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Shiflett v. Lehigh Valley Health Network, Inc.

Supreme Court of Pennsylvania

September 26, 2019

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

          Argued: April 9, 2019

          Appeal from the Order of Superior Court at No. 2293 EDA 2016 dated November 9, 2017, reconsideration denied January 12, 2018, Vacating the Judgment entered July 18, 2016 of the Lehigh County Court of Common Pleas, Civil Division, at No. 2014-C-0388 and Remanding for a new trial

          SAYLOR, C.J., BAER, TODD, DONOHUE, DOUGHERTY, WECHT, MUNDY, JJ.

          OPINION

          DONOHUE JUSTICE.

         Betty and Curtis Shiflett sued Lehigh Valley Hospital and Lehigh Valley Health Network, Inc. (collectively, the "Hospital") for negligence in connection with injuries Betty suffered while in the hospital for knee surgery. The jury returned a verdict for the Shifletts, awarding them $2, 391, 620 in damages. The Superior Court ruled that one of the claims upon which the Shifletts prevailed at trial was time-barred and should not have been submitted to the jury. Finding that some portion of the jury's damage award may have been based upon the time-barred claim, the intermediate appellate court remanded the case for a new trial on damages. We conclude that the Superior Court erred in this regard, as pursuant to the "general-verdict rule" adopted by this Court in Halper v. Jewish Family & Children's Services, 963 A.2d 1282 (Pa. 2009), the Hospital waived any entitlement to a new trial on damages when it failed to request a special interrogatory on the verdict sheet that would have permitted the jury to allocate the damages awarded on each claim.

         Betty Shiflett ("Betty") underwent knee surgery at Lehigh Valley Hospital (hereinafter "the Hospital") on April 12, 2012. While recovering in the hospital's post-surgical unit ("PSU"), Betty fell out of bed. Three days after surgery she was transferred to the transitional skills unit ("TSU") for occupational and physical therapy. Shortly after her transfer to the TSU, Betty experienced pain and a clicking sound in her knee. Betty reported these symptoms to nurse Kristina Michels Mahler ("Nurse Mahler"), but Nurse Mahler did not report these complaints to the treating doctor. On April 19, 2012, a physical therapist informed doctors of Betty's complaints about her knee. The doctors determined that Betty had suffered an avulsion fracture of her left tibial tuberocity. Betty then endured two additional surgeries in an attempt to fix her knee, both of which were unsuccessful. Betty has been left with no extensor mechanism in her leg, suffers from chronic pain, and is confined to a wheelchair.

         In February 2014, the Shifletts filed a complaint in which they asserted a claim for negligence in connection with Betty's fall in the PSU as well as a claim of loss of consortium. Complaint, 2/7/2014, at 5-7. Therein, the Shifletts alleged that the Hospital's employees were negligent in failing to provide adequate fall protection for Betty in the PSU and that the Hospital failed to oversee adequately its professional staff. Id. ¶ 14. According to the Shifletts, but for this negligence, Betty would not have suffered the avulsion fracture and permanent disability. Id. The Hospital filed preliminary objections, complaining that the averments were too vague, general and overbroad to discern the nature of the alleged misconduct at issue. In response, the Shifletts filed an amended complaint, refining their allegations to specify that they were asserting claims against Hospital for both vicarious liability and corporate liability with respect to the negligence associated with the events that occurred in the PSU. See Amended Complaint, 3/27/2014, at ¶¶ 22-29, ¶¶ 30-37. The Hospital again objected on the basis that the averments were impermissibly overbroad and vague, see Preliminary Objections, 4/10/2014, at 5-9, but the trial court did not agree. It overruled the preliminary objections and the case proceeded toward trial.

         More than a year later (and more than three years after the events in the Hospital), the Shifletts sought leave to amend their complaint for a second time in light of evidence revealed during discovery. In the proposed amended complaint, the Shifletts sought to add allegations of negligence regarding Nurse Mahler's conduct in the TS U.Specifically, they sought to include allegations that because of Nurse Mahler's failure to report Betty's complaints to the doctors, Betty received multiple rounds of physical therapy that increased the risk of additional injury to her knee and the need for surgery. See Proposed Second Amended Complaint, 7/2/2015, at 22. The Hospital opposed the motion, arguing that the proposed amended complaint added a new cause of action that was barred by Pennsylvania's two-year statute of limitations for negligence claims. 42 Pa.C.S. § 5524. The learned trial court disagreed and allowed the amendment.

         At trial, the Shifletts offered evidence that on April 12, 2012, Betty underwent left knee revision surgery at the Hospital. N.T., 2/5/2016, at 165-66. Nurse Terri Langham ("Nurse Langham") identified Betty as a fall risk, as she could not stand and was taking medication that caused her to become confused. N.T., 2/3/2016, at 54-62. Early on the morning of April 14, 2012, Betty awoke, thought she was at home, and attempted to get out of bed. She fell, hitting her left knee. No injury to her knee was immediately diagnosed. Nurse Langham testified that she had seen the Hospital's written fall prevention protocols during her orientation when starting her employment, but had never reviewed them again. N.T., 2/3/2016, at 9-18. Cynthia Balkstra, an expert on nursing practices, testified that the Hospital's fall prevention guidelines were inadequate and Nurse Langham's failure to review them was inappropriate:

A. The purpose of the guidelines, again, is to make sure that you use them. So the more regular-the more regular use of them, the more discussion about them, the more promotion of them the better because staff-I mean, it's easy-there's lots of things to remember as a nurse, and it's easy for a staff person to forget exactly what is in the guidelines. So the more emphasis, the more reeducation to the guidelines the better.
Q. Is reviewing the guidelines during orientation and not looking at them again, is that an appropriate use of the guidelines in your opinion as a nurse?
A. No.

