Court Opinion

ID: 9840644
Source: CourtListenerOpinion
Date Created: 2023-09-19 17:09:03.892361+00
Date Added: 2024-06-11T10:38:51.551500
License: Public Domain

J-A20020-23

                               2023 PA Super 170

 BOBBI JO SINORACKI,                     :   IN THE SUPERIOR COURT OF
 INDIVIDUALLY, AS THE                    :        PENNSYLVANIA
 ADMINISTRATRIX OF THE ESTATE OF         :
 DAVID SINORACKI, DEC’D, AND AS          :
 PARENT AND NATURAL GUARDIAN             :
 OF D.S., A MINOR, MADISON               :
 SINORACKI, AND MEGAN SINORACKI          :
                                         :
                   Appellant             :   No. 1064 MDA 2022
                                         :
                                         :
              v.                         :
                                         :
                                         :
 THE CHILDREN’S SERVICE CENTER           :
 OF WYOMING VALLEY, KIDSPEACE,           :
 KIDSPEACE CHILDREN’S HOSPITAL,          :
 INC., KIDSPEACE CORPORATION,            :
 KIDSPEACE CORPORATION,                  :
 KIDSPEACE NATIONAL CENTERS OF           :
 PA, INC., KIDSPEACE NATIONAL            :
 CENTERS, INC., KIDSPEACE                :
 NATIONAL CENTERS, INC.,                 :
 KIDSPEACE SERVICES, INC.,               :
 KIDSPEACE PSYCHIATRIC HOSPITAL,         :
 MUHAMMAD A. KHAN, M.D.                  :
                                         :
              v.                         :
                                         :
                                         :
 DIANE HOCKENBERRY AND LEE               :
 HOCKENBERRY, INDIVIDUALLY AND           :
 AS PARENTS AND NATURAL                  :
 GUARDIANS OF Z.H., A MINOR

                Appeal from the Order Entered June 21, 2022
              In the Court of Common Pleas of Luzerne County
                  Civil Division at 2018-06389, 2018-10415

 BOBBI JO SINORACKI,                     :   IN THE SUPERIOR COURT OF
 INDIVIDUALLY, AS THE                    :        PENNSYLVANIA
 ADMINISTRATRIX OF THE EST. OF           :
 DAVID SINORACKI, DEC’D, AND AS          :
                                         :
J-A20020-23

  PARENT AND NATURAL GUARDIAN                    :
  OF D.S., A MINOR, M.S. AND M.S.                :
                                                 :
                       Appellant                 :   No. 1065 MDA 2022
                                                 :
                                                 :
                v.                               :
                                                 :
                                                 :
  DIANE AND LEE HOCKENBERRY,                     :
  INDIVIDUALLY AND AS PARENTS                    :
  AND NATURAL GUARDIANS OF Z.H.,                 :
  A MINOR

                  Appeal from the Order Entered June 21, 2022
                In the Court of Common Pleas of Luzerne County
                           Civil Division at 2018-06389

BEFORE:      PANELLA, P.J., MURRAY, J., and STEVENS, P.J.E.*

OPINION BY MURRAY, J.:                               FILED SEPTEMBER 19, 2023

       In these consolidated appeals, Bobbi Jo Sinoracki, individually and as

administratrix of the estate of David Sinoracki, and as parent/guardian of

D.S., Madison Sinoracki, and Megan Sinoracki (Appellant), appeals from the

orders respectively granting (1) the motion for judgment on the pleadings

filed by Children’s Service Center of Wyoming Valley (CSC or Center); and (2)

the motion for summary judgment filed by CSC employee Muhammad A.

Khan, M.D. (Dr. Khan).1 After careful consideration, we affirm.

       The trial court thoroughly detailed the underlying facts as follows:

____________________________________________

* Former Justice specially assigned to the Superior Court.

1 We collectively refer to Dr. Khan and CSC as Defendants.

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J-A20020-23

           At a young age, Z.H. was diagnosed with an inoperable
     arteriovenous malformation (“AVM”) in the left occipital region of
     his brain. An AVM is an abnormal tangle of arteries and veins that
     can develop in the brain and cause neuropsychological
     disturbances, including schizophrenic and erratic psychotic
     behavior. Since his diagnosis, Z.H.’s AVM increased in size,
     causing vision problems, increased headaches, and pain.

            The assistance of CSC was sought as Z.H.’s behavior
     became increasingly erratic and aggressive. CSC operates a
     pediatric mental and behavioral health practice and offers walk-
     in, telephonic, and mobile crisis intervention services. Throughout
     his treatment with CSC[, Z.H.’s] providers diagnosed him with
     attention deficit/hyperactivity disorder and oppositional-defiant
     disorder.

