Title: Brugaletta v. Garcia
Citation: N/A
Docket Number: 
State: new-jersey
Issuer: new-jersey Supreme Court
Date: July 25, 2018

Brugaletta v. Garcia Annotate this Case Justia Opinion Summary This appeal arose out of a discovery dispute in a medical malpractice action involving a hospital’s and its staff’s care of a patient. The parties disagreed over the boundaries of privileged material under the Patient Safety Act (PSA), N.J.S.A. 26:2H-12.23 to -12.25c, and plaintiff’s ability to receive responsive discovery in order to prepare her action. The New Jersey Supreme Court affirmed the appellate panel’s order shielding the redacted document at issue from discovery because the PSA’s self-critical-analysis privilege prevents its disclosure. The Court also affirmed the determination that, when reviewing a discovery dispute such as this, a trial court should not be determining whether a reportable event under the PSA has occurred. The Court reversed the judgment to the extent it ended defendants’ discovery obligation with respect to this dispute, finding that defendants had an unmet discovery duty under Rule 4:17-4(d) that had to be addressed. The matter was remanded for further proceedings. Read more Want to stay in the know about new opinions from the Supreme Court of New Jersey? Sign up for free summaries delivered directly to your inbox. Learn More › You already receive new opinion summaries from Supreme Court of New Jersey. Did you know we offer summary newsletters for even more practice areas and jurisdictions? Explore them here . SYLLABUSThis syllabus is not part of the opinion of the Court. It has been prepared by the Office of the Clerk for the convenience of the reader. It has been neither reviewed nor approved by the Court. In the interest of brevity, portions of an opinion may not have been summarized.) Janell Brugaletta v. Calixto Garcia, D.O. (A-66-16) (079056)Argued March 12, 2018 -- Decided July 25, 2018LaVECCHIA, J., writing for the Court. This appeal arises from a discovery dispute in a medical malpractice action involving a hospital’s and its staff’s care of a patient. The parties clash over the boundaries of privileged material under the Patient Safety Act (PSA), N.J.S.A. 26:2H-12.23 to -12.25c, and plaintiff’s ability to receive responsive discovery in order to prepare her action. Plaintiff Janell Brugaletta went to the emergency room of defendant Chilton Memorial Hospital (CMH). She was admitted and underwent multiple surgical interventions. During the period of those repeated procedures, plaintiff’s doctor recorded that plaintiff missed doses of an antibiotic that the doctor had ordered. Plaintiff does not appear to have been informed of that fact prior to the filing of the Appellate Division’s opinion in this matter, although it is in plaintiff’s medical record turned over in discovery. Plaintiff filed a complaint alleging deviations from standards of medical care in defendants’ diagnosis, care, and treatment of her. During pre-trial discovery, plaintiff served a set of interrogatories on defendant CMH. The fifth interrogatory requested the names and addresses of anyone who made or was aware of “a statement regarding this lawsuit,” as well as access to, or a summary of, the statement, unless subject to a claim of privilege. CMH objected to the question as overly broad and asserted that information sought by the request was privileged. Plaintiff asked for a more specific answer, and CMH expanded as follows: “Without waiving said objections, and without limitation, there are 2 Reports regarding this matter. The reports are not included herein based upon the above objections. Additionally, the information contained in said reports is protected by the privilege of self-critical analysis,” as well as both the PSA and other legislation and hospital policy. Plaintiff made a motion to compel discovery of the identities of the CMH committee or committees that reviewed plaintiff’s case; submission of the related unredacted reports for in camera review; and disclosure of redacted versions to plaintiff. CMH moved for a protective order. The trial court heard argument on the motions and conducted an in camera review of the incident reports during which the court heard ex parte argument from defendants’ counsel. During the ex parte argument, the court marked the reports for identification as DCP-1 and DCP-2, respectively. The trial court filed a written opinion ordering the release of a redacted version of DCP-2. The court found that the report was the product of a self- critical analysis conducted pursuant to the PSA and reviewed its content. The court found, 1 contrary to CMH’s determination, that the report revealed plaintiff had suffered a Serious Preventable Adverse Event (SPAE) under the PSA. The court then considered two interrelated issues: (1) “when a hospital erroneously fails to report a [SPAE], what[,] if anything, should be the remedy?”; and (2) “what standard [of review] should be applied?” The court ordered the release of DCP-2 but prepared a redacted version of the document in an attempt to honor the self-critical-analysis privilege while revealing the facts of the SPAE to plaintiff. Further, the court ordered CMH to report the SPAE to the DOH. The Appellate Division reversed the trial court’s order. 448 N.J. Super. 404, 408, 419 (App. Div. 2017). The appellate panel first determined that the only precondition to the applicability of the PSA’s self-critical-analysis privilege is whether the hospital performed the self-critical analysis in compliance with N.J.S.A. 26:2H-12.25(b) and its implementing regulations. Id. at 414-15. The panel considered whether the trial court properly found that a SPAE had occurred, and it determined that the trial court’s SPAE determination was in error because “an expert opinion was essential” in order to demonstrate that plaintiff’s assumed serious adverse event occurred because of an error in her care. Id. at 418-19. The Court granted plaintiff’s motion for leave to appeal. ___ N.J. ___ (2017).HELD: The Court affirms the panel’s order shielding the redacted document from discovery because the PSA’s self-critical-analysis privilege prevents its disclosure. The Court also affirms the panel’s determination that, when reviewing a discovery dispute such as this, a trial court should not be determining whether a reportable event under the PSA has occurred. The Court reverses the judgment to the extent it ends defendants’ discovery obligation with respect to this dispute, finding that defendants have an unmet discovery duty under Rule 4:17-4(d) that must be addressed. Accordingly, the Court provides direction on how the court should have addressed, through New Jersey’s current discovery rules, the proper balancing of interests between the requesting party and the responding party here, and remands to the trial court.1. The PSA was legislatively designed to minimize adverse events caused by patient-safety system failures in a hospital or other health care facility. Through that multi-faceted statutory scheme, the Legislature sought to encourage self-critical analysis related to adverse events and near misses by fostering a non-punitive, confidential environment in which health care facilities can review internal practices and policies and report problems without fear of recrimination while simultaneously being held accountable. The PSA requires health care facilities to formulate processes wherein patient safety committees comprised of members with “appropriate competencies” can perform self-critical analyses on SPAEs and near-miss incidents, formulate evidence-based plans for increasing patient safety, and provide for on- going personnel training related to patient safety. N.J.S.A. 26:2H-12.25(b); N.J.A.C. 8:43E- 10.4 and -10.5(a). When a health care facility or an employee thereof suspects that a SPAE may have occurred, the facility’s patient safety committee must have in place a process for employees to alert the committee to that fact. N.J.A.C. 8:43E-10.5(a)(1). Then the patient safety committee must do two things: (1) perform a “root cause analysis” to identify the causes of a SPAE and appropriate corrective action, N.J.A.C. 8:43E-10.3 and -10.4(d)(7); and (2) report the SPAE to the DOH and to the affected patient. Notably, the PSA confers a 2 privilege on a facility’s self-critical analysis and the reporting of a SPAE to the DOH.N.J.S.A. 26:2H-12.25(f)(1), -12.25(g)(1); N.J.A.C. 8:43E-10.9(a)(1). Regulations promulgated to clarify the PSA’s self-critical-analysis privilege specify that the documents, materials, or information must have been developed “exclusively during the process of self- critical analysis.” N.J.A.C. 8:43E-10.9(b). (pp. 18-22)2. In C.A. ex rel. Applegrad v. Bentolila, the Court dismissed, in dicta, an argument that a finding that an event is not reportable should abrogate the self-critical-analysis privilege.219 N.J. 449, 471 n.14 (2014). (p. 23)3. Importantly, the privileges provided in the PSA do not bar the discovery or admission into evidence of information that would otherwise be discoverable or admissible. Relatedly, the PSA provides that its provisions do not change the discoverability of information or documents obtained from other sources, or in other contexts. (pp. 23-24)4. The trial court was well within proper judicial bounds when examining the facts underlying the claim of privilege in this case. When a requesting party demands information or documents over which the opposing party claims a privilege, the responding party may withhold that information or document as long as it expressly asserts the claimed privilege and details the nature of the information withheld. When a requesting party challenges an assertion of privilege, the court must undertake an in camera review of the purportedly privileged document or information and make specific rulings as to the applicability of the claimed privilege. However, the court exceeded its authority, first in declaring that a SPAE had occurred and then in issuing its related orders that CMH disclose to plaintiff a redacted version of DCP-2 and report the event to the DOH. The Legislature inserted no role for a trial court to play in reviewing the SPAE determination made by a patient safety committee of a health care facility. The Court declines to entangle the courts in an essentially administrative function, and accordingly expresses no opinion on what standard should govern the determination of whether a SPAE occurred or the related issues of causation and expert testimony. To the extent that the Appellate Division refined the review standard for identifying a SPAE, the Appellate Division’s analysis is vacated. (pp. 24-27)5. The language and structure of the PSA leave no reasonable doubt about the legislative intent regarding the self-critical-analysis privilege. As the Appellate Division properly held, the only precondition to application of the PSA’s privilege is whether the hospital performed its self-critical analysis in procedural compliance with N.J.S.A. 26:2H-12.25(b) and its implementing regulations. 