The opinion
Moss v Mount Sinai Beth Israel
2024 NY Slip Op 34559(U)
December 5, 2024
Supreme Court, New York County
Docket Number: Index No. 805392/2017
Judge: John J. Kelley
Cases posted with a "30000" identifier, i.e., 2013 NY Slip
Op 30001(U), are republished from various New York
State and local government sources, including the New
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This opinion is uncorrected and not selected for official
publication.
INDEX NO. 805392/2017
NYSCEF DOC. NO. 192 RECEIVED NYSCEF: 12/06/2024
SUPREME COURT OF THE STATE OF NEW YORK
NEW YORK COUNTY
PRESENT: HON. JOHN J. KELLEY PART 56M
Justice
---------------------------------------------------------------------------------X INDEX NO. 805392/2017
KATHY MOSS, as Administrator of the Estate of ESTHER
MOSS, Deceased, MOTION DATE 10/15/2024
Plaintiff, MOTION SEQ. NO. 005
-v-
MOUNT SINAI BETH ISRAEL, BETH ISRAEL MEDICAL DECISION + ORDER ON
CENTER, and MOUNT SINAI HEALTH SYSTEM, INC., MOTION
Defendants.
---------------------------------------------------------------------------------X
The following e-filed documents, listed by NYSCEF document number (Motion 005) 169, 170, 171, 172,
173, 174, 175, 176, 177, 178, 179, 180, 181, 182, 183, 184, 185, 186, 187, 188, 189, 190, 191
were read on this motion to/for SUMMARY JUDGMENT (AFTER JOINDER) .
In this action to recover damages for medical malpractice based on alleged departures
from good and accepted medical practice, and to recover damages for wrongful death, the
plaintiff moves pursuant to CPLR 3212 for summary judgment on the issue of liability against
the defendants. The defendants oppose the motion. The motion is denied.
The crux of the plaintiff’s claim is that, during the October 20, 2015 admission of her
decedent, Esther Moss, to the defendant hospital Beth Israel Medical Center (BIMC), a division
of the defendants Mount Sinai Beth Israel and Mount Sinai Health System, Inc., radiologists
employed by BIMC failed to observe a subdural hematoma on a magnetic resonance imaging
(MRI) scan of her decedent’s head that had been caused by a fall earlier that day, thus delaying
the decedent’s withdrawal from the anticoagulant drug Coumadin (warfarin). The plaintiff further
alleged that BIMC emergency room physicians negligently failed timely to refer her for a
neurology consultation. She asserted that, by retaining her decedent on a maintenance dosage
of Coumadin after her decedent had fallen and struck her head, and failing immediately to refer
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her to a neurologist, her decedent went into a coma while still at BIMC several days after her
admission, and ultimately died from a brain bleed on November 6, 2015.
In her complaint, the plaintiff alleged that the defendants were negligent in that their
medical and health-care personnel failed properly to read and interpret radiographic studies,
and, thus, failed to make a proper and adequate diagnosis. The plaintiff further alleged that,
based on these departures from good and accepted practice, the defendants’ personnel failed
to render proper, adequate, and immediate medical care and treatment, which included their
failure properly to discontinue maintenance medications. In addition, she alleged that the
defendants’ personnel “failed to perform indicated medical procedures; performed improper
and/or contraindicated medical procedures; [and] negligently and carelessly and in violation of
good, sound medical custom and practice failed to exercise due and reasonable care under the
circumstances, so as to avoid injuring” the plaintiff’s decedent.
In her bill of particulars, the plaintiff first asserted that she would be relying upon the
doctrine of res ipsa loquitur. She also reiterated the allegations set forth in the complaint, and
further alleged that the defendants neglected to perform adequate, thorough, and timely
examinations of her decedent, failed properly to read and interpret the October 20, 2015 MRI
scan, and, thus, failed timely to diagnose the plaintiff’s decedent with a cranial subdural
hematoma or hemorrhage upon her admission to BIMC on October 20, 2015.
In addition, the plaintiff alleged in her bill of particulars that the defendants departed from
good and accepted practice in failing timely to perform a computed tomography (CT) scan, to
test for blood platelets, or to administer a blood test to measure the decedent’s international
normalized ratio (INR) for the purpose of determining whether her blood had become too thin to
withstand an ongoing cranial hematoma or hemorrhage. With respect to the CT scans that
ultimately were performed, the plaintiff alleged that the defendants misread or misinterpreted
those scans, instead reaching and relying upon a “hasty, superficial, incorrect, unsupported
diagnosis and further proceeding upon the basis of that incorrect diagnosis by placing a
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heightened concern on the patient's cardiologic condition as opposed to the more immediate
neurologic injuries.” She further alleged that the defendants’ personnel committed malpractice:
“[i]n failing and neglecting to adequately, properly and timely take heed and give
appropriate consideration, credence and medical significance to the consultation
and radiographic reports that were received, as well as to the [decedent’s]
relevant medical history and complaints, signs and symptoms, including low
platelets, increased INR levels, anticoagulant medications including heparin and
warfarin, the interplay between INR levels, low platelets, warfarin and heparin,
and an intra-cranial bleed, and . . . the CAT Scan of October 20th, 2015 revealing
intra-cranial hemorrhage, follow-up CAT Scan of October 23rd, 2015 revealing
increased intra-cranial hemorrhage as compared to prior study; in failing and
neglecting to adequately, timely and properly review all CAT Scan films; in failing
to request the October 20th, 2015 CAT Scans be reviewed again in view of the
findings of the October 23rd, 2015 CAT Scans demonstrating an intra-cranial
hemorrhage; in failing and neglecting to timely institute proper and adequate
medical treatment as of October 20th, 2015 by ceasing all prescriptions of
coumadin, or other like anti-coagulants; [and] in failing to transfer the patient on
October 20th, 2015 to ICU in view of her intra-cranial hemorrhage and elevated
INR levels.”
Furthermore, the plaintiff alleged in her bill of particulars that the defendants’ personnel
committed malpractice when the ignored the October 23, 2015 advice and recommendations of
family medicine practitioner Aubrey Raimondi, M.D., to discontinue the administration of
Coumadin to the decedent. She also faulted the defendants for failing to request proper and
appropriate consultations with a neurologist and internist.
