Kalstein v County of Nassau

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Kalstein v County of Nassau 2012 NY Slip Op 30569(U) February 27, 2012 Sup Ct, Nassau County Docket Number: 006371-10 Judge: Arthur M. Diamond Republished from New York State Unified Court System's E-Courts Service. Search E-Courts (http://www.nycourts.gov/ecourts) for any additional information on this case. This opinion is uncorrected and not selected for official publication. [* 1] SUPREME COURT - STATE OF NEW YORK Present: HON. ARTHUR M. DIAMOND Justice Supreme Court ----------------------------------------------------------------------- x KENNETH R. KALSTEIN, as Temporar Guardian and on behalf of SYLVIA KALSTEIN , an Incapacitated Person TRIL PART: NASSAU COUNTY Plaintiffs, INDEX NO: 006371- -againstMOTION SEQ. NO: 1 COUNTY OF NASSAU AND NASSAU HEALTH CARE CORPORATION d/b/a NASSAU UNIVERSITY MEDICAL CENTER Defendants. ------------------------------------------------ x The following papers having been read on this motion: SUBMIT DATE: 1/18/12 Notice of Motion.............................. Answering Affidavit...... ..... .......... Rep Iy ..... ...... ........ ...... ....... .... ............. , This motion by the defendant Nassau Health Care Corporation d//a Nassau County Medical Center ("NUMC" ) for an order pursuant to CPLR 3212 granting it sumary judgment dismissing the complaint against it is denied. The plaintiff in this action , Sylvia Kalstein s son Kenneth R. Kalstein , seeks to recover damages for medical malpractice based upon the defendant NUMC' s allegedly negligent treatment of his mother Sylvia Kalstein. He alleges that during her stay at NUMC , Ms. Kalstein s left side peripheral IV site became infitrated which caused extravasation of medication on to her upper extremity which lead to severe ischemic necrotic injury to her left arm and hand. The plaintiff has advanced two causes of action; medical malpractice and negligent granting of staff privileges. NUMC seeks summar judgment dismissing the complaint against it. The facts pertinent to the determination of this motion are as follows: Ms. Kalstein was admitted to NUMC on Januar 31 , 2009 having suffered a massive cerebellar hemorrhagic stroke at her home. Ms. Kalstein s admittance record from the Emergency [* 2] Room indicates that she was at high risk for skin breakdown. Dr. Mehta performed an emergent suboccipital craniectomy with drainage of the hematoa. While the operative report indicates adequate IV was performed " it also indicates that peripheral infusion lines admission and the EMS report indicates that it was "difficult to establish IV. " that were present on Ms. Kalstein spent a few days in the Surgical Intensive Care Unit and was transferred to the Coronar Care Unit on Februar 2 2009 where she remained until she was transferred to Winthrop University Hospital on Februar 8 , 2009. During her stay, Ms. Kalstein had two peripheral IV sites to facilitate the infusion of numerous medications , one on her upper left extremity and one on her right. It is not disputed that on Februar 1 2009 , Ms. Kalstein s left IV site became infitrated leading to extravasation ofIV medications on her upper left extremity. It is also not disputed that calcium gluconate was infused right before the infiltration was diagnosed and that medication is known to be caustic to the skin and can cause necrosis. Ms. Kalstein ; s char reflects that Dr. Zuhrov , a hospital resident , placed a central line at 12:40 PM and was notified ofa blister where the IV infiltrated at4:30 PM. NUMC' s records reflect that a skin integrity consult and assessment was done three days later on Februar a skin and integrity nurse. Blackened skin was first noted on Februar 711 . A 4 2009 by consult by a dermatologist or plastic surgeon was not sought. That Ms. Kalstein suffered considerably from ischemic necrosis as a result of the infitration and extravasation is not disputed , either. At her examination- before- trial Nurse Fantastico , an employee ofNUMC , testified in general terms regarding the procedure she followed when checking IVs as follows: In the morning we always check the IV site. Check the patient. If the lines are okay. Then by ten o clock we give the medications. We check the IV site again. If it' s - you know , you check if the things. Around probably eleven o ar is soft , those kind of clock , I check again , but everyhing is being checked like every hour. Restraints we check every half an hour. Most of the time we re really with the patient. You know, I stay with the patient most of my time. I check on their central monitor. By eleven [* 3] clock I noticed that (Ms. Kalstein sJ ar (wasJ getting very, you know cold and it' s swollen , so I took out the IV immediately. Nurse Fantastico testified that when she discovered Ms. Kalstein s infiltrated IV shortly after 11 :00 AM on Februar P\ she immediately discontinued the IV , elevated the extremity and applied an Xeroflow dressing. She testified that she promptly notified Dr. Zuhrov who placed a central line at 12:40 PM to enable the continued administration of IV medications. She testified that thereafter NUMC treated Ms. Kalstein s extremities via placing Xeroflow dressing, elevating the extremity, changing dressings , applying Bacitracin , Collagenase and Silvadene and having the extremity evaluated by a wound care specialist. The plaintiff alleges that the defendants " failed to properly insert