{ "id": 4243823, "name": "JUDY HAMMOND, Plaintiff v. SAIRA SAINI, M.D., CAROLINA PLASTIC SURGERY OF FAYETTEVILLE, P.C., VICTOR KUBIT, M.D., CUMBERLAND ANESTHESIA ASSOCIATES, P.A., WANDA UNTCH, JAMES BAX, and CUMBERLAND COUNTY HOSPITAL SYSTEM, INC., Defendants", "name_abbreviation": "Hammond v. Saini", "decision_date": "2013-09-03", "docket_number": "No. COA12-1493", "first_page": "359", "last_page": "373", "citations": [ { "type": "official", "cite": "229 N.C. App. 359" } ], "court": { "name_abbreviation": "N.C. Ct. App.", "id": 14983, "name": "North Carolina Court of Appeals" }, "jurisdiction": { "id": 5, "name_long": "North Carolina", "name": "N.C." }, "cites_to": [ { "cite": "621 S.E.2d 173", "category": "reporters:state_regional", "reporter": "S.E.2d", "case_ids": [ 12634275, 12634276, 12634277 ], "year": 2005, "opinion_index": 0, "case_paths": [ "/se2d/621/0173-01", "/se2d/621/0173-02", "/se2d/621/0173-03" ] }, { "cite": "614 S.E.2d 371", "category": "reporters:state_regional", "reporter": "S.E.2d", "case_ids": [ 12633138 ], "year": 2005, "pin_cites": [ { "page": "376" } ], "opinion_index": 0, "case_paths": [ "/se2d/614/0371-01" ] }, { "cite": "648 S.E.2d 208", "category": "reporters:state_regional", "reporter": "S.E.2d", "case_ids": [ 12639034 ], "weight": 2, "year": 2007, "pin_cites": [ { "page": "293-94" } ], "opinion_index": 0, "case_paths": [ "/se2d/648/0208-01" ] }, { "cite": "628 S.E.2d 851", "category": "reporters:state_regional", "reporter": "S.E.2d", "case_ids": [ 12635639 ], "weight": 9, "year": 2006, "pin_cites": [ { "page": "854" }, { "page": "864" }, { "page": "864-65" }, { "page": "864" }, { "page": "865" }, { "page": "865" } ], "opinion_index": 0, "case_paths": [ "/se2d/628/0851-01" ] }, { "cite": "641 S.E.2d 316", "category": "reporters:state_regional", "reporter": "S.E.2d", "case_ids": [ 12637834 ], "weight": 3, "year": 2007, "pin_cites": [ { "page": "318" }, { "page": "319", "parenthetical": "emphasis in original" }, { "parenthetical": "footnote and emphasis omitted" } ], "opinion_index": 0, "case_paths": [ "/se2d/641/0316-01" ] }, { "cite": "673 S.E.2d 694", "category": "reporters:state_regional", "reporter": "S.E.2d", "case_ids": [ 12642964 ], "pin_cites": [ { "page": "701-02" } ], "opinion_index": 0, "case_paths": [ "/se2d/673/0694-01" ] }, { "cite": "689 S.E.2d 898", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 2010, "pin_cites": [ { "page": "908", "parenthetical": "holding that where \"defendant fail[ed] to make any specific argument in his brief' regarding certain issue, the issue was deemed abandoned on appeal" } ], "opinion_index": 0 }, { "cite": "202 N.C. App. 587", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 4175304 ], "year": 2010, "pin_cites": [ { "page": "597", "parenthetical": "holding that where \"defendant fail[ed] to make any specific argument in his brief' regarding certain issue, the issue was deemed abandoned on appeal" } ], "opinion_index": 0, "case_paths": [ "/nc-app/202/0587-01" ] }, { "cite": "360 N.C. 60", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 3788768, 3797185, 3792645, 3792391, 3791370, 3790892, 3791181, 3789709, 3794291, 3790036, 3789205, 3788855 ], "year": 2005, "opinion_index": 0, "case_paths": [ "/nc/360/0479-05", "/nc/360/0060-05", "/nc/360/0068-02", "/nc/360/0060-06", "/nc/360/0060-08", "/nc/360/0060-02", "/nc/360/0060-04", "/nc/360/0060-09", "/nc/360/0060-01", "/nc/360/0060-07", "/nc/360/0060-03", "/nc/360/0490-05" ] }, { "cite": "171 N.C. App. 287", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 8436567 ], "year": 2005, "pin_cites": [ { "page": "294" } ], "opinion_index": 0, "case_paths": [ "/nc-app/171/0287-01" ] }, { "cite": "N.C. Gen. Stat. \u00a7 90-21", "category": "laws:leg_statute", "reporter": "N.C. Gen. Stat.", "opinion_index": 0 }, { "cite": "566 S.E.2d 128", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 2002, "pin_cites": [ { "page": "130" } ], "opinion_index": 0 }, { "cite": "151 N.C. App. 584", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 9081463 ], "year": 2002, "pin_cites": [ { "page": "586" } ], "opinion_index": 0, "case_paths": [ "/nc-app/151/0584-01" ] }, { "cite": "361 N.C. 426", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 3745792, 3739073, 3742562, 3742250, 3744530, 3745567 ], "year": 2007, "opinion_index": 0, "case_paths": [ "/nc/361/0426-06", "/nc/361/0426-03", "/nc/361/0426-01", "/nc/361/0426-02", "/nc/361/0426-04", "/nc/361/0426-05" ] }, { "cite": "177 N.C. App. 290", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 8301249 ], "year": 2006, "opinion_index": 0, "case_paths": [ "/nc-app/177/0290-01" ] }, { "cite": "482 S.E.2d 546", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1997, "pin_cites": [ { "page": "551-52", "parenthetical": "holding that hospital's accident report was not protected from discovery under Rule 26(b)(3" } ], "opinion_index": 0 }, { "cite": "125 N.C. App. 618", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 11870701 ], "year": 1997, "pin_cites": [ { "page": "625", "parenthetical": "holding that hospital's accident report was not protected from discovery under Rule 26(b)(3" } ], "opinion_index": 0, "case_paths": [ "/nc-app/125/0618-01" ] }, { "cite": "229 S.E.2d 191", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1976, "pin_cites": [ { "page": "201", "parenthetical": "citing C. Wright & A. Miller, Federal Practice and Procedure \u00a7 2024, at 197 (1970)" } ], "opinion_index": 0 }, { "cite": "291 N.C. 19", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 8557249 ], "year": 1976, "pin_cites": [ { "page": "35", "parenthetical": "citing C. Wright & A. Miller, Federal Practice and Procedure \u00a7 2024, at 197 (1970)" } ], "opinion_index": 0, "case_paths": [ "/nc/291/0019-01" ] }, { "cite": "577 S.E.2d 624", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 2003, "opinion_index": 0 }, { "cite": "356 N.C. 673", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 1511235, 1511365, 1511372, 1511567, 1511165 ], "year": 2003, "opinion_index": 0, "case_paths": [ "/nc/356/0673-04", "/nc/356/0673-01", "/nc/356/0673-03", "/nc/356/0673-02", "/nc/356/0673-05" ] }, { "cite": "574 S.E.2d 171", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 2, "year": 2002, "pin_cites": [ { "page": "176", "parenthetical": "quoting N.C. R. Civ. P. 26(b)(3)" }, { "page": "176", "parenthetical": "holding that \"plaintiff's interrogatories did not violate Rule 26(b)(3)\" because they \"did not ask defendants for documents or tangible things\"" } ], "opinion_index": 0 }, { "cite": "155 N.C. App. 129", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 9249153 ], "weight": 2, "year": 2002, "pin_cites": [ { "page": "136", "parenthetical": "quoting N.C. R. Civ. P. 26(b)(3)" }, { "page": "136-37" } ], "opinion_index": 0, "case_paths": [ "/nc-app/155/0129-01" ] }, { "cite": "547 S.E.2d 810", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 2, "year": 2001, "opinion_index": 0 }, { "cite": "353 N.C. 371", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 135616, 135649, 135948, 135763, 135735 ], "weight": 2, "year": 2001, "opinion_index": 0, "case_paths": [ "/nc/353/0371-05", "/nc/353/0371-03", "/nc/353/0371-01", "/nc/353/0371-02", "/nc/353/0371-04" ] }, { "cite": "541 S.E.2d 782", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 4, "pin_cites": [ { "page": "788" }, { "page": "789", "parenthetical": "citation and quotation marks omitted" }, { "page": "788" }, { "page": "786" } ], "opinion_index": 0 }, { "cite": "142 N.C. App. 18", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 9439394 ], "weight": 4, "pin_cites": [ { "page": "27" }, { "page": "29" }, { "page": "27" }, { "page": "23-24" } ], "opinion_index": 0, "case_paths": [ "/nc-app/142/0018-01" ] }, { "cite": "181 N.C. App. 747", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 8376286 ], "weight": 2, "year": 2007, "pin_cites": [ { "page": "751" }, { "page": "752" } ], "opinion_index": 0, "case_paths": [ "/nc-app/181/0747-01" ] }, { "cite": "703 S.E.2d 158", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 2010, "opinion_index": 0 }, { "cite": "364 N.C. 602", "category": "reporters:state", "reporter": "N.C.", "year": 2010, "opinion_index": 0 }, { "cite": "694 S.E.2d 416", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 16, "year": 2010, "pin_cites": [ { "page": "419" }, { "page": "533-34" }, { "page": "418" }, { "page": "418-19" }, { "page": "419" }, { "page": "538" }, { "page": "421" }, { "page": "540" }, { "page": "422" }, { "page": "538-39" }, { "page": "421" }, { "page": "533" }, { "page": "418" } ], "opinion_index": 0 }, { "cite": "204 N.C. App. 532", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 4176550 ], "weight": 2, "year": 2010, "pin_cites": [ { "page": "535" } ], "opinion_index": 0, "case_paths": [ "/nc-app/204/0532-01" ] }, { "cite": "738 S.E.2d 780", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 2013, "pin_cites": [ { "page": "782", "parenthetical": "holding that only questions of whether requested files were shielded from discovery by statutory privilege were properly before appellate court" } ], "opinion_index": 0 }, { "cite": "686 S.E.2d 512", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 2009, "opinion_index": 0 }, { "cite": "363 N.C. 651", "category": "reporters:state", "reporter": "N.C.", "year": 2009, "opinion_index": 0 }, { "cite": "195 N.C. App. 625", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 4164347 ], "pin_cites": [ { "page": "636-37" } ], "opinion_index": 0, "case_paths": [ "/nc-app/195/0625-01" ] }, { "cite": "693 S.E.2d 353", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 2010, "opinion_index": 0 }, { "cite": "363 N.C. 813", "category": "reporters:state", "reporter": "N.C.", "year": 2010, "opinion_index": 0 }, { "cite": "678 S.E.2d 787", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 3, "year": 2009, "pin_cites": [ { "page": "790", "parenthetical": "medical review privilege" }, { "page": "791" }, { "page": "791-92" } ], "opinion_index": 0 }, { "cite": "198 N.C. App. 120", "category": "reporters:state", "reporter": "N.C. App.", "case_ids": [ 4169344 ], "weight": 3, "year": 2009, "pin_cites": [ { "page": "123-24", "parenthetical": "medical review privilege" }, { "page": "124" }, { "page": "126" } ], "opinion_index": 0, "case_paths": [ "/nc-app/198/0120-01" ] }, { "cite": "719 S.E.2d 37", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 2011, "opinion_index": 0 }, { "cite": "365 N.C. 369", "category": "reporters:state", "reporter": "N.C.", "year": 2011, "opinion_index": 0 }, { "cite": "717 S.E.2d 1", "category": "reporters:state_regional", "reporter": "S.E.2d", "weight": 3, "year": 2011, "pin_cites": [ { "page": "4" }, { "page": "4", "parenthetical": "concluding that only portion of discovery order concerning attomey/client privilege and work product immunity was immediately appealable" }, { "page": "8", "parenthetical": "citation and quotation marks omitted" } ], "opinion_index": 0 }, { "cite": "522 S.E.2d 577", "category": "reporters:state_regional", "reporter": "S.E.2d", "year": 1999, "pin_cites": [ { "page": "579" } ], "opinion_index": 0 }, { "cite": "351 N.C. 159", "category": "reporters:state", "reporter": "N.C.", "case_ids": [ 1155801 ], "year": 1999, "pin_cites": [ { "page": "163" } ], "opinion_index": 0, "case_paths": [ "/nc/351/0159-01" ] } ], "analysis": { "cardinality": 1220, "char_count": 36003, "ocr_confidence": 0.73, "pagerank": { "raw": 1.1482568424360516e-07, "percentile": 0.5807496884953525 }, "sha256": "83e2f46b90b9e993e18b138f0f15f92ea54f0a0f81d7bebd0543bc07d41372ca", "simhash": "1:0aa95572261e8a61", "word_count": 5681 }, "last_updated": "2023-07-14T15:07:10.338246+00:00", "provenance": { "date_added": "2019-08-29", "source": "Harvard", "batch": "2018" }, "casebody": { "judges": [ "Chief Judge MARTIN and Judge BRYANT concur." ], "parties": [ "JUDY HAMMOND, Plaintiff v. SAIRA SAINI, M.D., CAROLINA PLASTIC SURGERY OF FAYETTEVILLE, P.C., VICTOR KUBIT, M.D., CUMBERLAND ANESTHESIA ASSOCIATES, P.A., WANDA UNTCH, JAMES BAX, and CUMBERLAND COUNTY HOSPITAL SYSTEM, INC., Defendants" ], "opinions": [ { "text": "DAVIS, Judge.\nCumberland County Hospital System, Inc. (\u201cCCHS\u201d), James Bax (\u201cBax\u201d), and Wanda Untch (\u201cUntch\u201d) (collectively \u201cdefendants\u201d) appeal from the trial court\u2019s orders compelling them to produce certain documents and divulge certain information in discovery to Judy Hammond (\u201cplaintiff\u201d). After careful review, we dismiss in part, affirm in part, and remand in part.