Production of Peer Review Documents; Pennsylvania Peer Review Protection Act; Federal Healthcare Quality Improvement Act
Leadbitter v. Keystone Anesthesia Consultants, LTD., 229 A.3d 292 (Pa. Super. 2020), allocatur granted Sept. 15, 2020, appeal docket 19 WAP 2020
The Supreme Court granted allocatur in this case to determine whether the Peer Review Protection Act (PRPA) and/or federal Healthcare Quality Improvement Act (HQIA) protects disclosure of professional opinions and performance evaluations of a surgeon that a hospital credentialing committee obtained from other physicians and reviewed before granting hospital privileges to the surgeon.
This case arises from a negligence action filed by James Leadbitter and his wife against St. Clair Hospital and other defendants following two spinal surgeries on James Leadbitter performed by Dr. Petraglia after which Mr. Leadbitter suffered a series of strokes resulting in permanent brain damage, cortical blindness, motor weakness, and impairment of his extremities. During the course of litigation, the Leadbitters filed a motion to compel production of Dr. Petraglia’s unredacted credentialing file. Specifically at issue was the disclosure of:
- Professional opinions relating to Dr. Petraglia’s competence;
- Professional Peer Review Reference and Competency Evaluation, which contains evaluations of Dr. Petraglia’s performance and prepared by other physicians;
- Ongoing Professional Practice Evaluation of St. Clair Hospital Summary Report, which contains performance-related data that St. Clair Hospital compiled; and
- Responses to St. Clair inquiries to the National Practitioner Data Bank (“NPDB”).
Slip op. at 2. In their motion, the Leadbitters relied on the Pennsylvania Supreme Court’s decision in Reginelli v. Boggs, 181 A.3d 293 (Pa. 2018), in which:
…the Supreme Court interpreted PRPA as creating two distinct categories of entities: a “review committee” and a “review organization.” [Reginelli,] 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.
Slip op. at 7. The trial court, relying exclusively on Reginelli granted the motion to compel and ordered the Hospital to produce Dr. Petraglia’s unredacted credentialing file. The Hospital appealed the trial court’s order, arguing that the 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. In addition, the Hospital claimed that the trial court improperly compelled it to produce the NPDB query responses, which the Hospital alleged were protected from disclosure pursuant to the HQIA.
As to the PRPA, Superior Court emphasized that it was “constrained to follow the holdings of” Reginelli v. Boggs, 181 A.3d 293 (Pa. 2018), and Estate of Krappa v. Lyons, 211 A.3d 869 (Pa. Super. 2019) and explained that:
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).
Slip op. at 7-8. Applying this precedent, the court reasoned that because the credentialing committee was engaging in a professional evaluation of Dr. Petraglia’s qualifications, it only qualified as a “review organization,” which is not afforded peer review privileges as a “review committee” under the PRPA. In so holding, Superior Court noted that “In light of the fact that the Supreme Court assumed that documents in a credentialing file are not peer review documents and in this case, the documents at issue are peer review documents, it would be helpful for the Supreme Court to grant allocatur and address this issue directly,” explaining that it “share[s] the observation of the Dissent in Reginelli that”:
…the Majority’s distinction between a review “organization” and review “committee” will result in the “same chilling effect upon free and frank discussions aimed to ensure and improve an appropriate quality of care that PRPA strives to vitiate.” Reginelli, 181 A.3d at 315 (Wecht, J., dissenting). This chilling effect will also occur when a credentialing committee is reviewing whether it should grant hospital privileges to a physician with no relationship to the hospital. It is crucial that a committee considering whether to authorize a physician to practice at its hospital has the opportunity to obtain candid and accurate evaluations of the physician before the physician practices at its hospital. The privilege PRPA provides is an important step to encourage other physicians to provide to hospitals accurate assessments of the performance of their peers.
Slip op. at 9 (footnote omitted). As to the HQIA, Superior Court held that because the confidentiality provisions of HQIA follow state law, HQIA does not preclude the production of the evaluations of Dr. Petraglia. The court reasoned that while the Act protects disclosure of information submitted to the NPDB for the purposes of credentialing, the Act “provides, however, that ‘[n]othing in this subsection shall prevent the disclosure of such information by a party which is otherwise authorized, under applicable State law, to make such disclosure.’” Slip op. at 10 quoting 42 U.S.C. § 11137(b)(1). Therefore, the court reasoned, because Pennsylvania law does not protect the professional evaluations of Dr. Petraglia in the file of the credentialing committee, they are not protected under the HQIA.
The Supreme Court granted allocatur to consider the following issues, as stated by the petitioner:
(1) Whether the Superior Court’s holding directly conflicts with the Pennsylvania Peer Review Protection Act, 69 P.S. §§ 425.1, et seq., and misapplies Reginelli v. Boggs, 181 A.3d 293 (Pa. 2018), by ordering the production of acknowledged “peer review documents” solely because they were maintained in a physician’s credentialing file?
(2) Whether the Superior Court’s holding directly conflicts with the Federal Healthcare Quality improvement Act, 42 U.S.C. § 11137(B)(1), and federal regulations which protect from disclosure, responses to statutorily-required inquiries of the national practitioner data bank, by ordering the production of such documents solely because they were maintained in physician’s credentialing file?