Court Opinion

ID: 9911720
Source: CourtListenerOpinion
Date Created: 2023-12-20 18:09:20.185691+00
Date Added: 2024-06-11T12:53:55.139205
License: Public Domain

J-A21037-22

NON-PRECEDENTIAL DECISION - SEE SUPERIOR COURT O.P. 65.37

 DESIREE LAMARR-MURPHY,                 :   IN THE SUPERIOR COURT OF
 INDIVIDUALLY AND AS                    :        PENNSYLVANIA
 ADMINISTRATRIX OF THE ESTATE OF        :
 CHRISTOPHER B. MURPHY,                 :
 DECEASED; AND BRIANNAH LAMARR          :
                                        :
                   Appellants           :
                                        :
                                        :   No. 1846 EDA 2021
              v.                        :
                                        :
                                        :
 DELAWARE COUNTY MEMORIAL               :
 HOSPITAL; PROSPECT DCMH, D/B/A         :
 DELAWARE COUNTY MEMORIAL               :
 HOSPITAL; AND PROSPECT MEDICAL         :
 HOLDINGS, INC.                         :

           Appeal from the Judgment Entered August 18, 2021
   In the Court of Common Pleas of Philadelphia County Civil Division at
                           No(s): 180401968

 DESIREE LAMARR-MURPHY,           :         IN THE SUPERIOR COURT OF
 INDIVIDUALLY AND AS              :              PENNSYLVANIA
 ADMINISTRATRIX OF THE ESTATE OF  :
 CHRISTOPHER B. MURPHY,           :
 DECEASED; AND BRIANNAH           :
 LAMARR,                          :
                                  :
                Appellants        :
                                  :         No. 1847 EDA 2021
                                  :
           v.                     :
                                  :
                                  :
 CROZER KEYSTONE HEALTH SYSTEM :
 D/B/A CROZER KEYSTONE HEALTH     :
 SYSTEM EMERGENCY SERVICES;       :
 PROSPECT CROZER, LLC; CKHS, INC. :
 D/B/A CROZER- KEYSTONE HEALTH    :
 SYSTEM; RYAN ARNOLD AND          :
 KENNETH BROWN, JR.
J-A21037-22

            Appeal from the Judgment Entered August 18, 2021
    In the Court of Common Pleas of Philadelphia County Civil Division at
                            No(s): 171003272

BEFORE: LAZARUS, J., MURRAY, J., and McCAFFERY, J.

MEMORANDUM BY McCAFFERY, J.:                     FILED DECEMBER 20, 2023

       This consolidated appeal arises out of a negligence action filed by

Desiree Lamarr-Murphy, individually and as administratrix of the Estate of

Christopher B. Murphy (Decedent)1, and Briannah Lamarr (collectively,

Appellants).2 Desiree was Decedent’s wife and Briannah was one of his four

daughters. Their suit concerns the emergency medical services rendered to

Decedent by Appellees, Ryan Arnold, an emergency medicine technician

(EMT), and Kenneth Brown, Jr., a paramedic,3 as well as their employer,

Delaware County Memorial Hospital (DCMH) (collectively, Defendants). At the

conclusion of an eight-day trial, a jury determined that Arnold was 49%

responsible for the harm to Decedent while Decedent himself was 51% liable.

____________________________________________

1 We refer to Desiree and the estate of Decedent collectively as “the Estate.”

2 We note the trial court purported to consolidate two underlying cases.
Judgment was entered in both cases and Appellants filed a separate notice of
appeal at each underlying docket. The appeals were listed consecutively in
this Court. Because the trial court only appeared to be using the caption from
one trial court docket, this Court issued a rule to show cause order directing
the trial court to clarify the correct captions. The trial court responded,
providing the correct captions. We then entered orders directing this Court’s
Prothonotary to correct the captions on this Court’s dockets.

3 We refer to Arnold and Brown collectively as “DCMH EMS.”

                                           -2-
J-A21037-22

Based on the jury’s verdict and its denial of post-trial motions, the court

entered judgments in favor of Defendants on August 18, 2021. On appeal,

Appellants raise the following challenges: (1) the trial court erred in finding

that Defendants were immune from liability under the Pennsylvania

Emergency Response Provider and Bystander Good Samaritan Civil Immunity

Act4 (Good Samaritan Act); (2) the court erred in submitting the issue of

comparative negligence to the jury; (3) the verdict was against the weight of

the evidence; and (4) the court erred in granting a compulsory nonsuit for

Briannah’s claim of negligent infliction of emotion distress (NIED). Based on

the following, we affirm.

                         I.     Facts and Procedural History

       The relevant facts and procedural history of this involved case are

gleaned from the certified record. Where there are factual disputes between

the parties, we will highlight them.

       At the time of the April 24, 2016, incident, Decedent was 39 years old.

See Complaint, 10/26/17, at ¶ 4. He had a prior history of blood clots in his

legs, otherwise known as a deep venous thrombosis, and was hospitalized in

2005 for treatment.           See N.T., 6/15/21, at 116.   He did not have a

reoccurrence of a blood clot following that hospitalization. Id. at 122.

____________________________________________

4 See 42 Pa.C.S. § 8332.

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       During the week prior to the event at issue, Decedent complained of

pain in his right leg due to a flare-up of gout.      See N.T., 6/14/21, at 96.

Desiree testified that Decedent would have flare-ups two to three times a year.

N.T., 6/15/21, at 117. Decedent decided to stay home from work, as a United

States Postal Service employee, that week as he had leg and knee pain and

was having difficulty walking. See N.T., 6/14/21, at 173; N.T., 6/15/21, at

118. On Monday, April 18, 2016, Desiree first noticed that Decedent started

using a crutch. N.T., 6/15/21, at 123. At one point, Desiree told Decedent to

go “see his gout doctor[,]” but he did not “listen[.]” Id. at 124-25.. On Friday,

April 22, 2016, his daughter, Briannah, also suggested Decedent go to the

doctor based on his symptoms. See N.T., 6/14/21, at 174. That night, he

was still able to prepare dinner and was singing and dancing.         See N.T.,

6/15/21, at 123-24.

       On the morning of Sunday, April 24, 2016, while at home on Sellers

Avenue, Upper Darby Township, Decedent began having difficulty breathing.

See N.T., 6/14/21, at 101.          One of his daughters, Imani Lamarr, heard a

“thud” and observed her father laying partly on the basement steps. Id. at

99, 101.      She then called 9-1-15 and DCMH EMS was dispatched at

approximately 11:16 a.m. to the residence. Arnold indicated “the call came

____________________________________________

5 Imani testified that she told the 9-1-1 operator that her father had fallen,

had gout, and could not get up. See N.T., 6/14/21, at 102.

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through . . . as a . . . [basic life support (BLS)] call[,]” which is considered “a

less emergent situation than [an] advanced life support[(ALS) call.]” N.T.,

6/16/21, at 13.

       DCMH EMS arrived on the scene at approximately 11:17 a.m. See N.T.,

6/16/21, at 13. At approximately 11:21 a.m., they moved Decedent from the

steps to the kitchen floor. See N.T., 6/14/21, at 103; N.T., 6/22/21, at 31.

They then placed him on a stretcher and transported him to the ambulance.6

See N.T., 6/14/21, at 132-33. Briannah recalled Imani speaking with DCMH

EMS for four to five minutes as they asked her questions about Decedent’s

prior medical history.7 See id. at 104-05, 134. Imani also called Desiree,

who provided certain information regarding Decedent to relay to the

responders.     See id. at 106.       Desiree was “without a doubt positive” she

shared that Decedent presently was suffering from gout and a history of a

blood clot, but did not understand why he could not breathe.            See N.T.,

6/15/21, at 128. She then left her part-time job to meet them at the hospital.

Id.

____________________________________________

6 Arnold described the vehicle as a “mobile intensive care unit” or “MICU[.]”

N.T., 6/16/21, at 9. The MICU is not equipped with heparin, a blood thinner,
or tissue plasminogen activator (TPA), a clot buster.” Id. at 10. These drugs
are not carried on ambulances in the Commonwealth of Pennsylvania. See
N.T., 6/22/21, at 26.

7  Briannah did not remember any discussion regarding deep venous
thrombosis, clotting, or a pulmonary embolism, but did hear her sister and
DCMH EMS speaking about Decedent’s gout. See N.T., 6/14/21, at 176.

                                           -5-
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      Based on Decedent’s status after evaluation, Arnold suspected a

pulmonary embolism. See N.T., 6/16/21, at 15. He also stated there are no

specific embolism protocols, but there are for “seriously ill appearing

patients[.]” Id. at 17, 19. In his EMS report, Arnold described Decedent’s

condition as follows: (1) swollen right knee; (2) pale skin; (3) sweating

heavily; (4) rapid breathing or tachypneic; (5) highly anxious; (6) decreased

lung sounds in all fields bilaterally; and (7) respiratory distress. See id. at

45-47.

      Meanwhile, Decedent told the responders he was having trouble

breathing as they placed “leads on his chest” to conduct an electrocardiogram

(EKG) test.    See N.T., 6/14/21, at 134; N.T., 6/16/21, at 25.              At

approximately 11:24 a.m., they also provided him with several liters of

oxygen after a “capillary refill [was] done on [his] pinkie which show[ed] there

was a delayed capillary response [and Decedent] was deoxygenated.” N.T.,

6/17/21, at 144, 241; N.T., 6/22/21, at 31.

      As Crozer EMS was moving Decedent outside towards the ambulance,

Briannah ran into the home to find her father’s wallet before leaving. See

N.T., 6/14/21, at 135.

      Arnold and Brown did not initially ventilate Decedent because his

“breathing was adequate,” and placed him in the ambulance for transport at

approximately 11:25 a.m. See N.T., 6/16/21, at 25; N.T., 6/22/21, at 32.

For the next several minutes, Arnold placed a LIFEPAK defibrillator monitor, a

                                     -6-
J-A21037-22

peripheral IV/18-gauge angio catheter, and a 12-lead EKG monitor on

Decedent.8 See N.T., 6/22/21, at 33-35. They also gave Decedent chewable

baby aspirin at approximately 11:30 a.m.9 Id. at 36-37. Two minutes later,

Arnold took a set of Decedent’s vital signs, and noted that Decedent appeared

to “calm down after [the] aspirin administration” and his respiratory rate

decreased so Arnold gave him a “normal saline, 500 milliliter via IV drip.” Id.

at 37. Arnold stated that Decedent’s rapid “heart rate . . . decreased by two

beats a minute. The [oxygen saturation] started out with 88 percent [and

then was] 91 percent. [Decedent was] moving in the right direction in terms

of oxygen saturation.” Id. at 38.

       Arnold indicated he made the decision to take Decedent to Lankenau

based on Decedent’s “chest pain and shortness of breath” and because “[h]is

signs and symptoms were extremely consistent not only with pulmonary

embolism but also extremely consistent with . . . acute coronary syndrome[.]”

N.T., 6/16/21, at 55.         Moreover, Lankenau had a primary percutaneous

coronary intervention (PPCI) center and an extracorporeal membrane

oxygenation (ECMO) machine which led Arnold to “believe that Lankenau

____________________________________________

8 The information acquired from the 12-lead EKG was transmitted to Lankenau

Medical Center (Lankenau) prior to their arrival, which alerted the emergency
department and mobilized their response team. See N.T., 6/22/21, at 35-36.

