Caruso v. St. Elizabeth Medical Center: Expert Affidavits, Timely Specialist Consultation, and Hospital/Vicarious Liability at the Summary Judgment Stage

I. Introduction

The Appellate Division, Fourth Department’s decision in Caruso v. St. Elizabeth Medical Center, 2025 NY Slip Op 06410 (Nov. 21, 2025), is a significant reaffirmation and refinement of several core principles in New York medical malpractice litigation, particularly as they arise at the summary judgment stage.

The plaintiff, Patricia M. Caruso, sued individually and as administrator of the estate of her deceased husband, Philip P. Caruso, alleging that his wrongful death and conscious pain and suffering were caused by defendants’ delayed detection and treatment of a stroke after his admission to St. Elizabeth Medical Center (“SEMC”). The defendants included:

• St. Elizabeth Medical Center (“SEMC”) and its affiliated system, Mohawk Valley Health System;
• Dr. Shwe Win, a physician involved in decedent’s care at SEMC;
• Dr. Lev Goldiner, alleged to be involved in the decedent’s care and medical decision-making;
• Slocum-Dickson Medical Group, P.C. (“SDMG”), alleged to be vicariously liable for Dr. Goldiner’s conduct.

At the trial level, Supreme Court, Oneida County (Denton, J.) granted full summary judgment to Dr. Goldiner and SDMG, and granted partial summary judgment to SEMC, Mohawk Valley Health System, and Dr. Win, leaving only limited direct claims against SEMC. On appeal, the Fourth Department substantially reversed those dismissals.

The appellate court’s opinion emphasizes three interlocking themes:

1. The rigorous but defendant-friendly structure of the summary judgment burden in medical malpractice cases, and the role of “battle of the experts” disputes;
2. The circumstances in which hospitals and their nursing staff may face direct liability for failing to ensure timely specialist consultation (here, a neurological consult for a suspected stroke) or for failing to notify the ordering physician when a consult cannot be timely obtained;
3. The preservation of claims based on vicarious liability and derivative claims when underlying malpractice claims survive, including where there is a factual dispute about the existence of a doctor–patient relationship and about “loss of chance” causation.

In doing so, the court clarifies that:

• An adequately supported plaintiff’s expert affidavit can create “a classic battle of the experts” that precludes summary judgment;
• Determination of a doctor–patient relationship may present triable fact questions, and cannot always be resolved as a matter of law;
• Hospitals can face direct liability for systemic and nursing-level failures in arranging specialist consultation or communicating its unavailability, particularly in time-sensitive contexts like stroke care;
• Causation theories framed as a patient having a “better chance of recovery” are sufficient at the summary judgment stage when properly supported by expert opinion.

II. Summary of the Opinion

The Fourth Department unanimously modified the Supreme Court’s order “on the law” and, as modified, affirmed without costs.

A. Reinstatement of Claims Against Dr. Goldiner and SDMG

The appellate court:

• Denied in part the motion for summary judgment by Dr. Lev Goldiner and SDMG;
• Reinstated the causes of action against them for:
  • medical malpractice,
  • wrongful death,
  • conscious pain and suffering, and
  • the derivative cause of action (presumably for loss of consortium or similar).

While the trial court had found that the “Goldiner defendants” met their initial burden on both deviation and causation, the Appellate Division held that plaintiff’s expert affidavit created triable issues of fact regarding:

• When the decedent began experiencing stroke symptoms, and
• Whether, when Dr. Goldiner was informed of decedent’s condition, he was still within the therapeutic window for certain stroke treatments that Dr. Goldiner allegedly should have promptly ordered.

Because the plaintiff’s expert opinion directly and substantively contradicted the defense expert’s affirmation, the court held this was a “classic battle of the experts” for a jury, not for the court, to resolve.

The court also rejected the defense’s alternative argument that summary judgment should be affirmed on the ground that no doctor–patient relationship existed between decedent and Dr. Goldiner, finding that factual questions precluded such a ruling as a matter of law.

B. Reinstatement of Claims Against Dr. Win

The court likewise:

• Denied in part the motion by SEMC, Mohawk Valley Health System, and Dr. Shwe Win;
• Reinstated the:
  • medical malpractice,
  • wrongful death,
  • conscious pain and suffering, and
  • derivative
  causes of action against Dr. Win.

