Seels, R. v. Tenet Health System , 167 A.3d 190 ( 2017 )


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  • J-A06045-17
    
    2017 Pa. Super. 227
    RAYMOND SEELS, ADMINISTRATOR OF                   IN THE SUPERIOR COURT OF
    THE ESTATE OF TERRI SEELS-DAVILA,                       PENNSYLVANIA
    DECEASED, AND RAYMOND SEELS, IN
    HIS OWN RIGHT,
    Appellant
    v.
    TENET HEALTH SYSTEM HAHNEMANN,
    LLC, D/B/A HAHNEMANN UNIVERSITY
    HOSPITAL AND PHILADELPHIA HEALTH &
    EDUCATION CORPORATION AND DREXEL
    UNIVERSITY COLLEGE OF MEDICINE,
    Appellees                 No. 1838 EDA 2015
    Appeal from the Judgment Entered July 22, 2015
    In the Court of Common Pleas of Philadelphia County
    Civil Division at No(s): 00560 September Term, 2012
    BEFORE: PANELLA, SHOGAN, and SOLANO, JJ.
    OPINION BY SHOGAN, J.:                                  FILED JULY 18, 2017
    Appellant, Raymond Seels, administrator of the estate of Terri Seels-
    Davila (“Seels-Davila”), deceased, and Raymond Seels,1 in his own right,
    appeal from the judgment entered on July 22, 2015, in favor of Tenet Health
    System Hahnemann, LLC, d/b/a Hahnemann                University Hospital and
    Philadelphia Health & Education Corporation and Drexel University College of
    ____________________________________________
    1
    Appellant is Seels-Davila’s father.
    J-A06045-17
    Medicine (collectively “Appellees”) in this medical malpractice action.    We
    affirm.
    The trial court provided a thorough recitation of the relevant facts of
    this case, which is set forth below:
    In early 2010, 38-year-old Terri Seels-Davila (“Seels-
    Davila”) and her husband Levi Davila were working in Managua,
    Nicaragua as Jehovah’s Witnesses missionaries. During this time,
    Seels-Davila became pregnant and received prenatal care in
    Nicaragua for the first seven months of her pregnancy. N.T.
    4/24/15 at 11. In early September 2010 she returned to her
    hometown of Philadelphia to ensure that “she was seen by the
    best health care in a first world country.” 
    Id. at 11,
    16, 39-40,
    61-63; N.T. 4/21/15 at 33. Adherents of the Jehovah’s Witness
    faith refuse to accept blood transfusions and so, with the help of
    Appellant, who was her father and a retired licensed nurse and
    also a devout Jehovah’s Witness, Seels-Davila chose Hahnemann
    University Hospital as the hospital where she would deliver her
    baby. N.T. 4/24/15 at 12-16.
    Hahnemann was one of the few regional medical facilities
    that engage in outreach to “Bloodless Medicine” patients, the
    term used for patients who, for various reasons, refuse blood
    transfusions. In order to assist these patients, Hahnemann had a
    “Bloodless Medicine Program” with three clerical staff who were
    Jehovah’s Witnesses. See N.T. 4/23/15 at 154. These clerks
    were responsible for explaining the risks inherent in not
    receiving blood transfusions and alternative treatment methods
    if transfusions are refused, ensuring the bloodless patients’
    wishes were memorialized on blood transfusion refusal consent
    forms, and that this information was transmitted to and
    prominently displayed on the patient’s medical chart and hospital
    wristbands upon admission.
    On November 19, 2010, Seels-Davila and her father met
    with Iris Jiminez, one of the clerks at Hahnemann’s Center for
    Bloodless Medicine. N.T. 4/24/15 at 12-13, 41. After talking with
    Ms. Jiminez, Seels-Davila signed a form entitled “Hahnemann
    University Hospital Center for Bloodless Medicine and Surgery
    Medical Directive/Release” where she indicated the following:
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    J-A06045-17
    I, Terri Elaine Seels-Davila ... request that no blood (whole
    blood, red cells, white cells, platelets and plasma) be
    administered to me during this hospitalization. I will accept
    the use of nonblood [sic] volume expanders (such as
    dextran, saline, or Ringer’s solution or hetastarch) and
    other nonblood management.
    Appellant’s Motion in Limine to Preclude Appellees from Offering
    Testimony and/or Evidence of Informed Consent and/or Any
    Medical Release, Ex. A at 1 (“Consent MIL”). In addition to these
    restrictions, Seels-Davila further stated that she did not consent
    to the use of hemodilution (i.e. blood storage, even of her own
    blood). 
    Id. This administrative
    process took approximately
    fifteen minutes and did not involve any of Hahnemann’s doctors,
    nurses, or other employees besides Ms. Jiminez. N.T. 4/24/15 at
    13-14.
    On Wednesday November 24, 2010, Seels-Davila went into
    labor and was admitted to Hahnemann at approximately 4:30
    PM. 
    Id. at 16,
    44. She arrived with her cervix dilated to
    “approximately four centimeters,” but quickly began to
    experience difficulties with her labor. N.T. 4/23/15 at 13. Dr.
    Minda Green, who was the attending obstetrician/gynecologist at
    the time of Seels-Davila’s admission, insisted that Seels-Davila
    talk with the Center’s staff to again review her treatment
    choices. N.T. 4/21/15 at 65-66, 69-72. After a conversation with
    these advocates and Dr. Brandi Musselman, another Hahnemann
    obstetrician, Seels-Davila signed a form at 6:25 PM entitled
    “Consent for Refusal for Transfusion of Blood and/or Human
    Source Products,” (“Consent for Refusal”) in which she again
    expressly indicated that she refused to accept blood transfusions
    as part of her treatment at Hahnemann, stating that:
    I [Seels-Davila] understand from Dr. Musselman that it
    may be advisable for me to receive a transfusion of blood,
    blood components or other human source products. I
    understand the circumstances that might make a
    transfusion necessary and the benefits of such a
    transfusion to my health. I have been given the attached
    information sheet, which describes the risks, benefits, and
    alternatives to the transfusion of blood and/or human
    source products ... I refuse all blood components and
    human source products.[]
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    J-A06045-17
    Consent MIL, Ex. D at 1; N.T. 4/21/15 at 69-70; N.T. 4/24/15 at
    44; see N.T. 4/27/15 at 93-97 (Dr. Musselman testifying
    regarding her pre-cesarean section discussions with Seels-
    Davila, as well as Seels-Davila signing the Consent for Refusal).
    Seels-Davila also indicated on this form that she consented to
    the use of a cell saver machine, if necessary, for intra-operative
    blood salvage and, below the signature line, handwrote “I am
    one of Jehovah’s Witnesses. No blood.”
    Consent MIL, Ex.Eat 1. According to Dr. Musselman, Seels-Davila
    specifically told her that she “would rather die than receive blood
    products.” N.T. 4/27/15 at 97. At 6:31 PM, Seels-Davila also
    signed a form entitled “Consent for Delivery,” checking off boxes
    indicating that she consented to giving birth via “vaginal
    delivery” or “cesarean section.” Consent MIL, Ex. C at 1.
