Lowy v. PeaceHealth
174 Wash. 2d 769, 280 P.3d 1078 (2012)
Rule of Law:
Washington's quality improvement statute, RCW 70.41.200(3), which protects hospital quality assurance records from "review or disclosure," refers to external review and does not prevent a hospital from internally consulting its privileged quality improvement database to identify otherwise discoverable patient medical records.
Facts:
- Dr. Leasa Lowy, a staff physician at St. Joseph's Hospital in Bellingham, was admitted to the hospital as a patient.
- While a patient, Lowy sustained ulna nerve damage to her left arm, causing serious permanent impairment.
- Lowy claims her injury was the result of an improper intravenous (IV) infusion procedure.
- Lowy testified that she became aware of about 170 IV injuries at the hospital when she saw a list on a computer screen detailing IV injuries with patient names replaced by identification numbers.
- Lowy brought a medical negligence action against St. Joseph's Hospital, alleging corporate negligence and a serious, systemic problem with IV infusion injuries.
- Lowy sought discovery of information relating to instances of "IV infusion complications and/or injuries at St. Joseph’s Hospital for the years 2000-2008."
- The hospital's patient medical records are maintained electronically, but the hospital does not have the capability to electronically search these records for the requested information.
- PeaceHealth maintained a "Cubes" database for quality assurance purposes, containing information derived from incident reports, which included the list of IV infusion injuries Lowy had seen.
Procedural Posture:
- Dr. Lowy brought a medical negligence action against St. Joseph's Hospital in state trial court.
- Lowy sought discovery from St. Joseph's Hospital regarding IV infusion complications and injuries.
- St. Joseph's Hospital moved for a protective order to prevent it from being required to review its quality assurance records to identify discoverable medical records.
- The trial court first agreed with Lowy, but then granted the protective order on the hospital's motion for reconsideration.
- Lowy appealed the trial court's grant of the protective order to the Washington Court of Appeals (intermediate appellate court).
- The Court of Appeals reversed the protective order, ruling in favor of Lowy.
- The Washington Supreme Court (highest court) granted review of the Court of Appeals' decision.
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Issue:
Does Washington's quality improvement statute, RCW 70.41.200(3), which shields hospital quality improvement committee records from "review or disclosure," prohibit a hospital from internally reviewing its own privileged quality assurance database to identify and produce discoverable, non-privileged patient medical records when compelled for civil litigation?
Opinions:
Majority - Chambers, J.
No, Washington's quality improvement statute does not prohibit a hospital from internally reviewing its own privileged quality assurance database to identify and produce discoverable, non-privileged patient medical records. The court held that its policy favoring open discovery requires privileges to be narrowly construed, particularly those in derogation of common law. The prohibition of "review" in RCW 70.41.200(3) refers to external review, not internal review, an interpretation supported by the legislative history of the 2005 amendment which sought to prevent non-judicial, external access in anticipation of Initiative 336. The court reasoned that the hospital’s interpretation would lead to absurd results, potentially undermining the quality improvement program itself or encouraging hospitals to conceal discoverable information. Analogizing to the attorney work product doctrine in _Hickman v. Taylor_, the court explained that privileges protect discussions and self-analysis, but not the underlying facts or "information that goes into or comes out of the committee." Since Lowy sought discoverable patient records, not the privileged database itself, and the hospital could easily locate this unprotected information without revealing the inner workings of its quality assurance committee, the statute does not provide a shield for such information. Hospitals have the burden to produce discoverable information and can seek a protective order under CR 26(c) if necessary to address specific concerns about compromising the privilege.
Dissenting - J.M. Johnson, J.
Yes, Washington's quality improvement statute prohibits a hospital from internally reviewing its own privileged quality assurance database to identify and produce discoverable, non-privileged patient medical records when compelled for discovery. Justice Johnson argued that the legislature expressed a strong public policy for confidentiality of hospital quality assurance records to encourage candid self-evaluation and improve patient care. The plain meaning of RCW 70.41.200(3), stating records are "not subject to review or disclosure," clearly bars Lowy's discovery request. Forcing the hospital to cull its privileged database for the plaintiff's purposes would effectively disclose some of its contents, which is prohibited. The dissent contended that identifying patient files through the database would inevitably reveal which cases were routed to and considered by the quality improvement committee, thus disclosing privileged information. The threat of disclosure would deter incident reporting, undermining the statute's purpose of fostering candor and constructive criticism, as recognized in _Anderson v. Breda_ and _Coburn v. Seda_. The dissent rejected the majority's broad work product analogy, noting that the peer review statute does not contain an undue hardship exception and should not have one read into it. The public interest in candid hospital review procedures to improve health care should prevail over a plaintiff’s demand for information from the most convenient source.
Analysis:
This case significantly reinforces the principle of liberal discovery and the narrow construction of statutory privileges in Washington. It clarifies that while hospital quality assurance committees' internal deliberations and materials specifically created for those deliberations are protected, the underlying factual patient records that exist independently are not, even if a privileged system is the most efficient means of locating them. The decision balances the need to encourage hospitals' self-assessment and quality improvement against a patient's fundamental right to access information relevant to a medical negligence claim. Going forward, hospitals cannot use the existence of a privileged quality improvement database as a blanket defense to avoid producing otherwise discoverable patient data, requiring them to find ways to facilitate discovery without revealing protected committee 'inner workings' or risk being compelled to use their internal systems to do so.
