The New York Court of Appeals' recent memorandum decision in Barry v Lee, on its face, is cryptic and indicates a summary-judgment, burden shifting analysis.1 The case concerns an interesting theory in the medical malpractice context -- i.e., whether rendering a certain course of treatment could have increased the decedent's chances of survival.
The underlying Appellate Division, First Department's opinion sets out the facts and arguments at issue in Barry. The treatment at issue concerned administering tissue plasminogen activator (tPA), which can dissolve clots and open arteries in 10-15 minutes. The upside of tPA is that it is a fast-acting "clot buster" for patients suffering strokes or embolisms. The downside is that tPA might not work and could lead to uncontrollable bleeding and death. To further complicate the issue, there is a six-hour window within which to administer tPA following the appearance of symptoms.
Hospitals have protocols for tPA use. Some protocols are to not use tPA under any circumstance. The hospital in Barry v Lee allowed for the use of tPA, and there was an inference from defendant Dr. Lee's testimony that it was not his practice to administer tPA under any circumstances concerning a pulmonary embolism.
The defendant doctor in Barry v Lee performed a differential diagnosis of the decedent upon her admission to defendant Bronx-Lebanon Hospital Center and determined that she was suffering from a pulmonary embolism. Despite the diagnosis, the doctor and staff did not administer tPA until after waiting hours for the results of blood tests and an angiogram to confirm the diagnosis. Part of the doctor's consideration of not administering tPA was that the decedent recently gave birth and reported postpartum bleeding.
After approximately four hours post admission, the decedent's condition severely worsened, prompting medical staff to administer tPA just two minutes before she went into cardiac arrest. Despite the treatment, the decedent unfortunately died from the embolism.
The appeal at issue presents itself in a summary-judgment context in a medical malpractice case. The motion concerned a "battle of the experts," and the First Department determined that the defendants failed to make a prima facie showing of their entitlement to judgment as a matter of law because their expert did not address the proposition that prompt administration of tPA would have increased decedent's chances of survival. The Majority also noted that, even assuming the defendants met their burden, the plaintiff through her expert raised a triable issue of fact on both negligence (a departure from the standard of care) and causation elements. Thus, the First Department reversed the Supreme Court's grant of the defendant's summary judgment motion dismissing the complaint.
Justice Singh, with Justice Tom concurring, dissented concluding the defendants met their burden, and that the plaintiff failed to raise a material issue of fact on causation because her expert failed to explicitly state that the departures she highlights proximately caused decedent's death, and that decedent would have had a substantial probability of survival had a thrombolytic drug been administered.
In its memorandum decision, Judges Rivera, Fahey, Stein, Wilson, and Feinman concurred with the First Department's holding that the plaintiff rebutted the defendants' prima facie showing and raised a triable issue of fact. Chief Judge DiFiore and Judge Garcia dissented for the reasons stated in Justice Singh's dissenting opinion.
1 The Court of Appeals addressed the appeal on the sua sponte merits track. The SSM track decides the appeal on the parties' submissions only, and generally renders a short memorandum decision. Therefore, my characterization of the memorandum as "cryptic" comments on the nature of decisions resulting from the SSM track and not on any ulterior motive by the Court. (see 22 NYCRR 500.11).
(see Appellants' Brief Download Appellant's Brief)
(see Respondent's Brief Download Respondent's Brief)