Court Opinion

ID: 9810071
Source: CourtListenerOpinion
Date Created: 2023-08-31 21:38:54.979831+00
Date Added: 2024-06-11T13:39:21.042893
License: Public Domain

JUSTICE MARQUEZ,
dissenting.
128 Today, the majority concludes that because Cedar Springs Hospital remained licensed by the Colorado Department of Public Health and Environment ("CDPHE") during all relevant periods, CDPHE necessarily "approved" the hospital's quality management program, and therefore, documents created as part of the program were protected by the quality management privilege under section 25-8-109, C.R.S. (2014). I generally agree that ongoing licensure implies CDPHE approval of a hospital's quality management program. Such an inference is justified, however, only where CDPHE is actually aware of the components of the hospital's program.
129 In this case, such an inference is unwarranted because it is undisputed that Cedar Springs made permanent changes to its quality management plan in 2008 (prior to Simpson's treatment) that it did not report to CDPHE. Although CDPHE regulations require a facility to report only "permanent and substantive" changes to its quality management plan prior to implementation, 6 Code Colo. Regs. 1011-1:II-3.1.4 (2014), Cedar Springs has failed to show that the permanent changes it made to the quality management plan in 2008 were not substantive. Its bare assertions that such changes were non-substantive do not, in my view, establish that the changes would not have impacted CDPHE's approval of the hospital's program. If the changes were indeed patently non-substantive, then a court should be able to make that determination. However, Cedar Springs neither produced nor identified the purportedly non-substantive changes made in 2008 and instead argued that Simpson failed to show that the hospital made substantive changes that it should have reported. The statutory privilege at issue is a powerful one, and Cedar Springs had the burden to establish it was entitled to that privilege. Cedar Springs' argument turns this burden on its head.
30 In my view, a hospital that relies on ongoing licensure as evidence of the Department's continued approval of its quality management program must establish that it notified the Department of changes made to the quality management plan-or otherwise establish that it did not need to report the changes made. Here, Cedar Springs failed to meet this (minimal) burden because it neither submitted a description of its 2008 plan changes to CDPHE nor otherwise established that the 2008 changes were non-substantive and therefore did not have to be reported. Accordingly, I respectfully dissent.
I.
1 31 Simpson initially requested production of the minutes from meetings of two Cedar Springs quality management committees. Cedar Springs argued that such documents were protected by the quality management privilege under section 25-3-109.
132 Notably, Cedar Springs argued that because the hospital remained licensed, CDPHE necessarily had approved its quality management program. Simpson eventually moved for in camera review and production of certain minutes from Cedar Springs' supplemental privilege log, arguing that a quality management program can be "approved" by CDPHE only if it complies with CDPHE regulations, and Cedar Springs had failed to comply with a CDPHE regulation requiring the facility to submit a schedule for plan implementation. The court granted Simpson's motion, reasoning that Cedar Springs had failed to meet its burden to show that the privilege applied. Following an in camera inspection of the meeting minutes, the court ordered the hospital to release the records to Simpson.
*187133 Based on a review of the minutes produced, Simpson requested additional doe-uments, including a minutes notebook for 2008. Cedar Springs moved for reconsideration of the trial court's earlier ruling ordering in camera review and production of the minutes. Specifically, Cedar Springs sought reconsideration of the trial court's ruling that the quality management privilege was inapplicable and produced, for the first time, a letter from CDPHE dated October 14, 2008, stating that Cedar Springs' "plan has been approved." Cedar Springs asked the court to rule that the quality management privilege applied to bar Simpson from introducing the previously disclosed minutes at trial and to preclude Simpson from further discovery of quality management documents, including ' the minutes notebook for 2008.
4 34 In response to Cedar Springs' motion for reconsideration, Simpson pointed out that the newly disclosed October 2008 approval letter from CDPHE expressly informed Cedar Springs that "permanent and substantive changes in your plan must be reported to the Department prior to implementation." Simpson also established that Cedar Springs had made changes to its quality management plan in January 2008,1 yet had failed to submit a description of such changes to CDPHE prior to implementation. In its reply in support of its motion for reconsideration, Cedar Springs did not show that it had reported such changes to CDPHE or that it was not required to report the changes. Indeed, it did not even identify what changes it had made to the plan in 2008.
IL.
135 The quality management privilege covers "records, reports, or other information of a licensed or certified heath care facility that are part of a quality management program." § 25-38-1098). As the majority notes, the statutory definition of a "quality management program" is somewhat circular, see maj. op. 118, but such a program must be "approved by" CDPHE. § 25-38-1092). Relevant here, CDPHE regulations require a facility that makes a "permanent and substantive change" to its quality management plan to submit a description of the change to the Department prior to implementation. 6 Code Colo. Regs. 1011-1-II-8.1.4. The Department shall notify the facility if the change fails to meet regulatory requirements. Id.
136 The party claiming a statutory privilege has the burden of proving its applicability. Hartmann v. Nordin, 147 P.3d 43, 51 (Colo. 2006). In this case, Cedar Springs had the burden to show the documents at issue were part of an approved quality management program and therefore exempt from discovery. Cedar Springs argued that the hospital's continued licensure established that CDPHE approved its quality management program. It further asserted that the 2008 changes to its quality management plan were non-substantive and, therefore, it need not have reported them to CDPHE.
137 I have no quarrel with the general notion that where CDPHE licenses a facility, it is reasonable to infer that the facility's quality management program is "approved" by the Department. See maj. op. 1° 19-21. Such an inference is justified, however, only because we assume that the Department has before it all information necessary to determine whether a program complies with applicable regulations, See id. at 120. In my view, such an inference is unwarranted in this case. It is undisputed that Cedar Springs made permanent changes to its quality management plan following CDPHE's initial approval, yet Cedar Springs failed to establish either that CDPHE was made aware of those changes or, alternatively, that such changes were non-substantive (and therefore not required to be reported to CDPHE for its consideration)2 Under these *188circumstances, we cannot properly infer that ongoing licensure of the hospital reflects CDPHE approval of Cedar Springs' quality management program. Consequently, in my opinion, Cedar Springs did not meet its burden to show it was entitled to the protection of the quality management privilege.
IIL.
38 The quality management privilege is a powerful and important one, and Cedar Springs had the burden to establish it was entitled to the privilege. In my view, a hospital that relies on CDPHE licensure as evidence of the Department's continued approval of its quality management program must at least establish that it notified the © Department of reportable changes made to the quality management plan-or otherwise establish that changes made to its program were not required to be reported. Because Cedar Springs did not meet its (minimal) burden in this case, I respectfully dissent.

. The quality management plan document reflects that it was issued in July 2001 and later revised in January 2008.

. Cedar Springs could have met this minimal burden by establishing that it had submitted the 2008 changes to CDPHE, or by presenting the actual changes made or a copy of the original 2001 plan for comparison. If indeed the changes were patently non-substantive, as Cedar Springs claimed, then the non-substantive nature of such changes should be readily determinable by a trial court.