Preview
FILED: NASSAU COUNTY CLERK 10/24/2022 01:24 PM INDEX NO. 611506/2018
NYSCEF DOC. NO. 131 RECEIVED NYSCEF: 10/24/2022
EXHIBIT 3
FILED: NASSAU COUNTY CLERK 10/24/2022 01:24 PM INDEX NO. 611506/2018
NYSCEF DOC. NO. 131 RECEIVED NYSCEF: 10/24/2022
SUPREME COURT OF THE STATE OF NEW YORK
COUNTY OF NASSAU
----------------------------------------------------------------------X
DINO BONAVITA,
AFFIRMATION IN
OPPOSITION TO
Plaintiff,
SUMMARY JUDGMENT
-against-
Index No.: 611506/2018
SYED MUJAHID SAYEED, M.D., PRECISION
SURGERY OF NEW YORK, P.C., NORTH SHORE
UNIVERSITY HOSPITAL, and
NORTHWELL HEALTH,
Defendant.
----------------------------------------------------------------------X
BURT M. GREENBERG, M.D., a physician duly licensed to practice medicine in the State
of New York, affirms the following under the penalties of perjury, pursuant to CPLR § 2106:
1. I am a physician licensed to practice medicine in the State of New York. I have been
Board certified by the National Board of Medical Examiners since 1979 and the American Board
of Plastic Surgery since 1989. I received my medical degree from the State University of New
York, Upstate Medical School in 1979. I completed residencies in General Surgery and Plastic
Surgery at the Hospital of the University of Pennsylvania. Thereafter, I completed a Fellowship
in Hand and Microsurgery at Massachusetts General Hospital.
2. I am currently affiliated with eleven hospitals. I have previously held teaching
appointments at the Hospital of the University of Pennsylvania, Shriners Burn Institute for
Crippled Children, and Cornell University Medical College. I have authored and/or co-authored
over 30 peer reviewed journal articles. As such, I am fully familiar with the standards of care in
the fields of hand and upper extremity surgery.
FILED: NASSAU COUNTY CLERK 10/24/2022 01:24 PM INDEX NO. 611506/2018
NYSCEF DOC. NO. 131 RECEIVED NYSCEF: 10/24/2022
3. I submit this Affirmation in opposition to the summary judgment motion made on behalf
of Defendant, Syed Mujahid Sayeed, M.D. I further submit this Affirmation in response to the
expert Affirmation of Roy G. Kulick, M.D. The opinions expressed herein are based upon my
review of the pleadings, the Bill of Particulars, the relevant deposition testimony, Plaintiff’s
medical records, radiological imaging taken of the Plaintiff’s injured hand, and my own
observations and treatment of Plaintiff, Dino Bonavita. These opinions are based upon my years
of training, education, knowledge, and experience in the fields of microsurgery and as a
physician in general. The views presented herein are all made within a reasonable degree of
medical certainty. For the reasons set forth below, it is my opinion that the treatment provided
by Dr. Sayeed to Mr. Bonavita fell below good and accepted standards of medical care. It is
further my opinion that the acts and omissions of Dr. Sayeed were the proximate cause of certain
injuries sustained by the Plaintiff.
Factual Summary
4. Dino Bonavita presented to the Emergency Department of North Shore University
Hospital on July 21, 2017, with multiple lacerations to his right hand from glass resulting in
difficulty in movement and an inability to extend his fingers. Mr. Bonavita was first evaluated
by the emergency room physician, who consulted Dr. Sayeed about treatment of the Plaintiff’s
injuries. As per Dr. Sayeed’s progress notes in the records, Mr. Bonavita sustained injuries to
the extensor tendon at the proximal interphalangeal joint on the index finger, injuries to the
extensor tendon and lateral band mechanism on the base of the right ring finger overlying the
metacarpophalangeal joint, and injury to the joint capsule (DEF EX I, pgs. 39-40).
