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HomeMy WebLinkAbout03-0531MARY ANN ALHAJ and IBRAHIM ALHAJ, her husband Plaintiffs V. KWAN H. WON, M.D. 3810 Trindle Road Camp Hill, PA 17011 KWAN H. WON, M.D., P.C. 3810 Trindle Road Camp Hill, PA 17011 Defendants IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION - LAW NO. ?p3, r JURY TRIAL DEMANDED PRAECIPE FOR WRIT OF SUMMONS TO THE PROTHONOTARY OF SAID COURT: Please issue writ of summons in the above-captioned action. Writ of Summons shall be issued and forwarded to ( ) Attorney (x) Sheriff Respectfully submitted, ANGINO & RO?VNER, P. . Neil J. RcAlm?f squ? t I.D. No((2210 4503 N. Front Street Harrisburg, PA 17110 (717) 238-6791 Date: Counsel for Plaintiff(s) ZIu?C? WRIT OF SUMMONS TO THE ABOVE NAMED DEFENDANT(S): YOU ARE NOTIFIED THAT THE ABOVE-NAMED PLAINTIFFS HAVE COMMENCED AN ACTION AGAINST YOU. Prothonotary Date:- by Dep y 256256.1\NJR\MAR -rak W J w ? REGULAR SHERIFF S RETUR 00531 P ASE NO: 2003 OF PElvSYLVANIA? AUNT W OFL CUMBERL D v LJ ET CRY AID AL VS ff WON Deputy Sheri of .?----- KWAN 1 aw , Sheriff or duly sworn according to JASON VIORAL lvania, who being pennsY was served upon Cumberland County _ the the within WRIT OF SUMMONS says, WON KWAN H MD at 1359:00 HOURS, DEFENDANT ` Tp_T_ND E ROAD at 3810 PA 17011 AMP HILL C KWAN WON OF SUMMONS attested copy °f WRIT a true and together with is attention to the contents thereo= ting and at the same time direc Sheriff's Costs: Docketing Service Affidavit Surcharge 3-7 5th day of Februar , 18.00 9.66 .00 10.00 00 2003 on the __.-- by handing to so Answers: J R Thomas Kline 02/06/2003 ANGINO & ROVNER By: Sworn and Subscribed to before day of me this A•D rothonotary SHERIFF'S RETURN - REGULAR CASE NO: 2003-00531 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND ALHAJ MARY ANN ET AL VS WON KWAN H MD JASON VIORAL Sheriff or Deputy Sheriff of Cumberland County,Pennsylvania, who being duly sworn according to law, says, the within WRIT OF SUMMONS WON KWAN H MD PC was served upon the DEFENDANT , at 1359:00 HOURS, on the 5th day of February , 2003 at 3810 TRINDTF RnAn CAMP HILL, PA 17011 KWAN WON a true and attested copy of WRIT OF SUMMONS together with and at the same time directing His attention to the contents thereof. Sheriff's Costs: Docketing 6.00 Service .00 Affidavit .00 Surcharge 10.00 11 1 V . V V Sworn and Subscribed to before me this 7 day of /I?ar 1? X13 A.D. rothonotary So Answers: ?,, R. Thomas Kline 02/06/2003 ANGINO * ROVNER By: 2 e ty heriff by handing to MARY ANN ALHAJ and IN THE COURT OF COM ON PLEAS IBRAHIM ALHAJ, her husband CUMBERLAND COUNTY PA Plaintiffs CIVIL ACTION - LAW V. NO. 03-531 KWAN H. WON, M.D., and KWAN H. WON, M.D., P.C. Defendants JURY TRIAL DEMAND NOTICE TO DEFEND You have been sued in court. If you wish to defend against the claims set forth in must take action within twenty (20) days after this Complaint and Notice are served, by ente personally or by attorney and filing in writing with the Court your defenses or objections to tl you. You are warned that if you fail to do so the case may proceed without you and a judgme you by the Court without further notice for any money claimed in the Complaint or for requested by the Plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF Y LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FC OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Bar Association 2 Liberty Avenue Carlisle, PA 17013 800/990-9108 NOTICIA Le han demandado a usted en la corte. Si usted quiere defenderse de estas demandas sugnuientes, usted tiene viente (20) dias de plazo al partir de la fecha de la demands y la n presentar una apariencia escrita o en persona o por abogado y archivar en la corte en forma e objeciones a las demandas en contra de su persona. Sea avisado que si usted no se defiende, la puede entrar una orden contra usted sin previo aviso o notificacion y por cualquier queja o a] peticion de demanda. Usted puede perder dinero o sus propiedades o otros derechos importante; LLEVE ESTA DEMANDA A UN ABOGADO IMMEDIATEMENTE. SI NO TIENE EL DINERO SUFICIENTE DE PAGAR TAL SERVICIO, VAYA EN I TELEFONO A LA OFICINA CUYA DIRECCION SE ENCUENTRA ESCRITA A DONDE SE PUEDE CONSEGUIR ASISTENCIA LEGAL. Cumberland County Bar Association 2 Liberty Avenue Carlisle, PA 17013 800/990-9108 e following pages, you ig a written appearance claims set forth against may be entered against v other claim or relief DO NOT HAVE A I BELOW TO FIND expuestas en las paginas etificacion. Usted debe >crita sus defensas o sus corte tomara medidas y ivio que es pedido en la para usted. ABOGADO O SI NO JA O LLAME POR PARA AVERIGUAR 258704.1\NJR\MAR MARY ANN ALHAJ and IN THE COURT OF COM ON PLEAS IBRAHIM ALHAJ, her husband CUMBERLAND COUNTY, PA Plaintiffs V. KWAN H. WON, M.D., and KWAN H. WON, M.D., P.C. Defendants CIVIL ACTION - LAW NO. 03-531 JURY TRIAL DEMAND COMPLAINT 1. Mary Ann Alhaj and Ibrahim Alhaj, are husband and wife and Mechanicsburg, Cumberland County, Pennsylvania. 2. Defendant Kwan H. Won, M.D., is a licensed physician who adult residents of himself out as a specialist in otolaryngology, practicing in Cumberland County, Pennsyly ia. Plaintiffs are asserting a professional liability claim against the Defendant. A Certificate o Merit is filed herewith. 3. Defendant Kwan H. Won, M.D., P.C. is a corporate medical practice the employer and master of Defendant Kwan H. Won, M.D. 4. The facts and occurrences hereinafter related took place on or about 5. On or about November 28, 2000, Mary Ann Alhaj sought prof Defendant Kwan H. Won, M.D., because of complaints of dizziness and r 6. At that time Dr. Won indicated to Mary Ann Alhaj that she had referred her to Johns Hopkins Medical Center in Baltimore, Maryland. at all times was 6, 2001. services of the s Disease and 7. Mary Ann Alhaj went to Johns Hopkins Hospital where she was t?ld that she did not have the signs and symptoms of Meniere's Disease. 8. By letter of December 15, 2000, Dr. Howard W. Francis, of the Johns Hopkins Outpatient Otolaryngology, Head and Neck Surgery Section, informed Dr. on that Mary Ann Alhaj had "normal peripheral vestibular disfunction testing in the office." 258704.1 \NJR\MAR 9. Dr. Francis informed Defendant Dr. Won that Mary Ann Alhaj h?d only "mild low frequency mixed hearing loss." 10. Dr. Francis informed Defendant Dr. Won "I do not believe the Meme e Disease is active nor any other labyrinthine disorder at this time." 11. Nevertheless, Defendant, Dr. Won, insisted to Mary Ann Alhaj that she did have Meniere's Disease and that the bilateral injections of Gentamycin would provide her with relief. 12. Plaintiff Mary Ann Alhaj returned to Defendant Kwan H. Won, M.D., on January 16, 2001, at which time he insisted that his testing showed that she had Menie e's Disease and he recommended injections of Gentamycin, an ototoxic drug in her ears. 13. Defendant Kwan H. Won, M.D., did not explain to Mary Ann Al aj that findings of Meniere's Disease on his testing were equivocal and did not establish a diagnosis of the disease. 14. Defendant Kwan H. Won, M.D., did not tell Mary Ann Alhai that injections of Gentamycin in both ears at the same time was not an accepted or standard of treatment of Meniere's Disease. 15. On or about February 6, 2001, Defendant Kwan H. Won, M.D., instilled Gentamycin into both of Mary Ann Alhaj's ears, at the same time. 16. Defendant Kwan H. Won, M.D., did not discuss Mary Ann Alhaj' condition with the doctors at Johns Hopkins Hospital. 17. As a result of the bilateral injections of Gentamycin, she has su fered hearing loss, increased disequilibrium, permanent and irreparable damage to her disfunction and inability to go about her activities of daily living. ring and vestibular 258704. ] \NJR\MAR COUNT - I NEGLIGENCE Won. M.D.. and Kwan H. Won. M.D.. P.C. 18. Paragraphs 1 through 17 are incorporated herein as if set forth at 19. The aforesaid consequences were the direct and proximate result of tho negligence of Dr. Kwan Won and Kwan H. Won, M.D., P.C., as follows: a. Insisting that Mary Ann Alhaj had Meniere's Disease when neither l[iis testing nor the testing nor the testing at Johns Hopkins Hospital provided evide ce of Meniere's Disease; b. Performing simultaneous bilateral Gentamycin injections, a procedure which is completely inappropriate and below the standard of care. c. Failing to inform Mary Ann Alhaj that a bilateral injection of Gentamy in is not done and would compromise the hearing in both ears at the same time; d. Utilizing an experimental, untried and dangerous method of treatment not used for the treatment of Meniere's Disease, i.e., bilateral injections of Gentamycin. 20. The injuries suffered by Mary Ann Alhaj and the failure to alleviate hor condition, but in fact to make it worse were the direct result of the negligence of Defendant D4. Won in utilizing inappropriate diagnostic and treatment methods as set forth above. WHEREFORE, Plaintiff Mary Ann Alhaj demands judgment against amount in excess of Twenty-Five Thousand ($25,000) Dollars, exclusive of 1 in excess of any jurisdictional amount requiring compulsory arbitration. Defendants, in an and costs, and 258704.1 \NJR\MAR CLAIM I - DAMAGES Alhai v. Kwan H. Won, M.D., and K 21. Paragraphs 1 through 20 are incorporated herein as if set forth at lengtl 22. Plaintiff Mary Ann Alhaj incurred expenses in attempt to treat her medic 23. As a result of her treatment and its attendant consequences, Plaintiff hE income and, in the future, will suffer a loss of earnings and earning potential, therefor. 24. As a direct result of her treatment, Plaintiff will have to live with made therefor. 25. As a direct result of her treatment, Plaintiff Mary Ann Alhaj has underg future undergo, great mental and physical pain and suffering, great inconvenie her daily activities, and a loss of life's pleasures and enjoyment, and claim is mad 26. As a direct result of her treatment, Plaintiff Mary Ann Alhaj has expel embarrassment and disfigurement and claim is made therefor. 27. As a direct result of Defendants' negligence, Plaintiff Mary Ann AIN permanent injury of loss of hearing. 28. As a direct and proximate result of Defendants' negligence as set forth are liable to Plaintiff for the injuries alleged herein. WHEREFORE, Plaintiff Mary Ann Alhaj demands judgment against amount in excess of Twenty-Five Thousand ($25,000) Dollars, exclusive of inte in excess of any jurisdictional amount requiring compulsory arbitration. condition. suffered a loss of claim is made pain and claim is and will in the in carrying out therefor. humiliation, has experience a Defendants Defendants, in an and costs, and 258704.1 \NJR\MAR CLAIM II - LOSS OF CONSORTIUM 29. Paragraphs 1 through 28 are incorporated herein as if set forth at 1 30. As a result of the injuries suffered by his wife, Plaintiff Mary Ibrahim Alhaj has lost the companionship, consortium and society of his wife. WHEREFORE, Plaintiff Ibrahim Alhaj, demands judgment against De Alhaj, Plaintiff ts, Kwan H. Won, M.D., and Kwan H. Won, M.D., P.C., in an amount in excess of TwOty-Five Thousand ($25,000) Dollars, exclusive of interest and costs, and in excess of any jurisdictional amount requiring compulsory arbitration. Date: N #Q Respectfully submitted, ANGINO & ROVNER, P Neil J. E I.D. 8 /ront squ re 450 Street Harrisburg, PA 17110 (717) 238-6791 Counsel for Plaintiff(s) 258704.1 \NJR\MAR MARY ANN ALHAJ and IN THE COURT OF COM ON PLEAS IBRAHIM ALHAJ, her husband CUMBERLAND COUNTY PA Plaintiffs V. KWAN H. WON, M.D., and KWAN H. WON, M.D., P.C. Defendants CIVIL ACTION LAW NO. 03-531 JURY TRIAL DEMANDE13 Certificate of Merit as to Kwan H. Won, M.D. I, Neil J. Rovner, certify that: (XXX) an appropriate licensed professional has supplied a written statement to the undersigned that there is a basis to conclude that the care, skill o knowledge exercised or exhibited by this defendant in the treatment, practice or work tat is the subject of the complaint, fell outside acceptable professional standards and that such conduct was a cause in bringing about the harm; OR ( ) the claim that this defendant deviated from an acceptable professional standard is based solely on allegations that other licensed professionals for whom thi defendant is responsible deviated from an acceptable professional standard and an appropriate licensed professional has supplied a written statement to the undersigned that there is a basis to conclude that the care, skill or knowledge exercised or exhibited by the other licensed professional in the treatment, practice or work that is the subject of the complaint, fell outside acceptable rofessional standards and that such conduct was a cause in bringing about the harm; OR ( ) expert testimony of an appropriate licensed professional is unnecessary for prosecution of the claim against this defendant. Date: 4/8/03 Neil J. F ~r, FAquire 259091.1 \NJR\MAR VERIFICATION I, Mary Ann Alhaj, Plaintiff, have read the foregoing Complaint and Rio hereby swear or affirm that the facts set forth in the foregoing are true and correct to the best of my knowledge, information and belief. I understand that this Verification is made subject to the penalties of 18 Pa.C.S.A. Section 4904, relating to unsworn falsification to authorities. WITNESS: Witness Dated: Ll VERIFICATION I, Ibrahim Alhaj, Plaintiff, have read the foregoing Complaint and do that the facts set forth in the foregoing are true and correct to the best of my and belief. I understand that this Verification is made subject to the penalti?s of 18 Pa.C.S.A. swear or affirm ledge, information Section 4904, relating to unsworn falsification to authorities. Witness U Dated: , 5 O Ibrahim A'7 Dated: ?/ 5?D3 CERTIFICATE OF SERVICE I, Megan A. Reinard, an employee of the law firm of Angino & certify that I am this day serving a true and correct copy of Complaint upon all certified mail return receipt requested addressed as follows: Kwan H. Won, M.D. 3810 Trindle Road Camp Hill, PA 17011 Kwan H. Won, M.D., P.C. 3810 Trindle Road Camp Hill, PA 17011 -, P.C., do hereby of record via Megan A -'I?.einard Dated: LIl' C) 258704.1 \NJR\MAR c"', , . c_- rii ? .. ;'? : ( ;n _ _. ? r C ., -_ -` ? _ ? ?. -C MARY ANN ALHAJ and IBRAHIM ALHAJ, her husband Plaintiffs V. KWAN H. WON, M.D., and KWAN H. WON, M.D., P.C. Defendants IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION - LAW NO. 03-531 JURY TRIAL DEMANDED AFFIDAVIT OF SERVICE This is to certify that on the 8th day of April, 2003, a true and correct copy of the Complaint, Civil Action No. 03-531 was mailed to Kwan H. Won, M.D., certified mail, return receipt requested at 3810 Trindle Road, Camp Hill, PA 17011. A copy of the certified mail receipt 7002 2030 0001 0403 6204 is attached hereto. Megan A. Reinard ACCEPTANCE OF SERVICE This is to certify that on the 9th day of April, 2003, a true and correct copy of the above-noted Complaint was served upon the Defendant via certified mail, return receipt requested at the above-noted address. A copy of the signed receipt No: 7002 2030 0001 0403 6204 is attached hereto. Y1 ?t - - MeganN Reinard Sworn to and subscribed before me this 11`" day of April, 2003. Tiffany M'jPatrick Notary Public Notarial Seal Tiff?riy M. Patrick, Notary Public qty Of Harrisburg, Dauphin County •'W Commission Expires Dec. 12, 2005 Member, Pennsylvania Association Of Notaries 259249.1 \NJR\MAR ¦ Cornpiete items 1, 2,. Also complete item 4 if Restricted Delivery is desired. ¦ PrNnt your name and address on the reverse so that we can return the card to you. ¦ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: Ktu 1A . W or, C, . Comp 4i,-Lt A. Signature ? Agent X ? Ache B. ReceivefbY r n Nam) C D. is delivery address dilferewnt from item 1? ? Yes 9 YES, enter delivery address below: ? No 3. Service Type Mortified Mail ? Express Mail ? Registered UPRetum Receipt for Merchsrdse ? Insured Mail ? C.O.D. 4. Restricted Delivery? (Extra Fee) ? Yes 2. Artk 7002 2030 0001 0403 6204 R PS Form 3811, August 2001 Domedic Return Rsosipt 2ACPRRS-Z-006 CERTIFIED MAIL. RECEIF (Domestic Mail Only; No Insurance Covers M C3 ° Postage $ rl C3 Certified Fee C3 Return Reciept Fee Postmark Here (Endorsement Required) M Restricted Delivery Fee y ?I4 Rl (Endorsement Required) ° ru Total Postage & Fees ru ° Sent ? /To /?? ,?t _ b...lN?ll?!_-;N:!l?W ., m -? . P - - --------------------------------- e et, beet Apt. No., ?{ h T /? or PO Box No. ---- ___!_(+- j? if City, State, ZI +4 r I PS Form 3800 June 2002 U CERTIFICATE I, Megan A. Reinard, em OF SER?CE certif employee of the law y that I am this day serving a true and firm of ??nO & Rovner ' P•C•, do hereby certified correct copy of the mail return receipt requested addressed as g uPon all defendants via follows: foregoing Kwan H. Won, M.D. 3810 T Indle Road CaMP Hill, PA 17011 Kwan H. Won M.D., P.C. 810 rindle R ad o Camp Hill, PA 17011 Dated: ? I 1110 Megan A. Reinard ?59249.] NJR\MAR ? } ? ; ? ??? -'[? -, f?1, _ -- - cr ; -? ; -; ? ? '? ?` ti .`? ? ?C MARY ANN ALHAJ and IBRAHIM ALHAJ, her husband Plaintiffs V. KWAN H. WON, M.D., and KWAN H. WON, M.D., P.C. Defendants IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION - LAW NO. 03-531 JURY TRIAL DEMANDED AFFIDAVIT OF SERVICE This is to certify that on the 8th day of April, 2003, a true and correct copy of the Complaint, Civil Action No. 03-531 was mailed to Kwan H. Won, M.D., certified mail, return receipt requested at 3810 Trindle Road, Camp Hill, PA 17011. A copy of the certified mail receipt 7002 2030 0001 0403 6198 is attached hereto. Megan A. Reinard ACCEPTANCE OF SERVICE This is to certify that on the 9th day of April, 2003, a true and correct copy of the above-noted Complaint was served upon the Defendant via certified mail, return receipt requested at the above-noted address. A copy of the signed receipt No: 7002 2030 0001 0403 6198 is attached hereto. Sworn to and subscribed before me this 11 th day of April 2003. _v._._.._.. f J1 Tiffa M, atrit Notary Public "? Dauphin Ex?res Dec. Memnsylvania Association Megan A. Reinard Notarial Seal r M. Patric k, Notary CO-fNotanes EO 259247.1 \NJR\MAR • Complete hems 1, 2, and 3. Also complete ilsrn 4 if Restricted Delivery is desired. ¦ Print your name and address on the reverse so that we can return the card to you. ¦ Attach this card to the back of the mailpiece, or on the front if space permits. 1. Article Addressed to: Kwon 4 . Won, ffl- D. ?z 10-Ft i'rv le- P W amp 4-apA -+d) A. Signature x 77 ` ? Agent i ? AddrMNtr B. Received by (Pri C- ate of Dstiwry ??q.(R D. Is delivery address different from item 1? ? Yes If YES, enter delivery address below: ? No 3. Service Type i Certified Mail ? Express Mail ? Registered S Return Receipt for Merchandise ? Insured Mail ? C.O.D. 4. Restricted Delivery? (Extra Fee) ? Yes 2. ArticieNur 7002 2030 0001 0403 6198 (Transfer fr P$ Form 3811, August 2oo1 Dorraatic Ratan Reorript z SRI-WZ-O es CERTIFIED MAILTM RECEIP (Domestic Mail Only; No Insurance Covera m -- C3 ° Postage $ r1 ° Certified Fee ° Postmark C3 Return t Fee (Endorsement t Required) Here ° Restricted Delivery Fee M (Endorsement Required) ° I 'Li Total Postage & Fees ru ° Sent To ° - ? a?! A:_&-a0'M'-D--------------------------------------- Street Apf. ;90.;S,& // ?/ a or PO Box No.(V ? L IC kocul - - ------------------------------ ---4-----------1 IP - City, Stets, Z+ PS Form 3800. June r0022 See Reverse for Instructions CERTIFICATE OF SERVICE I, Megan A. Reinard, an employee of the law firm of Angino & Rovner, P.C., do hereby certify that I am this day serving a true and correct copy of the foregoing upon all defendants via certified mail return receipt requested addressed as follows: Kwan H. Won, M.D. 3810 Trindle Road Camp Hill, PA 17011 Kwan H. Won, M.D., P.C. 3810 Trindle Road Camp Hill, PA 17011 `rl Megan A. Reinard Dated: q ) (1103 259247.1\NJR\MAR MARY ANN ALHAJ and IBRAHIM ALHAJ, Plaintiffs IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION - LAW V. KWAN H. WON, M.D.; and KWAN H. WON, M.D., P.C., Defendants TO: Mary Ann Alhaj and Ibrahim Alhaj, Plaintiffs c/o Neil J. Rovner, Esquire Angino & Rovner, P.C. 4503 North Front Street Harrisburg, PA 17110 Counsel for Plaintiffs NO. 03-531 JURY TRIAL DEMANDED NOTICE TO PLEAD YOU ARE HEREBY NOTIFIED TO PLEAD TO THE ANSWER WITH NEW MATTER OF DEFENDANTS TO PLAINTIFFS' ANSWER WITH NEW MATTER WITHIN TWENTY (20) DAYS OF SERVICE OR A DEFAULT JUDGMENT MAY BE ENTERED AGAINST YOU. Respectfully yours, Date: 54 /?? O FAR L & Rre-- Joseph ICC A. Ricci, Esquire Attorney I.D. No. 49803 Lawrence F. Barone Attorney I.D. No. 68921 4423 North Front Street Harrisburg, PA 17110 (717) 230-9201 Counsel for Defendants MARY ANN ALHAJ and IBRAHIM ALHAJ, Plaintiffs V. KWAN H. WON, M.D.; and KWAN H. WON, M.D., P.C., Defendants IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION - LAW NO. 03-531 JURY TRIAL DEMANDED ANSWER WITH NEW MATTER OF DEFENDANTS KWAN H. WON, M.D. AND KWAN H. WON, M.D., P.C. TO PLAINTIFFS' COMPLAINT AND NOW COME Defendants, Kwan H. Won, M.D., and Kwan H. Won, M.D., P.C., by and through his counsel, Farrell & Ricci, P.C., by Joseph A. Ricci, Esquire, and Lawrence F. Barone, Esquire, and answers the Plaintiffs' Complaint as follows: 1. Denied. After reasonable investigation Answering Defendants are without information sufficient to admit or deny the truth or falsity of the said averments and accordingly deny the same and demand strict proof thereof at the time of trial if deemed material. 2. Admitted in part. It is admitted that Defendant Kwan H. Won, M.D., is a licensed physician, practicing in Cumberland County, Pennsylvania. It is further admitted that Plaintiffs are asserting a professional liability claim against the Defendant and that a Certificate of Merit was filed contemporaneously with the Complaint. All other averments contained in this Paragraph are specifically denied and strict proof thereof is demanded at the time of trial if deemed material. 3. Admitted. 4. Denied. The averments contained in this Paragraph are denied in conformity with Pa.R.C.P. 1029(e). 5. Denied. The averments contained in this Paragraph are denied in conformity with Pa.R.C.P. 1029(e). 6. Denied. The averments contained in this Paragraph are denied in conformity with Pa.R.C.P. 1029(e). 7. Denied. The averments contained in this Paragraph are denied in conformity with Pa.R.C.P. 1029(e). 8. Denied. The averments contained in this Paragraph are denied in conformity with Pa.R.C.P. 1029(e). 9. Denied. The averments contained in this Paragraph are denied in conformity with Pa.R.C.P. 1029(e). 10. Denied. The averments contained in this Paragraph are denied in conformity with Pa.R.C.P. 1029(e). 11. Denied. The averments contained in this Paragraph are denied in conformity with Pa.R.C.P. 1029(e). 12. Denied. The averments contained in this Paragraph are denied in conformity with Pa.R.C.P. 1029(e). 13. Denied. The averments contained in this Paragraph are denied in conformity with Pa.R.C.P. 1029(e). 14. Denied. The averments contained in this Paragraph are denied in conformity with Pa.R.C.P. 1029(e). 2 15. Denied. The averments contained in this Paragraph are denied in conformity with Pa.R.C.P. 1029(e). 16. Denied. The averments contained in this Paragraph are denied in conformity with Pa.R.C.P. 1029(e). 17. Denied. The averments contained in this Paragraph are denied in conformity with Pa.R.C.P. 1029(e). COUNT - I NEGLIGENCE Marv Ann Alhai v. Kwan H Won M.D., and Kwan H Won, M.D., P.C. 18. Answering Defendants hereby incorporate by reference their responses to Paragraphs 1 through 17 of the Plaintiffs' Complaint as if more fully set forth herein at length. 19 Denied. To the extent this Paragraph is an averment of proximate causation, it is denied as a conclusion of law to which no affirmative response is required. To the extent an affirmative response is required, said averments are specifically and unequivocally denied and strict proof thereof demanded at time of trial if deemed material. By way of further answer, it is specifically and unequivocally denied that at any time material hereto, the Answering Defendants were negligent in the care and treatment of the Plaintiff. To the contrary, at all times material hereto, the Answering Defendants provided proper and appropriate care required for treatment of patients such as the Plaintiff. (a) It is further specifically denied that testing by Dr. Won and Johns Hopkins failed to show evidence of Meniere's Disease. (b) It is further specifically denied that simultaneous bilateral Gentamycin injections were inappropriate or below the standard of care for this patient's condition. To the contrary, at all times material 3 hereto, Answering Defendants provided proper and appropriate care within the standard of care required for treatment of patients such as the Plaintiff Mary Ann Alhaj. (c) It is further specifically denied that Answering Defendants failed to inform Plaintiff Mary Ann Alhaj that bilateral injections of Gentamycin is not done on or that it would compromise hearing in both ears at the same time. To the contrary, Plaintiff Mary Ann Alhaj was fully informed of all aspects of the procedure, all risks, and potential consequences. By way of further answer, as a health care professional, Plaintiff Mary Ann Alhaj was made acutely aware of the foregoing. Further, it is denied that bilateral injections of Gentamycin is "not done" in cases such as Plaintiffs. To the contrary, at all times material hereto, Answering Defendants provided proper and appropriate care within the standard of care required for treatment of patients such as the Plaintiff Mary Ann Alhaj. (d) It is further specifically denied that the methods utilized by Dr. Won were either experimental, untried or dangerous. To the contrary, at all times material hereto, Answering Defendants provided proper and appropriate care within the standard of care required for treatment of patients such as the Plaintiff Mary Ann Alhaj. 20. Denied. It is specifically and unequivocally denied that at any time material hereto, Answering Defendants were negligent in the care and treatment of the Plaintiff. Said averments are specifically and unequivocally denied and strict proof thereof demanded at time of trial if deemed material. By way of further answer, it is specifically denied that the treatment provided by Dr. Won in any way worsened Plaintiff Mary Ann Alhaj's condition or that the diagnostic and treatment methods utilized by Dr. Won were negligent in any manner. WHEREFORE, Answering Defendants respectfully request that judgment be entered in their favor and against the Plaintiffs and that Answering Defendants be awarded appropriate costs and fees. CLAIM I - DAMAGES Marv Ann Alhaj v Kwan H Won, M .D., and Kwan H Won M .D., P.C. 4 21. Answering Defendants hereby incorporate by reference their responses to Paragraphs 1 through 20 of the Plaintiffs' Complaint as if more fully set forth herein at length. 22. Denied. Said averments are specifically and unequivocally denied and strict proof thereof demanded at time of trial if deemed material. By way of further answer, to the extent this Paragraph is an averment of the Plaintiffs' alleged damages, it is denied since after reasonable investigation, Answering Defendants are without information sufficient to admit or deny the truth or falsity of the said averments and accordingly deny the same and demand strict proof thereof at the time of trial if deemed material. 23. Denied. Said averments are specifically and unequivocally denied and strict proof thereof demanded at time of trial if deemed material. By way of further answer, Answering Defendants deny that any damages claimed by Plaintiff are a result of treatment provided by Answering Defendants. To the extent this Paragraph is an averment of the Plaintiff's alleged damages, it is further denied since after reasonable investigation, Answering Defendants are without information sufficient to admit or deny the truth or falsity of the said averments and accordingly deny the same and demand strict proof thereof at the time of trial if deemed material. 24. Denied. Said averments are specifically and unequivocally denied and strict proof thereof demanded at time of trial if deemed material. By way of further answer, Answering Defendants deny that any damages claimed by Plaintiff are a result of treatment provided by Answering Defendants. To the extent this Paragraph is an averment of the Plaintiffs' alleged damages, it is further denied since after reasonable investigation, Answering Defendants are without information sufficient to admit or deny the 5 truth or falsity of the said averments and accordingly deny the same and demand strict proof thereof at the time of trial if deemed material. 25. Denied. Said averments are specifically and unequivocally denied and strict proof thereof demanded at time of trial if deemed material. By way of further answer, Answering Defendants deny that any damages claimed by Plaintiff are a result of treatment provided by Answering Defendants. To the extent this Paragraph is an averment of the Plaintiffs' alleged damages, it is further denied since after reasonable investigation, Answering Defendants are without information sufficient to admit or deny the truth or falsity of the said averments and accordingly deny the same and demand strict proof thereof at the time of trial if deemed material. 26. Denied. Said averments are specifically and unequivocally denied and strict proof thereof demanded at time of trial if deemed material. By way of further answer, Answering Defendants deny that any damages claimed by Plaintiff are a result of treatment provided by Answering Defendants. To the extent this Paragraph is an averment of the Plaintiffs' alleged damages, it is further denied since after reasonable investigation, Answering Defendants are without information sufficient to admit or deny the truth or falsity of the said averments and accordingly deny the same and demand strict proof thereof at the time of trial if deemed material. 27. Denied. Said averments are specifically and unequivocally denied and strict proof thereof demanded at time of trial if deemed material. By way of further answer, Answering Defendants deny that any damages claimed by Plaintiff are a result of treatment provided by Answering Defendants. To the extent this Paragraph is an averment of the Plaintiffs' alleged damages, it is further denied since after reasonable 6 investigation, Answering Defendants are without information sufficient to admit or deny the truth or falsity of the said averments and accordingly deny the same and demand strict proof thereof at the time of trial if deemed material. 28. Denied. To the extent this Paragraph is an averment of proximate causation, it is denied as a conclusion of law to which no affirmative response is required. To the extent an affirmative response is required, said averments are specifically and unequivocally denied and strict proof thereof demanded at time of trial if deemed material. By way of further answer, it is specifically and unequivocally denied that at any time material hereto, the Answering Defendants were negligent in the care and treatment of the Plaintiff. It is therefore denied that Defendants are liable to Plaintiff for injuries alleged herein. WHEREFORE, Answering Defendants respectfully request that judgment be entered in their favor and against the Plaintiffs and that Answering Defendants be awarded appropriate costs and fees. CLAIM II - LOSS OF CONSORTIUM Ibrahim Alhai v. Kwan H. Won M.D., and Kwan H Won M.D., P.C. 29. Answering Defendants hereby incorporate by reference their responses to Paragraphs 1 through 28 of the Plaintiffs' Complaint as if more fully set forth herein at length. 30. Denied. After reasonable investigation Answering Defendants are without information sufficient to admit or deny the truth or falsity of the said averments and 7 accordingly deny the same and demand strict proof thereof at the time of trial if deemed material. WHEREFORE, Answering Defendants respectfully request that judgment be entered in their favor and against the Plaintiffs and that Answering Defendants be awarded appropriate costs and fees. NEW MATTER 31. Plaintiffs have failed to state a claim upon which relief can be granted. 32. Plaintiffs' claim is barred and/or limited by the applicable Statute of Limitations. 33. It is believed, and therefore averred, that the discovery will show that the Plaintiff was negligent and that her negligence exceeded the negligence, if any, of the Answering Defendants, thereby barring Plaintiffs' recovery by operation of the Pennsylvania Comparative Negligence Act. 34. It is believed, and therefore averred, that discovery will show that the Plaintiff was negligent and that by virtue of her negligence, her claims may be limited by the operation of the Pennsylvania Comparative Negligence Act. 35. It is believed, and therefore averred, that discovery will show that the Plaintiff voluntarily assumed a known risk thereby barring recovery by the operation of the Doctrine of Assumption of Risk. 36. Plaintiffs injuries, if any, were sustained as a result of natural or unknown causes and not as the result of any action or inaction on behalf of the Answering Defendants. 8 37. At all times material hereto, Answering Defendants provided full, complete, proper, reasonable and adequate medical care and treatment in accordance with the applicable standard of care. 38. No conduct on the part of the Answering Defendants was a substantial factor in causing or contributing to any harm which the Plaintiffs may have suffered. 39. If Plaintiffs suffered any damage, the damages were caused by the conduct of others over whom the Answering Defendants had no control or right to control. 40. All claims and causes of action pleaded against the Answering Defendants are barred by Plaintiffs knowing and voluntary informed consent to the care in question. 41. To the extent they were required to do so, the Answering Defendants took all reasonable and necessary steps to make a proper and appropriate diagnosis and to the extent it may be determined that that diagnosis was in error, the Answering Defendants assert that the error in diagnosis was a reasonable and legally justifiable error. 42. Insofar as the Answering Defendants elected a treatment modality which is recognized as proper but may differ from another appropriate treatment modality, then said Answering Defendants raise the "two schools of thought" defense. 43. Answering Defendants incorporates by reference all the defenses available to them as set forth in the Medical Care Availability and Reduction of Error Act, 40 P.S. § 1303.101 et seq. 9 WHEREFORE, Answering Defendants respectfully request that judgment be entered in their favor and against the Plaintiffs and that they be awarded appropriate costs and fees. Respectfully submitted, FARRZLL & RICCI, P.C. Date: .S // G /0:5 I-A a --' 'Joseph A. Ricci, Esquire Attorney I.D. No. 49803 Lawrence F. Barone Attorney I.D. No. 68921 4423 North Front Street Harrisburg, PA 17110 (717) 230-9201 Counsel for Defendants 10 VERIFICATION I, Kwan H. Won, M.D., hereby verify that the facts set forth in the foregoing Answer with New Matter of Defendants Kwan H. Won, M.D. and Kwan H. Won, M.D., P.C. to Plaintiffs' Complaint are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904, relating to unsworn falsification to authorities. Date: Kw . Won, M.D. VERIFICATION I, Kwan H. Won, M.D., hereby verify that the facts set forth in the foregoing Answer with New Matter of Defendants Kwan H. Won, M.D. and Kwan H. Won, M.D., P.C. to Plaintiffs' Complaint are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S. §4904, relating to unsworn falsification to authorities. Date: /0? K an . Won, M.D. CERTIFICATE OF SERVICE AND NOW, this day of May, 2003, I, Lawrence F. Barone, Esquire, hereby certify that I served a true and correct copy of the foregoing Answer with New Matter upon all counsel of record by depositing a copy of same in the United States mail, regular delivery, postage prepaid at Harrisburg, Pennsylvania, addressed as follows: Neil J. Rovner, Esquire Angino & Rovner, P.C. 4503 North Front Street Harrisburg, PA 17110 r ? j' C.7 -? --? _, G`; ?? `° - ; "7 [ ' -? `T . _ ,? ? { _ ` U ` lJ' MARY ANN ALHAJ and IBRAHIM ALHAJ, her husband Plaintiffs V. KWAN H. WON, M.D., and KWAN H. WON, M.D., P.C. Defendants IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION - LAW NO. 03-531 JURY TRIAL DEMANDED PLAINTIFFS' REPLY TO NEW MATTER OF DEFENDANT 31. Denied. 32. Denied. Plaintiffs had adequately set forth a claim under the laws of the Commonwealth of Pennsylvania. 33. Denied. Plaintiffs were in no way negligent, comparatively or contributorily in any way which bars or lessens the Plaintiffs recovery by operation of the Comparative Negligent Act. 34. See answer to paragraph 33 above. 35. It is denied that Plaintiffs in any way knowingly assumed the risk of negligent treatment by Dr. Won. 36. Denied. Plaintiffs injuries were factually caused and a proximate result of the actions of the Defendant which are set forth in the Complaint. 37. Denied as set forth more fully in the Complaint which is incorporated herein by reference. 38. Denied. Defendants conduct was the cause of Plaintiffs harm. 39. Denied. Defendant is the sole cause of Plaintiffs harm. 40. Denied. Plaintiffs in no way consented to any improper and negligent treatment. 41. Denied. The Defendant did not make use of the best scientific evidence available to him in diagnosing the Plaintiff. 42. Denied. The two schools of thought defense is inapplicable because there is no substantial body of accepted thought that permits bilateral injections of Gentamycin. 261072.2UVJR\MAR 43. This paragraph sets forth unspecified conclusions of law to which no answer is necessary. To the extent the Medical Care Availability and reduction of Error Act is not found to be applicable or constitutional, this paragraph is Denied. WHEREFORE, Plaintiffs request Your Honorable Court to dismiss the New Matter of Defendants. Date: Respectfully submitted, ANGINO & ROVNER, P.C. M61 J. PjbvAer, Es4uire 1. D. Ng(. 212) 108 4503 N. Front Street Harrisburg, PA 17110 (717) 238-6791 Counsel for Plaintiff(s) 261072.2\NJR\MAR ATTORNEY AFFIDAVIT I, Neil J. Rovner, Esquire, state that I am counsel for Plaintiffs, that I am authorized to make this Verification on behalf of said Plaintiff, and have read the foregoing and do hereby declare and affirm that the facts set forth in the foregoing are correctly derived from the discovery record. I understand that this Verification is made subject to the penalties of 28 U.S.C. §1746, relating to unworn falsification to authorities. Sworn to and subscribed to before me on this 22nd day of May, 2003 4Tiffanyt VP' k Notary Public NOMM Seal 1Mary M. PaW* Not" Pubk CkY Ck Hanblxxg, Dauphin County MY Corrsion Expires Dec. 12, 2005 Member, Pennsylvania Association Of Notaries 251969.1\NJR\MAR CERTIFICATE OF SERVICE I, Megan A. Reinard, an employee of the law firm of Angino & Rovner, P.C., do hereby certify that I am this day serving a true and correct copy of Reply to New Matter upon all counsel of record via postage prepaid first class United States mail addressed as follows: Lawrence F. Barone, Esquire Farrell & Ricci, P.C. 4423 North Front Street Harrisburg, PA 17110 0. Megan . Reinard Dated: 261072.2\NJR\MAR C7 ?> ? z -.? F.• MARY ANN ALHAJ and IBRAHIM ALHAJ, her husband Plaintiffs V. KWAN H. WON, M.D., and KWAN H. WON, M.D., P.C. Defendants IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION - LAW NO. 03-531 JURY TRIAL DEMANDED PLAINTIFFS' MOTION FOR STATUS CONFERENCE AND NOW, comes the Plaintiffs, by and through their counsel, Angino & Rovner, P.C., to respectfully request this Honorable Court to schedule a Status Conference in order to establish discovery deadlines and a trial date. In support thereof, Plaintiffs aver the following: A Writ of Summons was filed in this instant medical malpractice case on or about February 4, 2003. 2. A Complaint was filed on or about April 9, 2003. The parties have engaged in discovery with the exchange of Interrogatories and Request for Production of Documents. 4. The deposition of Plaintiffs and Defendants will take place on October 3, 2003. 5. Plaintiffs had sent Defendant discovery requests which were due on or about June 2, 2003 which have not been answered. Plaintiffs' counsel is Neil J. Rovner, Esquire, 4503 North Front Street, Harrisburg, PA 17110 and telephone number is (717) 238-6791. 7. Defendants Kwan H. Won, M.D. and Kwan H. Won, M.D., P.C. is represented by Joseph Ricci, Esquire and Lawrence F. Barone, Esquire of Farrell & Ricci, P.C., 4423 North Front Street, Harrisburg, PA 17110 and telephone number is (717) 230-9201. 265809.1\CMG\CMG WHEREFORE, Plaintiffs respectfully request Your Honorable Court to schedule a Status Conference for the purposes of establishing discovery deadliness, exchange of expert reports and a trial date. Date: (-y 1 (?'G Respectfully submitted, ANGINO & 265809.1\CMG\CMG 4503 N. Front Street Harrisburg, PA 17110 (717) 238-6791 Counsel for Plaintiff(s) CERTIFICATE OF SERVICE I, Christine M. Gallagher, an employee of the law firm of Angino & Rovner, P.C., do hereby certify that I am this day serving a true and correct copy of Plaintiffs' Motion for a Status Conference upon all counsel of record via postage prepaid first class United States mail addressed as follows: Joseph Ricci, Esquire Lawrence F. Barone, Esquire Farrell & Ricci, P.C. 4423 North Front Street Harrisburg, PA 17110 Dated: Christine M. Gallagher 265809.1 \CMG\CMG - n nil ?J a) SEP 19 2003 MARY ANN ALHAJ and IBRAHIM ALHAJ, her husband Plaintiffs V. KWAN H. WON, M.D., and KWAN H. WON, M.D., P.C. Defendants IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION - LAW NO. 03-531 JURY TRIAL DEMANDED ORDER 1 AND NOW, this _ day of t 1 2003, upon consideration of Plaintiffs' Motion for a Status Conference, IT IS HEREBY ORDERED AND -,?n?.N fad DECREED that a Status Conference is scheduled for 2003 at 1130 o'clock g /m in Courtroom No. ?_. oq.a3 BY THE COURT: 265809.1\CMG\CMG t TT- ,r {: ?JS MARY ANN ALHAJ and, IN THE COURT OF COMMON PLEAS OF IBRAHIM ALHAJ CUMBERLAND COUNTY, PENNSYLVANIA Plaintiffs V. CIVIL ACTION - LAW KWAN H. WON, M.D. and NO. 03-531 KWAN H. WON, M.D., P.C., : Defendant JURY TRIAL DEMANDED ORDER OF COURT AND NOW, this 12th day of November, 2003, upon consideration of Plaintiffs' Motion for Status Conference, and following a conference in the chambers of the undersigned judge in which Plaintiffs were represented by Lisa M. Benzie, Esquire, standing in for Neil J. Rovner, Esquire, and Defendants were represented by Lawrence F. Barone, Esquire, standing in for Joseph A. Ricci, Esquire, and pursuant to an agreement of counsel, the following deadlines are established in this case in the absence of further order of Court: 1. With the exception of the exchange of expert reports, discovery shall be complete by March 16, 2004; 2. Plaintiffs' expert report shall be furnished to Defendants by April 16, 2004; Defendants' expert report shall be furnished to Plaintiffs by May 14, 2004; 3. Any dispositive motion shall be filed by June 15, 2004; and 4. Counsel are directed to list the case for trial during the September 2004 term of court. Pirsuant to an agreement of counsel, trial counsel are attached for appearance in Cumberland County for that trial term in this case. By the Court, YN AIASNN?d rL?a.•:i;`; J:J ,/Lisa M. Benzie, Esquire 4503 North Front Street Harrisburg, PA 17110 Zaw th e Plaintiffs rence F. Barone, Esquire 4423 North Front Street Harrisburg, PA 17110 For the Defendants 11" 1 lJ/ pcb CERTIFICATE PREREQUISITE TO SERVICE OF A SUBPOENA PURSUANT TO RULE 4009.22 IN THE MATTER OF: MARY ANN ALHAJ, ET AL -VS- COURT OF COMMON PLEAS TERM, CASE NO: 03-531 KWAN H. WON, MD, ET AL As a prerequisite to service of a subpoena for documents and things pursuant to Rule 4009.22 MCS on behalf of JOSEPH A. RICCI, ESQ. certifies that (1) A notice of intent to serve the subpoena with a copy of the subpoena attached thereto was mailed or delivered to each party at least twenty days prior to the date on which the subpoena is sought to be served, (2) A copy of the notice of intent, including the proposed subpoena, is attached to this certificate, (3) No objection to the subpoena has been received, and (4) The subpoena which will be served is identical to the subpoena which is attached to the notice of intent to serve the subpoena. DATE: 01/26/2004 jtM on behpj( , 8? ?: J EP A. RI ES O. torney for DEFENDANT DE11-470213 45083--1,03- C O MM O N W E A L T H OF P E NN S Y L VAN 2 A COUNT Y OF CUMBER LAND IN THE MATTER OF: MARY ANN ALHAJ, ET AL -VS- KWAN H. WON, MD, ET AL TO DR. JOSEPH DE14ARIO DR. HOWARD ROY COHEN WOMEN'S CANCER CENTER OF PA WOMEN'S CANCER CENTER OF PA MEDICAL RECORDS MEDICAL RECORDS MEDICAL RECORDS EMPLOYMENT COURT OF COMMON PLEAS TERM, CASE NO: 03-531 TO: NEIL ROVNER, ESQ. MCS on behalf of JOSEPH A. RICCI, ESQ. intends to serve a subpoena identical to the one that is attached to this notice. You have twenty (20) days from the date listed below in which to file of record and serve upon the undersigned an objection to the subpoena. If the twenty day notice period is waived or if no objection is made, then the subpoena may be served. Complete copies of any reproduced records may be ordered at your expense by completing the attached counsel card and returning same to MCS or by contacting our local MCS office. DATE: 01/06/2004 CC: JOSEPH A. RICCI, ESQ. - PR-551 Any questions regarding this matter, contact MCS on behalf of JOSEPH A. RICCI, ESQ. Attorney for DEFENDANT THE MCS GROUP INC. 1601 MARKET STREET #800 PHILADELPHIA, PA 19103 (215) 246-0900 DE02 -252554 4 5 0 8 1- C O 1 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND MARY ANN ALHAJ, ET AL vs. File No. 03-531 KWAN H. WON, MD, ET AL SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: Custodian of Records for DR JOSEPH DEMAR IO (Name of Person or Entity) Within twenty (20) days after service of this subpoena, you are ordered by the court to produce the following documents or things: **** SEE ATTACHFD RIDER **** at The M Group. n 1601 Market Street. Suite 800 Philad lphia PA 19103 You may deliver or mail legible copies of the documents or produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek, in advance, the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days after its service, the party serving this subpoena may seek a court order compelling you to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: NAME: JOSEPH A. RICCI, ESQ. ADDRESS: 4423 NORTH FRONT STREET HARRf B rn PA 17110 TELEPHONE: (215) 246-0900 SUPREME COURT ID #: ATTORNEY FOR: Defendant r Date: Seal of the Court BY COURT: -Uk All Prothonotary/Clerk Ci it Division U *Depty ACA01 n1 EXPLANATION OF REQUIRED RECORDS TO: CUSTODIAN OF RECORDS FOR: DR. JOSEPH DEMARIO 310 N. SALEM CHURCH MECHANICSBURG, PA 17055 RE: 45081 MARY ANN ALHAJ Please call for prior approval for fees in excess of $100.00 for hospitals, $50.00 for all other providers. Entire medical file, including but not limited to any and all records, correspondence to and from the consulting and treating physicians, files, memoranda, handwritten notes, history and physical reports, medication/ prescription records, including any and all such items as may be stored in a computer database or otherwise in electronic form, relating to any examination, diagnosis or treatment pertaining to: Dates Requested: up to and including the present. Subject : MARY ANN ALHAJ 801 SOUTH MARKET STREET, MECHANICSBURG, PA 17055 Social Security #: 182-50-3335 Date of Birth: 07-21-1958 SU10-482212 4 5 0 8 1- L O 1 CERTIFICATE PREREQUISITE TO SERVICE OF A SUBPOENA PURSUANT TO RULE 4009.22 IN THE MATTER OF: MARY ANN ALHAJ, ET AL -VS - COURT OF COMMON PLEAS TERM, CASE NO: 03-531 KWAN H. WON, MD, ET AL As a prerequisite to service of a subpoena for documents and things pursuant to Rule 4009.22 MCS on behalf of JOSEPH A. RICCI, ESQ. certifies that (1) A notice of intent to serve the subpoena with a copy of the subpoena attached thereto was mailed or delivered to each party at least twenty days prior to the date on which the subpoena is sought to be served, (2) A copy of the notice of intent, including the proposed subpoena, is attached to this certificate, (3) No objection to the subpoena has been received, and (4) The subpoena which will be served is identical to the subpoena which is attached to the notice of intent to serve the subpoena. MCS on behalf of DATE: 01/26/2004 JOSEPH A. RICCI, ESQ. Attorney for DEFENDANT DE11-470603 45081-1,02 COMMONWEALTH OF P E NN S Y L VAN 2 A COUNTY OF CUMBER LAN D IN THE MATTER OF: COURT OF COMMON PLEAS MARY ANN ALHAJ, ET AL -VS- KWAN H. WON, MD, ET AL 10 4 DR. JOSEPH DEMARIO DR. HOWARD ROY COHEN WOMEN'S CANCER CENTER OF PA WOMEN'S CANCER CENTER OF PA TO: NEIL ROVNER, ESQ. A MEDICAL RECORDS MEDICAL RECORDS MEDICAL RECORDS EMPLOYMENT TERM, CASE NO: 03-531 MCS on behalf of JOSEPH A. RICCI, ESQ. intends to serve a subpoena identical to the one that is attached to this notice. You have twenty (20) days from the date listed below in which to file of record and serve upon the undersigned an objection to the subpoena. If the twenty day notice period is waived or if no objection is made, then the subpoena may be served. Complete copies of any reproduced records may be ordered at your expense by completing the attached counsel card and returning same to MCS or by contacting our local MCS office. DATE: 01/06/2004 CC: JOSEPH A. RICCI, ESQ. - PR-551 Any questions regarding this matter, contact MCS on behalf of JOSEPH A. RICCI, ESQ. Attorney for DEFENDANT THE MCS GROUP INC. 1601 MARKET STREET #800 PHILADELPHIA, PA 19103 (215) 246-0900 DE02-252554 4 5 0 8 1- C O 1 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND MARY ANN ALHAJ, ET AL vs. KWAN H. WON, MD, ET AL File No. 03-531 SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: Custodian of Records for DR. HOWARD Ay OHEN (Name of Person or Entity) Within twenty (20) days after service of this subpoena, you are ordered by the court to produce the following documents or things: **** SEE ATTACHED RIDER **** at The MC Group. Inc 1601 Market S=et. Suite 800 Philad lphia PA 19103 You may deliver or mail legible copies of the documents or produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek, in advance, the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days after its service, the party serving this subpoena may seek a court order compelling you to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: NAME: JOSEPH A. RICCI, ESO ADDRESS: 4423 NORTH FRONTSTREET HARRl B TR PA 17110 TELEPHONE: (215) 246-0900 SUPREME COURT ID #: ATTORNEY FOR: Defendant Date: C Seal of the Court BY COURT: Prothonotary/Clerk, Ci iI Divisi n Dep y EXPLANATION OF REQUIRED RECORDS TO: CUSTODIAN OF RECORDS FOR: DR. HOWARD ROY COHEN 4713 E. TRINDLE RD. MECHANICSBURG, PA 17055 RE: 45081 MARY ANN ALHAJ Please call for prior approval for fees in excess of $100.00 for hospitals, $50.00 for all other providers. Entire medical file, including but not limited to any and all records, correspondence to and from the consulting and treating physicians, files, memoranda, handwritten notes, history and physical reports, medication/ prescription records, including any and all such items as may be stored in a computer database or otherwise in electronic form, relating to any examination, diagnosis or treatment pertaining to: Dates Requested: up to anH?cluding the present. Subject : MARY ANN 801 SOUTH MARKET STREET, MECHANICSBURG, PA 17055 Social Security A 182-50-3335 Date of Birth: 07-21-1958 SU10-482502 45081-1,02 CERTIFICATE PREREQUISITE TO SERVICE OF A SUBPOENA PURSUANT TO RULE 4009.22 IN THE MATTER OF: MARY ANN ALHAJ, ET AL -VS - COURT OF COMMON PLEAS TERM, CASE NO: 03-531 KWAN H. WON, MD, ET AL As a prerequisite to service of a subpoena for documents and things pursuant to Rule 4009.22 MCS on behalf of JOSEPH A. RICCI, ESQ. certifies that (1) A notice of intent to serve the subpoena with a copy of the subpoena attached thereto was mailed or delivered to each party at least twenty days prior to the date on which the subpoena is sought to be served, (2) A copy of the notice of intent, including the proposed subpoena, is attached to this certificate, (3) No objection to the subpoena has been received, and (4) The subpoena which will be served is identical to the subpoena which is attached to the notice of intent to serve the subpoena. MCS on behalf of DATE: 01/26/2004 JOSEPH A. RICCI, ESQ. Attorney for DEFENDANT DE11-470215 4 5 0 8 1- L 0 3 COMMONWEALTH OF P E NN S Y L VAN 2 A COUNTY OF CUMBER LAN D IN THE MATTER OF: COURT OF COMMON PLEAS MARY ANN ALHAJ, ET AL TERM, -VS- CASE NO: 03-531 KWAN H. WON, MD, ET AL OF INTENT TO SERVE A DR. JOSEPH DEMARIO MEDICAL RECORDS DR. HOWARD ROY COHEN MEDICAL RECORDS WOMEN'S CANCER CENTER OF PA MEDICAL RECORDS WOMEN'S CANCER CENTER OF PA EMPLOYMENT TO: NEIL ROVNHR, ESQ. MCS on behalf of JOSEPH A. RICCI, ESQ. intends to serve a subpoena identical to the one that is attached to this notice. You have twenty (20) days from the date listed below in which to file of record and serve upon the undersigned an objection to the subpoena. If the twenty day notice period is waived or if no objection is made, then the subpoena may be served. Complete copies of any reproduced records may be ordered at your expense by completing the attached counsel card and returning same to MCS or by contacting our local MCS office. DATE: 01/06/2004 CC: JOSEPH A. RICCI, ESQ. - PR-551 Any questions regarding this matter, contact MCS on behalf of JOSEPH A. RICCI ESQ. Attorney for DEFENDANT THE MCS GROUP INC. 1601 MARKET STREET NS00 PHILADELPHIA, PA 19103 (215) 246-0900 DE02-252554 4 5 0 8 3.- C O 1 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND MARY ANN ALHAJ, ET AL vs. File No. 03-531 KWAN H. WON, MD, ET AL SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: Custodian of Records for WOMEN'S CANCER CENTER OF PA (Name of Person or Entity) Within twenty (20) days after service of this subpoena, you are ordered by the court to produce the following documents or things: **** SEE ATTACHED RIDER **** at _ The MCS Group. Jar_ 1601 Market Stmrt Suite 800 Philadelphia, PA 1910 You may deliver or mail legible copies of the documents or produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek, in advance, the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days after its service, the party serving this subpoena may seek a court order compelling you to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: NAME: JOSEPH A. RICCI. ESO ADDRESS: 4423 NORTH FRONT TRF T ARR B1RpA 17110 TELEPHONE: (215) 246-0900 SUPREME COURT ID #: ATTORNEY FOR: Defendant CC ?C o? Q 7? Date: Seal of the ourt ACA., n, BY THE CnI iRT- EXPLANATION OF REQUIRED RECORDS TO: CUSTODIAN OF RECORDS FOR: WOMEN'S CANCER CENTER OF PA FREDRICKSEN OP CNTR 2025 TECHNOLOGY PKWY MECHANICSBURG, PA 170509497 RE: 45081 MARY ANN ALHAJ INCLUDING RECORDS FROM DR. WILLS AND DR. MISAS Please call for prior approval for fees in excess of $100.00 for hospitals, $50.00 for all other providers. Entire medical file, including but not limited to any and all records, correspondence to and from the consulting and treating physicians, files, memoranda, handwritten notes, history and physical reports, medication/ prescription records, including any and all such items as may be stored in a computer database or otherwise in electronic form, relating to any examination, diagnosis or treatment pertaining to: Dates Requested: up to and including the present. Subject : MARY ANN ALHAJ 801 SOUTH MARKET STREET, MECHANICSBURG, PA 17055 Social Security N: 182-50-3335 Date of Birth: 07-21-1958 SU10-482216 4 S O 8 1- L 03 CERTIFICATE PREREQUISITE TO SERVICE OF A SUBPOENA PURSUANT TO RULE 4009.22 IN THE MATTER OF: COURT OF COMMON PLEAS MARY ANN ALHAJ, ET AL TERM, -VS- CASE NO: 03-531 KWAN H. WON, MD, ET AL As a prerequisite to service of a subpoena for documents and things pursuant to Rule 4009.22 MCS on behalf of JOSEPH A. RICCI, ESQ, certifies that (1) A notice of intent to serve the subpoena with a copy of the subpoena attached thereto was mailed or delivered to each party at least twenty days prior to the date on which the subpoena is sought to be served, (2) A copy of the notice of intent, including the proposed subpoena, is attached to this certificate, (3) No objection to the subpoena has been received, and (4) The subpoena which will be served is identical to the subpoena which is attached to the notice of intent to serve the subpoena. MCS on behalf of DATE: 01/26/2004 JOSEPH A. RICCI, ESQ. Attorney for DEFENDANT DEII-470216 4 SO 8 1- 1, 0 4 COMMONWEALTH Or P E WW S Y L VAN T A COUNTY OF CUMBER LAN D IN THE MATTER OF: COURT OF COMMON PLEAS MARY ANN ALHAJ, ET AL TERM, -VS- CASE NO: 03-531 KWAN H. WON, MD, ET AL OF INTENT TO SERVE A DR. JOSEPH DEMARIO MEDICAL RECORDS DR. HONARD ROY COHEN MEDICAL RECORDS WOMEN'S CANCER CENTER OF PA MEDICAL RECORDS WOMEN'S CANCER CENTER OF PA EMPLOYMENT TO: NEIL ROVNER, ESQ. MCS on behalf of JOSEPH A. RICCI, ESQ. intends to serve a subpoena identical to the one that is attached to this notice. You have twenty (20) days from the date listed below in which to file of record and serve upon the undersigned an objection to the subpoena. If the twenty day notice period is waived or if no objection is made, then the subpoena may be served. Complete copies of any reproduced records may be ordered at your expense by completing the attached counsel card and returning same to MCS or by contacting our local MCS office. DATE: 01/06/2004 CC: JOSEPH A. RICCI, ESQ. - PR-551 Any questions regarding this matter, contact MCS on behalf of JOSEPH A. RICCI, ESQ. Attorney for DEFENDANT THE MCS GROUP INC. 1601 MARKET STREET #800 PHILADELPHIA, PA 19103 (215) 246-0900 DE02-252554 45083.-COI- COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND MARY ANN ALHAJ, ET AL vs. File No. 03-531 KWAN H. WON, MD, ET AL SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: Custodian of Records for WOMEN'S CANCER CENTER OF PA (Name of Person or Entity) Within twenty (20) days after service of this subpoena, you are ordered by the court to produce the following documents or things: **** SEE ATTACHE RIDER **** at The MCS Group. Inc 1601 Market tre t Suite 800 Philadelphia, PA 19103 You may deliver or mail legible copies of the documents or produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek, in advance, the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days after its service, the party serving this subpoena may seek a court order compelling you to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: NAME: JOSEPH A RICCI ESO ADDRESS: 4423 NORTH FRONT STREET HARRl B IRC nq 17110 TELEPHONE: (215) 246-0900 SUPREME COURT ID #: ATTORNEY FOR: Defendant Date: i Se=the rt B COURT: Prpthonotary/Clerk, C' it Division \ep tR tL 2_. EXPLANATION OF REQUIRED RECORDS TO: CUSTODIAN OF RECORDS FOR: WOMEN'S CANCER CENTER OF PA FREDRICKSEN OP CNTR 2025 TECHNOLOGY PKWY MECHANICSBURG, PA 170509497 RE: 45081 MARY ANN ALHAJ Please call for prior approval for fees in excess of $100.00 for hospitals, $50.00 for all other providers. Any and all employment records, applications, files, memoranda, compensation, time and attendance records, personnel records, payroll and salary reports and all medical records as an employee, including any and all such items as may be stored in a computer database or otherwise in electronic form, pertaining to: Dates Requested: up to and including the present. Subject : MARY ANN ALHAJ 801 SOUTH MARKET STREET, MECHANICSBURG, PA 17055 Social Security #: 182-50-3335 Date of Birth: 07-21-1958 SU10-482218 45083--L 04 ?' ? ? ?? ? ? .,?, r CERTIFICATE PREREQUISITE TO SERVICE OF A SUBPOENA PURSUANT TO RULE 4009.22 IN THE MATTER OF: COURT OF COMMON PLEAS MARY ANN ALHAJ, ET AL TERM, -VS- CASE NO: 03-531 KWAN H. WON, MD, ET AL As a prerequisite to service of a subpoena for documents and things pursuant to Rule 4009.22 MCS on behalf of JOSEPH A. RICCI, ESQ. certifies that (1) A notice of intent to serve the subpoena with a copy of the subpoena attached thereto was mailed or delivered to each party at least twenty days prior to the date on which the subpoena is sought to be served, (2) A copy of the notice of intent, including the proposed subpoena, is attached to this certificate, (3) No objection to the subpoena has been received, and (4) The subpoena which will be served is identical to the subpoena which is attached to the notice of intent to serve =he subpoena. DATE: 03/04/2004 M on behalf of SE ?R CI' E 4-Attorney for DEFENDANT DE11-477497 4S081-LOS COMMONWEALTH Op COUNTY or IN THE MATTER OF: MARY ANN ALHAJ, ET AL -VS- KWAN H. WON, MD, ET AL PEWXE3WLVAN2A C UMBER LAN D COURT OF COMMON PLEAS TERM, CASE NO: 03-531 TO: NEIL ROVNER, ESQ. MCS on behalf of JOSEPH A. RICCI, ESQ. intends to serve a subpoena identical to the one that is attached to this notice. You have twenty (20) days from the date listed below in which to file of record and serve upon the undersigned an objection to the subpoena. If the twenty day notice period is waived or if no objection is made, then the subpoena may be served. Complete copies of any reproduced records may be ordered at your expense by completing the attached counsel card and returning same to MCS or by contacting our local MCS office. DATE: 02/13/2004 MCS on behalf of CC: JOSEPH A. RICCI, ESQ. - PR-551 JOSEPH A. RICCI, ESQ. Attorney for DEFENDANT Any questions regarding this matter, contact THE MCS GROUP INC. 1601 MARKET STREET 11800 PHILADELPHIA, PA 19103 (215) 246-0900 DE02-255945 4 5 0 8 1- C O 1 NATIONAL PERSONNEL RECORDS CTR OTHER COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND MARY ANN ALHAJ, ET AL vs. File No. 03-531 KWAN H. WON, MD, ET AL SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: Custodian of Records for NATIONAL PERSONNEL RECORDS CTR (Name of Person or Entity) Within twenty (20) days after service of this subpoena, you are ordered by the court to produce the following documents or things:-**** SEE ATTA H D RIDER **** at You may deliver or mail legible copies of the documents or produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek, in advance, the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days after its service, the party serving this subpoena may seek a court order compelling you to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: NAME: -JOSEPH A RICCI ESO ADDRESS: 4423 NORTH FRM S1 JEE HARK B TRG PA 1711 TELEPHONE: (215) 246-0900_ SUPREME COURT ID #: ATTORNEY FOR: Defendant MAR 0 4 ?004 Date: I( UO Seal of the ourt BY COURT: &- j Prothonotary/Clerk, EXPLANATION OF REQUIRED RECORDS TO: CUSTODIAN OF RECORDS FOR: NATIONAL PERSONNEL RECORDS CTR DEPT. OF VETERANS AFFAIRS 9700 PAGE BLVD. ST. LOUIS, MO 63132 RE: 45081 MARY ANN ALHAJ Subject : MARY ANN ALHAJ 801 SOUTH MARKET STREET, MECHANICSBURG, PA 17055 Social Security k: 182-50-3335 Date of Birth: 07-21-1958 SU10-488136 4 5 0 8 1- L O 5 r '...;.I (11Fn T S T_ l c rn C i= .::_ N J C+J PRAECIPE FOR LISTING CASE FOR TRIAL (Must be typewritten and submitted in duplicate) TO THE PROTHONOTARY OF CUMBERLAND COUNTY Please list the following case: (Check one) (X) for JURY trial at the next term of civil court O for trial without a jury MARY ANN ALHAJ and IBRAHIM ALHAJ, her husband Plaintiffs IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA V. KWAN H. WON, M.D., and KWAN H. WON, M.D., P.C. Defendants CIVIL ACTION - LAW NO. 03-531 JURY TRIAL DEMANDED O Assumpsit O Trespass O Trespass (Motor Vehicle) * See, Order dated November 12, () Other - Medical Malpractice hereto as Exhibit A, specially attaching this case foothe WSeptemberesley 2004 Oler, Term. Jr., which is attached r__- The trial list will be called on August 10, 2004. Trials commence on September 13, 2004. Pre-trials will be held on August 18, 2004. (Briefs are due 5 days before pre-trials.) (The party listing this case for trial shall provide the praecipe to all counsel, pursuant to forthwith a copy of local Rule 314-1.) Indicate the attorney who will try case for the party who files this praecipe: Neil J. Rovner, Esq uire, Angino & Rovner, P.C., 4503 North Front Street, Harrisbur, Indicate trial counsel for other parties if known: g PA 17110 Joseph Ricci, Farrell & Ricci, 4423 North Front Street, Harrisburg pA 1714 n This cas e is ready for trial. Date: May 25, 2004 269300.1 \NJR\MAR Signed: Print Name: ] e] J. Attorney for Plaintiff(s) MARY ANN ALHAJ and, IN THE COURT OF COMMON PLEAS OF IBRAHIM ALHAJ CUMBERLAND COUNTY, PENNSYLVANIA Plaintiffs V. CIVIL ACTION - LAW KWAN H. WON, M.D. and NO. 03-531 KWAN H. WON, M.D., P.C., : Defendant JURY TRIAL DEMANDED ORDER OF COURT AND NOW, this 12th day of November, 2003, upon consideration of Plaintiffs' Motion for Status Conference, and following a conference in the chambers of the undersigned judge in which Plaintiffs were represented by Lisa M. Benzie, Esquire, standing in for Neil J. Rcvner, Esquire, and. Defendants were represented by Lawrence F. Barone, Esquire, standing in for Joseph A. Ricci, Esquire, and pursuant to an agreement of counsel, the following deadlines are established in this case in the absence of further order of Court: 1. With the exception of the exchange of expert reports, discovery shall be complete by March 16, 2004; 2. Plaintiffs' expert report shall be furnished to Defendants by April 16, 2004; Defendants' expert report shall be furnished to Plaintiffs by May 14, 2004; 3. Any dispositive motion shall be filed by June 15, 2004; and 4. Counsel are directed to list the case for trial during the September 2004 term of court. Pursuant to an agreement of counsel, trial counsel are attached for appearance in Cumberland County for that trial term in this case. By the Court, CERTIFICATE OF SERVICE I, Megan A. Moll, an employee of the law fine of Angino & Rovner, P.C., do hereby certify that I am this day serving a true and correct copy of Reply to New Matter upon all counsel of record via postage prepaid first class United States mail addressed as follows: Joe Ricci, Esquire Lawrence F. Barone, Esquire Farrell & Ricci, P.C. 4423 North Front Street Harrisburg, PA 17110 %?Ck any Meg A. Moll Dated: 5/ 25/6) y 269300.1MRWAR C7 ^' 0 ? L ca t 'rl cl? I-,jrn ?1 Cn i? MARY ANN ALHAJ and IBRAHIM ALHAJ, her husband Plaintiffs V. KWAN H. WON, M.D., and KWAN H. WON, M.D., P.C. Defendants IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION - LAW NO. 03-531 JURY TRIAL DEMANDED PLAINTIFFS' MOTION AMEND COMPLAINT TO ASSERT PUNITIVE DAMAGES 1. Factual Background Plaintiff in her Complaint filed on April 8, 2003 asserted the following facts see, Complaint attached hereto as Exhibit A): 12. Plaintiff Mary Ann Alhaj returned to Defendant Kwan H. Won, M.D., on January 16, 2001, at which time ]re insisted that his testing showed that she had Meniere's :Disease and he recommended injections of Gentamycin, an ototoxic drug in her ears. 13. Defendant Kwan H. Won, M.D., did not explain to Mary Ann Alhaj that findings of Meniere's Disease on his testing were equivocal and did not establish a diagnosis of the disease. 