Zahir v Good Samaritan Hospital

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Zahir v Good Samaritan Hospital 2012 NY Slip Op 32205(U) August 14, 2012 Sup Ct, Suffolk County Docket Number: 33245/2006 Judge: William B. Rebolini 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] Short Form Order SUPREME COURT· STATE OF NEW YORK IAS. PART 7 SUFFOLK COUNTY PRESENT: HON. WILLIAM B. REBOLINI Justice Azmat Zahir, as Administrator of the Estate of Kiran Fatima Zahir, Azmat Zahlr and Nuzhat Zahir, Plaintiffs, Motion Sequence No.: 008: MG Motion Date: 4/24/12 Submitted: 6/5/12 Index No .. 3324512006 -againstAttorneys/Parties [See Annexed Riderl Good Samaritan Hospital, Mary Gidget Vilela, M.D., Delia Rogu, M.D., Murk SchWaJ1Z, M.D., Elizabeth Pleickhardt, M.D., Marion Rose, M.D., Cathenne Caroma, M.D_, Donald Moyer, M.D., Cynthw Rosenthal, M.D., Michael Bianco, M.D. & Hafiz Rehman, M.D., Defendants. Upon the following papers numbered 1 to 24 read upon this motion For summary judgment: Notice of Motion and supporting papers (008), 1 -19; Answenng Affidavits and supporting papers, 20 - 22, Replying Affidavits and supporting papers, 23 - 24; It is, ORDERI!:/J that thlS motion (008) by the defendant, Elizabeth Plcickhardt, M.D., pursuanr to CPLR 32 I2 for an order granting summary judgment dismissing the complaint IS granted and the complamt as asserted against her is dlS1nISscd wlth preJudice. In thIs action, the plamtiffs, A7.mat Zahir and Nuzhat Zahir, assert causes medical malpractice premised upon the ullcged negligent departures from good standards of care and treatment provided to their seven year old Infant daughter, Kiran and for her wrongful death At the dJrcction of her pediatrician, Dr. Hafiz Rehman, of action for and accepted Fatima Zahir, the infant had [* 2] Zulli)" v. Good Samaritan Index No.: 33245/2006 Page 2 Hosp. et al. been admitted to the emergency room 3t Good Samaritan Hospital for evaluation of right lower quadrant ahdomil1:.J1 p:.lin on December 14, 1004. In the emergency foom. she was seen by the cmergcncy dcpal1111cnt auendingphysicians. Dr. Mary Vi lela and Dr. Delia Rogu. Shc was rherc:.Jfter admittcd from the emergency room 10 the pediatric intensive carc unit (PlCU) for observalultl on December 15, 1004, wilh a diagnosis of possiblc appendicitis. Dr. Cathenne Caroma was lhe anending pediatric intensivisL Defendant Dr. Elizabeth Pleickhardt was the resIdent physician who adm1l1istered care and treatment to the infant under the supervision of Dr. Caronia. Dr. Mark Schwanz was the attending surgeon. Or. Michael Blanco was the attending anesthesIOlogist. The infant died December 15.2004. The moving defendant. Elizabeth Pleickhardt, M.D .. seeks summary judgment dismissing the complaint as assel1ed aga1l1st her on the bases that, as a pediatric resident physician, she did not depart from good and accepted standards of medical care and treatment; there IS no proximate cause between [he care and treatment rendered by her and the injuries suffered by the deceased lllfant; she followed the directions of the attending phYSIcians; she did not exercIse any independent medical judgment; and the direction of the supervising physician did not deviate so greatly from normal medical practice that she should be held liable. The proponent or a summary Judgment motion must make a prill/a facie showing or entlt Icrncnt to.i udgment as a matter of law, tendeling sufficient evidence to eliminate any matenal issues or fUCI from the case. To granl summary judgment it must clearly appear that no material and triable issue or fact is presented (Frielld,\' of Animals I' Associated Fur Mfrs., 46 NY2d 1065,416 NYS2d 790 119791; Sillman v Twentieth Celltury-Fox Film Corporation,.l NY2d 395, 165 NYS2d 49811957]). The movant has the imlml burden of proving entitlcment to summary Judgmelll (WiueKrad I' N. Medical Center. 64 NY2d 851,487 NYS2d J 1() 11985j). Fmlure to makc such a showing requires dC1l1al or the motIon, regardless of lhe suffiCIency or the opposing papers (WilleKrad),.tV. y, V. Medical Cellter, S/lPru). Once such proor has becn orfered, the burden then slli fts to the upp()sing party, who, in order to defeat the motion for summary Judgment. must proffer eVidence ill ~ldmissible form.,.and must "show facts suffiCIent to requIre a lnal of any issue of ract" (CPLR ~lJ~lbl: Zllckermalll' City of New York, 49 NY2d ))7, 417 NYS2d )9) [1980]). The 0PPOSlllg party Illust assemhle, lay bare and reveal his proof in order to establish tlwt the matters set forth in his pleadings are real and capable of being establIshed (Castro v Liberty Bus Co., 79 AD2d 1014.43) NYS2d 340 [2d Depl 19811) Y.v. ln supporl of this applIcation, the moving defendant has suhmitted. inter aha, an attorney's affirmation: a copy oflhe summons and complaint, the moving defendant's answer. and lhe amended veri fied hill {If particulars: a ccnified copy of the Good Samaritan Hospital record: the unsigned hut cenified copies of the transcripts oflhe examinations before trial of Mary Gidget Vilela, M D. dated Apnl 16.2008. Mark A. Schwartz, M.D. dated June 11.2009. Elizabeth Plclckhardt, M.D. dated June 9. 2009. Michael Biunco, M_D. dated June 18.10 la, Azmat Zahir dated January 18. 2008. and Nuzhat J. i'...ahir dated January 28. 2008: the signed transcripts of [he examinations before trial of [* 3] Zahir \'. Good Samaritan Index No.: 3.U4512006 Page .:; Hosp. ct al- Delia Rogu, M.D. dated June 24, 2008, and Catherine Caroma, M.D. dated October 29.2009: and the alTirmation of the moving defendant's expert. Bruce Michael Greenwald. M.D. The requisite clements of proof 11la medical malpractice action are (I) a devlation or departure from accepted pracllce, and (2) evidence that such depm1ure was a proximate cause of inJury or damage (//oltoll v SprailllJrook Mallor Nursing Home, 253 AD2d 852, 678 NYS2d 503 12d Dept 1998"1, pp denied 92 NY2d 818, 685 NYS2d 420 [1999]). To prove aprilllaj(/(:ie case " of medIcal malpractice, a plaintiff must establIsh that defendant's negligence was a substantIal h.leror ill producmg the alleged injury (see, Derdiariall v Felix ContrGl.:tillg COI1!., 51 NY2d 308, 434 NYS2d 166 [1980): Prete v Rajla-Demetrialls, 224 AD2d 674, 638 NYS2d 700 [2d Dept 1996)). Except as to matters wilhin the ordinary experience and knowledge of laymen, expert medical opinion is necessary to prove a devHltion or depal1ure from accepted standards of medical care and that such departure was a proximate cause of the plaintiff's injury (see, Fiore v Galang, 64 NY2d 999. 489 NYS2d 47 [1985]: Lyons l' McCaliley, 252 AD2d 5 16,517,675 NYS2d 375 [2d DeptJ. app del/ied92 NY2d 814, 681 NYS2d475 [1998]: Bloom v City of New York, 202 AD2d 465. 