Preview
FILED: QUEENS COUNTY CLERK 06/14/2021
06/15/2021 04:09
06:03 PM INDEX NO. 717964/2018
NYSCEF DOC. NO. 102
118 RECEIVED NYSCEF: 06/14/2021
06/15/2021
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF QUEENS
■x
THERESA ROBINSON AND DEREK ROBINSON
Index No.: 717964/2018
Plaintiffs,
EXPERT AFFIRMATION
-against- IN SUPPORT OF MOTION
FOR SUMMARY JUDGMENT
NORTHWELL HEALTH, INC, LONG ISLAND
JEWISH MEDICAL CENTER, DEEPAK NANDA,
MD, PC, DEEPAK NANDA M.D., EMMANUEL
M. PAFOS, M.D
Defendants.
x
GENEVIEVE SICURANZA, M.D., a physician duly licensed to practice medicine in
the State of New York hereby affirms the truth of the following matters, under penalty of perjury:
1. I am a physician duly licensed to practice medicine in the state of New York and I am
board certified in Maternal Fetal Medicine and Obstetrics and Gynecology. This affidavit
is submitted in support of the motion for summary judgment brought on behalf of Deepak
Nanda, M.D. (hereinafter "Dr. Nanda") and Deepak Nanda, M.D. P.C. (hereinafter "Dr.
Nanda PC").
2. I received my medical degree from the University Central Caribe School of Medicine in
1985. I then completed an internship and residency in Obstetrics and Gynecology at St
Vincent Catholic Medical Centers in 1987, followed by a Maternal Fetal Medicine
fellowship at Stony Brook University Hospital in 1991. I have been Board Certified in
Obstetrics and Gynecology since 1994 and in Maternal Fetal Medicine since 2000. I am
a Clinical Professor in the Department of Obstetrics and Gynecology at NYU Long Island
School of Medicine and Chief of Obstetrics at NYU Winthrop Hospital and the Patient
Safety Officer. I am a Fellow in the American College of Obstetrics and Gynecology and
FILED: QUEENS COUNTY CLERK 06/14/2021
06/15/2021 04:09
06:03 PM INDEX NO. 717964/2018
NYSCEF DOC. NO. 102
118 RECEIVED NYSCEF: 06/14/2021
06/15/2021
a Member of the American Society of Maternal Fetal Medicine. Therefore, based on my
knowledge, training and years of experience, I am familiar with the accepted standards of
obstetrical care applicable at the time of the events relevant herein. It is my opinion to a
reasonable degree of medical certainty that Dr. Nanda and Dr. Nanda PC acted in accord
with good and accepted practice and that their involvement in the care and treatment of
plaintiff Theresa Robinson and that this care and treatment was not a contributing factor
in the alleged injuries to the plaintiff Theresa Robinson.
3. I have reviewed the Verified Bill of Particulars as to the claims being made against Dr.
Nanda and Dr. Nanda PC along with the relevant medical records, including the prenatal
records from Dr. Nanda’s office and the hospital records of Long Island Jewish Medical
Center, as well as the deposition transcripts of the plaintiffs and the defendants in this
matter. It is my opinion within a reasonable degree of medical certainty, based upon my
years of training and experience in obstetrics and maternal fetal medicine, as well as my
review of the pertinent records, that Dr. Nanda and Dr. Nanda PC acted in accord with
good and accepted obstetrical and maternal fetal medicine practice in their care and
treatment of Theresa Robinson in 2015 and 2016. Furthermore, itis my opinion to a
reasonable degree of medical certainty that the care and treatment provided by Dr. Nanda
and Dr. Nanda PC and the advice given to Mrs. Robinson, especially with respect to her
decision to proceed with a trial of labor and attempt a vaginal delivery after a prior
cesarean section (“hereinafter VBAC”), did not in any way cause the injuries alleged in
this action. Furthermore, plaintiffs Bill of Particulars alleges that Dr. Nanda PC is
vicariously liable for the care and treatment of codefendant Dr. Emmanuel Pafos.
