J-A06042-15
NON-PRECEDENTIAL DECISION - SEE SUPERIOR COURT I.O.P. 65.37
CHRISTOPHER WHITE AND NINA WHITE, IN THE SUPERIOR COURT OF
INDIVIDUALLY AND AS PENNSYLVANIA
ADMINISTRATORS OF THE ESTATE OF
RICHARD C. WHITE A/K/A RICHARD
CURTIS WHITE, DECEASED
Appellants
v.
RICHARD M. CORNISH, M.D., DARELL T.
COVINGTON, M.D., POCONO
EMERGENCY ASSOCIATES, P.C., AND
POCONO MEDICAL CENTER
Appellees No. 1806 EDA 2014
Appeal from the Order June 4, 2014
In the Court of Common Pleas of Monroe County
Civil Division at No(s): 8231-CV-2012
BEFORE: PANELLA, J., OTT, J., and JENKINS, J.
MEMORANDUM BY JENKINS, J.: FILED APRIL 13, 2015
Appellants Christopher and Nina White, as Administrators of the Estate
of Richard C. White, filed this medical malpractice action against Richard M.
Cornish, M.D., Pocono Emergency Physicians, P.C.,1 Darrell T. Covington,
M.D., and Pocono Medical Center. The trial court granted summary
judgment for Dr. Covington, finding he owed no duty to Mr. White and
____________________________________________
1
Appellants initially named “Pocono Emergency Associates, P.C.” as a
defendant. The parties agreed the appropriate party was “Pocono
Emergency Physicians,” but did not formally correct the caption.
J-A06042-15
finding Appellants’ experts provided contradictory testimony. We reverse
and remand.
Mr. White was Dr. Covington’s patient beginning in 2003. Opinion,
5/13/2014, at 3. On July 22, 2009, Dr. Covington maintains he sent Mr.
White the following unsigned letter:
This letter is to notify you that your past due account in
the sum of $44.18 has been written off as an “Uncollected
Bad Debt”. We have billed you on several occasions by
statement with no response from you. As of thirty (30)
days from the above date listed, we can no longer provide
services to you as your doctor due to the non-payment of
your account. If you pay this amount in full, we will
reconsider seeing you as our patient.
Should you have any questions, please call our office at
(570) 421-8968 between the hours of 9:00 AM and 5:00
PM on Tuesdays, Wednesdays or Fridays.
Letter From Darell T. Covington, M.D. to Richard C. White dated July 22,
2009, Motion for Summary Judgment of Defendant, Darell T. Covington,
M.D. at Exh. B. Mr. White did not pay this balance. Dr. Covington sent at
least one similar letter to Mr. White in the past, but resumed treating Mr.
White after discussing payment obligations with him. N.T. of Dep. of Dr.
Covington, 2/6/2014, at 160-165 [Covington Dep. Vol. II]. However, Mr.
White did not visit Dr. Covington following the July 22, 2009 letter.
On September 22, 2010, Mr. White was treated at the Pocono Medical
Center emergency department and discharged. Report of Ira Mehlman,
M.D., at 2. On September 29, 2010, Mr. White visited Nicholas Teleo, M.D.,
a surgeon. Id. Dr. Teleo’s notes regarding Mr. White’s history state:
-2-
J-A06042-15
“Incisional hernia – behind colostomy – watched by Dr. Covington.”
Covington Dep. Vol. II, at 151.2
On October 3, 2010, Mr. White was again admitted to the Pocono
Medical Center emergency department, where Dr. Cornish, an emergency
room physician, treated him. Following a CT scan, a radiologist
recommended a surgical consult. Imaging Report, Pocono Medical Center
Imaging Services, dated 10/3/2010. At Mr. White’s request, Dr. Cornish
called Dr. Covington, a colo-rectal surgeon. N.T. of Dep. of Dr. Cornish, at
124. The telephone call lasted three minutes and fourteen seconds. 3 Id. at
127-28, 165-68. Dr. Cornish testified that the conversation with Dr.