Importantly, the plaintiff also alleged in her bill of particulars that the defendants failed
properly to correlate and evaluate the findings and patient history that they obtained, which
reflected the presence of elevated INR levels, with the ongoing administration of Coumadin or
other anti-coagulation drugs, which should have been extremely concerning for a patient who
had just fallen and struck her head. In addition, she contended that the defendants were
negligent in failing to administer vitamin K or fresh blood plasma intravenously from October 23,
2015 through October 26, 2015, after they finally recognized the presence of a cranial
hemorrhage, or to consider surgical intervention to relieve cranial pressure, and instead
prescribed and treated the decedent with heparin, another anticoagulant drug, despite Dr.
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Raimondi’s recommendation to cease all anticoagulant therapy, a recommendation that they did
not impart to the decedent or her family members.
It is well settled that the movant on a summary judgment motion “must make a prima
facie showing of entitlement to judgment as a matter of law, tendering sufficient evidence to
eliminate any material issues of fact from the case” (Winegrad v New York Univ. Med. Ctr., 64
NY2d 851, 853 [1985] [citations omitted]). The motion must be supported by evidence in
admissible form (see Zuckerman v City of New York, 49 NY2d 557, 562 [1980]), as well as the
pleadings and other proof such as affidavits, depositions, and written admissions (see CPLR
3212). The facts must be viewed in the light most favorable to the non-moving party (see Vega
v Restani Constr. Corp., 18 NY3d 499, 503 [2012]). In other words, “[i]n determining whether
summary judgment is appropriate, the motion court should draw all reasonable inferences in
favor of the nonmoving party and should not pass on issues of credibility” (Garcia v J.C.
Duggan, Inc., 180 AD2d 579, 580 [1st Dept 1992]). Once the movant meets his or her burden,
it is incumbent upon the non-moving party to establish the existence of material issues of fact
(see Vega v Restani Constr. Corp., 18 NY3d at 503). A movant's failure to make a prima facie
showing requires denial of the motion, regardless of the sufficiency of the opposing papers (see
id.; Medina v Fischer Mills Condo Assn., 181 AD3d 448, 449 [1st Dept 2020]).
“The drastic remedy of summary judgment, which deprives a party of his [or her] day in
court, should not be granted where there is any doubt as to the existence of triable issues or the
issue is even ‘arguable’” (De Paris v Women's Natl. Republican Club, Inc., 148 AD3d 401, 403-
404 [1st Dept 2017]; see Bronx-Lebanon Hosp. Ctr. v Mount Eden Ctr., 161 AD2d 480, 480 [1st
Dept 1990]). Thus, a moving plaintiff does not meet his or her burden of affirmatively
establishing entitlement to judgment as a matter of law merely by pointing to gaps in the
defense. He or she must affirmatively demonstrate the merit of his or her claim (see Koulermos
v A.O. Smith Water Prods., 137 AD3d 575, 576 [1st Dept 2016]; Katz v United Synagogue of
Conservative Judaism, 135 AD3d 458, 462 [1st Dept 2016]).
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“To sustain a cause of action for medical malpractice, a plaintiff must prove two essential
elements: (1) a deviation or departure from accepted practice, and (2) evidence that such
departure was a proximate cause of plaintiff's injury” (Frye v Montefiore Med. Ctr., 70 AD3d 15,
24 [1st Dept 2009]; see Roques v Noble, 73 AD3d 204, 206 [1st Dept 2010]; Elias v Bash, 54
AD3d 354, 357 [2d Dept 2008]; DeFilippo v New York Downtown Hosp., 10 AD3d 521, 522 [1st
Dept 2004]). Where a physician fails properly to diagnose a patient’s condition, thus providing
less than optimal treatment or delaying appropriate treatment, and such insufficient care or
delay proximately causes injury, he or she will be deemed to have departed from good and
accepted medical practice (see Zabary v North Shore Hosp. in Plainview, 190 AD3d 790, 795
[2d Dept 2021]; Lewis v Rutkovsky, 153 AD3d 450, 451 [1st Dept 2017]; Monzon v
Chiaramonte, 140 AD3d 1126, 1128 [2d Dept 2016] [“(c)ases . . . which allege medical
malpractice for failure to diagnose a condition . . . pertain to the level or standard of care
expected of a physician in the community”]; O'Sullivan v Presbyterian Hosp. at Columbia
Presbyterian Med. Ctr., 217 AD2d 98, 101 [1st Dept 1995]).
A plaintiff moving for summary judgment in a medical malpractice action must make a
prima facie showing of entitlement to judgment as a matter of law by establishing the absence of
a triable issue of fact as to the defendant’s departure from accepted standards of medical
practice (Alvarez v Prospect Hosp., 68 NY2d 320, 324 [1986]; Frye v Montefiore Med. Ctr., 70
AD3d at 24) and by establishing that he or she was injured by such treatment (see McGuigan v
Centereach Mgt. Group, Inc., 94 AD3d 955 [2d Dept 2012]; Sharp v Weber, 77 AD3d 812 [2d
Dept 2010]; see generally Stukas v Streiter, 83 AD3d 18 [2d Dept 2011]).
To satisfy the burden on a summary judgment motion, a plaintiff must present expert
opinion testimony that is supported by the facts in the record, addresses the essential
allegations in the complaint or the bill of particulars, if one has been served, and is detailed,
specific, and factual in nature (see Roques v Noble, 73 AD3d at 206;.Joyner-Pack v. Sykes, 54
AD3d 727, 729 [2d Dept 2008]; Koi Hou Chan v Yeung, 66 AD3d 642 [2d Dept 2009]; Jones v
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Ricciardelli, 40 AD3d 935 [2d Dept 2007]). If the expert’s opinion is not based on facts in the
record, the facts must be personally known to the expert and, in any event, the opinion of an
expert should specify “in what way" the patient's treatment was improper and “elucidate the
standard of care” (Ocasio-Gary v Lawrence Hospital, 69 AD3d 403, 404 [1st Dept 2010]).
The same standards as apply to a plaintiff’s prima facie showing also apply to a
defendant seeking to oppose a motion for summary judgment. Thus, the opinion of the
defendant’s expert must “explain ‘what defendant did and why’” (Ocasio-Gary v Lawrence
Hospital, 69 AD3d at 404, quoting Wasserman v Carella, 307 AD2d 225, 226, [1st Dept 2003]).
Where a bill of particulars has been served, a defendant must address and rebut specific
allegations of malpractice set forth therein (see Wall v Flushing Hosp. Med. Ctr., 78 AD3d 1043
[2d Dept 2010]; Grant v Hudson Val. Hosp. Ctr., 55 AD3d 874 [2d Dept 2008]; Terranova v
Finklea, 45 AD3d 572 [2d Dept 2007]). Where the expert’s “ultimate assertions are speculative
or unsupported by any evidentiary foundation, however, the opinion should be given no
probative force” (Diaz v New York Downtown Hosp., 99 NY2d 542, 544 [2002]; see Frye v
Montefiore Med. Ctr., 70 AD3d at 24).
