Claimants Jack Stiffler and Laura Campbell, individually and as
co-administrators of the Estate of their son, Jeffrey Stiffler, have brought
this claim based upon allegations of medical malpractice and/or negligence
allegedly resulting in the wrongful death of their son. The trial of this claim
was bifurcated, and this decision therefore addresses solely the issue of
Undisputed testimony and medical records establish that Jeffrey Stiffler, at
the time an inmate at Mohawk Correctional Facility (Mohawk), went to sick call
at the facility on December 13, 2002, and based on his symptoms, was provided
with an over-the-counter medication. Mr. Stiffler returned to sick call on
December 17, 2002, and in the afternoon of that day he was transferred to the
infirmary at Mid-State Correctional Facility (Mid-State). Mr. Stiffler was then
transferred to St. Luke’s Medical Center (St. Luke’s) on
December 18, 2002, where he remained a patient until his death on December 23,
2002. Claimants allege that during the time that Mr. Stiffler was being treated
at Mohawk and Mid-State, he received inadequate and untimely medical care from
the medical staff at these facilities, leading to his death at St. Luke’s.
Michelle Holdbrook, a registered nurse employed by the Department of
Correctional Services at Mohawk, testified that she was on duty on December 13,
2002 when Mr. Stiffler appeared at sick call, with complaints of body
aches, sore throat, phlegm, nausea, and temperature. Based on his complaints
and his elevated temperature, Nurse Holdbrook administered Medicedin-D,
apparently believing that claimant was suffering from a cold. Nurse Holdbrook
admitted that she did not take Mr. Stiffler’s vital signs, such as
respiratory rate, blood pressure, or pulse. Additionally, Nurse Holdbrook did
not perform any type of physical examination, and did not listen to his lungs,
despite his complaints of having white/yellow phlegm. Nurse Holdbrook also
testified that at the time that she saw Mr. Stiffler, the pulse oximeter at the
infirmary was not in working order, and that she therefore did not take Mr.
Stiffler’s oxygen saturation level.
According to the medical records (Exhibit A) and the testimony, Mr. Stiffler
next appeared for sick call at the Mohawk Correctional Facility infirmary on the
morning of December 17, 2002. As noted in Mr. Stiffler’s medical records,
he complained of vomiting for the past two to three days, that he had a fever
and had perspired all night long, that his clothing was all wet in the morning,
and that he had chest pain when he coughed.
He was examined that day by Nurse Richards. Nurse Richards testified that Mr.
Stiffler had numerous complaints. During her examination, Nurse Richards noted
that Mr. Stiffler’s blood pressure was below normal, and that his
temperature was elevated at 102 degrees. Nurse Richards listened to Mr.
Stiffler’s lungs, and noted that there was no air exchange in the lower
left lobe. Nurse Richards testified that she was unable to take Mr.
Stiffler’s oxygen saturation level, since the pulse oximeter was not
available that day. Nurse Richards acknowledged, however, that it would be
important to know Mr. Stiffler’s oxygen saturation level, based upon his
complaints and appearance that day. Nurse Richards testified that Mr. Stiffler
did not have any shortness of breath and that there was fair exchange except for
the lack of air exchange in the left lower base or lobe. Nurse Richards took
Mr. Stiffler’s temperature when she examined him, and noted that it was
102 degrees. She testified that later that morning, his temperature spiked to
Nurse Richards referred Mr. Stiffler to Dr. Mohammed Seedat, a physician at
Mohawk, who requested that Nurse Richards “telemed
prior to a possible transfer from
Mohawk. The “telemed” was not available and a second opinion was
therefore not obtained at that time. Dr. Seedat, when he examined Mr. Stiffler,
noted that he was using his accessory muscles to breathe, and that he heard
abnormal lung sounds. Dr. Seedat, however, failed to document what type of lung
sounds he heard during his examination.
Dr. Seedat testified that he then contacted Mid-State to arrange a transfer.
Dr. Seedat testified that although he believed that Mr. Stiffler was developing
pneumonia, he did not order any chest x-rays because he thought it would delay
When he was advised by Nurse Richards that Mr. Stiffler’s temperature had
spiked to 103.4 degrees, he ordered antibiotics and directed Nurse Richards
to administer Cipro.
