MEDICAL MALPRACTICE-MANOR CARE

June 15th, 2022 by Rieders Travis in Medical Malpractice

Stetts v. Manor Care of Williamsport PA, Pa. No. 16-0983 (C.P. Lycoming December 30, 2021) (Linhardt, J.)  Plaintiff commenced this action by filing a Writ of Summons on June 28, 2016, followed by a Complaint on February 16, 2018. Defendants are Manor Care of Williamsport PA (North), LLC d/b/a ManorCare Health Services – Williamsport North (“Facility”), a skilled nursing facility, HCR ManorCare, Inc., and HCR Manor Care Services, LLC (“Corporate Defendants”). Plaintiff alleges that Decedent, Gary E. Stetts (“Mr. Stetts”) was a resident at the Facility from July 30, 2014 through August 25, 2014, and that while there he suffered a “skin tear to the right calf, a fluid-filled blister to the right heel, significant weight loss, poor hygiene, and severe pain” attributable to the negligent, reckless, or intentional actions of Defendants. Plaintiff alleges numerous grounds for liability, including not only claims that individual employees of the Facility were negligent or reckless but also broad claims of corporate liability, including allegations that various policies and procedures of the Corporate Defendants resulted in understaffing and generally unsafe practices at the Facility. Defendants filed Preliminary Objections to the Complaint on March 7, 2018; this Court ruled on the Preliminary Objections on March 15, 2019. Plaintiff filed an Amended Complaint on March 28, 2019. The Amended Complaint includes four counts: breach of duty of care against all Defendants; breach of fiduciary duty against the Facility; aiding and abetting breach of fiduciary duty against the Corporate Defendants; and a claim under the Survival Statute against all Defendants. Defendants filed an Answer and New Matter on April 23, 2019, and Plaintiff filed a Reply to New Matter on May 13, 2019. Following the close of discovery, Defendants filed the two instant motions: a Motion for Partial Summary Judgment, and a Motion to Remand to Compulsory Arbitration. The Court agrees with Plaintiff that the record contains a genuine issue of material fact that precludes a grant of summary judgment on this claim. Dr. Dupee’s expert report, when read as a whole, alleges conduct which, if proven at trial, could be found to violate the duty imposed by 18 Pa. C.S. § 2713. Dr. Dupee opines that the Facility “chose to deny” certain assessments and procedures, “thus allowing Mr. Stetts to suffer painful injury to his leg.” He notes the need for “[e]ducation of all staff regarding proper transfer critiques” and “transfer of information so that the entire staff is informed and educated as to how to properly and safely transfer a patient such as Mr. Stetts.” Specifically, he remarks “Mr. Stetts suffered an extremely painful injury due to carelessness by the ManorCare Williamsport North staff, in direct defiance of the facility mechanical lift policy…. Mr. Stetts was morbidly obese, requiring at least a 3-person assistance with transfers. The failure to raise the arms on his motorized chair, which was the standard of care, directly resulted in this preventable injury, a result of the carelessness and indifference by the ManorCare Williamsport North staff.” The language of Dr. Dupee’s opinions, when read in a light most favorable to Plaintiff, could support a finding of intent, knowledge, or recklessness sufficient to allow a jury to conclude that the Facility violated 18 Pa. C.S. § 2713.  Because Dr. Dupee’s opinions, if accepted, could ostensibly support a finding that the Facility violated 18 Pa. C.S. § 2713, the Court cannot say that Defendants’ right to judgment on this issue is so “clear and free from all doubt” as to allow a grant of summary judgment. The Amended Complaint also added language that “Defendants… were negligent ‘per se’ and violated… 35 P.S. §10225.701 in that they had reasonable cause to suspect that Gary E. Stetts was the victim of abuse or neglect and failed to report said abuse and neglect to the appropriate agency and law enforcement officials.”

