J-S11001-24 

 

NON-PRECEDENTIAL DECISION - SEE SUPERIOR COURT O.P. 65.37 

JOHN L. TWYMAN, 

 Appellant 

 v. 

ANNE WIEDEMANN M.D., FAMILY 

PRACTICE OF WILLOW GROVE, 

ABINGTON MEMORIAL HOSPITAL, 

ANTHONY WYDAN, M.D., JENNIFER 

ORR, M.D., THOMAS JEFFERSON 

UNIVERSITY HOSPITAL 

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 IN THE SUPERIOR COURT OF 

 PENNSYLVANIA 

 No. 1063 EDA 2023 

Appeal from the Order Entered June 26, 2023 

In the Court of Common Pleas of Montgomery County Civil Division at 

No(s): 2018-16338 

BEFORE: BOWES, J., McLAUGHLIN, J., and COLINS, J.*

MEMORANDUM BY BOWES, J.: FILED OCTOBER 8, 2024 

 John L. Twyman appeals pro se from the order entered June 26, 2023, 

denying his motion to remove the entry of compulsory nonsuit as to his 

medical malpractice claims against Anne Wiedemann, M.D.,1 Family Practice 

of Willow Grove (“Willow Grove”), and Abington Memorial Hospital 

(collectively, “Appellees”). We affirm. 

____________________________________________ 

*

 Retired Senior Judge assigned to the Superior Court. 

1

 After the complaint was filed naming Dr. Wiedemann as a defendant, she 

married and now uses the last name Tenthoff. For convenience, we will refer 

to her as Dr. Tenthoff throughout the remainder of this writing. 
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 This case arises from Appellant’s allegations that Dr. Tenthoff failed to 

properly diagnose him with pernicious anemia.2 Abington Memorial Hospital, 

which does business as Willow Grove, is a family medical practice operating 

under the umbrella of Thomas Jefferson University Hospital. Appellant first 

saw Dr. Tenthoff during a sick visit in 2007, when she substituted for another 

doctor who was unavailable. From that point, Appellant continued to see Dr. 

Tenthoff as his primary care physician throughout the years, predominantly 

for issues relating to his high blood pressure. 

On December 5, 2014, Appellant presented with complaints of ear wax 

buildup and itching arising from an allergic reaction. Dr. Tenthoff prescribed 

him an oral steroid, recommended that he obtain an over-the-counter 

medicine to address the ear wax, and refilled his blood pressure medication. 

Approximately a week later, Appellant faxed to the practice a report containing 

laboratory results of blood work that had been performed as part of his 

employment (“LabCorp Report”). According to Dr. Tenthoff, the LabCorp 

Report showed that Appellant’s red blood count and mean corpuscular volume 

levels were slightly abnormal. However, she had no specific concerns because 

his hemoglobin levels were normal and because he had never expressed 

____________________________________________ 

2

 According to Cleveland Clinic: “Pernicious anemia, one of the causes of 

vitamin B12 deficiency, is an autoimmune condition that prevents your body 

from absorbing vitamin B12. Left untreated, pernicious anemia can cause 

serious medical issues, including irreversible damage to your nervous 

system.” Cleveland Clinic, Pernicious Anemia, 

https://my.clevelandclinic.org/health/diseases/22377-pernicious-anemia 

(last visited Jul. 17, 2024). 
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having symptoms associated with something like pernicious anemia, such as 

numbness, tingling, confusion, weakness, or problems with walking or 

balance. Accordingly, Dr. Tenthoff made no follow up on the LabCorp Report, 

and Appellant requested none. Over the next several years, Appellant 

maintained his regular visits with the practice and Dr. Tenthoff. 

 On February 2, 2017, Appellant saw Dr. Tenthoff for indigestion, 

increased urinary frequency, and nocturia, which is excessive urinating 

overnight. The doctor diagnosed him as having either gastro esophageal 

disease (“GERD”) or benign prosatic hyperplasia. Accordingly, she prescribed 

omeprazole and requested that he contact the office the following week if his 

symptoms did not abate. Appellant called the practice approximately five days 

later, relaying that he was still suffering symptoms. Dr. Tenthoff consequently 

instructed him to increase the daily dose of the omeprazole. 

 Dr. Tenthoff next spoke with Appellant on the phone on March 2, 2017, 

when he informed her that his condition had not improved. Dr. Tenthoff 

referred him to a gastrointestinal specialist. Appellant did not see any 

specialist pursuant to the doctor’s advice, though he did visit an urgent care 

facility called Patient First Urgent Care. 

