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MEDICAL QUALITY REVIEW

Evidence Code §ll57

CONTENTS

CASES

CASE OUTLINE






CONTENTS

BURDEN OF PROOF ON PARTY ASSERTING PROTECTION
NATURE OF MEDICAL REVIEW COMMITTEE
NATURE OF PROTECTION
PROTECTED MATERIAL
UNPROTECTED MATERIAL
EXCEPTION: PERSON REQUESTING HOSPITAL STAFF PRIVILEGES
CRIMINAL PROCEEDINGS

CASES

Alexander v. Superior Court (1993), 5 Cal.App.4th 1218
Bell v. Sharp Cabrillo Hospital  (1989) 212 Cal.App.3d 1034
Brown v. Superior Court (1985), 168 Cal.App.3d 489
California Eye Institute v. Superior Court (1989)215 Cal.App.3d 1477
Cedars-Sinai Medical Center v. Suprerior Court (1993), 12 Cal.App.4th 579
County of Kern v. Superior Court ( ),  82 Cal..App.3d 396
Hinson v. Clairemont Community Hospital (1990) 218 Cal.App.3d 1110
[overruled by Alexander re discovery of  applications for staff privileges in med mal case]
Matchett v. Superior Court
(1974), 40 Cal.App.3d 623
Mt.Diablo Hospital Med. Ctr. v. Superior Court (1984),158 Cal.App.3d 344
People v. Superior Court(Memorial Med. Ctr.)(1991), 234 Cal.App.3d 363
Roseville Community Hospital v. Superior Ct. (1977), 70 Cal.App3d 809
Santa Rosa Memorial Hospital v. Superior Court
(Leary) (1985) 174 Cal.App.3d 711
Schulz v. Superior Court
(1977), 66 Cal.App.3d 440
Scripps Memorial Hospital v. Superior Court
(1995), 37 Cal.App.4th 1720
Snell v. Superior Court (1984), 158 Cal.App.3d 44
[rejected in Brown re fact of malpractice insurance; approved by SC in Alexander re application for staff priv.]
University of So. Calif. v. Superior Court(1996), 45 Cal.App.4th 1283
West Covina Hospital v. Superior Court (1986), 41 Cal.3d 846
West Covina Hospital v. Superior Court (Tyus) (1984) 153 Cal.App.3d 134
Willits v. Superior Court of Santa Clara
(1993), 20 Cal. App.4th 90





CASE OUTLINE

Evidence Code Sec. 1157 protection from compelled discovery

Organizations: organized committees or peer review body [B&P sec. 805]
                      responsible for evaluation / improvement of quality of care
Subject matter:   proceedings and records
                          person in attendance need not testify as to what transpired
                          exceptions: (c) statements by person who is party; person requesting hospital staff privileges; bad faith action against insurance carrier

PURPOSE

Matchett v. Superior Court, supra, 40 Cal.App.3d at p. 627 [seminal case frequently quoted and followed]

West Covina Hospital v. Superior Court (1986), 41 Cal.3d 846

Willits v. Superior Court of Santa Clara (1993), 20 Cal. App.4th 90 "Above all, the intention of the Legislature must be ascertained and followed. (People v. Superior Court (1969) 70 Cal.2d 123, 132....)" [R]egard is to be had not so much to the exact phraseology as to the purpose of 1157. It is based on the principle that “external access to peer investigations conducted by staff committees stifles candor and inhibits objectivity” The Legislature determined that it was more important to promote the goal of medical staff candor at the cost of impairing plaintiffs' access to evidence. (Matchett v. Superior Court, supra, 40 Cal. App.3d at p. 629, fn. omitted.)”
"The confidentiality bestowed by section 1157, then, has its price; it denies a plaintiff access to information which could prevent her from recovering..”

BURDEN OF PROOF ON PARTY ASSERTING PROTECTION

Matchett v. Superior Court (1974), 40 Cal. App. 3d 623, 627 "In passing upon the claim of immunity, a court must have before it facts which allow it to match the staff committee's mission and function against the specifications of the statute. The trial court record in the present case is seriously flawed. The burden of establishing entitlement to nondisclosure rested with the party resisting discovery, not the party seeking it. [citation] .... In resisting discovery, defendant Petway presented no facts at all. He filed only an argumentative memorandum declaring: 'The documents sought are clearly not subject to discovery and are privileged pursuant to Evidence Code section 1157'."

