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Estate of Krappa v. Lyons

Supreme Court of Pennsylvania

December 19, 2019

ESTATE OF LEONARD P. KRAPPA, DECEASED, BY AND THROUGH HIS ADMINISTRATOR, LEONARD A. KRAPPA AND MARGARET KRAPPA, INDIVIDUALLY AND IN HER OWN RIGHT
v.
MARK LYONS, D.O.; FRANK PIRO, M.D.; JONATHAN C. SULLUM, M.D.; JUAN C. BARRERA, M.D.; JAMES FRANGOS, M.D.; LOUIS DEGENNARO, M.D.; AND COMMUNITY MEDICAL CENTER PETITION OF: COMMUNITY MEDICAL CENTER

          Petition for Allowance of Appeal from the Order of the Superior Court

          ORDER

          PER CURIAM.

         AND NOW, this 19th day of December, 2019, the Petition for Allowance of Appeal is DENIED. Petitioner's Application for Leave to File Reply to Answer is DENIED.

         CONCURRING STATEMENT

          WECHT JUSTICE.

         I agree that the instant petition does not merit this Court's review. While this case suggests an issue of significant interest that may present itself in due course, it does not properly frame that issue for our consideration now. Nonetheless, the issue is worth mention, because it is likely to arise, recur, and materially affect many future disputes.

         Less than two years ago, this Court issued its decision in Reginelli v. Boggs, 181 A.3d 293 (Pa. 2018).[1] In that case, this Court decided several interpretive questions arising under the Peer Review Protection Act ("PRPA"), 63 P.S. §§ 425.1-425.4.[2] The PRPA creates a limited evidentiary privilege for certain records pertaining to physicians' assessment of other physicians' performance, i.e., "peer review."[3] The instant case appears to be the first Superior Court opinion, published or otherwise, to apply Reginelli.

         In this matter, the files as to which the parties dispute the PRPA's application were compiled by a "credentialing committee" in service of determining whether to "credential" and/or "recredential" two physicians subject to a medical malpractice suit. Estate of Krappa v. Lyons, 211 A.3d 869, 871 (Pa. Super. 2019). Respondent-Plaintiffs sought discovery of the committee's unredacted files concerning these physicians. Petitioner-Defendant Community Medical Center asserted privilege claims as to many of the records, in furtherance of which it submitted privilege logs encompassing numerous documents, the vast majority of which it specifically denominated "peer review documents," and some of which were described in ways that suggested the denomination was apt. See, e.g., Privilege Log of the Credentialing File of Frank A. Piro, M.D., at 2 ¶ 8 (describing a "Medical Staff Peer Recommendation" as a "[p]eer [r]eview document generated for . . . quality improvement purposes pursuant [to] MCARE. Not for redistribution outside [the] Committee."). Thus, Petitioner invoked the PRPA's protections. After reviewing the documents in camera, and considering arguments based upon the then hot-off-the-presses Reginelli decision, the trial court determined that none were protected by the privilege. On appeal, the Superior Court, which conducted its own in camera review, agreed. Estate of Krappa, 211 A.3d at 871, 875.

         While Reginelli addressed a number of discrete questions of statutory interpretation, the aspect of the case relevant to this matter drew a categorical distinction between peer review and credentialing, as such. The Superior Court in this case relied heavily upon this distinction. It is not necessary here to delve into the lengthy statutory provisions at issue.[4] It suffices to say that this Court interpreted the relevant provisions to provide that "a review organization" is defined by the PRPA to encompass functionally distinct peer review committees and credentialing committees. Only the work and files of the former enjoy the PRPA privilege; files compiled for purposes of credentialing, as such, are subject to discovery. See Reginelli, 181 A.3d at 305-06. In doing so, this Court offered a relatively narrow definition of what comprises a "credentialing record."

         The Court explained as follows:

[A credentialing committee is] a "hospital board, committee or individual" involved in the review of "the professional qualifications or activities of its medical staff or applicants thereto" by a "hospital board, committee or individual."10 [63 P.S. § 425.2.] This . . . category of "review organizations" does not involve peer review, as that term is defined in the PRPA, which is limited to the evaluation of the "quality and efficiency of services ordered or performed" by a professional health care provider. [Id.] Review of a physician's credentials for purposes of membership (or continued membership) on a hospital's medical staff is markedly different from reviewing the "quality and efficiency of service[s] ordered or performed" by a physician when treating patients. Accordingly, although "individuals reviewing the professional qualifications or activities of its medical staff or applicants for admission thereto," [id.], are defined as a type of "review organization," such individuals are not "review committees" entitled to claim the PRPA's evidentiary privilege . . . .
10 Professional "qualifications" would include, for instance, a physician's continuing maintenance of his or her board certifications, and "activities" could include clinical research initiatives, continuing education, service on professional committees or organizations and, more broadly speaking, other qualifications deemed necessary by the hospital. Credentials review permits a hospital to retain, and then maintain, a medical staff of quality professionals.

Reginelli, 181 A.3d at 305-06 (footnotes 11 and 12 omitted; emphasis added). I am concerned that the marked difference posited by the Reginelli Court will prove more difficult to discern in practice than it is to describe in the pages of a judicial opinion.

         The PRPA embodies the legislature's effort to protect physicians who candidly reveal concerns about the quality of care rendered by their peers to committees that conduct such assessments, so as to ensure candid and reprisal-free physician assessments by those who are most qualified and best positioned to make them. See Reginelli, 181 A.3d at 300 ("[The PRPA] was enacted to serve the legitimate purpose of maintaining high professional standards in the medical practice for the protection of patients and the general public based upon the General Assembly's determination that because of the expertise and level of skill required in the practice of medicine, the medical profession itself is in the best position to police its own activities." (cleaned up)). Thus, the PRPA's immunity and confidentiality provisions reflect the legislature's effort "to foster free and frank discussion by review organizations." Id. (quoting Sanderson v. Frank S. Bryan, M.D., Ltd., 522 A.2d 1138, 1140 (Pa. Super. 1987)); see 63 P.S. ยง 425.1, Historical and Statutory Notes ("An Act providing for the increased use of peer review groups by giving protection to individuals and data who report to any review group."). Such protection is not necessary with respect to essentially binary or anodyne inquiries, such as as whether a physician has maintained board certifications, pursued continuing education, conducted research, or otherwise attained ...


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