ESTEVEZ v. NEW YORK CITY HEALTH AND HOSPITALS CORPORATION (2026)

Order, Supreme Court, Bronx County (Alicia Gerez, J.), entered on or about June 12, 2025, which, to the extent appealed from, denied defendant's motion for summary judgment dismissing the complaint, unanimously affirmed, without costs.

Defendant met its prima facie burden through expert testimony that administration of Heparin during decedent's approximately 51/212 hours in the emergency department would not have changed her outcome because Heparin ordinarily acts over several days to reduce a patient's clot burden and cannot prevent an existing clot from breaking off.  In opposition, plaintiff submitted a detailed affirmation from a board-certified vascular surgeon who directly addressed defendant's timing and physiologic arguments.  Plaintiff's expert explained that Heparin has immediate effects, even if it is not a complete treatment for a pulmonary embolism.  Therapeutic administration of Heparin helps the body begin dissolving the clot, keeps the clot from enlarging or shifting, reduces spasm in the pulmonary artery, and stabilizes strain on the right side of the heart.  According to plaintiff's expert, these short-term effects would have added critical time the night of the emergency room visit to complete the diagnostic evaluation and initiate definitive treatment such as thrombectomy or ECMO. The expert further explained that decedent's fatal collapse was caused by the clot's shift and extension, together with arterial spasm, which triggered acute right ventricular failure, a type of clinical decline that early therapeutic Heparin would have reduced.  These competing explanations for decedent's acute worsening raise triable issues of fact as to whether timely therapeutic Heparin administration would have altered her clinical course during the hours before her cardiac arrest.

Plaintiff's expert also explained that decedent's decline was not caused by fluid overload, renal failure, or a dangerous heart rhythm related to high potassium, as defendant suggests.  He noted that her lungs were clear on physical examination, chest X-ray, and ultrasound;  her elevated potassium was promptly treated;  continuous cardiac monitoring showed no arrhythmias;  and her breathing and heart problems worsened in a way that is consistent with rapidly progressing pulmonary embolism and not complications from missed dialysis.  By ruling out these other possible causes, plaintiff's expert reinforced his opinion that decedent died from pulmonary embolism with right heart strain and that timely therapeutic Heparin would have changed her clinical course.  Based on the record disputing whether prompt anticoagulation would have changed the outcome of an evolving pulmonary embolism, summary judgment must be denied (Labby v. Cummings, 246 AD3d 663, 664 [1st Dept 2026] ).