    After over 12 hours of labor, Seels-Davila developed a
    fever and her unborn child’s heart rate spiked. N.T. 4/21/15 at
    83-84; N.T. 4/23/15 at 13-14. Accordingly, Dr. Green decided to
    perform a cesarean section at approximately 7:00 AM on
    Thursday, November 25, 2010. N.T. 4/21/15 at 84-85; N.T.
    4/23/15 at 13-14. Seels-Davila’s child was successfully delivered
    at 7:16 AM, and her uterus was then exteriorized. N.T. 4/21/15
    at 103. Dr. Green and Dr. Asata Mehta, a third-year resident,
    “tagged” the corners of Seels-Davila’s uterine incision, cleaned
    the sides of her abdomen and pelvis with sponges to remove
    excess blood, and inspected the incision multiple times to ensure
    that it was not bleeding. 
    Id. at 104-106.
    Drs. Green and Mehta
    then cut these “tags,” and proceeded to suture close each of the
    abdominal wall layers that had been cut during the cesarean
    section, checking for bleeding throughout the whole process. 
    Id. at 105-106.
    Following surgery, Seels-Davila was transferred to the
    Post-Anesthesia Care Unit (“PACU”) at approximately 8:20 AM.
    N.T. 4/23/15 at 16. Her vital signs were checked, including her
    blood pressure which was recorded as 100/48. 
    Id. At 8:30
    AM,
    Seels-Davila’s blood pressure was taken again, this time
    registering as 97/50. Id.; N.T. 4/21/15 at 136. Additional
    readings were taken at 8:40 AM and 8:45 AM, at which points
    Seels-Davila’s blood pressure was respectively 102/55 and
    108/53. N.T. 4/21/15 at 136. At 9:00 AM, her blood pressure
    was measured as being 89/62. N.T. 4/21/15 at 136-37; N.T.
    4/23/15 at 16-18. At 9:15 AM, Seels-Davila’s blood pressure fell
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    J-A06045-17
    significantly to 67/32, at which point the anesthesia unit was
    notified. N.T. 4/23/15 at 18-19. At 9:20 AM, PACU staffers and
    Dr. Saninuj Malayaman, an anesthesiologist, arrived at her
    bedside. N.T. 4/22/15 at 6; N.T. 4/23/15 at 29.
    At 9:30 AM, Dr. Yusef Morant-Wade, a third-year resident,
    called Dr. Kelli Daniels, who had taken over for Dr. Green as
    attending obstetrician at around 8:30 AM that morning. N.T.
    4/21/15 at 129-131; N.T. 4/23/15 at 95. Dr. Morant-Wade
    advised Dr. Daniels that Seels-Davila’s blood pressure had
    precipitously dropped, but that she was not exhibiting any other
    telltale signs of internal bleeding such as shortness of breath,
    palpitations, pain, or a distended stomach. N.T. 4/22/15 at 18,
    21; N.T. 4/23/15 at 31-32. Dr. Daniels responded by ordering a
    complete blood count (“CBC”) test, in order to see if Seels-
    Davila’s hemoglobin levels were dropping, and to determine
    whether she was anemic or had low levels of oxygen-carrying
    red blood cells. N.T. 4/21/15 at 131, 158-59. Based on the
    information provided by Dr. Morant-Wade, Dr. Daniels surmised
    that the likely cause of Seels-Davila’s abnormally low blood
    pressure was either blood loss during the C-section, the
    anesthesia given during her cesarean section, or by Pitocin, a
    medication that was given to Seels-Davila to help her uterus
    contract after her cesarean section. N.T. 4/21/15 at 138; N.T.
    4/22/15 at 12, 22. At 9:35 AM, Dr. Malayaman administered 10
    milligrams of Ephedrine to Seels-Davila, and confirmed that
    Seels-Davila was a Jehovah’s Witness who would not consent to
    the use of blood products as part of her treatment. N.T. 4/23/15
    at 29. Within minutes, the Ephedrine boosted Seels-Davila’s
    blood pressure, which registered 91/48 at 9:40 AM. 
    Id. Despite this
    improvement, PACU staffers began to suspect that Seels-
    Davila was suffering from internal bleeding, documenting their
    collective concerns at 9:42 AM through a note on her medical
    records. N.T. 4/23/15 at 35. At 10:00 AM, Seels-Davila’s blood
    pressure had fallen to a “dangerously low” level of 64/39, with a
    subsequent reading five minutes later that showed her blood
    pressure as 67/25. N.T. 4/23/15 at 31, 32. At 10:05 AM, a nurse
    attempted to draw blood from Seels-Davila for use in the CBC
    test, but was unable to do so and had to call for assistance. 
    Id. at 96-97;
    see Appellant’s Trial Exhibit P-7 at 5 (“1005 Unable to
    obtain blood for CBC-CL Robbin RN called for assist.”). Seels-
    Davila was still alert and oriented at 10:10 AM, and asked for ice
    chips, but shortly thereafter she began to slur her speech. N.T.
    4/23/15 at 33; Appellant’s Trial Exhibit P-7 at 5. At 10:15 AM, a
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    J-A06045-17
    nurse successfully took Seels-Davila’s blood for the CBC test.
    N.T. 4/23/15 at 96; see Appellant’s Exhibit P-7 at 5 (“1015 ... CL
    Robbins drawing CBC.”).
    Dr. Daniels was then called to Seels-Davila’s bedside and,
    along with PACU staffers, began to administer large volumes of
    intravenous fluids to Seels-Davila. N.T. 4/23/15 at 34-35;
    Appellant’s Trial Exhibit P-7 at 5. This seemed to improve Seels-
    Davila’s condition, as her speech pattern returned to normal, and
    her blood-oxygen saturation levels reached 100%. N.T. 4/23/15
    at 35. Dr. Daniels performed a “head to toe” bedside
    examination of Seels-Davila, determining that there were still no
    obvious signs of internal bleeding. N.T. 4/22/15 at 22-24. By
    10:46 AM, Dr. Daniels was joined at Seels-Davila’s bedside by
    Dr. Asemato (the chief resident) and Dr. Malayaman, to observe
    and monitor their patient. N.T. 4/23/15 at 36. At 10:59 AM, the
    results of the CBC test came back and showed that Seels-
    Davila’s condition was deteriorating, as her hemoglobin count
    had dropped precipitously from 14.1 at admission, to 7.8 at the
    time that the test had been administered. N.T. 4/21/15 at 146-
    47; N.T. 4/23/15 at 36. In addition, during this time frame (i.e.
    between 10:00 AM and 11:00 AM), Dr. Daniels performed a
    bedside sonogram that revealed the presence of extraneous fluid
    in Seels-Davila’s abdomen, which Dr. Daniels suspected was
    blood. N.T. 4/21/15 at 140; N.T. 4/22/15 at 23; N.T. 4/23/15 at
    37. Accordingly, Dr. Daniels made the decision to bring Seels-
    Davila back to the operating room for an exploratory
    laparotomy, in order to determine the exact cause of Seels-
    Davila’s distress. N.T. 4/23/15 at 38.