465. 609 NYS2d 45 [2d Dcpt 1994J). A resident who assists a doctor during a medical procedure, and who does not exercise any independent medical judgment, cannot be held liable for malpractice so long as the doctor's directions did not so greatly deviate from normal practice that the resident should be held liable for falllllg to ll1tervene (IJellaflore v Roccotta, 83 AD3d 632,920 NYS2d 373 [2d Dept 201 ! I; Muniz et al v Katiowitz, et ai, 49 AD3d 5 11,856 NYS2d 120 [2d Dept 20081; Brinkley v Na::iSllll flealth Care Corporation, 2012 NY Slip Op 30961 U lSup. Ct., Nassau County]). A private phySician may be held vicariously iiahle for conduct of a resident phYSICianwhere the resident is under the direct supervIsIon and control nf the private physiCIan at the time of the conduct; the key is whether the resldcnt cxerC1SCS Indepcnclenlmcdical Judgment (sce Hill v St. Clare's /hHpital, 67 NY2d 72, 499 NYS2d 904119861: Freeman et al v Mercy Medical Cel/ter et al. 2008 NY Slip Op 31337U [Sup. Cl.. Nassau County]). Azmat 7.ahir testified to the extent that on Monday, December 13, 2004, Kiran complained she was not feeling well. That evening she began to run a fever Dr. Rehman's office was called. and Motnn was advised. The following day. she did nol attcnd school. She was not active and rested on the couch. Shc wore a Jacket as she was cold. She could nO! walk on her own and complained of pain in her stomach. Upon seeing Dr. Rehman. her pediatrician, on Decemher 14, 2004. she was sent to Good Samanlan emergency room. where an inlravcnous wus staned. hlood and urine tcsts and x-rays wcre taken. She thcn waited to be seen hy the surgeon. Dr. Schwanz. About midnight. Kiran complaincd of having a hard lime hreathing. had pam in her hclly. and was feellllg hot bUI stated that her feet wcre t:old_ She was given oxygen. Her eyes had hecome swollen. Mr Zahirconlinued lhat ahout I:00 a.m .. Dr. Schwartz saw the child and ordered a CT scan, which \vas performed at uhout.:tOO a.m. He was advlscd that nothIng showed on lhe scan. and lhul [* 4] Znhir v. Good Sanulrilan Index No.: 3~n45/2006 1I05p. ct al. Page -* Kiran was being admitted to the hospital. About 8:00 a.m .. Dr. Schw<lI1zsaw the child and advIsed him that thcycouldn't find anythmg. but needed to operate on her appendix. Mrs. Zahir anived at the hospItal. and Dr. Caronia spoke with him and his wife. Kiran went to the opcratingroom waIting area. then to the operating room. Thereafter. Dr. Sehw,1l1ztold him that Kiran had a heart attack and passed away. An autopsy was done by Dr. Wilson. [-Iedid not know the results oj"the autopsy, but remembered hearing somcLllll1gabout a viral I1lI'cetion. Dr. Ella Rogu teslified to the extent that she IS licensed to practice lllcdicllle in New Yllrk and was employed at Good Samaritan HOspltallll December 2004. She slated lhat Kiran Zahlr was adml1led to the pediatric emergency room at Good Samaritan HospItal on December 14.2004. She was seen in lliage after she passed out in the triage area bathroom. She saw the infant about 10:00 p.m. while makmg rounds with Dr. Vilela, anOlher emergency room physiciun who had seen <lnd examined the child. She was udvised by Dr. Vilela that the infant presented with abdominal pain. fever. and some urinary complaints. and that the werking diagnosis was a urinary tract infection or appendicitis_ Dr. Rogu testiried that she examined the chlld but did Ilot wlite a note as it \vas a very busy night m the emergency room. She stated that Kirun was medicated for pain with Morphine at 1:00 a.m. on December 15,2004, and with Teradol at 4:05 a.m. At 4:00 a.m., the mfant was noted 10 be lethargIc, she had swelllllg of her eyelids, her respirations were shullow, and her hands and extremities were cool and clammy. She developed nasal nanng, was given oxygen, and arteri<ll blood gases were drawll. The CT scan of the abdomen was completed at about 3:00 <l.m. on December 15111 <lndwas read as negative for appendicitis. Her di<lgnosis was that of intra-abdominal infection. She descrihed the care and treatment whkh she ordered for the child. She could nol rememher if she contacted the Illfant 's pediatrician. She could not remember whether she considered Ihat the infant might be in septic shock. Dr. Rogu stated that the child's tcmperature was low, her respirations were labored, her extremIties cool, and her eyelids swollen, hut she (hd not have fluid overload ut thIS lime. Dr. Rugu continued that she thought she started to entertaIll the diagnOSIs of sepsis and contacted Dr. Schwarlz. the surgeon. advising him that theehild was having severe abdommal pam. Dr. Schwal1z saw Kiran at about 1~:40 a.m. 011Decemher 15,2004. She could not rec<lll if she advised him that the child had a rapid hean and respiratory rates, low temperature, difficulty breathing, cool and clammy extremities. elevated glucose. aCIdosis, leth<lrgy.thready pulse, and thut she was dehydrated. She testified that these were early signs that the infant was decompensating or had sepsis_ It was decided to admit Kiran 10 the pediatric ltltensive care unit (PICU). At ahollt 5:30 a.m., KirLInwas seen by a reSIdent from PICLJ. Dr. Pleickhardt. Al 5:40 a.m., a repon was given 10the PICU nurses. and the child was transfelTcd 10 PICU to the service of Dr Caroniu_ Dr. Rogu lestified that shc rcported to Dr. Caronia about the infant <Itubout 4:00 u.m., Ihcn left the emergency room at 7:00 a.m. at the end of her shift. At about I :00 p.m. later that day. she learned Kiran had died. Dr. Rogu 0pllled thut il was not a departure from the standard of care not to administer pressors for Kiran's blood pressure while she was still In the emergency room prior to [* 5] Zahir v. Good Samaritan Index No.: 33245/2006 Page 5 Hosp. et al. her transfer to PICU as she had been administered and determined that the chlld appeared stable. a fluId bolus. She had consIdered her vllal signs Mark A. Schwartz, M.D. testlficd that he IS l1censed to practice medicine In New York and is board certified 1Jl general surgery, wIth added qualifications 1ll vascular surgery. He first saw Kiran Zahir at 1:00 a.l11. on December 15,2004. He obtained the history that the child had lower abdom11lal pain for two to threc days prior to coming to the hospital. Upon examination, hc found that she had mild nght lower abdominal pain, no pelitomtis, nausea, or vonl1ting. He spoke to Dr. Car011la and advised her that he felt the chlld was very sick and that she should come in to sec her as he did not thmk Kiran was suffering from a surgIcally correctable cause for