New York State Court of Claims

New York State Court of Claims

ZAMENICK v. THE STATE OF NEW YORK, #2006-028-014, Claim No. 106397


A prison physician’s decision, based on insufficient information, to discontinue Dilantin, a medication to prevent seizures, constituted a departure from accepted medical practice standards and was a proximate cause of the inmate’s death several weeks later within several hours of his suffering a grand mal seizure. Awards are made for the decedent’s conscious pain and suffering, his funeral expenses and his son’s loss of guidance and nurture.

Case Information

AMANDA ZAMENICK, as Administratrix of the Estate of RUDOLPH ZAMENICK, a/k/a RUDY ZAMENICK and on behalf of next of kin
Claimant short name:
Footnote (claimant name) :

Footnote (defendant name) :

Third-party claimant(s):

Third-party defendant(s):

Claim number(s):
Motion number(s):

Cross-motion number(s):

Claimant’s attorney:
BY: LUBELL & LUBELL, P.C. BY: Lewis Lubell, Esq.
Defendant’s attorney:
BY: Paul F. Cagino, Esq.Assistant Attorney General
Third-party defendant’s attorney:

Signature date:
June 1, 2006

Official citation:

Appellate results:

See also (multicaptioned case)

The facts giving rise to this claim are not in dispute. Claimant’s decedent, Rudolph Zamenick, was sentenced to a term in State prison that began in April 2001. In early May he was transferred to Mt. McGregor Correctional Facility (hereinafter “Mt. McGregor”). He had a history of seizure disorder, which apparently began after a fall in 1998 but which may also have been related to drug and alcohol use and withdrawal. Prior to his incarceration, Zamenick had been prescribed Dilantin, an anti-seizure medication, and shortly after his arrival at Mt. McGregor, on May 4, 2001, he was issued a 30-day supply of the drug (200 mg, twice a day), with two refills.
Another 30-day supply was given to him on May 29. His next visit to the medical facility occurred on June 14, 2001, and on that occasion he was seen for the first time by Dr. Michael Crook. After conducting an examination and interview, Dr. Crook discontinued the Dilantin.
Laboratory tests conducted on April 19 showed that Zamenick’s blood had a low (subtherapeutic) level of Dilantin. Another blood test was taken on May 31, but the results of that test were not available on June 14 when he was examined by Dr. Crook. When those results were received a short while later, they revealed that the level of Dilantin in his blood was appropriate for someone who was taking that drug (i.e., the level was therapeutic).
On June 23, 2001, at approximately 3:00 p.m., Zamenick suffered an episode that was either a seizure or a heart attack
while in his dorm room. He was taken to the Mt. McGregor medical facility and, upon suffering chest and arm pain, to Saratoga Hospital. He was pronounced dead at 6:10 p.m. The cause of his death, which is not disputed, was a myocardial infarction (heart attack) caused by a fresh thrombus in the lower descending artery. In other words, plaque in the arteries had became dislodged and quickly blocked, or occluded, the artery leading into the heart.
At issue in this case is whether it was a departure of good and accepted medical practice for Dr. Crook to discontinue the Dilantin as he did, based on the information that was available to him on June 14, and, if his action was such a departure, whether it was a proximate cause of Zamenick’s death nine days later. The claim asserts causes of action for physical injury/pain and suffering and wrongful death.
Factual Testimony and Evidence
Claimant Amanda Zamenick testified that she and the decedent were married on April 30, 1990 and that their only child, a son, was born later that year. Before their marriage, she knew that her husband was in recovery from overuse of drugs and alcohol, but she was unsure as to how long it had been since he was a substance abuser. She described their family life for the next eight years as “very happy.” In the summer of 1998, while at his construction job, her husband fell from a height. Within two weeks after the accident, he began to experience seizures, and she witnessed several of them in November and December of that year. He was prescribed Dilantin to control the seizures, and to the best of her knowledge, he always took his medication as prescribed.
Because of the accident, Zamenick was on substantial pain medication the following year and by the end of 1999, he had relapsed into substance abuse. The couple separated at that time, so she could not say with certainty whether he continued to take his medication regularly. Her husband was in prison at the time of his death, she stated, because he had been convicted of DWI for the third time.
Dr. Michael Crook, a board-certified internist, testified that he was licensed to practice medicine in New York in 1981 and began working for the Department of Correctional Services (DOCS) in 1993. In May 2001, he was assigned to work at Mt. McGregor as Director of Health Services. When Zamenick arrived at the facility that month, Dr. Crook wrote two routine prescriptions for him, including Dilantin; he had arrived with three prescription medicines, but two of the prescriptions had run out. The renewal of those prescriptions was based on the recommendations of medical staff from another facility. At the same time that he renewed the prescriptions, Dr. Crook ordered that laboratory tests be performed, which they were on May 31. The first time the physician actually saw Zamenick as a patient was on June 14, 2001.
