Client Advisory

Devon S. Davis, Grace Metushi

The Pennsylvania Superior Court recently issued a divided opinion addressing the scope of legal protections for hospitals’ internal investigation documents under state and federal patient-safety laws.

In Griffin v. The Bryn Mawr Hospital, the court considered whether four internal reports created after the alleged mishandling of fetal remains were shielded from discovery. The majority held that while the documents were not protected under Pennsylvania’s Medical Care Availability and Reduction of Error Act (“MCARE Act”) the documents were entitled to protection under the Patient Safety Quality and Improvement Act (“PSQIA”).

Regarding the MCARE privilege, the court held that the statute applies only to incidents involving direct patient care, not post-treatment conduct. Judge Jill Beck wrote, “[t]he Hospital’s mishandling of the fetal remains was wholly attenuated from Griffin’s care and therefore did not constitute ‘clinical care of a patient’…Nor could the mishandling of fetal remains have injured the patient,’ as is required to be considered an ‘incident’ under the law or have resulted in her ‘death or compromise[d] patient safety’ as is required for it to constitute a ‘serious event.’”

However, on the application of the PSQIA, a majority concluded that three of the documents were protected under federal law because they were generated within the hospital’s patient safety evaluation system, emphasizing the statute’s goal of promoting candid internal review and reporting. In reaching this holding, the majority looked to the legislative history of the PSQIA, including the Senate report which reflected a legislative intent to define “patient safety work product broadly.” The Court therefore held that this means the “document in question must simply contain ‘deliberations or analysis of, or …reporting pursuant to, a patient safety evaluation system” to qualify for the privilege under the PSQIA.

In a partial dissent, Judge Mary Murray argued that the documents were unrelated to improving patient care or preventing medical errors and therefore should not be shielded. Judge Murray cautioned that the majority’s interpretation could allow providers to broadly insulate internal materials from discovery.

Key Takeaways: This decision emphasizes the importance of delineating clear patient safety systems and investigation protocols and maintaining the security and confidentiality of that information. It is important to coordinate with defense counsel who understand PSQIA’s application to sensitive documents constituting patient safety work product.