5. According to Dr. Sayeed’s operative report, he performed an exploration of the
penetrating wounds in Mr. Bonavita’s right hand and an x-ray was taken, which indicated that
2
FILED: NASSAU COUNTY CLERK 10/24/2022 01:24 PM INDEX NO. 611506/2018
NYSCEF DOC. NO. 131 RECEIVED NYSCEF: 10/24/2022
there were no foreign bodies present and that there were no bone fractures. Dr. Sayeed discussed
treatment options with Mr. Bonavita and it was decided that Dr. Sayeed would operate on Mr.
Bonavita’s injuries that day in the Emergency Department. Dr. Sayeed’s records state that the
procedure he performed consisted of: 1) exploration of the wounds to the right hand; 2) repair of
the extensor tendon and lateral bands of the right ring finger and metacarpal joint; 3) repair of the
metacarpophalangeal joint capsule of the right ring finger; 4) repair of the extensor tendon at the
proximal interphalangeal joint of the right index finger; 5) debridement of skin and subcutaneous
tissue of the right hand; 6) repairs measuring 7cm of the right dorsal hand; and 6) application of a
short-arm splint (DEF EX I, pg. 42).
6. Dr. Sayeed testified that all the noted injuries were repaired during the first procedure on
July 21, 2017. X-rays taken before the operation did not indicate the presence of foreign bodies
and Dr. Sayeed neither felt nor visualized any foreign bodies in the wound (i.e. glass shards). Dr.
Sayeed further testified that he utilized nylon sutures in the procedure as opposed to chromic
(absorbable) sutures (DEF EX E, pg. 15). After the procedure, Mr. Bonavita was referred to an
Occupational Therapist to aid in his recovery and range of motion in his injured right hand.
7. Mr. Bonavita was seen in Dr. Sayeed’s private office for several follow-up appointments.
On August 17, 2017, Dr. Sayeed noted that Mr. Bonavita was doing well and the nylon sutures
from the July 21, 2017 operation were removed. Dr. Sayeed saw Mr. Bonavita again on
September 21, 2017, and his notes indicate that Mr. Bonavita complained of pain on the palmar
surface of his hand and numbness in his thumb. Dr. Sayeed also noted a nodule on the tendon of
his index finger, which he deemed consistent with tendinitis (DEF EX H, pgs. 27, 30).
8. According to the notes of Occupational Therapist, Nick Roselli, subsequent to Mr.
Bonavita’s first operation, he experienced decreased range of motion and decreased grip strength
3
FILED: NASSAU COUNTY CLERK 10/24/2022 01:24 PM INDEX NO. 611506/2018
NYSCEF DOC. NO. 131 RECEIVED NYSCEF: 10/24/2022
in his right hand. Mr. Bonavita also complained of extreme pain which interfered with daily
activities such as holding utensils and a toothbrush. Mr. Roselli also noted a palpable nodule at
the volar metacarpophalangeal joint of the right index finger (DEF EX H, pg. 17).
9. Another x-ray was taken of Mr. Bonavita’s right hand on October 4, 2017. The
radiologist that interpreted this imaging noted faint, small densities adjacent to the distal aspect
of the right fourth proximal phalanx consistent with the presence of foreign bodies (Id at 21).
Mr. Bonavita again presented to Dr. Sayeed’s office on October 12, 2017, following the results
of the imaging conducted on October 4, 2017. On that date, Dr. Sayeed performed an
exploratory procedure through the operative scar under local anesthesia and noted that no foreign
were present (Id at 16). Dr. Sayeed closed the wound with four nylon sutures.
Standard of Care
10. It is my opinion, to within a reasonable degree of medical certainty, that Dr. Sayeed’s
course of treatment rendered to Mr. Bonavita was a departure from good and accepted standards
of care for a hand surgeon. Mr. Bonavita was seen by myself for assessment of his injuries at
Glen Cove Hospital on October 16, 2017. On that date, Mr. Bonavita reported to me that he was
unable to extend his right ring finger and attempting to do so was painful. Mr. Bonavita also
detailed that he experienced pain in and around the area of the right ring finger dorsally while
resting, and edema of the right hand and ring finger.
