Mechanism-of-Injury Statements in Medical Records Are Admissible When Germane and Attributable to the Patient — No Per Se Requirement of Provider Testimony (Pillco v. 160 Dikeman St., LLC)

Introduction

This appeal from the Supreme Court, Kings County, presented a recurring and often misunderstood evidentiary question: when, and under what conditions, may a patient’s description of how an accident occurred, as recorded in medical records, be used to defeat a plaintiff’s motion for summary judgment? In Pillco v. 160 Dikeman St., LLC (2025 NY Slip Op 04495), the Appellate Division, Second Department, uses a Labor Law § 240(1) case to deliver a detailed primer on the business records exception, hearsay-within-hearsay in medical records, and the attribution of statements to the patient. The court affirms the denial of plaintiff’s § 240(1) summary judgment motion, holding that a statement in the plaintiff’s pain management records—“was on a ladder, was picking up heavy sheetrock and felt a pull on his lower back and right shoulder”—was admissible under CPLR 4518 as germane to diagnosis and treatment, and sufficiently attributable to the plaintiff.

Beyond the immediate outcome, the decision clarifies that, in the Second Department, testimony from the medical provider who recorded the statement is not always necessary to attribute the statement to the patient; the records themselves (and other record evidence) may suffice. The court also provides guidance on which “how-it-happened” details are germane to diagnosis and treatment, distinguishing between facts that inform medical care and facts that are investigatory or liability-focused.

Summary of the Judgment

• The plaintiff, a laborer, alleged a gravity-related accident: while removing sheetrock from a ceiling using an A-frame ladder, a piece of sheetrock fell on his shoulder, causing the ladder to shake and the plaintiff to fall about seven feet, with the ladder and sheetrock landing on him. He sought summary judgment on liability under Labor Law § 240(1).
• The general contractor and third-party defendant (ATA, the employer) opposed, submitting (i) an affidavit from ATA’s co-owner (“Billy” Yalcin), and (ii) certified records from Precision Pain Medicine reflecting the mechanism statement quoted above.
• The Second Department held: (a) Yalcin’s affidavit—given his lack of personal knowledge of the accident—did not, by itself, raise a triable issue about how the accident occurred; but (b) the medical record statement was admissible under the business records exception and raised a triable issue of fact as to the accident mechanism.
• The court affirmed the denial of plaintiff’s summary judgment motion.

Detailed Analysis

I. The Factual and Procedural Context

Plaintiff Fabian Pillco sued owner 160 Dikeman Street, LLC and general contractor KSK Construction Group, LLC, claiming a Labor Law § 240(1) violation arising from a September 25, 2019 incident at a Brooklyn construction site. His employer, ATA Construction New York, Inc., was impleaded for indemnification. On summary judgment, plaintiff relied on his deposition testimony, given through a Spanish interpreter, describing a falling-object-and-fall-from-height sequence.

ATA opposed with Yalcin’s affidavit denying that he instructed plaintiff to remove sheetrock or to use a ladder, and with certified medical records from Precision Pain (exam by Dr. Khaimov) stating: “Accident: Patient was on a ladder, was picking up heavy [sheetrock] and felt a pull on his lower back and R shoulder,” and linking the patient’s history to the provider’s objective findings. The Supreme Court denied plaintiff’s § 240(1) motion; plaintiff appealed.

II. The Evidentiary Issue Framed

The appeal centered on whether the Precision Pain statement could be considered under the business records exception to defeat summary judgment. The court recognized the multiple layers of hearsay inherent in medical records:

• Level 1: The medical records themselves (admissible if CPLR 4518 foundation is met), and
• Level 2: The statement within the record describing how the event occurred (admissible only if the embedded statement also falls within a hearsay exception or otherwise satisfies business-record principles).

The court held both levels were satisfied here: (i) the medical records were properly certified; and (ii) the mechanism statement was germane to diagnosis and treatment and sufficiently attributable to the plaintiff.

