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Home My WebLink About95-00604 'I, il' rli , ;'1 1,'1 .: ," " " , , , , " , if I>" , ,'II , -11, " " " , .. , , 1,1 " , ' '1,,1 " , , ,/ I' " , , 1'1,' " ,,'f,' t(\ ,Ii , , 'k >,i 'I' I"~ ',' " ,!. i'l , " , 'I'. , I., " " I' \ ,i,'1 " II I! ,,' ;j , , , " , I, ''o\ 'I ,,' ii " '" " , , , , , ' , , ','I " I , " " , .'- j ,ill 'I" 'I, , , " II" " I " " I, III , , ' " " ill " " , " /' " ," ,I, "' " , il 'I': ! \! '" " ji ',I. 'II pI " 'J,! " 'I, " d,it ;,. \r' j, ',_I ii' ,",1 , , , , i' .' , , ,'I " , , !' , " " '1 ! I' " , , " " '-,I 1,1 '" , " , , " , " , ' , ' '1,; ;.\ ., ii " ,II :,1 " !, 1'1' ""1 ,,'; " " " ')>1 1'1, it' 'I ',' " , ,( " " ., I " , " 'II " " ., , 'I " , " , " , , III '" ;I,' ill II d \' ;'1 ",II ,I' !']I , , , , ,,' i Iii d " " , II , " , " " I ,'j ',' " Ii , " , , , " 'it '" " " , -II "I " ',:1 ,/ I , " ,1'\ " , " ,;;.\ Ii, " , " , , " " " I, " ,/ In -',' "I I "' ,,\ 'I' ,', \'I , i'l , \, i\ 'I 'I' 'i , , '\\ ,II' ,'J ,il I. " , II , , " " ," J i ,if .., 'I ",' , " , " , " " " "I' " '.,(' ,/ \" ,; , , "',"il' , , . " ( I 1\ 'ii, , .II \ I, /\i_'d' ,'., " ,,:'I)I'II:i I, '\;II~.Il\I,,)>\ ",I HI- \: ',I,"" , , '.\1 ll(. .Li , , 1/'1; .. I,,, " " Ii" I , ,j" , \I " , , , , 'I' '1'1 I' 'I 'l'it 11\",1..>, 1:'\ 'I "I '1'1 i;,! i, III " !' , I II :i-_i:;;j'~\" '!:,', ,-:1 ; :_ilijJf :"1]\) "'.')' " \. "'I ,.:1 '::',1) 'j\t "'\_i!! " " ,I Batt.~~, tbat Defendant, Dr. Rou.., committed a batt.r~ in b~. treatment of Plaintiff when hel a, Failed to inform Plaintiff that a ateroid J.n~ecl:ion .uch e. Depo-Medrol lIIodiUe. the body'. bllnune re.ponae, thu. lowering reai.tance to diveree .tillluli caueing infection, b. F.iled to inform Plaintiff that he ri.ked deVeloping intection, particularly in view of hie diabetic statu., from lY>>~i..ion to an iniectio~ of Depo-Medrol, c. Failed to inform Plaintiff ot the lIIedicel !alternative. aveilable to treat hi. oondition, other than the administration of a .teroid iniection ond corresponding aspiretion, d, Failed to inform Plaintift that the admini.tration of a steroid such a. Depo-Medrol raplete. liver glucagon and rai.e. blood gluco.e, alao impairing peripheral utilization ot gluco.e, e, Failed to inform Plaintiff that it, in tact, be elected to lubmit to an iniection of Oepo-Medrol, be would have to monitor biB in.ulin requirement. ver.y carefully, a. it was likely that hi. in.ulin requirement. would increa.e a. a con.equence of tbe .teroid medioation, and f. A. a reault of having feiled to .ecure Richard Ketzman'. informed con..nt for the performence of the .teroid iniection and &lairation, he pertormed en unauthorized prooedUre, whicb procedure oon.tituted a technicel battery. III. STATEMENT OF OUEST ION INVOLV~ WHETHER DEFENDANT IS NOT ENTITLED TO A GRANT OF HIS DEMURRER TO PLAINTIFFS' CLAIM FOR BATTERY IN COUNT I OF THE COMPLAINT WHERE PENNSYLVANIA RECOGNIZES THE THEORY OF INFORMED CONSENT ~N SITUATIONS I~VOLVING DISPUTE FOR THE NBED FOR AN INJECTION? :II (8u9ge.ted an.wer in the attirmative.) IV. ~UMIlt1T DEFENDANT IS NOT ENTITLED TO A GRANT or HI' DIlHURRIR TO PLAINTIFF8' CLAIM FOR JATTIRY IN COUNT I OF THB COMPLAINT WHERW PINNSYLVANIA HAl RIlC':OGNIZID THIl THIORY or INrORMIlD CONIINT IN S%TUATIONS WHIlRIl THIl NIIllD FOR AN INJICTION II DISPU'l'ID. Plaintitt. contend that the Detendant h.. correctly .et torth the .tandard governing this Court tor the determination on whether or not a Demurrer .hould be 9ranted. Monover, Plaintitt. tind that Detendant corr~ctly characteriud the traditional approach in Penn.ylvania, invclving intormed con.ent, where, currently, intor.ed con.ent io, indeed, grounded in battery, Gray v. Grunneale, 423 Pa. 144, 223 A,2d 663 (1966). plaintitt. agree that the ba.i. tor an action tor lack of informed con..nt ocour. when a phy.ioian touohe. . patient, re.ultinq in a technioal battery, unle.. the touching i. done with the patient'. full informed con.ent. 14. Beoau..e penn.ylvania 11 one of the minority .tate. that embrace. the informed con.ent doctrine under a theory ot battery, a. oppo.ed to negliqenoe, the court in Boyer v. smith, 345 Pa. Super, 66, 497 A.2d 646 (1985), ditferentiate. that the doctrine dae. not include the edminbtration ot therapeutic drug. beoau.e the admini.tration at .edication. doe. not involve the "touchinq" requirement of a battery action. 3 A aa.inal caaa diacuaainq tha lack of applicability of informad con.ant action. to the pre.cription of medication. i. ~u v. SpancI, 413 Pa. Super. 35a, 605 A.ad 39~ (199a), In thi. c..a, the appellant w.. trlllted with intravenou. naqyl, In antibiotic medication, Bacau.e of the action of the madication on h.r .y.tem, the appellant alleqed that Ihe developed peripheral neuropathy al a complication of the medication itaelf, She opined that the phYlioian failed to IIdvi.a har of the potantial risk ot the development ot this complicating' paripheral neuropathy lIa a conaequence of the medication employed. A non-auit was qranted by the trial court and affirmed by the Superior Court ot Pennlylvania. Id., at 396. The rationale behind thil deciaion ia that becauae the appellant wa. cllliminq harm trom the actual let ion ot the medication, and not throuqh the method ot adminiltration ot the medication, Ihe could not purlue thil action under a battery count. Whethar or not ahe had reoeived the antibiotio orally or throuqh injection, hyr rilk at encounterinq peripheral neuropathy would have been the .ame. Therefore, the method of adminiatration of the IIntibiotic wal not in question. conversely, and critical to thia analYlia, the c..e ot Karibillnian v, Thomllll Jetterson Univeraitv HOlbital, 717 r. supp, 1081 (I,D. Pa, 1989), expands the dootrine ot intormed con.ent to allow IUch a theory to prevail where it il the nlI4 tor the injection itself, the partioular edminiatration ot the 4 medication, that i. di.puted. In ~arib1ania~, the plaintiff received an injection of Thorotr..t durinq a cerebral Arter ioqraphY, Th. ~lIrib1anian court .pecifically determined the lollcwinql Wh.n it i. the ne.d for an injection which the pati.nt di.pute., it i. r.a.onable to impo.e a duty at informed con..nt. 'or example, there ara .om. druq. which may be admini.tered either orally or by injecticn! the d.ci.ion to inject .uch a druq .hould b. mllde only with the plltient'. informed con.ent, On the other hand, When it i. the lubetanoe admini.tered, not the m.thod ot IIdmini.tration, which i. challenqed, I a9ue with JUdqe Hoftman that it 18 ab.urd to invoke the duty of informed con.ent .imply b.cau.. the phydcien or nurlle mu.t touch the plltient to inject the drUq. Id. It 1084, In their Complaint, Plaintiff. con.i.tently point out in flrl9raph 30, Count I, Battery, that Defendant, Dr. Roumm, i. oritici.ld tor committinq a battery in hi. treatment of Plaintiff when he performed II .teroid injection and oorra.pondin9 a.piration under circum.tance. which did not inolude qa!ninq the patient'a tull informad con.ent. bl, Complaint attechad II. ..hlblt "A," Defenee coun.el, in hi. argument .upporting the Preliminllry Objection. advanced, allege. the fo110winql The reaaoninq of Judql Lord in Karibiani~D al.o would mandate tha di.mi..al of the battery count in the in.tant calle .. Plaintiff. clearly allege that it i. the Depo-Medrol that aau.ed or contributed to the difflcultie. of Mr. Kataman IS and not the method by which it waa adminiatered. Of courae, auch an argument would be abaurd aa Oe~o-Medrol oan only be adminiatered by injection, Unfortunately, defenae counael ie incorrect in hie characterization of the medicine involved in thia matter, In fact, Medrol tableta are available, alao indicated for the treatment of acute gouty arthritia in rheumatic diaordera, and are the counterpart to the Oepo-Medrol aterile aqu80ua auapendon which require. injection. Medrol tableta, like Oepo- Medrol, contain Methylprednisolone which is a glucocorticoid, and could have been administered in the caae at bllr, aa oppoaed to the recommended action of an injection of the liquid form of thia medication. Although it ie true that the ingeation of Medrol tableta alao may mask aigna of infection, and may be cauaative in new infectiona, the manner of injecting thie medication (Oepo-Medrol) sUbatantiaUy enhllncea the po..ibility for infection to develop, particularly in the diabetic patient, For example, the 1995 edition of the Phyaician'a Oe.k Reference referable specificlIlly to the Oepo-Medrol injection adminiatered to Mr, Ratzman, the Plaintiff, indicatee the followingl MUlti-dolle use of Oepo-Medrol atarile IIqueoua auapendon from a dngh vial requirea apecial care to avoid contamination. Although initially sterile, any multi-do.e uae of vial. may lead to contamination unle.a atrict aaeptic technique ia obaerved, Pllrticulllr care, auch a. II u.e of di.po.abl. .t.rile .yrinqe. and n..dl.. i. n.o....ry. Whan mUlti-do.. viah Ire u.ed, .pecial care to prevent cont.min.tion ot the cont.nt. i. ....nti.l, Th.r. i. .om. .vid.nce that b.nzalkonium chlorid. b not In ad.quata anti-.eptic for .t.rUizing thb product. A povidon.-iodin. .olution or .bUn produot i. recomm.nded to ol.an.. the vial top prior to a.piration of cont.nt., Thi. .p.cific warning found in the Phycician'. D..k R.t.r.nc. ..t. forth that an individual who .ubmit. to injeotion may develop .n inf.ction a. a con..quence of bact.ria b.ing introduced into the patient'. .yetem through the ineertion of a n..dl., .nd .ubeequent puncture of the akin. A diabetio patient i. particularly .u.ceptibl. to inj.ction. of any nature b.cau.e of thi. tendency to pot.ntially introduc. bact.rial .timulu., Of oour.., it i. quite clear that oral inge.tion of m.dioation do.. not po.e thi. eam. ri.k, II. there i. no punctur. of the .kin, and no opportunity to introduce bact.rial ag.nt.. Therefor., clearly in k.epinq with Pllragraph 30 (a)- (f) under Count I, Battery, of the Complaint at h.u., the Plaintiff. ar. di.puting the need for an injection in the care Ind treatment of Mr. l<atlzman, Speoifically, Para9rllph 30(c) criticiu. Dr, Roumm for hiD "teUure to inform Plaintiff of the m.dical .lternative. availllble to tr.at hi. condition, other than the admini.tration of a .t.roid inj.otion and oorr..ponding a.piration." On. of the mediclIl alt.rnativ.. whioh the Plaintiff WII not attorded In opportunity to conlider waG Idlllini.tration of the medication in qua.tion in the form of 7 IIlhlblt A " , " :I '.1' ".Ii, (~;) II " ,', " " " ," ,', " ',l , , " " " " , I, ., Ii " , , , ,\ , , 'I " , " '" I,]' , ill , " I', , ',! " , , II., " " , , " , , S. That on or about February.5, 1993, Plalntiffretumed to the ofllces of Cowley Auociates complalnlna of a warm, swollen, painful left ankle. 