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NON - PRECEDENTIAL DECISION - SEE SUPERIOR COURT I.O.P. 65.37 HORACE DAVIS, ADMINISTRATOR OF THE ESTATE OF GRACE KELLY DAVIS, DECEASED,

v.
2507 CHESTNUT STREET OPERATIONS, LLC D/B/A/ THE BELVEDERE CENTER, GENESIS HEALTHCARE, LLC, DELAWARE COUNTY MEMORIAL HOSPITAL, CROZER
- CHESTER MEDICAL CENTER, CROZER
- KEYSTONE HEALTH SYSTEM, KINDRED HOSPITAL PHILADELPHIA
HAVERTOWN, KINDRED HOSPITAL EAST, LLC, KINDRED HEALTHCARE, INC., MERCY CATH OLIC MEDICAL CENTER OF SOUTHEASTERN PENNSYLVANIA D/B/A MERCY FITZGERALD HOSPITAL AND MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA : : : : : : : : : : : : : : : : : : : : : : : : IN THE SUPERIOR COURT OF

PENNSYLVANIA

No. 1048 EDA 2018

Appeal from the Order Entered March 27, 2018 In the Court of Common Pleas of Delaware County Civil Division at No(s): 2017
- 001749
BEFORE: OTT, J., STABILE, J., and McLAUGHLIN, J. MEMORANDUM BY OTT, J.: FI LED SEPTEMBER 16 , 2019 Kindred Hospital Philadelphia
- Havertown, Kindred Hospital East, LLC, and Kindred Healthcare, Inc. (collectively, “Kindred”) 1 appeal from the order

_________________ ____________________ _______ 1 The remaining entities listed in this appeal with Kindred are not a party to this appeal.J - A01003
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of the Delaware County Court of Common Plea s , dated March 27, 2018, overruling their preliminary objections to the complaint f iled by Horace Davis, Administrator of the Estate of Grace Kelly Davis, deceased, (“Davis”) 2 in this medical professional liability action. Kindred raises the following three arguments: (1) whether the trial court erred in refusing to enforce the Alterna tive Dispute Resolution (“ADR”) Agreement signed by Decedent , where Davis failed to meet his burden to demonstrate by clear and convincing evidence that Decedent lacked the capacity to understand the agreement; (2) whether the court erred in refusing to en force two ADR Agreements signed by Davis despite evidence of long
- standing and continuously granted authority conferred upon him by Decedent; and (3) whether the court erred and/or abused its discretio n by refusing to enforce the ADR Agreement on the groun ds of unconscionability, even though the terms of the agreement were verbally explained and understood by Davis . Based on the following, we affirm. The trial court set forth the following underlying facts as follows: [Decedent] entered Kindred Hospital Philadelphia
Havertown, owned and operated by Defendants, Kindred Hospital East, LLC and Kindred Healthcare, Inc., on April 2, 2015 and remained in the facility through April 20, 2015. Upon admission,

_________________ ____________________ _______ 2 Horace Davis and Grace Kelly Davis were husband and wife. They were will be referred to Davis and Decedent, respectively. Davis is a retired non
attorney magis terial district judge. See Defendants’ Supplemental Memorandum of Law in Support of Defendants’ Preliminary Objection to Enforce the Alternative Dispute Resolution Agreement, 10/25/2017, Exhibit C, Deposition of Horace Davis (8/31/2017), at 9.J - A01003
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she presented with pressure ulcers which persisted and deteriorated during her stay at [Kindred’s] facility. [Decedent] was again admitted to Kindred Hospital Philadelphia
- Havertown on June 19, 2015; this admission lasted until July 9, 2015 during which time her same wounds persisted and deteriorated. [Decedent] was last admitted to Kindred Hospital Philadelphia
Havertown on July 30, 2015; this admission lasted until August 25, 2015 during which time her same wounds persisted and deteriorated further to a stage of IV. Throughout [Decedent]’s stay at [K indred’s] facility, she allegedly received inadequate care and treatment
. [Decedent] died on November 20, 2015 and [Davis] alleges that the pressure ulcers, which were caused solely and exclusively by the conduct of [Kindred] (and/or their respective agen ts, servants, employees) caused and/or contributed to her demise. Trial Court Opinion, 7/2/2018, at 2 (record citations omitted)
. During Decedent’s stay at the hospital, she and Davis executed several Voluntary Arbitration Agreements, which were identica l and contained the same terms. “The Agreements were allegedly executed on or about March 13, 2015 by [Davis] , on or about June 19, 2015 by decedent, Mrs. Davis, and on or about July 31, 2015 by [Davis] at the time of three separate admissions of [Deceden t] to [Kindred’s] facility.” Id. at 2 (footnote omitted). An example of the Agreement is as follows, in relevant part: VOLUNTARY ALTERNATIVE DISPUTE RESOLUTION AGREEMENT

BETWEEN PATIENT AND HOSPITAL Under both federal and state law two or more parties may agree i n writing for the settlement by arbitration of any dispute arising between them. The following is an agreement to resolve any and all disputes that might arise between the Patient and the Hos pital through alternative dispute resolution methods, including mediation and arbitration. I. This Alternative Dispute Resolution Agreement ( “Agreement” ) is made and entered into this 1 9 day of June , 2015 , by andJ - A01003
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between Kindred Hosp. Havertown ( “Hospita l” ) and DAVIS, GRACE ( “Patient” ) (collectively, the “Parties” ). The term “ Patient ” includes the Patient, his/ her Guardian or Attorney in Fact, agent, or any person acting as the Patient’ s Legal Representative whose claim is derived through or on behalf of the Patient. II. Alternative dispute resolution, including mediation and arbitration, is a fair, c ost - effective method to quickly resolve disputes, which may arise as a result of the Patient’ s hospitalization, without the substantial time and expense of using the courts. Mediations and arbitration hearings take only weeks or months to schedule, while civil litigation generally takes years to complete. By avoiding the court system, Patient and Hospital avoid significant costs. There are charges and fees involved in mediation and arbitration, but mediations and arbitration hearings will almost always resolve a dispute sooner and at less cost than a trial. III. It is i mportant to understand, that both the Patient and the Hospita l wil l have only a limited right to appeal an arbitration award. Unless there is evidence of fraud on the part of the arbitrator(s) or a serious procedural defect, an arbitration award will be final. Both the Hospital and the Patient will be bound by the decision of the arbitrator(s). IV. This Agreement is optional. The Hospital will provide needed services to you even if you do not sign the Agreement. V. By signing this Agreement, you give up your Constitutional right to a trial by a jury or a judge, and you agree that any dispute between you and the Hospital will be subject to mediation and binding arbitration. Likewise, by signing this Agreement the Ho spital gives up i ts right to a trial by a j ury or a judge, and agrees that any dispute with you will be subject to mediation and binding arbitration.

... B. Scope of ADR. Any and all claims disputes arising out of or in any way relating to this Agreement , including disputes regarding the validity or scope of the Agreement or the interpretation of the Agreement, and any and all disputes relating to the Patient’ s stay at the Hospital, whether arising out of State or Federal law, whether existing or arising in the future, whether for statutory,J - A01003
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compensatory or punitive damages, and whether sounding in breach of contract, tort or breach of statutory duties (including, without limitation, any claim based on violation of rights, negligence, medical malpractice, any other departure from the accepted standards of health care or safety or unpaid charges), irrespective of the basis for the duty or of the legal theories upon which the claim is asserted, shall be submitted to ADR, as described in the DJS Rules of Proce dure, and resolved by binding arbitration. This Agreement includes claims against the Hospital, its employees, agents, officers, directors, any parent company, subsidiary or affiliate of the Hospital and/or its Medical Director(s) in his capacity as Medic al Director. Only disputes that would constitute legally cognizable cause of action i n a court of law may be submitted to the ADR process. All claims based in whole or in part on the same incident(s), transaction(s), or related course of care or services provided by Hospital to the Patient, shall be submitted and mediated or arbitrated in one proceeding or the claim shall be waived. Preliminary Objections of Kindred to Plaintiff’s Complaint, 3/21/2017, at Exhibit B. On March 3, 2017, Davis instituted this medical negligence action against Kindred and several other defendants. Subsequently, [o] n March 22, 2017, [Kindred] filed Preliminary Objections to [Davis’] Complaint seeking to compel arbitration of [Davis’] claims under the Agreements that had been executed by [ Davis ] and [Decedent]
. On April 11, 2017, [Davis] responded to [Kindred’s] Preliminary Objections asserting that the Agreements are unenforceable as [Decedent] lacked the mental capacity to enter into the Agreement she executed, that [ Davis ] lacked the authority to bind [Decedent] to the Agreements he executed, that the Agreements are unconscionable contracts of adhesion, and that enforcing the Agreements would deny the wrongful death beneficiaries the ir constitutional right to a jury trial. [Kindred] filed a Supplemental Memorandum of Law on April 25, 2017 in response to [Davis’] Answer and asserted that [Davis] failed to meet the burden of showing that [Decedent] was “incompetent” to enter into the A greement that she signed, that [Davis] had apparent authority and/or agency by estoppel was established to execute the Agreements he signed, that the Agreements are notJ - A01003
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unconscionable as the Pennsylvania Superior Court did not find unconscionable an agreem ent to arbitrate that was similar in all material respects to the Agreements at issue, and that the facts averred in [Davis’] Complaint do not support a wrongful death claim
. Further, [Kindred] requested discovery in the fo rm of a deposition of [Davis] an d request for production of documents. On July 13, 2017, this Court entered an Order granting additional time for the parties to conduct discovery and supplement the record as deemed necessary on issues relating to the validity and/or enforceability of t he Agreements. On October 25, 2017, upon completion of the additional discovery permitted by the Court, which included the depositions of [Kindred’s] Admissions Coordinator and [Davis] , [Kindred] filed a Supplemental Memorandum of Law in support of their position to enforce the Agreements. On October 26, 2017, [Davis] filed a Supplemental Memorandum of Law in support of his position. On March 27, 2018, this Court entered an Order overruling [Kindred’s] Preliminary Objections to [Davis’s] Complaint from w hich [Kindred] took their appeal on April 4, 2018. Trial Court Opinion, 7/2/2018, at 3
- 4 (citations omitted)
. Spec ifically, the court found: [Kindred’s] Preliminary Objections were properly overruled as [Decedent] did not have the requisite mental capacity to enter the Agreement, [Davis] did not have authority to enter the Agreements and the Agreements are unconscionable. As such, the Agreements requiring the parties to proceed to arbitration are each unenforceable as a whole and this action should remain before this Court. Id. at 4. This appeal followed. 3

_________________ ____________________ _______ 3 We note:

“ As a general rule, an order denying a party’ s preliminary objections is interlocutory and, thus, not appealable as of right. There exists, however, a narrow exception to this oft
- stated rule for cases in which the appeal is taken from an order denying aJ - A01003
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We begin with the following : “Our standard of review of an order of the trial court overruling [or granting] preliminary objections is to determine whether the trial court committed an error of law. When considering the appropriateness of a ruling on preliminary objections , the appellate court must apply the sa me standard as the trial court.” DeLage Landen Fin. Servs., Inc. v. Urban P'ship, LLC , 903 A.2d 586, 589 (Pa. Super. 2006) (citation omitted ). “ When preliminary objections , if sustained, would result in the dismissal of an action, such objections should be sustained only in cases which are cle ar and free from doubt.” Id. (cita tions omitted). Moreover, our review “is limited to determining whether the trial court’s findings are supported by substantial evidence and whether the trial court abused its discretion in denying [the objections].” Gaffer Ins. Co., Ltd. v. Discover Rein surance Co. , 936 A.2d 1109, 1112 (Pa. Super. 2007) (citation omitted)
.

