Title: Ex parte Fairfield Nursing and Rehabilitation Center, L.L.C. PETITION FOR WRIT OF MANDAMUS: CIVIL (In re: Leisa Roby, individually and as the personal representative of the estate of Brenda Joyce Roby, deceased v. Fairfield Nursing and Rehabilitation Center, L.L.C., et al.)

State: alabama

Issuer: Alabama Supreme Court

Document:

REL: 03/27/2009
Notice: This opinion is subject to formal revision before publication in the advance
sheets of Southern Reporter.  Readers are requested to notify the Reporter of Decisions,
Alabama Appellate Courts, 300 Dexter Avenue, Montgomery, Alabama 36104-3741 ((334) 229-
0649), of any typographical or other errors, in order that corrections may be made before
the opinion is printed in Southern Reporter.
SUPREME COURT OF ALABAMA
OCTOBER TERM, 2008-2009
____________________
1080158
____________________
Ex parte Fairfield Nursing and Rehabilitation Center, L.L.C.
PETITION FOR WRIT OF MANDAMUS
(In re: Leisa Roby, individually and as the personal
representative of the estate of Brenda Joyce Roby, deceased
v.
Fairfield Nursing and Rehabilitation Center, L.L.C., et al.)
____________________
1080160
____________________
2
Ex parte Fairfield Nursing and Rehabilitation Center, L.L.C.
PETITION FOR WRIT OF MANDAMUS
(In re: Myrtis Hill and Fred Hill
v.
Fairfield Nursing and Rehabilitation Center, L.L.C., et al.)
(Jefferson Circuit Court, Bessemer Division, CV-06-1363 and
CV-06-1266)
SMITH, Justice.
These two petitions for the writ of mandamus, which have
been consolidated for purposes of issuing one opinion, involve
separate actions against Fairfield Nursing and Rehabilitation
Center, L.L.C. ("Fairfield"), in the Jefferson Circuit Court.
The trial court entered an order in both actions requiring
Fairfield to produce certain documents that Fairfield asserts
are privileged under § 22-21-8, Ala. Code 1975, and therefore
not subject to discovery.  We grant the petitions and issue
the writs.
Facts and Procedural History
Fairfield is a long-term-care facility.  In case no.
1080158, Leisa Roby, individually and as the personal
representative of the estate of Brenda Joyce Roby, deceased,
1080158; 1080160
This Court in Ex parte Orkin, Inc., 960 So. 2d 635, 640
1
(Ala. 2006), "reaffirm[ed] the principle that 'the party
3
alleged medical-malpractice claims against Fairfield relating
to Brenda's death while she was a patient at Fairfield.  In
case no. 1080160, Myrtis Hill and Fred Hill sued Fairfield
asserting medical-malpractice claims based on injuries Myrtis
allegedly suffered as a result of Fairfield's actions.  Leisa
Roby and the Hills are hereinafter collectively referred to as
"the plaintiffs" or "the respondents."
In the underlying cases, the plaintiffs filed requests
for the production of documents.  In the Roby action, Leisa
requested "any and all incident reports and/or complaints
involving Brenda Roby."  The Hills filed a similar request in
their action, seeking "incident reports regarding Myrtis Hill
from June 1992 to Present."  Fairfield filed an objection to
both requests based on several grounds, including the
contention that the requests sought information privileged
under § 22-21-8, Ala. Code 1975.  
The plaintiffs in each case moved the trial court to
compel the production of the requested documents. The trial
court granted the motions to compel.  Fairfield filed a motion
to "reconsider" in each case, citing § 22-21-8.   Accompanying
1
1080158; 1080160
seeking a writ of mandamus in a discovery dispute must
properly move for a protective order under Rule 26(c), Ala. R.
Civ. P.[, before petitioning for the writ].'" (Quoting Ex
parte CIT Commc'n Fin. Corp., 897 So. 2d 296, 298 (Ala.
2004).).  In Ex parte Gentiva Health Services, Inc., [Ms.
1061805, Nov. 14, 2008] ___ So. 3d ___, ___ (Ala. 2008), this
Court held that a motion to "reconsider" that was in substance
a motion for a protective order satisfied the requirement that
a party seeking a writ of mandamus in a discovery dispute
first move for a protective order under Rule 26(c), Ala. R.
Civ. P.  ("Gentiva's motion to 'reconsider' the trial court's
order requiring production of [the] resignation letter
specifically sought to prohibit discovery of [the] resignation
letter, as protected under § 6-5-551, Ala. Code 1975, and the
motion clearly afforded the trial court the opportunity to
address its alleged error before Gentiva sought mandamus
relief from this Court to correct the alleged error.  In
substance, Gentiva's motion to 'reconsider' was actually a
motion for a protective order. ... Therefore, Gentiva filed a
motion for a protective order before it petitioned this Court
for the writ of mandamus; thus, Gentiva is not procedurally
barred from seeking mandamus relief on the basis that it
failed to file a motion for a protective order.").
4
each motion were affidavits asserting that Fairfield does not
keep in the ordinary course of business incident reports and
witness statements concerning residents and that any such
documents do not become part of a resident's medical chart.
Additionally, the affidavits asserted that incident reports
and witness statements are created for quality-assurance
purposes.