9 Briannah testified that when Crozer EMS gave her father baby aspirin, he

spit it out based on his difficulty with breathing. See N.T., 6/14/21, at 133.

                                           -7-
J-A21037-22

would be able to take care [of him] either way.” Id. at 56. DCMH did not

have those machines. Id. at 58.

       The ambulance departed at approximately 11:34 a.m. for Lankenau.

See N.T., 6/16/21, at 14. Briannah went with her father to the hospital.10

See N.T., 6/14/21, at 107. As will be discussed below, the ambulance traveled

a different route than Desiree and Briannah would have taken to get to

Lankenau, as there was a “difference of ten traffic lights.”11 N.T., 6/15/21, at

121. Briannah also testified that Crozer EMS stopped at red lights and stop

signs en route to the hospital. See N.T., 6/14/21, at 139. Arnold indicated

the ride from Decedent’s home to Lankenau generally should take

approximately six to eight minutes. See N.T., 6/16/21, at 16. Brown was

____________________________________________

10 Briannah noted that initially the ambulance’s lights and sirens were not
activated but were later turned on at the entrance of Lankenau. See N.T.,
6/14/21, at 135-36, 138. On cross-examination, Briannah acknowledged that
she made this assumption because she did not see Brown “manipulating the
switches[,]” but she also could not see the lights on top of the truck or their
reflections on buildings and stop signs. Id. at 185. A neighbor, Robert
Fedirko, testified that he believed the ambulance’s lights were on when it
pulled away from Decedent’s residence. Id. at 209. Brown averred that lights
were activated and the sirens were used intermittently via the horn. See N.T.,
6/16/21, at 93.

     Both daughters testified that they did not observe DCMH EMS act with
any “urgency” regarding their handling of Decedent. See N.T., 6/14/21, at
106-07, 134.

11 Desiree testified the course she would have taken was three miles in
distance, and the route taken by DCMH EMS was 3.7 miles — a difference of
approximately 3,700 feet. See N.T., 6/22/21, at 100-101, 108.

                                           -8-
J-A21037-22

familiar with the neighborhood based on living there for 26 years. Id. at 79.

He intimated that he did not make a U-turn on Sellars Avenue to get to State

Road, which would have been the most direct route, because “it would take a

three to four point with an unrestrained person[, Arnold,] in the back tending

to an ill patient.”12 Id. at 85-86.

       At approximately 11:36 to 11:38 a.m., when they were three to four

minutes away from Lankenau, Decedent’s respiratory rate increased suddenly

and he went into cardiopulmonary arrest. See N.T., 6/16/21, at 34, 78; N.T.,

6/22/21, at 39.      Arnold ordered Brown to stop the vehicle so that he and

Brown could administer cardiopulmonary resuscitation (CPR).         See N.T.,

6/14/21, at 153; N.T., 6/16/21, at 34. Briannah indicated they were stopped

for approximately 15 minutes as she watched them give Decedent chest

compressions and oxygen. See N.T., 6/14/21, at 153, 155. While the two

responders were administering compressions and giving epinephrine, an

adrenaline medication, their supervisor, Jerome Casey, arrived to assist at

approximately 11:44 a.m. See id. at 155; N.T., 6/22/21, at 43. Casey then

assessed the situation and at 11:46 a.m., they gave Decedent another

milligram of epinephrine.       See N.T., 6/22/21, at 43. At 11:48 a.m., they

____________________________________________

12 Brown stated that the ambulance at issue is 24 feet in length, it was parked

perpendicularly on Sellers Avenue, and there would be approximately a foot
from the front bumper to the curb — making a U-turn precarious. See N.T.,
6/16/21, at 99.

                                           -9-
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performed an orotracheal intubation of Decedent. Id. at 44. At 11:50 a.m.,

they conducted another rhythm check on Decedent and he was “in asystole”

so they restarted compressions while giving him more epinephrine. Id. at 44-

45. They then resumed transporting him to Lankenau. See id. at 45. The

ambulance arrived at the Lankenau’s emergency department at 11:56 a.m.

See N.T., 6/16/21, at 15.

       Approximately 39 to 40 minutes had elapsed from the time DCMH EMS

arrived at Decedent’s home to when they arrived at the hospital.13 See N.T.,

6/16/21, at 77. Decedent was pronounced dead on arrival. The following

day, an autopsy examination was conducted and Decedent’s cause of death

was “determined to be acute pulmonary thromboembolism due to deep

venous thrombosis.”14 N.T., 6/15/21, at 36.

       Appellants filed a complaint and amended complaint in October 2017,

and March 2018,15 respectively, in which they brought a suit against Arnold,

____________________________________________

13 In his deposition which was read to the jury, Supervisor Casey indicated
that time period was “reasonable” for someone who is exhibiting signs of a
pulmonary embolism to get to the hospital. N.T., 6/16/21, at 112.

14 The medical examiner (ME) described the size of the embolus as “large.”

N.T., 6/15/21, at 44. The ME also noted Decedent’s toxicology report revealed
findings of synthetic opiates (hydrocodone) and Delta-9 Carboxy
tetrahydrocannabinol (THC), which is a non-active ingredient in marijuana.
Id. at 41, 46. Nevertheless, the ME stated these toxins were not a
contributing factor to Decedents’ death. Id. at 41.

15 During this time Crozer Keystone and DCMH EMS filed preliminary
objections, which were overruled without prejudice on March 2, 2018. See
(Footnote Continued Next Page)

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Brown, Defendant Crozer Keystone Health System d/b/a Crozer Keystone

Health System Emergency Medical Services, which operates on behalf of

Defendant Prospect Crozer, LLC, and Defendant CKHS, Inc. d/b/a/ Crozer-

Keystone Health System.16           In the amended complaint, they raised the

following causes of action: (1) negligence and gross negligence against all

defendants by Estate; (2) wrongful death against all defendants by Estate;

(3) survival action by Estate; and (4) NIED against all defendants by Briannah.

       Arnold, Brown, and Crozer Keystone filed an answer and new matter,

and alleged, in relevant part, that Arnold and Brown were employees of

DCMH.17 See Answer with New Matter, 4/13/18, at 4-5. They denied any

negligence or gross negligence on their part, and asserted that all medical

care provide by DCMH EMS met the applicable standards of care. Id. at 5-

11. They also denied Briannah’s NIED allegations. Id. at 11-12. In their new

matter, they alleged, in pertinent part, that Appellants’ claims were barred by

____________________________________________

Order, 3/2/18. The court also granted Appellants leave to file an amended
complaint. See id.

16We will refer to Crozer Keystone Health System d/b/a Crozer Keystone
Health System Emergency Medical Services, which operates on behalf of
Defendant Prospect Crozer, LLC, and Defendant CKHS, Inc. d/b/a/ Crozer-
Keystone Health System collectively as “Crozer Keystone.”

17Defendants stated that CKHS EMS is a fictitious name owned by DCMH.
See Defendants’ Answer with New Matter, 4/13/18, at 3. They denied that
Crozer Keystone was responsible for the ambulance that transported Decedent
on April 24th. Id.

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the Pennsylvania Comparative Negligence Act,18 and Defendants were

immune from liability pursuant to the Good Samaritan Act. Id. at 13, 15.

       On June 22, 2018, Appellants filed a second complaint against DCMH,

Prospect DCMH, LLC, and Prospect Medical Holdings, Inc. alleging it is

responsible for the ambulance that transported Decedent. See Complaint,

6/22/18, at ¶ 9. They further alleged that “DCMH EMS inexplicably stopped

the ambulance on the side of the road. . ., rather than activating lights and

sirens and speeding to Lankenau Hospital while [CPR] was initiated by the

non-driving EMS employee.” Id. at ¶ 30. Additionally, they claimed:

             Despite the severity and emergent nature of [Decedent]’s
       collapse, dire physical condition, and cardiopulmonary arrest,
       which was readily known and observable by DCMH EMS and its
       employees or agents, DCMH EMS did not: (a) provide immediate
       and necessary life-saving first aid; (b) properly perform CPR for
       an appropriate amount of time; (c) provide immediate
       anticoagulation; and/or (d) promptly and emergently transport
       [Decedent] to the nearest medical facility.

Id. at ¶ 37. Like their first complaint, they raised the following causes of

action: (1) negligence and gross negligence against all defendants by Estate;

(2) wrongful death against all defendants by Estate; (3) survival action by

Estate; and (4) NIED against all defendants by Briannah. Id. at ¶¶ 45-64.

____________________________________________

18 See 42 Pa.C.S. § 7102, et seq.

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       DCMH and the related parties19 filed an answer and new matter, denying

Appellants’ allegations and raising defenses, in relevant part, related to the

Comparative Negligence Act and the Good Samaritan Act. Answer, 8/9/18, at

15, 18.

       On August 10, 2018, the trial court consolidated the two matters based

on a motion filed by Appellants. On September 3, 2019, Defendants filed a

motion for summary judgment, alleging that they are immune from liability

under the Good Samaritan Act, Appellants failed to establish a prima facie

____________________________________________

19Notably, with respect to the relationship of the defendant parties, they
averred the following:

       Prospect DCMH, LLC, did not transact business in the
       Commonwealth of Pennsylvania during the relevant times alleged
       in [Appellants’] Complaint. On January 8, 2016, Crozer-Keystone
       Health System, a not for profit corporation, entered into an Asset
       Purchase Agreement with Prospect Medical Holdings, Inc., and
       Prospect DCMH, LLC, wherein substantially all of the assets of
       Crozer-Keystone Health System would be acquired by Prospect
       Crozer, LLC. Pursuant to the asset purchase agreement, Prospect
       Crozer, LLC, did not assume the liabilities of Crozer-Keystone
       Health System, a not for profit corporation, for claims or potential
       claims arising out of events reported prior to July 1, 2016,
       including medical professional liability claims. Prospect Crozer,
       LLC, and Crozer-Keystone Health System, a not for profit
       corporation, closed on the acquisition of certain assets of Crozer-
       Keystone Health System, a not for profit corporation, and its
       subsidiaries on July 1, 2016. Therefore, Answering Defendant
       Prospect DCMH, LLC was not transacting business relative to the
       claims raised by [Appellants] or involved in the medical care
       and/or treatment of . . . Decedent during the relevant times
       alleged in Plaintiffs Complaint. . . .

Answer, 8/9/18, at 3.

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case of gross negligence or intent to harm.        See Defendants’ Motion for

Summary Judgment, 9/3/19, at 14-36. They also claimed Crozer Keystone

Health System d/b/a Crozer Keystone Health System Emergency Medical

Services, Prospect Crozer, LLC, and CKHS, Inc. d/b/a/ Crozer-Keystone Health

System, and Prospect Medical Holdings, Inc. are not proper parties to the

instant action. Id. at 36-38. One month later, Appellants filed a response to

Defendants’ motion for summary judgment. On October 9, 2019, the trial

court denied Defendants’ motion for summary judgment.20

        The parties then exchanged multiple motions in limine and responses.

Related to this appeal, the trial court found that the Good Samaritan Act

applied, and consequently, Appellants were required to prove gross negligence

as to all defendants and all claims. See N.T., 6/14/21, at 6, 10, 21-23.