 On March 9, 2017, while Dr. Tenthoff was out of town, Appellant called 

Willow Grove and spoke with a receptionist. The trial court summarized the 

following events thusly: 

[Appellant] requested that he be placed on the medication 

pantoprazole because the originally prescribed omeprazole was 

not helping. . . . No further symptoms were communicated to 
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the practice besides throat discomfort. Dr. Tenthoff requested 

that one of the medical assistants in her office contact [Appellant] 

to clarify which medication he was requesting[, since pantoprazole 

and omeprazole were simply different brands of the same generic 

drug]. Later that evening, [Appellant] contacted Dr. Anthony 

Wydan, the on-call physician. [Appellant] was angry that 

pantoprazole had not been called into the pharmacy for him after 

he had requested it. Dr. Tenthoff was unaware that [Appellant] 

had already received a prescription for pantoprazole from Patient 

First Urgent Care . . . 

 

On [the following] morning of March 10, 2017, [Appellant] 

called the practice and began yelling at staff. He told staff he had 

lost weight, indicated that he would be requesting his medical 

records, and said “I will show her what the pain is of having 

someone try to kill you.” [Appellant] “said that if he did not 

receive a phone call from Dr. Tenthoff by 5:00 p.m. with an 

apology, there were consequences to be had.” Dr. Tenthoff took 

[Appellant]’s words as a direct threat. [She] determined that the 

office needed to start the process “to get him removed to make 

sure we were all safe.” 

 . . . . 

Dr. Tenthoff testified that during [Appellant’s] treatment with her 

in 2017, [Appellant] had no symptoms that would have required 

her to check a complete blood count [test (“CBC”)] of [vitamin] 

B12 levels. 

Trial Court Opinion, 6/1/23, at 4-5 (cleaned up). 

 Within several days of these phone calls, Appellant obtained a blood test 

through Patient First Urgent Care, which revealed that he was severely 

dehydrated and required emergency treatment. He immediately went to 

Doylestown Hospital based on that and other related problems, including 

malnourishment, weight loss, the inability to swallow, confusion, and slurred 

speech. Doctors at the hospital diagnosed Appellant with, inter alia, pernicious 

anemia. After receiving treatment, his condition gradually improved. 
J-S11001-24 

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Appellant filed a pro se complaint against the Appellees and several other 

defendants, which, as amended a third time, raised one count each of 

professional negligence, intentional infliction of emotional distress (“IIED”), 

and vicarious liability. Within the complaint, Appellant alleged that from the 

time he sought help from Dr. Tenthoff in early February 2017 until his 

diagnosis in March, he suffered from bouts of psychosis and hallucinations, 

and was “also suffering from severe malnutrition, fatigue, sleeplessness[,] and 

hopelessness.” Third Amended Complaint, 10/26/28, at ¶ 14. Appellant also 

sought punitive damages in conjunction with the IIED claim. Prior to trial, the 

parties stipulated to discontinue any actions against any defendants besides 

Appellees. 

 The case proceeded to a jury trial wherein Appellant represented 

himself. Appellant called Dr. Tenthoff as if on cross, who testified consistently 

with the above background. Appellant testified on his own behalf. Critically, 

he also called Mark Levin, M.D. as an expert witness. As will be discussed in 

more detail infra, Dr. Levin’s testimony generally bore out that Appellant had 

likely suffered from pernicious anemia for several years prior to 2017 and that, 

had Willow Grove done a CBC test in December 2014 after receiving the 

LabCorp Report, Appellant would have been diagnosed sooner and treated 

before his condition became dire. 

 Appellant also introduced testimony from Arlene Stillwater, Psy.D., a 

clinical psychologist. Among other things, she relayed that Appellant began 

treating with her in 2021 for post-traumatic stress disorder (“PTSD”), 
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depression, and anxiety, which Appellant claimed arose from his near-death 

experience before going to Doylestown Hospital. 

At the conclusion of Appellant’s case-in-chief, Appellees moved for 

compulsory nonsuit, contending that Appellant had not met his burden of proof 

as to any of his claims. The trial court, which had access to the transcripts 

containing Dr. Levin’s testimony prior to the close of Appellant’s case, granted 

the motion. Specifically, the court placed the following on the record at trial: 

With respect to the claims for [IIED], the [c]ourt rules that there 

is insufficient evidence to support those causes of action, so the 

nonsuit with respect to those will be granted. 

 . . . . 

