PROTECTION & ADVOCACY FOR PERSONS WITH DISABILITIES, STATE OF CT, Plaintiff-Appellee, v. MENTAL HEALTH & ADDICTION SERVICES, Thomas A. Kirk /o Comm, Defendant-Appellant, Connecticut Hospital Association, Inc. and National Association of Protection and Advocacy Systems, Amicus Curiaes.
Docket No. 05-1457-CV.
United States Court of Appeals, Second Circuit.
Decided: May 5, 2006.
448 F.3d 119
Argued: February 28, 2006.
Nancy B. Alisberg, Managing Attorney, Office of Protection & Advocacy for Persons with Disabilities, Hartford, Connecticut, for Plaintiff-Appellee.
Jennifer A. Osowiecki, Cox & Osowiecki, LLC, Hartford, Connecticut, for Amicus Curiae Connecticut Hospital Association, Inc.
Kenneth Pasquale, Stroock & Stroock & Lavan LLP, New York, New York, for Amicus Curiae National Disability Rights Network, formerly known as National Association of Protection and Advocacy Systems.
Before: SOTOMAYOR and RAGGI, Circuit Judges, and CEDARBAUM, District Judge.*
SOTOMAYOR, Circuit Judge.
This case raises the question whether the Protection and Advocacy for Individuals with Mental Illness Act (“PAIMI“),1
BACKGROUND
The parties have stipulated to the relevant facts. OPA is a state-created agency that is authorized to represent and investigate suspected abuse of individuals with disabilities or mental illness residing in facilities in Connecticut. See
On January 21, 2000, Rose Marie Cinami, a patient at the Cedarcrest Hospital who was diagnosed with schizophrenia, died after choking on her breakfast. OPA subsequently opened an investigation into her death. The administrator of Cinami‘s estate authorized OPA to access her records and OPA requested all of Cedarcrest Hospital‘s records relating to her care. Cedarcrest Hospital, which is administered by the Department, disclosed all of its records relating to Cinami‘s care except for its peer review records. Peer review records are those created by or for the peer review committee at Cedarcrest Hospital. The hospital peer review committee is a “committee of Cedarcrest Hospital” comprised of healthcare staff at the hospital that “engage[s] in the evaluation . . . of the quality and efficiency of services ordered or performed by other health care professionals.”
On April 3, 2002, James Bell, a patient at the Whiting Forensic Institute division of the Connecticut Valley Hospital, died while being transported in restraints. OPA opened an investigation into his death and requested all records relating to his case, including the peer review records. Because Bell had died and OPA made a probable cause determination that he had been subject to abuse or neglect, it did not need consent to obtain the files. See
OPA filed this action pursuant to
The Department argued that the term “all records of . . . any individual” is ambiguous and that the district court therefore had to defer to the regulatory interpretation promulgated by the United States Department of Health and Human Services (“HHS“), which provides that a P & A system may receive all records, including peer review reports, “except that nothing in this section is intended to preempt State law protecting records produced by medical care evaluation or peer review committees.”
The District Court for the District of Connecticut (Dominic J. Squatrito, Judge) granted OPA‘s motion for summary judgment. Following the reasoning of the Third and Tenth Circuits in their treatment of this issue, the district court concluded that the grant of access in
On appeal, the Department argues that the district court erred in concluding that
DISCUSSION
This Court reviews a district court‘s grant of summary judgment de novo. Peck v. Baldwinsville Cent. Sch. Dist., 426 F.3d 617, 625 (2d Cir.2005). Moreover, questions of statutory interpretation and “the appropriate level of deference to accord agency regulations [are] . . . purely of law, subject to de novo review.” Kruse v. Wells Fargo Home Mortgage, Inc., 383 F.3d 49, 54 (2d Cir.2004) (citation and internal quotation marks omitted).
Two PAIMI provisions granting OPA access to patient records are at issue here. Section 10805(a) provides that a P & A system such as OPA:
shall . . . (4) in accordance with section 10806 of this title, have access to all records of—
(A) any individual who is a client of the system if such individual, or the legal guardian, conservator, or other legal representative of such individual, has authorized the system to have such access;
(B) any individual (including an individual who has died or whose whereabouts are unknown)—(i) who by reason of the mental or physical condition of such individual is unable to authorize the system to have such access; (ii) who does not have a legal guardian, conservator, or other legal representative, or for whom the legal guardian is the State; and (iii) with respect to whom a complaint has been received by the system or . . . there is probable cause to believe that such individual has been subject to abuse or neglect; and
(C) any individual with a mental illness, who has a legal guardian, conservator, or other legal representative, with respect to whom a complaint has been received by the system or with respect to whom there is probable cause to believe the health or safety of the individual is in serious and immediate jeopardy . . . .