    Dr. Daniels reviewed Seels-Davila’s admission paperwork
    prior to surgery, noting that, as 
    mentioned supra
    , Seels-Davila
    had authorized the use of a cell saver machine. Dr. Daniels
    discussed this with her patient while trying, unsuccessfully, to
    convince Seels-Davila that she should consent to a blood
    transfusion. However, according to Dr. Daniels, Seels-Davila
    “was adamant about not receiving blood and was instead given
    one liter of albumin” before her transfer to surgery. N.T. 4/21/15
    at 159-61; see also N.T. 4/22/15 at 30 (Dr. Daniels testified that
    Seels-Davila “said that she was a minister in the faith i.e.
    Jehovah’s Witnesses and that she was okay with whatever
    happened.”); N.T. 4/27/15 at 7-10 (Nurse Flanagan testifying
    that, while enroute to the operating room, she unsuccessfully
    attempted to get Seels-Davila to authorize the use of blood
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    J-A06045-17
    transfusions if such treatment was deemed necessary). At
    approximately 11:00 AM, Dr. Daniels called the operating room
    and informed the staff that she would need a cell saver machine
    for use during the laparotomy. N.T. 4/21/15 at 159-60. This was
    an essential step, as cell savers are normally not used in
    emergency surgical procedures and require additional time to
    set-up. 
    Id. at 73-75.
    These machines can only be fully operated
    by a perfusionist, who is called in from offsite and usually takes
    around 30 minutes to arrive at the hospital. Id.; cf. Amron
    Deposition at 66 (stating that Hahnemann contracts with “an
    outside service that just about every hospital in the city uses as
    their source for perfusionists ... Probably 80 percent of the
    hospitals in the city are using the same company so--it may be
    70 percent but it’s largely one company.”)
    Nurse Wayne Rivers brought the cell saver to the operating
    room, connected a suction catheter to the machine, put in
    anticoagulants, “and did whatever else was necessary to set the
    cell saver up.” N.T. 4/21/15 at 148-49. The emergency
    laparotomy procedure began at 11:33 AM and the cell saver
    machine was switched on and began collecting Seels-Davila’s
    blood. At approximately 12:00 PM, the perfusionist joined Dr.
    Daniels in the operating room and began essentially cleaning the
    blood for re-infusion into the patient. N.T. 4/21/15 at 148-51,
    156-57, 161.
    During the exploratory laparotomy surgery, Dr. Daniels
    discovered that Seels-Davila was bleeding internally, and used
    the cell saver in an attempt to salvage the approximately 2,500
    to 3,000 CCs of blood [that] had pooled in her abdomen. This
    effort was complicated by the fact that a good portion had
    already become clotted. N.T. 4/21/15 at 145; N.T. 4/22/15 at
    36-37; N.T. 4/23/15 at 38. According to Dr. Daniels, Dr. Morant-
    Wade was “continuously trying to break up the clots to suction
    the blood to put it into the cell saver filtration canister,” which
    was “a difficult thing to do because it’s almost like suctioning
    Jell-0 through ... a suction tube.” N.T. 4/22/15 at 36. As a result
    of these efforts, the cell-saver machine was able to process
    approximately 1800 CCs of this pooled blood and, after being
    filtered and processed, 626 CCs were ultimately transfused to
    Seels-Davila in the form of packed red blood cells. N.T. 4/23/15
    at 118, 126-27.
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    While it was clear that Seels-Davila was bleeding
    internally, the source of the bleeding was not readily apparent.
    Dr. Daniels had no choice but to extend the incision by cutting
    upward, in an “upside-down T fashion,” to get a better visual of
    the uterus. N.T. 4/21/15 at 144. After properly doing so, Dr.
    Daniels discovered that Seels-Davila had an extremely rare
    uterine anomaly, in which her uterus had a small extra horn or
    “nub” on its side, outside of where her child had been gestating.
    
    Id. This additional
    horn exhibited a two centimeter-long cut,
    which was apparently the source of Seels-Davila’s internal
    bleeding. 
    Id. at 144-45,
    161. The manner in which this cut had
    occurred was never fully resolved by the physicians or the
    evidence offered at trial. Whether Dr. Green was negligent in the
    performance of the C-section by cutting this uterine horn was
    one of the key issues before the jury.
    Dr. Daniels repaired the cut of Seels-Davila’s anomalous
    horn, put a compression stitch on the right uterine artery (i.e.
    the artery which provides the bulk of the uterine blood supply),
    and tied off the uterine ovarian ligament (the other major source
    of blood for the uterus) to slow down the bleeding. N.T. 4/21/15
    at 144-45. Dr. Daniels also used a B-lynch compression suture,
    wrapping it around Seels-Davila’s uterus in an effort “to kind of
    shrink the uterus down because it wasn’t contracting on its
    own.” N.T. 4/21/15 at 145; see N.T. 4/22/15 at 40-41 (Dr.
    Daniels: “Because her uterus wasn’t contracting down, we gave
    her medications. We gave her Hemabate and Methergine, which
    both, again, make the muscles contract, and that didn’t work, so
    we did a compression suture called a B-lynch suture.”). During
    this surgery, Dr. Daniels also installed a “JP drain” in Seels-
    Davila’s abdominal cavity, in order to permit blood and other
    fluids to evacuate, and to allow for monitoring of activity within
    the cavity without additional exploratory surgery. N.T. 4/21/15
    at 165.
    After the surgery, Seels-Davila was taken down to the
    surgical intensive care unit. N.T. 4/21/15 at 165; N.T. 4/27/15
    at 54. At some point between 2:00 p.m. and 4:00 p.m., Dr.
    Daniels noticed that more blood was emptying from Seels-
    Davila’s JP drain, and decided to take her back into the operating
    room for the purpose of removing her uterus. N.T. 4/21/15 at
    165. Dr. Daniels believed that the loss of so much blood had, in
    effect, caused Seels-Davila’s remaining blood to be depleted of
    its clotting factors, and that this additional surgery was
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    J-A06045-17
    necessary under the circumstances, given that Dr. Daniels was
    prohibited from halting the internal bleeding through the
    transfusion of fresh blood. N.T. 4/22/15 at 43-44, 49-50.
    Accordingly,     Dr.    Daniels   performed     a    supracervical
    hysterectomy, a procedure through which the uterus is removed
    while the cervix is left intact and in place within the patient’s
    body. N.T. 4/21/15 at 166. Seels-Davila lost roughly 300 CCs of
    blood during this surgery and, all told, lost an estimated five
    liters of blood during the three surgeries. 
    Id. at 167-68.
    The
    blood that was processed through the cell saver and returned to
    her did not help with her clotting issues, however, as the
    filtration process strips away any platelets or other components
    that would assist with coagulation. See N.T. 4/23/15 at 127.
