Title: HCA Health Services of Virginia v. Levin
Citation: N/A
Docket Number: 992934
State: Virginia
Issuer: Virginia Supreme Court
Date: June 9, 2000

Present:  Carrico, C.J., Hassell, Keenan, Koontz, and Kinser, 
JJ., and Compton and Stephenson, Senior Justices 
 
 
HCA HEALTH SERVICES OF VIRGINIA, 
INC., D/B/A RESTON HOSPITAL 
CENTER, ET AL. 
 
v.  Record No. 992934 
 
STEPHEN M. LEVIN, M.D., ET AL. 
                                          OPINION BY  
SENIOR JUSTICE A. CHRISTIAN COMPTON 
INOVA HEALTH SYSTEM                      June 9, 2000 
 
v.  Record No. 992935 
 
STEPHEN M. LEVIN, M.D., ET AL. 
 
 
FROM THE CIRCUIT COURT OF FAIRFAX COUNTY 
Leslie M. Alden, Judge 
 
 
In these appeals of a contempt order arising from a 
defamation action, we consider the scope and application of the 
statutory privilege from disclosure accorded peer review records 
possessed by certain medical organizations. 
 
In 1998, Stephen M. Levin, M.D., filed an action for 
damages against, among others, WJLA-TV, a television station 
that broadcasts in the Washington, D.C., metropolitan area, 
which includes Northern Virginia and Maryland.  In a second 
amended motion for judgment, the plaintiff, who practices 
medicine in Northern Virginia, sought recovery against 
defendants for defamation, conspiracy, trespass, and the 
unauthorized use of his name and picture. 
 
The lawsuit stems from a news story WJLA-TV and the other 
defendants disseminated about the plaintiff.  A board-certified 
orthopedist, the plaintiff alleges the defendants defamed him by 
accusing him of sexual assaults upon female patients in 
connection with his use of internal pelvic diagnostic 
examinations and "intrapelvic stretching techniques," when the 
patients were suffering from "pelvic floor problems."  The 
plaintiff asserts the techniques he employs are recognized as 
"medically appropriate and effective."  The plaintiff alleges 
defendants characterized him as the "DIRTY DOC" and the "X-RATED 
DOCTOR." 
 
During discovery proceedings in the pending action, 
appellants Reston Hospital Center and Pentagon City Hospital 
(collectively, the hospitals) as well as appellant INOVA Health 
System (INOVA), received subpoenas duces tecum issued and served 
at the request of WJLA-TV.  Neither the hospitals nor INOVA are 
parties to the litigation; instead, they are third parties whose 
peer review records are sought by WJLA-TV in its effort to 
defend the plaintiff's defamation action. 
 
The subpoenas sought, for example, all documents dealing 
with any formal or informal complaint made against the plaintiff 
by any patient or health care provider; all documents describing 
any disciplinary action taken against the plaintiff by any 
hospital, medical licensing board, or medical association; and 
 
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all documents that refer to any decision to grant, revoke, or 
suspend the plaintiff's hospital privileges.  WJLA-TV sought to 
use the information in an effort to validate its allegedly 
defamatory statements about the plaintiff and to resist 
plaintiff's claim for lost income as the result of the 
defamation. 
 
The hospitals and INOVA filed motions to quash the 
subpoenas duces tecum.  Relying on the provisions of Code 
§ 8.01-581.17, they asserted the documents sought are 
privileged, confidential, and not discoverable. 
 
As pertinent, the statute provides that peer review 
information kept by hospitals and health-related organizations 
"are privileged communications which may not be disclosed or 
obtained by legal discovery proceedings unless a circuit court, 
after a hearing and for good cause arising from extraordinary 
circumstances being shown, orders the disclosure" of such 
information. 
 
Following briefing and oral argument on the respective 
motions to quash, the trial court denied the motions and ordered 
the documents produced.  In a letter opinion, the court stated 
that Code § 8.01-581.17 is not "applicable outside the context 
of medical malpractice actions"; that the plaintiff had waived 
the statutory privilege by filing suit and putting his 
reputation at issue; and that, even if the statute is 
 
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applicable, WJLA-TV had shown the required "good cause arising 
from extraordinary circumstances" because the peer review 
records "are clearly relevant to the issue of the truth of the 
alleged defamatory statements, as well as the mitigation of 
damages suffered by Plaintiff for loss of reputation income." 
 
Counsel for the hospitals and INOVA advised the trial court 
that they were of opinion the discovery order was interlocutory, 
that they wished to generate an appealable order, and thus their 
clients would not comply with the discovery order.  The trial 
court, in a November 1999 order, found them in civil contempt of 
the disclosure order and assessed each organization a fine of 
$150 per day "until such time as each purges itself of the 
contempt." 
 
Pursuant to Code § 19.2-318, the hospitals and INOVA 
appealed the contempt order to the Court of Appeals of Virginia, 
which stayed that portion of the trial court's order imposing 
daily fines.  Subsequently, and before the matters had been 
determined by the Court of Appeals, this Court, in a December 
1999 order entered pursuant to Code § 17.1-409(A) and (B)(1), 
certified these cases for review.  We determined that the 
matters are of such imperative importance as to justify the 
deviation from normal appellate practice and to require prompt 
decision in this Court. 
 