her illness Dr. Schwartz stated that the CAT of the chlld's abdomen had been read as negative WIth no aeute sIgns of appendicItis, however, he noted her pain to be 111the nght lower quadrant of the abdornen, consIstent WIth uppendlcitis. He felt there was a questionable appendicitis, although he thought it \vas highly unlIkely. Therefore, he wanted to discuss hcr CAT scan with radiology and see the chIld aga1ll 111 one to 1\\10 hours. Dr. Caroll1a asked him to speak to the resident. At the time of tIllS cxamination, he felt the chlld hud septic shock and adVIsed the pediatricians, but he did not write It in the notc. Dr. Schwartz testified that he then saw the infant again at 5:00 a.m. before she was transferred to PICU. He wanted her admitted to PICU for resuscitation (aggressIve fluid therapy, treatment for acidosis and her reSpm.llory condition, With the possibility of antibiotICS) und reevaluatIon thereafter. He did not have a work1llg cause for the acidosis and stated that It was Important to determine the cause. He stated that he felt the infant was in shock when she was transferred to PICU. I Ie testified that shock is the inadequate perfusion of bodily organs, characteril.ed hy cool and clammy skin, dry mucous membranes, cyanosis or discoloration of the extremities, low blood pressure. elevated heart rate, low urine output, and lethargy. He believed that Klran \\iUS sufrering from sepllc shock and staled that he advised the pediatnclans, but dId not write it In the nole. He continued that the chJ1cl was getting sicker and thought Kiran possibly had dppendicitis. Dr Schwartz testified that at 7:00 a.I11., the child was still having right lower quadrant pain and tenderncss with a negative CT scan, however, he suspected acute appendicitis and planned 10 proceed With the appendectomy. The pediatricwns had exhausted theIr search, I'elt nothlng else could be dunc, and the chlld appeared to be gett1l1g v,'orsc. Kiran's while blood celJ count was [6,900, which he charactenl.ed as abnormally high. He consulted WIth hIS senior partner, 80n D' Angeles. Thc chIld was seen by the anestheSIOlogist, Michael Bianco. She was taKen into the operating room at 8:40 a_m., adminlstcl-cd allesthesHl by IV induction, and was intubated at 8·55 a.In .. when she became bradycardic (her heult rate slowed) and hypotensive (her bJood pressure lowered). l\ code was called at 8:59 a.m. due to sinus bradycardia. Chest compress1tll1s were slUrleu. CVP and A 11I1eswere Inserted estabilshlllg bl1uteral femoral lines. Dopamine and Dobutaml ne were adminIstered for hcr blood pressure, and her heart rate I ncrcascd to 130's and her [* 6] Zahir \'. Good Samaritan Index No.: 332-15/2006 Page 6 lIosp. et al. hlood pressure to 115/80. Oxygen satumtion levels were at 100 percent. Dr. Schwanz stated that Ihey detennined that she was reasonably stable Jnd that surgery could be started, bUI it just did nOI tum out to be the case as another code was called at 10: 11 a.m_ Kiran had developed a qUivering heart With httle contractility due to pericardial effusion which was tapped to drain the fluid around the heal1. She was defibrillated and chest compressions were continued. Kmlll was pronounced dead at 10:41 a.m. on December 15,2004. EIlLabeth Plclckhardt, M.D. testified that she is currently licensed to practlce medicll1e in New Jersey. In December 2004, she was in her third yearo!" resldcncy at Winl'hrop Hospitul. As part 01" that residency, she was required to do a pediatric rotation from December I through December 31,2004, at Good Samaritan Hospital. She begJn her 24 hour shift working on December 14,2004 at 7:00 a.m. and was on duty until 7:00 a.m. on December 15, 2004. She saw patients on the pediatric floor dUling lhe day, and at about 5:00 or 6:00 p.m., she then saw PICU patients until the followmg moming. She stated that the auending physician is always in charge of PICLL Dr. Curonia was the di rector of PICU, and was the pedialJic intcnsive care attending from 6:00 p.m. on December 14,2004 through 7:00 a.ln. December 15,2004. Dr. P1cickhardl stated that she rcmembered Kiran Zahlr because the child expired. Dr. Pleickhardt testified that she saw the child on December 15, 2005 ~tt about 5:30 a.m. in the cmergcncy room because she was the PICU resident on duty and the child was being admilled to PICU. She obtamcd the history and the test results, which she reviewed with the emergency room attending physician, Dr. Rogu. She also obtained history from the family. Shc recorded that the child had a three-day history of a fever, that she was drinkmg and eating less, and that two nights prior, she complaincd of abdommal pain and the inabdity to urinatc. She noted the results the blood tests, including venous blood gas test results tuken at 4:40 am., which showed she was In metabolic acidosis (a drop in the hody PH below normal), unrelated to aCidOSIS assoclaled with respiratory problems. This melaholic '.lCldosis. she stated, pOSSibly mdlcalcd dehydratlon. The bands portion of the white blood cell reSL which indicate an active infection, was z.ero. She fell the test results could indicate very early stages of bucterial infection, or stress on the body if there was a recent surgery. The electrolytes were normal but the sodium bicarbonate was a little low at 17, She continued that the unofficial read of the CT scan of the abdomen/pelvis was that there was no appendiCitis, however. it did reveal a positive amount of pericardial fluid (lluid around the heart). Vital signs were normal. Klran's eyelids were noted to be edematous (swollcn). Bowel sounds wcre positive in all four quadranls. and her abdomen was soft and nondistended. Abdominal pam was difficull to ascertain as the child had been medicated with Morphine. It was her opimon that the child was dehydrated. She did not note the child's extremities as being cold and clammy. her respirations shallow. that she had nasal flaring, or that she was having abdominal or chest pain. Fluid boluses had been ordered and antibiotics administered, which meant that the chi ld could have been improving. and thus, these findings charted by the nurse carlier had improved. Kiran's blood sugar inCl-eased from lJ I to 239. possibly indicating stress on the body. or [* 7] Zahir v. (;000 Samaritan Hosp. ct a!. Index No.: .'