Dantzig v. Mueller

• Decision Date: 14 September 2022
• Docket Number: Index No. 805253/2018,Motion Seq. No. 017
• Citation: 2022 NY Slip Op 33119 (U)
• Parties: PAUL DANTZIG, Plaintiff, v. RICHARD L. MUELLER, M.D., and PRAMOD SANGHI, M.D., Defendant.
• Court: New York Supreme Court

2022 NY Slip Op 33119(U)

PAUL DANTZIG, Plaintiff,
v.
RICHARD L. MUELLER, M.D., and PRAMOD SANGHI, M.D., Defendant.

Index No. 805253/2018, Motion Seq. No. 017

Supreme Court, New York County

September 14, 2022

Unpublished Opinion

MOTION DATE 06/21/2022

DECISION + ORDER ON MOTION

HON. JOHN J. KELLEY J.S.C.

The following e-filed documents, listed by NYSCEF document number (Motion 017) 332, 333, 334, 335, 336, 337, 338, 339, 340, 341, 342, 343, 344, 345, 346, 347, 348, 349, 350, 351, 352, 353, 354, 355, 356, 357, 358, 359, and 379 were read on this motion to/for JUDGMENT - SUMMARY .

I. INTRODUCTION

In this action to recover damages for medical malpractice based on alleged departures from good and accepted practice and lack of informed consent, the defendant cardiologist Pramod Sanghi, M.D., moves pursuant to CPLR 3212 for summary judgment dismissing the complaint insofar as asserted against him. The plaintiff opposes the motion. The motion is granted, and the complaint is dismissed insofar as asserted against Sanghi.

The crux of the plaintiff's claims against Sanghi is that Sanghi failed to diagnose mitral insufficiency, failed to perform a proper stress test, failed correctly to read a coronary computed tomography (CT) scan, placed a stent in his heart despite being contraindicated by virtue of his rheumatoid arthritis, and inappropriately installed an improperly sized stent in any event. The plaintiff further alleged that Sanghi failed to obtain his informed consent for the procedure. In addition, he alleged that, as a consequence, he sustained scapholunate advanced collapse (SLAC)-type osteoarthritis of the wrist, necessitating two surgeries.

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II. FACTUAL BACKGROUND

On February 15, 2018, the plaintiff presented to internist Omid Nikrouz, M.D., complaining of intermittent irregular heart palpitations. Dr. Nikrouz formulated a plan including blood laboratory testing, a referral for Holter-monitor heart-rhythm testing, and a stress electrocardiogram (EKG) to rule out coronary artery disease. Sanghi first saw the plaintiff on February 21, 2018, at which time the plaintiff reported that he had heart palpitations for the prior month, was suffering from fatigue while exercising, and evinced cyanotic, or blue-tinted hands. According to Sanghi, the plaintiff presented with palpitations, hyperlipidemia, premature ventricular contractions (PVCs), EKG abnormalities, including a prolonged QT wave, dizziness, chest pain, elevated levels of triglycerides and glucose in his blood, atherosclerotic heart disease without angina pectoris, aortic valve sclerosis, and mitral valve regurgitation. After the examination, Sanghi memorialized his impressions as "palpitations (cause? arrhythmia,? PVCs), PVCs (? Symptomatic), dizziness/blue hands (? transient cyanosis) and fatigue/decreased exercise tolerance (? cause)," and noted that the plaintiff refused to wear a Holter-monitor or agree to take a beta blocker to decrease his heart rate. On February 26, 2018, the defendant cardiologist Richard Mueller, M.D., who worked in the same practice as Sanghi, saw the plaintiff, and recommended an echocardiogram (ECG), a carotid doppler test, a stress ECG, and cardiac telemetry. According to Sanghi, the plaintiff again refused a beta blocker. The plaintiff did, however, undergo a stress ECG, which resulted in an "equivocally abnormal" finding, and showed a worsening of the baseline ST wave depression, which measured the interval between ventricular depolarization and repolarization.

On February 27, 2018, the plaintiff underwent an EKG with Mueller, who interpreted the result as showing a slightly prolonged QT wave interval, and advised the plaintiff that this finding carried a real, but low, risk of ventricular tachycardia and sudden death. On March 8, 2018, at Mueller's request, the plaintiff underwent a CT angiogram of his coronary arteries at Cardiology Diagnostic Associates/East River Medical Imaging. The test showed that the plaintiff presented

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with a left anterior descending (LAD) artery with multifocal low-density disease in the proximal and mid segments, with a focal stenosis, or constriction of blood flow, estimated at greater than 70% in the proximal segment, a condition that Mueller suspected was likely obstructive. Mueller's plan was to confirm the finding a fractional flow reserve analysis CT (FFR-CT). The plaintiff underwent this test on March 12, 2018, with the results confirming the presence of obstructive arterial disease in the proximal LAD artery.

