Court Opinion

ID: 9954315
Source: CourtListenerOpinion
Date Created: 2024-03-25 21:11:13.104197+00
Date Added: 2024-06-11T08:12:04.937614
License: Public Domain

Cox v Kerr
               2024 NY Slip Op 30936(U)
                     March 19, 2024
             Supreme Court, Kings County
        Docket Number: Index No. 518088/2018
          Judge: Consuelo Mallafre Melendez
Cases posted with a "30000" identifier, i.e., 2013 NY Slip
 Op 30001(U), are republished from various New York
 State and local government sources, including the New
  York State Unified Court System's eCourts Service.
 This opinion is uncorrected and not selected for official
                       publication.
  FILED: KINGS COUNTY CLERK 03/20/2024 01:01 PM                                                            INDEX NO. 518088/2018
  NYSCEF DOC. NO. 191                                                                              RECEIVED NYSCEF: 03/20/2024

                                                                          At an IAS Term, Part 15 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 19th day of March
                                                                          2024.

            SUPREME COURT OF THE STATE OF NEW YORK
            COUNTY OF KINGS
            --------------------------------------------------------------------------X
            NYESHA N. COX, as the Administrator for the Estate of                          DECISION & ORDER
            GEORGIE A. BARNEY, deceased,
                                                                                           Index No. 518088/2018
                      Plaintiff,                                                            Mo. Seq. 3, 4, & 5

              -against-

            SHELLINE C. KERR, F.N.P., KATHLEEN EDOUARD, M.D.,
            MARIE F. SCHMIDT, M.D., NWOSU NGOFA, M.D.,
            RATESH KHILLAN, M.D., MIRELA SAM, M.D., SREEDEVI
            RAMAKRISHNAIAH, M.D., MOHAMED MANSOUR, M.D.,
            WILLIAM TURSI, M.D., MADHVI RANA, M.D., THOMAS J.
            FORLENZA, M.D., LUCIA PALLADINO, M.D., AZZA
            ELEMAM, M.D., KEITH DIAZ, M.D., INTERFAITH
            MEDICAL CENTER AND RICHMOND UNIVERSITY
            MEDICAL CENTER,

                      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. 3: 120 – 122, 124 – 148
                          Seq. 4: 149 – 152, 153 – 176, 183 – 184, 185, 186
                          Seq. 5: 177 – 178, 179, 180, 181 – 182

                      Defendants Mirela Sam, M.D., and Azza Elemam, M.D. move for an order granting

            summary judgment in their favor dismissing the complaint pursuant to CPLR §3212 (Seq. No.

            3). Plaintiff does not oppose the motions of Mirela Sam, M.D., and Azza Elemam, M.D (Seq.

            No. 3).

                      Defendants Shelline C. Kerr, F.N.P., Kathleen Edouard, M.D., Marie F. Schmidt, M.D.,

            Sreedevi Ramakrishnaiah, M.D., and Nwosu Ngofa, M.D., and Interfaith Medical Center move

            for an order granting summary judgment in their favor dismissing the complaint pursuant to

                                                                    1

                                                                1 of 22
[* 1]
  FILED: KINGS COUNTY CLERK 03/20/2024 01:01 PM                                                  INDEX NO. 518088/2018
  NYSCEF DOC. NO. 191                                                                    RECEIVED NYSCEF: 03/20/2024

            CPLR §3212 (Seq. No. 4). Plaintiff opposes the motion of Interfaith Medical Center, Shelline C.

            Kerr, F.N.P, and Kathleen Edouard, M.D., but does not oppose that branch of the motion seeking

            summary judgment in favor of Marie F. Schmidt, M.D., Sreedevi Ramakrishnaiah, M.D., and

            Nwosu Ngofa, M.D.

                    Defendants William Tursi, M.D., Madhvi Rana, M.D., Thomas J. Forlenza, M.D., Lucia

            Palladino, M.D., Keith Diaz, M.D., and Richmond University Medical Center move for an order

            granting summary judgment in their favor dismissing the complaint as to these defendants

            pursuant to CPLR §3212 (Seq. No. 5). No opposition was submitted in response to the motion of

            William Tursi, M.D., Madhvi Rana, M.D., Thomas J. Forlenza, M.D., Lucia Palladino, M.D.,

            Keith Diaz, M.D., and Richmond University Medical Center (Seq. No. 5).

                    As a preliminary matter, referring to movants’ argument that as Plaintiff did not timely

            file the Affirmation in Opposition to this motion it should not be considered, the court excuses

            the untimeliness of the Affirmation in Opposition to this motion. The untimely submission has

            not prejudiced the movants, and if Plaintiff would have requested a further adjournment to file

            opposition, the court would have granted it.

                    This action is brought by Nyesha N. Cox, Plaintiff-administrator, on behalf of Georgie A.

            Barney (“Mr. Barney,” deceased) for alleged acts of malpractice by defendants associated with

            Interfaith Medical Center. Mr. Barney was treated by defendants Shelline C. Kerr, F.N.P. (“Nurse

            Kerr”), and Kathleen Edouard, M.D. (“Dr. Edouard”) at defendant-facility Interfaith Medical

            Center (“IMC”) on or about August 20, 2016, and on or about August 25, 2016 to August 26,

            2016.

                    Plaintiff alleges that movants Nurse Kerr, Dr. Edouard, and Interfaith Medical Center

            were negligent in failing to properly formulate a complete differential diagnosis in view of Mr.

            Barney’s complaints of constipation, lower back pain, and leg cramping; in negligently

                                                              2

                                                           2 of 22
[* 2]
  FILED: KINGS COUNTY CLERK 03/20/2024 01:01 PM                                                   INDEX NO. 518088/2018
  NYSCEF DOC. NO. 191                                                                     RECEIVED NYSCEF: 03/20/2024

            discharging Mr. Barney without performing a complete work-up in view of his complaints; in

            failing to order tests such as an abdominal x-ray, hematology, chemistry, HIV (human

            immunodeficiency virus) testing, and abdominal CT; in failing to call for consults such as

            gastroenterology; in negligently attributing Mr. Barney’s back pain to a disc bulge; in failing to

            obtain Mr. Barney’s complete medical and social history; in failing to take heed of Mr. Barney’s

            medical and social history; in failing to take into account Mr. Barney’s sexual orientation as part

            of his medical history; in failing to recommend to Mr. Barney testing for HIV; and in failing to

            admit Mr. Barney for treatment and observation. Plaintiff claims that as a result of Defendants’

            negligent acts and omissions, Mr. Barney died on September 28, 2016 due to the complications

            arising from the treatment rendered while under the care of Nurse Kerr, Dr. Edouard, and

            Interfaith Medical Center.

