Court Opinion

ID: 9774601
Source: CourtListenerOpinion
Date Created: 2023-08-29 18:26:11.25585+00
Date Added: 2024-06-11T07:32:11.299116
License: Public Domain

Justice SAYLOR,
dissenting.
Previously, I joined Mr. Justice Eakin’s dissenting opinion opposing the overruling of Flanagan v. Labe, 547 Pa. 254, 690 A.2d 183 (1997). See Freed v. Geisinger Med. Ctr., 601 Pa. 233, 254-56, 971 A.2d 1202, 1214-15 (2009) (Eakin, J., dissenting). Upon reargument, I maintain the views ably expressed in that dissent, and I join Justice Eakin’s dissenting opinion on reargument as well. Furthermore, I have material differences with the majority’s perspective concerning the advisability of sua sponte revisiting precedent, both in general and, more particularly, as applied in the present case.
I. The Grant of Reargument
Preliminarily, I agree with the majority’s observation that the interests of all parties are best served by reargument, thus permitting the litigants to be heard on the questions the majority has made dispositive, including the advisability of overruling precedent sua sponte. See Majority Opinion at 227, 5 A.3d at 214. I would go further, however, to say that *240this approach also best advances the broader interests of justice; mitigates potential due process concerns; and better conforms to the adversarial system of judicial review.
II. The Sua Sponte Overruling of Flanagan
Initially, the majority characterizes the occasions upon which this Court has revisited precedent on its own initiative as “numerous.” Majority Opinion at 227-30, 5 A.3d at 214-15. In fact, particularly in comparison with the regularity with which this Court recites, enforces — and, indeed, stresses— ordinary principles of issue preservation and presentation,1 such independent reordering of rules of decision is rare, and for good reasons. The need to grant reargument in the present case to permit Petitioners actually to be heard on a legal basis invoked on the majority’s own initiative to justify overturning a favorable judgment — despite never having been raised by Petitioners’ opponent — illustrates the difficulties occasioned by this irregular practice.
In addition to their infrequency, sua sponte adjustments to rules of decision tend to occur in cases where the Court has had difficulty, over time, in administering particular, fundamental rules governing judicial review. Indeed, four of the five Pennsylvania opinions referenced by the majority arise out of, or directly concern, capital litigation.2 The death cases *241comprise a unique area of the law, where this Court bears the responsibility to conduct direct appellate review over all verdicts and final post-conviction orders, and in which the Court has had great difficulty in maintaining a consensus covering core matters of review.3
Regarding the approach of the United States Supreme Court, as referenced by the majority, that Court has expressed reservations similar to those set forth here. See, e.g., Colorado Republican Fed. Campaign Comm. v. Fed. Election Comm’n, 518 U.S. 604, 626, 116 S.Ct. 2309, 2321, 135 L.Ed.2d 795 (1996) (explaining that “the ‘principles that animate our policy of stare decisis caution against overruling a longstanding precedent on a theory not argued by the parties’ ” (quoting United States v. Int’l Bus. Machs. Corp., 517 U.S. 843, 855, 856, 116 S.Ct. 1793, 1800, 1801, 135 L.Ed.2d 124 (1996))). As in Pennsylvania, the decisions in which the High Court has taken the extraordinary step of reordering rules of decision on its own motion tend to be ones of widespread application that have generated ongoing controversy. Indeed, the majority’s categorization of its Freed decision with such watershed decisions of civil and criminal procedure as Erie Railroad Company v. Tompkins, 304 U.S. 64, 58 S.Ct. 817, 82 L.Ed. 1188 *242(1938) (holding that state substantive rules of decision apply in federal diversity cases), and Mapp v. Ohio, 367 U.S. 643, 81 S.Ct. 1684, 6 L.Ed.2d 1081 (1961) (extending the application of the federal exclusionary rule to the States), seems particularly inapt. See Majority Opinion at 229-31, 5 A.3d at 215-16.
I do agree there are situations in which appellate courts legitimately may raise and decide matters of their own accord. My point is that, particularly where the Court is not merely applying a settled rule of decision to sustain a valid order or judgment,4 the practice is peculiarly one that calls for the exercise of prudence and restraint, since it tests the limits of the adversarial process grounding the judicial system. Accord Adam A. Minali and Michael R. Smith, Playing God: A Critical Look at Sua Sponte Decisions by Appellate Courts, 69 Tenn. L.Rev. 245, 272-86 (2002) (discussing the impact of sua sponte decision-making upon the adversarial system). With respect, it is my considered position that the sua sponte overruling of Flanagan did not reflect such deliberativeness.
