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Candelaria v. St. Agnes Hospital

March 29, 2010



This is an action arising out of medical treatment that New York state prison inmate Plaintiff Juan Candelaria ("Plaintiff" or "Candelaria") allegedly received at Defendant St. Agnes Hospital ("Defendant" or "St. Agnes") while he was in state custody. In his Amended Complaint ("Complaint") Plaintiff asserts a claim under 42 U.S.C. § 1983, alleging deliberate indifference to Plaintiff's serious medical needs in violation of Plaintiff's rights under the Eighth and Fourteenth Amendments. The Court has previously construed the Complaint to also assert a state law medical malpractice claim against St. Agnes. The Court has jurisdiction of this action pursuant to 28 U.S.C. §§ 1331, 1343 and 1367.

St. Agnes moves for summary judgment on Plaintiff's claims, and Plaintiff moves for sanctions for St. Agnes's alleged spoliation of evidence and to preclude St. Agnes from introducing certain evidence at trial. On December 4, 2009, the Court held oral argument on the motion for summary judgment and the motion for spoliation sanctions. The parties thereafter made post-argument submissions. The Court has considered carefully the parties' submissions and arguments and, for the following reasons, grants St. Agnes's motion with respect to the Section 1983 claim, declines to exercise supplemental jurisdiction of the state malpractice claim, and denies Plaintiff's motions as moot.


The following material facts are undisputed unless otherwise indicated.*fn1 In August of 1997, while an inmate at Green Haven Correctional Facility, Plaintiff underwent a series of laboratory studies which revealed higher-than-normal levels of BUN and creatinine. (Decl. of Adam B. Siegel ("Siegel Decl."), Ex. D, Report of Jeffrey Silberzweig, M.D. ("Silberzweig Report") at 1 (relating findings of Dr. Bendheim)*fn2 .) According to prison records, the physician assigned to treat Plaintiff noted that "old labs [had] not show[n] these abnormalities." (Silberzweig Report at 1.) Plaintiff's elevated serum creatinine level persisted and after several weeks he was diagnosed with "acute renal failure with emesis in a patient with a neurogenic bladder"*fn3 and, on August 25, 1997, was brought to the Emergency Department at St. Agnes. (Id. at 2; Def.'s 56.1 St. ¶ 1; Pl.'s 56.1 St. ¶ 1.) St. Agnes, a now defunct entity, treated Candelaria pursuant to a contract with the New York State Department of Correctional Services ("NYSDOCS"). (Siegel Decl., Ex. N., agreement between St. Agnes and NYSDOCS ("DOCS Contract").)

Upon admission to St. Agnes, Plaintiff was initially seen by Dr. Snehal Vyas. Dr. Vyas noted Plaintiff's past history of hypertension and his need for self-catheterization. (Silberzweig Report at 2.) Dr. Vyas noted that Candelaria had "acute kidney injury" and suggested possible causes including "reduction of glomerular filtration pressure due to treatment with Vasotec" and "dehydration." (Id.) Dr. Vyas ordered intravenous ("IV") hydration and a renal ultrasound, and requested an evaluation by Renal Services. (Id.) Dr. Vyas also ordered that Plaintiff's "Is and Os," or fluid input and output, be monitored in order to assess the suitability of continued IV hydration. The next day, August 26, 1997, Dr. Lynda Ann Marie Szcezch, a renal specialist, saw Candelaria. (Pl. 56.1 St. ¶ 2.) After noting Plaintiff's past history of hypertension and after reviewing, among other things, the initial renal ultrasound, Dr. Szcezch diagnosed Candelaria with "acute on chronic renal failure." (December 11, 2009, Decl. of Adam Siegel ("Siegel Supp. Decl."), Ex. E ("Szcezch Notes 8/26/97"), at ST.AG000023; Silberzweig Report at 2.) Dr. Szcezch speculated that the chronic component of Candelaria's kidney failure was caused by a glomerular process and that the acute component might be due to "vasomotor issues related to ACEI" or an "exacerbation of the underlying disease." (Silberzweig Report at 2.) She "suggested" a second renal ultrasound and an number of additional serologic studies. (Id.) The following day, August 27, 1997, Dr. Szcezch saw Plaintiff again, interpreted certain new laboratory results "to indicate moderate renal impairment" and ordered a urinalysis. (Id. at 2-3.) Dr. Vyas also saw Plaintiff on that day and discontinued the IV fluids. (Id. at 3.)