It was not an emergency call, so prior to meeting him, Dr. Crook stated, he would have reviewed the inmate’s ambulatory health record (Exhibit 4). He then took the patient’s history, asking about his seizure history, alcohol problems, hypertension and heart disease. According to Dr. Crook, Zamenick informed him that he was taking Dilantin because of alcohol withdrawal seizures and said that he was on another medication, Atenolol (a beta-blocker), because he had had a heart attack in the past. The patient filled out consent forms to permit Dr. Crook to obtain records from St. Luke’s Hospital in Newburgh. The doctor did not call any of the patient’s previous physicians before making an initial diagnosis that the seizures Zamenick had suffered in the past were from alcohol withdrawal. His physical examination focused on the patient’s heart, and there were no abnormal findings.
According to Dr. Crook, the patient also informed him during the June 14 visit that he was not going to take Dilantin anymore. The physician acknowledged that he should have made a record of this statement in his notes, but he did not do so. The doctor also noted in reviewing the record that the most recent blood test results (those taken April 19) showed that the Dilantin level in the patient’s blood was low.
The decision to take Zamenick off the Dilantin was made, he stated, because he believed that he didn’t need it any more. One factor he considered in reaching this conclusion was the low level of Dilantin shown in the only blood test that was available to him at the time. When shown Exhibit 2, from St. Luke’s Hospital showing that the diagnosis for this patient six months earlier had been “chronic seizure disorder,” with “status epilepticus”
and a history of tonoclonic seizures,
Dr. Crook replied that this was the first time he had seen those records. If he had been able to see these records on June 14, 2001, he acknowledged, he might have reached a different decision about discontinuing the Dilantin. Dr. Crook also acknowledged that there was nothing in any of the medical records or the patient’s history to indicate that Zamenick was not responding to the medication.
On June 23, 2001, at about 3:50 p.m., Dr. Crook received a phone call, informing him that Zamenick had had a possible seizure in his dorm. He advised the nurse to admit him to the infirmary and to begin administering Dilantin. Later, about 4:30 p.m., he was informed that the patient was complaining of chest pain and had vomited. At that point, Dr. Crook advised that the Rescue Squad be called, but he was later informed that before the squad arrived, Zamenick had gone into cardiac arrest, and attempts to resuscitate him had not been successful. Either in that phone call or in a separate one received not long after, Dr. Crook was informed that the patient had passed away. Following an autopsy, the official cause of death was listed as an acute myocardial event, which Dr. Crook described as a “widow maker,” caused by a clot that obstructed the artery leading into the heart.
When asked if he was certain that Zamenick had had a seizure on June 23, Dr. Crook said that he could not be sure, that it was the R.N. who had made an independent diagnosis that it was a seizure. Dr. Crook’s own previous diagnosis, as noted, had been that Zamenick had alcohol-withdrawal seizures. Now that he was able to review the records from St. Luke’s in preparation for trial, he noted that they also showed that Zamenick’s diagnosis had been substance-abuse- related seizures. He added that it was “nearly impossible” to get records from outside physicians and hospitals for use in treating inmates.
Dr. Crook testified that even if he had received the May 31, 2001 lab results, showing a therapeutic level of Dilantin in the patient’s blood, he would still have discontinued the medication. One of the possible side effects of Dilantin use is that it can cause chemical hepatitis, and this, he said, had been a concern when the doctor ordered a hepatitis screen in the blood tests performed May 31. (When those test results finally arrived, after Zamenick’s death, they did show that he had tested positive for hepatitis.) If the diagnosis of alcohol-related seizures was correct, therefore, discontinuance of Dilantin was entirely warranted because it would be inappropriate to administer a medication for which there is no longer any need. In any event, he stated, Dilantin does not help control alcohol-related seizures. As a general practice, Dr. Crook stated, in treating inmates, he would change an inmate’s pre-existing medication regimen if, in his opinion, the medication was not working, if it was too strong or too weak a dose, or if it was not a medication indicated for the condition in question.

