Title: Ex parte Altapointe Health Systems, Inc.
Citation: N/A
Docket Number: 1160544
State: Alabama
Issuer: Alabama Supreme Court
Date: September 8, 2017

Rel: 09/08/2017
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
SPECIAL TERM, 2017
____________________
1160544
____________________
Ex parte Altapointe Health Systems, Inc., and Altapointe
Healthcare Management, LLC
PETITION FOR WRIT OF MANDAMUS
(In re: Jim Avnet, father and next friend of Hunter Avnet,
an incompetent person
v.
Altapointe Health Systems, Inc., and Altapointe Healthcare
Management, LLC)
(Mobile Circuit Court, CV-16-900514)
MAIN, Justice.
1160544
Altapointe 
Health 
Systems, 
Inc., 
and 
Altapointe
Healthcare 
Management, 
LLC 
(hereinafter 
referred 
to
collectively as "Altapointe"), petition for a writ of 
mandamus
directing the Mobile Circuit Court to vacate its order
compelling Altapointe 
to 
respond 
to 
certain 
discovery requests
and to enter a protective order in its favor in an action
pending against it.  We grant the petition in part and deny it
in part.
I.  Facts and Procedural History 
On March 13, 2016, Jim Avnet, as father and next friend
of Hunter Avnet, sued Altapointe Health Systems, Inc., and
Altapointe Healthcare Management, LLC, in the Mobile Circuit
Court.  Altapointe operates group homes for adults suffering
from mental illness.  Avnet asserted that Hunter, a resident
at one of Altapointe's group homes, was assaulted by another
resident, Kerdeus Crenshaw.  Avnet alleged that Hunter was
attacked by Crenshaw with a blunt object and was stabbed
numerous times in the head with a kitchen knife.  Hunter
sustained serious injuries as a result of the attack.  Avnet
asserted various claims of negligence and wantonness against
Altapointe, including claims that Altapointe failed to comply
2
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with various unspecified regulations and guidelines designed
to protect Hunter's safety and that Altapointe was negligent
or wanton in hiring, training, and supervising its employees.
Along with his complaint, Avnet served Altapointe with
written 
discovery 
requests. 
 
Avnet's 
discovery requests 
sought 
the total amount of Altapointe's liability-insurance coverage
limits; 
information regarding 
prior 
claims 
or 
lawsuits 
against
Altapointe alleging personal injury or assault at the home;
information concerning whether Altapointe was aware of any
previous "aggressive acts" by Crenshaw; and information and
documents regarding Altapointe's own investigation of the
incident.
Altapointe objected to Avnet's discovery requests,
contending that the information and documents requested were
protected by certain discovery privileges.  With regard to the
request for its insurance limits and information regarding
prior claims, Altapointe contended that the discovery was
barred by provisions of the Alabama Medical Liability Act, §
6-5-480 et seq., Ala. Code 1975, and § 6-5-540 et seq., Ala.
Code 1975 ("the AMLA") –- specifically, § 6-5-548(d), Ala.
Code 1975, and § 6-5-551, Ala. Code 1975.  Section 6-5-548(d)
3
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bars discovery of "[t]he limits of liability insurance
coverage available to a health care provider."  Section 6-5-
551 prohibits a party from conducting discovery "with regard
to any other act or omission."  With regard to the
interrogatory as to whether Altapointe had knowledge of prior
"aggressive acts" by Crenshaw, Altapointe contended that it
could not respond to the interrogatory without violating the
psychotherapist-patient privilege.  See § 34-26-2, Ala. Code
1975; Rule 503, Ala. R. Evid.  Finally, Altapointe argued that
discovery 
of 
information 
and 
documents related 
to 
Altapointe's
own investigation into the incident was precluded by the
quality-assurance privilege of § 22-21-8, Ala. Code 1975.
Avnet then moved to compel production of the discovery
objected to by Altapointe.  Altapointe opposed the motion to
compel and moved for a protective order.  On March 21, 2017,
following a hearing, the trial court entered an order granting
Avnet's motion to compel and denying Altapointe's motion for
a protective order.  The trial court ordered Altapointe to
provide the requested discovery within 10 days of the order. 
This petition followed.
II.  Standard of Review
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"'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)."
Ex parte Fairfield Nursing & Rehabilitation Ctr., L.L.C., 22
So. 3d 445, 447 (Ala. 2009).
