Leadbitter v. Keystone Ansethesia Consultants, Ltd.

229 A.3d 292

James E. LEADBITTER and Tammy M. Leadbitter, His Wife

v.KEYSTONE ANSETHESIA CONSULTANTS, LTD., a Corporation, Christopher Merck, D.O., Ajoy Katari, M.D., John P. Weldon, M.D. and St. Clair Hospital

v.Carmen Petraglia, M.D. and South Hills Orthopaedic Surgery Associates, a Corporation

Appeal of: St. Clair Hospital

No. 1414 WDA 2018

Superior Court of Pennsylvania.

Argued May 14, 2019

Filed February 12, 2020

John C. Conti, for appellant.

Elizabeth L. Jenkins, Pittsburgh, for Leadbitter, J. and T., appellees.

BEFORE: BENDER, P.J.E., DUBOW, J., and FORD ELLIOTT, P.J.E.

OPINION BY DUBOW, J.:

Appellant, St. Clair Hospital, appeals from the September 17, 2018 Order granting Appellees', James E. and Tammy M. Leadbitter's, Motion to Compel and directing Appellant to produce the unredacted credentialing file of defendant, Carmen Petraglia, M.D. After careful review, we affirm.

The relevant facts and procedural history are as follows. On June 24, 2014, Dr. Carmen Petraglia, a physician in private practice, applied for an appointment to the medical staff at St. Clair Hospital. On July 28, 2014, Dr. Petraglia applied for orthopedic surgery clinical privileges at St. Clair Hospital. In considering Dr. Petraglia's applications, the hospital's credentialing committee reviewed numerous documents, including the following, which are at issue in this appeal:

1. Professional opinions relating to Dr. Petraglia's competence;

2. Professional Peer Review Reference and Competency Evaluation, which contains evaluations of Dr. Petraglia's performance and prepared by other physicians;

3. Ongoing Professional Practice Evaluation of St. Clair Hospital Summary Report, which contains performance-related data that St. Clair Hospital compiled; and 4. Responses to St. Clair inquiries to the National Practitioner Data Bank ("NPDB").¹

The credentialing committee recommended that St. Clair Hospital grant clinical privileges to Dr. Petraglia in the Department of Surgery, Section of Orthopedic Surgery.² On September 8, 2014, Dr. Petraglia accepted the appointment.

On November 13, 2014, Dr. Petraglia examined Appellee James Leadbitter at Dr. Petraglia's medical office and recommended spinal surgery. On January 14, and January 15, 2015, Dr. Petraglia performed two spinal surgeries on Mr. Leadbitter at St. Clair Hospital. Following the surgeries, Mr. Leadbitter suffered a series of strokes, resulting in permanent brain damage, cortical blindness, motor weakness, and impairment of his extremities, which Appellees alleged the negligence of St. Clair Hospital and the other defendants caused.

On January 11, 2017, Appellees filed an Amended Complaint raising claims of negligence and loss of consortium against all defendants, including St. Clair Hospital, and vicarious liability and corporate negligence against St. Clair Hospital.³ That same day, Appellees also filed a separate negligence action against Dr. Petraglia and South Hills Orthopaedic Surgery Associates, P.C. On January 27, 2017, the trial court consolidated the two actions.

On March 22, 2017, Appellees served upon St. Clair Hospital a First Set of Interrogatories and Request for Production of Documents seeking, inter alia , "the complete credentialing and/or privileging file for [ ] Petraglia." Motion to Compel, 8/29/19,⁴ at ¶¶ 4-5. St. Clair Hospital responded to Appellees' Request for Production of Documents by producing only those documents that it determined were discoverable portions of Dr. Petraglia's credentialing file and removing or redacting portions it claimed were privileged.

Following an additional request for production of documents,⁵ St. Clair Hospital produced another tranche of documents. St. Clair Hospital continued to assert, however, that some portions of Dr. Petraglia's credentialing file were privileged and, thus, refused to produce the file in full.

On August 29, 2018, Appellees filed a Motion to Compel production of Dr. Petraglia's unredacted credentialing file, in which it asserted that, pursuant to the Pennsylvania Supreme Court's decision in Reginelli v. Boggs , 645 Pa. 470, 181 A.3d 293 (2018), they were entitled to the complete, unredacted file. On September 10, 2017, St. Clair Hospital filed a response to the Motion, claiming that the Peer Review Protection Act ("PRPA"), 63 P.S. § 425.1, et seq ., and the Healthcare Quality Improvement Act ("HQIA"), 42 U.S.C. § 11101 et seq ., shielded them from producing the requested documents.

