.

Matthew P. Keris

Chair, EMR and Audit Trail Practice

Shareholder

Portrait of Matthew P. Keris

Matthew has defended health care providers, businesses and device manufacturers in civil litigation for more than two decades. He is a shareholder in the firm's Health Care Department and Chair of the EMR and Audit Trail Practice Group. Matt is also an Mcare-approved mediator.

Matt had the privilege of trying the first Pennsylvania civil jury trial to verdict during the COVID-19 Pandemic in July 2020.

In addition to his litigation practice, Matt is a recognized thought leader whose insights have been featured by prominent outlets including NBC News, Thomson Reuters, and Law360. He is frequently invited to provide commentary for leading industry publications such as The Legal Intelligencer, Becker’s Hospital Review, ED Legal Letter, Risk Review, Litigation Management, and Counterpoint. Matt also serves as an editor of the health risk management journal, Patient Safety.

Matt currently serves on the advisory committee of American Legal Connections (ALC) and serves as a co-editor of its’ newsletter. He has previously served as President of the DRI Foundation, Pennsylvania Defense Institute (PDI) and the Pennsylvania Association for Health Care Risk Management. He also previously served on the Board of Directors of both DRI and PDI. In 2023, Matt was the recipient of the DRI Foundation Community Service Award, which honors a DRI member who has demonstrated a commitment to the well-being of the general public by initiating or participating in programs which have a positive impact on the community.

