D'Orta v. Margaretville Memorial HospitalD'Orta v. Margaretville Memorial Hospital
Calendar Date: September 12, 2017
Before: Petеrs, P.J., McCarthy, Rose, Mulvey and Rumsey, JJ.
O‘Connor, McGuinness, Conte, Doyle, Oleson, Watson & Loftus, LLP, White Plains (Montgomery L. Effinger of counsel), for Margaretville Memorial Hospital and another, appellants.
Sholes & Miller, LLP, Poughkeepsie (Mary Pat Burke of counsel), for Kingston Hospital, appellant.
Steinberg, Symer & Platt, LLP, Poughkeepsie (Ellen A. Fischer of counsel), for Kingston Neurological Associates, PC and another, appellants.
Dreyer Boyajian LLP, Albany (John B. Casey of counsel), for respondent.
MEMORANDUM AND ORDER
Rumsey, J.
Appeals from two orders of the Supreme Court (Cahill, J.), entered March 3, 2016 and April 7, 2016 in Ulster County, which denied defendants’ motions for summary judgment dismissing
Plaintiff was playing cards at the home of a friend in the early morning hours of March 6, 2010 when he suddenly collapsed to the floоr. After his collapse, plaintiff had difficulty speaking clearly, the right side of his face was drooping and he was unable to use his right hand. Plaintiff‘s companions thereafter contacted his fiancée, Jennifer Slauson, at her home by telephone at approximately 1:00 a.m. to advise her of plaintiff‘s symptoms. Slauson transported plaintiff to defendant Margaretville Memorial Hospital (hereinafter Margaretville Hospital), where he prеsented at 2:16 a.m. seeking emergency medical treatment. Based on Slauson‘s report that plaintiff had collapsed approximately one hour prior to arrival, the time of the onset of plaintiff‘s symptoms was rеcorded in the Margaretville Hospital records as 1:16 a.m. Plaintiff was examined by a nurse practitioner, who consulted by telephone with defendant Susan Marion Fiore, a physician with Margaretville Hospital. They determined that plaintiff required more intensive care for his symptoms, which were indicative of a stroke, than could be provided with the limited resources available at Margaretville Hospital and contacted defendant Joubin Meta, a doctor at defendant Kingston Hospital, to arrange for plaintiff‘s transfer to Kingston Hospital.
Plaintiff was transported with advanced life support by an ambulance that originated in the City of Kingston, Ulster County — a 45-minute drive frоm the Village of Margaretville, Delaware County — and departed from Margaretville Hospital at 3:45 a.m. Upon plaintiff‘s arrival at the emergency department at Kingston Hospital at 4:52 a.m., he was examined by Meta, who consulted at 5:29 a.m. by telephone with defendant Fabio O. Danisi, a board-certified neurologist employed by defendant Kingston Neurological Associates, PC (hereinafter Kingston Neuro). Meta and Danisi considered administering tissue рlasminogen activator (hereinafter TPA), a drug that can dissolve clots in certain stroke patients that Margaretville Hospital was unable to administer, before ultimately concluding that TPA was contraindicated because plaintiff‘s stroke was too severe and because too much time had passed since the last known time when he had exhibited normal neurological function, which also was recorded in the Kingston Hospital recоrds as 1:16 a.m.
Plaintiff commenced this medical malpractice action in December 2011. The gravamen of plaintiff‘s complaint is that defendants committed malpractice by failing to ensure that he received TPA, which hе contends would have reduced the neurological deficits he sustained as a result of the stroke.
“On a motion for summary judgment in a negligence-based medical malpractice action, the defendаnt is required to establish, through competent evidence, either that there was no departure from accepted standards of practice in the plaintiff‘s treatment or that any such deviation did not injure the plaintiff. This burdеn may be satisfied through a physician‘s affidavit or affirmation describing the facts in specific detail and opining that the care provided did not deviate from the applicable standard of care. Only if the defendant meets this initial burden of establishing its entitlement to judgment as a matter of law does the burden shift to the plaintiff to raise a triable issue of fact” (Randall v Kingston Hosp., 135 AD3d 1100, 1101 [2016] [internal quotation marks, brackets and citations omitted]).
Margaretville Hospital and Fiore met their initial burden by submitting the affidavit of Timothy Haydock, a physician board-certified in emergency medicine, who noted that Margaretville Hospital is a 15-bed facility with limited resources that was not authorized to administer TPA and opined that the care given to plaintiff while he was at Margaretville Hospital met appropriate standards of care for such institutions. Further, Haydock opined that the window for administering TPA for acute ischemic strokе had been extended, by an advisory statement jointly issued by the American Heart Association and the American Stroke Association in 2009 (hereinafter the AHA/ASA Advisory statement), from three hours to 4.5 hours after the onset of symptoms and, thеrefore, that any alleged delay by Margaretville Hospital or Fiore in completing the transfer of plaintiff could not have caused any injury to him because he
Kingston Hospital likewise met its initial burden of demonstrating that the care provided to plaintiff was within acceptable standards of care by submitting an affirmation from board-certified neurologist S. Murthy Vishnubhakаt, who opined that plaintiff was promptly evaluated upon his arrival at Kingston Hospital and received care that met appropriate standards. With respect to the time period for administration of TPA, Vishnubhakat stated that the standard of care provided for administration of TPA within three hours from the onset of stroke symptoms and that the AHA/ASA Advisory statement was only a recommendation for extension of the time period to 4.5 hours for patients meeting specific criteria not exhibited by plaintiff. Vishnubhakat further opined that plaintiff was outside of the 4.5-hour time period when he presented at Kingston Hospital and, in any event, was not a suitable candidate for TPA treatment. Notably, Vishnubhakat characterized plaintiff‘s stroke as severe — based on plaintiff‘s symptoms and the scores that he received on the NIH Stroke Scale — and opined that, given the extent of plaintiff‘s stroke and medical history, the administration of TPA could have harmed, rather then benefitted, plaintiff by causing plaintiff to suffer a possibly lethal hemorrhage, a conclusion that he stated was retrospectively confirmed by a subsequent MRI that showed a significant hemorrhage that could have been made even more severe by administration of TPA.
Danisi and Kingston Neuro likewise met their initial burden on their motion for summary judgment dismissing the complaint. In his deposition testimоny and his affidavit, Danisi noted that the Food and Drug Administration had approved TPA for administration to stroke victims within three hours from the time of last known normal neurological function and that the benefits of TPA markedly decrease — and thе risks increase — when it is administered more than three hours after the onset of symptoms. Danisi acknowledged that TPA may be administered to certain patients for up to 4.5 hours, but opined that plaintiff was not a candidate for TPA treatment in any event because his symptoms at onset raised the possibility that plaintiff had also had a seizure and, based on his NIH Stroke Score, because his stroke was too severe. Danisi further opined that administration оf TPA would not have improved plaintiff‘s outcome, but, rather, would likely have caused edema and hemorrhage in the middle cerebral artery resulting in profound neurologic injury or death, which, like Vishnubhakat, he opined was confirmed by the subsequent MRI.
In addition,
Peters, P.J., McCarthy, Rose and Mulvey, JJ., concur.
ORDERED that the orders are affirmed, with costs.
Rumsey, J.