14. Defendant Kwan H. Won, M.D., did not tell Mary Ann Alhaj that injections of Gentamycin in both ears at the same time was not an accepted or standard of treatment of Meniere's. Disease. Plaintiffs further alleged in paragraph 19 of the complaint the following: 19. The aforesaid consequences were the direct and proximate result of the negligence of Dr. Kwan Won and Kwan H. Won, M.D., P.C., as follows: a. Insisting that Mary Ann Alhaj had Meniere's Disease when neither his testing nor the testing nor 277146-1 the testing at Johns Hopkins Hospital provided evidence of Meniere's Disease; b. Performing simultaneous bilateral Gentamycin injections, a procedure which is completely inappropriate and below the standard of care. c. Failing to inform Mary Ann Alhaj that a bilateral injection of Gentamycin is not done and would compromise the hearing in both ears al. the same time; d. Utilizing an experimental, untried and dangerous method of treatment not used for the treatment of Meniere's Disease, i.e., bilateral injections of Gentamycin. Plaintiffs took the deposition of Kwan H. Won, M.D., the Defendant, on October 3, 2003. See, Deposition of Dr. Won attached hereto as Exhibit B. Dr. Won admitted that in his 29 years of practice he only treated two patients with Gentamycin and had never before treating Mary Ann Alhaj treated any Meniere's patients with bilateral injections of Gentamycin. Won Depo, 10/3/03 p. 44, line 18 through p. 45, line 3. Further Dr. Won admitted that he had never explained to Mary Ann Alhaj that he had never performed a bilateral injection of Gentamycin previously. Won Depo. 10/3/03 p. 61, lines 24 through p. 62, line 12. Dr. Won admitted that he had never consulted any other physician concerning the advisability of doing an injection of Gentamycin despite his never having done it before. Won Depo. 10/3/03 p. 62. Dr. Won further admitted (Won Depo. 10/3/03, p. 65, lines 8-13) that all the references he consulted indicated that bilateral Gentamycin injection is not usually recommended and, in fact, that in searching for articles, he found no article that mentioned bilateral Gentamycin. Won Depo. 10/3/03 p. 66, lines 1-3. 277146-1 Dr. Won indicated on his deposition page 70, line 16 through p. 71, lines 1-13, the following: Q As I understand it - but I guess my questions was really you made - you made a decision to do this injection bilaterally? A. Uh-hum. Q You had never done it before? A Uh-hum. Q And you knew it wasn't a treatment that was a standard treatment? A Uh-hum. Q Yes, is that correct, you knew that? A Yeah. Q All right. And then you made a decision to use less Gentamycin than you would normally use? A Uh-hum. Q Is that correct? A Uh-hum. Q You have to say, yes or no. A Yes. Q Okay. So that's something else that's different from what you usually do? A Yes. The rationale is this. Q Yes, I understand. You have explained your rationale. 277146-1 Q What I'm asking you is not what your rationale was, but where did you find any information that this was an appropriate technique to use less Gentamycin bilaterally in this particular situation. A There is no such a reference. Q Okay. So this is something that you created yourself? A Yes. Won Depo. 10/3/03 p. 70, line 16-23. II. Argument Plaintiffs seek to amend the Complaint to add a claim for punitive damages. That claim was already inherent in the factual allegations of Plaintiffs' Complaint. The issue before the Court in determining whether to allow such an amendment after the statute of limitations has run is whether or not a new cause of action would arise from the amendment. Our courts have held that a new cause of action does not occur if Plaintiffs' amendment merely adds to or amplifies the original Complaint or if the original Complaint states a cause of action showing that the Plaintiff has a legal right to recover what is claimed in the subsequent Complaint. Wilson v. Howard Johnson Co., 421 Pa. 455, 460, 219 A.2d 676, 678-79 (1966). A new cause of action does arise if the amendment proposes a different theory or a different kind of negligence from the one previously raised or if the operative facts supporting the claim are changed. See, Junk v. East End Fire Dent., 262 Pa. Super. 473, 396 A.2d 12,69 (1978). As Plaintiffs had set forth, the Complaint in this matter alleged the use of an untried, experimental procedure on Mary Ann Alhaj which was unjustified from a medical standpoint. Defendant Kwan H. Won, M.D., has admitted in his deposition that the facts set forth in the pleadings are true. The allowance of punitive damages based on the factual pattern of trying an 277146-1 experimental and dangerous procedure on Mary Ann Alhaj clearly support a claim for punitive damages. See also, Stalsitz v. Allentown Hose, 814 A.2d 766 (Pa. Super. 2002). Plaintiffs assert that the addition of a claim for punitive damages based upon the same facts pled in the Complaint which have now been admitted by Defendant Won will not add a new cause of action but simply allow the ad damnum clause to be modified to include a claim for punitive damages. Date: Respectfully submitted, ANGINO & .C. I.D. Nd. 22108/ 4503 N. Front Street Harrisburg, PA 17110 (717) 238-6791 Counsel for- Plaintiff(s) 277146-1 MARY ANN ALHAJ and IBRAHIM ALHAJ, her husband Plaintiffs IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION - LAW V. KWAN H. WON, M.D., and NO. 03-531 r: KWAN H. WON, M.D., P.C. JURY TRIAL DEMANDED Defendants NOTICE TO DEFEND You have been sued in court. If you wish to defend against the claims set forth in the follovg pages, yoy must take action within twenty (20) days after this Complaint and Notice are served, by entering a written appearance personally or by attorney and filing in writing with the Court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without ;you and a judgment maybe entered against you by the Court without further notice for any money claimed in the Complaint or for any other claim or relief requested by the Plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP. Cumberland County Bar Association 2 Liberty Avenue Carlisle, PA 17013 800/990-9108 NOTICIA Le ban demandado a usted en la corte. Si usted quiere defenderse de estas demandas expuestas en las paginas sugnuientes, usted tiene viente (20) dias de plazo al partir de la fecha de la demanda y la notificacion. Usted debe presenter una apariencia escrita o en persona o por abogado y archivar en la corte en forma escrita sus defensas o sus objeciones a las demandas en contra de su persona. Sea avisado que si usted no se defiende, la corte tomara medidas y puede entrar unit orden contra usted sin previo aviso o notificacion y por cualquier queja o alivio que es pedido en la peticion de demanda. Usted puede perder dinero o sus propiedades o otros derechos importantes para usted. LLEVE ESTA DEMANDA A UN ABOGADO IMMEDIATEMENfE. SI NO TIENE ABOGADO 0 SI NO TIENE EL DINERO SUFICIENTE DE PAGAR TAL SERVICIO, V.AYA EN PERSONA 0 LLAME POR TELEFONO A LA OFICINA CUYA DIRECCION SE ENCUENTRA ESCRITA ABAJO PARA AVERIGUAR DONDE SE PUEDE CONSEGUIR ASISTENCIA LEGAL. Cumberland County Bar Association 2 Liberty Avenue Carlisle, PA 17013 800/990-9108 258704.1 \N1R\M AR MARY ANN ALHAJ and IBRAHIM ALHAJ, her husband Plaintiffs V. KWAN H. WON, M.D., and KWAN H. WON, M.D., P.C. Defendants IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION - LAW NO. 03-531 JURY TRIAI. DEMANDED COMPLAINT I. Mary Ann Alhaj and Ibrahim Alhaj, are husband and wife and adult residents of Mechanicsburg, Cumberland County, Pennsylvania. 2. Defendant Kwan H. Won, M.D., is a licensed physician who holds himself out as a specialist in otolaryngology, practicing in Cumberland County, Pennsylvania. Plaintiffs are asserting a professional liability claim against the Defendant. A, Certificate of Merit is filed herewith. 3. Defendant Kwan H. Won, M.D., P.C. is a corporate medical practice who at all times was the employer and master of Defendant Kwan H. Won, M.D. 4. The facts and occurrences hereinafter related took place on or about February 6, 2001. 5. On or about November 28, 2000, Mary Ann Alhaj sought professional services of the Defendant Kwan H. Won, M.D., because of complaints of diZZiness and nausea. 6. At that time Dr. Won indicated to Mary Ann Alhaj that she had Meniere's Disease and referred her to Johns Hopkins Medical Center in Baltimore, Maryland. 7. Mary Ann Alhaj went to Johns Hopkins Hospital where she was told that she did not have the signs and symptoms of Meniere's Disease. 8. By letter of December 15, 2000, Dr. Howard W. Francis, of the Johns Hopkins Outpatient Otolaryngology, Head and Neck Surgery Section, informed Dr. Won that Mary Ann Alhaj had "normal peripheral vestibular disfunction testing in the office." 258704.1 MRWAR 9. Dr. Francis informed Defendant Dr. Won that Mary Arm Alhaj had only "mild low frequency mixed hearing loss." 10. Dr. Francis informed Defendant Dr. Won " I do not believe the Meniere Disease is active nor any other labyrinthine disorder at this time." 11. Nevertheless, Defendant, Dr. Won, insisted to Mary Ann Alhaj that she did have Meniere's Disease and that the bilateral injections of Gentamycin would provide her with relief. 12. Plaintiff Mary Ann Alhaj returned to Defendant Kwan H. Won, M.D., on January 16, 2001. at which time he insisted that his testing showed that she had Meniere's Disease and he recommended injections of Gentamycin, an ototoxic drug in her ears. 13. Defendant Kwan H. Won, M.D., did not explain to Mary Ann Alhaj that findings of Meniere's Disease on his testing were equivocal and did not establish a diagnosis of the disease. 14. Defendant Kwan H. Won, M.D., did not tell Mary Ann Alhaj that injections of Gentamycin in both ears at the same time was not an accepted or standard of treatment of Meniere's Disease. 15. On or about February 6, 2001, Defendant Kwan H. Won, M.D., instilled Gentamycin into both of Mary Ann Alhaj's ears, at the same time. 16. Defendant Kwan H. Won, M.D., did not discuss Mary Ann Alhaj's condition with the doctors at Johns Hopkins Hospital. 17. As a result of the bilateral injections of Gentamycin, she has suffered hearing loss, increased disequilibrium, permanent and irreparable damage to her hearing and vestibular disfunction and inability to go about her activities of daily living. 258704.1\NJR\N4AR COUNT -I NEGLIGENCE Marv Ann Alhai v. Kwan H. Won, M.D., and Kwan H. Won, M.D., P.C. 18. Paragraphs 1 through 17 are incorporated herein as if set forth at length. 19. The aforesaid consequences were the direct and proxirnate result of the negligence of Dr. Kwan Won and Kwan H. Won, M.D., P.C., as follows: a. Insisting that Mary Ann Alhaj had Meniere's Disease when neither his testing nor the testing nor the testing at Johns Hopkins Hospital provided evidence of Meniere's Disease; b. Performing simultaneous bilateral Gentamycin injections, a procedure which is completely inappropriate and below the standard of care. c. Failing to inform Mary Ann Alhaj that a bilateral injection of Gentamycin is not done and would compromise the hearing in both ears at the same time; d. Utilizing an experimental, untried and dangerous method of treatment not used for the treatment of Meniere's Disease, i.e., bilateral injections of Gentamycin. 20. The injuries suffered by Mary Ann Alhaj and the failure to alleviate her condition, but in fact to make it worse were the direct result of the negligence of Defendant Dr. Won in utilizing inappropriate diagnostic and treatment methods as set forth above. WHEREFORE, Plaintiff Mary Ann Alhaj demands judgment against Defendants, in an amount in excess of Twenty-Five Thousand ($25,000) Dollars, exclusive of interest and costs, and in excess of any jurisdictional amount requiring compulsory arbitration. 258704. I \N.i R\M A R CLAIM I - DAMAGES Marv Ann Alhai v. Kwan H. Won, M.D., and Kwan H. Won, M.D., P.C. 21. Paragraphs 1 through 20 are incorporated herein as if set forth at length. 22. Plaintiff Mary Ann Alhaj incurred expenses in attempt to treat her medical condition. 23. As a result of her treatment and its attendant consequences, Plaintiff has suffered a loss of income and, in the future, will suffer a loss of earnings and earning potential, and claim is made therefor. 24. As a direct result of her treatment, Plaintiff will have to live with continual pain and claim is made therefor. 25. As a direct result of her treatment, Plaintiff Mary Ann A.Ihaj has undergone, and will in the future undergo, great mental and physical pain and suffering, great inconvenience in carrying out her daily activities, and a loss of life's pleasures and enjoyment, and claim is made therefor. 26. As a direct result of her treatment, Plaintiff Mary Ann .Alhaj has experienced humiliation, embarrassment and disfigurement and claim is made therefor. 27. As a direct result of Defendants' negligence, Plaintiff Mary Ann Alhaj has experience a permanent injury of loss of hearing. 28. As a direct and proximate result of Defendants' negligence as set forth above, Defendants are liable to Plaintiff for the injuries alleged herein. WHEREFORE, Plaintiff Mary Ann Alhaj demands judgment against Defendants, in an amount in excess of Twenty-Five Thousand ($25,000) Dollars, exclusive of interest and costs, and in excess of any jurisdictional amount requiring compulsory arbitration. 258704.1 \NJR\MAR CLAIM II - LOSS OF CONSORTIUM Ibrahim Alhai v. Kwan H. Won, M.D., and Kwan H. Won, M.D., P.C. 29. Paragraphs 1 through 28 are incorporated herein as if set forth at length. 30. As a result of the injuries suffered by his wife, Plaintiff Mary Ann Alhaj, Plaintiff Ibrahim Alhaj has lost the companionship, consortium and society of his wife. WHEREFORE, Plaintiff Ibrahim Alhaj, demands judgment against Defendants. Kwan H. Won, M.D., and Kwan H. Won, M.D., P.C., in an amount in excess of Twenty-Five Thousand ($25,000) Dollars, exclusive of interest and costs, and in excess of any jurisdictional amount requiring compulsory arbitration. Respectfully submitted, ANGINO & ROVNER, P.C. I.D. . 2:x'108 450 I.D.X. Street Harrisburg, PA 17110 (717) 238-6791 Counsel for Plaintiff(s) Date: q/En 258704.1\N1R\MAR MARY ANN ALHAJ and IBRAHIM ALHAJ, her husband Plaintiffs V. KWAN H. WON, M.D., and KWAN H. WON, M.D., P.C. Defendants CIVIL ACTION -LAW IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA NO. 03-531 JURY TRIAL DEMANDED Certificate of Merit as to Kwan H. Won, M.D. I, Neil J. Rovner, certify that: (XXX) an appropriate licensed professional has supplied a written statement to the undersigned that there is a basis to conclude that the care, skill or knowledge exercised or exhibited by this defendant in the treatment, practice or work that is the subject of the complaint, fell outside acceptable professional standards and that such conduct was a cause in bringing about the harm; OR (_) the claim that this defendant deviated from an acceptable professional standard is based solely on allegations that other licensed professionals for whom this defendant is responsible deviated from an acceptable professional standard and an appropriate licensed professional has supplied a written statement to the undersigned that there is a basis to conclude that the care, skill or knowledge exercised or exhibited by the other licensed professionals in the treatment, practice or work that is the subject of the complaint, fell outside acceptable professional standards and that such conduct was a cause in bringing about the harm; OR ( ) expert testimony of an appropriate licensed professional is unnecessary for prosecution of the claim against this defendant. Date: 4/8/03 259091.1\N1R\ MAR VERIFICATION I, Mary Ann Alhaj, Plaintiff, have read the foregoing Complaint and do hereby swear or affirm that the facts set forth in the foregoing are true and conrect to the best of my knowledge, information and belief. I understand that this Verification is made subject to the penalties of 18 Pa.C.S.A. Section 4904, relating to unsworn falsification to authorities. WITNESS: Witness Dated: Dated: Z 1 I Marylha Dated: -Y 9- 3 VERIFICATION I, Ibrahim Alhaj, Plaintiff, have read the foregoing Complaint and do hereby swear or affirm that the facts set forth in the foregoing are true and correct to the best of my knowledge, information and belief. I understand that this Verification is made subject to the penalties of 1S Pa.C.S.A. Section 4904, relating to unswom falsification to authorities. Witness Ibrahim Alba' Dated: 5 03 Dated: -76b ? CERTIFICATE OF SERVICE I, Megan A. Reinard, an employee of the law firm of Angino & Rovner, P.C., do hereby certify that I am this day serving a true and correct copy of Complaint upon all counsel of record via certified mail return receipt requested addressed as follows: Kwan H. Won, M.D. 3810 Trindle Road Camp Hill, PA 17011 Kwan H. Won, M.D., P.C. 3810 Trindle Road Camp Hill, PA 17011 Megan A.'keinard Dated: LI`1?1 L-'), 258704.1\N1R\MAR MARY ANN ALHAJ AND : IN THE COURT OF COMMON PLEAS IBRAHIM ALHAJ, HER HUSBAND,: CUMBERLAND COUNTY, PENNSYLVANIA PLAINTIFFS V KWAN H. WON, M.D., AND KWAN H. WON, M.D., P.C., DEFENDANTS CIVIL ACTION - LAW NO. 03-531 JURY TRIAL DEMANDED DEPOSITION OF: KWAN H. WON, M.D. TAKEN BY: PLAINTIFFS BEFORE: DIANE F. FOLTZ, RMR NOTARY PUBLIC DATE: OCTOBER 3, 2003, 1:00 P.M. PLACE: FARRELL & RICCI, P.C. 4423 NORTH FRONT STREET HARRISBURG, PENNSYLVANIA APPEARANCES: ANGINO & ROVER, P.C. BY: NEIL J. ROVNER, ESQUIRE FOR - PLAINTIFFS FARRELL & RICCI, P.C. BY: JOSEPH A. RICCI, ESQUIRE FOR - DEFENDANTS Hu9hr. roil, 2080 Linglestown Road • Suite 103 Harrisburg, PA 17110 717.540.0220 • fax 717.540.0221 • Lancaster 717.393.5101 Multi-Page TM KWAN H. WON, M.D. Vla VIS1;K J. LUUS Page 2 Page 4 I WITNESSES I A Uh-hula. 2 NAME EXAMINATION 2 Q The first thing is that I want to be sure that if 3 MAN H. WON, M.D. 3 I ask you a question, if you don't understand it for some BY: MR. ROVNER 3 4 reason, maybe it's the way I've phrased it or something 6 5 like that, will you ask me either to rephrase it or repeat 6 6 it or tell me what you don't understand about it? Do you 7 7 understand that? 8 8 A Yes. 9 9 Q All right. Also you have to answer out loud in lD 10 words to my questions. Nodding of the head or noises that 11 signify an answer are not the best answer to give. Do you 12 EXHIBITS 12 understand that? 13 13 A Yes. 14 WON DEPOSITION EXHIBIT PRODUCED AND NARKED 14 Q Okay. Verygood. And the reason that I tell you 15 1. OFFICE RECORDS AND BILLS 3 15 these things is that I am going to assume if I ask you a 16 2. CERTIFICATION OF HEALTH CARE PROVIDER 16 question and you answer the question that you have heard 17 FAMILY AND MEDICAL LEAVE ACT OF 1993 86 17 the question, that you have understood the question, and 1B 18 that the answer you are giving me is the one you want to be 19 19 placed on the record here while you are under oath. Do you 20 20 understand that? 21 21 A Yes, uh-hum. 22 22 Q Okay. Do you have any questions about what I 23 23 have just explained to you? 24 24 A No. 25 25 Q Okay. Doctor, is there any reason why you would Page 3 1 STIPULATION 2 It is hereby stipulated by and between counsel 3 for the respective parties that sealing, certification and 4 filing are hereby waived; and that all objections except as 5 to the form of the question are reserved to the time of 6 trial. 7 (Office records and bills produced and marked 8 Won Deposition Exhibit No. 1.) 9 10 KWAN H. WON, M.D., called as a witness, being 11 duly sworn, testified as follows: 12 EXAMINATION 13 BY MR. ROVNER: 14 Q Could you please state your full name? 15 A Kwan, K-w-a-n, middle initial H., W-o-n. 16 Q And, Dr. Won, my name is Neil Rovner, and I 17 represent the Alhajs who brought this lawsuit, and I'm 18 going to be asking you some questions about your 19 involvement in the treatment of Mary Ann Alhaj, and 1 20 assume you have given depositions before? 21 A Yes. 22 Q Okay. I am going to go over some ground rules 23 for the depositions, and if you don't understand any of 24 these rules or you need to talk with your attorney about 25 it, you can do that. Page 5 1 be unable to answer questions or participate in this 2 deposition today, any reasons of health or anything else? 3 A No. 4 Q All right. So you feel able to do that? 5 A Yes. 6 Q Okay. Good. Dr. Won, I'm going to focus for a 7 moment here on your treatment of Mary Ann Alhaj, and it 8 looks to me as if you have your original office records 9 there; is that correct? 10 A Yes. 11 Q All right. Good. And we may make reference to 12 them. I have also made copies of the office records and 13 bills and :I have marked those as Exhibit No. 1, Won 1, and 14 those are:right there next to you with your attorney if you 15 need to refer to that as well. All right? Do you 16 understand that? 17 A Yes. I really have no information on this, you 18 know. I didn't check, or I guess my office, the secretary 19 supplied these. 20 MR. RICCI: Okay. 21 BY MR. ROVNER: 22 Q You are indicating that the exhibit that we have 23 here which is a copy of what you supplied to counsel, you 24 haven't reviewed that exhibit? 25 A I haven't, yeah. I never reviewed it, and that Page 2 - Page 5 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 :WAN H. WON, M.D. )CTOBER 3, 2003 Multi-Page TM Page 6 1 is the record of my -- I guess the secretary who does the 2 billing. 3 MR. Ricci; All right. Neil, just so that the 4 record is clear, I think, Doctor -- and correct me if I'm 5 wrong -- what you are referring to is not being familiar 6 with is the billing record; is that correct? 7 THE WITNESS: Right. 8 MR. ROVNER: That's only the top four sheets of 9 the exhibit. There are other -- 0 THE wITNESs: Okay. 1 MR. ROWER: There is other information here as 2 well. All right? 3 MR. RICCI: Okay. 4 BY MR. ROVER: 5 Q All right. Now, Doctor, do you have there your 6 first sheet of your fast contact with Mary Ann Alhaj? 7 A Yes, I do. 8 Q Okay. And we're going to refer to that. That is 9 in the record, and that appears to be a sheet with Mary Ann :0 Alhaj's name at the top; is that correct? :1 A Yes, uh-hum. :2 Q And her address and the date of the office :3 visit? 4 A Yes. .5 Q And what is the date of the office visit? Page 7 1 A September 28th, year 2000. 2 Q All right. And to the best of your recollection, 3 is that the first time you ever saw Mary Ann Alhaj as a 4 patient? 5 A Yes. 6 Q Had you ever seen her on any other occasion? 7 A No. 8 Q All right. Do you know how she came to your 9 office? 0 A The record indicates she had a self-referral. 1 Q So there was no physician involved as far as you 2 knew in referring her? 3 A No. 4 Q Okay. And on this sheet that we are referring 5 to, do you have a particular name for that sheet? 6 A Well, this is the -- I don't have a particular 7 name. 8 Q All right. 9 A But all the patients, all patients who come in 0 first for the first time to my office, we use this sheet 1 for convenience. 2 Q Okay. This is sort of an initial visit? 3 A Initial visit sheet, yes. 4 Q Okay. And can you tell me when you first saw 5 Mary Ann Alhaj, did she tell you anything about her Page 8 1 previous medical services that she had had? 2 A Yes, she actually says that she saw just about 20 3 physicians, I know it's not on the record, so that 4 everybody in town, tried every medication, nothing really 5 helping, and I heard about you, and you are my last resort. 6 I, you know, came here for the help, and I state -- 7 Q Now, you are indicating to me information that 8 does not appear on your record; is that correct? 9 A Yes. 10 Q All right. So you aretelling me you have an 11 independent recollection of this first visit that she made 12 to you that's not recorded in your records? 13 A Uh-hum. 14 Q Is that correct? 15 A Yes. 16 Q Okay. Did you record anywhere any additional 17 information about that first visit other than in your 18 office records? 19 A On the record of the February dash, she saw 20 Dr. Cohn, told her there was fluid. 21 Q I'm song, Doctor. I don't think you understood 22 my question. 23 A Oh. 24 Q My question was we have these documents from your 25 office records and office notes. Page 9 1 A Uh-hum. 2 Q Did you keep any information of any kind other 3 than what is in your chart, your records right there? 4 A No. No. 5 Q Okay. All right. So what you are telling me 6 about seeing 20 doctors and trying every medication, that 7 is something that you are saying that you recall from her 8 visit approximately three years ago? 9 A Yes. 10 Q Okay. Doctor, have you written down for yourself 11 for any reason other than for your attorney any information 12 regarding your recollection of Mary Ann Alhaj's visits to 13 your office? Have you written down any statements or 14 anything else except things that you are giving to your 15 attorney? Have you ever written down any statements about 16 her? 17 A Other than -- 18 Q Other than what's on the record? 19 A No. 20 Q Never? 21 A No. 22 Q Okay. Now, when she came to you, I think you 23 were starting to tell me about her history and who she saw; 24 is that correct? 25 A Uh-hum. age 6 - Page 9 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 Multi-Page TM KWAN H. WON, M.D. V1_ It V25L"K S, LUUS Page 10 1 Q All right. Tell me what you learned about her 2 medical history. 3 A According to what I have written down, she 4 started having this problem May, 1998. 5 Q Uh-hum. 6 A A little over two years ago. 7 Q Uh-hum. 8 A But on the top there was an HL and ear fluid. 9 That's my secretary's note when they call in, their 10 complaint, why they are coming. 11 Q What's HL mean? 12 A Hearing loss. 13 Q Okay. And ear fluid? 14 A Ear fluid, yeah, that's also my -- I guess she 15 called in and says I have ear fluid and hearing loss. 16 That's what that is. 17 Q And what was the name of the secretary who took 18 that information down? 19 A Let me see whose writing that is. It's either -- 20 Taddy Atdeff. 21 Q Can you spell that name for me? 22 A T-a-d-d-y, A-t-d-e-f-f. 23 Q Okay. 24 A Whoever is answering the telephone recorded the 25 information, you know, why do you want to make an Page 12 1 1 husband for me? 2 A Slender, tall, maybe brown hair, maybe about five 3 foot nine to five foot seven. That's all I can recall. 4 Q Okay. Do you recall speaking to this person? 5 A Maybe one or two words, but I don't know what I 6 said. I can't recall. 7 Q All right. Do you recall what Ms. Alhaj looks 8 like? 9 A She looks probably my height, maybe -- 10 Q How tall would that be? 11 A Five foot four. 12 Q Okay. 13 A Five foot five. 14 Q Uh-hum. 15 A And maybe around 150, 160 pounds. She wear some 16 pale clothes. She told me she's a nurse. That's what I 17 can recall. 18 Q Okay. So more than likely she was in the 19 exami ning; room when you first came in to see her, is that 20 right? 21 A Yes. 22 Q And would there be like a chart in a chart 23 holder, or would there be a chart in there or something? 24 A Yeah. Usually I said to my girl take the patient 25 into the room. The patient sitting in the mobile black Page 11 1 appointment, and they state hearing loss, ear fluid. 2 That's what the patient said, yeah. 3 Q Okay. And is the rest of the writing on this 4 page yours? 5 A That is my writing, no question. 6 Q Other than the name, address and so forth? 7 A Right. 8 Q Okay. Now can you tell me when Mrs. Alhaj came 9 to you, where did you first see her? Was it in the waiting 10 room or was it in the office? 11 A It was always in the examination room. 12 Q In the examination room? 13 A Yes. 14 Q Do you recall whether you were in the examination 15 room and she came in or whether she was already in the 16 examination room when you came in? 17 A Yeah, usually a patient is in the examination 18 room, then I come in. 19 Q Okay. Do you recall whether on this first visit 20 Ms. Alhaj was with anyone else? 21 A My recollection was she was there with her 22 husband. 23 Q Your recollection is with her husband? 24 A Uh-hum. 25 Q Okay. And did you --can you describe her Page 13 1 chair. The family can sit on the side, the chair. Then 2 there's usually a chart on the chart rack right outside of 3 the door. That's how our routine procedure. 4 Q You said mobile black chair; is that what you 5 said? 6 A Yeah, an ENT chair, it goes up and down or, you 7 know, by pressing a button. 8 Q Is it like a desk chair? 9 A Similar to the dentist chair. 10 Q A dentist chair? 11 A And it rotate, move up and down in a position, 12 backward, forward, and the ENT examination chair, let's put 13 it that way. 14 Q Okay. Very good. Do you recall speaking at all 15 to the person who brought her back to the office -- I mean 16 to the examining room before examining Mrs. Alhaj? 17 A I'm not sure. Are you talking about my -- 18 Q Your person, yeah, whoever it was? 19 A Oh, there's no way I can say that. I have four 20 rooms. They alternate. There's no way I can recall who 21 did that. 22 Q Okay. 23 A Uh-hum. 24 Q And the answer that you gave me that you cannot 25 recall is a perfectly fine answer. Page 10 -Page 13 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 :WAN H. WON, M.D. )CTOBER 3, 2003 Multi-Page TM Page 14 1 A Okay. 2 Q If you can't recall, that's what I want you to do 3 because I don't want you to guess. 4 A Sometimes I'm in the other room that's close to 5 the door. In the meantime my girls will bring another 6 patient into the examination room, so you just don't see 7 it. 8 Q Right. 9 A But even if I saw it there's no way I can recall, 0 you know. 1 Q Okay. I understand. 2 A Okay. 3 MR. RICCI: And you are saying you don't recall 4 who did that? 5 THE WITNESS: Who did that, I don't recall. 6 MR. RICCI: I'm not sure that was Mr. Rovner's 7 question though. 8 THE WITNESS: Who brought the patient to the 9 room? 0 BY MR. ROVNER: 1 Q Right. 2 A No, I can't recall. 3 MR RICCI: All right. 4 BY MR. ROVNER: 5 Q The question I have is probably going to be the Page 15 1 same answer, but did you have any conversation with this 2 person, whoever it was, about Mrs. Alhej? 3 A Conversation with who? 4 Q With whoever brought her back to the examining 5 room. In other words, I know you don't remember who 6 brought her to the examining room, but do you remember 7 having a conversation like, you know, is there somebody in 8 room No. 2 and what do they look like or anything like 9 that? 0 A I can't recall. 1 Q Okay. Is it your practice to talk to the people 2 who bring them back into the room and to discuss the 3 patient with them at all? 4 A No. With my girl? 5 Q Yeah. 6 A No, I don't. In my practice I usually don't. 7 Q Okay. Very good. 8 A Uh-hum. 9 Q All right. Now, let me get back to the part of D this that says cc. Does that mean chief complaint on the 1 form that you have here? 2 A Yes, that's the chief complaint. 3 Q Okay. Good. All right. Let's go then to the 4 part after it, ear fluid and what you have written down 5 here. Page 16 1 A That's my -- I say -- 2 Q After ear fluid, after that. 3 A It says one and a half years ago by FMD. Family 4 medical doctor, that's what that means. 5 Q What was one and a half years ago? What's 6 referring to one and a half years ago? 7 A One and a half years ago that I guess the patient 8 was treated or saw the family medical doctor. Okay. 9 Q Uh-hum. For what? 10 A For the -- I didn't write all the detail in the 11 complaint, but, you know, the -- it was constant 12 conversation when you have a patient that comes in. I'm 13 asking the question and answering, you know. Really this 14 is abbreviated. You can't write everything down. 15 Q I understand that, right, but I'm just wondering 16 what you are referring to? 17 A The problem indicating that her chief complaint 18 was started one and a half years ago, started with the 19 family doctor. 20 Q Okay. All right. Now, in the chief complaint 21 did she -- did the nurse write down anything about vertigo 22 or dizziness, the nurse? 23 A Not on here. 24 Q Okay. The next line that looks like begins with 25 Feb, Fe-b, can you tell me what that is? Page 17 1 A That is indicating February. 2 Q Yeah. 3 A She was told that she had some fluid and saw the 4 Dr. Cohn, Harold, and then also saw the neurologist. 5 Q Okay. And what kind of a doctor is Dr. Cohn? 6 A He's an ENT doctor, uh-hum. 7 Q All right. And then -- 8 A Then complaint is disequilibrium. It's a balance 9 problem. 10 Q Next what does that say? 11 A It says ear pops. 12 Q Uh-hum. 13 A Ear drains. 14 Q Uh-hum. 15 A Occipital headache. 16 Q All right. And the occipital is back of the 17 head? 18 A Yeah, back of the head here (indicating). 19 Q Okay. And the next line down? 20 A She has seen ENT and neurologists. 21 Q Okay. Is that neurologists, more than one? 22 A Yes. 23 Q Okay. Do you know who they were? 24 A No, I don't. You know, in fact, I thought she 25 saw more than one ENT doctor, too, you know, from what she age 14 - Page 17 HUGHES ALBRIGHT FOLTZ WATALF. 717-540-ononl7-'t9'i-5101 Multi-Page TM KWAN H. WON, M.D. UC1 Unk-K S, LU US Page 18 1 described, yeah. 2 Q Did you take down the name of the neurologist or 3 any other EN[ doctor? 4 A Well, yes, I would, but I don't know that I'm 5 going to record it here, you know. This is a 6 self-referral. This is the initial taking the history. 7 Q Okay. And it looks off to the left there are the 8 initials Mal. Does that -- 9 A That means she had an Ma] done so I have it 10 written down, yes. 11 Q All right. And it says tried and then there are 12 a number of medications? 13 A It's Lasix, Dyazide, Antivert, Phenergan. 14 Actually she told me a lot more, but you couldn't list all 15 of them. 16 Q Do you recall any of the other ones that you say 17 that she told you? 18 A Every time I mentioned -- she said she just about 19 tried everything. 20 Q But you didn't list what else she tried? 21 A No, I didn't list other than what I have listed 22 there. 23 Q Okay. And do you know what Lasix would be given 24 for? 25 A Probably as a diuretic. I don't know who gave Page 20 1 Q Okay. Did you ask for Dr. Cohn's records at any 2 time other time? Did you request from Dr. Cohn copies of 3 his records? 4 A Customarily we don't usually request for them 5 unless a patient has signed the consent and we have the 6 patient to go ahead and bring the old record. 7 Q All right. Did you ask Mary Ann Alhaj at any 8 time after this first meeting of September 28th to bring 9 Dr. Cohn's records? 10 A I told her that I like to see Dr. Cohn's 11 record because there was a fluid. I'm sure some tests 12 were done, and I was unable to -- or I didn't get his 13 record. 14 Q How about any neurologists' records, did you get 15 any of those records? 16 A I thought I had some, the Mal report. I don't 17 know when I received that, whether -- I can't recall 18 whether she brought it in or I received it later. 19 Q Okay. At some point you say you had the Ma] 20 report? 21 A Yes. 22 Q Okay. 23 A Either it was faxed or... 24 Q Do you have that Mai report in your -- 25 A Yes. Page 19 1 her Lasix though. 2 Q And would that be effective in helping the 3 problems that she was complaining of, Lasix? 4 A Well, if there's a Meniere's, the Dyazide is 5 usually used. 6 Q If there is a what? 7 A If there is an inner ear problem. 8 Q Inner ear? 9 A Problem with the Meniere's syndrome, Dyazide is 10 an accepted treatment, yes, but, you know, the use of 11 Lasix, but that's the same thing. 12 Q And Antivert, what is that for? 13 A Antivert is Meclizine which is a -- it does have 14 some antiemetic for the dizziness, anti-vertiginous drug. 15 Q And what about Phenergan? 16 A Phenergan is also an antiemetic, try to prevent 17 the nausea, vomiting. 18 Q Now, at any time did you ever talk with Dr. Cohn 19 about his treatment or his involvement in treatment of Mary 20 Ann Alhaj? 21 A No. 22 Q Okay. Did you ever ask for Dr. Cohn's records? 23 A I asked her to bring some records but -- 24 Q Did she bring Dr. Cohn's records? 25 A No. Page 21 1 Q Okay. And do you have any system in your office 2 for deciding when you have obtained that? 3 A No. 4 Q All right. Now, there is a fax-mark on top 5 there; is that right? 6 A Is that the date that they were sending it in or 7 not? 8 Q The mark that I see there is -- 9 A The 9/27/2000. 10 Q There's a fax machine imprint of 9/27/2000; is 11 that right'? 12 A Many times we asked them to go ahead and call 13 your doctor and send me the record, and then their doctor, 14 sometimes they fax the information to my office. 15 Q Right, I understand. What I'm asking you though 16 is the fax mark that's on the top of this indicates 17 9/27/00. Is that when you think you may have received it? 18 A I think so. 19 Q All right. All right. And was there anything -- 20 you saw -- did you see the name of the referring physician 21 there, the physician who asked for the Mal and ordered 22 it? A Yes, uh-hum. Q And who was that? A Charles Yanofsky. Page 18 - Page 21 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 LWAN H. WON, M.D. OCTOBER 3, 2003 Multi-Page`"" Page 22 1 Q Do you know Dr. Yanofsky? 2 A Yes, I know him. 3 Q Okay. Did you ever ask Dr. Yanofsky for any 4 other records of Mary Ann Alhaj? 5 A No, I did not. 6 Q Did you ever have any conversations with 7 Dr. Yanofsky about Mary Ann Alhaj? 8 A No, huh-uh. 9 Q Okay. Were you aware of any findings that were 10 out of the ordinary or out of normal in that MRI? 11 A It says there is no change. She apparently had 12 another MRr done earlier, in January. That's nine months 13 earlier. 14 Q Okay. Did you read it when you received it? 15 A Yes. 16 Q Okay. Was there anything out of the ordinary 17 that was noted on that? 18 A Well, my interest is when the patient complains 19 of a dizziness, you know, the balance problem, you are !0 concerned about a tumor, acoustic neuroma or meningioma. ! 1 That's what I'm looking for, but I did not find it there, !2 any abnormal tumor in the internal auditory canal or in the !3 CP angle. Okay. A Q Did you see anything in there about a lesion in :5 the pons? Page 23 1 A Yes, I read about that. 2 Q Okay. 3 A Uh-hum. 4 Q And did that impact on your treatment at all? 5 A No, I don't think the pons was, you know, the 6 finding. It's not going to cause what this patient has, 7 the symptoms that this patient has. 8 Q And did you discuss with any neurologist or 9 anyone else these findings on the MRI? 0 A No. 1 Q Are you a neurologist? 2 A No, I'm not. 3 Q Okay. Okay. Let's go down then to the next, 4 what looks like the next section, sort of divided into 5 three columns. 6 A Uh-hum. 7 Q And there is on the left-hand side, there looks 8 like some preprinted boxes. It looks like they can be 9 checked. 0 A Uh-hum. 1 Q It says ears, nose, throat, headache. 2 A Uh-hum. 3 Q Okay. And what are those boxes for? 4 A Those are boxes initially planned for sometime 5 you can write very fast when we are taking a history so Page 24 1 easy to go ahead just to mark it off. Initially we 2 started, but I almost no longer using now. 3 Q So you did not mark off anything in that area? 4 A No. 5 Q Okay. Now, let's go to the center area, all 6 right? It says -- what is the first writing above there? 7 A On the top? 8 Q Uh-hum. 9 A It says 1970, unable to pass, I guess she tried . 10 to go into Navy, because of a hearing loss. 11 Q All right. What was your understanding of what 12 that meant? 13 A Well, that's her statement, you know, because I 14 think that's before we did a hearing test and all that. 15 She said something about she has some high frequency loss 16 from working in the airline. 17 Q Are you saying this was loss before or after 1970 18 that you are referring to? 19 A It says that she has a -- 1970 she failed to pass 20 the test for the Nary. 21 Q Okay. 22 A That's just part of her history. 23 Q That was your understanding? 24 A Yes, uh-hum. 25 Q Okay. Let's go down then to the center part. It Page 25 1 looks like the date 5/98, okay? Do you see that? 2 A Yes. 3 Q Okay. Can you read that for me slowly into the 4 record? 5 A May, '98, was dizzy, so saw Dr. Cohn. He is an 6 ENT. Then the MRI was ordered. 7 Q Uh-hum. 8 A The abnormal finding at pons. 9 Q Uh-hum. 10 A And sent to neurologist. 11 Q Uh-hum. 12 A And still dizzy, especially in the morning. 13 Q Okay. Did she tell you how long the dizziness, 14 what you are calling dizziness lasted? 15 A Usually lasted all day if I recall, yes. 16 Q Did you write down how long the dizziness 17 lasted? 18 A No, I did not. 19 Q All right. Did you write down whether it was 20 every day? 21 A She says it is severe enough that she is unable 22 to work. 23 Q Okay. Did she tell you, did she indicate to 24 you whether or not the dizziness was getting better or 25 worse? age 22 - Page 25 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 Multi-Pagerm KWAN H. WON, M.D. nrlrnuuv z )Anz Page 26 1 A It's not getting any better. 2 Q Okay. Did she indicate to you what symptoms she 3 had with the dizziness? 4 A Well, she has a -- her ears will close and open, 5 pressure. She has a balance problem. 6 Q Okay. And did you indicate that in your records 7 concerning the ears opening and closing? 8 A Not on this page though. 9 MR. Ricci: Other than the comment about the ear 10 pops and the ear draining up above there. 11 BY MR. ROVNER: 12 Q Is that what you are saying, ear pops and ear 13 draining, that's the same as ear opening and closing? 14 A Ear pops open and closed, yeah. 15 Q Okay. And when -- let's go down to the next one. 16 Tried every medication available and not helping. Is that 17 something she told you? 18 A Yes. 19 Q Okay. And we already talked about what 20 medications you knew about. Do you recall -- you don't 21 recall offhand any of the others that she mentioned? 22 A Oh, I think she mentioned many other medications. 23 She had this for two years, and she tried everything. She 24 was actually very desperate, that something aught to be 25 done. She said I'm so dizzy I cannot walk. I'm a nurse at Page 27 1 the hospital, and the -- so, you know, we really actually 2 talked about the Valium, Ativan and a few other things, and 3 she said I already tried that. 4 Q Okay. And have you recorded that information 5 anywhere? 6 A No. 7 Q Okay. All right. Now, by the way, do you 8 keep track of how many patients you see in a given year 9 roughly? 10 A Yes. 11 Q How many patient visits, not individual patients 12 but visits? 13 A The patient visit? 14 Q Yeah. 15 A Yes, uh-hum. 16 Q Approximately how many in let's say the year 2000 17 roughly? 18 A I see about 20 to 25 patients a day. 19 Q Okay. And how many days would that be? 20 A Five days a week. 21 Q Okay. Are there also times when you are in the 22 operating room? 23 A Only in the office a half a day. 24 Q Okay. 25 A And a half a day I am in the operating room. Page 28 1 Q Okay. So what is a half day in the office? 2 A That is a Monday, Wednesday, Thursday. 3 Q Okay. And how long is a half day? What are your 4 office hours? 5 A The office hours could be somewhere four to five 6 hours. Sometimes like a Thursday I'm in the office until 7 in the evening. It depends on the number of patients. 8 Q Okay. And the 20 to 25 patients that you see a 9 day, does that include patients that you are operating on? 10 A That includes the post-op care, yes. 11 Q Post-op care. How about patients you are 12 operating on? 13 A They are not included. 14 Q Okay. 15 A I mean they are in the hospital. 16 Q Okay. 17 A Okay. 18 Q All right. 19 A But, in fact, when they come in the next day for 20 like a dressing change, in a sense they are included. 21 Q Right. So would I be correct in saying that 22 Tuesday and Friday are full office days? 23 A I would say it could be full but not entire whole 24 day. 25 Q Okay. Page 29 1 A Until we finish, until the last patient is seen. 2 Okay. 3 Q Okay. And then what -- then you operate then on 4 the afternoons on Monday, Wednesday and Thursday? 5 A Only in the morning. 6 Q The, morning? 7 A Only in the morning. 8 Q On Monday, Wednesday, Thursday? 9 A Three days, yes. 10 Q Okay. And how many operations would you do on an ii average morning? 12 A Maybe about three or four patients. 13 Q Okay. All right. I'm sorry. Let's go down 14 again this sheet where it says ENT examination. 15 A Yes, uh-hum. 16 Q Okay. Now, over on the left-hand side it says 17 ear, and there's some more check boxes; is that correct? 18 A Yes, uh-hum. 19 Q All right. And then there's an empty space out 20 to the right of that which I assume is for you to write 21 notes and things like that? 22 A Uh-hum. 23 Q All right. Is that yes? 24 A Yes. 25 Q Okay. Good. Page 26 - Page 29 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 CWAN H. WON, M.D. 3CTOBER 3, 2003 Multi-Page TM Page 30 1 A Sorry. 2 Q Now, it looks like there are only two checks on 3 the right and the left for R-i-n-n-e. Is that correct? On 4 the box underneath ear, is that what that is? 5 A I don't know when the -- on the top on the 6 ear? 7 Q Yes. 8 A Yes, it says N1.. It's normal. 9 Q Normal, right? 10 A Okay. I just do that for if there's a left one I1 that's abnormal, I mark the left or right, but when you 12 have both sides normal I write the normal, NL 13 Q I see only two checkmarks in those boxes. 14 A Okay, Rinne, yes. 15 Q What does that mean? :6 A That is a test with a tuning fork, usually 512, .7 that's the hertz, 512 hertz, checking the bone conduction 8 and air conduction. 9 Q And -- !0 A And when the air conduction is loud it's a Rinne :1 positive. Okay. !2 Q So what do the checkmarks mean? 3 A The checkmark mean there is no fluid behind the !4 drum. I mean you can have a small amount of a fluid, still :5 air conduction is louder, but if a large amount of a fluid, Page 31 1 the bone conduction is louder, then I would write on the 2 side B. (Indicating), what is that called? It's louder 3 than the AC. 4 Q Okay. Do those ch=kmarks mean that the Rinne 5 test was normal? 6 A Normal. 7 Q Okay, good. All right. And then down below 8 there is another -- there is some other words written. 9 What does that say? 0 A No nystagnus. 1 Q Okay. And what is nystagmus? 2 A Nystagmus is a sudden jerk of eye movement. The 3 only time we check that is when the patient has a vertigo 4 or balance problem, suspecting an inner ear. Okay. 5 Q Did you actually observe Mrs. Alhaj have any 6 balance problems while you were examining her? 7 A The -- she did not have any attack or anything 8 like that while examining her, but I checked the nystagmus. 9 Q Okay. And was there any nystagmus? 0 A No. 1 Q And what did that indicate to you? 2 A Well, you know, if you see -- nystagmus is such a 3 -- it's a complicated meaning. If the patient has a -- I 4 have the patient to watch my finger, follow my finger. If 5 the vertical nystagmus, you are concerned about a central Page 32 1 lesion. You have a horizontal nystagnus but it's 2 persistent, not tiring, then again we are concerned about 3 the retrolabyrinthine lesion. If it's a tiring, then you 4 are concerned about the inner ear, the vestibule lesion, 5 you know. Sometimes if you have a rotational nystagmus or 6 an altering nystagmus, you are concerned about the central 7 lesion, Chiari malformation and so forth. 8 Q Okay. And so all this was normal? 9 A Normal, yes. 10 Q All right. Now, let's go over to examination of 11 the nose. Anything that was -- 12 A All it says normal. 13 Q All normal? 14 A Yes. 15 Q She had her tonsils out? 16 A Yes. 17 Q It doesn't say whether she had her adenoids out. 18 Did they also come out? 19 A Adenoids always disappear by the time teen, so if 20 they were taken out before the 12 years old, they are 21 routinely taken out. When it's an adult, it's already 22 gone, so you just take the tonsils out. 23 Q So you don't whether she had them both 24 removed at the sameknow time? 25 A No, no. Page 33 1 Q Okay. And larynx and neck, anything out of the 2 ordinary there? 3 A The larynx, no examination. That's not my 4 obligation. Yeah, I don't routinely examine the larynx- 5 Q And no problem with the neck? 6 A No problem with the neck. 7 Q Okay. Now, underneath it says impression, 8 studies and treatment. Do you see that? 9 A Yes. 10 Q Okay. Now, do you fill that out at the same time 11 you are filling out the front of the sheet, or do you fill 12 that out at the end of the appointment? 13 A Impression, yeah, impression is filled it out if 14 the hearing test is done after the audio and so forth, you 15 know, yeah. 16 Q All right. Now, that was -- was that the -- all 17 right. On September 28th, that visit, did you do any 18 further testing other than what you have told us? You did 19 the Rinne test. You did the test for nystagmus. You 20 looked at the ear and the nose and the throat and the neck. 21 Did you do any further testing on her at that time? 22 A My recollection is I did a hearing test on that 23 day. The date is different, whether we misprinted, 24 miswritten, because I recall I spent a considerable time, 25 have the husband wait in the -- there is for the surgical age 30 - Page 33 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 Multi-Page"" KWAN H. WON, M.D. V(:1L111:K J. ZUU3 Page 34 1 room where they wait when the hearing test is being done, 2 and after the hearing test is done then I explain to her in 3 detail, and we discussed the medical management, my 4 recollection. 5 Since she had every -- the tests had been done, 6 every medication was tried, I recall that I gave her plenty 7 of samples of a Lipoflavonoid. 8 Q Okay. Let me stop you for a minute, and we'll go 9 back to the hearing test, all right? Now, the date we have 10 that's on there is 9/29/00. You think that that's an 11 incorrect date? 12 A Probably the same day. You know, I do not have 13 audiologist on Thursday and Friday. 14 Q Uh-hum. 15 A So I think it's an incorrect date, yeah. 16 Q All right. As you look at the hearing test 17 today, does it show you anything that's abnormal for the 18 date that's 9/29/00 or whatever date that was? 19 A Yeah, there is some mixed hearing loss but mostly 20 sensory neural hearing loss. 21 Q Okay. And how does that show itself? 22 A The normal hearing, we like to see the less than 23 20 decibel. Normal ear about a 5 to 10 or 5 to 15 24 decibels, depends on the standardization of the machine, 25 but on her case showing right ear the 30 to 45, left ear Page 36 1 associated with her symptoms. 2 Q Arid which symptoms were important? 3 A Well, you know, I didn't write the actual word of 4 a vertigo, but she had a vertigo, balance problem, 5 tinnitus. She has a pressure in the ear. 6 Q Did she have any ringing in her ears? 7 A Yes. 8 Q And where did you record that? 9 A I may not record it, but I know she had a ringing 10 in the ear. 11 Q Doctor, is tinnitus an important symptom of 12 Meniere's disease? 13 A Well, that is one of the symptoms, but, you know, 14 you don't always have to have all the symptoms to make a 15 diagnosis 16 Q Did she have tinnitus? 17 A I think she did. 18 Q Are you sure whether she did or not? 19 A Yea, yes. 20 Q Okay. But you didn't record it anywhere? 21 A No. 22 Q And what would a patient tell you in order for 23 you to know that they had tinnitus? 24 A They tell you usually that I have a ringing or a 25 noise in my ear, uh-hum. Page 35 1 same way, and when she did the bone conduction it's 2 compatible with mostly sensory neural hearing loss on both 3 sides. 4 Q So the bone conduction you are saying? 5 A The bone conduction, if purely it is conducted 6 for hearing loss, bone conduction will show somewhere 5 to 7 15 decibel. Those are the difference because of the fluid, 8 but when you look at it, she has the mainly sensory neural 9 hearing loss. 10 Q Okay. Well, let's go then to the part of your 11 chart where you have written some notes. In the original 12 it appears to be a blue sheet of paper; is that correct? 13 A Yes. 14 Q Okay. Now, did you write anything on the blue 15 sheet of paper with regard to the September 28th visit? 16 A No. 17 Q Okay. Did you writedown your impression on or 18 about September 28th of what Ms. Alhaj's problem was? 19 A Yes, I was -- you know, after the hearing test, 20 after reviewing her symptoms, my impression was a 21 Meniere's. 22 Q Okay. And what was it about the hearing test 23 that made you think it was Meniere's? 24 A Well, the Meniere's disease is a difficulty with 25 the low frequency hearing loss and usually sensory neural Page 37 1 Q Okay. 2 A Uh-hum. 3 Q Is that the same as ear pops? 4 A Ear pops is different. Maybe that means more of 5 a pressure, a pressure that pops and opens. 6 Q Okay. And did you when you examined Ms. Alhaj 7 see any draining in either ear? 8 A No, I did not. 9 Q Okay. And you didn't see any problems with her 10 tympanic membranes? 11 A No. 12 Q Before you wrote down your impression as 13 Meniere's disease, did you perform any other tests other 14 than the audiological tests and your examination to 15 determine your impression of Meniere's disease? 16 A Other than some simple neurologic tests, you 17 know, like; a nystagmus, you know, the arm to touching her 18 nose and telling her to just -- you know, watching her 19 walking, other than that, no other tests other than that. 20 Q Did you have her walk? 21 A We,Il, we can -- yeah, we watch it. I didn't have 22 her to walk, but she did not complain, but after the 23 audiogram it's obvious that she has a more of an inner ear 24 problem. 25 Q And other than Meniere's disease were you Page 34 -Page 37 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 KWAN H. WON, M.D. DCTOBER 3, 2003 Multi-Page TM Page 38 1 considering any other problems for the inner ear in your 2 differential diagnosis? 3 A No. You know, there is -- you know, there is 4 many differential diagnoses. 5 Q Okay. So did you feel that she had inner ear 6 fluid? 7 A You mean middle ear fluid? 8 Q Was there too much inner ear fluid? Was there 9 some problem with the inner ear fluid? 10 A You are talking about the endolymphatic sac? I1 Q Yes. 12 A Yes, that's a Meniere's, but you can't tell. 13 Q Okay. 14 A You can't see it. 15 Q You can't see anything? 16 A No one can see it. Only by autopsy you can find 17 it. Okay? 18 Q Okay. Did you perform an ENG? t9 A No. !0 Q Do you have the ability -- !I A I don't perform the ENG. I usually refer out to !2 the Polyclinic. !3 Q Okay. Did you refer her to the Polyclinic for an !4 ENG? !5 A No, no. Page 39 1 Q How about electrocochleography? 2 A Yes, there are several tests. None of them are 3 essential for the diagnosis of Meniere's. There are a lot 4 of diseases can be positive on the, you know, the 5 electrocochleography. I wasn't doing it here. 6 ENGs again, unless a patient has a real attack, 7 20 to 40 percent of the time it's negative, so it is 8 non-specific and does not -- the ENG alone does not make a 9 diagnosis. 0 Q Does the ENG help you make a diagnosis? 1 A It certainly help, yes. 2 Q Okay. How about the electrocochleography, can 3 that help you make a diagnosis? 4 A It could help the diagnosis, but be less 5 essential than the ENG probably. 6 Q You did send her for some auditory evoked 7 potentials? 8 A No, I did not. 9 Q You did not, okay. I thought I saw in here 0 that -- 1 A I think I told her to go to a neurologist to get 2 some more tests done. That's what they did there. 3 Q Okay. 4 A Yes. 5 Q Did they report to you the results of -- well, Page 40 1 you didn't send her to there at that time. Sony. We'll 2 get into that later. All right. 3 Is there such a thing as otoacoustic emissions 4 testing? 5 A Yes. 6 Q Did you do that? 7 A No. 8 Q Do you have the ability to do that in your 9 office? 10 A Yes, I think my office can do that. I don't have 11 any information. We do that more on the children with some 12 hearing loss, possibly sensory neural hearing loss. 13 Q Did you discuss -- you say you gave her some 14 Lipoflavonoids? 15 A Yes. 16 Q Is that correct? 17 A Yes. 18 Q Are these essentially some kind of vitamins? 19 A Yes. 20 Q And did you discuss with her -- I'm sorry. 21 Strike that. 22 And the next thing it says on this treatment line 23 at the bottom of the first visit, again we are looking back 24 at that, it says HA discussed, and what is HA discussed? 25 A That's a hearing aid. Page 41 1 Q Okay. And tell me what you had discussed about 2 that. 3 A Well, you know, I always explain the hearing test 4 result, you know, each column by column, and I'm sure I 5 told her that the hearing test is compatible with the 6 Meniere's, and she says that she's having a good bit of a 7 hearing problem, so we usually discussed the speech 8 discrimination test down here, right and left, since it is 9 about the 96 percent you could wear the hearing aid if you to are having difficulty in daily life. Since it is 96 11 probably either ear, you know, that type of a discussion, 12 give a recommendation. 13 Q Did you recommend that she get a hearing aid? 14 A I did mention that it is borderline type of, but 15 if she has a problem with the hearing she could use a 16 hearing aid, yes. 17 Q Did you discuss with her any other changes or 18 strategies she could take to try to alleviate her 19 symptoms? 20 A Well, actually she said she tried just about 21 everything that is available in the past two years, and 22 that's where the Lipoflavonoid came. 23 Q Did you discuss with her any dietary changes? 24 A That she also was taking Dyazide because we 25 discussed the low salt diet, you know, avoiding the age 38 - Page 41 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 Multi-Page r''` KWAN H. WON, I?LD. Page 42 1 alcohol, caffeine always help. 2 Q Are you telling me you remember discussing all 3 this with her? 4 A I remember discussing the low salt. Okay. 5 Q Okay. Did you provide her with a low salt 6 diet? 7 A No. 8 Q Did you have any handouts that you -- 9 A No, I don't have that, no. 10 Q You didn't give her any information? 11 A That's where the family physician -- 12 MR. RICCI: Doctor, you have got to let 13 Mr. Rovner finish his question first -- 14 THE wrrNEss: Okay. 15 MR. RICCI: -- and then you can answer. 16 BY MR. ROVNER: 17 Q Yes. She only has two hands to take down the 18 information. 19 A Okay. 20 Q Okay. So did you have any information on 21 Meniere's disease that you handed to her? 22 A No, I did not. 23 Q Did you have any information about hearing aids 24 that you gave to her? 25 A No. Page 43 1 Q Okay. You already said no information about low 2 salt diet. I mean you didn't hand her any -- 3 A No. I do not hand any paper for any disease. 4 Q And did you diagnose Meniere's disease in both 5 ears at that time? 6 A Yes. 7 Q Okay. And have you treated patients before 8 Mrs. Alhaj with Meniere's disease? 9 A Yes. 10 Q Have you treated patients other than Mrs. Alhaj II with Meniere's, bilateral Meniere's disease? 12 A I really can't recall. Mostly unilateral. 13 It could be one or two many years ago, but I can't 14 recall. 15 Q But bilateral Meniere's disease is rather rare, 16 isn't it? 17 A It is rare, but it is reported up to 50 percent. 18 It's somewhere the 3 to 78 percent is recorded. 19 Q 3 to 78 percent you are saying? 20 A Yeah, yeah. 21 Q And where is that recorded? 22 A I can supply the reference later, but it 23 generally is around 50 percent, averaging it out, but I 24 just don't see that many. 25 Q Okay. Would you provide your counsel with the VUIUnnx s. cvos Page 44 1 reference that you are referring to? 2 A Bilateral? 3 Q Bilateral. 4 A Bilateral of the Meniere's? 5 Q Yes, yes. Have you ever before Mrs. Alhaj 6 treated any patient with Meniere's disease with Gentamicin 7 injections? 8 A Maybe one or two. 9 Q Okay. And how long have you -- how long have you 10 been in practice? I I A 29 years. 12 Q Okay. 13 A 29 years. 14 Q Okay. Sothis would have been almost --well, 15 about three years ago or two and a half years when the 16 injections happened, so you had been in practice then about 17 26, 27 years? 18 A Since 1974 I have been practicing. 19 Q 1974? 20 A So that's 29, yes. 21 Q And from 1974 you have treated perhaps two 22 patients with Gentamicin? 23 A One or two since that, yes. I can't count the 24 number. It could be one or two more but not that many. 25 Q All right. Now, before Mrs. Alhaj had you Page 45 1 treated any Meniere's patients with bilateral injections of 2 Gentamicin? 3 A No, no. 4 Q Can you give me a rough estimate in those 20 some 5 odd years before Mrs. Alhaj was being treated how many 6 people you may have treated for Memere's disease? 7 A I so, at least about two, three dizzy patients 8 every day. 9 Q Two or three of them every day? 10 A Every day. In fact, I saw two this morning. 11 Q Okay. 12 A Okay. And I don't have a computerized statistics 13 or anything, but it's common, you know. Most of the 14 dizziness is not a Meniere's. It's not that uncommon. 15 Let's put it that way. 16 Q Okay. Now, it looks to me from your records that 17 there was an appointment scheduled for November 8th of 2000 18 at which Mrs. Alhaj did not come? 19 A Yes, 20 Q Is that correct? 21 A Yes. 22 Q Allright. Do you know why that appointment was 23 cancelled? 24 A No, I have no idea. 25 Q Okay. The next appointment I see is November Page 42 -Page 45 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 CWAN H. WON, M.D. )CTOBER 3, 2003 Multi-Page''` Page 46 1 28th which would have been two months after the first 2 appointment. Is that the second only appointment, other 3 appointment? 4 A Yes, yes. 5 Q The next appointment I mean. Do you recall any 6 contact with Mrs. Alhaj between September 28th, 2000, and 7 November 28th, 2000? 8 A No. 9 Q Okay. All right. Now, let's look at November 10 28th, 2000, and your notes there, okay? 11 A Yes. 12 Q The first note that -- first of all, are all 13 these notes in your handwriting? 14 A Yes, that's my handwriting. 15 Q All right. And the fast thing that's written 16 there is what? 17 A Seeing allergist. 18 Q Okay. And do you know what allergist that is? .9 A I can't recall it. !0 Q Do you know why she was seeing an allergist? !1 A You know, I'm not sure. My impression was she !2 was just going around to so many different doctors to get !3 help. !4 Q And let's read the next part into the record. !5 Was this note of 11/28/2000, was that completed on that Page 47 1 date? 2 A Yes. 3 Q Okay. 4 A It's always completed that day, right. 5 Q Can you read slowly into the record what it is 6 that you wrote there? 7 A She is in tears. 8 Q Uh-hum. 9 A And wants something done, dash she can't walk 0 because of the dizziness. 1 Q Okay. Let's stop you right there. Was this 2 something different from what she had told you in September 3 or the same? 4 A The same. She said Lipoflavonoid is not helping. 5 I'm so dizzy I lose my balance and... 6 Q And did you ask her how frequent the dizziness 7 was at that time? 8 A She -- you know, I'm sure I did. I don't know 9 how frequently. My impression she was just about dizzy .0 almost every day and can't function. .1 Q Did you ask her how long she had the dizziness? 2 A You know, usually hours to day, I recall, you 3 know. When she got up it makes her worse, you know. 4 Q I'm not sure I understood your answer. Hours? 5 A Hours to a day. Page 48 1 Q Hours to a day? 2 A Uh-hum. 3 Q And would this be every day? 4 A Either every day or frequent enough that she was 5 unable to work. 6 Q Okay. You haven't recorded the frequency there? 7 A No. 8 Q Okay. Now go ahead. 9 A I have discussed several options, ototoxic drug 10 injecti on or other surgery or nerve section, et cetera. 11 Q And by ototoxic drug were you referring to 12 Gentamicin? 13 A Yes. 14 Q Okay. And did you say that to her, it's an 15 ototoxic drug, or did you explain it in some other fashion? 16 A Yeah, I thought she seemed to understand very 17 well. My impression was that she is a nurse from Holy 18 Spirit Hospital, and the ototoxic drug is damaging for the 19 hearing. I think she understood that well. 20 Q All right. When you say she's a nurse, do you 21 know what kind of a nurse she is? 22 A No, I don't. She told me she's a nurse from Holy 23 Spirit. That's all I know. I can recall. 24 Q Do you know if she was an RN? 25 A Either RN or LPN, that's what I assume. Page 49 1 Q Do you know if she was a nursing assistant? 2 A Well, she said she was a nurse. Okay. That's my 3 recollection. 4 Q Okay. Did you at that time have privileges at 5 Holy Spirit Hospital? 6 A Yes. 7 Q Do you remember ever seeing Ms. Alhaj at the Holy 8 Spirit Hospital? 9 A No. 10 Q Okay. Did you have patients that were on the 11 med. surg. floor? 12 A Most of my patients are outpatients. I don't 13 know what floor is the med. sung. floor. 14 Q Okay. That's fine. All right. You say ototoxic 15 drug injection or other surgery. What other surgery? 16 A That's the endolymphatic sac surgery, we call the 17 shunt surgery or sac surgery. 18 Q Okay. And nerve section? 19 A Nerve section is usually a vestibular 20 neurectomy. It's the cochlear vestibular, taking the 21 vestibular nerve and cutting. 22 Q Do you perform either the endolymphatic sac 23 surgery or the vestibular neurectomies? 24 A No. 25 Q Let's read the next paragraph there that's in age 46 - Page 49 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 i Multi-Page' KWAN H. WON, M.D. Ul:l UtshK J. lUU9 Page 50 1 your own handwriting. 2 A Since it is not routinely done, dash asked her to 3 go to large center where procedure is done frequently. So 4 I explained to her, you know, I don't do this type of a 5 surgery, none of us doing this routinely. You should go to 6 the place where they do many number of surgery. 7 Q And did you recommend a particular place? 8 A I recommended go to Johns Hopkins. 9 Q Okay. And why particularly Johns Hopkins? 10 A That's where I came from, and I usually send most I 1 of my referral to my alma mater where I trained. 12 Q Okay. So you trained at Johns Hopkins? 13 A Yes. 14 Q Okay. Did you have a particular physician that 15 you referred or were going to refer her to? 16 A No, I didn't. 17 Q And TMs or TM's normal, is that tympanic 18 membranes? 19 A Yes, tympanic membranes are normal. 20 Q What's the next line say? 21 A No changes from previous exam. 22 Q Okay. All right. Do you recall whether she 23 actually did go to Johns Hopkins? 24 A You know, I'll tell you, I received a letter 25 because, you know, I do the recommendation. If they don't Page 51 1 know how to go about it, I give them a number and where to 2 call and all that, but I don't specifically refer to 3 certain particular physician because there are so many 4 changes, you know, the staff at Hopkins now. 5 Q Sure. Did you make an appointment for her at -- 6 at your office or do you -- 7 A We don't do that. 8 Q You don't do that? 9 A We don't do that. We just recommend it and 10 provide a number sometimes. Here's the number to call. 11 Q Okay. So you did not know whether Ms. Alhaj was 12 going to go to Johns Hopkins until or did go to Johns 13 Hopkins until you received a letter? 14 A Yes. 15 Q All right. 16 A She said she is going to go. You know, we were 17 talking about the other place, Penn State and all that, you 18 know. 19 Q Okay. Now, the letter -- are you referring to a 20 letter of December 15th, 2000, if you want to find that in 21 your records? MR RICCI: Right here. THE wiTNEss: Yes, uh-hum. BY MR. ROVNER: Q Okay. And the letter of December 15th, 2000, Page 52 1 that was from Dr. Howard W. Francis, M.D.? 2 A Uh-hum. 3 Q Yes? 4 A Yeas. 5 Q Okay. And do you know Dr. Francis? 6 A No. 7 Q When you received the letter from Dr. Francis, 8 did you read it? 9 A Yes, I did, uh-hum. 10 Q Did you have any contact or discussion with 11 Dr. Francis at any time concerning Ms. Alhaj? 12 A No. 13 Q I'm going to refer you to the second page of that 14 letter. 15 A Uh-hum. 16 Q And, in fact, the second to the last paragraph. 17 He says l have made the referral, and we are now waiting 18 for an appointment. Did you understand that he had 19 suggested that Ms. Alhaj go to a neurologist? 20 A Uh-hum. 21 Q Yes? 22 A Yeas. 23 Q Okay. All right. The next line says I do not 24 believe the Meniere disease is active nor any other 25 labyrinthine disorder at this time. Do you see that? Page 53 1 A Yes. 2 Q Arid do you -- did you disagree or agree with 3 Dr. Francis' assessment? 