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Hand v. St. Michael's Medical Center

Superior Court of New Jersey, Appellate Division

May 14, 2013

MARGARET HAND, as Executrix of the Estate of Francis Hand and Margaret Hand, Individually, Plaintiff-Appellant/Cross-Respondent,
ST. MICHAEL'S MEDICAL CENTER, Defendant, and CONSTANTINO COSTEAS, M.D., Defendant-Respondent, and MICHAEL PHUNG, M.D., Defendant-Respondent/Cross-Appellant.


Argued October 11, 2012

On appeal from Superior Court of New Jersey, Law Division, Hudson County, Docket No. L-2491-08.

Frank J. Nostrame argued the cause for appellant/cross-respondent.

Jeremy P. Cooley argued the cause for respondent Constantino Costeas, M.D. (Lenox, Socey, Formidoni, Giordano, Cooley, Lang & Casey, LLC, attorneys; Michael A. Pattanite, Jr., on the brief).

Jeffrey T. LaRosa argued the cause for respondent/cross-appellant Michael Phung, M.D. (Schenck, Price, Smith & King, LLP, attorneys; Mr. LaRosa, of counsel and on the brief).

Before Judges Grall, Simonelli and Accurso.


Plaintiff Margaret Hand, as executor of her husband's estate and on her own behalf, appeals judgments in favor of defendants Dr. Constantino Costeas, M.D., and Dr. Michael Phung, M.D., that were entered in an action on an amended complaint charging them with medical malpractice.[1] The claim against Dr. Phung was dismissed on summary judgment, and the claims against Dr. Costeas were tried and dismissed at the close of plaintiff's case pursuant to Rule 4:37-2(b).[2] Finding no reversible error in any of the determinations challenged on appeal, we affirm.[3]

Plaintiff's husband was sixty years old and had several serious conditions when he died on May 27, 2007. These conditions include chronic obstructive pulmonary disease (COPD), coronary disease, renal disease, hypertension, hypercholesterolemia and peripheral arterial disease. Before 2005, decedent had undergone coronary bypass surgery and lower extremity arterial bypass surgery.

Dr. Phung served as Hand's cardiologist starting in June 2005. At that time, Hand was taking Digoxin to slow his heart rate, which his general practitioner had prescribed.

Between January 2006 and May 2007, Hand was hospitalized three times, and on each occasion his irregular heart beat was problematic. In January 2006, Hand was admitted to Christ Hospital with an infection, but his heart was also in atrial fibrillation. Hand's Digoxin level was very low on admittance, and his atrial fibrillation was controlled when he left the hospital after a ten-day stay.

The following January, Hand went to Christ Hospital because he was short of breath. An atrial flutter was detected and attributed to his COPD, which can interfere with heart rhythm. On this hospitalization, Hand's Digoxin level was good and his heart rate was not too rapid, but his heart's rhythm was abnormal. Because of the irregular rhythm, which was present despite the normal heart rate, Dr. Phung determined that Hand needed Coumadin, a blood thinner, to reduce the risk of his throwing a fatal blood clot.

In May 2007, Hand returned to Christ Hospital with breathing problems. Again, his heart was in atrial fibrillation. As in January 2006, Hand's Digoxin level was low, and his heart rate and rhythm returned to normal range after a few days.

In Dr. Phung's opinion, as long as Hand's heart rhythm was abnormal he would need Coumadin to reduce the risk of a blood clot. Thus, Dr. Phung recommended that Hand transfer from Christ Hospital to see Dr. Costeas at St. Michael's Medical Center for an evaluation to determine whether Hand was a candidate for a Radiofrequency Catheter Ablation (RFA).

The RFA is an invasive procedure. Using probes inserted through catheters into the veins and heart, it addresses abnormal electrical circuits with a burst of radiofrequency energy that burns the abnormal area and eliminates the irregularity. It is a high-risk procedure.

Dr. Phung spoke to Dr. Costeas twice before Hand was transferred to St. Michael's. He described Hand's medical condition and the steps that had been taken to address it. According to Dr. Phung, he told Dr. Costeas that Hand was on medication to slow his heart rate and thin his blood, and he shared his concern that Hand, who was apparently not taking his ...

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