Hyams v. CVS Health Corporation

District Court, N.D. California·Decided December 11, 2019·No. 4:18-cv-06271·Unknown

Opinion

1 2 3 4 5 6 7 10 San Francisco Division 11 RYAN HYAMS, Case No. 18-cv-06271-PJH (LB)

12 Plaintiff, DISCOVERY ORDER REGARDING (1) PATIENT-SAFETY WORK 13 v. PRODUCT PRIVILEGE AND (2) BURDEN AND 14 CVS HEALTH CORPORATION, et al., PROPORTIONALITY 15 Defendants. Re: ECF No. 99, 115, 126, 129, 130, 132 16 18 The court assumes the reader’s familiarity with the subject matter and procedural history of 19 this case. The parties have raised more discovery disputes, regarding (1) patient-safety work 20 product (“PSWP”) under the Patient Safety and Quality Improvement Act, 42 U.S.C. § 299b-21 et 21 seq. (“PSQIA”),1 and (2) burden and proportionality with respect to the plaintiff’s Interrogatories 22 Nos. 1–4 and 19.2 The court issues this order defining the scope of PSWP protection and directs 23 the defendants to (1) immediately produce all surveillance video and still photographs that they are 24 withholding on the basis of PSWP and (2) reexamine all other withheld documents in light of the 25 26 1 Pl. PSWP Mem. – ECF No. 100; Defs. PSWP Opp’n – ECF No. 115; Pl. PSWP Reply – ECF No. 126. Citations refer to material in the Electronic Case File (“ECF”); pinpoint citations are to the ECF- 27 generated page numbers at the top of documents. 2 Defs. Suppl. Burden Mem. – ECF No. 129; Pl. Suppl. Burden Opp’n – ECF No. 130; Defs. Suppl. 1 court’s guidance and produce any non-PSWP documents by December 19, 2019. The court 2 overrules the defendants’ burden and proportionality arguments and orders them to respond to the 3 plaintiff’s interrogatories. 4 6 1. Patient-Safety Work Product 7 The PSQIA defines PSWP with reference to two concepts: “patient safety organization” (often 8 referred to as “PSO”) and “patient safety evaluation system” (often referred to as “PSES”). “The 9 term ‘patient safety organization’ means a private or public entity or component thereof that is 10 listed by the Secretary [of Health and Human Services] pursuant to [PSQIA requirements],” 11 42 U.S.C. § 299b-21(4), and “[t]he term ‘patient safety evaluation system’ means the collection, 12 management, or analysis of information for reporting to or by a patient safety organization,” 13 42 U.S.C. § 299b-21(6). 14 The PSQIA defines three categories of PSWP: 15 1. materials3 “assembled or developed by a provider for reporting to a patient safety 16 organization and [] reported to a patient safety organization; . . . and which could result 17 in improved patient safety, health care quality, or health care outcomes,” 42 U.S.C. 18 § 299b-21(7)(A)(i)(I) (the “Reporting Prong”) 19 2. materials “developed by a patient safety organization for the conduct of patient safety 20 activities; and which could result in improved patient safety, health care quality, or 21 health care outcomes,” 42 U.S.C. § 299b-21(7)(A)(i)(II) (the “PSO-Developed 22 Prong”), and 23 3. materials that “identify or constitute the deliberations or analysis of, or identify the fact 24 of reporting pursuant to, a patient safety evaluation system,” 42 U.S.C. § 299b- 25 21(7)(A)(ii) (the “Deliberations Prong”). 26 27 3 Specifically, “any data, reports, records, memoranda, analyses (such as root cause analyses), or 1 Notwithstanding the above, the PSQIA excludes from the definition of PSWP “information that is 2 collected, maintained, or developed separately, or exists separately, from a patient safety 3 evaluation system,” among other things. 42 U.S.C. § 299b-21(B)(ii). 4 The defendants invoke the “constitute the deliberations and analysis” portion of the 5 Deliberations Prong to withhold 71 documents, arguing that the documents contain “[t]he data 6 collected, and the analysis performed concerning the representative patient audit[, which] 7 constitute deliberations and analysis within CVS’s PSES.”4 8 1.1 “Deliberations or Analysis . . .” 9 The plain language of the Deliberations Prong extends the definition of PSWP only to 10 “deliberations or analysis.” 42 U.S.C. § 299b-21(7)(A)(ii). It does not extend the definition of 11 PSWP to the underlying facts or documents that might have been the subject of deliberation and 12 analysis. 13 This is confirmed by guidance from the Department of Health and Human Services (“HHS”), 14 the agency charged with administering the PSQIA: 15 We note that the statutory protections for deliberations and analysis in a patient safety evaluation system apply without regard to the status of the underlying 16 information being considered (i.e., it does not matter whether the underlying information being considered is patient safety work product or not). A provider can 17 fully protect internal deliberations in its patient safety evaluation system over 18 whether to report information to a PSO. The deliberations and analysis are protected, whether the provider chooses to report the underlying information to a 19 PSO or not. However, the underlying information, separate and apart from the analysis or deliberation, becomes protected only when reported to a PSO. See 20 section 921(7)(A)(i)(1) of the Public Health Service Act, 42 U.S.C. 299b- 21 21(7)(A)(i)(1). To illustrate, consider a hospital that is reviewing a list of all near-misses 22 reported within the past 30 days. The purpose of the hospital’s review is to analyze 23 whether to report any or part of the list to a PSO. The analyses (or any deliberations the provider undertakes) are fully protected whether the provider reports any near- 24 misses or not. The status of the near-misses list does not change because the 25 26 4 Defs. Privilege Log Addendum – ECF No. 101 at 188–89. The defendants do not invoke the 27 Reporting Prong, the PSO-Developed Prong, or the identify-deliberations-or-reporting component of the Deliberations Prong. See id.; Defs. PSWP Opp’n – ECF No. 115 at 12. The court expresses no 1 deliberations took place. The fact that the provider deliberated over reporting the list does not constitute reporting and does not change the protected status of the 2 list. Separate and apart from the analysis, this list of near misses is not protected unless it is reported. By contrast, this provision fully protects the provider’s 3 deliberations and analyses in its patient safety evaluation system regarding the list. 4 5 Patient Safety and Quality Improvement, 73 Fed. Reg. 8112, 8122–23 (Feb. 12, 2008) (proposing 6 rules) (emphasis added); accord Patient Safety and Quality Improvement, 73 Fed. Reg. 70,732, 7 70,743 (Nov. 21, 2018) (adopting final rules) (explaining that “information that constitutes the 8 deliberation or analysis within a patient safety evaluation system is protected,” as contrasted from 9 “[i]nformation underlying the analysis”) (emphasis added).5 10 HHS’s construction of the Deliberations Prong is consistent with deliberative privileges in 11 other contexts. For example, the government enjoys a deliberative-process privilege over 12 “documents reflecting advisory opinions, recommendations and deliberations comprising part of a 13 process by which government decisions and policies are formulated.” Karnoski v. Trump, 926. 14 F.3d 1180, 1203 (9th Cir.

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