Opinion ID: 2084511
Heading Depth: 1
Heading Rank: 5

Heading: The Factual Error Issue Concerning a Sinus/Sinus Tract

Text: The trial judge made extensive oral findings of fact and conclusions over a two day period, approximately three and one half months after trial, without benefit of a transcript, but with reliance on his own notes made during trial. Our review of the judge's findings leads us to conclude that, for the most part, they are consistent with the trial testimony and documentary evidence. Nonetheless, Ms. Drevenak asserts that the trial court's opinion is replete with erroneous findings of fact.... However, she discusses only one alleged factual finding which she believes was the most material, ... [and] a major basis of the trial court's opinion; that is, the finding concerning the presence or absence of a sinus tract in Ms. Drevenak's knee, and the definition of sinus and sinus tract. In essence, Ms. Drevenak argues that the trial court erred in making a distinction between a sinus and a sinus tract; ignored its decision to take judicial notice of the definition of sinus found in STEDMAN'S MEDICAL DICTIONARY; and erroneously concluded that a sinus is not a sinus tract. Dr. Abendschein maintains that the trial court's findings regarding a sinus and sinus tract are not plainly wrong and there was substantial evidence to support the findings. The sinus or sinus tract issue stems from a March 1993 entry into Ms. Drevenak's medical chart by Dr. Abendschein: There was a small area of draining sinus in the distal aspect of the knee which was to be checked at home. The trial court summarized its findings regarding a sinus and sinus tract as follows: There was also the issue where the plaintiffs indicated that if you have a sinus tract drainage, that gives you a very high percentage of indicia of deep knee infection. Now, the defense's retort to that and... I credit the defense ... [is] that if you have a sinus tract, the way to eliminate the sinus tract and this is my understanding of the testimony, the way to eliminate the sinus tract in a patient that has one is it has to be cut out. Now, there was no denying that there was drainage. That was the other factor There's no denying there was drainage. That point was not disputed by anyone. What the dispute revolved around was this, was that drainage from a sinus tract which meant there was a tunnel or a hole from the inside, from the knee up to the surface or whether there was drainage, but there was no tract. And this wasn't rebutted, as I recall. The testimony was, the elimination of the sinus tract can only be done by cutting it out. And nobody said that that wasn't the case. All the dispute was about was whether it was a sinus tract or just some drainage more so from the surface. There's also testimony from the home health care aide that she did have some training. She wasn't a doctor, of course, in viewing wounds and looking at wounds. And she indicated that the drainage that Ms. Drevenak had while she was tending her in the home wasn't anything unusual, wasn't anything different from what she had seen of persons under similar circumstances. [35] Keeping in mind that she's not a doctor, it only goes toward the issue of whether there was drainage at which they classified a sinus drainage or whether there was in fact a sinus tract along the leg from which fluid was drained. And I find that there was no sinus tract. There was sinus drainage, but it wasn't a sinus tract. The trial judge singled out the testimony of Dr. Lewis: He also indicated he didn't believe that the drainage came from a sinus tract as opposed to a sinus or some other opening in the skin, he didn't feel that it was a sinus tract. The record on appeal shows that neither of Ms. Drevenak's experts, Dr. Smialowicz and Dr. Shall, gave testimony about the definition of a sinus or sinus tract, nor offered an opinion as to whether Ms. Drevenak had a sinus or sinus tract. As the trial judge found, Dr. Lewis, testifying for Dr. Abendschein, declared: I am not sure I would characterize it as a sinus tract. Indeed the word sinus tract appears a couple of times in the record, and I think it is probably inaccurate. Drainage and a sinus tract are not the same thing.... [T]here was some drainage, and that is different from a sinus tract. On cross-examination, Dr. Mayrer, the infectious disease expert for Dr. Abendschein, agreed that the following statement is more likely than not to be true: [A] prosthesis exposed at the base of an unhealed surgical wound of the end of a sinus tract is obviously infected. He also said: A sinus tract, a hole that extends and bores all the way to the base of unhealed surgical wound to the site of a prosthetic device is in fact obviously infected. That is not what [Ms. Drevenak] had. During redirect examination he asserted: A sinus is just a [railroad] tie, a hole. A tract is something that goes further than just a hole. It's like a little thin column going from point a to point b. Neither the testimony of Dr. Lewis nor Dr. Mayrer is inconsistent with the definition of sinus found in STEDMAN'S MEDICAL DICTIONARY: Sinus cavity channel hollow, a channel for the passage of blood or lymph without the coats of an ordinary vessel. Two, a hollow in the bone or other tissue. Three, a fistula or tract leading to a separating cavity. Dr. Mayrer summarized the Stedman definition: The first was channel, the second was h[o]llow or hole, the third is fistula or tract, [36] demonstrating that, in fact, three meanings are set forth in the dictionary. The defense experts appeared to distinguish the first and second Stedman definition from the third, and the trial court accepted that distinction. Based upon our review of the record on appeal, the trial court's factual findings regarding the absence of a sinus tract in Ms. Drevenak's knee is supported by substantial evidence, specifically, the testimony of Doctors Lewis, Mayrer and Abendschein. In addition, the court's resolution of the issue is not inconsistent with the three meanings of sinus found in STEDMAN'S MEDICAL DICTIONARY. Consequently, the court's finding that there was a draining sinus but not a sinus tract is not plainly wrong. [37] For the foregoing reasons we affirm the judgment of the trial court. So ordered.