As used in this section, the term “records” includes reports prepared 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 occurring at such facility that describe incidents of abuse, neglect, and injury occurring at such facility and the steps taken to investigate such incidents, and discharge planning records.
In 1991, Congress reauthorized and amended PAIMI. See Protection and Advocacy for Mentally Ill Individuals Amendments Act of 1991, Pub.L. No. 102-173, 105 Stat. 1217 (Nov. 27, 1991). None of the 1991 amendments made any changes to the statutory provisions at issue here. Congress did require, however, that “[n]ot later than 6 months after the date of enactment of this subsection, the Secretary [of HHS] shall promulgate final regulations to carry out this title.”
Reports prepared by individuals and entities performing certification or licensure reviews, or by professional accreditation organizations, as well as related assessments prepared for the facility by its staff, contractors or related entities, except that nothing in this section is intended to preempt State law protecting records produced by medical care evaluation or peer review committees.
II
Our analysis begins with the text of the statute. The first question is whether the plain language of PAIMI unambiguously grants OPA access to peer review records. If it does, our inquiry ends, “for the court, as well as the agency, must give effect to the unambiguously expressed intent of Congress.” Chevron U.S.A., Inc. v. Natural Res. Def. Council, Inc., 467 U.S. 837, 842-43 (1984). If, however, “the statute is silent or ambiguous with respect to the specific issue, the question for the court is whether the agency‘s answer is based on a permissible construction of the statute.” Id. at 843; Wachovia Bank, N.A. v. Burke, 414 F.3d 305, 315 (2d Cir.2005). An agency interpretation is reasonable if it is “rational and consistent with the statute.” Sullivan v. Everhart, 494 U.S. 83, 89 (1990) (quotation marks and citation omitted).
OPA argues that the statutory language of PAIMI, on its face, gives it access to the peer review records at issue here. PAIMI provides that a P & A system such as OPA shall have access, in accordance with
The Department contends that PAIMI is not so straightforward. It notes that PAIMI does not explicitly refer to peer review records and that the statutory requirement of
Two other courts of appeal have considered the question whether PAIMI requires the disclosure of peer review reports and held that PAIMI‘s reference to “all records” unambiguously includes peer review records. See Ctr. for Legal Advocacy v. Hammons, 323 F.3d 1262 (10th Cir.2003); Pa. Prot. & Advocacy, Inc. v. Houstoun, 228 F.3d 423 (3d Cir.2000) (Alito, J.). In Houstoun, the Third Circuit held that the plain language of
Relying on the same reasoning as the Third Circuit, the Tenth Circuit also held that peer review reports constitute “records” within the meaning of
We agree with the reasoning of the Third and Tenth Circuits that PAIMI‘s language is clear. For a statute to be ambiguous, alternative dictionary definitions of a word must each make sense within the language and structure of the statute. See Nat‘l R.R. Passenger Corp. v. Boston & Maine Corp., 503 U.S. 407, 418 (1992) (holding that “[t]he existence of alternative dictionary definitions . . . each making some sense under the statute” indicates that a statute is ambiguous); see also MCI Telecomms. Corp. v. Am. Tel. & Telegraph, Co., 512 U.S. 218, 226 (1994) (noting that the Boston & Maine “opinion did not rely exclusively upon dictionary definitions, but also upon contextual indications” and rejecting the argument that “courts must defer to the agency‘s choice among available dictionary definitions“). Here, the definition of the word “of” that indicates possession or ownership would render a significant part of
The Department next argues that the fact that the New Hampshire Supreme Court upheld HHS‘s regulatory interpretation of
The Department also argues that legislative history of the 1991 reauthorization of PAIMI support the conclusion that
The issue of access to peer review records was raised in both the House and Senate Committee Reports. The House Report stated:
The Committee recognizes that almost all hospitals have established medical care evaluation or peer review committees as part of their Joint Commissions on Accreditation of Health Care Organizations (JCAHO) accreditation requirements. The purpose of these committees is to review and evaluate patient care in the facility in order to improve the quality of care.
