J-A28033-15
NON-PRECEDENTIAL DECISION - SEE SUPERIOR COURT I.O.P. 65.37
QUADINA BONILLA, IN THE SUPERIOR COURT OF
PENNSYLVANIA
Appellant
v.
JEANES HOSPITAL,
Appellee No. 193 EDA 2015
Appeal from the Judgment Entered February 4, 2015
In the Court of Common Pleas of Philadelphia County
Civil Division at No(s): 05051 January Term, 2012
BEFORE: GANTMAN, P.J., PANELLA, and SHOGAN, JJ.
MEMORANDUM BY SHOGAN, J.: FILED: January 21, 2016
Appellant, Quadina Bonilla, appeals from the judgment entered on
February 4, 2015, in favor of Jeanes Hospital in this medical malpractice
case. After careful consideration, we reverse and remand this matter for a
new trial.
The trial court summarized the factual and procedural history of this
case as follows:
[Appellant] brought this medical malpractice action against
[Jeanes Hospital] alleging that the care provided to her in its
emergency department on February 23, 2010 was negligent in
that its staff failed to diagnose and treat cauda equina
syndrome, resulting in permanent neurologic deficits.
[Appellant] alleged, inter alia, that [Jeanes Hospital’s]
emergency department staff breached the standard of care in
failing to properly diagnose and treat after she reported pelvic
numbness, the lack of sensation when urinating, and the lack of
feeling the urgency to urinate.
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At trial, [Jeanes Hospital] argued that [Appellant] never
made such a report and that they did not breach the standard of
care. They also presented a surveillance video which showed
[Appellant] climbing the steps of her home while carrying
shopping bags and climbing in and out of an automobile she was
operating to pump gas. Armed with this video and her medical
records, [Jeanes Hospital] suggested alternatively that
[Appellant] either did not have cauda equina syndrome at the
time she was seen by emergency department personnel, or that
if she did have such ailment, its onset had occurred prior to her
presentation and that any opportunity to address this malady
had already passed. Furthermore, [Jeanes Hospital] argued that
[Appellant] had significantly exaggerated the extent of her
disability.
[Jeanes Hospital] relied to a significant extent on the fact
that on February 21, 2010, two days prior to her presentation to
Jeanes Hospital, [Appellant] had visited St. Luke’s Hospital with
complaints of pain in her low back that were almost identical to
the complaints of low back pain that she alleged to have made in
[Jeanes Hospital’s] emergency department on February 23,
2010. All of the parties agreed that cauda equina syndrome was
a condition that required immediate surgical intervention within
hours of [Appellant] experiencing symptoms, and that if
immediate intervention did not occur, the condition would
become permanent and irreversible. [Appellant] was ultimately
not able to meet her burden of proof by a preponderance of
evidence that [Jeanes Hospital’s] proven negligence was the
factual cause of the harm suffered by [Appellant]. Critical to the
jury’s determination was [Jeanes Hospital’s] argument that if
[Appellant] did have cauda equina syndrome, it had become
irreversible by the point in time that she presented to its
emergency department on February 23, 2010.
During trial, the parties became involved in an evidentiary
dispute that formed the factual nexus for the appeal filed by
[Appellant]. This dispute concerned a document that the parties
referred to as the Extended Discharge Instruction. Counsel for
[Appellant] admitted to receiving a summary of the discharge
instruction during discovery; however, he alleged that the
Extended Discharge Instruction was not produced in response to
his request for production of documents. As a result of review
for this appeal, Counsel for [Jeanes Hospital] agreed that it failed
to produce the Extended Discharge Instruction in the proper
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course of discovery. . . . [Jeanes Hospital’s] Counsel admitted
that he had not personally provided the document in question
but believed [Appellant’s] Counsel had received the documents
through some other means and, therefore, sought to introduce
the Extended Discharge Instruction and offer it into evidence
before the jury.
Trial Court Opinion, 5/8/15, at 1-3.
After discovering that the extended discharge instructions had not
been disclosed prior to trial, Appellant made a motion for a mistrial on the
basis that introduction of this document “severely” prejudiced Appellant’s
case. N.T., 6/11/14, at 84. The trial court denied that motion for mistrial.