Dr. Seedat testified that based upon his examination and Mr. Stiffler’s
symptoms, Mr. Stiffler had some respiratory problems, but that he did not
believe he was in “terrible respiratory
. However, based on his
condition, he decided to transfer Mr. Stiffler to the next higher medical
facility (Mid-State), and he did not believe it was necessary to transfer Mr.
Stiffler to an outside hospital. Dr. Seedat acknowledged that chest x-rays were
not ordered at Mohawk, nor was Mr. Stiffler administered any IV fluids prior to
Medical records and testimony establish that Mr. Stiffler, after first being
seen at the Mohawk infirmary at approximately 8:00 a.m. on December 17, 2002,
was transferred to the Mid-State infirmary at approximately 1:30 p.m. that day.
Nurse Karen Williams was employed at Mid-State, and was on duty when she
admitted Mr. Stiffler from Mohawk. Nurse Williams took Mr.
Stiffler’s vital signs, and recorded a temperature of 102 degrees,
blood pressure of 96/54, respirations of 30, and a pulse of 88. She further
testified that she took Mr. Stiffler’s oxygen saturation rate, and that it
was “most likely normal”, although she did not record his oxygen
saturation level in his chart. She also testified that
Mr. Stiffler’s blood pressure reading did not concern her, since it
was close to her normal blood pressure. Nurse Williams also notified Dr.
Nicaise, who was on duty at the time, that Mr. Stiffler had been admitted
to the infirmary. Nurse Williams testified at trial that Mr. Stiffler was
“resting comfortably” and that he was not in distress as he waited
for the doctor.
Mr. Stiffler’s medical records (Exhibit A) establish that between 2:00
p.m. and 10:00 p.m. on December 17, 2002, Mr. Stiffler was administered two
liters of saline solution, and was provided Tylenol at 5:00 p.m.
Nurse Lee Graves, a registered nurse employed at Mid-State, testified that he
worked the night shift from 10:00 p.m. on December 17, 2002 to 6:00 a.m. on
December 18, 2002. Nurse Graves testified, as set forth in claimant’s
medical records, that he assessed Mr. Stiffler at 11:00 p.m. on December 17,
2002 and took his vital signs at that time. Mr. Stiffler had a temperature of
101 degrees, a pulse rate of 112, and respirations of 20. The notes made by Mr.
Graves stated that his lungs were slightly decreased but clear; and that he
complained of a cough, although none was noted. Mr. Graves testified that
during his shift, he never heard Mr. Stiffler have any labored breathing or
shortness of breath. Mr. Graves then assessed Mr. Stiffler once again at
approximately 5:30 a.m., when he had a temperature of 99.8 degrees, and
complained of a green/brown sputum. On both occasions, Mr. Graves administered
Tylenol to Mr. Stiffler.
Deborah J. Bonomo, a registered nurse employed at Mid-State, also testified at
the trial. Nurse Bonomo testified that in December 2002 her work shift ran from
6:00 a.m. to 2:00 p.m. She therefore came on duty at 6:00 a.m. on December 18,
2002. Although she was not assigned to work in the infirmary on that day, she
did assist the other nurse on duty, and attended to Mr. Stiffler. Her notes, as
set forth in Mr. Stiffler’s medical records, indicated that Mr. Stiffler
was complaining of shortness of breath and that he could not lie flat. She took
Mr. Stiffler’s vital signs at approximately 10:00 a.m. and recorded a
temperature of 101 degrees, pulse of 96, respirations of 22, and blood pressure
of 118/80. She believed that Mr. Stiffler had diminished lung capacity, and at
approximately 10:30 a.m., examined Mr. Stiffler and found that he had decreased
breath sounds. She also utilized a pulse oximeter to read Mr. Stiffler’s
oxygen level and found it to be 84%, which she considered low. She then
notified Dr. Ramineni, who authorized oxygen and nebulizer treatment. Mr.
Stiffler was then provided oxygen at the rate of four liters per minute nasal
cannula. Mr. Stiffler was also provided with nebulizer treatment with
Albuterol at two intervals.