Santa Rosa Memorial Hospital v. Superior Court (Leary) (1985) 174 Cal.App.3d 711 at p.727 [Court must look beyond form to substance and in camera review normally required]

Brown v. Superior Court (West Hills Medical Center) (1985) 168 Cal.App.3d 489, 500-501. 

"The burden of establishing entitlement to nondisclosure rested with the party resisting discovery, not the party seeking it. [Citation.]" (Matchett v. Superior Court, supra, 40 Cal.App.3d at p. 627.) The cases clearly allow information from administrative files that does not result from investigations conducted by the committees. (Saddleback Community Hospital v. Superior Court (1984) 158 Cal.App.3d 206, 209 [204 Cal.Rptr. 598].) That the request "may include materials generated by hospital committees" (italics added) is not enough. Hospital, which is resisting discovery in trying to show entitlement to nondisclosure, must sufficiently establish "that an answer cannot be given without divulging the 'proceedings [or] the records' of the medical staff committees to which section 1157 refers." (Mt. Diablo Hospital Medical Center v. Superior Court, supra, 158 Cal.App.3d at p. 348.) The trial court should review the discovery requests with this standard in mind.

Willits v. Superior Court of Santa Clara (1993), 20 Cal. App.4th 90   Citing Matchett: A hospital has the “burden of demonstrating why the information claimed to be immune should be deemed a record or proceeding of a medical staff committee.” The court must have before it facts which allow it to match each committee's mission and function against the specifications of the statute.
In camera hearing may be required. “Thus, when application of the statute to disputed discovery is not facially apparent, as will often be the case, the burden on the party resisting discovery ordinarily cannot be sustained except upon judicial inquiry into the pertinent facts at an in camera hearing. [Citations.] If it is revealed at such a hearing that only portions of a report or other document are derived from the work of a protected committee the court may order such portions excised and compel disclosure of the remainder." p.105

NATURE OF MEDICAL REVIEW COMMITTEE [EC 1157(a)]

Statutory requirements
1. Organization:   "...organized committees...of staffs in hospitals
peer review body B&P Code 805
review committees of local & state professional societies

2.having responsibility of evaluation and improvement of the quality of care

Peer Review Procedure

Bell v. Sharp Cabrillo Hospital  (1989) 212 Cal.App.3d 1034, 1038-9

"A. The Hospital's Peer Review Reapplication Procedure
The Hospital reviews each medical staff physician for reappointment every two years. Each physician reviewed submits a "reappointment questionnaire" to the Hospital's medical staff coordinator. The coordinator is a hospital employee, responsible for accumulating the questionnaires and ascertaining as to the status of each physician's license from the Board of Medical Quality Assurance (BMQA). The BMQA report identifies physicians who have reports of adverse action taken against their license or privileges at any particular hospital. fn. 3
"After the medical staff coordinator receives a physician's reappointment application, it is reviewed to determine whether the doctor had admitted an appropriate number of patients to the hospital and had completed a sufficient number of continuing medical education credits. The completed application and the BMQA report are then forwarded to the specific section or supervisory committee (i.e., surgery) to which the physician belonged. Upon review, the department forwards the application with a recommendation to the executive medical committee. Within the context of this case, if there appears to be something warranting further inquiry as to whether the physician should be reappointed, it is the chief of surgery's responsibility to make the inquiry or to appoint a committee to investigate and then offer a recommendation to the executive medical committee. After approval by the executive medical committee, the chief of staff takes a list of those physicians approved to the board of trustees, the ultimate governing body of the hospital. However, if at the executive medical committee level concerns are expressed, the matter will normally be referred back to the individual department, where the application should go through the same process again with a more detailed inquiry and another recommendation."
Footnote 3. "Business and Professions Code section 805 provides that if a hospital takes an action to revoke, limit or suspend a physician's privileges for more than 45 days, the hospital is required to report this action and the reasons underlying it to the BMQA. Hospitals are then required by Business and Professions Code section 805.5 to inquire of the BMQA whether any other "805 Report" has been filed by any other hospitals against a physician before granting or renewing privileges to a staff physician.
"The reliability of this reporting system is questionable; for, it is known to the BMQA that hospitals do not always report such actions, but rather place pressure upon an incompetent physician to resign his privileges. Under such circumstances, no "805 Report" is filed with the BMQA. Criminal sanctions may be imposed upon a hospital for willful failure to report such action, but the criminal sanction is a minimum of $200 and a maximum of $1,200."

