Wright v. Stephens: Post-Death Appeal Jurisdiction and the “Loss-of-Chance” Standard Re-Aligned

Introduction

On 6 June 2025 the Appellate Division, Fourth Department, issued its decision in Wright v. Stephens (2025 NY Slip Op 03416). The case arises out of a 2013 medical-malpractice and wrongful-death claim by the estate of Ernest H. Ramsey against multiple medical defendants, including Physician Assistant Vicky K. Stephens and Delphi Healthcare, PLLC (“Delphi defendants”), and Jones Memorial Hospital and related nursing personnel (“JMH defendants”). After a second jury trial ended with a defense verdict, the Ramsey estate appealed, joined (improperly, as it turned out) by the estate of Sandra Ramsey (the decedent’s wife, who had died post-verdict).

The Fourth Department reversed, reinstated all claims on behalf of the Ramsey estate, and ordered a new trial. In doing so the court created a multifaceted precedent that touches:

Appellate jurisdiction where a party dies before filing a notice of appeal;
The scope of vicarious liability evidence against hospitals for conduct of unnamed employees;
Admissibility of electronic medical record (“EMR”) audit-trail testimony;
The correct jury instruction for “loss-of-chance” causation in medical-malpractice cases.

Summary of the Judgment

1. Jurisdiction: The court dismissed the appeal as to Sandra Ramsey’s estate because her death preceded the notices of appeal and no valid substitution occurred before those notices were filed. An attorney’s authority terminates upon the client’s death; therefore the notices were nullities.

2. Reversal on Merits: As to Ernest Ramsey’s estate, the judgment was reversed and a new trial granted because:

The trial court erroneously limited evidence of JMH’s vicarious liability only to named personnel, contrary to Braxton v. Erie Cty. Med. Ctr.;
The court wrongly excluded expert testimony on the EMR audit trail that would have clarified the timeline of care and potential delay in treatment;
The jury received an incorrect “loss-of-chance” charge that required proof of a “substantial probability” rather than a “substantial possibility,” conflating traditional causation with the relaxed loss-of-chance standard;
The plaintiff’s EMTALA claim was properly dismissed because the statute addresses patient dumping, not negligent treatment once care has begun.

Analysis

Precedents Cited and Their Influence

Henry v. New Jersey Transit Corp., 39 NY3d 361 (2023) – reaffirmed that subject-matter jurisdiction is lost upon a party’s death until substitution;
Aurora Bank FSB v. Albright, 137 AD3d 1177 (2d Dept 2016) and Vapnersh v. Tabak, 131 AD3d 472 (2d Dept 2015) – cited for the rule that an attorney’s authority ceases on the client’s death and any appeal filed thereafter is void;
Braxton v. Erie County Medical Center Corp., 208 AD3d 1038 (4th Dept 2022) – established that a plaintiff may prove hospital liability through the negligence of unnamed staff; directly controlling on the evidentiary error;
Vargas v. Lee, 170 AD3d 1073 (2d Dept 2019) – permitted discovery of EMR audit trails when there is a legitimate question of chart alteration; used to justify admissibility of such proof at trial;
“Loss-of-chance trilogy”: Wild v. Catholic Health Sys., 85 AD3d 1715 (4th Dept 2011); Clune v. Moore, 142 AD3d 1330 (4th Dept 2016); Leberman v. Glick, 207 AD3d 1203 (4th Dept 2022) – together they hold that a plaintiff need show only a “substantial possibility” of a better outcome; the trial court’s charge deviated from this settled line.

Legal Reasoning

1. Post-Death Appeals and Jurisdiction

The appellate panel relied on the hornbook principle that a notice of appeal is jurisdictional: if it is a nullity when filed, it cannot be salvaged later. Because Sandra Ramsey died months before the notices were filed, the attorney had no authority to act; the later order of substitution could not retroactively validate the appeal.

2. Vicarious Liability Evidence

Drawing from Braxton, the panel stressed that a hospital’s duty of care extends through all of its staff and contractors, identified or not. Limiting evidence to named individuals artificially shields the institution from liability and undermines the agency principles that underlie hospital accountability. By excluding such evidence the trial court deprived the jury of a complete factual record, necessitating reversal.

3. EMR Audit-Trail Expert Testimony

The court distinguished between (a) testimony aimed at proving fraud (which had not been pleaded) and (b) testimony that simply reconstructs the timeline of care — a critical element in delay-in-treatment cases. The latter is squarely relevant and within the scope of permissible expert analysis. The exclusion therefore constituted an abuse of discretion.

4. “Loss-of-Chance” Charge

New York recognizes “loss of chance” as a distinct causation doctrine in medical negligence. The proper inquiry is whether a departure from the standard of care deprived the patient of a substantial possibility of a better outcome, not whether it was more probable than not that the patient would have survived. By injecting “substantial probability” and “substantial factor” language, the trial court reverted to the traditional greater-than-50% standard rejected in the cited Fourth-Department cases, thereby confusing the jury and warranting a new trial.

5. EMTALA Directed Verdict

Consistent with Second Circuit and prior Fourth-Department precedent, EMTALA addresses outright refusal to screen or stabilize uninsured patients, not negligent care thereafter. Because Ernest Ramsey was triaged and treated, the EMTALA claim fell outside statutory coverage, and dismissal was affirmed.

Impact of the Judgment

Jurisdictional Clarity: Appellate practitioners must ensure substitution precedes any notice of appeal if the client dies; otherwise the appeal is void. Courts are likely to invoke this decision in future sua sponte dismissals.
Hospital Liability Evidence: Trial courts statewide will face difficulty limiting vicarious-liability evidence to identified staff. Plaintiffs may now rely more heavily on institutional policies and generalized proof of systemic negligence.
EMR Audit Trails: The decision strengthens plaintiffs’ ability to introduce audit-trail experts to show chronology and chart alterations, an area of growing importance as health records move fully electronic.
Loss-of-Chance Standard: The opinion harmonizes the Fourth Department’s line of cases with the new 2023 PJI §2:150 et seq., and will influence trial courts to adopt the “substantial possibility” language henceforth.

Complex Concepts Simplified

Notice of Appeal: A document that triggers the appellate court’s power to review. If it is invalid when filed, the appeal cannot proceed.
Substitution (CPLR §1021): Formal replacement of a deceased party with the estate representative. Without substitution, the court loses jurisdiction.
Vicarious Liability: Legal responsibility of an employer (e.g., a hospital) for the acts of its employees or agents, whether or not they are named defendants.
EMR Audit Trail: An electronic log automatically generated by hospital software showing who accessed a patient’s chart, when, and what changes were made — like a “black box” for health records.
Loss-of-Chance Doctrine: In medical negligence, recovery is allowed when malpractice reduces a patient’s chance of survival or better outcome, even if full survival was statistically unlikely.
EMTALA: A federal statute preventing hospitals from refusing to screen or stabilize emergency patients for financial reasons; not a substitute for state malpractice claims.

Conclusion

Wright v. Stephens is a significant Fourth-Department decision that simultaneously clarifies procedural, evidentiary, and substantive aspects of New York medical-malpractice litigation. Procedurally, it underscores that a dead client cannot appeal without prior substitution. Evidentially, it opens the door to broader proof of hospital negligence through unnamed actors and technical EMR data. Substantively, it realigns jury instructions with the true “loss-of-chance” standard, safeguarding plaintiffs from an unduly high causation burden. Collectively these holdings will reverberate through trial strategy, motion practice, and appellate procedure in New York for years to come.