          On August 25, 2014, Z.H. had an initial evaluation with CSC
     by Paul Termini, M.D., who noted that Z.H. had increasing
     behavioral disturbances which included substance abuse, school
     suspensions, self-injurious behavior, and physical assaults. Dr.
     Termini further noted concerns of ongoing anger issues.

           On February 20, 2015, Z.H. underwent a second evaluation
     with CSC by Shiva Rezvan-Homami, PSA. Z.H.’s anger issues and
     substance abuse persisted. Concerns for the safety of [Z.H.’s]
     brother due to [Z.H.’s] aggressive behavior was noted.

           On May 13, 2015, … Dr. Khan[], with CSC, became aware
     of Z.H.’s substance abuse and noted that Z.H. had anger outbursts
     at home and was destructive and combative. Dr. Khan frequently
     saw Z.H. and managed his medications throughout his treatment
     with CSC. On July 9, 2015, Dr. Khan noted no change in Z.H.’s
     behavior after beginning to take the antipsychotic, Abilify. It was
     noted that Z.H. made no connection between information he was
     given and that he did not pay attention.

           On August 11, 2015, Z.H. presented to Geisinger [Medical
     Center,] where he admitted to drinking one half of a bottle of
     vodka by himself with the intention of harming himself and
     verbalized that he “didn’t want to live anymore.” Z.H. also
     explained that he had suicidal ideations when he drank. Further,
     Z.H. struck his head repeatedly[,] which could have resulted in
     severe injury or death due to his AVM. Consequently, Geisinger

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     noted suicidal ideations.

            On August 17, 2015, Z.H. had a third psychological
     evaluation with Dr. Rezvan-Homami, who noted continued
     behavioral disturbances, continued suicidal ideations, self-
     injurious conduct, increased and severe aggression, paranoia, and
     anger. Dr. Rezvan-Homami further noted that “it was a miracle
     that [Z.H.] has not been hospitalized, has not been sent to rehab,
     or arrested.”

            On August 22, 2016, Z.H. presented to CSC and was seen
     by Dr. Khan[,] who noted that Z.H. has been completely off his
     medication since January, 2016, was not going to school and was
     isolating himself, not eating, and very depressed, still abusing
     substances, and angry. Z.H. also showed signs of paranoia,
     thinking people were after him, and schizophrenia, by talking to
     himself. It was further noted that his insight and judgment were
     poor. Abilify was prescribed.

           On August 23, 2016, Z.H. threatened to kill his father.
     Z.H.’s parents called the police, who forcibly restrained Z.H. and
     brought him back to Geisinger for evaluation, bagged with a “spit
     hood” and handcuffed due to his aggressive behavior.            On
     presentation to the emergency department, security was called
     and Z.H. was placed in four-point restraints. While at Geisinger,
     Z.H.’s parents reported that he had been presenting with
     paranoia, mood swings, anger, and behavioral issues for three and
     a half days prior. They further reported delusions suffered by
     Z.H., some of which he had acted upon, such as him throwing up
     his medications because of a belief that his mother was poisoning
     him, paranoia about cars and trucks near his house in that he
     thought that someone was going to harm him, and a desire to kill
     his father because of a belief that his father was assaulting his
     mother. While at Geisinger, a CT scan was performed which
     showed that the AVM had steadily increased in size since 2008,
     but that there was no acute abnormality. … Additionally, in a
     discussion with Dr. Ichord, with the Children’s Hospital of
     Philadelphia, Todd J. Holmes, M.D., with Geisinger, was told that
     Z.H. should be treated like “any brain injured patient with
     neuropsychiatric manifestation.”

          Later the same day, Z.H. was transferred to KidsPeace for
     homicidal ideations and paranoia. While there, his psychiatrist
     was Mahmoud Elfatah, M.D. Z.H. reported that a [J]eep stopped

                                   -4-
J-A20020-23

     in front of his house and he threw rocks to attack it because he
     felt someone was after him. The psychiatric evaluation revealed
     that Z.H. had punched his brother and had anger problems, [and]
     had markedly impaired insight and judgment. Dr. Elfatah also
     noted that Z.H. was increasingly suspicious and paranoid and
     attributed it to Z.H.’s marijuana use. Z.H. was refusing to stay
     and aggressively pushed through several staff members and was
     slamming his body against the door.         Z.H. was continually
     aggressive towards the staff members and had even assaulted
     another patient by punching him without provocation. Z.H. was
     restrained at one point and was placed in a safe room. During his
     stay[,] Dr. Elfatah changed Z.H.’s medication from Abilify to
     Seroquel, another anti-psychotic medication. On August 25,
     2016, Dr. Elfatah and others discharged Z.H. to Family Based
     Services at CSC after determining that Z.H. no longer displayed
     homicidal ideation.

