LANCASTER – After a woman who was a resident of the Hamilton Arms Center skilled nursing facility for two months died in June of last year, her daughter has argued the facility is directly responsible for the events in question and is now seeking to compel it to fully participate in case discovery.
Kathleen Paxton (as Administratrix of the Estate of Betty Jane Hahn, deceased) of Lancaster first filed suit in the Lancaster County Court of Common Pleas on June 19, 2023 versus Hamilton Arms Center Opco, LLC (doing business as “Hamilton Arms Center”) of Lancaster, HACHC, LLC of Wilmington, Del. and Panacea Health Corp., of Harrisburg.
The suit explained that Betty Jane Hahn was a resident of the facility from April 25, 2022 through June 24, 2022 and was incapable of independently providing for all of her daily care and personal needs without reliable assistance.
“Ms. Hahn was admitted to Hamilton Arms Center on April 25, 2022, following a hospital stay where she was diagnosed with Alzheimer’s dementia and paroxysmal atrial fibrillation. An April 25, 2022 Medication Review Report notes that Ms. Hahn had a 0.1 cm x 0.1 cm wound on her sacrum at the time of her admission to the Facility. A Nutrition Evaluation created upon intake described the wound as a Stage II pressure ulcer. A wound evaluation completed on April 28, 2022 describes Ms. Hahn’s sacrum wound as a 0.6 cm x 0.5 cm Stage III pressure ulcer. Noted interventions included a turning and repositioning routine, as well as the encouragement of hydration and mobility,” the suit said.
“An April 29, 2022, nutrition note recommended that Ms. Hahn receive supplemental protein liquid twice daily to support wound healing. The order for supplemental protein was not entered until May 9, 2022. By May 12, 2022, Ms. Hahn’s sacrum wound had worsened and was described as unstageable. That same day, Ms. Hahn’s sacrum wound was measured at 1.5 cm x 1.0 cm with slough tissue and a moderate amount of serous drainage. A May 17, 2022 therapy note indicates that Ms. Hahn was self-limiting her food intake due to a history of esophageal dysphagia, and had poor acceptance of the supplemental liquid protein. A once-daily frozen treat and house nutritional shake were added to Ms. Hahn’s nutritional plan.”
The suit added that “a wound evaluation completed on May 19, 2022 described Ms. Hahn’s sacrum wound as Stage IV with bone exposure. The wound was measured as 3 cm x 3 cm, with an unmeasurable depth and undermining present. Necrotic tissue was removed to establish viable tissue, and the evaluation indicated that the exposed bone had osteomyelitis”, in addition to a May 23, 2022 physician progress note which “indicated that Ms. Hahn’s sacral wound had a foul odor with necrotic tissue and bone exposure. The wound was to be cleaned and packed with dressing daily. A 30- day prescription for doxycycline was ordered.”
“On May 24, 2022, Ms. Hahn was weighed at 108.8 pounds. This was noted as a significant weight loss of 20.2 pounds over 30 days. A nutrition note created that same day indicated that the supplemental liquid protein was discontinued due to poor acceptance. A May 25, 2022 late entry daily skilled note indicated that Ms. Hahn’s sacral wound had a foul odor and green/yellow drainage. The wound edges were red and irritated with undermining present. A May 25, 2022 nursing note indicated that Ms. Hahn was turned and repositioned to her side, but rolled to her back shortly after. No additional intervention is noted. On May 26, 2022, Ms. Hahn was seen for her weekly wound evaluation. During the visit, Ms. Hahn’s daughter requested that Ms. Hahn be transferred to the emergency room for further evaluation and treatment of the sacral wound. Ms. Hahn was transferred to the emergency room that same day,” the suit stated.
“Upon admission to the hospital, Ms. Hahn was diagnosed with sacral osteomyelitis and leukocytosis. Vancomycin and ceftriaxone intravenous antibiotics were prescribed. A May 27, 2022 lab report indicates that a wound culture was positive for proteus mirabilis colonies and enterococcus faecalis colonies. Ms. Hahn was seen by an infectious disease physician on May 31, 2022. The physician noted that Ms. Hahn was not a candidate for debridement and wound closure. Palliative care was recommended. On June 2, 2022, Ms. Hahn was discharged from the hospital. Upon discharge, Ms. Hahn was prescribed a two-week course of oral augmentin. Ms. Hahn returned to the Facility on June 2, 2022.”
After continued deepening of her wound and a brief hospital stay and final return to the facility, Betty Jane Hahn passed away on June 24, 2022.
“The defendants negligently caused severe injury to Betty Jane Hahn when they: mismanaged the facility, under-budgeted the facility, understaffed the facility, failed to train or supervise the facility’s employees, failed to provide adequate and appropriate healthcare as described herein, engaged in incomplete and inconsistent documentation; failed to develop an appropriate care plan, failed to ensure the highest level of physical, mental and psychosocial well-being, failure to supervise, failure to ensure safety, failure to implement adequate safety precautions and failure to provide sufficient food and water, which, together, caused Betty Jane Hahn to suffer a Stage IV sacral pressure ulcer with osteomyelitis, severe pain, and ultimately death,” the suit said.
The defendants filed preliminary objections on Aug. 1, 2023, which labeled all of the plaintiff’s claims as “insufficient” in a general sense. The objections further argued that the demand for punitive damages was inappropriate and ill-founded.
In response to the defense’s objections, the plaintiff filed a reply on Aug. 17, 2023 which denied them in their entirety.
On Oct. 20, 2023, Lancaster County Court of Common Pleas Judge Leonard G. Brown III issued a split ruling on those same preliminary objections.
