Hamil v. Bashline

• Decision Date: 05 October 1978
• Citation: 481 Pa. 256,392 A.2d 1280
• Parties: Martha S. HAMIL, Administratrix of the Estate of Kenneth C. Hamil, Appellant, v. H. Woodrow BASHLINE, Don L. Bashline, Wayne L. Bashline, Vincent D. D'Angelo, Leslie A. McClimans, John F. Johnston and Anthony Linfante, t/a the Bashline Hospital Association, Ltd.
• Court: Pennsylvania Supreme Court

Page 1280

392 A.2d 1280

481 Pa. 256

Martha S. HAMIL, Administratrix of the Estate of Kenneth C.

Hamil, Appellant, v. H. Woodrow BASHLINE, Don L. Bashline, Wayne L. Bashline, Vincent D. D'Angelo, Leslie A. McClimans, John F.

Johnston and Anthony Linfante, t/a the

Bashline Hospital Association, Ltd.

Supreme Court of Pennsylvania.

Argued March 6, 1978.

Decided Oct. 5, 1978.

Reargument Denied Nov. 9, 1978.

Henry S. Moore, Grove City, Stephen M. Feldman, Philadelphia, for appellant.

George Hardy Rowley, Voorhies, Dilley, Keck, Rowley & Wallace, Greenville, for appellee.

Francis E. Shields, Philadelphia, amicus curiae for Pennsylvania Medical Society.

Joseph J. Musto, Wilkes-Barre, amicus curiae, for Pennsylvania Defense Institute.

Before EAGEN, C. J., and O'BRIEN, ROBERTS, POMEROY, NIX, MANDERINO and LARSEN, JJ.

OPINION OF THE COURT

POMEROY, Justice.

The present appeal involves the degree of certainty required of expert medical testimony to establish, in a medical malpractice case, the causal relation between the harm suffered by a plaintiff-patient and the alleged negligence of a doctor or hospital in failing properly to diagnose and treat the plaintiff's condition in a manner which might have prevented the harm. We believe that such causation may be founded upon expert opinion testimony to the effect that defendant failed to exercise reasonable care in performing an undertaking to render services to a patient which the defendant should recognize as necessary for the other's protection, that this failure increased the risk of physical harm to the patient, and that such harm did in fact result. Because the jury was not properly charged as to this standard, a new trial will be required.

A few minutes before midnight on May 31, 1968, Mrs. Martha S. Hamil telephoned defendant, Bashline Hospital Association, Ltd. (Bashline), ¹ and told the night supervisor that her husband was suffering from severe chest pains. Mrs. Hamil was advised by the supervisor to bring Mr. Hamil to the hospital. Upon the Hamils' arrival, the Bashline doctor assigned to the emergency unit could not be located but another physician, Dr. J. F. Johnston, was present and ordered an electrocardiogram (EKG) to be taken. Due to a faulty electrical outlet, the EKG machine failed to function. Dr. Johnston then directed that another machine be used, and thereafter left the hospital. A second EKG machine could not be found and, upon receiving no further aid or treatment, Mrs. Hamil transported her husband to the private office of a Dr. Saloom. Mr. Hamil died in Dr. Saloom's office while an EKG was being taken.

In 1969, Martha Hamil, in her capacity as administratrix of the estate of her husband, instituted this action in trespass under the Wrongful Death and Survival Acts. The basis of the complaint was that Bashline failed to employ recognized and available methods of treating decedent's malady, a myocardial infarction. In support of that theory, plaintiff called as its expert medical witness Dr. Cyril Wecht, who outlined the use of beds, oxygen and pain relieving drugs in the treatment of chest pains. Dr. Wecht then expressed his professional opinion that if Bashline had employed the methods and treatment which he had described, Mr. Hamil would have had a 75% Chance of surviving the attack he was experiencing when admitted to the hospital. Dr. Wecht also gave it as his opinion that this substantial chance of recovery was terminated by defendant's failure to provide prompt treatment. ² Defendant's expert witness, Dr. John B. Treadway, opined that death was imminent at the time of Hamil's arrival at the hospital and that the patient would have died regardless of any treatment Bashline might have provided. It was Dr. Treadway's opinion, accordingly, that any negligence of the hospital in the circumstances was immaterial.

Following the introduction of all the evidence, the trial court determined that Dr. Wecht's testimony had failed to establish, with the required degree of medical certainty, that the alleged negligence of the defendant was the proximate cause of plaintiff's harm. The court therefore directed a verdict in favor of the defendant. Upon appeal the Superior Court, relying largely on the Restatement (Second) of Torts (hereafter the "Restatement") § 323(a) (1965) concluded that plaintiff had in fact presented a Prima facie case of negligence and accordingly reversed the trial court and granted a new trial. See Hamil v. Bashline, 224 Pa.Super. 407, 307 A.2d 57 (1976) (Bashline I ).