                    Plaintiff also asserts claims for negligent hiring and lack of informed consent, which are

            also the subject of this summary judgment motion.

                    Defendants now move for summary judgment, contending that their experts’ testimony

            demonstrates that their treatment of the decedent was within the standard of care, and it could not

            have been the cause of his injuries and wrongful death, and that plaintiff has not sufficiently

            rebutted their contention to create a triable issue of fact.

                    On August 20, 2016, at 4:48am, Mr. Georgie A. Barney presented to the Emergency

            Room (“ER”) at Interfaith Medical Center with "severe back pains that shoot down to my legs

            causing to cramp up (sic). Have not used the bathroom in 2 days." Mr. Barney was assigned an

            ESI Triage Level of 4 by Geosenelle Cayo, R.N. at 5:50 a.m., who noted chief complaint of

            "lower back pain x 1 week associated with leg cramping-patient also c[omplains] o[f]

            constipation. He denied p[ast] m[edical] h[istory]." His temperature was normal at 97.1°F and

                                                               3

                                                           3 of 22
[* 3]
  FILED: KINGS COUNTY CLERK 03/20/2024 01:01 PM                                                  INDEX NO. 518088/2018
  NYSCEF DOC. NO. 191                                                                   RECEIVED NYSCEF: 03/20/2024

            his blood pressure was 151/88. Mr. Barney told Nurse Cayo that he had previously tested

            Negative for HIV, and he declined an HIV test during his August 20, 2016 ER visit.

                   Mr. Barney was seen at around 7:25am by Defendant Shelline C. Kerr F.N.P. (“Nurse

            Kerr”). Nurse Kerr authored an ED Physician Documentation. Mr. Barney's stated complaint was

            "back pain, cramps and bathroom problems." Mr. Barney denied any past medical history. Under

            the heading History of Present Illness, Nurse Kerr wrote that Mr. Barney denied nausea,

            vomiting, diarrhea, chest pain and paresthesia. Nurse Kerr performed a physical examination and

            noted that Mr. Barney's neck had a full range of motion and was non-tender. There were no

            abnormal findings regarding the patient's neck, including the lymph nodes. Nurse Kerr's

            assessment was "Lower back pain ... patient has problems sitting erect, tenderness on palpation

            to lower back, r[ange] o[f] m[otion] limited, back symmetrical no swelling, no redness." Nurse

            Kerr also noted that none of Mr. Barney's organs were enlarged, his abdomen was non-tender and

            soft, and the bowel sounds were normal.

                   Nurse Kerr ordered a CT scan of the lumbar spine and pain management medications,

            including Toradol, a nonsteroidal anti-inflammatory medication, and Robax, a muscle relaxant.

            The CT scan revealed a "[m]ild concentric disc bulge at L5-S1," and ruled out stenosis, nerve

            root impingement and an aortic dissection. Nurse Kerr informed Mr. Barney of the results of the

            CT scan, recommended that he include more fiber and water in his diet, and advised him to take

            a laxative if his bowel movement did not return. Mr. Barney was given a prescription for Mobic,

            a nonsteroidal anti-inflammatory drug. It was noted that an HIV test was not done as he had

            declined to take one. Mr. Barney was given instructions to follow-up with his primary care

            physician but to return to the ER in an emergency, and Mr. Barney said that he understood these

            instructions. Mr. Barney was discharged home on August 20, 2016, at 1:29pm.

                                                            4

                                                        4 of 22
[* 4]
  FILED: KINGS COUNTY CLERK 03/20/2024 01:01 PM                                                  INDEX NO. 518088/2018
  NYSCEF DOC. NO. 191                                                                    RECEIVED NYSCEF: 03/20/2024

                   Consistent with the substance of the other notes in the record, Nurse Kerr wrote an

            addendum note six days later, which documented the patient’s complaint of lower back pain

            radiating to hips and thighs for one week worsening prior to visit (9/10 on pain scale), and an

            inability to move bowels as usual for two days. Nurse Kerr testified that she was not aware of

            Mr. Barney's sexual orientation, and she did not ask him because the inquiry was not related to

            his care and would not have altered her treatment of Mr. Barney during the August 20, 2016 ER

            presentation.

                   On August 25, 2016, at 11:51pm, Mr. Barney arrived at Interfaith Medical Center for

            emergency medical care. At 12:06am on August 26, 2016, Daphne Collier, R.N., noted the

            following, “I am having chest pressure since couple of hours and getting wors[e]. Patient stated

            that he did not have a BM since last Friday. [D]enies vomiting.” Mr. Barney was assigned an ESI

            Triage Level of 3. His blood pressure was elevated at 189/106. Nurse Collier had an EKG

            performed, which showed a normal sinus rhythm, and his temperature was normal at 98.9°F. Mr.

            Barney told Nurse Collier that he had previously tested Negative for HIV, and he also declined

            an HIV test during his visit on August 26, 2016.

                   Mr. Barney was seen by Kathleen Edouard, M.D. (“Dr. Edouard”) on August 26, 2016, at

            12:20am. Dr. Edouard authored an ED Physician Documentation that noted Mr. Barney’s

            complaints of non-radiating “pain involving all chest area for a few days” and constipation. The

            chest pain was reproducible by deep breathing, meaning the pain was the same when the patient

            breathed. Dr. Edouard noted that Mr. Barney did not feel bloated and had no abdominal pain. Dr.

            Edouard asked Mr. Barney about his past medical history and Mr. Barney told Dr. Edouard that

            he did not have HIV or AIDS.

