WPC/! / ANuɍr}Q=E;Ǔd~AN,ԲC9Fb2voRIa,*CPڜm*yeetM;oX)d$kȳ 6a{Z3U{8ʧJqD=@Cv;bdfH_XghI$W5xh^Bk$/ͽ[[0*U&y.M/sE(wXlWjW#UN % 0(   0l ^  w# 4' ; J mL Nc UNe 1 72: 1ul 72 0c 0Dv  lg lUL??AM*z? 0wyp`zB 0 1> 1 1X 1 1r 1 1pyl n n n n n n n n n n n n n n n n n n n n n n n n n B!\\CDFCOMPUTER\HP LaserJet 1100 (MS),,,,0(hH  Z6Times New Roman RegularX($  $    18    _ԀRaikes,984S.W.2dat469(internalcitationsomitted).((3$ !      0  K4 [4CabCAB3|xU(9 Z6Times New Roman Regular OACEKQY_ekqAutoList1i.i.(1)i.i.i.i.i.i.3#37=CIQYag1.a.i.(1)(a)(i)1)a)i)(;3$2#  0  .3  0  (#$  0   $    22    _ԀSee_Shobe_Ԁv._EPI_ԀCorp.,Ky.,815S.W.2d395(1991).  $    1    _ԀAccreditationSurveyattachedasExhibit1. $    2    _ԀSentinelEventPolicyandProceduresattachedasExhibit2. b $    3    _ԀSeeExhibit1. ] $    4    _ԀId. b $    5    _ԀSeeExhibit2.*@FAZ4FrnkGothITC Bk BT Book $    6    _ԀNortonResponsetoRequestforAdmissionsNos.18,19,20.NortonsComplete  DiscoveryResponses,includingthese,areattachedasExhibit3. $    7    _ԀSeeNortonResponsetoRequestforProductionNos.__,__,__. C $    8    _ԀSeee.g._Meenach_Ԁv.GeneralMotors,Ky.,891S.W.2d398(1995);_Futrell_Ԁv._Shadoan_,  Ky.,828S.W.2d649(1992). $    9    _ԀSeee.g._Futrell_. p $    10    _ԀKy.,503S.W.2d177(1973). $    11    _ԀId.____Ԁ $    12    _ԀId.at_178._(O;$0  2#  a  .3  0` (#(# f $    13    _ԀId.at177. $    14    _ԀSeeNazareth,503S.W.2dat178. $    16    _ԀId.at178;citingTerrellv.WesternCasualty&SuretyCo.,Ky.,427S.W.2d825  (1968). p $    17    _ԀKy.,984S.W.2d464(1998). $    21    _Ԁ_TARC_Ԁv.Vinson,_Ky.App_.,703S.W.2d482(1984). $    23    _Ԁ904F.Supp.592(_W.D.Ky_.1995).(b$0  0` (#(#2#   .3  0 ` (#` (#(CEMU]emu}AutoList2(1)(1)(1)(1)(1)(1)(1)(1)(CEMU]emu}AutoList3(1)(1)(1)(1)(1)(1)(1)(1)(CEMU]emu}AutoList4(1)(1)(1)(1)(1)(1)(1)(1)(CEMU]emu}AutoList5(1)(1)(1)(1)(1)(1)(1)(1)(CEMU]emu}AutoList6(1)(1)(1)(1)(1)(1)(1)(1)(CEMU]emu}AutoList7(1)(1)(1)(1)(1)(1)(1)(1)(CEMU]emu}AutoList8(1)(1)(1)(1)(1)(1)(1)(1) f $    15    _ԀId.at179. o $    20    _ԀKy.,15S.W.3d724(2000). b $    19    _ԀSeeid. $    24    _ԀSee_Futrell_,828S.W.2dat651. d !  _XXXXNO.00CI074564(#JEFFERSONCIRCUITCOURT  ;(#DIVISIONTWO(2)  ЀLYNNNGUYEN,byandthroughherA(#PLAINTIFFS L  guardianRobertLe,KIMBERLYROSELE, 8  byandthroughherfatherRobertLe, $ t andROBERTLE,Individually  `  (OA 3! !v.@  MEMORANDUMINSUPPORT@@bb)OF $  @V V MOTIONTOCOMPELDISCOVERY    NORTONHOSPITALS,INC.,  A(#DEFENDANTS   KENNETH_ZEGART_,M.D., t SHARON_EHRINGER_,M.D. ` andDONMILLER,_C.R.N.A._ L  @BB"GGGGGGGGG $t  @"FACTSOFTHECASE  8   OnJanuary12,2000,at2:27A.M.,LynnNguyen,a26yearoldwoman,wasadmittedto  NortonHospital( Norton)inpretermlaborwithherfirstchild.Uponadmission,and  continuouslyoverthenextseveralhours,Lynnexhibitedclearsignsofpulmonaryedema,alife p threateningconditionifleftuntreated.Despitethesesigns,themedicalpersonnelresponsiblefor H! Lynnsmedicalcarefailedtointervene.ThisinactionallowedLynnsconditiontodeteriorate.  #p! At8:00A.M.,barelyoveranhourafterdeliveringherdaughter,KimberlyRoseLe,Lynn $H # sufferedcardiacarrest.Althoughanemergency CodeBlueteamwasabletorestoreLynns & "% heartbeat,shehadsufferedirreversiblebraindamage.Thisdamagewassoseverethatitresulted (#' inapermanentcoma,otherwiseknownasa persistentvegetativestate.Lynnremains *%) hospitalizedtoday,andhasnohopeofrecovery.Sheisphysicallystableand,accordingtoher X,'+ attendingphysician,hasanormallifeexpectancyifgivenadequatecare.    