Court Opinion

ID: 9895850
Source: CourtListenerOpinion
Date Created: 2023-11-08 20:10:32.271384+00
Date Added: 2024-06-11T09:12:20.268333
License: Public Domain

J-A18034-23

                              2023 PA Super 230

 BRENDA HUTCHINSON AND            :           IN THE SUPERIOR COURT OF
 DOUGLAS HUTCHINSON               :                PENNSYLVANIA
                                  :
                 Appellants       :
                                  :
           v.                     :
                                  :
 THIERRY C. VERSTRAETEN, M.D.; E. :
 RONALD SALVITTI, M.D., INC.,     :
 INDIVIDUALLY, D/B/A              :
 SOUTHWESTERN PENNSYLVANIA EYE :
 CENTER, A FICTITIOUS NAME, AND   :
 D/B/A SOUTHERN PENNSYLVANIA      :
 EYE SURGERY CENTER, A            :
 FICTITIOUS NAME; AND ALLEGHENY :
 OPHTHALMIC & ORBITAL             :
 ASSOCIATES, P.C.                 :           No. 886 WDA 2022

              Appeal from the Judgment Entered July 26, 2022
    In the Court of Common Pleas of Washington County Civil Division at
                             No(s): 2018-175

BEFORE: BENDER, P.J.E., LAZARUS, J., and KUNSELMAN, J.

OPINION BY KUNSELMAN, J.:                     FILED: November 8, 2023

      Brenda and Douglas Hutchinson appeal from the judgment entered on

the jury’s defense verdict in favor of Dr. Thierry C. Verstraeten, M.D.; E.

Ronald Salvitti, M.D., Inc.; and Allegheny Ophthalmic & Orbital Associates,

P.C. (“the Eye Clinic”). The Hutchinsons challenge the trial court’s ruling that

barred one of their experts from testifying at the jury trial.     Because the

Hutchinsons’ arguments do not establish an abuse of discretion, we affirm.

      The Hutchinsons sued the Eye Clinic for medical malpractice, based on

vicarious liablity and corporate negligence. They alleged that Dr. Verstraeten
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blinded Ms. Hutchinson’s right eye by improperly injecting fluid into it. The

Hutchinsons claimed the Eye Clinic then altered Ms. Hutchinson’s medical

records to conceal Dr. Verstraeten’s mistake. They rooted that claim in the

testimony of Jessica Page, a self-described “expert in Health Information

Technology (HIT) and Operations.”             Hutchinsons’ Renewed Motion for

Sanctions, Ex. 2 at 1.

      According to the Hutchinsons, the parties vociferously disputed the

accuracy of Ms. Hutchinson’s medical records.        The doctor and his scribe

testified that the March 3, 2016 medical record documented an injection into

Ms. Hutchinson’s eyeball, rather than below it.            The Eye Clinic’s health

insurance billing statement also confirmed billing and payment for an injection

into Ms. Hutchinson’s eyeball. Thus, it was the Hutchinsons’ position that the

injection had gone into Ms. Hutchinson’s eyeball, which occluded her Central

Retinal Artery and blinded the eye. Dr. Verstraeten maintained he did not

inject the fluid directly into Ms. Hutchinson’s eyeball.

      The Hutchinsons claimed that someone had altered Ms. Hutchinson’s

March 3, 2016 medical record to add or modify documentation after the fact.

This prompted the Hutchinsons to hire Ms. Page as their expert witness. As

the Hutchinsons claim in their brief:

      Ms. Page had years of experience managing ophthalmological
      practices. She also had significant experience and specialized
      training on the ophthalmological practice software used by [the
      Eye Clinic]—Medflow . . . Ms. Page authored three detailed reports
      about alterations to Mrs. Hutchinson’s medical record.

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             Ms. Page’s opinions and the ongoing contentious debates
      over this alteration issue were based primarily upon the
      completeness of [the Eye Clinic’s] proffered electronic medical
      record audit trail (sometimes referred to generally as “the audit
      trail”). The audit trail is a representation of the electronic medical
      record. It should show, among other data points, who accessed
      the records, where and when the records were accessed, and
      whether changes were made to the records.

