On May 25, 2021 a
Exhibit,Appendix
was filed
involving a dispute between
Ann Marie Turner,
and
Moshim Kukar Md,
Roswell Park Cancer Institute Corporation,
for Torts - Medical, Dental, or Podiatrist Malpractice
in the District Court of Erie County.
Preview
FILED: ERIE COUNTY CLERK 05/25/2021 11:49 PM INDEX NO. 806930/2021
NYSCEF DOC. NO. 7 RECEIVED NYSCEF: 05/25/2021
EXHIBIT C
FILED: ERIE COUNTY CLERK 05/25/2021 11:49 PM INDEX NO. 806930/2021
NYSCEF DOC. NO. 7 RECEIVED NYSCEF: 05/25/2021
Patient Name: Turner, Ann marie Medical Record No:
507160
Page 21 DOB: /1982
[Dateof Service: 26-Feb-202000:00]Operative Reports [Charted Location: 3 West Clinic]-
for Visit: 3031681665, [Signed by: Kukar, Moshim (MD) 23-Mar-2020 14:47]; [Entered by:
SCM18PrSvc, SCM18PrSve (Other) 02-Mar-2020 07:07] General, Complete, Entered, Signed
in Full, General
ROSWELL PARK CANCER INSTITUTE
Elm & Carlton Streets
Buf falo, NY 14263
(716) 845-2300
OPERATIVE REPORT
PATIENT: Turner, Ann marie DATE OF OPERATION:
02/26/2020
SERVICE: S MR#: 507160
DOB: 1982 FLOOR: *
PREOPERATIVE DIAGNOSIS: Right-sided papillary thyroid
cancer.
POSTOPERATIVE DIAGNOSIS: Right-sided papillary thyroid
cancer.
PROCEDURE: Right thyroid lobectomy and isthmusectomy,
nervorrhaphy
SURGEON: Moshim Kukar, MD.
ASSISTANT: Daniel Kagedan, MD, Fellow.
ANESTHESIA: General endotracheal with Neurosign monitoring.
ESTIMATED BLOOD LOSS: 5 mL.
DESCRIPTION OF PROCEDURE: After correct patient
identification, the patient was brought to the operating
room. She was laid supine. A preprocedure checklist was
performed. General endotracheal anesthesia with Neurosign
tube was administered. She was positioned for the procedure
and prepped and draped in the usual fashion. A detailed
checklist was performed.
We started by making a 4 cm incision at the level of the
cricoid cartilage in the skin crease. This was deepened
down to the platysma and subplatysmal flaps were raised in
all directions. The midline rhaphe was divided with
electrocautery and the thyroid isthmus was identified. We
started by mobilizing the right pole of the thyroid. She
did have a fairly large superior pole of the thyroid, which
FILED: ERIE COUNTY CLERK 05/25/2021 11:49 PM INDEX NO. 806930/2021
NYSCEF DOC. NO. 7 RECEIVED NYSCEF: 05/25/2021
Patient Name: Turner, Ann marie Medical Record No:
507160
Page 22 DOB: 1982
was carefully skeletonized and clipped and divided with the
Harmonic device. We did divide the gland in the midline and
elevated the isthmus off the trachea and then divided with
the Harmonic. Then we started mobilizing more laterally and
divided the middle thyroid vein, and then continued with the
inferior dissection. Of note there was a fair amount of
thyroiditis and the tissues were sticky. After mobilizing
the inferior pole it was evident that the nodule was
actually more posterior and was sitting more riqM at the
insertion of the recurrent larvnaeal nerve into the
cricothyroid joint. That part was extremely sticky and
adherent, although-I do not think that there was any frank
invasion of the tumor into the trachea. We kept carefully
mobilizing the these areas and identify the inferior
parathyroid gland which was dissected off the thyroid and
left behind with intact blood supply. The superior
dissection civen the location of this nodule was oretty
challenging and at one point, we realized that the nerve was
bifurcating and the anterior branch was extremely stuck to
the tumor. So we sharply dissected this off, but in the
process it seemed like the nerve the anterior branch
been compromised. Sc then we continued with that dissection
and carefully got the tumor off the Berry ligament off the
trachea and delivered the specimen out of the wound. We
could see that there was signal in the in the nerve, but it
was not as robust as before and the anterior branch of the
recurrent laryngeal nerves seemed to be compromised. So we
did place a 6-0 Prolene suture to approximate the end of the
nerves. Again, there was reasonable signal low down on the
nerve as well and both parathyrcids were preserved. Since
given this issue and there was a 1 cm tumor to begin with,
we elected not to proceed on the other side and decided to
close the woug.
Complete hemostasis was obtained and confirmed with Valsalva
maneuver. The Fibrillar was placed at the surgical bed and
the midline rhaphe was closed with running 3-0 Vicryl and
platysma was closed with interrupted 4-0 PDS and skin was
closed with 4-0 Prolene. Dermabond was applied. The
patient was awakened, extubated, and transferred to the
recovery room in stable condition.
Given the location of tumor and thyroiditis, we are
requesting a modifier 22 for this case.
Electronically signed by Moshim Kukar, Staff Physician at
03/23/2020 14:43:18
Moshim Kukar, Staff Physician
Surgical Oncology
FILED: ERIE COUNTY CLERK 05/25/2021 11:49 PM INDEX NO. 806930/2021
NYSCEF DOC. NO. 7 RECEIVED NYSCEF: 05/25/2021
Patient Name: Turne r, Ann marie Medical Record No:
507160
Page 23 DOB: 1982
DD: 03/01/2020
DT: 03/02/2020/TT:12:13//rl
DOCUMENT #:07266969/ JOB # : 16450
Document Filed Date
May 25, 2021
Case Filing Date
May 25, 2021
Category
Torts - Medical, Dental, or Podiatrist Malpractice
For full print and download access, please subscribe at https://www.trellis.law/.
