Case Information
*0 FILED IN 6th COURT OF APPEALS TEXARKANA, TEXAS 10/13/2015 11:22:43 AM DEBBIE AUTREY Clerk
*1 ACCEPTED 06-15-00049-CV SIXTH COURT OF APPEALS TEXARKANA, TEXAS 10/13/2015 11:22:43 AM DEBBIE AUTREY CLERK NO . 06 - 15 - 00049 - C V I N T H E C OU R T O F A PP E A L S F O R T H E S I X T H D I S T R I C T O F TE XA S TE XA R KANA , TE XA S CR I S T I NA M A R E N TE i nd i v i du a ll y a nd a s r e p r e s e n t a ti v e o f t h e E S T A TE O F C H R I S T I AN M A R E N TE , D ecea s e d , A pp e ll an t s v . E UN I C E A S HA , a nd E P I C H E A LT H S E R V I C E S , I N C . A pp e ll ee s O n A pp ea l fr o m C a u s e N u m b e r 86812 F r o m t h e 40
[1] h D i s t r i c t C ou r t o f E lli s C oun t y , T e x a s A M E ND E D BR I E F F O R A PP ELL AN T S ( W I T H A PP E ND I X ) O R A L A R GU M E N T R E QU E S TE D D oug l a s T . F l oyd A tt o r n e y f o r A pp e ll a n t s 3336 T h e r ondunn D r . P l a no , T e x a s 75023 214 - 704 - 7081 469 - 519 - 9488 F AX T . B . N . 07181700 l a w y e r f l o yd @ a o l . c o m
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*2 D E N T I T Y O F P AR T I E S AND C O UN S EL P L A I N T I FF / A PP ELL AN T : CR I S T I NA M A R E N TE i nd i v i du a ll y a nd a s r e p r e s e n t a ti v e o f t h e E S T A TE O F C H R I S T I AN M A R E N TE , D ecea s e d D E F E NDAN T S / A PP ELLEE S : E UN I C E A S HA , a nd E P I C H E A LT H S E R V I C E S , I N C . C OUN S EL F O R P L A I N T I FF I A PP ELL AN T : D oug l a s T . F l oyd
· 3336 T h e r ondunn D r . P l a no , T e x a s 75023 214 - 704 - 7081 469 - 519 - 9488 F AX T . B . N . 07181700 l a w y e rf l oyd @ a o l . c o m
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OUN S EL F O R E UN I C E A S AH I A PP ELLEE D a v i d M . W a l s h , I V P e t e r A nd e r s on , C h a m b l ee , R y a n , K e r s h a w a nd A nd e r s on , P . C . 2777 N . S t e mm on s F r ee w a y , S u it e 1157 D a ll a s , T e x a s 75207 214 - 905 - 2003 214 - 905 - 1213 F AX d m w a l s h @ c h a m b l ee r y a n . c o m C OUN S EL F O R E P I C H E A LT H S E R V I C E S , I N C . / A PP ELLEE W i n s t on L . B o r u m B O R U M & HAN C O C K , L . L . P . 2485 B u r n e tt P l aza 801 C h e rr y S t r ee t , U n it 414 F o r t W o r t h , T X 76102 817 - 336 - 4100 817 - 33 6 - 41412 F A X bo r u m @ bo r u m h a n c o c k . c o m P R E S I D I NG J UDG E A T T R I A L : H on . R ob e r t C a rr o ll 40 [1] h D i s t r i c t C ou r t E lli s C oun t y , T e x a s 201 C a r o li n e , 11 t h F l oo r H ou s t on , T e x a s 77002 1 0 1 S ou t h M a i n S t r ee t W a x a h ac h i e , T x 75165 972 - 825 - 5060 972 - 825 - 5061 F AX
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*3 A BLE O F C O N TE N T S I D E N T I T Y O F T H E P A R T I E S AND C OUN S EL ................................... ii T A B LE O F C ON TE N T S ....................................................... iii I ND E X O F AU T HO R I T I E S ..................................................... v S T A TE M E N T O F T H E C A S E ................................................... 1 I SS U E S P R E S E N TE D .......................................................... 2 S T A TE M E N T O F F A C T S ...................................................... 3 S U MM A R Y O F T H E A R GU M E N T .............................................. 8 A R GU M E N T ................................................................. 9 A . D r . M a r a b e l ' s r e po r t w a s s u ff i c i e n t t o s a t i s f y t h e r e qu i r e m e n t s o f TE X . C I V . P R A C . &
R E M . §74 . 351 ......................................................... 12 B . N u r s e B i ngh a m s ' r e po r t w a s s u ff i c i e n t t o s a t i s f y t h e r e qu i r e m e n t s o f TE X . C I V . P R A C . & R E M . §74 . 351 ............. • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 12 [1] C . N o e xp e r t r e po r t w a s n ece ss a r y w it h r e s p ec t t o A pp e l l a n t s ' c l a i m s f o r v i ca r i ou s l i a b i li t y a g a i n s t E p i c H ea lt h S e r v i ce s , I n c . . ......................................... 20 P R AY E R ................................................................... 20 C E R T I F I C A TE O F S E R V I C E . ................................................. 21 C E R T I F I C A TE O F C O M P L I AN C E .............................................. 21 A PP E ND I X ................................................................. 22
a . O r d e r on D e f e nd a n t s E un i ce A s a h ' s a nd E p i c H ea lt h S e r v i ce s , I n c . ' s O b j ec ti on s t o P l a i n ti ff s A m e nd e d C h a p t e r 7 4 E xp e r t R e po r t s a nd M o ti on s t o D i s m i ss b . E xp e r t R e po r t o f P a tti B i ngh a m , R N c . C u rr i c u l u m v it ae o f P a tti B i ngh a m , R N
11 . *4 d . E xp e r t R e po r t o f D r . C h a r l e s M a r a b l e , M . D . e . C u rr i c u l u m v it ae o f D r . C h a r l e s M a r a b l e , M . D . f . C i v . P r ac . & R e m . C od e S ub c h a p t e r H P r o ce du r a l P r ov i s i on s S ec . 74 . 351 , S ec .
74 . 402 a nd S ec . 403 iii .
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*5 ND E X O F AU T HO R I T I E S
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A S E S A d eye m i v . G u e rr e r o , 329 S . W . 3d 241 ( T e x . A pp . - D a ll a s 2010 , no p e t . ) ................... 9 B a ll an v . G i b s on , 151 S . W . 3d 281 ( T e x . A pp . - D a ll a s 2004 , no p e t . ) .................... 16 B l an v . A li , 7 S . W . 3d 741 ( T e x . A pp . - H ou s t on [ 14 t h D i s t . ] 1999 , no p e t . ) ............... 11
c A m e r i c an T r an s iti ona l C a r e C e n t e rs o f T ex a s , I n c . v . P a l a c i o s , 46 S . W . 3d 873 l ( T e x . 2001 ) ............................................................... 12 , 13 J a ck s on L a w O ffi ce , P . C . v . C happ e ll , 37 S . W . 3d 15 ( T e x . A pp . - T y l e r 2000 , p e t . d e n i e d ) ............................................... 18 L a rs on v . D o w n i ng , 197 S . W . 3d 303 ( T e x . 2006 ) ..................................... 9 G r a y v . C H C A B a y s ho r e , L . P ., 189 S . W . 3d 855 ( T e x . A pp . - H ou s t on [ 1 s t D i s t . ] 2006 , no p e t . ) ........................................ 9 G r oup v . V i ce n t a , 164 S . W . 3 r d 724 ( T e x . A pp . -[ H ou s t on 14 t h D i s t ] 2005 ) ............. 17 , 18 O b s t e t r i c a l & G y n ec o l og i c a l A ss o c s ., P . A . v . M c C o y , 283 S . W . 3d 96 ( T e x . A pp . - H ou s t on [ 14 t h D i s t . ] 2009 , p e t . d e n i e d ) ................................... 20 R itt g e r v . D ano s , 332 S . W . 3d 550 ( T e x . A pp . - H ou s t on [ 1 s t D i s t . ] 2009 , ' no p e t . ) ............ , ........................ 11 S c o r e s b y v . San till an , 346 S . W . 3d 546 ( T e x . 2011 ) ................................ 9 , 10 P a ck a r d v . G u e rr a , 252 S . W . 3d 511 ( T e x . A pp . - H ou s t on [ 14 D i s t . ] 2008 ) ................ 19
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T A T U TE S T e x . C i v . P r ac . & R e m . §74 .............................................. ' . .. . . .. 18 T e x . C i v . P r ac . & R e m . C od e A nn . § 74 . 351 . .. . .. . . .. . .. . .. . .. . .. . 2 , 9 , 11 , 12 13 , 16 , 19 T e x . C i v . P r ac . & R e m . § 74 . 351 (r)( 5 )( A )-( B ) ...................................... 19 T e x . C i v . P r ac . & R e m .. § 7 4 . 3 5 1 ( r ) ( 6 ) . .. . . .. . .. . . .. . .. . .. . . .. . . 2 , 8 , 9 , 1 1 , 1 2 , 1 3 , 16 , 19 T e x . C i v . P r ac . & R e m . § 7 4 . 4 0 1 . .. . .. . . .. . .. . .. . . .. . .. . .. . . .. . .. . .. . . .. . . 1 1 , 14 , 19 T e x . C i v . P r ac . & R e m . § 7 4 . 4 0 2 . .. . . .. . . .. . . .. . . .. . . .. . .. . . .. . . .. . . 14 , 1 6 , 1 7 , 18 , 19
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V *6 Tex. Civ. Prac. & Rem.§ 74.402(b)(l) ...................................... 17, 18, 19 Tex. Civ. Prac. & Rem. § 74.402(a)(2) ...................................... 17, 18, 19 TEX. GOV'T CODE ANN.§ 311.005(13) (Vernon 2005) ............................. 18
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T A TE M E N T O F T H E CA S E *7 T h i s i s a h ea lt h ca s e li a b ilit y c l a i m i nvo l v i ng nu r s i ng n e g li g e n ce a g a i n s t E un i ce A s a h , R . N . ( h e r e i n a f t e r r e f e rr e d t o a s " N u r s e A s a h " ) , a nd h e r e m p l oy e r , E p i c H ea lt h S e r v i ce s , I n c ., w h i c h w a s o r i g i n a ll y f il e d on M a r c h 4 , 2013 , i n E lli s C oun t y , T e x a s , ( CR 7 ) a nd s ub s e qu e n tl y a m e nd e d on M a r c h 27 , 2013 . ( CR 16 ) . P a tti B i ngh a m , R . N . a nd D r . C h a r l e s M a r a b l e , M . D . p r e p a r e d i n iti a l e xp e r t r e po r t s w h i c h w e r e s ub s e qu e n tl y a m e nd e d a nd s e r v e d on D e f e nd a n t s on A ugu s t 29 , 2013 . ( CR 197 ) . O n S e p t e m b e r 17 , 2013 , E p i c H ea lt h S e r v i ce s f il e d D e f e nd a n t E p i c H ea lt h S e r v i ce , I n c . ' s O b j ec ti on t o P l a i n ti ff s A m e nd e d C h a p t e r 74 E xp e r t R e po r t s & M o ti on t o D i s m i ss . ( CR 199 ) . O n S e p t e m b e r 18 , 2013 , A s a h f il e d D e f e nd a n t E un i ce A s a h ' s O b j ec ti on s t o P l a i n ti ff s A m e nd e d C h a p t e r 74 E xp e r t R e po r t s & M o ti on t o D i s m i ss . ( CR 219 ) . O n J un e 23 , 2015 , t h e D i s t r i c t C ou r t g r a n t e d D e f e nd a n t s ' m o ti on s t o d i s m i ss on a ll P l a i n ti ff s ' i ss u e s a nd s i gn e d a n O r d e r on D e f e nd a n t E un i ce A s a h & E p i c H ea lt h S e r v i ce s , I n c . ' s O b j ec ti on s t o P l a i n ti ff s a m e nd e d c h a p t e r 74 E xp e r t R e po r t s & M o ti on s t o D i s m i ss . ( CR 379 ) .
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SS U E S P R E S E N TE D *8 1 . W e r e t h e e xp e r t a m e nd e d r e po r t s p r ov i d e d t o t h e A pp e ll ee s i n c o m p li a n ce w it h T e x . C i v . P r ac . & R e m . 74 . 35 l ( a ) ? D i d t h e a m e nd e d e xp e r t r e po r t s c o m p l y w it h t h e r e qu i r e m e n t s o f T e x . C i v . P r ac . & R e m .
2 . 74 . 35 l (r)( 6 ) a nd pu t t h e A pp e ll ee s on no ti ce o f t h e c ondu c t ca ll e d i n t o qu e s ti on ? D i d t h e d i s t r i c t c ou r t e rr i n d i s m i ss i ng t h e c l a i m s o f v i ca r i ou s li a b ilit y a g a i n s t a n
3 . e m p l oy e r o f a h ea lt h ca r e p r ov i d e r on t h e b a s i s o f t h e e xp e r t r e po r t s ? 2
STATEMENT OF FACTS
On September 10, 2012, CHRISTIAN MARENTE, hereinafter Christian, was a *9 seventeen-year-old male with a history of Jeune syndrome and restrictive lung disease. Jeune syndrome (asphyxiating thoracic dystrophy, ATD) is a rare autosomal recessive skeletal dysplasia [ dysplasia is an abnormality within the cells of tissue that affects growth, development and function] characterized by a small, narrow chest and variable limb shortness. There is a considerable neonatal mortality as a result of respiratory distress. Renal, hepatic, pancreatic, and ocular complications may occur later in life. Christian had respiratory complications that had left him with a tracheostomy and mechanical-ventilator dependent. He had asthma and chronic kidney disease and had received a kidney transplant in July 2007. On September 10, 2012 CHRISTIAN was on oxygen 2 liters at all times. At night, he was on the ventilator; thus requiring 24 hour sitting provided by a home health service.
At approximately 5:00 p.m. on September 10, 2012, EUNICE ASAH, hereinafter Nurse Asah, a home health nurse provided by EPIC Health Services was bathing Christian in his home at 313 E. Freeman, Ennis, Texas. They were alone and while putting him "back to bed" the "tracheostomy" came out. As documented in the EMS Patient Care Report, Nurse Asah "made multiple attempts to place the trachea tube back into place but has been unsuccessful." Christian received Bag-Valve-Mask [BVM] ventilation and became pulseless. Nurse Asah began chest compressions. EMS was called and upon arrival continued Cardio- pulmonary resuscitation, obtained a blood pressure and then transported Christian to Children's Medical Center, Dallas, Texas for ongoing care. Christian had been pulseless approximately 10-15 minutes.
Nurse Asah initially stated she was "changing out his trach and the patient was moving around ... and it came out." Nurse Asah says she "made multiple attempts to place the trachea 3 t ub e b ac k i n t o p l ace " bu t c ou l d no t . A cc o r d i ng t o t h e Dis~harge S u mm a r y fr o m C h il d r e n ' s M e d i ca l C e n t e r , s h e t h e n t r i e d t o r e p l ace t h e t r ac h ea w it h a 5 . 5 t r ac h t ub e , bu t w a s no t s u cce ss f u l . S h e t h e n b e g a n b a g - v a l v e m a s k i ng [ B V M ] C h r i s ti a n t h r ough h i s t r ac h ea i n w h i c h *10 s h e h a d t o l d t h e 911 d i s p a t c h e r t h e t r ac h w a s " h a l f w a y i n . "
N u r s e A s a h s pok e w it h t h e 911 d i s p a t c h e r f o r a t o t a l o f 6 m i nu t e s . D u r i ng t h i s ti m e , s h e d i d no t i d e n ti f y h e r s e l f a s a R e g i s t e r e d N u r s e . T h e 911 d i s p a t c h e r w a s t e d v a l u a b l e ti m e e xp l a i n i ng t o N u r s e A s a h ho w t o ' c o m p l e t e t h e C a r d i o - pu l m on a r y r e s u s c it a ti on [ C P R ] p r o ce du r e s .
E M S r ece i v e d t h e ca ll a t 17 : 23 a nd a rr i v e d a t t h e ho m e 17 : 28 . U pon a rr i v a l , C h r i s ti a n d i d no t h a v e a pu l s e , a nd C P R w a s c on ti nu e d . E M S do c u m e n t e d " P t ' s t r ac h ea op e n i ng i s b l o c k e d by t h e p t ' s n ec k . " T h e y no t e d i n s e r ti ng a " 6 . 0 mm ET t ub e t h r ough h i s t r ac h ea . " T h e y t h e n t r a n s f e rr e d C h r i s ti a n t o t h e a i r po r t w h e r e a i r ,. t ea m e m e r g e n c y f li gh t , A i r E v ac 74 , m e t t h e m a nd t r a n s f e rr e d C h r i s ti a n t o C h il d r e n ' s M e d i ca l C e n t e r i n D a ll a s , T e x a s .
C h r i s ti a n w a s p r onoun ce d d ecea s e d on S e p t e m b e r 23 , 2012 . N u r s e A s a h h a s r e po r t e d a t l ea s t t w o d i ff e r e n t r ea s on s a s t o ho w t h e t r ac h e o s t o m y t ub e
ca m e ou t . N u r s e A s a h f i r s t r e po r t e d i n h e r 911 ca ll t h a t w h il e pu tti ng C h r i s ti a n b ac k t o b e d t h e t r a c h e o s t o m y c a m e o u t . I n r e s p o n s e t o i n t e r r og a t o r i e s , N u r s e A s a h r e po r t e d t h a t s h e r e m ov e d t h e t r ac h e o s t o m y i n p r e p a r a ti on t o r e p l ac i ng t h e t r ac h .
T h e f i r s t s t a t e m e n t by N u r s e A s a h i m p li e s t h a t t h e t r ac h ca m e ou t acc i d e n tl y . T h e s ec ond s t a t e m e n t m a k e s it c l ea r t h a t N u r s e A s a h r e m ov e d t h e t r ac h i n t e n ti on a ll y . W h a t i s i m po r t a n t i s t h a t C r i s ti n a M a r e n t e w a s t h e on l y p e r s on t h a t e v e r c h a ng e d t h e t r ac t a nd n e v e r c h a ng e d t h e t r ac h on N u r s e A s a h ' s s h i f t . N u r s e A s a h t r y t o i gno r e t h e f ac t t h a t t h e r e p l ac i ng o f t h e t r ac h w a s no t h e r r e s pon s i b ilit y a nd s h e s hou l d h a v e n e v e r h a v e und e r t a k e n t h e p r o ce du r e o f r e m ov i ng t h e
4 trach for the purpose of replacing the trach on the date in question. The removing and replacing of the trach in the home was the sole responsibility of the mother, Cristina Marente. Second, Nurse Asah ignores the fact that the removing and replacing of the trach was never done on her *11 shift. It was always done on the following shift with another nurse present when Cristina Marente changed the trach.
As set forth in Appellants' First Amended Petition:(CR 18-19).
NEGLIGENCE - BREACH OF STANDARD OF CARE:
a. Among the Significant Breaches in Standard of Care by EPIC Health Services, Inc., and through its employee, EUNICE ASAR, RN: 1. ASAH's conduct fell below nursing Standard of Care when she failed to
properly care for the trach. 11. ASAH's conduct fell below nursing Standard of Care when she failed to immediately call appropriate emergency medical assistance when the patient showed initial signs of distress.
111. ASAH's conduct fell below nursing Standard of Care when she failed to give the 911 dispatcher the correct street address of 311 East Freeman Street.
1v. ASAH's conduct fell below nursing Standard of Care when she failed to immediately identify herself as a registered nurse resulting in unnecessary delay.
v. ASAH's conduct fell below nursing Standard of Care when she failed to properly communicate with the 911 operator. vi. ASAH's conduct fell below nursing Standard of Care when she failed to 5 r e m a i n ca l m a nd c o ll ec t e d i n a p r o f e ss i on a l m a nn e r . vn . A S AH ' s c ondu c t f e ll b e l o w nu r s i ng S t a nd a r d o f C a r e w h e n s h e f a il e d t o h a v e t h e p r op e r t r a i n i ng f o r ho m e h ea lt h ca r e f o r t r ac h e o s t o m y p a ti e n t s . b . T o ac h i e v e po s iti v e ou t c o m e s i n p a ti e n t s w it h t r ac h t ub e s , e v e r y nu r s e n ee d s t o *12 k ee p a b r ea s t o f t h e b e s t p r ac ti ce s , d e v e l op , a nd m a i n t a i n t h e n ece ss a r y s k ill s . A nu r s e w ho p e rf o r m s t r ac h ca r e n ee d s t o b e f a m ili a r w it h t h e i r f ac ilit y ' s po li c y a nd p r o ce du r e . P e r t h e S i x - S t e p D ec i s i on - M a k i ng M od e l f o r D e t e r m i n i ng N u r s i ng S c op e o f P r ac ti ce i n T e x a s , " A nu r s e a l w a y s h a s a du t y t o h i s / h e r c li e n t s / p a ti e n t s t o a ss u r e t h a t t h e y a r e s a f e . O n e o f t h e m o s t i m po r t a n t ac ti on s a nu r s e ca n t a k e t o w a r d t h a t go a l i s m a k i ng s u r e t h a t h e / s h e on l y acce p t s t ho s e a ss i gn m e n t s f o r w h i c h t h e nu r s e h a s t h e e du ca ti on , t r a i n i ng , a nd s k ill c o m p e t e n c y . P hy s i ca l a nd e m o ti on a l a b ilit y ca n a l s o i m p ac t a nu r s e ' s a b ilit y t o m a i n t a i n c li e n t s a f e t y w h e n acce p ti ng a n a ss i gn m e n t . "
c . P l a i n ti ff s a ss e r t t h a t t h e ca r e r e nd e r e d t o C H R I S T I AN M A R E N TE by E P I C HO M E S E R V I C E S , I N C ., a nd E UN I C E A S A R d i d no t m ee t nu r s i ng S t a nd a r d o f C a r e . A S A R s hou l d h a v e :
P r o p e r l y m a i n t a i n e d C h r i s t i a n ' s t r a c h e o s t o m y w h il e t r a n s f e rr i ng o r i . c h a ng i ng t h e t r ac h s it e . n . I mm e d i a t e l y ca ll e d E m e r g e n c y p e r s onn e l f o r a dd iti on a l h e l p . I d e n ti f y R e g i s t e r e d N u r s e qu a li f i ca ti on s t o a pp r op r i a t e a u t ho r iti e s t o a vo i d 111 . unn ece ss a r y d e l a y i n a dd iti on a l a ss i s t a n ce . 1v . M a i n t a i n a c o m po s e d , p r o f e ss i on a l c ondu c t w h il e und e r a n e m e r g e n c y s it u a ti on . 6 v . F o ll o w t h e A m e r i ca n H ea r t A ss o c i a ti on ' s gu i d e li n e s f o r C a r d i o - pu l m on a r y r e s u s c it a ti on . v i . I n s tit u t e d a pp r op r i a t e nu r s i ng i n t e r v e n ti on s t h a t r e qu i r e d s t a b ili za ti on i n a p a ti e n t ' s c ond iti on . *13 V I L B ee n p r op e r l y t r a i n e d i n t h e ca r e o f a t r ac h e o s t o m y p a ti e n t a nd i n ho w t o p r op e r l y ac t i n a n e m e r g e n c y s it u a ti on . 7
S
U MM ARY O F T H E AR G U M E N T N u r s e B i ngh a m ' s a m e nd e d e xp e r t r e po r t f u l f ill s t h e r e qu i r e m e n t o f T e x . C i v . P r ac . & R e m . §74 . 35 l ( r )( 6 ) . S h e f u ll y d i s c u ss e s t h e s t a nd a r d o f ca r e , ho w t h e s t a nd a r d w a s b r eac h e d by N u r s e A s a h , a nd ho w t h e b r eac h l e d t o C h r i s ti a n ' s i n j u r i e s . F u r t h e r m o r e , t h e r e po r t i s m o r e t h a n s u ff i c i e n t t o i n f o r m t h e N u r s e A s a h o f t h e c ondu c t ca ll e d i n t o qu e s ti on a nd p r ov i d e s a b a s i s f o r *14 t h e t r i a l c ou r t t o c on c l ud e t h a t t h e c l a i m s h a v e m e r it .
D r . M a r a b l e ' s a m e nd e d e xp e r t r e po r t f u l f ill s t h e r e qu i r e m e n t s o f TE X . C I V . P R A C . & R E M . § 7 4 . 3 5 1 ( r)( 6 ) . H e f u ll y d i s c u ss e s t h e s t a nd a r d o f ca r e , ho w t h e s t a nd a r d w a s b r eac h e d by N u r s e A s a h , a nd ho w t h e b r eac h l e d t o C h r i s ti a n ' s i n j u r i e s w it h r e s p ec t t o N u r s e A s a h ' s c ondu c t . F u r t h e r m o r e , t h e r e po r t i s m o r e t h a n s u ff i c i e n t t o i n f o r m N u r s e A s a h o f t h e c ondu c t ca ll e d i n t o qu e s t i on a nd p r ov i d e s a b a s i s f o r t h e t r i a l c ou r t t o c on c l ud e t h a t t h e c l a i m s h a v e m e r i t .
N o e xp e r t r e po r t w a s n ece ss a r y w i t h r e s p ec t t o A pp e l l a n t s ' c l a i m s f o r v i ca r i ou s li a b il it y a g a i n s t E p i c H ea lt h S e r v i ce s . T h e c ou r t e rr e d by d i s m i ss i ng t ho s e c l a i m s on t h e b a s i s o f E p i c H ea lt h S e r v i ce s ' s ob j ec ti on s t o t h e e xp e r t r e po r t .
