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Smart Summary

Factual and Procedural Background

Plaintiff Katherine Machac sustained a lower back injury after falling from a horse on September 2, 1993. She was transported by ambulance to Benedictine Hospital, where defendant Ferdinand Anderson, an emergency room physician, examined her and ordered X rays of her lower back. Defendant David J. Hall, a staff radiologist, interpreted the X rays. Both Anderson and Hall concluded no abnormalities were present. Several months later, a chiropractor treated plaintiff and diagnosed a fracture of the L-1 vertebra caused by the accident, noting that the lack of prompt treatment resulted in autofusion of vertebrae and a permanent partial disability. Plaintiff initiated this medical malpractice action.

Following the filing of the note of issue, defendants Hall, Anderson, and the hospital each moved separately for summary judgment dismissing the complaint. The Supreme Court granted leave to Anderson and the hospital to move for summary judgment beyond the 120-day period prescribed by CPLR 3212(a), then granted all motions and dismissed the complaint against all defendants. Plaintiff appealed.

Legal Issues Presented

  1. Whether defendants Hall, Anderson, and Benedictine Hospital were entitled to summary judgment dismissing the medical malpractice claims against them.
  2. Whether the affidavits submitted by defendants met the prima facie burden to warrant summary judgment.
  3. Whether the hospital’s liability, if any, was properly dismissed given its vicarious liability for its employees’ conduct.
  4. Whether the Supreme Court properly granted leave to move for summary judgment beyond the 120-day period without showing prejudice.

Arguments of the Parties

Defendant David J. Hall's Arguments

  • His affidavit acknowledged that a subsequent review of the X rays revealed a slight deformity of the L-1 vertebra which could have been a fracture.
  • He asserted that he followed all appropriate and accepted medical practices and exercised ordinary and reasonable care in reviewing the X rays and preparing his report.
  • Any misreading of the X rays was an error in medical judgment and did not constitute medical malpractice.

Defendant Ferdinand Anderson's Arguments

  • Submitted a detailed affidavit describing the accepted standard of care for an emergency room physician treating a patient with lower back pain and no radiation symptoms.
  • Demonstrated adherence to the standard by performing a physical examination, ordering X rays, preliminarily reviewing them, and obtaining an official interpretation from a radiologist.
  • Argued that his failure to correctly interpret the X rays was not a proximate cause of plaintiff’s damages, as plaintiff was released with instructions to follow up with her own physician and the ultimate interpretation was by the radiologist.

Plaintiff's Arguments

  • Opposed Anderson’s motion by submitting the affidavit of her treating chiropractor.
  • Chiropractor concluded plaintiff had sustained a fracture and suffered permanent disability due to delayed treatment.

Table of Precedents Cited

Precedent Rule or Principle Cited For Application by the Court
Kelly v. St. Peter's Hospice, 160 A.D.2d 1123, 1124 Affidavit of a party may suffice to make out a prima facie case if specific and factual. Court found Hall’s affidavit conclusory and insufficient to meet the prima facie burden despite Kelly’s general principle.
Alvarez v. Prospect Hosp., 68 N.Y.2d 320, 325-326 Conclusive affidavits lacking factual relationship to injury do not establish no merit to cause of action for summary judgment. Applied to reject Hall’s conclusory affidavit as inadequate to warrant summary judgment.
Winegrad v. New York Univ. Med. Ctr., 64 N.Y.2d 851, 853 Affidavits must contain more than bare conclusory assertions regarding standard of care. Supported the conclusion that Hall’s affidavit failed to establish entitlement to summary judgment.
Stuart v. Ellis Hosp., 198 A.D.2d 559 Standard of care for emergency room physician includes ordering X rays and obtaining official interpretation. Used to support Anderson’s assertion of adherence to accepted standard of care.
Koeppel v. Park, 228 A.D.2d 288, 290 Failure to correctly interpret X rays by ER physician may not be proximate cause if official interpretation by radiologist is provided. Supported court’s conclusion that Anderson’s failure was not proximate cause of plaintiff’s damages.
Crozier v. Lesniewski, 195 A.D.2d 657 Chiropractors are not licensed or competent to interpret X rays for fractures. Used to reject plaintiff’s chiropractor affidavit as competent evidence against Anderson’s motion.
Rossi v. Arnot Ogden Med. Ctr., 252 A.D.2d 778, 779-780 Leave to move for summary judgment beyond 120-day period under CPLR 3212(a) may be granted absent showing of prejudice. Supported court’s decision to allow late motion by Hall and hospital without prejudice shown.