Norton,likeallhospitalseligibleforfederalfunding,isaccreditedbytheJoint  CommissiononAccreditationofHealthcareOrganizations(the JCAHO).Aspartofits ` accreditationsurvey,theJCAHOreviewsitsmembersprocessesforidentifying,reportingand 8  respondingto sentineleventssuchastheeventinwhichLynnwasinjured. #  1      ׀Thepurposeof  ` theseguidelinesistoimprovepatientoutcomes.  8    In1996,theJCAHOpromulgated SentinelEventPolicyandProcedures.Theystatein   part:    I.SentinelEvents  p Insupportofitsmissiontoimprovethequalityofhealthcareprovidedtothe \ public,theJointCommissionincludesthereviewoforganizationsactivitiesin H responsetosentineleventsinitsaccreditationprocess... 4 0 ` uAsentineleventisanunexpectedoccurrenceinvolvingdeathorserious  \ physicalorpsychologicalinjury,ortheriskthereof.Seriousinjuryorloss H oflimborfunction.4` `  0 ` uSucheventsarecalled sentinelbecausetheysignaltheneedfor   immediateinvestigationandresponse ` `   II.GoalsofthePolicy    Thegoalsofthepolicyarefourfold: l ` uTohaveapositiveimpactinimprovingpatientcare. X  uTofocustheattentionofanorganizationthathasexperienceda D! sentineleventonunderstandingthecausesthatunderlietheevent,andon 0"  makingchangesintheorganizationssystemsandprocessestoreducethe #l! probabilityofsuchaneventinthefuture. $X" uToincreasethegeneralknowledgeaboutsentinelevents,theircauses, $D # andstrategiesforprevention. %0!$ uTomaintaintheconfidenceofthepublicintheaccreditationprocess| #  2       &"% `  Aspartofthesentineleventpolicy,theJCAHOrequireshealthcareorganizationstoperforma )$(  rootcauseanalysiswhenasentineleventoccurs,andtouse theinformationfromthedata  analysistoidentifychangesthatwillimproveperformanceorreducetheriskofsentinelevents. #  3      ׀  ЀTomaintainJCAHOaccreditation,healthcareorganizationsmustalso ensurethattheprocesses ` foridentifyingandmanagingsentineleventsaredefinedandimplemented.| #  4       8  Ѐ  NortonHealthcarehascompliedwiththeJCAHOmandate,andhasestablished Sentinel  ` Event/CriticalIncidentProcessforInvestigationaspartofitsCorporateCompliance&Policy  8  Manual.0 #  5      ׀Inthisdocument,Nortonstates:    Thecriticalincidentiscalled sentinelbecauseitsendsasignalorsoundsa   warningthatrequiresimmediateattentionandaction. Thegoalofthisprocessis   tohaveapositiveimpactinimprovingcare,maintainingasafeenvironment p andinfocusingattentiononunderlyingcausestopromoteriskreduction.  X  `     h      p (Emphasisadded) @ QAspartofthisprocess,NortonHospitalemployeesaredirectedtocompletean Occurrence h Report.Ӏ1NortonHospitalhasadmittedthatitidentifiedLynnNguyensoutcomeasasentinel @ event,andthatitengagedin sentineleventconferences, rootcauseanalysesand peer  review. #  6          Throughproperdiscoveryrequests,PlaintiffhasspecificallyrequestedthatNorton x producethefindingsofthesevarious_inquiries._ԀNortonhasobjected,andhasrefusedtoproduce P   thesedocuments.Insupportofitsobjection,Nortoncitesgroundsofpeerreviewprivilege, ("x  attorneyclientprivilege,andattorneyworkproductimmunity. #  7      ׀Asdiscussedbelow,noneof   thesearepropergroundsforinsulatingtherequesteddocumentsfromdiscovery.Plaintiff  thereforerequests,inaccordancewithanextensivebodyofKentuckylaw,thatthedocumentsbe ` helddiscoverable,andthatthisCourtordertheirproduction. 