P. Gregory Haddad, Esq.
D.
Michael Burke, Esq.
Steptoe & Johnson, PLLC
Burke,
Schultz and Harman
Morgantown, West Virginia
Martinsburg,
West Virginia
Ancil G. Ramey, Esq.
Barry
J. Nace, Esq.
Steptoe & Johnson, PLLC
Paulson
& Nace
Charleston, West Virginia
Washington,
District of Columbia
Attorneys for the Petitioners
Attorneys
for the Respondents
Paul T. Farrell, Jr., Esq.
Wilson, Frame, Benninger & Metheney, PLLC
Morgantown, West Virginia
Attorney for Amicus Curiae,
West Virginia Trial Lawyers Association
JUSTICE DAVIS delivered the Opinion of the Court.
1. '[T]his Court
will use prohibition . . . to correct only substantial, clear-cut,
legal errors plainly in contravention of a clear statutory, constitutional,
or common law mandate which may be resolved independently of any disputed
facts and only in cases where there is a high probability that the trial will
be completely reversed if the error is not corrected in advance. Syllabus
Point 1, [in part,] Hinkle v. Black, 164 W. Va. 112, 262 S.E.2d
744 (1979).' Syllabus point 1, in part, State ex rel. DeFrances v. Bedell,
191 W. Va. 513, 446 S.E.2d 906 (1994) [(per curiam)]. Syllabus
point 1, State ex rel. Charleston Mail Association v. Ranson, 200 W. Va.
5, 488 S.E.2d 5 (1997).
2. Interpreting a statute
or an administrative rule or regulation presents a purely legal question subject
to de novo review. Syllabus point 1, Appalachian Power Co.
v. State Tax Department of West Virginia, 195 W. Va. 573, 466 S.E.2d
424 (1995).
3. W. Va. Code,
30-3C-3 [1980] provides that '[t]he proceedings and records of a review organization
shall be confidential . . . Provided, That information, documents
or records otherwise available from original sources are not to be construed
as immune from discovery or use in any civil action merely because they were
presented during proceedings of such [a review] organization. . . .'
The language of the statute grants a privilege to all the records and proceedings of a review organization,
but no privilege attaches to information, documents or records considered
by a review organization if the material is 'otherwise available from original
sources.' Syllabus point 3, State ex rel. Shroades v. Henry,
187 W. Va. 723, 421 S.E.2d 264 (1992).
4. If the language
of an enactment is clear and within the constitutional authority of the law-making
body which passed it, courts must read the relevant law according to its unvarnished
meaning, without any judicial embroidery. . . . Syllabus
point 3, in part, West Virginia Health Care Cost Review Authority v. Boone
Memorial Hospital, 196 W. Va. 326, 472 S.E.2d 411 (1996).
5. A hospital committee that
is responsible for considering applications for admission to its staff and
for issuing staff privileges or credentials in accordance therewith is a review
organization within the definition of W. Va. Code § 30-3C-1
(1975) (Repl. Vol. 1998). As a review organization, such hospital
committee may also avail itself of the health care peer review privilege,
codified in W. Va. Code § 30-3C-3 (1980) (Repl. Vol. 1998),
provided it satisfies the requisite criteria for the assertion of that privilege.
6. The enactment of
West Virginia Code §§ 30-3C-1 to -3 (1993) clearly evinces a public policy encouraging health care professionals to
monitor the competency and professional conduct of their peers in order to
safeguard and improve the quality of patient care. Syllabus point 2,
Young v. Saldanha, 189 W. Va. 330, 431 S.E.2d 669 (1993).
7. 'Where a particular
construction of a statute would result in an absurdity, some other reasonable
construction, which will not produce such absurdity, will be made.' Syl. pt.
2, Newhart v. Pennybacker, 120 W. Va. 774, 200 S.E. 350 (1938).
Syllabus point 3, State v. Kerns, 183 W. Va. 130, 394 S.E.2d 532
(1990).
8. An application for the
issuance or renewal of staff privileges that is created solely for consideration
by a hospital credentialing committee is protected by the health care peer
review privilege pursuant to W. Va. Code § 30-3C-3 (1980) (Repl.