4 A It's somewhat I disagree, but in a sense he says 5 it is not active. Meniere's disease is not always easy to 6 make a scientific diagnosis other than signs and symptoms. 7 Q Did you believe that she still had Meniere's 8 disease? 9 A Yes. 10 Q Did you believe that the Meniere's disease was 11 active? 12 A You know, I haven't seers her for awhile, so, you 13 know, so maybe she always wean and wane, up and down, 14 plateau, then recur, so I really can't tell you now, but it 15 usually lasts for years. 16 Q Well, it appears that the next time you saw 17 Ms. Alhai was January 16th? 18 A Yes. 19 Q Is that correct? 20 A Uh-hum. 21 Q All right. When you saw Ms. Meniere on January 22 16 -- Ms. Alhaj on January 16th, did you believe that her 23 Meniere's disease was still active? 24 A Yes. 25 Q Okay. Is Meniere's disease something that is Page 50 - Page 53 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 CWAN H. WON, M.D. )CTOBER 3, 2003 Multi-Page TM Page 54 Page 56 1 going to be active one month and then inactive another 1 MR. ROVNER: Do you want to look through and make 2 month? 2 sure there is nothing in there that we shouldn't see? 3 A Yes, it's variable, uh-hum. 3 MR. Ricci: Sure, let me just double-check. 4 Q Okay. Did you -- well, did you contact anyone at 4 Okay. There's nothing here that you can't see. These are 5 Johns Hopkins to find -- to get any of their records of 5 all just insurance certification forms. 6 what testing they did? 6 MR ROWER: Okay. 7 A No. 7 MR. RICCI: I'll have my secretary make a 8 Q Okay. 8 complete copy of all of this so we both are up to speed, 9 MR RICCI: Beyond the description of testing 9 okay? 0 that Dr. Francis provided in his letter? 10 BY MR ROWER: 1 MR. ROVNER: Sure, sure. 11 Q We are going to mark this Certification of Health 2 MR. Ricci: Okay. 12 Care Provider Family Medical Leave Act Form as Exhibit No. 3 BY MR RovNER 13 2 for the deposition. There is a handwritten note on there 4 Q Now, at some time in November you gave Ms. Alhaj 14 that looks like it says originally or abbreviation for 5 an excuse to get off work; is that right? Did you do 15 originally sent to patient 11/30/00. Do you see that? 6 that? 16 A Yes. 7 A What is it? 17 Q Okay. Do you know whose writing that is? 8 Q Did you give her an excuse to be off work? 18 A That looks like D.J. Flickinger, the girl. 9 A I can't recall that. I know she brought the 19 Q And who is D.J. Flickinger? :0 disability form for me to fill that out because she said 20 A She another secretary. :1 she cannot work. You know, I don't know what month it was, 21 Q Okay. Is she a nurse or a secretary? :2 you know. Usually the patient bring it for me from their 22 A A secretary. 3 employer, or yes, I recall that. 23 Q Secretary. 4 Q Did you keep a copy of the disability form? 24 A Yeah, they bring this in frequently when they 5 A I think I do have it in my record. 25 have a tonsil taken out. They want to take off or they are Page 55 1 MR. ROVNER: Because I didn't get a copy, I don't 2 believe. 3 MR. RICCI: I don't have a copy in mine. You can 4 look. 5 THE WITNESS: Oh, this is -- is that what you are 6 referring to? 7 BY MR. ROVNER: 8 Q I don't know. I haven't seen it. 9 A The patient usually bring it if they wanted to be 0 off. 1 MR. RICCI: Yes. It annears to be a Fatnily Page 57 1 taking the family. I just fill it out, leave it out there, 2 and my secretary take care of it. Sometime they pick it 3 up. That's what that is. 4 Q So does it appear to you that this was filled out 5 somewhere around the end of November? 6 A It should have a date here. What's the date? 7 Q I didn't see a date on it. 8 A No date? 9 MR- ROVNER: Sorry. 10 MR. RICCI: No. I didn't even hear it ring. I I I caw vnu iumn. If vnu want to take a hmak_ we ran do that 2 Medical Leave Act Form. I'll get a copy for you. 12 If you want to take a break, I'll run down and make a 3 MR. ROVNER: All right There's a note -- can we 13 photocopy of this. 4 mark this or we'll mark a copy of this as Won 2? 14 (Recess from 2:11 p.m, to 2:14 p.m.) 5 MR. RICCI: Do you want me to grab a copy right 15 MR. ROVNER: Okay. So we looked at that form 6 now? 16 that we are going to mark as Exhibit No. 2 when we get it? 7 MR. ROVNER: What I'm thinking is there might be 17 MR. RICC1: Right. 8 other things in the record. Have you been through the 18 MR RovNER: All right. Can I take a look 9 chart? 19 through the doctor's file? D MR. RJCCI: No, not with any great deal of 20 MR. Ricci: You could, but it's downstairs being 1 specificity. I looked at his treatment notes that I have 21 copied. 2 got. 22 MR. ROVNER: Oh, the whole file? 3 MR. ROVNER: Yeah. Maybe -- 23 MR. Ricci: This is my copy. 4 MR. RICCI: We can do that. We can go through 24 MR. ROVNER: The whole file is being copied? 5 the chart. 25 MR. Ricci: Yeah, I thought that's what you age 54 - Page 57 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 Multi-Page KWAN H. WON, M.D. V%_ I[ vvrK.5, Luw Page 58 1 wanted, so I'm sure we have everything because I think 2 there was some insurance forms that I didn't have in my 3 copy either. 4 MR. RoVNER: Should we wait then for the record 5 to come back? 6 MR. RICCI: It will only take a minute. 7 MR. ROVNER: Or can we use the copy here? 8 MR. RICCI: We can use -- the work form that we 9 are talking about is not in this copy. 10 MR. ROVNER: Yeah, I'm not going to use that now. 11 MR. RICCI: Yeah, we can work off the copy if you 12 want. That's fine. 13 MR. ROVNER: Sure. Let's refer to Exhibit No. 1. 14 If something comes up, we can go to the original if 15 necessary. 16 MR. RICCI: Sure. 17 BY MR. ROWER: 18 Q The next appointment I see is on January 16th of 19 2001. Do you recall any contacts with Ms. Alhaj other than 20 possibly the Medical Leave Act Form between November 28th 21 and January 16th of '01? 22 A I really can't recall that. 23 Q Okay. Do you keep records of telephone calls 24 that come into your office? 25 A No. Page 60 I had Meniere's disease? 2 A I told her she has Meniere's, yes. 3 Q Okay. 4 A She complained of on the 16th mainly the pressure 5 in her ear, the ear opens and close, and she had a lot of 6 pressure. 7 Q Uh-hum. Okay. Did she complain about dizziness 8 at that time? 9 A Yes, uh-hum. 10 Q Did you write that down? 11 A No. Her symptoms were the same. 12 Q Okay. You explained -- it says underneath 13 disappointed with im. What does it say underneath there? 14 Do you see the note that says disappointed with im? 15 MR. RICCI: Where are you looking at? 16 MR.. ROVNER: 1116- 17 THE wrlNEss: Yeah, she says still have pressure, 18 disappointed with Jffit, Johns Hopkins. 19 BY MR. ROVNER: 20 Q And what is underneath there? 21 A It says explained possible further sensory neural 22 hearing lass from Gentamicin. 23 Q Okay. Are you saying you explained to her that 24 the Gentamicin could cause her further hearing loss? 25 A Yes, uh-hum. Page 59 1 Q Okay. 2 A But I keep -- when I called them on the record, 3 reporting the x-ray report or a CAT scan report, but coming 4 in, no. 5 Q When you saw Ms. Alhaj on January 16th of 2001, 6 you had already had the letter from Dr. Francis at Johns 7 Hopkins? 8 A Yeah, I think I did, yes. 9 Q Okay. Did you recall any discussions with 10 Ms. Alhaj about whether or not Dr. Francis felt that she 11 had Meniere's disease? 12 A I don't know whether we discussed that. I can't 13 recall that. The only thing was she came in just crying 14 that she was disappointed with the Johns Hopkins. is Q Okay. 16 A She was blaming actually I sent her to Hopkins. 17 Q Did she say why she was disappointed? 18 A You know, what she says -- she says he's not 19 helping any. He want me to see the neurologist. I already 20 saw several neurologists. I still have the same symptoms 21 and I'm very disappointed with their finding. 22 Q Okay. 23 A That's what she said. 24 Q Do you recall discussing at all with Ms. Alhaj at 25 that time that you believed, you still believed that she Page 61 1 Q Okay. Did you discuss any other problems that 2 Gentamicin might cause? 3 A The main concern with the Gentamicin is the 4 hearing loss. 5 Q I understand. Did you explain to her any other 6 problems with Gentamicin injection? 7 A I don't think I did. I think I was mainly 8 concerned about the -- you know, we talked about all the 9 different additional treatment, the labyrinthectomy, the 10 nerve section and all that which I don't do it, and we 11 discussed the only non-invasive, minimum procedure would be 12 putting the Gentamicin, but because it is both sides, I'm 13 really concerned about the hearing loss, and she wants 14 something done about it. You know, she just couldn't 15 function, and she wants something done, so we discuss about 16 the hearing loss. 17 Q Did you - in addition to the hearing loss, you 18 say you did not discuss anything else? 19 A I don't think I did, no. 20 Q Okay. Did you ever explain to Ms. Alhaj that you 21 had only injected one or two otber patients with 22 Gentamicin? 23 A No, I did not, no. 24 Q Did you explain to her that you had never 25 performed a bilateral injection of Gentamicin? Page 58 -Page 61 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 CWAN H. WON, M.D. )CTOBER 3, 2003 Multi-Page'" Page 62 1 A No, I did not. I know I told her that it is very 2 rare. We are in the last resort, you know, because over 90 3 percent or even more Meniere's disease do well with the 4 medication. They function well. The attacks are 5 infrequent. They can live a daily life, but this is very 6 extreme cases. 7 Q Did you indicate in your records anywhere that 8 this was the last resort, it was an extreme case? 9 A No, I did not, but she has tried now every t0 medication. I sent her to Hopkins. She was disappointed. t 1 I have the same problem. Can you do something for me, you t2 know, so that was the situation, you know. t3 Q Did you suggest to her that she make an 14 appointment with the neurologist at Johns Hopkins just to 15 make sure? 16 A I don't know that I said or not. You know, there 17 was -- you know, she knows those are -- that was their 18 recommendation, you know. 19 Q Now, you had never done a bilateral injection of ?0 Gentamicin before this, before you were -- this one you ! 1 were planning to do? !2 A Yes. !3 Q Okay. You had or -- !4 A Bilateral, no, no. !5 Q Okay. All right. Did you consult any other Page 63 1 physician concerning the advisability of doing a bilateral 2 injection of Gentamicin? 3 A No. 4 Q Okay. Did you do any research on bilateral 5 injections of Gentamicin before you did this? 6 A Yes, I did, uh-hum. 7 Q Okay. And what did you research? 8 A Most of them do not like to do a bilateral 9 because the main concern is the hearing loss, but when I 0 read all the report, when intractable, severe Meniere's 1 disease not responded by any medication or any medical 2 therapy, it is most popular using Gentamicin injection. 3 These are the unilateral cases, you know. I already told 4 her that I don't do this type of a surgery. That's why I 5 sent her to the big center. 6 There's nothing left, so I wanted to go ahead. 7 You know, I told her that, you know, labyrinthectomy she 8 could lose her complete hearing, the procedure I don't do, 9 still having a lot of complication. Only thing is we can't !0 tell when her symptoms are acting up whether it is from .1 right ear or left ear because of a bilateral disease. I !2 wanted to use the smallest amount of Gentamicin, see if she 3 responds, whether she gets any help. !4 Q Okay. Let me go back. Okay. I think you told !5 me about intractable, severe Meniere's disease, and you Page 64 1 explained to me about unilateral cases? 2 A Uh-hum. 3 Q Did you consult any reference, article, book of 4 any kind concerning bilateral injections for Meniere's 5 disease? 6 A Yes, the most of the record indicating a 7 bilateral, severe Meniere's disease, most are recommending 8 either the vestibular neurectomy, No. 2 protocol is 9 Streptomycin IM, and there is some difficulty finding to Streptomycin. That's how we find the ototoxicity from 11 Streptomycin when they treating TB. That protocol is 12 giving her two grams a day for five days, stop, five days. 13 That usually responds, and other protocol also mentioned 14 that the pure continuous use of Gentamicin, use of iM or 15 rv, because the less possible, less hearing loss, but you 16 run into the problem with the possible nephrotoxicity. 17 So those are the -- so when it comes to the 18 bilateral, no one has a good answer. 19 Q Let me ask you this. Okay. What were the 20 references that you refer to with regard to bilateral 21 injections of Gentamicin into the ear? 22 A The bilateral injection -- not because it is 23 routinely done on bilateral, my aim was whether she is 24 responding or not, you know, so I was going to give her -- 25 in fact, when they give Gentamicin they usually give a Page 65 1 large dose about four to nine days or seven days three 2 times a day. That's why I did not even give her the 3 Gentamicin. 4 Normally when I did a unilateral, you instill the 5 Gentamicin through the tube, give a patient a drop to use 6 that evening, and the next morning then come back for 7 follow-up for the hearing test. 8 Q All right. Let me stop you again. Can you give 9 me the name of any reference, any book that you referred to 10 with regard to bilateral injections of Gentamicin before 11 you did this on Mrs. Alhaj? 12 A Bilateral Gentamicin injection is usually not 13 recommended. 14 Q Wait. Okay. 15 A Okay. 16 Q Did you -- 17 MR. Rtccl: Hang on just a second. Doctor, you 18 have to listen to Mr. Rovner's question. 19 THE WrTNESS: Okay. 20 MR. Ricci: He's asking if you remember the 21 specific names of any references that you looked at, 22 treatises, books, articles, before you treated Mrs. Alhaj. 23 If you don't remember the specific references you referred 24 to, then that's your answer. That's all he wants to know 25 is do you remember what specific titles you looked at? 'age 62 -Page 65 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 Multi-Page KWAN H. WON, M.D. Page 66 1 THE wITNEss: I looked at the bilateral -- I 2 don't think there was any article that mentioned about 3 bilateral Gentamicin in searching for the article. 4 MR. RICCI: Okay. 5 THE WITNESS: Okay. 6 BY MR. ROVNER: 7 Q Did you -- do you recall looking at specifically 8 an article or a book with regard to your plan of treatment 9 for Mrs. Alhaj before you injected her? 10 A No. 11 Q Okay. 12 A You mean bilateral? 13 Q Yes. 14 A No. 15 Q Are you aware of any books or articles at the 16 present time on which you would rely to say that bilateral 17 injections of Gentamicin for Meniere's disease is an 18 acceptable treatment? 19 A No. 20 Q Was there anything to prevent you from using 21 Gentamicin in one ear to see how that worked and then if 22 that didn't work to try it in another ear, the other ear? 23 A We thought about that, too. I thought about 24 that, too, but to purely inject the one ear, patient is not 25 responding, you're not sure whether you injected the right Page 67 1 ear, what I'm saying, the proper ear or the Gentamicin did 2 not respond, so the only way to see whether there is any 3 response would be in my way of thinking is that give a 4 small dose in both ears, since there is a very little 5 chance of a hearing loss, then see what happens. 6 Q So let me go back a little bit. You're saying 7 you did not know whether the right ear or the left ear 8 would be causing more of the problems? 9 A Yes, no one can say. No one can -- yes, there's 10 no way of testing that, yes, yes. 11 Q If you injected one ear at a time, you would have 12 a 50 percent chance of getting the right ear, the correct 13 ear? 14 MR. RICCI: Well, assuming you only have a 15 unilateral problem. 16 BY MR. ROVNER: 17 Q Well, no. I'm asking him. If she had -- if she 18 indeed did have a bilateral problem -- 19 A Uh-hum. 20 Q Okay. If she indeed did, okay, is there one side 21 or the other that's generally causing more of a problem? 22 A No. You can't predict that, yes. 23 Q Was there anything to prevent you from trying one 24 side first and then the other? 25 A Well, eventually -- the only thing is that she V%_ I UDV-JK 3, Lvvs Page 68 1 has to go through the two procedure. I think the result 2 would be the same. 3 Q Ah right. 4 A Bomuse the interpretation would be the same. 5 Q You don't know how she would have responded to an 6 injection on one side, do you? 7 A I don't know what that means. 8 Q You cannot predict how she would have responded 9 to only a unilateral injection on let's say the right side 10 or the left side before you did it on both sides? I 1 A Yeats, you can't predict, yes, uh-hum. 12 Q Right. You knew that this was a procedure that 13 was very unusual, and you had only -- you had never done it 14 before, the bilateral injections? 15 A Yes, uh-hum. 16 Q But you did not consult with anyone as I 17 understand it, no one at Johns Hopkins, no one at Hershey 18 Medical Center, you didn't consult with anyone about this 19 unusual procedure that you had never done before? 20 A Yeah, I had no intention to give a full dose of 21 Gentamicin in both the ears, see. This is just my 22 intention was whether there is any response since nothing 23 was helping. That was my intention. If she had any 24 change, then we were going to formulate the, you know, 25 whether a different type of procedure should be done Page 69 1 because that's the only reason that we just inject the one 2 time. Okay. 3 I did not even have the patient to usually lie on 4 the 30 minutes on one side. That's the normal protocol. 5 When I have a unilateral Gentamicin, we usually put about 6 half cc into the middle ear, have the patient lie down for 7 30 minutes, then give a drop to the patient, go home, put 8 some more in, then in the morning put some more in, and 9 then come to the office, we do the hearing test. 10 Q Okay. I understand what you said about the 11 unilateral and about the amount of Gentamicin given. If 12 you had -- did you get a response, a favorable response to 13 the Gentamicin injection? 14 A In her case, no, we didn't get any response, no 15 change. 16 Q Okay. If you had gotten a response -- 17 A Uh-:hum. 18 Q -- would you have used more Gentamicin? 19 A I would probably use iM. 20 Q Intramuscular? 21 A Yeah, or I try to get the Streptomycin through 22 the FDA if she -- if she does not want to go to the other 23 institution and have the surgery done, that's what I would 24 do if she didn't respond -- if she partially responded. 25 Q What I'm trying to understand is -- all right. Page 66 -Page 69 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 K-WAN H. WON, M.D- )CTOBER 3, 2003 Multi-Pager'' Page 70 1 Let me ask the question this way. Did you consult any 2 reference with regard to using a smaller dose of Gentamicin 3 bilaterally as opposed to your normal dose that you would 4 use unilaterally? Do you understand what I'm saying? You 5 made a decision you are going to use less Gentamicin. 6 Where did you get that idea? 7 A To see whether there is any response because 8 there is no treatment options available at this juncture 9 other than surgery, and she was, you know, so tearful, !0 wants to have something done, so I wanted to have some I 1 non-invasive procedure. 12 If there is any response, usually the patient can 13 tell the difference of the dimness is different, you 14 know, then we know that the aminoglycoside, the Gentamicin 15 is working. That was my intention to. 16 Q As I understand it -- but I guess my question was 17 really you made -- you made a decision to do this injection 18 bilaterally? 19 A Uh-hum. ?0 Q You had never done it before? 1I A Uh-hum. >.2 Q And you knew it wasn't a treatment that was a 3 standard treatment? >.4 A Uh-hum. >5 Q Yes, is that correct? You knew that? Page 71 1 A Yeah. 2 Q Allright. And then you made a decision to use 3 less Gentamicin than you would normally use? 4 A Uh-hum. 5 Q Is that correct? 6 A Uh-hum. 7 Q You have to say yes or no. 8 A Yes. 9 Q Okay. So that's something else that's different .0 than from what you usually do? 1 A Yes. The rationale is this. .2 Q Yes, I understand. You have explained your 3 rationale. 4 MR Ricci: Let him ask the question. 5 BY MR. ROVNER: 6 Q What I'm asking you is not what your rationale 7 was, but where did you find any information that this was 8 an appropriate technique to use less Gentamicin bilaterally 9 in this particular situation? !0 A There is no such a reference. :1 Q Okay. So this is something that you created :2 yourself? :3 A Yes. A Q All right. Now, the next visit that I see on the !5 record here is -- you can refer to either record if you Page 72 1 want. 2 A Okay. 3 Q Okay. Is March 28th of '01, is that right? 4 A Yes, uh-hum. 5 Q Okay. Incidentally, at any time that you saw 6 Mary Ann Alhaj -- 7 MR. RICCI: Excuse me just a second here. Just 8 to clarify the record, there is a note for 3/16. 9 MR. ROVNER: Right, right. 10 MR. RICCI: Which is a do not show. 11 MR. ROVNER: Yes. I said the next time you saw 12 her. 13 MR. RICCI: I'm sorry. I thought you said the 14 next note on the chart. 15 MR. ROVNER: Okay. Maybe I did. If I did, I'm 16 wrong. 17 MR. RICCI: Maybe I heard it wrong. That could 18 be, too. 19 BY MR. ROVNER: 20 Q At any time that you saw Ms. Alhaj as a patient, 21 did she ever have otitis media? 22 A No. 23 Q Do I understand that in order to instill the 24 Gentamicin that you had to put tubes in her ears? 25 A Well, three different way of doing it. Yeah, you Page 73 1 have to penetrate the eardrum. 2 Q Right. The way that you chose to do it was to 3 put in tubes? 4 A Yes. 5 Q Okay. And what are the other ways? 6 A Numb the -- anesthetize the ear, using the 7 needle, go right through, penetrate through the eardrum, 8 then injecting. The other one is the wick. You know, 9 again you are making an opening into the eardrum, put the 10 wick, that's if you plan to use a long-term use, the 11 anterior inferior lip, aiming to the round window, leave a 12 wick there, have the patient to put it in two or three 13 times a day, let the wick to wet. 14 Q Sort of drip it in there? 15 A Yeah, drip, just dropping it, to give the 16 drops. 17 Q And why did you chose to use myringotomy tubes? 18 A Myringotomy tube is less painful, and it's a 19 local procedure, and you get the less contact of the 20 medication through the other tissue. You know, using a 21 spinal needle you can just inject it through the tube. 22 Q Uh-hum, okay. And are the tubes supposed to be 23 left in place then after this? 24 A Usually the tube comes out by itself, yes. 25 Q Okay. Do you recall any complaints Ms. Alhaj had 'age 70 - Page 73 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 Multi-Page"'` KWAN H. WON, M.D. Page 74 1 during the procedure? 2 A No, I don't recall. I think it was done under 3 the local topical anesthesia. It's a little uncomfortable 4 sometimes. 5 Q When you saw Ms. Alhaj in your office, the 6 examining room, is there anyone from your staff that's 7 present when you see her and examine her? 8 A In the examination room? 9 Q Yes. 10 A My staff usually are not present. 11 Q Okay. In the operating suite when you put the 12 myringotomy tubes in and you installed the Gentamicin, was 13 there somebody there assisting you? 14 A Yeah, usually one scrub nurse and circulating 15 nurse. 16 Q And are these nurses that are for the hospital? 17 A Yes. 18 Q Okay. Let's look then at the next visit. As 19 your counsel has pointed out there is a note on March 16th 20 of '01 that says did not show or DNS. Then there is on 21 3/28/01, there is a note, and there seems to be a drawing 22 on that note? 23 A Yes, uh-hum. 24 Q Okay. And there is some letters above the 25 drawing. Page 75 1 A It says AD. That's right ear. 2 Q Right ear, okay. 3 A Auricle dextral, yes. 4 Q And is this entire note of 3/28/01 in your 5 handwriting? 6 A Yes, in my handwriting. 7 Q Okay. And what was the drawing of the right ear 8 or -- is it the right eardrum? 9 A Yes, yes, uh-hum. 10 Q And what is the drawing of the right eardrum for? 11 A That represents the eardrum. That small circle 12 with the dot is the tube. The dot is a lumen. Okay. Then 13 there's a little perforation of the drum on her right ear, 14 yes, surrounding the tube. That's what that is, uh-hum. 15 Q So is this drawing illustrating the fact that 16 there is a perforation of the eardrum larger than would be 17 necessary to put the tube through? 18 A This probably happened afterward. 19 Q You say it happened afterward? 20 A Afterward. Occasionally with the tube sometimes 21 they leave some perforation. 22 Q Okay. So the right ear had for want of a better 23 word a perforation in addition to the tube? 24 A The tube is here. V%_ .1 Unnic.5, avvs Page 76 1 A The eardrum usually seals the tube off, but there 2 is a little opening there. 3 Q Okay. 4 A Okay. That's the opening. 5 Q There was an opening around the tube? 6 A Yeah, around the tube, yes, that's what the 7 drawing iis. 8 Q Arid why was that significant to you? 9 A Well, you know, not significant. Most of those 10 will heal, occasionally may need to repair afterward, but 11 it rarely happens on the tubes. 12 Q And right on the right-hand side of the drawing 13 there looks to be something that looks like left. What 14 does that say, LT? 15 A It says the left tube is okay. 16 Q Okay. 17 A Okay. 18 Q So the tube was still in at that time? 19 A Yes, left tube is okay, but right tube has a 20 little extra space opening. That's why I drew the picture. 21 Q Okay. And then it says still dizzy? 22 A Still dizzy on any movement. 23 Q Okay. Was there any change then in her condition 24 that you were treating her for between January 16th and 25 March 28th? Page 77 1 A No. 2 Q Okay. All right. And did you have any 3 discussion with her about the fact that the operation was 4 not successful? 5 A You know, this is the type of operation some 6 respond, some do not. You know, the operation is 7 successful, but the patient did not respond to Gentamicin. 8 Q All right. And underneath it says audio; is that 9 right? 10 A Yes., uh-hum. 11 Q So there was another audiogram or speech test or 12 audiogram done? 13 A Yes. 14 Q All right. And how did that audiogram compare? 15 A I would consider left ear is almost the same. 16 There is sometimes five or ten DB difference from the 17 calibration of the machine. It depends on how the patient 18 responded„ but it's almost compatible with audio one. 19 On the right ear there was some loss especially 20 in the lower frequency, maybe a little more conductive 21 component. That could be from that little perforation 22 reflecting. Otherwise essentially no change. 23 Q So would the conduction component be affected by 24 the perforation? 25 A The perforation, yes. Page 74 -Page 77 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 [WAN H. WON, M.D. Multi-Page' )CTOBER 3, 2003 Page 78 1 Q How about the air conduction component? 2 A You know, this is -- this is air conduction. 3 Q Correct. 4 A The top one. Okay. 5 Q Right. 6 A It's bone conduction on the bottom. 7 Q Right. 8 A Okay. For instance, of 500 she has a 55. She 9 should be able to hear the 35, the difference of 20. There .0 is an airborne gap, okay, so that when you are comparing to i 1 the audio study done in September, the airborne gap on the .2 500 was 5, but this time it's 20, so it's a little more 13 conductive component. That could be from that hole around .4 the tube. 5 Q Okay. .6 A That's why. The rest arewhen you look at the .7 bone conduction, on the right 35, the same. 1,000, there's 8 a little bit nerve loss. She put little X mark on because 9 it's questionable when the patient responds, and they have !0 to repeat that again, so it's bone conductions are almost !I -- they are comparable to the first test, so I think !2 there's a low pitch conductive components reflecting 3 there's a hole around the tube with that. * Q Now, let me ask this question again because I'm ;5 not sure I understood your answer. Are both components, Page 79 1 the air conduction and the bone conduction, affected by the 2 hole around the myringotomy tube? 3 A Bone conduction do not. 4 Q Okay. 5 A Okay. The air conduction conductive component is 6 reflected by if you have a hole, fluid, abnormal bone joint 7 or stiffness of eardrum, the conduction is interfered. 8 Q I understand. 9 A Okay. 0 Q Underneath there where it says audio -- well, 1 strike that. Did you feel that the audiogram testing that 2 was done on March 28th, '01, in your office showed any 3 improvement at all? 4 A Hearing, no. 5 Q Yeah. As I understand it, it showed some 6 increased hearing loss -- 7 A Yes. 8 Q -- but you attributed that to the hole? 9 A To the component, yes, because bone conduction is 0 not lost, yes. 1 Q Now, there's a note here that says trial .2 something. Is that Zyrtec? 3 A Zyrtec. 4 Q And why were you giving her Zyrtec? 5 A Well, you know, now she tried every medication. Page 80 1 We tried the Gentamicin, did not help, and there is a 2 theory, although we don't know the cause of Meniere's, the 3 pathogenesis, allergy is one that always come up, 4 allergies, vascular problem, family history, genes, so 5 forth, so she still dizzy. She needed some help, so I gave 6 her some samples of the Zyrtec. She says that she saw the 7 allergist, I think. I don't recall what the allergist 8 said, so I gave her some samples of Zyrtec. 9 Q Did you have any discussions with any allergist 10 about -- 11 A No. 12 Q -- this problem? Okay. After the March 28th, 13 2001, office visit, that Mary Ann Alhaj had did you ever 14 we her as a patient again? 15 A No. 16 Q Did you ever have any contact with her or anyone 17 from her family again? 18 A No. 19 Q All right. Do you ever remember in any of the 20 office visits her being accompanied by another woman? 21 A Yeah, I thought, I thought she came in with the 22 other lady. I thought she was also a hospital worker or 23 some friend. 24 Q Did you know that other lady? 25 A I can't recall. I can't recall that well. Page 81 1 Q Do you recall any discussion or questions that 2 the other lady may have had? 3 A You know, every time she comes in I remember that 4 we did a long, long discussion. It's a very unusual case, 5 very unpredictable disease. She's not responding to any 6 treatment, so we almost in a blind end what to do, so we 7 did a lot of discussion. 8 Q So you had discussion with this other woman? 9 A I think she was in the same, you know, the same 10 room, you know, examining or after the hearing test and 11 all. 12 Q Can you tell me anything you remember about any 13 discussions you may have had with this other woman? 14 A I really can't recall anything specific. 15 Q Okay. I'll just check my notes. Doctor, since 16 the beginning of this lawsuit, have you had any discussions 17 with any medical personnel, I don't mean your lawyer or 18 anybody that your lawyer hired, but have you had any 19 discussions with any medical personnel about this case? 20 A No. 21 Q Have you done any research yourself concerning 22 bilateral use of Gentamicin for Meniere's disease since the 23 start of this case? 24 MR. RICC1: Well, hang on, Doctor. To the extent 25 the doctor has done some research at my request in regard age 78 - Page 81 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 Multi-Page TM KWAN H. WON, M.D. Of-rnRFR 3 ')nn't Page 82 1 to trial preparation issues, I'm not sure that that's an 2 appropriate question. Now, if you want to ask the Doctor 3 if he has done research independent of any requests of 4 Counsel, then I don't have a problem with that. 5 MR. ROVNER: Actually, Joe, you know, I don't 6 think we have to argue this in front of a judge, but I 7 don't see any difference if whether you asked him to do it 8 since he's a party or whether he did it himself unless he 9 plans to testify as an expert witness which in your Answers 10 to Interrogatories you said you were going to have an 1 I independent expert. 12 MR. RICCI: Yeah, we intend to have an 13 independent expert. He is not going to testify as his own 14 expert, right. 15 MR. ROVNER: He is not going to testify as to the 16 standard of care? 17 MR. Ricci: Right. I intend to have an 18 independent expert to testify to standard of care. Now, to 19 the extent the Doctor offers testimony of a medical nature 20 because of the nature of his treatments, well, of course 21 he's going to do that, but in regard to the question of 22 standard of care, we will have an independent standard of 23 care expert. 24 MR. ROVNER: I Understand. BY MR. ROVNER: Page 83 1 Q Doctor, did you do any medical research -- and 2 this is the only question is going to be did you do the 3 medical research -- 4 A I -- 5 Q Just a second, before -- 6 MR. Ricci: Let him ask the question. 7 BY MR. ROVNER: 8 Q I have to qualify my question here, so listen to 9 the whole question, all right? 10 MR. Ricci: Listen carefully, Doctor. 11 BY MR. ROVNER: 12 Q The first question is since the beginning of this 13 lawsuit did you do any medical research of any kind into 14 the use of Gentamicin for bilateral Meniere's disease? 15 MR RICCI: Independent from requests of Counsel? 16 MR. ROVNER: No, no, no, no. I want to know yes 17 or no, did he do it? 18 MR. RICCI: Go ahead. 19 MR. ROVNER: And you are saying I can't find out 20 about what he found out if it's at your request. 21 MR. Ricci: To the extent that the communications 22 between Doctor and Counsel -- 23 MR. ROVNER: I'm not asking for that. I'm asking 24 if he ever did any research. I'm asking if he performed 25 this act. Page 84 1 MR RICCI: Okay. 2 BY MR. ROVNER: 3 Q Did you do any research on the use of Gentamicin 4 bilaterally at the same time for Meniere's disease since 5 the start of this lawsuit? 6 A Let's put it this way. I constantly read, you 7 know, at least a dozen different journals, but I look into 8 more in a treatment of Meniere's disease. 9 Q I really don't understand your answer. What I'm 10 asking you specifically is because of this lawsuit, because 11 of the allegations that you made -- you did bilateral 12 injections of Gentamicin at the same time for Meniere's 13 disease, did you perform any research in attempting to 14 determine whether -- well, did you do any research on that 15 specific issue, not just did you come across it in a 16 medical journal, but did you do any research on that issue? 17 MR. Ricci: And you are asking after the start of 18 the lawsuit? 19 MR. ROVNER: After the start of the lawsuit, and 20 he has already told us, I think, before the -- that before 21 the operation he didn't do any and doesn't know of any. 22 MR. RICCI: Well, that's -- I don't think that's 23 an accurate characterization of his testimony, but another 24 question I have for you now though, Neil, is what relevance 25 does subsequent research have to your question of the Page 85 1 standard of care and the way he treated Mrs. Alhaj? 2 MR. ROWER: I want to know what he has -- YOU 3 know, what he knows. 4 THE wl'INEss: rm aware that the -- you know, we 5 don't use a bilateral Gentamicin for normal dose 6 constantly. My aim was a different purpose. I had no 7 intention to put the 30, 40 milligrams of Gentamicin in 8 both the ears for seven days, you know. We discussed this 9 because of a hearing loss, even a small dose you could have 10 a hearing loss. 11 BY MR. ROVNER: 12 Q Okay. 13 A I'm aware that -- I had no intention to treat the 14 ears with Gentamicin because if she didn't want to go back 15 to Hopkins, she didn't want to have surgery done, it's a 16 minimum procedure. I thought she very understandable. I 17 always thought that she was a nurse and easy to explain to 18 her, so let's go to the minimum procedure, but you could 19 lose the hearing, so I'm going to just put the one drip in 20 each ear, come back, get a hearing test done. The hearing 21 test was done, not -- to make sure that she doesn't have a 22 hearing loss from the Gentamicin, see. 23 Q I understand all that, and you have said that a 24 number of times. I thought I asked you if there was any 25 reference before, before the operation that you were aware Page 82 -Page 85 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 SWAN H. WON, M.D. Multi-Page nA 3CTOBER 3, 2003 Page 86 1 of that said that you should do bilateral injections of 2 Gentamicin for bilateral Meniere's disease? 3 A Not for definitive treatment. 4 Q Is there any reference that you are aware of that 5 says that you do those injections, bilateral injections of 6 Gentamicin for anything other than definitive treatment? 7 A No. 8 Q Okay. 9 A Plenty unilateral report but not the bilateral. 10 Q Right. And the next question I'm going to ask 11 you is since the beginning of this lawsuit, okay, have you 12 done any research into the issue of bilateral injections of 13 Gentamicin for Meniere's disease? 14 A No, not what I already know of, no. 15 MR. ROVNER: That's all I have. 16 MR. RiCCI: We're all done, Doctor. 17 (Certification of Health Care Provider Family and 18 Medical Leave Act of 1993 produced and marked Won 19 Deposition Exhibit No. 2.) ?0 (The deposition was concluded at 2:56 p.m.) ii 12 >3 >q !5 Page 87 1 COUNTY OF DAUPHIN 2 : SS 3 COMMONWEALTH OF PENNSYLVANIA 4 I, Diane F. Foltz, a Notary Public, authorized to 5 administer oaths within and for the Commonwealth of 6 Pennsylvania, do hereby certify that the foregoing is the 7 testimony of Kwan H. Won, M.D. 8 I further certify that before the taking of said 9 deposition, the witness was duly sworn; that the questions '.0 and answers were taken down stenographically by the said I Reporter-Notary Public, and afterwards reduced to .2 typewriting under the direction of the said Reporter. .3 1 further certify the said deposition was taken at .4 the time and place specified in the caption sheet hereof. .5 1 further certify I am not a relative or employee or 6 attorney or counsel to any of the parties, or a relative or .7 employee of such attorney or counsel, or financially 8 interested directly or indirectly in this action. 9 I further certify that the said deposition !0 constitutes a true record of the testimony given by the !I said witness. !2 IN WITNESS WHEREOF, I have hereunto set my hand 5 this 15th day of October, 2003. !4 !5 Diane F. Foltz, RMR 'age 86 - Page 87 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 CERTIFICATE OF SERVICE I, Christine M. Gallagher, an employee of the law firm of Angino & Rovner, P.C., do hereby certify that I am this day serving a true and correct copy of the foregoing upon all counsel of record via hand-delivery as follows: Joseph Ricci, Esquire Farrell & Ricci, P.C. 4423 North Front Street Harrisburg, PA 17110 Christine M. Gallagher Dated: U ( (O 10 Lf 277146-1 MARY ANN ALHAJ and IBRAHIM ALHAJ, her husband Plaintiffs V. KWAN H. WON, M.D., and KWAN H. WON, M.D., P.C. Defendants IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION - LAW NO. 03-531 JURY TRIAL DEMANDED PLAINTIFFS' MOTION TO PRECLUDE DEFENDANTS FROM USING AN EXPERT WITNESS 1. On November 12, 2003, a Status Conference was held before the Honorable J. Wesley Oler, Jr., to establish discovery deadlines, expert report deadlines and a date certain for trial. 2. The Honorable J. Wesley Oler, Jr. issued an Order dated November 12, 2003 which is attached hereto as Exhibit A. That order provided that: 1. With exception of the exchange of expert reports, discovery shall be complete by March 16, 2004; 2. Plaintiffs' expert report shall be furnished to Defendants by April 16, 2004; Defendants' expert report shall be furnished to Plaintiffs by May 14, 2004; 3. Any dispositive motion shall be filed by June 15, 2004; and 4. Counsel are directed to list the case for trial during the September 2004 term of court... (emphasis added) 3. On or about December 12, 2003, almost four months prior to the actual due date established by the Court, Plaintiffs produced the expert report of George Gates, M.D., F.A.C.S., along with a copy of his curriculum vitae to Defendants' counsel. See letter, report and curriculum vitae attached hereto as Exhibit B. 4. On or about February 11, 2004, Plaintiffs produced a supplemental expert report of George Gates, M.D., F.A.C.S. See, letter and supplemental report attached hereto as Exhibit C. 276635-1 4. As of this date, Plaintiffs have not received an expert report from the Defendants. 5. Plaintiffs have not been contacted by defense counsel, Joseph Ricci, Esquire, regarding an expert report on behalf of his clients to the date of this Motion. WHEREFORE, Plaintiffs pray Your Honorable Court to preclude the Defendants from providing an expert report and from utilizing an expert in defense of the above captioned matter and to further preclude Defendant Kwan H. Won, M.D. to serve as his own expert witness. Respectfully submitted, Date: "((j o 1 ANGINO &: ter$s ire Neil J. RYron I.D. No. 45 03 N. t reet Harrisburg, P 17110 (717) 238-6791 Counsel for Plaintiff(s) P.C. 276675-1 MARY ANN ALHAJ and, IN THE COURT OF COMMON PLEAS OF IBRAHIM ALHAJ CUMBERLAND COUNTY, PENNSYLVANIA Plaintiffs V. CIVIL ACTION - LAW KWAN H. WON, M.D. and NO. 03-531 KWAN H. WON, M.D., P.C., : Defendant JURY TRIAL DEMANDED ORDER OF COURT AND NOW, this 12th day of November, 2003, upon consideration of Plaintiffs' Motion for Status Conference, and following a conference in the chambers of the undersigned judge in which Plaintiffs were represented by Lisa M. Benzie, Esquire, standing in for Neil J. Rovner, Esquire, and Defendants were represented by Lawrence F. Barone, Esquire, standing in for Joseph A. Ricci, Esquire, and pursuant to an agreement of counsel, the following deadlines are established in this case in the absence of further order of Court: 1. With the exception of the exchange of expert reports, discovery shall be complete by March 16, 2004; 2. Plaintiffs' expert report shall be furnished to Defendants by April 16, 2004; Defendants' expert report shall be furnished to Plaintiffs by May 14, 2004; 3. Any dispositive motion shall be filed by June 15, 2004; and 4. Counsel are directed to list the case for trial during the September 2004 term of court. Pursuant to an agreement of counsel, trial counsel are attached for appearance in Cumberland County for that trial term in this case. By the Court, ANGING &- Rc JNER, P. C. 4503 NORTH FRONT STREET HARRisouRG, PA 171101708 717/23"791 FAX 717/23&5610 RICHARD C. ANGINO NEIL). ROVNER JOSEPH M. MELU]A TERRY S. HYMAN DAVID L LL*a MICHAEL E KOSM RICHARD A. SADLOCK JAMES DECINn JOAN L STEHULAK LISA M. BENZIE V.1V W.ANGINO?ROVNER.COM EMAIL NROVNERCCANGINO-ROVNER.COM December 12, 2003 Joseph Ricci, Esquire Farrell & Ricci, P.C. 4423 North Front Street Harrisburg, PA 17110 RE: Alhaj v. Won, et al. Dear Joe: Enclosed please find the expert report and Curriculum Vitae of George Gates, M.D., F.A.C.S., regarding the above-captioned action. Should you have any questions, please feel free to contact my, office. Very truly yours, ?r J; Neil J. 4er NJR/cmg Enclosures 269555.1\CMG\CMG March 27, 2003 Neil J. Rovner, Esq. Angino & Rovner, P.C. 4503 North Front Street Harrisburg, PA 17110-1708 Re: Mary Ann Alhaj: Dear Mr. Rovner: 00,6 4, lj'4&ej AD., f?4.e f 0*ffiiN"_0f4* 1f505#dJ Aad k/, , A/ad?ytarWX At your request I reviewed the records of Ms. Alhaj pertaining to the bilateral injection of gentamicin into both middle ears on Feb. 6, 2001 by Kwan H. Won, M.D. There were 10 sets of records bound into the document 25663.1\LMH\LMH; the cover page is attached for reference. These records indicate Ms. Alhaj suffered from an incompletely understood condition that caused her to have headaches, imbalance, and attacks of nausea starting in May 1998. She underwent an extensive workup at Johns Hopkins Hospital where a diagnosis of Meniere's disease was excluded. The bilateral gentamicin injections caused loss of vestibular function and worsened her hearing. She now has oscillopsia, i.e. blurred vision with head motion, which is a permanent and untreatable consequence of the gentamicin injections. Oscillopsia makes it difficult and often impossible for gainful employment, car driving, and most of the normal activities of daily living. Oscillopsia is a known and predictable consequence of bilateral vestibular loss, such as that caused by injecting gentamicin into both ears. She also has chronic disequilibrium and is at risk for falls and the consequences thereof. Gentamicin injection into the middle ear is a widely used treatment for Meniere's disease. However, it is only done in ONE ear because Meniere's disease is a one-eared disorder in 95% of cases. People with proven bilateral Meniere's disease have been treated with intramuscular streptomycin titration to relieve vertigo. Bilateral intratympanic gentamicin injections for Meniere's disease or other conditions have not been described in the literature. Gentamicin injection is not recommended for conditions other than Meniere's disease. The treatment Ms. Alhaj received at the hands of Dr. Won was outside the scope of the usual and customary practice of otolaryngology. These injections caused her harm. This harm is not remediable. SincVA.Gates, Ge M.D. GAG/a //ere 415-67620b1 /Ca 425-697-6303 EA4' CdB8WPt" E rx/'R.G e CURRICULUM VITAE George A. Gates, M.D. Updated January 2003 Personal Data Born: Chicago, Illinois; July 25, 1935 Married: Mary Brient Gates Three children Predoctoral Education University of Michigan 1952-1955 Ann Arbor, MI University of Michigan M.D. 1955-1959 Ann Arbor, MI Postdoctoral Education Internship/Residency: St. Joseph Mercy Hospital, Ann Arbor, MI 1959-1960 University of Michigan Medical Center General Surgery: 1962-1963 Otorhinolaryngology 1963-1966 Graduate Courses Bronchoesophagology - University of Illinois, Chicago, IL 1964 Rhinoplasty, Otoplasty - University of Illinois, Chicago, IL 1965 Head and Neck Surgery - Columbia University, College of Physicians and Surgeons, New York City, NY 1966 Fellowship: Otology/Neurotology, Ear Medical Group, Nashville, TN 1985 Military Service General Medical Officer; Lt. USNR: USNAS Minneapolis 1960-1962 Faculty Appointments Instructor - Department Otorhinolaryngology, University of Michigan, Ann Arbor, MI 1966-1970 Assistant Professor - Department of Otorhinolaryngology, University of Michigan, Ann Arbor, MI 1970-1971 Associate Professor and Head - Division of Otolaryngology University of Texas Health Science Center at San Antonio, TX 1971-1974 Professor and Head - Division of Otorhinolaryngology, University of Texas Health Science Center at San Antonio, TX 1974-1988 Professor, Vice-Chairman, and Director of Research - Department of Otolaryngology, Washington University School of Medicine, St. Louis, MO 1988-1993 Adjunct Professor, Department of Speech and Hearing, Washington University School of Medicine (Central Institute for the Deaf), St. Louis, MO 1990-1993 Professor, Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA 1993- Curriculum Vitae George A. Gates. M.D. Page 2 Facultv ADoointments, continued Director, Virginia Merrill Bloedel Hearing Research Center, University of Washington, Seattle, WA 1993- Adjunct Professor, Department of Epidemiology University of Washington School of Medicine, Seattle, V/A 1994- Teachina/Hospital ADDOintments University of Michigan Hospital, Ann Arbor, Michigan 1966-1970 Wayne County Hospital, Eloise, MI Director, Department of Otorhinolaryngology 1967-1970 Medical Center Hospital, San Antonio, TX Chief, Otorhinolaryngology 1971-1988 President, Medical Dental Staff 1983-1984 Audie L. Murphy Veteran's Administration Hospital, San Antonio, TX Acting Chief, Otolaryngology 1973-1974 Consultant in Otolaryngology 1973-1988 Barnes Hospital, St. Louis, MO 1988-1993 University of Washington, Seattle, WA 1993- Director, Dizziness and Balance Center, University of Washington Medical Center, Seattle, WA 1996- Awards American Academy of Ophthalmology and Otolaryngology, Inc. for distinguished services in the educational programs 1978 American Medical Association - Physician's Recognition Award 1988-1991 Presidential Citation - The American Academy of Otolaryngology- Head and Neck Surgery For unusual duty and devotion to the Academy and to the specialty 1988 American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc. Distinguished Service Award 1996 American Adademy of Otolaryngology-Head and Neck Surgery Foundation, Inc., Millenium Society 2002 Grant SuDDort Comprehensive Rehabilitation of the Laryngectomy, NIH 1975 -1977 $177,254 Efficacy of Adenoidectomy/Tympanostomy Tubes 1980 -1985 For Persistent Otitis Media with Effusion, NIH $1,974,144 National Conference on Otolaryngology Research, NIH 1982 -1983 $10,000 Effects of Aging upon Communication, NIH-NINCDS 1982 -1985 $459,160 Second National Conference on Research Goals and Methods 1986 -1987 for Otolaryngology-Head and Neck Surgery, NIH-NINCDS $10,000 Meniere's Disease Study Center, Deafness Research Foundation 1989 $15,000 Hearing Loss in Alzheimer's Disease, Missouri Alzheimer's Association 1990 $20,000 Presbycusis: Biomedical Risk Factors, NIDCD 1992 -1995 $280,000 Presbycusis: Biomedical Risk Factors, NIDCD 1995 -1998 $205,000 Curriculum Vitae George A. Gates. M.D. Page 3 Presbycusis: Biomedical Risk Factors, NIDCD 1999-2002 $323,293 Implantable Hearing Aid Beta Test, SoundTec, Inc. 1999-2002 $40,000 Meniett Device Clinical Trial, Medtronic Xomed 2002-2003 $338,354 Barany Society XXII Regular Meeting, Seattle, WA 2002 Approved Board Certification American Board of Otolaryngology 1966 Medical Licensure Michigan 1959 Texas 1971 Missouri 1988 Washington 1993 Consultantships Veteran's Administration Hospital, Ann Arbor, MI 1967- 1970 Brooke General Hospital, Brooke Army Medical Center, Fort Sam, Houston, TX 1971- 1988 Wilford Hall Air Force Hospital, Lackland Air Force Base, TX 1972- 1988 Audie L. Murphy Veteran's Administration Hospital, San Antonio, TX 1973- 1988 Cancer Therapy & Research Foundation of South Texas, San Antonio, TX 1980- 1988 Otologic Consultant to the Central Institute for the Deaf, St. Louis, MO 1989- 1992 Organizations General Memberships American Medical Association 1966- Bexar County Medical Society 1971-1988 San Antonio Society of Otolaryngology-Head and Neck Surgery 1971-1988 Texas Medical Association 1971-1988 Texas Otolaryngology Association 1972-1988 Association for Research in Otolaryngology 1976- American Federation for Clinical Research 1988- St. Louis Medical Society 1989-1993 National Association of Teachers of Singing 1989- Acoustical Society of America 1995- Elected Fellowships American Academy of Otolaryngology-Head and Neck Surgery 1966 American College of Surgeons 1967 American Neurotology Society 1971 American Academy of Facial Plastic and Reconstructive Surgery 1973-1990 Texas Society of Ophthalmology and Otolaryngology 1975-1988 American Society for Head and Neck Surgery 1977 American Laryngological, Rhinological and Otological Society 1979 American Bronchoesophagology Society 1979 American Laryngological Association, Inc. 1981 Collegium Oto-Rhino-Laryngologicum Amicitiae Sacrum 1984 American Otological Society 1987 Barany Society 1998 Curriculum Vitae Georqe A. Gates. M.D. Page 4 Special National Orqanization Responsibilities Accreditation Council for Graduate Medical Education a. Residency Review Committee for Otolaryngology 1983- 1989 Acoustical Society of America a. Accreditation Standards Committee on Noise 1995 Special National Organization Responsibilities continued American Academy of Facial Plastic and Reconstructive Surgery a. Research Committee: Member 1980- 1987 b. Research Committee: Chairman 1985- 1987 American Academy of Otolaryngology - Head and Neck Surgery a. Task Force on Preparation of New Materials 1969- 1972 b. Committee on Head and Neck Surgery 1973- 1978 c. Committee on Drugs (Chairman 1975-1980) 1971- 1980 d. Continuing Education Faculty 1973- 1976 e. Committee on Hearing and Equilibrium 1974- 1980 f. Associate Secretary for Continuing Education (SIPac Program Chairman) 1975- 1981 g. Coordinator for Instruction 1982- 1985 h. Member, Board of Directors 1982- 1987 i. Research Committee (Chairman 1986-1987) 1982- 1987 j. Computer Committee 1984- 1988 k. Ad-Hoc Committee, New NIH Institute, Chairman 1987 1. Committee on Humanitarian Efforts 1988- 1993 m. Subcommittee on Medical Aspects of Noise 1990- 1996 n. Vice President 1992 o. Chairman, writing group on Presbycusis. Geriatric Otorhinolaryngology Conference, Washington, D.C., March 25-26, 1988 1988 p. Subcommittee on Outcomes Research 1997 - q. Appropriations Task Force 1999 - r. Development Committee 1999 - American College of Surgeons a. Member, Advisory Committee for Otolaryngology 1978 -1982 b. Member, Committee on Trauma 1981 -1983 c. Graduate Education Committee 1986 -1989 d. Credentials Committee, Missouri 1990-1993 American Laryngological, Rhinological and Otological Society a. Program Committee 1998 American Society for Head and Neck Surgery a. Education Committee 1983 -1985 Association of Academic Departments of Otolaryngology a. Committee on Core Curriculum, Secretary 1973 -1975 b. Delegate to Council of Academic Societies 1975 -1976 c. Member of Executive Committee 1975 -1978 Association for Research in Otolaryngology a. Executive Committee 1984 -1989 b. President 1987 -1988 c. Chair, Governmental Relations Committee 1989 -1990 d. Award of Merit Committee 2000-2002 Collegium Otorhinolaryngologicum Amicitae Sacrum (CORLAS) a. Treasurer 2001 - Deafn ess Research Foundation a. Scientific Director 2001 - b. Scientific Review Committee 1986 -1989 c. Board Member 1991 -1993 d. Scientific Director 2001 Curriculum Vitae George A. Gates. M.D. Page 5 National Institutes of Health a. Communicative Disorders Review Committee NINCDS 1979-1983 b. Chairman, Board of Scientific Counselors, National Institute on 1991-1996 Deafness and Other Communication Disorders (NIDCD) c. Chairman, Consensus Development Conference on Cochlear Implants 1995 in Adults and Children, National Institutes of Health Special National Organization Responsibilities. continued d. Member, Search Committee for the Senior Executive Service (SES) 1997 position of Director, National Institute on Deafness and Other Communication Disorders (NIDCD) e. Member Search Committee for the Director, Division of 1998 Intramural Research, National Institute on Deafness and Other Communication Disorders (NIDCD) f. Special Emphasis Review Panel (NIDCD) 2002 National Research Council a. Committee on Hearing, Bioacoustics and Biomechanics Task force for Speech Understanding and Aging 1983- 1984 Society of University Otolaryngologists a. Committee on Education Methodology 1973- 1975 b. Undergraduate Education Committee 1973-1975 c. Delegate to Council of Academic Societies 1976- 1982 d. Chairman Research Committee 1981- 1982 e. President Elect 1988- 1989 f. President 1990 g. Long-range Planning Committee 1990- 1993 Southwest Oncology Group a. Member Head and Neck Committee 1979- 1988 Standing Panel for Accreditation Appeals in Otolaryngology -ACGME 1990- 1999 The Centurions a. Member- Executive Committee 1982- 1994 b. President 1990- 1992 The EAR Foundation, Nashville, TN a. Board of Directors 1987 b. Member, Medical Advisory Board 1987 Editorial Responsibilities The Annals of Otology, Rhinology, and Laryngology a. Associate Editor 1996- b. Senior Editorial Advisor 1977- c. Review Board 1977- American Journal of Otolaryngology a. Editorial Board 1978-1992 Archives of Otolaryngology a. Editorial Board 1979- Journal of Occupational Hearing Loss a. Editorial Board 1997-1999 The Volta Review a. Editorial Board 1989-1992 JAMA a. Reviewer 1998- Institutional committees Curriculum Vitae George A. Gates M.D. Page 6 Operating Room Committee, Medical Center Hospital 1971-1988 Cancer Coordinating Committee, UTHSC, San Antonio 1975-1988 Member, Search Committee for Chief Executive Officer, Bexar County Hospital District 1983-1988 Operating Room Committee, Barnes Hospital 1989-1992 Cori Society - Washington University School of Medicine 1990-1993 Implant & Investigational Device Committee, UWMC 2000- Special Local Responsibilities Deacon, First Presbyterian Church, San Antonio, TX 1979-1988 Sunshine Cottage School for Deaf Children, San Antonio, TX a. Board of Directors 1985-1988 St. Louis ENT Club; President, St. Louis, MO 1993 Listen & Talk, Seattle, WA a. Board of Directors 1999 b. Speech Hearing & Deafness Center, Seattle, Advisory Board 2000 Publications *1. Gates GA, Henley KS, Pollard HM, et al. Cell population of hurnan liver. J Lab Clin Mad 57:182-184, 1961. 2. Work WP, Gates GA. Non-neoplastic diseases of the major salivary glands. J Lab State Med Soc 118:190-195, 1966. *3. Gates GA, Ritter FN, Mesara BW. Multiple primary mixed tumors of the salivary gland: a case report. Arch Otolaryngol 84:329-331, 1966. 4. Work WP, Gates GA, Boles R, Fletcher MM. Salivary gland disease. University of Michigan Medical Center Journal 32, 1966. *5. Gates GA, Work WP. Radioisotope scanning of the salivary glands: a preliminary report. Laryngoscope 77:861-875, 1967. 6. Gates GA. Radioisotope scanning of the salivary glands. Surc Forum 18:498-499, 1967. 7. Work WP, Gates GA. Tumors of the parotid gland and parapharyngeal space. Otolaryngol Clin North Am 2:497-514,1969. *8. Dicke T, Gates GA. Malignant teratoma of the paranasal sinus: report of a case. Arch Otolarngol 91:391, 1970. *9. Gates GA. Current status of radiosialography in tumor diagnosis. Trans Am Acad Opthalmol Otolaryngol 74:1183-1195, 1970. *10. Gates GA, Young JH, Winegar LK, et al. The thermoelectric air simulator: a new instrument for vestibular testing. Arch Otolaryngol 92:80-84, 1970. *11 Gates GA. Radiosialographic aspects of salivary gland disorders. Laryngoscope 82:115-130, 1972. 12. Gates GA. Minor Salivary gland tumors of the oral cavity. Otolaryngol Clin North Am 5:283-289, 1972. 13. Gates GA. Diagnosis and treatment of parotid tumors. Tex Med 69:74-78, 1973. 14. Gates, GA. Embryology and anatomy of the salivary glands. Paparella and Shumrick DA (eds): Otolaryngology, Philadelphia, WB Saunders Company, 1973, vol 1, 233-238. 15. Gates GA. Physiology of the salivary glands. Paparella MM and Shumrick DA (eds): Otolaryngology. Philadelphia, WB Saunders Company, 1973, vol 1, 347-356. 16. Gates, GA. Biochemistry of the salivary glands and saliva. Paparella MM and Shumrick DA (eds): Otolaryngology. Philadelphia, WB Saunders Company, 1973, vol 1, 401-407. 17. Gates GA. Diagnostic radiology of the salivary glands. Paparella MM and Shumrick DA (eds): Otolaryngology. Philadelphia, WB Saunders Company, 1973, vol 1, 1096-1112 Curriculum Vitae George A. Gates, M.D. Page 7 18. Gates GA. Vertigo. Strome M (ed). Differential diagnosis in pediatric otolaryngology. Little, Brown & Co 1975, 75-92. *19. Cooper JC, Gates GA, Owen JH, Dickson HD. An abbreviated impedance bridge technique for school screening. J Speech Hear Disord 40:260-269, 1975. *20. Young JH, Merte H, Gates GA. Analysis of thermal gradients within human temporal bones. International Journal of Heat and Mass Transfer 19:503-511, 1976. 21. Langley L, Horn K, Cooper JC, Gates GA. Variability of the type C tympanogram. Medical Audiology Newsletter (Issue 4) 3:3-5, 1976. *22 Horn KL, Gates GS, Cobb AH. Maggot therapy for subacute rriastoiditis. Arch Otolaryngol 102:377- 379, 1976. 23. Gates GA. Interpretation of diagnostic tests for acoustic neuroma: a self-instructional package. Am Academy of Opthalmol Otolaryngol, Rochester, Minnesota, 1976. 24. Horn KL, Gates GA, Cobb AH. Atraumatic palatal perforations: case report and literature review, Ear Nose Throat J 55:252-258, 1976. 25. Weaver RG, Meyerhoff WL, Gates GA. Teratomas of the head and neck. Surg Forum 27:539-542, 1976. *26. Cooper JC, Langley LR, Meyerhoff WL, Gates GA. The significance of negative middle ear pressure. Laryngoscope 87:92-97,1977. 27. Gates GA, Meyerhoff WL. Tympanomastoidectomy. Jaffee BF (ed): Hearing Loss in Children. Baltimore, University Park Press, 1977, 555-573. 28. Gates GA. Sialography and scanning of the salivary glands. Otolaryngology Clin North Am 10:379-390, 1977. *29. Gates GA, Meyerhoff WL, Montalbo PJ. Pseudomonas mastoiditis. Laryngoscope 87:483-492, 1977. *30. Horn KL, Ende MJ, Langley LR, Gates GA. Scanning ultrastructure of the stria vascularis. Arch Otorhinolaryngol 215:35-43, 1977. 31. Gates GA. The airways. In American Academy of Orthopaedic: Surgeons (ed): Emergency Care and Transportation of the Sick and Injured, Ed 2. Menasha, George; Banta Co, Inc, 40-41,1977. *32. Horn, KL, Langley LR, Gates, GA. Effect of ethacrynic acid on the stria vascularis. Arch Otolaryngol 102:539-541, 1977. *33. Oswalt CE, Gates GA, Holmstrom FMG. Pulmonary edema as a complication of acute airway obstruction. JAMA 238:1833-1835, 1977. *34. Shaffer HL, Gates GA, Meyerhoff WL. Acute mastoiditis and cholesteatoma. Trans Am Acad Opthalmol Otolaryngol 86:394-399, 1978. *35. Horn KL, Langley LR, Gates GA. Effect of ethacrynic acid ococ:hlear histochemistry. Arch Otolaryngol 104:42-46, 1978. *36. Gates GA, and Fernandez AT. Laryngotracheoplasty for acquired subglottic stenosis in infants and children: experience with six cases. Laryngoscope 88:1468-1476,1978. *37. Gates GA. Management of inflammatory airway obstruction in children. Trans Am Acad Opthalmol Otolaryngol 86(3.1): 506-507, May-June, 1978. *38. Young WC, Gates GA. The use of cyanoacrylate in transsphenoidal hypophysectomy. Laryngoscope 88:1468-1476, 1978. *39. Holzen TW, Newman R, Meyerhoff WL, Gates GA. Rabies: otolaryngologic manifestations. Trans Am Acad Opthamol Otolaryngol 86(3.1): 506-507, May-June, 1978. *40. Stehling LC, Gates GA. Preoperative management of infants and children with acquired subglottic stenosis. Anesthesiology Review, VI: 24-27, 1978. *41. Davis JC, Dunn JM, Gates GA, Heimbach RD. Hyperbaric oxygen: a new adjunct in the management of radiation necrosis. Arch Otolaryngol 105:58-61, 1979. Curriculum Vitae George A Gates M.D. Page 8 *42. Welch RW, Luckmann K, Ricks PM, Drake ST, Gates GA. Manometry of the normal upper esophageal sphincter and its alterations. Laryngectomy. J. Clin Invest 63:1036-1040, 1979. *43. Weaver RG, Gates GA. Mucoceles of the sphenoid sinus. Otolaryngol Head Neck Surg, 87:168-173, 1979. *44. Welch RW, Gates GA, Luckmann KF, Ricks PM, Drakes ST. Changes in the force-summed pressure measurements of the upper esophageal sphincter prelaryngectomy and postlaryngectomy. Ann Otol Rhino Laryngol, 88:804-808, 1979. 45. Gates GA, Holt RH, Mattox DE, Cooper JC, Jr. What's new in otolaryngology. Texas Med, 75:40-41, 1979. *46. Cortez EA, Mattox DE, Holt GR, Gates GA. Unilateral tonsillar enlargement. Otolaryngol Head Neck Surg, 87:707-716, 1979. *47, Pare] SM, Gates GA. Prosthetic support of laryngotracheoplasty for acquired stenosis in infants and children. J Prosthet Dent, 43:322-326, 1980. *48. Smith BL, Franz JL, Mira JG, Gates GA, Sapp J, Cruz AB. Simultaneous combination of radiotherapy and multi-drug chemotherapy for stage iii and stage iv squamous carcinoma of the head and neck. J Surg Oncol 15:91-98, August, 1980 49. Gates GA. Upper esophageal sphincter: pre and post-laryngectomy - a normative study. Laryngoscope 90:454-464, 1980. *50. Gates GA, Johns ME. Embryology and anatomy of the salivary glands. Paparella and Shumrick(eds). Otolaryngology, Vol 1, 2nd ed. Philadelphia, WB Saunders, 1980, 124-131. 51. Gates GA, Johns ME. Physiology of the salivary glands. Paparella and Shumrick (eds) Otolaryngology, Vol 1, 2nd ed. Philadelphia, WB Saunders, 1980, 354-365. 52. Gates GA, Johns ME. Biochemistry of the salivary glands. Paparella and Shumrick (eds) Otolaryngology, Vol 1, 2nd ed. Philadelphia, WB Saunders, 1980, 354-365. 53. Gates GA, Johns ME. Diagnostic radiology of the salivary glands. Paparella and Shumrick (eds) Otolaryngology, Vol 1, 2nd ed. Philadelphia, WB Saunders, 1980, 1067-1112. 54. Gates GA. Vertigo in children. Ear Nose Throat J 59(9): 358-365, 1980. *55. Gates GA. The current status of hyperalimentation in head and neck cancer. Otolaryngol Head and Neck Surg 88:(Nov-Dec) 1980. 56. Johns ME, Tegtmeyer CJ, Gates GA. Salivary gland imaging. In English. 6(ed); Otolaryngology. Hagerstown, MD: Harper & Row, 1980, VIII, chap. 60. 57. Gates GA, Cooper JC Jr. The effect of anesthetic gases on middle ear pressure in the presence of effusion. Ann Otol Rhinol Laryngol 80(Supp.68):62-74, 1980. *58. Holt GR, Gates GA. Managing childhood ear infections. Comp Ther 6:59-65, 1980. *59. Palva T, Gates GA, Paradise JL, Birck HG, Bradley WH, Gebhart DE, Lundgren K Meyerhoff WL, Muenker G, Sander WH, Schwartz RH, Shurin PA, Thomsen J, Ulvestad RF, Wullstein HL, Roydhouse N. Recent advances in otitis media with Effusion: panel A management. Ann Otol Rhinol Laryngol (Suppl:3 pt 3 suppl 69): 23-26, 1980 60 Gates GA. Editorial: Research in Otolaryngology-Head & Neck Surgery. Arch Otolaryngol 107(9):526- 7,1981. 61. Gates GA. What's new in otolaryngology-head and neck surgery. Bull Am Col Surg, January 1981. 62. Gates GA. Medical Study. Bexar County Med News 34(7):10 11, 1981. *63. Gates GA. Research in otolaryngology-head and neck surgery. Arch Otolaryngol 107:526-527, September 1981. 64. Gates GA. Auditory Screening. Gates (ed): Guidelines for Clinical Auditory Evaluation. American Academy of Otolaryngology-Head and Neck Surgery, 106-112, 1981. Curriculum Vitae George A. Gates. M.D. Page 9 65. Gates GA. Laryngotracheoplasty for subglottic stenosis. L. Bernstein (ed): Third International Symposium on Plastic and Reconstructive Surgery of the Head and Neck, Vol. II: Rehabilitative Surgery, New York: Grune & Stratton, Inc., September 1981, 279-282. 66. Mattox DE, Gates GA. Pharyngopalatoplasty for nasopharyngeal stenosis. Bernstein L (ed): Plastic and Reconstructive Surgery of the Head and Neck, Vol 2. Grune & Stratton, 1981, 339-334. *66. Gates GA. Current concepts in otolaryngology: malignant neoplasms of the minor salivary glands. N Eng J Med 306(6):718-722, March, 1982. *67. Gates GA, Ryan W, Cooper JC, Lawlis GF, Cantu E, Hayashi T, Lauder E, Welch R, Hearne E. Current status of laryngectomee rehabilitation: I. Results of therapy. Am J Otolaryngol 3(1):1-7, January-February, 1982. *68. Gates GA, Ryan W, Cantu E, Hearne E. Current status of laryngectomee rehabilitation: II. Causes of failure. Am J Otolaryngol 3(1):8-14, January-February, 1982. *69. Ryan W, Gates GA, Cantu E, Hearne E. Current status of laryngectomee rehabilitation: I II. Understanding of esophageal speech. Am J Otolaryngol 3(2):,91-96, March-April, 1982. *70. Gates GA, Ryan W, Lauder E. Current status of laryngectomee rehabilitation: IV. Attitudes about laryngectomee rehabilitation should change. Am J Otolaryngol, March-April, 3(2): 97-103, 1982. *71. Holt GR, Young WC, Aufdemorte T, Mattox DE, Gates GA. Head and Neck Manifestations Of Uncommon Infectious Diseases. Laryngoscope 92(6 Pt 1): 634-39, 1982. *72. Gates GA, Hearne EM III. Predicting Esophageal Speech. Ann Otol Rhinol Laryngol 91:454-457,1982. *73. Gates GA. Quo vadis? Bexar County Medical News, Summer, 1982. *74. Cooper JC Jr, Hearne EM III, Gates GA. Normal Tympanometric Shape. Ear Hear 3:241-245, 1982. *75. Mira JG, Gates GA, Whiteley AB. Technique Modification for Radioactive Implants When Plastic Tubes Are Used In Fibrosed Head and Neck Areas. Int J Radiat Onco Biol Phys 8:1799-1801, 1982. 76. Gates GA, Mikiten TM. Idiopathic Paralyses (Bell's Palsies), in Graham and House (eds): Disorders of the Facial Nerve. New York: Raven Press, 279-285, 1982. 78. Mathog RA, Brookhouser PE, Naunton RF, Stebbins WC, Gates GA. Current Research Resources, In First National Conference on Research Goals and Methods In Otolaryngology. Ann Otol Rhinol Laryngol Supplement 100 91:19-20,1982. 