4. Prior to the pregnancy at issue and the involvement of Dr. Nanda and Dr. Nanda PC in
FILED: QUEENS COUNTY CLERK 06/14/2021
06/15/2021 04:09
06:03 PM INDEX NO. 717964/2018
NYSCEF DOC. NO. 102
118 RECEIVED NYSCEF: 06/14/2021
06/15/2021
December of 2015, the records reflect that Mrs. Robinson had been pregnant five times,
one of which resulted in the birth of her first son in 2009. Mrs. Robinson delivered her
first child via cesarean section and the cesarean section was apparently performed,
according to the records, by Dr. Nanda and due to fetal distress. The pregnancy at issue
in this case was Mrs. Robinson’s sixth pregnancy. The records reflect that Mrs. Robinson
clearly expressed her desire for a VBAC with the pregnancy at issue. VBAC is a
commonly used term for a patient's desire to attempt to deliver a baby vaginally after
delivering a prior baby via cesarean section. This type of delivery also is known as trial
of labor after cesarean section or TOLAC. With the pregnancy at issue, Mrs. Robinson
testified that she originally chose Dr. Mamie Sanders group called Women for Women
Obstetrics and Gynecology for her prenatal care. However Mrs. Robinson also testified
in her deposition that she switched to Dr. Nanda at approximately 20 weeks pregnant since
he had delivered her first child in 2009 and because his office was closer to her home.
5. As evidenced by the office records of Dr. Nanda and Dr. Nanda PC, Mrs. Robinson
presented to Dr. Nanda’s-office for the first time on December 8, 2015, when she was
approximately 20 weeks pregnant. However, Dr. Nanda testified in his deposition that
prior to December 8, he first encountered Mrs. Robinson at Long Island Jewish Medical
Center on September 25,2015 when she presented for an ultrasound. That ultrasound was
normal and performed for genetic screening. At her prenatal office visit with Dr. Nanda
on December 8,2015 Mrs. Robinson expressed her desire to deliver this baby via VBAC.
The records reflect no contraindications to a trial of labor after cesarean section and in
fact, reveal the opposite. In my opinion, Mrs. Robinson was an appropriate candidate for
a trial of labor when she presented to Dr. Nanda’s office on December 8,2015. Dr. Nanda
FILED: QUEENS COUNTY CLERK 06/14/2021
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06:03 PM INDEX NO. 717964/2018
NYSCEF DOC. NO. 102
118 RECEIVED NYSCEF: 06/14/2021
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testified that on that first visit he would have asked Mrs. Robinson the reason for her prior
cesarean section, if there was anything unusual that led to the delivery by cesarean section,
whether the baby was a large for gestational age baby and if she were ever told by another
physician that she should avoid a vaginal delivery in the future. Dr. Nanda appropriately
assessed Mrs. Robinson prenatally and appropriately supported Mrs. Robinson’s express
desire to deliver via VBAC.
6. Based on the prenatal chart and the deposition testimony of Dr. Nanda, it appears that
Mrs. Robinson had a relatively uneventful prenatal course. Dr. Nanda saw her on two
more occasions prenatally and may have interpreted one of the ultrasounds performed
between March 1, 2016, and April 9, 2016. The only finding of significance in relation
to the prenatal care and the ultrasounds was that the ultrasound on February 2, 2016
showed that the baby was in a transverse lie and that there was polyhydramnios which is
an abnormally high amniotic fluid level. Dr. Nanda testified that this condition must be
monitored closely and my review of the records confirms that it was. Moreover, this
condition did not ultimately alter Mrs. Robinson’s prenatal course or the well being of the
baby. Dr. Nanda testified that there was never a contraindication for a VBAC delivery in
Mrs. Robinson’s case and that she remained a candidate for a trial of labor throughout the
prenatal care time frame. Based on my review of the records, Mrs. Robinson was an
appropriate candidate for a trial of labor to attempt a vaginal delivery after a prior cesarean
section up to and including April 12, 2016 when she was admitted to deliver her second
child.
