6 N.Y.3d 434 (2006)
Federal law protects nursing home records created or generated for quality assurance purposes from disclosure in response to subpoenas issued by a grand jury conducting a Medicaid fraud investigation, but this protection does not extend to records maintained to comply with other state or federal regulations.
Summary
The New York Attorney General’s Medicaid Fraud Control Unit (MFCU) issued subpoenas to nursing homes as part of a resident care investigation. The Park Associates, a consultant for the homes, moved to quash the subpoenas, arguing that certain records were privileged under federal law (the Federal Nursing Home Reform Act). The dispute centered on whether certain reports (incident, skin condition, weight, infection control) were protected as quality assurance committee work product. The court held that records specifically created for quality assurance are protected, but routine records maintained to comply with state or federal regulations are not, even if reviewed by the quality assurance committee. This promotes candid self-review without hindering regulatory oversight.
Facts
The Medicaid Fraud Control Unit (MFCU) of the Attorney General’s office initiated an investigation into resident care at three nursing home facilities. As part of the investigation, an Erie County grand jury issued subpoenas seeking 59 categories of documents and reports. The Park Associates, Inc., a consultant for the facilities, moved to quash portions of the subpoenas, arguing that certain records were protected under New York State Public Health Law and the Federal Nursing Home Reform Act. The contested documents included incident/accident reports, monthly skin condition and pressure sore reports, monthly weight reports, infection control reports, and lists of facility-acquired infections.
Procedural History
The Supreme Court denied the motion to quash, finding the records were maintained per state regulations, not solely for quality assurance. The Appellate Division affirmed, rejecting the Public Health Law privilege claim and concluding the records weren’t within the scope of the federal quality assurance committee privilege. The New York Court of Appeals granted leave to appeal.
Issue(s)
Whether federal law (42 USC § 1396r(b)(1)(B)(ii)) protects from disclosure nursing home records, specifically incident/accident reports, monthly skin condition and pressure sore reports, monthly weight reports, infection control reports, and lists of any facility-acquired infections, subpoenaed by a grand jury conducting a Medicaid fraud investigation, when the nursing homes argue that these records were generated by the facilities’ quality assurance committees.
Holding
1. No, because where facilities are compelled by a statutory or regulatory dictate to maintain a particular record or report that is not expressly related to quality assurance, the fact that a quality assurance committee reviews such information for quality assurance purposes does not change the essential purpose of the document.
2. Yes, because compilations, studies or comparisons of clinical data derived from multiple records, created by or at the request of committee personnel for committee use, are “records of such committee” and are entitled to protection from disclosure pursuant to federal law.
Court’s Reasoning
The Court reasoned that the Federal Nursing Home Reform Act (FNHRA) aims to improve nursing home care quality. It mandates quality assessment and assurance committees (42 USC § 1396r(b)(1)(B)), and a 1990 amendment protects the “records of such committee” from disclosure (42 USC § 1396r(b)(1)(B)(ii)). The Court distinguished between records maintained to comply with regulations and those generated specifically for quality assurance. Following this logic, incident/accident and infection control reports are required by regulations (42 CFR 483.65(a)(3); 10 NYCRR 415.30(f)) and must be disclosed, even if reviewed by the committee. The Court distinguished this from the State Education Law privilege which attaches to the proceedings and work product of hospital quality assurance committees which “ ‘enhance the objectivity of the review process’ ” and ensure that the committees “ ‘may frankly and objectively analyze the quality of health services rendered’ ” (Logue v Velez, 92 NY2d 13, 17 [1998]). However, monthly skin condition, weight reports, and lists of facility-acquired infections, not being mandated by other regulations and created for quality assurance, are protected.
The Court declined to adopt the narrow standard articulated by the Supreme Court of Missouri in State ex rel. Boone Retirement Ctr., Inc. v Hamilton, 946 SW2d 740 (Mo 1997) because the federal statute does not restrict quality assurance records to only those reports created by quality assurance committee members themselves. The Court defined “records of such committee” as including “any reports generated by or at the behest of a quality assurance committee for quality assurance purposes.” The Court emphasized that a privilege log should be compiled to specify the nature of the contents of the documents, who prepared the records and the basis for the claimed privilege.