8    @& ARGUMENT   L      A.TheDocumentsAreRelevant      AccordingtoCR26.02(1), Partiesmayobtaindiscoveryregardinganymatter,not   privileged,whichisrelevanttothesubjectmatterinvolvedinthependingaction. Ifthese p variouslydescribedinvestigationscompliedwiththeJCAHOmandates,thentheyinvolvedan P intensivereviewbymedicalprofessionalstotrytodeterminewhatwentwronginLynnscase, (x andhowitcouldbeprevented.Thesearethecorequestionstobeansweredinthislitigation. P   Nortondoesnotdisputethatthesedocumentsarerelevant.Instead,itseekstoasserta ( privilegethatwouldshieldthemfromdiscovery.Privileges,underCR26.02,aretobeconstrued  narrowly._ | #  8      _ԀThebasicpremisethatlitigationisasearchforthetruthyieldsonlyinthefaceof  overwhelmingpolicyconsiderationstothecontrary._! #  9      _ԀThequestionbeforethiscourtiswhether `  anyprivilegeexiststhatrisestothislevel.Nortonsprimaryassertionofpeerreviewprivilegeis 8"  contrarytoKentuckylaw,asdiscussedbelow. $`"    B.NortonsSentinelEventConferenceandRootCauseAnalysisArePeerReviews %8!$ _  Priortodiscussingtheextensivehistoryofa peerreviewprivilegeinKentucky , itis  importanttoestablishthattheactivitiesvariouslylabeledas rootcauseanalysis, sentinelevent  conferenceand peerreviewareinterchangeable.NotwithstandingNortonsargumentstothe h contrary,whatitengagedinherewasapeerreview. @    NortonsResponsestoInterrogatoriesrevealthatitwishestodistinguishitsinvestigation  h frompeerreview.Thereisanobviouslegalbenefittothiswordmincing,sincepeerreview  @  documentshavealwaysbeendiscoverableinmedicalmalpracticeactions.Nortonclearlyhopes   thatitcan_recharacterize_Ԁitsactivitiesunderadifferentrubric,andtherebynavigatearoundthe   longprecedentofcasescompellingittoproducethesedocuments.DespiteNortonsefforts, x though,itsowndiscoveryResponsesrevealitspositiontobeuntenable: P  0  INTERROGATORYNO.11: DidNortonHospitalinitiate,undertake,orotherwise (x participateinanyofthefollowingactivitieswithregardtoorinanywayrelatedtoLynn h NguyenshospitalizationatNortonHospital:T(#(#   0 `  a)sentineleventconference(orsimilaractivity);@` (#` (#   0 `  b)rootcauseanalysis(orsimilaractivity);,` (#` (#   0 `  c)peerreview(orsimilaractivity);` (#` (#   0 `  d)voluntarilyreporttotheJCAHO?` (#` (# 0   ANSWER: 0 (#(#a)Yes;0h (# (#h(#h(#   0 `  b)Yes;` (#` (#   0 `   c)No,butseeresponsetoa)andb)above; |` (#` (#   0 `  d)No.d ` (#` (# +   `     h     (Emphasisadded) P! ThisAnswerambiguouslydeniesthatapeerreviewtookplace,butinessenceadmitsthatthe (#x! sentineleventconferenceandrootcauseanalysisarefunctionallyidentical.NortonsResponses %P # toRequestsforAdmissionareinconsistentwiththeambiguousdenialabove,andbetraythe &("% absurdityofNortonsposition: ($'  REQUESTFORADMISSIONNO.20: NortonHospitalinitiatedorhas *%) otherwiseengagedina peerreviewregardingthefactsandcircumstances x+&* surroundingLynnNguyensoutcomeand/orthecareshereceived. d,'+ 0 ` Response: AdmitP-(,` `  2Asthetritewaterfowlbasedadagegoes,Nortonknowsthatboththesentinelevent  conferenceandrootcauseanalysislooklikeandquacklikepeerreview.And,inits  weakermoments,Nortonevenconcedesthattheyarepeerreview. `    C.PeerReviewDocumentsareDiscoverable 8    Kentuckyhasalonghistoryofcasesonthe_discoverability_Ԁofpeerreviewrecords.  ` Thesecasesconstruebothcommonlawand,sincethepassageofKRS311.377in1977,  8  thatstatute.Universally,thesecasesholdthatpeerreviewdocumentsarediscoverablein   medicalmalpracticesuits.      Kentuckyshighestcourtfirstanalyzedthisissueinthe1973caseofNazareth p LiteraryandBenevolentInstitutionv.Stephenson._" #  10      _ԀInthatcase,aphysicianwith H temporarystaffprivilegesatSS.MaryandElizabethHospitalwassuedfornegligencein  p conjunctionwithaseriousinjurytoapatient._#| #  11      _ԀThehospitalultimatelydeniedthe H physicianprivileges,afteraninternalreviewandhearing._$0 #  12      _ԀPlaintiffsoughtdiscoveryof    writtenstatementsreceivedbythehospitalfromphysicianmembersofitsstaffinwhich  reports[_we]re_Ԁmadeabouttheprofessionalactivitiesofoneofthedefendant  physicians._& #  13      _ԀThehospitalrefusedtoproducethestatements.AfterJudgeStephenson X  orderedthestatementsproduced,andthreatenedtostriketheHospitalsanswerifitfailed 0"  toproducethem,theHospitalappliedforawritofprohibition. $X"   TheCourtofAppealsweighedtwoargumentsadvancedbytheHospital.Thefirst %0!$ attemptedtoanalogizethereportsofthehospitalsinternalinvestigationtoattorneywork  product,andtoimmunizethemfromproductiononthatground.Thesecondwaswhat  hasnowbecomethestandard peerreviewpositiontakenbyhospitals.Thisargument ` beginswiththedecidedlyuncontroversialpropositionthathospitalsshouldbeencouraged 8  todiscusstheirfailuresfrankly,andtotakeremedialmeasureswhendoingsoadvances  ` publichealth._' #  14      _ԀThesecondprongoftheargumentisactuallycomprisedoftwoseparate,  8  butrelated,propositions.Thefirstpropositionisthatifahospitalsinternal   communicationscanbediscovered,thiswillhaveachillingeffectontheabilityor   willingnessofpersonnelengagedinthepeerreviewtospeakfrankly.Thesecondelement p isthatthischillingeffectoutweighsthebeneficialeffectthatbroaddiscoveryhason H seekingthetruth.  p   TheNazarethCourtrejectedtheHospitals chillingeffectargument,holding: H 0  [_T]his_Ԁmightberegardedasaninitiallyappealingargument,onreflection,one   mightwelldebatewherethepublicinterestlies.Claimsofprivilegearecarefully   scrutinized,andimpedimentstothediscoveryoftruthareaffordedvalidityin  relativelyfewinstancesinthecommonlaw.Inanyevent,wefindnoapplicable  privilegeexpressedineitherthegenerallawofevidenceexistinginthisstateorin  thestatutesofthisstateexpressinganyprotectionofconfidentialityinthe l situation_presented.8| #  15      _X    TheCourtalsosummarilydismissedthehospitalscontentionthatthenotesconstituted 0"  attorneyworkproduct: $X" 0  Inthefirstplace,thesereportswerenotpartofalawyersfiledevelopedin %0!$ anticipationoflitigation.Inthesecondplace,ifweindulgedthehospitals &"% argumenttotheextentofwrappinganauraofjudicialprotectionaroundits '#& internallyoperatedhearingprocedures,wewouldstillbefacedwiththe (#' recognizedrulethatdocumentspreparedinpreparationofonecasearenot )$( protectedfromdiscoveryinalatercasewheretheymayberelevanttotheissues  involved.