III.  Analysis
Altapointe first contends that the trial court erred in
compelling discovery relating to Altapointe's liability-
insurance coverage limits and prior claims.  Specifically, it
5
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argues that that information is protected from discovery by
two provisions of the AMLA.   Section 6-5-548(d) bars
discovery of "[t]he limits of liability insurance coverage
available to a health care provider," and § 6-5-551 bars
discovery "with regard to any other act or omission."  To
determine whether those provisions preclude the discovery
sought, we must make a threshold determination as to whether
Avnet's claims fall under the AMLA.
The AMLA applies "[i]n any action for injury or damages
or wrongful death, whether in contract or in tort, against a
health care provider for breach of the standard of care."  §
6-5-548(a), Ala. Code 1975.  There is no dispute that
Altapointe is a "health-care provider" as that term is defined
by the AMLA.  Nevertheless, the AMLA does not apply to all
claims against health-care providers arising out of the
relationship 
between 
the 
health-care provider 
and 
the 
patient. 
Ex parte Addiction & Mental Health Servs., Inc., 948 So. 2d
533 (Ala. 2006).
"'[T]he [AMLA] applies "only to medical-
malpractice actions," Mock v. Allen, 783
So. 2d 828, 832 (Ala. 2000), "in the
context of patient-doctor and patient-
hospital relationships."  Thomasson [v.
Diethelm], 457 So. 2d [397,] 399 [(Ala.
6
1160544
1984)]. 
 By definition, 
a "medical-
malpractice action" is one for redress of
a "medical injury."  See 6-5-540 (purpose
of the [AMLA] is to regulate actions for
"alleged medical injury") (emphasis added
[in Taylor]); see also Ala. Code 1975, § 6-
5-549.1 (same).'"
Addiction & Mental Health Servs., 948 So. 2d at 535 (quoting
Taylor v. Smith, 892 So. 2d 887, 893 (Ala. 2004)).  
Recently, in Ex parte Vanderwall, 201 So. 3d 525, 537
(Ala. 2015), this Court reviewed a case in which a physical
therapist was alleged to have sexually assaulted a patient  by
inappropriately touching the patient's genitals and breasts
during a physical-therapy appointment.  It was 
undisputed that
there was no therapeutic or medical reason for the therapist
to have touched the patient in such a manner.  In Vanderwall,
this Court explored the text and interpretative history of the
AMLA and concluded that the AMLA was not applicable to the
claim and, thus, did not provide the physical therapist 
relief from discovery of information relating to other acts or
omissions on the part of the physical therapist.  In reaching
this conclusion we overruled the "place and time" rule
previously applied this Court.1  We concluded: "[I]t is clear
1In Vanderwall, we reasoned:
7
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that the AMLA is not just concerned with who committed the
alleged wrongful conduct or when and where that conduct
occurred, but also with whether the harm occurred because of
the provision of medical services."  201 So. 3d at 537-38.
In this case, Hunter is alleged to have suffered a
violent and unprovoked attack by a fellow resident of the
group home in which he lived.  The gravamen of Avnet's
complaint is that Altapointe negligently and wantonly failed
to safeguard Hunter from such an attack.  There are no express
allegations of medical negligence.  Rather, Altapointe's
contention that the AMLA applies to Avnet's claims relies
"Vanderwall has asked us to apply an interpretation
of the AMLA from cases that exalt a broad reading of
the statute over the plain text. Mock [v. Allen, 783
So. 2d 828 (Ala. 2000),] and O'Rear [v. B.H., 69 So.
3d 106 (Ala. 2011),] posit that the legislature
intended the AMLA to apply to any action in which
the alleged injury was inflicted by a medical
provider at the same place and time as medical
treatment, rather than applying only to actions in
which the alleged injury occurred because of medical
treatment. ...  We do not believe the legislature
intended for the protections afforded under the AMLA
to apply to health-care providers who are alleged to
have committed acts of sexual assault; such acts do
not, by any ordinary understanding, come within the
ambit 
of 
'medical 
treatment' 
or 
'providing
professional services.'"
201 So. 3d at 536-37. 
8
1160544
solely on the fact that the attack occurred in its facility. 
Altapointe summarizes its argument as follows:
"Hunter Avnet's mental illness prevented him from
being able to independently live and care for
himself, hence his residency at [the group home]. 
The attack on Hunter Avnet occurred during his
residency.  Thus, Hunter Avnet's injuries, and
subsequent legal claims, arose out the rendition of
healthcare services."