        The matter proceeded to a jury trial on June 14, 2021. Two days later,

Arnold, Brown, and DCMH filed a motion for compulsory nonsuit, alleging that

under the Good Samaritan Act, Appellants were required to prove gross

negligence and they failed to do so, offering only evidence of ordinary

negligence. See Defendants’ Motion for Compulsory Nonsuit, 6/16/21, at ¶¶

6-19.    Appellants filed a written response one day later.      The trial court

____________________________________________

20 During this time, on October 1, 2019, the parties entered a joint stipulation,

which provided that all claims against Crozer Keystone and Prospect Medical
Holdings, Inc. were dismissed with prejudice. See Stipulation of Dismissal of
Less Than All Defendants and to Amend Complaint, 10/1/19, at ¶ 1. The
stipulation also amended the caption. Id. at ¶ 2.

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granted the nonsuit against Briannah for the NIED cause of action, and in

favor of DCMH on the issue of corporate negligence. See N.T., 6/17/21, at

29; N.T., 6/14/21, at 7. The court denied the motion for compulsory nonsuit

as to all other claims. At trial, Defendants argued that Decedent’s failure to

obtain medical care for his knee pain during the week prior to the incident at

issue constituted comparative negligence.      See N.T., 6/14/21, at 90-91.

Appellants objected and argued that because there was purportedly no expert

testimony on the issue of factual causation between Decedent’s knee pain and

his death. See N.T., 6/22/21, at 127-28. The court overruled Appellants’

objection and provided the jury with standard jury instructions on comparative

negligence. See N.T., 6/21/21 (Closing Arguments), at 4.

      On June 22, 2021, the jury found the following: (1) Arnold was grossly

negligent in his care and treatment of Decedent; (2) Brown was not grossly

negligent in his care and treatment of Decedent; (3) Arnold’s grossly negligent

act was a factual cause of harm to Decedent; (4) Decedent was negligent and

his ordinary negligence was a factual cause of the harm he sustained; and (5)

Arnold was 49% negligent while Decedent was 51% negligent. See Verdict

Sheet, 6/22/21, at 1-2 (unpaginated).

      On June 25, 2021, at both dockets, Appellants filed motions for post-

trial relief, claiming: (1) they were entitled to a judgment notwithstanding the

verdict on the jury’s finding of comparative negligence as to Decedent; (2) it

was improper to charge the jury on comparative negligence; (3) the Good

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Samaritan Act did not apply to the case; (4) the court’s definition of gross

negligence was in error; and (5) multiple other trial court errors.             See

Appellants’ Motions for Post-Trial Relief, 6/25/21, at 1-10 (unpaginated).

Defendants filed a response. On July 27, 2021, the trial court entered orders,

at both dockets, denying Appellant’s post-trial motions. On August 18, 2021,

judgments were entered on behalf of Arnold, Brown, and DCMH.                    This

consolidated appeal followed.21

                       II.    Issues and Standard of Review

       Appellants raise the following issues for our review:

       I. Does the “Emergency response provider and bystander good
       Samaritan civil immunity” statute apply to a private hospital and
       its EMS crew, where the statute: (a) covers only “persons”,
       “agencies” and “authorities”, but not hospitals; (b) excludes
       “hospitals emergency facilities and related personnel”; and (c)
       excludes harm caused by the “operation or use” of a vehicle?

       II. Should the trial court have submitted the defense of
       comparative negligence to the jury where Defendants failed to
       present expert testimony proving that [Appellants’] decedent’s
       failure to seek medical care for his knee pain was a factual cause
       of his death from a pulmonary embolism in his lung a week later?

       III. Whether a jury’s allocation of fault is against the weight of the
       evidence where it assigns 49% of the fault to the party found to
       be culpable of gross negligence, and 51% of the fault to the party
       found to be culpable of ordinary negligence?

       IV. Should the trial court have granted a compulsory nonsuit on
       [Appellant] Briannah Lamarr’s claim for negligent infliction of
____________________________________________

21 Appellants complied with the trial court’s directive to file a Pa.R.A.P. 1925(b)

concise statement of errors complained of on appeal.           The court issued a
Pa.R.A.P. 1925(a) opinion on March 2, 2022.

                                          - 16 -
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      emotion distress where the evidence showed that she
      contemporaneously observed grossly negligent conduct that
      caused her father’s death?

Appellants’ Brief at 5-6.

      Because Appellants’ claims largely stem from the denial of their post-

trial motions, we emphasize this Court’s review of a trial court’s denial of a

motion for post-trial relief is limited:

      Our review is limited to determining whether the trial court abused
      its discretion or committed an error of law. An abuse of discretion
      exists when the trial court has rendered a judgment that is
      manifestly unreasonable, arbitrary, or capricious, has failed to
      apply the law, or was motivated by partiality, prejudice, bias, or
      ill will. If the alleged mistake concerned an error of law, we will
      scrutinize for legal error. On questions of law, our standard of
      review is de novo and our scope of review is plenary.

Zaleppa v. Seiwell, 9 A.3d 632, 635 (Pa. Super. 2010) (citations & quotation

marks omitted).

                            III. Good Samaritan Act

      In their first argument, Appellants claim the trial court improperly

applied the Good Samaritan Act to the present case. See Appellants’ Brief at

31. They argue that DCMH is not covered under the language of the statute

“because: (1) a hospital cannot be a ‘person’ nor an ‘emergency response

provider’ as defined in the statute, and (2) the statute expressly excludes

‘hospital emergency facilities’ from protection under the statute.” Id.

      The Good Samaritan Act provides, in pertinent part:

      (a) General rule. — Any person, including an emergency
      response provider, whether or not trained to practice medicine,
      who in good faith renders emergency care, treatment, first aid or

                                       - 17 -
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       rescue at the scene of an emergency event or crime, or who
       moves the person receiving such care, first aid or rescue to a
       hospital or other place of medical care, shall not be liable for any
       civil damages as a result of rendering such care, except in any act
       or omission intentionally designed to harm or any grossly
       negligent acts or omissions which result in harm to the person
       receiving emergency care or being moved to a hospital or other
       place of medical care.

                                       *       *    *

       (c) Exception. — This section shall not relieve a driver of a
       vehicle, including an ambulance or other emergency rescue
       vehicle, from liability arising from an operation or use of such
       vehicle pursuant to subsection (a).

       (d) Definition. — For the purposes of this section, the term
       “emergency response provider” includes Federal, State and local
       emergency public safety, law enforcement, emergency response,
       emergency medical services personnel, response teams, agencies
       and authorities, excluding hospital emergency facilities and
       related personnel.

42 Pa.C.S. § 8332.22

       Returning to Appellants’ argument, they claim that the statute “defines

‘emergency response provider’ in a manner that is designed to protect public

officials such as fire and police personnel that respond to an emergency scene

[and it] was also intended to protect private ‘persons’ “(i.e., good Samaritans)

who happen upon an emergency scene, including those that have medical

training.” Appellants’ Brief at 32. They claim, “No reasonable reading of the

____________________________________________

22 Effective September 9, 2022, Subsection (d) was deleted and the definition

of “emergency response provider” was moved to a newly created Subsection
(e) that set forth certain definitions, including “emergency response provider.”
The definition is essentially the same as the prior subsection.

                                           - 18 -
J-A21037-22

statute supports the trial court’s conclusion that it protects a private hospital

from liability arising out of the negligence of its employees.” Id. at 32-33.

Appellants suggest that the Good Samaritan Act is not facially applicable

because DCMH “is not a ‘person’ or ‘agency’ or ‘authority[.’”]       Id. at 33.

Moreover, they allege that “[i]f the statue were intended to protect private

hospitals, the legislature would have stated as much[,]” but the statute “does

not” include hospitals in its definition of emergency response providers, and,

in fact, even “excludes ‘hospital emergency facilities.’” Id.

      Additionally, Appellants contend that even if Arnold and Brown were

entitled to immunity, “their immunity would not benefit” DCMH. Appellants’

Brief at 33. Relying on Regester v. County of Chester, 797 A.2d 898, (Pa.

2002), they argue that “DCMH is not immune from liability for harm caused

by its own ordinary negligence, or by the ordinary negligence that may be

imputed to it through the conduct of its agents.” Appellants’ Brief at 34.

      Appellants further maintain that Arnold and Brown are not protected

under the Good Samaritan Act because the statute states “an ‘emergency

response provider’ is entitled to immunity does not include ‘hospital

emergency facilities and related personnel.’” Appellants’ Brief at 35 (emphasis

omitted), citing 42 Pa.C.S. § 8332(d). They allege Arnold and Brown fall under

the category of “related personnel.” Id. Moreover, Appellants complain that

Brown is not entitled to immunity for his operation or use of the ambulance

because he “failed to activate the ambulance’s lights and sirens; took the

                                     - 19 -
J-A21037-22

wrong route to the hospital; stopped and waited at all red lights; failed to use

his horn; and missed a turn.”          Id. at 36. They state, “All these acts and

omissions involved the ‘operation or use’ of a vehicle, rather than ‘care,

treatment, first aid or rescue.’” Id.

       Lastly, Appellants argue that in its analysis, the trial court improperly

“relied upon another statute for ‘guidance’, the Emergency Medical Services

System Act (‘EMSSA’)[23 and] pieced together different definitions from

EMSSA to conclude that an ambulance cannot be considered an ‘emergency

response facility.’” Appellants’ Brief at 37. Appellants insist their argument

focused on DCMH not the ambulance and the “court erroneously focused only

on whether the ambulance qualified as a ‘hospital emergency facility’ without

addressing the broader issue of whether . . . DCMH was one.”           Id. at 38

(emphasis omitted).

       This issue requires us to interpret the Good Samaritan Act, which

implicates the principles of statutory construction. “Since ‘the construction of

____________________________________________

23 The EMSSA provides, in pertinent part:

       No EMS agency, EMS agency medical director or EMS provider who
       in good faith attempts to render or facilitate emergency medical
       care authorized by this chapter shall be liable for civil damages as
       a result of an act or omission, absent a showing of gross
       negligence or willful misconduct. This paragraph shall also apply
       to students enrolled in approved courses of instruction and
       supervised pursuant to rules and regulations.

35 Pa.C.S. § 8151(2).

                                          - 20 -
J-A21037-22

the language of the Act is a question of law,’ our standard of review is de

novo.” Stop Blight Inc. v. Dinardo, 303 A.3d 516, 519 (Pa. Super. 2023)

(citation omitted).

      We are also mindful of the following principles:

         [t]he Statutory Construction Act directs that the object of
         all interpretation and construction of statutes is to ascertain
         and effectuate the legislature’s intent. 1 Pa.C.S. § 1921(a);
         Chanceford Aviation Properties, LLP v. Chanceford
         Twp. Bd. of Supervisors, 592 Pa. 100, 923 A.2d 1099,
         1104 (2007). Generally, the best indicator of legislative
         intent is the plain language of the statute. Walker v.
         Eleby, 577 Pa. 104, 842 A.2d 389, 400 (2004).

            In construing statutory language, “[w]ords and phrases
         shall be construed according to rules of grammar and
         according to their common and approved usage[.]” 1
         Pa.C.S. § 1903(a). When the words of a statute are clear
         and unambiguous, there is no need to look beyond the plain
         meaning of the statute “under the pretext of pursuing its
         spirit.” 1 Pa.C.S. § 1921(b); Commonwealth v. Conklin,
         587 Pa. 140, 897 A.2d 1168, 1175 (2006). Only “[w]hen
         the words of the statute are not explicit” may a court resort
         to the rules of statutory construction, including those
         provided in 1 Pa.C.S. § 1921(c). Chanceford, 923 A.2d at
         1104.

