Opinion
This аppeal arises from the tragic death of a four year' old child following his treatment for an earache. The plaintiff, Anthony D. Boone, on his own behalf and as administrator of the estate of his son Kyle Kalik Boone, appeals from the judgment of the trial court rendering summary judgment in favor of the named defendant, William W. Backus Hospital. The plaintiff claims on appeal that the trial court improperly determined that his claims alleging negligence and recklessness were, in fact, claims alleging medical malpractice and, therefore, that he was required to present expert testimony to establish proximate causation. We disagree and affirm the judgment of the trial court.
The record reveals the following facts and procedural history relevant to this appeal. On December 22, 1999, at approximately 5:30 p.m., Heidi Hansen brought her four year old son, the plaintiffs decedent (decedent), to the hospital because he was complaining of рain in his right ear and she observed pus oozing from the ear. A physician at the hospital diagnosed the decedent with “right purulent
By the time the decedent arrived home, he was sweating, disoriented, breathing shallowly, his muscles were limp, and he had to use the bathroom but was unable to sit upon the toilet by himself. At 9:35 p.m., the plaintiff called the hospital and reported that the decedent was vomiting, had diarrhea, and was violently ill. The hospital responded that these symptoms were caused by the medication and advised the plaintiff to lay him down in bed. The plaintiff followed the hospital’s instructions, but at this point the decedent’s hands were clenched, he was not breathing well, and his lips and gums were white. The plaintiff and Hansen brought the decedent back to the hospital, arriving at 11:15 p.m. At 11:24 p.m., the decedent was lethargic and did not respond to verbal commands. On December 23, 1999, at 12:10 a.m., in an attempt to revive the decedent, hospital personnel administered various medications to him and began cardiopulmonary resuscitation. These measures were unsuccessful and, at 2:44 a.m., the decedent was pronounced dead. An autopsy revealed that the cause of his death was “ ‘hemolysis due to [an] idiosyncratic reaction to Ceftriaxone.’ ”
On June 25,2001, the plaintiff commenced the present action against the named defendant. He subsequently
filed an amended complaint
1
that alleged, in the first count, that the defendant was negligent in one or more of the following ways: (1) hiring and/or retention of its staff; (2) failing to provide adequate supervision and training of its staff; (3) failing to adequately train, educate or instruct its staff to recognize a severe allergic reaction to medication; (4) failing to warn its staff about the risks and dangers of allergic reactions; (5) failing to provide adequate and proper medical treatment; and (6) failing tо respond adequately to the emergency
On August 29, 2002, the trial court entered a scheduling order that required the plaintiff to disclose any expert witnesses on or before October 26, 2002. On December 5, 2002, the plaintiff had not yet disclosed any expert witnesses and, accordingly, the dеfendant filed a motion to preclude future disclosures to prevent possible prejudice and delay. On March 3,2003, the trial court granted the defendant’s motion and foreclosed the plaintiff from offering expert testimony in support of his claims. The defendant then filed a motion for summary judgment, arguing that the plaintiffs complaint alleged a medical malpractice claim and that, because the plaintiff would be required to present expert testimony to prevail upon such a claim but now was precluded from doing so, no genuine issue of material fact existed.
In response to the defendant’s motion for summary judgment, the plaintiff submitted the following documents to the trial court to support his recklessness and negligence claims: (1) the defendant’s “Emergency Department Discharge Instructions” instructing the decedent to return to the hospital if he felt that his “condition [was] not improving (and especially if it [was] worsening)”; (2) a page of an autopsy report indicating that the final cause of the decedent’s death was “hemolysis due to [an] idiosyncratic reaction to Ceftriaxone”; (3) a printout from an Internet website entitled “RxList” describing Rocephin as “ROCEPHIN (ceftriaxone sodium) FOR INJECTION”; (4) a printout from the same website detailing “warnings” and “precautions” for the use of Rocephin; 2 (5) a printout from the website listing the side effects of Rocephin; and (6) one page of the defendant’s medical records for the decedent indicating his allergy to sulfa drugs and penicillin.