\nFactual Background\nOn 28 September 2011, plaintiff filed a complaint in Cumberland County Superior Court against defendants as well as Carolina Plastic Surgery of Fayetteville, PC.; Cumberland Anesthesia Associates, P.A.; Sairi Saini, M.D. (\u201cDr. Saini\u201d); and Victor Kubit, M.D. (\u201cDr. Kubit\u201d), which contained the following allegations: Plaintiff reported to Cape Fear Valley Medical Center - operated by CCHS - on 17 September 2010 for a surgical procedure to remove a possible basal cell carcinoma from her face. Dr. Saini, who was employed by Carolina Plastic Surgery of Fayetteville, was responsible for performing the procedure, and Dr. Kubit, an anesthesiologist with Cumberland Anesthesia Associates, was responsible for administering anesthesia during the surgery. Bax and Untch, both registered nurse anesthetists employed by CCHS, were also involved in the provision of anesthesia to plaintiff during the surgery.\nPlaintiff was given total intravenous anesthesia. During the operation, Kubit, Bax, and Untch administered supplemental oxygen to plaintiff through a face mask. Drapes were placed around plaintiffs face in such a way that oxygen escaping from the face mask built up under the drapes. When Dr. Saini used an electrocautery device to stop bleeding on plaintiffs face, the oxygen trapped under the drapes ignited and burned the drapes near plaintiffs face. Plaintiff sustained first and second degree bums on her face, head, neck, upper back, right hand, and tongue. Plaintiff also suffered a respiratory thermal injury, right bronchial edema, oral stomatitis, and nasal trauma, which left her with permanent injuries, including scarring.\nAn answer was filed on behalf of Bax, Untch, and CCHS, generally denying plaintiffs allegations of negligence. Plaintiff subsequently served separate sets of requests for production of documents and interrogatories on Bax, Untch, and CCHS. In their responses, each of them objected to certain aspects of these discovery requests on the grounds that they sought documents or information that was protected from disclosure based on the medical review privilege, the work product doctrine, and the attomey/client privilege. Based on these objections, defendants refused to produce the responsive documents or provide answers to the challenged interrogatories.\nPlaintiff filed motions to compel discovery from defendants pursuant to Rule 37 of the North Carolina Rules of Civil Procedure. In opposing the motions, defendants\u2019 counsel filed an affidavit from Harold Maynard (\u201cMaynard\u201d), CCHS\u2019s risk manager, regarding the accident review process in existence at CCHS. Attached to the affidavit was a copy of an administrative policy of CCHS entitled \u201cSentinel Events and Root Cause Analysis\u201d (\u201cRCA Policy\u201d). Defense counsel also submitted to the trial court a copy of a document labeled \u201cFire in Operating Room RCA\u201d (\u201cRCA Report\u201d) and copies of reports entitled \u201cRisk Management Worksheets\u201d (\u201cRMWs\u201d).\nAfter conducting an in camera review of the documents withheld by defendants, the trial court entered separate orders on 18 June 2012 granting plaintiff\u2019s motions to compel. Defendants appealed to this Court from these orders.\nAnalysis\nI. Appellate Jurisdiction\n[1 ] As a preliminary matter, we must determine whether this Court possesses jurisdiction over defendants\u2019 appeal. Defendants\u2019 contentions on appeal can be divided into two categories. First, they argue that a segment of the documents and information requested by plaintiff are immune from discovery based on recognized privileges - namely, the medical review privilege, the work product doctrine, and the attorney/ client privilege. Second, they contend that portions of plaintiff\u2019s discovery requests are overbroad and seek information that is neither relevant nor reasonably calculated to lead to the discovery of admissible evidence pursuant to Rule 26 of the North Carolina Rules of Civil Procedure.\n\u201cAn order compelling discovery is generally not immediately appeal-able because it is interlocutory and does not affect a substantial right that would be lost if the ruling were not reviewed before final judgment.\u201d Sharpe v. Worland, 351 N.C. 159, 163, 522 S.E.2d 577, 579 (1999). However, where a party asserts a privilege or immunity that directly relates to the matter to be disclosed pursuant to the interlocutory discovery order and the assertion of the privilege or immunity is not frivolous or insubstantial, the challenged order affects a substantial right and is thus immediately appealable. K2 Asia Ventures v. Trota,_N.C. App._,_, 717 S.E.2d 1, 4, disc. review denied, 365 N.C. 369, 719 S.E.2d 37 (2011).\nFor this reason, orders compelling discovery of materials purportedly protected by the medical review privilege or work product doctrine are immediately reviewable on appeal despite their interlocutory nature. See, e.g., Woods v. Moses Cone Health Sys., 198 N.C. App. 120, 123-24, 678 S.E.2d 787, 790 (2009) (medical review privilege), disc. review denied, 363 N.C. 813, 693 S.E.2d 353 (2010); Boyce & Isley, PLLC v. Cooper, 195 N.C. App. 625, 636-37, 673 S.E.2d 694, 701-02 (work product doctrine), disc. review denied, 363 N.C. 651, 686 S.E.2d 512 (2009). Accordingly, this Court has jurisdiction to review defendants\u2019 contentions on appeal that are based on the medical review privilege and the work product doctrine.\nHowever, with regard to the arguments advanced by defendants based on overbreadth and relevancy, we do not possess jurisdiction to consider these contentions because they do not invoke a recognized privilege or immunity, and defendants have failed to otherwise show that they affect a substantial right. See Wind v. City of Gastonia, N.C. App._,_, 738 S.E.2d 780, 782 (2013) (holding that only questions of whether requested files were shielded from discovery by statutory privilege were properly before appellate court); K2 Asia Ventures,_N.C. App. at_, 717 S.E.2d at 4 (concluding that only portion of discovery order concerning attomey/client privilege and work product immunity was immediately appealable).