J-A20020-23

2023 PA Super 170

BOBBI JO SINORACKI, 

INDIVIDUALLY, AS THE 

ADMINISTRATRIX OF THE ESTATE OF 

DAVID SINORACKI, DEC’D, AND AS 

PARENT AND NATURAL GUARDIAN 

OF D.S., A MINOR, MADISON 

SINORACKI, AND MEGAN SINORACKI 

Appellant

v.

THE CHILDREN’S SERVICE CENTER 

OF WYOMING VALLEY, KIDSPEACE, 

KIDSPEACE CHILDREN’S HOSPITAL, 

INC., KIDSPEACE CORPORATION, 

KIDSPEACE CORPORATION, 

KIDSPEACE NATIONAL CENTERS OF 

PA, INC., KIDSPEACE NATIONAL 

CENTERS, INC., KIDSPEACE 

NATIONAL CENTERS, INC., 

KIDSPEACE SERVICES, INC., 

KIDSPEACE PSYCHIATRIC HOSPITAL, 

MUHAMMAD A. KHAN, M.D.

v.

DIANE HOCKENBERRY AND LEE 

HOCKENBERRY, INDIVIDUALLY AND 

AS PARENTS AND NATURAL 

GUARDIANS OF Z.H., A MINOR

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 IN THE SUPERIOR COURT OF

 PENNSYLVANIA

 No. 1064 MDA 2022

Appeal from the Order Entered June 21, 2022

In the Court of Common Pleas of Luzerne County

Civil Division at 2018-06389, 2018-10415

BOBBI JO SINORACKI, 

INDIVIDUALLY, AS THE 

ADMINISTRATRIX OF THE EST. OF 

DAVID SINORACKI, DEC’D, AND AS 

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 IN THE SUPERIOR COURT OF

 PENNSYLVANIA
J-A20020-23

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PARENT AND NATURAL GUARDIAN 

OF D.S., A MINOR, M.S. AND M.S. 

Appellant

v.

DIANE AND LEE HOCKENBERRY, 

INDIVIDUALLY AND AS PARENTS 

AND NATURAL GUARDIANS OF Z.H., 

A MINOR

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 No. 1065 MDA 2022

Appeal from the Order Entered June 21, 2022

In the Court of Common Pleas of Luzerne County

Civil Division at 2018-06389

BEFORE: PANELLA, P.J., MURRAY, J., and STEVENS, P.J.E.*

OPINION BY MURRAY, J.: FILED SEPTEMBER 19, 2023

In these consolidated appeals, Bobbi Jo Sinoracki, individually and as 

administratrix of the estate of David Sinoracki, and as parent/guardian of 

D.S., Madison Sinoracki, and Megan Sinoracki (Appellant), appeals from the 

orders respectively granting (1) the motion for judgment on the pleadings 

filed by Children’s Service Center of Wyoming Valley (CSC or Center); and (2) 

the motion for summary judgment filed by CSC employee Muhammad A.

Khan, M.D. (Dr. Khan).1 After careful consideration, we affirm.

The trial court thoroughly detailed the underlying facts as follows:

____________________________________________

* Former Justice specially assigned to the Superior Court.

1 We collectively refer to Dr. Khan and CSC as Defendants.
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At a young age, Z.H. was diagnosed with an inoperable 

arteriovenous malformation (“AVM”) in the left occipital region of 

his brain. An AVM is an abnormal tangle of arteries and veins that 

can develop in the brain and cause neuropsychological 

disturbances, including schizophrenic and erratic psychotic 

behavior. Since his diagnosis, Z.H.’s AVM increased in size,

causing vision problems, increased headaches, and pain.

The assistance of CSC was sought as Z.H.’s behavior 

became increasingly erratic and aggressive. CSC operates a 

pediatric mental and behavioral health practice and offers walkin, telephonic, and mobile crisis intervention services. Throughout 

his treatment with CSC[, Z.H.’s] providers diagnosed him with 

attention deficit/hyperactivity disorder and oppositional-defiant

disorder.

On August 25, 2014, Z.H. had an initial evaluation with CSC 

by Paul Termini, M.D., who noted that Z.H. had increasing 

behavioral disturbances which included substance abuse, school 

suspensions, self-injurious behavior, and physical assaults. Dr. 

Termini further noted concerns of ongoing anger issues.

On February 20, 2015, Z.H. underwent a second evaluation 

with CSC by Shiva Rezvan-Homami, PSA. Z.H.’s anger issues and 

substance abuse persisted. Concerns for the safety of [Z.H.’s]

brother due to [Z.H.’s] aggressive behavior was noted.

