Catastrophic Medical Injury

In Leadbitter v. St. Clair Hospital et al., No. 19 WAP 2020 (Pa., August 17, 2021), the Pennsylvania Supreme Court unanimously enforced peer review limitations on discovery set forth in the Pennsylvania Peer Review Protection Act (PRPA) and the federal Health Care Quality Improvement Act (HCQIA).
 
The plaintiffs alleged that the defendant hospital’s credentialing and privileging process was inadequate, and that it knew or should have known that the physician who performed surgery on the plaintiff-husband lacked the expertise to perform the surgery. As a result, the plaintiffs served interrogatories and a request for documents seeking the complete credentialing and/or privileging file for the surgeon. The hospital asserted a privilege over certain documents, but the trial court compelled production of the entire credentialing file, and the Superior Court affirmed.
 
The Supreme Court unanimously reversed and limited the scope of its prior decision in Reginelli v. Boggs, 181 A.3d 293 (Pa. 2018), which held that the PRPA’s evidentiary privilege applies to the documents of a “review committee” but not to the documents of all “review organizations.” Rejecting a focus on the particular name of the committee conducting a review, which had arisen in the lower courts in the wake of Reginelli, the Leadbitter court held that the PRPA’s protections extend to peer review conducted by any committee, regardless of whether the committee engages exclusively in peer review. In support of this conclusion, the court emphasized that the PRPA’s definition of “review organization” includes “any committee engaging in peer review.” Id., citing 63 P.S. § 425.2. Therefore, the court held that a hospital’s credentials committee enjoys the PRPA’s protection if (but only if) it engages in peer review.
 
Finally, the Supreme Court rejected the conclusion of the trial court and Superior Court that the protections of the PRPA and HCQIA are co-extensive, meaning that information that is not confidential under the PRPA necessarily is not confidential under the HCQIA. The court held that the HCQIA extends independent, federal protection to certain information provided by the National Practitioner Data Bank (NPDB) to hospitals in response to requests concerning a specific practitioner. This protection is not dependent on state law and prevents discovery of information contained in the NPDB.
 
Leadbitter’s twin holdings—that a hospital’s credentials committee qualifies as a “review committee” under the PRPA if it engages in peer review and the HCQIA prohibits discovery of NPDB information—restore reasonableness to the scope of peer review protections under both state and federal law. These holdings are a welcome clarification of an area of law that had become muddled in the wake of Reginelli.

 

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