Dual structure of hospitals recognized by case law based on 1157 and administrative regulations of hospitals

Administrative governing body

may include non-health care professionals
ultimate responsibility for quality

Organized medical staff entity

composed of health care professionals
responsible to admin
responsible for quality of medical care to patients
functions include executive review, credentials, utilization review, infection control, evaluation of staff applications and credentials, appointments, reappointments, assignment of clinical privileges, ability to perform surgical and/or other procedures competently

Alexander v. Superior Court (Saheb) (1993) 5 Cal.4th 1218, 1224

Matchett v. Superior Court (1974) 40 Cal.App.3d 623 TrCt denied all discovery based on 1157; CtApp remanded for reconsideration of administrative committees. Appellate Court examined the function and activities of 4 committees to determine in each case whether it qualified for immunity.  "In an accredited hospital, the organized medical staff is responsible to the hospital governing body for the quality of in-hospital medical care; it evaluates the qualifications of applicants and holders of staff privileges; it recommends appointment, reappointment, curtailment and exclusion from staff privileges; it provides peer group methods for reviewing basic medical, surgical and obstetrical functions."

Santa Rosa Memorial Hospital v. Superior Court (19 ),174 Cal.App3d 711 [Committee membership not restricted to physicians; Infection control committee w/in 1157: established by hospital by-laws; composed of 6 physicians +nurses+administrators; responsible for investigation, control & prevention of infection; infection control program required by state]

Willits v. Superior Court of Santa Clara (1993), 20 Cal. App.4th 90 citing Mt. Diablo  Committee to evaluate and approve standards for granting physician privileges to administer new drug treatment. The terms `evaluation and improvement of the quality of care rendered in the hospital' include  consideration of standards for new physician treatments and drug care. Legislative intent to encourage full and candid evaluation is the same, whether related to the competence of doctors or to the use of treatments and drugs.  Plaintiffs sought discovery of the standards, which defendant hospital produced, as well as the minutes of the five committees approving the standards, which the hospital claimed to be privileged under section 1157.

Willits v. Superior Court of Santa Clara (1993), 20 Cal. App.4th 90 citing Santa Rosa Memorial Hospital v. Superior Court (1985) 174 Cal. App.3d 711 [220 Cal. Rptr. 236], After examining the functions of defendant hospital's infection control committee, the court concluded that it was a "medical staff committee" court noted increasing concern that hospitals were misusing section 1157 in order to frustrate discovery.

See also West Covina Hospital v. Superior Court (1986), 41 Cal.3d 846



NATURE OF PROTECTION

Protection of proceedings & records from discovery; not privilege or prohibition on admissibility


University of Southern California v. Superior Court 45 Cal.App.4th 1283, 1292  ["It is true that some decisions use the word "privilege" to describe the exemption from discovery set forth in section 1157. (See, e.g., Alexander v. Superior Court, supra, 5 Cal.4th 1218, 1223-1224, fn. 4.) However, section 1157 clearly does not create a "privilege" as that term is used in division 8 of the Evidence Code. Section 912's privilege waiver provisions therefore do not apply to section 1157's discovery exemption."]


Mt.Diablo Hospital Med. Ctr. v. Superior Court
(1984),158 Cal.App.3d 344 [interrogatories to the hospital asking for information about the action taken on the doctor's application for staff privileges, the action taken to revoke his staff privileges, and any investigation or evaluation of his qualifications during his tenure on the hospital staff. Other questions were directed to the existence of a hospital committee to review qualifications and standards of practice and some sought the identity of the committee members. Though highly relevant, records are not discoverable]

Person in attendance not required to testify as to what transpired at meeting i.e. can't stop voluntary testimony

West Covina Hospital v. Superior Court (1986), 41 Cal.3d 846
Alexander v. Superior Court (1993), 5 Cal.App.4th 1218
Santa Rosa Memorial Hospital v. Superior Court
(1985) 174 Cal. App.3d 711 [220 Cal. Rptr. 236]
[service on committee doesn't protect all knowledge or all documents that person possesses; do subject records or knowledge reveal committee proceedings or records ?]