Covington was a surgical consultation and that he relied on this conversation
when discharging Mr. White. Id. He stated that Dr. Covington said he
believed Mr. White was suffering from enteritis and did not require a surgical
admission to the hospital. Id. Further, Dr. Cornish testified that Dr.
Covington said he “would be happy to see [Mr. White] as an out-patient if no
____________________________________________
2
Dr. Covington testified Dr. Teleo was wrong. Covington Dep. Vol. II, at
149-151.
3
The contents of this telephone call are disputed. Dr. Covington disputes
Dr. Cornish’s version of the telephone call and claims he told Dr. Cornish
that Mr. White was not his patient. N.T. of Dep. of Dr. Covington,
11/21/2013, at 71 [Covington Dep. Vol. I]; N.T. of Dep. of Dr. Cornish, at
166 (Dr. Covington did not say Mr. White was not his patient). We view the
disputed facts in the light most favorable to Appellants, the non-moving
parties. See Summers v. Certainteed Corp., 997 A.2d 1152, 1159
(Pa.2010).
-3-
J-A06042-15
better in several days.” Id. at 128. Dr. Cornish stated Dr. Covington asked
questions to be presented to Mr. White, and that he [Dr. Cornish] relayed
Mr. White’s answers to Dr. Covington. Id. at 124.
After this telephone conversation, Dr. Cornish discharged Mr. White
from the emergency department and gave discharge instructions, which
provided a diagnosis of gastroenteritis and listed Dr. Covington as the
follow-up contact. N.T. of Dep. Dr. Cornish, at 127-31. On October 3,
2010, the Pocono Medical Center emergency department faxed a copy of Mr.
White’s emergency room record to Dr. Covington. Covington Dep. Vol. I, at
97-100. Dr. Covington received it, signed it, and placed it in Mr. White’s
chart. Id.
On October 5, 2010, Mr. White returned to the emergency
department. Covington Dep. Vol. II, at 231. That same day, Dr. Cornish
put the following note in the emergency room record concerning the visit of
October 3, 2010:
The increased bowel distention on the CT compared to the
CT from the 22-September, as well as the protracted
nature of the illness and the increased WBC count
prompted me to suggest to the patient that I consult
surgery. The patient expressed desire for me to call Dr.
Covington, who had operated him [sic] in the past. I
described the case to Dr. Covington, to include the H&P,
the physical exam, the labs and the CT readings. I
reentered the patient’s room during that call to obtain
detailed answers from the patient to some of Dr.
Covington’s questions. Dr. Covington felt that the patient
was likely to have an enteritis rather than a bowel
obstruction on the basis of the watery diarrhea and
elevated WBC, the continuance of flatus and the lack of
-4-
J-A06042-15
abdominal tenderness. He did not feel that he needed
surgical admission, but would be happy to see him as an
outpatient if no better in several days. I conveyed his
impression to the patient.
Pocono Medical Center Emergency Record, Doctor Notes, 10/5/2010, Bates
No. 00371; N.T. of Dep. of Dr. Cornish, at 97-98.4
Although Dr. Covington performed emergency surgery on Mr. White,
Mr. White died on October 8, 2010.5 Covington Dep. Vol. II, at 230. The
certificate of death completed by Dr. Covington lists the cause of death as
gangrenous/ischemic small bowel, sepsis, and multiple system failure. Id.
at 230-33. It also states Mr. White was in “septic shock” when admitted on
October 5, 2010. Id. at 229.
Appellants produced expert reports from Ralph Silverman, M.D., a
colo-rectal surgeon, Albert Weihl, M.D., an emergency department
physician, and Ira Mehlman, M.D., an emergency medicine physician.
Dr. Silverman opined:
____________________________________________
4
Dr. Cornish entered this note after Mr. White returned to the emergency
department on October 5, 2010. N.T. of Dep. of Dr. Cornish, at 54. He
stated that Mr. White’s return to the emergency department “prompted me
to look at that chart from the 3rd to refresh my memory as to the patient’s
status and I think it’s probable to say if I had no other patients to see or no
other work that was pending that I would have just gone ahead and
completed the chart at that time.” Id. at 54-55.
