Before the court are the preliminary objections of defendant, HCR Manor Care Inc., t/a Manor Care of Pottsville, to the complaint filed by the plaintiff, Mamie I. Frantz, individually and as executrix of the estate of Curtis L. Frantz Sr. her deceased husband. Plaintiff maintains that the quality of care delivered to the plaintiff’s decedent from the defendant fell below an acceptable standard of care resulting in Mr. Frantz’ death. Defendant is engaged in the business of providing nursing home services as a health care provider licensed by the Commonwealth with its principal place of business located in the City of Pottsville, Schuylkill County, Pennsylvania.
On December 18, 2000, plaintiff’s decedent was admitted to the defendant’s nursing home for respite care. Prior to his admission, plaintiff had been providing care to her husband at home with the assistance of Pinnacle Hospice Care. Respite care was recommended by Hospice to allow plaintiff to deal with her health problems brought on by the demands of being her husband’s primary care giver. Plaintiff’s decedent had been diagnosed with lung cancer in October 1999. His health slowly declined over time. Plaintiff’s decedent received hospice care on November 29, 2000 until his transfer to
Plaintiff asserts that at the time of her husband’s admission he had the following: (1) reddened area on his buttocks commonly referred to as a pressure area also known as a stage one decubitus ulcer; (2) impaired lung capacity with a physician’s order for constant oxygen; (3) dietary needs requiring soft and pureed food which needs were discussed with defendant’s staff; (4) pain which required narcotic pain medication through a patch applied to his skin with physician-ordered medication for break-through pain control; (5) shortness of breath which required the administering of Ativan on an as-needed basis; (6) inability to walk and sit without support.
The complaint also avers that during the course of the decedent’s six-day stay at the nursing home the decedent was not provided with oxygen; suffered three falls; had no precautions to protect him from the falls until after the first two falls; was not provided with pureed or soft form food; was not turned and positioned to prevent the progression of the ulcer on his buttock; mouth care and hydration were not provided every two hours; nor was staff intervention provided to the decedent as re
Plaintiff’s second amended complaint sets forth five counts: negligence, negligence per se, corporate liability, wrongful death in which punitive damages are requested, and survival action in which punitive damages are also requested. The preliminary objections sub judice are:
I. A demurrer to the negligence per se and negligence claims for violations of federal and state regulations.
II. Amotion to strike paragraphs 54(p) and (y) for lack of specificity.
III. A demurrer to corporate liability, and, in the alternative, a motion to strike the corporate liability allegations for lack of specificity.
When reviewing preliminary objections in the nature of a demurrer, we must accept all material facts set forth in the complaint as well as all inferences reasonably deducible therefrom as true. The question presented by the demurrer is whether, on the facts averred, the law says with certainty that no recovery is possible. “Where any doubt exists as to whether a demurrer should be sustained it should be resolved in favor of overruling the demurrer.” Jackson v. Garland, 424 Pa. Super. 378, 381, 622 A.2d 969, 970 (1993), The Reverend J.E.J. Sr. v. Tri-County Big Brothers/Big Sisters Inc., 692 A.2d 582 (Pa. Super. 1997).
Under Pennsylvania law, preliminary objections should only be sustained in cases that are “free and clear from doubt.” Bower v. Bower, 531 Pa. 54, 57, 211 A.2d 181, 182 (1992). Therefore, “a court must overrule [objections in the nature of a demurrer] if the complaint pleads sufficient facts which, if believed, would entitle the petitioner to relief under any theory of law.” Wilkinsburg Police Officers Association v. Commonwealth, 535 Pa. 425, 431, 636 A.2d 134, 137 (1993). Since we must follow these principles, the defendant’s preliminary objections are sustained in part and overruled in part.
