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Azaravich, L. v. Wilkes-Barre Hospital, Superior Court of Pennsylvania, decided June 5, 2024.
Person was treated at a hospital for psychiatric problems. Two days after discharge, the patient hung himself with an electrical cord.

A complaint was filed, and later an amended complaint – claiming that the treatment of the Decedent was grossly negligent and/or reckless.

Summary judgement was filed and granted. This case discusses what negligence is, vicarious liability, and gross negligence.


Appellant Laura Azaravich, Administrator of the Estate of Steven Azaravich (Decedent), appeals from the order granting the motions for summary judgment filed by Appellees Wilkes-Barre Hospital Company, LLC D/B/A Wilkes-Barre General Hospital, Daniel May, Crisis Response and Recovery Center of NEPA, and Community Counseling Services (collectively “Appellee Hospital”), Noel Estioko, M.D., and Dana Simon, PA. Appellant Former Justice specially assigned to the Superior Court.
contends that there are genuine issues of material fact that preclude the entry of summary judgment. Appellant also argues that the trial court erred in its application of the immunity provision of the Mental Health Procedures Act (MHPA) to Appellant’s corporate negligence claim. We reverse and remand for further proceedings. The underlying facts of this case are well known to the parties. Briefly, on July 20, 2015 at 12:14 p.m., Decedent called 911 and reported that he was having suicidal thoughts. Pittson City police officers went to Decedent’s home and after Decedent informed the officers that he had thoughts of hanging himself, the officers transported Decedent to Wilkes-Barre General Hospital (WBGH). Appellant checked himself into the emergency department at WBGH. Several WBGH staff members evaluated Decedent. Appellee Simon, a physician assistant (PA), documented that Appellant was experiencing depression and suicidal ideation at 1:20 p.m. Appellee Simon entered an order to detain Decedent at 1:32 p.m.
At 3:50 p.m., Lorna Ruckle, a registered nurse, assessed Decedent with a “high risk” of suicide. Appellee May, a crisis clinician, evaluated Decedent at 5:40 p.m.
We may cite to the parties’ initial or supplemental reproduced record for the parties’ convenience.
May’s handwritten notes indicate that Decedent had reported that he did not have an intent to hang himself, did not have current thoughts of harming himself, and wanted outpatient treatment. May consulted with Jyoti Shah, M.D., the on-call psychiatrist. May did not inform Dr. Shah of Nurse Ruckle’s risk of suicide assessment performed earlier that day and May only reported Decedent’s symptoms as he had assessed them. Dr. Shah does not have access to WGBH’s computer system to check medical records,3and she is dependent on the crisis clinician to provide her with full, complete, and accurate information about a patient. Dr. Shah approved releasing Decedent from WBGH and ordered outpatient treatment for Decedent. Decedent was discharged from WBGH at 6:32 p.m. with a taxi voucher and a call was scheduled for the following day to schedule outpatient psychiatric treatment for Decedent. Appellee Estioko was working as a physician in the emergency department at WBGH during the time Decedent was there. Although WBGH’s records state that a physician treated and evaluated Decedent and Appellee Estioko. The computer system that WBGH was using in 2015 is known as the “IBEX system”. Appellee Estioko testified in his deposition that he did not personally evaluate Decedent on July 20, 2015. Tragically, Decedent took his own life two days later by hanging himself with an electrical cord. Decedent’s parents, Allan Azaravich and Diane Azaravich, acting both individually and on behalf of Decedent’s estate, commenced this action by filing a complaint on July 19, 2017. Both Allan Azaravich and Diane Azaravich passed away during the pendency of this matter. The register of wills subsequent granted letters of administration for Decedent’s estate to Appellant, Decedent’s sister. Appellant filed a second amended complaint on October 31, 2017. Therein, Appellant raised five claims: medical negligence against all Appellees, corporate negligence against Appellee Hospital, wrongful death against all Appellees, a survival action against all Appellees, and a claim for punitive damages against all Appellees. Appellant asserted that Appellees’ conduct and the treatment of Decedent was grossly negligent and/or reckless. See id. The parties filed cross-motions for summary judgment. Appellant also filed exhibits with the trial court in support of her motions and in opposition to Appellees’ motions. parties stipulated to the dismissal of other defendants to this action; and on August 23, 2022, the trial court granted summary judgment in favor of defendant Richard Merkel, M.D. Appellant has not appealed from the August 23, 2022 order.