8
ARGUMENT
The issue in this Appeal is whether or not Nurse Bingham's amended expert report and Dr. Marable's amended expert report fulfills the requirement of Tex. Civ. Prac. & Rem. §74. The Courts have said, "In determining whether an expert is qualified, we must be careful not to draw expert qualifications "too narrowly." Larson v. Downing, 197 S.W.3d 303, 305 (Tex. 2006); Adeyemi v.Guerrero, 329 S.W.3d 241, 247 (Tex. App.-Dallas 2010, no pet.). Defendants *15 attempt to frame the argument around the medical condition of Christian to avoid addressing the specific negligent acts of Nurse Asah that essentially have nothing to do with his medical condition and therefore ask the court to narrowly define the expert qualifications necessary to fulfill the requirements of Tex. Civ .. Prac. & Rem. §74.
A health care liability claimant must timely provide each defendant healthcare provider with an expert report. See Tex. Civ. Prac. & Rem. Code Ann.§ 74.351; Gray v. CHCA Bayshore, L.P., 189 S.W.3d 855, 858 (Tex.App.-Houston [1st Dist.] 2006, no pet.) The report must provide a "fair summary" of the expert's opinions as of the date of the report regarding the applicable standards of care, the manner in which the care rendered by the health care provider failed to meet the standard, and the causal relationship between that failure and the injury, harm, or damages claimed. Tex. Civ. Prac. & Rem. Code Ann. §74.351(r)(6).
If a defendant health care provider files a motion to dismiss, challenging the adequacy of a claimant's expert report, a trial court must grant the motion if it appears, after a hearing, that the report does not represent an objective good faith effort to comply with the definition of an expert report or is not sufficiently specific to provide a basis for the trial court to conclude that the claims have merit. Id § 74.351(1); Scoresby v. Santillan, 346 S.W.3d 546, 555-56 (Tex. 2011). In setting out the expert's opinions, the report must provide enough information to fulfill two
9 pu r po s e s : ( 1 ) it m u s t i n f o r m t h e d e f e nd a n t o f t h e s p ec i f i c c ondu c t t h a t t h e p l a i n ti ff h a s ca ll e d ' i n t o qu e s ti on , a nd ( 2 ) it m u s t p r ov i d e a b a s i s f o r t h e t r i a l c ou r t t o c on c l ud e t h a t t h e c l a i m s h a v e m e r it . S c o r e s b y , 346 S . W . 3d a t 556 .
W e w ill a dd r e ss t h e qu a li f i ca ti on s a nd s u ff i c i e n c y o f D r . M a r a b l e ' s e xp e r t r e po r t f i r s t b eca u s e e ss e n ti a ll y t h e s a m e a r gu m e n t a pp li e s t o t h e qu a li f i ca ti on s a nd s u ff i c i e n c y o f N u r s e B i ngh a m ' s e xp e r t r e po r t .
*16 A S C ON C E R N S D R . M A R A B LE A s s t a t e d a bov e , D e f e nd a n t s a tt e m p t t o fr a m e t h e a r gu m e n t a r ound t h e m e d i ca l c ond iti on o f C h r i s ti a n t o a vo i d a dd r e ss i ng t h e s p ec i f i c n e g li g e n t ac t s o f N u r s e A s a h t h a t e ss e n ti a ll y h a v e no t h i ng t o do w it h h i s m e d i ca l c ond iti on , w h e n N u r s e A s a h s t a t e s :
" B u t t h e i ss u e i s no t w h e t h e r N u r s e A s a h i s qu a li f i e d t o t r ea t C h r i s ti a n i n t h i s s e tti ng , bu t w h e t h e r D r . M a r ab l e i s qu a li f i e d t o o ff e r op i n i on s a bou t a p e d i a t r i c ho m e h ea lt h ca r e nu r s e t r ea ti ng a p a ti e n t s u c h a s C h r i s ti a n und e r t h e s e c i r c u m s t a n ce s . A nd t h a t i s w h e r e D r . M a r a b l e ' s r e po r t f a il s . H e do e s no t s t a t e t h a t h e i s f a m ili a r w it h t h e nu r s i ng s t a nd a r d o f i ca r e a pp li ca b l e t o nu r s e s ( 1 ) ca r i ng f o r a p e d i a t r i c p a ti e n t w it h J e un e s ynd r o m e / r e s t r i c ti v e l ung d i s ea s e ; ( 2 ) w it h a t r ac h e o s t o m y r e qu i r i ng t h e a d m i n i s t r a ti on o f c on ti n uo u s o xy g e n t h e r a p y a n d n i g h t ti m e v e n til a ti on w it h a m ec h a n i ca l v e n til a t o r ; ( 3 ) i n t h e ho m e h ea lt h ca r e s e tti ng ; a nd - m o s t i m po r t a n tl y -- ( 4 ) r e qu i r i ng t r ac h e o s t o m y t ub e c h a ng e s , s u c h a s w a s p e rf o r m e d by N u r s e A s a h i n t h i s ca s e , o r ( 5 ) r e s pond i ng t o a n e m e r g e n c y s it u a ti on s u c h a s t h e on e f ace d by N u r s e A s a h i n t h i s ca s e . " ( CR 232 ) T h e on l y r ea l i ss u e c on ce r n s nu m b e r ( 5 ) a bov e a s t o t h e a pp r op r i a t e r e s pon s e by N u r s e
A s a h t o t h e s p ec i f i c e m e r g e n c y s it u a ti on s h e c r ea t e d m a d e t h e b a s i s o f t h i s s u it . D r . M a r a b l e ' s r e po r t w a s s u ff i c i e n t t o s a ti s f y t h e r e qu i r e m e n t s o f T e x . C i v . P r ac . & R e m . 1 0 74 . 35 . 1 . A dd iti on a ll y , D r . M a r a b l e i s f u ll y qu a li f i e d und e r T e x . C i v . P r ac . & R e m . 74 . 402 t o o ff e r op i n i on s i n t h i s ca s e .
N u r s e A s a h a ll e g e s t h a t D r . M a r a b l e w a s no t qu a li f i e d und e r T e x . C i v . P r ac . & R e m . 74 . 402 t o r e nd e r a n op i n i on a s t o t h e s t a nd a r d o f ca r e a pp li ca b l e t o N u r s e A s a h i n t h i s ca s e . ( CR 233 )
" T h e e xp e r t t e s ti f y i ng i n a m e d i ca l m a l p r ac ti ce ca s e n ee d no t b e a s p ec i a li s t i n t h e p a r ti c u l a r b r a n c h o f t h e p r o f e ss i on f o r w h i c h t e s ti m ony i s o ff e r e d ; t h e s t a t u t e s e tti ng ou t t h e *17 r e qu i s it e qu a li f i ca ti on s f o c u s e s no t on t h e d e f e nd a n t do c t o r ' s a r ea o f e xp e r ti s e , bu t on t h e c ond iti on i nvo l v e d i n t h e c l a i m . " R itt g e r v . D ano s , 332 S . W . 3d 550 , 558 ( T e x . A pp . - H ou s t on [ 1 s t D i s t . ] 2009 , no p e t . ) ( c iti ng B l an v . A li , 7 S . W . 3d 741 , 745 ( T e x . A pp . - H ou s t on [ 14 t h D i s t . ] 1999 , no p e t . )) .
D r . M a r a b l e i s m o r e t h a n qu a li f i e d t o t e s ti f y a bou t t h e s t a nd a r d o f ca r e f o r a nu r s e li k e N u r s e A s a h p e rf o r m i ng t h e du ti e s s h e w a s s uppo s e t o b e p e rf o r m i ng a t t h e ti m e w it h C h r i s ti a n . N u r s e A s a h c on ti nu e s t o f o c u s h e r a r gu m e n t s on t h e m e d i ca l c ond iti on o f C h r i s ti a n a nd no t on t h e e x t e n s i v e m e d i ca l h i s t o r y o f D r . M a r a b l e i n w o r k i ng w it h nu r s e s .
T h e m e d i ca l c ond iti on o f t h e p a ti e n t i n t h i s ca s e i s no t t h e p r op e r i nqu i r y und e r T e x . C i v . P r ac . & R e m . 7 4 . 4 0 1 . D r . M a r a b l e a r ti c u l a t e d v e r y c l ea r l y i n h i s e x p e r t r e po r t , b o t h i n t h e i n t r odu c ti on ( CR 253 ) a nd t h e s ec ti on titl e d " QUA L I F I C A T I ON S " a s t o h i s e xp e r i e n ce a s t o t h e m a tt e r s m a d e t h e b a s i s o f t h i s s u it a nd w it h t h e S t a nd a r d o f C a r e " ( CR 254 - 263 ) t h a t h e i s f a m ili a r w it h t h e s t a nd a r d o f ca r e f o r a nu r s e w a t c h i ng a p a ti e n t und e r t h e c i r c u m s t a n ce s i n t h i s ca s e a nd t h a t N u r s e A s a h b r eac h e d t h a t s t a nd a r d o f ca r e .
D r . M a r a b l e ' s r e po r t c o m p l i e s w it h t h e r e qu i r e m e n t s o f T e x . C i v . P r a c . & R e m . §74 . 351 (r)( 6 ) w it h r e s p ec t t o a ll A pp e l l ee s . 11 " A n e xp e r t r e po r t m u s t d i s c u ss t h e s t a nd a r d o f ca r e , b r eac h , a nd ca u s a ti on w it h s u ff i c i e n t s p ec i f i c it y t o i n f o r m t h e d e f e nd a n t o f t h e c ondu c t t h e p l a i n ti ff h a s ca ll e d i n t o qu e s ti on a nd t o ( p r ov i d e a b a s i s f o r t h e t r i a l c ou r t t o c on c l ud e t h a t t h e c l a i m s h a v e m e r it . " A m e r i c an T r an s iti ona l C a r e C e n t e rs o f T ex a s , I n c . v . P a l a c i o s , 46 S . W . 3d 873 , 875 ( T e x . 2001 ) . D r . M a r a b l e ' s r e po r t d i d e x ac tl y w h a t t h e S up r e m e C ou r t r u l e d it m u s t i n P a l a c i o s . I n h i s r e po r t , D r . M a r a b l e d i s c u ss e d , i n d e t a il , t h e s t a nd a r d o f ca r e , w h a t s p ec i f i c c ondu c t o f eac h d e f e nd a n t b r eac h s a i d s t a nd a r d o f ca r e , a nd ho w t h a t b r eac h p r ox i m a t e l y ca u s e d C h r i s ti a n ' s i n j u r i e s . T h e d i s t r i c t c ou r t gav~ no r ea s on i ng f o r g r a n ti ng t h e m o ti on s t o d i s m i ss , bu t a d i s m i ss a l f o r f a il u r e t o c o m p l y w it h *18 t h e r e qu i r e m e n t s o f T e x . C i v . P r ac . & R e m . §74 . 35 l (r)( 6 ) w ou l d c on s tit u t e a n a bu s e o f d i s c r e ti on a nd ca nno t b e uph e l d .
T e x . C i v . P r ac . & R e m . §74 . 35 l (r)( 6 ) r e qu i r e s on l y " a f a i r s u mm a r y o f t h e e xp e r t ' s op i n i on s a s o f t h e d a t e o f t h e r e po r t r e g a r d i ng a pp li ca b l e s t a nd a r d s o f ca r e , t h e m a nn e r i n w h i c h t h e ca r e r e nd e r e d by t h e phy s i c i a n o r h ea lt h ca r e p r ov i d e r f a il e d t o m ee t t h e s t a nd a r d s , a nd t h e ca u s a l r e l a ti on s h i p b e t w ee n t h a t f a il u r e a nd t h e i n j u r y , h a r m , o r d a m a g e s c l a i m e d . " A m o ti on t o d i s m i ss s hou l d on l y b e g r a n t e d i f " t h e r e po r t do e s no t r e p r e s e n t a n ob j ec ti v e good f a it h e ff o r t t o c o m p l y w it h [ t h a t ] d e f i n iti on . " T e x . C i v . P r ac . & R e m . §74 . 351 ( 1 ) .
D r . M a r a b l e ' s r e po r t f u l f i l l s a ll t h r e e r e qu i r e m e n t s o f T e x . C i v . P r ac . & R e m . §74 . 35 l (r)( 6 ) . H e s u mm a r i ze s h i s op i n i on s a s t o t h e a pp li ca b l e s t a nd a r d s o f ca r e , t h e m a nn e r i n w h i c h t h e ca r e r e nd e r e d by N u r s e A s a h f a il e d t o m ee t t ho s e s t a nd a r d s , a nd t h e ca u s a l r e l a ti on s h i p b e t w ee n t h a t f a il u r e a nd t h e i n j u r y , h a r m , o r d a m a g e s c l a i m e d . ( CR 254 - 263 )
I n a l e ng t hy p a r a g r a ph i n t h e s t a nd a r d o f ca r e s ec ti on o f h i s r e po r t , D r . M a r a b l e e xp l a i n s , i n d e t a i l , t h e ca u s a l l i nk b e t w ee n N u r s e A s a h ' s a c ti on s a nd C h r i s t i a n ' s i n j u r y . ( CR 256 ) H e r e it e r a t e s a nd e l a bo r a t e s upon s e v e r a l po i n t s i n p a r a g r a ph s i n t h e b r eac h o f t h e s t a nd a r d o f c a r e
1 2 ( CR 258 - 258 ) a nd ca u s a ti on ( CR 262 - 263 ) s ec ti on s o f h i s r e po r t . A s r e qu i r e d by T e x . C i v . P r ac . & R e m . §74 . 35 l (r)( 6 ) a nd P a l ac i o s , D r . M a r a b l e ' s r e po r t i n f o r m e d N u r s e A s a h o f t h e s p ec i f i c c ondu c t ca ll e d i n t o qu e s ti on . B a s e d on C h r i s ti a n ' s a s c r ea t e d by N u r s e A s a h a nd t h e s p ec i f i c s t e p s N u r s e A s a h s hou l d h a v e t a k e n s p ec i f i c i d e n ti f i e d ac ti on s s e t f o r t h i n h i s r e po r t . ( CR 261 - 262 )
A
S C ON C E R N S E P I C H E A LT H S E R V I C E S D r . M a r a b l e ' s r e po r t a dd r e ss e s A pp e ll a n t s ' d i r ec t li a b ilit y c l a i m s a g a i n s t E p i c H ea lt h S e r v i ce s . A s h e d i d w it h c ondu c t o f N u r s e A s a h , h e e xp l a i n e d , i n d e t a il , ho w E p i c H ea lt h *19 S e r v i ce s ca u s e d C h r i s ti a n ' s i n j u r i e s . E p i c H ea lt h S e r v i ce s s hou l d h a v e h a d p r o t o c o l s f o r e v a l u a ti on , c on s u lt a ti on , a d m i ss i on , a nd f o ll o w - up t h a t r e s u lt e d i n a d e qu a t e ca r e o f p a ti e n t s s hou l d a n e m e r g e n c y c ond iti on a r i s e . T h e f a il u r e t o h a v e i n p l ace a nd a b i d e by s u c h p r o t o c o l s w a s a b r eec h i n t h e s t a nd a r d o f ca r e . " ( CR 261 - 262 )
" E p i c H ea lt h S e r v i ce s ' f a il e d [ s i c ] t o h a v e o r i m p l e m e n t a d e qu a t e p r o t o c o l s f o r e v a l u a ti on c on s u lt a ti on , a d m i ss i on , a nd f o ll o w - up t h a t r e s u lt e d i n a d e qu a t e ca r e o f t h i s p a ti e n t w it h du r a l s i nu s t h r o m bo s i s a nd i d i op a t h i c i n t r ac r a n i a l hyp e r t e n s i on . T h e f a il u r e t o h a v e i n p l ace a nd a b i d e by s u c h p r o t o c o l s w a s a b r eec h i n t h e s t a nd a r d o f ca r e t h a t w a s a p r ox i m a t e ca u s e o f C h r i s t i a n ' s d e a t h . ( CR 262 - 263 ) T h e f o r e go i ng p a r a g r a ph s i n D r . M a r a b l e ' s r e po r t a r e c l ea r l y s u ff i c i e n t t o " i n f o r m t h e d e f e nd a n t o f t h e s p ec i f i c c ondu c t t h e p l a i n ti ff h a s ca ll e d i n t o qu e s ti on " a nd t o " p r ov i d e a b a s i s f o r t h e t r i a l c ou r t t o c on c l ud e t h a t t h e c l a i m s h a v e m e r it . " P a l a c i o s , 46 S . W . 3d a t 879 .
A
S C ON C E R N S NU R S E B I NGHA M N u r s e B i ngh a m ' s r e po r t w a s s u ff i c i e n t t o s a ti s f y t h e r e qu i r e m e n t s o f T e x . C i v . P r a c . & R e m . 74 . 351 . T h e s a m e a r gu m e n t f o r D r . M a r a b l e a pp l i e s t o N u r s e B i ngh a m . 13 N u r s e B i ngh a m i s f u ll y qu a li f i e d und e r T e x . C i v . P r ac . & R e m . 74 . 402 t o o ff e r op i n i on s i n t h i s ca s e . N u r s e A s a h ' s ob j ec ti on t o N u r s e B i ngh a m ' s r e po r t b eca u s e " N u r s e B i ngh a m ' s c r iti c i s m s o f N u r s e A s a h s o l e l y r e l a t e t o h e r h a nd li ng o f t h e S e p t e m b e r 10 , 2012 t r ac h e o s t o m y i n c i d e n t . " ( CR 227 ) . T h a t i s a b s o l u t e l y c o rr ec t , b eca u s e t h a t i s t h e on l y ti m e N u r s e A s a h n e g li g e n tl y ca u s e d t h e t r ac h t o b e r e m ov e d a nd p a n i c k e d w h e n s h e c ou l d no t pu t t h e t r ac h b ac k i n . T h e ca r e a nd t r ea t m e n t p r ov i d e d by N u r s e A s a h up un til t h e i n c i d e n t w a s a d e qu a t e b eca u s e N u r s e A s a h n e v e r c h a ng e d o r r e m ov e d t h e t r ac h b e f o r e t h e d a t e i n qu e s ti on .
N u r s e A s a h a tt e m p t s t o b e gu il e t h e i ss u e s by c on ce n t r a ti ng on t h e m e d i ca l c ond iti on o f *20 C h r i s ti a n a nd i m p l y i ng t h a t on l y s o m e on e t h a t h a s t r ea t e d a p a ti e n t w it h J e un e s ynd r o m e / r e s t r i c ti v e l ung d i s ea s e i n a ho m e h ea lt h ca r e e nv i r on m e n t ca n g i v e a n op i n i on on t h e n e g li g e n ce o f a nu r s e t h a t n e g li g e n tl y r e m ov e s a t r ac h a nd t h e n p a n i c s w h e n s h e ca nno t r e - i n s e r t t h e t r ac h . T h a t i s no t a r e qu i r e m e n t t o qu a li f y a s a n e xp e r t und e r C P RC §74 . 402 .
N u r s e B i ngh a m i s ce r ti f i e d a nd qu a li f i e d a s a r e g i s t e r e d nu r s e a nd i s ac ti v e l y p r ac ti c i ng h ea lt h ca r e i n r e nd e r i ng h ea lt h ca r e s e r v i ce s r e l e v a n t t o t h e c l a i m . N u r s e A s a h ' s du ti e s on t h e d a t e i n qu e s ti on w e r e a s a " s itt e r " t h a t s t a y e d w it h Chris~ian a nd ob s e r v e d h i m . H e r du ti e s i n c l ud e d w a s h i ng a nd f ee d i ng C h r i s ti a n ; m on it o r i ng t h e b r ea t h i ng e qu i p m e n t a nd p e r i od i ca ll y s u c ti on i ng m u c u s ou t o f h i s t r ac h e o s t o m y . N u r s e B i ngh a m h a s m o r e qu a li f i ca ti on s a nd e xp e r i e n ce a s a r e g i s t e r e d nu r s e t h a n N u r s e A s a h a nd N u r s e B i ngh a m ' s qu a li f i ca ti on s a nd e xp e r i e n ce c l ea r l y s ho w t h a t s h e kno w s t h e s t a nd a r d o f ca r e i n a n e m e r g e n c y s it u a ti on s u c h a s t h a t c r ea t e d by N u r s e A s a h on S e p t e m b e r 10 , 2012 .
N u r s e B i ngh a m a dd r e ss e d t h e p r op e r s t a nd a r d o f ca r e f o r a ho m e h ea l t h ca r e nu r s e i n h e r r e po r t . ( CR 243 ) 1 4 1 . M on it o r t h e v it a l s i gn s o f C h r i s ti a n p e r t h e S k ill e d N u r s i ng F l o w s h ee t d a il y ; T o a nno t a t e t h e S k ill e d N u r s i ng F l o w s h ee t d a il y ; . 2 . 3 . M on it o r t h e v e n til a t o r e qu i p m e n t; 4 . M on it o r t h e m u c u s bu il d up i n t h e t r ac h a nd s u c ti on t h e m u c u s ou t p e r i od i ca ll y ; C l ea n a r ound t h e t r ac h op e n i ng ; 5 . O b s e r v e C h r i s ti a n f o r a ny s i gn s o f s t r e ss o r d i ff i c u lt y b r ea t h i ng ; 6 . 7 . B a t h C h r i s ti a n a s r e qu i r e d . N u r s e B i ngh a m s t a t e d i n h e r r e po r t t h a t N u r s e A s a h d i d breach~d t h e s t a nd a r d o f ca r e .
( CR 243 - 245 ) " It i s m y op i n i on t h a t on S e p t e m b e r 10 , 2012 , N u r s e A s a h b r eac h e d t h e S t a nd a r d o f C a r e *21 a pp li ca b l e t o E un i ce A s a h , R N , a s f o ll o w s :
N u r s e A s a h , R N b r eac h e d t h e nu r s i ng S t a nd a r d o f C a r e w h e n s h e r e m ov e d t h e 1 . t r ac h fr o m C h r i s ti a n ; a p r o ce du r e t h a t w a s no t h e r r e s pon s i b ilit y . N u r s e A s a h , R N b r eac h e d t h e nu r s i ng S t a nd a r d o f C a r e w h e n s h e f a il e d t o 2 . i mm e d i a t e l y ca ll a pp r op r i a t e e m e r g e n c y m e d i ca l a ss i s t a n ce w h e n t h e p a ti e n t s ho w e d i n iti a l s i gn s o f d i s t r e ss . N u r s e A s a h , R N b r eac h e d t h e nu r s i ng S t a nd a r d o f C a r e w h e n s h e f a il e d t o g i v e
3 . t h e 911 d i s p a t c h e r t h e c o rr ec t s t r ee t a dd r e ss o f 311 E a s t F r ee m a n S t r ee t . N u r s e A s a h , R N b r eac h e d t h e nu r s i ng S t a nd a r d o f C a r e w h e n s h e f a il e d t o
4 . i mm e d i a t e l y i d e n ti f y h e r s e l f a s a r e g i s t e r e d nu r s e r e s u lti ng i n unn e ce ss a r y d e l a y . N u r s e A s a h , R N · b r eac h e d t h e nu r s i ng S t a nd a r d o f C a r e w h e n s h e f a il e d t o
5 . p r op e r l y c o mm un i ca t e w it h t h e 911 op e r a t o r . N u r s e A s a h , R N b r eac h e d t h e nu r s i ng S t a nd a r d o f C a r e w h e n s h e f a il e d t o r e m a i n
6 . ca l m a nd c o ll ec t e d i n a p r o f e ss i on a l m a nn e r . N u r s e A s a h , R N b r eac h e d t h e nu r s i ng S t a nd a r d o f C a r e w h e n s h e f a il e d t o h a v e
7 . t h e p r op e r t r a i n i ng f o r ho m e h e a l t h ca r e f o r t r ac h e o s t o m y p a t i e n t s . T h e e xp e r t r e po r t o f N u r s e B i ngh a m c l ea r l y s ho w s t h a t s h e i s a p e r s on qu a li f i e d a s a n 1 5 e xp e r t w it n e ss t o op i n e a s t o t h e s t a nd a r d o f ca r e a g a i n s t N u r s e A s a h , a h ea lt h ca r e p r ov i d e r i n a h ea lt h ca r e li a b ilit y l a w s u it , b eca u s e N u r s e B i ngh a m :
( 1 ) i s p r ac ti c i ng h ea lt h ca r e i n a f i e l d o f p r ac ti ce t h a t i nvo l v e s t h e s a m e t yp e o f ca r e o r t r ea t m e n t a s t h a t d e li v e r e d by t h e d e f e nd a n t h ea lt h ca r e p r ov i d e r , i f t h e d e f e nd a n t h ea lt h ca r e p r ov i d e r i s a n i nd i v i du a l , a t t h e ti m e o f t e s ti m ony i s g i v e n o r w a s p r ac ti c i ng t h a t t yp e o f h ea lt h ca r e a t t h e ti m e t h e c l a i m a r o s e ;
( 2 ) h a s kno w l e dg e o f acce p t e d s t a nd a r d s o f ca r e f o r h ea lt h ca r e p r ov i d e r s f o r t h e d i a gno s i s , ca r e , o r t r ea t m e n t o f t h e ill n e ss , i n j u r y o r c ond iti on i nvo l v e d i n t h e c l a i m ; a nd
( 3 ) i s qu a li f i e d on t h e b a s i s o f t r a i n i ng o r e xp e r i e n ce t o o ff e r a n e xp e r t op i n i on r e g a r d i ng t ho s e acce p t e d s t a nd a r d s o f h ea lt h ca r e . ( CR 240 ) *22 T e x . C i v . P r ac . & R e m . C od e §74 . 402 ( b ) T h e e xp e r t r e po r t o f N u r s e B i ngh a m c l ea r l y p r ov i d e s a " f a i r s u mm a r y " o f t h e e xp e r t ' s op i n i on s a s o f t h e d a t e o f t h e r e po r t r e g a r d i ng : ( 1 ) t h e a pp li ca b l e s t a nd a r d s o f ca r e , ( 2 ) t h e I ' /
m a nn e r i n w h i c h t h e ca r e r e nd e r e d by t h e phy s i c i a n o r h ea lt h ca r e p r ov i d e r f a il e d t o m ee t t h e s t a nd a r d s , a nd ( 3 ) t h e ca u s a l r e l a ti on s h i p b e t w ee n t h a t f a il u r e a nd t h e i n j u r y , h a r m , o r d a m a g e s c l a i m e d . T e x . C i v . P r a c . & R e m . C o d e § 7 4 . 3 51 (r ) ( 6 ) ; s e e a l s o B a ll a n v . G i b s o n , 15 1 S . W . 3d 281 , 283 ( T e x . A pp . - D a ll a s 2004 , no p e t . ) .