    • Roger Williams University School of Law (J.D., 1996)
    • Shippensburg University of Pennsylvania (B.A., cum laude, 1993)
    • Pennsylvania, 1996
    • U.S. District Court Middle District of Pennsylvania, 2000
    • New York, 2011
    • U.S. District Court Northern District of New York, 2020
    • Connecticut, 2021
    • U.S. Supreme Court, 2023
    • AV® Preeminent™ by Martindale-Hubbell®
    • The Best Lawyers in America®, Medical Malpractice Law - Defendants (2023-2027)
    • The Best Lawyers in America®, Litigation – Health Care (2024-2027)
    • Defense Research Institute Foundation Community Service Award, 2023
    • DRI Leadership Award 2023
    • “Service Award” by the Defense Research Institute, October 2021
    • "Exceptional Performance Citation" by the Defense Research Institute, July 2015
    • American Legal Connections, Healthcare Advisory Committee Member
    • American Society for Health Care Risk Management (ASHRM)
    • Claim and Litigation Management Alliance (CLM), Co-Chair for Pennsylvania Membership Development, 2012
    • Defense Research Institute (DRI), Atlantic Region Director, 2019-2021; State Membership Chairman, 2017; State Representative to DRI on behalf of Pennsylvania Defense Institute, 2017
    • DRI Foundation, President, 2021-2023
    • Healthcare Standards Institute (HSI), Workgroup on AI Governance Standards for Healthcare Operations
    • Lackawanna County Bar Association
    • Pennsylvania Association for Health Care Risk Management (PAHCRM), President, 2026, 2016, 2012
    • Pennsylvania Bar Association, Health Care Law Committee, Secretary, 2010-2012; Health Care Law Subcommittee on Civil Litigation, Chairman, 2011
    • Pennsylvania Coalition for Civil Justice Reform
    • Pennsylvania Defense Institute (PDI), President, 2014; Executive Board, 2009-2013; Board of Directors, 2007-2009, 2015-2023; state representative to the Defense Research Institute, 2017
    • Obtained a defense verdict in a long-term case that included a unique spoliation issue, allegations of cover-up regarding the cause of death and a “no show” plaintiff-son. A longtime nursing home resident died after suffering head trauma following a fall. The plaintiff was the resident’s son, who was not his mother’s guardian and, according to staff, had not visited her in the three years that she was in residence. The cause of death was “end stage dementia” and upon learning the same, the plaintiff contacted a lawyer who delivered the body across the state to a forensic pathologist for a private autopsy, and the body was subsequently cremated. No notice was provided to the nursing home administration of the impending autopsy. The forensic pathologist alluded that the cause of death was not end stage dementia, but blunt force trauma. The defense did not learn about the private autopsy until years later when the report was provided in discovery. A motion for sanctions for spoliation was filed by the defense which was followed by depositions of the funeral home staff, and a hearing involving the forensic pathologist and the attending physician. The forensic pathologist admitted that autopsy specimens were lost and photos claimed to not exist by plaintiff’s counsel, in fact were on her computer. Although the spoliation motion was denied, the court held that at trial, the defense could question the forensic pathologist on the cremation, destroyed specimens and failure to produce the autopsy photographs at trial. On the eve of trial, the judge proctored an agreement between the parties to arbitrate the case “on expert reports only.” At arbitration, plaintiff’s counsel continued to pursue a conspiracy theory about “the true cause of death” along with standard negligence criticisms about fall prevention. The plaintiff was cross-examined on a prior crimen falsi conviction and an Orphans’ Court petition initiated by the local Area Agency on Aging where the deceased resident complained that she was afraid of her son which was relevant to his “loss of society and companionship” claim. 
    • Received a unanimous defense jury verdict within thirty minutes of deliberation in a five-day fire-loss subrogation trial. This case was one of the first Pennsylvania civil jury trials held during the COVID-19 pandemic. Taking into account safety and social distancing protocols, jury selection took place in a local school auditorium, two witnesses presented testimony via Zoom, and everyone present in the courtroom was subject to temperature screenings and required to wear a face covering. Given the current national health situation, this trial could serve as an example of how the court system and counsel can adapt to the changing health and legal landscape. 
    • Obtained entry of judgment of non pros based on the plaintiff’s failure to timely and properly file a Certificate of Merit (COM) in accordance with Pa.R.C.P. 1042.3 on behalf of a nursing home chain and its consulting company. With the Complaint, plaintiff attached an expert report from a nursing expert but did not attach a COM. Defendants filed a Notice of Intent to Enter Judgment of Non Pros, and judgment was subsequently entered. The plaintiff then filed a Petition to Strike/Open the Entry of Judgment of Non Pros, arguing that the expert report attached to the Complaint constituted a COM. The defense successfully fought the plaintiff’s attempts to open the judgment. The Court ultimately found that plaintiff’s repeated failures to comply with the applicable rules placed their case “beyond the purview of equitable relief,” and therefore reinstated the entry of judgment and dismissed plaintiff’s Complaint with prejudice.
    • Received a defense verdict in less than one hour in a dental malpractice case involving allegations of the use of excessive force and the failure to obtain the patient’s informed consent after a patient’s jaw was fractured during a molar extraction. It was admitted that jaw fracture was a known risk of the extraction, but that the dentist did not warn the patient of this risk. It was also conceded that the dentist caused the fracture. Lastly, the patient’s damages were not contested, which included the pain and suffering associated with the fracture and permanent numbness to the lower jaw. On cross-examination of the patient’s seasoned expert, he was confronted with prior inconsistent testimony regarding his experience in extracting molars and his opinion that all risks of a procedure need to be shared with the patient. Further, the expert agreed with the defense’s argument that the risk of jaw fracture of an erupted right lower molar was less than .0009% and the patient had a better chance of dying from complications associated with the extraction than suffering a fracture. The jury was persuaded by the defense’s arguments early in the case due to the thorough cross-examination of the patient’s expert. 
