Ungurian v. Beyzman

232 A.3d 786

Susan UNGURIAN, individually and as guardian of Jason Ungurian, an incapacitated person

v.Andrew BEYZMAN, M.D.; Robert Burry, CRNA; North American Partners in Anesthesia (Pennsylvania), LLC, individually and d/b/a NAPA; North American Partners in Anesthesia, LLP, individually and d/b/a NAPA; Wilkes-Barre Hospital Company, LLC, individually and d/b/a Wilkes-Barre General Hospital, Wyoming Valley Health Care System, Commonwealth Health and/or Commonwealth Health Systems, Inc. ; Community Health Systems, Inc., individually and d/b/a Wilkes-Barre General Hospital, Wyoming Valley Health Care System, Commonwealth Health and/or Commonwealth Health System

Appeal of: Wilkes-Barre Hospital Company, LLC d/b/a Wilkes Barre General Hospital

Susan Ungurian, individually and as guardian of Jason Ungurian, an incapacitated person

v.Andrew Beyzman, M.D.; Robert Burry, CRNA; North American Partners in Anesthesia (Pennsylvania), LLC, individually and d/b/a NAPA; North American Partners in Anesthesia, LLP, individually and d/b/a NAPA; Wilkes-Barre Hospital Company, LLC, individually and d/b/a Wilkes-Barre General Hospital, Wyoming Valley Health Care System, Commonwealth Health and/or Commonwealth Health Systems, Inc. ; Community Health Systems, Inc., individually and d/b/a Wilkes-Barre General Hospital, Wyoming Valley Health Care System, Commonwealth Health and/or Commonwealth Health System

Appeal of: Wilkes-Barre Hospital Company, LLC, individually and d/b/a Wilkes-Barre General Hospital

Susan Ungurian, individually and as guardian of Jason Ungurian, an incapacitated person

v.Andrew Beyzman, M.D.; Robert Burry, CRNA; North American Partners in Anestesia (Pennsylvania) LLC, individually and d/b/a NAPA; North American Partners in Anesthesia LLP, individually and d/b/a NAPA; Wilkes-Barre General Hospital, Wyoming Valley Healthcare System, Commonwealth Health and/or Commonwealth Health System, Inc. individually and d/b/a Wilkes-Barre General Hospital, Wyoming Valley Healthcare System, Commonwealth Health and/or Commonwealth Health Systems

Appeal of: Wilkes-Barre Hospital Company, LLC d/b/a Wilkes-Barre General Hospital

Susan Ungurian, individually and as guardian of Jason Ungurian, an incapacitated person

v.Andrew Beyzman, M.D.; Robert Burry, CRNA; North American Partners in Anesthesia (Pennsylvania), LLC, individually and d/b/a NAPA; North American Partners in Anesthesia, LLP, individually and d/b/a NAPA; Wilkes-Barre Hospital Company, LLC, individually and d/b/a Wilkes-Barre General Hospital, Wyoming Valley Health Care System, Commonwealth Health and/or Commonwealth Health Systems, Inc. ; Community Health Systems, Inc., individually and d/b/a Wilkes-Barre General Hospital, Wyoming Valley Health Care System, Commonwealth Health and/or Commonwealth Health System

Appeal of: Wilkes-Barre Hospital Company, LLC d/b/a Wilkes-Barre General Hospital

Susan Ungurian, individually and as guardian of Jason Ungurian, an incapacitated person

v.Andrew Beyzman, M.D.; Robert Burry, CRNA; North American Partners in Anestesia (Pennsylvania) LLC, individually and d/b/a NAPA; North American Partners in Anesthesia LLP, individually and d/b/a NAPA; Wilkes-Barre General Hospital, Wyoming Valley Heathcare System, Commonwealth Health and/or Commonwealth Health System, Inc. individually and d/b/a Wilkes-Barre General Hospital, Wyoming Valley Healthcare System, Commonwealth Health and/or Commonwealth Health Systems

Appeal of: Wilkes-Barre Hospital Company, LLC d/b/a Wilkes-Barre General Hospital

No. 298 MDA 2019

No. 300 MDA 2019

No. 722 MDA 2019

No. 949 MDA 2019

No. 950 MDA 2019

Superior Court of Pennsylvania.

Argued January 23, 2020

Filed April 28, 2020

Reargument Denied June 30, 2020

Ira L. Podheiser, Pittsburgh, for appellant.

Joseph A. Quinn Jr., Kingston, for appellee.

BEFORE: LAZARUS, J., STABILE, J., and DUBOW, J.

OPINION BY DUBOW, J.:

Appellant, Wilkes-Barre Hospital Company, LLC d/b/a Wilkes-Barre General Hospital ("Hospital"), appeals from five Orders entered in the trial court compelling production of documents that Hospital alleges are privileged by the Patient Safety Quality Improvement Act ("PSQIA"), 42 U.S.C. § 299b-22(a), and the Peer Review Protection Act ("PRPA"), 63 P.S. § 425.4. After careful review, we affirm.

Briefly, this matter arises in the context of a medical malpractice action brought by plaintiff, Susan Ungurian, against multiple corporate and individual defendants. Mrs. Ungurian alleges that, on March 5, 2018, the negligence of defendants caused the total and permanent incapacity of her son, Jason Ungurian, who was undergoing a cystoscopy¹ at Hospital. In the course of discovery, on August 7, 2018, August 17, 2018, and September 13, 2018, Mrs. Ungurian propounded requests for production of documents and interrogatories on all defendants, including Hospital.

