Court Opinion

ID: 9952732
Source: CourtListenerOpinion
Date Created: 2024-03-20 16:14:36.851209+00
Date Added: 2024-06-11T14:44:04.418245
License: Public Domain

J-A01026-24

NON-PRECEDENTIAL DECISION - SEE SUPERIOR COURT O.P. 65.37

  CORI LARSEN                                  :   IN THE SUPERIOR COURT OF
                                               :        PENNSYLVANIA
                       Appellant               :
                                               :
                                               :
                v.                             :
                                               :
                                               :
  WAYNE MEMORIAL HOSPITAL AND                  :   No. 1400 EDA 2023
  PAIGE CASTELINO AND JOHN DOE 1               :
  AND JOHN DOE 2 AND JOHN DOE 3                :

                  Appeal from the Order Entered April 26, 2023
                 In the Court of Common Pleas of Wayne County
                     Civil Division at No(s): 2020-CV--00433

BEFORE:      LAZARUS, P.J., PANELLA, P.J.E., and COLINS, J.*

MEMORANDUM BY PANELLA, P.J.E.:                          FILED MARCH 20, 2024

       Cori Larsen appeals from the order entered in the Wayne County Court

of Common Pleas on April 26, 2023, granting summary judgment in favor of

Wayne Memorial Hospital (“WMH”) and Paige Castelino (“Dr. Castelino”)

(collectively “Appellees”). After careful review, we affirm.

       The trial court opinion set forth the relevant facts and procedural history

of this case as follows:

              [Larsen] commenced this suit by filing a complaint on
       December 22, 2020 against [Appellees] for injuries she sustained
       in her capacity as an emergency medical technician for Cottage
       Hose Volunteer Ambulance Company. On December 30, 2018,
       [Larsen] was part of the EMS crew transporting a minor patient
       (initials T.D.) from Wayne Memorial Hospital (hereinafter, “WMH”)
       in Honesdale, Pennsylvania to a psychiatric facility in Pittsburgh,
____________________________________________

* Retired Senior Judge assigned to the Superior Court.
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     Pennsylvania. T.D. was involuntarily admitted to WMH on or about
     December 25, 2018 pursuant to Section 7302 of the Mental Health
     Procedures Act. Paige Castelino, M.D. (hereinafter, “Dr.
     Castelino”) treated T.D. while T.D. was a patient of WMH. Dr.
     Castelino authored the discharge summary for T.D, as follows:

        Patient admitted for suicidal intent and depression. Patient
        during admission had extremely combative behavior and
        medicated extensively and warranted multiple attempts at
        restraints including physical. Patient now accepted at the in
        patient psych in Pittsburg [sic]. Explained and warned EMS
        crew that patient is extremely combative can give IM Ativan
        and IM Haldol as per psych recommendations en route.
        Requested ALS for medical personnel however EMS crew
        stated psych facility won't accept a sedated patient and they
        would be ok with BLS transport. Patient d/c at this time.

     Dr. Castelino was not present during T.D.’s discharge on
     December 30, 2018. During the ambulance trip that day, while en
     route to Pittsburgh, T.D. attacked and injured [Larsen]. [Larsen]’s
     alleged injuries include a detached retina, fractured teeth,
     concussion, and contusions of the knee and ribs.

             In her Complaint, [Larsen] asserts professional medical
     liability claims against WMH and Dr. Castelino and brings the
     following counts: Count I — Gross Negligence, Negligence against
     Dr. Castelino; Count II — Corporate Negligence, Gross Negligence
     against WMH; Count III — Negligent Performance of an
     Undertaking to Render Services, Gross Negligence against Dr.
     Castelino and WMH; Count IV — Negligent Misrepresentation
     against Dr. Castelino, and; Count V — Res Ipsa Loquitor against
     Dr. Castelino. After multiple continuances, this matter is currently
     scheduled for a jury trial to commence on May 8, 2023. Discovery
     has been completed pursuant to the Court’s scheduling order of
     February 21, 2023.

           On April 3, 2023, WMH filed six (6) motions requesting the
     [c]ourt to grant either partial summary judgment or complete
     summary judgment in its favor. On that same date, Dr. Castelino
     also filed a motion for summary judgment. Plaintiff provided
     timely responses thereto. On April 19, 2023, counsel appeared
     before this [c]ourt to conduct the scheduled pre-trial conference
     and argument on motions in limine. During a discussion in
     chambers with the undersigned and counsel, counsel represented

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      that they were prepared to argue the motions for summary
      judgment and agreed to do so if the [c]ourt’s schedule permitted.
      This was later confirmed on the record. Consequently, on April 19,
      2023, in addition to hearing argument on the parties’ motions in
      limine and conducting pre-trial conference, the [c]ourt heard
      argument on the motions for summary judgment[].