Dr. Szcezch saw Plaintiff on August 28, 1997, as did a Dr. Haber, and "had no new recommendations." (Silberzweig Report at 3.) On August 29, 1997, Dr. Szcezch received the results of the urinalysis. (Id.) She made a "presumptive diagnosis of [focal segmental glomerulosclerosis]" ("FSGS") and "discussed the prognosis for Mr. Candelaria's renal disease with him and discussed the possibility of a renal biopsy" to conclusively identify the various components of Plaintiff's kidney disease. (Id.; see also Siegel Decl., Ex. H., Tr. of Dep. of Dr. Szcezch ("Szcezch Dep.") at 59:16-60:5.) Dr. Haber also saw Plaintiff that day and "noted that the renal ultrasound showed no renal vein thrombosis."*fn4 (Silberzweig Report at 3.) It appears from Dr. Silberzweig's report that Dr. Szcezch did not review the ultrasound herself. On September 1, 1997, Dr. Anjani Dubey, a nephrologist (see Def.'s 56.1 St. ¶ 51; Pl.'s 56.1 St. ¶ 51), reviewed the August 29, 1997, urinalysis results. (Silberzweig Report at 3.) The next day, September 2, 1997, Dr. Szcezch saw Plaintiff and noted that a number of the seriologies were negative. (Id.) "She stated that no further intervention or diagnostic procedures were indicated." (Id.)

Dr. Szcezch testified at her deposition that she had ruled out numerous possible causes of Plaintiff's kidney disease, namely the nephritic group (as opposed to the nephrotic group) of diseases, including "Membranoproliferative glomerulonephritis [(']MPGN[')], IGA nephropathy, Lupus, Alport's disease, Wegener's granulomatosis, [and] Goodpasture's Syndrome," and ultimately decided against performing a biopsy because she perceived a risk of dangerous bleeding as a result of the procedure and little benefit to knowing the precise cause of the disease given that the course of treatment would be unaffected. (Szcezch Dep. at 59:16-64:9.) Dr. Szcezch further explained that she believed that, even if a biopsy had been performed and it had revealed a treatable condition, and the subsequent treatment had had an "efficacy . . . of 100 percent" and been "absolutely successful," it would nevertheless have left Plaintiff "with a creatinine of five"*fn5 and "he would have progressed to end-stage renal disease without a doubt in [her] mind" and delayed dialysis by only "a matter of months." (Szcezch Dep. at 74:3-75:5.) Such a minimal potential benefit from performing a biopsy was, in Dr. Szcezch's opinion, not "worth the risk of bleeding[,] the risk associated with the therapies" for treating any treatable condition that may have been found, or the risk of infection. (Id. at 75:4-17; see also id. at 75:20-25 (the potential to keep Plaintiff off dialysis for a few more months "would have come at a much greater cost than the benefit").)

On September 4, 1997, Dr. Dubey saw Plaintiff and "noted a 'stable creatinine of 5.5'" and "cleared him for discharge from a renal standpoint." (Silberzweig Report at 3 (quoting "St. Agnes p. 00035," submitted as Def.'s 56.1 St., Ex. 1, ST.AG000035).) On September 7, 1997, Dr. Dubey "suggested proceeding with AV fistula creation [in preparation for hemodialysis] prior to discharge." (Silberzweig Report at 4.) Plaintiff was discharged on September 17, 1997 (Def.'s 56.1 St. ¶ 1; Pl.'s 56.1 St. ¶ 1), and began dialysis in November 1997 (Def.'s 56.1 St. ¶ 5). Plaintiff's expert retained for this litigation, Dr. Silberzweig, finds many faults with the care that St. Agnes provided to Plaintiff. In particular, Dr. Silberzweig opines that St. Agnes failed to adequately treat Plaintiff's dehydration in that he was given too little IV fluid, the wrong kind of fluid, and the IV fluids were discontinued too early. (Silberzweig Report at 7.) Dr. Silberzweig also notes that St. Agnes did not strictly monitor Plaintiff's "Is and Os" and opines that as a result St. Agnes's staff mistakenly concluded that Plaintiff had insufficient urine output to tolerate a higher rate and prolonged provision of IV hydration. (Id.) Dr. Silberzweig also faults St. Agnes's failure to take notice of the indication of "more of an acute component to [Plaintiff's] kidney disease [that] should have prompted a more aggressive search for reversible causes of acute kidney injury" which "would have confirmed the diagnoses of dehydration and urinary tract infection." (Id.) Such diagnoses, according to Dr. Silberzweig, "could have led to arrest and reversal of the acute component of [Plaintiff's] kidney disease." (Id.)

Dr. Silberzweig asserts that Dr. Szcezch's decision to not perform a renal biopsy prevented her and the other St. Agnes doctors from discovering Plaintiff's "underlying pathology." (Silberzweig Report at 7.) He opines that according to "the ultrasound reports," and in light of the normal size of Plaintiff's kidneys at the time, "a biopsy would have been feasible." (Id. at 8.) Dr. Silberzweig notes that "[t]he physicians' notes never indicate that they personally examined the ultrasound films" and asserts that "such an examination should have been carried out to determine the feasibility of a kidney biopsy." (Id.) Had a biopsy shown "the [FSGS] that Dr. Szczech [sic] anticipated, Mr. Candelaria's course at St. Agnes would have been unaffected." (Id. at 7.) However, "had it shown a different diagnosis like membranous nephropathy or [MPGN], specific therapies including steroids and other immunosuppressive agents might have been employed with the anticipation of arresting the progression of [Plaintiff's] disease and possibly reversing it." (Id. at 7-8.)