Vol. 1998).
Davis, Justice:
The petitioners herein, the Charles Town General Hospital,
doing business as Jefferson Memorial Hospital, and the Medical Staff thereof
[hereinafter collectively referred to as the Hospital or Jefferson
Memorial Hospital], request this Court to issue a writ of prohibition
to prevent the Circuit Court of Berkeley County from enforcing its order entered
March 23, 2001. By that order, the circuit court, ruling in favor of the respondents
herein, Anna Marie Chaffins [hereinafter referred to as Mrs. Chaffins]
and her husband, Thomas Chaffins, Jr. [hereinafter referred to as Mr.
Chaffins], determined that certain documents held by the Hospital and
sought by the Chaffins in their underlying medical malpractice lawsuit were
discoverable. In this petition for writ of prohibition, the Hospital claims
that the circuit court improperly found that these documents were not protected
by the privilege contained in W. Va. Code § 30-3C-3 (1980) (Repl.
Vol. 1998) of the West Virginia Health Care Peer Review Organization Protection
Act, W. Va. Code § 30-3C-1, et seq. Upon a review of the
parties' arguments, the record of documents at issue in this proceeding, and
the pertinent authorities, we find that the writ requested by the respondents
should be granted as moulded. To the extent that the contested documents are
available from original sources extraneous to the medical credentialing process,
they are not privileged and are subject to discovery. However, those documents,
such as applications for staff privileges, that were generated as part and parcel
of the credentialing process are protected by the health care peer review privilege
pursuant to the terms of
W. Va. Code § 30-3C-3. In light of these rulings, we remand
this matter to the Circuit Court of Berkeley County for further proceedings
consistent with this Opinion.
The Chaffins then filed a lawsuit against Dr. Rydland,
alleging medical malpractice.
(See footnote 1) They also named Jefferson
Memorial Hospital and its medical staff parties defendant to their civil action,
claiming that the Hospital had been negligent in extending staff privileges, or credentials, to Dr. Rydland and later renewing such
privileges.
(See footnote 2) During the proceedings below, the Chaffins
sought discovery of various documents in the Hospital's possession concerning
its decision to issue and renew Dr. Rydland's application for staff privileges
in an attempt to establish whether the Hospital knew of various professional
complaints that had been lodged against Dr. Rydland when it made these decisions.
The Hospital claimed that such documents were protected from disclosure by
the privilege applicable to health care peer review organizations contained
in W. Va. Code § 30-3C-3 (1980) (Repl. Vol. 1998).
(See footnote 3)
Upon the Chaffins' motion to compel discovery of these documents, the
Circuit Court of Berkeley County performed an in camera review thereof,
and, by order entered March 23, 2001, ruled as follows:
It appears to the Court that the issue is whether
certain documents are privileged under the peer review [statute]. The Court
in reviewing the documents . . . stamped 000001 - 000137 finds that
the only document that falls under the peer review privilege is document 000080.
The Court finds that all other documents were generated as part of the credentialing
process and are not privileged. The Court further finds that these documents
are confidential in nature and certain protections should be afforded these
documents.
Based upon the circuit court's determination that the majority of the Hospital's
records at issue were not privileged and thus were subject to discovery by
the Chaffins, the Hospital filed this petition for writ of prohibition and requests this Court to prevent
the circuit court from enforcing its order.
Also at issue in the case sub judice is the
correctness of the circuit court's interpretation and application of the applicable
statutory law concerning privileges relating to health care peer review proceedings. As this contention involves a question
of law, we apply a plenary review to the circuit court's decision in this
regard. Interpreting a statute or an administrative rule or regulation
presents a purely legal question subject to de novo review. Syl.
pt. 1, Appalachian Power Co. v. State Tax Dep't of West Virginia, 195
W. Va. 573, 466 S.E.2d 424 (1995).
Having set forth the appropriate standards for issuing
the writ requested by the respondents herein, we proceed to consider the parties'
arguments.