Even assuming the SEMC defendants met their initial burden on their summary judgment motion, the plaintiff, through expert evidence, raised triable issues as to whether decedent would have had a better chance of recovery had Dr. Win immediately informed Dr. Goldiner of decedent’s condition and the MRI results.

C. Reinstatement of Vicarious Liability Claims Against SEMC

Because the claims against Dr. Win survived, the court held that Supreme Court erred in dismissing:

• The vicarious liability claims against SEMC predicated on Dr. Win’s alleged malpractice.

D. Reinstatement of Certain Direct Liability Claims Against SEMC

On SEMC’s own, direct liability (distinct from vicarious liability), the Appellate Division found that plaintiff’s expert evidence raised triable issues of fact whether SEMC, acting through its nursing staff, deviated from the standard of care by:

1. Failing to ensure that decedent was seen by a neurologist on the day of admission; or
2. Alternatively, failing to inform decedent’s primary care physician that:
   • a neurology consult was not available during the weekend, and
   • the order for a neurological consult could not be honored until three days after admission.

That failure, if proven, could support direct liability against SEMC for departure from accepted hospital and nursing standards of care.

E. Derivative Cause of Action

Because underlying malpractice, wrongful death, and conscious pain and suffering claims survived against the physician and institutional defendants, the court also reinstated the derivative claims against the Goldiner defendants and SEMC defendants.

III. Analysis

A. Precedents Cited and Their Influence

The court’s reasoning is deeply rooted in a line of prior Appellate Division and Court of Appeals decisions governing:

• Summary judgment burdens in medical malpractice cases;
• Sufficiency and quality of expert affidavits;
• Vicarious liability and the effect of exoneration of individual physicians;
• Doctor–patient relationship issues; and
• Causation concepts such as “better chance of recovery.”

1. Summary Judgment Framework and Burden Shifting

The court reiterates the familiar rule from cases like:

• Bubar v Brodman, 177 AD3d 1358 (4th Dept 2019);
• Fargnoli v Warfel, 186 AD3d 1004 (4th Dept 2020);
• Bristol v Bunn, 189 AD3d 2114 (4th Dept 2020).

These cases collectively confirm:

• A defendant moving for summary judgment in a medical malpractice action has the initial burden of establishing:
  • No departure from good and accepted medical practice; or
  • That any departure did not proximately cause the plaintiff’s injury.
• If the defendant meets that burden, the plaintiff must then raise a triable issue of fact, but only as to those elements on which the defendant met its prima facie burden.

In Caruso, the Fourth Department:

• Accepts that the “Goldiner defendants” met their initial burden on both deviation and causation, and that SEMC defendants likewise met (or are assumed to have met) theirs;
• Focuses on whether plaintiff’s expert submissions were legally sufficient to raise triable issues of fact on those same elements.

2. Expert Affidavits and “Battle of the Experts”

The court relies on prior authority such as:

• Cooke v Corning Hosp., 198 AD3d 1382 (4th Dept 2021);
• Thompson v Hall, 191 AD3d 1265 (4th Dept 2021);
• Blendowski v Wiese, 158 AD3d 1284 (4th Dept 2018);
• Occhino v Fan, 151 AD3d 1870 (4th Dept 2017);
• Diaz v New York Downtown Hosp., 99 NY2d 542 (2002).

These cases guide the court in determining when an expert affidavit is:

• Sufficiently detailed, grounded in the record, and non-speculative to create a triable issue of fact; or
• Insufficient because it misstates facts, is conclusory, or is purely speculative.

In Caruso, the court concludes:

• Plaintiff’s expert:
  • Did not misstate the facts in the medical record;
  • Was not vague, conclusory, or speculative within the meaning condemned by Occhino and Diaz;
  • Squarely opposed the defense expert’s conclusions on:
    • When stroke symptoms began; and
    • Whether decedent was still within the window for effective stroke treatment.
• The conflict between the experts created a “classic battle of the experts,” as described in Blendowski v Wiese, which a jury — not the court — must resolve.

This use of precedent underscores that the court is not simply applying a generic “experts disagree” formula. It:

• Scrutinizes whether plaintiff’s expert opinion rests on an accurate view of the record;
• Then, only if the opinion passes that threshold, accepts that an expert conflict creates a triable issue.