Discovery of facts and information from other sources not prohibited
Alexander v. Superior Court (1993), 5 Cal.App.4th 1218, fn.4. [ "...nor does section 1157 prevent a plaintiff from otherwise discovering relevant information by, inter alia, deposing a physician and asking whether he or she was previously denied staff privileges, or by reviewing public records...."]

Santa Rosa Memorial Hospital v. Superior Court (1985) 174 Cal. App.3d 711

Administrative matters are not protected
Willits v. Superior Court of Santa Clara (1993), 20 Cal. App.4th 90

Snell v. Superior Court (1984), 158 Cal.App.3d 44 [Plt sought personnel files and applications for staff privileges. Hospital declaration that only files in that category were maintained by the peer review committee. Since no such files existed in hospital administrative files, 1157 protected them.


PROTECTED MATERIAL [EC 1157(a)&(b)]

proceedings

records

Not the fact that a particular doctor was or was not evaluated
Not the fact that a hospital did or did not require a particular doctor to carry med mal insurance
Not the fact that a doctor was terminated, suspended or denied staff privileges

Brown v. Superior Court (West Hills Medical Center) (1985) 168 Cal.App.3d 489, 502
Hinson v. Clairemont Community Hospital (1990) 218 Cal.App.3d 1110

Not limited to documents generated by committee

Alexander v. Superior Court, 5 Cal.4th 1218, 1227 [app. for staff privileges; SC rejects generated vs submitted distinction and determines documents submitted can be within protection, i.e. not excluded from protection by 1157]

Willits v. Superior Court of Santa Clara (1993), 20 Cal. App.4th 90, 98 citing  Alexander v. Superior Court,  5 Cal.4th 1218, 1227 doctors' applications submitted to a hospital medical committee protected "`Committee members and those providing information to the committee must be able to operate without fear of reprisal. Similarly, it is essential that doctors seeking hospital privileges disclose all pertinent information to the committee. Physicians who fear that information provided in an application might someday be used against them by a third party will be reluctant to fully detail matters that the committee should consider.'"

Cedars-Sinai Medical Center v. Superior Court (1993), 12 Cal.App.4th 579, p.581

Placing doc in committee file does not create protection

Santa Rosa Memorial Hospital v. Superior Court (19 ),174 Cal.App3d 711

Cf. Snell v. Superior Court (1984), 158 Cal.App.3d 44 [Plt sought personnel files and applications for staff privileges. Hospital declaration that only files in that category were maintained by the peer review committee. Since no such files existed in hospital administrative files, 1157 protected them.

 specific documents

Applications & reapplications for staff privileges
 Alexander v. Superior Court (Saheb) (1993) 5 Cal.4th 1218 [“ it is clear that applications for staff privileges are the province of the hospital's medical staff committee. ... Although a hospital's administrative governing body makes the ultimate decision about whether to grant or deny staff privileges, it does so based on the recommendation of its medical staff committee." Plt in med mal sought to discover from Hospital the physicians' applications and reapplications for staff privileges; TrCt granted; SC rev'd CtApp & held applications for staff privileges are records of organized committees responsible for quality "in this case." The Court disapproved Hinson to the extent inconsistent and it qualified its ruling to the facts in the case before including declarations from the Hospital regarding the origins,  purpose and limited use and distribution of the application forms]

Hinson v. Clairemont Community Hospital (1990) 218 Cal.App.3d 1110, 1128  ["We conclude neither an application for staff privileges nor the fact a physician's privileges have been denied, suspended or terminated prima facie fall within the scope of Evidence Code section 1157. An application for staff privileges is not included within Evidence Code section 1157 since the application is neither necessarily a "proceeding" nor a "record" of a committee; it is a document prepared and completed by an individual physician.

Snell v. Superior Court (1984), 158 Cal.App.3d 44 [Plt sought personnel files and applications for staff privileges. Hospital declaration that only files in that category were maintained by the peer review committee. Since no such files existed in hospital administrative files, 1157 protected them.
testimony as to what transpired at meeting
Cannot compel member of committee to testify as to what transpired
Santa Rosa Memorial Hospital v. Superior Court (19 ),174 Cal.App3d 711
Willits   "In Santa Rosa Memorial Hospital v. Superior Court (1985) 174 Cal. App.3d 711 [220 Cal. Rptr. 236], deposition of a nurse member of the infection control committee the trial court erred in granting the motion to compel."