Dr. Crook acknowledged that his decision to discontinue the Dilantin was not related to any drug interaction, unpleasant side effect, or the patient’s failure to respond to the medication. Instead, he relied on his understanding that Zamenick was being treated for seizures that were alcohol-related. This information must have come from Zamenick himself as there was nothing in the medical records available to him on June 14 that confirmed or even suggested a connection between Zamenick’s seizures and consumption of alcohol or drugs. He also acknowledged that he did not try to obtain information about other physicians’ diagnoses before discontinuing the drug. When questioned, Dr. Crook acknowledged that if he had known the patient’s diagnosis at St. Luke’s was “status epilepticus”, “tonoclonic seizures” or “chronic seizure disorder” or if he had known that the patient was not a reliable informant, as was indicated in the St. Luke’s records, his decision to discontinue might have been different.
Expert Testimony
Dr. Seymour Gendelman, a neurologist and member of the American Epilepsy Society testifying for Claimant, defined the categories into which most seizures fall:
Sensory seizures: minor (petit mal)
Psycho-motor seizures: temporal lobe, marked by behavioral changes
Focal seizure: a single aspect of sensibility is involved
Progressive seizure: begins local and then generalizes
Generalized seizure: (i.e., grand mal) major motor activity with all areas involved, marked by convulsions and loss of consciousness and can last minutes; when involuntary muscle reaction (clonic) become repetitive it can be life-threatening, affecting respiration, blood pressure, and chemical dynamics
Status Epilepticus: multiple grand mal seizures, one after another, marked by unconsciousness, injury to tongue and other parts of the body, hostility if approached, and very slow recovery, with marked confusion.