Id. at 93-94. The jury issued a verdict in favor of Jeanes Hospital on June
20, 2014. Appellant filed a post-trial motion on June 30, 2014, seeking a
new trial. By order entered November 26, 2014, the trial court denied
Appellant’s post-trial motion. Appellant filed a notice of appeal on December
26, 2014.1 Pursuant to a praecipe for entry of judgment, judgment was
entered on February 4, 2015. Both Appellant and the trial court complied
with Pa.R.A.P. 1925.
Appellant presents the following issue for our review:
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1
Appellant’s notice of appeal indicates that she is appealing from the
November 26, 2014 order denying her post-trial motion. We note that an
order denying post-trial relief is interlocutory and generally not appealable
unless it is reduced to judgment. Dominick v. Hanson, 753 A.2d 824, 825
n.1 (Pa. Super. 2000). However, judgment in this case was entered by
order dated February 4, 2015; therefore, we will consider the appeal filed
after the entry of judgment. Id.; Pa.R.A.P. 905(a). This date is properly
reflected in the appeal paragraph.
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Whether the trial court’s order denying post-trial relief should be
vacated, with instructions to enter a mistrial as previously
requested by [Appellant], because Jeanes’ use of the Phantom
Discharge Instructions subjected [Appellant] and her experts to
“trial by ambush,” violated the Pretrial Order, and allowed
Jeanes to unfairly attack the credibility of [Appellant] and her
counsel. The trial court’s refusal to declare a mistrial in
response to these circumstances was “manifestly unreasonable.”
Appellant’s Brief at 2-3.
Appellant argues that Jeanes Hospital failed to produce the extended
discharge instructions, which she refers to as the “phantom discharge
instructions,” during discovery but then inappropriately introduced them at
trial. Appellant’s Brief at 18. Appellant maintains that upon discharge from
Jeanes Hospital, she was presented with summary discharge instructions,
which she refers to as her “actual discharge instructions.” Id. at 22. These
discharge instructions were produced by Jeanes Hospital during discovery
and were Bates-stamped, along with all trial exhibits to which the parties
stipulated, prior to trial. Id. at 22. Appellant’s “actual discharge
instructions” did not include a warning to seek immediate medical attention
if certain symptoms presented themselves, but such warning was included
on the extended discharge instructions. Id. at 23.2 Appellant asserts that
Jeanes Hospital improperly presented these extended discharge instructions
during trial, despite the admission by Jeanes Hospital’s counsel that he had
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2
Appellant maintains that the fact that her signature is on the “actual
discharge instructions,” but not on the extended discharge instructions, is
proof that she received only the summary discharge instructions. Id. at 26.
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not provided the extended discharge instructions to Appellant during
discovery or at any time prior to trial. Id.
Furthermore, Appellant contends that the extended discharge
instructions were directly related to the issue of causation. Appellant’s Brief
at 19-20. In his closing, Jeanes Hospital’s counsel argued that Appellant
was responsible for her injuries due to her failure to seek medical attention
for symptoms despite receiving detailed extended discharge instructions
directing her to seek such immediate medical attention. Id. at 19-20.
Appellant maintains that Jeanes Hospital invited the jury to conclude that
Appellant was to blame for having cauda equina syndrome as a result of
failing to obey these detailed discharge instructions. Id. at 21. Thus,
Appellant argues that introduction of this evidence unfairly prejudiced her
position. Id.
Additionally, Appellant posits the use of these undisclosed extended
discharge instructions negatively impacted the testimony of Appellant’s
expert witness, Physician’s Assistant (“PA”) Johanna Moore. Appellant’s
Brief at 21. Based on the extended discharge instructions presented to her
during cross-examination, PA Moore conceded that the instructions satisfied
the standard of care required of Jeanes Hospital and that her previous
opinion to the contrary was “wrong.” Id. at 21, 29. Appellant contends this
concession and reversal of expert opinion negatively impacted her case. Id.
at 21, 29. Thus, Appellant maintains that she was prejudiced by
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introduction at trial of the extended discharge instructions and, accordingly,
is entitled to a new trial. Id. at 20-21.