_________________ ____________________ _______ petitio n to compel arbitration.” Shadduck v. Christopher J. Kaclik, Inc. , 713 A.2d 635, 636 (Pa. Super. 1998) (citations omitted). See also 42 Pa.C.S. § 7320(a)(1) (stating appeal may be taken from court order denying appl ication to compel arbitration) ; Pa.R.A.P. 311(a)(8) (stating appeal may be taken as of right and without reference to Pa.R.A.P. 341(c) from order
“ which is made appealable by statute or general rule. ” ). Elwyn v. DeLuca , 48 A.3d 457, 460 (Pa. Super. 2012). See Preliminary Objection of Kindred to Plaintiff’s Complaint, 3/21/2017, at 3
- 5 (arguing that pursuant to the arbitration agreement, Davis’ claims should be submitted to arbitration)
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In its first issue, Kindred claims Davis did not establish by clear and convincing evidence that Decedent was incapacitated which prevented her from knowingly entering into the June, 19, 2015, arbitration agreement. Kindred’s Brief at 16. Relying on Cardinal v. Kindred Healthcare, Inc. , 155 A.3d 46 (Pa. Super. 2017) , appeal denied , 170 A.3d 1063 (Pa. 2017) , Kindred states: The fatal flaw in the trial court’s reasoning ste ms from its failure to apply the accepted rule that [Decedent’s] signature on the Agreement creates a presumption that the Agreement is valid, thereby shifting the burden to her to demonstrate, by clear and convincing evidence, that the signature was not v alidly obtained. Id. Moreover, Kindred alleges:

There is no dispute that both [Decedent] and the [Kindred] representative actually signed this particular Agreement. [Davis] now claims that [Decedent] did not understand what [ she ] was signing due to mental incapacity. [Davis’] defense is the exact type of affirmative incapacity defense where the burden shifts to h[im] to demonstrate that the Agreement is void for some reason outside the parameters of the document. See , e.g. , Sall ey v. Option One Mortg. Corp. , 925 A.2d 115, 129 (Pa. 2007) (party challenging the agreement bears the burden of proof); MacPherson v. Magee Mem’ l Hosp. for Convalescence , 128 A.3d 1209, 1221 (Pa. Super. 20 15) ( en banc ) (party asserting arbitration agreement is void due to procedural and substantive unconscionability has the burden of proof). Applying the correct evidentiary burdens, the trial court clearly erred in finding that clear and convincing evidence showed that [Decedent] did not knowingly and voluntarily enter into the ADR Agreement. While [ the court ] cited to record evidence that [it] believed supported a conclusion of mental incapacity, [it] gives short shrift to evidence supporting the opposite conclusion. [Decedent’s] treating physici an, Dr. Kamran Tareen, noted on July 1, 2015 that her “ MS (Mental Status) was at baseline.”J - A01003
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Additionally, the Neurology Progress note, from the same day, noted that [Decedent] was “ awake, alert, and oriented x3. Speech is fluent.”

... The situation here i s virtually identical to Cardinal
. There is evidence suggesting both impairment and lucidity. In such a case, as Cardinal instructs, there cannot be “ clear and convincing ” evidence of impairment sufficient to invalidate this agreement. Additionally, t he testimony of [ Davis ] further establishes that there was no significant impairment on the part of his wife at the time [Decedent] signed the June 2015 ADR Agreement. He was present, and watched her sign the June 2015 ADR Agreement. Per [ Davis’ ] testimony, [Decedent] had a basic understanding that she was being readmitted to Kindred and that this document was part of the paperwork necessary to get her back into the Facility. Id. at 17 - 18 (emphasis removed ; reproduced record citations omitted )
. We are guided by the following: Arbitration agreements are matters of contract. Under Pennsylvania law, it is presumed that an adult is competent to enter into an agreement, and a signed document gives rise to the presumption that it accurately expresses the state of mind of the signing party. Estate of McGovern v. Com. State Employees’ Ret. Bd. , 512 Pa. 377, 517 A.2d 523, 526 (Pa. 1986). To rebut this presumption, the challenger must present evidence of mental incompetency which is clear, precise and co nvincing. Id. This burden of proof requires that the witnesses must be found to be credible, that the facts to which they testify are distinctly remembered and the details thereof narrated exactly and in due order, and that their testimony is so clear, direct, weighty and convincing as to enable the [finder of fact] to come to a clear conviction, without hesitancy, of the truth of the precise facts in issue. Evans v. Marks , 421 Pa. 146, 218 A.2d 802, 804 (Pa. 1966). [W]here mental capacity to execute a n instrument is at issue, the real question is the condition o f the person at theJ - A01003
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- very time he executed the instrument . . . in question[. A] person’ s mental capacity is best determined by his spoken words and his conduct, and [] the testimony of persons who observed such conduct on the date in question outranks testimony as to observations made prior to and subsequent to that date. Mere mental weakne ss, if it does not amount to inability to comprehend the contract, and is unaccompanied by evidence of imposition or undue influence, is insufficient to set aside a contract. Id. (citations and quotation marks omitted). Moreover, “[i]t is well settled th at mere weakness of intellect resulting from sickness or old age is not legal grounds to set aside an executed contract if sufficient intelligence remains to comprehend the nature and character of the transaction, and no evidence of fraud, mutual mistake o r undue influence is present.” Taylor v. Avi , 272 Pa. Super. 291, 415 A.2d 894, 897 (Pa. Super. 1979) (citations omitted). “[F]ailure of memory does not prove incapacity, unless it is total or so extended as to make incapacity practically certain. A tes tator may not be able at all times to recollect the names of persons or families of those with whom he has been intimately acquainted
. . . and yet his understanding of the ordinary transactions of his life may be sound.” Id. , quoting Lawrence’s Estate , 2 86 Pa. 58, 132 A. 786, 789 (Pa. 1926). Cardinal v. Kindred Healthcare, Inc. , 155 A.3d 46, 50 (Pa. Super. 2017) , appeal denied , 170 A.3d 1063 (Pa. 2017)
. Here, the trial court found the following: Documents prepared by [Kindred’s] own medical professional around the date the Agreement was signed by [Decedent] (June 19, 2015 2 ), compel the conclusion that [Decedent’s] thoughts were impaired at the time that she executed the Agreement and therefore she lacked the mental capacity to enter the Agreement. [Decedent’s] admission records to [Kindred’s] facility prepared by Kamran Tareen, M.D. dated June 20, 2015 reflect that [Decedent] was a 79 year woman with multiple complex medical issues including a large cerebellar infarction (stroke), Chronic Kidney Dis ease, IV, atrial fibrillation with pacemaker status, multiple myeloma (cancer of the plasma cells) in remission, stage II decubitis ulcer, sepsis due to a urinaryJ - A01003
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tract infection, history of C difficile colitis, sever [e] hypoproteinemia, and anemia. (Admi ssion Report dated June 20, 2015, Exhibit C of Plaintiff ’ s Answer in Opposition to Defendants ’ Preliminary Objections to Plaintiff ’ s Complaint). It is further noted that on June 12, 2015, approximately a week prior to her execution of the Agreement, she w as found to have an acute change in mental status. (Admission Report dated June 20, 2015, Exhibit C of Plaintiff ’ s Answer in Opposition to Defendants’ Preliminary Objections to Plaintiff ’ s Complaint). The change in mental status was diagnosed as the resul t of a new left cerebellar infarction (stroke). (Admission Report dated June 20, 2015, Exhibit C of Plaintiff ’ s Answer in Opposition to Defendants’ Preliminary Objections to Plaintiff ’ s Complaint). [Decedent] also had a subarachnoid area of hemorrhage an d, although Dr. Tareen notes that [Decedent] is “ oriented [to person, place and time] ” , he recommended that she follow
- up with a neurologist for evaluation. (Admission Report dated June 20, 2015, Exhibit C of Plaintiff ’ s Answer in Opposition to Defendants ’ Preliminary Objections to Plaintiff’ s Complaint). It is further noted in the June 20, 2015 report that [Decedent] had a history of multiple episodes of having acute change of mental status with recovery. (Admission Report dated June 20, 2015, Exhibit C of Plaintiff ’ s Answer in Opposition to Defendants’ Preliminary Objections to Plaintiffs Complaint).

________________________ 2 The agreement is not dated by [Decedent] next to her signature; however, the agreement on page 1 is dated June 19, 2015. Just above [Decedent’s] signature, the Agreement states, “ IN WITNESS WHEREOF, the parties, intending to be legally bound, have signed this Agreement as of the date first written above”
. This date was June 19, 2015, the date of [Decedent’s] admission to [K indred’s] facility. (Exhibit B of Plaintiff’ s Answer in Opposition to Defendants’ Preliminary Objections to Plaintiff’ s Complaint). [Kindred] suggest [s] that the Agreement was signed on July 1, 2015 by [Decedent] , when their representative executed the ag reement, but the record does not support this. Additionally, [Kindred’s] admissions coordinator’ s deposition testimony does not confirm the date on which [Decedent] signed the agreement.

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- In Dr. Tareen ’ s progress note dated June 2 1, 2015, two (2) days after [Decedent] signed the Agreement, a CT scan was still pending of [Decedent] and he was still waiting on Neurology consults and Dr. Tareen notes that [Decedent] is “ oriented [to person] ” only. (Progress Note dated June 21, 2015, E xhibit C of Plaintiff ’ s Answer in Opposition to Defendants ’ Preliminary Objections to Plaintiff ’ s Complaint). Further, as reflected in the June 21, 2015 note, when [Decedent] was asked if she ate breakfast that morning, she said she could not remember if she ate or not and therefore the doctor recommended that she be assisted with eating. (Progress Note dated June 21, 2015, Exhibit C of Plaintiff’ s Answer in Opposition to Defendants’ Preliminary Objections to Plaintiff ’ s Complaint). Alth ough the medical records submitted by [Kindred] reflect that [Decedent’s] “ [mental status (“MS”)] was at baseline ” , there is no evidence of what her baseline was. (Progress Note dated July 1, 2015, Exhibit D of Defendants ’ Supplemental Memorandum of Law i n Support of Defendants’ Preliminary Objections to Enforce Alternative Dispute Resolution Agreement). Further, certain

... medical records submitted by [Kindred] are dated July 1, 2015, the day their representative signed the Agreement, not the date that th e Agreement reflects that it was signed by [Decedent]
. In addition, although it is stated in Dr. Tareen’ s discharge summary dated July 20, 2015 that [Decedent] did not have any neurological defects, this was as of July 20, 2015, almost a month after [she] executed the Agreement and more than a month after she suffered her stroke. (Discharge Summary dated July 20, 2015, Exhibit C of Plaintiff’ s Answer in Opposition to Defendants’ Preliminary Objections to Plaintiff’ s Complaint). Lastly, [Kindred’s] assertion that [Davis] testified that he believed that [Decedent] understood she was being admitted into the hospital and that signing the documents was a part of the admissions process does not speak conclusively to whether [Decedent] was competent to ent er the Agreement. To the contrary, and more specific to the issue, [Davis] , who was present when [Decedent] signed the Agreement, testified that [she] did not understand what the [admission] documents entailed and her conditions prevented her from signing the remaining admissions documents. (8/31/17 Horace Davis Deposition N.T. 31, 32, 46). The record of this action establishes that, at the time that the Agreement was signed, [Decedent] was an elderly resident, with multiple health conditions, and was noted by [Kindred’s] ownJ - A01003
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doctor as having an acute change in mental status a week before the execution of the Agreement, and this doctor believed as of June 20, 2015, the day after [Decedent ] signed the Agreement, that a neurological evaluation was necessary. Her cognitive impa irments , coupled with her age and medical conditions, undoubtedly affected her ability to understand the te rms of a sophisticated legal agreement. Therefore, this Cou rt finds that [Decedent] was incompetent at the time she entered the Agreement and therefore the Agreement that she signed dated June 19, 2015 is void. Trial Court Opinion, 7/2/2018, at 5
- 8. We note t he court made several critical factual findings: (1) Decedent was an elderly woman with multiple complex medical issues, including seve ral incidents of cerebellar inf a r ctions (otherwise known as strokes) and she had
a subarachnoid area of hemorrhage , and the treating physician had requested
a neurological evaluation of Decedent ; 4 (2) the June 20, 2015, medical admission report indicated Decedent had a history of multiple episodes of having acute changes of mental status with recovery ; (3) a lthough the medical records submitted reflected that D ecedent’s mental status was at baseline, there is no evidence of what her baseline was ; and (4) Davis testified that he was present when Decedent signed the Agreement and she did not understand what the admission documents entailed and her condition preven ted her from signing the remaining documents. Based on the totality of the circumstances,