Following oral arguments on Fairfield's motions to
reconsider, the trial court, in each case, ordered Fairfield
1080158; 1080160
5
to produce the requested documents.  Fairfield then petitioned
this Court for a writ of mandamus in each case.
Standard of Review
"Mandamus is an extraordinary remedy and will be
granted only when there is '(1) a clear legal right
in the petitioner to the order sought, (2) an
imperative duty upon the respondent to perform,
accompanied by a refusal to do so, (3) the lack of
another adequate remedy, and (4) properly invoked
jurisdiction of the court.'  Ex parte Alfab, Inc.,
586 So. 2d 889, 891 (Ala. 1991).  In Ex parte Ocwen
Federal Bank, FSB, 872 So. 2d 810 (Ala. 2003), this
Court announced that it would no longer review
discovery orders pursuant to extraordinary writs.
However, we did identify four circumstances in which
a discovery order may be reviewed by a petition for
a writ of mandamus.  Such circumstances arise (a)
when a privilege is disregarded, see Ex parte
Miltope Corp., 823 So. 2d 640, 644-45 (Ala. 2001);
.... 
The 
burden 
rests 
on 
the 
petitioner 
to
demonstrate that its petition presents such an
exceptional case--that is, one in which an appeal is
not an adequate remedy.  See Ex parte Consolidated
Publ'g Co., 601 So. 2d 423, 426 (Ala. 1992)." 
Ex parte Dillard Dep't Stores, Inc., 879 So. 2d 1134, 1136-37
(Ala. 2003).
Discussion
The issue presented by these petitions is whether
Fairfield sufficiently demonstrated that it is entitled to the
privilege in § 22-21-8, Ala. Code 1975, with respect to the
requested documents.  Section 22-21-8 provides:
1080158; 1080160
6
"(a) 
Accreditation, 
quality 
assurance 
and
similar materials as used in this section shall
include written reports, records, correspondence,
and 
materials 
concerning the accreditation or
quality assurance or similar function of any
hospital, 
clinic, 
or 
medical 
staff. 
The
confidentiality established by this section shall
apply to materials prepared by an employee, advisor,
or consultant of a hospital, clinic, or medical
staff and to materials prepared by an employee,
advisor or consultant of an accrediting, quality
assurance or similar agency or similar body and to
any individual who is an employee, advisor or
consultant of a hospital, clinic, medical staff or
accrediting, quality assurance or similar agency or
body.
"(b) 
All 
accreditation, 
quality 
assurance
credentialling and similar materials shall be held
in confidence and shall not be subject to discovery
or introduction in evidence in any civil action
against a health care professional or institution
arising out of matters which are the subject of
evaluation and review for accreditation, quality
assurance 
and 
similar functions, purposes, or
activities. No person involved in preparation,
evaluation or review of accreditation, quality
assurance or similar materials shall be permitted or
required to testify in any civil action as to any
evidence or other matters produced or presented
during the course of preparation, evaluation, or
review of such materials or as to any finding,
recommendation, evaluation, opinion, or other action
of such accreditation, quality assurance or similar
function 
or 
other 
person 
involved 
therein.
Information, 
documents, 
or 
records 
otherwise
available from original sources are not to be
construed as being unavailable for discovery or for
use in any civil action merely because they were
presented or used in preparation of accreditation,
quality assurance or similar materials nor should
any person involved in preparation, evaluation, or
1080158; 1080160
7
review 
of 
such 
materials 
be 
prevented 
from
testifying as to matters within his knowledge, but
the witness testifying should not be asked about any
opinions or data given by him in preparation,
evaluation, or review of accreditation, quality
assurance or similar materials."
In support of its assertion of the privilege in both of
the underlying cases, Fairfield offered the affidavits of
Donna Guthrie, the executive director of its facility, and
Janie Dawson, the former director of nursing at the facility.
Both Guthrie's and Dawson's affidavits identically stated as
follows:
"Incident reports and witness statements concerning
residents are not kept in the ordinary course of
business, nor do they become a part of the resident
medical chart. ... Incident reports and witness
statements 
are 
created 
for 
quality 
assurance
purposes.  The creation of the reports and the
gathering of statements are needed to guarantee the
high quality of care for all residents. ...  The
confidentiality of the incident reports and witness
statements is needed to keep investigations of
incidents 
at 
the 
facility 
candid 
and 
open.
Production 
of 
incident 
reports 
and 
witness
statements to those outside the facility would be
detrimental to the quality of care provided for all
residents." 
In Ex parte Coosa Valley Health Care, Inc., 789 So. 2d
208 (Ala. 2000), this Court reaffirmed the principle that the
party asserting the privilege under § 22-21-8 has the burden
of proving the existence of the privilege and the prejudicial
1080158; 1080160
8
effect of disclosing the information.  789 So. 2d at 219-20
(citing Ex parte St. Vincent's Hosp., 652 So. 2d 225, 230
(Ala. 1994)).  Fairfield contends that the affidavits it
submitted 
with 
its 
motions 
to 
reconsider sufficiently
demonstrated that the requested documents were privileged
"quality assurance" materials under § 22-21-8 and that
disclosing the information would be prejudicial to Fairfield.
