K.H. v. Kumar, S., M.D ( 2015 )


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  • J-A08018-15
    
    2015 Pa. Super. 177
    K.H., A MINOR, BY HIS PARENT AND                      IN THE SUPERIOR COURT OF
    NATURAL GUARDIAN, H.S., AND PARENT                          PENNSYLVANIA
    AND GUARDIAN, E.H., IN THEIR OWN
    RIGHT
    Appellants
    v.
    SHAKTHI M. KUMAR, M.D., ET AL
    Appellee                        No. 497 MDA 2014
    Appeal from the Judgment Entered on February 19, 2014
    In the Court of Common Pleas of Lancaster County
    Civil Division at No.: Cl-09-00313
    BEFORE: SHOGAN, J., WECHT, J., and STRASSBURGER, J.*
    OPINION BY WECHT, J.:                                       FILED AUGUST 25, 2015
    K.H. through his parents, H.S. and E.H.,1 and his parents individually
    (collectively, “Appellants”), appeal the trial court’s November 27, 2013, and
    February 19, 2014 orders granting summary judgment in favor of Appellees
    Shakthi Kumar, M.D.; Yvonne Siwek, M.D.; Lancaster Pediatric Associates,
    Ltd. (“Lancaster Pediatric”); Donald Diverio, Jr., D.O.; AO Orthopedics, Inc.;
    Vincent Avallone, Jr., D.O.; Julie A. Mack, M.D.; Gene C. Smigocki, M.D.;
    Lancaster Radiology Associates, Ltd. (“Lancaster Radiology”); Lancaster
    General     Hospital        (“LGH”),    Atilla   Devenyi,     M.D.;   and   Regional
    ____________________________________________
    *
    Retired Senior Judge assigned to the Superior Court.
    1
    K.H.’s biological father, as explained infra, is C.S. E.H. married H.S.
    after the events underlying this lawsuit transpired.
    J-A08018-15
    Gastroenterology Associates of Lancaster, Ltd. (“Regional Gastroenterology”)
    (collectively, “Appellees”), and dismissing Appellants’ amended complaint
    with prejudice. Although this case nominally presents several issues, their
    resolution principally rests upon our answer to one question: Whether, as
    the trial court ruled, the lack of an express statutory civil remedy under the
    Child Protective Services Law (“CPSL”), 23 Pa.C.S. §§ 6301, et seq.,
    implicitly precludes a common-law remedy in tort for harms sustained due to
    child abuse when a physician has failed to report reasonable suspicions that
    a child is a victim of abuse to the government authorities designated by the
    CPSL. After careful review of the record and the seventeen party briefs filed
    in this case, we reverse and remand for further proceedings.
    I.    Introduction
    This case presents this Court with various challenges to two trial court
    orders that entered summary judgment for Appellees and collectively
    dismissed all of Appellants’ claims against the Appellees.        Motions for
    summary judgment are governed by Pa.R.C.P. 1035.2, which provides as
    follows:
    After the relevant pleadings are closed, but within such time as
    not to unreasonably delay trial, any party may move for
    summary judgment in whole or in part as a matter of law
    (1)   whenever there is no genuine issue of any material
    fact as to a necessary element of the cause of action
    or defense which could be established by additional
    discovery or expert report, or
    (2)   if, after the completion of discovery relevant to the
    motion including the production of expert reports, an
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    adverse party who will bear the burden of proof at
    trial has failed to produce evidence of facts essential
    to the cause of action or defense which in a jury trial
    would require the issues to be submitted to a jury.
    Pa.R.C.P. 1035.2.
    In reviewing an order granting or denying summary judgment, we
    apply the following standard:
    We must examine the entire record in the light most favorable to
    the non-moving party and resolve all doubts against the moving
    party when determining if there is a genuine issue of material
    fact. We will only reverse the lower court’s grant of summary
    judgment if there is a manifest abuse of discretion. Summary
    judgment should be granted only in cases where the right is
    clear and free of doubt. Summary judgment serves to eliminate
    the waste of time and resources of both litigants and the courts
    in cases where a trial would be a useless formality.
    First v. Zem Zem Temple, 
    686 A.2d 18
    , 20 (Pa. Super. 1996) (citations
    and internal quotation marks omitted).
    Although it is clear that a jury is not permitted to reach a verdict
    based upon guess or speculation, it is equally clear that a jury
    may draw inferences from all of the evidence presented. Cade
    v. McDanel, 
    679 A.2d 1266
    (Pa. Super. 1996).
    It is not necessary, under Pennsylvania law, that every fact
    or circumstance point unerringly to liability; it is enough
    that there be sufficient facts for the jury to say reasonably
    that the preponderance favors liability. . . . The facts are
    for the jury in any case whether based upon direct or
    circumstantial evidence where a reasonable conclusion can
    be arrived at which would place liability on the defendant.
    It is the duty of [the] plaintiffs to produce substantial
    evidence which, if believed, warrants the verdict they
    seek. . . . A substantial part of the right to trial by jury is
    taken away when judges withdraw close cases from the
    jury. . . .
    -3-
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    Id. at 1271
    (quoting Smith v. Bell Tel. Co. of Penna.,
    
    153 A.2d 477
    , 480 (Pa. 1959)).
    
    First, 686 A.2d at 21
    (citations modified).
    II.   FACTUAL AND PROCEDURAL HISTORY
    As noted, we are constrained in this procedural posture to grant
    Appellants the most favorable account of the evidence of record.              For
    present purposes, the trial court’s account of the factual background and
    procedural history of this case suffices.
    [K.H.] was born to [H.S.] and her former husband, [C.S.], on
    June 29, 2002 at [LGH]. [K.H.] was born prematurely at thirty-
    three weeks[’] gestation as a result of maternal preeclampsia.
    Following his birth, [K.H.] was admitted to the Neonatal
    Intensive Care Unit where he remained until his release from the
    hospital on July 15, 2002. After his discharge, [K.H.] was
    monitored by Dr. Shakthi Kumar at [Lancaster Pediatric]. [K.H.]
    suffered from respiratory, cardiac and gastrointestinal
    complications due to his prematurity, and was admitted to LGH
    on five occasions in July and August of 2002 pursuant to these
    issues.
    On September 9, 2002, [H.S.] took [K.H.] to [Lancaster
    Pediatric] with symptoms including congestion, spitting up,
    wheezing and refusing to sleep and eat. [K.H.] was examined
    by Dr. Yvonne Siwek, who ordered a chest X-ray. The X-ray was
    performed and read by Dr. Julie Mack at LGH. Dr. Mack noted
    that [K.H.’s] lungs were clear, but that the X-ray showed healing
    fractures of the fifth and sixth ribs and flattening of the vertebral
    bodies at T8, T9, T12, L2, L3 and L4. Dr. Mack discussed her
    findings with Dr. Siwek by telephone. While concerned about
    the potential of child abuse, Dr. Mack concluded that the more
    likely cause of the injuries was a congenital issue secondary to
    [K.H.’s] premature birth.           Dr. Siwek memorialized the
    conversation with an entry in her office chart and referred [K.H.]
    to Dr. Donald Diverio, a pediatric orthopedist at AO Orthopedics.
    On September 12, 2002, [K.H.] was examined by Dr. Diverio.
    Dr. Diverio noted that [K.H.] became irritable upon palpation of
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    his ribs. Dr. Diverio additionally reviewed the September 9th X-
    rays. At the conclusion of the office visit, Dr. Diverio accused
    [H.S. and C.S.] of child abuse.1 After the appointment, [H.S.
    and C.S.] took [K.H.] to see Dr. Kumar and told her about
    Dr. Diverio’s allegations. [Appellants] assert that, following their
    conversation, Dr. Kumar called Dr. Diverio and discussed
    [K.H.’s] injuries with him.
    ____________________
    1
    During his deposition, Dr. Diverio denied accusing [H.S.
    and C.S.] of abusing [K.H.]. Nevertheless, for summary
    judgment purposes, viewing the record in the light most
    favorable to the non-moving party, the [c]ourt will assume
    that these allegations were made as pled in Plaintiffs’
    Amended Complaint.
    Later the same day, [K.H.] underwent a bone survey performed
    and read by Dr. Mack at LGH.          Dr. Mack’s report identified
    healing rib fractures and vertebral deformities.
    On October 2, 2002, [K.H.] was seen by Dr. Atilla Devenyi, a
    gastroenterologist at [Regional Gastroenterology]. Dr. Devenyi
    examined [K.H.] and noted a rash or bruise on his sternum and
    chest wall. Dr. Devenyi reported his findings to Dr. Kumar.
    [K.H.] was seen in Dr. Kumar’s office on October 3, 2002, where
    she also observed the mark on his lateral chest wall and
    sternum.    Dr. Kumar noted in her office chart, “Seen by
    Dr. Devenyi yesterday. Ordered PT/PTT, CBC with platelets for a
    pattern seen on the chest that was suspicious for abuse. He also
    ordered a skeletal survey[.”] Later that day, Dr. Kumar spoke
    with Dr. Devenyi about the skeletal survey and laboratory tests
    that he ordered, and, following their conversation, the tests were
    canceled.
    On December 3, 2002, [K.H.] presented at [Lancaster Pediatric]
    for an appointment with Dr. Kumar. Dr. Kumar examined [K.H.]
    and noted an increase in the size of his head as well as a bruise
    on his forearm. On December 6, 2002, [K.H.] underwent a
    chest X-ray at LGH. Dr. Mack read the X-ray and reported[]
    “minimal deformity of [the] anterior lateral 7th rib compatible
    with [a] remote healing fracture” as well as “smooth periosteal
    reaction involving both humeri[.”] Dr. Mack additionally noted,
    “if there is any clinical concern of non-accidental trauma, full
    skeletal series should be performed[.”]
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    On December 6, 2002, [K.H.] underwent         an ultrasound of his
    head at LGH. Dr. Gene Smigocki read           and interpreted the
    ultrasound and noted, “no evidence             of hydronephrosis.
    Asymmetrically prominent left frontal horn.   No hemorrhage[.”]
    On December 18, 2002, [K.H.] was discovered at home in his
    crib unresponsive by [C.S.] and was rushed to LGH. A CT scan
    of his head was performed[,] which showed a left frontal
    intracranial hemorrhage. Consequently, [K.H.] was transported
    via helicopter to Milton S. Hershey Medical Center. It was later
    confirmed that [K.H.] had suffered non-accidental injuries
    including “contusion in the high left parietal region with
    surrounding edema with mass effect, interhemispheric subdural
    hematoma, tentorium subdural hematoma, and small left
    frontoparietal subdural hematoma[.”]        It was additionally
    determined that [K.H.] suffered these injuries because he was
    shaken. As a consequence of this incident, [C.S.] was charged
    with and convicted of felony child abuse and is currently serving
    a five- to ten[-]year prison sentence.
    [Appellants] claim that, as a result of his injuries, [K.H.] suffers
    from permanent brain damage and seizures, physical and
    neurodevelopmental deficits, disabilities and delays, delayed
    growth and development, and other physical traumas.
    [Appellants] additionally allege that [K.H.] has sustained
    numerous personal injuries including substantial pain and
    suffering, mental anguish, loss of life’s pleasures, humiliation,
    embarrassment and disfigurement.
    On January 13, 2009, [H.S.] and her current husband, [E.H.], on
    behalf of [K.H.] and in their own right, filed a Complaint for
    medical professional liability in the Lancaster County Court of
    Common Pleas.        In the Complaint, [Appellants] asserted
    negligence claims against Dr. Kumar, Dr. Siwek, [Lancaster
    Pediatric], Dr. Diverio, AO Orthopedics, Dr. Mack, [Lancaster
    Radiology,] and LGH, alleging that they collectively failed to
    recognize, treat and report child abuse pursuant to
    Pennsylvania’s [CPSL] §§ 6311 and § 6313.[2] [Appellees] filed
    ____________________________________________
    2
    Specifically, section 6311 of the CPSL obligates, inter alia, any person
    “licensed or certified to practice in any health-related field under the
    jurisdiction of the Department of State,” as well as any “employee of a
    health care facility or provider licensed by the Department of Health, who is
    (Footnote Continued Next Page)
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    J-A08018-15
    Preliminary Objections in the nature of a demurrer, which
    [o]bjections were overruled without [o]pinion by the Honorable
    Dennis E. Reinaker on October 13, 2009. On November 19,
    2009, the Court amended its [o]rder overruling the [p]reliminary
    [o]bjections to include a certification for immediate interlocutory
    appeal to the Superior Court. [Appellees] then filed a “Petition
    for Allowance of Appeal” with the Superior Court[,] which was
    denied via a per curiam [o]rder on February 16, 2010.
    On August 11, 2011, [Appellants] filed an Amended Complaint
    containing additional claims of negligence against Dr. Avallone,
    Dr. Smigocki, Dr. Devenyi and [Regional Gastroenterology],
    alleging that they also failed to report a suspicion of child abuse
    pursuant to the CPSL. Moreover, [Appellants] asserted medical
    negligence claims against Drs. Mack and Smigocki based upon
    misreads of radiographic imaging.         [Appellees] demurred a
    second time, and their [p]reliminary [o]bjections were overruled
    again without [o]pinion by Judge Reinaker on January 4, 2012.
    On June 22, 2012, the case was reassigned to me [i.e., Judge
    Wright].
    With discovery now complete, [Appellees] have filed Motions for
    Summary Judgment seeking to dismiss [Appellants’] claims
    against them.      In their [m]otions, [Appellees] assert that
    summary judgment is warranted because the CPSL does not
    create a private civil cause of action for violation of the reporting
    requirements contained in 23 Pa.C.S.A. § 6311 and § 6313.
    Further, [Appellees] argue that Pennsylvania law does not
    authorize negligence per se claims based upon violations of the
    _______________________
    (Footnote Continued)
    engaged in the admission, examination, care or treatment of individuals” to
    “make a report of suspected child abuse . . . if the person has reasonable
    cause to suspect that a child is a victim of child abuse.” 23 Pa.C.S.
    §§ 6311(a)(1), (3). Notably, subsection 6311(b)(3) provides that “[n]othing
    in this section shall require the mandated reporter to identify the person
    responsible for the child abuse to make a report of suspected child abuse.”
    Section 6313 directs the reporting procedure, requiring a mandated reporter
    to “immediately make an oral report of suspected child abuse to the
    department via the Statewide toll-free telephone number . . . or a written
    report using electronic technologies,” and further directs that an oral
    reporter submit a written report to the assigned department or agency
    within forty-eight hours.
    -7-
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    CPSL, and that there is no common[-]law duty for a physician to
    report a reasonable suspicion of child abuse.        Additionally,
    [Appellees] contend that, even if the [c]ourt recognizes a duty
    for physicians to report suspected child abuse, [Appellants]
    cannot establish that [Appellees’] conduct was the legal cause of
    [K.H.’s] injuries. Finally, LGH asserts that [Appellants] have
    failed to establish that they are liable for the conduct of the
    physicians through the doctrine of ostensible agency, or that the
    hospital engaged in corporate negligence.
    Trial Court Opinion (“T.C.O.”), 11/27/2013, at 2-6 (citations omitted).
    After reviewing Appellees’ various arguments, the trial court entered
    partial summary judgment as follows:
    [Appellees’] Motions are granted insofar as all of [Appellants’]
    claims based upon [Appellees’] alleged failure to recognize, treat
    and report reasonable suspicions of child abuse are dismissed.
    LGH’s Motions are also granted as to [Appellants’] corporate
    negligence claims related to the hospital’s failure to adopt
    policies to ensure quality care for the patient and to select and
    retain competent physicians. However, Dr. Mack, Dr. Smigocki,
    [Lancaster Radiology] and [LGH’s] [m]otions are denied with
    respect to any averments of negligence that are specifically
    premised on the misinterpretation of radiological studies by
    Drs. Mack and Smigocki, and the vicarious liability of Lancaster
    Radiology Associations and [LGH] on these medical malpractice
    claims.
    Order, 11/27/2013, at 1-2.
    The parties thereafter filed motions for reconsideration.            After
    reviewing the motions, the trial court entered an order denying Appellants’
    motion for reconsideration, granting Appellees’ motion for reconsideration,
    and dismissing Appellants’ amended complaint in its entirety.     See Order,
    2/19/2014, at 1.   The trial court order included a footnote explaining the
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    court’s reversal of course as to those claims that initially survived summary
    judgment:
    Upon further review of [Appellants’] expert reports submitted by
    Drs. [Alan E.] Oestreich and [James] Abrahams, the [c]ourt
    determined that, while both experts initially opine that Drs. Mack
    and Smigocki misinterpreted [K.H.’s] radiographic studies, they
    ultimately conclude that the only damage caused by these errors
    was that the physicians failed to recognize and report suspected
    child abuse.      The [c]ourt has already determined that
    Pennsylvania law does not authorize a private cause of action
    against a physician for failure to report suspected child abuse.
    Accordingly, [Appellees’] Motion for Reconsideration must be
    granted.
    