79. Mathog RA, Brookhouser PE, Naunton RF, Stebbins WC, Gates GA. Current Research Resources, in First National Conference on Research Goals and Methods In Otolaryngology. Ann Otol Rhinol Laryngol Supplement 100 91:19-20, 1982. 80. Gates GA. Diseases of the Salivary Gland, In Bluestone And Stool (eds): Pediatric Otolaryngology. Philadelphia: WB Saunders, 1983. 81. Mattox DE, Gates GA. Letter to the Editor: Alternatives to tracheostomy in sleep apnea. N Eng J Med 308:656, March, 1983. *82. Gates GA. Workshop on Effects of Otitis Media on the Child: Socioeconomic Impact of Otitis Media. Pediatrics 71:639-652, April 1983. *83. Gates GA. Commentary: Sulfur Hexafluoride Therapy. Arch Otolaryngol 109:357, 1983. *84. Gates GA. Masked Mastoiditis. Laryngoscope 93:1034-1037, 1983. *85. Gates GA. Deep Neck Infection. Am J Otolaryngol 4:420-421, 1983. *87. Neal GD, Gates GA. Invasive Pseudomonas Osteitis Of The Temporal Bone. Am J Otol 4:332-337, 1983. *88. Holt GR, Standefer JA, Brown WE, Gates GA. Infectious Disease of the Sphenoid Sinus. Laryngoscope 94:330-335, 1984. 89. Gates GA, Chakeres DW. Interpretation of Diagnostic Tests for Acoustic Neuroma. A Self-Instructional Package. The American Academy of Otolaryngology-Head andNeck Surgery, Inc., 1984. Curriculum Vitae George A. Gates. M.D. Page 10 90. Gates GA, Wachtendorf CA, Holt GR, Hearne EM. The History Of Treated Persistent Otitis Media With Effusion, In: Lim DJ, Bluestone CD, Klein JO, Nelson JD (eds): Recent Advances in Otitis Media with Effusion. Philadelphia: BC Decker, 1984, 346-348. 91. Avery-Wachtendorf CA, Lopez LL, Cooper JC Jr, Hearne EM, Gates GA. The Efficacy Of School Screening For Otitis Media. In Lim DJ, Bluestone BD, Klein JO, Nelson JD (eds): Recent Advances in Otitis Media With Effusion. Philadelphia: BC Decker, 1984, 242-348. 92. Gates GA, Holt GR, Avery -Wachtendorf CA, Hearne EM, Jorgenson JR. Microbiology Of Medically Treated Persistent Otitis Media With Effusion. In Lim DJ, Bluestone CD, Klein JO, Nelson JD (eds); Recent Advances in Otitis Media with Effusion. Philadelphia: BC Decker, 1984, 242-246. *93. Gates GA, Wachtendorf C, Hearne EM, Holt GR. Treatment Of Chronic Otitis Media: Results Of Tympanostomy Tubes. Am J Otolaryngol 6:249-253, 1985. *94. Standefer JA, Mattox DE, Aufdemorte TB, Geiser CF, Gates GA. Midfacial Burkitt's Lymphoma. Otolaryngol Head Neck Surg 93(2):262-267, 1985. *95. Gates GA, Saegert J, Wilson N, Johnson L, Shepherd A, Hearne EM. Effect Of Beta Blockade On Singing Performance. Ann Otol Rhinol Laryngol 94(6):570-574,1985. *96. Nogami H, Yoshimura F, Herbert DC, Aufdemorte TB, Gates GA, Holt GR, Sheridan PJ. Changes In The Nuclear Uptake And Retention Of 3h-Estrogen In Gonadotrophs And Lactotrophs As A Function Of Age. Anat Rec 212:228-291, 1985. *97. Gates GA, Wachtendorf C, Hearne EM, Holt GR. Treatment Of Chronic Otitis Media With Effusion: Results Of Myringotomy. Auris Nasus Larynx (Tokyo) 12(Suppl): S262-264, 1985. *98. Neal GD, Gates GA. Complications Of Tracheostomy And Intubation, in Johns ME (ed): Complications and Sequelae of Head and Neck Surgery. Philadelphia: BC Decker, 103-109, 1986. *99. Gates GA. Otologic Referral: Indications And Results. Pediatr Inf Dis 5:1-5, 1986. *100. Nau TW, Gates GA, Escobedo MB. Management of Neonatal Subglottic Stenosis. Otol. Clin., NA 19 (1): 153-162, 1986 *101. Aufdemorte TB, Van Sickels JE, Dolwick MF, Sheridan PJ, Holt GR, Aragon SB, Gates GA. Estrogen Receptors In The Temporomandibular Joint Of The Baboon (Papio Cynocephalus), An Autoradiographic Study. Oral Surg, Oral Med, Oral Path (61) 4:307-314, 1986. *102. Gates GA, Folbre TW. Indications For Adenotonsillectomy. Arch Otolaryngol, 112(5):501-502, 1986. *103. Gates GA. Complications And Sequelae Of Chronic Otitis Media With Effusion, Controversies In Screening For Middle Ear Disease And Hearing Loss in Children. Pediatrics 77:60-61, 1986. *104. Gates GA, Avery C, Cooper JC, Hearne EM, Holt GR. Predictive Value of Tympanoplasty In Middle Ear Effusion. Ann Otol Rhinol Laryngol 95:46-50, 1986. *105. Gates GA, Avery C, Prihoda TJ, Holt GR. Post-Tympanoplasty Tube Otorrhea. Laryngoscope 96:630- 634,1986. *106. Gates GA, Wachtendorf-Avery C, Holt GR, Hearne EM. Medical Treatment Of Chronic Otitis Media With Effusion (Secretory Otitis Media). Otolarygol Head Neck Surg 94:350-354, 1986. *107. Gates GA. Differential Otomanometry. Am J Otol 7:147-150, 1986. *108. Avery CA, Gates GA, Prihoda TJ. Efficacy Of Acoustic Reflectometry In Detecting Middle Ear Effusion. Ann Otol Rhinol Laryngol 95:472-476, 1986. 109. Avery C, Selent-Binder LA, Lopez LL, Gates GA. Evaluation Of The Acoustic Otoscope For Detecting Middle Ear Effusion, In: Proceedings of the International Conference on Acute and Secretory Otitis Media, Part 1. Amsterdam: Kugler Publications, 23-29, 1986. *110. Mercier RJ, Neal GD, Mattox DE, Gates GA et al. Cisplatin And 5-Fluorouracil Chemotherapy In Advanced Or Recurrent Squamous Cell Carcinoma Of The Head and Neck. Cancer 60:2609-2612, 1987. *111. Clarke LR, Wiederhold ML, Gates GA. Quantitation Of Pneumatic Otoscopy. Otolaryngol Head Neck Surg 96:119-124, 1987. Curriculum Vitae George A. Gates, M.D. Page 11 *112. Gates GA, Avery CA, Prihoda TJ, Cooper JC. Effectiveness OF Adenoidectomy And Tympanoplasty Tubes In The Treatment Of Chronic Otitis Media With Effusion. N Eng J Med 317(23): 1444-1451, 1987. *113. Gates GA, Montalbo PJ. The Effect Of Low-Dose Beta-Blockage On Performance Anxiety In Singers. J Voice 1(1): 105-108,1987. *114. Gates GA, Avery CA, Prihoda TJ. Effect Of Adenoidectomy Upon Children With Chronic Otitis Media With Effusion. Laryngoscope 98(1): 58-63, 1988. *115. Gates GA, Avery CA, Prihoda TJ, Holt GR. Delayed Onset Post-Tympanotomy Otorrhea. Otolaryngol Head Neck Surg 98(2): 111-115,1988. *116. Gates GA. The Lateral Facial Approach To The Nasopharynx And Infratemporal Fossa. Otolaryngol Head Neck Surg 99:321-325, 1988. *117. Haughey BH, Gates GA, Skerhut HE, Brown WE. Cerebral Shift Following Lateral Craniofacial Resection And Flap Reconstruction. Otolaryngol Head Neck Surg 101, 1989. *118. Gates GA, Northern JL, Ferrer HP, Jerger J, Marchant CD, Fiellau-Nikolajsen M, Ranney JB, Renvall U, Ruben RJ, Stewart I, Teele DW. Recent Advances In Otitis Media: Diagnosis And Screening. Ann Otol Rhinol Laryngol 98:39-41, 1989. *119. Gates GA, Tucker JA. Sliding Flap Tracheoplasty. Ann Otol Rhinol Laryngol 12:926-929, 1989. *120. Gates GA. Salivary Gland Disease in Children, in Healy GB (ed): Common Problems in Pediatric Otolaryngology, 1989. *121. Gates GA, Cooper JC, Kannel WB, Miller NJ. Hearing in the Elderly: The Framingham Cohort, 1983- 1985. Ear and Hear 11:247-256, 1990. *122. Gates GA, Hough JV, Gatti WM, Bradley WH. The Safety And Effectiveness Of An Implanted Electromagnetic Hearing Device. Arch Otolaryngol Head Neck Surg 115:924-930, 1990. *123. Knox B, Gates GA, Berry SA. Optic Nerve Decompression Via The Lateral Facial Approach. Laryngoscope 100:458-462, 1990. 124. Gates GA, Painter C. Objective Assessment of Laryngeal Function. In Cummings C, Frederickson JM, Harker L, Krause C, Schuller D, eds, Otolaryngology-Head and Neck Surgery. Update 11. C.V. Mosby, 1990. *125. Bolger WE, West CB Jr., Parsons DS, Gates GA. Upper Airway Obstruction Due To Massive Gingival Hyperplasia. A Case Report And Description Of A New Surgical Treatment. Int J Pedi Otorhinolaryngol 19:63-72, 1990. *126. Gates GA, Cooper JC. Incidence of Hearing Decline in the Elderly. Acta Otolaryngol (Stockh) 111:240- 248,1991. *127. Popelka GR, Gates GA. Hearing Aid Evaluation and Fitting. Otolaryngol Clin N Am 24; 415-428,1991. 128. Gates GA. Current Issues In ENT Infectious Disease. Ann Otol Rhino Laryn, 12:304-311, Sept. 1991. *129. Gates GA. Sinusitis im Kindesalter. Arch Oto-Rhino-Laryngol (suppl 1) 67-78, 1991. *130. Cooper JC Jr, Gates GA. Hearing in the Elderly: The Framingham Cohort, 1983-1985. Part 11. Prevalence of Central Auditory Processing Disorders. Ear Hear 12:304-411, 1991. *131. Gates GA. Reviewing the Literature. Arch Otolaryn Head Neck: Surg, 1991. *132. Davis J, Gates GA, Lerner C, et al. Adjuvant Hyperbaric Oxygen Therapy Of Malignant External Otitis. Arch Otol Head Neck Surgery 118:89-93, 1992 *133. Gates GA, Popelka GR. Neural Presbycusis: A Diagnostic Dilemma. Am J Otol 13(4): 313-317, 1992. *134. Haughey BH, Gates GA, Arfken CL, Harvey J. Met-Analysis Of Second Malignant Tumors In Head And Neck Cancer: The Case For An Endoscopic Screening Protocol. Ann Otol Rhinol Laryngol 101:105- 112,1992. *135. Gates GA. Coping with dysphonia. J Voice 6:22-26, 1992. *136. Gates GA, Rice DH, Koopman C, Schuller D. Flutamide-Induced Regression Of Angiofibroma. Laryngoscope 102:641-644, 1992. *137. Wooley AL, Hogikan ND, Gates GA, Haughey BH, Schechtman KB, Goldenburg JL. The Effects Of Blood Transfusion Upon Recurrence Of Head And Neck Carcinoma: Retrospective Review And Meta- Analysis. Ann Otol Rhinol Laryngol 101:9, 724-730, 1992. *138. Cooper, JC, Gates, GA. Central Auditory Processing Disorders in the Elderly: The Effects of Pure Tone Average and Maximum Word Recognition. Ear and Hearing, 13:4, 278-280, 1992. *139. Gates GA, Muntz HR, Gaylis B. Adenoidectomy and Otitis Media. Ann Otol Rhino Laryn 101 Suppl 155:24-32, 1992. *140. Gates GA, Cobb J, D'Agostino R, Wolf P. The relation of hearing in the elderly to the presence of cardiovascular disease and cardiovascular risk factors. Arch Otolaryngol 119, 2:156-161, 1993. *141. Gates GA. Nerve excitability testing. Technical Pitfalls And Threshold Norms Using Absolute Values. Laryngoscope 103:379-395, 1993. *142. Gates GA, Sertl GO, Grubb RL, Wippold FJ, II/ Closure Of Clival CSF Fistula With BOP. Arch Otol Head Neck Surgery 120:459-462, 1994. 143. Gates GA, Valente M. Fitting Strategies for Patients with Conducive Hearing Loss. Strategies for Selecting and Verifying Hearing Aid Fittings in Thieme Medical Publishers New York: 249-266,1994. *144. Garcia P, Gates GA, Schechtman KB. Does Topical Antibiotic. Prophylaxis Reduce Post - Tympanostomy Tube Otorrhea Ann Otol Rhinol Laryngol 103:54-58, 1994. *145. Gates GA, Karzon RK. Distortion Product Otoacoustic Emissions (DPOEs) in the Elderly. Am J Otol 15(5): 596-605, 1994. *146. Gates GA. Adenoidectomy for Otitis Media with Effusion. Ann Otol Rhinol Laryngol 103 (S163), 54-58, 1994. *147. Castellanos PF, Gates GA, Esselman G, Song F, Vannier MW, Kuo M. Anatomic Considerations in Botulinum Toxin Type A Therapy for Spasmodic Dysphonia. Laryngoscope 104:656-662, 1994. *148. Gates GA, Stewart IA, Northern JL, et al. Diagnosis and screening. Ann Otol Rhino Laryngol 103(suppl 164):53-57, 1994. *149. Bluestone CD, Klein JO, Gates GA. 'Appropriateness' of Tympanoplasty Tubes: Setting the Record Straight. Arch Otol Head Neck Surg 120:1051-3,1994. *150. Skinner MW, Gates GA, Ketten DR, Vannier MW, Yoffie RL, Kalender WA. Determination of the Position of Nucleus Cochlear Implant Electrodes in the Inner Ear. Am J Otol 15(5): 644-51, 1994. *151. Barlow DW, Duckert LG, Kreig CS, Gates GA. Ototoxicity of Topical Otomicrobial Agents. Acta Otolaryngol (Stockh) 115:231-235, 1995. *152. Gates GA. The Appropriateness of Tympanoplasty Tubes. JAMA 273(9): 699, 1995. *153. Gates GA. Facial Palsy, in Feske S and Samuel M, eds. The Office Practice of Neurology. New York: Churchill Livingstone 74-83, 1995. 154. Gates GA, Karzon RK, Garcia P, Peterein J, Storandt M, Morris JC, Miller JP. Auditory dysfunction in aging and senile dementia of the Alzheimer's type. Arch Neurol 52(6):626-34, 1995. *155. Gates GA, Adkins WY, Baldwin RL, Busis SN, Clark WW, Dobie RA, Einhorn KH, Kwartler Gates GA, Adkins WY, Baldwin RL, Busis SN, Clark WW, Dobie RA, Einhorn KH, Kwartler JA, Meza G, Rodgers GK, Rubin AM, Schaffer SR, Sherbin M, Toole AF, Touma JB, Wilkins SA. Evaluation of people reporting occupational hearing loss. The Subcommittee on Medical Aspects of Noise, AAO-HNS 1995. 156. Gates GA. Otitis media with effusion. Hughes and Pensak (second eds): Textbook Of Clinical Otology. New York, NY: Thieme Medical Publishers, 1995. *157• Gates GA. NIH Consensus Conference Report: Cochlear implants in adults and children. JAMA 274:1955-1961, 1995. Curriculum Vitae George A. Gates, M.D. Page 13 158. Monsell EM, Balkany TA, Gates GA, Goldenberg RA, Meyerhoff WL, House JW. Committee on Hearing and Equilibrium guidelines for the diagnosis and evaluation of therapy in Meniere's disease. Otol. Head Neck Surg 113:181-5, 1995. 159. Gates GA. Sizing up the adenoid. Arch Otolaryngol Head Neck Surg 122(3):239-40, 1996. *160. Gates GA. Cost-effectiveness considerations in otitis media treatment. Otolaryngol-Head Neck Surg 114:525-530. 1996. *161. Gates GA, Linn RT RT, Cobb JL, Rees TS, Wolf PA, D'Agostino R. Central auditory dysfunction, cognitive dysfunction and dementia in older people. Arch Otolaryngol Head Neck Surg 122:161-167, 1996. *162. Richards TL, Gates GA, Gardner JC, Merrill T, Hayes CE, Panagiotides H, Serafini S, Rubel E. Functional MR spectroscopy of the auditory cortex in healthy subjects and Patients with sudden hearing loss. AJNR Am J Neuroradiol 18:611-620, 1997. *163. Seely DR, Gates GA. Parosteal osteogenic sarcoma of the mastiod bone. Ann Otol Rhino[ Laryngol 106(9):729-32, 1997. 164. Marra CM, Wechkin HA, Longstreth WT, Rees TS, Syapin CL, Gates GA. Hearing loss and antiretroviral therapy in patients with HIV-1. Arch Neurol 54 (4): 407-10, 1997. 165. Gates GA, Rees TA. Hear Ye? Hear Ye! Successful auditory aging. West J Med 167:247-252, October 1997. 166. Murphy MP, Gates GA. Hearing Loss: does gender play a role? Medscape Women's Health 2(10):2, 1997. *167. Alsarraf R, Jung CJ, Perkins J, Crowley C, Gates GA. Otitis media health status evaluation: a pilot study for the investigation of cost-effective outcomes of recurrent acute otitis media treatment. Ann Otol Rhinol Laryngol 107:120-128, 1998. *168. Piccirillo JF, Gates GA, White DL, Schectman KB. Obstructive sleep apnea treatment outcomes pilot study. Otolaryngol- Head Neck Surg 118:833-844, 1998. *169. Ketten DR, Skinner MW, Wang G, Vannier MW, Gates GA, Neely JG. In vivo measures of cochlear length and insertion depth of nucleus cochlear implant electrode rays arrays. Ann Otol Rhinol Laryngol Suppl 175:1-16, 1998. 170. Gates GA. Cost effective treatment of otitis media. Pediatric Otorhinolaryngology: an Update, Proceedings of the 4th international conference on pediatric ENT. Kugler Publications, 85-88, 1998. 170. Gates GA. Treatment and prevention of acute otitis media. Pediatric Otorhinolaryngology: an Update, Proceedings of the 4th international conference on pediatric ENT. Kugler Publications, 85-88, 1998. *171. Mostafapour SP, Lahargoue K, Gates GA. Noise-Induced Hearing Loss in Young Adults: The role of personal listening devices and other sources of leisure noise. The Laryngoscope 108:1832-9, 1998. *172. Alsarraf R, Jung CJ, Perkins J, Crowley C, Alsarraf NW, Gates GA. Measuring the indirect and direct costs of otitis media. Arch Otolaryngol-HNS 125:12-18, 1998 173. Gates GA. Meniere's Disease: medical therapy, In Harris JP, editor: Meniere's Disease. The Hague, Netherlands: Kugler Publications, 1998. 174. Gates GA. Sudden sensorineural hearing loss, in Canalis R and Lambert P: The Ear: A Textbook of Otology. Philadelphia, PA: Lippincott-Raven Publishers, 1999. *175. Gates GA, Couropmitree NN, Myers RH. Genetic associations in age-related hearing thresholds. Arch Otolarybgol-HNS 125:654-659, 1999. *176. Murphy MP, Gates GA. Measuring the effects of Meniere's Disease: Results of the patient-oriented severity index (MD POST) version 1. Ann Otol Rhinol Laryngol '108:331-337, 1999 *177. Gates GA. Editorial: So where's the evidence? Otolaryngol-HNS 120:619-620, 1999. *178. Gates GA, Schmid P, Blinne W, Nam B, D'Agostino R. High frequency audiometric notches in older people. J Occup Hear Loss 2:1-10, 1999. *179. Gates GA. Innovar treatment for Meniere's disease. Acta Otolaryngol (Stockh) 119: 189-193, 1999. Curriculum Vitae George A Gates M.D. Paae 14 *180. Gates GA. Editorial: Critical judgment. Am J of Otol 20:2934, 1999. *181. Gates GA. The real cost of otitis media. Acta Paediatr (5):467-8, 1999. *182. Gates GA. Editorial: Otitis media: The pharyngeal connection. JAMA 282 (10):987-9, 1999. *183. Gates GA. Treatment research in Otolaryngology-Head & Neck Surgery. Arch Otolaryngol-HNS 125:1408-09, 1999. *184. de Serres LM, Derkay C, Astley S, Deyo RA, Rosenfeld RM, Gates GA. Measuring quality of life in children with obstructive sleep disorders. Arch Otolaryngol-HNS 126:1423-1429, 2000. *185. Gates GA, Schmid P, Kujawa S, Nam B, D'Agostino R. Longitudinal threshold changes in older men with audiometric notches. Hear Res 141 (1-2):220-228, 2000. *186. Gates GA. Clinimetrics of Meniere's Disease. Laryngoscope 110(Suppl 94):8-11, 2000. *187. Gates GA. Safety of ofloxacin otic and other ototopical treatments in animal models and in humans. Pediatr Infect Dis J 20:104-107, 2001. *188. Gates GA, Beiser A, D'Agostino RB, Wolf PA. Central auditory dysfunction may precede the onset of clinical dementia in people with probable Alzheimer's disease. J Am Geriatr Soo Mar;50(3):482-8, 2002. 189. Grant GA, Rostomily R, Kim DK, Mayberg MR, Farrell D, Avellino A, Duckert LG, Gates GA, Winn HR. Delayed facial nerve palsy following vestibular schwannoma resection. J Neurosurg, Jul 97(1):93-6, 2002. *190. Gates GA, Green JD. Intermittent pressure therapy of intractable Meniere's disease using the Meniett device: a preliminary report. Laryngoscope, Aug 112:1489-93., 2002. 191. Gates GA, Klein JO, Lim DJ, Mogi G, Ogra PL, Pararella MM, Paradise JL, Tos M. Recent advances in otitis media: 1. Definitions, terminology, and classification of otitis media. Ann Otol Rhino[ Laryngol Suppl, 188:8-18, 2002. 192. Gates GA, Rees TS. Otologic changes and disorders, in Cassel CK, Cohen HJ et al: Geriatric Medicine, 4m Edition. New York, NY: Springer-Verlag, 2002. 193. Gates GA. Hearing, in Ham RJ, Sloane PD, Warshaw G: Primary Care Geriatrics: A Case-Based Approach, 4th Edition. Orlando, FL: Harcourt, Inc. Publishers, 2002. 194. Skinner MW, Ketten DR, Holden LK, Harding GW, Smith PG, Gates GA, Neely JG, Kletzker GR, Brundsen B, Blocker B. CT-Derived Estimation of Cochlear Morphology and Electrode Array Position in Relation to Word Recognition in Nuclues-22 Recipients. JARO September 2002: 332-350. *195. Gates GA, Mills D, Nam B, Rubel E, D'Agostino RB. Effects of age on the distortion product otoacoustic emission growth functions. Hear Res, 163: 53-60, 2002. *196. Cilento B, Norton S, Gates GA. The effects of aging on distortion product otoacoustic emissions (DPOAE) by gender and frequency. In press, Oto-HNS, 2002. *197. Van Laer L, DeStefano AL, Myers RH, Flothman K, Thys S, Fransen E, Gates GA, Van Camp G, Baldwin CT. Is DFNA5 a susceptibility gene for age-related hearing impairment? Eur J of Human Gen, 10:883-886, 2002. 198. Gates GA, Murphy MP, Rees TS, Fraher A. Screening for handicapping hearing loss in the elderly. In press, J of Fam Prac, Dec 2002. *199. DeStefano AL, Gates GA, Heard-Costa N, Joost O, Myers RH, and Baldwin CT. Genome-wide linkage analysis to presbycusis in the Framingham heart study cohort. IIn press, Arch Otol Head Neck Surg, 2002. 200. Gates GA, Verrall A. The daily vertigo diary: A patient-based reporting method for tracking treatment responses in Meniere's disease. Submitted 2002, American Otological Society. *201. Baldwin CT, DeStefano A, Joost O, Myers RH, Gates GIA. Analysis of the Connexin-26 AG35 mutation in strial presbycusis: The Framingham study. Submitted JARO, 2001. 202. Gates, GA, Feeney, MP, Higdon,RJ. Word recognition and the articulation index in older listeners with probable age-related auditory neuropathy. Submitted to the J Am Acad of Audiology, 2003. Curriculum Vitae George A Gates M.D. Page 15 203. Dilating the clinical research stricture. Arch Otolaryngol-NHS 129:155-156. indicates peer reviewed publication Books 1. Gates GA. Editor. Guidelines for Clinical Auditory Evaluation. American Academy of Otolaryngology- Head and Neck Surgery, Rochester, 1981. 2. Gates GA. Editor. Current Therapy in Otolaryngology-Head and Neck Surgery. 1982-1983. Trenton, NJ. BC Decker/Mosby, 1984. 3. Gates GA, Mattox DE, Holt GR (eds): Decision-Making in Otolaryngology-Head and Neck Surgery. St. Louis: BC Decker/Mosby, 1984. 4. Gates GA. Editor. Current Therapy in Otolaryngology-Head and Neck Surgery - 1984-1985. Trenton, NJ: BC Decker, 1984. 5. Gates GA: Editor. Current Therapy in Otolaryngology-Head and Neck Surgery - 1986-1987. Trenton, NJ: BC Decker, 1986. 6. Gates GA: Editor. Current Therapy in Otolaryngology-Head and Neck Surgery -4th Edition. Philadelphia, BC Decker, 1989. 7. Gates GA: Editor. Current Therapy in Otolaryngology-Head and Neck Surgery - 5th Edition. Philadelphia, Mosby-Year Book, Inc. 1993. 8. Gates GA: Editor. Current Therapy in Otolaryngology-Head and Neck Surgery - 6th Edition. Philadelphia, Mosby-Year Book, Inc. 1998. Book Reviews 1. Gates GA. Head & Neck Surgery-Otolaryngology, 2nd edition, edited by Bailey BJ et al, in Otolaryngology-HNS 122(4):622, 2000. Abstracts 1. Longstreth WT Jr, Syapin CL, Rees TR, Gates GA: Hearing Loss and HIV: Effects of Antiretroviral Medications. October 1994. Meeting Presentations 1. Diagnostic sialometry, with W.B. Litton. Research Forum. American Academy of Ophthalmology and Otolaryngology. November 1965. Chicago, IL. 2. Radioisotope scanning of the salivary glands: A preliminary report, with W.P. Work. Triological Society, Middle Section Meeting. January 1967. Oklahoma City, OK. 3. Relationship between thermally induced vestibular nystagmus and endolymphatic pressure changes, with J.H. Young. Committee for Research in Otolaryngology of the American Academy of Ophthalmology and Otolaryngology, Seventh Annual Meeting. September 22, 1973. Dallas, TX. 4. Traumatic aneurysms of the petrous carotid artery with eustachian tube hemorrhage, with D. Wayne Laster and Jim L. Story. The American Academy of Neurological Surgery. November 5-8, 1975. Phoenix, AZ. 5. Parosteal osteogenic sarcoma. American Academy of Ophthalmology and Otolaryngology Meeting. September 25, 1975. Dallas, TX. 6. Pseudomonas mastoiditis, with P.J. Montalbo and W.L. Meyerhoff. American Laryngological, Rhinological and Otological Society. April 27, 1976. Palm Beach, Florida. 7. Pulmonic barotrauma: an unreported cause of non-cardiac pulmonary edema with Charles E. Oswalt and Fritz M.G. Holstrom. Annual Meeting of South Texas Chapter Of the American College of Surgeons. January 28, 1977. Austin, TX. 8. Hyperbaric treatment of osteoradionecrosis with Davis J.C., Dunn J.M., Heimbach R.D. American Society for Head and Neck Surgery, Triological Meeting. May 12, 1977. Boston, MA. Curriculum Vitae George A. Gates. M.D. Page 16 9. Acute mastoiditis and cholesteatoma with H. Shaffer, M.D. and W.L. Meyerhoff, M.D. American Academy of Ophthalmology and Otolaryngology. October, 1977. Dallas, TX. 10. Laryngotracheoplasty for acquired subglottic stenosis in infants; and children: experience with six cases with Alberto T. Fernandez, M.D. Southern Section meeting of the American Laryngological, Rhinological and Otological Society, Inc. January 13, 1978. Houston, TX. 11. The use of cyanacrylate in transsphenoidal hypophysectomy with William C. Young, M.D. Middle Section Meeting of the American Laryngological, Rhinological, and Otological Society, Inc. January 21, 1978. New Orleans, LA. 12. Air caloric parameters for sinusoidal nystamographic output with J.C. Cooper, Ph.D., and Robert J. Pellerin, M.A. American Academy of Ophthalmology and Otolaryngology Annual Meeting. September 12, 1978. Las Vegas, NV. 13. Mucoceles of the Sphenoidal Sinus with G.R. Weaver. American Academy of Ophthalmology and Otolaryngology Annual Meeting. September 12, 1978. Las Vegas, NV. 14. Unilateral Tonsillar Enlargement with E.A. Cortez, D.E. Mattox, and G.R. Holt. American Academy of Ophthalmology and Otolaryngology Annual Meeting, September 12, 1978. Las Vegas NV. 15. Threshold excitability test for neurodiagnosis. Symposium of Facial Nerve Surgery. American Academy of Otolaryngology. October 1978. Dallas, TX. 16. Change in the force-summed pressure measurements of the upper esophageal sphincter prelaryngectomy and postlaryngectomy with Richard W. Welch, M.D., Kenneth F. Luckmann, M.D. Phillip M. Ricks, M.D., and Samuel T. Drake, M.D. American Bironcho-Esophagogical Assn. April 2, 1979. Los Angeles, CA. 17. The upper esophageal sphincter: pre and post laryngectomy - a normative study. American Laryngological, Rhinological and Otological Society, Inc. Apirl 4, 1979. Los Angeles, CA. 18. Laryngotracheoplasty for treatment of subglottic stenosis. The Third International Symposium on Facial Plastic and Reconstructive Surgery of the Head and Neck. April 30, 1979. New Orleans, LA. 19. The effect of anesthetic gases on middle ear pressure in the presence of effusion with J.C. Cooper, Jr., Ph.D. Second International Symposium on Recent Advances in Otitis Media with Effusion. May 9. 1979. Columbus, OH. 20. Threshold nerve excitability. American Academy of Otolaryngology, State of the Arts, "The Current Status of Hyperalimentation in Head and Neck Cancer." October 1979. New Orleans, LA. 21. Esophageal voice acquisition - a more realistic outlook, with William Ryam, Ph.D., Evangeline Cantu, MS American Speech and Hearing Association. November 19, 1979. Atlanta, GA. 22. The idiopathic facial paralyses (Bell's palsies), with Terry M. Mlikiten, Ph.D. IV International Symposium of Facial Nerve Surgery. September 2-5, 1980. Los Angeles, CA. 23. What's new in Otolaryngology - Head and Neck Surgery. Amer Coll of Surg 1980 Clinical Congress. October 1980. Atlanta, GA. 24. Chronic mastoid disease in a Mexican-American population, with John Mowry, M.D., Douglas E. Mattox, M.D., and G. Richard Holt, M.D. The Annual Meeting of the American Academy of Otolaryngology-Head and Neck Surgery. September 21-25, 1980. Los Angeles, CA. 25. Predicting esophageal speech. American Laryngological Association. May 2, 1982. Palm Beach, FL. 26. Midfacial Burkitt's lymphoma with John A. Standefer, M.D., and Douglas E. Mattox, M.D. The Annual Meeting of the American Academy of Otolaryngology-Head and Neck Surgery. October 17-21, 1982. New Orleans, LA. 27. Socioeconomic impact of otitis media, Workshop on Effects of Otitis Media on the Child. August 25, 1982. Chicago, IL. 28. The history of treated persistent otitis media with effusion. Third International Symposium on Recent Advances in Otitis Media with Effusion. May 17-21, 1983. Fort Lauderdale, FL. Curriculum Vitae George A Gates M.D. Pao- 17 29. Microbiology of medically treated persistent otitis media with effusion. Third International Symposium on Recent Advances in Otitis Media with Effusion. May 17-21, 1983. Fort Lauderdale, FL. 30. The role of myringotomy in acute otitis media. Workshop on "Questions About Antimicrobial Management of Otitis Media." January 13, 1984. Miami, FL. 31. Complications and sequelae of otitis media. Presymposium on Management of Otitis media. January 13, 1985. Kyoto, Japan. 32. Treatment of chromic otitis media with effusion: Results of myringotomy. Extraordinary International Symposium on recent Advances in Otitis Media with Effusion. January 14, 1985. Kyoto, Japan. 33. Treatment of chronic otitis media with effusion: Results of tympanostomy tubes. International Conference on Current Aspects of Basic and Clinical Ear Research. January 21, 1985. Oita, Japan. 34. Predictive value of tympanometry in middle ear effusion. American Otological Society, Inc. May 25-26 1985. Miami Beach, FL. 35. The value of tympanometry in middle ear effusion. American Otological Society, Inc. May 25-26, 1985. Miami Beach, FL. 36. The effect of beta blockade on singing performance. American Laryngological Society. May 25, 1985. Miami Beach, FL 37. Differential otomanometry. Contemporary Issues of Middle and Inner Ear Physiology and Pathology. October 26-27, 1985. Ann Arbor, MI. 38. Post-Tympanostomy otorrhea. Triological Section Meeting Program. January 17, 1986. Orlando, FL. 39. Effects of Low Dose Nadolol Upon Performance Anxiety. Voice Foundation 15th Symposium. June 2-6, 1986. New York, NY. 40. Efficacy of Adenoidectomy and Tympanostomy Tubes in the Treatment of Chronic Otitis media with Effusion: One-Year Results. Collegium Oto-Rhino-Laryngologicum Amicitae Sacrum. September 11, 1986. Munich, Germany. 41. Effect of Adenoidectomy upon Children with Chronic Otitis Media with Effusion. The Annual Meeting of the Triological Society. April 28 - May 2, 1987. Denver, CC). 42. Surgical treatment of chronic otitis media with effusion, with C. A. Avery, T.J. Prihoda, J.C. Cooper. The Fourth International Symposium on Recent Advances in Otitis Media. June 3, 1987. Bal Harbor, FL. 43. The Lateral Facial Approach to the Pterygomaxillary Fossa and Nasopharynx. Annual Meeting of the American Academy of Otolaryngology-Head and Neck Surgery. September 19-23, 1987. Chicago, IL. 44. Endolymorphic Sac Surgery for Meniere's Disease: A Proposal for a Cooperative Multi-Institutional Randomized Clinical Trial. The Second International Symposium on Meniere's Disease: Pathogenesis, Pathophysiology, Diagnosis and Treatment. June 20-22, 1988. Boston, MA. 45. Optic Nerve Decompression via the lateral facial approach. With B. Knox and S. Berry. Middle Sectior of the Triologic Society. January 22, 1989. Indianapolis, IN. 46. Sliding Flap Tracheoplasty with JA Tucker. American Laryngological Association. April 1, 1989. San Francisco, CA. 47. Six-year changes in hearing in the 60th-90th decades. The Aging Ear: Current Concepts of Presbycusis. June 1, 1989. St. Louis, MO. 48. Use of ultrafast computed tomography in the study of vocal covering. Voice Symposium. June 7, 1990. Philadelphia, PA. 49. Incidence of hearing decline in the elderly. Collegium Otorhinolaryngologicum Amicitiae Sacrum. August 21, 1990. Basel, Switzerland. 50. Neural presbycusis: a diagnostic dilemma, with G. Popelka. COSM. May 6, 1991 Waikoloa, HI. 51. Flutamide-induced regression of angiofibroma, with D.H. Rice, C.F. Koopman. D.E. Schuller, COSM. May 6, 1991. Waikoloa, HI. Curriculum Vitae George A. Gates. M.D. Page 18 52. Nerve Excitability Testing: Technical Pitfalls and Threshold Norms. Trilogic Society, Middle Section. January 25, 1992. Cleveland, OH. 53. Conductive hearing loss and amplification. Amplification in the "90's" presented by Washington University School of Medicine and the International Hearing Aid Seminar, April 24-25,1992. St. Louis, MO. 54. The relation between cardiovascular disease and presbycusis. Yale Medical School. May 13, 1992. New Haven, CT. 55 Advanced MR imaging in sudden deafness. Walter P. Work Society Annual Meeting. September 24, 1994. Tucson, AZ. 56. Ototoxicity of Topical Otomicrobial Agents. September 18, 1994. Seattle, WA. 57. Cost Effective Management of Otitis Media. 88th Annual Scientific Assembly, Southern Medical Association. November 2-6, 1994. Orlando, FL. 58. Otitis Media. 19th Annual Mid-Winter Family Practice Seminar, Texas Academy of Family Physicians. February 18, 1995. San Antonio, TX. 59. Medical Aspects of Presbycusis. American Academy of Audiology. March 30, 1995. Dallas, TX. 60. Cost Effective Management of Otitis Media with Effusion. 64th Annual Clinical Conference, Research Study Club of Los Angeles,. March 31-April 2, 1995. Pasadena, CA 61. Neuroimaging of Sudden Deafness. 64th Annual Clinical Conference, Research Study Club of Los Angeles. March 31-April 2, 1995. Pasadena, CA. 62. Biomedical Aspects of Presbycusis. 64th Annual Clinical Conference, Research Study Club of Los Angeles. March 31-April 2, 1995. Pasadena, CA. 63. Innovar Therapy for Meniere's Disease. 64th Annual Clinical Conference, Research Study Club of Los Angeles. March 31-April 2, 1995. Pasadena, CA. 64. Meta Analysis and Other Tools for Retrospective Outcome Research Assessment. The 1995 Combined Otolaryngological Spring Meetings (COSM), American Academy of Otolaryngology-Head and Neck Surgery. April 29-May 4, 1995. Palm Desert, CA. 65. Magnetic resonance Imaging in Idiopathic Sudden Sensorineural Hearing Loss. The 1995 Combined Otolaryngological Spring Meetings (COSM), American Academy of Otolaryngology-Head and Neck Surgery. April 29-May 4, 1995. Palm Desert, CA. 66. Otitis Media and PE Tubes in Children. Otology for the Non-Otolaryngologist, sponsored by the University of Washington School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Virginia Merrill Bloedel Hearing Research Center. May 12-13, 1995. Seattle, WA. 67. Facial Paralysis and Bell's Palsy. Otology for the Non-Otolaryngologist, sponsored by the University of Washington School of Medicine, Department of Otolaryngology-Head and neck Surgery, Virginia Merrill Bloedel Hearing Research Center. May 12-13, 1995. Seattle, WA. 68. Differential Diagnosis of Hearing Loss - Noise & Aging. Otology for the Non-Otolaryngologist, sponsored by the University of Washington School of Medicine, Department of Otolaryngology- Head and Neck Surgery, Virginia Merrill Bloedel hearing Research Center. May 12-13, 1995. Seattle, WA. 69. Cochlear Implant. Otology for the Non-Otolaryngologist, sponsored by the University of Washington School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Virginia Merrill Bloedel Hearing Research Center. May 12-13, 1995. Seattle, WA. 70. Cost-Effectiveness Considerations in Otitis Media Treatment. 6th International Symposium on Recent Advances in Otitis Media with Effusion. June 4-8, 1995. Fort Lauderdale, FL. 71. Sudden Sensorineural Hearing Loss. Alumni Day, University of Washington School of Medicine. June 16, 1995. Seattle, WA. 72. Otitis Media. St. Joseph's Hospital presentation to primary physicians and pediatricians. July 14, 1995. Bellingham, WA. Curriculum Vitae George A. Gates M.D Page 19 73. NIH Consensus Conference presentation. William House Cochlear Implant Study Group Annual Meeting 1995. September 16, 1995. New Orleans, LA. 74. Hearing Research at the Virginia Merrill Bloedel Hearing Research Center. Washington State Audiology Society. University of Washington School of Medicine. September 18, 1996. Seattle, WA. 75. Cochlear Implants. Self-Help for the Hard of Hearing Convention. October 25, 1996. Portland, OR. 76. Meniere's Disease. Southwestern Texas Methodist Hospital Annual Meeting. January 17, 1997. San Antonio, TX 77. Otology Update. Northwest Hearing Convention. March 1, 1997. Couer d'Alene, ID. 78. Magnetic Resonance Imaging in Idiopathic Sudden Sensorineural Hearing Loss. American Otological Society. April 29-30, 1998. Palm Desert, CA. 79. Otology Update. Listen & Talk School. November 8, 1999. Seattle, WA. 80. Overview of the Ear, Hearing and Auditory Disorders. Ears, Hearing & Beyond 2000, University of Washington. March 11, 2000. Seattle, WA. 81. Implantable Listening Devices. Ears, Hearing & Beyond 2000, University of Washington. March 11, 2000. Seattle, WA. 82. Evaluation and Management of Parotid Gland Lesions. Missouri Society of Otolaryngology Head and Neck Injury of the Missouri State Medical Association at their 142nd Annual Convention. April 5-9, 2000. Kansas City, MO. 83. Update on Meniere's Disease. Missouri Society of Otolaryngoliogy Head and neck Surgery of the Missouri State Medical Association at their 142nd Annual Convention. April 5-9, 2000. Kansas City, MO. 84. Hearing programs: Opportunities for Foundations. 10th Annual North American Conference of Lions Foundations. April 29, 2000. SeaTac, WA. 85 Barany Society. June 3-8, 2000. Uppsale, Sweden. 86. Aging and Noise-Induced Hearing Loss. Alumni Day, Department of Otolaryngology, University of Washington School of Medicine. June 9, 2000. Seattle, WA. 87. Adenoidectomy for Otitis Media. Alumni Day, Department of Otolaryngology, Boston University Schoo of Medicine. June 16, 2000. Boston, MA. 88. Noise and Aging: Biological Basis. 6th Annual Symposium on Noise-Induced Hearing Loss, July 8, 2000. Cambridge, England. 89. Randomized Clinical Trials. AAO Annual Meeting. September 23-28, 2000. Washington, D.C. 90 XVII World Congress of the International Federation of Oto-Rhino-Laryngological Societies (IFOS). October 21-26, 2001. Cairo, Egypt. 91. Otitis Media Update. 2nd Jordanian ENT Conference, October 22-27, 2000. Amman, Jordan. 92. Good News for Bad Ears. Fall Meeting of the University of Washington School of Medicine Alumni Association Board. November 1, 2000. Seattle, WA. 93. High Tech Advances in Hearing Care. Saturday Seminar, University of Washington. November 4, 2000. 94. Deafness Research Foundation. December 16-18, 2001. Washington, D.C. 95. The Triooogical Section 2002 Western Section Meeting. February 1-3, 2002. Pasadena, CA 96. Advances in Otolaryngology Head and neck Surgery. Ninth Annual Conference. February 19-24, 2002. Scottsdale, AZ. 97. Otitis Media and Language Learning Sequelae: Current Research and Controversies. May 1-2, 2002. Arlington, VA. 98. Combined otolaryngological Spring Meetings (COSM). May 10-14, 2002. Boca Raton, FL. 99. Medtronic Xomed presentation. May 29-31, 2002. Jacksonville, FL. Curriculum Vitae George A. Gates. M.D. Page 20 100. NIH Review Committee. July 28-30, 2002. Washington, DC 101. Society of University Otolaryngologists-Head and Neck Surgeons. October 25-28, 2002. Scottsdale, AZ. 102. Age and Noise Interaction Meeting. November 1-7, 2002. Nottingham, UK 103. Intermittent transtympanic micropressure applications control. Association for Research in Otolaryngology. February 23-27, 2003, Daytona Beach, Florida. 104. Lectures and Formal Presentations Course Director 1. Basic Workshop in Skin Surgery (with B.J. Bailey, M.D., Galveston, and J. Gunter, M.D., Southwestern Medical School, Dallas) January 1972 at Galveston, October 1972, at Dallas, September 1972. 2. Facial Plastic Surgery for Otolaryngology. April 27-29, 1973. University of Texas Health Science Center, San Antonio, Texas. 3. Facial Nerve Palsy (Co-director with AE Grant) May 19, 1973, University of Texas Health Science Center, San Antonio, Texas. 4. Ophthalmology and Otolaryngology for the Primary Care Physician. October 18-19, 1974. The University of Texas Health Science Center, San Antonio, Texas. 5. Maxillofacial Trauma Conference. April 25-26, 1975. University of Texas Health Science Center San Antonio, Texas. 6. Laryngectomy Rehabilitation Conference, October 24-26,1975, University of Texas Health Science Center, San Antonio, Texas. 7. Allergy and Immunology for the Practitioner. June 16-18,1978, University of Texas Health Science Center, San Antonio, Texas. 8. Oculoplastic Orbital Update and Rhinology Update. February 28,1980, University of Texas Health Science Center, San Antonio, Texas. 9. Advances in the Treatment of Otic Infections. July 14, 1980, American Academy of Otolaryngology Committee on Drugs, Anaheim, California. 10. Conference Chairman: The First National Conference on Research Goals and Methods in Otolaryngology. April 15-17, 1982, Bethesda, Maryland. 11. Spastic Dysphonia: One Disorder or Many? Voice Care Symposia. Course Director and Panel Moderator, June 10, 1984, New York. 12. Conference Chairman: Second National Conference on Research Goals and Methods in Otolaryngology, April 3-5, 1986, Bethesda, Maryland. 13. Current Concepts in Otolaryngology-Head and Neck Surgery: Snoring and Sleep Apnea. Program Director, May 29-30, 1987, University of Texas Health Science Center at San Antonio, Texas. 14. General Chairman of Program Committee: The Eleventh Research Meeting of the Association for Research in Otolaryngology, January 31 -February 4, 1988, Clearwater Beach, Florida. 15. Symposium II Chairman: Cochlear Microvascular Disorders. The Eleventh Research Meeting of the Association for Research in Otolaryngology, January 31 -February 4, 1988, Clearwater Beach, Florida. 16. Program Director: Current Concepts in Endoscopic Sinus Surgery. May 20-21, 1988, University of Texas Health Science Center at San Antonio, Texas. 17. The Aging Ear: The Epidemiology, Pathophysiology, Evaluation and Rehabilitation of Presbycusis. Conference Chairman, June 1 -3, 1989, St. Louis, MO. 18. Course Co-director. The Art and Science of Singing. May 19th, 1990. Co-sponsor: U. Missouri at St. Louis. 19. Conference Chairman: Current Issues in ENT Infectious Disease. March 17,1990, Orlando, FL. 20. Laser safety course. Barnes Hospital, March 16 and 30,1991, St. Louis, MO. Curriculum Vitae George A. Gates. M.D. Page 21 21. Spasmodic Dysphonia update. July 20, 1991, Philadelphia, PA. 22. Conference Chairman: 1995 Outcomes Research in Otolaryngology-Head & Neck Surgery, October 20-22, 1995, Bethesda, MD. Postaraduate Education Ph.D. Advisor For: Jack H. Young, Jr. Dissertation: Analysis of Vestibular System Responses to Thermal Gradients Induced in the Temporal Bone. Ph.D. (Bioengineering) granted 1972, University of Michigan. Masters Degree Supervisor For: Karl L. Horn. 1975. Dissertation: The Early Effects of Ethnacrynic Acid Upon the Guinea Pig Cochlear Duct. ANGINO & R(- JNER, RC. 4503 NORTH FRONT STREET HARRISBURG, PA 17110.1708 717/238-6791 FAX 717/23&5610 RICHARD C. ANGINO NEIL J. ROVNER JOSEPH M. MELILLO TERRY S. HYMAN DAVID L LUTZ MICHAEL E. KOSIK RICHARD A. SADLOCK JAMES DECINTI JOAN L STERR AK LISA M. BENZIE V WW.ANGINO-ROVNER.COM EMML+ NROVNM@ANGINO-ROVNER.COM February 11, 2004 Joseph Ricci, Esquire Farrell & Ricci, P.C. 4423 North Front Street Harrisburg, PA 17110 RE: Alhaj v. Won, et al. Dear Joe: Enclosed please find Dr. Gates' supplemental expert report. Should you have any questions, please feel free to contact my office. Very truly NJR/mar Enclosure 271949.1\NJR\MAR ?? VIRGINIA MERRILL BLOEDEL HEARING RESEARCH CENTER University of Washington, Box 357923 Seattle, Washington 98 1 9 5-7 923 206-685-2962 FAX: 206-616-1828 bloedel@u. washi ngton. ed u http://depts.washington.edu/hearing/ January 13, 2004 Angino & Rovner, P.C. 4503 North Front Street Harrisburg, PA 17110-1708 RE: Marv Ann Alhai Dear Mr. Rovner: I reviewed the October 2003 deposition of Dr. Won in regard to Mary Ann Alhaj's case. My original opinion that Dr. Won's treatment was inappropriate still stands. There are five considerations that deserve mention. First, Dr. Won had alternative non- invasive therapies to consider, such as vestibular rehabilitation and use of vestibular suppresant medications. Second, the effects of Gentamicin in causing vestibular denervation are well known, and that the dose is unpredictable, to wit, a single injection may cause total loss of vestibular function and, in some cases, total deafness. Thus there is no basis for assuming that a small dose is not likely to cause harm. Third, bilateral vestibular denervation is widely recognized as a permanent, unremediable, and highly morbid consequence of intravenous Gentamicin therapy and that bilateral intratympanic injections, as were done in this case, increase the likelihood of bilateral denervation. Fourth, there is no clinical guideline for bilateral denervation therapy in Meniere's disease. Fifth, the patient probably did not have Meniere's disease and Gentamicin therapy is solely reserved for this diagnosis. For these reasons, it is my opinion the care rendered in this case was inappropriate. Sincerely yours, Geo-ge A. Gates, M.D. Dire or, Virginia Merrill Bloedel Hearing Research Center CERTIFICATE OF SERVICE I, Christine A Gallagher, an employee of the law firm of Angino & Rovner, P.C., do hereby certify that I am this day serving a true and correct copy of the foregoing upon all counsel of record via pteid as follows: Joseph Ricci, Esquire Farrell & Ricci, P.C. 4423 North Front Street Harrisburg, PA 17110 L ??- Christine AVL Gallagher Dated: t( 1101 01 276635-1 MARY ANN ALHAJ IN THE COURT OF COMMON PLEAS OF and IBRAHIM ALHAJ, CUMBERLAND COUNTY, PENNSYLVANIA her husband, Plaintiffs V. CIVIL ACTION - LAW KWAN H. WON, M.D., and KWAN H. WON, M.D., P.C., Defendants NO. 03-531 CIVIL TERM ORDER OF COURT AND NOW, this 15'h day of June, 2004, upon consideration of Plaintiffs' Motion To Amend Complaint To Assert Punitive Damages, a Rule is hereby issued upon Defendants to show cause why the relief requested should not be granted. RULE RETURNABLE within 20 days of service. BY THE COURT, Neil J. Rovner, Esq. 4503 North Front Street Harrisburg, PA 17110 Attorney for Plaintiffs Joseph Ricci, Esq. 4423 North Front Street Harrisburg, PA 17110 Attorney for Defendants :rc C_r 2:i ?J r L ` • r. -0y L ? Gy e /Yri vt. ?Lt?p? Phi r_, -i MY U0Z AEV!QNOHIO 8d 3Ni d0 do ado-a31id 11 MARY ANN ALHAJ IN THE COURT OF COMMON PLEAS OF and IBRAHIM ALHAJ, CUMBERLAND COUNTY, PENNSYLVANIA her husband, Plaintiffs V. CIVIL ACTION - LAW KWAN H. WON, M.D., and KWAN H. WON, M.D., P.C., Defendants NO. 03-531 CIVIL TERM ORDER OF COURT AND NOW, this 15"' day of June, 2004, upon consideration of Plaintiffs' Motion To Preclude Defendants from Using an Expert Witness, a Rule is hereby issued upon Defendants to show cause why the relief requested should not be granted. RULE RETURNABLE within 20 days of service. BY THE COURT, J Neil J. Rovner, Esq. 4503 North Front Street Harrisburg, PA 17110 Attorney for Plaintiffs Joseph Ricci, Esq. 4423 North Front Street Harrisburg, PA 17110 Attorney for Defendants 0 ? G- 14-4 :rc Zc :c !ad S I imr un Air" 'O v giWd 3HI JO C) MARY ANN ALHAJ and IBRAHIM ALHAJ, Plaintiffs V. KWAN H. WON, M.D.; and KWAN H. WON, M.D.,Defendants IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION - LAW NO. 03-531 JURY TRIAL DEMANDED REPLY OF DEFENDANTS TO PLAINTIFFS' MOTION TO PRECLUDE DEFENDANTS FROM USING AN EXPERT WITNESS AND NOW COMES Defendants by and through their counsel, Farrell & Ricci P.C., by Joseph A. Ricci, Esquire, and replies to the Plaintiffs' Motion to Preclude Defendants from Using Expert Witness as follows: 1. Admitted. Admitted. 3. Admitted. 4. Admitted. 5, Admitted. Denied. It is specifically denied that the Plaintiffs have not been contacted by contrary, plaintiffs, counsel was advised that the expert counsel for the Defendants. To the witness retained by the Defendants has been unable to complete his report due to the failure of the Plaintiffs to cooperate with discovery. There are significant issues concerning the nature of the Plaintiffs' alleged damages and resultant questions of causation. Defendants have requested the production of the medical records of the Mrs. Alhaj a) from her family physician. These records have not been produced as a result of the Plaintiff's failure to sign the necessary release. See response of Dr. Demario attached hereto as Exhibit "A." b) Defendants have requested the production of medical records of the Women's Cancer Center of Pa. and Dr. Misas since Mrs. Alhaj testified that this physician was providing medical care. Dr. Misas through the women's Cancer center has indicated that they have no records. See response of Women's Cancer Center attached hereto as Exhibit `B:' c) Plaintiffs' counsel upon leaming of the refusal of his client to cooperate with discovery indicated that he would permit an extension of the time permitted to the Defendants to produce expert reports. releases to obtain the requested d) To date plaintiff has not provided the necessary records. e) The Defendants are prejudiced in their ability to provide an expert report without the cooperation of the Plaintiffs. WHEREFORE, it is respectfully requested that this Honorable court deny the Plaintiffs' request to preclude experts. Respectfully submitted, Dated: oseph A. ci, Esquire Pa. ID 49803 Farrell & Ricci C. --4423 rout Street Harrisburg, PA 17110 (717) 230-9201 Counsel for Defendants EXHIBIT " vc" _ CERTIFICATION OF CUSTODIAN s aw Air AU W, ZT AL VS. arm H. WW$ MDr SP AL do8E88 I am the authorized Custodian of Records For; DR R1YEAANN ALSAJ of; and I have he utl 9rR 3T cerim kBER&RICODURG o PAS B 17055 Sol UTS X- a3335 D08: 07/11/58 [XIDICAL RECORDSI searc sworn according to law, I hereby certify, depose and say that these records co rse of bushed by reproduced ed in the ordinary Being duly in my presence at my direction. These records were prepar authorized personnel On or About theeLetime ' of f the Rcords co s tute aU threcords of said individual described by me or under my direction. above. G IS TRUE AND CORRECT: I HEREBY CERTIFY THAT THE FOLLOWIN # OF X-RAYS. PAGES ! _?- ** A: I HAVE ATTACHED Bl TIUS INCLUDES ALL MATERIAL. REQUESTED. C. THIS INCLUDES ALL CORRESPONDENCE BETWEIDN ALL FACILITIES. D: I HAVE ATTACHED THE PATIENT INFORMATION SHEET OR ID SHEET WHEN APPLICABLE. FOR $100.00 AND OVCR' E- PRIOR APPROVAL REQUIRED HOB P ALL OTHER PROVIDE FOR $50-00 ANA OVER' Date w w Sign 1-31e-re THE DOCUMENTS REQUESTED ARE NOT IN OUR POSSESSION DUE TO THE FOLLOWING; No X-Ras Records Destroyed After __,___..._.---. K Years CCC1 rd No en f- No Records _ Y - Pr&ftctcd 1?ledica s Destroyed After Years otherl'?.L' ? T? s i Qrl n ? t?7 re.(P??.._._.- X"Ray sted information does not exist under it is to be understood that tH does not mean that the reque another owever, with the information fu,rntshed to our office and to the best of my spelling or another > above to be a true and accurate staternent. lmowledge, I certify the i .2 - d - Signature Date MUST SIGN AND RETURN c' MS PAGE! s $ s3?i?a3s Nri?is?Na l?a?ds wdvi?o? tiooa 'va vaj EXHIBIT "I3" LL1C1_ll".-I<rTTtV1? vi vv.r aW= ANN AtMj' ET AL V.S. IaW H. Wm, MD, ET AL wumaa o - R NN ALNAJ I am the authorized custodian of Records or: NAY A BCNANICSBIIRG PA 17055 and I have the authorit to certify the attached records o '. L RECORDS] S l SOUTH MARKET RKET STRB DOH: ST 07/21/58 [NBDICA and 801 SOIITB de se and say that these records were searched 182-50-3335 Being duly sworn according to law, I hereby certify, Po course of business by in my presence at my direction. These records were prepared in the ordinary reproduced records has been ma the records of said individual described authorized personnel on or about the time of the event or act and careful search for the by me or under my direction. Therefor , these records constitute all above. FOLLOWING IS TRUE AND CORRECT" # OF X-RAYS I HEREBY CERTIFY THAT THE PAGES / ** A: I HAVE ATTACHEDQSTED. B: THIS INCLUDES ALL MATERIAL EN ALL FACILITIES. C: TENS INCLUDES ALL CORRESpONDEN INFORMATION f SHEET OR ID SHEET D: I HAVE ATTACHED THE HOSPITALS PATIENT FOR $100.00 AND OVER WHEN APPLICABLE. R. E: PRIOR APPROVAL OVEDERS R $50 OO AND OVF ALL OTHE Date Sign ] ere ARE NOT IN OUR POS?iESSION DUE TO THE FOLLOWING: DOCUMENTS REQUESTED Years VNoX-RaYs Records Destroyed After No Records _ - Years _ Other X_Rays Destroyed After ---- office and to the best of my It is to be understood that this does noNr bean that the furnished to our PP "irmation information does not exist under another spelling or another name. However, ant,, ate statementy knowledge, I/cceerti the above to be a true Date MUST SIGN AND RETURN THIS PAGE'. 5 0 $ 1 _ L p 3 CERTIFICATE OF SERVICE'; AND NOW, thi hereby certify that I s- day of July 2004, I, Joseph A. Ricci, Esquire, Of the foregoing Reply of Defendants to Plaintiff`s' Motion to served a true and correct copy Preclude Experts upon all counsel of record by depositing a copy of same in the United States mail, regular delivery, postage prepaid at Harrisburg, Pennsylvania, addressed as follows: Neil J. Rovner, Esquire Angino & Rovner, P.C. 4503 North Front Street Harrisburg, PA 17110 PR-551 Reply to Motion to preclude Experts N ]1 ` y r- tats r'F- Qi ? v > M W V 0 MARY ANN ALHAJ and IBRAHIM ALHAJ, Plaintiffs V. KWAN H. WON, M.D., and KWAN H. WON, M.D., P.C., Defendants IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION - LAW NO. 03-531 JURY TRIAL DEMANDED REPLY OF DEFENDANTS TO PLAINTIFFS' MOTION TO ASSERT CLAIM FOR PUNITIVE DAMAGES AND NOW COMES, Defendants Kwan H. Won, M.D. and Kwan H. Won, M.D., P.C., by and through their counsel Farrell & Ricci P.C., by Joseph A. Ricci, Esquire, and replies to the Plaintiff's Motion [sic] Amend Complaint to Assert Punitive Damages as follows: 1. Statement of Facts The above-captioned matter has its genesis in a long and protracted inner ear problem suffered by the Plaintiff, Mary Alhaj. Mrs. Alhaj testified that she, first became aware of hearing difficulties when she was a member of the United States Navy, after her graduation from High School in 1976. At this time she learned, as a result of her Navy physical, that she suffered from hearing loss. (See deposition of Mary Ann Alhaj attached hereto as Exhibit "A" page 18.) She noted that the hearing loss did not restrict her naval duties because "they figured I was probably going to go deaf anyway" since she was a machinist who worked on and around jet engines. Id. Following her departure from the Navy Mrs. Alhaj spent time in the Middle East. While residing in Israel she became violently ill sometime during the summer of 1995. Among the symptoms that she suffered were severe headaches which she described as "really, really bad frontal lobe headaches." Id. at page 10. Despite having "never really experience[ing] being sick like that before" Id., Mrs. Alhaj sought no medical attention and did nothing to treat the illness other than use herbs and lemon juice. Id. p. 11. Mrs. Alhaj began to experience significant difficulty with her health in the summer 1998. At this time she began to experience significant pressure in the base of her skull. After experiencing this symptom for about one month she finally sought medical care. Id. at p. 43. By the early months of 1999 the pain was present constantly and now Mrs. Alhaj also began to suffer from dizziness. During this time, Mrs. Alhaj was treating with Dr. Cohen an otolaryngologist since she felt the source of her problems might have been with heir ears. Id. at p. 45. Dr. Cohen was unable to identify a specific problem with the ears and made a referral to Dr. Yanofsky a neurologist. Dr. Yanofsky attempted to treat Mrs. Alhaj's symptoms with numerous medications. Id. at p. 48. Unfortunately the medications were without effect. Ultimately, Dr. Yanofsky elected to perform a spinal tap to see if there may be some underlying pathology to explain Mrs. Alhaj's symptoms. This study also failed to explain the medical problems experienced by Mrs. Alhaj. Id. Ultimately, Mrs. Alhai was told by Dr. Yanofsky that he had no explanation for her symptoms. This led her to become quite frustrated since she felt there was an answer to be found. Id. at p. 54. In her quest for an answer to her medical complaints, which had now been persisting for more than 2 years, Mrs. Alhaj eventually sought care from Dr. Won in the fall of 2000. By this time, Mrs. Alhaj reported to Dr. Won that the dizziness was worsening and rendering her unable to work. (She had been placed on medical leave by Dr. Won in November, Alhaj deposition page 86.) She also reported that when she experienced the dizziness she also had a feeling of pressure in her ears which she characterized as ear pops. She had advised Dr. Won about her numerous efforts to resolve her problems and the failures with which she met. See Kwan Won Deposition attached hereto as Exhibit "B" pages 25-26. In fact, Mrs. Alhaj's frustrations had reached a point where she concluded: " I had seeked [sic] may opinions. I was at my last opinion, so I was going to try this no matter what..." Alhaj deposition p. 73. As a result of his evaluation of Mrs. Alhaj, Dr. Won concluded that his patient was suffering from an inner ear disturbance known a Menieres Disease. He supported his diagnosis 2 with testing of Mrs. Alhaj's hearing which displayed a pattern characteristic of the disease process. As a result of this conclusion, Mrs. Alhaj was presented with two choices-she could undergo surgery which would require a cutting of the nerves in the inner ear or she could undergo treatment with gentamicin, a drug which would be temporarily placed in the inner ear to effect the operation of the nerves believed to be responsible for Menieres Disease. Although, Mrs. Alhaj received, at the recommendation of Dr. Won, a consultation with the ENT department of Johns Hopkins, she elected to undergo the gentamicin procedure despite receiving allegedly contradictory information. Because of Mrs. Alhaj's long history of difficulty and because of the information obtained by Dr. Won as a result of history taking and examination, he concluded that Mrs. Alhaj's symptoms were most consistent with bilateral Menieres Disease. This conclusion was based upon his 29 years of medical practice as well as his experience in treating the disease. Dr. Won noted that most of the cases he has seen have been unilateral or one-sided; however, he explained that approximately 50% of Menieres patients suffer from bilateral disease. Won deposition pages 4344. One of the acceptable treatments employed is the use of gentamicin placed in the inner ear. Because Dr. Won has experienced success with the use of gentamicin and because the medical literature is replete with examples of successful gentamicin use on a unilateral basis, Dr. Won felt that gentamicin uses was an acceptable treatment modality for Mrs. Alhaj. As explained by Dr. Won: Most of them do not like to do bilateral because the main concern is the hearing loss, but when I read all the report, when intractable, severe Menieres disease not responded by any medication or any medical therapy, it is most popular using Gentamicin injection. These are the unilateral case, you know. I already told her that I don't do this type of surgery [labyrinthectomy] That's why I sent her to the big center. There's nothing left, so I wanted to go ahead. You know, I told her that, you know, labyrinthectomy she could lose her complete hewing, the procedure I don't do, still having a lot of complication. Only thing is we can't tell when her symptoms are acting up whether it is from right ear or left ear because of a bilateral disease. I wanted to use the smallest amount of Gentamicin, see if she responds, whether she gets any help. 3 Won deposition page 63. Significantly, after the procedure was performed, Dr. Won retested Mrs. Alhaj's hearing and found that there was essentially no change from the studies prior to the procedure. Unfortunately, he was unable to follow the patient post procedure because she left his practice. II. Argument In Pennsylvania, a claim for punitive damages is based upon the elements set forth in Restatement (2"d) of Torts, §908(2). This section states, in pertinent part: Punitive damages may be awarded for conduct that is outrageous because of the defendant's evil motive or his reckless indifference to the rights of others. In assessing punitive damages, the trier of fact can properly consider the character of the defendant's act, the nature and extent of the harm to the plaintiff that the defendant caused or intended to cause, and the wealth of the defendant. Restatement (2"d) of Torts, §908(2) (emphasis added). In interpreting this section, the Supreme Court of this Commonwealth has determined that: The imposition of damages to punish a civil defendant is appropriate only where the conduct complained of is especially egregious. Punitive damages may not be awarded for misconduct that constitutes ordinary negligence such as inadvertent mistake and error of judgment. Martin v. Jons-Manville Corporation, 508 Pa. 154, 170, 494 A.2d 1088, 1096-97 (1985) (citations omitted)(emphasis added). When determining if punitive damages should be awarded, the Martin Court further noted that: The nature of the tortfeasor's act itself together with his motive, the relationship between the parties and all other circumstances should be taken into account. Id. at 170, 494 A.2d at 1096 (citing Feld v. Miriam, 506 Pa. 383, 585 A.2d 742 (1984)). This need to assess the conduct of the tortfeasor requires a subjective analysis of the facts as plead. This subjective standard was explicitly adopted in the case of SVH Coal v. Continental Grain Co., 526 Pa. 489, 587 A.2d 702, (1991) noting: Comment a to Section 500 [Restatement (Second) of Torts] describes two distinct types of reckless conduct which represents very different mental states: (1) where the "actor knows, or has reason to know ...of the facts which create a high degree of risk of physical 4 harm to another, and deliberately proceeds to act, or to fail to act, in conscious disregard of, or indifference to, that risk," and (2) where the "actor has such knowledge, or reason to know, of the facts, but does not realize or appreciate the high degree of risk involved although a reasonable man in his position would do so." The first type of reckless conduct described in Section 500 demonstrates a higher degree of culpability than the second on the continuum of mental states which range from specific intent to ordinary negligence. An " indifference" to a known risk under Section 500 is closer to an intentional act than the failure to appreciate the degree of risk from a known danger.... Under Pennsylvania law, only the first type of reckless conduct described in Comment a to section 500 is sufficient to create a jury question on the issue of punitive damages. Id. at _, 587 A.2d at 504-05. Accordingly, it is necessary to plead facts to show that the tortfeasor was aware that his conduct would create a high degree of risk, yet deliberately proceeded forward despite his knowledge. Indeed, even allegations of gross negligence do not give rise to a claim for punitive damages under Pennsylvania law. Id. at 1098; See also Harvey v. Hassinger, 315 Pa.Super. 97, 104, 461 A.2d 814, 817(It is not proper to award punitive damages based on the gross negligence of the defendant). In other words, no allegations of negligence, either ordinary negligence or gross negligence can possibly amount to a claim for punitive damages under Pennsylvania law. In situations such as the one at bar, the Courts of this Commonwealth are more frequently confronting allegations of punitive damages. Concerned about the growth of punitive damage allegations, a sister Court of this Honorable Court has stated: The concept of punitive damages seems to be getting out of line. We see it more and more alleged in cases or ordinary or, at best, gross, negligence. It is fast becoming a counterpart to the ineffective counsel contention found in practically all post-conviction hearing petitions. We wish to reiterate and emphasize that it is reserved for the rare instances of extreme behavior. Chambers v. Domino's Pizza, Inc., 110 Dauph. 1 (1989). In the present case, the Plaintiff has alleged no facts which support a conclusion that the Defendants acted with the requisite level of intent to sustain a claim for punitive damages. A review of the argument advanced reveals that the Plaintiffs' allegations directed against Dr. Won concern his diagnosis, care and treatment of Mary Ann Alhaj following a protracted two year treatment history which culminated in the patient's disability and consequent inability to work. 5 As such, these allegations concern only the applicable standard of care allegedly owed to the Plaintiffs decedent. Significantly, these allegations do not allege with requisite factual specificity averments of the necessary subjective intent of the Defendant. Such a failure is fatal to Plaintiffs' attempt to amend the pleading. Significantly, the Plaintiff cites to only one case is support of her claim that the treatment rendered supports an imposition of punitive damages. This case, Salsitz v. Allentown Hospital, 814 A.2d 766 (Pa. Super, 2002) contains absolutely no mention of punitive damages. To the contrary, the case primarily addresses the applicability of the doctrine of informed consent. The court concludes that use of medication to treat a patient, even when administered intravenously, does not give rise to a cause of action for informed consent. Interestingly, that scenario is applicable to the case at bar; thus, the Salsitz court is actually supportive of Dr. Won's care. A review of the facts, as enunciated by the Plaintiff', reveals nothing more than a physician bringing his medical knowledge to bear to treat an intractable problem. Both the Plaintiff and Dr. Won are in agreement that Mrs. Alhaj's medical condition had advance to a point at which she was "at my last opinion, so I was going to try this no matter what." Alhaj deposition page 73. Accordingly, knowing that gentamicin injections have been proven effective in the treatment of Menieres Disease, and knowing that the surgical alternative could have rendered Mrs. Alhaj deaf, Dr. Won attempted to treat the disease minimally to determine if there was an effect. Significantly, post procedure testing failed to identify any change in the patient's hearing. While the Plaintiff may argue that such treatment was grossly negligent as untried and unproven, she cannot argue that the Doctor acted with evil motive or reckless indifference. Accordingly the Plaintiff has failed to establish the requisite intent necessary to support punitive damages against Dr. Won. Therefore, this Honorable Court should deny the Plaintiffs' request to amend the Complaint. 6 III. Conclusion Because the Plaintiff is unable to establish the necessary intent to support a claim for punitive damages, the Plaintiffs' request to amend the Complaint should be denied. Respectfully submitted, Date: 14 V_ee/ J6seph ,4. icci, Esquire Pa. ID 498 Farrell liC Ric ' P.C. 4423 No rout Street Harrisburg, PA 17110 (717) 230-9201 Counsel for Defendants EXHIBIT "A" (MARY ANN ALHAJ AND IN THE COURT OF COMMON PLEAS IBRAHIM ALHAJ, HER HUSBAND,: CUMBERLAND COUNTY, PENNSYLVANIA PLAINTIFFS : CIVIL ACTION - LAW V : NO. 03-531 KWAN H. WON, M.D., AND KWAN H. WON, M.D., P.C., DEFENDANTS JURY TRIAL DEMANDED DEPOSITION OF: MARY ANN ALHAJ TAKEN BY: DEFENDANTS BEFORE: DIANE F. FOLTZ, RMR NOTARY PUBLIC DATE: OCTOBER 3, 2003, 8:55 A.M. PLACE: FARREL:L & RICCI, P.C. 4423 NORTH FRONT STREET HARRISBURG, PENNSYLVANIA APPEARANCES: ANGINO & ROVER, P.C. BY: NEIL J. ROVNER, ESQUIRE FOR - PLAINTIFFS FARRELL & RICCI, P.C. BY: JOSEPH A. RICCI, ESQUIRE FOR - DEFENDANTS ALSO PRESENT: IBRAHIM ALHAJ Hu qh-s Albs lolU N,? . . ........ Natole cJ, • 2080 Linglestown Road • Suite 103 • Harrisburg, PA 17110 717.540.0220 0 fax 717.540.0221 • Lancaster 717.393.5101 Multi-Page 711 MARY ANN ALHAJ VG 1 V2S]:iK 3, ZUU3 Page 2 Page 4 1 WITNESSES 1 questions is being recorded. Because of that it's very 2 NAME EXAMINATION 2 important that you answer my questions with words. 3 MARY ANN ALHAJ 3 A Okay. 4 BY: MR. RICCI 3 4 Q All. right. You can't say uh-hum because 5 5 inflection is important, and although you and I understand 6 6 what that means, when we look at the written record we 7 won't know what your answer was, all right? e 8 A Yea. s 9 Q Okay. If for any reason you don't understand one 10 10 of my questions, please let me know. I'll be more than 11 11 happy to rephrase it so that you do understand it, all 12 EXHIBITS 12 right? 13 13 A Yes. 14 ALHAJ DEPOSITION EXHIBIT PRODUCED AND MARKED 14 Q And if for some reason you don't hear my 15 2. CONSENT TO OPERATION, DIAGNOSTIC 15 question, a fire truck goes by the window or a truck or 16 PROCEDURE, ANESTHETIC 76 16 some other noise that keeps you from hearing the question, 17 17 let me know, and I'll be glad to repeat it so that you do is 18 hear it, all. right? 19 19 A Yes. 20 20 Q Okay. If you answer my questions today I'm going 21 21 to assume a couple of things: One, that you heard the 22 22 question, that you understood the question, and the answer 23 23 you gave was the answer you intended to give under oath. 24 24 Is that all right? 25 25 A Yes. Page 3 1 STIPULATION 2 It is hereby stipulated by and between counsel 3 for the respective parties that reading, signing, sealing, 4 certification and filing are hereby waived; and that all 5 objections except as to the form of the question are 6 reserved to the time of trial. 