Dilantin (generic: phenytoin) has been used as an anti-seizure medication since the 1930s, and Dr. Gendelman stated that it was his firm opinion that no seizure medication should ever be started or terminated abruptly, unless perhaps the patient has been taking it for only a few days, because such an abrupt change in medication level increases the risk of seizures occurring. Prior to discontinuing any medication that has been taken regularly, especially a seizure medication, the doctor should thoroughly and carefully examine all records and consult with others who have treated the patient.
Dr. Gendelman testified that a review of Zamenick’s medical records revealed he had chronic, major motor (grand mal) seizures and that he had been in status epilepticus on several occasions, with tonoclonic seizures. Discontinuing medication that controlled seizures of this severity would inevitably have the result of reducing the patient’s threshold for subsequent seizures.
When asked to comment on the difference in the Dilantin levels between Zamenick’s April 19 test (6.9) and May 31 test (15.7), Dr. Gendelman said that the earlier, lower reading was below therapeutic level, which could indicate either that he had not been taking his medication as prescribed, perhaps missing a few doses, and/or that there had been a long interval of time between taking it and having his blood drawn. The second, higher level was well within the therapeutic range and certainly showed that the patient had been taking the medicine, although it wouldn’t automatically mean that he took every dose, as the blood may have been drawn shortly after administration.
In general, it is a physician’s duty to assess the risks versus the likely gains before making any change in a patient’s medication. In this instance, for example, there would have been no harm in continuing the Dilantin until there was further information, as the patient was not suffering or having negative effects from it. Although the results of the April 19 laboratory tests indicated a lower than optimal level of Dilantin, they also indicated clearly that the medication was being taken. Therefore, Dr. Crook had to have known that the patient was in fact taking the medication, and undoubtedly Zamenick told him that he had been doing so for an extended period of time. To abruptly discontinue the Dilantin in these circumstances, in a patient with a known seizure disorder and history of recurrent seizures was, in Dr. Gendelman’s opinion, a clear departure from good and accepted medical practice and one that was a substantial factor in causing the seizure that occurred on June 23, 2001. The risk to the patient from abrupt discontinuance was significant, while there would have been essentially no risk in continuing the medication until there was more information available.
Dr. Gendelman also noted that a patient doesn’t get actual hepatitis from taking Dilantin but, rather, there are sometimes abnormalities in liver function after years of using the medication. Furthermore, in his opinion, Dilantin is an effective medication even if the seizures are or have in the past been alcohol-related. In fact, records obtained for trial (but not available to Dr. Crook on June 14) reveal that Zamenick had had seizures in October 2000 and December 2000, times when they could not have resulted from drug or alcohol intoxication or withdrawal. No matter what the cause of seizures, however, it is a dereliction of duty to the patient to stop the medication when there was no acceptable reason for doing so. At a minimum, he should have waited for the May 31 test results, and preferably he should have obtained previous medical records before making the change. Finally, Dr. Gendelman stated, if the doctor was determined to discontinue the medication on so little information, it should have been tapered off rather than stopped abruptly.
With respect to the events of June 23, Dr. Gendelman stated that all the records he reviewed were consistent with the fact that Zamenick had a generalized seizure at approximately 3:30 in the afternoon. It is apparent that this was also Dr. Crook’s opinion, he pointed out, because that physician, appropriately, prescribed that 400 mg of Dilantin be given immediately.
On cross-examination, Dr. Gendelman agreed that drug or alcohol intoxication – or particularly alcohol withdrawal – can cause seizures. Even if this had been the cause of Zamenick’s initial seizures, however, it is his opinion that it is still possible that the seizures will continue even after the withdrawal ends. For example, the intoxication-related seizures may cause changes in the brain that are permanent, including lowering the patient’s threshold for seizures. Nevertheless, he agreed that discontinuing medication is often appropriate once seizures have stopped but cautioned that any change should be made carefully. Dr. Gendelman also agreed that adult patients have a right not to take medication if that is their decision, but a physician should, in his view, continue to write prescriptions for medications that are warranted and to encourage the patients to make use of them.
Dr. Louis David Carmichael, a board-certified internist who also testified on behalf of Claimant, said that he frequently works on seizure patients in consultation with a neurologist. He
described grand mal seizures in the same manner as Dr. Gendelman and said that they can cause enormous physiological stress to the body system and organs. They can be like sprinting “full out” for a quarter mile, and patients can physically hurt themselves as they thrash around. These seizures can also cause biochemical changes in the body.