    Id. at 1
    n.1. The trial court’s February 19, 2014 order rendered final the
    court’s entry of summary judgment for Appellees as to all of Appellants’
    claims. This timely appeal followed.
    On March 18, 2014, the trial court directed Appellants to file a concise
    statement   of   the   errors   complained    of   on     appeal   pursuant   to
    Pa.R.A.P. 1925(b), and Appellants timely complied on April 8, 2014.           On
    April 30, 2014, the trial court issued its Rule 1925(a) opinion, which directed
    this Court’s attention to the explanations provided in its lengthy November
    27, 2013 opinion, which coincided with its initial order entering partial
    summary judgment.
    II.   DISCUSSION
    Appellants raise the following issues for review:
    1.    Did the trial court commit an error of law by granting
    summary judgment in favor of [Appellees] on purely legal issues
    that had been decided in favor of [Appellants] on preliminary
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    objections by a judge of coordinate jurisdiction where no new
    law or evidence was presented?
    2      Did the trial court commit an error of law by granting
    summary judgment in favor of [Appellees] on [Appellants’]
    legally cognizable claims for professional medical negligence
    based on [Appellees’] departure from the applicable standard of
    care where [Appellants] established a duty based on the
    [Appellees’] admissions and expert opinions?
    3.    Did the trial court commit an error of law by granting
    summary judgment on [Appellants’] anticipated request for a
    negligence per se jury instruction at trial?
    4.    Did the trial court commit an error of law by granting
    summary judgment in favor of [Appellees] where the record
    contained more than adequate evidence, including multiple
    expert reports, demonstrating [that Appellees’] medical
    negligence increased the risk of harm to [K.H.]?
    5.     Did the trial court commit an error of law by granting
    summary judgment in favor of [LGH] on [Appellants’] claims for
    corporate negligence where the record contained more than
    sufficient evidence that [LGH] failed to have appropriate policies
    in place for the retention and availability of patients’ prior
    radiology studies, and failed to have adequately trained,
    experienced, and qualified physicians to read pediatric
    radiographs?
    Brief for Appellants at 4-5 (footnote omitted).3
    A.     The Coordinate Jurisdiction Doctrine Does Not Preclude
    the Trial Court from Granting Summary Judgment.
    Appellants’ first issue is the easiest to resolve, requiring only brief
    discussion. As 
    noted, supra
    , the trial court’s entry of summary judgment for
    Appellees hinged principally, perhaps exclusively, upon the proposition that
    ____________________________________________
    3
    Issues two and four overlap sufficiently that we will consider them
    together as Appellants’ second issue.
    - 10 -
    J-A08018-15
    Appellants’ claims, however denominated, amounted to claims for civil relief
    for violations of the CPSL’s reporting obligations. In effect, Appellants argue
    that Judge Reinaker, the first judge assigned this case, conclusively decided
    this issue in their favor.    Consequently, the coordinate jurisdiction rule
    barred Judge Wright, to whom the matter later was assigned, from granting
    summary judgment for Appellees. We disagree.
    Our Supreme Court has described the coordinate jurisdiction rule as
    follows:
    Generally, the coordinate jurisdiction rule commands that[,]
    upon transfer of a matter between trial judges of coordinate
    jurisdiction, a transferee trial judge may not alter resolution of a
    legal question previously decided by a transferor trial judge.
    More simply stated, judges of coordinate jurisdiction should not
    overrule each other’s decisions.
    The reason for this respect for an equal tribunal’s decision . . . is
    that the coordinate jurisdiction rule is based on a policy of
    fostering the finality of pre-trial applications in an effort to
    maintain judicial economy and efficiency. Furthermore, . . . the
    coordinate jurisdiction rule serves to protect the expectations of
    the parties, to [e]nsure uniformity of decisions, to maintain
    consistency in proceedings, to effectuate the administration of
    justice, and to bring finality to the litigation.
    Zane v. Friends Hosp., 
    836 A.2d 25
    , 29 (Pa. 2003) (citations modified;
    internal quotation marks omitted).
    The trial court addressed this issue only briefly in its Rule 1925(a)
    opinion, rejecting Appellants’ argument by reference to this Court’s decision
    in Salerno v. Philadelphia Newspapers, Inc., 
    546 A.2d 1168
    , 1170
    (Pa. Super. 1988). In Salerno, this Court made the following observations:
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    [The coordinate jurisdiction rule] is not intended to preclude
    granting summary judgment following denial of preliminary
    objections. “The failure to present a cause of action upon which
    relief can be granted may be raised at any time. A motion for
    summary judgment is based not only upon the averments of the
    pleadings but may also consider discovery depositions, answers
    to interrogatories, admissions and affidavits.”        Austin J.
    Richards, Inc., v. McClafferty, 
    538 A.2d 11
    , 14-15 n.1
    (Pa. Super. 1988). We can discern no reason for prohibiting the
    consideration and granting of a summary judgment if the record
    as it then stands warrants such action.        Cf. DiAndrea v.
    Reliance S.&L. Ass’n, 
    456 A.2d 1066
    , 1069 (Pa. Super. 1983).
    This is particularly true when the preliminary objections were
    denied without an opinion. Farber v. Engle, 
    525 A.2d 864
          (Pa. Cmwlth. 1987).
    