J-A27018-23-5-for Appellant’s exhibits). On December 20, 2022,5the trial court issued an order and opinion granting Appellees’ motions for summary judgment, denying Appellant’s motions for summary judgment, and dismissing all claims against Appellees with prejudice. Appellant filed a timely appeal. The trial court did not order Appellant to comply with but filed a Rule 1925 opinion adopting its December 20, 2022 opinion and order. On appeal, Appellant raises two issues:1.Where, as here, the trial court grants summary judgment in favor of [Appellees] and against [Appellant] thereby putting [Appellant] out of court, and the trial court’s stated basis for the grant of summary judgment is that [Appellant] failed to establish that the [Appellees] acted in [a] grossly negligent manner, despite the fact that [Appellant] produced no less than six separate expert reports detailing the grossly negligent behavior of [Appellees], which expert reports and opinions the trial court chose to assail and thereafter ignore, whether the trial court committed an abuse of discretion or error of law in granting summary judgment against [Appellant], the non-moving party, in whose favor the trial court was required to be factually biased, such that this Court should reverse the trial court’s decision granting summary judgment against [Appellant] and remand this case to the trial court for a trial before a jury. Where, as here, the trial court refused to apply the negligence standard as opposed to the gross negligence standard to the non-mental health claims such as the severe deviation of the credentialing, staffing, and others, whether the trial court – The trial court’s opinion and order are both dated December 19, 2022, but the trial court notified the parties of the entry of its opinion and order on December 20, 2022.
We have amended the caption accordingly.
J-A27018-23-6-committed an abuse of discretion or an error of law, such that this court is required to reverse the trial court’s December [20], 2022 order granting summary judgment and remand it to the trial court for trial before a jury. Appellant’s Brief at 7-8 (formatting altered). Our standard of review is de novo and our scope of review is plenary. Summary judgment is appropriate where there is no genuine issue of material fact as to a necessary element of a cause of action that can be established by discovery or expert report. In reviewing an order granting a motion for summary judgment, an appellate court must examine the entire record in the light most favorable to the non-moving party and resolve all doubts against the moving party. Liberty Mut. Grp., Inc. v. 700 Pharmacy, LLC, 270 some citations omitted and formatting altered).Where the nonmoving party bears the burden of proof on an issue, [s]he may not merely rely on [her] pleadings or answers in order to survive summary judgment. Failure of a non-moving party to adduce sufficient evidence on an issue essential to [her] case and on which [s]he bears the burden of proof establishes the entitlement of the moving party to judgment as a matter of law. Finder v. Crawford, 167 A.3d 40, 44 (Pa. Super. 2017) (citation omitted). Further, our Supreme Court has held: The moving party has the burden to demonstrate the absence of any issue of material fact, and the trial court must evaluate all the facts and make reasonable inferences in a light most favorable to the non-moving party. [Summers v. CertainTeed Corp., 997 A.2d 1152, 1159 (Pa. 2010)]. The trial court is further required to resolve any doubts as to the existence of a genuine issue of material fact against the moving party and may grant summary judgment only where the right to such a judgment is clear and free from doubt. This Court has held that the summary judgment standard that a trial court must view the facts, and all reasonable
J-A27018-23-7-inferences, in a light most favorable to the non-moving party “clearly includes all expert testimony and reports submitted by the non-moving party or provided during discovery; and, so long as the conclusions contained within those reports are sufficiently supported, the trial judge cannot sue them in an order and opinion granting summary judgment.” An appellate court may reverse a grant of summary judgment only if the trial court erred in its application of the law or abused its discretion. 1159. Bourgeois v. Snow Time, Inc., some citations omitted and some formatting altered); (emphasizing that “it is not the court’s function upon summary judgment to decide issues of fact, but only to decide whether there is an issue of fact to be tried” (citation omitted)). Additionally, the Bourgeois Court explained: Any dispute over what . . . standards [of care and/or conduct] are [applicable to the defendant] goes to the weight and credibility of [the expert’s] testimony, which is not a proper consideration at the summary judgment stage as courts must view the evidence in a light most favorable to the non-moving party; instead, it should be resolved by a factfinder at trial. Bourgeois, 242 A.3d at 658-59 (citation omitted); (stating that “while conclusions recorded by experts may be disputed, the credibility and weight attributed to those conclusions are not proper considerations at summary judgment; rather, such determinations reside in the sole province of the trier of fact” (citations omitted)). Rule of Civil Procedure 1029 provides that, subject to certain exceptions, any general denials or demands for proof in a responsive pleading are treated as admissions.
