MEDICAL MALPRACTICE-NURSING HOME-CAUSATION

Stetts v. Manor Care of Williamsport PA, Pa. No. 16-0983 (C.P. Lycoming March 18, 2022) (Linhardt, J.)  The procedural history of this case is discussed at length in this Court’s December 30, 2021 Opinion and Order addressing Defendants’ Motion to Remand to Compulsory Arbitration and Defendants’ Motion for Partial Summary Judgment. In that Opinion and Order, the Court denied the Motion to Remand and granted in part the Motion for Partial Summary Judgment. Specifically, the Court denied the Motion as to negligence per se claims based on 18 Pa. C.S. § 2713, the breach of fiduciary duty claim, corporate negligence claims premised on a failure to train or supervise staff, and punitive damages claims arising from the August 1, 2014 incident. The Court granted the Motion as to negligence per se claims based on the Older Adults Protective Services Act, the aiding and abetting breach of fiduciary duty claim, all 2 corporate negligence claims not premised on failure to train or supervise, and all punitive damages claims not arising out of the August 1, 2014 incident. On January 11, 2022, Plaintiff filed the instant Motion seeking reconsideration of the grant of summary judgment as to Plaintiff’s corporate negligence claim premised on alleged understaffing of the facility (as well as related punitive damages claims). In the alternative, Plaintiff requested that this Court certify the issue for interlocutory appeal. Defendants filed an Answer to the instant Motion on January 27, 2022, and the Court heard argument on January 31, 2022.  Taken in a light most favorable to Plaintiff, the evidence clearly establishes that Mr. Stetts suffered injury at the Facility; assistance at the 147-bed facility was not always immediate and was occasionally significantly delayed; Mrs. Stetts and Mark Stetts had the impression, as laypeople, that the facility was understaffed; and two unnamed staff members made statements suggesting they too believed the Facility was understaffed. The Court found that Plaintiff did not present any evidence from which a factfinder could conclude that any of the delays or perceived understaffing reported by Mrs. Stetts or Mark Stetts caused injury to Mr. Stetts. The Court similarly found that Plaintiff did not present evidence that any of the injuries allegedly suffered had understaffing as a contributing factor. Ultimately, the Court’s conclusion was that the record at summary judgment did not contain facts which established that HCR ManorCare, Inc.’s actions “[were] a substantial factor in causing the harm to the injured party.” This is because 1) the record was insufficient to demonstrate that HCR ManorCare, Inc. caused or otherwise allowed this Facility, in Williamsport, between July 30, 2014 and August 25, 2014, to be understaffed, and 2) the record was insufficient to demonstrate that alleged understaffing caused or contributed in any legally significant way to Mr. Stetts’s injuries. In Scampone v. Grane Healthcare Co., 11 A.3d 967 (Pa. Super. 2010), the Superior Court found (and the Supreme Court did not disagree) that the plaintiff had presented enough evidence to support the jury’s verdict against Highland on the issue of corporate negligence based on understaffing, and had presented enough evidence against Grane on the issue of understaffing that the grant of a nonsuit on that claim was improper. Plaintiff seems to read the holding of Scampone to be this: if a plaintiff can demonstrate understaffing at the facility for which the corporation overseeing the facility is responsible, and plaintiff can establish that the facility’s breaches in the standard of care caused harm to the resident, then the plaintiff may present the evidence of understaffing to the jury, who is free to accept or reject the plaintiff’s contention that the understaffing was connected to the injury in such a way that the corporation’s action or inaction is “a substantial factor in causing the harm to the injured party.” The question at the heart of Plaintiff’s request for reconsideration, then, is: if the record demonstrates understaffing, and demonstrates a breach of care, what showing is required to connect alleged understaffing to the alleged harm suffered by a resident prior to allowing the case to proceed to a jury? The plain language of Thompson makes clear that some showing is required. Under Thompson, a plaintiff must show that the corporation’s negligence was “a substantial factor in causing the harm to the injured party.” If that negligence is alleged to be understaffing, but there is no connection between understaffing and the breach that caused the injury, then the corporation’s negligence cannot be said to be a factor, let alone a substantial one, in causing the harm to the injured party. Further, although some connection must be established, it is apparent that expert testimony is not always required to establish this connection. In Scampone, the plaintiff presented expert testimony that Highland breached its duties, and those breaches caused the decedent’s injuries and death, but only lay testimony established the existence of understaffing and the causal connection between the understaffing and the breaches. The Court in Scampone did not hold, however, that expert testimony is never required to establish a causal connection between understaffing and breaches of duties of care; it addressed whether the evidence presented in that case was sufficient to establish that connection, not whether any quantum of lay evidence presented in any case would necessarily be sufficient. Thus, the question becomes: when may the causal connection between understaffing and a breach of duty of care be shown by lay evidence, and when is expert testimony required? In the absence of an obvious connection between the alleged breach and the harm suffered, Pennsylvania case law requires expert testimony to provide the causal connection. That is what the Court found to be missing here. Ultimately, whether understaffing was a substantial factor in causing the injury is a question of causation, which, under Welsh, must be proved by expert testimony in a corporate negligence case unless the causal relationship is obvious. The record does not establish this connection by expert testimony, lay testimony, or other evidence, and therefore as a matter of law Plaintiff cannot show on the record that the alleged negligence of HCR ManorCare, Inc. was a “substantial factor in causing the harm to” Mr. Stetts. For this reason, the Court DENIES Plaintiff’s Motion for Reconsideration of its December 30, 2021 Order.