$6.6M Stroke Malpractice Award Upheld by Appeals Court

The Massachusetts Appeals Court has affirmed a $6.6 million judgment in a medical malpractice case involving the death of Nancy McDonough, who suffered a fatal stroke just days after being switched from one blood-thinning medication to another. The lawsuit, brought by Stephen McDonough on behalf of the decedent’s estate, alleged that Dr. Sayuj Paudel committed medical negligence when he discontinued McDonough’s use of the anticoagulant Lovenox after it caused kidney issues. Instead of prescribing intravenous Heparin, as the plaintiffs argued was medically appropriate, Paudel ordered the drug to be administered via subcutaneous injection.

The estate claimed that this deviation from standard care was a critical misstep. Nancy McDonough soon suffered a stroke and passed away several days later. A Middlesex County jury rendered a $3.4 million verdict, with $3.2 million in prejudgment interest, bringing the total to $6.6 million. Paudel appealed the ruling, alleging that flawed jury instructions unfairly swayed the trial’s outcome.

The Jury Instructions Dispute

Central to Paudel’s appeal was his challenge to the trial judge’s causation instruction. He contended that the jury was wrongly told that if Paudel’s actions had any “impact” on the patient’s death, the legal standard for causation would be satisfied. According to Paudel, this misstatement effectively replaced the proper “but for” causation standard, under which the plaintiff must prove the harm would not have occurred in the absence of the physician’s negligence.

The three-justice panel rejected this argument, citing the state Supreme Judicial Court’s ruling in Luppold v. Hanlon, a recent decision that addressed similar concerns. “The instruction articulates the fundamentally correct legal principle of ‘but for’ causation and forecloses the arguments raised by the defendants here,” the panel wrote.

The court also noted that although jurors raised a clarification question during deliberations, the judge responded appropriately. The clarification, to which neither party objected, reinforced that the passage in question referred solely to “but for” causation. As the panel explained, “The judge conveyed [that] with careful examination of its text,” the jury would be able to interpret the instruction correctly.

Prejudgment Interest and Pandemic Delays

Paudel’s counsel also argued that the trial delay, which pushed proceedings into January 2024, unfairly inflated the prejudgment interest award. They pointed to disruptions caused by COVID-19 as the reason for the postponement. However, the panel found no merit in that claim.

According to the court, the original trial date was scheduled for September 2021—well after the initial wave of pandemic-related restrictions but before Massachusetts’s high court issued emergency COVID directives. Moreover, the panel highlighted that by the time the trial was actually held, there were “no longer any COVID-related restrictions on jury trials in effect.” As the panel summarized, “The defendants have pointed to no evidence that COVID had anything to do with the further extension.”

Attorney Response to the Ruling

Attorney Bill Thompson, representing McDonough and the decedent’s estate, said he was unsurprised by the outcome. “We believed from the beginning the appeal lacked merit and would be unsuccessful,” Thompson told Law360. “Today's decision validated our view.” Counsel for Paudel did not comment on the ruling at the time of publication.

The Law Firms Involved

Stephen McDonough is represented by Lubin & Meyer PC, with attorneys William J. Thompson, Andrew C. Meyer Jr., Julie A. Davis, Adam R. Satin, and Peter Ghattas participating in the case. Dr. Sayuj Paudel is represented by Bruce & Kelly PC, through attorneys John D. Bruce and Susan E. Johnson Bowen.

What’s Next?

While the appeals court decision leaves the $6.6 million award intact, Dr. Paudel could still attempt to seek further review by the Massachusetts Supreme Judicial Court. However, the appellate panel’s reliance on a recent, high-court precedent significantly weakens the likelihood of a reversal. For now, the affirmed award adds another data point in Massachusetts’s evolving landscape of medical malpractice litigation, particularly surrounding stroke mismanagement and anticoagulation therapy.