In April 2017, New York medical malpractice plaintiff E. Ann Holland was delivered by ambulance to defendant Cayuga Medical Center symptomatic of a stroke. After a CT scan revealed that she was indeed suffering a stroke in the left cerebral artery and that it was ischemic in nature, the physician on duty prescribed that she be treated with 90 milligrams of Alteplase (“tPA”) by infusion, and directed that it be administered so that Holland received 10% of the medication in the first minute, with the remaining 90% dispensed over the following 60 minutes. However, rather than program the machine to dispense the initial bolus in “1” minute as prescribed, a nurse programmed “11” causing the machine to be set to dispense 9 milligrams per minute for 11 minutes. After approximately three minutes, the mistake was discovered, the dosage was recalibrated, and the machine reset. However, approximately 30 minutes later, Holland showed signs of significant distress and the tPA was discontinued. A second brain scan was then taken to detect any hemorrhaging, but none was found, and an MRI taken the following day revealed that clots remained in her left hemisphere. Ultimately, Holland does have aphasia and comprehension limitations.

Holland and her spouse, derivatively, commenced a New York medical malpractice action alleging the misadministration of the tPA resulted in injuries to Holland. The defendants moved for summary judgment dismissing the complaint, asserting a lack of proximate cause between the dosage error and Holland’s injuries. The plaintiffs opposed the motion and cross-moved for summary judgment or alternatively to preclude the defendants’ expert witnesses. The New York Supreme Court, addressing the plaintiffs’ claims as sounding in medical malpractice, denied the motions, finding that the conflicting medical opinions raised issues of fact precluding summary judgment. The defendants appealed from the portion of the order denying their motion for summary judgment.

In its Decision entered on June 17, 2021, the New York Supreme Court Appellate Division, Third Department stated: “For plaintiffs to satisfy their burden, it was incumbent on them to submit their own expert affidavit raising a question of fact with respect to these issues. Plaintiffs submitted the affidavit of Richard Lechtenberg, a board-certified neurologist. In this affidavit, Lechtenberg opined that Holland did not receive the proper tPA dosing and that this breach deviated from the applicable standard of care. He further stated that because Holland was given an improper dose, she was deprived of a substantial possibility of a better outcome, up to and including a 100% recovery. Additionally, Lechtenberg specifically states that Holland “experienced a worsening of her stroke likely caused by progression of cerebral ischemia and clots evolving/propagating from her stroke condition,” and that the “specified tPA treatment [could have] prevent[ed] the stroke worsening.” After reviewing his affidavit, we find it neither speculative nor conclusory, and any scrutiny with respect to the source or basis for the expert’s opinion, or the credibility of the affiant himself, is properly left to cross-examination at trial … In light of these contrasting expert opinions, and viewing the evidence in a light most favorable to plaintiffs, we find that plaintiffs raised “a triable issue of fact regarding whether [Holland] would have had a better outcome” if given the proper administration of tPA.””

Source Holland v Cayuga Med. Ctr. at Ithaca, Inc., 2021 NY Slip Op 03896.

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