HomeMy WebLinkAbout04-3463
Tucker Arensberg, P.C. 111 North Front Street
BY: Lee C. Swartz (I.D. No: PA-07258) and P. O. Box 889
Stephen M. Greecher, Jr. (I.D. No. PA-36803) Harrisburg, PA 17108-0889
ATTORNEYS FOR PLAINTIFFS (717) 234-4121
LINDSAY A. ESTACIO, a Minor, By Her
Parents and Natural Guardians,
RICHARD A. ESTACIO and LORI
ESTACIO, and RICHARD A. ESTACIO and
LORI ESTACIO, in Their Own Right,
Plaintiffs
V.
MARY A. BARTAS-WHITE, D.O.;
HOLY SPIRIT HOSPITAL OF THE
SISTERS OF CHRISTIAN CHARITY;
HOLY SPIRIT HOSPITAL;
HOLY SPIRIT CORPORATION;
HOLY SPIRIT HEALTH SYSTEM;
HOLY SPIRIT VENTURES, INC.;
SPIRIT PHYSICIAN SERVICES, INC.;
SISTERS OF CHRISTIAN CHARITY
HEALTH CARE CORPORATION;
Defendants
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. ,l'A?3 l ./vtt?cr2?
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
CIVIL ACTION COMPLAINT
"NOTICE"
You have been sued in court. If you wish to defend
against the claims set forth in the following pages, you
most take action within twenty (zo) days after this
complaint and notice are served, by entering a written
appearance personally or by attorney and filing in
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claims set forth against you. You are warned that if you
fail to do so the case may proceed without you and a
judgment may be entered against you buy 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 of other
rights important to you.
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ONCE. IF YOU DO NOT HAVE A LAWYER GO TO OR
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OFFICE CAN PROVIDE YOU WITH INFORMATION
ABOUT HIRING A LAWYER IF YOU CANNOT AFFORD
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PROVIDE YOU WITH INFORMATION ABOUT
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LAWYER REFERENCE SERVICE
Cumberland County Bar Association
32 South Bedford Street
Carlisle, Pennsylvania 170t3
(717) 249-3166 - Toll Free (Soo) 99o-91o8
"AVISO"
"Le han demandado en corte. Si usted desea defender contra Ias demandas
dispuestas on ]as pAginas siguientes, usted debe tomar la acci6n en el plazo de
veinte (20) dfas despuds de esta queja y se sirve el aviso, incorporando on aspccto
escrito personalmente o y archivando on escribir con la corte sus defensas a
objeciones a las demandas dispuestas contra usted el abogado le advierte que que si
usted no puede facer asi quo el caso puede proceder sin usted y on juicio se poetic
incorpomr contra usted compm la corte sin aviso adicional para cualquier dinero
demandado on la queja o para cualquier otra demanda o relevaci6n pedida por el
demandante. Ustcd puede ponder el dinem o la caracterlstica de otra endereza
importante a usted.
USTED DEBE LLEVAR ESTE PAPEL SU ABOGADO INMEDIATAMENTE.
SI USTED NO HACE QUE UN ABOGADO VAYA A O LLAME POR
TELEFONO La OFICINA DISPUESTA ABAJO. ESTA OFICINA PUEDE
PROVEER DE USTED LA INFOPMAC16N SOME EMPLEAR A UN
ABOGADO. SI USTED NO PUEDE PERMITIRSE AL HIRE A UN ABOGADO,
ESTA OFICINA PUEDE PODER PROVEER DE USTED LA INFORMAC16N
SOBRE LAS AGENCIAS QUE LOS SERVICIOS JLIRIDICOS DE LA OFERTA
DE MAYO A LAS PERSONAS ELEGIBLES EN LJN HONORARIO REDUCIDO
O NINON HONORARIO
SERVICIO DE REFERENCIA LEGAL
Cumberland County Bar Association
32 South Bedford
Carlisle, Pennsylvania 17013
(717) 249-3166 - Toll Free (Soo) 990-9108
LINDSAY A. ESTACIO, a Minor, By Her
Parents and Natural Guardians,
RICHARD A. ESTACIO and LORI
ESTACIO, and RICHARD A. ESTACIO and
LORI ESTACIO, in Their Own Right,
Plaintiffs
V.
MARY A. BARTAS-WHITE, D.O.;
HOLY SPIRIT HOSPITAL OF THE
SISTERS OF CHRISTIAN CHARITY;
HOLY SPIRIT HOSPITAL;
HOLY SPIRIT CORPORATION;
HOLY SPIRIT HEALTH SYSTEM;
HOLY SPIRIT VENTURES, INC.;
SPIRIT PHYSICIAN SERVICES, INC.;
SISTERS OF CHRISTIAN CHARITY
HEALTH CARE CORPORATION;
Defendants
COMPLAINT
Parties
NO.
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
1. Plaintiff, Lindsay A. Estacio, is a minor who resides at 1462 Timberbrook Drive,
Mechanicsburg, Cumberland County, PA 17050.
2. Plaintiff, Richard A. Estacio, is an adult individual and the parent and natural
guardian of Lindsay A. Estacio, and he resides at 101 Wickshire Circle, Lititz, Lancaster County,
PA 17543.
3. Plaintiff, Lori Estacio, is an adult individual and the parent and natural guardian of
Lindsay A. Estacio, and she resides at 1462 Timberbrook Drive, Mechanicsburg, Cumberland
County, Pennsylvania 17050.
4. Plaintiffs, Richard A. Estacio and Lori Estacio, are divorced and have joint
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
custody of Lindsay A. Estacio.
5. Defendant, Mary A. Bartas-White, D.O., is an adult individual, a licensed
professional, a physician licensed to practice medicine in the Commonwealth of Pennsylvania,
with an office located at Holy Spirit Hospital, Community Mental Health Center, 503 North 21St
Street, Camp Hill, Cumberland County, PA 17011, who holds herself out as a specialist in the
field of psychiatry. Plaintiffs are asserting a professional liability claim against this Defendant.
6. A Certificate of Merit with respect to Dr. Mary A. Bartas-White, pursuant to
Pa.R.C.P. 1042.3, is filed with this Complaint and attached hereto as Exhibit "A".
7. Defendant, Holy Spirit Hospital of the Sisters of Christian Charity, is a corporation
organized and existing under the laws of the Commonwealth of Pennsylvania, located at 503
North 21St Street, Camp Hill, Cumberland County, PA 17011.
8. Defendant, Holy Spirit Corporation, is a corporation with an address c/o Holy
Spirit Hospital, 503 North 21St Street, Camp Hill, Cumberland County, PA 17011.
9. Defendant, Holy Spirit Health System, is a corporation located at 503 North 2151
Street, Camp Hill, Cumberland County, PA 17011.
10. Defendant, Holy Spirit Ventures, Inc., is a corporation located at 503 North 21St
Street, Camp Hill, Cumberland County, PA 17011.
11. Defendant, Spirit Physician Services, Inc., is a corporation located at 503 North
2181 Street, Camp Hill, Cumberland County, PA 17011.
12. Defendant, Holy Spirit Hospital, is a corporation or other entity or a fictitious
name of other entities located at 503 North 21St Street, Camp Hill, Cumberland County, PA
17011.
13. Defendant, Sisters of Christian Charity Health Care Corporation, is a corporation
organized and existing under the laws of the Commonwealth of Pennsylvania, located at 1100
Grampian Boulevard, Williamsport, Lycoming County, PA 17701.
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14. Defendants, Holy Spirit Hospital of the Sisters of Christian Charity, Holy Spirit
Hospital, Holy Spirit Corporation, Holy Spirit Health System, Holy Spirit Ventures, Inc., Spirit
Physician Services, Inc., and Sisters of Christian Charity Health Care Corporation, are
hereinafter referred to collectively as "Holy Spirit" or the "Holy Spirit Defendants" and all
allegations made hereafter with respect to Defendants Holy Spirit or the Holy Spirit Defendants
shall refer to each of the aforesaid Defendants individually and collectively.
Facts
15. On or about August 10, 2000, Lindsay A. Estacio began seeing Dr. Mary A.
Bartas-White at the Holy Spirit Hospital, Community Mental Health Center.
16. Dr. White's initial diagnosis of Lindsay A. Estacio was:
Axis 1 1. Bipolar disorder, not otherwise specified.
2. Separation anxiety disorder by history.
3. Parent child relational problems.
Axis 11 Deferred.
Axis III Deferred.
Axis IV Severe stressors (parents separated when she was 4; she
experienced her father's move to Delaware about a year ago and
father has since remarried; patient has had emotional and behavioral
difficulties getting more severe since about the 5'" Grade).
Axis V GAF presently equals 50.
17. Lindsay Estacio's date of birth is February 19, 1988. She was 12 years old at the
time that she began treating with Dr. White.
18. Over the ensuing years, Lindsay Estacio had multiple visits with Dr. White and a
therapist at the Holy Spirit Hospital, Community Mental Health Center. The Community Mental
Health Center may also be known as the Behavioral Health Center.
19. During the course of her care, under the direction of Dr. White, Lindsay Estacio
was prescribed various medications, including Depakote, Prozac, Depakote ER, and Wellbutrin.
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20. On February 28, 2002, Lindsay Estacio was seen by Dr. White, at which time Dr.
White noted that Lindsay Estacio was doing quite well overall on Depakote ER and Lindsay
reported, "1'm having the best school year ever."
21. At Lindsay Estacio's June 27, 2002 appointment with Dr. White, Dr. White
mentioned Lamictal as a substitute for Depakote ER after weaning off the Depakote ER.
Lamictal was mentioned as being "weight neutral." The records contain no discussion of any
risks of Lamictal. The records state, "Mom will research Lamictal and then call with decision in
near future."
22. Lindsay Estacio's mother, Lori Estacio, was referred to literature to review with
respect to Lamictal and when she was not able to locate the literature, she was provided with a
Literature Review titled, "Lamotrigine for Bipolar Disorder," through Dr. White's office, a true and
correct copy of which is attached hereto as Exhibit "B". Lamictal and Lamotrigine are the same
medication.
23. Lindsay Estacio was seen at the Holy Spirit Hospital, Community Mental Health
Center, on July 9, 2002, July 13, 2002, and July 23, 2002. On each occasion she was seen by
a therapist and was not seen by Dr. White.
24. On July 25, 2002, Lindsay Estacio's mother, Lori Estacio, called the Holy Spirit
Hospital, Community Mental Health Center, and spoke to T. Tumalo. Lori Estacio requested
that Lamictal be prescribed for her daughter. Lori Estacio did not discuss this request with Dr.
White during this call.
25. In response to the telephone call from Lindsay Estacio's mother, Lori Estacio, Dr.
White prescribed Lamictal for Lindsay Estacio without further discussing Lamictal with Lindsay
Estacio or Lori Estacio. The prescription of Lamictal for Lindsay Estacio was never discussed
with Lindsay Estacio's father, Richard Estacio.
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26. On July 25, 2002, Dr. White prescribed Lamictal for Lindsay Estacio, with the
dosage being 25 mg. per day by mouth for one week, increased to 50 mg. by mouth per day for
one week, then increased to 75 mg. per day thereafter.
27. Lindsay Estacio began taking Lamictal as prescribed, beginning on or about
July 29, 2002, in the dosages as prescribed by Dr. White.
28. Lindsay Estacio was next seen at the Holy Spirit Hospital, Community Mental
Health Center, on August 6, 2002. She was seen at that time by a therapist and was not seen
by Dr. White.
29. At the time that Lindsay Estacio was prescribed Lamictal, which is also known as
Lamotrigine, she was 14 years old.
30. Lindsay Estacio took the Lamictal for three weeks. For the first week she took 25
mg. by mouth per day. For the second week, she took 50 mg. by mouth per day. During the
third week, she took 75 mg. per day.
31. On August 12, 2002, Lindsay Estacio noted swollen glands and she was taken to
her family doctor on August 15, 2002, and strep tests were carried out and were negative.
32. On or about August 17, 2002, Lindsay Estacio went to the beach at Ocean City,
Maryland. Her last dose of Lamictal was on or about August 14, 2002.
33. On or about August 18, 2002, Lindsay Estacio noticed puffy eyes and blisters.
She also noticed sensitivity to light. She was taken to a local clinic at Ocean City, Maryland,
that afternoon.
34. Lindsay Estacio's mother drove down to Ocean City, Maryland on or about the
night of August 18, 2002, and brought Lindsay home.
35. Early in the morning of August 19, 2002, a rash was noted on various parts of
Lindsay Estacio's body, including her nose, cheeks, anterior chest, lower legs, and her hands.
5
36. Lori Estacio took Lindsay Estacio to the Holy Spirit Hospital Emergency Room
where she arrived at approximately 4:30 a.m., on August 19, 2002.
37. On August 19, 2002, Lindsay Estacio was transferred from Holy Spirit Hospital to
Harrisburg Hospital. The physician at Holy Spirit Hospital noted, "The patient is going to be
transferred to Harrisburg Hospital with possibility of early Stevens Johnson syndrome in relation
to her Lamictal therapy which was recently initiated."
38. Lindsay Estacio was treated and evaluated at Harrisburg Hospital on August 19
and August 20, 2002. She was thereafter transferred to the Hershey Medical Center. Her
diagnoses included Stevens Johnson syndrome.
39. On August 20, 2002, Lindsay Estacio was transferred to the Hershey Medical
Center. Thereafter, she was transferred to the Crozer-Chester Medical Center by helicopter,
where she spent five weeks in the burn center.
40. Lindsay Estacio was in the burn center because she presented with a burn-like
condition with blisters on the skin. Lindsay Estacio's condition involved substantial portions of
her body, including mucus membranes, and was both external and internal. Lindsay Estacio
has been described as having Stevens Johnson Syndrome and toxic epidermal necrolysis. The
conditions and symptoms from which Lindsay was suffering as described herein were the result
of her use of the Lamictal prescribed by Dr. White and will hereafter be referred to collectively
as the "reaction to the Lamictal."
41. After discharge from the Crozer-Chester Medical Center, Lindsay Estacio
continued to have substantial medical care, treatment, and therapy because of her reaction to
the Lamictal, and the conditions, symptoms and complications related thereto, including
physical therapy, occupational therapy, treatment at Harrisburg Hospital for pneumonia,
6
treatment at Johns Hopkins University Hospital for vaginal stenosis, dermatological care, and
treatment at Will's Eye Hospital for her eyes.
42. As a result of her injuries, Lindsay Estacio was unable to return to school for the
2002-2003 school year and had home bound instruction.
43. When Lindsay Estacio tried to return to school for the 2003-2004 school year,
she was forced to transfer from the school she had attended throughout her life, Cumberland
Valley, because she was sensitive to the conditions in the school because of the renovations
that had been done to the school. She experienced an allergic or allergic-like reaction to
conditions at her school due to or related to her reaction to the Lamictal and the conditions,
symptoms and complications related thereto.
44. Lindsay Estacio's sweat glands do not function properly and have been
permanently damaged, limiting her ability to exercise as a result of or related to the reaction to
Lamictal that she suffered.
45. Lindsay Estacio's eyes are not symmetrical, they are dry, painful, red, itchy, lack
full mobility and the right eye does not tear, as a result of or related to the reaction to the
Lamictal that she suffered.
46. As a result of or related to the reaction to the Lamictal that Lindsay Estacio
suffered, she is sensitive to the sun and must limit her exposure to the sun.
47. As a result of or related to the reaction to the Lamictal that Lindsay suffered, she
will continue to require medical care and treatment which may include further surgery.
48. The injuries and damages claimed herein are the result of and arise from Lindsay
Estacio's use of Lamictal prescribed for her by Defendant, Dr. White.
49. At no time prior to Lindsay A. Estacio developing the symptoms of the adverse
reaction to the Lamictal did Plaintiffs discover, or could Plaintiffs have discovered through the
exercise of reasonable care, that Lindsay A. Estacio was harmed as a result of Defendants'
tortious conduct.
Damages
50. As a direct and proximate result of the tortious conduct of Defendants as is set
forth more fully herein, or as a result of Defendants' tortious conduct increasing the risk of harm
to Lindsay Estacio of Lindsay Estacio suffering the harm that she has suffered, substantial
injuries and damages have been incurred.
51. The damages claimed in this case include:
a. Past, present and future expenses for Lindsay Estacio's medical care,
treatment, therapy, and health care, which to date exceed $1,000,000.00.
b. Past, present and future pain, suffering and loss of life's pleasures.
C. Scarring and disfigurement, past, present and permanent.
d. Mental anguish, emotional distress and psychological trauma,
e. Exacerbation, aggravation of her pre-existing psychological condition.
f. Lost earnings and earning capacity.
COUNTI
Lindsay A. Estacio, a Minor by Her Parents and Natural Guardians
Richard A. Estacio and Lori Estacio v. Marv A. Bartas-White, D.O. and Holy Spirit
Negligence
52. Incorporated herein by reference are all prior paragraphs and all subsequent
paragraphs of this Complaint.
53. At all times relevant hereto and with respect to the care provided to Lindsay A.
Estacio, Mary A. Bartas-White, D.O., was an agent, servant or employee or an ostensible agent,
8
servant or employee of one or more or all of the Holy Spirit Defendants identified herein, and in
charge of Lindsay Estacio's care set forth herein.
54. In the event that Mary A. Bartas-White, D.O., was not an actual agent, servant or
employee of the aforesaid Holy Spirit Defendants, she was at all times relevant hereto and with
respect to the care of Lindsay A. Estacio, an ostensible agent, servant or employee of one or
more or all of the aforesaid Holy Spirit Defendants in that she was held out as an agent, servant
or employee of the Holy Spirit Defendants by the aforesaid Holy Spirit Defendants.
55. Lindsay A. Estacio went to Holy Spirit Hospital, Community Mental Health
Center, seeking a second opinion, at which time she came under the care of Dr. White. At that
time when she first saw Dr. White, Lindsay A. Estacio carried a diagnoses of: Axis I, 1.
Undifferentiated somatoform disorder, generalized anxiety disorder, depressive disorder NOS;
academic problem.
56. Holy Spirit is vicariously liable for the tortious conduct of Dr. White set forth
herein and the resulting damages in that at all times relevant hereto and with respect to the care
provided to Lindsay A. Estacio by Dr. White, Dr. White was an agent, servant or employee of
Holy Spirit or an ostensible agent, servant or employee of Holy Spirit acting in her capacity as
such.
57. The care provided to Lindsay A. Estacio by Mary A. Bartas-White, D.O., fell
below the applicable standard of care:
a. Dr. White did not carry out a proper evaluation of and reach an
appropriate diagnosis of Lindsay A. Estacio.
b. Dr. White did not confer with or fully or adequately confer with Lindsay A.
Estacio's father, Richard A. Estacio, with respect to her evaluation and diagnosis of
Lindsay A. Estacio.
9
C. Dr. White did not consider or adequately consider information provided to
her or offered to be provided to her by Lindsay A. Estacio's father, Richard A. Estacio,
with respect to her evaluation and treatment of Lindsay A. Estacio.
d. The prescription of Lamictal for Lindsay A. Estacio was not appropriate
under the circumstances.
e. An improper and excessive dosage of Lamictal was prescribed for
Lindsay A. Estacio.
f. Dr. White failed to assure and determine that the proper dosage of
Lamictal was in fact prescribed and ordered.
g. Dr. White was not fully and adequately aware of the characteristics of
Lamictal.
h. Dr. White was not aware of the amount of Lamictal that could be safely
administered to a patient such as Lindsay A. Estacio.
58. The care provided to Lindsay A. Estacio by Mary A. Bartas-White, D.O., fell
below the applicable standard of care in that Mary A. Bartas-White, D.O., did not fully and
adequately inform Lindsay A. Estacio or her mother, Lori Estacio, of all the material risks
associated with the use of Lamictal and the magnitude thereof.
59. Lindsay A. Estacio and Lori Estacio agreed to the use of Lamictal in justifiable
reliance on the representations and information regarding Lamictal provided by Dr. White.
60. Mary A. Bartas White, D.O., knew, had reason to know, or should have known
that Lindsay A. Estacio and Lori Estacio were relying on her to provide them with information
necessary for the making of the decision as to whether to agree to the use of Lamictal in the
treatment of Lindsay A. Estacio.
10
61. The only discussion by Dr. White with Lindsay A. Estacio and her mother, Lori A.
Estacio, regarding the use of Lamictal occurred at the June 27, 2002 visit by Lindsay A. Estacio
and Lori A. Estacio to the Holy Spirit Hospital, Community Mental Health Center.
62. The care provided to Lindsay A. Estacio by Dr. Mary A. Bartas-White fell below
the applicable standard of care in that Dr. White never discussed the use of Lamictal with
Lindsay A. Estacio's father, Richard A. Estacio.
63. At the June 27, 2002 visit, Dr. White "suggested weaning off the Depakote ER
going over to Lamictal, which is weight neutral," according to the note of June 27, 2002. Dr.
White made no note of discussing risks during the June 27, 2002 visit. Dr. White did state that
there had been incidents of fatal rashes associated with Lamictal. Dr. White stated that she
would increase the Lamictal dosage slowly and watch carefully for any rash and advised that if a
rash developed, the medication should be stopped immediately. Through Dr. White's office, the
"Literature Review of Lamotrigine for Bipolar Disorder," attached hereto, was provided to Lori
Estacio. The disclosure of risks associated with Lamictal by Dr. White to Lindsay A. Estacio and
Lori Estacio further fell below the applicable standard of care in that:
a. Dr. White failed to inform Lindsay A. Estacio and Lori Estacio that
because of her age, Lindsay A. Estacio had a higher risk of developing a rash or other
reaction to Lamictal while using, or as a result of using, Lamictal.
b. Dr. White failed to inform Lindsay A. Estacio and Lori Estacio that,
because of her age, Lindsay A. Estacio had a higher risk of developing a serious or
even fatal rash or other serious or fatal reaction to Lamictal while using, or as a result of
using, Lamictal.
C. Dr. White failed to inform Lindsay A. Estacio and Lori Estacio that if a
rash developed, including a serious rash, Stevens Johnson syndrome, toxic epidermal
11
necrolysis or other serious reaction to Lamictal, there would be no antidote and the
condition would have to run its course on its own, and merely stopping the Lamictal may
not bring about a resolution of the condition or halt the progression of the condition.
d. Dr. White failed to inform Lindsay A. Estacio and Lori Estacio that the use
of Lamictal by Lindsay A. Estacio was an off-label use and that the use of Lamictal for a
person of Lindsay A. Estacio's age and for the condition and purpose for which Dr.
White prescribed Lamictal for Lindsay A. Estacio, who was 14 years old, had not been
approved.
e. Dr. White failed to disclose to Lindsay A. Estacio and Lori Estacio the
nature, extent, symptoms, conditions, complications and potential disfigurement
associated with a serious but less than fatal rash occurring or other serious reaction to
Lamictal occurring while taking or as a result of using Lamictal.
f. Dr. White failed to inform Lindsay Estacio and Lori Estacio of all the signs
and symptoms of an adverse reaction to Lamictal.
g. Dr. White represented that the dosages prescribed would minimize the
risk of a rash developing.
h. Rather than disclosing all of the material risks of using Lamictal to
Lindsay A. Estacio and Lori Estacio, Dr. White attempted to minimize any risks by
informing Lindsay A. Estacio and Lori Estacio that she had prescribed Lamictal for other
girls Lindsay's age and by stating that the risk of rash would be controlled by the
Lamictal dosage prescribed.
i. Rather than disclosing all of the material risks of using Lamictal to
Lindsay A. Estacio and Lori Estacio, Dr. White relied on Lori Estacio to research
12
Lamictal and provided Lori Estacio with the article on Lamotrigine attached hereto as
Exhibit "B".
64. The care provided to Lindsay A. Estacio by Mary A. Bartas-White, D.O., fell
below the applicable standard of care and was negligent.
65. The negligence of Mary A. Bartas-White, D.O., as set forth herein, was a direct
and proximate cause of the injuries and damages claimed herein or said negligence increased
the risk of harm to Lindsay A. Estacio of Lindsay A. Estacio suffering the harm that she has in
fact endured and will suffer and endure in the future, thereby resulting in the injuries and
damages claimed herein.
WHEREFORE, Lindsay A. Estacio, a Minor, by her parents and natural guardians,
Richard A. Estacio and Lori Estacio, demands judgment in her favor against Defendants in an
amount in excess of the amount required for referral to arbitration according to local rules, plus
interest, delay damages and costs of suit.
COUNT II
Lindsay A. Estacio. By Her Parents and Natural Guardian,
Richard A. Estacio v. Mary A. Bartas-White, D.O. and Holy Spirit
Misrepresentation
66. Incorporated herein by reference are all prior paragraphs and all subsequent
paragraphs of this Complaint.
67. Lindsay A. Estacio and Lori Estacio agreed to use the Lamictal in justifiable
reliance on the representations and information regarding Lamictal provided by Dr. White.
68. Mary A. Bartas White, D.O., knew, had reason to know, or should have known
that Lindsay A. Estacio and Lori Estacio were relying on her to provide them with information
13
necessary for the making of the decision as to whether to agree to the use of Lamictal in the
treatment of Lindsay A. Estacio.
69. Dr. White represented that the dosages of Lamictal prescribed for Lindsay A.
Estacio would minimize the risk of a rash developing. Said representation constituted a
negligent misrepresentation.
70. Dr. White advised Lindsay Estacio and Lori Estacio that Lindsay should stop
taking Lamictal if a rash developed, but failed to state that stopping the Lamictal may not bring
about a resolution of the rash or other reaction or halt the progression of the rash or other
reaction, which statement was made in the context of a discussion of the risk of a serious or
fatal rash, which representation in said context constitutes a negligent misrepresentation.
71. In reliance on the representations made by Dr. White and the information
provided by Dr. White regarding the use of Lamictal, Lindsay A. Estacio and Lori Estacio agreed
to the use of Lamictal for the treatment of Lindsay A. Estacio.
72. The injuries and damages claimed herein are a direct and proximate result of the
negligent misrepresentations of Dr. White set forth herein. The negligent misrepresentations of
Dr. White as set forth herein increased the risk of harm to Lindsay A. Estacio of Lindsay A.
Estacio suffering the harm that she has in fact endured and will suffer and endure in the future,
thereby resulting in the injuries and damages claimed herein.
73. Holy Spirit is vicariously liable for the tortious conduct of Dr. White set forth
herein.
WHEREFORE, Lindsay A. Estacio, by her parents and natural guardians, Richard A.
Estacio and Lori Estacio, demand judgment in her favor against Defendants in an amount in
excess of the amount required for referral to arbitration according to local rules, plus interest,
delay damages and costs of suit.
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COUNT III
Lindsay A. Estacio, a Minor, By Her Parents and Natural Guardians
Richard A. Estacio and Lori Estacio v. Holy Spirit
Corporate Nealiuence
74. Incorporated herein by reference are all prior paragraphs and all subsequent
paragraphs of this Complaint.
75. Holy Spirit was negligent in that:
a. Holy Spirit failed to formally adopt and enforce adequate rules and
policies to insure quality care for patients with respect to patients presenting with the
conditions with which Lindsay A. Estacio presented, with respect to evaluating and
diagnosing patients such as Lindsay A. Estacio, with respect to the use of medications,
the dosages of medications for patients such as Lindsay A. Estacio and the disclosure of
the risks of such medications;
b. Holy Spirit failed to select and retain competent physicians;
c. Holy Spirit failed to observe and oversee persons who practice medicine
within its walls, with respect to patient care and particularly with respect to the care that
Lindsay A. Estacio received from Mary A. Bartas-White, D.O., the evaluation and
diagnosis of Lindsay A. Estacio, the prescribing of medications for Lindsay A. Estacio,
the dosage of those medications and the disclosure of the risks of such medications;
76. Holy Spirit is a hospital or medical facility that provides a full range of health care
services, including psychiatric and psychological care and services;
77. Holy Spirit had actual or constructive knowledge of the negligent matters set forth
in this count.
78. The injuries and damages claimed herein were the direct and proximate result of
the negligence of Holy Spirit or, in the alternative, the negligence of Holy Spirit as set forth
15
herein increased the risk of harm to Lindsay A. Estacio suffering the harm that she has in fact
endured and will suffer and endure in the future, thereby resulting in the injuries and damages
claimed herein.
WHEREFORE, Lindsay A. Estacio, a Minor, by her parents and natural guardians,
Richard A. Estacio and Lori Estacio, demands judgment in her favor against Holy Spirit, in an
amount in excess of the amount required for referral to arbitration according to local rules, plus
interest, delay damages and costs of suit.
COUNT IV
Richard A. Estacio and Lori Estacio. In Their Own Rlaht
v. Defendants. Marv A. Bartas White and Holy Spirit
79. Incorporated herein by reference are all prior paragraphs and all subsequent
paragraphs of this Complaint.
80. Richard A. Estacio and Lori Estacio are the parents and natural guardians of
Lindsay A. Estacio and are responsible for her expenses incurred with respect to her medical
and health care, and will continue to be responsible for said expenses.