Upon retrial, substantially the same testimony was presented by the parties and the case was this time submitted to the jury. Following deliberation, the jury returned a verdict in favor of defendant and, by answers to special interrogatories, expressed its belief that although Bashline had acted in a negligent manner, plaintiff had failed to establish this negligence as a proximate cause of the decedent's death. A new appeal was taken to the Superior Court in which appellant asserted that the trial court's charge to the jury had failed to comply with the holding of Bashline I. Without resolving that issue, a divided Superior Court affirmed the entry of judgment for the defendant on the ground that it was mistaken in ordering the new trial at the time of the first appeal. See Hamil v. Bashline, 243 Pa.Super. 227, 364 A.2d 1366 (1976) (Bashline II ). ³ This appeal followed. ⁴

I.

A proper resolution of the present controversy requires that it be viewed in the context of certain well-established principles of tort law.

(A) Causation

It is settled in the law that except in rare situations not here involved the mere occurrence of an injury does not prove negligence and that an admittedly negligent act does not necessarily entail liability; rather even when it is established that the defendant breached some duty of care owed the plaintiff, it is incumbent on a plaintiff to establish a causal connection between defendant's conduct and the plaintiff's injury. Stated another way, the defendant's conduct must be shown to have been the proximate cause of plaintiff's injury. Flickinger Estate v. Ritsky, 452 Pa. 69, 305 A.2d 40 (1973); Dornan v. Johnston, 421 Pa. 58, 218 A.2d 808 (1966); Cuthbert v. Philadelphia, 417 Pa. 610, 209 A.2d 261 (1965); Gift v. Palmer, 392 Pa. 628, 141 A.2d 408 (1958); Fries v. Ritter, 381 Pa. 470, 112 A.2d 189 (1955). Proximate cause is a term of art denoting the point at which legal responsibility attaches for the harm to another arising out of some act of defendant, Flickinger Estate v. Ritsky, supra ; W. Prosser, Law of Torts, § 41 (4th ed. 1971); and it may be established by evidence that the defendant's negligent act or failure to act was a substantial factor in bringing about the plaintiff's harm. Flickinger Estate v. Ritsky, supra; Whitner v. Lojeski, 437 Pa. 448, 263 A.2d 889 (1970) (plurality opinion); Majors v. Brodhead Hotel, 416 Pa. 265, 205 A.2d 873 (1965); Diakolios v. Sears, Roebuck & Co., 387 Pa. 184, 127 A.2d 603 (1956); Simon v. Hudson Coal Co., 350 Pa. 82, 38 A.2d 259 (1944); Frangis v. Duquesne Light Co.,232 Pa.Super. 420, 335 A.2d 796 (1975). The defendant's negligent conduct may not, however, be found to be a substantial cause where the plaintiff's injury would have been sustained even in the absence of the actor's negligence. Majors v. Brodhead Hotel, supra; DeAngelis v. Burns, 404 Pa. 230, 171 A.2d 762 (1961); Frangis v. Duquesne Light Co., supra ; Restatement, § 432.

(B) Proof

It is the plaintiff's burden to prove that the harm suffered was due to the conduct of the defendant. As in many other areas of the law, that burden must be sustained by a preponderance of the evidence. Cwiakala v. Paal, 427 Pa. 322, 235 A.2d 145 (1967); Zeman v. Canonsburg Boro, 423 Pa. 450, 223 A.2d 728 (1966); Amon v. Shemaka, 419 Pa. 314, 214 A.2d 238 (1965). Whether in a particular case that standard has been met with respect to the element of causation is normally a question of fact for the jury; the question is to be removed from the jury's consideration only where it is clear that reasonable minds could not differ on the issue. Topelski v. Universal South Side Autos, Inc., 407 Pa. 339, 180 A.2d 414 (1962); Restatement, § 434; W. Prosser, Law of Torts, § 45 (4th ed. 1971); F. Harper and F. James, The Law of Torts, Vol. 2, § 20.2 (1956). In establishing a Prima facie case, the plaintiff need not exclude every possible explanation of the accident; it is enough that reasonable minds are able to conclude that the preponderance of the evidence shows defendant's conduct to have been a substantial cause of the harm to plaintiff. Finney v. G.C. Murphy, Co., 406 Pa. 555, 178 A.2d 719 (1962). Thus, once a plaintiff has established facts from which a jury could reasonably conclude that defendant's actions were a substantial factor in bringing about the harm,

". . . 'the fact that some other cause concurs with the negligence of the defendant in producing an injury does not relieve the defendant from liability unless he can show that such other cause would have produced the injury independently of his negligence,' Carlson v. A. & P. Corrugated Box Corporation, 364 Pa. 216, 223, 72 A.2d 290, 293 (1950). See Yenchko v. Grontkowski, 385 Pa. 272, 122 A.2d 705 (1956)." Majors v. Brodhead Hotel, supra, 416 Pa. at 273, 205 A.2d at 878.

(C) Expert Testimony

Normally a plaintiff may establish his case of causation with any evidence, direct or circumstantial, which tends to show defendant's actions as the legal cause of his harm. Where, however, the ultimate determinations lie beyond the knowledge or expertise of the average layperson, expert testimony is permitted (and sometimes required) to aid the jury in its understanding of the factors involved and the teaching of the pertinent discipline with respect thereto. Reardon v. Meehan, 424 Pa. 460, 227 A.2d 667 (1967); Weisman v. Sauder Chevrolet Co., 402 Pa. 272, 167 A.2d 308 (1961); Densler...