DISSENTING OPINION BY
Judge SMITH-RIBNER.I dissent from the majority’s decision to affirm the order of the Court of Common Pleas of Cumberland County. The trial court sustained Appellees’ preliminary objections and dismissed Appellants’ nine-count complaint raising claims of civil rights violations, a failure to protect Appellant Seth Fitzgerald Robbins, a minor, and an infliction of emotional distress in connection with permanent injuries caused by the minor child’s biological mother. I also disagree with the majority that this case must be strictly construed under the rubric of DeShaney v. Winnebago County Department of Social Services, 489 U.S. 189, 109 S.Ct. 998, 103 L.Ed.2d 249 (1989), among other cases, and that Appellants do not have viable state-related causes of action against Appellees. The majority has denied Appellants their right to have the facts of their case determined by a reasonable jury, not by this Court.
In DeShaney the United States Supreme Court held that the state had no constitutional duty to protect a child from his father after the state had received reports of the father’s abuse. The court denied the child’s civil action under 42 U.S.C. § 1983 against social workers and local officials who received complaints that the child was abused but failed to take any action to remove the child.1 The court reasoned that the Due Process Clause of the Fourteenth Amendment imposes no affirmative obligation on the state to protect life, liberty or property of a citizen against invasion by a private actor. Moreover, while the state may have been aware that the child was in danger no special relationship existed between the child and the state, which played no role in creating the danger that the child faced nor did anything to render the child more vulnerable to the danger.
Appellants request this Court to reject a strict reliance upon DeShaney and to apply exceptions to the general rule that the Due Process Clause provides no basis for a Section 1983 cause of action. Those exceptions provide that a duty to protect may arise out of certain special relationships between the state and the injured child or when a state-created danger or risk of harm exists which causes injury to the plaintiff. Kneipp v. Tedder, 95 F.3d 1199, 1208 (3d Cir.1996). Unlike the majority, I am convinced that the state-created danger theory should be applied to Appellants’ case, which imposes liability under Section 1983 for acts committed by a private citizen when the danger or risk of harm causing the plaintiffs injury was created by the state. The Kneipp court agreed that De-Shaney left open the possibility that a constitutional violation may occur despite the absence of a special relationship. The court enunciated a four-part state-created danger test that a plaintiff must meet to prevail:
(1) the harm ultimately caused was foreseeable and fairly direct; (2) the state actor acted in willful disregard for the safety of the plaintiff; (3) there existed some relationship between the state and *1255the plaintiff; (4) the state actors used their authority to create an opportunity that otherwise would not have existed for the third party’s crime to occur.
If properly analyzed under the Kneipp test the facts as averred demonstrate, first, that the reasoning in DeShaney for denying relief does not apply. The Supreme Court decided the case strictly on a special relationship test, which I agree does not apply here, and at no time did the court foreclose relief under the state-created danger theory when appropriate factual circumstances exist. It did not rule that a special relationship is a prerequisite to state liability in all cases of injury due to private violence. Second, if believed by a jury, the facts as averred demonstrate that the harm suffered by Seth was foreseeable and direct, that state actors acted in a willful disregard for the child’s safety, that some relationship existed between the state and the child and that state actors used their authority to create an opportunity for Seth’s mother to abuse him. That opportunity otherwise would not have existed but for the state actors’ conduct.
An analogous situation was presented in Ford v. Johnson, 899 F.Supp. 227 (W.D.Pa.1995), aff'd, 116 F.3d 467 (3d Cir.1997). The District Court for the Western District of Pennsylvania denied the CYS defendants’ motion to dismiss a civil action filed by a biological mother arising out of the death of her two-year-old child, Shawntee Ford. The child was beaten to death by her father after he was granted custody by the family court in Allegheny County. The district court held that where CYS takes affirmative action to remove a child from a parent and then returns the child to the same household and the parent thereafter inflicts injury, CYS has created a danger that would not have otherwise existed. According to the court: “The fact that the child is placed with a parent as opposed to a foster parent should not change the standards by which social agencies and their employees conduct their investigations.” Ford, 899 F.Supp. at 233. The complaint averred that CYS faded to investigate the father’s circumstances and to report known information, which would have disqualified him from regaining custody of the child.
The district court in Ford adopted the state-created danger theory, which permitted the plaintiff to prove liability against the CYS defendants if she could establish that state actors created a dangerous environment, knew that it was dangerous and used their authority to create an opportunity otherwise unavailable for a third party to commit a crime. Evidence must exist to show the defendants’ indifference to the child’s conditions. Id. The reasoning and holding in Ford are particularly persuasive here where Seth clearly was under CYS’ authority and supervision by virtue of the agency’s open case files on the family and the affirmative duty on CYS to monitor, supervise and investigate what went on in the' child’s home after it acquired information about the series of abuses perpetrated against Seth and his brothers, their hospitalizations and the death of Seth’s oldest brother Stephen. See also Currier v. Doran, 242 F.3d 905 (10th Cir.2001) (citing Ford, among other cases, the court applied the state-created danger theory and held that state officials may be liable for injuries caused by private actors when the officials create danger that leads to harm).
CYS only made three scheduled visits to the Fitzgerald home before Susan Fitzgerald was ultimately arrested for murdering Stephen. Once CYS intervened in March of 1995, it assumed an affirmative duty to protect Seth and to put Susan Fitzgerald on notice that her behavior and the care of her children would be monitored and investigated. Seth was again injured on *1256September 12, 1995 when his mother tried to suffocate him. CYS was scheduled to make a home visit that day but allowed Susan Fitzgerald to cancel the home visit despite CYS’s knowledge of Stephen’s death on August 29. CYS had authority to monitor and to investigate the mother’s care of her children, and it was CYS’ conduct and indifference to this responsibility, which created a known dangerous environment for Seth leading up to his sustaining permanent injuries at the hands of his mother.
