J-S26004-17
NON-PRECEDENTIAL DECISION - SEE SUPERIOR COURT I.O.P. 65.37
BERNADETTE AND TRAVIS SNYDER IN THE SUPERIOR COURT OF PENNSYLVANIA Appellants
v.
MOUNT NITTANY MEDICAL CENTER, DR. SARA BARWISE, MD, DR. MICHAEL FEFFER, MD, DR. UPENDRA THAKER, MD
No. 1545 MDA 2016
Appeal from the Order Entered August 18, 2016 In the Court of Common Pleas of Centre County Civil Division at No(s): 2015-884
BEFORE: BOWES, DUBOW, AND FITZGERALD,* JJ.
MEMORANDUM BY BOWES, J.: FILED MAY 26, 2017
Bernadette and Travis Snyder appeal pro se from the August 18, 2010
order entering summary judgment against them in this medical malpractice
action. Summary judgment was granted because they failed to produce the
report of an expert witness to establish that the defendants herein were
negligent. We affirm.
On February 26, 2015, the Snyders, acting pro se, instituted this
medical malpractice action against Appellees Mount Nittany Medical Center,
Dr. Sara Barwise, Dr. Michael Feffer, and Dr. Upendra Thaker. They
premised their right to recover upon the following allegations. On March 1,
* Former Justice specially assigned to the Superior Court. J-S26004-17
2013, Ms. Snyder, who had placenta previa,1 underwent a scheduled
caesarian section at the Mount Nittany Medical Center. The baby was safely
delivered, but Ms. Snyder thereafter suffered cardiac arrest due to an
amniotic fluid embolism. She was revived through the use of
cardiopulmonary resuscitation and intubation.
The complaint continued as follows. After Ms. Snyder stabilized from
the embolism, she began to suffer from a condition known as disseminated
intravascular coagulation, which occurs when blood clots form inside blood
vessels. During disseminated intravascular coagulation, the clots can use up
the blood’s clotting factors, which can lead to bleeding in other areas. Dr.
Feffer placed a right internal jugular central line inside of Ms. Snyder’s
jugular vein to administer medication. Mount Nittany Medical Center
personnel were unsuccessful in their attempts to stop Ms. Synder’s bleeding,
and transferred her to Geisinger Clinic (“Geisinger”) in Danville,
Pennsylvania.
The complaint indicated that personnel at Geisinger observed that Ms.
Snyder’s neck, face, and body, were swollen and concluded that the right
internal jugular central line was not placed in the correct position. An x-ray
confirmed the diagnosis, the line was removed and Ms. Snyder’s condition
____________________________________________
1 Placenta previa is a condition where the placenta lies low in the uterus and partially or completely covers the cervix.
-2- J-S26004-17
was stabilized. The Snyders averred that Ms. Snyder’s intubation was
prolonged due to the incorrectly placed internal jugular central line and that
she continued to suffer side effects from these medical events.
In January 2016, the trial court issued a pre-trial conference order that
required the parties to produce the reports of any expert witnesses whom
they intended to call at trial by May 15, 2016. Appellees presented two
expert witness reports, both of which indicated that Appellees did not
deviate from the applicable standard of care in their treatment of Ms.
Snyder. The Synders did not produce any report. At the May 15, 2016 pre-
trial conference, the Snyders indicated that none would be forthcoming.
Appellees thereafter moved for summary judgment. Appellees’ motion was
granted, and the action was dismissed. This timely appeal followed. The
Snyders raise this position on appeal:
Whether the Lower Court erred when it granted summary judgment in favor of Appellees Mount Nittany Medical Centre, Dr. Sara E. Barwise, Dr. Michael J. Feffer, and Dr. Upendra Thaker where a substantial amount of fact exists as to whether the Doctrine of Res Ipsa Loquitur applies in this case.
Appellants’ brief at 5.
Initially, we set forth our standard of review when a trial court has
granted summary judgment. This court can “reverse a grant of summary
judgment if there has been an error of law or an abuse of discretion.”