T h e h ea r t o f N u r s e A s a h ' s ob j ec ti on s t o N u r s e B i ngh a m i s t h a t s h e do e s no t qu a li f y a s a n e xp e r t und e r C P RC § 74 . 402 b eca u s e t h e on l y p e r s on t h a t ca n qu a li f y i s a n e xp e r t i s a r e g i s t e r e d nu r s e s itti ng a t t h e ho m e o f a j uv e n il e p a ti e n t w it h J e un e s ynd r o m e a nd r e s t r i c ti v e l ung d i s ea s e t h a t h a s a t r ac h e o s t o m y on S e p t e m b e r 10 , 2012 . T h i s i s b eca u s e N u r s e r A s a h a ll e g e t h a t t h e " f i e l d o f p r ac ti ce " i s a " r e g i s t e r e d nu r s e s itti ng a t t h e ho m e o f a j uv e n il e p a ti e n t w it h J e un e
1 6 syndrome and restrictive lung disease that has a tracheostomy on September 10, 2012" and only a "registered nurse sitting at the home of a juvenile patient with Jeune syndrome and restrictive lung disease that has a tracheostomy on September 10, 2012" is the only field of practice that involves the same type of care or treatment as that delivered by Defendant Asah.
Plaintiffs' position iS that the "field of practice" is that of a registered nurse in Texas for which Nurse Bingham is more than qualified to opine on. Nurse Asah's position is an overly restrictive interpretation of CPRC § 74.402. The issue of an overly restrictive interpretation of CPRC § 74.402 was addressed in Group v. Vicenta , 164 S.W.3rd 724 (Tex.App.-[Houston 14th Dist] 2005). Group involves the issue of a chiropractic standard of care. Group argued beginning at p. 730,
" ... under section 74.402(b)(l), to qualify as an expert witness on the issue of whether Group departed from accepted standards of care, Dr. Saqer must be "practicing health *23 care in a field of practice that involves the same type of care or treatment as that delivered by the defendant health care provider, if the defendant health care provider is an individual; at thetime the testimony is given or was practicing that type of health care at the time the claim arose. "TEX. CIV. PRAC. & REM. CODE ANN.§ 74.402(b)(l). Group argues the term "practicing health care" as defined by subsection (a) requires a qualified expert in a chiropractic malpractice case to either be a chiropractor, train chiropractors at an accredited educational institution, or serve as a consulting health care provider to chiropractors and be licensed, certified, or registered as a chiropractor. See TEX. CIV. PRAC. & REM.CODE ANN.§ 74.402(a)(l), (2) ("For purposes of [section 74.402], 'practicing health care' includes: (1) training health care providers in the same field as the defendant health care provider at an accredited educational institution; or (2) serving as a consulting health care provider and bying licensed, certified, or registered in the same field as the defendant health care provider.") (emphasis added). Group contends Dr. Saqer does not meet the statutory definition of"practicing health care." In response, Vicente argues Dr. Saqer's report demonstrates he has Page 731 adequate knowledge, skill, experience, training, and education regarding his treatment of patients with conditions similar to Vicente's to qualify him as an expert under subsect~on (b)(l). Group's asserted construction of section 74.402, subsections (a)(l)-(2) and (b)(l), improperly limits and confines the definition of the term "practicing health care." Subsection (a) uses the term "includes" in defining "practicing health care." Although
17 Chapter 74 does not define the term "includes," the Code Construction Act defines "includes" as a term "of enlargement and not of limitation or exclusive enumeration, and use of [includes] does not create a presumption that components not expressed are excluded." TEX. GOV'T CODE ANN.§ 311.005(13) (Vernon 2005); see Jackson Law Office, P.c. v. Chappell, 37 S.W.3d 15, 25-26 (Tex.App.-Tyler 2000, pet. denied). Thus, section 74.402(a)'s two definitions of "practicing health care" are not exclusive. In addition, under the literal language of section 7 4.402(b )(1 ), an expert is only required to be "practicing health care in a field of practice that involves the same type of care or treatment as that delivered by the defendant health care provider." See TEX. CIV. PRAC. & REM.CODE ANN.§ 74.402(b)(l) (emphasis added). Subsection (b)(l) does not require an expert to be practicing health care in the same field as the defendant health care provider, here, the field of chiropractic. Instead, under subsection (b )(1 ), the expert only must practice health care in a field of practice involving the same type of care or treatment.' [5] Reading section 74.402 subsections (a) and (b)(l) together, subsection (a) expands upon the definition of "practicing health care" to include qualified teachers and consulting health care providers who may not otherwise be qualified under subsection (b)(l) because they are not practicing health care and instead teach or consult. Group's proffered construction of subsection (a) and (b )( 1) results in a person being qualified as an expert only if the person trains health care providers in the same field as the defendant health care provider or ifthe person serves as a consulting health care provider and is licensed, certified, or registered in the same field as the defendant health care provider. According *24 to Group, if a person practices health care in a field of practice that involves the same type of care or treatment as that delivered by the defendant health care provider, but the person is not certified in the same field of practice as the defendant Page 732 health care provider, is not a teacher, or is not a qualified consultant, the person is unqualified. Group's asserted construction of section 74.402(a) is unnecessarily restrictive and is contrary to the plain and common meaning of the language of the statute. Having considered the language of section 74.402 in its entirety, we disagree with Group that the two definitions of "practicing health care" under section 74.402(a) are exclusive." As in Group, Plaintiff argues that CPRC § 74.402 is not to be interpreted so overly
restrictive as to disqualify Nurse Bingham simply because as Defendant Asah claims, she is not a "registered nurse sitting at the home of a juvenile patient with Jeune syndrome and restrictive lung disease that has a tracheostomy on September 10, 2012." Group clearly stands for the proposition that CPRC § 74.402 is not to be interpreted so overly restrictive as requested by
18 Defendants. Further more, Group, at 731 "(section 74.402(b)(l) does not require expert to be practicing in same field, only in field of practice involving same kind of care)."
As concerns the claim by Defendant Asah that Nurse Bingham (and Dr. Marable) relied on the statement of Cristina Marente that she was the only person that ever changed the trach of Christian Marente, and that the statement is somehow unreliable and irrelevant and that such statement under section 74.402(d) relates to the admission of testimony at trial, Plaintiff points to Packard v. Guerra, 252 S.W. 3d 511 (Tex.App.-Houston [14 Dist.] 2008) where the court stated at 530,
" ... the plain language of the Medical Liability Act does nqt limit the two sections to trial. To start narrowly, the headings of sections 74.401 and 74.402 are entitled, "Qualifications of an Expert Witness in Suit Against a [Physician/Health Care Provider]" ; they do not limit the sections to experts testifying at trial. Even more obviously, sections 74.401 (f) and 74.402 (f) discuss pre-trial objections to the qualifications of an expert witness, making it appear that the sections cover the whole spectrum of expert witnesses in a health care liability suit from pre-trial to trial. Another section in the Act also suggests a broader interpretation. Subsection 74.351(r)-which contains the definitions for section 74.351 , entitled "Expert Reports" -defines an expert who is qualified to give an expert *25 report (pre-trial) as one who is qualified to testify under sections 74.401 and 74.402 . See TEX. CIV. PRAC. & REM. CODE§ 74.351 (r)(5)(A)-(B).[15] It does not limit the qualifications to 74.401(a)-(c) and 74.402(a)-(c)-those sections referring specifically to physicians and health care providers. It includes all of sections 74.401 and 74.402, including the exceptions contained in 74.401(d) and 74.402(d). Thus, an expert report, which is filed only 120 days after suit and will before trial, includes the report of an expert described in the "good cause" exception of sections 74.401 (d) and 74.402 (d). This plain language also does not seem to support a presumption that the good cause exceptions contained in sections 74.401 (d) and 74.402 (d) apply only at trial.
And in Packard at p. 532 the Court clearly stated, "For these reasons, we hold that sections 74.401(d) and 74.402(d) are available for use at the expert report· phase of a health care liability claim." The exact meaning of Section 74.402(d) is a little more difficult to determine because
Appellants found no cases on point: (d) The court shall apply the criteria specified in Subsections (a), (b), and© in determining whether an expert is qualified to offer expert testimony on the issue of
19 w h e t h e r t h e d e f e nd a n t h ea lt h ca r e p r ov i d e r d e p a r t e d fr o m acce p t e d s t a nd a r d s o f h ea lt h ca r e bu t m a y d e pa r t f r o m t h o s e c r it e r i a i f , un d e r t h e c i r c u m s t a n ce s , t h e c o u r t d e t e r m i n e s t h a t t h e r e i s good r e a s o n t o ad m it t h e e xp e r t' s t e s ti m o n y . T h e c o u r t s h a ll s t a t e o n t h e r ec o r d t h e r e a s o n f o r ad m itti n g t h e t e s ti m o n y i f t h e c o u r t d e pa r t s f r o m t h e c r it e r i a . D e f e nd a n t A s a h c on ti nu e s t o a ss e r t t h a t t h e on l y nu r s e t h a t qu a li f i e d t o t e s ti f y a s a n
e xp e r t i s on e t h a t h a s c o mm itt e d n e g li g e n ce by r e m ov i ng a t r ac h w it hou t a u t ho r it y , a u t ho r i za ti on o r r ea s on a nd t h e n f a il e d i n a n a tt e m p t t o i n s e t t h e t r ac h . C l ea r l y , t h i s i s no t w h a t w a s i n t e nd e d by M e d i ca l L i a b ilit y A c t .
NO
E X P E R T R E P O R T N E C E SS A R Y F O R V I C A R I O U S L I A B I L I T Y
A
G A I N S T E P I C H E A LT H S E R V I C E S I n a dd iti on t o t h e d i r e c t li a b ilit y c l a i m s A pp e ll a n t s a ss e r t e d a g a i n s t E p i c H ea lt h S e r v i ce s , A pp e ll a n t a l s o a ll e g e d t h a t " E p i c H ea lt h S e r v i c e s i s v i ca r i ou s l y li a b l e f o r n e g li g e n ce o f it s nu r s e s , t e c hn i c i a n s , s e r v a n t s a nd o r a g e n t s w ho a r e it s a c t u a l a g e n t s , a pp a r e n t a g e n t s , o s t e n s i b l e a g e n t s , a nd a g e n t s by e s t opp e l ac t s a nd / o r o m i ss i on s . " W it h r e s p e c t t o A pp e ll a n t s ' c l a i m s *26 a g a i n s t E p i c H ea lt h S e r v i c e s f o r v i c a r i ou s li a b ilit y f o r t h e c ondu c t o f N u r s e A s a h , N u r s e B i ngh a m a nd D r . M a r a b l e ' s r e po r t w a s no t r e qu i r e d t o a dd r e ss t h e m . I n f a c t , no e xp e r t r e po r t i s n ee d e d a t a ll f o r c l a i m s o f v i c a r i ou s li a b ilit y b a s e d upon o s t e n s i b l e a g e n c y . O b s t e t r i c a l & G y n ec o l og i c a l A ss o c s ., P . A . v . M c C o y , 283 S . W . 3d 96 , 107 ( T e x . A pp . - H ou s t o n [ 14 t h D i s t . ] 2009 , p e t . d e n i e d ) .
P
RAY E R F o r t h e f o r e go i ng r ea s on s , A pp e ll a n t s r e s p ec t f u ll y r e qu e s t s t h i s hono r a b l e c ou r t t o r e v e r s e t h e j udg m e n t a nd r e m a nd t h i s ca s e t o t h e d i s t r i c t c ou r t f o r t r i a l on t h e m e r it s . R e s p ec t f u ll y s ub m itt e d , / S / D oug l a s T . F l oyd C OU N S E L F O R P L A I N T I F F S / A P P ELL A N T S
20 Douglas T. Floyd 3336 Therondunn Dr. Plano, Texas 75023 214-704-7081 469-519-9488 FAX T.B.N. 07181700 lawyerfloyd@aol.com
CERTIFICATE OF SERVICE
I certify that a copy of this Brief for Appellant has been served upon the opposing counsel either by hand delivery, U.S. mail, or facsimile. IS/ Douglas T. Floyd DOUGLAS T. FLOYD
CERTIFICATE OF COMPLIANCE This document complies with the typeface requirements of Tex. R. App. P. 9.4(e) because it has been prepared in a conventional typeface no smaller than 14-point for text and 12-point for footnotes. IS/ Douglas T. Floyd
DOUGLAS T. FLOYD
*27 21
APPENDIX
Order on Defendants Eunice Asah's and Epic Health Services, Inc.'s Objections to 1. Plaintiffs Amended Chapter 7 4 Expert Reports and Motions to Dismiss 2. Expert Report of Patti Bingham, RN 3. Curriculum vitae of Patti Bingham, RN 4. Expert Report of Dr. Charles Marable, M.D. 5. Curriculum vitae of Dr. Charles Marable, M.D.
i 6. Civ. Prac. & Rem. Code Subchapter H Procedural Provisions Sec. 74.351, Sec. 74.402 and Sec. 403 *28 22 \ _ ' 1
.
O r d e r on D e f e nd a n t s E un i ce A s a h ' s a nd E p i c H ea lt h S e r v i ce s , Inc.:~ O b j ec ti on s t o
P
l a i n ti ff ' s A m e nd e d C h a p t e r 74 E xp e r t
R
e po r t s a nd M o ti on s t o D i s m i ss [1] *29 F I LE D F O R R E C O R D C AU S E NO . 86812 I N T H E 4o7 iii ~BtcflJ3= 55 CR I S T I NA M A R E N TE § § I ND I V I DUA LL Y AND A S
M E L A H I E i \ EE D D I S T R I C T C L E H K § R E P R E S E N T A T I V E O F T H E ELL I S C OUN T Y . T X § E S T A TE O F C H R I S T I AN § M A R E N TE , D E C E A S E D
§ v
s
. D I S T R I C T C OU R T O F § §
E UN I C E A S A R AND E P I C § § E L L I S C OU N T Y , TE XA S H E A L T H S E R V I C E S , I N C .
O R D E R ON D E F E NDAN T S E UN I C E A S AH ' S AND E P I C H E A LT H S E R V I C E S , I N C . ' S O B J E C T I ON S T O P L A I N T I FF ' S A M E ND E D C HA P TE R 74 E X P E R T R E P O R T S AND M O T I ON S T O D I S M I SS
C A M E ON t o b e h ea r d ( l ) D e f e nd a n t E un i ce A s a h ' s O b j ec ti on s t o P l a i n ti ff ' s A m e nd e d C h a p t e r 74 E xp e r t R e po r t s a nd M o ti on t o D i s m i ss a nd ( 2 ) D e f e nd a n t E p i c H ea lt h S e r v i ce s , I n c . ' s O b j ec ti on s t o P l a i n ti ff ' s A m e nd e d C h a p t e r 74 E xp e r t R e po r t s a nd M o ti on t o D i s m i ss . A f t e r r e v1 e w m g a nd c on s i d e r i ng t h e M o ti on s , P l a i n ti ff ' s R e s pon s e , a nd t h e pleading~ on f il e w it h t h e C ou r t , t h e a r gu m e n t s o f c oun s e l a t t h e t w o *30 p r op e r l y - no t i ce d h ea r i ng s on t h e M o t i on s , a nd t h e s ub s e qu e n t a dd iti on a l b r i e f i ng by t h e p a r t i e s a s r e qu e s t e d by t h e C ou r t , t h e C ou r t r u l e s t h a t D e f e nd a n t s ' O b j ec t i on s a r e S U S T A I N E D a nd r u l e s t h a t D e f e nd a n t s ' M o t i on s t o D i s m i ss a r e G R AN TE D . O R D E R O N D E F E N DA N T S O B J E C T I ON S A N D M O T I ON T O D I S M I SS P a g e 1
379 .. I T I S T H E R E F O R E O R D E R E D , AD J UDG E D , AND D E CR EE D t h a t ( 1 ) D e f e nd a n t E un i ce A s a h ' s O b j ec ti on s t o P l a i n ti ff s A m e nd e d C h a p t e r 74 E xp e r t R e po r t s a r e S U S T A I N E D a nd D e f e nd a n t E un i ce A s a h ' s M o ti on t o D i s m i ss i s G R AN TE D a nd ( 2 ) D e f e nd a n t E p i c H ea lt h S e r v i ce s , I n c . ' s O b j ec ti on s t o P l a i n ti ff s A m e nd e d C h a p t e r 74 E xp e r t R e po r t s a r e S U S T A I N E D a nd D e f e nd a n t E p i c H ea lt h S e r v i ce s , I n c . ' s M o ti on t o D i s m i ss i s G R AN TE D . P l a i n ti ff s c l a i m s a g a i n s t a ll D e f e nd a n t s a r e , t h e r e f o r e , d i s m i ss e d w it h p r e j ud i ce . T h e C ou r t o r d e r s t h a t P l a i n ti ff t a k e no t h i ng a g a i n s t D e f e nd a n t s , w ho a r e h e r e by d i s c h a r g e d .
I T I S F U R T H E R O R D E R E D , AD J UDG E D , AND D E CR EE D T UA T t h e D e f e nd a n t E un i ce A s a h r ec ov e r h e r r ea s on a b l e a nd n ece ss a r y a tt o r n e y s ' f ee s a nd c ou r t c o s t s a s r e qu i r e d und e r S ec ti on 74 . 351 ( b ) o f t h e T e x a s C i v il P r ac ti ce & R e m e d i e s C od e a s f o ll o w s :
T h e a m oun t o f $ ~ 7 [1] fr o m P l a i n ti ff C r i s ti n a ) ~ D . v [0] M a r e n t e , I n d i v i du a l l y a n d a s R e p r e s e n t a t i v e o f t h e E s t a t e o f C h r i s t i a n \ , *31 M a r e n t e , D ecea s e d , f o r r ec ov e r y o f r ea s on a b l e a nd n ece s s a r y a tt o r n e y s ' f ee s a nd c ou r t c o s t s f o r w o r k p e rf o r m e d i n t h i s ca s e .
T h e C ou r t f u r t h e r o r d e r s t h a t D e f e nd a n t E un i ce A s a h r ec ov e r h e r r ea s on a b l e a nd n ece s s a r y a tt o r n e y s ' f ee s a nd c ou r t c o s t s i n t h e a m oun t o f $ L )~:.,""' o . ; J 0 f r o m P l a i n ti ff C r i s ti n a M a r e n t e ,
O R D E R ON D E F E N D A N T S O B J E C T I O N S A ND M O T I O N T O D I S M I SS P a g e 2 380 ..
Individually and as Representative of the Estate of Christian Marente,
Deceased, in the event of an ultimately unsuccessful appeals to the Court of Appeals.
Additionally, the Court further orders that Defendant Eunice Asah recover her reasonable and necessary attorneys' fees and court costs in the amount of $ { \.J c [0]
..: 0. ~it> from Plaintiff Cristina Marente, Individually and as Representative of the ,Estate of Christian
I
Marente, Deceased, if Plaintiff Cristina Marente, Individually and as Representative of the Estate of Christian Marente, Deceased, files a petition for review and review is not granted by the Supreme Court of Texas or if Defendant Eunice Asah seeks review in the Supreme Court of Texas that is ultimately successful.
Additionally, the Court further orders that Defendant Eunice Asah recover her reasonable and necessary attorneys' fees and court l 1 c $"" 0 [0] costs in the amount of $ from Plaintiff Cristina · 0 0 Marente, Individually and as Representative of the Estate of Christian *32 Marente, Deceased, if briefing on the merits is requested in the Supreme Court of Texas but review is ultimately denied (i.e. a petition for review is denied) or this Court's ruling is ultimately affirmed by the Supreme Court of Texas.
ORDER ON DEFENDANTS OBJECTIONS AND MOTION TO DISMISS Page 3 381 .. T h e C ou r t f u r t h e r o r d e r s t h a t D e f e nd a n t E un i ce A s a h r ec ov e r h e r r ea s on a b l e a nd n ece ss a r y a tt o r n e y s ' f ee s a nd c ou r t c o s t s i n t h e 0 0 ] r ( C J c ) .. fr o m P l a i n ti ff C r i s ti n a M a r e n t e , a m oun t o f $ I nd i v i du a ll y a nd a s R e p r e s e n t a ti v e o f t h e E s t a t e o f C h r i s ti a n M a r e n t e , D ecea s e d , i n t h e e v e n t t h a t a p e titi on f o r r e v i e w i s g r a n t e d by t h e S up r e m e C ou r t o f T e x a s a nd o r a l a r gu m e n t o cc u r s i n t h e ca s e bu t r e v i e w 1 s u lti m a t e l y d e n i e d o r t h i s C ou r t ' s r u li ng i s u lti m a t e l y a ff i r m e d .
T h e C ou r t f u r t h e r o r d e r s t h a t D e f e nd a n t E un i ce A s a h r ec ov e r h e r r ea s on a b l e a nd n ece ss a r y a tt o r n e y s ' f ee s a nd c ou r t c o s t s i n t h e a m oun t o f $ ~ i n t h e e v e n t t h a t P l a i n ti ff C r i s ti n a
- - - - - - - M a r e n t e , I nd i v i du a ll y a nd a s R e p r e s e n t a ti v e o f t h e E s t a t e o f C h r i s ti a n M a r e n t e , D ecea s e d , s ee k r e h ea r i ng i n t h e S up r e m e C ou r t o f T e x a s bu t t h a t m o ti on i s u lti m a t e l y d e n i e d . I T I S F U R T H E R O R D E R E D , AD J UDG E D , AND D E CR EE D
T H A T t h e D e f e nd a n t E p i c H ea lt h S e r v i ce s , I n c . r ec ov e r it s r ea s on a b l e a nd *33 n ece ss a r y a tt o r n e y s ' f ee s a nd c ou r t c o s t s a s r e qu i r e d und e r S ec ti on 7 4 . 3 51 ( b ) o f t h e T e x a s C i v il P r ac ti ce & R e m e d i e s C od e a s f o ll o w s :
( 0 1 ~ 0 0 . 0 ° fr o m P l a i n ti ff C r i s ti n a T h e a m oun t o f $
I
M a r e n t e , I nd i v i du a ll y a nd a s R e p r e s e n t a ti v e o f t h e E s t a t e o f C h r i s ti a n O R D E R O N D E F E ND A N T S O B J E C T I O N S A N D M O T I ON T O D I S M I SS P a g e 4 [38] [2] M a r e n t e , D ecea s e d , f o r r ec ov e r y o f r ea s on a b l e a nd n ece ss a r y a tt o r n e y s ' f ee s a nd c ou r t c o s t s f o r w o r k p e rf o r m e d i n t h i s ca s e .
\ T h e C ou r t f u r t h e r o r d e r s · t h a t D e f e nd a n t E p i c H ea lt h S e r v i ce s , I n c . r ec ov e r it s r ea s on a b l e a nd n ece ss a r y a tt o r n e y s ' f ee s a nd c ou r t c o s t s i n t h e a m oun t o f $ ~I 3 1 ? . ) 1 fr o m P l a i n ti ff C r i s ti n a M a r e n t e , I nd i v i du a ll y a nd a s R e p r e s e n t a ti v e o f t h e E s t a t e o f C h r i s ti a n M a r e n t e , D ecea s e d , i n t h e e v e n t o f a n u lti m a t e l y un s u cce ss f u l a pp ea l s t o t h e C ou r t o f A pp ea l s .
A dd iti on a ll y , t h e C ou r t f u r t h e r o r d e r s t h a t D e f e nd a n t E p i c H ea lt h S e r v i ce s , I n c . r ec ov e r it s r ea s on a b l e a nd n ece ss a r y a tt o r n e y s ' f ee s a nd c ou r t c o s t s i n t h e a m oun t o f $ 3 , ~ ~ 3 ~ 3
fr o m P l a i n ti ff C r i s ti n a M a r e n t e , I nd i v i du a ll y a nd a s R e p r e s e n t a ti v e o f t h e E s t a t e o f C h r i s ti a n M a r e n t e , D ecea s e d , i f P l a i n ti ff C r i s ti n a M a r e n t e , I nd i v i du a ll y a nd a s R e p r e s e n t a ti v e o f t h e E s t a t e o f C h r i s ti a n M a r e n t e , D ec e a s e d , f il e s a p e titi on f o r r e v i e w a n d r e v i e w i s n o t g r a n t e d by t h e S up r e m e C ou r t o f T e x a s o r i f D e f e nd a n t E p i c H ea lt h S e r v i ce s , I n c . s ee k s r e v i e w i n t h e S up r e m e C ou r t o f T e x a s t h a t i s u lti m a t e l y *34 s u cce ss f u l .
A dd iti on a ll y , t h e C ou r t f u r t h e r o r d e r s t h a t D e f e nd a n t E p i c H ea lt h S e r v i ce s , I n c . r ec ov e r it s r ea s on a b l e a nd n ece ss a r y a tt o r n e y s ' O R D E R O N D E F E N D AN T S O B J E C T I O N S A N D M O T I O N T O D I S M I SS P a g e 5 383 fees and court costs in the amount of $ C) ~ 1 ·>. '$ 3
from
Plaintiff Cristina Marente, Individually and as Representative of the Estate of Christian Marente, Deceased, if briefing on the merits is requested in the Supreme Court of Texas but review is ultimately denied (i.e. a petition for review is denied) or this Court's ruling is ultimately affirmed by the Supreme Court of Texas.