           On August 26, 2016, Z.H. was [riding in the front
     passenger’s seat of] his mother[’s vehicle when he] grabbed the
     steering wheel and drove into oncoming traffic[,] crashing the car
     because he believed someone was watching him. Z.H.’s parents
     immediately sought to have him readmitted to KidsPeace that
     same day. His mother further reported that he had run into traffic
     attempting to harm himself. Z.H. was readmitted for homicidal
     ideations, paranoia, and explosive behaviors. Z.H. was refusing
     medication, had increasing paranoia, made threats, and continued
     to express the belief that he was being poisoned by his mother
     and that others were watching him. Dr. Elfatah noted that Z.H.
     was “floridly psychotic,” that Z.H.’s AVM had neurocognitive
     effects, and that Z.H. had recently received a “grim report”
     regarding the prognosis of his medical condition and [the report]
     coincided with his increasingly reckless behavior. As a result of
     Dr. Elfatah’s evaluation[,] Z.H. was diagnosed with mood
     dysregulation disorder, cannabis-induced psychotic disorder, and
     cannabis use disorder. Z.H. was rated a low risk on the homicide
     risk assessment score.

           On August 29, 2016, while Z.H. was still at KidsPeace, Katie
     Lennon, Z.H.’s social worker, noted that Z.H. was struggling to
     adjust to the program and demonstrated noncompliance with
     following basic rules and expectations. He was determined to not
     be ready for family interaction. He was highly anxious, easily
     agitated, and disorganized in his thoughts. On September 1,
     2016, Z.H.’s parents visited him for a family session. He became

                                   -5-
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     angry and threw a chair against a wall and broke a toilet paper
     dispenser. Z.H. continued to display worsening behavior and
     limited signs of improvement for the duration of his fourteen-day
     admission. …

           In [Z.H.’s] discharge summary, completed by Andrew Clark,
     M.D., it was believed that the neuropsychiatric implications of
     Z.H.’s AVM and marijuana use were difficult to discern. His
     prognosis was fair and it was noted that his AVM was a significant
     stressor and that further drug use interacting with his AVM risked
     his psychiatric stability. Ms. Lennon, at one point during the
     discharge process, instructed Z.H.’s parents to follow an
     “emergency crisis plan” and to attempt to persuade Z.H. to “use
     coping skills to manage the situation and maintain safety,” such
     as taking a 5-minute break, reading, listening to music, … and
     remaining positive. Z.H. was ultimately discharged home.

            On September 8, 2016, the night of his discharge, Z.H.
     stayed awake all night and sat on his front porch due to paranoia
     that someone was going to hurt him or his family. On September
     9 and 10, 2016, Z.H.’s parents continuously called KidsPeace and
     CSC, advising them of Z.H.’s continued behavior. Ms. Lennon
     noted that she spoke with Z.H.’s mother and that Z.H. had again
     been aggressive towards [Z.H.’s] father and made threats towards
     him again. She further noted that Z.H. was awake until 6 AM
     sitting on the front porch with a pile of rocks “feeling like someone
     was going to come to the house and harm them.” He was also
     noted to be difficult to deescalate and was refusing to attend his
     therapy appointments. The recommendation was to proceed to
     the visits at CSC.

           Z.H.’s mother took him to CSC [on September 10, 2016,] to
     see Dr. Khan. Dr. Khan knew that Z.H. had been admitted twice
     to KidsPeace and of the [August 26, 2016,] car incident that took
     place between admissions …. Dr. Khan was also aware that Z.H.
     was smoking marijuana, acting “bizarrely,” had cognitive
     impairment as a result of his AVM, that he was admitted to
     KidsPeace a second time for increasing paranoia and aggression,
     that Z.H.’s medication had been recently switched from Abilify to
     Seroquel, and that he stayed awake all night with a pile of rocks
     ready to protect himself and his family.

           Following this visit, Z.H.’s parents continued to call
     KidsPeace and CSC, including CSC’s crisis intervention services.

                                     -6-
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     On September 10, 2016, a counselor with CSC spoke with Z.H.’s
     mother and provided several options on how to address her
     concerns. The counselor advised that she would come to the
     house to respond to the crisis the following day.

          At no time from discharge on September 8, 2016 to
     September 11, 2016 did CSC or KidsPeace, or their agents and/or
     employees consider or pursue involuntary commitment of Z.H.

            On September 11, 2016, Z.H.’s father saw his son leave the
     front porch and driveway moments before … Z.H. entered the
     Sinoracki family’s home and violently assaulted Bobbi Jo, Megan,
     and David [Sinoracki] with a kitchen steak knife. … Shortly
     thereafter, Z.H.’s father entered the Sinoracki family’s home and
     forcibly restrained [Z.H.] on a chair in the living room. The police
     responded to the scene and took Z.H. into custody. Ultimately,
     David Sinoracki succumbed to his injuries.

