Tong-Summerford, A. v. Abington Mem. Hosp. ( 2018 )


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  • J-A31033-17
    
    2018 Pa. Super. 16
    ANITA E. TONG-SUMMERFORD, AS          :   IN THE SUPERIOR COURT OF
    ADMINISTRATOR OF THE ESTATE           :        PENNSYLVANIA
    OF MARVIN JEROME SUMMERFORD,          :
    DEC.                                  :
    :
    :
    v.                       :
    :
    :   No. 3114 EDA 2016
    ABINGTON MEMORIAL HOSPITAL            :
    AND RADIOLOGY GROUP OF                :
    ABINGTON, P.C. AND KRISTIN L.         :
    CRISCI, M.D.                          :
    :
    :
    APPEAL OF: ABINGTON MEMORIAL          :
    HOSPITAL                              :
    Appeal from the Judgment Entered September 2, 2016
    In the Court of Common Pleas of Montgomery County Civil Division at
    No(s): No. 2010-35494
    ANITA E. TONG-SUMMERFORD,             :   IN THE SUPERIOR COURT OF
    ADMINISTRATOR OF THE ESTATE           :        PENNSYLVANIA
    OF MARVIN JEROME SUMMERFORD           :
    :
    :
    v.                       :
    :
    :
    ABINGTON MEMORIAL HOSPITAL,           :   No. 3310 EDA 2016
    RADIOLOGY GROUP OF ABINGTON,          :
    P.C., VALERIE BONICA, D.O. AND        :
    KRISTIN L. CRISCI, M.D.               :
    :
    :
    APPEAL OF: RADIOLOGY GROUP OF         :
    ABINGTON, P.C., AND KRISTIN L.        :
    CRISCI, M.D.                          :
    Appeal from the Judgment Entered September 2, 2016
    In the Court of Common Pleas of Montgomery County Civil Division at
    No(s): No. 2010-35494
    BEFORE:   PANELLA, J., OLSON, J., and STEVENS*, P.J.E.
    ____________________________________
    * Former Justice specially assigned to the Superior Court.
    J-A31033-17
    OPINION BY STEVENS, P.J.E.:                        FILED JANUARY 30, 2018
    In these consolidated appeals, Appellants Abington Memorial Hospital
    (hereinafter “AMH”); Kristin L. Crisci, M.D. (hereinafter “Dr. Crisci”); and
    Radiology   Group   of   Abington,   P.C.   (hereinafter   “RGA”)   (hereinafter
    collectively, at times, “Appellants”) appeal from the judgment entered in the
    Court of Common Pleas of Montgomery County on September 2, 2016, at
    which time the trial court denied their respective post-trial motions, molded
    the verdict of $5,000,000 in favor of Anita E. Tong-Summerford, as
    administrator of the estate of Marvin Jerome Summerford, deceased,
    (hereinafter “Appellee”) to add delay damages in the amount of $947,157.53,
    and ordered the delay damages to be apportioned between the Wrongful
    Death Act and Survival Act claims in the same proportionate allocation as in
    the verdict: 30% ($284,147.26) to the Wrongful Death Act claim and 70%
    ($663,010.27) to the Survival Act claim. Upon our review, we affirm.
    The trial court set forth the facts and procedural history herein as
    follows:
    On November 30, 2008, Marvin Summerford, age 88, was
    transferred to the emergency department of Abington Memorial
    Hospital (hereinafter, "AMH" or the "Hospital") from a long-term
    care facility. Mr. Summerford's past medical history included
    dementia, hypertension, congestive heart failure, and pulmonary
    insufficiency. On December 1, 2008, Mr. Summerford suffered
    cardiac arrest secondary to pneumonia, and a code was called due
    to pulseless electrical activity, decreased heart rate, and low blood
    pressure. Mr. Summerford survived and was transferred to the
    ICU.
    On December 2, 2008, a feeding tube was inserted and an
    order was placed for an x-ray to confirm proper placement.1 The
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    J-A31033-17
    x-ray revealed that the tube had been inadvertently inserted into
    the lung and was therefore removed. The feeding tube was re-
    inserted, and another x-ray was ordered to confirm proper
    placement. Again, the feeding tube was not properly placed.
    On the next day, December 3, 2008, Valerie Bonica, D.O.,
    an AMH resident, inserted a new feeding tube into Mr.
    Summerford. Dr. Bonica ordered a portable chest x-ray to confirm
    proper placement of the tube at 3:55 p.m. In response to this
    order, x-ray technologist Jillian Nickel, an AMH employee,
    performed a portable x-ray at 4:53 p.m. capturing the lower chest
    and abdomen.2 This image was interpreted by Kristin Crisci, M.D.,
    a radiologist, who incorrectly read the study as showing
    termination of the feeding tube in decedent's stomach when, in
    fact, it terminated in Mr. Summerford's left lung. Dr. Crisci signed
    her report at 5:33 p.m. She did not order additional imaging. In
    reliance upon Dr. Crisci's report, Dr. Bonica ordered
    administration of a feeding solution (Jevity) at 10 cc's per hour for
    the first eight hours. The first feed was administered at
    approximately 11:00 p.m. on December 3, 2008. From 11:00
    p.m. to 7:00 a.m. the next morning, 50 cc's of Jevity and 420 cc's
    of flush was administered through the feeding tube into Mr.
    Summerford's lung.
    Mr. Summerford's condition deteriorated. At 4:38 a.m. on
    December 4, 2008, Dr. Bonica placed a STAT order for portable
    chest x-ray to aid in the diagnosis/treatment of pneumonia. The
    x-ray was completed at 4:46 a.m. but was not analyzed by a
    radiologist until 8:13 a.m., at which time the radiologist
    recognized the feeding tube was positioned in Mr. Summerford's
    left lung. By this time, Mr. Summerford had already been
    pronounced dead at 7:11 a.m. on December 4, 2008.
    After a five-day jury trial, the jury returned a verdict on May
    13, 2016 in favor of [Appellee] and against [Appellants] AMH and
    Dr. Crisci/Radiology Group of Abington, P.C. (hereinafter, "Dr.
    Crisci")3 in the total sum of $5,000,000 ($1.5 million for the
    wrongful death claim and $3.5 million for the survival action
    claim). The jury apportioned liability as follows: AMH 25% and Dr.
    Crisci 75%. The verdict was molded to add Rule 238 delay
    damages for [Appellee] and against [Appellants], resulting in a
    molded verdict in the amount of $5,947,157.53.4
    AMH and Dr. Crisci each filed timely motions for post-trial
    relief seeking judgment n.o.v., a new trial, and remittitur.
    Following oral argument, on September 2, 2016 this court denied
    [Appellants'] post-trial motions, molded the verdict, and entered
    judgment on the jury verdict in favor of [Appellee] and against
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    J-A31033-17
    [Appellants]. Thereafter, AMH and Dr. Crisci filed timely appeals,5
    which were consolidated on November 7, 2016 by Order of the
    Superior Court. On October 4, 2016, the court ordered defendants
    to file a concise statement of errors pursuant to Pa. R.A.P.
    1925(b).
    ____
    1 The feeding tube is supposed to be inserted into the esophagus
    and end up in the stomach. However, due to the close proximity
    of the esophagus and trachea in the back of the throat and the
    difficulty visualizing the proper placement of the feeding tube for
    insertion, occasionally the feeding tube is inadvertently placed in
    the trachea instead of the esophagus. Accordingly, it is necessary
    that an x-ray be obtained to confirm proper placement of the tube
    into the stomach, as opposed to the lung, before feeding solution
    is administered through the tube. All parties agreed that it was
    not negligence for a feeding tube to be inadvertently inserted into
    the trachea instead of the esophagus. N.T. 05.09.16 (a.m.), p. 19.
    2 There was disagreement whether the image captured by the
    portable x-ray was an abdominal study or a lower chest study. Dr.
    Crisci testified that notwithstanding Dr. Bonica's order for a chest
    x-ray, the technologist performed an abdominal study. N.T.
    05.10.16 (p.m.), p. 93. [Appellee’s] expert Dr. Igidbashian
    testified that it was an abdominal study. N.T. 05.10.16 (a.m.), p.
    95. However, AMH's expert, Dr. Hani Abujudeh, testified that," ...
    this was not a chest x-ray. It was not an abdominal x-ray. It was
    a hybrid x-ray, between a chest and an abdomen." N.T. 05.11.16
    (p.m.), p. 144.
    3 It was stipulated that Dr. Crisci was an employee/agent of
    Radiology Group of Abington, P.C. ("RGA"). By agreement of all
    parties, Dr. Crisci and RGA appeared together on the verdict
    sheet. N.T. 05.12.16 (p.m.), p. 89-91.
    4[Appellants] do not raise any issue on appeal regarding the
    addition of delay damages.
    5AMH appeal Docket Number 3114 EDA 2016; Dr. Crisci appeal
    Docket Number 3310 EDA 2016.
    Trial Court Opinion, filed 12/29/16, at 1-3.
    -4-
    J-A31033-17
    On October 18, 2016, Dr. Crisci and RGA filed a timely Concise
    Statement of Errors Complained of on Appeal wherein they raised ten (10)
    issues. On October 25, 2016, AMH filed its Statement of Matters Complained
    of on Appeal wherein it also set fourth ten (10) issues.
    In their brief, Dr. Crisci and RGA raise the following Statement of
    Questions Presented:
    A.    Should the trial court have entered              a judgment
    notwithstanding the verdict in favor of [Dr.]   Crisci because
    [Appellee] failed to prove, by competent        and sufficient
    evidence, her prima facie case of negligence    against her?
    B.    Whether the trial court erred in denying Appellants' Motion
    for a Non-Suit?
    C.    Whether the trial court erred in denying a new trial on the
    basis of highly inflammatory and unfairly prejudicial
    statements made by Co-[Appellants’] radiology expert, Hani
    Abujudeh, M.D.?
    D.    Whether the trial court abused its discretion and/or made
    an error of law in permitting [co-Appellants’] radiology
    expert, Hani Abujudeh, M.D., to testify to issues relating to
    the standard of care of Dr. Crisci, beyond the opinions
    testified to by [Appellee’s] expert, which resulted in
    prejudice to Dr. Crisci?
    E.    Whether the trial court committed an abuse of discretion
    and/or an error of law in only granting in part the Motion in
    Limine filed by Crisci to preclude [Appellee’s] expert, Vartan
    Igidbashian, D.O., from testifying to causation issues
    outside his expertise?
    F.    Whether the trial court committed an abuse of discretion
    and/or an error of law in denying a new trial because of
    improper statements made by [Appellee’s] counsel?
    -5-
    J-A31033-17
    G.    Whether the trial court committed an abuse of discretion
    and/or an error of law in denying Appellants' Motion for
    Post-trial relief on the basis that statements made by
    [Appellee’s] counsel, in disregard of the [c]ourt's ruling on
    subsequent remedial measures, were highly and unfairly
    prejudicial to [Appellants]?
    H.    Whether the trial court committed an abuse of discretion
    and/or an error of law in denying Appellants' Motion for
    Remittitur because [Appellee] failed to introduce sufficient
    evidence to support the Jury's unreasonable award of
    damages?
    I.    Whether the trial court abused its discretion and/or made
    an error of law in denying Appellants' Motion for a New Trial
    on damages since the verdict was against the weight of the
    evidence?
    Brief of Appellants at 1-2.
    In its brief, AMH sets forth the following Statement of the Questions
    Involved:
    1. Whether this Court should grant a new trial on the basis that
    the trial court allowed [Appellee] to vigorously cross-examine a
    defense expert using industry guidelines, but where there was no
    foundation for the guidelines' applicability to the medical
    treatment at issue, and where this Court and the Supreme Court
    have repeatedly rejected the trial court's rationale that the
    Defendant should be made to rebut the improperly admitted
    evidence with cross-examination.