On September 13, 2018, the trial court held a hearing on Appellees' Motion after which, relying exclusively on Reginelli , supra , it granted the Motion to Compel and ordered St. Clair Hospital to produce Dr. Petraglia's unredacted credentialing file. This timely appeal followed.⁶ Both Appellant and the trial court have complied with Pa.R.A.P. 1925.

St. Clair Hospital raises the following two issues on appeal:

1. Whether the [t]rial [c]ourt erred and/or abused its discretion in granting [Appellees'] Motion to Compel and compelling production of professional opinions and performance evaluations relating to [ ] Petraglia's competence and an Ongoing Professional Practice Evaluation of [Appellant], which are protected from disclosure pursuant to the [PRPA]?

2. Whether the [t]rial [c]ourt erred and/or abused its discretion in granting [Appellees'] Motion to Compel and compelling production of responses to statutorily-required inquiries of the National Practitioner Data Bank on the part of [Appellant] which are protected from disclosure by federal law, 42 U.S.C. § 11137(b)(1) and 45 C.F.R. § 60.20(a) ?

Appellant's Brief at 5.

In its first issue, St. Clair Hospital argues that the trial court erred in not finding that PRPA protected the disclosure of the professional opinions and performance evaluations of Dr. Petraglia that the credentialing committee obtained from other physicians and reviewed before granting hospital privileges to Dr. Petraglia. St. Clair Hospital argues that because these are peer review documents, PRPA precludes their disclosure.

In order to evaluate the argument of St. Clair Hospital, we must analyze the language of PRPA. We start with general principles of statutory construction.

"Where the issue is the proper interpretation of a statute, it poses a question of law; thus, our standard of review is de novo , and the scope of our review is plenary." Yocabet v. UPMC Presbyterian , 119 A.3d. 1012, 1019 (Pa. Super. 2015) (quotation marks and citations omitted). We also note that the courts generally disfavor evidentiary privileges. Reginelli , 181 A.3d at 300.

We now turn to the language of PRPA and begin by considering its definition of "peer review." PRPA defines "peer review" as "the procedure for evaluation by professional health care providers of the quality and efficiency of services ordered or performed by other professional health care providers ...." Id. (citing 63 P.S. § 425.2 ). In this case, St. Clair Hospital seeks to use the PRPA privilege to prevent disclosure of professional evaluations that its credentialing committee considered before granting Dr. Petraglia surgery privileges at St. Clair Hospital. We find that since "professional health care providers"—other physicians—prepared those documents and the documents evaluated the "quality and efficiency of services ordered or performed" by Dr. Petraglia, the documents meet the statutory definition of "peer review" documents. The analysis, however, does not end there. We must also analyze PRPA in light of the Supreme Court's holding in Reginelli .

The Supreme Court in Reginelli interpreted the application of the privilege that PRPA sets forth in terms of, inter alia , the entity that holds the peer review documents. Reginelli , 181 A.3d at 305. In particular, the Supreme Court concluded that the evidentiary privilege only applies to the peer review documents of a "review committee " and not to the documents of a "review organization ." Id. at 305-06 (emphasis added).

The Supreme Court interpreted PRPA as creating two distinct categories of entities: a "review committee" and a "review organization." Id. at 305. According to the Reginelli Court, PRPA defines a "review committee" as "any committee engaging in peer review" and a "review organization" as "any hospital Board, committee or individual reviewing the professional qualifications or activities of its medical staff or applicants for admission thereto." Id.

Applying this statutory interpretation to the facts of Reginelli, the Supreme Court focused on the fact that the peer review documents at issue were part of a file created and maintained by an "individual." The Supreme Court concluded that since it was an "individual" who reviewed the documents, and PRPA includes "individuals" in its definition of a "review organization," the PRPA privilege did not apply to those professional evaluations. Reginelli , 181 A.3d at 306. Similarly, this Court recently held that based on Reginelli , PRPA does not shield from disclosure evaluations that a credentialing committee generates. Estate of Krappa v. Lyons , 211 A.3d 869, 875 (Pa. Super. 2019).

Turning to the facts of this case and the peer review documents in question, we are constrained to follow the holdings of Reginelli and Krappa . Reginelli requires that, to determine the applicability of the PRPA privilege, we must consider whether a "review organization" or a "review committee" reviewed the professional evaluations of Dr. Petraglia. Since St. Clair Hospital's credentialing committee is a committee that reviewed the professional qualifications and activities of Dr. Petraglia following his application for hospital privileges at St. Clair Hospital, the credentialing committee is a review "organization." Therefore, the PRPA privilege does not apply to the documents that the credentialing committee reviewed.

We also note that the Supreme Court concluded in a footnote that credentialing review is not "entitled to protection from disclosure under PRPA's evidentiary privilege." Reginell...