Court Opinion

ID: 9634870
Source: CourtListenerOpinion
Date Created: 2023-08-22 13:26:58.896195+00
Date Added: 2024-06-11T18:09:12.284646
License: Public Domain

JOHNSON, Judge,
dissenting:
I am obliged to dissent. The majority fails to apply the appropriate standard of review. As a result, the majority concludes the grant of a new trial to be error. This holding *457by the majority does not recognize the grant of a new trial as a discretionary decision by the trial court.
Our scope of review requires the appellant must be able to show: the trial court palpably and clearly abused its discretion, or committed an error of law which controlled the outcome of the case and is cited by the trial court as the sole reason for granting a new trial, before an appellate court will reverse, Westinghouse Elevator Company v. Herron, 514 Pa. 252, 523 A.2d 723 (1987). It is presumed that the trial court is justified in granting a new trial even when the reason given is insufficient, unless it is stated to be the only reason. Mohr v. Plotkin, 186 Pa.Super. 615, 142 A.2d 414, (1958). Ackerman v. Delcomico, 336 Pa.Super. 569, 486 A.2d 410 (1984). Our inquiry, then, should focus on whether the trial court’s decision finds any support in the record. Westinghouse, supra. If such support can be found, the trial court must be affirmed, for in that event, the trial court has not abused its discretion. Id.
I do not regard the trial court’s statement of reasons as a single reason for the grant of a new trial in view of the trial court’s statement that:
The plaintiffs contend that these facts also raised issues as to a violation of the Medical Practice Act of 1974, supra and as a corollary the independent negligence of the hospital as to supervision. A thorough examination of the record has convinced the Court that the plaintiffs should have had the benefit of having these two additional issues presented to the jury for determination. The jury should have been requested to determine whether there was a violation of the statute and if so was such negligence a substantial contributing cause of the husband plaintiff’s harm either on the basis of any violation of the statute by the intern and/or the hospital as to the supervision requirement, (citation omitted).
Opinion, 2/3/86 at 2.
Therefore our review should be limited to whether a clear and palpable abuse of discretion has occurred. Westinghouse, supra, 514 Pa. at 260, 523 A.2d at 727.
*458The primary duty of a trial judge in charging a jury is to clarify the issues so that the jury comprehends the questions which they are to decide. The instructions must give the jury a reasonable guide for the determination of the alleged negligence required. The jury cannot determine whether a party is guilty of negligence without knowing the degree of care required of that person or entity. Wood v. Smith, 343 Pa.Super. 547, 495 A.2d 601 (1985). See, also, Crotty v. Reading Industries, 237 Pa.Super. 1, 345 A.2d 259 (1975).
In this case, the trial court, in the grant of a new trial, held that the jury should have determined whether there was a violation of the Medical Practice Act of 1974 and if negligence under the act was a substantial contributing cause of the harm to the plaintiff based upon the independent negligence as to supervision by Presbyterian Hospital, or the violation of the statute by the intern, Dr. Wilson. The ultimate question is whether the trial court has acted within the limits of its judicial discretion, when the record adequately supports the trial court’s grant of a new trial. Thompson v. City of Philadelphia, 507 Pa. 592, 493 A.2d 669 (1985). I find the grant of a new trial to be supported by the record.
The Pennsylvania Legislature enacted the Medical Practice Act of 1974, P.L. 551, No. 190, 63 P.S. § 421.10 et seq., in order to license physicians and thereby protect the public from unlicensed and unqualified practitioners of medicine. The Legislative Journal-House, H.B. 760, 2795-2798, (December 4, 1973). Yet, Presbyterian University Hospital argues that no violation of the Act’s purpose occurred when Intern David Wilson examined Mr. Solomon, diagnosed his severe jaw pain as periodontal disease, and released him from the Emergency Room — all with no supervision. Mr. Solomon suffered a heart attacked two days later.
Intern Wilson did have a license, but it was a temporary license for a graduate medical trainee (N.T., Vol. II, 6/7/85 at 210). Under the Medical Practice Act of 1974, a temporary trainee license:
*459... shall be recognized only as conferring upon the licensee the right to participate1 in approved graduate medical training within the complex of the hospital to which he is assigned.
63 P.S. § 421.4. (emphasis added). The Act further limits the practice of medicine by interns by requiring hospitals to supervise said interns. The Act defines an intern as:
