoming not specifically designated to be privileged by 
statute.

 

CCMH objected to producing 
any studies, reports, statements, notes, diaries, memoranda, data, or other 
information regarding: any pertinent event or happening concerning Harston's 
care as related by an employee or agent of the hospital; the character and 
maintenance of medical care at the hospital; the care provided to other patients 
by Harston's treating physician; and the personnel, vitae and accreditation 
information furnished by the treating physician to the hospital to secure 
hospital staff privileges. The premise for the objection to the request for 
production was "such information is confidential and prohibited from disclosure 
by Wyoming Hospital Records and Information Act, W.S. § 35-2-606, 609, and W.S. 
§ 35-17-105; § 35-2-910, 35-2-103; W.S. § 16-4-203(a); and 42 U.S.C. § 
11101-11152."

 

[¶6]      While it may be 
an oversimplification, the position of the hospital was that the CCMH 
credentials committee came within the definition found in WYO. STAT. § 35-17-101 
(1994) as a committee of a medical staff with the responsibility of evaluation 
and improvement of the quality of care rendered in a hospital. CCMH contended 
this information was confidential and privileged pursuant to the provisions of 
WYO. STAT. § 35-17-105 (1994):

 

All reports, findings, proceedings and data of the 
professional standard review organizations is confidential and privileged, and 
is not subject to discovery or introduction into evidence in any civil action, 
and no person who is in attendance at a meeting of the organization shall be 
permitted or required to testify in any civil action as to any evidence or other 
matters produced or presented during the proceedings of the organization or as 
to any findings, recommendations, evaluations, opinions or other actions of the 
organization or any members thereof. However, information, documents or other 
records otherwise available from original sources are not to be construed as 
immune from discovery or use in any civil action merely because they were 
presented during proceedings of the organization, nor should any person who 
testifies before the organization or who is a member of the organization be 
prevented from testifying as to matters within his knowledge, but that witness 
cannot be asked about his testimony before the organization or opinions formed 
by him as a result of proceedings of the organization.

 

Acknowledging the exception 
of information, documents, or other records otherwise available from original 
sources, CCMH invoked a tandem position asserting that all such information 
constituted "health care information" within the definition found in WYO. STAT. 
§ 35-2-605(a)(vii) (1994) and was protected by the provisions of WYO. STAT. §§ 
35-2-606 and -609 (1994).

 

[¶7]      Harston filed 
motions to compel discovery resulting in additional objection by the hospital. 
In an Order on Plaintiffs' Motion to Compel Discovery, dated August 3, 1994, the 
court ruled:

 

IT IS HEREBY ORDERED that Campbell County Memorial 
Hospital shall provide to Plaintiff the dates of any incident reports prepared 
in connection with the care rendered to Plaintiff, Harston, as well as the 
purposes for which such reports are prepared. Campbell County Memorial Hospital 
shall not disclose the author of the incident report nor the subject matter of 
the incident report. Plaintiffs' request for the production of the incident 
reports is denied.

 

IT IS FURTHER ORDERED that all records, materials, 
and personnel files relating to the appointment, reappointment, credentialing 
and privileges of [the treating physician] in the possession of the Hospital 
credentialing committee, peer review or quality assurance personnel are exempt 
from discovery, and Plaintiffs' request for such materials is 
denied.

 

CCMH then delineated the 
dates of four "confidential" reports, asserting "their sole function is peer 
review and quality assurance." Harston also was supplied with title pages and 
tables of contents for two "Consultation Reports" undertaken by the University 
of New Hampshire Assistant Professor of Health Management and Policy. The stated 
purpose of these consultations and follow-up reports was "a review of medical 
staff and hospital quality assurance activities."

 

[¶8]      CCMH consistently 
denied discovery of the contents of the reports as being privileged and 
confidential materials. Harston continued with discovery efforts in the face of 
the court's order, and subpoenas were issued to various hospital employees and 
medical experts requesting, among other things, that all records concerning the 
credentialing process of Harston's treating physician, as well as all peer 
review and quality assurance materials regarding that physician's treatment of 
Harston, be produced. These materials were sought because of a statement in an 
affidavit filed with the court by the Chairman of the Credentials Committee in 
which it was averred:

 

The guidelines of the Joint Commission were adhered 
to in connection with the appointment, reappointment, credentialing and 
privileging of [treating physician]. The credentialing manual, bylaws and rules 
and regulations of Campbell County Memorial Hospital's Medical Staff were all 
followed in connection with the credentialing and re-credentialing of [treating 
physician]. [Treating physician] has never sat in judgment on his own 
credentialing, privileging or peer review. The affected physician excuses 
himself or herself from the review of his or her 
credentials.

