Heimbecker v. Trevlyn

245 A.3d 1077 (Table)

Gerard P. HEIMBECKER, Administrator, C.T.A., Estate of Henry G. Heimbecker, a/k/a H. Gerard Heimbecker, Deceased; Kathleen D. Heimbecker and Theresa H. Sablosky, Guardians of the Estate of Kathleen Heimbecker, an Incapacitated Person; Kathleen D. Heimbecker, Individual; Susan M. Heimbecker; Gerard P. Heimbecker, Individual, Appellants v. Dean TREVLYN, M.D., Appellee.

No. 3465 EDA 2019

Superior Court of Pennsylvania.

Filed December 16, 2020

MEMORANDUM BY FORD ELLIOTT, P.J.E.:

Gerard P. Heimbecker, administrator of the Estate of Henry G. Heimbecker ("decedent"), Kathleen Heimbecker and Theresa H. Sablosky, Guardians of the Estate of Incapacitated Person, Kathleen D. Heimbecker, Susan M. Heimbecker and Gerard P. Heimbecker (hereinafter, "appellants") appeal from the January 6, 2020 judgment entered in favor of Dr. Dean Trevlyn, and against appellants, in this medical malpractice action in the Court of Common Pleas of Delaware County. After careful review, we affirm.

The trial court ¹ aptly summarized the facts as follows:

... [T]he [d]ecedent had been at the shore with his family for Memorial Day weekend in 2011. On June 1, 2011, while pulling a cart from the beach the [d]ecedent felt a "tweak in his left shoulder and had a little bit of discomfort." When the pain in his shoulder grew worse and his wrist became swollen, the [d]ecedent called his primary care physician, Dr. Friedrich, who advised the [d]ecedent to take some aspirin and call back the next day. The next day the [d]ecedent called the doctor's office again, and it was suggested that he may have a rotator cuff injury. The [d]ecedent was advised to go see Dr. Trevlyn. The [d]ecedent returned home from the shore on Sunday June 5, 2011 and on Monday June 6, 2011, the [d]ecedent called Dr. Trevlyn and was given an appointment that same day. According to the [d]ecedent's daughter, Susan Heimbecker, Dr. Trevlyn diagnosed the [d]ecedent with gout, gave him a prescription for Indocin for the gout and a prescription for an MRI of his shoulder. A few days later, on June 9, 2011[,] the [d]ecedent was found unresponsive and slumped over in a chair in his bedroom. He was taken by ambulance to Delaware County Hospital where he remained for a few hours before being transferred to Jefferson Hospital. Unfortunately, the [d]ecedent passed away on June 12, 2011.

... Appellants offered Dr. Steven Graboff, an expert in orthopedic medicine, who opined that Dr. Trevlyn was negligent and breached the standard of care. According to Dr. Graboff, when the [d]ecedent presented in Dr. Trevlyn's office complaining of shoulder pain and a swollen wrist, the standard of care required Dr. Trevlyn to emergently admit the [d]ecedent to the hospital and have him seen by internal medicine and infectious disease doctors. Dr. Graboff opined that Dr. Trevlyn misdiagnosed the [d]ecedent's wrist as having gout as opposed to an infection and opined that he should have begun immediate treatment as though the wrist was infected "because that could potentially kill him." According to Dr. Graboff, the [d]ecedent had a wrist infection that got into his blood and ultimately killed him.

... Dr. Trevlyn recounted that the [d]ecedent came to see him on June 6, 2011. The [d]ecedent explained that he had been pulling a beach cart and had felt a pull in his left shoulder. The [d]ecedent further explained that after that the pain increased to a point that he was having trouble moving his shoulder and that he had also developed pain and swelling in his left hand. Dr. Trevlyn examined the [d]ecedent and found that he presented with a likely rotator cuff tear in his shoulder, and an MRI was ordered. Dr. Trevlyn also examined the [d]ecedent's wrist, which was swollen and warm. Dr. Trevlyn found that he presented with gout. Dr. Trevlyn opined, "[t]hen I looked into his medical history. He has a history -- he's an older man. He has a history of hypertension. He has a history of diabetes. He has a history of high cholesterol. He's on certain medications. And all these things are risk factors for gout. I know based on my training and my experience that the most common cause of a warm, red, swollen, painful wrist is gout. That day I made the diagnosis of gout based on that." Accordingly, Dr. Trevlyn treated the gout with medication and told the [d]ecedent to follow up with him if the pain persisted over the next one to two days. Dr. Trevlyn explained that the [d]ecedent did not have any signs of an infection, such as a cut or open sore. As to the cause of the [d]ecedent's death, Dr. Trevlyn explained that it was his understanding that the autopsy did not show that the wrist contributed to the [d]ecedent's death. According to Dr. Trevlyn, the [d]ecedent died of bacterial endocarditis.