I. NEGLIGENCE PER SE
“The concept of negligence per se establishes both duty and required breach of duty where an individual violates an applicable statute, ordinance or regulation designed to prevent a public harm....” Braxton v. PennDOT, 160
In paragraphs 72-94 of the instant complaint, plaintiff alleges that defendant is liable under a theory of negligence per se for alleged violations of the Code of Federal Regulations and the Pennsylvania Code with regard to the plaintiff’s care including the following: 42 C.F.R. §483.10(b)(ll), §483.13(c); §483.15(a), (e), (g), (h); §483.20(a); §483.25(a)(l)(iv), (a)(3), (c)(2), (d)(1), (h)(2), (i), (j); §483.35(a), (b), (c), (d), (e); and §483.75(d)(l) and 28 Pa. Code 201 et seq. Congress enacted the Nursing Home Reform Law (NHRL) as part of the Omnibus Budget Reconciliation Act of 1987. OBRA revised the regulations of nursing homes subject to Medicare and Medicaid, subchapters XVIII and XIX of the Social Security Act, respectively. 42 U.S.C. §1395i-3
“The General Assembly finds the health and welfare of Pennsylvania citizens will be enhanced by the orderly and economical distribution of health care resources to prevent needless duplication of services. Such distribution of resources will be furthered by governmental involvement to coordinate the health care system. Such a system will enhance the public health and welfare by making the delivery system responsive and adequate to the needs of its citizens, and assuring that new health care services and facilities are efficiently and effectively used; that health care services and facilities shall continue to meet high quality standards; and, that all citizens receive humane, courteous, and dignified treatment. In developing such a coordinated health care system, it is the policy of the Commonwealth to foster responsible private operation and ownership of health care facilities, to encourage innovation and continuous development of improved methods of health care and to aid efficient and effective planning using local health systems agencies. It is the intent of the General Assembly that the Department of Health foster a sound health care system which provides for quality care at appropriate health care facilities throughout the Commonwealth.”
The Wagner court also relates that negligence per se is also recognized in the Restatement (Second) of Torts §286:
“The court may adopt as the standard of conduct of a reasonable man the requirements of a legislative enactment or an administrative regulation whose purpose is found to be exclusively or in part,
“(a) to protect a class of persons which includes the one whose interest is invaded, and
“(b) to protect the particular interest which is invaded, and
“(c) to protect that interest against the kind of harm which has resulted, and
*465 “(d) to protect that interest against the particular hazard from which the harm results.”
However, Wagner holds: “Negligence per se does not apply where the purpose of the statute or regulation is to secure the individual’s enjoyment of rights or privileges to which they are entitled only as members of the public.” Pa. Suggested Standard Civil Jury Instruction, 2nd ed., vol. 1, §3.30.
Defendant cites Chalfin v. Beverly Enterprise Inc., 741 F. Supp. 1162 (E.D. Pa. 1989), for the proposition that failure to comply with the federal and state regulations is neither per se negligence nor evidence of negligence. However, Chalfin, supra, appears to have been overruled or at least distinguished by McCain v. Beverly Health and Rehabilitation Services Inc. t/a Phoenixville Manor, (2002 WL 1565526, E.D. Pa.). In extending the protections of OBRA to the plaintiff’s decedent against a nursing home, the McCain court in attempting to predict how Pennsylvania state courts would react to the same issue sub judice stated: “Courts in Pennsylvania have recognized that the absence of a private cause of action in a statutory scheme is an indicator that the statute did not contemplate enforcement of an individual harm. However, it is just an indicator or a factor to consider and does not necessarily preclude the statute’s use as a basis of a claim of negligence per se. A statute may still be used as a basis for a negligence per se claim when it is clear that, despite the absence of a private right of action, the policy of the statute will be furthered by such a claim because its purpose is to protect a particular group of individuals.” The McCain court then reviewed section 286 of Restatement (Second) of Torts requirements