When diagnosing and prescribing medication for a patient with a history of such seizures, he stated, it is incumbent on the physician to review all of the patient’s prior records before deciding on treatment. At the very least, in the situation presented here, Dr. Crook should have obtained and considered the May 31 lab tests before making any adjustments in the patient’s anti-seizure medication. Even without those results, however, the April lab tests, while showing a low reading, made it clear that Zamenick was taking the medication. In light of the fact that Dr. Crook did not have the information necessary to determine that a change in medication was either needed or wise, he should have continued the pre-existing prescription. This is particularly true since there were no adverse consequences from doing so.
With respect to the events of June 23, Dr. Carmichael stated that all of the information available – that Zamenick had begun having abnormal movements while lying on his cot, that he had cut his tongue during the event, and that it took him a half hour to regain consciousness and return to normal – strongly suggest that he had a grand mal seizure. He, too, noted that Dr. Crook must have reached the same conclusion because the medication he prescribed, 400 mg of Dilantin, is consistent with treatment given for diagnosis of an ongoing seizure. The ultimately determined cause of death, a heart attack caused by a fresh thrombus, underscores that the events leading to Zamenick’s death occurred within the preceding few hours. The cardiac arrest, therefore, was a sequela of the seizure, and in fact it is not unusual for a grand mal seizure to trigger a heart attack.
In Dr. Carmichael’s opinion, Dr. Crook deviated “widely” from accepted medical standards by abruptly discontinuing this patient’s Dilantin. Discontinuing this type of medication, particularly if it is not done gradually, results in an increased risk of subsequent seizures, especially in a patient who has had chronic and very severe seizures. In his opinion, there was simply no reason to alter Zamenick’s medication until all relevant information was obtained and reviewed. When asked about possible negative side effects associated with Dilantin, Dr. Carmichael said that they can include short-term sleepiness, fuzzy thinking, dizziness, nausea and abdominal discomfort. Long-term adverse effects of Dilantin can include disorders of the gums and interference with certain hormones and liver functions. There was no record, however, suggesting that Zamenick had experienced any of these to any significant degree.
Dr. Anthony Marinello, Defendant’s pharmacology expert, testified that he frequently works with seizure patients and confirmed that drug and alcohol use and/or withdrawal can cause seizures. Dilantin is an accepted prescription to inhibit seizures from alcohol withdrawal, but once the person is through withdrawal and no longer drinking, it is safe to remove the drug. One of the reasons for stopping it as soon as possible is that longer-term use of Dilantin can cause hepatitis in some patients. He acknowledged, however, that this type of hepatitis is what is known as “chemical hepatitis” and that the liver function returns to normal once the medication is discontinued.
Upon reviewing Zamenick’s records, it was Dr. Marinello’s opinion that this patient suffered from seizures caused by alcohol/drug withdrawal and, consequently, that Dr. Crook did not deviate from the acceptable standards of medical practice when he discontinued the Dilantin. For one thing, Zamenick’s EEG test results were normal, suggesting that he did not have a chronic seizure disorder, because over ninety per cent of those who do, have abnormal EEGs.
As to the cause of death, Dr. Marinello said that he was aware of no data or studies showing a correlation between seizures and myocardial infarction. In his opinion, Zamenick suffered a “cardiac seizure” in the afternoon of the day of his death. In other words, it was a heart attack and loss of oxygen that caused the seizure-like convulsions when he was in his cubicle around 3:30 that afternoon. Accordingly, he stated, it would have made no difference whether he had discontinued the Dilantin or remained on therapeutic doses of the medication, because the Dilantin would not have prevented the heart attack. When referred to the notes of the nurse who attended Zamenick when he was still in the dorm on that day, he acknowledged that the terms “unconscious” and “confused” were possibly more often related to a seizure than to a seizure-like reaction to a heart attack. He also said that he had no hard facts on which he could reject the nurse’s conclusion that the patient experienced a grand mal seizure, as there was nothing in the chart from that early period referencing chest pain, left-side weakness, shortness of breath or other signs more typically associated with heart attacks. In fact, had Zamenick not subsequently felt chest pain and if the cause of death had not been established by an autopsy, there would have been nothing in the facility records to indicate that he suffered from anything other than a seizure.
On cross-examination, Dr. Marinello acknowledged that the medical records from Mt. McGregor do not contain anything attributing Zamenick’s seizures to alcohol withdrawal. On the other hand, he pointed out, Dr. Crook also had a competent, coherent patient who could provide sufficient additional information from which such a diagnosis could be made. Dr. Marinello agreed that if a patient says that he will refuse to take his medication, that information should be noted in the chart, but he did not feel that it was a deviation from accepted medical standards to fail to record such information.
Dr. Michael Martinelli, Defendant’s cardiac expert who had examined the autopsy report, concurred that the cause of death was an acute coronary insufficiency. Specifically, he stated, a clot had broken away and almost completely blocked one of the patient’s arteries. Plaque formation is the result of many things – diabetes, high blood pressure, smoking, cholesterol – and alcoholism can be related also because it can cause longstanding high blood pressure. He opined that Zamenick’s first complaints of chest pain occurred when the clot broke away and death was preceded by a second bout of chest pain. Thirty per cent of the people who experience this type of heart attack die suddenly.