11. Following Mr. Bonavita’s complaints, an MRI of Mr. Bonavita’s right hand was done on
October 18, 2017. This imaging revealed a partial tear of the right fourth finger extensor tendon,
and a partial laceration of the sagittal band at the level of the fourth metacarpophalangeal (“MP”)
joint, accompanied by enhancing edema. Within the edema were several punctate low signal
structures which correlated with faint radiopaque foreign bodies on the lateral radiogram from
4
FILED: NASSAU COUNTY CLERK 10/24/2022 01:24 PM INDEX NO. 611506/2018
NYSCEF DOC. NO. 131 RECEIVED NYSCEF: 10/24/2022
October 4, 2017. Additional smaller foreign bodies were seen dorsal to the fourth finger
proximal phalangeal shaft (DEF EX H, pg. 6).
12. According to Dr. Sayeed’s Operative Report from July 21, 2017, the intended results of
the procedure were to repair the extensor tendon and lateral bands of right ring finger metacarpal
joint, and repair of the MP joint capsule of the right ring finger. However, the MRI from
October 18, 2017 indicated that the extensor tendon was not properly repaired. Dr. Sayeed also
failed to repair the MP joint capsule of the right ring finger. This shows that Dr. Sayeed failed to
achieve the intended results of the July 21, 2017 surgery, and did not discover that these injuries
were present during the exploratory procedure on October 4, 2017, both of which were
significant departures from the standard of care for a hand surgeon.
13. With respect to the shards of glass that were present in Mr. Bonavita’s injuries, the pre-
surgery x-ray taken on July 21, 2017 did not indicate the presence of foreign bodies. However, it
is my opinion, to within a reasonable degree of medical certainty, that one or more of the foreign
bodies later discovered in Mr. Bonavita’s wounds should and could have been visualized by Dr.
Sayeed during the subsequent exploratory procedure on October 4, 2017. Foreign bodies in the
surgical area in question would have resulted in persistent pain in the patient’s hand and
eventually necessitate surgical removal to relieve the pain Mr. Bonavita experienced.
14. I performed corrective surgery on Mr. Bonavita’s hand on October 31, 2017 to further
explore for remaining foreign bodies and to repair the tears in the tendon and ligaments. Under
Loupe magnification, exploration of the tendon repair previously performed revealed: 1) callus
within a segment of the length of tendon without primary extensor tendon anastomosis; 2)
laceration and tear of the radial portion of the sagittal band at the right fourth metacarpal joint
with right ring finger tendon decentralization; 3) glass appearing foreign bodies at the level of
5
FILED: NASSAU COUNTY CLERK 10/24/2022 01:24 PM INDEX NO. 611506/2018
NYSCEF DOC. NO. 131 RECEIVED NYSCEF: 10/24/2022
the dorsal aspect of the right ring finger; and 4) fragments of dark colored suture material, which
were not incorporated into any tendon repair, yet remained present in the surgical wound.
15. During the October 31, 2017 procedure, I removed glass foreign bodies and suture
material from Mr. Bonavita’s hand and removed a significant amount of lateral tendon-based
scar tissue, allowing for the tendon to be centralized. I also performed proximal and distal
tenolysis was performed for full mobilization. The joint capsule was repaired, a suture callus
was removed, and the newly-dissected ends of the proximal and distal right ring finger extensor
tendon were repaired. The extent of the surgery and repairs I performed on Mr. Bonavita’s hand
on October 31, 2017 would not have been necessary if Dr. Sayeed had proficiently performed the
July 21, 2017 surgical procedure. The presence of loose suture material in the wound indicates
that it was left there by Dr. Sayeed during one or both of the procedures he performed.
