| Mazella v Beals |
| 2014 NY Slip Op 08147 [122 AD3d 1358] |
| November 21, 2014 |
| Appellate Division, Fourth Department |
[*1]
| Janice Mazella, as Administratrix of the Estate ofJoseph Mazella, Deceased, Respondent, v William Beals, M.D., Appellant, et al.,Defendant. (Appeal No. 3.) |
Gale Gale & Hunt, LLC, Syracuse, Meiselman, Packman, Nealon, Scialabba& Baker P.C., White Plains (Myra I. Packman of counsel), fordefendant-appellant.
Del Duchetto & Potter, Syracuse (Ernest A. Del Duchetto of counsel) andAlessandra Deblasio, New York City, for plaintiff-respondent.
Appeal from an amended judgment of the Supreme Court, Onondaga County (JohnC. Cherundolo, A.J.), entered May 21, 2013. The amended judgment, insofar as appealedfrom, awarded plaintiff money damages upon a jury verdict.
It is hereby ordered that the amended judgment so appealed from is affirmed withoutcosts.
Memorandum: In this medical malpractice and wrongful death action, William Beals,M.D. (defendant) appeals from an amended judgment awarding money damages toplaintiff. We reject defendant's contention that Supreme Court erred in denying hisposttrial motion seeking to set aside the verdict on the ground that plaintiff had failed toestablish a prima facie case of medical malpractice. To establish his entitlement to thatrelief, defendant was required to establish that the evidence was legally insufficient tosupport the verdict, i.e., "that there [was] simply no valid line of reasoning andpermissible inferences which could possibly lead rational [persons] to the conclusionreached by the jury on the basis of the evidence presented at trial" (Cohen v HallmarkCards, 45 NY2d 493, 499 [1978]). On this record, we conclude that "there is a validline of reasoning supporting the jury's verdict that defendant deviated from the applicablestandard of care in [his treatment] of plaintiff's [decedent] . . . , and thatsuch deviation was a proximate cause of [the] injuries" of plaintiff's decedent(Winiarski v Harris [appeal No. 2], 78 AD3d 1556, 1557 [2010]; see generally Sacchetti vGiordano, 101 AD3d 1619, 1619-1620 [2012]). We also reject defendant'salternative contention in support of his posttrial motion that the verdict is against theweight of the evidence, i.e., that the evidence so preponderated in defendant's favor thatthe verdict in favor of plaintiff could not have been reached on any fair interpretation ofthe evidence (see generally Lolik v Big V Supermarkets, 86 NY2d 744, 746[1995]). Here, we conclude that "the 'trial was a prototypical battle of the experts, and thejury's acceptance of [plaintiff's] case was a rational and fair interpretation of theevidence' " (Holstein vCommunity Gen. Hosp. of Greater Syracuse, 86 AD3d 911, 912 [2011],affd 20 NY3d 892 [2012]). With respect to our dissenting colleague's summary ofthe testimony of plaintiff's expert, we respectfully note that there may have been morethan one proximate cause of decedent's injuries (see generally Argentina v EmeryWorld Wide Delivery Corp., 93 NY2d 554, 560 n 2 [1999]), and that the jury wasentitled to credit plaintiff's theory that defendant's actions constituted one of thoseproximate causes.
Defendant further contends that the verdict must be set aside and a new trial grantedbecause, inter alia, he was denied a fair trial by the admission in evidence of certaindocuments [*2]of the Office of Professional MedicalConduct. Even assuming, arguendo, that the court erred in admitting those documents inevidence, defendant's contention lacks merit inasmuch as "that . . . error'would not have affected the result[,]' and . . . any such error therefore isharmless" (Cook v OswegoCounty, 90 AD3d 1674, 1675 [2011]).
Contrary to defendant's further contention, the court's failure to submit a specialverdict sheet to the jury was not prejudicial and does not require a new trial (seeSuarez v New York City Health & Hosps. Corp., 216 AD2d 287, 287 [1995];see also Kolbert v MaplewoodHealthcare Ctr., Inc., 21 AD3d 1301, 1301-1302 [2005]). We have considereddefendant's remaining contentions and, to the extent that they are properly before us, weconclude that they lack merit.
All concur except Smith, J.P., who dissents and votes to reverse the amendedjudgment insofar as appealed from in accordance with the following memorandum.
Smith, J.P. (dissenting). Because I disagree with the majority's conclusion that thenegligence of defendant William Beals, M.D. (defendant) was a proximate cause of thesuicide of Joseph Mazella (decedent), I respectfully dissent. I would reverse the amendedjudgment insofar as appealed from, grant defendant's motion to set aside the verdict asagainst the weight of the evidence (see generally Dentes v Mauser, 91 AD3d 1143, 1145-1146[2012], lv denied 19 NY3d 811 [2012]; Rivera v Greenstein, 79 AD3d 564, 568-569 [2010]), anddismiss the complaint with respect to defendant.
