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Cur~h.IH' (,I.J (.\)UNfY
(JENNtiY~V/lJ'III\
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NEIL R. FLICKINGER, INDIVIDUALLY r
AND AS ADMINISTRATOR OF THE ESTATE
Or BETTY J. FLICKINGER, DECEASED,
Plaintiff
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNA
NO. 96-3943 CIVIL
v.
CIVIL ACTION - LAW
RICHARD D. STEWART, M.D.; DANIEL
W. HOTTENSTEIN, M.D.; HOWARD J.
BRONFMAN, M.D. AND THE A.Z.
RITZMAN ASSOCIATES, INC.,
Defendants
JURY TRIAL DEMANDED
PLAINTIFF'S VERDICT SLIP
1. Do you find that the care of the following doctors were below
the acceptable standard of care under the circumstanoes?
a) Richard Stewart, M.D.
b) Paniel Hottenstein, M.P.
YllS
No
Yes
No
c) Howard Bronfman, M. D.
Yes
No
If your answer to question No.1 is yes, proceed to question No.2.
If your answer to question No. 1 is no, return to the Courtroom.
2. Do you find that the negligence of any of the following doctors
was a substantial factor in bringing about harm to Mrs. Flickinger?
a) Richard Stewart, M.D. Yes No
b) Daniel Hottenstein, M.D. Yes No
c) Howard Bronfman, M.D. Yes No
If your answer to question No. 2 is yes, proceed to question No. 3. If
your ans~/er to question No. 2 is no, return to the Courtroom.
141113/C5 ORIGINAL
3. Do you find that Defendants stewart, Hottenstein and Bronfman
were employees or agents of The A.I. Ritzman Assooiates, Ino, at the time
in question?
Yes
No
If your answer is yes to question No.2, please proceed to question
No.4. If your answer to question No.2 is no, return to tha.courtroom.
4. Percentage of causal negligence attributable to~
a) Richard stewart, M.D.
b) Daniel Hottenstein, M.D.
c) Howard Bronfman, M.D.
\
%
%
TOTAL
100 %
If your answer to No. 2 is yes, proceed to question No. 4.
4. Please state the amount of damages you awardt
a. ~-unera 1 Bills and other Related $
Expenses -~
b. Pain and SUffering $
o. Loss of wife'S society & services $
TOTAL $
once completed, return to the courtroom.
Foreperson
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The practice of medicine involves professional skill and
training and the application of techniques beyond the knowledge of
lay people. In evaluating the treatment of the doctor in this
case, you must not substitute your thinking as lay people ~s to
what would be proper treatment and technique, but you must be
guided by the testimony of the doctors as to whether the doctors in
this case employed proper treatment and technique. Chandler~.
QQQk, 438 Pa, 447, 265 A.2d 794 (1970), Lambert ~. Soltis, 422 Pa,
304, 221 A.2d 173 (1966).
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In determining whether a defendant doctor's learning, skill
and conduct fulfilled t.he duties imposed on him by law, you are not
permitted to set up arbitrarily a standard ot' your own, the
standard is set by the learning, skill and care ordinarily
possessed and practiced at the t.ime in queliltion by others of the
same profession in good standing. It follows, therefore, that the
only way you may properly learn that standard is through evidence
presented in this trial by physicians and surgeons called as expert
witnesses. Chandler~.~, 438 Pa. 447, 26Q A.2d 794 (1970) t
Lambert ~. Soltis, 422 Pa. 304, 221 A.2d 173 (1966).
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ContributorY Neoliaence
Plaintiff claims that Mrs. Plickinger was injured and
sustained Jamage as a result of the negligent conduct of one or
more of the Defendants. The Plaintiff has the burden of proving
these claims.
The Defendants deny the Plaintiff's claims and assert as an
affirmative defense that the Plaintiff was herself negligent and
that such negligence was a substantial factor in bringing about
Plaintiff's injuries. The Defendants have the burden of proving
this affirmative defense.
Based upon the evidence presented at this trial, the only
issues for you to decide in accordance with the law as I shall give
it to you are:
First: Were any of the Defenuants negligent?
Secondl Was the conduct of one or more of the Defendants a
substantial factor in bringing about ha~ to the Plaintiff?
Third: Was Mrs. Flickinger herself negligent and was such
negligence a substantial factor in bringing about injury to Mrs.
Plickinger? Pa. S. S. J. I. 3.00 (Civ.l
14
I~ you b~lieve ~rom the evidence that the conditions and
things of which the Pla1ntHf complains were caused or occasioned
by or from any cause or causes over which Defendants, Richard P.
Stewart, M.D., Daniel W. Hottenstein, M.D., and Howard J. Bronfman,
M.D., had no control, or for which they were not responsible, your
verdict must be in favor of Defendants, Richard P. Stewart, M.D.;
Daniel W. Hottenstein, M.D., and Howard J. Bronfman, M.D. It you
believe that it cannot be determined with reasonable certainty
whether the conditions of which Plaintiff complains were or were
not caused by any act or failure to act on the part of the
Defendants, Richard P. Stewart, M.D., Daniel W. Hottenstein, M.D.,
and Howard J. Bronfman, M.D., or by anything over which they had
control, your verdict must be in favor of Defendants, Richard P.
Stewart, M.D., Daniel W. Hottenstein, M.D., and Howard J. Bronfman,
M.D. You are not allowed to conjecture or speculate as to the
cause of the injuries, if any, in this case. Hamil~. Bashline,
4111 Pa, 256, 392 A.2d 1280 (1'l78) (Hamil III); Pa, S.S.J.I. (Civ.)
10.03 (1981).
~.
17
You must not guess or speculate as to which of Plaintiff's
expert witnesses you believe with respect to the cause of
Plaintiff's injuries or death or the manner in which they contend
that Defendants, Richard P. Stewart, M.D., Daniel W. Hottenstein,
M.D., and Howard J. Bronfman, M,D., deviated from the applicable
standard of care. Although you may resolve minor conflicts between
the Plaintiff's experts, if you find that Plaintiff's medical
experts attribute Mrs. Flickinger's injuries or death to distinct,
different and irreconcilable causes, or if you find an absolute
conflict between Plaintiff's experts with respect to the manner in
which they contend that Defendants, Richard P. Stewart, M.D.,
Daniel W. Hottenstein, M.D., and Howard J. Bronfman, M.D., deviated
from the applicable standard of care, then, as a matter of law, I
direct you answer "NO" to questions 1,3 and 5 on the verdict slip
that I will give you. ~ Mundano v. Phila. Ra9id Transit Co., 289
Pa. 151, 137A. 104 (1927) r Gorfti v. Montaomery, 384 Pa. Super. 256
558 A.2d 109 (1989).
rJ.;f'~
24
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In general, the opinion of an expert has value only when you
accept the facts upon which it is based. This is true whether the
facts are assumed hypothetically by the expert, come from his
personal knowledge, from some other proper source or from some
combination of these. Pa. S.B.J.I. (Civ.) 5.31.
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In addition to the ~bove, a physioian must also use the same
degroe of oare as Would a reasonable person under thlll ciroumstanoes
and, if he fails to do so, he is negligent,
Accept
Reject
Modif ied
Covered
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When a party has the burden of proof on a particUlar issue,
their contention on that issue must be established by a fair
preponderance of the ev idence.
The evidence established is a
contention by a fair preponderance ot tho evidence if you are
persuaded that it is more probablY accurate and true than not.
'1'0 put it another way, th ink I if you wi 11, of an ordinary
balance scale with a pan on each side. onto one side of the scale
place all of the evidence favorable to ~he Plaintiff; onto the
other, place all of the evidence favor to the Defendant. If, after
considering the comparable weight of the evidence, you feel that
the scales tip ever so slightlY or to the slightest degree in favor
of the plaintiffS, your verdict must be tor the plaintiffS.
In this case, the Pla intH t hilS the task of prov ing: (1) that
the delay in diagnosing thl! enlarging thoracic aortic aneurysm
which ultimately ruputred and led to Mrs. Flinkinger's death on
January 14, 1995 was negligent; and (2) that the negligence was a
substantial factor in bringing about the harm suffered by Betty
Flickinger. If, after considering all of the evidence, you feel
persuaded that these propositions are more probably true than not,
your verdict must be for the plaintiff.
Accept
Reject
Modif ied
covered V'
Pa. SSJI (civ) 5.50.
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POINT NO. 14
Pennsylvania law has long r~cognized that a substantial or
real factor in bringinq about harm need not be the only factor
whinh brings about harm to the Plaintiff. The Plaintiff need not
exclUde every possible explanntion:
[T]he fact that some other cause concurs with
the negligence of the dof~ndant in producing
an injury does not relieve the defendant from
liability unless he can show that such other
cause would have produced tho injury
independently of his negligence.
, ,
Maiors v. Brodhead Hotel, 416 Pa. 265, 205 A.2d 873 (1965),
g,uotina, Carlson v. A. & P. Corruaated Box corD., 364 Pa. 216, 223,
72 A.2d 290, 293 (1950) I Jones v. Montefiore..H2Ju2., 494 Pa. 410,
431 A.2d 920, 923 (1981).
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h~ve n."lan uppultullIly 10 pcrHlIlollly l,vl,wlhe CCh<x;.llltJO~JJT1 0111<110 eX~nlllle tllC
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fimllng\ In 'hr, rchocarrllUpr,Ullcpnrt daled 12flJ9.\ Thc r~pl)rt ~Cl', \0' ror ;l.\ III
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for the !tlJdy IS Ilot given lllllhc CChlK.udlogr~plllc repurt,
Bel'~use Ihe que~llnn IIll!u~ ,.1>e rcve,lVel alnund an aortic J11VllryIO\. I ""oul~
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:l.,,'cnJlIlg ,\<m;!.;! InI,111 rl)'!IOn ,If I~,<' ahrlutnln,ll J"lla JU~I bel,)" Ihr dlapluaglll, :Uld.l
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~roove p"lle,nor 10 the leil I'mlnde ,lnd idl ,1IIHlln ,lie "'n 111r .I',,-endlng ollln,l
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lhe~e IJl1~1 rwo ,eCliuns JJC n..nn"II) nOI "JlII:n~lIlcd ,}n ,n .\11 eCh().:ar<lli'p'1 ;Jill, goto",I)
JbnOmlal IlnwIIgs wOIII<t LOllun'l/lly be replmerJ by In ,1.\IUIC Illlclplell'l Ullhe C.'!.IC or
Mr~ Fli.klnger, whil~ these ,cglOcllI.:. Jre llightly prullull<nl. tl1r,y ,lre '1ll1 glo~'ily
Jl1nonll.11 No portiun r)( I~,e .1e:Atll,lJng ,W'!.l seen rr.cIl'UIe\ III nl c~~ Jll .i :; L 11\ III
diarr.~ler ~,' dl.',s~r:liJ;'n tl,lpS Jre ,,'en fj.lfrlnr. Ipec:11L quv\'IQn> .lb')UI Ule JM1"" II
Wl1ulJ hill'" l1l'en 11l,1pprupn,lIr I'm Ihl' Inll'rJ:'r"!r' In 11\~le JJ1Y (<.Immelll on Ifw pOI'"l1l< .,1
~un~ ,r.en '" thl\ 'IUU) t\JJllh)n,Jlly, beL,l';" such >m.<l1 ",:gml'nl,1 "f Ih" ,1I111.);jJ~ ,I(,:n
t."lllny lIJIl:>th,..,raL'l.... ~dH'K:3.111JUgr.ull. II \A'olllJ b~ Impll~~ll1lt~ It") ~~\l. \lJdt! the ~Ht'~\l"n(;c IJ( .i
IlUge llOmc ancury~m ,1! 'lie" n')llll\,,~cd by lr:tn"tlWtlll.lr: eCh'1Carcl1i,r,rrun 1~.IUler Ir
there w,~ ,llnll'JI 11I>pl",on 01'",11 ,Ulell'Y<IIl, a IrarlSfle'l'lugral ech(>cJrdJn~roltn or oilier
IfnaRlng ,roJJy Iu.h ol.'i.ln MIU "' C,\'[" ,III ,,: Ih(. ,)1.)".' wull:<1 l1a,' I"'" IiId",lIed
I hlwever, In reviewing uas '.\SI~. II .IPpeOlrl Uwn~ W,L' n,) dlOlLal queMlulI oJ( i\O~lIC
ancuryun in the ChC~l :11 the lim" 111,' ra(!Inlolr,,1 Wfff ,)Ikt.d In ,nl~rl'r~1 th"
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Defendants obtain copies of the films. Defendants' New Matter is
herein incorporated by reference.
5. Admitted.
6. Admitted in part and denied in part. It is admitted
that Mr.. Foulkrod's letter to Mr. Navitsky dated October 12
refers to a telophone call on October. 12. However, that was a
typographical error Ilnd in fact the telephone call was placed on
October 5, two weeks before serving Dr. Davidson's report.
7. Admitted.
8. Admitted ill part and denied in part. It is admitted
that Dr. Davidson ill 11 cardiologiat. The characterization that
this case is a radiological case is correct but misleading. This
case involvQ~ tho llllegation of a failure of the radiologists to
report a thoradc allourysm which the Plaintiff contends was
clearly vioible on chest x-rays. Significantly, only upon
receipt of all of the x- rays, including an echocardiogram imaged
at Holy Spirit Hospital on December 2, did counsel for Defendants
become aware of the fact that the echocardiogram accurately
images the aorta in the precise location where the autopsy report
indicates an aneurysm ruptured and the echocardiogram shows that
there is no aneurysm. Counsel for the Defendants then learned
that although cardiologists typically interpret echocardiograms,
only in Harrisburg and the West Shore are echocardiograms
primarily interpreted by radiologists. Accordingly, to get an
2
independent expert who could opine as to what is imaged on the
echocardiogram it became necessary to go beyond Harrisburg and
accordingly a cardiologist was selected.
9. It is admitted that Dr. Davidson's report was tendered
later than counsel for Plaintiff would have liked. It is
specifically denied that under the circumstances it could have
been produced any earlier. Defendants' New Matter is herein
incorporated by reference. By way of further answer, it is
specifically denied that Plaintiff would be unduly prejudiced
because counsel for Defendants notified counsel for Plaintiff as
to the identity of his expert and what would be stated in his
report on the telephone on October 5 and by the time the trial
starts Plaintiff will have had a full month to retain a
cardiologist to opine on the echocardiogram.
10. Defendants do not quarrel with Plaintiff's contention
that Plaintiff could not possibly have this case reviewed by a
cardiologist in a month. Particularly since it took the
Defendants 5 months to obtain an opinion from Dr. Davidson.
11. It is specifically denied that Dr. Davidson's opinions
are irrelevant to the case. The interpretation of the
echocardiogram which images the precise location of the aorta
where the pathologist found that it ruptured goes to the jugular
issue in this case.
12. Denied. If indeed Plaintiff has been unable to contact
3
a cardiologist to inte~pret the echocardiogram, justice requires
that this case be continued to enable Plaintiff to retain a
cardiologist to review the echocardiogram. Justice would not be
served by precluding Dr. Davidson's testimony at trial.
Defendants' New Matter is herein incorporated by reference.
13. Denied. Answer to Paragraph 12 is herein incorporated
by reference.
NEW MATTER
14. On July 23, 1996 Defendants promulgated Interrogatories
and a Request for production of Documents, specifically inclUding
Interrogatory 15 and Request for Production 6. True and correct
copies of Interrogatory 15 and Request for Production 6, together
with their Certificates of Service, are attached hereto herein
incorporated by reference and collectively marked Exhibit "A".
15. Fourteen months later, on April 18, 1997, Plaintiff
answered Defendants' Interrogatories. Plaintiff's Answer to
Inter.rogatory 15 is attached hereto, here~n incorporated by
reference and marked as Exhibit "B". Although fully within the
fair scope of the Request for Production of Documents, Plaintiff
did not produce copies of any x-rays. Nor did Plaintiff attach
medical records identified in Response to Request for Production
6.
16. Shortly after this litigation began, of course, the
Defendants went to the Radiology Department of Holy Spirit
4
Hospital looking for the films only to find that they had been
signed out to AnginQ & Rovner. On Saptember 4, 1996 counsel for
the Defendanty corresponded with Angino & Rovner and requested
copies of the medical records. A true and correct copy of the
September 4, 1996 letter is attached hereto, herein incorporated
by reference and marked Exhibit "C".
17. On Septenmer 18, 1996 Angino & Rovner forwarded to
counsel for the Defendants solely x-ray films imaged on November
30, December 7, December 30 and January 13, 1995. A true and
correct copy of Angino & Rovner's transmittal letter is attached
hereto, incorporated by reference and marked as Exhibit "D".
18. On April 24, 1997 counsel for the Pefendants requested
Plaintiff to produce copies of all x-rays identified in Answer to
Interrogatory 15. The film of the echocardiogram was
specifically within the ambit of records identified by Plaintiff
I
in Answer to Defendants' Interrogatory 15. A true and correct
copy of the April 24 letter is attached hereto, incorporated by
reference and marked as Exhibit "E".
19. By letter dated July 9, 1997 counsel for the ~laintiff
corresponded with counsel for Defendants pointing out that there
were 176 films in possession of counsel for Plaintiff and the
cost of copying those films would be $1,760.00. A true and
correct copy of the letter of Angino & Rovner dated July 9 is
attached hereto, incorporated by reference and marked as Exhibit
5
"PH,
20. By letter dated July 11, 1997 counsel for Defendants,
after conferring with Mr. Navit$ky on the telephone, relied on
Mr. Navitsky's representation that the only relevant films were
those chest x-rays imaged on November 30, December 7 and December
30, 1994 and January 13, 1995. Accordingly, counsel for
Defendants confirmed a request for those films by letter dated
July 11, 1997, a true and correct copy of which is attached
hereto, incorporated by reference and marked as Exhibit "G".
Those films and those films alone were forwarded to counsel for
Defendants on August 6, 1997. A true and correct copy of Angino
& Rovner's transmittal letter is attached hereto, incorporated by
reference arid marked as Exhibit "H".
21. In fact, counsel for Defendants relied upon counsel
for Plaintiff's representations that the only films imaging the
relevant anatomy were the chest x-rays. This representation has
turned out to be erroneous because in fact the eChocardiogram
images the exact area of the anatomy where an aneurysm ultimately
ruptured on January 14, 1995 and demonstrated that the aneurysm
was not present. when the echocardiogram was imaged on December 2.
Moreover, there turned out to be additional studies which clearly
demonstrate the area of adjacent structures which also
conclusively demonstrate the absence of an aneurysm in the area
of the descending thoracic aorta where an aneurysm ultimately
6
ruptured. Accordingly, counsel for the Plaintiff, perhaps
unknowingly, mislead counsel for the Defendants as to what other
studies imaged the area of the relevant anatomy and it was not
until the day of the Pretrial Conference, June 17, 1998 that
counsel for Defendants obtained the releva,nt films.
22. Upon receipt of the films for the first time delivered
by Angino & Rovner on J'une 17, 1998, counsel for Defendants
immediately met with his clients, reviewed the films and realized
the significance of the echocardiogram.
23. Counsel for Defendants immediately retained Robert
Zelis, M.D. to review the echocardiogram. It turned out that Dr.
Zelis did not finally inform Mr. Foulkrod that he did not have
the credentials to interpr.et the echocardiogram until October and'
in October Dr. Zelis advised Mr. Foulkrod for the first time that
he had turned the echocardiogram over to Dr. Davidson for review.
In less than two weeks Dr. Davidson prepared a report which was
served upon Mr. Navitsky the day it was received by Mr. Foulkrod.
Under the circumstances of this case, counsel for Defendants
sincerely regrets that he notified counsel for Plaintiff just one
month prior to trial of the substance of a new expert report and
only a week later was able to serve the report. Nevertheless,
justice requires that Dr. Davidson's opinion, which goes to a
jugular issue in this case, be admitted into evidence. This case
bears a 1996 docket number and been pending only two years.
7
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5~ The curriculum vitae of each and every expert that
will be called to testify at trial.
6. Any and all medical records, autopsy reports,
physician's reports and bills, hospital records or abstracts of
same which relate in any way to the injuries allegedly sustained
by Plaintiff.
7. Copies of your federal and state income tax returns
for the five years immediately preceding the events giving r.ise
to thJ,s action and for each year subsequent thereto and all
corresponding W-2 forms.
8. All doc~.ents or other demonstrative evidence which
Plaintiff intends to introduce or use at trial.
9. All documents identified, described, specified or
referenced in Plaintiff's responses to Defendant's
Interrcgatories .. First Set served upon Plaintiff simultaneously
with this Request for Production of Documents.
S. WALTER FOULKROD, III & ASSOCIATES
Date~
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S. WALTER FOULK~ ~ II'!:
Attorney I.D. No. 01982
S. WALJTER FOULKROD, IV
Attorney I.D. No. 65207
ANDREW H. FOULKRCD
Attorney I.D. No. 77394
Attorneys for Defendants,
RICHARD P. STEWART, M.D.,
DANIEL W. HOTTENSTEIN, M.D.,
HOWARD J. BRONFMAN, M.D., and
A. Z. RITZMAN ASSOCIATES, INC.
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counsel a photocopy of a new liability exper.t report from a new
liability expert, Dr. William R. Davidson, Jr., who apparently is
a cardiologist. A copy of Or. Davidson's report is attached hereto
as Exhibit B.
6. Defense counsel had called Plaintiff's counsel on the
evening of October 12, 1998, and told him that he was contemplating
the possible use of this new expert, although he did not have any
report from him at that time.
7. Plaintiff objects to any testimony by this new medical
expert at trial tor several rensons.
B. Dr. Davidson is a cardiologist. This is a radiOlogical
ca~~. Nothing that he offers is of relevancy to this case.
9. Dr. Davidson's report is unt lmely. Producing a new
expert, with new opinions, in a totally unrelated field of
medicine, two weeks before trial, is unduly prejudicial to the
Plaintiff.
10. Plaintiff cannot possibly have this entire case reviewed
by a cardiOlogist and have that cardiologist respond to the
Defendant's report from Dr. Davidson prior to trial.
11. As Dr. Davidson'S opinions are Irrelevant to the case, it
is respectfully submitted that this report is being offered in an
effort to obtain a continuance of the trial.
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NEIL R. FLICKINGER,
INDIVIDUALLY AND AS
ADMINISTRATRIX OF THE ESTATE~
OF BETTY J. FLICKINGER, I
DECEASED, I
Plaintiff t
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RICHARD P. STEWART, M.D.1 ~
DANIEL W. HOTTENSTEIN, M.D.lt
HOWARD J. BRONFMAN, M.D., ~
THE A.Z. RITZMAN ASSOCIATES,t
INC. , ~
Defendants ~
26
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 96-3954 CIVIL TERM
IH-~E: PEGTRIAL CONfERENCE
A pretrial conference was held Wednesday, June 17,
199B, before the Honorable Edward E. Guido, Judge. Present for
the Plaintiff was Michael J. Navitsky, Esquire, and present for
the Defendants was S. Walter foulkrod, III, Esquire.
This is a jury trial inVOlving alleged medical
malpractice. The parties indicate that it should take four days
to complete.
The parties stipulate that all medical bills are
reasonable to the extent of third party reimbursement and all
medical services were necessary.
A date certain is necessitated by the nature of
Defendants' practice. Therefore, the parties have agreed to"
continue this case to the November trial term. This will be the
first case heard before this Court on November 9, 1998. Both
parties are deemed to be attached for trial on that date.