-3245/2006 Pagl' 7 It was Dr. Pleiekhardt"s assessment lh.u the child had an aCUle febrile Illness. modenllc dehydration, and metabolic acidosIs of unclear etiology. She also assessed thaI the child \Vas developmg shock. but crossed it out in her note. It was her opinion that Kimn was not developing shock when she saw her, as her mental status was not compromIsed, her bJood pressure was not low as It was normal for a seven year old at l05/45, She continued that similarities between moderate dehydration and early shock arc developmg metabolic acidosIs, elevated heart rate, weaker pulse, prolonged capillary refill. possIble abnormal temperature, possIble difficulty breathmg, cool and clammy extrermt\cs. and decreased unnary output The mainstay for both conditions is flUId resuscItation, In the emergency room, the chrld was receIving DS 1f2 normal sal ine at 80 ce' s an hour, and was admInistered three bo! uses of norma! salIne. Her workIng differential diagnOSIswas bladder infection tlUl1progressed into a kidney infectlon, a virus, diabetes based upon the elevated blood sugar, and possible appendicitis, though less likeJy due to the neg<ltlve CT scan of the abdomen. Dr Pleickhardt stated the child's condition was guarded as her chnical status was changing or could change. She was evaluated IIIthe emergency room by a cardiologist, Dr. Rose. An EKO wa" raken. She ordered an endocnnology consult. Dr. Pleickhardt testified that she spoke to Dr. Caronia hetween 5:30 a.m. and 5:50 a.m., after she examined the child in the emergency room. and reponed to her the history. her findings upon physical examination, and the test results. Dr. Pleiekhardt stated that Dr- Caronia <lccepted the ehlid for admission and formulated a therapeutic plan as attending physician. Dr. Moyer. a third year pcdiatlic resident, took over for Dr. Pleickhardt when she signcd off at 7:00 a.m. Dr. Pleickhardt testIfied that the child was not critically ill when her shift ended. Catherine Caronia, M.D. testified to the extent that she IS licensed III New York and ISboard certified in general pediatrics and pediatric critical care medicine. She slaled that she \s pan of admil1lstration and runs the graduate medical education programs. She was the PICU attending for Kirall Zahir. She had been cont:.lcted about Klran Zahir at home by Dr. Rogu at about 5:00 or 5:30 a.m. on December J5. 2004, and was adVIsed that she was waiting to see if the child would be going to the npcr:.lting room or wDuld be admitted to PICU. She stated lhat Dr. Rogu was concerned hecause the chrld had received Morphlilc and Toradol and was still having abduminal pain. She arrived at lhe hospital at about 7:00 to 7:30 a.m. She spoke wilh Dr. Plcickhardt while she was driving to the hospital. and could rec<lllonly that one conversation with her. She stated that once adnl1lted to PICU, a chi Id is on continuous c<lrdiopulmonary monitoring for the heart and respIratory rates, and oxygen saturation. Dr. Pleickhardt, as a third yearrcsident, could write orders, and ordered recorded neuro checks every three hours and continuous cardiorespIratory monitoring. Dr. Carom a testIfied that Dr. Pleickhardt wrote her orders prior to contacting her. Dr. Carollia testified that when [he child was admitted to PICU, she was a SIck young girl who was slcepy bur arousable, and appropliate when aroused. She had tachyc'lrdia (high hean ratc). three second capillary refi 11 (delayed by one second), and her skin was cold and clammy. l-Icrcyelids were edematous, her hlood sugar was high. indicating a stressed patient who is very sick or diabettc. hut her oxygenation and ventilation were fine. Nasal flaring was noted, but she stated that it had to he put into context with the status of the patient at the ttme, with considerations such as fever. [* 8] Zahil' v. Good Samaritan Index No.: ~~324512006 Page 8 I-Iosp. et al. Oxygen was stnrted, Blood tests revealed acidosis. not respiratory In OrIgIn, but pmbably sccondilry to poor perfuslOn. Dr. Caronw stated that she believed that the child was in compensated shock at 4:00 a.m. based upon the record, considerIng that her blood pressure \vas still normal, but her heart n_ltewas h1gh, her extremItIes cool and clammy, weak radial pulses, central perfusion present, high glucose level. prolonged capillary refill. and the results of the blood gas which revealed aCidOSIS. She could not determ1l1e I-he degree of shock Without havlllg examined her to determine If she was arousable and the amount of her urine output. Dr- Caronia then testified that she did not "thlllk it was compensated shock. She's 111 shock," Then she continued, "It's compensated. She's still compensatIng." Dr. Caronla contll1ued that there is compensated shock when the body and ItS mechanisms arc able to Imuntalll perfusion to vital organs, and mallltalll a cellular perfUSIon. A child who is In compensated shock IS able to maintain blood pressure, may be tachycardic, and maintains blood nO\v. Uncompensated (decompensated) shock is when those mechanisms, which arc able to maintalll perfUSIon, and oxygen and nutntional deltvcry to vital orguns, are no longer able to do so. In a chi Id in decompensated shock, the blood pressure Will fall, there \vi II be a decrease in perfUSIon, or worsening of the perfUSIOn to the extremities, urine output may not be there, and the heart rate itself may fall due to lllcreasing acidosis and electrolyte abnormalIties_ She described a lethargic patient as a patient who may be easdy aroused, and when aroused, tYPIcally will be awake and alert and ~Ippropriate. If a paLient has been up all mght, especially a child, or Morphine has heen admimstered, lethargy may be noted. Dr. Caronia stated that a chrld with an infectIon who IS ll1 a septIc Slate and who receIves fluid, espeCially that of a colloidal factor, can develop captilary leak syndrome_ This can cause swelling of the eyelids, or can cause flUid to leak out anywhere there IS a space, such as into connect 1 ve tissue, underneath the skin, genitalia, peritoneal cavity, or the pleural space. This capillary leaK is due to not only the organism which causes the Infection, bUI due to the body's own Immunological inflammatory response to the organisms. Dr. CaroIlla further testl ried that there are many forms of shock, such us hypovolcmic shock, hemorrhagic shock, carcliogenic shock, and septic shock. It was her 0pl111on that the child had septic shock with redistribution, meanmg that It is not only the organism which is causlllg the problem, but the body's own Immunologic or 11lflammatory processes, whIeh continues to worsen the status of thl: patient. The septic shOCKcauses a redistribution of fluid, whetherextracapi llary orex travascular Small clots may form throughout' the vascular systelll. She stated that sept ic shock should be treated WIth rJuld (usually boiuses foll()\ved by recvaluation). treating the 11lfection by removlllg an abscess or aUl1lllllstefing