The plaintiff established her prima facie entitlement to judgment as a matter of law by
submitting the pleadings, the bill of particulars, relevant medical records, transcripts of party and
nonparty depositions, a certified autopsy report referable to the decedent, and the expert
affirmation of a board-certified psychiatrist and neurologist.
The plaintiff’s expert physician opined that the defendants’ medical personnel departed
from good and accepted medical practice in treating the plaintiff’s decedent, and that their
departures caused and contributed to the decedent’s conscious pain and suffering and,
ultimately, to the decedent’s comatose condition and death.
Upon review of the medical records and deposition testimony, the plaintiff’s expert
explained that, on October 20, 2015, the decedent had fallen at home, striking and fracturing
her elbow, and striking and injuring her head. The expert noted that the decedent was taken by
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ambulance to the BIMC emergency room, where a CT scan of her head was taken and read by
BIMC radiologist Daniel E. Meltzer, M.D., who reported that the scan was negative for any
subdural hematoma. The expert further explained that, at the time, the decedent had been on a
maintenance dosage of the anticoagulant Coumadin in light of her history of transient ischemic
attacks (TIAs). As the plaintiff’s expert characterized BIMC’s emergency room chart, the
decedent’s head injury was her chief complaint. The expert further noted that, on October 23,
2015, BIMC radiologist David Liu, M.D., concluded, contrary to Dr. Meltzer’s impression, that the
October 20, 2015 head CT scan actually reflected the presence of a thin, left-sided subdural
hematoma. The plaintiff’s expert concurred with Dr. Liu’s reading, and opined that the October
20, 2015 scan indeed depicted a thin, left sided subdural hematoma. Consequently, the expert
concluded that Dr. Meltzer deviated from good and accepted medical practice in failing to
properly read and interpret the October 20, 2015 CT scan, and opined that, had Dr. Meltzer
properly read that scan, the decedent’s anticoagulant medication regime should and would have
immediately been discontinued. The plaintiff’s expert further asserted that, upon the
discontinuance of anticoagulants, BIMC should have initiated either prothrombin complex
concentrate (PCC) or fresh frozen plasma (FFP) therapy to reverse the effects of Coumadin.
More specifically, the plaintiff’s expert asserted that, upon reading the October 20, 2015
CT scan, Dr. Meltzer reported having observed “a large subcutaneous hematoma just superior
to the right external ear.” According to the expert, this condition “would be a strong indication
that Ms. Moss struck the right side of her head upon falling.” The expert stated that it is well
known in the fields of both radiology and neurology that head injuries often involve coup
and contrecoup injuries, meaning an initial “blow” and a “counterblow,” and that a “coup-
contrecoup injury” thus refers to two separate head injuries sustained during the same incident.
The expert explained that a coup injury refers to the head injury that occurs directly under the
point of impact, while a contrecoup injury occurs on the opposite side of the brain from where
the head is struck. The plaintiff’s expert further explained that, although these types of injury
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can occur separately, if the blow is strong enough, the injuries usually appear together as a
coup-contrecoup injury, and that a coup-contrecoup injury is more likely if a head strikes a
stationary object, such as what occurred to the decedent when her head struck the floor of her
bathroom. The expert noted that the side of the decedent’s head that contacted the floor
sustained a large subcutaneous hematoma, while the opposite side involved the brain internally
striking the skull as a result of the blow, causing a subdural hematoma, that is, a contrecoup
injury. The plaintiff’s expert asserted that, based upon the decedent’s fall, the fact that she was
on a maintenance dosage of anticoagulants, and the presence of a large right-sided
subcutaneous hematoma, “it was imperative to carefully study the film, and specifically to look at
the left side for a contrecoup injury. Dr. Meltzer, however, concluded [ ] that there was no acute
subdural hematoma bilaterally, there was no midline shift, or extra axial collection.” Upon
reviewing the October 20, 2015 scan, the plaintiff’s expert concluded, however, that there was,
in fact, an acute thin left-sided subdural hematoma present thereon, which also was expressly
observed and noted by BIMC’s Dr. Liu when he reviewed that scan on October 23, 2015.
Accordingly, the plaintiff’s expert reiterated his conclusion that the “admitted failure by Dr.
Meltzer to carefully examine for a contrecoup brain injury and note the left sided subdural
hematoma on 10/20/15, was a deviation from good and accepted medical practice.”
Although the plaintiff’s expert conceded that, “[d]espite the emergency room’s reliance
on a false negative CT Scan reading,” BIMC “appropriately admitted the patient for observation
of her head injury since she was on anti-coagulants for her prior history of TIAs,” and was
“rightly concerned about a ‘delayed bleed,’” BIMC nonetheless improperly failed to admit the
decedent to the neurology department, and instead placed her under the care of former
defendant James McNeill Mumford, M.D., a family practice physician. The expert asserted that,
by virtue of the decedent’s head injury and anticoagulant regimen, she “needed to be under the
care of a neurologist, or at the very least, an immediate involvement of neurology in consultation
with family medicine, and placed on a strict nursing neurologic watch,” requiring an assessment
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every two hours. The plaintiff’s expert opined that BIMC emergency room physician Fahad R.
Khan, M.D., as well as Drs. Raimondi and Mumford, departed from good and accepted practice
between October 20, 2015 and October 24, 2015, by failing immediately to call for a
neurological consultation or transfer the decedent to the BIMC neurology department, instead
placing her on “a mere 24-hour nursing neurologic assessment” until the late evening hours of
October 24, 2015, when this type of strict watch finally was implemented.
With respect to BIMC’s failure immediately to transfer the decedent to the neurology
department, the plaintiff’s expert explained that BIMC’s emergency room resident, May Choi,
M.D., as well as the emergency room team of physicians, consisting of Dr. Khan, Carey C. Li,
M.D., and Kar-mun Woo, M.D., determined that the decedent’s primary complaint was a head
injury, with secondary concerns about her social needs to aide in ambulation, and they decided
that the decedent should be admitted to the hospital “[g]iven [her] inability to walk and possibility
of delayed bleed on coumadin.” Moreover, the expert noted that the primary diagnosis was a
head injury. The plaintiff’s expert expressly opined that, under these circumstances, it was
“imperative that Ms. Moss receive neurologic care and treatment to monitor her head injury, and
watch for any clinical signs of a delayed bleed in the presence of anticoagulant medication.”
