Opinion ID: 1822581
Heading Depth: 1
Heading Rank: 6

Heading: discovery of jcaho surveys

Text: ¶ 111. Because this case must be remanded to determine factual questions related to the parties' negligence, we must also address Hofflander's cross-petition for review of a discovery matter. ¶ 112. During pretrial discovery, Hofflander sought production of the records from site surveys conducted by the Joint Commission on Hospital Accreditation of Healthcare Organizations (JCAHO) regarding St. Catherine's Behavioral Services Unit. Saint Catherine's refused to disclose these materials, asserting that the surveys were properly subject to privilege under Wis. Stat. § 146.38. [38] The circuit court agreed with St. Catherine's and denied Hofflander's motion. The court of appeals subsequently affirmed this order. Hofflander, 247 Wis. 2d 636, ¶ 36. Hofflander renews her arguments and petitions this court to instruct the circuit court, upon remand, to permit discovery of the JCAHO surveys that predate her injuries. [44-46] ¶ 113. In most instances, discovery disputes remain within the circuit court's discretion. See Braverman v. Columbia Hosp., Inc., 2001 WI App 106, ¶ 11, 244 Wis. 2d 98, 629 N.W.2d 66 (citing Franzen v. Children's Hosp. of Wis., 169 Wis. 2d 366, 376, 485 N.W.2d 603 (Ct. App. 1992)). Appellate courts will uphold a discretionary decision if the circuit court applied the relevant law to the facts of record while using a process of logical reasoning. Id. However, when a circuit court's discretionary ruling is based upon an error of law, the court has erroneously exercised its discretion. Id. The correct meaning of § 146.38, including its proper scope, presents a question of law, which this court reviews de novo. See State ex rel. Badke v. Greendale Vill. Bd., 173 Wis. 2d 553, 569, 494 N.W.2d 408 (1993). ¶ 114. Hofflander contends that the JCAHO surveys provide information relevant to her claims [39] and that they are not properly privileged under § 146.38. According to Hofflander, the survey materials are exempt from privilege because the surveys were conducted by an outside agency that is unrelated to St. Catherine's and because the surveys were undertaken prior to the incident generating her injuries, not in response to it. ¶ 115. Hofflander's first basis for compelling disclosure, that JCAHO is not the kind of organization covered by the statute, is unsupported by the statute's plain language as well as prior case law interpreting the term organizations under the statute. Although there is no definition of organization in § 146.38, an entity constitutes an organization when it is determined to have at least some of the attributes commonly understood for that term; namely, a relatively constant membership, a body of officers, a purpose, and a set of regulations. Franzen, 169 Wis. 2d at 379-80. Hofflander directs this court to State ex rel. Good Samaritan Medical Center v. Moroney, 123 Wis. 2d 89, 365 N.W.2d 887 (Ct. App. 1985), for the proposition that decisions made by entities one step removed from the actual peer review process are not privileged. Id. at 99. Moroney held that conclusions by a hospital's own governing body are not privileged under § 146.38, since they were based on a peer review process independently conducted by internal review committees. Id. at 100. [40] [47] ¶ 116. We conclude that JCAHO is the type of organization contemplated under Wis. Stat. § 146.38(2). In the present case, the JCAHO survey materials constitute the record of the peer review evaluation. As the court of appeals has previously stated, that statute clearly envisions entities beyond the health care provider itself participating in the review and evaluation process. Braverman, 244 Wis. 2d 98, ¶ 31 (holding that reports generated by a Wisconsin Department of Health and Family Services review of a private hospital's quality assurance system were privileged). The type of review performed by the JCAHO for St. Catherine's is well within the ambit of § 146.38's protections. [48] ¶ 117. Similarly, Hofflander's assertion that § 146.38 governs only reviews and evaluations of health care provider services addressing specific, prior incidents is simply unfounded. Hofflander reaches this conclusion because the review undertaken by the Department of Health and Family Services (Department) in Braverman happened to be in response to the hospital's specific concerns over certain infections following surgery. Id., ¶ 7. However, the reactive nature of that review was not dispositive of the dispute over privilege. Rather, the court anchored its holding on a rejection of Braverman's contention that other statutes, which related to the Department's duties to publicly disseminate its investigations of diseases, essentially preempted the otherwise applicable force of § 146.38. Id., ¶ 29-31. There was no dispute in Braverman as to the circuit court's application of Franzen and Mallon v. Campbell, 178 Wis. 2d 278, 504 N.W.2d 357 (Ct. App. 1993), to find that the Department's materials from the investigation were properly privileged under § 146.38. ¶ 118. In addition, Hofflander's attempt to employ the facts of Braverman to create an artificial distinction is based on a misconstruction of the language of the statute. The privilege afforded under § 146.38(2) applies to records produced from the investigations, inquiries, proceedings and conclusions of reviewing organizations. Wis. Stat. § 146.38(2). These materials are distinguishable from information presented to evaluators during a review and from matters within the evaluators' own knowledge. Franzen, 169 Wis. 2d at 377-78. [41] These latter two sets of information, which are not privileged, are not distinguished by the timing of their creation, but by the source of their production. Hofflander seeks the JCAHO reports presented to the hospital containing the organization's conclusions from its review, not the records presented by St. Catherine's to aid the review. It is only the latter type of information that would be exempt from privilege under § 146.38(2). Id. at 377-78. ¶ 119. Finally, we decline to read into § 146.38 unstated limitations on the privileged nature of materials under the statute. The purpose of JCAHO reports is to enable hospitals to improve their services above the minimum levels set by the state. The reports are the record of a health care review program organized and operated to help improve the quality of health care. See Moroney, 123 Wis. 2d at 97. The evaluations go to the core of why protection is afforded under the statute. [Wisconsin] Stat. § 146.38 was `enacted to protect the confidentiality of the peer review process,' and to promote frank discussion among physicians to improve the overall quality of services they provide. Hofflander, 247 Wis. 2d 636, ¶ 34 (quoting Moroney, 123 Wis. 2d at 98). To permit discovery of these materials would subvert the central purpose of § 146.38 and its counterpart statute, Wis. Stat. § 146.37, [42] which is to encourage hospitals to perform quality-control reviews aimed at improving, prospectively, their services. Moroney, 123 Wis. 2d at 98; see also Hofflander, 247 Wis. 2d 636, ¶ 36 (Wisconsin Stat. § 146.38 is designed to encourage candid and voluntary studies and programs used to improve hospital conditions and patient care.). Limiting § 146.38's privilege to evaluations undertaken after a mishap and directed to that mishap would be a destructive policy not intended by the legislature. ¶ 120. For the foregoing reasons, we agree with the court of appeals that the JCAHO is an organization that performs functions equivalent to a peer review committee and that it provides information concerning how hospitals may improve their health care services. Hofflander, 247 Wis. 2d 636, ¶ 36. Accordingly, we concur with the court of appeals' affirmance of the circuit court's ruling that the JCAHO materials are immune from disclosure to Hofflander, pursuant to § 146.38.