Wisconsin Peer Review Statute

The information on this page was last updated by Horty, Springer & Mattern on June 30, 2022.

WISCONSIN

PEER REVIEW

Wis. Stat. Ann. §146.37 Health care services review; civil immunity.

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 (1g) Except as provided in §153.76 [relating to civil liability for violation of patient-identifiable data confidentiality], no person acting in good faith who participates in the review or evaluation of the services of health care providers or facilities or the charges for such services conducted in connection with any program organized and operated to help improve the quality of health care, to avoid improper utilization of the services of health care providers [See §146.81 below for definition*]  or facilities or to determine the reasonable charges for such services, or who participates in the obtaining of health care information under subch. I of ch. 153, is liable for any civil damages as a result of any act or omission by such person in the course of such review or evaluation. Acts and omissions to which this subsection applies include, but are not limited to, acts or omissions by peer review committees or hospital governing bodies in censuring, reprimanding, limiting or revoking hospital staff privileges or notifying the medical examining board or podiatry affiliated credentialing board under §50.36 or taking any other disciplinary action against a health care provider or facility and acts or omissions by a medical director in reviewing the performance of emergency medical services practitioners, as defined in §256.01(5) or ambulance service providers.

(1m) The good faith of any person specified in subs. (1g) and (3) shall be presumed in any civil action. Any person who asserts that such a person has not acted in good faith has the burden of proving that assertion by clear and convincing evidence.

(2) In determining whether a member of the reviewing or evaluating organization or the medical director has acted in good faith under sub. (1g), the court shall consider whether the member or medical director has sought to prevent the health care provider or facility and its counsel from examining the documents and records used in the review or evaluation, from presenting witnesses, establishing pertinent facts and circumstances, questioning or refuting testimony and evidence, confronting and cross-examining adverse witnesses or from receiving a copy of the final report or recommendation of the reviewing organization or medical director.

(3) This section applies to any person acting in good faith who participates in the review or evaluation of the services of a psychiatrist, or facilities or charges for services of a psychiatrist, conducted in connection with any organization, association or program organized or operated to help improve the quality of psychiatric services, avoid improper utilization of psychiatric services or determine reasonable charges for psychiatric services. This immunity includes, but is not limited to, acts such as censuring, reprimanding or taking other disciplinary action against a psychiatrist for unethical or improper conduct.

 

§146.38 Health care services review; confidentiality of information.

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(1m) No person who participates in the review or evaluation of the services of health care providers  [See §146.81 below for definition*]   or charges for such services may disclose an incident or occurrence report or any information acquired in connection with such review or evaluation except as provided in sub. (3) or (3m).

(2) All persons, organizations, or evaluators , whether from one or more entities, who review or evaluate the services of health care providers in order to help improve the quality of health care, to avoid improper utilization of the services of health care providers, or to determine the reasonable charges for such services shall keep a record of their investigations, inquiries, proceedings and conclusions. No such record may be released to any person under §804.10(4) or otherwise except as provided in sub. (3) or (3m). No such record may be used in any civil or criminal action against the health care provider or any other health care provider; however, except for incident or occurrence reports or records from other persons, organizations, or evaluators reviewing or evaluating health care providers, information, documents or records presented during the review or evaluation may not be construed as immune from discovery under §804.10(4) or use in any civil or criminal action merely because they were so presented. Any person who testifies during or participates in the review or evaluation may testify in any civil or criminal action as to matters within his or her knowledge, but may not testify as to information obtained through his or her participation in the review or evaluation, nor as to any conclusion of such review or evaluation.

(2m) An incident or occurrence report may not be used in any civil or criminal action against a health care provider.

