opinion of the Court:
¶ 1 In this case we are asked to determine what constitutes an actionable claim for abuse of a vulnerable adult under the Adult
BACKGROUND
¶ 2 Because the superior court granted summary judgment, we review the facts and reasonable inferences in the light most favorable to Marika Delgado as the non-moving party. See Andrews v. Blake,
¶3 This ease arises from the death of Sandra Shaw while she was a patient at Manor Care’s skilled nursing facility in Tucson. Dr. Gordon J. Cuzner was Shaw’s primary treating physician at Manor Care.
¶4 After being treated at four different hospitals in late 2011 and early 2012, Shaw was discharged to Manor Care for physical and occupational therapy, as well as skilled nursing care. When Shaw was admitted to Manor Care in March 2012, she was in poor health. Shaw was suffering from several serious medical conditions, including chronic kidney disease, decreased kidney function, acute kidney failure, anemia, heart disease, and hypertension; she also had recently undergone surgery to remove a brain tumor and had a history of urinary tract infections. Additionally, Shaw was confined to a wheelchair and needed assistance with walking, bathing, dressing, toileting, transfers, and bed mobility.
¶ 5 Following her admission, Shaw’s condition initially improved. However, by late April 2012, her condition was deteriorating. She became confused, refused to get out of bed, and began eating and drinking less. On April 30, Dr. Cuzner ordered lab tests and a urinalysis; the results indicated that Shaw had an “early” septic infection. Nonetheless, Dr. Cuzner issued no new orders or treatment for Shaw. On the morning of May 1, Shaw’s condition worsened. She was confused, disoriented, and lethargic, and had not eaten or taken any fluids in over two days. The assistant director of nursing was notified of her condition, but no further orders or treatment were provided for Shaw. A few hours later, she died. The cause of death was sepsis.
¶ 6 Delgado, Shaw’s sister and the personal representative of her estate, filed this action against Dr. Cuzner, Manor Care, and several persons and entities that allegedly owned or were related to Manor Care (collectively, “Defendants”). Delgado alleged several claims, including a claim for both abuse and neglect of a vulnerable adult under APSA See A.R.S. § 46-451(A)(l)(b) (defining “abuse”); A.R.S. § 46-451(A)(6) (defining “neglect”). Manor Care and Dr. Cuzner moved for summary judgment on Delgado’s APSA claim.
¶ 7 The superior court granted Defendants’ motion. In making its ruling, the court applied the four-part test adopted in McGill:
to be actionable abuse under APSA, the negligent act or acts (1) must arise from the relationship of caregiver and recipient, (2) must be closely connected to that relationship, (3) must be linked to the service the caregiver undertook because of the recipient’s incapacity, and (4) must be related to the problem or problems that caused the incapacity.1
¶ 8 The court of appeals reversed. Delgado v. Manor Care of Tucson,
DISCUSSION
¶ 10 We review de novo both a grant of summary judgment, Andrews,
¶ 11 Defendants argue Delgado has no actionable APSA claim because she cannot satisfy the third and fourth parts of the McGill test. They contend that Shaw’s sepsis was not “related to the problem or problems” that made her a vulnerable adult. McGill,
I. The McGill Test
¶ 12 In McGill, this Court addressed whether A.R.S. § 46—461(A)(1)(b) permits an APSA claim to be based on a physician’s single act of negligence. Id. at 526 ¶ 1,
¶ 13 In construing APSA, the Court held that “we can neither automatically limit the negligent act or omission wording of A.R.S. § 46—451(A)(1) to a series of negligent acts nor say that a single act of negligence involving an incapacitated person will never give rise to an APSA action.” Id. at 530 ¶ 16,
¶ 14 Attempting to harmonize the statutory language and the legislature’s intent, the Court formulated McGill’s four-part test. Id. at 526, 529-31 ¶¶ 1, 14-16, 21-22,
¶ 15 The McGill test has proved to be problematic. The legislature enacted APSA to protect vulnerable adults, and to further this purpose, it created a broad remedial cause of action against caregivers who, by means of abuse, neglect, or exploitation, endanger the life or health of a vulnerable adult. A.R.S. §§ 46-455(B), -455(0); see also In re Estate of Winn,
¶ 16 The McGill test has also been difficult to apply. As McGill recognized, “[w]e are well aware that this formulation does not provide an easy, bright-line test for judges and juries.” Id. at 530 ¶ 17,
II. APSA’s Requirements for an Abuse Claim
¶ 17 In identifying the elements for an APSA claim, our principal guide is the statute’s language. Section 46-455(B) provides that a “vulnerable adult whose life or health is being or has been endangered or injured by neglect, abuse or exploitation may file an action in superior court against any person or enterprise that has been employed to provide care....” (Emphasis added,) Thus, an APSA claim is premised initially on whether a person is a “vulnerable adult.” Id. A “vulnerable adult” is defined as “an individual who is eighteen years of age or older and who is unable to protect himself from abuse, neglect or exploitation by others because of a physical or mental impairment.” A.R.S § 46-451(A)(9).