There is no need for counsel to relist this case for
the November term. The Court Administrator is directed to do
so. Furthermore, a pretrial will not be held unless requested
in writing from either party at the call of the November trial
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221.5 fomt HlIIl Drive, SUllc 35
P.O, Bolt 6600
Harrilbllrl. PA 17112.0600
Fax: 717.541.1727
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re:
I hive had the opportUnity [0 roview all thllJll/Alrills 011 the F1lcklnlcr case. I
hive hod III d'!forlllnity 10 pmonllly review the echocardioaram and 10 IIxamine the
,.port provl by Or, Jl.abln on !he echOCMdio.ram. I:un in enti,. apcOllllnllliirb the
tlndinis in the echocardiosram repolt dilled 1212194. The report ioea so fllT au 10
incllldt a .pecitic di~I.iOl1 of the 'IIlllliun of nulla! ValVD prollpse, The alAled reuon
for the sNdy Is not given on the ecbocardiOIUphic repon,
Because the question in this cue revolves aroWld an aonJc ~eurysm. I would
like to dil1'ess to discuss echoclll'diogrlphic ILlICssment of the aorta, The aortic roolll
,enua1ly alWlYR scen in a transthoracic ech~iognm, The lOp nonl1Al aonJc root
dimensions are 3,7 em, In this .... thn AOru. MOl meU\lrd 3.4 em, The remalnder or
the aoru is nonnelly not dis.uucd In I tnnsthoracic e.chocardiogr.un lIS it IS
ineonsistenlly ae"n III\d only In vert small portion... In this Cll.!IC, D small portion of Ille
uc:ending aora, a small portion of the abdominal aorta just below rhe dilphralJ!l. and a
sinale shce tluou.h the rnid.d"-Scendln. thor..ic aOI1A lllthc level of the Ilriovenlricul...
groove posletior to the lert venuiele IIId lcft atrium arc seen, llle Metndinl aona
melLlu~ 4,2 em in diameter and is sli~htly dJlaled, The mid descending aona seen in the
A V 11'00ve mensUles 3.4 em in diameter :llld is entirely unremarkable in appe31ance, 'I'IIe
abdominal aona appean clllcltied and atherosclerotic with a dlameur or 3,S em While
these laaer two sections ere normally nOI commenced on in an cchocardioaram. grossly
abnOMllllllnc1Jnga would conunonly be reponed by an astute inlCrprelCr, 1n the case of
Mrs. Flicltinger. while these segrnenLs are slightly prominent. they OR not grossly
abnonnaJ, rfo portion or the dC$Cendlni aorta seen medSlllCS in eXCeSS of 3.5 cm in
diameter, No dilSecllon naps are seen Bamng specIfic qUestions about the aolta. il
would have been inappropriate for the illlCl"prtlet [0 nWle any comment on the portions of
aona scon in this study, Additionally. because such smiill segments of the aona arc seen
on any IllII\sthorlll:ic cchocardiogl1lm. it would be impO$sible \0 exclude the presence of a
Il1Ie aortic anellrysm at siteS not imaied by 1l1lllSthollClc eChocardiogram, Rather it
thtr. was clinical suspicion of an ancutylOl. a transelophageal echocardioiram or other
iOla.inll sllldy IUeh u an MRI or CAT scan of the aollA would have been Indicaled.
HOII/evtr, in reviewing this CWl, it appears there was no clinical question ot IOnic
aneurysm in the chest at the time the radiolo.in were llSIced 10 inlCrprelthis
ec:hocardiognm.
717 531 7%9
98~
P,01
,... -..- . .....
12,
'. .. '. .. ..
William Reed Davidson, Jr,. M n. lconL)
4
Outside IDlere,tsl
Active po.rticiplItion in loclll church,
Enjoy hislory. mU5ic and literature.
PubllclUlons
J.
Hodson RC. WilIlnms SK, lIl1<1 tli.Yid~on WR, Jr,: MelllbolJc conltol ot Ul'Ca melllbollsm
In Chlllll1ydomonns reinhardii and ChorelIlI pyrel1oldosll. ] BUCIIll: 1022-1035. 1975,
Dnvldsoo WR. It.. Bunerje~ SP, nod Liang C.S, DobullIlltine-induced curdinc udaptations:
Compa.rison Wilh exercis~ trained lInd sedentary flIlS, Am] Physlol 250: Hn5-'730. t 986,
Davidson WR Jr" Kawa>hlmll S, BlIl1erjee SP, and Liang C-S: Pres~rved Curdlllc beta-
adrenergic sen,~irivily in early ll!novllScular hypenension, Hypellen.sion 9: 461.472. 1987,
Goldsmith GH. Baily RG. BrettJer DB. Davidson '>VR..1L, Ballard JO. DnscoJ TE.
Greenberg 1M. Kn.sper CK, Levine PH and Ralooff 00: Pulmonary hypenension 10
patients with classical hemophilia. Anows of Internal Medidne 108: 797-799, 1988,
Sinoway L1. Hendrickson C. Davld.u1J1 WR_ Jl~. f>rophel S. Zelis R: The Charac~risucs
ot flow medil1l.ed hrachiaJ artery vasodilation in human subject:;, Circullllion Research
64:32-42, 1989,
,
..
3,
4,
5,
6.
Koch Kl., Davidson WR. Jr" Day FP, Spears I'M. Voss SR: Esophageal dysfunction 10
patients with milral valve prolapse and ch~st pain: A prospeclive sludy ulllizing provocati Ve
testing during esophageal manometry. Am I of Med 86:32.38. 1989.
Shenberger JS. Prophet SA, Waldhausen JA. wdson WR. 1r" Sinoway LI: Left
subclavian flap aOllopl:!Sly for coarcrarion of the aorta: effects on forearm vascular (unction
und growth, JACe 14:9~1-959, 1989
Koch KL, P~vld'on WR, Ir,: Esophageal dysfun.:tion and chest palO witll mitIal valve
prolapse. Cardiology Board ReView 7(4):38-47, 1990,
Davidson WR, Jr" E Fee: Influence of aging on pulmonary hemodynamics in a population
free of coronary artery disease, Am J Cardiol 6~: 145"-1458. 1990
Emnger SM.l&.'ilil.I.9n,~: Cor triatrialum in an adult: utility of color Doppler flow
imaging, Dynamic Cardionscular Imaging 3(4): 1~5-157. 1990,
Bradford RH. CL Shear. AN Chromos. C Dojovoc. FA Franklin, ~l Hesney. J Higgins. A
Langendorfer. JL Pool. H Schnaper. WP Stephenson CYiR Davidson, Jr,. Inv~sligator)
Expanded climcal evalumion of Lovasralin (EXCEL) 'ludy: design and patlcnt
characrerisrics of a double-blind, placebo-controlled study in palleOl\ with moderale
hyperchole'lerol~mla. Am] CardloI66:44B.~5B. 1990.
Davidson WR Jr" MJ Pa.~quale, C Fanclli: A Doppler echocardiographic ellarnination of
the nOrmal aortic valve an<llefr ventricular outflow trllCt. Am] Cardiol 67(6):547-549,
1991.
7.
8,
9,
10,
II.
. '.' ...... .'....
, .~
William Reed Davidian, Ir.. M,D, (cont,)
~
, 3.
Oascho IA. Copenhaver GL, Davidson WR, Ir,,; I5ch~miD'lnduced depres~ed ')islo/ic
lhlckening is tranSIently augmented by remote coronary occlusion, CathetenzDlIon nnd
Cl1J'diovoseu/ar Diag 25:2~3-2.59. 1992
Daviwon WR, Jr.. MI Pasquale. G Copenhaver, RD Aronoff' Determinants of delayed
ventricull1J' filling in man: A role (or external (orc~s, Echocordlogrnphy 9(4):421..'135, 1992
PawllUh DO. RL Moore. TI Musch, WR LJavl<.lson. Jr, Echocordlographic
evaluulion of size. fUllctlon, and mass of normal and hypertroplJled ral ventricles
Journal of Applied Physiology. 74:2.59g-2605. 1993,
SlJIffen RN and WR D6vid~lL: Eehoeardiogruphic assessment of olriaJ seplll1 defects.
Echocl1J'diogrophy 10(5):.545..~~2. 1993,
Brndford RH. SL Shear. AN Chremos. CA DuJovne. el. 3J,; Expanded clinical evaluation
of 10vastaIin (EXC[L) slUdy results: Two-year efficacy and sllfery foUow-up, Am J
Cl1J'diol 74:667-673. 1994, (WR Davidson. Ir,. Invesl1gator)
Dzwonczylc T ond~...YiP..Jr; The spectnlm of left vcnmcular .. atriol
communicotion in the adult: essentials at echocardiographlc assessment. Journal of the
American Sociery of Echo=diography, 8:263.269.1995,
David~on, WR, Ir,: MR.I: Tenors where Pac never thought to look, Annals of Inlemal
Medicine. (poem), Annals of Internal Medicme, 123:427. 1995.
Dovidson WR. Jr.. Ventricular hypertrophy in sleep apnea. Journal of Sleep Research
4(Suppl I), 176181. 1995,
14,
IS,
16,
17,
18,
19,
20.
21.
Galata 0, Davidson WR, Ir, Compliance of lipid profile reportmg in Pennsylvania with
NDlional Cholesterol Education Program Guidelin~s. (submitted (0 AJC 10/97),
Ediloria.ls and Book Reviews
2,
3.
4,
5,
AbstraCIS
I.
I,
Davidson WR.lL: The echocordiogmpher alld diaslole, Echocardlography 9(3):287.
1992,
DJvidson YiB..1.r.,; Introduction 10 second part of syrnposium on Doppler Evllluation of
Diastolic Performance, Echocardiography 9(4);385. 1992,
Davld.son WR, Jr,: What is ventricular filling ~ally telling us? Editorial
Echocardiography 9(4):459"163. 1992,
Davidson, WR Jr, and Cvron SF.: Echocardiogr3rhy in the adult With cong~nital heart
diseu..se, Edilona! Echocardiography IO('~):~13.5 5.1993,
l2;\Yidson, WR Ir: Book review of Valvular H~1lrt Dlse;J.se: Comprehensive eVIllUlIlion
and Treatment, Second edition. Edited by WF Fronkl and...", Brest. Philadelphia. PA.
F,A, Davis. 1993. 339 pages. Echocardiography 11(1):102-103. 1994,
Kawashima S. Davidson WR Ir" and !.iana C.S: Pinacidil: A new antihypertensive
IIgent with potent coronary vnsodilator properties, Clin Res 32(2): 334A. 1984,
, ............1 ,~ .....~I ...., I'" 1 I""
, ........
....,"I-...'.,....;);}>..i ....J'..>..i
.. .... ....... .'..
William Reed Davidson. Jr,. M,D, (conI,)
6
2.
Kawo.~tu",1I S. Davldsl1n WR, Jr.. ond Llong C.S: Reduced InolToplc IIl1d chronotropic
re.sponse$ to Pinll(;ldil in i1wlllte Nnovasculu hypertensive dogs, The PhllJ"/l1aco/olllsr
26(3): 2~7. 1984,
3,
Davidson WR. Jr,. Bonerjee 51'. ond Liang C-S: Brodycudla foUowing dobulamine
administration: Effects on cardlllL bela.adrenel'glc receplon compued to physicul
condilloning, Clin Res 32(J): 669A, 1984,
Davidson WR. Jr" KIIWll.lhlmll S. Dlllleljee 51'. and Lill/lg C-S: Mechanism of reduced
sympathetic re6ponses to afterload reduction in early renovlI.\culu hypertension, 1 Am
elii'd Cardlol.5(2): 4~6. 198.5,
4.
5.
Koch n. Spears PF. David..on WR. Jr.. and Voss S: Prospeclive evllluallon of
e5opb~gelllmOllllty with provocutive leSllng in plllieDts with chest pain IIl1d mltrnl valve
prolapse, Goslroenlerology 90 (5.1'12): 1496. 1986.
Day FP. Koch n. DJ1yidson WR, Jr,. IIl1d Spelll'S PM: Etiology of cheSI pain in plllienls
Wilh mlrral valve prolapse, 1 Am Card Cardlol9 (2, SUpp A): 9A. 19M7,
Davidson WR.li:.. Pawiush DG. Musch n, and Moore RL: Lefl ventricular mass in the
rol can be accuralely calcuJllled ecbocardiograph!caJly. Clinical Research 36. No.3: 27) A,
1988,
6,
7.
8,
Pasquale MJ and David_on WR, Jr,: Aortic valve area In man varies With Slroke volume,
Clinical Research 36, No.3; 306A, 1988.
Pasquale MJ, David~on wn" lr" lIlld Fanelli C: In vivo determinalion ot normal aortic
valve are:l in man - an application of the continuity equalion, C1Jnic~1 Re~earch 36. No, 3:
306A. 1988,
9.
10,
Davidson WR fr.. Fee E and Magill E: Intluencc of aging on pulmonary hemodvnamic.
in apopulntion free of coronary discose, Clinical Reselll'ch 36. :'110, J: 271A. 19~8,
(Presented)
ll.
PlI.\quale MI. Noonan TE. David~on WR, Jr..: Does lIonic valve arca remain consllIIlt
under varying hemodynlll111c condiuons in mun'!, Circulation 78. pt n. 0-350. 1988,
David~on WR, lr Pasquale MI. Aronoff RD: Doppler left ventncular filling paltern is
closely related 10 venrricular relaxation abllonnalities. J Am Coil Cardiology 13 (1':0, 2.
SUppl Al: 197A. \989
Shenberger IS, Prophet SA. t2;1vldson WR. Jr,. Waldhausen JA. Leuenberger UA,
Sinnway L1: lefl subclavian flap aortoplusty: effect on forearm vll.lcular function and
growth, Clin Research 3i, 1'0, 2: 296A. 1989, (Presented)
Stauffer fL, Qwilij,SllD WR,1r. Zwillich CN: EchocllJ'diosraphic and declrocardiographic
tinding~ in a.symph,')malic ,nonng men, Am Rev Respir Dis 139 (4.pt2): A 113, 1989,
Acccpled for presentalion,
Sllluffer 1L. Lehman RAW. Landis JR. Davidson. WR. Jr.. Zwillich CW: Sleep-
disordered breathing and daytime sleepiness. but nOl neuropsycholo,pcallmpnlnncnt. are
common in asymptomatic snoring men. ChesI96(2) SUppl. AUi\lSI. 1989,
12,
13.
14.
15.
25,
26,
27.
28,
29.
WUlto,m R~ed Davidson. Jr" 1\1,D (con!.)
7
16,
Sinow~y L!, Gifford R. Yang H, Prophet S, Baily RO, Davldsoll ~, Large
lncrell5CI in resting blood flow cause enlargemcnt of condull veuels inhUmans. Cire
1989: 80(Supp m:n.~~(\,
O,ayld.!on WBJL, Sexton CW, l.A!tunan IC: Antlhypenensive medic~tions i1.Ircr lefr
ventricular IIlItns pattem in normal sUbjccl~. lACe 1990: 15(Supp A),
David~on WR, Jr" ZwllHch CW, Stouffer IL. Reeves-Hoche MK: Cardiac sequelae of
51ee1>'dllordered breo'.h!ng, CUn Res. 1990; 38(2) Accepted ror presenllltion
Gascho IA. Copenhaver G, I2Al!Won WIt Jr,.: Functional rnyoc31dial rese/'1le can be
ellclled by remOle coronlll'}' occlusion. Clin Res. 1990;311(2)
Davidson.w&J,[" Iw;kson A. Pasquale MJ: Delayed ventricular filling of agin, 15 nor
caU!;ed by Bbnonnlll veOlrlcular relox~tion, Am College of Cardiol. PennsylvalUo Chapter
(accepted for pr~sentalion)
Jw;kson A, Davld..on WIt Ir,: Utili!) 'If IsovolumJc rclaxlllton time for eSllmating
ventricular reJaxlUion, Am College of Cardiol, Pennsylvanta Chapter (accepted for
presentation),
Ko~(ck DH, Qllvldson WR.. lr.. Norris IF. Moore RL: echocardiographic B5senlnent of
left ventricular mllSs in trained and hypertenSive rau, Med Sci SpOrt Exerc.
24(5 Suppl.):S93. 1992,
Statfen RI':. Davidson WR, I~: Pulsed Doppler improves the senSitivity/specificity of
two-dimensional echo and color Doppler for the diBgnosi~ of auial septal defect In adults,
American Heart Asso<:iauon, Circulollon 88(4.pt.2);I..56. 1993,
12llvidson WR, Ir . Stauffer JL. Reeves Hoc he' MK. Zwllllch CW Cardiw; sequelae of
sleep dlsordel'l!d breathing in obstlUctive sleep apneu: new evidence for nght ventneullll'
dysfunction, Am Rev Rcsplr Dis 147: AIOI ~, 1993
DaVidson WR, Ir. I,L, Stauffer. M,K, Reeves-Hoche, C.W, ZWill1ch, Mechanisms of
ventricular hypertrophy In slee~ Bpnell: An eChocardiogrnphic study, Presented at the 3rd
International Marburg Symposium on Cardiocirculutory Function Dunng Sleep. :'vIlII'burg.
Germany, August, 1994,
Iuliano PI, RN Stauffer, WR Davld~on.lr:... Newly described pulsed Doppler paltern~
diagnostic of significant Rtrial septal defect arCl validated by normalioling after surgical
repllir, Pennsylvlll'1i~ Chapter of American Collegc of Cardiology, September, 1994
(presentcd),
Iuliano PI. SE Cyran. WR DaVidson Ir Compensaled pulmoOlc insufficiency: l~ the
risht venlricular response to exercise normal'? lACe SpecioJ hsue 1;378A. 199~,
Griffin OC.I ArtltllUl. WR Davidson Ir, Doppler tissue imaging of myocardiill velocity:
PhYSiologiC variability in normals, 1 Am Soc of EChocardiography, 8:392. 1995,
David~on WR, Ir, The right ventricle: and Ob.llUctive sleep apena, Somnologic Supp,
2:20, 1997.
17,
18,
19.
20.
21.
22,
23,
24.
gJlTIrICATB or SBRVIce
I hereby certify that I, Jessie K. Walsh, an employee of
Angino & Rovner, P.c., have this "ItIP' day of L~~' /. , 199B,
served a true and correct copy of Plaintiff's Motion in Limine,
upon the following persClns by sending same United States first
class mail, addressed as followSI
s. Walter Foulkrod, III, Esquire
Andrew H. Foulkrod, Esquire
2215 Forest Hills Drive, suite 35
P.O. Box 6600
Harrisburg, PA
Counsel for Dr.
Dr. Bronfman,
17112-0600
stewart, Dr. Hottenstein,
& A.Z. Rit~mo!ln
~~1i~j~G
.;ress e K. Wa sh
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,
NEIL R. FLICKINGER,
INDIVIDUALLY AND AS
ADMINISTRATRIX OF THE ESTATE I
OF BETTY J. FLICKINGER, I
DECEASED, I
Plaintiff I
I
V. I
I
RICHARD P. STEWART, M.D.I I
DANIEL W. HOTTENSTEIN, M.D.II
HOWARD J. BRONFMAN, M.D.I :
THE A.Z. RITZMAN ASSOCIATES,:
INC., I
Defendants I
26
IN THE COURT OF COMMON PLEAS OF
CUMaERLAND COUNTY, PENNSYLVANIA
NO. 96-3954 CIVIL TERM
IN RE: PRETRIAL CONFERENCE
A pretrial conference was held Wednesday, June 17,
199B, before the Honorable Edward E. Guido, Judge. Present for
the Plaintiff was Michael J. Navitsky, Esquire, and present for
the Defendants was S. Walter Foulkrod, III, Esquire.
This is a jury trial involving alleged medical
malpractice. The parties indicate that it should take four days
to complete.
The parties stipulate that all medical bills are
reasonable to the extent of third party reimbursement and all
medical services were necessary.
A date certain is necessitated by the nature of
Defendants' practice. Therefore, the parties have agreed to
continue this case to the November trial term. This will be the
first case heard before this Court on November 9, 199B. Both
parties are deemed to be attached for trial on that date.
There is no need for counsel to relist this case for
the November term. The Court Administrator is directed to do
so. Furthermore, a pretrial will not be held unless requested
in writing from either party at the call of the November trial
"
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NEIL R. FLICKINGER, Individually,
and as the Administrator of the
ESTATE OF BETTY J. FLICKINGER,
DECEASED,
Plaintitt
v.
RICHARD P. STEWART, M.D.l
DANIEL W. HOTTENSTEIN, M.D.,
HOWARD J. BRONFMAN, M.D.l THE
A. Z. RITZMAN ASSOCIATES, INC.,
and 1I0LY SPIRIT HOSPITAL
Defendants
COMPLAINT
I
I
I
I
I
I
I
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I
I
I
I
I
I
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNA
NO. '/1., 1 'i \ '( (1((,,,, Tc...
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
1. Plaintiff, Neil R. Flickinger, is an adult resident or
LoYlJville, Perry County, Pennsylvania and is the widower of the
decedent, Betty J. Flickinger.
,
2. Plaintiff, Neil R. Flickinger, is the Administrator or
the Estate of his late wife, Betty J. Flickinger, by r,etters
Testamentary duly issued on January 27, 1995 by the Register or
Wills or Perry county, Pennsylvania.
3. Defendant, Richard P. Stewart, M.D., (hereinafter
Defendant Stewart) is an adult individual licensed to practice
medicine in the Commonwealth of Pennsylvania, and at all relevant
times was engaged in the practice of radiology in Cumberland
County, Pennsylvania.
4. Defendant, Daniel W. Hottenstein, M.D., (hereinafter
Defendant Hottenstein) is an adult individual licensed to practice
medicine in the Commonwealth of Pennsylvania, and at all relevant
times was engaged in the practice or radiology in Cumberland
County, Pennsylvania.
1
5. Defendant, Howard J. Bronfman, M.D., (hereinafter
Defendant Bronfman) is an adult individual licensed to practice
medicine in the Commonwealth of Pennsylvania, and at all relevant
times was engaged in the practice of radiology in Cumberland
County, Pennsylvania.
6. Defendant, The A. Z. Ritzman Associates, Inc.,
(hereinafter Defendant A. Z. Ritzman) is a corporate medical
institution consisting of a group of physicians who specialize in
the practice of radiology, with offices located in Cumberland
County, Pennsylvania, and who, at all relevant times, provided
radiological services to Defendant, Holy Spirit Hospital.
7. At all relevant times herein, Defendants Stewart,
Hottenstein and Bronfman acted as agents, apparent agents,
servants, members, partners, and/or employees of Defendant,
A.Z. Ritzman, and acted within the course and the scope of their
employment/association with this corporation.
B. Defendant, Holy Spirit Hospital, is a
institution with medical facilities and offices
Cumberland County, Pennsylvania.
9. At all relevant times herein, Defendants stewart,
Hottenstein and Bronfman acted as agents, apparent agents,
servants, members, partners, and/or employees of the Defendant,
Holy Spirit Hospital, and acted within the course and the scope of
their employment/association with this corporation.
corporate
located in
2
10. At all times when the decedent, Mrs. Flickinger,
underwent chest K-rays and/or radiological studies in the
Defendant, Holy spirit Hospital, all staff, inoluding Defendants
stewart, Hottenstein, Bronfman, and A.Z. Ritzman, and all x-ray
technicians, technologists, and hospital personnel were agents,
apparent agents, servants, members, partners, and/or employees of
Defendant Holy Spirit Hospital and at all times were acting within
the course and scope of said employment/assooiation.
11. At all times when the decedent, Mrs. Flickinger, had her
chest K-rays and/or radiological studies interpreted in Defendant,
Holy Spirit Hospital, all staff., including Defendants Stewart,
Hottenstein, Bronfman, and all x-ray technioians, technologists,
and radiological personnel were agents, apparent agents, servants,
members, partners, and/or employees of Defendant, A.Z. Ritzman, and
at all times were acting within the course and SCOpliI of said
employment/association.
12. On or about November 30, 1994, Mrs. Flickinger was
transported, by ambulance, to Defendant's, Holy Spirit Hospital,
emergency care unit (EeU). She was seventy-three (73) years old
and was complaining of the sudden onset of orushing chest pain and
shortness of breath which was not materially abated by the
administration of Nitroglycerin.