A physician who is receiving supervised2 graduate medical training at an approved hospital or its legal affiliate.
63 P.S. § 421.2(6) (emphasis added).
By limiting the type of license accorded an intern and by requiring hospitals to supervise interns, the Medical Practice Act of 1974 controls an intern’s practice of medicine. Because interns are not fully licensed physicians, they may not, under the act, present or hold themselves out as such and treat patients as though they have unlimited licenses.
It shall be unlawful for any person in the Commonwealth to engage in the practice of medicine and surgery, or pretend to a knowledge of any branch or branches of medicine and surgery, or to hold himself or herself forth as a practitioner in medicine and surgery, or to assume the title of doctor of medicine and surgery or doctor of any specific disease, ... unless he or she has first fulfilled the requirements of this Act and has received a certificate of licensure or permission from the board, ...
63 P.S. § 421.3. The Act required Intern Wilson to be supervised in order to practice medicine, 63 P.S. § 421.2(6); 49 Pa.Code § 17.15(c). Nonetheless, Intern Wilson treated Mr. Solomon without consulting a fully licensed physician or without having a fully licensed physician present during treatment. (N.T., Yol. II, 6/7/85 at 235-255). In fact, other than the triage nurse, Intern Wilson was the only *460person to examine Mr. Solomon. (N.T., Vol. II, 6/7/85 at 235-255, N.T., Yol. Ill, 6/7/85 at 295-297.). Intern Wilson’s supervisor, the Emergency Room resident on duty, was apparently asleep in another room during Mr. Solomon’s examination. (N.T., Vol. II, 6/7/85 at 295-297).
Therefore, a jury might find that: When Intern Wilson acted alone, he presented himself as a fully licensed physician, a clear violation of the Medical Practice Act of 1974, 63 P.S. § 421.3. The jury might also find that Intern Wilson also violated the Act because he treated Mr. Solomon without supervision. 63 P.S. § 421.2(6). 63 P.S. § 421.3. Furthermore, a jury might find that Intern Wilson violated the Pennsylvania Code which states that temporary licenses do not authorize independent practice; they only permit supervised practice.3
This supervised4 training experience shall not be converted into an independent staff service by or for any licensed graduate medical trainee.
49 Pa.Code § 17.15(c) (Effective July 21, 1979 through February 16, 1985) (emphasis added).
Both the Pennsylvania Code, 49 Pa.Code § 17.15(c), and the Medical Practice Act of 1974, 63 P.S. § 421.2(6), require hospitals to supervise interns. Neither the Act nor the Code, however, define supervision. Whenever the legislature leaves language undefined, "... effect must be given to the plain meaning of the words used.” Rodenbaugh v. Traction Co., 190 Pa. 358, 42 A. 953 (1899), cited with approval in Commonwealth v. Cohen, 142 Pa.Super. 199, 15 A.2d 730 (1940). Certainly, supervision can never plainly mean no supervision at all.5 The record indicates that: *461Intern Wilson examined Mr. Solomon (N.T., Vol. II, 6/7/85 at 235-255); he never consulted the Emergency Room resident (N.T., Vol. II, 6/7/85 at 295-297). He acted with no one other than the triage nurse knowing that he was treating a patient. No one checked Intern Wilson’s records to see who he treated and whether the treatment was proper in view of the patient’s symptoms. A jury might therefore conclude that had a qualified and fully licensed physician reviewed Intern Wilson’s treatment of Mr. Solomon, he or she could have discovered the deficient diagnosis and recalled Mr. Solomon for proper treatment.
Furthermore, a jury might determine that Presbyterian University Hospital violated the Medical Practice Act of 1974, 63 P.S. § 421.2(6) and the Pennsylvania Code, 49 Pa.Code § 17.15(c) when it failed to supervise Intern Wilson. That result would follow if supervision means that the hospital, through its fully licensed physicians, monitors interns’ activities and either sees that a fully licensed physician is physically present and guiding the intern, or at the very least, that fully licensed physicians review the records of patients treated by interns within a reasonable period of time.
Presbyterian University Hospital argues that the Medical Practice Act of 1974 and the Pennsylvania Code could not require such direct supervision of interns because such a requirement would severely tax hospital resources. A jury might find this argument to be persuasive.
On the other hand, a jury might reason that the Pennsylvania Legislature enacted the Medical Practice Act of 1974 to protect patients and reach a contrary result. The Act specifically protects patients from unqualified practitioners of medicine. 63 P.S. § 421.3. Interns have temporary licenses because they are not qualified to be fully licensed physicians. 63 P.S. § 421.2(4). Interns are not fully qualified practitioners of medicine and the Act protects patients from unsupervised care. 63 P.S. § 421 et seq.
