Central PA Medicine Winter 2021 - 13

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Judicial Decisions
Following Reginelli

evidence showing that the Committees were
" exclusively comprised of 'professional health
care providers.' "

Finally, it is important to recognize
that certain type of materials, such as
the files of a credentialing committee,
may not be protected under current case
law. For purposes of the PRPA, activities conducted by a formal peer review
committee, through formal channels and
procedures, are most likely to be entitled
to an expectation of confidentiality.

In the wake of Reginelli, lower courts
The Court, in Ungurian, also ruled that
in Pennsylvania have increasingly ordered
medical facilities to produce confidential a " Quality Improvement Medical Staff Peer
information, related to peer review and Review " was not entitled to protection,
patient safety activities. In particular, the because it was performed by a physician
Superior Court of Pennsylvania has issued whose medical license expired in 2014.
two important decisions addressing the scope Therefore, the Court concluded that the
It should also be noted that other statutes,
of the peer review privilege in Pennsylvania. reviewing physician did not qualify as a
licensed " professional health care provider, " such as the MCARE Act and the PSQIA,
First, in Estate of Krappa v. Lyons, decided
within the scope of the PRPA.
may also protect other types of reporting,
in May 2019, the Superior Court ruled that
compliance, and patient safety documentathe PRPA does not protect records generated
tion. However, it is important to carefully
by a hospital's credentialing committee.
Key Takeaways for
review the requirements of those statutes, to
In Estate of Krappa, the plaintiff sought Medical Providers
ensure compliance with the requirements
production of the complete, unredacted, creThe recent decisions in Reginelli, Estate for confidentiality.
dentialing files, pertaining to two defendant of Krappa, and Ungurian have caused
Candid peer evaluations remain essential
physicians. Based on the Reginelli decision, understandable concern among healthcare
to promoting patient safety and quality
the Superior Court ruled that the PRPA providers in Pennsylvania. However, Pennhealth care in Pennsylvania. Although recent
does not protect credentialing materials sylvania law still provides ample room to
judicial decisions have potentially limited
from discovery in malpractice litigation. engage in protected peer review activities,
the scope of the peer review privilege, those
The Court issued a broad statement that: when done through appropriate channels.
decisions can be used as a roadmap to ensure
" The PRPA's protections do not extend to
The key takeaway is that hospitals, and that peer review activities will be protected
the credentialing committee's materials,
in the event of litigation.
because this entity does not qualify as a other medical practices, should have, and
utilize, formal procedures and committees
'review committee.' "
for conducting true " peer review, " in order
Second, on April 28, 2020, the Superior to ensure that such activities are protected references
Court issued a decision in the case of Un- under the PRPA. It is crucial for medical 1. 63 P.S. § 425.4.
gurian v. Beyzman. In that case, the Court providers to familiarize themselves with 2. McClellan v. Health Maint. Org. of Pa.,
rejected a hospital's assertions of privilege, the recent judicial decisions, and use those 686 A.2d 801, 805 (Pa. 1996).
over several categories of documents that decisions as a roadmap to update their in- 3. Reginelli v. Boggs, 181 A.3d 293 (Pa. 2018).
relate to quintessential peer review and ternal procedures for conducting peer review. 4. Estate of Krappa v. Lyons, 211 A.3d 869
patient safety activities.
(Pa. Super. 2019).
For example, facilities should update their
In Ungurian, the Court's decision was peer review policies, to identify formal " peer 5. Ungurian v. Beyzman, 2020 Pa. Super. 105
primarily based on its finding that the review committees, " with clear procedures (Pa. Super. Apr. 28, 2020).
hospital did not provide sufficient evidence for conducting, and documenting, peer
to demonstrate that the documents qualified review activities. The review committee's
for protection under the PRPA, or a related records should be separately maintained
federal statute, the Patient Safety Quality by the committee, and only used for peer
Improvement Act (PSQIA).
review purposes.
Most significantly, the Superior Court
If hospitals, or smaller practices, wish to
emphasized that " the PRPA only applies to collaborate with outside medical providers
the observations of and materials produced or entities, for peer review activities, the
during an evaluation by 'professional health relationship and procedures should be clearly
care providers.' " In that regard, the Court documented in writing, ideally through a
ruled that the PRPA did not protect a formal contract. However, such practices
" Root Cause Analysis Report, " or meeting should be carefully navigated, until Pennminutes from a " Serious Safety Event Rating sylvania courts provide further guidance
Committee " and " Patient Safety Commit- on this issue.
tee, " because the hospital did not provide
Central PA Medicine Winter 2021 13

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Central PA Medicine Winter 2021

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