by Mark Bauman | Jun 24, 2023 | Legal News, Medical Malpractice
In an opinion authored by Senior Judge William H. Platt, the Superior Court of Pennsylvania recently addressed whether expert witnesses, specifically medical experts, can testify to matters that are not directly within their specialty.
In James v. Albert Einstein Med. Ctr., et al.[1], Florence James, individually and as the Executrix of her brother’s estate, brought suit against five physicians and the institutional medical providers for which they practice. Ms. James alleged that from December of 2004 until March of 2011, said providers failed to diagnose the cause of her brother’s various recurring abdominal problems.
In 2011 after a CT scan, liver biopsy, colonoscopy and other testing, Lafayette James was determined to have a neuroendocrine carcinoid tumor and subsequently died in February of 2014. Ms. James asserted that the Appellees failed to order the proper follow-up diagnostic tests and failed to make appropriate referrals to specialists. Ms. James reasoned that as a result of these failures, delay in diagnosis occurred and her brother’s tumor grew until it metastasized and became incurable.
The Appellees argued that at all times they complied with the standard of care. Further, they asserted that Lafayette James was a noncompliant patient who failed to follow through on various referrals to specialists, failed to return for scheduled follow-up visits, and failed to present himself for additional testing procedures. The Superior Court noted that the record confirmed that the decedent only presented every year or two, when his abdominal symptoms were acute.
At trial, Ms. James objected to the trial court’s acceptance of Dr. Steven Peikin as an expert defense witness in oncology, because oncology was outside of his expertise. After a ten-day trial, the jury returned a verdict for the defendants. Ms. James timely appealed, her main argument being that the trial court had erred in qualifying Dr. Peikin, a gastroenterologist, as an expert in oncology.
The Pennsylvania Superior Court ruled in favor of Appellees and held that it was proper for the trial court to permit Dr. Peikin to offer opinions regarding oncology, despite his specialty being gastroenterology. The Superior Court reached this decision based on the analysis set forth below.
The court started its analysis by explaining that the standard for evaluating qualifications of an expert witness under Pennsylvania law is a liberal one: “The test to be applied when qualifying an expert witness is whether the witness has any reasonable pretension to specialized knowledge on the subject under investigation. If he does, he may testify and the weight to be given to such testimony is for the trier of fact to determine.”[2]
In order to address experts in the practice of medicine, the Superior Court went on to explain, “In the area of medicine, specialties sometimes overlap and a practitioner may be knowledgeable in more than one field. It is for the jury to determine the weight to be given to the expert, in light of the qualifications shown by the expert witness.”[3]
Specifically addressing the allowance of cross-specialty expert witness testimony, the court relied on McDaniel v. Merck, Sharp & Dohme, which held, “Experts in one area of medicine have been ruled qualified to address other areas of specialization where the specialties overlap in practice, or where the specialist has experience in another related medical field.”[4]
The Superior Court further relied on McDaniel and explained, “Although a witness must demonstrate some special knowledge or skill, there is no requirement that a witness acquire that knowledge as a result of formal schooling; expertise acquired by experience is expertise nonetheless.”[5] The court next turned to the Medical Care Availability and Reduction of Error (MCARE) Act, to supplement the McDaniel reasoning, specifically turning to §1303.512(e) which states, “A court may waive the same specialty and board certification requirements for an expert testifying as to the standard of care if the court determines that the expert possesses sufficient training, experience, and knowledge to provide the testimony as a result of active involvement in or full-time teaching of medicine in the applicable subspecialty or a related field of medicine within the previous five year time period.”[6]
Applying the above analysis to Dr. Peikin, the Superior Court reasoned that although Dr. Peikin’s primary specialty was gastroenterology, he was qualified to give testimony related to oncology based on his experience and knowledge. The experience the court found relevant in its determination that Dr. Peikin was qualified to give such testimony was: he is the head of Gastroenterology and Liver diseases at Copper University Hospital, he diagnoses cancer as a gastroenterologist, he is on the “tumor board” at Cooper University Hospital (a board responsible for monitoring cancer patients and deciding courses of treatment), and he completed a two year fellowship in endocrine tumors at the National Institute of Health.
[1] James v. Albert Einstein Med. Ctr. et al., Pa. Super. Ct. (unpublished opinion) (September 12, 2017).
[2] B.K. ex rel. S.K. v. Chambersburg Hosp., 834 A.2d 1178, 1182 (Pa. Super. 2003).