    • Received defense verdict in a wrongful death and survival medical malpractice arbitration involving a single mother in her twenties from toxic shock syndrome. The plaintiff was admitted to a hospital facility with a provisional diagnosis of anaphylaxis secondary to a medication allergy. The patient deteriorated under the supervision of a nurse practitioner while on a telemetry unit and was eventually transferred to the intensive care unit. The patient succumbed to her condition several days later. There was a substantial future economic damage and pain and suffering component to the case given the plaintiff’s young age, rapid decline and extent of necrosis (face, upper and lower extremities).
    • Obtained a defense verdict in a nursing negligence claim. The plaintiff alleged to have suffered a fall in a hospital bathroom three days post-operatively that re-injured his surgically repaired knees. The nurses denied the patient fell to the ground and testified, consistent with their charting, that the patient lost balance in the bathroom and sat on a commode. There was a significant economic damage claim in that the plaintiff was a young restaurant owner who suffered two distinct orthopedic injuries that required multiple surgeries and additional future care. The jury returned a defense verdict 50 minutes after deliberation began, finding that the nurses were not negligent.
    • Obtained a defense verdict in a medical malpractice trial involving a middle-aged mother of two who was allegedly left a quadraparetic and wheelchair-bound as a result of a physician’s failure to timely diagnose and treat an infectious process of the cranial nerves and cerebellum. The plaintiff argued that as a result of the alleged negligence, she needed home health care for the rest of her life and submitted expert testimony arguing for the recovery of boardable future medical expenses totaling $4 million and past and future pain and suffering. The last settlement demand was $2 million.  No settlement offers were made prior to or during trial.
    • Successfully argued for the dismissal of punitive damages and Scampone corporate negligence claim against a Pennsylvania nursing home involving a resident who was injured while undergoing physical therapy at the facility. At the conclusion of considerable discovery yielding thousands of pages of administrative documents and multiple corporate defendant witnesses and former employees of the facility, summary judgment was granted as to plaintiff’s claims that neglect, lack of appropriate staffing and the facility owner’s general desire to make a profit over patient care caused or contributed to her injuries. In light most favorable to the plaintiff, the court held that the resident did not link the allegations of neglect and understaffing to her injuries which occurred in an acute incident during physical therapy. In addition, the court rejected the possible imposition of punitive damages, citing deposition testimony from the plaintiff about her interactions with the nursing home staff that was inconsistent with conduct warranting the imposition of punitive damages and the opinions of her own experts.
    • AI Notetaker Evidence and Litigation Clock: Preservation Before the Recording Disappears, Wickard AI Solutions CLE, October 27, 2026
    • Criminal Investigations in Healthcare: Advice From Attorneys, Doctors and Litigation: The L Word Podcast, October 20, 2026
    • Your Ambient Scribe is Listening: Is Your Policy Ready?, PLUS Podcast, October 2026
    • Electronic Medical Records in Medical Malpractice Cases: Emerging Issues; Signs of Alteration; Use at Trial, BARBRI webinar, September 29, 2026
    • Inaugural PDI & PAJ Trial Academy, Faculty, Penn State School of Law, State College, PA, May 27-29, 2026
    • Ambient Listening and Surgical Black Boxes: A Primer, Panelist, ALC Virtual Education, April 19, 2026
    • Current Landscape in Nursing Home Litigation, Defense Counsel Panelist, Pennsylvania Bar Institute Virtual Education, April 17, 2026
    • A Conversation with RaDonda Vaught on Criminalizing Errors, PAHCRM Annual Meeting, State College, PA,  April 9, 2026
    • Latest Trends and Risks of AI’s Integration into Medicine, Hawaii Association of Healthcare Risk Management Virtual Education, March 24, 2026
    • Anticipated AI Discovery Issues in Litigation, Association for Corporate Counsel Virtual Education, February 12, 2026
    • Anticipated Discovery Issues with Use of AI in Health Care: Views from the Plaintiff and Defense Perspective, Philadelphia Court of Common Pleas, In-Person Continuing Judicial Education, co-presenter, Philadelphia, PA, October 30, 2025
    • Anticipated AI Discovery Issues in Malpractice Litigation, ALC webinar, October 23, 2025
    • The Role of AI and EMRs in Discovery, MCIC Vermont Annual Client Education Conference, National Harbor, MD, October 22, 2025
    • When AI Meets Medicine, State Volunteer Mutual Insurance Company,  Podcast Guest, October 10, 2025
    • Audit Trail 101: Views from the Plaintiff and Defense Perspective, Part I, Philadelphia Court of Common Pleas, In-Person Continuing Judicial Education, co-presenter, September 25, 2025, Philadelphia, PA
    • Pennsylvania Medical Malpractice Legal Update, Pennsylvania Coalition for Civil Justice Reform webinar, July 21, 2025
    • New Jury Considerations in the Age of Big Law, Verdicts, and Medicine; and AI in Healthcare: Views from a Clinical and Legal Perspective, Hospital Insurance Forum 2025 Conference, Charleston, SC, June 2025
    • How to Prepare for AI from a Medico-Legal Perspective, MPLA Annual Meeting, Austin, TX, May 22, 2025
    • Leave No Footprint: Tips to Reduce Scrutiny on Non-Charted Information, University of California Health System Virtual Risk Summit 2025, May 19, 2025