    Salerno, 546 A.2d at 1170
    (citations modified).
    Appellants counterpose, inter alia, our Supreme Court’s decision in
    Goldey v. Trustees of Univ. of Penna., 
    675 A.2d 264
    (Pa. 1996). In this
    Court’s decision preceding the Supreme Court’s review, we appeared to
    expand Salerno’s reliance upon the lack of trial judge opinion in connection
    with denying preliminary objections to a far broader spectrum of motions
    and procedural contexts.     This Court’s ruling to that effect, our Supreme
    Court observed, “stretched far beyond the exception stated in Salerno,
    which was grounded in the differences between preliminary objections and
    summary judgment motions.”        
    Goldey, 675 A.2d at 267
    .        The Supreme
    Court, emphasizing that the “presence or absence of an opinion in support of
    the initial ruling is not controlling,” held without qualification that, “[w]here
    the motions differ in kind, as preliminary objections differ from motions for
    judgment on the pleadings, which differ from motions for summary
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    judgment, a judge ruling on a later motion is not precluded from granting
    relief although another judge has denied an earlier motion.” 
    Id. Appellants seek
    to distinguish Salerno from the instant case on the
    basis that, in the instant case, the record relevant to the purely legal issues
    raised on summary judgment before Judge Wright was no more expansive
    than the record as it appeared to Judge Reinaker when he overruled
    Appellees’ preliminary objections.             Brief for Appellants at 27.   For this
    reason, Appellants argue that the procedural context is immaterial, because
    the spirit of the coordinate jurisdiction rule was violated when the trial court
    accepted these arguments after they were rejected earlier by a different
    judge. 
    Id. at 27-28.
    In the strongest of the Appellees’ various briefs on this subject, 4
    Appellee Dr. Devenyi cites, inter alia, Mellon Bank, N.A., v. National
    Union Insurance Co. of Pittsburgh, PA, 
    768 A.2d 865
    (Pa. Super. 2001),
    as controlling authority. Brief for Dr. Devenyi, AO Pediatric Associates, Inc.,
    and Dr. Avallone at 11-12 (“Brief for Devenyi”).            In that case, one judge
    overruled preliminary objections asserted on the basis that the claimant in
    ____________________________________________
    4
    In sum, this Court is confronted with seventeen briefs—Appellants’
    primary brief, eight responsive briefs by Appellees, and Appellants’ reply
    brief to each responsive brief. In the discussion that follows, references to
    individual Appellees’ arguments will occur only rarely, because their
    arguments tend to be shared, incorporated by reference, or materially the
    same. Except when circumstances warrant otherwise, we will simply refer to
    “Appellees’” arguments.
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    J-A08018-15
    that case was not an insured, and did not provide an explanatory opinion.
    Later, when the same issue was raised before a different judge in a motion
    for summary judgment that did not present any new evidence in support of
    dismissal, this Court, citing Goldey, held that the differing nature of the two
    motions sufficed to preclude application of the coordinate jurisdiction rule.
    We agree that Mellon Bank is controlling. Consequently, we find it
    immaterial whether, in fact, the decisional record on summary judgment
    before Judge Wright varied at all from what Judge Reinaker had at his
    disposal in reviewing Appellees’ preliminary objections.        Under Mellon
    Bank, the procedural context alone precludes application of the coordinate
    jurisdiction rule.   Accordingly, we reject Appellants’ argument that Judge
    Wright was barred from granting Appellees summary judgment by Judge
    Reinaker’s prior contrary ruling in the context of preliminary objections.
    B.    Appellants Do Not Seek to Establish a Civil Cause of
    Action Under the CPSL.
    In taking up the questions presented as issues two and four, we
    cannot address whether Appellants set forth a prima facie case of medical
    malpractice in various particulars before first addressing the trial court’s and
    Appellees’ conclusions that Appellants seek relief that necessarily sounds in
    a putative civil violation of the CPSL, a statute that expressly provides only
    criminal sanctions against physicians who “willfully” fail to comply with its
    terms. See 23 Pa.C.S. § 6319(a)(1). The trial court ruled that the absence
    of an express provision in the CPSL providing for such a claim necessarily
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    signals the exclusion of any civil cause of action based upon a failure to
    report child abuse, requiring dismissal of all of Appellants’ claims.
    Only Appellee Regional Gastroenterology Associates of Lancaster—in a
    mere two sentences—addresses this issue in the terms that we find
    conclusive:     “In their Brief, Appellants concede that the [CPSL] does not
    create    a   private    cause     of   action       against   Appellees.         [Regional
    Gastroenterology]       accepts      this      concession.”       Brief     for   Regional
    Gastroenterology at 2. We agree.5
    That being said, Appellees’ arguments suggest that Appellants’ claims,
    even if framed as common-law medical malpractice, necessarily depend
    upon the existence of a civil remedy under the CPSL.                Appellees in effect
    assert that Appellants may not obtain the benefit of their artful pleading in
    seeking to invent a private cause of action that the legislature implicitly
    declined to create.      Notably, Appellees offer no controlling or entirely on-
    ____________________________________________
    5
    Appellants unnecessarily complicate their own position by suggesting
    that Regional Gastroenterology’s assertion that Appellants concede the
    matter “misses the point.” Reply Brief of Appellants to Brief of Regional
    Gastroenterology at 2 (unnumbered). Appellants elaborate that, “[w]hile
    the CPSL may not include an express private cause of action, [Appellants]
    have not sought to recover under the statutory provisions of the CPSL.” 
    Id. This strikes
    us as a distinction without a difference. In any event, even if
    Appellants did not disavow any such claim, we would find it waived for want
    of argument in support of such a position. See Commonwealth v. Veon,
    
    109 A.3d 754
    , 774 (Pa. Super. 2015) (deeming an issue waived under
    Pa.R.A.P. 2119(a) because the appellant failed to provide a “properly
    developed argument”).
    - 15 -
    J-A08018-15
    point case law establishing the necessity of construing Appellants’ claims in
    this fashion.     Furthermore, the CPSL does not expressly preclude civil
    liability for a failure to report abuse, nor immunize those who fail in their
    reporting obligations.
    Consequently, for purposes of determining whether Appellants have
    stated a prima facie case of medical malpractice or negligence, we think it
    most useful to evaluate the adequacy of Appellants’ showing in this regard
    as though the CPSL simply does not exist. Appellants claim not to rely upon
    it, and we find no reason in Pennsylvania law not to treat their asserted
    common-law claims as such.            If Appellants’ claims cannot stand without
    reference to the CPSL, our analysis would reveal that flaw. However, we do
    not find that to be the case.
    C.     Appellants Have Set Forth a Prima Facie Case of Medical
    Malpractice.
    We begin with the time-honored characterization of the standard that
    governs common-law medical malpractice claims:6
    [W]hen a plaintiff’s medical            malpractice claim sounds in
    negligence, the elements of the         plaintiff’s case are the same as
    those in ordinary negligence             actions.     As such, medical
    malpractice can be broadly              defined as the unwarranted
    ____________________________________________
    6
    At times, Appellants refer to their claims as ordinary negligence and in
    others as sounding in medical malpractice. However, the substance of their
    claims consists of assertions consistent with medical malpractice, and we
    treat them exclusively as such. See Grossman v. Barke, 
    868 A.2d 561
    ,
    566 (Pa. Super. 2005) (analyzing claims stated as ordinary negligence under
    the standards governing medical malpractice).
    - 16 -
    J-A08018-15
    departure from generally accepted standards of medical practice
    resulting in injury to the patient, including all liability-producing
    conduct arising from the rendition of professional medical
    services. Thus, to prevail in a medical malpractice action, a
    plaintiff must establish a duty owed by the physician to the
    patient, a breach of that duty by the physician, that the breach
    was the proximate cause of the harm suffered, and [that] the
    damages suffered were a direct result of the harm.
    Toogood v. Owen J. Rogal, D.D.S., P.C., 
    824 A.2d 1140
    , 1145 (Pa. 2003)
    (citations and internal quotation marks omitted); see Grossman v. Barke ,
    
    868 A.2d 561
    , 566 (Pa. Super. 2005).
    “Whether a duty of care exists in any given set of circumstances is a
    question of law.” Winschel v. Jain, 
    925 A.2d 782
    , 796 (Pa. Super. 2007).
    However, provided the plaintiff makes a prima facie showing of a duty, the
    standard of care and the defendant’s satisfaction of that standard are
    questions of fact to be submitted to a jury. Joyce v. Blvd. Phys. Therapy
    & Rehab. Ctr., P.C., 
    694 A.2d 648
    , 654-55 (Pa. Super. 1997).
    1.    Appellees owed the general duty of care to K.H.
    that    arises  in    the    physician-patient
    relationship.
    Our Supreme Court has spoken eloquently of the nature of the duty
    owed by any one person to another:
    In determining the existence of a duty of care, it must be
    remembered that the concept of duty amounts to no more than
    the sum total of those considerations of policy which led the law
    to say that the particular plaintiff is entitled to protection from
    the harm suffered. . . . To give it any greater mystique would
    unduly hamper our system of jurisprudence in adjusting to the
    changing times. The late Dean Prosser expressed this view as
    follows:
    - 17 -
    J-A08018-15
    These are shifting sands, and no fit foundation. There is a
    duty if the court says there is a duty; the law, like the
    Constitution, is what we make it. Duty is only a word with
    which we state our conclusion that there is or is not to be
    liability; it necessarily begs the essential question. When
    we find a duty, breach and damage, everything has been
    said.     The word serves a useful purpose in directing
    attention to the obligation to be imposed upon the
    defendant, rather than the causal sequence of events;
    beyond that it serves none. In the decision whether or not
    there is a duty, many factors interplay: [t]he hand of
    history, our ideas of morals and justice, the convenience of
    administration of the rule, and our social ideas as to where
    the loss should fall. In the end the court will decide
    whether there is a duty on the basis of the mores of the
    community, always keeping in mind the fact that we
    endeavor to make a rule in each case that will be practical
    and in keeping with the general understanding of mankind.
    Sinn v. Burd, 
    404 A.2d 672
    , 681 (Pa. 1979) (citations omitted).
    Althaus v. Cohen, 
    756 A.2d 1166
    , 1169 (Pa. 2000) (emphasis added;
    citations modified); see Thierfelder v. Wolfert, 
    52 A.3d 1251
    , 1265
    (Pa. 2012).
    The following overarching principle, which adapts the broader notion of
    duty to the context of medical malpractice, is enshrined in many decades of
    our case law:
    Duty is measured against the standard of care appropriate to the
    training of the physician and the time and place of the
    treatment. Our Supreme Court has explained the standard of
    care appropriate to a non-specialist physician as follows:
    The standard of care required of a physician . . . is well-
    settled . . . . A physician who is not a specialist is required
    to possess and employ in the treatment of a patient the
    skill and knowledge usually possessed by physicians in the
    same or a similar locality, giving due regard to the
    advanced state of the profession at the time of the
    treatment; and in employing the required skill and
    - 18 -
    J-A08018-15
    knowledge he is also required to exercise the care and
    judgment of a reasonable man.
    
    Joyce, 694 A.2d at 654
    (quoting Donaldson v. Maffucci, 
    156 A.2d 835
    , 838 (Pa. 1959))
    
    Winschel, 925 A.2d at 796-97
    (citations modified).
    A specialist acting within his or her specialty . . . is held to a
    higher standard; he or she is expected to exercise that degree of
    skill, learning and care normally possessed and exercised by the
    average physician who devotes special study and attention to
    the diagnosis and treatment of diseases within the specialty.
    Maurer    v.   Trustees    of   Univ.   of    Penna.,   
    614 A.2d 754
    ,   758
    (Pa. Super. 1992) (internal quotation marks omitted).
    The trial court began its discussion of Appellants’ common-law claims
    as follows:
    As a general rule, under Pennsylvania law, a person is not liable
    for the criminal conduct of a third party. Feld v. Merriam, 
    485 A.2d 742
    , 756 (Pa. 1984). Moreover, it is axiomatic that there is
    no duty to control the conduct of a third person to prevent him
    from causing physical harm to another unless (a) a special
    relationship exists between the actor and third person’s conduct,
    or (b) a special relationship exists between the actor and the
    other which gives the other a right to protection. Emerich v.
    Phila. Ctr. for Human Dev., Inc., 
    720 A.2d 1032
    , 1036
    (Pa. 1998). . . . Absent a special relationship, the duty that one
    person owes to another is “the general duty imposed upon all
    persons not to expose others to risk of injury which are
    reasonably foreseeable[.”] Schmoyer v. Mexico Forge, Inc.,
    