According to Sanghi, the plaintiff consented to undergo cardiac catheterization, but expressed his desire that it be limited to balloon angioplasty or a coronary bypass, rather than submit to the placement of a stent. Mueller noted that he had repeated discussions with the plaintiff about why a stent was the best procedure and that he should go on a regimen of 12 months of the blood thinner Plavix. Thereafter, the plaintiff exchanged multiple text messages with both Mueller and Sanghi concerning the procedure.

On March 14, 2018, the plaintiff texted Sanghi as follows:

"Hi Pramod, I faxed the labs. Do you have any days available besides Friday? . . . If you are able to do the catherization through my wrist, it shouldn't be any problem driving. . . . But if I just have balloon angioplasty (I'm hesitant on the stent initially unless the blockage is really bad because it'll destroy my life style) it shouldn't be too bad."

The plaintiff followed that up by inquiring "[w]hy not balloon as long as you are in there"? Sanghi responded that he thought that the "best thing is to have the procedure on Friday [March 16, 2018] and we'll just plan on taking pictures only through the wrist. Then we can discuss the options later depending on what we see," later informing the plaintiff that that approach would require the plaintiff to stay in the hospital for a longer period of time. Later that date, the plaintiff informed Sanghi that he had experienced a little sternal discomfort for the previous 7 to 10 days, which he characterized as neither pain nor pressure, and was thus anxious to have the procedure completed. He conceded that he didn't know whether it was related to ischemia, but inquired as to whether another EKG or monitor would be useful, to which Sanghi responded that he didn't think such testing would help. Sanghi informed the plaintiff that, rather, it would be

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best simply to perform the angiogram later that week. The plaintiff agreed to schedule the balloon angioplasty, explaining that he wished to have

"just pictures and balloon if possible. If it would buy me 6-12 months, that would be great-hopefully the [drug] repatha will kick in by then. And if we can do it through the wrist would be great because I have no way of getting home without driving. Obviously, no versed or other sedatives."

Sanghi and Mueller expressly informed the plaintiff that they would place him on their schedule for angioplasty for March 16, 2018, but cautioned him that he should "keep in mind that if [they got] a suboptimal balloon result, then we will have to stent. It's dangerous leaving a suboptimal balloon result in the proximal L[eft] A[nterior] D[escending]" artery. The plaintiff responded that "[h]opefully the balloon with flatten the entire plaque and enlarge the lumen sufficiently." After the plaintiff expressed concern that his recent blood work and radiation put him at risk for additional blood work, Sanghi informed him on March 16, 2018 that NYU Langone Hospital, where the procedure was to be performed, required laboratory test results for blood no more than 30 days prior to the procedure. The plaintiff refused to undergo more blood testing at that juncture. The procedure thus was postponed until March 23, 2018.

The plaintiff and Sanghi had the following text exchange on March 19, 2018:

Plaintiff: "Pramod, does a stent prevent a heart attack or embolus from a ruptured plaque?

Sanghi: "Good question. Yes it does for an individual plaque, but the problem is people have multiple plaques, not all can be seen angiographically. So stenting in general doesn't prevent plaque rupture.

"Also stent thrombosis is an added risk when a stent is placed. It's a low risk but we still see it.

Plaintiff: "This is why I'm leaning toward balloon if possible. I started repatha last week since Crestor is not lowering my I[ow] d[ensity] l[ipids] and if the balloon can enlarge my lumen adequately and I can buy 6-12 months, maybe I can reverse some of the damage with repatha if it lowers my Idl to 20-30 or less. Theoretically, I think it is my best hope for prolonging my life. Let me know what you think. I'm hoping the cath on Friday will make this possible.

Sanghi: "It's a good strategy in general however the proximal LAD is a bit tricky. Risk of restenosis is high after a balloon result and if it happens in the proximal

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LAD it can be life threatening. Cardiologist[s] typically don't recommend Balloon only in the proximal LAD.

Plaintiff: "I'll go by your recommendation but hopefully on visual inspection, it won't look as bad as the ct scan and the ffr"

(emphasis added). On March 20, 2018, the plaintiff texted the following to Sanghi:

"Hi Pramod, I took a dose of repatha 6 days ago and my Idl yesterday was an incredible 10. This is most likely the etiology of my problem. I'm looking forward to the cardiac catherization Friday to see the results especially since the ekg was normal yesterday. I know it's almost impossible to reverse c[oronary] a[rtery] d[isease], but I don't have any extrinsic factors and so maybe I can reverse it enough with my lifestyle and repatha to have a normal life. So I'm hoping ballooning might be enough to open the lumen sufficiently."

After the plaintiff and Sanghi exchanged more than 20 texts, in which the plaintiff reiterated that he...