                   Dr. Edouard performed a physical examination and noted that Mr. Barney’s neck had a

            full range of motion and was non-tender. She also noted that none of Mr. Barney's organs were

                                                               5

                                                         5 of 22
[* 5]
  FILED: KINGS COUNTY CLERK 03/20/2024 01:01 PM                                                       INDEX NO. 518088/2018
  NYSCEF DOC. NO. 191                                                                           RECEIVED NYSCEF: 03/20/2024

            enlarged, and his abdomen was non-tender and soft, and the bowel sounds were normal. At 1:00

            a.m., Rose Dieuveuille Jean Jacques, RN wrote that Mr. Barney was stable and had no

            complaints of nausea or vomiting but that he said his abdominal pain persisted. Nurse

            Dieuveuille wrote at 1:30 a.m. that blood work, chest x-ray, and pain medicine were tolerated,

            and the patient was awaiting reevaluation. She did not mention abdominal pain.

                   Dr. Edouard’s plan of care included electrocardiogram (ECG); x-ray of the chest; blood

            work consisting of complete blood count (CBC), comprehensive metabolic panel (CMP), and

            troponin level due to Mr. Barney’s complaints of chest pain. Dr. Edouard ordered an abdominal

            x-ray, lactulose, and a fleet enema for constipation. Dr. Edouard ordered the urinalysis; urine

            toxicology screen; and urine microscopic examination to see if there were any illicit drugs

            involved in the presentation, as is done with any patient who presents with chest or abdominal

            pain, and not as a result of any aspect of the patient's presentation or history.

                   At 3:00 a.m., Dr. Edouard reviewed the laboratory results. She noted that the abdominal

            x-ray showed moderate gaseous distention of multiple large bowel loops and moderate amount of

            stool involving the colon. She also noted that the chest x-ray was “normal,” and the ECG showed

            left ventricular hypertrophy. Further, she noted three complaints: chest wall pain, constipation;

            and abdominal pain. The presenting symptoms confirmed that the patient did not have an acute

            infection. Mr. Barney's Blood Urea Nitrogen was normal at 14mg/dL. Mr. Barney's Creatinine

            was normal at 0.7mg/dL. The abdominal x-ray showed no evidence of small bowel obstruction,

            moderate gaseous distention of multiple large bowel loops, and a moderate amount of stool

            involving the colon. The chest x-ray was normal.

                   At 4:00 a.m., Dr. Edouard saw Mr. Barney and wrote that he had a bowel movement and

            felt much better. Dr. Edouard reviewed the results of the CBC and urinalysis at the time of

            discharge. Mr. Barney’s CBC showed an elevated white blood count (WBC) of 14.2 (normal 4.5-

                                                               6

                                                           6 of 22
[* 6]
  FILED: KINGS COUNTY CLERK 03/20/2024 01:01 PM                                                    INDEX NO. 518088/2018
  NYSCEF DOC. NO. 191                                                                      RECEIVED NYSCEF: 03/20/2024

            11); decreased red blood cell count (RBC) of 3.80 (normal 4.5-5.9); decreased hemoglobin of

            11.7 (normal 13.5-17.5); decreased hematocrit of 35.5 (normal 41-53); and low platelet count of

            104 (normal 130-400). The CMP showed elevated alkaline phosphatase of 121 (normal 32-91);

            and elevated aspartate aminotransferase of 64 (normal 15-41). The troponin level was not

            elevated.

                   Nurse Dieuveuille wrote at 4:00 a.m. that the patient stated that he moved his bowels a

            tiny bit after receiving his medications, but she did not mention abdominal pain. She noted that

            Mr. Barney was encouraged to drink plenty of water as per the doctor's advice, and that the

            patient verbalized his understanding.

                   At the time of discharge, Mr. Barney's blood pressure was 162/98. Dr. Edouard testified

            that this was a significant decrease from the initial presentation and further outpatient testing

            could be done to determine if the patient needed long-term treatment for his blood pressure. The

            hospital record notes that Mr. Barney declined to be tested for HIV. Dr. Edouard ruled out the

            pain as cardiac and prescribed Acetaminophen and Miralax with further workup to be done on an

            outpatient basis. Mr. Barney was discharged home on August 26, 2016 at 4:26 a.m. in stable

            condition with instructions to follow up at the Bishop Walker Clinic.

                   Mr. Barney returned to Interfaith Medical Center for emergency care later on August 26,

            2016 at 8:11pm, where he wrote in his Emergency Medicine Patient Questionnaire Form, "Can't

            use the bathroom for a week bleeding came to the E.R. last night by ambulance." Mr. Barney was

            received in the ER on August 26, 2016 at 8:16 p.m. with his chief complaint being "blood in

            stool". The triage nurse, Keisandra Griffith, R.N., wrote "p[atient]t seen yesterday for

            abd[ominal] pain & constipation, tx and dx. [Patien]t states today the pain has returned and now

            he is having blood in stool. [Patien]t sent home with polyethylene gycol and RA tylenol. denies

            hx." His temperature was 99.8°F and his blood pressure was 157/109. For the fourth time, Mr.

                                                              7

                                                          7 of 22
[* 7]
  FILED: KINGS COUNTY CLERK 03/20/2024 01:01 PM                                                   INDEX NO. 518088/2018
  NYSCEF DOC. NO. 191                                                                     RECEIVED NYSCEF: 03/20/2024

            Barney advised that he had been tested for HIV and was negative. For at least the third time, Mr.

            Barney declined to be tested for HIV. Mr. Barney was assigned an ESI Triage Level of 4.

                   Mr. Barney was seen by an ER doctor on August 26, 2016 at 8:45 p.m. The ER physician

            wrote "36 year old who presents with a complaint of generalized abdominal pain and

            constipation for the past week. Was actually seen in the er 2 times before this past week. first

            time had mostly back pain and had a ct of the spine, which showed a disc bulge. seen yesterday

            for mostly abdominal pain, which he thought was related to constipation. Xray showed moderate

            stool. [Patien]t had several laxatives and an enema but only brown water came out. pain

            continues today and now feels it going up into his chest. sob and splinting noted with breathing.

            no fever or chills noted[.]"

                   On August 27, 2016 at 2:07 a.m., Mr. Barney was admitted to Interfaith Medical Center.

            A surgical consult took place on August 27, 2016 at 2:13 a.m. and generalized lymphadenopathy

            was noted. The patient remained at Interfaith Medical Center until September 3, 2016, when he

            transferred to Richmond University Medical Center. On September 28, 2016, Mr. Barney expired

            with diffuse large B cell lymphoma (“DLBCL”) noted as the preliminary cause of death. No

            claims are asserted as to this admission to defendant Interfaith Medical Center.