Not prohibition on voluntary testimony

West Covina Hospital v. Superior Court (1986), 41 Cal.3d 846, 849, 855 [4 / 3 decision; TrCt rev'd by CtApp rev'd by SC.  “We conclude that Evidence Code section 1157, subdivision (b) prohibits required testimony but does not preclude voluntary testimony.” 
“Evidence Code section 1157 [does not preclude] a hospital medical review staff committee member from testifying voluntarily about proceedings of the committee.”]


identities of committee members protected

Willits v. Superior Court of Santa Clara (1993), 20 Cal. App.4th 90 citing  Cedars-Sinai Medical Center v. Superior Court 12 Cal. App.4th at p. 588. identities of committee members who had evaluated the obstetrical privileges of defendant doctors protected. Voluntary testimony exception doesn't allow access to names.

Cedars-Sinai Medical Center v. Superior Court 12 Cal. App.4th at p. 588  [medical malpractice case Def sought protective order re identies of members of medical staff who has reviewed any aspect of the obstetrical privileges held by" the defendant physicians. "We grant Cedars's petition for writ of mandate because we conclude section 1157 embodies the Legislature's finding the public good is best served where medical staff review committees evaluate staff physicians in confidence."]




UNPROTECTED MATERIAL

Facts:  the fact a physician's privileges have been denied, suspended or terminated

Hinson v. Clairemont Community Hospital (1990) 218 Cal.App.3d 1110 [overruled by Alexander re discovery of  applications for staff privileges in med mal case based on the facts in the Alexander case but not on discovery of the fact of termination etc of privileges]

Whether investigation was conducted

Brown v. Superior Court (1985), 168 Cal.App.3d 489 [R.D. encourages investigations if have to answer]

Willits v. Superior Court of Santa Clara (1993), 20 Cal. App.4th 90 [Reconfirmed and approved Brown case.  Claim for "negligently screening the competency of its medical staff to insure the adequacy of medical care rendered to patients at its facility." Plaintiff seeks fact of screening not content. "[t]his result stimulates the evaluation process without permitting penetration of the content of committee discussions.... encourages hospitals to conduct evaluations."]

Whether hospital by-laws required medical malpractice insurance and enforced requirement

Brown v. Superior Court (1985), 168 Cal.App.3d 489 [Snell case holding rejected]

"Information developed or obtained by hospital administrators or others which does not derive from an investigation into the quality of care or the evaluation thereof by a medical staff committee, and which does not disclose the investigative and evaluative activities of such a committee,

Santa Rosa Memorial Hospital v. Superior Court, 174 Cal.App.3d 711, 724, 726
Hinson v. Clairemont Community Hospital (1990) 218 Cal.App.3d 1110, 1128

Interrogatories: answer without divulging proceedings or records

West Covina Hospital v. Superior Court (1986), 41 Cal.3d 846
Mt.Diablo Hospital Med. Ctr. v. Superior Court (1984),158 Cal.App.3d 344
Brown v. Superior Court (1985), 168 Cal.App.3d 489.[ hospital has burden of proof to show that interrogatory cannot be answered without divulging proceedings or records of protected committee]

Administrative files: delete protected material

Brown v. Superior Court (West Hills Medical Center) (1985) 168 Cal.App.3d 489, 500-501. 
"The burden of establishing entitlement to nondisclosure rested with the party resisting discovery, not the party seeking it. [Citation.]" (Matchett v. Superior Court, supra, 40 Cal.App.3d at p. 627.) The cases clearly allow information from administrative files that does not result from investigations conducted by the committees. (Saddleback Community Hospital v. Superior Court (1984) 158 Cal.App.3d 206, 209 [204 Cal.Rptr. 598].) That the request "may include materials generated by hospital committees" (italics added) is not enough. Hospital, which is resisting discovery in trying to show entitlement to nondisclosure, must sufficiently establish "that an answer cannot be given without divulging the 'proceedings [or] the records' of the medical staff committees to which section 1157 refers." (Mt. Diablo Hospital Medical Center v. Superior Court, supra, 158 Cal.App.3d at p. 348.) The trial court should review the discovery requests with this standard in mind.

