Munoz v. N.Y. Presbyterian-Columbia Univ. Med. Ctr.
| Decision Date | 10 April 2023 |
| Docket Number | Index No. 805037/2017,MOTION SEQ. NO. 001 |
| Citation | 2023 NY Slip Op 31317 (U) |
| Parties | ADONIS MUNOZ, Plaintiff, v. NEW YORK PRESBYTERIAN-COLUMBIA UNIVERSITY MEDICAL CENTER, MARIA VALERIA SIMONE, M.D., and RACHEL CAMPBELL, M.D., Defendants. |
| Court | New York Supreme Court |
The following e-filed documents, listed by NYSCEF document number (Motion 001) 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72 were read on this motion to/for JUDGMENT - SUMMARY .
In this action to recover damages for medical malpractice based on alleged departures from good and accepted practice, the defendants move pursuant to CPLR 3212 for summary judgment dismissing the complaint. The plaintiff opposes the motion. The motion is granted to the extent that the defendants are awarded summary judgment dismissing all of the claims asserted against the defendant resident Rachel Campbell, M.D., and dismissing the claims asserted against the defendant surgeon Maria Valeria Simone, M.D., and the defendant hospital New York Presbyterian-Columbia University Medical Center (NYPH) that sought to recover for (a) the creation or exacerbation of diagnosable psychiatric injuries that allegedly manifested themselves subsequent to the plaintiff's March 26, 2016 discharge from NYPH and (b) the plaintiff's inability to secure employment in the United States Marine Corps or pursue a career in the field of modeling. The motion is otherwise denied.
The crux of the plaintiff's claim is that, on March 16, 2016, Simone, assisted by Campbell, negligently performed an open umbilical hernia repair procedure, with mesh placement, at NYPH. Specifically, he alleged that the mesh implant was improperly placed and sutured, so that a small loop of his bowel was caught between the mesh and his anterior abdominal wall, leading to diffuse ischemia and necrosis of bowel tissue, thus necessitating both a subsequent exploratory laparotomy on March 18, 2016 and a second surgery on March 21, 2016 to repair the bowel and remove the dead tissue. The plaintiff further alleged that, while recovering from these surgeries at NYPH in late March 2016, he became confused, aggressive, and paranoid, and that, as a consequence of the surgical trauma, he suffered from even more severe psychiatric conditions several years later that caused him to be rejected from the United States Marine Corps and lose the opportunity to pursue a modeling career.
For some time prior to March 1, 2016, the plaintiff complained to one of his relatives, Amarillis Nunez, that he was suffering from pain in his umbilical area. Amarillis Nunez worked at the Charles Rangel Center, a clinic associated with NYPH, and thus assisted the plaintiff in scheduling an appointment with internist Yvette Ortiz, M.D., who worked at that clinic. On March 2, 2016, Dr. Ortiz saw the plaintiff as an outpatient, at which time he repeated his complaints. He reported a score of 17-20 on a PHQ-9 test, which is employed to screen for clinical depression. According to the defendants, that score indicated that the plaintiff was in the moderate-to-severe range for depression. Dr. Ortiz's assessment was that the plaintiff was a depressed, but otherwise healthy, male, who had been followed by a social worker. Dr. Ortiz reported that the plaintiff refused medications and wanted only to exercise and meditate. She formulated a plan for umbilical hernia repair surgery. Dr. Ortiz referred the plaintiff to the NYPH Surgery Clinic for further evaluation, and he was examined there on March 10, 2016. The plaintiff's chief complaint at that time was pain at his umbilical area when lifting weights. His history indicated that he was a 21-year-old male, with no significant past medical history, who was presenting for evaluation of an umbilical hernia, and reporting an approximately one-yearlong history of umbilical pain when lifting weights that compelled him to stop those exercises. The assessment at the Surgery Clinic was of a symptomatic umbilical hernia, with the plaintiff seeking surgical correction, and a recommendation of an open umbilical hernia repair. Upon examination by Simone, who was in charge of the Surgery Clinic at that time, he presented with a small, reducible hernia in the umbilicus. Simone recommended that the plaintiff undergo an open procedure, as compared to a laparoscopic approach, because the plaintiff was athletic, young, and healthy, with good tissue. She also recommended the placement of mesh as part of the repair, in addition to the primary closure of the defect.