                   Generally, “[i]n determining a motion for summary judgment, the court must view the

            evidence in the light most favorable to the nonmoving party.” Stukas v. Streiter, 83 A.D.3d 18, 23

            [2nd Dept. 2011]. “Thus, in moving for summary judgment, a physician defendant must

            establish, prima facie, ‘either that there was no departure or that any departure was not a

            proximate cause of the plaintiff's injuries.’ ” Hutchinson v. New York City Health and Hosps.

            Corp., 172 A.D.3d 1037, 1039 [2d Dept. 2019], citing Lesniak v. Stockholm Obstetrics &

            Gynecological Servs., P.C., 132 A.D.3d 959, 960 [2d Dept. 2015].

                                                             8

                                                         8 of 22
[* 8]
  FILED: KINGS COUNTY CLERK 03/20/2024 01:01 PM                                                    INDEX NO. 518088/2018
  NYSCEF DOC. NO. 191                                                                      RECEIVED NYSCEF: 03/20/2024

                   “In a medical malpractice action, a plaintiff, in opposition to a defendant physician's

            summary judgment motion, must submit evidentiary facts or materials to rebut the prima facie

            showing by the defendant physician that he was not negligent in treating plaintiff so as to

            demonstrate the existence of a triable issue of fact.” Stukas v. Streiter, 83 A.D.3d 18, 23 [2nd

            Dept. 2011]. “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

            A.D.3d 834, 836 [2d Dept. 2022]. “When experts offer conflicting opinions, a credibility

            question is presented requiring a jury's resolution [internal citations omitted].” Stewart v. North

            Shore University Hospital at Syosset, 204 A.D.3d 858, 860 [2d Dept. 2022] citing Russell v.

            Garafalo, 189 A.D.3d 1100, 1102, [2d Dept. 2020]. “Any conflicts in the testimony merely raise

            an issue of fact for the factfinder to resolve.” Palmiero v. Luchs, 202 A.D.3d 989, 992 [2d Dept

            2022], citing Lavi v. NYU Hosps. Ctr., 133 A.D.3d 830, 832 [2d Dept. 2015]. 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 A.D.3d 954, 966 [2d

            Dept. 2019].

                   In support of their motion seeking summary judgment on behalf of Nurse Kerr, Dr.

            Edouard, and Interfaith Medical Center, defendants submit an expert affirmation from Andy S.

            Jagoda, M.D., a physician board certified in Internal Medicine and Emergency Medicine and a

            Diplomate of the National Board of Medicine Examiners. Dr. Jagoda received a medical degree

            from Georgetown University School of Medicine and performed an internship in Internal

            Medicine at Bethesda Naval Hospital, where he later became the General Medical Officer. Dr.

            Jagoda performed a Residency at the Georgetown/George Washington University Hospital

            Combined Training Program in Emergency Medicine. Dr. Jagoda is Chair Emeritus, Department

            of Emergency Medicine and Chief Academic Officer, Mount Sinai Emergency Medicine System.

                                                              9

                                                          9 of 22
[* 9]
  FILED: KINGS COUNTY CLERK 03/20/2024 01:01 PM                                                  INDEX NO. 518088/2018
  NYSCEF DOC. NO. 191                                                                     RECEIVED NYSCEF: 03/20/2024

            Dr. Jagoda held the position of System Chair of Emergency Medicine for the Mount Sinai Health

            System and was Chair of the Department of Emergency Medicine at the Icahn School of

            Medicine at Mount Sinai, where he is also a Tenured Professor. Based on his education, training,

            and experience, Dr. Jagoda opines that the care provided by the defendants Kerr, Edouard, and

            Interfaith Medical Center during the August 20, 2016 and August 25-26, 2016 Emergency

            Department presentations was within and even exceeded the relevant standard of care in their

            treatment of the decedent.

                   Dr. Jagoda opines that the decedent was properly and completely worked-up by Nurse

            Kerr, Dr. Edouard, and IMC during the August 20, 2016 and August 25-26, 2016 Emergency

            Department presentations. Dr. Jagoda opines that proper diagnoses were made, complaints were

            properly addressed, discharge was appropriate, all necessary tests were performed, consults were

            not needed, and necessary medical and social history was obtained. Dr. Jagoda opines that

            Decedent’s sexual orientation had no bearing on the care provided, HIV testing was offered and

            declined, and there was no basis to admit the Decedent to the facility.

                   As to Nurse Kerr, Dr. Jagoda states that defendant Kerr testified that she was not aware of

            Mr. Barney’s sexual orientation and that had she known Mr. Barney was homosexual, it would

            not have altered the care she provided. Dr. Jagoda opines that this is proper and correct, and to do

            otherwise would have constituted a deviation. Mr. Barney told the nurse that he had been

            previously tested for HIV and that his results were negative. Dr. Jagoda opines that because Mr.

            Barney declined an HIV test during his August 20, 2016 ED visit, it was proper for Nurse Kerr to

            not inquire further about Mr. Barney’s HIV status.

                   Dr. Jagoda goes on to opine that it was also proper for Nurse Kerr to assign an ESI Triage

            Level of 4 to the patient, given his complaints. The defendant’s expert opines that Nurse Kerr

            performed a complete and adequate physical examination, authored an ED Physician

                                                            10

                                                        10 of 22
[* 10]
  FILED: KINGS COUNTY CLERK 03/20/2024 01:01 PM                                                 INDEX NO. 518088/2018
  NYSCEF DOC. NO. 191                                                                    RECEIVED NYSCEF: 03/20/2024

            Documentation, where she properly noted Mr. Barney’s Stated Complaint of “back pain, cramps

            and bathroom problems,” and noted that Mr. Barney denied nausea, vomiting, diarrhea, chest

            pain and paresthesia. Dr. Jagoda noted that Mr. Barney’s neck had a full range of motion and was

            non-tender, no abnormal findings regarding the patient’s neck were palpated, including the

            lymph nodes. Dr. Jagoda indicates that as part of Nurse Kerr’s physical examination of the

            patient, she noted that none of Mr. Barney’s organs were enlarged, and his abdomen was

            nontender and soft, and the bowel sounds were normal, and that the decedent was appropriately

            asked and denied any past medical history, which would have included any history of kidney

            problems. Dr. Jagoda opines that Nurse Kerr conducted a thorough and necessary physical

            examination of the patient.