    • Behind the Scenes: Understanding New Discovery Tactics and the Impact on Clinical Documentation, Virtual Allied World Presentation, May 15, 2025
    • Tips to Minimize and Manage Your Audit Trail Footprint, New England Regional Healthcare Risk Management Conference, Portland, ME, May 5, 2025
    • Legal Update, co-presenter, American College of Surgeons Keystone Chapter Spring Conference, Wilkes-Barre, PA, May 2, 2025
    • Tips for Keeping a “Clean” Medical Record in an Electronic World, 2025 PAHCRM Annual Education Conference, Lancaster, PA, April 16, 2025
    • Texting: A Tool and a Trap, American Legal Connections webinar, February 6, 2025
    • AI in Civil Litigation Practice: An Intro and Discussion on What is Coming, Philadelphia Association of Defense Counsel webinar, January 21, 2025
    • A-Z on AI! Artificial Intelligence Litigation Trends and Ethical Issues, webinar panelist, Pennsylvania Coalition for Civil Justice Reform, December 9, 2024  
    • Defending Artificial Intelligence Claims, AM Best Webinar, November 13, 2024
    • Doing It Right the First Time: Recommendations to Safely Use AI in Health Care, ASHRM 2024 Annual Conference, San Diego, CA, October 8, 2024
    • Multi-Disciplinary Evaluation of Opportunities and Risks with Artificial Intelligence (AI) in Health Care, ASHRM 2024 Annual Conference, San Diego, CA, October 8, 2024
    • Public Perception of "Big Medicine" Requires New Jury Considerations, ASRHM 2024 Annual Conference, San Diego, CA, October 7, 2024
    • The Future is Now: How AI is Being Used with Data Analytics Today and Maybe Tomorrow, panelist, Candello Annual Summit, Boston, MA, September 11, 2024
    • Multi-Disciplinary Evaluation of Liability Risks of AI in Health Care: The Board Focus, co-presenter, American Hospital Association Leadership Summit, San Diego, CA, July 22, 2024 
    • Advancement of AI Into Medicine, AEIX Event, Tysons Corner, VA, June 6, 2024
    • Charting Tips to Help the Future You, LVHN Annual Risk Symposium, Center Valley, PA, May 18, 2024
    • Coming to a Case Near You: AI in Medicine, Marshall Dennehey Trends in Health Care and Health Law Seminar, May 9, 2024
    • EHRs Under Examination: The Role of Clinical Informatics Experts in Legal Proceedings, AMIA 2024 Clinical Informatics Conference, Minneapolis, MN, May 2024 
    • Artificial Intelligence in Healthcare: An Introduction, 2024 AALNC Annual Forum, Pittsburgh, PA, April 19, 2024
    • Guidance On Navigating Your Institution During Multiple Legal Investigations, PAHCRM Spring 2024 Educational Meeting, Lancaster, PA, April 12, 2024
    • Advice for the Efficient Integration of AI Into Medicine, Co-Presenter, Hospital Insurance Forum Annual Meeting, Scottsdale, AZ, March 18, 2024
    • Voir Dire of an EMR/Audit Trail Expert, American Legal Connections webinar, March 15, 2024
    • Roundtable on Social Inflation, Co-Moderator, DRI IRT Meeting, Chicago, March 13, 2024
    • The New Liability Target: Forensic Patient Record Interactions, MPL Dental Workshop, Savannah, GA, February 16, 2024
    • Liability Risks of AI in Healthcare, co-presenter, 1st Annual Upstate Educational Meeting, Association for Healthcare Risk Management of New York, Saratoga, NY, October 30, 2023
    • Latest Developments on Healthcare AI Liability and EMR Site Inspections, co-presenter, American Legal Connections, webinar, October 26, 2023
    • Evaluating the Use of AI in Obstetric Diagnostics: Understanding Enhanced Capability and Inherent Risks, Forum on Obstetric Malpractice Claims, Philadelphia, PA, October 12, 2023
    • The Good, Bad, and Ugly in Defending a Hospital Security Assault Case, Moderator, ASHRM Annual Meeting, Minneapolis, MN, October 2, 2023
    • Medical Record Audit Trail Data and Inspections: What to Do When Data and Inspections are Requested in Litigation, panelist, Florida Society for Healthcare Risk Management and Patient Safety annual meeting; Orlando, FL, August 24, 2023
    • Criminal Prosecutions: Dobbs and the Future of Care, American Legal Connections Healthcare Symposium, Atlanta, GA, July 27, 2023 
    • Mistake or Crime?: The Criminalization of Healthcare Errors, panelist, Medical Professional Liability Association Conference, New Orleans, LA, May 18, 2023
    • AI Liability: What is Brewing and What We Will See, University of Rochester webinar, April 21, 2023
    • Best Practices for an Audit Trial Expert Deposition, co-presenter, American Legal Connections, webinar, April 6, 2023
    • Defending Rule 30(b)(6) Corporate Designee Depositions, co-presenter, ALC Regional Meeting, Atlanta, GA, March 23, 2023
    • Criminalization of Medical Errors - Will it Make Us Safer?, co-presenter, Hospital Insurance Federation, Annual Meeting, Scottsdale, AZ, March 20, 2023
    • Legal and Ethical Pitfalls in Managing Dual Civil and Criminal Investigations, DRI Medical Liability and Health Care Law Seminar, Chicago, IL, March 10, 2023
    • Relationships Matter: A Frank Discussion of Hot Button Issues Facing Claims Professionals and Counsel, panelist, DRI Insurance Roundtable, Chicago, IL, March 8, 2023
    • Artificial Intelligence in Healthcare: The Good, Bad, and Ugly, SCAHRM webinar, March 28, 2023
    • Fostering a Culture of Success: How to Get Your Lawyers’ and Staff’s Mindset from Surviving to Thriving, co-presenter, Association of Legal Administrators, Philadelphia Chapter webinar, January 26, 2023
    • The New Liability Issues of Artificial Intelligence in Health Care, Ethicon, a division of Johnson and Johnson, webinar, December 12, 2022
    • Recent Cases Warn Defendants Not to Become Lost on the Audit Trail, American Legal Connections webinar, December 1, 2022
    • It’s Not All About the Virus: Defending “Other” COVID-19 Pandemic Claims, ASHRM Annual Conference, Boston, MA, September 13, 2022
    • Legal and Technical Arguments to Manage, Explain and Defend Audit Trail Information, DRI Senior Living and Long-Term Care Litigation Seminar, Nashville, TN, September 9, 2022
    • "Managing Parallel Criminal and Civil Investigations," American Legal Connections Healthcare Risk and Litigation Symposium, Atlanta, GA, July 28, 2022
    • "Litigation Risks Associated with AI in Healthcare," Thomson Reuters webinar, June 27, 2022
    • "Artificial Intelligence and Dentistry: Protecting Yourself From Liability," client webinar, June 16, 2022