IVC/Centralline , failed to monitor and prevent the development of ischemia and necrosis of the left hand , failed to properly restrain the patient or apply appropriate pressure , failed to diagnose and treat the ischemic necrotic condition , failed to write MD orders , and failed to monitor the patient." On a motion for summar judgment pursuant to CPLR~ 3212 , the proponent must make a prima facie showing of entitlement to judgment as a matter of law, tendering sufficient evidence to Sheppard- Mobley v King , 10 AD3d 70 , 74 demonstrate the absence of any material issues of fact." affd as mod. , 4 NY3d 627 (2005), (2d Dept 2004), 324 (1986); such citing Alvarez v Prospect Hosp. , 68 NY2d 320 Winegrad v New York Univ. Med. Ctr. , 64 NY2d 851 , 853 (1985). " Failure to make prima facie showing requires a denial of the motion , regardless of the sufficiency of the opposing papers. Sheppard- Mobley v King supra, at p. 74; Alvarez v Prospect Hosp. supra Wine grad v New York Univ. Med. Ctr. supra . Once the movant's burden is met , the burden shifts to the opposing pary to establish the existence of a material issue offact. Alvarez v Prospect Hosp. supra, at p. 324. The evidence presented by the opponents of sumar judgment must be accepted as true and they must be given the benefit of every reasonable inference. Community Housing Management Corp. , 34 AD3d 518 Condominium , 158 AD2d 591 (2d Dept 1990). 521 (2d Dept 2006), citing See Demishick v Secofv Greens [* 4] The essential elements of medical malpractice are (1) a deviation or depare from medical practice , and (2) evidence that such departure was a proximate cause of injury omitted). Wexelbaum v. Jean , 80 AD3d 756 (2 AD2d 420 , 421 (2 accepted (citations DiMitri v. Monsouri , 302 Dept 2011), quoting Dept 2003). " In order to establish the liabilty of a physician for medical malpractice , a plaintiff must prove that the physician deviated or depared from accepted community standards of practice , and that such deparre Stukas v. Streiter , 83 AD3d 18 , 23 (2 was a proximate cause of the plaintiff s injuries. Dept 2011). " Thus , on a motion for sumar judgment dismissing the complaint in a medical malpractice action , the defendant doctor has the initial burden of establishing the absence of any departre from good and accepted medical practice or that the plaintiff was not injured thereby (citations omitted). W exelbaum v. Jean supra. at p. 757; Stukas v. Streiter supra , at p. 23 , see also 27. If the moving defendant only establishes that he did not commit medial malpractice , in opposing the motion , the plaintiff must establish the existence of a Stukas v. Streiter supra , at p. 30- 31. Similarly, material issue of fact with respect to only that issue. if the moving defendant only establishes a lack of proximate course , in opposing the motion , the plaintiff need establish only the existence of a material issue of fact with respect to that issue. Stukas v. Streiter supra, at p. 25. However, if the moving defendant establishes both a lack of negligence and proximate cause , in order to defeat sumar judgment , the plaintiff must establish an issue of Stukas v. Streiter supra, at p. 25. fact as to both of those issues. Habit evidence is admissible in cases " where the proof demonstrates ' repetitive practice ' by a person ' in complete control of the circumstances however frequent yet likely to var Rivera v Anilesh , 8 NY3d 627 391 (1997); see also from time a deliberate and ' as opposed to ' conduct to time depending on the surounding circumstances. ' 634 (2007), quoting Halloran v Virginia Chemicals , 41 NY2d 386 Biesiada v Suresh , 309 AD2d 1245 (4 AD2d 872 (4 Dept 1980). " If these conditions are satisfied ' Dept 2003); Nigro vBeniamin, 155 par should be able , by introducing evidence of such habit or regular usage , to allow the inference of its persistence. . . on a occasion. " Rivera v Anilesh supra at p. 364 , quoting paricular Halloran v Virginia Chemicals supra at p. [* 5] 392. In support of its motion , NUMC has submitted the affdavit of registered nurse M. Elayne De Simone. Having reviewed the plaintiff s Bil of Pariculars , Ms. Kalstein s medical records and the deposition testimony of Karen and Kenneth Kalstein, Dr. Zhurov and Nurse Fantastico , she opines to a reasonable degree of medical certainty that NUMC and its employees did not depar from good and accepted medical practice in their care of Ms. Kalstein and that those paries ' acts did not proximately cause her injuries. Nurse De Simone notes that Nurse Fantastico testified as to her custom and practice with regard to monitoring IV sites and managing medications being infused via IV. Nurse DeSimone notes that Nurse Fantastico ' s testimony establishes that she " routinely monitored the IV site , provided medications via the left IV per doctors ' orders , and timely and properly diagnosed the IV infitration and extravasation. Nurse DeSimone notes that upon discovering the problem with Ms. Kalstein s IV , Nurse Fantastico promptly notified a doctor and began appropriate treatment of the IV site and the extremity including removal of the IV , elevating the extremity and applying Xeroflow dressing. Nurse DeSimone also notes that a central line was placed by Dr. Zhurov at 12:40 PM. She opines that NUMC' s staff properly evaluated and treated Ms. Kalstein s upper extremity following the infiltration and extravasation. More specifically, she states that Ms. Kalstein