John F. Pinkard, M.D. v. HCA Health Services of Tennessee, Inc. D/B/A Summit Medical Center
545 S.W.3d 443
| Tenn. Ct. App. | 2017Background
- Dr. John F. Pinkard, a thoracic/vascular surgeon, had hospital privileges at Summit Medical Center revoked after peer-review investigations arising from several incidents including a disputed operation (patient J.E.F.).
- Pinkard sued Summit alleging the peer-review process was conducted in bad faith and with malice, and that Summit’s actions (e.g., denying access to the multi-layer CT angiogram) deprived him of a fair defense.
- Summit initially moved for summary judgment under the older Tennessee Peer Review Law (TPRL) and attached fair hearing and MEC materials; that motion was denied by the trial court.
- The legislature replaced the TPRL with the Healthcare Quality Improvement Act (HCQIA), Tenn. Code Ann. § 68-11-272, which declares QIC records and related statements confidential, privileged, and inadmissible, but includes an "original source" exception for documents not produced for QIC use.
- Summit relied on HCQIA privilege in a later summary judgment and in limine motions, arguing Pinkard could not introduce QIC-derived evidence to rebut the statutory presumption of good faith; Pinkard argued waiver and as-applied unconstitutionality under separation of powers.
- The trial court held the privilege non-waivable but concluded applying § 68-11-272(c)(1) here would violate separation of powers by depriving the court of inherent evidentiary authority; the Court of Appeals reversed on the constitutional point but affirmed non-waiver.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether Tenn. Code Ann. § 68-11-272(c)(1) (QIC privilege) is unconstitutional as applied under separation of powers | Pinkard: statute bars admission of QIC-derived evidence and usurps judicial authority to decide evidentiary relevancy, denying access to courts | Summit/State: statute furthered legislative purpose of patient safety and quality improvement; any intrusion on judicial evidentiary power is minor and permissible | Court: Privilege is constitutional as applied — statute furthers legislative power to promote public welfare and is workable alongside judicial evidentiary framework; reversed trial court on that ground |
| Whether the QIC privilege is waivable when defendant submits privileged materials in litigation | Pinkard: Summit waived the privilege by submitting fair hearing transcript and exhibits in earlier summary judgment motion | Summit: privilege cannot be waived; it benefits the peer-review process and third parties, not merely Summit | Court: Privilege cannot be waived; no individual holder exists and waiver would undermine the statutory confidentiality purpose; trial court correctly held privilege non-waivable |
| Whether Summit’s fair hearing was a QIC (i.e., which proceedings are privileged) | Pinkard: fair hearing panel functioned as a quasi-appellate safeguard, not a QIC, so some evidence is not privileged | Summit: MEC is a QIC and MEC-derived materials are privileged; fair hearing relied on MEC materials | Court: Fair hearing panel not a QIC, but MEC met QIC definition; evidence derived from MEC activities is privileged (subject to original-source exception) |
| Scope of discoverability/admissibility — applicability of the original-source exception | Pinkard: contends relevant evidence should be available; some materials not QIC-created | Summit: privileged MEC materials are inadmissible, but original-source exception limits only to materials not produced for QIC use | Court: Original-source exception operative — documents not produced for QIC use and available from original sources are discoverable and admissible even if presented to QIC; privilege does not bar obtaining facts from original sources |
Key Cases Cited
- Mansell v. Bridgestone Firestone N. Am. Tire, LLC, 417 S.W.3d 393 (Tenn. 2013) (describing limits on legislative encroachment into judicial functions)
- State v. Mallard, 40 S.W.3d 473 (Tenn. 2001) (legislature may not enact evidentiary rules that strike at the heart of the court’s judicial power)
- Powell v. Community Health Systems, Inc., 312 S.W.3d 496 (Tenn. 2010) (TPRL peer review privilege benefits the peer-review process and is not waivable by participants)