On May 13, 2015, ... Dr. Khan[], with CSC, became aware 

of Z.H.’s substance abuse and noted that Z.H. had anger outbursts 

at home and was destructive and combative. Dr. Khan frequently 

saw Z.H. and managed his medications throughout his treatment

with CSC. On July 9, 2015, Dr. Khan noted no change in Z.H.’s 

behavior after beginning to take the antipsychotic, Abilify. It was 

noted that Z.H. made no connection between information he was 

given and that he did not pay attention.

On August 11, 2015, Z.H. presented to Geisinger [Medical 

Center,] where he admitted to drinking one half of a bottle of 

vodka by himself with the intention of harming himself and 

verbalized that he “didn’t want to live anymore.” Z.H. also 

explained that he had suicidal ideations when he drank. Further, 

Z.H. struck his head repeatedly[,] which could have resulted in 

severe injury or death due to his AVM. Consequently, Geisinger 
J-A20020-23

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noted suicidal ideations. 

On August 17, 2015, Z.H. had a third psychological 

evaluation with Dr. Rezvan-Homami, who noted continued 

behavioral disturbances, continued suicidal ideations, selfinjurious conduct, increased and severe aggression, paranoia, and 

anger. Dr. Rezvan-Homami further noted that “it was a miracle 

that [Z.H.] has not been hospitalized, has not been sent to rehab,

or arrested.”

On August 22, 2016, Z.H. presented to CSC and was seen 

by Dr. Khan[,] who noted that Z.H. has been completely off his 

medication since January, 2016, was not going to school and was 

isolating himself, not eating, and very depressed, still abusing 

substances, and angry. Z.H. also showed signs of paranoia, 

thinking people were after him, and schizophrenia, by talking to

himself. It was further noted that his insight and judgment were 

poor. Abilify was prescribed.

On August 23, 2016, Z.H. threatened to kill his father.

Z.H.’s parents called the police, who forcibly restrained Z.H. and 

brought him back to Geisinger for evaluation, bagged with a “spit 

hood” and handcuffed due to his aggressive behavior. On 

presentation to the emergency department, security was called 

and Z.H. was placed in four-point restraints. While at Geisinger,

Z.H.’s parents reported that he had been presenting with 

paranoia, mood swings, anger, and behavioral issues for three and 

a half days prior. They further reported delusions suffered by

Z.H., some of which he had acted upon, such as him throwing up 

his medications because of a belief that his mother was poisoning 

him, paranoia about cars and trucks near his house in that he

thought that someone was going to harm him, and a desire to kill 

his father because of a belief that his father was assaulting his 

mother. While at Geisinger, a CT scan was performed which

showed that the AVM had steadily increased in size since 2008, 

but that there was no acute abnormality. ... Additionally, in a 

discussion with Dr. Ichord, with the Children’s Hospital of 

Philadelphia, Todd J. Holmes, M.D., with Geisinger, was told that 

Z.H. should be treated like “any brain injured patient with 

neuropsychiatric manifestation.”

Later the same day, Z.H. was transferred to KidsPeace for 

homicidal ideations and paranoia. While there, his psychiatrist 

was Mahmoud Elfatah, M.D. Z.H. reported that a [J]eep stopped 
J-A20020-23

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in front of his house and he threw rocks to attack it because he 

felt someone was after him. The psychiatric evaluation revealed 

that Z.H. had punched his brother and had anger problems, [and] 

had markedly impaired insight and judgment. Dr. Elfatah also 

noted that Z.H. was increasingly suspicious and paranoid and 

attributed it to Z.H.’s marijuana use. Z.H. was refusing to stay 

and aggressively pushed through several staff members and was 

slamming his body against the door. Z.H. was continually 

aggressive towards the staff members and had even assaulted 

another patient by punching him without provocation. Z.H. was 

restrained at one point and was placed in a safe room. During his 

stay[,] Dr. Elfatah changed Z.H.’s medication from Abilify to 

Seroquel, another anti-psychotic medication. On August 25, 

2016, Dr. Elfatah and others discharged Z.H. to Family Based 

Services at CSC after determining that Z.H. no longer displayed 

homicidal ideation.

On August 26, 2016, Z.H. was [riding in the front 

passenger’s seat of] his mother[’s vehicle when he] grabbed the 

steering wheel and drove into oncoming traffic[,] crashing the car 

because he believed someone was watching him. Z.H.’s parents 

immediately sought to have him readmitted to KidsPeace that 

same day. His mother further reported that he had run into traffic 

attempting to harm himself. Z.H. was readmitted for homicidal 

ideations, paranoia, and explosive behaviors. Z.H. was refusing

medication, had increasing paranoia, made threats, and continued 

to express the belief that he was being poisoned by his mother 

and that others were watching him. Dr. Elfatah noted that Z.H.

was “floridly psychotic,” that Z.H.’s AVM had neurocognitive 

effects, and that Z.H. had recently received a “grim report”

regarding the prognosis of his medical condition and [the report] 

coincided with his increasingly reckless behavior. As a result of 

Dr. Elfatah’s evaluation[,] Z.H. was diagnosed with mood 

dysregulation disorder, cannabis-induced psychotic disorder, and 

cannabis use disorder. Z.H. was rated a low risk on the homicide 

risk assessment score.

