Stang v. SmithStang v. Smith
The basic facts at issue in these proceedings are not uncommon. The negligence of multiple persons is alleged to have combined and caused injury to another — here death. Decedent’s estate files suit against all defendants. None of the defendants files a cross-claim against any other defendant. Prior to trial plaintiff settles with some, but not all of the defendants.
Under these circumstances, whether the names of the settling defendants should be included on the jury verdict slip in order that the liability of each defendant and the degree of their comparative fault can be assessed and determined by the jury, and whether an expert witness called by plaintiff to testify as to the causal negligence of a non-settling defendant, but who opined in response to pretrial discovery that the causal negligence of both settling and non-settling defendants was responsible for plaintiff’s injuries, can be cross-examined at trial on the witness’s earlier opinions critical of the settling defendants, are issues requiring the court’s attention. We address these issues below.
FACTUAL AND PROCEDURAL BACKGROUND
On November 21, 2007, John Stang (“decedent”) was found dead lying on the floor of the Intensive Care Unit (“ICU”) of the Gnaden Huetten Memorial Hospital (“hospital”). The cause of death was DVT/PE, pulmonary embolism caused by deep vein thrombosis from the lower extremities. In layman’s terms, he died of suffocation from сlots in his pulmonary arteries which prevented the exchange of oxygen between his blood and lungs.
What caused decedent’s death is not in dispute; why, is.
When Mrs. Stang spoke with Dr. Lesitsky onNovember 15,2007, she described decedent’s symptoms. Dr. Lesitsky made a preliminary diagnosis of benign positional vertigo and recommended that decedent lie down and get rest. Dr. Lesitsky also advised that if decedent’s condition continued or worsened he should be taken to the Hospital for further evaluation. This conversation occurred at approximately 2:00 A.M.
Later that morning, between 6:00 and 6:30 A.M., Mrs. Stang left for work. She was employed as a pilot driver — an escort for oversized over-the-road motor vehicles — and was scheduled to be out of state. Expecting to be away most of the day, Mrs. Stang arranged for her sixteen-year-old son, Edwаrd Curtis,
While she was away Mrs. Stang periodically checked with her son as to decedent’s condition. No change was noted. When Mrs. Stang returned home at 5:30 P.M.,
Decedent arrived at the hospital at 6:08 P.M. and was examined by Dr. Frank Penater, an emergency room physician, at 6:15 P.M. Dr. Penater found decedent to be dehydrated and suspected he had the flu. As a precautionary measure, deсedent was admitted to the hospital by Dr. Deborah Smith, an internist, for continued observation.
Dr. Smith was decedent’s attending physician upon his admission to the hospital. During her initial assessment of decedent at 8:16 P.M., Dr. Smith detected signs of nystagmus and disconjugate gaze, and decedent reported experiencing double vision. Dr. Smith ordered a brain CT scan. The results of this exam revealed that decedent had suffered an acute ischemic stroke in the posterior inferior cerebellar artery, more commonly referred to as a PICA stroke. At this point, decedent was transferred to the hospital’s ICU upon Dr. Smith’s order. Also on this date, November 15, 2007, at 10:45 P.M., Dr. Smith requested a neurological consult from Dr. Rajinish Chaudhry, the on-staff neurologist for the hospital.
Between his admission on November 15,2007, and his death on November 21,2007, decedent was under the care of three separate attending physicians: Dr. Smith from November 15, 2007 to November 17, 2007; Dr. Joseph McGinley from November 17, 2007 to November 19, 2007; and Dr. Patrick Hanley, from November 19,2007 to November 21,2007. During this time, decedent’s attending physicians neither ordered nor provided prophylactic preventive care against DVT and PE (e.g., anticoagulation therapy such as low dose Heparin) to decedent.
Decedent was examined by Dr. Chaudhry on November
Decedent’s wife (“plaintiff”), individually and in her capacity as administratrix of decedent’s estate, commenced the instant suit by praecipe for writ of summons filed on November 2, 2009. Named as defendants were the hospital; Drs. Smith, McGinley, Hanley, Lesitsky and Chaudhry; and Neil Wesner, M.D.
