In an opinion authored by the Honorable J. McLaughlin, the Superior Court of Pennsylvania recently vacated an entry of summary judgment based on The Medical Care Availability and Reduction of Error Act’s (“MCARE”) equitable tolling of the statute of limitations provision.

In Reibenstein v. Barax, et al.[1], Ms. Whitman (“Decedent”) passed away on April 28, 2010 as a result of a ruptured abdominal aortic aneurysm. Five days prior to her death, at the request of her primary care physician, Dr. Conaboy, Decedent underwent a CT scan. The scan was reviewed by Dr. Barax who prepared a report stating that Decedent had an abdominal aortic aneurysm that was poorly visualized. Dr. Barax did not document an aneurysm rupture or concern of possible rupture. Dr. Barax’s report stated that Dr. Conaboy was contacted with the study and findings. One year after Decedent’s death, the adminstratrix of Decedent’s estate, Ms. Reibenstein, commenced an action against Dr. Barax and his employer asserting causes of action under the Wrongful Death Act and Survival Act. During his deposition, Dr. Barax testified that he spoke with Dr. Conaboy and explained to him that the CT scan showed a previously undocumented abdominal aortic aneurysm, but he could not visualize the aneurysm very well and he could not confirm that it was not bleeding or rupturing. Based on Dr. Barax’s testimony, Ms. Reibenstein initiated a sperate action against Dr. Conaboy and his practice. The trial court consolidated the two cases.

MCARE provides a statute of limitations requiring a claimant to commence a wrongful death or survival action asserting a claim for medical professional liability claim within two years of death[2]. However, the statute of limitations is subject to equitable tolling for affirmative misrepresentation or fraudulent concealment of the cause of death[3].

The Conaboy defendants sought summary judgment citing the general two-year statute of limitations for personal injury actions and argued that the discovery rule did not apply. The trial court granted summary judgment in favor of the Conaboy Defendants, concluding that the action was commenced more than two years after death and there was no evidence of affirmative misrepresentation or fraudulent concealment of the cause of death. Reibenstein filed a timely appeal arguing that the trial court erred in granting summary judgment on the ground that pursuant to MCARE, the statute of limitations governing Reibenstein’s wrongful death claim against Dr. Conaboy could be equitably tolled.

Reibenstein argued that Dr. Barax’s concealment of his communication with Dr. Conaboy concerning Decedent’s aneurysm was directly related to the cause of death and therefore, based on MCARE, the two-year statute of limitation should have been equitably tolled. Reibenstein asserted that MCARE does not define “cause of death” or explain how a defendant must conceal the cause of death for equitable tolling to apply. Therefore, according to Reibenstein, the phrase affirmative misrepresentation or fraudulent concealment of the cause of death should encompass those acts that were part of the chain of causation leading to the patient’s death. In response, Conaboy asserted that because Decedent died of a ruptured abdominal aortic aneurysm, and because it was recorded as the cause of death on her death certificate, the statute of limitations may not be tolled.

The Superior Court explained that “cause of death” was not defined by MCARE. Further, “cause of death” could mean the immediate, medical cause of death, such as is ordinarily listed on the decedent’s death certificate, or “cause of death” could also mean the conduct leading to the decedent’s death but that is not the immediate medical cause of death. As both interpretations of “cause of death” were reasonable, the Superior Court found Section 1303.513(d) of MCARE to be ambiguous as to the meaning of “cause of death”.

The Superior Court then turned to the Statutory Construction Act[4] to resolve the ambiguity. The stated purpose of MCARE is to insure, inter alia, that high quality health care is available and to provide a person who has sustained injury as a result of medical negligence by a healthcare provider with fair compensation, while controlling the costs of medical malpractice insurance rates[5]. Subsection 1303.513(d) of MCARE is the statute of limitations for medical professional liability wrongful death and survival actions. In drafting this statute of limitations, the Pennsylvania General Assembly included a provision to allow for the equitable tolling of the two-year period in cases where there has been affirmative misrepresentation or fraudulent concealment of the cause of death. The General assembly included the equitable tolling provision to protect patients who have pursued their rights, and despite this, extraordinary circumstances prevent them from bringing a timely action. In such extraordinary circumstances, the restrictions imposed by the statute of limitations does not further the statute’s purpose.

The General Assembly’s inclusion of such an exception recognizes that wrongful death and survival actions may involve situations where the patient’s interest in fair compensation outweighs the interest in limiting malpractice insurance costs. Therefore, it is in the furtherance of the purpose of fair compensation that the Superior Court interpreted affirmative misrepresentation or fraudulent concealment of the cause of death to encompass those acts which caused the patient to die. Where a medical practitioner hides an action that was directly related to the cause of the patient’s death, the Commonwealth’s interest in redress outweighs the interest in controlling the cost of medical malpractice insurance. The Superior Court held that affirmative misrepresentation or fraudulent concealment of the cause of death means affirmative misrepresentations about or fraudulent concealment of conduct that a Plaintiff alleges led to the Decedent’s death.

The Superior Court in Reibenstein noted that the trial court, in its order granting summary judgment to the Conaboy Defendants, held that because Decedent died of an abdominal aortic aneurysm, and the death certificate listed aortic aneurysm as the cause of death, Reibenstein was not entitled to equitable tolling of the statute of limitations. Based on section 513(d) of MCARE, the Superior Court was constrained to conclude that the trial court erred in concluding that Reibenstein’s claims were barred by the statute of limitations, and therefore erred in granting summary judgment in favor of the Conaboy Defendants.

[1] Reibenstein v. Barax, et al., 2020 Pa. Super 179.

[2] 40 P.S. § 1303.513(d).

[3] See Dubose v. Quinlan, 643 PA. 244 (2017).

[4] 1 Pa.C.S.A. § 1921 (c).

[5] 40 P.S. § 1303.102.