On August 29, 2016, while Z.H. was still at KidsPeace, Katie 

Lennon, Z.H.’s social worker, noted that Z.H. was struggling to 

adjust to the program and demonstrated noncompliance with 

following basic rules and expectations. He was determined to not 

be ready for family interaction. He was highly anxious, easily 

agitated, and disorganized in his thoughts. On September 1, 

2016, Z.H.’s parents visited him for a family session. He became 
J-A20020-23

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angry and threw a chair against a wall and broke a toilet paper 

dispenser. Z.H. continued to display worsening behavior and 

limited signs of improvement for the duration of his fourteen-day 

admission. ...

In [Z.H.’s] discharge summary, completed by Andrew Clark, 

M.D., it was believed that the neuropsychiatric implications of 

Z.H.’s AVM and marijuana use were difficult to discern. His

prognosis was fair and it was noted that his AVM was a significant 

stressor and that further drug use interacting with his AVM risked 

his psychiatric stability. Ms. Lennon, at one point during the

discharge process, instructed Z.H.’s parents to follow an 

“emergency crisis plan” and to attempt to persuade Z.H. to “use 

coping skills to manage the situation and maintain safety,” such 

as taking a 5-minute break, reading, listening to music, ... and 

remaining positive. Z.H. was ultimately discharged home.

On September 8, 2016, the night of his discharge, Z.H. 

stayed awake all night and sat on his front porch due to paranoia 

that someone was going to hurt him or his family. On September 

9 and 10, 2016, Z.H.’s parents continuously called KidsPeace and 

CSC, advising them of Z.H.’s continued behavior. Ms. Lennon 

noted that she spoke with Z.H.’s mother and that Z.H. had again

been aggressive towards [Z.H.’s] father and made threats towards 

him again. She further noted that Z.H. was awake until 6 AM 

sitting on the front porch with a pile of rocks “feeling like someone

was going to come to the house and harm them.” He was also 

noted to be difficult to deescalate and was refusing to attend his 

therapy appointments. The recommendation was to proceed to 

the visits at CSC.

Z.H.’s mother took him to CSC [on September 10, 2016,] to 

see Dr. Khan. Dr. Khan knew that Z.H. had been admitted twice 

to KidsPeace and of the [August 26, 2016,] car incident that took 

place between admissions .... Dr. Khan was also aware that Z.H. 

was smoking marijuana, acting “bizarrely,” had cognitive 

impairment as a result of his AVM, that he was admitted to 

KidsPeace a second time for increasing paranoia and aggression, 

that Z.H.’s medication had been recently switched from Abilify to 

Seroquel, and that he stayed awake all night with a pile of rocks 

ready to protect himself and his family.

Following this visit, Z.H.’s parents continued to call 

KidsPeace and CSC, including CSC’s crisis intervention services. 
J-A20020-23

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On September 10, 2016, a counselor with CSC spoke with Z.H.’s 

mother and provided several options on how to address her 

concerns. The counselor advised that she would come to the 

house to respond to the crisis the following day.

At no time from discharge on September 8, 2016 to 

September 11, 2016 did CSC or KidsPeace, or their agents and/or 

employees consider or pursue involuntary commitment of Z.H.

On September 11, 2016, Z.H.’s father saw his son leave the 

front porch and driveway moments before ... Z.H. entered the 

Sinoracki family’s home and violently assaulted Bobbi Jo, Megan, 

and David [Sinoracki] with a kitchen steak knife. ... Shortly 

thereafter, Z.H.’s father entered the Sinoracki family’s home and 

forcibly restrained [Z.H.] on a chair in the living room. The police

responded to the scene and took Z.H. into custody. Ultimately, 

David Sinoracki succumbed to his injuries.

Trial Court Opinion, 11/4/22, at 1-7 (some capitalization modified).

Appellant initiated this negligence action against Defendants (and other 

parties not relevant to this appeal), by writ of summons filed September 7, 

2018. Appellant filed a complaint on December 18, 2018. CSC filed an answer 

on January 21, 2019. On October 10, 2019, CSC filed a motion for judgment 

on the pleadings. The trial court granted CSC’s motion on July 10, 2020. On 

February 23, 2022, following discovery, Dr. Khan filed a motion for summary 

judgment. The trial court granted Dr. Khan’s motion on April 20, 2022.