16. Given the foregoing, it is my opinion, to within a reasonable degree of medical certainty,
that Dr. Sayeed’s failings were a departure from the appropriate standard of care. These
departures proximately caused Mr. Bonavita to suffer a permanent limitation to the range of
motion in his right hand, the extent of which could have been avoided if the ligaments and
tendons were properly repaired by Dr. Sayeed in the initial July 21, 2017 surgical procedure or if
these lasting injuries were observed in the following exploratory procedure he performed on
October 4, 2017. Dr. Sayeed’s departures from good and accepted practice for a hand surgeon
also proximately caused Mr. Bonavita to endure prolonged pain and suffering from the presence
of the foreign bodies in his hand and necessitated the additional surgical procedure I performed
on October 31, 2017.
17. I disagree with the opinion of Defendant’s medical expert, Dr. Roy G. Kulick, M.D. that
the repair of the tendon mechanism and skin of Mr. Bonavita’s right hand were “appropriately”
6
FILED: NASSAU COUNTY CLERK 10/24/2022 01:24 PM INDEX NO. 611506/2018
NYSCEF DOC. NO. 131 RECEIVED NYSCEF: 10/24/2022
repaired (Kulick Affirmation, pg. 5). As detailed above, the repairs were not performed
successfully and this statement is contradicted by the medical records. Although the first
surgical procedure was performed under emergency circumstances, Dr. Sayeed should have at
least appreciated his failure to properly repair the tendon mechanism during the exploratory
procedure he performed on October 4, 2017.
18. I further disagree with Dr. Kulick’s opinion that Dr. Sayeed rendered appropriate care
and medical treatment to Mr. Bonavita following the first surgical procedure he performed.
Although an x-ray taken on October 4, 2017 indicated the retention of foreign bodies in the
wound, Dr. Sayeed performed only a limited exploration of the area. It is unclear how Dr.
Sayeed failed to locate any foreign bodies after their presence was visualized in the x-ray.
Additionally, Dr. Kulick failed to address the fact that Dr. Sayeed left unattached suture
fragments in the surgical wound, which is a clear departure from the standard of care. As such, I
believe that the postoperative treatment Dr. Sayeed rendered to Mr. Bonavita also fell below the
standard of good and accepted practice for a hand surgeon.
Dated: October 6, 2022
____________________________________
Burt M. Greenberg, M.D.
7
Preview
FILED: NASSAU COUNTY CLERK 10/24/2022 01:24 PM INDEX NO. 611506/2018 NYSCEF DOC. NO. 131 RECEIVED NYSCEF: 10/24/2022 EXHIBIT 3 FILED: NASSAU COUNTY CLERK 10/24/2022 01:24 PM INDEX NO. 611506/2018 NYSCEF DOC. NO. 131 RECEIVED NYSCEF: 10/24/2022 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF NASSAU ----------------------------------------------------------------------X DINO BONAVITA, AFFIRMATION IN OPPOSITION TO Plaintiff, SUMMARY JUDGMENT -against- Index No.: 611506/2018 SYED MUJAHID SAYEED, M.D., PRECISION SURGERY OF NEW YORK, P.C., NORTH SHORE UNIVERSITY HOSPITAL, and NORTHWELL HEALTH, Defendant. ----------------------------------------------------------------------X BURT M. GREENBERG, M.D., a physician duly licensed to practice medicine in the State of New York, affirms the following under the penalties of perjury, pursuant to CPLR § 2106: 1. I am a physician licensed to practice medicine in the State of New York. I have been Board certified by the National Board of Medical Examiners since 1979 and the American Board of Plastic Surgery since 1989. I received my medical degree from the State University of New York, Upstate Medical School in 1979. I completed residencies in General Surgery and Plastic Surgery at the Hospital of the University of Pennsylvania. Thereafter, I completed a Fellowship in Hand and Microsurgery at Massachusetts General Hospital. 