    649 A.2d 705
    , 708 (Pa. Super. 1994).
    T.C.O. at 18 (citations modified).
    The trial court relied exclusively upon a Georgia decision to support its
    finding that no relevant duty arose under the circumstances of this case.
    - 19 -
    J-A08018-15
    Specifically, the trial court deemed “persuasive” the Court of Appeals of
    Georgia’s decision in Cechman v. Travis, in which that court, faced with
    claims materially identical to those at bar, found no common-law duty on the
    part of the physician to discover and report a case of possible child abuse.
    T.C.O. at 19 (citing Cechman, 
    414 S.E.2d 282
    , 285 (Ga. Ct. App. 1991)).
    But see First Comm’l Trust Co. v. Rank, 
    915 S.W.2d 262
    , 267-68
    (Ark. 1996) (rejecting Cechman and noting that physician’s attorney
    conceded that common-law medical malpractice claim may lie for failure to
    report).
    We find the trial court’s resort to Cechman unconvincing.                 In
    connection with duty, we are confronted with a trial court decision and
    arguments by the Appellees reflecting an essential misapprehension by the
    trial court and the Appellees, one that perhaps descends from many cases in
    which the distinction between duty and standard of care has been blurred
    without consequence when properly separating the two was less critical than
    it is in this case. Stated specifically and in brief, the trial court and Appellees
    effectively maintain that the question of duty must be stated in the
    particular terms of the case presented. Thus, in the absence of an express
    common-law “duty” specifically to report suspected child abuse that has
    been recited in a prior controlling precedent, such a claim categorically is
    unavailable. However, to define the relevant duty in this case in that fashion
    improperly imports into the duty inquiry questions pertaining to whether a
    - 20 -
    J-A08018-15
    duty was breached, which is a question of fact as to which Appellants
    presented sufficient evidence to create a genuine issue of material fact.
    In most cases, this distinction will be of little import, which is why our
    medical malpractice case law tends to lack discussions that clearly segregate
    these inquiries.       However, disentangling these principles is critical to
    resolving the issue presented: If the question is simply whether Appellees
    owed K.H., as their patient, a duty of reasonable care, then the necessity of
    a duty clearly is satisfied. As our case law makes clear, a physician must
    “possess and employ in the treatment of a patient the skill and knowledge
    usually possessed by physicians in the same or a similar locality, giving due
    regard to the advanced state of the profession at the time of the treatment”
    and “is also required to exercise the care and judgment of a reasonable
    man.” 
    Winschel, 925 A.2d at 196-97
    . However, if, as the trial court and
    Appellees maintain, the question is whether Appellees had a specific duty to
    report suspicions of abuse, the absence of case law establishing such a duty
    lends at least some credence to Appellees’ claims that to vindicate
    Appellants’ view would create an entirely new form of liability, which this
    Court does not regularly do.7
    ____________________________________________
    7
    Although ultimately we find this argument immaterial to our analysis,
    the mere recognition of a viable basis for a tort claim that has not previously
    been presented to Pennsylvania courts should not be fatal per se to such a
    claim. As the Minnesota Supreme Court observed in Becker v. Mayo
    Foundation, 
    737 N.W.2d 200
    (Minn. 2007), the “[n]ovelty of an asserted
    right and lack of common-law precedent are no reasons for denying its
    (Footnote Continued Next Page)
    - 21 -
    J-A08018-15
    Although we find the relevant principle in the above-cited cases,
    Pennsylvania law is not a paragon of clarity in distinguishing duty from
    standard of care.        Nonetheless, additional suggestions as to the correct
    answer are found in the above cases and others.                 In Pratt v. Stein,
    
    444 A.2d 674
    (Pa. Super. 1982), for example, we held that a physician’s
    duty to a patient is simply the “exercise [of] reasonable medical care,”
    without importing into that question of duty the precise contours of what
    care was appropriate under the circumstances of that case.              Rather, we
    addressed the particular standard of care and the doctor’s satisfaction
    thereof as a question of fact.           
    Id. at 705.
       And in Ervin v. American
    Guardian Life Assurance Co., 
    545 A.2d 354
    (Pa. Super. 1988), this Court
    held that a cardiologist retained by an insurance company to review an
    insured’s electrocardiogram did not owe the claimant a duty that would
    support a medical malpractice action.            In so doing, we favorably quoted a
    Michigan decision to the effect that, where the claimant did not seek medical
    advice or treatment from the defendant, the physician lacked the duty that
    attaches to such a relationship.          
    Id. at 356
    (quoting Rogers v. Horvath,
    
    237 N.W.2d 595
    , 596-97 (Mich. Ct. App. 1976)).8
    _______________________
    (Footnote Continued)
    existence.     The common law does not consist of absolute, fixed, and
    inflexible rules. Its principles have been determined by the social needs of
    the community and have changed with changes in such needs.” 
    Id. at 216.
    8
    The Michigan Supreme Court later abrogated Rogers, holding that an
    independent medical examiner owes a limited duty to the subject of his
    (Footnote Continued Next Page)
    - 22 -
    J-A08018-15
    Perhaps most interestingly, just last year this Court reaffirmed a
    limited duty on the part of a physician to certain third parties in the
    treatment of a patient with a communicable disease.             Our decision was
    couched in the Restatement (Second) of Torts § 324A (“Liability to Third
    Person for Negligent Performance of Undertaking”), which provides that
    “[o]ne who undertakes, gratuitously or for consideration, to render services
    to another which he should recognize as necessary for the protection of a
    third person . . ., is subject to liability to the third person for physical harm
    resulting from his failure to exercise reasonable care . . . .”      Restatement
    (Second) of Torts § 324A.          We noted that the “original undertaking,” i.e.,
    “entry into the physician-patient relationship for treatment purposes,”
    imposed upon the physician “the duty to exercise reasonable care.”
    Matharu v. Muir, 
    86 A.3d 250
    , 259 (Pa. Super. 2014) (quoting Seebold v.
    Prison Health Servs., Inc., 
    57 A.3d 1232
    , 1244-45 (Pa. 2012)).
    Comparing these cases’ accounts of what general duty a physician
    owes to a patient to certain intrinsic principles of medical malpractice claims
    points to the proper approach to separating a physician’s duty from his
    standard of care. First, as 
    noted, supra
    , the duty inquiry is a pure question
    of law. Consequently, it is for the court in the first instance to determine
    without jury consideration whether a duty attaches under the circumstances
    _______________________
    (Footnote Continued)
    examination that is consistent with his professional training and expertise.
    See Dyer v. Trachtman, 
    679 N.W.2d 311
    (Mich. 2004).
    - 23 -
    J-A08018-15
    of the case before it.       However, we also have made clear that in all but
    extraordinary cases, establishing the applicable standard of care, or if one
    prefers, the contours of the general duty recognized in the first instance by
    the court, requires expert testimony and presents a question of fact for the
    jury. 
    Joyce, 694 A.2d at 654
    -55. If we allow the trial court to import into
    the duty inquiry a determination as to the precise standard of care at issue,
    and implicitly to decide on summary judgment that the standard has not
    been breached, we take from the jury its prescribed role in medical
    malpractice cases.       The integrity of the time-honored delineation of what
    belongs to the court and what belongs to the jury can be preserved only by
    separating a physician’s general duty to his patient, the formulation of
    which arises simply from the inception of any physician-patient relationship,
    from the elucidation of how that duty is to be fulfilled in a given case, which
    concerns the particular standard of care, and whether the defendant did so.
    The latter inquiries require a jury determination. See id.9
    ____________________________________________
    9
    Even as they argue for the expanded account of what duty a trial court
    must find as a matter of law before a case may proceed, Appellees LGH and
    Dr. Kumar elsewhere appear to concede that the inquiry properly proceeds
    from the threshold question of law on to trial and jury consideration as we
    explain herein. LGH, for example, notes that “a duty exists, as recognized
    by law as created by the physician/patient relationship, that requires the
    physician to act in accordance with specific norms or standards established
    by the profession, commonly referred to as the standard of care.” Brief
    for LGH at 20 (emphasis in original). LGH then notes that, “if no care is due,
    it is meaningless to assert that a person failed to act with due care.” 
    Id. (quoting Elbasher
    v. Simco Sales Serv. of Penna., 
    657 A.2d 983
    , 984-85
    (Pa. Super. 1995)). See Brief for Kumar at 36-37 (noting that “[w]hether a
    (Footnote Continued Next Page)
    - 24 -
    J-A08018-15
    In light of this account, it is clear that the trial court conflated the
    broader inquiry into Appellees’ duties into one inflected by the case- and
    physician-specific standard of care, the determination of which is reserved
    for the jury. This error led the court to conclude that no common-law claim
    for a failure to report would lie, when, in fact, the common-law claim that
    was asserted is (or may be) merely a species of medical malpractice, albeit
    one infrequently invoked, requiring expert testimony sufficient to enable a
    jury to conclude that the standard of care applicable to Appellees in this case
    entailed an obligation to report suspicions of child abuse.          Appellants
    established Appellees’ general duty as soon as they established the
    undisputed physician-patient relationship between K.H. and all of the
    Appellees in this case. Thus, we now must consider whether Appellants set
    forth sufficient evidence as to each of the remaining elements of a medical
    malpractice claim to establish a prima facie case for medical malpractice.
    2.    Appellants set forth a prima facie case that
    Appellees breached their respective duties to
    K.H.
    Having established the threshold duty that K.H.’s healthcare providers
    owed him as a consequence of the physician-patient relationship, we turn
    _______________________
    (Footnote Continued)
    physician is performing his duty . . . is established by the profession of which
    the physician is a member,” but stating that “[e]xperts do not establish
    whether a duty exists,” and conceding that Dr. Kumar had a duty to
    examine, diagnose, and treat K.H.).
    - 25 -
    J-A08018-15
    now to the question of breach. Because we review Appellants’ proffer in the
    light most favorable to Appellants, we must consider whether their evidence
    (a) could lead a jury reasonably to conclude that Appellees’ standards of
    care entailed obligations to form and/or report suspicions of abuse, and
    (b) establishes a basis upon which a jury reasonably could conclude that
    Appellants failed to meet their respective standards of care.
    (a)   Appellants’ evidence creates a genuine
    issue of material fact regarding whether
    Appellees’ standard of care imposed upon
    them a reporting obligation.
    Under the circumstances of this case, establishing the applicable
    standard of care for a general practitioner or a specialist generally requires
    expert testimony.   See 
    Donaldson, 156 A.2d at 838
    ; 
    Maurer, 614 A.2d at 758
    .   Typically, “[a] plaintiff [must] present an expert witness who will
    testify, to a reasonable degree of medical certainty, that the acts of the
    physician deviated from good and acceptable medical standards . . . .”
    Mitzelfelt v. Kamrin, 
    584 A.2d 888
    , 892 (Pa. 1990).
    “This requirement stems from judicial concern that, absent the
    guidance of an expert, jurors are unable to determine
    relationships among scientific factual circumstances.” Brannan
    v. Lankenau Hosp., 
    417 A.2d 196
    , 199-200 (Pa. 1980) (citing
    McMahon v. Young, 
    276 A.2d 534
    (Pa. 1971)). The standard
    by which an expert witness is qualified, however, is a liberal one.
    Lira v. Albert Einstein Med. Ctrs., 
    559 A.2d 550
          (Pa. Super. 1989); see Flanagan v. Labe, 
    666 A.2d 333
    , 335
    (Pa. Super. 1995) (nurse properly testified to standard of care
    pertaining to certain acts where she had in fact performed those
    acts). “If a witness has any reasonable pretension to specialized
    knowledge on the subject under investigation he may testify,
    and the weight to be given to his [testimony] is for the jury.”
    - 26 -
    J-A08018-15
    
    Lira, 559 A.2d at 552
    (quoting Kuisis v. Baldwin-Lima-
    Hamilton Corp., 
    319 A.2d 914
    , 924 (Pa. 1974)).
    