448 N.J. Super. at 414-15. To construe the statute otherwise -- by making its protective privilege dependent on a SPAE finding -- would be at cross-purposes with the patent legislative desire to encourage trust and reporting by health care facilities whenever a concern about a near miss or adverse event comes to light. Accordingly, as intimated through dictum in C.A., the finding that an event is not reportable does not abrogate the self-critical-analysis privilege. The PSA was misapplied and the trial court’s discretion abused when it declared that a SPAE occurred and ordered CMH to release a redacted form of DCP-2 to plaintiff and report the event to the DOH. A court may not order the release of documents prepared during the process of self-critical analysis. (pp. 27-30) 3 6. Although a court may not order release in discovery of a report developed during self- critical analysis, even if redacted, and although a court may not determine whether it agrees with the health care facility’s conclusion as to whether an adverse event constitutes a SPAE and, based on that determination, order disclosure to the DOH, the court’s role in resolving this discovery dispute is far from over. (pp. 30-32)7. The PSA did not abrogate existing health care law and does not immunize from discovery information otherwise discoverable. The record in this case discloses that among the patient records, there are notations across several pages that, when read together, reveal the nature of the events underlying the divergent SPAE determinations of the committee and the trial court. Those notations are in plaintiff’s medical records pursuant to health care law requirements concerning patient recordkeeping. Defendants provided the court a concise step-by-step narrative, walking the court through the relevant excerpts of plaintiff’s patient records, to demonstrate that defendants had provided the underlying non-privileged facts about plaintiff’s care that sufficiently addressed the information requested in interrogatory five and that could be disclosed without piercing the PSA privilege. Instead, the trial court should have ordered defendants to provide plaintiff a narrative similar in form to the one they presented the court. That remedy would have allowed the court to balance the litigation interests of the parties, to avoid transgressing the privilege and the salutary purposes it is intended to achieve, and to keep the courts out of a regulatory scheme. (pp. 32-36)8. New Jersey trial courts have the authority under Rule 4:17-4(d) to compel a party producing documentary records to provide, with the records, a narrative that specifies where responsive information may be found. Plaintiff was entitled to be informed of an adverse incident related to her care in defendants’ response to discovery demands because such an incident was memorialized through various entries in her patient records. Yet, she was not informed of it and, notwithstanding her fifth interrogatory, received no specification or narrative to accompany the approximately 4500 pages of medical records that would lead her to the discrete yet interconnected notations of the incident that appear on nine pages of that record. The trial court should, on remand, order a narrative to accompany the documents already turned over to plaintiff in order to satisfy defendants’ obligation to provide a complete response to interrogatory number five. (pp. 36-43) AFFIRMED IN PART, REVERSED IN PART. JUSTICE ALBIN, dissenting, would make clear that the patient had a right to be told about the lapse in her treatment at the time it occurred and in a way that she reasonably could have understood under the Patient Bill of Rights, even if it had not been entered in her patient records as required by N.J.A.C. 8:43G-15.2(e), and even if she had not demanded the information in a medical malpractice lawsuit. In Justice Albin’s view, the majority’s interpretation of the PSA erodes significant rights the Legislature conferred on patients.CHIEF JUSTICE RABNER and JUSTICES PATTERSON, FERNANDEZ-VINA, SOLOMON, and TIMPONE join in JUSTICE LaVECCHIA’s opinion. JUSTICE ALBIN filed a dissenting opinion. 4 SUPREME COURT OF NEW JERSEY A- 66 September Term 2016 079056JANELL BRUGALETTA, Plaintiff-Appellant, v.CALIXTO GARCIA, D.O., STEVEN D. RICHMAN, M.D. and PATRICK J. HINES, M.D., Defendants, andCHILTON MEMORIAL HOSPITAL, Defendant-Respondent. Argued March 12, 2018 – Decided July 25, 2018 On appeal from the Superior Court, Appellate Division, whose opinion is reported at 448 N.J. Super. 404 (App. Div. 2017). Ernest P. Fronzuto argued the cause for appellant (Fronzuto Law Group, attorneys; Ernest P. Fronzuto, of counsel and on the brief, and Casey Anne Cordes, on the brief). Anthony Cocca argued the cause for respondent Chilton Medical Center (Bubb, Grogan & Cocca, attorneys; Anthony Cocca, of counsel and on the brief). E. Drew Britcher argued the cause for amicus curiae New Jersey Association for Justice (Britcher Leone, attorneys; E. Drew Britcher, of counsel and on the brief, and Jessica E. Choper, on the brief). Ross A. Lewin argued the cause for amicus curiae New Jersey Hospital Association 1 (Drinker Biddle & Reath, attorneys; Ross A. Lewin, of counsel and on the brief). Philip S. Goldberg submitted a brief on behalf of amici curiae American Medical Association and Medical Society of New Jersey (Shook, Hardy & Bacon, attorneys). JUSTICE LaVECCHIA delivered the opinion of the Court. This appeal arises from a discovery dispute in a medicalmalpractice action involving a hospital’s and its staff’s careof a patient. The parties clash over the boundaries ofprivileged material under the Patient Safety Act (PSA), N.J.S.A.26:2H-12.23 to -12.25c, and plaintiff’s ability to receiveresponsive discovery in order to prepare her action. In enacting the PSA, the Legislature sought to reducemedical errors by promoting internal self-reporting andevaluation by health care facilities. The Legislature protectedand encouraged this new system of self-critical analysis througha statutory privilege, designed to shore up the trust expectedand needed from health care facilities for the success of itsfacility-initiated program. At the same time, the Legislatureexpressly left untouched a plaintiff’s ability to securediscovery of underlying information available through othermeans. In this matter, the trial court endeavored to balance theinterests of the parties using the framework of the PSA andordered the release of a redacted document prepared internally 2 by hospital personnel during the process of self-criticalanalysis. On appeal, defendants claimed that the trial courtimpermissibly involved itself in a PSA regulatory function and,further, that release of the redacted document would result in abreach of the statutory privilege. The Appellate Divisionreversed the trial court’s order of release. We now affirm inpart and reverse in part the Appellate Division judgment, and weremand for proceedings in accordance with this opinion. We affirm the panel’s order shielding the redacted documentfrom discovery because the PSA’s self-critical-analysisprivilege prevents its disclosure. We also affirm the panel’sdetermination that, when reviewing a discovery dispute such asthis, a trial court should not be determining whether areportable event under the PSA has occurred. However, importantly, we reverse the judgment to the extentit ends defendants’ discovery obligation with respect to thisdispute. We find that defendants have an unmet discovery dutyunder Rule 4:17-4(d) that must be addressed. Accordingly, weprovide direction on how the court should have addressed,through our current discovery rules, the proper balancing ofinterests between the requesting party and the responding partyhere, and we remand to the trial court for entry of an orderconsistent with the guidance set forth in this opinion and forsuch further proceedings as are necessary. 3 I. Because this matter involves a confidential record andcomes before us on interlocutory appeal from the trial court’sdisposition of the discovery dispute, we present only a briefrecitation of the facts and procedural history. A. On January 12, 2013, plaintiff Janell Brugaletta1 went tothe emergency room of defendant Chilton Memorial Hospital (CMH)complaining of a week-long fever accompanied by abdominal andbody pains. She was examined by defendant Calixto Garcia, D.O.,diagnosed with pneumonia, and admitted to the hospital. AComputed Tomography (CT) scan revealed a pelvic abscess due to aperforated appendix. Plaintiff’s doctors drained the abscessand plaintiff’s fever abated. Although the abdominal painlessened, plaintiff experienced worsening pain in her legs. Additional CT scans led CMH doctors to determine thatplaintiff appeared to be developing a necrotizing fasciitis2 in1 Although some record documents spell plaintiff’s name as “Janelle,” we herein adopt the spelling used in the documents submitted on plaintiff’s behalf. 2 “Necrotizing fasciitis is a bacterial infection of the tissue under the skin that surrounds muscles, nerves, fat, and blood vessels. . . . Once in the body, the bacteria spread quickly and destroy the tissue they infect.” Ctrs. for Disease Control & Prevention, Acting Fast is Key with Necrotizing Fasciitis, https://www.cdc.gov/features/necrotizingfasciitis/index.html (last updated July 9, 2018). 