 

Harston wished to test this 
factual conclusion and sought all materials demonstrating consideration, review, 
and appointment or reappointment of the treating 
physician.

 

[¶9]      A hearing was 
held on November 3, 1994, relating to Harston's efforts to obtain these 
materials. After listening patiently to counsel, the trial judge had this to 
say:

 

Well, they're tough - those are clearly tough policy 
decisions, and the legislature has spoken to them, it seems to 
me.

Now, if you have some independent evidence that says 
the Kane [a prior medical malpractice case against a treating physician] case 
was here, there was a screw up, the screw up was known to people at the hospital 
before the Harston operation and it should have gone to the credentialing 
committee and it didn't go to the credentialing committee, then that's one 
thing. And it may be that it's an unfair burden to lay that upon you to have to 
do it, but it seems to me that's what the statute 
requires.

* 
* * * * *

And I may be wrong on this, and the Supreme Court has 
never hesitated to tell me in the past that I'm wrong. I'm not sure I even agree 
with the policy, but I think in reading the statute that that's what the 
legislature intended and requires me to do. And - and you're not going to get 
that stuff.

 

[¶10]   In an Order Ruling on Defendant 
Hospital's Motion for Protective Order, to Quash Subpoenas Duces Tecum, to 
Prohibit Depositions, for Sanctions and Objection to Subpoenas Duces Tecum 
Issued for Expert Witnesses of Defendant Noticed for their Deposition, entered 
on December 7, 1994, the court said:

 

The Court reaffirms its prior ruling of August 3, 
1994, and holds that documents shall not be produced, by subpoena or otherwise, 
which pertain to the credentialing, appointment, reappointment or privileging 
files of [the treating physician], or the quality management and peer review 
activities of CCMH.

* * * * * *

Plaintiffs may not directly or indirectly obtain 
records of Campbell County Memorial Hospital or individuals associated with CCMH 
in privileging and credentialing processes relating to such privileging and 
credentialing activities and decisions.

 

[¶11]   Thereafter, the court entered an 
Order Granting Summary Judgment for Campbell County Memorial Hospital. In 
pertinent part, that order stated:

 

IT IS HEREBY ORDERED that summary judgment is granted 
in favor of Campbell County Memorial Hospital on all issues herein. The court 
finds that there is no evidence of any violation of the standard of care. 
Plaintiffs have not demonstrated any causally connected injury or damages as a 
result of any acts or omissions of the nurses or employees of Campbell County 
Memorial Hospital. Plaintiffs have failed to meet their burden of proof, and the 
Court finds that there is no genuine issue of any material fact, and therefore 
summary judgment shall be granted.

 

[¶12]   In seeking reversal of the summary 
judgment, Harston urges that, after the filing of affidavits on the part of CCMH 
to the effect that the credentialing and review processes were followed, and 
there was no information to justify action, Harston was unable to produce 
affidavits or testimony from expert witnesses to the contrary because those 
witnesses had no way of knowing what occurred within the credentials committee 
of CCMH, nor even what information the credentials committee had before it. 
Harston has appealed from the summary judgment alleging error in ruling on her 
discovery efforts.

 

[¶13]   We review the discovery rulings of 
the trial court under an abuse of discretion standard. Global Shipping and Trading, Ltd. v. 
Verkhnesaldincky Metallurgic Co., 892 P.2d 143 (Wyo. 1995); Farrell v. Hursh Agency, Inc., 713 P.2d 1174 (Wyo. 1986); Mauch v. Stanley 
Structures, Inc., 641 P.2d 1247 (Wyo. 1982). See Thomas v. Harrison, 634 P.2d 328 
(Wyo. 1981); Harris v. Grizzle, 625 P.2d 747 (Wyo. 1981). This court has utilized definitions of abuse of discretion 
in a number of contexts, but we consistently have ruled it can be said to mean 
an error of law committed by the court under the circumstances. E.g., Pinther v. Pinther, 888 P.2d 1250 
(Wyo. 1995); Roberts v. Roberts, 816 P.2d 1293 (Wyo. 1991); Martinez v. 
State, 611 P.2d 831 (Wyo. 1980). We also have said that judicial discretion 
"is a composite of many things, among which are conclusions drawn from objective 
criteria; it means a sound judgment exercised with regard to what is right under 
the circumstances and without doing so arbitrarily or capriciously." Martin v. State, 720 P.2d 894, 897 (Wyo. 
1986). Further, we have said "the ultimate issue is whether or not the court 
could reasonably conclude as it did." Martinez, 611 P.2d  at 
838.

