Opinion ID: 3010672
Heading Depth: 4
Heading Rank: 4

Heading: analysis

Text: As noted above, plaintiff contends that this section does not bar discovery of the documents at issue because these documents were not  `produced by' a PRO `in connection with its deliberations.'  Plaintiff 's Br. at 42 (quoting 42 U.S.C. S 1320c-9(d)). Specifically, plaintiff argues that: (1) correspondence from the PRO cannot be said to be in connection with [PRO] deliberations because these documents do not include minutes and deliberations whose protection from discovery is the heart of critical selfanalysis[,] id. at 43; and (2) documents written by a target physician cannot be considered generated by the 16 PRO. Id. at 46. We conclude that plaintiff's reading of the phrase produced by [the PRO] in connection with its deliberations is far too narrow. In passing the 1982 amendments, Congress painted with a broad brush, leaving HHS to fill in many important details of the workings of peer review. Bowen, 834 F.2d at 1043; see id. at 1043 (observing that Congress provided skeletal requirements . . . and left much of the specifics . . . to the inventiveness of the HHS, empowering it to promulgate regulations governing PROs in order to implement the peer review program. (citation omitted)). Two relevant details that HHS filled in are the definitions of PRO deliberations and PRO information. The Secretary defines PRO deliberations as discussions or communications (within a PRO or between a PRO and a PRO subcontractor) including, but not limited to, review notes, minutes of meetings and any other records of discussions and judgments involving review matters regarding PRO review responsibilities and appeals from PRO determinations, in which the opinions of, or judgments about, a particular individual or institution can be discerned. 42 C.F.R. S 476.101(b). PRO information is defined as any data or information collected, acquired or generated by a PRO in the exercise of its duties and functions . . . . Id. When PRO NJ's quality review and sanction process is viewed in light of these broad definitions, it is clear the quality review inquiry sent by the PRO to Dwyer were generated by the PRO in connection with its deliberations. The physician-reviewer sent this inquiry to Dwyer after determining that there was, in fact, a potential quality issue regarding Dwyer's treatment of plaintiff. Moreover, the physician-reviewer asked Dwyer to respond to the inquiry. Once Dwyer responded to the inquiry, the physicianreviewer had to consider whether to end the inquiry and send an acceptance notice to Dwyer or to refer the matter to the Sanction Committee of the PRO. Regardless of which course was ultimately taken in this particular case, the physician-reviewer had to render a judgement on the quality of care Dwyer provided to plaintiff. He thus engaged 17 in the deliberative process within the meaning of the Act, and the inquiry sent to Dwyer was certainly in connection with such deliberations. Moreover, while the status of Dr. Dwyer's responses to the PRO inquiry presents a closer question, we conclude that this information was also generated by the PRO in connection with its deliberations. The physician-reviewer specifically requested that Dwyer assist the PRO by responding to its quality review inquiry. See 42 C.F.R. S 476.101(b) ( `PRO review system' means the PRO and those organizations and individuals who . . . assist the PRO[, and includes] . . . Health care institutions and practitioners whose services are reviewed.). Moreover, Dwyer's responses were generated solely as a result of, and during the course of, the PRO's quality review. As the district court aptly noted, Documents utilized by the PRO in the course of its quality inquiry--medical records for example--are discoverable for [sic] any source other than the PRO that might have them. However, documents generated or created by the PRO are not discoverable from any source. Thus, the documents generated by the PRO are absolutely privileged but documents which are generated for another purpose, but which the PRO review in the course of investigating the doctor are not. Dist. Ct. Op. at 6-7 (citing Todd, 152 F.R.D. at 687, 698). Thus, the PRO generated these responses, which were inextricably linked to the PRO review process and allowed the PRO to perform its responsibilities under the Act. Consequently, Dwyer's responses to the PRO inquiry are not subject to subpoena or discovery. In addition, the fact that plaintiffs sought to compel these documents from Dwyer, rather than the PRO, does not alter this outcome. Congress provided that the documents or information generated by the PRO in the course of its statutory duties is not subject to subpoena or discovery. See 42 U.S.C. S 1320c-9(d). The bar against discovery runs with the documents or information, not with the organization or individuals who happen to possess the documents or information at any given time. But see Todd, 18 152 F.R.D. at 686 (This court finds, therefore, that the Peer Review Protect [sic] Act bars production of documents solely as they exist in the possession of the Peer Review Organization.). Indeed, to hold otherwise would necessarily render the statute's mandate of confidentiality a nullity because a subject physician will have most, if not all, of the materials related to the inquiry within his possession. Thus, the absolute prohibition against discovery of these materials is not destroyed simply because the materials, or copies of the materials, are in the hands of the physician who is the subject of the PRO quality review inquiry and part of the PRO review system. Accordingly, plaintiff's argument must fail.8