Before reaching the merits of Appellant’s issue, we must first address
whether Appellant has waived her claim. The trial court concluded that
Appellant waived this claim by failing to object to Jeanes Hospital’s counsel’s
introduction of the extended discharge instruction at trial and provided the
following explanation for its decision:
This [c]ourt refused to grant a mistrial and denied
[Appellant’s] motion for post-trial relief because she failed to
make a timely specific objection to the introduction of the
Extended Discharge Instruction at trial.
***
[Appellant’s] motion to preclude the Extended Discharge
Instruction and the motion for mistrial were made at a point in
the trial where few viable, realistic options were available other
than to give a curative instruction and provide [Appellant] with
the opportunity to offer rebuttal evidence. This [c]ourt was not
involved in the discovery process, and it knew nothing about
[Jeanes Hospital’s] production of the various discharge
instructions. By the time [Appellant] brought this matter to the
attention of this [c]ourt, there was no way to preclude the
content of the Extended Discharge Instruction because its
content had been placed before the jury without objection on
June 10th during the cross-examination of [Appellant] and Dr.
Weihl. The discharge instruction was again introduced without a
clear specific objection to its content on June 11th during the
cross-exam of Johanna Moore, PA-C. This [c]ourt was unable to
prevent what had already occurred; it was impossible to
preclude what the jury had already seen and heard.
In all fairness, this [c]ourt could not grant [Appellant’s]
motion for mistrial because this case was in its fourth day of trial
and there was no showing of intentional misconduct on the part
of [Jeanes Hospital]. [Jeanes Hospital’s] Counsel averred that
any failure on their part to produce the Extended Discharge
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Instruction was inadvertent. It would have been unfair to force
[Jeanes Hospital] to incur the expense and inconvenience of a
second trial in a situation where [Appellant] completely failed to
object until after the content of the discharge instruction was
placed into evidence.
Trial Court Opinion, 5/8/15, at 8-9 (internal citation omitted).
This Court has provided the following explanation with regard to
waiver on this basis:
In 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 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. In this
jurisdiction [. . .] one must object to errors, improprieties or
irregularities at the earliest possible stage of the adjudicatory
process to afford the jurist hearing the case the first occasion to
remedy the wrong and possibly avoid an unnecessary appeal to
complain of the matter.
Hong v. Pelagatti, 765 A.2d 1117, 1123 (Pa. Super. 2000) (internal
citations omitted).
As noted, the trial court asserted that the content of the extended
discharge instructions was placed before the jury on June 10, 2014, during
the cross-examination of Appellant and one of Appellant’s expert witnesses,
Dr. Weihl, without objection. A review of the transcript reveals that instead
of Jeanes Hospital’s counsel physically producing the extended discharge
instructions during examination of these witnesses, Jeanes Hospital’s counsel
simply referred to the content of a set of discharge instructions. Specifically,
defense counsel questioned Appellant as to whether she remembered getting
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“discharge instructions from Jeanes Hospital.” N.T., 6/10/14, at 68.
Appellant agreed that she had received discharge instructions. Id. at 68-70.
As noted, however, the discharge instructions to which counsel referred were
not presented to Appellant for her review. Id.
Jeanes Hospital’s counsel also questioned Appellant’s expert, Albert
Weihl, M.D., about what he described as “very, very detailed extended
instructions” Appellant received upon discharge from Jeanes Hospital. N.T.,
6/10/14, at 191. Dr. Weihl testified that he was aware that Appellant
received instructions upon her discharge from Jeanes Hospital. Id. Again,
defense counsel did not present the discharge instructions to Dr. Weihl for
review during this line of cross-examination. Id. at 191-192.
Because neither Appellant nor Dr. Weihl was physically presented with
the discharge instructions to which defense counsel was referring,
Appellant’s counsel and the witnesses had no opportunity or reason to view
the instructions Jeanes Hospital’s counsel had referenced. As such, the
discharge instructions as referenced by Jeanes Hospital’s counsel during
cross-examination of these two witnesses could be interpreted to have been
references to the discharge instructions Appellant received upon discharge.
