Court Opinion

ID: 9381735
Source: CourtListenerOpinion
Date Created: 2023-03-23 16:08:13.887657+00
Date Added: 2024-06-11T17:17:34.302320
License: Public Domain

J-A05032-23

NON-PRECEDENTIAL DECISION - SEE SUPERIOR COURT I.O.P. 65.37

 WILLIAM R. ANDERSON                     :   IN THE SUPERIOR COURT OF
                                         :        PENNSYLVANIA
                    Appellant            :
                                         :
                                         :
               v.                        :
                                         :
                                         :
 CONSOLIDATED RAIL CORPORATION           :   No. 1573 EDA 2021

               Appeal from the Order Entered July 27, 2021
           In the Court of Common Pleas of Philadelphia County
                     Civil Division at No. 170801984

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

MEMORANDUM BY MURRAY, J.:                           FILED MARCH 23, 2023

     William R. Anderson (Appellant) appeals from the order entering

summary judgment in favor of Consolidated Rail Corporation (Conrail). After

careful review, we are constrained to reverse and remand for further

proceedings.

     The trial court summarized the case history as follows:

           Appellant commenced this personal injury action under the
     Federal Employers Liability Act (“FELA”), [45 U.S.C. § 51, et seq.,]
     by complaint, on August 22, 2017. A Case Management Order
     (“CMO”) listing, inter alia, expert report deadlines was issued on
     December 5, 2017. The first CMO provided that [Appellant’s]
     expert report was due no later than November 5, 2018. The
     deadline was extended on four occasions, the last being April 1,
     2021, wherein [the trial court] provided that “[Appellant] shall
     submit expert reports no later than 03-May-2021.” See CMO
     (04/01/2021). Despite the directive, and with no permission or
     excuse, [Appellant] submitted the expert report of [] Mark Levin[,
     M.D. (Dr. Levin)] (the “Levin Report”), on May 5, 2021.

                                   ***
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             [] In his complaint, Appellant alleged that occupational
       exposures to diesel exhaust, creosote, and asbestos, while
       [Appellant was] working for … Conrail[] as a timekeeper and
       trackman[,] caused him to develop stage 0 chronic lymphocytic
       leukemia (“CLL”). Appellant offered the Levin [R]eport … on the
       issue of causation.

Trial Court Opinion, 10/1/21, at 1, 2.

       The Levin Report detailed Appellant’s occupational and medical history:

       [Appellant] worked for Conrail from 1976 to 1990. Initially,
       [Appellant] did clerical work for 2 years and moved to [being] a
       trackman for 5 years and was a track foreman from 1983 to 1990.
       After [Appellant] left Conrail, he went to Red’s Towing for 22
       years. [Appellant] weas [sic] exposed to diesel exhaust, creosote,
       and asbestos on a daily basis throughout his employment with
       Conrail. On July 17, 2012, at age 64, [Appellant] was diagnosed
       with … CLL[]. [Appellant’s] father smoked but did not do so at
       home. [Appellant] never smoked. [Appellant’s] father died of
       lung cancer and his mother died of stomach cancer.

Levin Report, 5/3/21, at 2 (unnumbered).1

       In preparing his Report, Dr. Levin stated he had reviewed “the

Complaint, [Appellant’s] deposition, Appellant’s discovery responses, medical

and billing records,” id., as well as a report (Perez Report) prepared by

Hernando R. Perez, Ph.D. (Dr. Perez), who Appellant also had retained as an

expert.2 According to Dr. Levin, the Perez Report established that Appellant’s

____________________________________________

1The Levin Report is attached to Conrail’s motion for summary judgment.
See Motion for Summary Judgment, 6/7/21, Ex. A.

2 Dr. Perez is an expert in the field of industrial hygiene and occupational
health. See Perez Report, 4/25/19, at 1 (attached to Conrail’s motion for
summary judgment as Ex. K). Dr. Perez interviewed Appellant, listed
(Footnote Continued Next Page)

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“exposure[s to] diesel exhaust including benzene, creosote, and asbestos, are

higher than ambient or background levels of exposure.” Id.3 Dr. Levin quoted

the following passage from the Perez Report:

       Among the established carcinogens present in diesel exhaust is
       benzene. Benzene resulting from diesel exhaust emissions has
       been observed to be present at established health hazard
       concentrations in personal air samples of bus maintenance
       workers. Given the similarities in work environments between bus
       and locomotive maintenance facilities, similar exposure conditions
       can be anticipated. Benzene exposure is an established cause of
       leukemia. This association is relevant to the case of [Appellant]
       given his chronic occupational exposure to diesel exhaust and
       leukemia diagnosis.