Although the expert accepted that the decedent’s needs for rehabilitation in connection with
ambulation were “real,” the expert averred that the primary, life-threatening condition was a
head injury while on Coumadin, that neurologic care and monitoring thus should have been the
prime concern, and that ambulatory rehabilitation services could also have been provided on a
neurological floor. As the expert described it,
“[i]t is difficult to explain how a patient with a fractured elbow and a significant
head injury with a large left sided subcutaneous hematoma was neither
admitted to orthopedics nor neurology. This is especially true when the BIMC ER
physician, Dr. Khan, states in the ER record that the primary diagnosis was a
‘head injury.’”
Nonetheless, the expert asserted that, once the decedent was admitted into the family
practice department, it was incumbent upon every resident and attending physician in that
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department immediately to seek a neurologic consultation, as that was the chief reason for the
decedent’s admittance into BIMC. The expert thus faulted Dr. Raimondi, as the initial family
medicine resident who saw the decedent after the BIMC family medicine department was
assigned to the decedent the admission date, for failing to request a neurological consultation or
a neurologic nursing watch, and characterized these failures as deviations from good and
accepted medical practice. Similarly, the expert faulted Dr. Mumford, who was assigned as the
decedent’s primary physician in the family medicine department, for failing to request a
neurologic consultation or a neurological nursing watch when he saw the decedent on October
21, 2015, October 22, 2015, and October 23, 2015, also characterizing these failures as
deviations from good and accepted medical practice.
The expert concluded that a neurologic consultation, conducted pursuant to the
standards of care in neurology in 2015, “would have likely and appropriately resulted in an order
for a neurological nursing watch,” which would have entailed enhanced monitoring for clinical
signs of neurologic impairment, such as slurred speech, uneven grip, orientation to time, place,
and person, and complaints of headaches. The expert noted that this type of neurologic watch
entailed, at a minimum, that decedent be monitored every two hours for such signs and
symptoms. Further, the plaintiff’s expert opined that such a neurologic consultation would likely
and appropriately have resulted in an order for a repeat CT scan either on October 21, 2015 or
October 22, 2015, at the latest, to ensure that there was no delayed internal head bleeding,
particularly because a repeat scan would have revealed, earlier than Dr. Liu’s October 23, 2015
report, the mistake that Dr. Metlzer had made on October 20, 2015, thus providing an earlier
opportunity for intervention and the best chance to resolve the effects of the anticoagulants.
In addition, the plaintiff’s expert asserted that, on October 23, 2015, Dr. Mumford
reported that the decedent had been complaining of headaches over the two days prior to that
date, even though the BIMC chart for October 21, 2015 and October 22, 2015 did not report
those complaints. Consequently, and also in light of the decedent’s medical history and her
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anticoagulant medication regimen, the expert concluded that a repeat CT scan should have
been conducted on both October 21, 2015 and October 22, 2015. In this respect, the expert
opined that the failure of BIMC’s nursing staff to record and report the decedent’s complaints of
on those two days constituted deviations from good and accepted nursing practice. The expert
noted that Dr. Mumford himself testified at his deposition that, had he been aware in real time
that the decedent had complained of headaches for two consecutive days, he would have
ordered an immediate repeat CT scan, since complaints of headaches in this setting would be
an indication for a repeat CT scan. Even in the absence of reports of headaches, however, the
plaintiff’s expert concluded that the decedent’s situation demanded proactive monitoring and
diagnostic testing. The expert also asserted that, notwithstanding Dr. Meltzer’s failure to
observe the presence of a subdural hematoma, BIMC staff should have anticipated that a head
trauma to an elderly patient on anticoagulants might have caused hemorrhaging, and that BIMC
nursing and medical personnel should not have waited for any possible hematoma “to expand to
the point where it manifested clinical symptoms such as headaches or agitation.”
Upon review of both the October 20, 2015 initial scan, and the October 23, 2015 repeat
CT scan, the plaintiff’s expert concluded that the later scan revealed a thin left sided subdural
hematoma that was larger than the one present on the earlier scan. The expert noted that,
shortly after the repeat scan of October 23, 2015, BIMC cardiologist Meir Shinnar, M.D., ordered
that all anticoagulant medications be discontinued, a directive that was confirmed after a
neurological consultation with physician’s assistant Anthony Conrad. As the plaintiff’s expert
characterized it, “Dr. Mumford inexplicably over-rode that order, and directed that [the
decedent’s] anti-coagulant regime be continued despite the presence of a growing subdural
hematoma.” The expert expressly concluded that Dr. Mumford’s failure and refusal immediately
to discontinue anticoagulant medications on October 23, 2015 constituted a deviation from good
and accepted medical practice.
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The plaintiff’s expert asserted that, inasmuch as the October 23, 2015 CT scan reflected
the presence of a thin subdural hematoma located on the left side of decedent’s cranium that
was no more than 8 millimeters wide, but which had grown in size since the October 20, 2015
CT scan, the hematoma reflected a contrecoup head injury, but did not, at that juncture, cause
any midline shift. As the expert explained it, the brain is divided into two hemispheres, with a
line running down the middle of the top of the brain that is clearly visible on a CT scan
examination. The expert asserted that, as Iong as the pressure within the cranium is relatively
equal on both sides, the “midline” runs down the center, but if one side of the cranium evinces
more pressure than the other side, it causes the brain to shift within the cranium and, as a
result, the midline marker moves away from the side with the excess pressure, and towards the
opposite side of the cranium. The expert continued that, if a hematoma develops and enlarges
sufficiently, as it did in the decedent’s case, it will create physical pressure on the brain within
the closed confines of the skull, and this pressure can cause the midline to shift which, in turn,
causes the brain to squeeze against the skull on the side opposite the hematoma, resulting in
brain damage and intense pain. The expert asserted that the shift was not large enough to be
reflected on the October 23, 2015 CT scan but that, nonetheless, “appropriate and timely
intervention was absolutely necessary, and would have provided Ms. Moss with a significantly
increased chance to recover,” since she already was evincing symptoms of a midline shift in the
form of headaches, patient agitation, discomfort, slurred speech, and, in an extreme case like
hers, a seizure disorder, because the pressure pushing the brain to one side against the skull
began to cause brain damage, with the intracranial pressure manifesting itself by those
symptoms. The expert averred that, at that time, regardless of the scan results, it was
“imperative to do whatever one can in this life-threatening scenario to lessen the pressure, or at
the very least, prevent further bleeding,” which could and should have been accomplished by
the immediate cessation of anticoagulant medication and the implementation of either FFP,
PCC, or Vitamin K therapy to reverse the adverse effects of the anticoagulants, characterized
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by the expert as the best options at that juncture to save the decedent’s life. The expert averred
that PCC therapy was the “gold standard” in 2015 for the reversal of the adverse effects of
anticoagulants, and that it was the only therapy approved by the United States Food and Drug
Administration for the “[u]rgent reversal of acquired coagulation factor deficiency induced by
warfarin-induced anticoagulation in patients presenting with major acute bleeding (intracerebral
hemorrhage-ICH) or a need for urgent invasive surgery or procedure.” The plaintiff’s expert
further explained why PCC therapy was superior to FPP and Vitamin K therapy, even in
connection with a general, rather than an urgent, need for reversal of the effects of
anticoagulants.