7. Mrs. Robinson was admitted to the labor and delivery department of Long Island Jewish
Medical Center (“LIJMC”) at or about 1:15 a.m. on April 12, 2016 and she was admitted
FILED: QUEENS COUNTY CLERK 06/14/2021
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NYSCEF DOC. NO. 102
118 RECEIVED NYSCEF: 06/14/2021
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by Dr. Nanda. In his deposition testimony, Dr. Nanda testified that the risks associated
with a VBAC delivery were discussed and the risk of surgical complications were
included in this discussion. In addition, the nurses’ notes from LIJMC indicate that the
VBAC delivery plan was discussed with Mrs. Robinson and that her consent was obtained
at 2:48 a.m. on April 12, 2016. With these risks in mind, Mrs. Robinson expressed her
continuing desire for a VBAC delivery and signed the consent to proceed with this
delivery option.
8. Dr. Nanda testified and the records reflect that Mrs. Robinson arrived at LIJMC sometime
around midnight on April 12, 2016 and that prior to her arrival, her membranes had
ruptured. Mrs. Robinson signed the consent form for a trial of labor and the risks and
benefits were discussed with her at that time. Throughout the day on April 12, 2016 Dr.
Mrs. Robinson was experiencing irregular contractions, her cervix was not fully dilated
and she was being monitored for the onset of active labor. Dr. Nanda was at the bedside
several times according to the LIJMC records and Mrs. Robinson’s deposition testimony.
Although there was some evidence of decelerations on the fetal heart monitoring strips,
this is not unusual, and resuscitative measures undertaken by the nursing staff were
appropriate. It is my opinion with a reasonable degree of medical certainty that at no time
was a cesarean section indicated between 1:15 a.m. on April 12 and approximately 5 p.m.
on April 12 when Mrs. Robinson’s care was turned over to the codefendant Dr. Emmanuel
Pafos. Dr. Nanda testified that during the day a balloon catheter was placed to attempt
mechanical dilation of the cervix and this was good practice. Then, around 5:00 p.m., the
decision was made to start low dose Pitocin in the hopes of promoting further cervical
dilation. In my opinion these measures that were taken to promote the onset of active labor
FILED: QUEENS COUNTY CLERK 06/14/2021
06/15/2021 04:09
06:03 PM INDEX NO. 717964/2018
NYSCEF DOC. NO. 102
118 RECEIVED NYSCEF: 06/14/2021
06/15/2021
were appropriate. The Pitocin was slowly titrated and Mrs. Robinson began active labor
and proceeded to full cervical dilation.
9. Codefendant Dr. Pafos took over the management of Mrs. Robinson’s labor and delivery
at some time between 5:00 p.m. and 6:00 p.m. on April 12, 2016. Dr. Nanda testified he
would have given Dr. Pafos a report of the days events and the efforts to promote cervical
dilation. A Foley catheter was inserted near 7:30 p.m. and at 7:51 p.m. the cervix was
now 5 centimeters dilated. Shortly after 8:00 p.m. the Pitocin was increased and then
increased a bit more at 9:54 p.m. By 10:49 p.m. there was increased pressure and the
cervix was dilated to 10 cm. However, the baby had not significantly descended. At
10:55 Dr. Pafos was at the bedside according to the records and the deposition testimony
of Dr. Pafos. By 11:00 p.m. on April 12 Mrs. Robinson was in active labor, fully dilated
and around 11:34 p.m. Mrs. Robinson started pushing. At or about 11:45 p.m. recurrent
late decelerations were noted and with Dr. Pafos by the bedside, the maternal pushing
continued. Due to the recurrent later decelerations oxygen was started at 11:54 a.m. and
the Pitocin was discontinued. Mrs. Robinson was placed on her left side which is thought
to relieve pressure from the uterine blood vessels and increase blood flow to the baby.
