Medical malpractice filings are spiking as lawyers target Philly juries as a 'slot machine'

Sep. 17—Main Line Health has four hospitals, all outside Philadelphia.

Yet the nonprofit has been hard hit by a change in medical malpractice rules last year allowing cases to be filed in Philadelphia even if the incident occurred elsewhere, so long as a defendant regularly does business in the city.

As a result, Main Line is facing at least 28 malpractice lawsuits in the city based on care provided in the suburbs. That couldn't have happened two years ago, before the Pennsylvania Supreme Court ended a two-decade ban on "venue shopping." This opened the gates to more suits in the city, which is known for eight-figure verdicts.

The hook for Main Line is that it has two doctors offices in Philadelphia, according to the complaints. Only the much larger Jefferson Health has more Philadelphia lawsuits from the suburbs, with 33.

At City Hall, more than dozen such cases are being filed every month, and from all directions. Patients who received care at hospitals as far away as Scranton and York are now seeking justice in Philadelphia's Court of Common Pleas.

In all, 43% of 657 medical malpractice complaints initiated in Philadelphia between Jan. 1, 2023, and April were based on care provided outside the city, according to an Inquirer analysis of court data.

It's no surprise more cases are coming to Philadelphia, given the potential for multimillion dollar verdicts and settlements, said Nick Gaudiosi, east region health-care practice leader for Aon, a major insurance broker.

"Philadelphia is like a slot machine. It's a slot machine that everybody wants to play," he said.

Medical malpractice lawsuits often take years to work through, so it's too soon to know the impact of the migration of cases into Philadelphia. Already, health systems and doctors say they are under greater pressure to settle, given the potential for hefty Philadelphia verdicts.

The rise in lawsuits filed in the city means the number of filings in suburban counties is likely going down. An Inquirer review found that the number of malpractice cases in Delaware County fell by more than half, to 32 in 2023 from 67 in 2022. Statewide data were not yet available and are expected this fall.

In one particularly far-reaching claim, Regional Hospital of Scranton is being sued in Philadelphia City Hall — 124 miles away from the medical campus where a patient died in February 2022. The reason for suing in the city? A temporary staffing nurse accused of negligence in the case has a home address in South Philadelphia.

The changed world of health care

The health-care landscape in which the rules just changed looks dramatically different than in 2003. That was when the state decided to require malpractice cases be filed in the county where the issue occurred. Back then, the malpractice insurance market was in turmoil, making it harder for doctors and hospitals to afford coverage.

Philadelphia courtrooms, then and now, draw an outsized share of medical malpractice lawsuits. But health systems today are far more likely to have a Philadelphia connection after a period of significant health-system consolidation.

That means now far-flung organizations like Jefferson Health, which has acquired hospitals from South Jersey to Scranton and Hazleton since 2015, and growing private physicians groups are fair game for many more Philadelphia lawsuits.

A recent trend toward higher jury verdicts and settlements also worries medical providers. In January 2023, a jury reached a $183 million verdict against the University of Pennsylvania Health System, a Pennsylvania record. Other big verdicts have followed: $32 million against the shuttered Hahnemann University Hospital and $45 million against Temple University Health System last month.

The combination, tort reform advocates warned, is adding to costs for health systems and could lead back to the climate last seen in the early 2000s, when four medical malpractice insurers failed and others stopped doing business in Pennsylvania.

The latest run of high verdicts and settlements is already impacting the Philadelphia insurance market. It's now rare for insurers to offer more than $5 million in what is called "excess" coverage that goes beyond the state minimum of $1 million, an expert said. That means health systems need to use more insurers than they did historically to build adequate coverage.

"What we are seeing in Philadelphia now is insurers dramatically tightening their belts, not just in price but also in the limits of coverage they provide," said Richard T. Henderson, a senior vice president at TransRe, a New York reinsurance firm.

Meanwhile, cases are surging. The total number of cases last year in the city, when lawyers again had more latitude in where they could file lawsuits, was 544, up 34% from 2019, according to a February presentation by Daniel J. Anders, administrative judge in Philadelphia Common Pleas Court's trial division.

That's still far below the average of 1,204 medical malpractice cases that Philadelphia saw from 2000 to 2002, when the city's courts accounted for 44% of the cases statewide, according the data from the Administrative Office of Pennsylvania Courts.

Philadelphia is like a slot machine.

Nick Gaudiosi, Aon east region health-care practice leader

The reduced overall numbers reflect a raft of changes to state law that made it harder to sue hospitals and doctors for sometimes catastrophic injuries, said Shanin Specter, a founding partner of Kline & Specter, a Philadelphia law firm with a large medical malpractice group.