antibiotICS. and giVing supportive care, If deterioration continues. chronotropIC (hean r<lte) support such as epinephrine, InotropiC (pump) support, and vasopressors can he utillzed_ She stateu that at .'):30 :.l.rn., she woulJ have used fluid first, Instead ora vasopressor, as the chIld's blood pressure was 105/4.') and heart rate 146. A third bolus of flUid had been glvell. and her IV l"Iuld vv'aslilcreased one and a halftimes to one hundred and fivecc's per hour at 7:00 a.m. pursuanl to Dr Pleickhardt's order at ).50 a.m. However, that order \vas not picked up hy nurslTlg unti 16:45 a.m. At 5:30 a.m., the child needed 10 be in PICU and to be m0111tored. The 6:00 <I.m. hlood [* 9] Zahir v. Good Samaritan Index No.: 33245/2006 Pitgc 9 Hos». ct al. pressure 1Il PICU was 80/60. Dr Caronia testi ried that upon confirmation of thIs blood pressure, she should have been notIfied. She stated that Dr Pleickhardt, as a thlrd year resident, could evaluate and care for the patient. Shc continucd, though, that if she had known that the chlld already received multiple boluses of flLlld, that a colloid (Albumin) would also have been added. Dr Caronia stated that when she anived at the PIeU, she met wlth Dr. Plelckhurdt, examIned the child, spoke to the father and the nursing staff, attempted to stmi a second IV, and gave some verbal orders about fluids. The chdd then went to the operating room. When she exammed the child, she noted that she was sedated, had cool periphery, was acidotic, responded appropriately to questions, complained of being thirsty, had swollen eyelids, clear lungs bilaterally with good aeration, but had poslti ve Kussmaul breathing I . She ordered a lluid bolus sometime hetween 7 :00 a.m. and 8:00 a.m. after she examined the chJld. Albumlll was given at 8:00 a.m. Dr. Caro111a opined that It was not a departure from the standard of care for her not to order or admilllster treatment With a vasopressor at 7:00 a.m. Dr. Caronia did not know if she or Dr. Moyer ordered Morphine t·o be given to the m/'ant at 7:45 a.m.,.Iusl prIor to the chJld gomg to surgery, and stated that she did not know if It was appropnate to order the Morphine. Dr Caronia stated that when she was in the operating room, she spoke to Dr. Blanco and to Dr. Schwart/:, and asked that a central line be placed for postoperative management. She did not helieve she spoke to Dr. Schwartz In prelJ, although he wrote a note at 7:00 a.m while the chIld was stllllJl Plel!' \vhlch note she stated she did not revtew. Her note mdiealed the chdd was Critically 111 and needed emergency surgery. After she left the chlld in the holding area, she returned to PIelJ \vhen she was summoned to return to the operating room as the child was coding. CPR was Initiated by Dr. Rosenthal at 8 59 a.m. After the child died, she wrote a note whIch indicated the CBC reveuled "WBC with left shtft" indIcting neutrophils or segmented white blood cells, typlcully more Inellc'lll ve of hacterialll1fection. It was her 0plllion that she could not have done anything di fferently With respect to the c~lre of the child. Dr Blanco testJl'ied to the extent that he is hcensec!to practice mediCine in New Yurk Slate and is board certification 111 anesthesiology. He stated that Kiran Zuhir arrived 111 the holdlllg area of the operating room at about 7:45 a.m. He was in the opcratlllg room on another cuse with Dr Schwart/, and saw the child in the holding room al about 8:30 ,-un He was gIven a report by Dr Rosenthal and the olher inlensl V1SI", and was adVIsed that the chIld had been admItted the I1lght before due ("() three day hIstory of fever or 104, and that appendicitis was to be ruled out. Dr. Rosenthal a advised him that she felt the child needed a CYP line lllserted because she was behind In fluid and :ll"e IDr. ('aronia testified that Kussillal breathing is a type ofbrealhing trying to hlo\'" oil carbon dioxide \lr acid from the metabolic component would l.,liminale Illc Kussmal bl"cathll1g. lhat a pal.iellt ha.s when 11wy Getting rid of the acidosis [* 10] Zahir v. Good Samaritan Index No.: ~,3245/2006 Page 10 Hosp. ct al. could possIbly be gomg into shock He revlcwcd the chart and the labs, assessed the chIld, and reviewed her viral sIgns. He found that the child was .lust barely arousable, had an llTcgular heartbeat of 150, the respmHory rate was 33, double what It should be, and that she had a low blood pressure of 80/55. He assessed that the chlld was severely lll, and v.'us either in shock or gomg mto shocK. He classll'ied her condition as 4E. The worst condltion IS a 5, and E is emergent. He tcstll'ied that the blood gas taken at 4:40 a.l11. revealed a PH of 7 12, mdicating that she had either metabolic or reSpIratory UCldoS1S_ Dr. Bianco testified that he depends upon the surgeon to tell hIm whether the patient is physically or chmcaJly 111 need of an appendectomy. Dr. Schwartz advIsed h1ll1 th<.ltthe chlld had appemlicltls and needed surgery. Dr. Blanco asked ;.lllother anesthesiologist, Dr. Richard Moore, to assist hll11 as he thought the ehlld \\/as severely ill and that he might need a hand. He proceeded to Induce anesthesiu after taking vital slgns and placing a laryngoscope to Intubate her He thought her blood pressure would drop after he mclueed her, and It (lId drop from 83/41 to 50-60120. Her heart rute also dropped from about: 150 to 70 or 60, so he admimstered ephedrine about fi ve minutes after inducing her He testified that he did not think that the blood pressure and heart rate would drop as much as II dId. A code was then called at 8.59 a.l11. Chest compressions wcre started by Dr. Rosenthal. He adrmnistered emergency medications, 1l1cluding Dopamll1e and Dobutamll1c. Dr. Caro1lla admi1llstered eplnephrinc. CVP and A-hnes were established. At 9:30 a.l11., the child's heart rate \vas 130 and blood pressure [ 15/80, indicatlllg she was stabil1zed. Ilctastarch, a synthetic volume expander was given to replace l1ltravascular flUId which was escaping into the lllterstilial spaces Thereafter, the ChlId's vital signs began dropp1l1g slowly. At 10: II a.m., her blood pressure was barely palpable, her oxygen saturation dropped to SO(}(>, and her hcurt rate became low. An echocardlOgram showed little heart contractll1ty due to pencardial ctTuslOn whIch was tapped. Calci um was gi ven. She was thereafter dcfibri llated without capturc. Kiran Zahir was pronounced dead at IOAl a.m. It is noted that rhe causc or dcath listed on the Autopsy Report of May 9, 2005 hy James C Wilson, M.D. is "Acute VIral syndrome affecting heart lIver and lungs." Bruce Grccnwalcl, M D., the ex pert phYSICIan ror Elizabeth