Preview
FILED: KINGS COUNTY CLERK 10/05/2021 05:34 PM INDEX NO. 508009/2013
NYSCEF DOC. NO. 181 RECEIVED NYSCEF: 10/05/2021
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF KINGS
----------------------------------------------------------------------X
N. G., an Infant, by his Mother and Natural Guardian,
SHERRI SKIDMORE, Index # 508009/13
Plaintiff, EXPERT AFFRMATION
- against -
VASUDHA VISWANATHAN, M.D., CALIXTO
CAZANO, M.D., RAJENDRA BHAYANI, M.D.,
FERNANDO GINEBRA, M.D., SONY LOSEAU,
M.D. and WYCKOFF HEIGHT’S MEDICAL
CENTER,
Defendants.
---------------------------------------------------------------------X
LANCE PARTON, M.D., being duly sworn, hereby affirms the following under the
penalties of perjury:
I am a physician licensed to practice medicine in the State of New York and a professor of
pediatrics, and an associate professor of obstetrics and gynecology and anesthesiology. As a
specialist in the field of Neonatology, I am board certified by the American Board of Pediatrics,
and I have held a sub certification in neonatal-perinatal medicine since 1991. I am currently an
attending Neonatologist at Maria Fareri Children’s Hospital at Westchester County Medical Center
and have been practicing this specialty for over 20 years.
I have reviewed the file materials relevant to this cause of action as it pertains to Drs.
Cazano and Ginebra, to wit, the records of Wyckoff Heights Medical Center, the Bills of Particulars
served in this matter, the deposition of Sherri Skidmore, the mother of the infant plaintiff Nathaniel
Grayton, the depositions of defendant Cazano, defendant Ginebra, defendant Viswanathan and
defendant Bhayani. Based on my review of the file materials, I submit this Affirmation in support
of the motion for summary judgment in favor of Drs. Cazano and Ginebra, as there exist no
departures from good and accepted medical practice on the part of either of these physicians, and
FILED: KINGS COUNTY CLERK 10/05/2021 05:34 PM INDEX NO. 508009/2013
NYSCEF DOC. NO. 181 RECEIVED NYSCEF: 10/05/2021
their care and treatment could in no way have caused the injuries alleged to have been sustained by
the plaintiff as set forth in the above-referenced Bills of Particulars.
RELEVANT BACKGROUND FACTS
This is a case centering around a surgical procedure in the nature of an excision of an
external skin tag on the infant plaintiff N. G., at Wyckoff Heights Medical Center on April 2, 2009
when the infant plaintiff was approximately 5 weeks old. The child was born at term, the product of
a normal, spontaneous vaginal delivery, and exhibited no conditions that required other than routine
neonatal and pediatric care, save for the existence of the above-mentioned skin tag. The procedure
was to be performed by defendant Bhayani, a specialist in ENT surgery and Dr. Bhayani had
previously seen the infant plaintiff, spoken to the parents, and scheduled the procedure to be
performed on that date.
On April 2, 2009, the infant plaintiff was admitted to Wyckoff Heights Medical Center for
the procedure, which was to commence at approximately 9:00 a.m. that morning. However, the
surgery never actually commenced, as during the preoperative period, in the attempt to sedate,
anesthetize and intubate the patient, the child lapsed into respiratory distress, which was determined
to be secondary to a laryngospasm. Dr. Viswanathan, the attending anesthesiologist, was unable to
intubate the infant due to the laryngospasm, and as the respiratory situation became more urgent,
she, along with the rest of the operative team, called for a code seeking assistance in the OR.
Dr. Ginebra, attending Neonatologist on staff at Wyckoff Heights Medical Center, heard the
page and immediately presented to the operating room to lend assistance. After a brief
conversation, and observing that the patient was in clear respiratory distress, Dr. Ginebra took over
the intubation duties from Dr. Viswanathan, and made an attempt to intubate the child with the 3.5
mm. tube (the standard size for a child of this age) that was used by Dr. Viswanathan, but was
unsuccessful at passing it due to the child being in laryngospasm. Dr. Ginebra requested a smaller
-2-
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NYSCEF DOC. NO. 181 RECEIVED NYSCEF: 10/05/2021
tube, a 2.5 mm. endotracheal tube (ETT), and was able to successfully insert the ETT and
effectively ventilate the patient and stabilize him. Approximately 5 minutes after the 2.5 mm. ETT
had been placed, that tube, which is very small, loosened and began to come out while Dr. Ginebra
was still present in the OR. Dr. Ginebra then requested a 3.5 mm. ETT, and was able to intubate the
baby very easily with that size tube, again the size that would typically be used, absent any
complications. Given what had occurred, the surgery was aborted, and the child was taken to the
neonatal intensive care unit.
