See T EX

. O CC

. C OD E A NN

. § 1 6 0 .0 0 7 (e ) (V e rn o n 2 0 0 4 ); T EX

. H E A L T H & S A F E T Y C OD E A NN

. § 16 1. 032 1 (V e rn o n S u p p . 2 0 0 7 ). 

### NUM BER 13-07- 052- CV



## COURT OF A PP EA LS
T H I R T E E N T H D I S T R I C T O F T E X AS C OR P U S C H R I S T I - E D I N B U R G

IN RE: K NA PP MEDICA L CEN TE R

On Peti tion for Wr it of M andamus



## ME MOR A N D U M OP I N I ON
Be fo re C hie f J us tice Vald ez an d Ju stice s Y añ ez an d Be na v ide s

M emo rand um Opin ion b y Ju stice Ya ñe z This mandamus i nv olv es a pr e- tr ial di sc ov er y di sput e. Rel ator, K n a pp M edi cal Cen ter ( “K napp” ), co mplai ns that the tr ial courtgranted onl y part of the r eli ef req uest ed by Kna pp in its mo tion fo r prote ctiv e orde r. Kna pp conte nds the tr ial court fa iled t o p ro t e ct informa tion th at is privil e ged und er the p eer revi ew and med ical comm ittee priv ileges. 1 Beca use w e c annot deter mine, on t he r ecord be f o re u s, thatthe tr ial co urt abu sed it s dis cr eti on, w e deny

Knapp ’s peti ti on.R e a l p a rti e s i n i n te re s t a re A u d re y L . J o n e s , D .O ., i n d i v i d u a l l y a n d t/ d /b /a S o u th w e s te r n H e a l th 2 D y na m i cs , P. A. , a Texa s co r po r at i on , a nd Nga G oo da hl , D. O

. , i nd i v i du al l y a nd t / d/ b/ a N ga G oo da hl , D. O

. , P. A. T hi s C our t r equest ed a ny r esponse by r eal par t i es t o be f i l ed b y Febr uar y 5, 200 7; howev er , no r esponse was fil e d

. R eal par t i es al l ege t hey wer e “ bl ackbal l ed” by phy si ci an m em ber s of Knapp’ s Execut i v e Com m i t t ee, 3
a n d w e re s u b s e q u e n tl y e x c l u d e d fro m th e e m e rg e n c y -r o o m s ta ff

. R e a l p a rti e s i n i ti a l l y s u e d o th e r d e fe n d a n ts and al l eged ot her cause s of act i on; howev er , Knapp i s t he o nl y r em ai ni ng d efe nd an t a nd t he r em ai ni ng c a u s e s o f a c ti o n a re th o s e l i s te d

. 2 Back ground Rea l par ti es in int er est ar e phy si ci ans w ho former ly prov ide d emergen cy -room 2

se rv ic es to K napp. In 1999, Knapp cont ra cte d w it h a n ew emerg ency -room se rv ic es pr ov ide r; r eal par

ti es w er e noti ncl uded among the phy si ci ans pr ov idi ng se rv ic es under the

new co ntr act

. Rea l par

ti es sued Knapp, al leg ing def amati on, tor ti ous int er

ferenc e w it h an

e xis t in g o r p ro s p e c t ive co n t ra c t , a n d ci vil co n s p ir a c y. 3 In th e cou rse of

w ritten dis c o ve ry, real parties requeste d nu me rous do cum ent s, inc lud ing “ all peer rev iew , repor ts, proce edi ng s, and f ind ing s” reg ar din g themsel v es dur ing thei r t e n u r e a tK n a p p

. Att h e d e p o s i t i o n o f T e r r y B e r g s t r o m, K n a p p ’ s C h i e f O p e ra ti ng Off ic er , Kn a pp’ s c ounse l obj ect ed and ins tr uct ed Berg strom not to an sw er v ar iou s qu e s t io n s co n c e rn in g m e e t in gs o f K n a p p ’s E m e rg e n c y Ro o m Co m m it t e e o r E xe c u t ive Commi ttee re g ardin g re al par ti es. Knapp filed a “ Mo ti on for Pr otec ti v e Order to Ex cl ude Pr iv il eg ed Pee r Rev iew Ev ide nce, ” in w hic h it re q uest ed a pr otec ti v e or der pr ecl udi ng r eal
pa rti es fr om : (1 ) eli ci ti ng or