Hutchinsons’ Brief at 10-11 (citation to the reproduced record and footnotes

omitted).

      The Hutchinsons believed the Eye Clinic had altered Ms. Hutchinson’s

medical records, after her eye injury.      They filed a motion to compel the

production of a complete and unredacted audit trail of the medical records,

which the trial court granted. The Hutchinsons further claimed the Eye Clinic’s

first production of an audit trail was incomplete.        After they moved for

sanctions, the Eye Clinic produced two more audit trails, but, according to the

Hutchinsons, those trails were also incomplete.

      The Hutchinsons then claimed that there were other alterations to the

medical record. One such alleged alteration was a handwritten alteration of

an earlier injection into Ms. Hutchinson’s eyeball changed to one under her

eyeball by an office employee who had not participated in the care. The trial

court eventually granted the Eye Clinic’s motion in limine to exclude this

evidence, because it ruled the evidence to be irrelevant.

      Ultimately, Ms. Page provided a final report, wherein she outlined all the

evidence of the Eye Clinic’s opinions on the alleged alteration of the electronic

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and handwritten medical record. The Hutchisons summarized her opinions as

follows:

            -     Missing Entries from the Standard Medflow
                  Audit Trail

            -     Alterations in the Exported Medflow Audit Log

            -     Impossible Reporting Constraints for [the Eye
                  Clinic’s] Production of the 7/14/21 Audit Report

            -     Unexplained     lengthy       entries into Ms.
                  Hutchinson’s medical        record by non-care
                  providers of the Clinic

            -     Inappropriate corrections to and alterations of
                  Ms. Hutchinson’s paper records

            -     EMR Alterations of the March 3, 2016 office visit

            -     Invalid electronic signatures of the Doctor

Hutchinsons’ Brief at 15 (citation to the reproduced record and footnotes

omitted).

      A few days before trial, the Eye Clinic filed a motion in limine to preclude

Ms. Page’s testimony, which the trial court granted. Opining from the bench,

the court said:

      the issue of the complete audit trail and the issues related to
      discovery with the electronic record, in my mind, is a complete
      separate and distinct issue [from the poor record-keeping of the
      Eye Clinic]. When and who accessed the records and so on, at
      this stage, really, is irrelevant.

            And no evidence exists that anyone altered the record that
      helped the [Eye Clinic] or to divert the [Hutchinsons’] attention to
      something that would damage the Plaintiff or to – yeah, to bolster
      the [Hutchinsons’] case or to hurt the [Eye Clinic]. This whole
      issue on the audit trail at this point I find is irrelevant and is only
      going to cause confusion to the jury.

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            Further, after reading Jessica Page’s -- all three reports --
      but particularly the last one, she goes way beyond her expertise
      in handwriting and standard of care and what she does in her
      practice, which she is really not -- she is not qualified to do.

            So, in light of everything, I am going to preclude the
      testimony of Jessica Page.

N.T., 8/12/21, at 161-62.

      The matter proceeded to a jury trial, and the jurors ruled Dr. Verstraeten

had acted within the standard of care. The jury also determined there was no

corporate negligence by the Eye Clinic. The Hutchisons moved for post-trial

relief, which the trial court denied. This timely appeal followed.

      The Hutchisons raise three issues. They are:

      1.    Did the [trial] court err when it excluded the relevant
            testimony of [Ms. Page]?

      2.    Did the [trial] court err by precluding critical relevant
            evidence to establish grounds for an adverse inference
            related to the intentional alteration and/or destruction of the
            plaintiffs’ medical record?

      3.    Did the [trial] court err by precluding critical relevant
            evidence to establish grounds for a spoliation and/or
            punitive damages jury charge?

Hutchinsons’ Brief at 5.

      As the Hutchinsons’ framing of issues indicates, they misunderstand our

deferential standard of review for an evidentiary ruling, such as the one they

now challenge on appeal. The issue for an appellant, when challenging a trial

court’s evidentiary ruling, is not – as the Hutchinsons claim and argue in their

brief – whether the trial court committed an “error.”      Instead, the proper

framing of the appellate issue is whether the trial court committed an abuse

                                     -5-
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of discretion.   As we explain, the Hutchisons never make an abuse-of-

discretion argument anywhere in their brief.       Thus, we dispose of all their

appellate issues simultaneously.