Shortly before trial was scheduled to commence on December 3, 2012, plaintiff reached settlement with the hospital and decedent’s attending physicians, Drs. Smith, McGinley and Hanley (“settling doctors”). (The hospital and settling doctors are collectively referred to herein as the “settling defendants.”). As part of this settlement, plaintiff executed a pro rata joint tortfeasor release on November 27, 2012, (the “release”) in accordance with the Uniform Contribution Among Tort-Feasors Act (“UCATA”), 42 Pa.C.S.A. §§ 8321-8327. This release provided that if Drs.
After settlement was reached, plaintiff moved to discontinue the action against the settling defendants, to preclude evidence that plaintiff had sued the settling defendants, and to bar the non-settling defendants from cross-examining her medical experts at trial about opinions they had previously rendered against the settling defendants. These motions were denied.
Following a two-week trial which began on September 30, 2013,
1. Denial of Plaintiff’s Motion to Discontinue Her Claims Against the Settling Defendants and to have the Settling Defendants Dismissed as Parties
Plaintiff claims we erred by denying her motion to discontinue her suit against the hospital and Drs. Smith, Hanley and McGinley, as well as placing the settling doctors’ names on the jury verdict slip in order that the jury could determine the comparative liability of the settling doctors vis-a-vis the non-settling defendants. We disagree.
Section 8326 of the UCATA, the provision which controls set-off, provides:
A release by the injured person of one joint tort-feasor, whether before or after judgment, does not discharge the other tort-feasors unless the release so provides, but reduces the claim against the other tort-feasors in the amount of the consideration paid for the release or in any amount or proportion by which the release provides that the total claim shall be reduced if greater than the consideration paid.
42 Pa.C.S.A. § 8326. Here, the relеase executed by plaintiff and given to the settling defendants stated in
It is understood that I, Lorrie Stang...am not hereby releasing any claims or demands that I have against Neil Lesitsky, M.D. and Rajinish Chaudhry, M.D. It is further understood and agreed, however, that if it should be determined that Neil Lesitsky, M.D. and Rajinish Chaudhry, M.D. are jointly or severally liable in tort to the plaintiffs with any person or entity herein released, the claim against and damages recoverable from Neil Lesitsky, M.D. and Rajinish Chaudhry, M.D. shall be reduced to the extent of the pro-rata share of legal responsibility or legal liability for which the parties herein released are found to be liable for as a consequence of the aforesaid medical care or treatment. It is intended that this Release shall comply with and be interpreted in accordance with the Uniform Contribution Among Joint Tortfeasor Act as enacted and amended in Pennsylvania.
The effect of this provision was to allow the non-settling defendants to reduce the amount of any monies jointly owed by them and the settling defendants to the plaintiff in an amount equal to the settling defendants’ apportioned share of the verdict. Baker v. ACandS,
In this case, plaintiff alleged and supported with expert reports claims that the defendants failed to properly evaluate and treat decedent’s stroke, and further failed to take proper steps to prevent оr, at a minimum, reduce the risk of the deep vein thrombosis/pulmonary embolism that ultimately caused decedent’s death. The claims as alleged in plaintiff’s amended complaint and supported by her expert reports set forth claims of liability in tort against the defendants for the damages claimed by plaintiff, making
Under settled Pennsylvania law, the non-settling defendants were entitled to have the settling defendants remain as parties to this action in order to establish their status as joint tortfeasors and, if found to be joint tortfeasors, to have the jury apportion or allocate liability among them in оrder that the amount of damages the non-settling defendants might be liable to pay could be determined. Thus, the inclusion of the settling defendants as parties at trial was necessary for the jury to evaluate the respective fault of all tortfeasors alleged to have been negligent and responsible for decedent’s death and, if applicable, apportion liability to the settling defendants. See Baker,
In Davis v. Miller,
It is therefore clear that an important factor in the determination of the amount of damages that Miller may be required to pay to plaintiffs is whether or not Mary Richardson would also have been liable to them had they not released her-in other words, whether she was a joint tortfeasor with Miller. If such she was, then, under the Act and the terms of the releases which plaintiffs gave her, they can recover from Miller only his pro rata share, in this case half, of the amount to which they otherwise would have been entitled; if, on the other hand, she was not a joint tortfeasor, the releases given her by plaintiffs would not inure to Miller’s benefit....
