Court Opinion

ID: 9548984
Source: CourtListenerOpinion
Date Created: 2023-08-07 18:11:35.606604+00
Date Added: 2024-06-11T15:19:41.980396
License: Public Domain

Schroeder, C.J.,
dissenting: The overwhelming considerations of public policy for refusing to allow disclosui'e of confidential hospital peer review committee records and minutes were well stated in Bredice v. Doctors Hospital, Inc., 50 F.R.D. 249, 250-51 (D.D.C. 1970), aff'd 479 F.2d 920 (D.C. Cir. 1973), the pertinent portion of which is quoted in the majority opinion. In declining to follow Bredice and holding there is no overwhelming public policy that precludes the discovery of these *29materials in the absence of specific legislation, the majority apparently deems those adverse effects of ordering disclosure discussed in Bredice to be so insignificant and slight not to outweigh the plaintiff s interest in discovery. I disagree.
The majority attempts to discredit the rationale of Bredice by quoting from Nazareth Literary & Benevolent Inst. v. Stephenson, 503 S.W.2d 177 (Ky. 1973), in which it was stated the applicability of Bredice was “seriously undermined” in Gillman v. United States, 53 F.R.D. 316 (S.D.N.Y. 1971). The characterization of the decision in Gillman by the court in Nazareth is misleading and should be given little, if any, weight in this court’s consideration of the instant case. The court in Gillman expressly agreed with and followed the holding in Bredice in holding that the discovery of the minutes and reports of the hospital’s Board of Inquiry concerning a patient’s suicide were not discoverable by the plaintiff. However, the court ordered disclosure of statements made by hospital personnel to the Board as to what actually happened concerning the incident, recognizing that “[statements taken shortly after an occurrence are unique and can never be duplicated precisely,” and that the discovery of factual data relied on by the Board would not impair the quality of the testimony by hospital employees before the Board. 53 F.R.D. at 319. The important distinction made in Gillman between the discovery of purely factual investigative matters and materials which are the product of reflective deliberation or policy-making processes, such as the reports and minutes of a medical review committee, was properly and accurately noted in Tucson Medical Center, Incorporated v. Misevch, 113 Ariz. 34, 37, 545 P.2d 958 (1976).
In Berst v. Chipman, 232 Kan. 180, 189, 653 P.2d 107 (1982), this court quoted with approval 8 Wigmore on Evidence § 2285, p. 527 (McNaughton rev. 1961), setting forth four prerequisites for granting a qualified privilege from discovery in a case. These prerequisites are:
“(1) The communications must originate in a confidence that they will not be disclosed.
“(2) This element of confidentiality must be essential to the full and satisfactory maintenance of the relation between the parties.
“(3) The relation must be one which in the opinion of the community ought to be sedulously fostered.
“(4) The injury that would inure to the relation by the disclosure of the *30communications must be greater than the benefit thereby gained for the correct disposal of litigation.” (Emphasis in original.)
Each of these conditions is present in the instant case. The peer review committee proceedings at Wesley are considered confidential by Wesley and those who participate. As discussed in Bredice and reiterated in the following cases, confidentiality is essential to maintaining the relation between the parties; this relation is one which should be fostered; and the injury to the public is greater than the benefit gained by the litigants. In discussing the public policy rationale underlying the Arizona statute precluding the discovery of reports and minutes of medical review committees, the court in Tucson Medical Center, Incorporated v. Misevch, 113 Ariz. at 38, stated:
“In a hospital accredited by the Joint Commission on Accredited Hospitals (JCAH), the medical staff is responsible to the governing body of the hospital for the quality of hospital patient care. It therefore evaluates the qualifications of applicants and members to hold staff privileges and recommends curtailment and exclusion when necessary. . . . Bearing the delegated responsibility for review, the candor of the members is necessary in the consideration of .their colleagues’ skills towards objectively regulating privileges, and the quality of treatment so depends. . . .
“Furthermore, the medical review of a procedure is not a part of current patient care, but is a retrospective discussion of treatment and, absent extraordinary circumstances, there is no good cause for disclosure in light of the considerable public interest to the contrary.”
The court in Dade County Med. Ass’n v. Hlis, 372 So. 2d 117 (Fla. Dist. Ct. App. 1979), held that although the statutory privilege for medical review committee records did not apply under the particular facts of the case, the considerations of public policy which prompted the recent enactment of the statute could not be overlooked and precluded the disclosure of the records. On this point the court observed:
“The function of the Ethics Committee of the DCMA, the records of which were ordered produced below, is to investigate, consider and discuss issues which involve the professional conduct of its member physicians. We think it self-evident that this activity, as a means of improving the quality of medical practice in our community through self-regulation, is a salutary one which should be encouraged. More to the point as to the issues presented here, we also agree with petitioner that it is important, perhaps indispensable, to the achievement of the committee’s purposes that its proceedings remain confidential. It is obvious that both complaints and free discussion about the activities of physicians would *31be markedly discouraged if their contents were to be held open to public perusal.” p. 119.