6. That the physician evaluatina Mr. Katzman on February .5, 1993 also dlaanosed the condition of "aout" and prescribed Colchicine and Lortab, an X-rIlY of the left foot was also obtained. 7. That durlna the evenina hours of February 5, 1993, Plaintiff called lhe medical offices of Cowley Associates to report that his pain was stili severe, even with the usage of Colchicine. 8. That on or about the evening of February 5, 1993, at approximately 8:00 p.m. Dr. lonathan Whitney of Cowley Associates phoned Dr. Roumm to discuss Mr. Katzman's condition. 9. That via telephone, Dr. lonathan Whitney communicated to Dr. Roumm that Mr. Katzman was experiencing severe ankle pain, and he was suspicious of gout, Dr. Roumm was then asked If he would evaluate the Plaintiff on all emergency basis if Mr, Katzman's symptoms did not Improve further. 10. That via the telephone conference between Doctors Whitney and Roumm, Dr. Roumm additionally learned that Mr. Katzman had experienced acute and abrupt onset of ankle pain which proccas had been onlloing for the past 2-3 day period, that the ankle and foot were painful, and the Plaintifr s uric acid level was elevated. II. That on or about February.5, 1993, at approximately 9:00 p.m., Dr. Roumm telephoned the Plaintiff to Inquire about his physical status relative to his left ankle; an appointment was then arranaed to take place on Saturday morning, February 6, 1993, at Dr. Roumm's office. 12. That on the momina of February 6, 1993, Plaintiff presented to Dr. Roumm's office as previously arranaed. 13. That durina the office consultation of February <I, 1993, Dr. Roumm inquired about the Plalntlrrs medical history, and learned that Mr. Katzman is an insulin-dependent diabetic, and also suffers from hypertension. 14. That after havina performed an examination relative to Plalntlfrs left foot and ankle, Dr. Roumm formed the impression of .probable acute aouty arthritis.. , 15. That durina the office consultation of February 6, 1993, Dr. Roumm made an attempt to aspirate Plalntlrrsleft ankle and injected the site with one and one-half (1111) cc. of Depomedrol. 2 16. That durlna the ofl1ce consullallon of February 6, 1993, Dr. Roumm advised that Mr. Katzman shQuld continue Iakina both the medications of Naprosyn IlI1d Colchicine: Mr. Katzman was further advised to call the ofl1ce on Monday to make a follow-up appointment. 17. That on or about Monday, February 8, 1993, Mr. Katlman called Dr. Roumm's ofl1ce as previously Instructed, and reported that his ankle was improved, but his right wrist was now painful; he also reported "dry lips." 18. That on the evenina of February 8, 1993, Mr. Katzman developed a fever, chills, and confusion consistent with a septio episode and diabetic ketoacidosis. 19. That on orabout February 9, 1993, Mr. Katzman was admitted to the Holy Spirit Hospital In an acutely confused state of mind, with a pulse of 100, and a temperature elevation of 103.6 dearees Fahrenheit. 20. That upon Plalntifr. admission to the Holy Spirit Hospital on F-:bruary 9, 1993, Dr. Roumm's partner, Dr. Sanford, aspirated a right and left wrist, as well as left ankle~ a STAT aram stain f, Jm the Joint nuid aspirates revealed 4-plus araln positive cocci streptocci-Iike oraanisms. 21. That Mr. Katzman was admitted to the Holy Splnt Hospital with an admission diaanosis of "polycentric, septic Joinll, acute and rlaht wrist, left ankle and possibly shoulders; probably history of sepsis, uncontrolled diabetes, probably even ketoacidosis; and history of hyperuricemia-acute lout." 22. That on or about February 17, 1993, while Plaintiff WIU hospilaH7.ed at Holy Spirit, an "intact" blister over the lateral malleolus of the left ankle WI., noted. 23. That on or about February 19, 1993, the bullae on the left ankle had ruptured, and was thus covered with a dressina. 24. That on or about February 23, 1993, a "blackish" eschar was noted over the lateral malleolus of the left ankle. 25. That on or about March 15, 1993, durlna the Holy Spirit Hospital hospilallzatlon, Plaintiff was sufferlna from multiple necrotic lacerations of the left ankle. 26. That on or about March 29, 1993, Plaintiff was transferred from Holy Spirit Hospital to the Mechanlcsbura RehabIHlallon Hospltal~ at that time he was admitted was three (3) wounds demonstratina necrotic tissue over the left ankle. 3 f. As a result of having failed to secure Richard Katzman's Informed consent for the pe,formance of the steroid Injection and aspiration, he pcrformed an unauthorized procedure, which procedure constituted a technical balle,y. 31. That as a result of Dr. Roumm's conduct as described In the preceding paragraph of thi$ complaint, Plaintiff developed sepsis, and/or suffered an aggravation of an underlying condition of sepsis which had not be.en diagnosed at the time of Dr. ROllmm's treatment on February 6, 1993, r~ulrlng prolonged hosplteli7,ation for treatment of this condition. 32. That as a result of Dr. Roumm's conduct as described in Paragraph 30 above, Plalntifrs diabetic condition became uncontrolled, and he suffered diabetic ketoacidosis, which condition also r~uired prolonged hospitalization to COrrect. 33. That as a result of Dr. Roumm's conduct as described In Paragraph 30 above, Mr. K.atzman's dual conditions of sepsis and diabetic ketoacidosis combh\ed to hasten the loss of his left leg In amputetion. 34. ThaI as a result of Dr. Roumm's conduct as described In Paragraph 30 above, Plaintiff incurred medical bills. 3S. That as a result of Dr. Roumm's conductllS described in Paragraph 30 above, Plaintiff lost wages. 36. That as a result of Dr. Roumm's conduct as described In Paragraph 30 above, Plaintiff has sustained a diminution of his earning potential in the future, 37. That iU a result of Dr, Roumm'a conduct as described In Paragraph 30 above, Plaintiff Is anticipated to incur future medical expenses. 38. That as a result of Dr. Roumm's conduct as described in Paragraph 30 above, Plaintiff has been caused to sustain, and will, in the future, continue to sustein pain, suffering, Inconvenience, emotional distress, embarrassment, and loss of life's pleasures. WHEREFORE, the Plaintiff, Richard Katzman, demands judgment against Alan D. Roumm, M.D. for judgment in excess of S2S,OOO, together with intcrcst and costs of suit, 5 COUNT II RICHARD KATZMAN v. ALAN D. ROUMM, M.D, NEGLIGENCE 39. Parasraphs Ithroush 38 are incorporated herein by reference. 40. That the Defendant, Dr. Roumm, wu negligent and careless In the mNicaltreatment and/or advi~ provldN to Plaintiff in that he: a. FailN to recoani:r.e that both the mNical conditions of diabetes and hypertension are considerN to be relative contra-indications to the administration of steroids, such that he did not sisnlflcantly weigh tile advantases of cortico-steroid therapy qainst the possibility of deleterious results; b. FailN to acquaint the Plaintiff with the other mNical alternatives to treatment of this condition; c. FailN to recommend further conservative therapy, u opposed to utili7.ation of a steroid injection, in view of Mr. Katzman's diabetic status; d. FailN to inform the Plailltlff thllt the administration of a steroid such III DepomNral repletes liver glycogen IllId ralses blood glucose, also impairing peripheral utilization of glucose, such that the Plaintiff did not appreciate the need for careful monitoring of his increased insulin requirements; e. FaliN to contact Cowley Auociates to inform Mr. Katzman's family physicians that a steroid injection had been administered such that his diabetic status could be appropriately monitored, f. FaliN to appropriately differentiate gouty arthritis from septic arthritis, prior to administration of the steroid injection as the administration of Depomedral in an infected joint would have been contra-indicated. 41. That as a result of Dr. Roumm's conduct as dacribed in the preceding paragraph of this complaint, Plaintiff developed sepsis, and/or suffered an asgravatlon of an underlying condition of sepsis which had not betn diaSnosed during Dr. Roumm's consultation of February 6, 1993, requiring prolongN hospitalization for treatment of this condition. 6 CIRTI'ICATI Q' .laVICI I hereby certity that I .erved II copy ot the t0r8go1nq doculllent upon the person(s) indicated below by depoeitinq a copy ot the IIIl11e 1n the United stet.. lIlail, po.taqe prepaJ.4, at Harr1.burg, Pennaylvllnia IInd addr....d II' tollowSI Peter J, Curry, E.quire Thollla., Thollla. , Hater P.O. Box U9 305 North Front street Harr1.burg, PA 17108 Attorney for Detendant, Alan D. Roumm , ' , \, ' , " , , i , , , Datedl /I J~lltfr I I " :: " , ", , ' , " I': , , " "d " , .' .111 I 'J~"m".', 'J~tJ"m, fy J("/,,. ,~"o""~V' ,11 1"uI an NOAYH 'AONY "AllY ~, 0. 10" "" '. M~A."lllAO. )'Io-IYIOI j) SEP 2l , 'I ';~ 'I r\\ALt ~ ';,ill; f .17"'.::'1'\' , , 'i i'" ",\" II' " ,ill; I' . , :~ I , " , , " I , , " '<'I , " I , ' " " , ' " ,',\ , " , , , r .,. ~ " ......I...H. ._-.......~. Dr. Rouam ba.ed on the care and treatment Dr, Roumm rendered to Richard ~atlman on or about Februllry 6, 1993. Detendant tiled a Preliminary Objection to Plaintittl' Complaint on September 18, 1895. Thia Briet i. .ubmitted in support at Detendant'. Preliminary Objection to plaintitt.' Complaint. II, ,TAT.N.HT O. .ACT., Plaintitt. are Richerd l<atzman, an inBulill-dependent diabetic, and hil wite, Patricia l<lIt70man, Detendant Allan O. Roumm, M.O. i. a rheumatoloqist who wa. conlulted by Kr, l<atzmanls primary care phYlioian. in February U93 concerninq hiB oomplaint. ot acute ankle pain which i. charllcteristic at qout, Mr. l<atzman had been .anaved on .everal medication. by hi. primary care phy.ician. in :(''rl~ the day. prior to the February 6, 1993 oonllultlltion with Dr. aouam. On February 6, 1993, Dr, Roullllll took a verbal hi.tory trom Hr. ~atlman, Followinq a thorouqh examination, Dr, Roumm 4tte.pted to a.pirate Nr, ~at.mlln'. ankle which yielded no tluid, Mr. Kat.man'. ankle wa. al.o injected with a oortiooateroid, Oepo-Medrol, at that ti.e. . \',\\. Hr. Ket.mlln wa. admitted to Holy spirit Ho.pitel on \. February 9, 1993, .eoondary to oontusion, dehydration and hyperqlyoe.ia. He IIpparenUy tailed to take his inllulin durinv the previou. day.. Mr. l<atzman experienced various complication. over the 8ub..quent .onth. and, ultimately, hillett lower extremity wa. - 2 - ..put.t.d mol'. th.n tour month. .tt.r hi. con.ult.tion with Dr. ROUJDII. Plaintitt. all.,e, inter alia, that Dr. RouJDII cOJDllitt.d . battery on Mr. Katzman when he t.Ued to intorm him th.t Depo- Medrol lD.y modify hie ilDlllune r..pon.. and impair p.riph.ral utililation ot qluco.e which may have contributed to Mr. K.tllDan'. ultimate injuriee. III. 