( #  16         Thisjustificationfornonproductionofpeerreviewfileswillbediscussedatgreater t lengthbelow,inthesectionrelatingtoworkproductandattorneyclientprivilege. L    In1978,fiveyearsaftertheNazarethdecision,thelandscapeofthisdispute $ t changedsomewhat,withthelegislaturesenactmentofKRS311.377.Thisstatutestates  L  inpertinent_part:_ $    (1)0 ` Anypersonwhoappliesfor,orisgrantedstaffprivilegesafterJune17,   1978,byanyhealthservicesorganizationsubjecttolicensingunderthe   certificateofneedand_licensure_ԀprovisionsofKRSChapter216B,shallbe   deemedtohavewaivedasaconditionofsuchapplicationorgrant,any p claimfordamagesforanygoodfaithactiontakenbyanypersonwhoisa \ member,participateinoremployeeoforwhofurnishesinformation, H professionalcounsel,orservicestoanycommittee,board,commissionor 4 otherentitywhichisdulyconstitutedbyanylicensedhospital,licensed  p hospice,licensedhomehealthagency,healthinsurer,healthmaintenance  \ organization,healthservicescorporation,organizedmedicalstaff,medical H society,orassociationaffiliatedwiththeAmericanMedicalAssociation, 4 AmericanPodiatryAssociation,AmericanDentalAssociation,American   OsteopathicAssociation,ortheAmericanHospitalAssociation,ora   medicalcarefoundationaffiliatedwithsuchamedicalsocietyor  association,orgovernmentalor_quasigovernmental_Ԁagencywhensuch  entityisperformingthedesignatedfunctionofreviewofcredentialsor  retrospectivereviewandevaluationofthecompetencyofprofessionalacts l orconductofotherhealthcarepersonnel.Thissubsectionshallhave X  equalapplicationto,andthewaiverbeeffectivefor,thosepersonwho, D! subsequenttoJune17,1978,continuetoexercisestaffprivileges 0"  previouslygrantedbyanysuchhealthservicesorganization.#l!` `  8  (2)0` xxAtalltimesinperformingadesignatedprofessionalreview $D # function,theproceedings,records,opinions,conclusions,and %0!$ recommendationsofanycommittee,board,commission,medical &"% staff,professionalstandardsrevieworganization,orotherentity,as '#& referredtoinsubsection(1)ofthissectionshallbeconfidentialand (#' privilegedandshallnotbesubjecttodiscovery,subpoena,or )$( introductionintoevidence,inanycivilactioninanycourtorinany |*%) administrativeproceedingbeforeanyboard,body,orcommittee,  whetherfederal,state,county,orcity,exceptasspecifically  providedwithregardtotheboardinKRS311.605(2).This  subsectionshallnotapplytoanyproceedingsormattersgoverned t exclusivelybyfederallaworfederalregulation.`` x` x Sincetheenactmentofthisstatute,hospitalshaveattemptedtosuppresspeerreview 8  materialsbyreferencetosubsection(2)ofthestatute,andhavearguedthatthis  ` subsectionprovidesthestatutoryauthoritythattheNazarethCourtnotedtobeabsent.  8  The1998KentuckySupremeCourtdecisioninSistersofCharityHealthSystems,Inc.v.   Raikesflatlyrejectstheargumentthatpeerreviewrecordsareinsulatedfromdiscoveryin   medicalnegligencesuits,andreaffirmsthattheNazarethholdingandrationaleremain p goodlaw.) #  17       H    TheRaikescourtbeginsitsanalysisbyenunciatingthegeneralstandardsofaRule  p 26analysis: H 0  thenearlyuniversalrule[is]thatprivilegesshouldbestrictlyconstrued,because   theycontravenetheprinciplethat thepublic...hasarighttoeverymans   evidence.Or,aswehavestatedrecently, broadclaimsofprivilegeare  disfavoredwhenbalancedagainsttheneedforlitigantstohaveaccesstorelevant  ormaterialevidence.Thus,claimsofprivilegearecarefullyscrutinized.  