co mpell ing any

tes ti mony

from w it ness es re g ar din g communi cat ion s t o or

from c ommitt ees , in cluding but not l imi ted t o the Emer g ency

R oom C ommitt ee and/ or Ex ecut iv e C ommitt ee; (2 ) eli ci ti ng or

co mpell ing any

tes ti mony

from w it ness es reg ar din g repor ts or re cords re cei v ed, made or dev elo ped to t he Emerg ency R oom C ommitt ee and/or Ex ecut iv e C ommitt ee, members o f the medi cal st aff and b o a rd ofI n re O s t eo pa t hi c M ed

. C t r. , 1 6 S .W

. 3d 88 1, 88 5 (T ex

. A pp

. –F ort W ort h 2 00 0, ori g. pro c ee di ng ) 4 ( ci t i ng I n re C ol onial

P i peline Co. , 9 6 8 S .W .2 d 9 3 8 , 9 4 1 (T e x
. 1 9 9 8 ) (o rig . p ro c e e d i n g ); W alker v. Packer , 827 S .W .2 d 8 3 3 , 8 4 0 -4 2 (T e x . 1 9 9 2 ) (o rig . p ro c e e d i n g ); Ar li ngt on M em '

l H osp. Found. , I nc. v. Bart on , 952 S. W

. 2d 9 2 7 , 9 2 9 (T e x . A p p .--F o rt W o rth 1 9 9 7 , o rig . p ro c e e d i n g ))

. 3 Knapp Me dic al Cen ter ; and [(3) ] [ p ]rodu cing or atte mp ting to introdu ce an y docu me nta ry

ev iden ce conc er nin g any

and all re por

ts or re cords re cei v ed, made , or dev elo ped by the E m e rge n cy R oom C ommitt ee or the Ex ecut iv e C ommitt ee, a nd any com mu nicatio ns to/ f rom th e respe ctiv e com mitt ees. [( 4) ] An y su ch other

r eli ef to w hic h i t s how s i tse lf j ust ly enti tl ed. At a he aring on Kna pp’s m otion on May 11, 200 6, Kn app sub m it t e d certain docu me nts to the cou rt fo r in cam er a ins pect ion

. T h e su bmit ted d ocument s a re not inc lud e d i n t h e r ecord before thi s C our t. On Janua ry

19, 2007, the t ri al cour t g ra nted Knapp’ s mot ion “ onl y

as t o the doc uments su bmit ted for i n- camer a r ev iew .” I n i ts

ma nda mu s petitio n, Kn app argues: Beca use the tr ial cour

t’ s or der is li mite d onl y to the w ri tten document s, Rea l P a rt i e s i n I n t e r e s tm a y

p a r a d e t h e i n d i v i d u a l p h y s i c i a n s a n d / o r me d i c a l s t a ff before the cour

t to eli ci t tes ti mony re g ar din g any or al communi cat ions or o p in io n s e xp re s s e d t o t h e E m e rg e n c y Ro o m Co m m it t e e a n d t h e E xe c u t ive Commi tte e reg ar din g [r eal par ti es’ ] q ual ific ati ons, professi onal co nduct , and/or the q ual it y of pa ti ent car e that eit her of them prov ide d. As suc h, R eal Par ti es in Interest may back -d oor the subs tanc e of t he co m munic ati ons made to the p eer

r ev iew co mmitt ee and d isc ov er w hat t he c ommitt ee cons ide re d i n c onduc ti ng the ev alu ati on protec ted b y the sta tutes

. Kna pp request s this Court to direct th e trial court to “issue a protective order excluding all priv ileged com mu nicatio n an d informa tion. ” Discus sion Ma ndamus w il l is sue to c or re ct a di sc ov er y order i f the order

c o n st it u te s a cl ear abuse of dis cr eti on and ther e i s n o adeq uate re medy by o rd inary

appeal

. A par

ty does 4Id

. 5

Id

. 6

M art inez v. Abbot t

Lab s. , 146 S. W

. 3d 2 60, 265 (T ex. App. –For t W or t h 20 04, pet

. den i ed) ( ci t i ng T EX

. 7 O CC

. C OD E A NN

. § 1 60

. 00 7(e ) ( V ern on 20 04 ) ( em ph as i s ad de d)) ; see a l so I n re The U ni v
. o f T ex