'T&TIMI~ O. OUI.TIOM IKYOLVIDI ..ITI.. D...IDAXT X. .~XTL.D TO A GaAHT O. RX' DlHvaall TO 'LaX~n.., CLaXII .0. I&"IIY X. COUIT I 01. J....YLVUIA IIU .aXL.D TO .ICOO.II. LaC. O. IDOUID CO.'nT X. IITOa'lIO.' I.,OL'X.a 18. &OIIX.IITI&'IO. O. II1DXCATI01f1 (Iu"e.ted an.wer in the .ttirmativ.,) III, UIIUIIIIrl' I D.f.....t i. ..tltl.. to tb. 9r..t of bi. ...~~~ to .1.1.tiff.' ol.ia for b.tt.ry wblob tb. J....ylv..l. .upr... court baa fail.. to r.oo9.1.. lD tbl. .ltuatlo.. Thi. Court r.c.ntly raiterated the applic.bl. .t.nd.1'1l of r.vi.w of pr.limin.ry obj.ction. in the n.ture at . demurrar. A d.murr.r .hould only b. 9rllnted in c.... th.t .r. tr.e trom doubt, C... v. Cheetnut Hill coll.a., 42. 'a. lup.r. 263, 632 A.2d ee7, e60 (le'3). Ae .xpl.in.d by the '-&II. courtl [.) pr.limin.ry obj.ction. in the nlltur. ot . d..urr.r .dmit .v.ry w.ll-pl.aded tllct and .11 int.renc.. rea.onably deductible ther.trom, it t.ftt. the log.l .uttici.ncy of the chall.n,.d complaint and will b. au.tain.d only in tho.. c.... where the plead.r ha. olearly fail.d to .t.t. a clailD tor which r.lief .ay b. grant.d. If th.r. i. IIny doubt, a. to whether a claim - 3 - "., -....~_.. ,or nU.t had been .tat.cl, the trial oourt .houlcl r..olvl it in t.vor ot overrulinq the demurrer. 14. at 560-561, auotina Ruthar'Qrd v, Do.pital, 417 pa,super. 316, 321-22, 612 (lU2) . pr..byt..rian A.2d 500, 502 Klin.p.t.r. Admini.t.ratrix of Snvd.r v. S".yd.r, 114 Dauph. 415, 417 (1994). The trial court .houlcl, how.v.r, di.reqard conclu.ion. ot law which are pleacled in the complaint, Smith v. Exxon corp., 431 Pa,Super. 221, 228, 647 A,2d 577, 580 (1994), oitinq ,avaliara v. Duff'. Bueina.. Inatitut., 413 PII,Super. 357, 361-312, 605 A.2d 397, 400 (1992). Traclitionally in Penn.ylvanie, intormed conaant ha. b.en qround.cl in battery. Gray v, Grunnaala, 423 Pa. 144, 223 A.2cl 663 (1961) . Th. bade tor an action tor lack ~t intoned con..nt occur. when a phyeician touohe. a patient, re.ultinq in a tachnical battery, unle.e the touchinq i. clone with the patient'. ccn.ent. 14. In Bovar v. Smith, 345 Pa.super. 66, 497 A.2d 646, 64' (11115), the court limited the dootrin. ot intormed con..nt to tho.. c.... involvin9 .urqical or operative proc.clure., 14, at 77-7'. Th. court in Bovar t.lt that to .xpand the doctrin. to the adaini.tration ot therapeutic clruqe would totally oblit.r.t. the .t.ndarcl. .at torth in~. 14. Thi. podUon h.. been con.ilt.ntly upheld in penn.y 1 vllnia. M.ll~v v.. Shanahan, 210 P..Sup.r. 440, 421 ~.2d 803 (1980)1 Kaeoh v. Mead John.on , CD., 39. Pa.Super, 329, 580 A,2d 1374 (19'0), - 4 - More recently, the ~ and Boyer decisions were tollowed in Wu v. Silence, 413 Pa,super, 311:1, 6011 1o,2d 3911 (1992). In ifII" appellllnt was treated with intravenous Haqyl, an sntibiotic. Appellllnt'lI theory ot recovery w.s that appellee tailed to advise her ot the potential risk ot peripherel neuropathy as _ result ot the treatment. 10 nonsuit was qunted by the trial court and attirmed by the Superior Court of Pannsylvania, 1d, at 396. The ifII, court held that it is olear that no cause of action was e.tablished. ld, Judqe Lord somewhat muddies the waters ot the clear Pennsylvania intormed con.ent law in Karib1anian v. Thomas ~er.on University Hcsllital, 711 ,.Supp, 1081 (1.0. Pa. 1"'), althouqh, even under his reasoninq, the battery count i. not appropriate in the instant matter. Kllrib111nien involved the injeotion ot Tborotrast durinq II cerebral arterioqraphy. Judqe Lord dismissed one of the intormed consent counts bOldinq that " [w) hen it ill the .ubstanoe administered, not the method ot administration, whioh is challenqed, I aqree with JUdqe Hottman that it is ebsurd to invoke the duty of informed consent si.ply becau.e a physician or nurse mu.t touch the patient to inject the druCJ." !d. It 1084, In the instllnt case, Plaintitfs allege that Dr. Rouaa committed a battery by failing to inform Mr, Katzman that Oepo- Medrol modifies the body'S immune system, may increase the risk for developinq an infection, repletes liver glucagon, raises blood - II - 91uco.e, and impair. peripheral utilization of 91uco.e, Dr. Rou.. al.o allegedly failed to provide altern.Uve. to the .dminbtraUon of Oepo-Medrol, which i. .v.il.ble only in .terile aqueou. .u.pendon for J,njecUon, Penneylvllnia courts h.ve con.i.tently followed the mandate of ~ .nd h.ve refueed to exp.nd the doctrin. of inform.d con..nt beyond tho.e c.... involvinq .urqic.l or oper.tiv. proc.dur... The re..oninq of Judqe Lord in K.rib~ani.n aleo would .andate the di.mi..al of the b.ttQry count in the in.t.nt c... .. Pl.intiff. cl.arly all.qa th.t it i. the Oapo-Madrol that cau..d or contributed to the difficulti.. of Mr, K.tzman .nd not the m.thod by which it w.. .dmini.t.r.d, ot couna, .uoh an Ilrqument would be ab.urd a. O.po-Medrol c.n only b. admini.t.r.d by injection. I.. CO.OLU.IOIIa ror the for.qoinq r.a.one, Oef.nd~nt'e Pr.liminary Obj.ction in the nature of a demurr.r to plaintiff.' olaim for batt.ry .hould be .u.tained and Count I be di.mi..ed from the complaint. Re.p.ctfully .ubmitted, I)ATII 9 !:wj9'5 .I . ,,' " I d , , " " " , I t ..,.., m ~ ~ , (,j,1 I \~ C.) t; . "" ';::". ~ ~ , " ~$ .(8 " T .J " , " 't" '-"" " '1' .'" .,.--... ........ .. ~,..... " .' -.4> CCJ.'MONWEM:rtl Of' PE~NNB,{I.vANI^, COJI';'I''{ ()/o' C.UofllF.fl/.AND , " In The Court of Carmon Ple/J1l of CUlloorl/Jnd county, Pennsylania No. 9')-604 civil 'l'enn Hllll110pS in Civi I Action Law , , Richard K/Jt:zm/Jn and P/ltrida KBt:zman, h.1a wl.fll VB Alan 0, flot.mn, M,O" Kenneth Snelt:zer, M,O" Jonathan Whitney, M.O" and Cowley ABaoclates Michael Barrkk, Oep.lty Sheriff, who bein9 <iuly Ilworn acc()nHng to law, saYll that on February 08, 199!\ at le35 o'clock P.M.. F..fl,,!,., he served a true copy of the within SlJTJ110ns in Civil Action Law, in the above entitled action, upon the within n/l1lt!d defendant, to wit, AlllJ\ D. Rcurm, M,O" by making known unto Alan O. Iloumn, M,O" at 650 Poplar Church flolld, CtIlIp tlUI, CunOOrland County, Pennllylvania, its contents and at the aane time handing to him personally the aaid true atteated copy of the Sl.flle, Michael BiIl:rick, Oep.Jty Aheriff, who OO.1ng duly sworn according to law, aays that on February 08, 1995 at 1125 o'clock P,M., E.B,'!'" he served a true copy of the within SlJTJ1100S in Civil Action I,aw, in the abovo entitled action, upon the within nM1ed defendants, to wite Kenneth Amelt:zer, M,O., Jonathan Whitney, M,O" and Cowley AsBoclo~.s, by making known unto Walter Wilaon, Arlministrator and adult in charge, accepted copies for all defendanta, at 425 North 21st Street, camp tlill, CUmt>erland County, PennsylviJnia, its contents and at the same time handing to him peraonal 1 y the truo attested copies of the stille. Sheriff'a CoatSI Docketing Service Surcharge So MswenH " L~ ,,:., ,'/~ , ~:",,,:,r..:i}(. .'. ~ .-/ ~ -,........,,~ 1. ThcJT1aa KLine, r.fuerIff 36,00 16,80 8,00 "60:86 N, by At ~y , 2-09-95 -\ SWOrn and Subscribed to llefore Me This I j !^Ooy of I. : CLC " 7- 1995, A,O, (.t C .... C, )l"..~U..._ ~ ~otary " ,I " ~ '. gl~TIFICATE QF SERVICB I HRRRBY CBRTIFY that I ser.ved a true and correct copy of the foregoing 'lAICI'. TO IHT.. AP'aAalHCI on all counsel of record by placing the same in the United States mail at Harrisburg, Pennsylvania, first-class postage prepaid, on the 101/ day of ~;;ltl' /lilt hI ' 1995, and addressp.d as folloWlI1 April L. Strang-Kutay, Esquire GOLDBERG, KATZMAN & SHIPMAN 320 East Market Street Post Office Box 1268 Harrisburg, Pennsylvania 17108-1268 (Counsel for Plaintiffs) REYNOLDS & HAVAS A Professional Corporation '. aird"".;.)- ams, Secretary " i' "I " " ' , " \" , , II I I " :J i, CBRTIFICATE OF ~BRVIC~ I HBRBBY CBRTIFY that I served a true and correct copy of the foregoing .lAICI.. TO 'XLI ClaTI'XCATI 0' SlaVICI on all counsel of record by placing the same in the United States mail at Harrisburg, Pennsylvania, fir~t-class postage prepaid, on the ~~I ' ~l day of "I;( /'haf'!, J ~ v April L. Strang-Kutay, Esquire aOLDBBRG, KATZMAN & SHIPMAN 320 Bast Market Street Post Office Box 1268 Harrisburg, Pennsylvania 17108-1268 (Counsel for Plaintiffs) , 1995, and addressed as followsl RBYNOLDS & HAVAS A Professional Corporation i . I " ,,, " ',1 , i' " kA Ie :a N ~ .! >>- ..~ .. ~.. IJj ~~:r. "1, !~;;.I ," 'r. I"."\!:.".t ~. :c 1:1:" ",,,.... t ',' ,1',.... ,-.j,' 11/ l,j".:..-'- ;"'ll.j~ t,)"" .1)1~1 ,...",.\" h ;::.) ci~ 't, 1'1 , . ,. I I, ~ ~ ~ i ~ I ' I ~ ! ~ t~~i J~ I · " , ,,", ~~. , " " ,,. ,... ..,.. . ~ , sY . ^"IG 1 (j m95 !J~ RICHARD KATZMAN and PATRICIA KATZMAN, his wif., PlaintiHs / IN THB COURT OF COMMON PLiAS OF CUMBERLAND COUNTY, PiNNA, CIVIL ACTION -- LAW VS. ALAN D, ROUMM, M.D, / KBNNRTH L, 5MBLTZDR, M.D" JONATHAN WHITNIiY / M, 0" and COWLIiY ASSOCIATIiS, Defendantll. NO. 604 CIVIL 1995 JURY TRIAL DBMANDBD AND NOW, this O.D.. 1(' --- IT day of )~- \. \ ~" \ I , , 1995/ upon consideration of the attached Stipulation of Counsel pursuant to Pennsylvania Rule of Civil Procedure No. 229,(Defendants, Kenneth L. 'Smeltzer, M.D. / Jonathan Whitney, M,D" and Cowley ASllociates, ar$ hereby ordered dismissed from the above-captioned action, , with prejudice. In accordance with thia Order, the names of the said dismissed Defendants shall hereinafter be deleted from the caption of this action. This dismissal Order shall not affect any rights the Plaintiffs may have to pursue their action as against the remaining Defendant, Alan D. Roumm, M,D. 8Y THB COURTt .,/'~-,- I l/ (," 'I"f' - I,,',) J. , " ;' 'i,; " " 'il " " " ',1'1 " " I' 1'1 'I . , \ltilll',," " 1I'I;~\jlJ':";::II:'i Ii, ~!j;((I" " n~", ~\" II \~)j"'" ~,l~~,:{~i\I;!:! i :';':";. ':~f}{;lj,~!,:" , 1fr'_~"'~"tt-l' ~t 'ff'lll' i' 'h V " t,t!t I \" I' I J ~' I ~lt . lit, ) '~_dl~:~ll.' "I __ <'f':" _~\~It;ilhll:'{ ',,',' ,I,I},; 1: ~l\Y.ij,';r\",;;!jliJ'l .J: \IJ~"-' I .11 _ i~t\~;'I!-,.lt;r '\' ,,~! ;\i'-\J ~ ,;'\: ,_."', , " '; I' " l111;'~t'iI';'i!:I\J,<I'\h;' ~:~X;l\l:; . i;'{,',l,' "~JI\ t' ,III "fS!i'<i\i' .