The Committee has been made aware that 46 states have statutes that protect the records produced by such committees from disclosure. It is the Committee‘s intent that the [PAIMI] 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, at 6 (1991), reprinted in 1991 U.S.C.C.A.N. 777, 782. The Senate Report summarized testimony from various witnesses before the committee, including Dennis R. Jones, the commissioner of the Texas Department of Mental Health and Mental Retardation. S. Rep. 102-114 (1991), 1991 WL 142023, at *3-4. Commissioner Jones testified about “the need to include report language clarifying access to peer review records” and explained that if P & A systems had access to peer review reports it “would reduce the candor about the quality of care by peers.” Id. at *3. Despite these references to avoiding preemption of state statutes protecting peer review records from disclosure, Congress did not amend the language of
As we recently noted, whether courts may consider legislative history at the first step of the Chevron analysis has been the subject of mixed messages from the Supreme Court. See Sash v. Zenk, 428 F.3d 132, 137 n. 5 (2d Cir.2005). Even were we to consider the statements made in the committee reports from the 1991 reauthorization, however, they would not lead us to conclude that the statutory language at issue is ambiguous.
First, the statements in the committee reports conflict with the clear preference for preemption in PAIMI‘s text. PAIMI provides that if state law prohibits the disclosure of “all records” to a P & A system required by
Second, the desire to avoid preempting state law expressed in the committee reports is at odds with the intent expressed in the statutory text giving P & A systems access to “all records of . . . any individual,”
Finally, the Department asserts that
In sum, we join our sister circuits in holding that the plain language of PAIMI that grants OPA access to “all records of . . . any individual,” including “reports prepared by any staff of a facility,” encompasses peer review reports. Because we conclude that Congress has clearly spoken to the question of whether OPA may have access to Cinami and Bell‘s peer review records, we do not proceed to the second step of the Chevron analysis to determine whether the regulatory interpretation is a permissible construction of the statute. Where, as here, Congress has unequivocally expressed its intent, the statute controls. See, e.g., Gen. Dynamics Land Sys., Inc. v. Cline, 540 U.S. 581, 600 (2004) (“[D]eference to [an agency‘s] statutory interpretation is called for only when the devices of judicial construction have been tried and found to yield no clear sense of congressional intent.“).
III
We must next consider whether PAIMI preempts Connecticut law in this area. “In the absence of an express congressional command, state law is preempted if that law actually conflicts with federal law or if federal law so thoroughly occupies a legislative field as to make reasonable the inference that Congress left no room for the States to supplement it.” Cipollone v. Liggett Group, Inc., 505 U.S. 504, 516 (1992) (internal citations and quotation marks omitted); Green Mountain R.R. Corp. v. Vermont, 404 F.3d 638, 641 (2d Cir.2005).
As noted, Connecticut protects peer review records from discovery. Specifically, Connecticut law provides:
The proceedings of a medical review committee conducting a peer review shall not be subject to discovery or introduction into evidence in any civil action for or against a health care provider arising out of the matters which are subject to evaluation and review by such committee, and no person who was in attendance at a meeting of such committee shall be permitted or required to testify in any such civil action as to the content of such proceedings . . . .
In this case, OPA sought the peer review records as part of a statutorily authorized investigation, not a civil action arising out of the subject of the peer review proceedings. OPA contends that a statutorily authorized investigation is not a civil action and thus there is no conflict between PAIMI and Connecticut law. This view finds support in Commissioner of Health Services v. Kadish, 17 Conn.App. 577, 554 A.2d 1097, 1099 (Conn.App.1989). In that case, the court considered whether Connecticut General Statute
The Department attempts to distinguish Kadish, arguing that because OPA, unlike the Department of Health, is statutorily authorized to bring civil actions on behalf of clients,
The question whether OPA could use documents it obtained in an investigation under PAIMI as evidence in a civil action is not before this Court. We note, however, that the Department‘s concerns in this regard appear misplaced. PAIMI requires that a P & A system that obtains records under
In the circumstances presented in this case, we do not see an actual conflict between PAIMI and Connecticut law. Nevertheless, the Department insists that one exists. To the extent that there is a conflict, PAIMI governs.
CONCLUSION
For the foregoing reasons, we AFFIRM the judgment of the district court.