Court's Reasoning and Analysis

The court analyzed the evidentiary submissions of the defendants in light of the applicable standards for summary judgment in medical malpractice cases. It found that Hall’s affidavit was largely conclusory, failing to provide specific factual evidence that he adhered to the standard of care, and thus did not meet his prima facie burden. The court emphasized that bare assertions of compliance with accepted medical practices, without factual connection to the injury, are insufficient.

Conversely, Anderson submitted a detailed affidavit demonstrating the accepted standard of care for emergency room physicians and his adherence to it, including obtaining an official interpretation of the X rays by a radiologist. The court concluded Anderson’s failure to detect the fracture was not a proximate cause of plaintiff’s injury since plaintiff was released with instructions to follow up and the radiologist’s interpretation was the one upon which plaintiff would rely.

The plaintiff’s opposition, relying on a chiropractor’s affidavit, was insufficient because chiropractors are not licensed or competent to interpret X rays for fractures, rendering that evidence inadequate to rebut Anderson’s prima facie showing.

Regarding the hospital, the court recognized its liability, if any, was vicarious for the conduct of its employees. It held the dismissal of the complaint as to the hospital based on Anderson’s conduct was proper, but dismissal based on Hall’s conduct was improper given the deficiencies in Hall’s motion.

Finally, the court found no prejudice in granting Hall and the hospital leave to move for summary judgment beyond the 120-day period prescribed by CPLR 3212(a), thus affirming that procedural ruling.

Holding and Implications

The court modified the judgment by reversing the grant of summary judgment in favor of defendant David J. Hall and the hospital as to claims based on Hall’s alleged malpractice, thereby denying those motions to that extent. It affirmed the dismissal of claims against Anderson and the hospital predicated on Anderson’s conduct.

The direct effect is that plaintiff’s claims against Hall and the hospital regarding Hall’s alleged malpractice may proceed, while claims against Anderson and the hospital regarding Anderson’s conduct remain dismissed. No new precedent was established; the decision applies existing standards regarding summary judgment in medical malpractice and vicarious liability.

KATHERINE MACHAC, Appellant, v. FERDINAND ANDERSON et al., Respondents.

Plaintiff injured her lower back when she fell from a' horse on September 2, 1993. She was taken by ambulance to defendant Benedictine Hospital (hereinafter the hospital), where she was examined by defendant Ferdinand Anderson, an emergency room physician. Anderson ordered X rays of plaintiff's lower back, which were interpreted by a staff radiologist, defendant David J. Hall. Based upon their respective review of the X rays, Hall and Anderson each concluded that no abnormalities were present. Several months later, plaintiff was treated by a chiropractor, who concluded that plaintiff had sustained a fracture of her L-1 vertebra in the September 2, 1993 accident and that the absence of prompt treatment resulted in an autofusion of her L-1 and T-12 vertebrae and a permanent partial disability. This action ensued.

Approximately 120 to 125 days following the filing of the note of issue, Hall, Anderson and the hospital each separately moved for summary judgment dismissing the complaint. Supreme Court granted Anderson and the hospital nunc pro tunc leave to move for summary judgment more than 120 days following the filing of the note of issue ( see, CPLR 3212 [a]) and then granted the motions and dismissed the complaint against all three defendants. Plaintiff appeals.

Hall supported his summary judgment motion with his own affidavit wherein he acknowledged that his subsequent review of plaintiff's X rays (following commencement of this action) showed "a slight deformity of the L-1 vertebra, which could have been a fracture". Nonetheless, Hall states that in reviewing the X rays he "followed all appropriate and accepted medical practices and procedures and exercised ordinary and reasonable care when doing so" and also that he exercised his best medical judgment in his reading of the September 2, 1993 X rays and in preparing his report thereon. Finally, he states that "[a]ny misreading of those X-rays was solely an error in medical judgment and does not constitute medical malpractice".