\nFor these reasons, we lack jurisdiction to consider defendants\u2019 arguments regarding overbreadth and relevancy. Consequently, those portions of defendants\u2019 appeal are dismissed.\nII. Medical Review Privilege\nWe now turn our attention to those issues on appeal that are properly before us. We begin by examining the applicability of North Carolina\u2019s medical review privilege codified-in N.C. Gen. Stat. \u00a7 131E-95.\nA. Statutory Framework\nAs this Court has recognized, \u201cN.C. Gen. Stat. \u00a7 131E-95, part of the Hospital Licensure Act, creates protection for medical review committees in civil actions against hospitals.\u201d Woods, 198 N.C. App. at 124, 678 S.E.2d at 791. The privilege is set out in N.C. Gen. Stat. \u00a7 131E-95(b), which provides, in pertinent part, as follows:\nThe proceedings of a medical review committee, the records and materials it produces and the materials it considers shall be confidential and not considered public records within the meaning of G.S. 132-1... and shall not be subject to discovery or introduction into evidence in any civil action against a hospital. . . which results from matters which are the subject of evaluation and review by the committee.\nN.C. Gen. Stat. \u00a7 131E-95(b) (2011).\n\u201cBy its plain language, N.C. Gen. Stat. \u00a7 131E-95 creates three categories of information protected from discovery and admissibility at trial in a civil action: (1) proceedings of a medical review committee, (2) records and materials produced by a medical review committee, and (3) materials considered by a medical review committee.\u201d Woods, 198 N.C. App. at 126, 678 S.E.2d at 791-92. The statute goes on to state, however, that \u201cinformation, documents, or records otherwise available are not immune from discovery or use in a civil action merely because they were presented during proceedings of the committee.\u201d N.C. Gen. Stat. \u00a7 131E-95(b).\nN.C. Gen. Stat. \u00a7 131E-76 defines the term \u201c[m]edical review committee\u201d as\nany of the following committees formed for the purpose of evaluating the quality, cost of, or necessity for hospitalization or health care, including medical staff credentialing:\na. A committee of a state or local professional society.\nb. A committee of a medical staff of a hospital.\nc. A committee of a hospital or hospital system, if created by the governing board or medical staff of the hospital or system or operating under written procedures adopted by the governing board or medical staff of the hospital or system.\nd. A committee of a peer review corporation or organization.\nN.C. Gen. Stat. \u00a7 131E-76(5)(a)-(d) (2011).\nOn appeal from a trial court\u2019s discovery order implicating the medical review privilege, this Court \u201creview[s] de novo whether the requested documents are privileged under N.C. Gen. Stat. \u00a7 131E-95(b).\u201d Bryson v. Haywood Reg\u2019l Med. Ctr., 204 N.C. App. 532, 535, 694 S.E.2d 416, 419, disc. review denied, 364 N.C. 602, 703 S.E.2d 158 (2010). In the present case, defendants, as the parties objecting to the disclosure of the materials on the basis of this privilege, bear the burden of establishing that plaintiff\u2019s discovery requests fall within the scope of the privilege. Hayes v. Premier Living, Inc., 181 N.C. App. 747, 751, 641 S.E.2d 316, 318 (2007). Where, as here, the trial court\u2019s order does not contain findings of fact and conclusions of law but rather simply lists the documents that are discoverable, \u201cit is presumed that the court on proper evidence found facts to support its [decision].\u201d Evans v. United Servs. Auto. Ass\u2019n, 142 N.C. App. 18, 27, 541 S.E.2d 782, 788 (citation and quotation marks omitted), cert. denied, 353 N.C. 371, 547 S.E.2d 810 (2001).\nB. Application of Medical Review Privilege\nDefendants contend that North Carolina\u2019s medical review privilege shields from discovery: (1) the RCA Report; (2) the RMWs; and (3) notes prepared by Maynard (CCHS\u2019s risk manager) after the operating room fire.\nThe RCA Report is a document consisting of multiple pages, containing a \u201cBrief Overview\u201d of the incident resulting in the operating room fire, a description of the post-fire review process undertaken by the hospital\u2019s Root Cause Analysis Team (\u201cRCA Team\u201d), and the RCA Team\u2019s ultimate recommendations based on that review process. The two RMWs appear to be computer-generated reports containing several different \u201cData\u201d sections that include set fields for entering information. In the \u201cGeneral Event Data\u201d section of both RMWs is a \u201cComments\u201d field, each of which contains a general description of the events surrounding the operating room fire. As for Maynard\u2019s meeting notes, while they were not submitted to either the trial court or this Court for review, Maynard\u2019s affidavit describes them as \u201cnotes reflecting the discussions that occurred\u201d in meetings he conducted regarding the fire.\nDefendants invoke the medical review privilege by asserting that these documents are all connected \"with the investigation of the operating room fire by the RCA Team. All of defendants\u2019 contentions regarding the applicability of the medical review privilege hinge on the proposition that CCHS\u2019s RCA Team is, in fact, a medical review committee for purposes of \u00a7 131E-76(5). If the RCA Team does not constitute a medical review committee as statutorily defined, then defendants\u2019 entire argument premised on the medical review privilege fails.\nDefendants do not identify in their brief which specific prong(s) of \u00a7 131E-76(5) they believe the RCA Team falls under in order to qualify as a medical review committee. At oral argument, however, counsel for defendants stated that the RCA Team would qualify as a medical review committee under either subsection (b) or (c) of \u00a7 131E-76(5). After carefully reviewing the record, we conclude that defendants failed to meet their burden of showing that the RCA Team qualifies as a medical review committee for purposes of \u00a7 131E-76(5)(b) or (c).