The Court further orders that Defendant Epic Health Services, Inc. recover its reasonable and necessary attorneys' fees and court costs in the amount of $ d [1] S oO · [0] J
from Plaintiff Cristina Marente, Individually and as Representative of the Estate of Christian Marente, Deceased, in the event that a petition for review is granted by the Supreme Court of Texas and oral argument occurs in the case but review is ultimately denied or this Court's ruling is ultimately affirmed.
The Court further orders that Defendant Epic Health Services, Inc. recover its reasonable and necessary attorneys' fees and court 0 - costs in the amount of$ in the event that Plaintiff - - - - - - -
Cristina Marente, Individually and as Representative of the Estate of
*35 Christian Marente, Deceased,'f6eeks rehearing in the Supreme Court of Texas but that motion is ultimately denied.
ORDER ON DEFENDANTS OBJECTIONS AND MOTION TO DISMISS Page 6 [384] .. T h e s e r u li ng s c o m p l e t e t h e C ou r t ' s r e s o l u ti on o f D e f e nd a n t s E un i ce A s a h ' s a nd E p i c H ea lt h S e r v i ce s , l n c . ' s O b j ec ti on s t o P l a i n ti ff s ' A m e nd e d C h a p t e r 74 E xp e r t R e po r t s a nd M o ti on s t o D i s m i ss s o t h a t t h i s O r d e r ( 1 ) c on s tit u t e s a f i n a l j udg m e n t r e g a r d i ng P f a i n ti ff s c l a i m s a g a i n s t D e f e nd a n t s E un i ce A s a h a nd E p i c H ea lt h S e r v i ce s , I n c ., ( 2 ) r e s o l v e s a ll c l a i m s a g a i n s t a ll p a r ti e s , a nd t h e r e f o r e ( 3 ) c on s tit u t e s a f i n a l a pp ea l a b l e o r d e r .
S I GN E D on t h i s t h e _ d a y o f J UN 2 3 2015 , 2015 .
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*36 O R D E R O N D E F E N DAN T S O B J E C T I O N S A ND M O T I ON T O D I S M I S S P a g e 7 [385] 2. Expert Report of Patti Bingham,/ RN *37 P lttt 81n a h1 m , R N · 106 ca ll e R i ca r do
V i c t o r i a , T e x a s 77904 C e ll : ( 361 ) 652 · 3558 F a x : ( 361 ) 575 · 8312
Q 1 tt l c nnu r s e @ y ahog . c o m P R O F . E SS l ONA L E X P E R I E N C E T h e C ou r t y a r d s , {Rehlbl~ltatlon & N u r s l n s H o m . e l 3401 e . A i r li n e , ,, 4 / 4 / 11 - · V i c t o r i a , T x 77901 W ee k e n d RN s upe r v i s o r- S upe r v l s o r / C ll n l c a l r e s pon s l b lll t i e s i n c l ude o v e r s ee i n1 P r e s en t a ll nu r s i ng c a r e t h r oughou t t he f a c H tt v , m on i t o r i ng v it a l s l gn s ,· p a ss l ng m e d i ca ti on s ; c h a n1 e d r e ss l np , t r ac h ca r e , c ondu c t r a np o f m o ti on e x e r c i s e s , c he ck t he s t a t u s o f w o un d s , ad m i n i s t e r ene m a s and s t a r t I n t r a v enou s OV l m e d i ca ti on s a nd f l u i d s . Blackb~rn G r oup , I n c ., 6709 G l e nk l r k R o a d , B a lti m o r e , M D . 21239
2 / 25 / 11 • { M ed i c a r e S e t A s i d e ( M SA : ) and C l a i m S e tt l e m en t S O i u t i on s C o m pan y ] P r e s e n t A ss l s tl n s w it h M S A / F u t u r e m e d i ca l c o s t p r o j ec ti on s ( l n c l ud l ng W o r k e r s C o m p e n s a ti on )
J I C k s on D e v i s H t a lt h ca r • , 3570 E . 1 li 11 A v e , D e nv e r , C o l o r ado 80206 1 / 2 / 2011 - M ed i c a r e A ud li : D e f en s e and M ed i c a r e A ppea l s - N u r s e A ud i t o r P r e s en t ' ., C \tl ze n s M e d l c 1 I C l n t e r , 2501 M e d i ca l D r i v e , V i c t o r i a , T e x a s 77901 . 01 / 2008 - 12 / 28 / 2010 C h ll r a 1 / S t a ff N u r s e o f D a y S u r 1 • r v
. ; • R e s pan s l b lll t l e s i n c l ude c li n l c a l and s up1 r v t s o r y : s t a r t i ng I V ' s , m a n a1 l n g ·. ' · F o l e v ca t h e t e r s , a ss a ss i n , po s t - ope r a t i v e p a ti e n t s , m a n aa l n a a nd i m p l e m e n t l na pa t i en t care~ s t a ff t n a r equ i r e m en t s ; pa r tf c l pa t l r . i g I n Q ua li t y A ss u r a n ce p r og r a m : a ud iti ng ~edlcal r ec o r d s a nd f a ll o w l na u p w it h p a ti e n t ca r e s a tt s f ae tl o n s u r v e y s .
T r i u m ph H o s p lt a l V l c t o r l 1 , 506 E . S a n A n t o a l o S t , V i c t o r i a , T e x a s { P R N & F u ll S / 25 / 06 - T i m e s S t a t u s ) • C ha r s e N u r s e / C ll n l c a l S t a ff N u r s e .. r e s pon s l b l l l t l e s t n c l uded p l ann l n1 t 02 / 21 / 08 m a n a g i ng , a nd a ss e ss i ng ca r e , a d m i n i s t r a ti on o f m e d i ca ti on s a nd treatments~ m a i n t a i n r eca r d o f c od e s a nd ca r e . w ound ca r e , a nd a ss i s t e d
· w i t h w ound VA C s . • C h a r r i : e n u r s e / C l l n l ca l S t a f f N u r s e .. M e d i c a l O b s e r v a t i on un it ( c o m p a r a b l e *38 U pd a t e d : 08 / 15 / 2013 1 P . B i ngh a m [248] 08 / 26 / 13 08 : I S A M P D T O o u g l . . F l oyd - > P e t e r A nd e r s on e 2149051213 P g ll/ 26 t o S t e p O o w n U n ltl - du tl e s l nduded s tt r tl ng I V s , m on i t o r i ng pa t i en t ' s r e s p l r a t o r v v e n til a ti on - t r ac h e o t o m y ' s , f n t ub a tl on s , pu l s e o il m e t r y , r e s pond t o a l 1 c od e s , H t na s ap s t r l c a nd m on i t o r dobho ff f aa d l ng t ub e s , f o l e y a nd s w a n g a n z ca t h e t e r s , ce n t r a l a nd a r t e r i a l li n e s , t e m po r a r y p ace m a k e r s .
H o t p l c : e o f S ou t h T t x i s .. 605 L o c u s t A v e ., V i c t o r i a , T e x a s 77901 2003 - 200 A d m i ss i on s C oo r d i n a t o r I c u e M 1nap r / C H n l ca l N u r s e 8 • R e s pon s i b l e f o r c oo r d l n a ti n11 a d m i ss i on s b e t w ee n ho s p it a l s , nu r s l n a ho m e s , p r i v a t e h o m e s , an d r e s p i t e c a r e f a c " 1 t i e s a l o ng w i t h du r ab l e m ed k : a l
.. equ i p m en t c o m pan i e s and pha r m a c i e s , c oo r d i na t ed c a r e , and a ss e ss e d a nd ' •
· i n t e r p r e t ed need s and r equ i r e m en t s • R e s pon s i b l e f o r c ll n l ca l ca r e o f p a ti e n t s - O b t a l n l ng do c t o r ' s o r d e r s , s t a r tl n l a nd m a i n t a i n i ng . I V ' s ca t h e t e r s , H ypod e r m ody s l s , F o l • y ca t h e t e r s , p a J n a nd n a u s ea c on t r o l , m 1nag i n1 p a i n pu mp~ ob t a i n i ng b l ood / u r i n e f o r c u lt u r e s , t r ac h ca r e , e t c .
• ' • C a s i M 1n a 11 m 1n t r e s po l ' lll b i 11 t 1u : M a k e l n lt\ a \ a ss e ss m e n t s r e1a r d t. n1 pa t i en tt r 11 t m en t p l an s and e s t ab U s h c o ll abo r a t i v e r e l a t l on s h l p s w l t h phy s i c i a n s , c li e n t s , p a ti e n t s , a nd p r ov i d e r s , c oo r d i n a t e d p a t 1 e n t ' s ca r e , a nd a ss e ss e d a nd I n t e r p r e t e d n ee d s a nd r equ i r e m en t s , c oo r d i n a t e d a d m i ss i on s w it h d l s c h a ' l e p l a nn e r s f r o m . h cs p l t a l s and t r a n s f e rr i ng pa t i en t s t o N u r s l n1 H o m e ' s a nd f a m ll y ho m e s a ss u r i ng t he n ece ss a r y m e d i ca ti on s a nd equ i p m en t w e r e a v a il ab l e .
C itl z t f t s M e d l C ll C e n t e r , 2501 M ed l c : a l D r i v e , V i c t o r i a , Te~s ' 07 / 27 / 1998 - 12 / 23 / 2003 O pe r a t i ng R oo m S t a ff N u r s e • F un c t i oned a s a c l r c u l a t f ng nu r s e I n a ll s u r s i ca l d i sc i p li ne s l ndud l ng , gene r a l , v a sc u l a r , o r t hoped i c , 09 - G V N , u r o l o sv , and pn m a r ll y c a r d i a c p a t i en t s .
• R e s pon s l b l e f o r p r e · ope r a t l \. l e an c l I n t r a - ope r a t i v e pha s e s o f s u r a i ca l e x pe r i en c e , r e qu i r i ng k no w l ed1 • o f 1ene r a l and s pe c l & l t y - equ l p m e " t a nd I n s t r u m en t a t i on , c o m p r ehen s i v e r e c o r d k eep i ng and r e v i e w .
• A i d e d c on s dou s s e d a ti on o f p a ti e n t s unde r 1o t n1 h ea r t ca t h e t e r li a tl on s , an1l~pfastles 1 li v e r b i op s i e s , and pe r l phe r a l v a sc u l a t u r e r uno ff s t ud i e s . E m e r 1en cy R o o m • C ha r s e n u r s e - r e s p an s l b l l i t l e s I n c l uded m ana & ' na a n d s t a fft n s a 15 bed
e m e r 1 e n c y r oo m d e p a r t m e n t . • E n s u r e t he p r o v i s i on o f q ua l tt y e m e r a en cy m e d i c a l c a r e t o p a t i e n t s r e qu i r i ng e m e r s en cy t r ea t m e n t l n acc o r d a n ce w it h phy s i c i a n o r d e r s , *39 U pd a t e d : 08 / 15 / 201 ! 2 • : P . B i ngha m [24] [9] u~·n~ti/ J.~ U t s : . L O A M l - ' U ' l " uougLa .··· r . L O Y < I - ; > l " ' B l : B r A nae r s on e ho s p it a l po ll c y , and s t anda r d nu r s i ng p r ac ti ce . • T r l a 1 e a nd pe r f o r m ed p a ti e n t a ss 8 ' s m e n t a nd nu r s i ng d i a gno s i s . • M a n a g e t h e p l a nn l n1 a nd l m p l e m e n t a tl on o f i n t e r v e n ti on s .
1993 · 1998 M a t qo r d • G • n •• I H o s p it a l , 1115 A v e G , B a y C lt y . T e x a s 77414 O p en t l n1 R oa m S t a ff N u r s e • F un c ti on e d a s a c l r c u l 1 tl n1 nu r s e I n a tl s u r a l ca l d i s c i p li n e s i n c l ud l n a ,
1 e n e r a l , v a s c u l a r , o r t hop e d i c , 08 - GYN , a nd E N T • R e s pon s i b l e f o r p r e - ope r a t i v e and r n t r a - op e r a ti v e ph a s e s a f s u r g i ca l e x pe r i en c e , r equ i r i ng k no w l ed11 o f 1ene r 1 I and s p ec i a lt y · M a t qo r d a H o m e H e a l t h A s en cy • D u ti e s l nduded a ss e ss m en t s o f s y s t e m s , w ound s , f n t r a v enou s s it e s ,
,. m e d i ca ti on s - s ub c u t a n e ou5 l y o r i n t r a m u s c u l a r I n j e c t i on s , an y o r de r ed t r ea t m e n t s - t r a c h e o s t o m y ca r e ; b r ea t h i n g t r ea t m e n t s , b l o od d r a w s , I n t r a v enou s f l u s he s , d r e ss l n1 c han1e s , o r w ound c a r e t he do c t o r ha s : o r d e r e d , a nd t eac h i ng a s I nd i c a t ed .
T r au m a C oo r d i na t o r I E R S t a ff N u r 11 • P r o v i ded o v e r s i gh t f o r a t l c l f n l c a l po li c i e s and p l ' O C f. l du r e s I n a«a r dan c e
w tt h l o ca l a nd s t a t e acc r e d iti ng bod y s t a nd a r d s ; A dh e r e d t o s t a t e T r a u m a gu i de li ne s and ho s p it a l s and S t a t e T r au m a po ll c 1e s [1] p r o ce du r e s , a nd r epo r t l n s r e qu i r e m e n t
• M a d e I n iti a l a ss e ss m e n t s r ep r d l n s pa t i en t t r ea t m e n t p l a n s a nd e s t a b li s h e d e o ll a bo r a tl v e r e l a tl on s h l p s w it h phy s i c i a n s , f a m ili e s , p a ti e n t s , . a nd p r ov i d e r s , e n s u r e d t h a t p a ti e n t s r ece i v e d t h e p r op e r l e v e l s o f ca r e
• E n s u r e t he p r o v i s i on o f qua li t y e m e r c en cv m e d l ca l c a r e t c pa t i en t s r equ i r 1n1 e m e r 1en cy t r ea t m en t I n a cc o r dan c e w i t h phy s i c i a n o r de r s , ho s p it a l po li c : y , a nd s t anda r d nu r s l n s p r a c ti c e .
• T r i a 1 e a nd p e rf o r m e d p a ti e n t a ss e ss m e n t a nd nu r s l n1 d i a gno s i s .
E
DUC A T I O N • A ss o c i a t e I n A pp li e d S C l e n ce N u r s l n s , W h a r t on C ou n t y J r . C o ll e g e , W h a r t on , T e x a s ... S ep t e m be r 2 2 , 1 9 9 3 · • A S s o c l a t e t n . A pp li ed S d • n ce R • s \ $ . t e r e d D e n t a l H y 1 l . ne , B ee C oun t y J r . Colleaa~ B ea v lll e , T e x a s · J un e 30 , 1980
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R O F E SS I ONA L C E R T I F I C A T I ON S • C e r ti f i e d A du lt , C h ll d , & I n f a n t C P R - A m e r i ca n H e . r t A ss o c i a ti on 2010 G u l d e ll n e s • C u rr en t • N H T . l . L . E . T r a l n6n s on L O n g T e r m c a r e S t a nd a r d s f o r M e d i ca i d - T e x a s S t a t e U n i v e r s it y , S a n M a r c o s ; 6 / 20 / 2005 U pd1 t ec l: 08 / 15 / 2013 P . 8 l n1ha m
*40 250 • ~1tlonal 8 o a r d f o r C e r t l f l c a tt on o f H o s p i c e an d P 1 H l 1 t l v e N u r s e s ( CH P N ) - I n a c t i v e · • C e r ti f i ca ti on N u r s e O p e r a tt n c R oo m ( C NO R ) · - 1n ac tl V • • P e d i a t r i c : A dv a n ce d L i f e S uppo r t • A d v a n c e d C a r d i a c li f e S u p p o r t • T n u m a N u r s \ ng C o r e C o u r s e
, P R O F ESS I O N A L A SS O C I A T I ON S • N a t l ona l A ll i a n c e o f C e r t i f i e d L e g a l N u r s e C o n s u l t a n t s • A m e r i c an A ss o c i a t i on o f Le ga l N u r s e C c l t i s u l t an t s
j . ,. U pd a t e d : 08 / 15 / 2013 P . B i ngh a m [251] *41 3
.
C u rr i c u l u m v it ae o f P a tti B i ngh a m , R N *42 2149051213 P g 2 / 26 P a tti B i ngh a m , R N 106 C a ll e R i ea r do . V i c t o r i a . T e xu 77904 ' • C e ll: ( 361 ) 652 - 3558 p a tti m n a @ . v . a hoo . C Q l D A ugu s t 20 , 2013 D oug l a s T . F l oyd A tt o r n e y tt La w 6521 P r e s t on R o a d . S u it e J OO P l a no , T e x a s 75024 R E : M r . C h r i s ti a n M a r e n . t e
·· D e a r M r . F l oy d : P l ea s e acce p t t h i s r e po r t u m y e xp e r t r e po r t und e r T e x . C i v . P r ac . & R e m . C ode § 74 . 351 . T h i s r e pon r e p l ace s t h e r e po r t o f J anua r y 8 , 20 l 3 a nd . Y un e 22 . 20 J 3 . J m C O B D S R J M I W F , J l I n a n i v4ng a t t he op i n i on s e t ou t b e l o w i n t h i s l e tt e r , I h a v e t e V i e w e d . t he f o ll o w i ng it o m a :
.. 1 . M e d i ca l r ec o r d s 1 i o m A i r E v ac L i f c t ca m . .. 2 p a g e s titl e d " ' P r e li m i n a r y P a ti e n t C a r e ; _ . R ec o r d " [ E m a il: M e d i ca l _ R ec o r d s _ J · 25 ] ~: 2 . C h il d r e n ' s M e d i ca l C e n t e r m e d i ca l r e QO J d s 3 .
ET M C - E M S ; R un N u m b e r : 110658 ; D a t e o f S e r v i ce ; 0911012012 • p a g e s 1~4 o f 4 " 4 . O u t p a ti e n t N o t e fr o m O u ? C h il d r e n ' s R ou . t e a t B a y l o r 07 / J 9 / 2012 , ; • s . K i dn e y T~lant V i s it N o . t a , 06120 / 2012 , · 1 - 4 paaa , P r o s r c ss N o t e : J o s e J . S a l gu e r o , M D O ff i ce N o t e s : 1112312011 , 09 / 14 / 20116 091812011 ,
6 . 08 /ll/ 20 J l , ' ; ~ ? . T e l e phon e E n c oun t m . . 8 , S k ill e d N u r s i ng P l o w s h ee i s d a t e d : 0810~012, 0810712012 , 08 / 1312012 , 08 / 2012012 . : r 0 81 27 / 20 12 , 09 131 20 10 I ' · J
9 . S k ill e d N u r , s i ng F l o w a h ee t da t ed 09 / 10 / 2012 s i p e d by E un i ce A s a b , R .. N . ; J O . R e po r t o f C r i s ti n a M a r c n t c .
B
A C KG R OUND M y n a m e i s P a tti B i q h a m . I a m a R e g i s t e r e d N u r s e i n t h e S t a t e o f T e x a s . M y T e x a s N u r s i ng C e r ti f i ca ti on N u m b e r i s 593336 . I ha v e been a r e g i a t c nd nun e i n T e x a s s i n ce S e p t e m b e r 22 , 1993 . M A R . B N T B 08 / 20 / 13
P AG E l [239] *43 .
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L M C A T I ON S ; r " t a m p r e s e n tl y a i e g i s t e r e d nu r s e i n T e x a s a nd h a v e been s o r e g i s t e r e d f o r ov e r 20 y ea r s . I h a v e
c on ti nu e d t o u s e m y nu r s i n & s k ill s w i t h i n t ho s e 20 y ea r s . I h a v e w o r k e d i n bo t h t he e m q e n c y r oo m a nd op e r a ti ng r oo m a t v a r i ou s ho s p i 11 l s i n T e x a s .· I h a v e been c e r t i f i ed i n P e d i a t r i c A dv a n ce d L i f e S uppo r t a nd A dv a n ce d C a r d i ac L i f e S u l > pn r t . I I D 1 qu a li f i e d t o ca r e f o r p e d i a t r i c , a do l e s ce n t , a nd a du lt p a ti e n t s i n a ll nu r a i n a s e tti ng s . I p r e s e n tl y w o r k a t T ho C ou r t y a r d . R e h a b ilit a ti on It. H ea lt h ca r e C e n t e r , 3401 E . A i r lill e t V i c t o r i a . T e x a s . 77901 , u a R e g i s t e r e d N u r s e s up e r v i s o r . T h i s S 6 -- b e d f ac ilii y c u rr e n tl y . b a s 49 H S i d e n t s . T he C e n t e r p r ov i d e s m e d i ca l xn a n a g e m c n t a nd 24 - hou r s k ill e d nu r s i n a ca r t , i n c l ud i ng . i n t r a v e nou s (I V ] t h e r a py w it h a n ti b i o ti c s . T P N a d m i n i s t r a ti on . and d i a b e ti c t h e r a py . T h e C e n t e r h a s phy s i ca l m e d i c i n e a nd r e h a b ilit a ti on a nd o f t ' e r w ound ca r e . R e h a b ilit a ti v e s e r v i ce s i n c l ud e
· . · . . S p e ec h , P h y s i ca l . a n d O c e u p a ti on a l T h e r a p y . M y s u p e r v i s o l y r e s po n s i b il i ti e s i n c l u d e e n s u r i ng t h e r e i s a d e qu a t e n U l ' S i ng s t. a ff du r i na t h e w ee k e nd s a nd w e ss i a g t h e h ea lt h n ee d s o f eac h r e s i d e n t l s up e r v i s e ~-4 L i o e m e d yo ea ti on a l N u r s e s [ L VN ] and 3 - 4 C e r ti f i e d N u r s e A i d e s [ C NA ] du r i ng t h e w ee k e nd s . I ov m ee t he ca r e t he s e nu r ae s g i v e ou r p a ti e n t s a nd i n f o r m t he phy s i c i a n a and f a m ili e s a s pa t i on t c a r e l c ond iti o m w u r an t. I n a dd iti on t a m y . s up e r v i s o r y du ti e s , I w o r k w it h t h e O t h e r nu r s e s p c r i ' o r m i ng p a ti on t · ca r e . I m on it o r p a ti e n t s f o r s i go s o f s t r e ss o r d i ff i c u lt y b : r ea t h i ng a nd p e i f o r m c o m p l e t e . t o t a l u s ea s m e n tt on p a ti e n t s . W h il e I c u rr e n tl y do no t h a v e t r ac h e o s t o m y p a ti e n t . a a t t he f ac ilit y , J h a v e t r ea t e d p a ti e n t s w i t h t r ac h e o s t o m y a t t h e nu r s i q ho m e m a ny d a l e s i n t h e p a s t . I a m p e non a ll y f a m i l i a r w i t h t he nu r s i ng s t a nd a r d o f ca r e t o be d e li v e r e d t . o p a ti e nu W i t h t r ac h e o t o m i e s •
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I h a v e pe r s ona l kno w l e dg e o f t h e ~standards 0£ ca r e f o r a r e g i s t e r e d nu r s e i n T e x a s i n t he s a m e t y pe o f ca r e o r t r o a t m e n t t h a t N u r ae A s a h d e li v e r e d t o C b r l s ti a n M a r e n . t a on S e p t e m b e r
,, . 10 , 2012 . . O n S e p t e m b e r 1 o . 2012 a nd a t a l t t c l e v a n t t i m e s t o t h e presen~ I h a v e p r ac ti ce d i n t h e 1 . ~calth ca r e f i e l d o f a . r ea f s t e r ed n c . n e t h a t i nvo l v e d t h e s a m e t yp e of ~ o r w a t m e n t t h a t N u r s e A s ah d e li v e r e d t o C h r i s ti a n M a r e n t e on t h a t d a t e . T h a t t yp e o f ca r e o r
., t r ea t m e n t i s m o r e s p ec i f i ca ll y i d e n t m e d 1 > $ l o w : I h a v e kno w l e dg e o f t h e acce p t e d s t a nd a r d s o f ca r e f o r a r ea ;i s t e r e d nu r s e o f t h e ca r e o r
2 . t r ea t m e n t f o r t h e c o n d iti o n i n v o l v e d i n t h o c l a i m ag a i n s t N u r s e A s a h a n d E p i c H ea lt h ,, S e r v i ce s , I n c . M y kno w l e dg e i s o f t h e e cc O J * d s t a nd a r d s o f ca r e i . s m o r e s p ec i f i ca ll y i nd c n ti f i e d b e l o w ; a nd · I a m qu a li f i e d b a s e d on m y 20 y ea r s o f t r a i n i na a nd . e xp e r i e n ce t o o ff e r a n e xp e r t op i n i on
l . r e g a r d i ng t ho s e acee p t e d s t a nd a r d s o f ca r e a s s h o w n i n m y c u r ti w l un i v it ae a tt ac h e d h e r e t o .
