Opinion ID: 6357225
Heading Depth: 3
Heading Rank: 5

Heading: 236E Althaus (3): The nature of the risk imposed and foreseeability of the harm incurred

Text: It would be difficult to overstate the risk to public health that this case presents, and we need not do so; the sheer number of exposed patients and the potentially severe consequences of infection with hepatitis C speak for themselves. Diversion and substitution of injectable medications lead to two identifiable harms. First, patients do not receive the substance that they are prescribed, which they require for their treatment. Second, where needles are reused, there is the risk of disease transmission. As in Phillips , the risk presented in this case is grave, and its potential sweep broad where, as here, the offending behavior goes unchecked for years. In turning to foreseeability, we confront the most elusive Althaus factor, both in its definition and in determining the weight it should be afforded. The Superior Court found that foreseeability weighed heavily in favor of imposing a duty. The court noted that the risk of transmission of blood-borne diseases was both serious and foreseeable, and accepted Plaintiffs' reliance upon Charlie v. Erie Insurance Exchange , 100 A.3d 244 (Pa. Super. 2014), for the proposition that foreseeability means the likelihood of the occurrence of a general type of risk rather than the likelihood of the occurrence of the precise chain of events leading to the injury. Id. at 256 . However, the court added little more than a bare recitation of the pleadings to support its conclusion. Furthermore, Charlie , which bears little resemblance to the instant case, offers an especially broad definition of foreseeability, one somewhat at odds with the definitions we have employed in the third-party duty cases we discussed above, such as DiMarco's foreseeable orbit of risk of harm. 583 A.2d at 424 ; see Cantwell , 483 A.2d at 1354 (finding that duty requires foreseeable harm to a foreseeable class of plaintiffs ) (emphasis added); cf. Commonwealth Dep't of Hwys. v. Eldridge , 408 Pa. 391 , 184 A.2d 488 , 491-92 (1962) ([A]n act cannot be negligent unless the harm is foreseeable to the class to which the complaining party belongs ....) (emphasis added). It is reasonable, nonetheless, to hold the view that the seasoned health care providers involved in identifying Kwiatkowski's misconduct could have anticipated that, were he to repeat his behavior elsewhere, it would create a serious risk of transmission of infectious disease. Moreover, given their presumptive familiarity with the compulsions and impulsiveness associated with addiction, those providers could have anticipated that Kwiatkowski would repeat his behavior elsewhere. Thus, we agree with Plaintiffs that Kwiatkowski's behavior certainly could have supported the inference by UPMC and Maxim that his addiction to narcotics was such that he would risk-as, indeed, he had risked-his career and the health of patients. Furthermore, it was foreseeable to UPMC and Maxim that future diversion and substitution would create a risk of disease-transmission through needle-sharing; that reporting to DEA or law enforcement body would lead to a criminal investigation and a felony prosecution that would end Kwiatkowski's career in the employ of CSA registrants; and, consequently, that failing to report might create an unreasonable risk to third-party patients in the care of other registrant health care providers. While the picture painted by the cases we reviewed above is blurry, we generally have held that the more specific or narrow is the likely victim or class of victims, the more foreseeable is the risk of harm. Thus, in Lindstrom v. City of Corry , 563 Pa. 579 , 763 A.2d 394 (2000), although we denied  relief following a full Althaus analysis, we found that it was legally foreseeable to a police officer pursuing a suspect that the pursuit would lead the suspect to act in ways injurious to himself. But in Sellers v. Abington , 630 Pa. 330 , 106 A.3d 679 , 689 (2014), under very similar circumstances, we declined to find it foreseeable that the passenger of a suspect fleeing a pursuing police officer could be injured. Thus, an injury to the passenger, who was unknown to the police officer, was unforeseeable, even though injury to the suspect was. Importantly, our cases collectively establish that narrow does not necessarily mean small in number. In Phillips , for example, we found a duty to protect that subjected the defendants to the potential for hundreds, even thousands, of lawsuits arising from fires set by children in possession of butane lighters lacking safety features-including fires resulting in fatalities to children and others and/or immense property damage. And while the class of juvenile fundraisers we found a duty to protect in R.W. was certainly less numerous, it nonetheless was still broadly categorized. Moreover, as we noted in Seebold , what sometimes seems like an unintuitively narrow account of foreseeability simply masks the fact that the Court, in fact, has found that other Althaus factors outweigh foreseeability in discerning whether the imposition of a duty would reflect sound policy. See Seebold , 57 A.3d at 1249 n.25 (clarifying that the somewhat cryptic usage of foreseeability in Witthoeft should not be read to suggest that the Court believed that it was unforeseeable that an accident might occur. Rather, the context reveals the Court was prioritizing other policy factors over such obvious foreseeability). Upon discovering Kwiatkowski's misconduct, UPMC and Maxim had every reason to suspect that this was not a one-time occurrence, as revealed by the number of syringes they found in his possession and the substances they found in his blood. Thus, they had reason to recognize that taking no action beyond terminating Kwiatkowski from the hospital created a foreseeable risk that Kwiatkowski would continue to work in the field and repeat the same dangerous behaviors causing greater risk than if UPMC had reported the diversion to DEA as prescribed by law. While Maxim did not share UPMC's legal reporting obligation, this does not diminish Maxim's ability to foresee that taking no steps to reduce the likelihood that Kwiatkowski would repeat the same behavior at another health care facility would increase the seriousness of the risks presented. Accordingly, foreseeability weighs in favor of imposing a duty upon Defendants to report Kwiatkowski to the DEA or another law enforcement agency.