 

[¶14]   We commence our analysis of the 
discovery ruling of the district court with a reprise of Wierdsma, 741 P.2d 1079. That case 
clearly stands for the proposition that this jurisdiction has recognized a claim 
of negligence against a hospital such as CCMH for failure to properly exercise 
its authority in admitting practitioners to staff privileges and failure to 
monitor the conduct of those who are granted staff privileges in a process such 
as that in vogue at CCMH. The hospital contends that Wierdsma, in which we recognized such a 
cause of action, has been overruled by statutory amendment since it was decided. 
Harston relies upon the construction of the statute we articulated in this 
way:

 

The district court relied on Secs. 35-2-602 and 
35-2-604, quoted above, to deny the plaintiff discovery access to all the 
hospital's personnel records pertaining to Dr. Wierdsma. A careful reading of 
those statutes indicates that documents which detail the committee's 
decision-making process, opinion, perspective, or final decisional results are 
not discoverable. The privilege protects from discovery the records concerning 
the internal proceedings of the hospital committee but does not exempt from discovery 
materials which the committee reviews in the course of carrying out its 
function, nor action which may be taken thereafter by the hospital as may be 
influenced by the committee decision. In short, privileged data does not 
include the materials reviewed by the committee, only those documents produced 
by the committee as notes, reports and findings in the review 
process.

 

Wierdsma, 
741 P.2d  at 1089 (emphasis added).

 

[¶15]   It is true that, in 1991, the 
legislature amended the statutes by repealing §§ 35-2-601 to -604, and those 
provisions were replaced with §§ 35-2-605 to -617. The contention that Wierdsma was overruled, however, does 
not seem to be supported because the same language quoted in Wierdsma is found in the provisions of 
WYO. STAT. § 35-2-609(d), with the only difference being that the word "such" 
has been omitted. In the definition section of the statute, the words "data" and 
"hospital medical staff committee" are identical to the definitions in the prior 
statute. Because the statute is quite similar to the prior statute, we hold that 
there was no legislative intent to overrule Wierdsma.

 

[¶16]   Furthermore, we find that the 
essence of the Wierdsma ruling was 
incorporated in the language of the statute relating to professional standard 
review organizations. WYO. STAT. § 35-17-105 (1994) (emphasis added) 
provides:

 

All reports, findings, proceedings and data of the 
professional standard review organizations is confidential and privileged, and 
is not subject to discovery or introduction into evidence in any civil action, 
and no person who is in attendance at a meeting of the organization shall be 
permitted or required to testify in any civil action as to any evidence or other 
matters produced or presented during the proceedings of the organization or as 
to any findings, recommendations, evaluations, opinions or other actions of the 
organization or any members thereof. However, information, documents or other 
records otherwise available from original sources are not to be construed as 
immune from discovery or use in any civil action merely because they were 
presented during proceedings of the organization, nor should any person who 
testifies before the organization or who is a member of the organization be 
prevented from testifying as to matters within his knowledge, but that witness 
cannot be asked about his testimony before the organization or opinions formed 
by him as a result of proceedings of the organization.

 

We hold Wierdsma retains its vitality, and the 
statutes relating to the professional standard review organizations and those 
relating to hospital records and information do not afford the absolute 
protection from discovery claimed by CCMH.

 

[¶17]   In what amounts to a tacit 
recognition of that proposition, CCMH then relies upon the confidentiality of 
patient records as described in WYO. STAT. § 35-2-606 (1994) which forecloses 
disclosure of any hospital care information about a patient without written 
authorization. While WYO. STAT. § 35-2-609 provides a laundry list of 
circumstances in which that disclosure may be made, an effort by a party such as 
Harston to obtain the information is not included there. The statute does 
provide:

 

(a) A hospital may disclose health care information 
about a patient without the patient's authorization to the extent a recipient 
needs to know the information, if the disclosure is:

* * * * * *

(ii) To any other person who requires health care 
information for health care education or to provide planning, quality assurance, 
peer review or administrative, legal, financial or actuarial services to the 
hospital or to assist the hospital in the delivery of health care and the 
hospital reasonably believes that the person: * * *.

 

WYO. STAT. § 35-2-609 
(1994).