In plaintiff’s amended complaint, paragraph 72 reads as follows: “Although the statutes and regulations contained in the paragraph below do not necessarily provide a private cause of action, decedent was a member of a class of nursing home residents that the statutes and regulations were designed to protect. The statutes and regulations do establish a minimal standard of care relevant to nursing facilities licensed by the Commonwealth of Pennsylvania of which defendant is one.” By this averment it is clear that plaintiff is not attempting to impart a private cause of action. Plaintiff then has the burden of showing that the statute would be furthered by such a claim because its purpose is to protect a particular group of individuals. Plaintiff correctly directs the court’s attention to this same issue having been addressed by Dauphin County in Wheeler v. Beverly Enterprises, no. 6011-2001, 10/25/02 (Dauphin Cty. 2002), Diggs v. Susquehanna Center for Nursing and Rehabilitation, 35
This court’s research, however, finds the opinion of Judge Dobson in Goda v. White Cliff Nursing Home, (no. 2002-1917 Mercer Cty., May 2003), to be on point. Judge Dobson held that OBRA was enacted “to improve the quality of care for Medicaid-eligible nursing home residents, and either to bring substandard facilities into compliance with Medicaid quality of care requirements or to exclude them from the program.” The court found that Mrs. Goda was a Medicaid recipient and a nursing home resident for which OBRA was intended to protect pursuant to the Restatement (Second) of Torts §286 analysis. However, Judge Dobson held “the only regulation alleged in the amended complaint that satisfies the first two elements of section 286 is 42 C.F.R. §483.250 which provides ‘the facility must provide each resident with sufficient fluid intake to maintain proper hydration and health.’ ”
Judge Dobson further held: “The remainder of the OBRA provisions and regulations cited in the amended complaint may not be used to support a cause of action for negligence per se. These various provisions and regulations set forth goals for a nursing home to attain. For
We also hold that the intent of PHCFA was to have the Department of Health implement a system to enhance the delivery of health care services to promote public health. PHCFA does not apply to a particular class of individuals but instead to the general public. As such, the statute and the regulations promulgated thereunder as more fully set forth in 28 Pa. Code §201.1 et seq. do not meet the Restatement (Second) of Torts §286 analysis thereby precluding plaintiff from using the PHCFA regulations as a basis for the negligence per se claim. However, OBRA, in our analysis, was enacted to protect the interests of nursing home residents whether eligible for or receiving Medicaid or Medicare. The plaintiff’s decedent’s eligibility for Medicare or Medicaid is irrelevant for the practical effect of OBRA and indeed its intent is to improve the standard of care in nursing homes generally. We hold further that the regulations cited in
II. LACK OF SPECIFICITY
Pa.R.C.P. 1028(a)(3) provides that a party may file a preliminary objection for “insufficient specificity in a pleading.” Pa.R.C.P. 1019(a) requires plaintiffs to plead the material facts that support the claims. A complaint is sufficiently specific if it provides the defendant with enough facts to enable the defendant to frame a proper answer and prepare a defense. Commonwealth ex rel. Milk
IE. CORPORATE NEGLIGENCE
Our court has reviewed the issue of corporate negligence, its history and applicability to hospitals and inapplicability to a physician group practice limiting itself to medical care and treatment related to obstetrics and gynecology. However, this issue of extending corporate liability to a nursing home has not been addressed by our courts of common pleas, the Superior or the Supreme Court of Pennsylvania. In Kendricks v. Zimmerman, no. S1351-02 Schuylkill County, Judge Stine relates the progression of the theory of corporate negligence in the health care field:
“The theory of health care corporate negligence was first adopted in Pennsylvania in the case of Thompson v. Nason Hospital, 527 Pa. 330, 591 A.2d 703 (1991). Under the doctrine of corporate negligence, a hospital owes a direct duty to patients to ensure their safety and well-being. Id. at 339, 591 A.2d at 707. The duties owed by a hospital to a patient are divided into four categories:
“(1) a duty to use reasonable care in the maintenance of safe and adequate facilities and equipment...;
“(2) a duty to select and retain only competent physicians ...;
*471 “(3) a duty to oversee all persons who practice medicine within its walls as to patient care ..and
“(4) a duty to formulate, adopt and enforce adequate rules and policies to insure quality care for the patients.”
