Court Opinion

ID: 9645976
Source: CourtListenerOpinion
Date Created: 2023-08-22 21:41:22.797859+00
Date Added: 2024-06-11T18:11:33.597591
License: Public Domain

PHILLIPS, Chief Justice,
concurring.
I agree with the conclusion of the majority that, in the absence of supporting evidence, the documents standing by themselves do not demonstrate the hospital’s claim of privilege as a matter of law. Because nothing in the documents indicates any connection to a hospital committee, I find no basis to hold the documents privileged under TEX.REV.CIV.STAT. art. 4447d, § 3. I thus concur in the majority’s result.
I disagree, however, with the standard articulated today for determining whether *497materials are privileged under art. 4447d, § 3. I believe the majority’s formulation is fatally vague and will bring confusion to an area where clarity should be paramount. I would hold that if the function and purpose of a committee is to improve patient care and treatment through self-evaluation and critical review, documents prepared by or at the direction of the committee for committee purposes are privileged.
Article 4447d, § 3, contains three specific protections. In summary, these provide: (1) The records and proceedings of any committee or joint committee of a hospital or other of several health care providers shall be confidential and shall be used by such committee and the members thereof only in the exercise of the proper functions of the committee and shall not be public records and shall not be available for court subpoena; provided that the statute does not apply to records made or maintained in the regular course of business; (2) no physician or specified health care provider furnishing information to any committee with respect to a patient shall be liable in damages to any person for furnishing such information; and (3) no member of such committee shall be liable in damages to any person for actions taken by the committee if the member acts without malice and in the reasonable belief that the action is warranted by the facts known to him.
Under this statute, certain information submitted to a committee is privileged, and both those who submit the information and those who act on it are protected from liability. As this court wrote in Texarkana Memorial Hospital, Inc. v. Jones, 551 S.W. 2d 33, 35 (Tex.1977):
The purposes of medical research and education, and the improvement of medical treatment, in any particular hospital or medical care facility is served by the free and uninhibited discussion of all events and experiences within the hospital or facility. The Legislature ... must have intended to protect and encourage open and thorough review and investigation by making the records and proceedings of any such committee confidential and by expressly providing that they “shall not be available for court subpoena.” (Emphasis original.)
The statute reflects a legislative judgment that the overall quality of medical care will be elevated by shielding certain in-house evaluations from public disclosure. Medical professionals are more likely to come forward with information about professional incompetence and misbehavior when protected from personal liability or public disclosure. “Constructive professional criticism cannot occur in an atmosphere of apprehension that one doctor’s suggestion will be used as a denunciation of a colleague’s conduct in a malpractice suit.” Bredice v. Doctors Hospital, Inc., 50 F.R.D. 249, 250 (D.D.C.1970).
The Legislature did not, however, provide a blanket privilege to all records of all committees. See Butler, Hospital Peer Review Committees: Privileges of Confidentiality and Immunity, 23 S.Tex.LJ. 45, 49-53 (1982). The statute excludes “records made or maintained in the regular course of business.” TEX.REV.CIV.STAT. art. 4447d, § 3. Moreover, there are other files and records which do not involve the type of critical appraisal which the statute was intended to protect. Thus, in previous cases, this court has sought to draw guidelines that promote the purpose of the statute without unduly hindering the discovery of relevant information by parties to lawsuits. These guidelines have focused on two criteria: the type of committee and the type of documents.
In Jones, the parents of a premature infant, who allegedly became blind as a result of treatment received in a hospital, sought documents from the committee meetings of departments involved in their son’s care. This court made two important holdings. First, it held that “the deliberations of every group of persons constituted by the rules and bylaws of the hospital in its service is placed behind the veil” of statutory privilege. 551 S.W.2d at 35 (emphasis added). Second, it defined “records made or maintained in the regular course of business” to mean “the records kept in connection with the treatment of the individual patients as well as the business and *498administrative files and papers apart from committee deliberations.” Id. Such records, the court held, would not become privileged merely because they were at some time presented to a committee pursuant to its deliberations. Id. at 36; see also Hood v. Phillips, 554 S.W.2d 160,167 (Tex.1977).
This court further clarified which documents are protected by the privilege in Jordan v. Court of Appeals for Fourth Supreme Judicial District, 701 S.W.2d 644, 648 (Tex.1986). Jordan involved a suit against a nurse and a hospital where the nurse had previously worked. Plaintiffs alleged that the hospital had failed to alert the public and the medical profession to the nurse’s incompetence. An investigation of deaths connected with the nurse had also been conducted by the local district attorney. Plaintiffs sought discovery of records belonging to different committees of the hospital related to investigation of the nurse’s work there.
As to which documents were discoverable, this court held:
[W]e find that the statutory language, “records and proceedings” means those documents generated by the committee in order to conduct open and thorough review. In general, this privilege extends to documents that have been prepared by or at the direction of the committee for committee purposes. Documents which are gratuitously submitted to a committee or which have been created without committee impetus and purpose are not protected. In addition, the privilege extends to minutes of committee meetings, correspondence between committee members relating to the deliberation process and any final committee product, such as recommendations.