Therefore, although Miller cannot recover contribution from the additional defendant, he does have an extremely valuable right in retaining her in the case, because, if the jury should find her to be a joint*439 tortfeasor, his liability to plaintiffs would be cut in half Her continuance in the case is therefore necessary, even though no recovery can be had against her either by plaintiffs or by defendant, in order to determine the amount of damages that defendant may be obliged to pay plaintiffs in the light of the situation created by their releases of the additional defendant’s liability.
Id. at 424 (emphasis added)(citations omitted). See also Slaughter v. Pennsylvania X-Ray Corp.,
2. Existence of Prima Facie Case Against Settling Doctors
Although a non-settling defendant has a right to require a settling defendant to remain as a party in the case during trial, there is no absolute right to have the settling defendant on the verdict slip. Hyrcza,
Plaintiff’s expert, Dr. Mark Graham, board certified in internal medicine, testified unequivocally that the settling doctors werе negligent in their care of decedent and, further, that this negligence increased the risk of harm, including death, to decedent. (N.T. 10/2/13, pp. 176-178, 180-183, 186-191). As to Dr. Smith, Dr. Graham testified that she deviated from the standard of care in failing to order aspirin and other anti-coagulation therapy for decedent (N.T. 10/2/13, pp. 180, 183) which increased the risk for decedent’s stroke progression and DVT or PE (N.T. 10/2/13, pp. 182-183), and that Dr. Smith’s negligence in failing to provide DVT prophylaxis deprived decedent of his “best chance” to prevent DVT. (N.T. 10/2/13, p. 186). As to Drs. McGinley and Hanley, Dr. Graham testified that they deviated from the standard of care by failing to order DVT prophylaxis, low-dose Heparin, and compression boots (N.T. 10/2/13, p. 188), thereby depriving decedent of his best chance to prevent DVT and/or PE and substantially increasing his risk of death. (N.T. 10/2/13, p. 189).
Dr. Graham further characterized the judgment of Drs. McGinley and Hanley that anticoagulation therapy was contraindicated due to decedent’s hypertension as
Dr. David Rosenbaum, a board-certified neurologist employed by plaintiff, testified that Dr. Chaudhry deviated from the standard of care for a neurologist by not seeing the decedent within twenty-four hours of the requested consult; that a neurologist should be aware that DVT prophylaxis is required by the standard of care for a stroke patient; that a neurologist who fails to prescribe aspirin and DVT prophylaxis for a stroke victim, if not prescribed by others, deviates from the standard of care; and that the failure to provide any DVT prophylaxis to decedent while he was in the hospital and the failure to provide aspirin or to transfer decedent to a stroke center at an earlier point in time, all caused or contributed to decedent’s death. In addition, Dr. Rosenbaum testified that Drs. Smith, McGinley and Hanley were each aware of the increased risk of DVT and PE due to stroke and their failure to provide or order any anticoagulation therapy caused оr contributed to decedent’s death.
As the foregoing shows, during plaintiff’s case-in-chief the evidence presented clearly allowed the jury to conclude that the settling doctors deviated from the applicable standard of care and that each of these deviations caused or contributed to decedent’s death. Under Herbert, this was sufficient to include the settling doctors on the verdict slip. Moreover, to the extent plaintiff’s experts’ attribution of negligence to the non-settling defendants was predicated on facts and conduct equally applicable to the settling doctors, even absent any explicit attribution of fault to the settling doctors, thе jury was entitled to take such information into account in assessing liability
3. Scope of Cross-examination of Plaintiff’s Expert Witnesses
Prior to trial, plaintiff’s medical experts opined that not only the non-settling defendants, but also the settling defendants, were negligent and responsible for decedent’s death. In particular, in Dr. Graham’s expert report he criticized the care provided by both the non-settling and settling defendants, opining that such care deviated from the applicable standard оf care, and concluding that this deviation caused or contributed to decedent’s death. Dr. Rosenbaum, who was critical of Dr. Chaudhry’s neurological care of the decedent, also opined that the delay in getting decedent to the hospital which resulted from Dr. Lesitsky’s failure to advise Mrs. Stang to take her husband to the hospital immediately for stroke evaluation both increased the risk of harm and caused or contributed to the decedent’s death. Absent settlement of plaintiff’s claims against the settling defendants, these experts were scheduled to testify on plaintiff’s behalf against the settling defendants.
