Opinion ID: 2402231
Heading Depth: 1
Heading Rank: 10

Heading: Peer-Review Privilege and Negligent Credentialing

Text: Doctor Samson urges us to address the relationship between the peer-review privilege and the negligent credentialing cause of action. The hospital also draws our attention to plaintiff's negligent credentialing claim. We feel compelled to explore these legal issues fully in light of the motion justice's repeated declaration that the peer-review privilege is incompatible with a negligent credentialing cause of action. This jurisdiction has adopted the doctrine of corporate negligence as a theory of hospital liability, which the parties in this case refer to as negligent credentialing. Rodrigues v. Miriam Hospital, 623 A.2d 456, 463 (R.I.1993). In Rodrigues, a case involving a doctor's refusal to perform a tracheostomy, the plaintiff argued that the hospital should have known that the doctor might refuse to perform the procedure, and, therefore, it should not have granted that doctor staff privileges. Id. at 463-64. We affirmed the directed verdict (now judgment as a matter of law) in favor of the hospital because there was no evidence to suggest that the hospital knew or should have discovered the doctor's reluctance or inability to perform tracheostomies. Id. at 464. A corporate negligence claim differs from a respondeat superior claim in that it imposes on the hospital a nondelegable duty owed directly to the patient that is independent of the doctor-hospital relationship. Id. at 462. A hospital or other health-care provider may be held liable for the failure to exercise reasonable care in hiring one of its employees or in extending staff privileges to a doctor. Id. at 463. Such a failure occurs when a hospital selects a person unfit or incompetent for the employment, thereby exposing third parties to an unreasonable risk of harm. Id. A plaintiff must show, however, `that the hospital had actual or constructive knowledge of the defect    which created the harm.' Id. at 464. Although we agree with Dr. Samson's point that our recognition of a cause of action cannot override the statutorily created peer-review privilege, we fail to see precisely how the privilege protecting the proceedings and records of a peer-review board disrupts a patient's ability to bring a corporate negligence claim against a health-care provider. First, it is essential to remain mindful of our holding that information relating to whether a doctor's privileges have been lost or restricted is not protected by the peer-review privilege. Moretti, 592 A.2d at 858. Making the fact of loss or restriction of privileges unavailable to the injured party is not necessary to accomplish the purposes of the peer-review statute and therefore should not be privileged. Id. The production of this information will do much to facilitate a corporate negligence claim because it will chronicle highly relevant facts  specifically, actions taken by the health-care provider, if any, to police its employees or agents. Furthermore, we also agree with the motion justice that patient complaints made to a hospital similarly are not protected by the peer-review privilege. By their nature, complaints precede the convening of a peer-review board and are formulated not by the peer-review board, but by patients or their families. We would have to stretch beyond the breaking point the meaning of the term proceedings or records in order to conclude that patient complaints are privileged. They are more in the nature of documents or records otherwise available from original sources, § 23-17-25(a); a hospital, therefore, may not render a patient complaint privileged and undiscoverable by passing it along for consideration by a peer-review board. To summarize, a plaintiff asserting a claim of corporate negligence against a health-care provider is entitled to discovery of patient complaints, even when those complaints lead to peer-review proceedings and ultimately to any possible limitations or restrictions placed on a doctor's privileges. Using that information and other relevant and unprivileged information, a plaintiff then must cultivate his or her claim that the health-care provider has hired or retained an incompetent or unfit employee and that the provider had actual or constructive knowledge of that incompetence or unfitness. In concluding as we do on this issue, we also take this opportunity to clarify how an applicable statute should be interpreted in light of our recognition of a corporate negligence cause of action. At the argument on the motion to compel, there was discussion about whether a corporate negligence claim sufficed, under § 5-37.3-7(d), as an action where    the legal entity which formed [a peer-review] board    is sued for actions taken by that board. If so, then the peer-review privilege, or at least the privilege created by § 5-37.3-7(c), would not apply whenever a plaintiff asserts a claim of corporate negligence. Section 5-37.3-7(d) reads: The provisions of [§ 5-37.3-7(c)] limiting discovery and testimony shall not apply in any legal action brought by a medical peer review board to restrict or revoke a physician's hospital staff privilege, or his or her license to practice medicine, or to cases where a member of the medical peer review board or the legal entity which formed this board or within which that board operates is sued for actions taken by that board; provided, that in this legal action personally identifiable confidential health care information shall not be used without written authorization of the person or his or her authorized representative or upon court order. (Emphasis added.) Read in its entirety, this statutory provision limits the peer-review privilege as it pertains to lawsuits between a health-care provider and its physicians over staff privileges. In this sense, the provision resembles Article V, Rule 1.6(b)(2) of the Supreme Court Rules of Professional Conduct, which renders the attorney-client privilege inapplicable when a lawyer attempts to establish a claim or defense on behalf of the lawyer in a controversy between the lawyer and the client. We are reluctant to read this exception to the privilege more broadly than that. Furthermore, we cannot interpret a statute in a way that will lead to an absurd result. Menard, 888 A.2d at 60. If we were to interpret the language of § 5-37.3-7(d) to include corporate negligence claims, then a plaintiff need only assert a claim of corporate negligence, pursuant to our liberal pleading standards, to evade the protections afforded to a health-care provider by our peer-review privilege. A rule of law allowing a plaintiff to eviscerate the peer-review privilege through artful pleading would be an absurdity. This Court did not intend that result when it recognized the doctrine of corporate negligence in Rodrigues, 623 A.2d at 463. In clarifying the relationship between a corporate liability action and the peer-review privilege, we think that the best course of action is to ensure that § 5-37.3-7(d) is not interpreted to do serious harm to the peer-review privilege, which, to reiterate, aims to foster high quality medical care through open discussions and candid self-analysis in peer-review meetings. Moretti, 592 A.2d at 857. 5