This court is asked whether the public benefits which flow from open, candid communication between hospitals and review committees is so substantial and could be so impaired by the prospect of public disclosure that a privilege for such communication should be recognized even without specific authority from traditional sources. The numerous cases cited to this court by the parties in their briefs show that other jurisdictions faced with a similar issue have reached different results. See, e.g., Annot., Discovery of Hospital’s Internal Records or Communications as to Qualifications or Evaluations of Individual Physician, 81 A.L.R.3d 944. As these cases demonstrate, considerations of public policy bring different courts to different results, depending upon whether the public interest in confidentiality of hospital inspection committee matters or the public interest in liberal discovery is weighed more heavily in the balance. Here the majority holds that in the absence of legislative action the public interest in maintaining the confidentiality of the files of Wesley Hospital’s peer review committee is not sufficient to outweigh the interest in discovery of relevant information in a lawsuit. The court’s decision will discourage hospitals from making investigations which are calculated to have a positive effect on improving the quality of health care in such institutions. The court’s decision will also encourage physicians practicing in those hospitals to accept and care for only those patients with uncomplicated health infirmities where the probability of success is reasonably sure, where the risk of error is slight, and the risk of malpractice claims is slight.
Hospitals in this state are required by administrative regulation to review and analyze the professional practices of their members in furtherance of the express purpose of K.S.A. 65-431 to promote “safe and adequate treatment of individuals in medical care facilities in the interest of public health, safety and welfare.” The maintenance of the confidentiality of the peer review system established by K.A.R. 28-34-6 is essential to the system’s success in fulfilling the purpose of K.S.A. 65-431. This court’s decision will gravely undermine the effectiveness and central purpose of such committees, and will effectively nullify efforts of hospitals to comply with the regulations.
The public policy behind the enactment of the statute and *32regulation cannot be overlooked. This public policy justifies the grant of a qualified privilege from discovery for these types of reports even in the absence of specific legislation. Under K.A.R. 28-34-6, promulgated under the authority of K.S.A. 65-431, hospitals are required, through the peer review committee system, to evaluate and review the actions of its member physicians. If discovery is permitted, the flow of candid and critical information essential to compliance with the regulation will cease, resulting only in errors which will not be discussed or corrected, thereby nullifying the purpose behind the enactment of the regulation. The belief expressed by the majority that the vast majority of doctors will not “shirk their duties to others in the profession and to the public by refusing to participate in peer review functions or, in doing so, might be less than candid in their comments and evaluations,” ignores the reality of human nature to refrain from open evaluation and candid criticism of a colleague where such may be used as damaging evidence by a plaintiff in a future lawsuit against the doctor or medical institution. A similar sentiment was expressed by the court in McKillop v. Regents of University of California, 386 F. Supp. 1270, 1276 (N.D. Cal. 1975), in refusing to order the disclosure of tenure evaluation reports:
“Plaintiffs suggestion that full disclosure encourages more thoughtful and honest tenure evaluations represents a somewhat utopian view of human relationships. It is a view which does not accord with that of University-level faculty members on record here, nor with the Court’s own experience in dealing with recommendations and the like.”
The majority’s view that the disclosure of these records will not have a serious negative impact on the successful and meaningful continuation of the peer review system is strongly disputed by Wesley and amicus curiae Kansas Hospital Association. The hospital association in its brief states:
“[T]he intent of the peer review process is to control the quality of patient care, and the misuse of committee records as weapons brought by physicians denied privilege or by patients in malpractice lawsuits will destroy effective review — and the patients and the public will be the losers. The exposure to liability is ever present, but to require the production of committee records is to invite disaster by discouraging doctors from participating or inhibiting their participation. The facts of life are that good peer review requires physicians to be candidly critical of other physicians, and opening committee records to malpractice lawyers will have a stifling effect on that candor.”
*33The communications which are the subject of this lawsuit were made in reliance on the expectation they would not be disclosed. In my opinion the element of confidentiality is essential to the promotion of a professional and harmonious relationship of the parties who participate in the hospital peer review system. The continuation of a professional and harmonious relationship is one which ought to be fostered. It is my opinion that in weighing the potential effects of ordering disclosure against the potential benefits of disclosure the scales tip decidedly in favor of protecting the confidentiality of the hospital peer review system which embodies a broader societal value.
It is respectfully submitted an order in mandamus should issue directing the trial judge to deny discovery of medical staff committee meeting minutes and other information in the possession of and belonging to the petitioner, Wesley.