    Certain that Seels-Davila’s very survival hinged on the
    ability to give her blood transfusions, Hahnemann doctors then
    sought in vain to get authorization from her family members to
    do such a procedure, despite Seels-Davila’s firm and repeated
    opposition to blood transfusions because of her faith. Dr. Daniels
    repeatedly asked Seels-Davila’s parents over the following two
    days to override their daughter’s advance directive but, each
    time the topic was broached, they rebuffed Dr. Daniels’
    entreaties. N.T. 4/22/15 at 43-49; N.T. 4/28/15 at 26. Out of
    desperation, Dr. Owen Montgomery, chairman of Hahnemann’s
    OB/GYN department, called [Seels] at 4:00 AM on Saturday,
    November 27, 2010, telling him that: “I know and I respect your
    daughter’s wishes. And I understand the family’s wishes. And
    I’m calling you not as her doctor, but as a father. I have three
    daughters ... I’m calling you father to father. And ... I respect
    your wishes. But. .. if there is ever going to be a time that your
    family changes their minds, it has to be now.” N.T. 4/28/15 at
    25. Though Dr. Montgomery “wasn’t even sure at that point
    whether just giving the ... transfusion would actually reverse the
    damage ... he was pretty sure it would still save Seels-Davila’s
    life ... and very sure that if Hahnemann doctors didn’t give her
    blood, that she would die.” 
    Id. at 25-26.
    This plea did not
    change the resolve of Seels-Davila’s parents, who, according to
    Dr. Daniels, told her “that it was God’s will, they stood strong in
    their faith i.e. that of the Jehovah’s Witnesses, and on behalf of
    their daughter declined any blood products.” N.T. 4/22/15 at 48.
    Later that day, Dr. Daniels and Dr. Montgomery contacted Levi
    Davila-Rios, Seels-Davila’s husband, who was still involved in
    missionary work in Nicaragua, to see if he would authorize a
    blood transfusion for his wife. 
    Id. at 52.
    In addition they
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    J-A06045-17
    attempted to secure an emergency visa for him, so that he could
    be with Seels-Davila. 
    Id. at 53.
    Despite these efforts, Mr. Davila-
    Rios also declined to assent to the transfusion, saying that he did
    not want to go against his wife’s wishes or submit her to medical
    treatment that violated her religious beliefs. Id.; N.T. 4/24/15 at
    73, 77-78.
    Seels-Davila’s condition continued to deteriorate and, on
    the morning of November 28, 2010, she passed away, in spite of
    her doctors’ uniform belief that a blood transfusion would have
    almost certainly saved her life. 
    Id. at 45,
    53-56 (testimony from
    Dr. Daniels; N.T. 4/24/15 at 21-24 (Appellant stating that
    Hahnemann personnel told him that Seels-Davila needed a blood
    transfusion); 
    id. at 30-31
    (noting date of death); N.T. 4/28/15 at
    26 (testimony from Dr. Montgomery). Critically important in
    this case is that even Appellant’s own expert, Dr. Prince
    testified that that a blood transfusion would have likely
    saved Seels-Davila from her ultimate fate. See N.T. 4/23/15
    at 117 (Drexel’s Attorney: “If Ms. Seels-Davila received a blood
    transfusion, do you believe she would have survived?” Dr.
    Prince: “More likely than not, yes, she probably would have
    survived.”).
    Trial Court Opinion, 6/14/16, at 2-14 (footnotes and internal brackets
    omitted) (emphases in original).
    On September 6, 2012, Appellant filed a medical malpractice suit
    against Appellees and included claims of vicarious liability, corporate
    negligence, negligent infliction of emotional distress, wrongful death, and
    survival. Appellant filed an Amended Complaint on October 19, 2012, and
    Appellees responded by filing preliminary objections.       On December 20,
    2012, the trial court sustained in part and overruled in part Appellees’
    Preliminary objections. The trial court struck, without prejudice, Appellant’s
    claims   of   negligence   against   unnamed   agents,   servants,   employees,
    contractors, workmen, and apparent or ostensible agents and other
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    J-A06045-17
    language deemed overly broad in Appellant’s Amended Complaint at
    paragraphs 8, 24, 34, 62, 63, 66, 75, 79, 80, 82, 93, and 95.            Order
    (Drexel), 12/20/12; Order (Hahnemann), 12/20/12. Despite the trial court
    striking these claims without prejudice, Appellant did not file a second
    amended complaint.
    A jury trial began on April 21, 2015, and on April 30, 2015, the jury
    returned a verdict in favor of Appellees. The jury found that the conduct of
    Dr. Green and Dr. Daniels did not fall below the applicable standard of care.
    N.T. 4/30/15 at 5-6. Thus, there was no negligence which could stand as
    the basis for Appellant’s ancillary claims, including vicarious liability.
    Accordingly, the trial court entered a verdict in favor of Appellees. Appellant
    filed post-trial motions, and the trial court denied the motions on May 13,
    2015. Appellant filed a notice of appeal on June 5, 2015.
    On June 26, 2015, Appellant filed a twenty-two-page Pa.R.A.P.
    1925(b) statement containing nineteen issues with subparts. 2        Appellees
    ____________________________________________
    2
    On July 20, 2015, this Court informed Appellant that he had improperly
    appealed from the order denying his post-trial motions, and that an appeal
    lies only from judgment entered subsequent to the trial court’s disposition of
    post-trial motions. Order, 7/20/15 (citing Pa.R.A.P. 301; Vance v. 46 And
    2, Inc., 
    920 A.2d 202
    (Pa. Super. 2006); and Melani v. Northwest
    Engineering, Inc., 
    909 A.2d 404
    (Pa. Super. 2006)). This Court directed
    Appellant to praecipe the trial court Prothonotary to enter judgment on the
    verdict in favor Appellees and file with the Prothonotary of this Court a
    certified copy of the trial court docket reflecting the entry of the judgment.
    
    Id. On July
    28, 2015, Appellant complied with this Court’s directive and
    certified that on July 22, 2015, judgment was entered on the verdict.
    (Footnote Continued Next Page)
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    J-A06045-17
    filed a motion to dismiss this appeal due to the length, format, bad faith,
    and the sheer number of issues Appellant purported to raise in his Pa.R.A.P.
    1925(b) statement.         Motion, 7/12/16.         This Court denied that motion on
    August 16, 2016.          Despite Appellant’s verbose and repetitive Pa.R.A.P.
    1925(b) statement, we conclude that each of the questions presented in
    Appellant’s brief was preserved in the issues set forth in the Pa.R.A.P.
    1925(b) statement or were fairly suggested thereby. Thus, we also decline
    the trial court’s suggestion that this Court quash the appeal due to the
    Pa.R.A.P. 1925(b) statement being “incomprehensible.” Trial Court Opinion,
    6/14/16, at 22.3
    In his brief on appeal, Appellant reduced the number of issues as
    follows:
    I. Whether the trial court wrongfully precluded an expert witness
    from testifying?
    II. Whether the trial court erred as a matter of law and abused
    its discretion and committed reversible error in excluding
    Appellant’s claims of corporate negligence against Appellees.
    III. Whether the trial court erred in permitting the admission of
    the consents for treatment into evidence in a medical
    malpractice trial at the time of trial which was an error of law.
    _______________________
    (Footnote Continued)
    Response to Order, 7/28/15. Thus, this appeal is now properly before this
    Court.
    3
    We note also that the trial court diligently analyzed Appellant’s garrulous
    Pa.R.A.P. 1925(b) statement in an effort to address the myriad issues
    presented.
    - 12 -
    J-A06045-17
    IV. Whether the trial court erred and abused its discretion and
    committed reversible error in the jury slip?