Fairfield primarily relies on two cases in support of its
position: Ex parte Qureshi, 768 So. 2d 374 (Ala. 2000), and
Kingsley v. Sachitano, 783 So. 2d 824 (Ala. 2000).
In Ex parte Qureshi, the  plaintiff, Larrimore, sought
information and documents from Vaughan Regional Medical
Center, Inc., pertaining to Dr. F.H. Qureshi, one of its staff
physicians.  Specifically,
"Larrimore issued a notice of deposition to Vaughan
Regional.  The notice sought, pursuant to Rule
30(b)(6), Ala. R. Civ. P., to have a representative
of 
Vaughan 
Regional testify regarding several
subjects, including Dr. Qureshi's qualifications,
training, education, and board certification in the
field of orthopedic surgery.  The notice further
sought any investigations or evaluations of Dr.
Qureshi and his qualifications, training, education,
and board certification in the field of orthopedic
surgery conducted or received by Vaughan Regional
before Dr. Qureshi was granted staff privileges.  In
addition, pursuant to Rule 30(b)(5), Ala. R. Civ.
P., the notice asked that Vaughan Regional produce
1080158; 1080160
9
certain documents at this deposition, including the
following:
"'3. All documents which evidence, or
relate or pertain in any way to, the
business 
or 
contractual 
relationship
between Vaughan Regional Medical Center,
Inc., and Dr. F.H. Qureshi, including,
without limitation, the following:
"'....
"'h. 
documents 
evidencing, 
or
pertaining 
in 
any 
way 
to, 
any
investigations 
or 
evaluations 
of 
Dr.
Qureshi and his qualifications, training,
education and board certification in the
field of orthopaedic surgery conducted or
received by [Vaughan Regional] before it
entered into a contractual relationship
with Dr. Qureshi;
"'i. 
documents 
evidencing, 
or
pertaining in any way to, Dr. Qureshi's
qualifications, training, education and
board 
certification 
in 
the 
field 
of
orthopaedic surgery;
"'j. correspondence between [Vaughan
Regional] 
and 
the 
American 
Board 
of
Orthopaedic 
Surgeons, 
and/or 
documents
received by [Vaughan Regional] from the
American Board of Orthopaedic Surgeons,
pertaining in any way to Dr. Qureshi; and
"'k. correspondence between [Vaughan
Regional] and any other institution or
hospital, or documents received by any
other institution or hospital, where Dr.
Qureshi has practiced medicine or received
training, pertaining in any way to Dr.
Qureshi.'"
1080158; 1080160
10
768 So. 2d at 375.
In its response to the motion to compel production of the
requested information, Vaughan Regional included 
"the affidavit of Dr. Lotfi Bashir, who was then
serving 
as 
chairman 
of 
Vaughan 
Regional's
credentialing committee.  In the affidavit, Dr.
Bashir stated that the documents that would be
responsive to Request 3(h)-(k) were maintained as
part of Vaughan Regional's credentialing file on Dr.
Qureshi.  Dr. Bashir further stated that it was
essential that the materials gathered by the
hospital be kept confidential, so as to ensure that
physicians applying for hospital staff privileges
would provide complete and accurate information
about their qualifications. Moreover, Dr. Bashir
stated, 
if 
the 
information 
did 
not 
remain
confidential 
then 
'physicians and health care
institutions from whom materials are requested in
the credentialing process would be less inclined to
provide frank and open criticisms of physician
applicants where warranted.'"
768 So. 2d at 375-76  (footnote omitted).  This Court held
that the requested information was privileged under § 22-21-8.
768 So. 2d at 380.
In Kingsley, the plaintiff, a vascular surgeon, sued
three doctors alleging, among other things, "negligence or
wantonness in the performance of a peer review of the
plaintiff by the Tissue and Transfusion Committee of Russell
Hospital."  783 So. 2d at 825.  The plaintiff issued a
subpoena to Russell Hospital seeking certain peer-review
1080158; 1080160
11
documents.  Citing § 22-21-8, Russell Hospital objected to the
subpoena.  783 So. 2d at 825.
At the request of the plaintiff in Kingsley, the trial
court "'held an evidentiary hearing to afford the plaintiff an
opportunity ... to seek the production of [the] documents.'"
783 So. 2d at 826 (quoting an order of the trial court).  The
trial court held that the subpoenaed documents were privileged
under § 22-21-8.
In affirming the order of the trial court, this Court
stated:
"In Ex parte Krothapalli, 762 So. 2d 836 (Ala.
2000), this Court chronicled the reasoning behind
confidentiality statutes such as § 22-21-8, which
have been adopted by many states.  The statutes
provide confidentiality for peer-review processes as
a method of 'encouraging self-regulation by the
medical 
profession 
through 
peer 
review 
and
evaluation.'  Cruger v. Love, 599 So. 2d 111, 113-14
(Fla. 1992) (quoted in Krothapalli, 762 So. 2d at
838).  The Florida Supreme Court, in Cruger,
explained that the statutes were enacted 'in an
effort to control the escalating cost of health care
by 
encouraging 
self-regulation by the medical
profession through peer review and evaluation.'  599
So. 2d at 113-14 (quoted in Krothapalli, 762 So. 2d
at 838).