Therefore, the Rules of Civil Procedures that govern pleadings, including Pa.R.C.P. 1029, do not apply to motions for summary judgment. Id.Medical Negligence In her first issue, Appellant argues that the trial court erred in granting summary judgment in favor of Appellees because the trial court failed to view the evidence in the light most favorable to Appellant as the non-moving party. Appellant’s Brief at 17-25(citing, inter alia, Bourgeois, 242 A.3d at 652). Specifically, Appellant contends that the trial court erred by accepting the moving parties’, i.e.Appellees, summary of the factual history of the case. Id. Further, Appellant claims that trial court erred by “assail[ing Appellant’s] experts’ credibility” because her experts partially relied on allegations of negligence in unrelated litigation against Appellee Estioko and because the trial court erroneously concluded that the experts’ conclusions were not supported by the record, and the experts did not understand the standard of gross negligence. . Therefore, Appellant concludesthat the trial court’s orders granting Appellees’ motions for summary judgment should be reversed and this case remanded for trial. Generally, to establish a prima facie cause of action for medical negligence, a plaintiff must demonstrate the following:(1) a duty owed by the physician to the patient; (2) a breach of that duty; (3) that the breach of duty was the proximate
J-A27018-23-9-cause of the harm suffered by the patient; and (4) that the damages suffered were a direct result of that harm. Determining whether there was a breach of duty involves a two-step process: first, a determination of the standard of care, and second, a determination of whether the defendant physician met that standard. To show causation, the plaintiff must show that the [defendants’] failure to exercise the proper standard of care caused the plaintiff’s injury. Mazzie v. Lehigh Valley Hosp. -Muhlenberg, 257 A.3d 80, 87 (Pa. Super. 2021) (citations omitted and formatting altered). A hospital may be liable for “negligence of its personnel” under a theory of respondent superior. Thompson v. Nason Hosp., 591 A.2d 703, 707 (Pa. 1991) (citation omitted). Further, “[a] hospital may be held vicariously liable for the acts of another health care provider through principles of ostensible agency” if certain facts are established. Section 302 of the MHPA describes the circumstances under which a mentally disabled person may be subject to an emergency involuntary examination:(a) Application for Examination.—Emergency examination may be undertaken at a treatment facility upon the certification of a physician stating the need for such examination; or upon a warrant issued by the county administrator authorizing such examination; or without a warrant upon application by a physician or other authorized person who has personally observed conduct showing the need for such examination. Examination and Determination of Need for Emergency Treatment.—A person taken to a facility shall be examined by a physician within two hours of arrival in order to determine if the person is severely mentally disabled . . . and in need of immediate treatment. If it is determined that the person is severely mentally
J-A27018-23-10-disabled and in need of emergency treatment, treatment shall be begun immediately. If the physician does not so find, or if at any time it appears there is no longer a need for immediate treatment, the person shall be discharged and returned to such place as he may reasonably direct. The physician shall make a record of the examination and his findings. . . . Section 114 of the MHPA states: In the absence of willful misconduct or gross negligence, a county administrator, a director of a facility, a physician, a peace officer or any authorized person who participates in a decision that a person be examined or treated under this act, or that a person be discharged, or placed under partial hospitalization, outpatient care or leave of absence, or that the restraint upon such person be otherwise reduced, or a county administrator or other authorized person who denies an application for voluntary treatment or for involuntary emergency examination and treatment, shall not be civilly or criminally liable for such decision or any of its consequences. In this context, “gross negligence” means “a form of negligence where the facts support substantially more than ordinary carelessness, inadvertence, laxity, or indifference. The behavior of the defendant must be flagrant, grossly deviating from the ordinary standard of care.”