Opinion ID: 3010672
Heading Depth: 4
Heading Rank: 3

Heading: Confidentiality of PRO Information

Text: The Act reflects a strong policy of confidentiality with respect to a PRO's quality review and sanction process. The Act requires a PRO to hold all data and information that it acquires in confidence and, subject to only limited exceptions, prohibits a PRO from disclosing such information. See 42 U.S.C. S 1320c-9(a). Congress has even exempted PROs from the requirements of the Freedom of Information Act. See id. In addition, any person who discloses information in violation of the Act's confidentiality provisions is subject to criminal penalties including a fine and imprisonment of not more than six months. See 42 U.S.C. S 1320c-9(c). Finally, to further protect the confidentiality of PRO-related materials, the Act immunizes many documents from subpoena and discovery proceedings: No patient record in the possession of an organization having a contract with the Secretary under this part shall be subject to subpoena or discovery proceeding in a civil action. No document or other information produced by such an organization in connection with its deliberations in making determinations under 14 section 1320c-3(a)(1)(B) or 1320c-5(a)(2) of this title shall be subject to subpoena or discovery in any administrative or civil proceeding; except that such an organization shall provide, upon request of a practitioner or other person adversely affected by such a determination, a summary of the organization's findings and conclusions in making the determination. 42 U.S.C. S 1320c-9(d). Regulations promulgated pursuant to the Act further buttress these confidentiality provisions. The regulations broadly define confidential information as (1) [i]nformation that explicitly or implicitly identifies an individual patient, practitioner or reviewer[;] (2) [s]anction reports and recommendations[;] (3) [q]uality review studies which identify patients, practitioners or institutions[;] (4) PRO deliberations. 42 C.F.R. S 476.101(b). Furthermore, PRO information includes any information collected, acquired or generated by a PRO in the exercise of its duties and functions . . . . Id. The regulations impose specific requirements to ensure the confidentiality of PRO information. For example, a PRO must provide physical security measures to protect PRO information, including measures necessary to secure computer files. See 42 C.F.R. S 476.115(a). The PRO must furnish confidentiality training and instructions to participants in PRO activities, and must designate an individual responsible for maintaining the system of assuring confidentiality. See 42 C.F.R. S 476.115(a) (c). Only persons who have completed a training program and signed a statement indicating that they understand the penalties for unauthorized disclosure are permitted access to confidential information. See 42 C.F.R. S 476.115(d). In addition, the regulations require a PRO to purge files of personal identifiers as soon as such identifiers are no longer necessary, to destroy hard copies of documents that are no longer needed, and to assure that other organizations providing data services to the PRO have established procedures to maintain confidentiality. See 42 C.F.R. S 476.115(e). Even where the disclosure of information by a PRO is authorized, the regulations establish procedures to protect 15 confidentiality. A disclosure requires an accompanying notice and statement advising the recipient of the limitations on permissible redisclosure. See 42 C.F.R. S 476.104. With certain enumerated exceptions, the regulations prohibit any person who obtains confidential PRO information from redisclosing it. See 42 C.F.R. S 476.107. These extensive provisions reflect a clear congressional policy of protecting the confidentiality of information related to PRO proceedings. This policy is consistent withthe underlying purpose of the federal and state peer review statutes, which is to encourage doctors to evaluate their peers honestly, without fear that the proceedings might later be used in a lawsuit. Todd, 152 F.R.D. at 686 (citing Morse v. Gerity, 520 F. Supp. 470, 471 (D. Conn. 1981)). An assurance of confidentiality is essential to facilitate the open communication necessary for a PRO to perform its duties. The Executive Vice President and Chief Executive Officer of the PRO NJ submitted an affidavit stating that without confidentiality, the organization would have great difficulty functioning and great difficulty obtaining information now volunteered from physicians to whom quality inquiries are advanced. App. at 167. See also General Care Corp. v. Mid-South Foundation for Medical Care, Inc., 778 F. Supp. 405, 417 n.10 (W.D. Tenn. 1991). As the preceding discussion demonstrates, Congress has clearly created a statutory scheme that is highly protective of information related to PRO proceedings.