-\ ':<.)11 ,-Ill ,.'n (Ii , " I" " d. " , " " 'Iii , -I, 1,1' , " ,,! " ., '1',1 'i '" " I I' I,i , oi' " , " " 'I, " , , I " 1', " " , " , , I. i! " ;""'j! , ;"1 ':1" ", .::/d, . I" ,Wi ''''''1'''''1;1'11 i.' I - I itJi ';~ j J, 'I" III',\'!I, ! "," "I j~" ""':jpry'r.J (1,11"':':-'}"'" ,'r",<"'"II!l. )'1 '\','1.'," '.' " ,") ,.1'1'1' i, 'i:';-','-I!'i)l:t';'~'c~t.-: " 'i,JI',,);~ "";"I'\'!",oi.l\ ,'.''-..,-''"'!'1L{61- f 'Jil j".\~';~,l-\r , '1~ , lIt I'~' I" ! , ,! " " .. " , " 'J~(JmQt, ']~tlmQ' &;7(,,/'," ;H".,.",'f' nl J'''UI . , ~Ol HO~~H 'IIO/lT IT~nT '~.' O. 'O~ ... 'II"/I~I"V~O. /ltl.1,11It I, " ""-\iil!"'-'''_'"'''-_'' ..- '. :1 I "j ",-"-II"I,-,,''''IHI, ".!.H.t~.j...." r"\ , .'1.'-: ,-, I. t. " I, " . , " " , ' , ,J' , " II " ,I., OOLDII~, JAT'~ . 'HIP~, P,O. .,ril L. .tre.,-aute, - I,D. .0. "12' 120 Nark.t .tr..t .tr....rrr -.u.r. '.0. ... lat' .erri,_urv,'A 1110'-12" 11111 2U-Uti .t'or>>'" for 'laiDtiffa ,Ii v. I I I I I I I I IN TUB COURT 0' COMMON P~IA' CUMBIlRLAND COUNTY, PINNA. No. 95-604 CIVIL ACTION - LAW JURY TRIAL DEMANDED RICHARD KATZMAN and PATRICIA KATZMAN, hi. wite, plaintiffs ALAN D. ROUMH, M.D., Detundant '~AIHTI"" .1..0..1 TO DI'IKDAHT', '..LIMI.~Y OBJICTIO. TO .LAIHTI".' CO..LAIHT AND NOW, come the Plaintiff., Richard IInd patricia Katllman, by and through their attorney., Goldberg, Katllman , Shipman, P.c., to re.pond to the Preliminary Objection tiled by Defendant ROUlllml L Admitted, :2 . Admitted. 3. Admitted, ... Admitted. 5. Admitted, 6. Admitted. 7. Admitted in part, denild in part. , Richard and Patrioia Katzman alllge battery again.t Dr. Rouam ba.ed on the admlni.tration ot II .tlroid in1ectio.n ot Depo-Medrol to , , , ell.viat. Mr. Katzman'. condition which we. pre..nted tor evaluation. 8. Admitted in p.rt, deni.d in p.rt, It i. .dmitted th.t the P.nn.ylv.nie Supr.mo Court ha. ground.d the doctrin. ot intorm.d con.ent in b.tt.ry. It i. turther .dmitted that in a non-em.rgency .ituation, in order tor a ~hy.ician to touch a p.tient without committing a tort, intormed con.ent i., ind..d, n.c....ry, It i., how.v.r, deni.d thllt the Sup.rior Court h.. , .xplicitly limited .nd refu.ed to expand the doctrine of inform.d con.ent to include the IIdmini.tr.tion ot therapeutic drug.. In fact, where the ne.d for .n injecUon of . th.ra"euUc drug 18 di.puted, penn.ylv.nia l.w unequivoc.lly hold. th.t an .ction in intormed con.ent may lie, WHEREFORE, Plaintift. re.pecttully reque.t that thil Court deny Def.nd.nt'. Demurrer. Re.pecttully .ubmittedl GOLDBERG, KATZMAN' SHIPMAN, P,C. BYI {', ,~ )f Apr . S nng- Il> # 46728 320 M.rket Street ~.O. Box 1268 H.rri.burg, PA 17108-1268 (717) 234-4161 Attorney tor Plaintift. " :a CERTIFICATE OF Bll:RVICI I HEREBY CERTIFY that I .erved a true and correct copy of the foreqoing document upon all coun.el of record by depoaitinq the lime in the po.tage prep.id, at H.rri.burq, penn.ylv.ni., on the of ~ tcJ'\ be,( Unitld Statal MaU, tint cl..., A' t"- day , 1995, .ddr....d a. follow.. Peter J. curry, Ellquir. THOMAS, THOMAS .. HAFER 305 North Front stra.t P.O. lox eg9 Harri.burg, PA 17108-099~ ,', " , " , II " il i'l , I, , , GOLDBERG, KATZMAN .. SHIPMAN, P.C. /' BYI'.... re ~ :r- '..- ,Jl .... M )'.. '.'i': II' ~ . "', .~ :/ .I~ . . Ii I.' ' 'f:' ,\' -I,'" . ifl , , , , , -~ N L~ 'i' " 't..,. .' , " " , , , " , " ~ ~ ~ I I 11 I ~ · ~ 11 : I J .~ ~ " , , , 'I , , li'I' I' " " ,I. , , , J(' " , , , ;" " " . , ,~, .' ~ 1,1' , , , '',;; I' ,\ . " .' 1 5. That on or about February 5, 1993, Plaintiff returned to the offite. of Cowley A.lOClate. complalllln. 01. warm, .wollen, painful left anlde. 6. That the phy.lclan evaluatln. Mr. Katzman on February 5, 1993 llIso dlalnosed the condition of "lOut" and prescribed Colchicine an4 Lortab; an X-ray of the left foot was also obtalned. 7. That durinl the evenlnl hours of February 5, 1993, Plaintiff called the medical oftlce. of Cowley AlIOClatcI to report that his pain was stllllOvere, even with the ulll&e of Colchicine. 8. That on or about the evenlnl of February 5, 1993, at approximately 8:00 p.m. Dr. Jonathan Whitney of Cowley Auoclates phoned Dr. Roumm todlscuII Mr. Katzman'. condition. 9. That via telephone, Dr. lonathan Whitney communicated to Dr. Roumm that Mr. Katzman was experlenclnllOvere ankle pain, and he was susplclou. of lout; Dr. Roumm wu , then asked If he would evaluate the Plaintiff on an emerlency basis If Mr. Katzman's symptoms did not Improve further. 10. That via the telephone conferente between Doctor. Whitney and Roumm, Dr. Roumm additionally Iwned that Mr. Katzman had experienced acute and abrupt onset of ankle pain which proceu had been onlolnl for the past 2-3 day period, that the ankle and loot were palnlul, and the Plaintiffs uric ICld level was elevated. II. That on or about February 5, 1993, at approximately 9:00 p.m., Dr. Roumm telephoned the Plalntlff to inquire about his physical status relative to hi. left anklel an appointment was then &milled to take place on Saturday momln., February 6, 1993, at Dr. Roumm'. oll1ce. 12, That on the momlnl of February 6, 1993, Plaintiff presented to Dr. Roumm'. office as previously &milled. la. That durinl the oftlce con.ultatlon of February 6, 1993, Dr. Roumm Inquired about the Plaintiff. medical hl.tory, and learned that Mr. Kaun'lIll I. an In.ulln-dependent diabetic, and also .ufler. from hypertension. 14. That after havln. performed an examination relative to Plalntllr.left foot and ankle, Dr. Roumm lormed the Impression of "probable ICUte louty arthritl.." 15. That durinl the office con.ultatlon of February 6, 1993, Dr. Roumm mide an attempt to aspirate Plaintiffs left ankle and Injected the .Ite with one and one-half (11M ce. 01 Depomedrol. 2 16. That durinl the ofnu consultation of February 6, 1993, Dr. Roumm advllCd that Mr. Katzman MOuld continue ta1dnl both the medications of Naprosyn and Colchicine; Mr. Katzman wu further advllCd 10 call the office on Monday 10 make a follow-up appointment. 17. ThaI on or aboUl Monday, february 8, 1993, Mr. Katzman called Dr. Roumm'. office u previously inslrUCted, and reported that his ankle wu ImproVed, but hla rilhl wri.t wu now painful. he also reported "dry lips." 18. ThaI on the evenlnl of February 8, 1993, Mr. Katzman developed a fever, chili., and confusion consistent with a septic episode and diabetic ketoacidosis. 19. ThaI on or about February 9, 1993, Mr. Katzman wu admitted to the Holy Spiril Hospital In an acutely confuaed state of mind, with a pulse of 100, and a temperature elevation of 103.6 delreea fahrenhelt. 20. That upon Plalntlfrs admission 10 the Holy Spirit Ho.pltal on FebrUary 9, 1993, Dr. Roumm's partner, Dr. Sanford, uplrated a riaht and left wrist, u well III left ankle; a STAT aram slain from the joint fluid upirates revealed "-plus ,ram positive c:oc:cl slreptoc:cl-lIb or,anisms. 21. That Mr. Katzman wu admitted 10 I~e Holy Spirit Hospital with an admlulon dlaano.b of "polycentric, septic jolnll, acute and rilht wrist, left IIlIde and pollibly shoulder., probably hlslOry of sepsis, uncontrolled dlabetea, probably even ketoacldosi.; and hlslOry of hyperuricemia-acute lout. " 22. That on or about February 17, 1993, while Plaintiff wu hospitalized at Holy Spirit, an "Intact" blister over the lateral malleolus of the left ankle wu noted. 23. That on or about February 19, 1993, the bullae on the left anlde had ruptured, and wu thus covered with a drollinl. 2... ThaI on or about February 23, 1993, a "blackish" eschar wu noted over the Ilteral malleolus of the left anlde. 25. That on or about March 15,1993, durinlthe Holy Spirit Hospital hospitalization, Plaintiff wu sufferlnl from multiple necrotic lacerations of the left anlde. 26, That on or about March 29, 1993, Plaintiff wu transferred from Holy Spirit HoapllallO the Mec:hanlcabur, Rehabllltatlon Hospllal~ at that time he wu admitted wu three (3) wound. demonstratln, necrotic tlllue over the left anlde. 3 27, That Mr, Kltzmlll'.left llllde continued 10 deteriorate until he eventually auccumbed 10 amputation on or Iboutlune 17, 1993, 10.Ina hlalower left Olttremlty. 28. That Mr. KItzman remained ho.pllallzed from February 9, 1993 until Auau.t 20, 1993. COUNT I RICHARD KATZMAN Y. ALAN D, ROtJMM, M.D. BA'l'TERY 29. Paraarapha I throuah 28 above are Incorporated herein by reference. 30. That the Defendant, Dr. Roumm, committed a battery In hla treatment of Plaintiff when he: a. Failed 10 Inform Plaintiff that a .terold injection .uch u Depomedrol modiflelthe body'a Immune mponae, thu. lowerina real.tance 10 diverse atlmuli caullna infection; b. Puled 10 Inform Plaintiff that he riaked developlna an Infection, particularly In view of hia diabetic atatua, from aubml..lon 10 III Injection of Depomedrol~ c. Puled 10 Inform Plaintiff of the medical alternativCl available 10 treat hla condition. other thlll the administration of . steroid Injection and correspondlna uplration; 'd, Puled 10 Inform Plaintiff that the admlnlatratlon of . .torold auch u Depomedrol replelel liver alucaaon IIId Willi blood alucolCl, allo Impalrina peripheral utilization of aluCOlC~ e. Puled 10 Inform Plaintiff that If, In fact, he elected to .ubmlt 10 III Injection of Depomedrol, he would have 10 monilOr hi, Inlulln requlremenll very carefully, u It wu likely that hi. In.uJin requirements would Increuc u a conaequence of the .terold medication; 4 f. A. a mull of havlnl failed to llecure Richard Katzmlll'.lnformed conlenl for Ihi performlllce of Ihi lterold Injection IIId aspiration, he performed an unauthorized procedure, which procedure conltltuted I tec:hnlcal battery. 31. That as I relult of Dr. Roumm's conduct as described In the precedlna JllII'IIraph of this complaint, Plaintiff developed IICplll, IIIdlor .uffered an auravatlon of III underlylnl condition of aep.11 which had not been dlaanolled at the time of Dr. Roumm'. treatment on February 6, 1993, rrqulrina prolonled hosplllllzatlon for treatment of thl. condition. 32. That as I mult of Dr. Roumm's conduct as described In Parqraph 30 above, Plaintiff I diabetic condition became uncontrolled, and he suffered diabetic ketoa.c:ldoal., which condition litO required prolonaed hospitalization to correct. 33. That .. I mult of Dr. Roumm's conduct as described In PlJqraph 30 above, Mr. Katzman's dual condition I of IICplis IIId diabetic ketoa.c:ldosls combined to hasten the Iou of hi. left lei In Illlputation. 