On September 26,2003, the trial court issued a memorandum of decision granting the defendant’s motion for summary judgment. The trial court concluded that the plaintiffs claims sounded in medical malpractice because (1) the defendant was sued in its capacity as a provider of emergency medical services, (2) the alleged negligence was of a specialized medical nature arising out of the medical professional relationship, and (3) the alleged negligence was substantially related to mediсal diagnoses or treatment and involved the exercise of medical judgment. The
The plaintiff argues on appeal that the trial court improperly determined that his claims against the defendant were medical malpractice claims requiring expert testimony as to the proximate cause of death. He also argues that even if his claims sound in medical malpractice, expert testimony was not required to prove proximate causation because the defendant’s actions constituted such gross want of care or skill as to give rise to an almost conclusive inference of negligence and fall under the doctrine of res ipsa loquitur. We disagree with the plaintiff and affirm the judgment of the trial court.
As a preliminary matter, we set forth the appropriate standard of review. “In seeking summary judgment, it is the movant who has the burden of showing the nonexistence of any issue of fact. The courts are in entire agreement that the moving party for summary judgment has the burden of showing the absence of any genuine issue as to all the material facts, which, under applicable principles of substantive law, entitle him to a judgment as a matter of law. The courts hold the movant to a strict standard. To satisfy his burden the movant must make a showing that it is quite clear what the truth is, and that excludes any real doubt as to the existence of any genuine issue of material fact. ... As the burden of proof is on the movant, the evidence must be viewed in the light most favorable to the opponent. . . . When documents submitted in support of a motion for summary judgment fail to establish that there is no genuine issue of material fact, the non-moving party has no obligation to submit documents establishing the existence of such an issue. . . . Once the moving party has met its burden, however, the opposing party must present evidence that demonstrates the еxistence of some disputed factual issue.
... It is not enough, however, for the opposing party merely to assert the existence of such a disputed issue. Mere assertions of fact . . . are insufficient to establish the existence of a material fact and, therefore, cannot refute evidence properly presented to the court under Practice Book § [17-45], . . . Our review of the trial court’s decision to grant [a] motion
I
Before addressing the plaintiffs substantive claims, we first address his argument that the trial court improperly determined that his negligence and recklessness claims were predicated solely on the defendant’s failure to treat or to readmit the decedent, rather than on both its failure to treat or to readmit the decedent and its initial administration of Rocephin. 4 The defendant counters that “ [o]nly toward the end of the process of opposing the defendant’s [mjotion for [s]ummary [j Judgment did the plaintiff attempt to portray his [c] om-plaint as also alleging negligence in connection with the defendant’s initial decision to administer Rocephin to the decedent” and that the trial court properly construed the complaint. We agree with the plaintiff.
“ [T]he interpretation of pleadings is always a question of law for the court .... Our review of the trial court’s interpretation of the pleadings therefore is plenary.” (Citation omitted; internal quotation marks omitted.)
DiLieto
v.
County Obstetrics & Gynecology Group, P.C., 265
Conn. 79, 104,
The complaint states that the decedent was diagnosed with an earache and that his condition was treated with Rocephin IM and Tylenol with Codeine Elixir. It then details the precipitous deterioration of his condition until his eventual death. The complaint alleges, inter alia, that the defendant failed to “warn its staff about the risks and dangers of allergic reactions” and failed to provide medical treatment adequately and properly to the decedent, and that these failures caused his injuries, losses and death. Thus, taken as a whole, the complaint alleges that the defendant administered prescription medication to the decedent, that he had an immediate allergic reaction to this medication, and that the defendant failed to treat this allergic reaction adequately and properly. Although the complaint does not specifically articulate the defendant’s initial administration of Rocephin to the decedent as a basis for the plaintiffs negligence and recklessness claims,
5
we must
Moreover, the defendant cannot claim surprise or prejudice by our interpretation of the plaintiffs complaint. We recognize that, in its initial memorandum in opposition to the defendant’s motion for summary judgment, the plaintiff focused on the defendant’s failure to readmit the decedent as the primary basis for his complaint. 6 In subsequent memoranda and documentary submissions to the trial court, however, the plaintiff explicitly argued that the defendant’s initial administration of Roсephin to the decedent was an additional basis of his complaint. 7 Thus, the allegations of the complaint, coupled with the plaintiffs characterization of the complaint in his memoranda to the trial court along with the accompanying materials, put the defendant on notice that the plaintiff had included the defendant’s administration of Rocephin to the decedent in his negligence and recklessness claims. Accordingly, we conclude that the trial court improperly construed the plaintiffs complaint to allege negligence and recklessness solely with respect to the defendant’s failure to treat or to readmit the decedent.