    Joyce, 694 A.2d at 654
    -55 (citations modified); see 
    Toogood, 824 A.2d at 1149
    (“[A] jury of laypersons generally lacks the knowledge to determine
    the factual issues of medical causation; the degree of skill, knowledge, and
    experience required of the physician; and the breach of the medical standard
    of care.”10).11
    Conspicuously absent from this appeal is any suggestion by Appellees
    that the numerous experts who have provided their opinions in this case on
    Appellants’ behalf are unqualified as such to speak on the subjects upon
    which they opine, and their respective credentials would militate strongly
    against any such challenge.          Consequently, the only question is whether
    Appellants provided expert evidence that defined a standard of care
    requiring reporting to a reasonable degree of medical certainty and asserted
    a breach thereof with respect to each Appellee.             Appellants provided
    voluminous evidence to precisely that effect.
    ____________________________________________
    10
    Here, too, it is clear that determining the standard of care is a task
    firmly ensconced with the jury, not the court under the guise of satisfying
    the threshold question of whether the defendant owed a duty to the plaintiff.
    11
    With the enactment of Pennsylvania’s Medical Care Availability and
    Reduction of Error Act (“MCARE”), 40 P.S. §§ 1303.101, et seq., additional
    mandatory qualifying criteria were imposed upon the introduction of such
    expert testimony. Because the parties to this matter do not dispute the
    qualifications of Appellants’ experts, the MCARE restrictions, which merely
    reinforce and give shape to the common-law expert testimony requirement
    that preceded MCARE’s May 20, 2002 effective date, are not at issue.
    - 27 -
    J-A08018-15
    Eli H. Newberger, M.D., a board-certified pediatrician, Assistant
    Professor of Pediatrics at Harvard Medical School, and Adjunct in Pediatrics
    at Childen’s Hospital of Boston, rendered a lengthy report that touched upon
    the standard of care governing Appellees, reviewed at length the medical
    history and records documenting Appellees’ treatment of K.H., and expressly
    rendered his opinions as to the standard of care and each physician’s
    individual failures to satisfy that standard “to a reasonabl[e] degree of
    medical certainty.”   Report of Eli H. Newberger, M.D., 7/8/2013, at 2, 23,
    attached as Exh. FF to Appellants’ Omnibus Memorandum of Law In
    Opposition to All Defendants’ Motion for Summary Judgment (“Appellants’
    Omnibus Memorandum”), 9/27/2013 (hereinafter “Newberger Report”).
    Dr. Newberger’s account of the standard of care was as follows:
    As a matter of background, Pennsylvania’s child reporting
    statute was harmonized with the model developed by the
    American Bar Association commission on which I served in the
    mid-1970’s.      Pursuant to the 1973 Federal Child Abuse
    Prevention and Treatment Act, prior to their receiving their
    monetary shares of the Congressional budgetary allocation for
    the National Child Abuse Center in the Department of Health,
    Education, and Welfare, states were required to conform their
    reporting standards to the Federal model. The threshold for
    reporting—reasonable cause or suspicion—was intentionally set
    low in order to assure that children would be protected from
    subsequent, more severe injuries than those initially reported.
    Infant injuries and their frequently fatal or lasting consequences
    were a particular focus of concern, and a national training
    initiative assured that the reporting requirements and their
    rationale were built into the training of medical students,
    primary care physicians, and especially, pediatricians. Thus, the
    standard of care for physicians in recognition and
    reporting of child abuse has been incorporated into the
    reporting statutes.
    - 28 -
    J-A08018-15
    Newberger Report at 2 (emphasis added).12
    Similarly, David Turkewitz, M.D., a board-certified pediatrician and,
    inter alia, Chairman of Pediatrics at York Hospital in York, Pennsylvania,
    Director of Section Pediatric Emergency Medicine of the Department of
    Emergency Medicine,13 and clinical professor of pediatrics at Pennsylvania
    State University, averred that, “[i]n order to comply with the standard of
    care a physician, particular[ly] a pediatrician, must appropriately recognize
    signs and symptoms of abuse, diagnose that abuse, and report that abuse.”
    Report of David Turkewitz, M.D., undated, at 2, attached as Exh. HH to
    Appellants’    Omnibus       Memorandum        (hereinafter   “Turkewitz   Report”).
    Dr. Turkewitz elaborated as follows:
    [T]he obligation to report a suspicion of child abuse is the
    standard of care governing any physician. This duty is also
    mandated by statute in Pennsylvania (and elsewhere).       A
    ____________________________________________
    12
    The language emphasized in this passage and those that immediately
    follow is important because, as worded, it suggests that the standard of care
    existed separately from, and was later baked into, the model law upon which
    the CPSL is founded, not that the statute supplied or supplanted the
    standard of care. Moreover, no authority of which we are aware suggests
    that, when a statute overlaps or is in conformity with a common-law
    standard of care, or vice-versa, that standard of care no longer governs the
    physician’s conduct independently of the statute. Even when they entirely
    overlap, the different standards of proof governing criminal and civil claims
    for failure to report suggest otherwise: Under medical malpractice, a
    plaintiff need only establish a negligent breach of the standard of care by a
    preponderance of the evidence, while criminal liability, even for the same
    alleged conduct, requires proof beyond a reasonable doubt of a “willful”
    failure to report.
    13
    This title is per Dr. Turkewitz’s curriculum vitae.
    - 29 -
    J-A08018-15
    reasonable suspicion of abuse is exactly that: if after analysis of
    decision[-]making components, there is a reasonable suspicion
    of abuse, then the physician has a duty to report under
    Pennsylvania mandating reporting requirements which is
    encompassed in the standard of care. Reasonable suspicion
    by no means requires a high degree of medical certainty. The
    threshold for reporting is purposely set low to encourage
    reporting of child abuse and to ensure children are protected
    from additional abuse which can lead to further injury or death.
    The goal is simple—protection of the child. . . . All physicians, in
    accordance with the standard of care, must therefore
    appropriately appreciate, assess, diagnose, and report signs and
    symptoms of abuse.
    
    Id. at 3
    (emphasis added).14
    In light of this expert evidence, it would be untenable to suggest that
    Appellants failed to adduce sufficient evidence to create a genuine issue of
    material fact regarding whether Appellees’ standard of care obligated them
    to report reasonable suspicions of child abuse to the appropriate authorities,
    independently of a similar statutory obligation.
    (b)    Appellants’ evidence raises a genuine
    issue of material fact regarding whether
    Appellees    breached    the   governing
    standard of care.
    We now move on to review Appellants’ experts’ opinions regarding
    each Appellee-physician’s performance under the standard of care.
    ____________________________________________
    14
    Without exception, the other experts cited below, who are cited, infra,
    as attesting that one or more Appellees breached the standard of care,
    similarly aver that the standard of care imposes a reporting obligation
    independently of the statute requiring same. To cite them all would gild the
    lily.
    - 30 -
    J-A08018-15
    Shakthi Kumar, M.D.
    With respect to Dr. Kumar, Dr. Newberger opined as follows:
    [Dr. Kumar] failed multiple times to make mandated reports of
    suspected abuse. While she should have reported on September
    12, 2002, each new injury thereafter provided even more reason
    to report, and her failure to act in accordance with the standard
    of care in assessment, diagnosis, and reporting of child abuse
    served not only to deny this child the protection that he needed
    and deserved, but enabled his abuser to continue to harm him.
    Dr. Kumar was at the core of over three months of escalating
    injuries to [K.H.] that were all suspicious of [sic] an ongoing
    pattern of abuse to the child, as well as concerns by several
    other physicians for abuse. Despite this, Dr. Kumar did nothing
    to protect the child from further abuse and actually defended
    against allegations of abuse by other physicians. This was a
    gross deviation from the standard of care that had catastrophic
    consequences of additional and more severe abuse that rendered
    [K.H.] neurologically devastated.
    Newberger Report at 22; see Report of Herschel R. Lessin, M.D., 7/8/2013,
    at 12, attached as Exh. LL to Appellant’s Omnibus Memorandum; Report of
    Maria McColgan, M.D., 7/8/2013, attached as Exh. JJ to Appellants’ Omnibus
    Memorandum (hereinafter “McColgan Report”); Turkewitz Report.
    Yvonne Siwek, M.D.
    With respect to Dr. Siwek, Dr. Newberger opined as follows:
    [Dr. Siwek], Dr. Kumar’s colleague at Lancaster Pediatrics, failed
    to report abuse, notwithstanding having written ABUSE in capital
    letters on the form in which she documented her visit with the
    infant at 2 months of age. She saw evidence of unexplained
    fractures that were highly concerning for abuse and failed to
    report her suspicions of abuse.
    - 31 -
    J-A08018-15
    Newberger Report at 22; see Report of Dan Cohen, M.D., 7/8/2013,
    attached as Exh. NN to Appellant’s Omnibus Motion; McColgan Report;
    Turkewitz Report.
    Donald D. Diverio, Jr., D.O.
    With respect to Dr. Diverio, Dr. Newberger opined as follows:
    [Dr. Diverio], according to his own account, despite being
    informed that the “parents are being investigated for child
    abuse” failed to connect the infant’s pain responses over the rib
    cage and on being turned to the prone position with his multiple
    underlying rib fractures, nor to consider the vectors of force that
    would produce rib fractures (violent squeezing of the thorax) and
    vertebral compressions (vertical forces from being bounced). He
    failed to explore with appropriate additional diagnostic studies
    whether there were other signs of osseous trauma. In addition
    to failing to properly diagnose abuse in this child, he also failed
    to make a mandated report of suspected abuse.                   The
    contemporaneous records of Dr. Kumar and testimony of others
    indicated that Dr. Diverio made allegations of abuse to the
    family, yet he failed to comply with the standard of care in
    reporting his suspicions of abuse.
    Newberger Report at 22-23; see Report of Mininder S. Kocher, M.D.,
    7/8/2013, attached as Exh. PP to Appellant’s Omnibus Memorandum;
    Turkewitz Report.
    Julie A. Mack, M.D.
    With respect to Dr. Mack, Dr. Newberger opined as follows:
    [Dr. Mack] missed important findings on several radiology
    studies and failed to pursue with appropriate radiographs her
    diagnosis of multiple rib fractures and appeared to advocate for
    a benign interpretation of worrisome findings that confused
    medical colleagues[,] and[] her actions were a key reason why
    the child’s abuse continued to its ultimate tragic ending. She
    violated both [LGH’s] policies on child abuse and the
    - 32 -
    J-A08018-15
    Pennsylvania mandate to report suspected abuse under the
    standard of care and state law.
    