BR I E F H I S T O R X A ND S U MM A & Y O F C A R E C h r i s t i a n M an m t e w a s a nv e n t ec n w y ea r- o l d m a l e w it h a h i s t o r y o f J e un e s ynd r o m e and r e . tt r i c ti v e l un s d i s c u e . J e un e s ynd r o m e (asphyxi~ t ho r ac i c dy s t r ophy , A T O ) u u a r e a u t o s o m a l r e c e ss i v e s k e l e t a l dy a p l a s i a [ dy s p l u i a i s a n a bno nn a lit y w it h i n t h e ce ll s o f ti ss u e t h a t
PA . 0£2 M A R E N T E 08120113 [2] [40] *44 ll~HOblilJ Pg 4/26 affects growth, development and fu.nctionJ characterized by a small, narrow chest and variable limb shortnou. The.re i1 a considerable neonaul mortality es a result of l'CSJ)iratory dist:esa. Renal, hepatic, pancreatic, and ocular complications may occur later in life. Christian had
. respiratoey complications that had left him with a tracheostoDly and mechanical-ventilator dependent. He had asthma and chronic kidney disease and had received a kidney transplant in 1uly2001. On January S, 2011. Christian underwent a trachcostomy at Children's Medical Center Dallas. On July 19, 2012, Christian had• medical cMck-up with Dr. Joseph Roaen a.t Our Children's House in Dallas. Texas. Per 'Dr. Rosen's notes, Chrlatian was eating and drinking by xnoudl md was on continual oxygen at 2 liters per minute. He had not had any Emergency Room visits 1inco 4/10/2012. Per his mother and Or. Rosen's notes. Christian was ''wi1hout coughina or wheezing." His tracheoatomy cuff was deflated during the da.y and bsd 3 liters durina th~ night. BegUming in February 2012, Nurse Asah. provided general nuxsina services for Christian, usually from 7:00 a.ni. until 7:00 p.m. Monday through Friday. Per the Flow Sheets Between August 6, 2012 and September 3, :20.12. the general nursina services provided by Nurse Asah
·, :1
were: i •'
I
Monitor the vital signs of Christian; To annotate the Skilled Nuraing Flowsheet daily; Monitor the ventilator equipment: Check the mucus build up in the 1l't.Ch and suction 1h~ mucwr out periodic:ally; Clean around the buh openina;; Observe Christian for any signs of stress or difficulty breathing: Bath Christian u required.
" '~ In lhc Skilled Nursing Flowsheets: named above, at no time did Nurse Asah change Christian's trachcostomy. It has been reported that OD September IO, 2012, at approximat.ely S:OO p.m., Nurse Asah WU bat.bin& Christian in his home. There i! conflicting information as to exaetly what occurred next~ Per the 911 call, Nurse Anh was alone and while putting Christian ''back to bed" tho. 1.
"tracheasrom.y'' came out. 2. · Per the Skilled Nursing Plowsheet Nurse Asah reported, "After l pulled out the dirty traoh. 1 was unsucceuful inscrti~ the clan 6.0 Bivona flex euff trach. A second attempt with the 5.0 Bi-vom. flex cuff'trach available was unsuccessfbl. [0]
3. Per the response to an interrogatories propounded to Nurse Asah, her verified response was as follows: INTERROOATOR.Y NO. 8: Describe in detail cVCJYtbing that you did with CHRISTJAN MARENTB in the one hour bofore bis ~tube came out on September 10, 2012.
MARENTB 08/20113 PAGE3 [241] *45 J . ' ( 08 / 2 B tl 3 08 : 15 A M P D T Dougl~. F l oyd - > P e t e r A nd e r s on ~ 2149051213 P g 5120 ' ~· AN S W E R : S ub j ec t t o a nd w it hou t w a i v i ng s a i d ob j ec ti on " on S e p t e m b e r 1 o . 2012 , N un c A . ah p r e p e r c d t o a i v e C h r i & ti a n M a r e n t e a b a t h . S h e f i r s t l a i d ou t A ll o f h e r s upp li e s b t f o r o ae tti n a s t a r t e d . T ha l i n c l ud e d t he ba t h s upp li e s . C h r i a ti a n [1] s ohange o f c l o t h e s . a : nd a ll o f ' t h e s upp li o s f o r t h e tt ac h e o s t c > m y c & a n ae . i n c l ud i ng a c J ea n 6 . 0 t r ac h . 1 . b ac k - up ( s m a ll e r) S . O t r ae b , a nd a n a m bu b a g .. C h r i s ti a n ' s t r ac h e o s t o m y c h a ng e o cc u rr e d e v ee y M ond a y . N u r s e A . s a h m a d e a ll o f t b ae p r e p a tt . U on s b e f o r e b a t h i ng C h M i an on S e p t e m b e r 1 O , 2012 . · U pon co~pletina h i a ba t h and d r ea s ill & C h r i s ti a n on S e p t e m b e r 10 t 2012 . N u r s e A s a h b e g a n t o c h a ng e h i • t r ac h . T he t r ac b i s h e l d i n p l ace w it h s o f t ti e s t h a t
· ; ti e a r ound h i s n ec k . S h e und i d t h e ti e s and c l ea n e d C h r i s ti a n ' 11 n ec k . I n acc o r du . ce w i t h h e r s t a nd a r d p r o ce d t r e , whi~h s h e h a d p e rf onn e d m an y ti m e s b e f o r e , N u r s e A s ah t h e n r e m ov e d t h e e x i s ti ng t: n w h e nd c on c u rr e n tl y a t t e m p t e d t o p l ace t h e c l ea n 6 . 0 t r ac h i n t o C h r i s tl a n ' s tt ac h c o s t o m y s it . c , bu t it w o W d no t 10 i n . S h e i mm e d i a t e l y g r a bb e d t he s m a ll e r , S . O t r ac h a n d t r i e d t o p l ac e i t i n t o C h r i s t i a n [1] s t r ac b c o s t o m y s it e . b u t it t oo w ou l d no t go l o . A t t h a t po i n t , s h e i mm e d i a t e l y ca ll e d 911 on b e t ce ll phon e a nd p r o cee d e d t o i n iti a t . e C P R . un til e m e r g e n c y m e d i ca l s e r v i ce s a rr i v e d . I n a dd iti on , p l ea s e s ee t he d e po s iti on o f N u r s e A s ah w h e n /i f t a k en f o r f b r t he t i n f o r m a . ti on c on cc m i n & t h e c~ p r ov i d e d t h a t d a y , a s w e ll a s t h e r e l e v a n t m ed i c a l r ec o r d s r e l a t ed t o t h i s m a tt e r .
A s do c u m e n t e d i n t h e E M S P a ti e n t C a r e R ep0n [1] N u r s e A . s a h [1] ' m a d e m u lti p l e a tt e m p t s t o p l ace t he ~hea t ub e b ac k i n t o p1 ace bu t ha s b ee n u n m M x : e ss f u l . " C h r l a ti a n r ece i v e d B a g · V a l v e - M a s k { B V M ] v e n til a ti on a nd b eca m o p tt 1 s o l c u . N u r s e A s ah b e g a n . c h e s t c o m p r e ss i on s . E M S w a s ca ll e d . a nd upon a m v a l c ond . nu e d C a r d i o - pu li non a r y r e s u s c it a ti on , ob t a i n e d a b l ood p r e . uu r c a nd t h e n t r a n s po r t e d C h r i s ti a n t o C h il d r e n ' s M e d i ca l C e n t o r , D a ll a s , T e x a s f o r ongo i ng c a r e . C h r i s ti a n had b ee n pu l s e l aa s a pp r ox i m a t e l y 10 - l S m i nu t e s bu t t ho e x ac t ti m e i . s u r i c l o a r f r o m t h e m e d i ca l r ec ; o r d s .
. , · '
A a r e po r t e d b y C r i s ti n a M a r e n t e , t h e m o t h e r o f C b r i s ti a n M ~t e, N u r s e A s a h h a d n e v e r c h a n s e d t h e tl ' l . C h o f C h r i s ti a n a tt d t h e c h a ng i ng o f t he t r ac h w a s n e v e r t h e r e s pon s i b ilit y o f N u r s e A s ah . T h e c h a ng i ng o f t h e tt ac h w a s s o l e l y t h t r e s pon s i b ilit y o f C r i s ti n a . C r i s ti n a had r ece i v e d s p r . c i a l t r e i n i na i n P e bn w y 2012 e t B a y l o r H o s p it a l D a ll a s on t h e p r o ce du r e f o r . c l u m g i n s t he t r ac h . I n f a c t. t h e m e d i ca l r ec o r d s s ho w t h a t t h e t r ac h w a s c h a ng e d e v C I) ' M ond a y on t h e s h i f t f o ll o w i ng t he e nd o f t h e s h i f t o f N \ U ' l e A nh . T h e p r o ce du r e o f c h a ng i ng t h e t r ac h s t a r t e d i n F e b r u a r y < 2012 a nd c on ti nu e d t h r o u g h S e p t e m b e r 3 . 2012 w h e n t h e t r ac h w a s c h a ng e d
,. e v e r y M ond a y by Cri~ sho~y b e f o r e C h r i s aa n w e n t t o b e d . T h e S k ill e d N u r s i ng F J o w s h ee t ~; o f N l , l r S e A s ah s ho w s t h a t t he l u t t i m e t he t r ac h w a s c bq e d w u S e p t e m b e r 3 , 2012 . T he
. S k ill e d . N u r s i n a F l o w s h ee t f o r M ond a y , S e p t e m b e r l , 2012 . s ho w s t h a t t h e t r ac h o f C h r i a ti a n w a s c h a ng e d on t h e s h i f t o f N u r s e M odup e O l o j o .t ha t b e g a n a t 7~00 p . m . on t h a t d a t e and on a ll p r o cee d i q M ond a y s du r i ng t h e r e l e v a n t ti m e pe r i od . B A S I S Q F E X P E R T ANA L Y S I S O n S e p t . e m b e r l O . 2012 . a t a pp r o x i m a t e l y 5 : l S p . m . N u r s e A s a h w u i n t h e ho m e o f s e v e n t ee n
., y ea r- o l d C b r l s ti a n M a r e n t . e p r ov i d i ng g e n e r a l n \ n i n a : ca r e o r t r ea t m e n t a s s e t f o r t h a bov e w h e n " t h e 1 r ac h w a s r e m ov e d by N u r s e A s a h . R e m ov i ng o r c h l n a i n a o f t h e tt ac h w a s no t t h e r e s p o n s i b i li f y o f N u r s e A s a h . N u r s e A s a h w a s un a b l e t o r e · i n s e r t t h e t r ac h o r a s ec o nd s m a ll e r 1 : a . c h . S h e t h e n b e g a n b a g - v a l v e m a s k i ng [ BV M } C h r i s ti a n t h r ough h i s t r a w a i n w h i c h s he b ad t o l d t h e 911 d i s p a t c h e r t h e t r ac h w a s " h a l f w a . y i n . " M A R . B N T B 08 / 20 /ll P AG E " 4 [242] *46 r . L u : y u . - , k " t n : . t s [1] · l\ n a " r tj on N u r s e A aa h s pok e w it h t h e 9 \ 1 d i s p a t c h e r f ' o r a t o t a l o f 6 · m i nu t c s . D u r i ng t h i s ti m e , s h e d i d no t i d e n ti f y h e r s e l f a s a R eg i s t e r ed N u r s e . T he 91 l d i s p a t e h e r w a s t ed v a l u a b l e ti m e c xp l a i n i q t o N u r s e A aah ho w t o c o m p l e t e t h e C a r d i o · pu l m onu y r ea u1 C it . a ti on { C P R ] p r o ce du r e s . P e r E M S r ec o r d s , p a g e 114 , B M S r e c e i v ed t h e ca n a t 17 : 23 a nd a rr i v e d a t t h e ho m e 17 : 28 . U pon m i v a l , C h r i s ti a n d i d no t h a v e a pu l s e . a nd · C P R . w a s c on li n . u e d . B M S do c u m e n t e d " P t ' s t r ae h ea op e n i n & i s b l o c k e d by t h e p t • s n ec k . " T h e y no t e d i n s o r dn & a [0] 6 . 0 mm ET t ub e t h r ough h i s t r ac h ea . " T h e y t h e n t r a n s f m e d C b r i s ti a n t o t h e a i ? po r t w h e r e a i r · t ea m e m e r gen cy f li gh t . A i r · E v ac 74 , m e t t he m a nd t r m f e : r e d C h r ilti a n t o C h il d r e n ' s M e d i ca l C e n t e r i n D a ll a s i T e x a s . ' D I E S T ANQA R D O F C A R E A PP L I C A B LE T O mm& E M AH ON 09 [ 101121 T he S t a nd a r d o f C a r e f o t a r ea i s t e r e d n u r s e i s t h e l e v e l a t w h i c h t he a v e r a g e , p r u d e n t p r o v i d e r i n a g i v e n oo mm un it y w ou l d p r ac ti ce . I t i s ho w s i m il a r l y 4u a ll f i e d . p r ac titi on e r s w ou l d h a v e m a n a g e d ~e p a tl . e n t [1] s ca r e und e r t h e s a m e o r 1 i m ill r c i r c u m s t a n . cc s . I n m y op i n i on . t h e a pp r op r i a t e s t a nd a r d o f ca r e t ha t N u r ae A aah . s hou l d h a v e p r ov i d e d C h r i s ti a n M a r e n t c w a s d e p e ii d e n t on t h e du ti e s a nd r ea pon . s i b iliti c s o f N u r s e A nh i n c a r i ng f o r C h r i s ti a n . T ho s e du ti e s
, • a nd r e s pon s l b ilitl ea w e r e t o p r op e r l y : Moniio~ t h e v it a l s i gn s o f C h r i s ti a n p e r t h e S k ill e d N u r s i ng F l o w s h ee t d a il y ; 1 . 2 . T o a nno t a t e t h e S k ill e d N u r a i ng P l o w s h ee t d a il y ; 3 . M on it o r t h e v e n til a t o r e qu i p m e n t; 4 . M on it o r t h e m u c u s bu il d up i n t h e t r ac h a nd s u c ti on t he m ' ll C u s ou t p e r i od i ca ll y ; s
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O b s e r v e C h r i s ti a n f o r a ny s i gn s o f s t r e ss o r d i ff i c u lt y b r ea t h i ng ; 6 . : [1] 7 . B a t h C h r i s ti a n a s r e qu i r e d . I t i a m y op i n i on . t h a t t h e m e d i c a l c ond i t i on o f t he p a t i e n t i s no t t h e d e t e r m i n a t i v e o f t h e · s t and a r d o f ca r e i f t h e du ti e s a nd r e s pon s i b iliti e s o f t h e m i a no c l n u r s e do no t r e qu it e a ny s p ec i a li ze d tt a i n i ng b a s e d on t h e p a ti e n t & a c t u a l m ed i c a l c ond iti on . I n t h i s . ca s e . t he f ac t t h a t C h r i s t i a n bad a h i s t o r y o f ' J e un e s ynd r o m e a nd r e s t r i c ti v e l ung d i H a s e d i d no t r e qu i r e N u r s e A s a h t o ha v e a ny s p ec i a li ze d t r a i n i ng t o p e rf o r m h e r a ss i a n e d nu r a i n a du ti e l a s I O t f o r t h abo v e . A dd iti on a ll y , t he l o ca ti on o f t h e nu r s i n a s e r v i ce s p r o v i ded by N u r s e A aah d i d no t r e qu i r e a ny s p ec i a li ze d ' t ndn i n a t o p e rf onn he r u ! i a n e d nu r s i ng du ti e s . T h e s t a o . d a r d o f ca r e w ou l d b e t h e s a m e w h e t h e r o r no t i n a ho s p it a l , nu r s i ng ho m e , 01 ' p r i v a t e ho m e . BR I A C H E 8 O F T H E S T ANDA R D O J C A R J 1 J Y N JJ B S E A S A J li . I t i s m y o p i n i on t h a t on S e p t e m b e r 10 , 20 12 . N W ' S C A . uh b r e ac h e d t h e S t a nd a r d o f C a t e a pp li ca b a l e t o E un i ce A s a h . R N . a s f o ll o w s : M A R E N T E 08120113 P AG E S [243] *47 t vd f ' ... u1 . & . - It. # " '' - " • . a . .... r u . .. . a r- [1] - [1] , & , 2149051213 pg 7 / 26 l . N uu e A s ab . R N b r ea c hed t h e nu r s i ng S W l d l r d o f C a r e w h e n s h e r e m o ' Y e d t ho t r ac b . fr o m C h r i s ti a n : a p tt J C o c l u t e t b & t w u no t h e r r upo m i b i H t y . 2 . N u r s e A aah , R N b r eac h e d ' t ho nu r a m a S t a nd a r d o f C m w h e n a h c f a J l e d t o i mm e d i a t e l y . ca ll a pp r op rf m e m e r g e n c y m e d i ca l a ss i s t a n ce w hen t h e p a ti e n t s ho w e d i n iti a l s i gn s o f d i s t r e ss .
3 . N u r s e A nh , R N b r ea c hed t h e n . u r a i q S tl nd a r d o f C m w h e n s h e f a il e d t o s i v e t h e 911 d i s p a t c h e r t h e c o J n C t s t r ee t a dd r e ss o f 311 E a t F t u m a n S t r ee t . · N u r s e A uh , R N b r eac h e d t h e nun i ng S t a nd a r d o f C m w h e n 1h e f a il e d t o i mm e d i a t e l y
4 . i d e n ti f y h e r s e l f a s a r e g i s t e r e d nu r s e r e s u J ti n a i n ~ssary d e l a y . : i 5 . N u r s e A s a h . R N b r ea c h e d t h e n m s i n a S t m d a r d o f C i r e w he n- ~ f a il e d t o p r o p e r l y ! c o mm un i ca t e w i t h t h e 911 op e r a t o r . ' 6 . N u r s e A s a b . R N b r ea c h e d t he nu r s i o s S t a nd M d o f C i r o w h c n t h e f a il e d t o r e m a i n ca l m a nd c o ll ec t e d i n a p r o f e ss i on a l m a nn e r . 7 . N u r s e A s ah . R N b r eac h e d t he nu r s l n s S U nd a r d o f C 1 r e w h e n s h e f a il e d t . o h a v e t h e p r op e r t r a i n i ng f o r ho m e h ea lt h ca r e f o r t r ac h e o s t o m y p a ti e n t s . t o ac h i e v e po s iti v e ou t c o m e s i n p a ti e n t s w it h t r ac h t ub e s , e v e r y nu r s e n ee d s t O k ee p a b r ea s t o f t h e b ea t p r ac ti ce s , d e v e l op . end m a i n t a i n t he n ccc s m y s k ill s . A n \ D ' 9 e w ho p e rf o r m s t r ac h ca r e n ee d s t o be f a m ili a r w it h t he i r t ac ilit y • s po li c y a nd p r o ce d \ 11 ' 0 . P e r t h e S i x - S t e p D ec i s i on · M a k i ng M od e l f o r D e t e r m i n i ng N u r s i ng S c op e o f P r ac ti c e i n T e x a s . " A nu r s e a l w a y s ha s a du t y t o b i s / h e r c li e nu / p a ii e n t s t o a ss u r e t h a t t h e ) ' a r e .t a f e . O ne o f t he m o s t i m po r t a n t ac ti on s a nu r s e ca n t a k e t o w a r d i ha1 a o a J i a m a k i n a s u r e t h a t h e . I . t h e on l y a cc t J p t s t ho s e a ss t a n m e m s f o r w h i c h
· t h e nu r s e ha s t h e e du ca ti on . t r a i n i n a . a nd s k ill c o m p e t e n c y . P hy s i ca l and e m o ti on a l a b ilit y C l J l a l $0 i m p ac t a n u r s e ' s a b ilit y . t o m a i n t a i n c li e n t s a f e t y w h e n a cc ep t i ng a n a ss i a n m e n t . " I t i s m y op i n i on . w i t h a r ea s on a b l e d e g r ee o f nu r s i ng ce r t a i n l y t h a t t h e c m i r e nd e r e d t o C h r i s ti a n M a r e n t e by E p i e H o m . e S e r v i e o . I n e .. and N u r s e A . aa h d i d no t m ee t t he a pp li ca b l e nu r s i ng S t a nd a r d o f C a r e . I t i 5 m y op i n i on N u r s e A s ah s hou l d h a v e :
N o t h a v e a tt e m p t e d t o c h a ng e t he t m c h o f C h r i s ti a n ; a p r o ce du r e t ha t w a s no t h e r ' I. ; [1]
r e s pon s i b i li t y . l 2 . l mm e d i a l y ca ll e d E m e r g e n c y p e r s onn e l f o r a dd iti on a l he l p W h e n s h e c ou l d no t r e - i n s e r t thelrtCh~ .. . ,. 3 . I mm e d i a t e l y identify~ a s a R . e & i s t e r ed N u r s e qu a lil ca tl on s t o t he a pp r op r i a t e a u t ho r iti e s t o a vo i d unn ccc ss m y d e l a y i n a dd iti o zza l a ss i s t a n ce .
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M a i n t a i n a c o m po s e d . p r o f e ss i d m ll c ondu c t w h il e und e r a n c m e r g e n e y ' s it u a . ti on . 4 . ·., s
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F o ll o w t h e A m e r i ca n H ea r t A s a o c i a li on • a a u i d e li no s :f o r C a t d i o · pu l m on m y r e s u s c it a ti on . .. ;.
M A ll B N T E 08120 / 13 P AO E 6 244 *48 -----------~----------·· ··-· ·-· 08/26/ 1_3 08: 15AM PDT Dougl.. Floyd -> Peter Anderson e
-'·
,\ 2149051213 Pg B/26 Instituted appropriate nuning interventions that requited stabilization in a patient's 6. condition. Been properly trained in. the care of a tnchcostomy patient and in how to properly aet in 1. an ema-gency situation. 1lIB SIANQ6RD OF CARE APPUCA8L£ TO BPJC ffW,TH SERVICES. INC. It is my opiniC?n t.bat baaed on my experience u a registered DUJ'BI and supervising nurse w.ith
· duties to determine the treatmen.t atandards to be used by nurses under my responsibility that the · applicable .standard of care for Epic Health Services, Inc .• are the treatment standards to be applied are to ensure that lll patients recaive appropriate care re1udless of the setting and to · only assign nurses to patients that meet those standaxds. Those $t.andards of care inclgdc; To ensure that nurses are properly trained to provide basic nursing services;
l. 2. To ensure that nurses are properly mformed to bow the limitations of their assigned
•' duties and responsibilities to lssianed patients; 3. To properly instTUCt assigned nurses not to undertake nursing/medical proceduros that are not the nurses usigned duties and responsibilitiea; ' I 4. To ·ensure that assigned nurses bav~ the appropriate communication skills. particu!arly in an emergenc.y situation; and s. To ensuze that assigned .nurses have the proper training and experience to remain calm and collected in an emergency situation. BREACttES bF THE STANDARD OF CARE.BY SPIC HIW,m SEaVIq~s .. INC. It is my opinion that on September 10. 2012 that Epic Health Services, Inc •• breaclied the applicable standards of care for a medical provider of nursing services by assignment of Nurse Asah to provide nursing services t.o Christian Muente as follows: £pie Health Services, lnc., failed:
I I. fj 1. To ensure tha~ Nurse Asah was properly trained to provide basic nursing lel'Vicea;
2. To ensure that Nurse Asah wu propaly infonned to know the limitations of her wiped duties and responsibiiities to Christian Mamitc; 3. Ta properly insttuct Nurse Asah not to undmak.e nursitiWmedical procedures tba1 are not her assigned duties ancl responsibilities; f !- ;1 r
To enaure that Nurse Asah bad the appropriate communication skills, particularly in an 4,' emeraency situation; and To ensure 1hat Nurse Asah hacl_the proper training and experience to remain calm and
s. MA.R.BNTE 08120/13 PAGB7
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817 - 334 - 0586 F AX 817 · 334 · 0338 O FF I C E A ugu s t 20 , 2013 . . D 01 J & l aa T . F k > yd M / J m t J y A t L & w 6521 P r e s t on R oad , S u it e 100 P l a no , T e x a s 1S024 RB : · C AU S E # 86812 ; C H R I S t I AN M A R E N ' I E v E UN I CB A S AHAND B P I C H B A L n t
S E R V I C E S , I N C . · .. P l ea s e acce p t t h i s a s ~amended l b m . i e xp e r t r e po r t m 1 b e a bov e ca s e . R E C O R D S R E V I E W E D : I n a n M n a a t t h e op ili on t e l ou t 1a t e t i n d i s r epo r t, l h a w r e v f ll w ed . t b c : i ) ll o w q it e m s :
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M eda l r ec o r d s t o m A i r B v a c L i f i:t ea m ' ,, ,. C b ili r en ' s M edba l C e m e r i e c o t d s E u t T o m M e c li ?a l C m r . ~ ! M S T e x a s D c p a r a m il o f S u H ea ll h S e r v i c ea V t a l S 1 a ti a ti o a D ea t h C e r ti f b \t e 0 \il p l d e . m m t . e s f t o m O u r C h il d r e n ' a H ou s e P r op s no t e s t o m D r . J o s e J . S " ' * ° • M . D . S k ill ed N u r s i og F l o M b D o t d a t e d 09 / 10 ' 2012 s W l ed by~ . N ab . R . N . M a tt m s r e l a t ed t o m e r e , I JJ d i ' l a ~ o t C r il m l . M a r ez t e c onoe m i n f t be t r ea t o lt o f ·. · C b r D n M a t e lll e B M XG R . O U N D : M y n a m e f a C h a r a b o u p . Mm b l D . M . D . I a m a B o a r d C e r ti f i e d N e u r o l og itt , A l ' J d m . vp l a ooo f a q > l oy a r d1800 8 [111] A W ., S • 1 18 , F o r t W onh , T e xu 76104 . QUA L M C A . 110 N S : l a m ac t h i e l y pn . c t i : i J a m e d i a no w . aa w e ll e . s 1b c t i zz 1 1 » ~ a r o s e m a n a r ea ~to t h e c l a i m , I a m B o a r d C e r ti f i e d i n N e u r a b§ . I h A \ ' e s ub s t an t i a l t r a i n i D g and C l q ) c r t i sc i n 1b e at es .~ r . o t i t c l a m · I h a v e t h e kno f t dg e o f acce p t e d s t a nd a r d s o f m c d i ca l . ca r e f J r ' lll c d i a p s B , c m . = a n :l ~of t he ilj u y [1] i l J n c u o r oond m n i nvo l v e d b t il il c i d e m , w~is d l a t o f a i o x i c enceptalo~, u s u & r c d b y d r . p a ti e n t I a m 1 i n i 6a r w t h a m x i c encepbabpa~ and J a w 1 r ll f a t p a t f a l l a d i 1b il il 1 D ea s t h r oughou t m y r e s il e n ce . u w o ll a s in~J1rlvate a l b a r i d bo s pb l pn c t b . I ha . Y e s ee n li e r a l y 11 . m d r ed s o f P AG B l C D M I M A RB N T B • 08120 / J 3
253 . ..,...., \ .... """ ..... ~ ww , .1.vl'W.-~ r [1] . [1] . a . *52 pa t i m l t a w ho lave~ b y po U :: a s w e ll a s I JJ O x i o ~- I t i s u s u a l ! ¥ t h e r i e u r o J ogy w ko t b a t il oo m $d h • 8od ee o f • * cnccpb&Jopa~. m l ll 8na1 i y 1b tl m u r o l o a v ae m ce no a s k e d m p r il m b r a il d ea t h o x an ill a1 i m l on p a ti m t s . Neurolcp~ a s w e n a s pu l r . r m a r y m e d U :l c ml~ a n U I U lll y t he on e s w h > h a v e 0 s e a b & y m . t i = I C U t o · b m JJ e v e m r a m r aen m a s . I uo h a v e t x t e m i v e experdl~ i n d ea li u , g w it h p l dk t do u w o l u adu l t n e u r o l og i ca l ca w . I n : & c 1 . t o m 1986 t o 2000 , 1 d i ! bothp~ a u ! ad l * c ouub , a d t o m l OOO t o t h e p r e w i t ti n e , 1 a tilt s ee : Y O U O I c h J ' l c h a 3 . bu t t he y a r e U M J l y ov e r ! li e 13 . e r 14 . I c u rr e n tl y and .. n ee 1986 n , a u l a r l y r c k ~ m u m l og l ca l p tt i en t a f l r bo a h l a1 l h cae . A s a
. r e s uk i s l ' t he s e r e m nu , I w r l S e t b e O % de r l k b > m e b e a k h c u e i U b : 1 m i > . r m : n e s a m 1 b c n l b l b w up w l . l h tt e pa t i d t o i n s u r e i b lt tti e y r o ce i v e d . 1h e p R S C ! W ca r e m t c o ! J li w c t o r e c e i v e t ba t C l f t i f it i s on g a q . T h i s ii a . YKY C O f tlll O ll e i u a ti oo . il . ' o W o t U cc •
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. A m ' a ll ho ll & li I a m m t [1] R e s i U e t e d N u r s e , b eca m e o f s w c xp c r i: no c s p 1986 i n ~iailg p a . d e m i f b r bo m = l a l h C & R m 1 W O l 1dog w ll h m r aea t h a t p l ' O v ii e mm = hea l t h ca r e tl r q r " p a til m r s , I a m qua . li ft ed t o u c e r t a m w b m i a . m ae s bou k l h a w a d e qu a t e C l ' ••• t b • t o n a t ce rf a il il m ae s ii , & bob be4 l 1h C an > D ' i o mmm . I a m qv a ll & e d t o It. a t e t h e s t & nd a i d o f ca r e ,, i > r a m r ae t r eaq C l m i an M u e m e au l op i ne on ' d i e b r ea d l o f ' l b a S ll sx W d o f c : a r e . M y e xp e r i e : n t e a nd b i q n w o r l dag w t hb ca ll h c a r e i n s t b t i > m a W > h a s P f) i c H ea lt h S e r v . l c ' ee , I n c ., q~ m e t o r e nd e r • o p . i D ) n u t o t b c eu m da r d o f ca r e f > r s u c h f n s tf l n t i o m and op Q I o n t h e b t eac h o f t h e s 1 a nd a n :l o f ca r e . M E D I C A L LE GA L S T ANDA R D : U n i . a tlt e do t b e rf t e , a ll n t ' op i a i m a i n 1h : i a r epo r t a r c b a s e d upon t b e m ed l : a l l ega l n m d a r d o f r ea s on a b l e m c d i ' : a1 p r ob a b il y .