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We awarded the appeals and consolidated them for briefing 
and argument.  On appeal, a brief amicus curiae has been filed 
supporting the appellants by The Virginia Hospital and 
Healthcare Association, Medical Society of Virginia, American 
Medical Association, and American Hospital Association. 
 
Three questions are presented on appeal.  Is the privilege 
accorded by Code § 8.01-581.17 to medical peer review records 
applicable only in medical malpractice actions?  Does the 
statutory privilege belong to and may it be unilaterally waived 
by an individual physician who is the subject of peer review?  
Did WJLA-TV demonstrate "good cause arising from extraordinary 
circumstances," as required by the statute, to justify 
disclosure of confidential peer review records?  We answer each 
of those queries in the negative. 
 
First, the statutory language is clear, unambiguous, and 
unqualified.  The plain language states that peer review records 
"are privileged communications which may not be disclosed or 
obtained by legal discovery proceedings."  No language of the 
statute limits its application to a particular type of suit or 
action. 
 
When statutory language is clear and unambiguous, there is 
no need for construction by the court; the plain meaning of the 
enactment will be given it.  Brown v. Lukhard, 229 Va. 316, 321, 
330 S.E.2d 84, 87 (1985).  Courts must give effect to 
 
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legislative intent, which must be gathered from the words used, 
unless a literal construction would involve a manifest 
absurdity.  Abbott v. Willey, 253 Va. 88, 91, 479 S.E.2d 528, 
530 (1997).  Certainly, it is not manifestly absurd to conclude 
that the § 8.01-581.17 privilege applies to all kinds of 
litigation, not just to medical malpractice actions. 
 
WJLA-TV contends that because the statute in issue is 
codified in the Medical Malpractice section of Chapter 21.1 of 
Title 8.01, the General Assembly necessarily intended that it 
not apply outside the medical malpractice context.  The trial 
court apparently was influenced by the statute's placement in 
the Code. 
 
There is no merit to WJLA-TV's contention.  When, as here, 
the legislature's intent is unambiguously expressed in the 
statute, recourse to devices of statutory construction, such as 
comparing it with other statutes in pari materia or considering 
other extraneous circumstances, is not permitted.  City of 
Richmond v. Sutherland, 114 Va. 688, 691, 77 S.E. 470, 471 
(1913). 
 
Also, to restrict the privilege, as WJLA-TV urges and as 
the trial court ruled, ignores the underlying purpose of the 
statute.  The obvious legislative intent is to promote open and 
frank discussion during the peer review process among health 
care providers in furtherance of the overall goal of improvement 
 
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of the health care system.  If peer review information were not 
confidential, there would be little incentive to participate in 
the process. 
 
Turning to the second question, we hold, contrary to the 
trial court's ruling, that the statutory privilege does not 
belong to the physician who is the subject of peer review and 
may not be unilaterally waived by the physician.  To allow the 
subject of peer review to waive the privilege runs counter to 
the purpose of the statute that encourages physicians to 
participate candidly in the peer review of other physicians, 
with the expectation that the information submitted will remain 
confidential and shielded from public disclosure. 
 
Moreover, to allow the peer review subject to waive the 
privilege is at odds with the plain language of the statute.  
There is no suggestion in the words of the enactment that the 
privilege resides in, and may be waived by, the target of peer 
review. 
 
Upon the third question, we conclude the trial court erred 
in finding WJLA-TV established the required "good cause arising 
from extraordinary circumstances" sufficient to warrant 
disclosure of the peer review records.  As we have stated, the 
trial court determined that the information sought by the 
subpoenas is "clearly relevant" to the issues of the truth of 
the alleged defamation as well as mitigation of damages.  The 
 
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court said that "WJLA is entitled to pursue all facts that are 
relevant to its defense of this action," and thus WJLA-TV had 
met the statutory requirement. 
 
However, there is a vast difference between the legal 
principle of "relevance" and the term "extraordinary 
circumstances."  There is nothing "extraordinary" about the mere 
need to defend this lawsuit.  Manifestly, the General Assembly 
did not contemplate a test for disclosure that is so easily 
satisfied. 
 
In the present case, WJLA-TV claimed only that it has to 
defend itself from defamation based on a news story it decided 
to disseminate after it, presumably, had become satisfied of its 
truth.  The need to establish a defense, which must be made in 
all civil actions, is the essence of usual and ordinary, and is 
not "extraordinary." 
 
Consequently, the contempt order will be set aside and the 
respective motions to quash the subpoenas duces tecum will be 
granted.  Additionally, the daily fines will be annulled and 
dismissed.  See Robertson v. Commonwealth, 181 Va. 520, 538-39, 
25 S.E.2d 352, 360 (1943) (disobedience of order to produce 
documentary evidence excused if order is erroneous because 
defendant refused to divulge privileged information). 
Record No. 992934 — Reversed and final judgment. 
Record No. 992935 — Reversed and final judgment. 
 
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