Plelckhardt, M.D., has subml tted his arhrmation in \VhlCh he affirms that he is lIcensed to practice medicIIlc in New York anells board certIfied III pediatnc cntical care meelicine and pediatrics. He docs not l11dlcate WIth any specd'icity which materials he reVIewed, except to state that he revIewed" the pleadings, Bills of Particulars. perti nent medical records and depOSItIon transcn piS ol"the parties." He does not set forth hIS training and work experlencc to Cjual1fy as an expert In thIS m~ltter. however, pJallltlfls have nor 1l1terposed an ohjectiul1 thereto He set forth his opInion with a reasonable degree of medical ccrtainty that lhe care and treatment provided to the child by Dr. Plelckhardt was at all tImes in accordance with good and accepted standards of care for a pedIatriC reSIdent. and that there were no departures or deVIations from the standards of care on her part which caused or contTi buted to Kiran Zahi [-'s death. [* 11] Zallir v. Good Samaritan Index No.: 33245/2006 Page 11 Aosl>. et al. Dr. Greenwald set forth the care and treatment rendered to Kiran Zah1r by Dr. \l1lela and Dr. Rogu upon her admIssIon to Good Samaritan Hospital emergency department on December 14, 2004 at 1:27 p.m. for complaints of nght abdominal pam and fever. He further set forth the testing ordered and the findings upon evaluation, Including the workJng dlagnosls or UTI (urinary tract lllfeetion) versus appendicItis. At 11 :00 p.m., Dr. Schwartz, the attending surgeon, was called Into evaluate the child. Dr. Rogu. the emergency room physicwn, momtored the child while she \.','asin the emergency room and ordered antibiotics intravenously at 4:00 a.In. December 15,2004. After reccivlllg the result's of the CT scan of the abdomen, Dr. Rogu decided to admIt the chdd to rlcu and notd'ied Dr Caroma, the attending pediatnc intensivist for PICLJ, of the test results. Dr. Schwartz reexammed the child at about 5:00 a.m. on December 15,2004. Elizabeth Plclckhardt, M.D., the pediatric resident on call for pediatnc ICU admIssions at 5::10 a.m., spoke to Dr. Rogu, completed an admitting history and physIcal exammation, documented her findings, the aVailable lest results, and her <lssessment and plan. Dr. Plcickhardt discussed the patient with Dr. Caronia and Ihey formulated lhe plan of' trealment together. Dr. Pleickhardt wrote her admission note and adrlllttlllg orders at 5::10 a_m The chJld was transfelTcd to PICU at 5:40 a.m Dr. Pleickhardt remained 111 allendance in prell until 7:00 '.l.Jll, December 15, 2004, when her shift ended. Dr. Greenwald stated that at all limes dunng KHan Zahlr's admission to Good Samaritan Hospital on December 14 and 15,2004, her care and treatment was under the superVIsion, direction, and control or the attending physicians in the emergency room, rrCLl, and operating room. He continued that, as a pediatric reSIdent physIcian lJl traimng III December 2004, Dr. Plelckhardt proVIded mccl1cal care to patients under the supervIsion and control of attenclmg physicians \ovhile the chi ld was in the emergency room on December 15, 2004 between 5:30 a.In. and 7:00 'l.In., and In PICU under the supervIsIon and control of the pediatric intensi vist, Catherine Caronia, M.D. Dr. Greenwald stated that Dr. Caronia was in charge or patients In the PICU and wus responsible 1'01' thc medical care provided by Dr. PlclCkhardL AdditIOnally, during that time, the chIld \vas also seen and evaluated by Dr. Schwartz, the attending surgeon Al 7:45 a_Ill., the management of care was transferred to Dr. Schwartz and Dr Bianco. Dr. Plctckhardt did not participate in lhe chJld's Illanagemcnl and care aftcr 7:00 a.m on December 15,2004. Dr. Greenwald opined that Dr Pleickhardt' acted in accordance \vlth the standard of care and her responslbtlrties as a resldentlll obtainmg a detaJleu and appropriate history. He continued that she performed a complete and approprl:J.lc physical examInation, as was reflected by the documentation contained in her -'i:30 a.m. note of December 15,2004. Based upon the history and physIcal examinatIon findings. and review of lest results, including blood gases obtamcd at 4:42 a.Ill .. CBC With differential and biochellilstry panel, urinalYSIS and abdominal CT Scan, Dr Plclckhardt's assessment was acute rebrile Jllness, moderate dehydration, and metabolic acidosis 01" unclear etiology. In accordance wnh the st·andard of care and her responsibilities as a pedialric rcsldcnt, Dr. Pleickhardt communJcated WIth her supervIslIlg attending physician, Dr. Carollla, to report the findll1gs, avwlable lest results, and assessment of the child's condition and course in the emergency department. She then entered orders for the aclrll1ssioll of the chIld 10 rIel) at -'i ::'i() a.1ll. [* 12] Zahir v. Good Smnarilan Index No.: 33245/2006 Pagl' 12 Hosp. et al. Dr Greenwald opined that Dr. Pleiekhard!'s assessment of the child's condition at 5:30 :.l.m_was reasonable and appropliate based on thc information obtained by her and available to her at the time. including consultation wIth the emergency department attending, Dr. Rogu. Dr. Greenwald further opined Ihat Dr. Plcickhardt initially considered "dcvelopmg shock'· as pal1 of her assessment, and calTceted her notc to delete shock from the assessment because it was her opinion that the child was not clearly In shock at the time she saw her, as supported by thc avai lable information that the child was aleJ1 and Olientcd, had urinated in the emergency room, and that her blood pressure was within an accepted and normal range for a seven year old child. None of the attending physicians who managed the child's care in the emergency room, PICU, or holding area of the operating room, documented a diagnosis of shock. From 5:30 a.m. through 7:00 a.m on December 14, 2004, therc was no mdication to mtubate the infant or to imtiate vaso-pressor medication as the chi ld was not in respiratory fai lure, her blood pressures werc acceptable, there was urine output at 7:00 a.m., and she was oriented and appropnately responded to questions and made complaims. Dr. Greenwald stated that Dr. Plcickhardt's !!lllial plan of care and admission orders, made In c(lnsuIt~ltion with, and under the supervIsIon of Dr. Caronia, were appropriate and properly provided for appropriate intravenous lluids, continuous cardia-respiratory mOllltoring, temperature and neuro checks, strict Illtake and output, and additional laboratory work. Repeat boluses of intravenous fluid as needed was Included in Dr. Pleickhardt's plan of care at 5:30 a.m. At 8:00 a.m., one hour arter Dr. Plelckhardt' s shi ft ended, Dr Caronia made the determi