As a demonstration of Bells Up AI's legal workflows, we have created a simulation of oral argument in SanMiguel v. Grimaldi, a real case argued in 2025 before the New York State Court of Appeals.
In this demonstration, you have the opportunity to argue first as counsel for the Appellant, and then as counsel for the Respondent. There are three judges on this demonstration panel, each run by a different AI agent, engineered to adopt the judge's personality on the bench and perspectives on the law and facts.
You can ask for substantive help at any time by clicking Ask For Help, which will send the argument so far to a separate AI model that has the briefs and relevant case law in its prompt. When you're finished, click Conclude Argument to see how the judicial agents regarded your argument.
Judges in oral argument are impatient. They will not respond well to long-winded submissions. Keep it brief.
On July 3, 2012, Veronica SanMiguel was admitted to St. Barnabas Hospital at 41 weeks gestation. Labor lasted over 42 hours. She requested a cesarean section at least three times; each request was denied by Dr. Meryl Grimaldi. Without obtaining SanMiguel's informed consent, Dr. Grimaldi attempted vacuum extraction twice — both attempts failed. An emergency C-section was finally performed. The consent form SanMiguel had signed authorized “obstetrical care including vaginal delivery... and possible operative or cesarean delivery.” The words “vacuum” and “extractor” never appeared. Dr. Grimaldi testified that her practice was to explain procedures “as I'm doing things” — during active labor.
SanMiguel's son, Keegan Dayle Karp, was born with no heartbeat. He was resuscitated — intubated, given chest compressions — and placed on a ventilator. He was transferred to Montefiore Medical Center for brain cooling. He was never responsive. The neonatal physician told the parents the child would likely need life support for the rest of his life. On the eighth day, life support was withdrawn. He died. Cause of death: perinatal anoxic/ischemic encephalopathy — oxygen deprivation during birth.
SanMiguel was involuntarily committed to Bellevue Hospital's psychiatric ward for five days. She was diagnosed with PTSD, major depressive disorder, and anxiety. She suffered physical manifestations including hives and rashes triggered by stress. She was placed on Klonopin and remains on it years later. She could not return to work or socialize. The sight of children, even in photographs, caused acute distress. Her testimony: “It reminds me of my child, and what I could have had, and what I am missing out on... on being a mother.”
New York has a long-standing rule, established in Sheppard-Mobley v. King (2005), that bars a mother from recovering emotional distress damages in a medical malpractice case when her child is born alive and she suffers no independent physical injury. The theory behind the rule is that the child's own estate can sue for the child's injuries, so the mother's emotional damages claim is unnecessary — a “gap-filling” measure is only needed when the child is stillborn (under Broadnax v. Gonzalez, 2004) and no other claim exists.
SanMiguel conceded that Sheppard-Mobley barred her ordinary malpractice claim. But she argued that her lack-of-informed-consent claim was different — it was about what was done to her body without her permission, not merely about what happened to her child. The First Department agreed (4-1), holding that informed consent “implicates the prospective mother's active role as decision-maker for herself and on behalf of her fetus.” The First Department also invited the Court of Appeals to reconsider Sheppard-Mobley itself.
Two questions reached the Court of Appeals:
Dr. Grimaldi's briefs argued that informed consent is legally a subspecies of malpractice — citing the statutory text of Public Health Law section 2805-d (titled “Limitation of medical malpractice action based on lack of informed consent”) and a line of Court of Appeals decisions treating informed consent as a malpractice cause of action. On stare decisis, Grimaldi relied on Grady v. Chenango Valley (2023), which requires “compelling justification” to overrule precedent, not merely a belief that “it's time.” Grimaldi invoked Howard v. Lecher (1977) — where the Court described a hypothetical nearly identical to SanMiguel's facts and said “it is clear that there could be no recovery” — as direct precedent. The reply brief argued that New York is actually in the majority of states (33 of 50) that do not permit this recovery, that New York already has the highest malpractice payouts and premiums in the nation, and that Governor Hochul's third veto of the Grieving Families Act in December 2024 made judicial intervention even less appropriate.