[3] Id.
[4] McDaniel v. Merck, Sharp & Dohme, 533 A.2d 436 (1987).
[5] Id. at 440.
[6] 40 Pa. Stat. Ann. §1303.512
by Mark Bauman | Jun 23, 2023 | Legal News, Medical Malpractice
In an opinion authored by Justice David N. Wecht, the Supreme Court of Pennsylvania recently addressed whether certain jurors should have been presumed prejudiced and dismissed based on their indirect relationship with the defendant’s employer, who was not a party to the case at the time of trial.
In Shinal v. Toms,[1] Megan L. Shinal had treated with Steven A. Toms, M.D. for a recurring, non-malignant tumor in the pituitary region of her brain. She had had surgery years earlier to extract the tumor through her nose, but the surgeon was unable to remove the entire tumor. At the time she saw Dr. Toms, the tumor had grown and extended into vital structures of the brain, threatening her eyesight, carotid artery, and her pituitary and hormone function.
Mrs. Shinal underwent an open craniotomy total resection of the brain tumor at Geisinger Medical Center in January 2008. During the surgery, Dr. Toms perforated her carotid artery, resulting in hemorrhage, stroke, brain injury, and partial blindness.
Mr. and Mrs. Shinal initiated a medical malpractice action in the Court of Common Pleas of Montour County against Dr. Toms, Geisinger Medical Center, and Geisinger Clinic, alleging that Dr. Toms failed to obtain Mrs. Shinal’s informed consent for the surgery.
Prior to jury selection, the Shinals moved to strike all potential jurors who were either employed or insured by, or had family members employed or insured by, any Geisinger entity. The trial court granted the motion in part, directing that any prospective jurors who were employed by Geisinger Medical Center or Geisinger Clinic, or who had family members residing in the same house who were so employed, would be stricken for cause. After numerous prospective jurors were disqualified, however, the court aborted the selection process and postponed trial. The Shinals’ motion for a change of venue was denied.
The hospital entities then were dismissed on a motion for summary judgment, since the duty to obtain informed consent does not belong to a physician’s employer or the employer’s agents.[2] The trial court also amended its order regarding juror disqualification. Relying on Cordes v. Assoc. of Internal Medicine,[3] the trial court held that per se disqualification of prospective jurors was not required based on an employment relationship with a non-party Geisinger entity. Rather, the inquiry would focus on whether the financial or situational relationship of the prospective juror or their close family member would give rise to an appearance of partiality or bias.
During jury selection, the Shinals moved to strike four jurors for cause based on their or their immediate family member’s employment with a Geisinger entity.[4] The trial court denied the motion since all four jurors indicated that they believed they could be fair and impartial, that they did not know Dr. Toms personally or as patients, and that they did not believe a negative verdict against Dr. Toms would negatively impact their or their family member’s employer. The Shinals exhausted their four peremptory strikes on these jurors.
At the conclusion of trial, the jury returned a verdict in favor of Dr. Toms.
The Shinals appealed, asserting that the trial court failed to strike for cause the four jurors with personal or familial employment relationships with Geisinger entities. The Superior Court affirmed, and the Shinals appealed to the Supreme Court.
With regard to jury selection, the Court began by noting that a trial court is required to strike a juror “when the prospective juror has such a close relationship, familial, financial, or situational, with the parties, counsel, victims, or witnesses or alternatively, when the juror demonstrates a likelihood of prejudice by his or her conduct and answers to questions.”[5] Such strikes are a question of law, subject to de novo review. On the other hand, if a juror’s conduct or answers to questions reveal a likelihood of prejudice, the trial court’s discretion is given much weight and reversed only in the case of palpable error.
The Court first considered whether the jurors in this matter should have been presumed prejudiced and stricken, a question of law. It noted that the mere existence of some familial, financial, or situational relationship does not require dismissal in every case. “[R]emote relationships should be scrutinized by the trial court in order to elucidate the particulars and address the potential appearance of partiality.” The Court also noted, however, that Pennsylvania law holds that “where there is a direct employment relationship between a juror and a party or participant, the courts must presume prejudice and the juror must be stricken for cause.”