    Id. at 23;
    see Report of Alan E. Oestreich, M.D., 7/6/2013, attached as Exh.
    TT to Appellants’ Omnibus Memorandum; Turkewitz Report.
    Gene C. Smigocki, M.D.
    With respect to Dr. Smigocki, Dr. Newberger opined as follows:
    [Dr. Smigocki] failed to appropriately interpret and report
    abnormal findings in a 12/6/06 head ultrasound that were
    indicative of abusive head trauma and would have resulted in a
    heightened concern for abuse to this child by the clinicians and
    reporting, especially in light of the plethora of other injuries
    preceding the ultrasound.
    Id.; see Report of James J. Abrahams, M.D., 7/8/2013, attached as Exh. VV
    to Appellants’ Omnibus Memorandum; Turkewitz Report.
    Atilla G. Devenyi, M.D.
    With respect to Dr. Devenyi, Dr. Newberger opined as follows:
    [Dr. Devenyi] documented a hemorrhagic rash/bruise that
    covered the skin from the sternum to the lateral chest wall.
    Notwithstanding his explicit concern about the risk of inflicted
    injury, documented in the records of Dr. Kumar and manifested
    in his ordering both a skeletal x-ray survey and clotting studies,
    he improperly acquiesced with Dr. Kumar in cancelling those
    studies. Moreover, after his examination and discussion with
    Dr. Kumar, Dr. Devenyi failed to make a mandated report of
    suspected abuse.
    Id.; see Report of Fredric Daum, M.D., 7/8/2013, attached as Exh. RR to
    Appellants’ Omnibus Memorandum; Turkewitz Report.
    More than enough expert testimony was presented by Appellants to
    create a genuine issue of material fact regarding the nature of the relevant
    - 33 -
    J-A08018-15
    general and specialist standards of care, independently of the CPSL, as well
    as whether each Appellee conformed to those that applied to him or her or
    breached the standard, and, in so doing, his or her duty to K.H.15
    Accordingly, we turn to Appellants’ evidence in support of damages and
    causation.
    3.     Appellants have provided ample evidence to
    raise a jury question with respect to damages.
    Because the adequacy of Appellants’ proffered expert evidence
    regarding the nature and scope of Appellants’ damages has not been
    challenged on appeal, it is not necessary to address this issue at length. In
    the interests of comprehensiveness, we simply note that Appellants
    ____________________________________________
    15
    Appellees make much of the proposition that they had no duty to third
    parties, or to control third parties. However, it is clearly the case that the
    duty asserted by Appellants was Appellees’ duty to K.H., which, at least in
    its broadest strokes, cannot be disputed. Appellees also argue at length that
    their duty extends only to diagnosis and treatment, and does not reach any
    obligation to report, a proposition flatly contradicted by several of
    Appellants’ experts. See, e.g., Brief for Smigocki at 31-33. Moreover, other
    cases, albeit distinguishable in various particulars, have established that a
    physician’s duty to a patient or, in certain narrow circumstances, to a third
    party, may reach outside the examination room. See Emerich, 
    720 A.2d 1032
    (holding that a mental health professional has a duty to warn a third
    party of a patient’s threat to harm the third party); DiMarco v.Lynch
    Homes—Chester County, Inc., 
    583 A.2d 422
    (Pa. 1990) (permitting suit
    against physician by a third party who contracts a communicable disease
    when third party establishes that he contracted disease due to physician’s
    erroneous advice to patient). Thus, it is clear that the precise scope of a
    physician’s duty to a patient (and to others) is more complex than any of
    Appellees’ arguments would allow, and can be extended to matters affecting
    the public interest that fall outside the narrow bounds of diagnosis and
    treatment of the maladies presented by a given patient.
    - 34 -
    J-A08018-15
    furnished several reports from qualified experts attesting in detail to the
    necessities of K.H.’s ongoing care, K.H.’s medical prognosis, and the costs
    Appellants will incur in attending to his needs.       See Report of David L.
    Hopkins,    7/8/2013,   attached    as   Exh.   III   to   Appellant’s   Omnibus
    Memorandum (actuarial cost estimate); Report of B.A. McGettigan, R.N.,
    7/7/2013, attached as Exh. GGG to Appellants’ Omnibus Memorandum
    (home care analysis and cost estimate); Reports of Thomas Rugino, M.D.,
    12/8/2012, 7/6/2013, and 7/8/2013, Attached respectively as Exhs. XX, YY,
    and ZZ to Appellants’ Omnibus Memorandum (medical analysis and
    prognosis).
    4.   Appellants’ evidence raises a genuine issue of
    material fact regarding whether Appellees’
    alleged breach of their respective standards of
    care caused K.H.’s damages.
    We now examine whether Appellants provided a prima facie showing
    that Appellees’ alleged breaches of the applicable standards of care caused
    K.H.’s injuries. The trial court did not believe so, reasoning as follows:
    [E]ven if [Appellees] owed a duty to [K.H.] to report a
    reasonable suspicion that he was a victim of abuse, under the
    circumstances of this case there is insufficient evidence of
    causation for [Appellants’] negligence claims to proceed. In a
    medical malpractice suit for negligence, the expert testimony
    requirement “means that a plaintiff must present medical expert
    testimony to establish that the care and treatment of the plaintiff
    by the defendant fell short of the required standards of care and
    that the breach proximately caused the plaintiff’s injury.”
    
    Toogood, 824 A.2d at 1145
    . . . . An expert may not base his
    opinion regarding causation on mere speculation or conjecture.
    Instead,
    - 35 -
    J-A08018-15
    [w]hen a party must prove causation through expert
    testimony[,] the expert must testify with “reasonable
    certainty” that “in his professional opinion, the result in
    question did come from the cause alleged[.”] An expert
    fails this standard of certainty if he testifies that the
    alleged cause “possibly[,”] or “could have” led to the
    result, that it “could very properly account” for the result,
    or even that it was “very highly probable” that it caused
    the result.
    Kovach v. Cent. Trucking, Inc., 
    808 A.2d 958
    , 959-60
    (Pa. Super. 2002) (citing Cohen v. Albert Einstein Med. Ctr.,
    N. Div., 
    592 A.2d 720
    , 723-24 (Pa. Super. 1991)).
    In the case at bar, [Appellants] cannot establish to a reasonable
    degree of medical certainty that [Appellees’] failure to report
    their alleged suspicions that [K.H.] was a victim of child abuse
    caused his injuries on December 18, 2002. [K.H.] was not
    injured as a result of any of the treatment he was given by
    [Appellees]. Rather, [Appellants] allege that [Appellees] were
    negligent merely for failing to discover and report the non-
    medical source of [K.H.’s] condition. Even if [Appellees] had
    reported a suspicion of child abuse to the appropriate
    authorities, there is no way to prove that Lancaster County
    Children and Youth Services would have definitely intervened
    and removed [K.H.] from his home.                Suggesting that
    [Appellees’] failure to report the abuse “could very [probably]”
    account for [K.H.’s] injuries is insufficient as a matter of law.
    [Appellants] are required to demonstrate to a reasonable degree
    of medical certainty that [Appellees] caused [K.H.’s] injuries,
    which they are unable to do in this case without engaging in
    speculation and conjecture.
    T.C.O. at 20-21 (citations modified).
    The trial court’s recitation of the standard is incomplete, because it
    wholly neglects to acknowledge, and arguably contravenes, Pennsylvania
    case law recognizing the relaxed burden of proof reserved for cases in which
    it would be unreasonable and inequitable to demand that a plaintiff provide
    - 36 -
    J-A08018-15
    conclusive evidence that the defendant is the direct and exclusive cause of
    the harm alleged. This Court has explained as follows:
    In Hamil v. Bashline, our Supreme Court adopted the relaxed
    “increased-risk-of-harm” standard for use in certain medical
    malpractice claims.      
    392 A.2d 1280
    , 1288 (Pa. 1978).  In
    adopting this principle, the Hamil Court reasoned:
    In light of our interpretation of [subs]ection 323(a),[ 16] it
    follows that where medical causation is a factor in a case
    coming within that Section,[17] it is not necessary that the
    plaintiff introduce medical evidence in addition to that
    already adduced to prove defendant’s conduct increased
    the risk of harm—to establish that the negligence asserted
    resulted in plaintiff’s injury. Rather, once the jury is
    apprised of the likelihood that defendant’s conduct resulted
    in plaintiff’s harm, [subsection 323(a)] leaves to the jury,
    and not the medical expert, the task of balancing
    probabilities.
    
    Hamil, 392 A.2d at 1288
    .                Subsequently, our high court
    explained:
    ____________________________________________
    16
    Negligent Performance of Undertaking to Render Services
    One who undertakes, gratuitously or for consideration, to render
    services to another which he should recognize as necessary for
    the protection of the other's person or things, is subject to
    liability to the other for physical harm resulting from his failure
    to exercise reasonable care to perform his undertaking, if
    (a) his failure to exercise such care increases the risk of
    such harm . . . .
    Restatement (Second) of Torts § 323(a).
    17
    We have held that subsection 323(a) applies, inter alia, to failure-to-
    diagnose cases. See Jones v. Montefiore Hosp., 
    431 A.2d 920
    , 925
    (Pa. 1981) (citing Gradel v. Inouye, 
    421 A.2d 674
    (Pa. 1980)). We can
    conceive of no reason why it would not apply in this case, which involves
    both failure-to-diagnose and failure-to-report claims.
    - 37 -
    J-A08018-15
    An example of this type of case is a failure of a physician
    to timely diagnose breast cancer.           Although timely
    detection of breast cancer may well reduce the likelihood
    that the patient will have a terminal result, even with
    timely detection and optimal treatment, a certain
    percentage of patients unfortunately will succumb to the
    disease. This statistical factor, however, does not preclude
    a plaintiff from prevailing in a lawsuit. Rather, once there
    is testimony that there was a failure to detect the cancer in
    a timely fashion, and such failure increased the risk that
    the woman would have either a shortened life expectancy
    or suffered harm, then it is a question for the jury whether
    they believe, by a preponderance of the evidence, that the
    acts or omissions of the physician were a substantial factor
    in bringing about the harm. See Jones v. Montefiore
    Hosp., 
    431 A.2d 920
    (Pa. 1981).
    
    Mitzelfelt, 584 A.2d at 892
    ; see Smith v. Grab, 
    705 A.2d 894
    ,
    899 (Pa. Super. 1997) (stating expert’s testimony demonstrating
    increased risk of harm “furnishes a basis for the fact-finder to go
    further and find that such increased risk of harm was in turn a
    substantial factor in bringing about the resultant harm”) (quoting
    
    Hamil, supra
    ).
    Accordingly, in cases where the plaintiff has introduced sufficient
    evidence that the defendant’s conduct increased the risk of
    injury, the defendant will not avoid liability merely because the
    plaintiff’s medical expert was unable to testify with certainty that
    the defendant’s conduct caused the actual harm. Montgomery
    v. S. Phila. Med. Grp., Inc., 
    656 A.2d 1385
    , 1392
    (Pa. Super. 1995) (citing 
    Mitzelfelt, supra
    ). The trial court may
    send the issue of causation to the jury “upon a less than normal
    threshold of proof” as long as reasonable minds could conclude
    that a preponderance of the evidence shows the defendant’s
    conduct was a substantial factor in causing the resulting harm.
    