First, consistent with Justice Eakin’s views, I do not regard the straightforward principle announced in Flanagan — that *243nurse testimony as to medical diagnoses is constrained according to the legislatively-established limits of the nursing profession-as implicating the exception to stare decisis pertaining to decisions which are plainly erroneous. See Freed, 601 Pa. at 255, 971 A.2d at 1215 (Eakin, J., dissenting). Furthermore, I agree with Petitioners that Flanagan simply did not engender the sort of pervasive difficulties present in such cases. See Joint Supplemental Brief of Appellants on Reargument at 10.5 Rather, the Freed majority identified only a single area of reasonable dispute concerning the breadth of Flanagan— whether the decision impacted on expert testimony concerning causation — which it readily corrected in Freed. See Freed, 601 Pa. at 242-44, 971 A.2d at 1207-08.6 It is also worth noting that even such decisions as Erie and Mapp have generated strong and enduring responses raising legitimacy concerns in light of their sua sponte undertakings.7
*244In addition to the inherent sensibility in reconciling expert qualifications with express statutory limits on professional competency, Flanagan was consistent with a significant trend, on the parts of courts and legislatures in many jurisdictions, of raising the standards governing expert witness testimony in medical malpractice actions.8 Indeed, as all Justices participating in Freed recognized, in the Medical Care Availability and Reduction of Error (MCARE) Act,9 the Pennsylvania General Assembly has specifically implemented a scheme which not only is consistent with Flanagan but expands upon it. See Freed, 601 Pa. at 256, 971 A.2d at 1215 (Eakin, J., dissenting) (referring to 40 P.S. § 1303.512).10 This Court has *245previously refused to overrule common law decisions to accomplish “a closed-ended departure from current practice,” where the Legislature has codified the pre-existing common law. See Pioneer Commercial Funding Corp. v. Am. Fin. Mortgage Corp., 579 Pa. 275, 292-93, 855 A.2d 818, 829-30 (2004). I continue to question the wisdom of undertaking such a closed-ended departure in any event, let alone outside the normal parameters of judicial review.11
Finally, to the extent the Freed majority raised a concern with a conflict between rules specific to medical malpractice actions and the broader class of tort cases, see Freed, 601 Pa. at 244-47, 971 A.2d at 1208-10, such concern seems unfounded, in that the salutary purposes of the special rules are very clear. See infra § III (discussing the implementation of special rules in the medical malpractice arena to address social policy issues). Indeed, this Court itself has implemented an extensive set of rules unique to professional liability claims encompassing medical malpractice. See Pa.R.Civ.P. Nos. 1042.1-1042.72.
III. Subtexts of Freed
I also believe there are two strong subtexts of Freed (which ostensibly concerned statutory construction) bearing mention.12 The first is who — as between the Legislature and this Court — may regulate the admission of expert evidence in the *246courtroom. This question is implicated, in particular, since the majority has repeatedly couched the relevant evidentiary principles as “procedural” in nature, see Majority Opinion at 233, 5 A.3d at 217; Freed, 601 Pa. at 250-51, 253, 971 A.2d at 1212, 1214, and this Court has maintained that Article V, Section 10(c) of the Pennsylvania Constitution reposits exclusive control of procedural matters in this Court. See, e.g., Commonwealth v. McMullen, 599 Pa. 435, 444, 961 A.2d 842, 847 (2008).
The second subtext is that Freed was issued in the wake of what has been termed a medical malpractice crisis. The disconcerting circumstances include: prohibitive malpractice insurance costs; hospital and practice closings; physician departures from the Commonwealth (albeit with the numbers and causes being in dispute); the phenomenon of some physicians altering their practices to avoid complex, high-risk interventions; and multiple remedial attempts by the Legislature to advance stabilization, including the creation and maintenance of government-run administrative schemes of supplemental insurance and regulation. See, e.g., 40 P.S. §§ 1303.101-1303.1115. In my view, consistent with that of the General Assembly, the matter of medical malpractice reform presents a social policy issue with direct impact on citizen access to health services and quality of care matters. See generally 40 P.S. § 1303.502 (“Ensuring the future availability of and access to quality health care is a fundamental responsibility that the General Assembly must fulfill as a promise to our children, our parents and our grandparents.”).13
*247Nevertheless, after Freed, it would seem that there is a very strong case to be made that the 2002 MCARE Act’s requirements for the admission of expert testimony in medical malpractice cases violate Article 10(c) and should be suspended. Indeed — since this Court has promulgated an entire body of evidentiary rules via its procedural rulemaking powers, see Pa.R.E. 101(b) — under a strong approach to the exclusivity (and in light of Freed’s pronouncement), there would seem to be little doubt that MCARE requirements (as well as all other legislative inroads into evidentiary matters) are unconstitutional. Notably, such a strong approach appears to have prevailed in 1997, when this Court suspended numerous provisions of prior medical malpractice reform legislation as intruding on the Court’s exclusive powers under Section 10(c). See, e.g., 40 P.S. § 1301.813-A (Dilatory or frivolous motions, claims and defenses) (suspended).14