 

[¶18]   The resolution of the discovery 
issue in this case is found in the language of WYO. STAT. § 35-2-610(a)(ix) 
(1994):

 

(a) Health care information shall not be disclosed by 
a hospital pursuant to compulsory legal process or discovery in any judicial, 
legislative or administrative proceeding unless:

* * * * * *

(ix) A court has determined that particular health 
care information is subject to compulsory legal process or discovery because the 
party seeking the information has demonstrated that the interest in access 
outweighs the patient's privacy interest.

 

The trial court recognized 
the difficult dilemma its ruling created for Harston but, in effect, the court 
simply said it had no choice. We hold that the trial court does have a choice, 
which imposes upon it the obligation to weigh the interest of the party seeking 
the information against the patient's privacy interest.

 

[¶19]   Other cases from this court have 
defined the appropriate technique for accomplishing that duty. The materials 
which are sought should be submitted to the trial court so it can determine 
whether the interest in access of a party such as Harston to the materials 
reviewed by a hospital committee outweighs the privacy interest of the patient 
to whom those records may relate. The propriety of an in camera inspection is 
supported by this court's decisions in First Wyoming Bank v. Continental Ins. 
Co., 860 P.2d 1064 (Wyo. 1993), and Continental Ins. Co. v. First Wyoming 
Bank, 771 P.2d 374 (Wyo. 1989). We recognized the balancing function in Sheridan Newspapers, Inc. v. City of 
Sheridan, 660 P.2d 785 (Wyo. 1983). Appropriate models for accomplishing the 
in camera inspection can be found in 
Gale v. State, 792 P.2d 570 (Wyo. 
1990) (relying upon provisions of WYO. STAT. § 14-3-214 (July 1986 Repl.)), and 
Devous v. Wyoming State Bd. of Medical 
Examiners, 845 P.2d 408 (Wyo. 1993), in which we recognized that a similar 
process is provided in WYO. STAT. § 33-26-408(e) (1987).

 

[¶20]   We also recall the decision of this 
court in Houghton v. Franscell, 870 P.2d 1050 (Wyo. 1994). In our view, the thrust of Houghton could logically lead 
the district court to conclude that materials relied upon by the committee in 
connection with the original extension of staff privileges to the treating 
physician should, at least, be subjected to the same in camera inspection to 
determine whether the interest of Harston in having that information in 
connection with her litigation outweighs any privacy interest asserted with 
respect to those documents.

 

[¶21]   With respect to the claimed error 
relating to discovery, we hold the trial court did commit an abuse of discretion 
by not accomplishing the weighing function identified in WYO. STAT. § 
35-2-610(b). The question of whether, after that process is pursued, Harston 
will be given the benefit of any additional information that will permit her to 
adequately oppose the claim by CCMH of no genuine issue of material fact is 
problematical. Nevertheless, orderly procedure requires Harston first be given 
the benefit of the in camera inspection and the weighing 
process, and the summary judgment granted in favor of CCMH must be reversed so 
the discovery determination can be made in the trial court in an appropriate 
fashion.

 

[¶22]   We recall the allusion to Article 
1, Section 8 of the Wyoming Constitution in Wierdsma, 741 P.2d  at 1087. While it 
is not necessary to our determination of the issues in this case, the escape 
valve provided in WYO. STAT. § 35-2-610(a)(ix) is appropriate in light of the 
language of that provision of the constitution which provides, in pertinent 
part:

 

All courts shall be open and every person for an 
injury done to person, reputation or property shall have justice administered 
without sale, denial or delay.

 

Earlier, in a concurring 
opinion, the word "delay" in this constitutional provision was emphasized. Hoem v. State, 756 P.2d 780 (Wyo. 1988) 
(Thomas, J., concurring). In this instance, the constitutional issue, were it 
posed, might well reach the question of "denial" of justice to Harston or 
perhaps even whether justice was administered.

 

[¶23]   We address only briefly two other 
matters raised by CCMH. It suggests lack of jurisdiction in this court and the 
trial court because of the failure to file an appropriate claim under the 
Wyoming Governmental Claims Act. That issue was raised in the trial court, and a 
ruling adverse to CCMH was made. In the absence of an appeal by CCMH from that 
ruling, it remains the law of the case and is not open for consideration by this 
court. In a similar vein, CCMH suggests that, by settling with other parties, 
Harston released CCMH with respect to the claim for negligent credentialing. We 
cannot discern from the record that this issue was raised in the trial court 
and, consequently, we will not consider it on appeal.

 

[¶24]   The Order Granting Summary Judgment 
for Campbell County Memorial Hospital entered in the trial court is reversed, 
and the case is remanded to the trial court for further proceedings in 
accordance with this opinion.