## Facts

- Leslie E. Marshall was hospitalized at a facility operated by Arnot Ogden Medical Center (AOMC).
- A registered nurse employed by AOMC mistakenly injected Marshall with an insulin-reducing medication that was not prescribed for him.
- Marshall’s daughter allegedly warned the nurse immediately before the injection that Marshall was not diabetic and did not use insulin, but the nurse administered the medication anyway.
- The attending physician, Renee Abderhalden-Friend, M.D., was informed by phone of the medication error and instructed the nurse to monitor Marshall’s glucose every two hours and call if it fell below 120.
- Glucose readings were 132 at 8:15 p.m. and 107 at 10:15 p.m.; the physician allegedly ordered that glucose testing be discontinued until the next morning.
- At 6:15 a.m., Marshall’s glucose was 15; he died shortly thereafter, and the death was attributed to insulin overdose from the medication error.
- The executor of Marshall’s estate sued AOMC, the nurse (identified as “Jane Doe”), and the physician for negligence and medical malpractice, including punitive damages.

## Issues

1. Whether the plaintiff raised triable issues of fact permitting punitive damages claims against AOMC and the nurse, defeating their motion for partial summary judgment.
2. Whether the complaint stated a claim for punitive damages against the physician sufficient to survive dismissal under CPLR 3211(a)(7).
3. Whether the alleged conduct could be found to constitute reckless indifference equivalent to willful misconduct or a wanton and reckless disregard for patient rights in a medical malpractice case.

## Decision

- The appellate court affirmed in part and reversed in part the order dismissing punitive damages claims.
- The court reversed the grant of partial summary judgment to AOMC and the nurse, holding that the record raised triable issues supporting punitive damages.
- The court reversed the dismissal of punitive damages against the physician under CPLR 3211(a)(7), holding that the complaint adequately pleaded facts that could support such damages.
- Punitive damages claims were reinstated against all defendants.

## Legal Principles

- In medical malpractice actions, punitive damages may be awarded only for conduct showing reckless indifference equivalent to willful or intentional wrongdoing, or a wanton and reckless disregard of a patient’s rights; ordinary negligence is insufficient.
- On summary judgment, the nonmovant receives the benefit of favorable inferences, and the question is whether a fact-finder could conclude the conduct meets the punitive-damages standard.
- On a CPLR 3211(a)(7) motion, the court accepts the complaint’s allegations as true and asks whether they state a cognizable legal theory supporting punitive damages.
- Allegations that a nurse administered an unprescribed, high-risk medication despite an explicit family warning, and without proper verification, can support an inference of aggravated misconduct beyond inadvertence.
- Allegations that an attending physician discontinued glucose monitoring overnight after learning of an insulin-reducing medication error and declining glucose readings can support an inference of reckless disregard for a known, substantial risk.
- A hospital may face punitive damages exposure based on an employee’s conduct attributable to the hospital when that conduct could be found wanton or recklessly indifferent.

## Conclusion

The court held that the pleaded and proffered facts surrounding an unprescribed insulin-reducing injection, alleged disregard of an explicit family warning, and the alleged decision to halt glucose monitoring overnight could allow a jury to find reckless indifference or wanton disregard, so punitive damages could not be eliminated at the pleading or summary-judgment stages.


Marsh v. Arnot Ogden Med. Ctr., 91 A.D.3d 1070, 937 N.Y.S.2d 383 (N.Y. App. Div. 3d Dep’t 2012)