Therefore, we cannot conclude that it was clear to the witnesses, the jury, or
Appellant’s counsel that by referring to “discharge instructions,” defense
counsel was referring to the extended discharge instructions, as opposed to
the summary instructions Appellant admitted receiving upon discharge from
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the hospital. As a result, we cannot agree with the trial court that
Appellant’s counsel waived his objection to introduction of the extended
discharge instructions because he failed to object to reference of these
instructions during cross-examination of Appellant and Dr. Wiehl.
The first time the extended discharge instructions were physically
introduced was on the third day of trial during cross-examination of
Appellant’s expert witness, PA Johanna Moore. N.T., 6/11/14, at 53. The
record reflects that during cross-examination of PA Moore, Jeanes Hospital’s
counsel showed her the extended discharge instructions. Id. When shown
a page of the extended discharge instructions, PA Moore indicated that she
had not seen that page before.3 N.T., 6/11/14, at 53. Appellant’s counsel
questioned where that page was located in the medical record. Id. Jeanes
Hospital’s counsel indicated it was from the discharge instructions. Id. at
54. Appellant’s counsel further asked if the document was Bates-stamped,
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3
This discharge instruction included the following statement:
Seek immediate medical attention if you have numbness,
tingling, weakness or problems with your use of your arms or
your legs, you experience severe back pain not relieved with
medications, there is a change in bowel or bladder control, you
have increasing pain.
N.T., 6/11/14, at 56.
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and defense counsel responded that it was not.4 Id. The court directed
defense counsel to show Appellant’s counsel the document, and then
directed Jeanes Hospital’s counsel to proceed. Id. Jeanes Hospital’s counsel
continued with a few more questions, at which point, Appellant’s counsel
stated, “Objection, Your Honor.” Id. at 55. The trial court overruled the
objection. Id. at 56.
After the court dismissed the witness, Appellant’s counsel indicated to
the court that he wanted to “put something on the record.” Id. at 78. At
that point, Appellant’s counsel indicated that the discharge instructions
shown to the witness had not been produced during discovery. Id. at 79.
The trial court questioned Appellant’s counsel as to why he did not ask for a
sidebar so that the issue could have been addressed. Id. at 79. Appellant’s
counsel indicated that he was not certain that the document had not been
produced until he had an opportunity to review the voluminous record. Id.
at 79.
Given the surrounding circumstances, we conclude that the basis of
Appellant’s counsel’s objection was apparent. As soon as the document was
provided to PA Moore, Appellant’s counsel questioned the source of the
document and why it was not Bates-stamped. The basis of the objection
was apparent to the trial court as evidenced by the trial court’s failure to
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4
The parties had stipulated to the exhibits to be used at trial and had the
documents Bates-stamped. N.T., 6/11/14, at 84.
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inquire as to the basis of Appellant’s objection before overruling it. N.T.,
6/11/14, at 55-56. Thus, under the circumstances of this case, we decline
to find that Appellant waived this claim. Accordingly, we are constrained to
conclude that the trial court erred in determining that Appellant failed to
preserve this issue.
Thus, we shall address the merits of Appellant’s claim. In reviewing a
trial court’s decision to deny a request by a party for a mistrial, we will
reverse only if the trial court committed an abuse of discretion or legal error
in denying the request. Gorski v. Smith, 812 A.2d 683, 712-713 (Pa.
Super. 2002).
In reviewing a trial court’s denial of a motion for a new trial, the
standard of review for an appellate court is as follows:
It is well-established law that, absent a clear abuse
of discretion by the trial court, appellate courts must
not interfere with the trial court’s authority to grant
or deny a new trial.
***
Thus, when analyzing a decision by a trial court to
grant or deny a new trial, the proper standard of
review, ultimately, is whether the trial court abused
its discretion.
