Title Pennsylvania Protection & Advocacy, Inc. v. Houstoun
Date 2000
By Alito
Subject Misc
Contents
Page 1
LEXSEE 228 F3D 423
PENNSYLVANIA PROTECTION & ADVOCACY, INC. v. FEATHER HOUSTOUN, IN HER OFFICIAL CAPACITY AS SECRETARY OF THE DEPARTMENT OF PUBLIC WELFARE OF THE COMMONWEALTH OF PENNSYLVANIA; CHARLES CURIE, IN HIS OFFICIAL CAPACITY AS DEPUTY SECRETARY OF THE OFFICE OF MENTAL HEALTH OF THE DEPARTMENT OF PUBLIC WELFARE OF THE COMMONWEALTH OF PENNSYLVANIA; GREGORY M. SMITH, IN HIS OFFICIAL CAPACITY AS THE SUPERINTENDENT OF ALLENTOWN STATE HOSPITAL, Appellants
No. 99-1969
UNITED STATES COURT OF APPEALS FOR THE THIRD CIRCUIT
228 F.3d 423; 2000 U.S. App. LEXIS 24790
May 23, 2000, Argued
October 3, 2000, Filed
PRIOR HISTORY: **1 ON APPEAL FROM THE UNITED STATES DISTRICT COURT FOR THE EASTERN DISTRICT OF PENNSYLVANIA. (Dist. Court No. 98-cv--04180). District Court Judge: J. Curtis Joyner.
DISPOSITION: Affirmed.
CASE SUMMARY:
PROCEDURAL POSTURE: Defendant appealed from the decision of the United States District Court for the District of Eastern Pennsylvania, which required defen- dant to disclose hospital peer review reports to plaintiff pursuant to the Protection and Advocacy of Mentally Ill Individuals Act, 42 U.S.C.S. §§ 10801-10905.
OVERVIEW: Defendant commonwealth of Pennsylvania refused to disclose hospital peer review reports concerning attempted suicide of mental patient to plaintiff non-profit corporation that qualified as an eligible system under the Protection and Advocacy of Mentally Ill Individuals Act (PAMII), 42 U.S.C.S. §§
10801-10905. On defendant's appeal from an order requiring disclosure of the reports, the court found that the plain language of 42 U.S.C.S. § 10805(a)(4)(A) requiring disclosure of records to independent state advocacy organizations, encompassed the peer review reports at issue, since they were reports prepared by the staff of a facility rendering care and treatment. The peer review reports were records of an individual under 42
U.S.C.S. § 10805(a)(4). Thus, plaintiff was entitled to have access to the records. There was nothing in the
text of PAMII that supported the contention that the federal statute did not require disclosure of peer review reports that were protected under state law. There was no conflict between state and federal law because state law did not forbid such disclosure.
OUTCOME: The decision was affirmed because the plain language of the federal statute requiring disclosure of records to independent state advocacy organizations encompassed the peer review reports at issue and there was no conflict between federal and state law.
LexisNexis(R) Headnotes
Healthcare Law > Treatment > Incompetent, Minor & Mentally Disabled Patients
HN1 An organization that qualifies as an eligible sys- tem shall have access to all records of any individual who is a client of the advocacy organization, pursuant to 42
U.S.C.S. § 10805(a)(4)(A) of the Protection and Advocacy for Mentally Ill Individuals Act, 42 U.S.C.S. §§ 10801-
10905.
Healthcare Law > Business Organization & Administration > Patient Confidentiality
Healthcare Law > Treatment > Incompetent, Minor & Mentally Disabled Patients
HN2 See 42 U.S.C.S. § 10806(b)(3)(A).
Healthcare Law > Business Organization & Administration > Patient Confidentiality
Healthcare Law > Treatment > Incompetent, Minor & Mentally Disabled Patients
HN3 It is clear that in the definition of "records" in
228 F.3d 423, *; 2000 U.S. App. LEXIS 24790, **1
Page 2
the Protection and Advocacy for Mentally Ill Individuals Act, 42 U.S.C.S. §§ 10801-10905, 42 U.S.C.S. § 10806 controls the types of records to which eligible systems shall have access under 42 U.S.C.S. § 10805. Section
10805 provides that an independent advocacy organiza- tion shall, in accordance with § 10806, have access to certain records. 42 U.S.C.S. § 10805(a)(4). In addition,
§ 10806, which is entitled "Access to records," provides that an eligible system shall have access to the type of records described in subparagraph (A). 42 U.S.C.S. §
10806(b)(3)(B).