Nurse Bonomo testified that after Mr. Stiffler was examined by Dr. Ramineni,
she was directed to prepare the necessary paperwork to have Mr. Stiffler
transferred to an outside hospital (St. Luke’s) for further evaluation and
Dr. Ramineni testified that he examined Mr. Stiffler on the morning of
December 18, 2002 and found that Mr. Stiffler had decreased air flow into the
lung fields, especially on the left side. Based upon his physical assessment,
as well as Mr. Stiffler’s condition following the administration of oxygen
and the nebulizer treatments, Dr. Ramineni suspected that Mr. Stiffler had
pneumonia. He testified that his decision to have Mr. Stiffler transferred to
St. Luke’s was based upon the fact that chest x-rays and further tests,
such as sputum cultures and blood cultures, could be accomplished more
expeditiously at the outside hospital rather than in the prison infirmary.
Mr. Stiffler was transported to St. Luke’s Medical Center and arrived
there shortly before 12:00 noon on December 18, 2002. John Gian, M.D., was Mr.
Stiffler’s treating physician at St. Luke’s, and he testified
at trial. Dr. Gian first examined Mr. Stiffler at approximately 3:30 p.m.
on December 18, and noted that he was having respiratory difficulties, and that
he had inadequate oxygenation in his blood.
Dr. Gian testified that Mr. Stiffler’s condition worsened at St.
Luke’s, and he was transferred to the intensive care unit at approximately
9:00 p.m. on December 19, 2002, when he was considered to be in respiratory
failure. Mr. Stiffler’s condition continued to deteriorate, and he died
at St. Luke’s Medical Center on December 23, 2002.
Michael Sikirica, M.D., was the medical examiner who performed an autopsy on
Mr. Stiffler on December 24, 2002. Dr. Sikirica testified that Mr.
Stiffler’s right lung weighed 1,360 grams and his left lung weighed 1,090
grams at the time of autopsy, whereas a “normal” lung weighs between
300 and 500 grams. There was no evidence of bacteria in Mr. Stiffler’s
Dr. Sikirica testified, as set forth on the death certificate, that Mr.
Stiffler died from multi-system organ failure due to respiratory failure and
hypoxia due to pneumonia. He also testified that in his opinion, Mr. Stiffler
had had pneumonia for approximately 5 to 10 days at the time of his death.
In addition to Dr. Sikirica and Dr. Gian, medical experts were also called by
each party to testify with regard to the actions taken by the medical staff,
including both nurses and physicians, at Mohawk and Mid-State during the course
of their treatment of Mr. Stiffler.
Nurse Alexandra Schneider testified as claimants’ expert in the area of
nursing, and offered testimony regarding the nursing care received by Mr.
Stiffler at both Mohawk and Mid-State.
Nurse Schneider testified that in her opinion, the medical notes of Nurse
Holdbrook from December 13, 2002, were incomplete and below the acceptable
standard of care in that she failed to note the appearance of Mr. Stiffler when
he was examined by her. Additionally, Nurse Schneider testified that Nurse
Holdbrook failed to do a lung exam with a stethoscope, and that she prescribed a
decongestant without listening to his chest or taking his blood pressure.
Nurse Schneider testified that Nurse Richards, who examined Mr. Stiffler on
December 17, 2002, also deviated from accepted standards of nursing care.
Specifically, when Nurse Richards noticed that Mr. Stiffler had no air exchange
in his lower left lobe, an oxygen saturation test should have been performed.
Since the pulse oximeter at Mohawk was not working, Nurse Schneider testified
that Nurse Richards had other options in that she could have performed other
tests, that she could have found a working pulse oximeter, or that she could
have spoken to the on-duty physician and recommended that a chest x-ray be
Nurse Schneider also testified that Nurse Williams, who examined claimant when
he was transferred to Mid-State, also deviated from accepted standards of care
by failing to record lung sounds and oxygen saturation findings. She also
deviated from good and accepted standards when she equated her blood pressure to
the blood pressure that she took from Mr. Stiffler at that time.
In sum, it was the opinion of Nurse Schneider that collectively, Mr. Stiffler
received inadequate nursing care from the staff at both facilities, in that they
failed to perform certain tests, failed to adequately record all of their
findings and observations, and failed to adequately treat Mr. Stiffler for his
Judy Kilpatrick, a Nurse Practitioner and Clinical Specialist, was called by
the defendant as an expert in clinical nursing. Nurse Kilpatrick agreed with
Nurse Schneider that the examination notes taken by Nurse Holdbrook during her
examination of December 13, 2002 were inadequate and incomplete, and that Nurse
Holdbrook apparently failed to take complete vital signs of Mr. Stiffler at that
time. Nurse Kilpatrick, however, testified that the physical assessment and
patient history taken by Nurse Richards, and her treatment of Mr. Stiffler on
the morning of December 17, 2002, were all performed in conformance with good
and accepted nursing practices. She further testified that the decision by Dr.