(Altapointe's petition, at 13.)   Altapointe's contention,
however, merely applies the discredited "time and place"
argument to the facts of this case; it has submitted no actual
evidence linking the violent assault on Hunter to his medical
care.  Because there is no evidence before us that would
permit us to conclude that the assault on Hunter was somehow
linked to the administration of medical care or professional
services by Altapointe, we cannot say that the AMLA applies to
Avnet's claims.  Accordingly, Altapointe has not established
a clear legal right to an order limiting discovery under the
above provisions of the AMLA.
Next, we turn to the Altapointe's contention that it was
entitled to a protective order from the discovery sought
related to any prior aggressive acts by Crenshaw on the basis
of the psychotherapist-patient privilege.  In his written
9
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discovery request to Altapointe, Avnet propounded the
following interrogatory:
"Prior to the incident made the basis of this
lawsuit, were the Defendants aware of any prior
aggressive acts of K[e]rdeus Crenshaw based on any
reports, 
incarcerations, 
arrests, 
convictions,
treatments, or other similar incidences at any
location?"
Altapointe objected to this interrogatory on the ground that
to answer it would violate the psychotherapist-patient
privilege.  In essence, Altapointe argues that, because all of
its knowledge of Crenshaw stems from the patient-provider
relationship, 
answering 
Avnet's 
interrogatory 
would
necessarily violate the psychotherapist-patient privilege.
This argument, however, is based on an overbroad definition of
the privilege.
The psychotherapist-patient privilege is intended to
protect confidential relations and communications between a
patient and his or her psychotherapist.  We have described the
privilege and its underlying public policy as follows:
"The 
psychotherapist-patient 
privilege, 
as
adopted by the legislature, provides, in pertinent
part, 
that 
'the 
confidential 
relations 
and
communications 
between 
licensed 
psychologists,
licensed psychiatrists, or licensed psychological
technicians and their clients are placed upon the
same basis as those provided by law between attorney
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1160544
and client, and nothing in this chapter shall be
construed 
to 
require 
any 
such 
privileged
communication to be disclosed.'  Ala. Code 1975, §
34-26-2.  Rule 503, Ala. R. Evid., 'Psychotherapist-
Patient Privilege,' provides further explication of
this privilege, providing, in pertinent part:
"'(b) General Rule of Privilege.  A
patient has a privilege to refuse to
disclose and to prevent any other person
f r o m  
d i s c l o s i n g  
c o n f i d e n t i a l
communications, made for the purposes of
diagnosis or treatment of the patient's
mental or emotional condition, including
alcohol or drug addiction, among the
patient, 
the 
patient's 
psychotherapist, 
and
persons who are participating in the
diagnosis or treatment under the direction
of the psychotherapist, including members
of the patient's family.
"'(c) Who May Claim the Privilege. 
The privilege may be claimed by the
patient, 
the 
patient's 
guardian 
or
conservator, 
or 
the 
personal 
representative
of a deceased patient.  The person who was
the psychotherapist at the time of the
communication 
is 
presumed 
to 
have 
authority
to claim the privilege but only on behalf
of the patient.
"'....'
"....
"'The strength of the public policy on which the
statutory 
psychotherapist-patient privilege 
is 
based
has been well recognized by this Court.  It follows
that the privilege is not easily outweighed by
competing interests.'  Ex parte United Serv.
Stations, Inc., 628 So. 2d 501, 504 (Ala. 1993). 
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1160544
The Court has explained the public policy that
supports the privilege as follows:
"'Statutes such as § 34-26-2 are
intended to inspire confidence in the
patient and encourage him in making a full
disclosure to the physician as to his
symptoms and condition, by preventing the
physician from making public information
that 
would 
result 
in 
humiliation,
embarrassment, or disgrace to the patient,
and are thus designed to promote the
efficacy of the physician's advice or
treatment.  The exclusion of the evidence
rests in the public policy and is for the
general interest of the community.  See 81
Am. Jur. 2d Witnesses § 231 at 262 (1976);
Annot., 44 A.L.R.3d 24 Privilege, in
Judicial or Quasi-judicial Proceedings,
Arising 
from 
Relationship 
Between
Psychiatrist or Psychologist and Patient
(1972).
"'"[A] psychiatrist must have his
patient's confidence or he cannot
help 
him. 
'The 
psychiatric
patient confides more utterly
than anyone else in the world. 