Next in the chronology, defendant Dr. Cazano was the attending Neonatologist in the NICU
at Wyckoff Heights Medical Center, and his role was confined to monitoring and treating the infant
plaintiff during the late morning and afternoon of April 2, 2009. While the child was essentially
stable, late that afternoon he sustained a period of oxygen desaturation, at which point Dr. Cazano
changed his ventilatory regimen to exchange oxygen in the infant’s lungs at a higher rate and
pressure, which had the desired effect of correcting the desaturation. Based on his testimony, Dr.
Cazano felt that this was more of a short-term solution and the child required more extensive and/or
specialized respiratory treatment, namely, extracorporeal membranous oxygenation (ECMO) which
was not available at Wyckoff Heights Medical Center, and thus he arranged for transfer of the infant
plaintiff to New York Presbyterian Hospital which was done later that same evening.
Following the child’s discharge from New York Presbyterian Medical Center, no further
respiratory complications secondary to the laryngospasm episode that occurred in the OR at
Wyckoff Heights Medical Center ever occurred. In fact, the only respiratory issue the child has
ever had is recurrent bouts of asthma, of which there is an extensive family history. Other than
asthma, which, as will be detailed below, bears no causal relationship to the laryngospasm event at
Wyckoff Heights Medical Center, the child has suffered no respiratory sequalae.
ALLEGATIONS
-3-
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NYSCEF DOC. NO. 181 RECEIVED NYSCEF: 10/05/2021
The allegations posited by the plaintiff as to departures from good and accepted medical
practice on the parts of Drs. Ginebra and Cazano can be capsulized as follows: failing to see that
the infant was properly intubated, failing to properly recognize the significance of and determining
the etiology and act upon the patient’s laryngospasm, failing to timely and properly recognize that
the infant was in respiratory failure, failing to timely and properly transfer the infant, failing to
properly and timely stabilize the infant, and failing to consult with a cardiologist.
Dr. Ginebra
The allegations as they pertain to Dr. Ginebra are clearly specious, do not apply to his role in
the case, and as will be detailed below, cannot be causally related to the claimed injuries in this case.
To elaborate, Dr. Ginebra was not assigned to this patient’s care, and only responded to a
code that he heard over the hospital’s loudspeaker when the child had already suffered the
laryngospasm, was already in respiratory distress, and a full code was in place. He responded
to the code and he was the one able to intubate the plaintiff when the plaintiff had previously been
unable to be intubated due to the laryngospasm. Given that the patient was in a laryngospasm, the
properly sized tube (the 3.5 mm. ETT) could not be inserted, and thus Dr. Ginebra appropriately
tried a smaller tube, which he was able to insert without difficulty, and enabled him to adequately
oxygenate the child, remove him from the respiratory distress situation that was occurring, and
prevent any further damage, including catastrophic neurologic damage, from occurring. Thereafter,
once the situation calmed down, and the laryngospasm began to resolve, the smaller tube began to
dislodge, while Dr. Ginebra was there and under his observation. He immediately responded and
was able to replace the smaller tube with the appropriately sized 3.5mm. ETT without incident.
Thereafter, the child was taken to the neonatal ICU and Dr. Ginebra had no further involvement
with his care.
-4-
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It is beyond specious to allege that Dr. Ginebra’s care and treatment was substandard or
caused any of the complications that occurred in the OR that morning. Indeed, as pointed out
above, the child had already coded, was in respiratory arrest and in full laryngospasm when Dr.
Ginebra came into the room. Indeed, the child was being bagged by the anesthesiologist at that
moment, and Dr. Ginebra was the one who was able to prevent the situation from becoming worse
by taking over the intubation attempt and successfully intubating the child.
