GOLD,BUTKOVITZ&ROBINS,P.C. ATTORNEYFORDEFENDANT, BY:ALANS.GOLD JOHNF.McCORMICK,M.D. ATTY.ID.NO. 23400 BY:SEANROBINS ATTY.ID.NO.68828 7837OLDYORKROAD ELKINS PARK,PA19027 (215)635-2000 RUSSELL MILITELLO : PHILADELPHIACOUNTY COURT OFCOMMONPLEAS : V. : FEBRUARYTERM,2002 ST.AGNES MEDICAL CENTER,etal. : NO.1588 O RDE R This matterhavingcomebeforetheCourt upontheMotionforSummaryJudgment of Defendant,JohnF.McCormick,M.D.; andtheCourt havingconsideredthesubmissions in support oftheMotion; andhavingconsideredthesubmissions inoppositionthereto; andfor goodcauseshown; ITIS THIS ________dayof____________________,2004,herebyORDERED,that the MotionforSummaryJudgment ofDefendant,McCormick,is herebyGRANTED,andsummary judgment is enteredinhis favorandagainst thePlaintiff,andthePlaintiff’s claims aretherefore DISMISSEDWITHPREJUDICEas against Dr.McCormick. BYTHECOURT: ________________________________________ J. GOLD,BUTKOVITZ&ROBINS,P.C. ATTORNEYFORDEFENDANT, BY:ALANS.GOLD JOHNF.McCORMICK,M.D. ATTY.ID.NO. 23400 BY:SEANROBINS ATTY.ID.NO.68828 7837OLDYORKROAD ELKINS PARK,PA19027 (215)635-2000 RUSSELL MILITELLO : PHILADELPHIACOUNTY COURT OFCOMMONPLEAS : V. : FEBRUARYTERM,2002 ST.AGNES MEDICAL CENTER,etal. : NO.1588 MOTIONFORSUMMARYJUDGMENT OF DEFENDANT,JOHNF.MCCORMICK,M.D. MovingDefendant,JohnF.McCormick,M.D.(“McCormick”),byandthroughhis attorneys, Gold,Butkovitz &Robins, P.C.,herebymoves beforethis HonorableCourt foran OrdergrantingSummaryJudgment inhis favor,andagainst thePlaintiffs ontheirThird AmendedComplaint,andinsupport whereof,stateas follows: 1. This matterwas commencedbythePlaintiffs withthefilingofaWrit of Summons onFebruary12,2002. 2. OnFebruary26,2002,aPraecipeandRuletoFileComplaint werefiledand served,andonorabout March21,2002,thePlaintiffs filedaComplaint. 3. PreliminaryObjections tothePlaintiffs Complaint werefiled,towhichPlaintiffs respondedbyfilinganAmendedComplaint,onorabout May30,2003. 4. PreliminaryObjections werethereafterfiledas toPlaintiffs’AmendedComplaint, andonorabout July10,2002,Plaintiffs filedaSecondAmendedComplaint. 5. OncemorePreliminaryObjections followed,as toPlaintiffs’SecondAmended Complaint,andoncemorePlaintiffs respondedwiththefilingofaThirdAmendedComplaint on orabout August 19,2002. (AcopyofthePlaintiffs’ThirdAmendedComplaint is attached heretoas Ex.“A”) 6. PreliminaryObjections tothePlaintiffs’ThirdAmendedComplaint werefiled. 7. ByOrderdatedOctober24,2003,theCourt grantedinpart certainPreliminary Objections tothePlaintiffs’ThirdAmendedComplaint,as follows: ...All references to: recklessness,conduct inreckless disregard,or willful andwantonconduct andall claims forpunitivedamages containedinparagraphs 53,54,57,58,59,59(i),60,64,65,66, 66(i),67,98,99,102,104,105andinthe“wherefore”clause followingparagraph105andall otherclaims forpunitivedamages arestricken; ... 8. Plaintiffs, intheirThirdAmendedComplaint,attempt toset forthclaims of medical malpracticeandprofessional negligenceas toeachofthedefendants: St.Agnes Medical Center(“St.Agnes”),CatholicHealthEast,MarcChristopherPetrone,M.D.(“Petrone”),as well as movingdefendant,JohnF.McCormick,M.D. 9. PennsylvaniaRuleofCivil Procedure1035sets forththestandardforgranting summaryjudgment. It states inrelevant part: Aftertherelevant pleadings areclosed,but withinsuchtimeas to not unreasonablydelaytrial,anypartymaymoveforsummary judgment inwholeorinpart as amatteroflaw(1)wheneverthere is nogenuineissueofanymaterial fact as toanecessaryelement of thecauseofactionordefensewhichcouldbeestablishedby additional discoveryorexpert report,or(2)if,afterthecompletion ofdiscoveryrelevant tothemotion,includingtheproductionof expert reports, anadversepartywhowill beartheburdenofproof at trial has failedtoproduceevidenceoffacts essential tothecause ofactionordefensewhichinajurytrial wouldrequiretheissues to besubmittedtoajury. 