Trial Court Opinion, 11/4/22, at 1-7 (some capitalization modified).

     Appellant initiated this negligence action against Defendants (and other

parties not relevant to this appeal), by writ of summons filed September 7,

2018. Appellant filed a complaint on December 18, 2018. CSC filed an answer

on January 21, 2019. On October 10, 2019, CSC filed a motion for judgment

on the pleadings. The trial court granted CSC’s motion on July 10, 2020. On

February 23, 2022, following discovery, Dr. Khan filed a motion for summary

judgment. The trial court granted Dr. Khan’s motion on April 20, 2022.

     On June 21, 2022, Appellant filed a “Praecipe to Mark Settled,

Discontinued, and Ended,” regarding Appellant’s claims against the remaining

                                    -7-
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Defendants.2 This timely appeal followed. Appellant and the trial court have

complied with Pa.R.A.P. 1925.

       Appellant presents two issues for review:

       1. Did the trial court err in dismissing [Appellant’s] negligence
          claims against Dr. Khan on the ground that he owed no duty
          applicable to this case under common law, where the record
          establishes that Dr. Khan undertook to provide medical
          professional services to [Z.H.] for the protection of others, both
          generally and as relates to [Appellant], and therefore Dr. Khan
          undertook a corresponding duty of care under Pennsylvania
          law?

       2. Did the trial court err in dismissing [Appellant’s] negligence
          claims against the Center on the ground that it owed no duty
          applicable to this case under common law, where the complaint
          alleges that the Center undertook to provide professional
          services to [Z.H.] for the protection of others, both generally
          and as relates to [Appellant], and therefore the Center
          undertook a corresponding duty of care under Pennsylvania
          law?

Appellant’s Brief at 4.

       Preliminarily, we note Appellant’s brief does not comply with Pa.R.A.P.

2119(a), which requires the argument section

       be divided into as many parts as there are questions to be argued;
       and shall have at the head of each part - in distinctive type … -
       the particular point treated therein, followed by such discussion
       and citation of authorities as are deemed pertinent.

Id.    Appellant’s argument headings do not correspond to the issues.

Nonetheless, we overlook the defect and address Appellant’s issues together.

____________________________________________

2 “A praecipe to discontinue constitutes a final judgment.”
                                                         Levitt v. Patrick,
976 A.2d 581, 587 (Pa. Super. 2009) (citation and brackets omitted).

                                           -8-
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      Appellant claims she established that Defendants owed the Sinoracki

family a duty of reasonable care, and thus the trial court erred in granting Dr.

Khan’s motion for summary judgment and CSC’s motion for judgment on the

pleadings. See Appellant’s Brief at 22-69.

      In reviewing the grant of summary judgment, we recognize:

      [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). “Only when the facts are so clear that reasonable minds could not

differ can a trial court properly enter summary judgment.” Straw v. Fair,

187 A.3d 966, 982 (Pa. Super. 2018) (citation omitted).

      As to judgment on the pleadings:

      Entry of judgment on the pleadings is permitted under
      Pennsylvania Rule of Civil Procedure 1034, which provides that
      “after the pleadings are closed, but within such time as not to
      unreasonably delay trial, any party may move for judgment on
      the pleadings.” Pa.R.C.P. 1034(a). A motion for judgment on the
      pleadings is similar to a demurrer. It may be entered when there
      are no disputed issues of fact and the moving party is entitled to
      judgment as a matter of law.

      Appellate review of an order granting a motion for judgment on
      the pleadings is plenary. The appellate court will apply the

                                      -9-
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      same standard employed by the trial court. A trial court must
      confine its consideration to the pleadings and relevant
      documents. The court must accept as true all well pleaded
      statements of fact, admissions, and any documents properly
      attached to the pleadings presented by the party against whom
      the motion is filed, considering only those facts which were
      specifically admitted.

      We will affirm the grant of such a motion only when the moving
      party’s right to succeed is certain and the case is so free from
      doubt that the trial would clearly be a fruitless exercise.

Kote v. Bank of N.Y. Mellon, 169 A.3d 1103, 1107 (Pa. Super. 2017)

(citation omitted).

      The crux of this appeal is whether Defendants owed a duty to the

Sinoracki family. This issue presents a question of law, for which our standard

of review is de novo and our scope of review is plenary.        Maas v. UPMC

Presbyterian Shadyside, 234 A.3d 427, 436 (Pa. 2020).

      Appellant argues:

      Under Pennsylvania law, when a physician voluntarily undertakes
      to act within the doctor-patient relationship for the protection of a
      non-patient third party, the physician assumes a corresponding
      duty of reasonable care to any third party who is within the
      orbit of harm.