Moreover,theburdenofprovingthataprivilegeappliesrestswiththeparty l claimingitsbenefit.| #  18      X    TheCourtthenengagesinaclosereadingofthestatutorylanguage,concludingthatthe 0"  overridingpurposeofSubsection(1)ofKRS311.377istoprotecthospitalsand $X" physicianswhoparticipateinpeerreviewfromanyliabilitythatmightarisefromthe %0!$ honest,goodfaithperformanceofthatduties.Applyingtraditionalprinciplesofstatutory '#& construction,theCourtholdsthatSubsection(2)shouldnotbeconstruedanymore )$( broadlythanSubsection(1),andthatsincethefirstrelatedtopotentialclaimsby  physiciansagainstpeerreviewentities,thesecondshouldalso.Becausetheplaintiffina  medicalmalpracticesuitisnotaffectedinanywaybytheprohibitiononaphysician ` suingapeerreviewentity,themalpracticeplaintiffisalsonotsubjecttothelimitationof 8  rightsonwhichthehospitalrelies.< #  19        `   TherecentcaseofMcFallv.Peace,Inc.;| #  20      ׀clarifiesthattheRaikesholdingisnot  8  limitedtophysiciancredentialingmatters,andcanindeedbeextendedtoencompassself   criticalanalyses.McFallinvolvedanallegationthatOurLadyofPeace( _OLOP_)and   oneofitsphysicianshadimproperlysupervisedapatient,whohadcommittedsuicide p shortlyafterheradmission.AfterMs.McFallsdeath,thefacility,aspartofitsstandard H procedure,completedaQualityAssuranceForm.TheCourtdescribedthisformas a  p routineformfilledoutby_OLOP_snursingcoordinatorwhoreviewedandcritiqued H _OLOP_sresponsetotheCode300reportedin[Plaintiffs]case...and,whenappropriate,   laterreviewedby_OLOP_ssafetycommitteeaspartofacomprehensivepeerreview  programtomonitorandimprovethequalityofpatientcare.    _OLOP_Ԁfailedtoproducethedocumentindiscovery,anddefendedthecase X  successfullyattrial.TheSupremeCourt,however,vacatedthejudgmentinfavorof 0"  _OLOP_,heldthat_OLOP_Ԁshouldhaveproducedthedocument,andremandedthecaseto $X" thetrialcourt.Thiscaseisimportantbecauseitemphasizesthatevenwhereapeer %0!$ reviewdocumentmaybeovertlycriticalofthefacilitysactionsorinactions,thisself '#& criticalcomponentwillnotjustifyinsulatingthedocumentfromdiscovery. )$(  D.WorkProductImmunityDoesNotAttachtoDocumentsthat  NortonGeneratesIntheOrdinaryCourseofBusiness     Inadditiontoallegingapeerreviewprivilege,Nortonrehashesthesameworkproduct ` assertionfoundinbothNazarethandRaikes.Forthereasonsnotedbythosecourts,and 8  reiteratedinnumerouscasessince,thisobjectionmustfail.  `   The workproductprivilegediscussedintheseminalcaseof_Hickman_Ԁv.Taylor,isnow  8  codifiedasFed.R.Civ.P.26(c).KentuckysfunctionallyidenticalruleisCR26.02(3)(a),which   shieldsfromdiscoverydocumentscontainingthe mentalimpressions,conclusions,opinions,   andlegaltheoriesofcounsel._* #  21      _Ԁ IfNortonwishestosuppresspeerreviewmaterialhere,itmust p showwherecounselsimpressionsoropinionsarecontainedinthepeerreviewdocuments.The H mostlogicalmeansbywhichtodothiswouldbetosubmitanprivilegelog,containing  p descriptionsofthedocumentsdetailedenoughfortheCourttoevaluatetheprivilegeclaim. H