A D.C. Superior Court judge has ordered Washington Hospital Center to open the records of a confidential peer review of a prominent heart surgeon whose performance was questioned in the deaths of five patients nearly a decade ago. It is the first such ruling in the District.

The order, which was appealed yesterday, seeks to pierce the secrecy surrounding the hospital's internal investigation of Richard N. Scott, whose open-heart surgery privileges were suspended and who left the hospital after a series of hospital reviews and studies criticized his performance in the patient deaths. The hospital said that, as part of an agreement with Scott, it would not release details of the internal reviews to anyone, including other hospitals.

City law says that hospitals can keep peer review records secret, except in cases in which there is an "extraordinary necessity" that the records be opened. On June 29, Judge Richard Salzman ruled that such a showing had been made in a lawsuit filed by the family of one patient, Willard Jackson, who died in 1980 during cardiac bypass surgery performed by a medical team headed by Scott.

Given the passage of time and the apparent loss or destruction of some records, Salzman said, "the peer review materials appear to be the most reliable evidence available of the events surrounding Mrs. Jackson's death."

The peer review process is typically carried out in the utmost secrecy, with most records never released, even to plaintiffs who subpoena them in malpractice suits. The process has long been defended by the medical profession and upheld in the courts as the most effective way of self-regulation. It is believed doctors, nurses and others will candidly assess their colleagues' performances only when they are assured that strict confidentiality will be maintained and that their reports will not become embroiled in litigation.

Although a lawyer for Jackson's family hailed the ruling, hospital attorney J. Joseph Barse said in court papers that it would have a "profound effect on the practice and procedures" at Washington Hospital Center, and that if the order is upheld, the hospital would face a "terrible dilemma" that might force it to disband its peer review process altogether.

The hospital has asked for a stay and clarification of the order. Scott's attorneys filed a notice of appeal to the D.C. Court of Appeals.

With a Monday deadline for the hospital to produce the material, the case may become a key test of what one hospital attorney has called "a balancing of the public's right to know . . . and the privacy of the process."

Scott has denied the allegations raised in the Jackson suit. The suit alleges malpractice and concealment of negligence through the confidentiality of peer review. The Jackson family said it learned of the hospital's investigation of Scott only after a 1988 Washington Post article.

Richard Mudd, the family's attorney, said that in legal clashes between the hospital's obligation to provide good care and the rights of a patient, "the odds are rather stacked against the individual."

Salzman's order is tailored to the facts of the Jackson case, but Scott's and the hospital's attorneys criticized it for placing no limit on dissemination of the material, and because the records may include other cases. Other patients' names are to be deleted.

During internal hospital reviews in 1981 and 1982, Scott strongly defended his overall performance and suggested that other medical staff members' mistakes may have contributed to one patient's death. In other cases, Scott blamed his patients' poor health or the riskiness of their operations.

David Levin, Scott's attorney, said, "We maintain that anyone looking at that {Jackson} case fairly would find that the standard of care was more than adequately met."

Some medical groups expressed concern at the ruling. John Niles, president of the D.C. Medical Society, said, "The medical profession is continually being criticized for not policing itself, and we cannot police ourselves if the review of our findings can become public." He said he fears such orders "will become the rule rather than the exception."

"What is troubling," said Daniel Johnson, an American Medical Association officer, "is the possibility that this could put a chill on the peer review process, which has heretofore enjoyed confidentiality in all 50 states and the District of Columbia. The confidentiality is not to conceal information. On the contrary, it's designed to stimulate people . . . to come forward."