On October 28, 2015, the District Court of Appeal in the First District of Florida held in Southern Baptist Hospital, Inc. v. Jean Charles, Jr. et al. that the federal Patient Safety and Quality Improvement Act of 2005 (PSQIA) preempts a provision of the Florida Constitution that provides patients with a broad right of access to records of adverse medical incidents.
In this case, the plaintiff sought documents pertaining to adverse medical incidents at Southern Baptist Hospital pursuant to Article 10, §25 of the Florida Constitution (commonly referred to as Amendment 7). Amendment 7 establishes a constitutional right of access for patients with respect to any records made or received in the course of business by a health care facility or provider in relation to an adverse medical incident (which term includes medical negligence, intentional misconduct, or any other act, neglect, or default of a health care facility or provider that caused or could have caused injury to or death of a patient). Amendment 7 is commonly used to compel discovery in medical malpractice actions filed under Florida law.
Southern Baptist Hospital refused to produce certain requested documents that were potentially responsive — primarily occurrence reports compiled by the hospital that were not specific to the circumstances of the plaintiff’s case — on the basis that such documents were privileged and confidential patient safety work product (PSWP) under the PSQIA. The PSQIA established a voluntary reporting system that incentivizes the creation of patient safety evaluation systems (PSEs) by hospitals and other health care providers by providing broad confidentiality and privilege protections for PSWP collected or maintained within a PSE for reporting to a recognized patient safety organization (PSO). The PSQIA defines PSWP to include, in pertinent part, any documents or reports that could improve patient safety, health care quality, or health care outcomes and are collected by a provider within a PSE for reporting to a PSO.
After the trial court rejected Southern Baptist Hospital’s arguments against producing the occurrence reports, the hospital sought certiorari from the District Court of Appeal to review the discovery orders. The District Court of Appeal found that Southern Baptist Hospital’s occurrence reports met the definition of PSWP because they were placed into the hospital’s PSE for reporting to a PSO, and they did not exist outside of the hospital’s PSE. The District Court of Appeal thus quashed the trial court’s discovery orders and further held that Amendment 7 is both expressly and impliedly preempted by the PSQIA under the Supremacy Clause. In reaching its conclusion, the District Court of Appeal noted that allowing broad discovery under Amendment 7 of documents constituting PSWP would be “contrary to Congress’s intent to cultivate a culture of safety to improve and better the healthcare community as a whole.”
The District Court of Appeal’s decision in this case is likely to spurn further litigation over the permissible scope of discovery in medical malpractice cases under Florida law and the PSQIA.