_________________ ____________________ _______ 4 The doctor subsequently indicated that two days after she signed the ag reement, Decedent was oriented to person only and she could not remember if she ate breakfast that morning. See Trial Court Opinion, 7/2/2018, at 6.J - A01003
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Decedent endured an acute change in mental status around the same time she signed the document , specifically evidence of the recent cerebellar infraction and subarac hnoid hemorrhage , which can reasonably be inferred as dispositive in determining that , while Decedent may have been oriented to person, place or time questions, there is clear and convincing evidence to support the trial court’s finding that Decedent did not comprehend the legal consequences of the document she was signing. 5 Furthermore, knowing that she was being admitted to Kindred, a place she had been before , does not equate to comprehending the legal consequences of the document she was signing. 6 Mo reover, we find Cardinal , supra , which Kindred relies on, distinguishable from the present matter. In reversing the trial court’s decision, a panel of this Court determined there did not exist clear, precise,

_________________ ____________________ _______ 5 This is supported by the fact that Davis stated she did not sign any other documents that day. See Defendant’s Supplemental Memorandum of Law in Support of Defendants’ Preliminary Objection to Enforce the Alternative Dispute Resolution Agreement, 10/25/2017, at Exhibit C, Deposition of Horace Davis, 8/31/2017, at 31
- 32(“Q. Okay. And were you concerned at all with her signing this document? A. No. Q. Okay. Did you think she understood? A. I don’t know what you mean by understood. She understood that she was being admitted to the hospital and this is part of the stuff that was necessary to get her back into the facility. Q. Okay. Do you know if she signed the other admissions document? A. The other admission s document? Q. Did she sign or did you sign them? A. I think I signed the other. Q. You signed the other. Why was that? A. Because her hand wasn’t steady and there was some conditions that prevented her from signing.”).
6 Moreover, that initial agreement, dated March 12, 2015, was signed by Davis and not Decedent.J - A01003
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and convincing evidence to support the court’s finding that the decedent lacked capacity to enter into the arbitration agreement. See Cardinal , 155 A.3d at 51. First, the p anel concluded “the trial court’ s focus on the knowledge possessed by [the hospital] employee ... regarding the contents and implications of the agreement [wa]s misplaced” because it was “ irrelevant to this inquiry what [the hospital employee] knew or did not know about the agreement” as the “concern is whether clear and convincing evidence exists on the record to demonstrate that [the d]ecedent lacked capacity to enter into the contract.” Id. Second, the panel “flatly reject[ed] the trial cou rt’s reliance on the fact that [the d] ecedent had, some years prior to signing the agreement, exec uted a power of attorney in favor of his nephew,” the appellee in the appeal, because “mere existence of a power of attorney can in no way be construed as indicia of incapacity on the part of the principal.” Id. Lastly, the panel found the trial court omi tted certain medical evidence concerning the decedent was “ ‘awake, alert, [and] oriented" on [the date of admission] and ‘alert [and] oriented’ on ... the very date the agreement was executed[.]” Id. at 52. Furthermore, while the trial court noted that the hospital employee had observed the decedent having difficulty affixing his signature to the agreement, the employee’s deposition testimony also reveal ed that she “went on to acknowledge that she actually had no independent recollection of [the d]ecedent’ s ability to sign his name during her meeting with him” and the decedent “ was able to express other preferences, such as his desire to d eclineJ - A01003
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the facility’ s assistance with the management of his personal f unds and his wish to have his bills submitted directly to Medicare.” Id. Here, the court did not rely on the deposition statements made by Kindred’s employee to analyze Decedent’s state of mind at the time signed the agreement
. Second, there was no argu ment put forth by Davis that Decedent was incapacitated due to executing a power of attorney. Third, there wa s no evidence presented in Cardinal that the decedent had suffered a stroke a week prior to signing the admission documents and acute changes in mental status like in the present matter. Accordingly, Kindred’s first argument fails. Next, Kindred claims the trial court erred in finding that Davis had no legal authority to waive his wife’s rights under the Survival Act 7 when he signed the Agreements. Kindred’s Brief at 20 . Rather, Kindred alleges Davis had Decedent’s express ve rbal consent to sign the Agreements on her behalf. Id. It also asserts there was evidence of apparent authority and authority by estoppel to establish Davis had legal authority to sign the documents at issue. In support of this argument, Kindred points to the following : [Davis’] testimony establishes that h e did in fact have his wife’ s express verbal authority to sign admission papers on her behalf. The authority was granted to him by his wife, based on their continuous, repeated affirmations of agreement. [Davis’]

_________________ ____________________ _______ 7 See 42 Pa.C.S. § 8302 (“ All causes of action or proceedings, real or personal, shall survive the death of the plaintiff or of the defendant, or the death of one or more joint plaintiffs or defendants.”).J - A01003
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testimony confirms that this process was d one with [Decedent’s] knowledge and consent.

... As is clear from the testimony of [Davis] , he consistently acted on his wife’ s behalf, with her consent. Upon [Decedent’s] admission to Kindred, it was their joint decision that he would get her signed in and settled, based on their long
- standing course of conduct, and, in essence, a meeting of their minds prior to her admission.

... [Davis’] actions on behalf of his wife con stituted a reasonable basis upon which the admission person could rely in having him sign the admission documents. [Davis] , with the approval of [Decedent] , held himself out as the legal representative in signing the documents. Although [Davis] did not ha ve a formal Power of Attorney document, it is clear that the existence of the relationship, in the context of an ongoing course of conduct (where [the husband and wife] executed admissions documents together and agreed on the disposition of her admission), establishes express or apparent agency, and/or agency by estoppel.

... By signing the underlying Agreement, [Davis] acknowledged that he was voluntarily relinquishing the right to a jury trial in favor of Alternative Dispute Resolution, on behalf of his w ife, with whom he conferred daily, and kept watch over. It was more than reasonable for Kindred staff to rely upon [Davis] as his wife’ s authorized agent. There is no evidence that [Decedent] , who was present in the Hospital for all those weeks, did anything to disavow Kindred staff of the idea that her husband, who happened to be a retired Magisterial Judge, could be counted on to act in her best interests, and with her consent. During his testimony, [Davis] made it clear that he and his wife commun icated daily as to virtually all her healthcare decision
- making. Kindred reasonably relied on those manifestations of his authority to allow him to sign off on the pertinent paperwork. It is also clear from [Davis’] testimony that he understood the basic c omponents of the ADR Agreement.J - A01003
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Id . at 21
- 24
. Initially, we note the trial court found this issue was waived for Kindred’s failure to include in its concise statement. See Trial Court Opinion, 7/2/2018, at 8 n.2 (“ Although this Court addresses whether [Davis] had the authority to execute the March 13, 2015 and July 30, 2015 Agreements, [Kindred has] waived their ability to challenge this issue by not including it in their Concise Statement of Matters Complained of on Appeal.”). We review ed the concise statement , 8 and are in agreement wi th the trial court that Kindred did not list an agency argument in its therein concise statement. Accordingly, Kindred

_________________ ____________________ _______ 8 Rather, Kindred’s concise statement identifies the following issues: 1. Whether the Trial Court erred in refusing to enforce the ADR agreement signed by decedent Grace Kelly Davis, a retired nurse, where Plaintiff failed to meet her burden of proof to establish evidence that Mrs. Davis lacked capacity to enter into the agreement?. 2. Whether the Trial Court erred in refusing to enforce the two ADR agreements signed by decedent's husband (a retired Magist erial Judge), despite Mr. Davis’ unequivocal acknowledgment of his understanding of the arbitration agreements? 3. Whether the Trial Court erred in refusing to enforce valid ADR agreements, signed over multiple admissions by decedent's husband (a retired Magisterial Judge) and the decedent (a retired nurse, Gr ace Kelly Davis), given husband’ s testimony that the documents were presented, explained, reviewed and si gned by the admissions staff? Concise Statement of Errors Complained of on Appeal, 5/17/2018, at 2.J - A01003
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- 19
-

has waived this issue. See Pa.R.A.P. 1925(b)(4)(vii) (“ Issues not included in the Statement and/or not raised in accordance with the provisions of this paragraph (b)(4) are waived .” ). 9 Assuming arguendo Kindred had not waived this issue, this argument is unavailing. With respect to the issue of agency, we are guided by the following:

“ Agency is the re lationship which results from the consent of one person that another may act on his behalf.” Lincoln Avenue Industrial Park v. Norley , 450 Pa. Super. 621, 677 A. 2d 1219, 1222 (Pa. Super. 1996) (citation omitted). “The creation of an agency relationship re quires no special formalities.” Walton , 66 A.3d at 787 (citation omitted). “The existence of an agency relat ionship is a question of fact.” Id. “ The party assert ing the existence of an agency relationship bears the burden of proving it by a fair prep onderance of the evidence.” Id. An agency relationship may be created by any of the following: (1) express authority, (2) implied authority, (3) apparent authority, and/or (4) authority by estoppel. Exp ress authority exists where the principal delibera tely and specifically grants authority to t he agent as to certain matters. Implied authority exists in situations where the agent ’ s actions are “ proper, usual and necessary ” to carry out express agency . Appa rent authority exists where the principal , by word or conduct, causes people with whom the alleged agent deals to believe that the principal has granted the agent authority to act. Author ity by estoppel occurs when the principal fails to take reasonable steps to disavow the third party of their belie f that the purported agent was authorized to act on behalf of the principal. Walton , 66 A.3d at 786 (citations omitted) (emphasis added).

_________________ ____________________ _______ 9 See also Commonwealth v. Johnson , 107 A.3d 52, 69 n.7 (Pa. 2014) (finding Rule 1925 waiver applied because a ppellant failed to include a claim in his concise statement ) , cert. denied , 136 S. Ct. 43 (U.S. 2015)
.J - A01003
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- 20
-

McIlwain v. Saber Healthcare Grp., Inc., LLC , 208 A.3d 478, 485 (Pa. Super. 2019). Moreover, “[t]he basic elements of agency are the manifestation by the principal that the agent shall act for him, the agent’s acceptance of the undertaking and the understanding of the parties that the principal is to be in control of the undertaking.” Walton , 66 A.3d at 787 ( citation omitted). Additionally, “ [a]gency cannot be inferred from mere relationships or family ties.” Wisler v. Manor Care of Lancaster PA, LLC , 124 A.3d 317, 323 (Pa. Super. 2015) (citation omitted) , appeal denied , 128 A.3d 222 (Pa. 2015)
. Here, t he trial court found the following : As there is no written document granting [Davis] express authority or to establish implied authority, [Kindred] maintain [s] there was apparent agency and/or agency by estoppel. Apparent agency and agency by est oppel focus on the words and conduct of the principal, [Decedent]
. “ An agent cannot simply by his own words, invest himself with apparent authority. Such authority emanates from the action of the principal and not the agent .” To prevail on a claim of agency by estoppel on the issue of authority to sign the Agreements, [Kindred] must prove that [Decedent] intentionally or carelessly caused [Kindred’s] admissions coordinator to believe an agency relationship existed, or knowing that the admissions coordi nator held such a belief, [Decedent] did not take reasonable steps to clarify the facts. [Kindred] ha[s] failed to offer any evidence of [Decedent’s] conduct at the time the Agreements were executed or her conduct with the admissions coordinator at any time before execution of the Agreements. There is no evidence that [Decedent] knew [Davis] was executing the Agreements specifically. Neither [Davis] nor [Kindred’s] admissions coordinator could recall whether [Decedent] was present in the room when the Agreements were executed by [Decedent]
. (8/31/17 Horace Davis Deposition N.T. 22
- 23 and 8/31/17 Lilia Margolies Deposition N.T. 27
- 28). [Davis] also testified that he did not tellJ - A01003
- 19