Ordinarily, this Court does not accept appeals from
interlocutory discovery orders or entertain requests for extraordinary relief
that have the same purpose and effect as a direct appeal. See, e.g.,
Syl. pt. 3, James M.B. v. Carolyn M., 193 W. Va. 289, 456 S.E.2d
16 (1995) (Under W. Va. Code, 58-5-1 (1925), appeals only may be
taken from final decisions of a circuit court. A case is final only when it
terminates the litigation between the parties on the merits of the case and
leaves nothing to be done but to enforce by execution of what has been determined.).
See also State ex rel. Ward v. Hill, 200 W. Va. 270, 275,
489 S.E.2d 24, 29 (1997) (observing that most discovery orders are interlocutory
and reviewable only after final judgment (citation omitted)). When, however,
the lower court's ruling concerns a discovery matter that involves the disclosure
of potentially privileged information, we have found the writ of prohibition
to be an appropriate vehicle for mounting such a challenge. See, e.g.,
Syl. pt. 2, State ex rel. United Hosp. Ctr., Inc. v. Bedell, 199 W. Va.
316, 484 S.E.2d 199 ('When a discovery order involves the probable invasion
of confidential materials that are exempted from discovery under Rule[s] 26(b)(1)
and (3) of the West Virginia Rules of Civil Procedure, the exercise of this
Court's original jurisdiction is appropriate.' Syl. pt. 3, State ex rel.
USF & G v. Canady, 194 W. Va. 431, 460 S.E.2d 677 (1995).).
Cf. Syl. pt. 3, State ex rel. McCormick v. Zakaib, 189 W. Va.
258, 430 S.E.2d 316 (1993) ('A writ of prohibition is available to correct
a legal error resulting from a trial court's substantial abuse of its discretion
in regard to discovery orders.' Syllabus Point 1, State Farm Mutual Automobile Insurance Co. v. Stephens, 188 W. Va. 622, 425 S.E.2d
577 (1992).); Nutter v. Maynard, 183 W. Va. 247, 250, 395
S.E.2d 491, 494 (1990) (Although review of discovery matters is not
generally appropriate through extraordinary remedies, we have previously 'granted
extraordinary relief where a discovery order presents a purely legal issue
in an area where the bench and bar are in need of guidelines . . . .'
State ex rel. Bennett v. Keadle, 175 W. Va. 505, [508,] 334 S.E.2d
643, 646 (1985) [(citation omitted)].). Given that the crux of the case
sub judice is the assertion of such a privilege, we find that it is
proper to consider this question upon a petition for writ of prohibition.
Turning now to the question raised by the parties, i.e., whether documents generated during a credentialing process are privileged, we must first view the contested statutory language. W. Va. Code § 30-3C-3 (1980) (Repl. Vol. 1998) directs, in pertinent part, (See footnote 5) that
[t]he proceedings and records
of a review organization shall be confidential and privileged and shall not
be subject to subpoena or discovery proceedings or be admitted as evidence in
any civil action arising out of the matters which are subject to evaluation
and review by such organization . . . : Provided, That information,
documents or records otherwise available from original sources are not to be
construed as immune from discovery or use in any civil action merely because they were presented
during proceedings of such organization[.]
Reviewing this statute in our earlier decision in State ex rel. Shroades
v. Henry, 187 W. Va. 723, 421 S.E.2d 264 (1992), we succinctly re-stated
and interpreted the relevant language:
W. Va. Code, 30-3C-3
[1980] provides that [t]he proceedings and records of a review organization
shall be confidential . . . Provided, That information, documents
or records otherwise available from original sources are not to be construed
as immune from discovery or use in any civil action merely because they were
presented during proceedings of such [a review] organization. . . .
The language of the statute grants a privilege to all the records and proceedings
of a review organization, but no privilege attaches to information, documents
or records considered by a review organization if the material is otherwise
available from original sources.
Syl. pt. 3, id. In Shroades, however, we did not consider the
precise question at issue herein regarding the availability of the privilege
to records generated during the credentialing process. Thus, we must determine
(1) whether the petitioner Hospital is a review organization within
the meaning of W. Va. Code § 30-3C-1 (1975) (Repl. Vol. 1998)
to whom the privilege is applicable and (2) if the Hospital may assert the
privilege, what documents are protected thereby.