"Even when you add in the increase of cases that are now being brought, it pales in comparison to the number of malpractice cases that were brought 25 years ago," he said. Specter also noted that in some cases, verdicts include expenses for years of care and don't have to be paid upfront.

Health system impact

Health systems that primarily operate in the Pennsylvania suburbs immediately outside of Philadelphia are seeing their city court docket swell.

Main Line Health is defending six cases over care delivered at Riddle Hospital Delaware County's Middletown Township. And another ten cases involve Lankenau Medical Center in Wynnewood, just outside the Philadelphia city limits.

At Jefferson, 25 of 33 cases from outside the city involve Jefferson Abington Hospital in Montgomery County. (The Jefferson total does not include several cases filed in Philadelphia against Lehigh Valley Health Network in anticipation of Jefferson's recently completed acquisition of the system.)

Tower Health has seen the third-highest number of cases from outside the city.

It owns three hospitals — all of them outside of the city — and runs St. Christopher's Hospital for Children in North Philadelphia in a joint venture with Drexel University.

Tower's total of 21 included eight for Reading Hospital, seven for Phoenixville Hospital, and four for Pottstown Hospital.Tower recently boosted its medical malpractice reserves by an additional $18 million, citing the shift of cases to Philadelphia.

Main Line, Jefferson, and Tower declined to comment.

Higher verdicts and settlements have spurred the University of Pennsylvania Health System to boost its professional liability reserves by $90 million.

It is defending at least seven lawsuits from Chester County Hospital, six from Lancaster General, and one from Princeton Medical Center. The question of whether lawsuits against Penn Princeton can be filed in Philadelphia is under appeal in Pennsylvania Superior Court.

PJ Brennan, Penn's chief medical officer, said it's best to keep cases in the home county. "The venue rule change creates inconvenience for all parties, and poses a strain on access to care when health-care workers must miss work in their own community to be present for out-of-town trials," he said.

"The change has also encouraged the filing of lawsuits which likely would not have been filed in the other counties, but are now filed in Philadelphia because of the potential for higher yield before a jury," he said.

Reasons for filing in Philadelphia

Often the reason for filing in Philadelphia is straightforward: It makes sense logistically. The rule change aligns medical malpractice with other types of personal injury lawsuits; cases can be brought in any county where a defendant regularly conducts business, or where a defendant can be served.

And Philadelphia courts can be efficient compared to other jurisdictions, said Tom Duffy, a veteran malpractice attorney whose firm recently won a $45 million verdict against Temple.

"You file a lawsuit, you get a date, you get deadlines, you move forward, and you get the case tried," he said.

The legal rationale is clear for systems like Thomas Jefferson University, which owns hospitals in the city and outside the city. The new rule makes it clear cut to file cases in Philadelphia involving Jefferson Lansdale Hospital or Jefferson Einstein Montgomery Hospital.

Genesis Healthcare, the Kennett Square nursing home giant, also has facilities in and outside the city.

In other cases, the justification for filing in Philadelphia is a legal case in its own right.

Wellspan in York and Penn State Health's Hershey Medical Center near Harrisburg each face lawsuits in the city, where the complaints say they "regularly conduct business." Wellspan said it has no business in the city. Penn State declined to comment on litigation.

York County's May Eye Care Center & Associates and UPMC Hanover were sued in the city because the manufacturer of a drug used in an eye procedure regularly does business in Philadelphia, the plaintiff's lawyers at Kline & Specter say.

A case against Doylestown Hospital listed 23 reasons why it was proper to sue the Bucks County institution in Philadelphia, including that it purchased supplies and equipment in the city and used Philadelphia courts to defend its business interests.

Fighting for transfers

Some defendants are fighting to have Philadelphia cases transferred out by making what is called a "forum non conveniens" motion — namely, it's not convenient.

A physician and a physician assistant in a case involving Regional Hospital of Scranton — 124 miles from Philadelphia — did that on Aug. 28. They pointed out that only connection to the city was a nurse with a South Philadelphia address.

"It would be oppressive and vexatious for the parties and witnesses to need to drive for over two hours to attend depositions, hearings, and trials in this matter," the motion said.

Brian S. Chacker, a Philadelphia lawyer for the plaintiff in that case, did not respond to an email asking whey the suit was filed in the city.

About a dozen cases have been transferred out of Philadelphia, sometimes after a case was first filed in a suburban county and then refiled in the city after the rule change.

But transfers for the sake of convenience are rare.

"The defendant has an uphill climb" to win a transfer and the state Supreme Court has even tightened those requirements, said Curt Schroder, executive director of the Pa. Coalition for Civil Justice Reform, a group that advocates for changes that would benefit health-care defendants.

Judges "will give great weight to where the plaintiff decides to file the case," Schroder said.

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