On June 21, 2022, Appellant filed a “Praecipe to Mark Settled,

Discontinued, and Ended,” regarding Appellant’s claims against the remaining 
J-A20020-23

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Defendants.2 This timely appeal followed. Appellant and the trial court have 

complied with Pa.R.A.P. 1925.

Appellant presents two issues for review:

1. Did the trial court err in dismissing [Appellant’s] negligence

claims against Dr. Khan on the ground that he owed no duty 

applicable to this case under common law, where the record 

establishes that Dr. Khan undertook to provide medical 

professional services to [Z.H.] for the protection of others, both 

generally and as relates to [Appellant], and therefore Dr. Khan 

undertook a corresponding duty of care under Pennsylvania 

law?

2. Did the trial court err in dismissing [Appellant’s] negligence

claims against the Center on the ground that it owed no duty 

applicable to this case under common law, where the complaint 

alleges that the Center undertook to provide professional 

services to [Z.H.] for the protection of others, both generally 

and as relates to [Appellant], and therefore the Center 

undertook a corresponding duty of care under Pennsylvania 

law? 

Appellant’s Brief at 4.

Preliminarily, we note Appellant’s brief does not comply with Pa.R.A.P. 

2119(a), which requires the argument section 

be divided into as many parts as there are questions to be argued; 

and shall have at the head of each part - in distinctive type ... -

the particular point treated therein, followed by such discussion 

and citation of authorities as are deemed pertinent.

Id. Appellant’s argument headings do not correspond to the issues. 

Nonetheless, we overlook the defect and address Appellant’s issues together.

____________________________________________

2 “A praecipe to discontinue constitutes a final judgment.” Levitt v. Patrick, 

976 A.2d 581, 587 (Pa. Super. 2009) (citation and brackets omitted).
J-A20020-23

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Appellant claims she established that Defendants owed the Sinoracki 

family a duty of reasonable care, and thus the trial court erred in granting Dr. 

Khan’s motion for summary judgment and CSC’s motion for judgment on the 

pleadings. See Appellant’s Brief at 22-69.

In reviewing the grant of summary judgment, we recognize:

[S]ummary judgment is only appropriate in cases where there are

no genuine issues of material fact and the moving party is entitled

to judgment as a matter of law. Pa.R.C.P. 1035.2(1). When

considering a motion for summary judgment, the trial court must

take all facts of record[,] and reasonable inferences therefrom[,]

in a light most favorable to the non-moving party[,] and must

resolve all doubts as to the existence of a genuine issue of material

fact against the moving party. An appellate court may reverse a

grant of summary judgment if there has been an error of law or

an abuse of discretion. Because the claim regarding whether

there are genuine issues of material fact is a question of law, our

standard of review is de novo and our scope of review is plenary.

Nicolaou v. Martin, 195 A.3d 880, 891-92 (Pa. 2018) (some citations

omitted). “Only when the facts are so clear that reasonable minds could not 

differ can a trial court properly enter summary judgment.” Straw v. Fair, 

187 A.3d 966, 982 (Pa. Super. 2018) (citation omitted).

As to judgment on the pleadings:

Entry of judgment on the pleadings is permitted under 

Pennsylvania Rule of Civil Procedure 1034, which provides that 

“after the pleadings are closed, but within such time as not to 

unreasonably delay trial, any party may move for judgment on 

the pleadings.” Pa.R.C.P. 1034(a). A motion for judgment on the 

pleadings is similar to a demurrer. It may be entered when there 

are no disputed issues of fact and the moving party is entitled to 

judgment as a matter of law.

Appellate review of an order granting a motion for judgment on

the pleadings is plenary. The appellate court will apply the 
J-A20020-23

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same standard employed by the trial court. A trial court must 

confine its consideration to the pleadings and relevant 

documents. The court must accept as true all well pleaded

statements of fact, admissions, and any documents properly

attached to the pleadings presented by the party against whom

the motion is filed, considering only those facts which were

specifically admitted.

We will affirm the grant of such a motion only when the moving

party’s right to succeed is certain and the case is so free from

doubt that the trial would clearly be a fruitless exercise.

Kote v. Bank of N.Y. Mellon, 169 A.3d 1103, 1107 (Pa. Super. 2017) 

(citation omitted).

The crux of this appeal is whether Defendants owed a duty to the 

Sinoracki family. This issue presents a question of law, for which our standard 

of review is de novo and our scope of review is plenary. Maas v. UPMC

Presbyterian Shadyside, 234 A.3d 427, 436 (Pa. 2020). 

Appellant argues:

Under Pennsylvania law, when a physician voluntarily undertakes 

to act within the doctor-patient relationship for the protection of a 

non-patient third party, the physician assumes a corresponding 

duty of reasonable care to any third party who is within the 

orbit of harm.