nation to administer thesc fluid boluses. Dr. Greenwald stated that the deCIsion or whether to treat the child with sodium bicarbonate, based upon the Initial blood gas results at 4:42 a.m. received by the emergency department, was the rcsponsll)J!lty of Dr. Rogu, and 110t Dr. Pleiekhardl. When Dr. Pleickhardt appropriately reported the results to Dr. Carom a, the deCision to admJllistcr treatment WIth sodium hlC,Jrbonate was then the responsibility or Dr Caronia. Dr. Greenwald concluded that Dr. Plclcl\hardt did not exercise any medical judgment· in connection wi th the medical services provided hy her to the child whu was under the superVision and control of the attending physician, Dr. Caroni'-l. between .:"i:10 a.l11. and 7:00 a.m. on December 15, 2004. Upon review of the evidentiary submiSSions, it IS determined that Dr. Pleickhardt has demonstrated prill/a facie entitlement to summary Judgment dismissing the complaltll. The ad11l1ssible eVIdence demonstrates that Dr. Plelckhardt did not depart from good and accepted pedli.ltric and medical standards of care: thut she did n01 proximately cause or contribule to the infant plalnti ff's injuries: that she acted under thc direction of the :lncnding physicians: she did not exelusc any independent judgment: and that dwing her care and treatment of the infant. the physicians did not deviate so greatly from normal practice that she was responsible to lIltervClle. To rebut a prill/alacif! showing of cntitlement to an order granting summary judgment defendants. plaintiff must demonstrate lhe eXistence of a triable issue of fael by submitting hy all [* 13] Zahir v. Good Samaritan Hosp. et al. Index No.: _U2-15/2006 Page U CXpCI1" aflldavlt of mcrit altcsting to adeviation or departure from acccptcd practice, and contaimng s an opinion [hat the defendants' acls or omIssions were a competent-producing cause of the injuries or the plaintitT (see Lf<ihitz v Beth Israel Mell. Ctr . ¢Killgs Highway Dill., 7 I\D3d 759, 776 NYS2cJ 907 [2d Dept2004!: DOlllaradzki v Glen COlle OIJ/GYN A.\"socs., 242 AD2d 282, 660 NYS2d 739 12d Dept 1997]). As set f011h in Feinberg v Feit, 23 AD3d 517, 519, 806 NYS2d 661 (1ct Dept 20(5), "[s]ummary judgment 1Snot appropliate 111 medical malpractice action where the parties a adduce conflicting medical expert opin1ons (citations om1tted). Such credibility Issues can only be resolved by Cl.1Ury." The rlaintil'fs have submItted the affidavit of their expert phys1cian, w1th the physic1an's name and the notary redacted.l The plaintiffs' expert' averred that he is licensed 10 practlce medic1I1c in Massachusetts ,mc! is board certified in general pediatrics and pediatric Critical cure medicine. He set forth 1m training :.lnd experience and the records :.lnd reports reviewed, mcluding the uutopsy report. He opined with a reasonable degree of medical ce11ainty that Dr. Plclckhardt depm1ed from good and accepted standards of medical practic.:e by failing to promptly and accurately rep0l1 Kiran's condition and symptoms to Dr. Caronia al 5:30 a.m. and failing to ask Dr. Caronia to come to the hospital immediately as the child was clearly in circulatory shock. He fmther opined that it was a departure from the standard of care for Dr. Pleickhardt not to diagnose CIrculatory shock when she examined the child at 5:30 a.l11. The plmntilT's expert opined that circulatory shock IS a syndrome in which there IS an inadequate deli very of oxygen to the tissues of the body, causing the body to inelTecti vely metabolIze sugar 10 generate energy, causing a bui Id up m lactIC acid resulting in metabolJc acidosis. This bui ldup is best detected by either measunng an elevated level of lactic acid or a decreased level or serum blcurboIwte in the blood. findings consistent with circulatory shock arc tachycardia, lethargy, cool and clammy sk111,elevated resp1ratory rate, metabolic acidosis, weak peripheral pulses, delayed caplllary ref1l1, and decreased urine output. The plallltiff's expert noted that when Dr. VJleia examined Klran at 6:50 p.m., she already had symptoms of shock, to wit, cool and clammy 5k111, rapid heart rate and thrcudy pulses. If this constellation of signs and symptoms. opined plaintifls' expert. IS present, and lhe blood pressure remains in the normal runge, the patlent is said to he in compensated shock. He continued that decompensated shock ensues when the blood pressure becomes inadequate. Hypotension is usually a late finding in children because they arc able to sustalll the tachycardia for much longer than adults because theIr hearts arc so healthy. 21\ signed LOPYof pl'linti ITs' expert affirmation has h<.:cnsubmitted to this eourl for in C:lml'ra inspection IManlll(ll'Mercy llospital. 2-1-1AD.2d -I-812d DCpl 19981; McCarty v. COII/mlil/ity limp. oIG/ell Cove, 203 I\.D.2d 432 [2d DCpl t99-1-1) [* 14] ZHhir \'. Good Samaritan Index No.: 33245/2006 Page 14 Hosp. et al. The plaintiffs· expcI1 also opined thai It was a departure from the standard of care when Dr. Plelckhardt examined Kiran at 5:30 a.m. and did not obtain her own vital signs instead of recording signs obtained the day before: failed to order additional boluses of fluid to restorc perfusion: failed 10 order vasopressors at 5:40 a.m.; failed to conect the metabolic acidosis with either sodium bicarbonate or THAM; failed to recognize the need for the child to be intubated to correct the metabolic aCidosIs: failed to order more frequent vit:.ll signs; failed to order more frequent monitoring and documentation of fluid intake and output: falled to adequately assess the child's response to fluid challenges: fuiled to stabilize the child; fai led to adequatel y assess tissue perfusion: and faded to adequately assess volume status, thus contributing to the demise of the chlld. The plaintiffs expert stated that Dr. Plcickhardt crossed out "developing shock" and ehunged il to moderate dehydr:.ltion and did not discuss th:.ltdiagnosIs with Dr. Caroni:.l, who denied speaking with Dr. Pleickhardt until sometime between 7:00 and 7:30 a_m. The plaintifFs' expert opined that Kmm should have been admitted to PICU earlier Ihml she was admined, and that she needed a cenlral venous c:.ltheter 10accurately monitor the adequacy of flll1d resuscitalion. He continued that Ihe child's condition deteriorated between 5:30 a.m. and 7:00 a.m., as evidenced by her decreasing blood pressure and persistent metabolic acidosis. evidencing decompensaling shock. It is the plaintiffs' expert's conclusion that if Kiran's shock had been timely diagnosed and aggressively trealed, perfusion to her vital organs would have been restored and she would have