Nassau County Jury Awards $40M in Stroke Malpractice Case

In April 2018, a 45-year-old man living in Farmingdale, New York, experienced a sudden onset of classic stroke symptoms while caring for his young twin sons at home. According to Stuart L. Finz, lead trial attorney at Finz & Finz, he immediately called 911 after unsuccessfully trying to reach his wife, who was attending a class. Emergency medical services from the local fire department arrived promptly and documented stroke-consistent findings, as well as the precise time of symptom onset, in their run sheet.

The patient was transported to St. Joseph Hospital, a Long Island facility within the Catholic Health system. He arrived by ambulance within approximately 45 minutes of symptom onset, placing him squarely within the treatment window for thrombolytic therapy. The lawsuit later alleged that what followed at St. Joseph and, subsequently, at Good Samaritan Hospital constituted a cascade of preventable errors that allowed the stroke to progress untreated, leaving the patient with permanent left-sided hemiparesis and wheelchair dependence.

The case was filed in 2019 in Nassau County Supreme Court under Index No. 616864/2019. Like many complex medical malpractice actions in New York, it was significantly delayed by the COVID-19 pandemic before proceeding to a four-week jury trial in 2025.

Allegations of Stroke Mismanagement

The plaintiff’s theory of liability focused on two critical periods: evaluation at St. Joseph Hospital and subsequent management at Good Samaritan Hospital Medical Center, both operated within the same health system. Emergency medical personnel had recorded an explicit onset time based on the patient’s own report, and that information was transmitted to the triage nurse at St. Joseph in the EMS run sheet.

However, according to the proof presented by Mr. Finz and the Finz & Finz trial team, St. Joseph’s staff disregarded the EMS documentation and instead relied on a “last known normal” time provided by the patient’s wife, who had left the home hours earlier. The hospital allegedly had an internal policy of favoring third-party history over direct patient reporting for stroke timing, even when the patient remained alert, oriented, and communicative—an approach plaintiffs argued was inconsistent with American Heart Association and American Stroke Association guidelines governing acute stroke care.

Using the later “last known normal” time, clinicians concluded that the patient was outside the 4.5-hour window for administration of tissue plasminogen activator (tPA), a clot-busting medication that can substantially reduce long-term disability when administered promptly. As a result, tPA was not offered.

The patient was then transferred to Good Samaritan Hospital for possible mechanical thrombectomy, a catheter-based procedure that removes an ischemic clot and restores cerebral perfusion. Before intervention, Good Samaritan obtained a CT perfusion study to assess the proportion of irreversibly infarcted tissue (“core”) versus salvageable tissue (“penumbra”). Plaintiffs alleged that the interventional neurosurgeon misread the perfusion maps, overestimating the infarcted core at 50% or more, and therefore deemed the patient ineligible for thrombectomy despite arriving within the applicable treatment window.

According to Mr. Finz, expert testimony established that the core volume was closer to 20–25%, leaving substantial brain tissue in the penumbra and making the patient an appropriate candidate for both tPA and mechanical thrombectomy. Instead, he was admitted for monitoring while the stroke completed, resulting in permanent hemiparesis, impaired gait, and dependence for nearly all activities of daily living.

Defense Strategies and Plaintiff’s Rebuttal

Defense counsel advanced several interlocking theories to justify the decision not to treat. One component centered on imaging: the defense argued that CT images suggested an older ischemic process, which they characterized as a prior stroke within days or weeks of the index event. On that premise, they contended that tPA was contraindicated because guidelines discourage thrombolysis in the setting of a recent stroke, given heightened hemorrhagic risk.

The defense also sought to undermine the reliability of the patient’s self-reported onset time by pointing to a later chart entry diagnosing “hemi-neglect,” a condition in which a stroke victim may be unaware of one side of the body. If the patient could not appreciate his left side, the argument went, he could not provide a dependable history of when his deficits began.

The Finz & Finz trial team countered these narratives with detailed medical and documentary evidence. Chart entries described the patient as alert, oriented, and able to communicate clearly with medical staff in the critical early hours. EMS documentation captured a specific onset time contemporaneous with the 911 call. The triage nurse testified regarding the hospital policy not to rely on patient-reported onset times, which plaintiffs argued deviated from national stroke standards.

An interventional neuroradiologist, retained as a key expert, walked the jury through CT perfusion imaging and quantitative thresholds endorsed in the stroke literature—specifically, that a core volume of approximately 55% or less, with remaining penumbra, typically supports thrombectomy candidacy even beyond six hours. According to Mr. Finz, this expert opined that proper interpretation of the perfusion maps would have shown a core in the 20–25% range and should have led to timely endovascular intervention.