            A statute is ambiguous when there are at least two
         reasonable interpretations of the text under review[.] See
         Delaware Cnty. v. First Union Corp., 605 Pa. 547, 992
         A.2d 112, 118 (2010). Moreover, “[s]tatutes in pari materia
         shall be construed together, if possible, as one statute.” 1
         Pa.C.S. § 1932. Finally, it is presumed “[t]hat the General
         Assembly does not intend a result that is absurd, impossible
         of execution or unreasonable.” 1 Pa.C.S. § 1922(1).

      Warrantech Consumer Prods. Servs., Inc. v. Reliance Ins.
      Co. in Liquidation, 626 Pa. 218, 96 A.3d 346, 354-55 (Pa. 2014)
      (italics added).

                                     - 21 -
J-A21037-22

Turnpaugh Chiropractic Health & Wellness Ctr., P.C. v. Erie Ins. Exch.,

297 A.3d 404, 417-18 (Pa. Super. 2023) (paragraph breaks added).

     A review of the record reveals the following. In May of 2021, Defendants

filed a motion in limine supporting the application of the Good Samaritan Act

and alleged that the law “governs all aspects of [Appellants’] claims and

theories in this case, such that ‘gross negligence’ is the applicable standard

for liability.” Motion in Limine of Defendants Supporting Application of the

Emergency Response Provider and Bystander Good Samaritan Civil Immunity

Law, 5/26/21, at 2. Appellants opposed the motion, claiming:

     There are exceptions to the blanket use of the gross negligence
     standard in the case. [Appellants] allege that the Defendants
     were negligent in the use and/or operation of the vehicle which is
     a stated exception. Furthermore, prior case law and the plain
     wording of the statute exempt hospitals and emergency facilities
     from the qualified immunity.

Appellants’ Opposition to the Motion in Limine of Defendants Regarding the

Application of the Emergency Response Provider and Bystander Good

Samaritan Civil Immunity Law, 6/7/21, at ¶ 6.

     On June 14, 2021, the trial court initially granted Defendants’ motion in

limine and then heard the following argument on the applicability of the Good

Samaritan Act:

     [Appellants’ Counsel:] Our Good Samaritan Act that was in place
     at the time of the case does have a vehicle exception in the
     [Regester] case. It was rejected.

           The claim was that the EMTs, little bit different factually,
     went the wrong way, got lost en route to the patient’s house. By

                                    - 22 -
J-A21037-22

     the time they got to the patient’s house, he was already in full
     blown cardiac arrest.

           Our case is different. Our case is, when they arrived at . . .
     Sellers Avenue, [Decedent] was still alive and breathing and
     although the [Regester] case rejected the vehicle exception
     proffered by the plaintiff, there’s an interesting distinction in the
     vehicle exception act that was in place at the time of the
     [Regester] case.

           [T]he Supreme Court in that case said operation of the
     vehicle means if you get lost it doesn’t mean if you get into an
     accident we all understand that to be, but in the motor vehicle
     exception in place for this case, they added some words. It’s
     operation or use. It’s no longer mere operation of the vehicle.

           Our position is that the failure to use lights and sirens is a
     use of the vehicle, and if the jury were to believe that that was a
     negligent omission that our case would, therefore, fall within that
     vehicle exception. That’s the vehicle exception.

           As to the other portion of the acts, the act states under the
     general rule any person including an emergency response provider
     and the “any person” language at least as far as the [Regester]
     case stated they rejected that the any person also applies to the
     corporate entity in the [Regester] case and said that it
     specifically does not apply because it didn’t say any hospital, a
     person, any corporation.

            We have [DCMH] as a stand alone defendant in this case,
     so I would submit to the Court that when this immunity statute
     reads any person, it does not include [DCMH]. Arguably it applies
     to drivers and the paramedic.

             Furthermore, when you look at the definition of emergency
     response provider, it specifically excludes hospital emergency
     facilities and related personnel.

           It’s our view that [DCMH] is providing, in essence, a
     mobile ER. That’s what the legislature was referring to
     when they said excluding hospital emergency facilities and
     related personnel.

                                 *     *      *

                                     - 23 -
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       [Defendants’ Counsel]: . . . The [Regester] case is not applicable
       here. The [Regester] case dealt with a completely different
       statute of the Emergency Medical Services Act which actually was
       repealed by the Pennsylvania state legislature.        It has no
       precedential value.

             The [Regester] case, thankfully[,] Your Honor[,] there is
       a case from [Judge] Massiah-Jackson in the case of [Kronfeld v.
       Sugarhouse HSP Gaming, L.P., 2014 WL 12862634 (Pa. Com.
       Pl. Dec. 9, 2014)24]. This is a case that held that the Good
       Samaritan Act grants immunity to any person, and they define
       any person as, quote, a corporation, partnership or limited liability
       company.

              This Court can also take guidance from 35 Pa.C.S. [§] 8151
       stating that an EMS or medical command are entitled to gross
       medical standard as well. DCMH is entitled to protection since the
       only connection is that of vicarious liability. In order to get to
       DCMH, you have to prove gross negligence between the two
       individual providers.

             Your Honor, I think you’re on the right track when you
       ordered that gross negligence standard applied to all defendants
       and all claims.

             Now, to the vehicle exception standard, . . . I think it’s really
       important to read it in context, Section 8332(b) which provides
       that any person who moves the person receiving such care, first
       aid or rescue to a hospital or other place of medical care shall not
       be liable for any civil damages. Anybody rendering EMS care or
       moves a patient to a hospital is not liable for civil damages.

             The vehicle use exception . . . has only been applied in a
       couple cases cited in our brief. Those instances where the vehicle
       exception was actually applied were instances where the
____________________________________________

24 We note this case involved a different subsection of the Statutory
Construction Act. See 1 Pa.C.S. § 1991. Moreover, we are not bound by the
decisions of courts of common pleas. See Jamison v. Concepts Plus, Inc.,
552 A.2d 265, 267 (Pa. Super. 1988).

                                          - 24 -
J-A21037-22

       ambulance was driven carelessly, struck a car or struck a
       pedestrian. That’s not the case here.

              The argument that [Brown] stopped and pulled over to
       perform CPR, took too long to the hospital, drove too slowly,
       stopped at stop lights, stop signs, didn’t use lights and sirens,
       that’s not the purpose of the vehicle use exception[.]

             Those are all emergency transport care decisions informed
       and directed by the condition of the patient as it exists at that
       particular time. That’s a care decision.

              If anything, it’s a safe operation of the vehicle, going too
       slow, stopping at stop signs. [The] ambulance must abide by rules
       of the road. That includes abiding by speed limits and stop signs,
       stop lights.

             I would respectfully submit to you that the gross negligence
       standard applies to all claims and to all defendants, and that
       includes DCMH.

N.T., 6/14/21, at 18-23 (emphasis added). The trial court confirmed that its

ruling stood. Id. at 23.

       In its Rule 1925(a) opinion, the trial court explained that because the

phrase, “hospital emergency facilities,” was not defined by the Good

Samaritan Act, it looked to the EMSSA and related definitions.25 Trial Ct. Op.,

____________________________________________

25 Under the EMSSA, a “facility” is a “physical location at which an entity
operates a health care facility licensed under Federal or State law.” 35 Pa.C.S.
§ 8103. “Hospital” is defined, in relevant part, as “[a]n institution having an
organized medical staff that is primarily engaged in providing to inpatients, by
or under the supervision of physicians, diagnostic and therapeutic services or
rehabilitation services for the care or rehabilitation of injured, disabled,
pregnant, diseased, sick or mentally ill persons.”           Id.    Additionally,
“emergency” is defined as:

(Footnote Continued Next Page)

                                          - 25 -
J-A21037-22

3/2/22, at 4-5. The trial court further pointed out that the Good Samaritan

Act extends to “[a]ny person . . . who moves the person receiving such

care[.]” Id. at 6, citing 42 Pa.C.S. § 8332(a). Based on these definitions, the

court found:

              According to [Appellants], the “statute does not apply to
       [their] claims of negligent operation of the mobile intensive care
       unit (failing to use lights and sirens, taking the wrong route),
       because the statute explicitly excludes conduct related to the
       “operation and use” of the emergency vehicle[.]

             To find in favor of [Appellants] on this issue, the court must
       broaden the definition of “use” to include what the appellate court
       previously labeled as “ambulance service.” The court declined.
       The “failing to use lights and sirens” and “taking the wrong route”
       do not amount to the negligent operation and/or use of an
       ambulance and the exception does not apply.

Trial Ct. Op. at 6-7 (footnotes omitted).

____________________________________________

       A physiological or psychological illness or injury of an individual,
       such that a prudent layperson who possesses an average
       knowledge of health and medicine could reasonably expect the
       absence of immediate emergency medical services to result in:

       (1) placing the health of the individual or, with respect to a
       pregnant woman, the health of the woman or her unborn child, in
       serious jeopardy;

       (2) serious impairment of bodily functions; or

       (3) serious dysfunction of a bodily organ or part.

Id. An “ambulance” is considered a “ground, water or air vehicle which is
maintained or operated for the purpose of providing emergency medical
services to and transportation of patients.” Id.

                                          - 26 -
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      At the outset, we recognize that there is very limited case law

addressing the Good Samaritan Act. Moreover, Appellants’ suggestion that

DCMH provided “a mobile ER[,]” meaning its ambulance constituted a mobile

emergency room, is a novel consideration. See N.T., 6/14/21, at 20.

      We now turn to the plain language of the statute. The general rule is

that “[a]ny person, including an emergency provider, . . . shall not be liable

for any civil damages as a result of rendering such care, except in any act or

omission intentionally designed to harm or any grossly negligent acts or

omissions which result in harm to the person receiving emergency care or

being moved to a hospital or other place of medical care.”          42 Pa.C.S. §

8332(a). In other words, an emergency provider is granted immunity unless

that individual’s actions amount to intentional harm or gross negligence. The

term, “emergency response provider,” includes individuals that qualify as

“emergency response, emergency medical services personnel, [and] response

teams, . . . excluding hospital emergency facilities and related personnel.”

42 Pa.C.S. § 8332(d) (emphases added).            We observe that Subsection

8332(d) expressly provides an exclusion for hospital emergency facilities and

related personnel.    Read in context, the critical word of this exclusion is

“facilities” or “facility.” In construing the word, “facility,” in accordance with

its “common and approved usage[,]” one could readily ascertain that the word

does not account for modes of transportation, like an ambulance.           See 1

Pa.C.S. § 1903(a). Additionally, we can also look to the description of the

                                     - 27 -
J-A21037-22

ambulance at issue, which did not contain a surgical team of physicians and

nurses and was not equipped with certain medications like heparin, a blood

thinner, or TPA, a clot buster.26 See N.T., 6/16/21, at 9-10; N.T., 6/17/21,

at 186. Our conclusion is supported by fact that the general rule specifically

states that “an emergency response provider . . . shall not be liable for . . .

harm to the person . . . being moved to a hospital[.]” 42 Pa.C.S. § 8332(a)

(emphasis added).