Appellant’s Brief at 22 (emphasis added) (citing DiMarco v. Lynch HomesChester County, Inc., 583 A.2d 422, 425 (Pa . 1990)). According to 

Appellant,

Dr. Khan and the Center voluntarily undertook to act for the 

protection of [Z.H.] and others within his orbit of harm when 

treating [Z.H.] for his homicidal ideations and the Defendants 

thereby assumed a duty to act reasonably within the scope of that 

undertaking.
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Appellant’s Reply Brief at 1-2; see also Appellant’s Brief at 54 (claiming

Defendants’ “undertaking with respect to [Z.H.] summoned a duty to act for 

the protection of everyone within [Z.H.’s] orbit of harm – including the 

Sinoracki family....”).

Appellant further asserts there is a

long-tenured principle of Pennsylvania law that the voluntary 

choice to undertake obligations within the context of medical 

treatment for another’s protection brings forward the duty of 

reasonable care applicable not just to a patient but to third parties 

as well.

Id. at 36. In support, Appellant relies primarily on DiMarco, supra, as well

as Matharu v. Muir, 86 A.3d 250 (Pa. Super. 2014) (en banc), and Troxel

v. A.I. Dupont Inst., 675 A.2d 314 (Pa. Super. 1996). See Appellant’s Brief

at 30-36, 54; Appellant’s Reply Brief at 12. 

Appellant recognizes that the “record evidence established [Z.H.] posed

an imminent threat of harm and homicide to people around him, but he had

not explicitly threatened the Sinoracki family....” Appellant’s Brief at 45. 

However, Appellant claims:

The record establishes Dr. Khan actually knew or should 

have known that the possibility [Z.H.] would hurt others was 

not merely theoretical, and that [Z.H.] posed a

demonstrated risk of harm to persons near him when 

experiencing paranoia-driven symptoms. Indeed, [Z.H.’s] 

violent and paranoid actions known to Dr. Khan obviously 

represented a danger not just to [Z.H.,] but to anyone in

[Z.H.’s] immediate orbit wherever [Z.H.] happened to be.

Those non-patients included [Z.H.’s] ... neighbors as 

evidenced by [Z.H.’s] pattern of sitting outside his house 

with a pile of rocks nearby. 
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Id. at 53-54. Appellant asserts, “In these circumstances, the appropriate 

course of action involved [Z.H.’s] hospitalization and other type of 

management....” Id. at 45; see also Appellant’s Reply Brief at 15 

(“Defendants ... breach[ed their] duty when they failed to hospitalize [Z.H.] 

and pursue other treatment as his mental condition devolved.”).

Defendants argue the trial court did not err because Appellant failed to 

establish they owed a duty of care to the Sinoracki family.

3 According to 

Defendants, DiMarco, Matharu, and Troxel are distinguishable and 

unavailing. CSC Brief at 17-22; Dr. Khan Brief at 13-17; Amicus Brief at 9-

14. Defendants claim Appellant’s proposed duty of care is not supported by 

precedent, and its scope is not limited to reasonably foreseeable harm. CSC 

Brief at 22-27; Dr. Khan Brief at 5 (stating Appellant “seek[s] the creation of 

a new, never-before-imposed duty on mental health providers to protect third 

parties from harm by their patients,” which “would stretch foreseeability 

concepts beyond all limits....” (quotation marks omitted)); Amicus Brief at 15 

(“[Appellant’s] proposed duty ... has no limits, and would exist anytime a 

patient under treatment for mental illness harms anyone.”).

The Pennsylvania Supreme Court has stated that Emerich v.

Philadelphia Ctr. for Human Dev., 720 A.2d 1032 (Pa. 1998), is the 

“seminal case setting forth a mental health professional’s duty to warn third

____________________________________________

3 The American Medical Association and the Pennsylvania Medical Society have 

filed a brief advocating on behalf of Defendants (Amicus Brief).
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parties.” Maas, 234 A.3d at 437. The Emerich Court “concluded the special 

relationship between a patient and mental health professional may, in limited 

circumstances, give rise to an affirmative duty to warn a third party of 

potential harm caused by his patient.” Id. at 437–38 (citation omitted). 

Pertinently:

The facts underlying Emerich were that, in the space of thirty

minutes, a psychiatric patient (Joseph) told his therapist he was

going to kill his former girlfriend, identified by Joseph and known

to the therapist as Teresa Hausler. The therapist immediately

advised Hausler to stay away from Joseph, without specifically

telling her he planned to kill her. Hausler ignored the therapist’s

warning to stay away and Joseph shot her to death. Ultimately,

the Emerich Court determined the therapist had a duty to warn

Hausler, satisfied the duty by telling her to stay away, and

affirmed the dismissal of the case on summary judgment. 