Levin Report, 5/3/21, at 3 (quoting Perez Report, 4/25/19, at 8) (footnotes

omitted by Dr. Levin).

       Dr. Levin opined:

       I conclude [Appellant’s] exposure to benzene was more likely than
       not a contributory cause of his CLL. It is my professional medical
       opinion based upon more likely than not [sic] … that [Appellant’s]
       CLL was caused by benzene exposure. It is widely accepted that
       leukemia is caused by benzene.
____________________________________________

publications he reviewed in preparing his report, and stated that he
“additionally reviewed relevant peer reviewed scientific literature to inform
[his] opinions.” Id. at 1-2; see also id. at 19-20 (list of references).

3The Perez Report stated, inter alia: “[Appellant] experienced diesel exhaust
exposures across the continuum from low to intermediate during his career as
a track laborer, foreman and track supervisor. [Appellant’s] work settings
were representative of environments associated with elevated risk of
occupationally related cancer.” Perez Report, 4/25/19, at 8. Dr. Perez further
detailed Appellant’s exposures to different toxic substances while working for
Conrail, including creosote, asbestos, and benzene. See id. at 8-15; but see
also id. at 16 (observing Appellant “did not have air sampling or biological
monitoring performed to assess his exposures at any point during his career
with [Conrail].”).

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Levin Report, 5/3/21, at 5 (unnumbered; break omitted).

     On June 7, 2021, Conrail filed a motion for summary judgment,

claiming:

     Dr. Levin’s report wholly fails to identify or discuss any, let alone
     a generally accepted, methodology supporting his threadbare
     opinions on general and specific causation. As a result, the
     undisputed record is devoid of any grounds on which a jury could
     find a causal connection between [Appellant’s] alleged
     occupational exposures and his CLL.          Accordingly, summary
     judgment must be entered in favor of Conrail and against
     [Appellant].

                                     ***

     In a case that must be proven based upon established scientific
     and medical research, the Levin Report fails to establish either
     general or specific causation. Instead, Dr. Levin summarily opines
     that “[Appellant’s] exposure to benzene was more likely than not
     a contributory cause of his CLL,” and that “[i]t is my professional
     medical opinion based upon more likely than not and based on all
     of the above, that [Appellant’s] CLL was caused by benzene
     exposure.” [] Levin Report[, 5/3/21,] at 3 (emphasis added).

Motion for Summary Judgment, 6/7/21, at 1-2, 4 (paragraph numbers and

breaks omitted). According to Conrail, the deficient Levin Report “identifies

no methodology, nor does it reflect the employment of any methodology, by

which [Dr. Levin] makes the leap from association to causation.” Id. at 6.

Conrail further claimed, “there is nothing in Dr. Levin’s report quantifying

[Appellant’s] specific exposures.”   Id. at 7.   Finally, in the alternative to

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summary judgment, Conrail requested the trial court schedule a Frye4 hearing

to determine the admissibility of the Levin Report. Id. at 25.

       Appellant filed a response opposing Conrail’s summary judgment motion

on July 6, 2021, asserting “Dr. Levin’s report establishes both general and

specific causation.” Response, 7/6/21, ¶ 19. Appellant claimed, “a relaxed

standard of causation is applied under the FELA.” Id. ¶ 20 (citing Rogers v.

Missouri Pac. R.R. Co., 352 U.S. 500 (1957)). Appellant asserted that Dr.

Levin’s report was “the product of a differential diagnosis, which is a generally

accepted methodology.” Id. ¶ 65 (citing Stange v. Janssen Pharm., Inc.,

179 A.3d 45, 55 (Pa. Super. 2018) (“differential diagnosis is a generally

accepted methodology”)). Appellant explained:

       Dr. Levin reviewed the Complaint, [Appellant’s] deposition,
       [Appellant’s] discovery responses, medical and billing records and
       Dr. Perez’s industrial hygiene report. [Dr. Levin] conducted a
       literature search and reviewed findings from several well[-
       ]regarded organizations such as [the International Agency on
       Research of Cancer, Environmental Protection Agency, and the
       National Toxicology Program]. He thereafter used his professional
       judgment based upon his education, training and experience in
       formulating his opinions. As part of his differential diagnosis, Dr.
       Levin considered [Appellant’s] genetic predisposition to cancer,
       and ruled out tobacco smoke.