       Moreover, based on the language of the statute, we find that Appellants’

contention — that “[n]o reasonable reading of the statute supports the trial

court’s conclusion that it protects a private hospital from liability arising out

of the negligence of its employees” — is misplaced. Appellants’ Brief at 32-

33. It is clear that the purpose of the Good Samaritan Act is to exclude an ER

facility and those personnel working in an ER from immunity in tort liability

cases with respect to their medical care. Plainly speaking, the Act was not

intended to protect ER facilities from any negligence practices, nor was it

intended to protect treating doctors from medical malpractice claims.

However, emergency responders, like those that work in ambulances and

transport people to a hospital, were provided with immunity protection under

the law. Thus, DCMH, acting in its limited role as a provider of emergency

____________________________________________

26 It merits mention that TPA was described as a dangerous medication due

to its side effects. See N.T., 6/17/21, at 83.

                                          - 28 -
J-A21037-22

ambulatory services, and its emergency responder employees, DCMH EMS,

were protected under the Good Samaritan Act.

      We also observe that Appellants did not sue DCMH under a theory of

direct liability but rather under the concept of vicarious liability. Therefore,

their claim against DCMH is derivative of their claim against DCMH EMS. See

Mamalis v. Atlas Van Lines, Inc., 528 A.2d 198, 200 (Pa. Super. 1987) (“A

claim of vicarious liability depends on the life of the claim from which it

derives.   Termination of the claim against the agent extinguishes the

derivative claim against the principal. Moreover, a claim of vicarious liability

is indivisible from the direct claim since both are based on the act or acts of

only one tortfeasor.”) (citations omitted).

      Lastly, to the extent Appellants allege Brown is not entitled to immunity

for his “operation or use” of the ambulance based on purported negligent

actions like failing to activate the ambulance’s lights and sirens, taking a

different route to the hospital, stopping and waiting at red lights, and failing

to use his horn, we find this argument is misdirected. Appellants’ Brief at 36.

Indeed, Appellants fail to present any case law that Brown’s acts amounted to

gross negligence like intended instances where an ambulance collides with

another vehicle or hits a bystander during transportation. Indeed, the case

Appellants reference, Regester, does not support their argument for several

reasons.

                                     - 29 -
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       First, Regester concerned a different statute, Emergency Medical

Services Act,27 which was repealed in 2009. Second, the Regester Court held

that a paramedic’s failure to follow directions and maintain adequate

familiarity with the area did not implicate the vehicle liability exception.

Regester was previously summarized by our sister court as follows:

       In Regester, the [Supreme] Court examined the alleged
       negligence of paramedics in failing to follow driving directions
       relayed by the paramedics’ dispatch, causing a delayed arrival
       that proved critical to the inability of the paramedics to revive a
       decedent. The plaintiffs argued for a rule that would have allowed
       for all negligent decision-making occurring within the course of
       the operation of a vehicle to fall within the vehicle exception. The
       Court noted that its own decisions . . . “establish that the vehicle
       liability exception encompasses more than merely negligent
       driving.    However, the Court found that there was no
       “controlling authority” for the broad rule that “any and all
       decisions made during the operation of a vehicle implicate
       the exception.” The Court held that the medics’ failure to
       follow directions and maintain adequate familiarity with
       the area did not implicate the vehicle exception, stating:

          Here, while properly acknowledging that there is some
          range of negligence associated with the physical operation
          of a vehicle beyond actual driving that will implicate the
          vehicle liability exception, the Commonwealth Court
          correctly concluded that the form of negligence alleged by
          the Regesters does not qualify. To the contrary, such
          allegations of negligence...[are] more closely associated
          with the public service involved (ambulance service) than it
          is with the physical operation of the vehicle as such.

Cornelius v. Roberts, 71 A.3d 345, 352 (Pa. Commw. 2013) (citations

omitted; emphasis added). Therefore, even if we were to apply Regester to

____________________________________________

27 See 35 P.S. § 6931(j)(2) (repealed eff. Aug. 18, 2009).

                                          - 30 -
J-A21037-22

the present matter, the analysis would find in favor of Brown as his acts were

similar to those in Regester. According, Appellants’ first argument fails.

                           IV.   Comparative Negligence

         Next, Appellants complain the trial court erred by submitting the issue

of comparative negligence to the jury.          See Appellants’ Brief at 39.   They

state:

         Based on [Decedent]’s failure to seek treatment for his gout-like
         symptoms, the jury found that he was comparatively negligent.
         The jury also found that [Decedent]’s failure to seek treatment for
         his gout-like symptoms was a factual cause of him later dying as
         a result of suffering a pulmonary embolism in his lung. Yet there
         was no competent testimony showing that [Decedent]’s gout-like
         symptoms related to his pulmonary embolism. This result cannot
         stand because Defendants failed to introduce competent expert
         evidence to support their claim that [Decedent]’s failure to seek
         treatment for his gout-like symptoms was a factual cause of him
         later dying from a pulmonary embolism.

Id. at 39-40.

         Relying on Pascal v. Carter, 647 A.2d 231 (Pa. Super. 1994), and

Angelo v. Diamontoni, 871 A.2d 1276 (Pa. Super. 2005), Appellants

contend the “trial court erred in allowing the jury to consider the affirmative

defense of comparative negligence in the absence of supporting expert

testimony on the issue of medical causation.” Appellants’ Brief at 40. They

maintain that the “determination of whether [Decedent]’s gout-like symptoms

were causally related to the pulmonary embolism is beyond the knowledge of

a layperson” and Defendants “needed to support their affirmative defense of

comparative negligence with competent expert testimony, at least on the

                                       - 31 -
J-A21037-22

issue of factual causation if not also on the standard of care.” Id. at 45-46.

They allege Defendants’ two experts did not provide the requisite testimony.

Id. at 48-49.

       Furthermore, they argue that Defendants’ cross-examination of their

own expert witness was insufficient to meet their burden of proof. Id. at 51-

52.   Appellants state that the answers given by their expert during cross-

examination “were hardly sufficient to meet Defendants’ burden of proof [as

their] expert stated only that he ‘believed’ that [Decedent’s] knee pain was

the ‘beginning’ of the ‘thrombophlebitis’ that ‘ultimately’ led to the pulmonary

embolism.” Id. at 53 (emphasis omitted). They contend thrombophlebitis

was never defined and the vague terms — “beginning” and “ultimately” —

were not given any contextual meaning.             Id.   Appellants conclude that

because the trial court erred when it submitted the question of comparative

negligence to the jury, the judgment in favor of Defendants must be vacated

and a new trial on damages only is required. Id. at 57-58. They state that a

“damages only” trial is warranted “because the liability of . . . Arnold has been

‘fairly determined’” and the issue of “Arnold’s gross negligence is not

intertwined with the question of damages.” Id. at 58.28

____________________________________________

28 In their brief, Appellant also asserted Defendants’ counsel did not lay a
proper foundation under Pennsylvania Rule of Evidence 705, and “questioned
[their] expert on the wrong legal standard of causation[,]” asking about the
“increased risk of harm” doctrine. Appellants’ Brief at 54. Appellants state
the court never instructed the jury on this doctrine, which they claim “allows
(Footnote Continued Next Page)

                                          - 32 -
J-A21037-22

       We begin with following:

             As a general proposition, a court should only charge the jury
       on the law applicable to the factual parameters of a particular case
       and it may not instruct jury on inapplicable legal issues. More
       specifically, when there is no evidence of plaintiff’s negligence, no
       instruction to the jury on contributory negligence should be given.

Boyle v. Indep. Lift Truck, Inc., 6 A.3d 492, 495 (Pa. 2010) (citations &

quotation marks omitted)

       Here, the trial court found the following:

       [Appellants] assert[ ] that “[c]omparative negligence applies only
       in cases of ordinary negligence of the defendant.” [Appellants],
       however, offer[ ] no caselaw in support of this assertion. The
       cases cited by [Appellants] involve wanton conduct, analysis of a
       different statute, or reference the dissent.

             The parties agree that this case is not about intentional
       conduct. Wanton or willful conduct involve intent; comparative
       negligence is prohibited in such actions. Gross negligence is
       something less; and there is no such bar when a party has
       provided evidence to a jury. Comparative negligence was an
       available defense here.

____________________________________________

for a lower quantum of proof in some case[;]” rather, it instructed the jury as
to factual causation. Id. at 54-55.

       A review of Appellants’ Rule 1925(b) concise statement reveals that they
did not include this Rule 705 issue in their list of trial court errors. Accordingly,
it is waived. See Pa.R.A.P.1925(b)(4)(vii) (“[i]ssues not included in the [Rule
1925(b) s]tatement . . . are waived”); McKeeman v. CoreStates Bank,
N.A., 751 A.2d 655, 658 (Pa. Super. 2000) (“[a]n appellant’s failure to include
an issue in his [Rule] 1925(b) statement waives that issue for purposes of
appellate review”).

                                          - 33 -
J-A21037-22

Trial Ct. Op. at 7-8 (footnotes omitted).          We agree with the trial court’s

determination that Appellants should not be granted relief on this issue but on

a different basis.29

       Comparative negligence is statutorily defined as follows:

       In all actions brought to recover damages for negligence resulting
       in death or injury to person or property, the fact that the plaintiff
       may have been guilty of contributory negligence shall not bar a
       recovery by the plaintiff or his legal representative where such
       negligence was not greater than the causal negligence of
       the defendant or defendants against whom recovery is
       sought, but any damages sustained by the plaintiff shall be
       diminished in proportion to the amount of negligence attributed to
       the plaintiff.

42 Pa.C.S. § 7102 (a) (emphasis added).               “Contributory negligence” is

commonly defined as:

       [C]onduct on the part of a plaintiff which falls below the standard
       to which he should conform for his own protection and which is a
       legally contributing cause, cooperating with the negligence of the
       defendant, in bringing about the plaintiff’s harm. Contributory
       fault may stem either from a plaintiff’s careless exposure of
       himself to danger or from his failure to exercise reasonable
       diligence for his own protection.

Thompson v. Goldman, 114 A.2d 160, 162 (Pa. 1955) (citations omitted).30

“In addition, a plaintiff’s negligent conduct must be a proximate cause of his

____________________________________________

29 See Wakeley v. M.J. Brunner, Inc., 147 A.3d 1, 5 (Pa. Super. 2016)
(“[I]t is well settled that if the court’s decision is correct, we may affirm on
any ground.”).

30 See also Columbia Med. Grp., Inc. v. Herring & Roll, P.C., 829 A.2d

1184, 1191 n.7 (Pa. Super. 2003) (“Black’s Law Dictionary defines the
contributory negligence doctrine as follows: ‘The principle that completely bars
(Footnote Continued Next Page)

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injury if his conduct is to affect his recovery. For negligent conduct to be a

proximate cause of an injury, it must be a substantial factual cause of the

injury for which damages are sought.” Zieber v. Bogert, 747 A.2d 905, 908

(Pa. Super. 2000).