3. Vicarious Liability and Exoneration of the Individual Physician

The court cites Behar v Cohen, 21 AD3d 1045 (2d Dept 2005), lv denied 6 NY3d 705 (2006), in connection with two related propositions:

• When an individual physician has been exonerated from malpractice, claims seeking to hold an entity (e.g., medical group or hospital) vicariously liable for that physician’s conduct ordinarily cannot stand.
• Conversely, where the physician is not entitled to summary judgment, vicarious liability claims premised on his/her conduct should not be dismissed at the summary judgment stage.

In Caruso:

• Because claims against Dr. Goldiner (and separately against Dr. Win) survive, the court logically holds that:
  • Vicarious liability claims against SDMG (for Dr. Goldiner’s acts) also survive; and
  • Vicarious liability claims against SEMC (for Dr. Win’s acts) likewise cannot be summarily dismissed.

In short, the court reaffirms the principle that vicarious liability rises or falls with the underlying liability of the agent/employee, at least where the claim is purely derivative of that conduct.

4. Alternative Grounds for Affirmance

The defendants urged an alternative ground to uphold the trial court’s dismissal, relying on:

• Parochial Bus Sys. v Board of Educ. of City of N.Y., 60 NY2d 539 (1983);
• Verdugo v Fox Bldg. Group, Inc., 218 AD3d 1179 (4th Dept 2023);
• Melgar v Melgar, 132 AD3d 1293 (4th Dept 2015).

These cases stand for the proposition that an appellate court may affirm a trial court’s order on a different legal ground than that relied upon below, where the record permits it.

Here, the Goldiner defendants argued that, even if their expert proof did not warrant summary judgment, they should prevail because they had no doctor–patient relationship with the decedent, which would generally be fatal to a malpractice claim. The Fourth Department rejected that attempt, finding that:

• There are questions of fact regarding the doctor–patient relationship that preclude judgment as a matter of law.

5. Doctor–Patient Relationship as a Factual Question

The court cites:

• Rogers v Maloney, 77 AD3d 1427 (4th Dept 2010);
• Croscutt v Aldridge (appeal No. 2), 309 AD2d 1143 (4th Dept 2003).

Those cases emphasize that whether a doctor–patient relationship existed may entail factual questions (e.g., whether a physician was consulted, reviewed records, gave advice, or exercised judgment regarding a particular patient). Such questions generally are not appropriate for summary disposition when disputes exist in the evidentiary record.

In Caruso, applying this precedent, the Appellate Division refuses to definitively rule out a doctor–patient relationship between decedent and Dr. Goldiner on the existing record, thereby preserving that issue for trial.

6. Causation and “Better Chance of Recovery”

Causation is addressed in part through:

• Finnegan v Kasowitz, 239 AD3d 1337 (4th Dept 2025);
• Clune v Moore, 142 AD3d 1330 (4th Dept 2016).

These cases involve the concept that a plaintiff may establish causation in malpractice by showing that a departure deprived the patient of a better chance of recovery or survival – sometimes referred to as a “loss of chance” or diminished survival prospect theory.

In Caruso, this concept is applied to Dr. Win’s alleged inaction. The court notes that plaintiff’s expert raised a factual issue “whether decedent may have had a better chance of recovery had Win immediately informed Goldiner about decedent’s condition and the results of the relevant MRI.”

By citing Finnegan and Clune, the Fourth Department signals continuity: a departure can be actionable if it reduces a patient’s chance for a better outcome, and such causation questions, when disputed by competent experts, are for the jury.

7. Derivative Claims

Finally, the court references:

• O’Mara v Ranalli, 191 AD3d 1494 (4th Dept 2021);
• Ingutti v Rochester Gen. Hosp., 145 AD3d 1423 (4th Dept 2016).

Those cases establish that derivative claims (e.g., for loss of consortium or services) are dependent on the viability of the underlying malpractice claim. When the primary claim is revived or sustained, the derivative claim ordinarily must be revived as well.

Thus, once the Appellate Division reinstated the malpractice, wrongful death, and conscious pain and suffering claims against the physicians and institutions, it also reinstated the derivative cause of action.

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B. The Court’s Legal Reasoning

1. Summary Judgment Against Dr. Goldiner and SDMG

The court’s reasoning on Dr. Goldiner’s and SDMG’s motion proceeds in distinct steps:

1. Initial Burden Met by Defendants.

   The court agrees with Supreme Court that the “Goldiner defendants” initially met their summary judgment burden. Their expert affidavit established:

   • Either no departure from good and accepted medical practice; or
   • No causal link between any departure and decedent’s injuries or death.