survived. Based upon the opinions of the defendant's and plaintiff's experts, there arc factuallsS11eS concerning whether or not Kir:.ln was in circulatory shock at 5:30 a.m. when Dr. Pleiekhardt examined the chi Id. However, it is detcrmined thai plainli rfs' expert '5 opi nions do not cstabllsh that Dr. PlelCkhardt '5 alleged departures were the prox imate or subslantial cause of the infant's demise. The plullltdls' expert's Opi1ll011S ith regard to proxllnatc cause are conclusory and unsupported. w The plalntl ITs' expert docs not address Ihe cause of death sel forlh in the aUIOpsyreport: "acule VI ral syndrumc :.lFfectl11geart. bver and lungs" to proximately reIale the child's death 10Dr. Pleickhardt h While pla11l11 ex pert stated thai (he chi Id's condition waS deterIorating between 5<~0unci ffs' 7:00 a.Ill., as evidenced by her decreased blood pressurc and persistenl mctabol ic acidosis. he does no! sUPP0l1this opinion with Ihe blood pressure readings, and inste:.ld stated that there were no vilal signs laken between 6: 15 a.m and 8:00 a.m. Thus. his opinion that the blood pressure was decreasing is unsuPPul1ed by the record. The plaintills' expert Slated that Dr. Pleickhardt failed to order additional holuscs of fluid It)rcslorc perfu<;ion: failed to ordcr vasoprcssors al 5:40 a.m.: fai led to con·CCIthe metabolic acidosis with eilher sodium bicarhonale or THAM: failed 10recognize the need for Ihe child 10 bc 111lUb:.ltcd to correct the metabolic acidosis: failed to order more frequent vllal signs: failed to order more frequcnt monitOring and documentation of fluid intake and output: failed to adequately asscss the chil{fs response 10 fluid challenges: failed 10 stabilize Ihe child: fuilcd to adequ:.ltely assess tissue perfusion. and f,-uledto adequately assess volume status, thus contnbuti ng to the demise of the chIld. [* 15] Zahir v. Good Samaritan Hosp. et al. Jndex No.: 33245/2006 Page 15 However, the plaintiffs' expert docs not set forth the standard of care or how the volume status should have been assessed or the cJllld slabilizecL and the baSIS for such 0pII1l0ns. The plmntill's expert stated that Dr. Plelckhardt crossed out "developlIlg shock" and changed II to moderate dehydration and did not discuss that diagnosis wIth Dr. Carom a, who denied speaking \vilh Dr. Plcickhardt until sometime between 7:00 and 7:30 a.111. However, Dr. Rogu stated she spoke with Dr. Caronla at 4:00 a.m. and Dr. Pleiekhardt stuted she spoke wIth Dr. Curonia at 5·30 a.m. The piaintllTs· expert does not opine that it was Dr. Pleickhardt's rcsponsibi1Jty to admit the child to PICU carher, or that she exerCIsed independent Judgment or acted wIthout bemg under the superVIsIon or direction of the attending physicians. W1l'h regard to the plaintiff's expert's claim that Dr. Plclckhardt should have employed the use of a vasopressor at 5:40 a.m., Dr. Carol1la stated that at 5:30 a.m., she would have used flUId first lnstcau ofa vasopressor as the child's blood pressure was 105/45 anu heart rate 146. A third holus offlulu had been given, and her IV flUId was Increaseuone and" halftimes to one hundred and five cc's per hour at 7:00 a.m_ pursuant to Dr. Plelckhardt's oreler of at 5:50 a.m. However, that order was not pickcd up by nurs1Jlg until 6:45 a.ln. Based upon the forcgomg, the plaintiffs' expert docs not opine that Dr. Caronia would have permitted Dr. Pleickhardt to admmlster a vasopressor at that lime, nor does he state how Dr. Plelckhardt depm1cd from the standard of care whcn she ordered udditional fluids which were not admlllistered timely by the PICLJ staff. Additionally, Dr Plelckhardt stated that she did not note the chlld's extremities to bc cold and clammy, her respirations shallow, that there was nasal flanng, or that she was haVIng abdominal or chest pain at 5:30 a_m. She testified that fluid boluses had been ordcred and antibiotics administered, which mewlt that the chdd could have beenllTlproving when she examined her III the emergency room, and thus, these findings charted earlier by the nurse had improved with the fluid boluses given. Thus. except for a conclusory assertion, the plallltlils' expert docs not support his 0plllion that a vasopressor should have been employed at 5:40 a. In., or that the chi lei \vas in decompensati ng shock The pL.untills' expert opined that the chlld needed a central venous catheter to accurately 11101litorthe adequacy of flUId reSUSCitatIon. However, even after Dr. Caronia ani ved III PICU about 7:00 a_Ill, a central venous catheter and an A-line were not established until upproximatcly 9:00 a.1ll ,two hours after Dr. Plcickhardt completed her shll'1. The plaintiffs' expert continued thaI the chi ld's condition deteriorated between 5:;\0 a.111.and 7:00 <1.111., eVlc!enecd by her decrea~1 ng blood as pressure and pcrsistcnlllletaholic aCldoslS, eVidencing decompensating shock. The plailltll"!"s' ex perl docs not support this opinion with eVIdence of decreusing blood pressLlre~ hetween 5:30 a.m. and 7:0() a,m. or adclit-ional blood gas studies to demonstrate changes or worsening metuholJc aCIdosis Based upon the foregOing, It IS deterlllllled that pla1l1tiff's expen has not r~lIsed any r,lclual Issues to prcclude ~ul1lm:,lry Judgment being granted to Dr Pleidhardt. He has not raised factual Issue as to any alleged departures by defendant Dr. Plelekhardt beIng the proxllnate cause of Kurin 7:aI1l1"· death. The plainti ffs' ex pen has not cstahhshed that Dr. Plelckhardt exercised independent s [* 16] Z<lhir v. Good Sumaritun Index No.: 33245/2006 Page 16 Hosp. et al. Judgment. Nor hus he established that Dr. Caronia so greatly devJated I'rom normal practice that Dr. Plclckhardt should be held liable for failing to intervene. Accordingly, summary Judgment as asserted against her is dismissed. lS granted to defendant Dr. Plclckhardt and the complaint Dated: HON. WILLIAM B. REBOLlNI, .I.S.c. FINAL lJISI'OSlTlON X NON-FINAL DISPOSITION [* 17] RIDER Attorney for Plaintiff: Brian Neary. Esq. Elm Street lIuntington. NY 11743 so for Defendants Good Samaritan Hospital Marv Gid2:ct Vilcla. M.D .. Delia Rm~u. M.D .. Marion Rose. M.D .. Cathenne Caronia. M.D .. Donakl Mover. M.D .. Cynthia RosenthaL M.D .. Michael Bianco. M.D. and Hafiz Rehman. M.D.: AtlOlllCV Bower & Lawrence, P.C. 261 Madison Avenue 121h Floor New York, NY 10016 Defemh.ll11 Pro Sc: M~lrk SChW<l11Z, M.D. 229 Shoreward Dn ve Gre,l! Neck, NY 11021 Attorney for Defendant Elizabeth Plcickhardt. M.D.: Muntfort, l"k,lity, McGUIre &Salley 1140 Pranklin Avenue Garden CIty, NY 115;;0 Clerk of the Co un

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