    Id. The determination
    then rests with the jury. 
    Mitzelfelt, supra
    ; Montgomery, supra at 1391 (citing Jones, supra).
    Carrozza v. Greenbaum, 
    866 A.2d 369
    , 380-81 (Pa. Super. 2004), aff'd on
    other grounds, 
    916 A.2d 553
    (Pa. 2007) (footnote omitted; citations
    modified; all emphasis as rendered in Carrozza); see Vogelsberger v.
    - 38 -
    J-A08018-15
    Magee-Womens Hosp. of UPMC Health Sys., 
    903 A.2d 540
    , 563-64
    (Pa. Super. 2006) (“Once there is sufficient testimony to establish that
    (1) the [health care provider] failed to exercise reasonable care, that
    (2) such failure increased the risk of physical harm to the plaintiff, and
    (3) such harm did in fact occur, then it is a question properly left to the jury
    to decide whether the acts or omissions were the proximate cause of the
    injury.   The jury, not the medical expert, then has the duty to balance
    probabilities and decide whether defendant’s negligence was a substantial
    factor in bringing about the harm.”).
    In reliance upon Hamil and other decisions, this Court further has held
    that “[a] defendant cannot escape liability because there was a statistical
    possibility   that   the    harm   could   have   resulted   without   negligence.”
    Montgomery v. S. Phila. Med. Grp., Inc., 
    656 A.2d 1385
    , 1392
    (Pa. Super. 1995).         The concurrence of a contributing cause with the
    negligence at issue in a given case “does not relieve the defendant from
    liability unless he can show that such other cause would have produced the
    injury independently of his negligence.”          
    Id. (internal quotation
    marks
    omitted); accord Kearns v. Clark, 
    493 A.2d 1358
    , 1361 (Pa. Super. 1985);
    Brozana v. Flanigan, 
    454 A.2d 1125
    , 1128 (Pa. Super. 1983) (approving
    jury charge that informed the jury that it could find liability if the defendant’s
    negligence “either was a substantial factor in bringing about the loss of
    appellant’s leg or increased the risk of losing the leg and that increased risk
    was a substantial factor in the loss of the leg”).
    - 39 -
    J-A08018-15
    Several of Appellants’ experts in this case have opined to a reasonable
    degree of medical certainty, and without obvious resort to pure conjecture,
    that Appellees’ alleged breaches of their standards of care over a period of
    approximately three months substantially increased K.H.’s risk of harm.18
    Moreover,     we    have    the   highly       detailed   account   provided   by   Larry
    Breitenstein, Ph.D., an expert with extensive credentials in social work
    focusing upon child abuse and child neglect, who, in preparing his doctoral
    ____________________________________________
    18
    See, e.g., Newberger Report at 15 (“Dr. Kumar’s and Dr. Siwek’s
    deviations from the standard of care in assessment, diagnoses, and
    reporting of child abuse on September 12, 2002, increased the risk of harm
    of further abuse to [K.H.] and were a substantial contributing factor in him
    suffering a permanent and catastrophic brain injury.”), 16 (“Dr. Mack’s and
    Dr. Kumar’s conduct in connection with the 9/12/02 skeletal survey deviated
    from the standard of care, increased the risk of harm to K.H., and was a
    substantial contributing factor to K.H. suffering further abuse [that] resulted
    in a severe and irreversible brain injury.”), 17 (“Dr. Devenyi’s failure to
    report his suspicion of abuse on October 2, 2002 or anytime thereafter was a
    deviation in the standard of care that increased the risk of harm to [K.H.]
    and was a substantial contributing factor to him suffering further abuse and
    a permanent brain injury.”), 21 (“[D]ue to the missed interpretation of the
    ultrasound by Dr. Smigocki, [K.H.] was denied one final opportunity to avoid
    the continued abuse that culminated in the permanent brain injury . . . .”),
    22-23 (noting that Dr. Diverio failed to comply with the standard of care in
    reporting his suspicions of abuse, and opining that “[a]ll of the
    aforementioned deviations in the standard of care by [K.H.’s] providers in
    the diagnosis of child abuse and the failure to report suspicions of abuse
    increased the risk of harm and were substantial contributing factors in
    [K.H.’s] enduring further and more severe abuse and increased the risk of
    harm of him suffering an abusive head injury, which he went on to suffer”;
    adding that, “[h]ad abuse been appropriately diagnosed and reported by any
    of [Appellees] at any time prior to December 18, 2002[,] an appropriate
    investigation of the abuse would have occurred and [K.H.] would have been
    in a safe environment [free] from any further abusive trauma”).
    - 40 -
    J-A08018-15
    dissertation, examined “nearly two hundred thousand Pennsylvania child
    abuse and neglect reports,” and who served for fifteen years as director of
    Westmoreland County’s Children’s Bureau, handling reports of abuse like
    those not made in this case between September and December of 2002.
    See Report of Larry Breitenstein, Ph.D., 7/8/2013, at 1, attached as Exh.
    EEE   to   Appellants’   Omnibus   Memorandum     (hereinafter   “Breitenstein
    Report”). Highlights of Dr. Breitenstein’s report include his opinion, “based
    on [his] training, expertise and knowledge handling child abuse cases, [that]
    the obvious signs and symptoms of child abuse to [K.H.] that were missed
    by this child’s physicians . . . [were] as troublesome as [he has] seen in
    [his] career.” 
    Id. at 2.
    In a detailed account of the procedures prescribed
    for children and youth agencies who receive a report of abuse featuring
    symptoms such as those at issue in this case even as early as September 9,
    2002, Dr. Breitenstein opined that an investigation would have been
    conducted within twenty-four hours of the report; the case would have been
    designated “high risk” in light of K.H.’s age and the nature of his injuries;
    and the investigation would have “involved immediately going to the location
    of the child.”   
    Id. at 4.
      Because the suspected abuse involved “serious
    physical injury,” Dr. Breitenstein indicated, the children and youth agency
    “would also have notified the District Attorney,” and “a detective or other
    law enforcement officer designated by the county district attorney would
    have collaborated with [Children and Youth Services (“CYS”)] and been
    involved with the interviews and the investigation.” 
    Id. Moreover, “[g]iven
    - 41 -
    J-A08018-15
    that the parents were the primary persons that cared for the child, their
    interviews would have been extensive and comprehensive to determine if
    they were the abuser [sic].” 
    Id. at 5.
    Dr. Breitenstein’s lengthy report addressed directly why it was his
    expert opinion, to a reasonable degree of professional certainty, that K.H.’s
    catastrophic brain injury would have been prevented had an appropriate
    report been made by one or more of K.H.’s physicians between September
    and December 2002:
    The [CPSL] provides remedies to protect children even if the
    perpetrator is unknown. The CPSL provides that the child may
    be taken into custody pursuant to a court order or by a law
    enforcement officer or duly authorized court officer if there are
    reasonable grounds to believe that the child is suffering from
    illness or injury or is in imminent danger from his surroundings
    and his removal is necessary. From September 9, 2002 until
    December 18, 2002, [K.H.] suffered from severe injuries (rib
    fractures, vertebral compressions, rapid increase in head size, as
    well as bruising and scratches) and given his age and
    vulnerability to future abuse he would certainly be considered to
    be in imminent danger.        Therefore, either the investigating
    officer or detective would have taken protective custody or
    the CYS worker would have sought a court order for
    protective custody if the perpetrator was unknown and/or
    had not been arrested.
    
    Id. at 5
    (emphasis added). Given Dr. Breitenstein’s credentials, experience,
    and the detail and certainty with which he asserted his conclusions regarding
    causation, the trial court’s conclusion that, “[e]ven if [Appellees] had
    reported a suspicion of child abuse to the appropriate authorities, there is no
    way to prove that [CYS] would have definitely intervened,” T.C.O. at 21,
    appears to us to be a patent usurpation upon the sort of determination of
    - 42 -
    J-A08018-15
    fact   that   belongs    with    a   jury.     Dr. Breitenstein   outlined   what   he
    characterized as mandatory protocols observed by children and youth
    agencies in every county in Pennsylvania that essentially guaranteed some
    significant degree of intervention upon a report of K.H.’s symptoms.19
    ____________________________________________
    19
    Appellees, Dr. Kumar in particular, attempt to cast Dr. Breitenstein’s
    testimony as wholly conjectural, opining that he cannot presume to know
    how CYS would have responded to a report under these circumstances. The
    strongest rebuttal of this argument is Dr. Breitenstein’s report, which not
    only outlines his extensive experience in responding to these requests, but
    also outlines mandatory events that would follow a report of this nature as
    well as testifying with a reasonable degree of professional certainty that
    proper reports in this case would have resulted in a heightened degree of
    scrutiny, and a more rapid response, then reports of lesser harm.
    Furthermore, Dr. Kumar’s resort to Kovach v. Central Trucking, Inc., 
    808 A.2d 958
    (Pa. Super. 2002), for the proposition that “no matter how skilled
    or experienced the expert witness may be, he will not be permitted to guess
    or to state a judgment based on mere conjecture,” does her argument no
    favors, given our ruling in that case. See Brief for Kumar at 32 (quoting
    
    Kovach, 808 A.2d at 959
    ). In Kovach, we reversed a trial court ruling
    excluding a physician-expert’s testimony upon the basis that it was
    speculative. Specifically, we determined that the trial court should not have
    excluded the expert’s testimony regarding whether the accident sued-upon
    resulted in the plaintiff’s knee injuries, even though the expert admitted that
    he could not be certain about the condition of the plaintiff’s knees before the
    accident, or whether the injuries complained of were entirely a result of the
    accident or constituted an aggravation of a pre-existing injury. Nonetheless,
    because the expert testified to a reasonable degree of medical certainty that
    the accident had been a substantial cause, if not the only cause, of the
    plaintiff’s injuries, we ruled that the trial court should have admitted the
    
    testimony. 808 A.2d at 959-61
    . We read Dr. Breitenstein’s testimony as
    neither less certain nor more qualified or conjectural than the expert’s in
    Kovach. Consequently, his testimony certainly provided sufficient support
    with regard to causation to avoid summary judgment in the instant case.
    Dr. Siwek also attacks the sufficiency of Dr. Breitenstein’s testimony.
    However, she does so almost entirely by quibbling with the assertions
    therein. See Brief for Siwek at 15-18. Dr. Siwek’s alternative view of the
    case has no place in a summary judgment proceeding; to the extent that we
    (Footnote Continued Next Page)
    - 43 -
    J-A08018-15
    In light of the liberal standard Pennsylvania courts are directed by
    Hamil and its progeny to apply to increased-risk-of-harm cases where direct
    causation cannot be established, and Appellants’ voluminous evidence,
    stated to a reasonable degree of medical or professional certainty, that
    Appellees’ acts or omissions substantially increased K.H.’s risk of harm, the
    trial court simply applied too rigid a standard in finding that Appellants’
    evidence of causation was so speculative as to warrant dismissal.     To the
    contrary, the causation evidence submitted by Appellants for precisely that
    purpose was a model of the sort of evidence that Hamil deemed sufficient to
    support a prima facie case of medical negligence.    Consequently, the trial
    court erred when it found Appellants’ causation evidence wanting.20
    Having 
    found, supra
    , that Appellants’ showings also were adequate to
    establish jury questions regarding all four elements of medical malpractice,
    we conclude that the trial court erred in entering summary judgment in
    favor of Appellees.
    D.     Appellants’ Entitlement to a Jury Instruction Regarding
    Negligence Per Se Is Moot.
    _______________________
    (Footnote Continued)
    deem Dr. Breitenstein’s testimony to have been sufficiently certain to reach
    a jury, we need only consider that testimony, viewing it in the light most
    favorable to the Appellants.
    20
    The trial court’s erroneous conclusions follow in part from a question-
    begging premise. In ruling that K.H. “was not injured as a result of any
    treatment,” the court implicitly assumed that the standard of care entails
    only clinical treatment, and does not require reporting suspicions of abuse,
    which we have found involves a fact question to be determined by a jury.
    - 44 -
    J-A08018-15
    We now turn to Appellants’ third issue.     Appellants contend that the
    trial court erred in determining that they are not entitled to a negligence per
    se jury instruction on the grounds that Appellees’ violation of the CPSL,
    without more, would suffice to establish a breach of Appellees’ duty for
    purposes of setting forth claims of medical malpractice, leaving the jury after
    such a finding to assess only proximate causation and damages. We need
    not resolve this issue, for two reasons.
    First, whether to provide a negligence per se instruction is not typically
    a matter that is disposed of in a motion for summary judgment, insofar as
    its propriety most often is a matter to be measured against the evidence
    adduced at trial. Second, the trial court’s ruling on this matter was based in
    part upon premises that we have rejected above. Thus, the court may rule
    differently in light of our analysis of those premises and the parties’
    presentations of the evidence at trial. Because this issue was prematurely
    addressed, and presently is moot, we leave its final disposition for the trial
    court in the first instance, without prejudice to Appellants’ entitlement to
    raise the issue in a future post-trial appeal, should the trial court again
    reject their request for such an instruction.
    E.    Appellants Have Set Forth a Cognizable Claim for
    Corporate Negligence Against LGH.
    Finally, we consider Appellants’ argument that the trial court erred in
    dismissing their claims against LGH for corporate negligence. The following
    standard governs:
    - 45 -
    J-A08018-15
    Corporate negligence is a doctrine under which the hospital is
    liable if it fails to uphold the proper standard of care owed the
    patient, which is to ensure the patient’s safety and well-being
    while at the hospital.         This theory of liability creates a
    nondelegable duty which the hospital owes directly to a patient.
    Therefore, an injured party does not have to rely on and
    establish the negligence of a third party.
    The hospital’s duties have been classified into four general
    areas: (1) a duty to use reasonable care in the maintenance of
    safe and adequate facilities and equipment—Chandler Gen.
    Hosp. Inc. v. Purvis, 
    181 S.E.2d 77
    (Ga. Ct. App. 1971); (2) a
    duty to select and retain only competent physicians—Johnson
    v. Misericordia Comm. Hosp., 
    301 N.W.2d 156
    (Wis. 1981);
    (3) a duty to oversee all persons who practice medicine within its
    walls as to patient care—Darling v. Charleston Comm. Mem.
    Hosp., 
    211 N.E.2d 253
    (Ill. 1965); and (4) a duty to formulate,
    adopt and enforce adequate rules and policies to ensure quality
    care for the patients—Wood v. Samaritan Institution, Inc.,
    