   This shifted the burden to plaintiff.

2. Plaintiff’s Expert Creates Genuine Factual Dispute.

   In opposition, plaintiff submitted an expert affidavit that:

   • Identified a different timeline for when stroke symptoms began;
   • Asserted that, at the time Dr. Goldiner was notified of decedent’s condition, decedent was still within the effective time window for certain stroke therapies;
   • Opined that prompt treatment within that window was required under accepted standards of care and that failure to do so constituted a breach and caused harm.

   The court finds this affidavit fact-based, not speculative, and sufficiently detailed to counter defendants’ expert.

3. “Classic Battle of the Experts.”

   As in Blendowski, the experts’ opposing conclusions on:

   • The onset time of the stroke, and
   • The availability and efficacy of treatments at the critical times,

   create a factual dispute. The court characterizes this as a “classic battle of the experts” that cannot be resolved on summary judgment.

4. Doctor–Patient Relationship Cannot Be Rejected as a Matter of Law.

   On the defense’s alternative appellate argument that no doctor–patient relationship existed, the court:

   • Invokes Rogers and Croscutt to note that the creation of such a relationship can involve disputed factual questions;
   • Holds that those questions exist here and must be decided by a factfinder, not on summary judgment.
5. Vicarious Liability of SDMG.

   Because the direct claims against Dr. Goldiner survive, the derivative malpractice, wrongful death, and conscious pain and suffering claims against SDMG—premised on Goldiner’s conduct—also survive. The court explicitly ties this conclusion to the Behar framework.

2. Summary Judgment Against Dr. Win and SEMC (Vicarious Aspect)

As to Dr. Win, the Fourth Department’s logic parallels its analysis of Dr. Goldiner:

1. Assumption of Prima Facie Showing.

   The court assumes, “even assuming, arguendo,” that the SEMC defendants met their initial burden in showing no departure or no causation as to Win.

2. Plaintiff’s Expert on “Better Chance of Recovery.”

   Plaintiff’s expert opined that:

   • Had Dr. Win immediately informed Dr. Goldiner of decedent’s condition and MRI results, decedent would have had a better chance of recovery;
   • The delay reduced that chance, thereby contributing causally to decedent’s eventual outcome.

   In light of Finnegan and Clune, the court treats that diminished likelihood of a better outcome as a cognizable harm whose existence and extent raise triable issues of causation.

3. Vicarious Liability of SEMC for Win’s Conduct.

   Since Win’s alleged malpractice claims survive, and SEMC is alleged to be vicariously liable for Win’s actions, summary judgment in SEMC’s favor on those vicarious claims is improper under Behar. The Appellate Division therefore reinstates the vicarious liability claims against SEMC premised on Win’s treatment (or lack of timely communication) regarding the stroke.

3. Direct Liability of SEMC for Nursing and Systemic Failures

Perhaps the most practically significant aspect of the opinion concerns SEMC’s direct liability. The plaintiff contended that SEMC, through its nursing staff and systemic operations, failed to:

• Ensure timely neurological consultation when a stroke was suspected or ordered;
• Notify decedent’s primary care physician that a neurology consult was unavailable over the weekend, and that the consult order would be delayed three days.

The court concludes:

• Even assuming SEMC’s initial showing of no deviation/no causation, plaintiff’s expert created triable issues by explaining that:
  • Accepted standards required that decedent receive a neurology consult on the day of admission given the suspected stroke; or, at the least,
  • Required the hospital’s nursing staff to inform the ordering physician when a consult was impossible over the weekend and would be delayed.
• Failure to comply with those standards could constitute a departure from the accepted standard of care attributable directly to SEMC.

This aspect of the ruling underscores that hospitals may be liable not only for the malpractice of individual physicians, but also for:

• How they organize services;
• How nursing staff respond to specialist orders;
• How they handle staffing and availability during weekends or off-hours; and
• How they communicate the unavailability of vital consults to ordering physicians.

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C. Impact and Future Significance

1. Reinforcing the High Bar for Defendants at Summary Judgment in Med Mal Cases

This decision reinforces the reality that, in New York:

• Defendants often face a difficult path to obtaining summary judgment in contested medical malpractice cases, especially where timing, treatment windows, and causation are fact-intensive and hotly disputed;
• When a plaintiff presents a well-supported expert affidavit that directly addresses the defense expert’s points, courts are inclined to let a jury weigh credibility and resolve technical medical disputes.

