Court Opinion

ID: 9948839
Source: CourtListenerOpinion
Date Created: 2024-03-08 00:08:42.406273+00
Date Added: 2024-06-11T14:26:05.636039
License: Public Domain

140 Nev., Advance Opinion l

                       IN THE SUPREME COURT OF THE STATE OF NEVADA

                SUNRISE HOSPITAL AND MEDICAL                             No. 85844
                CENTER, LLC; AND CORD OLSEN,
                RN,
                Petitioners,
                vs.                                                           FILE
                THE EIGHTH JUDICIAL DISTRICT
                COURT OF THE STATE OF NEVADA,                                 isilAR 07 20
                IN AND FOR THE COUNTY OF                                      EU
                                                                         CL                    URT
                CLARK; AND THE HONORABLE
                                                                        BY
                MARIA A. GALL, DISTRICT JUDGE,                                H1EF DEPlif'/ CLERK

                Respondents,
                  and
                TIFFINY GRACE, INDIVIDUALLY
                AND AS LEGAL GUARDIAN AND
                MOTHER OF E.G.,
                Real Party in Interest.

                            Original petition for a writ of prohibition challenging a district
                court order compelling discovery.
                            Petition granted.

                Hall Prangle & Schoonvelcl, LLC, and Nathan R. Reinmiller and Michael E.
                Prangle, Las Vegas,
                for Petitioners.

                Prince Law Group and Dennis M. Prince, Kevin T. Strong, and Andrew R.
                Brown, Las Vegas,
                for Real Party in Interest.

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                       BEFORE  THE     SUPREME             CO u-RT,    HERNDON,        LEE.     and
                       PARRAGUIRRE, JJ.

                                                        OPINION

                       By the Court, HERNDON, J.:
                                   In this opinion, we address the contours of the privilege created
                       by the federal Patient Safety and Quality Improvement Act of 2005
                       (PSQIA), 42 U.S.C. §§ 299b-21-299b-26, that applies to information that
                       qualifies as patient safety work product. We determine that under the
                       PSQIA, identifiable patient safety work product is privileged from discovery
                       in civil proceedings and the privilege cannot be waived.
                                        FACTS AND PROCEDURAL HISTORY
                                   E.G. was born prematurely at Sunrise Hospital on January 8,
                       2018. Sunrise's medical team placed him in the Neonatal Intensive Care
                       Unit due to complications from the premature birth. On February 27, 2018,
                       his assigned nurse, Cord Olsen, changed his fluid lines. Shortly thereafter,
                       E.G. decompensated, his oxygen levels and heart rate plummeted, and his
                       skin splotched with discolorations.   He entered into cardiac arrest, and
                       medical staff rushed to save him. E.G. ultimately suffered a hypoxic event,
                       leading to permanent developmental damage.
                                   Sunrise has a Patient Safety Committee, which investigated
                       E.G.'s cardiac arrest with the goal of improving future healthcare outcomes.
                       Dr. Jeffrey Murawsky, the Chief Medical Officer of Sunrise, chaired the
                       committee. His deposition testimony revealed that Sunrise used a patient
                       safety evaluation system as its internal process for collecting, managing,
                       and analyzing the information that it reported to the patient safety
                       organization. The Patient Safety Committee reviewed that information,

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                     collected additional data, and maintained that data within its internal
                     evaluation system.
                                 Real party in interest Tiffiny Grace, E.G.'s legal guardian, sued
                     Sunrise Hospital and Nurse Olsen for professional negligence.         During
                     discovery, she attempted to depose Dr. Murawsky. She sought to discover
                     what information the Patient Safety Committee             examined in     its
                     investigation. Sunrise objected to some of the questions Grace posed on the
                     basis of privileges under both Nevada law and the PSQIA. Grace halted the
                     deposition, citing the need for answers to those questions. She then moved
                     to compel further deposition testimony from Dr. Murawsky.
                                 On October 24, 2022, the district court issued an order rejecting
                     Sunrise's PSQIA arguments after concluding that any privilege was waived
                     by disclosure and directed the parties to further brief whether Sunrise
                     waived its privilege under Nevada law.         Following that briefing, on
                     December 6, 2022, the district court issued its second order, granting
                     Grace's motion to compel. The district court determined that Sunrise had
                     permitted Dr. Murawsky to testify about certain privileged topics, Sunrise
                     had permitted other personnel to testify about those topics, and Sunrise had
                     waived any privileges by permitting such testimony. The district court
                     again rejected Sunrise's PSQIA arguments as unpersuasive. Sunrise filed
                     the instant writ petition challenging both orders.
                                 In November 2023, after this matter was fully briefed and set
                     for oral argument, the district court sua sponte filed a third order relating
                     to the motion to compel. Neither party was alerted to the court's intentions,
                     and, as a result, they were not invited to further brief any issues or
                     otherwise participate.   However, the district court addressed only the