From a causal standpoint, the only permanent damage alleged to have been sustained by the
infant plaintiff in this matter is the fact that he is alleged to have suffered “frequent colds, stridor,
asthma, shortness of breath, the necessity for the use of a nebulizer and pharyngeal dysphagia
(difficulty swallowing). While the Bill of Particulars lists the “possibility” of brain damage with
delays in all areas and impairment of daily activities, same has not occurred with this infant
plaintiff.
There is no known, documented, or published connection between laryngospasm and these
alleged injuries, and both from that standpoint, as well as from elemental medical and anatomical
standpoints, these alleged injuries are unequivocally unrelated to the laryngospasm episode that
occurred in this matter. The child certainly has had bouts of asthma throughout his childhood and
early adolescence, but by bringing forth these claims, plaintiffs ignore that this condition is
widespread in children of this age in general, and that his family has a well-documented and long
history of asthma. Asthma is by definition, accompanied by shortness of breath, stridor and often
the need for the use of nebulizers, and thus these are alleged damages that have no causal
connection to the laryngospasm event suffered in the OR, nor the care and treatment rendered to
him in the NICU at Wyckoff Heights Medical Center. As to the pharyngeal dysphagia, based on the
testimony of the infant plaintiff’s mother, Sherri Skidmore, this is no longer an issue or the infant
plaintiff, and any difficulty swallowing would, at this age, be completely unrelated to the care and
-5-
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NYSCEF DOC. NO. 181 RECEIVED NYSCEF: 10/05/2021
treatment rendered by Drs. Ginebra and Cazano. Indeed, if there were any difficulty swallowing
attendant to the events that occurred on April 2, 2009, they would be transient, short-lived and
would have resolved within days to weeks at the outside.
Dr. Cazano
The allegations as to Dr. Cazano are similarly simply without merit. Dr. Cazano did not
even see this patient until after the events had not only unfolded in the OR, but after the child had
been stabilized, intubated and then brought to the NICU for observation and monitoring. Therefore,
any alleged departures and/or injuries associated with the fact that this child suffered a
laryngospasm and needed to be intubated simply cannot based on any construct of the facts herein,
be applicable to Dr. Cazano.
With respect to the neonatal management under Dr. Cazano’s supervision on the afternoon
of April 2, 20009, there is simply no issue with respect to the fact that Dr. Cazano’s treatment was at
all times in accord with good and accepted medical practice. Indeed, the child was stable
throughout that period of time, and when he did experience an episode of oxygen desaturation, Dr.
Cazano acted promptly by altering the respiratory therapy in place, both oxygenation and the
pressure at which it was administered, and achieved the desired results of increasing the saturations
and stabilizing the patient. He also consulted with a pediatric cardiologist, Dr. Patel, which is
another allegation in the Bill of Particulars that is unfounded. Dr. Patel did not suggest any
alternatives to Dr. Cazano’s management.
Further to his credit, Dr. Cazano made the prudent and appropriate determination that in the
best interests of the child, he required more sophisticated equipment and extensive monitoring than
could be afforded at Wyckoff Heights Medical Center, and arranged for a transfer to New York
Presbyterian Hospital. This was effected that evening, and the child did not suffer any
-6-
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NYSCEF DOC. NO. 181 RECEIVED NYSCEF: 10/05/2021
complications, nor injuries, as a result of the transfer or its timing. Indeed, this proved to be a wise
decision that afforded the infant plaintiff the level of care he needed, which clearly contributed to
his excellent outcome in this matter.
Similarly with respect to the issue of causation, it is simply impossible to connect any of the
care and treatment rendered by Dr. Cazano to the injuries that are alleged to have been sustained by
the plaintiff in this matter. Indeed, with respect to the acute injuries that are related to the events
that occurred in the OR (the laryngospasm, the arrest, the need for intubation, etc.), these all took
place before Dr. Cazano was ever in attendance of this patient.
As to the alleged permanent injuries of asthma, need for nebulizer treatments, shortness of
breath, etc., again, none of these could in any construct of the facts and applicable medicine be
connected to the care and treatment rendered by Dr. Cazano.
