| Smith-Johnson v Gabbur |
| 2009 NY Slip Op 06530 [65 AD3d 1122] |
| September 15, 2009 |
| Appellate Division, Second Department |
| Twana Smith-Johnson et al., Appellants, v NagarajGabbur, Defendant, and Sushma Nakra et al., Respondents. |
—[*1] Michael A. Cardozo, Corporation Counsel, New York, N.Y. (Stephen J. McGrath, Amy G.London, Cheryl Payer of counsel), for respondents.
In an action, inter alia, to recover damages for medical malpractice, etc., the plaintiffs appealfrom an order of the Supreme Court, Kings County (Rosenberg, J.), dated December 7, 2007,which granted that branch of the motion of the defendants New York City Health and HospitalsCorp., Coney Island Hospital, and Sushma Nakra which was for summary judgment dismissingthe complaint insofar as asserted against them.
Ordered that the order is reversed, on the law, with costs, and that branch of the motion ofthe defendants New York City Health and Hospitals Corp., Coney Island Hospital, and SushmaNakra which was for summary judgment dismissing the complaint insofar as asserted againstthem is denied.
On June 25, 2003, at approximately 6:30 p.m., the plaintiff Twana Smith-Johnson(hereinafter the injured plaintiff), who at the time was approximately 31 weeks pregnant, arrivedat the emergency room of the defendant Coney Island Hospital (hereinafter the hospital), afacility operated by the defendant New York City Health and Hospitals Corp. (hereinafter HHC),complaining of abdominal pain. At approximately 7:15 p.m., the defendant Sushma Nakra, theobstetrical attending physician on duty that evening, diagnosed the injured plaintiff withpre-eclampsia, and determined, based on a fetal monitor, that the fetus was suffering from fetalbradycardia, i.e., fetal heart rate of less than 100 beats per minute. Nakra recorded the injuredplaintiff's blood pressure at 7:15 p.m. as 185/85, and a pre-anesthesia record indicates that herblood pressure at 7:25 p.m. was 201/106. At approximately 7:33 p.m., Nakra performed anemergency cesarean section on the injured plaintiff, delivering the baby at 7:35 p.m. After thecesarean section, Nakra noted that the injured plaintiff had suffered from a "complete placentalabruption," a diagnosis also noted by hospital staff in the anesthesiology records, the initialnewborn profile, and in two progress reports dated June 25, 2003.
Postdelivery, the injured plaintiff was unable to move her left side and she was found to havesuffered a cerebrovascular accident, i.e., a stroke. At approximately 8:30 p.m., the injured [*2]plaintiff's blood pressure was around 170/100, at which pointHydralazine, an antihypertensive agent, was first administered to her. She was then transferred toMaimonides Medical Center where she underwent surgery to evacuate a large, intraparenchymalhematoma.
The injured plaintiff, with her husband suing derivatively, thereafter commenced the instantaction against, among others, Nakra, HHC, and the hospital (hereinafter collectively the hospitaldefendants), seeking, inter alia, to recover damages for medical malpractice. The gravamen ofthe plaintiffs' allegations is that the hospital defendants negligently failed to treat the injuredplaintiff's hypertension prior to and during the cesarean section with fast-acting antihypertensivemedications, and that as a result she suffered a stroke during the cesarean section.
After joinder of issue and the completion of some discovery, the hospital defendants moved,inter alia, for summary judgment dismissing the complaint insofar as asserted against them onthe ground that, as a matter of law, they were not liable for medical malpractice in theirtreatment of the injured plaintiff. In support of the motion, the hospital defendants submittedaffirmations from Dr. Frank Manning, a board certified specialist in obstetrics, gynecology, andmaternal fetal medicine, and Dr. Elizabeth Frost, a board certified anesthesiologist. The SupremeCourt awarded summary judgment to the hospital defendants, finding that they established,prima facie, through the affirmations of their experts, that they did not depart from good andaccepted medical practice in their treatment of the injured plaintiff, and therefore, could not, as amatter of law, be held liable for her alleged injuries. The court also held that the plaintiffs failedto raise a triable issue of fact in opposition to the hospital defendants' prima facie showing bysubmitting, inter alia, affidavits of a board certified obstetrician/gynecologist (hereinafterOB/GYN) and a board certified anesthesiologist. We reverse.
