Opinion ID: 2559203
Heading Depth: 2
Heading Rank: 2

Heading: The Question of Ordinary Versus Professional Negligence for Purposes of the Certificate of Merit Requirement

Text: Rule 1042.3(a) provides: (a) In any action based upon an allegation that a licensed professional deviated from an acceptable professional standard, the attorney for the plaintiff. . . shall file with the complaint or within sixty days after the filing of the complaint, a certificate of merit signed by the attorney or party that either (1) an appropriate licensed professional has supplied a written statement that there exists a reasonable probability that the care, skill or knowledge exercised or exhibited in the treatment, practice or work that is the subject of the complaint, fell outside acceptable professional standards and that such conduct was a cause in bringing about the harm, or (2) the claim that the defendant deviated from an acceptable professional standard is based solely on allegations that other licensed professionals for whom this defendant is responsible deviated from an acceptable professional standard, or (3) expert testimony of an appropriate licensed professional is unnecessary for prosecution of the claim. Pa.R.Civ.P. 1042.3(a). [3] Thus, the Rule requires a certificate of merit where there is an allegation that a licensed professional deviated from an acceptable professional standard. Appellant does not dispute that Appellee qualified as a licensed professional, which includes a health care provider, Pa.R.Civ.P. 1042.1(b)(1)(i). Yet, she asserts her complaint sets forth only a claim of ordinary negligence, and no allegations that professional standards were not met; thus, she contends no certificate of merit was needed. In addition to the text, the circumstances surrounding the adoption of Rule 1042.3 informs the proper reach of the Rule regarding whether a certificate of merit is necessary in this matter. Rule 1042.3, one in a series of rules that govern procedure in a civil action in which a professional liability claim is asserted, [4] was born as a result of the increased frequency in which malpractice actions of questionable merit were being commenced. The rule sought to avoid the burdens that such frivolous claims imposed upon litigants and the courts. Womer v. Hilliker, 589 Pa. 256, 266, 908 A.2d 269, 275 (2006). Thus, our Court desired to set forth an orderly procedure to identify and weed non-meritorious malpractice claims from the judicial system efficiently and promptly. Id. As noted above, and as expressly stated by the parties and the Superior Court, our Court has not spoken to the issue of what constitutes ordinary negligence and what is professional negligence in this context. Recently, however, in the realm of the engineering profession, our Court set forth the procedure to be followed in determining whether a certificate of merit is required, and also spoke to the question of whether a claim sounds in professional negligence or alleges only ordinary negligence. Merlini v. Gallitzin Water Auth., 602 Pa. 346, 980 A.2d 502 (2009). In Merlini, Mary Rose Merlini filed a complaint against an engineering firm, the water authority, and a contractor. She alleged that the contractor, working with the engineering firm and under the direction and supervision of the water authority, came upon her property bordering State Route 4001 in Cambria County and, without right-of-way, easement, or permission, constructed a water line on her property, thereby impairing its use. The defendants filed a praecipe for judgment of non pros, asserting Merlini alleged a professional liability claim without filing a certificate of merit, and judgment was entered against her. Merlini filed a petition to open the judgment of non pros, arguing her cause of action sounded in ordinary negligence. The trial court denied her motion. On appeal, the Superior Court, in finding for Merlini, looked to, inter alia, a Michigan Supreme Court decision to explain the distinction between ordinary and professional negligence, concluding there are two questions in determining ordinary versus professional negligence: (1) whether the claim pertains to an action that occurred within the course of a professional relationship; and (2) whether the claim raises questions of professional judgment beyond the realm of common knowledge and experience. Merlini v. Gallitzin Water Authority, 934 A.2d 100, 