Justice GREEN delivered the opinion of the Court.
In this mandamus proceeding, Christus Santa Rosa Health System (Christus) challenges the trial court's order compelling production of its medical peer review committee's records pertaining to a surgery performed by Dr. Gerald Marcus Franklin. Christus contends that the documents are protected from production by the medical peer review committee privilege, provided in section 160.007(a) of the Texas Occupations Code, and that the trial court abused its discretion in ordering Christus to produce
The relevant facts are undisputed. In March 2012, Dr. Franklin performed surgery on Leslie Baird to remove the left lobe of her thyroid.
In March 2013, Baird filed suit against Dr. Franklin and his medical group for medical malpractice as a result of the failed surgery. Soon after, Dr. Franklin filed a motion to designate Christus as a responsible third party, alleging that Christus was responsible for the surgery's failure because it had failed to inform him that the cryostat machine, a critical piece of equipment, was unavailable. Dr. Franklin argued that he needed a cryostat machine to diagnose the removed tissue intraoperatively. Because the machine was unavailable, Dr. Franklin contends, he could not complete the surgery and had to end the operation without removing the left lobe of Baird's thyroid. Baird named Christus as a defendant.
On March 7, 2014, Dr. Franklin served his first request for production on Christus, asking for, among other things, documents from Christus's medical peer review file. Christus timely served responses and objections and filed a motion for protective order and a privilege log listing all of the documents withheld based on an assertion of privilege. Christus argued that it was not required to produce the requested documents because those documents were privileged under the medical peer review committee privilege. See TEX. OCC. CODE § 160.007(a). After Dr. Franklin filed a motion to compel, Christus sent the documents listed in the privilege log to the trial court for an in camera inspection.
Christus filed a petition for writ of mandamus in the court of appeals, which was also denied. 487 S.W.3d 599, 600 (Tex. App.-Austin 2014) (mem.op.). Christus subsequently filed a petition for writ of mandamus in this Court.
"Mandamus relief is proper to correct a clear abuse of discretion when there is no adequate remedy by appeal." In re Frank Kent Motor Co., 361 S.W.3d 628, 630 (Tex.2012). "A trial court clearly abuses its discretion if `it reaches a decision so arbitrary and unreasonable as to amount to a clear and prejudicial error of law.'" Walker v. Packer, 827 S.W.2d 833, 839 (Tex.1992) (quoting Johnson v. Fourth Ct. App., 700 S.W.2d 916, 917 (Tex.1985)). Furthermore, the trial court abuses its discretion when it fails to adequately inspect documents tendered for an in camera inspection before compelling production "when such review is critical to the evaluation of a privilege claim." In re Living Ctrs. of Tex., Inc., 175 S.W.3d 253, 261 (Tex.2005).
We have long held that "a party will not have an adequate remedy by appeal when the appellate court would not be able to cure the trial court's discovery error." Walker, 827 S.W.2d at 843. If the trial court issues an erroneous order requiring the production of privileged documents, the party claiming the privilege is left without an adequate appellate remedy. In re Mem'l Hermann Hosp. Sys., 464 S.W.3d 686, 697-98 (Tex.2015); In re Living Ctrs., 175 S.W.3d at 256; Mem'l Hosp. — The Woodlands v. McCown, 927 S.W.2d 1, 12 (Tex.1996); Walker, 827 S.W.2d at 843. If the documents at issue are alleged to be privileged, "mandamus is appropriate if we conclude that they are privileged and have been improperly ordered disclosed." In re Living Ctrs., 175 S.W.3d at 256.
Christus argues that the trial court abused its discretion when it erroneously ordered production of documents protected from discovery by the medical peer review committee privilege. See TEX. OCC. CODE § 160.007(a). "Pleading and producing evidence establishing the existence of a privilege is the burden of the party seeking to avoid discovery. The party asserting the privilege must establish by testimony or affidavit a prima facie case for the privilege." In re Mem'l Hermann Hosp., 464 S.W.3d at 698 (internal citations omitted). If the party asserting the privilege establishes a prima facie case for the privilege and "tenders documents to the trial court, the trial court must conduct an in camera inspection of those documents before deciding to compel production." In re E.I. DuPont de Nemours & Co., 136 S.W.3d 218, 223 (Tex.2004) (per curiam). Once the party claiming privilege presents a prima facie case that the
Whether a discovery privilege applies is a matter of statutory construction. See In re Mem'l Hermann Hosp., 464 S.W.3d at 700-01 (using the rules of statutory construction to determine whether the anticompetitive action exception to the medical peer review privilege applied). Privileges are disfavored in the law because they "contravene the fundamental principle that the public ... has a right to every man's evidence," and should, therefore, be strictly construed. Jordan v. Ct. App. for the Fourth Sup. Jud. Dist., 701 S.W.2d 644, 647 (Tex.1985) (omission in original) (internal quotations omitted). "Statutory construction is a question of law we review de novo." In re Mem'l Hermann Hosp., 464 S.W.3d at 700. When construing a statute, we look to the plain language to determine the intent of the Legislature. State v. Shumake, 199 S.W.3d 279, 284 (Tex.2006). If the statute is unambiguous, we apply the words according to their common meaning, but we may consider the objective of the law and the consequences of a particular construction. Id.