As I said, I have Dr. Levin’s transcribed notes. And after careful 

review of the transcribed notes of testimony, of Dr. Levin’s 

testimony, the court find[s] the following: 

Plaintiff failed to produce an expert, medical testimony at 

trial regarding the standard of care applicable to Dr. 

Tenthoff during her treatment of [Appellant]; 

That the plaintiff did not produce an expert medical 

testimony at trial which qualified Dr. Levin to express expert 

medical opinion regarding the standard of care or a standard 

of care violation by a family physician pursuant to Section 

1303.512(c) of the [Medical Care Availability and Reduction 

of Error Act.] 

And the plaintiff failed to produce expert medical testimony 

at trial which was held to a reasonable degree of medical 

certainty. 

Those magic words don’t need necessarily to be expressed, 

according to case law, but the court has to be satisfied, in 

looking at the entirety of an expert’s testimony, that the 
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expert has the requisite degree of certainty that is 

equivalent to a reasonable degree of medical certainty. 

Here the plaintiff failed to produce medical testimony at trial 

which was held to a reasonable degree of medical certainty 

or language equivalent to that, that Dr. Tenthoff violated 

the standard of care, risk of harm, or was a proximate cause 

or probable cause of any harm to him. 

N.T. Trial, 1/6/23, at 173-75 (some capitalization altered) 

Since the court found that Dr. Tenthoff was not liable for either 

malpractice or IIED, Appellant’s count for vicarious liability and request for 

punitive damages were likewise dismissed. Appellant timely filed a post-trial 

motion requesting removal of the nonsuit and a new trial. The court denied 

the motion and this pro se appeal followed.3 Appellant was ordered to file a 

statement of errors pursuant to Pa.R.A.P. 1925(b), and he did so. The court 

thereafter issued a responsive opinion. 

Appellant presents three issues for our consideration, which we have 

reordered for ease of disposition: 

I. Did the court abuse its discretion when granting the Appellees’ 

January 6, 2023 motion for compulsory nonsuit when 

____________________________________________ 

3

 At the time Appellant filed his notice of appeal, there was no entry of 

judgment on the docket. We have stated that “in a case where nonsuit was 

entered, the appeal properly lies from the judgment entered after denial of a 

motion to remove nonsuit.” Billig v. Skvarla, 853 A.2d 1042, 1048 

(Pa.Super. 2004). Accordingly, we remanded the case and directed Appellant 

to praecipe the trial court Prothonotary to enter final judgment on the verdict 

and to file with this Court a certified copy of the trial court docket reflecting 

the entry of judgment within fourteen days. Appellant complied, and we 

therefore treat this appeal as timely. See Pa.R.A.P. 905(a)(5) (“A notice of 

appeal filed after the announcement of a determination but before the entry 

of an appealable order shall be treated as filed after such entry and on the 

day thereof.”). 
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Appellant’s medical expert provided standard of care, liability, 

and causation testimony at trial? 

II. Did the trial court abuse its discretion by not providing relief 

under Pa.R.C.P. 227.1 by not removing its January 9, 2023 

compulsory [nonsuit] as Appellant met a prima facie case for 

medical malpractice? 

III. Did the trial court abuse its discretion by dismissing Appellant’s 

claims for [IIED] and punitive damages at the close of 

Appellant’s case in chief? 

Appellant’s brief at 6 (cleaned up). 

 We review these claims under the following standard: 

A trial court may enter a compulsory nonsuit on any and all causes 

of action if, at the close of the plaintiff’s case against all 

defendants on liability, the court finds that the plaintiff has failed 

to establish a right to relief. Absent such finding, the trial court 

shall deny the application for a nonsuit. On appeal, entry of a 

compulsory nonsuit is affirmed only if no liability exists based on 

the relevant facts and circumstances, with appellant receiving “the 

benefit of every reasonable inference and resolving all evidentiary 

conflicts in [the appellant’s] favor.” The compulsory nonsuit is 

otherwise properly removed and the matter remanded for a new 

trial. 

The appellate court must review the evidence to determine 

whether the trial court abused its discretion or made an error of 

law. 

Baird v. Smiley, 169 A.3d 120, 124 (Pa.Super. 2017) (internal citations 

omitted). 

