Iowa’s highest court says error-reporting document is confidential

A trial court initially told an Iowa hospital to turn over its patient safety network (PSN) incident report and related documents to a man as part of discovery in his medical malpractice lawsuit, but the Supreme Court of Iowa has said the hospital does not have to share the protected information.

In a ruling in Willard v. State of Iowa, the high court said the Iowa Morbidity and Mortality Study Law (MMSL), which was passed to keep peer-review information and materials confidential, protects the information from being given to a patient who sued after being treated at the University of Iowa Hospitals and Clinics (UIHC).

“A PSN clearly falls within the legislative intent of ‘any study for the purpose of reducing morbidity or mortality,’ ” the justices said. “The PSN system allows the UIHC to keep track of patient incidents and to route them to the appropriate department for resolution. The PSN system can also result in revised policies for the hospital as a whole or for use in studies, reports and presentations.”

Dennis Willard asked to discover the PSN as part of the medical liability suit he filed after being brought to the hospital following a motorcycle crash. He learned about the document after his lawyer deposed a UIHC senior imaging technologist who said she didn’t recall the scan itself, but remembered Willard because she learned that an incident report had been filed about the scan the day after he was treated.

Willard’s injuries were so severe that he was transferred from a hospital in Davenport, Iowa, to UIHC, a state-owned health system. He had an abdominal CT scan there to determine if he had internal organ damage from the crash. Imaging technologists raised Willard’s arms for the scan because he was sedated and intubated. Willard claims UIHC was negligent in how it handled him during the CT scan and it resulted in injuries to his left shoulder, arm and foot. The injuries did not show in x-rays that had been taken at the Davenport hospital, he said.

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Error-reporting confidentiality threatened in court

The Litigation Center of the AMA and State Medical Societies and the Iowa Medical Society (IMS) filed a friend-of the-court brief in Willard that explained how the first step to a safer health system is identifying an error so it can be studied. The brief went on to say that physicians, nurses and others on the hospital staff must be willing to report an error, and that the only way they will be willing to do that is if there are protections in place for reporting errors.

In the ruling, the Supreme Court of Iowa agreed that confidentiality is an important protection for physicians and other hospital staff.

“The protection afforded by the confidentiality privilege allows hospital staff to feel comfortable reporting any and all safety concerns because those reports will remain confidential and not be subject to discovery in a legal proceeding,” the court said. “This confidentiality allows hospitals to utilize PSNs to reduce adverse patient safety events based on preventable medical errors.”

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