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HomeMy WebLinkAbout06-54241~0.- o~- ~Y~.~ Civ~~?eR~1 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA Ianet L. Ritter Arun Kapoor 55 William Drive ~~ Sprint Drive Carlisle. Pa 17013 Carlisle, Pa 17013 PRACEIPE OF WRIT OF SUMMONS TO THE PROTHONOTARY OF SAID COURT: Please issue writ of summons in the above-captioned. grit of Summons shall be issued and forwazded to( Sheriff ) Janet L. Ritter ~~ 55 William Drive ~ _ ~ ignature of laintiff Cazlisle, Pa 17013 Dated: WRIT OF SUMMONS TO THE ABOVE DEFENDANT: YOU ARE NOTIFIED THAT THE ABOVE NAMED PLANTIFF HAS COMMENCED AN ACTION AGAINST YOU.. . /) t !~ d Dated 9 ~~' By: --C> '~-- -~ ~ ~ ...- ~ ~ to ~- MICHAEL M. BADOWSKI, ESQUIRE Pa. Supreme Court I.D. No. 32646 MARGOLIS EDELSTEIN 3510 Trindle Road Camp Hill, Pennsylvania 17011 General Telephone: [717) 975-8114 Direct Dial: [717] 760-7500 Fax: [717J 975.8124 E•Mail: mbadowski@margolisedelstein.com Attorney for Defendant ARUN KAPOOR, M.D. JANET L. BITTER, V. ARUN KAPOOR, M.D., Plaintiff Defendant COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -LAW No. 06-5424 JURY TRIAL DEMANDED ENTRY OF APPEARANCE TO THE PROTHONOTARY: Kindly enter the appearance of Margolis Edelstein on behalf of Defendant Arun Kapoor, M.D. in the above-captioned action. Date: f ~~ `~ ~~~ MARGOLIS EDE I L ` By: Michael M. Badowski, Esquire Attorneys for Defendant Arun Kapoor, M.D. Supreme Court ID #32646 CERTIFICATE tJF SERVICE I HEREBY CERTIFY that I served a true and correct copy of the foregoing on all counsel/ parties of record by placing the same in the United States mail at Camp Hill, Pennsylvania, first class postage prepaid, on the ~ day of ~ ~® ~~ , 2006, and addressed as follows: Janet L. Ritter 55 William Drive Carlisle, PA 17013 Pro Se Plaintiff MARGOLIS EDELSTEIN Laurie C. Hollinger, Paralegal ~.-~ ^`' ~_ ~ CJ «. c-~, ~';:` •--+ _~.. -r~ iTi ~ _ iJC 1 ~ Gi ~ 1 C-' ~ ` ~ ' - ~- - C.,7 t i ~S-tl - - -i ~.,. . _ r'"7 ~-~ ^C MICHAEL M. BADOWSKI, ESQUIRE Pa. Supreme CouR I.D. No. 32646 MARGOLIS EDELSTEIN 3510 Trindle Road Camp Hill, Pennsylvania 17011 General Telephone: [717J 975.8114 Direct Dial: [717] 760.7500 Fax: [717]975.8124 E-Mail: mbadowski~margolisedelstein.com Attorney for Defendant ARUN KAPOOR, M.D. JANET L. BITTER, COURT OF COMMON PLEAS OF Plaintiff CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -LAW v. No. 06-5424 ARUN KAPOOR, M.D., Defendant JURY TRIAL DEMANDED PRAECiPE FOR RULE TO FILE COMPLAINT TO THE PROTHONOTARY: Please issue a Rule upon Plaintiff to file a Complaint within twenty (20) days from service hereof or suffer judgment non pros. Date: (~ ~ ~I Respectfully submitted, MARGOLIS ED 1. By: Michael M. Badowski, Esquire Attorneys for Defendant Arun Kapoor, M.D. Supreme Court ID #32646 TO THE PLAINTIFF: RULE You are hereby ordered and directed to file your Complaint against the Defendant in the above-captioned matter within twenty (20) days of service of this Rule against you or suffer judgment non pros. Dated: d _ Prot onotary ~`~ - ~i n ~ ' ---~ ~= ~ _ ,~~ - _ --- ~ _ '' {,_. _:: ~;=; ;~ _? - . c~ .:. r ~~;~ --. MICHAEL M. BADOWSKI, ESQUIRE Pa. Supreme Court I.D. No. 32646 MARGOLIS EDELSTEIN 3510 Trindle Road Camp Hill, Pennsylvania 17011 General Telephone: [i'17] 975-8114 Direct Dial: [717] 760-7500 Fax: [717] 975-8124 E-Mail: mbadowski@margolisedelstein.com Attorney for Defendant ARUN KAPOOR, M.D. JANET L. RITTER, v. ARUN KAPOOR, M.D., Plaintiff COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -LAW No. 06-5424 Defendant JURY TRIAL DEMANDED CERTIFICATE OF SERVICE I HEREBY CERTIFY that I have served a signed and sealed Rule to File Complaint on the Plaintiff by placing the same in the United States mail at Camp Hill, Pennsylvania, Certified Mail, Return Receipt Requested, on the 13~ day of October, 2006, addressed as follows: Janet L. Ritter, Pro Se 55 William Drive Carlisle, PA 17013 MARGOLIS EDELSTEIN Lau ie C. Hollinger, Paralegal d Q ~ ~~: 2 `~ _ . ~ _.