Seedat to transfer Mr. Stiffler from Mohawk to Mid-State was proper, and that
the nursing care that Mr. Stiffler received at Mid-State was also consistent
with good and accepted nursing standards.
In sum, although Nurse Kilpatrick acknowledged that there were certain
deficiencies by the various nurses in failing to take or record Mr.
Stiffler’s vital signs on different occasions, and although there were
other deficiencies in Mr. Stiffler’s medical records, it was her opinion
that these deficiencies did not affect the care or treatment received by Mr.
Stiffler, and did not have any effect on Mr. Stiffler’s outcome.
Herbert Feldman, M.D., testified on behalf of the claimants. Dr. Feldman is
board certified in family practice, and was qualified as an expert by the Court.
Based on his review of the medical records, Dr. Feldman was of the opinion that
there were numerous deviations from good and accepted medical practice by the
nurses and physicians at Mohawk and Mid-State in their care and treatment of Mr.
Initially, Dr. Feldman was of the opinion that when Mr. Stiffler appeared on
December 13, 2002, Nurse Holdbrook should have examined him, taken all of his
vital signs, listened to his lungs, and had his phlegm taken for a culture.
Dr. Feldman also testified that on December 17, 2002, when Mr. Stiffler was
seen by Nurse Richards at Mohawk, his illness had progressed, based upon his
additional symptoms compared to his symptoms on December 13, 2002.
Dr. Feldman was of the opinion that Mr. Stiffler was “acutely ill”
on December 17, 2002, and that it was “highly significant” that Mr.
Stiffler had no air exchange in his lower left lobe. He was of the opinion that
an oxygen saturation test was needed at that time, but was not performed (since
the pulse oximeter was broken). He was of the further opinion that on the
morning of December 17th, Mr. Stiffler needed oxygen and continuous
intravenous fluids and antibiotics.
He further testified that there were further deviations from accepted standards
of care during the period of time from the morning of December 17, 2002 until he
was transferred to St. Luke’s Medical Center in the late morning of
December 18, 2002. Specifically, Dr. Feldman testified that Mr. Stiffler
should have been provided with continuous intravenous fluids, and not just the
few liters of fluids that Mr. Stiffler received after his transfer to Mid-State.
Additionally, Dr. Feldman testified that the examinations of Mr. Stiffler which
were performed at both Mohawk and Mid-State were incomplete and inadequate. Dr.
Feldman testified that based on his symptoms and complaints, Mr. Stiffler should
not have had to wait approximately 24 hours for the first test of his oxygen
saturation levels, and that chest x-rays should have been taken during this time
period for a proper diagnosis of his illness.
Dr. Feldman testified that a timely chest x-ray at this time would have
confirmed the presence of pneumonia, and therefore would have allowed Mr.
Stiffler to begin receiving appropriate and proper treatment for this illness.
He testified that once diagnosed, pneumonia is treated with antibiotics and
supportive care, including oxygen and fluids. He further stated that if
pneumonia is subsequently determined to be viral in nature, rather than
bacterial, the antibiotics will be discontinued, but the supportive care (oxygen
and fluids) will be continued. Obviously, a person’s chances of survival
and recovery, even from viral pneumonia, are much higher when supportive care is
provided upon early diagnosis.
Dr. Feldman concluded by testifying that in his opinion, a “true
emergency” existed on the morning of December 17, 2002, and that claimant
at that time was in respiratory distress, as evidenced by the fact that he was
using his accessory muscles to breathe, with no air exchange in his lower left
lobe. Based on these findings, Dr. Feldman was of the opinion that claimant
needed treatment at that time in a hospital setting, and that he did not receive
proper and adequate treatment at either Mohawk or Mid-State prior to his
transfer to St. Luke’s. He concluded by testifying that the delay in
sending Mr. Stiffler to St. Luke’s, coupled with the inadequate care and
treatment, was a proximate cause of his subsequent death on December 23, 2002.