However, the Court’s efforts to define the limits of exclusivity of its procedural rulemaking powers solely in terms of the nebulous line between substance and procedure have yielded a number of facially implausible holdings. See, e.g., Laudenberger v. Port Auth. of Allegheny County, 496 Pa. 52, 66-67, 436 A.2d 147, 155 (1981) (treating the promulgation of a rule awarding monetary damages for delay in civil cases as procedural rulemaking); Commonwealth v. Morris, 565 Pa. 1, 30, 771 A.2d 721, 738 (2001) (holding that a stay of a capital prisoner’s execution is “substantive”).15 In the face of such decisions, one jurist has commented that “[t]he demarcation between laws bearing on substantive rights and those that are ‘purely procedural’ is notoriously vexing and has fostered *248disagreement amongst generations of jurists.” Wexler v. Hecht, 847 A.2d 95, 111 (Pa.Super.2004) (Johnson, J., dissenting). Moreover, this Court regularly abides various inroads by the Legislature into procedural matters, with the regular enforcement of procedural provisions of the Post Conviction Relief Act presenting a ready example. See, e.g., 42 Pa.C.S. § 9545. Thus, there would appear to be some indistinct line between procedural matters treated by the Court as being within its exclusive province and procedural matters as to which the Court will share the authority.
There are several difficulties with a broad and intransigent notion of exclusivity. First, many matters of procedure touch heavily on substance, so that the most effective way to achieve some sort of substantive impact is to adjust the procedure. This Court’s directed interventions in the professional liability arena — including venue restrictions, see Pa.R.Civ.P. No. 1006(a.l), and certificate-of-merit requirements, see Pa. R.Civ.P. No. 1042.3 — provide ready examples. Thus, under the strong approach, although the Court exclusively controls important means to effect substantive improvements, it lacks tools necessary to make fully informed and proactive social policy decisions. See Official Comm. of Unsecured Creditors of Allegheny Health Educ. and Research Found. v. PriceWaterhouseCoopers, LLP, 605 Pa. 269, 302, 989 A.2d 313, 333 (2010) (referencing the broader tools available to the legislative branch in making social policy judgments, such as policy hearings and comprehensive investigations).16
This state of affairs often places the Court in a reactive role when it comes to broader social policy matters impacted by judicial procedures. For example, the Court encountered significant pressure to adjust civil practice after it substantial*249ly invalidated the legislative medical malpractice reform efforts in 1997. See, e.g., House Resolution No. 385 (adopted Dec. 12, 2001) (captioned: “Urging the Supreme Court of Pennsylvania to reinstate certain provisions of Act 135 of 1996 amending the Health Care Services Malpractice Act to provide for medical malpractice tort reform.”). It should not be talking out of turn to relate that the thwarted legislative medical malpractice reform efforts, as well as the representative branch’s continued entreaties, were factors in the Court’s ultimate promulgation, in 2003, of a certificate of merit requirement, see Pa.R.Civ.P. No. 1042.3, parallel that which the Legislature had attempted to implement in 1996. See 40 P.S. § 1301.821-A (suspended). The medical malpractice venue restriction embodied in Rule of Civil Procedure 1006(a.l) followed an analogous path, albeit within a more compressed timeframe: a substantively identical provision was first enacted by the Legislature in 2002, which this Court incorporated into the civil procedural rules in 2003. See Pa.R.Civ.P. No. 1006, Explanatory Comment — Jan. 27, 2003.
As starkly demonstrated by these circumstances, there is a substantial lag factor, in procedural adjustments having social policy ramifications, consequent to the Court’s limited role and resources.17 In such circumstances, it is very difficult to discern how the Legislature can effectively address social policy issues if all remedial measures touching on court procedures are to be vetted through the Court, perhaps for the better part of a decade.