Dilantin, Dr. Martinelli stated, could not have played a role in preventing this episode, since that medication is specifically directed toward preventing seizures. The physician said that he was not aware of any studies linking seizures and occlusion of arteries, nor did he know of any documented connection between grand mal seizures and heart symptoms. With respect to the specific condition that caused this patient’s heart attack, he stated there is no stimuli known to cause plaque to rupture, although some theorize that cold weather can be a triggering event. There is also no way to know, in a particular case, how long plaque buildup has been occurring.
Applicable Law and Discussion
The State has an obligation to provide ordinary and appropriate medical treatment to inmates in its institutions (Gordon v City of New York, 120 AD2d 562 [2d Dept 1986], affd 70 NY2d 839 [1987]) and to make proper diagnoses and treatment (id.; Rivers v State of New York, 159 AD2d 788 [3d Dept 1990], lv denied 76 NY2d 701). When, as here, medical malpractice involves patient treatment, three component duties are owed by the physician to the patient: (1) the duty to possess the requisite knowledge and skill such as is possessed by the average member of the medical profession; (2) a duty to exercise ordinary and reasonable care in the application of professional knowledge and skill; and (3) the duty to use his or her best judgment in the application of this knowledge and skill (Littlejohn v State of New York 87 AD2d 951, 952 [87 AD2d 951], citing Pike v Honsinger, 155 NY 201, 209- 210 [1898]). Consequently, Claimant must establish that Defendant’s medical staff failed in one or more of those duties and that that failure was a proximate cause of his damages, i.e., that it was a substantial factor in causing or exacerbating his injuries (Kennedy v Peninsula Hosp. Center, 135 AD2d 788 [2d Dept 1987]; Koster v Greenberg, 120 AD2d 644 [2d Dept 1986]).
The standard of care a physician owes to a patient is to use such reasonable and ordinary care, skill and diligence as physicians in good standing in the same neighborhood, in the same general line of practice, ordinarily have and exercise in like cases. Physicians are expected to use the proper degree of care in making careful diagnoses of their patients’ ailments and in deciding upon treatment plans (O'Neil v State of New York, 66 Misc 2d 936 [Ct Cl 1971], and cases cited therein). When considering what medication should be given to a patient (or, as a necessary corollary, whether medication should be discontinued), the doctor is expected to use his “best professional judgment in balancing the risks and benefits” of administering or not administering a particular drug (Lipsky v Bierman, 16 AD3d 319 [1st Dept 2005]). Physicians have a duty "to balance the risks against the benefits of various drugs and treatments and to prescribe them and supervise their effects" (Tenuto v Lederle Labs., Div. of Am. Cyanamid Co., 181 Misc 2d 367, [Sup Ct, Richmond Co 1999], quoting Martin v Hacker, 83 NY2d 1, 9).
There is little doubt, in the opinion of the Court, that Dr. Crook’s discontinuing Zamenick’s Dilantin prescription on June 14, 2001 was a departure from the good and accepted standard of responsible medical practice in any area of the country. There was no need to make such a step immediately, because the patient was not suffering from any of the obvious side effects of the medication and, in fact, had been taking it for several years, apparently without difficulty. Consequently, the risk of continuing him on the medication, at least until lab tests and prior medical records could be obtained, was virtually nonexistent. On the other hand, the risks of unfavorable reaction from stopping the medication “cold turkey” were several and some of them were significant. Whatever the original cause may have been, his prior seizures had been strong, and grand mal seizures are always potentially harmful to the one who suffers them. In addition, reducing an anti-seizure medication will in most instances lower an individual’s tolerance and increase the likelihood that he will have a seizure. That risk alone is unacceptable, particularly when it would be so easy to wait for the new blood test results (which were known to have been conducted on May 31) and to request earlier medical records, records that would establish with certainty why Dilantin had been prescribed in the first place, what the cause of the seizures was most likely to have been, and how long Zamenick had been taking the medication.
In truth, there was very little to support Dr. Crook’s conclusion that the seizures had been caused by alcohol and/or drug withdrawal. The information could only have come from Zamenick himself, for there was no reference to this possible etiology in the medical records available to him on June 14. Certainly, as Dr. Marinello pointed out, Dr. Crook had an apparently conscious, coherent patient who could inform him of past problems with substance abuse. If he was going to rely on the patient’s background information and “self-diagnosis,” however, he should have been particularly careful to get a full background. Had he done so, he would have learned about a 1998 accident, which immediately preceded the first seizures, and he would have learned that at least two seizures occurred at a time when Zamenick could not possibly have been consuming alcohol or taking drugs. These additional facts would reasonably have raised questions about the type of seizures Zamenick had and their cause, enough questions to warrant getting more information before altering medication that the patient had been taking for several years. Even the low reading shown in the April 19 test results was enough to establish that the medication was being taken, although perhaps without 100 per cent reliability.