Healthcare Law > Business Organization & Administration > Patient Confidentiality
Healthcare Law > Treatment > Incompetent, Minor & Mentally Disabled Patients
HN4 A peer review report is a record of an indi- vidual under the Protection and Advocacy of Mentally Ill Individuals Act, 42 U.S.C.S. §§ 10801-10905. 42
U.S.C.S. § 10805(a)(4).
Healthcare Law > Business Organization & Administration > Patient Confidentiality
Healthcare Law > Treatment > Incompetent, Minor & Mentally Disabled Patients
HN5 The Protection and Advocacy of Mentally Ill Individuals Act (PAMII), 42 U.S.C.S. §§ 10801-10905, requires that an independent advocacy organization be given access to peer review reports irrespective of state law. PAMII preempts any state law that gives a healthcare facility the right to withhold such records.
Healthcare Law > Business Organization & Administration > Patient Confidentiality
Healthcare Law > Treatment > Incompetent, Minor & Mentally Disabled Patients
HN6 See Pa. Stat. Ann. tit. 63 § 425.4 (West 1996). Healthcare Law > Business Organization & Administration > Patient Confidentiality
Healthcare Law > Treatment > Incompetent, Minor & Mentally Disabled Patients
HN7 The intent of the legislature, as revealed by the plain language of Pa. Stat. Ann. tit. § 425.4 (West 1996), and confirmed by its legislative history, is to prevent the disclosure of peer review information to outside parties seeking to hold professional health care providers liable for negligence.
Healthcare Law > Business Organization & Administration > Patient Confidentiality
Healthcare Law > Treatment > Incompetent, Minor & Mentally Disabled Patients
HN8 The Protection and Advocacy of Mentally Ill Individuals Act, 42 U.S.C.S. §§ 10801-10905, imposes a duty of confidentiality on the advocacy organizations
themselves. 42 U.S.C.S. § 10806(a).
COUNSEL: James M. Sheehan, General Counsel, John A. Kane, Chief Counsel, Howard Ulan, Senior Asst. Counsel (argued), Department of Public Welfare Office of Legal Counsel, Harrisburg, PA, Attorneys for Appellants.
David M. Allen, Schuyler, Roche & Zwirner, Chicago, IL, Attorney for Amicus-Appellant.
Mark J. Murphy (argued), Disabilities Law Project, Pittsburgh, PA. Ilene W. Shane, Robin Resnick, Disabilities Law Project, Philadelphia, PA, Attorneys for Appellee.
S. Paul Prior, New Jersey Protection & Advocacy, Inc., Trenton, NJ, Attorney for Amicus-Appellee.
JUDGES: Before: ALITO and RENDELL, Circuit
Judges, and DUHE, Senior Circuit Judge. *
* The Honorable John M. Duhe, Jr., United States Court of Appeals for the Fifth Circuit, sitting by designation.
OPINIONBY: ALITO
OPINION:
*425 OPINION OF THE COURT
ALITO, Circuit Judge:
In 1986, Congress enacted the Protection and Advocacy for Mentally Ill Individuals Act (PAMII), Pub. L. No. 99-319, 100 Stat. 478 (codified at 42 U.S.C. §§
10801 **2 -10905). The Act provides funding for the states to establish independent organizations (referred to in the Act as "eligible systems") that monitor and pro- tect the rights of the mentally ill. See 42 U.S.C. § 10803. These organizations are intended to "investigate incidents of abuse and neglect of individuals with mental illness" and to take appropriate action to "protect and advocate the rights of such individuals." 42 U.S.C. § 10801(b). Congress found that funding was needed for such organi- zations because the mentally ill were vulnerable to abuse, injury, and neglect and because the states' response to these problems was often inadequate. See 42 U.S.C. §
10801(a).