In section 160.007 of the Texas Occupations Code, the Legislature provided a privilege for records made by a medical peer review committee in the course of its review. TEX. OCC. CODE § 160.007(a). Under section 160.007(a), "each proceeding of a medical peer review committee is confidential, and any communication made to a medical peer review committee is privileged." Id. The Occupations Code defines "medical peer review committee" as "a committee of a health care entity ... that operates under written bylaws approved by the policy-making body ... and is authorized to evaluate the quality of medical and health care services or the competence of physicians." Id. § 151.002(a)(8). Such a committee engages in "medical peer review" when it evaluates "medical and health care services, including evaluation of the qualifications and professional conduct of professional health care practitioners and of patient care provided by those practitioners." Id. § 151.002(a)(7). The parties do not dispute that Christus's committee satisfies these definitions.
In Irving Healthcare System v. Brooks, we recognized that "[t]he overarching purpose of the [medical peer review committee privilege] is to foster a free, frank
The Legislature has established several limited exceptions to the medical peer review privilege. See TEX. OCC. CODE § 160.007. Texas Occupations Code section 160.007(d) provides the exception relevant to this case:
Id. § 160.007(d). However, disclosure of the recommendation and decision to the affected physician under this exception "does not constitute waiver of the confidentiality requirements" established under the statute. Id.
In presenting its prima facie case for privilege, Christus filed an affidavit from the director of quality and patient safety, the Medical Staff Bylaws (the Bylaws), and a privilege log.
Regardless, the trial court had the opportunity to correct this error when hearing Christus's motion to reconsider. See In re C.O.S., 988 S.W.2d 760, 765 (Tex. 1999) ("In a civil case, judicial economy generally requires that a trial court have an opportunity to correct an error before an appeal proceeds."); cf. In re Blevins, 480 S.W.3d 542, 543 (Tex.2013) (per curiam) ("[G]enerally a writ will not issue against one judge for what another did.").
In In re Living Centers of Texas, we granted mandamus relief when the trial court failed to conduct a proper review of documents submitted for in camera inspection before compelling production. 175 S.W.3d at 261-62. There, the trial court used "only superficial indicators to deny Living Center's privilege claim." Id. at 262. Here, the trial court reviewed the documents only to prevent "other people's... health information and/or [s]ocial [s]ecurity numbers" from being disclosed. The trial court even stated that he "didn't look at [the documents] closely enough" to determine whether the medical peer review committee took any action that could result in disciplinary action — the standard for applicability of the section 160.007(d) exception — because "[t]hat wasn't the reason [he] was looking at it." In fact, when the trial court put several documents into a manila folder to remain sealed, he was unsure whether the final peer review report was included in those documents.
To determine whether in camera inspection is critical to the evaluation of the medical peer review committee privilege claim in this case, we must consider the parties' arguments about the meaning of section 160.007(d) in this context. Dr. Franklin argues that because Christus's medical peer review committee had the opportunity to recommend discipline — even though it did not — the committee took an action that could have resulted in one of the disciplinary measures listed in the statute. Under Dr. Franklin's interpretation, a medical peer review committee would "take action" whenever it convenes to review the quality of medical care or competence of a physician because it has the ability to recommend disciplinary action. We disagree.
Looking to the intent of the Legislature, as we must, we conclude that the Legislature intended a medical peer
If the Legislature wanted to provide for peer review document disclosure to a physician every time a medical peer review committee reviews the physician's actions, then it could have done so. See R.R. Comm'n of Tex. v. Gulf Energy Expl. Corp., 482 S.W.3d 559, 568 (Tex.2016) ("Had the Legislature intended to place an objective limitation on the term in contravention of its ordinary meaning, it could have done so."). In fact, that is exactly what it did in section 160.007(c), which allows certain documents from the medical peer review committee to be disclosed to: "(1) another medical peer review committee; (2) an appropriate state or federal agency; (3) a national accreditation body; (4) the [Texas Medical B]oard; or (5) the state board of registration or licensing of physicians of another state." TEX. OCC. CODE § 160.007(c). Unlike section 160.007(d), section 160.007(c) does not limit the application of the exception to circumstances in which the medical peer review committee takes certain actions; the documents may be disclosed to the listed entities regardless of what the committee decides or the ultimate resolution of the underlying issue. Id. In section 160.007(d), however, the Legislature qualified the exception with specific language: "If a medical peer review committee takes action that could result in [discipline]...." Id. § 160.007(d). Clearly, in section 160.007(d), the Legislature intended for the medical peer review committee to take action beyond simply convening a meeting for the exception to apply.