Preview
FILED: ERIE COUNTY CLERK 05/25/2021 11:49 PM INDEX NO. 806930/2021 NYSCEF DOC. NO. 7 RECEIVED NYSCEF: 05/25/2021 EXHIBIT C FILED: ERIE COUNTY CLERK 05/25/2021 11:49 PM INDEX NO. 806930/2021 NYSCEF DOC. NO. 7 RECEIVED NYSCEF: 05/25/2021 Patient Name: Turner, Ann marie Medical Record No: 507160 Page 21 DOB: /1982 [Dateof Service: 26-Feb-202000:00]Operative Reports [Charted Location: 3 West Clinic]- for Visit: 3031681665, [Signed by: Kukar, Moshim (MD) 23-Mar-2020 14:47]; [Entered by: SCM18PrSvc, SCM18PrSve (Other) 02-Mar-2020 07:07] General, Complete, Entered, Signed in Full, General ROSWELL PARK CANCER INSTITUTE Elm & Carlton Streets Buf falo, NY 14263 (716) 845-2300 OPERATIVE REPORT PATIENT: Turner, Ann marie DATE OF OPERATION: 02/26/2020 SERVICE: S MR#: 507160 DOB: 1982 FLOOR: * PREOPERATIVE DIAGNOSIS: Right-sided papillary thyroid cancer. POSTOPERATIVE DIAGNOSIS: Right-sided papillary thyroid cancer. PROCEDURE: Right thyroid lobectomy and isthmusectomy, nervorrhaphy SURGEON: Moshim Kukar, MD. ASSISTANT: Daniel Kagedan, MD, Fellow. ANESTHESIA: General endotracheal with Neurosign monitoring. ESTIMATED BLOOD LOSS: 5 mL. DESCRIPTION OF PROCEDURE: After correct patient identification, the patient was brought to the operating room. She was laid supine. A preprocedure checklist was performed. General endotracheal anesthesia with Neurosign tube was administered. She was positioned for the procedure and prepped and draped in the usual fashion. A detailed checklist was performed. We started by making a 4 cm incision at the level of the cricoid cartilage in the skin crease. This was deepened down to the platysma and subplatysmal flaps were raised in all directions. The midline rhaphe was divided with electrocautery and the thyroid isthmus was identified. We started by mobilizing the right pole of the thyroid. She did have a fairly large superior pole of the thyroid, which FILED: ERIE COUNTY CLERK 05/25/2021 11:49 PM INDEX NO. 806930/2021 NYSCEF DOC. NO. 7 RECEIVED NYSCEF: 05/25/2021 Patient Name: Turner, Ann marie Medical Record No: 507160 Page 22 DOB: 1982 was carefully skeletonized and clipped and divided with the Harmonic device. We did divide the gland in the midline and elevated the isthmus off the trachea and then divided with the Harmonic. Then we started mobilizing more laterally and divided the middle thyroid vein, and then continued with the inferior dissection. Of note there was a fair amount of thyroiditis and the tissues were sticky. After mobilizing the inferior pole it was evident that the nodule was actually more posterior and was sitting more riqM at the insertion of the recurrent larvnaeal nerve into the cricothyroid joint. That part was extremely sticky and adherent, although-I do not think that there was any frank invasion of the tumor into the trachea. We kept carefully mobilizing the these areas and identify the inferior parathyroid gland which was dissected off the thyroid and left behind with intact blood supply. The superior dissection civen the location of this nodule was oretty challenging and at one point, we realized that the nerve was bifurcating and the anterior branch was extremely stuck to the tumor. So we sharply dissected this off, but in the process it seemed like the nerve the anterior branch been compromised. Sc then we continued with that dissection and carefully got the tumor off the Berry ligament off the trachea and delivered the specimen out of the wound. We could see that there was signal in the in the nerve, but it was not as robust as before and the anterior branch of the recurrent laryngeal nerves seemed to be compromised. So we did place a 6-0 Prolene suture to approximate the end of the nerves. Again, there was reasonable signal low down on the nerve as well and both parathyrcids were preserved. Since given this issue and there was a 1 cm tumor to begin with, we elected not to proceed on the other side and decided to close the woug. Complete hemostasis was obtained and confirmed with Valsalva maneuver. The Fibrillar was placed at the surgical bed and the midline rhaphe was closed with running 3-0 Vicryl and platysma was closed with interrupted 4-0 PDS and skin was closed with 4-0 Prolene. Dermabond was applied. The patient was awakened, extubated, and transferred to the recovery room in stable condition. Given the location of tumor and thyroiditis, we are requesting a modifier 22 for this case. Electronically signed by Moshim Kukar, Staff Physician at 03/23/2020 14:43:18 Moshim Kukar, Staff Physician Surgical Oncology FILED: ERIE COUNTY CLERK 05/25/2021 11:49 PM INDEX NO. 806930/2021 NYSCEF DOC. NO. 7 RECEIVED NYSCEF: 05/25/2021 Patient Name: Turne r, Ann marie Medical Record No: 507160 Page 23 DOB: 1982 DD: 03/01/2020 DT: 03/02/2020/TT:12:13//rl DOCUMENT #:07266969/ JOB # : 16450