"In support of his position, the plaintiff cites
Ex parte St. Vincent's Hospital, 652 So. 2d 225
(Ala. 1994), in which this Court declined to apply
§ 22-21-8 so as to prevent disclosure of the records
of 
a 
hospital's 
infection-control 
committee.
1080158; 1080160
12
However, in that case there was no evidence that a
function of the committee was accreditation or
quality assurance.
"The trial judge in this case had before him the
deposition of Frank Harris, president and chief
executive officer of Russell Hospital.  Harris
testified that he had reviewed the documents
requested by the plaintiff and had determined that
they 
were 
the 
subject 
of 
quality 
assurance,
credentialling, and accreditation and thus were
subject to the privilege of § 22-21-8.
"We have carefully reviewed the record in this
case, and we find no abuse of discretion on the part
of the trial judge. His judgment is due to be
affirmed, on the authority of Ex parte Qureshi, 768
So. 2d 374 (Ala. 2000), and Ex parte Krothapalli,
supra."
783 So. 2d at 828.
We agree with Fairfield that the evidence presented in
the affidavits submitted in support of the assertion of the
privilege is substantially similar to the evidence presented
in the affidavits in Kingsley and Ex parte Qureshi.  The
affidavits Fairfield offered stated that the requested
documents were created for quality-assurance purposes, that
the documents are needed to guarantee the high quality of care
for all residents, and that the confidentiality of the reports
and statements is necessary.  Section 22-21-8 expressly
applies to "quality assurance" materials.
1080158; 1080160
13
The affidavit in Kingsley stated that the requested
documents 
"were 
the 
subject 
of 
quality 
assurance,
credentialling, and accreditation."  783 So. 2d at 828.  The
affidavit in Ex parte Qureshi stated that the requested
documents were a part of the hospital's credentialing file.
768 So. 2d at 376.  Additionally, the affidavit in Ex parte
Qureshi stated that "it was essential that the materials
gathered by the hospital be kept confidential" to ensure that
"complete 
and 
accurate 
information" would be provided
regarding the qualifications of physicians seeking privileges
at the hospital.  768 So. 2d at 376.
The respondents in these present cases have not offered
any evidence in opposition to the affidavits submitted by
Fairfield with its motions to reconsider.  The respondents
contend, however, that Fairfield was required to provide more
detailed facts in support of its assertion of the privilege.
They argue that Fairfield was required to show (1) that
the incident reports and witness statements were considered by
a quality-assurance committee and (2) that the records were
created at the direction of such a committee and not in the
regular course of business.
1080158; 1080160
14
In Ex parte Krothapalli, 762 So. 2d 836 (Ala. 2000), this
Court applied § 22-21-8 to a request for a hospital to produce
the credentialing files of one of its physicians.  This Court
stated:
"In construing a statute, we must ascertain and
give effect to the intent of the Legislature as that
intent is expressed through the language of the
statute. See BP Exploration & Oil, Inc. v. Hopkins,
678 So. 2d 1052, 1054 (Ala. 1996).  The intent of
the Legislature in adopting a statute may be gleaned
from considering the language used, the reason and
necessity for the statute, and the goals the
Legislature sought to accomplish.  Id.  Section
22-21-8 was enacted as Act No. 81-801, Ala. Acts
1981.  The title to that Act reads:  'To provide for
the confidentiality of all written materials and
activities concerning the accreditation, quality
assurance, or similar function of any hospital,
clinic, or medical staff.'
"In construing this statute, we adopt the
reasoning of the Florida Supreme Court and the South
Carolina Supreme Court in the following cases, in
which those courts construed peer-review statutes
substantially similar to § 22-21-8.
"In Cruger v. Love, 599 So. 2d 111 (Fla. 1992),
the Florida Supreme Court, construing Florida's
peer-review statute, Fla. Stat. Ann. § 766.101(5)
(1989), stated:
"'The 
Florida 
Legislature 
enacted
these peer review statutes in an effort to
control the escalating cost of health care
by encouraging self-regulation by the
medical profession through peer review and
evaluation.  In order to make meaningful
peer review possible, the legislature
1080158; 1080160
15
provided a guarantee of confidentiality for
the peer review process....
"'....
"'... While we recognize[] ... that
the discovery privilege [impinges] upon the
rights of litigants to obtain information
helpful or even essential to their cases,
we assume[] that the legislature balanced
that against the benefits offered by
effective self-policing by the medical
community.
"'We hold that the privilege provided
by [the peer-review statutes] protects any
document considered by the committee or
board as part of its decision-making
process.  The policy of encouraging full
candor in peer review proceedings is
advanced only if all documents considered
by the committee or board during the peer
review 
or 
credentialing 
process 
are
protected. Committee members and those
providing information to the committee must
be 
able 
to 
operate 
without 
fear 
of
reprisal. Similarly, it is essential that
doctors 
seeking 
hospital 
privileges
disclose all pertinent information to the
committee. 
Physicians 
who 
fear 
that
information provided in an application
might someday be used against them by a
third party will be reluctant to fully
detail matters that the committee should
consider.'
"599 So. 2d at 113-14. (Citation omitted.)