In closing argument, plaintiffs characterized the hospital defenses as reverse-engineered from the chart rather than grounded in real-time clinical judgment. As Mr. Finz reportedly told the jury, the defenses were “fabricated” after the fact to justify a course of non-treatment that fell below accepted standard of care.

Jury Verdict and Damages

After approximately four weeks of testimony and deliberations in Nassau County Supreme Court, the jury returned a plaintiff’s verdict against the defendant physicians and both hospitals. The Court’s verdict extract documented the award as a $40+ million verdict, believed to be the 2nd highest medical malpractice verdict in the history of Nassau County and one of the highest medical malpractice awards reported in New York State.

According to the Court’s verdict extract, the jury awarded:

• $10 million for past pain and suffering
• $20 million for future pain and suffering
• $3 million for spousal loss of services
• More than $7 million in life care costs and related future economic damages

The plaintiff, now in his early fifties, has a projected life expectancy of roughly 20 more years, during which he is expected to remain wheelchair-dependent and require assistance for most daily functions. The award is intended to fund comprehensive long-term care, including attendant care, therapies, adaptive equipment, home modifications, and other supports necessary to preserve his quality of life.

Mr. Finz noted that one of the more telling moments during jury deliberations came when jurors requested a readback of the life care planner’s damages testimony, including specific cost figures. For experienced trial lawyers, such a request often signals that the jury is actively working with the plaintiff’s numbers and may be inclined to credit them, particularly in high-value catastrophic injury cases.

Practice Implications for Stroke and ER Malpractice Litigation

This verdict highlights several recurring themes in modern stroke malpractice litigation:

1. Time-of-onset documentation is central. Where symptom onset is disputed, contemporaneous EMS records, patient statements, and electronic call logs can be pivotal. A hospital policy that categorically disfavors patient-reported timing, particularly when the patient is documented as alert and oriented, may be portrayed as inconsistent with national stroke guidelines and local standard-of-care expectations.
2. CT perfusion interpretation carries significant liability risk. As perfusion imaging becomes more routine in stroke centers, misinterpretation of core versus penumbra can expose both hospitals and individual neurosurgeons to claims that a treatable stroke was allowed to progress. Detailed expert testimony on perfusion thresholds and the correlation with functional outcomes is likely to remain a key battleground.
3. Coordinated multi-defendant cases require intensive preparation. Here, multiple physicians and two institutions were named as defendants, each with distinct roles in the chain of care. Finz & Finz’s trial team described months of preparation, including extensive literature review and carefully constructed cross-examinations, to align the medical narrative across disciplines and shift responsibility from unavoidable outcome to preventable harm.
4. Damages presentation must match the medical story. The plaintiff’s attorneys anchored the damages case in a vivid account of the patient’s pre-injury life, family responsibilities, and cultural background, as well as the enduring impact of his disability. Life care planning and economic testimony connected these human losses to specific long-term costs, ultimately supporting an eight-figure award.

From a broader policy standpoint, large verdicts in stroke mismanagement cases may encourage hospitals to reevaluate internal protocols, particularly around stroke triage, time-of-onset assessment, and imaging practices. Catholic Health and similarly situated systems may face increased pressure to align their stroke pathways with evolving evidence and national guidelines, both to improve patient outcomes and to mitigate litigation risk

Impact of Expert Institute’s Expert Search

Mr. Finz, lead trial attorney at Finz & Finz, emphasized that Expert Institute’s Expert Search was critical in locating the interventional neuroradiologist who helped anchor the liability case. The expert is an actively practicing proceduralist at a major stroke center who routinely performs mechanical thrombectomies, sometimes several in a single day. Mr. Finz stated he was “excellent” and someone he “would highly recommend,” noting that the doctor balances a demanding clinical schedule with careful, case-specific preparation.

At trial, this expert walked the jury through CT perfusion imaging, explained the difference between core and penumbra, and dismantled the defense theory that the scans showed an older stroke that contraindicated treatment. He testified that the true core volume was closer to 20–25%, placing the patient squarely within accepted thresholds for both tPA and mechanical thrombectomy. That combination of up-to-the-minute procedural experience and clear, confident communication to the jury was a key factor in demonstrating that the failure to treat fell below the standard of care.

Case Details

Case Name: CHARLEMAGNE HOBOUR et al. v. ERNST J. PAUL M.D. et al.
Court: Supreme Court of the State of New York, County of Nassau
Case Number: 616864/2019

Plaintiff’s Firm: Finz & Finz, P.C.
Plaintiff’s Trial Team:

• Stuart L. Finz
• CaraMia R. Hart
• Brandon S. Finz