 Appellant’s first two issues concern the trial court’s refusal to remove 

the compulsory nonsuit as to the medical malpractice count. This Court has 

stated that “[m]edical malpractice can be broadly defined as the unwarranted 

departure from generally accepted standards of medical practice resulting in 

injury to a patient.” Nigon v. Jewell, 313 A.3d 1124, 1133 (Pa.Super. 2024) 
J-S11001-24 

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(citation omitted). To prove this action, a plaintiff must demonstrate the 

following elements: 

a duty owed by the physician, that the breach was the proximate 

cause of the harm suffered, and the damages were a direct result 

of harm. With all but the most self-evident medical malpractice 

actions, there is also the added requirement that the plaintiff must 

provide a medical expert who will testify as to the elements of 

duty, breach, and causation. 

Id. Further, as to causation, “the plaintiff must show that the defendant 

physician’s failure to exercise the proper standard of care caused the plaintiff’s 

injury. Generally, a plaintiff in a medical negligence action must present 

expert testimony to establish the physician’s deviation from the standard of 

care proximately caused the plaintiff’s injury.” Id. 

 In its 1925(a) opinion, the trial court offered a thorough analysis as to 

why it did not err in granting a compulsory nonsuit regarding Appellant’s 

professional negligence claim. First, it summarized Dr. Levin’s testimony as 

such: 

Dr. Levin testified that he reviewed the [LabCorp Report] of 

December 14, 2014, and noted that “the white [blood] count was 

decreased, the platelet count was decreased[,] and the red blood 

count was decreased. And the MCV . . . was decreased.” He 

testified that these levels could be pre-markers for pernicious 

anemia as well as other serious conditions. Dr. Levin also testified 

that in 2004, [Appellant] was put on [vitamin] B12 injections but 

only took them for a month. Upon examination of the March 11, 

2017 Doylestown Hospital record, Dr. Levin acknowledged that 

[Appellant] was diagnosed with a B12 deficiency, pernicious 

anemia, GERD, pancytopenia, and gastritis. Dr. Levin testified 

that “pernicious anemia in my opinion based on everything I 

reviewed, has been in place for years.” Dr. Levin further testified 

that had any testing been done at the time of the December 2014 

report was reviewed by Dr. Tenthoff, the diagnosis of pernicious 
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anemia or vitamin B12 deficiency could have been made. He 

testified that “doing a CBC. . . and B12 level would have given you 

the diagnosis. Another thing that could have been done is to have 

the lab do a blood smear which would have also confirmed a B12 

deficiency.” 

. . . . 

Significantly, . . . Dr. Levin never offered his expert opinion 

within a reasonable degree of medical certainty regarding 

the standard of care in this case, whether [Appellees] 

deviated from that standard of care and whether any 

violation in the standard of care either increased the risk of 

harm or was a factual cause of harm to [Appellant]. 

Trial Court Opinion, 6/1/23, at 9-10 (cleaned up, emphasis added). 

 After reviewing Dr. Levin’s testimony, the trial court concluded that it 

properly granted nonsuit against Appellant on his malpractice claim because 

Appellant failed to meet his burden of establishing a prima facie case for 

professional negligence. Id. at 15. Specifically, it found that “Dr. Levin never 

testified that Dr. Tenthoff’s conduct fell below the standard of care for a family 

physician or for any other physician.” Id. at 16. Rather, the court determined 

that the doctor’s testimony only established that “[Appellant] had pernicious 

anemia while under Dr. Tenthoff’s care. Dr. Levin never testified that the 

standard of care was violated by failing to diagnose and treat that condition 

or that said deviation increased the risk of harm or was [the] factual cause of 

any harm.” Id. at 19. 

 Appellant vigorously disputes this finding in his principal brief, which is 

over 100 pages in length and which he readily admits exceeds the word limit 
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provided by Pa.R.A.P. 2135(a)(1).4 He asserts that Dr. Levin “provided 

testimony as to the standard of care as to the diagnosis and treatment of 

pernicious anemia to a reasonable degree of medical certainty.”5 Appellant’s 

brief at 34 (some capitalization altered). Id. at 36-37. Appellant further 

states that the court erred because Dr. Levin established harm, opining that 

“Appellant was suffering prolonged, untreated pernicious anemia during the 

medical occurrence at issue as confirmed by the medical records from 

Doylestown Hospital between March 11, 2017 and March 12, 2017.” Id. at 

41. 

Furthermore, Appellant highlights that there was testimony that Dr. 

Tenthoff was the cause of his harm, arguing that “[b]ased on the evidence in 

Appellant’s case-in-chief, a reasonable jury could have easily concluded 

Appellees’ failure to properly diagnose, treat, and manage Appellant’s 

____________________________________________ 

4

 “The certification requirement is not limited to counsel: Pro se litigants, too, 

are obliged to provide a certification for a primary brief that exceeds thirty 

pages.” In re deLevie, 204 A.3d 505, 510-11 (Pa.Super. 2019). While we 

could sanction Appellant for violating this rule, we decline to do so in this 

instance since his defective brief has not hampered our review. 