“Defendants’ objection under Pennsylvania Rule of Civil Procedure 1019(a), Pennsylvania Rule of Civil Procedure 1028(a)(2) and Pennsylvania Rule of Civil Procedure 1028(a)(3) as to all of plaintiff’s claims is overruled. Defendants assert that the complaint is insufficiently plead and contrary to law because plaintiff did not include separate counts against each individual defendant. Plaintiff contends that the averments in the complaint ‘are not distinct causes of action, but rather theories of recovery encompassed within one cause of action – negligence.’ Plaintiff cited persuasive authority from Courts of Common Pleas around the Commonwealth that held, ‘separate counts are required when more than one cause of action is stated, but when the factual background is identical for all defendants regarding negligence, no further delineation or separate allegations to each defendant is required. Here, since the factual background for the negligence claim is identical, the complaint is sufficiently clear to enable defendants to prepare a defense,” Brown said.
“Defendants’ objection under Pennsylvania Rule of Civil Procedure 1028(a)(4) to strike all claims for punitive damages and any language describing moving defendants’ conduct as ‘reckless,’ ‘intentional,’ ‘reckless indifference,’ and/or ‘willful and wanton’ is sustained without prejudice. Plaintiff avers that defendants ‘recklessly reduced expenditures for needed staffing, training, care and supplies, at the expense of the healthcare of the residents and despite the knowledge that this cost-cutting would inevitably lead to severe injuries, such as those suffered by Betty Jane Hahn.’ As a result of defendants’ alleged recklessness, ‘Betty Jane Hahn was caused to suffer serious and permanent injuries.’ These allegations, without more specificity, are legally insufficient to support punitive damages. Allegations of ‘recklessness’ are stricken without prejudice. Plaintiff may file a motion to reconsider punitive damages at the close of discovery if such a claim is supported by evidence obtained during discovery.”
The defendants answered the litigation on Nov. 14, 2023 and denied its substantive allegations, before providing new matter in their own defense.
“Plaintiff’s complaint fails to state a cause of action upon which relief can be granted. At all times material hereto, answering defendants, through their agents, servants and employees, provided skilled nursing services and/or other health care services in accordance with the applicable standard of care. At all material times, one or more of answering defendants were not a health care provider, provided no healthcare services to plaintiff or plaintiff’s decedent and therefore, had no duty to plaintiff or plaintiff’s decedent and are not liable for the causes of action alleged. If it is determined that answering defendants are liable on the plaintiff’s causes of action, answering defendants aver that the plaintiff’s recovery should be eliminated or reduced in accordance with the Pennsylvania Comparative Negligence Act,” according to the new matter, in part.
“Plaintiff’s claims are barred in whole or in part by plaintiff’s and/or plaintiff’s decedent’s assumption of the risk and/or contributory negligence. All of the claims and causes of action pleaded against answering defendants are barred by plaintiff’s and/or plaintiff’s decedent’s knowing, voluntary, fully-informed consent to the care rendered. It is further averred that if the plaintiff and/or plaintiff’s decedent suffered any injuries and/or damages as alleged, they were caused solely and primarily by the carelessness, recklessness and/or negligence of third parties over whom answering defendants exercised no control and for whom answering defendants cannot be held accountable. Plaintiff’s claims are barred in whole or in part by the applicable statute of limitations and/or the equitable doctrine of latches.”
Among other additional defenses, the defendants argued that “Hahn’s medical condition on admission to the facility was severely compromised and as such any injuries that [she] may have developed and/or any injuries she sustained during her residency at the facility were unavoidable.”
In a Nov. 30, 2023 reply filing, plaintiff counsel “specifically denied that the injuries and damages alleged in plaintiff’s complaint are not causally related” and that they were pre-existing in nature – in addition to classifying the vast majority of the defense’s arguments as “conclusions of law, to which no official response was required.”
UPDATE
Plaintiff counsel filed a motion to compel discovery on April 3, arguing that the defense has ignored prior deadlines to provide evidence during the discovery process.
“On or about Nov. 8, 2023, defendants were served with plaintiff’s interrogatories and requests for production. On Dec. 18, 2023, counsel for plaintiff granted counsel for defendants a 30-day extension to provide discovery responses. Counsel for plaintiff sent a good faith letter to counsel for defendants on Feb. 5, 2024, requesting answers to plaintiff’s interrogatories and requests for production. Counsel for defendants responded to the good faith letter via email on Feb. 14, 2024, requesting an additional 10 days to provide discovery responses. To date, defendants have failed to respond to plaintiff’s discovery requests,” the motion to compel stated.
“Pennsylvania Rule of Civil Procedure No. 4003.1 states that a party may obtain discovery regarding any matter, not privileged, which is relevant to the subject matter involved in the pending action, whether it relates to the claim or defense of the party seeking discovery or to the claim or defense of any other party, including the existence, description, nature, content, custody, condition and location of any books, documents or other tangible things and the identity and location of persons having knowledge of any discoverable matter. Plaintiff is in need of the information, documents, and depositions requested in order to properly prosecute their claim against the defendants. Defendants’ failure to respond to plaintiff’s requests is prejudicial, is hindering plaintiff’s ability to prosecute this case and violates Pennsylvania Rules of Civil Discovery Procedures.”
For counts of negligence, survival and wrongful death, the plaintiff is seeking damages in excess of $50,000, plus costs and any other relief the Court deems appropriate given the circumstances.
The plaintiff is represented by Ryan J. Duty of Senior Justice Law Firm, in Pittsburgh.
The defendants are represented by Lee J. Janiczek and Alexander D. MacMullan of Lewis Brisbois Bisgaard & Smith, in Wayne.
Lancaster County Court of Common Pleas case CI-23-04261
From the Pennsylvania Record: Reach Courts Reporter Nicholas Malfitano at nick.malfitano@therecordinc.com