- 21
-

[Decedent] about the Agreements or the fact that he signed them, and Mrs. Davis did not instruct him to sign the Agreements. (8/31/17 Horace Davis Deposition N.T. 23, 40, 47). It is irrelevant whether [Decedent] had given [Davis] express verbal authority to sign the admissions paperwork in general, as [Kindred] argues, unless this verbal authority was given while [Kindred’s] representative was present such that [Decedent’s] words caused the admissions coordinator to believe that [Decedent] had granted [Davis] the authority to act. There is no evidence of such. Further, there is no evidence that [Decedent] verbally gave [Davis] the authority to sign the Agreements specifically. Lastly, there cannot be agency by estoppel because [Kindred] have offered no evidence of [Decedent’s] negligence. Trial Court Opinion, 7/2/2018 , at 9
- 10 (citation omitted)
. We agree with the court’s conclusion and would affirm on the basis of the court’s opinion as a review of the evidence reveals “ there was no express, implied, or apparent authority, nor authority by estoppel to establish an ag ency relationship” between Decedent and Davis in relation to signing the arbitration agreements. McIlwain , 208 A.3d at 485
- 486
. Lastly, Kindred complains the court erred in finding that the agreement was void due to unconscionability. See Kindred’s Brief at 24
- 33. Kindred states: The basic thrust of [the trial court’s] analysis appears to be grounded in the idea that the ADR Agreement is one
- sided, and that it did not clearly indicate that the Agreement was voluntary, and that the Agreeme nt was not adequately explained to [Davis or Decedent]
. However, if taken to its logical conclusion, it seems clear that this Decision, if left to stand, would void every single nursing home ADR or Arbitration Agreement in the Commonwealth of Pennsylvania , because, in the trial court’ s view, it appears that all such Agreements are one
- sided, and can never be fair to both the facility and the resident. That, however, is not the law.J - A01003
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- 22
- The trial court ’ s Opinion striking down the ADR Agreement in this case was not an objective assessment of the ADR Agreement and witness testimony. The court’ s expressed view is in complete contravention of numerous precedents from this court, the Supreme Court of Pennsyl vania, and the Supreme Court of the United States, which hold that the federal and state interests in favoring arbitration of disputes are paramount and play a central factor in determining whether Agreements, such as the one at issue here, should be enfor ced. Kindred’s Brief at 24
- 25. B ecause we previously determined that (1) the court correctly found Decedent was an incapacitated person at the time she signed the June, 19, 2015, arbitration agreement which prevented her from knowingly entering into the contract, and (2) Kindred waived any argument concerning any authority on the part of Davis to sign the March 13, 2015 , and July 30, 2015 , Arbitration Agreements and thereby legally b ound himself and Decedent, we need not reach the issue of whether the Arb itration Agreements were unconscionable. Accordingly, we conclude the trial court did not err in entering the March 27, 2018, order overruling their preliminary objections to the complaint filed by Davis. Order affirmed.J - A01003
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Judgment Entered.

Joseph D. Seletyn, Esq. Prothonotary

Date: 9/16/19Circulated 08/19/2019 11:51 AM

IN T H E C O U R T O F C O M M O N P L E A S O F D E L A W ARE C O U N T Y , P E NN S Y L V A

N I A C I V I L A C T I O N

- L A W

H o r a c e D av i s , A dm i n i s tr a t o r o f th e E s t a t e o f G r a c e K e ll y D a v i s , D e c e a s e d P l ai n t i ff , 

### v . 2 5 0 7 C h e s tnu t S tr e e t O p e r a t i o n s , L L C d / b / a T h e B e l v e d e r e C e n t e r G e n e s i s H e a lth c a r e , L L C , D e l aw ar e C o un ty M e m o r i a l H o s p i t a l , C r o z e r C h e s t e r M e d i c a l C e n t e r , C r o z e r - K e y s t o n e H e a l th S y s t e m , Ki n dr e d H o s p i t a l P h il a d e l p h i a - H av e rt o w n , Ki n dr e d H o s p i t a l E a s t , L L C , K i n dr e d H e a lth c a r e , I n c . , M e r c y C a th o l i c M e d i c a l C e n t e r : o f S o u th e a s t e r

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n P e n n s y l v an i a D e fe n d an t s . N o . 1 7

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C HRI S T O P H E R J

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## O P I N I O N

B U RR , S .J

. F I L E D : Jul y 2 , 2 0 1 8

D e fe n d an t s , K i n dr e d H o s p i t a l P h i l a d e l p h i a - H av e rt o wn , K i n dr e d H o s p i t a l E as t , L L C an d K i n dr e d H e a lth c ar e , In c . ( h e r e i n aft e r " D e fe n d an t s " ) h av e a p p e al e d fr o m th i s C o urt ' s O r d e r o f M ar c h 2 7 , 2 0 1 8 o v e rru l i n g th e i r P r e l i m i n ary O b j e c ti o n s t o P l ai n t i f

f s C o mp l ai n t i n th i s
m e d i c al p ro fe s s i o n a l l i ab i l i ty a c t i o n . I n th e i r P r e l i m i n ar y O b j e c t i o n s , D e fe n d an t s r e qu e s t e d th i s C o urt t o di r e c t th e p art i e s t o ar b i tr a t i o n p ur s u an t t o P a . R

. C

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. 10 2 8 ( a ) ( 6 ) o n P l a i n ti f f' s s urv i v a l cl a i m s i n a c c o r d an c e w i th th e V o l un t ar y A r b i tr a t i o n A g r e e m e n t s ( h e r e i n a ft e r " A g r e e m e n t s " )

e x e c u t e d b y th e d e c e d e n t , G ra c e K e ll y D av i s , an d h e r hu s b an d , H o ra c e D av i s ( h e r e in a ft e r 

# A D D E N D U M C" P l a i n t i f f ' )

. T h e A gr e e m e n t s w er e al l e g e d l y e x e c u t e d o n o r ab o u t M ar c h 13 , 2 0 1 5 b y P l a i n t i ff ,
o n o r ab o u t Jun e 1 9 , 2 0 1 5 b y d e c e d e n t , M r s . D a v i s , an d o n o r ab o u t Ju l y 3 1 , 2 0 1 5 b y P l ai n t i ff a t th e t i m e o f thr e e s e p ara t e a dmi s s i o n s o f M r s . D av i s t o D e fe n d an t s ' f a c i l i ty '

. T h e di s p o s i t i o n o f D e fe n d an t s ' P r e l i m i nar

y O b j e c t i o n s b y thi s C o urt turn e d o n w h e th e r o r n o t th e A g r e e m e n t s ar e
v a li d an d e nf

o r c e ab l e . Th e al l e g e d fa ct s un d e r l y i n g thi s d i s p u t e ar e s e t fo rth i n P l a i n t i ff s C o mp l ain t fi l e d o n F e b ru ary 1 7 , 2 0 1 7

. Mrs

. D av i s e n t e r e d K i n dr e d H o s p i t al P lri l a d e l p h i a - H av e rt o wn , o wn e d an d o p e ra t e d b y D e f e n d an t s , K i n dr e d H o s p i t al E a s t , L L C an d K i n dr e d H e a lth c ar e , I n c . , o n A p r i l 2 , 2 0 1 5 an d r e m a i n e d i n th e fa c i l i ty thr o u gh A p r il 2 0 , 2 0 1 5

. 

## ( ,r 3 4 o f C o mp l ai n t )

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a dm i s s i o n , s h e p r e s e n t e d w i th p r e s s ur e u l c e r s w hi c h p e r s i s t e d an d d et e r i o r a t e d d ur i n g h e r s t ay a t D e fe n dan t s ' f

ac i l i ty
. 

## ( ,r ,r 3 3 ; 3 5 o f C o mp l ai n t )

. Mr s . D av i s w as a g a i n adm i tt e d t o Ki n dre d H o s p i t al P hi l a d e l p hi a - H av e rt o w n o n Jun e 1 9 , 2 0 1 5 ; thi s a dm i s s i o n l a s t e d un t i l Ju l y 9 , 2 0 1 5 d uri n g w h i c h t i m e h e r s a m e w o un d s p e r s i s t ed an d d e t e r i o r a t e d

. 

## c,r ,r 3 9 , 4 0 o f C o mp l ai n t )

. Mr s . D av i s w a s a g a i n a dm i tt e d t o K i n dr e d H o s p i t a l P h i l a d e l p h.i a - H av e rt o wn o n Ju l y 1 3 , 2 0 1 5 ; th i s
a dm i s s i o n l a s t e d un t i l Ju l y 2 0 , 2 0 1 5 d ur i n g w hi c h ti m e h e r s am e w o un d s p e r s i st e d an d d e t e r i o r a t e d

. 

## ( fl 4 3 , 4 4 , 4 5 o f C o mp l a i n t )

. Mr s . D av i s w a s l as t a dmi tt e d t o K i n dr e d H o s p i t a l P h i l a d e l p hi a - H av e rt o w n o n Ju l y 3 0 , 2 0 1 5 ; thi s a dm i s s i o n . l a s t e d un t i l A u g u s t 2 5 , 2 0 1 5 d ur in g .
w hi c h t i m e h e r s am e w o un d s p e r s i st e d an d d e t e r i o r a t e d furth e r t o a s t a g e o f I V

. 

## ( ,r ,r 4 7 , 4 8 o f

· C o mp l ai n t )

. T hr o u g h o u t M r s . D av i s ' s t ay a t th e D e f e n d an t s ' fa c i l i ty , s h e a ll e g e d l y r e c e i v e d i n ad e qu a t e c ar e an d tr e a tm e n t. 

## ( ,r 1 0 3 o f C o mp l a in t )

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an d P l ai n t i ff al l e g e s th a t th e p r e s s ur e u lc e r s , w h i c h w e r e c au s e d s o l e l y an d e x cl u s i v e l y b y th e
c o n d u c t o f a ll D e f

e n d an t s ( an d/ o r th e i r r es p e c ti v e a g e n t s , s e rv an t s , e mp l o y e e s ) c au s e d an d / o r
c o n tr i b u t e d t o h e r d e m i s e . 

## ( ,r ,r 4 9 , 5 0 o f C o mp l a i n t )

.
1 E a c h o n e o fth e A g r e e m e n t s i s i d e n t i c a l an d c o n t a in th e s am e t e rm s . 2O n M ar c h 2 2 , 2 0 1 7 , D e fe n d an t s fi l e d P r e l i m i n ary O b j e c t i o n s t o P l a i n t i ff

s C o mp l a i n t s e e k i n g t o c o mp e l ar b i tr a t i o n o f P l a i n t i f

f s cl ai m s un d e r th e A g r e e m e n t s th a t h a d b e e n e x e c u t e d b y P l a i n t i ff an d M r s . D av i s . 

## ( ,r ,r 5 , 8 o f P r e li m i n ary O b j e c t i o n s )

. O n Ap r i l 11 , 2 0 1 7 , P l a i n t i ff r e s p o n d e d t o D e fe n d an t s ' P r e li m i n ar y O b j e c t i o n s a s s e rt i n g th a t th e A g r e e m e n t s
ar e un e n fo r c e ab l e a s M r s . D av i s l a c k e d th e m e n t a l c a p a ci ty t o e n t e r i n t o th e · A g r e e m e n t s h e
e x e c u t e d> th a t P l ai n t i ff l a c k e d th e au th o r i ty t o b i n d M r s . D av i s t o th e A g r e e m e n t s h e e x e c u t e d , th a t th e A gr e e m e n t s ar e un c o n s ci o n ab l e c o n tra c t s o f a dh e s i o n , an d th a t e n f o r c i n g th e A g r e e m e n t s w o ul d d e n y th e wr o n g fu l d e a th b e n e fi ci ari e s th e i r c o n s t i t u t i o n al r i g h t t o a j ury tr i a l. 

### ( ,r I V o f P l ain t i f

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y O b j e c t i o n s t o P l ai n t i ff

s C o mp l a i n t )

. D e f

e n d an t s fil e d a S u

p p l e m e n t a l M e m o ran d

um o f L aw o n Ap r i l 2 5 , 2 0 1 7 i n r e s p o n s e t o P l a i n t i f f' s An s w e r an d a s s e rt e d th a t P l a i n t i ff fa i l e d t o m e e t th e b ur d e n o f s h o w i n g th a t M r s : D av i s w a s " i n c o mp e t e n t » t o e n t e r i n t o th e A gr e e m e n t th a t s h e
s i g n e d , th a t P l ai n t i ffh a d a p p ar e n t au th o r i ty an d

/ o r a g e n c y b y e s t o p p e l w a s e s t ab li s h e d t o e x e c u t e th e A gr e e m e n t s h e s i g n e d> th a t th e A gr e e m e n t s ar e n o t un c o n s c i o n ab l e a s th e P e nn s y l v ani a S u p e r i o r C o urt d i d n o t fi n d un c o n s ci o n ab l e an a gr e e m e n t t o ar b i tr a t e th a t w a s s i m i l ar i n a ll

m a t e r i al r e s p e c t s t o th e A g r e e i n e n t s a t i s s u e , an d th a t th e fa c t s av e rr e d i n P l ai n t i ff s C o mp l a i n t d o n o t s u p p o rt a · w ro n g fu l d e a th cl a i m . 