81. As the parents and natural guardians of Lindsay A. Estacio, Richard A. Estacio
and Lori Estacio make a claim herein for the medical and related expenses incurred and to be
incurred while Lindsay A. Estacio is a minor as a result of the tortious conduct of Defendants as
set forth herein, which expenses currently exceed $1,000,000.00.
WHEREFORE, Richard A. Estacio and Lori Estacio, demand judgment in their favor
against Defendants, in an amount in excess of the amount required for referral to arbitration
according to local rules, plus interest, delay damages and costs of suit.
Respectfully submitted,
SIGNATURE FOLLOWS ON PAGE #17
16
TUCKER ARENS)..P.C.
St n M. reecher, Jr.
Attorney's I.D. No. PA-36803
Lee C. Swartz
Attorney's I.D. No. PA-07258
111 North Front Street
P. O. Box 889
Harrisburg, PA 17108-0889
(717) 234-4121
ATTORNEYS FOR PLAINTIFFS
DATE: July 16, 2004
69598.1
17
LINDSAY A. ESTACIO, a Minor, By Her
Parents and Natural Guardians,
RICHARD A. ESTACIO and LORI
ESTACIO, and RICHARD A. ESTACIO and
LORI ESTACIO, in Their Own Right,
Plaintiffs
V.
MARY A. BARTAS-WHITE, D.O.;
HOLY SPIRIT HOSPITAL OF THE
SISTERS OF CHRISTIAN CHARITY;
HOLY SPIRIT HOSPITAL;
HOLY SPIRIT CORPORATION;
HOLY SPIRIT HEALTH SYSTEM;
HOLY SPIRIT VENTURES, INC.;
SPIRIT PHYSICIAN SERVICES, INC.;
SISTERS OF CHRISTIAN CHARITY
HEALTH CARE CORPORATION;
Defendants
NO.
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
CERTIFICATE OF MERIT
AS TO MARY A. BARTAS-WHITE, D.O.
I, STEPHEN M. GREECHER, JR., certify that 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 that is the subject
of the Complaint, fell outside acceptable professional standards and that such conduct was a
cause in bringing about the harm.
By:
DATE: 7,/
70015.1
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
Attorney's I.D. No/PA-36803
Tucker Arensberg, P.C.
111 North Front Street
P. O. Box 889
Harrisburg, PA 17108-0889
(717) 234-4121
ATTORNEYS FOR PLAINTIFFS
EXHIBIT "A"
alui?e Re?ielx is.,.
- T
brought to You by the puhlibher of
CINS News
ne,cca.;uetwsonlinr.cmn
,. .• . ... ??" ?r :`. _s.? . , ..., _"..? _'_• Hay 2002
A summary of research on;
Lamotri Tine for
Bipolar, Disorder
ori?iiSulfy publislie[1':..
pcesente(i.`atr
Yayc iat17C' '
Asso?latioiis?DD1=?nuunl
`IYteefin; "
-•Eiolo?caL E"SyshTatrr
. -JOUrns? Oli EJlnleal`
1'svchiatrg'
-• Jo urn ?l`ottiGJiuicalPsvchopharmueufogy' .'
-Jou('nafeot?PSvcillutly Se.
tVeuroscience,•
:r
'Psychlatr.• Rrsearch,'
American Psychiatric Association Annual Arnerican.lournal of Psychiatry
Meeting. Earl N, Biwn Y, Edwards K, et aL - 1997;154:8: Kus,unakar V, Yatham LIV.
Double-blind comparison of lamotrigine us. Lamomgine treatment of rapid cycling bipolar
_
va(proate on mood and body weight. Poster tt,, -.-. diwrder(letter). -
resentation, tt
p May 2001; New Orleans, La.
5t ?Jp urrta(;af Clinical Psychopharmacology.
American Psychiatric Association Annaa h 2000;70:607-614. Frye(YU, KefterTA, Kimbrell
Meeting. Bowden C. Ascher J, Calabresel. ev. 'UP eral.A placebo-contro,aid.3tudy of lumoc.
aL Lamatrigine:. evidence for mood s[afiil'ca -; rigine and gabaprnttn mbno<herd y in refrac-
n m
don in bipa(ai•1'depression, Poster present¢ ? .>`tor]y mood duorders. ':? ,,?;
don, 11/fay 2001:lYrw Orleans, La.
- w
Journal
American Psychiatric Association A"wsl"'M 88. Calabrese JR Btiwdtirs.CF::,Sbiks G, V UA
Meeting. Calabrese J, Bowden C,.De[leaugh- double-&iend:placeba-eonttollad:'ssudy of Cam-
Geiss r, et uL.Lamo[riginederrtatts<rates long- otrigine monocherapflircouteaaenis with bipo-
term mood stabilLation in recently. manic, :.s Lou-I'depremion-.
patients, Posterpresentation, May. 2001;.lYeea: 91Lssneric¢tajourrzaL of P'sychtaerx.
Orleans, La. 1999;J56-:101971023: Cc/alireselR:.Hawden
American Psychiatric .4'ssoctation:ArtnuuL _:-CE::HcEIi'oy'K eeaE". Speetrurteda&activity of
Meeting. AscherJ,Barnaa S,.Batev:aV UL r "lamotrigine in+.treatmenr-refriU30i:y bipolar
Safety and tolerability of (amotmgme in can di.sardee. i
trolled mood disorder trials. Posterpresenta-- :Blo lugpca F"Psrchiatry_:I9994595'3-9J8.
tiun, Nay 2001: Net- Orleans, La:: "- . Bowden.C1 ;Calabrese JR:tYfeFiCaar SL, et aL
American Psychiatric .4ssociatian Annual .The:rffjscacy,oIamotrisitte^in:rapid cycling
IVleeting. Ylessrnheinter J.4. Ascher J;.Eart lY. -" andnun-eapid. cyclicgpatiente unth bipolar
New irtfbrmatioaconferming tfte:impormncroJ= .-.dverdee.,
dosing and rash with lamatrigiree: Poster pre- ;cLmericamP`1.7chiatree-ASsoceatton:itnaLal
sentation, May 2001;.(veea Orleans,. La: -: ._bCeetiny_$uppes P; dseKeK ?Bawden C. or UL
Journal of Clinical Psychiatry.. _ _ Latrwcrs?ine.in.raptd'=cycGigl bipolar disorder:
2000;ti1:841.i50.. Cafabrese J;Suppes T, -`. prediccorr ofeespanr?': Paster presentation,
Bowden CL.eraGA.doufi(e-blind: p(ncebo-con - :lYlay'_(101 1VeunOtfeans. La.
:rolled, prophylasia.study of(an.ocrifu'ins in _: JtrurrtaGaj+Eiyckin try & Neuroscience.
rapid.cycling bipolar disorder. , ' 20Q1}26:168: Dursun S, Deuarajaa S.
Psychiatry Research. 1999; 7_^^:145-148-. -Piychalsho;maco(ogyfor the clinician.
Kasumaknr V, Yucham L11-1, open studyaf- - -
(arnotrigine in refractory bipolar riepression_
EXHIBIT "B"
Loio,j-m .-Nli, i1lom-h F ? t"r1YF Tflrlf:y
? Irholl h (If of s,ioo urrtn's in epilep y pa lieats at all
A /
1 n.B.tlnlutla rate of +0'Z, to oo%, (Lauulferr rt al.
Lpilel tai 1000:+ [,uppl 101:S21-S47) - it oFteii goes
I I nCi'rtu1ll (11'i rgwI tz r•I all. NeurnloI 190 Q::5 [stLIJ pl
:Ant?icl ilelrlif. ( lru,, (_1LD5) hotcever', Iatie
r-ouutlook het"Il Ifilized in the treatment tll'tnood disor'-
drra. tyilh run•jt, iestilo..
\alplrfwo• (Deparun. rAbB(,tt) is all AEI)5howti oFie :t'ive in
hl treunilr•rLr of I:,ifmlar tlisnr(let. hmvevet. it is a1,0 LUMUriut-
Oil t\ Lill MC I!_1111 Millnl + L" or iuorr ill all to IJ(NO of IfUneuts
((',urniaiYrl .d. ((ur.l \r•1linl5ci 1QQ1:2+3t0=2++: Diuesseia
rI al. :Irla :Aewol .%Lcayid 1011+:60:65-60: Dvao e_i al.
ii.pih•h.virt IOQ:i:;i6(,uppl +):72: kojan•i el al. .'[fill Nenrnl
IJQp:3Q.1'0-ill-0. Tlii, rrul'nlnwatc silly Ial'ferr has heeu
IiIIrd If, tIvul'IIwIII IjolLOlt tpliaif :r (Lr"gar et al. 13RJ
10810'_'1 foul often remains a prol-deua Ihr va.l-
pl.( aw IlllavU IIII oulahoiu.rlrt- course nrthei:r Iese tulle dro,.
LaloWl'i_irar (Lwnirtal, GlaxcSuaitIII<Ji(le), atauljtet
.I) rrrtill look I I to brut Bipolar tlisotdet: was cot if-
it] .(I In valproatr of it ilooltle.-hliull stwiv of epilepav
pulu•u I, r.\perir•nci11, aov fvpe. of sei u:re The
orclliraliuos e•ffrrt., fill nnlot?l an(I Wri,_ht well- rsalttined.
Sol'jrrl, were eli,ilale tot the srLAV if [hrv were Lo'ed 12
or rrh let allrl hall a di:goosis orepilepsy dial could efFec-
HVI'v I,t• treated tvit11 either valprnarc fir lantnrri??iue. in
iulLlilinl. sIII)jecI 01.11! rr•tfllirrtrl Io rirltrr nor Ife oodego-
iii_ Inv ii l u-rtt WirlI a I I AED ar rl It, Altar uF st•hrr.lion for [Ire
,III . Ur I( , hr ahlet Io.3afr•Iv Wi[hch'Ltw flout the uterlica-
Iif II. PaI isms Wert Ila.la,i hlr lot the 9tt itk if they ILad
I•,<I,t/hint to I;i o lull i_i Wva li rna're. LI ,al->a l?rrutiu
(\I Iron Iol. PI'i zel) iII IIIr• Q0 days prior to ,n II IN nn.fer.
\I'Irr a °_-w re.l: ,I.rcetlill, prrrrr,s+ sohp+cts Wert- rall-
Ilonrly us:isued Lo 101-.t•ll'o roller lanurtri,iue or vulproat.e.
hhrc rrnlairted orI IBr otr,dication for 1; w elks. by Which
ruins uololri,_ 11t. I nsa e, WOO( eseulatrd to a daily runMet
Ilo,,r n( ''-'00 Inr (20 m.i5 nth'/hr far valproar,e). -this was
olllmr(I hr '_'+ u,•rl<s of nuliuu•nanrr rill-rally ill which thl•
loony/ri?inr rrnulr wi eived 100 to 5ft) Illy per Clay aryl Iire
talnonw I ]Lmlt Wit, ,iyro 20 1(, 00 o,/I: per day.
Of Iltr t).i :rt Bjcr Is io Ilse Iulnurti_ow ronp Wear
tynnwn. will a 111ozo1 u,rnl :l+.,t±JO. Pifly-roll pelf-ell W
IBr Oll ,Itlyrt'1, of IBr• yalploa1•,ruup tame ietrtale. with a
n1OnII uBr nf:10, 1=1+.
\I Ilo• Ii1nr of sr rlrenill . I.Be narart tyei L"l I'r of palie.uts iu
III( I:olfill it'll r "It'll tyny 156 ponurls. rotopa red In -161
IanIIf I, ill IIf ?aI Ioale hoop. Cha let afizcll tonir-rlooir
tc?, IBr Ion-,I I LIItonn Iapr' of ,eiznrr lot fill .l ill hrrt11
?rhtn ll m. '11w Inn,I roouuoo prrvioosiy Im-,r.rihed ,AI':D Was
bile /n mill MiLill.lin. Plizrr: PbrnettlL Betfeli: unc?•ra) for
Inn11 ±routl,_ fUi o'l" l by i a1'butuazf-I III• (CaIILUIInl.
Sllirr•: ft rl•rnl. \I iItII II-I's) utt11 I)IIi:I hat'IriIaI
TI WIe tats at ta almost If Ill lit l rate Of,ubjects iu 110th groups,
hutt-rver. Cahn were oor oo auv In'evinrts ED regimen. fn
all. +6'%1 of suhjecrs in the taanon iamnr• nup remained fit
the ,ruck tlunn'h rite completion of the waiauenanee
plaa. cv r'onlpwPd in 38% in the vall,trnute 2101-11J.
BV the end of the 3a-week ttL(l). ,abjecrs Ill the val-
proate "rrolap eXjxPtienced a meant wtt^ht lain of 12
potulrl, Li cwirte'ur. for subjects in the lauloni`inr. croup.
itfeau Wr iQJtt gain was I,es, thaul 2 pounds tht'oz.tLItocu the
dutiution of the sL2uh.
Lamou Mine also nuU?etfontterl yzdurrrhte ou Ineasmev of
Inoo1. evaltlatted thro at the Ltae of the Beck DepEl"siou
h.tVP(ttolA (BDI). the Cornell DlstLvrnia Rartne Scae_ unit
die Profile of iWood States. Latnottigioe. otJjjeccs reported
improvemeaats ill morn/ beg.itua,ius at Week 10 1,r1 'the main-.
tC IIll) tce phase. a, measured 1) v BDI score. By the call r le
snlrh: their improvement teas rl,early + tares _reater than
_ Char or vr,lf"-o"te ?rt6?et rs. The Cornell DvstLvuija RadnP
Srade tieldell siutilar results- with scow. irnlnovttneur for -
lutnurri_iruc stl.bjects apps tnutatelr ? tiaiaes 7eater dteua
their lot valproatl-=lhierrs. Luuwttigine patients also rated
ILetrrr vu the Prnrile of ;\'hnal States, rspe,cially in such
arras as drpttssiou-dtjectinu :wd total mood disnubance.
Bared on: EarIN, Biton P, Edwards K et al. Double-blind com-
parison of lamotrio ne vs. valproate on mood and body weight.
Poster presentation, Annual Meeting of the American Prychiatric
Association; May 2001; New Orleans, La.
UiYIIO'!'RIGINN, BENEFITS DI11'li1i.S5im
1.3wi 1-u 1'.mENa;S
The Idepre,,ive plt sc- (it' hipol.u- rGsotder is ussoaaatel
With/ hhher risk of suicide pnr>rrr psvr houhciai func-
lionine>',; and looker fen"th Of epis.a-le rUITLpated to tlae
mantic phase. -Cu date, there is uo US Food and Dot;
?ch,llittivnaGinl. tpprorr;d utedication lbt tilt trr:alptent of
bipolar depression.
Lcunolri!_ior hits lien snldie.d rot efPrrtivent-ss iv the
treunaenr of.hipolar drtpremiou. With favo.L'able results.
'11ais soda rN toliued its use in the prevelttinu nr delay of
depressive upisntle rectu'retlce, it) biputw' I patients whole
Ilao,i I'e ceot episode. wa, IlelJfe,881l111.
Individuals INt-W Lli?-ihle for the ,nick if Ater mere. nut-
purirnts u'ed 18 of' older tvho had a dia,nosis of bipotar 1
will had rxperiem ed 3 or trios lhr?,no.etic turd Stntisticcd
:6/0/111(11 of.I/tribal ULsorrlers. Fourth r(liliuu (OS'il/-(A)
vpisnrles or luood (lisorder in rife pa,r a vents (iuclucfihl at
least 2 depressive ePi,odes laid I oaanir, episoLle). llediUd
ceiteria also had to be nmr. owiodut, rife ubseoce of ?ett-
craJ Ilealllt pavhleuts. purricutaiv thyroid abnormalities.
Study sobjer-ts (n=068) teen. , veu lionotrigi ie 100 to
800 Io" per rlav (.is wouotlterapr fir iu addition to their
cunrnl hipolar treannent re'rintrn. Original cpatulefir I,—
ilnells Weer urauiuarod in salfjerrs wilo Ileuloustratetl at
clinical response to lamotrigirre. The f-linical Global
bnpression-Severity Scale (C•CI-S) .vas aduimistererl for i
weeks to determine d hich patients had achieved stabiliza-
tion of depression. About one half (n= i68) were stabilized
while on lamonisine and eligible to participate in the ran-
domrizacion phase of the study, as evidenced liv score* of 3
or lower on the CGl-S. Of the eligible subjects. 131 elect-
ed to continue with the double-blind study. and were ran-
domly assigned to treatment witli_lamog-igine. lidiiaun. or
p1? ac.ebo for to months. f amo 3 nr was oho well mlerar-
P,1 headache was the most common side effect, repoitied
by I b % of the subiects.
_=i_emea aze,of the stbjects who entered die random-
ization phase was 43, and 57% of :subjects were female.
This group experienced an average of 3.3 depressive
episodes in die 3 years prior to the study.. In all, 35% of
this poprilatiou had attempted suicide, and b3% had
tmdergone a psvchiatric hospitalization.
Although data front the randomized portion of the snrcly
have, vet to be released, the large mmnber of subjects who
were stabilized with larnotrigine, in the ear•lc phase of the
study (Figure 1) points to its effectiveness ill the a'eatnrent
of bipolar depression. according to the researchers.
Bared on: Bowden C, Ascher) Calabrese) et al. Lamotrigine:
evidence for mood stabilization in bipolar 6 depression. Poster pre-
sentation, Annual Meeting of the American Psychiatric
Association; May 2001; New Orleans, La.
9.M
130/c H) PO,tiIAMC, til. NIG ATIL-.N` ,: RESPOND
%
i
TO L m0Tl3JGlNF
Already shown effective in the neatment of bipolar
epression (Calabrese et al. Clio Psachiatir 1999;
60?79<38). larnonwine was subsequelrrly smdied to cleter-
tmne ifs efficacy in the treatment of bipolar patients in
whom die most recent episode was manic or InTomanic.
Individuals were eligible for this dotdcle-blind. placebo-
controlled. flexible close 6mdv if they had a diagnokl of
Bipolar I with most recent episode evaluated as manic or
hyponianic, were at least lu° yeas of age, and had no sig-
nificant health problems. including, thyroid abmormalirv.
In an open-label c eannent phase, subjects (n=349) were
given 100 to 200 mg per clav of larnorrigine as monother-
apy or in coal imen.on with thew rurient n eatmew regimen
for a period of u to 16 weeks. Patients who were imclally
taking concomitant bipolar medications were weaned to
lainotrigine monotheiapy during this eariv phase.
Those patients who achieved mood scabih2a6on were
eligible to enter the randomization phase. Stabilization
was determined by a score of 3 or lower on the CGI-S for
$ consecutive weeks followina_ week 8 of treatment.
Patients were also required to discontinue concornitwt
medications. excluding certain anaio!vtics and hypnotics.
Stabilized patients (n=175) were randomized to treat-
ment with lamonigine (100 to -i00 m;), lldinim ([Eskalith
CR, G1aso3mithKline; Lithobid, Solvay: othersj 100 to
Stabilized an lamatri6ine
? Side effects
`' ? Consent withdrawn
Lost to follow up
? All other
n=962
Figure 1. Nlood'.vaabilization in bipolar 1 depression: stzr.dv results.
Bowden ar al. American Ps yarn Association Annual Meating; May 2001; New Odeana. Ls.
9
12
10
c
N a
a ?
o `
N nd p;
d
4
R z.. ," .
2 .
All rash
A
M Placebo (n=708)
Q Lamotrigine (n=760)
Q Desipramine (n=147)
® Lithium (n=114)
Urticaria Maculopapular
Figure 2. Incidence of rash.
Source: Ascher at al. American Psychiatric Association Annual Meeting; May 2001; New Oneans, La.
400 mg), or placebo for up to 76 weeks. There were ao mg-
nificant differences between the 3 treatment groups in age.
gender. or number of past bipolar episodes. In the lithium
group, 70% of subjects had been hospitalized for psychi-
atric reasons, compared to 58% in the latnotrigine g coup
and 61% of subjects taking placebo. The lithium group
also had a higher percentage of subjects who had attempt-
ed suicide.
The results were evaluated for tune to an intervention
for a manic or depressive episode. Both lauronigine attn.(
lithium outperformed placebo in the amount of time to
intervention for any mood episode and time to any bipolar
event. Larnuuigirre was superior to placebo in time to a
The incidence of serious rash was
greatly reduced when practitioners
followed the modified dosing
recommendations.
depressive episode, while lithittw surpassed placebo for
Janie to a manic episode.
Larnotrl^ine therapy wns well tolerated; side effects such
as-insonmia, nausea, rash, and diarrhea were more corn-
nnonly found in the lithintn ancd placebo groaps'than in the
lamutri sine group. Headache, however: occurred in _20"95-of
la)rnotngine subjeuts, compare( to =, o o panes wTM t)ok-.-
lithimn. and Tb'/o--of individuals in the placebo group.
Based on: Calabrese J Bowden C,A DePiaugh-Geiss J, et a1
Lamotrigine demonstrates long-term mood stabilization in recent-
ly manic patients. Poster Presentation. Annual Meeting of the
American Psychiatric Association; May 2001; New Orleans, La.
SAFETY Of LAIwom]GINE CONFIRMED IN
META-ANALYSIS
ltlsough lrunotrigine is known to be well tolerated ui
i the treannent of epilepsy. resetuchers sought to exarn-
ine its--safety La the psycluatrir. population, given its
increasing use, in the treatment of moor.( disorders.
Data frwn 5 double-blind, placebo-warrvlled studies of
t¢hipolar and bipolar depression patients and 2 i:lonbie-
blind. placebo-controller( studies of bipolar inarria patients
were collared and anaivzed.
The rlepressiou srueffes were 7 to 10 weeks in duration.
rllta,,ether. 002 subjects were randomized to talnotngine
_4_
Simple rash
(closage range, 50 to 400 mg per dav), while 536 were
randomized to placebo. One study compared desipramiue
(Norpnwniu, Aventis: others [n=14?]) 200 mg per clay to
l'mrotriaine and placebo.
One of the 2 sntdies of mania patients included patients
in an acute nharuc episode and lasted for 3 weeks. Subjects
were rahiclonnized to creannent with larnottigine 50 mg per
day (u=33). Iitiium 0.8-1.3 inEcl/L per day (u=:36), or
placebo (n=95). The second. 6-week stttciv ralulomizecl stnb-
jects to treatment with lamotigine 200 mg per clay (n='f),
lithium 0.8-1.3 mEt1/7per clav'(n ??), or placebo (n=77).
i '11110ri",rN ..-cu Roll rnlP ntPd by snnhjects in all 7 aniil-
j,e Anton, both die depressed and manic patients,
adverse events oi:riured in the larnoc igine group at a he-
queucy similar to fiat in the placebo Troup and mxaLved
the nervous, reapiratorv, and digestive systems. Results
were a so smiilar for headache, infection, and pain. Rates
of rash are shown in Figure 2. The rate of rash was slight-
Iv hither for depressed parients in the lamociairre group
than for arnv other treatinent population. occurring in 9%
of patients in this group. Adverse events were reported IZy
32 depressed patients in the lamntrigine group and 82
patients in the placebo group; in the snulies of patients
with manna, 63 patients on lamotrigine complained of
adverse events, compared to 65 patients on placebo.
Desiprannine resulted in a lugher rate of infection, fatigue,
drv mouth, dizziness, aarnsea, constipation, and sweatin,r,
compared to both lanonigine and placebo. Ninety-seven
patients uh the desiprtimine group complained of adverse
events. Lithium was also fotund to lie well tolerated: on[v
56 subjects reported adverse events.
The good tolerability profile of larnotrigine was also evi-
dent by the number of patient withdrawals. Less than
36% of patients in both the placebo and larnotiigine
groups withdrew from the suuly, compared to 35% on
lithium and 40% of those taking desipraraine. The rate of
withdrawal due to adverse events in both the lannotrigine
and the lithiunn groups was approximately 10%, which
was slightly higher than the placebo group. Patients in the
rlesiprarnine group withdrew clue to adverse events at a
rate of approximately 20%.
ous rash; with painctilai attention to the effect of closing.
To do so. thev a.xmrinecl all controlled cloaca] cnials
involving lamocrigine for the occtuc•ence of serious rash.
defined as "anv skins reaction associated with patient hos-
pitalization and lanrotrigine discontnuation. or am case
reported as possible Stevens-Johnsoa syrrclrome [SJS] or
toxic epidermal necrolysis."
Safety information was available on 10,611 adult clirri-
cad trial subjects (1,337 in whom lamottig tie was used to
eat bipolar disorder). Of these individuals, 28 0.26%
eiperienced serious rash. 11 (0,01% developed STS, and
one had ton c epidermal necrolpsis.
In 1994, the dosing recommendations for larnotrigine
were modified. Researchers discovered that thelincidence
of serious rash was greatly reduced when practitioners fol-
lowed the modified dosing recommendations. In epilepsy
patients, when the previously recornrnended dosage was
used in clinical vials. more than i in 17000 patients saf-
fered from a serious rash. When the modified closing was
wed. less than 2 in 1,000 were rioted to have a rash. In vi-
als with bipolar patients using fire modified closing, serious
rash was reported in less than 1 patient for everv 1,000,
Accorcin, to the German Registry for Serious
Cataneow Reactions, incidence of SJ9 also declined as a
result of changes in the recommended closing of larnotrig-
ine. The incidence of pediatric SJS declined from
50/10.000 to less than 20/10,000 in 1994, the vear the
closing revisions occurred. There was also a decline in
adult SJS, although the fib Tres were not as dramatic.
The researchers concluded that there is an effect of dosing
of lamotrigine on the incidence of serious rash, including STS.
Bared on.-MessenbeimerJA, Ascher, , Eari N New information
,firming the importance of dosing and rash with lamotrigine.
con
Potter presentation, Annual Meeting of the American Psychiatric
Association; May 2001; New Orleans, La.
RAPID-CYCLING PATIENTS EFFECTIVELY
TREATED WITH LAIYIOTRIGINE
Based on-AScher jr Barnett S, Batey S, et al. Safety and tolera-
bility of lamotrigine in controlled mood disorder trials. Paster pre-
sentation, Annual Meeting of the American Psychiatric
Association; May 2001; New Orleans, La.
STUDY SBO1'Vs EFFECTS OF EAytoTRIGINE
DOSAGE ON RASH INCIDENCE
T r,eoasideration of the increased utnnber of individuals
posed to lamotnisirne-parriv associated with the vol-
r
urine o£Clinical trials investigatini, its use in the treatment
Of bG polar clisorrler-a team 04rese"auclners sou,ht to exam-
ine the relationslhip benveen lamotrigiire and iisk of seni-
aped cyciiii is believed to occur iii 14% to 53% of
_„"gat3ents diagnosed with bipolar disorder (Dunner at
al .4relti,Cea Psi chiatny 1974:30:229-233; Tonclo et al.
Anna T,w-hiatn- 1998;155:638-645). As marry as 82% of
these patients respond poorly to lithirun (Dormer at al).
While combination therapy is often empiovftd (Sachs at at.
Postgracl ,Vied 2000; Spec No: 1-104; Kustunaker et a1.
Owl J Psychiatn- 1997;42[suppl 12]:15-1009), particu-
larly involving (livalproex (Depakote, Abbott) arid lithi-
um, there have been no controller) trials involy ng the use
of these medications in creating rapid cycling, Researchers
in the current trial .sought to snidv r safety and efficacy
of lainotrigine in the Ion,-rerm prevention of inood
episodes in rapid-rvclong bipolar disorder.
Patients were eligible for this double-blind study if
rhev were aced 18 or older acid had a diagnosis of bipo-
lar I or II according to DSiI!!P criteria. Subjects were
excluded d rhev were mot deemed to he in good physical
health. or had an .Isis II cliaenoeis based on DSAf-IT'cn-
teria (typically associated with medication noncompli-
auce). Patients mere also ineligible if rhev were actively
suicidal or had one of several diagnoses in which anxiety
was a significant symptom.
The snarly consisted of 2 phases. In the initial. open-
label please. lamonigine was administered to 324
patients-who were either eutbvtnic or met the criteria for
a manic. lrvpomanic. depressed, or mixed episode--on a
flexible scl}eelule. taking into consideration concomitant
adrn nisn•znion of divalproe or carbarnazepine. Patients
were titrated to a target dose of 200 mg per dap for the
first 5 weeks; after week 5, dosages could be increased to
up to 300 me per day Additional psychotropic medication
was pennitted only eluting the first 4 weeks of the open
label phase; all psychonopic medications were tapered
after -i to r4 weeks of lamorrigine use if patients "met the
minimum criteria for wellness."
Patients were eligible For the randomization phase if
they successfully had been administered a minimmn
dosage of lamonigine 100 rng per day and scored li or
lower on the Hamilton Depression Scale (HAM-D) and 13
or lower on the Mania Rating Scale (MRS). Patients who
were eligible for randomization also were required to
clerhonstrate no change in lamorigme dosage during the
final week of the preliminary phase, demonstrate no mood
episodes requiring additional medication or ele.ctror-onvul-
sive therapy during the last 4 weeks of the open-label
phase, and successfully taper off of additional pharma-
cotherapv.
