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MCARE Not Liable For All Injuries Occurring in Hospitals

On January 4, 2011, the Commonwealth Court of Pennsylvania held in Polyclinic Medical Center v. Medical Care Availability and Reduction of Error Fund, that the Medical Care Availability and Reduction of Error Fund (MCARE) is not required to provide insurance coverage for injuries caused by other patients as opposed to the hospital’s health care providers and/or their agents.

In the underlying claim, in December 1993, a female patient sued a hospital for personal injuries she sustained by another patient while in the hospital’s psychiatric unit. The other psychiatric patient, a male, took a wheelchair, that was openly stored in the unit, and ran into the female patient’s left ankle and leg. The female patient claimed that her injuries developed into reflex sympathetic dystrophy, a condition causing permanent debilitating pain in her ankle and leg. She alleged the hospital was vicariously and directly liable for the supervision, training and monitoring of its employees who failed to properly supervise the male patient and its failure to properly store and supervise its wheelchairs.

In 1994, the hospital’s basic professional liability insurer accepted coverage for the patient’s claim and then submitted the required claim to MCARE. In 2005, MCARE denied liability coverage for the female patient’s injuries. MCARE claimed that since the patient’s injuries were not caused by the furnishing of medical services, they did not have an obligation to provide coverage. MCARE’s position was upheld by the Commonwealth Court.

Judge Dan Pellegrini, writing for the panel, stated that MCARE was not required to provide coverage and “to hold otherwise would make MCARE responsible for not only providing coverage for all injuries caused by health care providers and their agents when furnishing medical services, but also for injuries caused by patients doing anything at all so long as a health care provider had responsibility for their care, greatly expanding the scope of the Act.” He went on to state that, “MCARE is only available when a person has sustained injury or death as a result of tort or breach of contract by a health care provider or its equivalent or by an agent thereof.” Since the male psychiatric patient could not be considered an agent of the hospital, MCARE was not required to provide insurance coverage to the hospital for the female patient’s claim.

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