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Shiflett v. Lehigh Valley Health Network, Inc.

Superior Court of Pennsylvania

November 9, 2017

BETTY L. SHIFLETT AND CURTIS SHIFLETT, HUSBAND AND WIFE Appellees
v.
LEHIGH VALLEY HEALTH NETWORK, INC.; AND LEHIGH VALLEY HOSPITAL Appellants

         Appeal from the Judgment Entered July 18, 2016 In the Court of Common Pleas of Lehigh County Civil Division at No(s): 2014-C-0388

          BEFORE: SHOGAN, J., SOLANO, J., and PLATT, J. [*]

          OPINION

          SOLANO, J.

         Appellants, Lehigh Valley Health Network, Inc., and Lehigh Valley Hospital (together, "Lehigh Valley"), appeal from the judgment entered following a jury trial and verdict in favor of Appellees Betty L. Shiflett and Curtis Shiflett. We conclude that the Shifletts' second amended complaint pleaded a new cause of action - for vicarious liability against Lehigh Valley for the negligent actions of Nurse Kristina Michels Mahler in Lehigh Valley's Transitional Skills Unit - that did not appear in the Shifletts' first amended complaint, and that this new cause of action was barred by the applicable statute of limitations. Accordingly, we vacate the judgment and reverse with respect to the verdict against Lehigh Valley for vicarious liability regarding Nurse Michels Mahler's actions. We reject Lehigh Valley's contentions of error with respect to the verdict of corporate negligence related to the Shifletts' claim of improper care in Lehigh Valley's Post-Surgical Unit. We remand for a new trial on the question of damages.

         On April 12, 2012, Ms. Shiflett underwent left knee surgery at Lehigh Valley Hospital. On April 14, 2012, Ms. Shiflett fell out of her hospital bed in Lehigh Valley's Post-Surgical Unit ("PSU") and suffered an avulsion fracture of her left tibial tubercle, which was not diagnosed until April 19, 2012. N.T., 2/5/16, at 31, 39.[1]

         On April 15, 2012, Ms. Shiflett was transferred to Lehigh Valley's Transitional Skills Unit ("TSU"), where she received physical and occupational therapy. N.T., 2/3/16, Tr. of Cynthia Balkstra, at 61-64, 68-69; N.T., 2/5/16, at 39, 64, 66-69; Trial Ct. Op. at 2.[2] Ms. Shiflett claims that soon after her arrival at the TSU, she repeatedly reported "sharp pain" and a "clicking" in her knee to Kristina Michels Mahler, a nurse working in the TSU, but Nurse Michels Mahler did not notify a physician about those complaints. As a result, there was a delay in diagnosing Ms. Shiflett's avulsion fracture. After Ms. Shiflett's physical therapist reported Ms. Shiflett's concerns on April 19, 2012, she had two additional surgeries to repair her avulsion fracture, but those surgeries were unsuccessful. Ms. Shiflett was left with no extensor mechanism in her leg and was no longer a candidate for further surgery due to past infection.[3]

         On February 7, 2014, the Shifletts filed a complaint against Lehigh Valley ("Original Complaint") that made the following factual allegations:

