Storrs — Three judges from the state Appellate Court heard arguments Tuesday in the case of Jill M. Procaccini, whose survivors won $512,000 in a wrongful death lawsuit against Lawrence + Memorial Hospital emergency room doctors after she died of a methadone overdose in 2008 within hours of being treated for an overdose and released from the hospital.

At issue is whether Procaccini, a 32-year-old who battled addiction for years, succumbed to a second, fatal overdose from the same dose of methadone after the effects of the opioid antidote Narcan wore off, or whether she ingested more methadone after leaving the New London hospital. Methadone stays in the system longer than heroin and other opiates.

Appellate Judges Eliot D. Prescott, Raheem L. Mullins and Robert E. Beach Jr., who usually hear cases in Hartford, traveled to the University of Connecticut and held court in the Rome Ballroom as part of the court's annual "On Circuit" program to provide students and the public a better understanding of the appellate process.

Students in UConn's special law program and business law classes offered mixed opinions on the case after attorneys from both sides delivered 20-minute arguments and answered questions from the three-judge panel. The judges are expected to issue a decision within a few months.

Procaccini, 32, who struggled for years with cocaine and heroin addiction, overdosed at a friend's home in New London on Nov. 28, 2008, according to court records. New London firefighters and hospital paramedics found her near death about 7 p.m. and revived her with Narcan, the antidote to an opioid overdose. She was taken to L+M, where she admitted using methadone. She was monitored in the emergency room and released at 11:45 p.m. The hospital tested her urine, which was positive for both heroin and methadone. 

Anxious to leave the hospital, Procaccini was able to walk out on her own and return home with her friend, Charles Hope. Sober himself for several years at that point and trying to help Procaccini get straight, Hope had testified at the trial in Superior Court in July 2015 that she seemed fine when he left her in a guest bedroom, watching TV, and went to sleep at 1:30 a.m. She was dead, in the same position in which Hope had last seen her, when he checked on her about 10:30 the next morning.

Attorney Daniel J. Krisch of the Halloran & Sage Law firm, representing the L+M doctors, argued Tuesday that Procaccini's estate had not proved at the trial that the emergency room doctor who treated her caused her death by failing to admit her to the hospital for 24 hours. Though the effect of Narcan, or naloxone, wears off after 90 minutes, Procaccini had been in the hospital for three hours after receiving the antidote, and her medical record showed her vital signs had improved, Krisch said.

Though methadone stays in the system for up to a day, and patients can "renarcitize" after the Narcan wears off and go into respiratory failure, no expert had testified at the trial that Procaccini had suffered from a delayed onset of respiratory depression, Krisch argued. The state Office of the Chief Medical Examiner ruled the cause of death was methadone toxicity.

"Was there evidence that the effects of opioids would immediately resurface after the Narcan wears off?" asked Judge Prescott.

"Yes," Krisch responded.

Attorney Matthew E. Auger of the Suisman Shapiro law firm argued that he had elicited testimony at the trial from Dr. Eric Schwam, an expert on the standard of care, who said the hospital's failure to admit Procaccino for 24 hours after detecting a methadone overdose was a deviation from the standard of care.

"He talked about decades of experience that have shown that if you discharge a patient after overdosing on a long-acting opioid, in most cases the patient will be dead the next day," Auger said.

Auger referenced the Food & Drug Administration warning that the respiratory depressant effect from methadone occurs later and lasts longer than its analgesic, or pain-relieving, effects. 

Krisch argued that the plaintiffs also failed to present evidence about Procaccini's life expectancy, which is the normal procedure in a wrongful death lawsuit. The jury had awarded her estate $150,000 in damages to compensate for Procaccini's loss of her capacity to enjoy life's activities, having heard testimony about things she enjoyed in life, including traveling and spending time with her niece and nephew, according to the court record.

k.florin@theday.com