Wunderly, K. v. Saint Luke's Hospital ( 2023 )

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NON-PRECEDENTIAL DECISION - SEE SUPERIOR COURT O.P. 65.37
KATHRYN J. WUNDERLY, EXECUTRIX : IN THE SUPERIOR COURT OF
OF THE ESTATE OF KENNETH E. : PENNSYLVANIA
WUNDERLY, DECEASED :
:
Appellant :
:
:
v. :
: No. 2796 EDA 2022
:
SAINT LUKE'S HOSPITAL OF :
BETHLEHEM, PENNSYLVANIA D/B/A :
ST. LUKE'S HOSPITAL - SACRED :
HEART CAMPUS AND ST. LUKE'S :
HEALTH NETWORK, INC. D/B/A ST. :
LUKE'S UNIVERSITY HEALTH :
NETWORK AND ABOVE AND BEYOND :
INCORPORATED D/B/A ABOVE & :
BEYOND MOUNTAIN VIEW :
Appeal from the Order Entered October 14, 2022
In the Court of Common Pleas of Lehigh County Civil Division at No(s):
2021-C-1562
BEFORE: OLSON, J., McLAUGHLIN, J., and KING, J.
MEMORANDUM BY McLAUGHLIN, J.: FILED JUNE 14, 2023
Kathryn J. Wunderly (“Wunderly”), Executrix of the Estate of Kenneth
E. Wunderly (“Kenneth”), Deceased, appeals the grant of the motion for
judgment on the pleadings in favor of Saint Luke’s Hospital of Bethlehem,
Pennsylvania D/B/A St. Luke’s Hospital – Sacred Heart Campus and St. Luke’s
Health Network, Inc. D/B/A St. Luke’s University Health Network (“St.
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Luke’s”).1 Wunderly argues the Mental Health Procedures Act, 50 P.S. § 7101,
et seq., (“MHPA”) does not apply and, even if it did such that St. Luke’s had
immunity for negligence claims, the complaint sufficiently alleged gross
negligence. We affirm.
In June 2021, Wunderly filed a wrongful death and survival action
asserting claims of negligence and corporate negligence against St. Luke’s.
She alleged Kenneth was admitted to St. Luke’s Hospital – Sacred Heart
Campus on September 28, 2019, and, when admitted, he was documented
with Stage I pressure ulcers to his right and left buttocks. Complaint at ¶ 23.
During his admission, Kenneth acquired pressure related skin breakdown,
pressure wounds, and the deterioration of existing pressure wounds. Id. at ¶
24. She alleged that on or about October 14, 2019, while still a patient at St.
Luke’s, Kenneth was documented with unstageable pressure ulcers to his right
buttocks and posterior perineum, and deep tissue injury pressure wounds to
his left buttocks and left heel. Id. at ¶ 25. That same day he was transferred
to a different facility. Id. at ¶ 26. Kenneth died on October 24, 2019. Wunderly
alleges the pressure ulcers and wounds caused and/or contributed to
Kenneth’s death.
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1 Wunderly also asserted claims against Above & Beyond Incorporated d/b/a
Above & Beyond Mountain View (“Above & Beyond”). In October 2022, the
parties entered into a stipulation agreeing to dismiss Above & Beyond from
the matter with prejudice, and the court entered an order dismissing the
entity.
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Wunderly alleged St. Luke’s was negligent by failing to: adopt proper
protocols for pressure ulcer prevention; properly assess Kenneth’s risk of
pressure ulcer development and risk of breakdown in light of his limited
mobility and other risk factors; rotate, turn, or position Kenneth to avoid
pressure ulcer formation and deterioration and develop a written plan for the
same; monitor for pressure ulcer formation; use frequent turning to relieve
pressure on pressure points; provide sufficient nutrition to meet Kenneth’s
needs; identify and properly diagnose Kenneth’s pressure ulcers in a timely
manner; timely complete weekly skin assessments and document same;
prevent formation of pressure ulcers; provide appropriate wound care; timely
and properly order and/or implement appropriate pressure ulcer
interventions; provide complete and consistent documentation as to the
condition of the pressure ulcers and Kenneth’s general medical condition; and
implement an individualized care plan. Id. at ¶ 31. For the corporate
negligence claim, Wunderly alleged St. Luke’s failed to: use reasonable care
in the maintenance of the facility and equipment used for prevention and
treatment of pressure wounds; select and retain competent nursing staff;
oversee the provision of wound care and bed sore care by the nursing staff;
and formulate, adopt, and enforce adequate rules and policies to ensure
quality wound care and bed sore prevention. Id. at ¶ 36.