Going forward, defense counsel seeking summary judgment must:

• Provide expert affidavits tightly aligned with the record;
• Be prepared that a plaintiff’s credible, record-based counter-opinion will often be sufficient to defeat summary judgment, creating a “battle of the experts.”

2. Hospital Duty Regarding Specialist Consultations and Off-Hours Coverage

The decision also sends a strong message to hospitals:

• When a physician orders a critical specialist consult (here, neurology for a stroke), nursing and administrative systems must:
  • Either secure that consult promptly; or
  • If that is impossible (e.g., weekend unavailability), communicate that limitation back to the ordering physician so that alternatives can be considered.
• A hospital may be held directly liable for:
  • Organizational or staffing policies that delay consults; and
  • Nursing-level failures to follow up on ordered consults or to inform physicians that orders cannot be timely executed.

Given that stroke treatment is time-sensitive and the opinion explicitly references the “period of efficacy” for treatment, hospitals and health systems are on notice that improper weekend or off-hours arrangements may support malpractice claims if they impede timely stroke care.

3. Doctor–Patient Relationship and Informal Involvement

The court’s refusal to summarily reject a doctor–patient relationship between decedent and Dr. Goldiner highlights that:

• Physicians who are consulted, even informally, about a patient’s care or who review imaging, lab results, or provide advice may be found by a factfinder to have established a doctor–patient relationship;
• Attempts to avoid liability solely by characterizing involvement as “curbside consultation” or non-patient-specific can be vulnerable where the facts suggest more direct involvement.

Future litigants can expect more factual exploration, at trial rather than at the summary judgment stage, on:

• What exactly the physician did or knew;
• Whether the physician’s input was relied upon in caring for the patient;
• Whether the physician effectively undertook responsibility for aspects of the patient’s diagnosis or treatment.

4. Continued Acceptance of “Better Chance of Recovery” Causation Theories

By invoking Finnegan and Clune, and by using the language of “better chance of recovery,” the court continues the line of New York cases that accept:

• That a departure from accepted practice can be actionable if it diminished the patient’s chance of a better outcome, even if the plaintiff cannot prove with certainty that the outcome would have been different.

For future cases, this means:

• Plaintiffs can continue to frame causation arguments in “loss of chance” terms, supported by expert testimony quantifying or explaining how timely action could have improved outcomes;
• Defendants should anticipate that causation will often present a jury question where time-sensitive care (e.g., stroke, sepsis, myocardial infarction) is at issue.

5. Systemic Liability and Risk Management

Beyond the specific parties, the opinion has broader institutional implications:

• Hospitals and health systems should review:
  • Weekend and off-hours specialist coverage arrangements;
  • Nursing protocols for specialty consult orders;
  • Communication policies requiring notification to ordering physicians when consults cannot be honored promptly.
• Risk management programs should ensure:
  • Clear documentation of consult requests;
  • Escalation protocols when specialist services are unavailable;
  • Training emphasizing that “we cannot do this consult now” is itself a critical piece of information that must be relayed to the physician.

Failing to implement such systems, particularly for high-risk, time-sensitive conditions like stroke, increases potential exposure to direct institutional liability under Caruso.

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IV. Complex Concepts Simplified

1. Summary Judgment in Medical Malpractice Cases

Summary judgment is a procedure where a party asks the court to decide a case (or part of it) without a trial, arguing that:

• There are no genuine disputes over material facts; and
• The moving party is entitled to judgment as a matter of law.

In medical malpractice cases:

• The defendant-doctor or hospital must first submit expert evidence showing:
  • They followed accepted medical practices; or
  • Even if they fell short, that did not cause the patient’s injury.
• Only after this showing must the plaintiff respond with their own expert, identifying:
  • What the defendants did wrong (departures); and
  • How those departures caused the harm.

If both sides submit competent experts who disagree on important medical questions, courts generally hold that a jury must resolve those questions — summary judgment is then inappropriate.

2. “Battle of the Experts”

A “battle of the experts” occurs when:

• Each side presents qualified medical experts;
• Those experts rely on the same or similar medical records; and
• They give conflicting opinions about crucial issues like:
  • What the standard of care required;
  • Whether it was met; or
  • What caused the patient’s harm.