    • "Risks and Legal Aspects of Artificial Intelligence in Health Care," Ohio Hospital Association Annual Meeting, Columbus, OH, June 14, 2022
    • A New Frontier: Maintaining Transparency and Defenses Following the RaDonda Vaught Criminal Verdict, CHART Institute virtual conference, June 7, 2022
    • New Risks With the Application of Artificial Intelligence to Medicine, Washington Healthcare Risk Management Society Annual Meeting, Seattle, WA, June 3, 2022
    • RaDonda Vaught: What Happened and What Can We Learn From Her Trial, virtual lesson, Duke University School of Nursing, June 2, 2022
    • A Hard Task: Balancing Transparency While Avoiding Liability Following the RaDonda Vaught Criminal Verdict, webinar, West Virginia ASHRM Chapter, May 20, 2022
    • Artificial Intelligence in Healthcare: Revolutionary or Risky?, panelist, Medical Professional Liability Association Annual Meeting, Salt Lake City, UT, May 13, 2022 
    • The New Reality - Managing the EMR and Audit Trail, panelist, New England Regional Healthcare Risk Management Conference, Groton, CT, May 2, 2022
    • A Discussion on the RaDonda Vaught Criminal Trial, panelist, New England Regional Healthcare Risk Management Conference, Groton, CT, May 2, 2022
    • Best Practices for Balancing Transparency While Avoiding Liability Following the RaDonda Vaught Criminal Verdict, American Society for Healthcare Risk Management, national webinar, April 15, 2022
    • Liability Issues with Artificial Intelligence in Healthcare Litigation, American Legal Connections, national webinar, January 27, 2022
    • Anticipated Liability Risks of Artificial Intelligence in Healthcare, ASHRM Annual Conference, October 4 (live session) and October 26, 2021 (virtual session)
    • Healthcare Acquired Infections in Nursing Homes and Hospitals: Standards of Practice, Claims, Defenses, Damages, Strafford Legal Publications National Webinar, October 19, 2021
    • Coming Soon: AI Issues in Healthcare Liability Claims, Pennsylvania Association for Healthcare Risk Management, September 17, 2021
    • The Risks and Legal Aspects of Artificial Intelligence in Healthcare, Hospital Insurance Federation webinar, May 19, 2021
    • The Future is Here: AI and Healthcare Claims, South Carolina Chapter of the American Society of Healthcare Risk Management webinar, April 23, 2021
    • Integrating Health Care and Technology: Apps, Medical Devices and AI, client webinar, February 18, 2021
    • Artificial Intelligence in Medicine: Risk Management and Litigation Issues, online continuing education conference, Pennsylvania Patient Safety Authority, January 12, 2021
    • It’s Not All About the Medicine: The New Scrutiny on Your EMR Documentation, presented at a virtual meeting of the Luzerne/Lackawanna Medical Society, November 18, 2020
    • The Return of Jury Trials: The Current State of Jury Trials in the Age of COVID-19, national teleconference for American Legal Connections (ALC), November 12, 2020
    • Learn From Those Who Know: Jury Trial Tactics During the COVID-19 Pandemic, DRI National Remote CLE, September 15, 2000
    • Lessons and Observations Made From a Socially-Distanced Jury Trial During the COVID-19 Pandemic, Inaugural PDI Remote CLE, September 10, 2020
    • Lessons Learned in with EMR Discovery, Hospital Insurance Federation (HIF), September 9, 2020
    • Managing EMR and Audit Trail Discovery, LAMMICO Defense Panel Meeting, August 20, 2020
    • Preparing A Claim for Trial: How Recent Issues, Decisions and Trends Are Impacting Litigation Outcomes, client webinar, June 4, 2020
    • “Warning Fatigue” Now a Matter of Criminal Liability: The Radonda Vaught Story, Pennsylvania Patient Safety Authority Webinar, May 24, 2020
    • Telehealth and Documentation in the Time of COVID-19: Information and Best Practices to Protect Patients and Clinicians webinar, May 14, 2020 
    • "Say 'Goodbye' to Medical Negligence Cases as We Know Them," The Legal Intelligencer, September 5, 2024 
    • "Litigation Landscape: Your GPS for Avoiding Legal Action," In Session with Allied World, Winter 2023
    • "Sanctions Against Health System Demonstrate That It's Time to Get Serious About Audit Trail Discovery," Journal of Healthcare Risk Management, August 18, 2022
    • "Evolution of the EMR: The Integration of AI in Medicine," The Legal Intelligencer, March 28, 2022
    • "Artificial Intelligence in Medicine Creates Real Risk Management and Litigation Issues," Journal of Healthcare Risk Management, September 2020
    • "A Civil Jury Trial During the Pandemic: Observations From Those Who Know," The Legal Intelligencer, August 7, 2020
    • "Report From the Trenches: Defending Patient Falls in Acute Care Settings," Becker's Hospital Review, August 28, 2018
    • "Negligent Advice of a Class III Medical Device Sales Rep," The Legal Intelligencer, Medical Malpractice Supplement, April 11, 2017
    • "A Pandora’s Box: The EMR’s Audit Trail," Counterpoint, newsletter of the Pennsylvania Defense Institute, February 2017
    • "It Ain’t Over ‘Til It’s Over: Judge Wettick Affirms Practice of Limiting Deposition Opinions of Defendant Physicians," Defense Digest, Vol. 22, No. 4, December 2016
    • "Wake Me Up!! I've Had Enough!! Litigation Nightmares With the Electronic Medical Record," The Risk Management Quarterly, newsletter of the Association for Healthcare Risk Management of New York, Inc. (AHRMNY)
    • "EMR's and Litigation: Issues Decided and What's Next?" The Legal Intelligencer, Medical Malpractice Supplement (page 5), April 12, 2016
    • Electronic Medical Records and Litigation, published by Thomson Reuters Legal, September 2014
    • "OMG?! The Impact of Social Media on the Tripartite Relationship," Co-Author, Litigation Management Magazine, Spring 2013
    • "What's It Worth? Best Practices in Defending Economic Damages in the Catastrophic Accident," Co-Author, Litigation Management Magazine, Fall 2012
    • "Reducing Medical Malpractice E-Discovery Issues and Costs," The Legal Intelligencer, February 14, 2012
    • "A View From the Trenches: Discovery Issues With Electronic Medical Records," Risk Rx, Special Edition on the Electronic Health Record, University of Florida, Vol. 8, No. 1 January-March, 2011; and Florida Hospital Association's Risk Review, August 23, 2011