Moreover, our review must be tailored to a well-settled, two-part
analysis:
We must review the court’s alleged mistake and
determine whether the court erred and, if so,
whether the error resulted in prejudice necessitating
a new trial. If the alleged mistake concerned an error
of law, we will scrutinize for legal error. Once we
determine whether an error occurred, we must then
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determine whether the trial court abused its
discretion in ruling on the request for a new trial.
Gurley v. Janssen Pharms., Inc., 113 A.3d 283, 288–89 (Pa. Super.
2015).
With regard to discovery disputes, we have explained:
Preliminarily, we note the “‘[t]he purpose of the discovery
rules is to prevent surprise and unfairness and to allow a fair
trial on the merits.’” Pennsylvania Rule of Civil Procedure 4019
provides for sanctions if a party fails to provide discovery. “The
decision whether to sanction a party, and if so the severity of
such sanction, is vested in the sound discretion of the trial
court.” When a court refuses to impose sanctions, we must
review the evidence to determine whether the court abused its
discretion.
Dominick v. Hanson, 753 A.2d 824, 826 (Pa. Super. 2000) (internal
citations omitted). According to Pa.R.C.P. 4019, a trial court may “make an
appropriate order” if a party “fails to make discovery or to obey an order of
court respecting discovery.” Pa.R.C.P. 4019(a)(1)(viii). “[T]he decision
whether to sanction a party for a discovery violation and the severity of such
a sanction are matters vested in the sound discretion of the trial court.”
Philadelphia Contributionship Ins. Co. v. Shapiro, 798 A.2d 781, 784
(Pa. Super. 2002). When a court refuses to impose sanctions, we must
review the evidence to determine whether the court abused its discretion.
Dominick, 753 A.2d at 826. This Court has held that when a party has
failed to produce evidence during discovery, an appropriate sanction is
prohibiting admission of the evidence at trial. Duncan v. Mercy Catholic
Med. Ctr. of Southeastern Pa., 813 A.2d 6, 12 (Pa. Super. 2002).
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During discovery in this case Appellant requested any documents
related to Appellant’s medical treatment at Jeanes Hospital. Appellant’s
post-trial motion, Exhibit D (Letter, 6/24/10); Exhibit E (Letter, 7/27/10);
and Exhibit F (Letter, 8/12/10); Appellant’s first set of interrogatories, at ¶¶
37, 43. Appellant also requested that Jeanes Hospital list and identify all
exhibits and documents it intended to use at trial. Appellant’s first set of
interrogatories at ¶ 48. Jeanes Hospital answered, indicating that it had
produced a complete record of Appellant’s hospital records. Exhibit H,
Appellant’s interrogatories (first set), with Jeanes Hospital’s answer, at ¶ 43.
It further reserved the right to supplement its answer to the interrogatory
asking for identification of documents or evidence to be produced at trial.
Id. at ¶ 48. However, it is undisputed that the extended discharge
instructions used by Jeanes Hospital on the third day of trial were not
provided to Appellant during discovery or at any time prior to trial. 5 Thus,
admission of these extended jury instructions at trial violated the purpose of
the discovery rules, which is to “prevent surprise and unfairness and to allow
a fair trial on the merits.” Dominick, 753 A.2d at 826. Accordingly, we
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5
During argument on Appellant’s post-trial motion, Jeanes Hospital’s counsel
admitted that he did not produce the extended discharge instructions to
Appellant’s counsel. N.T., 10/30/14, at 54-55. Jeanes Hospital’s counsel
alleged: “As a matter of fact, I didn’t have the extended instructions until
the morning [Appellant] testified.” Id. at 55.
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conclude that the extended discharge instructions should not have been
admitted at trial.
This determination, however, constitutes only part of the requisite
analysis. We must also determine whether admission of this evidence
prejudiced Appellant. “It is axiomatic that ‘the...admission of evidence, even
if erroneous, is not considered a ground for a new trial where no harm or
prejudice has resulted.’” Duncan, 813 A.2d at 12.