____________________________________________

4 See Frye v. United States, 293 F. 1013 (D.C. Cir. 1923) (holding courts
should not admit scientific evidence at trial unless the underlying methodology
has gained general acceptance in the scientific community); see also Pa.R.E.
702(c) (incorporating Frye).

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Id. ¶ 29. Finally, Appellant argued “Dr. Levin’s use of the words ‘more likely

than not’ does not serve to form a basis to preclude his opinions in this

matter.” Id. ¶ 30.

      On July 27, 2021, the trial court granted Conrail’s motion for summary

judgment, concluding that Appellant’s “expert report fails to establish

causation.” Order, 7/27/21. Appellant timely appealed. Appellant and the

trial court have complied with Pa.R.A.P. 1925.

      The trial court explained its rationale for entering summary judgment

as follows:

            Excusing formatting and grammatical issue[s], the Levin
      Report was not only late but deficient. It failed to identify
      generally accepted methodologies used to support the opinions
      offered. In addition, there is no mention of the manner or levels
      of [Appellant’s] exposure to [] “diesel[] exhaust, creosote, and
      asbestos.” Lastly, the Levin Report merely concludes that the
      Appellant’s “exposure to benzene was more likely than not a
      contributory cause of his CLL,” [Levin Report, 5/3/21, at 5
      (unnumbered),] but fails to identify the source of the exposure.
      At best, the Levin Report makes the case for a correlation, not
      causation. Even under FELA’s relaxed standard of causation, more
      is required.

Trial Court Opinion, 10/1/21, at 3-4; see also id. at 2 (“There is no portion

of the Levin Report that identifies the level of exposure during [Appellant’s]

work at Conrail or the length of exposure.”).

      Appellant presents two issues for our review:

      1. Whether the Trial Court abused its discretion in granting
         [Conrail’s] Motion for Summary Judgment as a matter of law
         excluding Mark Levin, M.D.[?]

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         2. Whether it was error of law for the Trial Court to conclude
            “[Appellant’s] expert report fails to establish causation” in light
            of the Pennsylvania Supreme Court’s decision in Walsh v.
            BASF Corp., 234 A.3d 446 (Pa. 2020)[?]

Appellant’s Brief at 4.

         Preliminarily, we reiterate that this action arises under FELA. Section 1

provides:

         Every common carrier by railroad … shall be liable in damages to
         any person suffering injury while he is employed by such carrier
         … for such injury or death resulting in whole or in part from the
         negligence of any of the officers, agents, or employees of such
         carrier….

45 U.S.C.A. § 51. “FELA cases adjudicated in state courts are subject to state

procedural rules, but the substantive law governing them is federal.” Labes

v. N.J. Transit Rail Operations, Inc., 863 A.2d 1195, 1198 (Pa. Super.

2004) (citation and footnote omitted).

         “In FELA cases, ‘the plaintiff must prove the common law elements of

negligence: duty, breach, foreseeability, and causation.’”                Welsh v.

AMTRAK, 154 A.3d 386, 395 (Pa. Super. 2017) (emphasis added; citation

and quotes omitted).       Under FELA, a jury may find liability as long as the

evidence justifies the conclusion that railroad negligence “played any part,

even the slightest, in producing the injury….”           Rogers, 352 U.S. at 506

(emphasis added; footnote citation omitted); see also Criswell v. Atl.

Richfield Co., 115 A.3d 906, 912 (Pa. Super. 2015) (noting FELA employs a

relaxed standard of causation that is less demanding than the common law

test).

                                         -7-
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      Appellant first challenges the trial court’s finding that the Levin Report

failed to establish causation. See Appellant’s Brief at 14-25. Appellant claims,

contrary to the trial court’s determination, “Dr. Levin’s opinion on specific

causation [] was formed using a differential diagnosis etiology….” Id. at 23;

but see also id. at 14 (asserting “Dr. Levin’s expert Report identified opinions

for both general and specific causation.”). Appellant argues:

      Dr. Levin, as part of his differential diagnosis, properly identified
      and considered the risk factors and/or alternative causative
      factors which could lead to [Appellant’s] CLL, which includes
      smoking, and a family history of cancer, along with workplace
      exposures. Dr. Levin discussed in his report that he considered
      [Appellant’s] genetic predisposition to cancer and ruled out
      tobacco smoke.

