Mazella v. Beals

• Court: New York Court of Appeals Court of Appeals
• Writing for the Court: RIVERA, J.
• Citation: Mazella v. Beals, 2016 NY Slip Op 5182, 27 N.Y.3d 694, 57 N.E.3d 1083, 37 N.Y.S.3d 46 (N.Y. 2016)
• Decision Date: 30 June 2016
• Parties: Janice MAZELLA, as Administratrix of the Estate of Joseph Mazella, Deceased, Respondent, v. William BEALS, M.D., Appellant, et al., Defendant.

27 N.Y.3d 694

57 N.E.3d 1083

37 N.Y.S.3d 46

2016 N.Y. Slip Op. 05182

Janice MAZELLA, as Administratrix of the Estate of Joseph Mazella, Deceased, Respondent,

v.William BEALS, M.D., Appellant, et al., Defendant.

Court of Appeals of New York.

June 30, 2016.

Gale Gale & Hunt, LLC, Syracuse (Kevin T. Hunt of counsel), and Meiselman, Packman, Nealon, Scialabba & Baker P.C., White Plains (Myra I. Packman of counsel), for appellant.

Alessandra DeBlasio, New York City, and DelDuchetto & Potter, Syracuse, for respondent.

OPINION OF THE COURT

RIVERA, J.

In this medical malpractice and wrongful death action, we conclude that the trial court erroneously admitted evidence concerning defendant's negligent treatment of 12 other patients, and that this evidence tainted the jury's deliberative process. On the facts of this case, the trial court abused its discretion by admitting evidence that was irrelevant to defendant's liability and that unduly prejudiced the jury. Therefore, the Appellate Division should be reversed and a new trial ordered.

I.

Plaintiff Janice Mazella commenced the instant action against defendant William Beals, M.D. and codefendant Elisabeth Mashinic, M.D., claiming that their substandard medical treatment of her husband, Joseph Mazella, proximately caused his suicide. At trial, defendant Beals admitted he deviated from accepted medical practice by prescribing decedent the antidepressant drug Paxil for over a decade while failing to adequately monitor his condition. However, defendant Beals maintained that he was not liable for malpractice because superceding acts severed the causal connection between his conduct and the suicide, including medical care provided by Dr. Mashinic. For her part, plaintiff argued that defendant Beals' treatment and conduct towards decedent was a contributing factor leading to decedent's death. A jury found defendant Beals solely liable and he now appeals.

Defendant began treating decedent in October 1993, when he diagnosed him with major depression, obsessive-compulsive disorder (OCD) and generalized anxiety disorder. Defendant prescribed 20 mg of Paxil and eventually discontinued decedent's antianxiety Klonopin medication, previously prescribed to decedent by his family physician. In April 1994, defendant tapered off decedent's Paxil dosage and instructed decedent to discontinue it the following month, and to call him if there were any problems.

Decedent next contacted defendant on April 7, 1998, following an episode of depression. Defendant concurred with the recommendation of decedent's family physician that decedent should be placed on the antianxiety drug Ativan and 40 mg of Paxil. Within a few weeks decedent showed improvement and defendant reduced the Ativan dosage, eventually discontinuing it within the month. Defendant also reduced decedent's Paxil dosage to 20 mg.

For more than 10 years, defendant refilled the prescriptions for Paxil by telephone or facsimile, without seeing or examining decedent. Then on August 9, 2009, decedent called defendant complaining about anxiety, an increase in obsessive thoughts, and difficulty sleeping. Defendant, who was away on vacation at the time, was unable to see decedent but instructed him to double the Paxil dosage to 40 mg. He also prescribed the antipsychotic medication Zyprexa, for decedent's anxiety and sleep problems. The following day, on August 10th, decedent and plaintiff called defendant. They told defendant that decedent was pale, nauseous, and light-headed, and did not feel well. Defendant instructed decedent to double the Zyprexa and that he would call him the next day in the late afternoon.

On August 11th, plaintiff observed decedent's condition worsen and she took him to the emergency room. After decedent was cleared medically he was transferred to the hospital's Community Psychiatric Emergency Program (CPEP) for overnight observation. According to the hospital records admitted into evidence, decedent complained of suicidal ideations, difficulty sleeping and controlling his thoughts, and feeling as if his body was on fire inside. That night he was taken off Zyprexa and given Ativan. Upon his discharge the following day, decedent was told to discontinue Zyprexa, take Klonopin, and reduce his Paxil dosage to 30 mg.

For the next five days decedent appeared stable. On August 17th, plaintiff and decedent visited defendant, now returned from vacation. This would be the last time defendant had contact with decedent before the suicide.