- a ~- +~'~ J I q~ ~/; .y JANET L. BITTER Plaintiff v ARUN KAPOOR Defendant COMPLAINT JURY TRIAL DEMANDED The plaintiff Janet L. Ritter a citizen of the County of Cumberland, and State of Pennsylvania , residing at 55 William Drive ,Carlisle. Pa ,wishes to file a complaint under Title No Rule 5 c ~I The defendant ARUN KAPOOR , M.D ,located at the Carlisle Surgery and Pain Mtg Clinic address known as 31 Sprint Drive Carlisle. Pa 17013. Breach of Contract 2/9/00 Breach of Duty Failure to warn Risk of Product( did not sign consent form). Failure to Diagnose ,run test ,before procedure Harassed by telephone .Med Malpractice Personal Injury (Spinal Injury) Does not have a report of my visits Developed Adhesive Aarachnoiditis, from( Depo Medrol) used for ESI (Sciatica) (not FDA approved for the spine) This condition was was not revealed to me till 7./05, by the same PCP that sent me for the injections for sciatica(treatment should have been ice, heat, rest, pain med for a few days or a few weeks, While trying to find the source of the pain and what was wrong with me I went to 29 Dr COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION- LAW NO.06-5424 ~ ~ ~ ~~ 5 -~ ~~o ~- y,.y _ ~ ~ ~~,~~ ~ ~ i T took 33 Pain Meds, 2 CT scans, 2 .Emg test ,Bone scan ,Nerve block w/ Depo Medrol did not know this till i picked up all reports, I was asked when i had 7~ Mri,s in Jan/06 at another locations if I ever had epidural Steriod injections I said yes 2, when she injected the gangelion in my wrist, I asked why this was done, was told to see if i had a herniated disk or Scar tissue ,I told her the latter, no one ever in ail my tests ever asked me this. On my pain clinic reports in Jan/00 states i had a herniated disk and sciatica that was a bad guess, and Feb.00 reports states i had spinal Stenosis and sciatica, and 2 surgeons said i do not have either (another lie) Here is a copy of the DepoMedroi MSDS ALSO a website where I learned about this AA after being told on July 16~' .OS a1129 Drs knew this and kept this information from me so i would or could not file a legal suit lots of more infor Janet Ritter ~ S S tc~.~ ~-~~' -cam, " ~.9 ~ ~ c~ ~ ~tL_ ~z ,, ~~.~ / ~~~~~ ~ ~ ~ ~ = 5: '. ;'~'T ; ~ - y, ~-.:~ t . ~ ri's . ~ .--~ " -° C~ .' -,,. COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JANET L BITTER, CIVIL ACTION-LAW Medical Professional Liability Action Plaintiff.. v ARUN KAPOOR, M.D. Defendant... !~ Dm~N 0E1~ COMPLAINT Plaintiffhereby declares the following: ill c~ o ~ .S ya y The plaintiff, Janet L. Ritter, resides at the following address SS William Drive, Carlisle, PA 17013. The defendant, Arun Kapoor, M. D. doing business at Carlisle Surgery and Pain Clinic located at 31 Sprint Drive , Carlisle, PA 1701 S, previous address was S Sprint Drive, Carlisle, PA 17013. The defendant is contracted by the Carlisle Regional Medical Center located at 361 Alexander Spring Road, Carlisle, PA 1701 S, previous address was ~~' Sprint Drive, Carlisle, PA 17013. The defendant is associated with Blue Mountain Anesthesia Associates located at P.O. Box 947, Chambersburg, PA 17201. ~~ Plaintiff has a claim against the defendant based on the following: • Breach of Contract • Breach of Duty • Failure to disclose risks associated with medications/procedures (no consent form signed) • Failwe to properly diagnose plaintiff before procedure by running tests, exams etc... • Harassment via telephone • Medical malpractice • Personal Injury (Spinal Injury) • Failure to disclose medical reports to plaintiff when requested • Developed debilitating Adhesive arachnoiditis after receiving medication, Depo Medrol, via epidwal spinal injection by defendant. Depo Medrol is not approved by the FDA for use in the spine. VERIFICATION I hereby certify that all statements made in the foregoing civil complain are true to the best of my knowledge and belief. I am aware that willful false statements can subject me to punishment under the law. ~~ ntiffs Signature / ~., Da e Plaintiffs Address % ;/ ~ _oZ ~° Imo- ~ ~' ~ 7 Plaintiff s Telephone ~-' J ~'7 ~ '-T1 ~ ==,1J ~-- . C .:s~ ._ .. t , _a ; C"~ _- ~ "~i C`., - ,~ SEJ COURT OF COMMON PLEAS OF C ~ ~ ~ L RCTI o~J CUMBERLAND COUNTY PENNSYLVNIA 1ME.fl1CAl., Rot=tSSton-IkL. LI-~t3~uT-y -~ C~ o~J CERTIFATE OF MERIT as to ARUM KAPOOR I orb certify, that laintiff [1] Plaintiff has in her possession reports from two licensed professionals that state to their knowledge, and belief the care and treatment by the defendant, in the practice of medicine, skill and knowledge, exercised and exhibited fell outside acceptable professional standards and that such conduct was just cause in bringing about the harm, that is the subject of this complaint . AND/b Q. [2] Expert testimony or appearance of these licensed professionals mentioned above are unnecessary for prosecution of the claim against the defendant. + ~-, ~<: Dateb Pro Sec cam".-f t-`~4`1 ~? c > C_- --~ ~^ --fit --~ -- G'a ~ -+ ~, ~~ ~ { ~ ,~{~ ~i ~,~ C.i CONSEB,UnriuE Mark P. Holencik, D.O. 49 Brookwood Avenue Carlisle, PA 17013 Phone: (717) 24~-0241 (~17) 243-4395 Fax: (717) 243-4019 To Whom It May Concern: ~~~~~~~. January 14, 2004 RE: Janet Ritter SS: 206-32-1820 Janet Ritter is a 61-year-old female who is doing miserably after two successive relatively recent lumbar surgical procedures. She has seen a dozen doctors over the course of the last several years and simply "saw my opening of practice advertisement in the paper and decided to give me a try as she does not want surgery and knows I no longer perform it". This lady is otherwise in fairly good health and worked for many years stocking floors and in the central supply aspect of the Cazlisle Hospital. She developed low back and radiative right lower extremity pain in a sciatic distribution and was sent by Drs. Deil and Daniels, her family physician, for diagnostic studies and subsequent treatment, ending up at the Hershey Medical Center under treatment of Dr. Gelb, since moved to Maryland, and undergoing a decompression laminectomy from L3 to LS with partial fascectomy as I have reviewed the information. This was dated 5/2/?000. She received absolutely no relief at all and was actually worse after the surgery. The spine doctor told her that he did not know what was wrong and told her to "go back to her family doctor" and she was placed on strong pain pills and somewhere along the line received an epidural s~jection that did not help. She went back to Hershey this time to a new physician, an orth;~pedist named Dr. Weiner and she was told that she had spondylolisthesis or abnormal motion at L4-5 and that she needed a fusion. I looked at the same x-rays they did, I believe, and s.