II
Having construed the proper scope of the plaintiffs complaint, we next address his claim that the trial court improperly determined that his claims of negligence and recklessness constituted medical malpractice claims requiring expert testimony. Specifically, the plaintiff argues that the dеfendant’s actions in administering Rocephin to the decedent and subsequently refusing to treat or to readmit him were so egregious that an average person could find them to be negligent and reckless on the basis of common knowledge and experience. We disagree.
“The classification of a negligence claim as either medical malpractice or ordinary negligence requires a court to review closely the circumstances under which the alleged negligence occurred. [Professional negligence or malpractice . . . [is] defined as the
failure of one rendering professional services
to exercise that degree of skill and learning commonly
The plaintiff concedes that his claims against the defendant satisfy the first element of a medical malpractice claim because the defendant is being sued in its capacity as an institution providing medical care. The plaintiff disputes, however, that the defendant’s alleged negligent and reckless conduct was of a specialized medical nature. He further contends that while the alleged negligence was substantially related to medical diagnosis or treatment, it did not involve the exercise of medical judgment.
A
We first address the plaintiffs claim that his allegation that the defendant negligently and recklessly administered Rocephin to the decedent is not a medical malpractice claim because the administration of the drug was not of a specialized medical nature and did not involve the exercise of medical judgment. The plaintiff argues that expert testimony is not necessary because Rocephin contains penicillin and a lay jury does not need expert testimony to determine that penicillin should not be given to a patient with a penicillin allergy. We reject this argument because the plaintiff failed to provide the trial court with any evidence that Rocephin contains penicillin.
8
Moreover, we conclude that the
prescription of medication to a patient is inherently of a specialized medical nature because only licensed health care professionals may do
Because the administration of prescription medication is of a specialized medical nature and requires the exercise of medical judgment, we conclude that the trial court properly determined that the plaintiffs claim that the defendant negligently and recklessly administered Rocephin to the decedent sounds in medical malpractice. See
Gold
v.
Greenwich Hospital Assn.,
supra,
B
The plaintiff next argues that the trial court improperly determined that his claim that the defendant negligently and recklessly refused to treat or to readmit the decedent, despite his obvious symptoms of an adverse reaction to medication, was a medical malpractice claim. We disagree.
The plaintiff first argues that the defendant’s refusal to treat or to readmit the decedent was not of a specialized medical nature because any layperson could discern that the decedent was having an allergic reaction and the defendant’s own discharge instructions urged patients to return to the emergency room if their condition did not improve or if it worsened. The defendant counters that “the determination by a healthcare provider as to whether certain symptoms are an uncomfortable but acceptable reaction to medication such that a patient may safely return home or whether the symptoms are consistent with a life threatening reaction is unquestionably a decision of a specialized nature arising out of the professional-patient relationship.” We agree with the defendant that the determination by emergency medical personnel of the nature or severity of apatient’s reaction to prescribed medication is of a specialized medical nature arising out of the professional-patient relationship. The issue in the present matter, whether the vomiting was a typical reaction to the drugs received by the decedent or an indication of a condition requiring readmission to the hospital, is not within the knowledge of a typical layperson. Cf.
State
v.
Orsini,
The plaintiff next argues that the defendant’s refusal to readmit the decedent was not substantially related to medical diagnosis or treatment and did not involve
the exercise of medical judgment becausе “the conditions exhibited by [the decedent] were more akin to a patient with a visible injury, such as a bleeding wound or broken bone, being refused treatment in an emergency room.” We disagree that this case can be analogized to the summary denial of treatment for an obvious injury. In the present matter, the defendant admitted
Ill
The plaintiff next claims that, even if his negligence and recklessness claims sound in medical malpractice, the trial court improperly determined that the defendant’s conduct was not grossly negligent and, therefore, that the plaintiff was required to present expert testimony in support of his medical malpractice claim. Specifically, the plaintiff contends that the defendant’s administration of Rocephin to the decedent and subse quent refusal to treat or to readmit him exhibited such gross want of care or skill that expert testimony wаs not necessary to establish causation. We disagree.
“[T]o prevail in a medical malpractice action, the plaintiff must prove (1) the requisite standard of care for treatment, (2) a deviation from that standard of care, and (3) a causal connection between the deviation and the claimed injury.” (Internal quotation marks omitted.)
Gold
v.