Alternatively,NortoncouldsubmitanyallegedlyprotecteddocumentstotheCourtforincamera   review._| #  22      _ԀInstead,Nortonhasbaldlyassertedaprivilege,andaccompaniedthatassertionwith  noevidentiarysupport.Thisgoesbeyondamerefailuretomakeaparticularizedandconcrete  showingofworkproduct,andsimplydismissestherequirementoutofhand. X    Basedontheirostensiblepurposes,sentineleventconferencesandrootcauseanalyses 0"  wouldnotseemtoqualifyforworkproductprivilege.Theconferencesandreportsarenot $X" createdtoassistNortoninlitigation,butinsteadtohelpitprovidebettercaretoitspatients.The %0!$ facilitycritiquesitsownqualityofcare,nottodefendlawsuits,buttoimproveoutcomes.One '#& wouldhopeandexpectthatneithercounsel,noranyoneelsewhoisnotahealthcareprofessional, )$( wouldplayasignificantroleinaccomplishingthisdecidedlyclinicalfunction.    Theonlylogicalpurposeforinvolvingcounselinpeerreviewisthepresentone!to  insulatetheresultingdocumentfromdiscovery.Courtshaveuniversallycondemnedthistypeof ` abuseoftheworkproductdoctrine. 8   E.0  Noattorneyclientprivilegeattachestosentineleventprocess.  `(#(#   Nortonalsocontendsthattheattorneyclientprivilegeprotectstheinformationsought.  8  Thiscontention,liketheworkproductassertiondiscussedabove,ispremisedonthenotionthat   Nortoncancallitsattorneysintoameeting,andbydoingsoshieldthesubstanceofthemeeting   fromdiscovery.Thisisrepugnantfromapublicpolicystandpoint,andbaselessasamatterof p evidencelaw. H   TheattorneyclientprivilegeiscodifiedasKentuckyRuleofEvidence503(b):  p 8  8`   Aclienthasaprivilegetorefusetodiscloseandtopreventany H otherpersonfromdisclosinga confidentialcommunicationmade 4 forthepurposeoffacilitatingtherenditionofprofessionallegal $ servicestotheclient:` x` x 8  8`   (1)0 ` x` xBetweentheclientorarepresentativeoftheclientandthe  clientslawyerorarepresentativeofthelawyer; x x 8  8`   (2)0 ` x` xBetweenthelawyerandarepresentativeofthelawyer;\  x x 8  8`   (3)0 ` x` xBytheclientorarepresentativeoftheclientortheclients 4"  lawyerorarepresentativeofthelawyerrepresenting  #p! anotherpartyinapendingactionandconcerningamatter  $\" ofcommoninteresttherein;$H # x x 8  8`   (4)0 ` x` xBetweenrepresentativesoftheclientorbetweentheclient & "% andarepresentativeoftheclient;or' #& x x 8  8`   (5)0 ` x` xAmonglawyersandtheirrepresentativesrepresentingthe )$( sameclient.*%) x x Theelementsnecessaryfortheinvocationoftheattorneyclientprivilegeweremostrecently X,'+ enumerated_______________________in_ԀU.S.ExRelBurnsv.A.D.RoeCo.,Inc.:     ` (1)0 Wherelegaladviceissought, (# (# ! ! -(8 "3"     ` 3b2(  2  )3  0   fromaprofessionallegaladvisorinhiscapacityassuch,3b݌` (# (# Ќ   .(88-"3"     ` 32(  3  )3  0   thecommunicationsrelatingtothatpurpose,3D݌8  (# (# Ќ   /(88."3"     ` 32(  4  )3  0   madeinconfidence,3ӆ݌ ` (# (# Ќ   0(88/"3"     ` 32(  5  )3  0   bytheclient,3I݌ 8  (# (# Ќ   1(880"3"     ` 3u2(  6  )3  0   areathisinstancepermanentlyprotected,3u݌  (# (# Ќ   2(881"3"     ` 32(  7  )3  0   fromdisclosurebyhimselforhislegaladvisor,3G݌  (# (# Ќ   3(882"3"     ` 32(  8  )3  0   excepttheprivilegebewaived.