Pennsylvania Superior Court Redefines “Cause of Death” in Medical Malpractice Cases

Last year, the Pennsylvania Superior Court issued an opinion that has caused waves within the medical and legal communities.

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ByAnjelica Cappellino, J.D.


Published on September 21, 2021


Updated onSeptember 21, 2021

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The case in point was Reibenstein v. Barax, 236 A.3d 1162 (Pa. Super. 2020), a medical malpractice case. The Superior Court reversed and remanded the trial court’s summary judgment ruling in favor of the defendants. The opinion required the courts to consider the legal definition of “cause of death.” The opinion hinged on whether the plaintiff timely filed their lawsuit within the applicable two-year statute of limitations period.

The Superior Court’s ruling adopted a broader definition of the term. As a result, the court found that the plaintiff’s lawsuit was timely. Currently, the case is pending before the Pennsylvania Supreme Court on appeal. However, a number of different advocacy groups and medical organizations have spoken out strongly with opinions on the case. Additionally, the groups and organizations spoke about how the decision can have long-standing implications for medical malpractice cases.

The Case History

Plaintiff Linda Reibenstein filed the lawsuit after Mary Ann Whitman passed from a ruptured abdominal aortic aneurysm in 2010. Reibenstein is the administratrix of the decedent’s estate. Five days before Mrs. Whitman’s death, she had undergone a CT scan. Her primary care physician, Dr. Patrick Conaboy, requested the scan. Dr. Charles Barax reviewed the scan and then drafted a radiology report to Dr. Conaboy. The report found that Mrs. Whitman suffered from an abdominal aortic aneurysm that was “poorly visualized” in the study. However, the report did not mention any concern for the possibility of a rupture.

One year after Mrs. Whitman’s death, Ms. Reibenstein commenced a lawsuit against Dr. Barax and his employer, Mercy Hospital, Scranton. As part of the discovery process, Dr. Barax went through a deposition in February 2015. Here, Dr. Barax testified he had spoken with Dr. Conaboy about the scan and that because “he could not visualize the aneurysm very well, he could not confirm that it was not bleeding or rupturing.” Based on this testimony, Ms. Reibenstein sued Dr. Conaboy and his practice in 2016 for wrongful death claims.

Dr. Conaboy sought summary judgment on the basis that the two-year statute of limitations had passed. The Medical Care Availability and Reduction of Error Act (MCARE) established these limitations. There was no “affirmative misrepresentation or fraudulent concealment of the cause of death” which would permit equitable tolling. The trial court subsequently granted the summary judgment motion on reconsideration.

The Arguments

The main issue on appeal before the Pennsylvania Superior Court was whether equitable tolling could be applied to the statute of limitations governing the wrongful death claim. Even though, the correct identification of the decedent’s cause of death was on her death certificate. The plaintiff argued Dr. Barax’s concealment of his communications with Dr. Conaboy concerning Mrs. Whitman’s aneurysm was directly related to her cause of death. Therefore, the statute of limitations should have been tolled. The plaintiff cited Section 1303.513(d) of MCARE’s tolling provision in her argument. She pointed out that the statute does not define “cause of death” in the context of equitable tolling. Additionally, it does not explain how concealment or misrepresentation must occur in order for the tolling to apply.

In contrast, Dr. Conaboy argued there was no concealment and the statute of limitations may not be tolled. Dr. Conaboy asserted that this was because the statute’s plain language dictates the cause of death as recorded on Mrs. Whitman’s death certificate was accurate

The Superior Court’s Opinion

The Superior Court found that the applicable statute was ambiguous. The court looked to MCARE’s legislative purposes of providing “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.” In furtherance of the purpose of fair compensation, the court interpreted the language “affirmative misrepresentation or fraudulent concealment of the cause of death,” to “encompass those acts which caused the patient to die.” Therefore, the Superior Court found that the trial court erred in concluding no equitable tolling applied. The court found this reasoning because the death certificate listed the correct cause of death. So, the court remanded the case to the trial court to determine the existence of any fraudulent concealments of affirmative misrepresentations.

The American Medical Association and other physician advocacy groups have heavily criticized the Superior Court’s opinion. As these groups argue, the term “cause of death” is a “medical term of art.” It defines “cause of death” as a “specific injury or disease that leads to death” and is distinct from legal causation. MCARE does not define “cause of death.” However, the groups argue the term is so common within the medical community that it is unambiguous. Therefore, it is not subject to court interpretation.

What Does This Mean for the Future?

Equitable tolling provision could be invoked if “cause of death” is broadened to any acts that can lead to death. This is specific to cases of concealment or misrepresentation that go beyond a correctly filed death certificate. If the tolling provisions become easier to invoke, more medical malpractice cases may be filed outside of the two-year period. Physicians and insurance companies are undoubtedly concerned about growing costs and increased legal liability. But this decision may have a different outcome for patients who, as per MCARE’s purposes, need to be fairly compensated. The Superior Court’s interpretation of “cause of death” may ultimately lead to more equitable outcomes.

About the author

Anjelica Cappellino, J.D.

Anjelica Cappellino, J.D.

Anjelica Cappellino, Esq., a New York Law School alumna and psychology graduate from St. John’s University, is an accomplished attorney at Meringolo & Associates, P.C. She specializes in federal criminal defense and civil litigation, with significant experience in high-profile cases across New York’s Southern and Eastern Districts. Her notable work includes involvement in complex cases such as United States v. Joseph Merlino, related to racketeering, and U.S. v. Jimmy Cournoyer, concerning drug trafficking and criminal enterprise.

Ms. Cappellino has effectively represented clients in sentencing preparations, often achieving reduced sentences. She has also actively participated in federal civil litigation, showcasing her diverse legal skill set. Her co-authored article in the Albany Law Review on the Federal Sentencing Guidelines underscores her deep understanding of federal sentencing and its legal nuances. Cappellino's expertise in both trial and litigation marks her as a proficient attorney in federal criminal and civil law.

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