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State of Missouri v Jaynes

Case No. WD72684 (MO Ct. App., W. Dist., Nov. 9, 2010)

This is an original proceeding in prohibition. Relator Kirksville, Missouri, Hospital Company, LLC, d/b/a Northeast Regional Medical Center ("NERMC") seeks to prohibit the respondent, the Honorable Ralph H. Jaynes, visiting judge in the Circuit Court of Boone County, Missouri, from allowing plaintiffs, Francis and Janie Watson ("Watsons") to discover documents relating to the credentialing of Dr. John Bailey ("Dr. Bailey") in an underlying medical malpractice and negligent credentialing action. Forty pages of documents were ordered produced, following in camera review. NERMC claims all of these documents are protected from discovery by section 537.035.4, the peer review statute.

Our preliminary writ of prohibition is dissolved.

Factual Background

Dr. Bailey submitted an application for surgical privileges in back surgery to NERMC in mid-1997. Temporary privileges were afforded Dr. Bailey. At or near the same time, a question arose about whether Dr. Bailey had successfully completed training with the Columbia Spine Fellowship. NERMC's Director of Surgery expressed a concern that Dr. Bailey had been granted temporary privileges before this issue had been resolved. He proposed submitting Dr. Bailey's first twenty-five spinal instrumentation cases to an independent, fellowship trained, spine surgeon for review.

NERMC's Executive Committee approved this recommendation and retained Dr. John Flood, an independent spine surgeon practicing in Michigan, for this purpose. Dr. Flood reviewed twenty cases involving spine surgeries performed by Dr. Bailey. Dr. Flood prepared a written report, which he submitted to NERMC. NERMC contends the report was sought as a part of considering whether to afford Dr. Bailey permanent privileges.

The Watsons filed a lawsuit against Dr. Bailey and NERMC in 2004 claiming Dr. Bailey negligently treated and performed surgery on Mr. Watson. The Watsons further claim that NERMC was negligent in granting Dr. Bailey staff privileges to perform spine surgeries. The Watsons learned of Dr. Flood's report and took Dr. Flood's deposition on April 29, 2008. Numerous objections were asserted by NERMC in reliance on the peer review privilege described in section 537.035. The Watsons filed a motion for enforcement of discovery relating to the objections, which was thereafter granted in part and denied in part. Dr. Flood's second deposition was conducted on September 18, 2009, with a Special Discovery Master, John Hutcherson, in attendance.
 

 

Judge(s): Cynthia L. Martin
Jurisdiction: Missouri Court of Appeals, Western District
Related Categories: Health Care , Malpractice
 
Circuit Court Judge(s)
Cynthia Martin
Mark Pfeiffer
James Welsh

 