Results

Defense Verdict Secured in a Contentious Long-Term Care Case

We received a defense verdict in a contentious long-term care case that included a unique spoliation issue, allegations of cover-up regarding the cause of death and a “no show” plaintiff. A longtime nursing home resident, who was suffering from “end-stage dementia,” died nine days after suffering head trauma following a fall. The plaintiff was the resident’s son who was not his mother’s guardian. The plaintiff contacted a lawyer who delivered the body across Pennsylvania to a forensic pathologist for a private autopsy. No notice was provided to the nursing home administration of the impending autopsy, despite the fact that the lawyer had sued the long-term facility several times in the past. The corpse was cremated shortly after the autopsy without an opportunity for the defense to examine the body. The defense did not learn about the private autopsy until years later, when the report was provided in discovery. A motion for sanctions for spoliation was filed by the defense, which was followed by depositions of the funeral home staff and a hearing involving the forensic pathologist and the attending physician. Although the spoliation motion was denied, the court held that the defense could question the forensic pathologist on the cremation, destroyed specimens and failure to produce the autopsy photographs at trial. On the eve of trial, the judge proctored an agreement between the parties to arbitrate the case “on expert reports only.” At arbitration, plaintiff’s counsel continued to pursue a conspiracy theory about “the true cause of death” along with standard negligence criticisms about fall prevention. The plaintiff was cross-examined on a prior crimen falsi conviction and an Orphans’ Court petition initiated by the local Area Agency on Aging, wherein the deceased resident complained that she was afraid of her son, which was relevant to his “loss of society and companionship” claim. Not surprisingly, the plaintiff denied every allegation of the Orphans’ Court petition, which detracted his appearance and credibility. 

Partial Summary Judgment on Behalf of a Nursing Home and its Corporate Defendants

In the complaint and throughout discovery, the plaintiff raised claims of overarching neglect in addition to a fall that occurred during physical therapy. The plaintiff alleged negligence, corporate negligence, and punitive damages premised upon allegations of understaffing, Department of Health violations and putting profits over patient care. The plaintiff sought to hold not only the nursing home, but also its management company and a holdings company, liable for such claims. The defense sought partial summary judgment and asked the court to limit the plaintiff’s claims to the fall only and argued that neither the record evidence nor the plaintiff’s expert reports supported the all-encompassing claims of neglect. The court agreed and narrowed the claims, thereby significantly hampering the plaintiff’s case. The court limited the claims to proceed at trial to the fall only. The court also dismissed punitive damages and dismissed the holdings company defendant outright.

Thought Leadership

Say ‘Goodbye’ to Medical Negligence Cases as We Know Them

September 5, 2024

For claims that do arise in the new era of AI use, we can anticipate they will be more complex, cost more to litigate and impact a larger class of patients.  

Defense Digest

On the Pulse…Marshall Dennehey’s National EMR and Audit Trail Practice Group Is Ready to Assist with Health Care Technology Litigation Issues