Once settlement was reached, plaintiff requested that the testimony of Drs. Graham and Rosenbaum be limited to their opinions critical of the non-settling defendants only and that the non-settling defendants be barred from cross-examining plaintiff’s experts as to any opinions held by them critical of the settling defendants. By order dated September 16,2013, we refused to restrict the scope of the non-settling defendants’ cross-examination of plaintiff’s
In Boucher v. Pennsylvania Hospital,
Generally, every circumstance relating to the direct testimony of an adverse witness or relating to anything within his or her knowledge is a proper subject for cross-examination, including any matter which might qualify or diminish the impact of direct examination. Specifically regarding medical experts, the scope of cross-examination involving a medical expert includes reports or records which have not been admitted into evidence but which tend to refute that expert’s assertion.
Id. at 629 (citations and quotation marks omitted), appeal denied,
Without question, cross-еxamination of plaintiff’s medical experts with respect to the entirety of their opinions as expressed in their expert reports was permissible for impeachment purposes: the manner in which plaintiff sought to limit the testimony of her medical experts in her case-in-chief would otherwise have been skewed and given the false impression that these experts were of the opinion that the non-settling
Moreover, this evidence was also admissible to prove the substantive liability of the settling defendants. First, the evidence was not hearsay. The opinions being elicited were those of the witness on the stand being cross-examined and they were clearly subject to questioning by all parties. Nor did such questioning run afoul of the rule that one party may nоt compel an expert for the opposing party to offer an opinion against his will. Boucher,
CONCLUSION
The standard for granting a new trial for rulings made by the court requires not only technical error, but also demonstrated harm. Harman ex rel. Harman v. Borah,
The jury concluded that none of the individual defendants were negligent in their care of decedent. Consequently, not only did the jury find that neither
Notes
. Mr. and Mrs. Stang were married on November 10, 2006. This was the third marriage for each. Mr. Curtis was decedent’s stepson.
. By order dated April 13,2011, entered pursuant to stipulation, Dr. Wesner was dismissed as a defendant prior to trial.
. At plaintiff’s request, a last minute continuance of the trial scheduled for December 3,2012 was granted due to a family emergency of plaintiff’s counsel. As part of counsel’s agreement to continue trial, all counsel agreed to maintain the status quo as it existed for the trial which was to commence on December 3, 2012.
. At the close of plaintiff’s case, plaintiff moved for a compulsory nonsuit as to each of the settling defendants. We denied the motion as to the settling doctors and granted the motion as to the hospital. No party has appealed our decision to dismiss the hospital from this suit.
. Plaintiff has preserved four determinative issues for post-trial relief. See motion for post-trial relief filed on October 21, 2013, letter dated December 6, 2013, withdrawing multiple issues from consideration, and plaintiff’s brief in support of post-trial motion filed on January 13, 2014. Of these four issues, three are discussed below. The fourth concerns our order dated October 4,2012, barring decedent’s son, Andrew Stang, from testifying at trial as a disсovery sanction. The reasons for that order were set forth in a footnote opinion to the order and will not be repeated here.
Since the October 4,2012, order, two events have occurred rendering any error of which plaintiff complains, and we see none, harmless. First, ever since decedent’s death, Andrew Stang has been withdrawn and emotionally unable to cope with his father’s death. Andrew was
Second, had Andrew Stang testified his testimony would have been relevant only to the issue of damages. As the jury found no liability against any defendant and never reached this issue, our October 4,2012, order could have had no effect on the jury verdict.