III. Precedents Cited and Their Influence

• Williams v Alexander, 309 NY 283:
  • Bedrock rule: Entries in hospital/medical records are admissible as business records only if germane to diagnosis or treatment. Hospitals are not in the business of investigating liability; details aimed at fault often are not germane.
  • However, some mechanism-of-injury facts (e.g., being hit by a car) may be germane; other particulars (which car, why it happened) are not.
  • Pillco applies Williams by distinguishing medically relevant mechanism facts (“felt a pull” while lifting a heavy object) from litigation-focused details (“which car,” or “belt color”).
• People v Ortega, 15 NY3d 610 (including People v Benston):
  • Reaffirmed Williams; held that certain descriptors (domestic violence, safety plan) and the nature of the weapon (a belt) were germane to diagnosis/treatment; cosmetic specifics (belt color) were not.
  • Also held that whether a patient was coerced to ingest drugs is germane to diagnosis, as coercion can affect dose control and treatment.
  • Pillco analogizes: “felt a pull” while lifting heavy sheetrock is germane to assessing back/shoulder injuries; this is a different diagnostic picture than a seven-foot fall.
• Matter of Leon RR, 48 NY2d 117 and Johnson v Lutz, 253 NY 124:
  • Each link in the hearsay chain must be within the business duty or fall under a hearsay exception; you cannot “bootstrap” a party admission via an otherwise inadmissible record.
  • Pillco uses Leon RR/Johnson to require both (1) admissible business record and (2) independently admissible embedded statement (here, germane and attributable to the patient).
• Yassin v Blackman, 188 AD3d 62:
  • Explains hearsay-within-hearsay in police reports; reiterates that each layer must qualify for an exception.
  • Pillco uses Yassin to emphasize this two-tier analysis for medical records.
• Grechko v Maimonides Med. Ctr., 188 AD3d 832; Nelson v Bogopa Serv. Corp., 123 AD3d 780:
  • Only entries germane to diagnosis/treatment are admissible under CPLR 4518.
• Robles v Polytemp, Inc., 127 AD3d 1052 and Goodrich v Watermill Townhouses, 169 Misc 2d 314:
  • Records can themselves suffice to show the patient as the source when they clearly indicate that the patient provided the history.
  • Pillco follows this approach: the Precision Pain records state the “patient described” the incident, and the plaintiff’s deposition reinforced that he communicated directly in English.
• Ginsberg v North Shore Hosp., 213 AD2d 592; Sanchez v Manhattan & Bronx Surface Tr. Auth., 170 AD2d 402:
  • If the source of the information is unknown or ambiguous (e.g., possibly a third party), the record is inadmissible absent additional proof.
  • Pillco distinguishes these cases: here, the record and deposition established patient attribution.
• Mosqueda v Ariston Dev. Group, 155 AD3d 504 (First Department); Quispe v Lemle & Wolff, 266 AD2d 95; Gunn v City of New York, 104 AD2d 848; Mikel v Flatbush Gen. Hosp., 49 AD2d 581:
  • In those cases, providers could not confirm whether the patient supplied the history, or the records did not establish patient attribution.
  • Pillco respectfully disagrees with any reading of Mosqueda as imposing a categorical requirement that the recorder must testify in all cases; when records clearly attribute the history to the patient, and the context supports it, provider testimony is not always necessary.
• Labor Law § 240(1) standards and cases (e.g., McCarthy v Turner, Narducci, Cahill, Rivas, Castano, Orellana, Robinson):
  • The plaintiff met his prima facie burden; the question was whether the defense raised a triable issue of fact as to the occurrence/mechanism through admissible evidence.

IV. The Court’s Legal Reasoning

1) Yalcin’s affidavit did not create a triable issue on mechanism

• Affiant lacked personal knowledge of the accident and did not claim to have witnessed it.
• His denials about giving instructions or being present post-accident were immaterial to the core mechanism (falling sheetrock, ladder movement, seven-foot fall) and did not physically negate plaintiff’s account.
• No inconsistent versions by the plaintiff were shown; a denial that a conversation occurred is not the same as evidence of an inconsistent account.
• Thus, Yalcin’s submission did not undermine plaintiff’s credibility on the accident’s mechanics.