                   Dr. Jagoda opines that Nurse Kerr’s assessment of “Lower back pain ... patient has

            problems sitting erect, tenderness on palpation to lower back, r[ange] o[f] m[otion] limited, back

            symmetrical. no swelling, no redness” was correct. Dr. Jagoda opines that Nurse Kerr

            implemented a proper plan of care of pain management and a CT scan of the lumbar spine. Dr.

            Jagoda opines that it was an appropriate plan for Nurse Kerr to order Toradol, a nonsteroidal

            anti-inflammatory medication, and Robax, a muscle relaxant for pain, and a CT scan of the

            lumbar spine, given the patient’s complaints and presentation. Dr. Jagoda opines that it would

            have been inappropriate to order an abdominal x-ray at this time because there were no signs of

            an abdominal mass or related complaints, there were no complaints that gave rise to the need for

            a gastroenterology consult, and decedent did not have a fever and his other vital signs were not

            indicative of a need for hematology or chemistry testing as alleged. Dr. Jagoda opines that Nurse

            Kerr was correct to rely upon the reading of the CT scan and attributing the patient’s complaint

            to those findings.

                                                            11

                                                        11 of 22
[* 11]
  FILED: KINGS COUNTY CLERK 03/20/2024 01:01 PM                                                   INDEX NO. 518088/2018
  NYSCEF DOC. NO. 191                                                                     RECEIVED NYSCEF: 03/20/2024

                   Dr. Jagoda opines that Nurse Kerr properly ruled out an aortic dissection as a cause for

            the patient’s complaints. Dr. Jagoda addresses the allegations that additional lab work was

            necessary, and opines that this claim is absurd because the complaints were back pain with

            cramps and bathroom problems and the constipation was of only two days duration and Mr.

            Barney denied nausea, vomiting, chest pain, diarrhea, and paresthesia, so there was no basis for

            lab work at the time of the August 20th presentation. Dr. Jagoda opines that the patient was

            correctly directed to follow up with his primary care physician or to return to Interfaith Medical

            Center if his condition worsened. Dr. Jagoda opines that Nurse Kerr correctly advised Mr.

            Barney of the results of the CT scan, to take a laxative if his bowel movement does not return,

            and to include more fiber and water in his diet. Dr. Jagoda opines that none of Mr. Barney’s vital

            signs, complaints, results of his physical examination, results of the CT scan, medical history, or

            social history warranted his being admitted to the hospital. In sum, Dr. Jagoda opines, to a

            reasonable degree of medical certainty, that the decedent was properly worked-up, treated, and

            discharged by Nurse Kerr.

                   As to Dr. Edouard, Dr. Jagoda opines that Dr Edouard was correct in assessing the

            decedent’s chest wall pain and constipation, and the suitable plan of care was pain medication,

            and x-rays of the abdomen and chest. The defendant’s expert opines that it was appropriate

            practice for Dr. Edouard to have asked Mr. Barney about his medical history, as he was the

            source of information concerning the timing and the duration of his complaints, and Mr. Barney

            reiterated to Dr. Edouard that he did not have HIV or AIDS. As before, Dr. Jagoda opines that

            performing HIV testing without the patient’s consent would have been improper.

                   Dr. Edouard recorded as part of her examination that none of Mr. Barney’s organs were

            enlarged, his abdomen was non-tender and soft, the bowel sounds were normal, and she noted

                                                            12

                                                         12 of 22
[* 12]
  FILED: KINGS COUNTY CLERK 03/20/2024 01:01 PM                                                    INDEX NO. 518088/2018
  NYSCEF DOC. NO. 191                                                                      RECEIVED NYSCEF: 03/20/2024

            that Mr. Barney’s neck was non-tender and had a full range of motion. Dr. Jagoda opines that

            these were thorough and adequate physical examinations of the decedent.

                   Dr. Jagoda goes on to opine that it was good practice for Dr. Edouard to order an

            electrocardiogram and a chest x-ray because the patient presented with complaints of chest pain,

            and an abdominal x-ray because Mr. Barney was complaining of constipation. Dr. Jagoda opines

            that it was proper for Dr. Edouard to order blood work CBC with differential because infection

            was a consideration; order a Troponin level test due to the complaint of chest pain; order

            lactulose and a fleet enema for constipation; and order a urine toxicology screen to see if there

            were any illicit drugs involved in the presentation. The defendant’s expert opines that these tests

            are ordered generally for patients who present with chest pain without risk factors for cardiac

            disease, and not as a result of any aspect of the patient’s presentation or history. Dr. Jagoda

            opines that this is absolutely appropriate given the presentation and to rule out a possible

            etiology for the complaints.

                   Dr. Jagoda noted that Dr. Edouard testified that after being informed of the patient’s

            persistent pain, she would have seen the patient and asked how he was feeling, assessed the

            degree of pain, and awaited the results of the studies ordered. Mr. Barney, when questioned by

            Dr. Edouard, denied abdominal pain, constipation, diarrhea, nausea, and vomiting. She noted that

            there was stool in the rectum and as a result there was no need for further testing. Dr. Jagoda

            opines that this was appropriate for the situation because the abdominal x-ray was more than

            sufficient to determine the nature of the abdominal complaints, showed no evidence of small

            bowel obstruction or moderate gaseous distention of multiple large bowel loops, and showed a

            moderate amount of stool involving the colon and a normal chest x-ray.

                   Dr. Jagoda opines that Dr. Edouard’s review of the patient’s laboratory results, the CBC,

            and the urinalysis at the time of discharge all constituted good practice. Dr. Jagoda opines that

                                                             13

                                                         13 of 22
[* 13]
  FILED: KINGS COUNTY CLERK 03/20/2024 01:01 PM                                                     INDEX NO. 518088/2018
  NYSCEF DOC. NO. 191                                                                       RECEIVED NYSCEF: 03/20/2024

            Dr. Edouard properly ruled out the pain as cardiac and appropriately discharged the patient in

            stable condition with prescriptions for Acetaminophen and Miralax to address the complaints of

            constipation, with instructions to follow-up at the Bishop Walker Clinic and further workup to be

            done on an outpatient basis.