¶ 18 APSA also requires a party to show that a vulnerable adult has suffered an “injury caused by [a caregiver’s] negligent acts or omissions.” A.R.S. §§ 46-451(A)(l)(b), - 455(B). APSA defines a caregiver as a person or “enterprise” employed to provide care to a vulnerable adult, and includes care provided at a nursing home or an acute care hospital. A.R.S. § 46-455(B), 455(Q); see Wyatt,
¶ 19 Thus, by its terms, APSA identifies four requirements for an actionable abuse claim: (1) a vulnerable adult, (2) has suffered an injury, (3) caused by abuse, (4) from a caregiver. A.R.S. §§ 46-451(A)(1)(b), -455(B).
¶ 20 The fact that APSA identifies the requirements for an abuse claim, combined with the difficulties accompanying the four-part McGill test, prompts us to reconsider the McGill test. In particular, the third and fourth prongs of the McGill test are not found in the statute, and, when applied, have produced a great deal of confusion.
¶ 21 Defendants argue that if the McGill test is not followed, then “APSA will apply to virtually all medical malpractice cases arising from care provided to adults in inpatient healthcare institutions,” including care of “acute conditions.” To avoid this potential liability, Defendants urge us to continue following the four-part test and not expand the “boundaries” set by McGill.
¶ 22 We recognize that the broad language of APSA creates considerable overlap between medical malpractice claims arising under the MMA and abuse claims under APSA, However, we will not engage in a “narrow construction” of APSA that “thwartfs] the legislature’s goal of protecting vulnerable adults.” Wyatt,
¶ 23 Additionally, Defendants claim that based on the doctrine of legislative acquiescence, that the McGill test has been incorporated into APSA. Specifically, Defendants contend that APSA has been amended several times since the McGill test was adopted and, therefore, the legislature has tacitly approved of the test. Cf. Madrigal v. Indus. Comm’n,
¶25 We therefore disapprove the McGill test and hold that an actionable APSA abuse claim requires proof of the four basic elements set forth in the statute. See supra, ¶19.
III. Delgado’s APSA Claim
¶ 26 Viewing the facts and all reasonable inferences in the light most favorable to Delgado, as we must, we conclude that the superior court erred in granting summary judgment in favor of Defendants.
¶ 27 Shaw qualifies as a vulnerable adult. She was a frail seventy-four-year-old woman who, at the time of her admission, needed assistance in virtually every daily activity of life. There is no dispute that Man- or Care qualifies as an “enterprise” employed to provide care to Shaw, and that Dr. Cuzner was her primary physician at Manor Care. Additionally, in her capacity as personal representative of Shaw’s estate, Delgado properly alleges damages for Shaw’s injuries. A.R.S. § 46-455(P); In re Guardianship/Conservatorship of Denton,
¶28 Delgado has also presented a triable issue as to whether Manor Care abused Shaw, thereby causing her death. Delgado submitted medical records and the preliminary expert affidavits of Nurse Kathleen Hill-O’Neil and physician Leonard S. Williams showing that due to Shaw’s serious medical conditions, she could not care for herself and required close monitoring and medical attention to ensure her safety and well-being. Nurse Hill-O’Neil opines that the nursing staff at Manor Care breached the applicable standard of care by failing to notify Dr. Cuzner about Shaw’s deteriorating condition and also by failing to provide necessary treatment and care as her condition worsened. See Cornerstone Hosp. of Se. Ariz., L.L.C., v. Marner,
¶ 29 The superior court also erred in granting summary judgment in favor of Dr. Cuzner. Dr. Williams opines that Dr. Cuzner breached the standard of care by failing to properly treat Shaw’s sepsis. Dr, Williams also concludes that Dr. Cuzner’s breach of the standard of care caused Shaw “unnecessary pain and suffering and contributed to her death.”
¶ 30 Dr. Cuzner asks us to address his argument that he should not be held liable irrespective of any potential liability on the part of Manor Care. However, throughout this litigation, including briefing in his petition for review, Dr. Cuzner joined in Manor Care’s argument that there was no viable APSA claim under the McGill test because Shaw’s death was not related to the conditions causing her incapacity. Thus, our analysis regarding Dr. Cuzner is limited solely to the legal and factual arguments raised by Manor Care, and we decline to address his arguments not raised below.
¶31 Defendants argue that Delgado has failed to present any admissible evidence showing abuse. Specifically, Defendants claim the superior court granted them motion to strike the affidavits of Nurse Hill-O’Neil and
¶ 32 In sum, on this record, we conclude the superior court erred in granting summary judgment in favor of Defendants on Delgado’s APSA abuse claim. In addition, like the court of appeals, because we reverse the superior court’s grant of summary judgment based on Delgado’s abuse claim, we do not decide whether Delgado alleged an actionable claim for neglect pursuant to APSA. AR.S. § 46-451(A) (6). Delgado,
CONCLUSION
¶33 Accordingly, we vacate the court of appeals’ opinion, reverse the superior court’s grant of summary judgment, and remand this case to the superior court for further proceedings.
Notes
. Cf. 2009 Ariz. Sess. Laws, ch. 119, §§ 4-10 (1st Reg. Sess.) (providing that a "vulnerable adult” includes an "incapacitated person,” and amending all references in APSA to "incapacitated or vulnerable adult” to "vulnerable adult”).