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Discovery of County Health System’s After-Incident Reports Not Shielded; Surgical Fire


A woman went to a medical center for surgery to remove a possible basal cell carcinoma from her face. The surgery was performed by a plastic surgeon and total intravenous anesthesia was administered by an anesthesiologist. During the surgery, drapes were placed on the woman's face. The anesthesiologist along with nurse anesthetists, both county health system employees, administered supplemental oxygen to the woman through a face mask. The supplemental oxygen built up under the drapes on the woman's face. The oxygen and the drapes were ignited by an electrocautery device used by the plastic surgeon to stop bleeding. The resulting fire caused first and second degree burns and left the woman with permanent injuries and scars.

 

The woman sued the two nurse anesthetists and the county health system for medical negligence. The woman served interrogatories and requests for production of documents. The nurse anesthetists and the county health system objected to some of the woman’s discovery requests and argued that North Carolina statutory law shielded from discovery (1) documents titled “Quality Care Control Reports” (“QCC Reports”), (2) notes taken by the county health system’s risk manager, and (3) a document titled “Root Cause Analysis Report” (“RCA Report”). In opposition to the woman’s motion to compel, the nurse anesthetists and the county health system submitted an affidavit from the county health system’s risk manager and a copy of an administrative policy titled “Sentinel Events and Root Cause Analysis” (“RCA Policy”). In addition, they submitted copies of the documents that they had withheld to the trial court for in camera review. The nurse anesthetists and the county health system argued that after the operating room fire that injured the woman, the county health system established a Root Cause Analysis Team (“RCA Team”), which constituted a medical review committee pursuant to N.C.G.S. § 131E–76(5). They contended that as a result, the QCC Reports, the county health system’s risk manager’s notes, and the RCA Report, which allegedly were considered or produced by the RCA Team, were protected by N.C.G.S. § 131E–95. Pursuant to subsection 131E–95(b), “[t]he proceedings of a medical review committee, the records and materials it produces and the materials it considers” are shielded from discovery and introduction into evidence in certain civil cases.

 

The Cumberland County Superior Court granted the woman's motions to compel discovery. The Court of Appeals affirmed the trial court's conclusion that N.C.G.S. § 131E–95 did not apply because the nurse anesthetists and county health system had not shown that the withheld documents were part of a medical review committee's proceedings, were produced by a medical review committee, or were considered by a medical review committee as required by the statute.

 

The Supreme Court of North Carolina affirmed. The court held that the trial court did not err by concluding that the QCC Reports, the county health system’s risk manager’s notes, and the RCA Report were not protected by N.C.G.S. § 131E–95(b).

 

The trial court did not err by concluding that the QCC Reports, the county health system’s risk manager’s notes, and the RCA Report were not protected by N.C.G.S. § 131E–95(b). The affidavit from the county health system’s risk manager was insufficient to demonstrate that the RCA Team met the criteria for a medical review committee as defined by N.C.G.S. § 131E–76(5)(c). Instead, the affidavit merely recited the language of the statute and offered the conclusory assurance that each requirement had been satisfied. The affidavit did not provide specific evidence that could serve as the basis of findings of fact or conclusions of law. In addition, the affidavit explained none of the formal organizational processes that led to the adoption of the RCA Policy and the creation of the RCA Team and identified none of the departments or personnel involved. The RCA Policy was also insufficient to demonstrate the applicability of N.C.G.S. §§ 131E–76(5) and 131E–95(b). Nothing about the RCA Policy indicated that the RCA Team operated under the policy in this investigation. In addition, the court found that it did not appear that the RCA Policy was adopted by the governing board or medical staff of the county health system. The policy stated only that it was approved by and originated in entities that were not the governing board or medical staff of the county health system.

 

The Supreme Court of North Carolina affirmed the appellate court insofar as it affirmed the trial court’s finding that the QCC Reports, the county health system’s risk manager’s notes, and the RCA Report were not protected by N.C.G.S. § 131E–95(b).

 

See: Hammond v. Saini, 2014 WL 7270542 (N.C., December 19, 2014) (not designated for publication).

 

See also Medical Law Perspectives, November 2014 Report: More Than Skin Deep: Skin Cancer Misdiagnosis and Other Liability Issues

 

See also Medical Law Perspectives, September 2012 Report: Cosmetic Surgery Gone Wrong: High Hopes Meet Unexpected Results

 

See also Medical Law Perspectives, August 2012 Report: Anesthesiology Errors: Complications, Malpractice, and Catastrophe

 

 

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