The italicized statutory language quoted above clearly indicates that the statutory definition of a review organization includes hospital committees that consider whether staff privileges, or credentials, should be issued to individuals applying for admission to such facilities. W. Va. Code § 30-3C-1. Accordingly, we hold that a hospital committee that is responsible for considering applications for admission to its staff and for issuing staff privileges or credentials in accordance therewith is a review organization within the definition of W. Va. Code § 30-3C-1 (1975) (Repl. Vol. 1998).
As a review organization, such hospital committee may also avail
itself of the health care peer review privilege, codified in W. Va. § 30-3C-3
(1980) (Repl. Vol. 1998), provided it satisfies the requisite criteria for
the assertion of that privilege. Based upon the parties' representations,
it appears that the Hospital does have such a committee that evaluated Dr.
Rydland's application for staff privileges and considered her application
for the renewal of her credentials. Therefore, the Hospital may assert the
health care peer review privilege set forth in W. Va. Code § 30-3C-3
to the extent it has satisfied the criteria therefor.
The next question we must resolve in our decision
of this case is the nature of the documents that are subject to this privilege.
At the outset, it should be reiterated that records, documents, and the like
that are available from original sources extraneous to the credentialing process
are not privileged and, thus, are subject to discovery. W. Va. Code § 30-3C-3
([I]nformation, documents or records otherwise available from original
source are not to be construed as immune from discovery or use in any civil
action merely because they were presented during proceedings of [a review]
organization[.]); Syl. pt. 3, in part, State ex rel. Shroades v.
Henry, 187 W. Va. 723, 421 S.E.2d 264 (The language of [W. Va.
Code § 30-3C-3] grants a privilege to all the records and proceedings
of a review organization, but no privilege attaches to information, documents
or records considered by a review organization if the material is 'otherwise
available from original sources.'). Of particular interest to the instant proceeding, however,
are documents that are utilized by a hospital's credentialing committee but
that have not originated solely within the committee's proceedings, such as
applications for initial staff privileges and for the renewal thereof. These
types of documents are problematic because they do not fit neatly within the
rubric of the peer review privilege: technically, the origin of these documents
is with the individual who has applied for staff admission, but these records
would not have been created were it not for the hospital's review organization
charged with considering the applications and issuing such credentials, whose
original records are, in fact, entitled to the statutory privilege.
It is not disputed that hospitals enjoy broad discretion
when deciding whether a particular staff member's credentials should be revoked
or renewed.
The decision of a private
hospital to revoke, suspend, restrict or to refuse to renew the staff appointment
or clinical privileges of a medical staff member is subject to limited judicial
review to ensure that there was substantial compliance with the hospital's
medical staff bylaws governing such a decision, as well as to ensure that
the medical staff bylaws afford basic notice and fair hearing procedures,
including an impartial tribunal.
Syl. pt. 1, Mahmoodian v. United Hosp. Ctr., Inc., 185 W. Va.
59, 404 S.E.2d 750 (1991). Furthermore, such competency determinations are
safeguarded, in large part, by the confidentiality provisions of W. Va.
Code § 30-3C-3 that accord privilege status to records originating in a hospital's credentialing committee reviewing
the professional qualifications or activities of its medical staff or applicants
for admission thereto. W. Va. Code § 30-3C-1. In this
regard, [t]he enactment of West Virginia Code §§ 30-3C-1
to -3 (1993) clearly evinces a public policy encouraging health care professionals
to monitor the competency and professional conduct of their peers in order
to safeguard and improve the quality of patient care. Syl. pt. 2, Young
v. Saldanha, 189 W. Va. 330, 431 S.E.2d 669 (1993).
Based upon the Legislature's decision to entrust such important decisions regarding the competency of staff physicians to the hospital review organizations according them these credentials, we believe it would be incongruous to find that applications for staff privileges or the renewal thereof are not protected by the peer review privilege simply because they are created by individuals who are not, themselves, members of the hospital's credentialing committee. Rather these applications are as integral a part of the hospital review organization's proceedings as are those records generated exclusively during the committee's consideration of the subject documents, and indeed, perhaps even more crucial since the applications, themselves, often provide the starting point for the committee's deliberations. Our decision in this regard is further buttressed by our commitment to uphold the legislative intent of a statutory provision where a literal application of the same would not achieve this goal.