The medical malpractice arena is a unique area of litigation in which it is necessary to balance the interests of physicians *250and injured patients. On the one hand, physicians, by virtue of their occupation, are required to lay hands on patients, and medical decision-making may be complex and some procedures carry high risks. In their efforts to help others, physicians’ personal assets are potentially at risk. Some patients who face an inevitable decline in their health, or who suffer setbacks after making informed choices, may nevertheless look for a source of blame. The phenomena of frivolous lawsuits and professional witnesses increase the cost and potential exposure for physicians and insurers. See, e.g., Cooper v. Schoffstall, 588 Pa. 505, 522-25, 905 A.2d 482, 493-95 (2006). Although medical malpractice litigation may be steeped in science, physicians are exposed to a “more-likely-than-not” determination by five-sixth of twelve lay jurors who need not necessarily even agree on the ultimate question of liability. See Fritz v. Wright, 589 Pa. 219, 223, 907 A.2d 1083, 1085 (2006) (adopting the “any majority” rule governing jury verdicts).
On the other hand, injured patients also have substantial, constitutionally protected, interests. Medical negligence does occur, and where the requirements of tort law are met, injured patients are entitled to just compensation. See Pa. Const. art. I § 11 (embodying the right a remedy). Injured patients may face difficulties in obtaining expert witnesses, particularly in specialty areas, on account of a reluctance on the part of other practitioners to judge a peer negatively. In cases in which evidence of negligence is not readily available or where the amount of potential recovery is not substantial, injured patients may have difficulty obtaining representation and advancing a lawsuit. Litigation phenomena such as that of the professional witness work in both directions. See Cooper, 588 Pa. at 522-25, 905 A.2d at 493-95. More generally, plaintiffs face many of the same unavoidable uncertainties inherent in the justice system as do defendants.
In light of such important, conflicting interests, and the impact of malpractice litigation on access to and quality of medical care, it is very clear that the necessary regulation of *251the medical malpractice litigation arena requires difficult social policy judgments appropriate to the legislative branch.
In Laudenberger, this Court determined that it was authorized to adjust substantive matters via its rulemaking powers to further procedural ends. See Laudenberger, 496 Pa. at 66-67, 436 A.2d at 155. I continue to believe this principle should work in both directions. “[A]s I have previously expressed, both in gray areas between substance and procedure, and in matters that have not yet been occupied by this Court via its own procedural rules, I would allow some latitude to the Legislature to make rules touching on procedure, so long as such rules are reasonable and do not unduly impinge on this Court’s constitutionally prescribed powers and prerogatives.” McMullen, 599 Pa. at 458, 961 A.2d at 856 (Saylor, J., concurring and dissenting).18
With Article V, Section 10(c), the framers of the Pennsylvania Constitution gave the Court the authority to defend itself from unwarranted encroachments. I do not believe, however, that the framers intended to preclude the Court from intelligently distinguishing between such intrusions and legitimate efforts on the part of the Legislature to accomplish its own responsibilities in advancing beneficial social policy in the Commonwealth. Indeed, the Constitution specifically sets out the suspension requirement in much narrower terms than the rulemaking power. See Pa. Const. art. V, § 10(c) (“All laws shall be suspended to the extent they are inconsistent with rules prescribed under these provisions.” (emphasis added)). *252As demonstrated in numerous historical anecdotes, the Court has the ability to respect statutes where there are no contrary rules, or to promulgate rules consistent with the will of the policy-making branch.
Given its superior tools and resources, the Legislature may very well have a better view of the “broader picture” to which the majority lays claim. Majority Opinion at 229, 5 A.3d at 215. The alternative is for this Court to continue to assume a central role in substantive social policy reform efforts, carrying the unfortunate byproduct of direct involvement in inherently political processes and decisions.
IY. Conclusion
In summary, I do not believe Flanagan was wrongly decided. Even if it was, the reasoning and effect were not so poor as to implicate an exception to the necessary, stabilizing principle of stare decisis. This is so, particularly, since the General Assembly had the ability to clarify its intentions in the aftermath of Flanagan. Indeed, the majority’s approach is especially troubling, since the Legislature has demonstrated, in no uncertain terms, that these intentions are entirely consistent with Flanagan and contrary to Freed.
Furthermore, the majority’s sua sponte decision-making appears to me to implicate the broader issue of this Court’s power under Article V, Section 10(c). On that matter, I believe we should consider: the Legislature’s primacy in public policy matters; the limitations inherent in the adjudicatory process;19 and the character and appropriate application of this Court’s resources. See PriceWaterhouseCoopers, 605 Pa. at 301 n. 27, 989 A.2d at 333 n. 27. Where the Legislature attempts to address important matters of social policy, I *253believe a greater measure of comity and deference is in order than sometimes has been shown in the past.