Appellant’s Brief at 22 (emphasis added) (citing DiMarco v. Lynch Homes-

Chester County, Inc., 583 A.2d 422, 425 (Pa . 1990)).              According to

Appellant,

      Dr. Khan and the Center voluntarily undertook to act for the
      protection of [Z.H.] and others within his orbit of harm when
      treating [Z.H.] for his homicidal ideations and the Defendants
      thereby assumed a duty to act reasonably within the scope of that
      undertaking.

                                     - 10 -
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Appellant’s Reply Brief at 1-2; see also Appellant’s Brief at 54 (claiming

Defendants’ “undertaking with respect to [Z.H.] summoned a duty to act for

the protection of everyone within [Z.H.’s] orbit of harm – including the

Sinoracki family….”).

      Appellant further asserts there is a

      long-tenured principle of Pennsylvania law that the voluntary
      choice to undertake obligations within the context of medical
      treatment for another’s protection brings forward the duty of
      reasonable care applicable not just to a patient but to third parties
      as well.

Id. at 36. In support, Appellant relies primarily on DiMarco, supra, as well

as Matharu v. Muir, 86 A.3d 250 (Pa. Super. 2014) (en banc), and Troxel

v. A.I. Dupont Inst., 675 A.2d 314 (Pa. Super. 1996). See Appellant’s Brief

at 30-36, 54; Appellant’s Reply Brief at 12.

      Appellant recognizes that the “record evidence established [Z.H.] posed

an imminent threat of harm and homicide to people around him, but he had

not explicitly threatened the Sinoracki family….”      Appellant’s Brief at 45.

However, Appellant claims:

      The record establishes Dr. Khan actually knew or should
      have known that the possibility [Z.H.] would hurt others was
      not merely theoretical, and that [Z.H.] posed a
      demonstrated risk of harm to persons near him when
      experiencing paranoia-driven symptoms. Indeed, [Z.H.’s]
      violent and paranoid actions known to Dr. Khan obviously
      represented a danger not just to [Z.H.,] but to anyone in
      [Z.H.’s] immediate orbit wherever [Z.H.] happened to be.
      Those non-patients included [Z.H.’s] … neighbors as
      evidenced by [Z.H.’s] pattern of sitting outside his house
      with a pile of rocks nearby.

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Id. at 53-54.     Appellant asserts, “In these circumstances, the appropriate

course of action involved [Z.H.’s] hospitalization and other type of

management….”          Id. at 45; see also Appellant’s Reply Brief at 15

(“Defendants … breach[ed their] duty when they failed to hospitalize [Z.H.]

and pursue other treatment as his mental condition devolved.”).

       Defendants argue the trial court did not err because Appellant failed to

establish they owed a duty of care to the Sinoracki family.3       According to

Defendants, DiMarco, Matharu, and Troxel are distinguishable and

unavailing. CSC Brief at 17-22; Dr. Khan Brief at 13-17; Amicus Brief at 9-

14. Defendants claim Appellant’s proposed duty of care is not supported by

precedent, and its scope is not limited to reasonably foreseeable harm. CSC

Brief at 22-27; Dr. Khan Brief at 5 (stating Appellant “seek[s] the creation of

a new, never-before-imposed duty on mental health providers to protect third

parties from harm by their patients,” which “would stretch foreseeability

concepts beyond all limits….” (quotation marks omitted)); Amicus Brief at 15

(“[Appellant’s] proposed duty … has no limits, and would exist anytime a

patient under treatment for mental illness harms anyone.”).

       The Pennsylvania Supreme Court has stated that Emerich v.

Philadelphia Ctr. for Human Dev., 720 A.2d 1032 (Pa. 1998), is the

“seminal case setting forth a mental health professional’s duty to warn third

____________________________________________

3 The American Medical Association and the Pennsylvania Medical Society have

filed a brief advocating on behalf of Defendants (Amicus Brief).

                                          - 12 -
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parties.” Maas, 234 A.3d at 437. The Emerich Court “concluded the special

relationship between a patient and mental health professional may, in limited

circumstances, give rise to an affirmative duty to warn a third party of

potential harm caused by his patient.”         Id. at 437–38 (citation omitted).

Pertinently:

      The facts underlying Emerich were that, in the space of thirty
      minutes, a psychiatric patient (Joseph) told his therapist he was
      going to kill his former girlfriend, identified by Joseph and known
      to the therapist as Teresa Hausler. The therapist immediately
      advised Hausler to stay away from Joseph, without specifically
      telling her he planned to kill her. Hausler ignored the therapist’s
      warning to stay away and Joseph shot her to death. Ultimately,
      the Emerich Court determined the therapist had a duty to warn
      Hausler, satisfied the duty by telling her to stay away, and
      affirmed the dismissal of the case on summary judgment.
      Emerich, 720 A.2d at 1045. The Court summarized its holding
      as follows:

          [I]n Pennsylvania, based upon the special relationship
          between a mental health professional and his patient,
          when the patient has communicated to the professional
          a specific and immediate threat of serious bodily injury
          against a specifically identified or readily identifiable third
          party and when the professional, determines, or should
          determine under the standards of the mental health
          profession, that his patient presents a serious danger of
          violence to the third party, then the professional bears a
          duty to exercise reasonable care to protect by warning
          the third party against such danger.