    Appellant’s Brief at 6 (full capitalization omitted).4
    In Appellant’s first issue on appeal, he alleges that the trial court erred
    in precluding the testimony of a proffered expert witness.            “Whether a
    witness has been properly qualified to give expert witness testimony is
    vested in the discretion of the trial court.”      Kovalev v. Sowell, 
    839 A.2d 359
    , 362-363 (Pa. Super. 2003) (citation omitted).          “It is well settled in
    Pennsylvania that the standard for qualification of an expert witness is a
    liberal one. When determining whether a witness is qualified as an expert
    the court is to examine whether the witness has any reasonable pretension
    to specialized knowledge on the subject under investigation.” 
    Id. (citations omitted).
    The determination of whether a witness is a qualified expert
    involves two inquiries:
    When a witness is offered as an expert, the first
    question the trial court should ask is whether the
    subject on which the witness will express an opinion
    is so distinctly related to some science, profession,
    business or occupation as to be beyond the ken of
    the average layman. ... If the subject is of this sort,
    the next question the court should ask is whether
    the witness has sufficient skill, knowledge, or
    experience in that field or calling as to make it
    appear that his opinion or inference will probably aid
    the trier in his search for truth.
    ____________________________________________
    4
    For purposes of our discussion, we have renumbered Appellant’s issues.
    - 13 -
    J-A06045-17
    
    Sowell, 839 A.2d at 363
    (citations and quotation marks omitted).
    The trial court denied Appellant’s attempt to have Dr. Ronald Paynter,
    M.D., testify as an expert to support the claim that Hahnemann had
    committed corporate negligence by failing to properly operate, staff, and
    maintain its bloodless medicine program. N.T., 4/20/15, at 68-90. The trial
    court concluded that Dr. Paynter’s expert report was misleading because the
    bloodless medicine program was an administrative program, and there was
    no evidence that Dr. Paynter was an expert or had any experience in
    bloodless medicine. Trial Court Opinion, 6/14/16, at 15. Thus, there was no
    evidence that Dr. Paynter had any specialized knowledge on the subject of
    this type of administrative program, and his testimony would only confuse
    the jury. 
    Id. The trial
    court stated:
    this [c]ourt disqualified Dr. Paynter because his report
    mischaracterized the nature of bloodless medicine, as well as the
    role of the bloodless medicine program itself in handling
    Hahnemann patients, and because Dr. Paynter had provided
    nothing whatsoever to show that he had any experience or
    specific knowledge as to how such “programs” are supposed to
    be run. As was borne out throughout the trial, from physician
    witnesses, and experts on both sides, there is no specialized
    medical training that doctors ever receive in “bloodless
    medicine.” Dr. Paynter completely mischaracterized the
    function of the clerks who staffed the Bloodless Medicine
    Program at Hahnemann.
    
    Id. The trial
    court further explained its decision as follows:
    In the instant matter, it was abundantly clear that Dr.
    Paynter had no specialized knowledge regarding bloodless
    medicine programs, or even an accurate grasp of what
    - 14 -
    J-A06045-17
    “bloodless medicine” actually entailed. Consequently, allowing
    him to testify would have misled the jury and had an unfairly
    prejudicial impact on Hahnemann’s defense. In his report, Dr.
    Paynter identified himself as “an expert in the administrative
    standards applicable to hospitals in the United States, including
    Hahnemann,” and stated that it was his opinion that Hahnemann
    had not “provided a bloodless medicine program despite holding
    itself out as a hospital that offered such a program” by failing to
    provide “specific training in the methods required to deal with
    bloodless medicine patients.” Paynter Expert Report at 1, 3. He
    then followed this by listing twenty-one separate “hospital
    accreditation standards,” each of which were accompanied by a
    vague, single-sentence description, opining “that Hahnemann
    failed to comply with the above standards,” without ever
    explaining specifically how they were violated. 
    Id. at 5.
    Dr.
    Paynter then closed with a general, catchall paragraph in which
    he stated that he believed, “with a reasonable degree of medical
    certainty,” that Hahnemann
    willfully and negligently failed to provide executive
    and management oversight, supervision, education,
    competency-based training, planning sufficient staff,
    resources, policies and an effective performance
    improvement/quality assurance program to its
    patients and staff. The hospital administration and/or
    governing boards knew or should have known that
    failure to ensure the provision of executive and
    management oversight, supervision, education,
    competency      based      training,  sufficient staff,
    resources, policies, and ·an effective quality
    assurance program to the Center would endanger
    patients and likely result in injuries and death to
    patients such as Ms. Seels-Davila. These deviations
    did result in her injuries and death.
    
    Id. at 6-12.
    Distinctly absent from these materials was anything
    suggesting that Dr. Paytner had any specific experience in
    creating, operating, or supervising a bloodless medicine program
    at an administrative level, that he had specific knowledge
    about cell saver machines or autologous blood transfusions, or
    that he knew or understood what specific types of bloodless
    medicine “training” would have satisfied the applicable standard
    of care under the circumstances. 
    Id. at 1-12;
    see N.T. 4/20/15
    at 70,52 80-92 (discussing this [c]ourt’s reasoning).
    - 15 -
    J-A06045-17
    52
    This [c]ourt: “Dr. Paynter basically just recites
    the history as he reads the records, and just says,
    ‘this is clear that they violated all kinds of standards.’
    But he doesn’t ever say specifically what standards
    should be in this practice, this discreet and
    specialized practice, of bloodless medicine, whether
    it’s transfusion or cell savers or perfusionists. He
    never says that. He just said Seels-Davila died and
    therefore, the Hahnemann staff ... did everything
    wrong.”
    Moreover, Dr. Paynter’s depiction of “bloodless medicine”
    grossly mischaracterized the nature of the concept itself, and
    would have given the jury a starkly inaccurate understanding of
    what it actually entails. As described by Dr. Paynter in his report,
    “bloodless medicine” is purportedly a distinct field, for which
    medical personnel need to receive specialized training in order to
    provide competent, effective care. See Paynter Expert Report at
    2-3. In reality, however, “bloodless medicine” requires nothing
    of the sort. Rather, as the testimony at trial clearly revealed,
    even by [Appellant’s] own expert, all doctors always try to
    minimize surgical blood loss and can, and do, capably treat
    patients who refuse, for one reason or another, to allow the use
    of various blood products during the course of their treatment,
    without needing to have some sort of formalized expertise.
    There are no specific medical courses or training in “bloodless
    medicine” as such knowledge in this area is part and parcel to,
    and integrated, into the overall general medical training. See
    N.T. 4/21/15 at 66, 94-95 (testimony from Dr. Green);54 N.T.
    4/22/15 at 8-9 (testimony from Dr. Daniels);55 Appellant’s
    Motion in Limine to Exclude in Part the Appellees’ Expert
    Testimony of Arnold W. Cohen, M.D., Ex.Cat 4-6 (“Cohen MIL”)
    (Frank expert report). 56 Indeed, even Dr. Prince, Appellant’s
    own expert, admitted that not only had he himself never been
    specially trained in bloodless medicine, and that such training did
    not actually exist. N.T. 4/23/15 at 56-57.
    54
    Appellant’s Attorney: “Is it fair to say, ma’am,
    that during your medical education, you had no
    specific education in bloodless medicine?” Dr.