Approximately 3 minutes later it is noted that Dr. Pafos began discussing the need for a
cesarean section delivery and the decision was made at 12:11 a.m. Mrs. Robinson was in
the delivery room by 12:18 a.m. and a healthy baby girl was delivered at 12:48 a.m.
10. Significantly as Dr. Pafos testified, shortly before midnight on April 12, 2016 there was
concern for the baby’s well-being and Dr. Pafos appropriately advised Mr. and Mrs.
Robinson that his recommendation was to abandon the VBAC delivery plan and proceed
with a cesarian section. However, even at that point, and in no uncertain terms, Mrs.
FILED: QUEENS COUNTY CLERK 06/14/2021
06/15/2021 04:09
06:03 PM INDEX NO. 717964/2018
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Robinson expressed her desire for the VBAC delivery plan. With the use of profane
language which Dr. Pofos testified that he understood under the emotional circumstances,
Mrs. Robinson vehemently expressed her desire to continue to attempt to deliver
vaginally. However, by 12:11 a.m. Dr. Pofos appropriately was able to convince the
Robinsons that a cesarean section delivery was the correct course of action. In my
opinion, at that point, the decision to convince the Robinsons to deliver via cesarean
section directly led to delivery of a healthy baby.
11. Prior to taking Mrs. Robinson to the operating room at 12:18 p.m. on April 13, 2016, it is
the testimony of Dr. Pofos that he discussed the risks and benefits of the cesarean section
including the risks of bleeding, infection and damage to organs, uterus or the baby with
Mr. and Mrs. Robinson and the nurses’ notes indicate Mrs. Robinson was aware of the
risks and benefits. Prior to making the incision in the uterus to retrieve the baby. Dr. Pafos
testified that he noted a rupture at the site of the healed uterine scar for the prior cesarean
section. When this area ruptures during labor, Dr. Pofos testified that it tears a portion of
the posterior aspect of the bladder because of adhesions or prior scar tissue. Dr. Pofos
appropriately described this complication of a uterine rupture during labor. The baby was
delivered in good health and Dr. Rofeim, a urologist, was brought in to repair the bladder
tear. The records reflect that Mrs. Robinson tolerated the delivery and repair well and was
discharged to the recovery room. Dr. Pafos testified that he saw Mrs. Robinson for several
post-partum visits, that she was doing well, and that the skin incision was healing.
12. It is my opinion to a reasonable degree of medical certainty that Mrs. Robinson was an
appropriate candidate for a trial of labor after cesarean section with respect to the
pregnancy at issue and that neither Dr. Nanda nor Dr. Nanda PC deviated from the
FILED: QUEENS COUNTY CLERK 06/14/2021
06/15/2021 04:09
06:03 PM INDEX NO. 717964/2018
NYSCEF DOC. NO. 102
118 RECEIVED NYSCEF: 06/14/2021
06/15/2021
standard of care in this case by supporting the plaintiff mother's desire to attempt a vaginal
delivery after cesarean section. Furthermore, it is my opinion to a reasonable degree of
medical certainty that Dr. Nanda and Dr. Nanda PC appropriately evaluated the plaintiff
Theresa Robinson when she presented to Long Island Jewish Medical Center, considered
and ordered the appropriate testing, and had the appropriate discussions regarding the risks
and benefits of a trial of labor after cesarean section with Mrs. Robinson.
13. In conclusion, based on a reasonable degree of medical certainty, it is my opinion that Dr.
Nanda and Dr. Nanda PC did not depart from the standard of care and that the care
rendered by Dr. Nanda and Dr. Nanda PC did not cause the injuries that are claimed on
behalf of the plaintiffs in this matter.