4 her thigh muscles and right buttock due to the abscess drainageleaking around a nerve. Plaintiff obtained a second opinion,and, thereafter, an orthopedic surgeon performed a fasciotomyand debridement. After those procedures, plaintiff was placedin the intensive care unit. Plaintiff then underwent furthersurgical interventions, including additional procedures todebride the fasciitis and close the wound left by the abscess,as well as an appendectomy. On January 30, 2013, during the period in which plaintiffwas undergoing repeated procedures, plaintiff’s doctor recordedthat plaintiff missed doses of an antibiotic that the doctor hadordered. Plaintiff does not appear to have been informed ofthat fact prior to the filing of the Appellate Division’spublished opinion in this matter, although it is in plaintiff’smedical record turned over in discovery. By the time of her February 13, 2013 discharge -- threeweeks after appearing in the CMH emergency room -- plaintiff’sabscess drains were removed and the abdominal pain was resolved.Nevertheless, plaintiff reports having left the hospitalexperiencing residual pain and permanent injuries to her legsand buttock. On January 13, 2015, plaintiff filed a complaint naming Dr.Garcia and CMH as defendants, alleging deviations from standardsof medical care in their diagnosis, care, and treatment of her. 5 About a year later, plaintiff filed an amended complaint to addclaims against Steven D. Richman, M.D., Patrick J. Hines, M.D.,and Montclair Radiology, alleging that Doctors Richman andHines, who performed her CT scans and CT-guided drainage,negligently failed to detect a second abscess. During pre-trial discovery, plaintiff served a set ofinterrogatories on defendant CMH on March 5, 2015. The fifthinterrogatory requested the following: State: (a) the name and address of any person who has made a statement regarding this lawsuit; (b) whether the statement was oral or in writing; (c) the date the statement was made; (d) the name and address of the person to whom the statement was made; (e) the name and address of each person present when the statement was made; and (f) the name and address of each person who has knowledge of the statement. Unless subject to a claim of privilege, which must be specified: (a) attach a copy of the statement, if it is in writing; (b) if the statement was oral, state whether a recording was made and, if so, set forth the nature of the recording and the name and address 6 of the person who has custody of it; and (c) if the statement was oral and no recording was made, provide a detailed summary of its contents.On June 1, 2015, defendant CMH responded: Upon the advice of counsel, objection to the form of the question. This request is overly broad, burdensome and intended to harass this defendant and seeks information that is not reasonably calculated to lead to the discovery of admissible evidence pursuant to R. 4:10-2 and is otherwise irrelevant under N.J.R.E. 401. Further, this request seeks information that is protected by the work- product doctrine, the peer review privilege, the privilege of self-critical analysis, the attorney client privilege and is otherwise evidence of subsequent remedial measures under N.J.R.E. 407. Without waiving said objections, to be provided. Following plaintiff’s request for a more specific answer tointerrogatory number five, CMH served plaintiff with furtherdetail regarding the claimed privilege. The expanded answerrepeated the above response verbatim until the final sentence,upon which it elaborated as follows: Without waiving said objections, and without limitation, there are 2 Reports regarding this matter. The reports are not included herein based upon the above objections. Additionally, the information contained in said reports is protected by the privilege of self-critical analysis and the Peer [R]eview and Improvement Act of 1982[,] 42 U.S.C. § 1320c-3 et seq., the Health Care Quality Improvement Act[,] 42 U.S.C. § 11101, et seq. N.J.S.A. 2A:84A-22.8, [the PSA,] and Hospital Policy. The documents and the 7 information contained therein are strictly confidential and may not be disclosed or distributed to any person or entity outside the peer review or utilization review process, except as otherwise provided by law. Enclosed is a Privilege Log of Incident Reports. Please note, there exists a letter dated February 20, 2013 from Charlene McCallum, Patient Representative, to [plaintiff], bates stamped Confidential -- Incident Report 005, which is being disclosed. [3] However, the 2 Incident Reports referenced above, are not being produced based on the aforementioned objections. On September 22, 2015, plaintiff made a motion to compeldiscovery of the identities of the CMH committee or committeesthat reviewed plaintiff’s case; submission of the relatedunredacted reports for in camera review; and, ultimately,disclosure of redacted versions to plaintiff. CMH filed across-motion for a protective order. Accompanying CMH’s motionwas the certification of Ebube Bakosi, M.D., stating that twoincident reports prepared “for the sole purpose of complyingwith the requirements of the PSA” were generated regardingplaintiff and that those reports were forwarded to the PatientSafety Committee but no other committees. The trial court heard argument on the motions and conductedan in camera review of the incident reports during which the3 The report, designated Incident Report 005, appears related to a complaint plaintiff had regarding the CMH staff and is not a subject of this appeal. 8 court heard ex parte argument from defendants’ counsel. Duringthe ex parte argument, the court marked the reports foridentification as DCP-1 and DCP-2, respectively.4 On March 29, 2016, the trial court filed a written opinionordering the release of a redacted version of DCP-2. The courtfound that the report was the product of a self-criticalanalysis conducted pursuant to the PSA and reviewed its content.The court found, contrary to CMH’s determination, that thereport revealed plaintiff had suffered a Serious PreventableAdverse Event (SPAE) under the PSA.5 The court then consideredtwo interrelated issues: (1) “when a hospital erroneously failsto report a [SPAE], what[,] if anything, should be the remedy?”;and (2) “what standard [of review] should be applied?” Thecourt first rejected as “unjust and incorrect” a reading of thestatute that would “automatically negate the entire privilegewhenever a failure to report occurs” after considering“instances where a hospital’s Patient Safety Committee [formedand operating pursuant to the PSA and its implementingregulations] makes a good faith finding that there was not a4 DCP-1 is not a subject of this appeal. 5 We will return to the definition of and requirements attendant upon SPAEs later in the opinion. For now, it suffices to note that health care facilities have certain reporting obligations with respect to SPAEs under the PSA. We focus here on the trial court’s conclusions based on its determination that plaintiff suffered a SPAE that the CMH failed to report. 9 [SPAE], only to have a [c]ourt disagree.” The court noted that“[s]uch an outcome would not comport with the inherentdiscretion that Patient Safety Committees have in determiningwhether a [SPAE] occurred.” Instead, to respect the inherent discretion vested inPatient Safety Committees for making SPAE determinations, aswell as the policy goals of the PSA, the court determined that [i]f a reviewing [c]ourt concludes that a [SPAE] occurred and was not reported, the Hospital must be ordered to report the event to the Patient and to the New Jersey Department of Health [(DOH)] as mandated by the [PSA]; [and] [i]f the [c]ourt further concludes that the Hospital’s decision not to report was “arbitrary and capricious,” the hospital loses its privileges under the [PSA]. Although the court found a “clear error in judgment” inCMH’s finding that no SPAE occurred here, it determined that theerror did not rise to the level of being an arbitrary andcapricious act. Thus, although the court ordered the release ofDCP-2, the court prepared a redacted version of the document inan attempt to honor the self-critical-analysis privilege whilerevealing the facts of the SPAE to plaintiff. Further, thecourt ordered CMH to report the SPAE to the DOH. The court stayed its order to permit defendants to file forleave to appeal. B. 10 The Appellate Division granted plaintiff leave to appealand reversed the trial court’s order. Brugaletta v. Garcia, 448 N.J. Super. 404, 408, 419 (App. Div. 2017). Framing the issueas a review of a discovery disposition, id. at 411, theappellate panel first determined that the only precondition tothe applicability of the PSA’s self-critical-analysis privilegeis whether the hospital performed the self-critical analysis incompliance with N.J.S.A. 26:2H-12.25(b) and its implementingregulations, id. at 414-15. According to the panel, the plainlanguage of N.J.S.A. 26:2H-12.25(g), which establishes the self-critical-analysis privilege, does not condition the privilege ona SPAE finding or compliance with the PSA’s reportingrequirements. Id. at 416-17. The panel also reviewed the trial court’s decision to orderthat CMH report the SPAE to plaintiff and the DOH. Id. at 417-19. In so doing, the panel considered whether the trial courtproperly found that a SPAE had occurred, and it determined thatthe trial court’s SPAE determination was in error. Id. at 418-19. In order to determine whether the record containedsufficient evidence to support the trial court’s SPAEdetermination, the panel looked to the definitions of the threeelements of a SPAE. Id. at 418 (citing N.J.S.A. 26:2H-12.25(a);N.J.A.C. 8:43E-10.3). The panel said that a proper finding of aSPAE requires: (1) an adverse event, or “a negative consequence 11 of care that results in unintended injury or illness”; (2) aserious event, or one that results in “death or loss of a bodypart, or disability or loss of bodily function lasting more thanseven days or still present at the time of discharge”; and (3) apreventable event, meaning one that “could have been anticipatedand prepared against, but occurs because of an error or othersystem failure.” Id. at 413 (quoting N.J.S.A. 26:2H-12.25(a)and later citing N.J.A.C. 8:43E-10.3). The panel assumed for the sake of analysis that an adverse,serious event took place. Id. at 418-19. However, the panelstated that the third PSA requirement -- a preventable event --is a causation element, namely that “the event must occurbecause of the error or system failure.” Id. at 418 (internalquotation marks omitted). Relying on Kelly v. Berlin, 300 N.J.Super. 