St. Barnabas Hospital's briefs took a more institutional approach. The opening brief presented a century-long doctrinal survey from Drobner v. Peters (1921) through Sheppard-Mobley, arguing that New York's common law has consistently limited — not expanded — emotional damages in medical contexts. The brief deployed Howard v. Lecher as near-direct precedent and argued that PHL section 2805-d was enacted specifically to limit physician liability, not to create a new avenue for emotional damages. The reply brief introduced Governor Hochul's December 2024 veto as new authority and framed SanMiguel's informed consent theory as “an end-run around settled law” — the same physician, the same procedure, the same injury, just a different label. St. Barnabas also raised a case the plaintiff had conspicuously omitted: Trombetta v. Conkling (1993), which declined to extend emotional distress recovery to a niece to prevent “unmanageable proliferation” of claims.
SanMiguel's main brief presented arguments in escalating order of breadth. The narrowest: Sheppard-Mobley never addressed informed consent — the plaintiff in that case had stipulated to withdraw her informed consent claim before appeal, so the Court of Appeals never analyzed it. Applying Sheppard-Mobley here would extend it to a cause of action it did not reach. The brief grounded the informed consent distinction in bodily autonomy, citing Cardozo's foundational principle in Schloendorff v. Society of New York Hospital (1914): every person has the right to determine what shall be done with their own body. SanMiguel was the patient; the vacuum extraction was performed on her body; she was the only person who could legally consent. She was not a bystander to someone else's injury — she was the patient from whom consent was required and withheld. On overruling Sheppard-Mobley, the brief walked through a century of this Court correcting its own mistakes on emotional damages — Drobner overruled by Woods, the physical-impact rule eliminated by Battalla, Tebbutt overruled by Broadnax — and argued that Sheppard-Mobley is the next mistake in line.
SanMiguel's amici response brief attacked the defense amici's out-of-record evidence as inadmissible hearsay and introduced the only judicially noticeable data in the case: medical malpractice filings in New York City had declined 12% from 2018 to 2024, directly contradicting the claim that liability exposure was rising. The brief also disclosed that St. Barnabas Hospital held a “D” patient safety grade from the Leapfrog Group — reframing the liability discussion from “systemic overreach” to “institutional accountability.” On the hospital industry's cost arguments, the brief noted that HANYS's own February 2025 state budget testimony identified four drivers of hospital fiscal distress and did not include malpractice costs among them.
Five organizations filed amicus briefs — three supporting the defense, two supporting SanMiguel.
The Medical Society of the State of New York (MSSNY) and the American Medical Association (AMA) filed the most empirically dense brief in the case. Their argument was entirely about systemic consequences: New York had $550 million in malpractice payouts in 2024, the highest in the nation. OB/GYN premiums in Nassau and Suffolk Counties averaged $171,672 annually — more than triple the rate in Los Angeles. Nearly 75% of OB/GYNs over 55 had been named as defendants. Expanding emotional damages, they argued, would accelerate physician attrition and worsen access to obstetric care, particularly in underserved communities.
The Greater New York Hospital Association (GNYHA) and the Healthcare Association of New York State (HANYS) argued from the hospital perspective. New York accounts for more than 20% of all U.S. obstetrics-related malpractice payments. Only 3,419 OB/GYNs are active in the state. Three New York counties are already classified as maternity care deserts. Both organizations had also filed amicus briefs in the original Sheppard-Mobley case. Their strongest argument was institutional: the Governor vetoed the Grieving Families Act three times on explicit healthcare-cost grounds, making judicial expansion of the same damages the Governor rejected a separation-of-powers problem.