34. That 118 I relult of Dr. Roumm's conduct u described In Parqraph 30 above, Plaintiff Incurred medical bUl.. 3'. Thlt .. I mult of Dr. Roumm'l conduct.. described In Parqraph 30 above, Plaintiff lolt w..ea. 36. That u a mult of Dr. Roumm's conduct u described In Parqraph 30 above, Plaintiff Iw su.taIned I diminution of hll earnln. potential In the future. 37. That.. a mult of Dr. Roumm's conduct u describe4 In Parqraph 30 above, Plaintiff I. lIIt1clplted to Incur future medical expenses. 38. That.. a mult of Dr. Roumm's conduct.. described In Parqraph 30 above, Plaintiff Iw been eluted to .u.lIIn, IIId will, In the future, continue to ,ultaln pain, lufferin., Inconvenience, emotional dl.treu, embanu.ment, and 10.. of life'. plwum. WHEllEFORE, the Plaintiff, Richard Katzmlll, demands judlment ..ainlt Alan D. Roumm, M.D. for Judlment In exc:eu of $2',000, tolether with Intemt and COlta of .ult, . . . -.~. COUNT U RICHARD KATZMAN v, ALAN D. ROt1MM, M,D. NEGLIGENCE 39. P.....raph. 1 throuah 38 are Inc:orporlted herein by reference. 40. That the Defendant, Dr. Roumm, WII neallaent llI\d carele.. In the medlW treatment llI\d/or advice provided to Plaintiff In that he: a. Pailed to ~anl:r.e that both the medlc:a1 condition. of dlabete. llI\d hyperten.lon are con.ldered to be relative contra-Indication. to the admlnl.tratlon of .terold., .uch that he did not .Ianlllc:antly welah the advlntaae. of cortlc:o-.terold therapy ..ain.t the po..lbllity of deleterlou. multi; b. Pailed to acquaint the Plaintiff with the other medlc:a1 alternative. to treatment of thl. condition I c, Pailed to ~mmend further conlCrvatlve therapy, II oppoacd to utilization of a .terold InjCQtion, In view of Mr. Katzmlll\" diabetic: .tatu.; d. Failed to Inform the Plaintiff that lite admlnl.tration of a .terold .uch II Depomedral repletea liver Ilycoaen llI\d ralses blood IluCOIC, allO Impalrlnl peripheral utilization of IluCOIC, .uch that the Plaintiff did not appreciate the neal for careful monltoril\l of hi. Inc:rwed In.ulln requirement.; e. Pailed to contact Cowley A.soclatea to Inform Mr. Katzmlll\'. family phy.iclan. that a .terold Injection had been admlnl.tered .uc:h that hi. diabetic: .tatu. could be appropriately monitored: f. Palled to appropriately differentiate aouty arthrltl. from aeptic arthriti., prior to admlnl.tratlon of the .teroid Injection II the admlnl.tratlon of Depomedralln an Infected Joint would have been contra-indicated. 41. That II a l"CIult of Dr. Roumm'. conduct II deacrlbed In the prec:cdlnl parqraph of thl. complaint, PIaIntlft developed sep.I., llI\elIor .uffered llI\ ",rlvatlon of llI\ underlyinl :ondltlon of sepal. which had not been dlllinoled durina Dr. Roumm'. con.ultatlon of February 6, 1993, requlrinl prolanlcd ho.pitallzatlon for treatment of thl. condition. , V..UICA'I!OH J '0 boroa.J aokDowlo''lo tbet I bava read tllo tor.'loiD, doouaODt aD' tbet tbo taoto otato. bor.iD aro truo aDd oorroot to tb. ~oot ot .J tDowlod90, iDforaatioD aD4 b.li.t. X uD4erotal'1d tbat allJ tal.. atat..ollt. hare ill are .Ido oUbj.ot to pOlleltio. of 11 'A C.,. '4'04 rolatin9 to un.worD tel.itioetioD to lutboriti... DateI1.,JI- "5 Y~'.:... ...jJ.-+< ~,,~~ - , , , , " , , , , " , , , , , i Coun.el punuant to Penn.ylvania Rule of Civil Proc.dure 2:n w.. filed in that reqard. 3. On Auqu.t 23, 19915, Plai\\Uft., coun.el filed a complaint naminq Alan O. Rouam, M.D., a. the .ole Defendant. (A copy of PlaintHf.' complaint ia attached hereto.. Exhibit "A.") 4. In their complaint, Pl.intiff. .11ege b.ttery and ne91iqence a9ain.t Dr. Rouam ba.ed on the c.re .nd tre.tment Dr. loumm rendered to Richard K.tzm.n on or .bout Febru.ry 6, 1993. ,aILINI.1RY OIJICTIOH I. THI 6ATUal 0' A DUva..., oa I. THI ALTIUATIVI, 'AUva. TO COUOIUI TO LA", TO ILAXKTX".' CLAIM ,oa IATTlay I. COUKT I 15. penn.ylv.ni. Rula of civil Procedure 1028(.) (2) provida., in part, th.t . party may prelimin.rily object to . ple.dinq for failure to conform to law. 6. penn.ylv.ni. RUle of civil Procedure 1028(')(4) provide. that a p.rty m.y prelimin.rily object to . ple.din9 for l'9al insufficiency. 7. In Count I of the complaint, Rich.rd .nd p.tricia lCatam.n alleqe b.ttery '9ain.t Dr. Roumm b.sed on the .dministration of Depo-Medrol to allevi.te Mr. K.tzm.n's Iwollen .nd tinder left ankle. 8. The Pennlylv.ni. supreme Court ha. 9rounded the doctrine of informed con.ent in battery. In a non-emergency situ.tion, in ord.r for a physioi.n to touch a pati.nt without oommittin9 a tort, infor..d con.ent 11 n.c....ry. Th. sup.rior Court h.. limited thi. - 2 - Ellhlblt A OOLDBBIlO, KAllMAN" SIIlPMAN, p,C. April L. 1lII....Ku..' . 1.0. No. 44721 320 MIl... IlIIttt StrlwNrr, SqUll" P.O. lIox IUI IIarriIbIItI. PA 17101-1261 17171 ZJ4.4161 Alto,..,. tor PlIIPI.ltr. RICHARD KATZMAN and I PATRICIA KATZMAN, hLs wile, I P1alntllt. I I V. I I ALAN D. ROUMM, M.D., I Defendant IN mE COURT OF COMMON ",EAB Cl]MBERLAND COUNTY, PA NO. 95-604 CIVIL ACTION. LAW JURY TRIAL DEMANDED WMI!LAJN[ AND NOW, come the Plaintiffs, Richard and Patricia Katzman, by their attorney., Goldbera, Katzman" Sblpman, P.C., who respectfully represent as follows: I. That the plaintiffs are adult individuals livlnland residinlat 102 Harrison Drive, New Cumberland, Pennsylvania. 2. That the Defendant, Alan D. Roumm, M.D., (herelnaf'ter referred to as "Dr. Roumm") is a physician licensed to practice medicine in the Commonwtalth of Pennsylvania, with his business address at 650 Poplar Church Road, Camp Hili, Pennsylvania. 3. That on or about February 4, 1993, Plaintiff presented to the medical offices of Cowley Associates for the complaint of abrupt onset of left foot pain, Mr. Katzman reported to the physician who evaluated him on this date that he had self-medicated with 2~0 millilrams of Naprosyn on two occasions. with some relief of his symptoms. 4. That the Cowley Associate physician formed the impression of "acute arthritis. lout)'?," and prescribed Napros)'n, with further instructiollS 10 obtain an X-ra)' of the left foot If relier had not been obtained by the following day. 5. That on or about Pebruary 5, 1993, Plalntlffretumed to the offices of Cowley Associates complalninl of a warm, swollen, palnfullefl ankle. 6. That the physician evaluatlnl Mr. Katzman on Pebruary 5, 1993 also dialnosed the condition of "lout" and prescribed Colchicine and Lortab: an X-ray of th: left foot was also obtained. 7. That durlnl the eveninl hours of Pebruary 5, 1993, Plaintiff called the medical offices of Cowley Associates to report that his pain was stili severe, even with the U5ale of Colchicine. 8. That on or about the eveninl of Pebruary 5, 1993, at approximately 8:00 p.m. Dr. 10nathan Whitney of Cowley Associates phoned Dr. Roumm to discuss Mr. Katzman '. condition. 9. That via telephone, Dr. 10nathan Whitney communicated to Dr. Roumm that Mr. Katzman Will experlencinl severe ankle pBin. and he Will suspicious of lout; Dr. Roumm was then asked if he would Ilvaluate the Plaintiff on an emerlency basis if Mr. Katzman's symptoms did not improve further. 10. That via the telephone conference between Doctor. Whitney and Roumm, Dr. Roumm additionally learned that Mr. Katzman had experienced acute and abrupt onset of ankle pain which process had been onlolnl for the put 2-3 day period, that the ankle and foot were painful, and the Plalntlfrs uric acid level was elevated. 11. That on or about Pebruary 5, 1993, at approximately 9:00 p.m., Dr. Roumm telephoned the Plaintiff to inquire about his physical sllltus relative to his left ankle; an appointment Will then Il1TIJlled to lake place on Saturday mominl, February 6, 1993, at Dr. Roumm's oftlce. 12. That on the mominl of February 6, 1993, Plaintiff presented to Dr. Roumm's office III previously arranled. 13. That durinl the office consulllltlon of February 6, 1993, Dr. Roumm Inquired about the Plalntlfr. medical history, and learned that Mr. Katzman Is an insulin-dependent diabetic, rand also .uffer. from h yperten$ion. 14. That after havinl performed an examination relative to Plalntlfr.left foot and anlde, Dr. Roumm formed the impression of "probable acute louty arthritis." 15. That durlnl the office consulllltlon of February 6, 1993, Dr. Roumm made an attempt to aspirate Plalntlfr.left ankle and injected the site with one and one.half (1111) ce. of Depomedrol. 2 , 16. 'That durlnlthe ofllce consultation of February 6, 1993, Dr. Roumm advised that Mr. Katzman should continue taklnl both the medications of Naprosyn and Colchicine; Mr. Katzman was further advised to call the ofllce on Monday to make a follow-up appointment. 17. 'That on or about Monday, February 8, 1993, Mr. Katzman called Dr. Roumm's oftlce III previously Instructed, and reported that his ankle was Improved, but his right wrist was now painful; he also reported "dry lips," 18. 'That .on the evening of February 8, 1993, Mr. Katzman developed a fever, chills, and confusion consistent with a septic episode and diabetic ketoacidosis. 19. 'That on or about February 9, 1993, Mr. Katzman was admitted to the Holy Spirit Hospital in an acutely confused state of mind, with a pulse of 100, and a temperature elevation of 103.6 delrees Fahrenheit. 20. That upon Plaintiffs admission to the Holy Spirit Hospital on February 9, 1993, Dr. Roumm's partner, Dr. Sanford, aspirated a rllht and left wrist, as well as left ankle; a STAT lram stain from the joint fluid aspirates revealed 4-plus lram positive cocci streptocci.like orlanisms. 21. That Mr. Katzman was admitted to the Holy Spirit Hospital with an admission diaanosls of "polycentric, septic join"', acute and rllht wrist, left ankle and possibly shoulders; probably history of sepsis, uncontrolled diabetes, probably even ketoacidosis, and history of hyperurlcemia.acute lOUt." 22. 'That on or about February 17, 1993, while Plaintiff was hospitalized at Holy Spirit, an "intact" blister over the lateral malleolus of the left ankle was noted. 23. That on or about February 19, 1993, the bullae on the left ankle had ruptured, and was thus covered with a dresslnl. 24. That on or about February 23, 1993, a "blackish" eschar was noted over the lateral malleolus of the left ankle. 25. That on or about March 15, 1993, durlnl the Holy Spirit Hospital hospitalization, Plalntlff Will sufferlnl from multiple necrotic lacerations of the left ankle. 26, That on or about March 29, 1993, Plaintiff was transferred from Holy Spirit Hospital to the Mechanlcsburl Rehabilitation Hospital, at that time he was admitted Will three (3) wound. demonstrlltlnl necrotic tissue over the left ankle. . 