256, 268 (App. Div. 1997), the panel concluded that “anexpert opinion was essential” in order to demonstrate thatplaintiff’s assumed serious adverse event occurred because of anerror in her care. Id. at 419. Because “the trial court [did]not rely on an expert opinion to conclude that Brugaletta’sserious adverse event occurred because of” an error in her care,the panel declared the trial court’s SPAE finding to beunsupported by the record. Ibid. (internal quotation marksomitted). C. 12 We granted plaintiff’s motion for leave to appeal pursuantto Rule 2:2-2(b). ___ N.J. ___ (2017). We also granted amicuscuriae status to the New Jersey Association for Justice (NJAJ),the American Medical Association and Medical Society of NewJersey (collectively, AMA), and the New Jersey HospitalAssociation (NJHA). II. A. Plaintiff maintains that the PSA’s procedural requirementsfor investigating whether a SPAE occurred and the requirementsto disclose a SPAE are distinct. According to plaintiff, thedisclosure requirements rely on a hospital’s subjectivedetermination as to whether a SPAE has occurred. Plaintiffasserts that, because the PSA conferred on patients the right toknow about SPAEs that occur during their treatment or care,judicial review of SPAE determinations must logically follow,otherwise, the PSA could become a method of informationsuppression by hospitals seeking to avoid disclosure of SPAEs.Thus, plaintiff argues that judicial review is necessary toenforce and protect the patient’s right to know, as well as toavoid a patient suffering irreparable harm. Plaintiff urgesadoption of the trial court’s standard because it balances “thecompeting policy interests set forth in the PSA: the hospital’s 13 interests in confidential self-critical analysis and the goal ofsystem-wide reporting and patient notification” of SPAEs. Plaintiff maintains that the Appellate Division’scontrasting approach places an insurmountable burden onplaintiffs seeking to enforce their right to know under the PSAby requiring a court to rely on an expert opinion on causationwhen, in fact, the relevant regulations create a presumption ofcausation. Moreover, plaintiff contends that it is morepractical to place the burden on the hospital to disprovecausation. That is because (1) plaintiffs are not likely toknow the factual circumstances underlying a SPAE because therecords are unobtainable; and (2) it is the hospital assertingthe privilege and, therefore, the hospital should bear the costand burden of disproving causation. B. Defendants argue that the right to know, which plaintiffinsists was created in the PSA, does not exist and, to theextent that it does, it is not the primary focus of the statuteor its implementing regulations. According to defendants, the PSA was enacted to fosterconfidential reporting of self-critical analyses in order tomake patient environments safer. In that vein, defendants notethat the PSA mandates that hospitals must meet severalobligations, including creation of a patient safety committee, 14 compliance with investigative procedures, and reporting to theDOH and SPAE-affected patients. To incentivize compliance, thePSA also created an absolute privilege for material producedpursuant to the PSA’s procedural requirements and within thescope of the statute, which privilege is not reliant on whethera hospital correctly determines that a SPAE has occurred or on apatient’s need for information. Defendants point to thestatute’s language to argue that the Legislature did not providefor judicial review of SPAE determinations and that the self-critical-analysis privilege does not rely on whether a hospitalfails to find a SPAE and report it to the DOH and the patient.Defendants assert that such review is inconsistent with thestatute’s express goals. Further, defendants claim that plaintiff misstates thepanel’s holding in asserting that the Appellate Division placedan insurmountable burden on her by requiring an expert opinionto demonstrate causation. Rather, according to defendants, thepanel merely held that the record did not support a finding of aSPAE and rejected plaintiff’s argument that the PSA’simplementing regulations created a presumption of causation. Finally, defendants emphasize that the informationunderlying what the trial court found to be a SPAE is alreadyavailable to plaintiff: defendants have turned over non-privileged discovery in the form of plaintiff’s hospital chart, 15 which contains the factual material underlying what the trialcourt determined was a SPAE. C. Supporting plaintiff, amicus NJAJ argues that a hospitalshould not be permitted to use its compliance with the PSA’sprocedural requirements as a means to circumvent the PSA’sdisclosure requirement. According to the NJAJ, the PSA did notabrogate preexisting law: like prior law, the PSA does notcloak facts related to a patient’s treatment in privilege merelybecause they were discovered pursuant to a mandatoryinvestigation. Further, the NJAJ asserts that the AppellateDivision erred by failing to analyze CMH’s claim of privilegeconsistent with Christy v. Salem, 366 N.J. Super. 535 (App. Div.2004). The NJAJ argues that Christy requires a court to“balance a 'plaintiff’s right to discover information concerninghis care and treatment’ . . . against the 'public interest toimprove the quality of care and help to ensure thatinappropriate procedures . . . are not used on future patients’”when a privilege is claimed. (quoting 366 N.J. Super. at 541).Finally, the NJAJ urges this Court to allow courts to perform incamera reviews of hospitals’ SPAE determinations and, if thereviewing court finds that a SPAE occurred, to permit that courtto release any factual matter relating to the SPAE to theplaintiff and report the SPAE to the DOH. 16 D. Supporting defendants’ position, amici AMA and NJHA argueagainst a judicially crafted exception to the self-critical-analysis privilege that relies on a court’s review of a SPAEdetermination or a hospital’s compliance with the PSA’sreporting requirements. According to those amici, the self-critical-analysis privilege is contingent only on compliancewith the PSA’s procedural requirements, which, if met, shieldthe analysis and its resulting reports. The NJHA emphasizes that the court’s role in reviewing PSA-related issues is limited to ruling on discovery challenges andthat the PSA does not provide for judicial review of ahospital’s overall compliance with the statute. That role,according to the NJHA, is filled by the DOH. Further, the NJHAargues requiring a hospital to turn over all of the factualmaterials underlying a SPAE, as well as the fact that a SPAEoccurred, would result in providing patients with moreinformation than the PSA requires. The NJHA points to PSAlanguage that a hospital need advise a patient only that a SPAEhas, or likely has, occurred. III. We turn first to the claim that the trial court erred as amatter of law, misconstruing its role when interacting with thePSA process and the scope of the self-critical-analysis 17 privilege. Generally, we accord substantial deference to atrial court’s disposition of a discovery dispute. See CapitalHealth Sys., Inc. v. Horizon Healthcare Servs., Inc., 230 N.J. 73, 79-80 (2017). We will not ordinarily reverse a trialcourt’s disposition of a discovery dispute “absent an abuse ofdiscretion or a judge’s misunderstanding or misapplication ofthe law.” Ibid. To the extent that our review involvesquestions of statutory interpretation, however, our review is denovo. Verry v. Franklin Fire Dist. No. 1, 230 N.J. 285, 294(2017). A. The statute that created the self-critical-analysisprivilege is central in the parties’ arguments. The PSA wasalready examined in C.A. ex rel. Applegrad v. Bentolila, 219 N.J. 449 (2014), a case in which we had our first opportunity toconsider the applicability of the privilege and did so bysetting forth the basic structure of the statute. 6 For our 6 In that discussion, we noted that although the PSA was enacted in 2004, its implementing regulations were not effective until March 2008, C.A., 219 N.J. at 462, 467, which was roughly nine months after the document at issue was prepared, id. at 455. We concluded that the hospital in that matter should not be penalized with disclosure of its deliberative material because it did not adhere to strict rule requirements about internal committee operation during self-critical analysis when those rule requirements had not yet been made known. Id. at 473. The present matter arose after the regulatory structure was in full effect. 18 present analysis, we summarize the core features of the PSA andits implementing regulations. The PSA was legislatively designed to minimize adverseevents caused by patient-safety system failures in a hospital orother health care facility. N.J.S.A. 26:2H-12.24(b) and (c).As noted in C.A., through that multi-faceted statutory scheme,the Legislature sought to encourage self-critical analysisrelated to adverse events and near misses by fostering a non-punitive, confidential environment in which health carefacilities can review internal practices and policies and reportproblems without fear of recrimination while simultaneouslybeing held accountable. 219 N.J. at 464; see also N.J.S.A.26:2H-12.24(e). The PSA requires health care facilities to formulateprocesses wherein patient safety committees comprised of memberswith “appropriate competencies” can perform self-criticalanalyses on SPAEs and near-miss incidents, formulate evidence-based plans for increasing patient safety, and provide for on-going personnel training related to patient safety. N.J.S.A.26:2H-12.25(b); N.J.A.C. 8:43E-10.4 and -10.5(a). Thus,reported SPAEs receive intense review through the patient safetycommittee’s process of self-critical analysis. See N.J.A.C.8:43E-10.4(b)(3). 