Court Opinion

ID: 9954288
Source: CourtListenerOpinion
Date Created: 2024-03-25 21:10:29.501337+00
Date Added: 2024-06-11T08:12:03.417315
License: Public Domain

Lodato v New York City Health & Hosps. Corp.
               2024 NY Slip Op 30939(U)
                     March 20, 2024
             Supreme Court, Kings County
        Docket Number: Index No. 528154/2019
          Judge: Consuelo Mallafre Melendez
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  FILED: KINGS COUNTY CLERK 03/20/2024 01:00 PM                                                                 INDEX NO. 528154/2019
  NYSCEF DOC. NO. 116                                                                                   RECEIVED NYSCEF: 03/20/2024

                                                                               At an IAS Term, Part 7 of the Supreme Court of
                                                                               the State of NY, held in and for the County of
                                                                               Kings, at the Courthouse, at 360 Adams Street,
                                                                               Brooklyn, New York, on the 20th day of March
                                                                               2024.

            SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF
            KINGS
            --------------------------------------------------------------------------X
            VITO LODATO as the Administrator of the Estate of MARCO                             AMENDED
            LODATO, deceased,                                                                   DECISION & ORDER

                     Plaintiff,                                                                 Index No. 528154/2019
                                                                                                 Mo. Seq. 2 & 3
              -against-

            NEW YORK CITY HEALTH AND HOSPITALS
            CORPORATION, NYU LANGONE HOSPITALS, NYU
            LANGONE HEALTH SYSTEM and NYU LANGONE
            HOSPITAL-BROOKLYN,

                      Defendants.
            --------------------------------------------------------------------------X
            HON. CONSUELO MALLAFRE MELENDEZ, J.S.C.

            Recitation, as required by CPLR §2219 [a], of the papers considered in the review:
            NYSCEF #s: Seq. 2: 62 – 64, 65 – 86, 106, 107, 108 – 109
                       Seq. 3: 87 – 88, 89 – 102
                       Transcript of Oral Argument February 28, 2024

                     Defendant, NEW YORK CITY HEALTH AND HOSPITALS CORPORATION, moves

            this Court for an order pursuant to CPLR § 3212 granting summary judgment and directing entry

            of judgment to NEW YORK CITY HEALTH AND HOSPITALS CORPORATION (sequence 2).

            Plaintiff submitted opposition to this motion.

                     Defendants, NYU LANGONE HOSPITALS and NYU LANGONE HOSPITALS s/h/a

            “NYU LANGONE HOSPITAL-BROOKLYN” and NYU LANGONE HEALTH SYSTEM

            (hereinafter NYU Defendants), move this Court for an order pursuant to CPLR § 3212 granting

            summary judgment and dismissing the plaintiff’s claims in their entirety against NYU Defendants

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  FILED: KINGS COUNTY CLERK 03/20/2024 01:00 PM                                                   INDEX NO. 528154/2019
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            and directing entry of judgment to NYU Defendants (sequence 3). This motion is unopposed.

            Accordingly, the motion on behalf of NYU Defendants is granted without opposition, and all

            claims against NYU Defendants are dismissed.

                   This case involves treatment of Mr. Lodato at South Brooklyn Health, formerly known as

            Coney Island Hospital (hereinafter “NYCHHC”) during his hospitalization from January 28, 2019

            through to his discharge on February 7, 2019. Mr. Lodato was admitted to NYU Langone Hospital

            Brooklyn on February 8, 2024 less than 24 hours after he was discharged from Coney Island

            Hospital the day prior, where he was diagnosed with a gastrointestinal hemorrhage. At the time of

            his presentation to NYU, Mr. Lodato’s bleeding could not be controlled and he passed away the

            same day at that hospital. Plaintiff claims that Mr. Lodato’s personal injuries and death were due

            to NYCHHC’s negligent and improper treatment of the patient’s duodenal ulcer, NYCHHC’s

            failure to appreciate objective signs of a gastrointestinal bleed, and a premature discharge of the

            patient from their facility. Plaintiff also alleges NYCHHC: (1) failed to obtain surgical and

            interventional radiology consults following the EGD on January 31, 2019 to monitor a re-bleed;

            (2) failed to perform serial CBC’s on Mr. Lodato every 12 hours prior to discharge to monitor

            gastrointestinal bleeding and to diagnose a duodenal ulcer; and (3) failed to perform a repeat upper

            endoscopy to ensure the duodenal ulcer was appropriately treated.

