Cole v. Champlain Valley Physicians' Hospital Medical Center

Citations: 116 A.D.3d 1283; 984 N.Y.S.2d 225

Court: Appellate Division of the Supreme Court of the State of New York; April 17, 2014; New York; State Appellate Court

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An appeal was made from a Supreme Court order that denied motions for summary judgment by several defendants in a medical malpractice and wrongful death case involving the decedent, Edwin E. Cole Sr. Cole was admitted to Champlain Valley Physicians’ Hospital Medical Center (CVPH) with serious respiratory issues. A CT scan revealed fluid in his lung, leading to complications including a collapsed lung after an unsuccessful drainage attempt. Thoracic surgeon Craig Nachbauer inserted chest tubes and monitored Cole's condition, while pulmonologist William Bruce Bunn canceled a bronchoscopy due to respiratory distress but later scheduled a thoracoscopy.

Cole's condition worsened, necessitating ventilation, and surgery was delayed until he was stable. Before the thoracoscopy, Bunn performed a thoracentesis, which removed fluid. During the surgery, after Nachbauer completed his procedure, anesthesiologist Madeline Waid encountered a critical situation when blood obstructed Cole's airway, resulting in cardiac arrest and death.

The plaintiff, Cole’s widow, initiated legal action against multiple defendants. The remaining five defendants sought summary judgment, asserting they had met the standard of care required in medical malpractice cases. They provided medical records, expert affidavits, and testimonies to support their claims that they did not deviate from accepted medical standards. The court found these submissions sufficient, leading to the denial of the summary judgment motions for all defendants except CVPH, prompting the appeal.

Waid, an employee of CVPH, was found not culpable during the fatal surgery, but the court noted that the care provided to the decedent by CVPH employees in the two weeks prior was not sufficiently addressed, contributing to the decedent's injuries and death. Consequently, CVPH was denied summary judgment as it failed to meet its initial burden, despite the adequacy of the plaintiff's opposing arguments. The burden then shifted to the plaintiff to prove triable questions regarding deviations from accepted standards of care by Waid, Bunn, and Nachbauer, and whether these deviations caused injury or death.

The plaintiff presented a detailed expert affidavit claiming that Waid's actions, specifically through overinflation or improper insertion of the endotracheal tube, caused a hemorrhage leading to the decedent's death. Although the bleeding's exact source was unidentified, the expert argued that it typically indicates negligence, given Waid's exclusive control over the decedent's medical care while he was unconscious. This allowed the plaintiff to invoke res ipsa loquitur to suggest Waid's negligence.

While Bunn and Nachbauer were not directly responsible for the immediate cause of the bleeding, the expert contended their inadequate care prior to surgery weakened the decedent, affecting his ability to survive the operation. Bunn was criticized for not performing necessary procedures like bronchoscopy and thoracentesis sooner, which the expert claimed would have improved the decedent's condition. The autopsy indicated that the primary cause of death was cardiorespiratory arrest from an acute bleed, with other contributing factors linked to respiratory distress and organ failure due to delayed medical intervention.

Bunn's expert argued that he acted appropriately by postponing surgery until the decedent's condition stabilized, while the plaintiff's expert maintained that timely treatment of the lung fluid would have prevented further complications. Similar claims about inadequate care were made against Nachbauer, who argued his duties were limited as a surgical consultant. The ongoing factual disputes necessitate further examination of whether Bunn and CVPA breached their duty of care and whether such breaches caused harm to the decedent.

Nachbauer's involvement in the decedent's treatment was confined to inserting and monitoring chest tubes following a lung collapse and consulting with other physicians regarding potential thoracic surgery. He did not address the decedent’s infections, pneumonia, or renal failure, as those were managed by other doctors. However, evidence from medical records and Nachbauer's deposition suggests he engaged in consultations with Bunn about the decedent's condition and surgical scheduling. This involvement imposed a duty on Nachbauer to meet the standard of care, as established in case law indicating that physicians jointly participating in decision-making share liability for negligence. The contrasting opinions from the plaintiff's expert concerning the timeliness of surgical intervention raised factual questions about whether Nachbauer failed to meet the standard of care and how such a failure might have impacted the decedent's health and ultimate death. Consequently, the Supreme Court correctly denied the defendants' motions for summary judgment. Although there is no direct evidence that the decedent experienced conscious pain during the final surgery, potential claims for pain and suffering due to alleged malpractice in the preceding weeks remain viable for trial. Multiple original defendants have been removed from the case due to discontinuances or successful summary judgment motions. The claims against CVPA are based solely on vicarious liability for Bunn’s actions. Nachbauer's argument regarding the inadmissibility of the plaintiff's expert affidavit, based on the expert's presumed employment by the plaintiff's counsel, was rejected, as any bias does not affect the expert's competency, with credibility assessments being inappropriate at the summary judgment stage. The order is affirmed, with costs.