7 8 MARY ANN ALHAJ, called as a witness, being duly 9 swom, testified as follows: 10 EXAMINATION 11 BY MR. RICCI: 12 Q Good morning, Mrs. Alhaj. My name is Joseph 13 Ricci. I'm an attorney that represents Dr. Won in a 14 lawsuit that you have brought against him. We're here this 15 morning to do what's called take your deposition. Have you 16 ever had a deposition taken before? 17 A No, sir. 18 Q Okay. Let me go through some basic ground rules 19 so we both understand what's going to happen. The purpose 20 of a deposition is for the lawyers to be able to ask the 21 witnesses questions so that we have an understanding of the 22 basis for your claims, okay? 23 A Uh-hum. 24 Q Because we have a court reporter who is sitting 25 here to my left, everything that you say in response to my Page 5 1 Q Okay. Could you tell me your full name, please? 2 A Mary Ann Alhaj. 3 Q And do you spell Mary Ann as one word or two 4 separate words? 5 A Two words, no E. 6 Q Okay. What's your current address? 7 A 801 South Market Street, Mechanicsburg, 8 Pennsylvania. 9 Q Okay. How long have you lived at South Market 10 Street in Mechanicsburg? 11 A Two and a half years. 12 Q And with whom do you reside at the South Market 13 Street address? 14 A My husband, Ibrahim. 15 Q And that's 1-b-r-a-h-a-m? 16 A H-i-m. 17 Q H-i-m. Okay. Do either you or your husband have 18 any children? 19 A No. 20 Q Is this the first marriage for both of you? 21 A No. This is my second. 22 Q Okay. Did you have any children from your first 23 marriage? 24 A Yes. 25 Q What are their names and ages? Page 2 -Page 5 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-3';93-5101 MARY ANN ALHAJ OCTOBER 3, 2003 Multi-Page TM Page 6 1 A Joshua Kerr. 2 Q K-e-r-r? 3 A Uh-hum. Renshaw. He's an adult. 4 Q And that's the only child? 5 A Uh-hum. 6 Q Where does Joshua live? 7 A In Chambersburg. 8 Q And how old is Joshua? 9 A He'll be 22 next week. 10 Q How frequently do you and Joshua see each lI other ? 12 A I don't. 13 Q When is the last time you and Joshua had seen 14 each other? 15 A I don't even actually know that he lives in 16 Chambersburg. 17 Q All right. 18 A It's been since he was a child. 19 Q When was it that you last had contact with 20 Joshua? 21 A He was about six years old. 22 Q Okay. And is there a reason you haven't been in 23 contact with your son? 24 A For many years I didn't know where he was. My 25 husband took him. We had a very nasty divorce. Page 7 1 Q Okay. When did you marry your first husband? 2 A I know this. 1980. It was March 20th of 1980. 3 Q And where were you married? Was it local? 4 A Huh-uh. Honolulu, Hawaii. 5 Q Were you living in Hawaii at the tune? 6 A Yes. 7 Q And when were the two of you divorced? 8 A I believe it was 1988. 9 Q And where was the divorce finalized? 10 A It was here in Cumberland County. 11 Q And where were you living at that time? 12 A In Mechanicsburg. 13 Q Okay. When did you and Mr. Alhaj marry? 14 A September 17th, 1995. 15 Q And where was that marriage? 16 A Jerusalem, Israel. 17 Q Okay. And you were both living in Israel at the 18 time? 19 A Yes. 20 Q Does Mr. Alhaj have any children? 21 A No. 22 Q Okay. Let me back you up a second. You said you 23 had been living at your current address for about two and a 24 half years. Where did you live before that? 25 A I lived with my father at 405 West Marble Page 8 1 Street. 2 Q And that's in Mechanicsburg as well? 3 A Uh-hum. I lived with him for the reason my 4 parents were in a car accident and my mother was killed. 5 Q I'm sorry to hear that. 6 A Thank you. But he was like in bad health, so we 7 had moved out of our house, place of residence, and moved 8 in with him to take care of him. 9 Q How long did you live with your father? 10 A Approximately about a year. I1 Q Is your father still alive today? 12 A Yes. 13 Q He's doing better, I take it? 14 A Driving me crazy. 15 Q Okay. That's probably a good sign. 16 A It is. 17 Q Okay. Prior to moving in with your dad, where 18 did you live? 19 A On Market Street. 20 Q At the 801 South Market? 21 A No. It was actually 201 South Market Street. 22 Q Okay. 23 A That was our first address when we came back to 24 the United States. 25 Q Okay. And when did you come back to the Page 9 1 States? 2 A The summer of 1996. 3 Q Okay. Prior to coming back to the States, where 4 had you been living? 5 A Ibrahim and I were married in Jerusalem, Israel, 6 and then we moved back to, Amman, Jordan where his family 7 was, and that's where we lived. 8 Q What years did you live in Amman? 9 A I'm trying to figure out. It was about a year. 10 '95. It was in '95 to '96. 11 Q Okay. 12 A Because right after we got married in Jerusalem, 13 we left Israel and went to Amman -- 14 Q Okay. 15 A -- until we came back to the States. 16 Q All right. And before moving to Amman, you were 17 living in Jerusalem? 18 A Uh-hum. 19 Q How long had you lived in Jerusalem? 20 A About a year. 21 Q Where did you live before that? 22 A The States. 23 Q All right. Did you have a family doctor or a 24 medical care specialist that you would see while you were 25 living in Amman? Page 6 -Page 9 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 Multi-Page"'` MARY ANN ALHAJ Page 10 1 A No. I didn't really see any doctors when I lived 2 in the Middle East. 3 Q Okay. Did you have any illnesses or sicknesses 4 while you were living in Amman, Jordan? 5 A Not in Amman, but when I lived in Jerusalem I did 6 get severely ill at one time. 7 Q Okay. Tell me a little bit about that, if you 8 could. When did you get ill in Jerusalem? 9 A It was probably the summer of '95. 10 Q Had you been married yet? 11 A I think that was before we were married. 12 Q Okay. 13 A I'm not positive on that, but I think it was 14 before we were married. 15 Q Okay. 16 A And it was a pretty violent illness with vomiting 17 and that other thing. 18 Q Okay. 19 A The D word. 20 Q Okay. 21 A And I had never really experienced being sick 22 like that before. 23 Q All right. Did you have any other symptoms other 24 than the vomiting and the diarrhea? 25 A Severe headaches, really, really bad frontal lobe Page 11 1 headaches. 2 Q Any other symptoms? 3 A No. 4 Q Did you have any dizziness at that time? 5 A No. 6 Q Did you have any ringing of your ears? 7 A No. 8 Q Did you have any sense of pressure -- 9 A No. 10 Q -- in your ears? 11 A (Shakes head from side to side.) 12 Q All right. Did you seek any medical attention 13 for that illness? 14 A No. 15 Q How long did the illness last? 16 A Probably about a week. 17 Q Did you do anything to treat the illness? 18 A No. 19 Q Did you take any medicines of any type? 20 A No medicines. I took no medicines. Herbs and 21 things are like really big over there, lemon juice and 22 things like that, but I took nothing medicinal. 23 Q Okay. Did you take any herbs or other types of 24 natural homeopathic remedies? 25 A I just drank a lot of like fresh lemon juice. U11- IUts1GK J. LUU3 Page 12 1 Q Fresh lemon juice you said? 2 A Yes, but other than that, nothing, and it just 3 seemed to run its course. 4 Q Is there a reason that you didn't seek any 5 medical attention? 6 A It wasn't really a real big availability at that 7 time in my life where we were living. That was the big 8 reason. 9 Q Okay. Did you have a doctor that you saw at any 10 time while you were living in Jerusalem? 11 A No, I did not. 12 Q Did you attempt to go to a hospital or some other 13 type of health clinic? 14 A No. 15 Q Is there a reason that you didn't? 16 A I wasn't real big on their health care. 17 Q In what way, what do you mean? 18 A In the old city it's kind of like a little remote 19 compared to what we know and the clinics. You know, I just 20 -- truthfully I didn't feel it was necessary. I thought I 21 just had a real bad strain of the flu or like food 22 poisoning. 23 Q Okay. 24 A And it did run its course within a week. 25 Q Okay. Prior to that time had you ever had Page 13 1 experience with headaches before that? 2 A No. 3 Q Other than the time that you lived in Israel and 4 the time that you lived in Jordan, have you had any other 5 foreign travel? 6 A Yes, prior to that when I lived in Hawaii, I was 7 in the Philippines. 8 Q How long had you spent in the Philippines? 9 A I was there for like three weeks. 10 Q That was a vacation? 11 A Yes, my first husband was in the military, and he 12 had been deployed to the Philippines, and I had just gone 13 over there for like a visit, and then I flew back to 14 Hawaii. 15 Q Okay. 16 A And I have traveled a lot in Mexico. 17 Q All right. When you traveled in Mexico, where 18 have you gone, been primarily the resorts? 19 A I have been to Acapulco and Mexico City and 20 wonderful Tijuana. 21 Q Okay. Were you required to receive any 22 vaccinations or shots of any type to go to the Philippines? 23 A No. 24 Q Were you required to receive any vaccinations or 25 shots to go to Jerusalem? Page 10 - Page 13 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 MARY ANN ALHAJ OCTOBER 3, 2003 Multi-Page TM 1 A (Shakes head from side to side.) 2 Q How about when you went to -- 3 MR. ROWER: You have to answer out loud. 4 THE wrrNEss: Oh, I'm sorry. No. 5 BY MR. RICCI: 6 Q Okay. And how about Amman, Jordan, were you 7 required to receive any inoculations or shots when you went 8 to Jordan? 9 A No. 10 Q Okay. And the trips to Mexico, were you required 11 to receive any shots or inoculations? 12 A No. 13 Q Could you tell me a little bit about your 14 education? Where did you go to high school? 15 A Mechanicsburg High School. 16 Q And when did you graduate? 17 A 1976. 18 Q Following your graduation from high school, did 19 you go on for any additional education? 20 A I went in the military, the Navy, United States 121 Navy. 22 Q Upon graduation from high school? 123 A Yes. 1',24 Q Where were you stationed? 25 A At -- I went to A School in Millington, 1 Tennessee, and then Corpus Christi, Texas. 2 Q Those were your only two postings? 3 A Uh-hum. 4 Q What was your responsibility while in the Navy? 5 What was your -- 6 A I was an AD. 7 Q I'm sorry. An AD? 8 A Aviation machinist mate. 9 Q And what were your duties? 10 A Hanging out in the hangar. It was kind of 11 chauvinistic back then. 12 Q Okay. 13 A Women didn't really -- it was more working for 14 the chief than it was anything else. 15 Q What types of things did you do for the chief? 16 A Ran errands. 17 Q Okay. Did you do any machinist's work? 18 A Most of the machinist's work I ever did was like 19 lock wiring. In a jet engine every single bolt has to be 20 locked together with a wire. 21 Q Okay. 22 A And that's the most of the maintenance on those 23 jets so... 24 Q Okay. Were you around jets that were actually 25 onerating and running their engines? Page 14 Page 16 1 A Yes. 2 Q Okay. Were you required to wear ear protection 3 at any time? 4 A Yes. 5 Q And did you do that? 6 A Yes. 7 Q What type of ear protection did you wear? 8 A We had these little -- they were small rubber 9 plugs that we put in our ears, and sometimes -- I can't to think what you call them now. 11 Q The headphones? 12 A Yeah, the headsets. 13 Q Okay. How often were you required to wear ear 14 protection in the course of your job? 15 A A lot of time, most of the time when we were out 16 doing FOD walk-downs, and if we were out on the deck, 17 basically we weren't in the hangar, it wasn't a necessity. 18 You did though. I mean some people did, some people 19 didn't, but if you were out on the flight line you had to 20 have ear protection. It was a requirement. 21 Q How frequently would you be out on the flight 22 line? 23 A It varied. I can't give a definite, you know. 24 One day you could be out there, and the next day you 25 weren't out there. It really varied on what the schedules Page 17 1 were, what the flight schedules were, and, you know, even 2 depending on what your job is, you know, it's not 3 necessary. Most of the time when I was out there it was 4 for FOD walk down. 5 Q And what does that mean? 6 A FOD walk-down, every morning you had to go out on 7 the deck and do -- it's foreign object debris. You have to 8 clear the runway, you know, make sure there's no pieces for 9 when the jets take off, but that was about it. Most of the 10 time I was in the hangar. 11 Q Okay. So when you would be doing the foreign 12 object detection walks, I would assume that flight 13 operations were not going on at that moment? 14 A Not usually. Some mornings they would be out 15 there starting up, but most of the time it was quiet. We 16 would be out there like at six o'clock in the morning, you 17 know, but sometimes we would go out at 7:00 or 8:00, and 18 they were on deck -- 19 Q Okay. 20 A -- waiting to go, but it wasn't all the time. 21 Q All right. Were you required to undergo any type 22 of physical examination on your entry into the Navy? 23 A Oh, yes. 24 Q Where did you have your physical performed? 25 A At New Cumberland at AFEES. Page 15 Page 14 -Page 17 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 Multi-Page TM MARY ANN ALHAJ Page 18 1 Q I'm sorry? 2 A AFEES, it's called AFEES in New Cumberland. It's 3 at the Army Depot. 4 Q A-F-E-E-S? 5 A Uh-hum. 6 Q Do you remember who the doctor was? Was it a 7 military doctor or a private doctor? 8 A To be honest with you, it was many years ago. 9 Q Okay. 10 A I hate to admit that. I'm pretty sure it was 11 military because I don't think at that point in time they 12 used civilian doctors at all. 13 Q Okay. Do you recall if there were any concerns 14 raised about your health in any fashion at the time of your 15 Navy physical? 16 A Yes, there was a hearing problem. 17 Q Okay. What was the nature of the hearing 18 problem? 19 A They said that I had slight -- I always knew as a 20 child that I had slight loss in my one ear, but it wasn't 21 anything relevant, and they said that it wasn't enough to 22 keep me out of the military because they figured I was 23 probably going to go deaf anyway, I guess. 24 Q Okay. 25 A But I had had ear infections when I was small. Page 19 1 Q Okay. I was just about to ask you. How did you 2 know you had hearing problems? 3 A But these were not deficits that were -- I had 4 hearing problems. 5 Q Okay. You said that you have always known you 6 have had a hearing loss in your one ear? 7 A (Nods head up and down.) 8 Q Which ear was that? 9 A I think it's this one (indicating). t0 Q You are pointing to your right area? 11 A Yes. 12 Q Okay. Is that the ear that you had infections in 13 as a child, or did you have infections in both ears? 14 A Actually I had them in both. 15 Q Okay. What types of infections did you have? 16 A Just general, children's ear infections. 17 Q Can you recall ever having to go to the hospital 18 for those infections? 19 A No. 20 Q Do you remember seeing doctors about those 21 infections. 22 A Uh-hum, yes. 23 Q Do you remember who the doctors were you saw? 24 A Dr. Gribb. 25 Q I'm sorry? Vl,l V"r-A J, LVV3 Page 20 1 A Dr. Gribb. 2 Q G-r-i-b-b? 3 A Yes. He is dead. 4 Q Where was Dr. Gribb's office located? 5 A On Second Street in Harrisburg. 6 Q Do you remember what it is that Dr. Gribb did for 7 you to treat your ears? 8 A I don't recall that. I really don't because I 9 was very small when I had them. 10 Q Do you remember if he ever put tubes in your 11 ears? 12 A No, I never had tubes. I know I never had 13 tubes. 14 Q All right. Do you remember how frequently you 15 would have these ear infections? No? 16 A I'm sorry. I just remember that I had 17 them. 18 Q That's fine. It's a long time ago. 19 A Yeah. 20 Q And if you're not sure of an answer, that's a 21 perfectly acceptable response. 22 A Yeah, I just can't tell you. 23 Q Other than the ear infections, were there any 24 other problems that you had with your hearing or your ears 25 that you are aware of? Page 21 1 A No, none. 2 Q At the time -- or when did you leave the Navy? 3 A In '80. 4 Q And at the time of your departure from the Navy, 5 did you end up having a departure physical as well, or was 6 that not required? 7 A It wasn't required. 8 Q Okay. After you left the Navy, did you go on to 9 any further training or education? 10 A No, I got married. 1l Q Okay. While you were married did you stay at 12 home, or did you have a job outside of the home? 13 A No. I always worked. 14 Q Tell me a little bit about your employment. What 15 are the types of jobs you held? 16 A Nursing. 17 Q Excuse me just a second. 18 A Sure. 19 Q I'm. sorry. Excuse me. 20 A That's okay. 21 Q You were about to tell me about the types of jobs 22 that you held. 23 A When I was in Hawaii because when I got out of 24 the Navy, I moved to Hawaii. 25 Q Okay. Page 18 -Page 21 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 MARY ANN ALHAJ OCTOBER 3, 2003 Multi-Page TM Page 22 1 A And I worked at a business office over there. 2 Q And what types of jobs did you do for the 3 business office? 4 A It was like secretarial. 5 . Q What kind of a business was it? 6 A It was called Global Communications. 7 Q What kind of business did they do? 8 A It was like -- God, I can't think of these words 9 this morning. Telecommunications. 10 Q It was a phone company? 11 A Basically. 12 Q Okay. How long did you work for Global 13 Communications as a secretary? 14 A About a year. 15 Q And what did you do after that? 16 A We left Hawaii and got transferred to Pensacola, 17 Florida. 18 Q Okay. 19 A And I took some schooling there, and I went into 20 nursing. 21 Q What type of schooling did you have in Pensacola? 22 A Like for cNA. 23 Q Nursing assistant? 24 A Uh-hum. 25 O How long was the program that you were in? Page 23 I A It was like eight weeks. 2 Q And where did you go to school, if you recall? 3 A It was like at a -- not like a processing center, 4 but it was -- it wasn't like at a school. It was like the 5 nursing home paid for it. 6 Q Okay. 7 A So it was basically in the nursing home. 8 Q Okay. And what nursing home were you working 9 at? 10 A Oh, God. I don't remember the name of it. I'm 11 sorry. 12 Q That's all right. It was in Pensacola? 13 A Yeah. 14 Q What did you do at the nursing home? 15 A Just the ADLS for the patients. 16 Q When you say you did the ADLs, did you assist 17 them with getting dressed? 18 A Eating. 19 Q Brushing their teeth, eating? 20 A Things like that, yes. 21 Q Anything else that you did at the nursing home? 22 A Not really. 23 Q How long did you work at the nursing home in 24 Pensacola? 25 A It was like two years. Page 24 1 Q What did you do after that? 2 A My husband was transferred, and then he went to 3 Jacksonville and deployed for a year, and I came back up to li 4 live with my parents. 5 Q Okay. 6 A And I stayed with my parents while he was 7 deployed, and at that time I worked in a nursing home. 8 Q Which nursing home did you work at? 9 A Messiah. 10 Q Messiah? 11 A Uh-hum. 12 Q And what did do you at Messiah? 13 A The same thing. 14 Q Okay. And how long did you stay at Messiah? 15 A It was a couple of years. 16 Q Okay. What did you do after that? 17 A He came home, and we got divorced, and I just 18 kept working. 19 Q Were you still working at Messiah Village at that 20 time? 21 A Yes. 22 Q Okay. At some point you left your employment 23 with Messiah. Do you recall when that was? 24 A No. I'm trying to think. I can't recall. 25 Q Do you recall what you did after Messiah? Page 25 1 A I know I went -- I think after Messiah I went to 2 work for Leader in Camp Hill? 3 Q Okay. Do you know why you left Messiah? 4 A I didn't like it. 5 Q Okay. How long did you work for the Leader 6 Nursing Home? 7 A Not very long, about a year. 8 Q Again this was helping patients with their ADLS? 9 A Yeah, and due to the lack of staff, I just kind to of gave up on it. 11 Q Okay. 12 A And I think that's when I went to waitressing. I 13 made more money anyway. 14 Q Okay. Where did you waitress? 15 A I think after that, after Leader I went to Eat'N 16 Park. 17 Q Okay. The one in Lemoyne? 18 A Uh-hum. 19 Q The one in Carlisle? Lemoyne? 20 A Lemoyne, yes. 21 Q How long did you work as a waitress? 22 A I hate these dates. I remember the first couple 23 -- I was there for at least two years because in those two 24 years, I went to Israel twice in those two years. 25 Q For vacations? Page 22 - Page 25 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 Multi-Page " MARY ANN ALHAJ Page 26 1 A Yes. 2 Q All right. 3 A And then the last time I came back from Israel, I 4 came back in January, and I moved to Israel permanently in 5 April. 6 Q Okay. And what year did you move to Israel? 7 A '94. 8 Q All right. And you were in Israel until '95 when 9 you married your husband? 10 A '96. 11 Q '96? 12 A Well, yeah, because we went back, yes, because we 13 went to Amman, Jordan, then. 14 Q Okay. 15 A Yes. 16 Q And then in '96 you returned to the States? 17 A Yes. 18 Q Okay. After your return to the States in '96, 19 did you again seek employment? 20 A Yes. 21 Q Where did you work? 22 A I went back to Messiah. 23 Q And was it in the same position you were in when 24 you left? 25 A Yes. Page 27 1 Q And again you were working with assisting 2 patients with their activities of daily living? 3 A Yes. 4 Q How long did you stay at Messiah? 5 A A year. 6 Q And why did you leave at that time? 7 A The same old thing, staffing. 8 Q What did you do next? 9 A I went to Holy Spirit Hospital. 10 Q And what were you doing for Holy Spirit? 11 A The same thing. 12 Q Was there a particular floor or department? 13 A I worked on the med. surg. floor. 14 Q How long did you stay in Holy Spirit? 15 A Four and a half years. 16 Q And when did you leave, if you recall? 17 A 2000 -- February of 2001. 18 Q And why did you leave at that time? 19 A I had -- I got a better job offer. 20 Q And where was that? 21 A At the Women's Cancer Center. 22 Q All right. And how was that job a better offer? 23 A It was less strenuous for me, because my health 24 has been bad. 25 Q How about wages, were the wages the same, better, VI.I VISrIK 3. LUU3 Page 28 1 worse? 2 A They were about the same. 3 Q Do you recall how much you were making when you 4 left Holy Spirit Hospital? 5 A It was like 10 something an hour, almost 11 6 probably. 7 Q And how many hours a week were you working? 8 A I worked 40. 9 Q How about the Women's Cancer Center, what were 10 you making per hour there? 11 A It was about the same. 12 Q And how many hours were you working? 13 A 40. 14 Q What were your duties at the Women's Cancer 15 Center? 16 A I assisted the physicians with the exams. 17 Q In what way? 18 A There has to be a female in the room, and I would 19 help with biopsies and surgical procedures. 20 Q How would you help? 21 A Handing them the instruments. 22 Q Okay. Are you still working at the Women's 23 Cancer Center today? 24 A No, I'm actually on medical leave from there. 25 Q When did you go onto medical leave? Page 29 1 A May. 2 Q May of this year? 3 A Yes. 4 Q Had you worked continuously at the Cancer Center 5 from February of 2001 until May of 2003? 6 A Ulrhum. 7 Q Okay. Who is your supervisor at the Women's 8 Cancer Center? 9 A Her name is Ann. 10 Q Do you know what her last name is? 11 A Cudderford. 12 Q Dc you how to spell that? 13 A C-u-d-d-e-r-f-o-r-d. 14 Q Is '.she still there today; do you know? 15 A LA-hum. 16 Q Okay. 17 A Yes, yes, yes. 18 Q Who was your supervisor at Holy Spirit? 19 A Donna Miller. 20 Q And do you know, is Donna still at Holy Spirit? 21 A I oauldn't tell you that. I don't know. 22 Q Do you know what Donna's title was? 23 A She was the RN, case manager of the floor. 24 Q And was there a particular floor that you worked 25 on? I know you said med. Burg. Page 26 -Page 29 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 MARY ANN ALHAJ OCTOBER 3, 2003 Multi-Page"" Page 30 1 A It was 7, 7 med. Burg. 2 Q Okay. And do you know what Ann Cudderford's 3 title is? 4 A I don't think she really has one. 5 Q Okay. That's fine. Where is the Women's Cancer 6 Center located? 7 A It's at the Fredricksen Outpatient Center. g Q Okay. And were you paid by the Women's Cancer 9 Center, or were you paid by Pinnacle Health Systems? 10 A No, they are not affiliated with Pinnacle Health. 11 Q Oh, they're not? I thought they were. 12 A It's a doctors' office. It's a straight doctors' 13 office. 14 Q And who is the doctors' office? 15 A Dr. Misas and Dr. Willis. 16 Q All right. Now, you said that you went onto 17 medical leave in May of 2003? 18 A Uh-hum, yes. 19 Q What's the reason for the medical leave? 20 A My health. I have been on heavy medication. 21 Q What is it about your health that prevents you 22 from being able to work? 23 A At this point it's I had occipital nerve surgery 24 done in April, and they had me on the Fentanyl patches 25 which are more powerful than morphine. Page 31 1 Q Are you still on Fentanyl patches today? 2 A No, actually, thank God, last week I finished 3 them up and went through my withdrawal, and I'm finished 4 with them. 5 Q All right. Are you on any other medications at 6 this point? 7 A No. 8 Q Sitting here today you are completely medication 9 free then? 10 A Yes. 11 Q Okay. What was the purpose for the Fentanyl 12 patches? 13 A I was having severe pain on the side of my head 14 that came around to my face and in my left ear 15 (indicating). 16 Q Where did the pain start? You started to -- you 17 showed me with your fingers. 18 A Yeah. It starts in my left ear, and it goes 19 behind my head and around the front of my face. 20 Q Okay. It starts in your left ear, it moves 21 towards the back of your head? 22 A Yes. 23 Q And in essence does a U turn and comes around to 24 the front of the face? 25 A Uh-hum, yes. 'age 30 - Page 33 Page 32 1 Q Is there a point on your face where the pain 2 stops? 3 A Like right here (indicating). 4 Q You are pointing to the edge of your cheek 5 bone? 6 A Uh-hum (indicating), yes. 7 Q Near the crease with your nose? 8 A Yes. 9 Q All right. How frequently were you experiencing io this pain? 11 A 24/7. 12 Q Did the pain get better or worse at any 13 time? 14 A It was hard to tell wearing the Fentanyl patches. 15 I didn't know what my pain level was. 16 Q Had you been wearing the Fentanyl patches before 17 your occipital nerve surgery? 18 A Yes. 19 Q When did you start to wear the Fentanyl patches? 20 A February of last year. Of this year actually. 21 I'm sorry. 22 Q February of 2003? 23 A Yes. 24 Q And who is the doctor that prescribed those 25 patches for you? Page 33 1 A Originally? 2 Q Yeah, in February of 2003 when you started to 3 wear them. 4 A Do I have to answer that? 5 Q Yes, you do, Ma'am. 6 A Dr. Misas. 7 Q And how do you spell that? 8 A M-i-s-a-s. 9 Q And do you know why it is that Dr. Misas io prescribed Fentanyl patches for you? 11 A He knew I was having pain. 12 Q Okay. Had Dr. Misas provided any type of 13 exam ination or study to determine the cause of the 14 pain? 15 A He looked me over. 16 Q Okay. 17 A I mean he knew that I was having pain. He's a 18 doctor. 19 Q Okay. And how did he know you were having 20 pain? 21 A Him and I talked about it frequently. 22 Q Okay. All right. When did you first start 23 having this pain? 24 A It started out slowly and progressively got 25 worse. HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 Multi-Page " MARY ANN ALHAJ orTnRFR Z )nni "r - Page 34 Page 36 1 Q When did you first notice it? 1 A Not that I recall. 2 A In the summer of 2001. 2 Q Arid were you ever having any ringing or buzzing 3 Q And it's the same type of pain that you described 3 in your ears? 4 to me a moment ago? It would start in your left ear? 4 A Not that I recall at that time. 5 A Yes. 5 Q By the way, Mrs. Alhaj, when you talk with your 6 Q And travel to the back of your head? 6 physicians I assume that you try to be as honest with them 7 A (Nods head up and down.) 7 as you can? 8 Q And curve around to the front? 8 A Of course. 9 A Yes. 9 Q Arid you try to answer their questions as 10 Q Okay. When the pain first started, was it 10 completely as you can? 11 present all of the time? I 1 A Yes. 12 A No. 12 Q You understand that pain and dizziness are things 13 Q Okay. How frequently would you notice the 13 that somebody can't see by looking at you; is that fair to 14 pain? 14 say? 15 A Maybe three, four times a week. 15 A Yes. 16 Q Okay. How long would it last when it would come 16 Q So it's important for you to describe those 17 on? 17 things accurately to the physicians to the best of your 18 A A few hours. 18 ability? 19 Q Would it change in its character throughout that 19 A And I think I have. 20 three to four hours of time? 20 Q Okay. Have you ever tried to withhold 21 A No. 21 information or keep information from your doctors when they 22 Q Would it be the same intensity from the moment it 22 have asked? 23 started until the moment it went away? 23 A No. 24 A Yes. 24 Q The pain that you were experiencing in your ears 25 Q How would you describe that intensity on a scale 25 that we have been talking about, did that also give you a Page 35 Page 37 1 of one to ten? 1 sense of fullness in your ears, almost like you would get 2 A Ten. 2 when you are on an airplane? 3 Q And the pain would last three to four hours 3 A Yes. 4 and it would come on three to four times a week; is that 4 Q Okay. And the visual disturbances that you were 5 right. 5 describing; and your balance problems, did that give you a 6 A Yes. 6 sense of the world kind of spinning around you or rotating 7 Q Were there any other symptoms that you were 7 in some way that you felt unsteady on your feet? 8 experiencing at the time you were having this pain? 8 A No, I never had spinning sensations. 9 A Yes. 9 MR. ROVNER: At what point in time are we talking 10 Q What other symptoms would you experience? 10 about? 11 A At that point I was having balance disorders. I1 MR. RICCI: At the time that these symptoms were 12 Q Okay. Describe that for me. What do you mean by 12 starting. 13 balance disorders? 13 MR. ROVNER: Okay. 14 A I have trouble walking. 14 BY MR. RICCI: 15 Q Okay. 15 Q Okay. What is it then that made you feel that 16 A Particularly in open areas. 16 you were unsteady on your feet? 17 Q What types of trouble would you experience when 17 A That period of time was very difficult for me 18 you were walking? 18 being able to walk. I would walk sideways. 19 A I was particularly if I walk on like uneven 19 Q Okay. 20 ground. If I'm on flat ground I'm okay. And I was also 20 A It wasn't a matter of standing on my feet. It 21 having oscillopsia with my vision. 21 was a mater of which way my body was going to go. 22 Q What do you mean by that? 22 Q All right. Did you have a sense that you were 23 A Oscillopsia is a bouncing vision. 23 pulling to one side or the other? 24 Q Okay. Any other symptoms that you were 24 A I had a very bad sense of pulling to the 25 experiencing? 25 right. Page 34 - Page 37 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 MARY ANN ALHAJ Multi-Pagel'`` UCl V1f1GK 3, LUU3 Page 38 1 Q Okay. And this sense of pulling to the right, 2 would that be all the time, or would that only be when you 3 were experiencing this pain and -- 4 A No, it was constant. 5 Q Okay. All right. When you went on your medical 6 leave of absence this past spring, were you required to 7 fill out any paperwork for that? 8 A No, sir. 9 Q Do you have an understanding as to whether or not 10 your job would be available for you to return to when you 11 feel you are medically able? 12 A Honestly, I mean I'm not really sure what's going 13 on with that situation. I mean they're still paying my 14 medical, and I really need to speak with Dr. Misas, so I 15 can't give you an honest answer about that at this point. 16 Q Okay. Now that you have stopped Fentanyl patches 17 and you are medication free -- 18 A Yes. 19 Q -- do you have a desire to go back to work? 20 A I do. 21 Q Do you have any plans at this time to restart 22 working? 23 A No, I do not. 24 Q Is there a reason that you couldn't go back to 25 work today? Page 39 1 A I still don't feel physically able at this point. 2 Q Okay. In what ways do you not feel physically 3 able to work? 4 A I have severe fatigue, No. 1. 5 Q All right. 6 A And now that I'm off the Fentanyl patches I'm 7 having the ear pain that I had before. 8 Q Okay. When did you notice a return of the ear 9 pain? 10 A About three days ago. 11 Q Is the pain as intense as it was before the 12 patches? 13 A Yes. 14 Q Are you experiencing that pain now? 15 A Yes. 16 Q Is the pain constant, or does it come and go? 17 A It's constant. 18 Q Have you told any doctors about the return of the 19 pain now? 20 A No. 21 Q Who is the doctor that performed the occipital 22 nerve surgery that you talked about? 23 A Dr. Roger Ostdahl. 24 Q And is it Dr. Ostdahl that continued the 25 prescription for the Fentanyl patches? Page 40 1 A Yes. 2 Q Do you have any scheduled appointments with 3 Dr. Ostdahl at this point? 4 A No. 5 Q Do you have plans to make an appointment with 6 Dr. Ostdahl? 7 A No. 8 Q Is there a reason that you are not going to see 9 him about the ear pain that has returned? 10 A Because he is a neurosurgeon. He did his 11 surgery. He's done. That's it. 12 Q Do you have plans to see any other doctors at 13 this point? 14 A No. 15 Q Okay. Do you have a family physician at this 16 point in time? 17 A Yes. 18 Q Who is your family physician? 19 A Joseph Demario. 20 Q And where is Dr. Demario's office located? 21 A Silver Creek. 22 Q Silver Creek, I'm not sure I'm familiar with 23 that. 24 A It's in Mechanicsburg. 25 Q Mechanicsburg? Page 41 1 A Uh-hum. 2 Q Whereabouts in Mechanicsburg? 3 A Right off the Carlisle Pike by the Toyota 4 dealer. 5 Q Okay. How long has Dr. Demario been your family 6 physi cian? 7 A I went to him after I had my surgery with 8 Dr. Ostdahl which would have been in April. 9 Q And what was the reason you saw Dr. Demano at 10 that time? 11 A Dr. Ostdahl because he was the surgeon referred 12 me to go back to the family doctor to do my pain control. 13 Q Okay. Did Dr. Demario manage the pain control? 14 A Yes. 15 Q How long has Dr. Demario been your family doctor? 16 A Just since April. 17 Q Did you have a family doctor before that time? 18 A No, sir. 19 Q After you returned to the United States in 1996 <V -- 21 A Yes. 22 Q -- when is the first time that you ever sought 23 medical care for any reason? 24 A It would have been the summer of 1998. 25 Q And what was the reason for seeking medical care Page 38 - Page 41 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 Multi-Page'"' MARY ANN ALHAJ Page 42 1 at that time? 2 A That is when I first started having the pressure 3 in the base of my skull. 4 Q Okay. Now, you had previously described the 5 pressure as starting in your left ear? 6 A No, I did not. 7 Q Okay. Let me just -- let me clarify something if 8 I could. I think you said that in the summer of 2001 you 9 were getting pain that started in your left ear? 10 A Correct. 11 Q It moved to the back of your skull and then 12 around to the front, and you said when you had that pain 13 you also had a sense of pressure. Am I correct in that 14 description? 15 A In my ear, not the base of my head. 16 Q Okay. And that's what I'm trying to clarify. In 17 1998 you started to have pressure, but it was in the base 18 of your skull? 19 A Yes, I had no ear problems. 20 Q Okay. That's what I'm trying to get a sense 21 of. A Okay. Q All right. In 1998 you said you started to have pressure at the base of your skull? A (Nods head up and down.) Page 43 1 Q Was it on one side or the other or right in the 2 middle? 3 A It was smack in the middle. 4 Q Okay. And describe for me what kind of symptoms 5 you were having. 6 A I had no pain. 7 Q Okay. 8 A It was more of an annoyance to me than anything. 9 It just felt like something was sitting on the back of my 10 head. It was not painful. It was annoying. 11 Q Okay. And that first started in the summer of 12 '98? 13 A Yes. 14 Q How long after you noticed this sensation before 15 you made an appointment with the doctor? 16 A Probably about a month, about a month. 17 Q Did you take any medication of any type to 18 address that, any Tylenol or aspirin? 19 A Before I went to the -- 20 Q Yes. 21 A No, I don't believe so. 22 Q Okay. Was there anything that you did that 23 seemed to make that pressure better or worse? 24 A No. 25 Q Once the pressure started in the summer of '98, Uq.IUMEK J. Luus Page 44 1 was it constant, or did it come and go? 2 A It was constant. 3 Q Did you have any other symptoms associated with 4 that pressure? 5 A Not in the beginning I did not, not when I first 6 got it. 7 Q Okay. At some point other things started to 8 happen as well? 9 A Yes. 10 Q When was that? 11 A Probably later in that winter, January, February. 12 Q All right. What are the other symptoms that you 13 started to notice? 14 A I started in the mornings where I would get a 15 little disoriented and dizzy, slight, and some nausea, but 16 it would pass as soon as I got up. It did not -- it was 17 not a constant thing. 18 Q Okay. 19 A It (lid not stay with me all day. 20 Q How long after you got up before the sensations 21 of dizziness and nausea would pass? 22 A It would be like 10, 15 minutes. As soon as 1 23 would take my shower I would be fine, but the pressure 24 would still be there. 25 Q Okay. Any other symptoms that you noticed that Page 45 1 came along with the pressure other than the dizziness, the 2 nausea in the mornings? 3 A No. 4 Q All right. Now, let me back you up. You said 5 that after this pressure started in the summer of '98 -- 6 A Yes. 7 Q -- about a month or so later you made an 8 appointment with the doctor? 9 A Yes.. 10 Q Who is the doctor you went to see? 11 A Dr. Howard Cohn. 12 Q Where is Dr. Cohn's office located? 13 A He is with Grossman and them down on Center 14 Street in Cramp Hill. 15 Q Okay. Do you know what kind of doctor Dr. Cohn 16 is? 17 A Yes, he's an ENT. 18 Q And why did you select Dr. Cohn as the doctor to 19 go see? 20 A I thought at first it might be my ears. 21 Q And why is it you felt it was in your ears? 22 A Where -- I didn't really know to be honest with you. Q Okay. A I didn't know what doctor to go see. I started Page 42 - Page 45 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 MARY ANN ALHAJ Multi-Page"" JCTUBI?K J. LUUJ Page 46 1 with anENT. 2 Q Okay. 3 A So I don't -- I can't give you a viable reason 4 why I went to Dr. Cohn, but people told me to go to 5 Dr. Cohn, too, so I went to Dr. Cohn. 6 Q All right. Who recommended Dr. Cohn to you? 7 A People I worked with. 8 Q At Holy Spirit Hospital? 9 A Yes. 10 Q Okay. And do you know why it is they recommended 11 that you see Dr. Cohn? 12 A No. 13 Q Did you ultimately make an appointment with 14 Dr. Cohn? 15 A Yes. 6 Q Do you remember when that was? 17 A No, I do not. 18 Q All right. How many times did you see Dr. Cohn? 19 A Once. 20 Q Tell me about that visit. 21 A He immediately told me it was not my ears. He 22 did not think it was anything to do with my ears. He sent 23 me for an Ntx1. At the point of the Mai they found a lesion 24 in the pons. He sent me directly to the neurologist. 25 Q Okay. Page 47 1 A There was no reason for me to be seen by an 2 ENT. 3 Q Do you recall what Dr. Cohn did to examine 4 you? 5 A Yeah, I believe he did audio tests, and he looked 6 in my ears and -- 7 Q Did he tell you the results of any of those 8 examinations? 9 A Yes, I'm sure he did. 10 Q Do you recall what he told you? 11 A No. 12 Q Do you recall if he mentioned to you the results 13 of the audio tests? 14 A I do remember him telling me about the slight 15 hearing loss, but I had told him that I knew that I had 16 that. 17 Q All right. Who was the neurologist to which 18 Dr. Cohn sent you? 19 A Yanofsky. 20 Q And did you go to see Dr. Yanofsky? 21 A Yes. 22 Q All right. When is it that you first saw 'p3 Dr. Yanofsky, if you recall? 124 A Probably January of 2000 or '99. I don't I25 remember these dates. I really apologize for this, but I Page 48 1 don't. 2 Q That's fine. We have the records and we can -- 3 A I know it was very quickly after I seen Dr. 4 Cohn. 5 Q Okay. 6 A It was probably a month after I seen Dr. Cohn 7 that I got in to see Yanofsky so... 8 Q What do you recall about your visit with 9 Dr. Yanofsky? 10 A He did all the basic neurological testing, and, 11 you know, the eyes and all that, and, you know, he felt at 12 that time that the problem was the lesion that was in the 13 pons could not be biopsied or tested because of where the 14 location was, so he said just to watch it, and they would 15 do periodic nalus, and he had -- he had tried different 16 medications for me. 17 Q Do you recall the types of medications he 18 tried? 19 A He had tried Lasix and Klonopin and Scopolamine, 20 and nothing really prevailed. 21 Q Am I understanding your responses to some 22 questions that I had sent to your lawyer correctly that all 23 of your prescriptions would have been filled at the cvs 24 pharmacy on Simpson Street in Mechanicsburg? 25 A Yes, sir. Page 491 1 Q Okay. Did the Lasix, Klonopin or Scopolamine 2 seem to have any meal effect? 3 A No. 4 Q Now, by the time you are seeing Dr. Yanofsky, am 5 I correct that that's when the pressure was there, but now 6 you were also starting to have morning dizziness and the 7 nausea that was accompanying that? 8 A Uh-hum, yes. 9 Q Okay. Had that set of symptoms changed at any to point after you saw Dr. Yanofsky? 11 A No. 12 Q Okay. Who is the next doctor that you would have 13 seen in regard to your symptoms? 14 A Well, after -- Dr. Yanofsky did a spinal 15 tap. 16 Q Okay. 17 A I did have that done. 18 Q And do you know why Dr. Yanofsky did a spinal 19 tap? 20 A Yes, that was in regards to my sickness in the 21 Middle East. 22 Q What was he thinking about in regard to that? 23 A Just to see if there was bacteria or foreign 24 bodies that would have been in there from that, and that 25 all came out negative. Page 46 - Page 49 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 Multi-Pagerm MARY ANN ALHAJ nrrrnniuv z ?nnq J? 4VVJ Page 50 Page 52 1 Q Okay. Now, after you had your -- well, back up. 1 A Yeah, so... 2 Do you remember when it was that you had your spinal tap? 2 Q Okay. After you had the spinal tap by 3 A No. I'm sorry. 3 Dr. Yanofsky, was there a change in the symptoms that you 4 Q That's all right. I think the records -- 4 were experiencing? 5 A They are. They are there. They should be there. 5 A No. 6 Q I think it was in the spring of 2000, if 1 6 Q Okay. 7 understand the records. 7 A No. 8 A I think so. That probably would have been about 8 Q Did you have any complications from the spinal 9 correct. 9 tap? 10 Q Okay. 10 A Yes. 11 A But that all came out negative, and at that I1 Q What were the complications? 12 point, you know -- I'm sorry. 12 A I didn't listen. 13 Q Go ahead. Go ahead. Finish what you're 13 Q What does that mean? 14 saying. 14 A You're supposed to lay flat for three hours and 15 A No, go ahead. I'm done. , 15 I -- I had it done in the hospital, and I convinced him to 16 Q How soon after you first started to see 16 let me go home and I would lay flat, and I didn't, and like 17 Dr. Yanofsky did you have the spinal tap? Was that within 17 three days later I had the horrible, horrible spinal 18 a few months of your visits with him? 18 headache and all that, so they ended up they had to do a 19 A It was probably approximately six months. 19 blood patch on me. 20 Q Okay. Let me back you up then. You told me that 20 Q Okay. Is there a reason you didn't follow 21 you saw Dr. Cohn in the summer of 1998, and if the spinal 21 Dr. Yanofsky's suggestions to lay flat for three hours? 22 tap with Dr. Yanofsky was in the spring of 2000 and you had 22 A I'm kind of antsy. It's hard for me to lay like 23 only seen him for a few months, that gives us almost a 23 that. 24 two-year gap between Dr. Cohn and Dr. Yanofsky. 24 Q Okay. 25 A Well, let me say this. Don't quote me on these 25 A I mean you're supposed to lay completely with Page 51 Page 53 1 dates because the records are all there. These dates are 1 your head down, you know, and I just kept putting my head 2 like irrelevant to me. 2 up, and it's not that I wasn't laying down. It was just 1 3 Q Okay. 3 kept putting my head up because I was so uncomfortable and 4 A I can't -- I may be quoting you the wrong years , 4 1 just didn't -- it was hard for me to do that 5 when I'm saying this because there was not a two-year gap, . 5 Q Okay. After you had the blood patch did that 6 so maybe it was in '99 when I went first went to see 6 seem to help with the headaches? 7 Dr. Cohn. 7 A Oh, tremendously. Oh, it was amazing. I mean 8 Q Okay. That's fine. I'm just trying to get a 8 once they did it, put the blood in me, it was gone. 9 sense. I'm not -- 9 Q Okay. 10 A You know, I'm probably quoting you the wrong 10 A I was completely normal, but my pressure in the 11 dates is what it is. I'm sure. 11 base of my head was still there. 12 Q That's fine. I'm not trying to trick you. I'm 12 Q Okay. And were you still having the dizziness 13 really not. 13 and the nausea? 14 A I'm not going to let you. 14 A I can't recall that I had that every single 15 Q I don't think you will, and I'm sure your lawyer 15 day, you know. I did have it, but it was such small 16 won't let me try to trick you. I'm just trying to get a 16 periods. It wasn't, you know, to where it was detrimental 17 sense of the timeframe here. 17 to me. 18 A Because I know that the timeframe of these things 18 Q Okay. It would come and it would go? 19 happened very quickly. There was not large gaps. 19 A Yeah. 20 Q Okay. 20 Q Okay. 21 A I'm not talking years here where there was from 21 A Yes. 22 my seeing Yanofsky or seeing Cohn to where I got the spinal 22 Q All right. Who is the next doctor that you saw? 23 tap. I know that. 23 A Dr. Won. 24 Q Okay. That's fine, and that's what I was trying 24 Q Why is it you went to see Dr. Won? 25 to clarify in my own mind. 25 A I was frustrated with Dr. Yanofsky, not that he Page 50 - Page 53 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-3';93-5101 MARY ANN ALHAJ OCTOBER 3, 2003 Multi-Page M Page 54 1 wasn't trying to do everything, but I still felt there was 2 another answer out there. I wasn't getting relief from 3 this, so I thought, well, I'm going to try another ENT, and 4 I knew Dr. Won had been around for years and years and 5 years, so that's why I said I'm going to try this, and I 6 went to Dr. Won. 7 Q Did you talk to Dr. Yanofsky about your concerns 8 that you were getting frustrated, he wasn't getting an 9 answer for you? 10 A Yes, I did. 11 Q And what was his response to that? 12 A He said the only thing he could do is just to 13 keep watching it, you know. It was -- I at that point 14 myself, I did not feel, you know, I was going to get any 15 results, so I wanted to go down another avenue to see if 1 16 could. 17 Q Okay. Did you tell Dr. Yanofsky you were going 18 to go down another avenue? 19 A No, I did not. 20 Q Did you ask for his advice or recommendations as 21 to who you should consult with? 22 A No. 23 Q Okay. Why is it that you chose Dr. Won as the 24 type of doctor that you wanted to see? 25 A I knew he was an ENT, and for some reason in my Page 55 1 mind I kept thinking that it could possibly be my ears. 2 Q Okay. 3 A I don't know why I thought that. I just did and 4 I thought, well, I'll go see him, and like I said, I had 5 beard his name for years and years and years. 6 Q All right. 7 A And I just called hire and made an appointment. 8 Q Okay. 9 A It wasn't anything spectacular. 10 Q Okay. 11 A I just thought I'd try something different. 12 Q Fair enough. Now, the records I have suggest you 13 saw Dr. Won in September of 2000 for the first time. Does 14 that sound about right to you? 15 A Yeah, I will say yes on that, yes, because it was 16 in the fall so... 17 Q Okay. Did anybody go with you to Dr. Won's 18 office on that first appointment? 19 A Yes. 20 Q Who is that? 21 A Her name is Renee Bloom. She is like a sister to 22 me. 23 Q Where does Renee live? 24 A She lives here in Harrisburg. 25 O Do you know what her address is? Page 56 1 A Not offhand. 2 Q Do you know what street she lives on? 3 A She just moved, and that's why I'm not real 4 familiar with it. I'll have to get that. If you need that 5 information, I can definitely get it for you. 6 Q Is Renee married? 7 A She's divorced. 8 Q Okay. And she lives here in Harrisburg? 9 A Yes. 10 Q She lives in the city? 11 A Yes. 12 Q When Renee went to the doctor's with you, did she 13 remain in the waiting room? 14 A No. 15 Q She came back into the office with you? 16 A Yes. 17 Q All right. Tell me about that visit. What 18 happened? 19 A I kind of went into detail and was very 20 frustrated about what I was going through to Dr. Won, and 21 he suggested to me that it was my inner ear nerves, and he 22 was talking to me about getting this surgery that you cut 23 both sides of the head open back behind your ears and that 24 I needed that, and I asked him specifically. I said what 25 -- how does this benefit me? And he said that it would Page 57 1 settle the inner ear nerves, but he did not do the surgery, 2 so he wanted me to go to Johns Hopkins for this, and that's 3 how I ended up going to see Dr. Francis. 4 Q Okay. Did Dr. Won conduct any examination at the 5 time that you saw him? 6 A I think -- I recall, I think he did do a hearing 7 test. 8 Q All right. Do you remember anything else about 9 his examination? 10 A No, I do not. 11 Q Okay. Do you remember if he looked in your 12 ears? 13 A I don't remember. 14 Q Okay. Do you remember if he had you -- well, 15 strike that. Is it fair to say you don't really recall 16 what Dr. Won did in the way of an examination at that 17 time? 18 A Oh, I recall what he didn't do. 19 Q Okay. What didn't he do? 20 A I mean he didn't like -- he didn't do -- like 21 have me do like any vestibular testing or anything like 22 that. I mean I sat in the chair the whole time. 23 Q When you say vestibular testing, what do you 24 mean? 25 A Like walking, turning, and he never mentioned the Page 54 - Page 57 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 Multi-Page"'' MARY ANN Al-HAJ OCTOBER 3. 2003 Page 58 1 word Meniere's disease to me, and the only thing I got out 2 of that conversation was about getting that surgery done, 3 and that he couldn't do it. He wanted me to go to Johns 4 Hopkins. 5 Q All right. Did you tell him where you worked at 6 that point? Did he know you were a nurse, nursing aide? 7 A Yes, uh-hum. 8 Q Did you tell him about the doctors that you had 9 seen before him? 10 A I'm sure I did. 11 Q Did you tell him what those doctors did for 12 you? 13 A Yes. 14 Q Did you tell him that those things that they did 15 didn't seem to work? 16 A (Nods head up and down.) 17 Q You are nodding your head yes? 18 A Yes. I'm sorry. 19 Q Okay. And you expressed to him that because you 20 had seen these other doctors and what they were doing 21 wasn't working, that made you frustrated? 22 A Yes, I did tell him I was frustrated. 23 Q Okay. When you went into the office, there's a 24 waiting room; is that right? 25 A Yes. Page 59 1 Q And then you told the person at the desk that you 2 were there to see Dr. Won? 3 A Yes. 4 Q What happened next? 5 A In what regards? 6 Q Well, how did you get back to Dr. Won's office? 7 Who took you back? What was the process? 8 A I assume the nurse probably came out and got me 9 and took me back. I don't really recall, but that's a 10 pretty standard procedure. 11 Q Do you know if Dr. Won came out to get you? 12 A I don't believe so. I don't -- 13 Q You don't remember? 14 A I can't honestly answer, that question. 15 Q Okay. All right. Do you know how far Dr. Won's 16 office is from the reception room? Is it -- 17 A It's not too far. 18 Q Is it down a hallway? Is it right there? Is it 19 around the comer? 20 A It's down the hallway -- 21 Q Okay. 22 A -- the room I went to. 23 Q All right. Anything else that you remember about 24 that visit with Dr. Won? 25 A No. Page 60 1 Q Do you remember if your friend Renee made any 2 comments to Dr. Won? 3 A Oh, I know she did. She always does. That's why 4 I take her. 5 Q Okay. What do you remember Renee telling 6 Dr. Won? 7 A I don't remember. You would have to ask Renee 8 that. 9 Q Okay. Now, when you say she always makes 10 comments, what do you mean by that? 11 A She's a nurse. 12 Q Oh, okay. 13 A Okay. 14 Q And where does she work? 15 A At Holy Spirit. 16 Q Is she a registered nurse? 17 A Yes. 18 Q All right. 19 A And this is why I take her because I have -- 20 sometimes I don't pay attention but she always pays 21 attention. 22 Q Okay. 23 A She'll ask questions that I don't ask. 24 Q Do you remember if she had any questions for 25 Dr. Won at that time? Page 61 1 A I don't remember that day. I really -- I can't 2 honestly. Like I said, you would have to ask her that. 3 Q Okay. Fair enough. After your visit with 4 Dr. Won, did you agree that you should go see a doctor at 5 Johns Hopkins? 6 A Well, initially that day I came home and spoke to 7 my husband about this. . 8 Q What do you recall about that conversation? 9 A Well, he wasn't very happy about that. He didn't 10 think that. that was the way to go. He thought that seemed 11 a little drastic. 12 Q What seemed drastic? 13 A That surgery. 14 Q Okay. 15 A You know, I mean all of a sudden somebody is 16 talking about cutting the back of my head open on both 17 sides, so we weren't like real comfortable with it, but we 18 both did decide we would go talk to the doctor at Johns 19 Hopkins, so we did. 20 Q Okay. Did your husband go with you to Hopkins? 21 A No, Renee went with me the first time. 22 Q Okay. All right. Do you know why it is that 23 Dr. Won suggested that you see a doctor at Johns Hopkins? 24 A He told me that he was not apt to do that type of 25 surgery, that they would have to do it there. Page 58 - Page 61 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 MARY ANN ALHAJ OCTOBER 3, 2003 Multi-Page"" Page 62 1 Q Okay. And do you know why it was that he 2 recommended Hopkins as opposed to the University of 3 Pennsylvania or Hershey Medical Center or some other 4 hospital? 5 A I think be's probably partial to Hopkins due to 6 he taught there. 7 Q Okay. And how do you know that be has taught 8 there? 9 A You know, to be honest with you, I'm not sun: how 10 I know that. 11 Q Okay. That's fair enough. 12 A Somebody told me that. 13 Q Okay. Tell me what happened when you went to 14 Johns Hopkins and saw Dr. Francis. 15 A Dr. Francis -- you know, I explained to him the 16 whole history from day one and all the doctors and all the 17 medicines and, you know, all my symptoms, and he was pretty 18 adamant that this was not Meniere's. He felt that I would 19 be better off served being seen by their neurology !i20 department. 1121 Q Is this the first time you had heard the phrase 122 Meniere's disease? !23 A Yes. 24 Q All right. And do you know why Dr. Francis was 25 talking about Meniere's disease if you hadn't beard that Page 63 1 mentioned before? 2 A Well, I kind of figured it out at that point. 3 Q Figured what out? 4 A That he -- that Dr. Won had said this to him 5 because he -- you know, I was refened to him by Dr. Won. 6 Q Do you know if Dr. Won and Dr. Francis spoke 7 about your condition before your examination? 8 A Well, I assumed that they had. Consults usually 9 go that way. 10 Q But do you know for a fact that they did or 11 didn't have communication? 12 A No, I do not, not for a fact, but a consult, a 13 doctor -- you don't walk into a consult blind. 14 Q Okay. Who scheduled the appointment with 15 Dr. Francis? Was that you? 16 A No, they did, his office. 17 Q And did they do that while you were there with 18 your first visit? 19 A No, they had called me later after it was set 20 up. 21 Q Okay. All right. Tell me what else you recall 22 about Dr. Francis' visit. 23 A I had asked Dr. Francis about Meniere's disease, 24 and he did explain to me what it was, and he actually did 25 -- he did do some vestibular things with me, and he said Page 64 1 you do not have vestibular dysfunction. I mean he walked 2 me and turned me and did those things, and he said I do not 3 feel you have a vestibular dysfunction. 4 Q Okay. 5 A And he -- at that time he did put me -- I believe 6 put me on Klonopm. 7 Q And you had previously been on Klonopin from 8 Dr. Yanofsky, correct? 9 A Yes. It really didn't -- 10 Q Did you take it this time? 11 A For awhile, not long-term. It didn't really seem 12 to benefit me. 13 Q So you stopped the medicine before the 14 prescription ran out? 15 A Probably so. 16 Q All right. Now, you had mentioned earlier today 17 that you were having some gait problems, and had those 18 started by this time? 19 A No. 20 Q They had not? 21 A No. 22 Q All you had at this point was the dizziness? 23 A Uh-hum. 24 MR. ROVNER: Yes? 25 BY MR. RICCI: Page 65 1 Q When you were feeling dizzy did you feel that you 2 were unsteady on your feet in any way? 3 A No. I -- you know, I think that word dizziness, 4 too, is really misrepresented, what I was trying to 5 explain. It was more like a disorientation than a 6 dizziness even to begin with. It's hard to relate words to 7 some of these physical. 8 Q Okay. Do you remember Dr. Francis doing anything 9 other than you said vestibular testing? 10 A Yes. 11 Q He made you walk? 12 A Yes. 13 Q Okay. Did he do any other testing that you are 14 aware of? 15 A He did -- I do believe be did a hearing test also 16 while I was there. 17 Q Did he tell you the results of that hearing test? 18 A If he did, I don't recall. 19 Q All right. Do you remember anything else that he 20 did? 21 A No, not really. 22 Q Do you remember any physical examinations that he 23 performed? 24 A Yes, he checked my eyes. He did my eyes and all. 25 He actually did he seemed a lot more neurology also. Page 62 - Page 65 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 Multi-Page"" MARY ANN ALHAJ Page 66 1 Q And he recommended that you see a neurologist at 2 Hopkins? 3 A Yes, he told me I would be better situated by 4 seeing a neurologist. 5 Q What did you think of that recommendation? 6 A You know, at this point I didn't know what to 7 think anymore. 8 Q Okay. You didn't follow through on that 9 recommendation though; is that correct? 10 A No, I did eventually see a neurologist at Johns 11 Hopkins. 12 Q But at the time that Dr. Francis recommended it, 13 you chose not to see a neurologist at that time; is that 14 correct? 15 A I don't think it was the point of not choosing to 16 see one. I was just not seeing one at that time. 17 Q Is there a reason that you didn't make an 18 appointment with a neurologist at Dr. Francis' 19 recommendation at that time? 20 A Well, I wanted to come back and talked to Dr. Won 21 first and see what his recommendation since I was under his 22 care at that time. 23 Q Okay. Did you go back and return to Dr. Won? 24 A Yes, I did. 25 Q Did you go to that visit alone, or did you have Page 67 1 someone with you? 2 A No. Renee was with me. 3 Q All right. What do you recall about that visit? 4 A He -- we went to him, and, you know, we told him, 5 Dr. Francis, what he had, you know, said to me about, you 6 know, he didn't think I had this Meniere's disease, and he 7 said they were wrong, you know, and at this point I don't 8 know who to believe anymore. 9 Q Okay. 10 A Okay? And he -- Dr. Won swore to me in front of 11 me and Renee that this would work, to do bilateral 12 Gentamicin injections. He said since they won't do the 13 surgery, we'll do -- and the same question came up again, 14 and I asked it and so did Renee. And what are these 15 Gentamicin injections going to do? It will settle the 16 inner ear nerve. This is how he always responded to that 17 question. 18 Q Uh-hum. What else did he tell you about the 19 Gentamicin? 20 A That was it. I never heard from him that this 21 was a toxic drug, that it would destroy my inner ear. This 22 was never, never brought up to me about the oscillopsia, 23 about the balance disorders. I mean this was never ever -- 24 none of these risk factors were ever given to me, never. 25 Q What did Dr. Won explain to you about the use of VG 1 VtShK J. MU3 Page 68 1 the Gentamicin? 2 A I will repeat this again. The only thing he ever 3 said to me was it will settle my inner ear nerves. 4 Q Okay. 5 A This is the only thing he ever said to me about 6 the Gentamicin. 7 Q Did he talk to you about how the procedure would 8 be performed? 9 A He explained to me that he would put the tubes in 10 the ears. 11 Q Okay. What did he describe about that? 12 A Just that he would put tubes in my ears. 13 Q Okay. 14 A So he could inject the Gentamicin into my ears 15 through the tubes. 16 Q What else did he tell you was going to happen? 17 A That was pretty much it. He just -- you know, he 18 just kept repeating that this would calm things down. It 19 would calm things down. You know, I was never told that it 20 would destroy my inner ear nerves. 21 Q Did he explain to you how the Gentamicin was 22 going to calm things down? 23 A No. Even the day of surgery. 24 Q Did you have an understanding of what the 25 Gentamicin was going to do for you? Page 69 1 A I j ust thought it was going to make things 2 better. 3 Q Okay. 4 A You know, I didn't --I didn't know how toxic 5 this drug was until after this procedure, and I 6 investigated it. I made the mistake of not investigating 7 it before 'this procedure, but I think he made the mistake 8 by not telling me. 9 Q Okay. Do you remember if your friend Renee had 10 any questions for Dr. Won about what was going to be done? 11 A Oh, yes. The day of the surgery when I'm in the 12 -- 13 Q Let's not get there just yet. We're still with 14 the visit that you had with Dr. Won after Hopkins but 15 before the surgery, and I'm wondering if Renee had any 16 questions at that time for Dr. Won? 17 A I can't recall what Renee said to him in the 18 office. 19 Q Okay. 20 A This is very vivid to me the day of the surgery 21 what she said to him. 22 Q Okay. 23 A Like I said, the days when we were in the office, 24 1 really, you know, I'm not going to sit here and say what 25 she said wid what she didn't say because I just don't Page 66 - Page 69 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 MARY ANN ALHAJ OCTOBER 3, 2003 Multi-PageTM Page 70 1 recall. 2 Q Okay. That's fine. Now, let me just stop you 3 here for a second. At this point Dr. Won has talked about 4 putting tubes in your ears? 5 A Yes. 6 Q And using some Gentamicin to help calm things 7 down to use your words? 8 A Yes. 9 Q All right. Did you discuss that concept with 10 Dr. Yanofsky at all? 11 A Oh, no. 12 Q Is there a reason you didn't go back to 13 Dr. Yanofsky? 14 A I felt I was being taken care of. 15 Q Okay. 16 A Why would I have went -- in the middle of all 17 this go back to Dr. Yanofsky. 18 Q Did you have an understanding that Dr. Won wanted 19 to use the Gentamicin to treat Meniere's disease? 20 A At that point, yes, I did understand that. He 21 said Meniere's -- 22 Q Okay. 23 A --at that point. 24 Q Did you question the diagnosis in light of what 25 you told me Dr. Francis told you, that there's absolutely Page 71 1 no way you have Meniere's disease? 2 A At this point I feel like I had had 21 different 3 opinions. 4 Q Okay. 5 A And I was willing to, you know, to try it if it 6 would work, and he swore to me it would work. 7 Q Okay. 8 A I trusted him. 9 Q All right. Did you make any attempt to contact 10 Dr. Francis at Johns Hopkins after this visit with Dr. Won 11 before your procedure at the hospital? 12 A No. 13 Q All right. 14 A Because that happened very quickly. 15 Q Okay. Now, tell me about the procedure at the 16 hospital. Where did you have this done? 17 A Harrisburg. 18 Q Okay. And that was done as an outpatient; is 19 that right? 20 A Yes. 21 Q All right. Did anyone go to the hospital with 22 you for that procedure? 23 A Renee. 24 Q Okay. Did your husband go with you? 25 A No. Page 72 1 Q Was your husband working at this point in time? 2 A Yeah. 3 Q What does he do for a living? 4 A He's a tailor. 5 Q Okay. Tell me what happened when you went to the 6 hospital. 7 A I remember very distinctly that morning. It was 8 in the pre-op area, and Dr. Won came in for me to sign the 9 consent papers, and I -- I'll never forget Renee asked -- 10 she looked at him dead in the face and asked him what is 11 this going to do for her, and he walked away, and then we 12 asked the nurse. 13 Q He just completely ignored it? 14 A He walked away. He absolutely walked away from 15 her. 16 Q Do you know if Dr. Won heard Renee ask the 17 question? 18 A Well, the nurse heard it. I heard it. 19 Q How do you know the nurse heard it? 20 A Because we asked her. She was standing there at 21 the end of the bed, and we looked at her, and she's there 1 22 don't know what it's going to do. She even said the same 23 thing, that she didn't know what it was going to do. She 24 said I don't know what it will do. But he just like 25 totally ignored the question. Throughout the whole process Page 73 1 he totally ignored the questions. 2 Q All right. Let's go back then. I'm a little 3 confused. I thought you said that either you or Renee or 4 both of you would ask Dr. Won questions, and he would 5 respond to those questions and give you answers as to what 6 he thought he was going to be able to do for you? 7 A I think he was very evasive with those answers. 8 Yes, he answered the questions. I'm not saying he didn't 9 answer them. I think he was very evasive how he answered 10 them. 11 Q Okay. Were you comfortable with Dr. Won and what 12 he was suggesting for you? 13 A On the -- the last time I was in the office I was 14 questioning, you know, should I do this because he did seem 15 evasive about things. 16 Q Okay. That's what I'm trying to get a sense of, 17 Mrs. Alhaj. If you have a doctor who's evasive, he's not 18 answering your questions, he's not really giving you the 19 information you want, and it's contradicting what everyone 20 else is telling you, is there a reason you didn't seek 21 another opinion? 22 A I had seeked many opinions. I was at my last 23 opinion, so I was going to try this no matter what, and I 24 felt a lot, too, with Dr. Won that his problem with 25 evasiveness was I really believe sometimes he doesn't know Page 70 - Page 73 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 Multi-Pagen' MARY ANN ALHAJ nrTnuFu z inns Page 74 Page 76 1 what you're saying to him. I don't think that he's trying 1 Q Well, that's what I'm n to figure g out bete. 2 to be evasive. I think he just plain doesn't understand 2 I can't read on this copy, but it indicates the surgery 3 what you're asking him, because he would throw -- I 3 that Dr. Won was going to perform with the Gentamicin. Do 4 remember one time Renee asked him something, and he went -- 4 you recall, does that appear to be your signature on the 5 he left the room and came back with this book, and he 5 line that says signature of patient? 6 throws this book at her instead of him answering the 6 A Ys, I signed that. 7 question. 7 Q Okay. Do you recall seeing this document while 8 Q Do you remember what the book was about? 8 you were at the hospital? 9 A I couldn't tell you. 9 A Yes. 10 Q Okay. That was at the very first visit you had 10 Q And this is the consent form that you had signed; 11 with Dr. Won, wasn't it? 11 is that correct? 12 A I don't member. Like I said. I can't honestly 12 A Correct. 13 say. 13 Mtt. Ricci: r11 get a copy for you, Diane. 14 Q And that's when Dr. Won gave you some medications 14 MR. ROvNER: Are you going to mark it? 15 to take home with you to try; is that right? 15 Ma. RICCC We'll mark that as Alhaj 1. 