Dated: New York, New York
June 10, 2021
'fi LAASL.CVY)$f6Ji /t/Ub
Genevieve Sicuranza, M.D.
Preview
FILED: QUEENS COUNTY CLERK 06/14/2021 06/15/2021 04:09 06:03 PM INDEX NO. 717964/2018 NYSCEF DOC. NO. 102 118 RECEIVED NYSCEF: 06/14/2021 06/15/2021 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF QUEENS ■x THERESA ROBINSON AND DEREK ROBINSON Index No.: 717964/2018 Plaintiffs, EXPERT AFFIRMATION -against- IN SUPPORT OF MOTION FOR SUMMARY JUDGMENT NORTHWELL HEALTH, INC, LONG ISLAND JEWISH MEDICAL CENTER, DEEPAK NANDA, MD, PC, DEEPAK NANDA M.D., EMMANUEL M. PAFOS, M.D Defendants. x GENEVIEVE SICURANZA, M.D., a physician duly licensed to practice medicine in the State of New York hereby affirms the truth of the following matters, under penalty of perjury: 1. I am a physician duly licensed to practice medicine in the state of New York and I am board certified in Maternal Fetal Medicine and Obstetrics and Gynecology. This affidavit is submitted in support of the motion for summary judgment brought on behalf of Deepak Nanda, M.D. (hereinafter "Dr. Nanda") and Deepak Nanda, M.D. P.C. (hereinafter "Dr. Nanda PC"). 2. I received my medical degree from the University Central Caribe School of Medicine in 1985. I then completed an internship and residency in Obstetrics and Gynecology at St Vincent Catholic Medical Centers in 1987, followed by a Maternal Fetal Medicine fellowship at Stony Brook University Hospital in 1991. I have been Board Certified in Obstetrics and Gynecology since 1994 and in Maternal Fetal Medicine since 2000. I am a Clinical Professor in the Department of Obstetrics and Gynecology at NYU Long Island School of Medicine and Chief of Obstetrics at NYU Winthrop Hospital and the Patient Safety Officer. I am a Fellow in the American College of Obstetrics and Gynecology and FILED: QUEENS COUNTY CLERK 06/14/2021 06/15/2021 04:09 06:03 PM INDEX NO. 717964/2018 NYSCEF DOC. NO. 102 118 RECEIVED NYSCEF: 06/14/2021 06/15/2021 a Member of the American Society of Maternal Fetal Medicine. Therefore, based on my knowledge, training and years of experience, I am familiar with the accepted standards of obstetrical care applicable at the time of the events relevant herein. It is my opinion to a reasonable degree of medical certainty that Dr. Nanda and Dr. Nanda PC acted in accord with good and accepted practice and that their involvement in the care and treatment of plaintiff Theresa Robinson and that this care and treatment was not a contributing factor in the alleged injuries to the plaintiff Theresa Robinson. 3. I have reviewed the Verified Bill of Particulars as to the claims being made against Dr. Nanda and Dr. Nanda PC along with the relevant medical records, including the prenatal records from Dr. Nanda’s office and the hospital records of Long Island Jewish Medical Center, as well as the deposition transcripts of the plaintiffs and the defendants in this matter. It is my opinion within a reasonable degree of medical certainty, based upon my years of training and experience in obstetrics and maternal fetal medicine, as well as my review of the pertinent records, that Dr. Nanda and Dr. Nanda PC acted in accord with good and accepted obstetrical and maternal fetal medicine practice in their care and treatment of Theresa Robinson in 2015 and 2016. Furthermore, itis my opinion to a reasonable degree of medical certainty that the care and treatment provided by Dr. Nanda and Dr. Nanda PC and the advice given to Mrs. Robinson, especially with respect to her decision to proceed with a trial of labor and attempt a vaginal delivery after a prior cesarean section (“hereinafter VBAC”), did not in any way cause the injuries alleged in this action. Furthermore, plaintiffs Bill of Particulars alleges that Dr. Nanda PC is vicariously liable for the care and treatment of codefendant Dr. Emmanuel Pafos. 