+ #  23      3ڌ݌p (# (# Ќ  Aswithotherprivileges,itisthepartyseekingtoassertattorneyclientprivilegewhobearsthe H burdenofprovingitsapplicability.Here,Nortonhasnotdischargedthisburden.  p   Nortoncannotprovethatitspeerreview,rootcauseanalysisorsentineleventconferences H involve confidentialcommunications,asthattermisdefinedin_KRE_Ԁ503(a)(5):   8  8`   Acommunicationis confidentialifnotintendedtobedisclosed  tothirdpersonsotherthanthosetowhomdisclosureismadein  furtheranceoftherenditionofprofessionallegalservicestothe  clientorthosereasonablynecessaryforthetransmissionofthe l communication.X ` x` x Communicationsmadeatsentineleventconferencesandduringrootcauseanalysisarecertainly 0"  notconductedforthepurposeof furtheringtherenditionofprofessionallegalservicestothe $X" client.AstheJCAHOGuidelinesmakeclear,sentineleventconferencesandrootcause %0!$ analysesareconductedtoimprovethequalityofhealthcarerenderedtothepublic. '#&   Furthermore,sentineleventconferencesandrootcauseanalysisaretypicallycalledand )$( attendedbymembersofthehospitalstaff,notbylawyers.Itappearsthatinthiscaselawyers h+&* attendedpeerreviewand/orsentineleventconferencesheldconcerningLynnstreatment.  However,communicationsattheseconferenceswouldhavetakenplaceinthepresenceofthird  personswhowerenotclientsofthoselawyers.Thesecommunicationswouldnotbeconfidential ` underthedefinitionaboveand,therefore,wouldnotfallundertheattorneyclientprivilege. 8    Lastly,evenifNortonhadgonetothelengthofdelegatingallpeerreviewdutiesto  ` employeesandinhousecounsel,thepeerreviewwouldstillnotbeprivileged,asthemeeting  8  wasnotconvenedforthepurposeofseekinglegaladvice.= #  24      ׀Acorporationcannotestablish   privilegebybringinganattorneyintoanonlegalsetting,anymorethanitcanmakeanotherwise   discoverabledocumentprivilegedbyroutingitthroughitsattorneys.Aseeminglyendlesslineof p  maildropcasesshowsthatthereisnothingnovelinmanipulatingprivilegesinanattemptto H shielddocumentsfromdiscovery.Universally,though,courtshavesealedoffthesecreative  p attemptstoescapediscoveryrules.. H @$$%Conclusion     DuringLynnNguyenscourseofcareatNortonsomething,orsomeconstellationof  things,wenttragicallywrong.Thisfactmaybetooobvioustorestate,anditiscertainlyagross  understatement.Nevertheless,thislitigationis,andshouldbe,aquesttofindoutwhatwent X  wrong. 0"    Nortonandotherhospitalsarecompelled,bothbytheiraccreditingagenciesandbytheir $X" owninternaloperationspolicies,toconveneagroupofmedicalprofessionalstoinquireinto %0!$ eventslikethisone,withaneyetowardimprovingthecaretheycanprovide.Nortonhasdone '#& this.TheresultsofNortonsinquirymayhaveaneffectontheprogressoroutcomeofthis )$( litigation.ThetacticaladvantageNortongainsbysuppressingitsfindingsisoutweighed h+&* actuallyoverwhelmedbythepolicyofbroaddiscoveryembodiedintheRulesofCivil  Procedure.AsignificantlineofKentuckycasesaddressesthisverydispute;ineverysuchcase,  peerreviewdocumentshavebeenhelddiscoverable.Forthisreason,asdiscussedmorefully ` above,PlaintiffsubmitsthatsheisentitledtotheentryoftheattachedOrder. 8  XLXXX  #XXXXL#Respectfullysubmitted,   _________________________ (x CarlD.Frederick d StevenM.Frederick P _SEILLER_ԀWATERMAN,LLC < 462S4thStreet.,#2200 ( Louisville,KY40202  (502)5847400XLXXX@9#XXXXLX#Ԉ  (X(#(#(