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                proportionality of the requested discovery and refused a protective order; it
                again rejected Sunrise's PSQIA arguments in conclusory fashion.
                                                 DISCUSSION
                              This original proceeding asks us to determine whether the
                district court exceeded its jurisdiction by compelling testimony concerning
                allegedly privileged information.     Because harm from disclosure of that
                information cannot be remedied in the normal course of an appeal and this
                petition concerns a novel issue of law, we consider the petition. In doing so,
                we first consider whether the PS QIA patient safety work product privilege
                can be waived. We then consider the district court's decision in the context
                of whether the information that Grace seeks to discover constitutes
                privileged patient safety work product.
                Writ relief
                              Writ relief is appropriate to prevent the disclosure of privileged
                information.    "When the district court acts without or in excess of its
                jurisdiction, a writ of prohibition may issue to curb the extrajudicial act."
                Toll v. Wilson, 135 Nev. 430, 432, 453 P.3d 1215, 1217 (2019) (internal
                quotation marks omitted). "Therefore, even though discovery issues are
                traditionally subject to the district court's discretion and unreviewable by a
                writ petition, this court will intervene when the district court issues an
                order requiring disclosure of privileged information." Id.
                              Furthermore, writ relief is appropriate when "an important
                issue of law needs clarification and this court's invocation of its original
                jurisdiction serves public policy." Canarelli v. Eighth Jud. Dist. Ct., 136
                Nev. 247, 250-51, 464 P.3d 114, 119 (2020) (internal quotation marks
                omitted). "One such instance is when a writ petition offers this court a
                unique opportunity to define the precise parameters of a privilege conferred

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                by a statute that this court has never interpreted." Diaz v. Eighth Jud.
                Dist. Ct., 116 Nev. 88, 93, 993 P.2d 50, 54 (2000) (cleaned up).
                            The district court order below compels the disclosure of
                allegedly privileged information, so we elect to entertain this petition for a
                writ of prohibition. Our intervention will clarify the extent of the privilege
                afforded by the PSQIA, a federal act we have yet to address. It will also
                serve public policy by helping medical providers and attorneys understand
                the extent to which patient safety work product is privileged.
                Standard of review
                           We review discovery matters for an abuse of discretion. Club
                Vista Fin. Servs., LLC v. Eighth Jud. Dist. Ct., 128 Nev. 224, 228, 276 P.3d
                246, 249 (2012). But we review conclusions of law, including the meaning
                and scope of statutes, de novo. Dewey v. Redev. Agency of Reno, 119 Nev.
                87, 93-94, 64 P.3d 1070, 1075 (2003).
                Under the PSQIA, patient safety work product is privileged, and that
                privilege cannot be waived
                            The PSQIA provides that "patient safety work product shall be
                privileged and shall not be .. . subject to discovery ... [or] adrnitted as
                evidence in any Federal, State, or local governmental civil proceeding." 42
                U.S.C. §§ 2994-22(a)(2), (4). Patient safety work product comes in two
                categories: identifiable and nonidentifiable.    Identifiable patient safety
                work product includes the identities of the providers, patients, or reporters
                involved. 42 U.S.C. § 299b-21(2). Nonidentifiable patient safety work
                product includes all other patient safety work product (i.e., that without
                identifying information). 42 U.S.C. § 299b-21(3). Nonidentifiable patient
                safety work product may be voluntarily disclosed, and when it is, it is
                exempted from privilege. 42 U.S.C. § 299b-22(c)(3). Our opinion concerns
                the privilege as it pertains to identifiable patient safety work product.
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                                There are only a few exceptions to PSQIA privilege for
                identifiable patient safety work product: in certain criminal proceedings, in
                civil actions brought by a good-faith reporter, or when every medical
                provider identified in the work product authorizes disclosure. 42 U.S.C.
                § 299b-22(c)(1)(A)—(C). None of those exceptions apply here.
                                Nonetheless, the district court found that Sunrise could waive
                the PSQIA's grant of privilege over patient safety work product. It erred in
                doing so by abusing the negative-implication canon to create a necessary
                condition for privilege where none exists in the PSQIA's implementing
                regulation. I
                                The regulation, 42 C.F.R. § 3.208, states that patient safety
                work product disclosed in accordance with 42 C.F.R. § 3.204(b)(1) or
                disclosed impermissibly shall remain privileged. But the district court
                interpreted this regulation to mean that patient safety work product
                disclosed permissibly shall not remain privileged. This maneuver was both
                logically invalid and incorrect as a matter of law.
                                The plain language of the regulation describes when patient
                safety work product shall continue to remain privileged. 42 C.F.R. § 3.208.
                It does not purport to describe when patient safety work product shall be
                excepted from privilege, as the implementing regulations cover those

