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Thomas v. County of Chester

United States District Court, E.D. Pennsylvania

May 15, 2018

CRYSTAL THOMAS, as administratrix of the estate of Louis Thomas, Plaintiff,


          RUFE, JUDGE

         Plaintiff Crystal Thomas brings this wrongful death and survival action in her capacity as administratrix of the estate of her father, Louis Thomas. Mr. Thomas was admitted to County of Chester, Pocopson Home for long-term nursing care, but died months later due to severe malnutrition, dehydration, sepsis, and kidney failure. Plaintiff raises six claims against Pocopson Home and Dr. Nadeem Paroya, Mr. Thomas's attending physician, including (a) two claims against Pocopson Home pursuant to 42 U.S.C. § 1983, alleging it provided deficient care in violation of Mr. Thomas's statutory rights, (b) two claims against Pocopson Home under Pennsylvania law, alleging wrongful death and survival actions, and (c) two claims against Dr. Paroya under Pennsylvania law, also alleging wrongful death and survival actions.[1] Defendants have moved to dismiss.[2] For reasons that follow, the motion to dismiss filed by Pocopson Home will be granted in part and denied in part, and the motion to dismiss filed by Dr. Paroya will be denied.

         I. BACKGROUND

         The Second Amended Complaint alleges the following facts, which are assumed to be true for purposes of the Motions to Dismiss. Pocopson Home is a long-term care nursing facility owned and operated by Chester County, Pennsylvania.[3] On June 19, 2016, Louis Thomas was admitted to Pocopson Home because he suffered from chronic kidney disease and vision deficit.[4]Mr. Thomas also experienced impaired mobility and incontinence episodes, requiring long-term nursing care. Pocopson Home is a long-term care nursing facility owned and operated by Chester County, Pennsylvania.[5] Upon admission, Mr. Thomas did not have any bed sores and was given a prognosis of “stable” and “good” rehabilitation potential.[6] Despite this prognosis, Mr. Thomas's health declined during his stay at Pocopson Home, ultimately ending in his death less than a year later.

         Plaintiff alleges Mr. Thomas was mistreated at Pocopson Home. For example, Pocopson staff allegedly verbally and physically abused Mr. Thomas by calling him names and even, in one instance, slamming him against a wall.[7] Mr. Thomas also experienced recurring mistreatment when he sought assistance with his meals. Legally blind, Mr. Thomas was unable to see the meals in front of him and needed help identifying each food. Pocopson staff, however, “would simply slam his meal tray on the table and then leave, instead of describing the food or placement to him.”[8] As a result, his meal and fluid consumption was drastically reduced.

         In February 2017, Mr. Thomas's health sharply declined. His medical charts documented a decrease in food and fluid intake, as well as marked weight loss. On February 22, 2017, his “chart indicated that he . . . had an 11 lb. weight loss in 30 days” and “was only accepting 50% of most meals and had decreased snacking.”[9] By March 8, 2017, Mr. Thomas's charts indicated that he had lost 28 pounds overall and had a “poor intake” of foods and fluids, consuming only “bites” of food and “juice with medication.”[10] Throughout this period, Dr. Paroya was repeatedly made aware of Mr. Thomas's decreased intake and weight loss, “but did not order a dietary consultation and made no changes to his care plan.”[11]

         On March 13, 2017, Mr. Thomas's breathing became labored, and he was rushed to Chester County Hospital. Hospital staff diagnosed Mr. Thomas with acute metabolic encephalopathy, kidney failure, and hypovolemic shock due to severe malnutrition and dehydration.[12] Mr. Thomas had lost of total of 34 pounds in less than six weeks.[13] In addition, hospital staff diagnosed Mr. Thomas with “severe sepsis from a genitourinary source, ” associated with incontinence that was not properly handled at Pocopson Home. Mr. Thomas also was suffering from bed sores that had not been noticed or documented by Defendants.[14] On March 17, 2017, Mr. Thomas was discharged to inpatient hospice, where he died the next day.


         Dismissal for failure to state a claim is appropriate if the complaint fails to allege facts sufficient to establish a plausible entitlement to relief.[15] In evaluating a motion to dismiss for failure to state a claim under Federal Rule of Civil Procedure 12(b)(6), the Court “take[s] as true all the factual allegations of the [complaint] and the reasonable inferences that can be drawn from them, ” but “disregard[s] legal conclusions and recitals of the elements of a cause of action, supported by mere conclusory statements.”[16] Instead, to prevent dismissal, a complaint must “set out sufficient factual matter to show that the claim is facially plausible.”[17] “A claim has facial plausibility when the plaintiff pleads factual content that allows the court to draw the reasonable inference that the defendant is liable for the misconduct alleged.”[18]

         III. ANALYSIS

         A. Immunity Pursuant to Pennsylvania's Political Subdivision Tort Claims Act

         Pocopson Home argues that because it is owned and operated by Chester County, the Pennsylvania Political Subdivision Tort Claims Act[19] (“PSTCA”) bars all claims against it. Under the PSTCA, municipalities and local agencies are immune from liability “for any damages on account of any injury to a person or property caused by any act of the local agency or an employee thereof or any other person.”[20] This immunity is waived “to the extent the agency would otherwise be liable for a narrow subset of negligent acts by its agents or employees.”[21]Although the immunity conferred by the PSTCA is “effective against a state tort claim, ” it “has no force when applied to suits under the Civil Rights Act.”[22]