Dr. Silberzweig asserts that the results of a urinalysis which revealed the presence of Staphylococcus epidermidis "indicate the presence of a urinary tract infection." (Silberzweig Report at 7.) He further opines that, in light of other aspects of Plaintiff's medical condition and personal circumstances, the presence of this microorganism "should have been interpreted as indicative of a urinary tract infection." (Id.) Dr. Silberzweig remarks that the infection, which "was never noted or treated" by the St. Agnes doctors, "required but did not receive treatment with antibiotics" and that "[s]uch treatment would likely have led to improved kidney function." (Id.)

Finally, Dr. Silberzweig discusses a number of other errors he perceives in the care provided by St. Agnes, including the failure to "note[], evaluate[] or treat[]" anemia that set in near the end of Plaintiff's hospital admission, the treatment of which "might have resulted in slowing of the progression of [Plaintiff's] chronic kidney disease" (Silberzweig Report at 7), the administration of phosphosoda, despite its contraindication, "likely contribut[ing] to accelerated progression of kidney disease and cardiovascular disease" (id. at 8), the general failure to pay any attention to Plaintiff's "loss of 20-25% of his kidney function" over the course of his admission at St. Agnes (id.), and the failure to "hold his discharge until Mr. Candelaria's creatinine level was stable" despite "numerous notes from the Renal physicians indicating a desire" to implement such a hold (id.). Dr. Silberzweig concludes that, "[i]f Mr. Candelaria had received appropriate care, his kidney function could have been preserved for an additional 12 months or longer" (id.) and that, as a result of the inadequacies that he perceives in Plaintiff's treatment at St. Agnes, Plaintiff's "life expectancy has been reduced by approximately four years" (id. at 10).


Summary judgment should be granted when "the pleadings, the discovery and disclosure materials on file, and any affidavits show that there is no genuine issue as to any material fact and that the movant is therefore entitled to judgment as a matter of law." Fed. R. Civ. P. 56(c). A fact is considered material "if it 'might affect the outcome of the suit under the governing law,'" and an issue of fact is a genuine one where "the evidence is such that a reasonable jury could return a verdict for the nonmoving party." Holtz v. Rockefeller & Co. Inc., 258 F.3d 62, 69 (2d Cir. 2001) (quoting Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 248 (1986)). The moving party bears the burden of establishing the absence of any genuine issue of material fact. Anderson, 477 U.S. 242 at 256. However, "[t]he party against whom summary judgment is sought . . . 'must do more than simply show that there is some metaphysical doubt as to the material facts. . . . [T]he nonmoving party must come forward with specific facts showing that there is a genuine issue for trial.'" Caldarola v. Calabrese, 298 F.3d 156, 160 (2d Cir. 2002) (quoting Matsushita Elec. Indus. Co. v. Zenith Radio Corp., 475 U.S. 574, 586-87 (1986)). The Court must construe the evidence in the light most favorable to the non-moving party and draw all reasonable inferences in favor of the non-moving party. Spinelli v. City of New York, 579 F.3d 160 (2d Cir. 2009).

The Eighth Amendment "establish[es] the government's obligation to provide medical care for those whom it is punishing by incarceration." Estelle v. Gamble, 429 U.S. 97, 103 (1976). "[D]eliberate indifference to serious medical needs of prisoners constitutes the 'unnecessary and wanton infliction of pain' proscribed by the Eighth Amendment." Id. at 104 (internal citation omitted). However, inadvertence, negligence, or medical malpractice, alone, do not constitute deliberate indifference within the meaning of the Eighth Amendment. Id. at 105-06. A deliberate indifference claim requires a showing (1) that the harm resulting from the inadequate medical care was "in objective terms, sufficiently serious," and (2) that the defendant acted "with a sufficiently culpable state of mind." Chance v. Armstrong, 143 F.3d 698, 702 (2d Cir. 1998) (internal quotation marks and citations omitted). The second, subjective, element requires a showing that the defendant "'kn[e]w of and disregard[ed] an excessive risk to inmate health or safety; the official must both be aware of facts from which the inference could be drawn that a substantial risk of serious harm exists, and he must also draw the inference.'" Id. (quoting Farmer v. Brennan, 511 U.S. 825, 837 (1994)). Thus, in order for the defendant's mental state to fall within this definition, he need not know that the harm will result from his act or omission, but must know that there is a substantial risk of such a result. See Farmer, 511 U.S. at 842. This standard is "equivalent to ...

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