13. Defendant, Holy Spirit Hospital, recorded that
Mrs. Flickinger had a history of an aortic aneurysm in her abdomen
which necessitated its repair by said Defendant in 1989. They also
recorded that she had no personal history of heart disease but that
3
she did have a history of chronic obstructj.ve pulmonary disease
(COPD), ankylosing spondylitis, gastroesophageal reflux disease,
and mitral valve prolapse.
14. While in the Defendant's ECU, Hrs. Flickinger underwent
a chest x-ray which was reported as demonstr.ating moderate dilation
of her aorta with calcification noted at its arch.
15. Later that same day, Hrs. Flickinger was admitted to
Defendant, Holy spirit Hospital, for chest pain, to rule out
myocardial infarction and for further evaluation.
16. Durinq this admission, on or about December 7, 1994,
Mrs. Flickinger underwent a second chest x-ray at Defendant, Holy
Spirit Hospital. This chest x-ray WHS read by Defendant stewart.
17. Defendant Stewart reported the results of this chest
x-ray, as similar to the findings from the November 30, 1994 chest
x-ray.
lB. plaintiff avers that this December 7, 1994 chest x-ray
demonstrated a change in the status of Mrs. FlickingQr's thoracic
aorta. The PA view of this x-ray evidenced an increase in the
width of her thoracic aorta, as seen through the heart shadow.
Moreover, the lateral view showed a tortuous and ectatic aorta. In
addition, there is noted a slight but distinct posterior bulge of
her aorta at the mid cardiac level (T 10-11 vertebral level).
19. On December 10, 1994, Mrs. Flickinger was discharged from
Defendant, Holy spirit Hcspital, with the final diagncsis being -
Chest pain of unknown etiology.
4
20. Over the next three (3) weeks, Mrs. Flickingel' presented,
once a week, to her family physicians, complaining of chest, rib,
and/or back pain and shortness of breath.
21. On or about December 27, 1994, Mrs. Flickinger was
referred by her family physicians for a chest x-ray at Defendant,
Holy Spirit Hospital.
22. This chest x-ray was performed and read at Defendant,
Holy spirit Hospital, on December 30, 1994, by Defendant
Hottenstein.
23. Defendant Hottenstein examined this chest x-ray of
Mrs. Flickinger and noted the presence of atheromatous
calcification in an 'Ilctatic (stretched) and tortuous (twisted)
thoracic aorta. However, Defendant Hottenstein made no comparison
with the previous appearance and dimensions of Mrs. Flickinger's
thoracic aorta and the fact that there had been a change in its
condition. No admission or further diagnostic tests were ordered
or recommended. Despite the ominous findings evident on this
x-ray, Mrs. Flickinger was merely discharged home.
24. Plaintiff avers that this December 30, 1994 chest x-ray
revealed an in,crease in the size of Mrs. FliCkinger's aorta at the
level of T 10-11, which was a significant and alarming enlargement
of Mrs. Flickinger's thoracic aorta and suggested its imminent
rupture.
25. On or about January 13, 1995, Mrs. Flickinger was again
referred by her family physician to Defendant, Holy Spirit
Hospital, for a chest x-ray.
5
26. This chest x-ray was performed on January 13, 1995, at
Defendant, Holy spirit Hospital, and was read by Defendant
Bronfman.
27. Defendant Bronfman read Mrs. Flickinger's chest x-ray as
demonstrating an eotatio (stretohed) aorta. He concluded that this
chest x-ray demonstrated no significant change since her
December 30, 1994 chest x-ray. No admission or further diagnostic
tests were ordered or recommended. Despite the ominous findings
evident on this chest x-ray, Mrs. Flickinger was merely discharged
home.
2B. Plaintiff avers that this January 13, 1995 chest x-ray
showed Mrs. Flickinger's aorta even more enlarged and dJ.reful on
both PA and lateral views than its appearance in the December 30,
1994 chest x-ray. This distinct aneurysmal-type bulge of the
posterior wall of Mrs. Flickingel" s aorta was most prominent on the
lateral x-ray view.
29. On or about January 14, 1995, an ambulance was summoned
to Mrs. Flickinger's residence and found her complaining of severe
chest pain. The ambulance transported her to Defendant's, Holy
Spirit Hospital, ECU.
30. As a result of the Defendants' failure to diagnose and
treat her worsening aneurysm, while in the ECU, Mrs. Flickinger sat
up from her bed yelling in pain and holding her chest, immediately
fell back, and died of a ruptured thoracic aneurysm.
31. Defendants, stewart, Hottenstein, Bronfman, A. Z.
Ritzman, and Holy Spirit Hospital, or their agents, apparent
6
agents, servants, members, partners, and/or employees, are jointlY
and severally liable to Plaintiff for the injuries and damages as
alleged herein.
32. 'fhe injuries suffered by Mrs. Fliokinger and by the
plaintiff were the direot and proximate result of the negligenoe of
Defendants, stewart, Hottenstein, Bronfman, A. Z. Ritzman, and Holy
spirit Hospital.
33. At all relevant times alleged herein, Defendants,
A.Z. Ritzman and Holy Spirit Hospital, had the right and duty to
exeroise oontrol, authority, and supervision over all agents,
apparent agents, servants, members, partners, and/or employees who
provided radiologioal servioes to its olients.
COUNT.....l
NEIL R. FLICKINGER, INDIVTDUALLY, AND AS ADMINISTRATOR OF
THE ESTATE OF BETTY J. FLICKINGER
V.
RICHARD P. STEWART. M.D.
34. Paragraphs 1 through 33 of this Complaint are
incorporated herein by reference.
35. Defendant, Richard P. Stewart, M.D., is liable to the
Plaintiff for injuries and damages alleged herein which were
direotly and proximately caused by his negligence inl
a) reading the December 7, 1994 chest x-ray but failing
to recognize or report the. ominous state of Mrs. Flickinger's
aorta, which demonstrated an dangerous Yidening in her thoraoio
aortal
7
b) tailing to appreoiate lite-threatening changes in
Mrs. Flickinger's aorta, whioh were evident on her serial ohest
x-rays,
0) tailing to review Mrs. Fliokinger's ohest x-rays
thoroughly and adequately,
d) tailing to immediately repeat chest x-rays on
Mrs. Flickinger atter her tilms demonstrated a dangerous widening
in her thoraoio aorta,
0) tailing to inform Mrs. Flickinger of the
lite-threatening condition of her aorta,
t) tailil,g to diagnose Mrs. Flickinger's aorta's
dangerous widening and tortuous and ectatic condition trom her
ohest x-ray,
g) misreading Mrs. Fliokinger's chest x-ray in regard
to the lite-threatening state of her aorta,
h) tailing to diagnose Mrs. FliCkinger's
lite-threatening aortic condition on December 7, 1994,
i) failing to order and/or recommend any diagnostJ,c
studies ot Mrs. Flickinger's aorta, even though her chest x-ray
demonstrated its tortuous and ectatic condition and its dangerous
widening,
j) failing to refer Mrs. Flickinger to a surgeon tor
evaluation of her aortic condition,
k) tailing to intorm Mrs. Flickinger's referring tamily
physician(s) ot the lite-threatening state of her aorta and her
8
need tor turther diagnostio studies, immediate tollow-up, and/or
hQr instant need to be reterred to a surgeon for evaluation I
1) t~iling to even oonsider the possibility that
Mrs. Fliokinger's chest x-ray, from December 7, 1994, demonstrated
a lite-threatening aortic condition and that her oondition
necessitated immediate diagnostic tests, fOllow-up, and/or reterrel
to a surgeon for prompt evaluationl
36. As a direct and proximate result of Detendant stewart'.
negligence in tailing to diagnose or even consider the
lite-threatening state ot Mrs. Flickinger's aorta, Mrs. Flickinger
died ot aortic ruptura on January 14, 1995.
WHEREFORE, Plaintiff, Neil R. Flickinger, Individually, and as
Administrator ot the Estatl'il of Betty J. Flickinger, demands
judgment against Defendant, Richard P. stewart, M.D., ill an amount
in excess of Twenty-Five Thousand dollars ($25,000) exclusive of
interest and costs and in excess of any jurisdictional amount
requiring arbitration.
COUNT II
NEIL R. FLICKINGER, INDIVIDUALLY, AND AS ADMINISTRATOR OF THE
ESTATE OF BETTY J. FLICKINGER
V.
DANIEL W. HOTTENSTEIN. M.D.
37. Paragraphs 1 through 33 of this Complaint and Count I are
incorporated herein by reference.
38. Detendant, Daniel W. Hottenstein, M.D., is liable to the
Plaintitf tor injuries and damages alleged herein which were
directly and proximately caused by his negligence in:
9
a) reading the Deoember 30, 1994 ohest x-ray but failing
to reoognize the ominous state of Mrs. Flickinger's aorta, which
was suggestivs of imminent rupturel
b) failing to appreciate life-threatening changes in
Mrs. Flickinger's aorta, which were evident on her serial chest
x-raysl
c) failing to review Mrs. Flickinger's chest x-rays
thoroughly and adequatelYI
d) failing to immediately repeat chest x-rays on
Mrs. Fliokinger after her films demonstrated imminent rupture of
her aortal
e) failing to inform Mra. Flickinger of the
life-threatening condition of her aortal
f) failing to diagnose Mrs. Flickinger's aorta's
imminent rupture from her cheat x-raYI
g) misreading Mrs. FliCkinger's chest x-ray in regard to
the life-threatening state of her aortal
h) failing to diagnose Mrs. FliCkinger's
life-threatening aortic condition on December 30, 19941
i) failing to order and/or recommend any diagnostic
studies of Mrs. Flickinger's aorta, even though her chest x-ray
demonstrated its imminent rupture I
j) failing to refer Mrs. Flickinger to a surgeon for
evaluation of her aortic condition I
k) failing to inform Mrs. Flickinger's referring family
physician(s) of the life-threatening state of her aorta and her
10
need for further diagnostio studies, immediate follow-up, and/or
her instant need to be referred to a Burgeon for evaluation I
1) failing to even consider the possibility that
Mrs. Flickinger's chest x-ray, from December 30, 1994, demonstrated
a life-threatening aortic condition and that her condition
necessitated immediatQ diagnostic tests, follow-up, and/or referral
to a surgeon for prompt evaluation.
39. As a direct and proximate result of Defendant
Hottenstein's negligence in failing to diagnose or even consider
the life-threatening state
of Mrs.
FliCkinger's aorta,
Mrs. FliCkinger died of aortic rupture on January 14, 1995.
WHEREFORE, Plaintiff, Neil R. Flickinger, Individually, and as
Administrator of the Estate of Betty J. Flickinger, demands
judgment against Defendant, Daniel W. Hottenstein, M.D., in an
amount in excess of Twenty-Five Thousand dollars ($25,000)
exclusive of interest and costs and in excess of any jurisdictional
amount requiring arbitration.
COUNT I II
NEIL R. FLICKINGER, INDIVIDUAl,LY, AND AS ADMINIS'i'RATOR OF
THE ESTATE OF BETTY J. FLICKINGER
V.
HOWARD J. BRONFMAN. M.D.
40. Paragraphs 1 through 33 of this Complaint and Counts I
and II are incorporated herein by reference.
11
41. Detendant, Howard J. Brontman, M.D., i. liable to the
Plaintift tor injuries and damages alleged herein whioh were
directly and proximately oaused by his negligence inl
a) reading the January 13, 1995 chest x-ray but tailing
to reoognize th~ ominous state of Mrs. Flickinger's aorta, which
was suggestive ot imminent rupture,
b) failil:g to appreciate life-threatening chanqss in
Mrs. Flickinger's aorta, which were evident on her serial chest
x-rays,
c) tailing to review Mrs. Flickinger's chesl: x-rays
thoroughly and adequately,
d) failing to immediately repeat chast x-rays on
Mrs. Flickinger atter her films demonstrated imminent rupture ot
her aorta,
e) tailing to inform Mrs. Flickinger o~ the
lite-threatening condition ot her aorta,
t) tailing to diagnose Mrs. Flickinger's aorta's
imminent rupture from her chest x-ray,
g) misreading Mrs. Flickinger's chest x-ray in regard
to the lite-threatening state of her aorta,
h) tailing to diagnose Mrs. Flickinger's
lite-threatening aortic condition on January 13, 1995,
i) failing to order and/or recommend any diagnostio
studies ot Mrs. Flickinger's aorta, even though her ohest x-ray
demonstrated its imminent rupture,
12
j) failing to refer Mrs. Flickinger to a surgeon for
evaluation of her aortic condition,
k) failing to inform Mrs. Flickinger's referring family
physician(8) of the life-threatening state of her aorta and her
need for further diagnostic studies, immediate fOllow-up, and/or
her instant need to be referred to a surgeon for evaluation,
1) failing to even consider the possibility that
Mrs. Flickinger's chest x-ray, from January 13, 1995, demonstrated
a life-threatening aortic condition and that her condition
necessitated immediate diagnostic tests, follow-up, and/or referral
to a surgeon for prompt evaluation,
42. As a direct and proximate result of Defendant Bronfman's
negligence in tailing to diagnose or even consider the
life-threatening state of Mrs. Flickinger's aorta, Mrs. Flickinger
died of aortic rupture on January 14, 1995.
WHEREFORE, Plaintiff, Neil R. Flickinger, Individually, and as
Administrator of the Estate of Betty J. Flickinger, demands
judgment against Defendant, Howard J. Bronfman, M.D., in an amount
in excess of Twenty-Five Thousand dollars ($25,000) exclusive of
intErest and costs and in excess of any jurisdictional amount
requiring arbitration.
13
COUNT IV
NEIL R. FLICKINGER, INDIVIDUALLY, AND AS ADMINISTRATOR OF
THE ESTATE OF BETTY J. FLICKINGER
V.
THE A. Z. RITZMAN ASSOCIATES. INC..and HOLY SPIRIT HOSPITAL
43. Paragraphs 1 through 33 of this Complaint and Counts I
through III are incorporated herein by referonce.
44. At all relevant times alleged herein, Defendants,
A.Z. Ritzman and Holy spirit Hospital, by way of their agents,
apparent agents, servants, members, partners, and/or employees
rendered radiological/medical services to decedent Mrs. Flickinger.
45. At all relevant times alleged herein, Defendants stewart,
Hottenstein
and
Bronfman were
radiologists/physicians
at
Defendants, A. Z. Ritzman and Holy Spirit Hospital, and at all
times were acting within their scope as agents, apparent agents,
servants, members, partners, and/or employees of Defendants,
A.Z. Ritzman and Holy spirit Hospital.
46. At all relevant times herein, Mrs. Flickinger reasonably
relied upon the apparent expertise, apparent competence, diagnosis,
evaluation, conClusions, and authority of Defendants, A.Z. Ritzman
and Holy Spirit Hospital, by way of its agents, apparent agents,
servants, members, partners, and/or employees who provided
radiological/medical services to its clients.
47. Defendants, The A.Z. Ritzman Associates, Inc. and Holy
Spirit Hospital, through the actions of .its agents, apparent
agents, servants, members, partners and/or employees, are liable to
the Plaintiff for injuries and damages alleged herein which were
directly and proximately caused by their negligence in:
14
a) reading the December 7, 1994, December 30, 1994 and
January 13, 1995 chest x-rays but failing to recognize tho ominous
state of Mrs. Flickinger's aorta, which was suggestive of a
dangerous widening and imminent rupture,
b) failing to appreciate life-threatening changes in
Mrs. Flickinger's aorta, which were evident on her serial chest
x-raysl
c) failing to review, examine, evaluate, and/or report
Mrs. Flickinger's chest x-rays thoroughly and adequately,
d) failing to immediately repeat chest x-rays on
Mrs. Flickinger after her films demonstrated a dangerous widening
and imminent rupture of her aorta,
e) failing to inform Mrs. Flickinger of the
life-threatening condition of her aorta,
f) failing to diagnose Mrs. Flickinger's aorta's
dangerous widening and imminent rupture from her chest x-ray,
g) misreading Mrs. Flickinger's chest x-ray in regard
to the life-threatening state of her aortal
h) failing to diagnose Mrs. Flickinger's
life-threatening aortic condition on December 7, 1994, December 30,
1994 and on January 13, 1995;
i) failing to order and/or recommend any diagnostic
studies of Mrs. Flickinger's aorta, even though her chest x-rays
demonstrated its dangerous widening and imminent rupture;
j) failing to refer Mrs. Flickinger, at any time, to a
surgeon for evaluation of her aortic condition I
15
k) tailinq to inform Mrs. Flickinqer's referrinq tamily
physician(s) of the life-threateninq state of her aorta and her
need for further diaqnostic studies, immediate follow-up, and/or
her instant need to be referred to a surqeon for evaluation,
1) tailinq to institute proper procedures and
safequards to aSSUre that x-rays demonstratinq a life-threateninq
aortic condition are completely and adequately evaluated by
competent radioloqists,
m) tailing to employ radiologists and staff who are
able to recognize obvious life-threateninq aortic conditions, which
are present in their patients,
n) failinq to institute procedures for the automatic
repeatinq of chest x-rays, the ordering of further diaqnostic
studies, the prompt referral to surgeons, and/or the disclosure to
patients and/or their referrinq physicians of life-threatening
oonditions that n~cessitate diliqent follow-up,
0) failing to even consider the possibility that
Mrs. Flickinqer's chest x-rays, from December 7, 1994, December 30,
1994 and January 13, 1995, demonstrated a life-threatening aortic
condition and that her condition necessitated immediate diagnostic
tests, follow-up, and/or referral to a surgeon for prompt
evaluation,
48. As a direct and proximate result of Defendants',
A.Z. Ritzman's and Holy Spirit Hospital, negligence in failing to
diagnose or even consider the life-threatening state of
16
Mrs. Fliokinger's aorta, Mrs. Flickinger died of aortic rupture on
January 14, 1995.
WHEREFORE, Plaintiff, Neil R. Fliokinger, Individually, and as
Administrator of the Estate of Betty J. Flickinger, demands
judgment against Defendants, The A. Z. Ritzman Associates, Inc. and
Holy spirit Hospital, in an amount in excess of Twenty-Five
Thousand dollars ($25,000), exclusive of interest and costs and in
excess of any jurisdictional amount requiring arbitration.
CLAIM I
SURVIVAL ACTION
NEIL R. FLICKINGER, INDIVIDUALLY, AND AS THE ADMINISTRATOR
OF THE ESTATE OF BETTY J. FLICKINGER
V.
RICHARD P. STEWART, M.D., DANIEL W. HOTTENSTEIN, M.D.,
HOWARD J. BRONFMAN, M.D., THE A.Z. RITZMAN ASSOCIATES, INC.,
and HOLY SPIRIT HOSPITAL
49. Paragraphs 1 through 33 of this Complaint and Counts I
through IV are incorporated herein by reference.
50. Plaintiff, Neil R. Flickinger, brings this action on
behalf of the Estate of Betty J. Flickinger, under and by virtue of
the Act of 1976, July 9, P.L. 5B6, No. 142, Pa. C.S.A. ~ B302.
51. Defendants, stewatt, Hottenstein, Bronfman, A.Z. Ritzman,
and Holy spirit Hospital, are jointly and severally liable to the
Estate of Betty J. Flickinger for damages as set forth herein.
52. Plaintiff, Neil R. Flickinger, Individually, and as
Administrator of the Estate of Betty J. Flickinger, deceased,
claims on behalf of said Estate the damages suffered by the said
Estate by reason of the death of the decedent, for the pain and
17
suffering the decedent underwent prior to death, economic 10ss5s,
and tor all other damages sustained by the said Estate by reason at
the death ot the decedent.
WHEREFORE, Plaintiff, Neil R. Flickinger demands jUdlJlllent
against D5tendant~, stewart, Hottenstein, Brontman, A.Z. Ritzman
and Holy Spirit Hospital, in an amount in excess at Twenty-Five
Thousand dollars ($25,000), exclusive of interest and costs and in
excess of any jurisdictional amount requiring arbitration.
CLAIM II
WRONGFUL DEATH
NEIL R. FLICKINGER, INDIVIDUALLY, AND AS THE ADMINISTRATOR OF THE
ESTATE OF BETTY J. FLICKINGER
V.
RICHARD P. STEWART, M.D., DM/IEL W. HOTTENSTEIN, M.D., HOWARD J.
BRONFMAN, M.D., THE A. Z. RITZMAN ASSOCIATES, INC.,
and HOLY SPIRIT HOSPITAL
53. Paragraphs 1 through 33 of this Complaint, Counts I
through V, and Claim I are incorporated herein by reference.
54. Plaintiff, Neil R. FliCkinger, Individually, and as the
Administrator of the Estate of Betty J. Flickinger, deceased,
brings this action for the wrongful death of Betty J. Flickinger,
on behalf of all persons entitled to recover therefore under and by
virtue of the Act of 1976, July 9, P.L. 5B6, No. 142, 42 Pa.
C.S.A., S 8301, as amended 1982, December 20, P.L. 1409, No. 326,
art. II, S 201, 42 Pa. C.S.A. S 8301.
55. Decedent, Betty J. Flickinger, did not bring an action
for her injuries during her lifetime.
18
law
66.
to
The following are the names of all persons
reoover damages for such wrongful death
entitled by
and their
relationship to the deoedentl
liAMB RELATIONSHIP ADDRESS
Neil Fliokinger Husband Loysvi1l8, PA
Mark Fliokinger Son Dunoannon, PA
Jarrett Flickinger Son Shermansdale, PA
Rebecoa KUhn Daughter Loysville, PA
67. As a result of the aforementioned events, the individuals
identified in paragraph 56 above, sustained reasonable hospital,
nursing, medioal, funeral expenses and expenses of administration,
and claim is made therefor.
5B. As a result of the aforementioned events, the individuals
identified in paragraph 56 above, have suffered a pecuniary loss
and have been, and in the future will be, deprived of the
decedent's companionship, contribution, support, comfort, services
and so on, for all of which damages are claimed.
59. Defendants are jointly and severally liable to the Estate
of Betty J. Flickinger for damages as set forth herein.
WHEREFORE, Plaintiff, Neil R. Flickinger demands judgment
against Defendants, stewart, Hottenstein, Bronfman, A.Z. Ritzman
19
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5. On October 20, 1998, defense counsel faxed Plaintiff's
counsel a photocopy of a new liabi li ty expert report from a new
liability expert, Dr. William R. Davidson, Jr., who apparently is
a cardiologist. A copy of Dr. Davidson's report is attached hereto
as Exhibit B.
6. Defense counsel had called Plaintiff's counsel on the
evening of October 12, 199B, and told him that he was contemplating
the possible use of this new expert, although he did not have any
report from him at that time.
7. Plaintiff objects to any testimony by this new medical
expert at trial for several reasons.
B. Dr. Davidson is a cardiOlogist. This is a radiological
case. Nothing that he offers is of relevancy to this case.
9. Dr. Davidson'S report is untimely. producing a new
expert, with new opinions, in a totally unrelated field of
medicine, two weeks before trial, is unduly prejudicial to the
Plaintiff.
10. Plaintiff cannot possibly have this entire case reviewed
by a cardiologist and have that cardiologist respond to the
Defendant's report from Dr. Davidson prior to trial.
11. As Dr. Davidson's opinions are irrelevant to the case, it
is respectfully submitted that this report is beinq offered in an
effort to obtain a continuance of the trial.