10. InErtel v.Patriot-News Co.,544Pa.93,674A.2d1038, cert.denied,519U.S. 1008,117S.Ct.512(1996),theSupremeCourt ofPennsylvaniaadoptedtheapproachofthe SupremeCourt oftheUnitedStates tosummaryjudgment. It heldthat henceforth,inorderto defeat amotionforsummaryjudgment,thepartyagainst whom themotionis directedmust submit sufficient evidenceoneveryissueessential tohis caseonwhichhebears theburdenof prooftosupport ajuryverdict inhis favor. Id.at 674A.2dat 1042. 11. Inthis case,thePlaintiffs havepresentedinsufficient evidencetosupport ajury verdict intheirfavoras totheirclaims ofmedical malpracticeas against movingdefendant,Dr. McCormick. Todefeat Dr.McCormick’s motionforsummaryjudgment,thePlaintiffs must establish theexistenceofsufficient evidencetosupport ajuryverdict intheirfavoronall elements ofthecauseofactionforwhichtheyhavetheburdenofproof. Ertel,544Pa.93,674 A.2dat 1042. 12. Plaintiffs’allegethat theirdecedent,Ms.JosephineMilitello(“Militello”),was admittedtoSt.Agnes Medical Centeronorabout June20,2001byherattendingphysician, defendant,Dr.Petrone,withadmittingdiagnoses ofchronicrenal failure,digoxintoxicityand insulindependant diabetes mellitus. (Ex.“A”,at ¶9) 13. Amongvarious medications, Plaintiffs’allegethat Ms.Militellowas receiving Coumadin(ananticoagulant medication)at thetimeofheradmissiontoSt.Agnes. (Ex.“A”,at ¶13) 14. Plaintiffs allegethat onJune5,2001,Ms.Militello’s INR ratio(ameasureofher blood’s anticoagulation)was miscalculatedas being1.61,...(Ex.“A”,at ¶17) 15. Plaintiffs allegethat onJune7,2001,Ms.Militello’s INR ratiowas miscalculated as being2.22,but that it was laterdeterminedtohaveactuallybeen5.25. (Ex.“A”,at ¶¶21and 23) 16. Plaintiffs allegethat onJune8,2001,Ms.Militello’s INR ratiowas miscalculated as being2.42,but that it was laterdeterminedtohaveactuallybeen6.29. (Ex.“A”,at ¶¶24and 26) 17. Plaintiffs allegethat onJune9,2001,Ms.Militello’s INR ratiowas miscalculated as being2.27,but that it was laterdeterminedtohaveactuallybeen5.51. (Ex.“A”,at ¶¶27and 29) 18. Plaintiffs allegethat onJune10,2001,Ms.Militello’s INR ratiowas miscalculatedas being2.18,but that it was laterdeterminedtohaveactuallybeen5.08. (Ex. “A”,at ¶¶31and33) 19. Plaintiffs allegethat onJune11,2001,Ms.Militello’s INR ratiowas miscalculatedas being2.18,but that it was laterdeterminedtohaveactuallybeen5.04. (Ex. “A”,at ¶¶34and36) 20. Plaintiffs allegethat onJune12,2001,Ms.Militello’s INR ratiowas miscalculatedas being2.06,but that it was laterdeterminedtohaveactuallybeen4.50. (Ex. “A”,at ¶¶37and39) 21. Plaintiffs allegethat onJune13,2001,Ms.Militello’s INR ratiowas miscalculatedas being2.06and2.11,but that it was laterdeterminedtohaveactuallybeen4.50 and4.74. (Ex.“A”,at ¶¶40-41,46and49) 22. Plaintiffs’allegethat theimpropercalculations ofMs.Militello’s INR ratio “contributedto[Ms.Militello’s] demiseandultimatedeath.” (Ex.“A”,at ¶54) 23. Specificallywithrespect tomovingdefendant,McCormick,Plaintiffs allegein theirThirdAmendedComplaint as follows: 7. At all times material hereto,Defendant JohnF. McCormick,M.D.(“Dr.McCormick”)was aphysician dulylicensedtopracticeintheCommonwealthof Pennsylvaniaandwas engagedinthepracticeofhis professioninPhiladelphia,Pennsylvaniaat SAMC. *** 79. Defendant,Dr.McCormick,was aphysicianwho undertooktodiagnose,treat andotherwisecarefor Decedent onorabout June2,2001,inthecourseofhis practiceat SAMC. 80. Defendant,Dr.McCormick,undertooktheaforesaidcareof Decedent withtheknowledgeandintentionthat Plaintiff would relyonDefendant’s opinions, trainingand experienceinregardtothemedical carerenderedtoher duringthecourseofhercareandtreatment at SAMC. 81. Defendant,Dr.McCormick,undertooktheaforesaidcareof Decedent forcompensationrenderedbyDecedent oron behalfofDecedent. 