UPDATES & ANALYSIS

Iowa Supreme Court 2016-17 preview: Does confidentiality in a ‘morbidity and mortality’ report apply to a dislocated shoulder?

by Rox Laird | March 6, 2017

Dennis Willard was admitted to the University of Iowa Hospitals and Clinics for treatment of injuries suffered in a motorcycle accident. Among his injuries was a dislocated shoulder, but Willard alleges that was inflicted by hospital staff while he was sedated. Now he is asking the Iowa Supreme Court to rule that he should have access to hospital records that might support his malpractice lawsuit against the state.

Oral arguments in the case, Willard v. State of Iowa, are scheduled to be heard at 1 p.m. Tuesday.

The records in question consist of 20 pages – out of more than 5,500 pages produced by the state hospital – of what is called a Patient Safety Net (PSN) report. PSNs are internal reports prepared by hospital staff documenting events that occur in the course of treatment with the goal of avoiding mistakes and improving medical procedures.

The State maintains that these PSN reports are confidential under state law and are thus exempt from discovery in civil suits. Confidentiality is necessary, the State argues, so hospital employees are comfortable reporting incidents that might affect patient care procedures.

Willard’s appeal has drawn the attention of other Iowa hospitals and medical professionals: Amicus curiae briefs were submitted to the Court by the Iowa Hospital Association and by the American Medical Association and the Iowa Medical Society. Both friend-of-the-court briefs support the State’s position, arguing that medical errors are reduced by studying internal incident reports, and by assuring confidentiality hospital staff will be more forthcoming.

According to a brief filed on behalf of the state hospital by Attorney General Tom Miller, the Legislature specifically exempted internal information compiled by hospitals documenting “morbidity and mortality” (disease and death) experience.

“The clear legislative intent” in protecting morbidity and mortality information from disclosure, the State argues, “is to provide a confidential method of reporting incidents or concerns about the care and treatment of patients and to allow for critical self-analysis for improvement of the practice of medicine.”

Willard counters that Patient Safety Net reports should not be swept into the category of privileged morbidity and mortality information. By dictionary definition, the terms morbidity and mortality refer to disease and death whereas the incident in his case involves a shoulder injury, which is “indisputably non-life threatening.”

Moreover, the plaintiff argues, while state law exempts certain hospital reports from being introduced as evidence in civil litigation, they still may be disclosed in discovery proceedings provided they are not used in court. “This statute deals with admissibility, not discoverability,” Willard argues in a brief filed with the Court.

(Go to Cases in the Pipeline at On Brief to read the briefs filed in Willard v. State of Iowa.)

Tags: Iowa Supreme Court, Iowa Supreme Court 2016-17 Preview