Discussing McHugh v. Proctor & Gamble Paper Products Co.[6] and the plurality opinion in Cordes, the Court held that “[a]n indirect employment relationship with an employer that has an ownership interest in a party defendant, standing alone, does not warrant a presumption of prejudice. However, a juror may reveal a likelihood of prejudice resulting from such an indirect employment relationship through his or her conduct or answers to questions.” The Court continued,
An indirect employment relationship will require removing a potential juror for cause if the juror believes that the outcome of the case could have a financial impact upon his or her employer. When it is apparent both that there is a common employer between a juror or a juror’s close family member and a party defendant, and that the juror believes that the employer would be affected by the outcome of the case, the trial court must remove the juror for cause.
The Court thus affirmed the trial court in not striking the jurors for cause. Neither Geisinger Health System nor Geisinger Clinic were trial defendants. None of the jurors knew Dr. Toms. None of the jurors worked directly for Geisinger Clinic (Dr. Toms’ employer) or Geisinger Medical Center (the site of the surgery). There was no indication that the non-party Geisinger employers had a financial stake in the outcome of the litigation. The indirect relationships did not require a presumption of prejudice as a matter of law. Additionally, there was no evidence of an abuse of discretion after the trial court further scrutinized the jurors’ relationships with Geisinger. Accordingly, it affirmed the trial court on this issue.
The Court also addressed a physician’s duty to provide information necessary to obtain informed consent. For a discussion of its holding on that issue, please click here.
[1] No. 31 MAP 2016 (June 20, 2017).
[2] Citing Valles v. Albert Einstein Med. Ctr., 805 A.2d 1232, 2139 (Pa. 2002).
[3] 87 A.3d 829, 843-45 (Pa. Super. 2014).
[4] One juror was an administrative secretary at the Geisinger sleep labs. Another juror’s wife worked as an administrative assistant in a pediatrics department for a Geisinger entity for thirty-five years. A third juror was a customer service representative for Geisinger Health Plan. An alternate juror was a retired physician assistant who had previously worked at a Geisinger entity, but never in Dr. Toms’ department. Also, his son worked as a night security officer for a Geisinger entity.
[5] Citing Commonwealth v. Bridges, 757 A.2d 859, 873 (Pa. 2001).
[6] 776 A.2d 266, 270 (Pa. Super. 2001).
by Mark Bauman | Jun 22, 2023 | Legal News, Medical Malpractice
In an opinion authored by Justice David N. Wecht, the Supreme Court of Pennsylvania recently held that physicians cannot rely on their staff or subordinates to disclose the information required to obtain informed consent from a patient; the information must come directly from the physicians themselves.
In Shinal v. Toms,[1] Megan L. Shinal had treated with Steven A. Toms, M.D. for a recurring, non-malignant tumor in the pituitary region of her brain. She had had surgery years earlier to extract the tumor through her nose, but the surgeon was unable to remove the entire tumor. At the time she saw Dr. Toms, the tumor had grown and extended into vital structures of the brain, threatening her eyesight, carotid artery, and her pituitary and hormone function.
While discussing surgical options with Mrs. Shinal, Dr. Toms recalled Mrs. Shinal stating that she wanted to “be there” for her child, which he understood as meaning that she wanted him to attempt to remove the entire tumor if he thought he could do so with reasonable risk. He recalled advising her that subtotal resection would be safer in the short term, but total resection offered the highest chance for long-term survival. Mrs. Shinal decided to undergo surgery, but she disputed that the differences between subtotal versus total resection were explained to her.
The records following their discussion indicate that Mrs. Shinal spoke to Dr. Toms’ physician assistant, who answered questions about scarring, radiation, the craniotomy incision, and the date of the surgery. The physician assistant also took her medical history, conducted a physical, and provided her with information relating to the surgery. Mrs. Shinal signed an informed consent form for “a resection of recurrent craniopharyngioma”, which identified risks of pain, scarring, bleeding, infection, breathing problems, heart attack, stroke, injury and death.
Mrs. Shinal underwent an open craniotomy total resection of the brain tumor at Geisinger Medical Center in January 2008. During the surgery, Dr. Toms perforated her carotid artery, resulting in hemorrhage, stroke, brain injury, and partial blindness.
Mr. and Mrs. Shinal initiated a medical malpractice action in the Court of Common Pleas of Montour County against Dr. Toms, Geisinger Medical Center, and Geisinger Clinic, alleging that Dr. Toms failed to obtain Mrs. Shinal’s informed consent for the surgery.