N.T., 2/3/2016, Dep. Tr. of Cynthia Balkstra at 45–46. Nurse Balkstra further testified that Betty's hospital records indicated that she had a fall risk assessment of six, indicating a "high risk for falling." Id. at 49–50. Nurse Balkstra testified that proper fall prevention measures were not utilized and indicated that this failure was a result of a lack of proper training by the Hospital:

A. My opinion is that the staff were not educated frequently enough on the use of the guidelines, and specifically the use of the guidelines per the risk.
So in other words, the high risk measures, strategies to prevent a fall were not utilized with Ms. Shiflett. And it – from what Ms. Langham's deposition stated, that she really didn't treat[ ] a six any different than she would have treated a two.
So that's a failure to educate, properly on the use of the guidelines, which you spend a lot of effort putting together. So you definitely want to use them appropriately.
Q. Did you reach a conclusion as to whether or not Lehigh Valley['s] failure to appropriately train its nursing staff how to use fall precautions guidelines increased the risk of [Ms.] Shiflett falling?
A. Yes, in this case it did because with a score of six, more of those high risk measures should have been put into place.

Id. at 69–70.

         Upon her transfer to the TSU for therapy and rehabilitation, Betty was under the care of Nurse Mahler. Nurse Mahler, although recording Betty's complaints in the nursing notes, failed to report to the doctors that Betty was experiencing increasing levels of pain and a clicking noise in her left knee. N.T., 2/3/2016, at 167-81. On or about April 19, 2012, a previously undiagnosed nondisplaced fracture in her left fibia avulsed (became displaced). Surgery failed to correct the avulsion fracture, leaving Betty in a permanently disabled condition, confined to a wheelchair with chronic pain.[1]

         In support of their claims, the Shifletts also called Dr. Robert Erickson as an expert witness. Dr. Erickson testified that based upon his review of Betty's records, she suffered the nondisplaced fracture of her left fibia when she fell from bed on the night of April 14. N.T., 2/5/2016, at 42. He further opined that avulsion fractures do not happen without trauma, that the fall from bed was the only trauma Betty experienced during the relevant time period, and the fall increased the risk that the nondisplaced fracture would avulse. Id. at 32-48. According to Dr. Erickson, the stress on the knee resulting from the physical therapy likely caused the avulsion to occur. Id. at 63-64.

         Dr. Walter Finnigan, an expert called to testify by the Hospital, did not disagree that Betty suffered a nondisplaced fracture in her left knee that avulsed during her time in the TSU, but contended that the fracture occurred during surgery rather than as a result of her fall from the bed. N.T., 2/9/2016, Dep. Tr. of Dr. Walter Finnigan at 132. He further testified that for adults, absent surgical intervention, a nondisplaced fracture will always result in an avulsion fracture. Id. at 217 ("And if there's a crack, it can't stay undisplaced… ."). Dr. Prodromas Ververeli, the surgeon who performed surgery on Betty's knee after the avulsion, testified that avulsion fractures only occur after a trauma and that the trauma resulting from Betty's fall increased the risk that she would suffer an avulsion fracture. N.T., 2/9/2016, Dep. Tr. of Dr. Prodromas Ververeli at 24-30.

         Betty testified that she is now permanently disabled and suffers from depression as a result. N.T., 2/4/2016, at 106. She indicated that she is embarrassed, as her husband has to care for her, including dressing and bathing her. Id. at 106. She has pain "[a]ll the time" and cannot even ride very far as a passenger in an automobile because travelling causes her too much pain. Id. The Shifletts' life care planner expert, Nadene Taniguchi, testified about the Shifletts' damages, including Betty's future medical costs. N.T., 2/5/2016, at 124–56.

         On February 8, 202016, the day before the case was submitted to the jury, the trial court met with counsel to confirm that the Shifletts' claim for corporate negligence related to the Hospital's alleged failure to train the nurse (Nurse Langham) on duty at the time of Betty's fall in the PSU.[2] Counsel for the Shifletts confirmed this representation, indicating that the Shifletts were presenting three claims of negligence: two for vicarious liability (relating to the negligence of Nurse Langham in the PSU and of Nurse Mahler in the TSU), and a claim of corporate liability relating to Betty's fall in the PSU. N.T., 2/8/2016, at 115. Later that day, the trial court presented counsel with a draft verdict sheet and advised counsel that she would discuss it with them the next day. The proposed verdict sheet was as follows:

1. Do you find that Nurse Langham of the Lehigh Valley Hospital was negligent?
Yes___ No___
If you answered Question 1 "Yes", proceed to Question 2.
If you answered Question 1 "No", proceed to Question 3.
2. Was the negligence of Nurse Langham of the Lehigh Valley Hospital a factual cause of harm ...

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