                   Dr. Jagoda opines that the allegation that a hematology consult be sought is absurd. Dr.

            Jagoda explains that there were no findings that were indicative of any blood disorders; both

            Nurse Kerr and Dr. Edouard testified that their physical examinations did not reveal

            lymphadenopathy; and Mr. Barney’s vital signs did not give any indication of infections.

                   Dr. Jagoda went on to conclude that "it is my opinion that Nurse Kerr, Dr. Edouard, IMC

            acted within the standard of care in all of their care and treatment of Mr. Barney, and that the

            care and treatment provided by them caused no harm in this matter. There is simply no causal

            connection between the treatment provided by Nurse Kerr, Dr. Edouard, and IMC and any of

            claimed injuries to Plaintiff-Decedent."

                   In sum, Defendants through their submissions establish their prima facie entitlement to

            summary judgment. “[W]here the moving defendant addressed the elements of both departure

            and proximate cause, the plaintiff was required to raise a triable issue of fact as to both of those

            elements.” DiMitri v Monsouri, 302 AD2d 420 (2d Dept 2003).

                   Plaintiff initially argues that Dr. Jagoda fails to explain his qualifications regarding

            human immunodeficiency virus infection (HIV), acquired immunodeficiency syndrome (AIDS),

            and various forms of lymphomas and their signs, symptoms, diagnosis, treatment, and

            complications. The court has reviewed the qualifications of Dr. Jagoda and finds that this expert

            is qualified to opine as to good and accepted standards of care applicable in this case.

            Furthermore, plaintiff offers not one opinion discussing the role decedent’s HIV positive status

                                                             14

                                                         14 of 22
[* 14]
  FILED: KINGS COUNTY CLERK 03/20/2024 01:01 PM                                                  INDEX NO. 518088/2018
  NYSCEF DOC. NO. 191                                                                     RECEIVED NYSCEF: 03/20/2024

            played in the departures claims against the moving defendants. It is also noted that the patient

            refused an HIV test a number of times during the time in question.

                   In response to defendants’ expert’s opinions, Plaintiff submits the affirmation from expert

            Ira Mehlman, M.D. (“Dr. Mehlman”), certified in Internal Medicine and Emergency Medicine.

            Dr. Mehlman is duly licensed to practice medicine in the State of New York. Dr. Mehlman is

            board certified in Internal Medicine, has been board certified in Emergency Medicine, and has

            been a director of emergency departments for over 20 years. Dr. Mehlman obtained his medical

            degree from Cornell University and thereafter completed his residency in Internal Medicine and

            in Endocrinology and Metabolism at Walter Reed Army Medical Center in Washington, D.C.

            Thereafter, Dr. Mehlman worked as an attending emergency room physician at various hospitals

            in the State of New York, Maryland, Washington D.C., and New Jersey. Dr. Mehlman is a Fellow

            of both the American College of Emergency Physicians (FACEP) and the American College of

            Physicians (FACP) in acknowledgement of his practice, scholarship, and leadership/teaching in

            the fields of Emergency Medicine and Internal Medicine, having obtained the rank of Associate

            Professor of Medicine and published in peer reviewed medical literature. Dr. Mehlman opines, to

            a reasonable degree of medical certainty, that defendants Nurse Kerr and Dr. Edouard departed

            from good and accepted standards of care that existed in 2016.

                   As to Nurse Kerr, Dr. Mehlman opines that the defendant departed from good and

            accepted standards of care in failing to include lymphoma in her differential diagnosis. Dr.

            Mehlman points out that Mr. Barney complained of severe back pain that shoots down to his legs

            causing cramps, and explains that some patients with lymphoma experience lower back pain

            radiating to the hips and thighs, which is believed to be caused by expanding lymph nodes

            pressing on nerves. Dr. Mehlman points out that Nurse Kerr testified that her examination of Mr.

            Barney’s lymph nodes was confined to the neck area “as part of the examination of the neck.”

                                                            15

                                                        15 of 22
[* 15]
  FILED: KINGS COUNTY CLERK 03/20/2024 01:01 PM                                                   INDEX NO. 518088/2018
  NYSCEF DOC. NO. 191                                                                      RECEIVED NYSCEF: 03/20/2024

            Further, Dr. Mehlman indicates that the decedent’s blood pressure was elevated at triage, which

            is more significant in this case because he had no history of hypertension. Dr. Mehlman explains

            that due to autonomic changes resulting from lymphoma, some patients may have elevated blood

            pressure and may represent a paraneoplastic manifestation. No medical explanation is offered for

            the term “paraneoplastic manifestation.” As to these and the opinions of Dr. Mehlman which are

            discussed below, the court finds that the expert’s opinions are of a general and conclusory nature

            relating to signs and symptoms of lymphoma. Dr. Mehlman does not opine as to how the failure

            to diagnose lymphoma or diffuse large B Cell lymphoma constitutes a departure from the

            standard of care in light of the patient’s complaints during these visits and the medical evidence

            submitted herein.

                   Dr. Mehlman opines that the defendant Kerr departed from good and accepted standards

            of care in failing to order tests such as an abdominal x-ray, hematology, chemistry, and

            abdominal CT. In Nurse Kerr’s deposition, she testified that an abdominal mass would have been

            in her differential diagnosis but “would be in the lower on the scale at that time or presentation.”

            However, Dr. Mehlman does not state how an abdominal x-ray is diagnostic of the decedent’s

            diffuse large B Cell lymphoma (“DLBCL”) or lymphoma; or considers that an abdominal x-ray

            was ordered by Dr. Edouard in the subsequent ER visit and that it was negative for an abdominal

            mass. Dr. Mehlman also does not consider that Dr. Edouard ordered blood work while the patient

            was under her care a few days after Nurse Kerr saw him. Dr. Mehlman also points out that the

            Decedent complained of inability to use the bathroom in three days, opining that fluid may build

            up if the lymphoma involves lymphatic tissue within the abdomen, bowel or stomach, causing

            swelling near the intestines, potentially leading to sensations of constipation, abdominal pressure,

            and pain. However, Dr. Mehlman’s opinion that while a mild bulging disc may have contributed

            to his lower back pain, it cannot be reasonably blamed for his other complaints, is conclusory.