In connection with the failure of BIMC personnel to discontinue the administration of
anticoagulants, and commence the administration of FPP or PCC therapy, the plaintiff’s expert
explained that Coumadin and other anticoagulants, through differing means, prevent the
blood from clotting, a necessary bodily function in the face of a bleed. The expert asserted that
the only purpose in continuing the administration of Coumadin as of October 23, 2015 was
cardiologic in nature, but that, despite the recommendations of neurological physician’s
assistant Conrad and cardiologist Dr. Shinnar to discontinue anticoagulant therapy, Dr. Mumford
nonetheless “ignored this recommendation to devastating effect,” a determination that the
plaintiff’s expert described as “indefensible.”
The expert explicitly concluded that each of the deviations from accepted medical
practice that he identified and described, specifically, the failure to recognize a subdural
hematoma on the initial CT scan, the failure to discontinue the administration of anticoagulants,
the failure to commence the administration of PCC, FPP, or Vitamin K, and the failure
immediately to order a neurological consultation and a neurological nurse watch, was a
“substantial factor in causing Ms. Moss to experience extreme pain, a mid-line shift of her brain
caused by the expanding subdural hematoma, seizure disorder, incoherent speech, intense
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headaches, resulting in a subsequent coma and death.” The expert opined that the decedent’s
suffering and death were “entirely avoidable.”
Contrary to the defendants’ contention, it is perfectly appropriate for the plaintiff to redact
the name of her retained medical expert from the copy uploaded to the New York State Court
Electronic Filing system, while submitting an unredacted copy to the court, as she did here (see
CPLR 3101[d][1][i]; 3121[b]; Gobind v Nercessian, 227 AD3d 464, 465 [1st Dept 2024]; Vega v
Mount Sinai-NYU Med. Ctr. & Health Sys., 13 AD3d 62, 63 [1st Dept 2004]; Wilcox v Winter,
282 AD2d 862, 863 [2d Dept 2001]). Nonetheless, in opposition to the plaintiff’s prima facie
showing, defendants raised triable issues of fact as to whether any BIMC personnel departed
from good and accepted practice, and whether those departures caused or contributed to the
decedent’s conscious pain and suffering and ultimate death.
In opposition to the plaintiff’s motion, the defendants relied on the submissions that the
plaintiff had made to the court, while also submitting an attorney’s affirmation, a statement of
allegedly undisputed material facts, and the affirmation of a board-certified neurologist and
psychologist, who opined that no physician, nurse, or other health-care provider at BIMC
departed from good and accepted practice, and that nothing that any such medical provider did
or did not do caused or contributed to the decedent’s injuries or death.
The defendants’ medical expert first provided a narrative of the decedent’s medical
history during the years leading up to 2015, explaining that,
“[b]eginning in at least 2013, Ms. Moss was suffering from significant and severe
cardiac issues, including congestive heart failure, paroxysmal atrial fibrillation
and atrial flutter. She had had a pacemaker implanted and been prescribed
Coumadin for treatment of her atrial fibrillation. Recent cardiac studies in April
and May 2015, including repeat transesophageal echocardiograms (TEE) had
revealed a thrombus in the apex of the left atrial appendage (LAA) while an
electrocardiogram (ECG) in April 2015 had demonstrated sinus rhythm with a 1st
degree AV block and anterior infarct. Additionally, a May 2015 transthoracic
echocardiogram (TTE) found that Ms. Moss was suffering from overall moderate
decreased left ventricular systolic function with an ejection fraction of 43%,
severe concentric left ventricular hypertrophy, severe valvular aortic stenosis,
mild aortic stenosis, mild tricuspid regurgitation and minimal pericardial effusion.
In addition, Ms. Moss’ medical history was significant for transient ischemic
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attacks (TIAs), hypothyroidism, memory difficulty, hyperparathyroidism,
overactive bladder and urinary incontinence, constipation, falls, dysphagia, and
gait instability.”
The defendants’ expert essentially reiterated the narrative of the decedent’s fall, her
presentation to the BIMC emergency department, and her admission to that hospital, noting, in
addition, that the decedent’s head pain had abated somewhat after she had been administered
pain medication, but that she still complained of pain in her neck and right arm, was conversant,
and was drinking coffee and eating cake at the time. The expert further asserted that, by 2:45
p.m. on October 20, 2015, emergency room personnel reported that the decedent “was feeling
better and resting comfortably,” while her vital signs remained stable. According to the
defendants’ expert, bloodwork studies demonstrated no indication of bleeding, and her INR
reading was a “2,” which, as the expert characterized it, “demonstrated therapeutic levels from
her at-home prescription” of Coumadin. The expert then described Dr. Meltzer’s reading of the
October 20, 2015 CT scan of the decedent’s head, noting that it was taken to evaluate “[h]ead
trauma. Large right temporal hematoma. On Coumadin.” According to the defendants’ expert,
that scan was compared to a prior head CT scan, which had been taken without contrast on
August 19, 2015. The expert reported that, when Dr. Meltzer interpreted the October 20, 2015
scan, he found a subcutaneous hematoma just superior to the right external ear, with some
bilateral chronic lacunar infarcts in the thalami, but no evidence of acute territorial infarct, no
midline shift, no extra axial collection, no acute intracranial hemorrhage, and no evidence of an
intracranial mass lesion, despite evidence of chronic microvascular ischemic changes.