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Click the maroon box above for a formatted PDF of the decision.
proceeding flood's report, dr. bailey's letter is already in the watsons' possession, albeit in a of getting some type of documentation in case there were to be any lawsuits a "peer review committee" under section 537.035, it follows that dr. flood's report section, no person who was in attendance at any peer review committee proceeding" is except as otherwise provided in this section, the interviews, memoranda, as a final observation, we note that none of the documents at issue in this ) ) produced. proceeding include patient identifying information, which would require redaction before documents bates stamped 000015 and 000027. before writ division: james e. welsh, presiding judge, mark d. pfeiffer, judge and 4 (n.d. 1996). llc d/b/a northeast regional dr. bailey's response to dr. flood's report relator, 537.035.3, which immunizes specified individuals from liability in connection with their participation in, or reliance our preliminary writ in prohibition is dissolved. need not address whether dr. flood's report concerns the health care provided any care provided any patient flood reviewed twenty cases involving spine surgeries performed by dr. bailey. dr. other proceedings before any health care review committee or board or committees, or the existence of the same, concerning the health care 537.035.4." id. however, the supreme court was careful to observe: our preliminary writ of prohibition is dissolved. merely because it was presented during proceedings before a peer review committee; and alleged harm that has already occurred. limited to governmental agencies, professional accrediting agencies, or missouri hospital company 10 permitted to disclose information acquired from the proceeding.5 merely because it was presented during proceedings before a peer review the documents we have reviewed in camera do contain a final page to dr. flood's nermc and was reviewed by the executive committee for its consideration as a part of nermc argues that faith hospital is factually indistinguishable from this case. discovery pursuant to either the first or second sentence of section 537.035.4. we need a spine surgeon. respondents argue that the findings and recommendations given by a certain specified documents "of peer review committees" are protected from discovery, first sentence of section 537.035.4 to be limited to "credentials committee findings and protecting or preserving the peer review process. we faced a similar situation in tennill, 965 s.w.2d at 948. there, we concluded 537.035.4. prepared by outside sources pursuant to section 537.035.4. respondent. person appearing before it, to be prevented from testifying as to matters numbered 000043 through 000065, though production of these documents will remain seven separate pages listed by case number, with a detailed typewritten the third category of documents ordered produced are minutes from executive 000034; 000058 through 000064).6 cases to an independent, fellowship trained, spine surgeon for review. 2 response to dr. flood's report. this document bears bates numbers 000035 through legislature intended to increase the level of health care in the state by 537.035.4, as it is not information acquired by dr. bailey in connection with or in the schaeperkoetter, 933 s.w.2d 407, 408 (mo. banc 1996). as noted in faith hospital, a information otherwise discoverable or admissible from original sources is the second sentence of section 537.035.4 prohibits a person who was in credentials committee's investigations,4 documents bates numbered 000008 through 000015, 000020 through 000043, and nermc also argues that redacting patient information does not protect or preserve the ) deliberations, reports, or minutes to any person or entity, including but not nermc followed dr. browning's suggestion. the original purpose for the outside the legislature's omission of the qualifying language relating to whether such information concerns the unrelated to this case. however, our inquiry does not end here. we must dr. flood's report section 537.035.4 to include within the specific delineation of privileged peer review 537.035.4. ) privileges. described in section 537.035.4 unless we first determine that the contested documents are second sentence, section 537.035.4 states that "[e]xcept as otherwise provided in this 6 protecting the report from discovery, if it is unfavorable, under section 537.035.4, relying on leblanc v. research we do not believe dr. flood's report is "a peer review committee report" as that bailey's files. if dr. flood's activities are insufficient to permit him to be characterized as our preliminary writ of prohibition is dissolved as to the documents ordered trial court error in prohibition actions." state ex rel. faith hosp. v. enright, 706 s.w.2d (i) are the minutes peer review committee documents concerning the health prohibit the respondent, the honorable ralph h. jaynes, visiting judge in the circuit nermc disagrees and argues that since dr. flood's report was requested by (quoting butler v. mitchell-hugeback, inc., 895 s.w.2d 15, 19 (mo. banc 1995)). the medical center, dr. bailey's letter is not "a peer review committee report." as was the case with critique of each of these spinal cases. interestingly, dr. flood's review does of the defendant physicians . . . with respect to other patients from 1980 until the date of with a credentials decision.8 855. nermc is not entitled to a permanent writ of prohibition to protect itself from an 8 nonadmissibility. provided any patient are privileged and shall not be subject to discovery, a permanent writ of prohibition to prevent production of documents the watsons (b) that a member, employee, or agent of a peer review committee, or any person 9 peer review committee's recommendation," id. at 206, the court in no way discussed the discoverability of reports attendance at a peer review committee proceeding from disclosing information acquired about opinions formed as a result of such committee hearings. the by section 537.035.4 as that person is an "original source." in prohibition assert that dr. flood's report is privileged under section 537.035.4 and that we learned during oral argument that, as was the case with seven pages from dr. report was sought as a part of considering whether to afford dr. bailey permanent the scope of these proceedings. we disagree. faith hospital held that production "of peer review committee reports" (ii) is dr. bailey a person who was in attendance at a peer review committee this is an original proceeding in prohibition. relator kirksville, missouri, we are first compelled to address a fundamental question relating to the committee, including about any testimony they may have provided to a committee. the second category of documents within those ordered produced is dr. bailey's meetings discussing dr. flood's report.3 problem. that problem, as expressed in dr. browning's letter, was that privileges had 9 contention that redaction of patient identifying information from documents otherwise court of boone county, missouri, from allowing plaintiffs, francis and janie watson privileged, in general, because it appears unknown portions of the letter have not been nermc in mid-1997. temporary privileges were afforded dr. bailey. at or near the 000065. minutes of an executive committee acting as a credentials committee are 4 provided to dr. bailey's patients but, rather, discovery concerning dr. bailey's abilities as clearly "a peer review committee" document as defined by the legislature in the first nermc has made no attempt in this proceeding to protect its executive committee the watsons' motion to enforce discovery. the watsons' motion to enforce discovery several pages of dr. flood's report. that a private outside company hired to conduct peer reviews of a hospital's physicians is through 0000019, and 0000057 had already been produced by agreement. the report connection with this proceeding has revealed that seven pages of dr. flood's report are with the columbia spine fellowship. nermc's director of surgery expressed a concern produced and bearing bates numbers 000008 through 000014; 000020 through 000026; western district nermc has not met its burden to establish that dr. bailey's letter is privileged 5 report was commissioned by and subsequently reviewed by the peer review committee. the motion to enforce discovery was considered by the special discovery master. ("watsons") to discover documents relating to the credentialing of dr. john bailey ("dr. 13 sentence, section 537.035.4 states that "[e]xcept as otherwise provided in this section," evidence and information about such causes of action unless that 000028 through 000034; and 000058 through 000064. review committees or officers shall be privileged. . . ." the language does hospital company, llc, d/b/a northeast regional medical center ("nermc") seeks to the complained of surgery." id. the supreme court held that this request fell "squarely redacted format. we do not know from our record the portions of the letter which are the respondent argues that not all functions of credentials committees are exempt further, notwithstanding nermc's contention in this proceeding that dr. flood's committee peer review meetings. these document bear bates numbers 000043 and (ii) is dr. flood a person who was in attendance at a peer review committee person or entity or be admissible into evidence in any judicial or 14 the course of his attendance at a peer review committee proceeding. appearing before such a committee, cannot be prevented from testifying about matters intended that all information provided to the committee be privileged, it would have factual background numerous objections were asserted by nermc in reliance on the peer same time, a question arose about whether dr. bailey had successfully completed training committees, including credentials committees, concerning the health care provided any nothing about eliminating the torts of medical malpractice or the negligent wd72684 nermc's director of surgery, wherein the recommendation to seek outside review of the documents are produced. though the special discovery master's report ordered that health care provided any patient. examine the nature of the minutes, as "[c]redentials committee findings and [f]rom time to time in peculiarly limited situations there are instances in before dr. flood's second deposition, the watsons filed a motion for enforcement pages of documents were ordered produced, following in camera review. nermc rights of dr. bailey. nermc failed to advise this court, however, that seven pages of dr. flood's report are violation of a privilege "cannot be adequately remedied on appeal. once the proverbial not a "peer review committee" as defined by the legislature in sections 537.035.1(2) and by a lengthy passage commencing with the words "provided, however." this lengthy information is reflective of the deliberations of the peer review committee. claims all of these documents are protected from discovery by section 537.035.4,1 in section 537.035.1(2). faith hosp., 706 s.w.2d at 855. in faith hospital, plaintiffs cynthia l. martin, judge section 537.035.4, as it is not information acquired by dr. flood in connection with or in [n]ot all functions of credentials committees are exempt from discovery statements, memorandums, proceedings, findings, and other records of peer nermc asserted during oral argument that it is entitled to "shield" itself from lawsuits asserting a claim language affording privilege to certain documents of a peer review committee. in hill, protecting the deliberations of peer review committees. the statute says 2 states: discoverable or admissible from original sources will not be immune from discovery justifiable relief is not made available to respond to a trial court's order. in committee. a credentials committee is a "peer review committee" as that term is defined ) ) state ex rel kirksville care provided any patient of negligent credentialing with a favorable outside report addressing a physician's qualifications, while still report.7 was not asserted by nermc as the basis for its request for writ of prohibition, and arguendo, that the seven pages of dr. flood's report in the watsons' possession are we draw these descriptions, loosely, from nermc's privilege log relating to the forty pages of contested subject to the redacting instructions10 privileges, the record suggests otherwise. in the letter prepared by dr. glenn browning, our preliminary writ of prohibition is dissolved as to the documents bates 12 the kan.stat.ann. section 65-4915(4)(b) clearly states that "the reports, 3 15 to that intent, if possible, and to consider the words used in their plain and ordinary 8 it is apparent, therefore, that with respect to dr. flood's report, the watsons' motion to pursuant to either the first or second sentence of section 537.035.4. our preliminary writ of boone county, mo, had we not sought review of the contested on our in camera review of the minutes, we do not agree. the minutes bates numbered ) enforce was only seeking production of those portions of dr. flood's report, if any, that january 15, 2010 report. preliminarily protected from production by either the first or second sentence of section nermc has not met its burden to establish that dr. flood's report is immune from __________________________________ successfully complete a fellowship program in spine surgery. according to dr. 537.035.2. id. similarly, dr. flood is a private, outside physician hired to review dr. already in the watsons' possession. on these seven pages, dr. flood details his concerns missouri court of appeals it appears in the documents twice at bates numbers 000015 and 000027. this ) this court on july 7, 2010. under section 537.035.4. by its own terms, the exemption provided by this but only if the documents concern "the health care provided any patient." in the sentences of section 537.035.4. our preliminary writ of prohibition is dissolved as to the already in the watsons' possession. nermc also failed to advise this court that of the bailey") in an underlying medical malpractice and negligent credentialing action. forty nermc contends that its executive committee was operating as a credentials bailey's performance in response to dr. flood's letter but do not specifically discuss the counsel for nermc conceded that these seven pages of dr. flood's report are in the 537.035.4, although the report did not provide an explanation for this conclusion. this proceeding, were delivered by nermc for our in camera review on october 12, of discovery or in the alternative, an in-camera review, relating to specific documents minutes, reports, and deliberations about dr. compelled. 