82. Defendant,Dr.McCormick,heldhimselfout toDecedent andthepublicas anexpert inmedicine. *** 84. Defendant,Dr.McCormick,owedadutyofcareto Decedent whichwas breachedtoDecedent’s great detriment. 85. Defendant,Dr.McCormick,breachedhis dutyofcareto Decedent withknowledgeandreckless disregardforher safetytohergreat detriment bynumerous acts or omissions, inthefollowingways: (a) failingtoproperlymonitorDecedent’s laboratoryvalues, includingPT,INR andPTT,in that hefailedtorecognizethat thesevalues were improperlycalculatedandfailedtoensuretheywere properlycalculatedso that thedecedent wouldnot beover-anticoagulatedleadingtoherdeath; (b) failingtotakepropersteps toensurethat Decedent’s laboratoryresults wereaccurateby failingtorecognizethemiscalculations andfailing todoanythingtoensurethevalues wereproperly calculatedandherclottingabilitywas increased; (c) failingtoproperlyinterpret Decedent’s laboratoryresults inlight ofinconsistent laboratory values; (d) failingtorepeat Decedent’s erroneous laboratorytests includingPT,PTTandINR ratios to ensurethat shewas not over-anticoagulatedleading toherdeath; (e) failingtoconsistentlymonitorDecedent’s HGBandHCTlevels duringheradmissionto recognizethesigns ofexcess anticoagulation; (f) failingtotimelydiagnoseandtreat Decedent’s bleedinginthefaceofmiscalculatedPT,PTTand INR ratios; (g) failingtoconduct anaccurateandfull medical assessment ofDecedent includinganevaluationof all ofherlaboratoryresults andclinical signs and symptoms whichwouldhaverevealedthat shewas anemicandhadbeenexcessivelyanticoagulated givenheractual INR ratios hadtheybeenproperly calculated; (h) failingtoproperlytrainandsupervisethe medical/surgical residents toappreciatethesigns andsymptoms ofanemiaandbleedingand recognizethat thePT,PTTandINR ratios hadbeen improperlycalculated; (I) failingtoproperlytrainandsupervisethe nursingstafftoappreciatetheclinical signs and symptoms ofanemiaandbleedingandrecognize that thePT,PTTandINR ratios hadbeen improperlycalculated; (j) failingtoensurethat Decedent was stableprior toundergoinganysurgical procedures, including herclottingfactors; (k) failingtoconduct properlaboratoryand diagnostictests priortoDecedent’s surgical procedureonJune13,2001so as torecognizethat shehadbeenexcessivelyanticoagulatedandwas at asignificant risk forabnormal bleedinganddeath; and (l) failingtoconduct properlaboratoryand diagnostictests subsequent toDecedent’s surgical procedureonJune13,2001toproperlydetermine herclottingfactors so that steps couldhavebeen takentoincreasehercoagulationandsaveherlife. 24. ThedeathcertificateissuedfollowingMs.Militello’s deathonJune13,2001, however,indicates as hercauseofdeath: “kidneyfailure.” (SeeacopyoftheCertificateof Death,attachedheretoas Ex.“C”) 25. ThePhiladelphiaMedical Examiner,Haresh G.Mirchandani,M.D.reviewedMs. Militello’s death,its circumstances andhermedical records, andconcludedthat hercauseof deathwas renal failure. (Ex.“D”,DepositionofHaresh G.Mirchandani,M.D.,at 43; Ex.“E”, DeathCertificateInformation,at1and6) AccordingtoDr.Mirchandani,“[t]herewas noclinical evidenceofbleeding”andthat “[t]hedeathofthis patient was not theresult oftreatment (coumadin)received.” (Ex.“E”,at 6; Ex.“D”,at 31-32) 26. Likewise,Ms.Militello’s attendingphysician,defendant,Dr.Petrone,whotreated Ms.Militelloduringherhospitalization,testifiedthat hefoundnoclinical evidenceofany bleeding,andthat it was his opinionthat shehaddiedas aresult ofkidneyfailure,andnot as a result ofhavingbeengiventoomuchcoumadin. (SeedepositionofDr.Petrone,Ex.