Pennsylvania Protection & Advocacy, Inc. (PP & A) is a Pennsylvania non-profit corporation that is quali- fied as an "eligible system" under PAMII. Dolores L. attempted suicide while a mental patient at Allentown
(Pennsylvania) State Hospital and, she died five days
228 F.3d 423, *425; 2000 U.S. App. LEXIS 24790, **2
Page 3
later. In accordance with Allentown State Hospital pol- icy and requirements of the Joint Commission on the Accreditation of Healthcare Organizations, the supervisor of the hospital appointed **3 two peer review commit- tees to evaluate the circumstances of Dolores L.'s death. These committees produced reports (peer review reports) intended to identify any mistakes that were made and that could have been avoided and any changes that could be
**5
10806, which is entitled "Access to records," pro- vides that "an eligible system shall have access to the type of records described in subparagraph (A)
the definition of "records" in § 10806 ." 42 U.S.C.
§ 10806(b)(3)(B) (emphasis added).
made in the hospital's policy or practices so as to reduce the likelihood of similar events in the future. PP & A requested Dolores L.'s records, but the hospital refused to turn over the peer review reports. *426 PP & A then filed this action against the responsible Pennsylvania officials (the Commonwealth) to challenge the refusal to permit access to the peer review reports. The District Court held that the reports must be disclosed. We affirm.
I.
The first issue in this case is whether the peer review reports fall within the scope of § 10805 of PAMII, which provides HN1 that an organization such as PP & A shall,
"in accordance with section 10806 of this title, have ac- cess to all records of . . . any individual who is a client of the" advocacy organization. 42 U.S.C. § 10805(a)(4)(A)
(emphasis added). The District Court held that the peer review reports fall within this language, and we agree.
The peer review reports **4 certainly constitute
"records" in the ordinary sense of the term, and they also fall squarely within the definition provided in HN2 Section 10806 of the Act, which states:
The term "records" includes reports pre- pared by any staff of a facility rendering care and treatment or reports prepared by an agency charged with investigating reports of incidents of abuse, neglect, and injury occur- ring at such facility that describe incidents of abuse, neglect, and injury occurring at such facility and the steps taken to investigate such incidents . . . .
42 U.S.C. § 10806(b)(3)(A). n1
n1 We note that the definition of "records"
is preceded in the statute by the language:
"As used in this section i.e., § 10806 ." 42
U.S.C. § 10806(b)(3)(A) (emphasis added). HN3 Nevertheless, it is clear that the definition of
"records" in § 10806 controls the types of records to which PA & A "shall have access" under § 10805 because § 10805 provides that an eligible system
"shall . . . in accordance with section 10806 of this title, have access to" certain records. 42 U.S.C.
§ 10805(a)(4) (emphasis added). In addition, §
The plain language of this definition encompasses the peer review reports at issue here, since they are clearly "re- ports prepared by . . . staff of a facility rendering care and treatment." Id. Allentown State Hospital is "a facility ren- dering care and treatment," and the reports were prepared by committees composed of members of the hospital's
"staff." n2 See J.A. 21a-23a. Therefore, the definition of
"records" encompasses Dolores L.'s peer review reports.
n2 The peer review reports may also constitute
"reports prepared by an agency charged with inves- tigating reports of incidents of abuse, neglect, and injury occurring at such facility that describe an in- cident of abuse, neglect, or injury occurring at such facility and the steps taken to investigate such incident ." 42 U.S.C. § 10806(b)(3)(A). Dolores L.'s peer review reports plainly describe, at a mini- mum, an "incident of . . . injury," namely, a suicide attempt, "and the steps taken to investigate such an incident ." Id. Moreover, the peer review commit- tees were indisputably "charged with investigating
a report of an incident of abuse, neglect, or injury occurring at the facility." Id. Whether these committees composed of hospital staff are "agen- cies" within the meaning of the statutory definition is debatable, but we need not decide that question here, since it is apparent that the peer review reports fall within the portion of the statutory definition dis- cussed in text.