Thomas Neil Thompson, M.D., board certified in diagnostic radiology, was called
as claimants’ expert radiologist
Thompson reviewed x-ray films (Exhibits 6 through 11) which were taken at
various times during Mr. Stiffler’s hospitalization at St.
Dr. Thompson testified that he reviewed the x-ray which was taken at St.
Luke’s on December 18, 2002 (Exhibit 6), and that this x-ray showed
“profound extensive bilateral infiltrates”, and that the lung was
“consolidated” and “markedly abnormal”.
Dr. Thompson also reviewed an x-ray taken on December 19, 2002 (Exhibit 8), and
testified that this x-ray also showed “extensive bilateral consolidative
pneumonia” and evidenced a progression of the disease as shown on the
Dr. Thompson also reviewed an x-ray taken on December 23, 2002 (Exhibit 11),
which showed “remarkable improvement”. Dr. Thompson attributed this
improvement to the supportive treatment that Mr. Stiffler received upon
entering St. Luke’s on December 18th.
Based upon his review of these x-ray films, Dr. Thompson was of the opinion
that if Mr. Stiffler had been diagnosed with pneumonia a few days earlier,
he very well may have been able to clear his lungs and recover from the
pneumonia with supportive care. Dr. Thompson opined that Mr. Stiffler
would have been “much more likely” to recover from the pneumonia,
and it was not as likely that he would have progressed into multi-system organ
Based upon the symptoms exhibited by Mr. Stiffler and his complaints on
December 17, 2002, Dr. Thompson was of the opinion that an x-ray should have
been ordered at that time, and that the failure to do so was a deviation from
good and accepted medical practice. Dr. Thompson further testified that the
precipitating cause of Mr. Stiffler’s multi-system organ failure was the
Harold Sokol, M.D., was qualified by the Court as defendant’s medical
expert. Dr. Sokol is a pulmonary and critical care specialist, and is board
certified in pulmonary disease, internal medicine, and critical care medicine.
Dr. Sokol acknowledged that the nurses at both Mohawk and Mid-State failed to
take vital signs, and also failed to document all of their findings, all of
which constituted a deviation from good and accepted medical practice. He
further testified that the failure to make a differential diagnosis during the
morning of December 17, 2002 was also a deviation from good and accepted medical
practice. He considered the documentation set forth in Mr. Stiffler’s
medical records as “poor” and “terrible”. On the other
hand, Dr. Sokol testified that these deviations in both nursing and medical care
did not cause or contribute to Mr. Stiffler’s subsequent death at St.
Based upon his review of Mr. Stiffler’s medical records, and specifically
the notes made by Nurse Richards on December 17th, Dr. Sokol was of the opinion
that Mr. Stiffler was suffering from an upper respiratory infection, influenza,
at that time, and that all of Mr. Stiffler’s symptoms were consistent with
influenza. According to Dr. Sokol, influenza is treated with supportive care,
and Mr. Stiffler received such supportive care (fluids and Tylenol for his
fever) while he was confined at the Mid-State infirmary.
Dr. Sokol was also of the opinion that Mr. Stiffler then developed acute
respiratory distress syndrome (ARDS) from his influenza, and that ARDS was the
cause of his death. He testified that there is no way of preventing ARDS, and
that there is no treatment other than supportive care for the influenza.
Dr. Sokol further opined that a pulse oximetry reading was not necessary on the
morning of December 17th, nor was a chest x-ray necessary since Mr. Stiffler had
all the symptoms of influenza.
Dr. Sokol agreed that if Mr. Stiffler in fact had viral pneumonia, as opposed
to bacterial pneumonia, supportive care is the only appropriate treatment, and a
patient should receive fluids and “plenty” of oxygen for such care.
Dr. Sokol further testified that in his opinion, there would have been no
difference in Mr. Stiffler’s outcome even if he had been hospitalized
on December 17, 2002 rather than December 18, 2002. In his opinion, the
multi-system organ failure had already commenced from the inflammation and that
the ARDS and multi-system organ failure were irreversible.