s " left hand was monitored appropriately and treatment rendered based upon the findings of examinations performed. " In conclusion , Nurse DeSimone opines "the care in staring the IV , monitoring the IV , and administration of the medication was entirely appropriate. She notes that " IV infiltrations can and do occur under the best circumstances with appropriate care; that the " infiltration was timely diagnosed and treated appropriately thereafter; " and , that "the subsequent monitoring and treatment of the left hand was entirely appropriate as well." NUMC has not established its entitlement to summar judgment. Its allegations regarding the care it provided once the necrotic condition was discovered is unacceptably conclusory. Assuming, arguendo , that NUMC has established its entitlement to summar judgment based on Nurse Fantastico s testimony and Nurse DeSimone s expert opinion thereby shifting the burden [* 6] to the plaintiff to establish the existence of a material issue of fact, the plaintiff has met his burden. In opposition , the plaintiff has submitted the affidavit of a Board Certified surgeon who has also reviewed the medical and legal records pertinentto this case. He notes that upon her admission to NUMC , Ms. Kalstein s skin condition was of normal temperatue , moisture and color and its integrity was intact. The plaintiff s expert notes that calcium gluconate ' s product information wars that it should not be given via intramuscular or subcutaneous routes because tissue necrosis or sloughing may occur. The plaintiff s expert then opines that " good practice requires that both calcium gluconate and/or vancomycin (which was also being administered) be administered through a subclavian central venous catheter so as to avoid the causation of any adverse effects , such as skin necrosis due to leakage of an IV line. " Thus , he opines that administration of vancomycin and calcium gluconate through a peripheral line was a depare from good medicine practice. He fuher opines that " calcium gluconate and vancomycin should not be administered through the same line because they are incompatible medications " and he notes that since there is no evidence reflecting which medications were administered through which lines , whether vancomycin and calcium gluconate were administered via the same line is certainly possible. The plaintiff s expert similarly faults NUMC for not having reflected in Ms. Kalstein s char not only which line was used for which drug but also documenting patency of the IV line prior to infusing medications as well as verifying needle placement in the vein and noting location; by whom; tye and amount of precisely when the infusion was started - date; time; solution; medications/additives added; actioilreaction to medications; additional solutions and medications , pertinent observations. She also faults NUMC' s staff for failing to record patency; care and location of injection site; and , pertinent observations while the infusion was in progress. And , the plaintiffs expert also faults NUMC for not utilizing a " transparent plastic dressing which would have allowed for easy inspection of the insertion site for infiltration. Finally, she faults NUMC for not obtaining appropriate timely consultations by a dermatologist and/or plastic surgeon given the urgency for timely and thorough treatment. That the plaintiffs Bil of Pariculars did not specifically allege fault by NUMC by [* 7] administrating calcium gluconate and vancomycin via IV as opposed to a central line and in the same line does not prevent him from doing so in opposition to NUMC' s motion. In his Bil of Pariculars the plaintiff alleged a failure to insert a catheter and/or a central line as well as failure to prevent the development of ischemic necrosis which encompasses the present claims. Neverteless , the calcium gluconate product information relied on by the plaintiffs expert states that it should not be administered intramuscularly or subcutaneously: It did not preclude administration via IV as was done here. Accordingly, the plaintiffs expert' s opinion that calcium gluconate should not be given through an IV fails as it is contradicted by hislher own product See. Shapiro v Gurin Jewish Geriatric Nursing and information and accordingly lacks support. Rehabiltation Center , 84 AD3d 1348 (2 Dept 2011). And , the failure to record things in Ms. Kalstein s hospital char did not mean that those things were not done and standing alone canot establish malpractice , either. Melendez v Parkchester , 76 AD3d 927 (1 st Dept. 2010). Nevertheless , that NUMC' s expert Nurse DeSimone opines that " (tJhere is absolutely no contraindication to using the same peripheral IV line to infuse vancomycin and calcium gluconate as was performed in this case " does no more than raise an issue of fact since the plaintiffs expert disagrees. Furthermore , the failure to obtain proper consults following discovery of the infltration and extravasation also presents an issue of fact. This constitutes the decision and order of this Court. ENTER DATED: February 27 2012 ON. ARTHU M. . r: DIAM . FEB To: 2 9 RED 2012 NASSAU COUNTY COUNTY CLERK' S OFFICE Attorney for Plaintiffs Attorney for Defendants NATHANIEL M. SWERGOLD, ESQ. GEISLER & GABRIELE, LLP. 124 Cedarhurst Avenue Cedarhurst , New York 11516 100 Quentin Roosevelt Blvd. O. Box 8022 Garden City, New York 11530

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