Emerich, 720 A.2d at 1045. The Court summarized its holding

as follows:

[I]n Pennsylvania, based upon the special relationship

between a mental health professional and his patient,

when the patient has communicated to the professional

a specific and immediate threat of serious bodily injury

against a specifically identified or readily identifiable third

party and when the professional, determines, or should

determine under the standards of the mental health

profession, that his patient presents a serious danger of

violence to the third party, then the professional bears a

duty to exercise reasonable care to protect by warning

the third party against such danger.

Id. at 1043.

The Emerich Court began its legal analysis by observing the

general common-law rule stating there is no duty to control the

conduct of a third party to protect another from harm. Emerich,

720 A.2d at 1036. Emerich recognized an exception to that rule:

“where a defendant stands in some special relationship with either

the person whose conduct needs to be controlled or in a

relationship with the intended victim of the conduct, which gives
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to the intended victim a right to protection.” Id. (citing

Restatement (Second) of Torts § 315 (1965)). Relying in part on

Tarasoff [v. Regents of Univ. of California, 551 P.2d 334, 340

(Cal. 1976)], the Emerich Court concluded the special

relationship between a patient and mental health professional

may, in limited circumstances, give rise to an affirmative duty to

warn a third party of potential harm caused by his patient. Id. at

1037.

In Tarasoff, ... the patient did not expressly identify his

threatened victim by name, but from the context of the threat,

the therapist could “readily identify” who she was. Emerich, 720

A.2d at 1036. The Emerich Court explained Tarasoff recognized

a duty to “protect” a readily identifiable third party from the

violent acts of a patient, and that “a duty to warn is subsumed in

this broader concept of a duty to protect.” Emerich, 720 A.2d at

1037 n.5. “‘The discharge of this duty may require the therapist

to take one or more of various steps, depending on the nature of

the case. Thus, it may call for him to warn the intended victim or

others likely to apprise the victim of the danger, to notify the

police, or to take whatever other steps are reasonably necessary

under the circumstances.’” Id., quoting Tarasoff, 551 P.2d at

340. The Emerich Court addressed the issue of duty only “in the

context of a duty to warn[,]” and left for another day whether

“some broader duty to protect” should be recognized. Id. 

Specifically regarding the duty to warn, the Emerich Court 

stated: “We find, in accord with Tarasoff, that a mental health 

professional who determines, or under the standards of the 

mental health profession, should have determined, that his 

patient presents a serious danger of violence to another, bears a 

duty to exercise reasonable care to protect by warning the 

intended victim against such danger.” Emerich, 720 A.2d at 

1040.

Notably, the Emerich Court further held “the circumstances

in which a duty to warn a third party arises are extremely limited.” 

Id. at 1040. Before the therapist’s duty is triggered, the patient

must communicate a “specific and immediate threat” against “a

specifically identified or readily identifiable victim.” Id.

[(emphasis added).] ... The Emerich Court noted, “as a practical

matter, a mental health care professional would have great

difficulty in warning the public at large of a threat against an

unidentified person. Even if possible, warnings to the general

public would produce a cacophony of warnings that by reason of
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their sheer volume would add little to the effective protection of

the public.” Id. at 1041 [(citation and quotations omitted).]

Maas, 234 A.3d at 437-38 (footnote omitted).

In Maas, the Pennsylvania Supreme Court affirmed the denial of a

motion for summary judgment filed by mental health treatment providers. 

The mental health patient in Maas had lived in a forty-unit apartment building 

and repeatedly told his doctors and therapists he would kill an unnamed 

“neighbor.” Id. at 429. The patient “ultimately carried out his threat, killing 

an individual who lived in his building, a few doors away from his own 

apartment.” Id. The victim’s mother initiated a wrongful death action against

the providers. Id. The providers sought summary judgment on the basis that

they had no duty to warn about the threats because the patient never 

“expressly identified a specific victim.” Id. In affirming the denial of summary

judgment, the Supreme Court observed the providers’

core contention ... is that the “neighbors” against whom [the 

patient] articulated murderous threats were not an enumerated 

and readily identifiable group of [apartment] residents, but 

instead, consisted of a large, amorphous, unidentifiable group of 

the public at large.

Id. at 438-39. The Court explained:

[T]he duty to warn applies not only when a specific threat is made 

against a single readily identifiable individual, but also when the 

potential targets are readily identifiable because they are 

members of a specific and identified group — in this case, 

“neighbors” residing in the patient’s apartment building. In these 

circumstances, the potential targets are not a large amorphous 

group of the public in general, but a smaller, finite, and relatively 

homogenous group united by a common circumstance.
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Id. at 439. 