      At the outset of their brief, the Hutchinsons correctly acknowledge that

“Questions that involve the relevancy of evidence are within the sound

discretion of the trial court.”   Id. at 3 (citing Cohen v. Albert Einstein

Medical Center, 592 A.2d 720, 725 (Pa. Super. 1991)). They then state,

“The unjustified exclusion of relevant evidence that is otherwise admissible,

however, is an abuse of that discretion.”    Id.    The Hutchinsons again cite

Cohen for that proposition. See id. Without citing any authority, the Cohen

panel did, in fact, say, “the unjustified exclusion of relevant evidence,

otherwise admissible, is an abuse of discretion.” Cohen at 725.

      However, if that statement from Cohen were correct, this Court would

review a trial court’s relevancy determinations de novo. Under the Cohen

standard of review, a mere difference of opinion between this Court and the

trial court as to what constitutes relevant evidence would also constitute an

abuse of discretion. Indeed, a close reading of Cohen reveals that the panel

reviewed the case’s evidence de novo and substituted its relevancy judgments

of the evidence to reverse the trial court and award the hospital a new trial.

      Cohen involved a hospitalized woman who supposedly suffered from

Munchausen’s Syndrome, the “repeated fabrication of illness, usually acute,

dramatic and convincing.” Id. at 724 (quoting MERCK MANUAL, 15th Ed., 1987)

(some punctuation omitted). Ms. Cohen claimed that, on her second or third

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day in the hospital, an unknown nurse administered an injection into her arm

to treat arthritis. She “felt a shock run down her arm and into her hand and

fingers. Thereafter, her left hand dropped uselessly at the wrist.” Id. at 722.

      Despite this adverse result, Ms. Cohen “did not report to anyone the

sudden pain and disability, and the hospital records [did] not contain any

reference to the injection.” Id. A week later, a doctor first noted “a left wrist

drop of unknown etiology.” Id. (quotation omitted). The condition lasted four

years, and she eventually had surgery to alleviate the pain and disability. Her

surgeon found “scarring of Ms. Cohen’s radial nerve . . . .” Id. She sued the

hospital whose unidentified nurse had allegedly performed the arm injection.

      As part of its defense, the hospital wished to call “a forensic psychiatrist

[to testify] that he had reviewed [Ms. Cohen’s] voluminous medical records

and was of the opinion that she suffered from Munchausen’s Syndrome.” Id.

at 725. Based on his testimony, the hospital wanted to argue to the jury that,

“because of [Ms. Cohen’s alleged] psychiatric illness she had either fabricated

her injury or produced it herself during a drug-induced stupor by leaning on

her arm and compressing it against a hard surface, thereby placing pressure

on the nerve.” Id. at 724. Ms. Cohen objected to the expert’s testimony on

the grounds that it was irrelevant, would confuse the jury by adding issues of

her mental health to the trial, would call for speculation, and would exceed

the psychiatrist’s expertise. The trial court agreed on all points and precluded

him from testifying. The jury returned a verdict in favor of Ms. Cohen.

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      On appeal, the Cohen panel initially said: “Questions pertaining to the

relevancy of evidence are within the sound discretion of the trial court, and

the [trial] court’s rulings thereon will be reversed on appeal only where there

has been an abuse of discretion and actual prejudice.”        Id. at 725 (citing

Lewis v. Mellor, 393 A.2d 941, 944 (Pa. Super. 1978), Westerman v.

Stout, 335 A.2d 741, 745 (Pa. Super. 1975), and Pirches v. General

Accident Insurance Co., 511 A.2d 1349, 1351 (Pa. Super. 1986)).

However, the panel failed to define an abuse of discretion. Instead, Cohen

converted the abuse-of-discretion review into a de novo review by announcing

that “the unjustified exclusion of relevant evidence, otherwise admissible, is

an abuse of discretion.” Id. at 725. This circular statement transformed the

underlying relevancy judgment into the linchpin for an abuse of discretion. By

doing so, Cohen eliminated any discretion for the trial court’s decision.