16 A Well, I don't recall getting medication from 16 (Consent to Operation, Diagnostic Procedure, 17 Dr. Won. 17 Anesthetic produced and marked Alhaj Deposition Exhibit No. 18 Q Do you member a term by the name of 18 1.) 19 Lipoflavonoids? 19 BY MR. Rosa: 20 A Vitamins. 20 Q Now, Dr. Won discussed with you the consent form, 21 Q Vitamins, that's right. Do you member Dr. Won 21 what's the: next thing that you recall happening at the 22 giving you some vitamins? 22 hospital? I think that's where we were. 23 A Yeah, I member he gave me a bottle of vitamins. 23 A I remember the issue with him and Renee and him 24 Q And did you take them? 24 walking away and then asking the nurse, and the next thing 25 A Yeah, but I didn't have any improvement though. 25 they took me in the OR and strapped me down. Page 75 Page 77 1 Q Did you take all of the vitamins Dr. Won had 1 Q Okay. 2 prescribed, or did you stop them early like you had with 2 A Arid I realize why they strapped me down because I 3 your other medications? 3 would have slapped them. 4 A Now, what other medications did I stop early on? 4 Q Pin sorry. Because you would have? 5 1 said one prescription of Klonopin. 5 A I would have slapped them because it was like 6 Q I think you said Klonopin you never finished, it 6 pouring battery acid into my head when they did these 7 wasn't working? 7 injections because I was not asleep for them. 8 A Yeah, but I had taken a whole script of Klonopin. 8 Q Okay. What do you mean by like pouring battery 9 I took Scopolamine. I took all my Lasix. Don't mix up 9 acid? It burned? 10 that I didn't take all my prescriptions. 10 A Yes, terribly, and at that point I knew there was I 1 Q It was just the Klonopin that you didn't finish? 11 something; wasn't right here, and then he turned my head and 12 A The last prescription of Klonopin because I was 12 did the other side. 13 getting no relief from the Klonopin. 13 Q Were you awake during this procedure? 14 Q Okay. Did you take all of the Lipoflavonoids 14 A Yes. 15 that Dr. Won had provided to you? 15 Q Did you say anything when you had this burning 16 A These were the vitamins, right? 16 sensation? 17 Q Right. 17 A Yes, I told him. I said it burned like hell. 18 A Yes. 18 Q What did he say? 19 Q And they didn't provide any relief to you? 19 A He said that's the way it's supposed to be. 1 20 A No. 20 said oh. 21 Q Mrs. Alhaj, I'm going to show you a document from 21 Q Which ear did he do first; do you remember? 22 the Harrisburg Hospital record which is labeled at the 22 A My left (indicating). 23 bottom Consent to Operation, Diagnostic Procedure, and that 23 Q Okay. How long were you on your right side so 24 is dated -- 24 that he could do the work on the left ear? 25 A February 6, 2001. 25 A It was very quick. Page 74 - Page 77 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 MARY ANN ALHAJ Multi-Page`"' ul IUIS1rK J, ZUU3 Page 78 1 Q All right. And after he had finished the work on 2 the left ear, what happened next? 3 A He turned my head and did my right ear. 4 Q And how long did that last? 5 A Very quick. It wasn't -- the whole procedure 6 probably was a half an hour, if I recall. 7 Q When you say the whole procedure, do you mean 8 from the time you were wheeled into the room -- 9 A Right. 10 Q -- to the time you left? 11 A Right. 12 Q Dr. Won wasn't present that whole half hour 13 period of time, correct? 14 A Not that I recall. 15 Q Okay. How long do you think Dr. Won was actually 16 with you while he was placing the tube and the Gentamicin 17 in the one ear and then doing the other ear? 18 A Five minutes. 19 Q Okay. Okay. What happened after you were done 20 with the procedure? 21 A They took me back to where I originally started 22 and did the usual discharge process. 23 Q Okay. How long were you at the hospital in total 24 that day; do you recall? 25 A Oh, I could not tell you. I have no idea. Page 79 1 Probably a few hours, but I'm guessing. It wasn't that 2 long. 3 Q Home in the afternoon? 4 A I was probably home by lunch time, yeah, because 5 I had it early in the morning. 6 Q Because you had it -- pardon me? 7 A I think I had it done in the morning. 8 Q All right. What happened the rest of that day? 9 Did the burning that you felt at the time of the procedure 10 disappear? 11 A That alleviated a little bit. 12 Q Okay. Had you noticed a change with the pressure 13 sensation or the pain that you were experiencing? 14 A No. It was still the same. 15 Q Okay. Did you have any change in your symptoms 16 or sensations in the days following -- 17 A Yes. 18 Q --the procedure? What changed? 19 A That's -- it didn't really start until the 20 following day, and I wasn't really sure what was happening. 21 1 felt like I was -- I couldn't see, first of all. 22 Q Okay. What do you mean you couldn't see? 23 A I had oscillopsia so bad I could not take one 24 step without my vision just -- my God, it was blurred, and 25 truthfully I had no idea what was going on. Page 80 1 Q Okay. 2 A And my balance started getting bad, and it like 3 progressed over like a ten-day period to where it got so 4 bad that I had ended up in the emergency room. 5 Q Okay. Now, let me just back you up a second. 6 A Uh-hum. 7 Q When you left the hospital did you receive any 8 instructions from anybody about what you should do with 9 follow-up for Dr. Won? 10 A I don't remember that myself, but I do remember 11 myself making an appointment with Dr. Won immediately 12 because I wanted to know what was going on. 13 Q Okay. The discharge instructions that I have 14 from the records your attorney provided me say that you 15 were supposed to make a follow-up appointment within two 16 weeks with Dr. Won. 17 A And I did. 18 Q Okay. Did you see Dr. Won within two weeks? 19 A Immediately, oh, yes. 20 Q Where did you see Dr. Won? 21 A In his office. Renee and I went back because I 22 wanted to know what was happening to me. 23 Q Okay. Dr. Won's records show that you cancelled 24 an appointment in early March, and you didn't see him until 25 the end of March. Do you have a reason to believe that's Page 81 1 not accurate? 2 A Yeah, because I remember I was very upset what 3 was happening, and I remember the next day I had to go see 4 Dr. Dukkipati. They wanted me to see the neurologist. 5 Q Okay. 6 A But I know that I made an appointment with him 7 and went to it. 8 Q Okay. Was that before or after you saw Dr. 9 Dukkipati? 10 A That was after I seen Dr. Dukkipati. 11 Q Okay. Do you recall if you made the appointment 12 to see Dr. Won before or after you saw Dr. Dukkipati? 13 A I don't recall that -- 14 Q Okay. 15 A --truthfully. 16 Q All right. 17 A I just remember that when I did see him, that he 18 again was very evasive about what was happening. 19 Q Let me back you up a second because we're not 20 quite to that point yet. The day after your procedure when 21 you had this jumping of your vision -- 22 A Uh-hum. 23 Q -- did you call Dr. Won's office? 24 A No, I just -- 25 Q Why not? Page 78 - Page 81 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 Multi-Page`"' MARY ANN ALHAJ OCTOBER 3- 2003 Page 82 Page 84 1 A I thought it was something that would pass. I 1 Q The pulling to the right when you walked? 2 wasn't relating it to the Gentamicin. 2 A Right, right. 3 Q Okay. 3 Q Any other symptoms? 4 A I did not relate this to the Gentamicin at all. 4 A No. 5 Q Okay. 5 Q How about the pain and the pressure in your ear 6 A It was like it didn't even dawn on me that that 6 that would start in your left ear, move to the back of the 7 was what was happening to me. 7 skull and then come around to the front? 8 Q How long did this jumping of your vision last the 8 A I did not have that at that point. 9 day after the procedure? 9 Q Okay. When did that start? 10 A I still have it till this day. 10 A That didn't start until a few months after I had 11 Q So once the jumping of the vision started, it's 11 that procedure done. 12 been present constantly? 12 Q Olkay. So those symptoms, that is, the pain in 13 A Now, it has improved greatly. 13 the ear that traveled to the back of the skull and around 14 Q Okay. Did it ever go away after it started? 14 to the front of the cheek -- 15 A No. 15 A Correct. 16 Q Was it there 24 hours a day, 7 days a week? 16 Q -- started in the summer of 2001? 17 A Yes. 17 A Correct. 18 Q Any other symptoms that you had other than this 18 Q Okay. 19 jumping of the vision? 19 A And then I had the lingering symptoms from the 20 A My main problem was my walking. 20 Gentamicin. 21 Q Okay. How was your walking affected? 21 Q The lingering symptoms are the oscillopsia? 22 A It was more to where I would pull to certain 22 A The oscillopsia and the vestibular, correct. 23 sides. I would walk sideways. 23 Q Okay. How soon after your procedure at the 24 Q Now, I think you had told me earlier that that 24 Harrisburg Hospital did you notice that you would pull to 25 first started in the summer of 2001, and we're in February. 25 the right when you walked? Page 83 Page 85 1 Am I wrong on that? 1 A Within a few days. It took a few days to really 2 A No, I did not say that. I did not. You asked me 2 intensify for me. It was probably like a couple of weeks 3 what my symptoms were in 2001. They were still the same 3 after the procedure that I went to the ER. 4 from February of 2001 until July. You asked me what my 4 Q Okay. Is there a reason that you didn't call 5 symptoms were. I did not say they started in that summer. 5 Dr. Won's office in those two weeks to complain of these 6 Q All right. Let me clarify that -- 6 symptoms? 7 A Okay. 7 A Well, at this point I really am having my doubts 8 Q -- because I'm just trying to get a sense of the 8 about him to begin with, so I truthfully thought they would 9 time line. 9 pass. 10 A No, no, I understand. I know, but -- 10 Q Okay. 11 Q Okay. 11 A I really did, because I thought -- and at this 12 A But this started in 2001, the beginning of 2001, 12 point I started investigating the Gentamicin myself. 13 and went all the way to the present so... 13 Q How did you -- 14 Q Okay. The symptoms that you have related to me 14 A On the Internet. 15 earlier then started in the days following the procedure 15 Q Okay. What did you learn about Gentamicin? 16 with Dr. Won? 16 A Well, the first thing that shocked me was that it 17 A Correct. 17 should never be done bilaterally, and it's only done in 18 Q Just so I'm clear, describe for me what symptoms 18 severe cases of Meniere's with severe vertigo which I never 19 they are that you believe started in the days following the 19 had, and then it goes into the symptoms of Gentamicin, and 20 procedure with Dr. Won. 20 it's the oscillopsia, the vestibular disorders, and I was 21 A The oscillopsia. 21 starting to figure out here, okay, this is from this 22 Q Okay. 22 Gentamicin. And it also did say that there are, you know, 23 A The vestibular disorder. 23 good possibilities of improvement which thank the Lord 1 24 Q Is that the pulling? 24 have had. You know, slowly but surely it cleared up to 25 A That would be vestibular disorder, right, right. 25 where I am now. I mean the first month or so after that I Page 82 -Page 85 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 MARY ANN ALHAJ OCTOBER 3. 2003 Multi-Page TM Page 86 i was not functionable. 2 Q Okay. 3 A And when I did go to Dr. Won, it was, oh, you'll 4 get better. You'll get better. That's what I got. I 5 still never heard that the Gentamicin did this to me. Not 6 once did that doctor ever tell me that. 7 Q Okay. Were you working at this period of time? 8 A No. 9 Q When had you stopped working? 10 A In December. 11 Q Or was it November? 12 A Okay. I'll take November. 13 Q Okay. Why did you stop working in November of it 14 would have been 2000, I guess? 15 A I was frustrated, and Dr. Won said he would put 16 me on leave. I thought why not. I'll take a vacation. 17 Q You were frustrated about what? 18 A The -- in my head, the problems I was having and 19 chasing doctor after doctor. 20 Q Were the problems you were having in your head 21 affecting you at work? 22 A I think more emotionally than physically. 23 Q Were they affecting you physically in any way? 24 A Just to where it bothered me. 25 Q How would it bother you? Page 87 1 A Because it wasn't pain. It was not pain. I 2 never had pain. It would just -- I just knew it was there 3 all the time. 4 Q Okay. Did it have any impact on your ability to 5 do your job physically? 6 A No, no. 7 Q You said that it was having an emotional impact. 8 In what way? 9 A More so because I was taking off a lot of work. 10 Q Okay. Why were you taking off work? I1 A I wasn't sleeping. I would call off a lot, and I 12 was emotionally distressed at that time. 13 Q Why were you calling off work if it wasn't 14 affecting you physically? 15 A Because I didn't feel like going. 16 Q Okay. 17 A It wasn't -- I wasn't like not going to work 18 because I was physically unable to go. It was just I just 19 didn't feel like it. 20 Q Okay. 21 A I was so disgusted with everything. I felt like 22 nothing was going the way I wanted it to go, you know. 23 Q And where were you working at that point in time? 24 A Holy Spirit. 25 Q At Holy Spirit. Page 88 1 A And, you know, that type of job is very 2 demanding. 3 Q Uh-hum. 4 A You know, you have to put all your needs on other 5 people, and at that point in my life I wanted my needs on 6 me -- 7 Q Okay. 8 A --to be honest. 9 Q Okay. So in the fall of 2000 Dr. Won agreed to 10 put you on a medical leave? 11 A Uh-hum. 12 Q And you took a medical leave from Holy Spirit at 13 that time? 14 A Yes. 15 Q At some point did you start to go work again? 16 A Yeah, yes, but honestly I don't remember when. 17 It was in the spring and -- yes. It was basically when my 18 symptoms, you know, really started to clear up a little bit 19 from the oscillopsia. I remember when I went back to work 20 because they were kind of hesitant on letting me come back 21 because when I would go down the halls, I would hold onto 22 the walls, and I was still really unbalanced with the 23 patients. 24 Q And when you went back to work it was at Holy 25 Spirit? Page 89 1 A Yes. 2 Q All right. When you went back to work did you go 3 back full time? 4 A Yes. 5 Q Did you ever miss work again after that for 6 health reasons? 7 A Yes. 8 Q When did you miss work again? 9 A I still would call off because I was having 10 problems. 11 Q How frequently were you calling off? 12 A Probably three, four times a month. 13 Q And what would lead to you calling off work? 14 A Not sleeping. 15 Q All right. And what was it that would keep you 16 awake at night? 17 A Basically the pressure in my head. 18 Q All right. 19 A And I -- really with the vestibular dysfunction, 20 it really brought on extreme exhaustion because I was 21 fighti ng to stay stable. 22 Q All right. You went back to Dr. Won one more 23 time after your procedure; is that right? 24 A Correct. 25 Q Tell me about that visit. Did you go alone, or Page 86 -Page 89 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 Multi-Page`"` MARY ANN ALHAJ OCTOBER 3 2003 Page 90 I Page 92 1 did Renee come with you again? 1 If not I can get them. 2 A Renee went with me. 2 Q I would ask that if you have them you could make 3 Q Was your husband with you? 3 copies for your attorney. 4 A No. 4 A Slue. I thought I did. 5 Q Okay. Tell me what happened about that last 5 MR. ROVNER: Are these -- 6 visit with Dr. Won. 6 n1E wrrNESS: I thought I gave you them. Maybe I 7 A I went back to ask him what happened, why did 7 didn't. I can get some for you. There's quite very good 8 this react this way to me. 8 sites. I was like really surprised about all the sites on 9 Q Okay. 9 Gentamicin. 10 A And he just said, oh, you'll be fine. You'll be 10 BY MR. R.ICCI: 11 fine. That's what he told me. 11 Q Okay. Well, if you could provide copies of the 12 Q Did you tell him you had gone to the emergency 12 material you printed out. 13 room? 13 A There's numerous doctors that made the same 14 A Yeah, he knew that. 14 statements about not being done bilaterally. 15 Q How did he know that? 15 Q Well, that's fine. If you can provide copies of 16 A I told him. I said I ended up in the ER because 16 what you researched to Mr. Rovner, I would appreciate it. 17 1 was flat on my back. I couldn't stand up. I mean that 17 A Okay. 18 day that Renee took me, I mean I was really bad that day. 18 Q Okay? All right. After you saw Dr. Won the last 19 That was the worst day. I couldn't walk forward. 1 19 time, did. you have any plans to go back to see Dr. Won? 20 couldn't walk sideways. I couldn't, but, you know, at that 20 A No. 21 point in time I still didn't know it was the Gentamicin 21 Q Why not? 22 that had done that. 22 A I was disgusted with him. 23 Q Okay. Did you tell Dr. Won that you had seen 23 Q And what was it -- 24 Dr. Dukkipati? 24 A Because I didn't feel he was fair with me. I 25 A Yes. 25 don't feel that he explained to me. Page 91 Page 93 1 Q And what was his reaction to that? 1 MR. ROVNER: Is this it? 2 A I can't say I recall what his reaction was. 2 TE E wrrNEss: That might be some of it. No. At 3 Q Okay. 3 that point in time I had made my mind up I would never go 4 A I don't think he really reacted. 4 back to him. 5 Q All right. Were you still having the symptoms 5 BY MR. RICCI: 6 that you were having before you had seen Dr. Won or before 6 Q Okay. Had you done your Internet research at 7 you had your procedure with Dr. Won? 7 this point before you saw Dr. Won? 8 A Yes. 8 A Ulrhum. 9 Q Did you tell him you were still having those 9 Q Did you ask him about the things you found on the 10 symptoms? 10 Internet? 11 A I don't recall if I did or not. 11 A No, I wanted to see what he was going to say to 12 Q Did you tell him you were having new symptoms? 12 me, and he said exactly what I thought he would, nothing. 13 A Oh, yeah, that's why I went to see him that day. 13 Q Wien he said nothing to you, did you say well 14 I asked him what in God's name is going on here. , , 14 gee, Dr. Won, I looked some things up and I found these 15 Q Okay. 15 things out, I have now got some questions? 16 A Because through this whole process I was never 16 A No. 17 told that there was this risk factor with this Gentamicin, 17 Q Wry not? 18 so when it came on, I was unaware that it was the 18 A I seeri no purpose in it. 19 Gentamicin because I was never told that the Gentamicin 19 Q Okay. 20 could do this until I go on a search and find out myself. 20 A What was done was done, and I had to go on and 21 Q Okay. When you were doing your Internet , 21 I had to find a doctor that would help me get through 22 searching, did you print any of those documents out? 22 this. 23 A Yes. 23 Q Okay. Who is the next doctor you decided to 24 Q Do you still have copies of those documents? 24 see? 25 A Mr. Rovner, didn't I give you copies of those? 25 A I was seeing Dr. Dukkipati because they had Page 90 - Page 93 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 MARY ANN ALHAJ OCTOBER 3, 2003 Multi-Page"` Page 94 1 brought him in through the ER that day, so I seen him, and 2 then -- 3 Q Did Dr. Dukkipati suggest to you what he thought 4 was happening or was going on? 5 A Oh, you know, all the doctors, you know, they 6 don't say that, yeah, it's probably the Gentamicin, but, 7 you know, nobody is going to give me a definite answer on 8 that so... 9 Q Okay. 10 A And then at one point in time I did go back and 11 see Dr. Francis. 12 Q Uh-hum. x,13 A And then I ended up seeing the neuro at Johns 14 Hopkins. 15 Q Why did you go back to Dr. Francis? 16 A That's what I'm trying to figure out. I don't 17 remember why I went back to him. That's a very good 18 question. 19 Q When you went to Dr. Francis the second time, did 20 you go alone, or did you bring somebody with you? 21 A My husband went with me. 22 Q Okay. What do you recall about that visit? 23 A To be honest with you, I don't recall nothing. 24 Oh, I know what it was. I talked to him about the 25 Gentamicin injections. Page 95 1 Q You called him on the phone? 2 A No, we went to his office, my husband and I, 3 because my husband was very distressed about this, and we 4 wanted to get information about the Gentamicin, and he did 5 go into detail about how it's, you know, done on one side 6 and, you know, it's never to be done bilaterally, blah, 7 blah, blah, and I believe it was at that point in time that 8 he wanted me to see this Dr. Walker -- 9 Q Okay. 10 A -- who is the neuro down there at Johns Hopkins, 11 and he set that up for me. They got that set up, and I 12 went to see him. 13 Q Okay. Did Dr. Francis tell you why you don't 14 administer Gentamicin bilaterally? 15 A Yeah, he told me. He said because it destroys 16 the inner ear nerves, and then the vestibular dysfunction 17 is just totally gone. 18 Q Did he tell you why they used Gentamicin on one 19 side I think you told us he said? 20 A Yes, he said that the only time they use 21 Gentamicin is like last resort where somebody is so 22 incapacitated with vertigo. That's what he told me. 23 Q Do you have an understanding of what vertigo 24 is? 25 A Yes. Page 96 1 Q What is it? 2 A Vertigo is actual movement of the room, and it 3 can be very incapacitating. 4 Q Have you ever experienced what you have described 5 as movement of the room? 6 A One time when I was drunk, but other than that, 7 no. No. I never had vertigo, never. 8 Q Okay. If your doctors would have described your 9 symptoms as being characteristic of vertigo, would you say 10 that that's an incorrect statement then? 11 A Totally. 12 Q Okay. Do you recall anything else about your 13 examination with Dr. Francis after your procedure with 14 Dr. Won? 15 A I don't remember what he did. I don't remember 16 if he even did an exam to be honest with you at that time. 17 I don't recall. 18 Q Okay. 19 A I just strictly -- I feel like I really talked to 20 him more that time than anything else. 21 Q Was Dr. Francis at that time critical of what 22 Dr. Won did? Did he say that he did something wrong or 23 improper? 24 A I didn't feel that Dr. Francis would ever be 25 critical of Dr. Won due to he was taught under him so... Page 97 1 Q Do you know if Dr. Francis was, in fact, one of 2 Dr. Won's students? 3 A Apparently so. 4 Q And how do you know that? 5 A I just find these things out. Somebody told me. 6 Q Do you know who told you that? 7 A I don't remember. He was very liberal with his 8 information on -- about the procedure itself. Okay? 9 Q Okay. 10 A But he honestly -- you know, no, he was not 11 critical. He did not relate Dr. Won's name in any of this 12 conversation. 13 Q Okay. That's fine. By the way, have any of your 14 doctors ever related Dr. Won's name to you in a critical 15 way? 16 A I have never -- yeah, one, Dr. Yanofsky. 17 Q What did Dr. Yanofsky say? 18 A I -- it was shortly after I had gone back to 19 work, and he seen me walking down the hallway. He didn't 20 know that I had this procedure done. 21 Q Okay. 22 A And he came up, and he said, Mary, what's wrong, 23 and I told him, and he basically says is he nuts? He said 24 you didn't have Meniere's disease. He said you never 25 should have been treated for this. 'age 94 - Page 97 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 Multi-Page"" MARY ANN ALHAJ Page 98 1 Q Okay. And is that what led to you writing to 2 Dr. Yanofsky to ask him to prepare a letter for you to that 3 effect? 4 A No. That really came about when I decided to 5 bring this case. 6 Q Okay. 7 A And what made me decide to bring this case was 8 from my own searching on the Internet and finding out how 9 this procedure was done wrong, and that was even before I 10 had talked to Dr. Yanofsky. Dr. Yanofsky seen me in the I1 hall that day, blah, blah, blah, and it was even after that 12 point, that I did not ask him that day for the letter. 13 Q By that time you had already in your own mind 14 decided you were going to pursue a lawsuit? 15 A Correct. 16 Q Had you made that decision before you saw Dr. Won 17 for the last time? 18 A No. 19 Q How soon after -- 20 A But shortly after that. It was probably a few -- 21 about a week after that, a week. Like I said, don't quote 22 me on these days, but it was after. I'm pretty sure. 23 Q Okay. 24 A It possibly could have been before, but I don't 25 know. I just remember searching the Internet, and I was v%.ivnisx j, zuuj Page 100 I I had these holes in there, so it didn't feel so nice. So 2 I flew off the table, and they stopped it. They said they 3 couldn't do it because I had the holes, the perforations. 4 Q Why did you fly off the table? 5 A Because it hurt so bad, it was horrible. It was 6 absolutely painful. 7 Q Okay. What else do you recall Dr. Walker doing? 8 A He did rotary chair tests, and he did like all 9 these vision testing and vestibular testing. 10 Q Do you remember Dr. Walker discussing the results I I of those exams with you? 12 A Yes. 13 Q What do you recall about that? 14 A 7nre only one I recall was that the rotary chair, 15 I didn't do too well on that one. It did show vestibular 16 dysfunction on the rotary chair test, and I can't remember. 17 I can't really remember anything else that he said. 18 Q Were the other tests normal? 19 A To be honest with you, I don't know. 20 Q Okay. 21 A I think some were and some weren't. It was kind 22 of like 50/50. He did come to the assumption that I did 23 have vestibular dysfunction. 24 Q Okay. Was anybody with you at the time that you 25 were being examined by Dr. Walker? Page 99 1 just shocked by what I had found. 2 Q And you had searched the Internet I think you 3 told me before you had seen Dr. Won? 4 A Correct. 5 Q Okay. And it was as a result of the information 6 that you found on the Internet that led you to the belief 7 that you wanted to pursue a possible lawsuit? 8 A Correct. 9 Q Okay. You told me that you followed Dr. Francis' 10 recommendations the second time you saw him to make a 11 neurology concert at Hopkins? 12 A Correct. 13 Q Consult, excuse me, at Hopkins, correct? 14 A Correct. 15 Q All right. Who did you see at Johns Hopkins at 16 that time? 17 A His name was Dr. Walker. He is actually a 18 specialist in vestibular therapy. 19 Q What did Dr. Walker do for you? 20 A He did all kinds of tests. They tried to do an 21 ENG test. They could not do it. 22 Q Why not? 23 A I flew off the table. I had had the perforations 24 in my ear drums, and an ENG test is where they put the 25 water, and they started running the water into my ears, and Page 101 I A Ibrahim, you were with Dr. Walker? 2 MR. ALHAJ: 1 think so. I had to wait outside. 3 THE WITNESS: Yeah, he didn't actually let him in 4 when they were doing the testing. He was there. 5 BY MR. R?CCI: 6 Q Haw many times did you see Dr. Walker; do you 7 recall? 8 A Just once. 9 Q Okay. Did you see Dr. Francis again after seeing 10 Dr. Walker? 11 A No. 12 Q Okay. So the only time -- you only saw 13 Dr. Francis two times? 14 A Correct. 15 Q Once before your procedure and once after? 16 A Yeah. 17 Q And you saw Dr. Walker one time? 18 A Yes. 19 Q All right. At some point you began to treat with 20 Dr. Fomadley? 21 A Yes. 22 Q How did you get to Dr. Fomadley? 23 A I was having trouble with my ears. I was like 24 having a lot of pain in them, and when I went to see him, 25 you know, I went to see him because I knew -- Dr. Misas Page 98 - Page 101 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 MARY ANN ALHAJ OCTOBER 3, 2003 Multi-Page TM Page 102 1 knew him and told me he was like one of the best ENrs 2 around, to go see him. 3 Q Okay. 4 A So I went to see him, and he said I had 5 perforation, so they tried the patches before they did the 6 surgery, but the patches didn't work. So at that point he 7 wanted to do the -- he did a skin graft and took skin from 8 behind one of my ears and did the patch, did the surgery, 9 reconstructive surgery on my right ear. 10 Q Okay. All right. Is that all that Dr. Fomadley 11 has done for you? 12 A Uh-hum. 13 Q Okay. Did Dr. Fomadley make any comments about 14 the use of Gentamicin? 15 A Yes. 16 Q What did he say? 17 A He felt that my problems were due to the 18 Gentamicin. He was one of the other doctors that felt that 19 I should not have been treated that way. 20 Q Okay. Did you ever provide Dr. Fomadley with 21 any of the records that were generated by Dr. Won or at 22 Harrisburg Hospital? 23 A Yes. 24 Q Did you give Dr. Francis or Dr. Walker the 25 records from Harrisburg Hospital and Dr. Won's office? Page 103 1 A I don't think from Harrisburg Hospital, but I do 2 think he had -- they had them from Dr. Won's office because 3 I had always made sure I had copies of everything when I 4 went, but I myself, I don't think I had a copy of the 5 consent. I'm not sure. 6 Q Had a copy of what? 7 A The consent form. 8 Q Okay. 9 A I didn't feel that necessary for -- I didn't 10 understand why they would need that. I I Q Okay. Is the only record that you ever had from 12 Harrisburg Hospital a copy of the consent form? 13 A Yes. 14 Q Okay. You never had a complete copy of the 15 operative report and what was done? 16 A Oh, no, no, no. Yes, I did have that. Sorry. 17 Q When did you get those records? 18 A I'm sorry. I don't remember. 19 Q Okay. Do you remember if you ever gave those 20 records to any of your doctors? 21 A Oh, I'm sure I did. 22 Q Okay. Do you remember which doctors you gave 23 those records to? 24 A Probably all of them. 25 O But you're not sure who? Page 104 1 A No. 2 Q Okay. 3 A The thing is though I don't think after this 4 point though I didn't see a lot of doctors, so I didn't 5 like give them to Dr. Yanofsky or like my past doctors. 6 Q Uh-hum. 7 A Then it probably would have just been 8 Dr. Fomadley. 9 Q Okay. How about Dr. Ostdahl, when did you start 10 to see Dr. Ostdahl? 11 A I -- when I went to work for Dr. Misas and 12 Dr. Willis, they felt that he could help me, and they sent 13 me to him. 14 Q Okay. 15 A And that's how I ended up going to him. 16 Q Okay. Now, Dr. Misas was the doctor that you 17 were working for at the Women's Cancer Center, correct? 18 A Yes. 19 Q As was Dr. Willis? 20 A Yes. 21 Q Had you ever consulted with Dr. Misas or 22 Dr. Willis to be your personal physicians? 23 A No. 24 Q Okay. So any information that they had or 25 recommended to you was for lack of a better description as Page 105 1 a friend as opposed to as a patient? 2 A Yes, yes. 3 Q Okay. Did Dr. Misas or Dr. Willis ever perform 4 an examination of you? 5 A No. 6 Q Okay. What did Dr. Misas suggest that 7 Dr. Ostdahl could do for you? 8 A Actually it wasn't Dr. Misas that did that. That 9 was Dr. Willis. 10 Q I'm sorry if I misstated. 11 A No, no, that's okay. Dr. Misas sent me to 12 Fornadley. 13 Q Okay. 14 A And Dr. Willis sent me to Dr. Ostdahl. 15 Q Okay. 16 A He just thought, you know, there might be some 17 nerve things going on in there, and so he sent me to see 18 Dr. Ostdahl, what he could do for me. 19 Q Okay. And what did Dr. Ostdahl suggest for 20 you? 21 A He sent me for nerve blocks on my occipital 22 nerve. Q And what was that supposed to do? A They test the nerve before they decide to do 'eery. If the nerve blocks work, then they know that Page 102 - Page 105 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 Multi-Page' MARY ANN ALHAJ nrrnunu z ?nn? Page 106 1 is the nerve doing that, and they can go in and proceed and 2 take it out, and the nerve blocks did work for the pressure 3 in the back of my head, and I did have the occipital nerve 4 surgery, and I have not had the pressure in my head since 1 5 had that. 6 Q Okay. And when did you have that surgery? 7 A In April of 2003. 8 Q Do you still have the dizziness in the morning? 9 A No. 10 Q Did that go away at the time of the occipital l I nerve surgery? 12 A Yeah, pretty -- that actually probably went away 13 even before that a little bit. 14 Q Okay. When did you notice that the dizziness had 15 disappeared? 16 A That actually started when I started taking the 17 Fentanyl patches. 18 Q When did you start the Fentanyl patches? 19 A February of 2003. 20 Q Okay. The occipital nerve surgery, was that on 21 one side or the other? 22 A That was the left. 23 Q Just the left side? 24 A Uh-hum. 25 Q Okay. After the occipital nerve surgery, have Page 107 1 you gone back to see Dr. Ostdahl? 2 A No. 3 Q Has Dr. Ostdahl ever expressed any criticism of 4 the diagnosis of Meniere's disease or the treatment with 5 the Gentamicin? 6 A He has to me. I mean he doesn't feel that it was 7 -- that it should have been done that way. 8 Q Okay. 9 A But, you know, he doesn't have a long history 10 either so... I 1 Q What do you mean he doesn't have a long history? 12 A He's a neurosurgeon. He's not like a family 13 doctor. He hasn't been with me throughout this entire 14 thing. 15 Q Okay. Have you provided Dr. Ostdahl with copies 16 of your various medical records? 17 A Yes. 18 Q Which records have you given to Dr. Ostdahl? 19 A Everything you guys have. 20 Q Okay. That would include Dr. Yanofsky's records, 21 Dr. Gantz' records, Dr. Dukkipati's records? 22 A That's all the records I have. All my -- I have 23 all my records, and usually when I go to these physicians 24 in order to help my cause, I think they should know the 25 past history. Page 108 1 Q Okay. Mrs. Alhaj, I understand that in addition 2 to the doctors we have talked about you also sought care at 3 the Pinnacle Health Center Vestibular Clinic? 4 A Uh-hum. 5 Q When did you start going to the vestibular 6 clinic? 7 A Probably a year ago. 8 Q Okay. 9 A Possibly. Don't quote me. 10 Q What is it that was done for you at the clinic? 11 A They -- Kelly did like an overview first of all, 12 you know, what my limitations were and stuff. 13 Q Okay. 14 A And, you know, you do walking, and she put me in 15 this cage thing that I could not do. I started screaming. 16 I mean they rock you and like that, and then basically a 17 lot of it is what you do at home. 18 Q Okay. 19 A It's home exercises. They try to retrain your 20 brain to pick up signals at different points, and it's a 21 lot of visual training is what it amounts to. 22 Q Okay. All right. Let's back up to that first 23 visit with -- Kelly was the therapist? 24 A Yes, Kelly Straub. 25 Q She said -- you said that she helped determine Page 109 1 what your limitations were? 2 A Uli-hum. 3 Q What were your limitations at that point? 4 A I don't want to say limitations. It's what my 5 vestibular problems were. 6 Q Okay. 7 A You can have vestibular dysfunction but not have 8 limitation. 9 Q Okay. 10 A You understand what I mean? 11 Q I understand what you mean. And I'm trying to 12 use -- 13 A And they determine what not your limitations so 14 much, it's more what your vestibular dysfunction was. 15 Q Okay. 16 A And I had a report from her, so like I say, the 17 only thing I recall from that visit was I did have some 18 trouble with walking over these stupid bricks and stuff, 19 but then they put me in this thing where they put a belt on 20 you, and it rocks you, and this is my big problem is 21 motion. Motion is not a good thing for me, so she took me 22 out of it. 23 Q In what way is motion not a good thing for you? 24 A This is where my vision comes into play. 25 Q Okay. Page 106 - Page 109 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 MARY ANN ALHAJ OCTOBER 3, 2003 Page I10 1 A I have very limited driving because of it. 2 Q All right. 3 A I drive to the grocery store, and that's about 4 it. When I turn my head to the left or the right is when 5 my vision goes. 6 Q Does the speed with which you turn your head 7 affect your vision? 8 A Totally. 9 Q How so? 10 A It makes it faster. Like if I do it real quick 11 it's very -- it jumps very fast. If I do it like at a slow 12 pace, it's a slower jumping. You know, when I'm just 13 sitting here it doesn't do it. 14 Q Okay. 15 A But it seems to be from left to right. 16 Q Okay. Is there any other way that motion affects 17 you? I18 A Particularly in a vehicle. 19 Q In what way does it affect you? 20 A I used to be able to drive in a car with no 21 problem. Now I am absolutely petrified. I scream, 1 22 holler, because it looks like they're coming in our lane, 23 and I drive my poor husband crazy because I'll like have my 24 head in my lap when I'm in a car because I'm just 25 hysterical. It all has to do with my vision. Page l l l 1 Q Okay. And what is it with your vision while 2 you're in the car? 3 A Like if I'm on a one lane, like just two lanes, 4 I'm okay. 5 Q Okay. 6 A It's when I have a car or a truck coming up 7 beside me, it looks like they're coming, they're in my 8 lane. 9 Q Okay. 10 A And it just freaks me out, and I just get 11 hysterical. I get absolutely -- that's why my eyes are 12 usually shut when I'm in the car, and that's why I only 13 drive to like to very limited places because I can't I 14 can't drive on a highway. I can't do it. 15 Q Okay. 16 A I cannot do it. 17 Q Have you talked to any of your doctors about your 18 vision problems? 19 A Yes. 20 Q With whom? 21 A I talked to Dr. Fomadley about this, and 22 Dr. Fomadley feels that I'm probably where I'm going to be 23 permanently with my vestibular and the vision. They just 24 feel I'm at a point where I have improved as much as I am 25 going to improve. Multi-Page Page 112 1 Q Okay. Has anybody suggested there is anything 2 further that can be done -- 3 A No. 4 Q -- in the way of medicine or surgical treatment 5 that would get you at further improvement than what you 6 have done on your own? 7 A Not with the oscillopsia. The problem is they 8 said the nerves are gone, and it's -- but I mean I try and 9 do visual training, you know, but it just doesn't seem 10 to -- you know, I'm not getting any more better. I think 11 I'm where I'm at, and I'm going to stay. 12 Q Okay. Have you talked to any doctors other than 13 Dr. Fomadley? 14 A No. 15 Q Have you seen any eye doctors? 16 A Yes, I did, but that was awhile back though. 17 Q Who did you see? 18 A I don't even remember his name. It was a doctor 19 out in Carlisle, and that was shortly after I had the 20 Gentamicin. It was probably like six, seven months. 21 Q Do you remember where his office is located? 22 A It was on Walnut Bottom Road. I don't remember 23 what his name was. But he -- you know, he just felt that 24 it was just part of. 25 Q Was it a doctor that is alone, or was he in a Page 113 1 group? 2 A No, it was a group. 3 Q Was it at the Belvedere Medical Center? 4 A No. I know where that is, and I know where you 5 are talking about. I can't remember what his name was. If 6 you need to know, I'll find out for you. 7 MR. ROVNER: Can you find out and let me know? 8 THE WITNESS: Sure. 9 BY MR. RICCI: 10 Q Could you, please. What did this doctor have to 11 say to you about your condition? 12 A He -- I mean he said my basic vision was fine. 13 Q Okay. 14 A You know, and like I said, this was like probably 15 six months after I had the injections, and he said it would 16 improve. 17 Q Okay. Have you ever gone back to this doctor? 18 A No. 19 Q Do you have any plans to go back to him? 20 A No. 21 Q Do you have any plans to see any other eye 22 doctors? 23 A I have no plans to see any doctors. 24 Q Okay. When you went to see the eye doctor in 25 Carlisle, did you go alone, or did your friend, Renee -- Page 110 -Page 113 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 Multi-Page"" MARY ANN ALHAJ nVTORPi2 z )nna Page 114 Page 116 1 A My husband went with me. 1 mean I can't say why I see improvements, if it's from that, 2 Q Your husband went with you. All right. Any 2 if it's from this, you know. I mean I fight this myself, 3 other doctors that you recall seeing other than the eye 3 and I think a lot of this is healing on my own. 4 doctor in Carlisle, Dr. Yanofsky, Dr. Ostdahl, Dr. Gantz, 4 Q What types of improvements have you seen? 5 Dr. Dukkipati, Dr. Fomadley, Dr. Francis, Dr. Walker, and 5 A Well, I mean my vision, I mean it used to do it 6 Kelly, the therapist at the Vestibular Center? 6 all the time. Now, it's just with my head movement. 7 A I think that that about sums it up. 7 Q Okay. 8 Q Okay. Now, let's go back. We were talking about 8 A I mean to me that's an improvement. 9 the vestibular findings of Kelly, and you had mentioned 9 Q Okay. 10 that the motion affected your eyesight? 10 A And I mean I am able -- I still when I go up and 11 A Uh-hum. 11 down stairs, I have to hold on because if not I go to the 12 Q Were there any other findings that Kelly made at 12 right. I'll go -- if I start at this side of the steps, 13 that initial visit related to vestibular function? 13 I'm at this side when I get up at the top because I pull to 14 A I don't recall. I can't answer that because I 14 the right. 15 don't recall. You would have to look at her report. 15 Q Okay. 16 Q Okay. Now, in terms of limitations, because you 16 A But I mean I have seen improvements, I'm not 17 drew a distinction between vestibular dysfunction and 17 going to deny that, from when I started all this. 18 limitation -- 18 Q What other improvements have you seen? 19 A Uh-hum. 19 A That's it. 20 Q Did Kelly identify any limitations at the time of 20 Q Okay. I understand in looking at your records 21 that initial visit? 21 that you used to bungee jump? 22 A I don't remember. 22 A Yeah 23 Q In your mind did you have any limitations at that 23 Q When were you a bungee jumper? 24 time? 24 A Oh, my God, that was years ago. 25 A I think I do have limitations due to my driving 25 Q What type of bungee jumping did you do? Page 115 Page 117 I and... 1 A What types are there? 2 Q Okay. What are the limitations? 2 Q Were you jumping off towers? Were you jumping 3 A And my being able to walk outside. 3 off bridges? Were you going to amusement parks? 4 Q How are you limited in walking outside? 4 A No, it was on a platform. 5 A I can't walk like on uneven pavement or like on 5 Q Okay. 6 grass. I go to the right. I just -- I just constantly go 6 A It was on a platform. 7 to the right. I'm fine on flat surfaces, but don't put me 7 Q How often did you go bungee jumping? 8 on uneven pavement. 8 A Do I have to answer that? 9 Q Okay. Any other limitations? 9 MR. ROVNER: Sure. 10 A No. 10 THE WITNESS: I don't know. It was quite 11 Q What types of exercises did Kelly have you do for 11 numerous times that one summer. 12 vestibular function? 12 BY MR. RICCI: 13 A At home I'm supposed to like stare, like take 13 Q It was just one summer that you bungee jumped? 14 things and stare at them at different points and stuff like 14 A Yeah, yes. 15 that. 15 Q What summer was that? 16 Q Okay. What else are you supposed to do? 16 A Oh, God, I don't remember. 17 A That's basically it. 17 Q Was it before you went to the Middle East, or was 18 Q Okay. How frequently are you supposed to do 18 it after? 19 these exercises? 19 A Yeah, it was before. Oh, he wouldn't let me do 20 A Like three times a day. 20 that. 21 Q For how long when you do them? 21 Q Okay. I understand you used to be a roller 22 A Like ten, fifteen minutes. 22 coaster nider, too? 23 Q Okay. Have you found that those exercises have 23 A Yeah. 24 helped? 24 Q When did you ride roller coasters? 25 A I mean I have seen improvements in myself, but I 25 A Oh, that was years ago. Page 114 - Page 117 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-'_593-5101 MARY ANN ALHAJ Multi-Page TM Jl7ukShK J. LVV} Page 118 1 Q Were you a member of any roller coaster clubs? 2 A No. 3 Q No? 4 A No. 5 Q Where did you ride roller coasters? 6 A Hershey. 7 Q Any other parks? 8 A I've been around. 9 Q What other types of roller coasters have you to ridden? 11 A Just the normal kind. 12 Q Well, do you like the wooden coasters? Do you 13 like the steel coasters? 14 A Yeah. 15 Q You like them both? 16 A Yeah. 17 Q Do you like the kinds that spin you around upside 18 down? 19 A Yeah. 20 Q Do you have a particular kind you like best of 21 all? 22 A I like The Bear. Q The Great Bear at Hershey? A Yeah. Q When's the last time that you have gone roller Page 119 1 coaster riding? 2 A '97or'98. 3 Q When you would go to the parks would you 4 primarily ride the roller coasters? 5 A Yes. 6 Q Spend the whole day on the roller coasters? 7 A Yes. 8 Q Any idea of the number of times you would ride a 9 roller coaster in a given day? 10 A It depends how crowded it was. 11 Q Okay. Did you have a personal best? 12 A No, no. I really don't know seriously. 13 Q Okay. But it would be multiple times a year? 14 A Oh, yeah, sure. 15 Q And were there parks that you would go to other 16 than Hershey? 17 A That was years ago though. I mean when I went to 18 Hershey this time, that was the first time I have been at a 19 park in a long time since I was younger. 20 Q Okay. 21 A I have settled down a little bit. 22 Q Okay. After you returned to the States, was the 23 only park that you had attended Hershey? 24 A Hershey, uh-hum. 25 Q And prior to going to Israel, when was the last Page 120 1 time you had been riding roller coasters? 2 A Oh, it was probably like 15, 20 years. It was 3 when I was younger. 4 Q Okay. Mrs. Alhaj, after you came back to the 5 States with your husband, what types of things did you do 6 for recreation and enjoyment? 7 A Oh, we go to the races. I love the races. 8 Q Silver Spring? 9 A Williams Grove. 10 Q Williams Grove? 11 A Yeah. And we go motorcycle riding a lot. 12 Q Do you have your own motorcycles? 13 A Uh-hum. 14 Q What kind of motorcycle do you ride? 15 A vTx lsoo Honda. I just ride on the back. 16 Q Okay. You don't have your own bike? 17 A No. He said my place on a bike is behind his ass 18 so. .. 19 Q Fair enough. 20 A No, I am not allowed to ride my own bike. 21 Q Okay. The vTx 1soo, that's an off-road bike? 22 A No. It's a cruiser. 23 Q Oh, it's a cruiser? 24 A Uh-hum. Uh-hum. 25 Q Okay. When you ride the Honda is it for Page 121 1 recreational riding, or do you actually take it on trips? 2 A Recreational. Yeah, we don't take it that far. 3 Q Since you are a passenger on the bike, do you 4 still ride today? 5 A No. 6 Q When's the last -- 7 A I don't -- I haven't rode since I have gone 8 through this. 9 Q When's the last time you went for a motorcycle 10 ride? 11 A Probably two years ago. 12 Q Had you gone riding after your procedure by 13 Dr. Won? 14 A Maybe once or twice. 15 Q Is there a reason you don't continue to ride? 16 A I don't feel safe on it anymore. 17 Q What is it that makes you feel unsafe? 18 A My vision and my imbalance. I'm afraid I'm going 19 to turn my head and fall off. 20 Q Okay. When was the last time you had ridden the 21 bike before your procedure by Dr. Won? 22 A Probably the summer before. 23 Q Because you are recreational riders is it fair to 24 say you generally don't ride in the fall or winter x!25 months? Page 118 - Page 121 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 Multi-PageTM MARY ANN ALHAJ AhTAi)TT ? vva vaaa:a? J, LVVJ Page 122 Page 124 1 A You do in the fall until it gets cold. 1 recreational activities you engaged in after you came back 2 Q Okay. Is there a reason you weren't riding your 2 to the United States? 3 bike in the fall of 2000? 3 A Normal. We would go out to dinner, go see my 4 A Did I say I wasn't? 4 family, go to the beach. 5 Q Yeah, you said the last time you had ridden 5 Q Do you still go out to dinner today? 6 before your procedure with Dr. Won was the summer before. 6 A Pretty much because I won't cook anymore 7 A Which would have been 2000. 7 . Q Why don't you cook anymore? 8 Q Right, and I'm asking if there's a reason you 8 A Because I'm too tired. 9 didn't ride in the fall months of 2000? 9 Q Were you the one that primarily did the cooking 10 A But I never said that I didn't ride in the fall 10 in the family? 11 months of 2000. 11 A (Nods head up and down.) 12 Q I thought you did, Mrs. Alhaj. I thought I asked 12 MR. RICCI: Okay. 13 you when is the last time that you had rode as a passenger 13 M.R. ROVNER: Say yes or no. 14 on the motorcycle before Dr. Won's procedure which was in 14 THE WITNESS: Yes. I'm sorry. I'm getting 15 February of 2001. 15 tired. 16 A And what did I say? 16 Mz ROVNER: I know. 17 Q And your answer was the summer of 2000. 17 BY MR. Ricci 18 A So we're going to argue over one month here? 18 Q We're getting close to being done. You said you 19 MR. ROVNER: It's just he wants to know when's 19 see your family. What family do you visit? 20 the last time to the best of your recollection. 20 A When my mother died, she died in September of 21 MR. Ricci: Right. 21 '98, and my younger brother moved home with his 12 children 22 THE WITNESS: i see what you are saying. 22 who lived like three blocks from me. 23 MR. ROVNER: Whether it was the summer or the 23 Q Okay. Do you have -- well, you said your younger 24 fall. 24 brother. That suggests you have other siblings. 25 THE WITNESS: That summer, that fall. 25 A Yeas, I have an older brother, too. Page 123 Page 125 1 MR. RICCI: Okay. That's what I'm just trying to 1 Q Any other siblings? 2 get a sense. 2 A No. 3 MR. ROVNER: Yes. 3 Q What's your older brother's name? 4 THE WITNESS: Okay. 4 A Dale. 5 MR. ROVNER: If you don't keep a log, you don't 5 Q Arid where does Dale live? 6 know the exact date. 6 A In Camp Hill. 7 THE WITNESS: No, okay. I got you. 7 Q Do you visit with Dale at all? 8 MR. RICCI: Okay? 8 A No. 9 MR. ROVNER: All right. 9 Q Okay. Your younger brother, what's his name? 10 THE WITNESS: Yeah, it was that summer probably. 10 A Danny. 11 BY MR. RICCI: I1 Q And what's -- I'm sorry. What's Dale's last 12 Q Okay. And my next question then is why did you 12 name? 13 stop riding at that point? 13 A Beaver, B-e-a-v-e-r. 14 A Because I didn't feel good. My pressure in my 14 Q And Danny's last name is Beaver? 15 head was getting -- because that was really the year when 15 A The, same. 16 it started getting bad for me. 16 Q And where does Danny live? 17 Q Okay. All right. Do you still go to the 17 A In 'Mechanicsburg. 18 races? 18 Q And you still visit with Danny? 19 A No, they are too expensive. 19 A On occasion. He visits me more. 20 Q When did you stop going to the races? 20 Q Okay. Does Dale come to visit you? 21 A I went last summer. I didn't go this summer or 21 A No. 22 the summer before. I didn't go last summer either. I 2 2 Q You two don't keep in touch? 23 haven't done much the last couple years. 2 3 A Yeah, I talk to him on the phone, but he goes 24 Q Okay. Other than going to the races and 2 4 bike riding with Ibrahim sometimes, but I'm just not real 25 motorcycle riding with your husband, did you have other 2 5 social these days. Page HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-3193-5101 122 Page ] 25 MARY ANN ALHAJ Multi-Page " JCl-OBIix s, LUUJ Page 126 1 Q Had you visited with Dale on a more frequent 2 basis when you first came back to the States? 3 A Yeah, I probably seen him more then. 4 Q Okay. How frequently would you see him then? 5 A I seen him a lot. He came to see me all the 6 time. He wasn't married then. 7 Q Okay. He's now married? 8 A Well, he was married. He just didn't know he was 9 married. 10 Q I'm not sure I understand that. 11 A It's so embarrassing. He was actually on the 12 front page of The Patriot about this, and Howard Stem even 13 got it. Him and his wife had been divorced for like nine, 14 ten years. 15 Q Okay. 16 A And they decided to get back together, and they 17 went out to Cumberland County to get a license, and here 18 they found out they were never divorced. 19 Q Oh. 20 A So it was... 21 Q Okay. 22 A So they weren't together, but they were together 23 so... 24 Q All right. So when Dale's wife who he thought 25 was his ex-wife came back -- Page 127 1 A Yeah. 2 Q -- they then started to live together? 3 A Yeah, yeah. 4 Q And after she moved back in I take it that your 5 visits with him decreased? 6 A Right. 7 Q Okay. Do you remember when that was? 8 A A couple years ago. 9 Q Okay. I assume Danny is married? 10 A He should be with all those children. 11 Q He's not? 12 A He is. 13 Q He is, okay. And when is it that he moved back 14 to Mechanicsburg; do you recall? 15 A When my mother died. 16 Q I'm sorry. You did tell me that. 17 A The fall of -- the winter of '98 actually they 18 came. My mom died in September. He came back in like 19 December. 20 Q Okay. Where had he lived before that? 21 A Out in Minnesota. 22 Q Okay. And since his return you two have kept in 23 touch. 24 A Oh, yeah, very close. 25 Q All right. Does Dale have any health problems Page 128 1 that you are aware of? 2 A No. 3 Q And how about Danny? 4 A No. 5 Q Does he have any health problems? 6 A No. 7 Q How about Danny's children, do any of them have 8 health problems that you are aware of? 9 A Some of the children, the younger children do, to but these children are adopted. 11 Q Okay. 12 A He has four of his own, and he adopted eight 13 children. 14 Q Okay. Do any of his natural children have any 15 health problems that you are aware of? 16 A No. 17 Q Okay. How about your father, does he have any 18 health problems that you are aware of? 19 A He was just recently diagnosed with Parkinson's. 20 Q Okay. 21 A And yesterday after I met with you I had to take 22 him for a biopsy for prostate. 23 Q Okay. 24 A But other than that he's been pretty good through 25 the years. Page 129 1 Q Okay. How about your mom before she passed away? 2 A That woman would have -- 3 Q Did she have any health problems? 4 A She would have lived until she was 100. 5 Q Okay. 6 A But she died. 7 Q All right. Aside from the emergency room visit 8 that you had at the Holy Spirit Hospital a few weeks after 9 your procedure, have you had to go back to a hospital for 10 any other reason after that other than the surgery with 11 Dr. Ostdahl? 12 A Yes, this last couple of weeks actually. 13 Q Okay. Tell me about that. 14 A I -- because of going off the Fentanyl patch, I 15 went through severe drug withdrawal. 16 Q Okay. 17 A And I ended up dehydrated. I didn't drink or eat 18 anything for like four days, and they had to hydrate me. 19 Q Where was that done? 20 A Harrisburg. 21 Q How long were you in the hospital? 22 A I was just in like a day. They just did it in 23 the ER. They hydrated me and let me go home. 24 Q You never were admitted to a room? 25 A No, no, no. I have never, huh-uh. Page 126 - Page 129 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 Multi-Page"" MARY ANN ALHAJ nr?rnu>r:u z )nn,2 Page 130 1 Q Other than the situation that led to the 2 rehydration procedure at Harrisburg and the emergency room 3 visit at Holy Spirit, any other hospital visits? 4 A No. 5 Q Okay. 6 A None. 7 Q All right. Do you have any plans to see any 8 doctors at this point today? 9 A (Shakes head from side to side.) 10 Q You are shaking your head no? 11 A No, I can't. At this point I don't feel that 12 there's anything anybody else can do for me. 13 Q Okay. Mrs. Alhaj, have you kept any diaries or 14 notes throughout this period of time? 15 A No, I just kept every single record. 16 Q Okay. 17 A I thought that was my diary. 18 Q When you say you kept every single record, you 19 mean your doctor's records? 20 A Uh-hum. 21 MR. RICCI: Okay. 22 MR. ROVNER: Yes? 23 BY MR. RICCI: 24 Q Did you make any notes or write anything on those 25 records? Page 131 1 A No. 2 Q Do you keep calendars of any type with notes on 3 your calendars about doctors' appointments and things that 4 are scheduled? 5 A Huh-uh, no. 6 Q Did you ever try to write anything down to sort 7 of get things in your own mind in terms of the chain of 8 events that occurred? 9 A No. 10 Q You have indicated that Renee Bloom may have some 11 information because she attended many of your doctor's 12 visits with you? 13 A Yes. 14 Q Is there anyone else other than Renee Bloom that 15 would have knowledge of the events that concern this 16 lawsuit? 17 A No. 18 Q Now, the address that you had previously told me 19 for Renee Bloom was North 21st Street, Camp Hill -- I'm 20 sorry. That's Holy Spirit, that's work? 21 A That's work. That's okay. 22 Q And you don't know her current home address? 23 A I will get that for you. I will give it to 24 Mr. Rovner immediately. 25 MR. ROVNER: Sure. Page 132 1 BY MR. RICCI: 2 Q Now, you have a telephone number written down 3 here as 329-5800. 4 A That's her cell phone. 5 Q That's her cell phone? 6 A Yeah. 7 Q Okay. 8 A But I'll get her home phone number to you. 9 MR. ROVNER: Okay. 10 BY MR. RICCI: 11 Q Okay. Mrs. Alhaj, is there anything else that 12 you remember about your contacts with Dr. Won that we 13 haven't talked about as you sit here today? 14 A No, not that I recall. 15 Q Okay. And aside from the individuals that we've 16 talked about, Dr. Dukkipati, Dr. Ostdahl, and Dr. Francis, 17 has anyone else offered any criticisms of the care that was 18 provided to you by Dr. Won? 19 A Yrs. 20 Q Who else has criticized Dr. Won? 21 A I mean legally do I have to say this? 22 MR. RICCI: Yes, I think you do, Ma'am. Unless 23 it was a conversation with your attorney -- 24 MR. ROVNER: Yes. 25 MR. RICCI: -- I have a right to know and ask it. Page 133 1 MR. ROVNER: It's a question -- was it something 2 that we talked about? 3 (Mrs. Alhaj and Mr. Rovner confer.) 4 MR. ROVNER: Well, you have to say that. 5 TER WrrNESS: Okay. The doctors that I work for. 6 BY MR. RICCI: 7 Q Dr. Misas and Dr. Willard -- or excuse me -- 8 Willis? 9 A Willis. 10 Q Okay. What did Dr. Misas say? 11 A That he was nuts. 12 Q Okay. What else has he said? 13 A Those were the words, and Dr. Willis, too. You 14 know, the thing that I hear the most is that this never 15 should have been done bilaterally. 16 Q Okay. 17 A You know, I mean I think there was a big mistake, 18 you know, made here, and that's what these doctors are 19 telling me. 20 Q Okay. That's Dr. Misas and Dr. Willis? 21 A Uh-hum. 22 Q Have they offered any other criticisms other than 23 the fact that this was done bilaterally? 24 A No. 25 MR. RICCI: Okay. I think that's all the HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-3.93-5101 Page 130 - Page 133 MARY ANN ALHAJ Multi-Page nmm?nrcv 2 I)AM VI.l VYaa -+? ? Page 134 1 questions I have at this time. Thank you, Ma'am. 2 THE WITNESS: Okay. 3 MR. ROVNER: Okay. 4 (The deposition was concluded at 11:20 a.m.) 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Page 135 1 COUNTY OF DAUPHIN 2 : SS 3 COMMONWEALTH OF PENNSYLVANIA 4 I, Diane F. Foltz, a Notary Public, authorized to 5 administer oaths within and for the Commonwealth of 6 Pennsylvania, do hereby certify that the foregoing is the 7 testimony of Mary Ann Alhaj. 8 I further certify that before the taking of said 9 deposition, the witness was duly swom; that the questions 10 and answers were taken down stenographically by the said 11 Reporter-Notary Public, and afterwards reduced to 12 typewriting under the direction of the said Reporter. 13 1 further certify the said deposition was taken at 14 the time and place specified in the caption sheet hereof. 15 1 further certify I am not a relative or employee or 16 attorney or counsel to any of the parties, or a relative or 17 employee of such attorney or counsel, or financially 18 interested directly or indirectly in this action. ',19 I further certify that the said deposition 20 constitutes a true record of the testimony given by the 21 said witness. 22 IN WITNESS WHEREOF, I have hereunto set my hand ?23 this 15th day of October, 2003. 24 X25 Diane F. Foltz, RMR Page 134 - Page 135 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 Multi-Page TM & - beginning AAAVV AWM AT XIAi -&- 24 Ill 82:16 24/7 p1 32:11 adamant [q addition [Il 62:18 108:1 & [31 1:15 1:19 additional [q 14:19 1:22 -3- address [s] 5:6 3 5:13 7:23 8:23 [21 1:14 2:4 329-5800p] 132:3 43:18 55:25 131:18 '80p] 21:3 131:22 ADL '94[11 26:7 -4- s [31 23:16 25:8 23:15 '95[4] 10:9 9:10 9:10 26:8 40 [2] 28:8 28:13 administer [21 135:5 95:14 '96[5] 9:10 26:10 [11 : 5 4423 Ill 1:16 admit[i] 18:10 26:11 26:16 26:18 admitted p] 129:24 '97 Ill ' 119:2 _5_ adopted [21 128:10 98 [61 43:12 43:25 128:12 45:5 119:2 124:21 50/50 p] 100:22 adult [116:3 127:17 d i '99 [21 47:24 51:6 6_ -6- a v ce Ill 54:20 AFEES p] 17:25 -0- 6p] 75:25 18:2 18:2 affect [21 110:7 03-531 111 1:5 _7_ 110:19 affected [2] 82:21 7[31 30:1 30:1 82:16 114:10 405 7 2 1 [41 2:15 39:4 76:15 76:18 10 [21 28:5 44:22 100 [1] 129:4 11 [1] 28:5 11:20[1] 134:4 12[11 124:21 15 [21 44:22 120:2 15th p1 135:23 17th [11 7:14 1800 [2] 120:15 120:21 1976 Ill 14:17 1980[217:2 7:2 1988 Ill 7:8 1995 [11214 1996[2] 9:2 41:19 1998 [4141:24 42:17 42:23 50:21 76 p] 2:16 affecting [31 86:21 86:23 87:14 7:00 Ill 17:17 affects Ill 110:16 ffili t d a a e p1 30:10 afraid Ill 121:18 801 [21 5:7 8:20 afternoon [1] 79:3 8:00 Ill 17:17 afterwards [11 135:11 8:55 p1 1:14 again [1q 25:8 26:19 27:1 67:13 68:2 81:18 88:15 8 9:5 89:8 90:1 [1] 135:2 101:9 against[l] 3:14 -A- ages [11 5:25 A-F-E-E-S p] 18:4 a.m [2] 1:14 134:4 ability [21 36:18 87:4 able [lo] 3:20 30:22 37:18 38:11 39:1 39:3 73:6 110:20 115:3 116:10 absence m 38:6 absolutely [5] 70:25 72:14 100:6 110:21 111:11 ago pot 18:8 20:18 34:4 39:10 108:7 116:24 117:25 119:17 121:11 127:8 agree [t] 61:4 agreed[i] 88:9 ahead [3] 50:13 50:13 50:15 aide pi 58:6 airplane [11 37:2 Albaj 124] 1:1 12 1-1n 0 1.14 -2- 20 Ill 120:2 2000 [1 2] 27:17 47:24 50:6 50:22 55:13 86:14 88:9 122:3 122:7 122:9 122:11 122:17 2001 (1 2) 27:17 29:5 34:2 42:8 75:25 82:25 83:3 83:4 83:12 83:12 84:16 122:15 2003 [s] 1:14 29:5 30:17 32:22 33:2 106:7 106:19 135:23 201 p1 8:21 20th [11 7:2 21(l] 71:2 21stp7 131:19 22 [11 6:9 Acapulco " 13:19 2:3 2:14 3:8 acceptable I,, 2021 3:12 5:2 7:13 accident [1] 8:4 7:20 36:5 73:17 75:21 7615 76:17 accompanying[1] 101:2 108:1 120:4 49:7 122:12 13011 117.11 accurate Ill 81:1 accurately p] 36:17 acid [2l 77:6 77:9 action [21 1:4 135:18 activities [21 27:2 124:1 actual [11 96:2 AD [2] 15:6 15:7 133:3 135:7 alive [1] 8:11 alleviated [11 79:11 allowed [t1 120:20 almost [31 28:5 37:1 50:23 alone pl 66:25 89:25 94:20 112:25 113:25 along [q 45:1 always [81 18:19 19:5 21:13 60:3 60:9 60:20 67:16 103:3 amazing [1] 53:7 Amman [9] 9:6 9:8 9:13 9:16 9:25 10:4 10:5 14:6 26:13 amounts [l] 108:21 amusement [l1 117:3 Anesthetic [21 2:16 76:17 ANGINO pl 1:19 Ann [9] 1:1 1:10 2:3 3:8 5:2 5:3 29:9 30:2 135:7 annoyance [q 43:8 annoying [11 43:10 answerps] 4:2 4:7 4:20 4:22 4:23 14:3 20:20 33:4 36:9 38:15 54:2. 54:9 59:14 73:9 94:7 114:14 117:8 122:17 answered p1 73:8 73:9 answering [21 73:18 74:6 answers pl 73:5 73:7 135:10 antsy [1l 52:22 anyway [2] 18:23 25:13 apologize [11 47:25 appearp] 76:4 APPEARANCESp1 1:18 appointment [131 40:5 43:15 45:8 46:13 55:7 55:18 63:14 66:18 80:11 80:15 80:24 81:6 81:11 appointments [2] 40:2 131:3 appreciate [11 92:16 April [s] 26:5 30:24 41:8 41:16 106:7 ,apt [11 61:24 area [2] 19:10 72:8 areas [1135:16 argue [1l 122:18 Army [l1 18:3 aside [21129:7 132:15 asleep [1] 77:7 aspirin [1] 43:18 ass [1l 120:17 assistp] 23:16 assistant p1 22:23 assisted [11 2816 assisting [1] 27:1 associated[1] 44:3 assume [s] 4:21 17:12 36:6 59:8 127:9 assumed p] 63:8 assumption [l ] 100:22 attempt [21 12:12 71:9 attended [21 119:23 131:11 attention [4] 11:12 12:5 60:20 60:21 attorney [6] 3:13 80:14 92:3 132:23 135:16 135:17 audio p] 47:5 47:13 authorized Ill 135:4 availability D l 12:6 available [11 38:10 avenue [21 54:15 54:18 Aviation p] 15:8 awake [21 77:13 89:16 aware [6] 20:25 65:14 128:1 128:8 128:15 128:18 away [9134:23 72:11 72:14 72:14 76:24 82:14 106:10 106:12 129:1 awhile p1 64:11 112:16 -B- B-e-a-v-e-r [l1 125:13 bacteria[l] 49:23 badpq 8:6 10:25 12:21 27:24 37:24 79:23 80:2 80:4 90:18 100:5 123:16 balance [51 35:11 35:13 37:5 67:23 80:2 base [51 42:3 42:15 42:17 42:24 53:11 basic [313:18 48:10 113:12 basis [2] 3:22 126:2 battery [2] 77:6 77:8 beach Ill 124:4 Bear [21 118:22 118:23 Beaver p1 125:13 125:14 beQ[? 