The matter proceeded to trial. At the conclusion of trial, the trial court instructed the jury on informed consent. The instruction stated that the jury could consider any relevant information communicated to Mrs. Shinal by any qualified person acting as an assistant to Dr. Toms. During deliberations, the jury asked whether information conveyed to Mrs. Shinal by the physician assistant could satisfy informed consent requirements, to which the trial court responded by repeating its prior instruction. The jury returned a verdict in favor of Dr. Toms.
The Shinals appealed, asserting that the trial court improperly instructed the jury to consider information given to Mrs. Shinal by anyone other than Dr. Toms when determining informed consent. The Superior Court affirmed, and the Shinals appealed to the Supreme Court.
The Court addressed whether physicians may rely on their subordinates to provide information to patients necessary to obtain their informed consent. It noted that the trial court instructed the jury that it could consider relevant information communicated by “any qualified person acting as an assistant” to Dr. Toms. The Shinals argued that this instruction was a misstatement of the common law and conflicted with the MCARE Act, 40 P.S. § 1303.504.
The Court acknowledged that the standard of review for examining jury instructions is “limited to determining whether the trial court committed a clear abuse of discretion or error of law controlling the outcome of the case.” An erroneous charge is grounds for a new trial if, as a whole, it is inadequate, unclear, or has a tendency to mislead or confuse a material issue.[2]
The Court noted that the doctrine of informed consent is grounded in a patient’s right to autonomy. It recognizes the patient’s right to be informed of the risks, benefits, likelihood of success, and alternatives to a proposed course of treatment so that the patient may make an informed decision. The Court previously had held that this duty was non-delegable in Valles. The Court noted that a hospital cannot be liable for a physician’s failure to obtain informed consent because the physician, and not the hospital, has the education, training, and experience necessary to properly advise the patient of the risks specific to that patient’s medical history.
The Court held that, for the same reasons, “a physician cannot rely on a subordinate to disclose the information required to obtain informed consent. Without a direct dialogue and a two-way exchange between the physician and the patient, the physician cannot be confident that the patient comprehends the risks, benefits, likelihood of success, and alternatives.”
The Court further stated that this holding was consistent with the MCARE Act, Section 504 states:
(a) Duty of physicians.—Except in emergencies, a physician owes a duty to a patient to obtain the informed consent of the patient or the patient’s authorized representative prior to conducting the following procedures:
(1) Performing surgery, including the related administration of anesthesia.
* * *
(b) Description of procedure.—Consent is informed if the patient has been given a description of a procedure set forth in subsection (a) and the risks and alternatives that a reasonably prudent patient would require to make an informed decision as to that procedure. The physician shall be entitled to present evidence of the description of that procedure and those risks and alternatives that a physician acting in accordance with accepted medical standards of medical practice would provide.
The Court noted that Section 504 places the duty to obtain informed consent upon physicians. Nothing in the Act suggests that a patient’s conversations with anyone other than the physician can control the analysis or satisfy the physician’s legal burden. The focus is on what information a physician gives to the patient, not what information the patient received. Accordingly, the Court held that a physician’s duty to provide information to patients necessary to obtain their informed consent is non-delegable, overruling Foflygen v. Allegheny General Hosp.[3] and Bulman v. Myers[4] to the extent that they held otherwise. As a result, the Court remanded that case for a new trial.
The Court also addressed the issue of juror bias. For a discussion of its holding on that issue, please click here.
[1] No. 31 MAP 2016 (June 20, 2017).
[2] Citing Quinby v. Plumsteadville Family Practice, Inc., 907 A.2d 1061, 1069 (Pa. 2006).
[3] 723 A.2d 705 (Pa.Super. 1999).
[4] 467 A.2d 1353 (Pa.Super. 1983).
by Mark Bauman | Jun 21, 2023 | Legal News, Medical Malpractice
The Honorable Kim R. Gibson of the United States District Court for the Western District of Pennsylvania recently granted a plaintiffs’ motion in limine to preclude the defendant from submitting calculations of future life care costs that were based on the Affordable Care Act.
In Welker v. Carnevale,[1] the plaintiff-mother alleged that the defendant obstetrician and hospital improperly administered the drug Pitocin while she was in labor, resulting in serious and permanent neurological disabilities to her son. The plaintiffs sought to preclude the defendants’ experts from presenting calculations for future life care costs based upon the Affordable Care Act, arguing that such evidence is barred by the collateral source rule.