104-05 (Pa.Super.2007) (citing Bryant v. Oakpointe Villa Nursing Centre, Inc., 471 Mich. 411, 684 N.W.2d 864, 871 (2004)). Before our Court, my distinguished colleague, Justice Eakin, writing for the majority, considered the difference between ordinary negligence and professional malpractice. He looked to the definition of medical malpractice as used bythe Superior Court the unwarranted departure from generally accepted standards of medical practice resulting in injury to a patient, including all liability-producing conduct arising from the rendition of professional medical services. Id. at 354, 980 A.2d at 506 (citation omitted). Furthermore, he noted the most distinguishing feature of professional malpractice is the need for expert testimony to clarify complex issues for a jury of laypersons. Id. (citations omitted). Thus, our Court considered whether the claims dealt directly with professional services, and whether the claims required expert testimony. Applying these concepts to the facts before it, our Court found, as did the Superior Court in that case, that, while the defendant's actions occurred while performing professional services, the issue the plaintiff raised was not one of professional judgment beyond the scope of common knowledge and experience. While our Court in Merlini spoke to the distinction between ordinary negligence and professional negligence for purposes of determining the requirement of a certificate of merit, as noted above, we did so in the context of the engineering profession. Our Court has not spoken to this important issue in the discrete area of health care, generally, or within the ambit of hospital injuries in particular. Our lower courts, however, have addressed the issue in the medical context, but have come to differing results. Compare Smith v. Friends Hosp., 928 A.2d 1072 (Pa.Super.2007) (claim of sexual assault by employees of hospital, while occurring within the course of a professional relationship, did not raise questions of medical judgment beyond the realm of common knowledge and experience, and, thus, no certificate of merit required); Swift v. Northeastern Hosp. of Philadelphia, 456 Pa.Super. 330, 690 A.2d 719 (1997) (determining plaintiff's claim that she slipped and fell on water on floor in emergency room restroom raised claim of premises liability and not malpractice) with Rostock v. Anzalone, 904 A.2d 943 (Pa.Super.2006) (action for failure to transmit radiographic studies taken after an automobile accident revealing the presence of a mass in lung, or failure to investigate, sounded in professional malpractice and not ordinary negligence); Yee v. Roberts, 878 A.2d 906 (Pa.Super.2005) (allegations that dental employee negligently caused acid-based etching solution to spill on plaintiff's face resulting in chemical burns arose in context of professional dental treatment, and, thus, required certificate of merit); Grossman v. Barke, 868 A.2d 561 (Pa.Super.2005) (plaintiff, who suffered injuries due to fall, after physician directed her to get on examination table, then left the room, asserted liability based upon defendant's professional knowledge, as a physician, and intended to proceed on medical malpractice theory of negligence). Similarly, other states have considered the difference between ordinary negligence and professional negligence in the medical context, and have reached varying conclusions. Importantly, and while not an exhaustive list, it appears a majority of states have concluded that hospital fall injuries raise an issue of ordinary negligence and do not require expert testimony. For example, numerous courts have concluded that, with respect to hospital fall injuries, only ordinary negligence is implicated. See, e.g., Friedmann v. New York Hosp.