3 ., f. As a result of havinl failed 10 secure Richard Katzman's informed consent for the performance of the steroid injection and aspiration, he performed an unauthorl:t.ed procedure, which procedure constituted a technical battery. 31. That as a result of Dr. Roumm' s conduct as described in the precedinll paralraph of this complaint, Plaintiff developed sepsis, and/or suffered an alllravatlon of an underlylnl condition of sepsis which had not been diallnosed at the time of Dr. Roumm's treatment on February 6, 1993, requlrlnl prolonlled hospitalization for treatment of this condition. 32. That as a result of Dr. Roumm's conduct as described In Paralraph 30 above, Pla\ntifrs diabetic condition became uncontrolled, and he suffered diabetic ketoacidosis, which condition also n:quired prolonled hospitalization to correct. 33. That as a result of Dr. Roumm's conduct as described in Parallraph 30 above, Mr. Katzman's dual conditions of sepsis and diabetic ketoacidosis combined to hasten the loss of his left lei In ampullltlon. 34. That as a result of Dr. Roumm's conduct as described in Paraaraph 30 above, Pla\ntlff Incurred medical bills. 35. That as a result of Dr. Roumm's conduct as described In Pll1'llIraph 30 above, Plaintiff lost Willes. 36. Thill as a result of Dr. Roumm's conduct as described in Pll1'llIraph 30 above, Plaintiff has 5ulta!ned a diminution of his eamini potential in the future. 37. That as a result of Dr. Roumm's conduct as described in Pll1'llIraph 30 above, Plaintiff II anticipated 10 incur future medical expenses. 38. That u a result of Dr. Roumm's conduct as described in PllrIlIraph 30 above, Plaintiff hu been caused 10 susta!n, and wID, in the future, continue to sustain paln, lutrerin., inconvenience, emotlonu distress, embarrassment, and loss 01 life's pleasures. WHERD"ORE, the Plaintiff, Richard Katzman, demands judlment llIainlt Alan D. Roumm, M.D. for judllment in elIcess of $25,000, toaether with interest and costa of lult. II Ii COUNT n JUCIIARD KATZMAN v. ALAN D. ROUMM, M.D. NEGLIGENCE 39. PlIIlIraphs 1 throulh 38 are Incorporated hereill by reference. "0. That the Defendant, Dr. Roumm, was neeHlent and careless In the medical treatment and/or advice provided 10 Plaintiff III that he: Failed to Inform the Plalnliff thai the administration of a steroid such as Depomedral repletes liver Ilycolen and raises blood Ilucose, also Impal.rlnl peripheral utilization of I'ucose, such thlll the Halntlff did not appreciate the need for careful monltorlnl of hil Increased Insulin requirements; Falled to COntact Cowley Associates to Inform Mr. Kat2man's family phYliclan. that a lteNld injection had been administered such that his diabetic status could be appropriately monltored~ Fuled 10 appropriately differentiate louty arthritis from septic arthritis, prior to administration of the steroid Injection as the administration of Depomednlln an Infected Joint would have betn contra-Indicated. 41. That as a result of Dr. Roumm's conduct as described in the Prectdinl pil'llraph of this complilnt, Plaintiff developed sepsis, and/or suffered an allravatlon of an underlylnl condition of sepsis which had not been diaanosed durlnl Dr. Roumm'l consultatlun of February 6, 1993, requlrlnl prolonled hospltllliutlon for treatment of this condllion. .. Failed to recolnize that both the medical conditions of diabetes and hypertenllon are considered to be relative contra-indicalions to the administration of steroids, such that he did not silniflcanUy weillh the advantaaes of cortlco-sterold therapy aaalnst the possibility of deleterious results; Failed 10 acqUaInt the Plaintiff with the other medical altematlves to treatment of this condilion; Fuled 10 recommend further conservative therapy, as opposed to ulillzatlon of a steroid Injeclion, in view of Mr. Katzman'. diabetic status; b. c. d. e. f. , .-..._.0,."..-.-.. 42. That as a result of Dr. Roumm's nealilent conductu described in PlU'IlIraph 40 above, Plalntlfrl diabetic Stlltlll became uncontrolled, and he luffered diabetic ketoacidolis, which condition also required prolonled hospltallmtion to correct. 43. That as a reault of Dr. Roumm's nellilent conduct as described in Paralraph 40 above, Mr. Katzman's dual conditions of sep~is and diabetic ketoacidosis combined to hasten the lOll of his left lower extremity to amputlltion. 44. That as a result of Dr. Roumm's nelliacnt conductu described In PlU'IlIraph 40 above, Plaintiff has incurred medical bills. 45. That as a result of Dr. Roumm's nellilent conduct as described In PlU'IlIraph 40 above, Plaintiff has 1011 wqes. 46. That as a result of Dr. Roumm's nellilent conduct as described In PlU'IlIraph 40 above, Plaintiff has sustained a diminution of hil earn\nl potentllll in the future. 47. Thill as a result of Dr. Roumm's nellilent conduct as described in PlU'IlIraph 40 above, Plalnbff II anticipated to Incur future medical bills. 48. That as. result of Dr. Roumm's nellilent conduct as described In PlU'IlIraph 40 above, Plaintiff has been caused 10 sustain, and will, In the future, continue to sUltaln pain, su(ferln" inconvenience, emotion.. distrell, embarrassment, and lOll of life's pleasures. WHEREFORE, the Plaintiff, Richard Katzman, demands Judlment .,alnlt Alan D. Roumm, M.D. for Judlment in excess of $25,000, tolether with interest and eos... of .Illt, COUNT m PATRICIA KATZMAN v. ALAN D. ROUMM, M.D. LOSS OF CONSORTIUM ,. :: 'I " '",. ", ' 11.: ,',i'f". J 49. Pal1anp/l. 1 throlllh 48 are hereby Ineorporated by reference. 7 50. That as a result of tho conduct of Defendant, Alan D. Roumm, M.D., wlfo Plaintiff, Patricia Kalzman, hu .usJained damqoa as I result of the Iou of services, IUidance, companionship, society, afrO(ltlon and consortium 0' her husband. WHEREFORE, tho Plaintiff, Patricia Katzman, demands Judlment qalnll Alan D. Roumm, M.D, for Judlment In exceu or $25,000, together with Interest and cosll of suit. Dated: ,) ~, 19!' , , Reipoctfully submitted, GOLDBi'.RG, KATZMAN" SHIPMAN, '.C. By: 11 p5 ~_ APM-tranl-KUtlly, Esquire 320B Market Street Strawberry Square Po.t Office Boll 1268 Harrisbuq, PA 17108-1268 Supreme Court Id. 146728 Attorney. 'or Plalntlff. RkIWd Kalzman and Patricia KalZm~ , I , , I , I'I I '1, ,I I I , , , , I I . , ' 'a. Jepc~t'~l 481-665 A.2d ('a..up.l'. ln5) 661 A.2d 397, Hoffman v. Brandywine HO'P'r ..------------------ Ixoerpt from pa98 661 A.2d 401 follow. ------------________ to the administration of therapeutic drugs. This Court has con.i.tently limited informed consent to a batt.ry theory. We will not exp.nd informed consent h'~e. ~n [Ioyel' v. Smith, 345 Pa.Super. 66, 497 A.2d 646 11985) I, the COUl't 'leld that the doctrine of informed consent .hould be 1 mited to those c.... involving .urgical or operative procedures. The Court ba.ed thi. detenaination on the fact that the penn.ylvallia Supreme Court, in Oray v. Q~~nn.gle [423 Pa. 144, 223 A.2d 663 (1966) I, grounded the dootrin. of informed con.ent "upon the legal theory that the pedorJll&nce of a ...dicd p~ocedure without. patient'. informed consent con.titutes a teohnical ....ult or b.ttery." Th. Court in Boyer felt that to .xpandthe doctrin. to the .dministration of therapeutic drugs would totally obliterate the .tandard's.t forth in Oray, and therefore, felt bound by the d,ci_ion of our 'upre.. Court in Oray. We must 'grle with the court in Boyer. , i,'(l/) ;1 I I '~j(( ~'/ " II: , " 'I \' / ,l 'I tL? ~ ' I' ,_#1 ',I ',' ) '" ' ", . ' I v} "'\ I , /' ,i 1\ ( , , I ,"j ,I 'I '!..'\ ' )i yi ) " ,/ " , , Ii .., , , I I I , t' , )' 'I : /" itl. l( ; \ I) " " , " "IU I 11'.1'".1' , 'I 'Ii ,II L I I ',,:' " I)' ,,',,, ' J i)1/,1".J jl,,', ' " " :: I"I! ',):,;' /' ;,:i " ! " ' . I J' '\ I I J. r I r "I I I ( 1/ I,: I' '( '/' ',) ! ( 1.1 ~,,'I/!, 1'/' ;'1 '. I{, ( / " .,I! i' 'i \ 7 r' ~:;, (' '//':' I ' (/ :/, .. " (/,J' , ',' I, ( 1:( I ',f,\ ,'} II": .,',',;1, I 'i) J{ /I' ,. j ; i}(~ " CJ . v, CopYl'ighi (0) w..t Publi.hing Co. 1996 No olaim to original U.S. Oovt. work.. RICHARD KATZMAN and PATRICIA KATZMAN, hi. wife Iff RB I I I I I I I NO. 95-604 CIVIL TERM I I DlfBND~T'S PRBLIMINARY OBJICTIONS IN THI COURT Of COMMON PLIAS or CUMBBRLAND COUNTY, PINNSYLVANIA V. ALAN D. ROUMM, M.D. TO P~INTX'fS' COMPLAINT IlfOR., SHIILY. P.J.. HO"BR. J.. OLlft. J. Qil6ION AND ORDIR Of COURT Plaintiffe Bllege that Richard Katzman suffered .evere injury and damege. as the result of the injection of . .teroid administered by defendant to relieve Mr. Katzman's .ymptom. associated with gout. D.fendant has demurred to pleintiff's claim of battery grounded in thft doctrine of informed con.ent, contendin9 that Pennsylvania law has limited battery claim. under this doctrine to surgical or operative procedures. We heard argument on December 6, 1995. fACTS AND PROCBDURAL HISTORY Both parties agree that the following accurately eummarize. the background of this casel Procedurally, plaintiffs initiated the present action by Writ of Summone on february 3, 1995, in which eeveral defendant. were originally named.l Plaintiffs' counsel was then .erved with a Rule to file a Complaint on 'ebruary 27, 1995. Sub.equent to the deposition of the pre.ent IThe other defendants were Kenneth Smeltzer, M.D., Jonathan Whitney, M.D., and Cowley As.ociate., pre.umably, the primary care providers. NO. 95-0604 CIVIL TIRM defendant, the parties stipulated to diemissal of the other def.ndants. On August 23, 1995, plaintiffs tiled a com~laint alle9inq battery and negligence based on the treatment defendant rendered to Mr. Ratzman on or about February 6, 1993. Defendant filed preliminary objections on September 18, 1995. Factually, plaintitf. aver that Mr. Ratzman complained to hi. primary care phy.ician. in February ot 1993 concernin9 acute ankle pain, characteristic ot gout. The primary care physiciana in turn conlulted with defendant re9ardin9 these aymptome. Prior to this consultation, Mr. Katzman, allo an inlulin dependent diabetic, had been managed on several medications by his primary care phydciAns. On February 6, 1993, dehndant took a verbal history from Mr. Ratzman and conducted a thorou9h examination. When defendant's attempt to aspirate Mr. Katzman'. ankle yielded no fluid, he injected the ankle with a corticosteroid, Depo- Medrol. Mr. Katzman was admitted to Holy Spirit Hospital on February 9, 1993, secondary to confusion, dehydration and hyperglycemia. Apparently, he had tailed to take his insulin durin9 the previous days. Mr. Katzman experienced various complications over the eubsequent months and Ultimately, hie left lower extremity was amputated more than four months after his coneultation with defendant. Plaintiff. epecifically allege in their compl~int at COUnt X, Battery, that defendant oommitted a battery in hie treatment 2 NO. 9~-0604 CIVIL TBRH of Mr. Katlman when he. 