5
Dr. Covington testified that he received a call from the hospital on October
5, 2010 informing him that Mr. White was at the emergency room, was in
septic shock, and the surgeon that was at the hospital was performing
another operation. Covington Dep. Vol. II, at 167-69. Therefore, Dr.
Covington went to the hospital and operated on Mr. White because “there
was no one available to operate and [Mr. White] was dying.” Id.
-5-
J-A06042-15
Based on the fact that Dr. Cornish called Dr. Covington
and that Dr. Covington said it was okay to discharge the
patient, a formal consult was initiated. Mr. White’s past
noncompliance with fiscal responsibilities is not an
acceptable excuse to refuse care in a potential emergent
situation especially when the consult has been initiated. As
such, Dr. Covington’s refusal to allow a full presentation by
Dr. Cornish of Mr. White’s case, and thus refusing to assist
this ER doctor and patient, was a deviation from the
standard of care.
...
Surgical intervention was the only way to decrease Mr.
White’s risk of further complications and death. Dr.
Covington’s refusal to come to the ER and evaluate Mr.
White contributed to a delay in the necessary surgical care
and was a deviation from the standard of care which
increased Mr. White’s risk of death.
Email from Ralph Silverman to Thomas J. Foley, dated Mar. 18, 2014.
Dr. Weihl opined:
In spite of the above, with ongoing unrelieved symptoms
for over 10 days, marked presumed new abnormalities in
laboratory testing indicating severe hyperglycemia, severe
elevation of white blood count, moderate unexplained
anemia, and new renal insufficiency, and a CT scan
showing progressive abnormalities, Dr. Cornish relied upon
only a telephone consultation with a surgeon and
discharged Mr. White to his home.
On October 3, 2010[,] Dr. Cornish deviated from the
standard of care and discharged Mr. White from the
Pocono Medical Center Emergency Department on a
dangerous drug therapy plan. Mr. White instead required
immediate admission to the hospital for medical treatment
of his multiple, newly discovered, metabolic and
hematologic abnormalities, and for surgical consultation
with a surgeon who actually examined and evaluated the
patient in person.
On October 3, 2010, Mr. White could not be reasonably,
prudently or safely discharged from the hospital.
Telephone contact by Dr. Cornish was required with Mr.
-6-
J-A06042-15
White’s primary physician, and arrangement for admission
to the hospital was required for urgently needed treatment
and further medical and surgical evaluation. Discharging
Mr. White to his home on October 3, 2010, in violation of
the standard of care, exposed Mr. White to increased risk
of harm and led directly to his death on October 8, 2010.
Letter from Albert C. Weihl, M.D., to The Foley Law Firm, dated Sept. 19,
2012, at 3-4.
Dr. Mehlman opined:
Dr. Cornish’s deposition remarks about the CAT scan of the
abdomen/pelvis . . ., his patient’s wrongly labeled
“aggressive” hydration . . . , the “black box” warnings
about metformin . . . , the management and interpretation
of [Mr. White’s] very critical glucose of >450 repeated and
its appropriate management . . . , a failure to understand
and know the critical concepts of SIRS . . . , and an
apparent 3 minutes 14 second conversation with Dr.
Covington . . . which he believes allowed him to discharge
this patient [is] very concerning and either represent[s] a
significant lack of knowledge, lack of concern, “asleep at
the wheel”, or “something else” — and Dr. Cornish’s
ultimate action of discharging this patient denied him a
good outcome and survival. The standard of care of
emergency medicine doctors is that they generally do not
admit patients themselves, BUT they do get patients
admitted by calling appropriate doctors, either of that
patient or on call for the ED that day, who then admit the
patients after an appropriate and meaningful conversation.
Emergency medicine doctors do not send seriously ill
patients requesting help home whatever anyone else tells
them: that is the standard of care. And there are many
mechanisms available to make the right thing, the right
outcome happen[.] Dr. Cornish, when all is said and done,
regardless of whatever (contested) conversation he might
have had with Dr. Covington, did not make the right things
happen, thus, he did not meet the standard of care on
10/3/10, with patient [Mr. White], and that denied [Mr.