He exposes to the therapist not
only what his words directly
express; he lays bare his entire
self, his dreams, his fantasies,
his sins, and his shame.  Most
p a t i e n t s  
w h o  
u n d e r g o
psychotherapy know that this is
what will be expected of them,
and that they cannot get help
except on that condition. ...  It
would be too much to expect them
to do so if they knew that all
they say -- and all that the
psychiatrist learns from what
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they say -- may be revealed to
the whole world from a witness
stand.'"
"'Taylor v. United States, 222 F.2d 398,
401 (D.C. Cir. 1955), quoting Guttmacher
and Weihofen, Psychiatry and The Law
(1952), p. 272.'
"Ex parte Rudder, 507 So. 2d 411, 413 (Ala. 1987)."
Ex parte Northwest Alabama Mental Health Ctr., 68 So. 3d 792,
796-97 (Ala. 2011). 
Unlike Northwest Alabama Mental Health Center, in which
the plaintiff sought production of all of a patient's mental-
health records, Avnet's request in this case is much
narrower.2  Avnet seeks to know whether Altapointe had
knowledge of any prior "aggressive" actions by Crenshaw.  It
is, of course, possible that Altapointe has knowledge of such
actions acquired through confidential communications with
Crenshaw made during the course of Crenshaw's treatment or
diagnosis.  In that case, such knowledge would be protected by
the psychotherapist-patient privilege.  But it is also
2Before Altapointe filed this petition, Avnet formally
withdrew his request for production of Altapointe's file on
Crenshaw and informed counsel for Altapointe in writing that
he did not seek Crenshaw's medical records and did not
consider such records responsive to any of his discovery
requests.
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possible that Altapointe had knowledge of prior incidents of
violence or aggression that it did not acquire in confidence. 
Rule 503, Ala. R. Evid., defines a "confidential
communication" 
for 
the 
purposes 
of 
the 
psychotherapist-patient
privilege as follows:
"A communication is 'confidential' if not intended
to be disclosed to third persons other than those
present to further the interest of the patient in
the consultation, examination, or interview, or
persons reasonably necessary for the transmission of
the communication, or persons who are participating
in the diagnosis and treatment under the direction
of the psychotherapist, including members of the
patient's family."
Thus, by definition, a patient's interactions with a third
party (other than those described by the rule) are not a
"confidential communications" with a psychotherapist.  Thus,
it follows that a mental-health provider's independent
knowledge of a patient's assault on a third party cannot be
considered as resulting from a confidential communication
protected by the psychotherapist-patient privilege.  By 
way 
of
example, Altapointe presumably knows of Crenshaw's assault of
Hunter because it happened in its facility to one of its
residents, and not because (or at least not solely because) it
was confidentially relayed to Altapointe by Crenshaw in the
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course of his treatment.  Thus, its knowledge of that event is
not the result of a protected confidential communication. 
Likewise, if Altapointe has knowledge of other such incidents
it learned of outside of its confidential comminations and
relations with Crenshaw, its knowledge of such incidents is
discoverable.
Thus, based on the above, we reject Altapointe's blanket
contention that 
all 
information 
within 
its 
knowledge
pertaining to Crenshaw is protected by the psychotherapist-
patient privilege.  Whether any particular information
responsive to Avnet's interrogatory concerning Crenshaw is
protected by 
the 
psychotherapist-patient privilege 
is 
an 
issue
that may be further addressed by the trial court upon a
properly supported motion for a protective order.  Based on
the materials and arguments now before this Court, however, 
Altapointe has not established a clear legal right to relief
from Avnet's discovery under the psychotherapist-patient
privilege.
Finally, Altapointe argues that the incident reports it
prepared in the wake of the Crenshaw's assault on Hunter are
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"quality-assurance" materials protected from disclosure by §
22-21-8.3  Section 22-21-8 provides, in part:
"(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 
function, 
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
3We note that § 22-21-8 is a statute generally applicable
to hospitals and health-care facilities and is not a part of
the AMLA.
16
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of such accreditation, quality assurance or similar
function or other person involved therein. ..."