'ailed to inform Plaintiff that a .teroid injection aa Depo-Medrol modifies the body'. immune re.pon.., low.ring r..iatance to div.r.e .timuli cau.in9 infection, b. 'ail.d to inform Plaintiff that he riaked dev.loping inf~ction! particularly in view of hi. diabetic .tatu., from .ubml..ion ~o an injeotion of Depo-Medrol, c. 'ail.d to inform Plaintiff of the medical alternative. available to treat hia condition, other than the admini.tration of a .teroid injection and corre.pondin9 aapiration, a. .uch thus d. 'ailed to inform Plaintiff that the adminiatration ofa ateroid .uch a. Depo-Medrol replete. liver gluca90n and rai... blood gluco.e, al.o impairing peripherAl utilization of qluco.., e. 'ailed to inform Plaintiff that if, in fact, he .l.ct.d to .ubmit to an injection of D.po-Medrol, he would have to monitor hia in.ulin requirem.nt. very car.fully, a. it wae likely th.t hi. in.ulin requirement. would incr.... a. a con.equ.nce of the .t.roid medication, and f. A.. re.ult of h.vin9 failed to .ecure Richard Katzman'. informed conaent for the p.rformance of the ateroid inj.ction and a.piration, h. p.rformed an unauthoriled proc.dure, which procedure con.tituted a t.chnical batt.ry.l Defendant demurred to thi. count of the complaint, maintainin9 that Pennaylvani. h.. failed to reo09niz. battery claim. re.ultin9 from lack of informed con.ent in .ituationa involving the adminiatration of medication. DISCUSSION Our eupr.me court .uccinctly .tated the Itandard of r.view for ruling on prelimlnary obj.ction. in the nature of a demurrer IComplaint .t !30(a)-(f). 3 NO. ge-OG04 CIVlt TBRM in A~leqheny County v. CQmmonwe.lth, 507 Pa. 360, 490 A.3d 403, (1985)1 A demurrer c.n only be .u.tained wh.re the complaint i. clearlr inlufficient to e.tabli.h the ple.der" ri9ht to rel ef. for the purpo.. of te.ting the leg.l IUffici.ncr of the challenged pleading a pr.limin.ry objection n the nature of a demurr.r .dmit. .. true all well-ple.ded, materi.l, relevant f.ot., and ev.ry inference f.irly d.ducible from tho.e f.ct.. The pl.ader'. conclu.ion. or.verment. of l.w .re not con.idered tQ b. .dmitted a. true by . demurrer. Since the .u.tainin9 of a demurr.r re.ult. in . denial of the pleader" cl.im or di.mi...l of hi. .uit, . preliminary objection in the n.ture of a demurrer .hould be .u.t.ined only in c.... that clearly .nd without a doubt fail to .t.te a claim for which relief m.y b. granted. If the fact. a. ple.ded .t.te . claim for r.lief which m.y be granted und.r any theory of l.w then th.r. i. .ufficient doubt to require the preliminary obj.ction in the n.ture of . demurrer to be rejected. Id. at 373, 490 A.2d at 408 (cit.tion. omitted). With r..pect to the law conc.rning informed con.ent, pl.intiff. h.ve conc.ded th.t defend.nt h.. correctly char.cterized the tr.ditional approach in p.nneylv.nia, namely that the doctrin. i. grounded in batt.ry. iIa Gr.y v. Grunn.~le, 433 Pa. 144, 154-160, 333 A.3d 663, 668-671 (1966). Plaintiffe further rec09niz. that in Boyer v. Smith, 345 Pa. Super. 66, 497 A.2d 646 (lg85), our Sup.rior Court limited the p.rameter. of the doctrine, .t.ting th.t it doe. not include the .dmini.tr.tion of ther.peutic dru9.. ld. at 73, 497 A.2d at 649. It i. the .pplic.tion of Wu v. Spence, 413 Pa. Super. 352, 605 A.2d 395 (1992) which incorporated .ome of the langulge of . feder.l ca.e Karibianian v. ~hom.. J.ff.r.on voiveraity Ho.pital, 717 r.8upp. 1081 (1.0. Pa. 1989), th.t ha. 4 NO. 95-0604 CIVIL TIRM resulted in the preeent di.pute. In~, the patient claimed a cauee of action for battery for the appellee's failure to advi.e her of potential side effect. before injecting her with flagyl, an antibiotic. 413 Pa. Super. at 353, 605 A.2d at 395. The trial court granted a nonsuit upcn findin9 that no cause of action exist. based upon a lack of informed consent of the ri.ks involved with a therapeutic dru9 treatment, the Superior Court affirmed. 19. Plaintiffs contend that the rea eon the non.uit wa. 9ranted wa. because appellant was claiming harm from the actual action of the medication, not the m.thod of administration. Plaintiff. direct us to thi. particular language from ~aribjanian, and cited in ~ to su.pport their position that the dootrine of informed consent has been expanded I When it is the need for an inj.ction which the patient disputes, it is rea.onable to impo.e a duty of informed consent. For example! there are some dru~. which mey be administered either orally or bI injection, the deci.ion to inject euch a drug shou d be made only with the patient's informed con.ent. On the other hand, when it is the .ub.tance admi~i.teredl not the methou of administration, which is challenged, I a9ree with Judge Roffman that it i. ab.urd to invoke the duty of informed consent .imply becauee the phy.ician or nur.e mu.t touch the patient to inject the dru9. ~ at 396, 605 A.2d at 396, citinq Karibjanian, 717 F.Supp. 1981, 1084 (1989) (discuesing the dissenting opinion of Hoffman, J., in Mallov v. Shanahan, 280 Pa. Super. 440, 444-446, 421 A.2d 803, 805-806 (1980)). Plaintiff. contend that because Depo-Medrol is alao 5 NO. ~5-0604 CIVIL TRRM available in tablet form, defend.nt ehould have informed Mr. ~at.man of the riek. '.Iociated with injectinq the druq, e.pecially in vilw of his diabet... Plaintiffs .ubmit th.t they ere di.putin9 the need for an injection, I permitt.d by applic.tion of Xarib1.nian and di.cu..ed in ~. We believe etov.r v. A..oci.tion of Thor.cic and C.rdiov..cul.r Surqeon., 431 P.. Bup.r. 11, 635 A.2d 1047 (1~~3l, to coqently det.rmine the i..u. pree.nt.d in thi. c.... Our Superior Court r.coqni..d the lam. .rqum.nt m.d. by plaintiff. here, yet the court .till refu.ed to exp.nd the doctrine, .t.t1n91"While we concede th.t Wu contained l.nquaqe to thil effect, we note th.t Wu mu.t be limited to itl f.ctual ..ttin9 of dru9 ther.py. Wu, in f.~t, .p.cifically refu.ed to expand the notion of informed con.ent in thi. reqard bec.u.e the milieu w.. one of druq therapy r.ther th.n eurqery." Stover, 431 P.. Super. .t 24, 635 A.2d .t 1053. In further notin9 the ca.e of Dible v. V,alev,1 which h.l,d no li.bility for failure to obtain con.ent prior to r.diation tre.tment. bec.u.e .urqery w.. not involved, our appell.te court pointed out th.t '[l)ikewi.e, the druq adminiltered in Wu wu administered outside of .urqery." Stover, 431 Pa. Super. .t 25, 635 A.2d .t 1054. Fin.lly, w. believe ISee Para9r.ph 30(c) of Plaintiff'. Compl.intl defend.nt "failed to inform Pl.intiff of the medical alternative. available to treat hi. condition, other than the .dmini.tr.tion of a .teroid injection .nd corre.pondin9 .'.pir.t1on." 1417 P.. Super. 302, 309, 612 A.2d 493, 496 (1992), allooatur d.njed, 535 P.. 619, 629 A.2d 1380 (1~~31. 6 NO. g&-0604 CIVIL TaRN footnote 6 of the Stover opinion to .um up the .tatu. in penn.ylvania re9arding battery cl.im. grounded in the doctrine of informed con.ent when therapeutic drug. .rft involved I We would be le.. th.n o.ndid if we did not admit to a deqree of artificiality in cre.tinq a di.tinotion whioh limit. the touching required for actionable informea con.ent to be the .ur9ical cut. The court in Wu wae .1.0 troubled by the need to draw .uch a di.tinction. However, t appeare th.t until .uch time a. our .upreme court expand. the technical ....ult definition, .uch .rtificiality mu.t hold .way. Appellant. h.ve cautioned u. that thi. i. a h.rd ca.e th.t ha. the potenti.l to make bad l.w. However, it i. our con.idered opinion that uur re.olution of this ca.e i. entirely con.i.tent with 10ng-.t.ndin9 leg.l precedent. lIl. .t 26, 63& A.2d .t 10&4. In view of the foregoin9, pl.intiff. b.ttery count mu.t be .tricken. ORDBR OF COURT AND NOW, thh Illth day of 1))/11'(. I) , 1996, after c.reful review of defend.nt'. preliminary objection in the n.ture of a demur~~T to plaintiff'. cl.im for battery, we hereby SUSTAIN the objection. Count I i. DISMISSED from the complaint, By the Court, 1.1 ~rpld e. Sheely Haro B. 8 eely, P.J. April Btrang-lCut.y, a.quire for the Pl.intiff Peter J. Curry, B.quire fur the Defend.nt lald ? ',), Admllled In part and denied In part. Itl~ acknowledged Ihat during Ihe February 5, 1993, lelephone conver~atlon Dr, Jonathan Whitney Informed Dr, Roumm that Mr, Katzman had had acule onset left ankle polin for approxlm.ately two to three days. Dr. Whitney Inquired a~ to whether Dr. Roumm would see Mr, Katzman and he agreed If there was a continued lack of Improvement on his current medication, 10. Admitted In part and denied In part. Itl~ admitted that Dr. Roumm was Informed that Mr, Katzman had experienced acute onset left ankle pain for approximately two to three days. Dr, Roumm was also Informed that Mr. Katzman had a uric acid level of 10.1. Olher Information conclJrnlng Mr. Kalzman's condition was dl~cussed a~ relayed by Dr, Roumm In hl~ depo~ltlon which wa~ taken In connection with this case. 11 .17, Admitted, 16, The averments contained In Paragraph 16 of Plalntlff~' Complaint set forth concluslon~ a~ opposed 10 ~tatements of fdct and no response Is required, In addition, the responding Defendant I~ without knowledge or Information ~ufflclent to either admit or deny the averments contained In Paragraph 16 of Plaintiffs' Complaint. Pursuant to the Pennsylvania Rules of Civil Procedure, ~ald averments are therefore denied and proof thereof Is demanded at the time of trial. 19 . 26. The responding Defendant I~ wilhoUl knowledge or Information sufficient to either admit or deny the averment~ contained In Paragraph 19 through 26 of Plaintiffs' Complaint. Pursuant to Ihe Penn~ylvanla Rule~ of Civil Procedure, said averments are therefore denied and proof thereof Is demanded at the time of trial. COUNT I Richard Katzman v. Alan D. Roumm, M.D. Battery 29 . 