    161 P.2d 556
    (Cal. Ct. App. 1945); see Comment, The Hospital-
    Physician Relationship: Hospital Responsibility for Malpractice of
    Physicians, 50 Wash.L.Rev. 385 (1975); Note, Medical
    Malpractice—Ostensible Agency & Corporate Negligence, 17 St.
    Mary’s L.J. 551 (1986).
    Thompson v. Nason Hosp., 
    591 A.2d 703
    , 707 (Pa. 1991) (citations
    modified; footnote omitted); see Scampone v. Highland Park Care Ctr.,
    LLC, 
    57 A.3d 582
    , 597-98 (Pa. 2012).
    Appellants’ claims hinge upon their claim that LGH failed to have
    appropriate policies in place for the retention and availability of patients’
    prior radiological studies and failed to retain adequately qualified physicians
    to read pediatric radiographs. The trial court rejected these claims for the
    following reasons:
    [Appellants’ claim regarding retention of radiographs] falls under
    the hospital’s duty to “adopt and enforce rules and policies to
    ensure quality care for the patient[.” Appellants] have failed to
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    J-A08018-15
    produce any specific policies or procedures that address LGH’s
    method for storing and organizing patients’ past radiological
    studies. Moreover, neither [Appellants], nor Dr. Oestreich in his
    report, claim that having had access to [K.H.’s] prior studies
    would have assisted Dr. Mack and Dr. Smigocki in interpreting
    the radiographic studies in question.     Instead, Dr. Oestreich
    asserts that the studies would have assisted the radiologists in
    diagnosing child abuse. Since the [trial c]ourt has already
    determined that Pennsylvania does not impose a duty upon
    physicians to report suspected child abuse, even if Drs. Mack
    and Smigocki had determined that [K.H.] was being abused,
    they would not have been under a statutory or common[-]law
    duty to report it.
    Finally, [Appellants] assert that, in employing Dr. Mack, LGH
    “failed to employ a pediatric radiologist [who] was adequately
    trained, experienced and qualified in reading pediatric
    radiographs and the recognition of abuse[.”] (Oestreich Report,
    [Appellants’]    Exhibit   TT    [to   Omnibus    Memorandum].)
    Specifically, Appellants point to the fact that, in her deposition
    testimony, Dr. Mack stated that she primarily read breast
    imaging studies, was the chief of the mammography section, and
    did not have a special[ty] in reading pediatric radiographs. As
    demonstrated by her Curriculum Vitae, Dr. Mack completed a
    Pediatric Radiology Fellowship at Children’s Medical Center in
    Dallas, Texas[,] from 1994 to 1995. . . . Additionally, she is
    Board Certified in Radiology with a “Certificate of Added
    Qualifications in Pediatric Radiology[.”] Given these credentials,
    there is absolutely no question that Dr. Mack was qualified to
    read K.H.’s studies.
    T.C.O. at 26.
    We begin with the trial court’s latter rationale.   In response to the
    determination that “there is absolutely no question that Dr. Mack was
    qualified to read [K.H.’s] studies,” Appellant argues that the trial court
    essentially resolved a material question of fact best left to the jury in
    accepting Dr. Mack’s CV as evidence conclusive of her qualifications despite
    Dr. Mack’s testimony that her principal responsibilities at the relevant time
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    J-A08018-15
    involved mammography rather than pediatric radiology.          The trial court
    provided no additional support to suggest that this was a determination
    appropriately resolved by the court rather than by a jury. However strongly
    Dr. Mack’s CV might militate in favor of finding that she was qualified, we
    find no principled basis not to have allowed the jury to resolve the
    discrepancy.   On summary judgment, as our governing standard makes
    clear, all doubts are to be resolved in favor of the non-moving party. The
    trial court’s conclusion in this regard is inconsistent with the governing
    standard.   Accordingly, to the extent the trial court’s ruling on corporate
    negligence depended on this finding, we reject it.
    With respect to the trial court’s first rationale, Appellants aptly note
    that the trial court expressly relied upon its own finding that no civil remedy
    for a failure to reporting child abuse would lie under the CPSL or the
    common law.     Insofar as we have rejected the trial court’s ruling in this
    regard, that rationale will not stand.
    Appellants further argue that the trial court’s determination that they
    “failed to produce any specific policies or procedures that address LGH’s
    method for storing and organizing patients’ past radiological studies” proves,
    rather than undermines, their claim, insofar as their allegations that LGH
    was negligent inhered in the absence of such policies.
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    J-A08018-15
    In support of this claim, Appellants cite the following exchange from
    Dr. Smigocki’s deposition testimony:21
    Q.     Is there somebody in your office that you would ask or—
    A.     Our office? No. It would be a hospital record.
    Q.     Is there somebody at the hospital that you would ask?
    A.     The film library.
    Q.     Is there a person that’s currently a custodian or at the film
    library that you would ask?
    A.     No.
    Q.    When you reviewed and interpreted the December 6th,
    2002, ultrasound, you had whatever information was written on
    the order form; correct?
    A.     I would assume.
    Q.     Okay. And you also had any previous studies; correct?
    A.     Possibly.
    Q.     Why do you say “possibly”?
    A.     Well, previous studies are not always available.
    Q.   Okay. And what are the range of reasons why they
    wouldn’t be available?
    A.     Sometimes they can’t be located. Sometimes—
    Q.     Like, if they’re lost?
    A.    They could be lost. They could be misplaced. They could
    be in a referring clinician’s trunk.
    ____________________________________________
    21
    This excerpt starts in medias res, a product of Appellants’ election to
    attach only excerpts of the deposition transcript to their Omnibus
    Memorandum. However, there is sufficient context to understand the thrust
    of Appellants’ contentions and the degree to which Dr. Smigocki’s testimony
    supports them.
    - 49 -
    J-A08018-15
    Q.    If they were lost or misplaced or in a referring clinician’s
    trunk, there would still be a record of the fact that they had
    existed; correct?
    A.    Presumably.
    Q.   Okay. So you would have available to you at least a list of
    what previous studies there were.
    A.    Yes.
    Q.     And if it turned out that you wanted to review a previous
    study, but it wasn’t in the—it would have been electronic or in
    the film jacket?
    A.    I don’t know how it was back in 2002.
    Notes of Deposition Testimony—Gene Smigocki, 10/4/2012, at 85-86.
    Even if we assume that this testimony, standing alone, provides only
    limited support for the proposition that LGH did not have an appropriate
    records policy, one that might have enabled Drs. Mack or Smigocki to
    conduct a clinically appropriate comparative review of K.H.’s radiographs
    with former studies, once again it usurps the trial court’s function to pass
    judgment on the weight of this evidence in reviewing a motion for summary
    judgment. This testimony provides a modicum of support for the proposition
    that LGH’s records policy was either inadequate, or inadequately conveyed
    to physicians with LGH privileges, such that corporate negligence might lie
    for a breach of LGH’s “duty to formulate, adopt and enforce adequate rules
    and policies to ensure quality care for the patients.” See 
    Thompson, 591 A.2d at 707
    . In his report, Dr. Oestreich noted that it was “unfortunate that
    Dr. Mack failed to review the chest x-ray from [K.H.’s] birth. To the extent
    that it was not made available to her, the hospital/practice group should
    - 50 -
    J-A08018-15
    have had a practice in place for the prior films to be available for review.”
    Oestreich Report at 8. This, viewed in tandem with Dr. Smigocki’s equivocal
    testimony regarding LGH’s policies for retaining prior scans, sufficed to
    create a genuine issue of material fact, such that it was error for the trial
    court to grant summary judgment to LGH relative to Appellants’ claims for
    corporate negligence.
    III. Conclusion
    In its contemporary form, the Hippocratic Oath sworn by aspiring
    physicians in the United States provides, inter alia, that “I will remember
    that I do not treat a fever chart, a cancerous growth, but a sick human
    being, whose illness may affect the person’s family and economic stability.
    My responsibility includes these related problems, if I am to care adequately
    for the sick.” The Oath also provides that “I will prevent disease whenever I
    can, for prevention is preferable to cure.” In its archaic form, the Oath also
    provided that “I will keep [the sick] from harm and injustice.”22
    These sound sentiments are embodied in the CPSL, it is true, but the
    potential harm that may befall children when their physicians fail to behave
    according to professional reporting requirements vastly exceeds the harm
    inuring to the public. Children, like all individuals, find legal protection, and
    ____________________________________________
    22
    For all quotations, see Bioethics, Johns Hopkins Sheradan Libraries &
    University   Museums,     available    at   guides.library.jhu.edu/c.php?g=
    202502&p=1335752 (last reviewed June 26, 2015).
    - 51 -
    J-A08018-15
    grounds for civil recourse, whenever a physician violates his or her duty of
    care. That duty of care is determined not by the General Assembly but by
    the community of physicians.       Irrespective of whether the legislature
    intended to imply a private right of action under the CPSL, it beggars belief
    that, in enacting that statute, the General Assembly intended to immunize
    from civil redress violations of the standard of care so severe that the
    legislature deemed them worthy of criminal punishment.       The anomaly is
    cast into relief even more stark when one considers that civil redress
    undisputedly remains available for far less egregious violations of that
    standard of care.
    We need not address on this day whether the CPSL itself furnishes
    such a remedy; Appellants do not argue that it does. Indeed, today we need
    not decide whether, as Appellants allege, Appellees serially violated the
    standard of care in passing K.H. amongst themselves while repeatedly
    setting aside concerns that he was the victim of abuse. Nor need we decide
    whether, in so doing, Appellees caused the crippling harm that eventually
    befell K.H. at the hands of his biological father’s continuing abuse. Indeed,
    the essence of our ruling is that it is not our place, nor that of the trial
    judge, to do so.    We need decide only whether the trial court improperly
    intruded upon Appellants’ right to have a jury hear testimony regarding the
    independent obligations of the standard of care and testimony to the effect
    that such violations, if any, substantially increased K.H.’s risk of harm over
    the several months that K.H. presented to the various Appellees, allegedly
    - 52 -
    J-A08018-15
    with tell-tale signs of continuing abuse the nature of which was readily
    detectable by those physicians. The trial court did precisely that, in violation
    of the governing standard.
    Specifically, the trial court improperly ruled that Appellants failed to
    present a prima facie case of medical malpractice against all six named
    Appellees who undertook K.H.’s care from September to December of 2002.
    This includes both Appellants’ claims of malpractice predicated on the
    failures to report suspicions of abuse as well as their claims against Dr. Mack
    and Dr. Smigocki, and the vicarious liability of Lancaster Radiology and LGH,
    for malpractice associated with their review of K.H.’s radiographs.23 We also
    find that Appellants have set forth a prima facie case of corporate negligence
    against LGH. Finally, we find that any decision regarding the propriety of a
    negligence per se instruction would be premature and advisory, insofar as
    our other disposition and analyses of related issues render the matter moot
    at this time.
    For the foregoing reasons, we reverse in all aspects the trial court’s
    entry of summary judgment for Appellees and its dismissal with prejudice of
    ____________________________________________
    23
    Because the trial court’s dismissal of these claims was based upon its
    finding that Appellants could not seek damages for the failure to report that
    Appellants allege was, in part, a consequence of Drs. Mack and Smigocki’s
    malpractice in this regard, our ruling that such claims will lie renders the
    trial court’s disposition of these claims erroneous.
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    J-A08018-15
    Appellants’ amended complaint, and we remand for further proceedings
    consistent with this opinion.
    Judgment reversed. Case remanded. Jurisdiction relinquished.
    Judgment Entered.
    Joseph D. Seletyn, Esq.
    Prothonotary
    Date: 8/25/2015
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