White] the chance to survive and assured his death. On
page 112 of his deposition, Dr. Cornish stated that “it was
my judgment that he didn’t require admission”: this was
-7-
J-A06042-15
very wrong, and reflects the failures on multiple levels of
Dr. Cornish to hear, understand and process the
information he had on patient [Mr. White], and what it
meant clinically, and what the standard of care required.
This failure to admit and further evaluate and treat patient
[Mr. White], assured his patient’s death.
...
Regardless of what Dr. Covington might have thought,
might have said in the roughly 3 minute and 14 second
conversation, ultimately, Dr. Cornish should never have
discharged patient [Mr. White] from what he knew, and
should have understood, with the available ancillary tests
he had (imaging and many abnormal serious lab tests,
such as WBC, BUN/creatinine, glucose, Na, CO2).
Letter from Ira Mehlman, M.D. to Foley Law Firm, dated 3/17/2014, at 4-7.
On March 17, 2014, Dr. Covington filed a motion for summary
judgment. On May 13, 2014, the trial court granted summary judgment in
favor of Dr. Covington. On May 15, 2014, Appellants filed a motion for
reconsideration and vacatur of the May 13, 2014 order or, in the alternative,
for a stay of proceedings and appellate certification. On June 4, 2014, the
trial court issued an amended order, reaffirming summary judgment for Dr.
Covington, but certifying the order as a final order for appellate purposes
pursuant to Pennsylvania Rule of Appellate Procedure 341(c)6 and 42 Pa.C.S.
§ 702(a).7
____________________________________________
6
Rule 341(c) provides: “When more than one claim for relief is presented in
an action, whether as a claim, counterclaim, cross-claim, or third-party claim
or when multiple parties are involved, the trial court or other governmental
unit may enter a final order as to one or more but fewer than all of the
claims and parties only upon an express determination that an immediate
appeal would facilitate resolution of the entire case. Such an order becomes
(Footnote Continued Next Page)
-8-
J-A06042-15
Appellants raise the following issues on appeal:
I. Whether the honorable trial court erred in granting
summary judgment based upon the alleged lack of
duty, or absence of a doctor-patient relationship,[]
as between defendant[,] Dr. Covington[,] and
decedent?
II. Whether the honorable trial court erred in applying
Mudano v. Philadelphia Rapid Transit Co., 289
Pa. 51, 137 A.104 (1927) and granting summary
judgment on the alternative ground that
[appellants’] expert reports allegedly conflicted with
one another?
Appellant’s Brief at 3 (unnecessary capitalization omitted).
“[S]ummary judgment is appropriate only in those cases where the
record clearly demonstrates that there is no genuine issue of material fact
and that the moving party is entitled to judgment as a matter of law.”
Summers v. Certainteed Corp., 997 A.2d 1152, 1159 (Pa.2010) (quoting
Atcovitz v. Gulph Mills Tennis Club, Inc., 812 A.2d 1218, 1221
(Pa.2002)). A “trial court must take all facts of record and reasonable
inferences therefrom in a light most favorable to the non-moving party” and
“must resolve all doubts as to the existence of a genuine issue of material
fact against the moving party.” Id. (citing Toy v. Metropolitan Life Ins.
_______________________
(Footnote Continued)
appealable when entered. In the absence of such a determination and entry
of a final order, any order or other form of decision that adjudicates fewer
than all the claims and parties shall not constitute a final order.”
7
Section 702(a) provides: “(a) Appeals authorized by law.--An appeal
authorized by law from an interlocutory order in a matter shall be taken to
the appellate court having jurisdiction of final orders in such matter.”
-9-
J-A06042-15
Co., 928 A.2d 186, 195 (Pa.2007)). Therefore, a trial court “may only grant
summary judgment ‘where the right to such judgment is clear and free from
all doubt.’” Id.
This Court “may reverse a grant of summary judgment if there has
been an error of law or an abuse of discretion.” Summers, 997 A.2d at
1159 (quoting Weaver v. Lancaster Newspapers, Inc., 926 A.2d 899,
902–03 (Pa.2007)). Whether there are no genuine issues as to any material
fact presents a question of law, and, therefore, our standard of review is de
novo. Id. “[W]e need not defer to the determinations made by” the trial
court. Id.