       Both    comparative      negligence     and   contributory   negligence   are

considered affirmative defenses. See Pa.R.C.P. 1030(b). “[A]n affirmative

defense is not an action, but rather is the statement of new facts and

arguments that, if true, will defeat a plaintiff’s action.”         Bayview Loan

Servicing, LLC v. Lindsay, 185 A.3d 307, 313 (Pa. 2018).                 “It is well

established that the burden of establishing comparative negligence rests on

the defendant.        In demonstrating that the plaintiff was negligent, [a]

defendant has the burden of showing that his conduct was unreasonable under

the circumstances.”       Rose v. Annabi, 934 A.2d 743, 746-47 (Pa. Super.

2007).

       Turning to the matter sub judice, Appellants present no case law that

states a defendant is required to present its own expert testimony for the

causation element of an affirmative defense. Rather, Appellants circumvent

the issue by relying on a parenthetical in Grossman v. Barke, 868 A.2d 561

(Pa. Super. 2005) that indicates “generally causation must be established

____________________________________________

a plaintiff’s recovery if the damage suffered is partly the plaintiff’s own fault.’
Black’s Law Dictionary 330 (7th ed. 1999).”).

                                          - 35 -
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through expert medical testimony[.]”          Id. at 567, citing Lattanze v.

Silverstrini, 448 A.2d 605, 608 (Pa. Super. 1982). See Appellants’ Brief at

41. We find that Grossman is distinguishable from the present matter for

several reasons.

     Significantly, Grossman involved a medical malpractice suit, which is

not the same type of case as the case before us, which concerns the treatment

and conduct of EMT responders. The Grossman Court explained:

     One of the most distinguishing features of a medical malpractice
     suit is . . . the need for expert testimony, which may be necessary
     to elucidate complex medical issues to a jury of laypersons.

                                 *     *      *

     Indeed, a jury of laypersons generally lacks the knowledge to
     determine the factual issues of medical causation; the degree of
     skill, knowledge, and experience required of the physician; and
     the breach of the medical standard of care.

Grossman, 868 A.2d at 566-67 (citation & quotation marks omitted).

Nevertheless, the Grossman Court also recognized that “even in a negligence

suit characterized as medical malpractice, expert testimony is not always

required if the alleged negligence is obvious or within the realm of a

layperson’s understanding.”     Id. (citation & quotation marks omitted;

emphasis added).

     Here, the critical issue, which resulted in the comparative negligence

jury instruction, concerns whether Decedent’s negligence in failing to seek

medical attention for his gout-like symptoms was the proximate cause of his

death. See Appellant’s Brief at 39. Timing is of the essence in this issue and

                                     - 36 -
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whether a reasonable person in Decedent’s place had a duty to seek urgent

medical care. Thus, although Defendants must prove causation, we find that

it was permissible for them to do so through the cross-examination of

Appellants’ expert witness, Carl W. Adams, M.D.31

       At trial, counsel for Defendants questioned Dr. Adams about Decedent’s

actions the week prior to the incident:

       Q. Let’s talk about the time in the week before the event.

            [Decedent] had been home with right knee pain for
       approximately a week; correct?

       A. Correct.

       Q. And that right knee pain was actually a deep vein thrombosis
       of his knee; would you agree with that?

       A. Well, his underlying diagnosis was gout, gouty arthritis, but I
       believe that it was [the] beginning of a thromboembolic --
       thrombophlebitis.

       Q. And that ultimately led to the clot traveling to his pulmonary
       arteries; correct?

       A. Pulmonary artery on the right; correct.

                                       *       *    *

       Q. If [Decedent] had taken his daughter’s advice, he would have
       been at the hospital a complete day in advance; correct?

       A. Presumably. Correct.

       Q. And would that have increased his chance of survivability?

____________________________________________

31 The videotaped deposition of Dr. Adams was played to the jury.      See N.T.,
6/15/21, at 98.

                                           - 37 -
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     A. Correct.

     Q. In fact, it would have increased it substantially, would you
     agree with that?

     A. Correct.

     Q. And did you read the testimony [of Desiree]?

                                 *     *      *

     [I]n her testimony, she reported that she had told him that he
     needed to go to a doctor as early as April 21st, three days before
     this incident; correct?

     A. Correct.

     Q. And she remined him again on the 22nd, which was two days
     before the incident; correct?

     A. Correct.

     Q. And if he had gone on the 21st or 22nd, is your opinion the
     same, that he would have had an increase chance of survivability?

     A. Correct.

     Q. [Desiree testified] that on the 21st [Decedent] said to her that
     he needed to get out of bed because he was afraid he was going
     to get a blood clot.

           Do you remember that testimony?

     A. I do. Because he had one before.

     Q. And that would indicate [Decedent] himself understood that he
     could be having a blood clot; correct?

     A. Correct.

Transcript of Videotaped Deposition of Carl W. Adams, M.D., 3/31/21, at 57-

60. Dr. Adams’ testimony amounted to a concession that Decedent’s knee

                                     - 38 -
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pain was the symptom of a blood clot that began one week prior to the incident

and he was aware of this potential medical issue.            More significantly, Dr.

Adams testified that if Decedent had sought treatment a couple days earlier,

his chance of survivability would have increased substantially. We find this

testimony was more than sufficient to put the issue of Decedent’s purported

contributory negligence before the jury.32 See Boyle, 6 A.3d at 495.

       Furthermore, Appellants’ reliance on Pascal and Angelo is misplaced.

In Pascal, the plaintiff injured his wrist during a football game. See Pascal,

647 A.2d at 232.        He visited the defendant-radiologist for x-rays and the

defendant “reported that there was no evidence of fracture or abnormality.”

Id. As a result of continued pain, another x-ray was taken and the plaintiff

was diagnosed with a fracture.          Id.    He filed a complaint alleging medical

malpractice against the defendant. Id. A jury returned a verdict in favor of

the defendant. Id. On appeal, the plaintiff argued he was entitled to a new

trial because the trial court erred in charging the jury on contributory

negligence. In granting relief to the plaintiff, a panel of this Court explained:

       [The plaintiff] alleged contributory negligence was in failing to
       seek treatment for [his] injured wrist earlier. [The defendant]
       argued that if [the plaintiff] had sought treatment for the wrist
       soon after the initial injury, the treatment could have obviated the
       need for surgery. There was testimony presented that earlier
       treatment might have made surgery unnecessary. However,
____________________________________________

32We presume that Defendants did not call their own expert because they
were aware that Dr. Adams’ deposition would be admitted at trial, and
believed his testimony could be used to support their defense.

                                          - 39 -
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      there was no testimony presented that a proper diagnosis of the
      fracture could have been made at an earlier date. In fact, the
      expert testimony indicated that the fracture became clearer over
      time.     Without any evidence demonstrating that an earlier
      diagnosis would have been successful in discovering [the
      plaintiff]’s injury, the failure to seek such a diagnosis cannot have
      been a cause of the need for surgery on the wrist. Moreover, it
      would be entirely speculative to assume without the benefit of
      expert testimony on the issue, that simply because it was
      negligent for [the defendant] to fail to diagnosis the fracture . . .,
      an earlier diagnosis would have been successful in discovering the
      injury to the wrist. Thus, as there was no evidence of causation
      between [the plaintiff’s] negligence and the injury alleged, the
      trial court erred in instructing the jury on contributory negligence.

Pascal, 647 A.2d at 233.

      We first point out that Pascal concerned a medical malpractice suit and

the alleged negligent acts of the defendant-doctor. That type of liability action

is not before us.   Moreover, there was no expert evidence regarding the

effectiveness of an earlier diagnosis in Pascal.       Here, there was expert

testimony regarding Decedent’s failure to seek medical attention for his gout-

like symptoms and causation — albeit from the plaintiff’s expert.              We

emphasize that Pascal did not address any limitations regarding the use of

an opposing party’s expert evidence — in other words, it did not rule that a

defendant must present its own expert testimony in order to prove

comparative or contributory negligence. Thus, Pascal does not apply to the

present matter.

      Likewise, Appellants’ reliance on Angelo is misguided.        Angelo also

concerned a medical practice suit wherein it was alleged that a physician failed

                                     - 40 -
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to diagnose the decedent’s Type I diabetes, and the decedent died as a result.

Angelo, 871 A.2d at 1278.

     At trial, both parties called expert witnesses to testify concerning
     the conformity of [the physician’s] treatment of [the decedent’s]
     symptoms and condition with the standard of care for family
     practice physicians. Neither [the defendants] nor the parties’
     experts testified that [the decedent] failed to comply with medical
     direction or that he had contributed to his own injuries in any other
     way. Moreover, the parties stipulated that the defendants would
     not offer [the physician’s] handwritten note suggesting a fasting
     blood draw to show contributory negligence in exchange for the
     [the plaintiff-administrator’s] agreement not to introduce
     circumstantial evidence that [the physician] had written the note
     only after she learned of [the decedent’s] death. . . .

Id. The jury found the physician was negligent and her negligence was a

substantial factor, but the plaintiff had been more than 50% responsible for

his own injuries. Id. A panel of this Court noted the following:

     [The physician] attempt[ed] to satisfy that standard countering
     that, notwithstanding the absence from her own case of testimony
     ascribing contributory negligence to [the decedent], [the
     decedent’s] own expert testified that [the decedent] was obliged
     to monitor his own health as part of the doctor-patient
     relationship. [The physician] argue[d] that evidence suggesting
     [the decedent’s] purported lack of diligence in self-monitoring,
     although slight, enabled the jury to find his actions the cause of
     his death. . . .

Angelo, 871 A.2d at 1281 (citation omitted). The panel concluded:

     The circumstances in this case, however, do not satisfy that
     second crucial element of the test for contributory negligence.
     [The decedent] reported his symptoms to [the physician] on two
     occasions and she responded each time with a diagnosis, albeit
     erroneous. On neither occasion does the evidence suggest that
     either [the decedent] or [the physician’ treated the visit as
     routine. In point of fact, [the decedent] appeared at the doctor’s
     office . . . reporting nausea, vomiting, diarrhea, sweating and
     chills over the prior two hours. This factor negates the suggestion

                                    - 41 -
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      that [the decedent] breached a duty in failing to report his
      symptoms. Moreover, [the decedent] left each visit assured of a
      diagnosis by a medical professional who was ostensibly more
      knowledgeable than he under the circumstances, and on whose
      expertise he was entitled to rely[.] His questions had been asked
      and answered and his duty as a patient satisfied. . . .

                                  *     *      *

      Having concluded that the record does not offer sufficient
      evidence to allow a charge to the jury on contributory negligence,
      we need only discern whether the charge provided here “probably
      misled” the jury. Under the circumstances at hand, we do so
      without hesitation. . . .

Id. 1281-82 (citations omitted). We note that Angelo concerned a sufficiency

of the evidence argument — whether there was sufficient evidence to show

the plaintiff breached his duty to report his symptom — as opposed to whether

a party is required to present expert testimony. Therefore, it does not control

the present case. Accordingly, Appellants’ second claim fails.

                          V. Weight of the Evidence

      In Appellants’ third issue, they claim the jury’s allocation of fault

between Decedent and Arnold was against the weight of the evidence.

Appellants’ Brief at 59-60. They state the “problem with the jury’s verdict is

patent” where the trial court instructed the jury on gross negligence.     Id.

Appellants argue that while the jury found that Arnold’s conduct amounted to

gross negligence and Decedent’s conduct constituted ordinary negligence, it

“inexplicably allocated more fault to [Decedent] than it did to” Arnold. Id. at

60. They insist that “[s]imple logic compels” a conclusion that the verdict was

                                      - 42 -
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against the weight of the evidence based on the court’s definition of gross

negligence. Id.