. H ea l t h C t r. at Tyl er , 33 S

. W

. 3d 82 2, 82 5 (T ex

. 20 00 ) ( ori g. pro c ee di ng ); In re O s t eo pa t hi c M ed

. C t r. , 16 S. W

. 3d a t 885

. I r ving Heal t hcare Sys. v. Brooks , 9 2 7 S .W .2 d 1 2 , 1 8 (T e x . 1 9 9 6 ) (o rig . p ro c e e d i n g ). 8 4 not h av e an adeq uate re medy by appeal w hen an appella te c our t c annot cur e the tr ial

cour t' s e rroneous di sc ov er

y order

. An appel lat e c our t cannot cure the err or

w hen a tr ial 5

cour t er ro neous ly

orders d is cl osure of pr iv il eg ed i nformati on th a t mater ial ly aff ect s t he ri gh t s o f t h e a ggr ie ve d p a rt y. 6

“ Th e m e d i c a l pe e r

r e v i e w c o mm i t t e e p r i v i l e g e p r o t e c t s r e c o r d s o r d e t e r mi n a t i o n s o f,

o r c o m m u n ic a t

ion s to , a medi cal peer r ev iew co mmitt ee unl ess they ar e made i n the

r eg ul ar c ou r s e of b us i ne s s o r t he p r i v i l eg e ha s b ee n w ai v ed .” A s t he Te x as S up r em e 7 Cou rthas note d, A litig ant shou ld not be able to discover throu gh a back door the substa nce of the proceed ing s o f a peer rev iew committe e and w hat that commi ttee had before i t i n ar ri v ing at it s d eci si ons. Si mil ar ly , dep osi ti on q uest ion s i nq uir ing about communi cat ion s to a peer r ev iew co mmitt ee and w hat t he c ommitt ee consid ered are obje ctiona ble be cause that in forma tion is inclu ded w ithin “all pr oceed ing s” of and “ all co mmunic ati ons made to” a medi cal peer r ev iew commi ttee. 8 W e ag re e w it h K n a p p t h a t real par ti es maynot “b ack -d oor the subs tanc e of the communi cat ion s made to the p eer r ev iew co mmitt ee” by

el ic it ing tes ti mony

from w it ness es

re g ar din g pr iv il eg ed i nformati on. At t his sta g e of t he pr oceed ing s, how ev er , t he tr ial co urt has g ra nted Knapp some, but n ot al l, of the reli ef i t re q uest ed in it s pr e- tr ial moti on for protec ti v e order

. The tr ial hasO n Jan uar y 26, 200 7, t hi s C our t st ay ed p r oceedi ngs i n t he t r i al cour t pen di ng d i sposi t i on o ft he 9 p e ti ti o n fo r w rit o f m a n d a m u s

. A t th e s a m e ti m e , th e p a rti e s e n te re d i n to a R u l e 1 1 a g re e m e n t a g re e i n g to a c o n ti n u a n c e o f th e tri a l p e n d i n g d i s p o s i ti o n o f th e o rig i n a l p ro c e e d i n g

.

See T EX

. R. C IV

. P. 193. 4( a) ( pr ov i di ng t hat a par t y m ay “ at any r easona bl e t i m e r equest a hear i ng 10
on an ob j ec t i on or cl ai m of pri vi l eg e a s s ert ed un de r t hi s rul e”). 5 not beg un. A pri v il eg e can be ass erted at anystag e of a leg al pr oceed ing

. W e dec li ne 9 1 0
to cons tr ue the tr ial cour t’ s or der as a final ru li ng on th e admi ss ibi li ty of w it ness tes ti mony

conc er nin g pr iv il eg ed i nformati on duri ng tri al. Acc or din g ly , w e concl ude the tri al cour t has not abu sed its discretio n, an d w e de ny Kna pp’s pe titio n f o r wri t of man dam us. W e also her eby l ift t he s tay

pr ev iou sl y

order ed by

thi s C our

t.

LINDA REYNA Y

AÑEZ, J u s t i c e

Me moran dum Opi nio n del iv er ed and filed thi s t he 13t h day

of Ma rc h, 20 08.