Suzanne K. Cianci, Limited Administrator of the Estate of Donald J. Tuohey, Sr., Deceased v The University of Rochester
Attorneys and Parties
Brief Summary
Medical malpractice arising from alleged resuscitation in contravention of a Medical Order for Life-Sustaining Treatment (MOLST) during an emergency.
Denied dismissal and post-trial motions; a jury awarded plaintiff damages for pain and suffering caused by chest compressions performed despite a MOLST.
The judgment awarding damages and the denial of defendant’s motion for a directed verdict; the complaint was dismissed.
Plaintiff failed to present expert testimony establishing the applicable standard of care and a breach; the expert described expectations and options but not the accepted standard or how it was violated.
Background
Decedent arrived at defendant’s hospital emergency department with complaints including abdominal pain, became unresponsive, and staff performed chest compressions. Staff were unaware that decedent had a Medical Order for Life-Sustaining Treatment (MOLST) declining life-saving measures, including chest compressions. The compressions revived him but allegedly caused rib fractures; he suffered another heart attack and died hours later. Plaintiff alleged medical malpractice for administering treatment without consent and contrary to the MOLST, causing pain and suffering. Supreme Court denied defendant’s motion to dismiss under New York CPLR 3211(a)(7) [rule allowing dismissal for failure to state a cause of action], and the case proceeded to trial, resulting in a plaintiff’s verdict.
Lower Court Decision
Supreme Court denied defendant’s CPLR 3211(a)(7) motion to dismiss, denied defendant’s motion for a directed verdict, and later denied its post-trial motion to set aside the verdict. The jury awarded damages for decedent’s pain and suffering based on performing chest compressions in contravention of the MOLST.
Appellate Division Reversal
The Appellate Division unanimously reversed, granted defendant’s motion for a directed verdict, and dismissed the complaint. While rejecting arguments that the claim was one for wrongful life or battery, and recognizing that a MOLST may ground a malpractice claim even in emergencies, the court held there was no expert testimony establishing the applicable standard of care or a breach. Plaintiff’s expert discussed what hospitals could do, were allowed to do, or should do, but did not state the accepted standard or that it was violated under the case’s specific circumstances. The court also noted that emergency circumstances do not categorically excuse compliance with a MOLST and that statutory immunity under Public Health Law § 2994-ee [permits disregarding a do-not-resuscitate order in good-faith belief of revocation or under significant and exceptional medical circumstances] was inapplicable on the pleaded facts, which alleged mere unawareness of the MOLST. The court acknowledged Public Health Law § 2994-bb [advance directive provisions permitting withholding of cardiopulmonary resuscitation in acute emergencies].
Legal Significance
The decision affirms that a claim for administering life-sustaining treatment contrary to a MOLST can proceed as medical malpractice (not wrongful life or battery) and that emergencies do not automatically negate the obligation to honor a valid advance directive. However, plaintiffs must present expert testimony identifying the accepted medical standard of care and explaining how it was breached; generalized expectations or options are insufficient. Statutory immunity under Public Health Law § 2994-ee is limited and does not apply where providers are merely unaware of a MOLST rather than acting in good-faith disregard under exceptional circumstances.
MOLST-based malpractice claims are viable, but they require precise expert proof of the standard of care and breach; absent such testimony, a directed verdict for the defense is warranted even after a plaintiff’s jury verdict.