This Court has given § 22-21-8 a broad interpretation.4 
See, e.g., Fairfield Nursing, 22 So. 3d at 452 (noting that
the language of § 22-21-8 does not require the existence of a
quality-assurance committee or limit the privilege to
materials created by such a committee); Ex parte Krothapalli,
762 So. 2d 836, 839 (Ala. 2000) (noting the "broad language
used by the Legislature" in the title to the act that became
§ 22-21-8).  Nevertheless, the party asserting the quality-
assurance 
privilege 
has 
the 
burden 
of 
proving 
its
applicability as well as the prejudicial effect of disclosing
the information in question.  Ex parte Coosa Valley Health
Care, Inc., 789 So. 2d 208, 219 (Ala. 2000) (noting that, with
regard to § 22-21-8, "the burden of proving that a privilege
exists and proving the prejudicial effect of disclosing the
information is on the party asserting the privilege").
In Fairfield Nursing, a long-term-care facility sought
mandamus relief from an order compelling production of
incident reports related to the alleged wrongful death of a
4Avnet has not asked this Court to revisit its
interpretation of § 22-21-8.
17
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patient.  In support of its assertion of the quality-assurance 
privilege, the facility offered two identically worded
affidavits from its executive director and director of
nursing, which stated:
"'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.'"
22 So. 3d at 448.  We held in Fairfield Nursing that this
evidence was sufficient to support application of 
the 
quality-
assurance privilege.
In Ex parte Qureshi, 768 So. 2d 374 (Ala. 2000), a
patient sued her doctor and the hospital at which the doctor
was credentialed alleging medical malpractice.  The patient
sought discovery from the hospital concerning the doctor's
qualifications.  The hospital objected to the discovery under
§ 22-21-8 and provided an affidavit from the chairman of its
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credentialing committee.  The chairman testified that the
documents responsive to the discovery request were part of the
hospital's credentialing file on the doctor; 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; and that if the
materials were not kept confidential, "'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 376.  Based on this evidence, we held that the
trial court erred in compelling production of the responsive
documents.
In this case, Altapointe submitted the affidavit of
Sherill 
Alexander, 
a 
registered nurse 
employed 
as 
Altapointe's
corporate compliance officer, to support its claim of a
quality-assurance privilege.5  Alexander testified:
5Avnet 
contends 
that 
the 
affidavit was 
untimely 
under 
Rule
6(d), Ala. R. Civ. P., because it was submitted the night
before the hearing on Avnet's motion to compel and
Altapointe's motion for a protective order.  Nothing in the
petition or attachments, however, indicates that Avnet
objected to the affidavit or that the trial court excluded the
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"3.
In the aftermath of the unexpected attack
on Mr. Avnet, Altapointe, through its Performance
Improvement Committee, of which I am a member,
directed a group of employees to investigate the
incident to determine the factors that caused the
incident, and whether adequate safeguards were in
place or whether there needs to be additional
safeguards implemented or put into place to prevent
future incidents from reoccurring.  As a result of
the investigation, we generated a 'Confidential
Incident Report.'
"4.
The process of the investigation, the
interviews 
conducted 
and 
the 
interview
reports/summaries, and the 'Confidential Incident
Report' itself were made for the purpose of quality
assurance.
"5.
The investigation process, the interviews
and interview summaries, and the Incident report are
created to guarantee the high quality of care for
all patients/consumers.
"6.
Confidentiality is 
essential 
to 
ensure 
that
we gather complete and accurate information.
"7.
These documents do not become part of the
consumers'/patients' medical chart, and are used
solely for the purposes of quality assurance and
improvement."
This testimony is precisely the type of evidence we have
previously held to be sufficient to establish the existence of
the quality-assurance privilege.  Accordingly, we hold that
Altapointe sufficiently established the application of the
affidavit.  Thus, we presume that the trial court considered
Alexander's affidavit.  See Ex parte McKenzie, 37 So. 3d 128,
131 n.1 (Ala. 2009).
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privilege.  Thus, the incident reports and related documents
created by Altapointe's Performance Improvement Committee in
response to the incident are not subject to discovery pursuant
to § 22-21-8.
V.  Conclusion
Altapointe has offered sufficient evidence demonstrating
that it is entitled to the quality-assurance privilege
provided in § 22-21-8 as to Avnet's request for information
and documents relating to Altapointe's own investigation of
the incident.  Accordingly, the petition for writ of mandamus
is granted as to that request.  As to the remaining requests,
however, Altapointe has not sufficiently established that the
discovery protections of the AMLA or the psychotherapist-
patient privilege apply.  Thus, as to those requests, the
petition is denied.
PETITION GRANTED IN PART AND DENIED IN PART; WRIT ISSUED.