We agree with the Supreme Court that the hospital defendants established, prima facie,through the affirmations of their experts, that they did not depart from good and acceptedmedical practice in their treatment of the injured plaintiff (see Sheenan-Conrades v Winifred Masterson Burke RehabilitationHosp., 51 AD3d 769, 770 [2008]; Rebozo v Wilen, 41 AD3d 457, 458 [2007]; Williams v Sahay, 12 AD3d 366,368 [2004]). Specifically, both experts opined, within a reasonable degree of medical certainty,that the most appropriate treatment for the injured plaintiff was an emergency cesarean sectionperformed under general anesthesia, in light of her pre-eclampsia, hypertension, and suspectedplacental abruption. The experts explained that general anesthesia and delivery naturally lowersthe blood pressure, as does the blood loss resulting from a placental abruption, and thus, had theinjured plaintiff been treated with hypertensive medications prior to or during the cesareansection, it would have placed her and the fetus at risk of a hypotensive emergency. Dr. Frostfurther noted that even if the injured plaintiff had been "bucking" after extubation, i.e.,involuntarily attempting to remove her extubation tube, "this was during the period of time whenthe patient had already been observed not to be moving her left side," and thus, such buckingcould not have proximately caused her alleged injuries.
In opposition, however, the plaintiffs raised a triable issue of fact through the submission of,inter alia, the affidavits of a board certified OB/GYN and a board certified anesthesiologist, bothof whom opined that the hospital defendants "departed from accepted standards of care in failingto . . . implement an appropriate scheme of care," given the injured plaintiff'spresentation at the hospital as pregnant and with a high blood pressure "of unknown duration"(see Alvarez v Prospect Hosp., 68 NY2d 320, 324-325 [1986]; Rebozo v Wilen,41 AD3d at 458; Domaradzki v Glen Cove Ob/Gyn Assoc., 242 AD2d 282 [1997]).Indeed, the expert OB/GYN retained by the plaintiffs noted that although it was clear that theinjured plaintiff was hypertensive when she arrived at the hospital at approximately 6:30 p.m.,the hospital defendants failed to administer any hypertensive agent to her until two hours later,during which time it would have been appropriate to administer a fast-acting medication to hersuch as Labetalol, which is a combination of alpha blockers to address the hypertension and betablockers to address the heart rate. Alternatively, during such time period, the hospital defendantscould have administered other medications to the injured plaintiff such as Nitroprusside orNitroglycerine, which are similarly short-lived in the body and would have controlled the injuredplaintiff's hypertension within one or two minutes at no risk to her or the fetus. Put differently,the plaintiffs' expert OB/GYN indicated that treating the injured plaintiff with a fast-acting,short-lived hypertensive agent in the hour before or after the cesarean section would have [*3]quickly alleviated the hypertension without placing her or the fetusat any risk despite the possibility of a placental abruption.
Moreover, both of the plaintiffs' experts noted that, contrary to a postoperative note writtenat 9:20 p.m., which indicated that postsurgery, the injured plaintiff's blood pressure remainedstable at 144/88 until 8:30 p.m., the contemporaneous hospital records indicated that after thebaby was delivered at 7:35 p.m., the injured plaintiff's blood pressure fluctuated dramatically,rising from 144/88 at 7:45 p.m., 10 minutes after delivery, to 160/90 several minutes later, andspiking to more than 170/100 before 8:30 p.m. According to the plaintiffs' experts, such bloodpressure readings should have made it apparent to the hospital defendants that general anesthesiaand delivery had been insufficient to control the injured plaintiff's hypertension. Nevertheless,the hospital defendants did not administer Hydralazine, a hypertensive agent, to the injuredplaintiff until 8:30 p.m., well after she had already suffered a stroke.
The plaintiffs' expert anesthesiologist added that the hospital defendants departed from theaccepted standard of care by allowing the injured plaintiff to "buck" for 20 minutes after beingextubated. Moreover, the plaintiffs' expert anesthesiologist noted that Dr. Frost's assertion thathypertensive medication was not warranted before and during the cesarean section because ofconcerns of a placental abruption, was belied by the postoperative administration of Hydralazine,which is not used if there is a concern about bleeding because it is slow-acting and stays in thebody for a long period of time. In addition, given that the injured plaintiff's pre-eclampsia wassevere enough to cause high blood pressure and tachycardia, general anesthesia was actuallycontraindicated, as it posed the risk of "rais[ing] intracranial pressure."
Accordingly, since the plaintiffs raised triable issues of fact in opposition to the hospitaldefendants' prima facie showing of entitlement to judgment as a matter of law, the SupremeCourt erred in granting that branch of the hospital defendants' motion which was for summaryjudgment dismissing the complaint insofar as asserted against them (see Alvarez v ProspectHosp., 68 NY2d at 324-325). Spolzino, J.P., Santucci, Belen and Lott, JJ., concur.