    2. Whether this Court should grant a new trial on the basis that
    the trial court allowed [Appellee] to introduce an adverse event
    notification letter, required by the Medical Care and Reduction of
    Error Act, in violation of the statute's express prohibition on using
    such letters as admissions of liability, where the letter introduced
    during testimony that it was an acknowledgement of the "truth"
    after several hours of lies.
    3. Whether this Court should grant a new trial on the basis that
    the trial court allowed [Appellee’s] expert to substantiate an
    opinion with analysis that is not within the fair scope of his report,
    -6-
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    thus lending credibility to his opinion that may have affected the
    verdict.
    4. Whether this Court should vacate the judgment and grant a
    j.n.o.v., or else remand for a new trial, because the evidence failed
    to establish the elements of causation and notice, or else the
    verdict was against the clear weight of the evidence on these
    points.
    5. Whether this Court should remand for a new trial or else vacate
    the judgment and grant a j.n.o.v., because the verdict concerning
    the taking of the x-rays by the technologist was against the weight
    of the evidence, or else was unsupported by necessary,
    competent, and qualified expert testimony.
    6. Whether this Court should, in this rare case, grant a new trial
    on damages or a remittitur, because the gross verdict amount
    shocks the conscience, and the factors analyzed for such an
    argument preponderate heavily in favor of reducing the award.
    Brief of AMH at 5-6.
    For ease of discussion, we first will consider the claims raised by Dr.
    Crisci and RGA and thereafter discuss those asserted by AMH.         Where issues
    within each discussion are related, we will analyze them together.
    Initially, Dr. Crisci and RGA assert the trial court erred in failing to grant
    their motion for judgment notwithstanding the verdict (JNOV) due to
    Appellee’s failure to present competent evidence to support her negligence
    claim. Dr. Crisci and RGA also claim they are entitled to JNOV due to the trial
    court’s failure to grant their motion for a partial nonsuit on the issue of
    whether Dr. Crisci breached the standard of care in her interpretation of the
    thoracoabdominal x-ray of December 3, 2008. In doing so, they stress that
    while Dr. Igidbashian testified Dr. Crisci had breached the necessary standard
    of care when she did not order an additional study of the victim’s chest upon
    -7-
    J-A31033-17
    realizing an abdominal study had been done, he did not testify that there had
    been a breach in the standard of care with regard to Dr. Crisci’s interpretation
    of the actual study performed. Brief of Dr. Crisci and RGA at 13-14. Dr. Crisci
    and AMA reason that:
    [i]f Dr. Crisci read the study within the standard of care, the issue
    of whether another study should have been ordered was moot and
    should never have been considered by the jury. Without any
    testimony regarding a breach of the standard of care in the
    interpretation of the x-ray by Dr. Crisci, [Appellee] failed to satisfy
    her burden of proving a prima facie case of negligence and
    therefore, JNOV must be entered in Crisci’s favor.
    ***
    It was imperative to the defense for the trial court to have
    granted Dr. Crisci’s partial motion for non-suit so that the jury
    would not consider the issue of whether Dr. Crisci breached the
    standard of care in interpreting the x-ray.
    
    Id. at 14-15,
    20 (emphasis in original).
    At the outset, we note that where a defendant presents evidence
    following the denial of a motion for nonsuit, the correctness of the trial court's
    denial is rendered a moot issue and unappealable. See Williams v. A–Treat
    Bottling Co, Inc., 
    551 A.2d 297
    , 299 (Pa.Super. 1988). Here, Dr. Crisci and
    RGA raised a motion for partial nonsuit at the close of Appellee’s case which
    the trial court denied. See N.T. Trial, 5/11/16, at 222-24. However, Dr. John
    Kirby testified as a witness for Dr. Crisci following the denial of the nonsuit.
    See N.T. Trial, 5/12/16 a.m., at 95-136; N.T. Trial 5/12/16 p.m., at 1-14.
    Accordingly, the propriety of the court's order is a moot issue, Williams, 551
    -8-
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    A.2d at 299, and we next consider the trial court’s denial of their motion for
    JNOV. In doing so, we employ a well-settled standard of review:
    A JNOV can be entered upon two bases: (1) where the movant is
    entitled to judgment as a matter of law; and/or, (2) the evidence
    was such that no two reasonable minds could disagree that the
    verdict should have been rendered for the movant. When
    reviewing a trial court's denial of a motion for JNOV, we must
    consider all of the evidence admitted to decide if there was
    sufficient competent evidence to sustain the verdict. In so doing,
    we must also view this evidence in the light most favorable to the
    verdict winner, giving the victorious party the benefit of every
    reasonable inference arising from the evidence and rejecting all
    unfavorable testimony and inference. Concerning any questions of
    law, our scope of review is plenary. Concerning questions of
    credibility and weight accorded the evidence at trial, we will not
    substitute our judgment for that of the finder of fact. If any basis
    exists upon which the [court] could have properly made its award,
    then we must affirm the trial court's denial of the motion for JNOV.
    A JNOV should be entered only in a clear case.
    V–Tech Services, Inc. v. Street, 
    72 A.3d 270
    , 275 (Pa.Super. 2013)
    (citation omitted).
    Medical malpractice is defined broadly as the “unwarranted departure
    from generally accepted standards of medical practice resulting in injury to a
    patient, including all liability-producing conduct arising from the rendition of
    professional medical services.” Toogood v. Owen J. Rogal, D.D.S., P.C.,
    
    573 Pa. 245
    , 254, 
    824 A.2d 1140
    , 1145 (2003). “[T]o prevail in a medical
    malpractice action, a plaintiff must ‘establish a duty owed by the physician to
    the patient, a breach of that duty by the physician, that the breach was the
    proximate cause of the harm suffered, and the damages suffered were a direct
    result of the harm.’” 
    Id. (quoting Hightower–Warren
    v. Silk, 
    548 Pa. 459
    ,
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    698 A.2d 52
    , 54 (1997). Thus, the basic elements of medical malpractice and
    ordinary negligence are the same, although medical malpractice has some
    distinguishing characteristics. See Grossman v. Barke, 
    868 A.2d 561
    , 566
    (Pa.Super. 2005).
    Upon our review of the trial testimony, we agree with Dr. Crisci and RGA
    that Dr. Igidbashian did not opine Dr. Crisci had deviated from the standard
    of care by misinterpreting the x-ray she reviewed on December 3, 2008.
    However, it was not her “alleged misinterpretation” of that x-ray which was
    highlighted to the jury as being “a cause or a substantial factor in bringing
    about Mr. Summerford’s injury and death” as Dr. Crisci and RGA opine in their
    appellate brief, see Brief of Appellants at 19, but rather her failure to seek an
    additional study to achieve a proper diagnosis which was represented as
    constituting a deviation from that standard of care.      As such, Dr. Crisci’s
    analysis of an incomplete study was not determinative in deciding Appellee’s
    medical malpractice claim. In this regard, the trial court reasoned as follows:
    At trial, Dr. Vartan Igidbashian, [Appellee’s] expert
    radiologist, testified that the end/tip of the feeding tube was
    supposed to terminate in Mr. Summerford's stomach and not his
    lung.6 He testified that he could not determine based on the
    December 3rd x-ray alone whether or not the feeding tube was
    actually in Mr. Summerford's stomach:
    MR. TRUNK: That's the end of the feeding tube, correct?
    DR. IGIDBASHIAN: Correct.
    Q. Where is that supposed to be located?
    A. That's supposed to be located in the stomach.
    - 10 -
    J-A31033-17
    Q. Can you tell from this image whether that is in the
    stomach or not?
    A. No.
    N.T. 05.10.16 (a.m.), p. 90-91.
    Dr. Igidbashian stated that Dr. Crisci breached the standard
    of care by interpreting this x-ray instead of obtaining additional
    views:
    MR. TRUNK: And what should Dr. Crisci, the radiologist who
    reviewed this film, have done when she saw that an
    abdominal study was taken to check the placement of a
    feeding tube?
    DR. IGIDBASHIAN: She should have asked for additional
    views to include the chest, the major airway, so that you
    can make sure that the tube is not going through those and
    ending up in the lung, instead of coming through and ending
    up in the stomach.
    Q. Did she do that?
    A. No.
    Q. And was that a violation of the standard of care?
    A. Yes.
    N.T. 05.10.16 (a.m.), pp. 92-93.
    Dr. lgidbashian opined that Dr. Crisci was incorrect in
    concluding that the December 3rd study confirmed the
    feeding tube terminated in Mr. Summerford's stomach:
    MR. TRUNK: And then the conclusion [of Dr. Crisci] is:
    Feeding tube terminates within the stomach. Is that a
    conclusion that a radiologist would be able to reach by
    looking at the image, the abdominal study, that we just
    saw?
    DR. IGIDBASHIAN: No.
    - 11 -
    J-A31033-17
    Q. And was this the correct conclusion? The conclusion is
    that you cannot tell.
    Q. Was this the correct conclusion that Dr. Crisci reached?
    A. No.
    Q. Why is that?
    A. Because you cannot tell where it is exactly.
    Q. And where was the feeding tube?
    A. It was in the lung.
    N.T. 05.10.16 (a.m.), pp. 97-98.
    MR. TRUNK: You told us earlier that Dr. Crisci should have
    -- when she saw that study on December 3rd, she should
    have recognized that it was an abdominal study, and she
    should have ordered another study. Did I get that right?
    DR. IGIDBASHIAN: Yes.
    Q. Did she do that?
    A. No.
    Q. Was that a breach of the standard of care?
    A. Yes.
    Q. And did that failure increase the risk of harm to Mr.
    Summerford?
    A. Yes.
    N.T. 05.10.16 (a.m.), pp. 136-137.
    The expert testimony at trial was sufficient for the jury to
    find that Dr. Crisci violated the standard of care by her failure to
    order another study to make sure the feeding tube was in Mr.
    Summerford's stomach and not his lung. The court properly
    denied Dr. Crisci's motion for a non-suit because the evidence was
    - 12 -
    J-A31033-17
    sufficient for a jury to determine that Dr. Crisci was liable to
    [Appellee].
    Dr. Crisci claims she is entitled to judgment n.o.v. or a new
    trial because Dr. Igidbashian failed to testify that Dr. Crisci,
    "breached the standard of care in her interpretation of the
    thoracoabdominal x-ray performed on December 3, 2008." Crisci
    Post-Trial Motion, 3. In support of this argument, Dr. Crisci
    asserts: "Dr. Igidbashian testified that it was a breach of the
    standard of care for Dr. Crisci not to have ordered a new study;
    however, Dr. Igidbashian did not testify that there was a breach
    in the standard of care with regard to the interpretation of the
    study itself." 
    Id. At the
    conclusion of Plaintiffs case-in-chief, Dr. Crisci made
    the following oral motion for a partial non-suit:
    MS. RAYNOR (Counsel for Crisci): Your Honor, now that
    [Appellee] has closed her case, I would like to make a partial
    motion for nonsuit on the basis that, as I understand
    [Appellee’s] claims, there were two.
    Number 1, that Dr. Crisci misread an x-ray, which has been
    conceded and that she failed, allegedly failed to recognize it
    was a bad study from a technical perspective and ask for
    another study.
    [Appellee’s] expert, Dr. Igidbashian, testified that she
    breached the standard of care on only one of those pieces,
    which was not appreciating that it was not the proper study,
    and ordering another study that would better capture the
    anatomy.
    He did not state that she breached the standard of care by
    making an error, a mistake, and I think for that piece of it
    to go to the jury as -- he would have had to have given that
    testimony, and he did not.
    THE COURT: Okay. Do you want to respond to that?
    MR. TRUNK (Counsel for [Appellee]): He actually did
    give that testimony, and the testimony was that there was
    a breach of the standard of care to incorrectly interpret the
    study, and as well as to not ask for a new study.
    THE COURT: Okay.
    - 13 -
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    MS. RAYNOR: Your Honor, if l may say, I specifically asked
    him on recross, to be clear, that his own only claim of the
    breach of the standard of care was that she did not ask for
    another study for interpretation.
    XXX
    THE COURT: Okay. I'm going to deny the motion.