19 The PSA and its implementing regulations define a SPAE as“an adverse event that is a preventable event and results indeath or loss of a body part, or disability or loss of bodilyfunction lasting more than seven days or still present at thetime of discharge from a health care facility.” N.J.S.A. 26:2H-12.25(a); N.J.A.C. 8:43E-10.3. An adverse event is one “that isa negative consequence of care that results in unintended injuryor illness, which may or may not have been preventable,” and apreventable event is “an event that could have been anticipatedand prepared against, but occurs because of an error or othersystem failure.” N.J.S.A. 26:2H-12.25(a); N.J.A.C. 8:43E-10.3. When a health care facility or an employee thereof suspectsthat a SPAE may have occurred, the facility’s patient safetycommittee, required by N.J.S.A. 26:2H-12.25(b) and N.J.A.C.8:43E-10.4, must have in place a process for employees to alertthe committee to that fact. N.J.A.C. 8:43E-10.5(a)(1). Thenthe patient safety committee must do two things: (1) perform a“root cause analysis” to identify the causes of a SPAE andappropriate corrective action, N.J.A.C. 8:43E-10.3 and -10.4(d)(7); and (2) report the SPAE to the DOH and to theaffected patient. Regarding the latter, the patient safety committee mustreport all SPAEs to the DOH, N.J.S.A. 26:2H-12.25(c), withinfive business days of the event’s discovery, N.J.A.C. 8:43E- 20 10.6(b). The report to the DOH must include, among otherthings, how the event was discovered, the nature of the event,and what corrective actions were taken. N.J.A.C. 8:43E-10.6(c).A failure to report a SPAE to the DOH can subject a facility tocivil monetary fines. See N.J.A.C. 8:43E-3.4(a)(14). Thehealth care facility also must alert the affected patient to theSPAE, N.J.S.A. 26:2H-12.25(d); N.J.A.C. 8:43E-10.7(a)(1), andgenerally must do so within twenty-four hours of the event’sdiscovery, N.J.A.C. 8:43E-10.7(b). Notably, the PSA confers a privilege on a facility’s self-critical analysis and the reporting of a SPAE to the DOH. SeeC.A., 219 N.J. at 467. The PSA bars discovery of “[a]nydocuments, materials, or information received by the [DOH]” inthe context of reporting a SPAE. N.J.S.A. 26:2H-12.25(f)(1);N.J.A.C. 8:43E-10.9(a)(1). Similarly, regarding information developed as part of theprocess of self-critical analysis, the PSA provides that [a]ny documents, materials, or information developed by a health care facility as part of a process of self-critical analysis conducted pursuant to subsection b. of this section [(codified as N.J.S.A. 26:2H-12.25(b))] concerning preventable events, near-misses and adverse events, including serious preventable adverse events, and any document or oral statement that constitutes the disclosure provided to a patient or the patient’s family member or guardian pursuant to subsection d. of this section [(codified as N.J.S.A. 26:2H-12.25(d))], shall not be: 21 subject to discovery or admissible as evidence or otherwise disclosed in any civil, criminal, or administrative action or proceeding. [N.J.S.A. 26:2H-12.25(g)(1).]Regulations promulgated to clarify the PSA’s self-critical-analysis privilege delineated in section 12.25(g) specify thatthe documents, materials, or information must have beendeveloped “exclusively during the process of self-criticalanalysis” performed pursuant to N.J.A.C. 8:43E-10.4, -10.5, or -10.6. N.J.A.C. 8:43E-10.9(b); accord C.A., 219 N.J. at 467-68(discussing exclusivity requirement of N.J.A.C. 8:43E-10.9(b)(1)). As stated in C.A., pursuant to N.J.A.C. 8:43E-10.9, . . . the statutory privilege applies only to documents, materials and information developed exclusively during self-critical analysis conducted during one of three specific processes: the operations of the patient or resident safety committee pursuant to N.J.A.C. 8:43E-10.4, the components of a patient or resident safety plan as prescribed by N.J.A.C. 8:43E-10.5, or reporting to regulators under N.J.A.C. 8:43E-10.6. In the regulations that became effective in 2008, the statutory standard was expanded upon in two significant respects: first, to require that the documents, materials and information at issue be “exclusively” prepared in the setting of a qualifying self-critical analysis process, and second, to mandate that the self-critical analysis be conducted in accordance with one of three accompanying regulations as a prerequisite for the privilege to attach, N.J.A.C. 8:43E-10.4, -10.5 and -10.6. [ 219 N.J. at 468 (citations omitted).] 22 Although not presented in the facts of C.A., we dismissed,in dicta, an argument that a finding that an event is notreportable should abrogate the self-critical-analysis privilege.Id. at 471 n.14. We commented that nothing in the language ofthe PSA “limits the privilege to settings in which the incident[being investigated] is ultimately determined to be subject tomandatory reporting” to the DOH, and, therefore, the self-critical-analysis privilege “is not constrained to cases inwhich the deliberative process concludes with a determinationthat the case is reportable.” Ibid. We added the comment tounderscore our perception, at the time, that the goal offostering facilities’ and health care professionals’ trust inthe secrecy of a privileged process -- so needed for the PSAprocess to work -- implicitly resulted in privileged protectionno matter the ultimate outcome of the review process. Importantly, the privileges provided in the PSA do not barthe discovery or admission into evidence of information thatwould otherwise be discoverable or admissible. Even thoughparticular information, materials, or documents may have beendeveloped in the process either of self-critical analysis orreporting a SPAE to the DOH, such material may nevertheless bediscoverable and admissible if it is obtainable from any othersource or in “any . . . context other than those specified” inthe PSA. N.J.S.A. 26:2H-12.25(h). 23 Relatedly, the PSA provides that its provisions do notchange the discoverability of information or documents obtainedfrom other sources, or in other contexts, as provided in theAppellate Division’s opinion in Christy, issued prior to thePSA’s enactment. N.J.S.A. 26:2H-12.25(k); Christy, 366 N.J.Super. at 544-45 (holding, contrary to hospital’s claim ofprivilege, that plaintiff was entitled to “purely factual”content from hospital’s peer-review report but not todeliberative material).7 The Legislature’s expressacknowledgment of that decision, as well as its nod to documentsobtained through sources other than the PSA’s process of self-critical analysis, leaves no doubt of that Branch’s respect forthe importance of discovery in ensuring the fair resolution oflitigation brought before courts. B. Initially, we note that the trial court was well withinproper judicial bounds when examining the facts underlying theclaim of privilege in this case. When a requesting partydemands information or documents over which the opposing partyclaims a privilege, the responding party may withhold that7 In Christy, an Appellate Division panel balanced the “plaintiff’s right to discover information concerning his care and treatment” against the “public interest to improve the quality of care and help to ensure that inappropriate procedures, if found, are not used on future patients.” 366 N.J. Super. at 541. 24 information or document as long as it expressly asserts theclaimed privilege and details the nature of the informationwithheld. R. 4:10-2(e)(1) (providing for withholding ofrequested privileged information); R. 4:17-1(b)(3) (providingthat party need not reveal privileged information in response tointerrogatory as long as privilege is invoked according to Rule4:10-2(e)(1)). When a requesting party challenges an assertionof privilege, the court must undertake an in camera review ofthe purportedly privileged document or information and makespecific rulings as to the applicability of the claimedprivilege. See Seacoast Builders Corp. v. Rutgers, 358 N.J.Super. 524, 542 (App. Div. 2003) (discussing basic pre-trialdiscovery principles). Here, defendants invoked the PSA’s self-critical-analysisprivilege relating to DCP-2. In order to assess the basis forthe privilege, it was incumbent on the trial court to review, incamera, whether the privilege was properly invoked and whetherthe statutory privilege did, in fact, bar the informationplaintiff sought. See ibid. It was what came next that isproblematic. The claim of privilege asserted here alerted the trialcourt to a set of facts underlying CMH’s self-critical analysis.Based on those facts, the trial court determined that plaintiffwas subjected to a SPAE and that the hospital erred in 25 concluding otherwise. From that conclusion, the courtdetermined that CMH was required to turn over a redacted DCP-2and report the event to the DOH because the PSA requiredreporting of SPAEs to both the DOH and the patient. Althoughthe trial court correctly determined that it could review incamera the facts underlying what the hospital concluded was nota SPAE, we hold that the court exceeded its authority, first indeclaring that a SPAE had occurred and then in issuing itsrelated orders that CMH disclose to plaintiff a redacted versionof DCP-2 and report the event to the DOH. 1. The Legislature inserted no role for a trial court to playin reviewing the SPAE determination made by a patient safetycommittee of a health care facility. By contrast, the PSAprovides a regulatory oversight role for the DOH. TheLegislature vested enforcement of the PSA in the hands of theCommissioner of Health. N.J.S.A. 26:2H-12.25(j) (vesting powerin Commissioner of Health to “adopt such rules and regulationsnecessary to carry out the provisions of [the PSA]”); see alsoN.J.A.C. 8:43E-3.4(a)(14) (providing for civil monetarypenalties for health care facilities failing to disclose SPAEsto DOH). No corresponding role is explicit or implicit in thePSA with regard to a court called upon to resolve a discovery 26 dispute over a privileged document. We decline to entangle thecourts in an essentially administrative function. Accordingly, we need express no opinion on what standardshould govern the determination of whether a SPAE occurred orthe related issues of causation and expert testimony. To theextent that the Appellate Division refined and reversed8 thetrial court’s effort to establish a proper review standard foridentifying an event under review as a SPAE, we vacate theAppellate Division’s analysis. 