           When presented with a challenge to weight of the evidence
     claim, our standard of review is well-settled.

        Initially, we note the following relevant legal precepts:

           Appellate review of a weight claim is a review of the
           [trial court’s] exercise of discretion, not of the
           underlying question of whether the verdict is against
           the weight of the evidence. Because the trial judge
           has had the opportunity to hear and see the evidence
           presented, an appellate court will give the gravest
           consideration to the findings and reasons advanced by
           the trial judge when reviewing a trial court’s
           determination that the verdict is against the weight of
           the evidence. One of the least assailable reasons for
           granting or denying a new trial is the lower court’s
           conviction that the verdict was or was not against the
           weight of the evidence and that a new trial should be
           granted in the interest of justice.

           The factfinder is free to believe all, part, or none of
           the evidence and to determine the credibility of the
           witnesses. The trial court may award a judgment
           notwithstanding the verdict or a new trial only when
           the jury’s verdict is so contrary to the evidence as to
           shock one’s sense of justice. In determining whether
           this standard has been met, appellate review is limited
           to whether the trial judge’s discretion was properly
           exercised, and relief will only be granted where the
           facts and inferences of record disclose a palpable
           abuse of discretion. When a fact finder’s verdict is so
           opposed to the demonstrative facts that looking at the
           verdict, the mind stands baffled, the intellect searches
           in vain for cause and effect, and reason rebels against
           the bizarre and erratic conclusion, it can be said that
           the verdict is shocking.

           However, [i]f there is any support in the record for the
           trial court’s decision to deny the appellant’s motion for
           a new trial based on weight of the evidence, then we

                                    - 43 -
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            must affirm. An appellant is not entitled to a new trial
            where the evidence presented was conflicting and the
            fact-finder could have decided in favor of either party.

      McFeeley v. Shah, 226 A.3d 582, 594 (Pa. Super. 2020)
      (citations and quotation marks omitted).

Spencer v. Johnson, 249 A.3d 529, 566 (Pa. Super. 2021).

      In disposing of Appellants’ weight claim, the trial court explained:

            This point of error can be interpreted two ways: the verdict
      goes against the weight of the evidence, or there is an
      inconsistency in the jury’s answer. If the latter, this issue was not
      preserved at trial and is, therefore, waived.

                                  *     *      *

      The court did not find that the verdict was against the weight of
      the evidence. [Defendants] elicited testimony from [Appellants]
      and witnesses that . . . Decedent was exhibiting signs and
      symptoms that warranted immediate medical attention and that .
      . . Decedent failed to seek medical treatment, even against the
      suggestion of his family.

Trial Ct. Op. at 10-11 (footnotes omitted).

      To the extent that Appellants raise an inconsistent verdict challenge, as

their argument does intertwine suggestions of a discrepancy in the jury’s

decision, we agree with the trial court that they have waived this claim. See

Pa.R.A.P. 302(a).

      We now turn to the merits of Appellants’ weight argument. “We are

reminded that it is not the place of this Court to invade the trial judge’s

discretion any more than a trial judge may invade the province of a jury,

unless both or either have palpably abused their function.”       Spencer, 249

A.3d at 569 (citation omitted).

                                      - 44 -
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     A review of the record reveals the following.      The trial testimony

established that Decedent had a prior history of blood clots in his legs. See

N.T., 6/15/21, at 116. One week prior to the April 24th incident at issue,

Decedent was suffering from such knee pain and difficulty walking that he

decided to stay home from work. See N.T., 6/14/21, at 173. Two of his

family members suggested to him that he contact his treating physician,

including his gout doctor, but he declined to do so. See N.T., 6/14/21, at

174; N.T., 6/15/21, at 124-125. As mentioned above, on the morning of April

24th, Decedent collapsed on his basement steps and DCMH EMS responded

to the 9-1-1 call. See N.T., 6/16/21, at 13.

     Based on the circumstances, Defendants presented evidence that Arnold

asked one of Decedent’s daughter about his medical history.       See N.T.,

6/14/21, at 104-105, 134. When Decedent told DCMH EMS he was having

trouble breathing, they conducted an EKG test and provided him with oxygen.

See N.T., 6/14/21, at 134; N.T., 6/16/21, at 25; N.T., 6/17/21, at 144.

Arnold then placed a defibrillator monitor, a peripheral catheter, and an EKG

monitor on Decedent. See N.T., 6/22/21, at 33-35. They also gave Decedent

chewable baby aspirin at approximately 11:30 a.m. See id. at 36-37. Two

minutes later, Arnold took a set of Decedent’s vital signs, and noted that

Decedent’s rapid heart rate had decreased and his oxygen saturation was

improving. See id. at 38.

                                   - 45 -
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        Arnold made the decision to take Decedent to Lankenau based on his

symptoms and the medical equipment available at the hospital, but when they

were three to four minutes away, Decedent went into cardiopulmonary arrest.

See N.T., 6/16/21, at 34, 55-56, 78; N.T., 6/22/21, at 39-40. Arnold ordered

Brown to stop the vehicle so that he and Brown could administer CPR. N.T.,

6/14/21, at 153; N.T., 6/16/21, at 34.         During this time, while they were

administering compressions and giving epinephrine, Casey arrived to assist.

See N.T., 6/14/21, at 155; N.T., 6/22/21, at 43. They then performed an

orotracheal intubation of Decedent, and conducted another rhythm check on

Decedent, who was “in asystole[,]” so they restarted doing compressions

while giving him more epinephrine.       N.T., 6/22/21, at 44-45.       They then

resumed transporting him to Lankenau. Id. at 45.

        As mentioned above, approximately 39 to 40 minutes had elapsed from

the time DCMH EMS arrived at Decedent’s home to when they arrived at the

hospital. See N.T., 6/16/21, at 77. The jury heard testimony from Casey,

who indicated that the time period was “reasonable” for someone who is

exhibiting signs of a pulmonary embolism to get to the hospital. See id. at

112.

        Defense witness, Gregory C. Kane, M.D., an expert in the areas of, inter

alia,   pulmonary    medicine,   myocardial    infarction,   the   performance   of

diagnostic testing, the performance of CPR and resuscitation, and the transit

of patients by ambulance crews from the field into the hospital, testified at

                                      - 46 -
J-A21037-22

trial. See N.T, 6/17/21, at 56. He stated DCMH EMS’s “actions were within

the standard of care for what [his] expectation was and [his] awareness of

the Pennsylvania guidelines for providing EMS support, both BLS and ALS, of

[Decedent] in his transport” to Lankenau. Id. at 67. Dr. Kane testified that

Decedent’s blood clot was “large” and “it led him to have a cardiac arrest while

being transported to the hospital.”     Id. at 81.   The expert disagreed with

Appellants’ expert, Dr. Adams, about Decedent’s medical history and that it

automatically meant he was going to have a pulmonary embolism. Id. at 86-

87. Dr. Kane indicated one can have a heart attack even if that person had a

prior DVT. Id. at 86. He opined:

      [W]e have to remember that we still don’t know that there’s
      pulmonary embolism at the time that [Decedent] has his arrest,
      so if the ambulance had not stopped to do appropriate CPR —
      which is the standard in our field when a patient has arrest, to
      start CPR right away — they would have arrived in the emergency
      room without an understanding of what the condition was and
      would have needed to do some of those diagnostic studies to
      understand it.

           We’ve also seen that the surgeon had difficulty placing the
      ECMO, was unable to place the ECMO in the emergency room, so
      my opinion is that [Decedent] would not have survived even if the
      ambulance crew had just continued driving directly to the hospital.

Id. at 88-89.

      When asked “how far in advance would [Decedent] have had to have

arrived in the hospital to have a chance[,]” Dr. Kane responded:

      I would have estimated that had [Decedent] called for fire rescue
      an hour earlier, perhaps, he could have gotten to the emergency
      room in time, or they could have done some of the diagnostic work

                                      - 47 -
J-A21037-22

       to figure out he had a [pulmonary embolism] and administer some
       of these life saving treatments that we've discussed.

N.T, 6/17/21, at 89.

       The expert also stated that Arnold’s request for information regarding

Decedent were “routine questions that you would expect the EMTs to ask so

they could make the best decision to take the patient and a little bit about

what he would need as part of his report for transport.” N.T, 6/17/21, at 91.

Furthermore, he opined that when Brown stopped the ambulance to help

Arnold perform CPR, this was reasonable because

       [t]wo-person CPR is highly effective, [it] gives [a responder] a
       chance to vent late, give the patient additional oxygen for breathe
       for the patient if they’re not breathing, also in this case insert an
       endotracheal tube to gain access to lungs, provide high levels of
       oxygen and also enables somebody to do effective chest
       compressions, which would be very difficult to do in a moving
       ambulance, particularly going around corners.

Id. 92-93.

       The jury also heard from defense witness, James P. McCans, an expert

in EMT paramedic care, CPR, and operations of the vehicle,33 who testified

that DCMH EMS’s ambulance operation and care and treatment rendered met

the applicable standard of care. See N.T., 6/17/21, at 133-34. He noted that

Pennsylvania “has adopted a less [ambulance] lights and sirens model for EMS

response.” Id. at 137. Moreover, McCans indicated it was standard to “assess

the environment[,] talk to the patient, have communication with the patient’s

____________________________________________

33 See N.T., 6/17/21, at 129.

                                          - 48 -
J-A21037-22

family, build a story as to what’s occurring[.]” Id. at 139. The expert testified

that “[o]ne of the first signs of a cardiac issue is having trouble breathing

because [the] respiratory system will try to compensate for deficiency on the

cardiac side” and DCMS EMS was “following protocol” when they provided

Decedent with oxygen and aspirin. Id. at 143-44. McCans stated it was a

“totally appropriate” amount of time that they spent at Decedent’s residence.

Id. at 147. McCans mentioned he was familiar with the area and testified it

was a “reasonable route” for Brown to take to Lankenau and that responders

“don’t have the right or the permission by the state to just blow through a red

light or a stop sign.”   Id. at 149-50. He also indicated that they need to

“[a]void potholes” and “sudden accelerations and decelerations” while

responders are in the back doing CPR. Id. at 167.

      Additionally, McCans stated DCMH EMS were “following the American

Heart Association’s advance cardiac life support protocol.” N.T., 6/17/21, at

204. He testified that because Decedent went “into a flat line rhythm[,]” they

could not use a defibrillator and needed to do CPR. Id. at 156. He noted that

Pennsylvania “actually recommends that during pit crew CPR[,] the second

person is set up on the other side of the patient and [does] a minute on, a

minute off, swap back and forth [for] efficacy[.]” Id. at 157. McCans opined

that the decision to pull over and start two-person CPR is not addressed in the

EMS protocols and that it would be up to the paramedic and “his gut response

as to what to do, and if that was to occur at that point[.]” Id. at 200-201.

                                     - 49 -
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McCans stated that his practice — and what he tells young medics — is that if

he can hold his breath to get to the hospital, “then [he would] continue on”

but if he cannot, then he suggests stopping to conduct CPR. Id. at 201. He

commented that DCMH “worked very hard to save [Decedent’s] life” and they

“did not increase any harm to him.” Id. at 172-73.