The Defense Association of New York (DANY) filed the most doctrinally detailed defense amicus. Rather than relying on policy, DANY argued that the Legislature itself foreclosed the Appellate Division's reasoning in 1975 when it enacted PHL section 2805-d. That statute deliberately replaced the pre-existing battery/bodily-autonomy model of informed consent with an objective negligence standard, merging informed consent into the malpractice framework as a matter of legislative command. The Appellate Division's autonomy-based distinction, DANY argued, rested on a legal framework the Legislature had specifically eliminated fifty years ago.
The New York State Academy of Trial Lawyers (NYSATL) argued that Sheppard-Mobley's own text explicitly preserved the mother's informed consent claim — meaning the defendants were seeking an expansion of Sheppard-Mobley beyond its holding, not its routine application. NYSATL highlighted the “brain-dead at birth” problem: courts had applied Sheppard-Mobley to bar maternal recovery even where the child was clinically dead at delivery with no conscious experience, making the child's “independent remedy” entirely fictional. They cited the Connecticut Supreme Court's 2023 decision in Escobar-Santana v. State, which identified New York as a national outlier.
The New York State Trial Lawyers Association (NYSTLA) filed the most historically ambitious brief, situating the case within New York's broader wrongful death framework. New York still operates under the Lord Campbell's Act model — purely pecuniary loss — making it one of only two states (with Alabama) that do not permit recovery for grief or loss of companionship in wrongful death actions. For an infant with no earnings history and no dependents, wrongful death recovery approaches zero. NYSTLA argued that the zone-of-danger inconsistency was dispositive: after Greene v. Esplanade (2021), a grandmother standing near a car accident can recover for watching her grandchild's injury, but the mother — the patient in whose body the tort occurred — cannot recover at all.
Oral argument was active and contentious. Virtually no portion of any advocate's presentation proceeded without judicial interruption.
The appellants' arguments (Charles Bach for Dr. Grimaldi; James Catterson for St. Barnabas) focused on statutory text and stare decisis. Bach argued that PHL section 2805-d makes informed consent a subspecies of malpractice, foreclosing any distinction. He was immediately challenged by Judge Rivera, who pressed him on why an informed consent claim — which turns on whether the patient was told the risks and given a choice — is the same as a malpractice claim, which turns on whether the doctor departed from accepted practice. Judge Halligan posed a hypothetical that exposed the distinction: a physician performs a procedure flawlessly but fails to warn of a risk of infection. The patient gets infected. That is an informed consent claim with no malpractice. Bach conceded the hypothetical but maintained that the damages analysis must be the same.
The most significant exchange during the defense arguments came from Chief Judge Wilson, who pressed both defense counsel with the same question: “Would it be possible to retain Sheppard-Mobley and say this is closer to being stillborn, living for eight days, than living many, many years?” Neither defense counsel gave a satisfying answer. Catterson's response was the slippery slope: “Is it thirty seconds? Is it twenty minutes? Is it one day?” He then quoted the defense's strongest language — from Tebbutt: “Ideally, there should be a remedy for every wrong. This is not the function of the law, however.”
Judge Garcia delivered the clearest articulation of the remedial gap: the child's conscious pain and suffering and the mother's emotional distress are “completely different types of damages.” Judge Cannataro agreed — the cases where they would be comparable are “exceedingly rare.” These concessions from two majority judges acknowledged the core injustice of the rule, even as both ultimately voted to maintain it.
SanMiguel's argument (Annette Hasapidis) had strong moments and pivotal stumbles. Hasapidis was most effective when she cited Mendez v. Bhattacharya (2007), where then-Judge Renwick (now the Chief Justice of the First Department) had distinguished Sheppard-Mobley on the ground that the infant had no consciousness — holding that “Broadnax's considerations apply in this case because this child was never conscious.” She was also effective when she told Judge Troutman that the existing rule “discriminates only against women in childbirth.”
The pivotal stumble came when Judge Cannataro asked where the new line would be drawn. Hasapidis answered: “That is for a jury to decide based on the evidence before it.” Cannataro pressed: “For a jury to decide? ... But we decided this question as a matter of law.” The exchange continued through several rounds, with Cannataro asking more pointedly each time how long the mother's claim lasts — a week? a year? five years? — and Hasapidis unable to give him a specific limiting principle. This failure to answer the line-drawing question was, in the view of many observers, the moment the majority solidified.