706 s.w.2d at 856. dr. flood is not a member of nermc's executive disclosure of any interview, memoranda, proceedings, findings, that the documents bates numbered nermc/pr 000001 through 000007, 0000016 as a result. dr. flood did not attend a meeting of the nermc executive committee. his sought production of "peer review committee reports relating to the performance of one generated following review of several of dr. bailey's patient files; (2) dr. bailey's 10 the watsons filed a lawsuit against dr. bailey and nermc in 2004 claiming dr. discovery by claiming, after seeing the report, that the report was requested in connection reviewed by a peer review committee. we are not empowered to rewrite the statute in the special discovery master entered a report on january 15, 2010. the report indicated 537.035.4. the "exceptions" then described are: (a) that information otherwise april 29, 2008.2 courts must 'ascertain the intent of the legislature from the language used and give effect because we conclude that dr. flood's report is not a peer review committee report, we credentialing in missouri. id. at 206-07. though the court observed that section 537.035.3 provides qualified 000058 through 000065. the special discovery master advised that the documents plainly providing for that result. already have will not spare nermc from absolute irreparable harm. assuming, contested minutes. have any effect upon its confidentiality, nondiscoverability, or specifically concern the health care provided a patient. 16 deliberations are not exempt from discovery . . . unless they specifically concern the analysis 628 s.w.2d 414, 416 (mo. app. 1982). nermc has not met this burden with respect to section 537.035.4 describes two categories of privileged information. in the first according to plaintiff's discovery, the review of dr. flood only contains given nermc's noncompliance with the may 26, 2010 order. on july 7, 2010, nermc establish that such harm exists. state ex rel. vanderpool feed & supply co. v. sloan, review privilege described in section 537.035. the watsons filed a motion for immunity for individuals "if their negligence in granting staff privileges derives from their good faith reliance on a cynthia l. martin, judge circumstances. a similar argument was advanced in hill v. sandhu, 129 f.r.d. 548 (d.kan. nermc's executive committee approved this recommendation and retained dr. from discovery and that they are not seeking discovery concerning the health care patient." id. at 856 (emphasis added). page is not already in the watsons' possession. thus, we must address whether dr. committee" report within the intended scope of the first sentence of section 537.035.4 indicated that the special discovery master had reviewed the remaining documents in though nermc uses the word "investigations," that word does not appear in section 537.035.4 as a part sets of copies of the seven pages of dr. flood's report already in the watsons' possession. for prohibition particularly applies where privileges are at issue." state ex rel. wilfong v. minutes from executive committee peer review meetings source. availability of prohibition with respect to certain portions of dr. flood's report. our review committee report. nermc would thus have us rewrite the first sentence of believe our disclosure of the nature of twenty eight pages of those documents is inappropriate, under the bailey negligently treated and performed surgery on mr. watson. the watsons further patient identifying information be redacted, we conclude this was an instruction included alleged to involve dr. flood's report and identified on a privilege log prepared by proceeding protected from discovery under section 537.035.4 is not an appropriate mechanism for 000042. we have reviewed this document in camera. not, therefore, address the "exceptions" to the privilege afforded by the first and second brought against dr. bailey. it would certainly show that the hospital has we are cognizant that our in camera review of the contested documents afforded us this insight but do not the second sentence of section 537.035.4 ends with a semicolon and is followed nermc. specifically, the watsons sought production of documents bearing bates line with faith hospital, where our supreme court similarly construed the scope of the dr. bailey did not attend a nermc executive committee meeting. his letter, of this section, but such witness cannot be questioned about testimony or as a result, we need not discuss the application of the second sentence of section 537.035.4 to the sentence of section 537.035.4.9 report, therefore, is not immune from discovery pursuant to the second sentence of camera. the special discovery master granted the motion to enforce discovery for the filed a petition for writ of prohibition. a preliminary writ of prohibition was entered by committee nor is a member, employee, or agent or such committee, or other otherwise provided in this section, no person who was in attendance at such proceeding, or to disclose any opinion, recommendation, or evaluation committee documents any information, data, reports, or records commissioned or patient. 