Trial Court Opinion, 4/26/23, at 1-3 (footnotes omitted). The court

subsequently issued an opinion and order granting summary judgment in

favor of Appellees and dismissing Larsen’s case with prejudice. This timely

appeal followed.

      In reviewing a trial court’s grant of summary judgment, we are guided

by the following principles:

      We view the record in the light most favorable to the nonmoving
      party, and all doubts as to the existence of a genuine issue of
      material fact must be resolved against the moving party. Only
      where there is no genuine issue as to any material fact and it is
      clear that the moving party is entitled to a judgment as a matter
      of law will summary judgment be entered. Our scope of review of
      a trial court’s order granting or denying summary judgment is
      plenary, and our standard of review is clear: the trial court’s order
      will be reversed only where it is established that the court
      committed an error of law or abused its discretion.

Good v. Frankie & Eddie’s Hanover Inn, LLP, 171 A.3d 792, 795 (Pa.

Super. 2017) (citation omitted).

      “In order to set forth a cause of action in negligence, [a plaintiff is]

required to plead sufficient facts which would establish that: (1) the doctor

owed them a duty of care; (2) the doctor breached that duty; (3) they were

injured; and (4) the injuries were proximately caused by the doctor’s breach

of duty.” Crosby v. Crosby v. Sulz, 592 A.2d 1337, 1340 (Pa. Super. 1991)

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(citation omitted). “Moreover, the plaintiff must offer an expert witness who

will testify to a reasonable degree of medical certainty, that the acts of the

physician deviated from good and acceptable standards, and that such

deviation was the proximate cause of the harm suffered.” Eaddy v. Hamaty,

694 A.2d 639, 642 (Pa. Super. 1997) (citation and internal quotation marks

omitted).

      In its opinion, the court concluded that Appellees owed no duty to Larsen

pursuant to a medical professional liability claim. See Trial Court Opinion,

4/26/23, at 5. Further, the court concluded that even if a duty were owed to

Larsen, Larsen failed to meet her burden of producing a qualified expert report

to establish that the care and treatment provided fell short of the required

standard of care and that the breach proximately caused Larsen’s injury,

pursuant to the Medical Care Availability and Reduction of Error (MCARE) Act,

40 P.S. § 1303, et seq. See id. at 7-8.

      On appeal, Larsen argues the trial court erred in granting Appellees’

motion for summary judgment because (1) Appellees owed Larsen a duty,

notwithstanding the fact that Larsen was not Appellees’ patient, and (2)

Larsen’s liability expert was qualified to opine on breaches of the standard of

care by Appellees.

      Due to our disposition on the second issue, we need not reach the first

issue – as even if we assume, arguendo, that Appellees owed Larsen a duty,

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we agree with the trial court that Larsen failed to meet her burden of producing

a qualified expert to opine on a breach of the standard of care by Appellees.1

____________________________________________

1 Although we do not reach the issue, we note briefly that the case law cited

by Larsen in support of her proposed duty of care is distinguishable and
unavailing to the facts presented here. Larsen cites to Crosby, Emerich v.
Philadelphia Center for Human Development, Inc., 720 A.2d 1032 (Pa.
1998), and Matharu v. Muir, 86 A.3d 250 (Pa. Super. 2014), for their
rejection of the broad notion that a health care provider can never owe a duty
to someone other than that provider’s patient. Larsen asks us to apply the
rationale in a line of cases imposing liability on a physician where the plaintiffs
relied on a failure to warn theory. Here, Larsen did not proceed under a failure
to warn theory, as she conceded numerous times at the hearing, but rather a
negligence theory.

We are unaware of any precedent that supports Larsen’s proposed duty of
care between a medical professional and an unrelated third-party, in terms of
treatment of a mental health patient. As such, we view Larsen’s arguments as
a request for the imposition of a new, affirmative, common-law duty in tort.
This request for imposition of a new duty is reinforced by Larsen’s suggestion
that we consider the multifactorial test set forth in Althaus ex rel. Althaus
v. Cohen, 756 A.2d 1166 (Pa. 2000). However, while Larsen cites to Althaus,
she notably does not provide any analysis of those factors herself.

       In the absence of policy arguments or a request for an opportunity
       to develop a record, the court did not err in applying the default
       approach of declining to impose upon professional undertakings
       new affirmative common-law duties running to third-parties to the
       professional relationship. Moreover, the present appeal does not
       afford an adequate foundation to make an informed social policy
       assessment which would support the imposition of a new
       affirmative duty on physicians to make third-party interventions.

Seebold v. Prison Health Services, Inc., 57 A.3d 1232, 1250-51 (Pa.
2012). As Larsen failed to develop the record in the court below, we simply
are unable to properly assess such a broad claim as imposing a new duty in
tort.