Hall also submitted excerpts from the testimony at his deposition and Anderson's deposition but does not rely upon that evidence.

Although, if specific and factual in nature, the affidavit of a party to an action may suffice to make out a prima facie case ( see, Kelly v. St. Peter's Hospice, 160 A.D.2d 1123, 1124), we conclude that Hall's averments do not measure up to that standard. In our view, the only relevant evidentiary facts to be gleaned from Hall's affidavit are that the X rays he reviewed revealed, and he failed to observe, a deformity to plaintiff's L-1 vertebra which may have been a fracture. The balance of his averments, as previously set forth, are wholly conclusory. Fundamentally, affidavits "which [do] no more than simply state, in conclusory fashion, that [the physician has] acted in conformity with the appropriate standard of care * * * [or] `bare conclusory assertions * * * that [the physician] did not deviate from good and accepted medical practices, with no factual relationship to the alleged injury, do not establish that the cause of action has no merit so as to entitle [the movant] to summary judgment'" ( Alvarez v. Prospect Hosp., 68 N.Y.2d 320, 325-326, quoting Winegrad v. New York Univ. Med. Ctr., 64 N.Y.2d 851, 853). Under the circumstances, we conclude that Hall failed to meet his initial burden of making a prima facie showing of entitlement to judgment as a matter of law and that his motion should have been denied regardless of the sufficiency of the opposing evidentiary showing ( see, Winegrad v. New York Univ. Med. Ctr., supra, at 853).

We reach a different conclusion, however, with regard to Anderson. Unlike Hall, Anderson submitted a detailed affidavit setting forth the accepted standard of care for an emergency room physician attending to a patient such as plaintiff (i.e., an accident victim complaining of lower back pain with no radiation) and providing prima facie evidence of his adherence to that standard by conducting a physical examination, ordering X rays, making a preliminary review of the X rays and then obtaining the opinion of a radiologist for an "official interpretation" ( see, Stuart v. Ellis Hosp., 198 A.D.2d 559). Further, in view of the fact that Anderson released plaintiff with instructions to follow up with her own physician and that the ultimate interpretation of the X ray, the one that plaintiff would logically rely upon, was provided by Hall, we conclude that Anderson made a competent evidentiary showing that his failure to correctly interpret the X ray was not a proximate cause of plaintiff's claimed damages ( see, Koeppel v. Park, 228 A.D.2d 288, 290).

In opposition to Anderson's prima facie showing, plaintiff merely produced the affidavit of her treating chiropractor. Notably, a chiropractor is not licensed to interpret X rays for the detection of fractures ( see, Education Law § 6551 [a]) and is not competent to render an opinion in that regard ( see, Crozier v. Lesniewski, 195 A.D.2d 657). Accordingly, Supreme Court correctly granted Anderson's motion for summary judgment.

Inasmuch as the hospital's liability, if any, is solely vicarious, we conclude that Supreme Court correctly dismissed so much of the complaint against it as was predicated upon Anderson's alleged malpractice but erred in dismissing so much as was predicated upon Hall's. As a final matter, in the absence of any showing (or even allegation) of prejudice, we are unpersuaded that Supreme Court erred in granting Hall and the hospital leave to move for summary judgment a matter of a few days beyond the 120-day period specified in CPLR 3212 (a) ( see, Rossi v. Arnot Ogden Med. Ctr., 252 A.D.2d 778, 779-780).

Cardona, P. J., Spain and Carpinello, JJ., concur.

Ordered that the judgment is modified, on the law, without costs, by reversing so much thereof as granted summary judgment in favor of defendant David J. Hall and so much thereof as granted summary judgment in favor of defendant Benedictine Hospital dismissing so much of the complaint against said defendant as alleged its vicarious liability for the conduct of defendant David J. Hall; said motions denied to that extent; and, as so modified, affirmed.

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MACHAC v. ANDERSON
(May 20, 1999)