                                                             16

                                                         16 of 22
[* 16]
  FILED: KINGS COUNTY CLERK 03/20/2024 01:01 PM                                                    INDEX NO. 518088/2018
  NYSCEF DOC. NO. 191                                                                      RECEIVED NYSCEF: 03/20/2024

            Further, Dr. Mehlman does not comment that the patient’s other complaints were consistent with,

            and confirmed to be, constipation. Similarly, Dr. Mehlman does not support his conclusory

            opinion that a proper and complete differential diagnosis in this case must include lymphoma.

                   Next, Dr. Mehlman opines that Nurse Kerr departed from accepted standards of medical

            practice in failing to order blood tests that could show abnormalities in patients with lymphoma,

            such as a complete blood count (CBC) that may show low hemoglobin, and a hematocrit, low red

            blood cell (RBC) count, low platelet count, and elevated white blood count (WBC). Dr.

            Mehlman opines that chemistry may show elevated values suggestive of kidney and/or liver

            involvement, and radiological studies, including CT scans, PET scans and x-ray, may show

            lymphadenopathy and any extra nodal involvement. Although Dr. Mehlman opines that all these

            tests are necessary to rule out or diagnose lymphoma and should have been ordered by Nurse

            Kerr, he fails to provide an opinion on how neglecting to order these tests presents a departure

            from the standard of care in this case given the patient’s clinical presentation and the specific

            complaints he made to Nurse Kerr. Dr. Mehlman fails to account for the fact that Dr. Edouard

            ordered a CBC. The expert does not comment on how those test results relate to the claimed

            misdiagnosis of lymphoma by either or both treating defendants.

                   Lastly, Dr. Mehlman opines that the departures by Nurse Kerr were substantial factors in

            causing the progression of Mr. Barney’s DLBCL and death from DLBCL on September 28,

            2016. Dr. Mehlman opines that the departures by Nurse Kerr on August 20, 2016, caused a one-

            week delay in the patient’s treatment such that by the time Dr. Edouard saw the decedent in the

            ER on August 26, 2016, his symptoms included chest pain and abdominal pain, indicating a

            significant progression of his DLBCL with other organ involvement and leading to the

            decedent’s injuries and wrongful death. Again, this opinion is conclusory especially in light of

                                                             17

                                                         17 of 22
[* 17]
  FILED: KINGS COUNTY CLERK 03/20/2024 01:01 PM                                                   INDEX NO. 518088/2018
  NYSCEF DOC. NO. 191                                                                     RECEIVED NYSCEF: 03/20/2024

            the conclusory nature of the opinions relating to Nurse Kerr’s departures in the evaluation and

            treatment of the patient.

                   As to Dr. Edouard, Dr. Mehlman opines that the defendant departed from good and

            accepted standards of care that existed in 2016 by failing to formulate a proper and complete

            differential diagnosis of Mr. Barney. Dr. Mehlman opines that a full differential diagnosis of the

            decedent would have included lymphoma because pain in the chest area, coughing, and/or

            breathlessness is associated with lymphoma if it affects the chest wall area. However, Dr.

            Mehlman does not expound his opinions beyond conclusory statements. The hospital record

            indicates that Dr. Edouard evaluated Mr. Barney’s complaints of chest pain by ordering an

            electrocardiogram and a chest x-ray because of these complaints. Dr. Edouard also ordered a

            CBC with differential to consider infection, and ordered a Troponin level test due to the

            complaint of chest pain.

                   In a conclusory and vague manner, Dr. Mehlman points out that the decedent’s complete

            blood count (CBC) showed low hemoglobin and hematocrit, low red blood cell (RBC) count,

            low platelet count, and elevated white blood count (WBC), and he opines that the abnormal labs

            “are all consistent with lymphoma or a similar medical condition.” However, that these lab

            results are consistent with another “similar medical condition” is not at issue herein.

            Significantly, other than in a conclusory manner, Dr. Mehlman does not state how the assessment

            of these lab results constituted a departure of the standard of care. Dr. Mehlman also notes that

            the patient’s CMP showed elevated values suggestive of kidney and/or liver involvement, but he

            does not discuss how this is relevant to any departure claimed in this case. Once again, no

            opinions are given indicating that the standard of care was breached in the evaluation and

            interpretation of these lab results in light of the patient’s complaints and presenting symptoms.

                                                             18

                                                         18 of 22
[* 18]
  FILED: KINGS COUNTY CLERK 03/20/2024 01:01 PM                                                   INDEX NO. 518088/2018
  NYSCEF DOC. NO. 191                                                                     RECEIVED NYSCEF: 03/20/2024

                   With regards to decedent’s complaint of not having a bowel movement for a week, Dr.

            Mehlman opines in a conclusory manner that this complaint required lymphoma to be included

            as a differential diagnosis. In an attempt to support this opinion, the expert states that lymphoma

            involves lymphatic tissue within the abdomen, bowel or stomach, fluid may build up causing

            swelling near the intestines, potentially leading to sensations of constipation, abdominal pressure,

            and pain. Additionally, Dr. Mehlman states that the decedent’s abdominal x-ray showed moderate

            gaseous distention of multiple large bowel loops and moderate amount of stool involving the

            colon, and explains that gaseous distention results from bacterial growth in the stagnant contents

            of an obstructed bowel, which can be dangerous factor in the entire process of partial mechanical

            intestinal obstruction. In spite of this explanation, Dr. Mehlman does not comment how this

            finding called for including lymphoma as a differential diagnosis. Nor does the expert opine how

            or in what manner Dr. Edouard deviated from the standard of care in failing to diagnose

            lymphoma in light of these findings and the patient’s complaint of constipation.

                   Dr. Mehlman’s opinions are also retrospective, based on hindsight and are non-specific.

            While Dr. Mehlman opines that “additional radiological studies, including CT scans and PET

            scans may show lymphadenopathy and any extra nodal involvement, so all of these tests are

            necessary to rule out or diagnose lymphoma”, he fails to opine whether Mr. Barney’s symptoms

            at the time that Nurse Kerr treated the patient on August 20, 2016 reflected a need for these tests.