Id. (citations omitted)
“In 1998, the Superior Court extended corporate negligence to health maintenance organizations (HMOs), recognizing the role HMOs play in providing total health care to their patients. Shannon v. McNulty, 718 A.2d 828, 835 (Pa. Super. 1998). Although the court found that HMOs do not specifically practice medicine, HMOs are involved in the daily decision-making which affects patient care, such as limiting the length of hospital stays, restricting access to specialists, restricting access to therapy, or preventing emergency room care. Id. The Superior Court stated, ‘[w]e see no reason why the duties applicable to hospitals should not be equally applicable to an HMO when that HMO is performing the same or similar functions of a hospital.’ Id. at 836. The appellate courts did not intend to extend corporate negligence responsibility to a physician group practice limiting itself to medical care and treatment related to obstetrics and gynecology. Raspaldo v. Sacred Heart Hospital, 54 D.&C.4th 432, 436 (Lehigh Cty. 2000).”
In holding that corporate negligence did not extend to a physician group under the circumstances of Kendricks, supra, Judge Stine describes the salient features to be utilized in determining the applicability of corporate negligence:
“(1) whether the plaintiff was restricted in plaintiff’s choice of plaintiff’s use of the physician and/or the physician group;
*472 “(2) whether the defendant’s practice was more akin to a total health care institution such as a hospital as opposed to a physician group practice limited to a specific area of medicine.”
The Eastern District Court of Pennsylvania also reviews the history and the doctrine of corporate negligence as established in Thompson, supra, in Milan v. American Vision Center, 34 F. Supp.2d 279 (1998). The District Court predicted that under Pennsylvania law the doctrine of corporate negligence did not apply to an optometrist’s office as the corporate employer of the defendant optometrist. As in Judge Stine’s analysis, the Milan court opines that in extending corporate negligence to other health care professionals, the salient features are: (1) whether the health care corporation “plays a central role in the total health care of their patients”; (2) whether the patient is “constrained in her health care choices by the defendant”; (3) whether the patient is “given little or no say so in the stewardship of their care”; and (4) whether the defendant “involves themselves daily in decisions affecting their subscribers medical care.” The court concluded that optometrist’s offices play no gate keeping role in the total health care of its patients. “Like doctors’ offices in general, a patient entering an optometrist’s office does not forfeit legally or practically the ability to turn elsewhere for medical care. A hospital practically constrains a patient’s choice by inducing the patient to rely on its comprehensive services in times when the patient’s ability to make choices will be compromised.” Furthermore, the court notes that “a visit to an optometrist’s office generally does not require a pa
In Dontonville v. Jefferson Health System, 2002 W.L. 59318 (E.D. Pa. 2002), the Eastern District Court, in reviewing the concept of corporate negligence’s applicability to a corporate health system including a hospital and physicians’ group as corporate entities, allowed the action to proceed, citing a state court of common pleas’ decision in Oven v. Pascucci, 46 D.&C.4th 506, 512 (Lacka. Cty. 2000), for the holding that corporate negligence is an evolving doctrine under Pennsylvania law, which theory is based upon the systemic or institutional negligence of the defendant itself rather than the conduct of individual employees. Of note, is the Superior Court’s nonprecedential memorandum decision in Stevens v. Pacopis and Ameriplan USA Dental Care, per Justices Stevens, Olszewski and Beck, PICS case no. 03-1828 (Pa. Super. 2003), wherein this Superior Court panel held that the defendant discount dental service provider was not liable for the dental negligence of Dr. Pacopis under the theory of corporate negligence because of its not evidencing the characteristics of a health maintenance organization.
