BETTY L. SHIFLETT AND CURTIS SHIFLETT, HUSBAND AND WIFE, Appellants
LEHIGH VALLEY HEALTH NETWORK, INC.; AND LEHIGH VALLEY HOSPITAL, Appellees
Argued: April 9, 2019
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,
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.
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.
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
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
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?
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
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.
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
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.
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.
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
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
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
1. Do you find that Nurse Langham of the Lehigh Valley
Hospital was negligent?
If you answered Question 1 "Yes", proceed to
If you answered Question 1 "No", proceed to
2. Was the negligence of Nurse Langham of the Lehigh Valley
Hospital a factual cause of harm ...