      Id. at 1043.

             The Emerich Court began its legal analysis by observing the
      general common-law rule stating there is no duty to control the
      conduct of a third party to protect another from harm. Emerich,
      720 A.2d at 1036. Emerich recognized an exception to that rule:
      “where a defendant stands in some special relationship with either
      the person whose conduct needs to be controlled or in a
      relationship with the intended victim of the conduct, which gives

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     to the intended victim a right to protection.”         Id. (citing
     Restatement (Second) of Torts § 315 (1965)). Relying in part on
     Tarasoff [v. Regents of Univ. of California, 551 P.2d 334, 340
     (Cal. 1976)], the Emerich Court concluded the special
     relationship between a patient and mental health professional
     may, in limited circumstances, give rise to an affirmative duty to
     warn a third party of potential harm caused by his patient. Id. at
     1037.

            In Tarasoff, … the patient did not expressly identify his
     threatened victim by name, but from the context of the threat,
     the therapist could “readily identify” who she was. Emerich, 720
     A.2d at 1036. The Emerich Court explained Tarasoff recognized
     a duty to “protect” a readily identifiable third party from the
     violent acts of a patient, and that “a duty to warn is subsumed in
     this broader concept of a duty to protect.” Emerich, 720 A.2d at
     1037 n.5. “‘The discharge of this duty may require the therapist
     to take one or more of various steps, depending on the nature of
     the case. Thus, it may call for him to warn the intended victim or
     others likely to apprise the victim of the danger, to notify the
     police, or to take whatever other steps are reasonably necessary
     under the circumstances.’” Id., quoting Tarasoff, 551 P.2d at
     340. The Emerich Court addressed the issue of duty only “in the
     context of a duty to warn[,]” and left for another day whether
     “some broader duty to protect” should be recognized.           Id.
     Specifically regarding the duty to warn, the Emerich Court
     stated: “We find, in accord with Tarasoff, that a mental health
     professional who determines, or under the standards of the
     mental health profession, should have determined, that his
     patient presents a serious danger of violence to another, bears a
     duty to exercise reasonable care to protect by warning the
     intended victim against such danger.” Emerich, 720 A.2d at
     1040.

            Notably, the Emerich Court further held “the circumstances
     in which a duty to warn a third party arises are extremely limited.”
     Id. at 1040. Before the therapist’s duty is triggered, the patient
     must communicate a “specific and immediate threat” against “a
     specifically identified or readily identifiable victim.” Id.
     [(emphasis added).] … The Emerich Court noted, “as a practical
     matter, a mental health care professional would have great
     difficulty in warning the public at large of a threat against an
     unidentified person. Even if possible, warnings to the general
     public would produce a cacophony of warnings that by reason of

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      their sheer volume would add little to the effective protection of
      the public.” Id. at 1041 [(citation and quotations omitted).]

Maas, 234 A.3d at 437-38 (footnote omitted).

      In Maas, the Pennsylvania Supreme Court affirmed the denial of a

motion for summary judgment filed by mental health treatment providers.

The mental health patient in Maas had lived in a forty-unit apartment building

and repeatedly told his doctors and therapists he would kill an unnamed

“neighbor.” Id. at 429. The patient “ultimately carried out his threat, killing

an individual who lived in his building, a few doors away from his own

apartment.” Id. The victim’s mother initiated a wrongful death action against

the providers. Id. The providers sought summary judgment on the basis that

they had no duty to warn about the threats because the patient never

“expressly identified a specific victim.” Id. In affirming the denial of summary

judgment, the Supreme Court observed the providers’

      core contention … is that the “neighbors” against whom [the
      patient] articulated murderous threats were not an enumerated
      and readily identifiable group of [apartment] residents, but
      instead, consisted of a large, amorphous, unidentifiable group of
      the public at large.

Id. at 438-39. The Court explained:

      [T]he duty to warn applies not only when a specific threat is made
      against a single readily identifiable individual, but also when the
      potential targets are readily identifiable because they are
      members of a specific and identified group — in this case,
      “neighbors” residing in the patient’s apartment building. In these
      circumstances, the potential targets are not a large amorphous
      group of the public in general, but a smaller, finite, and relatively
      homogenous group united by a common circumstance.

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Id. at 439.