5 ) of the committee or board, or any member thereof; provided, however, that (i) is dr. bailey's letter a peer review committee report concerning the health (emphasis added.) nermc argues that the documents ordered produced involve a 7 such circumstances, the extemporaneous character of prohibition may be care provided a patient." faith hosp., 706 s.w.2d at 855. of the legislature's delineation of peer review committee documents protected from discovery. courts have "a strong reluctance to review interlocutory allegations of nonjurisdictional forty pages of documents at issue in this proceeding, twenty eight of those pages are four all concur. defend itself in later lawsuits. nermc cannot now shield dr. flood's report from ) 18 report was sought as a part of its consideration whether to afford dr. bailey permanent enforcement of discovery relating to the objections, which was thereafter granted in part dr. flood's report, though dr. bailey's letter was commissioned and reviewed by the redacting instructions involve removing discussions about other doctors or topics completely this fashion. jepson v. stubbs, 555 s.w.2d 307, 313 (mo. 1977). "if the legislature had person who is hired to guide a hospital in making a credentialing decision is not protected not contain a cover sheet or cover letter to a staff member of nermc with review of dr. bailey's cases was not, therefore, to credential dr. bailey but to solve a 852, 855 (mo. banc 1986) (citing state ex rel. morasch v. kimberlin, 654 s.w.2d 889 instead, dr. flood's report reflects the knowledge and/or opinions held by an outside the credentialing decision involving dr. bailey, the report must be viewed as a peer id. (emphasis added). the court made its writ of prohibition absolute "insofar as it at our request, the forty pages of documents ordered produced, and thus at issue in v. which absolute irreparable harm may come to a litigant if some spirit of already occurred. the proverbial bell has already been rung. faith hosp., 706 s.w.2d at within the exemption from discovery created by the general assembly in section about seven of the twenty dr. bailey patient charts he reviewed. during oral argument, nermc argues that the minutes concern the health care provided a patient. based deliberations." 706 s.w.2d at 855. we thus conclude that a report prepared by a third already been produced, we must nonetheless determine whether dr. bailey's letter is opinion filed: november 9, 2010 honorable ralph h. jaynes, 000043 acknowledge receipt of dr. flood's report, express reactions to the report without should be protected from discovery on the basis of the attorney/client privilege is beyond of prohibition is dissolved as to the documents bates stamped 000035 through 000042. documents in camera, that fact would not have been known to us. passage appears intended to describe the "exceptions" referred to by the phrase "except as report does not fall into the plain and ordinary meaning of any of these categories. disclose any information acquired in connection with or in the course of health care provided any patient is noted, but the significance of the omission is not addressed in this opinion. protected by hippa. the special discovery master specifically found that the within his personal knowledge and in accordance with the other provisions ) the court held: not include reports reviewed by the committee. . . . flood testified in his deposition that there would have been a final page to his report beyond the seven pages marked resolved. he proposed submitting dr. bailey's first twenty-five spinal instrumentation 7 and similarly his review also does not contain a signature page from john policy of kansas. by enacting kan.stat.ann. section 65-4915, the kansas minutes from production based on the attorney/client privilege. whether the minutes flood, d.o. the special discovery master's report was adopted by the trial court by docket i realize that this would be an extensive process but it seems one fair way 1990). the kansas peer review statute is similar to missouri's with respect to the redacted. though prohibition will not lie to protect a document from production that has ) addressing performance of a physician with respect to other patients could not be already been extended to dr. bailey notwithstanding evidence that he had failed to the minutes do not specifically discuss the health care provided any patient. the need not address, therefore, whether dr. bailey's letter "specifically concern[s] the health documents. minutes bates numbered 000065 similarly discuss follow up means of evaluating dr. as that phrase is used in section 537.035.4. original proceeding in prohibition expressly so said. it did not." trinity med. ctr., inc. v. holum, 544 n.w.2d 148, 157 that dr. bailey had been granted temporary privileges before this issue had been 3 prohibition is necessary to prevent nermc from the irreparable harm of its disclosure. health care provided a patient." faith hosp., 706 s.w.2d at 855 (emphasis added). otherwise provided in this section" prefacing the first and second sentences of section bailey's prior surgeries and thus "concern the health care provided to any patient." within their personal knowledge, though they cannot testify about the proceedings of a administrative action for failure to provide appropriate care. except as first sentence of section 537.035.4 protects "interviews, memoranda, proceedings, therefore, is not immune from discovery pursuant to the second sentence of section surgeries. the watsons learned of dr. flood's report and took dr. flood's deposition on entry dated may 26, 2010. the watsons filed a motion for sanctions on june 25, 2010, s.w.2d at 855. thus, prohibition will not lie unless absolute irreparable harm that cannot in the health care provided any patient any peer review committee proceeding shall be permitted or required to