Truax v. Roulhac, 126 A.3d 991, 996, (Pa.Super. 2015) (en banc) (citation
omitted). Summary judgment is entered “only in those cases where the
-3- J-S26004-17
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.” Id.
(citation omitted). The question of “whether there are no genuine issues as
to any material fact presents a question of law, and therefore, on that
question our standard of review is de novo[.]” Id.
When the trial court, and, concomitantly, this Court, determines
whether there is a genuine issue of material fact, we “must take all facts of
record and reasonable inferences therefrom in a light most favorable to the
non-moving party.” Id. We resolve any “doubts as to the existence of a
genuine issue of material fact against the moving party, and, thus, may only
grant summary judgment where the right to such judgment is clear and free
from all doubt.” Id. (citation omitted).
In this case, the Snyders, as plaintiffs, bear the burden of proving the
Appellees were negligent. If the party with the burden of proof does not
present “sufficient evidence on an issue essential to his case and on which
he bears the burden of proof,” the moving party is entitled to summary
judgment. Id. at 997 (citation omitted). Hence, a plaintiff must produce
evidence establishing the existence of a prima facie case that he has a cause
of action, or the trial court properly can grant summary judgment against
the plaintiff. Id.
The Snyders accuse Appellees of medical malpractice, which “consists
of a negligent or unskillful performance by a physician of the duties which
-4- J-S26004-17
are devolved and incumbent upon him on account of his relations with his
patients, or of a want of proper care and skill in the performance of a
professional act.” Fessenden v. Robert Packer Hosp., 97 A.3d 1225,
1229 (Pa.Super. 2014) (citation omitted). In order to set forth a prima facie
cause of action for medical malpractice, a plaintiff must establish “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.” Id. Of import herein is the
precept: “With all but the most self-evident medical malpractice actions,
there is also the added requirement that the plaintiff must provide a
medical expert who will testify as to the elements of duty, breach,
and causation.” Id.
Herein, the Snyders rely upon a “narrow exception to the requirement
that medical malpractice claims be supported by expert testimony;” “this
exception applies in those instances where the malpractice is obvious and
the medical and factual issues presented are such that a lay juror could
recognize negligence just as well as any expert.” Id. at 1230. Specifically,
they invoke the doctrine of res ipsa loquitur; which is Latin for "the thing
speaks for itself.” Res ipsa loquitur can be utilized only when all of these
elements are present:
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J-S26004-17
NON-PRECEDENTIAL DECISION - SEE SUPERIOR COURT I.O.P. 65.37
BERNADETTE AND TRAVIS SNYDER IN THE SUPERIOR COURT OF PENNSYLVANIA Appellants
v.
MOUNT NITTANY MEDICAL CENTER, DR. SARA BARWISE, MD, DR. MICHAEL FEFFER, MD, DR. UPENDRA THAKER, MD
No. 1545 MDA 2016
Appeal from the Order Entered August 18, 2016 In the Court of Common Pleas of Centre County Civil Division at No(s): 2015-884
BEFORE: BOWES, DUBOW, AND FITZGERALD,* JJ.
MEMORANDUM BY BOWES, J.: FILED MAY 26, 2017
Bernadette and Travis Snyder appeal pro se from the August 18, 2010
order entering summary judgment against them in this medical malpractice
action. Summary judgment was granted because they failed to produce the
report of an expert witness to establish that the defendants herein were
negligent. We affirm.
On February 26, 2015, the Snyders, acting pro se, instituted this
medical malpractice action against Appellees Mount Nittany Medical Center,
Dr. Sara Barwise, Dr. Michael Feffer, and Dr. Upendra Thaker. They
premised their right to recover upon the following allegations. On March 1,
* Former Justice specially assigned to the Superior Court. J-S26004-17
2013, Ms. Snyder, who had placenta previa,1 underwent a scheduled
caesarian section at the Mount Nittany Medical Center. The baby was safely
delivered, but Ms. Snyder thereafter suffered cardiac arrest due to an
amniotic fluid embolism. She was revived through the use of
cardiopulmonary resuscitation and intubation.