2. I am currently affiliated with eleven hospitals. I have previously held teaching appointments at the Hospital of the University of Pennsylvania, Shriners Burn Institute for Crippled Children, and Cornell University Medical College. I have authored and/or co-authored over 30 peer reviewed journal articles. As such, I am fully familiar with the standards of care in the fields of hand and upper extremity surgery. FILED: NASSAU COUNTY CLERK 10/24/2022 01:24 PM INDEX NO. 611506/2018 NYSCEF DOC. NO. 131 RECEIVED NYSCEF: 10/24/2022 3. I submit this Affirmation in opposition to the summary judgment motion made on behalf of Defendant, Syed Mujahid Sayeed, M.D. I further submit this Affirmation in response to the expert Affirmation of Roy G. Kulick, M.D. The opinions expressed herein are based upon my review of the pleadings, the Bill of Particulars, the relevant deposition testimony, Plaintiff’s medical records, radiological imaging taken of the Plaintiff’s injured hand, and my own observations and treatment of Plaintiff, Dino Bonavita. These opinions are based upon my years of training, education, knowledge, and experience in the fields of microsurgery and as a physician in general. The views presented herein are all made within a reasonable degree of medical certainty. For the reasons set forth below, it is my opinion that the treatment provided by Dr. Sayeed to Mr. Bonavita fell below good and accepted standards of medical care. It is further my opinion that the acts and omissions of Dr. Sayeed were the proximate cause of certain injuries sustained by the Plaintiff. Factual Summary 4. Dino Bonavita presented to the Emergency Department of North Shore University Hospital on July 21, 2017, with multiple lacerations to his right hand from glass resulting in difficulty in movement and an inability to extend his fingers. Mr. Bonavita was first evaluated by the emergency room physician, who consulted Dr. Sayeed about treatment of the Plaintiff’s injuries. As per Dr. Sayeed’s progress notes in the records, Mr. Bonavita sustained injuries to the extensor tendon at the proximal interphalangeal joint on the index finger, injuries to the extensor tendon and lateral band mechanism on the base of the right ring finger overlying the metacarpophalangeal joint, and injury to the joint capsule (DEF EX I, pgs. 39-40). 5. According to Dr. Sayeed’s operative report, he performed an exploration of the penetrating wounds in Mr. Bonavita’s right hand and an x-ray was taken, which indicated that 2 FILED: NASSAU COUNTY CLERK 10/24/2022 01:24 PM INDEX NO. 611506/2018 NYSCEF DOC. NO. 131 RECEIVED NYSCEF: 10/24/2022 there were no foreign bodies present and that there were no bone fractures. Dr. Sayeed discussed treatment options with Mr. Bonavita and it was decided that Dr. Sayeed would operate on Mr. Bonavita’s injuries that day in the Emergency Department. Dr. Sayeed’s records state that the procedure he performed consisted of: 1) exploration of the wounds to the right hand; 2) repair of the extensor tendon and lateral bands of the right ring finger and metacarpal joint; 3) repair of the metacarpophalangeal joint capsule of the right ring finger; 4) repair of the extensor tendon at the proximal interphalangeal joint of the right index finger; 5) debridement of skin and subcutaneous tissue of the right hand; 6) repairs measuring 7cm of the right dorsal hand; and 6) application of a short-arm splint (DEF EX I, pg. 42). 6. Dr. Sayeed testified that all the noted injuries were repaired during the first procedure on July 21, 2017. X-rays taken before the operation did not indicate the presence of foreign bodies and Dr. Sayeed neither felt nor visualized any foreign bodies in the wound (i.e. glass shards). Dr. Sayeed further testified that he utilized nylon sutures in the procedure as opposed to chromic (absorbable) sutures (DEF EX E, pg. 15). After the procedure, Mr. Bonavita was referred to an Occupational Therapist to aid in his recovery and range of motion in his injured right hand. 7. Mr. Bonavita was seen in Dr. Sayeed’s private office for several follow-up appointments. On August 17, 2017, Dr. Sayeed noted that Mr. Bonavita was doing well and the nylon sutures from the July 21, 2017 operation were removed. Dr. Sayeed saw Mr. Bonavita again on September 21, 2017, and his notes indicate that Mr. Bonavita complained of pain on the palmar surface of his hand and numbness in his thumb. Dr. Sayeed also noted a nodule on the tendon of his index finger, which he deemed consistent with tendinitis (DEF EX H, pgs. 27, 30). 