       Mindful of the above authority, we address the cases on which Appellant

relies. In DiMarco, our Supreme Court considered

       whether a physician owes a duty of care to a third party where
       the physician fails to properly advise a patient who has been
       exposed to a communicable disease, and the patient, relying upon
       the advice, spreads the disease to a third party.

DiMarco, 583 A.2d at 423. The medical professionals in DiMarco gave a

patient incorrect medical advice about whether she had Hepatitis B, a sexually

transmitted disease, and she subsequently transmitted the disease to plaintiff,

her paramour. Id. Applying the Restatement (Second) of Torts § 324A,4 the

____________________________________________

4 Section 324A provides:

     § 324A Liability to Third Person for Negligent Performance of
     Undertaking

     One who undertakes, gratuitously or for consideration, to render
     services to another which he should recognize as necessary for the
     protection of a third person or his things, is subject to liability to the
     third person for physical harm resulting from his failure to exercise
     reasonable care to protect his undertaking, if

        (a) his failure to exercise reasonable care increases the risk of
        such harm, or

        (b) he has undertaken to perform a duty owed by the other to
        the third person, or

        (c) the harm is suffered because of reliance of the other or the
        third person upon the undertaking.

RESTATEMENT (SECOND) OF TORTS, § 324A. This Court has stated: “To state a
cause of action under Section 324A …, a plaintiff must aver that the physician
(Footnote Continued Next Page)

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DiMarco Court noted that for the patient to state a claim, the medical

professionals must have undertaken “to render services to another which

[they] should recognize as necessary for the protection of a third person,” a

principle   the    Court    characterized      as   “essentially   a   requirement   of

foreseeability.” DiMarco, 583 A.2d at 424 (quoting Cantwell v. Allegheny

Cty., 483 A.2d 1350, 1353-54 (Pa. 1984)). The Court held:

       When a physician treats a patient who has been exposed to or
       who has contracted a … contagious disease, it is imperative that
       the physician give his or her patient the proper advice about
       preventing the spread of the disease. … The patient must be
       advised to take certain sanitary measures…. Such precautions are
       … taken to safeguard the health of others. Thus, the duty of a
       physician in such circumstances extends to those “within the
       foreseeable orbit of risk of harm.” Doyle v. South Pittsburgh
       Water Co., … 199 A.2d 875, 878 ([Pa.] 1964).

DiMarco, 583 A.2d at 424 (emphasis and paragraph break omitted).

       In Troxel, the plaintiff’s friend and the friend’s baby had a contagious

disease, cytomegalovirus (CMV). Troxel, 675 A.2d at 316. Plaintiff frequently

visited her friend and her friend’s baby during plaintiff’s pregnancy, unaware

of the CMV. Id. Plaintiff subsequently contracted CMV, and her baby died

from CMV-related complications shortly after his birth. Id. Plaintiff initiated

a wrongful death and survival action against her friend’s physicians

(defendants) for failing to advise the friend about the contagious nature of

____________________________________________

has undertaken to render services to another which he should recognize as
necessary for the protection of a third person.” Matharu, 86 A.3d at 259
(citation and quotation marks omitted).

                                          - 17 -
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CMV. Id.     This Court reversed the trial court’s order granting summary

judgment on the basis that defendants owed plaintiff no duty of care. See id.

at 321-23. Citing DiMarco, this Court held,

      where [a] physician undertakes the treatment of a patient with a
      communicable or contagious disease[, they have] … a duty to
      correctly inform the patient about the contagious nature of the
      disease in order to prevent its spread to those who are within the
      foreseeable orbit of risk of harm.

Id. at 322; see also id. at 323 (“The standard of care for a physician who is

treating a patient with a communicable disease is to inform the patient about

the nature of the disease and its treatment, to treat the patient, and to inform

the patient how to prevent the spread of the disease to others.”).

      Finally, in Matharu, an en banc panel of this Court held that the non-

patient plaintiff stated a negligence claim against physicians (defendants)

under Section 324A for failure to administer an injection to a patient/mother

(Mother) for the protection of Mother’s future, unborn children. Matharu, 86

A.3d at 260-61. We affirmed the trial court’s denial of defendants’ motion for

summary judgment, holding:

      Section 324A of the Second Restatement continues to require
      physicians to provide reasonable care in the patient’s treatment
      as is necessary for the protection of others, and establishes
      liability to certain third-parties when such reasonable care is
      lacking. As such, [plaintiffs’] claim that the failure to administer
      [the injection] during Mother’s pregnancy … in 1998 resulted in
      the death of [a subsequent child] in 2005 states a claim
      under Section 324A….

Matharu, 86 A.3d at 260 (citation omitted). We concluded:

                                     - 18 -
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      A physician-patient relationship existed between [defendants] and
      Mother, and the allegation that the failure to provide reasonable
      care within this relationship to protect certain readily
      identifiable third parties (including [Mother’s future children])
      adequately states a claim under Section 324A.