°e only about'2-3 mm of translational change at that level but the dictation states that left iliac bone graft was placed posterolateraIly and that a fusion was performed without instrumentation. She was braced fox only a very short period and immediately placed back on a ~~ Page 2 RE: Janet Ritter SS: 206-32-1820 treadmill and advised to exercise at home, she states, and she states that within 2 weeks after surgery her pain was back again worse than ever. The only place she feels good is in a hot tub. Her right lower extremity symptoms persist. She has tried a variety of nonsteroidal medications and a variety of nazcotic medications. She has tried Neurontin. She most recently has been given Zonogran 100 mg 2 pills at bedtime and has been seeing Dr. McMillan for pain management here locally. She has another appointment to go back to Hershey. Current medications include Hydrochlorothiazide for her blood pressure and Zocor 10 mg 1 a day. She takes Zoloft 100 mg 1 a day in the morning, Valium 5 mg 1-2 daily and Premarin 0.625 mg 1 a day. Her systems review demonstrates a history of hypertension for which she takes medication. No history of heart attack, murmur, or peripheral edema. There is no history of liver or kidney disease or blood dyscrasia. There is no history of diabetes or thyroid disease and no history of seizure or stroke. No history of ulcer, hematemesis, or rectal bleeding. No history of dysuria, hematuria, or incontinence. She has had 6 pregnancies with S living children. She ambulates with a single point cane. No history of transfusion, hepatitis, HIV, or cancer. She had two back surgeries an also a hysterectomy and some vocal cord nodes excised. She has undergone a bladder suspension. Father is deceased of a heart attack and mother deceased of bowel cancer. She has four sisters who are still alive and two deceased brothers, one age 46 of a myocardial infazction and one deceased at age 58 of lung cancer with three brothers remaining alive. She is a retired homemaker and married with five children and she lives with her husband at home. She smokes 1 pack of cigarettes per day and does not drink. Clinically she is 5 feet 2 inches tall and weighs 145 pounds and is 61 years of age. Her physical exam is mazkedly abnormal. In a level stance phase a plumb line from the base of her skull falls ~Q`°^3 .~ ~(~"' Page 3 ' FtE: Janet Ritter SS: 206-32-1820 through the mid right gluteal fold and she has mazked right sided paraspinal spasm and perhaps this represents a chronic right sciatic scoliasis convex away from the radicular side but she certainly has marked postural asymmetry and 4+ thoracolumbaz pazaspinal spasm. She is virtually unable to heel and toe walk secondary to weakness and pain and is able to flex in a level stance phase bringing her fingertips to the proximal thigh before diffuse midline and right sided low back pain intervenes. Extension is possible to 15 degrees shy of neutral again with a xnidline low back pain endpoint. She has marked weakness of her left hip flexors and also has pain to internal rotation of the left hip and I have to wonder if she has some degree of osteoarthritis there as she does not have hip radiographs today. What also concerns me is that she has rather mazked hyper-reflexia at the patellar jerk level at $!4+ bilaterally and absent Achilles reflexes with negative straight leg raise bilaterally. She has no signs of pigmentation or ulceration of the legs and no signs of cutaneous abnormality associated with poor circulation. I believe this lady deserves diagnostic testing to at least establish a firm diagnosis before further treatment is offered. I am sending her for a low pelvic AP radiograph with bilateral frog x-rays of the hips. I am sending her for a cervical and thoracic MRI looking for possible cord compression of those areas as I am not at all impressed with either her pre or postoperative lumbar MRI's relative to degree of stenosis of either foramen or central canal. If she did not get any better at all after surgery even for a brief time I would have to wander what the surgical objective was and she certainly does not have anything that resembles a degree of translational change necessary in my former