Greenwich Hospital Assn.,
supra,
“In this state, decisions indicating that the exception to the general requirement of expert testimony in medical malpractice cases might be applicable have involved foreign objects discovered in the body of a patient after surgery or abnormal injuries sustained during surgery.
[Puro
v.
Henry,
Although the circumstances surrounding the untimely death of the decedent are disturbing and tragic, nevertheless, we must conclude that the conduct of the defendant’s personnel in diagnosing and treating the decedent does not meet the high threshold of egregiousness necessary to fall within the gross negligence exception. The plaintiff relies upon
Bourquin
v.
B. Braun Melsungen,
supra,
In the present matter, there was insufficient evidence from which a lay jury could conclude, on the basis of its own common knowledge, that the defendant’s conduct constituted an obvious and egregious violation of an established standard of care and that this violation proximately caused the decedent’s injuries and death. See, e.g.,
Krause
v.
Bridgeport Hospital,
Expert testimony was necessary in this case to establish when, and in what manner, it is safe to administer Rocephin to a patient with a penicillin allergy. Even if it is assumed, arguendo, that the plaintiffs Internet materials were properly before the trial court in ruling on the defendant’s
In addition, expert testimony was necessary to establish whether the decedent’s symptoms, first exhibited after he received the Rocephin and Tylenol with Codeine Elixer, were consistent with an uncomfortable but nevertheless normal reaction to the medication or instead were indicative of a serious allergic reaction requiring his readmission and treatment.
10
Cf.
State
v.
Nunes,
Additionally, in order to prevail upon his medical malpractice claim, the plaintiff was required to establish that the defendant’s negligent conduct was a cause in fact and the proximate cause of the decedent’s injuries and death. See, e.g.,
Poulin
v.
Yasner,
We conclude that, unlike in
Bourquin
and
Shegog,
the evidence presented by the plaintiff in this case was insufficient to support an inference of proximate causation. See
Bourquin
v.
B. Braun Melsungen,
supra,
First, with respect to the defendant’s administration of Rocephin to the decedent, expert testimony was necessary to establish that the decedent died from an adverse reaction to the drug. The autopsy report 11 indicates that the decedent died of “hemolysis due to [an] idiosyncratic reaction to Ceftriaxone.” The plaintiffs Internet materials do indicate that Rocephin is a form of Ceftriaxone and that “pseudomembranous colitis” is a possibly life threatening adverse reaction to the drug. They do not indicate, however, what “hemolysis” is and whether it is equivalent to “pseudomembranous colitis.” See footnote 10 of this opinion. Thus, without the aid of expert testimony, thе relationship between the defendant’s administration of Rocephin to the decedent and the cause of his death could not be determined by an average layperson. Accordingly, expert testimony was necessary in order to establish that the defendant’s administration of Rocephin to the decedent proximately caused his injuries and death.
Second, with respect to the defendant’s alleged failure to treat or to readmit the decedent, expert testimony was necessary to establish that it was more likely than not that the injuries and death of the decedent could have been avoided had he been treated or readmitted to the emergency room in a more timely manner. The plaintiff’s complaint essentially alleges
In order for the plaintiff “to prevail on [his] claim that the defendant’s negligent acts decreased the decedent’s
chance for successful treatment, [the plaintiff] must show (1) that [the decedent had] in fact been deprived of a chance for successful treatment and (2) that the decreased chance for successful treatment
more likely than not
resulted from the defendant’s negligence.” (Emphasis in original; internal quotation marks omitted.)
Drew
v.
William W. Backus Hospital,
supra,
In the present matter, the plaintiff failed to present any evidence, of an expert or circumstantial nature, that (1) prior to the defendant’s alleged failure to treat or to readmit the decedent he had at least a 51 percent chance of survival, (2) the decedent had a decreased chance of successful treatment, and (3) this decreased chance more likely than not resulted from the defen dant’s negligent failure to treat or to readmit the decedent. Thus, the plaintiff put forth no evidence from which a lay jury could infer that the defendant’s failure to treat or to readmit the decedent proximately caused his injuries and death.
IV
The plaintiff next argues that the trial court improperly held that the doctrine of res ipsa loquitur was inapplicable to the present matter. Specifically, the plaintiff asserts that “the immediate causal connection between the giving of medication, [the decedent’s] obvious allergic reaction and the continued and uninterrupted deterioration in his condition until his death would allow the case to go to the juiy on the doctrine of res ipsa loquitur . . . .” We disagree.