      Thereafter, the Cohen Court mostly ignored the trial court’s analysis of

the relevancy issue and replaced it with its own. Indeed, it only paraphrased

the trial court’s reasoning and reduced its logic to a caricature. Then, after

quoting the rules on relevancy, Cohen decreed:

      In the instant case, the general exclusion of all evidence regarding
      Munchausen’s Syndrome deprived the jury of information which
      was relevant to assist it in weighing the credibility of [Ms. Cohen’s]
      testimony regarding the injection and subsequent injury. The
      evidence was also relevant to a determination of [her] damages.

Id. This conclusory language is the product of a de novo review, where an

appellate court substitutes its judgment for that of the trial court.

                                      -8-
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      Absent from Cohen is any discussion of how or why the trial court’s

reasoning was flawed. There is no contention that the trial court illogically

balanced the value of the expert’s testimony against its likelihood of confusing

the jury or creating a trial on Ms. Cohen’s mental health within the trial on the

hospital’s malpractice. The panel instead said that introducing Ms. Cohen’s

“medical history would admittedly have increased the complexity of this

already difficult case, but a trial court’s chief concern must be to allow the jury

to hear all evidence relevant to the issue being decided and to exclude only

that evidence which is inadmissible, as a matter of law, or which is unduly

prejudicial.” Id.

      If this were true, a trial court could never exclude technically relevant

evidence that would likely confuse the jury or produce a trial within the trial.

This is not the law.

      As this Court more recently held, “admissibility or exclusion of evidence

are subject to the abuse-of-discretion standard of review.” Rohe v. Vinson,

158 A.3d 88, 95 (Pa. Super. 2016), appeal denied, 176 A.3d 851 (Pa. 2017).

Additionally, the Supreme Court of Pennsylvania has explained, “An appellate

court cannot find an abuse of discretion merely for an error of judgment,

unless, in reaching a conclusion, the trial court overrides or misapplies the

law; or its judgment is manifestly unreasonable; or the evidence of record

shows that the court’s judgment exercised is manifestly unreasonable or

lacking in reason.” Commonwealth v. Baker, 766 A.2d 328, 331 (Pa. 2001).

Thus, the de novo review which the Cohen Court performed cannot be

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squared with the more recent pronouncements of the Supreme Court and its

directives that we defer to a trial court’s evidentiary determinations.

      Also, in the 32 years since Cohen, no appellate-court majority has cited

to it for the proposition upon which the Hutchinsons now rely. Hence, the

notion that a trial court commits a de facto abuse of discretion by excluding

evidence that this Court deems to be relevant is not firmly rooted in our

precedents. The only opinion to rely on Cohen for that proposition is a dissent

from the Commonwealth Court.        See Commonwealth v. Simpson, 2287

C.D. 2009, 2010 WL 9516187 at *3 (Pa. Cmwlth. 2010) (unpublished),

reargument denied, 4 A.3d 828 (2010), appeal denied, 23 A.3d 543 (Pa. 2011)

(Cohn Jubelirer, J. dissenting; advocating for reversal of a trial court’s

relevancy ruling in a criminal matter to grant defendant a new trial). That

dissent’s reliance on Cohen is not particularly compelling, nor does it

persuade us that the exclusion-of-relevant-evidence statement from Cohen

survived the adoption of the Pennsylvania Rules of Evidence.

      We hold that the adoption of the Pennsylvania Rules of Evidence in May

of 1998, seven years after Cohen, abrogated the statement that “the

unjustified exclusion of relevant evidence, otherwise admissible, is an abuse

of discretion.” Cohen, 592 A.2d at 725. Under the Rules of Evidence, courts

of common pleas enjoy broad discretion to determine whether evidence is

relevant and whether its admission outweighs the risk of confusing the jury.

See Pa.R.E. 401 and Pa.R.E. 403 (stating, “The court may exclude relevant

evidence if its probative value is outweighed by a danger of one or more of

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the following:     unfair prejudice, confusing the issues, misleading the jury,

undue delay, wasting time, or needlessly presenting cumulative evidence.”)