In its answer with new matter, St. Luke’s alleged that Kenneth was
admitted to St. Luke’s for mental health treatment under a 302 petition under
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the MHPA2 and remained involuntarily admitted under Section 303.3 It alleged
it is immune from legal action under Section 114 of the MHPA.
Wunderly filed a reply to the new matter, wherein she denied
paragraphs 69-100 of the new matter as “contain[ing] conclusions of law or
mixed conclusions of fact and law to which no responsive pleading is required
pursuant to the Pennsylvania Rules of Civil Procedure and which are therefore
denied.” Plaintiff’s Reply to New Matter, filed Nov. 2, 2021, at 1.
St. Luke’s moved for judgment on the pleadings. After a hearing, the
court granted the motion and entered judgment in favor of St. Luke’s and
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2 Under Section 302, “one who is severely mentally ill may be subjected to an
involuntary emergency examination if one of three mandatory prerequisites is
met: (1) certification of a physician; (2) warrant issued by the county
administrator authorizing such examination; or (3) application by a physician
or other authorized person who has personally observed actions indicating a
need for an emergency application.” Leight v. Univ. of Pittsburgh
Physicians, 243 A.3d 126, 140 (Pa. 2020) (footnote omitted); See 50 P.S. §
7302.
3 Section 303 provides:
(a) Persons Subject to Extended Involuntary
Emergency Treatment.--Application for extended
involuntary emergency treatment may be made for any
person who is being treated pursuant to section 302
whenever the facility determines that the need for
emergency treatment is likely to extend beyond 120 hours.
The application shall be filed forthwith in the court of
common pleas, and shall state the grounds on which
extended emergency treatment is believed to be necessary.
The application shall state the name of any examining
physician and the substance of his opinion regarding the
mental condition of the person.
50 P.S. § 7303(a) (footnote omitted).
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against Wunderly, concluding St. Luke’s was immune under the MHPA unless
the conduct was willful or grossly negligent and the complaint failed to set
forth facts that would support a finding of willful or grossly negligent conduct.
Wunderly raises the following issues:
1. Whether the trial court erred in granting St. Luke’s
Defendants’ Motion for Judgment on the Pleadings because
the immunity provisions of the Mental Health Procedures Act
do not apply to [Wunderly’s] claims?
2. Whether the trial court erred in granting St. Luke’s
Defendants’ Motion for Judgment on the Pleadings because
even if the immunity provisions of the Mental Health
Procedures Act do apply to [Wunderly’s] claims, the
pleadings contain sufficient averments to support a finding
that [St. Luke’s] actions constitute willful misconduct or
gross negligence?
Wunderly’s Br. at 8 (suggested answers omitted).
Wunderly’s issues challenge the grant of the motion for judgment on the
pleadings. Pennsylvania Rule of Civil Procedure 1034 permits a party to move
for judgment on the pleadings after the pleadings are closed. Pa.R.C.P. 1034.
“Entry of judgment on the pleadings is appropriate when there are no disputed
issues of fact and the moving party is entitled to judgment as a matter of law.”
