In this medical malpractice action, the plaintiff alleges that defendant physicians deviated from accepted medical standards in the care and treatment of plaintiff during surgical procedures. The issue before the court is whether a plaintiff may through discovery obtain the hospital's Peer Review Committee file.
The Court finds that any opinions, criticisms, or evaluations contained within the Peer Review Committee file are protected by the privilege of self-critical evaluation as defined in Wylie v. Mills, 195 N.J. Super. 332, 478 A.2d 1273 (Law Div.1984).
In order to obtain any other material, the Court must conduct an in camera review of the file and determine whether plaintiff has a particularized need for such material as defined in McClain v. College Hospital, 99 N.J. 346, 492 A.2d 991 (1985).
The defendant, Dr. Sinopoli, performed a hysterectomy on plaintiff in Community Memorial Hospital. As part of discovery, plaintiff subpoenaed certain records and information in the possession of the Community Memorial Hospital. She sought to depose the chairperson and/or a participant of the Peer Review Committee which reviewed Dr. Sinopoli's treatment of the plaintiff. Specifically, the plaintiff seeks:
Thereafter, defendant Sinopoli filed a motion to quash the subpoena duces tecum asserting that Peer Review material is confidential and privileged. At the time of the motion to quash the New Jersey Administrative Code dealt specifically with the Peer Review process. According to the Code, the Peer Review
process should identify problems that may exist in patient care and suggest appropriate action to correct those problems. This process was mandated at all medical care facilities, by both the Joint Commission on Accreditation of Health Care Organizations (JCAHO) and by the State Department of Health pursuant to the Licensing Standards for Health Care Facilities. N.J.A.C. 8:43B-6.1 et seq. Specifically, the medical staff of a hospital determined a formal method of monthly peer group review and evaluation of the clinical practice within the hospital. N.J.A.C. 8:43B-6.1(a)(2). The medical staff was to establish, develop, and adopt a set of rules, regulations and by-laws in conformity with the rules of the governing body of the hospital. The by-laws of the medical staff derived their source from guidelines used by the New Jersey Medical Society, the Joint Commission on Accreditation of Hospitals, or the American Osteopathic Association. N.J.A.C. 8:43B-6.2(a).
It should be noted that the above N.J.A.C. sections were repealed on February 5, 1990 and replaced with different sections regarding patient care. While not specifically addressing the area of Peer Review, these new sections provide a framework for the evaluation of the type and quality of care given to patients at hospitals. These changes in the code in no way substantively effect the decision of this Court.
According to the affidavit of Dr. John T. Kengeter, Vice President of Medical Affairs at Community Medical Center, the Peer Review process at the Community Center works as follows:
The medical staff of the hospital assumes the primary role in the quality assurance function. The medical staff is divided into departments according to specialities, including a department of obstetrics and gynecology. Each department conducts monthly reviews of completed records of discharged patients and reviews other sources of medical information relating to patient care in order to identify opportunities to improve care and to identify problems in patient care. If a department identifies problems in patient care or clinical performance, or
identifies patterns of deficient care, with regard to a particular physician, the department will take appropriate action. Such action includes having the physician identified attend a conference with the department chairman and/or the department as a whole (or subcommittee thereof). The purpose of such a conference is to provide the physician with the opportunity to respond to the possible deficiencies noted and to discuss and mutually agree to changes in the physician's pattern of practice if necessary. The department may determine as a result of such a meeting that no real problem exists or it may conclude that a physician requires additional training or supervision on certain types of cases until they have corrected the problem or demonstrated their proficiency in that area. Any recommendation for curtailing privileges, requiring supervision, or requiring additional training is forwarded to the executive committee of the medical staff for approval.
Rule 4:10-2(a) provides that, "[p]arties may obtain discovery regarding any matter, not privileged, which is relevant to the subject matter involved in the pending action . . ." Courts construe the rules of discovery liberally with the broadest possible latitude. A party must ". . . produce all relevant, unprivileged information which may lead to relevant evidence concerning the respective positions of both plaintiff and defendant." Shanley & Fisher, P.C. v. Sisselman, 215 N.J. Super. 200, 216, 521 A.2d 872 (App.Div.1987).
In Gureghian v. Hackensack Hospital, 109 N.J. Super. 143, 262 A.2d 440 (Law Div.1970), the application of the policy of open discovery resulted in the production of hospital reports. In Gureghian, the plaintiff sued the defendant hospital for negligently causing the death of an infant during delivery. The plaintiff sought the production of a report stating the cause of the infant's death including the autopsy findings. The report, a monthly summary of infant deaths occurring at or shortly after delivery, contained evidence of five other infant mortalities. The report was not included in the patient's record since it was not made during the course of her treatment by her physician. The Perinatal Mortality Committee of the Department of Obstetrics and Gynecology prepared the report more than one month after the infant's death and noted facts, causes of death, and autopsy findings concerning the infant. The court stated:
The committee report contains a capsulized finding as to the infant's condition at delivery and the cause of death as revealed by ...