Appellants’ first claim alleges the trial court erred in finding, as a
matter of law, that no doctor-patient relationship existed. We agree.
To establish medical negligence, a plaintiff must prove “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 harm.” Vazquez v. CHS Professional
Practice, P.C., 39 A.3d 395, 397 (Pa.Super.2012) (quoting Quinby v.
Plumsteadville Family Practice, Inc., 907 A.2d 1061, 1070–1071
(Pa.2006)).
The trial court found Dr. Covington did not owe a duty to Mr. White
because no physician-patient relationship existed. It found, as a matter of
law, no physician-patient relationship existed on October 3, 2010, and the
- 10 -
J-A06042-15
telephone conversation between Dr. Cornish and Dr. Covington did not
reestablish a physician-patient relationship. Opinion, 5-13/2014, at 5.
If Dr. Covington and Mr. White had a physician-patient relationship,
then Dr. Covington owed Mr. White a duty to act within the standard of care.
See Tomko v. Marks, 602 A.2d 890, 892 (Pa.Super.1992) (duty owed by
physician “arises from the physician-patient relationship” (quoting Craddock
v. Gross, 504 A.2d 1300, 1302 (Pa.Super.1986))). There is no
Pennsylvania precedent discussing whether a physician-patient relationship
exists in circumstances similar to those presented in this case and,
therefore, we review decisions from other jurisdictions for guidance.
In Campbell v. Haber, the New York Supreme Court, Appellate
Division, found an implied physician-patient relationship may have existed
where a physician called the cardiologist on call, who provided an opinion on
the test results, and the emergency room physician relayed the findings to
the patient and discharged him. 274 A.D.2d 946, 946-47 (N.Y.2000). It
found that whether a physician-patient relationship existed was a question of
fact for the jury. Id. The dissenting opinion in Campbell found that “what
transpired during the brief telephone call . . . did not give rise to a physician-
patient relationship between [the cardiologist] and [the] plaintiff. In the
absence of such relationship, there is no legal duty and hence no basis for
liability for medical malpractice.” Id. at 948. It noted there was no express
undertaking to provide medical treatment and the cardiologist did not
undertake to supervise the emergency room physician. The physician never
- 11 -
J-A06042-15
formally engaged the cardiologist as a consultant and the cardiologist only
had the information provided to him by the physician. The dissent further
noted there was no prior or subsequent relationship with the plaintiff and the
cardiologist never had direct contact with the plaintiff. Id. It concluded that
“[l]iability should not be predicated on the sort of informal consultation
between professionals that occurred here.” Id.
In Cogswell v. Chapman, 249 A.D.2d 865, 866 (N.Y.1998), the New
York Supreme Court, Appellate Division, found a physician-patient
relationship can be established by telephone if the call “‘affirmatively
advis[es] a prospective patient as to a course of treatment” and it is
foreseeable that the patient would rely on the advice. In Cogswell, an
ophthalmologist discussed a patient’s injury with the emergency room
physician, including minimal activity restrictions and follow-up visits, and the
written instructions provided to the patient were identical to those the
ophthalmologist stated he provided to the emergency room doctor. Id. at
866-67. The Court found an issue of fact existed regarding the
ophthalmologist’s level of participation because, under the totality of the
circumstances, a jury could find the ophthalmologist had more than an
informal interest and involvement in the patient’s care. Id. at 867.
Alternately, other courts have found that no physician-patient
relationship arises where a doctor is called for consultation, but does not
examine the patient, review the records, or anticipate a future physician-
patient relationship. See, e.g., Lopez v. Aziz, 852 S.W.2d 303, 305-307
- 12 -
J-A06042-15
(Tex.App.1993) (no physician-patient relationship where doctor consulted
OB-GYN specialist by telephone and followed the specialist’s advice, where
there was no contract to perform services, specialist did not accept any work
relating to plaintiff, did not conduct any tests or review any test results, did
not prepare any reports, and did not bill plaintiff, noting specialist “did no
more than answer the professional inquiry of a colleague”); Reynolds v.