September 1, 2024

Several years ago, Marshall Dennehey recognized the plaintiff bar’s increased interest in pursuing two types of medical negligence cases: one on the medicine and the other on the electronic medical record (EMR). In response, it became one of the first, if not the first, defense firms to devote a practice group to assisting health care clients and other counsel with EMR and audit trail preservation, production, expert, and discovery issues. With the widespread integration of AI into health care, it is readily apparent that medical malpractice cases will become even more complex and expensive to litigate and will involve third-party technology vendors as parties. We can provide efficient and sound advice in this regard, in addition to the services we already provide. Our specialized and experienced practice group can assist health care systems and their counsel in many ways from discovery through trial. Our group routinely assists with formulating responses to novel discovery requests. In addition, we involve third-party electronic medical record vendors in the litigation when their assistance is necessary in discovery, whether it be to explain a production issue or include them in an ongoing discovery dispute. Along those lines, our group has had success compelling plaintiffs’ early disclosure of their EMR and audit trail experts for purposes of challenging their qualifications and representations to the court and counsel.  Deposition preparation is another area where this practice group provides focused assistance. We can help to correlate a provider’s involvement in the documentation in comparison to the audit trail, as well as provide support with respect to a corporate designee’s deposition relating to the preservation and production of the EMR. As the chart becomes more complex, witnesses need to be adequately prepared not only on the medicine, but on the EMR and AI as well. Advice on the retention of the most qualified, effective, and experienced experts is also a frequently provided service of the group. As chair of this practice subgroup, I have established a working relationship with the American Medical Informatics Association (AMIA) and its leadership on the provision of qualified expert services in the field of clinical informatics in health care litigation. Far too often, courts and counsel are relying on “junk science” from persons who claim to be EMR and audit trail experts, but who have sketchy and limited experience. By retaining appropriately trained clinical informatics (whom I refer to as “chart physicians”) to assist in their cases, health care systems can get a better handle on record production, reduce litigation expenses, and diminish discovery motion practice through the objective and qualified advice of a true expert on EMR-related issues.  On-site inspections and interactions with the EMR during discovery by plaintiff’s counsel is also becoming more of a regular request and is expected to occur more frequently. Our practice group will identify the appropriate records custodian to navigate the chart and prepare them in advance if they are asked questions during the inspection. We will also mandate acceptable inspection protocols well in advance of the event so it is conducted in a scientifically appropriate manner that is least intrusive and inconvenient to health systems.  Since the mid-2000s, we have monitored and reported legal precedent for new discovery and trial issues associated with the EMR, audit trail, and AI. Very few can boast a greater legal acumen than our group. As the EMR becomes more of a tool that augments medicine, rather than an information repository with the integration of AI, new legal thought and litigation strategies need to be considered in cases, particularly where a medical error may be due to the EMR or AI. We can assist with the strategic decision of whether and how to include EMR and AI vendors in your cases, and we can outline the legal benefits and pitfalls to be considered prior to doing so.  Medical negligence cases are not going to become less complex as AI is utilized within the EMR. To the contrary, they are going to become more complex, with novel factual and legal issues facing your counsel that have never been raised before. Going into these cases with the right guidance and experience is necessary. Please consider Marshall Dennehey’s EMR and Audit Trail Discovery Practice Group in the future when the necessity of specialized legal services are required. It is not a matter of if you will come across a complex EMR or AI issue, it is just a matter of when. Let us help you or your counsel.    Defense Digest, Vol. 30, No. 3, September 2024, is prepared by Marshall Dennehey to provide information on recent legal developments of interest to our readers. This publication is not intended to provide legal advice for a specific situation or to create an attorney-client relationship. ATTORNEY ADVERTISING pursuant to New York RPC 7.1. © 2024 Marshall Dennehey. All Rights Reserved. This article may not be reprinted without the express written permission of our firm. For reprints, contact tamontemuro@mdwcg.com.

Events

Firm Highlights

Thought Leadership

Commonwealth Court Reaffirms the Constitutionality of Act 111's IRE Provisions

In this case, the claimant sustained a work injury of January 6, 1994, which was acknowledged by Notice of Compensation Payable (NCP). After the claimant’s receipt of 104 weeks of temporary total disability benefits, the employer filed a Request for an Impairment Rating Examination (IRE). The IRE was performed in May 2023 and the IRE physician found that the claimant had a 5% whole person impairment, under the AMA Guides. The employer filed a Petition based on the IRE results, and the Petition was granted by the WCJ. During litigation, the claimant argued that the IRE provisions of Act 111 (Section 306(a.3) of the Act) were not applicable to her injury, since it predated June 24, 1996, the date Act 57 went into effect, and that the IRE provisions were unconstitutional. The Workers’ Compensation Judge (WCJ)) granted the Petition and the Board affirmed. On appeal to the Commonwealth Court, the claimant argued that Act 111 violated the nondelegation doctrine and that its retroactive application to the claimant’s injury was unconstitutional. The court rejected the arguments on the basis that they had already found the same arguments without merit in multiple, prior cases. The court also addressed an argument made by the claimant that Act 111 was procedurally defective under the Pennsylvania Constitution because it was only considered on two days in each House after having undergone amendments and reassignments. The court noted that the Pennsylvania Constitution requires every bill to be considered on three different days in each House. The claimant maintained that, according to the legislative history, the bill did not receive three separate days of consideration from each House when it was assigned a new bill number. The court pointed out, however, that the bill number, H.B. 1840 remained constant and was considered on three occasions by the House. Further, the court concluded that minor amendments to the bill were germane to its original subject, which was to modify the Act’s IRE process, in accordance with Protz II.

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Florida Supreme Court Rules Florida Statute §627.70152 Does not Apply Retroactively