meaning.'" state ex rel. tennill v. roper, 965 s.w.2d 945, 948 (mo. app. w.d. 1998) (mo. banc 1983)). however, we have observed that: been diligent in trying to protect the rights of the patients as well as the "attorney/client privilege" with respect to these two documents. however, that privilege awarding of staff privileges. it likewise says nothing about protecting merely because it was commissioned and reviewed by nermc's executive committee. watsons' possession. consistent with this fact, these seven pages were not the subject of care provided any patient." id. credentials committee findings and person is not a peer review committee report under section 537.035.4 merely because the dr. bailey's first spine instrumentation surgeries originated, dr. browning states: ordered produced should be redacted to remove any patient identifying information committee. we must determine, therefore, whether dr. flood's report is a "peer review response to dr. flood's report; and (3) minutes from executive committee peer review belton hospital, 278 s.w.3d 201 (mo. app. w.d. 2008). we do not agree. leblanc concluded that section 2010. the contested documents fall into three categories: (1) dr. flood's report 1 cannot be characterized as a "peer review committee" report. documents ordered produced were not protected as peer review pursuant to section they did not already have in their possession. john flood, an independent spine surgeon practicing in michigan, for this purpose. dr. in the report out of an abundance of caution. we need not, therefore, address nermc's not to be construed as immune from discovery or use in any proceeding flood prepared a written report, which he submitted to nermc. nermc contends the his recommendation concerning the granting of privileges to dr. bailey, as exhibits. and denied in part. dr. flood's second deposition was conducted on september 18, 2009, flood's report is privileged by virtue of either the first or second sentence of section the record does not indicate how the watsons learned about dr. flood's review of dr. bailey's cases. subpoena, or other means of legal compulsion for their release to any numbers nermc/pr 000001 through 0000066 which the watsons alleged involved dr. given this construction, we need not address the application of the "exceptions" deliberations are not exempt from discovery, therefore, unless they 11 flood's recommendations to nermc concerning dr. bailey's credentialing and his (i) is dr. flood's report a "peer review committee report" concerning the with a special discovery master, john hutcherson, in attendance. upon, peer review committee proceedings, did not prevent recognition of the cause of action of negligent faith hospital did not address this question. state ex rel. richardson v. randall, 660 s.w.2d 699, 701 (mo. banc 1983). "the basis conclusion section is limited to those findings and deliberations "concerning the health other health care providers, whether proper or improper, shall not waive or bell has been rung, its sound can neither be recalled nor subsequently silenced." 706 dr. bailey submitted an application for surgical privileges in back surgery to knowledge and ability to perform complicated spine surgery. visiting judge, circuit court we do observe that nermc's privilege log asserts the additional privilege of relates to the proceedings, findings, deliberations, reports and minutes of peer review we are not inappropriately revealing information based on an in camera review by this disclosure, as dr. section 537.035.4 provides: included within the special discovery master's peer review statute. phrase was intended by the legislature in section 537.035.4. "when construing a statute, reference to any particular patient, and address the best means of responding to the report. course of his attendance at a peer review committee proceeding. our detailed and independent review of the materials submitted by the parties in nermc's executive committee, it was not prepared by the executive committee. we the remedy to be applied. browning's letter, nermc apparently envisioned the ability to use the outside report to findings, deliberations, reports, [or] minutes of peer review committees." dr. flood's 6 proceedings, findings, deliberations, reports, and minutes of peer review ) nermc's petition for writ of prohibition and its brief in this original proceeding peer review process. finally, nermc argues that dr. flood is not an "original source" 17 had it intended to do otherwise, the legislature could have used language id. at 550-51 (emphasis added). we are persuaded by this analysis, particularly as it is in ) claim that nermc was negligent in granting dr. bailey staff privileges to perform spine the court's interpretation of the peer review statute is in line with the public privileged peer review under section 537.035.4, the "harm" of their production has all statutory references are to rsmo 2000, as supplemented, except as otherwise noted. be adequately remedied on appeal has been established. the burden is on nermc to (bates numbers 000008 through 000014; 000020 through 000026; 000028 through


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