                        'Better known in its Latin form as "expressio unius est exclusio
                alterius," the negative-implication canon holds that the expression of one
                thing implies the exclusion of others. Antonin Scalia & Bryan Garner,
                Reading Law: The Interpretation of Legal Texts 107 (2012). "Virtually all
                the authorities who discuss the negative-implication canon emphasize that
                it must be applied with great caution, since its application depends so much
                on context." Id. The applicability of the canon is limited to when the
                subjects specified in the rule can reasonably be thought to be an expression
                of all that share in the quality described. Id.
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                exceptions in a different section.        See 42 C.F.R. § 3.204(b) (titled
                "[e]xceptions to privilege" and describing when privilege shall not apply to
                the enumerated disclosures). The negative-implication canon should not be
                applied to 42 C.F.R. § 3.208 because it creates an exception to privilege far
                broader than the exceptions to privilege explicitly carved out elsewhere in
                the PSQIA and its implementing regulations.
                            The district court's interpretation also fails to consider that the
                PSQIA's implementing regulations already contemplate when voluntary
                disclosure could defeat privilege, specifically, for nonidentifiable patient
                safety work product. 42 C.F.R. § 3.204(b)(4). Reading further exceptions to
                privilege into 42 C.F.R. § 3.208 would render the explicitly enumerated
                exceptions in 42 C.F.R. § 3.204(b) superfluous. That violates one of our long-
                held tenets of interpretation, which is to consider a statute's "provisions as
                a whole so as to read them in a way that [will] not render words or phrases
                superfluous or make a provision nugatory." S. Nev. Homebuilders Ass'n v.
                Clark County, 121 Nev. 446, 449, 117 P.3c1 171, 173 (2005) (internal
                quotation marks omitted).2
                            We reject the district court's interpretation and determine that
                PSQIA privilege is absolute.     Federal courts tasked with determining
                whether PSQIA privilege extends over alleged patient safety work product
                ask two questions: (1) whether those materials were "created for the

                      2 Because the plain language of the regulation suffices to support our
                conclusion, we need not reach other means of deciphering the drafters'
                intent. However, we caution district courts to be wary of finding exceptions
                to a rule via the negative-implication canon when such exceptions are
                explicit elsewhere in the regulatory scheme. It would be quite strange to
                make some exceptions explicit under the section titled "Exceptions to
                privilege" (42 C.F.R. § 3.204(b)) but others implicit under a section titled
                "Continued protection of patient safety work product" (42 C.F.R. § 3.208(b)).
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                purpose of reporting to a patient safety organization"3 and (2) whether they
                were (Cs() reported." Nelms v. Wellpath, LLC, No. 21-10917, 2023 WL
                2733379, at *2 (E.D. Mich. Mar. 31, 2023) (quoting Penman v. Correct Care
                Sols., LLC, No. 5:18-CV-00058-TBR-LLK, 2020 WL 4253214, at *3 (W.D.
                Ky. July 24, 2020), and citing Tinal v. Norton Healthcare, Inc., No. 3:11-CV-
                596-S, 2014 WL 12581760, at *11 (W.D. Ky. July 15, 2014)). We adopt the
                same test here in Nevada. The only factors bearing on whether identifiable
                patient safety work product may be privileged under the PSQIA are
                (1) whether the materials were created for the purpose of reporting to a
                patient safety organization and (2) whether they were so reported. If they
                are so privileged, then courts must consider whether one of the exceptions
                made explicit by 42 C.F.R. § 3.204(b) applies.
                            Because the PSQIA does not contemplate waiver of the
                privilege over identifiable patient safety work product, we conclude that
                such a privilege cannot be waived. Our interpretation accords with the
                PSQIA's stated goals.     Congress enacted the PSQIA to "strike[ ] the
                appropriate balance between plaintiff rights and creat[e] a new culture in
                the health care industry that provides incentives to identify and learn from
                errors." S. Rep. No. 108-196, at 4 (2003). The PSQIA grants privileges to
                information produced in pursuit of that goal, like patient safety work
                product. 42 U.S.C. § 299b-22. The statutory scheme does not permit a
                finding that a party has voluntarily relinquished PSQIA privilege

