ROCHESTER, N.Y. (CN) - New York is not liable to a doctor who contracted a highly contagious strain of tuberculosis during the autopsy of a prison inmate, a state appeals court ruled.
Natasha Muckova performed the autopsy in July 1995 during the first month of a residency in anatomical and clinical pathology at Strong Memorial Hospital in Rochester.
The hospital paged Muckova, a recent graduate of the University of Rochester Medical School, to participate in an inmate autopsy.
Jesus Cardenas had died in isolation at the Groveland Correctional Facility infirmary, located about an hour south of Rochester, while awaiting results of tests done at Erie County Medical Center, where he had been hospitalized briefly.
Those tests showed he was positive for mycobacterium tuberculosis, which is highly contagious and can be fatal.
The medical center relayed the test results to the prison's infection control nurse, a state Department of Health worker who was the designated liaison for infection control with the prison, the county and the state. In that role, the nurse could not note anything in Cardenas' medical record about the tests.
Though the medical center would send a formal report on the lab, it had to mail that report to the prison because Groveland had no fax machine. The report came in days after the autopsy, which standard procedure requires in prison deaths.
Muckova testified that she learned Cardenas was known to have HIV or AIDS and died while being ruled out for TB. She said she followed the recommendations from her supervisor about what precautions to take for the autopsy.
Strong Memorial has a special room for high-risk autopsies, which features washable walls and about four times the air exchanges per hour as compared to a regular autopsy room. This infectious room was unavailable on the day of the autopsy, however, and the regular room also had an air-flow problem that day, creating a higher risk of inhaling airborne mycobacterium tuberculosis pathogens.
A few days later, viewing dissections of Cardenas' large organs with her attending pathologist, Muckova learned she had been exposed to a strain of TB that was "both active and extremely contagious." She subsequently tested positive for TB and was put on a six-month regimen of drugs to prevent the disease from becoming active.
The drugs caused daily nausea, and Muckova also went through periods of anxiety and depression. Eventually, she shifted her area of specialty from pathology to internal medicine.
Muckova's disease has remained inactive but she sued for negligence in the New York State Court of Claims.
In May 2011, Judge Philip Patti ordered New York to pay Muckova $500,000, saying "there is no question in my mind that Dr. Muckova was owed a duty of care by the defendant."
Though he credited Muckova's ability "to maintain a successful personal and professional life since 1995 despite her TB," Patti noted the unavoidable stress of her situation.
"The saddest aspect of this case, perhaps, is that the entire situation was entirely avoidable," Patti wrote.
He later added: "Defendant's breach of duty here resulted in the spread of a permanent and potentially fatal communicable disease that claimant now must live with for the rest of her life."
A five-judge appellate panel reversed last week after finding that Muckova "has no private cause of action against defendant for the prison's failure to comply" with regulations that require inclusion of a tuberculosis diagnosis in a prisoner's medical chart.
"We agree with defendant that it owed no duty of care to claimant," according to the decision from the Appellate Division's Fourth Judicial Department.
Quoting precedent, the brief ruling states that "the laws and regulations of this state pertaining to the control of reportable or communicable diseases were enacted to protect the public in general, and not a particular class of persons. ... Stated otherwise, they 'were intended to benefit the injured [claimant], but in the broad sense of protecting all members of the general public similarly situated.'"
The court noted that Patti's decision had been broad enough for the appeal to cover both the state's duty to warn and its duty to record the disease in the prison records.
Muckova, though, narrowed the focus to the duty to maintain accurate records, abandoning the duty to warn.
On the records issue, the justices found an "absence of a showing, or indeed an allegation, that claimant had the requisite special relationship with defendant" that would create liability for the state.
Justices Nancy Smith, Erin Peradotto, Stephen Lindley, Rose Sconiers and Joseph Valentino issued the decision.
George Schell of Schell & Schell in Fairport argued for Muckova. Assistant Solicitor General Julie Sheridan represented the state.
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