10. On April 12, 2012, plaintiff Betty Shiflett underwent left knee revision surgery at Lehigh Hospital.
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12. In the early morning of April 14, 2012, as a direct and proximate result of the negligence of the defendants, including inadequate fall protection provided by defendants, an unattended Betty Shiflett fell and suffered a left tibia avulsion fracture.
13. A nursing note in the chart of Lehigh Hospital dated April
14. 2012 at 4:45 A.M. records that immediately after Betty Shiflett was found on the floor of her hospital room, a bed check was initiated and yellow socks were put on her feet.
14. The left tibia avulsion fracture suffered as a result of Betty Shiflett's fall would not have occurred in the absence of the negligence of the defendants including their failing to provide adequate and sufficient fall protection and monitoring.
15. On April 24, 2012, Dr. Ververeli performed open reduction surgery to repair Betty Shiflett's left tibia avulsion.
16. Post-surgical care of Betty Shiflett's left tibia reduction surgery was complicated by a staph infection. As a result, on May 22, 2012, Dr. Ververeli performed another surgery on her left knee, irrigating and debriding the left knee and inserting screws and antibiotic beads in an effort to treat the infection.
17. As a result of plaintiff Betty Shiflett's avulsion fracture and resulting tibial reduction surgery and infection, she continued to, and is likely to continue to stiffer pain, reduced range of motion, weakness and left knee instability and disability.
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20. The injuries and permanent disabilities suffered by plaintiff Betty Shiflett were the direct result of the defendants' negligence, by and through their agents, servants and/or employees and/or their ostensible agents following her April 12, 2012 left knee revision surgery at Lehigh Hospital which negligence includes:
a.) Failing to use due care or employ reasonable skill in the treatment administered to plaintiff Betty Shiflett.
b.) Employing inappropriate or inadequate methods, techniques and procedures in the care and treatment of plaintiff Betty Shiflett;
c.) Failing to timely and properly recognize that plaintiff Betty Shiflett was at significant risk for a post-operative fall;
d.) Failing to timely and properly prepare and/or otherwise have in place a patient care plan for plaintiff Betty Shiflett that would include appropriate monitoring and safeguards to reduce and/or eliminate her risk of postoperative fall;
e.) Failing to utilize and/or have in place reasonable and appropriate measures to prevent plaintiff Betty Shiflett from falling after her April 12, 2012 knee revision surgery, including but not limited to, full bed side rails, properly monitor the Plaintiff in her bed, a bed alarm and/or institute a bed check; provide non-skid socks;
f.) Failing to adopt and enforce adequate policies and procedures to plan for and to ensure the proper and safe use of reasonable fall protection methods;
g.) Failing to select and retain competent physicians and staff;
h.) Failing to properly oversee the professional staff working in Lehigh Hospital;
i.) Failing to properly train and educate professional staff to identify fall risks and use appropriate methods to reduce the risk of a fall; and
j.) Failing to adhere to the standard of medical care in the community.
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23. But for the negligence of the defendants described above, Plaintiff Betty Shiflett would have fully recovered from her knee revision surgery on April 12, 2012.

Original Compl., 2/7/14, at ¶¶ 10, 12-17, 20, 23 (emphases added). Of significance here, these allegations all pertained to alleged negligence leading to Ms. Shiflett's fall from the bed in her hospital room; they did not allege subsequent negligence in the TSU.

         Lehigh Valley filed preliminary objections. Among other things, it argued that the allegations in Paragraph 20(a), (b), (d), (h), and (j) were too "general, vague and overbroad" to state a valid claim and to permit formulation of defenses. Prelim. Objs. of Lehigh Valley, 3/11/14, at 9-11 ¶¶ 30-37; Br. in Supp. of the Prelim. Objs. of Lehigh Valley, 3/11/14, at 8-10.

         In response, the Shifletts filed an amended complaint ("First Amended Complaint") on March 27, 2014. This First Amended Complaint repeated the allegations in Paragraphs 10, 12-17, and 23 from the Original Complaint[4] and added the following new paragraphs:

23. In addition to the allegations of negligence described in paragraphs 1 through 21 above, the injuries and permanent disabilities suffered by plaintiff Betty Shiflett were the direct result of the defendants' negligence, by and through their agents, servants and/or employees and/or their ostensible agents following her April 12, 2012 left knee revision surgery at Lehigh Hospital which negligence includes: [eight subparagraphs that are identical to subparagraphs 20(a)-(d), (g)-(h), and (j) in the Original Complaint].
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31. In addition to the allegations of negligence described in paragraphs 1 through 29 above, the injuries and permanent disabilities suffered by plaintiff Betty Shiflett were the direct result of the defendants' negligence following her April 12, 2012 left knee revision surgery at Lehigh Hospital which negligence includes:
a.) Failing to timely and properly prepare and/or otherwise have in place patient care plans that would include appropriate monitoring and safeguards to reduce and/or eliminate risk of post-operative fall;
b.) Failing to utilize and/or have in place reasonable and appropriate fall protection measures, including but not limited to, full bed side rails, proper bed monitoring, a bed alarm and/or institute a bed check, provide non-skid socks;
c.) Failing to adopt and enforce adequate policies and procedures to plan for and to ensure the proper and safe use of reasonable fall protection methods;
d.) Failing to select and retain competent physicians and staff;
e.) Failing to properly oversee the professional staff working in Lehigh Hospital;
f.) Failing to properly train and, educate professional staff to identify fall risks and use appropriate methods to reduce the risk of a fall; and
g.). Failing to adhere to the standard of medical care in the community.

         First Amended Compl., 3/27/14, at ¶¶ 23, 31. The amendment added no paragraphs referencing Ms. Shiflett's care in the TSU.