    Green: “The education is on the job education, as
    [with] many aspects of our training.” ... Appellant’s
    Attorney: “Now, the bloodless medicine program as
    - 16 -
    J-A06045-17
    you understood it, is it fair to say that if you knew a
    patient was in the bloodless program, that the
    doctors and the medical team had to be careful to
    prevent the loss of blood?” Dr. Green: “We are
    careful with the prevention of loss of blood with
    every patient.” Appellant’s Attorney: “And that’s
    fair to say.” Dr. Green: “With every patient, yes.”
    Appellant’s Attorney: “But for a person who has
    sought out bloodless medicine, would there have
    been a heightened recognition of blood loss by you?”
    Dr. Green: “I treat every surgery as a heightened.
    Blood loss is important and I’m a surgeon, so every
    case I treat the same. Blood loss is at the top of the
    list particularly for delivery, for any form of delivery.”
    Appellant’s Attorney: “Is it also fair to say that
    you would have been warned or notified of her blood
    loss status because of a band that she would have
    worn?” Dr. Green: “That’s one of the identifiers. It’s
    very similar to an allergy band for other staff
    members. But again, we were already taken care of
    her, so this is something we already knew about.”
    Appellant’s Attorney: “Is it also fair to say that on
    a patient who has a bloodless medicine designation,
    that it should be the most skilled person in the
    surgical practice who performs the surgery on her?”
    Dr. Green: “What is that based on?” Appellant’s
    Attorney:       “I’m    asking    you    is  that    your
    understanding or was that your understanding
    then?” Dr. Green: “The surgery is performed the
    same way. There is no different way to do a C-
    section for a bloodless patient, for a Jehovah’s
    Witness, than someone that does accept blood. We
    have techniques. We are meticulous with every
    surgery. There is no different technique because she
    is Jehovah’s Witness. There is no special way to do a
    C-section on a Jehovah’s Witness.”
    55
    Dr. Daniels: “So while I was at Drexel, I was a
    clinical assistant-your first year at Drexel, you’re a
    clinical assistant. You pass your boards. I passed my
    boards my first year. You then become an assistant
    professor. I was also in charge of the medical
    students for 2007 until January of 2010. I was also-I
    ran the fourth-year clerkship pathway. So medical
    - 17 -
    J-A06045-17
    students who were interested in OB/GYN, went into
    this OB/GYN pathway which I also ran. And I was
    also in charge of what we call the physician refresher
    programs. The physicians who were in the field of
    obstetrics and gynecology, who had been out of
    practice for a while, who were trying to get back into
    practice, had a way to learn-to make sure their skills
    were up-to-date and to learn new evidence and to
    work on their skills.” Appellees’ Attorney: “Do you
    know of any specialized training for the care of
    bloodless medicine patients?” Dr. Daniels: “No.”
    Appellees’ Attorney: “Did Appellant’s Attorney ever
    bring to your attention during her examination of
    you here or in the deposition, any training or
    specialized training which exists anywhere for care of
    bloodless medicine patients?” Dr. Daniels: “No.”
    56
    “The standard of care for treating obstetric
    patients who do not accept allogenic blood
    transfusions is the same as the population at large.
    Entry into a bloodless program does not change the
    standard of care ... Dr. Paynter opines that the
    physicians and nurses in this case did not have any
    formal training in the care of Bloodless Medicine
    patients. The primary reason for this “lack” of
    training is that no such formal training exists. I am
    unaware of such a training program even in the most
    comprehensive academic medical centers.”
    Dr. Paynter’s obviously confused and mischaracterized an
    administrative function staffed by individuals without medical
    training, who are tasked with assisting patients in understanding
    the ramifications and risks of refusing blood transfusions,
    offering them alternatives to blood transfusions, and ensuring
    that medical staff are made aware that a particular patient is a
    “bloodless patient” - one who does not accept blood
    transfusions. See Cohen MIL, Ex. C at 4 (Frank expert report);58
    see also N.T. 4/20/15 at 84-85.59
    58
    “The focus of a Bloodless Medicine program is to
    help Jehovah’s Witness patients with their advanced
    directives form, which can be confusing since the
    patient is given choices of which blood products and
    blood derivatives they are willing to accept. The
    - 18 -
    J-A06045-17
    advanced directive form is usually filled out by the
    patient, with guidance from a program coordinator,
    who is often a Jehovah’s Witness themselves, with
    no formal medical training, but rather on the job
    training attained by working in the hospital. Most
    Bloodless Medicine programs operate in this fashion,
    as did Hahnemann’s ... program.”
    59
    This [c]ourt: “I have determined in this case is
    when they say bloodless medicine, it is [sic] truly
    refers to an administrative program ... The bloodless
    medicine program is a group of people who work
    with individuals to explain their options and what
    they can and can’t do ... I don’t believe Dr. Paynter
    has presented any ... specialized knowledge on the
    subject of this type of administrative program. So I
    think that you can see that when he does it in his
    report. He is referring to medical issues, not
    administrative issues. So I do believe it would
    confuse the jury.”
    The issues in this case were whether Appellees’ doctors
    were negligent in the performance of the C-section and in their
    care and treatment of Seels-Davila afterwards, not whether a
    clerk at the bloodless medicine program deviated from a
    standard of care. Accordingly, as Dr. Paynter neither established
    that he had any level of specialized experience regarding
    bloodless medicine related administrative programs, nor had an
    accurate grasp of what constitutes “bloodless medicine,” this
    [c]ourt properly refused to qualify him as an expert in that
    subject, and correctly prevented him from testifying in support
    of Appellant’s corporate negligence claim against Hahnemann.
    Trial Court Opinion, 6/14/16, at 26-29 (some footnotes omitted) (sic erat
    scriptum notation omitted) (emphases in original).
    After review, we discern no abuse of discretion by the trial court in
    refusing to qualify Dr. Paynter to testify as an expert. Dr. Paynter appears
    to conflate the medical objective of minimizing blood loss during surgery
    with a “bloodless medicine” program, which, as presented is primarily
    - 19 -
    J-A06045-17
    administrative.   Dr. Paynter failed to establish that he had any specialized
    skill, knowledge, or experience in the area of bloodless medicine that would
    have aided the jury in the search for truth.         
    Sowell, 839 A.2d at 363
    .
    Rather, we agree with the trial court that Dr. Paynter’s proposed testimony
    would have only served to confuse the jury.         Therefore, we conclude that
    Appellant is entitled to no relief on this claim of error.
    Second, Appellant argues that the trial court erred in excluding
    Appellant’s claims of corporate negligence and granting Appellees’ motion for
    nonsuit.   Our standard of review of an order granting compulsory nonsuit is
    as follows:
    A motion for compulsory non-suit allows a defendant to test the
    sufficiency of a plaintiff’s evidence and may be entered only in
    cases where it is clear that the plaintiff has not established a
    cause of action; in making this determination, the plaintiff must
    be given the benefit of all reasonable inferences arising from the
    evidence. When so viewed, a non-suit is properly entered if the
    plaintiff has not introduced sufficient evidence to establish the
    necessary elements to maintain a cause of action; it is the duty
    of the trial court to make this determination prior to the
    submission of the case to the jury.
