Pennsylvania Court Holds Grand Rounds Presentation is Protected Material Under the Peer Review Protection Act

41991

In the case of Van Houwelingen v. The Milton S. Hershey Medical Center, No. 1:22-CV-01233 (M.D. Pa. Aug. 21, 2024), the Plaintiffs asked the court to compel the production of a PowerPoint presentation given during a Grand Rounds conference presentation. The Defendant argued that the PowerPoint presentation was privileged material under the Pennsylvania Peer Review Protection Act (“PRPA”).

The Plaintiff, Dennis Van Houwelingen (“Houwelingen”), went to the Defendant, Milton S. Hershey Medical Center’s (“Hospital”) emergency room on October 1, 2020, with a history of a non-healing wound. He was admitted to the hospital and underwent several procedures to treat the wound before he was discharged to a skilled nursing center.

Houwelingen was admitted to the Hospital again a few weeks later because of complications flowing from the repeated procedures associated with the treatment of the wound during the previous hospital admission. Houwelingen underwent several additional procedures during this admission to the hospital, but his condition worsened. Ultimately, the healthcare providers caring for Houwelingen determined that they had misdiagnosed Houwelingen’s condition and concluded that he suffered from pyoderma gangrenosum (“PD”), an inflammatory skin disorder that is characterized by small, red bumps or pustules that eventually erode to form swollen open sores. Despite appropriate care for this condition, Houwelingen continued to experience significant pain and disfigurement because of the misdiagnosis.

Houwelingen filed a professional negligence action against the Hospital, and discovery ensued. During discovery, Houwelingen served an Interrogatory, asking if any aspect of his healthcare was the subject of a peer review investigation. The Hospital answered, identifying a PowerPoint presentation given at the Hospital’s Department of Dermatology’s Grand Round conference. Subsequently, Houwelingen served a request seeking the production of the Hospital’s Department of Dermatology’s Grand Rounds PowerPoint presentation. The Hospital objected to the production of the PowerPoint presentation, and Houwelingen moved the court to compel the production of the same.

Houwelingen argued that the PowerPoint presentation was not protected by the PRPA because the purpose of the PowerPoint presentation was to educate the Hospital’s Dermatology Department, including non-medical staff members, about Houwelingen’s condition and not to evaluate the performance of the healthcare providers involved in Houwelingen’s care. Houwelingen also argued that the Grand Rounds were not a peer review committee, or a peer review organization as defined by the PRPA, and they were not within the scope of the Hospital’s Quality and Patient Safety Plan.

In response, the Hospital submitted an affidavit to the Chair of the Hospital’s Dermatology Department, which showed that the Grand Rounds was open solely to professional healthcare providers and that the purpose of the patient discussion section was to evaluate the quality and efficiency of health care services provided to those patients and improve the quality of health care. The Hospital further argued that peer review in and of itself is educational and that there was nothing in the PRPA to exclude such material from the PRPA’s protection. Finally, the Hospital cited Leadbitter v. Keystone Anesthesia Consultants, Ltd., 256 A.3d 1164, 1178 (Pa. 2021) for the proposition that while the Grand Rounds are not specifically defined as a peer review committee or organization or identified as such in the Hospital’s Quality and Patient Safety Plan, it is not the title of the organization that matters, but rather the evaluation of the review that is performed.

The proceedings and records of a review committee shall be held in confidence and shall not be subject to discovery or introduction into evidence in any civil action against a professional health care provider arising out of the matters which are the subject of evaluation and review by such committee.

63 PA. CON. STAT. §425.4. “A committee which performs a peer-review function, although it may not be specifically entitled a ‘peer review committee,’ constitutes a review committee whose proceedings and records are protected under Section 4 [§ 425.4] of the act.”  Leadbitter, 256 A.3d at 1177. The court in Leadbitter explained that the PRPA’s definition of “review organization…subsumes ‘any committee engaging in peer review.’” Id.

After in camera review of the PowerPoint presentation and the materials provided by the parties, the court determined that the portion of the Grand Rounds conference that focused on a review of patient care was performing a peer-review function, making the Grand Rounds conference a peer-review committee.  Accordingly, the court concluded the evidence supports a finding that the patient discussion portions of the Grand rounds conferences are meant to be a time when professional healthcare providers can assess and critique the care provided by other professionals, and thus, within the very meaning of the PRPA.

The opinion in Van Houwelingen v. The Milton S. Hershey Medical Center, No. 1:22-CV-01233 (M.D. Pa. Aug. 21, 2024) can be accessed here.