4. Prior to the pregnancy at issue and the involvement of Dr. Nanda and Dr. Nanda PC in FILED: QUEENS COUNTY CLERK 06/14/2021 06/15/2021 04:09 06:03 PM INDEX NO. 717964/2018 NYSCEF DOC. NO. 102 118 RECEIVED NYSCEF: 06/14/2021 06/15/2021 December of 2015, the records reflect that Mrs. Robinson had been pregnant five times, one of which resulted in the birth of her first son in 2009. Mrs. Robinson delivered her first child via cesarean section and the cesarean section was apparently performed, according to the records, by Dr. Nanda and due to fetal distress. The pregnancy at issue in this case was Mrs. Robinson’s sixth pregnancy. The records reflect that Mrs. Robinson clearly expressed her desire for a VBAC with the pregnancy at issue. VBAC is a commonly used term for a patient's desire to attempt to deliver a baby vaginally after delivering a prior baby via cesarean section. This type of delivery also is known as trial of labor after cesarean section or TOLAC. With the pregnancy at issue, Mrs. Robinson testified that she originally chose Dr. Mamie Sanders group called Women for Women Obstetrics and Gynecology for her prenatal care. However Mrs. Robinson also testified in her deposition that she switched to Dr. Nanda at approximately 20 weeks pregnant since he had delivered her first child in 2009 and because his office was closer to her home. 5. As evidenced by the office records of Dr. Nanda and Dr. Nanda PC, Mrs. Robinson presented to Dr. Nanda’s-office for the first time on December 8, 2015, when she was approximately 20 weeks pregnant. However, Dr. Nanda testified in his deposition that prior to December 8, he first encountered Mrs. Robinson at Long Island Jewish Medical Center on September 25,2015 when she presented for an ultrasound. That ultrasound was normal and performed for genetic screening. At her prenatal office visit with Dr. Nanda on December 8,2015 Mrs. Robinson expressed her desire to deliver this baby via VBAC. The records reflect no contraindications to a trial of labor after cesarean section and in fact, reveal the opposite. In my opinion, Mrs. Robinson was an appropriate candidate for a trial of labor when she presented to Dr. Nanda’s office on December 8,2015. Dr. Nanda FILED: QUEENS COUNTY CLERK 06/14/2021 06/15/2021 04:09 06:03 PM INDEX NO. 717964/2018 NYSCEF DOC. NO. 102 118 RECEIVED NYSCEF: 06/14/2021 06/15/2021 testified that on that first visit he would have asked Mrs. Robinson the reason for her prior cesarean section, if there was anything unusual that led to the delivery by cesarean section, whether the baby was a large for gestational age baby and if she were ever told by another physician that she should avoid a vaginal delivery in the future. Dr. Nanda appropriately assessed Mrs. Robinson prenatally and appropriately supported Mrs. Robinson’s express desire to deliver via VBAC. 6. Based on the prenatal chart and the deposition testimony of Dr. Nanda, it appears that Mrs. Robinson had a relatively uneventful prenatal course. Dr. Nanda saw her on two more occasions prenatally and may have interpreted one of the ultrasounds performed between March 1, 2016, and April 9, 2016. The only finding of significance in relation to the prenatal care and the ultrasounds was that the ultrasound on February 2, 2016 showed that the baby was in a transverse lie and that there was polyhydramnios which is an abnormally high amniotic fluid level. Dr. Nanda testified that this condition must be monitored closely and my review of the records confirms that it was. Moreover, this condition did not ultimately alter Mrs. Robinson’s prenatal course or the well being of the baby. Dr. Nanda testified that there was never a contraindication for a VBAC delivery in Mrs. Robinson’s case and that she remained a candidate for a trial of labor throughout the prenatal care time frame. Based on my review of the records, Mrs. Robinson was an appropriate candidate for a trial of labor to attempt a vaginal delivery after a prior cesarean section up to and including April 12, 2016 when she was admitted to deliver her second child. 