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Tenth Circuit Allows Disclosure Of Peer Review And Quality Assurance Records To Patient Advocacy Group For Mentally Ill


HLD, v. 31, n. 6 (June 2003)

Tenth Circuit Allows Disclosure Of Peer Review And Quality Assurance Records To Patient Advocacy Group For Mentally Ill

Plaintiff, Center for Legal Advocacy (CLA), a designated patient protection and advocacy system (P&A System) for the mentally ill in Colorado, sought access to hospital records and documents related to four suicide deaths at the Colorado Mental Health Institute at Pueblo (CMHI). Pursuant to the 1986 Protection and Advocacy for Mentally Ill Individuals Act (PAMII), 42 U.S.C.� 10801, CLA sought declaratory judgment and injunctive relief that it was legally entitled to certain hospital peer review and quality assurance materials. The Colorado Department of Human Services and CMHI (collectively defendants) turned over all other patient records but argued that state law prevented disclosure of peer review and quality assurance materials. A federal magistrate recommended a ruling in CLA's favor, concluding that PAMII disclosure requirements applied to the peer review materials and therefore pre-empted the state's confidentiality statutes. The U.S. District Court for the District of Colorado vacated the magistrate's recommended ruling, holding that "PAMII does not preempt the Colorado peer review privilege." See HLD, v. 30, n. 3, p.78. In the court's view, PAMII grants access to patient records, not hospital peer review materials. CLA appealed.

The Tenth Circuit reversed, holding that PAMII requires disclosures to CLA of the peer review and quality assurance records at issue. Under PAMII, P&A Systems like CLA "have access to all records of . . . any individual." 42 U.S.C. � 10805(a)(4)(A). PAMII provides that "the term 'records' includes reports prepared by any staff of a facility rendering care and treatment or reports prepared by an agency charged with investigation reports of incidents of abuse, neglect and injury . . . and the steps taken to investigate such incidents and discharge planning records." 42 U.S.C. � 10806(b)(3)(A). The appeals court framed the relevant issue, one of first impression, as whether the statute permitted the conclusion that the broad definition in � 10806 encompassed peer review and quality assurance records. Answering the question in the affirmative, the appeals court followed the reasoning of the Third Circuit in Pennsylvania Protection and Advocacy Inc. v. Houstoun, 228 F.3d 423 (3d Cir. 2000), which held that peer review reports fall within � 10805(a)(4)(A)'s access provision, as well as the definition of records in � 10806(b)(3)(A). The appeals court declined to adopt the position, on which the district court relied, taken by the New Hampshire Supreme Court in Disabilities Rights Ctr., Inc. v. Commissioner, 732 A.2d 1021 (N.H. 1999), which held that PAMII did not require the disclosure of hospital quality assurance records protected under state law. The appeals court agreed with the Houstoun court's conclusion that state confidentiality law did not limit peer review disclosure in the context of PAMII and that a Department of Health and Human Services regulation exempting peer review records protected by state laws, 42 C.F.R. � 51.41(c), was an unreasonable interpretation of PAMII unworthy of deference.

In so holding, the appeals court rejected the district court's distinction between "patient records" and "hospital records" with respect to the access granted P&A Systems under PAMII. According to the appeals court, a straightforward interpretation of the statute's language supported the conclusion that "all records of . . . any individual" and "reports prepared by . . . staff of a facility" includes peer review and quality assurance records relating to a patient and his or her care. The appeals court disagreed with defendants that its interpretation is unfair because it allows mental health patients to grant a P&A System access to professional review records that other medical patients would not be entitled to under state law. The appeals court pointed out that, although a P&A System must obtain a patient's consent before obtaining records related to their care in order to investigate allegations of abuse or neglect, this fact "does not mean that patients themselves thereby have unfettered access to peer review records." Moreover, PAMII specifically requires a P&A System to maintain the same level of confidentiality imposed on mental healthcare providers under state and federal law. The appeals court also rejected defendants' contention that PAMII was ambiguous and that � 51.41(c)(4) was a reasonable interpretation of the statute. The appeals court acknowledged comments in a 1991 committee report that suggested the statute was not intended to pre-empt state laws exempting peer review and quality assurance reports from disclosure, but found those comments insufficient to override its interpretation of the statute's language, particularly given that Congress, in passing 1991 amendments to the statute, did not alter PAMII's text regarding record access to reflect the committee's remarks. Finally, the appeals court held that PAMII contained express language pre-empting state laws like Colorado's granting a statutory privilege for peer review and quality assurance records. In addition, such laws would be pre-empted to the extent they conflicted with PAMII's records access provision.

Center for Legal Advocacy v. Hammons, No. 01-1574 (10th Cir. Mar. 27, 2003) (11 pages).

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