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Continuous Treatment Did Not Apply to Failure to Diagnose Heart Disease


A man became a patient of a medical practice group at the age of 74. He visited the practice group periodically for monitoring of his blood pressure and cholesterol levels, which were generally well-controlled, and otherwise only went to the practice group for unrelated acute health issues. About six years later he terminated his relationship with them and, shortly thereafter, he suffered a massive heart attack, was diagnosed with coronary artery disease, and underwent bypass surgery. He died about a year and a half after terminating his relationship with the medical practice group.

 

His wife, individually and as executor of the man’s estate, sued the practice group. The complaint alleged that the practice group had committed medical malpractice by, among other things, failing to diagnose the man's coronary artery disease. The practice group moved for summary judgment dismissing the complaint on the grounds that they had neither deviated from the standard of care nor caused any injury. In the alternative, defendants sought partial summary judgment dismissing the claims with respect to any alleged malpractice occurring two and a half years or more prior to the filing of the complaint as time-barred.

 

The Albany County Supreme Court denied the practice group’s motion for summary judgment. The court found that issues of fact existed as to whether the continuous treatment doctrine applied and whether the practice group committed malpractice.

 

The Appellate Division of the New York Supreme Court, Third Department, affirmed in part and reversed in part. The court held that the trial court erred in denying the practice group’s motion for partial summary judgment dismissing any claims prior to the commencement of the limitations period because the continuous treatment doctrine did not apply to toll the statute of limitations. However, the wife adequately rebutted the practice group’s prima facie establishment of entitlement to summary judgment dismissing the complaint in its entirety.

 

The continuous treatment doctrine did not apply to toll the statute of limitations. While medical malpractice claims generally accrue at the time the malpractice is committed, the continuous treatment doctrine provides that when the course of treatment which includes the wrongful acts or omissions has continuously run and is related to the same original condition or complaint, that accrual comes only at the end of treatment. A patient's continuing general relationship with a physician or routine, periodic health examinations will not satisfy the doctrine's requirement of continuous treatment. The depositions presented by both the wife and the practice group indicated that high cholesterol and high blood pressure, two conditions the practice group monitored, were risk factors for the potential development of coronary artery disease, rather than symptoms of the condition itself. Symptoms of coronary artery disease included chest pain, shortness of breath, nausea, an acute change in the ability to tolerate exercise, and arm pain. The court found no proof that the man was treated by the practice group for any such symptoms prior to the commencement of the limitations period. Rather, the allegation was that the practice group failed to discover and treat the man's coronary artery disease by failing to order appropriate testing or refer the decedent to a specialist. The court concluded that those alleged omissions did not amount to the establishment of a course of treatment and, accordingly, the motion for partial summary judgment dismissing any claims prior to the commencement of the limitations period should have been granted.

 

The wife adequately rebutted the practice group’s prima facie establishment of entitlement to summary judgment dismissing the complaint in its entirety. She submitted a redacted affidavit from a physician board-certified in internal medicine with a subspecialty in cardiovascular disease who opined that, in light of the man's risk factors for heart disease, the practice group should have ordered a complete cardiac evaluation for the decedent after the commencement of the limitations period when he presented on two separate occasions with complaints including shortness of breath, achy arms, and nausea, all potential symptoms of heart disease. The expert also opined that, had the appropriate testing been ordered in conformance with the applicable standard of care, it would have revealed evidence of underlying coronary artery disease at a time when appropriate action could have been taken to avoid the damage ultimately caused by the man's heart attack. The court found the expert affidavit sufficient to demonstrate the existence of triable issues as to whether the practice group departed from the standard of care and whether any such departure proximately caused the man’s injury. Accordingly, the trial court appropriately denied the motion for summary judgment dismissing the complaint in its entirety.

 

The Appellate Division of the New York Supreme Court, Third Department, affirmed in part and reversed in part the trial court’s denial of the defendants' motion for summary judgment dismissing the complaint.

 

See: Hauss v. Community Care Physicians, P.C., 2014 WL 2972055, 2014 N.Y. Slip Op. 05003 (N.Y.A.D. 3 Dept., July 03, 2014) (not designated for publication).

 

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

 

 

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