Next, I note that the act commonly known as the Political Subdivision Tort Claims Act, 42 Pa.C.S. §§ 8541-8564, grants general immunity to employees of the local agency if an employee acting within the scope of his or her duty causes an injury to a person or to property. 42 Pa.C.S. § 8541. However, an individual employee is not protected from liability for “acts that are judicially determined to be a crime, actual fraud, actual malice or willful misconduct.” 42 Pa.C.S. § 8550. Under the facts averred, Ms. Runyon and CYS acted with a willful disregard of their duties and for the safety and welfare of Seth when dealing with Seth’s circumstances. In Ford the court applied the definition of willful disregard as reckless, willful or wanton misconduct, see 42 Pa. C.S. § 8836(d), and it followed this definition when denying CYS’ motion to dismiss based on governmental immunity. The court construed the plaintiffs allegations against CYS defendants as acts constituting willful misconduct which barred their claims of immunity.
There is every possibility that a jury may determine that CYS employee behavior amounted to willful, reckless or wanton misconduct. CYS failed to request medical records of the Fitzgerald children until after Stephen was murdered by his mother. In February of 1995 CYS received a child abuse referral from a physician after Stephen suffered a forearm fracture, but it closed the case file after only a cursory and inadequate review. Over the next three months, all three of Susan Fitzgerald’s children suffered serious and severe injuries, including fractures, concussions and laceration to the head, closed head injury and contusions and abrasions requiring hospitalizations. CYS reopened its file and again closed it in June of 1995 after determining that suspicions surrounding the children’s injuries were invalid and that it had no duty to proceed further despite such overwhelming evidence of child abuse. The injuries to Seth and his brothers continued, but CYS allowed Seth to remain with his mother without taking reasonable or proper action to protect the child. Finally CYS allowed the mother to cancel CYS’ scheduled home visit on September 12, 1995, less than two weeks after Stephen’s death.2
*1257When viewed in the light most favorable to Appellants, the facts as averred, if proved at trial, support the conclusion that Appellants have plead viable causes of action and that the trial court erred in granting the preliminary objections. This case is not about whether judges or attorneys may be “moved by natural sympathy” to identify ways to compensate an injured litigant. DeShaney. Rather the singular and fundamental issue before the Court is whether Appellants have sufficiently averred facts entitling them to recover damages for the permanent injuries suffered by Seth in a known dangerous environment. It is for the jury to decide, among other factors, whether the facts presented constitute state actors’ willful disregard for Seth’s safety and constitute a known dangerous condition created by state actors. See e.g. Armstrong v. Squadrito, 152 F.3d 564 (7th Cir.1998) (whether an actor’s conduct constitutes deliberate indifference is for the fact finder to determine). The order of the trial court should be reversed, and this case should be remanded for trial.
Judge FRIEDMAN joins in this dissenting opinion.
. The petitioner’s Section 1983 cause of action alleged that the respondents deprived the child of his substantive rights under the Due Process Clause of the Fourteenth Amendment by failing to protect him against his father's abuse. Although custody was initially withheld, the court returned the child to his father after two doctors, a police detective, social service caseworkers, hospital personnel and the county attorney jointly determined that because insufficient evidence of child abuse existed, the child could no longer remain in the court’s custody, particularly where in this instance the father denied any abuse.
. As for whether a cause of action for the intentional infliction of emotional distress may be entertained, I note that Appellees' conduct may be characterized at best as extreme and outrageous and that Appellants have set forth a viable cause of action for intentional infliction of emotional distress. Appellants cite Hunger v. Grand Central Sanitation, 447 Pa.Super. 575, 670 A.2d 173 (1996), where the Superior Court set forth the applicable standard in determining a cause of action for intentional infliction of emotional distress. A plaintiff must prove that the defendant’s conduct was extreme and outrageous and that the plaintiff suffered a medically confirmed injury. Appellees rely on Armstrong v. Paoli Memorial Hospital, 430 Pa.Super. 36, 633 A.2d 605 (1993) (citing Kazatsky v. King David Memorial Park, Inc., 515 Pa. 183, 527 A.2d 988 (1987)), for the proposition that Pennsylvania has not adopted the cause of action of intentional infliction of emotional distress as defined in the Restatement. In Kazatsky the court held that in order to prevail on an intentional infliction of emotional distress cause of action the plaintiff must provide competent medical *1257evidence to prove the existence of emotional distress. The court neither adopted nor rejected Section 46 of the Restatement (Second) Torts but merely stated what the plaintiff’s burden should be if Section 46 were accepted. See Hoy v. Angelone, 554 Pa. 134, 720 A.2d 745 (1998) (holding that the factor of retaliation is a consideration in recovering for intentional infliction of emotional distress in a sexual harassment case).
Furthermore, I agree that punitive damages are a form of relief and are not a separate cause of action. Appellants acknowledge that they erroneously pleaded punitive damages as a cause of action. According to Brennan v. National Telephone Directory Corp., 850 F.Supp. 331 (E.D.Pa.1994), if a plaintiff asserts punitive damages in a separate cause of action, the plaintiff should be granted leave to replead her claim for punitive damages as an appropriate substantive claim for damages.