"Similarly, the 
South 
Carolina 
Supreme 
Court, 
in
McGee v. Bruce Hosp. System, 312 S.C. 58, 439 S.E.2d
257 (1993), explained:
1080158; 1080160
16
"'The overriding public policy of the
confidentiality statute is to encourage
health care professionals to monitor the
competency and professional conduct of
their peers to safeguard and improve the
quality of patient care. The underlying
purpose behind the confidentiality statute
is not to facilitate the prosecution of
civil actions, but to promote complete
candor 
and 
open 
discussion 
among
participants in the peer review process....
"'....
"'We find that the public interest in
candid 
professional 
peer 
review 
proceedings
should prevail over the litigant's need for
information 
from 
the 
most 
convenient
source.'
"312 S.C. at 61-62, 439 S.E.2d at 259-60. (Citations
omitted.)
"It seems clear to us, as it did to the Supreme
Courts of Florida and South Carolina, that the
purpose of a peer-review statute is to encourage
full candor in peer-review proceedings and that this
policy is advanced only if all documents considered
by the committee or board during the peer-review or
credentialing process are protected.  In the title
to Act No. 81-801, the Legislature stated the
purpose of the Act as being '[t]o provide for the
confidentiality 
of 
all 
written 
materials 
and
activities concerning the accreditation, quality
assurance, or similar function of any hospital,
clinic, or medical staff.' Given the broad language
used by the Legislature in the title to this Act, we
conclude that the documents the plaintiff seeks from
the two hospitals are privileged."
762 So. 2d at 838-39.
1080158; 1080160
The dissenting opinion of Justice Johnstone in Ex parte
2
Krothapalli notes that the only evidence offered in support of
the assertion of the privilege was an affidavit that described
the contents of the requested file as
"'the medical staff credentials file regarding the
hospitals credentialing of Dr. Radha Krothapalli and
the nature and scope of his privileges to practice
medicine at Baptist Medical Center South.  Baptist
considers 
the 
contents 
of 
the 
file 
to 
be
confidential pursuant to Section 22-21-8 of the Code
of Alabama, 1975.'"
762 So. 2d at 839-40 (Johnstone, J., dissenting).
17
There is language in Ex parte Krothapalli suggesting that
the hospital in fact had an official "committee" presumably
similar to the entity respondents argue § 22-21-8 requires.
However, the opinion does not state clearly whether such a
committee existed, nor does it suggest that the existence of
such a committee is a prerequisite to a valid assertion of the
privilege under § 22-21-8.    
2
More importantly, the language of § 22-21-8 does not
require that a quality-assurance "committee" exist, nor does
it limit the privilege to materials created solely at the
direction of such a committee.  Rather, § 22-21-8(a) provides
that 
"[t]he confidentiality established by this section
shall apply to materials prepared by an employee,
advisor, or consultant of a hospital, clinic, or
1080158; 1080160
The 
respondents 
also 
cite 
caselaw 
from 
other
3
jurisdictions 
including 
Arizona, 
Connecticut, 
Florida,
Illinois, Massachusetts, Michigan, Mississippi, Missouri,
Nebraska, Nevada, New York, North Carolina, North Dakota,
Ohio, Rhode Island, Texas, Utah, Washington, and West
Virginia.  The respondents have not demonstrated, however,
that any of those foreign decisions involve the application of
a privilege statute substantially similar to § 22-21-8, Ala.
Code 1975, to facts analogous to those in the present cases.
18
medical staff and to materials prepared by an
employee, advisor or consultant of an accrediting,
quality assurance or similar agency or similar body
and to any individual who is an employee, advisor or
consultant of a hospital, clinic, medical staff or
accrediting, quality assurance or similar agency or
body." 
(Emphasis added.)  Further, subsection (b) provides that
"[a]ll accreditation, quality assurance credentialling and
similar materials ... shall not be subject to discovery or
introduction in evidence in any civil action against a health
care ... institution arising out of matters which are the
subject of evaluation and review for accreditation, quality
assurance and similar functions, purposes, or activities." 
To support their argument that § 22-21-8 requires
Fairfield to prove the existence of a quality-assurance
committee, the respondents rely primarily on the following two
Alabama cases:  Ex parte Anderson, 789 So. 2d 190 (Ala. 2000),
and Ex parte Cryer, 814 So. 2d 239 (Ala. 2001).   Neither of
3
1080158; 1080160
19
those cases, however, supports the respondents' argument that
Fairfield must affirmatively demonstrate the existence of an
official committee as a part of its assertion of the privilege
provided in § 22-21-8.  
The respondents cite Ex parte Anderson for its statement
that  
"information and documents that specifically concern
the ... incident and that may be obtained from [the
defendant doctor] himself as an 'original source'
are discoverable. ... 
"... 
[The 
plaintiff] 
is 
entitled 
to 
any
information and documents regarding her specific
allegations that can be obtained from [the defendant
doctor] himself as an original source.  Likewise
[the plaintiff] is entitled to any material produced
by the hospital or any associated committee in its
regular course of business."
789 So. 2d at 203 (citations omitted).  The respondents in
these present cases have not argued, however, that the
requested documents fall under the "original source" category
described in Ex parte Anderson.  See also § 22-21-8(b).
Moreover, the affidavits that Fairfield submitted state that
the requested documents are not kept in the regular course of
business.  Thus, Ex parte Anderson does not support the
respondents' position.
