Claimant alleges that he suffered personal injury as the result of the
departure of good and acceptable medical practice of the University Hospital at
Stony Brook, and its emergency room physicians, in failing to afford proper and
adequate treatment of a laceration of Claimant's left third finger, by failing
to diagnose and properly treat a laceration of the flexor tendon.
The trial was bifurcated and this decision addresses only the issues of the
putative liability of the Defendant.
On January 19, 1997, Claimant Eric Schmohl was working at his part-time job as
a bus boy in a local Long Island restaurant when the third or middle finger of
his dominant left hand was cut on a piece of broken glass. He was seventeen
years old and was then attending high school. Claimant was taken to the New
York State University Hospital at Stony Brook (UHSB) and entered the Emergency
Department where he was triaged and assigned to the Urgent Care Fast Track
An emergency room physician examined his laceration and, because Claimant was a
minor, then telephoned his mother to obtain permission to treat his injury. The
physician was an employee of the State of New York, and the Defendant's
liability is premised upon the alleged medical malpractice of the UHSB Emergency
Department and its physicians. A history was obtained, a physical exam of the
injured finger was performed, and then the laceration was sutured. Although not
the physician stated that the examination normally included flexation and
strength tests to determine the status of the flexor
Multiple x-rays were taken with the
report that "[n]o evidence of fracture or dislocation is noted [and] there is
also no evidence of radiopaque foreign body seen," and with the impression that
there was "[n]o evidence of radiopaque foreign body or injury to the osseous
Claimant denies that any flexation or strength test was performed. He was told
to return in ten days to have the sutures removed. However, he returned the
next day, January 20, 1997, the dressing was changed and a tetanus injection was
administered. On January 30, 1997, the sutures were removed.
Claimant continued to experience stiffness, pain and the inability to flex his
injured finger and, as a result of these symptoms, consulted another physician
(Dr. Sampson) in March 1997, who opined that the flexor tendon was damaged.
Claimant then consulted another physician, Dr. Nabil Kiridly, in April 1997, for
a second opinion. Dr. Kiridly concurred with the diagnosis of flexor tendon
damage. His consultation report notes: "Palpation of the middle finger showed
nodular mass within the flexor tendon in the area of the laceration. Mass is
moving with the tendon, tenderness in the area of the mass
His assessment was: "Nodular mass to the flexor tendon of the left middle finger
with weakness and pain. Most likely the mass is due to incomplete laceration of
the flexor tendon. Extent of tendon injury and healing cannot be evaluated at
the present time."
Claimant then consulted with Dr. M. Ather Mirza, who also concurred with the
prior diagnoses of the consulting physicians. Dr. Mirza first recommended a
conservative course of physical therapy. When there was no improvement he
performed corrective surgery on May 5, 1998. His report of the operation
records that "thre [sic] was found to be formation of scar in the area of the
flexor profundus as if some foreign body had lodged within the ulnar side of the
flexor profundus fairly distal to the proximal interphalangeal joint," but
concluded "no foreign body [was] found."
At trial Claimant's expert physician, Dr. Eric Muñoz, testified that the
treatment that Claimant received from the emergency room facility of the UHSB
and Dr. Snelling did deviate from good and accepted medical practice. He opined
that although the emergency room records indicated that the tendons were intact
and normal, that finding was not consistent with the later findings by Dr.
Muñoz that the tendon had been partially lacerated and not repaired, and
that a scar or adhesion had formed which impeded movement of that finger. Hence
Claimant's expert finds the failure to diagnose and the failure to treat the
partial laceration of the tendon in the emergency room were a deviation from
accepted medical standards.
In contrast, Defendant's expert physician, Dr. Salvatore R. Lenzo, testified
that the treatment received by Claimant at the UHSB emergency room was not a
departure from good and accepted medical practice. He reviewed the emergency
room records which state: "17 year old male cut hand on glass at work within one
hour. . . . [no] sensory, [no] motor complaints," and further note that the
tendon joints were intact and that "ROM WNL," to wit, that the range of motion
was within normal limits (Exhibit 1).
Dr. Lenzo reviewed the surgery report of Dr. Mirza and opined that the tendon
had been partially torn by the broken glass, but that the tear was so
sufficiently minor that it continued to function. At surgery, Dr. Mirza found
an adhesion on the flexor profundus tendon and he then removed the adhesion from
the tendon and applied sutures.
I find that Claimant suffered a partial laceration resulting from the glass
cut. Scar tissue (adhesion) thereafter naturally formed at the site of the
laceration and there was no undiscovered foreign body which remained in the
finger and which caused or contributed to the laceration of the tendon. The
findings by the emergency room physician were based on a normal range of motion
and a lack of sensory and motor complaints. I credit the Defendant's expert who
opined that the corrective surgery by Dr. Mirza, in utilizing an "# 8-0 nylon
suture" after the adhesion was removed to repair the tendon, indicated a minor
partial laceration. At the emergency room level of treatment, and absent a
total laceration of the tendon, with a normal range of motion, the proper course
of emergency room treatment is to close the wound and refer the patient to a
hand clinic or hand surgeon. I found persuasive Defendant's expert's opinion
that the partial tear was so minor that very fine suturing material (# 8-0
nylon) was thereafter utilized to repair the tear, and that had the tear been
more severe a wider or stronger suture of say # 5-0 nylon would have been
required. He thus opined that, given what he concluded to have been a minor
partial tear, Claimant might well have demonstrated a normal range of motion
when such test was given by the emergency room physician.
Claimant predicates liability on the failure of the emergency room physicians
to have diagnosed the partial tear of the profundus tendon, and would have me
conclude that the subsequent finding of such partial tear necessarily implies
the failure to have performed the range of motion examination in the emergency
room, and thus a deviation from standard medical care. This is a conclusion
that is not warranted by the evidence before me, and indeed is dispelled by the
persuasive testimony of Defendant's expert.
To be successful in establishing a cause of action sounding in medical
malpractice, a claimant must show the accepted medical standards of care (
Toth v Community Hosp. at Glen Cove
, 22 NY2d 255, 263), that the care and
treatment afforded him by the State constituted a deviation from the applicable
standard of care (Hale v State of New York
, 53 AD2d 1025, lv
40 NY2d 804), and of course that deviation was a proximate cause of
Since I find that the treatment Claimant received at the emergency department
of the University Hospital at Stony Brook and by the physicians employed by the
Defendant did not depart from good and accepted medical standards and the
practice of emergency medicine, Claimant has been unable to establish a
requisite element of medical malpractice.
Accordingly, the claim must be, and hereby is, dismissed. All motions
heretofore undecided are now denied.
Let judgment be entered accordingly.