Kennedy v. Consol Energy, Inc., 116 A.3d 626, 631 (Pa.Super. 2015)
(quoting Sisson v. Stanley, 109 A.3d 265, 274 (Pa.Super. 2015)) (internal
quotation marks omitted). “[W]e will reverse only if the trial court committed
a clear error of law or if the pleadings disclose facts that should be submitted
to a trier of fact.” Id. (quoting Sisson, 109 A.3d at 274). Further, “[w]e accept
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as true all well-pleaded allegations in the complaint.” Id. (quoting Sissan,
109 A.3d at 274). Our scope of review is plenary. Id.Wunderly first contends that the trial court erred in granting St. Luke’s
motion for judgment on the pleadings because the immunity provisions of the
MHPA do not apply to the claims. Wunderly argues that affording St. Luke’s
immunity “would not advance the purposes of” the MHPA. Wunderly’s Br. at
17. She maintains the development of pressure wounds was not the result of
a “treatment decision,” arguing that, taking all inferences in favor of
Wunderly, “by their very nature, for pressure injuries of this type and severity
to develop and deteriorate, [St. Luke’s] must have altogether ignored
[Kenneth] for prolonged periods of time.” Id. She argues that “offloading
pressure from the vulnerable decedent’s bony prominences cannot be said to
be medical care in the same vein as contemplated by the [MHPA],” as she
claims it does nothing to facilitate recovery from a mental illness. Id. at 17-
18. Wunderly attempts to distinguish Allen v. Montgomery Hospital, 696
A.2d 1175 (Pa. 1997). She maintains that the decedent in Allen was injured
by a restraint device intended to permit her to sit up in bed while preventing
her from falling out of bed due to her mental health conditions. She argues
that here, Kenneth’s injures bore “no relation to any treatment for mental
health conditions that underpin the immunity provisions of the MHPA.” Id. at
16. She further claims the nursing staff is not a “person who participates in a
decision that a person be examined or treated under” the MHPA and therefore
immunity does not apply. Id. at 18.
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The MHPA provides that, in the absence of willful misconduct or gross
negligence, facilities, physicians, and other authorized people shall be immune
from civil and criminal liability for certain decisions related to treatment under
the MHPA:
(a) In the absence of willful misconduct or gross negligence,
a county administrator, a director of a facility, a physician,
a peace officer or any other authorized person who
participates in a decision that a person be examined or
treated under this act, or that a person be discharged, or
placed under partial hospitalization, outpatient care or leave
of absence, or that the restraint upon such person be
otherwise reduced, or a county administrator or other
authorized person who denies an application for voluntary
treatment or for involuntary emergency examination and
treatment, shall not be civilly or criminally liable for such
decision or for any of its consequences.
50 P.S. § 7114(a). The Pennsylvania Supreme Court has interpreted “person”
to include “hospitals and other treatment facilities as well as their employees,”
reasoning that “denying such entities immunity would undermine the goals of
the MHPA.” Dean v. Bowling Green-Brandywine, 225 A.3d 859, 869 (Pa.
2020).
Further, the Supreme Court in Allen explained that the immunity under
the MHPA includes “medical care coincident to mental health care,” which is
“commonly understood to include the prevention or alleviation of both physical
and mental illness.” Allen, 696 A.2d at 1179. The Court relied on the definition
section of the MHPA, which defines “adequate treatment” and “treatment” as:
Adequate treatment means a course of treatment designed
and administered to alleviate a person’s pain and distress
and to maximize the probability of his recovery from mental
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illness. It shall be provided to all persons in treatment who
are subject to this act. It may include inpatient treatment,
partial hospitalization, or outpatient treatment. Adequate
inpatient treatment shall include such accommodations,
diet, heat, light, sanitary facilities, clothing[,] recreation,
education and medical care as are necessary to maintain
decent, safe and healthful living conditions.
Treatment shall include diagnosis, evaluation, therapy, or
rehabilitation needed to alleviate pain and distress and to
facilitate the recovery of a person from mental illness and
shall also include care and other services that supplement
treatment and aid or promote such recovery.
Id. at 1178-79 (quoting 50 P.S. § 7104) (emphasis in Allen).