During the trouble-blind randomization phase, 180
subjects were assigned to either the lamonigine (100 to
,500 ing per clay) or placebo groups. Multiple evaluations
were conducted during the randomization phase from
weeks 2 to 24.
Forty-nine patients in the placebo group, acrd 45
patients in the larnottioine group required additional med-
icarion for treatment of an emery ng mood episode. There
was no statisticall v significant difference in time to addi-
tional pharmarotherapv. Survival time in the study was 6
weeks longer for patients in rile larnorrigine group than for
those in the placebo rntp. There was also a greater per-
ceurage of patients in the larnotrigine group who compler-
err the smdy on rnonotherapy with no evidence of relapse.
Thirty-seven patients in the tamorrigme group were stable
for 6 months of moaotherapv, compared to 23 in the
placebo group.
TI r,_ washirer r f' - ACc 1 iwern -zonos in
reported adverse ev,ntc Twenn•-eight subjects in the
lamotrigine group versus 24 patients on placebo win-
plained of adverse events. most commoirly nausea and
headache. `
The authors believe These reauhs .su„,est that larnonig-
ine mar be an effecrive. well-tolaf 6 nv tll F • h_
.ir r sw der. Moreover, the surnyal rate in the stucly points
to lamonigma s potential efficacy for bipolar patients who
have difficulty complying with their treatment regimen
clue to poor side-effect profiles.
Based on: Calabrese J, Supper T, Bowden CL, et al. fI double-
blind, placebo-controlled, prophylaxis study of lamotngine in
rapid-cycling bipolar disorder. Journal of Clinical Psychiatry
.
2000;61:841-850
ADD-ON LA1VimiGINE EFFFCTIVE
IN SiPOI,9R DEPRESSIVFS
AS"week naturalistic study was performed by 2
researchers at Canadian institutions to determine the
e€fiea' of lamotrigine as an acid-on therapy to dvalproex
err-the"treatment of refractory bipolar- depression.
Subjects were selected from mood disorder programs at
2 Canadian universities. Patients were eligible for inclu-
sion if thev met the criteria for a bipolar depressive episode
based on the DAI-IF definition and were refractory to
treatment with either a combination of divalproex and
another mood stabilizer or divalproes and an antidepres-
sant. Patients with physical health problems, psychotic
symptoms, a recent history of drug or alcohol abuse, or
concomitant DSAI-IF Axis I or lI cliagnoses were excluded.
Subjects also were required to demonstrate a score of at
least 13 on the 21-item HfllVI-D.
Twelve female arid 10 male patients were selected for
the study, with a mean age of 25.13±12.14. Patients
reported 1 to 24 previous depressive episodes. ranging
from 7 to 38 weeks in duration. Five of the 22 subjects
were reported to be rapid curlers.
All patients were taking divalproex 1,000 to 2,500 mg
per tray at baseline phase. Lamotrigine 25 mg was added
to the existing treatment regimen at week 0 of the current
stuciv, and, then increased to 50 mg at week 2. Patients
were evaluated weekly and completed the 21-item HAM-
D at each visit. Liver function tests, complete blood count.
Survival time in the study was 6
weeks longer for patients in the
lamotrigine group than for those in
the placebo group.
-6-
and sertan divalproex levels were evaluated 3 tunes dtuiu2
the course of tine stud'v.
A response was defined as at least a 50% decluze in
scores nn the HAM-D for 2 consecutive weeks Li compar-
ison to baseline scores. Baseline scores on the H-U,f-D
rauepcl from 19 to 29. Improvement was demonstrated by
subjects in the first week. and scores steadily declined
throughout the 6-week study. In all, -,21% Of subjects
demonstrated a response by week 4. and 63% were in
remission by week 6, as evidenced by a HA:,1-D scope of 6
or lower. Three of the :5 rapid cyclers, however, slid not
respond to this coinbination treatment.
The treannent zegimea studied ire this trial was reported
big the researchers to be well-tolerated. Tire most common-
Iv reported adverse events were headache (5 cases), hand
tremors (3), drowsiness ('I), and dizziness (1); No subjects
experienced a switrh to a manic or a hypomanir, episode.
The authors cited as a trial limitation the fart that
this was an open, naturalistic study. Thev reconrtnend
ed that the topic be studied further hr double-blind.
controlled trials.
Based on: Kasumakar V, Yatham LN.dn open study oflamot-
rogine in refactory bipolar depression. Psychiatry Research
1997,,72.-145-148.
LAIVIOTRICINE EFFECTIVE IN SMALL
RAPID-CYCLING STUDY
?Tustuiakar and Yathvn reported on their 4-week
s tiely involving the adn rt gin ation of laznonigine to 7
^•ipaeemiti?with rapid-ev-rling bipolar disorder.
S3 of the 7 patients were newly diagnosed (mean age,
31" years) and had an average age of illness onset of
appro,drnately 21 Years. These patients were given larnoc-
rigine 25 mg bid, which was raised to 50 ing bid at week
2. Patients who did not respond were given 75 in- bid.
Four patients successfully responded to lamo rigine: 1
responders by the end of week 2. and 3 responded by meek
3.:1.11 of the responders achieved and remained in remis-
sion. The 2 patients who did not respond to lamorrigine
remained in depressive or inued episodes.
The seventh patient, described as an elderly woman
with rapid cycling for 8 years. had previously Undergone
unsuccessful treatment with lithium. rarbamazepine. and
divalproex. as well as several antidepressants. She was
administered tamorrigine in Conjunction with divalproex
therapy while in a depressive episode. The combination
therapy was effective in treating the depressive svrnpcorns
within a week. which had uor occurred while the patient
was on divaiproex monotherapy.
T_lre patient discontinued lamotxigine 4 weeks after
responding to treannent due to the development of rash. She
esumed therapy i ctavs later. and has remained in rerni.9-
lion. I'liere was no incidence of rash in the orner 6 patients.
The authors concltnded that l.unotritine a effective ui
clip nearment of rapirl-cycling bi}-01ar .usortler. Thev
noted that rash. a common side effect of lamoninine. is
snore likely when lamonisine is given in conjunction wiT
Ivalproes_anc1 recoznmencled a narlua increase u . u -
orrigine dosage to prevenr its occurrence.
Based on: KusumakarVYatham LN. Lamotrigine treatment of
rapid cycling bipolar disorder, (letter)..Bmerican journal of
Psychiatry 1997;154:8.
LAMOTRICINE SUPERIOR TO GARAPENT,IN
IN TREATMENT OF REFRACTORY MOOD
DISORDERS
Iris double-blind, placebo-controlled. crossover
study was the first to Compare the efficacy of lamot-
^rigine and gabapentin hr the treatment of refractory
"innoa[' disorders.
Although lithium, rarbama?epine, and divalproex have
been effective in the treatment of bipolar disorder. some
patients present with forms of the condition that clo not
respond to such therapies. These include patients with
rapid cycling, mixed or dysphoric,marria. and comorbid
drug and alcohol abuse.
Both larnotrigine and gabapentin have, been reported to
have antirnanic effects (Fogelson.and Sterzubach. J Clin
Psrchiatn• 1997;D-3:271-273; Stanton et al. Ara J
Psi-ehiatrv 1997;154:287; iMcElrov et- al. Ann Clin
Pa7ychiatry 1997;9:99-103), antidepressant properties
(Kusumakar et al. Fmrhiatn- Res 1997;?2:145-148;
Yming et al. Biol P.syrhiatn-1997;42:851-8'53; Schaffer at
al. Am JPs)-chiatn- 1997;154:291-292) and mood stabi-
lization qualities (Fatemi et al. J Clin Psrrhiatny
1997;58:522-527). This study sought to examine their
efficacy in the treatment of refractory mdod disorders-.
Thirty-one inpatients (13 women) with refractory bipo-
lar disorder and urupolar depression participated in the
study. Their diagnosis was Confirmed based on assessment
using the Structured'Cluilcal Intezview for DS.41-11"Ams I
Disorders (version 2.0). The urajonry of subjects (14) were
diagnosed with bipolar 11. while 11 patients were diag-
nosed with bipolar I, and 6 had unipolar depression.
The inran age of patients in the study at the Hine of
their admission to the hospital was 39.2 years (t9 t). The
mean age of onset of svtnptortu was 14 years (t8.3).
In this crossover snld%. all patients received all :3 treat-
merits. (gabapeutin. lazrrotrigme. and placebo) in 3 sepa-
rate phases. This design encbled the researchers to exzun-
ine possible differences in response to each treatment.
Patients were randomized to each treatment phase. eswh-
fishiug 6 possible combinations of sequences iu which
treatment could be adnimistered.
Lrunonigine was adunuisteeed at all initial to=e ul'
33 111a: rlie rla5t(!?e %N as torn°aserl euch week to a range of
300 of 500 tug per flat ha meek 6. CabaHtentiu was Ltli-
tial ll t,iyr•n at n rlosa,?-e of )00 i I111 pr_I dar. and was tirrat-
ed ro +.1300 w' her dar by the eucl of the srwly. L:[)()Il fail
cou'iplnrinn of arfl 3 phases of the sruclv.. dio.se patients who
a'e.,ponrled m any of rite n'Rartnents mere giveu rile ol)rjofl
nl` repeaun,is that condition blindly for purpose of
response cnufir?nation.
Tile Clinical Clobal inpression Scale rnoclitied for,bipo-
htr Woes.. ((:C[-BP) was the primary irt5tnrrrrent Used to
asst ti? r•esltnnae<wirh regard to hitpro V. nowt tin clepresioo:
mania. ill nyerMd ilhress..=klso usecl o?ere tile HiLVI-D.
MRS Spiefhet,er \rrsietV Rating Scale. and Brief
P vrltiatnr' Ratan- Scale.
?Lalflor6 ine nngre[fortnnd borh? r e tin cwd slsice-
to ill overall real as measured by a CGI-6P score of
touch Or very much i,rnprbyed. Si-teen (,32%) of patients
responded chile nn larnorriitte. compared to a (26%)
along ?abapeudn. and 7 (23%) ill the placebo onp.
Torn-rota percerar of patients with utartia responded to
latnoln,ioe. compared to 16 (32%) rnr placebo artd -i
(30'A) in the I labaI) eIs ti n monp. AlI1 0.g depressed
ppients. 1? (45'%) showed a response to l.tunoa'igue.
compared to ' (26%t) OR gabafetttin, and 6 (19%) of
placebo attbjects.
Both laretorrigirte asul "abapenriu were well-tolerated:
68'%t c the latnotrigine .n'oup aid of the gahapentut
?,roup reporter) nu ttwjnr side effects. teI•vuotrigrne
patient rerloiml hospitalizanoo line to rasli.
Crrfiuugh flew results sc`,gest that larnorrigitte is supe-
rior to gabupenria and placebo in the rreatrrtent of refrac-
torv snood disorders. the researchers carrion that thew
stodv is lujiured. The subjects were highly refractory amd
had esperieocrd considerable espOSLUe to other uredica-
tiowe to which rltev were intoleraur or refractory. Also. a
high peicennCce of the subjecrv were rapid cvdersa
grearor perceura?e Than r„ust.5 in the general population.
These Ihces linut rite ,,eue,ralizabili,n OI' rite Cintlhtgs.
The researchers ulso cored that the 6-week study phase
is a re_laitive.,h= brief period of tune ia'r which ro draw con-
r,lnsions. Mud called for lower studies to be. perfornterl.
Thev also aclaunvlethed that crossover designs are not
Amon depressed patients, 450;'o
showed a response to lamotrigine
compared to 2601o on ga-bapentin,
and 19% of placebo subjects.
n-picahv a preferred method of snuly. However, their rate
severtil reasons n by catnTovdr eFferts slid not corrFonud the
sruci. ittclttdbu, the fact that t.le tespottse rates Were:,hn-
ilar for till 3 phases.
Bated on. Frye AM,, Keteer TA, Kimbrell Tr3, et al A placebo-
controlled study of lamozmoine and gabapentin menotherapy in
refractory mood disorders., journal of Clinical Psychopharmacolo,U
2000;20:607-614.
LAYIOTRIGLNE BENEFITS B1POL,\R
DEPRESSION RATIENTS AS MONOTHERAPY
C alabre.se er ail described the first ranclotttized. pat.•tllel
!group. placebo-connnllecl sti.rrly of trioootlterapv in
the treaumeat of bipolar l depression. This 7-week smdv
inciucled treannent faciliries in tae United States, Europe,
and Ausrlaika.
Patieuts were eligible for the s-ur.ly if they were abed Iu
Or older acrd had been diaposed with bipolar I chsoider,
based ou D5111-!P" criteria. Patients were also rupured to
have experienced at least 2 snood episodes in the past 10
Years, inr:ladu'to at least I martin, or tnued episode. Patients
who were selected were esperittocing a major depressive
episocle at the time it[ the stnchc lasting herween 2 weeks
Laid 12 ninths. Foriaclosiou, patients also weai; rpquired
to obtain a store of at leasr I' on the 17-item HAM-D.
Reasons for esnd'uding i,nclividrrals from the stttdv incladerl
a recent cliagttosrs of pacts disorder, obsessive-comptdsive
disorder. social phobia. btdunia nervosa, rapid-cycling
bipolar disorden and several medical cortclitions.
Oue ltonchrod ainere-five patients were sele'cred For rise
sttrdv artd were rutdotttly assi`nted to larru>nigine at either
a rarget doe of SO utg per day. 300 nt_• per dav, or place-
bo. Patients rer•.eivin,, laurorturine had closing rtrated to
rite target closes over rile course of the 7-week study
Dating rite first 3 weeks of the snidv. ;ill patients receivin{
lanro¢igitte were oat the saute dosage Of 25 tng per day for
the first 2 weeks. and 50 tit,, per -lair For the third week.
Parieun were perwirred to rake specific wacountarrc drtras
for the treatruenr of agitariou. insomnia, and hostile
behaviors durtul" the first 3 weeks of the study. So Other
tnerlit aborts were pertrritterl.
Darin, rite 2 weeks prior to t:reanttenr., patients were
screened tryilll It variety (IF iusnumenrs. IuGhtding rite
Strucna'ed Glir6crd la:erview for DSNI-11'. rile HAui-D. the
Vlonegotne.n?--lsberg Depression .Ratio,, Scale (!blrlllRS),
the V[RS and the (Gl-S. A play sisal estuniua on curd lab-
nratnta tests were also condntrecl. Irnrucrliately before the
start Of rreaunetrt and daring the study, patients were
assessed rising rile, above'insrntutens as well as tile C'Iistical
Glohal lrrtpressiotts Scale for hnprneemeot (CG[-I) ;.;
1lrproshuauelr AM% of rile patients withdrew pi'e.na-
olrely li'ntn rite srocly. (11) in the placcho,lroop. 33 in the
Iatnorri,iotl 50-utl-Ver-flay group. eUld 13 iM rile larnor-
41_
ripiot 200-ni_-per-dai ,•nop).•Advm,(, evenh Nvere the
1110st (011lo on reasoue Cited for o-zrhdrateal. There inClud-
ed clevelopmenr or worseriill. of malda told depression.
and he.adarlte. which was the most ronunon adverse event
(occra:rin^ in olore than 30% of patients in each of the
tuuctdgiue e?softps Wilt 1?% of placebo Parietlts). Nausea.
paut_ rash, aiid dizziness were also Conunoith= reported.
Over,-dl_ fiowever. ltunocriginr tca, w-rTf mlrrnrerl 211 3
Lzlimps mere Pssetatiall ?- et:ILItil in fillrIII) er of Padent'.q with-
?,frawiu?' clue to adverse events'. .
Oae lttutrh'ed eighr(?Iett fen]ales and 77 males partid)ar-
ed in the stony. With 6 mean age of about -t0 vema. The
clean a"e of sn-1. cool onset was approsimat:rIV 21. itfl)
iVhaeh'-one gercettt of dae patients had received aeatm.ent
in rile p]st for hipolar rlisorrler•., rnosr cmnarionly with arai-
lepresstwts. litbitu.n, or valproate, :Moro. than hzdf of the
parient, had been pretiottYly hospittdizerl. .
Ao;ordioa to ieeults on I:he 1?-iurin Hlw1-D; lauam'ia'-
iue patients to both limps deuwnsernn:rl a 13-pniur
i]oprovcoleot. h'otn baseline s(;ores, compared to a 9-point
irtprovernertr,iu tamyiarubo ?rrn:gt. Scores oil the 31-ilem
1-JAyl-1) core also sur.iReandy unprover;l for thehunorric-
iale grYUrps versus placebo, a.9 evirlenrerl hr if uaeao scfirc
reduction of 191 points compared tit 1+6 in the placebo
group. Siruilai restdts weir seen off the VIADR,S. us the
mean acme unpr'overueut ill the taanotri?ine Foop wall 10
points, cofupared to 10 points in the placebo gtnftp.
Scores on the CGI-S dropped approxianatrly 1.3 prlutte
in body lanlouipie on-ottps. compared to a 0.9 reduction it]
dte placebo group. X111 :3 ;roups demonstrated improve-
nteut on the OCI-1, althmt"h the differences hetweeo theist
were not aigttificantly diffneor.
Cl'lann'en in .sclrres oil the VIRS wise u1in6nal. There wan
tin ineretue in scores for (lie, 50-alt-per-dag? lasnotri cirle
group and a slight decrease, for the placebo acid 200-w -
pe.r-day mroup. .
The atarhors note [hat ahhou;h this study sugp?esle that
huuorri"ine Iran wllif'it.aat C[Ficauv ill rile, trearvient o,t'hipu-
lar depression. 11'101-P were limitations. Sprr ]rically_ rile 2
lamotiiane grorps received the seuue dosage fur rlar First 3
weeks, tnultigq in both ,,coups h to mg difFeren]. durarioos of
treamtent at the. hurler dole. The tese-of hen9 n?cununeudrrl
a lower duration 101 '1110 blind please of future sruflie?.
Bated on: Calabrese YR, Bowden CL, Sachs G, et aL A double-
blind placebo-controlled study o(lamotri,ine monotherapy in outpa-
tients with bipolarI depression. JClin Psychiatry 1999; 60:79-88.
RLPRACTORY BIPOLAR P,MEN7;9 IMPROVE
Winj Lk)9o'rRmGiNr
A111111[1] enter ..t.urly i]n•olvioY facilnir..,, in the t,uiw(l
Srates (Mood Iitutdo]u. wo.1 Dennrul, w•as courluc]-
]td to evaluate the 'No.ttcc ill tarnor]A ioO ill ptuien]s with
rreuilltent-refractory bilp)(ar,lisunler. -
Scores on the CGI-S dropped 1.3
points in both lamotrigine groups,
compared to a 0.9 reduction in the
placebo group
SrvrutS-five patients were selected for the sUfdv bases)
Oil their tneuring D, tM-)T' r-riteiia for biloolar Jh.5orrler
depressed. hyponuttuc. manic, ttv.xed. not orherw-ise
ifierl or unspecified type. G:r:ha-rhref- prrn-cur
were diagnosed with bipolar- 1. 15°6, with bipolar (I. turd
2%) NOS. Moto al-e. of ousut. was 3a vetus. tl1. tyith a
narart current a;e of
+-t tl l .
Patients were excluded Fimn the 4111 IV if tltev [tail pre-
viuush- nodergone veuuluent with laruurri-nle. were expr-
rienlr,v a sag.ificant medical Oliless- hid beeo active),
stricided in late pant. or haul If Wsro.rv of dirt, anr.l ulruhnl
.base in the past 1.2 1110nt91s. In ariditiort. patient,, weir.
rcgttue(j to have been ruties1)011 ve a)War'd OF iutnleraut of
pervious rrteclieatioos. Sinn` sublttts receiver) larriot Iigine
as tut adjunct to exisdtsg medictt(iors, while, l:i received
lamob i_ute as rnouotlteratav.
The etitdv,lasted 23 weeki followed by a 24wer.-l< rsu;u-
,sion. Patients were perntitterl to rake 1CM7.epam (Ativart.
W.1-oth:-orhets). r:Itloretl hvdlate, artil osazepanr forireat.-
ment of insotunia or irntability. Duriu,< the aef ortrl 21-
we:elc phase, ronroutitaot ps valtlatrh: med'icatinus (Oulu he
introclucerl sir f6cuutiuurcl as needed.
LanrotaL;'iue doeages were Udoollisterrd hasrrl fill mn-
routittutt use of , .u'batnazepiue or vulprAate- For patielo s
who Wert, ttd<i.n!t tamotrt,iue as anouothecal)y m• ill nfin-
juncnon Witt] e] drug artier Chart vrdlnnarc or carba-
rrtazepme. lamorrigiue Was brrated Your it doaune ul! •_'$
fug per day to a mdxituom dosa-r.- of 500 ing per (lav by
rho 1itt.d week ot'treatrneut. Patieurs iaki.an vtdlaoap• L I
laulor'ri-into received initial hunorrigirur r(o,a_es of 25 m,•
ev0rv other day. ro(lowed hr antun'i;:ioe 25 oft per ]lay.
their itwrrutlrs of of to °_'o ]nu per rluv ru tr n]a.vifuu]n dole
of 200 ]fig. Patients skill, rnncouJtwtt tzuluuuttztrpiur;
were aduuuisrerrd lamotritwe at SO mo, per ,lay for the
first 2 wicks. followerl by 100 me pe,r day for wnrls 3 owl
i. then up to et 100-fist uxietwe per, day fur a ]uaxitoum
natal of '00 utr pm day.
Srrerad iasuvmeuts wore used it) ]leterufine w poosr.
fur ludic rho 31-tiro HAtbi-D. bIRS. CGI-5.ofd CGI-I.
Sro]t_swererake? l3little, dutiu,•ihr]uws] nfthesfotly.
Perim], alto had the opportottin ]n aive y-rhUl rrPnrri or
utl crier rvruts at c•arlf visit.
_9_
Fifty-rive percent of patients disconfirnued die study;
diseonrinuat oo most cornmonly was actr:ibuted to adverse
events Lul d lack of eff'icacv.
The results were broken down according to bipolar nTe.
.inonu the -11 patients who presented with depressive
sriuptouts. +0 were iucluded ui the efficacy analysis. 68%
of those responded to lanionigine oeattnent, and 18%
esperienced marked improvement on the 1?-item HAM-
D. Score, ou the 1'. -item FL04-1) choppecl from 20.3 at
baseline to a last-observation-r-aniecl-forward score of
11.8. Results wee similar on die 31-item HAM-D. -lean
scores on die 1 ;GI I lied c[ rapped From -1.8 to 3.0, and 45%
of patients Were reportedly much improved. Eight
depressed papFUrts received hunotrigine monotherapv, and
5 cletnontstraterl either moderate or' marked response, as
measured by the H,-LNI-D.
TItuTV-one patients presented with hyporshanic, manic.. or
mused s.?nptoms. In all, Bi% responded to treatment with
larnoomile as measured by score on the tVIRS; 81% report-
ecl a marked respnnsr.. Mean scores ors the MRS fell front
30.9 to S.t, and unproventents were noted after 7 days.
Seven patients discontinued the study clue, to rash; over-
all, rash was observed in 11 patients. Other common
adverse events that occurred in the saifv were dizziness
(29%), tremor (23%), and somnolence (21%0). Four
padeuts also experienced exacerbation of ni<lnia and 4
developed switches into mania. Although tile occurrence of
rash was a concern, the authors noted that the risk of rash
increases when lamotrigme is taken in conjunction with
valproate or when the recommenced initial dosage of laut-
otrigine is exeeeclecl.
The restults of the studv suggest that larnotrigine suc-.
cessfnllv reduces symptoms For patients with treatment-
refractory depressed, manic„ hvpo nanic, and mixed bipo-
lar I and fl clisorcler. Larnot igine appeared to be equally
effective whet aclntinistered as monotherapv or adjunctive
treatnnent.
Bared on; Calabrese JR, Bowden CL, McElroy SL, et a1
Spectmm ofactivity oflamotrigine in treatment-refractory bipolar
disorder. Am J Psychiatry 1999;156:1019-1023.
LAIVIDTRIGINE REDUCFS RAPID CYCLING
SYNIP`I'01VIS IN RFFRACTQRY PATIENTS
Lamotri,ire demonmtrated nFhcacv in treating bath
mama and depressive bipolar symptoms ht a study
involving rapid- and nwr-rapirl•ovelh g patients w It
bipolar chsorder. Lantonigine was also well tolerated in
this populauort. consisting of mYmv patients who pre-iout -
k were nonresponsive ro other forrn5 of treatmenr.
Rapid cycling is linked to serious impairment in func-
txotilug. Previous studies show that lithium (Danner et al.
Arch Celt P.s}eleiatrr 1976:38:11?-120: Denicolif et al../
LZirt ?q-(-1ucetn '19{J?,?fl:-t?0-t'ii) and carbamazepine
(Joyce et J. bit Clin Psrchoph¢rmcecol 198213:123-129:
Denicoff et al. ? Cur Psrclzintny 199?;53:+?0--k?8) have
not been successfirl m the treatment of rapid cycling.
Divalproes has demonstrated of=icacv in 3 open mainte-
nance studies (McEhov et al. ? Clirt Psychintf
1998;8:273-279; Calabrese et al. Ant ? Ps_rchiatry
1990:1-17:-131--1.3-1). In the current srudy. latnonigine was
examined for its efficacy as monodrerapy or in conjunction
with other medications.
Sevennr-five patients who wen currently in a manic,
htpOmanic, mixed, or depressive ep sprJe as defined by the
DS1ll7Ponteria participated in the study.. AJl patients were
at least 18 v ears of age. Forc -one of these patients met the
criteria for rapid cycling. All patients in the study had
unsuccessfully undergone rreanttent in the past.
Primary efficacy meastnes included the MRS derived
from the Schedule for Affective Disorders and
Schizophrenia, the H?UVI-D, acrd the Global Assessment
Scale (GAS).
Patients who took lamorri ine as monotherapv were
prescriber) an initial dosage of 25 mg per clay, which was
increased by up to 200 mg per clay to a maximum dosage
of 500 in, per clav. Patients taking valprdate were given
25 ing lamotrigine every other clay, which was increased to
a nraximurn of 200 mg per clay. Patients taking concomi-
tant carbarnazepine were initially given 50 Trig lamorrigine
per dap up to 700 mg.
The studv was 9-4 weeks in lerioath. Patients were given the
option of remaining in the sruciv art additional 24 weeks.
Both rapid-cycling and non-rapid-cycling patients
demonstrated significant improvement on all measures,
although rapid-cycling patients showed less improvement
on the MRS than non-rapid-cycling patients. Me" scores
on the -IRS fell from 20 for rapid cvclers and 23 for
non-rapid cvclers to 4 and 0, respectively, by week 48.
Improvement in depressive symptoms was similar in both
groups as evidenced by scores on the HAM-D. which fell
from approximately 20 to 10 for both groups. Rapid
cvclers' mean scores on the GAS went from about 45 to 60,
with non-rapid cvclers' inean scores shifting from 50 to 65.
Dizziness was the most common adverse event reported,
occurring in 13 rapicl cvclers (32%) and 15 non-rapid
cvclers (44%), followed 13v headache (15 [37%] and 8
[24%], respectivelv). Rash, a common side effect of 1am-
otzi,ine.. occurred in 8 of -;1 rapid cvclers (20%), aurd 14
of 34 non-rapid cvclers (il%). Thirteen percent of
patients (10) discontinued treatment due to adverse
events. including 7 because of rash.
The authors concluded that both rapicl- and non-
rapid-cycling patients clenronstated improvement in this study,
despite a previous lack of success with other medications.
The reseazchera cited several potential weaknesses in the
stttth-, including the fact that the rapid cvclers who clid not
improve sigrufic<andy had a high severity of symptoms at
file onset of teanuent. Therefore. famorrignre may not be,
appropriate lbr this subgroup of rapicl cvclers.
? 50
m
2 40
E
O
U
N -
to
+ 20 -
CL
w.
O 10
0
Placebo
® Lamotrigine
P <0,05
n=324
All Bipolar I
F{cure 3. t12onotherapy cooaplelers: stahie willtoul relapav.Jbr b rnontlm,
Source: Suppes at at. American Psychiatric Association Annual Meeting; May 2001; New Orleans, La.
In ar.lchrion, rltr, open cfesi t of rile acndv lends itself to
bills. Also there was a hilt percentage of patients with
rapid cycling wmpared to the general population. and this
may limit die,efierabzability of the restdty. Fimdly. while
malt reateins a roorern WFtrn administeria 4nnotri,ine.
this may be avoided bv.slowly ritratirt the (Im-. Smaller
.7 r7
doses.. however- may tesnlr io Amer mauu enteur uf'svmp-
tot,ns for patients with nmre. aeveca ),'orris of the disorder.
Bated on: Bowden CL, Calabrese JR, McElroy SL, et al The
efficacy of lamotrigine in raid cycling and non-rapid cycling
patients with bipolar disorder. Biol Psychiatry. 1999,-45.-953-958.