\nIn order to fall within \u00a7 131E-76(5)(b), defendants must show that (1) the RCA Team was comprised of the \u201cmedical staff of a hospital\u201d; and (2) it was \u201cformed for the purpose of evaluating the quality, cost of, or necessity for hospitalization or health care, including medical staff credentialing[.]\u201d N.C. Gen. Stat. \u00a7 131E-76(5)(b).\nDefendants have failed to meet even the first of these two prongs. Neither the RCA Report itself nor any other document presented by defendants identifies the members of the RCA Team as being part of the \u201cmedical staff of [CCHS],\u201d as required by the statute. N.C. Gen. Stat. \u00a7 131E-76(5)(b). This omission is fatal to defendants\u2019 attempt to avail themselves of this provision of \u00a7 131E-76(5). Therefore, we conclude that defendants have not shown that the RCA Team constitutes a medical review committee under \u00a7 131E-76(5)(b).\nIn order to qualify as a medical review committee under \u00a7 131E-76(5)(c), the RCA Team must have been \u201ccreated by the governing board or medical staff of the hospital or system or operating under written procedures adopted by the governing board or medical staff of the hospital or system.\u201d N.C. Gen. Stat. \u00a7 131E-76(5)(c). Maynard, in his affidavit, stated that \u201c[i]n general, the peer review committees established to . . . prepare a root cause analysis are created by the medical staff and governing board of CCHS and operate under the [RCA Policy] . . . .\u201d (Emphasis added.) The inherent ambiguity of the phrase \u201cin general\u201d leaves open the possibility that this sequence of events does not occur in every case. Notably absent from Maynard\u2019s affidavit is any statement that the RCA Team established in this specific case to review the operating room fire was created by the governing board or medical staff of CCHS or that the RCA Team operated under the RCA Policy. Nor does the RCA Report itself provide these details.\nSimilarly, defendants have also failed to establish that the RCA Policy was, in fact, \u201cadopted by the governing board or medical staff of the hospital or system.\u201d N.C. Gen. Stat. \u00a7 131E-76(5)(c). The policy contains a notation that it was \u201capproved by MN\u201d - yet nothing in the record, including Maynard\u2019s affidavit, identifies who \u201cMN\u201d is. For all of these reasons, we believe that defendants failed to satisfy their burden of proving that the RCA Team constitutes a medical review committee for purposes of \u00a7 131E-76(5)(c).\nEven assuming arguendo that the RCA Team did qualify as a medical review committee, defendants would still have been required to \u201cpresent ... evidence tending to show that the disputed [documents] were (1) part of the [RCA Team]\u2019s proceedings, (2) produced by the [RCA Team], or (3) considered by the [RCA Team] as required by\u201d \u00a7 131E-95. Hayes, 181 N.C. App. at 752, 641 S.E.2d at 319 (emphasis in original). This Court has\nemphasize [d] that these are substantive, not formal, requirements. Thus, in order to determine whether the peer review privilege applies, a court must consider the circumstances surrounding the actual preparation and use of the disputed documents involved in each particular case. The title, description, or stated purpose attached to a document by its creator is not dispositive, nor can a party shield an otherwise available document from discovery merely by having it presented to or considered by a quality review committee.\nId. (footnote and emphasis omitted).\nFirst, with respect to the RCA Report, defendants failed to submit any evidence revealing who produced or prepared it. While the document, on its cover page, identifies the event that is the subject of the report and the members of the team, it does not fist its author. Defendants assert - pointing to Maynard\u2019s affidavit - that the RCA Team produced the report. Maynard\u2019s affidavit, however, states only that \u201c[a] Root Cause Analysis Report was prepared____\u201d (Emphasis added.) It neither identifies the RCA Team members - individually or collectively - as the author of the RCA Report nor otherwise reveals the document\u2019s author.\nSecond, with respect to the computer-generated RMWs, defendants refer to these documents not as RMWs - the title provided on the face of the printouts - but rather as Quality Care Control Reports. Defendants maintain that these documents were prepared by Bax and Stephanie Emanuel (\u201cEmanuel\u201d), another nurse present in the operating room during the fire, as part of the review process outlined in the RCA Policy. Although the RCA Policy does, in fact, identify Quality Care Control Reports as a \u201cmeans\u201d for initiating a review, the RCA Policy nowhere refers to RMWs, and nothing on the face of the RMWs indicates they actually are the Quality Care Control Reports contemplated by the RCA Policy.\nNor is it clear who prepared the RMWs. Both RMWs indicate on their face that the information contained in the comments section was entered by someone with the initials \u201cRDE\u201d - without any further indication of that person\u2019s identity. However, other sections of the RMWs suggest that they may have been completed by Emanuel and Bax - although it is not clear that this is, in fact, what occurred. Thus, the source of the information contained in the RMWs is unclear.\nFinally, with respect to Maynard\u2019s meeting notes, these notes \u2014 as discussed below \u2014 may fall within the work product privilege. However, defendants have failed to meet their burden of establishing that these documents come within the purview of the medical review privilege.\nIn holding that defendants have failed to sustain their burden of proving that the three categories of documents at issue are privileged under \u00a7 131E-95, we find instructive our decision in Bryson v. Haywood Reg\u2019l Med. Ctr., 204 N.C. App. 532, 694 S.E.2d 416. In Bryson, the plaintiff - an internist - filed suit against the hospital where she had worked, claiming that her employment had been terminated in retaliation for her reporting \u201cpatient safety issues.