                   “‘In order to establish the liability of a physician for medical malpractice, a plaintiff must

            prove that the physician deviated or departed from accepted community standards of practice, and

            that such departure was a proximate cause of the plaintiff's injuries [internal citations omitted].’”

            Hutchinson v. New York City Health and Hosps. Corp., 172 AD3d 1037, 1039 [2d Dept. 2019]

            citing Stukas v. Streiter, 83 AD3d 18, 23 [2d Dept. 2011]. “Thus, in moving for summary judgment,

            a physician defendant must establish, prima facie, ‘either that there was no departure or that any

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  FILED: KINGS COUNTY CLERK 03/20/2024 01:00 PM                                                    INDEX NO. 528154/2019
  NYSCEF DOC. NO. 116                                                                      RECEIVED NYSCEF: 03/20/2024

            departure was not a proximate cause of the plaintiff's injuries.’” Hutchinson, 132 AD3d at 1039,

            citing Lesniak v. Stockholm Obstetrics & Gynecological Servs., P.C., 132 AD3d 959, 960 [2d Dept.

            2015]. “Expert testimony is necessary to prove a deviation from accepted standards of medical

            care and to establish proximate cause [internal citations omitted].” Navarro v. Ortiz, 203 AD3d

            834, 836 [2d Dept 2022]. “‘When experts offer conflicting opinions, a credibility question is

            presented requiring a jury's resolution.’” Stewart v. North Shore University Hospital at Syosset,

            204 AD3d 858, 860 [2d Dept. 2022] citing Russell v. Garafalo, 189 A.D.3d 1100, 1102, [2d Dept.

            2020] [internal citations omitted]. However, “expert opinions that are conclusory, speculative, or

            unsupported by the record are insufficient to raise a triable issue of fact [internal citations

            omitted].” Wagner v. Parker, 172 AD3d 954, 966 [2d Dept. 2019].

                   Defendant NYCHHC’s expert, Arnon Lambroza, M.D., a physician board-certified in

            internal medicine and gastroenterology, established that they are qualified to opine as to the care

            and treatment rendered to the patient at South Brooklyn Health, formerly known as Coney Island

            Hospital. Plaintiff’s expert a physician board-certified in internal medicine and gastroenterology,

            established that they are qualified to opine as to the care and treatment rendered to the patient by

            defendants.

                   Defendant NYCHHC’s expert opines defendant’s plan to monitor the patient’s blood counts

            every 12 hours and to transfuse, if necessary, in order to keep hemoglobin levels above 8.0 and the

            platelets above 50,000; avoid antiplatelets, anticoagulation, and administration of NSAID was

            proper and appropriate to ensure there was no further bleeding. The expert opines that monitoring

            the blood levels for a possible bleed was the standard of care. Further, the expert opines the doctors

            and staff at Coney Island Hospital monitored the patient as they recorded the patient’s hemoglobin

            and hematocrit levels as stable, and their care plan was to continue current management.

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  FILED: KINGS COUNTY CLERK 03/20/2024 01:00 PM                                                      INDEX NO. 528154/2019
  NYSCEF DOC. NO. 116                                                                        RECEIVED NYSCEF: 03/20/2024

                    Dr. Lambroza also opines Mr. Lodato’s low hemoglobin and hematocrit levels on discharge

            from Coney Island Hospital on February 7, 2019 were stable for him as Mr. Lodato’s baseline

            hemoglobin and hematocrit levels were well below the reference ranges as noted in the records

            from NYU-Brooklyn from December 2013 to May 2018. Moreover, Dr. Lambroza notes the

            patient’s blood levels were tested on February 1, 2, 3, 4, 5, and 6, 2019 to monitor Mr. Lodato’s

            hematocrit and hemoglobin levels and opines that the CIH physicians and staff appropriately

            followed the decedent’s blood levels to ensure there was no further bleeding and the decedent’s

            blood levels stabilized and were trending upwards with no sign of a further bleed for those seven

            (7) days. Dr. Lambroza also opines Mr. Lodato did not have any signs or symptoms of an

            abdominal perforation while in the care of Coney Island Hospital. Defendant’s expert opines based

            on the foregoing it was appropriate to discharge Mr. Lodato on February 7, 2019.