NYPH scheduled the surgery for March 16, 2016, and the plaintiff executed a consent for surgery on that date authorizing Simone to perform an open umbilical hernia repair, with placement of mesh. Simone classified the hernia as a symptomatic umbilical hernia that was "non-incarcerated" because it was reducible which, according to the defendants, meant that the contents within the hernia sac could be manually pushed intra abdominally and, thus, presented a transient, but not a permanent, issue.
Simone performed the surgery at NYPH on March 16, 2016, and was assisted by Campbell, who was then a resident at NYPH. As set forth in the operative report, the hernia defect measured one centimeter (cm) by two cm. Simone employed a mesh measuring four cm by four cm to allow for an appropriate overlap. In the course of the dissection, Simone opened the peritoneum constituting the hernia sac, upon which she decided to employ an intra abdominal dual layer Ventralex composite mesh, with an adhesion barrier of hydrogel on the visceral side. According to the defendants, the side of the mesh coated with hydrogel is placed on the visceral side in order to prevent adhesions, while the side that allows tissue ingrowth is meant to abut the peritoneum and the umbilical closure. The defendants did not remember whether Simone or Campbell inserted the mesh, but both of those physicians testified that, if Campbell performed that task, it was under Simone's direct supervision. The mesh was secured to the fascia in an underlay fashion, with interrupted 2-0 Prolene suturing, which, according to the defendants, meant that each stitch was separate and independently knotted. Simone testified at her deposition that it was her custom and practice to conduct sweep with her finger to ensure correct placement of the mesh and suturing, and to ensure that the mesh was deployed flat and up against the underside of the abdominal wall. The defendants claimed that, after sutures were placed, Simone performed another digital sweep and that a strap that had been employed to "tense up" the mesh was thereafter removed.
According to the intra operative report, Simone commenced the surgery at 7:57 a.m. on March 16, 2016, completed it at 9:11 a.m., and sent the plaintiff to the post anesthesia care unit (PACU) at 9:25 a.m. On his arrival at the PACU, the plaintiff was noted to be slightly drowsy but arousable and oriented as to person, place, and time, and was administered three liters of oxygen via nasal cannula, with his respirations even and nonlabored. The plaintiff had no complaints of respiratory distress, chest pain, chest pressure, or chest discomfort, and his abdomen was soft, non-distended, and tender to the touch. Upon concluding that the plaintiff evinced an appropriate body temperature and level of consciousness, optimal pain relief, and acceptable blood pressure levels and heart rat, Simone discharged the plaintiff from the PACU at 3:20 p.m. At that time, he was instructed to notify Simone if he experienced fever, chills, increased redness, severe pain, or increased drainage, and to limit his activities for 24 hours.
On March 17, 2016, the plaintiff returned to NYPH, where, in triage, he complained of frequent hiccups since his discharge, with pain at the surgical site, and the absence of a bowel movement since the surgery. He also presented with a fever and abdominal signs that were concerning for peritonitis. The differential diagnosis included bowel obstruction, perforation, and infection. The attending emergency medicine specialist noted the plaintiff's history, and included a note that the plaintiff had no bowel movement, little or no urine output, and presented with a body temperature of 102 degrees Fahrenheit. At that time, the plaintiff was tender in response to minimal palpation in the right lower quadrants, with localized rebound tenderness near the incision. The attending physician expressed concern that the plaintiff either was bleeding internally, or that there was a perforation of the peritoneum, with evolving peritonitis. NYPH personnel performed a computed tomography (CT) scan of the plaintiff's abdomen and pelvis, which showed the presence of fluid-filled distended loops of small bowel tissue throughout his abdomen that predominantly involved the jejunum, with the tethering of a very short segment of the small bowel along the anterior abdominal well along the midline surgical site. Upon obtaining the plaintiff's consent, NYPH surgeon Jennifer Kuo, M.D., performed an exploratory laparotomy early in the morning of March 18, 2016. During the exploratory laparotomy, Dr. Kuo identified and removed the umbilical mesh. She brought the small bowel into the operative field and examined it. According to the defendants, there was a clear demarcation between healthy and dead bowel tissue, and Dr. Kuo removed approximately 90 cm of ischemic jejunum. Dr. Kuo concluded that a small loop of bowel tissue had been caught between the mesh and the...
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