\u201d Id. at 533-34, 694 S.E.2d at 418. During discovery, the hospital refused to respond to several of the plaintiff\u2019s interrogatories and document requests, \u201ccontending that they sought disclosure of the proceedings, records, and materials produced or considered by a medical review committee, which constituted information protected from discovery under N.C. Gen. Stat. \u00a7 131E-95(b).\u201dM at 534, 694 S.E.2d at 418-19. In response to the plaintiff\u2019s motion to compel, the hospital submitted some - but not all - of the requested materials to the trial court for in camera review. Id., 694 S.E.2d at 419. After reviewing the filed documents, the trial court entered an order protecting some documents from disclosure but directing others to be produced. Id.\nOn appeal, the hospital argued that certain internal documents ordered by the trial court to be produced were \u201cprivileged because they relate[d] to internal peer review investigations of patient charts requested by its Risk Management Department.\u201d Id. at 538, 694 S.E.2d at 421. In rejecting the hospital\u2019s contention, we observed that (1) \u201cthe documents on their face do not establish that they are privileged\u201d; and (2) the hospital \u201csubmitted no affidavits or other evidence to support its claim that the documents at issue were protected from discovery under N.C. Gen. Stat. \u00a7 131E-95(b).\u201d Id. at 540, 694 S.E.2d at 422. Thus, because of the defendants\u2019 failure to provide sufficient evidence that the medical review privilege applied, id. at 538-39, 694 S.E.2d at 421, we were compelled to conclude that the hospital had \u201cfailed to meet its burden of showing that the documents f [e]ll into one of the three categories of privileged material under N.C. Gen. Stat. \u00a7 131E-95(b),\u201d id. at 533, 694 S.E.2d at 418.\nWhile, unlike in Bryson, defendants here did submit an affidavit in support of their argument based on the medical review privilege, the affidavit - as explained above - is insufficient to satisfy their burden of proving that the RCA Report, the RMWs, and Maynard\u2019s meeting notes are privileged under \u00a7 131E-95. The mere submission of affidavits by the party asserting the medical review privilege does not automatically mean that the privilege applies. Rather, such affidavits must demonstrate that each of the statutory requirements concerning the existence of the privilege have been met. Accordingly, defendants\u2019 arguments on this issue are overruled.\nIII. Work Product Doctrine\nDefendants also contend that the work product doctrine \u2014 set out in Rule 26(b)(3) of the North Carolina Rules of Civil Procedure \u2014 protects from disclosure notes made by Maynard regarding his discussions with Bax, Untch, and various other individuals possessing knowledge of the operating room fire as well as information about the content of these discussions.\nThe work product doctrine prohibits an adverse party from compelling \u201cthe discovery of documents and other tangible things that are \u2018prepared in anticipation of litigation\u2019 unless the party has a substantial need for those materials and cannot \u2018without undue hardship . . . obtain the substantial equivalent of the materials by other means.\u2019 \u201d Long v. Joyner, 155 N.C. App. 129, 136, 574 S.E.2d 171, 176 (2002) (quoting N.C. R. Civ. P. 26(b)(3)), disc. review denied, 356 N.C. 673, 577 S.E.2d 624 (2003).\nThe party asserting the work product doctrine \u201cbears the burden of showing (1) that the material consists of documents or tangible things, (2) which were prepared in anticipation of litigation or for trial, and (3) by or for another party or its representatives which may include an attorney, consultant, surety, indemnitor, insurer or agent.\u201d Evans, 142 N.C. App. at 29, 541 S.E.2d at 789 (citation and quotation marks omitted). Our Supreme Court has made clear, however, that \u201c[materials prepared in the ordinary course of business are not protected, nor does the protection extend to facts known by any party.\u201d Willis v. Duke Power Co., 291 N.C. 19, 35, 229 S.E.2d 191, 201 (1976) (citing C. Wright & A. Miller, Federal Practice and Procedure \u00a7 2024, at 197 (1970)).\nOn appeal, we review \u201cthe trial court\u2019s application of the work product doctrine ... under an abuse of discretion standard.\u201d Evans, 142 N.C. App. at 27, 541 S.E.2d at 788. Under this standard, a trial court\u2019s ruling may be reversed only upon a showing that it was manifestly unsupported by reason or so arbitrary that it could not have been the result of a reasoned decision. K2 Asia Ventures, .__ N.C. App. at_, 717 S.E.2d at 8 (citation and quotation marks omitted).\nDefendants contend that Maynard\u2019s notes were prepared in anticipation of litigation, relying on the following statement in Maynard\u2019s affidavit:\nBecause of the nature of the event (a fire in the operating room) and based on my experience as a Risk Manager, I immediately anticipated that litigation related to the event could result. In anticipation of litigation, I met with members of the plaintiff\u2019s family along with Jim Bax, CRNA, Dr. Saini, Dr. Kubit and Dr. Ruben Rivers to discuss the incident. I do not recall the date of that meeting. On September 20, 2010, in anticipation of litigation, I met with operating room personnel to discuss the event. This meeting occurred after my meeting with Ms. Hammond\u2019s family. After both of these meetings, and in anticipation of litigation, I prepared notes reflecting the discussions that occurred in the meetings.\nPlaintiff counters, however, by arguing that the record is unclear whether Maynard actually prepared his notes in the ordinary course of business pursuant to CCHS\u2019s policies regarding \u201cQuality Care Reports,\u201d \u201cReportable Incidents,\u201d and the \u201cPatient Safety Response Team.\u201d If so, plaintiff contends, the notes would not qualify for work product immunity under Rule 26(b)(3) because they would have been prepared pursuant to hospital policy as a matter of course following incidents of this nature regardless of whether litigation was anticipated. See Cook v. Wake County Hosp. Sys., Inc., 125 N.C. App. 618, 625, 482 S.E.2d 546, 551-52 (1997) (holding that hospital\u2019s accident report was not protected from discovery under Rule 26(b)(3) because \u201creport would have been compiled, pursuant to the hospital\u2019s [risk management] policy, regardless of whether [plaintiff] intimated a desire to sue the hospital or whether litigation was ever anticipated by the hospital\u201d).