The complaint continued as follows. After Ms. Snyder stabilized from
the embolism, she began to suffer from a condition known as disseminated
intravascular coagulation, which occurs when blood clots form inside blood
vessels. During disseminated intravascular coagulation, the clots can use up
the blood’s clotting factors, which can lead to bleeding in other areas. Dr.
Feffer placed a right internal jugular central line inside of Ms. Snyder’s
jugular vein to administer medication. Mount Nittany Medical Center
personnel were unsuccessful in their attempts to stop Ms. Synder’s bleeding,
and transferred her to Geisinger Clinic (“Geisinger”) in Danville,
Pennsylvania.
The complaint indicated that personnel at Geisinger observed that Ms.
Snyder’s neck, face, and body, were swollen and concluded that the right
internal jugular central line was not placed in the correct position. An x-ray
confirmed the diagnosis, the line was removed and Ms. Snyder’s condition
____________________________________________
1 Placenta previa is a condition where the placenta lies low in the uterus and partially or completely covers the cervix.
-2- J-S26004-17
was stabilized. The Snyders averred that Ms. Snyder’s intubation was
prolonged due to the incorrectly placed internal jugular central line and that
she continued to suffer side effects from these medical events.
In January 2016, the trial court issued a pre-trial conference order that
required the parties to produce the reports of any expert witnesses whom
they intended to call at trial by May 15, 2016. Appellees presented two
expert witness reports, both of which indicated that Appellees did not
deviate from the applicable standard of care in their treatment of Ms.
Snyder. The Synders did not produce any report. At the May 15, 2016 pre-
trial conference, the Snyders indicated that none would be forthcoming.
Appellees thereafter moved for summary judgment. Appellees’ motion was
granted, and the action was dismissed. This timely appeal followed. The
Snyders raise this position on appeal:
Whether the Lower Court erred when it granted summary judgment in favor of Appellees Mount Nittany Medical Centre, Dr. Sara E. Barwise, Dr. Michael J. Feffer, and Dr. Upendra Thaker where a substantial amount of fact exists as to whether the Doctrine of Res Ipsa Loquitur applies in this case.
Appellants’ brief at 5.
Initially, we set forth our standard of review when a trial court has
granted summary judgment. This court can “reverse a grant of summary
judgment if there has been an error of law or an abuse of discretion.”
Truax v. Roulhac, 126 A.3d 991, 996, (Pa.Super. 2015) (en banc) (citation
omitted). Summary judgment is entered “only in those cases where the
-3- J-S26004-17
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.” Id.
(citation omitted). The question of “whether there are no genuine issues as
to any material fact presents a question of law, and therefore, on that
question our standard of review is de novo[.]” Id.
When the trial court, and, concomitantly, this Court, determines
whether there is a genuine issue of material fact, we “must take all facts of
record and reasonable inferences therefrom in a light most favorable to the
non-moving party.” Id. We resolve any “doubts as to the existence of a
genuine issue of material fact against the moving party, and, thus, may only
grant summary judgment where the right to such judgment is clear and free
from all doubt.” Id. (citation omitted).
In this case, the Snyders, as plaintiffs, bear the burden of proving the
Appellees were negligent. If the party with the burden of proof does not
present “sufficient evidence on an issue essential to his case and on which
he bears the burden of proof,” the moving party is entitled to summary
judgment. Id. at 997 (citation omitted). Hence, a plaintiff must produce
evidence establishing the existence of a prima facie case that he has a cause
of action, or the trial court properly can grant summary judgment against
the plaintiff. Id.
