Matthews v. Clarion Hosp.

• Citation: 742 A.2d 1111
• Parties: Sybil MATTHEWS and Robert Matthews, her Husband, Appellants, v. CLARION HOSPITAL, A Corporation and David A. Buffone.
• Decision Date: 08 December 1999
• Court: Pennsylvania Superior Court

742 A.2d 1111

Sybil MATTHEWS and Robert Matthews, her Husband, Appellants, v. CLARION HOSPITAL, A Corporation and David A. Buffone.

Superior Court of Pennsylvania.

Argued June 22, 1999.

Filed December 8, 1999.

Mark E. Milsop, Pittsburgh, for appellant.

John A. Bass, Pittsburgh, for appellee.

Before KELLY, FORD ELLIOTT, and BROSKY, JJ.

FORD ELLIOTT, J.

¶ 1 This is an appeal from the trial court's order entering summary judgment in favor of defendant/appellee Clarion Hospital ("hospital"). The trial court treated this case as if it were a traditional medical malpractice case and required appellants to provide a medical expert who would opine to a reasonable degree of medical certainty that hospital's acts deviated from an acceptable medical standard and that such deviation was the proximate cause of appellant Sybil Matthews' harm. When appellants failed to provide an expert report on the issue of causation in a timely fashion, the court entered summary judgment.

¶ 2 We find, however, that this is a case of corporate negligence, not medical malpractice. See Thompson v. Nason Hospital, 527 Pa. 330, 591 A.2d 703 (1991). Nevertheless, a claim of corporate negligence, like a claim of medical malpractice, requires that in cases where a hospital's negligence is not obvious, a plaintiff must establish through expert testimony that a hospital's acts deviated from an accepted standard of care and that the deviation was a substantial factor in causing plaintiff's harm. Welsh v. Bulger, 548 Pa. 504, 512-14, 698 A.2d 581, 585 (1997). Expert testimony is not, however, required to establish a breach of duty "`where the matter under investigation is so simple, and the lack of skill or want of care so obvious, as to be within the range of the ordinary experience and comprehension of even nonprofessional persons.'" Id. at n. 11, 698 A.2d at 585 n. 11, quoting Chandler v. Cook, 438 Pa. 447, 451 n. 1, 265 A.2d 794, 796 n. 1 (1970). See also Brannan v. Lankenau Hospital, 490 Pa. 588, 417 A.2d 196 (1980).

¶ 3 Nor is expert testimony as to causation required "where there is an obvious causal relationship" between the injury complained of and the alleged negligent act. Lattanze v. Silverstrini, 302 Pa.Super. 217, 448 A.2d 605, 608 (1982) (emphasis in original), citing Smith v. German, 434 Pa. 47, 253 A.2d 107 (1969). "An obvious causal relationship exists where the injuries are either an `immediate and direct' or the `natural and probable' result of the alleged negligent act." Lattanze, 448 A.2d at 608, quoting Tabuteau v. London Guarantee & Accident Co., Ltd., 351 Pa. 183, 40 A.2d 396 (1945) (other citation omitted). Because we find that in this case, Sybil Matthews' injuries were the immediate and direct result of hospital's alleged negligent act, we also find that the trial court erred when it required appellants to establish causation to a reasonable degree of medical certainty through medical expert testimony. As a result, we vacate the summary judgment and remand. The factual and procedural history of the case necessary to understanding its resolution follows.

¶ 4 On September 10, 1993, after giving birth to a healthy baby, Sybil Matthews ("patient") underwent a tubal ligation at hospital.¹ David A. Buffone, M.D., also named as a defendant in this case, performed the operation.² In October 1995, patient filed a complaint in which she alleged that "[d]uring or incident to the aforementioned procedure ... the Defendants caused and/or allowed the patient to fall from the operating table upon which she was placed by said Defendants, ...." thereby injuring her right arm and shoulder. (R.R. at 8a, 11a.)

¶ 5 During the course of discovery, hospital requested that patient identify individuals she intended to call as experts; however, by March 17, 1997, when patient still had not provided the names of the experts she intended to call, hospital filed a motion for sanctions. On April 7, 1997, the court held a hearing on the motion for sanctions. In its order addressing the motion, the court indicated that the parties had discussed several issues, including the need for expert testimony as to causation, but that the issue was not properly before the court; therefore the court would not rule on it. (R.R. at 83a.) Nevertheless, the court invited either party to bring the issue before the court with an appropriate motion. (Id.) The court then ordered patient within 45 days to identify expert witnesses she intended to call and to provide hospital with copies of the expert reports, and instructed patient that if she did not comply, she would be precluded from introducing any expert testimony. In response, patient timely filed the expert report of Mary Rodgers Schubert, R.N., directed to the standard of care of operating room nurses, but did not file a report addressing the issue of causation.