When Chief Judge Wilson offered his “effectively stillborn” theory — an infant immediately placed on life support, never conscious, declared dead upon its withdrawal, is effectively born dead — Hasapidis accepted it. But the recovery was incomplete; she stumbled when Rivera asked what that theory would mean for the child's own claims, and had to be helped by Cannataro: “If the child is deemed born dead, the child can't have a claim.”
The Court of Appeals reversed, 4-3, dismissing SanMiguel's informed consent claim. The decision was issued on October 21, 2025.
The majority (Judge Singas, writing for Judges Garcia, Cannataro, and Halligan) held on both questions:
On Question 1, the court held that Sheppard-Mobley applies to informed consent claims. Informed consent is not a separate tort but a subspecies of malpractice — as reflected in both statutory text and case law. The distinction in the type of professional duty (duty of care versus duty to inform) does not move the claim outside Sheppard-Mobley's scope. Allowing informed consent to unlock emotional damages the Legislature intended to limit would invert the purpose of PHL section 2805-d.
On Question 2, the court declined to overrule Sheppard-Mobley. Applying the standard from Matter of Brooke S.B., the majority found no “extraordinary combination of factors” undermining the prior decision. The rule had operated cleanly for twenty years. Out-of-state authority largely predated Sheppard-Mobley and reflected no new national trend. The Broadnax asymmetry was “principled” because Broadnax filled a complete immunity gap — where the child is born alive, the estate has an independent cause of action. The majority expressly declined to address whether an infant born without consciousness and surviving only on life support should be treated as equivalent to a stillbirth.
Judge Rivera's dissent (joined by Judge Troutman) called for overruling Sheppard-Mobley outright. Rivera argued that the rule contradicts basic tort principles: the physician owes a duty to the mother as patient, the breach caused her severe emotional harm, and damages must follow. The born-alive/stillborn distinction is arbitrary — identical malpractice, identical grief, identical PTSD, but a different legal result based solely on whether advanced technology kept the infant's heart beating for a few days. Rivera invoked the century-long arc of this Court correcting its own mistakes: Drobner corrected by Woods, the physical-impact rule corrected by Battalla, Tebbutt corrected by Broadnax. She cited the emerging scientific consensus that PTSD produces physical health outcomes — undermining the premise of a clean physical/emotional distinction — and the zone-of-danger inconsistency with Greene v. Esplanade. Rivera wrote that the pregnant mother is “a patient, not a vessel,” and that telling SanMiguel to wait for legislative relief the executive has blocked is an abdication of the Court's common-law function.
Chief Judge Wilson's dissent took a different approach. He would not overrule Sheppard-Mobley, but he would carve out a narrow exception for these facts. Wilson's theory: the animating principle of both Broadnax and Sheppard-Mobley is that emotional damages should lie “where otherwise none would be available.” That principle fails here. SanMiguel's son was likely never conscious — under McDougald v. Garber, no consciousness means no claim for pain and suffering. The wrongful death claim under EPTL 5-4.3 yields near-zero for a newborn with no earnings. The estate's claims are, for practical purposes, worthless. The gap Broadnax was designed to fill exists in this case too. Wilson proposed treating an infant born without consciousness, surviving only by mechanical life support, as legally comparable to a stillbirth. He warned that as neonatal technology advances, the gap between “technically born alive” and “functionally stillborn” will widen — and the rule's injustice will compound. The majority called Wilson's approach “profoundly flawed,” arguing it would delegate to juries the task of defining available legal remedies and could have unexamined consequences for reproductive rights.
The case remains significant as the Court of Appeals' most recent and most closely divided word on maternal emotional damages in the medical malpractice context. The question Wilson's dissent posed — what happens when an infant is born alive only by virtue of technology — was expressly left open by the majority.