Bolin, Parker, and Wise, JJ., concur.  
Bryan, J., concurs in the result.
Shaw and Sellers, JJ., concur in part and  dissent in
part. 
Murdock, J., concurs in part, concurs in the result in
part, and  dissents in part.  
Stuart, C.J., recuses herself.
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SHAW, Justice (concurring in part and dissenting in part).  
As to the rulings of the main opinion on the
psychotherapist-patient privilege and the quality-assurance
privilege in Ala. Code 1975, § 22-21-8, I concur.  As to the
portion of the main opinion discussing the applicability of
the Alabama Medical Liability Act ("the AMLA")6 in this case,
I respectfully dissent.
In discussing whether the AMLA applies in this case, the
main opinion in part relies on the decision in Ex parte
Vanderwall, 201 So. 3d 525 (Ala. 2015).   I dissented from 
that decision, but I do not believe that it commands the
result in this case.  It states: "[T]he AMLA is not just
concerned with who committed the alleged wrongful conduct or
when and where that conduct occurred, but also with whether
the harm occurred because of the provision of medical
services."  201 So. 3d at 537.  Not only does Ex parte
Vanderwall acknowledge that "when and where" the wrongful
conduct occurs is relevant, the analysis can also look to
whether harm occurred because of the provision of medical
6See Ala. Code 1975, § 6-5-480 et seq. and § 6-5-540 et
seq.
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services.  To me, all of those factors are relevant in the
instant case.
In its petition for a writ of mandamus, Altapointe7 argues
as follows:
"'The Legislature declared that it enacted the
AMLA in response to increasing health-care costs
caused by "the increasing threat of legal actions
for alleged medical injury."' Ex parte Vanderwall,
201 So. 3d 525, 537 (Ala. 2015)(quoting Ala. Code §
6-5-540 (1975) (citations omitted)). Thus, the AMLA
will apply to actions against healthcare providers
alleging a 'breach of the standard of care.' Ala.
Code § 6-5-540 (1975). A breach of the standard of
care is defined as the 'fail[ure] to exercise such
reasonable, care, skill and diligence as other
similarly situated health care providers in the same
general line of practice, ordinarily have and
exercise in a like case.' Ala. Code § 6-5-548
(1975). This Court has interpreted the AMLA to apply
to 'conduct that is, or that is reasonably related
to, the provision of health-care services allegedly
resulting in a medical injury.' Ex parte Vanderwall,
201 So. 3d at 537 (citations omitted).
"Here, the standard of care applicable to
Altapointe is to provide residential and mental
health care in accordance with other similarly
situated residential mental health facilities.
Providing residential care was an integral part of
the medical care that Hunter Avnet received while at
Country Wood Court Group Home. Hunter Avnet's mental
illness 
prevented 
him 
from 
being 
able 
to
independently live and care for himself, hence his
residency at Country Wood. The attack on Hunter
7As does the main opinion, I use the name "Altapointe" to
refer collectively to the petitioners Altapointe Health
Systems, Inc., and Altapointe Healthcare Management, LLC.
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Avnet occurred during his residency. Thus, Hunter
Avnet's injuries, and subsequent legal claims, arose
out of the rendition of healthcare services.
"Avnet himself characterizes the claims against
Altapointe as based upon the 'fail[ure] to provide
a reasonably safe environment at the Country Wood
Court Group Home.' The very purpose of Country Wood
is to provide residential care in conjunction with
mental health services. Thus, providing a safe
residential environment is both the basis of the
applicable standard of care and Avnet's Complaint.
"Importantly, as part of Avnet's claims, he is
asserting that Altapointe knew or should have known
that Kerdeus Crenshaw was violent, and thus should
have prevented the unexpected attack. In fact, Avnet
claims that 'the remainder of the [discovery]
requests are clearly tailored to discover factual
information 
concerning 
this 
event 
and 
what
Altapointe knew about Kerdeus Crenshaw's potential
for violence.'  In fact, Avnet has gone as far as to
request:
"'A complete copy of the resident file of
K[e]rdeus Crenshaw, including but not
limited 
to: 
write-ups, 
disciplinary
reports, 
disciplinary 
actions,
hospitalizations, 
list 
of 
medicines,
therapeutic 
notes, 
progression 
notes,
interview notes, therapy notes, and any
other type of report, memo, or note, that
in any way touches or concerns K[e]rdeus
Crenshaw.'