## ( ,r I ( A

- D ) o f D e f e n d an t s ' S u

p p l e m e n t a l M e m o r an d

um o f L aw i n S u

p p o rt o f D e f

e n d an t s ' P r e li m i n ary O b j e c t i o n s t o E n fo r c e A l t e rn a t i v e D i s p u t e R e s o l u t i o n · A g r e e m e n t )

. F urth e r , D e fe n d an t s r e qu e s t e d d i s c o v e r y i n th e fo rm o f a d e p o s i t i o n o f P l a i n t i ff an d r e qu e s t fo r p r o d u c t i o n o f d o c um e n t s . · 

## ( ,r D o f D e fe n d an t s ' S u p p l e m e n t al M e m o r an d

um o f L aw i n S u

p p o rt o f D e f

e n d an t s > P r e l i m i n ar

y O b j e c t i o n s t o E n fo r c e Al t e rn a t i v e · D i s p u t e R e s o l u t i o n A g r e e m e n t )

.

3O n Ju l y 13 , 2 0 1 7 , th i s C o urt e n t e r e d an O r d e r g r an ti n g a d d i t i o n a l t i m e fo r th e

p art i e s t o c o n d

u c t d i s c o v e ry an d s u

p p l e m e n t th e r e c o r d as d e e m e d n e c e s s ary o n i s s u e s r e l a t i n g t o th e v al i d i ty an d/ o r e n fo r c e ab ili ty o f th e A gr e e m e n t s . O n O c t o b e r 2 5 , 2 0 1 7 , u p o n c o mp l e t i o n o f th e a d d i t i o n a l d i s c o v e ry p e rm i tt e d b y th e C o urt , w h i c h i n cl u d e d th e d e p o s i t i o n s o f th e D e fe n d an t s ' A dm i s s i o n s C o o r di n a t o r an d P l ai n t i ff , D e fe n d an t s fi l e d a S u p p l e m e n t al M e m o r an d

um o f L aw i n s u

p p o rt o f th e i r p o s i t i o n t o e n fo r c e th e A g r e e m e n t s . O n O c t o b e r 2 6 , 2 0 1 7 , P l a i n t i ff fil e d a S u p p l e m e n t a l M e m o r an d

um o f L aw i n s u

p p o rt o f hi s p o s i t i o n . O n M ar c h 2 7 , 2 0 1 8 , thi s C o urt e n t e r e d an O r d e r o v e rr u l i n g D e fe n d an t s ' P r e l i m i n ary O b j e c t i o ns t o P l a i n t i ff' s C o mp l a i n t fr o m w h i c h D e f e n d an t s t o o k th e i r a

p p e a l o n Ap ri l 4 , 2 0 1 8

. D e f e n d an t s ' P r e li m i n ar

y O b j e c t i o n s w e r e p ro p e rl y o v e rr u l e d a s M r s . D av i s d i d

n o t h av e th e r e qu i s i t e m e n t a l c a p a ci ty t o e n t e r th e A g r e e m e n t , P l a i n t i ff d i d n o t h av e au th o r i ty t o
e n t e r th e A g r e e m e n t s an d th e A gr e e m e n t s ar e un c o n s c i o n ab l e . A s s u c h , th e A g re e m e n t s

r e qu i r i n g th e p arti e s t o p ro c e e d t o ar b i tra t i o n ar e e a c h un e nf

o r c e ab l e a s a w h o l e an d th i s a c ti o n
s h o u l d r e m ai n b e fo r e thi s C o urt
.

" A wr i tt e n a g r e e m e n t t o s ub j e c t any e x i s t i n g c o n tr o v e r s y t o ar b i tra t i o n o r a p ro v i s i o n i n a wr i tt e n a g r e e m e n t t o s ub m i t t o ar b i tr a t i o n an y c o n tr o v e r s y th e r e a ft e r ar i s i n g b e tw e e n th e p art i e s i s v a li d , e nf o r c e ab l e an d i rr e v o c ab l e , s av e u p o n s u c h g ro un d s a s e xi s t a t l aw
o r i n e qu i ty r e l a ti n g t o th e v a li d i ty , e n fo r c e ab ili ty o r r e v o c a t i o n o f an y c o n tr a c t
. " 4 2 P a . C. S

. § 7 3 0 3

. I n W e i r v . E s t a t e o f C i a o , 5 5 6 A .2 d 8 1 9 , 8 2 4 ( P a . 1 9 8 9 ) , th e S u p r e m e C o urt n o t e d th e a p p li c ab le an a l y s i s w h e n th e r e e x i s t s a c h a ll e n g e t o th e m e n t a l c a p a ci ty o f a p e r s o n w h o
s i g ns a c o n tr a c t :

4« w r i tt e n i n s trum e n t s ar e n o t t o b e s e t as i d e e x c e p t u p o n c o n v i n c i n g t e s t i m o n y th a t th e i r e x e c u t i o n w a s t ai n t e d w i th fr au d , e i th e r a c t u al o r c o n s tr

u c t i v e , o r th a t th e p e r s o n s o e x e c u t i n g th e m d i d n o t h av e w h a t th e l aw c o n s i d e r s s uf fi c i e n t m e n t al c a

p a ci ty t o d o s o . ( ci t a t i o n o m i tt e d )

. C o n tr a c t s m a d e w i th an i n c o mp e t e n t b e fo r e h i s a d j u d i c a t i o n a s w e ak m i n d e d ar e v o i d ab l e an d c an b e av o i d e d o nl y o n p r o p e r s h o w i n g th a t h e w a s i n c o mp e t e n t a t th e t i m e . ( c i t a t i o n o m i tt e d )

. Wh e n m e n t a l c o mp e t e n c y i s a t i s s u e th e r e a l

. qu e s t i o n i s th e c o n d i t i o n o f th e p e r s o n a t th e v e r y t i m e h e m a d e th e g i ft o r e x e c u t e d th e i ns trum e n t. ( c i t a t i o n o m i tt e d )

. C o mp e t e n c e i s b e s t d e t e rmi n e d b y a p e r s o n 1 s w o r d s an d a c t s . T h e t e s t i m o n y o f p e r s o n s w h o o b s e rv e d th e a ll e g e d i n c o mp e t e n t o n th e d a t e i n qu e s t i o n i s g e n e ra ll y s u p e ri o r t o t e st i m o n y a s t o o b s e rv a t i o ns m a d e p r i o r t o an d s ub s e qu e n t t o th a t d a t e . O r d i n ar il y , c o mp e t e n c e i s p r e s um e d an d th e b ur d e n o f p ro o f i s u p o n th e p e r s o n w h o a ll e g e s th e i n c o mp e t e n c e . " ( c i t a t i o n o m i tt e d )

. T o r e b u t th e p r e s ump t i o n o f c o mp e t e n c e , " th e c h a ll e n g e r mu s t p r e s e n t e v i d e n c e o f

m e n t a l i n c o mp e t e n c y w hi c h i s ' c le ar , p r e ci s e an d c o n v i n c i n g ? ' , E s t a t e o f M c G o v e rn v . C o m . S t a t e E mp l o y e e s ' R e t. B d

. , 5 1 7 A. 2 d 5 2 3 , 5 2 6 (P a . 1 9 8 6 )

. M o r e o v e r , " [ i ] t i s w e ll s e tt l e d th a t

m e r e w e akn e s s o f i n t e ll e c t r e s u l t i n g fr o m s i c kn e s s o r o l d a g e i s n o t l e g a l gr o un d s t o s e t a s i d e an
e x e c u t e d c o n tra c t i f s u ffi c i e n t i n t e lli g e n c e r e m a i n s t o c o mp r e h e n d th e n a tur e an d c h ar a c t e r o f th e tr an s a c t i o n , an d n o e v i d e n c e o f fr au d , mu tu al mi s t ak e o r un d u e infl u e n c e i s p r e s e n t. " T ay l o r v . A v i , 4 1 5 A

. 2 d 8 9 4 , 8 9 7 ( P a . S u p e r . 1 9 7 9 ) ( c i ta t i o n s o m i tt e d )

. D o c um e n t s p r e p ar e d b y D e fe n d an t s ' o wn m e di c a l p ro fe s s i o n a l ar o un d th e d a t e th e A g r e e m e n t w a s s i gn e d b y M r s . D av i s ( Jun e 1 9 , 2 0 1 5 2), c o mp e l th e c o n cl u s i o n th a t M r s . D av i s '
th o u g h t s w e r e i mp ai r e d a t th e t i m e th a t s h e e x e c u t e d th e A g r e e m e n t an d th e r e fo r e s h e l a c k e d th e
m e n t al c a

p a c i ty t o e n t e r th e A gr e e m e n t. Mr s . D av i s ' a dm i s s i o n r e c o r d s t o D e fe n d an t s ' fa c i li ty p r e p ar e d b y K amr an T ar e e n , M

. D

. d a t e d Jun e 2 0 , 2 0 1 5 r e fl e c t th a t M r s . D av i s w a s a 7 9 y e ar 

### w o m an w i th mu l t i p l e c o mp l e x m e d i c a l i s s u e s in cl u d i n g a l ar g e c e r e b e ll ar i n far c t i o n ( s tro k e ) , C hr o n i c K i dn e y D i s e a s e , I V , a tr i a l fi b r ill a t i o n w i th p a c e m ak e r s t a t u s , mu lt i p l e m y e l o m a ( c an c e r

2 

### T h e a gr e e m e n t i s n o t d a t e d b y Mr s . D av i s n e x t t o h e r s i g n a tur e ; h o w e v e r , th e a gr e e m e n t o n p a g e I i s d a t ed Jun e 1 9 , 2 0 1 5

. Ju s t a

b o v e Mr s . D a v i s ' s i g n a t ur e , th e A gr e e m e n t s ta t e s , " I N WJ T NE S S WHE RE O F , th e p art i e s , i n t e n d in g t o b e l e g a ll y b o un d , h av e s i g n e d th i s A gr e e m e n t a s o fth e d a t e fir s t wr i tt e n ab o v e "

. T h i s d a t e w a s Jun e 1 9 , 2 0 1 5 , th e d a t e o f Mr s . D av i s ' a dm i s s i o n t o D e f e n d an ts ' fa c ili ty
. ( E xh i b i t B o f P l a i n t i ff' s A n s w e r i n O p p o s i t i o n t o D e fe n d an t s ' P r e li m in ary O b j e c t i o n s t o P l a i n t i f

f' s C o mp l a in t ). D e fe n d an t s s u g g e s t th a t th e A gr e e m e n t w as s i gn e d o n Ju l y I , 2 0 1 5 b y Mr s . D av i s , w h e n th e ir r e p r e s e n t a ti v e e x e c u t e d th e a gr e e m e n t , b u t th e r e c o r d d o e s n o t s u p p o rt th i s . A d d i ti o n a ll y , D e fe n d an t s ' a dm i s s i o n s c o o r d i n a t o r ' s d e p o s i t i o n t e s tim o n y d o e s n o t c o n fi rm th e d a t e o n w h i c h Mr s . D av i s s i gn e d th e a gr e e m e n t. 