                    Further, Dr. Lambroza opines a second look procedure was not necessary nor is it the

            standard of care in this case when there is no indication a patient is still bleeding. The expert opines

            a repeat upper endoscopy to ensure that the therapeutic approach employed (epinephrine injection,

            hemostatic clipping and cautery) effectively treated the duodenal ulcer prior to discharging Mr.

            Lodato is not the standard of care when the first EGD identified the source of the GI bleed, there

            was no active bleeding, and no fresh blood was found. Dr. Lambroza opines the patient had no

            indication of continued bleeding as there was no evidence of melena, no signs or symptoms

            consistent with a continued bleed, stable vital signs, and Mr. Lodato’s hemoglobin and hematocrit

            levels were trending upwards. Dr. Lambroza notes the EGD report identified “one non bleeding

            cratered duodenal ulcer in the duodenal bulb with a non-bleeding visible vessel (Forrest Class IIA

            ulcer).” Further, the expert opines based on the first EGD there were no other sources of upper GI

            bleeding. Therefore, Dr. Lambroza opines a second look procedure was inapplicable here.

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  FILED: KINGS COUNTY CLERK 03/20/2024 01:00 PM                                                     INDEX NO. 528154/2019
  NYSCEF DOC. NO. 116                                                                       RECEIVED NYSCEF: 03/20/2024

                   Based on the findings noted above, Dr. Lambroza opines none of the treatment rendered to

            Mr. Lodato at Coney Island Hospital from January 28, 2019 through February 7, 2019 was the

            proximate cause or a substantial factor in Mr. Lodato’s injuries or death.

                   Upon the opinions set forth by NYCHHC’s expert, Dr. Lambroza and the submissions in

            support of the motion, the court finds that the movants established their prima facie burden for

            summary judgment.

                   In opposition, Plaintiff’s expert opines a “non-bleeding visible vessel (Forrest IIA) requires

            endoscopic therapy as the first therapeutic course of treatment followed by consultation from

            interventional radiology and surgery for further definitive treatment”. The expert further opines

            “the presence of a visible vessel and its large ulcer size (30mm) suggested that there was a high

            probability of a re-bleed despite the therapy employed by Drs. Wagner and Trillo.” Plaintiff’s

            expert opines a surgical consult and interventional radiology consult were required for surgical

            definitive treatment in this instance as a re-bleed was likely with the large ulcer that had developed.

            The expert opines such failure to obtain a surgical and interventional radiology consultation for

            the patient following the performance of the EGD on January 31, 2019 was negligent and improper

            treatment of the duodenal ulcer and led to Mr. Lodato’s re-bleed and death on February 8, 2019.

            The expert opines had the consultation taken place, the severity of Mr. Lodato’s ulcer would have

            been appreciated to mitigate a re-bleed. Also, the expert opines Mr. Lodato had two ulcers and

            notes the chart has multiple entries identifying two ulcers, not only one.

                   Plaintiff’s expert also opines the standard of care “for patients who are diagnosed with a

            large duodenal ulcer with a visible vessel is to monitor the H&H (hemoglobin and hematocrit)

            every 12 hours while they remain hospitalized.” The expert elaborates on this by stating that the

            12-hour check of the H&H values can identify whether there is development of a gastrointestinal

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            bleed as abnormally low values would indicate bleeding. Plaintiff’s expert indicates that based on

            the MICU records on February 2, 2019, there was a GI recommendation to check CBC every 12

            hours. (NYSCEF Doc. 77, page 57). The expert opines that despite this order, Mr. Lodato’s CBC

            levels were taken every 24 hours and that this was a departure of the standard of care of the patient

            who was at high risk of a re-bleed. Specifically, the Coney Island Hospital record notes the last

            CBC was collected on February 6, 2019 at 9:56am and that Mr. Lodato was discharged on February

            7, 2019 at 13:13. (NYSCEF Doc. 79, page 243; Doc. 77, page 2). Plaintiff’s expert states that this

            record shows that the last H&H lab value was taken more than 12 hours since the last CBC

            collection. The expert opines that this indicates the defendants did not comply with the GI

            recommendation that CBC values be checked every 12 hours. Significantly, Plaintiff’s expert also

            notes that the record indicates that on Mr. Lodato’s last day of admission on February 7, 2019, his

            CBC was not tested. Thus, he opines that not checking the patient’s H&H levels before discharge

            is another departure from the accepted standard of care and such failure was a factor in causing the

            patient’s bleed and death.