In addition, Dr. Trevlyn called two experts in his defense, Dr. John Lewis Esterhai and Dr. Peter McCue. Both doctors testified that based upon their training and experience they were of the opinion to a reasonable degree of medical certainty that Dr. Trevlyn's treatment of the [d]ecedent met the standard of care, and they stated that Dr. Trevlyn was not negligent. Dr. Esterhai, an expert in the field of orthopedic surgery, opined that the [d]ecedent had an infection on his heart valve that showered into his blood stream and ultimately caused his death. According to Dr. Esterhai, "Dr. Trevlyn did not contribute to this patient's death. It is unfortunate that he had endocarditis that became bacterial endocarditis that then showered his bloodstream and his brain and likely his heart with bacteria. But that was not in any way, shape or form something that Dr. Trevlyn had any knowledge of, could have known about or could have made any difference in."

Dr. Esterhai stated that a review of the records showed that the [d]ecedent did not have a wrist infection, but merely had inflammation of the wrist. He explained that inflammation and infection are not synonymous. ... According to Dr. Esterhai, gout was the proper diagnosis based upon the [d]ecedent's presentation and his risk factors.[Footnote 2]

[Footnote 2] Dr. Esterhai testified that the [d]ecedent had six risk factors for gout.

Dr. McCue, an expert in the areas of anatomic pathology neuropathology and clinical pathological causes of death, testified that he reviewed the [d]ecedent's medical records and autopsy report and concluded that the [d]ecedent suffered from bacterial endocarditis. Dr. McCue explained that the bacterial endocarditis that affected the [d]ecedent's heart valves spread to his brain and eventually caused him to lose function in his brain, and lose function in his heart, and that "he just died."

Dr. McCue explained that the medical records, which showed no joint destruction, ruled out an infection of the [d]ecedent's wrist. He explained that bacterial endocarditis is a destruction of the heart valve, and that it had been sitting there for weeks and did not arise over the course of the five days following the [d]ecedent's visit to Dr. Trevlyn. Dr. McCue explained that had the wrist had an infection that contributed to the [d]ecedent's death it would have been noted on the final diagnosis of the autopsy report.

Trial court Rule 1925(a) opinion, 2/25/20 at 1-5 (citations to record omitted).

On November 15, 2018, a jury rendered its verdict in favor of Dr. Trevlyn. Appellants filed a motion for post-trial relief on November 26, 2018. ² The trial court denied the motion on November 8, 2019. Appellant timely filed a notice of appeal on December 6, 2019. The trial court ordered appellants to file a Pa.R.A.P. 1925(b) statement, which they filed on December 30, 2019.

The record reflects that on December 27, 2019, this court entered an order directing appellants to praecipe the trial court prothonotary to enter judgment and file with the prothonotary of this court, within ten days, a certified copy of the trial court docket reflecting the entry of judgment in order to comply with Pa.R.A.P. 301, which sets forth the requirements for a final appealable order. ( See order of court, 12/27/19.) This court further ordered that when appellants complied with Rule 301, this court would treat appellants’ previously filed notice of appeal as filed after the entry of judgment. Appellants timely complied. The record reflects that judgment was entered in favor of Dr. Trevlyn on January 6, 2020. By order entered January 8, 2020, this court discharged its December 27, 2019 order. The trial court filed its Rule 1925(a) opinion on February 25, 2020.

Appellants raise the following issues on appeal:

[1]. [Whether as] a matter of law and an abuse of discretion, the trial court erred in failing to grant [ ] appellants’ motion for judgment notwithstanding the verdict and, in the alternative, motion for a new trial[?]

[2]. [Whether as] a matter of law and an abuse of discretion, the trial court erred in [sic] when it precluded the testimony of [ ] appellants’ two expert witnesses which prejudiced [ ] appellants’ case[?]

[3]. [Whether as] a matter of law and an abuse of discretion, the trial court erred in precluding the admission of [ ] appellants’ three (3) minute video which prejudiced [ ] appellants’ case[?]

[4]. [Whether as] a matter of law and an abuse of discretion, the trial judge's behavior, both on and off the record, demonstrated prejudice to [ ] appellants. Consequently, [ ] appellants’ motion for the new trial should have been granted[?]

Appellants’ brief at iv (extraneous capitalization omitted).

Appellants first contend the trial court erred in failing to grant their motion for judgment notwithstanding the verdict or a new trial. As to each motion, appellants’ argue the verdict was against the weight of the evidence. ( See id. at 17, 18.) Appellants maintain that the undisputed testimony established that Dr. Trevlyn breached the standard of care with respect to the decedent. ( Id. at 18.)

We recognize the following standard of review with...