2) The medical records were admissible and the embedded statement was germane

• Germane to diagnosis and treatment: The Precision Pain records concerned evaluation of back and shoulder pain; the statement that the patient “was on a ladder, was picking up heavy sheetrock and felt a pull” directly informed differential diagnosis and treatment planning for musculoskeletal injury.
• Contrast with plaintiff’s deposition: The medical record lacks any mention of a fall; it describes a lifting strain. The diagnostic implications of a strain versus a seven-foot fall are materially different, making the mechanism medically significant.
• Supporting notations: The provider expressly wrote that the incident the patient described was the “competent medical cause” of the injury, that the complaints were consistent with the history, and that the history was consistent with objective findings—textbook indicators of medical relevance.

3) The embedded statement was attributable to the patient without provider testimony

• The records repeatedly reference the “patient described” incident and align complaints, history, and findings.
• At deposition, plaintiff confirmed he communicated directly in English with the provider and did not use an interpreter; when confronted with the record’s description, he did not deny giving it but suggested a “misunderstanding.”
• These factors together satisfied the attribution requirement. The court rejected the argument that provider testimony is invariably required to identify the source.

4) Language concerns go to weight, not admissibility

• Because plaintiff stated he communicated in English and the record is in English, there was no translation layer to validate.
• Any claimed misunderstanding or limited fluency bears on the credibility and weight of the statement, not on its admissibility at the summary judgment stage.

5) Triable issue of fact precludes § 240(1) summary judgment

• The admissible mechanism statement raises a factual dispute: was this a gravity-related fall (as plaintiff testified) or a lifting strain “felt a pull” (as the medical record suggests)?
• Because § 240(1) liability turns on a statutory violation that proximately causes injury from elevation-related risks, the divergence in mechanism is material and must be resolved by a factfinder.

V. Fine-Grained Guidance on “Germane to Diagnosis”

The court offers helpful examples clarifying germane versus non-germane detail:

• Generally germane: being hit by a car; being strangled with a belt; being forced to ingest substances; lifting a heavy object and “feeling a pull”; twisting a knee after stepping off a ladder.
• Generally not germane: which specific car caused impact; the color of the belt; whether a ladder was wooden or metal; fine-grained distinctions about why a ladder slipped versus a rung cracked; whether one fell versus jumped (in some contexts).
• Case-specific nuance: whether the patient fell from a ladder or merely strained while lifting can be diagnostically and legally significant—as here, the former suggests a gravity-related event central to § 240(1), the latter may not.
• When unclear: Courts may require expert or provider evidence on whether a particular entry is germane (e.g., where medical necessity is not obvious from the face of the record).

VI. The Relationship to Labor Law § 240(1)

Plaintiff’s prima facie showing was uncontested, but the court emphasizes that a plaintiff can be the sole eyewitness and still be denied summary judgment where admissible evidence places credibility or mechanism in dispute. If the factfinder credits the medical-record account (lifting strain, no fall/no falling object), the essential gravity-related nexus of § 240(1) may be absent. Conversely, if the factfinder credits plaintiff’s account (falling sheetrock triggers ladder movement and a seven-foot fall), § 240(1) liability could follow.

Notably, the court expressly did not reach alternative defenses such as “unauthorized work” or “recalcitrant worker”—issues flagged but not argued on appeal.

Impact and Implications

A. Evidence Law: A Clearer Roadmap in the Second Department

• No categorical provider-testimony requirement: The Second Department clarifies that the medical record itself can establish patient attribution where it clearly indicates the patient provided the history and surrounding evidence supports that conclusion.
• Robust application of the business records exception: Courts will scrutinize whether the embedded statement is actually germane to diagnosis/treatment, aligning with Williams and Ortega. Practitioners should expect closer parsing of mechanism details for medical relevance.
• Language issues: Absent a separate translation layer, claimed misunderstandings will typically go to weight, not admissibility, at the summary judgment stage.
• Hearsay-within-hearsay discipline: Pillco reinforces the two-layer analysis: admissible record + admissible embedded statement.