The Snyders accuse Appellees of medical malpractice, which “consists
of a negligent or unskillful performance by a physician of the duties which
-4- J-S26004-17
are devolved and incumbent upon him on account of his relations with his
patients, or of a want of proper care and skill in the performance of a
professional act.” Fessenden v. Robert Packer Hosp., 97 A.3d 1225,
1229 (Pa.Super. 2014) (citation omitted). In order to set forth a prima facie
cause of action for medical malpractice, a plaintiff must establish “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.” Id. Of import herein is the
precept: “With all but the most self-evident medical malpractice actions,
there is also the added requirement that the plaintiff must provide a
medical expert who will testify as to the elements of duty, breach,
and causation.” Id.
Herein, the Snyders rely upon a “narrow exception to the requirement
that medical malpractice claims be supported by expert testimony;” “this
exception applies in those instances where the malpractice is obvious and
the medical and factual issues presented are such that a lay juror could
recognize negligence just as well as any expert.” Id. at 1230. Specifically,
they invoke the doctrine of res ipsa loquitur; which is Latin for "the thing
speaks for itself.” Res ipsa loquitur can be utilized only when all of these
elements are present:
(a) the event is of a kind which ordinarily does not occur in the absence of negligence;
-5- J-S26004-17
(b) other responsible causes, including the conduct of the plaintiff and third persons, are sufficiently eliminated by the evidence; and
(c) the indicated negligence is within the scope of the defendant's duty to the plaintiff.
Id. (quoting Restatement (Second) of Torts § 328D(1)).
The Snyders refer us to Jones v. Harrisburg Polyclinic Hosp., 437
A.2d 1134 (Pa. 1981), where the plaintiff suffered from suprascapular nerve
palsy, i.e., intense pain in her neck, shoulder, and arm, after she underwent
a gynecological procedure. The plaintiff averred that her arm had been
misplaced during the medical events, which involved moving her into
different positions. Our Supreme Court ruled that res ipsa loqutur applied,
opining that suprascapular nerve palsy in the affected areas would “not
ordinarily occur during [the] gynecological procedures as were employed on
[the plaintiff] in the absence of negligence.” Id. at 1139. See also Quinby
v. Plumsteadville Family Practice, Inc., 907 A.2d 1061 (Pa. 2006) (res
ipsa loquitur charge warranted when an unattended quadriplegic fell from an
examination table during a minor operation and injuries from the fall caused
his death); Fessenden, supra (leaving a sponge inside a patient during an
operation constitutes obvious negligence and an expert witness report is not
necessarily to make out a prima facie case of medical malpractice).
In this lawsuit, the Snyders premise liability on the misplaced internal
jugular line, Appellees’ failure to recognize that fact, and Appellees’ inability
-6- J-S26004-17
to stabilize Ms. Snyder’s internal bleeding. Appellant’s brief at 7. Herein, as
the trial court aptly noted, the common layperson would not know whether a
jugular central line can be misplaced even when a doctor has not been
negligent and has exercised reasonable care. Likewise, an ordinary person
would not be familiar with the signs of a misplaced jugular central line, and,
accordingly, whether Appellees should have detected the issue. Finally, a
layperson would have no idea whether Ms. Snyder’s prolonged intubation
caused her claimed harm.
Simply put, the medical events in this case involve complex medical
issues and procedures that are beyond the ken of an ordinary person. See
MacNutt v. Temple Univ. Hosp., Inc., 932 A.2d 980 (Pa.Super. 2007)
(plaintiff could not use the doctrine of res ipsa loquitur to create inference
that surgeon was negligent in causing chemical burn to patient’s shoulder
during surgery to correct a condition that rendered patient’s arms
intermittently cold and paralyzed). The events in question could have
happened even though Appellees exercised reasonable care, and the
Snyders failed to establish the first element of the res ipsa loquitur doctrine.
Hence, expert testimony was necessary to establish that the Appellees were
negligent. The trial court did not abuse its discretion or commit an error of
law in opining that the lack of an expert opinion was fatal to the Snyder’s
case. Hence, we affirm its grant of summary judgment in favor of Appellees.
-7- J-S26004-17
Order affirmed.
Judgment Entered.
Joseph D. Seletyn, Esq. Prothonotary
Date: 5/26/2017
-8-