    N.T. 05.11.16 (p.m.), pp. 222-224.
    In Montgomery v. S. Philadelphia Med. Group, Inc., 
    656 A.2d 1385
    (Pa. Super. 1995), the Superior Court explained:
    A motion for a non-suit may be granted only where it is clear
    that no other conclusion could be reached under the
    evidence presented. Bowser v. Lee Hosp., 399 Pa.Super.
    332,337,582 A.2d 369,371 (1990), allocatur denied, 527
    Pa. 614,590 A.2d 755 (1991); A.J Aberman, Inc. v. Funk
    Bldg. Corp., 278 Pa.Super. 385,393,420 A.2d 594, 598
    (1980). When considering such a motion, issues of
    credibility and the weight to be assigned to the evidence are
    not to be resolved by the trial judge, but must be left for the
    finder of fact to resolve at the close of the evidence. Scott
    v. Purcell, 
    490 Pa. 109
    , 113,415 A.2d 56, 58 (1980).
    Because a jury may not reach its verdict on mere
    speculation, however, a trial court may enter a non-suit if
    the plaintiff has failed to produce sufficient evidence to meet
    his or her burden of proof. Morena v. South Hills Health Sys.,
    501 Pa. 634,462 A.2d 680, 683 (1983).
    
    Montgomery, 656 A.2d at 1388
    .
    Dr. Crisci is correct that Dr. lgidbashian did not offer an
    expert opinion that she violated the standard of care by
    misinterpreting the x-ray on December 3, 2008. His criticism of
    her care was limited to her failure to recognize the December 3,
    2008 x-ray was inadequate and failing to order an additional x-
    ray to confirm placement of the feeding tube.
    It is of no moment that the court denied Dr. Crisci's motion
    for a partial non-suit regarding an unproven claim. If erroneous,
    this ruling had no effect whatsoever regarding the admission of
    any evidence at trial or the court's charge to the jury at the
    conclusion of the case. It is not the court's practice to instruct the
    jury regarding the theories of liability or the defenses to liability
    but, instead, to instruct the jury that they must weigh the credible
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    J-A31033-17
    evidence and apply the law charged by the court in order to
    determine whether plaintiff satisfied her burden of proof or not. 7
    "Where a case is submitted to a jury on several theories which
    have been pleaded in the alternative, the verdict can be upheld if
    the evidence is sufficient to prove a valid cause under any of those
    theories." Niles v. Fall Creek Hunting Club, Inc., 
    545 A.2d 926
    ,
    931 (Pa.Super. 1988).
    ____
    6 The tip of the feeding tube is denser, and thus brighter, so that
    it can more easily be identified by x-ray.
    7Dr. Crisci did not request a limiting instruction that the jury
    should not consider Dr. Crisci’s misinterpretation of the x-ray as a
    basis for liability.
    Trial Court Opinion, filed 12/29/16, at 6-11.
    Viewing the foregoing evidence presented at trial in a light most
    favorable to Appellee as we must, we find it was sufficient to sustain the
    verdict. As such, we affirm the trial court’s decision to deny the motion for
    JNOV.
    In their third and fourth issues, Dr. Crisci and RGA challenge certain
    testimony of Dr. Hani Abujudeh, an expert in radiology, presented by AMH.
    Counsel for Appellee asked Dr. Abujudeh on cross-examination whether a
    first-year resident would be able to identify the path of the feeding tube from
    the image presented on the December 3, 2008, x-ray. Over objection, Dr.
    Abujudeh responded as follows:
    Q.   Could a first year resident tell on the image from
    December 3rd, 2008?
    Ms. Raynor: Objection, that’s beyond the scope of his
    report, and he’s asking for a standard of care opinion.
    The Court: Overruled. Go ahead.
    - 15 -
    J-A31033-17
    Q.    Could a first year resident determine on that x-ray
    that Dr. Crisci misinterpreted that the course of the feeding
    tube is misplaced and goes into the lungs and not the
    stomach?
    A.     Yes. In fact, the jury can also tell right now, based on
    education that I gave them, that is the wrong place, not just
    a first year resident.
    Q.   A first year resident, and even a jury of - - you’re
    assuming that they are not radiologists, I assume, right?
    A.    Right, based on experience that they have explored,
    you can see that the first one is going down this way, and
    the second one is going down on the same path.
    Q.     And that’s because that was a superb film to see,
    right?
    A.    Correct.
    N.T. Trial, 5/11/16 p.m., at 190-191.
    Dr. Crisci and RGA reason that the aforementioned exchange “gave the
    jury the misinterpretation that that they were more competent and trained to
    interpret such an x-ray than Dr. Crisci who attended medical school and was
    the Chair of the Radiology Department at Abington Hospital for years, and
    that, she was at best, not competent to read the film, or at worst, she was
    grossly negligent.” Brief of Appellants at 24. They further contend a new trial
    is warranted as this testimony was outside the scope of Dr. Abujudeh’s report
    in violation of Pa.R.C.P. § 4003.4(c) and exceeded the testimony of Appellee’s
    expert as to Dr. Crisci’s breach of the standard of care. 
    Id. at 27.
    - 16 -
    J-A31033-17
    When considering whether the trial court had erred in denying an
    appellant’s motion for a mistrial based upon certain remarks of a
    Commonwealth witness, our Supreme Court generally observed that:
    [e]very unwise or irrelevant remark made in the course of a trial
    by a judge, a witness, or counsel does not compel the granting of
    a new trial. A new trial is required when the remark is prejudicial;
    that is, when it is of such a nature or substance or delivered in
    such a manner that it may reasonably be said to have deprived
    the defendant of a fair and impartial trial.
    Commonwealth v. Goosby, 
    450 Pa. 609
    , 611, 
    301 A.2d 673
    , 674 (1973)
    (citations omitted).
    Initially, we note that prior to the aforesaid cross-examination, AMH had
    elicited testimony from Dr. Abujudeh, without a specific objection from Dr.
    Crisci or any objection from RGA, that a first year resident could observe the
    feeding tube had entered Mr. Summerford’s lung. N.T. Trial, 5/11/16 p.m.,
    at 159-160, 160-62. Once that testimony had been given without objection,
    Appellee properly explored it further on cross-examination. Furthermore, the
    record belies Dr. Crisci’s and RGA’s representation that the aforesaid
    testimony pertained to the relevant standard of care, for the objection to the
    specific question concerning whether this was a violation of the standard of
    care was sustained, and Dr. Abujudeh did not opine in this regard. See N.T.
    Trial, 5/11/16 p.m., at 192.
    Also, to the extent Appellants challenge Dr. Abujudeh’s surmising as to
    what a juror could observe as minimizing Dr. Crisci’s credentials, we note that
    - 17 -
    J-A31033-17
    Appellants failed to raise this argument at the proper juncture before the trial
    court; therefore, it is waived.
    [I]n order to preserve an issue for appellate review, a party must
    make a timely and specific objection at the appropriate stage of
    the proceedings before the trial court. Failure to timely object to
    a basic and fundamental error, such as an erroneous jury
    instruction, will result in waiver of that issue. On appeal, the
    Superior Court will not consider a claim which was not called to
    the trial court's attention at a time when any error committed
    could have been corrected.... By specifically objecting to any
    obvious error, the trial court can quickly and easily correct the
    problem and prevent the need for a new trial. Additionally, the
    appellate court should not be required to waste judicial resources
    correcting a problem that the trial court could have easily
    corrected if it had been given the opportunity to avoid the
    necessity of granting a new trial.
    Fillmore v. Hill, 
    665 A.2d 514
    , 515–16 (Pa.Super. 1995), appeal denied, 
    674 A.2d 1073
    (Pa. 1996) (citations omitted); Pa.R.A.P. 302(a).
    In addition, as the trial court notes, Dr. Abujudeh’s testimony was
    relevant to a key and contested issue concerning the quality of the December
    3, 2008, x-ray. As the trial court explained:
    It is important to review the evidence introduced in the trial
    record before Dr. Abujudeh's testimony regarding a central issue
    in the case -the quality of the December 3rd x-ray. Dr. Igidbashian
    had already testified that it was below the standard of care for Dr.
    Crisci to rely upon the December 3rd x-ray because, inter alia,
    there was inadequate visualization of the feeding tube, chest and
    major airway. N.T. 05.10.16 (a.m.), pp. 92-98. Dr. Crisci had
    earlier testified that the x-ray film was of good diagnostic quality
    (N.T. 05.10.16 (p.m.), p. 94), but acknowledged that she had
    misread the study:
    BY MR TRUNK:
    - 18 -
    J-A31033-17
    Q. That is, if you thought that the tube was coming this way out
    of the esophagus, and we now know that's not where it was
    coming out of, correct?
    A. Yes, absolutely.
    Q. So that means you were never able to visualize the tube going
    from what you thought was the area of the spine over to the left
    where we see it here, correct?
    A. Yes. I made a mistake in the interpretation of the film. That is
    correct.
    Q. And in other words, you could not see the full course of this
    tube?
    A. I could not see the full course of the. tube.
    N.T. 05.10.16 (p.m.), p. 103.
    A pivotal and contested issue in this case related to the
    quality of the x-ray taken on December 3, 2008[,] and whether it
    captured the appropriate anatomy. Dr. Igidbashian testified that
    its quality was not adequate to make a diagnosis and that the
    standard of care required that an additional study be ordered. N.T.
    05.10.16 (a.m.), pp. 92-93. Dr. Crisci testified that the diagnostic
    quality of the image itself was good, but that in hindsight, she
    could not see some of the anatomy needed to make a correct
    interpretation. N.T. 05.10.16 (p.m.), p. 94. Dr. Abujudeh testified
    that the quality of the study was so good that even lay people
    could see what the image showed. N.T. 05.11.16 (p.m.), p. 191-
    192. His testimony did not relate to the standard of care, but to
    the quality of the image. The court properly sustained the
    objection to a question eliciting a standard of care opinion by Dr.
    Abujudeh. His testimony was probative and relevant to the issue
    relating to the quality of the subject x-ray which was
    misinterpreted and whether another study was indicated. Dr.
    Abujudeh never testified that Dr. Crisci violated the standard of
    care.
    Trial Court Opinion, filed 12/29/16, at 13-14. For all of the foregoing
    reasons, these issues lack merit.
    - 19 -
    J-A31033-17
    Dr. Crisci and RGA next submit the trial court erred and abused its
    discretion when it only partially granted their motion in limine to preclude
    Appellee’s expert Dr. Igidbashian from testifying to causation issues that
    allegedly exceeded his expertise.    They maintain that as a radiologist, Dr.
    Igidbashian did not possess the necessary training and experience to provide
    competent trial testimony pertaining to internal medicine and forensic
    pathology. Brief of Appellants at 31. Dr. Crisci and RGA further represent
    that “Dr. Igidbashian was permitted to testify that Dr. Crisci increased the risk
    of harm by not ordering another radiology study. He was simply not qualified
    to offer causation opinions, as was confirmed by his own acknowledgement
    during his testimony at trial that he had never interpreted an x-ray taken to
    confirm feeding tube placement and had never determined the cause of death
    of anyone.” 
    Id. at 35.
    They conclude that the subject testimony “prejudiced
    Dr. Crisci in that the jury considered evidence on causation that it should never
    have considered and may have reached its verdict based upon his testimony.”
    
    Id. The referenced
    testimony was developed as follows:
    Q.   You told us earlier that Dr. Crisci should have –when
    she saw that study on December 3rd, she should have
    recognized that it was an abdominal study, and she should
    have ordered another study. Did I get that right?
    A.    Yes.
    Q.    Did she do that?
    A.    No.
    - 20 -
    J-A31033-17
    Q.   Was that a breach of the standard of care?
    A.   Yes.
    Q.  And did that failure increase the risk of harm to Mr.
    Summerford?
    A.   Yes.
    N.T. Trial, 5/10/16 a.m., at 136-37.