-Cornell Med. Ctr., 65 A.D.3d 850, 884 N.Y.S.2d 733 (2009) (claim concerning patient's leg ruptured after striking bed rail while aides prepared patient for dinner and adjusting bedding sounded in negligence rather than malpractice); Quintanilla v. Coral Gables Hosp., 941 So.2d 468 (Fla.Dist.Ct.App.2006) (claim nurse negligently spilled hot tea on patient resulting in burns on leg and thigh was not a direct result of receiving medical care or treatment by a hospital employee, and, thus, raised a claim of simple negligence); Mobley v. Hirschberg, 915 So.2d 217 (Fla. Dist.Ct.App.2005) (cause of action concerning dental assistant's dislodging x-ray machine arm and striking plaintiff patient in face, did not need to comply with medical malpractice procedures); Banfi v. Am. Hosp. for Rehabilitation, 207 W.Va. 135, 529 S.E.2d 600 (2000) (claim by stroke victim, who was not permitted to leave bed and who was found injured, lying on floor of room, did not require expert testimony as the applicable standard of care was within the common knowledge of the average lay jury); McGraw v. St. Joseph's Hosp., 200 W.Va. 114, 488 S.E.2d 389 (1997) (claim of negligence concerning patient's fall while hospital personnel attempted to assist patient into bed did not require expert testimony, consistent with majority of cases addressing hospital fall incidents which do not require expert testimony, and collecting cases); Sloan v. St. Francis Hosp., 1996 WL 697970, 1996 Conn.Super. LEXIS 3132 (cause of action alleging injury while being transported on gurney from emergency room to patient's room did not allege injury caused by medical malpractice, as the acts were not in the course of medical treatment and did not relate to the exercise of medical judgment, and, thus, did not require a good faith certificate); Jones v. Bates, 261 Ga. 240, 403 S.E.2d 804 (1991) (patient's claim that he suffered injuries from a lamp from which the heat shield had been removed during surgery was not necessarily one of medical malpractice, and, thus, should not have been dismissed); Rogers v. Schuyler, 158 A.D.2d 318, 551 N.Y.S.2d 5 (1990) (injuries to jaw, face, and neck when plaintiff fell from examining table while giving blood sample did not allege medical malpractice requiring medical expert opinion, but alleged only simple negligence); Bennett v. Winthrop Cmty. Hosp., 21 Mass. App.Ct. 979, 489 N.E.2d 1032 (1986) (plaintiff who fell from stretcher and suffered injuries raised claims that did not require expert testimony, noting majority of decision concerning bed care did not require such testimony and were administrative, ministerial, or routine and, thus, were distinguishable from medical or professional negligence); Rewis v. Grand Strand Gen. Hosp., 290 S.C. 40, 348 S.E.2d 173 (1986) (hospital's negligence in allowing patient to fall out of bed did not require expert testimony); Newhall v. Central Vermont Hosp., 133 Vt. 572, 349 A.2d 890 (1975) (allegation of nurses' failure to respond to patient's call light did not raise issue that was technical or beyond the common knowledge of a lay person); Gopaul v. Herrick Mem. Hosp., 38 Cal.App.3d 1002, 113 Cal.Rptr. 811 (Cal.Ct.App.1974) (need to restrain patient on gurney did not involve professional malpractice); Cramer v. Theda Clark Mem. Hosp., 45 Wis.2d 147, 172 N.W.2d 427, 428 (1969) (The standard of nonmedical, administrative, ministerial or routine care in a hospital need not be established by expert testimony because the jury is competent from its own experience to determine and apply such a reasonable care standard). Conversely, other decisions have found hospital fall injuries to raise issues of professional negligence. See, e.g., Indian River Mem. Hosp., Inc. v. Browne, 44 So.3d 237 (Fla.Dist.Ct.App.2010) (fall from stretcher alleges claim in medical malpractice); Santana v. St. Vincent Catholic Med. Ctr. of New York, 65 A.D.3d 1119, 886 N.Y.S.2d 57 (2009) (claims of failure to assess supervision, nursing care, and security concerning injury from fall from bed raised issues of medical malpractice and not ordinary negligence); Robinson v. Med. Ctr. of Cen. Georgia, 217 Ga.App. 8, 456 S.E.2d 254 (1995) (fall from bed due to side rail being down and unsecured was question of professional negligence); Stanley v. Lebetkin, 123 A.D.2d 854, 507 N.Y.S.2d 468 (1986) (claim regarding ankle fracture suffered while alighting from physician's examining table arose from physician-patient relationship and substantially related to treatment of patient, and, thus, alleged medical malpractice); Murillo v. Good Samaritan Hosp., 99 Cal.App.3d 50, 160 Cal.Rptr. 33 (Cal.Ct.App.1979) (failure to raise bed rails did not implicate ordinary negligence). Thus, from the above, it becomes abundantly clear that whether a claim concerning a patient's fall in a hospital or medical facility sounds in ordinary negligence or professional negligence has been a vexing issue for the lower courts of this Commonwealth and our sister states. Moreover, as this Court has not yet done so, it is an issue that we should confront.