8. According to the notes of Occupational Therapist, Nick Roselli, subsequent to Mr. Bonavita’s first operation, he experienced decreased range of motion and decreased grip strength 3 FILED: NASSAU COUNTY CLERK 10/24/2022 01:24 PM INDEX NO. 611506/2018 NYSCEF DOC. NO. 131 RECEIVED NYSCEF: 10/24/2022 in his right hand. Mr. Bonavita also complained of extreme pain which interfered with daily activities such as holding utensils and a toothbrush. Mr. Roselli also noted a palpable nodule at the volar metacarpophalangeal joint of the right index finger (DEF EX H, pg. 17). 9. Another x-ray was taken of Mr. Bonavita’s right hand on October 4, 2017. The radiologist that interpreted this imaging noted faint, small densities adjacent to the distal aspect of the right fourth proximal phalanx consistent with the presence of foreign bodies (Id at 21). Mr. Bonavita again presented to Dr. Sayeed’s office on October 12, 2017, following the results of the imaging conducted on October 4, 2017. On that date, Dr. Sayeed performed an exploratory procedure through the operative scar under local anesthesia and noted that no foreign were present (Id at 16). Dr. Sayeed closed the wound with four nylon sutures. Standard of Care 10. It is my opinion, to within a reasonable degree of medical certainty, that Dr. Sayeed’s course of treatment rendered to Mr. Bonavita was a departure from good and accepted standards of care for a hand surgeon. Mr. Bonavita was seen by myself for assessment of his injuries at Glen Cove Hospital on October 16, 2017. On that date, Mr. Bonavita reported to me that he was unable to extend his right ring finger and attempting to do so was painful. Mr. Bonavita also detailed that he experienced pain in and around the area of the right ring finger dorsally while resting, and edema of the right hand and ring finger. 11. Following Mr. Bonavita’s complaints, an MRI of Mr. Bonavita’s right hand was done on October 18, 2017. This imaging revealed a partial tear of the right fourth finger extensor tendon, and a partial laceration of the sagittal band at the level of the fourth metacarpophalangeal (“MP”) joint, accompanied by enhancing edema. Within the edema were several punctate low signal structures which correlated with faint radiopaque foreign bodies on the lateral radiogram from 4 FILED: NASSAU COUNTY CLERK 10/24/2022 01:24 PM INDEX NO. 611506/2018 NYSCEF DOC. NO. 131 RECEIVED NYSCEF: 10/24/2022 October 4, 2017. Additional smaller foreign bodies were seen dorsal to the fourth finger proximal phalangeal shaft (DEF EX H, pg. 6). 12. According to Dr. Sayeed’s Operative Report from July 21, 2017, the intended results of the procedure were to repair the extensor tendon and lateral bands of right ring finger metacarpal joint, and repair of the MP joint capsule of the right ring finger. However, the MRI from October 18, 2017 indicated that the extensor tendon was not properly repaired. Dr. Sayeed also failed to repair the MP joint capsule of the right ring finger. This shows that Dr. Sayeed failed to achieve the intended results of the July 21, 2017 surgery, and did not discover that these injuries were present during the exploratory procedure on October 4, 2017, both of which were significant departures from the standard of care for a hand surgeon. 13. With respect to the shards of glass that were present in Mr. Bonavita’s injuries, the pre- surgery x-ray taken on July 21, 2017 did not indicate the presence of foreign bodies. However, it is my opinion, to within a reasonable degree of medical certainty, that one or more of the foreign bodies later discovered in Mr. Bonavita’s wounds should and could have been visualized by Dr. Sayeed during the subsequent exploratory procedure on October 4, 2017. Foreign bodies in the surgical area in question would have resulted in persistent pain in the patient’s hand and eventually necessitate surgical removal to relieve the pain Mr. Bonavita experienced. 