2. Although we conclude that the trial court erred in passingjudgment as to CMH’s SPAE determination, we neverthelessconsider the discovery remedy it imposed for its finding, namelythe disclosure of the redacted report. The language and structure of the PSA leave no reasonabledoubt about the legislative intent regarding the self-critical-analysis privilege it authorizes. See DiProspero v. Penn, 183 N.J. 477, 492-93 (2005) (noting that statutory-interpretationanalysis begins with plain language of statute and that, wherelanguage of statute is unambiguous, analysis can come to end).The pertinent provisions of N.J.S.A. 26:2H-12.25 evidence an8 The Appellate Division applied a causality analysis, which it determined had not been met due to the absence of any expert analysis in the record before the trial court. Brugaletta, 448 N.J. Super. at 418-19. 27 intent to encase the entire self-critical-analysis process in aprivilege, shielding a health care facility’s deliberations anddeterminations from discovery or admission into evidence. As the Appellate Division properly held, the onlyprecondition to application of the PSA’s privilege is whetherthe hospital performed its self-critical analysis in proceduralcompliance with N.J.S.A. 26:2H-12.25(b) and its implementingregulations. Brugaletta, 448 N.J. Super. at 414-15. N.J.S.A.26:2H-12.25(g), which creates the privilege, does not conditionthe privilege on the finding of a SPAE. The subsection providesno such limiting basis for its invocation. By subsection (g)’svery terms, the privilege it announces encompasses “[a]nydocuments, materials, or information developed by a health carefacility as part of [its] process of self-critical analysis”under subsection (b). Thus, the Legislature’s protectiveprivilege around the process of performing a self-criticalanalysis is broad, provided procedural compliance is present.The privilege otherwise unconditionally protects the process ofself-critical analysis, the analysis’s results, and theresulting reports developed by a facility in its compliance withthe PSA. Our construction of the pertinent language is congruentwith the stated legislative findings and declarations, whichevince a clear purpose to establish a safe, non-punitive 28 environment within which concerns might be brought forth,examined, and used for improvements in patient safety. SeeN.J.S.A. 26:2H-12.24(e) and (f). To construe the statuteotherwise -- by making its protective privilege dependent on aSPAE finding -- would be at cross-purposes with the patentlegislative desire to encourage trust and reporting by healthcare facilities and their employees whenever a concern about anear miss or adverse event comes to light. Our constructiongives effect to all words of the statute. See McCann v. Clerkof Jersey City, 167 N.J. 311, 321 (2001) (“It is a cardinal ruleof statutory construction that full effect should be given, ifpossible, to every word of a statute. We cannot assume that theLegislature used meaningless language.” (quoting Gabin v.Skyline Cabana Club, 54 N.J. 550, 555 (1969))). And, it avoidsreaching a result that thwarts the patent overall legislativedesign. See Murray v. Plainfield Rescue Squad, 210 N.J. 581,592 (2012) (reaffirming that objective of statutoryinterpretation is to effectuate legislative intent). Accordingly, as intimated through dictum in C.A., we nowhold that the finding that an event is not reportable does notabrogate the self-critical-analysis privilege. Because the PSA shields the process of self-criticalanalysis, beginning to end, including its outcome, thehappenstance that a reviewing court becomes convinced that an 29 erroneous conclusion was reached as to whether a SPAE occurredis of no consequence to the privilege determination.Application of the privilege to the documents developed throughself-critical analysis, regardless of the conclusion reached, isan integral part of the legislative scheme on which courtsshould be wary to transgress. See C.A., 219 N.J. at 473 (notingprivilege’s essential role in promoting “thorough and candiddiscussions of events occurring in health care facilities”). In sum, we are compelled to conclude the PSA was misappliedand the trial court’s discretion abused when it declared that aSPAE occurred and ordered CMH to release a redacted form of DCP-2 to plaintiff and report the event to the DOH. See CapitalHealth Sys., 230 N.J. at 79-80. A court may not order therelease of documents prepared during the process of self-critical analysis. IV. Although a court may not order release in discovery of areport developed during self-critical analysis, even ifredacted, and although a court may not determine whether itagrees with the health care facility’s conclusion as to whetheran adverse event constitutes a SPAE and, based on thatdetermination, order disclosure to the DOH, the court’s role inresolving this discovery dispute is far from over. A. 30 Generally, a party “may obtain discovery regarding anymatter, not privileged, which is relevant to the subject matterinvolved in the pending action.” R. 4:10-2(a); see also In reLiquidation of Integrity Ins. Co., 165 N.J. 75, 82 (2000)(“Generally, . . . parties may obtain discovery regarding anynon-privileged matter that is relevant to the subject of apending action or is reasonably calculated to lead to thediscovery of admissible evidence.”). Discovery is availablethrough, among other approved means, written interrogatories.R. 4:10-1. We liberally construe our discovery rules “becausewe adhere to the belief that justice is more likely to beachieved when there has been full disclosure and all parties areconversant with all available facts.” Integrity Ins. Co., 165 N.J. at 82. When a requesting party demands access to or copies ofpapers in an interrogatory, the responding party may decline bystating with specificity the reason for its noncompliance inresponse to the interrogatory. R. 4:17-5(b). When a respondingparty declines to turn over requested documents, the requestingparty may file a motion to compel discovery, R. 4:23-5(c), afterhaving made a good-faith attempt to meet and confer with theresponding party or having notified the responding party thatcontinued noncompliance with the discovery request will lead toa motion to compel, R. 1:6-2(c). 31 In such circumstances, the court has the obligation toresolve the discovery dispute. B. As we stressed earlier, the PSA did not abrogate existinghealth care law and does not immunize from discovery informationthat would be otherwise discoverable. N.J.S.A. 26:2H-12.25(h)(“Notwithstanding the fact that documents, materials, orinformation may have been considered in the process of self-critical analysis . . . , the provisions of this act shall notbe construed to increase or decrease, in any way, theavailability, discoverability, admissibility, or use of any suchdocuments, materials, or information if obtained from any sourceor context other than those specified in this act.”); N.J.A.C.8:43E-10.9(e) (noting that PSA implementing regulations “shallnot be construed to increase or decrease, in any way, theavailability, discoverability, admissibility or use of anydocuments, materials or information otherwise available fromother sources merely because the documents, materials orinformation were presented during proceedings of the patient orresident safety committee”). Part and parcel of defendants’ argument was the assertionthat, although they did not directly disclose the eventsunderlying the trial court’s SPAE determination to plaintiff,they did turn over in discovery plaintiff’s non-privileged 32 medical records, which contain documents detailing the eventsunderlying the patient safety committee’s, and the trialcourt’s, SPAE assessments. Indeed, the record before usdiscloses that among the thousands-of-pages-long patientrecords, there are notations across several pages that, whenread together, reveal the nature of the events underlying thedivergent SPAE determinations of the committee and the trialcourt. Those notations are in plaintiff’s medical recordspursuant to health care law requirements concerning patientrecordkeeping. See N.J.A.C. 8:43G-15.2(e) (mandating inclusionin medical records of “[a]ny adverse incident”9); N.J.S.A. 26:2H-12.8 (providing non-exhaustive list of patient rights including,under subsection (c), patient’s right “[t]o obtain from thephysician complete, current information concerning his9 “Adverse incident” is a differently worded term than “adverse event,” utilized and defined in the PSA and its implementing regulations. See N.J.S.A. 26:2H-12.25(a); N.J.A.C. 8:43E-10.3. The regulations do not define what constitutes an adverse incident. Norms of statutory construction dictate that we look to the ordinary usage of a phrase’s constituent words. See DiProspero, 183 N.J. at 492 (noting, in statutory-construction context, that “[w]e ascribe to the statutory words their ordinary meaning and significance”); see also U.S. Bank, N.A. v. Hough, 210 N.J. 187, 199 (2012) (“We interpret a regulation in the same manner that we would interpret a statute.”). We accordingly find that “adverse” is generally understood to mean “in opposition to one’s interests: detrimental, unfavorable,” Webster’s New Int’l Dictionary 31 (3d ed. 1981), and “incident” means “an occurrence of an action or situation felt as a separate unit of experience,” id. at 1142. 