' ' [1] ' F A c r s O F C A S J ! ' I O P I N I ON S : C h r i s ti a n . M a r a D w u a t 7 - y ea r · o l d ~ DO B S / 12195 , w i t h .
a h i s t o ! y o f J~ 1 ) ' % 1d r o m c [1] a d J C S t r i c ti v c i q d i ua .t e . J e u m d f aeaae i s e . b« e d t uy 1 J w op l a s i a . o f t h e t ho r a x . o r a l s o kno w n u e s phyx i a til g t hon c i c ohond r ody a t r ophy . n m S ) ' ll d r o m e · s a rare~ d Js o r d a ' t ha t a t J b c U I a m W & y a c h i k l ' s ca r ti \ g e and bone s d e v e l op , t b a h ; a ) J y a . 6 e f s t M c h M ' I m c & F , pc~ mm m l 1 t g i L D ue t o 1 M m c aae b e i ng n a r t a W , t b il k ee p s t i l e c h il d ' s k m a s i o m d e v c J op i J g M l y o r e xp a nd ill g w b m d3 e c h ili m i u s . T h a y ca u l a o d e v c bp p r obb m w i h 1h li ' k i dn l y s . ' I h il i s t a k e n li m n d ll l d i c l a , '~euoe S ynd t o m = " u S ea t & C h ll d m s H o s ph li D . W a a b i w l nn . O n 8 /l 1 / 11 C h r i s ti a ll M A B E N T B w aa ee m l b t t h e t n t a b y D r . S a l p = r o , w ho . oo cc d h i s ntJUrOlo~ e x a m w aa t ! O rr m l , bo w e s w aaa \ W I . H e w u v e r y p e u m : and s m a r t. O n 9114 / 11 , b e i s s ee n by D r . S a l gu e r o , w ho no t e d h e m be a i m w i t h & non m l n e u r obg i c e x a m . P AO E . l C D M I M A R E N 1 B . 081 ' 20 / 13
.. . , 254 t 0~126~1·3 08 : 15 A M P D T D oug l • . F l OY . d . ::l ,, P e t e r ,~~"'~!!;~on e 2149051213 P g16 / 26 *53 O n 11123111 b e w u s ee n a p by D r . S t . l gu e J o . a m t W U no t e d r . o b e t il y U : r t . B i a n c u r o l o F e x a m . s ho w e d b e bad a mm a l ga i t.· ne ae C k w a s q , p l e . H e b a d a nep t i Y e B r ud z . i n s l d s . M 9111 i v e K e m i a ' s , m n a r i np l qp . m . & > c a l qp , m l w u m n m L T he phy a i:i a d s a u e ss m e n t a t t l m ti m e w a s un t p ec i c d a s t m n a . C O P D . r a l M n a . nd k i m e y t nn s p l an t s t a t u s . O n 7119 / 12 m W 8 B s ee n b y D r . 1o s c ph R o s e n a t 01 . 1 ' ~. H ou ac i n D a ll u , r- .. O n 9 / 10112 F p i c H a sJ t h S~ s e r tt b e i r e m pb ) " : C , U n a A ll ah . J N , t o ea t e i > r C h r l a f a n . P l ea s e no t s E p i c H ea ! h S e r v il e s p r o v i ded mm& b e l 1 l h ca r o t o C h r i s C i a n on a D J l . ti r m b a s i s m h i $ hou s e . a nd 1h e nu r s e s w ' o m c l i n 12 bo t r l h il J : s t o m 7 : 00 > J 4 . t . o 7 M P M , a ll d ? : 00 : P M t o
,. 7 : 00 A M . P l ea & e m t e . m J a r l l l l l ) ' 20 12 , t h o p m i m t had r e c e i v e d a nc.Moa~ a . a d w u a u ac h e d t . o a . w n til a m t bb c . ' I m on l y t J m ~ w u m t on a ~1Drwas w h m . ho w u b e i ng b a t h e d . E~ w it h d i e t r a r . b c o s t o "" h e w a s ab l e t o t d . and od ww i e b l d a J e 110n a b l y a c t i v e li t \ V i d J . b i f i m ' lil y & 11d f ii m l d a . I t b aa b ee n r e p c dd t h a t on S e p t e . a m e r 1 O , 2012 , tt appro~ 5 : 00 p . m ., N u r s e - A s a h w a s b a r m ng C h r i s ti a n i n h B boa . ' I be m is~ ~u t o e x ac tl y w b & t o C O ' l B ft l d ao x t. 1 . P e r t he 911 ca . D , N \ K l e A aa h W U l b M m l w h ill ' I pu tti ng C h r i r ti a n " b ac k r o bed ' * t he
" l m c h & a s t o t ! V " 08 B ou r . · 2 . P e r d i e S k B l ed N u r q F l o w a b ee t NU l ' & e A aah r epo r t ed , " A f t e r I pu ll e d ou t t h e d i t y · ., ua c b , I w a s u m u cce s d ll f n B . q t b e c l ea n6 . 0 B M > n a B e x e u t r t r ac h . A s ec ond a b t q ) t w it h t he s . o B i w m f l e x c u : f tt ac h a ' 4 i 11 . bk w u un s u cce l a ti ., l .. 3 . P e r t he r e s po ll S t t o c ilt m op t o r l e t p r opound e d t o N u r ae A . l ab . l m v e r i f i e d r e s po : m o . w a s a s m l b w s : ' • ' I N TE RR OGA T O R Y NO . 8 : ~in detail~tbltyoudid wthCHRIS~ .. ,.
M . AB . E N ' I ' B i n t h e o m bo i . r b e f b r e h ill t r ac h ~came ou t on S e p mm b e r 1 O . 2012 . .
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s upp li e s b e m r e s e t m ,, 1 t a n e d . T h a t i o c b :l ec l 1b c b a t h S l f l p J l ee . c m s ti a n ' s c l vq \ e o f ~ c f o t b c s . a nd a n o f 1h e s u pp i c s f > r t he f l a c ho c m on \ V o l w l g e , ii ob lil a a c l ea n 6 . o t r a c b , e . ba ck - up ( s m a ll e r) 5 . 0 t r e . c h . and a na m b u l q · C h r i s t i n ' s t r ac b e o lt . o m y a h m w : o cc u t l ' O d c v a y M o m a . y . N u r s e A s a h m a d e a ll o f t b ca o p m p a m f i m s b e i > r e b a t h i ng C b r ilti a uon S c . p t . e m b e r 10 , 2012 . U pon c o r q > . lt: d a g lil b a tl u m d d r e ss i u J C h r i s d a n on S e p t e t m « 10 .
• f r 2012 , N t n e A . uh b c pn t o c h19 I ii t r ac h . ' I h e t r ac M a h e l d i n p l ace w i t h s o t ti q t ha t m a m \ l l d h i s : ae ck . S he und ii t h e t f it e nd c l = a n e d C lli 111 ' a n ' • n = k . I n acc o r d a r l c o w l h ,. ' . h e r a T a t W J a r d p r o cec hn , w h C b . *b a d p e r b t m e d . m a q tti aa bd l r e , N u r s e A s a b . I h m r e m > w d t he e x i l t: q t r ac b ed co~~ t o p l ace t h e c b a n . 6 . 0 t n c h i m o
C D M I M A R E N T . E - 08120 / 13 P AG B 3 j 255 C h r i a D a n ' . s ~·· b li it w ou k l no t ao i t. S he mm d i a t a l y pbb e d r h e ~rt s . o l r & C h a m t r i ed t o p J acc i t ill o ctrid:im11r8Cheo~ U e . bu t i t t . oo w o W d *54 not~ m . A t t ha t p a i r , s h e i a m d i a t e \ v c a & d 911 onh c r cc n pho m a nd p r o cee d e d t o mm a12 C P R ua t il c m qe . n cy m ed i oa l a c m c e s m i Y l d . J n add t i on , p l ea s e s ee t il e d c po llii on o f N u r 8 C A s ah w b e M t ' t a k e n i > r f m be r ~n c o i a m il a t M c m p r ov ii c d t h tt d a y , II w e U . u t h e U \l & lt O ll db1 ~related t o t i s m a . tt = .
T h e P M T t ea m i > uod he had a ca r d i ac a m s r , i n m d ll ) ' lt . o l c a t 1730 I D d ab s en t r e s p i ' a 1o z y d r i v e .. H e w u no t e d t o h a v e c y m > U c a k i n . H it ca p i m y ze : 611 w u d e l e . ) « I . H i s pup il s i ze w u pup il d il a t a t b11 . Le w i o f C O lll C bu eaeaa w aa mespo~ w l b o ou t o f s i r m c u m r s t r ez > g tll . A t 1754 h il b l ood p r e u m e w e s 94162 , pu l s e w a s 142 , r ea ] > il a t o t y r a r e 13 , s ou r ce w a s s upp l = mm r a l . T h e A r E v ac Lbe m W U t b m ca D e d a t 1749 a nd m i\l e d a t 1809 , and W U w i f h .. p a ti m lt a t 1811 . H f i w a s J » t ed t. o be~ l c w l o f c o m Q b U I D I U . Loa o f c o m c i ou s n ea w u Q ) ft. d t o b e '' )! e s . " H B G J eaa o w C o m a S c a l e w u 3 . H o w u l b c n . 1 r a : n8po r t c d t a C b il d r e tt s M e d a l CC ! i « i 1 D a J l u , T e > caa . ' ! ' b e ~klgy c o m u tt adon no t e on C l n it ; i a n & OO w c d t h a t t h e B ' M S w 11 c & M m i " ' on t h e i r mM J , u w a s s t ill pu l ae Jc u . s o c l a t ~ w e m c o a lii u e d . H e w a s pen . a do ae o f ep il ep . b r i ne ft w a s e s t i na t e d t h e e p il od e o f puk e l eaaaa m . d ~ 10 · 14 ** 8 , bu t b e x a c t ti n e was~. H e w aa bqp i n r ou t e t o m t b e A f r B w c .: J n t h e H m e t p e y D epa r l J : m n t b e w a s , li v en 3 J i t e r a o f » m a 11 a b d \ J o t o p m f i a don , b \t d t s m t r equ i r e uyp e s a u r e s uppo r t . H e w u a ob i t o h a v e Dl)Ocb~ j ez k s a ll d w u li v e n A t i v an 4 q X 2 , D i t m i n 1 g r a m , . K e pp i a · l g mm . hyd m c o tti s on e a nd t hen a n l dd A a J . bo l u a o f 10 qk s ofp~in. h e f > r e m > v e m e : d s d ec r eaaec t . A t d l a t t i m , a s t a t C T o f t bo hea . d i w aa d O JJ . e on 9 / J 0 / 12 • . m w q , m l:l vobn c J o ss ii v o M ll a p m e . r i y t h e t o t llll J ob e s , bu t no e vk l e n ce o f m c . r a n i a l ~. D J 1 a o t m e t o f p~edema. H e w a s 1101 e d t o ~e ob \ und e d upon a rr . M l t o t h e ~-R.oom. bu t t he m o t h e r s t a t e d he w ou l d w a l k a nd o a t b y m ou t h , i l ll n c t w t h t h e f qn i y a t ll o l r J O , w b t h w u h il ba sc b p r i o r t o 09 / 10 / 2012 b c ii e : n t H e w u a d m i f m d 10 P I C U e nd N C \l ' O J ogy w a s c o m uk e d . BB G on 9 / 11 / 12 . sJ » w . d b \ll 1 t 111pp m s bn p a tt c m , bu t no s dnn ac t M : y . and t b a i > r e a 1 li : on w l 8 a m w e r e s m pp e d . T h e j e r k i ng w a s J ! O W i d t o b e poa r ~ • e b m l a m m t i s ea a d i v . l y . H e w u uo s o e n byn e phn > J o & Y a nd P i m C a b l r o i La s il c and ~ M R I o f t b e head on 9 / 1211 . l t bo w e d . ~ & y l m e t r i C a 1 ~m:l s up t m n t o r i a l ~ e d e m a o f ' t b e c o r t e x , and l q ) J I Q l r i o r ill d ee p g r a y l Y J I D r n ' ~. T b eae f b l i n s a r q i r eac u t 1 c queae o f p r o i > und a k > b a l il c h c ! S ~ l: w u t . H e w a s I O C X I. b y ca r d b lo g y ~ of ~. a nd b i d 111 & 1 ri a l a to p ~ ta c~. C D M I M . A R E N T B • 08 11 0 / 13
P A G B 4 256 08,~26/13 08 : 15 AH P D T D oug l • . F l oyd - > P e t e r A nd e r s on e 2149051213 P g l S / 26 P u m > D 8 r y m e db i no l & W h i m m i . i ; W [11] m J t )! e had e p a od ea o f eg i t l 1 i on w il : h eyp~ ~ b : r ea s e d r e s p i r a t m y r a t e , c on ce m f ng f i )r a u t o mm i c s u m r q .· ae w u g i\ C l . *55 V e m ec l , P~ml V a li m n m il a l y , t h e p mm y t ea m . h i d e . b ll 8 d il c uaabn . w il h t b e m o t m a bou t DN R . It w a s a o1 c d on a d m B O > u d m t b e p a ti e n t W u m a po m i v e t o W r b a l o r t ac til c s tit m li , bu t had t ea A :t M pup D s and t w it c h li k e m . > w mm r s O J l . e x a m T he r ea s on m r a d m i ss i on w a s a c u t e r ea pk a 1o r y d i s t m ss , t r a c be o s l O m y COl?f)~ a lll r e d mm r a l s t a t u a , i D d o v e r l oad , l OO n e y l r a J ! S p l a n t C O J q : > b1bn s , a m b kk m e y il g \ xy [1] c a r d8 c d ) ' S l h y d m i a , ~ i m n a b iil y a nd c o .,. o : i Y e d~n. A t B m d il & D r . M aa b ia s ~ M . D . [1] a de t h e eo mm n t 9 / 1 2 1 1 2 b t t h e y w e r e v e r y c on c e m l ! d a b o u t · b i s n e u r obg i ca . 1 p i op s a l on . NN ' O bgy a l s o no m d i J . t m t m t a d m t. p a ti e n t ac qu i r e d s m po r m r 10 . 15 mm , no t wel-d~ a t.I d h a d a qu ea ti on a b» s ll > r t ~ t m » c bn il : s e i an i t t h e Emer~ R oo m b e p a mm t t h a t i ndbn r i d 110 m c t m x i c b r an i\j u r y m i W U baded w l h pho s pho J a t c d D . il aa ti n . l . nd J C c pp m . H e no t ad d i e e r o f t h e bead a nd B E G . I t w a s a1 s o nob ! J d t h a t 1h e p r op s il had b ee n v e r i f i ed a i m 24 ! ¥ > 1 . 111 t o m 1b t e v e n ti s o t o k ee p ~ B OO on i > r no w . and i r eau m tt o f t he l q Y O C k m i c j e r k s c ouk l b e t r ead w i t h 'bemo~ ph ! e y t o i n o r Vap~. t l ¥ > ugb t h9 uae t bbe ss ii qu c s t i D n a b l c s j wD . lll e v e r y poo r . p l ' O p t i a . ~hBboapialitayhe W U intea~ ti > m m l t r ea t ed 1 W h C~and C d r i a x . O ae . H e b a d o cca s i o m l e p i a od e s o f 111 e } ff n ea . ~and h ) p c n e m i m , p r ob a b l y du a t o n e u r obp l 10 m i ng . · O n 91 ' l 3 / 12 , s uppo r t w a s w t ii d r a . w n du e t o t h e k t bo W qp ; ca n t b r a il d a m a . s e . H i a a d m it m t 1 i na l d i a p s e s w e m r e s p i m t o z y ti n 8 . ll d b)po~ w . 6p l a l op . _ it w a s no1 B d c a w o f d ea J hu ~i'atory u r e s t s ec ondny t o w il bd r a w ll o f ca r e , and 1 c Y C 1e brain~xic ~ I n a~ ca s e , t h e r e I N f > u r eb m l r . l 1b a t m e d t o b e f ill f ill r i d . 1b : r e i J c i = . b i a . eh o f s t. U da ! d o f ca r e . ee un t k > n m l d a r m g e s .
· W h a t i s ! h e s p ec . i & c ondu c t c a1 ll d i m o qu : s don ? I t i s ! be c ondu c t o f m n e A S a h . R N . w ho 1 B ll b e l o w t h e a t a nd ud o f c m w h t m . s h e A il e d t o h a w t h : : p r o p • o : a i b f na lll d e du . c a t i on i w h ca l r h C a t e i ' > r tt a c be f ) s t o m y p~, U w e ll II h e r ' & J u r e ., p i O p cz l y c u e i > r 1b e 1 r ae b e () s t . o m y , & a
J : .· w e ll a s t o i m n e d . i a t e t f c an g11 t 0 I l k 1h r m s d i : a l uUtaac~. m :I A il u r e t o do C P R .· I t i s t h e & il u r e o f t m s m n e 1ha t w a s t h e a ok l and cc bbg i c ca u s e i b r t h e s e v e r e a m x i: c n c : c ph a k > p a l hy . A m x i e eace pb a bp a d i y i s d e f a d a~ CC > D l ' l cJ t li c k o f o xys m t. o l b & b r a ii . w h tl h i n p : m za l ca u ae s a n e r m ph a bp a t h i c p~ a i a u iilt c d by abnd m l m t a1 & t & l U I t ha t i s acc onp m i e d by p~ ~1. B u a JJ y , ano~ 0n c ep : ba l opa1 i \ y 1 m 1111 bn . i D d a m aae duo t o * k o f oxyg e n . m t h i a c a s e . it bad ii a l m a n l h t a . ti o m , e nd m g i n C O I D I a nd dea t b o f C h r i n i a n M~. CD M I M . A R E N 1 ' B ~ 08120 / 13 P AG E S
257 uuug . L 1 : 1 .· 1 ·. r J . oy a - > 1 " e t e r A nd e r s on 2149051213 P g l 9 / 26 W l d l " ' 1 a r d t o t be 1 ca nd a n l o f ca r e f o r N a no A l a h d i e f o ll o ,.. lt a nd a r d l a r e a pp li ca b l e : ' ! 1 . If a d i s p l a c ed t r ac h e o s t . o m y lll b e i a s m p e o t e d , 1h c m anda z d o f ca r e r e qu i: e s b i 1 a t . e r a l a u s c u lt a ti on o f b r ea t b J O und a ,, ob s e r Y a t k m o f c l w t r il e m t f ill , a nd m e o f a n e xh a l e d *56 C 0 2 . d e tti c t o r m I S 8e88 i > r p l s ce r m n t .
• : 2 . T h e s 1a ll dud o f ca r e x e q m ee t h & t ob s t n . i c m d t r t d1 e o1 t O m , v1 W c l • s u s p e d e d w it h deo r ee sc d b r e & d11ound s b f l a t e m ll y , o r de c r w ed m e r il e and U 3 . T h e 111 a ll d a r d o f ca r e r e q t 1b s t ha t s a h b e i geo t ed ilt o t ba ~tube t o 1 l m s ec r e li o m , t h e n a P l O J * l y a i a l = d w c ti on c tt h m : r be paaaed i n t o d i e t ub e m 1 s uo ti on i s a pp li e d t o c l ea r aec r e m n a f i o m t b a u ac hoo lt O J lt ' t ub e • . T h e s u m da l d o f ca r e m r m n m a r e qu i r e i t ba t. i f ' t beob S 11uodon i s s t ill . p r eae r t, ; you l h a ll
4 . I C p e & t t h i s p r o« . du r c on e mm a f t e r a=~ w nda t i o tt b e L W ee n a tt e r q ) t s . S . If t h e r e i s no i q > r ov e : r m z t i n ~distrela, t h e u ac b l o s t on w t ub e w ill b e d w J eed mm
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d i a t e r . 6 . T h e s u m d a r d o f < lll ' :I r oqu il::l l b t . t i f & ~ t m c do a m t pu1 ea s il y , t h e de l q > t s h8 ll be x m de i m . n e d a t e l y w it h a s m a ll e r e i m d w be t o r e - eab l ah a n . & f n w . y . 7 . A f J m 11 . c t ub e J a p l ace d , 1 ss e s 1 i ! gp l l ce m a o f t h e I U bo w i h a t bu t t w o c od m a t o i y m ca s U l 81 s u c h aa l s t e m i g t o bn l & 1b s ound s . ~n o f equa l m e a nd A ll o f c h ea t . a nd m e o f C 02 d e t ec t o r aha D b e d O C t B D B D l ! d b y t h e RN .
· 8 . T he r t a m a r d of~ m r s e w n a i r w a y pbnu c 1 i on i n c b il d r e n r e qun a t b a t pno tili o m r s ca ll ea r l y 6 r a dv a 11 C e d h e l p . ! ,, 9 . A r ea s on a b l e a nd p r ud e n t ! l U l [8] e f s r e qu i ' e d t o r c a li c d i e p a ti a n t ' s da l a s aea s mm t ~aid i n iti a . 1 C m~respome i m w i •• l y . 11 . T o l m > w n c b e o s t on f 1 ' cans~ a l J o m ,, ca p a d m t . 12 . T o k : c o w bo w t . o p r ope r l y poan . r c m o w and r e p l ece a t m c . b c o . s t on i y t ube . 13 . T o kno w t o c a ll 911 i r ad i a t e \ y , i d e n ti f Y i .. e l f app i op r i a l e l y a D 1 g i Y e t h e c o rr ec t
. a dd r e ss o f t he A e & y . · D e t c r i b e d J e m un e r J n w h i c h t he ca n t f a ll e d t o m ee t t he s t a nd a r U . F a f h l r ea o f NU l ' l e . A s a b : A s an R N w o r k il gunda ' a c a m o ( B p i ) H edh S c r v i: ea . s he w a s •• t o c a r e b ' and t r ea t C b r i s ti u s . M a r e m e . H e r dudu i D c b l ed p r ope r ca r e a nd t t ea t m on t o f t b :
PA 056 25 8 . • • . 08126~13 08 : 15 A M P D T Dousl~. F l oyd - > P e t e r . A nd e r s on ~ 2149051213 P g20126 t r ac h c o s t o m y t ub e . S he A W T C b & v e d lt p r op e r t r a l r q t b r bo a b a l d l ca r e f l r ~tomy pa t l e r i & w b m * ' und e r t o4 : 1k t o r e p l ace t he f l 8 C . b . a . , P f O C O du r e t ha t w a s no t h e r r o s p O ll d U lil y . 1 . • *57 2 . S he & i k d t o p r op ee y ze i m e r t r m e & t b m r i n li n t t o , pn i v e m t h l s e v e r e a m x i: da m & 9 ! 1 . 3 . S h e p llli c k e d w hen a h e e ouk l no t i e i m a t d i e f n C h .