1080158; 1080160
20
Ex parte Cryer involved a claim of privilege as to
handwritten notes a defendant doctor had made in preparation
for a meeting with the physician shareholders of Mobile Ob-
Gyn, P.C., another of the defendants in the case.  814 So. 2d
at 243-44.  This Court held that § 22-21-8 did not apply to
the notes under the circumstances of the case because the
shareholder physicians did not qualify as "medical staff"
under § 22-21-8.  814 So. 2d at 244-45.  This Court stated:
"[Act No. 81-801, Ala. Acts 1981, from which § 22-
21-8 is codified,] specifically provides for the
confidentiality 
of 
all 
written 
materials 
and
activities concerning the accreditation, quality
assurance, or similar function of any hospital,
clinic, 
or 
medical 
staff. 
Accreditation 
and
quality-assurance functions 
generally 
are 
considered
to be connected to hospitals, clinics, etc., that
are regulated in a manner different from an
individual physician or a group of physicians
operating as a private association or a private
corporation, as is the case here. Consequently, we
conclude that the Legislature intended only to
provide for the confidentiality of all written
materials and activities concerning hospitals and
clinics, not private associations or corporations or
individual physicians."    
814 So. 2d at 245 (emphasis added).  In the present case,
however, it is undisputed that Fairfield, as a long-term-care
facility, qualifies under § 22-21-8 as a "hospital, clinic, or
1080158; 1080160
21
medical staff."  Therefore, Ex parte Cryer is distinguishable
from the present case.
The respondents also contend that 
"if [Fairfield's] argument is extended to its
logical (or, rather, illogical) conclusion, nearly
every document created by [Fairfield], including
garden-variety medical records, would be privileged
because they are all somehow related to the quality
of patient care.  Such a tenuous connection to
'quality assurance' would, in effect, bar discovery
in a medical negligence action."
That contention of the respondents, however, overlooks the
particular facts of the unopposed evidence Fairfield presented
in these cases in support of its assertion of the privilege--
i.e., the testimony in the affidavits indicating that the
requested documents are not kept in the ordinary course of
business and do not become a part of a resident's medical
chart.
Finally, the respondents suggest that Fairfield was
required to submit the documents for the trial court to
conduct in camera examinations.  See, e.g., Roby's answer, p.
10 ("Indeed, [Fairfield] did not ever submit the requested
documents to the trial court for an in camera review.").
However, the respondents do not indicate that they ever
requested such an in camera review, and they do not cite any
1080158; 1080160
We emphasize that the fact that Fairfield offered
4
evidence by affidavit distinguishes the instant case from
decisions in which no evidence was submitted in support of the
assertion of the privilege under § 22-21-8.  See, e.g., Ex
parte Coosa Valley Health Care, Inc., 789 So. 2d at 219-20
("Coosa Valley has offered no evidence to show that the
information sought was maintained for purposes of quality
assurance or for any other purpose covered by § 22-21-8.
Compare Ex parte Qureshi, 768 So. 2d 374 (Ala. 2000); Ex parte
Krothapalli, 762 So. 2d 836 (Ala. 2000) (in each of those
cases, the petitioner submitted evidence in the form of
affidavits establishing that the information sought by the
discovery requests was privileged). Accordingly, Coosa Valley
did not meet its burden of proving that the information sought
by the discovery requests was privileged."); Ex parte St.
Vincent's Hosp., 652 So. 2d 225, 230 (Ala. 1994) ("The
discovery sought by Zeneca is not privileged under either §
22-21-8 or § 34-24-58. The Infection Control Committee is a
standing hospital committee .... The burden of proving that a
privilege exists and proving the prejudicial effect of
disclosing the information is on St. Vincent's.  St. Vincent's
has produced no evidence that the Infection Control Committee
served as a utilization review committee and no evidence that
a function of that committee was accreditation or quality
22
authority 
indicating 
that 
Fairfield 
was 
required 
to
voluntarily submit the documents for such an inspection in the
absence of an order requiring it to do so.
Conclusion
 
Because 
Fairfield 
offered 
sufficient evidence
demonstrating that it is entitled to the privilege provided in
§ 22-21-8, the trial court exceeded its discretion in ordering
Fairfield to produce the requested documents in the underlying
actions.4
1080158; 1080160
assurance.").
23
The petitions for the writ of mandamus are granted.
1080158--PETITION GRANTED; WRIT ISSUED.
1080160--PETITION GRANTED; WRIT ISSUED.
Lyons, Woodall, Stuart, Bolin, and Shaw, JJ., concur. 
Parker, J., concurs in the result.  
Cobb, C.J., and Murdock, J., dissent.
1080158; 1080160
"'"Discovery matters are within the trial court's sound
5
discretion, and its ruling on those matters will not be
reversed absent a showing of abuse of discretion and
substantial harm to the appellant."  Wolff v. Colonial Bank,
612 So. 2d 1146,  1146 (Ala. 1992) ....'" Ex parte John Alden
Life Ins. Co., 999 So. 2d 476, 480 (Ala. 2008) (quoting Ex
parte Henry, 770 So. 2d 76, 79 (Ala. 2000)).  See also Ex
parte Ocwen Federal Bank, FSB, 872 So. 2d 810 (Ala. 2003).
24
COBB, Chief Justice (dissenting).
