Today, Division I of the Washington Court of Appeals issued a published opinion in Leasa Lowy v. PeaceHealth, et al., No. 63866-1-I, in which it ordered a hospital to search its quality assurance database to identify other medical incidents similar to the problem experienced by the plaintiff. This decision significantly broadens the ability of malpractice plaintiffs to access information generated by QA/QI processes.
The case involved a patient, a staff physician, who sustained a neurological injury to her arm after an intravenous infusion at the hospital. She brought a lawsuit against the hospital, alleging both individual and corporate negligence. With regard to her corporate negligence claim, Dr. Lowy requested that the hospital produce the charts of other patients who had experienced complications or injuries in connection with intravenous infusions.
The hospital offered two ways to respond to this request: It could search through its entire database of patient records (which the parties agreed was unduly burdensome), or it could run a search of its computerized quality assurance database to determine those patients' identities, and then pull their medical charts. The hospital maintained, and the trial court eventually agreed, that the plain language of RCW 70.41.200(3) prohibited a review of the database, as it consisted of information collected specifically for and maintained by a quality improvement committee.
The relevant portion of RCW 70.41.200(3) states:
Information and documents, including complaints and incident reports, created specifically for, and collected and maintained by, a quality improvement committee are not subject to review or disclosure . . . or discovery or introduction into evidence in any civil action. [Emphasis added.]
The court of appeals held that this statute did not prevent use of the hospital's QA database to identify pertinent records. Noting that the purpose of Title 70 RCW was to promote safe and adequate care of individuals in hospitals, it held that "to interpret [the statute] as preventing all hospital personnel from reviewing the contents of the database would frustrate the very purpose for which the quality assurance committee gathered the records in the first place." The court drew a distinction between external review and internal review, and held that internal review of a quality assurance database, even for purposes of responding to discovery, was permissible. The panel that decided the case consisted of Judge Mary Kay Becker (who authored the opinion), Judge Michael Spearman and Judge Marlin Appelwick. The hospital has 20 days to file a motion for reconsideration with the Court of Appeals, or 30 days to seek review of the opinion by the Washington Supreme Court.
Based upon the court's ruling, and in the absence of another viable alternative to produce the requested information, hospitals will be required to run an internal search of their quality assurance databases to discover the identity of patients who experienced complications similar to a plaintiff's, and then to produce de-identified versions of those patients' medical charts in response to discovery requests. It is likely that this ruling will be utilized by plaintiffs' counsel not only in corporate negligence cases, but in any medical malpractice case in which the plaintiff seeks to determine whether similar incidents have occurred. Additionally, it is likely that plaintiffs' counsel will attempt to expand upon this ruling by seeking information that even more directly implicates QA/QI activities, such as information regarding corrective or remedial actions, or the lack thereof. In order to avoid going down this road, hospitals and other providers with certified QA/QI processes should carefully examine whether it is possible to produce information regarding similar events through use of their EMR or billing systems, rather than QA/QI databases.
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