Interpreting section 160.007(d) to allow an exception to the privilege every time a medical peer review committee reviews a physician's actions would ignore the Legislature's specific language in section 160.007(d) and render the medical peer review committee privilege meaningless. "We must not interpret the statute `in a manner that renders any part of the statute meaningless or superfluous.'" Crosstex Energy Servs., L.P. v. Pro Plus, Inc., 430 S.W.3d 384, 390 (Tex.2014) (quoting Columbia Med. Ctr. of Las Colinas, Inc. v. Hogue, 271 S.W.3d 238, 256 (Tex. 2008)). Dr. Franklin's interpretation of the statute would require disclosure of the medical peer review committee's records every time the committee conducts a review, regardless of outcome. Under this interpretation, it is difficult to conceive of an instance where the physician would not be entitled to the documents and the documents would remain privileged. This would in turn enfeeble confidentiality and prevent physicians from engaging in candid
According to Dr. Franklin's deposition, he met with a three-member medical peer review committee several weeks after the failed surgery and gave a verbal report of the incident. During the meeting, he told the committee that he had difficulty performing the surgery because of complications resulting from an abundance of scarred tissue, which made distinguishing between thymus and thyroid tissue difficult. Because the cryostat machine was unavailable, he could not definitively diagnose the removed tissue, so he ended the surgery. Dr. Franklin testified that the committee concluded during the meeting that his actions during surgery were reasonable and valid, and the committee decided to take no further action.
According to Christus's counsel at oral argument, after the medical peer review committee reviewed the case, it decided to take no further action and closed the file without a report to the Medical Executive Committee (MEC).
It appears from the record and counsel's arguments that Dr. Franklin was called in
After the interview, the medical peer review committee likely prepared a "case review form." Dr. Franklin testified that he had been a member of the medical peer review committee in the past and that the committee normally fills out a form and assigns the case a level. While we do not have a copy of the case review form at issue in this case, the sealed documents contain a case review form and letter from the medical peer review committee's review of a case involving a different patient not at issue here. That form indicates that the committee can recommend four levels of action. Under Level 1, the committee can decide that the quality of care was satisfactory and that no further action is required. Under Level 2, the committee can refer the case to the "responsible physician" to consider "improvement opportunities" because the quality of care needs improvement. If the committee recommends Level 3, then the quality of care is of "significant concern" and the case will be referred to the "responsible physician" for a written response. Finally, the committee can recommend Level 4 if the quality of care standard was not met, in which case the "responsible physician" will appear in person to discuss the case.
On the mandamus record before us, we cannot determine whether the medical peer review committee took any action that could have resulted in discipline, which would authorize disclosure of the final medical peer review report and recommendation to Dr. Franklin under section 160.007(d). Taking into account the mandamus record presented to us, including the Bylaws, and counsels' arguments, it appears that the file was closed after the medical peer review committee finished its review. According to Christus's counsel, no report or final decision was submitted to the MEC and no recommendation was made; the medical peer review committee simply closed the file. We cannot determine from this record whether the medical peer review committee made a recommendation or final decision required to trigger the exception under section 160.007(d). Even assuming that closing the file or completing a case review form specifying that no further action is necessary constitutes a recommendation or final decision, we are not convinced that the committee in this case could have recommended any of the disciplinary measures listed in section 160.007(d). Even under Level 4, the case review form in the record indicates that the committee can recommend only that the "responsible physician [ ] appear in person to discuss care." It appears from the Bylaws that the committee could then
The trial court must review the allegedly privileged medical peer review documents and the evidence presented to determine whether, upon further review, Dr. Franklin has established that an exception to the medical peer review privilege applies.
We hold that the trial court did not adequately review the documents submitted for in camera inspection and such review is critical to the privilege issue in this case. See In re Mem'l Hermann Hosp., 464 S.W.3d at 698 ("[T]he trial court must conduct an in camera inspection of [the] documents before deciding to compel production.") (alteration in original) (quoting In re E.I. DuPont de Nemours, 136 S.W.3d at 222). Therefore, the trial court
Because the trial court improperly ordered that privileged documents be disclosed, Christus has no adequate remedy by appeal. See In re Living Ctrs., 175 S.W.3d at 255-56. Therefore, mandamus relief is appropriate. Id.
The trial court abused its discretion in failing to adequately review the allegedly privileged documents before ordering production. We hold that Christus's medical peer review committee records should not have been ordered produced without a proper in camera inspection to review the merits of the documents and determine whether the exception in section 160.007(d) applies. Because Christus is without adequate appellate remedy, mandamus relief is appropriate. We direct the trial court to vacate the parts of its August 19, 2014 order that compel production of the medical peer review committee records at issue here and determine whether, upon further examination, the section 160.007(d) exception to the medical peer review privilege applies in this case. We are certain that the trial court will comply. Our writ will issue only if it fails to do so.