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      Larsen contends her liability expert is qualified to offer his opinion on

the standard of care of Appellees. Accordingly, Larsen argues the record

contains sufficient expert testimony to survive summary judgment.

      Dr. Kenneth Robinson authored a report in which he concluded “that Dr.

Castelino and [WMH] failed to meet the standard of care, and that these

failures caused the significant injuries sustained by [] Larsen.” Brief in Support

of Motion for Summary Judgment, 4/3/23, at Exhibit P.

      In its opinion, the trial court concluded Dr. Robinson is not qualified to

render an opinion regarding the standard of care of Appellees, explaining as

follows:

            Dr. Robinson is board certified in emergency medicine while
      Dr. Castelino is board certified in internal medicine. Dr. Castelino,
      in her role as a specialist in internal medicine, treated T.D. and
      monitored her mental health over the course of T.D.’s multi-day
      commitment at WMH. Dr. Castelino is a hospitalist who
      coordinates the care of a patient during his or her stay. This is
      much different than the role of Dr. Robinson, chief of a hospital's
      department of emergency medicine. Further, Dr. Robinson states
      generally in the conclusion of his report that he has years of
      experience treating "a wide variety of patients" including
      "Behavioral Health patients." However, his curriculum vitae, while
      replete with experience, certifications and acclaim in the areas of
      emergency medical services and trauma, is silent with regard to
      internal medicine and experience coordinating care of mental
      health patients.

            While the Court does not discredit Dr. Robinson's accolades
      and expertise in the field of emergency medicine, he does not
      meet the qualifications of an expert in this case, specifically with
      regard to Section 512(c)(1)-(2). Further, the waiver allowed by
      Section 512(e) is not satisfied. The Court finds that Dr. Robinson
      is not qualified to testify as it pertains to the standard of care of
      Dr. Castelino and WMH in their treatment of T.D. Therefore,

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     summary judgment is appropriate on this basis because without a
     report from a qualified expert, [Larsen] has not met her burden.

Trial Court Opinion, 10/13/2016, at 3–4 (unnumbered).

     Pursuant to the MCARE Act, a professional testifying to a physician’s

standard of care must satisfy several requirements.

     Expert qualifications

     (a) GENERAL RULE.—No person shall be competent to offer an
     expert medical opinion in a medical professional liability action
     against a physician unless that person possesses sufficient
     education, training, knowledge and experience to provide
     credible, competent testimony and fulfills the additional
     qualifications set forth in this section as applicable.

     (b) MEDICAL TESTIMONY.—An expert testifying on a medical
     matter, including the standard of care, risks and alternatives,
     causation and the nature and extent of the injury, must meet the
     following qualifications:

        (1) Possess an unrestricted physician's license to practice
        medicine in any state or the District of Columbia.

        (2) Be engaged in or retired within the previous five years from
        active clinical practice or teaching. Provided, however, the
        court may waive the requirements of this subsection for an
        expert on a matter other than the standard of care if the court
        determines that the expert is otherwise competent to testify
        about medical or scientific issues by virtue of education,
        training or experience.

     (c) STANDARD OF CARE.—In addition to the requirements set
     forth in subsections (a) and (b), an expert testifying as to a
     physician's standard of care also must meet the following
     qualifications:

        (1) Be substantially familiar with the applicable standard of
        care for the specific care at issue as of the time of the alleged
        breach of the standard of care.

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J-A01026-24

        (2) Practice in the same subspecialty as the defendant
        physician or in a subspecialty which has a substantially similar
        standard of care for the specific care at issue, except as
        provided in subsection (d) or (e).

        (3) In the event the defendant physician is certified by an
        approved board, be board certified by the same or a similar
        approved board, except as provided in subsection (e).

     (d) CARE OUTSIDE SPECIALTY.—A court may waive the same
     subspecialty requirement for an expert testifying on the standard
     of care for the diagnosis or treatment of a condition if the court
     determines that:

        (1) the expert is trained in the diagnosis or treatment of the
        condition, as applicable; and

        (2) the defendant physician provided care for that condition
        and such care was not within the physician's specialty or
        competence.

     (e) OTHERWISE ADEQUATE TRAINING, EXPERIENCE AND
     KNOWLEDGE.—A court may waive the same specialty and board
     certification requirements for an expert testifying as to a standard
     of care if the court determines that the expert possesses sufficient
     training, experience and knowledge to provide the testimony as a
     result of active involvement in or full-time teaching of medicine in
     the applicable subspecialty or a related field of medicine within the
     previous five-year time period.