72:21 began p1 101:19 begin (2) 65:6 85:8 beginning [21 44:5 83:12 Index Page 1 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 behind - dates Multi-Page " X&AnV AIJ7S AT UAT behind [a] 31:19 brother's p1 125:3 changed [2) 49:9 communication p] correct [23] 42:10 56:23 102:8 120:17 brought ta] 3:14 79:18 63:11 42:13 49:5 64:8 66:9 50:9 66:14 belief [1] 99:6 67:22 89:20 94:1 character [q 34:19 Communications [2] 76:11 76:12 78:13 belt p] 109:19 Brushing [q 23:19 characteristic [1] 22:6 22:13 83:17 84:15 84:17 Belvedere [1] 113:3 bungee [s] 116:21 96:9 company [1) 22:10 84:22 89:24 98:15 benefit t2] 56:25 116:23 116:25 117:7 chasing p) 86:19 compared [11 12:19 99:4 99:8 99:12 117:13 chauvinistic p) complain [q 85:5 99:13 99:14 101:14 64:12 beside [11 111:7 burned [21 77:9 15:11 complete [q 103:14 104:17 77:17 checkedp] 65:24 completely [s] 31:8 correctly[i] 48:22 best [s] 36:17 118:20 119:11 102:1 12220 burning [21 77:15 check [2] 32:4 36:10 52:25 53:10 counsel [3) 3:2 79:9 84:14 72:13 135:16 135:17 belt r [13) 27:19 27:22 8:13 27:25 business [a] 22:1 chief [2115:14 15:15 complications [2] County [41 1:2 32:12 43:23 62:19 22:3 22:5 22:7 child [a] 6:4 6:18 52:8 52:11 7:10 126:17 135:1 66:3 69:2 86:4 buzzing p] 36:2 18:20 19:13 concept [q 70:9 Couple [7) 4:21 86:4 104:25 112:10 children [u] 5:18 concern p] 131:15 24:15 25:22 85:2 between [3] 3:2 -C- 5:22 7:20 124:21 concerns [2] 18:13 123:23 127:8 129:12 2 50:24 114:17 C-u-d-d-e-r-f-o-r-d 127:10 128:7 128:9 54:7 course [a] 12:24 16:14 :3 1 36:8 big [61 11:21 12:6 (1) 29:1 3 128:9 128:10 128:13 concert[i] 99:11 12:7 12:16 109:20 108:15 a e 128:14 ' concluded [1) 13 court [2] 1:1 3:24 133:17 g c p) children s [q 19:16 Condition [z] :7 63:7 crazy [2] 8:14 bike [s] 120:16 120:17 Calendars [21 131:2 choosing p) 66:15 113:11 110:23 120:20 120:21 122 3 121:3 131:3 calm [a] 68:18 68:19 Chose [2) 54:23 conduct t11 57:4 crease [q 32:7 : 121:21 66:13 Creek [2] 40:21 bilateral p] 67:11 67:11 6822 70:6 Christi [q 15:1 conferp] 133:3 40:22 bilaterally [61 85:17 Camp [al 25:2 city [3] 12:18 13:19 confused [t] 73:3 critical 4] 92:14 95 6 95:14 45:14 125:6 131:19 56:10 consent [9] 2:15 96:25 97:11 97:14 133:15 133:23 cancelled [t] 80:23 CIVIL p1 1:4 72:9 75:23 76:10 criticism[q 107:3 biopsied[1] 48:13 Cancer 191 27:21 civilian 111 18:12 76:16 76:20 103:7 103:12 103:5 criticisms [2] 132:17 biopsies [11 28:19 28:9 28:14 29:4 29:8 28:23 30:5 claims [1] 3:22 constant [6] 38:4 133:22 biopsy [q 12822 30:8 104:17 Clarify [a] 42:7 39:16 39:17 44:1 Criticized p] 132:20 bit [71 10:7 14:13 cannot p1 111:16 42:16 51:25 83:6 44:2 44:17 crowded [1] 119:10 79:11 88:18 caption [q 135:14 clear p] 17:8 83:18 constantly [2] 82:12 cruiser [21 120:22 1 106:13 6 Car 110:20 88:18 115:6 120:23 blab [6ah 6] 95:6 5: 95:7 110:2 :24 111:2 111:6 cleared [q 85:24 constitutes [1] 735:20 Cudderford [q 29:11 95:7 98:11 98:11 111:12 clinic [a] 12:13 consult [a] 54:21 Cudderford's [l1 98:11 blind [q 63:13 care [91 8:8 9:24 108:3 108:6 108:10 63:12 63:13 99:13 30:2 12:16 41:23 41:25 clinics [1] 12:19 Consulted p] 104:21 Cumberland [s) blocks [a) bl ock 105:21 22 124 66:22 70:14 108:2 Close [21124:18 127:24 Consults p] 63:8 1:2 7:10 17:25 106:2 l : 132:17 18:2 126:17 blood [3) 52:19 Carlisle [s] 25:195 clubs p] 118:1 contact p] 6:19 current [3] 5:6 53:5 53:8 41:3 112:19 113:25 CNA [1) 22:22 6:23 71:9 7:23 131:22 BIOOm [a) 55:21 114:4 coaster [4] 117:22 contacts [q 132:12 Curve p] 34:8 131:10 131:14 131:19 Case p) 29:23 98:5 118:1 119:1 119:9 continue p] 121:15 cut[1] 56:22 blurred [q 79:24 98.7 coasters [s1 117:24 continued P] 39:24 cutting [q 61:16 bodies [q 49:24 cases [1] 85:18 118:5 118:9 118:12 Continuously [q CVS p1 48:23 body [137:21 132:4 cell 2 132:5 118:13 119:4 119:6 49:4 [ ) 120:1 i WWI I 15:19 center [161 23:3 s] Cohn Ii 45:11 ng contradict 73:19 p] -D- bone [1] 32:5 27:21 28:9 4 28:15 29 8 45:15 45:18 46:4 control [21 41:12 D [1) 10:19 book p1 74:5 74:6 28:23 29: : 465 46:5 46:6 41:13 74:8 30:6 30:7 30:9 46:11 46:14 46:18 dad [1] 8:17 botber[t] 86:25 45:13 62:3 104:17 47:3 47:18 48:4 conversation [a] daily [1)27:2 bothered[i] 46:24 108:3 113:3 114:6 48:6 50:21 50:24 58:2 61:8 132:23 97:12 Dale [6] 125:4 125:5 Certain [q 82:22 51:7 51:22 125:7 125:20 126:1 bottle [q 14:23 certification [q Cohn's 111 45:12 convinced Ili 52:15 127:25 bottom [21 75:23 3:4 cold p] 122:1 cook [2] 124:6 124:7 Dale's [z) 125:11 11222 certify [s] 135:6 comfortable [2] cooking p] 124:9 126:24 bouncing [q 35:23 135:8 135:13 135:15 61:17 73:11 Copies [7] 91:24 Danny [s] 125:10 brain [1] 108:20 135:19 coming [a1 9:3 91:25 92:3 92:11 125:16 125:18 127:9 bricks [i] 109:18 chain [i] 131:7 110:22 111:6 111:7 92:15 103:3 107:15 128:3 bridges p] 117:3 chair ta) 57:22 100:8 Comments [3] 60:2 copy [6] 76:2 76:13 Danny's [21 125:14 bring [3) 94:20 100:14 100:16 60:10 102:13 103:4 103:6 103:12 128:7 98:5 98:7 Chambersburg [2] COMMON [q 1:1 103:14 date [21 1:14 123:6 brother [a] 124:21 6:7 6:16 Commonwealth t2) Corner [q 59:19 dated M 75:24 124:24 124:25 125:9 change [a) 34:19 135:3 135:5 us [q Corpus 15:1 dates Is) 25:22 47:25 52:3 79:12 79:15 Index Page 2 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 Multi-Page TM DAUPHIN - eating Lire UV AhTJ Ai nAT 51:1 51:1 51:11 DAUPHIN[] 135:1 dawn [1] 82:6 days p21 39:10 52:17 69:23 79:16 82:16 83:15 83:19 85:1 85:1 98:22 125:25 129:18 dead [21 20:3 72:10 deaf [q 18:23 dealer[1] 41:4 debris [7 17:7 December [2] 86:10 127:19 decide [31 61:18 98:7 105:24 decided [4] 93:23 98:4 98:14 126:16 decision [1] 98:16 deck [31 16:16 17:7 17:18 decreased [7 127:5 DEFENDANTS [3] 1:9 1:11 1:24 deficits [1] 19:3 definite [21 16:23 94:7 definitely[] 56:5 dehydrated Ell 129:17 DEMANDED Ell 1:9 demanding[1] 88:2 Demario [51 40:19 41:5 41:9 41:13 41:15 Demario's [l 40:20 deny[ll 116:17 department [21 27:12 departure [2] 21:4 21:5 depending Ell 17:2 deployed [3] 13:12 24:3 24:7 deposition pol 1:10 2:14 3:15 3:16 3:20 76:17 134:4 135:9 135:13 135:19 Depot[1] 18:3 describe [6] 34:25 35:12 36:16 43:4 68:11 8318 described [41 34:3 42:4 96:4 96:8 describing[] 37:5 description [21 42:14 desire I1] desk [1] 59:1 destroy [21 68:20 destroys [1] detail 12] 95:5 detection [] 17:12 determine [3] 33:13 108:25 109:13 detrimental p] 53:16 diagnosed [1] 128:19 dlagnOSis [2] 70:24 107:4 Diagnostic [] 2:15 75:23 76:16 Diane[4] 1:12 76:13 135:4 135:25 diaries M 130:13 diarrhea [I 10:24 Glary [1] 130:17 died [5] 124:20 124:20 127:15 127:18 129:6 different [s] 48:15 55:11 71:2 108:20 115:14 difficult [] 37:17 dinner [2] 124:3 124:5 direction [11 135:12 directly [2] 46:24 135:18 disappear [1] 79:10 disappeared [7106:15 discharge [2] 78:22 80:13 discuss [l7 70:9 discussed [1] 76:20 discussing [17 100:10 disease [91 58:1 62:22 62:25 63:23 67:6 70:19 71:1 97:24 107:4 disgusted [2] 87:21 disorder p] 83:23 83:25 disorders [4] 35:11 35:13 67:23 85:20 disorientation [17 65:5 disoriented[] 44:15 distinction[i] 114:17 distinctly[1] 72:7 distressed [2] 87:12 95:3 disturbances p] 37:4 divorce [2] 6:25 7:9 divorced [s] 7:7 24:17 56:7 126:13 126:18 38:19 Idizziness[u7 11:4 36:12 44:21 45:1 67:21 496 53:12 64:22 65:3 65:6 106:8 95:15 106:14 56:19 dizzy [21 44:15 65:1 doctor [361 9:23 12:9 18:6 18:7 18:7 32:24 33:18 39:21 41:12 41:15 41:17 43:15 45:8 45:10 45:15 45:18 45:25 49:12 53:22 54:24 61:4 61:18 61:23 63:13 73:17 86:6 86:19 86:19 93:21 93:23 104:16 107:13 112:18 112:25 113:10 113:17 113:24 114:4 IOCtor'S[3] 56:12 130:19 131:11 doctors [30] 10:1 18:12 19:20 19:23 36:21 39:18 40:12 58:8 58:11 58:20 62:16 92:13 94:5 96:8 97:14 102:18 103:20 103:22 104:4 104:5 108:2 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56:3 124:21 127:4 127:13 Index Page 6 HUGHES ALBRIGHT FOLTZ NATALE 717-540-0220/717-393-5101 Multi-Page`' movement - petrified IS A DV AXi V AV movement [31 96:2 96:5 116:6 moves [1] 31:20 moving [2) 8:17 9:16 MRI [2] 46:23 46:23 MRIs p] 48:15 Mrs [1013:12 36:5 73:17 75:21 108:1 120:4 122:12 130:13 132:11 133:3 multiple [1] 119:13 _N_ name [201 2:2 3:12 5:1 23:10 29:9 29:10 55:5 55:21 74:18 91:14 97:11 97:14 99:17 112:18 112:23 113:5 125:3 125:9 125:12 125:14 names [1] 5:25 nasty p] 6:25 natural [21 11:24 128:14 nature [11 18:17 nausea [s] 44:15 44:21 45:2 49:7 53:13 Navy [9] 14:20 14:21 15:4 17:22 18:15 21:2 21:4 21:8 21:24 Near [1] 32:7 necessary [3] 12:20 17:3 103:9 necessity [1] 16:17 need [4] 38:14 56:4 103:10 113:6 needed p1 56:24 needs [21 88:4 88:5 negative [21 49:25 50:11 rvn1L [11 1:20 nerve psi 30:23 32:17 39:22 67:16 105:17 105:21 105:22 105:24 105:25 106:1 106:2 106:3 106:11 106:20 106:25 nerves [4] 56:21 57:1 68:3 6820 95:16 112:8 neuro [2] 94:13 95:10 "Umuluglum [l] 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Mn'INESS OF SIGNATURE) (SIGNATURE OF PERSON AU15ZRUED DATE TIME TO OONSENr FOR PATIENT) I hereby authorize the performer, f the following operation(s) or procedure(s) I me to be performed under the direction of Dr. I consent to the pariomlerx? of such operation(s) and proms ure s) in addition to or rein tom tow nowccoontteemplated, whether or not arising from presently unibreseen conciftra, which the above named doctor or his associates or assistants may consider necessary or advisable durmg the course of the operation, I consent to the administration of such anesthetics as may be oonskWW appropriate by the physicians responsible for this service For the purpose of advancing medical education, I consent to the admittance of qualified observers to the Operatic Room. I consent to the disposal by hospital authorities of any tissue or parts which may be removed. The purpose, nature and risks of, and the alternatives to, the operation(s) and procedure(s) have been explained to me to my satisfaction by the above named doctor or his associates, and I realms that there is no certainty as to the results of the operation(s) or procedure(s). I Intend to be legally, bound by this Consent which I am signing voluntarily after it Iles been completed and after I have read it and fully understand iL -? SI NAATU (SIGNATURE OF PA IE TrTj-- O ?? - v I // F --tWIINIM OF WHEN PATIENT IS UNDER 18 YEARS OF AGE OR IS INCOMPETENT TO GIVE CONSENT Patient Identification Verified. (when required by departmental policy) Surgeon (RELATIONSHIP TO PAT1END PHYStcmws CERTmminAT10N I hereby certify that the patent who executed the foregomg Consent did so after having been advised orally as to the maUem referred to in the Conswit, after having received answers to arty questions, and after having read the completed Consent. PINNACLEHFALTH „,TM ini Hospitals amYr, M n1er.ar CONSENT TO OPERATION, DIAGNOSTIC PROCEDURE, ANESTHETIC rant VW MS WM PHytiICIAN LABFL ALHAJ,IWiRY 182503335 210212795 HSP 07121f195a 62 F 17055 Sol S MARKET ST 717-795-9183 MECHANICSSURG PWON KWAN H 182503335 P5SA4uMESOURCEINON-PHS 0M6101 yWN182!i0333S__ EXHIBIT "B" MARY ANN ALHAJ AND IN THE COURT OF COMMON PLEAS IBRAHIM ALHAJ, HER HUSBAND,: CUMBERLAND COUNTY, PENNSYLVANIA PLAINTIFFS CIVIL ACTION - LAW V NO. 03-531 KHAN H. WON, M.D., AND KWAN H. WON, N.D., P.C., DEFENDANTS JURY TRIAL DEMANDED DEPOSITION OF: KWAN H. WON, M.D. TAKEN BY: PLAINTIFFS BEFORE: DIANE F. FOLTZ, MR NOTARY PUBLIC DATE: OCTOBER 3, 2DO3, 1:00 P.M. PLACE: FARRELL 6 RICCI, P.C. 4423 NORTH FRONT STREET HARRISBURG, PENNSYLVANIA APPEARANCES: ANGINO I ROVER, P.C. BY: NEIL J. ROWER, ESQUIRE FOR - PLAINTIFFS FARRELL 6 RICCI, P.C. BY: JOSEPH A. RICCI, ESQUIRE FOR - DEFENDANTS I. LINI. wn Head • bon, 103 • Hanish.,. PA 17110 717.540.D220 • 1. 717540.0211 • Lancer, 717.393.5101 3 1 2 3 4 5 6 7 8 9 1D 11 12 13 14 15 16 11 18 19 20 21 22 23 24 25 STIPULATION It is hereby stipulated by and between counsel for the respective parties that sealing, certification and filing are hereby waived; and that all objections except as to the form of the question are reserved to the time of trial. (Office records and bills produced and marked Won Deposition Exhibit No. 1.) KWAN H. HON, M.D., called as a witness, being duly sworn, testified as follows: EXAMINATION BY MR. ROWER: Q Could you please state your full name? A swan, K-w-a-n, middle initial H., W-c-n. Q And, Dr. Won, my name is Neil Rovner, and I represent the Alhajs who brought this lawsuit, and I'm going to be asking you some questions about your involvement in the treatment of Mary Ann Rine, and I assume you have given depositions before? A Yes. Q Okay. I am going to go over some ground rules for the depositions, and if you don't understand any of these rules or you need to talk with your attorney about it, you can do that. I WITNESSES 2 NAME EXAMINATION 3 KHAN H. WON, M.D. 4 BY: MR. ROWER 3 5 6 7 8 9 10 11 12 EXHIBITS 13 14 HON DEPOSITION EXHIBIT PRODUCED AND MARKED 15 :I. OFFICE RECORDS AND BILLS 3 16 CERTIFICATION OF HEALTH CARE PROVIDER 17 FAMILY AND MEDICAL LEAVE ACT OF 1993 86 18 19 20 21 22 23 24 25 1 2 3 4 5 6 7 8 9 1D 11 12 13 14 15 16 11 18 19 20 21 22 23 24 25 2 4 A Uh-hum. Q The first thing is that I want to be sure that if I ask you a question, if you don't understand it for some reason, maybe it's the way I've phrased it or something like that, will you ask me either to rephrase it or repeat it or tell me what you don't understand about it? Do you Understand that? A Yes. Q All right. Also you have to answer out loud in words to my questions. Nodding of the head or norses that signify an answer are not the beet answer to give. Do you understand that? A Yes. Q Okay. Very good. And the reason that I tell you these things is that I am going to assume if I ask you a question and you answer the question that you have heard the question, that you have Understood the question, and that the answer you are giving me is the one you want to be placed on the record here while you are under oath. Do you understand that? A Yes, uh-hum. 0 okay. Or you have any questions about what I have just explained to you? A No. Q Okay. Doctor, is there any reason why you would i 2 3 4 5 6 ] 8 9 10 11 12 13 14 15 16 1] 18 19 20 21 22 23 24 25 5 be unable to answer questions or participate in this deposition today, any reasons of health or anything else? A No. Q All right. So you feel able to do that? A Yes. Q Okay. Good. Or. Wan, I'm going to focus for a moment here on your treatment of Mary Ann Alhaj, and it looks to me as if you have your original office records there; is that Correct? A Yee. Q All right. Good. And we may make reference to them. I have also made copies of the office records and bills and I have marked those as Exhibit No. 1, won 1, and those are right there next to you with your attorney if you need to refer to that as well. All right? Do you understand that? A Yes. I really have no information on this, you know. I didn't check, or I guess my office, the secretary supplied these. MR. RICCI: Okay. BY MR. ROVNER: Q You are indicating that the exhibit that we have here which is a copy of what you supplied to counsel, you haven't reviewed that exhibit? A I haven't, yeah. I never reviewed it, and that 1( 1] 1• 14 15 16 1] 18 19 20 21 22 23 24 25 A September 28th, year 2000. Q All right. And to the best of your recollection, is that the first time you ever saw Mary Ann Alhaj as a patient? A Yes. Q Had you ever seen her on any other occasion? A No. Q All right. Do you know how she came to your office? A The record indicates she had a self-referral. Q So there was no physician involved as far as you knew in referring her? A No. Q Okay. And on this sheet that we are referring to, do you have a particular name for that sheet? A Well, this is the -- I don't have a particular name. Q All right. A But all the patients, all patients who come in first for the first time to my office, we use this sheet for convenience. Q Okay. This I. sort Of an initial visit? A Initial visit sheet, yes. Q Okay. And can you tell me when you first saw Mary Ann Alhaj, did she tell you anything about her 1 2 3 4 5 6 B 9 10 11 12 13 14 15 16 1] 18 19 20 21 22 23 24 25 1 2 3 4 5 6 8 9 10 11 12 13 14 15 16 1] IS 19 20 21 22 23 24 25 6 is the record of my -- I guess the secretary who does the billing. MR. RICCI: All right. Neil, just ad that the record is clear, I think, Doctor -- and correct me if I'm wrong -- what you are referring to is not being familiar with is the billing record; is that correct? THE WITNESS: Right. MR. ROVNER: That's only the top four sheets of the exhibit. There are other THE WITNESS: Okay. MR. ROVNER: There is other information here as well. All right? MR. RICCI: Okay. BY MR. ROVNER: Q All right. Now, Doctor, do you have there your first sheet of your first contact with Mary Ann Alhaj? A Yes, I do. Q Okay. And we're going to refer to that. That is in the record, and that appears to be a sheet with Mary Ann Alhaj'e name at the top; is that correct? A Yes, uh-hum. Q And her address and the date of the office visit? A Yes. Q And what is the date of the office visit? 8 Previous medical services that she had had? A Yes, she actually says that she saw just about 20 Physicians, I know it's not on the record, so that everybody in town, tried every medication, nothing really helping, and I heard about you, and you are my last resort. I, you know, came here for the help, and I state -- Q Now, you are indicating to me information that does not appear on your record; £s that correct? A Yes. Q All right. So you are telling me you have an independent recollection of this first visit that she made to you that's not recorded in your records' A uh-hum. Q Is that Correct? A Yea. Q Okay. Did you record anywhere any additional information about that first visit other than in your o:ffo: reCOLd9? A On the record of the February dash, she saw Dr. Cohn, told her there was fl ufd. Q I'm sorzy, Doctor. I don't think you understood my question. A Oh. Q My question was we have these documents from your office records and office notes. 9 1 2 3 4 5 6 ? e 9 10 11 12 13 14 15 16 1? 18 19 20 21 22 23 24 25 A Uh-num. Q Did you keep any information of any kind other than what is in your chart, your records right there? A No. No. Q Okay. All right. So what you are telling me about seeing 20 doctors and trying every medication, that is something that you are saying that you recall from her visit approximately three years ago? A Yea. Q Okay. Doctor, have you written down for yourself for any reason other than for your attorney any information regarding your recollection of Mary Ann Alhaj's visits to your office? Have you written down any statements or anything else except things that you are giving to your attorney? Have you ever written down any statements about her? A Other than -- Q Other than what's on the record? A No. Q Never? A No. Q Okay. Now, when she came to you, I think you were starting to tell me about her history and who she saw; is that correct? A Ch-hum. 11 1 2 3 4 5 6 8 9 30 11 12 13 14 15 16 11 16 19 20 21 22 23 24 25 appointment, and they state hearing loss, ear fluid. That's what the patient said, yeah. Q Okay. And is the rest of the writing on this page yours? A That is my writing, no question. Q Other than the name, address and so forth? A Right. Q Okay. Now can you tell me when Mrs. Alhaj came to you, where did you first see her? Was it in the waiting room or was it in the office? A It was always in the examination room. Q In the examination room. A Yes. Q Do you recall whether you were in the examination room and she came in or whether she was already in the examination room when you came in? A Yeah, usually a patient is in the examination no., then I come in. Q Okay. Do you recall whether on this first visit Ms. Alhaj was with anyone else? A My recollection was she waa there with her husband. Q Your recollection is with her husband? A Uh-hum. Q Okay. And did you -- can you describe her 10 Q All right. Tell me what you learned about per medical history. A According to what I have written down, she started having this problem May, 1998. Q Uh-hum. A A little over two years ago. Q uh-ham. A But on the top there was an HL and ear fluid. That's my secretary'a note when they call in, their complaint, why they are coming. Q What's HL mean? A Hearing loss. Q Okay. And ear fluid? A Ear fluid, yeah, that's also my -- I guess she called in and says I have ear fluid and hearing loss. That's what that is. Q And what was the name of the secretary who took '!hat information down? A Let me see whose writing that is. It's either -- Teddy Atdeff. Q Can you spell that name for me? A T-a-d-d-y, A-t-d-a-f-f. Q Okay. A Whoever is answering the telephone recorded the information, you know, why do you want to make an 8 9 10 11 12 13 14 15 16 13 18 19 20 21 22 23 24 25 12 1 2 3 4 5 6 8 9 0 11 12 13 14 15 16 1? 18 19 20 21 22 23 24 25 husband for me? A Slender, tall, maybe brown hair, maybe about five foot nine to five foot seven. That's all I can recall. Q Okay. Do you recall speaking to this person? A Maybe one or two wards, but I don't know what I said. I can't recall. Q All right. Do you recall what Ms. Alhaj looks like? A She looks probably my height, maybe -- Q How tall would that be? A Five foot four. Q Okay. A Five foot five. Q Uh-num. A And maybe around 150, 160 pounds. She wear some pale clothes. She told me she's a nurse. That's what I can recall. Q Okay. So more than likely she was in the examining room when you first came in to see her, is that right? A Yes. Q And would there be like a chart in a chart holder, or would there be a chart in there or something? A Yeah. Usually I sail to my girl take the patient into the room. The patient sitting in the mobile black 13 2 3 4 5 6 8 9 10 11 12 13 14 15 16 1? 18 19 20 21 22 23 24 25 chair. The family can sit on the side, the chair. Then there's usually a chart on the chart rack right outside of the door. That's how our routine procedure. Q You said mobile black chair; is that what you said? A Yeah, an ENT chair, it goes up and down or, you know, by pressing a button. Q Is it like a desk chair? A Similar to the dentist chair. Q A dentist chair? A And it rotate, move up and tlown in a position, backward, forward, and the ENT examination chair, let's put it that way. Q Okay. Very good. Do you recall speaking at all to the person who brought her back to the office -- I mean to the examining room before examining Mrs. Alhaj? A I'm not sure. Are you talking about my -- Q Your person, yeah, whoever it vas? A Oh, there's no way I can say that. I have four rooms. They alternate. There's no way I can recall who did that. Q Okay. A Uh-hum. Q And the answer that you gave me that you cannot recall is a perfectly fine answer. 15 1 2 3 4 5 6 l S 9 i0 11 12 13 14 15 16 1] is 19 20 21 22 23 24 25 same answer, but did you have any conversation with this person, whoever it was, about Mrs. Alhaj? A Conversation with who? Q With whoever brought her back to the examining room. In other words, I know you don't remember who brought her to the examining room, but do you remember having a conversation like, you know, is there somebody in room No. 2 and what do they look like or anything like that? A I can't recall. Q Okay. Is it your practice to talk to the people who bring them back into the room and to discuss the patient with them at all? A No. With my girl? Q Yeah. A No, I don't. In my practice I usually don't. Q Okay. Very good. A Uh-hum. Q All right. Now, let me get back to the part of this that says CC. Does that mean chief complaint on the form that you have here? A Yes, that's the chief complaint. Q Okay. Good. All right. Let's go then to the part after it, ear fluid and what you have written down here. 14 1 2 3 4 5 6 ] 8 9 SO 31 12 13 14 15 16 17 is 19 20 21 22 23 24 25 A Okay. Q If you can't recall, that's what I want you to do because I don't want you to guess. A Sometimes I'm in the other zoom that's close to the door. In the meantime my girls will bring another patient into the examination room, so you just don't see it. Q Right. A But even If I saw it there's no way I can recall, you know. Q Okay. I understand. A Okay. MR. RICCI: And you are saying you don't recall who did that' THE WITNESS: Who did that, I don't recall. MR. RICCI: I'm not sure that vas Mr. Rovner's question though. THE WITNESS: Who hrounn. en..,....... ... .?_ room? BY MR. ROWER: Q Right. A No, I Can't recall. MR. RICCI: All right. Ely MR. ROVNER: Q The question I have is probably going to be the 16 1 2 3 4 5 6 B 9 SO 11 12 13 14 15 16 1? 3E 19 20 21 22 23 24 25 A That's my -- I say -- Q After ear fluid, after that. A It says one and a half years ago by FMD. Family medical doctor, that's what that means. Q What was one and a half years ago? What's referring to one and a half years ago? A One and a half years ago that I guess the patient was treated or saw the family medical doctor. Okay. Q Uh-hum. For what? A For the -- I didn't write all the detail in the complaint, but, you know, the -- it was constant Conversation when you have a patient that comes in. I'm asking the question and answering, you know. Really this is abbreviated. You can't write everything down. Q I understand that, right, but I'm just wondering what you are referring to? A The problem indicating that her chief complaint was started one and a half years ago, started with the family doctor. Q Okay. All right. Now, in the chief complaint did she -- did the nurse write down anything about vertigo or dizziness, the nurse? A Not on here. Q Okay. The next line that looks like begins with Feb, F-e-b, Can you tell me what that is. 1] 1 2 3 4 5 6 ] B 9 30 11 12 13 14 15 16 1] 18 19 20 21 22 23 24 25 A That is indicating February. Q Yeah. A She was told that she had some fluid and saw the Dr. Cohn, Harald, and than also saw the neurologist. 0 Okay. And what kind of a doctor is Dr. Cohn? A He's an ENT doctor, uh-hum. Q All right And then -- A Then complaint is diseguilibri um. It's a balance problem. Q Next what does that say? A it says ear pope. Q uh-hum. A Ear drains. Q Uh-hum. A Occipital headache. Q All right. And the occipital is back of the head? A Yeah, back of the head here (indicating). Q Okay. And the next line down? A She has seen ENT and neurologists. Q Okay. Is that neurologists, more than one? A Yes. Q Okay. Do you know who they were. A No, I don't. You know, in fact, I thought she saw more than one ENT doctor, too, you know, from what she 19 1 2 3 4 5 6 B 9 10 11 12 13 14 15 16 1] 1B 19 20 21 22 23 24 25 her Lasix though. Q And would that be effective in helping the problems that she was complaining of, Lasix? A Well, if there's a Meniere's, the Dyaride is usually used. Q If there is a what? A If there is an inner ear problem. Q Inner ear? A Problem with the Meniere's syndrome, Dyaride is an accepted treatment, yes, but, you know, the use of Lasix, but that's the same thing. Q And Antivert, what is that for? A Antivert is Meclirine which is a -- it does have some antiemetic for the dizziness, anti-vertiginous drug. Q And what about Phenergan? A Phenergan is also an antiemetic, try to prevent the nausea, vomiting. Q Now, at any time did you ever talk with Dr. Cohn about his treatment or his involvement in treatment of Mary Ann Alhaj? A No. Q Okay. Did you ever ask for Dr. Cohn's records? A I asked her to bring some records but -- Q Did she bring Dr. Cohn's records? A No. 1 2 3 4 5 6 8 9 30 11 12 13 14 15 16 1] 18 19 20 21 22 23 24 25 18 described, yeah. Q Did you take down the name of the neurologist or any other ENT doctor? A Well, yes, S would, but I don't know that I'm going to record it here, you know. This is a self-referral. This is the initial taking the history. Q Okay. And it looks off to the left there are the initials MRI. Does that -- A That means she had an MIT done so I have it written down, yes. Q All right. And it says tried and then there are number of medications? A IC's Lasix, Dyazide, Antivert, Phenergan. Actually she told me a lot more, but you couldn't list all of them. Q Do you recall any of the other ones that you say that she told you? A Every time I mentioned -- she said she just about tried everything. Q But you didn't list what else she tried? A No, I didn't list other than what I have listed there. Q Okay. And do you know what Lasix would be given for? A Probably as a diuretic. I don't know who gave 20 1 2 3 5 6 ? 8 9 10 11 12 13 14 15 16 1] 18 19 20 21 22 23 24 25 Q Okay. Did you ask for Dr. Cohn's records at any time other time? Did you request from It. Cohn copies of his records? A Customarily we don't usually request for them unless a patient hae signed the consent and we have the patient to go ahead and bring the old record. Q All right. Did you ask Mary Ann Alhaj at any time after this first meeting of September 28th to bring Dr. Cohn's records? A I told her that I like to see Dr. Cohn's record because there was a fluid. I'm sure some tests were done, and I was unable to -- or I didn't get his record. Q Now about any neurologists' records, did you get any of those records? A I thought I had some, the III report. I don't know when I received that, whether -- I can't recall w.oether she brought it in or I received it later. Q Okay. At some point you say you had the III report? A Yes. Q Okay. A Either it wag faxed or... Q Do you have that III report in your -- A Yes. , 21 1 2 3 4 5 6 ? 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Q Okay. And do you have any system in your office for deciding when you have obtained that? A No. Q All right. Now, there is a fax mark on top there; is that right? A Is that the date that they were sending it in or not? Q The mark that I see there is -- A The 9/27/2000. Q There's a fax machine imprint of 9/27/2000; is that right? A Many times we asked them to go ahead and call your doctor and send me the record, and then their doctor, sometimes they fax the information to my office. Q Right, I understand. What I'm asking you though is the fax mark that's on the top of this indicates 9/27/00. Is that when you think you may have received it? A I think so. Q All right. All right. And was there anything -- you saw -- did you see the name of the referring physician there, the physician who asked for the MRI and Ordered it? A Yes, uh-hum. Q And who was that? A Charles Yanofsky. 23 1 2 3 4 5 6 7 e 9 10 31 12 13 14 15 16 lJ 18 19 20 21 22 23 24 25 A Yes, I read about that. Q Okay. A Uh-hum. Q And did that impact on your treatment at all? A No, I don't think the pons was, you know, the finding. It's not going to cause What this patient has, the symptoms that this patient has. Q And did you discuss with any neurologist or anyone else these findings on the MRI? A No. Q Are you a neurologist? A No, I'm not. Q Okay. Okay. Let's go down than to the next, what looks like the next section, sort of divided into three columns. A Uh-hum. Q And there is on the left-hand aid., there looks like some preprinted boxes. It looks like they can be checked. A Uh-hum. Q It says are, noes, throat, headache. A Uh-hum. Q Okay. And what are those boxes for? A Those are boxes initially planned for sometime you can write very fast when we are taking a history so 22 Q Do you know Dr. Yanofsky? A Yes, I know him. Q Okay. Did you ever ask Dr. Yanofsky for any other records of Mary Ann Athal? A No, I did not. Q Did you ever have any conversations with Dr. Yanofsky about Mary Ann Alhaj? A No, huh-uh. Q Okay. Were you aware of any findings that were out of the ordinary or out of normal in that MRI? A It says there is no change. She apparently had another MRI done earlier, in January. That's nine months earlier. Q Okay. Did you read it when you received it? A Yes. Q Okay. Was there anything out of the ordinary that was noted on that? A well, my interest is when the patient complains of a dizziness, you know, the balance problem, you are concerned about a tumor, acoustic neurons or meningicma. That's what Ian looking for, but I did not find it there, any abnormal tumor in the internal auditory canal or in the CP angle. Okay. Q Did you see anything in there about a lesion in :he pons? 4 5 6 ? B 9 10 li 12 13 14 15 16 17 18 19 20 21 22 23 24 25 24 1 2 3 4 5 6 7 B 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 easy to go ahead just to mark it off. initially we started, but I almost no longer using now. Q So you did not mark off anything in that area? A No. Q Okay. Now, let's go to the center area, all right? It says -- what is the first writing above there? A On the top? 0 uh-num. A It says 1970, unable to pass, I guess she tried to go into Navy, because Of a hearing loss. Q All right, what was your understanding of what that meant? A Well, that's her statement, you know, because I think that's before we did a hearing test and all that. She said something about she has some high frequency loss from working in the airline. Q Are you saying this was loss before or after 1970 tnat you are referring to? A It says that she has a -- 1970 she failed to pass the test for the Navy. Q Okay. A That's lust part of her history. Q That was your understanding? A Yes, uh-hum. Q Okay. Leta go down then to the center part. It 2 3 4 5 6 l 8 9 10 11 12 13 14 15 16 1? 18 19 20 21 22 23 24 25 25 looks like the data 5198, Okay? Do you see that? A Yes. Q Okay. Can you read that for me slowly into the record? A May, '98, was dizzy, SO saw Dr. Cohn. He is an ENT. Than the MRI was Ordered. Q Uh-hum. A The abnormal finding at pons. Q Uh-hum. A And sent to neurologist. Q uh-hum. A And still dizzy, especially in the morning. Q Okay. Did she tell you how long the dizziness, what you are calling dizziness lasted? A Usually lasted all day if I recall, yea. Q Did you write down how long the dizziness lasted? A No, I did not. Q All right. Did you write down whether it was every day? A She says it is severe enough that she is unable to work. 0 Okay. Did she tell you, did she indicate to you whether or not the dizziness was getting better or worse? 2) 1[ 11 12 13 14 15 16 1) 18 19 20 21 22 23 24 25 the hospital, and the -- so, you knout we really actually talked about the Valium, Ativan and a few other things, and she aid I already tried that. 0 Okay. And have you recorded that information anywhere? A No. Q Okay. All right. Now, by the way, do you keep track of how many patients you see in a given year roughly? A Yes. Q How many patient visits, not individual patients but visits? A The patient visit? Q Yeah. A Yes, uh-bum. Q Approximately how many in let's say the year 2000 roughly? A I see about 20 to 25 patients a day. Q Okay. And how many days would that be? A Five day. a week. Q Okay. Are there also times When you are in the operating room? A Only in the office a half a day. Q Okay. A And a half a day I am in the operating room. 26 9 5 6 8 9 10 11 12 13 34 15 16 1) 18 19 20 21 22 23 24 25 28 4 5 6 8 9 10 11 12 13 14 15 16 1) 18 19 20 21 22 23 24 25 Q Okay. So what is a half day in the office? A That is a Monday, Wednesday, Thursday. Q Okay. And how long is a half day? What are your O:!fice hours? A The office hours could be somewhere four to five hours. Sometimes like a Thursday I'm in the office until in the evening. It depends on the number of patients. 0 Okay. And the 20 to 25 patients that you see a day, does that include patients that you are operating on? A That includes the post-op care, yes. Q Post-op care. How about patients you are operating on. A They are not included. Q Okay. A I mean they are in the hospital. Q Okay. A Okay. Q All right. A But, in fact, when they come in the next day for like a dressing change, in a sense they are included. Q Right. So would I be correct in saying that Tuesday and Friday are full office days? A I would say it could be full but not entire whole da y. Q Okay. A It's not getting any better. Q Okay. Ditl she indicate to you what aMptoma she had with the dizziness? A Well, she has a -- her ears will close and open, pressure. She has a balance problem. Q Okay. And did you indicate that in your records concerning the ears opening and closing? A Not on this page though. MR. RICCI: Other than the comment about the at pops and the ear draining up above there. BY MR. ROVNER: Q Is that what you are saying, ear pops and ear draining, that's the same as ear opening and closing? A Ear paps open and closed, yeah. Q Okay. And when -- let's go down to the next one. 'fried every medication available and not helping. Is that a omething she told you? A Yes. Q Okay. And we already talked about what medications you knew about. 00 you recall -- you don't recall offhand any of the others that she mentioned? A Oh, I think she mentioned many other medications. She had this for two years, and She tried everything. She was actually very desperate, that something aught to be [lone. She said I'm so dizzy I cannot walk. I'm a nurse at 29 1 2 3 4 5 6 8 9 10 11 12 13 14 15 16 1] 18 19 20 21 22 23 24 25 Okay. A Until we finish, until the last patient is seen. Q Okay. And then what -- then you operate then on the afternoons on Monday, Wednesday and Thursday? A Only in the morning. Q The morning? A Only in the morning. Q On Monday, Wednesday, Thursday? A Three days, yes. 9 Okay. And how many operations would you do on an average morning? A Maybe about three or four patients. Q Okay. All right. I'm sorry. Let's go down again this sheet where it says ENT examination. A Yes, uh-hum. Q Okay. Now, over on the left-hand side it says ear, and there's some more check boxes; is that correct? A Yes, uh-hum. Q All right. And then there's an empty space out to the right of that which I asaume is lot you to write notes and things like that? A Uh-hum. Q All right. Is that yes? A Yes. Q Okay. Good. 31 2 3 4 5 6 ] 8 9 10 11 12 13 14 15 16 1] 18 19 20 21 22 23 24 25 the bone conduction is louder, then I would write on the side e. (Indicating), what is that called? It's louder than the AC. Q Okay. Do those checkmarks an that the Rinne test was normal? A Normal. Q Okay, good. All right. And than down below there is another -- there is some other words written. What does that say? A No nystagmus. Q Okay. And what is nystagmus? A Nysta gmus is a sudden jerk of eye movement. The only time we check that is when the patient has a vertigo or balance problem, suspecting an inner ear. Okay. Q Did you actually observe Mts. Alhaj have any balance problems while you were examining her? A The -- she did not have any attack or anything like that while examining her, but I checked the nystagmus. Q Okay. And was there any nystagmus? A No. Q And What did that indicate to you? A Well, you know, if you see -- nystagmua is such a -- it's a complicated meaning. If the patient has a -- I have the patient to watch my finger, follow my finger. If the vertical nystagmus, you are concerned about a central 1 2 3 4 5 6 ? 8 9 10 11 I 12 13 14 15 16 11 16 19 20 21 22 23 24 25 30 n sorry. Q Now, it looks like there are only two checks on the right and the left for Is that correct? On the box underneath ear, is that what that is? A I don't know when the -- on the top on the ear? Q Yes. A Yes, it says NL. It's normal. 0 Normal, right? A Okay. I just do that for if there's a left one that's abnormal, I mark the left or right, but when you have both sides normal I write the normal, NL. Q I see only two chec snacks in those boxes. A Okay, Rinne, yes. 0 What does that mean? A That is a test with a tuning fork, usually 512, 'chat's the heztz, 512 hertz, checking the bone conduction ,and air conduction. Q And -- A And when the air conduction is loud it's a Alone positive. Okay. Q So what do the Chad kmarks ..an, A The checkmark mean there is no fluid behind the drum. I mean you can have a small amount of a fluid, still air conduction is louder, but if a large amount of a fluid, 32 6 9 l0 11 12 13 14 15 16 1] 18 19 20 21 22 23 24 25 lesion. You have a horizontal nystagmus but it's persistent, not tiring, then again we are concerned about the retrolabyrinthine lesion. If it's a tiring, then you are concerned about the inner ear, the vestibule lesion, you know. Sometimes if you have a rotational nystagmus or an altering nystagmus, you are concerned about the central lesion, Chiari malformation and ad forth. Q Okay. And so all this was normal? A Normal, yea. Q All tight. Now, let's go over to examination of the nose. Anything that was -- A All it says normal. Q All normal? A Yea. Q She had her tonsils out? A Yea. 9 It doesn't say whether she had her adenoids out. Did they also come out? A Adenoids always disappear by the time teen, so if they were taken out before the 12 years ofd, they are routinely taken out. When it's an adult, it's already gone, so you just take the tonsils out. 9 So you don't know whether she had them both removed at the same time? A No, no. 33 2 3 4 5 6 ] B 9 10 11 12 13 14 15 16 1] 18 19 20 21 22 23 24 25 Q Okay. And larynx and neck, anything out of the ordinary there? A The larynx, no examination. That's not my obligation. Yeah, I don't routinely examine the larynx, 0 And no problem with the neck? A No problem with the neck. Q Okay. Now, underneath it says impression, studies and treatment. Do you see that? A Yes. Q Okay. Now, do you fill that out at the same time you are filling out the front of the sheet, or do you fill that out at the and of the appointment? A Impression, yeah, impression is filled it out if the hearing test is done after the audir and so forth, you know, yeah. Q All right. Now, that was -- was that the -- all right. On September 28th, that visit, did you do any further testing other than net you have told us? You did the Rinds test. You did the test for nystagmus. You looked at the ear and the nose and the throat and the neck. Did you do any further testing on her at that time? A My recollection is I did a hearing test on that day. The date is different, whether we misprinted, miswritten, because I recall I spent a considerable time, have the husband wait in the -- there is for the surgical 35 2 3 4 5 6 8 9 10 11 12 13 14 15 16 1] 18 19 20 21 22 23 24 25 same way, and when she did the bone conduction it's ompatible with mostly sensory neural hearing loss on both aides. 0 So the bane conduction you are saying? A The bane conduction, if purely it is conducted for hearing loss, bone conduction will show somewhere 5 to 15 decibel. Those are the difference because of the fluid, but when you look at it, she has the mainly sensory neural hearing loss. Q Okay. Well, let's go than to the part of your chart where you have written some notes. In the original it appears to be a blue sheet of paper; is that correct? A Yes. Q Okay. Now, did you write anything on the blue sheet of paper with regard to the September 20th visit? A No. 0 Okay. Did you write down your impression on or about September 281h of what Ms. Alha3's problem was? A Yes, I was -- you know, after the hearing test, after reviewing her symptoms, my impression was a Meniere's. 0 Okay. And what was it about the hearing test that made you think it was Meniere's? A Well, the Meniere's disease is a difficulty with the low frequency hearing loss and usually aensOry neural 1 2 3 4 5 6 8 9 10 11 12 13 14 15 16 1? 18 19 20 21 22 23 24 25 34 room where they wait when the hearing test is being done, and after the hearing test Is done then I explain to her in detail, and we discussed the medical management, my recollection. Since she had every -- the tests had been done, every medication was tried, I recall that I gave her plenty of samples of a Lipoflavonoid. Q Okay. Let me stop you for a minute, and we'll go back to the hearing test, all right? Now, the date we have that's on there is 9/29/00. You think that that's an incorrect date? A Probably the same day. You know, I do not have audiologist on Thursday and Friday. Q Uh-hum. A So I think it's an incorrect data, yeah. Q All right. As you look at the hearing test today, does it show you anything that's abnormal for the date that's 9/29/00 or whatever date that was' A Yeah, there is some mixed hearing loss but mostly sensory neural hearing loss. Q Okay. And how does that show itself? A The normal hearing, we like to see the less than 20 decibel. Normal ear about a 5 to 30 or 5 to 15 decibels, depends on the standardization of the machine, out on her case showing right ear the 30 to 45, left ear 1 2 3 4 5 fi ] 8 9 10 11 12 13 14 15 16 1] 18 19 20 21 22 23 24 25 36 associated with her symptoms. Q And which symptoms were important? A Well, you know, I didn't write the actual word of a vertigo, but she had a vertigo, balance problem, tinnitus. She has a pressure in the ear. Q Did she have any ringing in her ears? A Yes. 0 And where did you record that? A I may not record it, but I know she had a ringing in the ear. Q Doctor, is tinnitus an important aymptom of Meniere's disease? A Well, that is one of the symptoms, but, you know, you don't always have to have all the sympt oma to make a diagnosis. Q Did she have tinnitus? A I think she did. Q Are you sure whether she did or not? A Yes, Yes. Q Okay. But you didn't record it anywhere? A No. Q And what would a patient tell you in order for you to know that they had tinnitus? A They tell you usually that I have a ringing or a noise in my ear, uh-hum. 2 3 4 5 fi l 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 2 3 4 5 6 ? B 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 37 Q Okay. A Oh-hum. Q Is that the same as ear pops? A ear pops is different. Maybe that means more of a pressure, a pressure that pops and opens. Q Okay. And did you when you examined Ms. Alhaj see any draining in either ear? A No, I did not. Q Okay. And you didn't see any problems with her tympanic membranes? A No. Q Before you wrote down your impression as Meniere's disease, did you perform any other tests other than the audiological tests and your examination to determine your impression of Meniere's disease? A Other than some simple neurologic tests, you know, like a nystagmus, you know, the arm to touching her nose and telling her co just -- you know, watching her walking, other than that, no other tests other than that. Q Did you have her walk? A Well, we can -- yeah, we watch it. I didn't have her to walk, but she did not complain, but after the audiogram it's ob...Me that she has a more of an inner ear problem. Q And other than Maniere's disease were you 39 Q How about electrocochleography? A Yes, there are several tests. None of them are essential for the diagnosis of Maniacs', There are a lot of diseases can be positive on the, you know, the electrocochleography. I wasn't doing it here. ENG. again, unless a patient has a real attack, 20 to 40 percent of the time it's negative, so it is non-specific and does not -- the ENG alone does not make a diagnosis. 0 Does the END help you make a diagnosis? A If certainly help, yes. Q Okay. How about the electrocochleography, can that help you make a diagnosis? A It could help the tliagnosis, but be less essential than the END probably. Q You did send her for some auditory evoked potential.? A No, I did not. Q You did not, okay. I thought I saw in here that -- A I think I told her to go to a neurologist to get some more tests done. That's what they did there. Q Okay. A Yes. Q Did they report to you the results of -- well, 38 1 2 3 4 5 6 B 9 10 it 12 13 14 15 16 17 18 19 20 21 22 23 24 25 considering any other problems for the inner ear in your differential diagnosis? A No. You know, there is -- you know, there is many differential diagnoses. Q Okay. So did you feel that she had inner at fluid? A You mean middle ear fluid? Q Was there too much inner ear fluid? Was there some problem with the inner ear fluid? A You are talking about the eoddlyo,hatic sac? Q Yea. A Yes, that's a Maniacs'a, but you can't tell. Q Okay. A You can't see it. Q You can't see anything? A No one can see it. Only by autopsy you can find it. Okay? Q Okay. Did you perform an ENG? A No. Q Do you have the ability -- A I don't perform the ENG. I usually refer out to the Polyclinic. Q Okay. Did you refer her to the Polyclinic for an ENG? A No, no. 40 You didn't and her to there at that time. Sorry. We'll get into that later. All right. Is there such a thing as otoacoustic emissions tasting? A Yes. Q Did you do that? A No. Q Do you have the ability to do that in your office? A Yes, I think my office can do that. I don't have any information. We do that more on the children with some hearing loss, possibly sensory neural hearing loss. Q Did you discuss -- you say you gave her some Lipoflavanoids? A Yes. Q Is that correct? A Yes. Q Are these essentially some kind of vitamins? A Yes. Q And did you discuss with her -- I'm aorry. Strike that. And the next thing it ¢eye on this treatment line at the bottom of the first visit, again we are looking back at that, it says HA discussed, and what is HA discussed? A That's a hearing aid, e 9 10 11 12 13 14 15 16 17 1s 19 20 21 22 23 24 25 1 2 3 4 5 fi 8 9 10 11 12 13 14 15 16 1? 18 19 20 21 22 23 24 25 41 Q Okay. And tell me what you had discussed about that. A Well, you know, I always explain the hearing test result, you know, each column by column, and I'm sure I told her that the hearing test is compatible with the Meniere's, and she says that she's having a goad bit of a hearing problem, so we usually discussed the speech discrimination test down here, right and left, since it is about the 96 percent you could wear the hearing aid if you are having difficulty in daily life. Since it is 96 probably either ear, you know, that type of a discussion, give a recommendation. Q Did you recommend that she get a hearing aid? A I did mention that it is borderline type of, but if she has a problem with the hearing she could use a hearing aid, yes. Q Did you discuss with her any that changes or strategies she could take to try to alleviate her symptoms? A Well, actually she said she tried just about everything that is available in the past two years, and that's where the Lipoflavcnoid came. Q Did you discuss With her any dietary changes? A That she also was taking Oyazide because we discussed the low salt diet, you know, avoiding the 43 I( 11 12 13 14 15 16 1? 18 19 20 21 22 23 24 25 Q Okay. You already said no information about low salt diet. I mean you didn't hand her any -- A No. I do not hand any paper for any disease. Q And did you diagnose Hamlets's disease in both eara at that time? A Yes. Q Okay. And have you treated patients before Mrs. Alhaj with Meniere's disease? A Yes. Q Have you treated patients other than Mrs. Alhaj with Meniere's, bilateral Meniere's disease? A I really can't recall. Mostly unilateral. It could be one or two many years ago, but I can't recall. Q But bilateral Meniere'a disease is rather rare, isn't it? A It is rare, but it is reported up to 50 percent. It's somewhere the 3 to ?e percent Ss recorded. Q 3 to 78 percent you are saying? A Yeah, yeah. Q And where is that recorded? A I can supply the reference later, but it generally is around 50 percent, averaging it out, but I just don't see that many. Q Okay. Would you provide your counsel with the 1 2 3 4 5 6 ? 8 9 10 11 12 13 14 15 16 11 18 19 20 21 22 23 24 25 1 2 3 4 5 6 ? B 9i 30 I1 12 13 la 15 16 1? 18 19 20 21 22 23 24 25 42 alcohol, caffeine always help. Q Are you telling me you remember discussing all this with her? A I remember discussing the low salt. Okay. Q Okay. Did you provide her with a low salt diet? A No. Q Did you have any handouts that you -- A No, I don't have that, no. Q You didn't give her any information? A That's where the family physician -- MR. RICCI: Doctor, you have got to let Yr. Rovner finish his question first -- THE WITNESS: Okay. MR. RICCI: -- and then you can answer. BY MR. ROVNER: Q Yes. She only has two hands to take down the information. A Okay. Q Okay. So did you have any information on Mandate's disease that you handed to her? A No, I did not. Q Did you have any information about hearing aids that you gave to her? A No. 44 ........ -- yw. ere rererring toe A Bilateral? Q Bilateral. A Bilateral of the Meniere's? Q Yes, Yes. Have you ever before Mrs. Alhaj treated any patient with Menlere'e tlisease with Gentamicin injections? A Maybe one or two. Q Okay. And how long have you -- how long have you been in practice? A 29 years. Q Okay. A 29 years. 0 Okay. So this would have been almost -- well, about three years ago or two and a half years when the injections happened, so you had been in practice then about 26, 27 years? A Since 1914 I have been practicing. Q 19?4? A So that's 29, yes. Q And from 1974 you have treated perhaps two patients with Gentamicin? A One or two since that, yes. I can't count the number. It could be one or two more but not that many. Q All right. Now, before Hrs. Alhaj had you 2 3 4 5 6 B 9 10 11 12 13 14 SS 16 1? 19 19 20 21 22 23 24 25 45 1 2 3 4 5 6 ? 8 9 10 11 12 13 14 15 16 1] 19 19 20 21 22 23 24 25 treated any Meniere's patients with bilateral injections of Gentamicin? A No, no. 0 Can you give me a rough estimate in those 20 some odd years before Mrs. Alhaj vas being treated how many people you may have treated for Matters's disease? A I see at least about two, three dizzy patients every day. Q Two or three of them every day? A Every day. In fact, I saw two this morning. Q Okay. A Okay. And I don't have a computerized statistics or anything, but it's convnon, you know. Most of the dizziness is not a Meniere's. It's not that uncommon. Let's put it that way. Q Okay. Now, it looks to me from your records that there was an appointment scheduled for November 8th of 2000 at which Mrs. Alhaj did not come? A Yes. Q Is that correct? A Yes. Q All right. Do you know why that appointment was cancelled? A No, I have no idea. Q Okay. The next appointment I see is November 4] date? A Yes. Q Okay. A It's always completed that day, right. Q Can you read slowly into the recortl what it is that you wrote there? A She is in tears. Q Uh-hum. A And wants something done, dash she can't walk because of the dizziness. Q Okay. Let's stop you right there. Was this something different fr. net she had told you in September or the same. A The same. She said LipoflaVOnoid is not helping. I'm so dizzy I lose my balance and... Q And did you ask her how frequent the dizziness was at that time? A She -- you know, I'm sure I did. I don't know how frequently. My impression she was just about dizzy almost every day and can't function. 0 Did you ask her how long she had the dizziness? A You know, usually hours to day, I recall, you know. When she got up it makes her worse, you know. 0 I'm not sure I understood your answer. Moore? A Hours to a day. 1 2 3 4 5 6 B 9 10 11 12 13 14 15 16 1] 18 19 20 21 22 23 24 25 46 28th which would have been two months after the first appointment. Is that the second only appointment, other appointment? A Yes, Yes. Q The next appointment I mean. Do you recall any contact with Mrs. Alhaj between September 28th, 2000, and November 28th, 2000? A No. Q Okay. All right. Now, let's look at November 29th, 2000, and your notes there, okay? A Yes. Q The first note that -- first of all, are all these notes in your handwriting? A Yes, that's my handwriting. Q All right. And the first thing that's written there is what? A Seeing allergist. Q Okay. And do you know what allergist that is? A I can't recall it. Q Do you know why she was seeing an allergist? A You know, I'm not sure. My impression was she was just going around to so many different doctors to get help. 0 And let's read the next part into the record. was this note of 11/28/2000, was that completed on that 1 2 3 4 5 6 ] 8 9 10 11 12 13 14 is 16 1] 18 19 20 21 22 23 24 25 48 Q Hours to a day? A Uh-hum. Q And would this be every day? A Either every day or frequent enough that she was unable to work. Q Okay. You haven't recorded the frequency there? A No. Q Okay. Nov go ahead. A I have discussed several options, ototoxic drug injection or other surgery or nerve section, at cetera. Q And by ototoxic drug were you referring to Gentamicin? A Yes. O Okay. And did you say that to her, it's an ototoxic drug, or did you explain it in some other fashion? A Yeah, I thought she seemed to understand very well. My impression was that she is a nurse from Holy Spirit Hospital, and the ototoxic drug is damaging for the hearing. I think she understood that well. Q All right. When you say she's a nurse, do you know what kind of a nurse she is? A No, I don't. She told me she's a nurse from Holy Spirit. That's all I know. I can recall. Q Do you know if she was an RN? A Either RN or LPN, that's what I assume. 1 2 3 4 5 6 ? B 9 10 it 12 13 14 15 16 17 is 19 20 21 22 23 24 25 2 3 9 5 6 9 9 10 11 12 13 14 15 16 1] is 19 20 21 22 23 24 25 49 Q Do you know if she was a nursing assistant? A Well, she said she was a nurse. Okay. That's my recollection. Q Okay. Did you at that time have privileges at Holy Spirit Hospital? A Yes. Q Do you remember ever seeing Hs. Alhaj at the Holy Spirit Hospital? A No. Q Okay. Did you have patients that were on the med. Bur, floor? A Most of my patients ate outpatients. I don't know what floor is the med. surg. floor. Q Okay. That's fine. All right. You say ototoxic drug injection or other surgery. What other surgery? A That's the endolymphatic sac surgery, we call the shunt surgery or sac surgery. Q Okay. And nerve section? A Nerve section is usually a vestibular neurectomy. It's the cochlear vestibular, taking the vestibular nerve and cutting. Q Do you perform either the endolymphatic sac surgery or the vestibular neurectomies? A No. Q Let's read the next paragraph there that's in 51 know how to go about it, I give them a number and where to call and all that, but I don't specifically refer to certain particular physician because there are so many changes, you know, the staff at Hopkins now. Q Sure. Did you make an appointment for her at -- at your office or do you -- A We don't do that. Q You don't do that? A We don't do that. We just recommend it and provide a number sometimes. Here's the number to call. Q Okay. So you did not know whether Ms. Alhaj was going to go to Johns Hopkins until or did go to Johns Hopkins until you received a letter? A Yes. Q All right. A She said she is going to go. You know, we were talking about the other place, Penn State and all that, you know. Q Okay. Now, the letter -- are you referring to a letter of December 15th, 2000, if you want to find that in your records? MR. RICCI: Right here. THE WITNESS: Yes, uh-hum. BY MR. ROUSER- Q Okay. And the letter of December 15t1, 2000, 1 2 3 4 5 6 B 9 10 11 12 13 14 15 16 17 is 19 20 21 22 23 24 25 50 your awn handwriting. A Since it is not routinely done, dash asked her to go to large center where procedure is done frequently. So I explained to her, you know, I don't do this type of a surgery, none of us doing this routinely. You should go to the place where they do many number of surgery. Q And did you recommend a particular place? A I recommended go to Johns Hopkins. Q Okay. And why particularly Johns Hopkins? A That's where I came from, and I usually send moat of my referral to my alma mater where I trained. Q Okay. So you trained at Johns Hopkins? A Yes. Q Okay. Did you have a particular physician that you referred or were going to refer her to? A No, I didn't. Q And INS or TM's normal, is that tympanic membranes? A Yes, tympanic membranes are normal. Q What's the next line say? A No changes from previous exam. Q Okay. All right. Do you recall whether she actually did go to Johns Hopkins? A You know, I'll tell you, I received a letter because, you know, I do the recommendation. If they don't 1 2 3 4 5 fi ] 6 9 10 11 12 13 14 15 16 1] 1B 19 20 21 22 23 24 25 52 that was from Dr. Howard W. Francis, M.D.? A uh-hum. Q Yes? A Yes. Q Okay. And do you know Dr. Francis? A No. Q When you received the letter from Dr. Francis, dial you read it? A Yes, I did, uh-hum. Q Did you have any contact or discussion with Dr. Francis at any time concerning Ms. Alhaj? A No. Q I'm going to refer you to the second page of that letter. A uh-hum. Q And, in fact, the second to the last paragraph. He says I have made the referral, and we are now waiting for an appointment. Did you understand that he had suggested that Ms. Alhaj go to a neurologist? A uh-hum. Q Yes? A Yes. 0 Okay. All right. The next line says I do not believe the Meniere disease is active nor any other labyrinthine disorder at this time. Do you see that? 53 A Yes. Q And do you -- did you disagree or agree with Dr. Francis' assessment? A It's Somewhat I disagree, but in a Sense he says It is not active. Meniere's disease is not always easy to make a scientific diagnosis other than signs and symptoms. Q Did you believe that she still had Meniere's disease? A Yes. Q Did you believe that the Meniere's disease was active? A You know, I haven't seen her for awhile, so, you know, so maybe she always wean and wane, up and down, plateau, then recur, so I really can't tell you now, but it usually lasts for years. Q Well, it appear. that the next time you saw Ms. Alhaj was January 16th? A Yes. Q Is that correct? A Uh-hum. Q All right. When you saw Ms. Meniere on January 16 -- Ms. Alhaj on January 16th, did you believe that her Meniere's disease was still active? A Yes. Q Okay. Is Meniere's disease something that is 1C 11 12 13 14 15 16 1? 18 19 20 21 22 23 24 25 55 believe. MR. ROVNER: Because I didn't get a copy, I don't MR. RICCI: I don't have a copy in mine. You can look. THE WITNESS: Oh, this is -- is that what you are referring to? BY MR. ROVNER: Q I don't know. I haven't ..an it. A The patient usually bring it if they wanted to be off. 1C 11 12 13 la 15 16 1] 18 19 20 21 22 23 24 25 MR. RICCI: Yes. It appear. to be a Family Medical Leave Act Form. I'll get a copy for you. MR. ROVNER: All right. There's a note -- can we mark this or we'll mark a Copy of this as Won 21 MR. RICCI: Do you want me to grab a copy right how, MR. ROVNER: What I'm thinking is there might be other things in the record. Have you been through the chart? MR. RICCI: No, not with any great deal of specificity. I looked at his treatment notes that I have got. MR. ROVNER: Yeah. Maybe -- MR. RICCI: He can do that We can go through the Chao. 54 2 3 4 5 6 ? 8 9 10 11 12 13 14 15 16 1? IS 19 20 21 22 23 24 25 going to be active one month and than inactive another month? A Yes, it's variable, uh-hum. Q Okay. Did you -- well, did you contact anyone at Johns Hopkins to find -- to get any of their records of what testing they did? A No. Q Okay. MR. RICCI: Beyond the description of testing that Or. Francis provided in his letter? MR. ROVNER: Sure, sure. MR. RICCI: Okay. BY MR. ROVNER: Q Now, at some time in November you gave Ms. Alhaj an excuse to get off work; is that right? Did you do that? A What is it? Q Did you give her an excuse to be off work? A I can't recall that. I know she brought the disability form for me to fill that out because she said she cannot work. You know, I don't know what month it was, you know. Usually the patient bring it for me from their employer, or yes, I recall that. Q Did you keep a copy of the disability form? A I think I do have it in my record. 56 1 2 3 4 5 6 ? 8 9 to 11 12 13 14 15 16 1? 18 19 20 21 22 23 24 25 MR. ROVNER: Do you want to look through and make sure there is nothing in there that we shouldn't see? MR. RICCI: Sure, let me just double-check. Okay. There's nothing here that you can't see. These are all just insurance certification forms. MR. ROVNER: Okay. MR. RICCI: I'll have my secretary make a Complete copy of all of this so we bath are up to speed, okay? Bf MR. ROVNER: Q We are going to mark this Certification of Health Care Provider Family Medical Leave Act Form as Exhibit No. 2 for the deposition. These is a handwritten note on there that looks like is says originally or abbteviation for riginally sent to patient 11/30/00. Do you see that? A Yes. Q Okay. Oo you know whose writing that is, A That looks like D.S. Flickinger, the girl. Q And who is D.S. Flickinger? A She another secretary. Q Okay. Is she a nurse or a secretary? A A aecretary. Q Secretary. A Yeah, they bring this in frequently when they have a tonsil taken out. They want to take off or they are 5] 1 2 3 4 5 6 0 9 10 11 12 13 14 15 16 1] 10 19 20 21 22 23 24 25 taking the family. I just fill it out, leave it ouo there, and my secretary take care of it. Sometime they pick it up. That's what that is. Q So does it appear to you that this was filled out swnewhere around the and of November? A It should have a date here. What's the date? Q I didn't see a date on it. A No date? MR. ROWER; Sorry. MR. RICCI: No. I didn't even hear it ring. I saw you jump. If you want to take a break, we can do that. If you want to take a break, I'll run down and make a photocopy of this. (Recess from 2:11 p.m. to 2:14 p.m.) MR. ROWER: Okay. So we looked at that form that we are going to mark as Exhibit No. 2 when we get it? MR. RICCI: Right. MR. ROWER: All right. Can I take a look through the doctor's file? MR. RICCI: You could, but it's downstairs being copied. MR. ROWER: Oh, the whole file? MR. RICCI: This is my copy. MR. ROWER: The whole file is being copied? MR. RICCI: Yeah, I thought that's what you 59 I 2 3 4 5 6 8 9 10 11 12 13 14 15 16 lJ 19 19 20 21 22 23 24 25 Q Okay. A But I keep -- when I called them on the record, reporting the x-ray report or a CAT scan report, but coming in, no. Q When you saw Ms. Alhaj on January 16th of 2001, you had already had the letter from Dr, Francis at Johns Hopkins? A Yeah, I think I did, yes. Q Okay. Did you recall any discussions with Ms. Alhaj about whether or not Dr. Francis felt that she had Meniere'S disease? A I don't know whether we discussed that. I can't recall that. The only thing was she came in just crying that she was disappointed with the Johns Hopkins. Q Okay. A She was blaming actually I sent her to Hopkins. Q Did She say why she as disappointed? A You know, what she seye -- She eeye he's not helping any. He want me to see the neurologist. I already saw several neurologists. I still have the Same symptoms and I'm very disappointed with their finding. Q Okay. A That's what she said. 0 Do you recall discussing at all with Ms. Alhaj at that time that you believed, you still believed that she 58 1 2 3 4 5 6 ] 0 9 10 11 ? 12 13 14 15 16 1] 18 19 20 21 22 23 24 25 wanted, so I'm sure we have everything because I think there was some insurance fe reas that I didn't have in my Copy either. MR. ROWER: Should we wait than for the record to come back? MR. RICCI: It will only take a minute. MR. ROWER: Or can we use the copy here? MR. RICCI: We can use -- the work form that we ,are talking about I. not in this copy. MR. ROWER: Yeah, I'm not going to use that now. MR. RICCI: Yeah, we can work off the copy if you want. That's fine. MR. ROWER: Sure. Let's refer, to Exhibit No. 1. If something Comes up, we can go to the original if necessary. MR. RICCI: Sure. IIY MR. ROWER: 0 The next appointment I see is on January 16th of 2001- Do you recall any contacts with Ms. Alhaj other than possibly the Medical Leave Act Form between November 28th and January 16th of '011 A I really can't recall that. 0 Okay. Do you keep records of telephone calls that come into your office? A No. 60 1 2 3 4 5 6 B 9 10 11 12 13 14 15 16 1? 16 19 20 21 22 23 24 25 had Meniese's disease? A I told her she has Meniere's, yes. 0 Okay. A She complained of on the 16th mainly the pressure in her ear, the ear opens and close, and she had a lot of pressure. Q Uh-hum. Okay. Did she complain about dimness a: that time? A Yes, uh-hum, 0 Did you write that down? A No. Her symptoms were the same. Q Okay. You explained -- it says underneath disappointed with JHH. What does it say underneath there? Do you see the note that says disappointed with JHH? MR. RICCI: Where are you looking at? MR. ROWER: 1/16. THE WITNESS: Yeah, she says still have pressure, d:sappointed with JHH, Johns Hopkins. B:! MR. ROVNER: 0 And what is underneath there? A It says explained possible further sensory neural hearing lose from Gentamicin. 0 Okay. Are you saying you explained to her that the Gentamicin could cause her further hearing lose? A Yea, uh-hum. i 2 3 4 5 fi 0 9 10 11 12 13 14 15 16 1] 18 19 20 21 22 23 24 25 2 3 4 5 6 ] 8 9 10 11 12 13 14 15 16 1] 18 19 20 21 22 23 24 25 61 Q Okay. Did you discuss any other problems that Gentamicin might cause? A The main concern with the Gentamicin is the hearing lose. Q I understand. Did you explain to her any other problems with Gentamicin injection? A I don't think I did. I think I vas mainly concerned about the -- you know, we talked about all the different additional treatment, the labyrinthectomy, the nerve section and all that which I don't do it, and we discussed the only non-invasive, minimum procedure would be putting the Gentamicin, but because it is both sides, I'm really concerned about the hearing loss, and she wants something done about it. You know, she just couldn't function, and she wants something done, so we discuss about the hearing loss. Q Did you -- in addition to the hearing loss, you say you did not discuss anything else? A I don't think I did, nc. Q Okay. Did you ever explain to Ms. Alhaj that you had only injected one or two other patients with Gentamicin? A No, I did arty no. Q Did you explain to her that you had never performed a bilateral injection of Gentamicin? 63 physician concerning the advisability of doing a bilateral injection of Gentamicin? A No. Q Okay. Did you do any research on bilateral injections of Gentamicin before you did this? A Yes, I did, uh-hem. Q Okay. And what did you research? A Most of them do not like to do a bilateral because the main concern is the hearing loss, but when I read all the report, when intractable, severe Mediate's disease not responded by any medication or any medical therapy, it is most popular using Gentamicin injection. These are the unilateral cases, you know. I already told her that I don't do this type of a surgery. That's why I sent her to the big center. There's nothing left, so I wanted to go ahead. You know, I told her that, you know, labyrinthectomy she could lose her complete hearing, the procedure I don't do, still having a lot of complication. Only thing is we can't tell when her symptoms are acting up whether it is from right ear or left ear because of a bilateral disease. I wanted to use the smallest amount of Gentamicin, see if she responds, whether she gets any help. Q Okay. Let me go back. Okay. I think you told me about intractable, severe Meniere's disease, and you 62 1 2 3 4 5 6 ] 8 9 ]0 11 12 13 14 15 16 1] 10 19 20 21 22 23 24 25 A No, I did not. I know I told her that it is very fare. We are in the last resort, you know, because over 90 percent or even more Meniere's disease do well with the medication. They function well. The attacks are infrequent. They can live a daily life, but this is very extreme cases. Q Did you indicate in your records anywhere that this was the last resort, it was an extreme case? A No, I did not, but she has tried now every medication. I sent her to Hopkins. She was disappointed. I have the same problem. Can you do something for me, you snow, so that was the situation, you know. Q Did you suggest to her that she make an appointment with the neurologist at Johns Hopkins just to make sure? A I don't know that I said or not. You know, there ,was -- you know, she knows those are -- that was their recommendation, you know. Q Wow, you had never done a bilateral injection of Gentamicin before this, before you were -- this one you were planning to do? A Yes. Q Okay. You had or -- A Bilateral, no, no. Q Okay. All right. Did you consult any other 64 1 2 3 4 5 6 0 9 10 'i 11 I 12 13 14 15 16 1? 