The collateral source rule provides that a claimant’s recovery should not be offset merely because coverage for the injury was provided by a collateral source, such as insurance. The defendants, however, argued that the Affordable Care Act was not insurance and that the Pennsylvania Supreme Court would hold that such calculations were proper in accordance with its holding in Moorhead v. Crozer Chester Med. Ctr., 765 A2d 786 (Pa. 2001). Moorhead held that a plaintiff’s recovery for past medical bills was limited to the amount actually paid by collateral sources. Thus, the plaintiff’s economic damages in that case were limited to $12,167.40, the amount that Medicare and insurance had paid to settle the $108,668.31 medical bill.
Judge Gibson was unpersuaded by the defendants’ position. He noted that several trial courts had considered this issue and held that calculations relating to the Affordable Care Act are barred by the collateral source rule.[2] Even though the Affordable Care Act is not literally insurance, the insurance it governs is still health insurance. Furthermore, the holding in Moorhead simply reduced the amount recoverable to the amount paid by the collateral source. Thus, Judge Gibson found its holding contrary to the defendants’ position because it held that the plaintiff may still recover damages paid by a collateral source. Finally, Judge Gibson noted that current events cast into doubt the continued existence of the Affordable Care Act, and this uncertainty further weighed against allowing it in calculations for future damages.
[1] U.S.D.C. W.D.Pa., 3:14-CV-149, Memorandum Opinion filed January 13, 2017.
[2] Citing Bernheisel v. Mikaya, No. 3:13-CV-01496, 2016 WL 4211897, at *4 (M.D. Pa. Aug. 9, 2016); Cordes v. United States, No. 2:13CV547, 2015 WL 10986360 (W.D. Pa. Nov. 20, 2015); Deeds v. Univ. of Pennsylvania Med. Ctr., 110 A.3d 1009, 1013, reargument denied (Apr. 7, 2015), appeal dismissed sub nom. Deeds ex rel. Renzulli v. Univ. of Pennsylvania Med. Ctr., 128 A.3d 764 (Pa. Super. Ct. 2015).
by Mark Bauman | Jun 20, 2023 | Legal News, Medical Malpractice
The Philadelphia County Court of Common Pleas recently issued an opinion in support of its order transferring a medical malpractice case to Berks County, holding that sending test results “does not rise to the level of rendering healthcare services” that would make Philadelphia County the proper venue for this case.
In Wentzel v. Cammarano, III, DO, et al.,[1] the plaintiff-mother alleged that she received prenatal care at Reading Hospital, and an ultrasound taken there led to an emergency caesarian section delivery at Reading Hospital. The baby continued having respiratory problems after birth, however, and Reading Hospital sent the baby’s echocardiogram test results to St. Christopher’s Hospital for Children in Philadelphia for interpretation. The complaint alleged that the echocardiogram tests showed pulmonary hypertension and heart valve insufficiency, conditions that would require immediate attention. The plaintiffs alleged that St. Christopher’s, and the interpreting physician there, delayed in sending the results of the test back to Reading Hospital, causing further delay of treatment.
Additionally, the plaintiffs alleged that the infant suffered a broken rib at either Reading Hospital or St. Christopher’s. The complaint, however, did not allege a claim for medical professional liability regarding the infant’s care received at St. Christopher’s during the infant’s admission, nor did the complaint allege that the echocardiogram was misread.
Accordingly, Judge Arnold New found that the allegation against St. Christopher’s regarding the broken rib was speculative. Judge New noted that the complaint alleged that St. Christopher’s negligence occurred prior to the infant’s admission there, and that any allegations of professional negligence were stated for the first time in plaintiffs’ response to preliminary objections. As such, the complaint’s only allegations against St. Christopher’s amounted to transmitting test results, which is not rendering healthcare services for purposes of establishing venue. The opinion cites to Cohen v. Furin, 946 A.2d 125, (Pa.Super. 2008) and Bilotti-Kerrick v. St. Luke’s Hospital, 873 A.2d 828 (Pa.Super. 2005), both of which held that a doctor’s telephone call was insufficient to establish venue in the advising doctor’s county. Judge New found that transmitting test results was even further removed from these cases since the question was one of timing, not advice. Transmittal of test results was an administrative function rather than a provision of healthcare services. Accordingly, he entered an order transferring this matter to Berks County, where Reading Hospital is located.