Id. (emphasis added).

      Consistent with the foregoing, we agree with Defendants’ assessment

of DiMarco, Troxel, and Matharu as distinguishable and unavailing. Rather,

we are persuaded by this Court’s decision in F.D.P. Ex Rel S.M.P. v. Ferrara,

804 A.2d 1221 (Pa. Super. 2002). In Ferrara, the plaintiffs were parents of

a child who had been sexually assaulted by a mentally ill neighbor (assailant).

Id. at 1224. Plaintiffs appealed the trial court’s dismissal of their negligence

claims against the non-profit corporations (defendants) that provided medical

treatment and housing to assailant. Id. at 1223-24. This Court affirmed the

trial court’s grant of defendants’ preliminary objections based on defendants

owing the plaintiffs no duty of care. Id. at 1228-29. We observed:

      [Plaintiffs] invite us to apply the rationale in a line of cases
      imposing liability on a physician for failing to properly advise a
      patient who has a communicable disease when the patient relied
      upon the improper advice and spread the disease to a third party.
      DiMarco v. Lynch Homes-Chester County, Inc., 525 Pa. 558,
      583 A.2d 422 (1990); Troxel v. A.I. Dupont Institute, 450 Pa.
      Super. 71, 675 A.2d 314 (Pa. Super. 1996).

            Those cases [] are specifically limited to their
      circumstances and impose liability due to the peculiar nature of
      communicable diseases, which involve a direct threat to public
      health. Under the reasoning employed in those cases, liability is
      premised upon the physician’s awareness that his advice
      concerning the communicable disease is directly relevant to its
      spread to third parties. Thus, the duty is imposed because “it is
      imperative that the physician give his or her patient the proper

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       advice about preventing the spread of the disease.” DiMarco,
       583 A.2d at 424. Moreover, those cases impose the duty pursuant
       to Restatement (Second) of Torts, § 324A, which relates to an
       actor who renders services under conditions where the actor
       should recognize that the services are necessary for the protection
       of a third person. Mental health services are provided for the
       protection of the patient. Furthermore, mental health patients do
       not have a disease that is communicable to the public nor do they
       present a peculiar threat to the public. The reasoning of those
       cases is not applicable herein.

Ferrara, 804 A.2d at 1229 (emphasis added).5

       We further emphasized:

       Pennsylvania courts are reluctant to subject a person to
       liability for the acts of a third party in the absence of
       compelling circumstances. Indeed, there are a number of
       cases significantly analogous to the present one where the courts
       have refused to impose such liability.

Id. at 1230 (emphasis added); see also id. at 1230-31 (discussing caselaw).

       Instantly, the trial court opined:

       Z.H. never verbally or otherwise identified a concrete group of
       people to which [the Sinoracki family] may have been a part of,
       as the target of his threats. … [] Z.H. made a verbal threat to kill
       his father, was consistently reported to be aggressive, had driven
       his mother’s car into traffic, and threw rocks at passing cars. …
       [I]f [Z.H.’s] threat were to be to any identifiable group including
       [the Sinoracki family,] it would be to the general public, including
       cars passing by. … [S]uch a group would not fall within the
       confines of a “readily identified third party,” and so [Appellant’s]
       claim relying on the application of a duty to warn must fail. …
       [T]here was nothing to suggest Z.H. was generally a threat to
       people beyond those in view and in his immediate environment.
       For example, concerning Z.H. sitting with rocks in front of his
       home, the record does not reflect that he was running after any
       vehicles or acting aggressively towards vehicles that did not pass
       by his home.        Without a record reflecting [any basis for
____________________________________________

5 Matharu is distinguishable for the reasons expressed in Ferrara.

                                          - 20 -
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      Defendants] to predict that Z.H. would go out of his way to assault
      the Sinoracki family[,] … the court cannot find that Z.H.’s threats
      were against [the Sinoracki family] as a “readily identifiable
      group.”

Trial Court Opinion, 11/4/22, at 18-19 (some capitalization modified).

      The trial court’s reasoning is supported by the record and law. See id.;

see also Maas, 234 A.3d at 439 (limiting tort liability to “readily identifiable”

“potential targets”). As Appellant failed to establish that Defendants owed the

Sinoracki family a duty of care, we conclude the trial court did not err in

granting Dr. Khan’s motion for summary judgment and CSC’s motion for

judgment on the pleadings. See Ferrara, supra; Emerich, 720 A.2d at 1036

(generally, there is no duty to control the conduct of a third party to protect

another from harm); Troxel, 675 A.2d at 321 (“without a finding of duty, the

issue of breach of duty cannot be submitted to the jury.”).

      Orders affirmed.

Judgment Entered.

Joseph D. Seletyn, Esq.
Prothonotary

Date: 09/19/2023

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