14. I performed corrective surgery on Mr. Bonavita’s hand on October 31, 2017 to further explore for remaining foreign bodies and to repair the tears in the tendon and ligaments. Under Loupe magnification, exploration of the tendon repair previously performed revealed: 1) callus within a segment of the length of tendon without primary extensor tendon anastomosis; 2) laceration and tear of the radial portion of the sagittal band at the right fourth metacarpal joint with right ring finger tendon decentralization; 3) glass appearing foreign bodies at the level of 5 FILED: NASSAU COUNTY CLERK 10/24/2022 01:24 PM INDEX NO. 611506/2018 NYSCEF DOC. NO. 131 RECEIVED NYSCEF: 10/24/2022 the dorsal aspect of the right ring finger; and 4) fragments of dark colored suture material, which were not incorporated into any tendon repair, yet remained present in the surgical wound. 15. During the October 31, 2017 procedure, I removed glass foreign bodies and suture material from Mr. Bonavita’s hand and removed a significant amount of lateral tendon-based scar tissue, allowing for the tendon to be centralized. I also performed proximal and distal tenolysis was performed for full mobilization. The joint capsule was repaired, a suture callus was removed, and the newly-dissected ends of the proximal and distal right ring finger extensor tendon were repaired. The extent of the surgery and repairs I performed on Mr. Bonavita’s hand on October 31, 2017 would not have been necessary if Dr. Sayeed had proficiently performed the July 21, 2017 surgical procedure. The presence of loose suture material in the wound indicates that it was left there by Dr. Sayeed during one or both of the procedures he performed. 16. Given the foregoing, it is my opinion, to within a reasonable degree of medical certainty, that Dr. Sayeed’s failings were a departure from the appropriate standard of care. These departures proximately caused Mr. Bonavita to suffer a permanent limitation to the range of motion in his right hand, the extent of which could have been avoided if the ligaments and tendons were properly repaired by Dr. Sayeed in the initial July 21, 2017 surgical procedure or if these lasting injuries were observed in the following exploratory procedure he performed on October 4, 2017. Dr. Sayeed’s departures from good and accepted practice for a hand surgeon also proximately caused Mr. Bonavita to endure prolonged pain and suffering from the presence of the foreign bodies in his hand and necessitated the additional surgical procedure I performed on October 31, 2017. 17. I disagree with the opinion of Defendant’s medical expert, Dr. Roy G. Kulick, M.D. that the repair of the tendon mechanism and skin of Mr. Bonavita’s right hand were “appropriately” 6 FILED: NASSAU COUNTY CLERK 10/24/2022 01:24 PM INDEX NO. 611506/2018 NYSCEF DOC. NO. 131 RECEIVED NYSCEF: 10/24/2022 repaired (Kulick Affirmation, pg. 5). As detailed above, the repairs were not performed successfully and this statement is contradicted by the medical records. Although the first surgical procedure was performed under emergency circumstances, Dr. Sayeed should have at least appreciated his failure to properly repair the tendon mechanism during the exploratory procedure he performed on October 4, 2017. 18. I further disagree with Dr. Kulick’s opinion that Dr. Sayeed rendered appropriate care and medical treatment to Mr. Bonavita following the first surgical procedure he performed. Although an x-ray taken on October 4, 2017 indicated the retention of foreign bodies in the wound, Dr. Sayeed performed only a limited exploration of the area. It is unclear how Dr. Sayeed failed to locate any foreign bodies after their presence was visualized in the x-ray. Additionally, Dr. Kulick failed to address the fact that Dr. Sayeed left unattached suture fragments in the surgical wound, which is a clear departure from the standard of care. As such, I believe that the postoperative treatment Dr. Sayeed rendered to Mr. Bonavita also fell below the standard of good and accepted practice for a hand surgeon. Dated: October 6, 2022 ____________________________________ Burt M. Greenberg, M.D. 7