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Claims Dismissed against Primary Care Physician and Cardiologist for Stopping Plavix


A man was under the care of a primary care physician and a cardiologist after he suffered an anterior wall myocardial infarction (i.e., a heart attack). To correct a 100% blockage, the cardiologist placed a stent in the man’s left anterior descending artery. The cardiologist also prescribed Plavix (clopidogrel), a blood thinner. Approximately two years after the man’s heart attack, the cardiologist placed additional stents in the man’s coronary arteries. The man continued to take Plavix.

 

Three years later, the primary care physician examined the man to clear him for hernia surgery. However, the man’s lab results revealed acute kidney failure. The primary care physician referred the man to a kidney specialist. The kidney specialist informed the man that a kidney biopsy was needed. The kidney specialist advised the man to check with the cardiologist to obtain medical clearance for the kidney biopsy. The man had to stop taking Plavix so that the kidney specialist could perform the biopsy. The kidney specialist’s notes indicated that he spoke to someone in the cardiologist’s practice group who stated that the man could go off Plavix for 10 to 12 days. The man stopped taking all of his medications at least three days prior to the biopsy. The biopsy was canceled. The day after the kidney biopsy was supposed to have been performed, the man died of cardiac arrest.

 

The estate sued the cardiologist, primary care physician, kidney specialist, and their respective practice groups for medical malpractice and wrongful death.

 

The primary care physician and his practice group moved for summary judgment dismissing the complaint as asserted against the primary care physician and associated practice group. In support of the motion, the primary care physician and associated practice group submitted the affirmation of an expert internist. The expert internist stated that the primary care physician and his practice group had no duty to the man regarding his Plavix prescription because it was handled by the man’s cardiologist and the cardiologist’s practice group.

 

The cardiologist and his practice group filed a separate motion for summary judgment dismissing the complaint as asserted against the cardiologist and associated practice group. In support of the motion, the cardiologist and associated practice group submitted the affirmation of an expert cardiologist. The expert cardiologist stated that the standard of care did not require the man to remain on Plavix for more than one year after the most recent placement of stents and that the prescription could be stopped for a few days without issue. Additionally, the expert stated that Plavix retains approximately 70% of its effects three days after discontinuance. Also, the expert cardiologist asserted that there was no evidence that the discontinuance of Plavix for four days was the proximate cause of the man’s death.

 

In opposition to the motions to dismiss, the estate submitted the affirmation of an expert cardiologist. The estate’s expert cardiologist stated that both the primary care physician and the cardiologist failed to adhere to accepted practices by failing to ensure that the man resumed his Plavix prescription after his kidney biopsy was canceled. Also, the estate’s expert cardiologist stated that this failure was the proximate cause of the man’s death.

 

The Suffolk County Supreme Court denied the motions to dismiss.

 

The Appellate Division of the New York Supreme Court, Second Department, reversed. The court held that the trial court erred in denying the motions to dismiss filed by the primary care physician, the cardiologist, and the associated practice groups.

 

The trial court erred in denying the motion to dismiss filed by the primary care physician and the associated practice group. The court held that physicians’ general duty of care to their patients may be limited to those medical functions undertaken by the physician and relied on by the patient. By submitting evidence that they played no role in treating the man for his heart issues, the primary care physician and the associated practice group established that no duty of care was owed to the man regarding his Plavix prescription. The court also noted that the cardiologist and the associated practice group, not the primary care physician, who treated the man for the heart attack, prescribed Plavix, and talked with the kidney specialist about stopping the Plavix prior to the biopsy. Additionally, the kidney specialist told the man to check with his cardiologist—not with his primary care physician—about being cleared for the biopsy. The court held that the estate failed to rebut the prima facie evidence that the primary care physician and the associated practice group owed no duty to the man regarding his Plavix prescription. In opposition to their motion to dismiss, the estate submitted no evidence to demonstrate that the primary care physician and the associated practice group assumed the duty to care for the man’s heart issues. Therefore, the trial court should have granted the motion for summary judgment dismissing the complaint as asserted against the primary care physician and the associated practice group.

 

The trial court erred in denying the motion to dismiss filed by the cardiologist and the associated practice group. The cardiologist and the associated practice group established that the cardiologist adhered to accepted practices when treating the man by submitting evidence that the accepted standard of care was to keep patients on Plavix for no longer than one year following the placement of stents. The court reasoned that, because the man’s most recent stents were placed three years before the scheduled kidney biopsy, the man did not need to be on Plavix at the time of the incident. Additionally, the court noted that the expert cardiologist stated that Plavix retained approximately 70% of its effects three days after discontinuance. The court held that the estate failed to rebut the prima facie evidence that the cardiologist and the associated practice group adhered to accepted practices in treating the man. The court found the estate’s expert cardiologist’s testimony was conclusory because the estate’s expert cardiologist based his assertion that the standard of care required the cardiologist to keep the man on Plavix indefinitely on the cardiologist’s decision to keep the man on Plavix without articulating what it was about the man’s particular case that required him to remain on Plavix for three years after the stents were placed. Also, the court noted that the estate’s expert cardiologist failed to articulate why a four-day discontinuance of Plavix would have posed a danger to the man and failed to respond to the cardiologist’s expert’s assertion that Plavix retained about 70% of its efficacy three days after discontinuance. The court concluded that the estate failed to raise a triable issue of fact as to whether the cardiologist and his practice group departed from the accepted standard of care. Therefore, the trial court should have granted the motion for summary judgment dismissing the complaint as asserted against the cardiologist and the associated practice group.

 

The Appellate Division of the New York Supreme Court, Second Department, reversed the trial court’s denial of the motions for summary judgment dismissing the complaint against the cardiologist, the primary care physician, and the associated practice groups.

 

See: Burns v. Goyal, 2016 WL 7445488 (N.Y.A.D. 2 Dept., December 28, 2016) (not designated for publication).

 

See also Medical Law Perspectives, November 2013 Report: Diagnosis and Treatment of Heart Attacks: Liability Issues

 

>See also Medical Law Perspectives, May 2013 Report: Drugs, Dosage, and Damage: Physician Liability for Prescribing or Administering Medication 

 

 

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