    Reading Radio, Inc. v. Fink, 
    833 A.2d 199
    , 209-210 (Pa. Super. 2003)
    (citation omitted).
    “Pennsylvania recognizes the doctrine of corporate negligence as a
    basis for hospital liability separate from the liability of the practitioners who
    actually have rendered medical care to a patient.” Rauch v. Mike-Mayer,
    
    783 A.2d 815
    , 826 (Pa. Super. 2001) (citation omitted).         The doctrine of
    corporate negligence imposes a non-delegable duty on the hospital to uphold
    - 20 -
    J-A06045-17
    a proper standard of care to patients. 
    Id. A hospital
    is directly liable under
    the doctrine of corporate negligence if it fails to uphold any one of the
    following four duties:
    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;
    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 ensure quality care for the patients.
    
    Id. at 826-827
    (quoting Thompson v. Nason Hospital, 
    591 A.2d 703
    ,
    707-708 (Pa. 1991)). In order to establish a prima facie case of corporate
    negligence, a plaintiff must demonstrate:
    1. the hospital acted in deviation from the standard of care;
    2. the hospital had actual or constructive notice of the defects or
    procedures which created the harm; and
    3. that the conduct was a substantial factor in bringing about the
    harm.
    
    Id. at 827
    (citation omitted). “Unless a hospital’s negligence is obvious, an
    expert witness is required to establish two of the three prongs: that the
    hospital deviated from the standard of care and that the deviation was a
    substantial factor in bringing about the harm.”   
    Id. (citation omitted).
    As discussed above, Appellant failed to produce an expert competent
    to testify regarding Appellees’ bloodless medicine policies or the applicable
    standard of care. As such, we agree with the trial court’s conclusion to grant
    - 21 -
    J-A06045-17
    Appellees’ motion for nonsuit as Appellant failed to provide the required
    support for a claim of corporate negligence.      Reading Radio, 
    Inc., 833 A.2d at 209-210
    ; 
    Rauch, 783 A.2d at 827
    . Accordingly, no relief is due.
    Next, Appellant avers that the trial court erred in denying his motion in
    limine in which he sought to preclude the admission of the consent-for-
    treatment evidence. We disagree.
    A motion in limine is a pretrial mechanism to obtain a ruling on the
    admissibility of evidence, and it gives the trial judge the opportunity to
    weigh potentially prejudicial and harmful evidence before the trial occurs,
    preventing the evidence from ever reaching the jury. Parr v. Ford Motor
    Co., 
    109 A.3d 682
    , 690 (Pa. Super. 2014) (citation omitted). “A trial court’s
    decision to grant or deny a motion in limine is subject to an evidentiary
    abuse of discretion standard of review.”       
    Id. at 690-691
    (citation and
    quotation marks omitted).
    Questions concerning the admissibility of evidence lie within the
    sound discretion of the trial court, and we will not reverse the
    court’s decision absent a clear abuse of discretion. An abuse of
    discretion may not be found merely because an appellate court
    might have reached a different conclusion, but requires a
    manifest unreasonableness, or partiality, prejudice, bias, or ill-
    will, or such lack of support so as to be clearly erroneous.
    
    Id. (internal citations
    omitted). “In addition, to constitute reversible error,
    an evidentiary ruling must not only be erroneous, but also harmful or
    prejudicial to the complaining party.”   
    Id. (internal citations
    and quotation
    marks omitted). Evidence is relevant if it has “any tendency to make a fact
    - 22 -
    J-A06045-17
    of consequence more or less probable than it would be without the
    evidence.”    Brady v. Urbas, 
    111 A.3d 1155
    , 1161 (Pa. 2015) (quoting
    Pa.R.E. 401). “Evidence about the risks of surgical procedures, in the form
    of either testimony or a list of such risks as they appear on an informed-
    consent sheet, may also be relevant in establishing the standard of care.”
    
    Brady, 111 A.3d at 1161-1162
    (Pa. 2015) (citation omitted). In this regard,
    we note that the threshold for relevance is low due to the liberal “any
    tendency” prerequisite. 
    Id. at 1162.
    The trial court thoroughly addressed this issue:
    Generally, with regard to medical consent and release
    forms, in situations where a plaintiff “only asserts negligence,
    and not lack of informed consent, evidence that a patient agreed
    to go forward with the operation in spite of the risks of which she
    was informed is irrelevant and should be excluded.” Brady v.
    Urbas, 
    111 A.3d 1155
    , 1162-63 (Pa. 2015). This is because
    “there is no assumption-of-the-risk defense available to a
    defendant physician which would vitiate his duty to provide
    treatment according to the ordinary standard of care and, thus,
    a patient’s actual, affirmative consent ... is irrelevant to the
    question of negligence.” 
    Id. at 1162.
    However, this legal
    precedent has never established a per se blanket prohibition
    against the admission of consent and release forms at trial.
    Indeed, the Pennsylvania Supreme Court has noted that such
    “information may be relevant to the question of negligence if, for
    example, the standard of care requires that the doctor discuss
    certain risks with the patient. Evidence about the risks of
    surgical procedures, in the form of either testimony or a list of
    such risks as they appear on an informed-consent sheet, may
    also be relevant in establishing the standard of care.” 
    Id. at 1161-62.61
    As such, “not all aspects of informed-consent
    information are always irrelevant in a medical malpractice case.”
    
    Id. at 1162
    (citation and quotation marks omitted).
    61
    In dicta, the Pennsylvania Supreme Court noted
    that other courts have found that proof of consent
    - 23 -
    J-A06045-17
    could be relevant and admissible where a patient has
    agreed to submit “to ‘an experimental medical
    procedure where the standards of care have not yet
    been fully developed or consents to treatment
    modalities known to be outside of the medical
    mainstream,’” or where the patient has “expressly
    consented to any particular risks associated with the
    unconventional or experimental treatment.” 
    Brady, 111 A.3d at 1162
    n. 7 (citing and quoting Storm v.
    NSL Rockland Place. LLC, 
    898 A.2d 874
    , 884 (Del.
    Super. Ct. 2005) and Schneider v. Revici, 
    817 F.2d 987
    , 995-96 (2d Cir. 1987)).
    This [c]ourt determined that the unique circumstances of
    this matter rendered Seels-Davila’s consent and release forms
    absolutely relevant and essential to the truth seeking function of
    a jury trial. It would have been manifestly unjust and improper
    to not allow them into evidence. Indeed, rather than allowing for
    misconceptions to arise about Seels-Davila “consenting” to
    substandard medical care at Hahnemann, the consents and
    releases made clear that Seels-Davila, of her own free will,
    consistently refused to accept safe, effective, routine, and life-
    saving medical treatment when she barred her doctors from
    administering blood transfusions, and even refused to collect and
    store her own blood in the event an emergency arose. There was
    not a shred of doubt that Seels-Davila fully understood the life-
    threatening ramifications of her decision to be a “bloodless”
    patient, and that she specifically agreed to hold the doctors
    harmless for any negative outcomes of her decision. See
    Consent MIL, Exs. A-E; see also N.T. 4/21/15 at 69-72
    (testimony from Dr. Green); N.T. 4/22/15 at 45-46 (testimony
    from Dr. Daniels); N.T. 4/23/15 at 114-17 (testimony from Dr.