PREDICTOWi OF RESPONSE, TO
gtnap of tfsestrclters was able to iClrunh rh tracteris-
rics of p.utrurs wirlt rapid rrdin?• Iupolar disorder
who responder) to la.nojrn,ioe that could t.ffectively pre-
rfictoverafl success wall rile trea[mrut.
Three Imodir.rl iwenn'-four patirus who suer r1le crite-
ria for bipolar f or If disorder with spiel t cLhng, accord-
ing to DSl/-I1 (v feria. were enrolled in the initial i) to 13
week open-label arabilizaduo phase of tile t-Llfly. Patients
mar ur trial nor have been ill a11 active episode at study
onset. Douin_• this phase. latnorricirtr 100 to .300 oo, was
added to parietns r;xtseutp hipofar rreaunent reritnens.
Co-ocuntiranr ntedioarfnns ogre discontinued lot. patiens
wito t:atihired a response. and rltose patients rftert wf-le
rainlowly assigireel to either trearment with lwtotri; to as
tnonudterapy or placebo for b rnnnths. Response was
determined by a score of 1-i or lower on the.. 1'-item HAM-
D. and a .score of 12 or lower on the MRS dminj the last
`? tver.ka of the open-label stabilization ohase.
The researchers were interrsted in identihma variables
that were predictive of a response to trounnrot. Then
focnsed on charam:eJiktics such is t,e of s'nipta¢r oruet.
,ender, aundler OF episodes, and historT of ltospitalizat ou.
One hundred ei^ltty-nvo padrnts entered the random-
ization phase, (age mange, 13, to 64). F?ftv-seven percent
were Female. A greater percentage (71%) were cliagrooaed
with bipolar I than with bipolar 11. Patiauts had an aver-
age of 0.1 episodes in the previous year. Fifty-Four percent
had previously talten vttlproate. while 40% had been on
liduum. Depressive episodes were most comtnonh• cited.
OnCllrTin, in 54%, of the 182 patients.
Overall. patients in the lamorri tine. anup remained its
rite sroflv for a median lime of 1:3.3 works, rompaxurl to
'.l weelcs for plitcebo patipors. 'Fite lantnnigine grntyt
(median length of stav ut anviv, 18 weeks) si,rtificanrly
oinperfonned placebo (merlian length of atav in snuck. b
weeks) for patients Willi ulore severe (b ov tlrow episodes)
bipolar disorder.
Patients in rile latnurrigine ntonorlterapv moop also out-
pedortned placr•.ho with regard to stab'ilizatioo in 111e absence
of s\ inproms for b inonthii (Furor )). TILs was e pecudlr
one for patients with hipolar ll cotrlpmed to bipolar I.
The authors it etttifie.d a ntmlhrr of vsu'ialtles aasocialerl
with it ,rrarer l,ikelilrood of response. uxln aita, Female
-11-
? J
Bipolar II
,,ender: an tLse of onser of bipolzu disorder of less than 10
years. ab.,rnce of fam l? history of bipolar d solder. and
quick stabilization [luring the iiutia phase of ureatrneim
Based ore: Steppes P. Ascher./. Bouderz C. Lanzotrigine
ut mpid-cn•cling bipolar des?oider: predictors of response.
Poster presentation. _41714leal ;Meeting of the .American
Psrchiatric.Association: -Wav2001: i?ew Orleans. La.
LAMOTRiCINE G IN? BE SCCCESSFU7. A
?. _. ?. ADDED TO 11STINC SCHIZOPHRENIA
REGIMENS
n a rlttesnoo and answer cola n in the Journal of
Psync?atii- & Veurosrlence. Dursun and Devarajau
responded to rile rluestioa of which clinical points to con-
Siderwheir lalnonisine is used ill conjunction with clozap-
ine ul die neamieut of schizoplueria.
Tire audiot:s note that the cluuonate system appears to
play a pzur ill the pathophNsiolog?- of schizophrenia. vet
there cue uu antipsychoric met.11carions that primarily rar-
,•et the gl unrnate system. There are 2 hypod'teses support-
ing the belief that the glutamate sy tear is- involved in
schizoplueuia. According to the ghltamate lrvpohareriou
h othesis. "psyrau togeuic ageur? SUCK as pbericvclitline
anal ketatnine (Ketalar. King: urher.Sj hloclc V-urethvl-D-
asparuae iecepturs.- No medication. has been Successful in
`restoring the proposed glutamate deficit."
In counast. the ,nlutaruace frvper$urction hypothesis
purports rhia are exuess of glutamate cournbutes to echiz-
oplu'eiia. Lamon?igirte has been shown to decrease '-the
release of dutarrlate hors t'he presynapric terminals." It
bras also been an effacdve adjunec to clozapine (Clozaril.
?ovaztis; others) hl reducing samptoms in parieats with
refracturc scluzoplireuia. Its use has also b' veil supported
because it does not rause weight lain and `may cotnrter-
act anv epilepcogertic acri?ic?' of clozapine. Lamotrigine is
also nor known to have serious csadiac. renal. or hepatic
side effects.
The authors propose several :ecornmendarions when
larnonigine is used to augment clozapine. First. thev cau-
tion that clozapine is intenderl to be user) as a monochera-
py. Before-? iuavchirin_ g'unotn_,iie.- phy sicians shOU.1d
ensure that blood levels for clozapine are iu the therapeu-
tic came and that patients have been riling ina?irnum
dosages for a urirumwu of 1u to `..f weeks. Coucomirant
medications should be avoided.
Se:nucfly, parents should be. irrf'orinerl about rill: of rash
widr lamomzaie mid Should be adaised ro monitor anv
changes to dle skin. Dosing of ',amonigine ihould lie
irtcreased cautiouale as !rights doi<ures tu-e mote 1il;eh- to
protluca rash. tlrr uutial I tcorrunentied 110s We is -1 `2.5 to 25
n>,, claily. nriared very slowly ba 25 n? prr den, ¢asemeuts
each week surd a tespnose is demousu'ared. 1?7llie moa
parents raspoud io 150-300 M, per day, a rnaa-urtpm
allowable clo,age is 300 rn- per clay.
rinally. a case of rgranuloct psis believer) to be associ-
ated with lantoui?e lads been reporr?,-?.1. It is_ therefore,
important for Cliniciala9 to Monitor For dus coucl,i.tiou whra
prescaibing Luliorrigiue.
Bated on: Dursun S, Devarajan S. Ps.VchopharmacoloEv for the
clinician. Journal of Psychiatry &Nc imscience.2001,26:168.
l1,osearea Poegauo Pe i. P.rr.D.
The preceding liteirtttue review i.s a scunurary? of*studies and represents wilt- a fraction of llte acailuble literattuze
wn latrwrigine. The reader is advised to research orz?irtal articles on this s-ubjert. Other pabltsfred sturliex m?47' Or
rrtu.r gut suppurt the firalmirs dts-cctssed rebune.
-1L?_
VERIFICATION
I, LORI ESTACIO, Plaintiff, acknowledge that the facts stated in the foregoing document
are true and correct to the best of my knowledge, information and belief.
I understand that any false statements herein are made subject to the penalties of
18 Pa.C.S.A. Section 4904, relating to unsworn falsification to authorities.
??Q
oz-(Clio
70025.1
VERIFICATION
I, LINDSAY A. ESTACIO, Plaintiff, acknowledge that the facts stated in the foregoing
document are true and correct to the best of my knowledge, information and belief.
I understand that any false statements herein are made subject to the penalties of
18 Pa.C.S.A. Section 4904, relating to unsworn falsification to authorities.
a69 e
70025.1
VERIFICATION
I, RICHARD A. ESTACIO, Plaintiff, acknowledge that the facts stated in the foregoing
document are true and correct to the best of my knowledge, information and belief.
I understand that any false statements herein are made subject to the penalties of
18 Pa.C.S.A. Section 4904, relating to unsworn falsification to authorities.
Richard A. Estacio
70025.1
? ??
? ?- c
? ??,-?
?J
?,:
LINDSAY A. ESTACIO, a Minor, By Her
Parents and Natural Guardians, RICHARD A.
ESTACIO and LORI ESTACIO, and
RICHARD A. ESTACIO and LORI ESTACIO,
in Their Own Right,
Plaintiffs
V.
MARY A. BARTAS-WHITE, D.O.; HOLY
SPIRIT HOSPITAL OF THE SISTERS OF
CHRISTIAN CHARITY; HOLY SPIRIT
HOSPITAL; HOLY SPIRIT CORPORATION;
HOLY SPIRIT HEALTH SYSTEM; HOLY
SPIRIT VENTURES, INC.; SPIRIT
PHYSICIAN SERVICES, INC.; SISTERS OF
CHRISTIAN CHARITY HEALTH CARE
CORPORATION,
Defendants
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 04-3463 CIVIL
CIVIL ACTION - LAW
JURY TRIAL ]DEMANDED
Please enter the appearance of Francis E. Marshall, Jr., Esquire and Thomas M. Chairs, Esquire
of Dickie, McCamey & Chilcote, P.C. on behalf of Defendants Mary A. Bartas-White, D.C., Holy Spirit
Hospital of the Sisters of Christian Charity, Holy Spirit Hospital, Holy Spirit Corporation, Holy Spirit
Health System, Holy Spirit Ventures, Inc., Spirit Physician Services, Inc. and Sisters of Christian Charity
Health Care Corporation.
Respectfully submitted,
Date: op? /),c y
1
DICKIE, M/Ci Y & CHILCOTE, P.C.
By: `
F n ' E. Marshall, Jr., Esquire
reme Court I.D. #27594
Thomas M. Chairs, Esquire
Attorney I.D. #78565
1200 Camp Hill Bypass
Suite 205
Camp Hill, PA 17011-3700
(717)7314800
Attorneys for Defendants
CERTIFICATE OF SERVICE
I, Francis E. Marshall, Jr., Esquire, hereby certify that I am this day serving a copy of the
foregoing document upon the person(s) and in the manner indicated below, which service
satisfies the requirements of the Pennsylvania Rules of Civil Procedure, by depositing a copy of
same in the United States mail, first-class postage prepaid, as follows:
Lee C. Swartz, Esquire
Stephen M. Greecher, Jr., Esquire
Tucker Arensberg, P.C.
111 North Front Street
P.O. Box 889
Harrisburg, PA 17108-0889
(Counsel to Plaintiffs)
DICKIE, MCS'M4FY & CHILCOTE, P.C.
Fr c E. Marshall, Jr., Esquire /
eme Ct. I.D. #27594 G
00 Camp Hill Bypass
Suite 205
Camp Hill, PA 17011
Dated: On O?`,` Counsel to Defendants Mary A. Bartas-White,
t vV x D.O., Holy Spirit Hospital of the Sisters of
Christian Charity, Holy Spirit Hospital, Holy Spirit
Corporation, Holy Spirit Health System, Holy Spirit
Ventures, Inc., Spirit Physician Services, Inc. and
Sisters of Christian Charity Health Care
Corporation
I'
C.7
z? r rl
a =_
1A) LJf f7
CO
SHERIFF'S RETURN - OUT OF COUNTY
CASE NO: 2004-03463 P
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
ESTACIO LINDSAY ET AL
VS
BARTAS-WHITE MARY A ET AL
R. Thomas Kline
, Sheriff or Deputy Sheriff who being
duly sworn according to law, says, that he made a diligent search and
and inquiry for the within named DEFENDANT , to wit:
SISTERS OF CHRISTIAN CHARITY HEALTH CARE CORPORATION
but was unable to locate Them in his bailiwick. He therefore
deputized the sheriff of LYCOMING County, Pennsylvania, to
serve the within COMPLAINT & NOTICE
On August 17th , 2004 , this office was in receipt of the
attached return from LYCOMING
Sheriff's Costs:
Docketing 6.00
Out of County 9.00
Surcharge 10.00
Lycoming County 22.50
.00
47.50
08/17/2004
TUCKER ARENSBERG
Sworn and subscribed to before me
this day of
A. D.
So answers
R. Thomas Kline
Sheriff of Cumberland County
Prothonotary
11561708092004 Lycoming County Pennsylvania Pa 1
S0S835 Docket Entries 8/0qe 972004
Case No 2004-03463 T
LINDSAY A. ESTACIO,A MINOR,ETC (VS) MARY A. BARTAS-WHITE, D.O.ETAL
Date
Filed
--------------------------------------------------------------------------------
7/16/04 COMPLAINT IN CIVIL ACTION. 75.00 DEPOSIT.
SERVE SISTERS OF CHRISTIAN CHARITY HEALTH CARE CORP. ONLY,
(FROM CUMBERLAND COUNTY).
--------------------------------------------------------------------------------
8/06/04 AT 2:30 P.M., SERVED THE WITHIN COMPLAINT IN CIVIL ACTION UPON THE
WITHIN NAMED DEFENDANT SISTERS OF CHRISTIAN CHARITY HEALTH CARE
CORPORATION, BY HANDING A TRUE AND ATTESTED COPY OF SAME TO
LINDA WILLLIAMSPORT RF?APERSON
AND BY MAKIING KNOWN 1100 HERMTHENCONTENTSBOULEVARD
AEREOF.
SO ANSWERS, CHARLES T. BREWER, SHERIFF OF LYCOMING COUNTY; BY:
STEPHEN L. BRION, DEPUTY.
SHERIFF'S COSTS: $22.50
PAID 8/9/04.
Sworn and Subscribed before me
this 11mtAAh d??a?y o
X12
I'M.= J. SUM
So Answers,
T. rewer,
SHERIFF OF L?'COMOUNTY, PENNA.
JnS'cf (
BY: Stephen L. Brion,
Deputy
SHERIFF'S RETURN - REGULAR
CASE NO: 2004-03463 P
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
ESTACIO LINDSAY ET AL
VS
BARTAS-WHITE MARY A ET AL
CPL. MICHAEL BARRICK
, Sheriff or Deputy Sheriff of
Cumberland County,Pennsylvania, who being duly sworn according to law,
says, the within COMPLAINT & NOTICE was served upon
BARTAS WHITE MARY A the
DEFENDANT , at 1500:00 HOURS, on the 21st day of July 2004
at 503 NORTH 21ST STREET
CAMP HILL, PA 17011 by handing to
GWYN BINNER, ADMINISTRATIVE SECRETARY
a true and attested copy of COMPLAINT & NOTICE together with
and at the same time directing Her attention to the contents thereof.
Sheriff's Costs: So Answers:
Docketing 18.00 a
Service 11.10
Affidavit .00 I
Surcharge 10.00 R. Thomas Kline
.00
39.10 08/17/2004
TUCKER ARENSBER
Sworn and Subscribed to before By:
me this 2/,a?t- day of Depu ej? ff
rc.a_1" ?-/U/oD\f `l eeA.DA.
1.
r thontary ? V
SHERIFF'S RETURN - REGULAR
CASE NO: 2004-03463 P
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
ESTACIO LINDSAY ET AL
VS
BARTAS-WHITE MARY A ET AL
CPL. MICHAEL BARRICK
, Sheriff or Deputy Sheriff of
Cumberland County,Pennsylvania, who being duly sworn according to law,
says, the within COMPLAINT & NOTICE was served upon
HOLY SPIRIT HOSPITAL OF THE SISTERS OF CHRISTIAN CHARITY the
DEFENDANT , at 1500:00 HOURS, on the 21st day of July 2004
at 503 NORTH 21ST STREET
CAMP HILL, PA 17011 by handing to
GWYN SINNER, ADMINISTRATIVE SECRETARY
a true and attested copy of COMPLAINT & NOTICE together with
and at the same time directing Her attention to the contents thereof.
Sheriff's Costs:
Docketing 6.00
Service .00
Affidavit .00
Surcharge 10.00
.00
16.00
Sworn and Subscribed to before
me this y/,jk day of
.2,6n L( A. D.
Oyu n ???.
Prothonotary '
So Answers:
R. Thomas Kline
08/17/200tii TUCKER ARBy: L.
puty Sher iff
SHERIFF'S RETURN - REGULAR
CASE NO: 2004-03463 P
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
ESTACIO LINDSAY ET AL
VS
BARTAS-WHITE MARY A ET AL
CPL. MICHAEL BARRICK
, Sheriff or Deputy Sheriff of
Cumberland County,Pennsylvania, who being duly sworn according to law,
says, the within COMPLAINT & NOTICE was served upon
HOLY SPIRIT HOSPITAL the
DEFENDANT , at 1500:00 HOURS, on the 21st day of July 2004
at 503 NORTH 21ST STREET
CAMP HILL, PA 17011 by handing to
GWYN SINNER, ADMINISTRATIVE SECRETARY
a true and attested copy of COMPLAINT & NOTICE together with
and at the same time directing Her attention to the contents thereof.
Sheriff's Costs:
Docketing 6.00
Service .00
Affidavit .00
Surcharge 10.00
.00
16.00
Sworn and Subscribed to before
me this 31,- day of
cZav `f A. D.
rO,..^6
iPr6thonotary 70
So Answii?
R. Thomas Kline
08/17/2004
TUCKER ARENSBERG
By:
Deputy riff
SHERIFF'S RETURN - REGULAR
CASE NO: 2004-03463 P
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
ESTACIO LINDSAY ET AL
VS
BARTAS-WHITE MARY A ET AL
CPL. MICHAEL BARRICK
, Sheriff or Deputy Sheriff of
Cumberland County,Pennsylvania, who being duly sworn according to law,
says, the within COMPLAINT & NOTICE was served upon
HOLY SPIRIT CORPORATION the
DEFENDANT , at 1500:00 HOURS, on the 21st day of July 2004
at 503 NORTH 21ST STREET
CAMP HILL, PA 17011 by handing to
GWYN BINNER, ADMINISTRATIVE SECRETARY
a true and attested copy of COMPLAINT & NOTICE together with
and at the same time directing Her attention to the contents thereof.
Sheriff's Costs:
Docketing 6.00
Service .00
Affidavit .00
Surcharge 10.00
.00
16.00
Sworn and Subscribed to before
me this A44- day of
, A ?on { A. D.
C P othonotary
So Answ%i?
R. Thomas Kline
08/17/2004
TUCKER ARENSBERG
By:?? ,
Deput Sheriff
SHERIFF'S RETURN - REGULAR
CASE NO: 2004-03463 P
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
ESTACIO LINDSAY ET AL
VS
BARTAS-WHITE MARY A ET AL
CPL. MICHAEL BARRICK
, Sheriff or Deputy Sheriff of
Cumberland County,Pennsylvania, who being duly sworn according to law,
says, the within COMPLAINT & NOTICE was served upon
HOLY SPIRIT HEALTH SYSTEM the
DEFENDANT , at 1500:00 HOURS, on the 21st day of July 2004
at 503 NORTH 21ST STREET
CAMP HILL, PA 17011 by handing to
GWYN BINNER, ADMINISTRATIVE SECRETARY
a true and attested copy of COMPLAINT & NOTICE together with
and at the same time directing Her attention to the contents thereof.
Sheriff's Costs:
Docketing 6.00
Service .00
Affidavit .00
Surcharge 10.00
.00
16.00
Sworn and Subscribed to before
me this 31,E day of
'4=o T C?
onotary '
So Answers:
R. Thomas Kline
08/17/20%Deputy TUCKER ABY:
Sheriff
SHERIFF'S RETURN - REGULAR
CASE NO: 2004-03463 P
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
ESTACIO LINDSAY ET AL
VS
BARTAS-WHITE MARY A ET AL
CPL. MICHAEL BARRICK
, Sheriff or Deputy Sheriff of
Cumberland County,Pennsylvania, who being duly sworn according to law,
says, the within COMPLAINT & NOTICE was served upon
HOLY SPIRIT VENTURES INC
the
DEFENDANT , at 1500:00 HOURS, on the 21st day of July 2004
at 503 NORTH 21ST STREET
CAMP HILL, PA 17011 by handing to
GWYN BINNER, ADMINISTRATIVE SECRETARY
a true and attested copy of COMPLAINT & NOTICE together with
and at the same time directing Her attention to the contents thereof.
Sheriff's Costs: So Answers:
Docketing 6.00 ??.6C
Service .00
Affidavit .00
Surcharge 10.00 R. Thomas Kiine
.00
16.00 08/17/2004
TUCKER ARENSBERG
Sworn and Subscribed to before By-
me this 3),a,V day of puty Sheriff
D.
tP7tolt-h?'onotary
SHERIFF'S RETURN - REGULAR
CASE NO: 2004-03463 P
COMMONWEALTH OF PENNSYLVANIA:
COUNTY OF CUMBERLAND
ESTACIO LINDSAY ET AL
VS
BARTAS-WHITE MARY A ET AL
CPL. MICHAEL BARRICK
Sheriff or Deputy Sheriff of
Cumberland County,Pennsylvania, who being duly sworn according to law,
says, the within COMPLAINT & NOTICE was served upon
SPIRIT PHYSICIAN SERVICES INC the
DEFENDANT , at 1500:00 HOURS, on the 21st day of July 2004
at 503 NORTH 21ST STREET
CAMP HILL, PA 17011 by handing to
GWYN BINNER, ADMINISTRATIVE SECRETARY
a true and attested copy of COMPLAINT & NOTICE together with
and at the same time directing Her attention to the contents thereof.
Sheriff's Costs:
Docketing 6.00
Service .00
Affidavit .00
Surcharge 10.00
.00
16.00
Sworn and Subscribed to before
me this 3(/,1- day of
01- c2.lsc1"? A . D.
othonotary
So Answer.:
,40 ,45eC-40
R. Thomas Kline
08/17/2004
TUCKER ARENSBERG
By:?
,Deputy Sheriff
LINDSAY A. ESTACIO, a Minor, By Her
Parents and Natural Guardians,
RICHARD A. ESTACIO and LORI
ESTACIO, and RICHARD A. ESTACIO and
LORI ESTACIO, in Their Own Right,
Plaintiffs
V.
MARY A. BARTAS-WHITE, D.O.;
HOLY SPIRIT HOSPITAL OF THE
SISTERS OF CHRISTIAN CHARITY;
HOLY SPIRIT HOSPITAL;
HOLY SPIRIT CORPORATION;
HOLY SPIRIT HEALTH SYSTEM;
HOLY SPIRIT VENTURES, INC.;
SPIRIT PHYSICIAN SERVICES, INC.;
SISTERS OF CHRISTIAN CHARITY
HEALTH CARE CORPORATION;
Defendants
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 04-3463 CIVIL
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
CERTIFICATE OF MERIT
AS TO HOLY SPIRIT HOSPITAL OF THE SISTERS OF CHRISTIAN CHARITY
I, STEPHEN M. GREECHER, JR., certify that the claim that this Defendant deviated
from an acceptable professional standard is based solely on allegations that a licensed
professional 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 licensed professional in the treatment, practice or work that is the subject of the
complaint, fell outside acceptable professional standards and that such c c s caus n
bringing about the harm. i?
By: UVINIM-W
Attorney's I.D. No. PA-36803
Tucker Arensberg, P.C.
111 North Front Street
P. O. Box 889
Harrisburg, PA 17108-0889
(717) 234-4121
ATTORNEYS FOR PLAINTIFFS
DATE: September 13, 2004
71768.1
CERTIFICATE OF SERVICE
AND NOW, this )3-#? day of SEPTEMBER, 2004, I, Jacquelyn Zettlemoyer,
Secretary to Stephen M. Greecher, Jr., Esquire, for the law firm, TUCKER ARENSBERG, P.C.,
attorneys for Plaintiffs, hereby certify that I have this day served the within document by
depositing a true and correct copy of the same in the United States Mail, first class, postage
prepaid, at Harrisburg, Pennsylvania, addressed as follows:
Francis E. Marshall, Jr., Esquire
Thomas M. Chairs, Esquire
Dickie, McCamey & Chilcote, P.C.
1200 Camp Hill Bypass, Suite 205
Camp Hill, PA 17011-3700
Jacq ly eer
71771.1
LINDSAY A. ESTACIO, a Minor, By Her
Parents and Natural Guardians,
RICHARD A. ESTACIO and LORI
ESTACIO, and RICHARD A. ESTACIO and
LORI ESTACIO, in Their Own Right,
Plaintiffs
V.
MARY A. BARTAS-WHITE, D.O.;
HOLY SPIRIT HOSPITAL OF THE
SISTERS OF CHRISTIAN CHARITY;
HOLY SPIRIT HOSPITAL;
HOLY SPIRIT CORPORATION;
HOLY SPIRIT HEALTH SYSTEM;
HOLY SPIRIT VENTURES, INC.;
SPIRIT PHYSICIAN SERVICES, INC.;
SISTERS OF CHRISTIAN CHARITY
HEALTH CARE CORPORATION;
Defendants
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
CERTIFICATE OF MERIT
AS TO HOLY SPIRIT HOSPITAL
I, STEPHEN M. GREECHER, JR., certify that the claim that this Defendant deviated
from an acceptable professional standard is based solely on allegations that a licensed
professional 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 licensed professional in the treatment, practice or work that i subject of the
complaint, fell outside acceptable professional standards and that such e a cause in
bringing about the harm.
By:
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY. PENNSYLVANIA
NO. 04-3463 CIVIL
StephMM -W'Greecher, Jr.
Attorney's I.D. No. PA-36803
Tucker Arensberg, P.C.
111 North Front Street
P. O. Box 889
Harrisburg, PA 17108-0889
(717) 234-4121
ATTORNEYS FOR PLAINTIFFS
DATE: September 13, 2004
71768.1
CERTIFICATE OF SERVICE
AND NOW, this 1?5 -` day of SEPTEMBER, 2004, I, Jacquelyn Zettlemoyer,
Secretary to Stephen M. Greecher, Jr., Esquire, for the law firm, TUCKER ARENSBERG, P.C.,
attorneys for Plaintiffs, hereby certify that I have this day served the within document by
depositing a true and correct copy of the same in the United States Mail, first class, postage
prepaid, at Harrisburg, Pennsylvania, addressed as follows:
Francis E. Marshall, Jr., Esquire
Thomas M. Chairs, Esquire
Dickie, McCamey & Chilcote, P.C.
1200 Camp Hill Bypass, Suite 205
Camp Hill, PA 17011-3700
Jacq l71771.1
LINDSAY A. ESTACIO, a Minor, By Her
Parents and Natural Guardians,
RICHARD A. ESTACIO and LORI
ESTACIO, and RICHARD A. ESTACIO and
LORI ESTACIO, in Their Own Right,
Plaintiffs
V.
MARY A. BARTAS-WHITE, D.O.;
HOLY SPIRIT HOSPITAL OF THE
SISTERS OF CHRISTIAN CHARITY;
HOLY SPIRIT HOSPITAL;
HOLY SPIRIT CORPORATION;
HOLY SPIRIT HEALTH SYSTEM;
HOLY SPIRIT VENTURES, INC.;
SPIRIT PHYSICIAN SERVICES, INC.;
SISTERS OF CHRISTIAN CHARITY
HEALTH CARE CORPORATION;
Defendants
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
CERTIFICATE OF MERIT
AS TO HOLY SPIRIT CORPORATION
I, STEPHEN M. GREECHER, JR., certify that the claim that this Defendant deviated
from an acceptable professional standard is based solely on allegations that a licensed
professional 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 licensed professional in the treatment, practice or work that i he subject of the
complaint, fell outside acceptable professional standards and that such c d ?S a cause in
bringing about the harm. //J j ?7
By:
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY. PENNSYLVANIA
NO. 04-3463 CIVIL
SteplWM`3We) her, Jr.
Attorney's I.D. No.-PA-36
Tucker Arensberg, P.C.
111 North Front Street
P. O. Box 889
Harrisburg, PA 17108-0889
(717) 234-4121
ATTORNEYS FOR PLAINTIFFS
DATE: September 13, 2004
71768.1
CERTIFICATE OF SERVICE
AND NOW, this 1'3c day of SEPTEMBER, 2004, I, Jacquelyn Zettlemoyer,
Secretary to Stephen M. Greecher, Jr., Esquire, for the law firm, TUCKER ARENSBERG, P.C.,
attorneys for Plaintiffs, hereby certify that I have this day served the within document by
depositing a true and correct copy of the same in the United States Mail, first class, postage
prepaid, at Harrisburg, Pennsylvania, addressed as follows:
Francis E. Marshall, Jr., Esquire
Thomas M. Chairs, Esquire
Dickie, McCamey & Chilcote, P.C.
1200 Camp Hill Bypass, Suite 205
Camp Hill, PA 17011-3700
Jacq ttlr
71771.1
LINDSAY A. ESTACIO, a Minor, By Her
Parents and Natural Guardians,
RICHARD A. ESTACIO and LORI
ESTACIO, and RICHARD A. ESTACIO and
LORI ESTACIO, in Their Own Right,
Plaintiffs
V.