### 5o f th e p l a s m a c e ll s ) i n r e m i s s i o n , s t a g e II d e c ub i t i s u lc e r , s e p s i s d u e t o a ur i n ar

y tra c t i n fe c t i o n , h i s t o r y o f C d i f

fi ci l e c o li t i s , s e v e r h yp o p r o t e i n e m i a , an d an e m i a . ( A dm i s s i o n R e p o rt d a t e d Jun e 2 0 , 2 0 1 5 , E xhi b i t C o f P l a i n t i ff' s A n s w e r i n O p p o s i t i o n t o D e fe n d an t s ' P r e li m i nary O b j e c t i o n s t o P l a i n t i f

f s C o mp l ain t )

. It i s furth e r n o t e d th a t o n Jun e 1 2 , 2 0 1 5 , a p p ro x i m a t e l y a w e e k p r i o r t o h e r e x e c u t i o n o f th e A gr e e m e n t , s h e w a s fo un d t o h av e an a c u t e c h an g e i n m e n t al s t a t u s . ( A dm i s s i o n R e p o rt d a t e d Jun e 2 0 , 2 0 1 5 , E x h i b i t C o f P l a i n t i ff s An s w e r i n O p p o s i t i o n t o D e fe n d an t s ' P r e li m i n ar

y O b j e c t i o n s t o P l ain t i f

f s C o mp l a i n t )

. Th e c h an g e in m e n t al s t a t u s w as d i a g n o s e d a s th e r e s u lt o f a n e w l e ft c e r e b e ll ar i n far c t i o n ( s tro k e )

. ( A dm i s s i o n R e p o rt d a t e d Jun e 2 0 , 2 0 1 5 , E x h i b i t C o f P l ai n t i ff' s An s w e r i n O p p o s i t i o n t o D e fe n d an t s ' P r e l im i n ary O b j e c t i o n s t o P l ai n t i ff

s C o mp l a i n t )

. M r s . D av i s al s o h a d a s ub ara c hn o i d ar e a o f h e m o rrh a g e
an d , al th o u g h D r . T ar e e n n o t e s th a t M r s . D av i s i s " o r i e n t e d [ t o p e r s o n , p l a c e an d t i m e ]" , h e
r e c o mm e n d e d th a t s h e f o l l o w - u p wi th a n e ur o l o g i s t fo r e v al u a t i o n . ( A dm i s s i o n R e p o rt d a t e d Jun e 2 0 , 2 0 1 5 , E xhi b i t C o f P l a i n t i f f s A n s w e r i n O p p o s i t i o n t o D e fe n d an t s ' P r e l i m i n ary O b j e c t i o n s t o P l a i n t i f

f s C o mp l a i n t )

. It i s furth e r n o t e d i n th e Jun e 2 0 , 2 0 1 5 r e p o rt th a t M r s . D av i s h a d a hi s t o r

y o f mu l t i p l e e p i s o d e s o f h av i n g a c u t e c h an g e o f m e n t a l s t a tu s w i th r e c o v e ry . ( A dmi s s i o n R e p o rt d a t e d Jun e 2 0 , 2 0 1 5 , E x h i b i t C o f P l a i n t i ff s An s w e r i n O p p o s i t i o n t o D e fe n d an t s ' P r e l i m i n ary O b j e c t i o n s t o P l a i n t i f

f s C o mp l a i n t )

. I n D r . T ar e e n ' s p ro g r e s s n o t e d a t e d Jun e 2 1 , 2 0 1 5 , tw o ( 2 ) d ay s a ft e r Mr s . D av i s
s i g n e d th e A g r e e m e n t , a C T s c an w a s s ti ll p e n d i n g o f M r s . D av i s an d h e w a s s t ill w a i t i n g o n N e uro l o g y c o n s u l t s an d D r . T ar e e n n o t e s th a t M r s . D av i s i s " o r i e n t e d [ t o p e r s o n ] " o nl y . ( P ro g r e s s N o t e d a t e d Jun e 2 1 , 2 0 1 5 , E x h i b i t C o f P l a i n t i ff s An s w e r i n O p p o s i t i o n t o D e fe n d an t s ' P r e l i m i n ar

y O b j e c ti o n s t o P l a i n ti ff' s C o mp l a i n t )

. F urth e r , a s r e fl e c t e d i n th e Jun e 2 1 , 2 0 1 5 n o t e , w h e n M r s . D av i s w as as k e d i f s h e a t e b r e ak fa s t th a t m o rnin g , s h e s a i d s h e c o u l d

6n o t r e m e mb e r i f s h e a t e o r n o t an d th e r e fo r e th e d o c t o r r e c o m m e n d e d th a t s h e b e a s s i s t e d w i th

e a t i n g . ( P ro g r e s s N o t e d a t e d Jun e 2 1 , 2 0 1 5 , E x h i b i t C o f P l a i n ti ff s An s w e r i n O p p o s i t i o n t o D e fe n d an t s ' P r e li m i n ar

y O b j e c t i o n s t o P l a in ti ff

s C o mp l a i n t )

. A l th o u g h th e m e d i c a l r e c o r d s s ub m i tt e d b y D e fe n d an t s r e fl e c t th a t Mr s . D avi s '

" M S w a s a t b a s e l i n e " , th e r e i s n o e v i d e n c e o f w h a t h e r b a s e l i n e w a s . ( P ro g r e s s N o t e d a t e d Ju l y 1 , 2 0 1 5 , E x h i b i t D o f D e fe n d an t s ' S u p p l e m e n t a l M e m o r an d

um o f L aw i n S u

p p o rt o f D e fe n d an t s ' P r e li m i n ar

y O b j e c t i o n s t o E n fo r c e Al t e rn a t i v e D i s p u t e R e s o l u t i o n A gr e e m e n t )

. F urth e r , c e rt a i n o f th e m e d i c a l r e c o r d s s ub m i tt e d b y D e fe n d an t s ar e d a t e d Ju l y 1 , 2 0 1 5 , th e d ay th e i r r e p r e s e n t a t i v e s i g n e d th e A g r e e m e n t , n o t th e d a t e th a t th e A g r e e m e n t r e fl e c t s th a t i t w a s

s i gn e d b y Mr s . D av i s . I n a d d i ti o n , a l th o u gh it i s s t a t e d i n D r . T ar e e n ' s di s c h ar g e s umm ar y d a t e d Ju l y 2 0 ; 2 0 1 5 th a t M r s . D av i s d i d n o t h av e an y n e ur o l o g i c a l d e fe c t s , th i s w a s a s o f Ju l y 2 0 , 2 0 1 5 , al m o s t a m o n th aft e r M r s . D avi s e x e c u t e d th e A g r e e m e n t an d m o r e th an a m o n th a ft e r s h e
s u ff e r e d h e r s tr o k e . ( D i s c h ar g e S umm ary d a t e d Ju l y 2 0 , 2 0 1 5 , E x h i b i t C o fP l a i n t i f f s An s w e r i n O p p o s i t i o n t o D e fe n d an t s ' P r e l i m i n ary O b j e c t i o n s t o P l a i n t i f

f' s C o mp l a i n t )

. L as tl y , D e fe n d an t s
as s e rti o n th a t P l ain t i ff t e s t i fi e d th a t h e b e l i e v e d th a t Mr s . D av i s un d e r s t o o d s h e w a s b e i n g
a dm i tt e d i n t o th e h o s p i t a l an d th a t s i g n i n g th e d o c um e n t s w a s a p art o f th e a dm i s s i o n s p ro c e s s d o e s n o t s p e ak c o n cl u s i v e l y t o w h e th e r Mr s . D av i s w a s c o mp e t e n t t o e n t e r th e A g r e e m e n t. T o th e c o n tr ary , an d m o r e s p e c i fi c t o th e i s s u e , P l ai n t i ff , w h o w as p r e s e n t w h e n Mr s . D av i s s i gn e d th e A g r e e m e n t , t e s t i fi e d th a t M r s . D av i s d i d n o t un d e r s t an d w h a t th e [ a dm i s s i o n ] d o c um e n t s
e n t a i l e d an d h e r c o n d it i o n s p r e v e n t e d h e r fr o m s i g n i n g th e r e m a i ni n g a dm i s s i o n s d o c um e n t s . ( 8 / 3 1 / 1 7 H o r a c e D avi s D e p o s i t i o n N

. T. 3 1 , 3 2 , 4 6 )

.

Th e r e c o r d o f th i s a c t i o n e s t ab l i s h e s th a t , a t th e t i m e th a t th e A g r e e m e n t w a s

s i g n e d , M r s . D av i s w a s an e l d e rl y r e s i d e n t , w i th mu l t i p l e h e a l th c o n d i t i o n s , an d w a s n o t e d b y th e

7D e f

e n d an t s ' o wn d o c to r a s h av i n g an a c u t e c han g e i n m e n t a l s t a t u s a w e e k b e fo r e th e e x e c u t i o n
o f th e A g r e e m e n t , an d th i s d o c t o r b e l i e v e d a s o f Jun e 2 0 , 2 0 1 5 , th e d ay a ft e r M r s . D av i s s i gn e d th e A g r e e m e n t , th a t a n e uro l o g i c a l e v al u a t i o n w a s n e c e s s ary . H e r c o gn i t i v e i mp a i rm e n t s ,
c o u p l e d w i th h e r a g e an d m e d i c al c o n d i t i o n s , un d o ub t e d l y a ff e c t e d h e r ab i li ty t o un d e r s t an d th e t e rm s o f a s o p h i s t i c a t e d l e g al a g r e e m e n t. T h e r e fo r e , th i s C o urt fi n d s th a t Mr s . D av i s w a s i n c o mp e t e n t a t th e ti m e s h e e n t e r e d th e A g r e e m e n t an d th e r e fo r e th e A gr e e m e n t th a t s h e s i g n e d d a t e d Jun e 1 9 , 2 0 1 5 i s v o i d

.

F urth e rm o r e , i n o r d e r fo r th e A g r e e m e n t s e x e c u t e d o n M ar c h 13 , 2 0 1 5 an d Ju l y · 3 1 , 2 0 1 5 b y P l a i n t i ff t o b e b i n d i n g u p o n M r s . D av i s , th e r e mu s t h av e e x i s t e d a t th e t i m e o f

e x e c u t i o n an a g e n c y r e l a t i o n s h i p b e tw e e n M r s . D av i s an d P l a i n t i ff 3

. S u c h a r e l a t i o n s h i p "

. . . c ann o t b e i nf

e rr e d fr o m m e r e r e l a t i o n s hi p o r f am i l y t i e s un a tt e n d e d b y c o n d it i o n s , a c ts o r
c o n d u c t cl e arl y i mp l y i n g an a g e n c y . " W al t o n v . J o hn s o n , 6 6 A

. 3 d 7 8 2 , 7 8 7 ( P a . S u p e r. 2 0 13 ) ( ci t a t i o n s o m i tt e d )

. R a th e r , "

. . ; an a g e n c y r e l a t i o n s h i p m ay b e c r e a t e d b y an y o f th e fo ll o wi n g : ( 1 ) e x p r e s s au th o r i ty , ( 2 ) i mp l i e d au th o r i ty , ( 3 ) a p p ar e n t au th o r i ty , an d

/ o r ( 4 )

au th o r i ty b y e s t o p p e l. " I d

. a t 7 8 6

.

" E x p r e s s au th or i ty e x i s t s w h e r e th e p r i n c i p a l d e li b e r a t e l y an d s p e c i fi c a ll y g r an t s
au th o ri ty t o th e . a g e n t a s t o c e rt a i n m a tt e r s . Imp li e d au th o r i ty e x i s t s i n s i tu a t i o n s w h e r e th e

a g e n t ' s a c t i o n s ar e " p ro p e r , u s u al an d n e c e s s ar y " t o c arr y o u t e x p r e s s a g e n c y . Ap p ar e n t a g en c y
e x i s t s w h e r e th e p r i n ci p a l , b y w o r d o r c o n d u c t , c au s e s p e o p l e w ith w h o m th e a ll e g e d a g e n t d e a l s t o b e l i e v e th a t th e p r i n c i p a l h a s g r an t e d th e a g e n t au th o ri ty t o a c t. A u th o r i ty b y e s t o p p e l o c c ur s
w h e n th e p ri n c i p a l fa i l s t o t ak e r e a s o n ab l e s t e p s t o d i s av o w th e th i r d p arty o f th e i r b e li e f th a t th e p urp o rt e d a g e n t w a s au th o r i z e d to a c t o n b e h al f o f th e p r in c i p a l. " I d

. ( c i t a t i o n s o m i tt e d )

.

3 A l th o u g h th i s C o urt a d dr e s s e s w h e th e r P l a in t i ff h a d th e au th o r i ty t o e x e c u t e th e M ar c h 1 3 , 2 0 1 5 an d Ju l y 3 0 , 2 0 1 5 A gr e e m e n t s , D e fe n d an t s ' h av e w a i v e d th e ir ab ili ty t o c h a ll e n g e th i s i s s u e b y n o t in cl u d i n g i t i n th e ir C o n ci s e S t a t e m e n t o f

M a tt e r s C o mp l a i n e d o f o n Ap p e a l. 