“The doctrine of res ipsa loquitur, literally the thing speaks for itself, permits a jury to infer negligence when no direct evidence of negligence has been introduced.
. . . The doctrine of res ipsa loquitur applies only when two prerequisites are satisfied. First, the situation, condition or apparatus causing thе injury must be such
that in the ordinary course of events no injury would have occurred unless someone had been negligent. Second, at the time of the injury, both inspection and operation must have been in the control of the party charged with neglect. . . . When both of these prerequisites are satisfied, a fact finder properly may conclude that it is more likely than not that the injury in question was caused by the defendant’s negligence.” (Citation omitted; internal quotation marks omitted.)
Godwin
v.
Danbury Eye Physicians & Surgeons, P.C.,
We conclude that the first requirement for the application of the doctrine of res ipsa loquitur has not been satisfied in the present matter because a jury reasonably could conclude that the decedent’s injuries and death could have occurred in the absence of negligence. “[T]he fact that an operation or treatment has resulted unfavorably does not, of itself, raise any presumption of want of proper care or skill.” (Internal quotation marks omitted.)
Krause
v.
Bridgeport Hospital,
supra,
As we have indicated, a patient may have an adverse reaction to prescription medication in the absence of the negligence of a physician or hospital in administering the drug. Moreover, even considering the plaintiffs Internet materials, these materials merely instruct that Rocephin should be given “cautiously” to penicillin-sensitive patients and accordingly, at best, indicate that the defendant made “a calculated risk” in its decision to administer Rocephin to the decedent in the hope that the drug’s beneficial properties would outweigh any possible adverse effects. See, e.g.,
McDermott
v.
St. Mary’s Hospital Corp.,
The judgment is affirmed.
In this opinion the other justices concurred.
Notes
On June 25, 2001, the plaintiff filed his first complaint in the present matter, which asserted claims of negligence and recklessness against the named defendant and a nurse Jane Doe, “a registered nurse employed by the [named] defendant . . . The named defendant filed a motion to dismiss the complaint with respect to Jane Doe because “the [c]ourt lack[ed] personaljurisdiction over [her], since Connecticut [pjractice does not permit actions against Jane Doe defendants.” The trial court grantеd the named defendant’s motion and entered a final judgment in favor of Jane Doe. On September 6,2002, the plaintiff filed an amended complaint seeking recovery against only the named defendant for negligence and recklessness. It is undisputed that the amended complaint is the operative complaint for the purpose of this appeal. Hereafter, in this opinion we refer to William W. Backus Hospital as the defendant.
These warnings included the following: “BEFORE THERAPY WITH ROCEPHIN IS INSTITUTED, CAREFUL INQUIRY SHOULD BE MADE TO DETERMINE WHETHER THE PATIENT HAS HAD PREVIOUS HYPERSENSITIVITY REACTIONS TO CEPHALOSPORINS, PENICILLINS OR OTHER DRUGS. THIS PRODUCT SHOULD BE GIVEN CAUTIOUSLY TO PENIC-LLIN-SENSOTVE PATIENTS. ANTIBIOTICS SHOULD BE ADMINISTERED WITH CAUTION TO ANY PATIENT WHO HAS DEMONSTRATED SOME FORM OF ALLERGY, PARTICULARLY TO DRUGS. SERIOUS ACUTE HYPERSENSITIVITY REACTIONS MAY REQUIRE THE USE OF SUBCUTANEOUS EPINEPHRINE AND OTHER EMERGENCY MEASURES.”
The trial court stated that it had “serious question as to whether and in what way it [could] consider these Internet pages.” It observed that the Internet materials “were perhaps but not clearly issued by the drug manufacturer of Rocephin” and that there were “no corroborating materials or affidavits submitted to indicate the source of [the] material, how current it was, whether in fact it came from the manufacturer, whether users received the material along with supplies of the drug.”
The trial court's memorandum of decisiоn states that “the whole case rests on the claim of failure to deliver medical services or treatment” and that “there is no claim that something was wrong with the drug administered or that the drug should not have been administered under any circumstance.”
The complaint does not allege explicitly that the defendant was aware of the decedent’s allergy to penicillin or that the decedent had an allergic reaction to Rocephin. The complaint does allege, however, that the decedent had an allergic reaction to something and that this allergic reaction began almost immediately after the defendant administered prescription medication to him. Additionally, it is undisputed that the defendant was aware of the decedent’s penicillin allergy.