    Prince); N.T. 4/27/15 at 93-97 (testimony from Dr. Musselman);
    N.T. 4/28/15 at 35-36 (testimony from Dr. Montgomery). For
    these reasons, this Court properly allowed into evidence Seels-
    Davila’s signed consent and release forms and testimony
    regarding the circumstances surrounding these executed forms.
    Trial Court Opinion, 6/14/16, at 33-34.
    We agree with the trial court’s analysis, and we discern no abuse of
    discretion in its ruling on the admissibility of the consent forms. The consent
    - 24 -
    J-A06045-17
    forms were not admitted merely to show that Seels-Davila understood the
    risks of treatment yet elected to proceed; rather, the consents were
    admitted to prove that Seels-Davila knowingly refused treatments that
    would have saved her life.         Accordingly, Appellant is due no relief on this
    issue.
    Finally, Appellant argues that the trial court erred in the language
    utilized on the jury verdict slip because it did not permit the jury to consider
    whether “other” unnamed hospital staff members or agents were negligent.
    Appellant’s Brief at 37.          This argument is meritless, and it fails to
    acknowledge or address a pretrial ruling striking allegations in Appellant’s
    complaint.
    At the outset, we note that when we examine a trial court’s
    instructions to the jury, we review the instructions to determine whether the
    trial court committed an abuse of discretion or error of law controlling the
    outcome of the case.         Bannar v. Miller, 
    701 A.2d 232
    , 240 (Pa. Super.
    1997) (citation omitted).5
    Error in a charge is sufficient ground for a new trial, if the charge
    as a whole is inadequate or not clear or has a tendency to
    mislead of confuse rather than clarify a material issue. A charge
    will be found adequate unless the issues are not made clear to
    the jury or the jury was palpably misled by what the trial judge
    said or unless there is an omission in the charge which amounts
    ____________________________________________
    5
    While Appellant in the case at bar presents a challenge to the verdict sheet
    as opposed to the oral instructions to the jury, in Bannar, this Court
    addressed those issues together and under the same standard.
    - 25 -
    J-A06045-17
    to fundamental error. When reviewing a charge to the jury, we
    will not take the challenged words or passage out of context of
    the whole of the charge, but must look to the charge in its
    entirety.
    
    Id. (internal citations
    and quotation marks omitted).
    The trial court addressed this issue as follows:
    Appellant next asserts that this [c]ourt erred:
    [w]hen it included the names of Dr. Minda Green and
    Dr. Kelli Daniels on the verdict sheet, who were not
    named as Defendants to this action ... and erred ...
    and abused its discretion in failing to also include the
    names and positions of other staff and agents of
    Appellees caring for Seels-Davila on the specific
    verdict sheet other than Dr. Minda Green and Dr.
    Kelli Daniels and failing to instruct on the correct
    parties ... The named parties on the verdict sheet
    were not the parties named to the lawsuit and other
    named and unnamed individuals were not included
    on the verdict sheet ... The jury verdict form was
    defective in that it did not include other staff and
    agents working at Hahnemann Hospital caring for
    Seels-Davila during the relevant time such as
    nursing staff, other professionals, and residents who
    committed negligence.[6]
    Appellant’s line of argument is absurd on its face, given
    that he asserted in his own Amended Complaint that Appellees
    were vicariously liable for Drs. Daniels’ and Green’s allegedly
    negligent acts, and Appellant’s counsel used Dr. Prince’s
    testimony to suggest that these two doctors gave Seels-Davila
    substandard treatment. See Amended Complaint at 7, 14; N.T.
    4/23/15 at 34-55, 57-144 (testimony from Dr. Prince regarding
    treat[ment] provided by Drs. Daniels and Green to Seels-Davila).
    Furthermore, the verdict sheet’s plain language that Drs. Daniels
    and Green were being referred to therein as Appellees’ agents
    or employees, rather than as direct defendants. See id.62
    ____________________________________________
    6
    Appellant’s Pa.R.A.P. 1925(b) statement, 6/26/16, at 9-10.
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    J-A06045-17
    62
    “Question 1 Do you find that the conduct of either
    Dr. Minda Green or Dr. Kelli Daniels acting as agents
    of the Appellees ... fell below the applicable standard
    of care? ... Question 3 If you answered “YES” to
    Question 1, was the negligence of Dr. Minda Green
    and/or Dr. Kelli Daniels, as agents or employees of
    Appellees ... the factual cause of Appellant’s
    damages?”
    Additionally, Appellant’s counsel fails to identify, in
    anything more than vague terms, any other agents or employees
    for whom Appellees were vicariously liable who should have been
    named on the verdict sheet. See Statement of Errors at 9-10.
    The only evidence of possible negligence presented by Appellant
    pertained to the actions of Doctors Green and Daniels. Assuming
    arguendo that this allegation of error referred to the Hahnemann
    PACU staff, see N.T. 4/28/15 at 47, 111-12, this argument is still
    without merit. First, as 
    noted supra
    , Judge Panepinto struck “all
    of Appellant’s allegations of negligence against unnamed agents,
    servants, workmen, employees, contractors and/or apparent of
    ostensible agents of Hahnemann,” without prejudice on
    December 20, 2012. See Panepinto Order, 12/20/12 #1 at 1. At
    no point thereafter did Appellant’s counsel address this ruling by
    filing a more specific Second Amended Complaint on behalf of
    her client. Therefore, with regard to Hahnemann, the only
    employees or agents for which that entity could have been
    deemed vicariously liable were those specifically named in
    Appellant’s Amended Complaint, a group which obviously did not
    include the unidentified members of the PACU staff.63 Moreover,
    despite Appellant’s counsel claim that her client was prejudiced
    by the “error”, counsel has failed to offer a scintilla of evidence,
    or explanation, as to the nature of the prejudice.
    63
    It would have been erroneous for Judge Panepinto
    to strike these allegations with prejudice, as
    vicarious liability can attach even where “employees
    are unnamed within a complaint or referred to as a
    unit, i.e., the staff.” Sokolsky v. Eidelman, 
    93 A.3d 858
    , 866 (Pa. Super. Ct. 2014). However, by
    dismissing said allegations without prejudice, Judge
    Panepinto offered Appellant’s counsel a chance to
    revise the allegations contained in her client’s
    Amended Complaint, in order to more specifically
    - 27 -
    J-A06045-17
    link these unnamed agents and employees to
    allegedly tortious acts. She, of course, did not avail
    herself of this opportunity.
    Trial Court Opinion, 6/14/16, at 35-36 (emphases in original) (sic erat
    scriptum notations omitted).    We agree with the trial court’s conclusions,
    and we conclude that Appellant is entitled to no relief on this issue.
    After review, we discern no errors of law or abuses of discretion
    committed by the trial court.     Accordingly, we affirm the July 22, 2015
    judgment entered in favor of Appellees.
    Judgment affirmed.
    Judgment Entered.
    Joseph D. Seletyn, Esq.
    Prothonotary
    Date: 7/18/2017
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