Waiver of Tennessee QIC Privilege by Voluntary Disclosure

Introduction

This commentary examines the Supreme Court of Tennessee’s decision in Payton Castillo v. David Lloyd Rex, M.D., 2025 WL ______ (Tenn. 2025), where the Court clarified the scope and waiver of the Quality Improvement Committee (QIC) privilege under Tennessee Code Annotated § 68-11-272. The case arose from a medical malpractice suit brought by Payton Castillo alleging negligent care of her husband, Mr. Castillo, at CHI Memorial Hospital. After her husband’s death, Memorial convened an internal QIC review and later held a “CANDOR” meeting with Mrs. Castillo. During that meeting, hospital management disclosed conclusions drawn from the QIC process. Plaintiffs sought discovery of those disclosures; defendants invoked the QIC privilege. The trial court and Court of Appeals denied protection for the meeting statements. On appeal, the Supreme Court held that (1) the privilege applies to statements “relating to activities of the QIC,” and (2) Memorial waived the privilege by voluntary disclosure.

Summary of the Judgment

The Court affirmed the Court of Appeals’ judgment on separate grounds, remanding for further proceedings. Key holdings:

The QIC privilege under Tenn. Code Ann. § 68-11-272(c)(1) covers any statements by hospital officers, employees or committee members that relate to QIC activities.
Hospital management’s voluntary disclosure of QIC-based conclusions during a post-mortem “CANDOR” meeting with the decedent’s family constituted waiver of the privilege as to those statements.
Waiver is limited to the substance of the disclosed statements and does not extend to the underlying QIC reports, interview notes, or the identity of QIC participants.

Analysis

Precedents Cited

The Court’s analysis built upon a line of Tennessee cases addressing medical peer review privileges:

Powell v. Community Health Systems, Inc. (312 S.W.3d 496, Tenn. 2010) – held the old Tennessee Peer Review Law privilege was non-waivable, but left waiver questions to the legislature.
Pinkard v. HCA Health Services (545 S.W.3d 443, Tenn. Ct. App. 2017) – extended Powell to hold the PSQIA peer-review privilege unwaivable, a view the Supreme Court now rejects.
Federal Ins. Co. v. Arthur Andersen & Co. (816 S.W.2d 328, Tenn. 1991) – analogized the accountant-client privilege to the attorney-client privilege, finding it waivable by the client.
Lee Medical, Inc. v. Beecher (312 S.W.3d 515, Tenn. 2010) – adopted principles for strict construction of statutory privileges and favored discovery of non-privileged information.

Legal Reasoning

The Court’s statutory analysis centered on three points:

Privilege Scope: Section 68-11-272(c)(1) applies to “records of a QIC” and “testimony or statements … relating to activities of the QIC.” The Court interpreted “relating to” broadly—any statement “connected to” the QIC process is privileged.
Privilege Holder: The Court rejected Pinkard’s view that the privilege inures only to committee participants. Instead it held that the privilege is held by the healthcare organization that forms or retains the QIC, analogous to corporate attorney-client privilege.
Waiver Doctrine: Absent an express statutory bar to waiver, the corporate holder may waive a privilege by voluntary disclosure. Hospital management’s disclosure of QIC-derived conclusions to Mrs. Castillo constituted waiver as to those statements.

Impact

This decision clarifies key aspects of Tennessee’s QIC privilege:

Healthcare organizations hold the privilege and may waive it—aligning QIC privilege with other professional privileges in Tennessee.
Voluntary disclosure by privileged organizations transforms formerly protected statements into discoverable evidence.
Future litigants and practitioners must carefully frame communications with patients or families post-adverse events to preserve privilege or intentionally waive it.
Courts will narrowly confine waiver to the specific disclosures, preserving the confidentiality of underlying QIC materials that were not revealed.

Complex Concepts Simplified

QIC Privilege: A statutory protection ensuring that internal hospital reviews (QICs) remain confidential so that providers can candidly evaluate patient care.

CANDOR Meeting: A post-adverse event discussion with patients/families aimed at open communication and resolution. Tennessee has no specific CANDOR statute, but hospitals may adopt such practices.

Waiver by Disclosure: When the privilege holder (here, the hospital) voluntarily shares privileged conclusions outside the protected forum, the privilege is lost for those exact disclosures. Other QIC materials not shared remain privileged.

Conclusion

The Supreme Court of Tennessee’s decision in Castillo v. Rex marks a pivotal clarification of Tennessee’s quality improvement committee privilege. It confirms that:

The QIC privilege extends to any statements “related to” QIC activities, regardless of the context in which they are made;
Healthcare organizations hold the privilege and may waive it;
Voluntary disclosure of QIC-derived statements to patients or families constitutes waiver as to those statements, but not to underlying QIC reports or corroborating data.

This ruling balances the public interest in candid peer review against the courts’ need for relevant evidence, providing clear guidance to hospitals, counsel, and trial courts on privilege claims and waiver boundaries.