Decatur Memorial Hosp., 660 N.E.2d 235, 237-240 (Ill.App.1996) (no
physician-patient relationship existed where emergency room doctor called
specialist, advised him of the circumstances of plaintiff’s admission to
hospital, and specialist asked questions, but specialist did not treat the
patient or commit to further involvement in his care, did not see, examine or
diagnose plaintiff, and did not bill for services); cf. Hill v. Kokosky, 186
Mich.App. 300 (2002) (specialist owed no duty to patient, where patient’s
obstetrician contacted specialists by telephone for opinions regarding the
plaintiff’s case, obstetrician provided the case history, but did not refer
plaintiff to specialists and specialists did not examine plaintiff or review her
chart, plaintiff did not seek specialists’ medical advice or treatment, and
opinions were addressed to the obstetrician as a colleague and were
recommendations, not a prescribed course of treatment).
We are constrained to concluded that, as in Campbell and Cogswell,
whether a physician-patient relationship existed between Dr. Covington and
Dr. White raises a genuine issue of material fact, which precludes summary
judgment.
- 13 -
J-A06042-15
Initially, a genuine issue of fact exists as to whether Dr. Covington
terminated the physician-patient relationship on July 9, 2009. The letter is
unsigned, and, although Dr. Covington likely sends such letters in his regular
course of business, Dr. Covington presented no proof he mailed the letter.
Further, assuming the letter was sent and received, Dr. Covington sent at
least one similar letter to Mr. White in the past and nevertheless resumed
treatment after discussing payment obligations. However, the July 9, 2009
letter stated the relationship was terminated unless Mr. White paid the
balance due, which he failed to do. Further, Dr. Covington provided no
treatment between the date of the letter, July 9, 2009, and the date of the
telephone call on October 3, 2010.
In addition, a genuine issue of material facts exists as to whether the
telephone conversation re-established a physician-patient relationship.
Unlike a blind telephone consultation where the doctor does not know the
patient, does not examine the patient, and does not review the records, Dr.
Covington knew Mr. White, Mr. White asked Dr. Cornish to call Dr.
Covington, Dr. Covington asked questions, which Mr. White answered
through Dr. Cornish, Dr. Covington received the medical records that same
day and placed them in Mr. White’s chart, and Dr. Covington told Dr. Cornish
- 14 -
J-A06042-15
that Mr. White could see him if the problems persisted.8 The jury would be
in the best position to determine whether a physician-patient relationship
existed between Dr. Covington and Mr. White. Because a genuine issue of
material fact exists as to whether there was a physician-patient relationship,
summary judgment is not appropriate.
We note that, unlike the cases in which other jurisdictions have found
no physician-patient relationship existed as a matter of law, Mr. White and
Dr. Covington had a prior physician-patient relationship, Dr. Covington told
Dr. Cornish that Mr. White could see him if the problems persisted, 9 Dr.
Covington received and signed Mr. White’s emergency room records, and he
placed the records in Mr. White’s chart. See Lopez, 852 S.W.2d at 305-
307; Reynolds, 660 N.E.2d at 237-240; Hill, 186 Mich.App. at 300.
Appellants next contend the trial court erred when it applied Mudano
v. Phila. Rapid Transit Co., 137 A. 104, 106 (Pa.1927), to find Appellants’
experts’ opinions conflicted with each other. Appellants’ Brief at 28-50. We
agree.
In Mudano, the Supreme Court of Pennsylvania found that a plaintiff
fails to sustain his burden of proof if he presents conflicting expert
____________________________________________
8
As we noted, Dr. Covington disputes this version of events. However, for
purposes of this appeal, we must view the facts in favor of the Appellants,
the non-moving party. See Summers, 997 A.2d at 1159.
9
Dr. Covington denies informing Dr. Cornish that Mr. White could see him if
the problems persisted. Covington Dep. Vol. I at 93-94.
