Opinion ID: 2148949
Heading Depth: 3
Heading Rank: 4

Heading: Do the policy considerations in favor of the tort of negligent credentialing outweigh any tension caused by conflict with the peer review statute?

Text: The function of peer review is to provide critical analysis of the competence and performance of physicians and other health care providers in order to decrease incidents of malpractice and to improve quality of patient care. Richard L. Griffith & Jordan M. Parker, With Malice Toward None: The Metamorphosis of Statutory and Common Law Protections for Physicians and Hospitals in Negligent Credentialing Litigation, 22 Tex. Tech. L.Rev. 157, 159 (1991); Kenneth R. Kohlberg, The Medical Peer Review Privilege: A Linchpin for Patient Safety Measures, 86 Mass. L.Rev. 157, 157 (2002). This court has held that the purpose of Minnesota's peer review statute is to promote the strong public interest in improving health care by granting certain protections to medical review organizations, Amaral v. Saint Cloud Hosp., 598 N.W.2d 379, 387 (Minn.1999), and to encourage the medical profession to police its own activities with minimal judicial interference, Campbell v. St. Mary's Hosp., 312 Minn. 379, 389, 252 N.W.2d 581, 587 (Minn.1977). This court has also recognized that the quality of patient care could be compromised if fellow professionals are reluctant to participate fully in peer review activities. Amaral, 598 N.W.2d at 388. The Larsons argue that policy considerations weigh in favor of the tort because allowing patients to hold hospitals liable for negligent credentialing will lead to more reasonable and responsible credentialing decisions, thereby improving the quality of health care. St. Francis and the amici argue that recognition of a negligent-credentialing claim will harm the quality of health care in Minnesota because, if physicians may be subject to liability for negligent credentialing, they will be reluctant to participate in peer review. St. Francis also argues that recognition of a negligent-credentialing tort is not necessary because patients who prove that a physician's negligence caused them harm are entitled to full compensation from the physician and his or her employer. See Schneider v. Buckman, 433 N.W.2d 98, 101-02 (Minn.1988). The Larsons counter that malpractice claims against problem physicians are not likely to compensate patients because those physicians are the least likely to have adequate malpractice insurance. The Larsons reason that if a hospital grants privileges to a problem physician, public policy goals are well served by holding the hospital liable for injuries not compensated for by the physician's insurance. St. Francis also argues that the trial of a negligent-credentialing claim will present serious procedural issues in addition to the effects of the limitations of the peer review statute. It argues that physicians who are faced with defending a medical malpractice claim within the same trial as a negligent-credentialing claim will be unfairly prejudiced by the admission of negative information that is relevant to the credentialing process, but is irrelevant to the determination of the malpractice claim. St. Francis argues that, to avoid this type of prejudice, courts will have to allow bifurcated proceedings, thereby increasing the time and expense of litigation. We recognize that a claim of negligent credentialing raises questions about the necessity of a bifurcated trial and the scope of the confidentiality and immunity provisions of the peer review statute. We likewise recognize that there is an issue about whether a patient must first prove negligence on the part of a physician before a hospital can be liable for negligently credentialing the physician. But, in part, these are questions of trial management that are best left to the trial judge. See Conwed Corp. v. Union Carbide Chems. and Plastics Co., Inc., 634 N.W.2d 401, 413 n. 11 (Minn.2001). Further, they cannot be effectively addressed in the context of this Rule 12 motion. We conclude that the policy considerations underlying the tort of negligent credentialing outweigh the policy considerations reflected in the peer review statute because the latter policy considerations are adequately addressed by the preclusion of access to the confidential peer review materials. We therefore hold that a claim of negligent credentialing does exist in Minnesota, and is not precluded by Minnesota's peer review statute. We reverse the answer of the court of appeals to the first certified question, answer that question in the affirmative, and remand to the district court for further proceedings consistent with this opinion. The Larsons also challenge dicta in the court of appeals opinion, noting that the confidentiality provisions of the peer review statute may present due process issues in the trial of a negligent-credentialing claim. But because we have concluded that the confidentiality provisions of the peer review statute do not preclude the presentation of evidence in defense of a negligent-credentialing claim, we conclude that the confidentiality provision is not facially unconstitutional. We leave for another day the question of whether circumstances might arise that would render the provision unconstitutional as applied. Reversed and remanded.