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NEIL R. FLICKINGER,
INDIVIDUALLY AND AS
ADMINISTRATRIX OF THE ESTATE:
OF BETTY J. FLICKINGER, I
DECEASED, t
Plaintiff t
t
V. t
:
RICHARD P. STEWART, M.D.; :
DANIEL W. HOTTENSTEIN, M.D.;:
HOWARD J. BRONFHAN, M.D.; :
THE A.Z. RITZMAN ASSOCIATES,:
INC., I
Defendants
26
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 96-3954 CIVIL TERM
IN REI PRETRIAL CONFERENCE
A pretrial conference was held Wednesday, June 17,
199B, before the Honorable Edward E. Guido, Judge. Present for
the Plaintiff was Michael J. Navitsky, Esquire, and present for
the Defendants was S. Walter Foulkrod, III, Esquire.
This is a jury trial involving alleged medical
malpractice. The parties indicate that it should take four days
to complete.
The parties stlpulate that all medical bills are
reasonable to the extent of third party reimbursement and all
medical services were necessary.
A date certain is necessitated by the nature of
Defendants' practice. Therefore, the parties have agreed to
continue this case to the November trial term. This will be the
first case heard before this Court on November 9, 199B. Both
parties are deemed to be attached for trial on that date.
There is no need for counsel to relist this case for
the November term. The Court Administrator is directed to do
so. Furthermore, a pretrial will not be held unless requested
in writing from either party at the call of the November trial
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-... -- .....-
lit,........ " l>l,"'cln.
$ccnon D( C.",iolun
The Millon S, H,,..,,
",.dit,1 c:..IC'
M,C H~7
'0, I.. 110
H",~.,,'4 170))
711 "I -..071.,
'" III 79.\H..
Omber 16, Ipga
5, Waller Foullr:rod. m
Aaomc)' atuw
2215 fORlt Hllll Drive, Suile 35
P.O, Box 6600
HllTisbur&. PA 17112-0600
FIX: 717.541-1727
re: r~i;fl~' Srewart, et. al.
~ Mr. Polllkrod:
I have had lbe oppol'tllllity lO review IIl1 '.bl IIIIleria1s OD the FIlcklnlcr cue. I
hive had III opponunity lO pmrnlll1y review the echocarelioaram and lO examine the
,.port provided by Or, }Ubin Olllbe echocardioanm. l:am in enara Ip1:O/lla1\t l&tilh tba
finelin,s in the echocard.io~ report dalCd 12f2J!J4, The report ,oes so fQ,f as lO
include a lpecl/i, di~lion of th. qu',lion of mlln) vain P,OllpW, The sl.lIled rellon
for the srody Is net gIven on the ecbocardlo,rapbic repon.
Because Ibe question in rhiJ care revolves aroWld an aortic 3Ileurysm. I would
like to elirress 10 discuss ecbocardiographic Luessment of the 3oort.1, The ;aortic root is
aenerally alWDYS seen in a IJ'a/Isthoracic uho.:Wiosnm, The lop normal aonic root
dim.n.ions are 3.7 em, In rhis .... rho lorue 1'001 mCUllre<i 3,4 em. Th. remainder or
the aoru IS normally not disClUSed in a lTansthoracic uhocardioer;m aJ it IS
inconlislIntJYlccn llIld only In very small portioru, In lhis cue, Ismail portiOD of the
Ilcending aorta. a small portion of the abdOminal aort.1 just below the diapbnam. and a
siDtlc shee t/vouJh the mid~~dinl thor..ie Aora AI tlu: level of the Itriovcncriculll
groove posterior lO the lefl ventricle IIId lefl atrium are seen. The ascendin, aorta
measures 4,2 t"IIl in diameter and is slightly dilalCd, The mid descendini aorta seen in the
A V rroove mellSures 3.4 em in diameter and is entirely unremarkable in appearan,", The:
abdominal aorta appears cll/cified and alherosclerotic \\11th a diameter of 3,5 em While
tIlese I.aaer two s~lions are nol'TTlaJly not commented on in an ~hocardloJl'afll, I!'fOssly
abnormal fiDc1lDgs would commonly be reported by an UNIe inlCrpre!Cr, In the cue of
Mrs. Flidcinaer, while these segments arc slightly prominent. they are not JTossly
abnormal, No portlon of the descendlna aolU seen mCIISlll'e.l in excess of 3,5 cm in
diameter. No diu~lJon naps arc seen Bamng spcciftc quesllons about the aorta, il
would hllvc been inappmpriale for !be inlCTJ:reter to maU any commenl on the portions of
AOrta seen in thi$ S1udy, AddItionally, because such small segments of the aolU arc seen
on Illy transthOl'al;le c,hocardiognm. il would be impossible 10 exclude the prescnce of a
IlI1e ",nic iIlIC\Iry5m II siles nol ima&ed bYlT1ll1slbOl1CIC eehocardiogram. Rather if
thefe was clinical suspicion of 11I\ aneUl)'Im, a tranluOphallcal echocarmoaranl or other
imalins slUdYlueh as an MR1 or CAT ~can of the IOllA would blve beeD IndiCaled.
However, in reviewinllhis cue, it appean there was no clinical qucstion of 10rtic
aneurysm in tile chest allhc time the radlololin were aslced to interpret this
cchocudiouun.
717 531 7969
9El~
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William Reed Davidson, lr., M,D. (conI.)
2
HODora III\d Awards:
Phi Bell Klipp.. 197~ ,
Alpha Omep A1phll, 1979
Mosby Book Award (Medical School), 1979
Llslcd in The Be~l Doctors in AmericL Nnrthell.u RllJlon, 1996-1997
ACldemlc Appolnlments:
198()"1982 C11ll1cal InsllUCtor of Medicine
Uruversity of PelJDsylvl1/1ia
1982-198.5 IIullUClOI' of Medicine
Ulllverslty of Rochester
. , 198.5. J 991 Asslstanl Prof~sor of Medicine
The Millon S, He~hey Medical Cenrer
The Perl/l5ylvlIllia Stale University
1991-1992
Alsociate Professor of Medicine
The MillOn S, Hershey Medical Cenler
The Pennsylvania Slale University
Associate Professor of Medicine - Tenun:d
The Mihon S, Hershey Medical Center
The Pennsylvania 5fJ1te University
Divisional Responsibilities. Hosplllll and College Committees,
Director, Echocardiography 1985.Pn:sem
Director. Cardiology Clinics 1986-1991. Acting Director 1992-1993
Director. Program for Adults with CongenJlal Heart DisellSe 1991-Prcsent
Coordinator. Cardiology Grand Roun~ 1986-1988
Adult Crillcal Care 'l:rut, Triage Officer 1988-1990
Search Comrrunee for Chief of Division of [memul Medicine. Department iJt
Medic:ine.1988.1989
Emergency Services Commiltee, 1989. J 990
Medical Student Selection Comrnittcc, 199()'Present
CUrriculum COmmillee. years 3 and 4, 1992.1994
Committee on Inlegr:llive Sciences, 1994-1995
Medicine SpeCialties PraclIce Site Director, 1994-Present
Consulting:
Interspec, Inc, - Testing of n~w echocordiographic equipmentlllld desi", (ealUreK
lnterspcc Supply Center's ProdUCt Advisory P3IIel
Vingmed, NS . Equipment cvlllualion ,
H.ewlctt.PIlCk.ard - Equipment evaluation
Acwon . Echocardioarophic equipment cvllluollon
1992-pl'llunt
12,
WUliam Reed Davidson, lr" Mn, (COnL)
4
OUbllde IlIltrt'blt
ActJ.ve plllticipltion In locll! church,
Enjoy IUltOI}', music and literature,
Publication I
I.
HodloD RC. WUIlIUlI.5 5K, and Oavidsnn:wL1L: MelllboUc c:onllol of urea melllbollsm
In ChlamydomonllS reinhardil ond Chorella pyrenuldosll. 1 Buet121: 1022.1035.1975,
Davidson WR, 1(" BllJ1erje~ Sp, and Liang C"s; D<lbulllmine.indured clll'dlac Ildapllltions:
Comparison Il/ilh exercise troined and sod\!ntary rOll, Am 1 Physiol 250: H725- 730, 1986.
David<nn WR Ir" KawlllihilM S. Banerjee SP, and Liang C-S: Preserved cwilc belli-
adrenergic sensitivity in early renovascullll' hypenensioD, Hypenension 9: 467.472, 1987,
Goldsmith GH, Baily RG, Brettler DB. Dovldlon WR.1r" Ballard 10. Doscol TE,
Greenberg 1M, Kasper CK, Levine PH IlI1d Ramoff 00: Pulmonary hypenension In
patients with classic4J hemophilia. Annllls of Internal Medicine 108: 797.799, 1988.
Sinoll/ay U Hendrickson C, Davidsnn WR Ir.. Prophet S, Zelis R: The Charocteristics
ot flow medillled brachilll artery vlISodilntion in hllllW1 subjects. Clrcullllion Research
64:32-42. 1989,
Koch KL, Dnvid.~on WR, Ir,. Day FP, Speo.n PM, Voss SR: Esophageal dysfunction In
palienrs with mitr.1l valve prolapse and chest pain: A/rospective slUdy utilizing provocative
testing during esophageal manometry. Am 1 of ~e 86:32.38. 1989,
Shenberger 15, Propher SA. WaJdhausen lA, Davidson WR. Ir.. Sinoway LI: left
subclavian flop aonoplllSty for cOlll'Crarlon of the DOrtl1: effects on forcurm v3.\cular (unction
and gro'Alth, lACC 14:953-959. 1989
Kocn KL, D.llYid~on WR 1r,: Esophllgeol dysfunction and chest pom with mitral valve
prolapse. Co.rdiology Boord Review 7(4):38.47. 1990,
Davidson WR, Ir" E Fee: Influence of Dging on pulmono.ry hemodynamics in a population
free of coronary OJ'tery disellSe, Am 1 Cl1I'dlol 65: 1454.1458, 1990
EmnJer SM. DnvidsoJLUlr.: Cor triatriatum in an adult: utility of color Doppler !low
imaging, Dynamic Co.rdiovlIScular /moging 3(4): 1 55-157. 1990,
Bradford RH. CL Sheo.r. AN Chremos. C Dujovne. FA Franklin. :-'1 Hesney. 1 Higgins. A
LlIlIgendorfer.1L Pool. H Schnaper. WP Stephenson (WR DDvldson, lr.. Invl!srigDtor)
Expanded climcal evaluution of LOVlISlDtin (EXCEL) study: design:llld pallCn!
chur.lcterislics uf a double-blind. plllceho.conrroll4d study in PQti'nl~ with moueralC
hyPercholesterolemia, Am 1 CardioI66:44B.55B. 1990,
Davidmn WR 1r.. Ml Pasquale. C Fanclli: A Doppler echOClll'cliogrophic eltruninotlon of
the normal nonic vlllve and Jeft venbiculo.r outflow IlOCL Am 1 Cardlo1 67(6):547'549,
1991.
2,
3,
4.
5,
6.
7.
8,
9,
10.
II.
20.
21.
Oascho JA, Copeni111ver GL, Dllvidmn WR. Jr..; I.schemill-lnduced depre~~ed ~Y5101ic
lIIlckening is tnnsienrly augmented by rr:mote coronlll)' occ1Uliion, CathelenZlltlOn I1nd
Cardlovucular Diog 25:253-259. 1992.
latil1!on WR, lr,. MJ Pasquale. G CopenhllVer. RD Aronoff' Determinants of deloyed
ventricular IUling ill mill: A role (or e~lernaJ forces, Echoco.rdiography 9(4):421-435. 1992.
Pawlwh DG. Rl Moore. TI Mu~ch, WR. bavid~on. Jr, EchocDrdlographic
evaluation of size. fUllctlon, and mOlS of normU! and hypertrophied rat ventricles.
Journal of Applied Physiology, 74:2598-2605,1993,
SWfen RN and WR DRVidson. Jr,: Echocardiogruphic llSsessment o( otrialseplll.l defects.
Echocardiography 10(.5):545.552, 1993,
Brndford RH, SL Shear, AN Chremos, CA DuJovne, et. aI.: E~pll1dcd cUnical eVDluation
of JOV&5lotin (EXCEL) sNdy resuJl$: Two-year efficacy and safety foUow-up. Am J
Cardiol 74:667.673. 1994, (WR DDvldson. Jr,. Investigator)
Dzwonczyk T and DllVidsoll. WR. Jr: The spectrum of left ventriculo.r -1IIri1ll
communication in the adult: essentials of echocardiographie assessmellt. Journal of the
Americlln Society of Echo=diography, 8;263.269. 1995.
David~on, WR, lr,: MRI: Tenors where Poc never thoughllO look, Annllls of Internal
Medicine, (poem), Annllls of Internal Medicine. 123:427. 1995,
Davidson WR, Jr.. Ventricular hypertrophy in sleep apnea. Journal of Sleep Research
4(Suppll), 176181. 1995,
Galolll O. Dllvidson WB.lL Complillnce of lipid profile reporting in Pennsylvania wlrl1
Norlonol Cholesl"o) EducDtion ProgrlllD Guidelines, (submiltcd to AJC 10/97).
........,.. .-.. _"" ' .,..,
. . .... . ,-
WlIIllIlrI Reed DQvidson, Jr" M,D, (com,)
13.
14.
IS.
16,
17,
18.
19.
I.
Edirnria.h nnd Bonk Reviews
2.
3.
4,
5.
Ab~rra.c[s
I.
.5
Davidson WR, Jr: The eCboca.rdiographer and dills[ole, Echocardiogrophy 9(3):287.
1992,
David~on WR. Jr,.: Introduction 10 second part of symposium on Doppler Evllluillion of
Diuslolie PerformQoce, Echocardiosraphy 9(4):38$. 1992,
Dovid.on WR, JI.: Whlll is ventric\llar filling renJly telling us? Editorial
Eehocardiogrophy 9(4):459-463. 1992.
David,on. WR lr, and Cvran SF.: Echocarwogrophy in the adult wirl1 congenitlll hellrt
dlscu.~e, Editon31 EChoeardiography 10(5):5 13..~ IS. 1993.
David,on, WR Jr,: Book review of Valvullll' Heart DiseoUe: Comprehensive EvllluQllon
Ilnd Trclltment. Second edilion, Edited by WF FrunkI and ..\N Brest. PhilAdelphia. P A,
F,A. Davis. 1993.339 pages, Eehoeardioglllphy 11(1): 102.103. 1994,
KaWllShlma. S. David.on WR Ir,. Ilnd Liang C-S: Pinacidl\: A new Ilntihypencnsive
IIgenl with polenl coronary vll.lodillllor propenies. Clln Res 32(2): 334A. 1984.
14,
1:5.
William Reed Davidson, Ir,. M.D, (conl.)
6
2.
KaWlLlhima S, Davidson WR, Ir.. I1I1d Llllng C.s: Reduc~d inotropIc II/ld chronotropic
r"ponses to Plnl.Cldil in awoke renovascular hypertensive dogs, The PhilTJllacologlst
26(3): 237, 1984,
3,
Davidson WR, Jr" Banerjee SP. IIOd Liang C.S: Brudycardia follOwing dobulamine
adminlllralion: Effects on cardiac belD-II.drcnerglc receplon compared to physlcul
COndillonlng, Clln Res 32(3): 669A, 1984.
Davld.<nn WR, Ir,. Kowll.lhlma 5, BllIIeljee SP, IIIld Lillllg C.S: Mecholllsm of reduced
sympathetic responses to afterload reduction in early renovascuJIIT hypertension. I Am
Card CardioI5(2): 436. 1985,
Koch Kl., Spears PF. David.<nn WR, Il... and Voss 5: PrOSpective evaluation of
esophageal molilily with provoclUive ltstlllg in parieDts with chest pain I1I1d mitruJ valve
prolapse, Gastroenterology 90 (:5.pt2): 1496, 1986.
Day FP, Koch KL, Davidson WR, Ir" IIOd Spears PM: Etiology of chest pain in patienls
witb mitmJ valve prolapse, I Am Card Cardiol9 (2, Supp A): 91\, 1987.
Davidson WR. Ir" Puw!ush DG, Musch n, and Moore RL: Lett ventricular mass In the
ralcan be accurately C:ucUIDlCd ecboclll'd1ographicaJly. Cllrtical Research 36. NO,3: 271A,
1988,
4.
:5.
6.
7.
8,
Pasquale MJ and David_on WR. Ir,: Aortic valve area In DUIlI varies wllh stroke volume,
Clinical Research 36. No.3: 306A, 1988.
Pasquale MI, David.on WJl.,JL, and Fanelli C: In vivo determination ot normal Dortic
valve arcn in ml1l1 -110 application oflhe continuily equation, ClInical Re~earch 36, 1'10,3:
306A. 1988,
9,
10,
DaVidson WR Jr.. Fee E Il11d ~agiJl E: Intluence of aging on pulmonary hemodvnamics
in a population free of coronary dJscll.le, Clinical Reseorch 36. No, 3: 271A, 19a5,
(PI'escnred)
Pasqualc MJ' Noonan TE. David.on WR Ir,,: Does uonic valve uca remain constllllt
under varying hemodynD.lTllc condtuons in man'!, Circulation 78. pt n. 0.350. 1985,
David.~on WR, Ir Pasquale MJ, Aronoff RD: Dopplcr lefl vcnllicular tllhng pattern is
closely relllted to veOlricular relaxation abnormalities. I Am Coli Cardiology 13 (No, 2.
SUppl A): 197A. 1989
Shenberger IS, Prophet SA. Davidson WR, Ir" Wtlldhausen IA. Leuenberger VA.
Sinoway LI: !..cft subclavian flap aortoplusty: effect on forearm vQ5culor function and
growth, Clin Rcsearch 3i. t-:o, 2: 296A. 1989, (Prescnted)
Stauffer IL, Davidson WR, Ir., Zwillich CN: Echocordiographic Il11d elcctrocllrdiugraphic
findings in a.sympromDtic moring me~, Am Rev Re~plr Ois 139 (4,pt2): A113. 1989.
AccCJlted for prcsent:llion,
Seauffer JL. Lehman RAW. Landis JR. David.<on WR. Jr.. Zwillich CW: Sleep,
disordered breathing and daytime slcepincsa, but not neuropsychological impnlnncnt, ore
COlllmon in asymptomatic snoring men, ChcU96(2) Suppl. AUIUSt. 1989,
l1.
12,
13.
WlIlIllm Reed Oavidson. Ir.. M,D (cont.)
7
16, SinowllY Lt, Gifford R. YlJJg H, Prophet S, Bl1lly RO, DllVIdson :mLk, LQI'Ue
increases in relting blood flow CQuse enlargernent of conduit vemf5friliUmuns. eirc
1989: 80(Supp 0):0.556,
17, Davidson WR,lr.. Se~ton CW, LctunIlJ'lIC: Anllhypcn.cn.sive medications II.Iler left
ventnculllT mUns pAttem in nonnal subjects, lACe 1990; J S(SUpp ,A.),
18, David50n WR,Ir,. ZwllJich CW, Slouffer It. Recves-Hoche MK: Cardiac sequeloe of
sleep-disordered breathing, CUn Res. 1990.38(2) Accepted for presenUlllon
19, Gascho lA. Copenhaver G. Davidson WR.lr,,: Functional myocudiaJ rescrve cQJl be
elicltcd by remote coronlllj' occlusion. Clin Res. 1990;38(2)
20. Oavidlon WR,Ir" Iackson A. PB.\quale MJ: Delayed ventrlcular tilling of agm, is not
caUlled by abnomwl venuicular relllJlation, Am CoUege of Curdlol. Penn'ylVlJUIl Chapter
(Ilccepted for presentation)
21. Jacluon A. Davidson WIt Ir.: Utility of isovolumic relaxodon time for eSlJmotJng
venrriculQl' relaxation, Am CoUese of Cardiol, Pennsylvania Chapter (accepr.cd for
prc.lentot!on),
22. K014lck DH. Davidson WR"lr., Norris IF, Moore RL: Echocardiographlc B.\senment of
left ventricular mll5S III !ruined and hypertenSIve ralS, Med Scl SpOrt EXerc.
24(5 Suppl.):S93. 1992,
23, Sl4ffen R)I;, O&:.:Won WR.Jr.: Pulsed Doppler improves the senSitivity/specifiCity of
two.dimensional echo and color Doppler for the diagnosb of auial septal defect In adullS.
American Heart Associauon, Circulation 88(4.pt.2):I.S6. 1993,
24. Davidson WR.lr . Stauffer lL, Reeves.Heche' MK. Zwilhch CW CQI'diac sequelae of
sleep dlsordel'fd breathing in obstructive sleep apnell: new evidence Cor nght vemncular
dysfunction, Am Rev ~splr Ois 147: AIOI5, 1993
25, Dllvrdson WR, Jr. I,L. SUluffer. M,K, Reeves-Hoche. C.W, Zwilllch, MechanISms of
venmcullll' hypertrophy in sleel' apnea: An echocnrdiogrnphic srudy, Presented at the 3rd
International Marburg Symposium on Cardiocirculutory Funchon Dunng Sleep, ~arburB.
Germony. August. 1994,
26, Iuliano PI. RN Stauft'er, WR Davld.on. 1( Newly described pUlsed Doppler pallcms
diagnostic of Significant alliol septal deCect arc vaJidnted by normi1lizing afler surgical
repair, Pennsylvanill Chapter of American College of Cardiology, Seplember. 1994
(presentcd),
27. Iuliano Pl. SE Cyran. WR DaVidson, Jr. Com~nsated pulmoniC insufficiency: I. the
right ventricular response to exercisc nonnal'! IACC Specli1l hsue 1:378,1.. 1995,
.28, Griffin DC, 1 AI1lI1I\11. ~ Davidson I., Doppler hssue imaging of myocardial velOcity:
Physiologic variability in normals. 1 Am Soc of Echeclll'diography. 8:392. 1995,
29. David.lon WR lr, The right ventricle and obstructive sleep apena, Somnologie Supp.
2:20, 1997.
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5. On October 20, 1998, defense counsel fs)(ed Plaintiff's
counsel a photocopy of a new liability expert report from a new
liability expert, Dr. Willinm R. Dnvidson, Jr., who apparently Is
a cardiologist. A copy ot Dr. Davidson's report is attached h~reto
as Exhibit B.
6. Defense' counsel had c,llled Plaintiff's counsel on the
evening of October 12, 1998, and told him that he w"s contemplating
the possible use of this new expert, although he did not have any
report from him at that time.
7. Plaintiff objects to any testimony by this new medical
expert at trial tor several reasons.
8. Dr. Davidson is a cardiologist. This is a radiological
case. Nothing that he offers is of relevancy to this case.
9. Dr. Davidson's report is untimely. Producing a new
expert, with new opinions, in a totally unrelated field of
medicine, two weeks before triill, is unduly prejudicial to the
Plaintiff.
10. Plaintiff cannot possibly have this ontiro case reviewed
by a cardiologist and have that cardiologist respond to the
Defendant's report from Dr. David~on prior to trial.
11. As Dr. Davidson's opinions are irrelevant to the case, it
is respectfully submitted that this report is being offered in an
effort to obtain a continuance of the trial.
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NEIL R. FLICKINGER,
INDIVIDUALLY AND AS
ADMINISTRATRIX OF THE ESTATE~
OF BETTY J. FLICKINGER, ~
DECEASED, ~
Plaintiff ~
~
V. ~
~
RICHARD P. STEWART, M.D.; ~
DANIEL W. HOTTENSTEIN, M.D.; ~
HOWARD J. BRONFMAN, M.D.; ~
THE A_Z. RITZMAN ASSOCIATES, ~
INC. , ~
Defendants ~
26
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 96-3954 CIVIL TERM'
~~ PRETRIAL CONFEREN~
A pretrial conference was held Wednesday, June 17,
199B, before the Honorable Edward E. Guido, Judge. Present for
the Plaintiff was Michael J. Navitsky, Esquire, and present for
the Defendants was S. Walter foulkrod, III, Esquire.
,
This is a jury trial involving allcged medical
malpractice. The partics indicate that it should take four days
to complete.