    This Court’s standard of review regarding evidentiary challenges is well-
    settled:
    [a]dmission of evidence is within the sound discretion of the trial
    court and will be reversed only upon a showing that the trial court
    clearly abused its discretion. An abuse of discretion is not merely
    an error of judgment, but is rather the overriding or misapplication
    of the law, or the exercise of judgment that is manifestly
    unreasonable, or the result of bias, prejudice, ill-will or partiality,
    as shown by the evidence of record.
    Commonwealth v. Tyson, 
    119 A.3d 353
    , 357-58 (Pa.Super. 2015) (internal
    citations and quotation marks omitted), appeal denied, 
    128 A.3d 220
    (Pa.
    2015). An appellant bears a “heavy burden” to show that the trial court has
    abused its discretion. Commonwealth v. Christine, 
    533 Pa. 389
    , 397, 
    125 A.3d 394
    , 398 (2015).
    In Miller v. Brass Rail Tavern, 
    541 Pa. 474
    , 
    664 A.2d 525
    (1995), the
    Pennsylvania Supreme Court held that a witness without a medical degree
    who acted in the dual role of mortician and county coroner was competent to
    give expert testimony as to one’s time of death. In doing so, the Court
    explained:
    - 21 -
    J-A31033-17
    [i]t is well established in this Commonwealth that the standard for
    qualification of an expert witness is a liberal one. The test to be
    applied when qualifying an expert witness is whether the witness
    has any reasonable pretension to specialized knowledge on the
    subject under investigation. If he does, he may testify and the
    weight to be given to such testimony is for the trier of fact to
    determine. It is also well established that a witness may be
    qualified to render an expert opinion based on training and
    experience. Formal education on the subject matter of the
    testimony is not required, nor is it necessary that an expert be a
    licensed medical practitioner to testify with respect to organic
    matters. It is not a necessary prerequisite that the expert be
    possessed of all of the knowledge in a given field, only that he
    possess more knowledge than is otherwise within the ordinary
    range of training, knowledge, intelligence or experience.
    
    Id. 541 Pa.
    at 
    480-81, 664 A.2d at 528
    (emphasis and internal citations
    omitted).
    Upon our review of the record, we find the trial court did not abuse its
    discretion in permitting Dr. Igidbashian to opine that the deviations in the
    standard of care increased the risk of harm to Mr. Summerford. As the trial
    court reasoned,
    [p]rior to trial, Dr. Crisci filed a Motion in Limine to preclude
    plaintiff’s expert, Dr. Igidbashian, from testifying at trial that Dr.
    Crisci's alleged failures increased the risk of harm to Mr.
    Summerford and were a substantial factor in causing his death.
    After argument on May 3, 2016, the court entered an order which
    stated: "Dr. Igidbashian is permitted to testify that the deviations
    in the standard of care increased the risk of harm to [Appellee’s]
    decedent. Dr. lgidbashian is precluded from testifying that
    deviations from the standard of care of Dr. Crisci caused
    [Appellee’s] decedent's death."
    Dr. Crisci argues that "only a qualified expert in internal
    medicine or forensic pathology" could provide credible, competent
    testimony regarding increased risk of harm or cause of death.
    Brief in Support of Motion for Post-Trial Relief, p. 13.
    Section 512 of the MCARE Act sets forth the standards for
    medical expert competency in Pennsylvania. As a general rule,
    - 22 -
    J-A31033-17
    "[n]o person shall be competent to offer an expert medical opinion
    in a medical professional liability action against a physician unless
    that person possesses sufficient education, training, knowledge
    and experience to provide credible, competent testimony." 40 P.S.
    § 1303.512.
    ***
    Dr. Igidbashian's qualifications as a board certified
    radiologist with 30 years of experience in the field of radiology
    qualified him to provide an expert opinion that the misplacement
    of a feeding tube in plaintiffs decedent's lung increased the risk of
    harm to the decedent. N.T. 05.10.16 (a.m.), pp. 136-137.
    Dr. Crisci's claim of error is undermined by her own
    acknowledgment that a misplaced feeding tube into a patient's
    lung could increase the risk of harm to the patient.
    MR. TRUNK: The reason the placement of a feeding tube is
    checked by x-ray, doctor, is because there can be harm to the
    patient if the feeding tube is placed in the wrong area; is that
    right?
    DR. CRISCI: There can be some degree of harm to the patient if
    it is not in the stomach.
    XXX
    Q. I asked you if there could be harm to the patient if you placed
    a feeding tube in the patient's lung. And you responded and
    qualified it and said that there could be some degree of harm. And
    I said, some degree of harm? Doctor, it can cause death, can't it?
    A feeding tube into a patient's lung can cause death.
    A. It may cause death. It may not cause death. That is correct.
    Q. But it has the potential to cause death. Can we agree on that?
    A. It certainly has the potential to cause death, yes.
    Q. And it has the potential to cause death in multiple ways, doesn't
    it?
    A. It has the possibility of causing death in a couple of ways, yes.
    N.T. 05.10.16 (p.m.), pp. 74-75.
    - 23 -
    J-A31033-17
    The court's ruling permitting Dr. Igidbashian to testify regarding
    increased risk of harm (and not cause of death) was proper.
    Trial Court Opinion, filed 12/29/16, at 14-16.
    Furthermore, Dr. Crisci and RGA’s own arguments in their appellate brief
    undermine their position that Dr. Igidbashian’s testimony was prejudicial to
    them. Dr. Crisci and RGA stress Dr. Igidbashian indicated he had never made
    a determination as to one’s cause of death and had interpreted no x-rays to
    confirm placement of an NG tube since 2011. Brief of Appellants at 32-33
    citing N.T. Trial 5/10/16, at 26, 32. It was within the province of the jury to
    weigh this testimony as to Dr. Igidbashian’s lack of knowledge in this regard
    which, arguably, undermined his earlier statements at trial concerning Dr.
    Crisci’s failure to order another radiology study.   See 
    Miller, supra
    .
    In their sixth and seventh issues, Dr. Crisci and RGA maintain the trial
    court should have granted them a new trial in light of certain statements made
    by Appellee’s counsel.    For the reasons that follow, we find these claims
    waived.
    In their concise statement of errors complained of on appeal, Dr. Crisci
    and RGA generally question “[w]hether the [t]rial [c]ourt committed an abuse
    of discretion and/or an error of law in denying Appellants’ Motion for Post-trial
    relief on the basis that statements made by [Appellee’s] counsel, in disregard
    of the [c]ourt’s ruling on subsequent remedial measures, were highly and
    unfairly prejudicial to [Appellants]?” See Concise Statement filed 10/18/16,
    at ¶ G. However, in their appellate brief, they raise a challenge to statements
    - 24 -
    J-A31033-17
    Appellee’s counsel made during closing argument pertaining to testimony
    counsel had elicited on cross-examination of co-defense counsel’s expert Dr.
    Abujudeh.   Brief of Appellants at 35-42.
    Pennsylvania Rule of Appellate Procedure 1925 provides that a
    Rule 1925(b) statement “shall concisely identify each ruling or
    error that the appellant intends to challenge with sufficient detail
    to identify all pertinent issues for the judge.” Pa.R.A.P.
    1925(b)(4)(ii). “Issues not included in the Statement and/or not
    raised in accordance with the provisions of this [Rule] are waived.”
    Pa.R.A.P. 1925(b)(4)(vii). This Court has considered the question
    of what constitutes a sufficient 1925(b) statement on many
    occasions, and it is well-established that “Appellant's concise
    statement must properly specify the error to be addressed on
    appeal.” Commonwealth v. Hansley, 
    2011 Pa. Super. 129
    , 
    24 A.3d 410
    , 415 (Pa. Super. 2011), appeal denied, 
    613 Pa. 642
    , 
    32 A.3d 1275
    (2011) (citation omitted). “[T]he Rule 1925(b)
    statement must be specific enough for the trial court to identify
    and address the issue an appellant wishes to raise on appeal.” 
    Id. (brackets, internal
    quotation marks, and citation omitted).
    In re A.B., 
    63 A.3d 345
    , 350 (Pa.Super. 2013).
    Moreover, “[a] theory of error different from that presented to the trial
    jurist is waived on appeal, even if both theories support the same basic
    allegation of error which gives rise to the claim for relief.” Commonwealth
    v. Ryan, 
    909 A.2d 839
    , 845 (Pa.Super. 2006) (citation omitted), appeal
    denied, 
    597 Pa. 714
    , 
    945 A.2d 768
    (2008). Because only claims properly
    presented before the trial court are preserved for appeal, and Dr. Crisci’s and
    RGA’s challenge to counsel’s statements in their Rule 1925(b) statement not
    only were vague but also did not mention closing argument, their contentions
    in their appellate brief concerning those statements are waived.
    - 25 -
    J-A31033-17
    We also would find any challenge to statements made by Appellee’s
    counsel waived for Dr. Crisci’s and RGA’s failure to make a timely and specific
    objection to the alleged statements on the record. See Commonwealth v.
    Yandamuri, ___ Pa. ____, n.23, 
    159 A.3d 503
    , 528 n.23 (2017) (finding
    challenge to prosecutor’s statement during closing argument waived where
    the appellant failed to demonstrate where in the record he had preserved this
    claim and the Supreme Court’s independent review did not disclose a
    contemporaneous objection). See also, Pa.R.A.P. 2119(e) (requiring an
    appellant to identify where in the record he preserved an issue for appellate
    review); 
    Filmore, supra
    .
    The final two issues Dr. Crisci and RGA present pertain to the
    $5,000,000 jury award which they argue was excessive, punitive and clearly
    exceeded what the evidence warrants. Brief of Appellants at 42. In support
    of this assertion, Dr. Crisci and RGA highlight the following facts from the
    record:
    In this case, [Appellee] did not submit evidence of economic
    loss at all.     The    jury’s award was based solely upon a
    noneconomic award. [Mr. Summerford] was 88 years old at the
    time of the alleged injury, had suffered multiple comorbidities
    including     dementia,     syncope,     hypertension,   pulmonary
    insufficiency, congestive heart failure, coronary artery disease,
    and other maladies prior to his admission to Abington Hospital,
    and importantly[] [h]e suffered a [c]ode the day prior to the
    alleged injury which was not related to the alleged injury, which
    reduced significantly his chances of mortality.
    Defense expert, John Kirby, M.D. testified that an 88 year-
    old person normally has a life expectancy of 4.55 years, but that
    Mr. Summerford had a zero percent life expectancy before the
    feeding tube in dispute was placed into Mr. Summerford at AMH.
    - 26 -
    J-A31033-17
    ...
    A careful review of [Appellee’s] testimony reveals that
    [Appellee] produced very little evidence of the value of loss value
    of the decedent’s life to the family by reason of the death of Mr.
    Summerford.       Mr. Summerford lived in a nursing home in
    Pennsylvania. [Appellee] lived in California or Georgia for most of
    her adult life, while her father lived in Norristown, PA. She visited
    her father whenever she could get to Pennsylvania. She testified
    that she spoke to him on the telephone several times each week;
    however, there are notes in Mr. Summerford’s nursing home
    records, asked about at trial, about the lack of family involvement
    and interest in his care. This is hardly the type of evidence to
    substantiate such a plainly excessive and exhorbitant [sic] award
    to [Appellee]. . . .
    Brief of Appellants at 45-46 (citations to reproduced record omitted)
    (emphasis in original).
    The grant or refusal of a new trial due to the excessiveness
    of the verdict is within the discretion of the trial court. This [C]ourt
    will not find a verdict excessive unless it is so grossly excessive as
    to shock our sense of justice. We begin with the premise that large
    verdicts are not necessarily excessive verdicts. Each case is
    unique and dependent on its own special circumstances and a
    court should apply only those factors which it finds to be relevant
    in determining whether or not the verdict is excessive.
    Tindall v. Friedman, 
    970 A.2d 1159
    , 1177 (Pa.Super. 2009) (citations
    omitted), reargument denied, June 1, 2009.