                   Additionally, the expert opines Mr. Lodato’s H&H values were abnormally low when

            collected after the procedure and if a CBC had been taken on February 7, 2019, the results would

            have been low enough to investigate a gastrointestinal bleeding source and the diagnosis of the

            duodenal ulcer would have been made prior to the ulcer’s erosion which resulted in a hemorrhage

            and the patient’s death. The expert notes Mr. Lodato’s hemoglobin and hematocrit levels were

            abnormal throughout Mr. Lodato’s hospitalization at Coney Island Hospital and this alone is

            objective evidence of a possible bleed. Furthermore, the expert opines had an investigation into

            gastrointestinal bleeding been made prior to his discharge Mr. Lodato could have undergone

            endovascular angiography or surgical intervention to treat the duodenal ulcer to prevent erosion of

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            the ulcer, a massive hemorrhage, and Mr. Lodato’s death. Thus, Plaintiff’s expert opines Mr.

            Lodato was prematurely and negligently discharged.

                   Plaintiff’s expert opines defendant’s failure to repeat an upper endoscopy to ensure that the

            endoscopic therapeutic treatment was effective in treating the ulcer with a visible vessel constituted

            a departure from accepted standard of care and was a substantial contributing factor to Mr. Lodato’s

            demise. The expert opines the signs of erosion to the muscle layer would take days to progress and

            a second endoscopy would have revealed endoscopically the gravity of Mr. Lodato’s condition

            before the ulcer perforated which caused the uncontrollable bleed that led to Mr. Lodato’s death.

            Plaintiff’s expert supports this opinion on the basis that 24 hours after plaintiff was discharged

            from Coney Island Hospital an emergent EGD at NYU found the same duodenal ulcer had eroded

            down to the muscle layer of the duodenum and there was questionable full thickness defect

            adjacent to a large and pulsating vessel.

                   Additionally,    plaintiff’s   expert   opines    that   another   departure   was   that   the

            gastroenterologists did not examine Mr. Lodato after February 1, 2019, and further, that he was

            discharged on February 7, 2019, not being examined by them. The expert also opines that Mr.

            Lodato was treated in the first instance in part because of maroon-colored stools on clinical exams

            and yet, after the first EGD the patient’s stool was not evaluated for indications of blood. The

            expert opines evaluation of the patient’s stool for blood would indicate a re-bleed. Based on the

            foregoing, plaintiff’s expert opines NYCHHC had no objective evidence the endoscopic therapy

            was effective in treating the duodenal ulcer with a visible vessel and opines that not performing a

            second upper endoscopy prior to discharging Mr. Lodato was a departure from the accepted

            standard of care as it would have revealed the procedure was ineffective and would have prevented

            the patient’s massive hemorrhage and death.

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                   As discussed above, the expert opines in detail that these failures were substantial factors

            in causing Mr. Lodato’s injuries and death.

                   Through the plaintiff’s expert’s affirmation, which is very detailed and non-speculative,

            issues of fact are raised as to defendant NYCHHC’s liability and proximate cause of plaintiff’s

            injuries and death. Plaintiff’s expert raises an issue of fact with his opinion that a surgical consult

            and interventional radiology consult were required to comport with the standard of care as Mr.

            Lodato was at high risk of a re-bleed due to the Forest IIA ulcer found, which in his opinion has a

            high-risk bleeding recurrence. It is noted that defendant’s expert, Dr. Lambroza does not opine on

            whether a surgical and interventional radiology consultation was the standard of care. On this

            question, Defendant’s expert opines the standard of care was only to monitor the H&H levels which

            in this case were found to be stable and determined the continued course of treatment was to

            continue current management.