The parties stipulate that all medical bills are
reasonable to the extent of third party reimbursement and all
medical services were necessary.
A date certain is necessitated by the nature of
Defendants' practice. Therefore, the parties have agreed to
continue this case to the November trial term. This will be the
first case heard before this Court on November 9, 199B. Both
parties are deemed to be attached for trial on that date.
There is no need for counsel to relist this case for
the Novemher term. The Court Administrator is directed to do
so. Furthermore, a pretrial will not be held unless requested
in writing from either party at the call of the November trial
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October 16. IQll8
5, Waller Foulkrod, m
AlIOl'Ilcy It Law
2215 Foml HIlls Drive. Suilc 3S
P.O, BOlll600
Hanisbl1rl. PA 17112.0600
Fax: 7]7.541.1727
/'C:
r~~i~' Stewart. el..ll.
~ Mr, Powkrod:
I have IW the opponuniry 10 review Il1Ilba marerialJ ODIM Fliekln.cr cue. I
have had 1/1 oppOllllniry 10 personally lIlViowlhe echocardlosram and ro examine the
,.port providad by Or, Rabin 00 !he ech~olf&l7l' J:un in on ora 1pftma\U ,.,ilb tba
tlndin,s in me echocardiosram report dated 12f2194, The repol1,DeS so fAr lIS 10
inc!uda a lpecifie djr;c\luioo of the 'f'I1.tion of IUlla) ValVD prolap5l. ThD Slaled reuon
for me INdy Is nOI gl ven on me ccbocArdiolraphic /'Cpon.
Because Ibe question in rhh cuo revolv<< iU'OWld an aortic aneuryml, I would
like to dJlTess fo diseuS$ echocardiographic ass.s.~nt of th. aorta, Th. IOrtJ-; root is
ienenlly a1way~ seen in a ITaIlsthoracic echOC#diogram, lne lOp normal aonic raot
dim.naions are 3.7 em, In thi. e.... tho AOrtiC rout meuuntd 3.4 em. The remainckr of
the IOru IS normally nOI dilcussed in a lI"aIlsthoracic o.:hocardiosram as illS
inconsistently lcen IIIld only in very ,mall pottioru, In [hIs clUe. Dlmall ponion of [he
llic:ending aon&. a saWl ponion of rm abdOminal lOrt.1jusl below the d1aphrallll. and a
sintJe 51,,:& throu,h the mid-desu-ndin, thoracic DOrtA at the level of the .lriovenlricular
groove portenor to the lert venlriele and 1.fl atrium are seen. The ascendin, aona
measures 4,2 r:m in diameter and is sli~htly cIllaled, The mid descendine aorta seen in lIIe
A V JI"OOve mensures 3,4 cm in diameter and is entirely unremarkable in appearance, The
&b.1ommaJ IOna appcan cl1lcified and a1herosclero~ with a dlamer:r or 3,5 em While
mese laI1c:r two sections are normally nOI commented on in an ccbocardio&ram. grouly
abnormll Ilndings WQuld commonly be reported by an astute interpreter, In the cue or
Mrs. FlickinRer. while these segmenu ase slightly prominent. they are nOI rrossly
abnormal, No portlon or tile desceDi1JnR aort.1 seen measures in e~CC55 0/3,5 cm In
diameter, No dlsse.ctJon naps are seen Bamng speCIfic quesliolU about th.e aora, it
would h,ve been inDppmpri= for the intCTJIre!C:l' to maU :.oy commenl on thc portions of
""na seen in this Study, Additlonally. because such small segments of !he aora are seen
on I/Iy translhOra<:IC echocardior;nm. il would be impossible 10 exclude the presence of a
IUJe aonic IlICUrylm al sites Dol irTlARed by tl1lI1stboT1Clc echocudiogram. Ralller it
lhtr. was clinical suspicion of an aneurylm, a lranscsophageal cchocardioinlm or otb:r
imaainl slUdy such Ai an MR1 or CAT scan of the aorta would bave beeD Indicaled.
However. in reviewinR this case. il appears lIIere Was no clinical question of 10rtic
aneurysm in llle chest allhe time me radiololin were wed 10 intetp/'CI!his
Ci:hocardlogram.
?1? 531 7969
98~
".el
.... --... . "-.
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W.I _~ ...~ .~'_w
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William Reed David,on.Sr.. M,D. (conI.)
HODOrs IUIQ Awards:
Phi Bell Kappa. 1975
Alphl Omep Alphll. 1979
Mosby Book Award (Medical Schoo!), 1979
Listed in 1m Besl Doctors in AmericL Northell,~1 R-.r1on, 1996-1997
Academic Appointments:
1980-1982 C1lnlcallll5llUCtor of Medicine
Uruversity of PenDsylvunla
1982-198S WlIUl;tor of Medicine
University of Rocbester
1985.1991 AsstS14n1 Professor of Medicine
The Millon S. Hershey Medical Center
The PennsylvlUlia SIlI1e University
1991-1992 Associate Profenor of Medicine
The Millon S, Hershey Medical Cemer
The Pennsylvania State Unlvenity
1992-present AssocilllC Professor of Medicine - TeDured
Tbe Milton S, Hersbey Medical Center
The Pennsylvania Stale University
Divisional Responsibilities, Hosplllll and Colleae Commlttte5/
Director. Echocardiography 1985.Presem
Director. Cardiology Clinics 1986-1991, Acting Director 1992. i 993
Di.rector, Program for Adults with Congenital Heart DisellSe 1991-Presenl
CoordiDIlIor. Cardiology Grnnd Rounds 1986-1988
Adult Critical Care t;wt, Triage Officer 1988-1990
Searcb Committee for Chief of Division of IJ1lcmul Medicine. Deparunent \it
Medicine, 1988. 1989
Emergency Services Committee, 1989.1990
Medical SlUdent Selection CommlltCll, 199Q.Present
Curriculum Committee, years 3 und 4. 1992.1994
Committee on integrative Sciences. 1994-1995
Medicine SpeCIalties Praclice Site DiJeclor, 1994-Present
Consulting:
lnterspec,lnc, - Testing of new echocardiogTuphic ~quipment IlIId desiJll (CIlNreK
!nterspec Supply Center's Product Advisory P:lI'lel
Vingmed. AlS - Equipment evaluation
Hewlett.PIlCIwd. Equipment evaluation
Acuson . Ecltocardiographic equipment evllluQtlon
2
-.' -~ .... ..-'
. ...wW......... ...._ , .,...
. ..
WlIlllIn Reed Davhuon, Ir" M,D. (conl.)
3
MenlLlcrlpt Rnle"er
10urnlll of the American College of ClII'dlolol)'
EchocardloJP"Dllhy
10urnal of the AmeriC411 Society of Echocardloernphy
American Iournal ot Cardlolol}'
The 10umal ot Thol'llCic and Cll1'dlov~lu Surgery
Medicine & Science In Sporu & ExercIse
10urnal of !be American Vr.temllr)' Medicine
Grant Revlewar
NHLBI
Americln Fedcralion tor Aging Reselll'Ch
IdJtorlal Board
Ecbocardlography - 1990. Present
Llc'Dsur.!
Pennsylvania. ItMD.023990-E
New York. 1t1~1.300
DEA ItAD9488239
C.rtlficatloDt
I. Diplomate. :-;ationll/ Board of Medical EXBmlners, 1980.
2. Diplomate, AmericlID Board of Internal Medicine, 1982, C.nlflcation 1188220.
3, Diplomate. Subspecialty Bouds In CardlovlISculu Discllses, 198', Certification 1188220.
ProC.sslonll Membersblps:
\.
2.
AmcriclIII College of Cardiology, Fellow, 1988
AmericlIII Helll't AssOCiation
a. NllionaJ
"Councll on Clinical Cardiology. Fellow, 1989
..Councll on Cardiopulmonary DIsease. 1989
b, Soulb CenlrD.l Pennsylvunla Chapter
.-Board of Directors, 1987-1988
-"Heart-At-Work" workme task force, 1986.1991
'-R.epre!\enwlon 10 Affiliate Central Prognrruning Corrunittee
c, Pcnn~ylvania Affiliate
..Public Policy Commllle~, 1987.1988
..Bourd ot Directors. 1988-1991
.-Chlllrman, Hc:aJr.hsite/Cornmunll)'site Tll$k Force, 1989.1990
" Vice President for Public Policy 1990.1991
AmcriclIII Society of Echoc3l'diography
Amcric:1III College ot Physicians
laternational Society for Adult Congenitol Cordioc Disease
Chri:ltian Medical & Ocntal Society
3.
4.
5.
6.
9.
11.
12,
William Reed Davidson, Ir,. MD, (COnL)
4
OUlllde IDlerfllll
Active panicipation in loclll church.
Enjoy hlalory. music and Iller.lUre,
PllbllCllloDa
J.
HodsoD RC. WillIlIl'IU SK, &lid D.vid~nn WR..Ir,: Me14bo\Jc control of W'Ca me14bollsm
In ChlamydomonllS rcinhardiJ and Chorella pyrenQtdoslL 1 Buell:!l: 1022.1035. 1975,
Davidson WR, It., Baner)ed SP, and LIMB C..,s, Dobu14mine-induced curdlac ud4platlons:
Comparison with exercise trained llI1d sedentary rau, Am I Ptlysiol 250: H725.730, 1986.
David.nn WR Ir" KawllJihima S. Bo.ne~ee SP. and Liang C.S: Preserved cllrdiac beta.
adrenergIc senstrivlly in early renovlLScular hypcnensioD, Hypcnension 9: 467.472, 1987,
Goldsmith GH, BaJly RG, Bremer DB, D~on WR, J~" Ballard 10, Doscol TE,
Greenberg 1M, Kll!Jler CK, Levine PH and Ramotf 00: Pulmonary hypenension In
plllienu with clas~iC<lI hemophilia. Annals of lntcrnul Medicine 108: 791.799. 1988.
Sineway U Hendlickson C. David..on WR. Ir" Prophet S. Zelis R: The CharllC~n51ics
of flew mediated brachial anery Vll5odiJalion in human subjects, ClrculBlion Research
64:32-42. 1989,
Koch n. Ollvid..on m, Ir,. Day FP, SpellrS PM, Voss SR: Esophageal dysfunction In
patients wid! milral valve prolapsc lII1d chesl pain: A prospeclive slUdy utilizing provocDtive
testing during esophageal manomelt)', Am lon-fed 86:32.38.1989,
Shenberger IS, Propher SA. Waldhausen lA, Davidson WR,Ir.. Sinoway LI: left
subclavian flap aOl'loplllSty for coarclalion of the aorta: cffects on forcafTn vlUcular function
and growth, IACC 14:953-959, 1989
Koch KL. DJlyj~\!lR.1t.: E~ophageal dysfunction and chesl pam with mitral valve
prolapse, Cardiology Board Review 7(4):38.47, 1990,
David~nn WR,JI" E Fee: Influence of aging on pulmonary hemodynamics in a populalion
free of coronary anery disea.se, Am 1 CardioI6~: 1454.1458. 1990
EllinJer SM. David..on Wit Ir,: Cor lrintrialUm in an adult: ulility of color Doppler flow
imagmg, Dynamic CardiovllScular Imaging 3(4): 155-157. 1990,
Bradford RH. CL Shear. AN Chremos. C Dujo\lne. FA Fr3J\klin.:-'1 Hesney. I Higgins, A
Ll1llgendorfer. JL Pool. H Schnaper. WP Slephenson CWR Davidson, I.,. Inv,mlgolor)
Expllllded climcal evaluation of [ovuslotin (EXCEL) slUdy: design ond pallen I
characteristics of a double.blind. placebo.controlled ~lUdy in PQllenu with moderate
hypercholftSlerolcmia, Am 1 Cardio166;44S.55B. 1990,
Dlvld~on WR If.. MI PlISquaJe. C Fanelli: A Doppler echocurdiogTophlc eluunination of
!he nonnal aortic valve and Jefl ventticular outflow ltllCL Am I Cardiol 67(6):547.549,
1991.
2.
3.
4,
5,
6.
7.
8,
10.
Willlllll1 Reed Davidlon. ]r,. M.D, (COlli,)
5
13.
Oascho ]A, Copenhaver 01.. Dllvldson WR. ]r..: Lscbdmill-Jnduced depres~ed systolic
thlckcning Is tran5icntly augmented by remote corona:y cxclu.sion. CathelenZlltlOn and
CardlovB5cuJar Diag 25:253-259. 1992.
Javid.son WR, Ir.. M1 Pasquule. G Copenhllver. RD Aronoff: Derenn!lIanu of delllyed
ventrlcularfUUng ill man: A rolc foruternlll forces, EchoCllrdiogruphy 9(4):421-435.1992
J>awlush DO. RL Moore. TI Musch, WR Davidson, k. Echocardlographic
evaluation of size. fUllcllon, and mass of normallllld hypertrophied rat venlricles,
]ournal of Applied Physiology. 74:2598-2605. 1993,
SllIffen RN and WR Dftvidson. ]r,: Echocardiogruph.ic IIJSeSSlDenl of IItrial septal defecu,
Echocardiogrllphy 10(5):545-552. 1993.
Bnulford RH, SL Shear. AN Chremos. CA DuJovne. et. III.: Expanded clinical evaluation
of 10vlLStnrin (EXCEL) study resulls: Two-year erficacy and safery follow-up, Am]
Cardiol 74:667-673. 1994, (WR Davidson. Jr,. Investigator)
Dzwonczyk T and Davidlon. WR, Ir: The specl1'Um of left ventricular -lIlrial
communication in the ;ulult: essemJah of echocardiograph.ic asseSSment. Journal of !.be
Americlln Scxicry of Echoc;u:diogruphy, 8:263-269. 1995.
Davidson. WR, If,: MRI: Terron where Pee never thought to look, Annals of Internal
Medicine, (poem), Annals of Internal Medicine, 123:427. 1995,
Davidson WR, ]r., Ventricular hypertrophy in sleep apnea.. Journal of Sleep Rr.sellrch
4(Suppll), 176-181, 1995,
Galllta O. Davidson WR If, Complial1ce of lipid prot1le reporting in PeMsy!vania with
NlUionlll Cholesterol Education Progrlltn Guidelines, (submirted 10 AJe 10/97).
14,
15,
16,
17,
18.
19,
20,
21.
EditnriRls nnd Book Reviews
2.
3,
4,
5,
Abur""ts
I.
I.
Davidson WR,1r,: The eCbocardiograplJer Ilnd diastole, Echoc:lCdlography 9(3):287.
1992,
Davidson WR. If,.: Introduction to second pW't of symposium on Doppler Evllluotion of
Diastolic Perfonnance, Echcxardiography 9(4):385.1992,
Dnvid,on WR, Ir,: What is vcntricular tilling really telling us? Editorial
EchocardiogrnplJy 9(4):459-463. 1992.
David.~on, WR Ir, Il11d cvran SF.: Echocardiography In the adull with congenital heart
discu.se, Edirorlal Echocardiography 10(5):513-515. 1993.
David~on, WR Je..;, Book review of Valvular Heart Disease: Comprehensive f!vaJuarion
and Trelltmenl, Second edition, Edited by WF Frankl and ,~N Brest. Philadelphia. PA.
F.A. Davis. 1993.339 pages, EchocardiogCllphy 11(1): 102- 103. 1994, ,
KawlIJhlma S. David~on WR Ir,. Ilnd Lillni C-S: Pinacidl1: A new antihyperrensive
aient with potent corona:y vasodilator properties, Clln Res 32(2): 334A. 1984.
~_, _~ ~_.~ *w__
14.
1'.
'w.....~~.w.. ..,_ . .,..
. .. -.... . ...
.~-
WilHam Reed Davld5on.Ir,. M.D, (cont.)
6
2.
Kawa.,hJmll S, Davidson WR. k. lIl1d LllIl1g C-S: Reduced inotropIc ;and chronolropic
rcsJlOnses to PinlA:ldll In awake renovascular hypertensive dogs, The Phill1JlacolOBI5l
26(3): 237. 1984.
3,
Davidson WR.,lr" Bllncljee SP. lIl1d Llllng C-S: Bl'lldyclII'dla foUowing dobularnine
adrnJnJstration: Effccu on cardiac betll-adl'llnerglc receptor5 compared to physlcul
conditioning, elln RCI 32(J): 669A. 1984.
Davidson WR. If.., KllwlI.lhima S. BlllIerjce SP, IllId LlUlg C-S: Mechlll\ism of reduced
sympathetic responses to afterload reduction in eOlly renovascular hypertension. 1 Ani
Curd Cardiol 5(2): 436. 1985.
Koch n. Spears PF. Davi,"on WR, lr . and Voss S: Prospective evaluation of
csopbll8eal motilily WIth provoc:<Uivc telung in rarlcnrs With chest pain Uld mirrnJ valve
prolapsc, Gastroentcrology 90 (,5.pt2): 1496. 986, ,
Day FP. Koch KL. DlIvld'on WR. lr . ;and S~lII'S PM: Etiology of cheSI pain in pllticnls
Wilh nutrnJ valvc prolapse, 1 Am Cud Cardlol9 (2. Supp A): 91\.1987,
D.eYfdson WR,. lL. PlIwlush DG, Mu"b n, and Moore RL: Lett ventricular mass in the
rat CUI be accurately calcull1led ecbocard1ogTaphJcally. Clinical Reselll'ch 36. No.3: 271 A.
1988,
4.
.5,
6,
7.
8,
Pasquale M1 and David,on WR, lr,: Aortic valve arclIln mnn vanes With Slroke volume.
alnical ReselU'ch 36. No, 3; 30M. 1988,
PlISqUlIlc MI. David~on WR. Ir" lllId Fllnclli C: In vivo detennJnation at normalllortic
valve are.a in mlll1 . an lIpplJcation of the conti~uity equation, QJnical Re~earch 36. No. 3:
306A. 1988,
9,
10,
DaVidson WR lr" Fee E llI'1d ~agjJJ E: lntluence of aging on pulmonary hemodvnamics
In lIpopulation free of coronary dlsCllSC, Clinical Research 36, No.3: 271A, 1988,
(Presented)
11.
PlISquale MI. Noonan TE. Davld~on WR, Jr,,: Does aonic valve area remlllO consllInt
under varying hcmodynlll'l1Ic conditions in mlln'!, CirCUlation 78. pI n. n-350. 1988,
David~on WR, lr Pasquale MI. Aronoff RD: Doppler Icft ventncular f1llJng pattern is
closely related to ventricular rela.xlltion abnormalities, 1 Am Coil COII'diology 13 (No, 2.
SUppl AI; 197A. 1989
Shcnberger IS. Prophct SA, Davld.on WR lr" Wnldhausen lA. Leuenberger UA.
Sinowny Ll: Left sube/llvian flap aortoplusry: effect on forearm vlIScullll' function and
growth, Clin ResearCh 3;,1'\0,2: 296A. 1989, (Presented)
Slauffer lL. Davidson WR, Jr.. Zwillich CN: EchOClll'diograpltic llI'1d electrocardiographic
tindlng~ in asymptomatic ,norlOg mcn, Am Rev Resplr Dis 139 (4,pt2): Al 13. 1989.
Accepted for presentation,
Stauffer 1L. tehmun RAW. Landls1R. Davidson WR If,. Zwilllch CW: Sleep-
di5Ol'dered breathing and daytime sleepiness. but not ncuropsycholosicollmpnlnnent. are
common in asymptomatic snoring men. Chest 96(2) Suppl. AUlUst. 1989,
12,
13.
~., _w ._~~ .w'_w
,~-,<,,,,,,'-''''''I.''',
. ..' ..... .,...,
, ,,,",..
Wllliam Reed Davichon. Ir.. M,D (eonl.)
7
16, SinowllY Lt. Gifford R. Yan!l H. Prophet 5, Baily RO. Davidson WR. Ir" LllI'ie
lJIcl1lllSCS in resting blood flow cause cnlllJ'gement of conduit vessels in humuns. eire
1989; 80(Supp m,U.556,
17, Davidson W~ Ir" Sexton CW, Lehman IC: Antihypen.clUivc medICations aller lefe
ventricular f1lliJ,g pattem in nOlTl'lalsubjel:L\, lACe 1990;' .5(SUpp A).
18, Dav,d~nn YiB.1L, Zwlllich CW, Stauffer Il. Reeves-Ho<:he :'vfK: Cardiac sequelae of
sleep-disordered breutlung, Clin Res, 1990.38(2) Accepted for present.1tion
19, Gucho IA. Copenhaver G, Davidson WR. Ir,,: functional rnyoc:u-dlaJ rcscl'\le can be
elicitcd by remote coronary OCclusion, Clin Res. 1990;38(2)
20. Davidson WR Ir,. Iackson A, Pll5quaJe MJ: Delayed ventricular filling of aging is not
caused by abnormal venuicular relaxauon. Am College of ClIl'dlol. Pennsylvania Chapter
(lIcceptcd for presentation)
21, Jackson A. ~,: Utilit)' of isovolumic relaxation tiOle for estimating
ventricular n:laxarion, Am College of Cardiol, Pennsylvania Chapler (accepted for
presentation),
22, Ko~kk DH, Davidson WR" lr~ Norm IF. Moore RL: cchocardiographic assessment of
left venrricular moss m u'amed and hypenenslve rats, Med Sci SpOrt .Exerc,
24(5 Suppl.):S93. 1992,
23, Staffen Rl':, Davldsoll WR, 1r,: Pulsed Doppler improves the senSItivity/specifiCity of
two.dimenSlonal echo and color Doppler for the diagnosi. of auial sepLal defect 1M adults,
American Heart Assoclauon. Circul.llion 88(4,pt.2);J-56. 1993.
24. DJlYidson ~'R..lL, Slauffer JL, Reeves Heche' ~fK. Zwillich CW Cardiac sequelae of
sleep disordered brearhlllg in Obstructive sleep apnea: new eVIdence (or nght venU'lcul1lJ'
dysfunction, Am Rev Resp.r Dls 147: AlOl 5, 1993
25, DaVIdson WR, 1r, J.l. Sliluffer. M,K, Reeves-Hoche. C. W, Zwllhch, Mechalllsms of
ventnculllJ' hypertrophy inslee~ apnea: AnechocardiographlC srudy. Presented at the 3rt!
Inlemationlll Marburg SymposIum on Cardlocirculurory Function Dunng Sleep, Y1lll'burg.
Germany. August, 1994,
26, Iuliano PI. RN Stauffer, WR Davidson, Jt,. Newly de'tribed pulsed Doppler patterns
diagnostic of ~'gnificant atnnl septal defect arc validnred by Ilormali,ing aftel' lurgical
repair, Pennsylvania Chapter of Amencan Collegc of Cardiology, September, 1994
(presented),
27. Iuliano PI. SE Cyran, WR DaVidson, Jr, Compensated pulmoniC insufficiency: h [he
right ventricular response to exercIse nonnal'1 IACC Specia.! Issue 1:378,.1.. 1995,
28, Griffin DC. I AnmM. WR Davidson Jr. Doppler tissue imuging ofmyoclIJ'dial velocity:
Physiologic variability In normals, J Am Sac of Echocnrdiography, 8:392. 1995,
29. Davidson WR Ir, The right ventricle ll11d ob.rructive sleep apena, Somnologic Supp,
2:20. 1997,
~
way of Complaint filed on or about July 11, 1996. (See a true
and correct copy of Plaintiffs' Complaint attached hereto as
Exhibit; "l}").
2. Movj.ng Defendants were served with Plaintiffs' Complaint
on July 17, 1996.
3. In their Complaint Plaintiffs allege that moving
Defendants were negligent in failing to diagnose a thoracic
aneurysm.