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h e r I h a b a s i: p r i o c i p ' .I M o f C P lt A p i J , a l d l ough l a m no t a m n e . bu t a m a ~doctor, I ba \I C had e x t c n8 i w t r a iii ag w t i h z u s e s du r i ng m y r e s i d e w y a s weUupostRSibJcc·~il;boepials. I h a ... e P ,. m ilt f l e I D c m s t o m n U 1g staft'throVibout~ t i m ha a s anattendilap~ and I ba v e dea l w i t h . hon h ea lt h c m . : I U I C f i 1 ~ p N t u w e h1 p r ue r i d y f n . - .,. c un m da y p r ac ti ce . I ha v e b a d u s e s f n . m y o ill c e , a . nd . I D ) ' do c t o r e x p cc t a a . m s e 1o b e c m q : 1e1en t c m uab t o 1 ii 161 ee r t a m
,. du m s a s iod~fecl by h e r odu c U i on and l r a D og . F o r e x a n : pb . a m no Z i d :l f i C a z d i t c C an i t b J it w ou H b e ~ec:ted t o unden r m ! a t r d il c p a mm . t o bo a bk i t o uade m abd 1 h e . t m db c i o111 [1] nd l odo ' 3gy a nd1 r e M m : n t o f ' ca r d i a o p a ti m ll a . A J . a boa b t e l t h w e n m s e , N u r s e A . uh . s h ou l d h a v e had 1 m u a ili g apen il c m l
· : kno w kd ae , b ece . u s e s h e w a s ad w r t i s ed a s s \ E h , t o ca r e 1b r . 1 r aa h = o s t on il:; ! J and ' 1 ' ea t an y l ) p e o f . ~ t 1 m t lll g t i t a r l s e i 1 t b l ho m e , e s p ec q .. ii t he ca r o o f C b i s d a n M mm t c , e m a t J eaa t b e p m p a r e d t o 1 r ea t a ny m w px : y t b a t ahou ll a r i s o ii & ho m e b e dh e w e p a ti e n t A l t he s e a bo \ ' C : f 8 il u r ca o f N t n e A ll h w u d : l c s ok C ll J ll J i on o f t m ano x i c e no e ph a l op a t by , w h i c h J ed t o i b t: bo s p i t a & r a t i ) D , c o m a an d de l t h o f C l r i a t i an M a r e n l l . 1b f s i s s ub a lll n lilt e d s u f li ? i m l y i n tf Jc m c db l r cc o r d a . U pon an i w l by t h e E M S s e r v i ce s . t h e p a 1 i e a t w u f b u n d t o be ~ic ( pu l s c t b a ) , and n : a p h t o i y · d e p i a s ec :t J n o t h e r w o r d s . n o t b r ea t b i D & H e w u qu a dq ) t e p l o r had j a cc i d pa r a l :, U . i . e ., m t m ov i e a ny e x t r m it y . H i a
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G l aa gp w C o m a S ca . 16 w a s 3 ou t o f I S . I n ua i o & t h e & CU , O r J e i a p . en S po X i r s i n ' e y e op e nq , 5 po i n t s i > r w d > a l r e s pon s e . a m s p o m m m o t o r r e s po m e . H o a p t 1 po i n t eac h j )r b a W . no e y e op e n i ng m v e t b a l r c s po m o a nd no m t o r mp~ a C D l a l s c o r e o f 3 . A t q s c o r e b c b w 9 . eooo r d E i g t o t he lit . c r a m , B & Y C t y I C V Q ' C S C O f C , a J 1d t h e k > w c r t b c I C O I C ~ il d i J a t ea I e s e
,, e l m l ce o f 1 eca v e r y . A cc o r d i 1 a t o t h e C JJ C , b u e c l on m o t o r r e 1po m e . W l ba l pe r 1b t m l r l c e a nd • op e n il ' J a t o app r op r i a t a & s t i m lli o f t h e G J u a o w C o m a S c a l e w e i e d M i & J l ed a l M i s bo m l b e u s e d t o a ss ea 1 t h e dep1h m :l du m t bn o f c o a a nd i q» li : ed c o m c i o u s m ss . T h f s ~helps t o gaua c 1h e i q > a c t o f a w i d e w r i = l ; y o f oond m n a s u c h u I C u t e ! > m il d a m . g e , m l i n d li s c u e , CD M J M A R E N T B - 08120 / 13 P A . G B 7 [259] du e t o 1e vc r c ano x i a ~ b y t h i s pa t il tt I t i s ea r . ill e t . e d t h e pa t i u had l a ck o f 0¥ ) 9 m f b r a t ll u t 10 . 14 m i m lt a . lt Js kno w n t b a t t he bn il r c qu m a c on s t a m :f l o w o f OX ) l m l r o 1 l m c don no m aa J b ' . A h ) . po7d c a no D :: . ij m y oo c t n w h e n t ha t f Dw ii d i s r up t ed , e u e J ii a D y S l m ' V i ! g t h e bn i 1 ~ p mm i n a i t i o m pd r m i ng ' V l t a l b i o c h c u D l p m ce ss e s . Ho~. a m x t m ea m a t o t a ll a C k o f oxyp i . I n g a n e r a 1 . I ha m l r e c o r : q > l r :t e m e d e p r i v m bn . t be m . n s e v e r e t he h a r m . t o t h e b r a i n . a m 1 ! K ! ... - r m conseq~. D i r iil b . e d OX ) W l n s 11pp l y ca n ca u s e s e r i > u e ~aiments i n c ogo ti w lll d l s , u *58 w e ll a & p~ p s y c ho l og i ca l m l o t he r f ll c ti a . M o tt tt m book B il d s ou r c e s s t a t e t h a t abo l . i : 5 m i m i e s i s t h e t m w e s t a r t s ee il g d y i D & o tt ho ce 11 s . (I l c h m n i a )
., A cc on : l m g r . o C f a . y O ood mm , M . D ., A ss o c i m P r obao r o f N e u r op a t bobo a t B a yb r C o •• o f '
M~. b B 1997 N e u m p a J ho l Q & ' f N o t e s . pap 18 a nd 19 , U J k abou t global~ w b i oh l ea d s t o w i d e s p r n d ' ti s s u e i q j u r y , r c m g m . c o t X t i t. b n a ~ t . o i r i c b e S o n c c p b a . b p a t h y ,
., w hbb t. b i a p a t i m t s u f!r c d , T h e n : m e I M l ' ! ' ij m y n y k w l t o d« m d i a a nd s p a s ttl y , J f t h e f s a h i m i c p e r i od i s p r o tt ac t e d , t he p a d e : m m a y no t r ep i 1 c on s c bu m w , a i d m a y e xb i b l d ec o r ti ca t e po a 1 U . i og a nd s e t u ca . m l m AY r ea n il . e . v eae t a ti w a t w b l e f i n il e l y . C ena i n ce ll popu l a ti on s l ba t a r e s e l ec tt v e \ yvu t n e r a b l e I O il c b e n1 c . i 1gu r y ill c b : f . e l a r g e ll C \ ll ' O ll S o f il o l m o f t h e s ec t o ? $ o f t h e b i > po c m pu a , P ud c q e t a D a o f t h e ca b e l bnud m : u r o m o f l a y e r a 3 a nd 5 o f t b c · c ab r a l c o r t e x . · N o t O l l l y d i d C l n ti a n M a . m u ' s b r a i n U ll d e i a o O J . ) F nd c p r M ti > n , t he m a n w a s a l s o d e p r i v e d o f a d e qu a t e & bod l b w . It i s a l s o m t ed t h e p a ti: m t b a d b ee n i n m d t o b e pu H l e u a m w k ' bou t r ea p il r o r y d r i v e . It w a s f il r l be r a s ee r t & f m d h e b a d a poo r O l u a o w C o m a S c a l e o f 3 . U ponh il m i Y a l a t t h e C h l d = ' s M edb l ce m r i n O d a s , he a t ill bad a vo r ypoo r p r ogno s a c mm i on o f b e i J a c a a tl ' > s e w it h pup i ' l s d il a t e d . a nd b a s i ca D y t f ace n with~ ae i r o . bp : a l i e s pon sc , e x ce p t il r pup ill ae y r eac ti on . T h i s w a s 1 l a : r he r s ub s t a n litt e d by t b e bu m ~BBG m l t h e MRI~. w h i c h ! w ill
! . e li ! b r d w on . '
P m gnpg F p ! ! o w i pg G a r d l o m p l m t m p r y R au9 c j t a li D a b y P l ' lll k T ho m k e a m S a s h a L W c il a m a m ; , f i o m 1b = D T S C HA R Z I ' BB I .. 2007 ; 104 ( 42 ) : 2869 - - SS , s t a t e s t b a t p a ti = m w ho h a v e und e r gon e ca n li > pu l m o i m y r e s u s c it a V onb a vo a poo r p r opa ill . F e w e r t han 5 % a u r v i w ~susoi:laiionon a~ il nn l &m a s , w b il e i n c ii ea q , t o 113 a un ii v c . T he y c . it h c r · < & a oon a h t w a r d s o r c s a un i v c w i r h s e v m e i r r e v e n i ) J e b r ahda nqe , cewina~ ~mcioUllJCIS,
P A G B 8 [260] ~ ~ . 08 / 28113 08 : 15 . A M P D T Dougl~. F l oyd - > P e t e r A nd e r s on ~ 2149051213 P g22126 u w on s c bu m o a s w a s a pp r ox i m a t . e l y 10 m i u . o s . ! l ec t r op ti y s m b a v ~ s u c h b m t s q > p r e s aa n t E F . G and M R I & b t > w ed . c h a n c t a :iil b c on a t d a : a l a p . T h e M R I r opo it o f 9 / 12 / 12 S ho w e d e x t = a i\ e ~iohllDIOrial and s up r a t c m o r ill c y r o ti c e d e t m o f t b a c o r t e x a nd 11 . 1p r m t o r l a l d a p l f . I Y m a tt e r & t r u c tl n l . 1 i nd ii s a r q > r e s e n ti q J sc q \ J CU o f p r o i n m d g l ob a l h)po~ il s W ; T h e p r ogno s i s o f p a ti mm ii c o m a w l h ~ 11 \ ' r ' O c b l m w i b . 24 & ou r a o f c a r d i > pu l m ; mm : y r ea u s c i r a t k m l ho w t ba t o \t o f 202 r t m i e d , 191 de c l . L ac k o f t m t o r ~ sp om e t o
*59 · a m xb s ti m J li o f t h e li c e I D d li r b s it c o m il e r ed f i O m a t e a poo r p r o s a o s it i f t h e t b i il g w u m a d e 3 d A ys d c r r e s i » c b t m O n : 6 D T h e r s 1 U li ee . 1b c yd i d m i b r > w O f 111 J p t.t i m t w ho ~ geaen J i z d o r ea r i ypo a 1 a m xb f ¥ c l o • c oo i > il ed ' W il h a n EE G w i d t b m t a upp r e ss i on w ho ' W C J lt on t o h a v e a Aw r a b l e c m n e . S p e c i b l l , y , a b t n t ~ n il BB G p w m a r e t h e ab sc noe b f c e r eb r a l e ' . b l t r i :: a l a . c t M l y i n t m fr a t 2 · 3 da y & .-~n, and a r c de f i o il = l r i p l o f i q > c nd ii g d ea t h o r a p e r a il m r i ~ l f lt e , u ii d i > a t. ed il t h i s i x lt .. ; du a L I n " J o m i a J . o ( C lili p a l N e m p A hy j obgy . [11] M a r c h : 14 ( 2 ) : 153 9165410 , dd > n 7 , C J i d ca l
· \ Acco~ o f t h B B u r s t S q > p r eaa bn . E P . O P a unby R w l e s , W e s un m e l a nd a nd C l a m s " ..
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:: 26 2 08t2~/l~ 08 : 15 A M P D T D oug l a • . F l o y d - > P e t e r A nde r s on e 2149051213 P g24 / 26 ~presaion BE O f b l k > w ed b y a . poa t i vc M . R J . w h e h w a s c b t n c t a il t i c o f a b M J o l C i c e v e n t . I t ill a 1 l o w e ll - l a l o w a , u i nd i c ued abo v e . t b a t t h e b lli 1 c onp . i e 8 ~ t h a n 5 % o f t h e bod ys w e W t, bu t ba s b ll y c on s u m e s a bou t 20 % o f t ho bod ys oxy s m S i J p li t i c a m cc nb i a l . h y po x i a m l a nox i a ~ c o t b e d ea t h o f t h e c e lll il b b n il , e s p cc i a U y t b e ce lll o f t h e ~pocall1lus, 1b e ·. P u l k i\j e ' s ce ti . and l s . y e r s 3 t S a nd 6 . l ' h e r e i b f tl , bad N ll ' S e A s a h b ee o . m o r c p r ope r l y I C m o1ed m ~tomyprotoco~ . b a d ll ) t r e m ov e d t be n c k , o r s u cee s d JJ l:/ r e m ov e d i t a . c d np l ace d it w il h a JJ I J W u a o k , t h i s qu e y w ou l d no t i . v e o cc m r e d . I t w a s a ll o no t ed t he c h il d . p r i o r t o tit , w a s ab l e t o w a k a nd t a l k , h a d 1 . f ili dy m n m l n e u r ob F e x i un acc o r d il g t o pdo rr e pon s . h w a s e - w m no t e d W h e n be appea r ed t o t b e ho s pb . l 1b t C T scan~ d i d no t s ho w a ny e W :l m i e o f 111 . ii & r c t o r 81 I J e v i d e n ce o f a *61 b l ee d . l t w a s OD 1y a 1 t c r 2 d a y s 1b a t d i e M R I s ho w e d 1 f z m o r e gbb a l e t k t 8 of~ a m x i a . It i a q i e xp e r t op i n i on t h & t Nw i c A s a h p m d c l ce d a m d il no t a c t a pp m p r i a . t e l y , mm l y o r pro~ du : i D g C h m ti a n [1] a c r i s i s . A ! a m r s e . N u r t e AB ah s . bou t d h a v e b ee n p m p a r e d t o ca r e 1b r C 1 m i a n a i v :l ~t t h e t ) tl e o f ~dat b l;l p e m d on 9 / 10 / 12 . l t l .t f u r t h e r m y e l pe r t op i nk m , t b a t Ep~ H e a l t h S a v i c t s , h i e ., m il ed t o p r o J > C d18q > C V i ae N u r : s e A s ah a nd ti e d t o m i au r e t ha t N u r s e A s ah w a s t r a l ce d a nd p m pa tt. d t . o x eep () D ! i t o 1b e e m qo m y s it u a t hn t h a t o cc u rr e d ~n 9 / 10 / 12 . A c oo r d il g f;f, d i e ti r e on a p a r t o ! F . p i . e . H ee l h S e rr i:: c s , I n c ., t o e n s u r e t h l t N u r s e A s a h W U 1 r a il e d e nd p r e p a r e d t o d ea l ' W i t h a n A f tl k i p a t e d s it u a ti m , d i ' ec t 1y li d 10 t h e qu r y a nd d ea t h o f ' C b r i s ti a n M ll C li e . If you m e d ae y addD>mlirdb~ p l o a s 6 l o t m a bo w . m l I w ill e o l q )]f w il h a u , y r c aao : nab i c r e qu ca t . ' I b i s . r q x i r t i a be il g w r itt e n i r . l an ~t t o i nb m a D . pa r t l e s e x a c t l y w h a t m y op iii on s :i n t h i s m& tt . c r a r c , ho w a nd , w h y I m i w d a t t ! a n . w h a t t h e s t m . i a r d o ( ca n : i s r e p t ' d i ng ~ l r ea t m e . m it~ ho w t h e a 1 B N . i a r d W U v i o l a t ed , a m r o w 1b c vk l & 1 i m l o f t b e s t a nd a r d ca u s e d t h ! qu i y m qu cs m n . I r e s e r v e t he r .f ab t t o c bu i & e , a l e r [1] w : od o r w it bdn J w D ' t ' op mm s hou l d 1 i J l ' ! J add t bna l i n1b r m a .t bn b e m a d e t o m d e r t h e d a t e o f t h i s r e po r t . Siim:c~ yo m . ~~
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C D M / b ' l a M a yb e s ub j ec t t o ~n v a . r i m : e . P A . O B 11 CD M I M A R B N ' I E .. 08120 / 13 263 *62 5 . C u rr i c u l u m v it ae o f D r . C h a r l e s M a r a b l e ,
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800 8 " ' A v e , S t e . #118 , F o r t W o r t h , T X 76104 A r ea s o f N e u r o l ogy , M e d i ca l M a l p r ac ti ce r e g a r d i ng N e u r o l og i ca l i ss u e s , Closed~Head I n j u r i e s , E xp e r ti s e : M e d i ca l C a s e : M a n a g e m e n t , P h a nn ac o l ogy , S p i n a l lnjurie~, T ox i c o l ogy P r o f e ss i on a l 26 y ea r s o f e xp e r i e n ce i n p r i v a t e p r ac ti ce , i n t e m s h i p s a nd ho s p it a l s ; E xp e r i e n ce : C on s u lti ng N e u r o l og i s t , J ohn P e t e r S m it h H o s p it a l , F t . W o r t h , T e x a s ( 1986 , 2004 - 2006 )
C on s u lti ng N e u r o l og i s t , V e t e r a n s A d m i n i s t r a ti on M e d i ca l C e n t e r , D a ll a s , T e x a s ( 1 98 6 o n l y ) A d j un c t C li n i ca l I n s t r u c t o r o f N e u r o l ogy , U n i v e r s it y o f T e x a s H ea lt h S c i e n ce *63 C e n t e r a t D a ll a s S ou t h w e s t e r n M e d i ca l S c hoo l , D a ll a s , T e x a s ( 1986 on l y )
. ..~ C u rr e n tl y on S t a ff a t F t . W o r t h a nd D a ll a s H o s p it a l s ; M e d i ca l P l aza , B a y l o r A ll S a i n t s a nd F o r e s t P a r k M e d i ca l C e n t e r ·.;, '
. E du ca ti on / B . S ., P h a r m ac y S e i e n ce , U n i v e r s it y o f T e x a s a t A u s ti n T r a i n i ng M . D ., U ili v e r s i d a d A u t ono m a d e G u a d a l a j a r a , 1976 - 1979
F i f t h P a t h w a y I n t e r n s h i p , L o m a L i nd a U n i v e r s it y M e d i ca l C e n t e r , G l e nd a l e , C A 1981 I n t e r n s h i p i n N e u r o l ogy a nd I n t e r n a l M e d i c i n e , T u l a n e U n i v e r s it y M e d i ca l S c hoo l , N e w O r l ea n s , L ou i s i a n a , J u l y 1982 · J un e 1983 N e u r o l ogy R e s i d e n c y , T u l a n e U n i v e r s it y M e d i ca l S c hoo l a nd A ff ili a t e H o s p it a l s , J un e · 1983 - J une 1984 N e u r o l o & Y R e s i d e n c y , U n i v e r s it y ofTex.~ H ea lt h S c i e n ce C e n t e r a t D a ll a s S ou t h w e s t e r n M e d i ca l S c hoo l a nd A ff i l i a t e d H o s p it a l s , D a ll a s , T e x a s
P r o f e ss i on a l B o a r d C e r ti f i e d i n N e u r o l ogy Q u a li f i ca ti on s : T a rr a n t C oun t y M e d i ca l S o c i e t y
T e x . a s M e d i c a l A s s o c i a ti on T e x a s N e u r o l og i ca l S o c i e t y A m e r i ca n A ca d e m y o f N e u r o l o & Y
C a s e s ! C li e n1 s : D e po ! ;iti on s - ov e r 700 P l a i n ti ff 90 o / o , D e f e n s e l OOA C ou r t a pp ea r a n ce s , ca s e r e v i e w &
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P ag e 24o f 38 C I V I L P RAC T I C E AND R E M E D I E S C O D E C H A P TE R 74 . M E D I CA L L I A B I L I T Y a l on e ( C P I- W : S ea s on a ll y A d j u s t e d U . S . C it y A v e r a g e -- A ll I t e m s ) , b e t w ee n A ugu s t 29 , 1977 , a nd t h e ti m e a t w h i c h d a m a g e s s ub j ec t t o s u c h li m it s a r e a w a r d e d by f i n a l j udg m e n t o r s e ttl e m e n t .
( c ) S ub s ec ti on ( a ) do e s no t a pp l y t o t h e a m oun t o f d a m a g e s a w a r d e d on a h ea lt h ca r e li a b ilit y c l a i m f o r t h e e xp e n s e s o f n ece ss a r y m e d i ca l , ho s p it a l , a nd c u s t od i a l ca r e r ece i v e d b e f o r e j udg m e n t o r r e qu i r e d i n t h e f u t u r e f o r t r ea t m e n t o f t h e i n j u r y .
( d ) T h e li a b ilit y o f a ny i n s u r e r und e r t h e c o mm on l a w t h e o r y o f r ec ov e r y c o mm on l y kno w n i n T e x a s , a s t h e " S t o w e r s D o c t r i n e " s h a ll no t e x cee d t h e li a b ilit y o f t h e i n s u r e d .
I n a ny ac ti on on a h ea lt h ca r e li a b ilit y c l a i m t h a t i s ( e ) t r i e d by a j u r y i n a ny c ou r t i n t h i s s t a t e , t h e f o ll o w i ng s h a ll b e i n c l ud e d i n t h e c ou r t ' s w r itt e n i n s t r u c ti on s t o t h e j u r o r s :
" D o no t c on s i d e r , d i s c u ss , no r s p ec u l a t e w h e t h e r o r ( 1 ) no t li a b ilit y , i f a ny , on t h e p a r t o f a ny p a r t y i s o r i s no t s ub j ec t t o a ny li m it und e r a pp li ca b l e l a w . "
" A f i nd i ng o f n e g l i g e n ce m a y no t b e b a s e d s o l e l y on ( 2 ) *66 e v i d e n ce o f a b a d r e s u lt t o t h e c l a i m a n t i n qu e s ti on , bu t a b a d r e s u lt m a y b e c on s i d e r e d by you , a l ong w it h o t h e r e v i d e n ce , i n d e t e r m i n i ng t h e i ss u e o f n e g li g e n ce . Y ou a r e t h e s o l e j udg e s o f t h e w e i gh t , i f a ny , t o b e g i v e n t o t h i s k i nd o f e v i d e n ce . " A dd e d by A c t s 2003 , 78 t h L e g ., c h . 204 , S ec . 10 . 01 , e ff . S e p t . 1 , 2003 .
S U BC HA P TE R H . P R O C E DU R A L P R OV I S I ON S I n a h ea lt h ca r e li a b ilit y S ec . 74 . 351 . E X P E R T R E P O R T . ( a ) c l a i m , a c l a i m a n t s h a ll , no t l a t e r t h a n t h e 120 t h d a y a f t e r t h e d a t e eac h d e f e nd a n t ' s o r i g i n a l a n s w e r i s f il e d , s e r v e on t h a t p a r t y o r t h e p a r t y ' s a tt o r n e y on e o r m o r e e xp e r t r e po r t s , w it h a c u rr i c u l u m v it ae o f eac h e xp e r t li s t e d i n t h e r e po r t f o r eac h phy s i c i a n o r h ea lt h ca r e p r ov i d e r a g a i n s t w ho m a li a b ilit y c l a i m i s a ss e r t e d . T h e d a t e f o r s e r v i ng t h e r e po r t m a y b e e x t e nd e d by w r itt e n a g r ee m e n t o f t h e a ff ec t e d p a r ti e s . E ac h d e f e nd a n t phy s i c i a n o r h ea lt h ca r e p r ov i d e r w ho s e c ondu c t i s i m p li ca t e d i n a r e po r t m u s t f il e a nd s e r v e a ny ob j ec ti on t o t h e s u ff i c i e n c y o f t h e r e po r t n o t l a t e r t h a n t h e l a t e r o f t h e 21 s t d a y a f t e r t h e d a t e t h e r e p o r t i s s e r v e d o r t h e 21 s t d a y
10 / 5 / 2 0 1 5 h tt p : // ww w . s t a t u t e s . l e g i s . s t a t e . t x . u s / D o c s / C P / h t m / C P . 7 4 . h t m P ag e 25 o f 38 C I V I L P RAC T I C E AND R E M E D I E S C O D E C H A P TE R 74 . M E D I CA L L I A B I L I T Y a f t e r t h e d a t e t h e d e f e nd a n t ' s a n s w e r i s f il e d , f a ili ng w h i c h a l l ob j ec ti on s a r e w a i v e d .