. See, e.g., Steiner v. Markel, 600 Pa. 515, 522, 968 A.2d 1253, 1257 (2009) (admonishing the Superior Court not to consider waived matters sua sponte); Danville Area Sch. Dist. v. Danville Area Educ. Ass'n, 562 Pa. 238, 247, 754 A.2d 1255, 1259 (2000) (explaining that ‘‘[s]ua sponte consideration of issues disturbs the process of orderly judicial decision making”).

. The capital cases cited by the majority in the relevant passage are Commonwealth v. Collins, 585 Pa. 45, 888 A.2d 564 (2005), Commonwealth v. Freeman, 573 Pa. 532, 827 A.2d 385 (2003), and Commonwealth v. Albrecht, 554 Pa. 31, 720 A.2d 693 (1998). See Majority Opinion at 227-30, 5 A.3d at 214-15. Although Commonwealth v. Grant, 572 Pa. 48, 813 A.2d 726 (2002), was not a death case, it arose in the midst of difficulties encountered by the Court in its administration of capital appeals and has had a direct and substantial effect on the way death penalty litigation is administered in Pennsylvania.
Even in this unique line of criminal cases, the Court recently has couched matters of issue preservation and presentation as being of "paramount importance.” Commonwealth v. Mitchell, 588 Pa. 19, 72 *241n. 20, 902 A.2d 430, 462 n. 20 (2006); see also id. ("Certainly, before we could consider abandoning prior precedent and the rules of statutory construction expressed above, we should, at bottom, do so in a case where the issue is squarely raised, briefed and argued.”). Indeed, ironically, the bulk of the adjustments accomplished sua sponte in the capital arena have occurred in the wake of the Court’s decision to enforce principles of issue preservation and presentation more strictly. See, e.g., Albrecht, 554 Pa. at 44-45, 720 A.2d at 700.