    Similarly:
    Our standard of review from the denial of a remittitur is
    circumspect and judicial reduction of a jury award is appropriate
    only when the award is plainly excessive and exorbitant. The
    question is whether the award of damages falls within the
    uncertain limits of fair and reasonable compensation or whether
    the verdict so shocks the sense of justice as to suggest that the
    jury was influenced by partiality, prejudice, mistake, or
    corruption. Furthermore, [t]he decision to grant or deny remittitur
    is within the sole discretion of the trial court, and proper appellate
    review dictates this Court reverse such an Order only if the trial
    - 27 -
    J-A31033-17
    court abused its discretion or committed an error of law in
    evaluating a party's request for remittitur. Renna v. Schadt, 
    64 A.3d 658
    , 671 (Pa. Super. 2013) (citations and quotation marks
    omitted).
    Tillery v. Children's Hosp. of Philadelphia, 
    156 A.3d 1233
    , 1246–47
    (Pa.Super. 2017), reargument denied, Apr. 24, 2017, appeal denied, No. 227
    EAL 2017, 
    2017 WL 4517582
    (Pa. Oct. 10, 2017).
    In analyzing these issues, the trial court reasoned as follows:
    Wrongful Death Action
    Wrongful death damages are recoverable to compensate the
    spouse, children, or parents of a deceased for the pecuniary value
    of losses they have sustained as a result of the death of the
    decedent. Slaseman v. Myers, 
    455 A.2d 1213
    , 1218 (Pa. Super.
    1983). The value of decedent's services to a decedent's family
    includes society and comfort. Machado v. Kunkel, 
    804 A.2d 1238
    ,
    1245 (Pa. Super. 2002). In Rettger v. UPMC 
    Shadyside, 991 A.2d at 915
    (Pa. Super. 2010), defendant hospital contended that the
    jury's award of $2.5 million for the wrongful death claim was
    excessive where decedent was unmarried, had no children or
    dependents and provided only limited services in his parents'
    home on weekends. The court rejected the hospital's argument
    and held that the term "services" in the context of a wrongful
    death claim "clearly extends to the profound emotional and
    psychological loss suffered upon the death of a parent or a child
    where the evidence establishes the negligence of another as its
    cause." 
    Id. at 933.
                [Appellee] offered the following testimony about her
    relationship with her father:
    [Appellee]: Yes, we were close. My father was -- my father was
    everything to me, and I would call him all the time and talk about
    everything. There wasn't anything that I couldn't talk to my dad
    about. My dad was understanding. He never condemned me. He
    always supported me and encouraged me.
    N.T. 05.11.16 (p.m.), p. 66.
    - 28 -
    J-A31033-17
    She testified that prior to her father's death she spoke with
    him several times each week over the phone. N.T. 05.11.16
    (p.m.), p. 48. Regarding the final phone call she had with her
    father, [Appellee] testified:
    MR. TRUNK: How did you end the conversation?
    [Appellee]: We always say one, two, three, because we never
    liked to hang up.
    Q. How long is this something you've been doing?
    A. For years, maybe 40 years. I don't know.
    Q. How many?
    A. Fifty years, a long time.
    Q. Every time you hang up, that's the way you hung up?
    A. Yes, we always say -- we hang up on the count of three. So we
    go one, two, three, and we hang up the phone, because neither
    one of us ever wanted to say goodbye. You know, so that's how
    we did it, and so I told my dad, I said, I want to call you back, and
    you know, so he sounded tired.
    So I said, well, you rest now, and I'll call you back, I'm going
    to call you back, and okay, okay. So one, two, three, we hung up.
    Q. Okay. Now –
    A. But I promised him I was going to call him back.
    N.T. 05.11.16 (p.m.), pp. 81-82.
    [Appellee] demonstrated her father's importance to her and
    her family by introducing family photographs of their time
    together at her graduation and at other times with her children
    and grandchildren. N.T. 05.11.16 (p.m.), pp. 59-65. [Appellee]
    testified she and her sister would rendezvous with her father over
    the years. N.T. 05.11.16 (p.m.), p. 65. In addition, one of
    [Appellee’s] sons attended high school in Norristown while living
    for an extended period of time with decedent, and another one of
    her sons lived with Mr. Summerford for four years while attending
    - 29 -
    J-A31033-17
    Temple University in Philadelphia. N.T. 05.11.16 (p.m.), pp. 54-
    55.
    This evidence was sufficient to submit to the jury for
    consideration of damages under the Wrongful Death Act.
    'The duty of assessing damages is within the
    province of the jury' and, thus, as a general matter, a
    compensatory damage award 'should not be interfered
    with by the court unless it clearly appears that the
    amount awarded resulted from caprice, prejudice,
    partiality, corruption or some other improper influence.'
    Gradel v. Inouye, 491 Pa. 534,421 A.2d 674, 680-81
    (1980) (quoting Tonikv. Apex Garages, Inc., 442 Pa.
    373,275 A.2d 296,299 (1971)).
    Paves v. Corson, 
    801 A.2d 546
    , 548-49 (Pa. 2002).
    The jury's award of $1.5 million is consistent with other
    Pennsylvania verdicts for wrongful death claims. See, Rettger,
    supra; Hyrcza v. W Penn Allegheny Health System, Inc., 
    978 A.2d 961
    (Pa. Super. 2009). The court properly denied Dr. Crisci's
    request for remittitur.
    Survival Action
    The measure of damages awarded in a survival action
    includes, inter alia, the decedent's conscious pain and suffering.
    Kiser v. Schulte, 
    648 A.2d 1
    , 4 (Pa. 1994). Here, the jury awarded
    decedent's estate $3.5 million as compensation for Mr.
    Summerford's conscious pain and suffering.
    In awarding damages for pain and suffering, a jury may
    consider, inter alia, the severity of the injury, the duration and
    extent of the physical pain and mental anguish which the decedent
    experienced, as well as the health and physical condition of the
    plaintiff prior to the injuries. See, Pa.R.C.P. 223.3. The defendant
    has the burden of convincing the court that the award deviates
    substantially from what is considered reasonable compensation.
    
    Hyrcza, supra
    .
    At trial, Dr. Ross testified about Mr. Summerford's conscious
    pain and suffering he experienced during the night of December
    3rd into the morning of December 4th.
    - 30 -
    J-A31033-17
    Dr. ROSS: He's conscious. Throughout the whole time
    course until his final arrest he was conscious. Haldol, Ativan
    is kind of a sedative that's given. That is lorazepam. In
    addition, he was becoming increasingly tachycardic. His
    heart is pounding. It's pounding in his chest. Tachypnea is
    40 to 50 breaths. He's huffing and puffing. He's breathing a
    lot because the fluid is building up in his left lung and he's
    becoming short of breath.
    MR. TRUNK: What was his breath rate before the crux of
    the feeding solution started on the night of the 3rd into the
    morning of the 4th?
    A . ... He started becoming short of breath. Short of breath
    because of the suffocation; he's having difficulty breathing.
    The work that he's doing, work of breathing, is becoming
    more and more labored, more and more difficult.
    …
    He continued to decline. He was tachypneic. His accessory
    muscles, we breathe with our diaphragms but we also use
    our intercostal muscles, your rib muscles. So he's just
    huffing and puffing trying to breathe, short of breath. Then
    he was intubated, and in time over the next hour his heart
    rate went down. He was having more and more difficulty
    breathing, then he had a cardiac arrest.
    Q. Doctor, all the things you described, were they caused
    by the feeding solution building up in Mr. Summerford's left
    lung?
    A. Yes.
    Q. Are the things that you described, would you consider
    that to be suffering?
    A. Yes. He was suffering, yes.
    Q. Relating to what we talked about earlier, a drowning
    victim, how, if at all, does this relate to a drowning victim?
    A. Well, the fluid built up in the lungs makes somebody
    more and more short of breath. They are experiencing
    feelings of suffocation, agitation, pain. The wheezing, the
    course [sic] breaths, trying to cough, all that sort of stuff
    - 31 -
    J-A31033-17
    produces more and more pain and suffering, just like a
    drowning.
    XXX
    Q. First let's get a time on this note, which is just above.
    This is a note timed at 12/4/08, 7:51 a.m. Is that after Mr.
    Summerford had already passed?
    A. Yes.
    Q. Now let's go down to the note below that. We read Dr.
    Bonica's note. This is a nursing note now, doctor, from an
    R.N. Jessica Schonewolf, correct?
    A. Yes.
    Q. And the same thing as you were doing with Dr. [ ]
    Bonica's note, but tell the jury what, if any, significance
    what she says were the symptoms Mr. Summerford was
    experiencing, how it relates to causing death and/or his pain
    and suffering.
    A. Yes. "Patient with increased restlessness." That's feeling
    agitated, feeling restless, feeling bad. Tachypnea, breathing
    excessively, huffing and puffing. Lethargy. He's kind of
    running out of steam and energy. Lopressor and Ativan are
    kind of sedatives to give him. He was given a nebulizer. That
    will open up some of your airways, especially when they
    tend to collapse when the fluid gets around them. Then a
    chest x-ray was completed and lasix given as well.
    Q. Are those things evidence of -- first of all, are those
    things related, everything that you read there, related to
    the feeding solution being in his lung?
    A. Yes.
    Q. Are they further evidence of Mr. Summerford
    unfortunately having experienced pain and suffering before
    he passed?
    A. Yes.
    N.T. 05.10.16 (p.m.), pp. 40-47.
    - 32 -
    J-A31033-17
    "The determination of the amount to be awarded for pain
    and suffering is primarily a jury question." Gunn v. Grossman, 
    748 A.2d 1235
    , 1241 (Pa. Super. 2000); see also, Whitaker v.
    Franliford Hosp. of City of Philadelphia, 
    984 A.2d 512
    (Pa. Super.
    2009).
    Dr. Crisci argues the trial court erred by failing to grant
    remittitur, claiming the jury verdict was so excessive as to deviate
    substantially from reasonable compensation and shock the
    conscience of the court.
    The question is whether the award of damages falls
    within the uncertain limits of fair and reasonable
    compensation or whether the verdict so shocks the
    sense of justice as to suggest that the jury was
    influenced by partiality, prejudice, mistake, or
    corruption. Furthermore, [t]he decision to grant or deny
    remittitur is within the sole discretion of the trial court,
    and proper appellate review dictates this Court reverse
    such an Order only if the trial court abused its discretion
    or committed an error of law in evaluating
    a party's request for remittitur.
    Gurley v. Janssen Pharm., Inc., 113 A.3d 283,294 (Pa. Super.
    2015), reargument denied (May 19, 2015). A verdict will not be
    found to be excessive, "unless it so grossly excessive as to shock
    our sense of justice." 
    Hyrcza, supra
    , 978 A.2d at 979.
    The court did not find that the verdict was excessive or
    shocking. Plaintiff produced expert testimony from Dr. Ross about
    the suffering Mr. Summerford endured during the night of
    December 3rd into the morning of December 4th. Dr. Ross
    described Mr. Summerford as conscious throughout the course of
    the night, during which time Mr. Summerford became increasing
    tachycardic, began huffing and puffing due to fluid building up in
    his lungs, started wheezing, became short of breath due to
    suffocation, and eventually suffered cardiac arrest. As stated
    above, Dr. Ross described Mr. Summerford's death as just like a
    drowning ("[Mr. Summerford was] experiencing feelings of
    suffocation, agitation, pain. The wheezing, the course [sic]
    breaths, trying to cough, all that sort of stuff produces more and
    more pain and suffering, just like a drowning.") N.T. 05.10.16
    (p.m.), p. 43.
    Dr. Crisci did not convince the court that the verdict
    deviated substantially from what is considered reasonable
    - 33 -
    J-A31033-17
    compensation. 
    Hyrcza, supra
    . There is no evidence that strongly
    suggests the jury was influenced by passion or prejudice.
    Accordingly, the court did not err by refusing to grant Dr. Crisci's
    request for a new trial on damages or remittitur.
    Trial Court Opinion, filed 12/29/16, at 27-33.