The plaintiff stated that his complaint was “based primarily upon the defendant [h]ospital’s refusal to readmit/treat his son who suffered an allergic reaction to medication he had received during his admission оn December 22, 1999,” and that “the crux of the [plaintiffs [c]omplaint is that the defendant’s failure to readmit his son under the circumstances presented constituted ‘ordinary negligence' . . . .”
In the plaintiffs rebuttal memorandum, he asserted that his claims of negligence “clearly include the prescription of medication (which was the only medical treatment provided) to the decedent that caused his allergic reaction, and encompasses the staffs failure adequately to treat and/or recognize that allergic reaction.” In the plaintiff’s supplemental memorandum, he stated that “[t]he allegations in the [rjevised [c]omplaint clearly allege neglect on the part of the [defendant in administering Rocephin and failing to treat [the decedent] for a severe reaction thereto.” Additionally, attached to the plaintiffs supplemental memorandum were (1) a single page of an autopsy report indicating that the decedent died of “hemolysis due to [аn] idiosyncratic reaction to Ceftriaxone” and (2) various print-outs containing information about Rocephin obtained from the Rx-List website.
The plaintiffs Internet materials, assuming that they were properly before the trial court in ruling on the defendant’s motion for summary judgment, do not establish that Rocephin contains penicillin. See footnote 3 of this opinion; see also
Great Country Bank
v.
Pastore,
General Statutes § 20-14c (3) provides that “ ‘[prescribing practitioner’ means a physician, dentist, podiatrist, optometrist, physician assistant, advanced practice registered nurse, nurse-midwife or veterinarian licensed by the state of Connecticut and authorized to prescribe medication within the scope of such person’s practice.”
The plaintiffs Internet materiаls arguably could establish the appropriate standard of care in the present matter. These materials provide that: “Pseudomembranous colitis has been reported with nearly all antibacterial agents, including ceftriaxone [Rocephin] and may range in severity from mild to life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea subsequent to the administration of antibacterial agents. . . . After the diagnosis of pseudomembranous colitis has been established, appropriate therapeutic measures should be initiated. Mild cases of pseduomembranous colitis usually respond to drug discontinuation alone. In moderate to severe cases, consideration should be given to management with fluid and electrolytes, protein supplementation and treatment with an antibacterial drug . . . .” Thus, these materials establish that diarrhea is indicative of a possibly serious reaction to Rocephin, namely pseudomembranous colitis, and that this reaction should be considered if a patient presents with diarrhea after administration of the drug. But, the decedent’s parents did not notify the defendant that the decedent was experiencing diarrhea until he had returned home at 9:35 p.m., approximately forty-five minutes after the administration of Rocephin and right before the decedent “sped back to the defendant [h]ospital.” Even if these materials can be construed to establish an appropriate standard of care, however, they do not establish that the defendant’s conduct breached the standard of care. Assuming that diarrhea is always or usually indicative of pseudo-membranous colitis, it is unclear, without the aid of expert testimony, what the “appropriate therapeutic measures” might be under these particular circumstances. Moreover, as discussed in part III of this opinion, it is not clear that the decedent’s injuries and death were caused by the defendant’s administrаtion of Rocephin.
Alternatively, the plaintiff alleges that expert testimony was not necessary in the present matter to establish the defendant’s breach of the applicable standard of care because the defendant’s breach can be inferred from its own discharge instructions, which provide in relevant part as follows: “You have received emergency care only and may require further medical care as directed above. If you are unable to obtain care elsewhere or if you require urgent medical attention, you should return to this Emergency Department. If you feel your condition is not improving (and especially if it is worsening), get recheclced!” We reject the plaintiffs argument because these instructions provide a suggested course of conduct for discharged patients, but do not specify any particular actions to be taken by the defendant hospital. Specifically, they do not inform the issue of whether the decedent required urgent mediсal attention or whether readmission to the hospital was required. Accordingly, these instructions do not establish the appropriate standard of care in the present matter.
Like the trial court, we assume for the salce of discussion only, that the uncertified autopsy report was properly before the court in ruling on the defendant’s motion for summary judgment. See
Great Country Bank
v.
Pastore,
We reiterate that “[t]he interpretation of pleadings is always a question of law for the court” and that our “interpretation of the pleadings therefore is plenary.” (Ini ernal quotation marks omitted.)
DiLieto
v.
County Obstetrics & Gynecology Group, P.C.,
supra,