I. PRELIMINARY OBJECTION PURSUANT TO Pa.R.C.P. No. 1028
(4) (LEGAL INSUFFICIENCY OF A PLEADING) TO PARAGRAPHS
33. 47 AND 48 OF PLAINTIFFS' COMPLAINT
4. Defendants incorporate paragraphs 1 - 3 of these
Preliminary Objections as though the same were fully set forth
herein at length.
5. Although a medical professional corporation can be
independently negligent e.g. for failure to train, failure to own
appropriate diagnostic equipment and failure establish policies,
a medical professional corporation cannot be vicariously liable
for the conduct of the surgeons affiliated with it.
6. In order for a principal I agent relationship to exist
the principal must have the right to supervise or control the
conduct of its agent.
7. A principal may be held vicariously responsible for the
acts of his agent where the principal controls the manner of
performance and the result of the agents work. It is the right
- 2
.
to control which is determinative. On the other hand, the right
to superviBe, even as to the work and the manner of performance,
is not sufficient. Strain v. Ferroni, 405 Pa. Super. 349, 592
A.2d 698 (1991).
8. The Medical Practice Act of 1985 states, in pertinent
part, as followsl
No person other than a medical doctor shall engage
in any of the following conduct except as
authorized or exempted in this actl
(1) Practice medicine and surgery.
(2) Purport to practice medicine and surgery.
(3) Hold forth as authorized to practice medicine
and surgery through use of a title including, but
not necessarily limited to medical doctor, doctor
of medicine, doctor of medicine and surgery,
doctor of a designated disease, physician,
physician of a designated diaease, or any
abbreviation for the foregoing.
(4) Otherwise hold forth as authorized to
practice medicine and surgery.
63 P.S. 8422.10.
9. Since a professional corporation cannot practice
medicine, purport to practice medicine or hold forth as being
authorized to practice medicine, then, as a matter of law it does
not have the right to supervise or control the conduct of its
physicians.
10. Thus, no principal/agent relationship can exist
between a professional corporation and the physicians associated
therewith.
- 3 -
11. Since no principal/agent relationship exits, a
professional corporation cannot be vicariously liable for the
conduct of affiliated physicians.
12. In paragraph 33 of Plaintiffs' Complaint, Plaintiffs
allege as followst
33. At all relevant times alleged herein, Defendants,
A. Z. Ritzman and Holy Spirit Hospital, had the right
and duty to exercise control, authority, and
supervision over all agents, apparent agents, servants,
members, partners, and/or employees who provided
radiological services to its clients.
13. In paragraph 47 of Plaintiffs' Complaint, Plaintiffs
allege as followst
47. Defendants, The A. Z. Ritzman Associates, Inc. and
Holy Spirit Hospital, through the actions of its
agents, apparent agents, servants, members, partners
and/or employees, are liable to the Plaintiff for
injuries and damages alleged herein which were directly
and proximately caused by their negligence in:
* * *
14. In paragraph 48 of Plaintiffs' Complaint, Plaintiffs
allege as follows:
48. As a direct and proximate result of Defendants',
A. Z. Ritzman's and Holy Spirit Hospital [sic],
negligence in failing to diagnose or even consider the
life-threatening state of Mrs. Flickinger's aorta, Mrs.
Flickinger died of aortic rupture on January 14, 1995.
WHEREFORE, Defendants respectfully request this honorable
court grant Defendants' Preliminary Objection pursuant to
Pa.R.C.P. No. 1028 (4) and enter an Order striking paragraphs 33,
47 and 48 of Plaintiffs' Complaint.
- 4 .
18. In paragraph 33 of Plaintiffs' complaint, Plaintiffs
purport to allege agency as follows I
33. At all relevant times alleged herein, Defendants,
A. Z. Ritzman and Holy spirit Hospital, had the right
and duty to exercise control, authority, and
supervision over all agents, apparent agents, servants,
members, partners, and/or employees who provided
radiological services to its clients.
19. In paragraph 44 of Plaintiffs' Complaint, Plaintiffs
purport to allege agency as follows:
44. At all relevant times alleged herein, Defendants,
A. Z. Ritzman and Holy Spirit Hospital, by way of their
agents, apparent agents, servants, members, partners,
and/or employees rendered radiological/medical services
to decedent Mrs. Flickinger.
20. In paragraph 46 of Plaintiffs' Complaint, Plaintiffs
purport to allege agency as follows:
46. At all relevant times herein, Mrs. Flickinger
reasonably relied upon the apparent expertise, apparent
competence, diagnosis, evaluation, conclusions, and
authority of Defendants, A. Z. Ritzman and Holy Spirit
Hospital, by way of its agents, apparent agents,
servants, members, partners, and/or employees who
provided radiological/medical services to its clients.
21. In paragraph 47 of Plaintiffs' Complaint, Plaintiffs
purport to allege agency as follows:
47. Defendants, The A. Z. Ritzman Associates, Inc. and
Holy Spirit Hospital, through the actions of its
agents, apparent agents, servants, members, partners
and/or employees, are liable to the Plaintiff for
injuries and damages alleged herein which were directly
and proximately caused by their negligence in:
* * *
.6-
22. In order to comply with Pa.R.C.P. No. 1029 (b) and (e),
Defendants must know the identity of those individuals who are
alleged to be their agents in order to know whether to admit or
specifically deny such allegations. Willinger v. Mercy Cath6li~
Medical Center of Southeastern Pennsylvania. Fitzgerald Mercy
Division, 241 Pa. Super. 456 at 462, 362 A. 2d 280 at 283 (1976),
affirmed 482 Pa. 441, 393 A. 2d 1188 (1978).
23. If the allegations set out above are allowed to remain,
Defendants would not be able to sp~cifically deny agency, and
therefore, agency would be deemed to be admitted.
WHEREFORE, Defendants respectfully request this honorable
court to enter an Order pursuant to Pa.R.C.P. No. 1028 (3)
striking paragraphs 31, 33, 44, 46 and 47 of Plaintiffs'
Complaint, or in the alternative, an Order for a more specific
pleading.
III. PRELIMINARY OBJECTION IN THE NATURE OF A MOTION TO
STRIKE PARAGRAPHS 31. 33. 44. 46 AND 47 OF PLAINTIFFS'
COMPLAINT PURSUANT TO Pa.R.C.P. 1028(2) (FAILURE OF A
PLEADING TO CONFORM TO RULE OF COURT) AND Pa.R.C.P.
1028(3) (INSUFFICIENT SPECIFICITY IN A PLEADING) OR. IN
THE ALTERNATIVE. A MOTION FOR A MORE SPECIFIC PLEADING
24. Defendants incorporate paragraphs 15 - 23 of these
Preliminary Objections as though the same were fully set forth
herein at length.
25. Pa. R.C.P. No. 1019 (a) states:
- 7 .
The material facts on which a cause of action or
defense is based shall be stated in a concise and
summary form.
26. In paragraph 31 of Plaintiffs' Complaint, Plaintiffs
purport to allege agency as follows:
31. Defendants, Stewart, Hottenstein, Bronfman, A. Z.
Ritzman, and Holy Spirit Hospital, or their agents,
apparent agents, servants, men~ers, partners, and/or
employees, are jointly and severally liable to
Plaintiff for the injuries and damages as alleged
herein.
27. In paragraph 33 of Plaintiffs' Complaint, Plaintiffs
purport to allege agency as follows:
33. At all relevant times alleged herein, Defendants,
A. Z. Ritzman and Holy Spirit Hospital, had the right
and duty to exercise control, authority, and
supervision over all agents, apparent agents, servants,
members, partners, and/or employees who provided
radiological services to its clients.
28. In paragraph 44 of Plaintiffs' Complaint, Plaintiffs
purport to allege agency as follows:
44. At all relevant times alleged herein, Defendants,
A. Z. Ritzman and Holy Spirit Hospital, by way of their
agents, apparent agents, servants, members, partners,
and/or employees rendered radiological/medical services
to decedent Mrs. Flickinger.
29. In paragraph 46 of Plaintiffs' Complaint, Plaintiffs
purport to allege agency as follows:
46. At all relevant times herein, Mrs. Flickinger
reasonably relied upon the apparent expertise, apparent
competence, diagnosis, evaluation, conclusions, and
authority of Defendants, A. Z. Ritzman and Holy Spirit
Hospital, by way of its agents, apparent agents,
servants, members, partners, and/or employees who
provided radiological/medical services to its clients.
- 8 -
30. In paragraph 47 of ~laintiffs' Complaint, Plaintiffs
purport to allege agency as followst
47. Defendants, The A. Z. Ritzman Associates, Inc. and
Holy Spirit Hospital, through the actions of its
agents, apparent agents, servants, members, partners
and/or employees, are liable to the ~laintiff for
injuries and damages alleged herein which were directly
and proximately caused by their negligence inr
. * *
31. ~a. R.C.~. No. 1019 (a) has been interpreted to mean
that th.,' pleadings must explain the nature of the claim to the
opposing party so as to permit him to prepare a defense, In re
Estate of Schofield, 477 A. 2d 473, 505 ~a. 95, (1984) at! well as
to apprise the Defendant of the nature and extent of ~laintiffs'
claim so that the Defendant has notice of what ~laintiffs intend
to prove at trial and may prepare to meet such proof with his own
evidence, Weiss v. EQ'uibank, 460 A. 2d 271, 31~ ~a. Super. 446
(1983) .
32. ~aragraphs 31, 33, 44, 46 and 47 of ~laintiffs'
Complaint constitute nonspecific allegations of agency failing to
set forth the material facts upon which they are based in
violation of Pa.R.C.~. No. 1019 (a) and which are legal
conclusions with no factual. basis which would permit Defendants.
to prepare a defense on the issue of agency.
33. The true criterion in determining whether an allegation
should be stricken as violative of Rule 1019 (a) is whether the
other party is prejudiced by the deviation therefrom. Cook v.
- 9 -
Resolut~ Insurance Comcany, 78 D. & C. 371, 24 Leh. L.J. 440
(1952) .
34. The prejudice to Defendants resulting from the failure
of the above quoted averment to comply with Pa.R.C.P. No. 1019
(a) is found in the Willinqe~ doctrine as stated in III.B. (1) a)
of Defendants' Brief in Support of Preliminary Objections.
WHEREFORE, Defendants respectfully request this honorable
court to enter an Order pursuant to Pa.R.C.P. 1028(2) and (3)
striking paragraphs 31. 33, 44, 46 and 47 of Plaintiffs'
Complaint or, in. the alternative, an Order for a more specific
pleading.
IV. PRELIMINARY OBJECTION IN THE NATURE OF_A MOTION ~
STRIKE PARAGRAPH 32 OF PLAINTIFFS' COMPLAINT PURSUANT
TO Pa.R.C.P. 102B(a) (2) OR. IN THE ALTERNATIVE. A
MOTION FOR A MORE SPECIFIC PLEADING PURSUANT TO
Pa.R.C.P. 1028(a) (~019(a)
35. Defendants incorporate paragraphs 1 - 3 of these
Preliminary Objections as though the same were fully set forth
herein at length.
36. Pa.R.C.P. No. 1019(a) requires a Plaintiff to state in
his Complaint, in concise and summary form, the material facts
upon which a cause of action is based.
37. The purpose of this Rule 1019 (a) is to require the
pleader to disclose in the Complaint the specific facts upon
which the Plaintiff's cause of action is based so that
Plaintiff's proof may be confined to such actions, thus enabling
- 10 -
the Defendant to reasonably prepare his defense. Baker v.
Ranaos, 229 Pa. Super, 333, 324 A.2d 498 (1974).
38. The Supreme Court of Pennsylvania in the case of Connor
v. Alleaheny General Hos~ital, supra., has attached great
significance to the use of nebulous boilerplate language in the
provisions of pleadings.
39. Footnote ~3 of the Connor decision places the onus on
the defendant to preliminarily object to such catch all language
in order to properly prevent a Plaintiff from introducing new
theories of negligence and new causes of action beyond the
statute of limitation~ which were originally not pleaded with the
requisite specificity.
40. The Connor decision has been cited as precedent by a
number of Pennsylvania Common Pleas courts in support of their
decisions to strike boilerplate allegations of negligence.
41. Recently, in the case of Starr v. Mvers, 109 Dauphin
147 1988, the court cited the Connor decision as precedent ~or
its holding that several of Plaintiff's allegations of negligence
were improper. Specifically, the Court held that:
It is our feeling that the only principal which offers
any meaningful guidance to perspective pleaders is to
require specificity in all allegations 0' negligence.
Thus, we will no longer countenance general averments
of negligence. Should discovery disclose the existence
of other acts of negligence, it should be noted that
the Rules of Civil Procedure provide for a liberality
in permitting' amendment. Furthermore, it well settled
that the decision to grant or deny permission to amend
- 11 -
ExhIbIt 11
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NEIL R. fLICKINGER, Individually,
and as tho Administrator of the
ESTATE Of BETTY J. FLICKINGER,
DECEASED,
Plaintit!
v.
RICHARD P. STEWART, M.D.,
DANIEL W. HOTTENSTEIN, M.~.,
HOWARD J. BRONFMAN, M.D., THE
A. Z. RITZMAN ASSOCIATES, INC.,
and HOLY SPIRIT HOSPITAL
Defendants
COMPLAINT
I IN THE COURT OF COMMON PLEAS
t CUMBERLAND COUNT~, PENNA
I
I
I NO.
I
I
I CIVIL ACTION - LAW
I
I
I
I JUR~ TRIAL DEMANDED
I
I
1. Plaintiff, Neil R. flickinger, is an adult resident of
Loysville, Perry county, Pennsylvania and is tho widower af the
decedent, Betty J. Flickinger.
2. Plaintiff, Neil R. Flickinger, is the Administrator of
the Estate of his late wife, Betty J. Flickinger, by Letters
Testamentary duly issued on January 27, 1995 by the Register of
wills of Perry County, Pennsylvania.
3. Defendant, Richard P. stewart, M. D. , (hereinafter
Defendant Stewart) is an adult individual licensed to practice
medicine in the Commonwealth of Pennsylvania, and at all relevant
times was engaged in the practice of radiology in Cumberland
County, Pennsylvania.
4. Defendant, Daniel W. Hottenstein, M.D., (hereinafter
Defendant Hottenstein) is an adult individual licensed to practice
medicine in the Commonwealth of Pennsylvania, and at all relevant
times was engaged in the practice of radiology in Cumberland
County, Pennsylvania.
1
5. Defendant, Howard J. Dronfmlln, M. D., (hereinafter.
Defendant Brontman) is an adult individual licensed to praotice
medicine in the Commonwealth of Pennsylvania, and at all relevant
times was ongaged in the practico of radiology in Cumberland
County, Pennsylvania.
6. Defendant, The A. Z. Ritzman Associates, Ino.,
(hereinafter Defendant A. z. Ritzman) is a corporate medical
institution consisting of a group of physicians who specialize in
the practice of radiology, with offices located in Cumberland
County, Pennsylvania, and who, at all relevant times, provided
radiological services to Defendant, Holy spirit Hospital.
7. At all relevant times herein, Defendants stewart,
Hottenstein and Bronfman acted as agonto, apparent agents,
servants, members, partners, and/or employees of Defendant,
A.Z. Ritzman, and acted within the course and the scope of their
employment/association with this corporation.
8. Defendant, Holy Spirit Hospital, is a
institution with medical facilities and offices
corporate
located in
Cumberland County, Pennsylvania.
9. . At all relevant times herein, Defendants stewart,
Hottenstein and Bronfman acted as agents, apparent agents,
s~rvants, members, partners, and/or employees of the Defendant,
Holy Spirit Hospital, and acted within the course and the scope of
their employment/association with this corporation.
2
la. At all times when the decedent, Mrs. Flickinger,
underwent chest x-rays and/or radiological studies in the
Defendant, Holy Spirit Hospital, all staff, including Defendants
stewart, Iiottenstein, Bronfman, and A. Z. Ritzman, and all x-ray
tlJchnicians, technologists, and hospitBl personnel were agents,
apparent agants, servants, members, partners, and/or employees of
Defendant Holy Spirit Hospital and at all times were acting within
the course and scope of said employment/association.
11. At all times when the decedent, Mrs. Flickinger, had her
ohest x-rays and/or radiological studies interpreted in Defendant,
Holy Spirit Hospital, all staff, including Defendants stewart,
Hottenstein, Bronfman, and all x-ray technicians, technologists,
and radiological personnel were agents, apparent agents, servants,
members, partners, and/or employees of Defendant, A. Z. Ritzman, and
at all times were acting wi thin the course and scope of said
employment/association.
12. On or about November 30; 1994, Mrs. Flickinger was
transported, by ambUlance, to Defendant's, Holy spirit Hospital,
emergency care unit (ECU). She was seventy-three (73) years old
and was complaining of the sudden onset of crushing chest pain and
shortness of breath which was not materially abated by the
administration of Nitroglycerin.
13. Defendant,
.
Holy Spirit
Hospital,
recorded that
Mrs. Flickinger hac! a history of an aortic aneurysm in her abdomen
which necessitated its repair by said Defendant in 1989. They also
recorded that she had no personal history of heart disease but that
3
she did have a history of chronic obstructive pulmonary disease
(COPD), anKylosing spondylitis, gastroesophageal reflux disease,
and mitral valve prolapse.
14. While in the Defendant's ECU, Mrs. Flickinger underwent
a chest x-ray which was reported as demonstrating moderate dilation
of her aorta with calcification noted at its arch.
15. Later that same day, Mrs. Flickinger was admitted to
Defendant, Holy Spirit Hospital, for chest pain, to rule out
myocardial infarction and for further evaluation.
16. Curing this admission, on or about December 7, 1994,
Mrs. Flickinger underwent a second chest x-ray at Defendant, Holy
Spirit Hospital. Thio chest x-ray was read by Defendant stewart.
17. Defendant stewart reported the results of this chest
x-ray, as similar to the findings from the November 30, 1994 chest
x-ray.
lB. Plaintiff avers that this December 7, 1994 chest x-ray
.
demonstrated a change in the status of Mrs. Flickinger's thoracic
,aorta. The PA view of this x-ray evidenced an increase in the
width of her thoracic aorta, as seen through the heart shadow.
Moreover, the lateral view showed a tortllous and ectatic aorta. In
addition, there is noted a slight but distinct posterior bulge of
her aorta at the mid cardiac level (T 10-11 vertebral level).
19. On December 10, 1994, Mrs. Flickinger was discharged from
Defendant, Holy Spirit Hospital', with the final diagnosis being -
Chest pain of unknown etiology.
4
:ZOo Over the next thr",'" (3) weeks, Mrs. flickinqer presented,
once a week, to her family physicians, complaining of chest, rib,
and/or back pain and shortness of breath.
21. On or about December 27, 1994, Mrs. Flickinger was
referred by her f~mily physicians for a chest x-ray at Dofendant,
Holy Spirit Hospital.
22. This chest x-ray wus performed and read at Defendant,
Holy Spirit HOl'\pital, on DeoenWer 30, 1994, by Defendant
Hottenstein.
23. Defendant Hottenstein examined this chest x-ray of
Mrs. FliCkinger and noted the prcscnce of atheromatous
calcification in an ectatic (stretched) and tortuous (twisted)
thoracic aorta. However, Defendant Hottenstein made no comparison
with the previous appearance and dimensions of Mrs. FliCkinger's
thoracic aorta and the fact that there had been a changa in its
condition. No admission or !u~ther niagnostic tests wer~ ordered
or recommended. Despite the ominous findings evident on this
x-rny, Mrs. Flickinger was merely discharged home.
24. Plaintiff avers that this December 30, 1994 chest x-ray
revealed an increase in the size of Mrs. FliCkinger'S aorta at the
level of T 10-11, which was a significant and alarming enlargement
of Mrs. Flickinger's thoracic aorta and suggested its imminent
rupture.
25. On or about January 13, 1995, Mrs. Flickinger was again
referred by her family physician to Defendant, Holy Spirit
Hospital, for a chest x-ray.
5
26. This chost x-ray was porformod on January 13, 199B, at
Defendant, Holy Spirit Hospital, and was road by Defendant
Bronfman.
27. Defendant Bronfman r~ad Mrs. Flickinger's chest x-ray as
demonstratin'iJ an ectatic (stretched) aOl:ta. He concluded that this
chest x-ra}' demonstrated no significant change since her
December 30, 199~ chest x-ray. Ho admission or further diagnostic
tests were ordered or recommended. Despite the ominous findings
evident on this chest x-ray, Mrs. Flickinger was marely discharged
home.
28. Plaintiff avers that this January 13, 1995 chest x-ray
showed Mrs. Flickinger's aorta ev~n more onlarged and direful on
both PA and lateral views than its appearance in the December 30,
1994 chest x-ray. This distinct aneurysmal-type bUl'iJe of the
posterior wall of Mrs. Flickinger'S aorta was most prominent on the
lateral x-ray view.
29. On or about January 14, 1995, an ambulance was summoned
to Mrs. Flickinger's residence and found her complaining of severe
chest pain. The ambulance transported her to Defendant's, Holy
Spirit Hospital, F.CU.
30. As a result of the Defendants' failure to diagnose and
treat her worsening aneurysm, while in the ECU, Mrs. Flickinger sat
up from her bed yelling in pain and holding her chest, immediately
fell back, and died of a ruptured thoracic aneurysm.
31. Defendants, stewart, Hottenstein, Bronfman, A. Z.
Ritzman, and Holy spirit Hospital, or their agents, apparent
6
agunts, servants, members, partnors, and/or employees, are jointly
and severally liable to Plaintiff for the injurios and damages as
alleged herein.
32. The injuriea suffered by Mrs. Flickinger and by the
Plaintiff were the direct and proximate result of the negligence of
Defendants, stewart, Hottenstein, Dronfman, A. Z. Ritzman, and Holy
spirit Hospital.
33. At all relevant times alleged herein, Defendants,
A.Z. Ritzman and Holy Spirit Hospital, had the right and duty to
exercise control, authority, and supervision over all agents,
apparent agents, servants, members, partners, and/or employees who
provided radiological services to its clients.
COUNT I
NEIL R. FLICKINGER, INDIVIDUALLY, AND AS ADMINISTRATOR OF
THE ESTATE OF BETTY J. FLICKINGER
V.
RICHARD P. STEWART. M.D.
34. Paragraphs 1 through 33 of this complaint aro
incorporated herein by reference.
35. Defendant, Richard P. stewart, M.D., is liable to the
Plaintiff for il1juries and damages alleged herein whioh were
directly and proximately caused by his negligence int
a) reading the December 7, 1994 chest x-ray but tailing
to recognize or report the ominous state of Mrs. Flickinger's
aorta, which demonstrated an dangerous widening in her thoracic
aorta,
7
b) tailing to approciato lito-threatening changes in
Mrs. Flickinger's aorta, which were evident on her serial chest
x-rays,
c) failing to review Mrs. Fliokingor's chest x-raytl
thoroughly and adequately,
d) failing to immediatoly repeat chest x-rays on
Mrs. Flickinger after her filma demonstratod a dangerous widening
in her thoracio aortal
e) failing to inform Mrs. Flickinger ot the
life-threatening condition of her aortal
f) failing to diagnose Mrs. Flickinger's aorta's
dangerous widening and tortuous and ectatic condition from her.
ohest x-raYI
g) misreading Mrs. Flickinger's chest x-ray in regard
to the life-threatening state of her aortal
h) failing to diagnos~ Mrs. FliCkinger's
life-threatening aortic oonditlcn on December 7, 1994,
i) failing to order and/or recommend any diagnostic
studies of Mrs. Flickinger's aorta, even though her chest x-ray
demonstrated its tortuous and ectatic condition and its dangerous
widening I
j) failing to refer Mrs. Flickinger to a surgeon for
evaluation of her aortic condition;
k) failing to inform Mrs. Flickinger's referring family
physician(s) of the life-threatening state of her aorta and her
8
need for further diagnostic studies, immediate follow-up, and/or
her instant need to be referred to a surgeon for evaluationr
1) fa il ing to evon cons idor i:he [loss ib i1 i ty tha t
Mrs. Flickinger's chost x-ray, from December 7, 1994, demonstrated
a lifo-threatening aortic condition and that her condition
neoessitated immediate diagnostic tests, follow-up, and/or referral
to a surgeon for prompt evaluationr
36. As a direct and proximate result of Defondant stewart's
negligence in failing to diagnoso or even consider the
life-threatening state of Mrs. Flickingor's aorta, Mrs. Flickinger
died of aortic rupture on January 14, 1995.