    Based on the foregoing, and following an independent review of the
    record, we find that the jury's $1.5 million award for Appellee’s wrongful death
    claim and its $3.5 award for Mr. Summerford’s conscious pain and suffering
    caused by the negligence of Dr. Crisci and RGA fell “within the uncertain limits
    of fair and reasonable compensation.” Renna v. Schadt, 
    64 A.3d 658
    , 671
    (Pa.Super. 2013). Therefore, “[c]ognizant of the fact that the amount of pain
    and suffering damages is primarily a jury question,” we agree with the trial
    court that the verdict was not “so grossly excessive as to shock our sense of
    justice.” Renna, supra at 671-72 (citation omitted); Tindall, supra at 1177.
    Hence, the trial court did not abuse its discretion in denying Appellants'
    request for a new trial or remittitur on this basis. See Renna, supra at 671;
    Tindall, supra at 1177.
    Finding no merit to the issues raised by Dr. Crisci and RGA, we next turn
    to a consideration of the questions AMH presents for our review in its appellate
    brief.
    AMH first asserts it is entitled to a new trial due to the trial court’s
    allowing Appellee to cross-examine a defense expert using industry guidelines
    in contravention of precedent from this Court and the Pennsylvania Supreme
    Court which rejected the trial court’s rationale that a defendant must be made
    - 34 -
    J-A31033-17
    to    rebut    improperly       admitted        evidence   with   cross-examination.
    While AMH presented ten issues in its concise statement of matters
    complained of on appeal, it has raised and developed this particular issue for
    the first time in its appellate brief.   1     Because only claims properly presented
    ____________________________________________
    1 AMH sets forth the following claims in its Statement of Matters Complained
    of on Appeal filed on September 29, 2016:
    1.      Failing to grant a judgment n.o.v., or at a minimum a new
    trial on all issues, where the verdict against [AMH] on the
    corporate negligence claim is unsupported by sufficient evidence,
    or was at a minimum against the weight of the evidence. The claim
    that the Hospital should have had a policy regarding chest x-rays
    to confirm placement of feeding tubes could not as a matter of law
    support a corporate negligence claim where a chest x-ray was
    ordered here, and thus any claimed lack of a policy could not have
    caused harm. Moreover, the undisputed evidence showed that co-
    Defendant Dr. Crisci did not request an additional x-ray, and
    simply misinterpreted the existing x-ray.
    2. Failing to grant a judgment n.o.v., or at a minimum a new trial
    on all issues, where the verdict against the [AMH] on the vicarious
    liability claim, for the x-ray study taken by Jillian Nickel, is
    unsupported by sufficient evidence, or at the very least is against
    the weight of the evidence. Given the undisputed testimony,
    including that introduced by the Plaintiff's expert and elicited by
    the Plaintiff's counsel, no two reasonable minds could disagree
    that the conduct of Ms. Nickel in obtaining the December 3 x-ray
    was not a breach of the standard of care.
    3. Failing to grant a judgment n.o.v., or at a minimum a new trial
    on all issues, because Dr. Igidbashian lacked the necessary
    competence, qualifications, and experience to testify as an expert
    with respect to [AMH’s] policies,
    4. Failing to grant a judgment n.o.v., or at a minimum a new trial
    on all issues, because Dr. Igidbashian's opinion was based upon
    improper and inadmissible hearsay testimony regarding [AMH]
    policies.
    5. Failing to grant a judgment n.o.v., or at a minimum a new trial
    on all issues, because Dr. Igidbashian's testimony that [AMH]
    - 35 -
    J-A31033-17
    ____________________________________________
    should have had a policy requiring radiology technologists to
    perform chest x-rays to confirm feeding tube placement, and Dr.
    Igidbashian's testimony regarding an x -way [sic] performed in
    August 2008, were both well beyond the fair scope of his report.
    6. Failing to grant a judgment n.o.v., or at a minimum a new trial
    on all issues, because Dr. Igidbashian lacked the necessary
    competence, qualifications, and experience to testify as an expert
    with respect to the conduct of radiology technician Jillian Nickel.
    7. Failing to grant a new trial where two essential witnesses and
    employees of [AMH], Jillian Nickel and Joan Diaz, were
    erroneously and improperly sequestered, resulting in unfair
    prejudice to [AMH] in its preparation of and presentation of its
    defense.
    8. Failing to grant a new trial where the Court improperly admitted
    evidence of (a) subsequent remedial measures regarding the x-
    ray system, (b) improper cross-examination evidence from Dr.
    Hani Abujudeh regarding standard of care, (c) irrelevant 2014
    policies from the American College of Radiology, (d) the December
    9, 2008 disclosure/apology letter, (e) impermissibly speculative
    testimony from codefendant's expert, Dr. Kirby, regarding an
    intubation on December 2, 2008 as a possible alternative
    explanation for death, (f) improper hearsay opinions of Dr.
    Breckenridge, and/or (g) irrelevant statements from Dr.
    Igidbashian regarding policies of a different hospital, St. Francis
    (which also were not previously disclosed).
    9. Failing to grant a new trial where this [c]ourt improperly
    precluded [AMH] from introducing evidence, through Dr. Kane,
    about the Hospital's policies.
    10. Failing to award a new trial on damages, or at the very least
    a remittitur, where the verdict was against the weight of the
    evidence, and was shockingly excessive as a matter of
    Pennsylvania common law and also under the MCARE Act, 40 P.S.
    §1303.515(a), was clearly punitive in nature, bears no
    resemblance to the damages proven, and so shocks the sense of
    justice as to suggest that the jury was influenced by partiality,
    prejudice, mistake or corruption.
    - 36 -
    J-A31033-17
    before the trial court are preserved for appeal, we find this claim waived. See,
    In re A.B.; Commonwealth v. 
    Ryan, supra
    .
    For the same reason, we find AMH has waived its second claim, because
    it has raised and developed a different theory of relief in its appellate brief
    than that it presented to the trial court in its concise statement.          In its
    Statement of Matters Complained of on Appeal, AMH averred the trial court
    erred in “[f]ailing to grant a new trial where [it] improperly admitted evidence
    of” … (d) the December 9, 2008[,] disclosure/apology letter[.]” See
    Statement of Matters Complained of on Appeal at 3, 
    ¶8(d), supra
    . However,
    in its appellate brief AMH avers that the introduction of the letter violated the
    Medical Care and Reduction Error Act’s express prohibition on using such
    letters as admissions of liability. See Brief of AMH at 5, ¶ 2. Appellant made
    no mention of the applicability of the Act in its concise statement, but rather
    generally challenged it as “improperly admitted evidence.” Moreover, at trial,
    the basis for AMH’s objection to the admission of the evidence was that it was
    “misleading” and “prejudicial to the defense” See N.T. Trial, 5/11/16, at 93.2
    ____________________________________________
    2 To the extent the issues AMH set forth in its concise statement may be
    deemed sufficiently specific to preserve this claim for appellate review, we
    note that after the trial court indicated it was overruling AMH’s objection, it
    stressed that:
    . . . I do not believe its construed to be an admission. There is -
    - it does state, as follows: In accordance with that law, we are
    sending you this letter to formally inform you that an x-ray
    relating to the placement of your father’s feeding tube may have
    - 37 -
    J-A31033-17
    Next, AMH submits this Court should grant a new trial in light of the trial
    court’s allowing Dr. Igidbashian, Appellee’s expert in radiology, to testify
    regarding an x-ray of Mr. Summerford taken on August 22, 2008, although
    this opinion testimony had not been contained within the fair scope of the
    ____________________________________________
    been incorrectly read, and in the context of how this case has
    developed, particularly the defense, it does not appear to be a
    contested issue by the defense that the x-ray in question was
    incorrectly read, and so I’m going to admit it.
    I did state, off the record, that if the hospital’s attorney
    wishes to submit a supplemental requested point for charge that
    would address that issue, I would certainly take it under
    consideration.
    N.T. Trial, 5/11/16, p.m. at 93-94.
    The trial court’s interpretation of the letter’s contents as well as its
    readiness to entertain a supplemental point for charge seemingly resolved
    AMH’s objection for, in response, counsel did not renew her objection, but
    rather replied “Okay. Thank you.” 
    Id. at 94.
    As a result, AMH also has
    failed to preserve this issue for failure to properly object on the record at trial.
    See Commonwealth v. 
    Yandamuri, supra
    .
    Notwithstanding, the trial court did instruct the jury as to the letter’s
    import and informed it that the notification did not constitute an admission of
    liability pursuant to the supplemental charge AMH provided:
    A medical facility, through an appropriate designee, shall
    provide written notification to a patient affected by a serious event
    or, with the consent of a patient, to an available family member
    or designee, within seven days of the occurrence or discovery of
    a serious event.       Notification shall not constitute an
    acknowledgement or admission of liability.
    N.T., 5/13/16 at 119; N.T., 5/12/16 p.m. at 96-97 (emphasis added). Juries
    presumably follow the trial court’s instructions. Commonwealth v. Cash,
    
    635 Pa. 451
    , 471, 
    137 A.3d 1262
    ,1273 (2016), cert. denied, 
    137 S. Ct. 1202
    ,
    197 L.Ed.2d. 249 (2017). There is no indication in the record that the jury
    did not do so herein.
    - 38 -
    J-A31033-17
    expert report he prepared and Appellee disclosed prior to trial. AMH Brief at
    31-32.
    By way of background, on direct examination, Dr. Igidbashian utilized
    an image to illustrate his testimony regarding the manner in which a proper
    radiologic study can reveal whether a nasogastric feeding tube mistakenly has
    been placed in the lung.   NT.   5/10/16, a.m. at 72-75.      Dr. Igidbashian
    explained that because the trachea and the lung are very close to each other
    anatomically, the tube occasionally and inadvertently may get lodged in the
    lung during insertion. 
    Id. at 75.
    For this reason, a chest x-ray of the upper
    abdomen, which also encompasses both lungs, allows one to view the whole
    course of the tube and to discern whether the tube has taken the proper
    course from the esophagus into the stomach. 
    Id. at 75-76.
    Thereafter, counsel for Appellee showed Dr. Igidbashian a chest x-ray
    that included the upper abdomen. This image of Mr. Summerford was taken
    during his stay at AMH on August 22, 2008, and its purpose was to check the
    feeding tube placement. 
    Id. at 78-81.
    AMH objected to testimony concerning
    this study as beyond the scope of Dr. Igidbashian’s expert report. 
    Id. at 82.
    The trial court overruled the objection and in doing so reasoned it is
    “foundational and history.” 
    Id. at 82.
         Dr. Igidbashian then proceeded to
    testify regarding the placement of the feeding tube shown on the August 22,
    2008, x-ray and opine that it had been inserted properly. 
    Id. at 83-85.
    - 39 -
    J-A31033-17
    In its brief, AMH reasons that the testimony surrounding the August 22nd
    x-ray at trial and Dr. Igidbashian’s comparisons of it with Mr. Summerford’s
    December 3rd x-ray, coupled with the reference of Appellee’s counsel to the
    earlier report during closing argument, constitute an unfair and surprise use
    of the evidence and show that it may have affected the verdict. Brief for AMH
    at 31, 34. AMH also contends that in overruling the objection on the basis
    that it was “foundational and history,” the trial court abused its discretion by
    raising sua sponte an argument not raised by a party. 
    Id. at 32-33.
    We previously reiterated our well-settled standard of review regarding
    evidentiary challenges. When considering this issue in its Rule 1925(a)
    Opinion, the trial court stated the following:
    . . . The front/cover page of Dr. Igidbashian's report contains a
    list of seven "Reviewed Studies and Accompanying Reports." The
    first item on the list is "8/22/2008 5:36pm Portable Chest X-ray."
    Of the seven studies and accompanying reports reviewed, three
    are identified by specific date and time in the body of the report.
    The August 22, 2008, is not one of these three. However, the
    report states: "Other films show different technicians taking
    different studies to check the placement of feeding tubes,
    demonstrating lack of appropriate protocols, enforcement of
    protocols, training, or oversight."