33 diagnosis, treatment, and prognosis in terms he can reasonablybe expected to understand”); N.J.A.C. 8:43G-4.1 (implementingN.J.S.A. 26:2H-12.8 and expanding list of patient rights);N.J.A.C. 8:43G-4.1(a)(24) and (25) (establishing patient’s right“[t]o have prompt access to the information contained in thepatient’s medical record,” and “[t]o obtain a copy of thepatient’s medical record”). Here, based on a review of the record before us, includingdefendants’ confidential appendix, it is apparent that plaintiffwas subjected to an adverse incident, per N.J.A.C. 8:43G-15.2(e). Although they did not use the term “adverse incident,”that much is discernible from the information that plaintiff’sdoctors and CMH placed in her patient records. That raw factualinformation was documented in plaintiff’s patient records wellbefore the process of self-critical analysis was commenced inher instance, which resulted in the report over which theparties clashed as a principle of privilege. Although, as we have held, DCP-2 is not subject todisclosure in discovery, even in redacted form, defendantsrightly did not object to release of the raw underlying factualdata and did, in fact, produce that material. But, it is buriedwithin mounds of plaintiff’s patient records. Specificity as towhere to find that information is lacking. Yet, when called onto defend against the release of privileged information, 34 defendants provided the court a concise step-by-step narrative,walking the court through the relevant excerpts of plaintiff’spatient records, to demonstrate that defendants had providedplaintiff with the underlying non-privileged facts about hercare that sufficiently addressed the information requested ininterrogatory number five and that could be disclosed withoutpiercing the PSA privilege. The trial court redacted DCP-2 in its effort to effectuatethe release of purely factual information while simultaneouslyprotecting deliberative material related to CMH’s self-criticalanalysis. The court’s purpose -- to achieve a fair resolutionto a difficult discovery issue -- was proper. However, thecourt should not have used a self-critical-analysis document toachieve its goal. Instead, the trial court should have used its common lawpower, in administering the discovery rules, to order defendantsto provide plaintiff a narrative similar in form to the one theypresented the court. That court-ordered remedy would haveallowed the court to balance the litigation interests of theparties, to avoid transgressing the privilege and the salutarypurposes it is intended to achieve, and to keep the courts outof a regulatory scheme in which we have no role vis-à-visdeclarations of SPAEs. Plaintiff was unquestionably entitled tothe raw data contained in her patient records. And mandating a 35 narrative to steer her to that information would have requireddefendants to identify, as they should have, an adverse incidentto plaintiff, see N.J.A.C. 8:43G-15.2(e), in language she couldunderstand, see N.J.S.A. 26:2H-12.8(c). C. The Court Rules provide that an evasive or incompleteanswer given in response to a discovery request, such as aninterrogatory, is treated as a failure to answer. R. 4:23-1(b).Where an interrogatory requests information that can be derivedfrom documents to which the requesting party has access, it maybe a sufficient answer to that interrogatory to pointspecifically to documents from which the requesting party canderive a response in keeping with Rule 4:17-4(d). That ruleprovides that it is a sufficient answer to such interrogatory to specify the records from which the answer may be derived or ascertained and to afford to the party serving the interrogatory reasonable opportunity to examine, audit or inspect such records and to make copies, compilations, abstracts or summaries. A specification shall be in sufficient detail to permit the interrogating party to locate and to identify, as readily as can the party served, the records from which the answer may be ascertained. [R. 4:17-4(d).]Importantly, the rule states that a specification is warrantedwhen “the burden of deriving or ascertaining the answer is 36 substantially the same for the party serving the interrogatoryas for the party served.” Ibid. Rule 4:17-4(d), adopted in 1972, “is taken from FederalRule of Civil Procedure 33(c).[10]” John H. Klock, 1B N.J.Practice: Court Rules Ann. cmt. 5 to R. 4:17-4 (6th ed. 2010).The Federal Rule, the language of which was substantiallyadopted in our Rule,11 provides that [i]f the answer to an interrogatory may be determined by examining, auditing, compiling, abstracting, or summarizing a party’s business records (including electronically stored information), and if the burden of deriving or ascertaining the answer will be substantially the same for either party, the responding party may answer by: (1) specifying the records that must be reviewed, in sufficient detail to enable the interrogating party to locate and identify them as readily as the responding party could; and (2) giving the interrogating party a reasonable opportunity to examine and audit the records and to make copies, compilations, abstracts, or summaries. [Fed. R. Civ. P. 33(d).]10 The federal option to produce business records, from which Rule 4:17-4(d) is derived, was renumbered and is now found at Fed. R. Civ. P. 33(d). 11 Notably, New Jersey is not the only state to substantially adopt the text of Federal Rule of Civil Procedure 33(d) into its Court Rules. See, e.g., Ala. R. Civ. P. 33(c); Del. Super. Ct. Civ. R. 33(d); Mass. R. Civ. P. 33(c); Pa. R. Civ. P. 4006(b); Tex. R. Civ. P. 197.2(c). 37 Federal Rule 33(d) is normally discussed in the context ofa party’s invocation of the rule in response to an interrogatoryand a subsequent challenge to the sufficiency of that responseby the requesting party through a motion to compel discovery.See, e.g., United States ex rel. Landis v. Tailwind SportsCorp., 317 F.R.D. 592, 594 (D.D.C. 2016) (noting that matterappeared before court in context of challenge to invocation ofoption to produce business records); S.E.C. v. Elfindepan, 206 F.R.D. 574, 576 (M.D.N.C. 2002) (“The [c]ourt normally firstbecomes involved when a party files a motion to compel.”). Bycontrast, the parties here have not invoked our analogue to thatrule, Rule 4:17-4(d); instead, the records have been presentedas a matter of course, and the issue is whether the presentationis sufficiently specific. Nevertheless, because our Rule 4:17-4(d) is derived from Federal Rule of Civil Procedure 33(d), “itis appropriate to look to federal decisions for guidance” ininterpretation of the rule. See, e.g., Adler v. Shelton, 343 N.J. Super. 511, 523-26 (Law Div. 2001) (interpreting Rule 4:10-2(d) by reference to federal cases discussing Federal Rule ofCivil Procedure 26). Generally, the federal option to provide business recordshas been understood to prohibit responding parties from usingthe option to refer to business records as a way to burden arequesting party. See 7 James W. Moore et al., Moore’s Federal 38 Practice § 33.105(1) (3d ed. 1997).12 According to the AdvisoryCommittee on the 1970 Amendments to the Federal Rules, [t]he interrogating party is protected against abusive use of this provision through the requirement that the burden of ascertaining the answer be substantially the same for both sides. A respondent may not impose on an interrogating party a mass of records as to which research is feasible only for one familiar with the records. [Fed. R. Civ. P. 33 advisory committee’s note to 1970 amendment.] When assessing the relative burdensomeness of a requestthat the responding party provide some narrative answer versusthe burdensomeness of requiring the requesting party to perusedocuments to ferret out the answer, courts have looked towhether the documents were “voluminous or incapable of beingdeciphered” by the requesting party. See Sodofsky v. FiestaProds., LLC, 252 F.R.D. 143, 148 (E.D.N.Y. 2008). Thus, whererecords are “well-organized, clear and straightforward,” a courtusually will find that the burden on the requesting party is12 Generally, when determining whether a response utilizing documents under Federal Rule 33(d) is sufficient, courts consider the following: (1) whether the documents to which the responding party points contain the information sought in the interrogatory; (2) whether the responding party has pointed with sufficient specificity to the documents containing the information sought in the interrogatory; and (3) whether the burden on the responding party to produce a narrative response is the same as the burden on the requesting party to look to the referenced documents and derive the requested information therefrom. Sodofsky v. Fiesta Prods., LLC, 252 F.R.D. 143, 147 (E.D.N.Y. 2008). 39 equal to that of the responding party and, therefore, permit aresponding party to answer an interrogatory by mere reference tobusiness records. See id. at 148-49. But more, in the form ofspecification, explanation, or narrative, may be required. The United States Court of Appeals for the Third Circuit,applying the federal analogue to our rule, found in Al Barnett &Son, Inc. v. Outboard Marine Corp. that invocation of the optionto refer to business records in response to an interrogatoryplaced a heavier burden on the requesting party where “each[responding] party served with interrogatories was more familiarwith his bookkeeping methods and records than was the[requesting party].” 