Id. at 24. According to Appellant,

      the [trial] court improperly determined that Dr. Levin could not
      reach an opinion on specific causation, because, as stated in [the
      court’s] 1925(a) opinion, “there is no portion of the Levin Report
      that identifies the level of exposure during [Appellant’s] work at
      Conrail or the length of exposure” and “there is no mention of the
      manner or levels of [Appellant’s] exposure to [] ‘diesel exhaust,
      creosote, and asbestos.’” [Trial Court Opinion, 10/1/21, at 3, 4.]
      However, the [c]ourt recites this proposition in error because (1)
      Dr. Levin’s opinions rely upon the industrial hygiene report
      of Dr. Perez, which discusses [Appellant’s] exposures in
      detail and provides ranges of exposure levels to diesel
      exhaust using a generally accepted methodology; (2) Dr.
      Levin’s report states that [Appellant’s] exposure to diesel exhaust,
      including benzene, creosote and asbestos are “higher than
      ambient or background levels of exposure,” and (3) dose analysis
      is not required for an expert to opine as to medical causation.

Appellant’s Brief at 24 (emphasis added; some capitalization modified).

      Appellant further claims, to the extent that Dr. Levin “does not

specifically call out any methodology by name in his report,” this is immaterial

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where “the methodology of drawing inferences from a review of published

scientific literature has been long recognized by courts as a generally accepted

methodology.”    Appellant’s Reply Brief at 1-2 (citing Commonwealth v.

Hopkins, 231 A.3d 855, 872 (Pa. Super. 2020) (“Courts accept a variety of

sources as evidence that the expert’s methodology is generally accepted,

including judicial opinions, scientific publications, studies, and statistics,

expert testimony, or a combination of the above.”) (citations omitted)).

      Finally, Appellant asserts, “[h]ad the trial court felt there were questions

regarding Dr. Levin’s methodology, the proper procedure would have been to

hold a Frye [h]earing as requested by [Conrail].” Appellant’s Brief at 25; see

also id. (“Instead, the trial court improperly determined that Dr. Levin’s

opinions were the result of no identifiable generally accepted methodology and

thereafter conducted its own analysis and formulated its own opinions. This

is a clear abuse of discretion….”).

      Conrail counters the trial court properly exercised its discretion in

determining the Levin Report failed to establish causation:

      [Dr. Levin] did not take the basic steps required under the Frye
      standard to show that he employed a generally accepted
      methodology. Instead, [Dr.] Levin relied on studies that show
      only an association between [Appellant’s] alleged exposures and
      his CLL, while providing no information about the methodology he
      used for choosing those studies.

Appellee’s Brief at 20. According to Conrail,

      Nothing in [Dr.] Levin’s report suggested that he employed any
      methodology to opine on general causation, much less a generally
      accepted one. The trial court acted within its discretion to

                                      -9-
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      determine [Dr.] Levin’s report was inadmissible under those
      circumstances. See Snizavich v. Rohm and Haas Co., 83 A.3d
      191, 194 (Pa. Super. 2013) (affirming the grant of summary
      judgment because the expert had failed to establish causation
      through the application of a “coherent scientific or technical
      methodology”).

Id. at 18-19 (emphasis in original).

      Conrail further argues:

      [Dr.] Levin’s report lacked any analysis of the amount (or dose)
      of [Appellant’s] exposure to benzene and asbestos, or to the
      products that contained those substances. In cases involving
      dose-responsive diseases, including in FELA cases, “expert
      witnesses may not ignore or refuse to consider dose as a factor in
      their opinions.” Howard ex rel. Estate of Ravert v. A.W.
      Chesterton Co., 78 A.3d 605, 608 (Pa. 2013)…. Without such
      evidence, no causal link between the plaintiff’s exposures and his
      disease may be inferred. See Wilson v. A.P. Green Indus.,
      Inc., 807 A.2d 922 (Pa. Super. 2002) (affirming summary
      judgment where evidence of regular exposure [was] insufficient
      to establish mesothelioma caused by plaintiff’s exposure to
      asbestos)….

Id. at 21.