B. Construction/Labor Law Practice

• Defense strategies: Certified medical records from pain management or other treating providers can be powerful tools to create triable issues on mechanism. Ensure records are properly certified, show patient attribution, and contain germane mechanism notations.
• Plaintiff strategies: Align mechanism-of-injury histories across medical providers; consider using interpreters and documenting translation; be prepared to explain discrepancies. Inconsistent histories can defeat even strong § 240(1) motions.
• Trial dynamics: Expect vigorous cross-examination on initial histories, language proficiency, and the consistency of objective findings with either version of events.

C. Inter-Departmental Alignment and Potential for Higher-Court Review

• The Second Department’s explicit disagreement with any per se reading of Mosqueda signals a potential departmental divergence on whether provider testimony is always necessary to attribute statements. Although Pillco carefully distinguishes Mosqueda on its facts, its rejection of a blanket rule could prompt further appellate clarification.
• Until the Court of Appeals speaks, practitioners should tailor evidentiary strategies to the Department’s precedents: in the Second Department, clear record-based attribution can suffice; in the First Department, consider obtaining provider testimony when attribution is contested or unclear.

Complex Concepts Simplified

• Business records exception (CPLR 4518): Allows admission of records made in the regular course of business, at or near the time of the event, by someone with a duty to report, if the record is trustworthy and relevant to the business purpose.
• Hearsay within hearsay: When a record (hearsay) contains another statement (hearsay), each layer must fit an exception. In medical records, the record itself may be admissible, but patient or third-party statements within must also be justified (e.g., as germane to treatment).
• Germane to diagnosis/treatment: Information that affects how medical providers diagnose and treat the patient. Think: mechanism facts that inform injury type, force, and likely damage—not liability details.
• Attribution to the patient: The proponent must show the patient was the source of the embedded statement. This can be shown via the record’s language (“patient described”), corroborating testimony, or provider testimony if the record is ambiguous.
• Triable issue of fact: A genuine, material factual dispute that requires a jury (or factfinder) to resolve; it defeats summary judgment.
• Labor Law § 240(1): Imposes a nondelegable duty on owners/contractors to provide safety devices for elevation-related risks. Plaintiffs must show a statutory violation and proximate causation by a gravity-related hazard.

Practical Guidance for Litigators

• For defendants:
  • Subpoena and obtain certified medical records early; identify “mechanism” entries.
  • Look for explicit record language tying “patient described” history to objective findings.
  • Depose the plaintiff about communications with providers, language used, and whether an interpreter was present.
  • If attribution is ambiguous, be prepared to call the provider or a custodian; if there was translation, be ready to prove the translator’s competence and accuracy.
• For plaintiffs:
  • Use qualified interpreters when needed, and document translation in intake forms.
  • Ensure consistency of the mechanism across providers where possible; promptly correct inaccuracies in medical histories.
  • Anticipate and prepare to explain discrepancies between deposition testimony and medical records (e.g., misunderstanding, language issues, triage shorthand).
• For all parties:
  • Remember that “which car,” “belt color,” or “ladder material” often won’t be germane; “felt a pull,” “twisted knee,” “forced ingestion,” or “being hit” commonly will be.
  • Don’t overlook the provider’s own notations linking history, complaints, and objective findings; these can be decisive on germane-ness.

Conclusion

Pillco v. 160 Dikeman St., LLC is a significant Second Department decision that sharpens the contours of the business records exception as applied to medical records in civil litigation. The court holds that a patient’s mechanism-of-injury statement is admissible if it is germane to diagnosis or treatment and properly attributable to the patient—without a categorical requirement that the recorder testify. Applying that framework, the court found that the Precision Pain record (“on a ladder… picking up heavy sheetrock… felt a pull”) was admissible and materially inconsistent with plaintiff’s fall narrative, thereby creating a triable issue of fact that defeated summary judgment under Labor Law § 240(1).

The decision delivers two enduring takeaways. First, “germane to diagnosis/treatment” is a functional, medical inquiry: does the detail guide diagnosis or care? Second, attribution can be proved from the face of the records and surrounding evidence; absence of provider testimony is not fatal where the record clearly reflects the patient as the source. For construction accident litigation, Pillco underscores that medical records can be outcome-determinative at the summary judgment stage, and it counsels meticulous attention to the accuracy and documentation of mechanism-of-injury histories from the very first medical encounter.