Opinion ID: 2387732
Heading Depth: 1
Heading Rank: 2

Heading: Kentucky Jurisprudence of the Confidentiality of Peer Review Materials

Text: The first case in which this Court addressed the issue of peer review and confidentiality was in Nazareth Literary & Benevolent Institution v. Stephenson, Ky., 503 S.W.2d 177 (1973). In Nazareth , no statutory authority protecting peer review material existed. The hospital argued that as a matter of public policy, peer review records must be kept confidential because their revelation would impede the freedom of communication between physicians and hospital authorities concerning proper methods of treatment and the corrections of mistakes. Id. at 178. The Court responded to this claim by stating that [c]laims of privilege are carefully scrutinized, and impediments to the discovery of truth are afforded validity in relatively few instances in the common law. Id. at 179. Accordingly, the Court held that there was no privilege in the common law for peer review and no basis had been offered which could support the creation of such a privilege. The issue of peer review confidentiality next surfaced in the case of McGuffey v. Hall, Ky., 557 S.W.2d 401 (1977). The constitutionality of an amendment to KRS 311.377 which purported to protect peer review material from discovery . . . in any civil action in any court was challenged. KRS 311.377 (1976). McGuffey differs materially from Nazareth , in that instead of merely asserting a common law privilege based on public policy considerations, McGuffey involved a statutory enactment of a privilege by the General Assembly. However, the McGuffey court struck the peer review privilege because it found that the subject-matter of the Act [which contained the privilege] is not sufficiently related to malpractice claims or insurance to pass constitutional muster under section 51 of the Kentucky Constitution. [2] Id. at 407. In 1980 the General Assembly attempted to re-enact the legislation which had been struck by McGuffey . 1980 Ky. Acts Ch. 135. The text was identical to that of the 1976 enactment of KRS 311 .377. The title of the act which sought to re-enact KRS 311.377 was AN ACT relating to the establishment of certificate of need, licensing and regulation of health facilities and health services. Id. However, the 1980 version of KRS 311.377 fared no better than its predecessor, in that the Court found that it violated section 51 of the Kentucky Constitution. The Court held that [t]he problem is that the 1980 re-enactment is a bill even more omnibus and even less related by title to a civil action asserting a malpractice claim than is the 1976 Bill. Sweasy v. King's Daughters Memorial Hospital, Ky., 771 S.W.2d 812, 815 (1989). The Sweasy court made clear that it was not ruling on whether KRS 311.377 applied to malpractice claims, but if it did apply to such actions, then KRS 311.377 was unconstitutional as enacted in 1980. Id. In reaction to the Sweasy decision, the General Assembly re-enacted KRS 311.377 in 1990. Id. In reviewing the preamble of the legislation it is clear the General Assembly believed that Sweasy had rendered KRS 311.377 unconstitutional. WHEREAS, the protection afforded to peer review participants for review functions relating to acts occurring from July 15, 1980, has been eliminated by the Supreme Court's decision in Sweasy v. King's Daughters Memorial Hosp., Ky., 771 S.W.2d 812 (1989), and the lack of such protection inhibits open and candid peer review; and WHEREAS, there is an urgent need to promote effective peer review for the protection and welfare of the public; 1990 Ky. Acts Chapter 271 (emphasis added). Since the Sweasy court conditioned rendering KRS 311.377 unconstitutional on its application to medical malpractice cases, the only reason the General Assembly needed to re-enact KRS 311.377 was if the General Assembly had desired the statute to apply to malpractice cases. The majority suggests that the General Assembly mistakenly interpreted Sweasy as holding that the statute was unconstitutional on its face. Slip op. at 468. I cannot agree with this interpretation of the General Assembly's actions. This Court stated in Sweasy that it was only rendering KRS 311.377 unconstitutional if it applied to medical malpractice actions. The General Assembly's 1990 re-enactment of KRS 311.377 stated that since this Court's decision in Sweasy had struck KRS 311.377 as enacted in 1980, it was necessary to re-enact KRS 311.377. I cannot read this course of events in any other way than to find that the General Assembly intended for KRS 311.377 to apply in medical malpractice actions. [3] When a court interprets a statute such as KRS 311.377 in one fashion, it is well within the province of the legislature to overturn the finding of the court by directing that the statute be interpreted in another fashion. That is precisely what has occurred in the instant case. In Sweasy we overruled