MARY A. BARTAS-WHITE, D.O.;
HOLY SPIRIT HOSPITAL OF THE
SISTERS OF CHRISTIAN CHARITY;
HOLY SPIRIT HOSPITAL;
HOLY SPIRIT CORPORATION;
HOLY SPIRIT HEALTH SYSTEM;
HOLY SPIRIT VENTURES, INC.;
SPIRIT PHYSICIAN SERVICES, INC.;
SISTERS OF CHRISTIAN CHARITY
HEALTH CARE CORPORATION;
Defendants
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
CERTIFICATE OF MERIT
AS TO HOLY SPIRIT HEALTH SYSTEM
1, STEPHEN M. GREECHER, JR., certify that the claim that this Defendant deviated
from an acceptable professional standard is based solely on allegations that a licensed
professional 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 licensed professional in the treatment, practice or wor 's the subject of the
complaint, fell outside acceptable professional standards and that siddh con was a cause in
bringing about the harm. ,7
By:
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 04-3463 CIVIL
9Ye Ti W. Grbecher, Jr.
Attorney's I.D. No. PA-36803
Tucker Arensberg, P.C.
111 North Front Street
P. O. Box 889
Harrisburg, PA 17108-0889
(717) 234-4121
ATTORNEYS FOR PLAINTIFFS
DATE: September 13, 2004
71768.1
CERTIFICATE OF SERVICE
AND NOW, this /3-:b( day of SEPTEMBER, 2004, I, Jacquelyn Zettlemoyer,
Secretary to Stephen M. Greecher, Jr., Esquire, for the law firm, TUCKER ARENSBERG, P.C.,
attorneys for Plaintiffs, hereby certify that I have this day served the within document by
depositing a true and correct copy of the same in the United States Mail, first class, postage
prepaid, at Harrisburg, Pennsylvania, addressed as follows:
Francis E. Marshall, Jr., Esquire
Thomas M. Chairs, Esquire
Dickie, McCamey & Chilcote, P.C.
1200 Camp Hill Bypass, Suite 205
Camp Hill, PA 17011-3700
Jac elyn ettlemoyer
71771.1
LINDSAY A. ESTACIO, a Minor, By Her
Parents and Natural Guardians,
RICHARD A. ESTACIO and LORI
ESTACIO, and RICHARD A. ESTACIO and
LORI ESTACIO, in Their Own Right,
Plaintiffs
V.
MARY A. BARTAS-WHITE, D.O.;
HOLY SPIRIT HOSPITAL OF THE
SISTERS OF CHRISTIAN CHARITY;
HOLY SPIRIT HOSPITAL;
HOLY SPIRIT CORPORATION;
HOLY SPIRIT HEALTH SYSTEM;
HOLY SPIRIT VENTURES, INC.;
SPIRIT PHYSICIAN SERVICES, INC.;
SISTERS OF CHRISTIAN CHARITY
HEALTH CARE CORPORATION;
Defendants
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 04-3463 CIVIL
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
CERTIFICATE OF MERIT
AS TO HOLY SPIRIT VENTURES, INC.
1, STEPHEN M. GREECHER, JR., certify that the claim that this Defendant deviated
from an acceptable professional standard is based solely on allegations that a licensed
professional 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 licensed professional in the treatment, practice or work t is t! ape subject o e
complaint, fell outside acceptable professional standards and that s ?onduc jwa?a c se in
bringing about the harm.
By:
StephL6F. C5fe r, Jr.
Attorney's I.D. o. PA-36803
Tucker Arenberg, P.C.
111 North Front Street
P. O. Box 889
Harrisburg, PA 17108-0889
(717) 234-4121
ATTORNEYS FOR PLAINTIFFS
DATE: September 13, 2004
71768.1
CERTIFICATE OF SERVICE
AND NOW, this 13i( day of SEPTEMBER, 2004, I, Jacquelyn Zettlemoyer,
Secretary to Stephen M. Greecher, Jr., Esquire, for the law firm, TUCKER ARENSBERG, P.C.,
attorneys for Plaintiffs, hereby certify that I have this day served the within document by
depositing a true and correct copy of the same in the United States Mail, first class, postage
prepaid, at Harrisburg, Pennsylvania, addressed as follows:
Francis E. Marshall, Jr., Esquire
Thomas M. Chairs, Esquire
Dickie, McCamey & Chilcote, P.C.
1200 Camp Hill Bypass, Suite 205
Camp Hill, PA 17011-3700
Jacquelyn tt?er r ")
71771.1
LINDSAY A. ESTACIO, a Minor, By Her
Parents and Natural Guardians,
RICHARD A. ESTACIO and LORI
ESTACIO, and RICHARD A. ESTACIO and
LORI ESTACIO, in Their Own Right,
Plaintiffs
V.
MARY A. BARTAS-WHITE, D.O.;
HOLY SPIRIT HOSPITAL OF THE
SISTERS OF CHRISTIAN CHARITY;
HOLY SPIRIT HOSPITAL;
HOLY SPIRIT CORPORATION;
HOLY SPIRIT HEALTH SYSTEM;
HOLY SPIRIT VENTURES, INC.;
SPIRIT PHYSICIAN SERVICES, INC.;
SISTERS OF CHRISTIAN CHARITY
HEALTH CARE CORPORATION;
Defendants
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
CERTIFICATE OF MERIT
AS TO SPIRIT PHYSICIAN SERVICES, INC.
I, STEPHEN M. GREECHER, JR., certify that the claim that this Defendant deviated
from an acceptable professional standard is based solely on allegations that a licensed
professional 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
b" ct o
f the
exhibited by the licensed professional in the treatment, practice or work is F
complaint, fell outside acceptable professional standards and that such con a cause in
bringing about the harm.
By:
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 04-3463 CIVIL
-6teptwm. G*6cher, Jr.
Attorney's I.D. No. PA-36803
Tucker Arensberg, P.C.
111 North Front Street
P. O. Box 889
Harrisburg, PA 17108-0889
(717) 234-4121
ATTORNEYS FOR PLAINTIFFS
DATE: September 13, 2004
71768.1
CERTIFICATE OF SERVICE
AND NOW, this l3`6?- day of SEPTEMBER, 2004, I, Jacquelyn Zettlemoyer,
Secretary to Stephen M. Greecher, Jr., Esquire, for the law firm, TUCKER ARENSBERG, P.C.,
attorneys for Plaintiffs, hereby certify that I have this day served the within document by
depositing a true and correct copy of the same in the United States Mail, first class, postage
prepaid, at Harrisburg, Pennsylvania, addressed as follows:
Francis E. Marshall, Jr., Esquire
Thomas M. Chairs, Esquire
Dickie, McCamey & Chilcote, P.C.
1200 Camp Hill Bypass, Suite 205
Camp Hill, PA 17011-3700
Jac ely tettl2ermoyer
71771.1
LINDSAY A. ESTACIO, a Minor, By Her
Parents and Natural Guardians,
RICHARD A. ESTACIO and LORI
ESTACIO, and RICHARD A. ESTACIO and
LORI ESTACIO, in Their Own Right,
Plaintiffs
V.
MARY A. BARTAS-WHITE, D.O.;
HOLY SPIRIT HOSPITAL OF THE
SISTERS OF CHRISTIAN CHARITY;
HOLY SPIRIT HOSPITAL;
HOLY SPIRIT CORPORATION;
HOLY SPIRIT HEALTH SYSTEM;
HOLY SPIRIT VENTURES, INC.;
SPIRIT PHYSICIAN SERVICES, INC.;
SISTERS OF CHRISTIAN CHARITY
HEALTH CARE CORPORATION;
Defendants
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
CERTIFICATE OF MERIT
AS TO SISTERS OF CHRISTIAN CHARITY HEALTH CARE CORPORATION
I, STEPHEN M. GREECHER, JR., certify that the claim that this Defendant deviated
from an acceptable professional standard is based solely on allegations that a licensed
professional 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 licensed professional in the treatment, practice or work that ' the subject of the
complaint, fell outside acceptable professional standards and that such d yy cause in
bringing about the harm.
By:
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY. PENNSYLVANIA
NO. 04-3463 CIVIL
S%ftRW M.`Grree!C ier, Jr.
Attorney's I.D. No. PA-36803
Tucker Arensberg, P.C.
111 North Front Street
P. O. Box 889
Harrisburg, PA 17108-0889
(717) 234-4121
ATTORNEYS FOR PLAINTIFFS
DATE: September 13, 2004
71768.1
CERTIFICATE OF SERVICE
AND NOW, this / 3 A day of SEPTEMBER, 2004, I, Jacquelyn Zettlemoyer,
Secretary to Stephen M. Greecher, Jr., Esquire, for the law firm, TUCKER ARENSBERG, P.C.,
attorneys for Plaintiffs, hereby certify that I have this day served the within document by
depositing a true and correct copy of the same in the United States Mail, first class, postage
prepaid, at Harrisburg, Pennsylvania, addressed as follows:
Francis E. Marshall, Jr., Esquire
Thomas M. Chairs, Esquire
Dickie, McCamey & Chilcote, P.C.
1200 Camp Hill Bypass, Suite 205
Camp Hill, PA 17011-3700
Jacquelyn ttlemoyer/?
71771.1
LINDSAY A. ESTACIO, a Minor, By
Her Parents and Natural Guardians,
RICHARD A. ESTACIO and LORI
ESTACIO, and RICHARD A.
ESTACIO and LORI ESTACIO, in
Their Own Right,
Plaintiffs
V.
MARY A. BARTAS-WHITE, D.O.;
HOLY SPIRIT HOSPITAL OF THE
SISTERS OF CHRISTIAN CHARITY;
HOLY SPIRIT HOSPITAL; HOLY
SPIRIT CORPORATION; HOLY
SPIRIT HEALTH SYSTEM; HOLY
SPIRIT VENTURES, INC.; SPIRIT
PHYSICIAN SERVICES, INC.;
SISTERS OF CHRISTIAN CHARITY
HEALTH CARE CORPORATION,
Defendants
IN THE COURT OF COMMON
PLEAS CUMBERLAND COUNTY,
PENNSYLVANIA
NO. 04-3463 CIVIL
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
NOTICE TO PLEAD
TO: Linday Estacio
Richard A. Estacio
Lori Estacio
c/o Lee C. Swartz, Esquire
Stephen M. Greecher, Jr., Esquire
Tucker Arensberg, P.C.
111 North Front Street
P.O. box 889
Harrisburg, PA 17108-0889
Counsel for Plaintiff(s)
YOU ARE HEREBY NOTIFIED TO PLEAD TO THE WITHIN NEW MATTER
WITHIN TWENTY (20) DAYS OF THE DATE OF SERVICE OF THIS PLEADING OR
JUDGMENT MAY BE ENTERED AGAINST YOU.
DICKIE, MCCAMEY & CHILCOTE, PC
Date: October 7, 2004
Thomas M. Chairs, Esquire
I.D. #78565
1200 Camp Hill Bypass, Suite 205
Camp Hill, PA 17011
(717) 731-4800
Counsel for Defendants Mary A. Bartas-
White, D. 0., Holy Spirit Hospital of the
Sisters of Christian Charity, Holy
Spirit Hospital, Holy Spirit Corporation,
Holy Spirit Health System, Holy Spirit
Ventures, Inc., Spirit Physician Services,
Inc. and Sisters of Christian Charity Health
Care Corporation
LINDSAY A. ESTACIO, a Minor, By
Her Parents and Natural Guardians,
RICHARD A. ESTACIO and LORI
ESTACIO, and RICHARD A.
ESTACIO and LORI ESTACIO, in
Their Own Right,
Plaintiffs
V.
MARY A. BARTAS-WHITE, D.O.;
HOLY SPIRIT HOSPITAL OF THE
SISTERS OF CHRISTIAN CHARITY;
HOLY SPIRIT HOSPITAL; HOLY
SPIRIT CORPORATION; HOLY
SPIRIT HEALTH SYSTEM; HOLY
SPIRIT VENTURES, INC.; SPIRIT
PHYSICIAN SERVICES, INC.;
SISTERS OF CHRISTIAN CHARITY
HEALTH CARE CORPORATION,
Defendants
IN THE COURT OF COMMON
PLEAS CUMBERLAND COUNTY,
PENNSYLVANIA
NO. 04-34113 CIVIL
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
ANSWER WITH NEW MATTER OF HOLY SPIRIT HOSPITAL
TO THE PLAINTIFF'S COMPLAINT
AND NOW, comes Defendant Holy Spirit Hospital, by and through its counsel,
DICKIE, MCCAMEY & CHILCOTE, P.C., by Thomas M. Chairs, Esquire, and files the
within Answer with New Matters to the Plaintiffs Complaint and in support thereof
avers as follows:
1. through 4. After reasonable investigation the Answering Defendant is without
knowledge or information sufficient as to form a belief as to the truth or falsity of the
averments set forth in paragraphs I through 4 of the Plaintiff s Complaint, and therefore
answering Defendant denies same and demands strict proof thereof at the time of trial.
Paragraph 5 of the Plaintiffs Complaint refers to a party other than the
Answering Defendant consequently no answer is required. In the alternative to the extent
that paragraph 5 of the Plaintiffs Complaint is deemed to contain facts that pertain to the
Answering Defendant, those allegations of fact that are denied generally according to
Pa.R.C.P. 1029.
6. Answering Defendant disputes any liability to the Plaintiff. It is admitted
that the Plaintiff's have attached a certificate of merit as Exhibit "A" to their Complaint.
Denied as stated. Sisters of Christian Charity Healthcare Corporation is a
corporation organized and doing business under the laws of the Commonwealth of
Pennsylvania with a principle place of business at 1100 Grampian Boulevard,
Williamsport, Lycoming County, Pennsylvania, 17001. Holy Spirit Hospital is a
corporation organized and existing under the laws of the Commonwealth of Pennsylvania
located at 503 North 2151 Street, Camp Hill, Cumberland County, Pennsylvania, 17011.
8. It is admitted that Defendant Holy Spirit Corporation is a corporation with
an address of 503 North 21Se Street, Camp Hill, Cumberland County, Pennsylvania,
17011. It is specifically and unequivocally denied that Holy Spirit Corporation is a
proper party to this litigation.
9. It is admitted that Defendant Holy Spirit Health System is a corporation
located at 503 North 21se Street, Camp Hill, Cumberland County, Pennsylvania, 17011. It
is denied that Holy Spirit Health System is a proper party to this litigation.
10. It is admitted that Defendant Holy Spirit Ventures, Inc. is a corporation
located at 503 North 215` Street, Camp Hill, Cumberland County, Pennsylvania, 17011. It
is denied that Holy Spirit Ventures, Inc. is a proper party to this litigation.
11. It is admitted that Defendant Spirit Physician Services, Inc. is a
corporation located at 503 North 2151 Street, Camp Hill, Cumberland County,
Pennsylvania, 17011. It is denied that Spirit Physician Services, Inc. is a proper party to
this litigation.
12. It is admitted that Defendant Holy Spirit Hospital is a corporation located
at 503 North 2151 Street, Camp Hill, Cumberland County, Pennsylvania, 17011.
13. It is admitted that Defendant Sisters of Christian Charity Health Care
Corporation is a corporation existing under the laws of the Commonwealth of
Pennsylvania with a principle place of business located at. 1100 Grampian Boulevard,
Williamsport, Lycoming County, Pennsylvania, 17701. It is denied that Sisters of
Christian Charity Health Care Corporation is a proper party to this litigation.
14. Defendants Holy Spirit Hospital and Sisters of Christian Charity, Holy
Spirit Corporation, Holy Spirit Health Systems, Holy Spirit Ventures, Inc., Spirit
Physician Services, Inc., and Sisters of Christian Charity Health Care Corporation are not
proper parties to this litigation.
15. through 21. Paragraphs 15 through 21of the Plaintiff's Complaint are denied
generally in accord with Pennsylvania Rule of Civil Procedure 1029.
22. Paragraph 22 is denied generally in accord with Pennsylvania Rule of
Civil Procedure 1029. By way of further response paragraph 22 of the Plaintiff's
Complaint makes reference to an Exhibit "B" purportedly attached to the Plaintiff s
Complaint. Plaintiffs Complaint contains no Exhibit "B".
23. through 45. Paragraphs 23 through 45 are denied generally in accord with
Pennsylvania Rule of Civil Procedure 1029.
46. through 51. Paragraphs 46 through 51 of Plaintiffs Complaint set forth
conclusions of law to which no response is required. In the alternative to the extent that
paragraphs 46 through 51 are deemed to contain facts to which a responsive pleading is
required, said averments are denied generally in accord with Pennsylvania under Rule of
Civil Procedure 1029.
COUNTI
Lindsay A. Estacio, a minor
by her parents and natural
guardians, Richard A. Estacio
and Lori Estacio v.
Mary A. Bartas-White, D.O. and
Holy Spirit Hospital
52. The above stated responses to paragraphs 1 through 51 of the Plaintiff s
Complaint are incorporated herein as if fully set forth.
53. Admitted in part; denied in part. It is admitted that Mary A. Bartas-White,
D.O. was at all times relevant hereto employed by the Holy Spirit Hospital. The balance
of the allegations set forth in paragraph 53 of the Plaintiffs Complaint are specifically
denied.
54. Paragraph 54 of the Plaintiffs Complaint sets forth conclusions to law to
which no response is required. By way of further response it is admitted that Defendant
Mary A. Bartas-White, D.O. was employed by the Holy Spirit Hospital. The balance of
the allegations set forth in paragraph 54 of the Plaintiffs Complaint are specifically
denied.
55. Paragraph 55 is denied generally in accord with Pennsylvania under Rule
of Civil Procedure 1029.
56. Paragraph 56 of the Plaintiff s Complaint sets forth conclusions of law to
which no response is required. By way of further response it is admitted that Defendant
Mary A. Bartas-White, D.O. was at all times material hereto, employed by the Holy
Spirit Hospital . The balance of the allegations set forth in paragraph 56 of the Plaintiff s
Complaint are specifically denied.
57. through 65. Paragraphs 57 through 65 of the Plaintiff s Complaint set forth
conclusions of law to which no response is required. In the alternative to the extent that
paragraphs 57 through 65 are deemed to contain facts to which a responsive pleading is
deemed required said averments are denied generally in accord with Pennsylvania Rule
of Civil Procedure 1029.
WHEREFORE, Answering Defendant denies that the Plaintiff's are entitled to the
relief requested or any relief whatsoever and demand that judgment be entered in favor of
Answering Defendant and that the Answering Defendant be awarded appropriate costs
and fees.
COUNT II
Lindsay A. Estacio, by her
parents natural guardians,
Richard A. Estacio and Lori Estacio v.
Mary A. Bartas-White, D.O.
and Holy Spirit Hospital
Misrepresentation
66. The above stated responses to paragraphs 1 through 65 of the Plaintiff s
Complaint are incorporated herein as if fully set forth.
67. through 72. Paragraphs 67 through 72 of the Plaintiffs Complaint set forth
conclusions of law to which no response is required. In the alternative to the extent that
paragraphs 67 through 72 are deemed to contain facts to which a responsive pleading is
deemed required said averments are denied generally in accord with Pennsylvania Rule
of Civil Procedure 1029.
73. Paragraph 73 of the Plaintiffs Complaint set forth conclusions of law to
which no response is required. In the alternative to the extent that paragraph 73 is
deemed to contain facts to which a responsive pleading is deemed required said
averments are denied generally in accord with Pennsylvania Rule of Civil Procedure
1029. By way of further response it is admitted that Marry A. Bartas-White, D.O. was an
employee of the Holy Spirit Hospital.
WHEREFORE, Answering Defendant denies that the Plaintiffs are entitled to the
relief requested or any relief whatsoever and demand that judgment be entered in favor of
Answering Defendant and that the Answering Defendant be awarded appropriate costs
and fees.
COUNT III
Lindsay A. Estacio, by her
parents natural guardians,
Richard A. Estacio and Lori
Estacio v. Mary A. Bartas-White, D.O.
and Holy Spirit Hospital
Corporate Negligence
74. The above stated responses to paragraphs 1 through 73 of the Plaintiffs
Complaint are incorporated herein as if fully set forth.
75. through 78. Paragraphs 75 through 78 of Plaintiff s Complaint set forth
conclusions of law to which no response is required. In tlae alternative to the extent that
paragraphs 75 through 78 are deemed to contain facts to which a responsive pleading is
required, said averments are denied generally in accord with Pennsylvania under Rule of
Civil Procedure 1029.
WHEREFORE, Answering Defendant denies that the Plaintiffs are entitled to the
relief requested or any relief whatsoever and demand that judgment be entered in favor of
Answering Defendant and that the Answering Defendant be awarded appropriate costs
and fees.
COUNT IV
Lindsay A. Estacio,
Richard A. Estacio and
Lori Estacio, in their own
right v. Mary A. Bartas-White, D.O.
and Holy Spirit Hospital
79. The above stated responses to paragraphs 1 through 51 of the Plaintiff s
Complaint are incorporated herein as if fully set forth.
80. and 81. Paragraphs 80 through 81 of the Plaintiff s Complaint set forth
conclusions of law to which no response is required. In the alternative to the extent that
paragraphs 80 through 81 are deemed to contain facts to which a responsive pleading is
deemed required, said averments are denied generally in accord with Pennsylvania under
Rule of Civil Procedure 1029.
NEW MATTER
82. To the extent that the evidence reveals that Plaintiff failed to follow
medical advice, failed to treat properly, or otherwise failed to mitigate her damages, this
Defendant pleads the defense of the failure to mitigate.
83. To the extent that the evidence reveals that Plaintiff failed to file this
action in a timely manner, this Defendant pleads the defense of the statute of limitations.
84. To the extent that the evidence reveals that the Plaintiff had a pre-existing
condition that caused or contributed to her injuries, this Defendant pleads the existence of
that pre-existing condition as a defense.
85. If at the time of trial it is established that this Defendant accepted less than
full payment for certain of Plaintiffs medical expenses or otherwise forgave certain of
those expenses, then this Defendant pleads any such set-offs as an affirmative defense.
86. This Defendant raises the acts and/or omissions of third parties over whom
Defendants had neither the right nor duty to control as a complete and/or partial bar to
Plaintiff s claims.
87. To the extent that the evidence reveals that Plaintiff lacked the capacity to
sue at the time this action was commenced, or at any time relevant hereto, this Defendant
pleads the lack of capacity to sue as an affirmative defense.
88. To the extent that it is determined that Plaintiff is or was engaged in other
litigations or proceedings pertaining to the injuries alleged in this Complaint, this
Defendant pleads the defenses of accord and satisfaction, arbitration and award, estoppel,
and release.
Respectfully submitted,
DICKIE, MCCAM[EY & CHILCOTE, P.C.
L(
Date: October 7, 2004 By:?
Francis E. Marsha r., Esquire
Supreme Court. I.D. #27594
Thomas M. Chairs, Esquire
Supreme Court I.D. #78565
1200 Camp ]Hill Bypass
Suite 205
Camp Hill, PA 17011
Phone 717-731-4800
Counsel for Defendants Mary A. Bartas-
White, D. 0., Holy Spirit Hospital of the
Sisters of Christian Charity, Holy
Spirit Hospital, Holy Spirit Corporation,
Holy Spirit Health System, Holy Spirit
Ventures, Inc., Spirit Physician Services,
Inc. and Sisters of Christian Charity Health
Care Corporation
VERIFICATION
I, Fran Charney, Director of Risk Management, hereby verify that the
averments set forth in the preceding 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: Vl: ? (t fWC -
Fran Charney
CERTIFICATE OF SERVICE
AND NOW, this 6 " day of October, 2004, I, Thomas M. Chairs,
Esquire, hereby certify that I did serve a true and correct copy of the foregoing document
upon all counsel of record by depositing, or causing to be deposited, same in the U.S.
mail, postage prepaid, at Harrisburg, Pennsylvania, addressed as follows:
By First-Class Mail:
Lee C. Swartz, Esquire
Stephen M. Greecher, Jr., Esquire
Tucker Arensberg, P.C.
I I INorth Front Street
P.O. box 889
Harrisburg, PA 17108-0889
Usk ?e-)
Thomas M. Chairs, Esquire
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LINDSAY A. ESTACIO, a Minor, By
Her Parents and Natural Guardians,
RICHARD A. ESTACIO and LORI
ESTACIO, and RICHARD A.
ESTACIO and LORI ESTACIO, in
Their Own Right,
Plaintiffs
V.
MARY A. BARTAS-WHITE, D.O.;
HOLY SPIRIT HOSPITAL OF THE
SISTERS OF CHRISTIAN CHARITY;
HOLY SPIRIT HOSPITAL; HOLY
SPIRIT CORPORATION; HOLY
SPIRIT HEALTH SYSTEM; HOLY
SPIRIT VENTURES, INC.; SPIRIT
PHYSICIAN SERVICES, INC.;
SISTERS OF CHRISTIAN CHARITY
HEALTH CARE CORPORATION,
Defendants
IN THE COURT OF COMMON
PLEAS CUMBERLAND COUNTY,
PENNSYLVANIA
NO. 04-3463 CIVIL
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
NOTICE TO PLEAD
TO: Linday Estacio
Richard A. Estacio
Lori Estacio
c/o Lee C. Swartz, Esquire
Stephen M. Greecher, Jr., Esquire
Tucker Arensberg, P.C.
111North Front Street
P.O. box 889
Harrisburg, PA 17108-0889
Counsel for Plaintiff(s)
YOU ARE HEREBY NOTIFIED TO PLEAD TO THE WITHIN NEW MATTER
WITHIN TWENTY (20) DAYS OF THE DATE OF SERVICE OF THIS PLEADING OR
JUDGMENT MAY BE ENTERED AGAINST YOU.
DICKIE, MCCAMEY & CHILCOTE, PC
C4
Date: October 7, 2004
Thomas M. Chairs, Esquire
I.D.#78565
1200 Camp ]Hill Bypass, Suite 205
Camp Hill, I'A 17011
(717) 731-4800
Counsel for Defendants Mary A. Bartas-
White, D. 0., Holy Spirit Hospital of the
Sisters of Christian Charity, Holy
Spirit Hospital, Holy Spirit Corporation,
Holy Spirit Health System, Holy Spirit
Ventures, Inc., Spirit Physician Services,
Inc. and Sisters of Christian Charity Health
Care Corporation
LINDSAY A. ESTACIO, a Minor, By
Her Parents and Natural Guardians,
RICHARD A. ESTACIO and LORI
ESTACIO, and RICHARD A.
ESTACIO and LORI ESTACIO, in
Their Own Right,
Plaintiffs
V.
MARY A. BARTAS-WHITE, D.O.;
HOLY SPIRIT HOSPITAL OF THE
SISTERS OF CHRISTIAN CHARITY;
HOLY SPIRIT HOSPITAL; HOLY
SPIRIT CORPORATION; HOLY
SPIRIT HEALTH SYSTEM; HOLY
SPIRIT VENTURES, INC.; SPIRIT
PHYSICIAN SERVICES, INC.;
SISTERS OF CHRISTIAN CHARITY
HEALTH CARE CORPORATION,
Defendants
IN THE COURT OF COMMON
PLEAS CUMBERLAND COUNTY,
PENNSYLVANIA
NO. 04-3463 CIVIL
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
ANSWER WITH NEW MATTER OF MARY A. BARTAS-WHITE, D.O.,
TO THE PLAINTIFF'S COMPLAINT
AND NOW, comes Defendant Mary A. Bartas-White, D.O., by and through her
counsel, DICKIE, MCCAMEY & CHILCOTE, P.C., by Thomas M. Chairs, Esquire, and
files the within Answer with New Matters to the Plaintiff's Complaint and in support
thereof avers as follows:
1. through 4. After reasonable investigation the Answering Defendant is without
knowledge or information sufficient as to form a belief as to the truth or falsity of the
averments set forth in paragraphs 1 through 4 of the Plaintiff's Complaint, and therefore
answering Defendant denies same and demands strict proof thereof at the time of trial.
5. Admitted in part; denied in part. It is specifically denied that Defendant,
Mary A. Bartas-White, D.O. is in anyway liable to the Plaintiffs. By way of further
response, it is admitted that Mary A. Bartas-White, D.O. is an adult with a license to
practice medicine in the Commonwealth of Pennsylvania. It is further admitted that Mary
A. Bartas-White, D.O. is a specialist in the field of psychiatry that practices at the Holy
Spirit Hospital, 503 North 21" Street, Camp Hill, Cumberland County, Pennsylvania.
6. Admitted in part; denied in part. It is specifically denied that Defendant,
Mary A. Bartas-White, D.O. is in anyway liable to the Plaintiffs. It is admitted that the
Plaintiffs have attached a certificate of merit as Exhibit to their Complaint.
7. through 14. Paragraphs 7 through 14 of the Plaintiff s Complaint refer to
parties other than the Answering Defendant consequently no answer is required. In the
alternative to the extent that paragraphs 7 through 14 of the Plaintiff s Complaint are
deemed to contain facts that pertain to the Answering Defendant, those allegations of fact
that are denied as after reasonable investigation the Answering Defendant is without
information sufficient to form a belief as to the truth or falsity of the averments set forth
therein.
15. through 21. Paragraphs 15 through 21of the Plaintiffs Complaint are denied
generally in accord with Pennsylvania Rule of Civil Procedure 1029.
22. Paragraph 22 is denied generally in accord. with Pennsylvania Rule of
Civil Procedure 1029.
