CANDIDA R. PEREZ, Plaintiff,
THE MOUNT SINAI HOSPITAL, IAN M. KRONISH, M.D., and MICAH D. MANN, M.D., Defendants 113157/10
ALICE SCHLESINGER, J.S.C.
This is a case about a dog bite. But since it is an action that sounds in medical malpractice, the owner of the dog is not the one being sued. Rather, it is the owner of the dog who was bitten and it is the two doctors from whom she sought treatment at The Mount Sinai Hospital who are being sued.
On the same day, May 3, 2010, that Candida Perez was bitten on her left calf, she went to the Mt. Sinai Internal Medical Associates ("Clinic") where she had been a long-time patient. She went because the wound was bleeding a lot and her pain was terrible. She evaluated the pain as a 10 out of 10, the highest category. There was also significant bleeding which could be stopped with pressure. Dr. Micah Mann, a resident, saw Ms. Perez even before she came into the exam room. He questioned her and was told that her dog was up to date with all vaccinations and that she herself had recently had a tetanus shot. Dr. Mann noted that the patient's vital signs were all normal and that at that time the patient had no sign of infection.
He stated that the wound did not have redness surrounding it and no significant swelling. Also, he said it did not feel warm. In describing it, he judged it was "about 1.5 centimeters by a centimeter, and diamond-shaped, and there was a small amount of subcutaneous fat" (p. 30 of Dr. Mann's deposition).
Dr. Mann spoke to his "preceptor," attending Dr. Ian Kronish who examined the wound also. Dr. Kronish described the wound as through the top layer. However, he did not believe it was extremely deep or that it needed stitches.
The two doctors decided to research animal bites to help them decide whether or not to prescribe antibiotics prophylactically. They went onto a website called "Up to Date", authored by physicians who, according to defense counsel are "world-renowned experts in their specialities;" the content of the site "is continually reviewed to ensure it is of the highest quality and based on the latest evidence" (Affirmation in Support of Motion at n 3).
The article viewed discussed various categories of animal bites and studies concerning treatment of them. Its conclusion was that antibiotics were not mandated unless the wound was on the hand, was of a puncture type, or if the patient was at an increased risk for infection due to diabetes or some other immune compromise.
Since Ms. Perez presented with none of these factors, the defendants decided not to prescribe antibiotics. Dr. Kronish, who knew the patient and believed she was reliable, gave her detailed instructions as to when to return if her symptoms worsened.
The symptoms worsened so that by the next morning, May 4, 2010, Ms. Perez had a fever of 102 which went up to 103. By the next morning, May 5, the fluid which had been draining from the wound and was clear yellow on May 4, was now thick and dark. Also, the skin around the wound was red and hot. These signs led Ms. Perez to call the Clinic, which had instructed her to return immediately.
She did return, this time with a clearly infected wound. This led to her admission to the hospital, with a surgical debridement performed by Dr. Lester Silver the next day, May 6. Dr. Silver's operative note described two wounds about an inch and a half apart, which he connected underneath. He noted that the wounds did not extend into the muscle or beneath the fascia. Ms. Perez was discharged from the hospital on May 12, 2010.
This motion by all defendants for summary judgment is supported by two affirmations. The first is authored by Dr. Bruce Farber, who is board certified in Internal Medicine and Infectious Diseases (Exh I). The second is from Dr. Jeffrey Ascherman, who is board certified in Plastic Surgery (Exh J). Both are well-credentialed and associated with major New York Hospitals, Dr. Farber with North Shore University and Dr. Ascherman with New York Presbyterian.
Not surprisingly, both opine that the defendant doctors did not in any way depart from accepted standards of medical care. Also, they agree that the doctors acted in accordance with the standards for treating dog bites. From each expert's perspective, they state that Ms. Perez was properly triaged and given a proper physical examination. Further, the wound was thoroughly irrigated and not sutured or closed over. Also, she was given proper instructions. As to her purported delay in returning to the Clinic, they say this contributed to the severity of the infection.
As to providing the patient with prophylactic antibiotics, Dr. Farber says that he believes, based on his review of current literature including the material from "Up to Date", that the defendants correctly determined that they should not have been prescribed. He says: "There is no evidence that providing prophylactic antibiotics to patients such as Ms. Perez decreases the likelihood of an infection" (¶11). Further, he describes this as a "low risk" and "shallow" dog bite from her own pet, and he ...