Matchett v. Superior Court (1974), 40 Cal.App.3d 623, 628 "It is at once apparent that the trial court's order was too sweeping. The medical staff immunity described in section 1157 extends to, first, the proceedings, and second, the records of the described staff committees. It does not embrace the files of the hospital administration (as distinguished from staff). The trial court should have inquired into the existence of a hospital administration file concerning the doctor and, if such a file existed, should have permitted its inspection, excluding any portions which reflected the proceedings of staff committees conforming to the specifications of the immunity statute."

County of Kern v. Superior Court ( ),  82 Cal..App.3d 396

Brown v. Superior Court (1985), 168 Cal.App.3d 489 [ delete matter "derived from the work of a protected committee."citing County of Kern case; each item in an administrative file must be examined in camera and determined to be on not be protected citing Schultz case]

Mt.Diablo Hospital Med. Ctr. v. Superior Court (1984),158 Cal.App.3d 344

Willits v. Superior Court of Santa Clara (1993), 20 Cal. App.4th 90 [Distinguish hospital administrative files concerning a doctor which is discoverable excluding portions which reflected the proceedings of staff committees]


EXCEPTION:PERSON REQUESTING HOSPITAL STAFF PRIVILEGES [Sec. 1157(c)]

Inapplicable to 

Medical Malpractice cases alleging negligent granting or review of hospital privileges

Matchett v. Superior Court (1974), 40 Cal. App. 3d 623, 628  "Petitioner points to that portion of section 1157 ... which declares: "The prohibition relating to discovery or testimony shall not apply ... to any person requesting hospital staff privileges...." He views this exception as a limitation which makes the immunity inoperative in a lawsuit charging the hospital with negligent selection or retention of "any person requesting hospital staff privileges."
"The contention rests upon an interpretation which is inconsistent with the statute's objective."

Non-physician;

University of Southern California v. Superior Court 45 Cal.App.4th 1283, 1289  ["An issue in this case thus is whether a resident in a surgical trainee program has "staff privileges" within the meaning of section 1157. So far as this record reflects, Dr. Comeau was not a physician with staff privileges to practice surgery at the Medical Center, but rather a postgraduate surgical resident in training."
"A staff physician treats his patients at the hospital. He has full authority to prescribe the patients' treatment, he is subject to no supervision during the course of treatment, and he generally bears full responsibility for negligence. The situation of the medical resident is entirely different. He treats his employer's patients, by assignment of his employer, subject to supervision by the hospital's chief of surgery, and because of the employer-employee relationship the hospital is liable for his negligence under accepted principles of respondeat superior.
"...no exception applicable to a resident ... who seeks reinstatement to a postgraduate training program."

Doctor defendant in med mal action

West Covina Hospital v. Superior Court (Tyus) (1984) 153 Cal.App.3d 134, 137

The exception in the first paragraph of the section, to nondiscoverability of "statements made by any person in attendance at such a meeting who is a party to an action or proceeding the subject matter of which was reviewed at such meeting," has been interpreted to not apply to medical malpractice actions. It was found to have been designed merely to set aside the immunity and permit discovery in suits by doctors claiming wrongful or arbitrary exclusion from hospital staff privileges. (Matchett v. Superior Court, supra, 40 Cal.App.3d 623; Schulz v. Superior Court (1977) 66 Cal.App.3d 440, 446 [136 Cal.Rptr. 67].)

Schulz v. Superior Court (1977), 66 Cal.App.3d 440. [Dr defendant attended committee meeting reviewing his case and communicated with the committee by letter. Held: not discoverable by plaintiff in med mal and hospital negligence case]

Dr. seeking monetary damages for exclusion or restriction

California Eye Institute v. Superior Court (1989)215 Cal.App.3d 1477 [ Disc. denied Dr. seeking $ for restriction of privileges after privileges fully restored] approved in Willits case.