### 8A s th e r e i s n o wr i tt e n d o c um e n t gr an t in g P l a i n t i ff e x p r e s s au th o r i ty o r t o e s t ab l i s h i mp l i e d au th o r i ty , D e fe n d an t s m a i n t a i n th e r e w a s a p p ar e n t a g e n c y an d

/ o r a g e n c y b y e s t o p p e l. Ap p ar e n t a g e n c y an d a g e n c y b y e s t o p p e l fo c u s o n th e w o r d s an d c o n d u c t o f th e p r i n c i p a l , M r s . D av i s . " An a g e n t c ann o t s i mp l y b y h i s o wn w o r d s , i n v e s t h i m s e l f w i th a p p ar e n t au th o r ity . S u c h

au th o ri ty e m an a t e s fr o m th e a c t i o n o f th e p r i n c i p a l an d n o t th e a g e n t
. " I d

. a t 7 8 7 ( ci t a t i o n s
o m i tt e d )

. T o p r e v a i l o n a c l a i m o f a g e n c y b y e s t o p p e l o n th e i s s u e o f au th o r i ty t o s i gn th e A g r e e m e n t s , D e fe n d an t s mu s t p r o v e th a t M r s . D av i s i n t e n t i o n a ll y o r c ar e l e s s l y c au s e d D e fe n d an t s ' adm i s s i o n s c o o r d i n a t o r t o b e l i e v e an a g e n c y r e l a ti o n s h i p e x i s t e d , o r k n o wi n g th a t th e a dm i s s i o n s c o o r d i n a t o r h e l d s u c h a b e li e f , M r s . D av i s d i d n o t t ak e r e a s o n ab l e s t e p s t o cl ar i fy th e fa c t s . I d

. a t 7 8 8

.

D e fe n d an t s h av e fa i l e d t o o ff e r an y e v i d e n c e o f M r s . D av i s ' c o n d u c t a t th e t i m e th e A g r e e m e n t s w e r e e x e c u t e d o r h e r c o n d u c t w i th th e a dm i s s i o n s c o o r d i n a t o r a t an y t i m e b e fo r e
e x e c u t i o n o f th e A gr e e m e n t s . T h e r e i s n o e v i d e n c e th a t M r s . D av i s kn e w P l a i n t i ff w a s e x e c u t in g

· th e A g r e e m e n t s s p e c i fi c a ll y . N e i th e r P l a i n ti ff n o r D e fe n d an t s ' a dm i s s i o n s c o o r d i n a t o r c o ul d

r e c al l w h e th e r M r s . D av i s w a s p r e s e n t i n th e ro o m w h e n th e A gr e e m e n t s w e r e e x e c u t e d b y P l ai n t i ff. ( 8 / 3 1 /1 7 H o ra c e D av i s D e p o s i ti o n N

. T. 2 2

- 2 3 an d 8 / 3 1 /1 7 Li l i a M ar g o l i e s D e p o s i ti o n N .T

. 2 7

- 2 8 )

. P l a i n t i ff al s o t e s t i fi e d th a t h e d i d n o t t e ll M r s . D av i s ab o u t th e A g r e e m e n t s o r th e fa c t th a t h e s i g n e d th e m , an d M r s . D avi s d i d n o t i n s tru c t h i m t o s i g n th e A g r e e m e n t s . ( 8 / 3 1/ 1 7 H o ra c e D av i s D e p o s i t i o n N

. T

. 2 3 , 4 0 , 4 7 )

. I t i s i rr e l e v an t w h e th e r M r s . D a v i s h a d g i v e n P l a i n t i ff

e x p r e s s v e r

b a l au th o r i ty t o s i g n th e a dm i s s i o n s p a p e r w o rk i n g e n e r al , a s D e fe n d an t ar gu e s ,
un l e s s th i s v e r

b a l au th o r i ty w a s g i v e n w h i l e D e fe n d an t s ' r e p r e s e n t a t i v e w a s p r e s e n t s u c h th a t Mr s . D av i s ' w o r d s c au s e d th e a dm i s s i o n s c o o r d i n a t o r t o b e l i e v e th a t Mr s . D av i s h a d g ran t e d M r. D av i s th e au th o r i ty t o a c t. Th e r e i s n o e v i d e n c e o f s u c h

. F urth e r , th e r e i s n o e v i d e n c e th a t Mr s .


### 9D av i s v e r b a ll y g av e P l ai n t i ff th e au th o r i ty t o s i g n th e A gr e e m e n t s s p e c i fi c al l y . L a s t l y , th e r e
c ann o t b e a g e n c y b y e s t o p p e l b e c au s e D e fe n d an t s h av e o ff e r e d n o e v i d e n c e o f Mr s . D av i s '

n e g li g e n c e . T h e A g r e e m e n t s ar e al s o un c o n s c i o n ab l e c o n tr a c t s o f a dh e s i o n . Th e c a s e o f M ann i o n v . M an o r C ar e . I n c . , 4 P a . D

. & C

. 5 th 3 2 1 ( P a . C t. C o m . P L 2 0 0 6 ) c o n s i d e r e d

ar b i tr a ti o n p ro v i s i o n s s i m i l ar t o th o s e s u b j u d i c e . Th e M ann i o n C o urt fo un d th e a gr e e m e n t t o
ar b i tra t e t o b e a c o n tr a c t o f a dh e s i o n . " A c o n tr a c t o f a dh e s i o n i s d e fi n e d a s a s t an d ar d fo rm
c o n tra c t p r e p ar e d b y o n e p arty , t o b e s i g n e d b y th e p arty i n a w e ak e r p o s i t i o n , u s u a ll y a
c o n s um e r , w h o h a s l i tt l e c h o i c e ab o u t th e t e rni s . " M anni o n a t 3 2 9

- 3 3 0 ( ci t i n g H u g e l v . M i ffl i n C o n s tr u c t i o n C o mp an y , I n c . , 7 9 6 A

. 2 d 3 5 0 , 3 5 7 ( P a . S u p e r . 2 0 0 2 ) )

. In fi n d i n g th e a gr e e m e n t t o b e a c o n tr a c t o f a dh e s i o n , th e C o urt s t a t e d a s fo ll o w s :

Th e A g r e e m e n t a t i s s u e fa ll s w i th i n thi s d e fi ni t i o n [ d e fi ni t i o n fo r c o n tr a c t o f a dh e s i o n ]

. It w a s a s t an d ar d fo rm d o c um e n t p r e p ar e d b y M an o r C ar e fo r s i g n a t ur e b y n e w r e s i d e n t s . . . G i v e n th e c i r c um s t an c e s , M s . M an n i o n w a s i n a w e ak e r p o s i t i o n wi th o u t an y m e an i n g ful c h o i c e w h e n s h e s i gn e d th e a gr e e m e n t
. . . Wh e n M s . M an n i o n r e c e i v e d th e fa x e d p a p e rw o rk , c o n s i s t i n g o f 2 1 p a g e s , s h e d i d n o t h av e t i m e t o r e a d th e m a t e r i al c ar e fu ll y b e fo r e s i g n i n g an d r e t

urni n g th e d o c um e n t s . S h e w a s v e ry u p s e t a t th a t t i m e an d r e c a ll s th e e x p e r i e n c e o nl y a s a b l ur . . M s . D e f r an c o n e v e r e x p l a i n e d th e ar b i tr a t i o n a g r e e m e n t t o h e r . N o r w as M s . M anni o n i n fo rm e d th a t s h e c o u l d m ak e c h an g e s i n th e p r e p r i n t e d d o c um e n t s .

. . . C o n s i d e r i n g th e p r e s s ur e s h e w a s un d e r d ur i n g thi s p e r i o d o f t im e , i t i s un d e r s t an d ab le th a t s h e fe l t s h e h a d l i tt l e c h o i c e b u t t o s i g n th e d o c um e n t s a s p r e s e n t e d

. . . Thu s , w e fi n d th a t th e a g r e e m e n t w as a c o n tr a c t o f a dh e s i o n . " I d

. a t 3 3 0

- 3

. 3 1.

T h e c i r c um s t an c e s a tt e n d an t t o Mr s . D av i s ' an d P l a i n t i f f s e x e c u t i o n o f th e A gr e e m e n ts w e r e s i m i l ar t o th e c i r c um s t an c e s i n M anni o n . W i th r e s p e c t t o Mr s . D av i s '

e x e c u ti o n o f th e A gr e e m e n t , s h e h a d b e e n i n an d o u t o f m e d i c a l fa c i l i t i e s fo r v ar i o u s m o n th s

u p o n h e r a dm i s s i o n i n Jun e 2 0 1 5 t o D e fe n d an t s ' fa c i l i ty . S h e w a s r i d d l e d wi th v ar i o u s m e d i c al

c o n d i ti o n s an d d i s ab ili t i e s a tt e n d an t t o s am e . P l a in t i ff t e s t i fi e d th a t , a l th o u g h Mr s . D av i s s i g n e d th e A g r e e m e n t i n Jun e 2 0 1 5 , h e r c o n d i t i o n s p r e v e n t e d h e r fr o m s i g ni n g th e r e m a i n i n g
10a dm i s s i o n s d o c um e n t s . ( 8 / 3 1 / 1 7 H o r a c e D av i s D e p o s i t i o n N

. T

. 3 1 , 3 2 )

. P l ai n t i ff w a s th e

e l d e r l y hu s b an d o f a v e ry 

### ill s p o u s e an d w a s r e s p o n s i b l e fo r h e r c ar e o n a fu ll t i m e b as i s . W i th

r e s p e c t th e M ar c h 1 3 , 2 0 1 5 A g r e e m e n t , P l a i n t i ff t e s t i fi e d th a t h e w a s p r e s e n t e d th e A g r e e m e n t wi th a m an y o th e r d o c um e n t s , th a t h e d i d n o t r e a d th e m b e c au s e h i s m a i n c o n c e rn w as g e tt i n g h i s w i fe th e . c ar e s h e n e e d e d , an d th a t h e 

### fe lt l i k e h e h a d t o s i g n th e d o c um e n t s . ( 8 / 3 1/ 1 7 H o r a c e D av i s D e p o s i t i o n N

. T

. 1 9 , 2 0 , 2 1 )

. W i th r e s p e c t t o th e Ju l y 3 1 , 2 0 1 5 A g r e e m e n t , P l a i n ti ff s t a t e d th a t ti m e w a s e s s e n t i al t o g e t M r s . D av i s a dmi tt e d t o th e fa c il i ty s o h e d i d n o t t ak e th e t i m e t o
r e a d th e A gr e e m e n t an d g e t s o m e un d e r s t an d in g o f i t. ( 8 / 3 1/ 1 7 H o r a c e D av i s D e p o s i t i o n N

. T

. 3 8 , 4 1 )

. L i l i a M ar g o l i e s w a s A dm i s s i o ns C o o r d i n a t o r fo r D e fe n d an t s ' fa c i l i ty a t th e t i m e o f

e x e c u t i o n o f th e A g r e e m e n t s . I n h e r c a p a c i ty a s A dmi s s i o n s C o o r d i n a t o r , s h e w o u l d p r e s e n t th e fo rm A g r e e m e n t t o . a ll r e s i d e n t s o r th e i r r e p r e s e n t a t i v e . ( 8 / 3 1 /1 7 L i li a M ar g o li e s D ep o s i t i o n N

. T

. 13 ?