In Allen, the Court concluded that Montgomery Hospital was immune
under the MHPA where it treated a patient from the Norristown State Hospital
for dehydration and a fever. While at Montgomery Hospital, the patient was
kept in a posey vest restraint, which is a “vest-like restraint which is tied to
the patient’s bed in order to keep the patient from falling out of bed, but which
allows the patient to move his or her arms and to sit up in bed.” Id. at 1176
n.1. Shortly before the patient was going to be transferred back to Norristown
State Hospital, a nurse discovered the patient hanging about six inches above
the floor with the posey restraint around her neck. Id. at 1176. The patient
survived but suffered permanent brain damage. Id. The Court concluded the
hospital could invoke the immunity provision of the MHPA unless its actions
constituted gross negligence. The Court reasoned that the patient was
mentally ill and in acute need of medical care and the care provided was
“designed to facilitate the recovery of a person from mental illness.” Id. at
1179 (internal quotation marks omitted).
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Here, the trial court concluded that the treatment Kenneth received for
his pressure ulcers was incidental to the treatment for his dementia and
mental health. Trial Court Opinion, filed Mar. 9, 2022, at 9. It reasoned that
Kenneth was involuntarily admitted to St. Luke’s under the MHPA and treated
for aggressive and combative behavior related to his dementia diagnosis. Id.
It pointed out the primary reason for the hospitalization was to stabilize his
mental health, and the treatment of his pressure ulcers was “coincident to
that mental health treatment.” Id. The court therefore concluded that St.
Luke’s was immune from suit unless the complaint alleged willful or grossly
negligent conduct.
The trial court did not commit a clear error of law in finding the MHPA
provided immunity unless the conduct was willful or grossly negligent. The
treatment for and prevention of pressure ulcers and other wounds was
coincident to the mental health care being provided by St. Luke’s, as it was
medical care “necessary to maintain decent, safe and healthful living
conditions,” and treatment that aided or promoted a recovery from a mental
illness. See Allen, 696 A.2d at 1179.
Wunderly next maintains that, even if MHPA immunity applies here, the
allegations of the complaint were sufficient to support an inference that St.
Luke’s conduct was grossly negligent. She maintains that, “[a]t a minimum,
it was a determination that should have been left for a jury to resolve.”
Wunderly’s Br. at 13. She argues the staff failed to monitor Kenneth or provide
basic, timely turning and repositioning. Further, St. Luke’s systematic failures
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allegedly included a failure to retain competent nursing staff and a failure to
oversee proper wound care.
Wunderly argues that it can be reasonably inferred from the allegations
that St. Luke’s grossly deviated from the ordinary standard of care and had
staff that were inadequate for preventing severe pressure wounds. She argues
that the failure “to take basic steps to ensure [Kenneth’s] skin integrity
demonstrate[s] that [St. Luke’s] personnel could be found to be culpable for
conduct that is substantially more than ordinary carelessness, inadvertence,
laxity or indifference.” Id. at 22. She claims she was not able to develop
evidence to demonstrate the nature and extent of the failures because her
claims were dismissed before discovery. She likens the case to Potts v. Step
By Step, Inc., 26 A.3d 1115 (Pa.Super. 2011), and Bloom v. DuBois Reg’l
Med. Ctr., 597 A.2d 671, 679 (Pa.Super. 1991).
“[T]he term gross negligence . . . mean[s] a form of negligence where
the facts support substantially more than ordinary carelessness, inadvertence,
laxity, or indifference. The behavior of the defendant must be flagrant, grossly
deviating from the ordinary standard of care.” Albright v. Abington Meml.
Hosp., 696 A.2d 1159, 1164 (Pa. 1997) (quoting Bloom, 597 A.2d at 679(Pa.Super. 1991)). Although “it is generally true that the issue of whether a
given set of facts satisfies the definition of gross negligence is a question of
fact to be determined by a jury, a court may take the issue from a jury, and
decide the issue as a matter of law, if the conduct in question falls short of
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gross negligence, the case is entirely free from doubt, and no reasonable jury
could find gross negligence.” Id. at 1164-65.