38, The averments contained In Paragraphs 29 through 38 have been dlsmlued In accordance with the March 19, 1996, Order of Harold E, Sheeley, p,J, WHEREFORE, the responding Defendant demands judgment in his filvor and. allalnst Plaintiffs, COUNT II Richard Katzman v. Alan D. Roumm, M.D. Negligence 39, The averments contained in Paragraphs 1 through 38 of this Answer with New Maller to Plaintiffs' Complaint are Incorporated herein by reference as If set forth at length, 40.48, The averments contained In Paragraphs 40 through 48 of Plaintiffs' Complaint set forth conclusions as opposed to statements of fact and no response 15 required. Nevertheless, said averments are denied and proof thereof 15 demanded at the time of trial. Furthermore, at all times relevant hereto, Alan 0, Roumm, M,D, ac.ted In accordance with the required standards of medical care and did not cause Plaintiffs' Injuries, WHEREFORE, the responding Defendant demands Judgment in his favor and allalnst Plaintiffs. COUNT III Patricia Katzman v. Alan D. Roumm, M.D. Loss of ConllOrtlum 49, The averments contained In Paragraphs 1 through 48 of this Answer with New Maller to Plaintiffs' Complaint are Incorporated herein by reference as If set forth at length, 50. The averments c.ontalned In PdrdgraphSO of Plaintiffs' Complaint set forth conclusions .IS opposed to statements of fact dnd no response Is required, Nevertheless, said averments are denied and proof thereof Is demdnded .It the time of trial. Furthermore, at all times relevant hereto, Alan 0, Roumm, M,O" dcted In accordance with the required standards of medical care and did not cause PloIlntlffs' oIlleged InJuries, WHEREFORE, the r~,pondlng Defendant demolnds Judgment In his favor and against Plaintiffs. NEW MAnER By way of further response to the dllegatlons contained in Plaintiffs' Complaint, the responding Defendant hereby raises the follOWing New Maller pursuant to Pa, R.C,P, No, 1030: 51, All care and treatment rendered to Plaintiff Richard Kalzman by responding Defendant was appropriate, reasonolble, and wllhln the required standards of medical care and did not cause Plaintiffs' alleged Injuries, 52, Plaintiffs' Complaint falls 10 stolte a cause of action upon which relief can be granted, 53. To the extent that the evidence may show that other per~on5, partnenhlps, corporations, or other legal entities caused or contributed 10 the Injurlcs andlor exacerbation of the pre-exlstlnll conditions of Richard Katzman as alleged, then the conduct of the responding Defendant was n(llthe proximate cause of such conditions or Injuries, 54, The Injuries and damages, If any, sustained by Plaintiffs as averred In the Complaint were caused In whole or In part by persons or entities over whom responding Defendant had no duty to supervise or control; therefore, responding Defendant Is not liable and Plaintiffs may not recover against him, 55, Plaintiffs' Injuries and losses, If any, were not caused by the conduct or negligence of responding Defendant, but rather were caused by medical conditions and causes beyond the control of the responding Defendant; therefore, Plaintiffs may not recover against him, 56, All acts or omissions of responding Defendant alleged to constitute negligence were not substantial contributing factors 10 the Injuries and damages as alleged In Plaintiffs' Complaint, 57. The acts or omls~lons of others and not responding Defendant constitute Intervening and/or superseding causes of the Injuries and/or damages alleged to have been sustained by Plaintiffs and respondlnll Dp.fendant cannot, therefore, pursuant to Pennsylvania Low, be held liable for the ollleged Injuries to Plillntlffs, 58, The responding Defendolnt's kwastlgoltlon Into this millter continues and discovery may reveal that Plaintiffs were otherwise contributorily negligent and/or assumed the risk of the Injury; and therefore, responding Defendant pleads these affirmative defenses to preserve the record, 59. Based upon Information and belief, It Is allelled that Plaintiff Richard Katzman WilS nellllllent In that his neRllllenc!! exce!!ded any alleged negllgenc!! of the responding Defendant, therefore thereby barring his recovery by the Pennsylvania Comparative Negligence Act, 60, The sole responsibility for any damalles sustained by Plaintiffs rests with the Plaintiffs or third parties over whom respondlnll Defendant had no control, no duty to control, or reason to control. 61. So far as responding Defendant elected a treatment modality which Is recollnlzed as proper but may differ from another appropriate treatment modality, then said Defendant raises the "two schools of thought" defense, 62, Plaintiffs' claims are barred by the applicable statute of limitations, 63, Plaintiffs' allegations are vallue and Imufflclently jJleaded under Pennsylvania law, 64. Plaintiffs' claims are barred andlor limited by the Health Care Servlcos Malpractice Act. WHEREFORE, the responding Defendant demands judgment In his favor and against Plaintiffs, Respectfully submllled, THOMAS, THOMAS & HAFER OATEDI. i)n/1/' /; D' /. ( I ""l By ,,!.A1( . I /' Peler I, Curry 305 North Front Street P. O. Box 999 Harrisburg, PA 17108 I,D, /I 16622 Allorneys for Defendant Roumm II' CI!RTIPICATE 0' 'ERVICI! I do hereby certify thet on thll dey I.erved 8 true end correct copy of the foregoing DEFENDANT'S ANSWER TO COMPLAINT WITH NEW MA TTER by tlrlt cl"l mall, pOltege prepeld, eddreued to the following: April Streng-KuteV, Esquire Goldborg, Ketzmen &I Shipmen 320 EOlt Merket Street p, O. Bo~ 1268 Herrllburg, PA 17108.1268 THOMAS, THOMAS &I HAF.ER " Det.1 1988 I " , " 'ii " , I I, II ", I- '" 1 , , " )1' " " " " " ',' " " '" " I " (".\ .', , I'" l,\ " ~-ii " , I I (.IT1 , ,~'1 , I . -~ '.\ 1.1;. rot , , [.'i,:l , , " . " ,') ,I (" r;'.' ,;',1 .~. ~ I , " , ~ ~.I )' n ,. ~l') Ii' " 'i' " " " .~ II GOLD"ao, aATlNAN I .II.MAN, ..C. April L. .tr.n9-~ut.y - I.D. No. 4612' JaO M.rket .treet .trawberry .quare '.0. 10. 12.. Harrilburv,'A 1710'-126' 17171 U4-4161 Attorney. 'ar 'lainti". ltICHAJtD ltATZMAH and -.. ".-j-IN THI COURT or CcSiDiQI("'YtiXi".- PATRICIA ltATZMANl hi, wife, C~BE~lJUln COUNTY, PA Plaintiff. I I v. I NO. 915-604 I ALAN D. ROUMM, M.D., I CIVIL ACTION - LAW I Defendant I JURY TRIAL DEMAND~O lfr.a:III'II...' ..,LV '1'0 D.p.lIDlUI'l". .n ....n.. AND NOW, come the Plaintiffa, Richard and Patricia lCat.man, by and throu9h their attorney.] Goldber9, lCatzman , Shipman, P.c., and re.peotfully repre.ent .a follow.' 151-157. Denied 151. It i, specifically denied that plaintiff. Were n'9liqent in any fa.hion with re.pect to thi. claim, nor did they assume the ri.k of injury. 159-64. Denied. WHIRIPORI, plaintiffa re.pectfully requeat that defendant'a N.w Natter be di..iIl.ed and that jUdq1llent be entered in their favor. Reapectfully lub.ittad, OOLDIIlO, JAT.HAH I 'II'HAH, '.G. Dated, I.{ ...11.::3 (,. By' rrlft' . ~ ylA-~~ -. Apr . S ran9-K~ y, .aqu1re 320 Market Street P.O. Box 1261 Harrisburq, PA 17101-1268 Supre.e Court Id. 14672' Attorney. for Plaintiff. Riohard lCat..an and Patricia lat..en ~ ,,' I," jl , 'I " I' ' , I~ , ,1,,' \ " , I:': I I, ,) '11:11 t ,II I I' , 'y I' ,~ I , ' 'r,'; c) '" " 'I I !~~ ~. I (,J '~r ., ) l:~ I "I r~ ~~! , , I " " " , ! 1,.1' , 1"1' .'I'(I(]LLI ,)1 I," qU tJ, GOLD"ao, JATIMAN I .HI.NAM, ..C. ~prl~ L. 'iran9.J~iay - I.D. Wo. ..73. no Marlqi .tr..t .irawblrrr '~ar. ',0. loa 131. Hlrrl.b~r9, PA 1110.-13.. 17171 314-4141 ~iiorney. for .1110i1". aICIWlD IATIJIM and PATRICIA KATIJlMl hi. wife, plaintiff. IN THI COURT or COMMON 'LIAI CUMBIRLAJfD COUNTY, PA v. I I I I I I I I I NO. 95-604 CIVIL ACTION - LAW JURY TRIAL DIMANDID ALAN D. ROUJOl, M.D., Defendant rlD.D OllDD AJfD NOW, thia ) (, tl day of /\1'(' 'I , leU, after ,_I careful review of Defendant" Preliminary Objection in the nature of a de.url'al' to Plaintiff.' claim for battery, we hereby .u.tain the objection. Count I i. DISMISSED from the complaint. An i..ediate appeal from thi. Order will facilitate I'e.olution of the anUn ca... DATI'; It ( (/ (" ~ 1:" ~{' , (v. 'I r I. \, .. I. HilLY, .J. , , . ,I , 2. Tha Court'. March lt, ltt6 order .ak.. it claar th.t .. to Pl.intiff.' complaint, the Pl.intiff. .ay only procaad on the clai. of n.qliqanc. and .ay not pur.ua the cl.im found.d in l.ck of inform.d con.ent. 3. Th. Plaintiff. de. ire to take .n appa.l from thi. Order to the Coaaonw..lth Court. 4. Under P.. l.A.P. 341(c), a tri.l court .ay entar. final order a. to one or more but f.wer than all clai.. or partia. only upon an .xpr... determin.tion that an immedi.t. .ppeal would facilitate r,.olution of tha .ntire c.... 5. R.cently, our P.nn.ylvania Supr... Court ha. accepted a ca.. in whioh it will revisit the h.u. of whf)th.r or not the Doctrin. of Inform.d Con.ent .hould b. found.d i~ batt.ry at in n'9Uq.nce. It the b.ttery th.ory i. abandon.d in favor of the concapt of n'9ligence qov.rninq .n informed oon.ent cl.ia, .uch . chan9' in p.nn.ylv.nia l.w will have . dir.ct and profound i.pact on the oa.. .t bar. 6. Pl.intiff. re.peotfully .ubait that .n i...diate appe.l fro. the Court'. Order would facilit.t. re.olution of tha entira 0'.' in vi.w of the .pp..l p.ndin9 b.for. the p.nn.ylvani. Supra.. Court and an imm.diate appeal will .nhanca the pro.pect. of ..ttl...nt of the entira c.... " II Ii,' J) , " ',' " " I' , ..1 'I " 1'1 'I , " " " , I, Ii ,I " , " 'I " I' I I 'I , \ , ,', " ," ,/.. <l f" 1,;\ ;,11 " .,.':' ','" , l:il I ..I ,,',:) ", I') , I,!) 'I,' , rq , , '.,'. , " ' ,\ .. 1,',.1 :, ~ I" t", ;f', , )I\' " , ,'. ~ " 0' ", !I " , I ,I ..1 , I ',1, , ' COMMONWEAL. TH OF PENNSYLVANIA eOl/flntOl/1It , c OU"T~OUII .QU~"I C~"41'LI. ,. A. 1701l.UI7 HA"OL.t) I, SHEIL. V ~"IIJOINT iUDClI '''I7I~*O''~'O . Hay 3, 19U Peter J. Curry, ..quire Thoma., Thomae , Hafer P.O. 'Box 999 Harrisbur9, Pa. 17108 D.ar Mr. Curry I We have received plaintiffs' motion for amended order in the c..e of Ka~.man v. Roumm, No. 95-604, Civil Term. aetore ruling on the mot~on, we request that you appri.e the Court of d.fendant'. position on the ~atter. Plea.. re.pond within fift.en (15) days of the date of thi. letter. Very! truly ;ur , (~~ \ - , Harold a. Sh.e , P.J. OCI April L. Strang-Kutay, a.quire Illd I Ii '. ! I I, 139. RICHARD KATZMAN AND PATRICIA : IN THE COURT OF COMMON PLEAS OF KATZMAN, HIS WIFE : CUMBERLAND COUNTY, PENNSYLVANIA . . . V ALAN D. ROUMM, M,D, , , : NO., 9~'604 CIVIL TERM ~ AND NOW, Ootober 13, 199~, by agreement of oounsel, the abov. captioned matter Ie hereby continued from the Ootober Argument Court 1I.t. Coun..1 I. directed to rell.tthe oa88 when ready, By the Court, April Btrang.Kulay, Eaq. For the Plaintiff Cq)\'" ....'" I,\r:, Il' ..\f\- Peter J, Curry, E.q, For the DelGndant :br II " I, , " "il I' " I. 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