Form Versus Substance: An Analysis of the Pennsylvania Supreme Court's Decision in Stimmler v. Chestnut Hill Hospital

Pennsylvania - Medical Malpractice

On September 30, 2009, the Pennsylvania Supreme Court rendered a decision in Stimmler v. Chestnut Hill Hospital, 981 A.2d 145 (Pa. Sept. 30, 2009), a medical malpractice case that provides clarification on the Court's view on requests for admissions and the level of expert opinion needed to surpass the summary judgment phase. This article will offer a synopsis of the case's factual and procedural history and will then provide an analysis of the case's impact upon medical malpractice law.

In Stimmler, the plaintiff was initially admitted to the hospital for labor and delivery. Shortly following the delivery of her child, the plaintiff developed peripheral circulatory failure. As a result, the plaintiff underwent an atecubital cutdown of both elbows. Two weeks later, she was discharged in stable condition.

Over the next 36 years, the plaintiff experienced circulatory and respiratory problems. Although she sought treatment with various doctors to determine the cause of her condition, the source of her complaints remained a mystery until three consecutive echocardiograms, performed between December 1999 and February 2000, revealed the presence of a 12- to 18-inch catheter coiled in the right atrium of her heart. As a result of the finding, the plaintiff filed suit against the hospital and the various individual physicians involved in the cutdown procedure.

On March 24, 2004, during the course of discovery, counsel for one of the physicians served a request for admissions upon the plaintiff. The request asked the plaintiff to admit that she had undergone 16 subsequent procedures between 1965 and 1999 that involved catheter devices and that the plaintiff had no other information indicating that the foreign object lodged in her body was a piece of the catheter from the 1965 cutdown procedure. Forty-seven days later, the plaintiff served her response denying the aforementioned admissions.

Shortly after receiving the plaintiff's response and after receiving her expert reports, several defendants filed motions for summary judgment, which were granted by the Philadelphia Court of Common Pleas. The plaintiff filed a timely appeal to the Pennsylvania Superior Court. In granting the motions for summary judgment, the trial court ruled that the plaintiff's experts' reports, taken as a whole, failed to establish to the requisite degree of medical certainty that the catheter used during the 1965 cutdown procedure was the catheter found on the 1999-2000 echocardiograms and was the cause of the plaintiff's injuries.

On appeal, the Pennsylvania Superior Court affirmed the trial court's ruling. The Superior Court concluded that due to the plaintiff's failure to file timely responses to the defendants' request for admissions, the plaintiff admitted that she underwent the 16 subsequent catheterizations and, therefore, could not establish that the 1965 cutdown procedure was the cause of her injuries. The Superior Court relied upon Pennsylvania Rule of Civil Procedure 4014, which states that the request is deemed admitted if the opposing party fails to timely respond.

The plaintiff then appealed to the Pennsylvania Supreme Court. In reversing the prior courts' rulings and remanding, the Supreme Court initially found that the plaintiff's experts' reports met the requisite degree of medical certainty. The Court noted that the reports must be taken as whole. Although one of the experts stated that he could not precisely say how the catheter came to reside in that portion of the plaintiff's heart, the Court found it sufficient that the plaintiff's experts reasoned that within a reasonable degree of medical certainty the 1965 cutdown procedure was the most likely culprit or had the "highest likelihood" of such a catheter being inserted. Based upon the plaintiff's experts' reports, and other records indicating that catheters used in cutdown procedures resembled the catheter found in the plaintiff, the Court further found that even if the request for admissions was deemed admitted, the admissions did not refute the findings of the experts. Although the Court briefly cautioned against disregarding Pa.R.C.P. 4014, the plaintiff's failure to timely respond and failure to file a motion to withdraw the deemed admission had no bearing on the Court's ultimate ruling.

After review of the Stimmler opinion, there are several lessons to be gained for those attorneys defending medical malpractice claims and those insurance professionals handling such claims. First, be as specific as possible when drafting request for admissions. The court specifically noted there was no request regarding the size of subsequent catheters that could match the catheter found in the plaintiff. Such a request would have been more effective in combating the plaintiff's experts' findings; as the court noted in certain circumstances, deemed admissions may provide sufficient basis for summary judgment. Imprecise requests for admissions, as drafted by the Stimmler defendant, will most likely highlight issues of fact within the case. As Stimmler demonstrates, the Supreme Court is reluctant to rule upon motions for summary judgment and prefers to leave any perceived issues of fact to the jury's determination.

Additionally, do not assume an untimely response to a request for admission is automatically deemed admitted. If the opposing party's admission is contradicted by its expert testimony, then the admission will most likely be deemed a nullity and will not be considered sufficient basis for granting summary judgment. Lastly, the Stimmler Court essentially threw a bone to the plaintiff, as the concurring opinion cautioned against disregarding the rules of civil procedure and noted that plaintiff's counsel should have moved for relief from the admission.

In conclusion, relying upon deemed admissions as your basis for summary judgment, failing to timely respond to request for admissions, and failing to take the appropriate remedial steps for an untimely response are all risky bets on whether the court will accept form over substance, or vice versa.

*Samantha is an associate in our Philadelphia, Pennsylvania, office. She can be reached at (215) 575-3569 or slkane@mdwcg.com.

Defense Digest, Vol. 16, No. 1, March 2010