In a decision that resolves years of appellate uncertainty and confirms that insurers and insureds alike can rely on the legal framework in place when a policy is issued, the Supreme Court of Florida last week found that Florida Statute §627.70152, which involves an insured’s requirement to provide an insurer with pre-suit notice before filing a suit, cannot be applied retroactively. In Universal Property & Casualty Insurance Company v. Hughes, the Court was presented with the issue of whether the statutory pre-suit notice requirement applied retroactively and whether it would apply to a breach of contract of an insurance policy that was issued before the statute went into effect. Before the Court was an appeal from a homeowner, Ms. Hughes, who sued her insurance carrier, Universal Property & Casualty Insurance Company (Universal) for breach of contract under an insurance policy that was in effect from April 24, 2019 through April 24, 2020. During the policy period, Ms. Hughes suffered a loss and, on May 29, 2019, made a claim for water damage. The carrier investigated the loss and issued payment; Ms. Hughes disputed the payment, finding the amount insufficient for repairs. On July 1, 2021, Florida Statute §627.70152 went into effect, which required insureds to provide notice of intent to initiate litigation against the carrier prior to filing a lawsuit; if an insured filed the lawsuit without complying with §627.70152, a court must dismiss the case without prejudice. On August 4, 2021, Ms. Hughes filed her lawsuit against Universal for breach of contract. Universal moved to dismiss based on her failure to comply with §627.70152. Ms. Hughes contended the notice requirement could not be applied retroactively. The trial court disagreed and dismissed the lawsuit without prejudice, and Ms. Hughes appealed. During the appeal, the Fourth District Court of Appeal, in Cole v. Universal Property & Casualty, 363 So. 3d 1089 (Fla. 4th DCA 2023), ruled that Florida Statute §627.70152 did apply retroactively to policies issued before the effective date of §627.70152. However, the Sixth District Court agreed with Ms. Hughes and overturned the trial court’s ruling, finding the statute could not retroactively apply to policies issued prior to the statute effective date. Thereafter, the other district courts weighed in, with the Third District Court agreeing with the Fourth District Court, and the First, Second and Fifth District Courts agreeing with the Sixth District Court. In resolving the conflict amongst the district courts, the Supreme Court advised “as a general rule, ‘the statute in effect at the time an insurance contract is executed governs substantive issues arising in connection with that contract.’ Hassen v. State Farm Mut. Auto. Ins. Co., 674 So. 2d 106, 108 (Fla. 1996). The Court applied the two-step test when deciding whether a statute has retroactive application: “First, the Court must ascertain whether the Legislature intended for the statute to apply retroactively. Second, if such an intent is clearly expressed, the Court must determine whether retroactive application would violate any constitutional principles.” Menendez v. Progressive Exp. Ins. Co., 35 So. 3d 873, 877 (Fla. 2010). In analyzing the Legislature’s intent, the Court must determine whether the Legislature has manifested a clear command for retroactivity in the statutory text.  In review of the statutory text, the Court found nothing in the language of the statute to indicate that the phrase “all suits” was serving another purpose of expanding its reach to suits based on policies that both predate and postdate the enactment of the statute. Buis v. Universal Prop. & Cas. Ins. Co., 394 So. 3d 738, 741 (Fla. 2d DCA 2024). Further, the Court noted the statute has an effective date, which has long been considered to be evidence against retroactive application of a statute. The Court concluded that, on its face, no provision of §627.70152 speaks to application of the statute to insurance policies issued before the statute’s effective date and therefore, the Legislature did not clearly command retroactivity of the statute to include insurance policies issued prior to the enactment of the statute. The Court briefly reviewed Universal’s argument that the presuit notice requirement was procedural, not substantive, and therefore should be applied retroactively; however, the Court agreed with the Sixth District Court’s finding that, in its entirety, §627.70152 transformed an insured’s ability to sue an insurance company under a property insurance policy and an insurer’s obligations to respond to and pay insurance claims, thus making the requirement a substantive change. The Court thereby upheld the decision of the Sixth District and disapproved the decision of the Fourth District in Cole.

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The Tolling Trap: Filing Alone Will Not Toll the Statute Without Good-Faith Service

The Eastern District of Pennsylvania recently reinforced a critical limitation on bad faith claims, holding that a timely filing alone will not preserve a cause of action absent a good-faith effort to serve the original process. The plaintiff had presented a claim for underinsured motorist benefits to his auto insurer. The insurer evaluated the claim and determined that the plaintiff’s accident-related damages did not exceed the bodily injury liability insurance limits of the at-fault driver and denied his claim. Among other claims, the plaintiff sought to present a claim for insurance bad faith under 42 Pa. C.S.A. § 8371, to which a two year statute of limitation applies. He first filed a praecipe for writ of summons before the expiration of the statute of limitation. However, the plaintiff did not attempt to serve the praecipe or writ until after the statute of limitations had expired. Additionally, the service failed as the plaintiff had mailed the original process to an incorrect address. Despite receipt of the Postal Service’s failure to deliver the original process, the plaintiff did not attempt to re-serve the writ. Two months later, the plaintiff filed a complaint and then successfully served that complaint. The insurer sought to dismiss the plaintiff’s bad faith claim as time-barred by the statute of limitations. The district court agreed. Though the plaintiff had filed a praecipe for a writ of summons prior to the expiration of the statute of limitations, the statute is only tolled if there is a good faith effort to serve that original process. In this case, the court determined that the plaintiff had failed to perform a “good faith effort to serve the original process”. Additionally, though the filing and service of a complaint can serve as alternative original process when the lawsuit is commenced by the filing of a praecipe for a writ of summons, the plaintiff filed his complaint after the statute of limitations had expired. The plaintiff’s bad faith claim was therefore determined to be barred by the statute of limitations and dismissed by the court, with prejudice. A key takeaway for the defense is not to assume that the statute of limitations has been successfully tolled by a plaintiff merely because a praecipe for a writ of summons or complaint has been filed prior to the expiration of the statute. A filed complaint or writ is only part of the equation. The defense should carefully review the docket and filings to confirm that the plaintiff also performed the requisite good faith effort to serve that original process. A thorough review of the docket may reveal that the plaintiff failed to make the good-faith service efforts necessary to toll the statute of limitations.