Young v. Kamath
Attorneys and Parties
Brief Summary
Medical malpractice and wrongful death arising from peri-procedural anticoagulation management for pacemaker surgery; informed consent; and hospital vicarious liability under respondeat superior in the emergency room (ER) context.
Denied summary judgment to all moving defendants on medical malpractice, wrongful death, and derivative loss of services; denied Southside Hospital’s bid to dismiss vicarious liability for Kamath; denied dismissal of lack of informed consent against Eric R. Uyguanco.
The lack of informed consent claim against Eric R. Uyguanco was dismissed on summary judgment.
Defendants showed, through deposition testimony, medical records, signed consent forms, and expert affirmation, that the decedent was informed of the reasonably foreseeable risks, benefits, and alternatives to pacemaker implantation and that a reasonably prudent patient would not have declined the procedure; plaintiff failed to raise a triable issue.
Background
John J. Young had a history of pulmonary embolism and deep vein thrombosis (DVT) and was on Coumadin. After developing bradycardia and atrioventricular (AV) block, he consulted electrophysiologist Eric R. Uyguanco at South Bay Cardiovascular, who recommended a pacemaker. Uyguanco advised stopping Coumadin four days pre-op due to bleeding risk and resuming after. On March 19, 2014, the pacemaker was placed without complication with an international normalized ratio (INR) of 1.2, and Coumadin was restarted. Days later, Young presented to Southside Hospital’s ER with chest pain, was evaluated by cardiologist Ganesh S. Kamath, admitted under hospitalist Jeetinder K. Gujral, and underwent a right ventricular lead revision on March 24. Both Kamath and Gujral recommended resuming Coumadin. On March 27, INR was 1.17; Gujral prescribed 5 mg Coumadin, but Young resumed his home 7.5 mg dose after discharge. On March 29, he returned to Southside with right leg pain and swelling; INR was 1.27 and DVT was diagnosed. Discharged to rehab on April 3, he returned on April 4 with left leg symptoms; INR was 4.71 and extensive left leg venous occlusions were found. Transferred to Stony Brook University Hospital, he underwent catheter-directed thrombolysis and then suffered a hemorrhagic stroke on April 10, dying on April 11, 2014. His wife, as executor, sued for medical malpractice, wrongful death, and lack of informed consent, alleging subtherapeutic anticoagulation and failures to ensure therapeutic INR at discharge caused the thrombotic events and death.
Lower Court Decision
The Supreme Court, Suffolk County, denied summary judgment to (1) Jeetinder K. Gujral and Southside Hospital on medical malpractice, wrongful death, loss of services, and Southside’s vicarious liability for Kamath; and (2) Ganesh S. Kamath and Eric R. Uyguanco on medical malpractice, wrongful death, loss of services, and lack of informed consent against Uyguanco.
Appellate Division Reversal
Modified on the law solely to grant summary judgment dismissing the lack of informed consent claim against Eric R. Uyguanco; otherwise affirmed. The court held both the Southside defendants and the South Bay defendants made prima facie showings on malpractice and causation, but plaintiff’s expert created triable issues by opining that defendants failed to ensure proper anticoagulation and therapeutic INR at discharge, contributing to DVT and death. On vicarious liability, although Kamath was not Southside’s employee, Southside did not establish prima facie that the decedent sought treatment from a privately selected physician rather than the hospital ER, so apparent agency/respondeat superior remained a triable issue. As to informed consent, documentary proof and expert affirmation established adequate disclosure and lack of proximate cause, and plaintiff failed to raise a triable issue.
Legal Significance
Reaffirms that conflicting expert opinions on standard of care and proximate cause preclude summary judgment in medical malpractice actions; clarifies that hospitals may face vicarious liability under apparent agency where ER patients seek treatment from the hospital rather than a privately chosen physician; and emphasizes the evidentiary showing needed to defeat a lack of informed consent claim where signed consent forms, records, and expert opinions demonstrate adequate disclosure. The derivative loss of services claim survives where underlying malpractice and wrongful death claims remain triable.
Except for dismissing the informed consent claim against the electrophysiologist, triable issues regarding peri-procedural anticoagulation and therapeutic INR management, as well as Southside Hospital’s potential ER-based vicarious liability for a non-employee cardiologist, required denial of summary judgment on malpractice, wrongful death, and derivative claims.