## Facts

- Dr. Leasa Lowy was admitted as a patient to St. Joseph Hospital, operated by PeaceHealth, and suffered left-arm ulnar nerve damage allegedly caused by improper IV infusion.
- Lowy alleged permanent impairment and asserted the hospital had a systemic problem with IV-infusion injuries.
- Lowy claimed she previously saw a hospital computer list reflecting approximately 170 IV-injury incidents, with patient identifiers replaced by numbers.
- The list was generated through the hospital’s internal quality-improvement/peer-review process.
- In discovery, Lowy sought nine years of records for all hospital patients who suffered IV-infusion injuries to support a corporate negligence theory.
- PeaceHealth conceded the underlying patient medical records were discoverable but asserted it could not electronically identify the relevant patients from its general systems and that manual review was unduly burdensome.
- Lowy sought to require PeaceHealth to use its internal quality-improvement list to identify the relevant patient charts and then produce the nonprivileged medical records, without disclosing the list.

## Issues

1. Whether RCW 70.41.200 permits a hospital to refuse to produce discoverable, nonprivileged patient medical records on the ground that locating them would require consulting privileged quality-improvement/peer-review materials.
2. Whether the statute’s prohibition on “review” of quality-improvement materials bars a hospital’s internal consultation of its own peer-review database for the limited purpose of identifying nonprivileged records.

## Decision

- The Washington Supreme Court affirmed the Court of Appeals and reversed the trial court’s protective order.
- The court held that “review” under RCW 70.41.200 refers to external review, not a hospital’s internal consultation of its own quality-improvement materials.
- The court held the hospital may consult its privileged quality-improvement database to identify and produce separate, nonprivileged, discoverable patient medical records.
- The court remanded for further proceedings consistent with allowing discovery of the patient medical records located through internal consultation of the quality-improvement database.

## Legal Principles

- Statutory privileges restricting discovery are construed narrowly in light of Washington’s policy favoring open discovery.
- RCW 70.41.200 protects quality-improvement/peer-review materials from external review and disclosure, but does not bar internal consultation by the hospital.
- A party may be required to use privileged materials internally to locate and produce nonprivileged, discoverable information, so long as the privileged materials themselves are not disclosed.
- The quality-improvement privilege cannot be used as a practical barrier to discovery of otherwise discoverable medical records merely because a privileged database provides an efficient method of identifying them.

## Conclusion

The court held that RCW 70.41.200 does not prevent a hospital from internally consulting privileged quality-improvement information to identify and produce separate, nonprivileged patient records, because the statute bars external review and disclosure of peer-review materials rather than a hospital’s internal use of them to comply with discovery.


Lowy v. PeaceHealth, 280 P.3d 1078 (Wash. 2012)