Given the foregoing, and the complete absence of any evidence to suggest the care and
treatment rendered by either Dr. Ginebra or Dr. Cazano deviated from good and accepted medical
practice, along with the fact that the injuries alleged to have been sustained by plaintiff can simply
not be plausibly medically connected to the care and treatment rendered by these individuals, it is
respectfully submitted that their request for summary judgment be granted in its entirely.
LANCE PARTON, M.D., FAAP
-7-
FILED: KINGS COUNTY CLERK 10/05/2021 05:34 PM INDEX NO. 508009/2013
NYSCEF DOC. NO. 181 RECEIVED NYSCEF: 10/05/2021
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF KINGS
----------------------------------------------------------------------X
N.G., an Infant, by his Mother and Natural Guardian,
SHERRI SKIDMORE, Index # 508009/13
Plaintiff, CERTIFICATION
PURSUANT TO 202.8-b
- against -
VASUDHA VISWANATHAN, M.D., CALIXTO
CAZANO, M.D., RAJENDRA BHAYANI, M.D.,
FERNANDO GINEBRA, M.D., SONY LOSEAU, M.D.
and WYCKOFF HEIGHT’S MEDICAL CENTER,
Defendants.
---------------------------------------------------------------------X
EDWARD R. NICHOLSON, ESQ., an attorney duly licensed and admitted to practice law
before the courts of the State of New York, hereby affirms the following pursuant to the
penalties of perjury:
I hereby certify pursuant to the Uniform Civil Rules for the Supreme Court and County
Court Section 202.8-b(c) that the foregoing Expert Affirmation complies with the word count
limit.
Type. A proportionally spaced typeface was used as follows:
Name of typeface: Times New Roman
Point size: 12
Line spacing: Double
Word Count. The total number of words in the Expert Affirmation, inclusive of point headings
and footnotes and exclusive of the caption, table of contents, table of authorities, signature block,
and this Statement is 2136.
Dated: New York, New York
October 5, 2021
Edward R. Nicholson ____
Edward R. Nicholson, Esq.
-8-
Preview
FILED: KINGS COUNTY CLERK 10/05/2021 05:34 PM INDEX NO. 508009/2013 NYSCEF DOC. NO. 181 RECEIVED NYSCEF: 10/05/2021 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF KINGS ----------------------------------------------------------------------X N. G., an Infant, by his Mother and Natural Guardian, SHERRI SKIDMORE, Index # 508009/13 Plaintiff, EXPERT AFFRMATION - against - VASUDHA VISWANATHAN, M.D., CALIXTO CAZANO, M.D., RAJENDRA BHAYANI, M.D., FERNANDO GINEBRA, M.D., SONY LOSEAU, M.D. and WYCKOFF HEIGHT’S MEDICAL CENTER, Defendants. ---------------------------------------------------------------------X LANCE PARTON, M.D., being duly sworn, hereby affirms the following under the penalties of perjury: I am a physician licensed to practice medicine in the State of New York and a professor of pediatrics, and an associate professor of obstetrics and gynecology and anesthesiology. As a specialist in the field of Neonatology, I am board certified by the American Board of Pediatrics, and I have held a sub certification in neonatal-perinatal medicine since 1991. I am currently an attending Neonatologist at Maria Fareri Children’s Hospital at Westchester County Medical Center and have been practicing this specialty for over 20 years. I have reviewed the file materials relevant to this cause of action as it pertains to Drs. Cazano and Ginebra, to wit, the records of Wyckoff Heights Medical Center, the Bills of Particulars served in this matter, the deposition of Sherri Skidmore, the mother of the infant plaintiff Nathaniel Grayton, the depositions of defendant Cazano, defendant Ginebra, defendant Viswanathan and defendant Bhayani. Based on my review of the file materials, I submit this Affirmation in support of the motion for summary judgment in favor of Drs. Cazano and Ginebra, as there exist no departures from good and accepted medical practice on the part of either of these physicians, and FILED: KINGS COUNTY CLERK 10/05/2021 05:34 PM INDEX NO. 508009/2013 NYSCEF DOC. NO. 181 RECEIVED NYSCEF: 10/05/2021 their care and treatment could in no way have caused the injuries alleged to have been sustained by the plaintiff as set forth in the above-referenced Bills of Particulars. RELEVANT BACKGROUND FACTS This is a case centering around a surgical procedure in the nature of an excision of an external skin tag on the infant plaintiff N. G., at Wyckoff Heights Medical Center on April 2, 2009 when the infant plaintiff was approximately 5 weeks old. The child was born at term, the product of a