WHEREFORE, Plaintiff, Neil R. Flickinger, Individually, and as
Administrator of the Estate of Betty J. Flickinger, demands
judgment against Defendant, Richard P. stewart, M.D., in an amount
in excess of Twenty-Five Thousand dollars ($25,000) exclusive of
interest and costs and in excess of any jurisdictional amount
requiring arbitration.
COUNT II
NEIL R. FLICKINGER, INDIVIDUALLY, AND AS ADMINISTRATOR OF THE
ESTATE OF BETT~ J. FLICKINGER
V.
DANIEL W. HOTTENSTEIN. ~
37. Paragraphs 1 through 33 of this Complaint and Count I are
incorporated herein by reference.
38. Defendant, Daniel W. Hottenstein, M.D., is liable to the
Plaintiff for injuries and damages alleged herein which were
directly and proximately caused by his neglig~nce in:
9
a) reading the Oecember 30, 1994 chest x-ray but failing
t? recognize the ominous state of Mrs. Flickinger's aorta, which
was suqgestive of imminent rupture,
b) fl1ilinq to appreciato life-threatening ohanges in
Mrs. Flickinger's aorta, which wore evident on her serial chnst
x-rays;
c) tailinq to 'revi..\~ Mrs. FlickingeL"~ chest x-rays
thorouqhly and adequately,
d) failing to immediately repeat chest x-rays on
Mrs. Flickinger after her films demonstrated imminent rupture of
her aorta;
e) failing to inform Mrs. Flickinger of the
life-threatening condition of her aorta;
f) failing to diagnose Mrs. flickinger's aorta's
imminent rupture from her chest x-ray;
g) misreading Mrs. Flickinger'S chest x-ray in regard to
the life-threatening state of her aorta;
h) failing to diagnose Mrs. Flickinger'S
life-threatening aortic condition on December 30, 1994'
i) failinq to order and/or recommend any diagnostic
studies of Mrs. Flickinger'S aorta, even though her chest x-ray
demonstr'ated its imminent rupture;
j) failing to refer Mra. Flickinger to a surqeon for
evaluation of her aortic condition;
k) failing to inform Mrs. Flickinger's referrinq family
physician(s) of the life-threatening state of her aorta and her
10
need for further diagnostic studies, iJtllnodiate follow-up, and/ot'
her instant need to ba referred to a surgeon for evaluation I
1) failing to even consider the possibility that
Mrs. Flickinger's chcst x-ray, from December 30, 1994, delDonstl'ated
a life-threatening aortic condition and that her condition
nccessitated immediate diagnostic tests, follow-up, and/or ~eferral
to a surgeon for prompt evaluation.
39. As a direct and proximate result of Defendant
Hottenstein's negligence in failing to diagnose or even consider
the
life-threatening state
of
Mrs.
Fl ickinger' s
aorta,
Mrs. Flickinger died of aortic rupture on January 14, 1995.
WHEREFORE, Plaintiff, Neil R. flickinger, Individually, and aa
Administrator of the Estate of Betty J. Flickinger, demands
judgment against Defendant, Daniel W. Hottenstein, M.D., in an
amount in excess of Twenty-Five Thousand dollars ($25,000)
exclusiva of interest and costs and in excess of any jurisdictional
amount requiring arbitration.
~NT III
NEIL R. FLIC~INGER, INDIVIDUALLY, AND AS ADMINISTRATOR OF
THE ESTATE OF BETTY J. FLICKINGER
V.
HQH~ BRONFMAN. M.D.
40. Paragraphs 1 through 33 of this Complaint and Counts I
and II are incorporated herein by reference.
11
41. Defendant, Howard J. Bronfman, M.D., is liable to the
Plaintiff forlnjuries and damages alleged herein which were
directly an~ proximately caused by his negligence inl
a) readJ.ng the January 13, 1995 chest x-ray but tailing
to recognize the ominous state of Mrs. flickinger's aorta, which
was suggestive of imminont rupture,
b) failing to appreciate lite-threatening changes in
Mrs. Flickinger's aorta, Which were evidmnt on he~ serial chest
x-rays,
c) failing to review Mrs. flickinger'S chest x-rays
thoroughly and adequately,
d) failing to immediately repeat chest x-rays on
Mrs. Flickinger after her films demonstrated imminent rupture of
her aorta,
e) fa il ing to inform Mrs. FliCkinger of the
life-threatening condition of her aorta,
f) failing to diagnose Mrs. Flickinger's aorta's
imminent rupture from her chest x-ray,
g) misreading Mrs. Flickinger'S chest x-ray in regard
to the life-threatening state of her aorta,
h) failing to diagnose Mrs. Flickinger's
life-threatening aortic condition on January 13, 1995,
i) , failing to order and/or recommend any diagnostic
studies of Mrs. Flickinger's aorta, even though her chest x-ray
demonstrated its imminent rupture,
1.2
j) fail~nq to refer Mrs. Flickinger to a 5urg~on tor
evaluation o( her aortic condition,
k) tailing to inform Mrs. Flickinger's reterring family
physician(s) of the life-threatening state of her aorta and her
need for further diagnostic stud.i.es, immediate tollow-up, and/or
her instant need to be referred to a Burgeon for evaluation,
1) failing to even consider the possibility that
Mrs. Flickingar's chest x-~ay, from January 13, 1995, demonstrated
a life-threatening aortic condition and that her condition
necessitated immediate diagnostic tests, follow-up, and/or referral
to a surgeon for prompt evaluation,
42. As a direct and proximate result of Defendant Bronfman's
negligence in failing to diagnose or even consider the
life-threatening state of Mrs. Flickinger's aorta, Mrs. Flickinger
died of aortic rupture on January 14, 1995.
WHEREFORE, Plaintiff, Neil R. Flickinger, Individually, and as
Administrator of the Estate 'of Betty J. FliCkinger, demands
judgment against Defendant, Howard J. Dronfman, M.D., in an amount
in excess of Twenty-Five Thousand dollars ($25,000) exclusive of
interest and costs and in excel!!G of any juriSdictional amount
requiring arbitration.
13 .
COUNT IV
NEIL R. FLICKINGER, mDIVIDUALI,~, AND AS ADMINISTRATOR OF
THE ESTATE OF BETTY J. FLICKINGER
V.
THE A. Z. RITZMAN ASS09IATES. INC. and HOL~ SPIRIT HOSPITAL
43. ~aragraphs 1 through 33 of this Complaint and Counts I
through III are inoorporated herein by reference.
44. At all relevant times alleged herein, Defendants,
A.Z. Ritzman and Holy Spirit Hospital, by way of their agents,
apparent agents, servants, members, partners, and/or employees
rendered radiOlogical/medical services to decedent Mrs. Flickinger.
45. At all relevant times alleged herein, Defendants ste\~art,
Hottenstein and Bronfman were' radiologists/physicians at
Defendants, A. Z. Ritzman and Holy Spirit Hospital, and at all
times were acting ~~thin their scope as agents, apparent agents,
servants, members, partners, and/or employees of Defendants,
A.Z. Ritzman and Holy Spirit Hospital.
46. At all relevant times herein, Mrs. Flickinger reasonably
relied upon the appart:1nt expertise, apparent competence, diagnosis,
evaluation, conclusions, and authority of Defendants, A.Z. Ritzman
and Holy Spirit Hospital, by way of its agents, apparent agents,
servants, members, partners, and/or employees who provided
radiOlogical/medical services to its clients.
47. Defendants, The A.Z. Ritzman Associates, Inc. and Holy
Spirit Hospital, through the actions of its agents, apparent
agents, servants, members, partners and/or employees, are liable to
the Plaintiff for injuries and damages alleged herein which were
directly and proximately caused by their negligence int
14
a) reading the pecombor 7, 1994, Docembor 30, 1994 and
January 13, 1995 chest x-rays but failing to recognize the ominous
state of Mrs. Flickinger's aorta, ....hich was suggestive of a
dangerous widening and imminent rupture I
b) failing to appreciate life-threatening changes in
Mrs. Flickinger's aorta, which ....ere ovident on her serial chest
x-rays,
c) !ailing to review, examine, evaluate, and/or report
Mrs. Flickinger's chest x-rays thoroughly and adequately I
d) failing to immediately repeat chest x-rays on
Mrs. Flickinger after her films demonstrated a dangerous widening
and imminent rupture of her aor.tal
e) failing to inform Mrs. Flickinger of the
life-threatening condition of her aortal
f) failing to diagnose Mrs. FliCkinger'S aorta's
dangerous wideni~~ and imminent rupture from her chest x-ray I
g) misreading Mrs. Flickinger's chest x-ray in regard
ta the life-threatening state of her aortal
h) failing to diagnose Mrs. Flickinger'S
life-threatening aortic condition on December 7, 1994, December 30,
1994 and on January 13, 19951
i) failing to order and/or recol1ll1lend any diagnostic
studies of Mrs. Flickinger's aorta, even though her chest x-rays
demonstrated its dangerous widening and imminent rupture I
j) failing to refer Mrs. Flickinger, at any time, to a
surgeon for evaluation of her aortio condition,
15
k) failing to inform Mrs. Flickinger's referring family
physician(s) ~f the life-threatening state of her aorta and her
need for further diagnostic studies, immediate follow-up, and/or
her instant need to be referred to a Burgeon for evaluation,
1) failing to institute proper procedures and
safeguards to assure that x-rays demonstrating a life-threatening
aortic condition are completely and adequately evaluated by
competent radiologists,
m) failing to employ radiologists and t!ltaff who are
able to recognize obvious life-threatening aortic conditions, which
are present in their patients,
n) failing to institute procedures for the automatic
repeating of chest x-rays, the ordering of further diagnostic
studies, the prompt referral to surgeons, and/or the disclosure to
patients and/or their referring physicians of life-threatening
conditions that necessitate diligent f?llow-up,
0) failing to even consider the possibility that
Mrs. Flickinger's chest x-rays, from December 7, 1994, December 30,
1994 and January 13, 1995, demonstrated a life-threatening aortic
condition and that her condition necessitated immediate diagnostic
tests, fOllOW-Up, and/or referral to a surgeon for prompt
evaluation,
48. As a direct and proximate result of Defendants',
A.Z. Ritzman's and Holy spirit Hospital, negligence in failing to
diagnose or even consider the life-threatening state of
1(;
Mrs. flickinger's aorta, Mrs. Flickinger died of aortic rupture on
January 14, 1995.
WHEREFORE, Plaintiff, Neil R. Flickinger, Individually, and as
Administr~tor of the Estato of Betty J. Flickinger, demands
judqroont against Defendants, The A. Z. Ritzman Associates, Inc. and
Holy spirit Hospital, in an amount in excess of 'rwenty.Five
Thousand dollars ($25,000), exclusive of interest and costs and in
excess of any jurisdictional amount requiring arbitration.
CLAIM I
SURVIVT\L T\CTION
NEIL R. FLICKINGER, INDIVIDUALLY, AND AS THE ADMINISTRATOR
OF THE ESTATE OF BETTY J. FLICKINGER
V.
RICHARD P. STEWART, M.D., DANIEL W. HOTTENSTEIN, M.D.,
HOWARD J. BRONFMAN, M.D., THE A.Z. RITZMAN ASSOCIATES, INC.,
and HOLY SPIRIT HOSPITT\L
49. Paragraphs 1 through J3 of this Complaint end Counts I
through IV are incorporated herein by reference.
50. Plaintiff, Neil R. Flickinger, brings this action on
behalf of the Estate of Betty J. Flickinger, under and by virtue of
the Act of 1976, July 9, P.L. 586, No. 142, Pa. C.S.A. ~ 8302.
51. Defendants, Stewart, Hottenstein, Bronfman, A.Z. Ritzman,
and Holy Spirit Hospital, are jointly and severally liable to the
Estate of Betty J. Flickinger for damages as set forth herein.
52. Plaintiff, Neil R. FliCkinger, Individually, and as
Administrator of the Estate of Betty J. Flickinger, deceased,
claims on behalf of said Estate the damages suffered by the said
Estate by reason of the death of the decedent, for the pain and
17
suffering the decedent underwent prior to death, economic losses,
and for all other damages sustained ny the said Estate by reason of
the death of the decedent.
WHEREFORE, Plaintiff, Neil R. Flickinger demands jUdlJ1llent
, ,
against Defendants, stewart, 1I0ttenstein, Dronfman, A.Z. Ritzman
and Holy spirit 1I0spital, in an amount in excess of Twenty-Five
Thousand dollars ($25,000), exclusive of interest and costs and in
excess of any jurisdictional amount requiring arbitration.
CLlIIM ;U
liBONGr'UL DElITH
NEIL R. FLICKINGER, INDIVIDUALLY, AND AS THE ADMINISTRATOR OF THE
ESTATE OF BETTY J. FLICKINGER
V.
RICHARD P. STEWART, M.D., DANIEL W. HOTTENSTEIN, M.D., HOWARD J.
BRONFMAN, M.D., THE A. Z. RITZMAN ASSOCIATES, INC.,
and HOLY SPIRIT HOSPITlIL
53. Paragraphs 1 through 33 'of this Complaint, Counts I
through V, and Claim I are incorporated herein by reference.
54. Plaintiff, Neil R. Flickinger, Individually, and as the
Administl'ator of the Estate of Betty J. Flickinger, deceased,
brings this action for the wrongful death of Betty J. Flickinger,
on behalf of all persons entitled to recover therefore under and by
virtue of the Act of 1976, July 9, P. L. 586, No. 142, 42 Pa.
C.S.A., ~ 8301, as amended 1982, December 20, P.L. 1409, No. 326,
art. II, ~ ~Ol, 42 Pa. C.S.A; ~ 8301.
55. Decedent, Betty J. Flickinger, did not bring an action
for her injuries during her lifetime.
18
56. The following ere the names of all persons entitled by
law to recovar damages for such wrongful death and their
relationship to the decedent I
IWU: RELATIONSHIP ADDRESS
Neil FliCkinger Husband Loysville, PA
Mark Fl iCkinger Son Duncannon, PA
Jarrett Flickinger Son Shermansdale, PA,
Rabecca KUhn Daughter Loysville, PA
57. As a result of the aforementioned events, the individuals
identified in paragraph 56 above, sustained reasonable hospital,
nursing, medical, funeral expenses and exp~nses of administration,
and claim is made therefor.
50. As a result of the aforementioned events, the individuals
identified in paragraph 56 above, have suffered a pecuniary loss
and have been, and in the future will be, deprived of the
decedant's companionship, contribution, support, comfort, services
and so on, for all of which damages are claimed.
59. Dafendants are jointly and severally liable to tha Estate
of Betty J. FliCkinger for damages as set forth herein.
WHEREFORE, Plaintiff, Neil R. FliCkinger demands jUdgment
against Defendan~s, Stewart, Hottenstein, Bronfman, A.Z. Ritzman
19
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NEIL R. FLICKINGER, Individually,
and as the Administrator of the
ESTATE OF BETTY J. FLICKINGER,
DECEASED,
Plaintitt
v.
RICHARD P. STEWART, M.D.,
DANIEL W. HOTTENSTEIN, M.D.,
HOWARD J. BRONFMAN, M.D., THE
A. Z. RITZMAN ASSOCIATES, INC.,
and HOLY SPIRIT HOSPITAL
Defendants
I IN THE COURT OF COMMON PLEAS
I CUMBERLAND COUNTY, PENNA
I
t
I NO. 96-3954 civil
I
I
I CIVIL ACTION - LAW
I
I
I
I JUR~ TRIAL DEMANDED
I
I
PLAINTIFF'S RESPONSE TO NEW MATTER
OF DEFENDANT HOLY SPIRIT HOSPITAL
1. The allegations constitute conclusions ot law to which no
response is required. To the extent that any response is required,
said allegations are denied.
Plaintift has stated a oause ot
aotion upon which relief can be granted against Holy spirit
Hospital.
2. The allegations constitute conclusions of law to which no
response is required. To the extent that any response is required,
said allegations are denied. Plaintitf's claims are not barred by
any statute of limitations.
3. The allegations constitute conclusions of law to which no
response is required. To the extent that any response is required,
said allegations are denied. Plaintift's loss of consortium claim
is part of the wrongful death claim.
4. The allegations constitute conclusions of law to which no
response is required. To the extent that any response is required,
said allegations are denied.
97613/JKW
Defendant, through its agents,
NEIL R. FLICRINGER, Individually,
and as the Administrator ot the
ESTATE OF BETTY J. FLICKINGER,
DECEASED,
Plaintiff
v.
RICHARD P. STEWART, M.D.,
DANIEL W. HOTTENSTEIN, M.D.,
HOWARD J. BRONFMAN, M.D., THE
A. Z. RITZMAN ASSOCIATES, INC.,
and HOLY SPIRI'r HOSPITAL
Defendants
I IN THE COURT OF COMMON PLEAS
r CUMBERLAND COUNTY, PENNA
I
I
I NO. 96-3954 civil
I
I
I CIVIL ACTION - LAW
r
I
I
I JURY TRIAL DEMANDED
I
I
PLAINTIFF'S ANSWER TO DEFENDANTS,
RICHARD P. STEWART, M.D., DANIEL W. HOTTENSTEIN, M.D.,
HOWARD J. BRONFMAN, M.D., AND THE A.Z. RITZMAN ASSOCIATES, INC.,
PRELIMINARY OBJECTIONS TO PLAINTIFF'S COMPLAINT
1. Admitted.
2. Admitted.
3. Admitted.
4. Admitted.
I.
5. Denied. Se. Plaintiffs'
Detendants' Preliminary Objections.
6. Denied. See Answer 5 above.
7. Denied. See Answer 5 supra.
B. Admitted as cited.
9. Denied.
10. Denied.
11. Denied.
12. Admitted.
13. Admitted.
99370/011
Brief in opposition to
,
WHEREFORE, Plaintiffs request this
Preliminary Objeotions of Defendants,
Bronfman, and A.Z. Ritzman Assooiates.
Court to Dismiss the
stewart, Hottenstein,
IV.
35. Admitted.
36. Denied. Pa. R.C.P. No. 1019 (a) states I
The material faots on whioh a oause of action or defen.e
is based shall be stated in a oonoi.e and summary form.
37. Denisd. See Answer 5 supra.
38. Denied. Sse Answer 5 supra.
39. Denied. See Answer 5 supra.
40. Denied. See Answer 5 supra.
41. Denied. See Answer 5 supra.
42. Admitted.
43. Denied.
44. Denied.
WHEREFORE, Plaintiffs request this
Preliminary Objections of Defendant"
Bronfman, and A. Z. Ritzman Associates.
Court to Dismiss the
stewart, Hottenstein,
Dated I '/,/'/ (Ie,
Respeotfully Submitted,
ANGINO , ROVNER, P.C.
. ~ - '- /7 /'
,~'~l.() --;~'-I~I'o'''L
~UAN S.~ARRIC;;- ESQUIRE
I.D. No. 77400
4503 North Front street
Harrisburg, PA 17110
(717) 238-6791
Attorneys for plaintiff
,
to the accuracy or inaccuracy of the corresponding av~rments of
Plaintiff's Complaint and the same are accordingly denied.
3-5. Admitted.
6. Admitted in part and denied in part. It is admitted
that Associates is a corporation with offices located in
Cumberland County, Pennsylvania. It is specifically denied that
Associates is a medical corporation. It is admitted that the
issued and outstanding capital stock of Associates is owned by
physicians who specialize in radiology. It is specifically
denied that Associates practices radiology. It is specifically
denied that under the Medical Practice Act of 1985 that
Associates is authorized to practice medicine or radiology.
Under the Medical Practice Act of 1985 only an individual may be
licensed to practice medicine and surgery and therefore only an
individual may practice radiology. It is specifically denied
that Associates is an individual licensed to practice medicine,
surgery or radiology. It is admitted that Associates has a
contract with Holy Spirit Hospital pursuant to which radiologists
affiliated with Associates provide radiology services to Holy
Spirit Hospital. It is specifically denied that Associates
provides radiology services to Holy Spirit Hospital.
7. Denied. It is specifically denied that Drs. StewQrt,
Hottenstein and Bronfman, at any time relevant hereto, acted as
agents, apparent agents, servants, members, partners or employees
- 2 -
~
of Associates. It is specifically denied that the professional
conduct of Drs. Stewart, Hottenstein and Bronfman was within the
course and scope of their employment of Associates. To the
contrary, Associates does not have the power or authority to
supervise, direct or control the manner and nature in which Drs.
Stewart, Hottenstein and Bronfman discharge their professional
I
responsibilities and Associates can not be vicariously liable to
the Plaintiff on the causes of action set forth in Plaintiff's
Complaint.
8. Answering Defendants are advised by counsel and
therefore aver that the corresponding allegation of Plaintiff's
Complaint does not pertain to them and that no answer is
required.
9. Denied. It is specifically denied that Drs. Stewart,.
Hottenstein and Bronfman were agents, servants, employees, or
.
otherwise acting for or on behalf of Defendant, Holy Spirit
Hospital or any other natural person, partnership, corporation or
other legal entity. To the contrary, at all times relevant
hereto, Drs. Stewart, Hottenstein and Bronfman were independent
contractors with staff privileges to practice radiology at Holy
Spirit Hospital.
10. Admitted in part and denied in part. It is
specifically denied that when Mrs. Flickinger underwent x-rays
and radiological studies at Holy Spirit Hospital that Answering
- 3 -
.
Defendants were agents, apparent agents, servants, members,
partnera and employeea of Holy Spirit Hospital. To the contrary,
answers contained in '6 & 7 of this Anawer are herein
incorporated by reference. It is admitted that persons other
than radiologists who may have participated in Mrs. Flickinger's
x-ray studies, including clerical personnel, medical secretaries
and radiology technologists, wer.e employees of Defendant, Holy
Spirit Hospital.
11. Denied. It is specifically denied that all staff of
Holy Spirit Hospital including Answering Defendants, were agents,
servants, employees or otherwise acting for or on behalf of
Associates. To the contrary, answers contained in '6, 7 and 10
are herein incorporated by reference.
12. Denied. Answering Defendants have no first hand
knowledge of allegations contained in '12 of Plaintiff's
Complaint, were totally uninvolved in that aspect of her care and
the same is specifically denied. By way of further answer,
~lswering Defendants are advised that the corresponding
allegations of Plaintiff's Complaint do not pertain to them and
that no answer' is required.
13-14. Admitted in part and denied in part. It is admitted
that Mrs. Flickinger had a portable chest x-ray in the emergency
care unit of Holy Spirit Hospital on November 30, 1994 at 2015
hours. The allegation as to what the chest x-ray demonatrated is
- 4
"
specifically denied. The report of the chest x-ray is the best
evidence of what it demonstrated and the report is not accurately
summarized in '14 of Plaintitf's Complaint.
15. Denied. Answering Defendants have no first hand
knowledge of allegations contained in '12 of Plaintiff's
Complaint, were totally uninvolved in that aspect of her care and
the same is specifically denied. By way of further answer,
Answering Defendants are advised that the corresponding
allegations of Plaintiff's Complaint do not pertain to them and
that no answer is required.
16. Admitted.
17. Denied. It is specifically denied that the allegations
of '17 of Plaintiff's Complaint accurately characterize Dr.
