Jean Charles, Jr., etc. v. Southern Baptist Hospital of Florida, Inc., etc.
209 So. 3d 1199
| Fla. | 2017Background
- Amendment 7 (Art. X, §25, Fla. Const., adopted 2004) grants patients access to any records relating to "adverse medical incidents," including occurrence reports created by providers.
- Congress enacted the Patient Safety and Quality Improvement Act (the Federal Act) in 2005 to create a voluntary, confidential reporting system (patient safety evaluation systems (PSES) → patient safety organizations (PSOs)) and to make "patient safety work product" privileged and confidential.
- Southern Baptist Hospital participated in the Federal Act and maintained "occurrence reports" in a PSES; some reports were extracted and produced, others were withheld as PSWP.
- Jean Charles sued Southern Baptist for medical malpractice and requested adverse-incident records under Amendment 7; the trial court ordered production of records the hospital claimed were protected under the Federal Act.
- The First District reversed, holding documents placed in a PSES and not existing outside it are PSWP and thus preempt Amendment 7; the Florida Supreme Court granted review and reversed the First District.
Issues
| Issue | Plaintiff's Argument (Charles) | Defendant's Argument (Southern Baptist) | Held |
|---|---|---|---|
| Whether adverse-incident records placed in a PSES are "patient safety work product" (PSWP) | Records are not PSWP if created/maintained for other or dual purposes or if required by state law | Documents placed in a PSES that do not exist outside it are PSWP and thus privileged | Held: Records created/maintained pursuant to state law (and subject to Amendment 7) are excluded from PSWP; placement in a PSES does not automatically cloak them with federal privilege |
| Whether the Federal Act expressly preempts Amendment 7 | Federal Act preserves state recordkeeping and reporting obligations; its exceptions exclude state-required records | The Federal Act's broad confidentiality and non-disclosure provisions expressly preempt state discovery rights for PSWP | Held: No express preemption — the records at issue fall within statutory exceptions, so the Act does not expressly preempt Amendment 7 |
| Whether the Federal Act impliedly (conflict/field) preempts Amendment 7 | Coexistence is possible; Act is voluntary and was not meant to displace state police powers or pre-existing state rights | Allowing both would frustrate the federal scheme encouraging candid reporting; federal privilege must defeat conflicting state rules | Held: No implied preemption — Congress did not clearly intend to displace state law; voluntary federal scheme can coexist with state reporting/disclosure requirements |
| Whether providers may unilaterally shield otherwise-discoverable state records by placing them in a PSES | A provider cannot evade state law by unilaterally placing state-required records into a PSES | Placing documents in a PSES creates PSWP protection if they meet the Act’s definition | Held: Providers may not unilaterally use the Federal Act to evade state recordkeeping and disclosure obligations; original/state-mandated records remain discoverable |
Key Cases Cited
- Florida Hosp. Waterman, Inc. v. Buster, 984 So.2d 478 (Fla. 2008) (explaining Amendment 7's purpose to expand patient access to adverse-incident records)
- Southern Baptist Hosp. of Fla., Inc. v. Charles, 178 So.3d 102 (Fla. 1st DCA 2015) (earlier appellate decision holding PSES documents were PSWP and preempted Amendment 7)
- Lee Med., Inc. v. Beecher, 312 S.W.3d 515 (Tenn. 2010) (describing Federal Act’s PSWP privilege framework)
- Tibbs v. Bunnell, 448 S.W.3d 796 (Ky. 2014) (explaining Congress’ aim to encourage voluntary provider reporting to PSOs)
- Baptist Health Richmond, Inc. v. Clouse, 497 S.W.3d 759 (Ky. 2016) (holding state-mandated reports are not protected PSWP)
- West Fla. Reg’l Med. Ctr., Inc. v. See, 79 So.3d 1 (Fla. 2012) (standard of review: statutory and constitutional construction reviewed de novo)
- Medtronic, Inc. v. Lohr, 518 U.S. 470 (1996) (presumption against preemption in areas of traditional state regulation)
- International Paper Co. v. Ouellette, 479 U.S. 481 (1987) (standard for implied preemption analysis)
- Chamber of Commerce v. Whiting, 563 U.S. 582 (2011) (focus on plain wording for express preemption clauses)