“F”,at 11) Dr.Petronedeterminedthat Ms.Militello’s deathwas causedbyrenal failure,andlistedit as the causeofdeathonherdeathcertificate. (Ex.“F”,at 79-80) Hewas verycertainthat herdeath was causedbyrenal failureat thetime,andheremains so tothis day. ThecorrectedINR values receivedat alaterdatedonot changehis mind. (Ex.“F”,at 80) 27. Dr.Petronetestifiedthat thereis noclinical evidencethat Ms.Militellowas bleedingduringheradmission. (Ex.“F”,at 81) Herhemoglobinandhematocrit results were stablethroughout heradmission. Dr.Petronetestifiedas totheonemarkedlylowhemoglobin level onJune13,2001,that: It was not consistent withherotherhemoglobin values andit was not consistent withherphysical exam. Sowerepeatedit,as wefrequentlydowhen there’s alabthat looks likeaquote,“redherring.” Andit camebackactually,therepeat,inlinewith herprevious hemoglobin. (Ex.“F”,at 81-82) 28. Initially,toset forthaprimafaciecaseofmedical malpractice,aplaintiffmust establish forthings: (1)theexistenceofadutyowedbythephysiciantothepatient,(2)abreach ofthat dutyfrom thephysiciantothepatient,(3)that thebreachofthat dutywas theproximate cause,orasubstantial factor,inbringingabout theharm sufferedbythepatient,and(4)the existenceofdamages sufferedbythepatient that werethedirect result ofthat harm. Mitzelfelt v. Kamrin,526Pa.54,584A.2d888,891(1990). 29. Toestablish acauseofactionformedical malpracticebasedonnegligence,the SupremeCourt ofPennsylvaniarequires that plaintiffs present expert testimony,toareasonable degreeofmedical certainty,that theacts ofthephysician-defendant deviatedfrom theapplicable standardofcare,andthat suchdeviationconstitutedtheproximatecauseoftheharm suffered. Brannanv.LankenauHospital,490Pa.588,417A.2d196(1980); Mitzelfelt,526Pa.54,584 A.2dat 892. Aplaintiffinamedical malpracticeaction“must present expert testimonyto establish that thecareandtreatment oftheplaintifffell short oftherequiredstandardofcareand that thebreachproximatelycausedtheplaintiff’s injury.” Toogoodv.Rogal,573Pa.245,824 A.2d1140,1145(2003). Theburdenis upontheplaintifftoshow,throughexpert testimony, that thephysicianinquestion“failedtoemploytherequisitedegreeofcareandskill.” Toogood, 573Pa.245,824A.2dat 1150. 30. As ageneral matter,aphysicianwhois not aspecialist,“is requiredto possess andemployinthetreatment ofapatient theskill andknowledgeusuallypossessedbyphysicians inthesameorasimilarlocality. Donaldson v.Maffucci,397Pa.548,156A.2d835,838(1959). 31. ThePlaintiffs havefailedtopresent anyexpert testimonywhatsoeversettingforth thestandardofcareapplicabletoaphysicianinDr.McCormick’s position,andopiniontoa reasonabledegreeofmedical certaintythat theacts ofDr.McCormickconstitutedtheproximate causeofharm sufferedbyMs.Militello. This failureis fatal tothePlaintiffs’claims against Dr. McCormick,andrequireagrant ofsummaryjudgment inDr.McCormick’s favor. 32. InEaddyv.Hamaty,694A.2d639(Pa.Super.1997),theCourt consideredan appeal ofthegrant ofsummaryjudgment enteredinfavorofdefendant-physicianbythetrial court. Thetrial court hadgrantedsummaryjudgment onthegrounds that theopinionof plaintiff’s expert thereinfailedtoestablish, toareasonabledegreeofmedical certainty,that the actions ofthedefendant breachedtheapplicablestandardofcareas tohis patient andthat they weretheproximatecause(orsubstantial factor)inbringingabout theharm alleged. Id.at 642- 643. TheSuperiorCourt foundthat theplaintiff’s expert “didnot express therequisitedegreeof medical certainty”andthat theplaintifftherefore“failedtostateaprimafaciecaseofmedical