In sum, despite certain deficiencies in recordkeeping, Dr. Sokol opined that
the treatment received by Mr. Stiffler at both Mohawk and Mid-State was proper
and in conformance with good and accepted medical standards. Dr. Sokol noted
that Mr. Stiffler was provided with two liters of saline solution during the
afternoon of December 17th as supportive care, and that the decisions of the
physicians, including the decision to transfer Mr. Stiffler to St. Luke’s
on the morning of December 18, 2002, were appropriate and well-founded.
Dr. Sokol testified that the mortality rate of ARDS in 2002 was approximately
50%, and that the only treatment available for ARDS is supportive care and that
Mr. Stiffler received such care while in the infirmary at Mid-State.
In this claim, and as can be seen from the foregoing, claimants essentially
contend that Mr. Stiffler received inadequate and untimely medical treatment at
both Mohawk and Mid-State from the morning of December 17, 2002 through the
morning of December 18, 2002, and that such care was a proximate cause in his
subsequent death at St. Luke’s.
It is well established that the State has an obligation to provide the inmates
of its correctional facilities with reasonable and adequate medical care
(Gordon v City of New York, 120 AD2d 562, affd 70 NY2d 839),
including the proper diagnosis and treatment of injuries (Rivers v State of
New York, 159 AD2d 788, lv denied 76 NY2d 701).
In a claim based upon medical malpractice, a claimant has the burden of proof
and must establish (1) a deviation or departure from accepted practice, and (2)
evidence that the deviation was the proximate cause of the injury involved
(Pike v Honsinger, 155 NY 201).
In this particular matter, therefore, liability, if any, must be based upon
whether appropriate and timely medical attention was provided by DOCS
(Department of Correctional Services) personnel from the date of Mr.
Stiffler’s initial presentation at the Mohawk Correctional Facility
infirmary on December 13, 2002 until his transfer to St. Luke’s Medical
Center in the late morning of December 18, 2002.
As can be determined from the trial testimony, defendant concedes that certain
actions taken by the medical staff at both facilities did not conform to good
and accepted medical standards. Specifically, defendant acknowledges that Nurse
Holdbrook, on December 13, 2002, failed to take Mr. Stiffler’s vital signs
and failed to fully assess his condition when he appeared for sick call at
Mohawk. Defendant further concedes that Dr. Seedat failed to document the type
of lung sounds he heard when he examined Mr. Stiffler on December 17th, and
failed to record his differential diagnosis on that day. Defendant also
concedes that Nurse Williams, when she examined claimant on December 17, 2002 at
Mid-State, failed to record Mr. Stiffler’s oxygen saturation rate, and
improperly compared Mr. Stiffler’s blood pressure to her own when she took
his vital signs at that time. Defendant contends, however, that these actions,
although not within proper and accepted medical and nursing standards, were not
the proximate cause of Mr. Stiffler’s death.
The crux of this claim, therefore, is a determination as to whether the
negligent acts, conceded or otherwise, of the medical staff at Mohawk and
Mid-State are proximately related to the death of Mr. Stiffler at St.
Luke’s several days later.
Although the medical experts differed as to when it developed, all of the
expert medical testimony established that at some point Mr. Stiffler developed
viral pneumonia, an untreatable but not necessarily fatal disease. As testified
to by Dr. Sikirica, the viral pneumonia led to the multi-system organ failure
which eventually took Mr. Stiffler’s life.
It is defendant’s position, therefore, that even though there were
certain instances of improper and deficient care provided to Mr. Stiffler at
Mohawk and Mid-State, there was no medical care available that would have
prevented Mr. Stiffler from developing the viral pneumonia, and there is no cure
for viral pneumonia once it is contracted. In essence, it is defendant’s
position that once Mr. Stiffler developed the viral pneumonia, this pneumonia
led inevitably to the multi-system organ failure which took his life.
The expert medical testimony, however, also established that while there is no
“cure” for viral pneumonia, it is not necessarily fatal in all
cases, and a full recovery is certainly possible. Dr. Feldman testified,
without contradiction, that early diagnosis with supportive care (fluids and
oxygen) provides an individual with the best opportunity for a complete
In this particular matter, when Mr. Stiffler first presented to the Mohawk
infirmary with an illness on December 13, 2002, he unquestionably was provided
with inadequate treatment at that time. His vital signs were not taken, and his
medical condition was not fully assessed.