Nonetheless, the Court grants Defendants’ motion for summary judgment on this claim. The Court agrees with Defendants that the Amended Complaint’s references to “35 P.S. §10225.101 et seq.” are insufficiently specific in a manner already addressed in the preliminary objections and highlighted in Defendants’ Answer. Broad averments to an Act with over twenty sections are insufficient to state a claim upon which relief can be granted. Further, although Plaintiff has adequately and specifically stated a claim for negligence per se premised on a violation of §10225.701, the record fails to support such a claim. Section 10225.701 imposes a reporting requirement upon “[a]n employee or administrator who has reasonable cause to suspect that a recipient is a victim of abuse….” Dr. Dupee’s opinion on the Older Adults Protective Services Act claim was clearly not addressed to this requirement of “abuse”, instead concluding “Mr. Stetts was denied services to protect his health, safety and welfare, as he was allowed to suffer a painful leg injury due to neglectful care by the Manor[C]are Williamsport North by failing to properly and safely transfer him to his wheelchair.” Plaintiff points to Mrs. Stetts’s deposition testimony indicating that she “repeatedly raised concerns to the staff that Mr. Stetts was not getting the care he so desperately needed,” and essentially argues that any one of these communications between Mrs. Stetts and a staff member was sufficient to trigger the reporting requirement. The record, however, is devoid of any evidence, let alone expert opinion, to establish that these communications were sufficient to constitute “reasonable cause to suspect… abuse” as would be required to trigger the statute. The record is also devoid of any testimony or evidence linking the alleged failure to report potential abuse to any injury or damages sustained by Mr. Stetts; therefore, any causation element of the claim, on the record before the Court, is pure conjecture. Defendants next seek summary judgment on Count Two of the Amended Complaint, which alleges, inter alia, “the Facility… was a fiduciary of [Mr. Stetts]”; “[t]he Facility breached and violated their relationship of trust, special confidence, and their fiduciary obligations and duties owed to [Mr. Stetts]”; “the Facility acted in bad faith and used their position of trust and special confidence to [Mr. Stetts’s] detriment and to their own advantage”; and “[t]he conduct of the Facility was intentional, outrageous, willful and wanton and exhibited a reckless indifference to its fiduciary duties as it related to [Mr. Stetts].” Plaintiff seeks punitive damages on this claim.  Keeping in mind that the Court must scrupulously avoid substituting its own judgment for that of the factfinder, the Court cannot conclude at this time that the issue is “clear and free from all doubt” so as to justify a grant of summary judgment. Plaintiff has alleged that the Facility “entered into a special relationship with [Mr. Stetts] due to their voluntary assumption of an overmastering and domineering role over the destiny of [Mr. Stetts’s] well-being, who was at all times a vulnerable individual requiring significant care and assistance.” Neither party has provided a case indicating whether the proof of a fiduciary relationship requires an expert to explicitly conclude that such a relationship existed, and the Court has been unable to find such a case. The question of whether the Facility exercised an “overmastering influence” over Mr. Stetts during the relatively brief time he was a resident there, as opposed to merely being in a relationship of special knowledge and care, is highly dependent on which facts Plaintiff can prove at trial. Therefore, summary judgment on this issue is inappropriate. Defendants next seek summary judgment on Plaintiff’s claims for aiding and abetting the Facility’s alleged breach of fiduciary duty. The elements of aiding and abetting a breach of a fiduciary duty are “(1) a breach of a fiduciary duty owed to another; (2) knowledge of the breach by the aider and abettor; and (3) substantial assistance or encouragement by the aider and abettor in effecting that breach.” Plaintiff argues, in response to the motion for summary judgment, that “the evidence of record demonstrates that under the budget set by HCR ManorCare, Inc., the Facility was constrained to a designated staffing level, far below that which was required to meet the needs of the residents,” but Plaintiff’s experts’ reports do not in any way connect the budgeting or corporate structure of the Corporate Defendants to staffing in the Facility, let alone the care provided to Mr. Stetts. Even taking “all facts of record, and all reasonable inferences therefrom, in a light most favorable to” Plaintiff, the record is devoid of evidence that any Corporate Defendant knew of an alleged breach of fiduciary duty or provided “substantial assistance or encouragement” to the Facility in effecting the Facility’s alleged breach of fiduciary duty. Therefore, the Court grants Defendants’ motion for summary judgment on this claim.  Defendants next seek summary judgment on Plaintiff’s corporate negligence claims. Reviewing the record in the light most favorable to Plaintiff, the Court finds that Plaintiff has raised a genuine issue of material fact with respect to one particular theory of corporate negligence against HCR ManorCare Services, LLC. Plaintiff’s evidence, if believed, could demonstrate that HCR ManorCare Services, LLC was the Facility’s “home office” and thus responsible for “centralized management and administrative services… such as centralized… personnel services, management direction and control, and other similar services.” In this capacity, HCR ManorCare Services, LLC arguably had “a duty to formulate, adopt, and enforce adequate rules and policies to ensure quality care for” the patients at the Facility. Plaintiff has sufficiently alleged that HCR ManorCare Services, LLC breached this duty by failing to ensure that its policies relating to patient transfers and the use of the lift were followed during the care of Mr. Stetts on August 1, 2014, either because the Facility’s staff was not trained in the policy or because the staff was inadequately supervised. Applying Section 323 of the Restatement (Second) of Torts to the evidence, taken in the light most favorable to Plaintiff, Plaintiff’s allegations are sufficient to establish that HCR ManorCare Services, LLC owed a duty of care to Mr. Stetts, failed to exercise that duty of care, and caused Mr. Stetts to suffer harm in reliance upon his belief that the Facility’s staff would be properly trained and knowledgeable in the use of the lift and transfers generally. The Court finds that Plaintiff has made a showing sufficient to defeat summary judgment that HCR ManorCare Services, LLC had some responsibility for the oversight of staff at the Facility, and that Plaintiff’s evidence, if believed, could demonstrate a causal connection between HCR ManorCare Services, LLC’s failure to train or supervise the Facility’s staff and Mr. Stetts’s injuries. Therefore, the Court will deny Defendants’ motion for summary judgment with respect to HCR ManorCare Services, LLC, on the theory that HCR ManorCare Services, LLC owed a direct duty to Mr. Stetts to ensure that the staff at the Facility was appropriately trained to operate the Facility’s specialized equipment, including the Hoyer lift.