"The only source for Altapointe's alleged
knowledge about Crenshaw can only come from
Crenshaw's medical records/mental health treatment.
Thus, Avnet's own allegations point to one logical
conclusion: that the AMLA applies to this action.
"... This case implicates the provision of
medical services to the actual plaintiff within the
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context of a patient-hospital (or residential
facility) relationship. ... Moreover, Avnet's injury
actually occurred during the provision of healthcare
services."
Altapointe's petition, at 12-15 (citations to exhibits
omitted).8 
Altapointe is not arguing that the AMLA applied, as the
main opinion states, "solely on the fact that the attack
occurred in its facility," ___ So. 3d at ___, but also because
the duty it allegedly breached was the failure to provide a
reasonably safe environment at 
the facility, i.e., to properly
house mental-health patients in a mental-health facility.9  It
seems to me that how residents of mental-health facilities are
housed, supervised, and protected from harming themselves or
others involves the "provision of medical services."  Ex parte
Vanderwall, 201 So 3d at 537. Altapointe was not operating a
hotel; it was operating a residential mental-health facility. 
Crenshaw was not a guest; he was a patient.  A decision
8These arguments were made nearly verbatim in the trial
court.
9The Court's application in this case of both the
psychotherapist-patient privilege 
and 
Ala. 
Code 
1975, 
§ 
22-21-
8, demonstrates that there was no dispute that Crenshaw was
receiving psychological care and that the "group home" was a
medical facility.
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regarding whether the residents posed a danger to themselves
or others, and how those residents should be housed to prevent
such danger, involves a medical/psychological determination,
not the decision of a layperson.
The main opinion states: "Because there is no evidence
before us that would permit us to conclude that the assault on
Hunter was somehow linked to the administration of medical
care or professional services by Altapointe, we cannot say
that the AMLA applies to Avnet's claims." ___ So. 3d at ___. 
If the main opinion's holding is indeed based solely on a
perceived failure to produce evidence, then the decision in
this case is limited and should not be read broadly as
adopting a blanket rule prohibiting the application of the
AMLA in cases alleging tortious acts committed by mental-
health patients under the care of a medical provider.  
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SELLERS, Justice (concurring in part and dissenting in part).
I concur in the holding of the main opinion that the
psychotherapist-patient privilege is not so comprehensive as
to exclude all knowledge the operators of a home for mentally
disabled persons might learn about a patient.  I agree that to
the extent a health-care provider has information, not 
learned
in confidence, such information is not subject to the
privilege.  I also concur in the holding that incident reports
prepared 
for 
quality-assurance are 
not 
discoverable. 
 
However,
I dissent from the main opinion insofar as it allows the
plaintiff to discover the limits of liability insurance.  I
believe that, once it is established that a defendant is a
health-care provider, then § 6-5-548, Ala. Code 1975, bars
discovery of insurance limits.  Notwithstanding that the act
that is the subject of litigation may not have been related to
the provision of medical services, once a threshold
determination is made that the defendant is a health-care
provider, insurance limits are not discoverable. 
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MURDOCK, Justice (concurring in part, concurring in 
the 
result
in part, and dissenting in part).
As to the holding of the Court that the Alabama Medical
Liability Act, § 6-5-480 et seq. and § 6-5-540 et seq., Ala.
Code 1975 ("the AMLA"), is not applicable in this case, I
concur in the result.  I concur in that portion of the main
opinion discussing the psychotherapist-patient privilege.  I
respectfully dissent as to the holding of the Court that
certain documents qualify for quality-assurance protection
under § 22-21-8, Ala. Code 1975.
As to the AMLA issue, I write separately only to note
that §§ 6-5-548 and 6-5-551, Ala. Code 1975, apply to "health
care providers."  Section 6-5-542, Ala. Code 1975, defines a
"health care provider" as a "a medical practitioner, dental
practitioner, 
medical 
institution, 
physician, 
dentist,
hospital, or other health care provider as those terms are
defined in Section 6-5-481."  Section 6-5-481(1), Ala. Code
1975, defines "medical practitioner" as one "licensed to
practice medicine or osteopathy," while § 6-5-481(8) defines
"other 
health 
care 
provider" 
as 
"[a]ny 
professional
corporation or any person employed by physicians, dentists, or
hospitals who are directly involved in the delivery of health
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care services."  I am unsure how the defendants in this case
qualify as "health care providers" under these definitions. 
29