         Once again, Lehigh Valley filed preliminary objections that argued, among other things, that the negligence allegations were too vague and general to state a claim and permit framing of defenses. Prelim. Objs. of Lehigh Valley, 4/10/14, at 7-9 ¶¶ 24-31. It also argued that, if not stricken, the broad averments of negligence might improperly be used to permit some "future, unexpected amendment to the complaint based upon new facts after the statute of limitations has run." Id. at 9 ¶ 30 (citation omitted); Br. in Supp. of the Prelim. Objs. of Lehigh Valley, 4/10/14, at 8.

         This time, the Shifletts responded by detailing why their allegations were sufficient:

Here, the Amended Complaint, read as a whole and in context, contains detailed and specific allegations that are more than sufficient to allow Lehigh [Valley] to defend against claims of vicarious and corporate liability. The Amended Complaint alleges that on "April 12, 2012 plaintiff underwent left knee revision surgery at Lehigh [Valley] Hospital." [First Amended Compl., 3/27/14, ] at ¶ 10. During surgery she was given a femoral nerve block and general anesthesia. Id. After surgery, "[d]espite having high risk factors for falling, including her age, being in an unfamiliar location, use of a nerve block and left knee instability, the physicians, nurses, officers, directors, and/or other employees or agents of the defendants that were responsible for [Ms.] Shiflett's post-surgical care did not provide her with adequate fall protection, including, among other things, full bed side rails, bed alarm and/or bed checks, non-skid footwear, and monitoring." Id. at ¶ 11. Foreseeably, "[i]n the early morning of April 14, 2012, as a direct and proximate result of the negligence of the defendants, including inadequate fall protection provided by the defendants, an unattended [Ms.] Shiflett fell and suffered a left tibia avulsion fracture." Id. at ¶ 12. [Ms.] Shiflett's avulsion fracture required additional surgery that was complicated by an infection. Id. at ¶¶ 15-16. As a result of her fracture and related infection, she "has been advised that there are no treatment options that would improve the condition of her left knee[, ] leaving her permanently injured, disabled and damaged." Id. at ¶ 17.
These averments provide the factual backdrop and context for the allegations of negligence contained in paragraph 23 of the Amended Complaint. In conjunction with these allegations, paragraph 23 specifically details the legal theories of vicarious liability against the defendants. As alleged in paragraph 23, defendants are liable for, among other things, "failing to use due care, " "[e]mploying inappropriate or inadequate fall protection methods, " "[f]ailing to timely and properly prepare and/or have in place reasonable and appropriate measures to prevent plaintiff . . . from falling" and "failing to adhere to the standard of medical care in the community." [First Amended Compl., 3/27/14, ] at ¶ 23. Thus, read as a whole and in context, the Amended Complaint sufficiently put the defendants on notice as to the vicarious liability claims against them and allow them to put on a defense.

Shifletts' Resp. to Lehigh Valley's Prelim. Objs. to Shifletts' First Am. Compl., 5/1/14, at 9-10 ¶ 26 (emphasis added). The Shifletts' explanation made no reference to any claim regarding care in the TSU and instead focused only on the defendants' failure to prevent her fall in the PSU. On July 1, 2014, the trial court overruled Lehigh Valley's preliminary objections.

         The case proceeded to discovery, and a trial date was set. On May 14, 2015 (more than three years after the events in the hospital that give rise to this case), the Shifletts filed a motion for leave of court to amend their complaint yet again. This time, they stated that they sought to conform their first amended complaint "to the evidence uncovered during discovery." Shifletts' Mot. for Leave of Ct. to Amend Compl. to Conform the Pleading to the Evid., 5/14/15, at 2. Their motion thus sought "leave to file a Second Amended Complaint identifying specific nurses responsible for [Ms.] Shiflett's post-surgical care by name and to include more specific facts supporting [the Shifletts'] claims." Id. at 4 ¶ 7. Specifically, the Shifletts proposed to include the following new paragraphs in their pleading:

14. One of [Lehigh Valley's] employees, Terry Langham, has been identified as responsible for implementing fall precautions the evening of April 13, 2012 and the early morning of April 14, 2012. Nurse Langham documented Betty Shiflett as a high fall risk but failed to implement appropriate fall prevention interventions, including a bed alarm and/or bed check, proper footwear, fall risk identification methods and monitoring, thus increasing the risk that Betty Shiflett would suffer a fall.
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20. On or about April 15, 2012, Betty Shiflett was transferred to Lehigh Valley Hospital's Transitional Skills Unit ("TSU"). Transfer documents prepared by the defendants make no mention of Betty Shiflett having fallen while inpatient at Lehigh Hospital.
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22. As a result of Nurse Michels [Mahler's[5]] failure to communicate Betty Shiflett's complaints, Betty Shiflett received multiple rounds of physical and occupational therapy between April 15 and April 19, 2012, increasing the risk of additional injury to her already compromised knee and, as a result, the need for subsequent surgical intervention.
23. On or about April 19, 2012, during a physical therapy session, a physical therapy assistant in the TSU heard the same "clicking noise" in Betty Shiflett's left knee that Betty Shiflett had previously reported to Nurse Michels [Mahler]. The physical therapy assistant notified the nursing staff and an x-ray was ordered.
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33. In addition to the allegations of negligence described in paragraphs 1 through 31 above, the injuries and permanent disabilities suffered by plaintiff Betty Shiflett were the direct result of the defendants' negligence, by and through their agents, servants and/or employees and/or their ostensible agents, including Nurses Terry Langham and Kristina Michels [Mahler], following Betty Shiflett's April 12, 2012 left knee revision surgery at Lehigh Hospital, which negligence includes:
a.) Failing to use due care or employ reasonable skill in the treatment administered to plaintiff Betty Shiflett;
b.) Employing inappropriate or inadequate fall protection methods, techniques and procedures in the care and treatment of plaintiff Betty Shiflett;
c.) Failing to timely and properly recognize that plaintiff Betty Shiflett was at significant risk for a post-operative fall;
d.) Failing to timely and properly prepare and/or otherwise have in place a patient care plan for plaintiff Betty Shiflett that would include appropriate monitoring and safeguards to reduce and/or eliminate her risk of postoperative fall;
e.) Failing to utilize and/or have in place reasonable and appropriate measures to prevent plaintiff Betty Shiflett from falling after her April 12, 2012 knee revision surgery, including but not limited to, full bed side rails, proper monitoring of Plaintiff in her bed, increased rounding, use of a bed alarm and/or bed check; use of appropriate non-skid socks; notification to Curtis Shiflett that his wife was a high fall risk; and notification to Curtis Shiflett that he could spend the night at his wife's bedside to reduce the risk of a fall;
f.) Nurse Michels[ Mahler's] failure to timely notify Betty Shiflett's physicians and physical therapists about Betty Shiflett's post-surgical complaints of increased left knee weakness and buckling, increasing sharp pain in her left knee and a clicking noise in her knee;
g.) Failing to select and retain competent physicians and staff; h.) Failing to properly oversee the professional staff working in Lehigh Hospital; and
i). Failing to adhere to the standard of medical care in the community.
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41. In addition to the allegations of negligence described in paragraphs 1 through 39 above, the injuries and permanent disabilities suffered by plaintiff Betty Shiflett were the direct result of the defendants' negligence following her April 12, 2012 left knee revision surgery at Lehigh Hospital which negligence includes:
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g.) Failing to properly train and educate professional staff to identify and report worsening physical symptoms and complaints

         [Proposed] Second Am. Compl., 7/2/15, at ¶¶ 14, 20, 22-23, 33, 41(g) (emphases added). Thus, for the first time, the proposed second amended complaint sought to add allegations of negligence regarding Ms. Shiflett's care in the TSU in the days following her fall.

         Lehigh Valley opposed the motion for leave to amend. In its opposition, Lehigh Valley argued:

The entire gist of the [First Amended] Complaint concerns fall prevention strategies. However, [the Shifletts] now seek to amend the Complaint to assert claims for care provided between August 14, 2012 and August 19, 2012. . . . [W]hat was a "fall prevention" case, is now a case with regard to nursing malpractice relative to the signs and symptoms of a displaced fracture.

Br. in Supp. of Answer to Pls.' Mot. for Leave of Ct. to Amend Compl. to Conform the Pleading to the Evid., 6/11/15, at 1-3. Lehigh Valley contended that the proposed amendment would "add a complete new cause of action" that was barred by the statute of limitations because it concerned events that occurred in April 2012, more than two years before the proposed amendment. Suppl. Br. in Supp. of Answer to Lehigh Valley's Mot. for Leave of Ct. to Amend Compl. to Conform the Pleading to the Evid., 6/12/15, at 1.

         On June 12, 2015, the trial court granted the Shifletts' motion for leave to file the second amended complaint, and the Shifletts filed that pleading on July 2, 2015 ("Second Amended Complaint"). As filed, the Second Amended Complaint was identical to the proposed pleading that had been attached to the Shifletts' motion for leave to amend. ...


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