However, the Court grants summary judgment on all other theories of corporate liability as to the two remaining Corporate Defendants, HCR ManorCare Inc. and HCR ManorCare Services, LLC. Specifically, the Court finds that Plaintiff has not demonstrated a genuine issue of material fact related to alleged understaffing of the Facility; the Court agrees with Defendant’s contention that Plaintiff’s experts do not address “how the staffing levels specifically affected the care Mr. Stetts received or any injuries resulting from the same.” Neither of Plaintiff’s experts has explained how alleged understaffing affected Mr. Stetts’s care at the Facility or otherwise caused him harm. Although Dr. Dupee referred to “inexcusable deviations from the standard of care by the apparently untrained, understaffed, unskilled, and under-supervised staff at ManorCare Williamsport North,” he did not provide any link between the alleged understaffing and the injuries suffered by Mr. Stetts. Indeed, the Court is unable to find support in Dr. Dupee’s report for his conclusion that the Facility was “apparently… understaffed….” Although Nurse Brzozowski’s report discusses staffing levels, her report also does not contain any link between those staffing levels and the care received by Mr. Stetts. In a light most favorable to Plaintiff, the record shows that, in other cases, at other times, staffing concerns were raised in facilities under the HCR umbrella. However, Plaintiff has not produced evidence of understaffing at the Facility here which led to injuries to Mr. Stetts. As such, the Court agrees with Defendants’ argument that Plaintiff has not satisfactorily addressed “how the staffing levels specifically affected the care Mr. Stetts received or any injuries resulting from the same.” To defeat summary judgment on this theory, Plaintiff would need to first allege facts linking the actions of HCR ManorCare Services, Inc. to inadequate staffing at the Facility, and then allege facts linking the inadequate staffing to the harm suffered by Mr. Stetts. Because the Court finds that Plaintiff has done neither, the Court will grant Defendants’ motion for summary judgment as to corporate negligence claims premised on alleged understaffing of the Facility. F. Motion for Summary Judgment to Dismiss Claims for Punitive Damages Defendants’ final motion for summary judgment seeks dismissal of Plaintiff’s claims for punitive damages.  Dr. Dupee’s export [sic] report, when read in the light most favorable to Plaintiff, could support a finding that Defendants were reckless, as opposed to merely negligent, in their transfer of Mr. Stetts. Plaintiff alleges, and Plaintiff’s experts suggest, that the transfer was performed by an insufficient number of staff members, who either did not know or did not follow the appropriate transfer procedure, and that the Facility recklessly disregarded the need for special transfer procedures given Mr. Stetts’s weight and health issues. For the foregoing reasons, the Court will grant in part and deny in part Defendants’ Motion for Partial Summary Judgment on Punitive Damages. The Court will deny the Motion as to the request for punitive damages relating to the August 1, 2014 incident, during which Mr. Stetts sustained injury in the course of an attempted transfer. The Court will grant the Motion as to all other theories of punitive damages.