701 S.W.2d at 647-48.
Today, the majority purports to follow Jordan to hold “that information is protected by the privilege if sought out or brought to the attention of the committee for purposes of an investigation, review, or other deliberative proceeding.” The court goes on to conclude that the “letters requesting information or credentials and experience of [the doctors] were routine administrative records, prepared by the hospital in the ordinary course of business.” In effect, the majority seeks to distinguish between two types of documents generated by a committee: (1) those generated by the hospital committee in its investigative or review process and hence privileged; and (2) those that represent mere “routine administrative records, prepared by the hospital in the ordinary course of business” and hence discoverable.
I believe this standard is unworkable. The documents currently before us are admittedly innocuous. They consist mostly of form letters sent to various institutions and physicians seeking licensing and training information, as well as personal recommendations. One could arguably categorize them as routine (and discoverable), since they are presumably part of the routine process of credentialling a physician. The attempt to categorize some letters as routine and others investigative, however, simply will not work as a general rule. A committee whose general purpose is to investigate never knows what it will find. It begins with routine inquiries. When those inquiries reveal irregularities, it probes further. Where would the line be drawn, for example, if solicitations for educational background information revealed misrepresentations or if personal recommendations revealed a pattern of incompetence. Would the early letters be deemed routine and hence discoverable, while the later letters are found privileged because they reveal there really is something to investigate? Or, would the early letters change status to become privileged also? Might doctors refrain from responding candidly to so-called routine letters because they are not privileged? Might they wait for an actual investigation, possibly brought on by needless injury to a patient, before revealing what they know?
Such possibilities are unacceptable. The purpose of the statute is to promote candor and candor relies in part on the certainty of privilege. Uncertainly of the kind generated by the majority’s test will necessarily undermine the purposes of the statute.
*499I would hold that for the privilege in art. 4447d, § 3 to have meaning, the investigative criteria should apply to the nature of the committee, not the documents. In Jones, we applied the privilege to “the deliberations of every group of persons constituted by the rules and bylaws of the hospital.” 551 S.W.2d at 35 (emphasis added). That standard is too broad. I would hold that if the function and purpose of a duly constituted committee is the improvement of patient care and treatment, through self-evaluation and critical review, the committee is protected by TEX.REV. CIV.STAT.ANN. art. 4447d, § 3. Cf. Matchett v. Superior Court for County of Yuba, 40 Cal.App.3d 623, 627, 115 Cal.Rptr. 317, 320 (1974).
Once it is established that Article 4447d, § 3 is applicable to a particular committee, I would hold that all documents meeting the criteria laid out in Jordan are privileged. Excluded from among these privileged documents, of course, are those “records made or maintained in the regular course of business.” TEX.REV.CIV.STAT. art. 4447d, § 3. This court has already defined such documents to be “the records kept in connection with the treatment of the individual patients as well as the business and administrative files and papers apart from committee deliberations.” Texarkana Memorial Hospital, Inc. v. Jones, 551 S.W.2d at 35.
As to the documents before us today, I agree with the majority that the burden of establishing the privilege is on the party asserting it. Peeples v. Honorable Fourth Supreme Judicial District, 701 S.W.2d 635, 637 (Tex.1985). In Weisel Enterprises, Inc. v. Curry, 718 S.W.2d 56, 58 (Tex.1986), this court discussed the steps a party must take to satisfy its burden of proof when asserting a privilege. We held that the party must plead the privilege and produce evidence supporting the claim. Where the content of the documents on their face substantiates the claim, the documents alone constitute adequate proof. Where the documents do not on their face support the privilege, however, additional evidence in the form of live testimony or affidavits must be adduced. Id.
There is nothing on the face of the documents before us to indicate that they are the product of a committee at Midway Park Hospital, investigative or otherwise.1 Nor has a statement of facts been preserved showing testimony, if any, that would support the claim of privilege. The only evidence to support the claimed privilege, in addition to the documents themselves, are two affidavits. Since the affidavits were submitted ex parte, I agree that we may not consider them. Thus, Midway Park Hospital did not meet its burden of establishing the documents were privileged. I therefore agree the documents are subject to discovery and concur in the result of the majority.
GONZALEZ and CULVER, JJ., join in this concurring opinion.

. In a case construing its privilege statute the California appeals court, faced with a similarly sparse record, elected to take judicial notice of "nationwide, generally accepted standards describing the organization and functions of medical staffs and medical staff committees in accredited hospitals." Matchett v. Superior Court for County of Yuba, 40 Cal.App.3d 623, 627, 115 CaLRptr. 317, 319 (1974). The California court relied on the standards promulgated by the Joint Commission on Accredited Hospitals. We have not been furnished with information on these standards, nor has any party requested us to take judicial notice thereof. See TEX.R. EVID. 201.