Under New York law, courts do not weigh who is more believable at the summary judgment stage. Instead, such credibility choices and technical assessments are for a jury at trial.

3. Doctor–Patient Relationship

A doctor–patient relationship is usually required for a medical malpractice claim. It typically exists when:

• A doctor agrees, explicitly or implicitly, to provide medical care or advice to a patient; and
• The patient relies on that medical judgment.

However, the boundaries are sometimes blurry:

• Did the doctor review the patient’s chart or imaging?
• Did the doctor give case-specific advice to another physician treating the patient?
• Was the doctor “on the team” managing the patient, or merely giving general, informal advice not tied to a specific patient?

Those factual questions often cannot be resolved on paper and become matters for a jury to decide, as the Fourth Department held in Caruso.

4. Vicarious Liability

Vicarious liability is a legal doctrine where one party (often an employer or principal) is held responsible for the negligent acts of another (an employee or agent), committed in the scope of their duties.

In Caruso:

• SDMG is alleged to be vicariously liable for Dr. Goldiner’s malpractice; and
• SEMC is alleged to be vicariously liable for Dr. Win’s malpractice.

If a jury finds that the physicians were negligent and caused harm, the employing or affiliating entities can be held liable under this doctrine.

5. Direct vs. Vicarious Hospital Liability

A hospital can face:

• Vicarious liability for its employees’ negligence (e.g., hospital-employed physicians, nurses); and
• Direct liability for its own policies, staffing decisions, and systems (e.g., scheduling, oversight, protocols).

In Caruso, the direct liability claim against SEMC focuses on:

• Nursing staff’s failure to secure a timely neurology consult; and
• Failure to inform the ordering physician that no weekend consults were available and that the order would be delayed by three days.

That alleged system-level failure is distinct from any negligence by individual doctors.

6. “Better Chance of Recovery” and Loss of Chance

The phrase “better chance of recovery” refers to situations where:

• Even if a patient was very ill and might have had a poor prognosis,
• Timely or proper treatment would still have increased the likelihood of survival or improved outcome.

When malpractice reduces that chance, New York law recognizes that as a viable form of causation. Plaintiffs must present expert testimony explaining:

• What should have been done;
• When it should have been done; and
• How that would have improved the patient’s odds, even if a perfect outcome was never guaranteed.

7. Derivative Claims

A derivative claim is one that a family member (often a spouse) brings for injuries they suffer as a result of the injured patient’s harm, such as:

• Loss of the patient’s services, companionship, or consortium;
• Additional burdens imposed by the injury or death.

If the primary malpractice claim fails, the derivative claim typically fails as well. Conversely, if the primary claim survives (as in Caruso), the derivative claim is likewise preserved for trial.

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V. Conclusion

Caruso v. St. Elizabeth Medical Center is a robust reaffirmation of several key doctrines in New York medical malpractice law:

• It underscores that competent, record-based expert disagreement on critical issues — such as when stroke symptoms began and whether treatment was still possible — creates a “battle of the experts” that must be decided by a jury, not resolved on summary judgment.
• It reinforces that the existence of a doctor–patient relationship is frequently a question of fact, especially where a physician’s involvement in a patient’s care is disputed or indirect.
• It confirms that hospitals may be held directly liable for systemic and nursing-level failures, particularly for:
  • Ensuring timely specialist consults in acute settings like stroke care; and
  • Communicating the unavailability of such consults to ordering physicians.
• It continues New York’s acceptance of “better chance of recovery” causation theories where timely intervention might have improved a patient’s outcome.
• It clarifies that vicarious liability and derivative claims must track the survival of the underlying malpractice actions; if the physician’s liability issues proceed to trial, so do those claims.

As a practical matter, Caruso signals to:

• Physicians: that their involvement in a patient’s course of care — even when indirect or contested — may give rise to triable malpractice claims where expert opinions conflict.
• Hospitals and medical groups: that they must rigorously manage specialist availability, consult orders, and communication practices, particularly during weekends or off-hours, to avoid institutional liability.
• Litigators: that well-prepared, detailed expert affidavits remain central in defeating or securing summary judgment in complex, time-sensitive malpractice cases.

Within the broader legal landscape, Caruso does not radically alter doctrine but meaningfully clarifies and applies established rules to the high-stakes context of delayed stroke diagnosis and treatment, emphasizing the systemic responsibilities of modern hospitals and the evidentiary role of expert testimony at the summary judgment stage.