Stewart's transcribed interpretation of the chest x-ray. The
report is the best evidence of Dr. Stewart's interpretation of
the chest x-ray and the report is not accurately summarized in
117 of Plaintiff's Complaint.
18. Denied. After reasonable investigation, and by reason
of the fact that the x-ray films have been removed from Holy
Spirit Hospital by or on behalf of the Plaintiff, Dr. Stewart is
unable to oonduct an investigation to ascertain the accuracy or
inaccuracy of the averment contained in '18 of Plaintiff's
Complaint and the same is specifically denied. By way of further
. 5 -
answer, when Dr. Stewart interpreted the chest film on December
7, 1994 he was not impressed with the change in thoracic aorta.
19-20. Denied. Mlswering Defendants have no first hand
knowledge of allegations contained in '12 of Plaintiff's
Complaint, were totally uninvolved in that aspect of her care and
the same is specifically denied. By way of further answer,
Answering Defendants are advised that the corresponding
allegations of Plaintiff's Complaint do not pertain to them and
that no answer is required.
21. Denied. After reasonable investigation, Answering
Defendants do not have information sufficient to form a beli,ef as
to the accuracy or inaccuracy to corresponding averment of
Plaintiff's Complaint and the same is accordingly denied.
22. Admitted.
23. Admitted in part and denied in part. It ls admitted
that a chest x-ray was imaged at Holy Spirit Hospital on December
30, 1994 and interpreted by Dr. Hottenstein. The
characterization of Dr. Hottenstein's report is specifically
denied. The report itself is the best evidence of Dr.
Hottenstein's interpretation of the chest x-ray (2 views) and the
report is not accurately summarized in '23 of Plaintiff's
Complaint.
24. Denied. After reasonable investigation, and by reason
of the fact that the x-ray films have been removed from Holy
- 6 -
Spirit Hospital by or on beha~f of the Plaintiff, Dr. Hottenstein
is unable to conduct an investigation to ascertain the accuracy
or inaccuracy of the averment contained in '24 of Plaintiff's
Complaint and the same is specifically denied. By way of further
answer, when Dr. Stewart interpreted the chest film on December
7, 1994 he was not impressed with the change in thoracic aorta.
25. Denied. After reasonable investigation, Answering
Defendants do not have information sufficient to form a belief as
to the accuracy or inaccuracy to corresponding averment of
Plaintiff's Complaint and the same is accordingly denied.
26. Admitted.
27. Admitted in part and denied in part. It is admitted
that a chest x-ray was imaged at HQly Spirit Hospital on December
30, 1994 and interpreted by Dr. Bronfman. The characterization
of Dr. Bronfman's report is specifically denied. The report
itself is the best evidence of Dr. Bronfman's interpretation of
the chest x-ray (2 views) and the report is not accurately
summarized in '27 of Plaintiff's Complaint.
28. Denied. After reasonable investigation, and by reason
of the fact that the x-ray films have been removed from Holy
Spirit Hospital by or on behalf of the Plaintiff, Dr. Bronfman is
unable to conduct an investigation to ascertain the accuracy or
inaccuracy of the averment contained in '28 of Plaintiff's
Complaint and the same is specifically denied. By way of further
- 7 -
answer, when Dr. Stewart interpreted the chest film on December
I
7, 1994 he was not impressed with the change in thoracic aorta.
29-30. Denied. Answering Defendants are advised by counsel
and therefore aver that the corresponding allegations of
~laintiff's Complaint do not pertain to them and that no answer
is required. By way of further answer, after reasonable
investigation, Answering Defendants do not have information
sufficient to form a belief as to the accuracy or inaccuracy of
this corresponding averment of Plai,ntiff's Complaint and the same
is accordingly denied.
31. Denied. By way of further answer, answers to '6, 7, 10
& 11 are herein incorporated by reference. It is specifically
denied that Answering DefendantR were negligent. It is
specifically denied that Answering Defendants are alone liable or
jointly and severally liable with others to Plaintiff.
32. Denied. It is specifically denied that Answering
Defendants were negligent or that their conduct caused or
contributed to the injuries as alleged in Plaintiff's Complaint.
33. Denied. It is specifically denied that Associates had
the right and duty to exercise control, authority and supervision
over all agents, apparent agents, servants, members, partners or
employees who provided radiological services to its clients. It
is specifically denied that Associates had clients or patients.
- 8 -
By way of further answer, answers contained in '6, 7, 10 and 11
are harein incorporated by reference.
COUNT I
NEIL R. FLICKINGER, INDIVIDUALLY, AND AS ADMINISTRATOR OF
THE ESTATE OF BETTY J. FLICKINGER
V.
RICHARD P. STEWART. M.D.
34. Answers contained in '1 through 33 above are herein
incorporated by reference.
35. Denied. It is specifically denied that Dr. Stewart was
negligent or that his conduct caused or contributed to the
injuries as alleged in Plaintiff's Complaint. 9y way of further
answer, Dr. Stewart is advised by counsel and therefore avers
that the allegations contained in subparagraphs (a) . (1) of '35
of Plaintiff's Complaint are denied by operation of law pursuant
to Pa.R.C.P. 1029(e) and that no further answer is required.
36. Denied. It is specifically denied that Dr. Stewart was
negligent or that his conduct caused or contributed to the
injuries as alleged in Plaintiff's Complaint.
WHEREFORE, Defendant, Richard P. Stewart, M.D., demands
judgment in his favor and against Plaintiff.
COUNT II
NEIL R. FLICKINGER, INDIVIDUALLY, AND AS ADMINISTRATOR OF
THE ESTATE OF BETTY J. FLICKINGER
V.
DANIEL W. HOTTENSTEIN. M.D.
. 9 .
37. Answers contained in '1 through 36 above are herein
incorporated by reference.
38. Denied. It is specifically denied that Dr. Hottenstein
was negligent or that his conduct caused or contributed to the
injuries as alleged in Plaintiff's Complaint. By way of further
answer, Dr. Hottenstein is advised by counsel and therefore avers
I
that the allegations contained in subparagraphs (a) - (1) of '35
of Plaintitf's Complaint are denied by operation of law pursuant
to ~a.R.C.~. 1029(e) and that no further answer is required.
39. Denied. It is specifically denied that Dr. Hottenstein
was negligent or that his conduct caused or contributed to the
injuries as alleged in Plaintiff's Complaint.
WHEREFORE, Defendant, Daniel W. Hottenstein, M.D., demands
judgment in his favor and against Plaintiff.
QQYNT III
NEIL R. FLICKINGER, INDIVIDUALLY, AND AS ADMINISTRATOR OF
THE ESTATE OF BETTY J. FLICKINGER
V.
HOWARD J. BRONFMAN. M.D.
40. Answers contained in '1 through 40 above are herein
incorporated by reference.
41. Denied. It is specifically denied that Dr. Bronfman
was negligent or that his conduct caused or contributed to the
injuries as alleged in Plaintiff's Complaint. By way of further
answer, Dr. Bronfman is advised by counsel and therefore avers
- 10 -
.
that the allegations contained in subparagraphs (a) . (1) of '35
of Plaintiff's Complaint are denied by operation of law pursuant
to Pa.R.C.P. 1029(e) and that no further answer is required.
42. Denied. It is specifically denied that Dt'. Bronfman
was negligent or that his conduct caused or contributed to the
injuries as alleged in Plaintiff's Complaint.
WHEREFORE, Defendant, Howard F. Bronfman, M.D., demands
judgment in his favor and against Plaintiff.
COUNT IV
NEIL R. FLICKINGER, INDIVIDUALLY, AND AS ADMINISTRATOR OF
THE ESTATE OF BET'I'Y J. FLICKINGER
V.
THE A.Z. RITZMAN ASSOCIATES. INC. and HOLY SPIRIT HOSPITAL
43. Answers contained in '1 through 42 above are herein
incorporated by reference.
44. Denied. It is specifically denied that Associates were
rendered radiology or medical services to Plaintiff. By way of
further answer, answers contained in '6, 7, 10 and 11 are herein
incorporated by reference.
45. Admitted in part and denied in part. It is admitted
that Drs. Stewart, Hottenstein and Bronfman were radiologists and
physicians. It is specifically denied that Drs. Stewart,
Hottenstein and Bronfman performed any professional services with
respect to the Plaintiff as agents, servants, employees or
otherwise acting for or on behalf of either Associates or Holy
. 11 -
Spirit Hospital. Answers contained in 16, 7, 10 and 11 are
herein incorporated by reference.
46. Denied. After reasonable investigation, Answering
Defendants do not have information sufficient to form a belief as
to the accuracy or inaccuracy of the co~re$ponding averment of
Plaintiff's Complaint and the same is accordingly denied.
47. Denied. It is specifically denied that Associates was
negligent or that his conduct caused or contributed to the
injuries as alleged in Plaintiff's Complaint. It is specifically
denied that Associates performed any professional services or
interpreted any x-rays or made any diagnoses or rendered any
professional opinions with respect to the care and treatment of
Plaintiff's decedent. Answers contained in 16, 7, 10 and 11 are
herein incorporated by reference. By way of further answer,
Associates is advised by counsel and therefore avers that the
allegations contained in subparagraphs (a) - (0) of 147 of
Plaintiff's Complaint are deemed to be denied by operation of law
pursuant to Pa.R.C.P. 1029(e) and that no further answer is
required.
48. Denied. It is specifically denied that Associates was
negligent or that its conduct caused or contributed to the
injuries as alleged in Plaintiff's Complaint.
WHEREFORE, A.Z. Ritzman Associates, Inc., demands judgment
in its favor and against Plaintiff.
- 12 -
CLAIM I
,SURVIVAL ACTION
NEIL R. FLICKINGER, INDIVIDUALLY, AND AS ADMINISTRATOR OF
THE ESTATE OF BETTY J. FLICKINGER
V.
RICHARD P. STEWART, M.D.1 DANIEL W. HOTTENSTEIN, M.D.,
HOWARD J. BRONFMAN, M.D.r THE A.Z. RITZMAN ASSOCIATES, INC.r
and HOLY SPIRIT HOSPITAL
4~. Answers contained in '1 through 48 above are herein
incorporated by reference.
50. Denied. Answering Defendants are advised by counsel
and therefore aver that the corresponding allegation of
Plaintiff's Complaint states a conclusion of law to which no
reply is required.
51. Denied. It is specifically denied that Answering
Defendants were negligent or that they are alone liable or
jointly and severally liable with others to the Estate of Betty
J. Flickinger.
52. Denied. After reasonable investigation, Answering
Defendants do not have informd,tion sufficient to form a belief as
to the accuracy or inaccuracy of the corresponding averment of
Plaintiff's Complaint and the same is accordingly denied.
WHEREFORE, Richard P. Stewart, M.D., Daniel W. Hottenstein,
M.D., Howard J. Bronfman, M.D., and A.Z. Ritzman Associates,
Inc., demand judgment in their favor and against Plaintiff.
. 13 .
CLAIM II
WRONGFUL DEATH
NEIL R. FLICKINGER, INDIV1DUALLY, AND AS ADMINISTRATOR OF
THE ESTATE OF BETT~ J. FLICKINGER
V.
RICHARD P. STEWART, M.D.I DANIEL W. HOTTENSTEIN, M.D.,
HOWARD J. BRONFMAN, M.D./ THE A.Z. RITZMAN ASSOCIATES, INC.,
and-HOLY SPIRIT HOSPITAL
53. Answers contained in '1 through 52 above are herein
incorporated by reference.
54. Denied. Answering Defendants are advised by counsel
and therefore aver that the corresponding allegation of
Plaintiff's Complaint states a conclusion of law to which no
reply is required.
55-58. Denied. After reasonable investigation, Answering
Defendants do not have information sufficient to form a belief as
to the accuracy or inaccuracy of the corresponding averment of
Plaintiff's Complaint and the same is accordingly denied.
59. Denied. It is specifically denied that Answering
Defendants were negligent, that they are liable to Plaintiff or
that they are jointly and severally lJ.able with other Defendants
to the Plaintiff.
WHEREFORE, Richard P. Stewart, M.D., Daniel W. Hottenstein,
M.D.. Howard J. Bronfman, M.D., and A.Z. Ritzman Associates,
Inc., demand judgment in their favor and against Plaintiff.
- 14 -
NEW MATTER
60. Facts set forth in the foregoing answers to Plaintiff's
Complaint are incorporated herein by reference as though fully
set forth at length.
61. At no time relevant hereto were Drs. Stewart,
Hottenstein, and Bronfman agents, servants, employees or
otherwise acting for or on behalf of any
other Defendant in this action or any other natural person,
partnership, corporation or other legal entity.
62. At no time relevant hereto was any other natural
person, partnership, corporation or other legal entity acting or
serving as an agent, servant, employee or otherwise for or on
behalf of Drs. Stewart, Hottenstein and Bronfman.
63. At no time relevant hereto was Associates an agent,
servant, employee or otherwise acting for or un behalf of any
other Defendant in this action or any other natural person,
partnership, corporation or other legal entity.
64. At no time relevant hereto was any other natural
person, partnership, corporation or other legal entity acting or
serving as an agent, servant, employee or otherwise for or on
behalf of Associates.
65. Associates did not render any medical or surgical or
professional services to Plaintiff's decedent. Associates is not
and cannot be vicariously liable for the conduct of Drs. Stewart,
- 15 -
Hottenstein and Bronfman. Under the Pennsylvania Medical
Practice Act of 1995, 63 P.S., 5422.10 et Beq., on~y an
individual person may be licensed as a medical doctor to practice
medicine and surgery. At no time hereto was Associates licensed
as a medical doctor and Associates did not in fact have the right
to supervise, direct or control the manner in which Drs. Stewart,
Hottenstein and Bronfman provided professional services to Betty
J. Flickinger.
66. In the event it is ultimately determined that
Associates is liable to Plaintiff, which liability is
specifically denied, under the Pennsylvania Professional
Corporation Law, 15 Pa.C.S.A. 52925(c), the professional
corporation may be held liable only to the extent of the value of
its property.
67. At all times relevant hereto Drs. Stewart, Hottenstein
and Bronfman complied with the applicable standard of care.
69. All care and treatment rendered to Plaintiff's decedent
by the employees, agents, apparent agents and/or servants of
Associates was appropriate, reasonable and within the applicable
standard of care.
69. At all times relevant hereto Drs. Stewart, Hottenstein
and Bronfman acted within and followed the precepts of a
respected school of thought and, accordingly, their professional
conduGt was fully commensurate with the applicable standard of
- 16 -
care. Evidence at trial may establish two or more schools of
thought applicable to the issues presented in this case.
70. Plaintiff's decedent assumed the risk of her injuries
and this action is therefore barred by the Doctrine of Assumption
of Risk.
71. Answering Defendants believe and therefore aver that
evidence accumulated through discovery and provided at trial may
establish Plaintiff's decedent was contributorily or
comparatively negligent, and in order to protect the record, Drs.
Stewart, Hottenstein and Bronfman hereby pleads contributory and
comparative negligence as an affirmative defense.
72. Answering Defendants are entitled to contribution in
accordance with the Pennsylvania Comparative Negligence Act, 42
P.G. ~7102.
73. In the event that it is determined that Answering
Defendants were negligent with regard to any of the allegations
contained in, and with respect to Plaintiff's Complaint, said
allegations being specifically denied, said negligence was
superseded by the intervening negligent acts of other persons,
parties and/or organizations other than answering Defendant and
over whom said Answering Defendants had no control, right or
I'esponsibility and, therefore, Drs. Stewart, Hottenstein and
Bronfman are not liable.
. 17 .
74. At all times relevant hereto, Drs. Stewart, Hottenstein
and Bronfman were competent and qualified physicians acting in
compliance with the applicable standard of care.
75. To the extent that the evidence may show that other
persons, partnerships, corporations or other legal entities
caused or contributed to the injuries or exacerbation of the pre-
existing condition of Plaint if f' s decedent, then the conduct of
the Answering Defendants was not the legal cause of such
condi t ions or inj uries .
76. Any acts or omissions of Answering Defendants alleged
to constitute negligence were not substantial factors
contributing and the injuries and da.mages alleged in Plaintiff's
Complaint.
77. Whatever injuries and damages, if any, were sustained
by Plaintiff as averred in Plaintiff's Complaint, were caused in
whole or in part by persons or entities over whom Answering
Defendants had no duty to supervise or control, then Answering
Defendants are not liable, and Plaintiff may not recover against
them.
78. Plaintiff's decedent's injuries and losses, if any,
were not caused by the conduct or negligence of Answering
Defendants but rather were caused by pre-existing medical
conditions and causas beyond the control of Answering Defendants,
Plaintiff may not recover against them.
- 18 -
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NEIL R. FLICKINGER, Individually,
and as the Administrator of the
ESTATE OF BETTY J. FLICKINGER,
DECEASED,
Plaintiff
v.
RICHARD P. STEWART, M.D.,
DANIEL W. HOTTENSTEIN, M.D.,
HOWARD J. BRONFMAN, M.D., THE
A. Z. RITZMAN ASSOCIATES, INC.,
and HOLY SPIRIT HOSPITAL
Defendants
t IN THE COURT OF COMMON PLEAS
I CUMBERLAND COUNT~, PENNA
I
I
I NO. 96-3954 civil
I
I
I CIVIL ACTION - LAW
I
t
I
I JUR~ TRIAL DEMANDED
I
I
PLAINTIFF'S RESPONSE TO NEW MATTER OF DEFENDANTS,
RICHARD P. STEWART, M.D., ~ANIEL W. HOTTENSTEIN, M.D.,
HOWARD. J. BRONFMAN. M.D.. & A. Z. RITZMAN ASSOCIATES. INC..
60. The allegations require no response. To the extent that
any response is required, said allegations are denied.
61. The allegations constitute conolusions of law to which no
response is required. To the extent that any response is reqUired,
said allegations are denied.
Ora. stewart, Hottenstein, and
Bronfman were and are agents, servants employees or otherwise
acting for or on behalf of any other Defendant in this action or
any other natural person, partnership, oorporati~n or other legal
entity. The doctors were and nre agents of A. Z. Ritzman, Inc. and
Holy Spirit Hoapital.
62. The allegations constitute conclusions of law to which no
response is required. To the extent that IIny response is required,
said allegations are denied.
102623/LAWI
63. The allegations oonstitute oonolusions of law to whioh no
response b reQuired. To the extent that any response is required,
said allegations are denied.
64. The allegations oonstitute conolusions of law to whioh no
response b required. To the extent that any response is required,
said allegations are denied.
65. The allegations oonstitute conolusions of law to whioh no
response is required. To the extent that any response is required,
said allegations are denied you have lost this argument and may not
roargue it at this time.
66. The allegations oonstitute oonolusions of law to whioh no
response is required. To the extent that any responS4 is required,
said allegations are denied you have lost this argument and may not
reargue it at this time.
67. The allegations oonstitute oonolusions of law to whioh no
response is required. To the extent that any response is required,
said allegations are denierl. The Defendants were negligent in
every conoeivable fashion and this negligenoe directly oaused
Plaintiff's injuries.
68. The allegations oonstitute oonolusions of law to which no
respOl1se is required. To the extent. that any response is required,
eaid allegations are denied. The Defendants were neqligent in
every conoeivable fashlon and this negligence directly caused
Plaintiff's injuries.
2
69. The allegations constitute conclusions of law to whioh no
response is required. To the extent that any response is required,
said allegations are denied. The conduct of Drs. stewart,
Hottenstein and Bronfman was not commensurate with the applicable
standard of care. Two schools of thought is not applioable to this
case.
70. The allegations constitute conclusions of law to which no
response is required. To the extent that any response is required,
said allegations are denied. Plaintiff's decedent did not assume
the risk. To the contrary, she placed her trust in Defendant' s
property to do their job and they failed to do so.
71. The allegations constitute conclusions of law to which no
response is required. To the extent that any response is required,
said allegations are denied. Plaintiff's decedent was no~
contributorily or comparatively negligent in any fashion.
72. The allegations constitute conclusions of law to which no
response is required. To tho extent that any response is required,
said allegations are denied. Answering Defendants are not entitled
to contribution.
73. The allegations constitute conclusions of law to which no
response is required. To the extent that any response is required,
said allegations are denied. The negligence of Drs. stewart,
Hottenstein and Bronfman was not superseded by intervening
negligent acts of other parties. Defendants' negligence directly
and proximately caused Plaintiff's injuries.
3
74. The allegations oonstitute conclusions of law to whioh no
response is required. To the extent that any response is required,
said allegations are denied. Drs. stewart, Hottenstein, and
Bronfman did not comply with the applicable standard of care and
their negligence directly and proximately caused Plaintiff's
injuries.
75. The allegations constitute conclusions of law to which no
r.esponse is required. To the extent that any response is required,
said allegations are denied. Answering Defendants' conduct was the
proximate cause of Plaintiff's decedent's injuries.
76. The allegations constitute conclusions of. law to which no
response is required. To the extent that any response is required,
said allegations are denied. Answering Defendants' negligence
caused or substantially contributed to Plaintiff's decedent's harm.
77. 'rhe allegations constitute conclusions of law to which no
response is required. To the extent that any response i.s required,
said allegations are denied. Plaintiff's decedent's injuries were
caused by Answering Defendants' negligence, as alleged in
Plaintiff's Complaint.
78. The allegations constitute conclusions of law to which no
response is required. To the extent that any response is required,
said allegations are denied. Plaintiff's injuries were caused by
Answering Defendants' negligence, not conditions or causes beyond
the control of Answering Defendants.
4
79. The alle'iJations oonstitute oonclusions of law to which no
re.pon.. is required. Tu the extent that any response is required,
said allegations are denied.
Answering Defendants' negligence
cau.ed plaintiff'. decedent's injurio.,
Re.pectfully SUbmitted,
ANGINO 'ROVNER, P.C.
Datedl
,
\..,.. S' ..../."~" .,k
I "'t-A..,.~- . . p . c..".'
DUANE S. BARRICK, ESQUIRE
I.D. No. 7'1400
4503 North Front Street
Harrisburg, PA 17110
(717) 238-6791
Attorney. for plaintiff
5
NBIL R. FLICKINGER, I IN THB COURT OF COMMON PLBAS OF
Individually, and as the I CUMBBRLAND COUNTY, PBNNSYLVANIA
ADMINISTRATOR OF THB I
BSTATB OF BBTTY J. I
FLICKINGBR, DBCBASBD I
I
I
V. I
I
I
RICHARD P. STBWART, M.D.,: NO. 96-3954 CIVIL TBRM
DANIBL W. HOTTBNSTBIN, I
M.D., HOWARD J. BRONFMAN,1
M.D., THE A.Z. RITZMAN I
ASSOCIATBS, INC. I CIVIL ACTION - LAW
I
VIRDICT SLIP
1. Do you find that any of the following Defendant. were
negligent? (You must answer lIS or NO for each).
a) Richard Stewart, M.D. YES NOZ
b) Daniel Hottenstein, M.D. YES NO
"
c) Howard Bronfman, M.D. YES NO ./
v
If your answer is YES as to any of the doctors, prooeed to
question No.2.
If your answer is NO as to all of the doctors, return to the
Courtroom.
2. Do you find that the negligence of any of the Defendsnts
was a substantial factor in bringing about ha~ to Mrs.
rlickinger? (Only answer for any 60ctor you answered iBI to in
question Ho. 1).
a) Richard Stewart, M.D. YES NO
b) Daniel Hottenstein, M.D. YES NO
c) Howard Bronfman, M.D. YES NO
If your answer is YES as to any of the doctors, proceed to
question No.3. If your answer is NO as to all remaining
doctors, return to the Courtroom.
3) Plea.e state the amount 01 damages you award I
a)
Funeral Bills and other Relatod Expenses,
Loss of Services, Sooiety and Comfort $
b)
Pain and Suffering $_
TOTAL $
ONCE COMPLETBP, RBTURN TO THB COURTROOM.
DATB
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