normal, spontaneous vaginal delivery, and exhibited no conditions that required other than routine neonatal and pediatric care, save for the existence of the above-mentioned skin tag. The procedure was to be performed by defendant Bhayani, a specialist in ENT surgery and Dr. Bhayani had previously seen the infant plaintiff, spoken to the parents, and scheduled the procedure to be performed on that date. On April 2, 2009, the infant plaintiff was admitted to Wyckoff Heights Medical Center for the procedure, which was to commence at approximately 9:00 a.m. that morning. However, the surgery never actually commenced, as during the preoperative period, in the attempt to sedate, anesthetize and intubate the patient, the child lapsed into respiratory distress, which was determined to be secondary to a laryngospasm. Dr. Viswanathan, the attending anesthesiologist, was unable to intubate the infant due to the laryngospasm, and as the respiratory situation became more urgent, she, along with the rest of the operative team, called for a code seeking assistance in the OR. Dr. Ginebra, attending Neonatologist on staff at Wyckoff Heights Medical Center, heard the page and immediately presented to the operating room to lend assistance. After a brief conversation, and observing that the patient was in clear respiratory distress, Dr. Ginebra took over the intubation duties from Dr. Viswanathan, and made an attempt to intubate the child with the 3.5 mm. tube (the standard size for a child of this age) that was used by Dr. Viswanathan, but was unsuccessful at passing it due to the child being in laryngospasm. Dr. Ginebra requested a smaller -2- FILED: KINGS COUNTY CLERK 10/05/2021 05:34 PM INDEX NO. 508009/2013 NYSCEF DOC. NO. 181 RECEIVED NYSCEF: 10/05/2021 tube, a 2.5 mm. endotracheal tube (ETT), and was able to successfully insert the ETT and effectively ventilate the patient and stabilize him. Approximately 5 minutes after the 2.5 mm. ETT had been placed, that tube, which is very small, loosened and began to come out while Dr. Ginebra was still present in the OR. Dr. Ginebra then requested a 3.5 mm. ETT, and was able to intubate the baby very easily with that size tube, again the size that would typically be used, absent any complications. Given what had occurred, the surgery was aborted, and the child was taken to the neonatal intensive care unit. Next in the chronology, defendant Dr. Cazano was the attending Neonatologist in the NICU at Wyckoff Heights Medical Center, and his role was confined to monitoring and treating the infant plaintiff during the late morning and afternoon of April 2, 2009. While the child was essentially stable, late that afternoon he sustained a period of oxygen desaturation, at which point Dr. Cazano changed his ventilatory regimen to exchange oxygen in the infant’s lungs at a higher rate and pressure, which had the desired effect of correcting the desaturation. Based on his testimony, Dr. Cazano felt that this was more of a short-term solution and the child required more extensive and/or specialized respiratory treatment, namely, extracorporeal membranous oxygenation (ECMO) which was not available at Wyckoff Heights Medical Center, and thus he arranged for transfer of the infant plaintiff to New York Presbyterian Hospital which was done later that same evening. Following the child’s discharge from New York Presbyterian Medical Center, no further respiratory complications secondary to the laryngospasm episode that occurred in the OR at Wyckoff Heights Medical Center ever occurred. In fact, the only respiratory issue the child has ever had is recurrent bouts of asthma, of which there is an extensive family history. Other than asthma, which, as will be detailed below, bears no causal relationship to the laryngospasm event at Wyckoff Heights Medical Center, the child has suffered no respiratory sequalae. ALLEGATIONS -3- FILED: KINGS COUNTY CLERK 10/05/2021 05:34 PM INDEX NO. 508009/2013 NYSCEF DOC. NO. 181 RECEIVED NYSCEF: 10/05/2021 The allegations posited by the plaintiff as to departures from good and accepted medical practice on the parts of Drs. Ginebra and Cazano can be capsulized as follows: failing to see that the infant was properly intubated, failing to properly recognize the significance of and determining the etiology and act upon the patient’s laryngospasm, failing to timely and properly recognize that the infant was in respiratory failure, failing to timely and properly transfer the infant, failing