(3) Information acquired in connection with the review and evaluation of health care services shall be disclosed and records of such review and evaluation shall be released, with the identity of any patient whose treatment is reviewed being withheld except as permitted under §146.82 [Confidentiality of patient health records], in the following circumstances:

(a) To the health care provider whose services are being reviewed or evaluated, upon the request of such provider;

(b) To any person with the consent of the health care provider whose services are being reviewed or evaluated;

(c) To the person requesting the review or evaluation, for use solely for the purpose of improving the quality of health care, avoiding the improper utilization of the services of health care providers , and determining the reason-able charges for such services;

(dm) With regard to an action under §895.441, to a court of record after issuance of a subpoena; and

(f) To the appropriate examining or licensing board or agency, when the organization or evaluator conducting the review or evaluation determines that such action is advisable.

(3m)(a) Information acquired in connection with the review and evaluation of health care services may be disclosed, and records of such review and evaluation may be released, in statistical form with the consent of the person authorizing or with the authority to authorize the review or evaluation. Information disclosed or records released under this subsection shall not reveal the identity of any patient except as permitted under §146.82.

(b) Information acquired in connection with the review or evaluation of health care services may be disclosed, and the records of such a review or evaluation released, to any of the following persons, with the consent of the person authorizing or with the authority to authorize the review or evaluation:

1. The employer of a health care provider, as defined in sub. (1)(b)1. and 3.

2. The parent, subsidiary, or affiliate organization of a health care provider, as defined in sub. (1)(b)2.

3. The parent, subsidiary, or affiliate organization of the employer of a health care provider, as defined in sub. (1)(b)1. and 3.

(3t) A record described under sub. (2) or an incident or occurrence report disclosed either under sub. (3) or (3m) or in violation of this section remains confidential and may not be used in any civil or criminal action against the health care provider or any other health care provider.

(4) Any person who discloses information or releases a record in violation of this section, other than through a good faith mistake, is civilly liable therefor to any person harmed by the disclosure or release.

(5) This section does not apply to §256.25.

(6) Health care provider specific information acquired by an administrative agency in order to help improve the quality of health care, to avoid the improper utilization of services of health care providers, or to determine the reasonable charges for health care services is exempt from inspection, copying, or receipt under §19.35(1).