. The act defines the term “Joint Tort-feasors” as “two or more persons jointly or severally liable in tort for the same injury to persons or property....” 42 Pa.C.S.A. § 8322. Two actors are jointly liable for an injury if their conduct “causes a single harm whiсh cannot be apportioned.... even though [the actors] may have acted independently.” Mattia v. Sears, Roebuck & Company,
. The Uniform Contribution Among Tort-feasors Act “is a comprehensive act which dictates the effect of a release as to other tortfeasors, the method for computing set-off, and under what, circumstances an action in contribution is to be allowed.” Baker v. ACandS,
Where a plaintiff and a settling defendant sign a pro tanto release, then the plaintiff’s ultimate recovery against the non-settling joint tortfeasors is the total award of damages reduced by the amount of consideration paid for the release. In contrast, if the parties sign a pro rata release (which is also known as an “apportioned share setoff’ release), then the plaintiff’s ultimate recovery against the non-settling tortfeasors is the total award of damages reduced by the settling party’s allocated share of the liability.
Id. at 666 n.l. Nevertheless, “a non-settling defendant is not entitled to a set-off in light of the settling defendant’s release unless the settling and non-settling defendants are both deemed to be joint tortfeasors. 42 Pa.C.S.A. § 8326.” Id. at 671.
Because joint tortfeasors are jointly and severally liable, meaning that one joint tortfeasor may be compelled to satisfy the entire money judgment, the UCATA is designed with the equitable goal that a joint tortfeasor pay only his fair share of the plaintiff’s injuries for which he is responsible. To achieve this result, a “joint tortfeasor’s recourse for paying more than its proportionate share of the verdict is to sue the nonpaying joint tortfeasоrs in contribution. See 42 Pa.C.S.A. § 7102; 42 Pa.C.S.A. §§ 8324 (c) and 8327.” Baker,
As to the right of contribution provided for under Section 8324 (b) of the UCATA, the Mattia Court stated:
*440 The right of contribution may be asserted during the original proceeding via joinder of a third-party defendant. See Pa.R.Civ.P. 2252. Or it may be pursued in a separate action brought by a tortfeasor who has previously been held liable to the original plaintiff. In the latter instance, the party seeking contribution must stand in the shoes of that original plaintiff and prove that the new defendant was a joint tortfeasor and that his tortious conduct also caused the harm at issue.
Mattia,
Requiring the settling defendants to remain as parties to the litigation and thus allowing the jury to potentially apportion liability to the settling dеfendants was necessitated further by the terms of the release which would otherwise prohibit the non-settling defendants from seeking contribution. See 42 Pa.C.S.A. § 8327 (liability to make contribution as affected by release) which provides:
A release by the injured person of one joint tortfeasor does not relieve him from liability to make contribution to another tortfeasor, unless the release is given before the right of the other tortfeasor to secure a money judgment for contribution has accrued and provides for a reduction to the extent of the pro-rata share of the released tort-feasor of the injured person’s damages recoverable against all the other tortfeasors.
(emphasis added). Compare National Liberty Ins. Co. v. Kling Partnership,
. The four elements that a plaintiff must prove to support a claim
(1) that the medical practitioner owed a duty to the patient,
(2) that the practitioner breached that duty.
(3) that that breach was a proximate cause of, or a substantial factor in, bringing about the harm suffered by the patient, and
(4) that the damages suffered by the patient were a direct result of the harm.
Herbert v. Parkview Hospital,
. This case is remarkably similar to the instant case on the key issues we address, including the jury’s verdict finding none of the defendants, settling or non-settling, negligent. The trial court’s opinion in Kol was affirmed by the Superior Court at
. In addition, at no time did plaintiff request a limiting instruction that the non-settling defendants’ cross-examination of plaintiff’s medical experts be restricted to impeachment purposes. See plaintiff’s motion to preclude evidence of, references to and examination of plaintiff’s expert witnesses and the settling defendants on DVT/PE prophylaxis, non-settling defendants’ responses thereto, court order dated September 16, 2013, ruling on the motion, and plaintiff’s objection at the time of trial. (N.T. 10/2/13, p. 3) (making no distinction in plaintiff’s objection to the non-settling defendants’ cross-examination of plaintiff’s medical witnesses between cross-examination for substantive or impeachment purposes).