            As mentioned above, Dr. Mehlman fails to opine why these tests were indicated in this case.

                   Lastly, Dr. Mehlman opines that the departures by Dr. Edouard were substantial factors in

            causing the progression of Mr. Barney’s DLBCL and death from DLBCL because they caused a

            further delay, such that by the time the decedent returned to the Emergency Department later on

            August 26, 2016, he had already developed bleeding, indicating a significant progression of his

            DLBCL with other organ involvement, and leading to his alleged injuries, and death. However,

                                                             19

                                                         19 of 22
[* 19]
  FILED: KINGS COUNTY CLERK 03/20/2024 01:01 PM                                                     INDEX NO. 518088/2018
  NYSCEF DOC. NO. 191                                                                       RECEIVED NYSCEF: 03/20/2024

            given the conclusory nature of the expert’s opinions on liability, his opinions on proximate cause

            are similarly conclusory. In addition, Dr. Mehlman insufficiently attributes the progression of the

            decedent’s condition to the delay between Dr. Edouard’s discharge of the decedent on August 26,

            2016 at 4:26 a.m. and his admission beginning on August 26, 2015 at 8:11 p.m., to establish

            proximate cause. Further, Dr. Mehlman ignores Interfaith records that indicate that the patient

            was not diagnosed with lymphoma for another few days after he was admitted complaining of

            blood in his stool; and after signing himself out against medical advice (AMA) on August 30th.

            During this admission, a rapid HIV test was ordered and positive results were obtained on

            August 27th. An inguinal biopsy was performed on August 30, 2016; those results became

            available after Mr. Barney had left the hospital AMA.

                   In summary, based upon the submissions of the parties and the affirmation of the experts,

            while movants established their prima facie establishment for summary judgment, plaintiff fails

            to raise an issue of fact as to both liability and proximate cause. The affirmation of their expert is

            conclusory, based on hindsight and not based on the evidence. “General and conclusory

            allegations of medical malpractice... unsupported by competent evidence tending to establish the

            essential elements of medical malpractice, are insufficient to defeat a defendant physician’s

            summary judgment motion.” Coffey v. Mansouri, 209 A.D.3d 714 [2nd Dept. 2022] citing Myers

            v. Ferrara, 56 A.D.3d 78, 84 [2nd Dept. 2008]. Accordingly, the court must grant summary

            judgment to Nurse Kerr and Dr. Edouard.

                   As summary judgment is granted to Nurse Kerr and Dr. Edouard, summary judgment is

            also granted to Interfaith Medical Center as to claims for its vicarious liability for the acts and/or

            omissions of the movants. Further, as no claims were raised as to any departures directly

            attributable to Interfaith Medical Center, any and all such claims, if any, are similarly dismissed

            and summary judgment is granted.

                                                              20

                                                          20 of 22
[* 20]
  FILED: KINGS COUNTY CLERK 03/20/2024 01:01 PM                                                   INDEX NO. 518088/2018
  NYSCEF DOC. NO. 191                                                                     RECEIVED NYSCEF: 03/20/2024

                   Defendant Interfaith seeks dismissal of Plaintiff’s negligent hiring claim. As no

            opposition was submitted, this cause of action is dismissed.

                   Defendants also seek dismissal of Plaintiff’s lack of informed consent claim.

                   “To succeed in a medical malpractice cause of action premised on lack of informed
                   consent, a plaintiff must demonstrate that (1) the practitioner failed to disclose the
                   risks, benefits and alternatives to the procedure or treatment that a reasonable
                   practitioner would have disclosed and (2) a reasonable person in the plaintiff’s
                   position, fully informed, would have elected not to undergo the procedure or
                   treatment (see Public Health Law § 2805-d [1], [3]). Expert medical testimony is
                   required to prove the insufficiency of the information disclosed to the plaintiff
                   (CPLR 4401-a).” Orphan v. Pilnik, 15 N.Y.3d 907, 908 [2010].

                   Plaintiff has not submitted opposition to this claim; further, Plaintiff’s lack of informed

            consent claim does not apply in this case. Accordingly, the cause of action for lack of informed

            consent is dismissed without opposition.

            Therefore, it is ORDERED that:

                   The motion of Defendants Mirela Sam, M.D., and Azza Elemam, M.D., is GRANTED,

            without opposition (Seq. No. 3); and

                   The branch of the motion on behalf of Defendants Shelline C. Kerr, F.N.P., Kathleen

            Edouard, M.D. is GRANTED (Seq. No. 4); and

                    The branch of the motion on behalf of Defendants Marie F. Schmidt, M.D., Sreedevi

            Ramakrishnaiah, M.D., and Nwosu Ngofa, M.D., and Interfaith Medical Center, is GRANTED,

            without opposition (Seq. No. 4); and

                   The motion of Defendants William Tursi, M.D., Madhvi Rana, M.D., Thomas J.

            Forlenza, M.D., Lucia Palladino, M.D., Keith Diaz, M.D., and Richmond University Medical

            Center is GRANTED, without opposition (Seq. No. 5).

                   Accordingly, the action is DISMISSED in its entirety.

                                                            21

                                                        21 of 22
[* 21]
  FILED: KINGS COUNTY CLERK 03/20/2024 01:01 PM                                                                 INDEX NO. 518088/2018
  NYSCEF DOC. NO. 191                                                                                  RECEIVED NYSCEF: 03/20/2024

                       The clerk is directed to enter judgment pursuant to CPLR § 3212 in favor of Mirela Sam,

            M.D., Azza Elemam, M.D., Shelline C. Kerr, F.N.P., Kathleen Edouard, M.D., Marie F. Schmidt,

            M.D., Sreedevi Ramakrishnaiah, M.D., Nwosu Ngofa, M.D., William Tursi, M.D., Madhvi Rana,

            M.D., Thomas J. Forlenza, M.D., Lucia Palladino, M.D., Keith Diaz, M.D., Interfaith Medical

            Center, and Richmond University Medical Center.

                       This constitutes the decision and order of the court.1

                                                                           ENTER.

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

            1
                This decision was drafted with the assistance of legal intern Jessica Ramsawak, Brooklyn Law School.

                                                                      22

                                                                 22 of 22
[* 22]