Mindful of the above authority, we address the cases on which Appellant

relies. In DiMarco, our Supreme Court considered 

whether a physician owes a duty of care to a third party where 

the physician fails to properly advise a patient who has been 

exposed to a communicable disease, and the patient, relying upon 

the advice, spreads the disease to a third party.

DiMarco, 583 A.2d at 423. The medical professionals in DiMarco gave a

patient incorrect medical advice about whether she had Hepatitis B, a sexually 

transmitted disease, and she subsequently transmitted the disease to plaintiff, 

her paramour. Id. Applying the Restatement (Second) of Torts § 324A,

4

the 

____________________________________________

4 Section 324A provides:

§ 324A Liability to Third Person for Negligent Performance of

Undertaking

One who undertakes, gratuitously or for consideration, to render 

services to another which he should recognize as necessary for the 

protection of a third person or his things, is subject to liability to the 

third person for physical harm resulting from his failure to exercise 

reasonable care to protect his undertaking, if

(a) his failure to exercise reasonable care increases the risk of 

such harm, or

(b) he has undertaken to perform a duty owed by the other to 

the third person, or

(c) the harm is suffered because of reliance of the other or the 

third person upon the undertaking.

RESTATEMENT (SECOND) OF TORTS, § 324A. This Court has stated: “To state a 

cause of action under Section 324A ..., a plaintiff must aver that the physician 

(Footnote Continued Next Page)
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DiMarco Court noted that for the patient to state a claim, the medical 

professionals must have undertaken “to render services to another which 

[they] should recognize as necessary for the protection of a third person,” a 

principle the Court characterized as “essentially a requirement of 

foreseeability.” DiMarco, 583 A.2d at 424 (quoting Cantwell v. Allegheny

Cty., 483 A.2d 1350, 1353-54 (Pa. 1984)). The Court held:

When a physician treats a patient who has been exposed to or 

who has contracted a ... contagious disease, it is imperative that 

the physician give his or her patient the proper advice about 

preventing the spread of the disease. ... The patient must be 

advised to take certain sanitary measures.... Such precautions are

... taken to safeguard the health of others. Thus, the duty of a

physician in such circumstances extends to those “within the

foreseeable orbit of risk of harm.” Doyle v. South Pittsburgh

Water Co., ... 199 A.2d 875, 878 ([Pa.] 1964).

DiMarco, 583 A.2d at 424 (emphasis and paragraph break omitted).

In Troxel, the plaintiff’s friend and the friend’s baby had a contagious

disease, cytomegalovirus (CMV). Troxel, 675 A.2d at 316. Plaintiff frequently 

visited her friend and her friend’s baby during plaintiff’s pregnancy, unaware 

of the CMV. Id. Plaintiff subsequently contracted CMV, and her baby died 

from CMV-related complications shortly after his birth. Id. Plaintiff initiated 

a wrongful death and survival action against her friend’s physicians 

(defendants) for failing to advise the friend about the contagious nature of

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has undertaken to render services to another which he should recognize as 

necessary for the protection of a third person.” Matharu, 86 A.3d at 259

(citation and quotation marks omitted). 
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CMV. Id. This Court reversed the trial court’s order granting summary

judgment on the basis that defendants owed plaintiff no duty of care. See id.

at 321-23. Citing DiMarco, this Court held,

where [a] physician undertakes the treatment of a patient with a 

communicable or contagious disease[, they have] ... a duty to 

correctly inform the patient about the contagious nature of the 

disease in order to prevent its spread to those who are within the 

foreseeable orbit of risk of harm.

Id. at 322; see also id. at 323 (“The standard of care for a physician who is 

treating a patient with a communicable disease is to inform the patient about 

the nature of the disease and its treatment, to treat the patient, and to inform 

the patient how to prevent the spread of the disease to others.”).

Finally, in Matharu, an en banc panel of this Court held that the nonpatient plaintiff stated a negligence claim against physicians (defendants)

under Section 324A for failure to administer an injection to a patient/mother

(Mother) for the protection of Mother’s future, unborn children. Matharu, 86

A.3d at 260-61. We affirmed the trial court’s denial of defendants’ motion for

summary judgment, holding:

Section 324A of the Second Restatement continues to require

physicians to provide reasonable care in the patient’s treatment

as is necessary for the protection of others, and establishes

liability to certain third-parties when such reasonable care is

lacking. As such, [plaintiffs’] claim that the failure to administer 

[the injection] during Mother’s pregnancy ... in 1998 resulted in 

the death of [a subsequent child] in 2005 states a claim 

under Section 324A....

Matharu, 86 A.3d at 260 (citation omitted). We concluded:
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A physician-patient relationship existed between [defendants] and 

Mother, and the allegation that the failure to provide reasonable 

care within this relationship to protect certain readily

identifiable third parties (including [Mother’s future children]) 

adequately states a claim under Section 324A.