If , a s t o a d e f e nd a n t phy s i c i a n o r h ea lt h ca r e p r ov i d e r , a n ( b ) e xp e r t r e po r t h a s no t b ee n s e r v e d w it h i n t h e p e r i od s p ec i f i e d by S ub s ec ti on ( a ) , t h e c ou r t , on t h e m o ti on o f t h e a ff ec t e d phy s i c i a n o r h ea lt h ca r e p r ov i d e r , s h a ll , s ub j ec t t o S ub s ec ti on ( c ) , e n t e r a n o r d e r t h a t:
a w a r d s t o t h e a ff ec t e d phy s i c i a n o r h ea lt h ca r e ( 1 ) p r ov i d e r r ea s on a b l e a tt o r n e y ' s f ee s a nd c o s t s o f c ou r t i n c u rr e d by t h e phy s i c i a n o r h ea lt h ca r e p r ov i d e r ; a nd
( 2 ) d i s m i ss e s t h e c l a i m w it h r e s p ec t t o t h e phy s i c i a n o r h ea lt h ca r e p r ov i d e r , w it h p r e j ud i ce t o t h e r e f ili ng o f t h e c l a i m . If a n e xp e r t r e po r t h a s no t b ee n s e r v e d w it h i n t h e p e r i od ( c ) s p ec i f i e d by S ub s ec ti on ( a ) b eca u s e e l e m e n t s o f t h e r e po r t a r e f ound d e f i c i e n t , t h e c ou r t m a y g r a n t on e 30 - d a y e x t e n s i on t o t h e c l a i m a n t i n o r d e r t o c u r e t h e d e f i c i e n c y . If t h e c l a i m a n t do e s no t r ece i v e no ti ce o f t h e c ou r t ' s r u li ng g r a n ti ng t h e e x t e n s i on un til a f t e r t h e 120 - d a y d ea d li n e h a s p a ss e d , t h e n t h e 30 - d a y e x t e n s i on s h a ll r un fr o m *67 t h e d a t e t h e p l a i n ti ff f i r s t r ece i v e d t h e no ti ce .
[ S ub s ec ti on s ( d )-( h ) r e s e r v e d ] ( i ) N o t w it h s t a nd i ng a ny o t h e r p r ov i s i on o f t h i s s ec ti on , a
c l a i m a n t m a y s a ti s f y a ny r e qu i r e m e n t o f t h i s s ec t i on f o r s e r v i ng a n e xp e r t r e po r t by s e r v i ng r e po r t s o f s e p a r a t e e xp e r t s r e g a r d i ng d i ff e r e n t phy s i c i a n s o r h ea lt h ca r e p r ov i d e r s o r r e g a r d i ng d i ff e r e n t i ss u e s a r i s i ng fr o m t h e c ondu c t o f a phy s i c i a n o r h ea lt h ca r e p r ov i d e r , s u c h a s i ss u e s o f li a b ilit y a nd ca u s a ti on . N o t h i ng i n t h i s s ec ti on s h a ll b e c on s t r u e d t o m ea n t h a t a s i n g l e e x p e r t m u s t a d d r e ss a ll li a b ilit y a nd ca u s a ti on i ss u e s w it h r e s p ec t t o a ll phy s i c i a n s o r h ea lt h ca r e p r o v i d e r s o r w it h r e s p ec t t o bo t h li a b ilit y a nd ca u s a ti on i ss u e s f o r a phy s i c i a n o r h ea lt h ca r e p r ov i d e r .
( j ) N o t h i ng i n t h i s s ec t i on s h a ll b e c on s t r u e d t o r e qu i r e t h e s e r v i ng o f a n e xp e r t r e po r t r e g a r d i ng a ny i ss u e o t h e r t h a n a n i ss u e r e l a ti ng t o li a b ilit y o r ca u s a ti on .
( k ) S ub j ec t t o S u b s e c ti o n ( t ) , a n e xp e r t r e po r t s e r v e d un d e r t h i s s ec ti on : i s n o t a d m i s s i b l e i n e v i d e n ce by a ny p a r t y ; ( 1 ) ( 2 ) s h a ll n o t b e u s e d i n a d e p o s iti o n , t r i a l , o r o t h e r
p r o cee d i ng ; a nd 1 0 / 5 / 2 0 1 5 h tt p : / / w ww . s t a t u t e s . l e g i s . s t a t e . t x . u s / D o c s / C P / h t m / C P . 74 . h t r n C I V I L P RAC T I C E AND R E M E D I E S C O D E C H A P TE R 74 . M E D I CA L L I A B I L I T Y P ag e 26 o f 38 ( 3 ) s h a ll no t b e r e f e rr e d t o by a ny p a r t y du r i ng t h e c ou r s e o f t h e ac ti on f o r a ny pu r po s e . ( 1 ) A c ou r t s h a ll g r a n t a m o ti on c h a ll e ng i ng t h e a d e qu ac y o f a n e xp e r t r e po r t on l y i f i t a pp ea r s t o t h e c ou r t , a f t e r h e a r i ng , t h a t t h e r e po r t do e s no t r e p r e s e n t a n ob j ec ti v e good f a it h e ff o r t t o c o m p l y w it h t h e d e f i n iti on o f a n e xp e r t r e po r t i n S ub s ec ti on (r) ( 6 ) .
[ S ub s ec ti on s ( m )-( q ) r e s e r v e d ] I n t h i s s ec ti on : (r)
" A ff ec t e d p a r ti e s " m ea n s t h e c l a i m a n t a nd t h e ( 1 ) phy s i c i a n o r h ea lt h ca r e p r ov i d e r w ho a r e d i r ec tl y a ff ec t e d by a n ac t o r a g r ee m e n t r e qu i r e d o r p e r m itt e d by t h i s s ec ti on a nd do e s no t i n c l ud e o t h e r p a r ti e s t o a n ac ti on w ho a r e no t d i r ec tl y a ff ec t e d by t h a t p a r ti c u l a r ac t o r a g r ee m e n t .
" C l a i m " m ea n s a h ea lt h ca r e li a b ilit y c l a i m . ( 2 ) [ ( 3 ) r e s e r v e d ]
" D e f e nd a n t " m ea n s a phy s i c i a n o r h ea lt h ca r e p r ov i d e r ( 4 ) a g a i n s t w ho m a h ea lt h ca r e li a b ilit y c l a i m i s a ss e r t e d . T h e t e r m i n c l ud e s a t h i r d - p a r t y d e f e nd a n t , c r o ss - d e f e nd a n t , o r c oun t e r d e f e nd a n t . *68 " E xp e r t " m ea n s :
( 5 ) ( A ) w it h r e s p ec t t o a p e r s on g i v i ng op i n i on t e s ti m ony r e g a r d i ng w h e t h e r a phy s i c i a n d e p a r t e d fr o m acce p t e d s t a nd a r d s o f m e d i ca l ca r e , a n e xp e r t qu a li f i e d t o t e s ti f y und e r t h e r e qu i r e m e n t s o f S ec ti on 74 . 401 ;
( B ) w it h r e s p ec t t o a p e r s on g i v i ng op i n i on t e s ti m ony r e g a r d i ng w h e t h e r a h ea lt h ca r e p r ov i d e r d e p a r t e d fr o m acce p t e d s t a nd a r d s o f h ea lt h ca r e , a n e x p e r t qu a li f i e d t o t e s ti f y u n d e r t h e r e qu i r e m e n t s o f S ec t i on 74 . 402 ;
( C ) w it h r e s p ec t t o a p e r s on g i v i ng op i n i on t e s ti m ony a bou t t h e ca u s a l r e l a ti bn s h i p b e t w ee n t h e i n j u r y , h a r m , o r d a m a g e s c l a i m e d a nd t h e a ll e g e d d e p a r t u r e fr o m t h e a pp li ca b l e s t a nd a r d o f ca r e i n a ny h ea lt h ca r e li a b ilit y c l a i m , a phy s i c i a n w ho i s o t h e r w i s e qu a li f i e d t o r e nd e r op i n i on s on s u c h ca u s a l r e l a ti on s h i p und e r t h e T e x a s R u l e s o f E v i d e n c e ;
( D ) w it h r e s p ec t t o a p e r s on g i v i ng o p i n i on t e s ti m ony a bou t t h e ca u s a l r e l a ti on s h i p b e t w ee n t h e i n j u r y , h a r m , o r d a m a g e s c l a i m e d a nd t h e a ll e g e d d e p a r t u r e fr o m t h e a pp li ca b l e s t a nd a r d o f ca r e f o r a d e n ti s t , a d e n ti s t o r p h y s i c i a n w ho i s o t h e r w i s e qu a li f i e d
1 0 / 5 / 2 0 15 h tt p : / / w ww . s t a t u t e s . l e g i s . s t a t e . t x . u s / D o c s / C P / h t m / C P . 74 . h t m Page 27of38 CIVIL PRACTICE AND REMEDIES CODE CHAPTER 74. MEDICAL LIABILITY to render opinions on such causal relationship under the Texas Rules of Evidence; or
(E) with respect to a person giving opinion testimony about the causal relationship between the injury, harm, or damages claimed and the alleged departure from the applicable standard of care for a podiatrist, a podiatrist or physician who is otherwise qualified to render opinions on such causal relationship under the Texas Rules of Evidence.
(6) "Expert report" means a written report by an expert that provides a fair summary of the expert's opinions as of the date of the report regarding applicable standards of care, the manner in which the care rendered by the physician or health care provider failed to meet the standards, and the causal relationship between that failure and the injury, harm, or damages claimed.
(s) Until a claimant has served the expert report and curriculum vitae as required by Subsection (a), all discovery in a health care liability claim is stayed except for the acquisition by the claimant of information, including medical or hospital records or other documents or tangible things, related to the patient's health care through:
*69 (1) written discovery as defined in Rule 192.7, Texas Rules of Civil Procedure; (2) depositions on written questions under Rule 200, Texas Rules of Civil Procedure; and (3) discovery from nonparties under Rule 205, Texas Rules of Civil Procedure. (t) If an expert report is used by the claimant in the course of the action for any purpose other than to meet the service requirement of Subsection (a), the restrictions imposed by Subsection (k) on use of the expert report by any party are waived.
(u) Notwithstanding any other provision of this section, after a claim is filed all claimants, collectively, may take not more than two depositions before the expert report is served as required by Subsection (a) . Added by Acts 2003, 78th Leg., ch. 204, Sec. 10.01, eff. Sept. 1, 2003. Amended by:
http://www.statutes.legis.state.tx.us/Docs/CP/htm/CP.74.htm 10/5/2015 P ag e 31o f 38 C I V I L P RAC T I C E AND R E M E D I E S C O D E C H A P TE R 74 . M E D I CA L L I A B I L I T Y
c ondu c t e d ou t s i d e t h e p r e s e n ce o f t h e j u r y . T h i s s ub s ec ti on do . e s no t p r e v e n t a p a r t y fr o m e x a m i n i ng o r c r o ss - e x a m i n i ng a w it n e ss a t t r i a l a bou t t h e ~itness's qu a li f i ca t i on s .
(f ) T h i s s ec ti on do e s no t p r e v e n t a phy s i c i a n w ho i s a d e f e nd a n t fr o m qu a li f y i ng a s a n e xp e r t . \ I n t h i s s ub c h a p t e r , " phy s i c i a n " m ea n s a p e r s on w ho i s : ( g ) li ce n s e d t o p r ac ti ce m e d i c i n e i n on e o r m o r e s t a t e s i n ( 1 ) t h e U n it e d S t a t e s ; o r a g r a du a t e o f a m e d i ca l s c hoo l acc r e d it e d by t h e ( 2 ) L i a i s on C o mm itt ee on M e d i ca l E du ca ti on o r t h e A m e r i ca n O s t e op a t h i c A ss o c i a ti on on l y i f t e s ti f y i ng a s a d e f e nd a n t a nd t h a t t e s ti m ony r e l a t e s t o t h a t d e f e nd a n t ' s s t a nd a r d o f ca r e , t h e a ll e g e d d e p a r t u r e fr o m t h a t s t a nd a r d o f ca r e , o r t h e ca u s a l r e l a ti on s h i p b e t w ee n t h e a ll e g e d d e p a r t u r e fr o m t h a t s t a nd a r d o f ca r e a nd t h e i n j u r y , h a r m , o r d a m a g e s c l a i m e d . A dd e d b y A c t s 2003 , 78 t h L e g ., c h . 2 0 4 , S ec . 10 . 01 , e ff . S e p t . 1 , 2003 .
S ec . 74 . 402 . QUA L I F I C A T I ON S O F E X P E R T W I T N E SS I N S U I T AGA I N S T ( a ) F o r p u r p o s e s o f t h i s s ec ti on , " p r ac ti c i ng H E A LT H C A R E P R OV I D E R . *70 h ea lt h ca r e " i n c l ud e s :
t r a i n i ng h ea lt h ca r e p r ov i d e r s i n t h e s a m e f i e l d a s ( 1 ) t h e d e f e nd a n t h ea lt h ca r e p r ov i d e r a t a n acc r e d it e d e du ca ti on a l i n s tit u ti on ; o r
s e r v i ng a s a c on s u lti ng h ea lt h ca r e p r ov i d e r a nd b e i ng ( 2 ) l i c e n s e d , c e r ti f i e d , o r r e g i s t e r e d i n t h e s a m e f i e l d a s t h e d e f e n d a n t h ea lt h ca r e p r ov i d e r .
I n a s u it i nvo l v i ng a h ea lt h ca r e li a b ilit y c l a i m a g a i n s t a ( b ) h ea lt h ca r e p r ov i d e r , a p e r s on m a y qu a li f y a s a n e xp e r t w it n e ss on t h e i ss u e o f w h e t h e r t h e h ea lt h ca r e p r ov i d e r d e p a r t e d fr o m acce p t e d s t a nd a r d s o f ca r e on l y i f t h e p e r s on :
i s p r ac ti c i ng h ea lt h ca r e i n a f i e l d o f p r ac ti ce t h a t ( 1 ) i n v o l v e s t h e s a m e t y p e o f c a r e o r t r ea t m e n t a s t h a t d e l i v e r e d b y t h e d e f e n d a n t h ea lt h ca r e p r ov i d e r , i f t h e d e f e n d a n t h ea lt h ca r e p r ov i d e r i s a n i nd i v i du a l , a t t h e ti m e t h e t e s ti m ony i s g i v e n o r w a s p r ac ti c i ng t h a t t y p e o f h ea lt h ca r e a t t h e ti m e t h e c l a i m a r o s e ; 1 0 / 5 / 2 0 15
h tt p : // www . s t a t u t e s . l e g i s . s t a t e . t x . u s / D o c s / C P / h t m / C P . 7 4 . h t m C I V I L P RAC T I C E AND R E M E D I E S C O D E C H A P TE R 74 . M E D I CA L L I A B I L I T Y P ag e 32 o f 38 ( 2 ) h a s kno w l e dg e o f acce p t e d s t a nd a r d s o f ca r e f o r h ea lt h ca r e p r o v i d e r s f o r t h e d i a gno s i s , ca r e , o r t r ea t m e n t o f t h e ill n e ss , i n j u r y , o r c ond iti on i nvo l v e d i n t h e c l a i m ; a nd i s qu a li f i e d on t h e b a s i s o f t r a i n i ng o r e xp e r i e n ce t o
( 3 ) ' o ff e r a n e xp e r t op i n i on r e g a r d i ng t ho s e acce p t e d s t a nd a r d s o f h ea lt h ca r e . I n d e t e r m i n i ng w h e t h e r a w it n e ss i s qu a li f i e d on t h e b a s i s
( c ) o f t r a i n i ng o r e xp e r i e n ce , t h e c ou r t s h a ll c on s i d e r w h e t h e r , a t t h e ti m e t h e c l a i m a r o s e o r a t t h e ti m e t h e t e s ti m ony i s g i v e n , t h e w it n e ss : i s ce r ti f i e d by a li ce n s i ng a g e n c y o f on e o r m o r e
( 1 ) s t a t e s o f t h e U n it e d S t a t e s o r a n a ti on a l p r o f e ss i on a l ce r ti f y i ng a g e n c y , o r h a s o t h e r s ub s t a n ti a l t r a i n i ng o r e xp e r i e n ce , i n t h e a r ea o f h ea lt h ca r e r e l e v a n t t o t h e c l a i m ; a nd i s ac ti v e l y p r ac ti c i ng h ea lt h ca r e i n r e nd e r i ng h ea lt h
( 2 ) ca r e s e r v i ce s r e l e v a n t t o t h e c l a i m . ( d ) T h e c ou r t s h a ll a pp l y t h e c r it e r i a s p ec i f i e d i n S ub s ec ti on s ( a ) , ( b ) , a nd ( c ) i n d e t e r m i n i ng w h e t h e r a n e xp e r t i s qu a li f i e d t o o ff e r e xp e r t t e s ti m ony on t h e i ss u e o f w h e t h e r t h e d e f e nd a n t h ea lt h ca r e p r ov i d e r d e p a r t e d fr o m acce p t e d s t a nd a r d s o f h ea lt h ca r e bu t m a y d e p a r t fr o m t ho s e c r it e r i a i f , und e r t h e c i r c u m s t a n ce s , t h e c ou r t d e t e r m i n e s t h a t t h e r e i s good r ea s on t o a d m it t h e e xp e r t ' s t e s ti m ony . *71 T h e c ou r t s h a ll s t a t e on t h e r ec o r d t h e r ea s on f o r a d m itti ng t h e t e s ti m ony i f t h e c ou r t d e p a r t s fr o m t h e c r it e r i a .
( e ) T h i s s ec ti on do e s no t p r e v e n t a h ea lt h ca r e p r ov i d e r w ho i s a d e f e nd a n t , o r a n e m p l oy ee o f t h e d e f e nd a n t h ea lt h ca r e p r ov i d e r , fr o m qu a l i f y i ng a s a n e x p e r t .
(f) A p r e t r i a l ob j ec ti on t o t h e qu a li f i ca ti on s o f a w it n e ss und e r t h i s s ec ti on m u s t b e m a d e no t l a t e r t h a n t h e l a t e r o f t h e 21 s t d a y a f t e r t h e d a t e t h e ob j e c ti ng p a r t y r ece i v e s a c opy o f t h e w it n e ss ' s c u r r i c u l u m v it ae o r t h e 21 s t d a y a f t e r t h e d a t e o f t h e w it n e ss ' s d e po s iti on . If c i r c u m s t a n ce s a r i s e a f t e r t h e d a t e on w h i c h t h e ob j ec ti on m u s t b e m a d e t h a t c ou l d no t h a v e b ee n r ea s on a b l y a n t i c i p a t e d b y a p a r t y b e f o r e t h a t d a t e a nd t h a t t h e p a r t y b e li e v e s i n go od f a it h p r ov i d e a b a s i s f o r a n o b j ec ti o n t o a ~itness's q u a l i f i ca ti o n s , a nd i f a n o b j ec ti o n w a s no t m a d e p r e v i o u s l y , t h i s s ub s e c t i o n d o e s no t p r e v e n t t h e p a r t y f r o m m a k i ng a n o b j ec ti o n a s s oon a s p r ac ti ca b l e und e r t h e c i r c u m s t a n ce s . T h e c ou r t s h a ll c ondu c t 1 0 / 5 / 2 0 1 5
h t t p : // ww w . s t a t u t e s . l e g i s . s t a t e . t x . u s / D o c s / C P / h t r n / C P . 74 . h t r n C I V I L P RAC T I C E AND R E M E D I E S C O D E C H A P TE R 74 . M E D I CA L L I A B I L I T Y P ag e 33 A > f 38
a h ea r i ng t o d e t e r m i n e w h e t h e r t h e w it n e ss i s qu a li f i e d a s s oon a s p r ac ti ca b l e a f t e r t h e f ili ng o f a n ob j ec ti on a nd , i f po ss i b l e , b e f o r e t r i a l . If t h e ob j ec ti ng p a r t y i s un a b l e t o ob j ec t i n ti m e f o r t h e h ea r i ng t o b e c ondu c t e d b e f o r e t h e t r i a l , t h e h ea r i ng s h a ll b e c ondu c t e d ou t s i d e t h e p r e s e n ce o f t h e j u r y . T h i s s ub s ec ti on do e s no t p r e v e n t a p a r t y fr o m e x a m i n i ng o r c r o ss - e x a m i n i ng a w it n e ss a t t r i a l a bou t t h e w it n e ss ' s qu a li f i ca ti on s . A dd e d by A c t s 2003 , 78 t h L e g ., c h . 204 , S ec . 10 . 01 , e ff . S e p t . 1 , 2003 .
S ec . 74 . 403 . QUA L I F I C A T I ON S O F E X P E R T W I T N E SS ON C AU S A T I ON I N ( a ) E x ce p t a s p r ov i d e d by S ub s ec ti on s H E A LT H C A R E L I A B I L I T Y C L A I M . ( b ) a nd ( c ) , i n a s u it i nvo l v i ng a h ea lt h ca r e li a b ilit y c l a i m a g a i n s t a phy s i c i a n o r h ea lt h ca r e p r ov i d e r , a p e r s on m a y qu a li f y a s a n e xp e r t w i t n e ss on t h e i s s u e o f t h e ca u s a l r e l a ti on s h i p b e t w ee n t h e a ll e g e d d e p a r t u r e fr o m acce p t e d s t a nd a r d s o f ca r e a nd t h e i n j u r y , h a r m , o r d a m a g e s c l a i m e d on l y i f t h e p e r s on i s a phy s i c i a n a nd i s o t h e r w i s e qu a li f i e d t o r e nd e r op i n i on s on t h a t ca u s a l r e l a ti on s h i p und e r t h e T e x a s R u l e s o f E v i d e n ce .
I n a s u it i nvo l v i ng a h ea lt h ca r e li a b ilit y c l a i m a g a i n s t a ( b ) d e n ti s t , a p e r s on m a y qu a li f y a s a n e xp e r t w i t n e ss on t h e i ss u e o f t h e ca u s a l r e l a ti on s h i p b e t w ee n t h e a ll e g e d d e p a r t u r e fr o m acce p t e d *72 s t a nd a r d s o f ca r e a nd t h e i n j u r y , h a r m , o r d a m a g e s c l a i m e d i f t h e p e r s on i s a d e n ti s t o r phy s i c i a n a nd i s o t h e r w i s e qu a li f i e d t o r e nd e r op i n i on s on t h a t ca u s a l r e l a ti on s h i p und e r t h e T e x a s R u l e s o f E v i d e n c e .
I n a s u it i nvo l v i ng a h ea lt h ca r e li a b ilit y c l a i m a g a i n s t a ( c ) pod i a t r i s t , a p e r s on m a y qu a li f y a s a n e xp e r t w it n e ss on t h e i ss u e o f t h e c a u s a l r e l a ti on s h i p b e t w ee n t h e a ll e g e d d e p a r t u r e fr o m acce p t e d s t a nd a r d s o f ca r e a nd t h e i n j u r y , h a r m , o r d a m a g e s c l a i m e d i f t h e p e r s on i s a pod i a t r i s t o r phy s i c i a n a nd i s o t h e r w i s e qu a li f i e d t o r e nd e r op i n i on s on t h a t ca u s a l r e l a ti on s h i p und e r t h e T e x a s R u l e s o f E v i d e n c e .
( d ) A p r e t r i a l o b j ec ti o n t o t h e q u a li f i ca ti o n s o f a w i t n e ss und e r t h i s s ec ti o n m u s t b e m a d e no t l a t e r t h a n t h e l a t e r o f t h e 21 s t d a y a f t e r t h e d a t e t h e o b j ec ti n g p a r t y r ece i v e s a c opy o f t h e w it n e ss ' s c u rr i c u l u m v it ae o r t h e 21 s t d a y a f t e r t h e d a t e o f t h e
10 / 5 / 2015 h tt p : // www . s t a t u t e s . l e g i s . s t a t e . t x . u s / D o c s / C P / h t m / C P . 7 4 . h t m CIVIL PRACTICE AND REMEDIES CODE CHAPTER 74. MEDICAL LIABILITY Page 34 of38
witness's deposition. If circumstances arise after the date on which the objection must be made that could not have been reasonably anticipated by a party before that date and that the party believes in good faith provide a basis for an objection to a witness's qualifications, and if an objection was not made previously, this subsection does not prevent the party from making an objection as soon as practicable under the circumstances. The court shall conduct a hearing to determine whether the witness is qualified as soon as practicable after the filing of an objection and, if possible, before trial. If the objecting party is unable to object in time for the hearing to be conducted before the trial, the hearing shall be conducted outside the presence of the jury. This subsection does not prevent a party from examining or cross-examining a witness at trial about the witness's qualifications. Added by Acts 2003, 78th Leg., .ch. 204, Sec. 10.01, eff. Sept. 1, 2003.
SUBCHAPTER J. ARBITRATION AGREEMENTS
Sec. 7 4. 451.. ARBITRATION AGREEMENTS. (a) No physician, professional association of physicians, or other health care provider shall request or require a patient or prospective patient to execute an agreement to arbitrate a health care liability claim unless the *73 form of agreement delivered to the patient contains a written notice in 10-point boldface type clearly and conspicuously stating: UNDER TEXAS LAW, THIS AGREEMENT IS INVALID AND OF NO LEGAL EFFECT UNLESS IT IS ALSO SIGNED BY AN ATTORNEY OF YOUR OWN CHOOSING. THIS AGREEMENT CONTAINS A WAIVER OF IMPORTANT LEGAL RIGHTS, INCLUDING YOUR RIGHT TO A JURY. YOU SHOULD NOT SIGN THIS AGREEMENT WITHOUT FIRST CONSULTING WITH AN ATTORNEY.
(b) A violation of this section by a physician or professional association of physicians constitutes a violation of Subtitle B, Title 3, Occup~tions Code, and shall be subject to the enforcement provisions and sanctions contained in that subtitle.
c (c) A violation of this section by a health care provider other than a physician shall constitute a false, misleading, or deceptive act or practice in the conduct of trade or commerce within the [1] http://www.statutes.legis.state.tx.us/Docs/CP/htm/CP.74.htrn 10/5/2015