When he returned to the Mohawk infirmary on December 17, 2002, his condition
had deteriorated. Nurse Richards, in her examination, found no air exchange in
his lower left lobe, and Dr. Seedat noted that Mr. Stiffler was using his
accessory muscles to breathe. Although he did not find the same lack of air
exchange as Nurse Richards, Dr. Seedat failed to document the type of lung
sounds that he heard, and did not record a differential diagnosis, although he
apparently suspected pneumonia.
Additionally, during the time that Mr. Stiffler was at Mohawk, his oxygen
saturation level was not taken (due to the pulse oximeter being broken), no
chest x-ray was taken, and he was not provided with any fluids or oxygen.
According to Dr. Feldman, claimant’s condition on the morning of December
17th presented a “true emergency”, and claimant needed supportive
care in the form of fluids, oxygen, and antibiotics at that time. Additionally,
a chest x-ray should have been taken since he was using his accessory muscles to
Even after Mr. Stiffler was transferred to the infirmary at Mid-State, his
oxygen saturation level still was not recorded until approximately 10:30 a.m. on
December 18, 2002.
Although he was provided
with a few hours of fluids, he did not continuously receive intravenous fluids
or oxygen during his time there. Additionally, chest x-rays were never taken
while he was at Mid-State, and there was no culture taken of his sputum.
Based on the foregoing, the Court finds that there was a significant delay in
determining Mr. Stiffler’s oxygen levels, especially based upon the
symptoms that he was presenting. Mr. Stiffler had a significantly elevated
respiratory rate, an abnormal lung examination with diminished breath sounds,
and he was using his accessory muscles to breathe. Even with these symptoms,
since the pulse oximeter at Mohawk was broken, Mr. Stiffler was not evaluated
for his oxygen need, and the question as to whether Mr. Stiffler needed
oxygen was never addressed or considered. As a result, based upon this delay in
determining Mr. Stiffler’s oxygen level, there was a significant delay in
providing any respiratory therapy to Mr. Stiffler while he was being treated at
both Mohawk and Mid-State.
Additionally, when Mr. Stiffler’s oxygen saturation level was finally
recorded at approximately 10:30 a.m. on December 18th at Mid-State, it was
extremely low (84%), he was given oxygen, and shortly thereafter was transferred
to St. Luke’s. Therefore, the Court also finds that the failure to timely
determine Mr. Stiffler’s oxygen level contributed to the delay in sending
him to St. Luke’s.
In sum, based upon the medical testimony and medical records, it is apparent to
this Court that the early signs of Mr. Stiffler’s illness were evident on
December 13, 2002, and that by December 17, 2002, it was apparent that Mr.
Stiffler was in need of timely and proper medical treatment, especially in the
form of supportive care.
This Court cannot say, with certainty, that Mr. Stiffler would have survived
his illness. Based upon the testimony, it is impossible to determine
specifically when the progression of Mr. Stiffler’s illness became
irreversible. However, medical testimony has convinced the Court that Mr.
Stiffler was not destined to die if he was timely diagnosed and provided with
appropriate supportive care. Furthermore, without timely and appropriate
supportive care, Mr. Stiffler’s chances of survival were severely reduced,
and it is apparent to this Court that Mr. Stiffler did not receive appropriate
supportive care at either Mohawk or Mid-State. Mr. Stiffler was never properly
evaluated, and therefore was never provided continuous oxygen or IV fluids until
he was admitted to St. Luke’s. The Court concludes, therefore, that one
may make the argument that although claimant was “monitored” while
at both Mohawk and Mid-State, he never received any meaningful treatment in
terms of appropriate supportive care, and this denial of supportive care was in
fact a proximate cause of his eventual death from multi-system organ failure due
to the pneumonia which he developed. The Court therefore finds that the
treatment received by Mr. Stiffler from the medical staff at both Mohawk and
Mid-State, taken as a whole, did not conform to accepted standards of medical
practice, and this deviation was a proximate cause of his eventual death.
Accordingly, the Court finds the defendant 100% liable in this matter.
Any motions not heretofore ruled upon are hereby denied.
The Clerk of the Court is hereby directed to enter an interlocutory judgment on
the issue of liability in accordance with this decision. The Court will set
this matter down for trial on the issue of damages as soon as practicable.
LET INTERLOCUTORY JUDGMENT BE ENTERED ACCORDINGLY