In a decision that could cast a shadow over hospital quality control, the Supreme Court last week let stand a lower court ruling to allow individuals to subpoena previously confidential peer-review records in federal lawsuits.
In so doing, the court ignored arguments contained in an amicus brief submitted by all the major healthcare interest groups.
The case is significant because peer review-in which a panel of physicians evaluates the performance of other physicians-works under the assumption that confidentiality protects open discussion of possible treatment mistakes.
"In the future, doctors will be very loath to discuss their own cases, as well as others'," said J.C. Pickett, M.D., president at the California Medical Association.
John Moorhead, M.D., president at the American College of Emergency Physicians, said, "We depend on peer review to improve quality. If we are identifying areas that need to be improved, and that information will be used against us in court, we won't know about many of these incidents, because people will be reluctant to come forward. It threatens the whole process."
Without comment, the high court declined June 7 to hear the 3-year-old case, in which the parents of a deceased infant sued both Redbud Community Hospital in Clearlake, Calif., and the treating physician, Wolfgang Schug.
The couple brought the lawsuit under state malpractice law and the federal Emergency Medical Treatment and Active Labor Act after their infant died in 1996 following treatment by Schug at the hospital.
EMTALA, passed by Congress in 1986, prohibits "patient dumping," the practice of refusing to treat or transfer patients because they cannot pay for services.
The U.S. District Court for the Northern District of California in San Francisco ruled in January 1998 and again in May 1998 that a state law protecting the confidentiality of peer-review proceedings did not apply to the case.
The district court ruled that because the lawsuit was brought under federal law, federal rules of discovery pre-empted the state law. Federal rules do not recognize a peer-review privilege.
U.S. District Judge Susan Illston ruled May 5, 1998, that because the child's parents claim that Schug destroyed his notes and altered the patient's medical records after going through peer review, the peer-review records are relevant to the case.
The unique facts of the case make it unlikely that peer-review records will be subpoenaed in future federal lawsuits, said David Ettinger, the Pasadena, Calif., lawyer who represented Redbud Community in its appeal to the U.S. Supreme Court.
The hospital's argument was reinforced in an amicus brief drafted by the California Medical Association.
Physician groups said they would take up the issue as it arises in future cases and may discuss asking Congress for federal protection for peer-review records. All 50 states and the District of Columbia have some form of privacy law shielding peer-review records.