23. through 45. Paragraphs 23 through 45 are denied generally in accord with
Pennsylvania Rule of Civil Procedure 1029.
46. through 51. Paragraphs 46 through 51 of the Plaintiff s Complaint set forth
conclusions to law to which no response is required. In the alternative to the extent that
paragraphs 46 through 51 are deemed to contain facts to which a responsive pleading is
deemed required, those allegations of fact are denied generally in accord with
Pennsylvania Rule of Civil Procedure 1029.
COUNTI
Lindsay A. Estacio, a minor
by her parents and natural.
guardians, Richard A. Estacio
and Lori Estacio v.
Mary A. Bartas-White, D.O. and
Holy Spirit Hospital
52. The above stated responses to paragraphs 1 through 51 of the Plaintiffs
Complaint are incorporated herein as if fully set forth.
53. Admitted in part; denied in part. It is admitted that Mary A. Bartas-White,
D.O. was at all times relevant hereto employed by the Holy Spirit Hospital. The balance
of the allegations set forth in paragraph 53 of the Plaintiffs Complaint are specifically
denied.
54. Paragraph 54 of the Plaintiff s Complaint sets forth conclusions to law to
which no response is required. By way of further response it is admitted that Defendant
Mary A. Bartas-White, D.O. was employed by the Holy Spirit Hospital. The balance of
the allegations set forth in paragraph 54 of the Plaintiff's Complaint are specifically
denied.
55. Paragraph 55 of the Plaintiffs Complaint is, denied generally in accord
with Pennsylvania Rule of Civil Procedure 1029.
56. Paragraph 56 of the Plaintiff's Complaint sets forth conclusions to law to
which no response is required. By way of further response it is admitted that Defendant
Mary A. Bartas-White, D.O. was at all times material hereto, employed by the Holy
Spirit Hospital. The balance of the allegations set forth in paragraph 56 of the Plaintiff s
Complaint are specifically denied.
57. through 65. Paragraphs 57 through 65 of the Plaintiffs Complaint set forth
conclusions to law to which no response is required. In the alternative to the extent that
paragraphs 57 through 65 of the Plaintiffs Complaint are deemed to contain facts to
which a responsive pleading is deemed required, those allegations of fact are denied
generally in accord with Pennsylvania Rule of Civil Procedure 1029.
WHEREFORE, Answering Defendant, Mary A. Bartas-White, D.O. denies that
the Plaintiffs are entitled to the relief requested or any relief whatsoever and demand that
judgment be entered in her favor against the Plaintiffs and that the Answering Defendant
be awarded appropriate costs and fees.
COUNTII
Lindsay A. Estacio, by her
parents natural guardians,
Richard A. Estacio and Lori Estacio v.
Mary A. Bartas-White, D.O.
and Holy Spirit Hospital
Misrepresentation
66. The above stated responses to paragraphs 1 through 65 of the Plaintiffs
Complaint are incorporated herein as if fully set forth
67. through 72. Paragraphs 67 through 72 of the Plaintiffs Complaint set forth
conclusions of law to which no response is required. In the alternative to the extent that
paragraphs 67 through 72 are deemed to contain facts to which a responsive pleading is
deemed required, those allegations of fact are denied generally in accord with
Pennsylvania Rule of Civil Procedure 1029.
73. Paragraph 73 of the Plaintiff's Complaint sets forth conclusions to law to
which no response is required. In the alternative to the extent that paragraph 73 is
deemed to contain facts to which a responsive pleading is deemed required, those
allegations of fact are denied generally in accord with Pennsylvania Rule of Civil
Procedure 1029. By way of further response it is admitted that at all times material
hereto Answering Defendant, Mary A. Bartas-White, D.O. was an employee of the Holy
Spirit Hospital.
WHEREFORE, Answering Defendant, Mary A. Bartas-White, D.O. denies that
the Plaintiffs are entitled to the relief requested or any relief whatsoever and demand that
judgment be entered in her favor against the Plaintiffs and that the Answering Defendant
be awarded appropriate costs and fees.
COUNT III
Lindsay A. Estacio, by her
parents natural guardians,
Richard A. Estacio and Lori
Estacio v. Mary A. Bartas-White, D.O.
and Holy Spirit Hospital
Corporate Negligence
74. through 78. Paragraphs 74 through 78 of the Plaintiff's Complaint refer to
parties other than the Answering Defendant consequently no answer is required. In the
alternative to the extent that paragraphs 74 through 78 of the Plaintiff's Complaint are
deemed to contain facts that pertain to the Answering Defendant, those allegations of fact
that are denied as after reasonable investigation the Answering Defendant is without
knowledge or information sufficient to form a belief as to the truth or falsity of the
averments set forth therein.
WHEREFORE, Answering Defendant, Mary A. Bartas-White, D.O. denies that
the Plaintiffs are entitled to the relief requested or any relief whatsoever and demand that
judgment be entered in her favor against the Plaintiffs and that the Answering Defendant
be awarded appropriate costs and fees.
COUNT IV
Lindsay A. Estacio,
Richard A. Estacio and
Lori Estacio, in their own
right v. Mary A. Bartas-White, D.O.
and Holy Spirit Hospital
79. The above stated responses to paragraphs 1 through 78 of the Plaintiffs
Complaint are incorporated herein as if fully set forth
80. and 81. Paragraphs 80 through 81 of the Plaintiff s Complaint set forth
conclusions of law to which no response is required. In the alternative to the extent that
paragraphs 80 through 81 are deemed to contain facts to which a responsive pleading is
deemed required, those allegations of fact are denied generally in accord with
Pennsylvania Rule of Civil Procedure 1029.
WHEREFORE, Answering Defendant, Mary A. Bartas-White, D.O. denies that
the Plaintiffs are entitled to the relief requested or any relief whatsoever and demand that
judgment be entered in her favor against the Plaintiffs and that the Answering Defendant
be awarded appropriate costs and fees.
NEW MATTER
82. To the extent that the evidence reveals that Plaintiff failed to follow
medical advice, failed to treat properly, or otherwise failed to mitigate her damages, this
Defendant pleads the defense of the failure to mitigate.
83. To the extent that the evidence reveals that Plaintiff failed to file this
action in a timely manner, this Defendant pleads the defense of the statute of limitations.
84. To the extent that the evidence reveals that the Plaintiff had a pre-existing
condition that caused or contributed to her injuries, this Defendant pleads the existence of
that pre-existing condition as a defense.
85. If at the time of trial it is established that this Defendant accepted less than
full payment for certain of Plaintiffs medical expenses or otherwise forgave certain of
those expenses, then this Defendant pleads any such set-offs as an affirmative defense.
86. This Defendant raises the acts and/or omissions of third parties over whom
Defendants had neither the right nor duty to control as a complete and/or partial bar to
Plaintiff s claims.
87. To the extent that the evidence reveals that Plaintiff lacked the capacity to
sue at the time this action was commenced, or at any time relevant hereto, this Defendant
pleads the lack of capacity to sue as an affirmative defense.
88. To the extent that it is determined that Plaintiff is or was engaged in
other litigations or proceedings pertaining to the injuries alleged in this Complaint, this
Defendant pleads the defenses of accord and satisfaction, arbitration and award, estoppel,
and release.
89. The recovery of medical expenses paid by any third-party, including any
insurance carrier, is barred pursuant to Section 508 of the Medical Care Availability and
Reduction of Errors Act (Act 13 of 2002 (40 P.S. §1301.508)).
90. Answering Defendant hereby invokes all provisions of the Medical Care
Availability and Reduction of Error Act to the extent such provisions constitute
affirmative defenses to Plaintiffs claims.
Respectfully submitted,
DICKIE, MCCAMEY & CHILCOTE, P.C.
0 ---
Date: October 7, 2004 By
Francis E. Maushall, Jr., Esquire
Supreme Court. I.D. #27594
Thomas M. Chairs, Esquire
Supreme Court I.D. #78565
1200 Camp Hill Bypass
Suite 205
Camp Hill, PA 17011
Phone 717-731-4800
Counsel for Defendants Mary A. Bartas-
White, D. 0., Holy Spirit Hospital of the
Sisters of Christian Charity, Holy
Spirit Hospital, Holy Spirit Corporation,
Holy Spirit Health System, Holy Spirit
Ventures, Inc., Spirit Physician Services,
Inc. and Sisters of Christian Charity Health
Care Corporation
I, Mary A. Bartas-White, D.O., hereby verify that the averments set forth in
the preceding 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.
DG,7, zoo°?
Date: /
Mary A. artas-White, D.O.
CERTIFICATE OF SERVICE
70- day of October, 2004, I, Thomas M. Chairs,
AND NOW, this of the foregoing document
Esquire, hereby certify that I did serve a true and correct co epo sited, same in the U.S.
deposited,
upon all counsel of record by depositing, or causing to be
Pennsylvania,
postage prepaid, at Harrisburg, addressed as follows:
g First-Class Mail:
Lee C. Swartz, Esquire
Stephen M. Greecheer,Jr., Esquire
Tucker Arenberg, C
111North Front Street
P.O.box 889
Harrisburg PA 17108-0889
Thomas M. Chairs, Esquire
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LINDSAY A. ESTACIO, a Minor, By Her
Parents and Natural Guardians, RICHARD
A. ESTACIO and LORI ESTACIO, and
RICHARD A. ESTACIO and LORI
ESTACIO, in Their Own Right,
Plaintiffs
V.
MARY A. BARTAS-WHITE, D.O.; HOLY
SPIRIT HOSPITAL OF THE SISTERS OF
CHRISTIAN CHARITY; HOLY SPIRIT
HOSPITAL; HOLY SPIRIT
CORPORATION; HOLY SPIRIT
HEALTH SYSTEM; HOLY SPIRIT
VENTURES, INC.; SPIRIT PHYSICIAN
SERVICES, INC.; SISTERS OF
CHRISTIAN CHARITY HEALTH CARE
CORPORATION,
Defendants
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY,
PENNSYLVANIA
NO. 04-3463 CIVIL
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
MOTION FOR COURT APPROVAL OF THE VOLUNTARY DISMISSAL OF HOLY
SPIRIT HOSPITAL OF THE SISTERS OF CHRISTRIAN CHARITY; HOLY SPIRIT
CORPORATION, HOLY SPIRIT HEALTH SYSTEM; HOLY SPIRIT VENTURES
INC.; SPIRIT PHYSICIANS SERVICES, INC.; SISTERS OF
HEALTHCARE CORPORATION CHRISTIAN CHARITY
AND NOW, come Defendants in the above captioned matter by and through their
attorneys, Dickie, McCamey & Chilcote, P.C. and file the within Motion for Court Approval of
the Defendant Corporations in the above captioned matter and in support thereof avers as
follows:
The Plaintiffs initiated this civil action with the filing of a Civil Complaint against
Dr. Mary A. Bartas-White, D.O. and a number of corporations.
2. The parties have stipulated to the voluntary dismissal of Holy Spirit Hospital of
the Sisters of Christian Charity; Holy Spirit Corporation; Holy Spirit Health System; Holy Spirit
Ventures Inc.; Spirit Physicians Services, Inc; and, Sisters of Christian Charity
Healthcare Corporation.
4. A true and correct copy of the original Stipulation to Dismiss signed by counsel
for all parties of record is attached hereto as Exhibit "A"
5. The Holy Spirit Hospital and the Sisters of Christian Charity; Holy Spirit
Corporation; Holy Spirit Health System; Holy Spirit Ventures, Inc.; Spirit Physician Services,
Inc.; and Sisters of Christian Charity Healthcare Corporation respectfully request this Honorable
Court enter an order approving the dismissal of said Defendants and directing the Prothonotary
to redact Holy Spirit Hospital of the Sisters of Christian Charity; Holy Spirit Corporation; Holy
Spirit Health System; Holy Spirit Ventures Inc.; Spirit Physicians Services, Inc; and Sisters of
Christian Charity Healthcare Corporation from the caprion of this case.
WHEREFORE, Holy Spirit Hospital of the Sisters of Christian Charity; Holy Spirit
Corporation; Holy Spirit Health System; Holy Spirit Ventures Inc.; Spirit Physicians Services,
Inc; and Sisters of Christian Charity Healthcare Corporation respectfully request this Honorable
Court enter an Order approving the voluntary dismissal of Holy Spirit Hospital of the Sisters of
Christian Charity; Holy Spirit Corporation; Holy Spirit Health System; Holy Spirit Ventures
Inc.; Spirit Physicians Services, Inc; and Sisters of Christian Charity Healthcare Corporation and
directing the Prothonotary to amend the caption of this case to redact Holy Spirit Hospital of the
Sisters of Christian Charity; Holy Spirit Corporation; Holy Spirit; Health System; Holy Spirit
Ventures Inc.; Spirit Physicians Services, Inc; and Sisters of Christian Charity Healthcare
Corporation.
Date: ( V O
Respectfully submitted,
DICKIE, MCCAMEY & CHILCOTE, P.C.
By:? ° OWN
Thomas M. Chairs, Esquire
Atty I.D. #78565
Suite 205
1200 Camp Hill Bypass
Camp Hill, PA 17011-3700
(717) 731-4800
Counsel for Defendants Mary A. Bartas-White,
D. 0., Holy Spirit Hospital of the Sisters of
Christian Charity, Holy Spirit Hospital, Holy
Spirit Corporation, Holy Spirit Health System,
Holy Spirit Ventures, Inc., Spirit Physician
Services, Inc. and Sisters of Christian Charity
Health Care Corporation
LINDSAY A. ESTACIO, a Minor, By
Her Parents and Natural Guardians,
RICHARD A. ESTACIO and LORI
ESTACIO, and RICHARD A.
ESTACIO and LORI ESTACIO, in
Their Own Right,
Plaintiffs
V.
MARY A. BARTAS-WHITE, D.O.;
HOLY SPIRIT HOSPITAL OF THE
SISTERS OF CHRISTIAN CHARITY;
HOLY SPIRIT HOSPITAL; HOLY
SPIRIT CORPORATION; HOLY
SPIRIT HEALTH SYSTEM; HOLY
SPIRIT VENTURES, INC.; SPIRIT
PHYSICIAN SERVICES, INC.;
SISTERS OF CHRISTIAN CHARITY
HEALTH CARE CORPORATION,
Defendants
N THE COURT OF COMMON
PLEAS CUMBERLAND COUNTY,
PENNSYLVANIA
N0.04-3463 CIVIL
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
STIPULATION FOR THE DISMISSAL OF HOLY SPIRIT HOSPITAL OF THE
SISTERS OF CHRISTIAN CHARITY; HOLY SPIRIT CORPORATION; HOLY
SPIRIT HEALTH SYSTEM; HOLY SPIRIT VENTURES, INC.; SPIRIT
PHYSICIAN SERVICES, INC.; SISTERS OF CHRISTIAN CHARITY HEALTH
CARE CORPORATION
The Holy Spirit Hospital of the Sisters of Christian Charity is neither a
registered name nor licensed affiliate/subsidiary of the Sisters of Christian Charity Health
Care Corporation.
2. The Holy Spirit Health System is an administrative entity that does not
provide health care to patients.
Holy Spirit Corporation serves an administrative function with respect to
the Medical Arts Building.
4. Holy Spirit Ventures, Inc. serves an administrative function for off site
surgery centers.
5. Spirit Physician Services, Inc. serves an administrative function for off site
family health centers.
6. Holy Spirit Hospital is the entity that fulfills the corporate obligations of
the hospital located at 503 North 2151 Street, Camp Hill, Cumberland County,
Pennsylvania, 17011, known to the public as Holy Spirit Hospital.
Mary A. Bartas-White, D.O., at all times relevant to the Plaintiff S
Complaint was employed by the Holy Spirit Hospital.
g. It is hereby agreed by and between counsel for all parties of record that the
following Defendants are dismissed from this matter without prejudice:
a. Holy Spirit Hospital of the Sisters of Christian Chanty;
b. Holy Spirit Corporation;
C. Holy Spirit Health System;
d. Holy Spirit Ventures, Inc;
e. Spirit Physician Services, Inc.; and,
f. Sisters of Christian Charity Health Care Corporation.
9. After the filing of this document the only remaining Defendants will be
Mary A. Bartas-White, D.O. and Holy Spirit Hospital.
10. In the course of discovery, should the Plaintiff determine that any of the
above referenced defendants were proper parties to this litigation, those entities may be
rejoined prior to the conclusion of this matter as defendants and the litigation will
proceed as if they had never been dismissed.
Counsel for Defendants: Mary A. Bartas-White, D.O.; Holy Spirit Hospital of the
Sisters of Christian Charity; Holy Spirit Hospital; Holy Spirit Corporation; Holy
Spirit Health System; Holy Spirit Ventures, Inc.; Spirit ]Physician Services, Inc.;
Sisters of Christian Charity Health Care Corporation
0v71'l
Thomas M. Chairs, Esquire
DICKIE, MCCAMEY & CHILCOTE, P.C.
Suite 205
1200 Camp Hill Bypass
Camp Hill, PA 17011-3700
Date: ?' /&' 64-
Counsel for Plaintiff: Lindsay A. Estacio, a Minor, By Her Parents and Natural
Guardians, Richard A. Estacio and Lori Estacio, and Richard A. Estacio and Lori
Estacio, in Their Own Right, i?
Stephen M. Greecher, Jr., Es
Tucker Arensberg, P.C.
I I INorth Front Street
P.O.box 889
Harrisburg, PA 17108-0889
Date: % 13 0 / 0`
AND NOW, this eaay of October, 2004, I, Thomas A Chairs, Esquire, hereby
certify that I did serve a true and correct copy of the foregoing document upon all counsel of
record by depositing, or causing to be deposited, same in the U.S. mail, postage prepaid, at Camp
Hill, Pennsylvania, addressed as follows:
Lee C. Swartz, Esquire
Stephen A Greecher, Jr., Esquire
Tucker Arensberg, P.C.
111 North Front Street
P.O. Box 889
Harrisburg, PA 17108-0889
(Counsel to Plaintiffs)
4n,
LChairs, Esquire
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LINDSAY A. ESTACIO, a Minor, By Her
Parents and Natural Guardians, RICHARD
A. ESTACIO and LORI ESTACIO, and
RICHARD A. ESTACIO and LORI
ESTACIO, in Their Own Right,
Plaintiffs
V.
MARY A. BARTAS-WHITE, D.O.; HOLY
SPIRIT HOSPITAL OF THE SISTERS OF
CHRISTIAN CHARITY; HOLY SPIRIT
HOSPITAL; HOLY SPIRIT
CORPORATION; HOLY SPIRIT
HEALTH SYSTEM; HOLY SPIRIT
VENTURES, INC.; SPIRIT PHYSICIAN
SERVICES, INC.; SISTERS OF
CHRISTIAN CHARITY HEALTH CARE
CORPORATION,
Defendants
OCT 2004
IN THE COURT OF COMMON LEAS
CUMBERLAND COUNTY,
PENNSYLVANIA
NO. 04-3463 CIVIL
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
ORDER
AND NOW, this Z day of -bc,4/p - . 2004, upon consideration of the
Stipulation of Counsel for all parties of record it is hereby ORDERED and DECREED that the
following Defendants are voluntarily dismissed from this case:
1. Holy Spirit Hospital of the Sisters of Christian Charity;
2. Holy Spirit Corporation;
3. Holy Spirit Health System;
4. Holy Spirit Ventures Inc.;
5. Spirit Physicians Services, Inc; and,
6. Sisters of Christian Charity Healthcare Corporation.
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V
It is further ORDERED and DECREED that the Prothonotary is directed to amend the
caption of this case to redact the above stated Defendants voluntafily dismissed by operation of
this Order.
,O
spa
a?
LINDSAY A. ESTACIO, a Minor, By Her
Parents and Natural Guardians,
RICHARD A. ESTACIO and LORI
ESTACIO, and RICHARD A. ESTACIO and
LORI ESTACIO, in Their Own Right,
Plaintiffs
V.
MARY A. BARTAS-WHITE, D.O.;
HOLY SPIRIT HOSPITAL OF THE
SISTERS OF CHRISTIAN CHARITY;
HOLY SPIRIT HOSPITAL;
HOLY SPIRIT CORPORATION;
HOLY SPIRIT HEALTH SYSTEM;
HOLY SPIRIT VENTURES, INC.;
SPIRIT PHYSICIAN SERVICES, INC.;
SISTERS OF CHRISTIAN CHARITY
HEALTH CARE CORPORATION;
Defendants
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 04-3463 CIVIL
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
PLAINTIFFS' REPLY TO NEW MATTER
OF DEFENDANT, MARY A. BARTAS-WHITE, D.O.
82. The allegations of Paragraph 82 state a legal conclusion to which no response is
required. To the extent the allegations are deemed factual, the allegations are denied pursuant
to the Rules of Civil Procedure.
83. The allegations of Paragraph 83 state a legal conclusion to which no response is
required. By way of further answer, this action was filed within the applicable Statute of
Limitations.
84. The allegations of Paragraph 84 state a legal conclusion to which no response is
required. To the extent the allegations are deemed factual, the allegations are denied pursuant
to the Rules of Civil Procedure.
85. The allegations of Paragraph 85 state a legal conclusion to which no response is
required. To the extent the allegations are deemed factual, the allegations are denied pursuant
to the Rules of Civil Procedure.
86. The allegations of Paragraph 86 state a legal conclusion to which no response is
required. To the extent the allegations are deemed factual, the allegations are denied pursuant
to the Rules of Civil Procedure.
87. The allegations of Paragraph 87 state a legal conclusion to which no response is
required. To the extent the allegations are deemed factual, the allegations are denied pursuant
to the Rules of Civil Procedure.
88. The allegations of Paragraph 88 state a legal conclusion to which no response is
required. To the extent the allegations are deemed factual, the allegations are denied pursuant
to the Rules of Civil Procedure.
89. The allegations of Paragraph 89 state a legal conclusion to which no response is
required.
90. The allegations of Paragraph 90 state a legal conclusion to which no response is
required.
DATE: 11 40
73304.1
TUCKER AR
By:
9te0Wdj d-'GreechiV, Jr.
Attorney's I.D. No. PA-36803
111 North Front Street
P. O. Box 889
Harrisburg, PA 17108-0889
(717) 2:34-4121
ATTORNEYS FOR PLAINTIFFS
VERIFICATION
I, LINDSAY A. ESTACIO, Plaintiff, acknowledge that the facts stated in the foregoing
document are true and correct to the best of my knowledge, information and belief.
I understand that any false statements herein are made subject to the penalties of
18 Pa.C.S.A. Section 4904, relating to unsworn falsification to authorities.
Lindsay A. Estaci
70025.1
VERIFICATION
I, LORI ESTACIO, Plaintiff, acknowledge that the facts stated in the foregoing document
are true and correct to the best of my knowledge, information and belief.
I understand that any false statements herein are made subject to the penalties of
18 Pa.C.S.A. Section 4904, relating to unsworn falsification to authorities.
r
Lori stacio
70025.1
VERIFICATION
I, RICHARD A. ESTACIO, Plaintiff, acknowledge that the facts stated in the foregoing
document are true and correct to the best of my knowledge, information and belief.
I understand that any false statements herein are made subject to the penalties of
18 Pa.C.S.A. Section 4904, relating to unsworn falsification to authorities.
`-''Richard A. Estacio
70025.1
CERTIFICATE OF SERVICE
AND NOW, this 16A day of NOVEMBER, 2004, I, Jacquelyn Zettlemoyer,
Secretary to Stephen M. Greecher, Jr., Esquire, for the law firm, TUCKER ARENSBERG, P.C.,
attorneys for Plaintiffs, hereby certify that I have this day served the within document by
depositing a true and correct copy of the same in the United States Mail, first class, postage
prepaid, at Harrisburg, Pennsylvania, addressed as follows:
Thomas M. Chairs, Esquire
Dickie, McCamey & Chilcote, P.C.
1200 Camp Hill Bypass, Suite 205
Camp Hill, PA 17011-3700
Jacquelyn lemoyer
71771.1
C {C,J
CJ ?.
LINDSAY A. ESTACIO, a Minor, By Her
Parents and Natural Guardians,
RICHARD A. ESTACIO and LORI
ESTACIO, and RICHARD A. ESTACIO and
LORI ESTACIO, in Their Own Right,
Plaintiffs
V.
MARY A. BARTAS-WHITE, D.O.;
HOLY SPIRIT HOSPITAL OF THE
SISTERS OF CHRISTIAN CHARITY;
HOLY SPIRIT HOSPITAL;
HOLY SPIRIT CORPORATION;
HOLY SPIRIT HEALTH SYSTEM;
HOLY SPIRIT VENTURES, INC.;
SPIRIT PHYSICIAN SERVICES, INC.;
SISTERS OF CHRISTIAN CHARITY
HEALTH CARE CORPORATION;
Defendants
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 04-3463 CIVIL
CIVIL ACTION - LAW
JURY TRIAL DEMANDED
PLAINTIFFS' REPLY TO NEW MATTER
OF DEFENDANT, HOLY SPIRIT HOSPITAL
82. The allegations of Paragraph 82 state a legal conclusion to which no response is
required. To the extent the allegations are deemed factual, the allegations are denied pursuant
to the Rules of Civil Procedure.
83. The allegations of Paragraph 83 state a legal conclusion to which no response is
required. By way of further answer, this action was filed within the applicable Statute of
Limitations.
84. The allegations of Paragraph 84 state a legal conclusion to which no response is
required. To the extent the allegations are deemed factual, the allegations are denied pursuant
to the Rules of Civil Procedure.
85. The allegations of Paragraph 85 state a legal conclusion to which no response is
required. To the extent the allegations are deemed factual, the allegations are denied pursuant
to the Rules of Civil Procedure.
86. The allegations of Paragraph 86 state a legal conclusion to which no response is
required. To the extent the allegations are deemed factual, the allegations are denied pursuant
to the Rules of Civil Procedure.
87. The allegations of Paragraph 87 state a legal conclusion to which no response is
required. To the extent the allegations are deemed factual, the allegations are denied pursuant
to the Rules of Civil Procedure.
88. The allegations of Paragraph 88 state a legal conclusion to which no response is
required. To the extent the allegations are deemed factual, the allegations are denied pursuant
to the Rules of Civil Procedure.
DATE:
73305.1
TUCKER
By:
,SlWelGreec
Attorney's I.D. No. 36803
111 North Front Street
P. O. Box 889
Harrisburg, PA 17108-0889
(717) 2:34-4121
ATTORNEYS FOR PLAINTIFFS
VERIFICATION
I, LINDSAY A. ESTACIO, Plaintiff, acknowledge that the facts stated in the foregoing
document are true and correct to the best of my knowledge, information and belief.
I understand that any false statements herein are made subject to the penalties of
18 Pa.C.S.A. Section 4904, relating to unsworn falsification to authorities.
?? -
Lindsay A. Estaci
70025.1
VERIFICATION
I, LORI ESTACIO, Plaintiff, acknowledge that the facts stated in the foregoing document
are true and correct to the best of my knowledge, information and belief.
understand that any false statements herein are made subject to the penalties of
18 Pa.C.S.A. Section 4904, relating to unsworn falsification to authorities.
Lori stacio
70025.1
VERIFICATION
I, RICHARD A. ESTACIO, Plaintiff, acknowledge that the facts stated in the foregoing
document are true and correct to the best of my knowledge, information and belief.
I understand that any false statements herein are made subject to the penalties of
18 Pa.C.S.A. Section 4904, relating to unsworn falsification to authorities.
Richard A. Estacio
70025.1
CERTIFICATE OF SERVICE
AND NOW, this 16-6 day of NOVEMBER, 2004, I, Jacquelyn Zettlemoyer,
Secretary to Stephen M. Greecher, Jr., Esquire, for the law firm, TUCKER ARENSBERG, P.C.,
attorneys for Plaintiffs, hereby certify that I have this day served the within document by
depositing a true and correct copy of the same in the United States Mail, first class, postage
prepaid, at Harrisburg, Pennsylvania, addressed as follows:
Thomas M. Chairs, Esquire
Dickie, McCamey & Chilcote, P.C.
1200 Camp Hill Bypass, Suite 205
Camp Hill, PA 17011-3700
Azn&a I A)
Jacquel Zettemoye
71771.1
T_l
{ 1_
?l
40? .4
LINDSAY A. ESTACIO, a Minor, By Her
Parents and Natural Guardians, RICHARD
A. ESTACIO and LORI ESTACIO, and
RICHARD A. ESTACIO and LORI
ESTACIO, in Their Own Right,
Plaintiffs
V.
MARY A. BARTAS-WHITE, D.O. and
HOLY SPIRIT HOSPITAL;
Defendants
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY,
PENNSYLVANIA
NO. 04-3463 CIVIL
CIVIL ACTION - MEDICAL
PROFESSIONAL LIABILITY
ACTION
JURY TRIAL DEMANDED
CERTIFICATE PREREQUISITE TO SERVICE OF A
SUBPOENA PURSUANT TO RULE 4009.22
As a prerequisite to service of a subpoena for documents and things pursuant to Rule
4009.22, Counsel for Defendants certify 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.