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146.81. Health care records; definitions
In ss. 146.81 to 146.84:
(1) “Health care provider” means any of the following:
(a) A nurse licensed under ch. 441.
(b) A chiropractor licensed under ch. 446.
(c) A dentist licensed under ch. 447.
(d) A physician, perfusionist, or respiratory care practitioner licensed or certified under subch. II of ch. 448.
(dc) A naturopathic doctor or limited-scope naturopathic doctor licensed under ch. 466.
<Text of subsec. (1)(dg) effective until May 1, 2023>
(dg) A physical therapist or physical therapist assistant who is licensed under subch. III of ch. 448 or who holds a compact privilege under subch. X of ch. 448.
<Text of subsec. (1)(dg) effective May 1, 2023>
(dg) A physical therapist or physical therapist assistant who is licensed under subch. III of ch. 448 or who holds a compact privilege under subch. X of ch. 448.
(dr) A podiatrist licensed under subch. IV of ch. 448.
(em) A dietitian certified under subch. V of ch. 448.
(eq) An athletic trainer licensed under subch. VI of ch. 448.
(es) An occupational therapist or occupational therapy assistant who is licensed under subch. VII of ch. 448 or who holds a compact privilege under subch. XI of ch. 448.
Text of subsec. (1)(et) effective May 1, 2023>
(et) A genetic counselor licensed under subch. VIII of ch. 448.
(eu) A physician assistant licensed under subch. VIII of ch. 448.
(f) An optometrist licensed under ch. 449.
<Text of subsec. (1)(fm) effective until January 1, 2023>
(fm) A pharmacist licensed under ch. 450.
<Text of subsec. (1)(fm) effective January 1, 2023>
(fm) A pharmacist or pharmacy technician licensed or registered under ch. 450.
(g) An acupuncturist certified under ch. 451.
(h) A psychologist who is licensed under ch. 455, who is exercising the temporary authorization to practice, as defined in s. 455.50(2)(o), in this state, or who is practicing under the authority to practice interjurisdictional telepsychology, as defined in s. 455.50(2)(b).
(hg) A social worker, marriage and family therapist, or professional counselor certified or licensed under ch. 457.
(hm) A speech-language pathologist or audiologist licensed under subch. II of ch. 459 or a speech and language pathologist licensed by the department of public instruction.
(hp) A massage therapist or bodywork therapist licensed under ch. 460.
(i) A partnership of any providers specified under pars. (a) to (hp).
(j) A corporation or limited liability company of any providers specified under pars. (a) to (hp) that provides health care services.
(k) A cooperative health care association organized under s. 185.981 that directly provides services through salaried employees in its own facility.
(L) A hospice licensed under subch. VI of ch. 50.
(m) An inpatient health care facility, as defined in s. 50.135(1).
(n) A community-based residential facility, as defined in s. 50.01(1g).
(p) A rural medical center, as defined in s. 50.50(11).
(q) An ambulance service provider, as defined in s. 256.01(3).
(r) An emergency medical services practitioner, as defined in s. 256.01(5).
(s) An emergency medical responder, as defined in s. 256.01(4p).
(2) “Informed consent” means written consent to the disclosure of information from patient health care records to an individual, agency or organization that includes all of the following:
(a) The name of the patient whose record is being disclosed.
(b) The type of information to be disclosed.
(c) The types of health care providers making the disclosure.
(d) The purpose of the disclosure such as whether the disclosure is for further medical care, for an application for insurance, to obtain payment of an insurance claim, for a disability determination, for a vocational rehabilitation evaluation, for a legal investigation or for other specified purposes.
(e) The individual, agency or organization to which disclosure may be made.
(f) The signature of the patient or the person authorized by the patient and, if signed by a person authorized by the patient, the relationship of that person to the patient or the authority of the person.
(g) The date on which the consent is signed.
(h) The time period during which the consent is effective.
(3) ”Patient” means a person who receives health care services from a health care provider.
(4) “Patient health care records” means all records related to the health of a patient prepared by or under the supervision of a health care provider; and all records made by an ambulance service provider, as defined in s. 256.01(3), an emergency medical services practitioner, as defined in s. 256.01(5), or an emergency medical responder, as defined in s. 256.01(4p), in administering emergency care procedures to and handling and transporting sick, disabled, or injured individuals. “Patient health care records” includes billing statements and invoices for treatment or services provided by a health care provider and includes health summary forms prepared under s. 302.388(2). “Patient health care records” does not include those records subject to s. 51.30, reports collected under s. 69.186, records of tests administered under s. 252.15(5g) or (5j), 343.305, 938.296(4) or (5) or 968.38(4) or (5), records related to sales of pseudoephedrine products, as defined in s. 961.01(20c), that are maintained by pharmacies under s. 961.235, fetal monitor tracings, as defined under s. 146.817(1), or a pupil’s physical health records maintained by a school under s. 118.125.
(5) “Person authorized by the patient” means the parent, guardian, or legal custodian of a minor patient, as defined in s. 48.02(8) and (11), the person vested with supervision of the child under s. 938.183 or 938.34(4d), (4h), (4m), or (4n), the guardian of a patient adjudicated incompetent in this state, the personal representative, spouse, or domestic partner under ch. 770 of a deceased patient, any person authorized in writing by the patient or a health care agent designated by the patient as a principal under ch. 155 if the patient has been found to be incapacitated under s. 155.05(2), except as limited by the power of attorney for health care instrument. If no spouse or domestic partner survives a deceased patient, “person authorized by the patient” also means an adult member of the deceased patient’s immediate family, as defined in s. 632.895(1)(d). A court may appoint a temporary guardian for a patient believed incompetent to consent to the release of records under this section as the person authorized by the patient to decide upon the release of records, if no guardian has been appointed for the patient.

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