- 15 -
J-A06042-15
testimony. Mudano, 137 A. at 106. The Court reasoned that if expert
testimony “was so conflicting regarding the proper inference to be drawn as
to render either one of two inconsistent inferences possible of adoption, the
adoption of the one or the other would be nothing more than a guess.” Id.
In Mudano, the Court found the trial court should have granted a
compulsory non-suit, as the two experts presented by the plaintiff were so
contradictory regarding the cause of plaintiff’s injury as to neutralize each
other’s opinions.
In Brannon v. Lankenau Hospital, the plaintiff’s expert testified on
direct examination that the defendant’s conduct fell below the 1965 standard
of care. 417 A.2d 196 (Pa.1980). The next day on re-direct he stated he
could not answer whether the conduct fell below the standard of care, but
then re-affirmed, again on re-direct, that the conduct fell below the standard
of care. Id. at 200. The Supreme Court of Pennsylvania found a
compulsory non-suit not proper, reasoning the testimony was a “relatively
minor divergence in only a part of appellant’s expert testimony,” and “when
viewed against the testimony as a whole, [it did not] sufficiently
compromise[] the witness’ testimony on direct to justify removal of this
issue from jury consideration.” Id.
In Brodowski v. Ryave, this Court noted that “conflicts in [expert]
testimony are fatal only if absolute.” 885 A.2d 1045, 1060-61
(Pa.Super.2005) (quoting Brannan, 417 A.2d 200) (alteration in original).
The Court in Brodowski found no irreconcilable conflict where one expert
- 16 -
J-A06042-15
testified that Dr. Ryave breached the standard of care “by failing to admit
Plaintiff to a ‘proper place prior to his departure’ even though he had more
than two hours to do so,” for failing to effectuate the proper consultation
with a neurologist, and for failing to properly sign out to the oncoming ER
doctor. Id. at 1061. A second expert testified that Dr. Ryave “did a very
good job in his evaluation and assessment” of Plaintiff and Dr. Ryave “did a
good job in his evaluation, but something fell apart after he left. He was
meant to properly convey to the ER doctor who was taking over that this
patient needed to be admitted to the hospital for evaluation of stroke, but
something went awry at that point.” Id. The second expert also testified
that “part of [Dr. Ryave's] job was to . . . appropriately sign her out when he
left his shift at 7:00 p.m. There was clearly some kind of breakdown that
occurred at that point.” Id. This Court found:
The experts’ testimony did not present an irreconcilable
conflict such that the Mudano rule would apply to
neutralize their opinions with regard to Dr. Ryave’s care.
Both experts’ opinions were consistent in that Dr. Ryave
may not have properly signed out before his departure.
Moreover, although Expert Preston stated that Dr. Ryave’s
evaluation, assessment, and differential diagnosis were
proper, Expert Chamovitz did not specifically opine on
these issues but, rather, opined on issues of treatment
implementation. Overall, the two experts’ testimony did
not present a Mudano conflict and the trial court erred by
granting Dr. Ryave’s nonsuit on that basis.
Id. The Brodowski court, however, found an irreconcilable conflict with
regard to the expert testimony regarding a second defendant, Dr. Vagano.
One expert testified Dr. Vagano should have obtained a neurology consult
- 17 -
J-A06042-15
himself. Id. at 1061-62. A second expert, however, stated it would have
been a good idea to have the patient seen by a neurologist, but it was often
the attending doctor that decides upon a neurologist and it would not be Dr.
Vagano’s duty to obtain the consult. Id.
Here, Appellants’ expert reports did not contain irreconcilable conflicts.
The experts opined that Dr. Covington, as a surgeon, deviated from the
standard of care when he provided his consultation by phone, without
examining the patient, and Dr. Cornish, as an emergency room physician,
deviated from a standard of care when he relied on the telephone
consultation. Nothing would preclude a jury from relying on the experts’
testimony to find Dr. Covington, Dr. Cornish, or both, deviated from
standards of care.
Order reversed. Case remanded. Jurisdiction relinquished.
Judgment Entered.
Joseph D. Seletyn, Esq.
Prothonotary
Date: 4/13/2015
- 18 -