Venosh v. Henzes – Aug. 2015 (Summary)

PEER REVIEW PRIVILEGE – HMOS

Venosh v. Henzes
No. 1393 MDA 2014 (Pa. Super. Ct. Aug. 7, 2015)

The Superior Court of Pennsylvania affirmed a lower court’s rejection of peer review privilege asserted by an independent practice type of health maintenance organization (“IPA-HMO”). The litigation arose out of complications a patient received after having knee surgery. The IPA-HMO withheld materials relating to a quality-of-care review that it conducted of the medical providers and the incident at issue. Under the Pennsylvania Peer Review Protection Act, peer review occurs only when one professional health care provider is evaluating another professional health care provider. Pennsylvania courts have previously determined that HMOs cannot assert peer review privilege because they are not considered professional health care providers. The court was not persuaded that a distinction should be made for IPA-HMOs because the entity does not provide health care services. Also, the fact that the IPA-HMO has a review committee made up of some medical professionals is not enough to afford it peer review privileges.