KRS 311.377 as it applied to medical malpractice actions, and in 1990, the legislature re-enacted KRS 311.377 to encompass such actions. The majority's actions, in ignoring the clear action of the General Assembly in legislatively overruling the decision in Sweasy , seriously damages the credibility of this Court. With all respect to my colleagues, I believe that they continue to compound the erroneous decisions of this Court with regard to KRS 311.377. Since the statute's, this Court has sought to avoid the clear mandate of KRS 311.377 to make confidential peer review material in all civil actions. In the past, this Court employed section 51 of the Kentucky Constitution to strike down the privilege. However, when the law was enacted in 1990, the General Assembly limited the contents of the bill to this topic alone and in doing so avoided the possibility of any section 51 challenges. Since the majority cannot employ to section 51, it has chosen to limit the effect of the privilege so as to render it irrelevant. Although I believe that the preceding discussion of Sweasy and the 1990 re-enactment of KRS 311.377 resolves the issue of the intent of the legislature, there are several other cases in which this Court was called upon to grapple with peer review and privilege issues. In Appalachian Regional Health Care v. Johnson, Ky., 862 S.W.2d 868 (1993), the issue was before this Court on an appeal of a denial of a petition for a writ of prohibition by the Kentucky Court of Appeals. The hospital sought to prohibit discovery of peer review materials in a medical malpractice case. This Court held that a writ of prohibition was not the correct remedy because there was no showing of irreparable harm due to the discovery of documents relating to peer review and there was no showing that the remedy of appeal was inadequate. Id. at 870-71. In discussing the goal of KRS 311.377, this Court noted that the statute was enacted to protect the reviewers, not the reviewed. Id. at 870. However, since the case was never addressed on the merits, it is strictly obiter dictum and as such is without precedential value. In the case of Adventist Health Systems/Sunbelt Health Care Corp. v. Trude, Ky., 880 S.W.2d 539 (1994), a doctor sought to rescind his resignation and be reinstated as a member of a hospital's medical staff. The doctor attempted to acquire peer review records and the defendant-hospital asserted KRS 311.377(2) as a defense for failing to produce the records. This Court held that KRS 311.377(2) covered any civil action and thus the records were privileged. Id. at 542. The latest case in this line is Leanhart v. Humana, Inc., Ky., 933 S.W.2d 820 (1996). In Leanhart , a plaintiff in a medical malpractice case sought to discover peer review materials held by the hospital in order to demonstrate that the hospital had been negligent in its recruiting of the defendant-doctor, in granting him staff privileges, and in permitting him to retain these staff privileges. Id. at 820. However, during the course of the oral argument of the case before this Court, it was established that the documents sought were not within the protection of KRS 311.377 because they were not peer review materials. They were simply other hospital documents such as administrative records, including complaints by patients and members of the nursing staff. Id. Since the documents were not internal Peer Review Committee records generated by that committee's investigation of the defendant-doctor, they were not peer review materials within the meaning of KRS 311.377(2). The relevance of Leanhart is that the coverage of KRS 311.377(2) is to be narrowly construed to only apply to those records which are generated by the peer review entity. The vast majority of records which a peer review committee holds will be discoverable since they are not the result of the decision-making process, but rather, records created for other purposes and used in making the decision. It is neither the wisdom nor the expediency of this legislation that concerns the court, for that is a matter for the legislative branch of our government. The sole duty herein is scrutiny of the act in the light of the constitution. Commonwealth, Revenue Cabinet v. Smith, Ky., 875 S.W.2d 873, 875 cert. denied sub nom Yeoman v. Kentucky, 513 U.S. 1000, 115 S.Ct. 509, 130 L.Ed.2d 417 (1994). The duty of the General Assembly is to determine the public policy of the Commonwealth and to enact legislation in conformity therewith. Commonwealth. v. Wilkinson, Ky., 828 S.W.2d 610, 614 (1992). It is the duty of this Court to interpret the legislation in light of the principles of statutory interpretation in accord with public policy as expressed by the General Assembly. Whether KRS 311.377(2) is fair or reasonable is a matter for the citizens of the Commonwealth to determine through their elected representatives. We are not a super-legislature and should not act as such.