Willits v. Superior Court of Santa Clara (1993), 20 Cal. App.4th 90 citing  California Eye Institute v. Superior Court (1989) 215 Cal. App.3d 1477 [264 Cal. Rptr. 83], ophthalmologist sought damages for wrongful restriction of his staff privileges at defendant hospital, discovery of documents from the medical staff executive committee that recommended the restriction; relied upon the exception in subdivision (c) for "any person requesting hospital staff privileges." Held: plaintiff was not a "person requesting hospital staff privileges" because the exception applied only in the context of administrative mandamus proceedings pertaining to staff privileges. Allowing doctors to obtain discovery in damage actions would inhibit that goal no less than allowing malpractice plaintiffs to obtain discovery. In fact, the inhibition may be more pronounced. "Obviously the consequences to the individual committee member where a doctor seeks to attain or retain staff privileges is far less severe and inhibiting than is a suit for damages, particularly where a committee member is or may be named as a defendant. The disincentive to full and frank participation in committee activities is much greater from the threat of disclosure in damage actions of any type than in mandate proceedings where the worst that can happen is the reversal of the hospital's staff privileges decision." (California Eye Institute v. Superior Court, supra, 215 99*99 Cal. App.3d at p. 1484;

CF.   Roseville Community Hospital v. Superior Ct. (1977), 70 Cal.App3d 809 [Bd of Dr terminated Dr. partnership employment contract based on recommendations of the medical staff setting forth that it (the medical staff) had "no confidence" in plaintiff. Plt entitled to discover "all written minutes, tapes or other magnetic recordings of the regular and special meetings of the executive committee of the medical staff  and executive committee meetings of the professional standards committee insofar as they relate to plaintiff. ]

Dr seeking monetary damages for interruption of income
St. Francis Memorial Hospital v. Superior Court (Deatherage) (1988) 205 Cal.App.3d 438 [Dr.complaining that her existing practice of electroconvulsive treatment (ECT hereinafter) was temporarily interrupted while the hospital established new guidelines for such treatment.]

Willits v. Superior Court of Santa Clara (1993), 20 Cal. App.4th 90 citing St.Francis Memorial Hospital v. Superior Court (1988) 205 Cal. App.3d 438 [252 Cal. Rptr. 380] [in suit for damages arising out of interruption of plaintiff doctor's practice while hospital instituted new procedures, plaintiff was denied discovery of documents pertaining to committee's evaluation of procedures].)

Critical care nurse seeking monetary damages for injury on the job

Willits v. Superior Court of Santa Clara (1993), 20 Cal. App.4th 90
EC 1157 protection applies to hospital employee suit for damages [critical care nurse needle pin prick]
“"[w]e do not (and cannot) decide the discoverability of any particular items requested.'”
Critical care nurse sought records of hospital in PI case arising from injury on the job. Trial court ruled that 1157 applied and precluded discovery; appellate court held the denial was overbroad and returned for closer scrutiny by trial court.

EXCEPTION: statements by PERSON IN ATTENDANCE

University of Southern California v. Superior Court 45 Cal.App.4th 1283, 1290 ["Nor does the "statements by persons in attendance" provision entitle Dr. Comeau to discovery. Dr. Comeau interprets this provision to allow discovery whenever suit is filed over some action of a committee such as the Resident Evaluation Committee. If that interpretation were the one intended by the Legislature, the exemption from discovery provided by section 1157 would have little or no meaning. It would not apply whenever suit is filed, which is the only situation in which discovery is available. For this reason, the court in Schulz v. Superior Court (1977) 66 Cal.App.3d 440, 446 [136 Cal.Rptr. 67] rejected such a broad interpretation: "The [statements by persons in attendance] exception created in section 1157 was designed to set aside the immunity and permit discovery in suits by doctors claiming wrongful or arbitrary exclusion from hospital staff privileges. It does not apply to a malpractice proceeding in which the doctor or the hospital have been made parties; such circumstances do not open to discovery hospital staff records containing medical committee investigation reports and peer appraisals." In reaching this decision, the Schulz court stated, "[t]o declare that the immunity is to be set aside when either the staff doctor or the hospital are parties to the malpractice proceeding would not only achieve an absurd result, but would render sterile the immunity provisions of the statute." (Schulz, supra, 66 Cal.App.3d 440, 445.)"]

 West Covina Hospital v. Superior Court (Tyus) (1984) 153 Cal.App.3d 134  [exception of (c) does not apply to medical malpractice cases citing Schultz and Matchett cases]


CRIMINAL PROCEEDINGS

Protection does apply

Scripps Memorial Hospital v. Superior Court (1995), 37 Cal.App.4th 1720

Protection does not apply and prosecutors can subpoena documents [SF & LA]

People v. Superior Court(Memorial Med. Ctr.)(1991), 234 Cal.App.3d 363