EMAIL TO A FRIEND COMMENT

 

Infant Loses Fingertips Due to Failure to Remove Arterial Line


A woman, who had been receiving pre-natal care at another facility, was delivered to the hospital by ambulance and entered through the emergency room. She was admitted to the neonatal intensive care unit (NICU), where she was treated by the doctor assigned to the NICU for that particular shift by the physician service the hospital contracted with to operate the NICU. The woman gave birth to a girl.

 

The doctor placed an arterial line in the infant's right wrist. Cyanosis was observed on the tips of the fingernails on the middle fingers of her right hand. Cyanosis indicated that the blood supply to those fingers was compromised and could not be reestablished without removal of the catheter. The doctor did not remove the arterial line placed in the infant's right wrist immediately upon being informed that cyanosis had been observed on the tips of the fingernails on the middle fingers of her right hand. The NICU records contained no contemporaneous entries concerning how the infant was monitored until hours later, after the infant's condition had progressed to necrosis (cell death) of the fingers. The infant suffered a serious injury to her right hand, resulting in the loss of the top portion of four fingers, which rendered her unable to perform certain activities with that hand and caused her to be the subject of ridicule by other children.

 

The infant and her mother sued the physician service and hospital. The Bronx County Supreme Court entered judgment against the health care providers after a jury trial, awarding the infant and her mother $300,000 for past pain and suffering and $4,200,000 for future pain and suffering.

 

The Appellate Division of the New York Supreme Court, First Department, affirmed the judgment, but vacated the damages awards, and remanded for a new trial on the issue of damages, unless the plaintiffs stipulated to reduce the awards for past and future pain and suffering to $200,000 and $1 million, respectively. The court held that the jury's finding that the doctor deviated from the accepted standard of care was supported by sufficient evidence and was not against the weight of the evidence, the trial court correctly determined as a matter of law that the physician service and hospital were vicariously liable for the doctor’s acts, and the damages award was excessive.

 

The jury's finding that the doctor deviated from the accepted standard of care in treating the infant was supported by sufficient evidence and was not against the weight of the evidence. The court noted that the trial evidence included expert testimony that the doctor should have removed the arterial line placed in the infant's right wrist immediately upon being informed that cyanosis had been observed on the tips of the fingernails on the middle fingers of her right hand, and that the failure to do so proximately caused the infant to lose the top portions of four fingers on that hand. The plaintiffs' expert did not engage in inappropriate retrospective analysis when he explained that cyanosis indicated that the blood supply to those fingers was compromised and could not be reestablished without removal of the catheter. One defendant doctor agreed that the placement of the catheter contributed to the decreased blood flow, and testified that the infant's condition warranted close monitoring. However, the NICU records contained no contemporaneous entries concerning the nature of this monitoring until hours later, after the infant's condition had progressed to necrosis of the fingers. The court concluded that the jury credited the plaintiffs' expert's testimony over that of the defense experts, and its verdict was not one that could not have been reached on any fair interpretation of the evidence.

 

The trial court correctly determined as a matter of law that the physician service and hospital were vicariously liable for the acts of the doctor. The court reasoned that the evidence established that the physician service had been contracted to operate the hospital's NICU and had assigned the doctor to the relevant shift. The mother, who had been receiving pre-natal care at another facility, was delivered to the hospital by ambulance and entered through the emergency room, seeking care from the hospital, rather than from an individual physician. She was admitted to the NICU, where, rather than receiving treatment from a doctor assigned to her, she was treated by the doctor assigned to the NICU by the physician service for that particular shift. The court held that this evidence established vicarious liability, regardless of the doctor's employment status.

 

The damages award was excessive. The infant suffered a serious injury to her right hand, resulting in the loss of the top portion of four fingers, which rendered her unable to perform certain activities with that hand and caused her to be the subject of ridicule by other children. However, based upon a review of cases involving similar injuries, the court found the damages award, $300,000 for past pain and suffering and $4,200,000 for future pain and suffering, excessive. The court vacated the damages awards and remanded for a new trial on the issue of damages, unless the mother and infant, within 30 days after service of a copy of the order with notice of entry, stipulated to reduce the awards for past and future pain and suffering to $200,000 and $1 million, respectively.

 

The Appellate Division of the New York Supreme Court, First Department, affirmed the trial court’s entry of judgment on a jury verdict in favor of the mother and infant, but vacated the damages awards as excessive.

 

See: Tart v. New York Bronx Pediatric Medicine, P.C., 2014 WL 1386451, 2014 N.Y. Slip Op. 02522 (N.Y.A.D. 1 Dept., April 10, 2014) (not designated for publication).

 

See also Medical Law Perspectives, December 2012 Report: When Urgency Leads to Errors: Liability for Emergency Care

 

See also Medical Law Perspectives, February 2013 Report: Emergency Medical Services: Liability and Immunity for Medical Rescue

 

 

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