40 P.S. § 1303.512 (“Section 512”).

     Larsen readily concedes that Dr. Robinson does not meet all the

requirements of Section 512(c). See Appellant’s Brief, at 37 (“[Larsen]

acknowledges that unlike Dr. Castelino, her expert is not board-certified in

internal medicine. Therefore, [Larsen] cannot satisfy the requirements of

Section 512(c)(3).”). Instead, Larsen argues Dr. Robinson is qualified

pursuant to the waiver allowed by Section 512(e).

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      [Section 512(e)] allows a court to waive the same specialty and
      board certification requirements for an expert testifying as to a
      standard of care if the court determines that the expert possesses
      sufficient training, experience, and knowledge to provide the
      testimony as a result of active involvement in ... medicine in a ...
      related field of medicine within the previous five-year time period.

George v. Ellis, 911 A.2d 121, 131 (Pa. Super. 2006) (citation omitted).

      The trial court concluded that the waiver allowed by Section 512(e) was

not satisfied. Relevantly, the court found that although Dr. Robinson “states

generally in the conclusion of his report that he has years of experience

treating ‘a wide variety of patients’ including ‘Behavioral Health patients’”, his

curriculum vitae (“CV”) did not reflect that experience. Trial Court Opinion,

4/26/23, at 8. Instead, the trial court found “his [CV], while replete with

experience, certifications and acclaim in the areas of emergency medical

services and trauma, is silent with regard to internal medicine and experience

coordinating care of mental health patients.” Id. (emphasis added).

      Larsen argues the trial court failed to follow the applicable MCARE

provision “by focusing on the practice of internal medicine [] in a vacuum, and

not as it relates to the specific care at issue in this case.” Appellant’s Brief, at

21-22. However, as the plaintiff bringing a medical negligence claim, it was

Larsen’s burden to produce a qualified medical expert’s opinion. The trial court

adequately reviewed everything that was provided, which only included Dr.

Robinson’s report and his CV. Based on those documents, the court was

unable to conclude that Dr. Robinson had the necessary background in order

to provide an opinion pursuant to the waiver allowed by Section 512(e).

                                       -9-
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      Larsen could have provided the court with other documentation, or

testimony from Dr. Robinson at the hearing, to prove this background. After

hearing scheduled arguments on the motions in limine and the issue of

bifurcation, the court asked counsel for each party whether they were ready

to proceed with summary judgment argument or if counsel wanted to schedule

argument for another date. See N.T., Argument on Defendant’s Motions for

Summary Judgment, 4/19/23, at 4. Counsel for each party indicated they

were ready to proceed at that time. See id. (court indicating that counsel had

agreed they were ready to proceed both in chambers and on the record, and

counsel for Larsen and Appellees agreeing they were ready to proceed).

Larsen did not request more time to prepare or gather more evidence.

      Larsen suggests that even if the trial court were inclined to grant

Appellees’ motions based on Dr. Robinson's qualifications, it still erred by not

affording Larsen an opportunity to develop a detailed record through extensive

questioning of Dr. Robinson during voir dire at trial. See Vicari v. Spiegel,

989 A.2d 1277, 1284 (Pa. 2010) ("Determining whether one field of medicine

is related to another with respect to a specific issue of care is likely to require

a supporting evidentiary record and questioning of the proffered expert during

voir dire.").

      “Summary judgment motions under new Rule 1035.2(2) are intended

to prevent just such a scenario: The purpose of the rule is to eliminate cases

prior to trial where a party cannot make out a claim or a defense after relevant

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discovery has been completed....” Eaddy v. Hamaty, 694 A.2d 639, 642-43

(Pa. Super. 1997) (citations and internal quotation marks omitted).

Accordingly, an appellant “must state a prima facie case before [she] will be

allowed to proceed to trial.” Id. at 643 (emphasis in original).

      We note that Larsen’s reliance on Vicari for her analysis of Section

512(e) is misplaced. The court in Vicari was not tasked with ruling on a

summary judgment motion. Rather, the case in Vicari went to jury trial, and

only after the plaintiff rested his case, was an oral motion for compulsory

nonsuit presented. Accordingly, the standard of review for summary judgment

did not apply there. As such, we do not find Vicari guides our review here.

      We have examined the certified record, including Dr. Robinson’s report

and CV, and agree with the trial court that Larsen has not satisfied the waiver

allowed by Section (e).

      Therefore, based upon our examination of the certified record, we

discern no error in the court’s decision to grant Appellees’ summary judgment

motions. Larsen needed to produce a qualified medical expert’s opinion, and

without one, Larsen could not establish a prima facie case of medical

negligence. On this basis, the court properly granted Appellees’ summary

judgment motions. Accordingly, we affirm.

      Order affirmed.

      Judge Colins joins the memorandum.

      President Judge Lazarus concurs in the result.

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Date: 3/20/2024

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