. The other Pennsylvania decision referenced by the majority is Cimaszewski v. PBPP, 582 Pa. 27, 868 A.2d 416 (2005). There, while the prior precedent of Finnegan v. PBPP, 576 Pa. 59, 838 A.2d 684 (2003), was not discussed in the briefs (since the briefing in Cimaszewski predated Finnegan), the Appellant actually raised the core substantive argument (an ex post facto analysis) that was credited by the Cimaszewski majority. See Brief for Appellant, Cimaszewski v. PBPP, 2002 WL 34430156, at *15-23 (Oct. 1, 2002). Thus, the present circumstances are materially distinguishable, since Respondent did not challenge Flanagan’s holding that nurse testimony was inadmissible as to the issue of the medical standard of care pertaining to a physician. Indeed, Respondent expressly accepted the correctness of that holding.

. Under the right-for-any-reason doctrine, an order or judgment may be affirmed for any reason appearing as of record. See Pa. Dep't of Banking v. NCAS of Del., LLC, 596 Pa. 638, 948 A.2d 752, 761-62 (2008). See generally Thomas G. Saylor, Right for Any Reason: An Unsettled Doctrine at the Supreme Court Level and An Anecdotal Experience with Former Chief Justice Cappy, 47 Duq. L.Rev. 489, 490 n. 2 (2009) (collecting cases). Here, however, the overruling of Flanagan did not appear as of record — it was accomplished by the Freed majority post hoc.
Moreover, the initial judgment was in Petitioners' favor, raising questions as to the appropriate application of the right-for-any-reason principle in the first instance. See id. at 492-97. Indeed, where, as here, the appellee before this Court was the appellant in the intermediate appellate court, we have indicated that matters not raised and preserved in the intermediate appellate court are unavailable for appellate review. See, e.g., In re J.M., 556 Pa. 63, 83 n. 15, 726 A.2d 1041, 1051 n. 15 (1999); accord Commonwealth v. McMullen, 599 Pa. 435, 443 n. 2, 961 A.2d 842, 846 n. 2 (2008) (holding that a litigant did not waive a claim “because it was the appellee in [the intermediate appellate] court." (emphasis added)).
Although Respondent also suggests a futility rationale to excuse his failure to challenge Flanagan in the common pleas and intermediate appellate courts, his failure to challenge Flanagan before this Court displaces any need to address such theory.

. Petitioners note:
The Majority ... cites as its only examples [of difficulties] the Superior Court's decision in this case and Commonwealth v. Jennings, 958 A.2d 536 (Pa.Super.2008). In Jennings, the Superior Court relied on its own decision in Freed and, therefore, it is only the Superior Court’s decision in Freed that is at issue. It is bootstrapping to cite the very lower court decision on appeal to evidence inconsistent application of the Flanagan rule.

Id.

. Furthermore, the Superior Court's position that expert standard-of-care and causation testimony may be treated differently seemed at least colorable. See, e.g., Rodriguez v. Jackson, 118 Ariz. 13, 574 P.2d 481, 485 (1977) ("[A] distinction must be made between testimony as to cause and testimony relative to the standard of care required of the physician.”). Thus, this was simply a matter of first impression to be resolved by the Court, rather than a symptom of an intractable difficulty presented by some irreconcilable flaw in Flanagan.