I join Justice Murdock's dissenting opinion; I agree
completely with his analysis.  In addition, I offer the
following observations.  These petitions present the Court
with the critical issue whether it should displace the trial
court's determination, made in the exercise of its sound
discretion,  that Fairfield was not entitled to the privilege
5
against discovery afforded by Ala. Code 1975, § 22-21-8.  I
recognize that 
the information sought by 
the 
respondents 
might
ultimately 
be 
discoverable 
through 
discovery 
attempts 
directed
at the original sources of the information even if Fairfield
is granted the § 22-21-8 privilege.  See, e.g.,  Ex parte
Krothapalli, 762 So. 2d 836 (Ala. 2000).  Generally, this
Court has upheld the privilege under § 22-21-8 when the
health-care provider has shown: (1) that a review committee
existed; (2) that the disputed discovery documents or
1080158; 1080160
25
testimony was created by the committee or sets forth the
activities of the committee; and/or (3) that the disputed
documents were submitted for an in camera inspection.  See,
e.g., Ex parte Cryer, 814 So. 2d 239 (Ala. 2001)(holding that
a doctor's handwritten notes were not protected by the § 22-
21-8 privilege).  See also Ex parte Qureshi, 768 So. 2d 374
(Ala. 2000)(upholding privilege where hospital produced
testimony of chairman of credentialing committee stating that
the documents requested were maintained as part of a doctor's
credentialing file); Krothapalli, supra (upholding privilege
where documents were submitted to the trial court for an in
camera inspection); and Ex parte Burch, 730 So. 2d 143 (Ala.
1999)(upholding 
privilege 
where 
hospital 
produced 
testimony 
to
the effect that a quality-assurance committee existed and that
its function was to review certain cases to lead to an
improvement in the care of patients at the hospital).  
Although the majority attempts to distinguish Cryer based
on Fairfield's status as a long-term-care facility, that
distinction does not address the fact that Fairfield failed to
show that the materials in question were generated as a
function of a committee created to perform a quality-assurance
1080158; 1080160
26
evaluation.  It is worth contrasting these facts with those in
Kingsley v. Sachitano, 783 So. 2d 824 (Ala. 2000), in which
the Court held that sufficient evidence was presented to
uphold the privilege against discovery because the material
sought was from a peer-review committee.  In Kingsley, the
Court distinguished its prior decision in Ex parte St.
Vincent's Hospital, 652 So. 2d 225 (Ala. 1994), in which it
held that the hospital did not meet its burden.  This Court in
Kingsley recognized that in St. Vincent's the hospital had
failed to show that the material sought was created as a
process of a committee whose purpose was accreditation or
quality assurance.  The opinion in St. Vincent's states: 
"The 
discovery 
sought 
by 
Zeneca 
is 
not
privileged under either § 22-21-8 or § 34-24-58. The
Infection Control Committee is a standing hospital
committee, 
coordinated 
by 
Becky 
Harrison, 
a
registered nurse. The burden of proving that a
privilege exists and proving the prejudicial effect
of disclosing the information is on St. Vincent's.
St. Vincent's has produced no evidence that the
Infection Control Committee served as a utilization
review committee and no evidence that a function of
that 
committee 
was 
accreditation 
or 
quality
assurance. The trial judge did not abuse his
discretion in ordering that St. Vincent's to produce
the records."
652 So. 2d at 230 (emphasis added).  
1080158; 1080160
27
Moreover, I respectfully dissent from the suggestion in
the majority opinion that the respondents were under some sort
of burden to require Fairfield to seek an in camera review.
After the trial court had granted discovery in each case of
the material Fairfield sought to avoid disclosing, the burden
was entirely on Fairfield to demonstrate that it was entitled
to protective orders.  
"Typically, when an objection to a discovery
request is made, the burden is on the objecting
party to state specifically and to support the
reasons for the objection. See Rules 26(b)(1) and
(c), Ala. R. Civ. P.
"'[T]he party who seeks a protective order
has the burden of showing good cause why
discovery should not be had.
"'"Thus, to be entitled to a
protective order, a movant must
either show good cause why the
objected-to 
deposition 
or
production of documents would be
unduly burdensome or expensive,
oppressive, 
embarrassing 
or
annoying, or that the subject
matter sought to be discovered is
privileged."' 
"Ex parte Scott, 414 So. 2d 939, 941 (Ala. 1982)
(quoting Assured Investors Life Ins. Co. v. National
Union Assocs., Inc., 362 So. 2d 228, 231 (Ala.
1978)); see, e.g., Ex parte Garrick, 642 So. 2d 951,
952-53 (Ala. 1994) ('Under Rule 26(b)(3), the party
objecting 
to 
discovery 
bears 
the 
burden 
of
1080158; 1080160
28
establishing 
the elements of the work-product
exception.')." 
Ex parte CIT Commc'n Fin. Corp., 897 So. 2d 296, 300 (Ala.
2004).  See also Ex parte CUNA Mut. Ins. Soc'y, 507 So. 2d
1328 (Ala. 1987), and Ex parte Scott, 414 So. 2d 939 (Ala.