      Finally, Conrail claims, in the alternative, that summary judgment was

proper where Appellant’s claims were barred by the applicable statute of

limitations.   Id. at 31 (citing 45 U.S.C. § 56 (no FELA “action shall be

maintained under this act … unless commenced within three years from the

day the cause of action accrued.”). According to Conrail,

      [Appellant] testified he was informed by his physician no later
      than 2013 that his exposures to diesel exhaust, asbestos, and
      creosote allegedly caused his CLL. Based on his own testimony,
      [Appellant] was required to file his claims no later than 2016.
      Because [Appellant] did not file suit until 2017, his claims are
      time-barred.

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Id. at 32 (citation to record omitted).

      We apply the following standard in reviewing the grant of summary

judgment:

      [S]ummary judgment is only appropriate in cases where there are
      no genuine issues of material fact and the moving party is entitled
      to judgment as a matter of law. Pa.R.C.P. 1035.2(1). When
      considering a motion for summary judgment, the trial court must
      take all facts of record and reasonable inferences therefrom[,] in
      a light most favorable to the non-moving party[,] and must
      resolve all doubts as to the existence of a genuine issue of material
      fact against the moving party. An appellate court may reverse a
      grant of summary judgment if there has been an error of law or
      an abuse of discretion. Because the claim regarding whether
      there are genuine issues of material fact is a question of law, our
      standard of review is de novo and our scope of review is plenary.

Nicolaou v. Martin, 195 A.3d 880, 891-92 (Pa. 2018) (some citations

omitted).

      Thus, our responsibility as an appellate court is to determine
      whether the record either establishes that the material facts are
      undisputed or contains insufficient evidence of facts to make out
      a prima facie cause of action, such that there is no issue to be
      decided by the fact-finder.

Welsh, 154 A.3d at 390 n.5 (citation omitted).

      The “admission of expert scientific testimony is an evidentiary matter

for the trial court’s discretion and should not be disturbed on appeal unless

the trial court abuses its discretion.”         Buttaccio v. Am. Premier

Underwriters, 175 A.3d 311, 315 (Pa. Super. 2017) (citation omitted). “An

abuse of discretion is not merely an error in judgment; rather, it occurs when

the law is overridden or misapplied, or when the judgment exercised is

manifestly unreasonable or the result of partiality, prejudice, bias or ill-will.”

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Scalla v. KWS, Inc., 240 A.3d 131, 136 (Pa. Super. 2020) (citations

omitted).

        This Court has explained that a

        proponent of expert scientific evidence bears the burden of
        establishing all of the elements for its admission under Pa.R.E.
        702,[5] which includes showing that the rule in Frye … is satisfied.
        See Grady [v. Frito-Lay, Inc.], 839 A.2d [1038,] 1045 [(Pa.
        2003)]. Frye, which is now embodied in Pa.R.E. 702(c), instructs
        that the court should not admit scientific evidence during trial
        unless the underlying methodology has gained general acceptance
        in the scientific community. See Commonwealth v. Topa, …
        369 A.2d 1277, 1281-82 (Pa. 1977). “Frye does not apply to
        every time science enters the courtroom[;] … Frye does apply,
        however, where an expert witness employs a novel scientific
        methodology in reaching his or her conclusion.” Folger ex rel.
        Folger v. Dugan, … 876 A.2d 1049, 1058 (Pa. Super. 2005) (en
        banc) (citations omitted). One method to assess a Frye motion
        is to conduct a Frye hearing, although a hearing is not mandatory.
        See id[.]
____________________________________________

5   Rule 702 provides:

        A witness who is qualified as an expert by knowledge, skill,
        experience, training, or education may testify in the form of an
        opinion or otherwise if:

            (a) the expert’s scientific, technical, or other specialized
            knowledge is beyond that possessed by the average
            layperson;

            (b) the expert’s scientific, technical, or other specialized
            knowledge will help the trier of fact to understand the
            evidence or to determine a fact in issue; and

            (c) the expert’s methodology is generally accepted
            in the relevant field.

Pa.R.E. 702 (emphasis added); see also Pa.R.E. 705 (“If an expert states an
opinion the expert must state the facts or data on which the opinion is
based.”).

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Buttaccio, 175 A.3d at 315 (footnote added).