to properly and timely stabilize the infant, and failing to consult with a cardiologist. Dr. Ginebra The allegations as they pertain to Dr. Ginebra are clearly specious, do not apply to his role in the case, and as will be detailed below, cannot be causally related to the claimed injuries in this case. To elaborate, Dr. Ginebra was not assigned to this patient’s care, and only responded to a code that he heard over the hospital’s loudspeaker when the child had already suffered the laryngospasm, was already in respiratory distress, and a full code was in place. He responded to the code and he was the one able to intubate the plaintiff when the plaintiff had previously been unable to be intubated due to the laryngospasm. Given that the patient was in a laryngospasm, the properly sized tube (the 3.5 mm. ETT) could not be inserted, and thus Dr. Ginebra appropriately tried a smaller tube, which he was able to insert without difficulty, and enabled him to adequately oxygenate the child, remove him from the respiratory distress situation that was occurring, and prevent any further damage, including catastrophic neurologic damage, from occurring. Thereafter, once the situation calmed down, and the laryngospasm began to resolve, the smaller tube began to dislodge, while Dr. Ginebra was there and under his observation. He immediately responded and was able to replace the smaller tube with the appropriately sized 3.5mm. ETT without incident. Thereafter, the child was taken to the neonatal ICU and Dr. Ginebra had no further involvement with his care. -4- FILED: KINGS COUNTY CLERK 10/05/2021 05:34 PM INDEX NO. 508009/2013 NYSCEF DOC. NO. 181 RECEIVED NYSCEF: 10/05/2021 It is beyond specious to allege that Dr. Ginebra’s care and treatment was substandard or caused any of the complications that occurred in the OR that morning. Indeed, as pointed out above, the child had already coded, was in respiratory arrest and in full laryngospasm when Dr. Ginebra came into the room. Indeed, the child was being bagged by the anesthesiologist at that moment, and Dr. Ginebra was the one who was able to prevent the situation from becoming worse by taking over the intubation attempt and successfully intubating the child. From a causal standpoint, the only permanent damage alleged to have been sustained by the infant plaintiff in this matter is the fact that he is alleged to have suffered “frequent colds, stridor, asthma, shortness of breath, the necessity for the use of a nebulizer and pharyngeal dysphagia (difficulty swallowing). While the Bill of Particulars lists the “possibility” of brain damage with delays in all areas and impairment of daily activities, same has not occurred with this infant plaintiff. There is no known, documented, or published connection between laryngospasm and these alleged injuries, and both from that standpoint, as well as from elemental medical and anatomical standpoints, these alleged injuries are unequivocally unrelated to the laryngospasm episode that occurred in this matter. The child certainly has had bouts of asthma throughout his childhood and early adolescence, but by bringing forth these claims, plaintiffs ignore that this condition is widespread in children of this age in general, and that his family has a well-documented and long history of asthma. Asthma is by definition, accompanied by shortness of breath, stridor and often the need for the use of nebulizers, and thus these are alleged damages that have no causal connection to the laryngospasm event suffered in the OR, nor the care and treatment rendered to him in the NICU at Wyckoff Heights Medical Center. As to the pharyngeal dysphagia, based on the testimony of the infant plaintiff’s mother, Sherri Skidmore, this is no longer an issue or the infant plaintiff, and any difficulty swallowing would, at this age, be completely unrelated to the care and -5- FILED: KINGS COUNTY CLERK 10/05/2021 05:34 PM INDEX NO. 508009/2013 NYSCEF DOC. NO. 181 RECEIVED NYSCEF: 10/05/2021 treatment rendered by Drs. Ginebra and Cazano. Indeed, if there were any difficulty swallowing attendant to the events that occurred on April 2, 2009, they would be transient, short-lived and would have resolved within days to weeks at the outside. Dr. Cazano The allegations as to Dr. Cazano are similarly simply without merit. Dr. Cazano did not even see this patient until after the events had not only unfolded in the OR, but after the child had been stabilized, intubated and then brought