1982).  It was not the respondents' burden to have Fairfield
present the material in question for an in camera review to
support its motions for a protective order; it was Fairfield's
burden.  It is undisputed that Fairfield failed to demonstrate
that the materials in question should be afforded the
privilege of § 22-21-8 by submitting the material to the trial
court for an in camera inspection.  Under the circumstances of
these cases, I do not believe that this Court can correctly
hold that the trial court exceeded its discretion in denying
Fairfield's motion for a protective order.  Accordingly, I
respectfully dissent. 
1080158; 1080160
The ambiguity of the term "quality assurance" is
6
lessened, however, if it is understood "'to embrace only
29
MURDOCK, Justice (dissenting).
Fairfield Nursing and Rehabilitation Center, L.L.C.
("FNRC"), asks this Court to hold that the trial court abused
its discretion.
The trial court's orders at issue are discovery orders.
The orders require the disclosure of materials that, for all
that appears, will reveal what happened to the plaintiffs'
injured family members, who was responsible for the injuries,
and in what measure such person or persons might be culpable.
FNRC's 
position 
that 
the 
trial 
court 
abused 
its
discretion is based on nothing more than bare –- indeed, bare
minimum –- assertions in identically worded affidavits signed
by one former employee and one current employee.  The key
averment included in each of these affidavits is a conclusory
one that the requested materials are somehow related (how, we
are not told) to something called "quality assurance."  The
affidavit speaks not of an established "quality assurance"
program or procedures, but instead simply borrows from
§ 22-21-8(b), Ala. Code 1975, the term "quality assurance," an
obviously general term that appears at best to be ambiguous.6
1080158; 1080160
objects similar in nature to those objects enumerated'" by the
terms that precede and follow it in § 22-21-8(b), i.e.,
"accreditation" and "credentialing," an understanding that
suggests something more in the way of procedure and substance
than was shown to the trial court in this case.  See Ex parte
Emerald Mountain Expressway Bridge, L.L.C., 856 So. 2d 834,
842-43 (Ala. 2003)(discussing the principles of context,
noscitur a sociis, and ejusdem generis in relation to
statutory construction).
30
Although 
FNRC 
asserts 
that 
these 
affidavits 
were
"unopposed," I submit that the trial judge could have acted
within his discretion to employ his common sense and
experience with regard to the issue at hand and, in the
context of the above-described concerns, to find inadequate
the conclusory assertions found in these affidavits.  Roby,
for example, argues in her brief that the affidavits fail to
provide any facts that would be material to aiding the trial
court in determining whether the privilege is applicable here:
"Although the affiants state that the materials are
allegedly 'created for quality assurance purposes,'
the affiants do not state what alleged system of
'quality assurance' that FNRC has in place or what
its alleged methods and procedures for ensuring
'quality assurance' are.  Nor do the affidavits
attempt to describe what individuals or committee
(if any) is responsible for monitoring 'quality
assurance.'  Finally, although the affidavits give
conclusory assurances that the materials 'are needed
to guarantee the high quality of care for all
residents' and 'to keep investigations of incidents
at the facility candid and open,' the reader is left
1080158; 1080160
31
to guess as to 'why' and 'how' these things are
allegedly achieved."
 
Roby brief, at 10.  Roby also argues: 
"[T]his Court has never construed the words 'quality
assurance' so loosely as FNRC argues should be done
in this case.  Nor  should the Court do so.  Indeed,
if FNRC's argument is extended to its logical (or,
rather, illogical) conclusion, nearly every document
created by FNRC, including garden-variety medical
records, would be privileged because they are all
somehow related to the quality of patient care.
Such a tenuous connection to 'quality assurance'
would, in effect, bar discovery in a medical
negligence action.  Moreover, it would turn the §
22-21-8 privilege into a full-fledged 'self critical
analysis' privilege -- a privilege this Court has
expressly refused to adopt."
Roby brief, at 11-12 (citing Ex parte Cryer, 814 So. 2d 239
(Ala. 2001)) (emphasis in original). 
The general rule in Alabama is that
"'"[d]iscovery matters are within the trial court's
sound discretion, and its ruling on those matters
will not be reversed absent a showing of abuse of
discretion and substantial harm to the appellant."'
Ex parte Coosa Valley Health Care, Inc., 789 So. 2d
208 (Ala. 2000) (quoting Wolff v. Colonial Bank, 612
So. 2d 1146, 1146 (Ala. 1992))."
  
Ex parte Cryer, 814 So. 2d at 243.  Nevertheless, "'[t]he writ
of mandamus is a drastic and extraordinary remedy, to be
issued,'" among other things, only when the petitioner has
shown "'a clear legal right ... to the order sought.'"  Id.
1080158; 1080160
32
(quoting Ex parte Coosa Valley Health Care, Inc., 789 So. 2d
208, 216 (Ala. 2000)).  "'"'[T]he right sought to be enforced
by mandamus must be clear and certain with no reasonable basis
for controversy about the right to relief,'" and "'the writ
will not issue where the right in question is doubtful.'"'"
Id. (quoting Ex parte Coosa Valley Health Care, Inc., 789
So. 2d at 216 (quoting earlier cases)).  Given the limited and
conclusory nature of the assertions contained in the
affidavits presented by FNRC, as well as the discretion
afforded the trial court with respect matters of discovery, I
cannot conclude that the petitioner in these cases has made
the required showing.  I therefore, respectfully, must
dissent.
Cobb, C.J., concurs.