18 19 20 21 22 23 24 25 explained to me about unilateral cases? A Oh-hum. Q Did you consult any reference, article, book of any kind concerning bilateral injections for Mediate's rise ase? A Yes, the most of the record indicating a bilateral, severe Maniacs', disease, moat are recommending ether the vestibular neurectomy, No. 2 protocol is Streptomycin IN, and there is some difficulty finding Streptomycin. That's how we find the ot.toxidity from Streptomycin when they treating TB. That protocol is giving her two grams a day for five days, stop, five days. That usually responds, and other protocol also mentioned that the pure continuous use of Gentamicin, as of IM or IV, because the less possible, less hearing loss, but you run into the problem with the possible nephrotoxicity. SO those are the -- so when it comes to the bilateral, no one has a good answer. Q Let me ask you this. Okay. What were the references that you refer to with regard to bilateral injections of Gentamicin into the ear? A The bilateral injection -- not because it is routinely done on bilateral, my aim was whether she is responding or not, you know, so I was going to give her -- in fact, when they give Gentamicin they usually give a 65 1 2 3 4 5 6 B 9 30 11 12 13 14 15 16 1? 18 19 20 21 22 23 24 25 large dose about four to nine days or seven days three times a day. That's why I did not even give her the Gentamicin. Normally when I did a unilateral, you instill the Gentamicin through the tube, give a patient a drop to vae that evening, and the next morning then come back for follow-up for the hearing test. Q All right. Let me stop you again. Can you give me the name of any reference, any book that you referred to with regard to bilateral injections of Gentamicin before you did this on Mrs. Alba)? A Bilateral Gentamicin injection is usually not recommended. Q Wail Okay. A Okay. Q Did you -- MR. RICCI: Hang on just a second. Doctor, you have to listen to Mr. Rovner'9 question. THE WITNESS: Okay. MR. RICCI: He's asking if you remember the specific names of any references that you looked at, treatises, books, articles, before you treated Mrs. Alhaj. If you don't remember the specific references you referred to, then that's your answer. That's all he wants to know is d0 you remember what specific titles you looked at? 67 i 2 3 4 5 6 ? B 9 30 11 12 13 14 15 16 1? 1B 19 20 21 22 23 24 25 ear, what I'm saying, the proper ear or the Gentamicin did not respond, so the only way to see whether there is any response would be in my way of thinking is that give a small dose in both ears, since there is a very little chance of a hearing loss, than a.. what happens. Q So let me go back a little bit. You're saying you did not know whether the right ear or the left ear would be causing more of the problems? A Yes, no one can say. No one can -- yes, there's no way of testing that, yes, yes. Q If you injected one ear at a time, you would have a 50 percent chance of getting the right at, the correct ear? MR. RICCI: Well, assuming you only have a unilateral problem. BY MR. RDVNER: Q Well, no. I'm asking him. If she had -- if she indeed did have a bilateral problem -- A Uh-hum. Q Okay. If she indeed did, okay, is there one side or the other that'. generally causing more of a problem? A No. You can't predict that, yes. 0 Was there anything to prevent you from trying one aide first and than the other? A Well, eventually -- the Only thing is that she 2 3 4 5 6 8 9 10 11 12 13 14 15 16 1? 18 19 20 21 22 23 24 25 1 2 3 4 5 6 B 9 10 11 12 13 14 15 16 1? 18 19 20 21 22 23 24 25 66 THE WITNESS: I looked at the bilateral -- I don't think there was any article that mentioned about bilateral Gentamicin in searching for the article. MR. RICCI: Okay. THE WITNESS: Okay. 13Y MR. ROVNER: Q Did you -- do you recall looking at specifically an article or a book With regard to your plan of treatment for Mrs. Alhaj before you injected her? A No. Q Okay. A You mean bilateral? Q Yes. A No. Q Are you aware of any books or articles at the present time on which you would rely to say that bilateral injections of Gentamicin for Meniere's disease is an acceptable treatment? A No. Q Was there anything to prevent you from using Centamicin in one ear to see no. that worked and then if that didn't work to try it in another ear, the other ear? A We thought about that, too. I thought about that, too, but to purely inject the one ear, patient is not responding, you're not sure Whether you injected the right 68 has to go through the two procedure. I think the result would be the same. Q All right. A Because the interpretation would be the same. Q You don't know how she woultl have responded to an injection on one side, do you? A I don't know what that mean.. 0 You cannot predict how she would have responded to only a unilateral injection on let's say the right side or the left side before you did it on both sides? A Yeah, you can't predict, yes, uh-hum. Q Right. You knew that this was a procedure that was very unusual, and you had only -- you had never done it before, the bilateral injections? A Yes, uh-hum. Q But you did not consult with anyone as I understand it, no one at Johns Hopkins, no one at Hershey Medical Center, you didn't consult with anyone about this unusual procedure that you hatl never done before? A Yeah, I had no intention to give a full dose of Gentamicin in both the ear., see. This is just my intention was whether there is any response since nothing was helping. That was my intention. If she had any change, then we were going to formulate the, you know, whether a different type of procedure should be done 69 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 because that's the only reason that we just inject the one time. Okay. I did not even have the patient to usually lie on the 30 minutes on one side. That's the normal protocol. When I have a unilateral Gentamicin, we usually or about half cc into the middle ear, have the patient lie down for 30 minutes, then give a drop to the patient, go home, put some more in, then in the morning put some more in, and then come to the office, we do the hearing test. Q , Okay. I understand what you said about the unilateral and about the amount of Gentamicin given. If you had -- did you at a response, a favorable response to the Gentamicin injection? A In her case, no, we didn't get any response, no change. Q Okay. If you had gotten a response -- A Uh-hum. Q -- would you have used more Gentamicin? A I would probably use IM. Q Intramuscular? A Yeah, or I try to get the Streptomycin through the FDA if she -- if ahe does not want to go to the other institution and have the surgery done, that's what I would do if she didn't respond -- if she partially responded. Q What I'm trying to understand is -- all right. 71 2 3 4 5 6 7 a 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 A Yeah. Q All right. And then you made a decision to use less Gentamicin than you would normally use. A Uh-hum. Q Is that correct? A Uh-hum. Q You have to say yes or no. A Yes. Q Okay. So that's something else that's different than from what you usually do? A Yes. The rationale is this. 0 Yes, I understand. You have explained your rationale. MR. RICCI: Let him ask the question. BY MR. ROWER: 0 What I'm asking you is not what your rationale was, but where did you find any information that this was an appropriate technique to use less Gentamicin bilaterally in this particular situation? A There is no such a reference. Q Okay. So this is something that you created yourself? A Yes. Q All right. Now, the next visit that I see on the record here is -- you can refer to either record if you 70 1 2 3 4 5 61 7i B 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 Let me ask the question this way. Did you consult any reference with regard to using a smaller dose of Gentamicin bilaterally as opposed to your normal dose that you would use unilaterally? Do you understand what I'm saying? You made a decision you are going to use less Gentamicin. Where did you get that idea? A To see whether there is any response because there is no treatment options available at this juncture other than surgery, and she was, you know, so tearful, wants to have something done, so I wanted to have aome non-invasive procedure. If there is any response, usually the patient can tell the difference of the dizziness is different, you know, then we know that the amico,lycoside, the Gentamicin is working. That was my intention to. Q As I understand it -- but I guess my question was really you made -- you made a decision to do this injection Bilaterally? A Uh-hum. Q You had never done it before? A Uh-hum. Q And you knew it wasn't a treatment that vas a standard treatment? A Uh-hum. Q Yes, is that correct? You knew that? 72 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 want. A Okay. 0 Okay. Is March 28th of '01, is that right? A Yes, uh-hum. Q Okay. Incidentally, at any time that you saw Mary Ann Alhaj -- - MR. RICCI: Excuse me just a second here. Just to clarify the record, there is a note for 3/16. MR. ROWER: Right, right. MR. RICCI: Which is a do not show. MR. ROWER: Yes. I said the next time you saw her. MR. RICCI: I'm sorry. I thought you said the next note on the chart. MR. ROWER: Okay. Maybe I did. If I did, I'm wrong. MR. RICCI: Maybe I heard it wrong. That could be, too. BY MR. ROWER: Q At any time that you saw Ms. Alhaj as a patient, did she ever have otitis media? A No. Q Do I understand that in olost to instill the Gentamicin that you had to put tubes in her ears. A Well, three different way of doing it. Yeah, you ]3 2 3 9 5 fi ] 8 9 10 11 12 13 14 15 16 1? 18 19 20 21 22 23 24 25 have to penetrate the eardrum. Q Right. The way that you chose to do it was to put in tubes? A Yes. Q Okay. And what are the other ways? A Numb the -- anesthetize the ear, using the needle, go right through, penetrate through the eardrum, then injecting. The that one is the wick. You know, again you are making an opening into the eardrum, put the wick, that's if you plan to use a long-term use, the anterior inferior lip, aiming to the round window, leave a wick there, have the patient to put it in two or three times a day, let the wick to wet. Q Sort of drip it in there? A Yeah, drip, just dropping it, to give the drops. Q And why did you chose to use myringotomy tubes? A Myringotomy tube is less painful, and it's a local procedure, and you get the less contact of the medication through the that tissue. You know, using a spinal needle you can just inject it through the tube. Q Uh-hum, okay. And are the tubes supposed to be left in place then after this? A Usually the tube comes out by itself, yes. Q Okay. Do you recall any complaints Ms. Alhaj had ]5 2 3 4 5 6 ] 8 9 10 11 12 13 14 15 16 1] 18 19 20 21 22 23 24 25 A It says AD. That's right ear. Q Right ear, okay. A Auricle dextral, yes. Q And I. this entire note of 3/28/01 in your handwriting? A Yes, I. my handwriting. Q Okay. And what was the drawing of the right ear or -- is it the right eardrum? A Yes, yes, uh-hum. Q And what is the drawing of the right eardrum for? A That represents the eardrum. That small circle with the dot is the tube. The dot is a lumen. Okay. Then there's a little perforation of the drum on her right ear, yes, Surrounding the tube. That's her that is, uh-hum. Q So is this drawing illustrating the fact that there is a perforation of the eardrum larger than would be necessary to put the tube through? A This probably happened afterward. Q You say it happened afterward? A Afterward. Occasionally with the tube sometimes they leave some perforation. Q Okay. So the right ear had for want of a better word a perforation in addition to the tube? A The tube is here. Q Right. 1 2 3 4 5 6 B 9 10 11 12 13 14 15 16 1] 18 19 20 21 22 23 24 25 1 2 3 4 5 6 ] 0 9 10 11 12 13 14 15 16 1] 18 19 20 21 22 23 24 25 ]4 during the procedure? A No, I don't recall. I think it was done under the local topical anesthesia. It's a little uncomfortable sometimes. Q When you saw Ms. Alhej in your office, the examining room, is there anyone from your staff that's present when you see her and examine her? A In the examination room? Q Yes. A My staff usually are not present. Q Okay. In the operating suite when you or the myringotomy tubes in and you installed the Gentamicin, was there somebody there assisting you? A Yeah, usually one scrub nurse and circulating nurse. Q And are these nurses that are for the hospital? A Yes. Q Okay. Let's look then at the next visit. As your counsel has painted out there is a note on March 16th of '01 that says did not show or DNS. Then there is on 3/28/01, there is a note, and there seems to be a drawing on that note? A Yes, uh-hum. Q Okay. And there is some letters above the drawing. 6 A The eardrum usually seals the tube off, but there I. a little opening there. Q Okay. A Okay. That's the opening. Q There was an opening around the tube? A Yeah, around the tube, yes, that's what the drawing is. Q And why was that significant to you? A Well, you know, not significant. Most of those will heal, occasionally may need to repair afterward, but it rarely happens on the tubes. Q And right on the right-hand side of the drawing there looks to be something that looks like left. What does that say, LT? A It says the left tube is okay. Q Okay. A Okay. Q So the tube was Still in at that time? A Yes, left tube is okay, but right tube has a little extra space opening. That's why I drew the picture. Q Okay. And then it says still dizzy? A Still dizzy on any movement. Q Okay. Was there any change than in het condition that you were treating her for between January 16th and March 28th? ]] 2 3 4 5 6 8 9 10 11 12 13 14 15 16 1] 1B 19 20 21 22 23 24 25 A Na. Q Okay. All right. And did you have any discussion with her about the fact that the operation was not successful? A You know, this is the type Of operation some respond, same do not. You know, the operation is successful, but the patient did not respond to Gentamicin. Q All right. And underneath it says audio; is that right? A Yes, uh-hum. Q 50 there was another audiogram or speech test or audiogram done? A Yes. 0 All right. And how did that audiogram compare? A I would consider left ear is almost the same. There is sometimes five or ten 08 difference from the calibration of the machine. It depends on how the patient responded, but it's almost compatible with audio one. O, the right ear there was some loss especially in the lower frequency, maybe a little more conductive component. That could be from that little perforation reflecting. Otherwise essentially no change. 0 So would the conduction component be affected by the perforation? A The perforation, yes. ]9 1 2 3 4 5 6 B 9 30 11 12 13 14 15 16 1] 18 19 20 21 22 23 24 25 the air conduction and the bane conduction, affected by the hole around the myringotomy tube? A Bone conduction do not. Q Okay. A Okay. The air conduction conductive component is reflected by if you have a hole, fluid, abnormal bone Joint or stiffness of eardrum, the conduction is interfered. Q I understand. A Okay. Q Underneath there where it says audio -- well, strike that. Did you feel that the abdiograra testing that was done on March 28th, '01, in your office showed any improvement at ell? A Hearing, no. Q Yeah. As I understand it, it showed some increased hearing loss -- A Yes. Q -- but you attributed that to the hole? A To the component, yes, because bone conduction is not lost, yes. Q Now, there's a note here that says trial something. Is that Zyrtec? A Zyrtec. Q And why were you giving her Zyrtec? A Well, you know, now she tried every medication. 1 2 3 9 5 fi B 9 10 11 12 13 14 15 16 1] 18 19 20 21 22 23 Z4 25 ]B Q Now about the air conduction component? A You know, this is -- this is it conduction. Q Correct. A The top one. Okay. Q Right. A It's bone conduction on the bottom. Q Right. A Okay. For instance, of 500 she has a 55. She should be able to hear the 35, the difference of 20. There is an airborne gap, okay, so that when you are comparing to the audio study done in September, the airborne gap on the 500 was 5, but this time it's 20, sO it's a little more conductive component. That could be from that hole around the tube. 0 Okay. A That's why. The rest are when you look at the bone conduction, on the right 35, the same. 1,000, there's a little bit nerve lose. She put little X mark on because it's questionable when the patient responds, and they have to repeat that again, s0 it's bone conductions are almost -- they are comparable to the first test, so I think there's a low pitch conductive components reflecting there's a hole around the tube with that. Q Now, let me ask this question again because I'm not sure I understood your answer. Are both components, so 8 9 10 11 12 13 14 15 16 1] 15 19 20 21 22 23 24 25 We tried the Gentamicin, did not help, and there is a theory, although we don't know the cause of Meniere's, the pathogenesis, allergy is one that always came up, allergies, vascular problem, family history, genes, ao firth, so she still dizzy. She headed some help, so I gave her some samples of the Zyrtec. She says that she saw the allergist, I think. I don't recall what the allergist said, so I gave her some samples of Zyrtec. Q Did you have any discussions with any allergist about -- A No. 0 -- this problem? Okay. After the March 28th, 2001, Office visit, that Mary Ann AlhaJ had did you ever sere her as a patient again? A No. 0 Did you ever have any contact with her or anyone from her family again? A No. Q All right. Do you ever remember in any of the office visits her being accompanied by another woman? A Yeah, I thought, I thought she came in with the other lady. I thought she was also a hospital worker or some friend. Q Did you know that other lady? A I can't recall. I can't recall that well. 1 2 3 4 5 6 ? 8 9 SO 11 12 13 14 15 16 1? Is 19 20 21 22 23 24 25 el Q Do you recall any discussion or questions that the other lady may have had? A You know, every time she comes in I remember that we tlitl a long, long discussion. It's a very unusual case, very unpredictable disease. She's not responding to any treatment, so we almost in a blind end what to do, so we did a lot of discussion. Q So you had discussion with this other woman? A I think she vas in the same, you know, the same room, you know, examining or after the hearing test and all. Q Can you tell me anything you remember about any discussions you may have had with this other woman? A I really can't recall anything specific. Q Okay. I'll just check my notes. Doctor, since the beginning of this lawsuit, have you had any discussions with any medical personnel, I don't mean your lawyer or anybody that your lawyer hired, but have you had any discussions with any medical personnel about this case? A No. Q Have you done any research yourself concerning bilateral use of Gentamicin for Mahler.'. disease since the start of this case? MR. RICCI: Well, hang on, Doctor. I. the extent the doctor has done some research at my request in regard 83 8 9 10 11 12 13 14 15 16 17 is 19 20 21 22 23 24 25 0 Doctor, did you do any medical research -- and this is the only question is going to be did you do the medical research -- A I -- Just a second, before -- MR. RICCI: Let him ask the question. BY MR. ROWER: 0 I have to qualify my question here, so listen to the whole question, all right? MR. RICCI: Listen carefully, Doctor. BY MR. ROVNER: 0 The first question is since the beginning of this lawsuit did you do any medical research of any kind into the use of Gentamicin for bilateral Maniere's disease? MR. RICCI: Independent from requests of Counsel? MR. ROWER: No, no, no, no. I want to know yes or no, did he do it? MR. RICCI: Go ahead. MR. ROWER; And you are saying I can't find out about what he found out if it's At your request. MR. RICCI: To the extent that the Communications between Doctor and Counsel -- MR. ROWER: I'm not asking for that. V. asking if he ever did any research. I'm asking if he performed this act. 1 2 3 4 5 6 ? 8 9 30 11 12 13 14 15 16 1? 1S 19 20 21 22 23 24 25 82 to trial preparation issues, I'm not sure that that's an appropriate question. Now, if you want to ask the Doctor if he has done research independent of any requests of Counsel, then I don't have a problem with that. MR. ROWER: Actually, Joe, you know, I don't think we have to argue this in front of a judge, but I don't see any difference if whether you asked him to do it since he's A party or whether he tlitl it himself unless he plans to testify as an expert witness which in your Answers to Interrogatories you said you were going to have an independent expert. MR. RICCI: Yeah, we intend to have an independent expert. He is not going to testify as his own expert, right. MR. ROWER: He is not going to testify as to the standard of care? MR. RICCI: Right. I intend to have an :.ndependent expert to testify to standard of care. Now, to the extent the Doctor offers testimony of a medical nature because of the nature of his treatments, well, of course tie's going to do that, but in regard to the question of standard of care, we will have an independent standard of care expert. MR. ROWER' I understand. ELY MR. ROWER; e4 2 3 4 5 6 ? R 9 10 11 12 13 14 15 16 1? Is 19 20 21 22 23 24 25 MR. RICCI: Okay. St MR. ROWER; Q Did you do any research on the use of Gentamicin bLlaterally at the same time for Meniere's disease since the start of this lawsuit? A Let's put it this way. I constantly read, you know, at least a dozen different journals, but I look into more in a treatment of Meniere's disease. Q I really don't understand your a...at. What I'm Asking you specifically is because of this lawsuit, because oi' the allegations that you made -- you did bilateral injections of Gentamicin at the same time for Meniere's disease, did you perform any research in attempting to determine whether -- well, did you do any research on that specific issue, not just did you come across it in A medical journal, but did you do any research on that issue? MR. RICCI: And you are asking after the start of the lawsuit? MR. ROWER: After the start of the lawsuit, and he has already told us, I think, before the -- that before the operation he didn't do any and doesn't know of any. MR. RICCI: Well, that's -- I don't think that's an accurate characterization of his testimony, but another question I have for you now though, Neil, is whet relevance does subsequent research have to your question of the 85 1 2 3 9 5 fi a 9 10 11 12 13 14 15 16 1? 19 19 20 21 22 23 24 25 standard of care and the way he treated Mrs. Alhaj? MR. ROWER: I ..or to know what he has -- you know, what he knows. THE WITNESS: I'm aware that the -- you know, we don't use a bilateral Gentamicin for normal dose constantly. My aim was a different purpose. I had no intention to put the 30, 40 milligrams of Gentamicin in both the ears for seven days, you know. We discussed this because of a hearing loss, even a small dose you could have a hearing loss. BY MR. ROVNER: Q Okay. A I'm aware that -- I had 10 intention to treat the ears with Gentamicin because if she didn't want to go back to Hopkins, she didn't want to have surgery done, it's a minimum procedure. I thought she very understandable. I always thought that she was a nurse and easy to explain to her, 30 let's go to the minimum procedure, but you could lose the hearing, 30 I'm going to just put the one drip in each ear, come back, get a hearing test done. The hearing test was done, not -- to make sure that she doesn't have a hearing lass from the Gentami Cin, see. 0 I understand all that, antl you have said that a number of times. I thought I asked you if there was any reference before, before the operation that you were aware 6? COUNTY OF DAUPHIN 55 COMMONWEALTH OF PENNSYLVANIA I, Diane F. Folts, a Notary Public, auth.ric.d to administer oaths within and for the Commonwealth of Pennsylvania, do hereby certify that the foregoing is the testimony of Kwan H. Won, M.D. I further certify that before the taking of said deposition, the witness was duly sworn; that the questions and answers were taken down stenographically by the said Reporter-Notary Public, and afterwards reduced to typewriting under the direction of the said Reporter. I further certify the said deposition was taken at the time and place Specified in the caption sheet hereof. I further certify I am not a relative or employee or attorney or counsel to any of the parties, or a relative or employee of such attorney or counsel, or financially interested directly or indirectly in this action. I further certify that the said deposition constitutes a true record of the testimony given by the said witness. IN WITNESS WHEREOF, I have hereunto set my hand this 15th day of October, 2003. rnIAWLL4 oYdNE esswo xAsk ?e . ' Wa\B. D F. olt RN NOt ary PVb11C 10 11 12 13 14 15 16 1? 19 19 20 21 22 23 24 25 06 2 3 4 5 6 8 9 30 11 12 13 14 1s 16 1] le 19 20 21 22 23 24 25 of that said that you should do bilateral injections of Gentamicin for bilateral Meniere's disease? A Not for definitive treatment. Q Is there any reference that you are aware of that says that you do those injections, bilateral injections of Gentamicin for anything other than definitive treatment? A No. 0 Okay. A Plenty unilateral report but not the bilateral. Q Right. And the next question I'm going to ask you is since the beginning of this lawsuit, okay, have you done any research into the issue of bilateral injections of 3entamicin for Meniere'a disease? A No, not what I already know of, no. MR. ROWER: That's all I have. MR. RICCI: We're all done, Doctor. (Certification of Health Care Provider Family and Medical Leave Act of 1993 produced and marked won Deposition Exhibit No. 2.) 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IW18161 913 vll:u 23:11 Wm 15:16 2319 n:EO Mu 311 ne6 nl MA2 WO W]0 n;e to vi9miWm 60;12 ]mu 31: q.10 u'riAivLm 1oe9 fell(:flR_C Al PIIBRH'1' F11312 HRAB P TlT-GII-Il»Of/]]ROi-1103 Index Pegs 9 STATEMENT KWAN H. WON, WEI., P.G. 9810 TRINDLE ROAD CAMP HILL, PA 17011 TELEPHONE: (717) 751-8877 F rf ar? fM/? '? ? L J DATE PROFESSIONAL SERVICES RENDERED CHARGER CREDITS BALANCE mar?4m -l nr? -rj d- FsJo?ip gySS?, q?S?e] ' ?(_?-an TASLJrdrtLP PDfFC?I??J x•(0170 `a`?130 gdbvgf??fi '7 ?13a ?•1,3d Co/?u?anuL P}C ?X(, ? S8 9 q ?? P STATEMENT - KWAN H. WON,-M.D., P.G. °?9610.TJt1NDLE. ROAD CAMP HILL. PA 17011 TELEPHONE; (717) 761-8677 F /l?lar? AA M DATE CHARGES PROFESSIONAL SERVICES RENDERED ll; 8 A? ZnSu/a?(c Pd ?-[Co-op 1 /1'1a`'`f ^n ? ?t Nr? 6? 60 p ?c 3gl? °19 a1? p ov I r?4?'"L?` v3 LdC a a -b• ,?// Grr ([?i IS"r?i-Fert? /1'1?riM ? . - l °?G-n-fmmn Cn ?R? qq-Sa k 7 J `?.? Q° rc'[Sae IEC -00 I1 qs-o r00 F?3 STATEMENT KWAN H. WON' 14.D" P.C. 3s1DTRINDLE ROAD CAMP H" PA 17011 - TELEPHONE: (717) 761-6877 /-nA E tiJ _J w "" - CHARGES CGREDR6 BALANCE PROFESSIONAL 6ERhCES RENDERED DATE ?d u31? rd,511ra4cst Sb a dJuS?"P 6 aD •lS.DO re4vrA d- v2?iCR i ?P? ?2S ?f, SS sct 6 J us'r?' I fro /I Ce P Q? ? STATEMENT KWAN H. WON, M.D., P.C. 981 O TRINDLE ROAD CAMP HILL. PA 17011 TELEPHONE' (717) 761-BS77 F 144 M GcrL/ ?'r?/I L J PROFESSIONAL SERVICES RENDERED CHARGES CIiED11 DATE Lj3.Sa Cd%AsvrailC? M BALANCE LAW OFFICES MYCHAK GECKLE IS WELKEK, 1. ?• PERSONAL INJURY ATTORNEYS 105 WEST THIRD STREET MEDIA. PA 19063 132 STATE STREET HARRISBURG. PA 17108 230 SOUTH BROAD STREET ITTH FLOOR 6 NORTH P R 1 ILO E. STATE STREET . PHILADELPHIA. PA 19102.4190 A T CARMEL• 7851 M UITE18 2ND FLOOR . ETT 5011ARE PA 17108 (215) 735-3326 7711 CASTOR AVENUE 1(600) 555-7760 PHILADELPHIA. PA 19149 / D BLDG. EXEC SUITE I 5B0 MIDDLETOWN BOULEVARD 104 N. CENTRE STREET LANGHORNE PA 19047 2ND FLOOR POTTSVILL E. PA 17901 54 EAST STREET MECHANICSBURG, PA 17055 COURT HOUSE SOLARE 39 NORTH 7TH STREET 16 WEST MARKET STREET STROUDSBURG, PA 18360 WEST CHESTER PA 19382 August 14, 2001 Dr. Kwan H. Won 3810 Trindle Road Camp Hill, PA 17011 RE: Our Client/Patient: Mary Ann Alhaj D/O/8: 7/21/58 _ _. _ ,en_Cn?947 Dear Dr. Won: Please be advised that our office represents the above- referenced individual in reference to a social security disability claim. We request a complete copy of your entire medical chart for Mary Ann Alhaj. Enclosed is the client's signed authorization permitting you to release this information. Thank you for your attention and anticipated cooperation. Sincerely,, MW/jjw Enclosure , Mychak Geckle E Welker, P.C. ;yl ? k -- Marla Welker ,v ATLEE, HALL BROOKHART, LLP ATTORNEYS AT LAW Kwan H. Won, M.D. 3810 Trindle Road Camp Hill, PA 17011 Re: Mary Ann Alhaj DOB: 07/21/1958 SSN: 182-50-3335 Dear Dr. Won: April 16, 2002 Please be advised that this office represents Mary Ann Alhaj, who has been your patient. We are requesting that you provide us with complete copies of all records in your possession pertaining to the care and treatment of this individual from February 6, 2001 to the present. An authorization is enclosed permitting the release of this information. We also require a patient account statement or copies of all medical bills listing all charges incurred for your services. If there are any copying charges to be incurred that exceed $150.00, please contact the undersigned, otherwise kindly forward a bill to our office, and we will remit by return mail. Should you require prepayment, please contact or fax the cost to the undersigned immediately. Enclosed is a Certification form which is to be completed and returned with the requested information. If you have any questions concerning the above requests, please feel free to contact our office. Thank you for your anticipated cooperation in this matter. Very truly yours, i y CSY/zac Enclosure 14:\02-l06WeueMRec\W on0l.ac ATLEE, HALL & BROOKHART, L.L.P. By: (1/7 ? Cynthia S. Yoder Records Custodian 717.393.9596 800.924.2309 717.393.2136 FAX law@atlechall.com William A Adee, Jr Thomas W Hail Dan M Brookhart Edward R Kennett Jaime D Jackson Robin A Jabour Eight North Queen Street Lancaster PA 17603 Mailing Addms PO Box 449 1 ...r.co-r PA 1 760 8-044 9 4? PIIVNACLEHFALTH HARRISBURG HOSPITAL 111 South Front Street Harrisburg, PA 17101 OPERATIVE REPORT Admitting Physician: KWAN H. WON, M.D. Date Dis: Date of Op: 02/06/2001 Surgeon: KWAN H. WON, M.D. A. PREOPERATIVE DIAGNOSIS: Intractable severe bilateral Me:niere's disease. POSTOPERATIVE DIAGNOSIS: Same. PROCEDURE PERFORMED: Bilateral tympanostomy; instillation of Gentamicin 1/2 ml, 20 mg into the middle ear. Anesthesia: Topical Operative Procedure: This is a 42-year-old lady who is a Registered Nurse from Holy Spirit Hospital who has had an extensive work-up including MRI and neurology consult. An audiogram was rather compatible with the Meniere's syndrome. The patient had been on all anti-vertiginous medications and also tried the Volipofiavinoid. The patient did not respond to any medical therapy, and I referred the patient to Johns Hopkins where she was consulted. Apparently she did not get any satisfactory treatment. The patient is constantly having vestibular dysfunction. She was unable to work. I saw her last in January in my office. I also emphasize that the patient may further lose her hearing fi-om the ototoxic drug and all the ramifications including complications were explained, and it was felt that the patient now has no other choice because the patient is absolutely unable to work because of her problems with dizziness. The'patient was brought in as an outpatient. Initially, under the operating microscope, the inferior portion of the tympanic membrane was blanched with Phenol for the topical anesthesia, and then the tympanostomy was made, and the Shepherd tube was placed. With the Shepherd tube, using the long spinal needle at 42 gauge, approximately 1/2 ml, 20 mg of Gentamicin was instilled into the middle ear. This was repeated on the opposite side. OP REPORT OP REPORT OP REPORT COPY FOR: KWAN H. WON, M.D. ALHAJ, MARY RM#: HSP MRN: 182-50-3335 CASE: 00210212795 ADM: 02/Z/2001 '- 4?> PINNACLEHEALTH OPERATIVE REPORT Date Dis: Date of Op: 02/06/2001 The patient could here the whispered voice well. c: KWAN H. WON, M.D. KWAN H. WON, M.D. DD: 02/06/2001 DT: 02108/2001 /mml D#: 784697 OP REPORT OP REPORT COPY FOR: KWAN H. WON, M.D. ALHAJ, MARY RM#: HSP MRN: 182-50-3335 CASE: 0021P212795- ADM: 02/12001 OP REPORT N 1 ' a•" J rt.M 9F? . " ? /-V 1 JSuY Lj? (r _ 5 .fr ( a? '$Ff P' qlmft?yi ? 4 •V : ,/ vv. ? *Ki ~f f? "t " C ? f= t t i.rv 7 A.IMh V AY.???y .?A9 I? - ry etc S .: < CC: N1L L-274 Onset: EARS- E) HEARING LOSS ? PAIN ? PRESSURE ? RINGING ? VOW ? NOSE EXPOSURE ? FREQ. WE ? DISCHARGE NOSE- ? TRAUMA ? SURGERY ? OM, ? DISCHARGE ? EPLSTAM ? PND ? SNORING ? SMELL THROAT- ? SORENESS ? VOICE CHANGE ? DYSPHAGIA HEADACHE- Elm INF. ?FACIAL ?UNILATERAL ?NIERMR. ?CONSTANT Nllergy: E? 1.2z= ?TiC?vQ9f ?C -!rY PMH .1. Okt-?i (EST) Current Rx: Tobacco: /70 Alcohol: a ENT EXAMINATION EAR NOSE LARYNX R AURICLE L ? CANAL ? EXTERNAL SEPTUM ? CORDS (TRUE) ? ? CORDS (FALSE) ? ?? ? DRUM ? ? TURBINATES ? -PHONATION ? PERFORATION ? SINUS TEND. EPIGOTTIS ? RETRACTION ? PALE MM ARYTENOIDS ? SCLEROSIS ? AL Q L NECK ? CONGESTION ?. OR r NODES / ? BULGING ? PALATE THYROID ? 0- PINNE TONGUE L TRACHEA ? WEBER ? TONSILS SALIVARY G. ? MEE ' ? UVULA CHEST ? TW ? - ADENDIDS ? / DENTURE L , s? Impression: Studies: ??j G? j Treatment: CO ' ?? DATE: KWAN H. WON, M.D. FRANK E. GABLE, BC-HIS 3610 Trindle Road Camp Hill, PA 17011 PATIENT, {? L ?Clr.. REWUiKSf ?/? o }.? 'T-4he? o? ? . AUDIONETERt Grason - Stadler GSI 16 ANSI 1969 S.N. D499 AIR M r Rlykt Aver. kTE ? wwuwurTffW E RIGHT 4000 2M o rrvnc r ?-- Usk. r. Lek Level Tne 250 S00 D- o N/ / - LEFT 100 2000 IRKKI Mi. r Level RI t WICK Typo 230 ER S00 250 r S00 K. 2 " N SPEECH R ECEPT ION T NR N O RIGHT N DISC LEFT F 1 IN FREEFIELD Llve Rlyht Left Makil. Ydl Live Ttw.d By B Yu'1 lw T ATE Be" ??y Vefn R D.IL (J USIK r S 6J 0.6. / S AM 1< D. . 6 S? y o O i Jv oo i SNORT INCREMENT SENSITIVITY INDEX TONE DECAY TEST RIGHT LEFT MASK EAR Fr.o. Tkrt.dsid Iffr• S d.?. 7finld Shlft Mari ;6 )ATE S00 1000. 2000 1000 1-6000 S00 1000 2000 1000 sow Iwd tl'M i ' I GSI NAME DATE ECU 1.6 co,3 PEAK 0.9 cm' L 3R 50 daPa - 40 daPa ?1.5 Cfia I 59a Hz HL9?il l I i 0.1 ! I cin.3 I 2000 Hz L f HLSti11 % f a.1L 1 J cm3 i r /r , a 0.'7 SEC -400 daPa 0 +2aa ECU 1.2 cm3 PEAK 1.3 m3 k / 6P, 50 daPa - 45 daPa 1.5 cm3 I 560 Hz I I H69 ii if iI I 0.11 cm3 i I j I 112000 Hz HLSS i 1` I 1L cm3 ' 9 0.'7 SEC -400 daPa a +206 -eurotVC Cenc. lar Church Road 897 Pop Camp Hill, PA 17011 (717)975.8585 Fax: (717) 975-0670 VISUAL EVOKED POTENTIAL STUDY Patient Name: Mary Alhaj SS#: 182-50-3335 Date of Study: 02/28/01 Referring Physician: K. Won, M.D. Neurologist: Ravi Dukkipati, M.D. The patient is a 42 year-old woman with dizziness, gait disturbance; r/o MS. Maria Michalek, M.D. Todd L. Samuels, M.D. Ravi Dukkipati, M.D. Both eyes were stimulated individually using standard pattern reversal checkerboard stimuli (check size 16). With stimulation of the left eye, the P100 response appeared at 106 ms. With stimulation of the right eye, the P100 response appeared at 106 ms. The amplitudes were 7.17 uV and 6.42 uV with stimulation of the left and right eye respectively. IMPRESSION: Normal. This visual evoked potential study is within normal limits. 0 Ravi Dukkipati, M.D. . y ltweu Tg. 897 Poplar Church Road Camp Hill, PA 17011 (717) 975-8585 Fax:(717)975-0670 Maria Michalek, M.D. Todd L. Samuels, M.D. Ravi Dukkipati, M.D. UPPER EXTREMITY SOMATOSENSORY EVOKED POTENTIAL S -TDY Patient Name: Mary Alhaj SS#: 182-50-3335 Date of Study: 02/28/01 Referring Physician: K. Won, M.D. Neurologist: Ravi Dukkipati, M.D. The patient is a 42 year-old woman with dimness, gait disturbance; r/o MS. Both median nerves were stimulated individually with recording done over Erb's point, the 2"d cervical spinous process, and contralateral somatosensory cortex. With stimulation of the left median nerve, the Erb's point: potential appeared at 10.4 ms, the cervical potential at 13.9 ms,, and the cortical potential at 20.5 ms. Interpeak latencies with left median nerve stimulation; N9-N13 3.5 ms, N13•-N20 6.6 ms, and N9-N20 10.1 ms. With stimulation of the right median nerve, the Erb's point potential appeared at 10.7 ms, the cervical potential at 14.2 ms, and the cortical potential at 20.0 ms. Interpeak latencies with left median nerve stimulation; N9-N13 3.5 ms, N13-N20 5.8 ms, and N9-N20 9.3 MS. IMPRESSION: Normal. This median nerve somatosensory evoked potential study is within normal limits. Ravi Dukkipati, M.D.- ' 41 Cen er: Pc. 897 Poplar Church Road Camp Hill, PA 17011 (717) 975-8585 Fax: (717) 975-0670 BRAINSTEM AUDITORY EVOKED POTENTIAL STUDY Patient Name: Mary Alhaj SS#: 182-50-3335 Date of Study: 02/28/01 Referring Physician: K. Won, M.D. Neurologist: Ravi Dukkipati, M.D. The patient is a 42 year-old woman with dizziness, gait disturbance; r/o MS. Maria Michalek, M.D. Todd L. Samuels, M.D. Ravi Dukkipati, M.D. Both ears were stimulated individually using alternating clicks. The hearing threshold was 25 dB on the left and 35 dB on the right. With stimulation of the left ear, waves I, III, and V appeared at 1.78, 4.22, and 6.14 ms. Interpeak latencies on the left; waves 1-111 2.44 ms, wavers III-V 1.92 ms, and waves I-V 4.36 ms. With stimulation of the right ear, waves I, 111, and V appeared at 1.78, 4.18, and 6.20 ms. Interpeak latencies on the right; waves 1-111 2.40 ms, waves III-V 2.02 ms, and waves I-V 4.42 ms. IMPRESSION: Normal. This brainstem auditory evoked potential study is within normal limits. Ravi Dukkipati, M.D. v ?cWeu G-Wlbgy' Cenie'i-pc. 897 Poplar Church Road Camp Hill, PA 17011 (717) 975.8585 Fax: (717) 975-0670 March 14, 2001 OFFICE NOTE RE: Mary A. Alhaj Maria Michalek, M.D Todd L Samuels, M.D Ravi Dukkipati, M.D. Mrs. Alhaj returned for follow up. Her last visit was three weeks ago. Today, she was accompanied by one of her good fiends. Her MRI of the brain from March 9, 2001 showed a small enhancing area of signal in the mid right pontine region. This area did not show well on FLAIR or on DWI imaging. No change was seen with regard'. to the signal abnormality when compared to previous MRP s May of 2000 and January of 2000. A cervical spine MR1 done on March 9n as well showed some very mild degenerative changes and no other cord pathology or disc pathology. She had Brainstem Auditory Evoked Responses, Visual Evoked Potentials and Somatosensory Evoked Potential on February 2e. All three: of these studies were normal Since the time of her last visit, she returned back to work but reported that she was having great difficulty. She is fiustrated with her continued "teeteffig gait". She apparently is `banging into walls". She denied any frank vertigo on today's visit but stated she has profound imbalance. She denied any development of any new neurologic symptoms since her last visit. On examination, she was observed to be rather anxious with a. somewhat flattened affect. She was alert and Billy oriented with fluent speech. Cranial nerves Il through )M examined were normal Motor examination reveals 515 strength- She continues to have an unsteady stance and veers in all four directions with her eyes closed but does not actually f3l She is able to correct herself Her gait is narrow based but once again unsteady. We had a lengthy discussion today regarding her perple)dng situation. She continues to have symptoms and has noted previously, there is a lesion of unclear significance in her pontine region. Her symptoms of chronic vertigo and imbalance may or may not be explained by this area of abnormality . In any case, she will begin a trial ofvestrbular rehabilitation. She is also to follow up with her other physicians. She will see me in follow up is about six weeks and is to call if there are new symptoms in the interim Ravipukkipaf4ALD. RD:mp cc: KwanK Won, AD. Sporting Hill[Aamdy Practice JOHNS HOPKINS M E D I C I S E Otolaryngology- Head and Neck Surgery Mailing Address: Johns Hopkins Outpatient Center 601 North Caroline Street, 6th Floor Baltimore, MD 21287-0910 FAX: (410) 955-0035 December 15, 2000 Kwan H. Won, M.D. 3810 Trindle Road Camp Hill, PA 17011 RE: ALHAJ, MARIANNE JHH #: 8-332-53-04 Dear Doctor Won: It was my pleasure to see your patient, Ms. Marianne Alhaj in Otolaryngology Clinic today. As you know, she is a 42-year-old nurse who has been significantly disabled by a syndrome of imbalance and headaches since 1996. She initially experienced a short duration of nausea and vomiting with fevers and night sweats while she was living in the Middle East a few years ago; however, there was a full :resolution of these symptoms. In 1996, she experienced the-onset of similar symptoms, but in a more chronic fashion. She describes a chronic occipital pressure which is particularly severe in the mornings-and improves as the day progresses, but returns on frequent occasions during the day. These episodes of increased occipital pressure are accompanied by al feeling of confusion and disorientation, difficulty focusing and the sense: of imbalance associated with nausea and vomiting. She throws up every morning because of this, and is now unable to work because of the recurrent episodes through the day. She also has a chronic low grade fever and night sweats. She has had an evaluation by infectious disease which has so far been negative; however, she denies having had a chest x-ray in the recent past. She denies any change in hearing. Her neurologic workup has included an MRI with gadolinium which reveals an ischemic lesion of the pons. Her past medical history is negative. She ha3 no known drug allergies. Her medications include Antivert and Phenergan. Her review of systems is remarkable for low grade fevers, chronic cough, no hemoptysis and elevated liver function tests. In the past she has lived in Israel and Oman for a total of three years. On physical examination, she is a healthy appearing female who appears healthy. There is no evidence of cyanosis or skin rashes. Her cranial nerve examination is normal. Her ear canals are clear. She has no spontaneous nystagmus. She has no head shaking induced nystagmus. She has stable gaze with head thrust. She has normal Romberg and gait. An audiogram performed in 09/00 reveals a mild low, frequency conductive hearing loss in both ears with normal word discrimination bilaterally. It is my impression that Ms. Alhaj has normal peripheral vestibular Patient: Alhal, Mary Ann I Final T)nrumo.ni History # B-332-53-04 dysfunction testing in the office. She also has only mild low frequency mixed hearing loss. Her symptoms including the feeling of pressure to the occipital area, and the experience of confusion and disorientation during these episodes are more reminiscent of a central pathology than of a peripheral problem. The presence of ischemic changes in tl2:,pons would certainly explain many of these symptoms. I strongly believe that she would be better served by seeing one of my neurology colleagues to further work her up and determine what may be . helpful to her. She is quite desperate to overcome this disabl;ng condition. I have given her a prescription for :Klonopin 0.5 mg b.i.d. t6 see if this would help control these episodes until she is able to undergo further testing and evaluation by our neurology group. I have made the referral, and we are now waiting for an appointment. I do not believe the Meniere disease is active, nor any other labyrinthine disorder at this time. Thank you for referring this patient feel free to contact me. If you have any questions, ,lease Sincerely, ' -w ? Howard W. Francis, M.D. HWF/akn CC LIST: DICTATED BY: FRANCIS, HOWARD WAYNE, M.D./859 D: 12/15/2000 T: 12/16/2000 Primary Pro FRANCIS, HOWARD 12/26/2000 THIS DOCUMENT HAS BEEN ELECTRONICALLY SIGNED Note: This not provides information pertaining only to a specific event A mort detailed medical history is available in the medical record. Patient: Alhaj, Mary Ann 2 Final Document History # 8-332-53-04 Kay 19, 3000 REt AGS: &W AU1AJ, NARY 405 M Marble street Mechanicsburg PA 17055 43, 192 SO 3135 09/27/00 09:30 3:01/02 N0:547 1 s+' STUDY: MRI of brain with vartabrobasilar MR angio¢raphy and with and without enhancement REIERRM M51CIAN: Charles Yanofsky, K.D. CLINICAL gxvmY: Pa XU PULg;.BROU NCE8: 1) 3) 4) 6) ntine lesion Sagittal T1 Axial !LAIR T2 DWI Thin T1 2D TOP 3D TOP Axial Coronal Thin Ti anhanced Axial T1 Enhanced ColDWr=j The pituitary gland is not enlarged. The pons is not enlarged.. The sass small round anhancin4 focus is again demonstrated just to the right of the sidline•Of the mid pons. This lesion can be seen only vary faintly on T2 iUnes but is not seen on inversion recovery. This lesion vas visC>ltlly identical at the time of the Previous examination. The filiding remains nonspecific. Tumor probably is less likely than a-Vftoass such as damyelinization or inflammatory residua but is not- Woessarily ruled out entirely. This is the only such enhanob'. lesion which is identified. The careballus is normal. No maim-:lesions or enhancing lesions are seen at the internal auditca..:oanals or the cerebellar pontins angle. The ventricles are not dilated or asymmetrical. There is no mass effect or displad$omt of midlins structures. a single tiny focus of subcortical white matter bright signal is seen in the sid lateral left ces6bral hemisphere on image 13. This was present previously and alio.-is unchanged. This too, does not enhance. There is no mass oftbat or displacement of aidline structures. No subdural collactidns have been demonstrated. r carotid vessels and carotid a it was wall shows as normal normal b vertebral vessels bilaterally. At the circle of Millis, no lesions have bean demonstrated. CDNCi.amt WU of the brain and internal auditory canals has not cbangad since the 1-27-00 eras. The same =all arduming focus is present just to time right of Us aidlist 4 thin the pons. The lesion has not, changed miss or signal characteristics and is barely perceivable on T2 imaging. The CONTINUED ON PAGE 2 Page 2 R! t AI. W i XARY 09/27/DO 09:30 15 :02/02 NO:547 lesion is not identified on inversion raccwary. This -is the only such lesion downstrated. one single tiny too" in the suboortical white Matter of the left owabral lleaisphere is unchanged probably represent aicrovascular isohaaia. No now intracranial lesions are daaonstrated. MR angiogsaphy of the carotid, vertebral and circle of Willis atructurat iiss norMil. Thank you... for raf erring this patient to us. aincsre:lY. G8D/sa 1/ George Et. Duriaak, K.D. Certification of Health" Care Provider (Family and Medical Leave Act of 1993) 1. Employee's Name: MAn,K A N N P? LN pa 2. Patient's Name Cif dff== from employee): 3. The attached sheet describes what is meant by a "serious health cmrdition" under the Family and Medical Leave Act Does the patient's condition' qualify under any of the categories described? If so, please check the applicable category. (1)_ (2)_ (3)_ (6) , or None of the above 4. Describe the medial farts which support your certification, including a brief statement as to how the medical facts meat the criteria of one of these categories: 5.a. State the appror®ate date the condition commenced, and the probable duration of the condition (and also the probable duration of the patient's present 1napadty' if different): b. Will it be necessary for the employee to take work only intermittently or to work on a less than full p schedule as a result of the condition (Including for trearmiart described in hem 6 below)?--L'\-./ If yes, give the probable duration::, c. If the condition is a chronic condition (condition #4) or pregnancy, state whether the patient is presently incapacitated= and the lilmly duration and frequency of episode; of incapacity=: 6.a. If additional treatments will be required for the condition, provide an estimate of the probable tuir!ber of such treatments If the patient will be absent from work or other daily activities because of treatment on an intermittent or part-time basis, also provide an estimate of the probable number and interval betweensuch treatments, actual. or estimated dazes of treatment if known, and period required for recmre'J if any -%. - 4'.. ?^r'?'w b. If any of these trwrments? will be provided by another provider of health services (e.g., physical therapist), please state the nature of the trram==* ' Here and elsewhere on this form the information sought relates only to the condition for which the employee is taking FIA A leave. December 1994 ' "Incapacity," for purposes of FMIA, is defined to mean inability to work. smwd school or perform other regular daily activities due to the serious health condition, treatmmt therefor, or revery ibex afro C. If a-regimen of continuing trrgcgneat by the padentis required under your supervision, provide a general description of such regiu= (e.g., prescription drags, physical therapy requiring special equipment): 7.a. If medial leave is required for the employee's absence from work because of the employee's own condition (including absences due to pregnancy or a chronic condition), is the employee unable to perform worst of nay 1®d? b. 'If able to perform some work, is the employee-unable to perform any one or more of the essential functions of the employee's job (the employee or the employer should supply you with information about the essential job functions)? If yes, please list the essential functions the employee is unable to perform: c. If neither a. nor b. applies, is it necessary for the employee to The absent from work for treatment? S.a. If leave is required to care for a family member of the employee with a serious health condition, does the patient require assistance for basic medial or personal needs or safety, or for transportation? b. If no, would the employee's, presence to provide psychological comfort be beneficial to the patient or assist in the patient's recovery? c. If the patient will need care only intermittently or on a part-time basis, please indicate the probable duration of this need: tore 4?Of Health Care Provider) (A ThadU RMd cap =. PA 17011 (Type of Practice) 7/ (reiephone number) To be completed by the employee needing family leave to care for a family member: State the are you will provide and an estimate of the period during which are wM be provided, including a schedule if leave is to be taken intermittently or if it will be necessary for you to work less than a full schedule: (Employee signature) . (date) 2 A 'Serious Health Condition' means an tInness, injury, iuu>Fiairmem, or physical or mental condition that involves one of the following: 1. Hospital Care Inpatient care (i.e., an overnight stay) in a hospital, hospice, or residential medical care facility, including any period of incapacity' or subsequent tratment in connection with or consequent to such inpatient care. 2. Absence Plus Treaeaent (a) A period of incapacity= of more than three consecutive calendar days (including any subsequent treatment or period of incapacity! relating to the same condition), that also involves: (1) Treatment' two or more times by a health care provider, by amuse or physician's assistant under direct supervision of a health care provider, or by a provider of healthcare services (e.g., physical therapist) under orders of, or on referral by, a. health care provider; or (2) Treatment by a health are provider on at Inst one occasion which results in a regimen of continuing treatment' under the supervision of the health are provider. 3. a an Any period of incapacity due to pregnancy, or for prenatal tare. 4. Chronic Conditions Remtirine Treatments A chronic condition which: (1) Requires periodic visits for treatment by a health are provider, or by a nurse or physician's assistant under direct supervision of a health are provider; (2) Continues over an extended period of time (including recurring episodes of a single underlying condition); and (3) May cause episodic rather than a continuing period of ncapacity2 (e.g., asthma, diabetes, epilepsy, etc.). 5. PermanemILone-term Conditions Reauirine Supervision A period of incapacity' which is permanent or long-term due to a condition for which treatment may not be effective. The employee or family member must be under the continuing supervision of, but need not be ' Treatment includes examinations to determine if a serious health condition exists and evaluations of the condition. Treatment does not include routine physical examinations, ere examinations, or dennl examingdona. ' A regimen of contiming treatment indudea for example, a we= of prescription medication (e g., an antibiotic) or therapy regtming special equipment to resolve or alleviate the health n,n.st;,.. A regimen of rrestmmt does not include the taking of over-the-counter medications such as aspirin, antihistamines, or salver, or bed-rest, drinking fluids, exercise, and other similar activities that can be initiated without a visit to a health care provider. receiving active treatment by, a health care provider. Examples include Alzheimer's, a severe stroke, or the terminal stages of a disease. 6. Multiple Treattnems (Non-Chronic Conditions) Any period of absence to-keceive multiple treatments (including any period of recovery therefrom) by a health care provider or by a provider of health ore services under orders of, or on referral by, a health are provider, either for restorative surgery after an accident or other injury, or for a condition that would likely result in a period of incapacity' of more than- three consecutive calendar days in the absence of medical intervention or treatment, such as cancer (chemotherapy, radiation, etc.), severe arthritis (physical therapy), kidney disease (dialysis). 4 CERTIFICATE OF SERVICE AND NOW, this day of July 2004, I, Joseph A. Ricci, Esquire, hereby certify that I served a true and correct copy of the foregoing Reply to Plaintiff;; Motion to Amend Complaint to Assert Punitive Damages upon all counsel of record by depositing a copy of same in the United States mail, regular delivery, postage prepaid at Harrisburg, Pennsylvania, addressed as follows: Neil J. Rovner, Esquire Angino & Rovner, P.C. 4503 North Front Street Harrisburg, PA 17110 PR-551 Reply to Motion to Amend Complaint n Q 1 r . C- te ? ? s t r -" r - u cr, rr r-,y ?• =C -r, -7 T W MARY ANN ALHAJ and IN THE COURT OF COMMON PLEAS 113RAHIM ALHAJ, her husband CUMBERLAND COUNTY, PA Plaintiffs CIVIL ACTION - LAW V. NO. 03-531 KWAN H. WON, M.D., and KWAN H. WON, M.D., P.C. JURY TRIAL DEMANDED Defendants PLAINTIFFS' RESPONSE TO DEFENDANT'S REPLY I'D PLAINTIFF ASSERT A CLAIM FOR PUNITIVE ;DAMAGES 1. Defendant's recitation of their version of the facts of this case boils down to the assertion that Dr. Won had good intentions in treating Mrs. Alhaj. 2. Nevertheless, Defendants do not and cannot contest the allegations of Paragraph 19 of the Plaintiffs' Complaint, specifically subparagraph (d) which indicated that Dr. Won utilized "an experimental, untried and dangerous method of treatment not used for treatment of Meniere's Disease, i.e., bilateral injections of gentamycin." 3. Plaintiffs have supplied an expert report indicating that this is an unacceptable method of treating Meniere's Disease no matter what the intentions. 4. Plaintiffs did not originally file for punitive damages until they had evidence from Dr. Won's own mouth that he had no scientific basis for utilizing this treatment. 5. In fact, Dr. Won had very little experience in his practice in using Gentamycin at all for treatment of Meniere's Disease as he indicated in his deposition. 6. Despite knowing that this experimental method of treatment was not supported either by the medical literature or his own experience, Dr. Won did not contact any colleagues or indeed review any literature before embarking on this experiment, however good his intentions were. 279383 7. Plaintiffs claims of punitive damages were not brought lightly nor in boilerplate fashion, but are only asserted as a result of Dr. Won's own words and Plaintiffs expert analysis. 8. Defendant has misconceived the Plaintiffs reliance in the case of Stalsitz v. Allentown Hospital, 814 A.2d 766 (Pa. Super 2002), incorrectly cited as Salsitz. The Stalsitz case stands for the proposition that amendments are only made where they introduce a new cause of action not originally pled after the statute of limitations where the operative facts do not appear in the Complaint. 9. As Plaintiff has pointed out, the original Complaint in this matter accused Dr. Won of utilizing an experimental, untried and dangerous method of treatment not used for the treatment of Meniere's Disease, i.e., bilateral injections of Gentunycin. 10. Thus, Plaintiffs are not adding a new cause of action, but merely amending the ad damnum clause by adding a complaint for punitive damages. Date: ? 120 IN Respectfully submitted, ANGINO & Neil I Yovner s4uirf I.D. No. 198 1 4503 N. Fron Street Harrisburg, PA 17110 (717) 238-6791 Counsel for Plaintiff(s) 279383 CERTIFICATE OF SERVICE I, Megan A. Moll, an employee of the law firm of Angirto & Rovner, P.C., do hereby certify that I am this day serving a true and correct copy of the foregoing upon all counsel of record via postage prepaid first class United States mail addressed as follows: Lawrence F. Barone, Esquire Joseph Ricci, Esquire Farrell & Ricci, P.C. 4423 North Front Street Harrisburg, PA 17110 ^D 11( ? Meg A. Moll Dated: -7 2 ()p y 279383 n? ?} o C PJ O _- cn -- o C-1 -n `u MARY ANN ALHAJ and IBRAHIM ALHAJ, her husband Plaintiffs V. KWAN H. WON, M.D., and KWAN H. WON, M.D., P.C. Defendants IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION - LAW NO. 03-531 JURY TRIAL, DEMANDED PLAINTIFFS' RESPONSE TO DEFENDANT'S REPLY TO PLAINTIFFS' MOTION TO PRECLUDE DEFENDANT'S EXPERT WITNESS 1. Paragraph 6 of Defendant's Reply states that Plaintiffs' counsel was advised that the expert witness retained by Defendants has been unable to complete his report due to the failure of Plaintiffs to cooperate with discovery. 2. Defendants requested releases to be provided for Plaintiffs military medical records and various other records. 3. Plaintiffs responded by providing those releases. 4. Defendants have not sought to subpoena the records that they allegedly have been unable to obtain. 5. Defendants have also stated that the Women's Cancer Center has indicated that they have no records for the Plaintiff. 6. Plaintiff and Plaintiffs' counsel have no control over these record responses and Defendant's have not sought to subpoena these records apparently. 7. Furthermore, Plaintiffs have no recollection of being requested for additional time to provide an expert report, nor are there any letters or memorandums in the Plaintiffs file indicating such a request was made. 279382 8. Defendants still have not explained why they have not subpoenaed records that they believe they need. 9. Furthermore, Defendants have obtained all medical records for Mrs. Alhaj's treatment for the injuries claimed in Plaintiffs Complaint. 10. If there records of her OB-GYN which have riot been obtained, it is difficult to see how these have any bearing whatsoever on the case at bar. 11. It is Defendants job to subpoena these records. Plaintiffs have provided the necessary releases requested to obtain Mrs. Alhaj's military records. Respectfully submitted, ANGINO & Date: -?/ZCIOq Neil J. Rroi ne E A¢(uie I.D. No. 221 8 4503 N. Fr t Street Harrisburg, A 17110 (717) 238-65791 Counsel for Plaintiff(s) 279382 CERTIFICATE OF SERVICE I, Megan A. Moll, an employee of the law firm of Angin.o & Rovner, P.C., do hereby certify that I am this day serving a true and correct copy of the foregoing upon all counsel of record via postage prepaid first class United States mail addressed as follows: Lawrence F. Barone, Esquire Joseph Ricci, Esquire Farrell & Ricci, P.C. 4423 North Front Street Harrisburg, PA 17110 Megan . Moll Dated: ?12-G'169 279382 a ? r? ?? -_' -, ,-? f Rzr _ O '? t ? _?. ' ` :+.. ? -,? _ ?!1 GJ Lgt "t7 -c G MARY ANN ALHAJ and IBRAHIM ALHAJ, her husband, Plaintiffs V. KWAN H. WON, M.D., and KWAN H. WON, M.D., P.C., Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 03-531 CIVIL TERM ORDER OF COURT AND NOW, this 23`d day of July, 2004, upon consideration of the following documents: (1) Plaintiffs' Motion To Amend Complaint To Assert Punitive Damages; (2) Reply of Defendants to Plaintiffs' Motion To Assert Claim for Punitive Damages; (3) Plaintiffs' Response to Defendant's Reply to Plaintiffs' Motion To Assert a Claim for Punitive Damages; (4) Plaintiffs' Motion To Preclude Defendants from Using an Expert Witness; (5) Reply of Defendants to Plaintiffs' Motion to Preclude Defendants from Using an Expert Witness; and (6) Plaintiffs' Response to Defendant's Reply to Plaintiffs' Motion To Preclude Defendant's Expert Witness, a hearing is scheduled for Monday, September 27, 2004, at 2:00 p.m., in Courtroom No. 1, Cumberland County Courthouse, Carlisle, Pennsylvania. 61, BY THE COURT, Neil J. Rovner, Esq. 4503 North Front Street Harrisburg, PA 17110 Attorney for Plaintiffs Joseph Ricci, Esq. 4423 North Front Street Harrisburg, PA 17110 Attorney for Defendants :rc MARY ANN ALHAJ and IBRAHIM ALHAJ, her husband, Plaintiffs V. KWAN H. WON, M.D., and KWAN H. WON, M.D., P.C., Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW NO. 03-531 CIVIL TERM ORDER OF COURT AND NOW, this 27 h day of July, 2004, it is ordered and directed that the hearing previously scheduled in the above matter for September 27, 2004, is rescheduled to Tuesday, August 17, 2004, at 10:45 a.m., in Courtroom No. 1, Cumberland County Courthouse, Carlisle, Pennsylvania. THE FOLLOWING matters will be heard at the hearing: (1) Plaintiffs' Motion To Amend Complaint To Assert Punitive Damages; (2) Reply of Defendants to Plaintiffs' Motion To Assert Claim for Punitive Damages; (3) Plaintiffs' Response to Defendant's Reply to Plaintiffs' Motion To Assert a Claim for Punitive Damages; (4) Plaintiffs' Motion To Preclude Defendants from Using an Expert Witness; (5) Reply of Defendants to Plaintiffs' Motion to Preclude Defendants from Using an Expert Witness; and (6) Plaintiffs' Response to Defendant's Reply to Plaintiffs' Motion To Preclude Defendant's Expert Witness, V?NIVAIA& rd 80 T add ca Inr x001 A ??GiVON1Oad 3HU J0 3?9?0-f7311? V,Keil J. Rovner, Esq. 4503 North Front Street Harrisburg, PA 17110 Attorney for Plaintiffs y Joseph Ricci, Esq. 4423 North Front Street Harrisburg, PA 17110 Attorney for Defendants BY THE COURT, m I _ r- 0` _2?-() 1 :rc MARY ANN ALHAJ IN THE COURT OF COMMON PLEAS OF and IBRAHIM ALHAJ, CUMBERLAND COUNTY, PENNSYLVANIA her husband, Plaintiffs V. CIVIL ACTION - LAW KWAN H. WON, M.D., and KWAN H. WON, M.D., P.C., NO. 03-531 CIVIL TERlv1 Defendants ORDER OF COURT AND NOW, this 23`d day of July, 2004, upon consideration of the following documents: (1) Plaintiffs' Motion To Amend Complaint To Assert Punitive Damages; (2) Reply of Defendants to Plaintiffs' Motion To Assert Claim for Punitive Damages; (3) Plaintiffs' Response to Defendant's Reply to Plaintiffs' Motion To Assert a Claim for Punitive Damages; (4) Plaintiffs' Motion To Preclude Defendants from Using an Expert Witness; (5) Reply of Defendants to Plaintiffs' Motion to Preclude Defendants from Using an Expert Witness; and. (6) Plaintiffs' Response to Defendant's Reply to Plaintiffs' Motion To Preclude Defendant's Expert Witness, a hearing is scheduled for Monday, September 27, 2004, at 2:00 p.m., in Courtroom No. 1, Cumberland County Courthouse, Carlisle, Pennsylvania. BY THE COURT, J. jetsley Oler, J . (5 , Al All X06,7 ,n Neil J. Rovner, Esq. 4503 North Front Street Harrisburg, PA 17110 Attorney for Plaintiffs Joseph Ricci, Esq. 4423 North Front Street Harrisburg, PA 17110 Attorney for Defendants :rc MARY ANN ALHAJ and IBRAHIM ALHAJ, her husband, Plaintiffs v ' KWAN H. WON, M.D, and KWAN H. WON, M.D, P.C., Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW 03-531 CIVIL TERM JURY TRIAL DEMANDED IN RE: MOTION TO AMEND COMPLAINT TO ASSERT PUNITIVE DAMAGES ORDER OF COURT AND NOW, this 17th day of August, 2004, upon consideration of Plaintiffs' Motion To Amend Complaint To Assert Punitive Damages, and following a conference in chambers in which Neil J. Rovner, Esquire, represented the Plaintiffs and Joseph Ricci, Esquire, represented the Defendants, Plaintiffs' motion is denied. Nothing herein is intended to preclude Plaintiffs from reasserting this motion at trial based upon the state of the record at that time. /ell J. Rovner, Esquire 4503 North Front Street Harrisburg, PA 17110 7s the Plaintiffs eph Ricci, Esquire 4423 North Front Street Harrisburg, PA 17110 For the Defendants By the Court, J. Weslf=_y 01 J . , J'. 00 :mae MARY ANN ALHAJ and IBRAHIM ALHAJ, her husband, Plaintiffs v KWAN H. WON, M.D, and KWAN H. WON, M.D, P.C., Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW 03-531 CIVIL TERM . JURY TRIAL DEMANDED IN RE: MOTION TO PRECLUDE DEFENDANTS FROM USING AN EXPERT WITNESS ORDER OF COURT AND NOW, this 17th day of August, 2004, upon consideration of Plaintiffs' Motion To Preclude Defendants from Using an Expert Witness, and following a conference in chambers in which Neil J. Rcvner, Esquire, represented the Plaintiffs and Joseph Ricci, Esquire, represented the Defendants, and pursuant to an agreement of counsel, it is ordered and directed as follows: 1. Plaintiffs will furnish to Defendants' counsel a medical release applicable to the records of Mary Ann Alhaj generated by Joseph Demario, and also Plaintiffs will furnish a release for the medical records of Mary Ann Alhaj in the possession of the Women's Cancer Center of PA, and counsel shall be permitted to provide that medical provider with experts from the Plaintiff's deposition in which she states that she received medical treatment from this group; these releases shall be supplied by Plaintiffs ta'? ? ?? ?'!' ^??? rlnn7 within 2 days of today's date. 2. Within 10 days of today's date, Defendants shall furnish to Plaintiffs' counsel their expert's report on liability, and at least 5 days prior to commencement of the trial term in September 2004, Defendants shall supply to Plaintiffs' counsel their expert's report on damages; any responsive report by Plaintiffs' expert shall be furnished to Defendants' counsel prior to trial. 3. It is noted that Plaintiffs' position is that these releases have already been furnished, but she is willing to do so again. 4. No other relief is granted to either party with respect to Plaintiffs' motion, again pursuant to agreement of counsel. ?1Geil J. Rovner, Esquire _l 4503 North Front Street CJ}'(fGL Harrisburg, PA 17110 YA For the Plaintiffs 21 -1016seph Ricci, Esquire 4423 North Front Street Q S ?',3 Harrisburg, PA 17110 For the Defendants :mae By the Court, Curtis R. Long Prothonotary (Office of the Protbonotarp Cumberlanb Countp Renee K. Simpson Deputy Prothonotary John E. Slike Solicitor n2 - S'31 CIVIL TERM ORDER OF TERMINATION OF COURT CASES AND NOW THIS 5TH DAY OF NOVEMBER 2007 AFTER MAILING NOTICE OF INTENTION TO PROCEED AND RECEIVING NO RESPONSE - THE ABOVE CASE IS HEREBY TERMINATED WITH PREJUDICE IN ACCORDANCE WITH PA R C P 230.2. BY THE COURT, CURTIS R. LONG PROTHONOTARY One Courthouse Square • Carlisle, Pennsylvania 17013 • (717) 240-6195 • Fax (717) 240-6573 MARY ANN ALHAJ and IBRAHIM ALHAJ, Plaintiffs KWAN H. WON, M.D.; and KWAN H. WON, M.D., P.C., Defendants IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA CIVIL ACTION- LAW NO. 03-531 JURY TRIAL DEMANDED ENTRY OFAPPEARANCE Please enter the appearance of the undersigned as counsel for Defendants, Kwan H. Won, M.D. and Kwan H. Won, M.D., P.C., in the above-captioned matter. Respectfully submitted, FARRELL & RICCI, P.C. ~0se~xA. Ricci, E~squire . Attorney I.D. No. 68921 4423 North Front Street Harrisburg, PA 17110 (717) 230-9201 Counsel for Defendants Won CERTIFICATE OF SERVICE AND NOW, this ~ ~4day of April, 2003, I, Lawrence F. Barone, Esquire, hereby certify that I served a true and correct copy of the foregoing Entry of Appearance upon all counsel of record by depositing a copy of same in the United States mail, regular delivery, postage prepaid at Harrisburg, Pennsylvania, addressed as follows: Neff J. Rovner, Esquire Angino & Rovner, P.C. 4503 North Front Street Harrisburg, PA 17110 /(Lawrence F. Baro~ttire