Case Title: In the Matter of George Infante v. Caroline R. Dignan. M.D.

Citation: 

Docket Number: 

State: new-york

Court: New York Appellate Court

Date: 2009-05-05T00:00:00Z

Document:
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This opinion is uncorrected and subject to revision before
publication in the New York Reports.
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No. 56  
In the Matter of George Infante, 
as Administrator of the Estate of 
Rosemary A. Infante, Deceased,
            Respondent, 
        v. 
Caroline R. Dignan, M.D., as 
Medical Examiner of Monroe County 
and Paul D. Gosnick, M.D., in his 
official capacity as Deputy 
Medical Examiner, 
            Appellants.
Howard A. Stark, for appellants.
Paul F. Stavis and Kenneth J. Doyle, for respondent.
Office of the Chief Medical Examiner of the City of New
York; Most Rev. Howard J. Hubbard, D.D., amici curiae.
READ, J.:
Because of the circumstances of decedent Rosemary A.
Infante's death on April 16, 2006, the Monroe County Office of
the Medical Examiner investigated its cause.  In an autopsy
report dated August 8, 2006, the medical examiner assigned to the
case, an experienced forensic pathologist, concluded that
decedent had died of multiple drug intoxication and that the
manner of her death was suicide.
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On December 8, 2006, petitioner George Infante,
decedent's father and the administrator of her estate, commenced
this CPLR article 78 proceeding, alleging that "th[e]
classification of decedent's death as a suicide [was] not based
upon any credible evidence and [was] simply speculation, and as
such the finding [was] arbitrary and capricious and/or an abuse
of discretion."  He sought a declaration that the manner of
decedent's death was unintentional or undetermined rather than
suicide.
On February 2, 2007, Supreme Court dismissed the
petition, adopting the reasoning of the Appellate Division's
decision in Matter of Mitchell v Helpern (17 AD2d 922 [1st Dept
1962], affd without opn 14 NY2d 817 [1964]), where a petitioner
likewise sought to compel a medical examiner to revise a death
certificate attributing death to suicide.  Quoting Mitchell, the
trial judge observed that "[w]hen the medical and other facts
could sustain different inferences, 'the determinations of the
Medical Examiners must be sustained as far as their entries on
the public record are concerned unless the determinations are
arbitrary'"; and that "'[a] public determination is arbitrary
when no reasonable man would be expected to make it.'"  Applying
these principles to the facts of the case, Supreme Court
acknowledged that "[a]n impartial evaluation of the medical and
factual circumstances . . . could result in differing conclusions
of the manner of death as an accident or cause unknown or
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suicide"; however, because "[t]here [was] sufficient information
on the record for a reasonable person to make the finding of
suicide," the medical examiner's "determination of the manner of
death as suicide . . . [was] not arbitrary."
On appeal, the Appellate Division, with two Justices
dissenting, reversed on the ground that "the evidence before [the
medical examiner] was insufficient to rebut the presumption
against suicide" (Matter of Infante v Dignan, 55 AD3d 1258, 1259
[4th Dept 2008]).  The majority recognized that the medical
examiner's "determination was based upon the autopsy and
toxicology report as well as information concerning the scene of
the death," but nonetheless concluded that "[t]he evidence from
which the determination was made failed to rebut the presumption
against suicide, and thus . . . [was] arbitrary and capricious"
(id. at 1261).
The two dissenting Justices would have applied the CPLR
article 78 standard of review unencumbered by any common-law
presumption.  As a result, although there were facts
"suggest[ing] that [the medical examiner's] determination of
suicide may well [have been] mistaken," his determination was not
"arbitrary or irrational" in their view (id. at 1263).  The
dissenting Justices found no authority indicating that the
presumption against suicide -- an evidentiary rule in litigation
involving life insurance claims -- was relevant where "a medical
examiner . . . discharg[ed] his or her administrative function of
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determining the means or manner of an unattended death" (id. at
1262 [quoting County Law § 674 [3] [a] [internal quotation marks
omitted]).  The double dissent on an issue of law brought the
case to us (see CPLR 5601 [a]), and we now reverse.
New York's common-law presumption against suicide has
no role to play in a medical examiner's determination of the
cause or manner of a decedent's death, or the judicial review of
such a determination (see e.g. Public Health Law § 4143 [3]
[directing medical examiner to certify whether a death from
external causes was "probably accidental, suicidal or homicidal"
(emphasis added)]).  The presumption is an evidentiary rule
relevant to resolving disputes over life insurance proceeds (see
Green v William Penn Life Ins. Co. of N.Y., _ NY3d _, 2009 NY
Slip Op _ [decided today]).  We have never considered the
presumption in any other context.
As a statutory matter, the County Law requires a
medical examiner to "determine the means or manner of death"
(County Law §§ 671, 674 [3] [a]) for the benefit of the public at
large rather than for the benefit of individuals, including a
decedent's family members (see e.g. Lauer v City of New York, 95
NY2d 95 [2000] [New York City Medical Examiner did not owe duty
of care to father of child whose death was wrongly attributed to
homicide]).  If medical examiners were forced to leaven their
decision-making with a common-law evidentiary presumption, the
medical and scientific quality of their work would be seriously
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compromised to the detriment of the citizenry.
In this case, there is evidentiary support for the
medical examiner's determination of suicide, although -- as every
judge who has reviewed the record has observed -- there is also
reason to believe that decedent may have accidentally overdosed
on prescription medication.  As was pointed out 45 years ago in
Mitchell, "[i]n . . . an arguable situation capable of sustaining
different inferences, the determinations of the Medical Examiners
must be sustained . . . unless [they] are arbitrary" (17 AD3d at
922).
  
Here, the medical examiner's determination was not
arbitrary.  He performed an autopsy, during which he removed
samples of decedent's heart blood, urine, liver, brain, and
gastric contents for comprehensive drug screen analysis.  The
results of this analysis, which were reported by an experienced
forensic toxicologist, disclosed an extremely high heart blood
concentration of the drug Fluoxetine (commercially known as
Prozac) -- a level 18 to 20 times higher than would be expected
with normal therapeutic usage.  In addition, the level of a
Fluoxetine metabolite in decedent's liver was comparatively high
in relation to the parent drug's level in her heart blood.  The
medical examiner characterized these autopsy and toxicological
findings as "most significant" in leading him to conclude that
decedent's manner of death was suicide.  In his opinion, these
levels and their ratio were consistent with intentional excessive
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consumption, but not chronic overusage or accidental overdose. 
In short, the medical examiner set forth a reasonable basis for
his determination in an area where administrative judgment
involves specialized medical and scientific expertise (see
generally Flacke v Onondaga Landfill Sys., 69 NY2d 355, 363
[1987] ["where . . . the judgment of the agency involves factual
evaluations in the area of the agency's expertise and is
supported by the record, such judgment must be accorded great
weight and judicial deference"]).
   
Accordingly, the order of the Appellate Division should 
be reversed, with costs, and Supreme Court's judgment reinstated.
*   *   *   *   *   *   *   *   *   *   *   *   *   *   *   *   * 
Order reversed, with costs, and judgment of Supreme Court, Monroe
County, reinstated.  Opinion by Judge Read.  Chief Judge Lippman
and Judges Ciparick, Smith, Pigott and Jones concur.  Judge
Graffeo took no part.
Decided May 5, 2009