Steidel v. County of Nassau

• Decision Date: 27 April 1992
• Citation: 182 A.D.2d 809,582 N.Y.S.2d 805
• Parties: Monica STEIDEL, Respondent, v. COUNTY OF NASSAU, Appellant.
• Court: New York Supreme Court — Appellate Division

Page 805

582 N.Y.S.2d 805

182 A.D.2d 809

Monica STEIDEL, Respondent, v. COUNTY OF NASSAU, Appellant.

Supreme Court, Appellate Division Second Department.

April 27, 1992.

Furey, Furey, Lapping, Keller, O'Reilly & Watson, P.C., Hempstead (James M. Furey and Ralph A. Catalano, of counsel), for appellant.

Kramer, Dillof, Tessel, Duffy & Moore, Garden City (Norman Bard, of counsel), for respondent.

Before THOMPSON, J.P., and BRACKEN, HARWOOD and COPERTINO, JJ.

MEMORANDUM BY THE COURT.

In a medical malpractice action to recover damages for personal injuries, the defendant appeals from a judgment of the Supreme Court, Nassau County (Roncallo, J.), entered November 27, 1989, which, upon a jury verdict, is in favor of the plaintiff and against it in the principal sum of $5,048,924.

ORDERED that the judgment is reversed, on the law, and as a matter of discretion, and a new trial is granted, with costs to abide the event.

On March 1, 1980, the plaintiff was admitted to Nassau County Medical Center to give birth to a child. At approximately 5:00 A.M., a first-year resident physician performed an amniotomy, that is, he artificially ruptured the plaintiff's fetal membranes. This first-year resident also ordered the placement of an internal electronic monitor. He left the labor room at approximately 5:03 A.M. Shortly thereafter, a nurse noted the occurrence of fetal heart decelerations and notified the first-year resident, who returned to the labor room at approximately 5:05 A.M.

The first-year resident confirmed the presence of fetal heart decelerations, which he knew could be caused by abnormally strong contractions, and continued for approximately one minute to examine the tracings of the fetal monitor in order to see if the decelerations would stop. The decelerations evidently continued, and the resident determined that an emergency Caesarean section was warranted. The evidence does not establish exactly when this decision was made; the decision was made as early as 5:07 A.M. or as late as 5:09 A.M.

Within approximately one minute, a second doctor confirmed the need for an emergency Caesarean section. The senior doctor ordered the procedure at approximately 5:10 A.M. Preparations for this surgery continued until approximately 5:15 A.M., at which time a Foley catheter was inserted. The plaintiff was brought into the operating room at 5:20 A.M., and the baby was delivered vaginally at 5:23 A.M.

After the baby was delivered, the plaintiff had a seizure. There is essentially no dispute that this seizure was caused by an amniotic fluid embolism. As a result of the seizure, the plaintiff suffered hypoxia and permanent brain damage.

The plaintiff's theory is that if the preparations for a Caesarean section had been speedier, the anaesthetic halothane would have been administered, and the administration of this drug would have averted the subsequent amniotic fluid embolism. In support of this theory, the plaintiff's expert testified that several departures from good medical practice had occurred. He testified that, to begin with, it was malpractice to have had a first-year resident treat the plaintiff. He testified, in effect, that the delay attributable to the first-year resident's need to obtain confirmation of his judgment from a more senior doctor represented malpractice.

This witness also testified that a "departure from appropriate medical practice" was reflected in the delay between approximately 5:10 A.M., when a senior doctor ordered the immediate Caesarean section, and 5:15 A.M., when a Foley catheter was inserted. This witness similarly characterized as a "departure from appropriate obstetric practice" the fact that there was an additional four or five minute delay between 5:15 A.M. and 5:20 A.M., when the plaintiff entered the operating room.

The plaintiff's expert witness also testified that, in his opinion, the anaesthetic halothane should have been administered "immediately", and that the failure to administer this drug "immediately" was a departure from good medical practice. One can only surmise that the witness's opinion is that halothane should have been administered between 5:05 A.M. and 5:07 A.M., that is, as soon as the fetal heart decelerations were first noted by a nurse and when the presence of fetal heart decelerations and strong contractions was confirmed by a doctor. However, this witness's testimony is not precise as to just how "immediate" the administration of halothane should have been.

With respect to causation, this witness was permitted to testify, over objection that, in his opinion, "each of [the several departures, including those noted above] in and of themselves [were] causally related to the brain damage [ultimately suffered by the plaintiff]". The defendant's attorney repeated his objection and, upon further interrogation by the court, the plaintiff's expert stated that "[m]y opinion is that * * * tetanic uterine contractions are oftentimes [the] precursor of amniotic fluid embolism which can cause severe brain damage".

The plaintiff's attorney then resumed his examination on the issue of causation, asking his witness whether the "appropriate medical practice that you described to the jury here this morning [was] to avoid just the type of thing that occurred here?" The witness responded affirmatively. Later, on redirect examination, the plaintiff's expert testified that it would be reasonable to "associate" the occurrence of an amniotic fluid embolism, on the one hand, with tetanic uterine contractions experienced during labor, on the other.

In its charge, the trial court did not itemize for the jury any of the several alleged departures which the plaintiff's expert testified had occurred and failed to submit a verdict sheet which would have allowed the jury to pass judgment on each of these separate allegations. Since the jury was not instructed to identify any alleged...