malpractice”as tothedefendant-physician,Dr.Hamaty: Dr.Mitchell [plaintiff’s expert]opinedwithareasonabledegreeof medical certaintythat thesteroids, intheabsenceofothercauses, ledtothedevelopment ofavascularnecrosis. Hedid notidentify anyconducton thepartofthetreatingphysician as abreach of duty,e.g.,that Dr.Hamatynegligentlyoverprescribedthe medication,that henegligentlyprescribedPrednisoneinlight of otheralternatives, orthat henegligentlyprescribedPrednisonefor anexcessiveperiodoftime. Nordid heidentifyanybreach as a proximatecauseof,orasubstantial factorin,appellant’s harm....Afterreviewingtheexpert report inits entirety,we concludethat Dr.Mitchell didnot express therequisitedegreeof medical certainty. Appellant thereforefailedtostateaprimafacie caseofmedical malpractice.(Id.at 642.)(emphasis added) Whilecarefullyandclearlydeterminingthat thePlaintiffin Eaddyhadfailedtodemonstratea breachintheapplicablestandardofcarebyDr.Hamatyduetotheexpert’s failuretoprovidean opinionas totheactions ofDr.Hamaty,theSuperiorCourt sent thematterbacktothetrial court solelyuponaprocedural technicality: theCourt hadruledonthedefendant’s summaryjudgment motionwithout providingthePlaintiffwith30days afterserviceofthemotiontofilearesponse. Nonetheless,theholdingis clear: Iftheplaintifffails toprovideanexpert opinionas towhether andhowthedefendant-physician’s actions havebreachedadutytothepatient,andthat such breachwas theproximatecauseoforsubstantial factorintheresultingharm,theclaim must fail. 33. Thesoleexpert opinionpresentedbythePlaintiffs is that ofBarryL.Singer, M.D.,whohas providedanopinionas tothecauseofdeathofMs.Militello. Dr.Singeropines that Ms.Militellodiedas aresult ofa“sharpdropinhemoglobinwhichawomanthis agewith multiplemedical problems couldnot tolerate.” (SeeDr.Singer’s report,April 14,2003,at 3; attachedheretoas Ex.“B”) 34. Dr.Singer,inhis report,states that he“reviewedrecords”pertainingtoMs. Militello’s admissiontoSt.Agnes Medical Center,betweenJune3,2001andJune13,2001. (Ex.“B”,at 1) Dr.Singerprovides someoverviewofthecourseofMs.Militello’s hospitalization(Ex.“B”,at 1-2),reviews brieflyherINR results andbrieflyherhemoglobin levels, althoughfails toindicateacompletereviewofthoseresults. (Ex.“B”,at 2) Dr.Singer states inhis report that Ms.Militellowas prescribedanexcessivedoseofCoumadinduringher hospitalization,andthat this was dueto“erroneous INR’s.” (Ex.“B”,at 2) 35. Dr.Singerthenconcludes that Ms.MilitellodevelopedbleedingonJune13, 2001,afterseveral days of“overanticoagulation”withCoumadin,andthat shediedfrom “cardiacarrest”becauseofthebleeding. (Ex.“B”,at 2-3) Dr.Singer’s solebasis forconcluding that Ms.Militello“develop[ed]bleeding”is that onJune13,2001,herHemoglobinlevel “droppedfrom 12.4to7.8,”thus indicatingalargeloss ofblood. (Ex.“B”,at 2-3) 36. Themedical records uponwhichDr.Singerrelies, however,donot reflect the datauponwhichherelies. EvenPlaintiffs’ThirdAmendedComplaint fails toreflect this data. ThePlaintiffs’allegethat onJune13,2001,Ms.Militello’s hemoglobinlevel was 7.8at 12:30 pm. (Ex.“A”,at¶47) ThePlaintiffs furtherallegethat herhemoglobinlevel was 12.4at 2:00 pm. (Ex.“A”,at ¶48) Preciselytheoppositeofthereadings uponwhichDr.Singerrelies entirelyforhis opinion. 37. Ms.Militello’s DischargeSummary,likewisedemonstrates thefallacyoftheDr. Singer’s opinionas tothecauseofMs.Militello’s death. (Seecopyofhemoglobin(“Hgb”) results summaryfrom Ms.Militello’s DischargeSummary,attachedheretoas Ex.“G”) Rather thandemonstratinga“falling”hemoglobinlevel duringheradmission,leadingtoherdeathon June13,2001,nineout ofthetenresults duringtheJune2throughJune13,2001period