In the case at bar, the jury should have been given an opportunity to decide whether Presbyterian University Hos*462pital adequately supervised Intern Wilson. The jury also should have been instructed that the plain meaning of supervision within the Medical Practice Act of 1974 and Pennsylvania Code requires the direct physical presence of a fully licensed physician who oversees all intern activities or at least reviews the treatment prescribed. The jury also should have been instructed that if it found that Intern Wilson was unsupervised, Presbyterian University Hospital and Dr. Wilson violated the Medical Practice Act of 1974. The jury should also have been instructed that violations of requirements imposed by law have been held to be negligence per se. Miller v. Hurst, 302 Pa.Super. 235, 448 A.2d 614 (1982).
I also reject the statement by the majority that the hospital was unfairly surprised when the plaintiffs attempted to premise the hospital’s independent liability on the negligent supervision of Intern Wilson. Paragraph 19 of the complaint alleges inter alia; in pertinent part:
19. Plaintiffs treatment and care by Defendant(s) Presbyterian University Hospital____was negligent and not in accordance with proper medical skill and care, both generally and in the following particulars:
In failing to exercise a degree in care and treatment required by medical professionals under the circumstances.
The appropriate duty of care a hospital owes to a person seeking emergency room treatment is set forth under § 323 Restatement of Torts 2d:
§ 323. Negligent Performance of Undertaking to Render Services
One who undertakes, gratuitously or for consideration, to render services to another which he should recognize as necessary for the protection of the other’s person or things, is subject to liability to the other for physical harm resulting from his failure to exercise reasonable care to perform his undertaking, if
*463(a) his failure to exercise such care increases the risk of such harm, or
(b) the harm is suffered because of the other’s reliance upon the undertaking.
Hamil v. Bashline, 481 Pa. 256, 392 A.2d 1280 (1978), Riddle Memorial Hospital v. Dohan, 504 Pa.Super. 571, 475 A.2d 1314 (1984). We have determined that:
[T]he changing role of the hospital in society creates a likelihood that patients will look to the institution rather than the individual physician for care.
The conception that the hospital does not undertake to treat the patient, does not undertake to act through its doctors and nurses, but undertakes instead simply to procure them to act upon their own responsibility, no longer reflects the fact. Present-day hospitals, as their manner of operation plainly demonstrates, do far more than furnish facilities for treatment. They regularly employ on a salary basis a large staff of physicians, nurses and interns, as well as administrative and manual workers, and they charge patients for medical care and treatment, collecting for such services, if necessary, by legal action.
Capan v. Divine Providence Hospital, 287 Pa.Super. 364, 367, 430 A.2d 647, 649 (1980).
By denying Mr. Solomon’s proposed point for charge, the trial judge took away from the jury the issue of negligent supervision and the independent liability of the hospital. This action, as the trial court has determined, was improper because the jury could reasonably conclude that the factors relevant to negligent supervision and negligence per se were present.
As Justice Hutchinson concurring in Thompson, supra, noted: “When the trial court takes the extraordinary step of granting a new trial, appellate courts in general and Superior Court in particular should defer to the trial court’s discretion.” 507 Pa. at 597, 493 A.2d at 674.
Accordingly, I would affirm the trial court.

. Websters Third International Dictionary defines participate as: 2. a. to take part in something (as an enterprise or activity) usually with others; b. to have part or share in something. At 1646.

. Websters Third International Dictionary defines supervise as: To coordinate, direct, and inspect continuously and at first hand the accomplishment of: oversee with the powers of direction of one’s own or another’s intentions. At. 2296.

. We note that Administrative Regulations have the effect of law and are binding if in accord with legislative intent. Federal Insurance Co. v. Commonwealth of PA Insurance Department, 509 Pa. 1, 500 A.2d 796 (1985).

. Websters Third International Dictionary defines supervision as 1:. The act, process or occupation of supervising: direction, inspection and criteria evaluation: oversight. At 2296.

. The Medical Practice Act of 1974 was replaced by the Medical Practice Act of 1985, 63 P.S. § 422 et seq., effective January 1, 1986. The Medical Practice Act of 1985 is silent with regard to supervision.