As the defendants’ expert interpreted the relevant medical chart, at 4:45 p.m. on October
20, 2015, the decedent was still complaining of joint pain, back pain, and neck pain, but denied
headache, dizziness, or lightheadedness, while her neurological examination reflected that she
was oriented, alert, and in no apparent distress, and her motor examination was normal in all
extremities, with normal sensation, normal gait, normal coordination, and normal speech. The
expert further noted, however, that emergency-room physician Dr. Woo reported that, “given
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[the decedent’s] inability to walk and possibility of delayed bleed on Coumadin, [the decedent]
will need observation versus admit regardless, watch right ear swelling closely, and consider
ENT consult if worse to rule out cauliflower ear (currently not so severe), consider MRI/CT for
hip if persistent inability to walk to rule out occult hip fracture, PT consult.” Moreover, once the
decedent was transferred to BIMC’s family medicine department, her chart, according to the
defendants’ expert, reflected that she was seen by Dr. Raimondi, who formulated a differential
diagnosis that included neural syncope, versus syncope secondary to arrhythmia, versus a
mechanical fall, and reported that there was no evidence of hemorrhage or bony trauma on the
CT of the head or the cervical spine. Moreover, the chart reflected that Dr. Raimondi thereafter
examined the decedent on October 21, 2015 at 1:00 p.m., and reported that the decedent was
feeling much improved.
According to the defendants’ expert, the relevant chart indicated that, on October 21,
2015, at both 6:51 a.m. and 12:34 p.m., BIMC personnel conducted neurological assessments
that reflected normal results, inasmuch as the decedent was alert and oriented to person, place,
and time, her speech was clear and coherent, her pupil size and reaction were normal, her
extremity strength was normal, she had no complaints of pain, and was in no distress. At 5:12
p.m. on that date, Dr. Mumford reported that the decedent’s fall may have been the result of
symptomatic aortic stenosis and, thus, requested that BIMC’s cardiology department follow up
with the decedent. He also suggested the possibility of catheterization or thoracic surgery for
valve replacement, and that, given the history of decedent’s falls, she “may need to consider
stopping Coumadin.” As the defendants’ expert further described it, on October 22, 2015, at
both 8:04 a.m. and 10:29 p.m., Dr. Mumford conducted additional neurological assessments
upon the decedent that generated results that were “grossly normal,” while her vital signs
remained stable throughout that day, and her INR level had decreased to 1.5 from 2.0 on the
previous day. According to the expert’s interpretation of the chart, the decedent did not report
any pain, other than pressure in her right arm at a level of 8 out of 10 at 9:18 a.m., and
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throbbing in her right arm and shoulder at a level of 5 out of 10 at 2:10 p.m. Dr. Mumford
reported that “cardiology recommendations to stop Coumadin appreciated, however, patient has
no signs of active bleeding, and given the history of TIAs off the Coumadin, we’ll continue for
now,” an assessment that he claimed to have discussed with the decedent’s treating
cardiologist, Vivek Reddy, M.D. The expert further noted that BIMC personnel nonetheless did
not administer Coumadin on October 22, 2015.
On October 23, 2015, Dr. Shinnar, the BIMC cardiologist, reported that the decedent had
experienced no significant overnight events, and expressed her desire to go home, after which
he concluded that no invasive procedure was warranted, and wrote that her options with respect
to anticoagulants were limited. As the defendants’ expert summarized the chart, Dr. Shinnar
expressed his view that the decedent presented a very high-risk score for embolization and
stroke if she remained off of Coumadin and, thus, his plan was to continue her on Coumadin,
the administration of which had been renewed that morning, particularly in light of her INR level
of 1.5, reflecting stability from the previous day.
During a neurological assessment that was conducted at 12:29 p.m. on October 23,
2015, the decedent had complained of a mild posterior headache, after which a CT scan of the
head, without contrast, was performed at 2:50 p.m., which, as noted revealed a thin, acute left-
sided hematoma measuring 8 mm at its greatest width, adjacent to the to the left frontal lobe,
but “causing minimal compression” and reflecting “no midline shift.” At 4:36 p.m., BIMC
personnel from the neurology department consulted on the patient and recommended frequent
neurology assessments, which were thereafter conducted every three hours. The
discontinuation of Coumadin also was recommended, and the administration of that drug was
thereupon discontinued. Subsequently, at approximately 5:30 p.m. on October 23, 2015, BIMC
personnel noted that there was a change in the decedent’s mental status, inasmuch as she
appeared disoriented when awakened, with difficulty following commands. BIMC personnel
from the neurosurgery department were called to the decedent’s bedside on an emergent basis,
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and a “stat” non-contrast CT scan of the head was performed. According to the defendants’
expert, when this scan was compared with the earlier study, there was no change. The
neurosurgery providers recommended that the administration of the anti-epileptic drug Keppra
(levetiracetam) be withheld, as they reported their concern that Keppra might have caused the
change in the decedent’s mental status.
The BIMC chart reflected that, on October 24, 2015 at 9:55 a.m., Dr. Mumford reported
that the decedent was clinically dehydrated, had experienced a recently altered mental status,
and intermittent agitation, and evinced INR levels that had further decreased to 1.4. Dr.
Mumford thereupon ordered a repeat CT scan of her head to evaluate her for progression of the
subdural hematoma, in light of her altered mental status and questionable delirium and
dehydration. While the administration Keppra to the decedent already had been discontinued,
at that juncture Dr. Mumford also ordered that the administration of Coumadin was to be
discontinued, after which administration of that drug was in fact discontinued for the remainder
of the decedent’s hospitalization. Dr. Mumford also requested neurosurgery and neurology
consultations, which were conducted on that date at 2:16 p.m. and 6:12 p.m., respectively.
According to the defendants’ expert, the decedent subsequently was found to have rhythmic
myoclonus in her right face and arm, lasting up to two to three minutes. BIMC personnel
administered 1,000 milligrams of Valproic acid, and performed a video electroencephalogram
(EEG). As the expert interpreted the decedent’s chart, she sustained more than 10 seizures on
October 24, 2015, after which BIMC administered her 2.5 mg of Diazepam, and she was started
on a phenytoin loading dose of 20 mg for each kilogram of her weight. The decedent
nonetheless continued to experience seizures, which BIMC personnel characterized as
“convulsive (myoclonic jerks) status epilepticus.”