On October 8, 2018, and October 10, 2018, Hospital served Mrs. Ungurian with responses and objections to her First and Second Requests for Production of Documents, and responded and objected to her First Set of Interrogatories. Hospital asserted that these documents were privileged pursuant to, inter alia , the PRPA and the PSQIA, and served Mrs. Ungurian with a privilege log, listing five documents Hospital was withholding. Relevantly, Hospital's privilege log identified the following documents as privileged:

1. Event Report completed on March 5, 2018[,] by Robert Burry, CRNA [ ("Burry Event Report") ] for event date of March 5, 2018[,] relating to "Surgery, Treatment, Test, Invasive Procedure" reviewed by Jacqueline Curley, R.N., Clinical Leader, on March 21, 2018[,] and Elizabeth Trzcinski, R.N., Risk Coordinator, on March 8, 2018;

2. The SSER (Serious Safety Event Rating) Meeting Summary dated April 12, 2018[,] prepared by Elizabeth Trzcinski, R.N., Risk Coordinator;

3. Meeting Minutes from the Patient Safety Committee held on May 15, 2018[,] prepared by Joan DeRocco, R.N., Director Patient Safety Services, and Elizabeth Trzcinski, R.N., Risk Coordinator;

4. Root Cause Analysis Report dated April 12, 2018; and

5. [Hospital's] Quality Improvement Staff Peer Review completed by Dale A. Anderson, M.D. on April 15, 2018.

Privilege Log, 10/8/18, at 2-3.

On December 3, 2018, Mrs. Ungurian filed a Motion to Strike Objections and Compel Responses to her First and Second Requests for the Production of Documents and First Set of Interrogatories Propounded upon Hospital. In her Motion, Mrs. Ungurian argued that Hospital had failed to establish that PSQIA and PRPA privileges applied to the documents in Hospital's privilege log.

Hospital filed a Response to the Motion, claiming that two documents—the Burry Event Report and the Root Cause Analysis—were patient safety work product privileged by the PSQIA. Hospital also asserted that the PRPA Privilege protected it from producing the Burry Event Report and the Root Cause Analysis along with other documents, including the Quality Improvement Peer Review Meeting minutes, the Serious Safety Event Rating Meeting, minutes from the Patient Safety Committee, and certain credentialing files. Hospital supported its privilege claims with an affidavit from Joan DeRocco-DeLessio, Director of Patient Safety Services ("Affidavit").² In addition to baldly asserting that each of the requested documents were "specifically designated as privileged peer review information[,]" the Affidavit describes the relevant documents as follows.

The Burry Event Report

Hospital described the Burry Event Report as a two-page document "completed on March 5, 2018," which was the day of the incident that gave rise to this action. Privilege Log, 10/8/18, at 2. CRNA Robert Burry completed the Report in compliance with Hospital's "Event Reporting Policy."³ Affidavit, 12/18/18, at ¶ 10.

The Root Cause Analysis Report

Hospital's Root Cause Analysis Committee produced the Root Cause Analysis Report on April 12, 2018, ostensibly "during the course of a peer review concerning [Jason] Ungurian's medical care on March 5, 2018." Affidavit at ¶ 26. Hospital purports that it prepared the Root Cause Analysis Report to evaluate Jason Ungurian's care and to improve patient safety and quality of care. Id. at ¶¶ 27-28. Hospital stated that it maintains the Root Cause Analysis Report within its ERS⁴ for reporting to CHS PSO, LLC,⁵ and that it electronically submitted the Root Cause Analysis Report to CHS PSO, LLC. Id. at ¶¶ 30-31.

The Quality Improvement Peer Review

Hospital referred to the Quality Improvement Peer Review as the "initiating part of the peer review process." Affidavit at ¶ 21. Dr. Dale Anderson was the physician reviewer of the Quality Improvement Medical Staff Peer Review Form. Id. at ¶ 20. According to Hospital's Privilege Log, Dr. Anderson completed the Quality Improvement Peer Review on April 15, 2018, more than one month after the incident in question. Privilege Log at 3.

The Serious Safety Event Meeting Summary

Hospital asserted that Elizabeth Trzcinski, R.N., Risk Coordinator, prepared the Serious Safety Event Meeting dated April 12, 2018, to summarize the meeting of Hospital's Serious Safety Event Committee. Privilege Log at 2; Affidavit at ¶ 23. In its Affidavit, Hospital does not provide the date the Committee met or who comprised the committee.

The Patient Safety Committee Meeting Minutes

Hospital held the relevant Patient Safety Committee Meeting on May 15, 2018. Affidavit at ¶ 34. The Affidavit describes the Committee as "a multidisciplinary group whose membership is representative of both the hospital and community it serves." Id. at ¶ 36.

The January 30, 2019 Order

The court held a hearing on Appellee's Motion after which, on January 30, 2019, it issued an Order ("January 30, 2019 Order") directing Hospital to produce the Burry Event Report, the Root Cause Analysis, and the Quality Improvement Peer Review. The court found that neither the PSQIA nor the PRPA privileges protected any of these documents.⁶

The February 5, 2019 Order

On February 5, 2019, the court amended the January...