New York State Court of Claims

New York State Court of Claims

SCHMOHL v. THE STATE OF NEW YORK, #2002-005-015, Claim No. 97660


Synopsis


The practices of the emergency room physicians in examining the laceration of Claimant's finger, even though a partial tear of a tendon was later discovered, was not a deviation of good and accepted medical practice. Claim dismissed.

Case Information

UID:
2002-005-015
Claimant(s):
IN THE MATTER OF THE CLAIM OF ERIC SCHMOHL
Claimant short name:
SCHMOHL
Footnote (claimant name) :

Defendant(s):
THE STATE OF NEW YORK
Footnote (defendant name) :

Third-party claimant(s):

Third-party defendant(s):

Claim number(s):
97660
Motion number(s):

Cross-motion number(s):

Judge:
DONALD J. CORBETT, JR.
Claimant's attorney:
Levine & Grossman, Esqs.By: Janice L. Jessup, Esq.
Defendant's attorney:
Eliot Spitzer, Attorney GeneralBy: Ellen Matowik, Assistant Attorney General
Third-party defendant's attorney:

Signature date:
January 9, 2003
City:
Rochester
Comments:

Official citation:

Appellate results:

See also (multicaptioned case)



Decision


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 Area.

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 documented[1]
the physician stated that the examination normally included flexation and strength tests to determine the status of the flexor tendons.[2] 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 structures." [3]
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 noted."[4]
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."[5]
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."[6]

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 denied 40 NY2d 804), and of course that deviation was a proximate cause of some injury.
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.


January 9, 2003
Rochester, New York

HON. DONALD J. CORBETT, JR.
Judge of the Court of Claims




  1. [1]See Exhibit 1. The physician's notes describe the location of the injury and the absence of any tendon or joint involvement.
  2. [2]See Exhibit 5, EBT of Dr. Snelling, pp 21-24.
  3. [3]See Exhibits 1 and 6.
  4. [4]Exhibit 2.
  5. [5]Exhibit 2.
  6. [6]See Exhibits 3 and 4.