At approximately 6:00 p.m. on October 24, 2015, BIMC personnel performed a repeat
CT scan of the decedent’s head, without contrast, which they reported as evincing no change in
the size of the hematoma. The decedent’s seizures nonetheless continued into October 25,
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2015, and anti-seizure medications were increased accordingly. By that date, BIMC nursing
staff undertook neurological assessments every two hours. At this time, the decedent’s INR
readings had decreased even further to 1.2. Yet another CT scan of the decedent’s head,
without contrast, was performed, and compared with the October 24, 2015 study. As the
defendants’ expert read the decedent’s chart, BIMC medical staff concluded that there was a
redemonstration of the left parietal subdural hematoma, with no midline shift or mass effect
detected. Thereafter, BIMC staff met with the decedent’s family, upon which she was
transferred to BIMC’s medical intensive care unit for “status epilepticus,” was intubated for
airway protection, and was sedated. BIMC’s neurology department evaluated the decedent,
and thereupon commenced monitoring of EEG results.
On October 31, 2015, BIMC pulmonologist Samuel Acquah, M.D., reported his
impression that the decedent likely was suffering from acute encephalopathy, due either to
lingering sedation or diffuse damage from prolonged generalized tonic clonic seizures. Dr.
Acquah further reported that there were still no signs of neurologic recovery, at which point the
decedent’s family agreed that hospice care would be the most appropriate course of treatment.
According to the BIMC chart, on November 1, 2015, a CT-scan of the decedent’s head, without
contrast, revealed a small left convexity subdural hematoma that had not increased in size since
the previous study, and reflected no midline shift. The last documented progress note in the
decedent’s chart, dated November 5, 2015, which was entered into the chart by the BIMC
neurology department, indicated that the decedent was still unresponsive, and that a plan had
been formulated to move her to palliative care. The decedent died on November 6, 2015.
The defendants’ expert expressly opined that there was no merit to the plaintiff’s claim
that Dr. Meltzer misread the October 20, 2015 CT scan of the decedent’s head. Rather, the
expert averred that, upon his or her own review of the films, “even with the benefit of hindsight
and in comparison to the October 23rd study, . . . there was no subdural hematoma seen on
the October 20, 2015 study,” and that, as such, Dr. Meltzer properly read and interpreted the
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scan, implicitly suggesting that it was BiMC’s Dr. Liu and the plaintiff’s expert who misread the
scan. The expert further concluded that the decedent was appropriately admitted to a family
medicine service at BIMC because, “[u]nder the circumstances that existed at the time of the
patient’s admission, there was absolutely no standard of care that dictated the location of her
admitting ‘floor’ and there certainly was no standard that required she be admitted to a
neurology floor.” The defendants’ expert characterized the contrary assertion of the plaintiff’s
expert as a “fabrication” with “no underlying support,” as “there is no bright line rule or algorithm
that is followed when admitting a patient to a certain department.” The defendants’ expert
asserted that, rather, a patient’s clinicians use their medical judgment to consider the patient’s
overall condition to make an appropriate admission determination and that, inasmuch as the
decedent was an elderly woman “with a host of medical issues, including significant cardiac
illness, which needed to be monitored and balanced,” admission to a family medicine floor was
appropriate, particularly because family medicine physicians and internists are, in fact, trained in
the observation and treatment of head injuries. In addition, the expert opined that, once the
decedent was admitted to the family medicine services floor, she was appropriately monitored
with consultations and provided treatment by appropriate specialists who investigated not only
the injuries caused by the decedent’s fall, but also the cause of her fall itself, while balancing the
need to treat her orthopedic injuries with the treatment of other preexisting health issues.
In addition, the defendants’ expert asserted that the defendants did not depart from good
and accepted practice by failing to place the decedent on a “neurology watch.” The expert
concluded that the decedent was appropriately evaluated and assessed from a neurological
standpoint at appropriate intervals, and that any and all complaints and pertinent test results
were appropriately appreciated and timely acted upon. In this respect, the defendants’ expert
explained that the standard of care did not require that any of the decedent’s doctors or nurses
do anything further than what they actually did and, thus, they were not obligated to order more
or different laboratory, imaging, or diagnostic tests, or refer the decedent to any other
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specialists. The expert further asserted that there was no indication for any of the clinicians
involved in the decedent’s treatment from October 20, 2015 through October 24, 2015 to order
additional or more frequent neurological monitoring since, during that period of time, the
decedent’s neurological status, clinical condition, and vital signs were “stable” and her blood
work was “reassuring.” Hence, the expert concluded that the decedent was not a candidate for
“neurological nursing watch,” as defined by the plaintiff, and that the standard of care did not
require that she be placed under close neurological observation or transferred to the neurology
floor. Rather, the expert asserted that the decedent’s neurological status was appropriately and
properly assessed and monitored at the appropriate frequency at all times.
The defendants’ expert also opined that Dr. Mumford’s care and treatment of the patient
between October 20, 2015 and October 24, 2015 was proper in all respects, and in accordance
with good and accepted medical practice. Specifically, the defendants’ expert expressly
disagreed with the plaintiff’s expert in connection with Dr. Mumford’s determination to continue
the decedent on Coumadin on October 21, 2015 and October 23, 2015, which the defendants’
expert characterized as an exercise of good and sound medical judgment. The defendants’
expert further concluded that, contrary to the assertions of the plaintiff’s expert, the decedent
was not administered any Coumadin at all on October 20, 2015, October 22, 2015, or after the
BIMC neurology recommended discontinuing it subsequent to the administration of the October
23, 2015 dosage. The defendants’ expert further asserted that,
“it appears that plaintiff is under the erroneous belief that Cardiology disagreed
with Dr. Mumford’s decision to continue the Coumadin on October 23rd. Instead,
Dr. Shinnar, the cardiologist, acknowledged in his comprehensive October 23rd
progress note that the patient was at very high risk whether Coumadin was
continued or stopped at that time and that he would seek the input of an
electrophysiologist to see if there was any technology that could be a solution.
Dr. Shinnar did not recommend discontinuing Coumadin at the time. Regardless,
Dr. Mumford’s decision to keep the patient on anti-coagulants on October 21st
and October 23rd was good medical judgment and there was no reason for the
hospital staff to disagree or contradict him.”