Both parties presented differing accounts of decedent's August 17th visit to defendant's office. According to plaintiff, defendant's conduct had a devastating adverse impact on decedent's condition. Plaintiff testified that defendant yelled at them, and that he appeared angry that she had taken her husband to CPEP because defendant viewed this as decedent trying to get help from someone else. She also claimed that defendant degraded decedent, accusing him of not taking more Paxil in the past “because [decedent] couldn't get an erection.” In response to defendant's comments, decedent pulled his shirt over his head, even while plaintiff tried to comfort him. According to plaintiff, defendant abruptly ended the session by standing up, waving them off and telling decedent, “Just go to CPEP. That's where you belong.” Plaintiff further claimed that defendant “threw [them] out of his office. He turned his back,” and never said goodbye. When decedent left he was a “crumbling mess,” and went to CPEP because he believed defendant was refusing to take care of him.

In contrast, defendant testified that during the August 17th visit, decedent was unresponsive and cried, and that when decedent spoke he was very upset because he felt that his wife thought he was acting like a baby. It was also the first time decedent could not assure defendant that he would not act upon his suicidal thoughts. Defendant advised decedent that the only option left was inpatient treatment at CPEP. Decedent rejected this advice because he did not want to be seen in a local psychiatric facility, and because decedent felt he could not go a period of time without working. Despite the differences in their respective accounts of the August 17th visit, defendant corroborated plaintiff's testimony that decedent pulled his shirt over his head, adding that decedent had been sobbing, and that he had never seen decedent act this way. He also admitted that he raised his voice, but claimed that he did so to emphasize that he could not be sure outpatient treatment would be adequate to address decedent's suicidal thoughts. Defendant testified that decedent eventually agreed to go to CPEP, and, as far as defendant knew, decedent remained his patient.

There is no dispute as to what happened after decedent last saw defendant. Decedent went to CPEP later that day and, while he initially declined inpatient care, after he complained of being suicidal he was placed on 15–minute safety checks for the next 27 hours and his access to “lethal means of suicide” was restricted. The following day, August 18th, he complained of feeling hopeless and worthless, and repeated that he would kill himself. His medications were adjusted and he was discharged.

After a difficult and restless night, decedent returned to CPEP on August 19th. He was administered Ativan, and placed on 15–minute safety checks for about 12 hours. That evening he was involuntarily transferred to the psychiatric unit at Auburn Memorial Hospital.

On August 20th, decedent met with Dr. Mashinic. She adjusted his medication and placed him on a multidrug regimen of increased Paxil, Klonopin, Zyprexa, Ativan, and another antipsychotic drug. That night, after Dr. Mashinic discontinued the one-on-one suicide watch, decedent attempted suicide by tying the belt of his hospital gown around his neck. Dr. Mashinic reinstated the suicide watch, and again changed decedent's medications, replacing Paxil with another antidepressant, and added Risperdal. Over the course of a week, doctors at Auburn adjusted decedent's medications as he continued to complain about anxiety and depression, and increased repulsive thoughts of a sexual nature. At times he reported a decrease in depression, but still complained of difficulty sleeping and relaxing.

Decedent was discharged on August 27th, and referred to the Brownell Center for outpatient psychiatric care. Brownell had a three-part screening and intake process, which decedent commenced on September 3, 2009, when he met with a social worker. At this time he complained of suicidal and obsessive sexual thoughts. During his second intake visit, on September 9th, he met with a psychotherapist and told her that everything was overwhelming, that he felt “as if someone ha[d] ‘taken his brain out,’ ” and that he had “suicidal thoughts come and go.” The Brownell psychotherapist scheduled an accelerated third intake appointment for September 11th. However, Brownell was unable to obtain decedent's previous medical records in time for this appointment. As a consequence, on September 11th decedent met instead with an independent licensed social worker and psychotherapist recommended by a family member. Decedent told the psychotherapist that he had suicidal thoughts, but could not act on them because of his daughters. The psychotherapist concluded decedent was not at risk of committing suicide and made plans to check up on him the next day.

As it turned out, decedent did not have any further contact with any medical professionals. Early on September 12, 2009, decedent went to his garage and committed suicide by stabbing himself with a knife. Shortly after, plaintiff found him there, face down in a pool of blood.

II.

In June 2010, plaintiff, as administrator of decedent's estate, commenced this medical malpractice and wrongful death action against defendant and Dr. Mashinic. She alleged that defendant's treatment of decedent was negligent, as demonstrated, in part, by his failure to properly prescribe and...