In order to find that the trial court’s evidentiary rulings
constituted reversible error, such rulings must not only have
been erroneous but must also have been harmful to the
complaining party. Appellant must therefore show error in the
evidentiary ruling and resulting prejudice, thus constituting an
abuse of discretion by the lower court. Based upon such
showing, our only remedy is to grant a new trial. When
improperly admitted testimony may have affected a verdict, the
only correct remedy is the grant of a new trial.
Collins v. Cooper, 746 A.2d 615, 619-620 (Pa. Super. 2000) (internal
citations and quotation marks omitted) (emphasis in original).
In this case, we are constrained to conclude that the improperly
admitted extended discharge instructions indeed may have affected the
verdict. As the trial court identified, defense counsel referred to the
extended discharge instructions in his cross-examination of two of
Appellant’s witnesses. Reference to “discharge instructions” was confusing
in that there were two separate sets of discharge instructions, which fact
came to light after these witnesses testified. Thus, reference to “discharge
instructions” had been made throughout trial without distinction between
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those that Appellant admitted she actually received, and those extended
discharge instructions that were not produced by Jeanes Hospital. There
was no way to go back and clarify the witness’s testimony or the jury’s
understanding regarding the different discharge instructions.
Furthermore, Jeanes Hospital’s counsel posited that Appellant arguably
caused her injuries by failing to heed the warning to seek immediate medical
help as stated on the extended discharge instructions. Jeanes Hospital’s
counsel made the following argument during his closing:
I’m going to suggest to you that the truth in this case is
that the responsibility for Ms. Bonilla’s injuries, the problem does
not lie with Jeanes Hospital. Her problems, her disc was not
caused by Jeanes Hospital. The conduct of Jeanes Hospital did
not increase the risk of harm. The case presented by [Appellant]
when you take out all of the frills, you stop nicking around the
edges and you focus on the real issues, the real medicine,
confirms what we have said all along from day one.
[Appellant] did not come to Jeanes Hospital with Cauda
Equina Syndrome. [Appellant] never made complaints of
bladder problems, saddle anesthesia, or the inability to feel the
urgency to urinate to anyone at Jeanes Hospital or before as she
claims.
Still, [Appellant] has somehow tried to manufacture a case
to develop a theory against the very emergency medicine staff
that made the correct diagnosis, instituted appropriate course of
treatment, made appropriate standard of care recommendations.
All [Appellant] had was back pain with radiculopathy. The
sad reality is [Appellant] is a very poor historian. She has also
shown a pattern and history of not following recommendations.
That’s the truth.
I’m not picking on [Appellant], but it is a fact. We know
she was discharged from Jeanes Hospital with detailed
discharge instructions. You saw them. Her true symptoms,
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Cauda Equina did not become apparent, by her own sworn
deposition and her own sworn trial testimony until several days
after she left Jeanes Hospital. The testimony is that she
developed increased pain, total numbness from the waist down
and total urinary incontinence around February 28th.
That was the moment. That was what the record says.
Despite this, she didn’t seek medical attention. She didn’t call
911. She didn’t get any help from anyone. She told us that the
reason that she didn’t do that is because she had an
appointment with Dr. Weinik on March 2nd. That’s just
incredible.
We heard that term subjective and objective. You may
remember my example, I had with Dr. Noble yesterday. I’m not
going to repeat it, but [Appellant] provided a subjective history
on March 2nd at Temple. There’s no doubt she’s a poor
historian.
There was no consistency in her history, no reliability in
much of what she had to say. That’s [Appellant’s] standard of
care. Is it negligence? I don’t know. That’s up for you to
decide. Did it cause or contribute to her ultimate injury? I
suggest that it did.
N.T., 6/18/14, at 52-55 (emphasis added).
In light of Jeanes Hospital’s argument that Appellant caused her
injuries by not seeking immediate medical help, introduction of the extended
discharge instructions directing Appellant to seek medical attention
immediately if she experienced certain symptoms, and Appellant’s failure to
do so, may have affected the verdict. Thus, Appellant was prejudiced by
introduction of and reference to the extended discharge instructions.
