Articles & Updates

Supreme Court of Pennsylvania Holds That “Cause of Death” Refers Specifically to Medical Cause of Death Under MCARE

Mar 20, 2023 | Articles & Updates

Article by Kenneth Rafferty, Esq.

The Supreme Court of Pennsylvania held that the phrase “cause of death” refers specifically to medical cause of death, as that phrase is used in Medical Care Availability and Reduction of Error Act (“MCARE”) § 513(b), stating that actions for wrongful death or survival must be commenced within two years after death in absence of fraudulent concealment of cause of death.  Reibenstein v. Barax, 286 A.3d 222 (Pa. 2022).

On April 12, 2010, the decedent consulted with a physician, complaining of a persistent cough, fever, and lower back pain.  The physician ordered an ultrasound and a CT scan of the decedent’s abdominal area.  The physician sent the scans to a radiologist for review.  The radiologist identified an aortic aneurysm and reported his findings to the physician.  The decedent died in April when the aortic aneurysm ruptured before her meeting with a vascular surgeon in mid-May.  Notably, the parties did not dispute the medical cause of death—a rupture of an aortic aneurysm. 

A year later, the decedent’s estate (herein “estate”) brought a wrongful death and survival action against the radiologist for failing to recognize the urgency of the decedent’s condition.  The estate did not bring claims against the physician because the estate was unsuccessful in obtaining a certificate of merit that would allow the estate to name the physician in its action.  Further, the radiologist made no effort to plead the physician into the litigation. 

Discovery progressed over several years.  The estate claimed the radiologist’s obstructionist actions prevented the estate from discovering crucial information before the statute of limitations expired as to the physician.  The estate made several unsuccessful attempts to schedule the radiologist’s deposition, and the deposition was taken only after court intervention.  First, the estate did not “officially notice” the radiologists deposition until well after the MCARE §513(b)’s two-year statute of limitations had run as to the physician.  Second, when the estate finally deposed the radiologist, the deposition took place five years after the decedent’s death, and almost four years after filing suit against the radiologist.  In the deposition, the radiologist indicated that he spoke with the physician regarding the scans and informed the physician of the radiologist’s concerns regarding the potential rupture of the aortic aneurysm—the full substance of which was not explained in the physician’s written discovery.  

Based on this testimony, but a year after the deposition, the estate filed a new wrongful death and survival action against the physician, which the trial court consolidated with the radiologist action.  The new suit was premised on the allegation that the physician failed to act on the urgency of the decedent’s condition.

The physician sought summary judgment on the basis that the statute of limitations had run almost three years before the estate sued the physician.  Initially, the trial court denied summary judgment.  Upon considering the physician’s motion of reconsideration—which called particular attention to MCARE § 513(d)—the trial court granted summary judgment for the physician, finding there was no evidence of an “affirmative misrepresentation or fraudulent concealment of the cause of death,” because no parties disputed the medical cause of death. 

The estate appealed.  The Superior Court of Pennsylvania reversed, interpreting “cause of death” more broadly to encompass considerations associated with the manner of death (i.e., legal cause).  The Superior Court determined that the tolling provision should be read as serving the legislature’s stated intention to ensure fair compensation, such that § 513(b)’s tolling provision applied not only to the medical cause of death but also to “affirmative misrepresentations about or fraudulent concealment of conduct the plaintiff alleges led to the decedent’s death” (emphasis added). 

The Superior Court vacated the entry of summary judgment and remanded to the trial court to consider whether there was a fraudulent concealment or affirmative misrepresentation of the physician’s failure to act on the urgency of the decedent’s condition.

MCARE § 513(d) provides that its two-year limitations period on death actions, which commences upon death, will be tolled when there is an affirmative misrepresentation or fraudulent concealment of the cause of death.  Here, it was undisputed that (1) the decedent died in April 2010 of a rupture of an aortic aneurysm (medical cause of death); and (2) the estate brought claims against the physician after the two-year period had run.  The Supreme Court reasoned that the available textual evidence favors the narrow construction that § 513(b) only applies to the medical cause of death.  The Supreme Court reasoned that to read “cause of death” as encompassing legal causation or manner of death would entail inserting language into § 513(b). 

The Supreme Court reversed the Superior Court’s ruling, holding ultimately that § 513(b)’s tolling provision could not bear the breadth of the Superior Court’s reading.