                      3 The PSQIA defines "patient safety organization[sr and states that
                they must obtain certification from the Secretary of Health and Human
                Services. 42 U.S.C. §§ 299b-21(4), 299b-24. It is undisputed that Sunrise,
                at all times relevant to this suit, maintained an active agreement with a
                certified patient safety organization, the HCA Patient Safety Organization,
                LLC.
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                pertaining to identifiable patient safety work product; that party might
                inadvertently disclose patient safety work product or disclose it in
                accordance with specific exceptions, but the privilege continues to exist. 42
                U.S.C. § 299b-22(a), (c); 42 C.F.R. § 3.208.
                            Finally, we note that the privilege flows in both directions.
                Nothing in the PSQIA precludes a plaintiff from asserting the same
                privilege when it suits them. If a medical provider were to attempt to
                introduce evidence including identifiable patient safety work product, then
                the plaintiff could object on the same grounds.
                We grant the petition for a writ of prohibition
                            The district court further erred by failing to determine whether
                the testirnony that Grace sought to compel constituted identifiable or
                n.onidentifiable patient safety work product. The two are treated differently
                under the PSQIA.      42 U.S.C. §§ 299b-21, 299b-22.       This court is not
                particularly suited to fact-finding in the first instance. Ryan's Express
                Transp. Servs., Inc. v. Arnador Stage Lines, Inc., 128 Nev. 289, 299, 279 P.3d
                166, 172 (2012).    We thus decline to decide whether the information
                constitutes identifiable or nonidentifiable patient safety work product. We
                grant the petition for a writ of prohibition to vitiate the district court's
                orders to the extent they found PSQIA protections waived and compelled
                the testimony of potentially privileged information. We further instruct the
                district court to, upon reconsideration of the issue, first determine whether
                the testimony that Grace seeks to compel constitutes identifiable or
                nonidentifiable patient safety work product.4

                     'We have considered the parties' remaining arguments about
                preemption and state law privilege. Because we find no conflict between
                the PSQIA and Nevada's state law privilege provided by NRS 49.265, we
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                                               CONCLUSION
                              The district court erred by concluding that Sunrise waived any

                privilege over identifiable patient safety work product under the PSQIA.
                Because that privilege cannot be waived, the district court must first
                deterrnine whether the testirnony that Grace seeks to compel concerns

                identifiable or nonidentifiable patient safety work product, and then rule on
                the rnotion to compel accordingly. Thus, we grant the petition for a writ of
                prohibition. The clerk of this court shall issue a writ of prohibition directing
                the district court to vacate its orders compelling the testimony of Dr.
                Murawsky and to reconsider Grace's motion to compel in light of this
                opinion.

                                                                A
                                                      Herndo,

                We concur:

                                                 J.
                Lee

                                                 J.
                Parraguirre

                need not apply any preemption doctrine. Nonetheless, to the extent that
                PSQIA privilege is broader than the privilege afforded under Nevada law,
                the PSQIA applies. See 42 U.S.C. § 299b-22(a) ("Notwithstanding any other
                provision of Federal, State, or local law      patient safety work product
                shall be privileged . . . ."); Nanopierce Techs., Inc. v. Depository Tr. &
                Clearing Corp., 123 Nev. 362, 370, 168 P.3d 73, 79 (2007) ("[W]hen a conflict
                exists between state and federal law, valid federal law overrides, i.e.,
                preempts, an otherwise valid state law.").
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