                   Assuming the standard of care was only to monitor the H&H levels, plaintiff’s expert

            indicates there are no records to support that Mr. Lodato’s CBC levels were checked every 12

            hours. Plaintiff’s expert opines the 12-hour monitoring would have identified a possible bleed and

            diagnosed a duodenal ulcer prior to discharging Mr. Lodato on February 7, 2019 and would have

            prevented Mr. Lodato’s death. Dr. Lambroza does not opine specifically on whether the standard

            of care was to monitor the CBC levels every 12 hours or whether those levels could be tested more

            infrequently. This alone would be a departure from the standard of care and therefore constitutes

            an issue of fact. Further, Dr. Lambroza’s opinion that NYCHHC discharged Mr. Lodato with below

            H&H levels stating that it was his baseline based on medical records from 2013 to 2018 is a

            retrospective analysis as Defendant NYCHHC did not have records of CBC lab values from 2013

            to 2018 to form their opinion when they discharged Mr. Lodato on February 7, 2019.

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                   Plaintiff’s expert also refutes Dr. Lambroza’s conclusion that the second endoscopy was

            not necessary or the standard of care as they opine that a repeat upper endoscopy remains the

            standard of care, and that had it been performed prior to Mr. Lodato’s discharge on February 7,

            2019 the procedure would have revealed a duodenal ulcer with a visible vessel. Based on the

            medical evidence in this case, Plaintiff’s expert’s opinion that the therapeutic approach treatment

            given to Mr. Lodato on January 31, 2019 by Drs. Tillo and Wagner was ineffective contradicts that

            submitted by Dr. Lambroza. There are also contradicting opinions as to whether the second

            endoscopy is the standard of care to identify signs of erosion of the ulcer prior to it perforating the

            muscle layer and causing his hemorrhage and death.

                   Based on the above, the court finds that Plaintiff’s expert’s opinions are well based on the

            facts and raise issues of fact as to whether the moving defendant departed from the standard of

            care and whether these departures were a substantial factor in causing the injuries and death to the

            decedent. Considering the foregoing conflicting opinions, which are detailed and not speculative,

            summary judgment is denied as all claims sounding in medical malpractice relating to defendants

            NYCHHC. “In order not to be considered speculative or conclusory, expert opinions in opposition

            should address specific assertions made by the movant's experts, setting forth an explanation of

            the reasoning and relying on specifically cited evidence in the record”. McHale v. Sweet, 217 AD3d

            666, 668 [2d Dept 2023] quoting Templeton v. Papathomas, 208 A.D.3d 1268, 1270 – 1271 [2d

            Dept 2022][internal quotation marks omitted]; see also Tristan v. New York Community Hosp., 154

            A.D.3d 994, 996 [2017]. “Summary judgment is not appropriate in a medical malpractice action

            where, as here, the parties adduce conflicting medical expert opinions. ‘Such credibility issues can

            only be resolved by a jury.’” Castillo v. Surasi, 181 AD3d 786, 788 -789 [2d Dept 2020], citing

            Feinberg v. Feit, 23 A.D.3d 517, 519 [2d Dept. 2005].

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  FILED: KINGS COUNTY CLERK 03/20/2024 01:00 PM                                                 INDEX NO. 528154/2019
  NYSCEF DOC. NO. 116                                                                     RECEIVED NYSCEF: 03/20/2024

                   In reference to the claim of lack of informed consent, Defendant NYCHHC established

            their prima facie entitlement to summary judgment through their expert’s affirmation, which is

            detailed and non-speculative. However, Plaintiff’s expert does not mention the claim of informed

            consent in their affirmation and it is therefore, unopposed. As such, the motion for summary

            judgment on this cause of action must be granted. “Where a party fails to oppose some or all

            matters advanced on a motion for summary judgment, the facts as alleged in the movant's papers

            may be deemed admitted as there is, in effect, a concession that no question of fact exists.” 144

            Woodbury Realty, LLC v. 10 Bethpage Rd., LLC, 178 A.D.3d 757, 761-62 [2d Dept 2019].

                   Accordingly, NYU Defendants’ motion for Summary Judgment is GRANTED; and

            NYCHHC Defendant’s motion for Summary Judgment is GRANTED ONLY TO THE EXTENT

            that Informed Consent is dismissed; and it is DENIED in all other respects.

                   The Clerk is directed to enter judgment in favor of NYU LANGONE HOSPITALS and

            NYU LANGONE HOSPITALS s/h/a “NYU LANGONE HOSPITAL-BROOKLYN”, and NYU

            LANGONE HEALTH SYSTEM.

                   This constitutes the decision and order of the court.

                                                                 ENTER.

                                                                 _______________________________
                                                                  Hon. Consuelo Mallafre Melendez
                                                                               J.S.C.

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