5

 In so doing, Appellant relies upon promulgated guidelines for the treatment 

of pernicious anemia from the National Heart, Lung and Blood Institute 

website, without citation to where in the record this document was entered 

into evidence. Similarly, in his reply brief, Appellant cites to and discusses a 

2020 medical training manual that was not introduced at trial. See Appellant’s 

reply brief at 21. We may not consider these materials. See Commonwealth 

v. Branthafer, 315 A.3d 113, 118 n.1 (Pa.Super. 2024) (stating that “under 

the Pennsylvania Rules of Appellate Procedure, any document which is not 

part of the officially certified record is deemed non-existent - a deficiency 

which cannot be remedied merely by including copies of the missing 

documents in a brief or in the reproduced record”). 
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pernicious anemia was not only reckless, but the proximate cause of his harm, 

injuries, and severe emotional distress.” Id. at 46 (emphasis in original); see 

also id. at 47 (discussing Carrozza v. Greenbaum, 866 A.2d 369 (Pa.Super. 

2004)). He additionally contends, without citation to the record, that “Dr. 

Levin testified that Dr. Tenthoff should have acted on the [LabCorp Report] 

outlining abnormal and elevated blood cell counts and levels,” and further that 

“the acceptable standard of care was to order a [CBC] . . . to determine the 

existence of pernicious anemia.” Id. at 48. 

 Upon review, we find that the trial court did not err in granting 

compulsory nonsuit against Appellant regarding the count for medical 

malpractice. Our close examination of Dr. Levin’s testimony confirms the 

conclusion that he failed to identify a standard of care to the jury, allege that 

Dr. Tenthoff deviated from that standard of care, or opine that any such 

deviation caused Appellant’s injuries. The substantial bulk of Appellant’s brief 

and reply brief is dedicated to pointing out the extensive testimony and 

evidence showing that (1) Appellant had pernicious anemia for years before it 

was diagnosed, and (2) it could have been diagnosed in December 2014 had 

additional testing been done by Dr. Tenthoff. Appellant takes great pains to 

reiterate these points numerous times throughout his filings in this Court. 

However, even assuming that this is true, that still falls short as a matter of 

law of meeting Appellant’s burden to establish professional negligence. 

Dr. Levin did not testify, for example, that the standard of care for a 

family practice would be to conduct a CBC test upon receiving lab results from 
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a patient when hemoglobin levels were within normal limits. He likewise did 

not attest to a reasonable degree of medical certainty that such testing would 

be expected to be performed when the patient did not complain of any 

symptoms associated with pernicious anemia or vitamin B12 deficiency, 

including confusion, instability, weakness, or numbness. Without expert 

testimony as to the appropriate standard of care and any deviation therefrom, 

the jury simply had no basis in which to find in Appellant’s favor for 

malpractice against Dr. Tenthoff. See Nigon, 313 A.3d at 1133. This is true 

regardless of the fact that Appellant appears to believe that the jury could 

simply infer testimony of a standard of care and any deviation therefrom 

through Dr. Levin’s testimony.6 

Since the vicarious liability count against Willow Grove and Abington 

Memorial Hospital relied upon a finding of professional negligence as to Dr. 

Tenthoff, they necessarily failed when the court dismissed the professional 

negligence action. Therefore, no relief is due. 

____________________________________________ 

6 See Appellant’s brief at 54 (“The acceptable standard of care for Dr. Tenthoff 

on December 18, 2014, or soon thereafter would have been to further 

evaluate the results for pernicious anemia or a Vitamin B-12 deficiency, and 

not simply closing the file and advising Appellant that he was fine.”); see also

Appellant’s reply brief at 19 (“Dr. Levin’s expert testimony was clear and 

concise that, upon reviewing the [LapCorp Report] and the low red blood cell 

count (RBC) and elevated mean corpuscular volume (MCV) level, Dr. Tenthoff 

should have known to order or perform a CBC to determine if Appellant was 

suffering from low Vitamin B-12 or pernicious anemia.” (emphasis in 

original)). As indicated, these conclusions were never provided by Dr. Levin, 

and instead are simply Appellant’s individualized notion of what he believed 

Dr. Tenthoff should have done as his physician. 
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 Appellant’s remaining claim maintains that the court improperly 

dismissed the count for IIED and Appellant’s corresponding request for 

punitive damages. “The four elements [a p]laintiff must show to establish 

[IIED] are: (1) the conduct must be extreme and outrageous; (2) the conduct 

must be intentional or reckless; (3) it must cause emotional distress; and (4) 

the distress must be severe.” Jordan v. Pennsylvania State University, 

276 A.3d 751, 775 (Pa.Super. 2022) (citation omitted). It is the responsibility 

of the court to determine, “as a matter of law, whether there is sufficient 

evidence for reasonable persons to find extreme or outrageous conduct.” Id. 