All of the common pleas court decisions that we reviewed in the negligence per se section of this opinion dismiss the preliminary objections with regards to the plaintiffs’ assertion of corporate liability against the respective nursing homes and allow the suit to proceed on this theory through discovery. Likewise, we are constrained to dismiss the preliminary objection as to corporate negligence. The plaintiff has pleaded sufficient facts which, if believed, would entitle the plaintiff to re
IV. PUNITIVE DAMAGES
We hold, as plaintiff contends, that the second amended complaint contains sufficient facts to state a claim for punitive damages under the survival action. Plaintiff notes that the recent Medical Care Availability and Reduction of Error Act (MCARE Act) enacted March 20,2002, recognizes that punitive damages may be imposed against “health care providers” for willful or wanton conduct or reckless indifference to the rights of others. 40 Pa.C.S. §1303.505. This standard includes reckless conduct where the actor knows, or has reason to know, of facts which create a high degree of risk of physical harm to another and deliberately proceeds to act, or fails to act, or exhibits a conscious disregard of, or indifference to, that risk. The Act specifically includes “nursing home” within the definition of health care provider. Section 1301.503. The punitive damage provisions of MCARE concerning nursing homes represent the union of existing common and statutory law. Existing case law, therefore, is instructive in addressing this issue.
In Count IV plaintiff seeks punitive damages in the wrongful death action. Plaintiff contends that although the Wrongful Death Act does not mention “punitive damages,” it specifically allows for “other damages.” 42 Pa.C.S. §8301(c). Plaintiff also notes that the MCARE Act specifically states that: “a person who has sustained injury or death as a result of medical negligence by a health care provider must be afforded a prompt determination and fair compensation.” 42 Pa.C.S. § 1303.102 (4). This is contradicted by the decision in Walsh v. Strenz, 63 F. Supp.2d 548 (M.D. Pa. 1999), which holds that there is no statutory authority for punitive damages in
The purpose of Pennsylvania’s wrongful death statute is to compensate enumerated relatives for pecuniary loss in the form of lost earnings occasioned by death, as well as for services the decedent would have performed for the surviving family members. 42 Pa.C.S. §8301. The case of Walsh v. Strenz, supra, discusses, at length, the development of the law of wrongful death in Pennsylvania and the appropriate damage claims. Damages recoverable in a survival action include decedent’s pain and suffering, loss of gross earnings from date of injury until death, and loss of earning power, less personal maintenance expenses from time of death through decedent’s estimated working life span. 42 Pa.C.S. §8302. In comparison, damages recoverable in a wrongful death action have been limited to “pecuniary loss” of the enumerated survivors, as well as certain designated damages, not including punitive damages. Walsh v. Strenz, supra at 552.
Plaintiff contends that the legislature intended to provide for punitive damages in cases of death by reason of medical malpractice under amendments to the Health Care Service Malpractice Act and subsequently in passing the MCARE Act. No amendments, however, have been made to the Wrongful Death Act, supra, and this we find controlling. Therefore, the defendant’s fourth preliminary objection to punitive damages as asserted via the wrongful death action is granted, stricken from
Accordingly, we enter the foregoing order.
ORDER
And now, December 12, 2003, upon consideration of the preliminary objections filed on behalf of defendant, HCR Manor Care Inc. t/a Manor Care of Pottsville, and the supporting briefs to the plaintiff’s second amended complaint, it is hereby ordered and decreed that the preliminary objections are sustained in part and denied in part as follows:
(1) the demurrer to Count II dealing with negligence per se is sustained and Count II negligence per se is stricken except as to plaintiff’s averment of the standard set forth in 42 C.F.R. §483.25(j);
(2) the motion to strike for lack of specificity is sustained and paragraphs 54 p and y are stricken with leave to amend;
(3) the demurrer to Count III concerning corporate liability is overruled and dismissed;
(4) the demurrer to plaintiff’s request for punitive damages in Count IV concerning wrongful death is sustained and the plaintiff’s request for punitive damages in the wrongful death action is stricken; and,
(5) the demurrer to Count V pertaining to plaintiff’s request for punitive damages in the survival action is overruled and dismissed. Plaintiff shall have 30 days from the date of this order to file a third amended complaint.