\nIn this regard, we note that on at least two occasions, plaintiff requested that CCHS \u201c[p]rovide all hospital bylaws, policies, rules, and/ or procedures\u201d relating to \u201cthe prevention of fire in operating rooms or during surgery . . . .\u201d CCHS, however, never provided plaintiff with the responsive policies. Nor did CCHS submit them to the trial court for consideration - despite counsel\u2019s acknowledgment during oral arguments at this Court that having the requested policies would have been helpful to the trial court in determining whether Maynard\u2019s notes were prepared in anticipation of litigation as required by Rule 26(b)(3).\nWe are unable to determine on the record currently before us whether the trial court abused its discretion in compelling the production of Maynard\u2019s notes in the face of defendants\u2019 work product objection. Nor do we believe that the trial court was capable of making a determination of whether these notes were made in the ordinary course of the hospital\u2019s business without first examining the policies requested by plaintiff and determining whether the notes were made pursuant to hospital policy.\nIn concluding that a remand to the trial court is necessary on this issue, we are guided by our decision in Diggs v. Novant Health, Inc., 177 N.C. App. 290, 628 S.E.2d 851 (2006), disc. review denied, 361 N.C. 426, 648 S.E.2d 208 (2007). In Diggs, the plaintiff suffered injuries during a surgical procedure and brought a medical malpractice claim against the hospital where the procedure was performed and against the members of the medical staff involved. Id. at 293-94, 628 S.E.2d at 854. During discovery, the plaintiff moved to compel the defendants to produce any documents \u201cdiscuss[ing]\u201d the plaintiff\u2019s injury or \u201cany problems ... during her... hospitalization.\u2019 \u201d Id. at 310, 628 S.E.2d at 864.\nThe defendants objected to the disclosure, arguing that the responsive documents - contained in their \u201c \u2018Risk Management file\u2019 \u201d - \u201cwere protected from production by the attorney-client privilege and the work product doctrine ...Id. After reviewing the documents in camera, the trial court denied in part and granted in part the plaintiff\u2019s motion to compel. Id. On appeal, the plaintiff contended that the trial court erred to the extent that it did not compel production of all the responsive documents.\nThis Court, after explaining that the work product doctrine shields from discovery only those \u201cdocuments prepared \u2018in anticipation of litigation,\u2019 \u201d reviewed the submitted documents in light of the hospital\u2019s \u201cpolicy \u2018for the reporting of all unexpected events\u2019 \u201d in order to determine whether the documents were prepared pursuant to that policy. Id. at 310-11, 628 S.E.2d at 864-65. However, after \u201ccarefully examin[ing] the documents and the information provided by [the] defendants regarding the nature of those documents[,]\u201d id. at 310, 628 S.E.2d at 864, we were \u201cunable to determine from the current record whether the documents at issue were generated pursuant to [the hospital\u2019s risk management] policy[,]\u201d id. at 312, 628 S.E.2d at 865.\nIn particular, we observed that while \u201ccertain documents appear to correspond to the reports and summaries required by the hospital\u2019s policy,\u201d they were not specifically labeled as such, and thus we could not properly determine their status. Id. at 312, 628 S.E.2d at 865. Thus, we \u201cremand[ed] to the trial court for further review as to these documents,\u201d emphasizing that the \u201cdefendants b[ore] the burden of demonstrating that the specified documents\u201d were protected. Id.\nSimilarly, here, for the reasons set out above, we remand to the trial court for it to conduct an analysis of whether Maynard\u2019s notes are protected by the work product doctrine based on its review not only of Maynard\u2019s affidavit and the other evidentiary submissions in the record but also based on its review of the pertinent policies of CCHS. We note our concern regarding the inordinate amount of time defendants have taken to provide the requested policies to plaintiff. We direct the trial court, on remand, to issue a deadline for defendants to submit the policies at issue both to plaintiff and to the trial court. After the trial court has completed its review, it shall issue a new order containing its determination of whether the work product doctrine serves as a bar to the issuance of an order compelling the production of these meeting notes. We leave it to the trial court\u2019s discretion whether defendants should be required to also submit the notes themselves to the court for an in camera inspection.\nFinally, we reject defendants\u2019 argument that the trial court abused its discretion in compelling them to respond to plaintiff\u2019s interrogatories despite their objections based on the work product doctrine. It is well established that the work product doctrine only applies to documents or other tangible things. See Long, 155 N.C. App. at 136-37, 574 S.E.2d at 176 (holding that \u201cplaintiff\u2019s interrogatories did not violate Rule 26(b)(3)\u201d because they \u201cdid not ask defendants for documents or tangible things\u201d).\nConclusion\nFor the reasons stated above, we dismiss defendants\u2019 appeal in part, affirm the trial court\u2019s orders granting plaintiff\u2019s motions to compel in part, and vacate and remand that portion of the trial court\u2019s orders compelling the production of Maynard\u2019s meeting notes.\nDISMISSED IN PART; AFFIRMED IN PART; REMANDED IN PART.\nChief Judge MARTIN and Judge BRYANT concur.\n. Defendants Carolina Plastic Surgery of Fayetteville, Cumberland Anesthesia Associates, Dr. Saini, and Dr. Kubit are not parties to this appeal.