. S h e t e s t i fi e d th a t th e p a t i e n t s w o u l d r e v i e w a p p ro x i m a t e l y tw e n ty s e v e n p a g e s o f d o c um e n t s fo r th e a dm i s s i o n s p ro c e s s w i th i n fi v e t o t e n mi nu t e s , fo ur p a g e s o f w h i c h c o n s i s t e d

o f th e A gr e e m e n t. ( 8 / 3 1/ 1 7 L ili a M ar g o l i e s D e p o s i t i o n N

. T

. 1 4 , 2 1 )

. S h e furth e r t e s t i fi e d i n h e r d e p o s i t i o n th a t a

p p ro x i m a t e l y 2 0 % o f th e t i m e s h e w o u l d j u s t l e av e th e a dm i s s i o n s p a c k e t i n th e p a ti e n t ' s ro o m an d w o u l d n o t b e p h y s i c a ll y p r e s e n t t o e x p l a i n th e d o c um e n t s w h e n th e p a t i e n t o r th e i r r e p r e s e n t a t i v e s i g n e d th e A gr e e m e n t an d w o u l d s i mp l y c o m e b a c k t o r e tr i e v e th e s i g n e d d o c um e n t s , i n cl u d i n g th e A g r e e m e n t. ( 8 / 3 1 /1 7 L i l i a M ar g o li e s D e p o s i t i o n N

. T

. 1 4

- 1 5 )

. W h e n
s h e w a s p r e s e n t , s h e w o u l d e x p l a i n th e t e rm s o f th e ar b i tra t i o n a g r e e m e n t t o th e p a t i e n t o r th e i r

r e p r e s e n t a ti v e . ( 8 / 3 1 /1 7 L ili a M ar g o l i e s D e p o s i t i o n N

. T

. 1 7

- 1 9 )

. I n h e r tw o ( 2 ) y e ar s o n th e j o b , s h e n e v e r o n c e r e v i s e d o r al t e r e d th e t e rm s o f th e A g r e e m e n t
. ( 8 / 3 1/ 1 7 L i l i a M ar g o l i e s D e p o s i t i o n N

. T. 3 0 )

. T h e s e fa c t s cl e ar l y s h o w th a t M r s . D av i s an d P l a i n t i ff w e r e i n a

l ls i g ni fi c an tl y w e ak e r b ar g a i ni n g p o s it i o n th an D e fe n d an t s an d h a d n o c h o i c e ab o u t th e te rm s o f

th e A g r e e m e n t
. F o r th e s e r e a s o n s , thi s C o urt fo un d th e A g r e e m e n t s t o b e c o n tr a c t s o f a dh e s i o n .

H o w e v e r , " [ a ] c o n tra c t o f a dh e s i o n i s n o t 

### i p s o f a c to un e n fo r c e ab l e . It i s
un e n fo r c e ab l e o n l y t o th e e x t e n t th a t i t i s fo un d t o b e un c o n s ci o n ab l e . " M anni o n , 4 P a . D

. & C

. 5 th a t 3 3 1. " A c o n tr a c t t e rm i s un c o n s ci o n ab l e i f ( 1 ) th e p arty c h al l e n g i n g i t h a s n o r e a s o n ab l e
c h o i c e i n a c c e p ti n g i t , a s i n th e c a s e o f a c o n tr a c t o f a dh e s i o n , an d ( 2 ) th e p r o v i s i o n unr e a s o n ab l y fav o r s th e o th e r p arty . " I d

. ( c it i n g L ytl e v . C i t iF i n an c i al S e rv i c e s . I n c . , 8 1 0 A .2 d 6 4 3 ( P a . S u p e r . 2 0 0 2 ) )

. I n P e n n s y l v an i a , un c o n s c i o n a b ili ty r e qu i r e s a s h o wi n g th a t th e c o n tr a c t w a s b o th p r o c e d ur al l y an d s ub s t an t i v e l y un c o n s c i o n ab l e w h e n m a d e . W i tm e r v . E x x o n C o rp . , 4 3 4 A

. 2 d 1 2 2 2 , 1 2 2 8 ( P a . 1 9 8 1 )

. P ro c e d ur al un c o n s c i o n ab i l i ty r e fe r s t o th e p ro c e s s i n w hi c h an a gr e e m e n t i s r e a c h e d an d m ay b e fo un d w h e r e p art i e s t o th e c o n tr a c t h av e un e qu al b ar g a i n i n g p o w e r. S e e G e rm an t o w n M f

g . C o . v . R aw l i n s o n , 4 9 1 A. 2 d 13 8 , 1 4 5

- 4 6 ( P a . 1 9 8 5 ) ; M o s c a t i e ll o 

### v . P i tt s b ur g h C o n tr a c t o r s E qu i p . C o . , 5 9 5 A

. 2 d 1 1 9 0 , 1 1 9 6

- 9 7 ( P a . 1 9 9 1 )

. An a gr e e m e n t i s s ub s t an t i v e l y
un c o n s c i o n ab l e w h e n i t unr e a s o n ab l y fav o r s th e dr a ft e r . H u e g e l v . M i ffl i n C o n s t
. C o .. I n c . , 7 9 6 A

. 2 d 3 5 0 , 3 5 7 ( P a . S u p e r . 2 0 0 2 )

. S ub s t an t i v e l y , un c o n s c i o n ab i li ty m ay al s o b e b a s e d o n a

v i o l a t i o n o f p ub li c p o l i c y . H al l v . Am i c a M u t. I n c . C o . , 6 4 8 A. 2 d 7 5 5 ( P a . 1 9 9 4 )

.

T h e A g r e e m e n t s ar e p ro c e d ur al l y un c o n s c i o n ab l e a s th e y ar e c o n tr a c t s o f

a dh e s i o n fo r th e r e a s o n s s e t fo rth h e r e i n . A t th e t i m e th a t th e A g r e e m e n t s w e r e e x e c u t e d , Mr s . D av i s an d P l a i n t i ff w e r e i n a h i g h l y e m o t i o n a l s t a t e a ft e r M r s . D av i s h a d s p e n t m o n th s in an d o u t

o f h e al th c ar e fa c ili t i e s b a tt l i n g a m y ri a d o f s e r i o u s h e al th c o n c e rn s , i n c l u d i n g c an c e r . D e fe n d an t s ' a dm i s s i o n c o o r d i n a t o r s h a d p r e s e n t e d th i s A g r e e m e n t a p p r o x i m a t e l y 4 0 t i m es a

m o n th t o n e w p a t i e n t s . ( 8 / 3 1 / 1 7 L ili a M ar g o l i e s D e p o s i t i o n N

. T

. 2 9 )

. T h e r e w a s a gr o s s d i s p ar i ty i n b ar g ai n i n g p o w e r b e tw e e n th e p art i e s fo r th e s e r e a s o n s .

1 2T h e A g r e e m e n t s ar e a l s o p ro c e d ura ll y un c o n s c i o n ab l e a s th e y v i o l a t e p u b l i c p o l i c y . A lth o u g h th e ar

b i tr a t i o n p ro c e s s w a s p o s s i b l y e x p l a i n e d , i t w a s n e v e r p ro p e r l y e x p l a i n e d

w h a t r i g h t s M r s . D av i s w a s g i v i n g u p . ( 8 / 3 1/ 1 7 Li li a M ar g o li e s D e p o s it i o n N

. T

. 1 8 � 1 9 )

. A

w ai v e r o f th e r i g h t t o a tr i a l b y j ur y mu s t b e kn o w i n g an d v o l un t ary . I n d e t e rm inin g w h e th e r th e r e w a s a kn o w i n g , v o l un t ary an d i n t e lli g e n t w a i v e r , th e c o urt s l o o k t o w h e th e r " (1 ) th e r e w a s
n o g ro s s d i s p ari ty i n b ar g a i ni n g p o w e r b e tw e e n th e p art i e s ; ( 2 ) th e p art i e s ar e s o p h i s t i c a t e d b u s i n e s s e n t i t i e s ; ( 3 ) th e p art i e s h a d an o p p o rtuni ty t o n e g o t i a t e th e c o n tr a c t t e rm s ; an d ( 4 ) th e
w a i v e r p r o v i s i o n w a s c o n s p i c u o u s . " F i r s t U n i o n N a t i o n a l B ank v . U

. S

. , 1 6 4 F

. S u p p . 2 d 6 6 0 , 6 6 3 ( E. D

. P a . 2 0 0 1 )

. M r s . D av i s an d P l a i n t i ff , b o th e l d e r l y a d

u l t s - o n e v e ry ill an d th e o th er p l a c e d i n t o a p o s i t i o n a s a fu ll t i m e c ar e g i v e r fo r h i s ill wi f e , e n t e r e d a c o n tr a c t w i th a h i g h l y
s o p h i s t i c a t e d c o rp o ra t e e n t i ty w i th n o e m o t i o n a l a tt a c hm e n t t o th e s i tu a t i o n . I t w a s n e v e r
e x p l ai n e d t o M r s . D av i s o r P l a i n t i ff th a t th e y c o u l d n e g o t i a t e th e t e rm s o f th e A g re e m e n t. ( 8 / 3 1 /1 7 L i l i a M ar g o li e s D e p o s i t i o n N

. T

. 1 8

- 1 9 )

. It mu s t b e n o t e d th a t M s . M ar g o li e s t e s t i fi e d i n h e r d e p o s i t i o n th a t th e A g r e e m e n t h a d n e v e r b e e n r e v i s e d d ur i n g h e r tw o ( 2 ) y e ar s a c t in g a s A dm i s s i o n s C o o r d i n a t o r . ( 8 / 3 1/ 1 7 L i l i a M ar g o l i e s D e p o s i t i o n N

. T

. 3 0 )

.

D e fe n d an t s c i t e M a c P h e r s o n v . M a g e e M e m o r i a l H o s p . fo r C o n v a l e s c e n c e , 1 2 8 A. 3 d 1 2 0 9 ( P a . S u

p e r . 2 0 1 5 ) an d C ar d i n al v . Ki n dr e d H e al th c ar e . I n c . , 1 5 5 A

. 3 d 4 6 ( P a . S u p e r. 2 0 1 7 ) w h e r e th e S u

p e r i o r C o urt e x am i n e d ar b i tr a ti o n a g r e e m e n t s an d c o n cl u d e d th a t th e
a g r e e m e n t s w e r e n o t p ro c e d ura ll y o r s ub s t an t i v e l y un c o n s c i o n ab l e . I n m ak i n g i t s d e c i s i o n , th e M c P h e r s o n C o urt n o t e d ( o n w h ic h th e C ar d i n al C o urt r e li e d a l s o ) th a t th e a g r e e m e n t a t i s s u e h a d

" a c o n s p i c u o u s , l ar g e , b a l d e d n o t i fi c a t i o n th a t th e p art i e s , b y s i g n i n g , ar e w a i v i n g th e ri g h t t o a tr i a l b e fo r e a j u d g e o r j ury . . . [ an d ] a n o t i fi c a t i o n a t th e t o p o f th e a g r e e m e n t , i n b o l d typ e fa c e
an d un d e rl i n e d , th a t it i s v o l un t ar y , an d i f th e p a t i e n t r e fu s e s t o s i g n i t , ' th e P a t i e n t w ill s t ill b e

13al l o w e d t o li v e i n , an d r e c e i v e s e rv i c e s ' a t th e fa c i l i ty
. " C ar d i n a l v . Ki n dr e d H e al th c ar e , I n c . ,

1 5 5 A. 3 d a t 5 3 ( c i t i n g M a c P h e r s o n v . M a g e e M e m o r i al H o s p . fo r C o n v al e s c e n c e , 1 2 8 A

. 3 d a t 1 2 2 1

- 2 2 )

. Th e A g r e e m e n t s i n th e i n s t an t m a tt e r c an b e d i s t i n g u i s h e d fr o m th e M c P h e r s o n an d C ar d i na l a gr e e m e n t s . I n M c P h e r s o n , th e h e a d i n g o f th e ar b i tr a t i o n a g r e e m e n t a t i s s u e r e a d :

" V O L U N T A R Y A G RE E M E N T : If y o u d o n o t a c c e p t th i s A g r e e m e n t , th e P a t i e n t w ill s t ill b e a ll o w e d t o li v e i n , an d r e c e i v e s e rv i c e s i n , th i s C e n t e r . " T h e v e ry fi r s t s e n t e n c e o f th e
a g r e e m e n t r e a d i n b o l d : " B Y A C C E P T I N G T H I S A G RE E M E N T , T HE P A R T I E S A RE W A I V I N G T HE I R RI G H T T O A T RIAL B E F O RE A JU D G E AND / O R A JU R Y O F A NY D I S P U T E B E T W E E N T HE M

. P L E A S E RE A D T H I S A G RE E M E N T C A RE F UL L Y A N D IN I T S E N T I RE T Y B E F O RE A C C E P T IN G I T S T E RM S

. " M a c P h e r s o n v . M a g e e M e m o r i al H o s p . fo r C o n v a l e s c e n c e , 1 2 8 A .3 d 1 2 0 9 , 1 2 13

- 1 4 ( P a . S u p e r . 2 0 1 5 )

. T h e C ar d i n a l a gr e e m e n t
s t a t e d a t th e v e r

y t o p : " T H I S A G RE E M E N T I S N O T A C O ND I TI O N O F A D M I S S I O N T O O R C O N T INU E D RE S I D E N C E IN T H E F A C I LI T Y

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