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In reaching that conclusion, the defendants’ expert explained that, in light of the decedent’s
comorbidities, Dr. Mumford had the difficult task of balancing her high-risk cardiac and
neurological needs, particularly because the decedent was in imminent danger of suffering a
stroke due to her atrial fibrillation, a danger that was “exponentially increased” due to a known
blood clot in her left atrial appendage. Hence, the defendants’ expert opined that the decision to
continue the decedent on anticoagulants was a proper exercise of medical judgment in reducing
the “very real and imminent” risk of stroke, particularly in light of the downward trend of the
decedent’s INR levels between October 20, 2015 and October 25, 2015, which, according to the
expert, demonstrated that she was not anticoagulated at any level that would be of concern for
a bleed. In any event, the defendants’ expert also concluded that Dr. Mumford again exercised
sound medical judgment when he discontinued the administration of Coumadin on October 24,
2015 in response to the change of the decedent’s mental status while he awaited further testing
results and neurology and neurosurgery consultations.
The defendants’ expert expressly disagreed with the conclusion of the plaintiff’s expert
that repeat CT scans were indicated on October 21, 2015 or October 22, 2015, since, based
upon the decedent’s examinations, neurological status, blood work, and radiology studies,
“there was no index of suspicion of a bleed on October 21st or October 22nd.” The defendants’
expert went on to explain that,
“[e]ven hypothetically accepting, plaintiff’s unsupported contention that the
patient was suffering from a headache on those dates, a headache after a fall,
with a negative prior CT-scan and reassuring exams, vital signs and blood work,
is not an indication for a repeat CT-scan.”
In addition, the expert averred that BIMC personnel administered appropriate treatment even
after the October 23, 2015 CT scan revealed the presence of a subdural hematoma,
characterizing the neurological care that they provided as “optimal management.” The
defendants’ expert rejected the opinion of the plaintiff’s expert that BIMC should have provided
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additional treatment, such as the administration of Vitamin K, FFP, or PCC, because such
treatment “could have proven catastrophic” in the decedent’s case because of her significant
comorbidities. Rather, the expert concluded that the decedent was not a candidate for any type
of anticoagulation reversal therapy, particularly in light of her downward trending INR levels
between October 20, 2015 and October 25, 2015. As the defendants’ expert phrased it, “the
only treatment available to the patient was medical management of her symptoms, which was
delivered in this case, and which was effective as the subdural hematoma diagnosed on
October 23, 2015 never increased in size and never caused a midline shift.” With respect to this
last opinion, the defendants’ expert criticized the plaintiff’s expert for basing his or her opinions
“on the incorrect notion that the patient suffered a midline shift,” concluding, after “[a] thorough
review of the record, and all radiology reports and films,” that the decedent never experienced a
midline shift. In light of that conclusion, the defendants’ expert rejected, as invalid, the plaintiff’s
expert’s opinion that the decedent had a better chance of survival had Coumadin been
discontinued and anticoagulation reversal therapy been implemented prior to the appearance of
this allegedly “nonexistent” midline shift.
Ultimately, the defendants’ expert concluded that the decedent’s death was caused by
uncontrollable seizures rather than a subdural hematoma, and that it was “entirely speculative”
for the plaintiff’s expert to opine that the decedent’s subdural hematoma or any minimal change
in the size thereof affected her seizure activity. Instead, the defendants’ expert asserted that
the decedent sustained a contusion from a fall, explaining that, inasmuch as the epileptic activity
on her EEG showed bilateral activity, but more so on the right, while the subdural hematoma
was on the left, the decedent’s right-sided seizure activity, which was the cause of her death,
was a consequence of her contusion and fall itself, rather than the subdural hematoma.
In reply, the plaintiff submitted an attorney’s affirmation and a counter statement of
material facts. In his affirmation, counsel noted that the defendants’ retained expert disagreed
with their own employee, Dr. Liu, as to whether a left-sided subdural hematoma appeared on
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the October 20, 2015 CT scan. Counsel further sought to sanction the defendants for their
alleged delays in providing outstanding discovery, including many relevant hospital records. In
this regard, counsel argued that “[t]hese records go to the heart of one of the Plaintiff's key
claims in this case; to wit: financial incentives received by BMIC [sic] for Medicare patients
admitted into the IFH clouded their judgment when admitting Ms. Moss, an 88-year-old woman
with a head injury on anticoagulants into family health, rather than neurology where she clearly
belonged.” The plaintiff’s attorney thus argued that the defendants should be precluded from
offering any defense to the plaintiff’s summary judgment motion.
As noted above, the plaintiff established her prima facie entitlement to judgment as a
matter of law on the issue of liability, in response to which the defendants raised triable issues
of fact, with their expert’s affirmation, as to whether they departed from good and accepted
medical practice or whether anything that they did or did not do caused or contributed to the
decedent’s injuries and death. Although the plaintiff now argues that the defendants should be
precluded from opposing her motion as a sanction for their alleged failures to respond to or
comply with outstanding discovery demands or orders, under most circumstances, including
those obtaining in this case, a motion pursuant to CPLR 3126 to impose sanctions for the willful
failure to make disclosure must be made prior to the filing of the note of issue and certificate of
readiness since, by that filing, a party represents that all discovery has been completed and that
there are no outstanding discovery requests (see Flanagan v Wolff, 136 AD3d 739, 741 [2d
Dept 2016]). The failure to make a motion pursuant to CPLR 3126 prior to the filing of the note
of issue and certificate of readiness is deemed a waiver of any contention that an adverse party
has failed to meet his or her disclosure obligations (see id.; K-F/X Rentals & Equip., LLC v FC
Yonkers Assoc., LLC, 131 AD3d 945, 946 [2d Dept 2015]; Marte v City of New York, 102 AD3d
557, 558 [1st Dept 2013]; Rivera-Irby v City of New York, 71 AD3d 482, 482 [1st Dept 2010]).
Hence, the plaintiff’s motion must be denied.
The plaintiff’s remaining contentions are without merit.
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Accordingly, it is,
ORDERED that the plaintiff’s motion for summary judgment on the issue of liability is
denied; and it is further,
ORDERED that counsel for the parties shall appear for an initial pretrial settlement
conference before the court, in Room 204 at 71 Thomas Street, New York, New York 10013, on
January 16, 2025, at 11:00 a.m., at which time they shall be prepared to discuss resolution of
the action and the scheduling of a firm date for the commencement of jury selection.
This constitutes the Decision and Order of the court.
12/5/2024 $SIG$
DATE JOHN J. KELLEY, J.S.C.
CHECK ONE: CASE DISPOSED X NON-FINAL DISPOSITION
□
GRANTED X DENIED GRANTED IN PART OTHER
APPLICATION: SETTLE ORDER SUBMIT ORDER
□
CHECK IF APPROPRIATE: INCLUDES TRANSFER/REASSIGN FIDUCIARY APPOINTMENT REFERENCE
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