Id. (emphasis added).

Consistent with the foregoing, we agree with Defendants’ assessment

of DiMarco, Troxel, and Matharu as distinguishable and unavailing. Rather,

we are persuaded by this Court’s decision in F.D.P. Ex Rel S.M.P. v. Ferrara, 

804 A.2d 1221 (Pa. Super. 2002). In Ferrara, the plaintiffs were parents of 

a child who had been sexually assaulted by a mentally ill neighbor (assailant). 

Id. at 1224. Plaintiffs appealed the trial court’s dismissal of their negligence 

claims against the non-profit corporations (defendants) that provided medical 

treatment and housing to assailant. Id. at 1223-24. This Court affirmed the 

trial court’s grant of defendants’ preliminary objections based on defendants 

owing the plaintiffs no duty of care. Id. at 1228-29. We observed:

[Plaintiffs] invite us to apply the rationale in a line of cases

imposing liability on a physician for failing to properly advise a

patient who has a communicable disease when the patient relied

upon the improper advice and spread the disease to a third party. 

DiMarco v. Lynch Homes-Chester County, Inc., 525 Pa. 558,

583 A.2d 422 (1990); Troxel v. A.I. Dupont Institute, 450 Pa.

Super. 71, 675 A.2d 314 (Pa. Super. 1996).

Those cases [] are specifically limited to their

circumstances and impose liability due to the peculiar nature of

communicable diseases, which involve a direct threat to public

health. Under the reasoning employed in those cases, liability is

premised upon the physician’s awareness that his advice

concerning the communicable disease is directly relevant to its

spread to third parties. Thus, the duty is imposed because “it is

imperative that the physician give his or her patient the proper
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advice about preventing the spread of the disease.” DiMarco,

583 A.2d at 424. Moreover, those cases impose the duty pursuant 

to Restatement (Second) of Torts, § 324A, which relates to an 

actor who renders services under conditions where the actor 

should recognize that the services are necessary for the protection 

of a third person. Mental health services are provided for the 

protection of the patient. Furthermore, mental health patients do 

not have a disease that is communicable to the public nor do they 

present a peculiar threat to the public. The reasoning of those 

cases is not applicable herein.

Ferrara, 804 A.2d at 1229 (emphasis added).

5

We further emphasized:

Pennsylvania courts are reluctant to subject a person to 

liability for the acts of a third party in the absence of 

compelling circumstances. Indeed, there are a number of

cases significantly analogous to the present one where the courts 

have refused to impose such liability.

Id. at 1230 (emphasis added); see also id. at 1230-31 (discussing caselaw).

Instantly, the trial court opined:

Z.H. never verbally or otherwise identified a concrete group of 

people to which [the Sinoracki family] may have been a part of, 

as the target of his threats. ... [] Z.H. made a verbal threat to kill 

his father, was consistently reported to be aggressive, had driven 

his mother’s car into traffic, and threw rocks at passing cars. ... 

[I]f [Z.H.’s] threat were to be to any identifiable group including 

[the Sinoracki family,] it would be to the general public, including 

cars passing by. ... [S]uch a group would not fall within the 

confines of a “readily identified third party,” and so [Appellant’s] 

claim relying on the application of a duty to warn must fail. ... 

[T]here was nothing to suggest Z.H. was generally a threat to 

people beyond those in view and in his immediate environment. 

For example, concerning Z.H. sitting with rocks in front of his 

home, the record does not reflect that he was running after any 

vehicles or acting aggressively towards vehicles that did not pass 

by his home. Without a record reflecting [any basis for 

____________________________________________

5 Matharu is distinguishable for the reasons expressed in Ferrara.
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Defendants] to predict that Z.H. would go out of his way to assault 

the Sinoracki family[,] ... the court cannot find that Z.H.’s threats 

were against [the Sinoracki family] as a “readily identifiable 

group.”

Trial Court Opinion, 11/4/22, at 18-19 (some capitalization modified). 

The trial court’s reasoning is supported by the record and law. See id.; 

see also Maas, 234 A.3d at 439 (limiting tort liability to “readily identifiable” 

“potential targets”). As Appellant failed to establish that Defendants owed the

Sinoracki family a duty of care, we conclude the trial court did not err in 

granting Dr. Khan’s motion for summary judgment and CSC’s motion for 

judgment on the pleadings. See Ferrara, supra; Emerich, 720 A.2d at 1036

(generally, there is no duty to control the conduct of a third party to protect

another from harm); Troxel, 675 A.2d at 321 (“without a finding of duty, the 

issue of breach of duty cannot be submitted to the jury.”).

Orders affirmed.

Judgment Entered.

Joseph D. Seletyn, Esq.

Prothonotary

Date: 09/19/2023