A Pennsylvania hospital must release the redacted medical records of about 10 emergency room patients who were equipped to heart monitors on the night a heart transplant patient died from heart complications after being treated at the hospital, a Lackawanna County judge has ruled.

The estate of Jessica Reap, who was 21 when she died, requested the records to establish the conditions and symptoms of the Mercy Hospital patients who did have heart monitors after Reap was told she could not be placed on a heart monitor because all of them were in use when she arrived at Mercy complaining of cardiac symptoms. The records would be redacted to not include names and Social Security numbers, the opinion said.

Lackawanna County Court of Common Pleas Judge Carmen D. Minora approved the plaintiff’s discovery request, holding that, among other things, the request sought information that was less invasive than those in other cases where Pennsylvania courts have granted discovery into the records of non-party patients.

Reversing a special master who had denied the estate’s discovery request, Minora found the records requested were relevant, the request was not overly broad, and that records would not blacken the character of certain patients whom those involved in the litigation may be able to anecdotally identify if the records were admitted.

The records were not meant to impeach the emergency room doctor who treated Reap, who subsequently admitted at a deposition that she needed a heart monitor, Minora said.

Minora also distinguished the case of Reap v. Mercy Healthcare Partners from recent medical malpractice cases where the court denied discovery requests because of patient privacy concerns, reasoning that the plaintiff’s inquiry is only targeting the symptoms of the patients who were admitted to the emergency room simultaneously to her and using heart monitors — and not their names — in order to bolster her claim that she had a more pressing need for the medical equipment.

"This inquiry — comparing [Reap's] symptoms to the symptoms of other patients already using the heart monitors unavailable to [Reap] at the time of her admittance — is essential proof of the core elements of [Reap's] claim," Minora said in a 19-page opinion. "In essence, did the decedent receive proper triage in the emergency room"?

The defense had argued the admission of Dr. John Viteritti that Reap needed a heart monitor was irrelevant, arguing that what the doctor believed was the standard of care was "’of no moment.’" Viteritti treated Reap on the night in question. Instead, the defense argued, the plaintiff estate needed expert medical testimony to establish that the hospital fell short of the required standard of care and such a breach was the proximate cause of the injuries alleged.

But Minora said no expert testimony could serve as a substitute for the records requested.

The hospital had further argued the estate must present expert testimony instead of the medical records, because, as the defendant saw it, the plaintiff was seeking the records for impeachment purposes.

Minora disagreed.

"Although plaintiff notes that in Dr. Viteritti’s deposition, Dr. Viteritti admitted that [Reap] needed a heart monitor, his testimony was just that: an admission," Minora said. "Plaintiff is therefore not seeking to impeach the defendant, because he has already admitted [Reap] needed a heart monitor and none were available. What [the estate] seeks to do is assess whether there were in fact no heart monitors available for [Reap] at the time of her visit to Mercy and the circumstances why they were not available."

"How many heart monitors does Mercy have, why were there none available, and were they down for repair?" he went on. "How many were actually in use?"

Along that line of reasoning, the instant discovery request did not violate Pennsylvania case law setting forth that impeachment is not compelling enough to overcome privacy interests because, in the court’s view, impeachment was not at issue.

The court also rejected arguments that the request for medical records was unduly burdensome and overly broad. The defense had argued the estate had no way of ensuring that redacting the names and Social Security numbers off the records would eliminate the risk of patient identification. Inadvertent disclosure could have "’devastating events’" on both the plaintiff and the hospital.

The defense likewise failed to persuade Minora that the records would "blacken the character" of non-party patients in violation of the Health Insurance Portability and Accountability Act, commonly referred to as HIPAA. The hospital developed the argument by suggesting that someone present at the trial, like a juror, attorney or legal staffer, may have known someone treated at the emergency room that night and could glean from the redacted records the private conditions of that patient.

But Minora found the argument lacked merit, holding the type of information requested was not designed to cause the private information to be exposed in violation of relevant state law.

The records request was "designed to be generic" and included even less identifying information than two other medical records discovery requests Pennsylvania courts had previously allowed.

First, in Stenger v. Lehigh Valley Hospital Center, a case in which the plaintiff sought damages after contracting AIDS from a blood transfusion, the Pennsylvania Supreme Court held the request for anonymous records of shipment dates of the donor’s blood and blood product, as well as results of tests performed on other recipients of the donor’s blood, were discoverable.

In Deborah Heart and Lung Center v. Virtua Health, a trial court allowed discovery of the names of people who were referred to a hospital when those records were sought under a lawful subpoena and a qualified protective order. The Philadelphia Court of Common Pleas held the names alone did not blacken the character of the patients.

Minora said Reap’s request was far less invasive to third-party patient privacy.

"[The estate's] request includes anonymous records and a date and a narrow window of time relevant to the hospitalization," Minora said. "Additionally, [the] plaintiff seeks a short, generic symptoms list of persons using emergency room heart monitors. This request has less potential for infringing on privacy concerns than a list of any patient admitted to a hospital or a list that includes other patients who received blood from a donor who may have had AIDS and perhaps contracted the disease as a result."

The case is being brought by Kathleen Reap, Jessica Reap’s mother, individually and as administrator of Reap’s estate. The lawsuit alleges Mercy failed to provide Reap with proper medical and nursing care, alleging causes of action for negligence, vicarious liability, corporate negligence, negligent infliction of emotional distress, and wrongful death and survival actions.

According to Minora, the complaint alleged Reap had a heart transplant when she was 7 years old in 1996 because of a hereditary condition. Then, in September 2010, for reasons not explained in the opinion, she was put on a waiting list for a second heart transplant and scheduled to have a defibrillator implanted the next month while she waited for her second heart transplant surgery. She presented to Mercy the following month and died shortly thereafter from heart complications.

Scranton attorney Vincent Cimini is representing Kathleen Reap and declined to comment.

Paul J. Wylam of The Perry Law Firm in Scranton is representing Mercy and did not return a call requesting comment.

Ben Present can be contacted at 215-557-2315 or bpresent@alm.com. Follow him on Twitter @BPresentTLI.

(Copies of the 19-page opinion in Reap v. Mercy Healthcare Partners, PICS No. 13-0382, are available from Pennsylvania Law Weekly. Please call the Pennsylvania Instant Case Service at 800-276-PICS to order or for information.)