In addition, the Court finds no reason to question the nurse’s conclusion that the event occurring at approximately 3:00 p.m. on June 23 was a grand mal seizure. The minimal description of the incident is consistent with what occurs during a grand mal seizure; the nurse who observed the event quickly decided that it was a seizure; and Dr. Crook himself, who presumably questioned her closely, was so convinced it was a seizure that he immediately ordered the medication appropriate for such an event. If, in fact, it had been the seizure-like episode related to a heart attack (a “cardiac seizure”) hypothesized by Dr. Marinello, Dr. Crook’s negligence would have been beyond doubt. He would have administered an inappropriate medication to a critically ill patient and, more importantly, he would have failed to initiate the treatment necessary for someone who has had a heart attack. As all experts agreed, Dilantin has no effect on preventing or minimizing heart attacks. Because Zamenick suffered a grand mal seizure in his dorm on June 23, the Court finds that Dr. Crook’s decision to suddenly and without good reason discontinue the Dilantin was a proximate cause of the pain and suffering caused by the seizure.
The question of whether Dr. Crook’s improper medical decision had a causal relation to Zamenick’s subsequent heart attack, and consequently to his death, is more problematic. No expert produced any studies or articles establishing such a connection between grand mal seizures and heart attacks. Only Dr. Carmichael testified that, in his experience, it was not unusual for a heart attack to follow a grand mal seizure, but he provided no factual data to support this conclusory statement. The other physicians professed to be unaware of any link between seizures and heart attacks.
To the extent that common sense suggests that an event which puts tremendous pressure on an individual’s body will necessarily put strain on his or her heart, there was no evidence or testimony to suggest that the sort of pressure created by a seizure would relate to the type of heart attack that Zamenick suffered: one caused by plaque becoming dislodged and blocking a vital artery. Nor was there any evidence that the plaque formation, which occurred over years, was affected by the recent change in medication. The only expert to testify about stimuli that may trigger plaque to rupture or break off was Dr. Martinelli, who stated there is no established knowledge as to what causes such an event, although it has been theorized that cold weather may play a role.
Accordingly, there was no competent evidence supporting a conclusion that the grand mal seizure suffered by Zamenick at 3:00 p.m. on June 23, 2001 was a proximate cause of the myocardial infarction he sustained several hours later. Furthermore, where there are multiple possible causes of an injury and none is shown to be more probable than another, liability cannot be imposed.
Where the facts proven show that there are several possible causes of an injury, for one or more of which the defendant was not responsible, and it is just as reasonable and probable that the injury was the result of one cause as the other, plaintiff cannot have a recovery since he has failed to prove that the negligence of the defendant caused the injury
(Ingersoll v Liberty Bank of Buffalo, 278 NY 1, 7 [1938]; Wiwigac v Snedaker, 282 AD2d 801, 803 [3d Dept. 2001]).
Consequently, the Court holds that the negligence of Dr. Crook in discontinuing Zamenick’s anti-seizure medication without proper study and information-gathering caused him to have a grand mal seizure nine days later. Claimant failed to prove by a preponderance of the credible evidence, however, that this act of negligence was a proximate cause of Zamenick’s fatal heart attack. The State is liable, therefore, only for the pain and suffering resulting from the grand mal seizure.
The conscious pain and suffering for which Defendant is liable would have begun around 3:20 p.m., or whenever Zamenick came to after the seizure which rendered him unconscious. Given the description of the effects that a grand mal seizure has on a patient’s body, it is likely that Zamenick continued to suffer some adverse reactions from the seizure until he again lost consciousness, because of the heart attack, at approximately 5:05 p.m. In the Court’s view, an appropriate award for the survival cause of action for conscious pain and suffering in this action is $15,000 (see LaPort v Bojedla, 262 AD2d 1025 [4th Dept 1999]).
Claimant is awarded $15,000 for the survival cause of action for conscious pain and suffering related to the June 23 grand mal seizure; the causes of action for pain and suffering related to the June 23 heart attack and for Zamenick’s death are dismissed.
To the extent Claimant has paid a filing fee, it may be recovered pursuant to Court of Claims Act §11-a(2).
Let judgment be entered accordingly.

June 1, 2006
Albany, New York

Judge of the Court of Claims

[1]. A defense witness, Patrick Stephan, RN, testified that a 30-day supply of medication was the maximum given to inmates at any one time.
[2]. This dispute is the major point of contention between the parties.
[3]. Status epilepticus is a series of motor seizures in which the patient is unaware of what is happening and there is slow recovery, with lethargy and confusion, when the seizures are over.
[4].Tonoclonic seizures are also referred to as “grand mal” seizures and can be life threatening, affecting the patient’s blood pressure and respiration.
[5]. There was some uncertainty as to how often he had occasion to change a patient’s medication. At trial he testified that he made such changes “often,” while at his pretrial deposition, he had indicated that it was something that occurred only rarely.