In Bloom, this Court concluded the complaint could “be construed to
plead facts sufficient to give rise to a finding of gross negligence.” 597 A.2d
at 679. We noted that the operative complaint “alleged that the defendants,
who held themselves out as competent to provide psychiatric treatment to
one in the position of [the plaintiff], completely failed to diagnose her mental
condition and treat her in a manner that would protect her from serious
physical harm.” Id. The complaint alleged that upon her admission the plaintiff
showed indications of “severe psychiatric and psychological disturbances, . . .
depression and paranoia,” which created an “unreasonably high probability of
self-destructive actions on her part.” Id. at 675. Further, it alleged “the
defendants all knew or had reason to know that their actions in dealing with
[the plaintiff] created an unreasonably high probability of self-destructive
harm for [the plaintiff] and that all defendants acted in conscious disregard of
this substantial risk.” Id. Finally, the amended complaint contained “specific
allegations of wrongdoing by defendants, including, inter alia, that the
defendants had failed to obtain adequate information concerning [the
plaintiff’s] possibly suicidal condition on admission and had failed properly to
medicate and clinically treat her.” Id. We pointed out that the defendants
were informed of the patient’s mental disorder, but “failed to take adequate
precautions to assure her safety,” such that she attempted suicide while in
the facility. Id. at 679. We concluded that the “allegations encompass the
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potential of showing conduct on the part of the defendants that might be
considered grossly negligent.” Id.In Potts, the plaintiff’s daughter, who had cerebral palsy, intellectual
disability, and neuromuscular scoliosis, lived in a facility run by Step By Step,
Inc. 26 A.3d at 1117. She became ill, and ultimately died from a perforated
gastric ulcer. Id. This Court found the complaint alleged gross negligence. We
explained that a nurse had specifically instructed two employees to contact
her immediately if the patient vomited or had problems holding down fluids,
but the employees did not contact her when the resident vomited, and no staff
member administered CPR or called 9–1–1. Id. at 1120. We pointed out that
during the delay, the patient’s condition worsened. We concluded that, based
on the facts pled in the complaint, “a jury could find Step By Step’s actions
constituted gross negligence, as they could be interpreted as ‘flagrant, grossly
deviating from the ordinary standard of care.’” Id. (citation omitted).
Here, the trial court found the allegations in the complaint sounded in
ordinary negligence and were insufficient as a matter of law to support a
finding of gross negligence or of willful conduct. It pointed out that the two
counts alleged against St. Luke’s were negligence and corporate negligence,
and the allegations included that St. Luke’s failed to properly assess, treat,
diagnose, and monitor the pressure ulcers, provide adequate care, and/or turn
and reposition Kenneth. The court concluded the allegations and factual
averments “are not so ‘flagrant’ or ‘extreme’ to go beyond ordinary
‘carelessness, inadvertence, laxity, or indifference.’” Trial Court Opinion at 10.
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It reasoned that the “allegations are simply that [Kenneth’s] pre-existing
pressure ulcers deteriorated over the course of his two-and-a-half week stay
at St. Luke’s, as well as during his ten-day stay at Above & Beyond, all of
which may have caused and/or contributed to his death.” Id. The court noted
Wunderly did not allege any facts related to the cause of the deterioration or
the sequence of events related to the treatment received. It noted that there
were no allegations that nursing staff left Kenneth unattended for days or
weeks, that he received no care, that anyone inflicted harm on him, or that
his injuries were completely ignored. Id.The court did not err in finding the complaint did not allege gross
negligence. The allegations raise an issue of ordinary negligence and do not
rise to the level of gross negligence. The allegations do not constitute flagrant
conduct or conduct that grossly deviated from the standard of care. Rather,
they include allegations of ordinary negligence, such as not properly caring for
the pressure ulcers and wounds. Unlike in Bloom, there is no allegation that
St. Luke’s had specific knowledge of harm and failed to take any action.
Similarly, unlike in Potts, there are no allegations the employees ignored
specific care instructions.
Order affirmed.
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Judgment Entered.
Joseph D. Seletyn, Esq.
Prothonotary
Date: 6/14/2023
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