Merely because an appellate court might have deemed evidence to be relevant

in the first instance does not mean that a trial court abused its discretion by

failing to admit that evidence.

       As such, the Hutchinsons’ reliance upon Cohen for their standard of

review is misplaced.1 Based on that reliance, they make a de novo argument,

which is simply untenable under our abuse-of-discretion standard of review.

       Abuse of discretion takes one of three forms. It “occurs if [(1) the trial

court] committed an error of law; [(2) the court] exercised its judgment in a

manifestly unreasonable manner; or [(3) the court’s] decision was the result

of partiality, prejudice, bias or ill-will, as shown by evidence on the record.”

Womer v. Hilliker, 908 A.2d 269, 273 (Pa. 2006).

       Rather than explaining which type of abuse occurred, the Hutchinsons

argue why they believe the trial court should have denied the hospital’s motion

in limine, as if our standard of review were de novo. They contend Ms. Page’s

testimony “was relevant.” Hutchinsons’ Brief at 26, 27. They then assert that
____________________________________________

1 The trial court also quoted Cohen v. Albert Einstein Medical Center, 592

A.2d 720 (Pa. Super. 1991), in its Rule 1925(a) Opinion for the appellate
standard of review. See Trial Court Opinion, 11/1/22, at 6. The trial court’s
reliance was equally misplaced for all of the above reasons. More importantly,
a trial court’s interpretation of the appellate standard of review is not binding
upon the appellate court. See, e.g., In re Wilson, 879 A.2d 199 (Pa. Super.
2005), abrogated on other grounds by In re Ajaj, 288 A.3d 94 (Pa. 2023).
In Wilson, we stated this Court reviews the applicable standard of review de
novo.

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the trial court “should have” allowed her to testify and argue that the adverse

ruling was “an error of law.” Id. at 26, 29. The Hutchinsons further claim

that, if a trial court rules evidence is irrelevant, but the appellate court deems

that evidence to be relevant, the trial court’s ruling is per se an abuse of

discretion. In essence, the Hutchinsons invite us to substitute our relevancy

judgment for that of the trial court, rather than defer to that court’s relevancy

ruling.

      Even if we agreed with the Hutchinsons that the trial court “erred” when

it made its relevancy ruling, Pennsylvania courts have long held that an “abuse

of discretion is not merely an error of judgment, but rather a misapplication

of the law or an unreasonable exercise of judgment.” Johnson v. Johnson,

222 A.3d 787, 789 (Pa. Super. 2019) (emphasis added). The Hutchinsons do

not explain how the trial court’s judgment was unreasonable.

      Moreover, when claiming an abuse of discretion, it is insufficient to

convince us that “the lower tribunal reached a decision contrary to the decision

that the appellate court would have reached.” B.B. v. Dep't of Pub. Welfare,

118 A.3d 482, 485 (Pa. Cmwlth. 2015) (some punctuation omitted). Instead,

an appellant must demonstrate one of the three abuses described above. See

Womer, supra. Again, the Hutchinsons do not identify which types of abuse

of the trial court supposedly committed, nor do they develop any argument

based on those recognized forms of abuse.

      As a result, they simply reargue the alleged relevancy of Ms. Page’s

testimony de novo to this Court. Accordingly, the Hutchinsons have failed to

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establish an abuse of discretion within the trial court’s discretionary judgments

that:

        no evidence exists that anyone altered the record that helped the
        [Eye Clinic] or to divert the [Hutchinsons’] attention to something
        that would damage the Plaintiff or to – yeah, to bolster the
        [Hutchinsons’] case or to hurt the [Eye Clinic]. This whole issue
        on the audit trail at this point I find is irrelevant and is only going
        to cause confusion to the jury.

              Further, after reading Jessica Page’s -- all three reports --
        but particularly the last one, she goes way beyond her expertise
        in handwriting and standard of care and what she does in her
        practice, which she is really not -- she is not qualified to do.

N.T., 8/12/21, at 161-62.

        In sum, the Hutchinsons have not argued – much less persuaded this

Court – that an abuse of discretion occurred. We therefore dismiss their three

appellate issues as meritless.

        Judgment affirmed.

 11/8/2023

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