Court Opinion

ID: 9682908
Source: CourtListenerOpinion
Date Created: 2023-08-24 13:19:23.881391+00
Date Added: 2024-06-11T18:17:43.056867
License: Public Domain

DISSENTING OPINION
McGEE, Justice.
I respectfully dissent.
The primary question presented in this case is the applicability and scope of Texas Revised Civil Statutes Annotated article 4447d, section 3, in precluding discovery of records kept by hospital organizations. Texarkana Memorial Hospital (Hospital) asserts that article 4447d, section 3, precludes discovery of such materials. Reppond, the plaintiff who is seeking the records, argues that section 3 is inapplicable in this situation or that if section 3 is applicable, the materials fall within an exception provided in section 3 and are discoverable. I would hold that article 4447d, section 3, precludes discovery of any records or minutes kept by hospital review organizations and precludes the discovery of any review organization reports or discussion of these reports appearing in any of the hospital records. I would hold, however, that the organizations from which the minutes are sought in this case are not review organizations.
The determination of what materials sought to be produced are discoverable requires a determination of what hospital organizations were included in the words “any hospital committee” as contained in article 4447d. I am aware that Webster’s New International Dictionary, (2d ed.), defines committee as “a body of persons appointed or elected to consider, investigate, or take action upon, and usually to report concerning some matter of business, as by a court, legislative body or a number of persons.” I do not believe the Texas Legislature intended to give relief from discovery to every hospital organization that could fit within the definition of a committee.
The limited judicial construction of section 3 is conflicting. In Karp v. Cooley, 493 F.2d 408 (5th Cir. 1974), cert. denied, 419 U.S. 845, 95 S.Ct. 79, 42 L.Ed.2d 73 (1975), the fifth circuit held that the reports and documents of a Baylor University College Investigating Committee were protected from court subpoena by section 3. The court stated that section 3 “protects from subpoena ‘the records and proceedings’ of any medical organization.” 493 F.2d at 425. Two Texas courts of civil appeals have reviewed section 3 with conflicting results. In French v. Brodsky, 521 S.W.2d 670 (Tex.Civ.App. — Houston [1st Dist.] 1975, writ ref’d n. r. e.), the court held that the records of the advisory board of a hospital were discoverable. The court stated that “the provisions of that statute, when read in their entirety, show that the purpose of the legislation is to restrict unauthorized use of data pertaining to patients examined or treated by physicians, hospitals or other institutions or organizations covered by the Act.” 521 S.W.2d at 676. It is important to note that in French the court also relied on the fact that the custodian of the hospital records made no assertion of a privilege *37under article 4447d, section 3. In Hood v. Phillips, 537 S.W.2d 291 (Tex.Civ.App.— Beaumont 1976, writ granted), the court held that records possessed by a doctor of earlier surgeries on other patients and records of the Board of Censors of the Harris County Medical Society were protected by article 4447d, section 3. The court stated that the evidence requested was not available, quoting article 4447d, section 3, and citing Karp v. Cooley, 537 S.W.2d at 295. The present case is distinguishable from these cases, and I do not consider them to be controlling of our question.
The legislative history of section 3 indicates what the Legislature intended by “any hospital committee.” A bill analysis prepared by the sponsor of section 3 accompanied the section when it was passed by the Texas Legislature. The bill analysis states in pertinent part:
“Background:
At present, records kept by governing boards of hospitals in establishing admission to practice in such hospitals and insuring adequate staff organization to review professional practices not be [sic] kept since they are subject to subpoena by courts.
“Purpose of the Bill:
The purpose of this Bill is to make records of hospital review committees immune from court subpoena.
“Section by Section Analysis:
Section 1: This section amends Chapter 372, Acts of the 58th Legislature, Regular Session, 1963, by adding a new Section 3 which relates:
Section 3: This section provides that records kept by hospital review boards on evaluating the adequacy of their staff and its professional practices shall be kept confidential and immune from court subpoena.” [Emphasis added].
I consider the language of the statute controlling and use the bill analysis only to assist in determining the legislative intent.
Careful reading of section 3 and the bill analysis discloses that the legislative intent in passing section 3 was two-pronged. First, the Legislature sought to encourage hospitals to keep detailed records of individuals admitted to practice in hospitals and records insuring adequate staff organization for review of practices by individuals on the hospital staff. Second, the Legislature sought to encourage and protect the free exchange of ideas and opinions in the organizations responsible for review of the staff and its professional practices. Considering the purposes sought to be promoted by the Legislature in passing section 3,1 would hold that the Legislature intended “any hospital committee” to apply to any hospital organization established exclusively for purposes of review. The minutes and reports of these review organizations and discussions of their reports are protected from discovery even if the reports or records are located in the minutes of other hospital organizations.