to the NICU for observation and monitoring. Therefore, any alleged departures and/or injuries associated with the fact that this child suffered a laryngospasm and needed to be intubated simply cannot based on any construct of the facts herein, be applicable to Dr. Cazano. With respect to the neonatal management under Dr. Cazano’s supervision on the afternoon of April 2, 20009, there is simply no issue with respect to the fact that Dr. Cazano’s treatment was at all times in accord with good and accepted medical practice. Indeed, the child was stable throughout that period of time, and when he did experience an episode of oxygen desaturation, Dr. Cazano acted promptly by altering the respiratory therapy in place, both oxygenation and the pressure at which it was administered, and achieved the desired results of increasing the saturations and stabilizing the patient. He also consulted with a pediatric cardiologist, Dr. Patel, which is another allegation in the Bill of Particulars that is unfounded. Dr. Patel did not suggest any alternatives to Dr. Cazano’s management. Further to his credit, Dr. Cazano made the prudent and appropriate determination that in the best interests of the child, he required more sophisticated equipment and extensive monitoring than could be afforded at Wyckoff Heights Medical Center, and arranged for a transfer to New York Presbyterian Hospital. This was effected that evening, and the child did not suffer any -6- FILED: KINGS COUNTY CLERK 10/05/2021 05:34 PM INDEX NO. 508009/2013 NYSCEF DOC. NO. 181 RECEIVED NYSCEF: 10/05/2021 complications, nor injuries, as a result of the transfer or its timing. Indeed, this proved to be a wise decision that afforded the infant plaintiff the level of care he needed, which clearly contributed to his excellent outcome in this matter. Similarly with respect to the issue of causation, it is simply impossible to connect any of the care and treatment rendered by Dr. Cazano to the injuries that are alleged to have been sustained by the plaintiff in this matter. Indeed, with respect to the acute injuries that are related to the events that occurred in the OR (the laryngospasm, the arrest, the need for intubation, etc.), these all took place before Dr. Cazano was ever in attendance of this patient. As to the alleged permanent injuries of asthma, need for nebulizer treatments, shortness of breath, etc., again, none of these could in any construct of the facts and applicable medicine be connected to the care and treatment rendered by Dr. Cazano. Given the foregoing, and the complete absence of any evidence to suggest the care and treatment rendered by either Dr. Ginebra or Dr. Cazano deviated from good and accepted medical practice, along with the fact that the injuries alleged to have been sustained by plaintiff can simply not be plausibly medically connected to the care and treatment rendered by these individuals, it is respectfully submitted that their request for summary judgment be granted in its entirely. LANCE PARTON, M.D., FAAP -7- FILED: KINGS COUNTY CLERK 10/05/2021 05:34 PM INDEX NO. 508009/2013 NYSCEF DOC. NO. 181 RECEIVED NYSCEF: 10/05/2021 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF KINGS ----------------------------------------------------------------------X N.G., an Infant, by his Mother and Natural Guardian, SHERRI SKIDMORE, Index # 508009/13 Plaintiff, CERTIFICATION PURSUANT TO 202.8-b - against - VASUDHA VISWANATHAN, M.D., CALIXTO CAZANO, M.D., RAJENDRA BHAYANI, M.D., FERNANDO GINEBRA, M.D., SONY LOSEAU, M.D. and WYCKOFF HEIGHT’S MEDICAL CENTER, Defendants. ---------------------------------------------------------------------X EDWARD R. NICHOLSON, ESQ., an attorney duly licensed and admitted to practice law before the courts of the State of New York, hereby affirms the following pursuant to the penalties of perjury: I hereby certify pursuant to the Uniform Civil Rules for the Supreme Court and County Court Section 202.8-b(c) that the foregoing Expert Affirmation complies with the word count limit. Type. A proportionally spaced typeface was used as follows: Name of typeface: Times New Roman Point size: 12 Line spacing: Double Word Count. The total number of words in the Expert Affirmation, inclusive of point headings and footnotes and exclusive of the caption, table of contents, table of authorities, signature block, and this Statement is 2136. Dated: New York, New York October 5, 2021 Edward R. Nicholson ____ Edward R. Nicholson, Esq. -8-