         Here, the state law wrongful death and survival actions stemming from the alleged negligent care of Mr. Thomas are not acts for which immunity is waived. Plaintiff contends the statutory “willful misconduct” exception applies to these state law causes of action.[23] But, Pennsylvania and federal courts have consistently held that this exception applies only to the immunity of agency employees, and not to the agencies themselves.[24] Thus, the state law claims against Pocopson Home will be dismissed with prejudice.[25]

         B. Municipal Liability Under Section 1983

         Pocopson Home also moves to dismiss Plaintiff's § 1983 claims.[26] Section 1983 “is a vehicle for imposing liability against anyone who, under color of state law, deprives a person of rights, privileges, or immunities secured by the Constitution and laws.”[27] Plaintiff has alleged that Pocopson Home is a long-term nursing care facility that is owned and operated by Chester County, and that its actions were taken under the color of state law.[28] Plaintiff also alleged that Pocopson Home staff violated provisions of the Federal Nursing Home Reform Act (“FNHRA”), and the Third Circuit has held that the FNHRA “confer[s] individual rights that are presumptively enforceable through § 1983.”[29]

         In addition, to state a § 1983 claim, a plaintiff must plead that the alleged violation was “caused by action taken pursuant to a municipal policy or custom.”[30] A “policy” is made “when a decisionmaker possessing final authority to establish municipal policy with respect to the action issues a final proclamation, policy or edict.”[31] A “custom” includes “practices of state officials . . . so permanent and well settled as to constitute a ‘custom or usage' with the force of law.”[32] In a recent, unpublished decision addressing the standard for municipal liability under § 1983 against a county-owned nursing home, the Third Circuit explained that:

There are three situations where acts of a government employee may be deemed to be the result of a policy or custom of the governmental entity for whom the employee works, thereby rendering the entity liable under § 1983. First, an employee's action can be said to result from a policy or custom where the appropriate officer or entity promulgates a generally applicable statement of policy and the subsequent act complained of is simply an implementation of that policy. Alternatively, a challenged action can be considered the result of a policy or custom where no rule has been announced as policy but federal law has been violated by an act of the policymaker itself. Finally, we treat actions as being the result of policy or custom where the policymaker has failed to act affirmatively at all, though the need to take some action to control the agents of the government is so obvious, and the inadequacy of existing practice so likely to result in the violation of constitutional rights, that the policymaker can reasonably be said to have been deliberately indifferent to the need.[33]

         The Second Amended Complaint states that Pocopson Home failed to comply with more than twenty separate provisions of the FNHRA and/or its regulations.[34] These include allegations that Pocopson Home “fail[ed], as a custom or policy, to develop a comprehensive care plan for patients, including Louis Thomas, as required by 42 C.F.R. § 484.30 and 42 U.S.C. § 1369r(b)(2), ”[35] and “fail[ed], as a custom and policy to provide sufficient nursing staff to provide . . . services that would allow patients or residents, including Louis Thomas, to attain or maintain the highest practicable, physical, mental, and psychological well-being, as required by 42 C.F.R. § 483.30 and 42 U.S.C. § 1396r(b)(4)(c).”[36] No. additional factual material about Pocopson Home's policy or custom is provided in the Second Amended Complaint.

         Plaintiff's references to the policy or custom of Pocopson Home are only conclusory, and Plaintiff does not allege that Mr. Thomas's death was “caused by affirmative actions on the part of a particular policymaker, ” so Plaintiff cannot proceed on the first two means of establishing liability.[37] However, Plaintiff may proceed on the third means of establishing liability, as she has set forth facts to support a claim that Pocopson Home was deliberately indifferent to the needs of Mr. Thomas and failed to train its staff.[38] The Second Amended Complaint alleges that Mr. Thomas underwent dramatic weight loss in a six week period, and that Pocopson Home staff was aware of his weight loss, but refused to assist him with his meals or to develop a plan to ensure that he was eating and drinking enough.[39] Instead, the staff simply recorded his lack of sustenance and concomitant decline. As a direct result of the alleged inaction, Mr. Thomas arrived at Chester County Hospital in a state of severe dehydration and malnutrition, and died less than a week later.[40] Accepting all factual allegations as true, the Court finds that Plaintiff has stated sufficient facts for the § 1983 claims to proceed on a deliberate indifference theory.

         C. Wrongful Death and Survival Actions Against Dr. Paroya

         Dr. Paroya moves to dismiss the state law claims raised against him by arguing that the Court should decline to exercise supplemental jurisdiction over these claims. A district court has discretion to exercise supplemental jurisdiction over state law claims that arise out of “a common nucleus of operative fact” with the accompanying federal claims.[41] The court may nonetheless decline to exercise supplemental jurisdiction if:

(1) the claim raises a novel or complex issue of State law,
(2) the claim substantially predominates over the claim or claims over which the district court has ...

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