      Appellants did not call their EMS expert to testify at trial. See N.T.,

6/17/21, at 5. As mentioned above, their other expert, Dr. Adams, conceded

that Decedent’s change of survivability would have increased if he sought

treatment earlier.

      In considering these circumstances, we cannot conclude the trial court

abused its discretion in refusing to grant a new trial. We recognize that gross

negligence involves a higher degree of deviation from the standard of care

than ordinary negligence. See Feleccia v. Lackawanna Coll., 215 A.3d 3,

19 (Pa. 2019). However, that does not necessarily equate to a greater amount

of liability. Appellants present no case law to suggest that the legal weight or

ramifications of gross negligence and ordinary negligence creates a scenario

where the former trumps the latter in terms of outcomes. Thus, while the

jury did find Arnold’s actions amounted to gross negligence, it could

reasonably determine that Decedent’s liability in his failure to seek treatment

greatly outweighed Arnold’s liability. “We reiterate it was solely for the [jury],

as the finder of fact, to determine the credibility of witnesses and to resolve

any conflicts or inconsistencies in the evidence. The jury was free to accept

                                     - 50 -
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all, some, or none of the testimony presented to them.” Spencer, 249 A.3d

at 571 (citations & quotation marks omitted). Thus, we conclude the trial

court did not abuse its discretion in determining that the verdict was not

against the weight of the evidence.         Accordingly, Appellants’ weight claim

merits no relief.

                 VI.    Negligent Infliction of Emotional Distress

         In their final argument, Appellants assert the trial court erred by

granting a compulsory nonsuit on Briannah’s claim for NIED. Appellants’ Brief

at 61.

         The standard of review on appeal from the denial of a motion to
         remove a compulsory nonsuit is as follows:

            The plaintiff must be allowed the benefit of all favorable
            evidence and reasonable inferences arising therefrom, and
            any conflicts in the evidence must be resolved in favor of
            plaintiff.  Further, [i]t has been long settled that a
            compulsory nonsuit can only be granted in cases where it is
            clear that a cause of action has not been established.
            However where it is clear a cause of action has not been
            established, a compulsory nonsuit is proper. We must,
            therefore, review the evidence to determine whether the
            order entering judgment of compulsory nonsuit was proper.

Braun v. Target Corp., 983 A.2d 752, 764 (Pa. Super. 2009) (citation

omitted).

         In addressing this issue, we are guided by the following:

               As explained in Doe v. Philadelphia Community Health
         Alternatives AIDS Task Force, 745 A.2d 25, 26 (Pa. Super.
         2000), aff'd, 564 Pa. 264, 767 A.2d 548 (2001), the cause of
         action for negligent infliction of emotional distress is restricted to
         four factual scenarios: (1) situations where the defendant had a
         contractual or fiduciary duty toward the plaintiff; (2) the plaintiff

                                        - 51 -
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       was subjected to a physical impact; (3) the plaintiff was in a zone
       of danger, thereby reasonably experiencing a fear of impending
       physical injury; or (4) the plaintiff observed a tortious injury
       to a close relative.

             When proceeding under this theory, a unanimous panel of
       this Court observed that

          [t]he crux of a negligent infliction of emotional distress
          claim is that appellees breached some duty they owed
          to appellant and that that breach injured her.

       Denton v. Silver Stream Nursing and Rehabilitation Center,
       739 A.2d 571, 578 (Pa. Super. 1999) (although Judge McEwen,
       P.J.E., filed a concurring and dissenting statement, he joined in
       the quoted section). Therefore, under this theory of recovery, a
       plaintiff must establish the elements of a negligence claim,
       “i.e., that the defendant owed a duty of care to the plaintiff,
       the defendant breached that duty, the breach resulted in
       injury to the plaintiff, and the plaintiff suffered an actual
       loss or damage.”

Toney v. Chester Cty. Hosp., 961 A.2d 192, 197-98 (Pa. Super. 2008) (en

banc) (some citations omitted; emphasis added).           After a petition for

allowance of appeal was granted in Toney, the Pennsylvania Supreme Court,

in an evenly-split plurality decision,34 discussed NIED under “special

relationship theory,” stating:

       Before 1970, our Court abided by the century-old common law
       “impact rule” in cases involving emotional distress claims. The
       impact rule “barred recovery for fright, nervous shock or mental
       or emotional distress unless it was accompanied by a physical
       injury or impact upon the complaining party.” Kazatsky v. King
       David Memorial Park, Inc., 515 Pa. 183, 527 A.2d 988, 992
       (Pa. 1987); see also, Potere v. City of Philadelphia, 380 Pa.
       581, 112 A.2d 100, 104 (Pa. 1955). We acknowledged that the
       “common law rationale for the impact rule is embodied in the
____________________________________________

34 We recognize that that while Toney is persuasive, it is not binding.

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     often-quoted statement of Lord Wensleydale in Lynch v. Knight,
     9 H.L.Cas. 557, 598, 11 Eng.Rpts. 854, 863 (1861): ‘Mental pain
     or anxiety the law cannot value, and does not [pretend to]
     redress, when the unlawful act complained of causes that alone.’”
     Id.; see also, W. Page Keeton et al., Prosser and Keeton on
     the Law of Torts, § 12, at 55 (5th ed. 1984). In Kazatsky, we
     further catalogued the concerns regarding recovery for psychic
     injury as including “medical science’s difficulty in proving
     causation, the danger of fraudulent or exaggerated claims, and
     the perception that recognition of such a cause of action would
     precipitate a flood of litigation.” Id.

           We did not diverge from the impact rule until Niederman
     v. Brodsky, 436 Pa. 401, 261 A.2d 84 (Pa. 1970), when we
     adopted the “zone of danger” theory of NIED liability, which
     provided compensation to those who did not actually suffer a
     physical impact resulting in emotional distress so long as they
     were in personal danger of the physical impact. We concluded
     that the fear of impact resulted in justifiable and compensable
     emotional distress.       The Court in Niederman allowed this
     extension of liability, in part, based upon the evolution of medical
     science’s ability to diagnose mental distress. Id. at 86.

            The most recent step in the evolution of NIED occurred in
     Sinn v. Burd, 486 Pa. 146, 404 A.2d 672 (Pa. 1979), where we
     adopted the theory of bystander liability. The adoption of the
     bystander liability theory of NIED allowed recovery for
     emotional distress for plaintiffs who witnessed an accident
     causing serious injury to a close family member, even if the
     plaintiff was not within the zone of danger of physical
     impact. As explained in Sinn, we limited recovery for serious
     mental distress to situations “where a reasonable person normally
     constituted, would be unable to adequately cope with the mental
     stress engendered by the circumstances of the event.” Id. at 683
     (internal quotations marks omitted). . . . Later, in Mazzagatti v.
     Everingham, 512 Pa. 266, 516 A.2d 672 (Pa. 1986), we refused
     to extend bystander liability where a plaintiff did not immediately
     witness the traumatic event, but instead came upon the scene
     later.

Toney v. Chester Cty. Hosp., 36 A.3d 83, 88-89 (Pa. 2011) (emphasis

added).

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      Turning to Appellants’ arguments, they claim that certain Sinn “factors”

were disputed at trial. See Appellants’ Brief at 62. They state Briannah’s

“observations of Defendants’ lack of urgency and care for her father, while he

was unable to breathe, satisfies the ‘observation’ requirement.” Id. at 63.

They allege she witnessed Arnolds’ and Brown’s negligent acts at her house,

en route to the hospital (where the responders stopped at the red lights and

pulled over to administer CPR to Decedent), and at the hospital (where Arnold

or Brown told her that everything would be okay). Id. at 65-70. They assert

that because of her distress as result of the actions of Arnold and Brown, she

had to move out of her family’s home and live with her grandmother, as well

as seek mental health services. Id. at 71-72. Appellants contend the trial

court “incorrectly asserted that the claim for [NIED] was based only on the

conduct of” Brown.    Id. at 73. They maintain the claim also included the

conduct of Arnold. Id. They also suggest the court “improperly focused on

only the following four allegations pertaining to . . . Brown: (1) driving in the

wrong direction; (2) failing to use lights and sirens; (3) waiting for the traffic

lights to turn green; and (4) not using the horn.”          Id.   They conclude

Briannah’s NIED claim “was based on much more than ‘a driver operating an

ambulance in compliance with the laws.’” Id. at 74.

      In finding no relief was warranted on the NIED cause of action, the trial

court explained:

            [Briannah] provided that her “claim is not based on the
      nature of care. It’s not based on whether they did an EKG[.]”

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      [Her] claim of [NIED] is based on a delay caused by the ambulance
      travelling in the “wrong” direction, a failure to employ lights and
      sirens during transport, waiting for the traffic lights to turn green
      prior to entering an intersection, and not using the horn.

                                  *     *      *

            [Appellants] argued that had the driver taken a different
      route, the trip would taken six to eight minutes. However, the
      patient went into cardiac arrest four minutes into the transport at
      11:38 a.m. According to the parties, the ambulance was parked
      for 15 minutes for care[.] Transportation resumed at 11:53 a.m.
      The ambulance arrived at the hospital three minutes later, 11:56
      a.m. Based upon [Briannah]’s testimony, the transport took
      seven minutes.

            Pennsylvania statute, 75 Pa.C.S. § 7105(d), provides that
      “[t]he driver of an ambulance . . . shall comply with maximum
      speed limits, red signal indications and stop signs.            After
      ascertaining that the ambulance . . . will be given the right-of-
      way, the driver may proceed through a red signal indication or
      stop sign.” As to the manner of transport, the court cannot find
      that a driver operating an ambulance in compliance with the laws
      amounts to a breach of duty. Based upon the evidence presented,
      the court found that [Briannah] failed to establish a cause of action
      for [NIED].

Trial Ct. Op. at 8-10 (footnotes omitted).

      We agree with the trial court’s analysis and affirm on its basis while

adding the following, additional commentary.           Contrary to Appellants’

argument, at trial, their counsel argued that Briannah’s claim “is based on a

23-minute window of time while she was in the ambulance, and just before

she got into the ambulance, she observed her dad in a critically ill state where

he could not move and he kept saying I can’t breathe[.]” N.T., 6/17/21, at

14-15. Their counsel previously had stated:

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      Our claim has nothing to do with the care. [Briannah is] in no
      position to judge whether the care they gave him was negligence.
      Her claim has to do with the fact that they made a series of
      mistakes in driving to the hospital, not using lights and sirens.
      That’s the evidence.

N.T., 6/14/21, at 17. We note that it is clear that a NIED cause of action has

not been established as Briannah failed to present any evidence that

Defendants owed a duty of care to her or that they breached that duty. See

Denton, 739 A.2d at 578. Rather, Briannah’s NIED claim amounted to an

allegation that DCMH EMS were not acting with urgency and made a few traffic

errors. Moreover, as Defendants point out:

            [Appellants] failed to come forward with any evidence to
      establish that her alleged distress was directly caused by . . .
      Brown’s ambulance drive. Beyond feeling anxious because her
      father was in the ambulance and she wanted the ambulance to
      hurry, . . . Briannah . . . offered no testimony regarding any
      discrete, identifiable, action or event of the manner in which the
      ambulance drove which specifically caused her emotional distress.

Defendants’ Brief at 41. Accordingly, Appellants’ final claim fails.

      Judgment affirmed.

Date: 12/20/2023

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