\n. An interlocutory order compelling production of documents alleged to be protected from disclosure by the attomey/client privilege also affects a substantial right and is, therefore, immediately appealable. Evans v. United Servs. Auto. Ass\u2019n, 142 N.C. App. 18, 23-24, 541 S.E.2d 782, 786, cert. denied, 353 N.C. 371, 547 S.E.2d 810 (2001). Here, although defendants make a passing reference to the attomey/client privilege in their brief, they make no specific argument regarding the applicability of this privilege as required under Rule 28(b)(6) of the North Carolina Rules of Appellate Procedure. Moreover, our review of the transcript of the hearing on plaintiff\u2019s motions to compel reveals that defendants likewise did not make any argument before the trial court concerning the attomey/client privilege. As such, defendants have waived any argument based on the attorney/ client privilege and, accordingly, we do not address its applicability in this opinion.\n. A trial court is not required to make findings of fact or conclusions of law where no request is made by the parties. J.M. Dev. Grp. v. Glover, 151 N.C. App. 584, 586, 566 S.E.2d 128, 130 (2002).\n. We note that defendants\u2019 brief contains a cursory, one-sentence argument that the documents at issue are also protected by the statutory privilege afforded to quality assurance committees in N.C. Gen. Stat. \u00a7 90-21.22A. This Court has recognized that the privilege applicable to quality assurance committees pursuant to \u00a7 90-21.22A \u201cis functionally identical\u201d to the privilege afforded to medical review committees under \u00a7 131E-95(b). Armstrong v. Barnes, 171 N.C. App. 287, 294, 614 S.E.2d 371, 376, disc. review denied, 360 N.C. 60, 621 S.E.2d 173 (2005). Accordingly, for the reasons already discussed, we conclude that defendants failed to sustain their burden of proving the applicability of \u00a7 90-21.22A as well.\n. In their brief, defendants mention in passing other discovery requests that they contend are protected by the work product doctrine. Defendants, however, fail to advance any specific argument regarding the applicability of the work product doctrine to the documents or information sought by these discovery requests. Defendants\u2019 failure to make a particularized argument regarding these specific discovery requests constitutes waiver of the issue on appeal. See Latta v. Rainey, 202 N.C. App. 587, 597, 689 S.E.2d 898, 908 (2010) (holding that where \u201cdefendant fail[ed] to make any specific argument in his brief\u2019 regarding certain issue, the issue was deemed abandoned on appeal).", "type": "majority", "author": "DAVIS, Judge." } ], "attorneys": [ "McGuireWoods, LLP, by Patrick M. Meacham and Monica E. Webb, for defendants-appellants Cumberland County Hospital System, Inc., James Bax, and Wanda Untch.", "Patterson Harkavy LLP, by Burton Craige and NarendraK. Ghosh; and Beaver, Holt, Stemlicht & Courie, P.A., by Mark A. Stemlicht, for plaintiff-appellee." ], "corrections": "", "head_matter": "JUDY HAMMOND, Plaintiff v. SAIRA SAINI, M.D., CAROLINA PLASTIC SURGERY OF FAYETTEVILLE, P.C., VICTOR KUBIT, M.D., CUMBERLAND ANESTHESIA ASSOCIATES, P.A., WANDA UNTCH, JAMES BAX, and CUMBERLAND COUNTY HOSPITAL SYSTEM, INC., Defendants\nNo. COA12-1493\nFiled 3 September 2013\n1. Appeal and Error \u2014 interlocutory orders and appeals\u2014 discovery order interlocutory \u2014 privilege asserted \u2014 substantial right\nThe Court of Appeals had jurisdiction to review contentions based on the medical review privilege and the work product privilege even though the trial court order compelling discovery was interlocutory. A substantial right is affected where a party asserts a privilege or immunity directly related to the matter to be disclosed and not frivolous or insubstantial.\n2. Appeal and Error \u2014 preservation of issues \u2014 argument waived \u2014 no objection\nDefendants waived on appeal any argument concerning the production of documents allegedly protected by the attorney client privilege when they did not make any argument before the trial court concerning that privilege or make a specific argument on appeal regarding the applicability of the privilege, although they made a passing reference to the privilege in their brief.\n3. Discovery \u2014 production of documents \u2014 medical review privilege\nThe trial court did not err in an action arising from an operating room fire by granting plaintiff\u2019s motion to compel production of documents, despite defendants\u2019 claim of medical review privilege. Defendants\u2019 contentions rested on the proposition that the hospital\u2019s Root Cause Analysis (RCA) Team was in fact a medical review committee, but defendants did not show that the RCA Team was part of the medical staff of the hospital, as required by N.C.G.S. \u00a7 131E-76(5) (b), or that the RCA Team was created by the governing board or medical staff of the hospital as required by N.C.G.S. \u00a7 131E-76(5)(c).\n4. Discovery \u2014 medical review privilege \u2014 statutory requirements\nEven if a Root Cause Analysis (RCA) Team that examined the cause of an operating room fire qualified as a medical review committee, defendants did not meet their burden of proving that thedocuments at issue were privileged under N.C.G.S. \u00a7 131E-95.The mere submission of an affidavit by the party asserting the medical review privilege does suffice; such affidavits must demonstrate that each of the statutory requirements have been met.\n5. Discovery \u2014 work product rule \u2014 hospital risk manager\nThe question of whether notes about an operating room fire made by the hospital\u2019s risk manager were protected from disclosure by the work product rule was remanded where the record did not allow a determination of whether the notes were made in the ordinary course of business.\nAppeal by defendants from orders entered 18 June 2012 by Judge Mary Ann Tally in Cumberland County Superior Court. Heard in the Court of Appeals 22 April 2013.\nMcGuireWoods, LLP, by Patrick M. Meacham and Monica E. Webb, for defendants-appellants Cumberland County Hospital System, Inc., James Bax, and Wanda Untch.\nPatterson Harkavy LLP, by Burton Craige and NarendraK. Ghosh; and Beaver, Holt, Stemlicht & Courie, P.A., by Mark A. Stemlicht, for plaintiff-appellee." }, "file_name": "0359-01", "first_page_order": 369, "last_page_order": 383 }