DICKIE, MCCAMEY & CHILCOTE, P.C.
n rte. , ,r
Date: niS?
Thomas M. Chairs, Esquire
Attorney I.D. #78565
1200 Camp Hill Bypass
Suite 205
Camp Hill, PA 17011-3700
Attorney for Defendants
to
so, CERTIFICATE OF SERVICE
AND NOW, this 22nd of September, 2006, I, Misty Lehman, hereby certify that I did
serve a true and correct copy of the foregoing Certificate Prerequisite to Service of a Subpoena
upon all parties of record by depositing, or causing to be deposited, same in the U.S. mail,
postage prepaid, at Camp Hill, Pennsylvania, addressed as follows:
By First-Class Mail:
Stephen M. Greecher, Jr., Esquire
Tucker Arensberg, P.C.
1 I I North Front Street
P.O. Box 889
Harrisburg, PA 17108-0889
(Counsel to Plaintiffs)
LINDSAY A. ESTACIO, a Minor, By Her
Parents and Natural Guardians, RICHARD
A. ESTACIO and LORI ESTACIO, and
RICHARD A. ESTACIO and LORI
ESTACIO, in Their Own Right,
Plaintiffs
V.
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY,
PENNSYLVANIA
NO. 04-3463 CIVIL
CIVIL ACTION - MEDICAL
PROFESSIONAL LIABILITY
ACTION
MARY A. BARTAS-WHITE, D.O. and
HOLY SPIRIT HOSPITAL;
Defendants
JURY TRIAL DEMANDED
NOTICE OF INTENT TO SERVE A SUBPOENA TO PRODUCE
DOCUMENTS AND THINGS FOR DISCOVERY PURSUANTTO RULE 4009.21
Defendants intend to serve a Subpoena identical to the Subpoena attached to this Notice,
addressed to the following: Giant Foods, 310 East Penn Drive, Enola, PA 17025.
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 no objection is made the subpoena may be
served.
DICIGE, MCCAMEY & CHI COTE, P.C.
Date: By: ?(??/?'? ,?l/?
Thomas M. Chairs, Esquire
Attorney I.D. #78565
1200 Camp Hill Bypass
Camp Hill, PA 17011-3700
(717) 731-4800
Attorney for Defendants
CERTIFICATE OF SERVICE
AND NOW, this day o 2006, I, Qhereby certify that
I did serve a true and correct copy of the foregoing Notice of Intent to Serve a Subpoena to
Produce Documents and Things for Discovery Pursuant to Rule 4009.21 upon all parties of
record by depositing, or causing to be deposited, same in the U.S. mail, postage prepaid, at Camp
Hill, Pennsylvania, addressed as follows:
By First-Class Mail:
Stephen M. Greecher, Jr., Esquire
Tucker Arensberg, P.C.
111 North Front Street
P.O. Box 889
Harrisburg, PA 17108-0889
(Counsel to Plaintiffs)
¦--_---------------- - - -- - - - - --- ------.--------_--------------_-___.- -----------------------
rr
1 '
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
Lindsay A. Estacio, et al.
Plaintiffs File No. 04-3463
V.
Holy Spirit Hospital, et al. ,
Defendants
SUBPOENA TO PRODUCE DOCUMENTS OR THINGS
FOR DISCOVERY PURSUANT TO RULE 4009.22
TO: Giant Foods
(NanSe 4f Persatt orEntity)
within twenty (20) days after service of this subpoena, you are ordered by the court to produce the
following documents or things: '
See Attachment A
Dickie, McCamey & Chilcote, PA, 1200 CAmp Hill Bypass, Suite 205,
- --
at rmng Hill - PA 17011
(Address)
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 malting 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: Thomas M. Chairs
ADDRESS: 1200 Camp Hill. Bypass-
Suite 205
Camp Ej 11 PA 17011
TE HONE:"
SUPREME COURT ID # RE)
ATTORNEY FOR: Def en ant
Date:
Seal of the Court
BY THE COURT:
Prothonotary, Civil Division
Deputy
ATTACHMENT A
1. Any and all documents and/or information in your care, custody or control
relating in any way to prescriptions for Lindsay Estacio, D.O.B. 02/19/1988,
Social Security Number: 196-74-9815 Address: 1462 Timber Brook Dr.
Mechanicsburg PA 17050.
2.. This request includes but is not limited to the following documents and/or
materials: complete records including an and all handwritten and typed
records, any computer printouts of information stored electronically including
but not limited to printouts of electronic signatures by the recipient of the
prescriotion, copies of medication leaflets which would have been provided
with any and all of Lindsey Estacio's prescriptions in 2002, any other
unspecified records regarding prescriptions for Lindsey Estacio in 2002.
DEPONENT IS ADVISED THAT IT IS SUFFICIENT TO PROVIDE THE
MATERIAL REQUESTED BY MAIL OR HAND DELIVERY IN LIEU OF APPEARING
IN PERSON FOR THIS DEPOSITION, PROVIDED THAT THE DEPONENT
CERTIFIES THAT THE RECORDS WHICH, HAVE BEEN SENT ARE TRUE,
ACCURATE AND COMPLETE COPIES OF THE REQUESTED MATERIAL BY
EXECUTING THE ATTACHED AFFIDAVIT BEFORE A NOTARY PUBLIC AND
FORWARDING SAME WITH THE DOCUMENTS.
Date:
DICKIE, MCCAMEY & CHILCOTE, P.C.
By:
Thomas M. Chairs, Esquire
Attorney I.D. #78565
1200 Camp Hill Bypass
Suite 205
Camp Hill, PA 17011-3700
Attorney for Defendants
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111910
DICKIE, MCCAMEY & CHILCOTE, P.C.
BY: THOMAS M. CHAIRS, ESQUIRE
ATTORNEY I.D. NO. 78565
BY: AARON S. JAYMAN, ESQUIRE
ATTORNEY I.D. NO. 85651
1200 Camp Hill Bypass, Suite 205
Camp Hill, PA 17011
(717)731-4800 (Tele)
(717)731-4803 (Fax)
LINDSAY A. ESTACIO, A MINOR, BY
HER PARENTS AND NATURAL
GUARDIANS, RICHARD A. ESTACIO
AND LORI ESTACIO, AND RICHARD A.
ESTACIO AND LORI ESTACIO, IN
THEIR OWN RIGHT,
Plaintiffs
ATTORNEY FOR: DEFENDANTS
MARY A. BARTAS-WHITE, D.O. AND
HOLY SPIRIT HOSPITAL
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY,
PENNSYLVANIA
NO. 04-3463 CIVIL
MEDICAL MALPRACTICE ACTION
V.
MARY A. BARTAS-WHITE, D.O. and
HOLY SPIRIT HOSPITAL,
Defendants
JURY TRIAL DEMANDED
DEFENDANTS' MOTION FOR CASE MANAGEMENT CONFERENCE
PURSUANT TO Pa.R.C.P. 1042.41
AND NOW, comes Defendants, Mary A. Bartas-White, D.O. and Holy Spirit Hospital,
by and through their attorneys, Dickie, McCamey & Chilcote, P.C., who respectfully request a
Case Management Conference.
This medical professional liability action involves Lindsay Estacio's alleged
allergic reaction to Lamictal, which Plaintiffs assert resulted in Stevens Johnson's syndrome.
2. Plaintiffs initiated this lawsuit by filing a Complaint on July 16, 2004.
3. The parties engaged in written discovery.
4. The following depositions have taken place to date:
Dr. White (2/3/06);
Nurse Tumolo (4/26/06);
Lindsay Estacio (9/7/06);
Richard Estacio (9/8/06); and
Lori Lewis (9/8/06).
5. Additional depositions are necessary but have not yet been scheduled.
6. No expert reports have been produced.
7. Defendants' counsel has sought and received concurrence from the Plaintiffs'
counsel in the filing of this Motion via a return voicemail message on 4/18/07.
WHEREFORE, Defendants, Mary A. Bartas-White, D.O. and Holy Spirit Hospital
respectfully request a Case Management Conference with the Court to set specific dates to
finalize discovery, disclose expert reports and to schedule the case for trial.
Respectfully submitted,
Date: April 20, 2007 By:
DICKIE, MCCAMEY & CHILCOTE, P.C.
Thomas M. h i , UAquire
ATTO E I 0.78565
Aaron S. Jayman, Esquire
ATTORNEY I.D. NO. 85651
1200 Camp Hill Bypass, Suite 205
Camp Hill, PA 17011-3700
(717) 731-4800
Attorney for Defendants, Mary A. Bartas- White,
D. 0. and Holy Spirit Hospital
2
CERTIFICATE OF SERVICE
AND NOW, April 20, 2007, I, Aaron S. Jayman, Esquire, hereby certify that I did serve a
true and correct copy of the foregoing upon all counsel of record by depositing, or causing to be
deposited, same in the U.S. mail, postage prepaid, at Camp Hill, Pennsylvania, addressed as
follows:
Stephen M. Greecher, Jr., Esquire
TUCKER ARENSBERG, P.C.
111 North Front Street
P.O. Box 889
Harrisburg, PA 17108
(Counsel for Plaintiff)
111910
DICKIE, MCCAMEY & CHILCOTE, P.C.
BY: THOMAS M. CHAIRS, ESQUIRE
ATTORNEY I.D. NO. 78565
BY: AARON S. JAYMAN, ESQUIRE
ATTORNEY I.D. NO. 85651
1200 Camp Hill Bypass, Suite 205
Camp Hill, PA 17011
(717)731-4800 (Tele)
(717)731-4803 (Fax)
LINDSAY A. ESTACIO, A MINOR, BY
HER PARENTS AND NATURAL
GUARDIANS, RICHARD A. ESTACIO
AND LORI ESTACIO, AND RICHARD A.
ESTACIO AND LORI ESTACIO, IN
THEIR OWN RIGHT,
Plaintiffs
ATTORNEY FOR: DEFENDANTS
MARY A. BARTAS-WHITE, D.O. AND
HOLY SPIRIT HOSPITAL
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY,
PENNSYLVANIA
NO. 04-3463 CIVIL
MEDICAL MALPRACTICE ACTION
V.
MARY A. BARTAS-WHITE, D.O. and
HOLY SPIRIT HOSPITAL,
Defendants
JURY TRIAL DEMANDED
DEFENDANTS' AMENDED MOTION FOR CASE MANAGEMENT CONFERENCE
PURSUANT TO Pa.R.C.P. 1042.41
AND NOW, come Defendants, Mary A. Bartas-White, D.O. and Holy Spirit Hospital, by
and through their attorneys, Dickie, McCamey & Chilcote, P.C., who respectfully request a Case
Management Conference and submit the following Amended Motion in support thereof.
1. This medical professional liability action involves Lindsay Estacio's alleged
allergic reaction to Lamictal, which Plaintiffs assert resulted in Stevens Johnson's syndrome.
2. Plaintiffs initiated this lawsuit by filing a Complaint on July 16, 2004.
3. The parties engaged in written discovery.
4. The following depositions have taken place to date:
Dr. White (2/3/06);
Nurse Tumolo (4/26/06);
Lindsay Estacio (9/7/06);
Richard Estacio (9/8/06); and
Lori Lewis (9/8/06).
5. Additional depositions are necessary but have not yet been scheduled.
6. No expert reports have been produced.
7. Defendants' counsel has sought and received concurrence from the Plaintiffs'
counsel in the filing of this Motion via a return voicemail message on April 18, 2007.
8. Judge Hess has previously entered an order in this case. The order was entered
as a result of a stipulation of counsel that voluntarily dismissed several defendants from the case.
WHEREFORE, Defendants, Mary A. Bartas-White, D.O. and Holy Spirit Hospital
respectfully request a Case Management Conference with the Court to set specific dates to
finalize discovery, disclose expert reports and to schedule the case for trial.
Respectfully submitted,
DICKIE, MCCAMEY & CHILCOTE, P.C.
Date: April 25, 2007 By:
Thoma M. h it , Esquire
ATTO . NO. 78565
Aaron S. Jayman, Esquire
ATTORNEY I.D. NO. 85651
1200 Camp Hill Bypass, Suite 205
Camp Hill, PA 17011-3700
(717) 731-4800
Attorney for Defendants, Mary A. Bartas-White,
D. 0. and Holy Spirit Hospital
2
CERTIFICATE OF SERVICE
AND NOW, April 25, 2007, I, Aaron S. Jayman, Esquire, hereby certify that I did serve a
true and correct copy of the foregoing upon all counsel of record by depositing, or causing to be
deposited, same in the U.S. mail, postage prepaid, at Camp Hill, Pennsylvania, addressed as
follows:
Stephen M. Greecher, Jr., Esquire
TUCKER ARENSBERG, P.C.
111 North Front Street
P.O. Box 889
Harrisburg, PA 17108
(Counsel for Plaintiff)
Aaron S Ja a , squire
4
APR 86 7007
LINDSAY A. ESTACIO, A MINOR, BY
HER PARENTS AND NATURAL
GUARDIANS, RICHARD A. ESTACIO
AND LORI ESTACIO, AND RICHARD A.
ESTACIO AND LORI ESTACIO, IN
THEIR OWN RIGHT,
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY,
PENNSYLVANIA
NO. 04-3463 CIVIL
MEDICAL MALPRACTICE ACTION
Plaintiffs
V.
MARY A. BARTAS-WHITE, D.O. and
HOLY SPIRIT HOSPITAL
Defendants
JURY TRIAL DEMANDED
ORDER
AND NOW, this 30(Aday of , 2007, upon consideration of Defendants'
Motion for Case Management Conference, a conference is hereby scheduled for SAt day of
2007, in the Cumberland County Courthouse in Courtroom with Judge
, :;S? .3 d,
Distribution:
Stephen M. Greecher, Jr., Esquire
Tucker Arensberg, P.C.
111 North Front Street
P.O. Box 889
Harrisburg, PA 17108
Aaron S. Jayman, Esquire
Dickie, McCamey & Chilcote, P.C.
1200 Camp Hill Bypass, Suite 205
Camp Hill, PA 17011
BY THE COURT:
I
:8 V ! - AM LOOZ
.14 .130
L?
i
LINDSAY A. ESTACIO, a minor,
by her parents and natural guardians,
RICHARD A. ESTACIO and LORI
ESTACIO, and RICHARD A.
ESTACIO and LORI ESTACIO,
in their own right,
Plaintiffs
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
NO. 04-3463 CIVIL
vs.
MARY A. BARTAS-WHITE, D.O.,
and HOLY SPIRIT HOSPITAL,
Defendants : JURY TRIAL DEMANDED
IN RE: CASE MANAGEMENT CONFERENCE
ORDER
AND NOW, this I se day of June, 2007, following conference with counsel in
chambers, the following case management order is adopted:
1. All fact discovery, including depositions of fact witnesses, will be completed within
sixty (60) days.
2. The plaintiffs' expert report(s) will be forthcoming within sixty (60) days.
3. Defendants' rebuttal expert reports will be submitted within one hundred twenty (120)
days. The plaintiffs' rebuttal expert reports shall be due thirty (30) days after the submission of
the defendants' expert reports.
It is anticipated that this matter will be tried during the February term of 2008 and
counsel herein are attached for the purpose of trial during that week. Counsel for the plaintiffs
will assume responsibility for listing the matter for trial.
BY THE COURT,
16 '£ Wd I - Nn r LOOT
1?t'b'. O11N.u a ow 3HA 30
3,011-4-40-T -M
N
Stephen M. Greecher, Jr., Esquire
Lee Swartz, Esquire
For the Plaintiffs
Aaron Jayman, Esquire
For the Defendants
Am
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.
( ) for trial without a jury.
CAPTION OF CASE
(entire caption must be stated in full) (check one)
LINDSAY A. ESTACIO, a Minor, By Her ( X) Civil Action - Law
Parents and Natural Guardians,
RICHARD A. ESTACIO and LORI ( ) Appeal from Arbitration
ESTACIO, and RICHARD A. ESTACIO and
LORI ESTACIO, in Their Own Right, ( )
(other)
vs.
(Plaintiff)
MARY A. BARTAS-WHITE, D.O.
and HOLY SPIRIT HOSPITAL,
VS.
(Defendant)
The trial list will be called on
and -o
-T-
a on. Trials commence on re-6. -y. 112*997
Pretrials will be held on --Tin . //, . c7ze5T'
(Briefs are due 5 days before pretrials.)
(The party listing this case for trial shall
provide forthwith a copy of the praecipe to
all counsel, pursuant to local Rule 214.1.)
NO- 04-3463 Civil
Indicate the attorney who will try case for the party who files this praecipe:
Stephen M. Greecher, Jr. and Lee C. Swartz
Indicate trial counsel for other parties if known: Thomas M. Chairs
This case is ready for trial.
Date: 1,-211; ?2^
Signed:
Print Name: Stephen M. Greecher, Jr.
Attorney for: Plaintiffs
Tucker Arensberg, P.C.
111 North Front Street, P. 0. Box 889
Harrisburg, PA 17108-0889
Telephone: (717) 234-4121
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265477
DICKIE, MCCAMEY & CHILCOTE, P.C.
BY Thomas M. Chairs, Esquire
ATTORNEY I.D. NO. 78565
BY Aaron S. Jayman, Esquire
ATTORNEY I.D. NO. 85651
1200 Camp Hill Bypass, Suite 205
Camp Hill, PA 17011
(717)7314800 (Tele)
(717)7314803 (Fax)
LINDSAY A. ESTACIO, A MINOR, BY
HER PARENTS AND NATURAL
GUARDIANS, RICHARD A. ESTACIO
AND LORI ESTACIO, AND RICHARD A.
ESTACIO AND LORI ESTACIO, IN
THEIR OWN RIGHT,
Plaintiffs
ATTORNEY FOR: DEFENDANTS
MARY A. BARTAS-WHITE, D.O. AND HOLY
SPIRIT HOSPITAL
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY,
PENNSYLVANIA
NO. 04-3463 CIVIL
MEDICAL MALPRACTICE ACTION
V.
MARY A. BARTAS-WHITE, D.O. AND
HOLY SPIRIT HOSPITAL,
Defendants
JURY TRIAL DEMANDED
DEFENDANT'S MOTION IN LIMINIE TO PRECLUDE TESTIMONY OF DR MARC
REUBINS AND PLAINTIFFS FROM PRESENTING A CAUSE OF ACTION FOR
NEGLIGENT FAILURE TO OBTAIN INFORMED CONSENT
AND NOW, come Defendants, Mary A. Bartas-White, D.O. ("Dr. White") and Holy
Spirit Hospital, by and through their counsel, Dickie, McCamey & Chilcote, P.C., and move this
Honorable Court to preclude the testimony of Dr. March Reubins and Plaintiffs from presenting
a cause of action for negligent failure to obtain informed consent, and in support thereof aver as
follows:
1. This medical professional liability action proceeds the trial on February 4, 2008.
2. Plaintiffs charge Dr. White with negligence for prescribing Lamictal to treat
minor-Plaintiff's diagnosis of bipolar disorder.
3. Plaintiffs further allege that minor-Plaintiff developed a life threatening rash,
from the prescription of Lamictal.
4. It is undisputed that prior to prescribing Lamictal, Dr. White specifically advised
minor-Plaintiff and her mother that Lamictal had a rare, but known association with a life
threatening rash.
5. Unfortunately, minor-Plaintiff experienced an allergic reaction which digressed to
Toxic Epidermal Necrolysis.
6. Plaintiffs intend to introduce evidence at trial that Dr. White negligently failed to
fully inform them of the risks of Lamictal.
7. At trial, Plaintiffs intend to play the videotape deposition testimony of one of their
experts, Dr. Mark Reubins, in an attempt to establish that Dr. White negligently failed to disclose
all of the facts, risks and alternatives associated with Lamictal and was further negligent for
failing to inform Plaintiffs that by stopping the medication the rash would stop. See, Dr.
Reubins' expert reports which are attached hereto as Exhibit "A."
8. However, the doctrine of informed consent does not apply to the prescription of
Lamictal, which all parties agree is a non-experimental and therapeutic drug.
9. Pennsylvania Courts have consistently held that the doctrine of informed consent
does not extend to the administration of therapeutic drugs to a patient. Keech v. Mead Johnson
& Co., 580 A.2d 1374 (Pa.Super. 1990); Boyer v. Smith, 497 A.2d 646 (Pa. Super. 1985);
Malloy v. Shanahan, 421 A.2d 803 (PA Super. 1990).
10. Furthermore, our Supreme Court has refused to recognize a cause of action for
negligent failure to obtain informed consent. Shaw v. Kirschbaum, 653 A.2d 12 (Pa.Super
1994).
2
11. Plaintiff's expert, Dr. Reubins, will essentially testify at trial that Dr. White
provided Plaintiffs with "inadequate caution" and was negligent in failing to fully obtain
informed consent. See, Dr. Reubins' expert reports which are attached hereto as Exhibit "A."
12. This testimony is improper and an attempt by Plaintiffs to expand the doctrine of
informed consent and its battery rationale to a negligence based rationale which has been
specifically rejected from this Commonwealth. Shaw v. Kirschbaum, 653 A.2d 12 (Pa.Super
1994).
WHEREFORE, Defendants respectfully submit that Plaintiffs should be precluded from
presenting the videotape testimony of, Dr. Mark Reubins, as well as any other evidence and
testimony that Dr. White failed to obtain informed consent and fully disclose all the facts, risks
and alternatives associated with the Lamictal.
Respectfully submitted,
DICKIE, MCCAMEY & CH"E, P.C.
Date: January 16, 2008 By:
Thomas hairs, Esquire
ATTO Y I.D. NO. 78565
Aaron S. Jayman, Esquire
ATTORNEY I.D. NO. 85651
1200 Camp Hill Bypass, Suite 205
Camp Hill, PA 17011-3700
(717) 731-4800
Attorney for Defendants, Mary A. Bartas- White, D. 0. and
Holy Spirit Hospital
3
MARC STEPHAN REUBINS, M.D.
DIPLOAAATE, AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY ADULT PSYCHIATRY
DIPLOMATE, AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY CHILD PSYCHIATRY
SUBSPECIALTY CERTIFICATION IN FORENSIC PSYCHIATRY, AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY ADULT PSYCHIATRY 1986-2006
CERTIFIED IN PSYCHOANALYSIS, NEW YORK PSYCHOANALYTIC INSTITUTE
December 11, 2007
Stephen M. Greecher, Jr.
Tucker Arenberg PC
111 North Front Street
PO Box 889
Harrisburg, Pa. 17108
Re: Estacio
Dear Mr. Greecher:
Reference is made to the information you sent to me with your cover letter of October 16, 2007.
These documents are reports of other experts who have reviewed this matter. They focus on
diagnosis and treatment of your client. In one of the letters there is dispute with my opinion that
inadequate caution was given to your client's parents concerning the possibility that an
irreversible rash could develop given the medication prescribed.
Dr. DelBello states "However, according to the documentation provided, Dr. White never stated
that the rash would go way if Lindsay discontinued the lamotrigine". Dr. White, by telling
Lindsay and her mother to stop the medication and call her if the rash developed suggests that by
stopping the medication the rash would stop. Lindsay and her mother clearly believed that this
was the case. This "one to one" result and connection is common thought in most people's mind
with relation to medication side effects. Nowhere is it written or suggested that Lindsay and her
mother understood that once the rash started it could continue and stopping the medication would
do nothing to the rash which then could have a life of its own once started. It was Dr. White's
responsibility to make it clear that, if a rash erupted, stopping the medication may not stop the
rash and its progression. This is a recognized serious and potential side effect of lamotrigine.
Thank you for the continued opportunity to view this material.
?Sincerely yours,
-A 'j
Marc S. Reubins, MD
Five Applegreen Drive • Old Westbury, New York 11588 • Tel: (518) 826-3131 • Fax. (818) 828-3384
E-mail: MARC@REUSINS.COM
MARC STEPHAN REUBINS, M.D.
DIPLOMATE, AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY ADULT PSYCHIATRY
DIPLOMATE, AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY CHILD PSYCHIATRY
SUBSPECIALTY CERTIFICATION IN FORENSIC PSYCHIATRY, AMERICAN BOARD OF PSYCHIATRY AND NEUROLOGY ADULT PSYCHIATRY 1996-2008
CERTIFIED IN PSYCHOANALYSIS, NEW YORK PSYCHOANALYTIC INSTITUTE
July 16, 2007
Stephen M. Greecher, Jr.
Tucker Arensberg PC
111 North Front Street
PO Box 889
Harrisburg, Pa. 17108
Re: Estacio
Dear Mr. Greecher:
The following is a summary of my opinion on the matter of medical damages concerning Lindsay
A. Estacio. This opinion is based on an exhaustive evaluation of legal documents, medical
records and various communications so listed in that list of data attached. Ms. Estacio developed
Stevens Johnson Syndrome as a result of her being medicated with Lamotrigine in the summer of
2002
In my opinion, the most significant and relevant issue in this matter for me as a practicing child
psychiatrist with reference to the use of psychotropic medication is that full disclosure necessary
when using a medication with such significant side effects as has lamotrigine. The standard of
care when using such a medication is to explicitly describe to both the parents and the patient the
specific side effects of this medication as well as the specific extent of the danger. On the matter
of the Stevens Johnson Syndrome, once the rash has appeared simply stopping the medication
will not avoid the potential sequelae of the syndrome.
In this case, it is clear that Lindsay's mother, and Lindsay by extension, were under the mistaken
belief that if the rash were to appear by stopping the medication the rash would be mitigated or
even disappear. Thus the syndrome would be avoided. A further element of this misperception
was that a controlled dosage, namely stopping the medication, would avoid the catastrophic
possibility of the rash and syndrome. The bitter medical reality is that once the rash appears it is
Called For hospitalization Five Applegreen Drive • Old Westbury, New York 11568 • Tel: (516) 626-3131 • Fax: (516) 626-3384
E-mail: MARC@REUSINS.COM
2
possible that it will proceed to the syndrome with the particular potential medical crisis
regardless of changes in dosing. A full disclosure of side effects demands that they be no
equivocation on this matter and the patient be clear that this medication could lead to a rash with
tragic medical significance and stopping the medication would not advert the possibility of a full-
blown syndrome. Giving Lindsay's mother medical research documentation on Bipolar
Disorder and Lamotrigine is insufficient information for fulfilling the medical requirement of full
disclosure.
This certainly reflects a significant breach of the standard care at the time when lamotrigine was
prescribed for this adolescent. There was a point in time in the recitation of the history where it
was clear that Lindsay's mother was totally unaware of the rapid movement from rash to full
syndrome. It was then when she said something to the effect of if the doctor prescribes it, it
must be safe, that she clearly connected dosing to sensation of rash giving this method
uninformed safety. The doctor was present when that was said and should have been a red flag
to her that Mrs. Estacio had no idea of the danger involved in a child taking lamotrigine. Given
this clear misunderstanding, allowing Lindsay and her mother to believe that there was safety in
stopping the medication when a rash occurred deprives them of the fullest understanding of the
danger inherent in using this medication. This lack of clarity on the point of the danger of this
medication for this child is a breach of the standard of care.
Sincerely yours,
Get- t I ??
Marc S. Reubins, MD
Legal and medical data review for the purpose of opinion on the Estacio matter
Deposition of Tangue Tumolo
Notes of Lindsay's Mother
Letter from Surgical Care dated August 18, 2005
Deposition of Lindsay A. Estacio
Deposition of Richard A. Estacio
Deposition of Lori Lewis
Letter from Tucker Arensberg dated April 19, 2006
Handwritten notes Lindsay's mother Lori Estacio
May 2002 article entitled Lamotrigine for bipolar disorder
April 2002 supplemented to the American Journal of Psychiatry -- practice guidelines for
the treatment of patients with bipolar disorder
2001 and 2002 PDR for lamictal
Medical report authorized by spell Linwood R. Haith, MD dated 8/18/2005
Admissions/discharge medical records of Crozer Chester burn treatment unit
Medical records of Tan and Garcia dated 12/28/96
Medical records of Hershey medical center 12/13/99 and 2/8/2000
Medical records of Mary Bartas White DO 8/10 2000 - 4/1/2003
Medical records of Stephan's Mental Health Center
Medical records of Holy Spirit Hospital
Medical records of Atlantic General Health System 8/18/2002
Medical records of Holy Spirit Hospital 8/19/2002
Medical records of Pinnacle Health 8/19/2002
Medical records of Hershey Medical Center 8/20/2002
Medical records of Life Lion Transport Notes
Deposition transcript-Mary A. Bartas White D.O
Civil action complaint
CERTIFICATE OF SERVICE
AND NOW, January 16, 2008, I, Thomas M. Chairs, Esquire, hereby certify that I did
serve a true and correct copy of the foregoing upon all counsel of record by depositing, or
causing to be deposited, same in the U.S. mail, postage prepaid, at Camp Hill, Pennsylvania,
addressed as follows:
By First-Class Mail:
Stephen M. Greecher, Jr., Esquire
TUCKER ARENSBERG, P.C.