**6
The Commonwealth asserts that § 10806(b)(3)(A) re- quires the disclosure of "incident reports," but not peer review reports. Appellant Br. at 7-8 ("Unlike incident reports, which are descriptive in nature, peer review re- ports involve high-order inferences evolving from pro- fessional analysis and evaluation . . . ."). However, the Commonwealth does not explain how this distinction fits the language of the statute; nor does the Commonwealth cite authority that supports its construction. The only au- thority that the Commonwealth *427 offers, Atkins v. Pottstown Memorial Medical Center, 430 Pa. Super.
279, 634 A.2d 258 (Pa. Super. Ct. 1993), is inapposite. In Atkins, the court merely held that incident reports are not shielded by the Pennsylvania statute that protects peer re- view reports from discovery. See 634 A.2d at 260. Neither
228 F.3d 423, *427; 2000 U.S. App. LEXIS 24790, **6
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Atkins nor the statute that the court interpreted in Atkins has anything to do with PAMII.
The Commonwealth also asserts that a peer review re- port is not a record "of any individual" because the record belongs to the hospital. Appellant Br. at 7. However, the preposition "of " may be used to show connection or asso- ciation, as well as ownership, see Random **7 House Dictionary of the English Language 999 (1967), and it seems clear that the term is used in the former sense here. Presumably, many, if not all, of Allentown State Hospital's other records concerning Dolores L. are just as much its property as the peer review reports, but there is no doubt that PAMII was meant to require the hospital to give PP & A access to those records, as the hospital did. Accordingly, we hold HN4 that a peer review report is a
"record of . . . an individual" under PAMII. 42 U.S.C.
§ 10805(a)(4). Thus, under this provision, PP & A was entitled to have "access" to these records. Id.
II.
The Commonwealth argues that, even if the peer re- view reports are "records of . . . an individual" un- der PAMII, PAMII does not require that PP & A be given access to those records because, according to the Commonwealth, Pennsylvania restricts the disclosure of peer review reports. There is nothing in the text of PAMII, however, that supports the Commonwealth's contention that this federal statute does not require disclosure of peer review reports that are protected under state law. Indeed, there is not even any mention of peer review reports **8 in the legislative history that accompanied the initial pas- sage of the Act in 1986. See S. Rep. No. 99-109 (1985), reprinted in 1986 U.S.C.C.A.N. 1361; H.R. Conf. Rep. No. 99-576, reprinted in 1986 U.S.C.C.A.N. 1377.
The Commonwealth relies, however, on subsequent legislative history and a regulation issued to imple- ment PAMII. Appropriations for PAMII expired in 1991 and were re-authorized that year. See Protection and Advocacy for Mentally Ill Individuals Amendments Act of 1991, Pub. L. No. 102-173, 105 Stat. 1217
(Amending Act). The House Report that accompanied the re-authorization stated that "it is the Committee's intent that the PAMII Act does not preempt State law regarding disclosure of peer review/medical review records relating to the proceedings of such committees." H.R. Rep. No.
102-319, reprinted in 1991 U.S.C.C.A.N. 777, 782. When Congress re-authorized PAMII, it provided that
"the Secretary of Health and Human Services shall pro- mulgate final regulations to carry out this title." Amending Act, § 9. Pursuant to this authority, 42 C.F.R. § 51.41(c)
(1999) provides that "information and individual records
. . . which shall be available to the P&A system under the
**9 Act shall include, but not be limited to . . . reports prepared . . . by or for the facility itself, that describe .. . in- jury occurring at the facility . . . and reports and records,
. . . prepared or maintained by the facility, in connection with such reports of incidents." 42 C.F.R. § 51.41(c)(2). The regulation goes on to provide that "nothing in this sec- tion is intended to preempt State law protecting records produced by medical care evaluation or peer review com- mittees." Id. § 51.41(c)(4)
The interpretation of PAMII set out in 42 C.F.R. §
51.41(c)(4) does not represent a reasonable interpretation of the statute, and we must therefore reject it. See Chevron, U.S.A., Inc. v. Natural Resources Defense Council, Inc.,
467 U.S. 837, 843-44, 81 L. Ed. 2d 694, 104 S. Ct. 2778
(1984). As *428 noted, PAMII requires that groups such as PP & A be given access to a defined category of records. Peer review reports either fall within that defi- nition or they do not. The statutory language cannot rea- sonably be construed to encompass identical peer review reports in some states but not others. If Congress wished to achieve that result, it needed to enact different statu- tory language. **10 It could not achieve that result, in the face of the statutory language it enacted, simply by inserting a passage in a committee report. Nor could that result be achieved by means of a regulation.