Records and minutes were sought from several different organizations of Hospital. It is necessary to review the responsibilities of the different inner-hospital organizations to determine what organizations were established exclusively for review purposes. Examination of the by-laws, rules and regulations of Hospital reveals that Hospital is organized into several different divisions with specific, if somewhat overlapping, responsibilities. Two of the most important divisions are the “clinical departments” or sections and the standing committees. The clinical departments are composed of general medicine, general surgery, obstetrics, gynecology, pediatrics and psychiatry. The clinical departments or sections are not review organizations but are divisions in Hospital’s staff based on doctors’ specialties or fields of expertise. The standing committees, however, are organized not by areas of study or expertise but are organized according to areas of hospital problems or review which span the entire spectrum of medical practice in Hospital. These committees consist of the executive-credentials committees, joint conference committee, medical records-tissue audit committee, emergency room committee, infection committee, sterilization committee, nominating committee, pharmacy-library-supply committee and uti*38lization committee. The composition of each committee is too voluminous to detail but the committees are comprised of members of different clinical departments to insure staff-wide consideration of each problem area in Hospital. These standing committees are charged with the review of other staff members, their professional practices and review of various problems encountered in all aspects of providing health care. The standing committees are the type of review organizations given protection by article 4447d, section 3; therefore, the records and proceedings of these committees should not be discoverable.
Discovery of the minutes of the general staff meetings was also sought. The general medical staff of Hospital consists of all the member-doctors of the active medical staff. In the meetings of the general medical staff ordinary business matters are discussed but reports of standing and special committees are also given, as well as a hospital analysis, review of problems relating to the care of particular patients, problems referred from clinical sections, and discussions and improvements of professional practices. The minutes of the general medical staff should be discoverable because it is not an organization established exclusively for review of hospital problems. Discovery of all the minutes of the general staff meetings would frustrate the previously announced legislative intent of keeping proceedings of review organizations secure from court subpoena. Reports of any hospital organization established exclusively for review given in the meetings of the general staff should not be subject to discovery. The discussions of problems directly engendered by these reports should also not be discoverable.
The trial court allowed discovery of the records of the Board of Directors of Hospital, as they pertain to the purchase of equipment and facilities in the nursery. The function of the Board of Directors is to establish the business policies of Hospital. The only review function performed by the Board of Directors is when the Board reviews the removal of a doctor’s privileges at Hospital. The Board’s review is of the determination by a standing committee that a doctor’s privileges should be removed. The records or minutes of the Board pertaining to this review function would be protected because this would be a discussion engendered by the report of a standing review organization. Here the minutes sought of the Board of Directors should be discoverable if the discussion concerning the purchase of equipment for the nursery does not arise from a report or recommendation made to the Board by a review organization.
The Repponds urge this court to construe article 4447d as a whole and allow very broad discovery of hospital materials. They contend that the statute applies only to restrict the unauthorized use of data pertaining to patients treated in organizations covered by the Act. French v. Brodsky, 521 S.W.2d 670, 676 (Tex.Civ.App. — Houston [1st Dist.] 1975, writ ref’d n. r. e.). Like the majority, I cannot ignore the language of section 3 which states that the records of any hospital committee “shall not be available for court subpoena. . . .”
The Repponds also contend that broad discovery should be allowed because materials sought to be discovered would come within the exception of section 3 which allows discovery of “records made or maintained in the regular course of business.” It is undisputed that the minutes of standing committees are kept in Hospital by the custodian of Hospital’s records in the same manner as all other records. I agree that it would violate our prior interpretation of the legislative intent to hold that minutes and records of review organizations are records “made or maintained in the regular course of business.” The construction asserted by the Repponds would have the Legislature, in the same sentence, specifically forbidding discovery of organization records then allowing their discovery because the records are kept by Hospital. I agree that the records of review organizations are not the kinds of records covered by the exclusion.
Hospital has argued that the materials sought to be discovered are minutes of com*39mittees organized under the by-laws, rules and regulations of Hospital and are protected from discovery by article 4447d, section 8. Prior discussion has disclosed that the organizations from which the minutes are sought are not organizations established exclusively for review but are clinical sections or administrative bodies of Hospital performing various other functions. Article 4447d, section 3, applies to organizations performing functions in addition to review only in situations where reports of review organizations are given and discussed in the meetings of these multi-purpose organizations.
I recognize that construction and application of the article in question involves important policy considerations urged by both Hospital and the Repponds. The minutes of any group organized exclusively for reviewing problems in the hospital should be protected, thereby insuring the free exchange of ideas. I believe the minutes of the meetings of the various clinical sections and the general staff should be discoverable with the exception of review organization reports and discussions of those reports. This would allow the discovery of material which would otherwise be unavailable. This approach would allow the free exchange of ideas so as to promote better health care facilities but not prevent plaintiffs from being able to establish a cause of action.
Specifically, I would allow discovery of the minutes of the pediatrics section meetings and the minutes of other clinical sections because none of the clinical sections are organizations established exclusively for review. (Item I, II and III). I would also hold that the minutes from the meetings of the general staff and the Board of Directors are discoverable because neither exclusively performs review functions. (Items IV and V). There are hospital organizations whose exclusive function is that of review. Reports or discussions of reports or problems presented by these review organizations in meetings of the clinical sections, general staff, or Board of Directors meetings should be protected from discovery. This would allow hospital-wide input into the problems reported by review organizations without fear of the discussions being subpoenaed by a court.
In conclusion, I agree with the majority that the trial court should be ordered to prohibit from discovery the minutes and reports of any hospital organization charged exclusively with the function of review. This prohibition should also extend to minutes of other hospital organizations only in the sense that reports of review organizations are given and discussed. However, I would hold and order that the trial judge permit the discovery of any records and minutes of hospital agencies or boards which did not exclusively perform review functions.