    Igidbashian Expert Report, p. 2,¶ 2.
    Dr. Igidbashian's report makes clear that the August 22,
    2008, study was one (out of only four) "other films" that indicated
    a lack of uniform procedure in the ordering and performance of x-
    rays to confirm tube placement. Moreover, it was an AMH study,
    so AMH had access to the image and radiologist's report of same
    at all times. The reference to AMH's August 22, 2008 study was
    foundational and part of the patient's history.
    Finally, there was not a discrepancy between the pre-trial
    report and Dr. Igidbashian's testimony. Dr. Igidbashian
    referenced the August 22, 2008 study to demonstrate the
    anatomy and path of a feeding tube. N.T. 05.10.16 (a.m.), pp.
    - 40 -
    J-A31033-17
    81-85. Dr. Igidbashian's testimony about the August 22, 2008 x-
    ray supported his position that different technicians took different
    studies to check the placement of feeding tubes, demonstrating a
    lack of consistency due to the lack of written protocols. No
    standard of care testimony was elicited regarding the August 22,
    2008 study. There was no discrepancy between his report and his
    testimony at trial.
    Trial Court Opinion, fled 12/29/16, at 47-48.
    Upon our review of the trial transcript, we find no abuse of discretion in
    the trial court’s decision to allow Dr. Igidbashian’s references to the August
    22, 2008, report.   As the trial court notes, the discussion concerning the
    August 22, 2008, x-ray, when read in the context of Dr. Igidbashian’s entire
    trial testimony, did not exceed the scope of his expert report or constitute
    unfair surprise, but rather served as an illustrative aid for the jury in its
    understanding of standard medical practice pertaining to radiologic studies
    taken to confirm the proper insertion of a feeding tube.      Furthermore, the
    August 22, 2008, x-ray was taken at AMA and was contained within Mr.
    Summerford’s medical records which Dr. Igidbashian testified he had
    reviewed; thus, it cannot be seemed surprising or prejudicial to AMH.
    In its fourth claim, AMH requests this Court to vacate the judgment and
    grant a JNOV or, in the alternative, remand for a new trial because the
    evidence was both insufficient to establish causation and notice with regard to
    the corporate negligence claim brought against AMH and against the clear
    weight of the evidence on these points. AMH reasons that as Dr. Igidbashian
    opined the standard of care required the ordering of a chest x-ray to confirm
    - 41 -
    J-A31033-17
    feeding tube placement, and he admitted Dr. Bonica did, in fact, order the x-
    ray, “the lack of a policy requiring that a chest x-ray be ordered did not and
    could not have played any causative role whatsoever in this case.” Brief of
    AMH at 35-37. AMH further posits a JNOV should be entered on the corporate
    negligence claim for AMH’s monitoring of Jillian Nickel because the sole
    reference to AMH’s notice of the potential for harm caused by Ms. Nickel’s
    performing improper x-ray studies was responses Dr. Igidbashian provided to
    Appellee’s hypothetical questions at trial. Reasoning that the jury was shown
    x-rays that Dr. Igidbashian indicated were appropriate prior to the December
    3, 2008, x-ray AMH concludes Appellee failed to prove notice, an essential
    element of her claim. 
    Id. at 38-40.
    We have set forth our standard of review for a JNOV above and reiterate
    here our well-settled standard of review of a challenge to the sufficiency of
    the evidence:
    The standard we apply in reviewing the sufficiency of the evidence
    is whether viewing all the evidence admitted at trial in the light
    most favorable to the verdict winner, there is sufficient evidence
    to enable the fact-finder to find every element of the crime beyond
    a reasonable doubt. In applying the above test, we may not weigh
    the evidence and substitute our judgment for the fact-finder. In
    addition, we note that the facts and circumstances established by
    the Commonwealth need not preclude every possibility of
    innocence. Any doubts regarding a defendant's guilt may be
    resolved by the fact-finder unless the evidence is so weak and
    inconclusive that as a matter of law no probability of fact may be
    drawn from the combined circumstances. The Commonwealth
    may sustain its burden of proving every element of the crime
    beyond a reasonable doubt by means of wholly circumstantial
    evidence. Moreover, in applying the above test, the entire record
    must be evaluated and all evidence actually received must be
    - 42 -
    J-A31033-17
    considered. Finally, the finder of fact while passing upon the
    credibility of witnesses and the weight of the evidence produced,
    is free to believe all, part or none of the evidence.
    Commonwealth v. Mucci, 
    143 A.3d 399
    , 408–409 (Pa.Super. 2016)
    (citation omitted), appeal denied, 
    168 A.3d 1252
    (Pa. 2017).
    In the alternative, AMH argues it is entitled to a new trial with respect
    to the corporate negligence claim as the jury’s verdict was against the weight
    of the evidence. 
    Id. at 41-44.3
    This Court has held that “[a] motion for new
    trial on the grounds that the verdict is contrary to the weight of the evidence,
    concedes     that   there    is   sufficient   evidence   to   sustain   the   verdict.”
    Commonwealth v. Rayner, 
    153 A.3d 1049
    , 1054 n. 4 (Pa.Super. 2016)
    (quoting Commonwealth v. Widmer, 
    560 Pa. 308
    , 315, 
    744 A.2d 745
    , 751
    (2000)). Our Supreme Court has described the standard applied to a weight-
    of-the-evidence claim as follows:
    The decision to grant or deny a motion for a new trial based upon
    a claim that the verdict is against the weight of the evidence is
    within the sound discretion of the trial court. Thus, “the function
    of an appellate court on appeal is to review the trial court's
    exercise of discretion based upon a review of the record, rather
    than to consider de novo the underlying question of the weight of
    the evidence.” An appellate court may not overturn the trial
    court's decision unless the trial court “palpably abused its
    discretion in ruling on the weight claim.” Further, in reviewing a
    challenge to the weight of the evidence, a verdict will be
    overturned only if it is “so contrary to the evidence as to shock
    one's sense of justice.”
    ____________________________________________
    3 AMH preserved this challenge to the weight of the evidence by raising it in
    its Motion for Post-Trial Relief filed on May 23, 2016.
    - 43 -
    J-A31033-17
    Commonwealth v. Cash, 
    635 Pa. 451
    , 466-67, 
    137 A.3d 1262
    , 1270 (2016)
    (internal citations omitted). A trial court's determination that a verdict was
    not against the interest of justice is “[o]ne of the least assailable reasons” for
    denying a new trial. Commonwealth v. Colon–Plaza, 
    136 A.3d 521
    , 529
    (Pa. Super. 2016) (quoting Commonwealth v. Clay, 
    619 Pa. 423
    , 432, 
    64 A.3d 1049
    , 1055 (Pa. 2013)). A verdict is against the weight of the evidence
    where “certain facts are so clearly of greater weight that to ignore them or to
    give them equal weight with all the facts is to deny justice.” Commonwealth
    v. Lyons, 
    833 A.2d 245
    , 258 (Pa. Super. 2003) (quoting Commonwealth v.
    
    Widmer, 560 Pa. at 318
    , 744 A.2d at 751–752).
    As this Court recently reiterated, in Tompson v. Nason Hospital, 
    527 Pa. 330
    , 
    591 A.2d 703
    (1991) the Pennsylvania Supreme Court “adopted the
    theory of corporate liability, as it relates to hospitals, by holding that the
    defendant hospital owed a non-delegable duty of care toward a patient of a
    doctor with staff privileges at the hospital. 
    Thompson, 591 A.2d at 707
    .”
    Breslin v. Mountain View Nursing Home, Inc., 
    171 A.3d 818
    , 823
    (Pa.Super. 2017). We further observed that the Thompson Court:
    adopted an ostensibly novel theory of liability—“corporate
    negligence”—under which a hospital operating primarily on a fee-
    for-service basis can be held liable if it breaches the non-delegable
    duty of care owed directly to the patient to ensure “the patient's
    safety and well-being” while at the hospital. The Court surveyed
    the jurisprudence of other states to identify “four general areas”
    into which a hospital's responsibilities to its patients could be
    classified: (1) duties to use reasonable care in the maintenance of
    safe and adequate facilities and equipment; (2) duties to select
    and retain competent physicians; (3) duties to oversee all persons
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    J-A31033-17
    who practice medicine within the hospital's walls; and (4) duties
    to formulate, adopt, and enforce adequate rules and policies to
    ensure quality patient care. Additionally, the Thompson Court
    ruled that the hospital owed a non-delegable duty directly to the
    patient to observe, supervise, or control his/her treatment
    approved by multiple physicians; to apply and enforce its
    consultation and monitoring procedures; and to ensure the
    patient's safety and well-being while at the hospital. See
    
    Thompson, 591 A.2d at 705
    , 707.
    
    Id. at 823-24
    (citation omitted).
    Our review of the record compels our conclusion that the trial court's
    denial of AMH’s sufficiency claim was proper. Viewing the evidence in the light
    most favorable to Appellee as the verdict winner, we find sufficient evidence
    to support the conclusions that AMH’s failure to formulate and implement
    appropriate policies and procedures in 2008 regarding chest x-rays was a
    factual cause of Mr. Summerford’s death such that the record contained
    sufficient evidence of a prima facie case of corporate negligence to allow the
    claim to go to the jury.    We also find that AMH’s weight-of-the evidence
    argument lacks merit in that it essentially restates that which it articulated in
    support of its challenge to the sufficiency of the evidence.   Upon our review
    of the record, we agree with the trial court that as the ultimate fact-finder,
    the jury properly weighed the evidence and found AMH liable under Appellee’s
    claim of corporate negligence.     In doing so, we adopt the sound reasoning of
    the trial court on these issues:
    In Thompson v. Nason Hospital, 
    527 Pa. 330
    , 
    591 A.2d 703
          (1991), the Pennsylvania Supreme Court recognized that a
    hospital can be directly liable for corporate negligence. The
    Supreme Court explained the concept as follows:
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    Corporate negligence is a doctrine under which the
    hospital is liable if it fails to uphold the proper standard
    of care owed the patient, which is to ensure the patient's
    safety and well-being while at the hospital. This theory
    of liability creates a nondelegable duty which the
    hospital owes directly to a patient.
    
    Id., 591 A.2d
    at 707. Under Thompson, a hospital has the
    following 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. (citations omitted).
                In addition, "[t]o establish a claim for corporate negligence
    against a hospital, a plaintiff must show that the hospital had
    actual or constructive knowledge of the defect or procedures that
    created the harm. Thompson." Welsh v. Bulger, 698 A.2d 581,585
    (Pa. 1997). Finally, "[t]he plaintiff also must establish that the
    hospital's negligence was a substantial factor in causing the harm
    to the injured party." 
    Id. The evidence
    at trial demonstrated that AMH's failure to
    formulate, adopt and enforce appropriate written policies and
    procedures regarding the performance of chest x-rays was a
    factual cause of the tragic outcome in this case. Dr. Igidbashian
    explained that AMH did not have a policy in place in 2008 directing
    the proper study to determine placement of a feeding tube:
    MR. TRUNK: Did [AMH] have a policy in place?
    DR. IGIDBASHIAN: Not that I saw.
    Q. Did they have any protocols in place?
    A. Not that I saw.
    Q. Did the standard of care require that a hospital, like
    Abington Memorial Hospital in 2008, have a procedure or
    protocol in place to check the placement of a feeding tube?
    A. Yes.
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    J-A31033-17
    N.T. 05.10.16 (a.m.), p. 131.
    XXX
    Q. What should a policy or procedure in 2008 have required
    the study be to check the placement of a feeding tube?
    A. A chest x-ray to include the upper abdomen.
    Q. And in that chest x-ray, what part of the anatomy should
    have been captured or should the policy say should be
    captured in that study?
    A. The main airway, the trachea, the lungs, and the
    esophagus; those should be in there. And you get a portable
    chest x-ray.
    N.T. 05.10.16 (a.m.), p. 133.