“The conduct must be so outrageous in character and so extreme in degree, 

as to go beyond all possible bounds of decency, and to be regarded as 

atrocious, and utterly intolerable in a civilized community.” Id. Our High 

Court has recounted that concerning outrageousness, “it has not been enough 

that the defendant has acted with intent which is tortious or even criminal . . . 

or even that his conduct has been characterized by ‘malice,’ or a degree of 

aggravation that would entitle the plaintiff to punitive damages for another 

tort.” Toney v. Chester County Hosp., 961 A.2d 192, 202 (Pa. 2008) 

(citations omitted). 

 The trial court concluded that Appellant presented no evidence at trial 

that any action or inaction by Dr. Tenthoff rose to the level of being “extreme 

and outrageous.” See Trial Court Opinion, 6/1/23, at 20-22. In his brief, 

Appellant focuses much of his discussion on the extent of the emotional 

distress he suffered as a result of his pernicious anemia. See, e.g., 
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Appellant’s brief at 63 (discussing Dr. Stillwater’s testimony and that as an 

expert, she “satisfied the requirements for a cause of action and proximate 

cause for his severe emotional distress and PTSD linking both, and Appellant’s 

on-going outpatient mental health treatment, to the harm and injuries 

suffered between February 2, 2017 and March 17, 2017 and its aftermath”). 

As to the severity of Dr. Tenthoff’s conduct, the thrust of Appellant’s claim is 

that she acted recklessly by abandoning him as a patient when he was 

suffering from serious medical issues, as well as by purportedly modifying 

hospital records.7

Based on our review, we agree with the trial court that, as a matter of 

law, the jury could not find that the evidence presented by Appellant was 

sufficient to satisfy this claim. Specifically, none of the testimony against Dr. 

Tenthoff would have permitted a juror to conclude that she acted 

outrageously, as required to prove IIED. See, e.g., Jordan, 276 A.3d at 775 

(concluding that the plaintiff’s assertion that the defendants failed to correctly 

diagnose an infection in the knee after a CT scan did not constitute “extreme 

and outrageous conduct”). Moreover, despite Appellant classifying Dr. 

Tenthoff’s actions as “reckless” on several occasions in his briefs to this Court, 

this is insufficient, since recklessness goes to the state of mind of the actor in 

____________________________________________ 

7

 Appellant also asserts that some of the conduct of counsel for Appellees was 

egregious during the pendency of litigation, such as withholding certain 

discovery. See Appellant’s brief at 81-84. However, this has no bearing as 

to whether Dr. Tenthoff engaged in “extreme or outrageous” conduct during 

the period alleged in Appellant’s third amended complaint. 
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causing harm and is a separate inquiry from whether the conduct itself was 

extreme or outrageous. See John v. Philadelphia Pizza Team, Inc., 209 

A.3d 380, 384 (Pa.Super. 2019) (“Pennsylvania law imposes liability on one 

who by extreme and outrageous conduct intentionally or recklessly causes 

severe emotional distress to another is subject to liability for such emotional 

distress” (citation omitted)). Finally, assuming that Appellant’s assertion that 

Dr. Tenthoff inappropriately altered records in March 2017 is true, he has not 

established how those acts were the cause of his severe emotional distress, 

as opposed to the purported failure to diagnose and treat his pernicious 

anemia. In short, he simply did not set forth sufficient evidence for the jury 

to find in his favor with respect to IIED, and therefore is not entitled to punitive 

damages. See DiGregorio v. Keystone Health Plan East, 840 A.2d 361, 

371 (Pa.Super. 2003) (“It is settled law that one cannot recover punitive 

damages independently from an underlying cause of action.”). 

Based on the above, the trial court did not err in entering a compulsory 

nonsuit against Appellant as to all the counts set forth in his third amended 

complaint. We therefore have no cause to disturb the order denying his 

request to remove the nonsuit. 

Order affirmed. 
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Date: 10/8/2024