## Facts

- Marie M. Hinlicky, age 71, underwent a carotid endarterectomy in October 1996 and died 25 days later from a myocardial infarction.
- Her internist, Dr. Robert O. Frank, treated her for hypertension for years and evaluated intermittent chest and arm complaints in 1993 and 1995, concluding they were not cardiac in origin based on EKG results and clinical assessment.
- In August 1996, after family history concerns, Frank referred her to vascular surgeon Dr. David C. Dreyfuss, who recommended endarterectomy.
- The anesthesiologist, Dr. Gregory Ilioff (Riverside Associates in Anesthesia, P.C.), reviewed her history and interviewed her, and decided no preoperative cardiac work-up was needed.
- Ilioff testified he relied on an American Heart Association/American College of Cardiology perioperative “flow chart” or “algorithm,” which he had incorporated into his practice, to decide whether further cardiac testing was indicated.
- The estate sued the physicians and anesthesia group for malpractice, alleging negligence in failing to obtain an appropriate preoperative cardiac evaluation.
- At a jury trial, over objection, the trial court admitted the algorithm into evidence during Ilioff’s testimony; the jury returned a verdict for all defendants.

## Issues

1. Whether the trial court abused its discretion by admitting into evidence a published AHA/ACC perioperative assessment algorithm referenced by the anesthesiologist as part of explaining his clinical decision not to order preoperative cardiac testing.

## Decision

- The Court of Appeals affirmed the defense verdict.
- The court held the trial court properly exercised discretion in admitting the algorithm.
- The algorithm was admissible where a treating physician testified he used and relied on it in practice as part of the basis for his decision-making.
- The plaintiff’s ability to cross-examine the physician and offer opposing expert testimony supported the ruling that admission was not unfairly prejudicial.

## Legal Principles

- Trial courts have broad discretion over evidentiary rulings, including admitting materials used in forming and explaining expert or treating-physician opinions.
- A clinical guideline or algorithm may be admitted when a proper foundation shows the witness incorporated it into practice and relied on it in treating the patient.
- Such materials may be received to explain the basis for a physician’s conduct and opinion regarding accepted practice, rather than as substantive proof of medical propositions independent of witness testimony.
- Adequate opportunity for cross-examination and rebuttal expert proof weighs against finding reversible error from admission of guideline-type evidence.

## Conclusion

The court upheld admission of a perioperative cardiac-assessment algorithm where a treating anesthesiologist testified that he relied on it in practice and used it in deciding against preoperative cardiac testing, and it affirmed the jury’s verdict for the defendants.


Hinlicky v. Dreyfuss, 6 N.Y.3d 636, 848 N.E.2d 1285 (N.Y. 2006)