    Dr.   Crisci     acknowledged     that  AMH's     x-ray
    technologist, Jillian Nickel, took an abdominal x-ray and not
    a chest x-ray as ordered by Dr. Bonica:
    MR. TRUNK: So, with that in mind, we can agree that the
    x-ray that Miss Nickel, the technologist, took was a film
    different than the study Dr. Bonica had ordered, correct?
    DR. CRISCI. That is absolutely correct.
    Q. Dr. Bonica ordered a chest x-ray and Miss Nickel took an
    abdominal x-ray, correct?
    A. That is absolutely correct.
    N.T. 05.10.16 (p.m.) p. 93.
    AMH x-ray technologist Jillian Nickel and AMH radiology
    manager Joan Diaz both testified that AMH lacked any written
    policy regarding the duties of a radiology technician. Ms. Nickel
    testified as follows:
    MR. TRUNK: Now, as of 2008, I'm talking December of
    2008, at the time of Mr. Summerford's death, there were no
    written policies at Abington Memorial Hospital regarding the duties
    you performed as a radiology technician or technologist, correct?
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    J-A31033-17
    JILLIAN NICKEL: No.
    Q. I'm incorrect?
    A. Huh?
    Q. I'm incorrect or I'm correct that there were no written
    policies?
    A. Correct.
    XXX
    Q. Okay. As a matter of fact, you got the study that you
    intended to get that day [December 3, 2008], right?
    A. Yes.
    Q. You got from the base of the lungs down even a little
    lower than the iliac crest, right?
    A. Yes.
    Q. And when you took that x-ray, you thought you were
    following what was a protocol at Abington Memorial
    Hospital, correct?
    A. For an Entec placement, yes.
    Q. For an Entec placement, and that's something that you
    say your boss, Joan Diaz, told you to do?
    A. Yes.
    N.T. 05.11.16 (p.m.) pp. 23-27.
    Ms. Diaz testified as follows:
    MR. TRUNK: Your responsibilities [as radiology manager at
    AMH from 1999-2008] relating to x-rays included
    overseeing staff, scheduling and operational means,
    correct?
    JOAN DIAZ: Correct.
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    J-A31033-17
    Q. And in 2008, as of 2008, the time of Mr. Summerford's
    care, there were no protocols or policies regarding the
    anatomy a radiology technologist should capture when
    viewing an x-ray to check the placement of a feeding tube;
    do you agree with that?
    A. Written? Correct.
    Q. Okay. There were no policies, written or otherwise?
    A. There were no policies.
    N.T. 05.11.16 (p.m.) p. 34.
    And later:
    MR. TRUNK: Back in 2008, was there any policy or protocol
    or guideline or anything that said that when checking the
    placement of a feeding tube, you need to get the upper
    chest, and you need to get the airway down to the
    abdomen? Was there anything like that?
    A. No.
    N.T. 05.11.16 (p.m.) p. 41.
    Finally, Dr. Igidbashian testified that AMH's breach
    significantly increased the risk of harm to Mr. Summerford.
    Q. And we talked about that there was no policy at
    Abington, policy or procedure or protocol, as to what study
    should be used to check the placement of a feeding tube.
    Was that a breach of the standard of care?
    A. Yes.
    Q. And did that increase the risk of harm to Mr.
    Summerford?
    A. Yes.
    Q. Back in 2008, should a hospital have known what could
    happen or what harm could result if the wrong study is taken
    to check the placement of a feeding tube?
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    J-A31033-17
    A. Yes.
    Q. And what should they have known about that? What did
    the standard of care require that a hospital know could
    happen, what harm could happen, if the wrong study is
    taken to check the placement of a feeding tube?
    A. That the patient can be severely affected by the
    malpositioned tube.
    Q. And affected, is that in a bad way?
    A. Harm to the patient.
    N.T. 05.10.16 (a.m.), pp. 137-138.
    This testimony sufficiently sets forth a prima facie case of
    corporate negligence.11 The evidence in the record clearly
    established there were no written policies or protocols in place in
    2008 regarding the performance of a chest x-ray. Ms. Nickels did
    not obtain a chest x-ray as ordered by Dr. Bonica. The technicians
    were left on their own to determine what anatomy to image. There
    was inconsistency within the department regarding how a chest
    x-ray should be performed. Dr. Igidbashian stated that the
    December 3rd x-ray failed to include portions of Mr. Summerford's
    airway to enable Dr. Crisci to make a correct interpretation.
    Dr. Igidbashian's expert testimony established that AMH's
    lack of written policies was below the standard of care and
    increased the risk of harm to plaintiffs decedent. Further, he
    testified that AMH should have known of the harm which could
    result from a wrong study to confirm placement of a feeding tube.
    Since the record contained sufficient evidence of a prima facie
    case of corporate negligence, the court correctly allowed that
    claim to go to the jury. The jury's verdict was supported by
    substantial evidence and the trial court properly denied AMH's
    request for JNOV on this ground. Robinson v. Upole, 
    750 A.2d 339
         (Pa.Super.2000); Rohm & Haas Co. v. Continental Cas. Co., 
    732 A.2d 1236
    , 1247 (Pa.Super.1999) quoting Moure v. Raeuchle, 529
    Pa. 394,604 A.2d 1003, 1007 (1992).
    ***
    As earlier stated, Dr. lgidbashian testified as follows:
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    J-A31033-17
    Q. We saw earlier that Dr. Bonica, first, ordered a chest x-
    ray. And you told us that Jillian Nickel, the technologist, performed
    an abdominal study. Was that a breach of the standard of care?
    A. Yes.
    Q. And did that increase the risk of harm to Mr.
    Summerford?
    A. Yes.
    N.T. 5.10.16 (a.m), p. 136.
    Q. If in this case Jillian Nickel testified -- this is a
    hypothetical question now, Doctor. If in this case Jillian Nickel
    testified, the technologist testified, that she was taught that you
    check the placement of a feeding tube by taking a study that goes
    from the base of the lungs, or the bottom of the lungs, down to
    the iliac crest, is that the proper study to take to check the
    placement of a feeding tube?
    A. No.
    Q. Why not?
    A. Because you don't see the airway.
    Q. And-
    A. You can't see the course of the tube.
    Q. If that is what she was taught, would that be a breach of the
    standard of care?
    A. Yes.
    Q. And if that's how she was performing studies to check the
    placement of a feeding tube, is that a breach of the standard of
    care?
    A. Yes.
    N.T. 5.10.16 (a.m.), p.140.
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    J-A31033-17
    There was sufficient evidence that the conduct of Jillian
    Nickel was below the standard of care and that AMH was
    vicariously liable for the conduct of its employee. Accordingly,
    AMH is not entitled to judgment n. o. v. on this ground.
    ___
    11 Dr. Igidbashian also testified that AMH breached its duty to
    provide oversight of how Ms. Nickels performed studies to check
    the placement of a feeding tube which increased the risk of harm
    to Mr. Summerford. N.T., 5.10.16 (a.m.), p.p. 139-141. AMH
    does not challenge on appeal the sufficiency of evidence offered
    in this regard.
    Trial Court Opinion, filed 12/29/16, at 33-39.
    AMH next argues this Court should vacate the judgment and grant a
    JNOV or, in the alternative, remand for a new trial on the vicarious liability
    claim against AMH due to the trial court’s permitting Dr. Igidbashian to opine
    as to Ms. Nickel’s conduct, although he was no qualified to do so. In setting
    forth this claim, AMH states the following:
    It was undisputed that AMH staff would (and did) only begin
    feeding when a radiologist confirmed the placement of a feeding
    tube. Therefore, liability in this case was hinged entirely on Dr.
    Crisci’s misinterpretation of the x-ray, which [Appellee] succeeded
    on at trial; but [Appellee] should not have been permitted to
    convert that error into a claim of negligence against AMH for the
    taking of the December 3 x-ray itself.
    ***
    And so, because the evidence was sufficient for the jury to
    find that [Appellee] proved that Dr. Crisci was negligent for
    misreading the x-ray taken then, necessarily, the verdict against
    AMH on the theory that a different x-ray study should have been
    done by Jillian Nickel, was against the clear weight of the
    evidence. . . .
    Brief of AMH at 52, 54 (emphasis in original).
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    J-A31033-17
    In the alternative, AMH asserts the verdict on the vicarious liability claim
    was against the clear weight of the evidence and unsupported by proficient
    expert testimony, for Dr. Igidbashian admitted he is not a radiology
    technologist who has taken x-ray films and has not positioned a patient for
    over thirty years. Brief of AMH at 55.
    We previously set forth herein the liberal standard for the qualification
    of an expert witness.      Dr. Igidbashian testified he had thirty years of
    experience in the radiology field and maintained an active medical practice in
    that field. He also worked as a clinical instructor in radiology and served as
    chairman of the St. Francis Hospital Radiology Department where he
    developed a policy and procedure concerning the radiologic confirmation of
    the placement of a feeding tube. N.T. Trial, 5/10/16 a.m. at 7-17. Although
    there was no objection to Dr. Igidbashian’s testifying as an expert in the field
    of radiology and in the field of radiological checking of feeding tubes, 
    Id. at 33,
    the trial court allowed Dr. Igidbashian to testify, over objection, as an
    expert regarding policies, procedures, and protocols relating to feeding tubes
    from a radiologic perspective. 
    Id. at 33-34,
    64-65.
    In Vicari v. Spiegel, 
    605 Pa. 381
    , 
    989 A.2d 1277
    (2010), our Supreme
    Court found an oncologist to be qualified to testify as an expert against both
    an otolaryngologist and radiation oncologist in a medical malpractice case,
    even though the oncologist was board certified by a different board and
    practiced in a different subspecialty than the defendant physicians. Therein,
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    J-A31033-17
    the oncologist testified as to whether the standard of care for the defendant
    physicians included a requirement that they offer a patient suffering from
    tongue cancer the option of follow-up chemotherapy and treatment with a
    medical oncologist.    The Court found the oncologist possessed sufficient
    training, experience and knowledge to testify as to the standard of care due
    to his active involvement in a related medical field and the fact he had
    maintained a clinical practice for 30 years, which included the administration
    of chemotherapy to cancer patients, including head and neck cancer patients.
    Herein, Dr. Igidbashian instructed and supervised radiology technologists
    concerning proper procedures that he, himself, helped to create in a hospital
    setting and in his role as Chairman of the Radiology Department at St. Francis
    Hospital. N.T., 5/10 16 a.m. at 58. In light of all the foregoing, we find the
    trial court properly permitted Dr. Igidbashian to testify regarding the
    applicable standard of care of radiology technologists generally and the
    actions of Ms. Nickel herein.
    Finally, AMH alleges that a new trial on damages or a remitter is required
    herein. AMH stresses that when the eighty-eight-year-old Mr. Summerford
    was admitted to the hospital on November 30, 2008, his prognosis was bleak
    as he suffered from numerous ailments, was critically ill, and had a life
    expectancy of only one year. AMH adds that Mr. Summerford was sedated
    throughout the time the feeding tube was inserted and the entire evening of
    December 3rd into December 4th, 2008; therefore, he does not have a
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    J-A31033-17
    substantial claim for pain and suffering of the type “usually seen in awards in
    the mid-seven figures.”       Brief of AMH at 57-58.   AMH explains that Mr.
    Summerford had no employment prospects and no economic damages were
    sought herein; thus, the 3.5 million survival act award exceeds “appropriate
    comparison with economic damages” and is “grossly exorbitant” and “shocks
    the conscience.” 
    Id. at 59-60.
    Upon noting that AMH’s arguments on this issue essentially mirror those
    presented by Dr. Crisci and RGA in their challenges to the damage award and
    in light of our disposition of that 
    claim supra
    , we find AMH is not entitled to
    relief on this final issue.
    Judgment affirmed.
    Judge Panella joins the Opinion.
    Judge Olson concurs in the result.
    Judgment Entered.
    Joseph D. Seletyn, Esq.
    Prothonotary
    Date: 1/30/18
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