. See, e.g., Erie, 304 U.S. at 87, 58 S.Ct. at 826 (Butler, J., dissenting) (“In view of grave consequences liable to result from erroneous exertion of its power ... the Court should move cautiously, seek assistance of counsel, act only after ample deliberation, [and] show that the question is before the Court[.]”). Mapp, 367 U.S. at 677, 81 S.Ct. at 1704 (Harlan, J., dissenting) (“I am bound to say that what has been done is not likely to promote respect either for the Court's adjudicatory process or for the stability of its decisions.”); cf. Kolstad v. Am. Dental Ass'n, 527 U.S. 526, 553, 119 S.Ct. 2118, 2133, 144 L.Ed.2d 494 (1999) (Stevens, J., concurring and dissenting) (“The absence of briefing or meaningful argument by the parties makes this Court’s gratuitous *244decision to volunteer an opinion on this nonissue particularly ill advised.”); State v. Zabawa, 279 Mont. 307, 928 P.2d 151, 158 (1996) (Nelson, J., concurring) (“While the temptation is often great to decide a case on the basis of the argument that 'should have been made,' but was not, in blind-siding an issue we run the very real risk of substituting advocacy for neutrality.”). See generally Barry A. Miller, Sua Sponte Appellate Rulings: When Courts Deprive Litigants of an Opportunity to be Heard, 39 San Diego L. Rev. 1253, 1260 (2002) ("The absence of a consistent principle leaves courts open to the accusation that ignoring the adversary process is a political action, where a court reaches out to legislate instead of following judicial norms.”).

. See, e.g., Stryczek v. Methodist Hosps., Inc., 694 N.E.2d 1186, 1189 (Ind.Ct.App.1998) (reflecting the common-law rule in Indiana that "[i]n an action for [medical] malpractice, whether the defendant used suitable professional skill must generally be proven by expert testimony, that is, other physicians, surgeons, or orthodontists, as the case may be”) (citation and quotation marks omitted); Morris v. Children’s Hosp. Med. Ctr., 73 Ohio App.3d 437, 597 N.E.2d 1110, 1115 (1991) (grounding the purposes of an evidentiary rule requiring liability experts in medical malpractice actions to be licensed to practice medicine in terms of discouraging the use of professional witnesses); Rodriguez, 574 P.2d at 485 (collecting decisions reflecting a similar approach); James Walker Smith, Hospital Liability § 11.02 (2009) (explaining that courts generally admit the testimony of nurse-experts "so long as they do not invade the province of expertise attributed to physicians and are limited to the expression of opinions of nursing care”); 1 McCormick On Evid. § 13 n. 17.2 (6th ed.2009) (collecting statutory provisions addressing special qualifications for expert testimony in medical malpractice cases).

. Act of March 20, 2002, P.L. 154, No. 13 (40 P.S. §§ 1303.101-1303.1115).

. Moreover, the relevant provisions of the MCARE Act specifically resolved the inconsistency arising from limiting the enhanced qualification requirements to nurses. See 40 P.S. § 1303.512(b) ("An expert *245testifying on a medical matter [must] [p]ossess an unrestricted physician’s license[.]”). Thus, the Legislature itself already had undertaken to cure an "incongruity” relied on by the Freed majority in retroactively overruling Flanagan. See Freed, 601 Pa. at 248, 971 A.2d at 1210.

. Parenthetically, to all appearances, the Court seems laboriously to be awaiting "the right case” in which to address the pervasive difficulties encountered in Pennsylvania state and federal courts in the aftermath of the unique interpretation of Section 402A of the Second Restatement of Torts adopted in Azzarello v. Black Brothers Company, Inc., 480 Pa. 547, 391 A.2d 1020 (1978). See generally Bugosh v. I.U. N. Am., Inc., 601 Pa. 277, 279, 971 A.2d 1228, 1229 (2009) (Saylor, J., dissenting, joined by Castille, C.J.). It is unclear why less patience was warranted in the present matter of far narrower applicability.

. While some of my thoughts along these lines may be of a sua sponte character, the appeal already has been untethered from the regular moorings, and, thus, I believe my further comments are warranted.