7. Mrs. Robinson was admitted to the labor and delivery department of Long Island Jewish Medical Center (“LIJMC”) at or about 1:15 a.m. on April 12, 2016 and she was admitted FILED: QUEENS COUNTY CLERK 06/14/2021 06/15/2021 04:09 06:03 PM INDEX NO. 717964/2018 NYSCEF DOC. NO. 102 118 RECEIVED NYSCEF: 06/14/2021 06/15/2021 by Dr. Nanda. In his deposition testimony, Dr. Nanda testified that the risks associated with a VBAC delivery were discussed and the risk of surgical complications were included in this discussion. In addition, the nurses’ notes from LIJMC indicate that the VBAC delivery plan was discussed with Mrs. Robinson and that her consent was obtained at 2:48 a.m. on April 12, 2016. With these risks in mind, Mrs. Robinson expressed her continuing desire for a VBAC delivery and signed the consent to proceed with this delivery option. 8. Dr. Nanda testified and the records reflect that Mrs. Robinson arrived at LIJMC sometime around midnight on April 12, 2016 and that prior to her arrival, her membranes had ruptured. Mrs. Robinson signed the consent form for a trial of labor and the risks and benefits were discussed with her at that time. Throughout the day on April 12, 2016 Dr. Mrs. Robinson was experiencing irregular contractions, her cervix was not fully dilated and she was being monitored for the onset of active labor. Dr. Nanda was at the bedside several times according to the LIJMC records and Mrs. Robinson’s deposition testimony. Although there was some evidence of decelerations on the fetal heart monitoring strips, this is not unusual, and resuscitative measures undertaken by the nursing staff were appropriate. It is my opinion with a reasonable degree of medical certainty that at no time was a cesarean section indicated between 1:15 a.m. on April 12 and approximately 5 p.m. on April 12 when Mrs. Robinson’s care was turned over to the codefendant Dr. Emmanuel Pafos. Dr. Nanda testified that during the day a balloon catheter was placed to attempt mechanical dilation of the cervix and this was good practice. Then, around 5:00 p.m., the decision was made to start low dose Pitocin in the hopes of promoting further cervical dilation. In my opinion these measures that were taken to promote the onset of active labor FILED: QUEENS COUNTY CLERK 06/14/2021 06/15/2021 04:09 06:03 PM INDEX NO. 717964/2018 NYSCEF DOC. NO. 102 118 RECEIVED NYSCEF: 06/14/2021 06/15/2021 were appropriate. The Pitocin was slowly titrated and Mrs. Robinson began active labor and proceeded to full cervical dilation. 9. Codefendant Dr. Pafos took over the management of Mrs. Robinson’s labor and delivery at some time between 5:00 p.m. and 6:00 p.m. on April 12, 2016. Dr. Nanda testified he would have given Dr. Pafos a report of the days events and the efforts to promote cervical dilation. A Foley catheter was inserted near 7:30 p.m. and at 7:51 p.m. the cervix was now 5 centimeters dilated. Shortly after 8:00 p.m. the Pitocin was increased and then increased a bit more at 9:54 p.m. By 10:49 p.m. there was increased pressure and the cervix was dilated to 10 cm. However, the baby had not significantly descended. At 10:55 Dr. Pafos was at the bedside according to the records and the deposition testimony of Dr. Pafos. By 11:00 p.m. on April 12 Mrs. Robinson was in active labor, fully dilated and around 11:34 p.m. Mrs. Robinson started pushing. At or about 11:45 p.m. recurrent late decelerations were noted and with Dr. Pafos by the bedside, the maternal pushing continued. Due to the recurrent later decelerations oxygen was started at 11:54 a.m. and the Pitocin was discontinued. Mrs. Robinson was placed on her left side which is thought to relieve pressure from