The evidence at trial established that defendant treated decedent for depression andother mental health conditions for many years before 2009 by, inter alia, prescribingmedications. The evidence further established that defendant did not personally seedecedent during approximately the last 10 years of that time, and defendant admitted thatsuch was negligent conduct. Decedent's condition flared up again and, on August 9,2009, he telephoned defendant, who was on vacation. There is evidence in the recordfrom which the jury could have concluded that decedent had either reduced the dosage ofthe medication prescribed by defendant or had stopped taking the medication prior totelephoning defendant, although there is also evidence in the record from which the jurycould have drawn the contrary conclusion. During that telephone call, defendant changedthe dosage of decedent's medication and prescribed an additional medication. During atelephone call the next day, defendant again adjusted decedent's medications.
The day after that, plaintiff telephoned defendant and informed him that she wasconcerned about decedent's condition. Defendant advised her to take decedent to anearby hospital's Comprehensive Psychiatric Emergency Program (CPEP), which shedid, and decedent was hospitalized overnight. Defendant met with decedent and plaintiffat defendant's office several days later, on August 17, 2009. Although the record containsvarying descriptions of the interactions between those three people during that meeting, itis clear that defendant's last contact with decedent occurred at that time, and defendantreferred decedent to CPEP for further treatment.
Even assuming, arguendo, that the above evidence and the other evidence introducedby plaintiff at trial was sufficient to establish that defendant was negligent in histreatment of decedent up until that time, it is undisputed that decedent receivedsignificant medical treatment after his last contact with defendant. The evidence at trialestablished that, after his last meeting with defendant, decedent went to CPEP, where thephysicians recommended that decedent enter an inpatient psychiatric facility, butdecedent declined to follow that advice. Decedent was treated overnight at CPEP andthen released, and the treating physician who released decedent prescribed differentmedications than those that had been prescribed by defendant. The physician at CPEPthought that decedent should not be released, but decedent and plaintiff convinced thephysician that plaintiff and decedent's other family members could care for him at home.Decedent returned to CPEP the next day and was admitted, and he was later transferredto the inpatient psychiatric unit of another hospital. Decedent remained there for about aweek, during which time another psychiatrist changed his medications again andprescribed other treatment for his condition. Decedent was released from that facilitybecause the physicians there concluded that he was not suicidal, and that his conditionhad improved sufficiently to allow him to continue treatment on an outpatient basis.None of the medical professionals who saw decedent during the week after his dischargefrom the inpatient psychiatric unit thought he was suicidal, and plaintiff wrote a noteduring that time frame indicating that she thought decedent was "80-90%better."
[*3] Decedent was released frominpatient psychiatric treatment under a regimen of medications that was different fromthe medications prescribed by defendant, and some of those medications carriedwarnings that they were not to be prescribed to those at risk of suicide. Rather thanreferring decedent to a psychiatrist upon discharge, the psychiatrist at the hospitalreferred him to a psychiatric clinic that had approximately a four-week intake process.When plaintiff spoke with the hospital's psychiatrist after decedent's discharge andexpressed concern regarding the newly-prescribed medications, the psychiatrist told herto have decedent continue taking one of the medications, but also said that decedentcould discontinue the other. Before decedent's application to be accepted for treatment atthe psychiatric clinic was completed, decedent committed suicide.
"The standard for determining whether the jury's verdict is against the weight of theevidence is whether the evidence so preponderated in [the aggrieved party's] favor thatthe verdict could not have been reached on any fair interpretation of the evidence"(Paterson v Ellis, 284 AD2d 981, 981 [2001]; see Lolik v Big vSupermarkets, 86 NY2d 744, 746 [1995]; Nicastro v Park, 113 AD2d 129,134 [1985]). Here, I agree with defendant that the jury's finding that the intervening actsof the other medical providers involved in decedent's care was not an intervening,superseding cause of decedent's injuries is not supported by the weight of theevidence.
"Ordinarily, a plaintiff asserting a medical malpractice claim must demonstrate thatthe doctor deviated from acceptable medical practice, and that such deviation was aproximate cause of the plaintiff's injury" (James v Wormuth, 21 NY3d 540, 545 [2013]). "Toestablish proximate cause, a 'plaintiff must generally show that the defendant'snegligence was a substantial cause of the events which produced the injury' "(Pomeroy v Buccina, 289 AD2d 944, 945 [2001], quoting Derdiarian v FelixContr. Corp., 51 NY2d 308, 315 [1980], rearg denied 52 NY2d 784 [1980];see Kush v City of Buffalo, 59 NY2d 26, 32-33 [1983]). Here, I agree withdefendant that the verdict is against the weight of the evidence under the circumstancespresented because plaintiff failed to establish that defendant's negligence was aproximate cause of decedent's suicide. To the contrary, I conclude that the psychiatrictreatment provided to decedent after defendant's involvement in the case endedconstituted an intervening act that severed any causal connection between defendant'snegligence and decedent's suicide. " 'An intervening act will be deemed asuperseding cause and will serve to relieve defendant of liability when the act. . . so attenuates defendant's negligence from the ultimate injury thatresponsibility for the injury may not be reasonably attributed to the defendant' "(Gardner v Perrine, 101AD3d 1587, 1587-1588 [2012], quoting Kush, 59 NY2d at 33). Thus, "[i]fthe negligent act of the third party is extraordinary under the circumstances andunforeseeable as a normal and probable consequence of defendant's negligence, then thethird party's negligence supersedes that of the defendant and relieves defendant ofliability" (DePesa v Westchester Sq. Med. Ctr., 239 AD2d 287, 288-289[1997]).