¶ 6 On August 11, 1998, patient filed her pre-trial statement, which listed as experts whose reports had been forwarded to counsel for defendants Nurse Schubert and Glenn A. Buterbaugh, M.D.³ At a pre-trial conference held on August 17, 1998, the parties argued the issue whether patient was required to submit a medical expert report on causation in order to establish a prima facie case of negligence. The trial court ordered patient to file such a report, prepared by one of the physicians already identified to hospital, within 20 days.⁴ No such report having been filed, hospital filed a motion for summary judgment on September 23, 1998. In the motion, hospital claimed it was entitled to summary judgment because patient had not established a prima facie case of negligence, having failed to file an expert report opining to a reasonable degree of medical certainty that hospital deviated from acceptable standards of care and that such deviation was the proximate cause of patient's injuries. (R.R. at 142a-144a, citing Mitzelfelt v. Kamrin, 526 Pa. 54, 584 A.2d 888 (1990).)

¶ 7 Patient then filed a brief in opposition to the motion, claiming that the reports prepared by her treating physicians established the requisite degree of causation. (R.R. at 161a-162a.) She also claimed that she had attempted to comply with the court's August 1998 order by repeatedly contacting Dr. Buterbaugh, who finally prepared a report, dated September 23, 1998, which patient appended to her brief. Additionally, patient claimed that her counsel had consulted with an orthopedic surgeon, Lawrence Honick, M.D., who had reviewed patient's medical history and who would opine that patient's injuries were caused by her fall from the operating table. Patient therefore requested that the court consider Dr. Buterbaugh's appended report, and also that the court permit patient to file an expert report prepared by Dr. Honick. (R.R. at 160a-166a.)

¶ 8 On January 6, 1999, the trial court entered summary judgment against patient, opining that "[t]he plaintiff in a medical malpractice case is required to present an expert witness who will testify, to a reasonable degree of medical certainty, that the defendant deviated from good and acceptable medical standards, and that such deviation was the proximate cause of the harm suffered." (Trial court opinion, 1/6/99 at 4, citing Mitzelfelt, supra at 62, 584 A.2d at 892.) The court also recognized, however, that the requirement of expert testimony regarding causation is not absolute:

`[W]here "the disability complained of is the natural and probable result of the injuries, the fact-finding body may be permitted to so find, even in the entire absence of expert opinion." The two must be `so closely connected and so readily apparent that a layman could diagnose (except by guessing) the causal connection.'

Trial court opinion, 1/6/99 at 4, quoting Smith v. German, supra at 51, 253 A.2d at 109, quoting Florig v. Sears, Roebuck & Co., 388 Pa. 419, 424, 130 A.2d 445, 447 (1957), citing Tabuteau, supra. Nevertheless, the court, which did consider Dr. Buterbaugh's report appended to patient's brief, concluded that in this case, medical expert testimony was essential and Dr. Buterbaugh's report was inadequate. As the court opined:

Dr. Buterbaugh's report does not state to a reasonable degree of medical certainty that [patient's] alleged fall from the operating table was a substantial factor in bringing about her injuries. To the contrary, it states that `the exact etiology of her [condition] is uncertain.' Dr. Buterbaugh's uncertainty and his enumeration of possible causes for [patient's] condition makes it clear that this is not a case where a layman could diagnose (except by guessing) the causal connection.

Trial court opinion, 1/6/99 at 5. The court then denied patient's request that she be permitted to file an expert report prepared by Dr. Honick, citing its April 7, 1997 order as dispositive of that issue.⁵ (Id.) As a result, the court entered summary judgment against patient, and this timely appeal followed.

¶ 9 On appeal, patient raises one issue: "Whether the trial court erred in dismissing the plaintiffs' claims pursuant to a motion for summary judgment where it had denied the plaintiffs the opportunity to establish causation through the testimony of a non-treating physician." (Appellants' brief at 3.)⁶See Pa.R.Civ.P. 1035.2(2). Underlying this issue is patient's claim that she was unaware until the pre-trial conference on August 17, 1998 that the reports of her treating physicians were inadequate for that purpose. (Appellants' brief at 7, 12, 13.)

When presented with a challenge to an order granting summary judgment, we view the record in the light most favorable to the non-moving party, resolving all doubts as to the existence of a genuine issue of material fact against the moving party. Ertel v. Patriot-News Company, 544 Pa. 93, 674 A.2d 1038 (1996). Concerning questions of law, our scope of review is plenary. Id. We are not bound by a trial court's conclusions of law; instead, we may draw our own inferences and reach our own...