the uterine blood vessels and increase blood flow to the baby. Approximately 3 minutes later it is noted that Dr. Pafos began discussing the need for a cesarean section delivery and the decision was made at 12:11 a.m. Mrs. Robinson was in the delivery room by 12:18 a.m. and a healthy baby girl was delivered at 12:48 a.m. 10. Significantly as Dr. Pafos testified, shortly before midnight on April 12, 2016 there was concern for the baby’s well-being and Dr. Pafos appropriately advised Mr. and Mrs. Robinson that his recommendation was to abandon the VBAC delivery plan and proceed with a cesarian section. However, even at that point, and in no uncertain terms, Mrs. FILED: QUEENS COUNTY CLERK 06/14/2021 06/15/2021 04:09 06:03 PM INDEX NO. 717964/2018 NYSCEF DOC. NO. 102 118 RECEIVED NYSCEF: 06/14/2021 06/15/2021 Robinson expressed her desire for the VBAC delivery plan. With the use of profane language which Dr. Pofos testified that he understood under the emotional circumstances, Mrs. Robinson vehemently expressed her desire to continue to attempt to deliver vaginally. However, by 12:11 a.m. Dr. Pofos appropriately was able to convince the Robinsons that a cesarean section delivery was the correct course of action. In my opinion, at that point, the decision to convince the Robinsons to deliver via cesarean section directly led to delivery of a healthy baby. 11. Prior to taking Mrs. Robinson to the operating room at 12:18 p.m. on April 13, 2016, it is the testimony of Dr. Pofos that he discussed the risks and benefits of the cesarean section including the risks of bleeding, infection and damage to organs, uterus or the baby with Mr. and Mrs. Robinson and the nurses’ notes indicate Mrs. Robinson was aware of the risks and benefits. Prior to making the incision in the uterus to retrieve the baby. Dr. Pafos testified that he noted a rupture at the site of the healed uterine scar for the prior cesarean section. When this area ruptures during labor, Dr. Pofos testified that it tears a portion of the posterior aspect of the bladder because of adhesions or prior scar tissue. Dr. Pofos appropriately described this complication of a uterine rupture during labor. The baby was delivered in good health and Dr. Rofeim, a urologist, was brought in to repair the bladder tear. The records reflect that Mrs. Robinson tolerated the delivery and repair well and was discharged to the recovery room. Dr. Pafos testified that he saw Mrs. Robinson for several post-partum visits, that she was doing well, and that the skin incision was healing. 12. It is my opinion to a reasonable degree of medical certainty that Mrs. Robinson was an appropriate candidate for a trial of labor after cesarean section with respect to the pregnancy at issue and that neither Dr. Nanda nor Dr. Nanda PC deviated from the FILED: QUEENS COUNTY CLERK 06/14/2021 06/15/2021 04:09 06:03 PM INDEX NO. 717964/2018 NYSCEF DOC. NO. 102 118 RECEIVED NYSCEF: 06/14/2021 06/15/2021 standard of care in this case by supporting the plaintiff mother's desire to attempt a vaginal delivery after cesarean section. Furthermore, it is my opinion to a reasonable degree of medical certainty that Dr. Nanda and Dr. Nanda PC appropriately evaluated the plaintiff Theresa Robinson when she presented to Long Island Jewish Medical Center, considered and ordered the appropriate testing, and had the appropriate discussions regarding the risks and benefits of a trial of labor after cesarean section with Mrs. Robinson. 13. In conclusion, based on a reasonable degree of medical certainty, it is my opinion that Dr. Nanda and Dr. Nanda PC did not depart from the standard of care and that the care rendered by Dr. Nanda and Dr. Nanda PC did not cause the injuries that are claimed on behalf of the plaintiffs in this matter. Dated: New York, New York June 10, 2021 'fi LAASL.CVY)$f6Ji /t/Ub Genevieve Sicuranza, M.D.