Here, the weight of the evidence establishes that decedent's condition improved afterdefendant stopped treating him, and that the immediate cause of his death was either thedisease from which he suffered or the medications that he took prior to his suicide. It isundisputed that defendant did not prescribe any medications for decedent forapproximately one month prior to his death, and defendant obviously did not cause theunderlying disease that all of the defendants were involved in treating.
Plaintiff offered the testimony of a medical expert who opined that defendant wasnegligent in prescribing decedent's medication, which caused decedent to become soovermedicated that he was in a toxic state, and that defendant was additionally negligentby refusing to provide care for decedent thereafter. That same expert, however, testifiedthat the later treatment providers were negligent and, most notably, that the psychiatristwho released decedent from the inpatient psychiatric unit at the hospital was "where thebuck stops. The buck stops with the psychiatrist to make sure [decedent] got help,. . . [and] if the social worker hadn't got the job done, to make suresomebody else got it done." Thus, even according to the testimony of plaintiff's expert,liability for decedent's suicide lay with the final treating psychiatrist.
Consequently, based on the different regimen of medications that decedent had beenprescribed, which were different from the medications that decedent had taken whileunder the care of defendant, plus the extensive medical treatment provided by othermedical professionals [*4]for several weeks, and theirprescription of medications that have an increased risk of suicide, all of which took placeafter defendant's treatment of decedent ended, I conclude that any causal connectionbetween defendant's prior negligent treatment of decedent and decedent's suicide wassevered. Thus, "there is simply no valid line of reasoning and permissible inferenceswhich could possibly lead rational [people] to the conclusion reached by the jury on thebasis of the evidence presented at trial" (Cohen v Hallmark Cards, 45 NY2d 493,499 [1978]).
I further conclude that defendant was deprived of a fair trial by an evidentiary error,i.e., the admission in evidence of a consent agreement that defendant had signed with theOffice of Professional Medical Conduct (OPMC), and that such error undoubtedlycontributed to the legal error of the jury's determination of defendant's liability. TheOPMC had charged defendant with negligence regarding 13 patients, and decedent islisted as patient A in OPMC's charges against defendant. Defendant thereafter signed aconsent agreement with OPMC, in which he agreed not to contest the allegations withrespect to those who were designated patients B through M in the consentagreement.
During cross-examination at trial, defendant admitted that he had failed toappropriately monitor decedent while he was on medication. Plaintiff's attorney thenasked whether that constituted medical malpractice. After Supreme Court overruled theobjection of defendant's attorney, defendant indicated that it was not. The court thenpermitted plaintiff's attorney to introduce the consent agreement in evidence and to use itto impeach defendant. That was error.
First, the question that plaintiff's attorney asked defendant called for defendant toadmit that he had committed medical malpractice with respect to his treatment ofdecedent. Defendant admitted that he was negligent in his care of certain patients but, asnoted above, it is well settled that the elements of "a medical malpractice [claim] are adeviation or departure from accepted community standards of practice and evidence thatsuch departure was a proximate cause of injury or damage" (Geffner v North Shore Univ.Hosp. 57 AD3d 839, 842 [2008]; see Foster-Sturrup v Long, 95 AD3d 726, 727 [2012]).Inasmuch as defendant did not admit to either medical malpractice or all the elements ofa claim of medical malpractice by signing the consent agreement, the court should havesustained the objection of defendant's attorney to the question as asked.
Next, even assuming, arguendo, that defendant had admitted to medical malpracticeby signing the consent agreement, and that it was permissible for plaintiff to use analleged prior inconsistent statement to impeach the credibility of a witness that sheherself had called (see generally Jordan v Parrinello, 144 AD2d 540, 541 [1988]),it is clear that defendant did not admit to any negligence in the consent agreement withrespect to decedent. Moreover, because defendant admitted in the consent agreement tonegligence only with respect to the 12 other patients, the consent agreement did notconstitute a prior inconsistent statement in the context of the issues at trial anddefendant's testimony, both of which concerned only decedent. Given the highlyprejudicial nature of the statements in the consent agreement, i.e., that decedent admittedthat he failed to provide proper care to 12 patients other than decedent, as well as thecomplete lack of either probative value to the issues at trial or relevance for impeachmentpurposes, I conclude that defendant was deprived of a fair trial by the admission of theconsent agreement in evidence, and by permitting plaintiff's attorney to cross-examinedefendant regarding it. Present—Smith, J.P., Fahey, Lindley and Valentino,JJ.