611 F.2d 32, 35 (3d Cir. 1979). In thatmatter, the defendant served interrogatories requestingfinancial information relating to the plaintiff’s antitrustdamages and the responding party attempted to invoke FederalRule 33’s option to produce business records. Id. at 34. Thecourt there found that because “[m]any of the records werehandwritten, and apparently difficult to read,” and theresponding parties were more familiar with the records, it wasmore burdensome on the requesting party to derive the requestedinformation from the documents than it was for the respondingparty to extract that same information and provide it to therequesting party. Id. at 35. Thus, in that case, theresponding party was ordered to provide an accompanying 40 narrative response. Id. at 34-35; see also Sabel v. MeadJohnson & Co., 110 F.R.D. 553, 554, 556-57 (D. Mass. 1986)(ordering responding party to provide narrative answer inresponse to interrogatory where, initially, responding partymerely pointed to 154,000-page document). Although no similar reported case law exists in New Jersey,our trial courts have the authority under Rule 4:17-4(d) tocompel a party producing documentary records to provide, withthe records, a narrative that specifies for the requesting partywhere responsive information may be found. We do not mean tosuggest that such a narrative is to be routinely provided indiscovery, but it is within the range of court-ordered remediesthat may be required to resolve a discovery dispute. Under thecircumstances presented in this appeal, where a patient sufferedan incident adverse to her interests and identifying features ofthat incident are memorialized in her patient chart, theprivileged nature of one document created during the process ofself-critical analysis does not prevent a more fulsome answer tointerrogatory number five. Although the patient chart entriesrelate to a later and otherwise privileged process under thePSA, the underlying data is not privileged. Notwithstandingthat this setting is different from most in which an ordercompelling a narrative usually arises, as noted above, wehighlight this power of the courts under the Court Rules as a 41 means for balancing the litigation interests in this matter,promoting a fair trial, and securing the public policiesinherent in the maintenance of a strong self-critical-analysisprivilege under the PSA. Plaintiff was entitled to be informed of an adverseincident related to her care in defendants’ response todiscovery demands because such an incident was memorializedthrough various entries in her patient records. Yet, she wasnot informed of it and, notwithstanding her fifth interrogatory,received no specification or narrative to accompany theapproximately 4500 pages of medical records turned over duringdiscovery that would lead her to the discrete yet interconnectednotations of the incident that appear on nine pages of thatrecord. As explained earlier, see supra at ___ (slip op. at 35-36), in these circumstances, we hold that the trial courtshould, on remand, order a narrative to accompany the documentsalready turned over to plaintiff in order to satisfy defendants’obligation to provide a complete response to interrogatorynumber five.13 V.13 In this matter, we resolve the instant discovery dispute as it arose. Our dissenting colleague makes broader pronouncements about the Patient Bill of Rights that are not material to the outcome of this case. We do not do so, and we disagree with the dissent’s attempt to cast our opinion in such a light. 42 We affirm in part and reverse in part the AppellateDivision judgment, and we remand for proceedings in accordancewith this opinion. We do not retain jurisdiction. CHIEF JUSTICE RABNER and JUSTICES PATTERSON, FERNANDEZ- VINA, SOLOMON, and TIMPONE join in JUSTICE LaVECCHIA’s opinion. JUSTICE ALBIN filed a dissenting opinion. 43 SUPREME COURT OF NEW JERSEY A- 66 September Term 2016 079056JANELL BRUGALETTA, Plaintiff-Appellant, v.CALIXTO GARCIA, D.O., STEVEN D. RICHMAN, M.D. and PATRICK J. HINES, M.D., Defendants, andCHILTON MEMORIAL HOSPITAL, Defendant-Respondent. JUSTICE ALBIN, dissenting. Plaintiff received treatment and care at Chilton MemorialHospital for serious medical illnesses, including a flesh-eatingbacterial infection. Plaintiff’s physician ordered a course ofantibiotics to address her critical medical condition. Despitethat order, health care professionals at Chilton failed toadminister doses of the antibiotics for a period of time. Noone at Chilton told the plaintiff-patient about this seriouslapse in her treatment. The information, though not easy tofind in plaintiff’s 4500-page medical chart, was released indiscovery after plaintiff filed a medical malpractice lawsuit,which did not identify the missed doses. 1 Unlike the majority, I would make clear that the patienthad a right to be told about the lapse in her treatment at thetime it occurred and in a way that she reasonably could haveunderstood. The patient’s right to know is not dependent on herfiling a medical malpractice lawsuit or requesting theinformation in a well-crafted interrogatory question. Thepatient’s affirmative right to know is enshrined in the publicpolicy of this State by laws passed by the Legislature. In enacting the Patient Bill of Rights, the Legislatureconferred on a patient admitted to a hospital the right to know“complete, current information concerning his diagnosis,treatment, and prognosis in terms he can reasonably be expectedto understand.” N.J.S.A. 26:2H-12.8(c). The Patient SafetyAct, N.J.S.A. 26:2H-12.23 to -12.25c, must be reconciled withthe Patient Bill of Rights, for both are part of a largerstatutory scheme known as the Health Care Facilities PlanningAct, N.J.S.A. 26:2H-1 to -26. The Patient Safety Act -- likethe Patient Bill of Rights -- confers on a patient the right toknow critical information about her care and treatment. To thatend, the Patient Safety Act specifically provides that a healthcare facility must inform a patient that she has been “affectedby a serious preventable adverse event . . . no later than theend of the episode of care, or, if discovery occurs after theend of the episode of care, in a timely fashion.” N.J.S.A. 2 26:2H-12.25(d); see also N.J.A.C. 8:43E-10.7(a) (“A health carefacility shall ensure that a patient . . . is informed of thefollowing: (1) Any serious preventable adverse event thataffected the patient[.]”). The majority has written out of the statute this importantpatient right by declaring that a court is not empowered toorder a health care facility to disclose to a patient that shehas suffered a serious preventable adverse event. See ante at___ (slip op. at 26) (“The Legislature inserted no role for atrial court to play in reviewing the [serious-preventable-adverse-event] determination made by a patient safety committeeof a health care facility.”). In effect, the majority has madehealth care facilities the final judge of whether a patient hassuffered a serious preventable adverse event. The majorityoffers no authority, statutory or case law, for sweeping awaythe right of judicial review -- the most elemental courtfunction. Nor has the majority adequately explained why thePatient Bill of Rights does not stand as an independent basisfor disclosure, whether an adverse event was serious andpreventable or not. Neither the trial court nor the AppellateDivision entertained any question about the role of judicialreview in this process, even though the Appellate Divisionconcluded that the trial court erred in its determination that aserious preventable adverse event occurred in this case. 3 I agree with the majority that “[p]laintiff was entitled tobe informed of an adverse incident related to her care indefendants’ response to discovery demands because such anincident was memorialized through various entries in her patientrecords.” Ante at ___ (slip op. at 42); see N.J.A.C. 8:43G-15.2(e) (“Any adverse incident, including patient injuries,shall be documented in the patient’s medical record.”).However, plaintiff was entitled to that information, even if ithad not been entered in her patient records as required byN.J.A.C. 8:43G-15.2(e), and even if she had not demanded theinformation in a medical malpractice lawsuit pursuant to thePatient Bill of Rights. The majority’s crabbed interpretationof the Patient Safety Act erodes significant rights theLegislature conferred on patients. In my view, sufficient credible evidence in the recordsupports both the trial court’s conclusion that a seriouspreventable adverse event occurred and its order disclosing theinformation in redacted form. Under the Patient Safety Act,that information could not be directly used in the lawsuitbecause the information was generated through the self-critical-analysis process. N.J.S.A. 26:2H-12.25(g)(1). I agree with themajority that, pursuant to that Act, the health care facilitywaives the privilege only if it does not follow the self-critical-analysis procedures set forth in the statute. Ante at 4 ___ (slip op. at 28). The trial court clearly erred in findingthat a health care facility waives the self-critical-analysisprivilege if it acts “arbitrarily” by not disclosing informationrequired by the Patient Safety Act. Even if the event was notserious and preventable, however, it certainly was adverse andsubject to disclosure under the Patient Bill of Rights.1 Ultimately, by requiring the hospital to provide aforthright narrative in response to an interrogatory question,the majority’s remedy will provide this plaintiff with easieraccess to critical patient information buried in mounds ofdiscovery. But in the next case, and other cases, where thecritical patient information is not released in discovery ormade part of the patient’s record, the majority, by itsexpansive reading of the privilege in the Patient Safety Act,may have diminished the patient’s right to know. To be sure, the self-critical-analysis privilege in thePatient Safety Act plays an important role in fostering andencouraging candor among health care professionals and thereforein critiquing their performances and improving the delivery ofmedical services for all patients. The self-critical-analysisprivilege will bar a plaintiff-patient from directly introducing1 Nothing in the Patient Bill of Rights suggests that disclosed information about a patient’s “diagnosis, treatment, and prognosis” is privileged. 5 disclosed information about her treatment and care, recordedpursuant to the Patient Safety Act, in a lawsuit against ahospital or health care professionals. N.J.S.A. 26:2H-12.25(g)(1). But the privilege does not render meaningless thePatient Bill of Rights and cannot justify withholding from thepatient critical information about serious mistakes made duringher treatment and care. See N.J.S.A. 26:2H-12.8(c). ThePatient Safety Act should not be construed to extinguish thePatient Bill of Rights. The statutory scheme does not sacrificethe patient’s right to know the truth about her medicaltreatment on the altar of the privilege. The failure of the majority to give meaning to the fullnessof the Patient Bill of Rights and the Patient Safety Act leavesme no choice but to respectfully dissent. 6