Although courts should not ordinarily stray beyond the plain language of unambiguous statutes, we recognize the need to depart from the statutory language in exceptional circumstances. . . . Courts, therefore, may venture beyond the plain meaning of a statute in the rare instances in which there is a clearly expressed legislative intent to the contrary . . .; in which a literal application would defeat or thwart the statutory purpose . . .; or in which a literal application of the statute would produce an absurd or unconstitutional result . . . . Where warranted a departure must be limited to what is necessary to advance the statutory purpose or to avoid an absurd or unconstitutional result.
State ex rel. Frazier v. Meadows, 193 W. Va. 20, 24, 454 S.E.2d
65, 69 (1994) (citations omitted). Accord Hutchison v. City of Huntington,
198 W. Va. 139, 150, 479 S.E.2d 649, 660 (1996) (The plain meaning
of legislation should be conclusive, except in the rare cases in which the literal
application of a statute will produce a result demonstrably at odds with the
intentions of the drafters. (internal quotations and citation omitted)).
Thus, '[w]here a particular construction of a statute would result in
an absurdity, some other reasonable construction, which will not produce such
absurdity, will be made.' Syl. pt. 2, Newhart v. Pennybacker, 120 W. Va.
774, 200 S.E. 350 (1938). Syl. pt. 3, State v. Kerns, 183 W. Va.
130, 394 S.E.2d 532 (1990). Therefore, we hold that an application for the issuance
or renewal of staff privileges that is created solely for consideration by a
hospital credentialing committee is protected by the health care peer review
privilege pursuant to W. Va. Code § 30-3C-3 (1980) (Repl. Vol.
1998). (See
footnote 7)
Writ
granted as moulded.
[t]he proceedings and records of a review organization shall be confidential and privileged and shall not be subject to subpoena or discovery proceedings or be admitted as evidence in any civil action arising out of the matters which are subject to evaluation and review by such organization and no person who was in attendance at a meeting of such organization shall be permitted or required to testify in any such civil action as to any evidence or other matters produced or presented during the proceedings of such organization or as to any findings,
recommendations, evaluations, opinions or other actions of such organization
or any members thereof: Provided, That information, documents or records
otherwise available from original sources are not to be construed as immune
from discovery or use in any civil action merely because they were presented
during proceedings of such organization, nor should any person who testifies
before such organization or who is a member of such organization be prevented
from testifying as to matters within his knowledge, but the witness shall
not be asked about his testimony before such an organization or opinions formed
by him as a result of said organization hearings: Provided, however, That
an individual may execute a valid waiver authorizing the release of the contents
of his file pertaining to his own acts or omissions, and such waiver shall
remove the confidentiality and privilege of said contents otherwise provided
by this section: Provided, further, That upon further review by any other
review organization, upon judicial review of any finding or determination
of a review organization or in any civil action filed by an individual whose
activities have been reviewed, any testimony, documents, proceedings, records
and other evidence adduced before any such review organization shall be available
to such further review organization, the court and the individual whose activities
have been reviewed. The court shall enter such protective orders as may be
appropriate to provide for the confidentiality of the records provided the
court by a review organization and all papers and records relating to the
proceedings had before the reviewing court.
(Emphasis added).
e.g., Ex parte Krothapalli, 762 So. 2d 836, 838-39 (Ala. 2000) (interpreting Ala. Code § 22-21-8(b)); Humana Hosp. Desert Valley v. Superior Court, 154 Ariz. 396, 402, 742 P.2d 1382, 1388 (Ct. App. 1987) (considering Ariz. Rev. Stat. Ann. § 36-445.01); Riggs Nat'l Bank v. Boyd, No. C.A. 96C-05-122-WTQ, 2000 WL 303308, at *6 (Del. Super. Ct. Feb. 23, 2000) (basing decision upon Del. Code Ann. tit. 24, § 1768); Cruger v. Love, 599 So. 2d 111, 114 (Fla. 1992) (reviewing Fla. Stat. Ann. §§ 395.011(9) (recodified as Fla. Stat. Ann. § 395.0191(8)), 766.101(5)).