Patient Safety Act and Dual Purpose

CareOne, a national for-profit company that operates nursing homes and assisted living facilities, is involved in multiple lawsuits alleging patients were abused and neglected at their facilities. During the lawsuits, victims sought access to CareOne’s incident reports arguing that these documents could provide evidence of notice of systemic problems with training, staffing, and care services.

The New Jersey Supreme Court determined that CareOne’s internal safety documents were not protected under the Patient Safety Act (PSA) because they served a dual purpose; both for internal safety reviews and compliance with federal and state regulations. This decision reversed a 2023 New Jersey Superior Court Appellate Division ruling, which had found that CareOne’s internal safety documents were protected under the PSA. The significance of this reversal prompted the appeal to the Supreme Court, given its substantial impact on the discovery process in nursing home cases.

The PSA is a law designed to improve patient safety by allowing healthcare providers to hide the results of incident investigations. The purpose was intended to allow healthcare providers to learn from errors without fear of those records being used against them in lawsuits, providing legal protections for records created solely for internal safety processes. If a document is created solely for improving safety, it can be protected from being shared in court. However, if those documents serve other purposes, such as fulfilling federal or state obligations, that protection is lost.

This dual-use issue makes the PSA discoverable if relevant. Most nursing homes, particularly those that receive Medicare or Medicaid funding, are required to report incidents as part of federal and state regulations, meaning their internal safety reviews will often serve both internal and external purposes.

In addition to federal requirements under CMS, New Jersey itself has its own regulations that nursing homes must comply with. The state’s Department of Health oversees nursing homes, and facilities are required to report certain incidents to the New Jersey DOH.

I believe the decision is a positive step toward transparency and accountability. Access to these types of documents is crucial in proving negligence and holding facilities accountable for preventable harm. That said, I do fear that nursing homes may become more secretive, underreport incidents, or manipulate records to avoid exposing their safety reviews in litigation.