Francisca Montilla, as Administratrix of the Estate of Maria Almonte, Plaintiff-Appellant,
St. Luke's-Roosevelt Hospital, et al., Defendants-Respondents.
& Grossman, Mineola (Steven Sachs of counsel), for
Elser Moskowitz Edelman & Dicker LLP, New York (Judy C.
Selmeci of counsel), for respondents.
Renwick, J.P., Moskowitz, Kapnick, Kahn, Gesmer, JJ.
from order, Supreme Court, New York County (Joan B. Lobis,
J.), entered July 20, 2015, which granted defendants'
motion for summary judgment dismissing the complaint, deemed
an appeal from judgment, same court and Justice, entered
September 16, 2015, dismissing the complaint (CPLR 5501[c]),
and so considered, said judgment unanimously affirmed,
August 14, 2009, plaintiff's decedent, a 66-year-old
woman, presented to defendant St. Luke's-Roosevelt
Hospital with a history of diabetes and hypertension, and a
chief complaint of altered mental status. Upon admission,
decedent underwent an initial "Fall Risk Assessment,
" which placed her in the moderate risk category.
Decedent's blood pressure was 175/93 in the emergency
room, and 160/75 when retested in the afternoon. On the same
day decedent was admitted, hospital personnel performed an
initial head CT scan; that study showed no intracranial
hemorrhage and no changes since an MRI performed on May 30,
August 15, 2009, decedent's blood pressure measured
120/80, and then increased to 150/90 on August 16. On August
17, decedent's blood pressure measured 144/82.
about 7:45 a.m. on August 18, 2009, four days after her
admission date, decedent complained of epigastric pain and
vomiting. The nurse's progress notes indicated that
decedent was found to be lethargic, a change from the
previous day, and her blood pressure measured 130/70. By 9:00
a.m., decedent's blood pressure had risen to 178/80.
that day, at about 10:20 a.m., a nurse found decedent on the
floor of her room. A report noted that decedent was
"lethargic" and "not answering
questions." At about 11:00 a.m., decedent vomited, and
at 11:20 a.m., her blood pressure was 160/90. A post-fall
assessment form indicated that decedent was receiving
Heparin, an anticoagulation medication. Decedent had another
CT study performed at about 1:30 p.m., and it showed an
intraventricular hemorrhage - that is, bleeding within the
ventricle, one of the spinal fluid-filled cavities of the
brain. This hemorrhage had not appeared on the CT scan
performed four days earlier.
hospital later transferred decedent to Roosevelt Neurosurgery
ICU, and decedent died on October 8, 2009. Plaintiff
commenced this action, alleging, among other things, that the
hospital negligently failed to prevent decedent from falling.
moved for summary judgment. On the motion, defendants
submitted the expert affidavit of a neurosurgeon, who
reviewed three CT scans, performed May 30, 2009; August 14,
2009; and August 18, 2009. Defendants' expert opined that
the August 18, 2009 head CT study showed a new
intraventricular hemorrhage; based on his review of the CT
scans, defendants' expert opined that the hemorrhage did
not result from a fall. Further, the hospital chart reviewed
by defendants' expert indicated that the nursing staff
found decedent on the floor; the chart contained no
documentation that decedent was bleeding or had suffered any
external injury as a result of a fall.
expert explained that intraventricular brain hemorrhaging
can, in fact, result from head trauma suffered in a fall. He
opined, however, that the pattern of injury revealed on
decedent's August 18 CT films was inconsistent with an
injury from a fall or other head trauma, as one would not see
an isolated intraventricular bleed resulting from head trauma
without seeing accompanying evidence of global injury, such
as skull fracture or brain contusion, on the CT study.
expert further opined that chronic elevated blood pressure
eventually weakens the delicate walls of the blood vessels in
the brain tissue abutting the ventricles; the vessels cannot
withstand a sudden spike in blood pressure, and therefore are
prone to rupture. Observing that decedent had a long-standing
history of high blood pressure, and that her blood pressure
was elevated just prior to the events at issue, the expert
concluded that decedent's hemorrhage was consistent with
bleeding resulting from her persistent acute hypertension.
opposition, plaintiff proffered a redacted expert affirmation
from a board-certified neurologist, who opined that while
"prolonged hypertensive crisis" was a
"potential cause" of intraventricular hemorrhage,
head trauma was also a "well-known and accepted cause of
intraventricular hemorrhage, " and indeed, had been
reported in medical literature since the advent of CT scan
technology. Plaintiff's expert further noted that,
because the intraventricular hemorrhage was first apparent
after decedent fell and hit her head, it was more likely than
not that the fall was the proximate cause of her
expert further noted that decedent's blood pressure was
elevated, but did "not give rise to a hypertensive
crisis, " as a hypertensive crisis is
"typically" evidenced by blood pressures "in
excess of 180/100." Nor did decedent's blood
pressure readings from August 15 to August 18, 2009 suggest
that she was experiencing a hypertensive crisis or that her
hypertension was worsening. Plaintiff's expert opined
that, based on decedent's blood pressure readings,
decedent's hypertension improved during the admission and
was normal, and she was not in a hypertensive crisis; indeed,
plaintiff's expert noted, the hospital had been planning
to discharge decedent. Furthermore, the expert noted that on
August 18, 2009, the day of her fall, decedent had been
taking Heparin, a drug that increases a patient's risk of