Additionally, Appellant’s expert witness PA Moore’s concession that her
prior opinion that the hospital had not met the required standard of care had
been erroneous, based on her review of the extended discharge instructions,
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may also have affected the verdict. Although the trial court denied
Appellant’s motion for a mistrial, it did acknowledge the damage done to
Appellant’s case by this concession:
[T]hat specific document that you confronted Ms. Moore
with, I’m not sure that [Appellant] was confronted with that
document.
We have a little conundrum here. [Appellant’s counsel]
said he never received that document. [Jeanes Hospital was]
able, unfortunately, to secure what might be considered a major
concession that [Jeanes Hospital] might not have been entitled
to because the assumption by Ms. Moore, when she made that
concession, is that [Appellant] had, in fact, received that
document and we don’t know that to be true.
So, how do I uncook that apple? I’ll give you some time to
think about it. Again, I’m not suggesting that you did anything
wrong. However, if [Appellant] never received that document,
then Ms. Moore’s concession was inappropriate and you are not
entitled to that concession if [Appellant’s counsel’s] assertion is
true.
N.T., 6/11/14, at 82.
Furthermore, we cannot agree with the trial court’s conclusion that the
admission of the extended discharge instructions was irrelevant to the jury’s
finding on the issue of causation. The trial court explained that:
Although the jury found [Jeanes Hospital] was negligent in its
provision of care to [Appellant], it also found that this negligence
did not cause [Appellant] any harm. [Appellant] objected to the
introduction of the Extended Discharge Instruction during the
cross-examination of her liability expert, and the Extended
Discharge Instruction was primarily relevant to the issue of
[Jeanes Hospital’s] negligence which was decided in [Appellant’s]
favor. Therefore, any error committed by this [c]ourt on this
issue should be considered harmless because the evidence at
issue was not relevant to the issue of causation.
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Trial Court Opinion, 5/8/15, at 10-11.
While we agree that the jury found Jeanes Hospital negligent in its
provision of care to Appellant, we cannot agree with the trial court’s
conclusion that admission of the extended discharge instruction was
irrelevant to the issue of causation. Indeed, the jury concluded that Jeanes
Hospital’s negligence did not cause Appellant any harm. However, it is
possible that the jury’s determination on this issue was influenced by its
belief that Appellant was the cause of her injuries for failing to follow the
instructions to seek immediate medical help. Thus, we conclude that the
admission of the extended discharge instructions was relevant to the issue of
causation. Accordingly, improper admission of the evidence was not
harmless error and resulted in prejudice to Appellant.
While impossible to discern exactly the impact use of this evidence had
on the jury’s verdict, we are constrained to conclude that improper
admission of this evidence may have influenced the jury. As such, the trial
court abused its discretion in failing to grant a new trial. Collins, 746 A.2d
at 620 (“When improperly admitted testimony may have affected a verdict,
the only correct remedy is the grant of a new trial.”)(emphasis in original).
We note the trial court’s position that any prejudice was cured by the
court’s action of providing the jury with a copy of the extended discharge
instruction along with a curative instruction addressing the discovery
dispute. Trial Court Opinion, 5/8/15, at 7. The trial court also offered to
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allow Appellant the opportunity to take the stand for a second time to testify
that she never received the extended discharge instructions, but Appellant’s
counsel declined that offer. Id.
Despite the trial court’s attempts, we cannot agree that these steps
cured the prejudice to Appellant’s case. The curative instruction was not
sufficient to clarify the confusion created throughout trial regarding the
“discharge instructions” and the fact that there were two separate sets of
discharge instructions, only one of which included the warning for Appellant
to seek immediate medical care. Additionally, while we need not comment
upon Appellant’s counsel’s strategic decisions, we cannot agree that if
Appellant had taken the stand to clarify the issue regarding the extended
discharge instructions, such action would have been sufficient to remedy the
prejudice caused to Appellant by introduction of the extended discharge
instructions. Accordingly, we cannot agree that the trial court’s curative
attempts negate the need for a new trial.
Judgment reversed. Case remanded for new trial. Jurisdiction
relinquished.
Judgment Entered.
Joseph D. Seletyn, Esq.
Prothonotary
Date: 1/21/2016
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