HN5 We thus hold that PAMII requires that an or- ganization such a PP & A be given access to peer review reports such as those at issue here irrespective of state law. PAMII preempts any state law that gives a healthcare fa- cility the right to withhold such records. See, e.g., Pacific Gas and Elec. Co. v. State Energy Resources Conservation and Development Comm'y, 461 U.S. 190, 204, 75 L. Ed.
2d 752, 103 S. Ct. 1713 (1983); Florida Lime & Avocado
Growers, Inc. v. Paul, 373 U.S. 132, 142-43, 10 L. Ed. 2d
248, 83 S. Ct. 1210 (1963).
III.
Although PAMII would preempt a Pennsylvania law that prohibited the disclosure of the peer review reports to PP & A, we note that there is no conflict between state and federal law here because Pennsylvania law does not forbid such disclosure. See Pa. Stat. Ann. tit. 63 § 425.4
(West 1996). HN6 Section 425.4 merely provides that
"the proceedings and records of a review committee shall be held in confidence and shall not be subject to discovery
**11 or introduction into evidence in any civil action
." Id. (emphasis added) Here, PP & A is seeking the peer review reports in order to fulfill the advocacy and inves- tigatory purposes of PAMII with regard to Dolores L.'s death. PP & A is not seeking to discover the reports or to introduce them into evidence in a civil action.
Pennsylvania's requirement that a peer review report
228 F.3d 423, *428; 2000 U.S. App. LEXIS 24790, **11
Page 5
"be held in confidence" also does not prevent disclosure of the reports to PP & A. Id. The statute does not say who is required to keep the report in confidence, and the statute has not been interpreted to preclude reports from being shared with persons outside of a peer review committee. See Hayes v. Mercy Health Corp., 559 Pa. 21, 739 A.2d
114, 117-19 (Pa. 1999) (holding that peer review commit- tee materials are not privileged from disclosure to a doctor mounting an internal challenge to a peer review commit- tee's disciplinary recommendation). There is nothing in the Pennsylvania statute to support the inference that a peer review report must be kept "in confidence" from a state's independent advocacy organization. To the con- trary, the inference to be drawn from the Pennsylvania statute's reference **12 to a "civil action" is that the statute requires that peer review reports be kept out of the hands of lawyers involved in civil litigation. See 739 A.2d at 118 HN7 ("Thus, the intent of the legislature, as re- vealed by the plain language of the Pennsylvania statute and confirmed by its legislative history, was to prevent the disclosure of peer review information to outside parties seeking to hold professional health care providers liable for negligence . . . .").
HN8 In addition, PAMII imposes a duty of confiden- tiality on the advocacy organizations themselves. See 42
U.S.C. § 10806(a) ("An eligible system which, pursuant to PAMII , has access to records which, under . . . State law, are required to be maintained in a confidential man- ner by a provider of mental health services, shall, except as provided in subsection (b) of this section, n3 maintain the confidentiality of such records to the same *429 extent as is required of the provider of such services."
(emphasis added)); Robbins v. Budke, 739 F. Supp. 1479,
1488 (D.N.M. 1990) (noting that PAMII requires that an advocacy organization maintain confidentiality of records to the same degree as **13 the health care provider). Since PAMII requires advocacy organizations themselves to maintain the confidentiality of peer review reports, dis- closure of peer review reports to advocacy organizations is not precluded by the Pennsylvania statute.
n3 Section 10806(b) provides for disclosure of records to the patient. In a civil action, the patient would still be precluded, by the same Pennsylvania statute, from discovering the report or from offering it into evidence. See Pa. Stat. Ann. tit. 63 § 425.4.
IV.
For the reasons explained above, the judgment of the
District Court is affirmed.
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