New York State Court of Claims

New York State Court of Claims

STIFFLER v. THE STATE OF NEW YORK, #2009-009-202, Claim No. 108631


Synopsis


The Court found the State liable for medical malpractice and negligence resulting in the death of claimants’ decedent.

Case Information

UID:
2009-009-202
Claimant(s):
JACK STIFFLER AND LAURA CAMPBELL, Individually and as Co-Administrators of the Estate of JEFFREY R. STIFFLER, Deceased
Claimant short name:
STIFFLER
Footnote (claimant name) :

Defendant(s):
THE STATE OF NEW YORK
Footnote (defendant name) :

Third-party claimant(s):

Third-party defendant(s):

Claim number(s):
108631
Motion number(s):

Cross-motion number(s):

Judge:
NICHOLAS V. MIDEY JR.
Claimant’s attorney:
BOTTAR LEONE, PLLC
BY: Timothy J. DeMore, Esq., and Lauren H. Seiter, Esq.,Of Counsel.
Defendant’s attorney:
HON. ANDREW M. CUOMO
Attorney General
BY: Belinda A. Wagner, Esq.,
Assistant Attorney GeneralOf Counsel.
Third-party defendant’s attorney:

Signature date:
August 6, 2009
City:
Syracuse
Comments:

Official citation:

Appellate results:

See also (multicaptioned case)


Decision

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 liability.


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 103.4 degrees.

Nurse Richards referred Mr. Stiffler to Dr. Mohammed Seedat, a physician at Mohawk, who requested that Nurse Richards “telemed him”[1] 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 this transfer.

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 distress”[2]. 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 his transfer.

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 treatment.

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 lungs.

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 performed.

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 symptoms.

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. Stiffler.

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[3]. Dr. Thompson reviewed x-ray films (Exhibits 6 through 11) which were taken at various times during Mr. Stiffler’s hospitalization at St. Luke’s.

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 earlier x-ray.

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 failure.

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 pneumonia.

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. Luke’s.

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.
DISCUSSION
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 recovery.

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 breathe.

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.[4] 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


August 6, 2009
Syracuse, New York

HON. NICHOLAS V. MIDEY JR.
Judge of the Court of Claims




[1]. “Telemed” is a means of communicating with an outside physician for the purpose of obtaining an opinion as to diagnosis and possible transfer to an outside facility. At the time, “telemed” was used for purposes of communicating with a physician at the Erie County Medical Center.
[2]. Unless otherwise indicated, all references and quotations are taken from the Court’s trial notes.
[3]. Dr. Thompson’s testimony was taken prior to trial. A transcript of his testimony was received into evidence as Exhibit 23 and a videotape of his testimony was received as Exhibit 24.
[4]. Although Nurse Williams testified that she took Mr.Stiffler’s oxygen saturation rate in the afternoon of December 17th when he was admitted to the Mid-State infirmary, the Court discredits this testimony due to the fact that no record was made of any such test.