Pennsylvania Superior Court Address Corporate Negligence Claim in the Context of the Mental Health Procedures Act

In the case of Azaravich v. Wilkes-Barre Hospital, 2024 PA Super 116, No 2017-08531. (June 5, 2024), the Pennsylvania Superior Court determined that the trial court erred in its application of the immunity provision of the Mental Health Procedures Act (MHPA) to the plaintiff’s professional negligence and corporate negligence claim, and the dismissal of those claims.

Steven Azaravich called 911, reporting suicidal thoughts. He told police officers that he had thoughts of hanging himself. Azaravich was transported to the Defendant, Wilkes-Barre General Hospital (WBGH), where he encountered defendant Dana Simon, a physician assistant (PA), who documented that Azaravich was experiencing depression and suicidal ideation. Therefore, Simon entered an order to detain Azaravich. Later, Lorna Ruckle, a registered nurse, assessed Azaravich with a “high risk” of suicide. Emergency medicine physician, defendant, Noel Estioko, M.D. did not evaluate Azaravich. Daniel May, a crisis clinician, evaluated Decedent at 5:40 p.m., and noted Azaravich’s claims that he did not have an intent to hang himself, did not have current thoughts of harming himself, and wanted outpatient treatment. May reviewed his assessment with Jyoti Shah, M.D., the on-call psychiatrist, but did not inform Dr. Shah of Nurse Ruckle’s risk of suicide assessment. Dr. Shah approved releasing Azaravich from WBGH and ordered outpatient treatment. Sadly, Azaravich took his own life two days later by hanging himself with an electrical cord.

Laura Azaravich, Administrator of the Estate of Steven Azaravich (Plaintiff) sued the defendants, alleging gross medical and corporate negligence and recklessness. Plaintiff produced several experts’ reports detailing the grossly negligent behavior of the Defendants, which is required under the MHPA. Plaintiff’s expert also opined that the WBGH was grossly negligent in the formulation of policy and procedure, and the hiring, retention, training and supervision of its staff. After the completion of discovery, the trial court issued an order and opinion granting the Defendants’ motions for summary judgment, finding that the Plaintiff did not meet her burden to demonstrate the Defendants’ gross negligence, and dismissing all claims against the Defendants with prejudice.

On appeal to the Pennsylvania Superior Court, the Plaintiff argued that the trial court abused its discretion in essentially ignoring the Plaintiff’s experts’ opinions. Plaintiff also argued that the trial court erred in failing to apply the negligence standard as opposed to the gross negligence standard to the non-mental health claims, i.e., credentialing, staffing, etc.

In the absence of willful misconduct or gross negligence, a county administrator, a director of a facility, a physician, a peace officer or any authorized person who participates in a decision that a person be examined or treated under this act, or that a person be discharged, or placed under partial hospitalization, outpatient care or leave of absence, or that the restraint upon such person be otherwise reduced, or a county administrator or other authorized person who denies an application for voluntary treatment or for involuntary emergency examination and treatment, shall not be civilly or criminally liable for such decision or any of its consequences.

50 P.S. § 7114(a). In this context, “gross negligence” means “a form of negligence where the facts support substantially more than ordinary carelessness, inadvertence, laxity, or indifference. The behavior of the defendant must be flagrant, grossly deviating from the ordinary standard of care.” Albright v. Abington Memorial Hosp., 696 A.2d 1159, 1164 (Pa. 1997).

Here, the Superior Court determined that the trial court failed to consider the Plaintiff’s expert reports in the light most favorable to Plaintiff as the non-moving party and assailed the Plaintiff’s experts’ credibility, which is not within the purview of the court. As such, the Court concluded that the Plaintiff presented sufficient evidence to establish genuine issues of material fact concerning whether the Defendants were grossly negligent in discharging Azaravich from WBGH with plans for follow-up outpatient treatment instead of involuntarily committing Decedent for further evaluation pursuant to Section 302 of the MHPA.

Concerning the Plaintiff’s corporate negligence claim, the Court referenced Thompson v. Nason Hosp., 591 A.2d 703 (Pa. 1991), wherein the Supreme Court held that a hospital has the following duties:

(1) a duty to use reasonable care in the maintenance of safe and adequate facilities and equipment; (2) a duty to select and retain only competent physicians; (3) a duty to oversee all persons who practice medicine within its walls as to patient care; and (4) a duty to formulate, adopt and enforce adequate rules and policies to ensure quality care for the patients.

To establish a prima facie case of corporate negligence. The plaintiff must establish all of the following:

1. [the hospital] acted in deviation from the standard of care;
2. [the hospital] had actual or constructive notice of the defects or procedures which created the harm; and
3. that the conduct was a substantial factor in bringing about the harm. Unless a hospital’s negligence is obvious, a plaintiff must produce expert testimony to establish that the hospital deviated from an accepted standard of care and that the deviation was a substantial factor in causing the harm to the plaintiff.

Corey v. Wilkes-Barre Hosp. Co., LLC, 307 A.3d 701, 708-09 (Pa. Super. 2023)

Here, the Court did not reach the question as to whether in a case involving the MHPA a Plaintiff is required to establish gross administrative negligence since it concluded that the Plaintiff developed sufficient competent evidence to establish genuine issues of material fact concerning whether WBGH was grossly negligent in its administration of its staff.

The case of Azaravich v. Wilkes-Barre Hospital, 2024 PA Super 116, No 2017-08531 (June 5, 2024) can be accessed here.