ORDER

For the foregoing reasons, the Court hereby ORDERS as follows: Defendants’ motion for summary judgment to dismiss Plaintiff’s negligence per se claims is GRANTED IN PART and DENIED IN PART. The motion is GRANTED as to Plaintiff’s claims of negligence per se based on an alleged violation of the Older Adults Protective services Act. The motion is DENIED as to Plaintiff’s claims of negligence per se arising out of alleged violations of 18 Pa. C.S. § 2713. Defendants’ motion for summary judgment to dismiss Plaintiff’s breach of fiduciary duty claims against the Facility is DENIED. Defendants’ motion for summary judgment to dismiss Plaintiff’s aiding and abetting breach of fiduciary duty claims against the Corporate Defendants is GRANTED. Defendants’ motion for summary judgment to dismiss Plaintiff’s corporate negligence claims is GRANTED IN PART and DENIED IN PART. The motion is DENIED as to the claim that HCR ManorCare Services, LLC failed to ensure that its policies relating to patient transfers and the use of the lift were followed during the care of Mr. Stetts on August 1, 2014, either because the Facility’s staff was not trained in the policy or because the staff was inadequately supervised. The motion is GRANTED as to all other claims of corporate negligence against both remaining Corporate Defendants. Defendants’ motion for summary judgment to dismiss Plaintiff’s claims for punitive damages is GRANTED IN PART and DENIED IN PART. The motion is DENIED as to the request for punitive damages relating to the August 1, 2014 incident, during which Mr. Stetts sustained injury in the course of an attempted transfer. The motion is GRANTED as to all other claims for punitive damages. Defendants’ motion to remand to compulsory arbitration is DENIED.

Attorney Cliff Rieders

Attorney Cliff RiedersCliff Rieders is a Nationally Board Certified Trial Lawyer practicing personal injury law. A large part of his practice involves multi-district litigation, including cases related to pharmaceuticals, vitamin supplements and medical devices. He is admitted in several state and federal courts, as well as the Supreme Court of the United States. Rieders is the past regional president of the Federal Bar Association and is a life member of the distinguished American Law Institute, which promulgates proposed rules adopted by many state courts. He is a past president of the Pennsylvania Association for Justice, formerly Pennsylvania Trial Lawyers Association. As a founder of the Pennsylvania Patient Safety Authority, he served on the Board for 15 years.

Not only has Rieders held many highly esteemed, leadership positions, he authored legislation related to the Patient Safety Authority and the Mcare Act, which governs medical and hospital liability actions in Pennsylvania. He authored texts upon which both practitioners and judges rely, including Pennsylvania Malpractice Laws and Forms, and Financial Responsibility Law Issues in Pennsylvania, the latter governing auto and truck collisions in Pennsylvania. In addition, he wrote several books on the practice of law in Pennsylvania regarding wrongful death and survivor actions, insurance bad faith, legal malpractice claims and worker rights, among others. Rieders also serves as a resource to practitioners as a regular speaker for Celesq, an arm of the world’s largest legal publisher, Thomson Reuters West Publishing.

As recognition of his wide range of contribution to his profession and of his dedication to protecting the rights of his clients, he received numerous awards, among them the George F. Douglas Amicus Curiae Award, the Milton D. Rosenberg Award, the B’nai B’rith Justice Award, and awards of recognition from the Pennsylvania Trial Lawyers. [ Attorney Bio ]