. The scale and cause of these problems has been the subject of debate. One commentator summarized such dialogue as follows:
Insurers and doctors blame “predatory” trial attorneys, "frivolous” lawsuits, and "out of control” juries for the spike in insurance premiums. In turn, consumer groups accuse insurance companies of "price gouging,” while plaintiffs' attorneys point to an exorbitant rate of medical errors and the need to deter malpractice and provide compensation to injured patients.
Mimi Marchev, Nat'l Acad, for State Health Policy, The Medical Malpractice Insurance Crisis: Opportunity for State Action 6 (July 2002), quoted in Christina O. Jackiw, The Current Medical Liability Insurance Crisis: An Overview of the Problem, Its Catalysts and Solutions, 13 Annals Health L. 505, 509 (2004).

. Parenthetically, Court’s action in 1997 was also undertaken sua sponte, and outside the context of any pending case, thus lending itself to controversy similar to that which attends Freed.

. See generally Commonwealth v. Morris, 573 Pa. 157, 187, 822 A.2d 684, 702 (2003) (Saylor, J., concurring) ("It would seem, at least to me, to be more rational to deem the maintenance of the status quo to be procedural and an affirmative award of relief substantive; indeed, given the Morris and Laudenberger holdings in these regards, it is quite difficult for me to predict how the substantive/procedural dichotomy will be applied to various decisions made by the legislative and judicial branches in future contexts as they may arise.” (citations omitted)).

. See generally Naylor v. Twp. of Hellam, 565 Pa. 397, 408, 773 A.2d 770, 777 (2001) (recognizing the General Assembly’s superior ability to examine social policy issues and determine legal standards so as to balance competing concerns); Program Admin. Servs., Inc. v. Dauphin County Gen. Auth., 593 Pa. 184, 192, 928 A.2d 1013, 1017-18 (2007) ("[I]t is the Legislature's chief function to set public policy and the courts' role to enforce that policy, subject to constitutional limitations.”).

. The Freed decision provides another compelling example. Across the country, the social issues impacted by medical malpractice litigation have caused legislatures and courts to consider enhanced qualification requirements for expert witnesses as one remedial measure. See generally Theodore R. LeBlang, The Medical Malpractice Crisis — Is There A Solution?, 27 J. Legal Med. 1, 1-2, 7, 10 (2006) ("Clearly, a debate has raged in state legislatures throughout the country and in the halls of Congress” and including "higher standards of qualification for expert witness” among the various reform proposals). Nevertheless, the Freed majority reached outside the parameters of ordinary judicial review to reinstate the liberal common-law rule with no comment on this broader context.

. Cf. Morris, 573 Pa. at 187, 822 A.2d at 702 (Saylor, J., concurring) (explaining that ”[w]here the Legislature has proceeded [at the boundary between legislative and judicial power], I have taken the position that a degree of comity is appropriate and deference due to such aspects of its design as may be deemed reasonable, although these may nonetheless have a procedural dynamic.”); Shaulis v. Pa. State Ethics Comm’n, 574 Pa. 680, 702-04, 833 A.2d 123, 136-37 (2003) (Saylor, J., dissenting) (expressing similar thoughts in the context of the Court’s power to regulate the practice of law); Gmerek v. State Ethics Comm’n, 569 Pa. 579, 595-604, 807 A.2d 812, 822-27 (2002) (Saylor, J., opinion supporting reversal) (same); Allen v. Mellinger, 567 Pa. 1, 14, 784 A.2d 762, 769 (2001) (Saylor, J., concurring, joined by Castille, J.) (advocating a reexamination of the means for determining the limits of the Court’s exclusive procedural rulemaking authority).

. See PriceWaterhouseCoopers, 605 Pa. at 301, 989 A.2d at 333 (explaining that, "[ujnlike the legislative process, the adjudicatory process is structured to cast a narrow focus on matters framed by litigants before the Court in a highly directed fashion.”).
While the Court can benefit from the advice of committees and public input in the rulemaking setting, notably, Freed’s “procedural” ruling retroactively enforcing the common-law standard for expert testimony in a medical malpractice action occurred in the narrower adjudicative setting.