      This Court was presented with similar facts in Labes, supra.           The

appellant/plaintiff previously worked for the defendant/railway, and developed

pain in his right knee which eventually required surgery. Labes, 863 A.2d at

1196-97.    The appellant initiated a negligence action under FELA, and

presented at trial evidence which included, inter alia:

      the testimony of his orthop[]edic surgeon, Dr. Esformes, in
      support of his causation argument that the repetitive nature of
      [appellant’s] work had caused back and knee problems, including
      specifically the heavy lifting and extended periods of kneeling on
      hard and uneven surfaces which his job required.

Id. at 1197. At the close of the appellant’s case, the trial court granted the

defendant’s motion for compulsory non-suit and dismissed the case. Id.

      The Labes Court recognized that claimants under FELA have a relaxed

standard of causation.    Id. at 1198 (citing Rogers, 352 U.S. at 506-07

(“Under this statute the test of a jury case is simply whether the proofs justify

with reason the conclusion that employer negligence played any part, even

the slightest, in producing the injury or death for which damages are sought.

It does not matter that, from the evidence, the jury may also … attribute the

result to other causes, including the employee’s contributory negligence.”)).

We explained that Pennsylvania Courts have

      consistently adhered to the Rogers standard, stating that in only
      the most frivolous cases may the courts deny a FELA
      plaintiff his or her qualified right to a jury trial. Ciarolla v.
      Union Railroad Co., … 338 A.2d 669, 671 (Pa. Super. 1975).
      “[FELA] is to be liberally construed on behalf of injured workers,

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     with the result that often recovery will be proper under [FELA]
     when it would not be under the common law of negligence.”
     Ignacic v. Penn Cent. Transp. Co., … 436 A.2d 192, 194 (Pa.
     Super. 1981) (citations omitted).

Labes, 863 A.2d at 1198 (emphasis added).

     The Court concluded:

     The trial court found “plaintiff merely showed it was possible that
     his injuries may have resulted from the defendant’s negligence.”
     Trial Court Opinion at 9 [(emphasis added)]. Under FELA,
     however, such a showing is sufficient. Indeed, a non-suit
     under FELA is justified only in those cases where there is a zero
     probability either of employer negligence or that any such
     negligence contributed to an employee’s injury. See Pehowic [v.
     Erie Lackawanna R. Co.], 430 F.2d [697, 699-700 (3rd Cir.
     1970) (stating “a trial court is justified in withdrawing [FELA]
     issues from the jury’s consideration only in those extremely rare
     instances where there is a zero probability either of employer
     negligence or that any such negligence contributed to the injury
     of an employee.”)).]

Labes, 863 A.2d at 1200 (emphasis added). We held “the determination of

negligence, if any, was for the jury” and reversed. Id.

     Although Labes involved the entry of non-suit, the reasoning is

applicable here. We further observe:

     Judges, both trial and appellate, have no special competence to
     resolve the complex and refractory causal issues raised by the
     attempt to link low-level exposure to toxic chemicals with human
     disease. On questions such as these, which stand at the frontier
     of current medical and epidemiological inquiry, if experts are
     willing to testify that such a link exists, it is for the jury to
     decide whether to credit such testimony.

Trach v. Fellin, 817 A.2d 1102, 1117 (Pa. Super. 2003) (en banc) (emphasis

added; citation omitted).

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       Finally, we agree with Appellant that if the trial court had “questions

regarding Dr. Levin’s methodology, the proper procedure would have been to

hold a Frye [h]earing,” Appellant’s Brief at 25, which Conrail had raised as an

alternative to summary judgment. See Buttaccio, supra (regarding Frye

hearings).

       For these reasons, we are compelled to reverse the entry of summary

judgment,6 and remand for further proceedings, which may include a Frye

hearing, consistent with this memorandum. In light of our disposition, we do

not address Appellant’s second issue.

       Order reversed. Case remanded for further proceedings. Jurisdiction

relinquished.

Judgment Entered.

Joseph D. Seletyn, Esq.
Prothonotary

Date: 3/23/2023

____________________________________________

6 To the extent Conrail argues Appellant’s action was barred by the statute of
limitations, this matter must be decided by the jury.              Because “the
determination concerning [a] plaintiff’s awareness of [his or her] injury and
its cause is fact intensive,” it is “ordinarily a question for a jury to decide”
when a plaintiff’s action accrued, for purposes of the statute of limitations and
accompanying “discovery rule.” Wilson v. El-Daief, 964 A.2d 354, 362 (Pa.
2009).

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