The plaintiffs appealed this order, and Judge New issued the opinion in accordance with Pennsylvania Rule of Appellate Procedure 1925.
[1] Wentzel v. Cammarano, III, DO, et al., Philadelphia County Court of Common Pleas, No. 1508-4185, filed August 18, 2016.
by Mark Bauman | Jun 19, 2023 | Legal News, Medical Malpractice
In Page v. Moses Taylor Hospital, et al.,[1] the Lackawanna County Court of Common Pleas denied defendants’ motion seeking to permanently seal plaintiffs’ settlement petition as well as all related filings and orders, finding that the defendants did not satisfy their burden of showing that their interest in sealing the settlement terms outweighs the presumption in favor of open access to judicial records.
This matter arose from the plaintiff-mother’s eclamptic seizure when her twins were 33.4 weeks gestation, after which the plaintiff-mother developed placental abruption that allegedly caused the twins to be stillborn. The plaintiff-mother also suffered hypovolemic shock, tachycardia and massive hemorrhaging, which required her to undergo an emergency hysterectomy and removal of her fallopian tubes and ovaries.
During the course of the case, the plaintiffs submitted an expert report regarding the pain and suffering of the twin fetuses. Defendants filed a motion in limine to preclude evidence of fetal pain and suffering, which was overruled.[2] Defendants also filed pre-trial motions regarding plaintiff-mother’s claim for negligent infliction of emotional distress and bereavement damages, both of which were also denied.
Thereafter, the parties reached a settlement agreement after the jury was selected. Plaintiffs filed a petition for court approval of the settlement, its allocation, and its distribution. Defendants then filed a motion seeking to permanently seal plaintiffs’ settlement petition and attached exhibits, as well as any subsequent related filings and orders. In support of their motion, defendants argued that “no legitimate public interest would be impaired in the sealing of the settlement terms, and no countervailing consideration should override the parties’ interests in confidentiality… [S]ealing of the terms of the settlement agreement would promote fairness and efficiency, in that it would encourage amicable settlement…The disclosure of the terms of the instant settlement agreement risks unnecessary and inappropriate influence on other cases involving defendants associated with the defendants in this matter.”
The court, however, was unpersuaded. In his opinion, Judge Terrence R. Nealon applied the common law approach to analyze the defendants’ request to seal the judicial records. Citing several Pennsylvania Superior Court cases,[3] the opinion notes that there is a presumption in favor of public access to court records. The court performs a balancing test of the factors in favor of access and the factors against it, and the moving party has the burden of showing that his or her interest in secrecy outweighs the presumption for open access. The opinion noted that, “while the general interest in encouraging settlement based upon a particularized need for confidentiality is a factor to be considered, it is outweighed by the public’s right of access if the settlement agreement involves information important to public health and safety or matters of legitimate public concern.”
Judge Nealon was unpersuaded by the defendants’ arguments that sealing the records would promote amicable settlements and would prevent influence on other malpractice cases involving the defendants. The opinion emphasizes that medical negligence claims, malpractice insurance premiums, and their affect on health care access are subject to public debate and legislation. Additionally, the opinion considered the newsworthiness of this case. It had already been the subject of media coverage in several instances, including the pre-trial motions regarding evidence of fetal pain and suffering and the plaintiff-mother’s claim for negligent infliction of emotional distress. The court found that the defendants did not satisfy their burden of showing how the disclosure of the terms of settlement would cause increased harm to the defendants so as to outweigh the public interest, particularly since the negligence allegations against the defendants had already been disseminated in the press.
Though the court denied the defendants’ motion to seal the petition for settlement and related filings, it temporarily sealed the petition and order in the event that the defendants sought an appeal of the order. The seal will be lifted if no timely appeal is filed.
[1] 2016 Pa. Ct. Comm. Pl. (unpublished opinion) (August 18, 2016).
[2] http://www.obrlaw.com/medical-malpractice.php?Court-Permits-Expert-Testimony-Regarding-Fetal-Pain-Suffering-Claims-89.
[3] Com. v. McKown, 79 A.3d 678 (Pa. Super. 2013); In re J. B., 39 A.3d 421, 434 (Pa. Super. 2012); Zdrok v. Zdrok, 829 A.2d 697, 699 (Pa. Super. 2003); Storms ex rel. Storms v. O’Malley, 779 A.2d 548, 568 (Pa. Super. 2001), app. denied, 570 Pa. 688, 808 A.2d 573 (2002).