111 North Front Street
P.O. Box 889
Harrisburg, PA 17108
(Counsel for Plaintiff)
Thorfids M. Chairs, Esquire
cl,
c -"t
266779
DICKIE, MCCAMEY & CHILCOTE, P.C.
BY Francis E. Marshall, Jr., Esquire
ATTORNEY I.D. NO. 27594
BY Thomas M. Chairs, Esquire
ATTORNEY I.D. NO. 78565
1200 Camp Hill Bypass, Suite 205
Camp Hill, PA 17011
(717)7314800 (Tele)
(717)7314803 (Fax)
LINDSAY A. ESTACIO, A MINOR, BY
HER PARENTS AND NATURAL
GUARDIANS, RICHARD A. ESTACIO
AND LORI ESTACIO, AND RICHARD A.
ESTACIO AND LORI ESTACIO, IN
THEIR OWN RIGHT,
ATTORNEY FOR: DEFENDANTS
MARY A. BARTAS-WHITE, D.O. AND HOLY
SPIRIT HOSPITAL
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY,
PENNSYLVANIA
NO. 04-3463 CIVIL
MEDICAL MALPRACTICE ACTION
Plaintiffs
V.
JURY TRIAL DEMANDED
MARY A. BARTAS-WHITE, D.O. AND
HOLY SPIRIT HOSPITAL,
Defendants
DEFENDANTS' MOTIONIN LIMINE TO PRECLUDE
DR. CHANG GYU-HAHN F2tOM TESTIFYING AT TRIAL
AND NOW, come Defendants, Mary A. Bartas-White, D.O. ("Dr. White") and Holy Spirit
Hospital, by and through their counsel, Dickie, McCamey & Chilcote, P.C., and submit this Motion
in Limine to Preclude Dr. Chang-Gyu Hahn from testifying at trial, and in support thereof aver as
follows:
This medical professional liability action charges Dr. White, a board certified
child and adolescent psychiatrist, with negligence for prescribing Lamictall to treat then 14 year-
old minor-Plaintiff's diagnosis of bipolar disorder.
1Lamictal is also referred to as Lamotrigine.
2. In support of their allegations, Plaintiffs have produced the expert report authored
by Dr. Chang-Gyu Hahn, a general adult psychiatrist who is not board certified in child and
adolescent psychiatry and has never practiced in that distinct subspecialty of psychiatry.
3. In 2002, the Pennsylvania state legislature enacted the Medical Care Availability
and Reduction of Error Act ("MCARE").
4. The MCARE Act, 40 P.S. § 1303.512 established the criteria for the qualification
of an expert witness in a medical professional liability action against a physician. The MCARE
Act reflects the Legislature's preference for the testimony of expert witnesses to share the
relevant area of expertise with the defendant physician. Herbert v. Parkview Hop., 854 A.2d
1285 (Pa.Super. 2004).
5. Section 512 of the MCARE Act provides:
Expert qualifications
(a) General rule.--No person shall be competent to offer an expert medical
opinion in a medical professional liability action against a physician unless that
person possesses sufficient education, training, knowledge and experience to
provide credible, competent testimony and fulfills the additional qualifications set
forth in this section as applicable.
(b) Medical testimony.--An expert testifying on a medical matter, including the
standard of care, risks and alternatives, causation and the nature and extent of the
injury, must meet the following qualifications:
(1) Possess an unrestricted physician's license to practice medicine in any state or
the District of Columbia.
(2) Be engaged in or retired within the previous five years from active clinical
practice or teaching.
Provided, however, the court may waive the requirements of this subsection for an
expert on a matter other than the standard of care if the court determines that the
expert is otherwise competent to testify about medical or scientific issues by
virtue of education, training or experience.
(c) Standard of care.--In addition to the requirements set forth in subsections (a)
2
and (b), an expert testifying as to a physician's standard of care also must meet the
following qualifications:
(1) Be substantially familiar with the applicable standard of care for the specific
care at issue as of the time of the alleged breach of the standard of care.
(2) Practice in the same subspecialty as the defendant physician or in a
subspecialty which has a substantially similar standard of care for the specific
care at issue, except as provided in subsection (d) or (e).
(3) In the event the defendant physician is certified by an approved board, be
board certified by the same or a similar approved board, except as provided in
subsection (e).
(d) Care outside specialty.--A court may waive the same subspecialty
requirement for an expert testifying on the standard of care for the diagnosis or
treatment of a condition if the court determines that:
(1) the expert is trained in the diagnosis or treatment of the condition, as
applicable; and
(2) the defendant physician provided care for that condition and such care was not
within the physician's specialty or competence.
(e) Otherwise adequate training, experience and knowledge.--A court may
waive the same specialty and board certification requirements for an expert
testifying as to a standard of care if the court determines that the expert possesses
sufficient training, experience and knowledge to provide the testimony as a result
of active involvement in or full-time teaching of medicine in the applicable
subspecialty or a related field of medicine within the previous five-year time
period.
40 P.S. § 1303.512.
6. The only criteria of the statute that Dr. Chang-Gyu Hahn satisfies appear in 40
P.S. § 1303.512(b). Dr. Chang-Gyu Hahn possesses a physician's license to practice medicine,
and has been engaged in the practice of medicine for the last five years. 40 P.S. §
1303.512(b)(1) and (2). Dr. Chang-Gyu Hahn, however, does not fulfill any of the additional
requirements set forth in this statute and should be precluded from testifying at trial.
3
7. Dr. Chang Gyu-Hahn does not satisfy any of the requirements found in 40 P.S. §
1303.512(c). See, Wexler v. Hecht, 847 A.2d 95 (Pa.Super. 2004) affirmed by 928 A.2d 973 (Pa.
2007)(podiatrist who was an expert in the general field of foot surgery lacked training and
experience necessary to opine about standard of care relevant to orthopedic surgeon).
8. Dr. Chang-Gyu Hahn is not familiar with the specific standard of care at issue,
i.e., treatment of a child with bipolar disorder, because he never trained or practiced in the
subspecialty of child and adolescent psychiatry - a subspecialty which requires 2 additional
years of training in an accredited residency in child and adolescent psychiatry. The only
residency that Dr. Chang-Gyu Hahn completed was in general adult psychiatry. 40 P.S. §
1303.512(c)(1). As a result, Dr. Chang-Gyu Hahn is a general adult psychiatrist. As a general
adult psychiatrist, Dr. Chang Gyu-Hahn does not treat psychiatric disorders affecting children.
Dr. Chang-Gyu Hahn refers children who need psychiatric care and treatment to a child
psychiatrist like Dr. White.
9. Dr. Chang-Gyu Hahn is also not board certified in child and adolescent psychiatry
similar to Dr. White. 40 P.S. § 1303.512(c)(3). This section of the statute is absolute and can
only be waived under 40 P.S. § 1303.512(d) and (e) for experts who have been actively involved
in or who have taught full-time in the applicable subspecialty or related field of medicine within
the previous five years. These exclusions are not applicable here and no further discussion is
required.
10. Dr. White has devoted her entire career to child and adolescent psychiatry
whereas Dr. Chang Gyu-Hahn has not devoted any portion of his career in this distinct
subspecialty of psychiatry.
4
11. For instance, Dr. White completed a 2 year child/adolescent psychiatry residency;
Dr. Chang-Gyu Hahn did not. Dr. White has worked exclusively in the subspecialty of
child/adolescent psychiatry since her residency; Dr. Chang-Gyu Hahn has not. Dr. White is
board certified in child/adolescent psychiatry; Dr. Chang-Gyu Hahn is not. Dr. White is a
member of the Academy of Child and Adolescent Psychiatry; Dr. Chang-Gyu Hahn is not. Dr.
White is a member of the Child Psychiatry Steering Committee; Dr. Chang-Gyu Hahn is not.
Dr. White has lectured, taught and published on a variety of child/adolescent psychiatry topics;
Dr. Chang-Gyu Hahn has not.
12. Dr. Chang-Gyu Hahn should not be permitted to testify simply because he treats
adults, not children, with bipolar disorder. The treatment of pediatric patients with bipolar
disorder varies greatly from the treatment of adult patients with bipolar disorder. For instance,
the use of Lamictal has been approved by the FDA in the long term treatment of bipolar disorder
in adults. The FDA, however, has not yet specifically approved the use of Lamictal to treat
pediatric patients with bipolar disorder, but it is approved to treat children and adolescents with
epilepsy. Nevertheless, it is a common practice in child psychiatry to prescribe Lamictal "off
label" to children with bipolar disorder. This specific distinction in the treatment between
pediatric and adult patients with bipolar disorders underscores the specialization necessary to
treat pediatric psychiatry patients. The specialization in education, training and experience in
child psychiatry is lacking from Dr. Chang-Gyu Hahn. This is precisely why Dr. Chang-Gyu
Hahn's office would refer a parent to a child psychiatrist if the parent called for an appointment -
Dr. Chang-Gyu Hahn does not treat children for bipolar disorder, a distinct subspecialty of the
practice of psychiatry.
5
13. It is well-settled that experts may be unqualified to testify about the standards of
care applicable in certain other medical fields. In other words, "it may appear that the scope of
the witness's experience and education may embrace the subject in question in a general way, but
the subject may be so specialized that even so, the witness will not be qualified to testify."
Dambacher v. Mallis, 485 A.2d 408, 419 (Pa. Super. 1984), appeal dismissed, 500 A.2d 428 (Pa.
1985); see also, Kovalev v. Sowell, 839 A.2d 359 (doctor with general medical training was
unqualified to testify about his orthopedic injuries); Yacoub v. Lehigh Valley Medical, 805 A.2d
579 (Pa.Super. 2002)(plaintiff failed to demonstrate that neurosurgeon was qualified to render
expert opinion about standard of care appropriate to internal medicine or special unit care
nursing); Dierolf v. Slade, 581 A.2d 649, 651 (Pa. Super. 1990) (orthodontist lacked training and
experience necessary to present expert testimony regarding oral surgery); McDaniel v. Merck,
Sharp, & Dohme, 533 A.2d 436, 441-442 (Pa. Super. 1987) (expert in anesthetic drugs lacked
training and experience to testify about whether continued use of an antibiotic drug caused
death).
14. Such is the case here. Dr. Chang-Gyu Hahn lacks the training and experience
necessary to render an expert opinion about the standard of care appropriate for a child
psychiatrist's care and treatment of child's bipolar disorder.2
15. Under these circumstances, it would be an abuse of discretion to allow Dr. Chang-
Gyu Hahn to testify as an expert against Dr. White at trial.
2 This is precisely why the Defendants retained Dr. Melissa DelBello, a world renowned child
and adolescent psychiatrist to testify on behalf of Dr. White. Unlike Dr. Chang-Gyu Hahn, Dr.
DelBello clearly has the requisite credentials, training and experience necessary to render an
expert opinion about the standard of care appropriate for a child psychiatrist's care and treatment
of a child's bipolar disorder. Plaintiffs were required to retain a similar qualified expert for trial
but instead chose Dr. Chang-Gyu Hahn.
6
16. The plain language of the expert qualifications section of the MCARE Act statute
forbids Dr. Chang Gyu-Hahn from testifying. If Dr. Chang-Gyu Hahn should be permitted to
testify at trial, the subspecialty and certification requirements of the statute will be completely
gutted and rendered meaningless in medical professional liability actions in Pennsylvania. This
is clearly not what our Legislature intended when it noted its preference for the testimony of
expert witnesses to share the relevant area of expertise with the defendant physician. Herbert v.
Parkview Hosn., 854 A.2d 1285 (Pa.Super. 2004).
17. Furthermore, nowhere in Dr. Chang-Gyu Hahn's expert reports, does Dr. Chang-
Gyu Hahn state his opinions are rendered to a reasonable degree of medical certainty. See, Dr.
Hahn's expert reports attached hereto as Exhibit "F." This omission is fatal to Dr. Chang-Gyu
Hahn's proposed trial testimony.
18. For a plaintiff to make out his cause of action in such a case, therefore, the law
requires that expert medical testimony be employed. In addition to its bearing on whether or not
the defendant's conduct was negligent, such testimony is needed to establish that the injury in
question did, with a reasonable degree of medical certainty, stem from the negligent act alleged.
Commonwealth v. Hamilton, 329 A.2d 212 (1974); Houston v. Cannon-Bowl, Inc., 278 A.2d
908 (1971).
19. Mr. Justice O'Brien, speaking for the Court in McMahon v. Young, 276 A.2d 534
(1971) justified this standard for medical opinion testimony as follows: "The issue is not merely
one of semantics. There is a logical reason for the rule. The opinion of a medical expert is
evidence. If the fact finder chooses to believe it, he can find as fact what the expert gave as an
opinion. For a fact finder to award damages for a particular condition to a plaintiff it must find as
a fact that the condition was legally caused by the defendant's conduct. Here, the only evidence
7
offered was that it was 'probably' caused, and that is not enough. Perhaps in the world of
medicine nothing is absolutely certain. Nevertheless, doctors must make decisions in their own
profession every day based on their own expert opinions. Physicians must understand that it is
the intent of our law that if the plaintiffs medical expert cannot form an opinion with sufficient
certainty so as to make a medical judgment, there is nothing on the record with which a jury can
make a decision with sufficient certainty so as to make a legal judgment." 276 A.2d at 535.
20. Dr. Chang-Gyu Hahn failed to render his opinions to a "reasonable degree of
medical certainty." Therefore, his opinions should not be precluded because there is "nothing on
the record with which a jury can make a decision with sufficient certainty so as to make a legal
judgment."
21. At a minimum, Dr. Chang-Gyu Hahn's opinions regarding dosing must be
precluded for failure to state those opinions with the requisite certainty. Specifically, Chang
Gyu-Hahn has opined as follows:
Lamotrigine dosing is another issue. The dosing of Lamotrigine was more
conservative than the recommendations in the year 2002 edition of the PDR. In
this regard, the dosing schedule could be seen within the standard of care.
However, based on the paucity of the available information on the usage of
Lamotrigine for adolescents and the fact that there were more conservative
recommendations available at that time, such as the American Psychiatric
Association (APA) guidelines published in April 2002), one should have
considered such options.
Lindsay developed SJS during the very early phase of her treatment, which points
to Lamotrigine as the causative agent. It also raises the possibility that the
dosing schedule contributed to the case of SJS. However, it is impossible to
determine whether this particular dosing schedule has caused this
unfortunate complication induced by Lamotrigine.
See, Exhibit "F." (emphasis added).
22. Dr. Chang-Gyu Hahn's dosing opinions are inadmissible. With regard to expert
testimony, the Pennsylvania Supreme Court has held that "[n]o matter how skilled or
8
experienced the witness may be, he will not be permitted to guess or to state a judgment based on
mere conjecture." Collins v. Hand, 246 A.2d 398 (Pa. 1968). Furthermore, an opinion will be
precluded as lacking requisite certainty if it is couched in terms such as "possible," "could have,"
"could very properly account for," or "very highly probable." Corrado v. Thomas Jefferson
Univ. Hosp., 790 A.2d 1022 (Pa.Super. 2001)("more likely than not" opinion insufficient);
Cohen v. Albert Einstein Med. Ctr., 592 A.2d 720, 723 (Pa. Super. 1991); Eaddy v. Hamaty, 694
A.2d 639, 642 (Pa.Super. 1997)("in all likelihood" "may have hastened the onset" is
insufficient).
23. Corrado, Cohen and Eaddy are obviously quite helpful, in that they opine that the
language used by Dr. Chang-Gyu Hahn is insufficient to meet the Plaintiffs' burden. In fact, the
language used by Dr. Chang-Gyu Hahn is couched in even more uncertain terms because he
states that "it is `impossible' to determine whether this particular dosing schedule has caused this
unfortunate complication induced by Lamotrigine."
24. If it is "impossible" to determine whether the dosing schedule in this case caused
the allergic reaction, Dr. Chang-Gyu Hahn should not be permitted to present the jury with that
those opinions. Such testimony clearly lacks the requisite degree of medical certainty because
there is "nothing on the record with which a jury can make a decision with sufficient certainty so
as to make a legal judgment."
25. It is the position of the Defendants that Dr. Chang-Gyu Hahn should not be
permitted to testify at trial because: (1) Dr. Chang-Gyu Hahn does not meet the criteria for an
expert witness in a medical professional liability action pursuant to the MCARE Act, 40 P.S. §
1303.512, et seq. and (2) Dr. Chang Gyu-Hahn's pretrial report fails to state his opinions with
sufficient certainty.
9
WHEREFORE, Defendants respectfully request that this Honorable Court preclude Dr.
Chang-Gyu Hahn from testifying at trial.
Respectfully submitted,
DICKIE, MCCAMEY & CHILCOTE, P.C.
Date: January 18, 2008 By: AttA?
, Esquire
Thom=a#
s
ATTO D. NO. 78565
Aaron S. Jayman, Esquire
ATTORNEY I.D. NO. 85651
1200 Camp Hill Bypass, Suite 205
Camp Hill, PA 17011-3700
(717) 731-4800
Attorney for Defendants, Mary A. Bartas- White, D. 0. and
Holy Spirit Hospital
10
CERTIFICATE OF SERVICE
AND NOW, January 18, 2008, I, Aaron S. Jayman, Esquire, hereby certify that I did
serve a true and correct copy of the foregoing document upon all counsel of record by hand
delivery as follows:
Stephen M. Greecher, Jr., Esquire
TUCKER ARENSBERG, P.C.
111 North Front Street
P.O. Box 889
Harrisburg, PA 17108
(Counsel for Plaintiff)
AL,
Aar n . an, Esquire
W
LINDSAY A. ESTACIO, a minor,
by her parents and natural guardians,
RICHARD A. ESTACIO and LORI
ESTACIO, and RICHARD A.
ESTACIO and LORI ESTACIO,
in their own right,
Plaintiffs
VS.
MARY A. BARTAS-WHITE, D.O.,
and HOLY SPIRIT HOSPITAL,
Defendants
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
NO. 04-3463 CIVIL
JURY TRIAL DEMANDED
IN RE: PRETRIAL CONFERENCE
Present at a pretrial conference held January 16, 2008, were Stephen Greecher, Esquire,
attorney for the plaintiffs, and Thomas Chairs, Esquire, attorney for the defendants.
This is a medical professional liability action charging Dr. White with negligence in the
prescription of lamictal to treat the minor plaintiff's bi-polar disorder. The plaintiffs allege that
the minor plaintiff developed Toxic Epidermal Necrolysis from the prescription of lamictal.
It is anticipated that several motions in limine will be filed in this case. Generally, these
motions challenge the qualifications of the various experts alleging, inter alia, that they are not
qualified in the necessary sub-specialties. In addition, the defendant will challenge the opinions
of plaintiffs' expert, Dr. Hahn, on the grounds that they involve speculation.
One of the allegations of negligence is that Dr. White failed to adequately warn the
plaintiffs of the possible side effects of lamictal. The defendant argues that the doctrine of
informed consent applies only to surgery. Citing to numerous cases, counsel argues that the
doctrine of informed consent does not extend to the administration of therapeutic drugs to a
patient. A core question in this case is whether a physician is negligent in failing to warn of the
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effects of a drug where the administration of the drug is otherwise within the standard of care.
There is little more than two weeks between now and the time of trial and counsel were warned
that the resolution of these motions in limine will have to await the designation of a judge to try
this case.
This case should be no more than four or five days in duration. Each side will receive
four peremptory challenges.
January 16, 2008
Stephen Greecher, Esquire
For the Plaintiffs
Thomas Chairs, Esquire
For the Defendants
Court Administrator
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LINDSAY A. ESTACIO, a Minor, By Her
Parents and Natural Guardians,
RICHARD A. ESTACIO and LORI
ESTACIO, and RICHARD A. ESTACIO and
LORI ESTACIO, in Their Own Right,
Plaintiffs
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO. 04-3463 CIVIL
CIVIL ACTION - LAW
V.
MARY A. BARTAS-WHITE, D.O. and JURY TRIAL DEMANDED
HOLY SPIRIT HOSPITAL,
Defendants
PLAINTIFFS' MOTION IN LIMINE
TO PRECLUDE TESTIMONY OF C. W. FETROW, PHARM.D.
AS TO THE STANDARD OF CARE APPLICABLE TO THIS CASE
1. In this medical malpractice case, Defendants have produced an expert report
authored by C. W. Fetrow, Pharm.D., attached hereto as Exhibit "A".
2. C. W. Fetrow, Pharm.D., is not a medial doctor; rather he is a doctor of
pharmacy as is set forth on his curriculum vitae that is attached hereto as Exhibit "B".
3. According to the report of C. W. Fetrow, Pharm.D., testimony will be offered from
C. W. Fetrow, Pharm.D., that:
(a) Lamotrigine was a very reasonable treatment option for Lindsay for
several reasons;
(b) Lindsay and her mother received adequate counseling with respect to the
risk associated with Lamotrigine;
(c) Care was taken by Dr. Bartas-White in order to minimize the risk of
Lamotrigine induced rash in Lindsay.
4. The proposed testimony of C. W. Fetrow, Pharm.D., clearly implicates the
standard of care applicable to this case.
5. The central issue in this case is the standard of care applicable to Defendant, Dr.
Mary Bartas-White's care of Plaintiff, Lindsay Estacio.
6. Whether an individual may testify according to the standard o care is governed
by the provisions of the MCARE Act, specifically 40 P.S. § 1303.512.
7. C. W. Fetrow, Pharm.D., does not meet any of the requirements of 40 P.S. §
1303.512 in that:
(a) he is not trained as a physician, is not competent to testify and does not
have the adequate education, training, knowledge, experience and qualifications to
render competent testimony;
(b) he does not have an unrestricted physician's license to practice medicine;
(c) since he is not a practicing physician, he cannot practice in the same
sub-specialty as Dr. White or in a sub-specialty which has a substantially similar
standard and is certainly not board certified in a medical specialty;
(d) he does not meet the requirements for otherwise adequate training,
experience and knowledge;
(e) he does not have active involvement in a full-time teaching of medicine in
the applicable sub-specialty or related field within the previous five years.
8. C. W. Fetrow, Pharm.D., is also not qualified to testify as to the standard of care
pursuant to the applicable principals of the common law given his lack of education, training,
and experience as a physician let alone a psychiatrist.
-2-
WHEREFORE, it is respectfully requested that the court enter an order precluding C. W.
Fetrow, Pharm.D., from testifying in this case as to the standard of care.
T
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Attorney's I.D. No. PA-36803
111 North Front Street
P. O. Box 889
Harrisburg, PA 17108-0889
(717) 234-4121
ATTORNEYS FOR PLAINTIFFS
1-2
DATE: 1
98751.1
-3-
CERTIFICATE OF SERVICE
-R tk
AND NOW, this o day of JANUARY, 2008, I, Jacquelyn Zettlemoyer, Secretary
to Stephen M. Greecher, Jr., Esquire, for the law firm, Tucker Arensberg, P.C., attorneys for
Plaintiffs, hereby certify that I have this day served the within document by depositing a true
and correct copy of the same in the United States Mail, first class, postage prepaid, at
Harrisburg, Pennsylvania, addressed as follows:
Thomas M. Chairs, Esquire
Dickie, McCamey & Chilcote, P.C.
1200 Camp Hill Bypass, Suite 205
Camp Hill, PA 17011-3700
ATTORNEYS FOR DEFENDANTS
Qkau-? hg2i ?f
Jacquely Zett emoye
98751.1
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PRAECIPE FOR LISTING CASE FOR TRIAL
(Must be typewritten and submitted in duplicate)
TO THE PROTHONOTARY OF CUMBERLAND
Please list the following case:
(X) for JURY trial at the next term of civil court.
( ) for trial without a jury.
CAPTION OF CASE
(entire caption must be stated in full)
LINDSAY A. ESTACIO, A MINOR, BY HER
PARENTS AND NATURAL GUARDIANS,
RICHARD A. ESTACIO AND LORI ESTACIO,
AND RICHARD A. ESTACIO AND LORI
ESTACIO, IN THEIR OWN RIGHT,
(Plaintiff)
(check one)
(x) Civil Action - Law
( } Appeal from arbitration
(other)
The trial list will be called on S- X7' 0
VS.
and
MARY A. BARTAS-WHITE, D.O. AND
HOLY SPIRIT HOSPITAL,
(Defendant)
vs.
Trials commence on & - -93 "off'
Pretrials will be held on G - y' O k-
(Briefs are due 5 days before pretrials)
No. 04-3463 Civil
Indicate the attorney who will be for the party who files Praecipe:
Thomas M. Chairs
Indicate trial counsel for other parties if known:
This case is ready for trial.
Date: 2 O t??
Signed:
Print Name: Thomas M. Chairs
Attorney for: Defendants
Dickie, McCamey & Chilcote, P.C.
1200 Camp Hill Bypass, Suite 205
Camp Hill, PA 17011
Tel: 717-731-4800
-494
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TIZI
286069
LINDSAY A. ESTACIO, A MINOR, BY
HER PARENTS AND NATURAL
GUARDIANS, RICHARD A. ESTACIO
AND LORI ESTACIO, AND RICHARD A.
ESTACIO AND LORI ESTACIO, IN
THEIR OWN RIGHT,
Plaintiffs
IN THE COURT OF COMMON PLEAS
OF CUMBERLAND COUNTY,
PENNSYLVANIA
NO. 04-3463 CIVIL
MEDICAL MALPRACTICE ACTION
V.
MARY A. BARTAS-WHITE, D.O. AND
HOLY SPIRIT HOSPITAL,
Defendants
JURY TRIAL DEMANDED
SUGGESTION OF MAJORITY
TO THE PROTHONOTARY:
1. I am an attorney-at-law in the Commonwealth of Pennsylvania and made the
following Certification on behalf of the plaintiffs.
2. Plaintiff, Lindsay A. Estacio, was born on February 19, 1988. The Civil Action
Complaint involved in this case was filed on July 16, 2004, at which time the Plaintiff, Lindsay
A. Estacio, was less than 18 years of age.
3. On February 19, 2006, Lindsay A. Estacio celebrated her 18th birthday, at which
time she attained majority.
4. This case is still being litigated.
5. As Lindsay A. Estacio has now obtained the age of majority, please substitute
Lindsay A. Estacio as an individual Plaintiff in this matter.
6. As Lindsay A. Estacio has now obtained the age of majority please remove from
the caption Lindsay A. Estacio, a minor by her parents and natural guardians, Richard A. Estacio
and Lori Estacio.
? fotS !o Y
Tucker Arensberg, P. C.
111 N. Front Street
Harrisburg, PA. 17101
(717) 234-4121
Attorney I.D. 36803
Attorneys for the Plaintiffs
Respectfully submitted,
CERTIFICATE OF SERVICE
AND NOW, this ? day of March, 2008, I, Pamela J. Gordon, for the law firm,
Tucker Arensberg, P.C., attorneys for Plaintiffs, hereby certify that I have this day served the
within document by depositing a true and correct copy of the same in the United States Mail,
first class, postage prepaid, at Harrisburg, Pennsylvania, addressed as follows:
Thomas M. Chairs, Esquire
Dickie, McCamey & Chilcote, P.C.
1200 Camp Hill Bypass, Suite 205
Camp Hill, PA 17011-3700
ATTORNEYS FOR DEFENDANTS
QL4??' ???
Pamela J. Gordon
ra
CD
LINDSAY A. ESTACIO, a minor,:
by her parents and natural
guardians, RICHARD A.
ESTACIO and LORI ESTACIO,
and RICHARD A. ESTACIO and
LORI ESTACIO, in their own
right,
Plaintiffs
v
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
MARY A. BARTAS-WHITE, D.O.
and HOLY SPIRIT HOSPITAL,
Defendants 04-3463 CIVIL TERM
IN RE: CASE STRICKEN FROM LIST
ORDER OF COURT
AND NOW, this 27th day of May, 2008, upon
consideration of the call of the civil trial list, and it being
indicated that this case has been settled, it is stricken from
the trial list.
By the Court,
.//Stephen M. Greecher, Jr., Esquire
111 North Front Street
P.O. Box 889
Harrisburg, PA 17108-0889
Fyr Plaintiffs
Thomas M. Chairs, Esquire
1200 Camp Hill Bypass
Suite 205
Camp Hill, PA 17011-3700
For Defendants
Court Administrator
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5?24/D$
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LINDSAY A. ESTACIO, a Minor, By Her
Parents and Natural Guardians,
RICHARD A. ESTACIO and LORI
ESTACIO, and RICHARD A. ESTACIO and
LORI ESTACIO, in Their Own Right,
Plaintiffs
NO. 04-3463 CIVIL
CIVIL ACTION - LAW
V.
MARY A. BARTAS-WHITE, D.O. and
HOLY SPIRIT HOSPITAL,
Defendants
JURY TRIAL DEMANDED
PRAECIPE TO DISCONTINUE
TO:
DATE:
101718.1
PROTHONOTARY, CUMBERLAND COUNTY:
Please mark the above captioned action discontinued with prejudice.
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
TUI
By:
Attorney's I.D. No. PA-36803
111 North Front Street
P. O. Box 889
Harrisburg, PA 17108-0889
(717) 234-4121
ATTORNEYS FOR PLAINTIFFS
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