surgical practice to have required a pasteralateral fusion and I may be missing something or missing some of the salient or pertinent radiographs. Page 4 RE: Janet Ritter SS: 206-32-1 &20 DIAGNOSIS: Post laminectomy syndrome with persistent right lower extremity sciatic pain as well as left hip pain of possible articular origin and bilateral hyper-reflexia of the knees unexplained. Sincerely, ~~,lQ~~~,h. Mark P. Holencik, DO MPH/dlb Dictated but not read cc: Janet Ritter PHN1 Pennsylvania Neurosurgery 8. Neuroscience Institute, Inc. September 8, 2005 James McMillen, MD 1001 S. Market Street, Suite D Mechanicsburg, PA 17055 RE: Ritter, Janet SS: 206-32-1820 BD: 9/8/1942 Dear Doctor Mc11~'llen: r--r~- Ui~~~~~ We had the pleasure of seeing your patient, Janet Ritter, in the Neurosurgery clinic today. She comes in for evaluation of her persistent low back pain. She was seen in conjunction with Amber L. Tl~,omas, PA-C and the attending physician, Dr. Peter A. Pahapill. She states that she has had this low back pain since 2000. She states that she has constant low back pain that is sharp with constant right buttock and proximal right posterior thigh pain. She states that nothing makes this better. She states that she has had three surgeries and this seems to be progressively getting worst after each of these surgeries. She states that she is very tired of having to take medication constantly for this and it not helping. She denies any numbness or tingling in her legs. She denies any bowel or bladder control issues with the exception of urge incontinence, She denies any weakness of the lower extremities. She denies having any falls. She does not walk with a cane or a walker. She had had epidural injections recently and she states that these did not help and in fact she thinks they made her worse. Surgical history includes a hysterectomy in 1970, bladder tuck in 1992, one back surgery in 2000 and another one in 2003 and another one in 2004. Stephen K. Powers, M.D., F.A.C.S. David Black, MA, PA-C 4310 Londonderry Road • Harrisburg. PA 17109 Peter A. Pahapill, M.D., Ph.D., F.R.C.S.C. Amber L. Thomas, PA-C tel: ('i r) 920-PNNI (7664) • toil free: (888) 920-x360 Barbara K. O'Connell, M.D. fax: (717) 920-1361 • email: info ~pnrn.org www.pnni,org James McMillen, MD RE: Ritter, Janet Page 2 Current medications include Valium (5 mg, as needed), Zoloft (100 mg, qd), and HCTZ (25 mg, qd), Premarin (0.625 mg, qd), Zocor (40 mg, qd) and she states that she stopped this two months ago. She also takes Fish Oil, Garlique, B 12, and Glucosamine/Chondroitin (qd). She has no known drug allergies. She does have an adverse reaction too D~ Medrol. ~-- Family history is positive for hypertension in her mother, diabetes in her sister and cardiac disease in her father and brother. She also has a family history positive of cancer in her brother and mother of the lump, colon and liver type. She denies a family history of neurosurgical problems. Social history shows that she does smoke approximately 1 pack or less per day. She does not drink alcohol and does not use illicit drugs. She is currently a housewife and is not working due to her chief complaint. She does state that she wants to return back to work. She is married with five children and several grandchildren. Her past medical history is positive for bronchitis, sore throat and sleep disturbance as well as dentures. She denies any neurologic problems. She does have a history of high blood pressure. She does have a history also of diarrhea, constipation and a blood transfusion. Nervous review is positive for numbness and weakness as described in the HPI and she denies any other seizures, epilepsy, paralysis, stroke, TIA, increased sensation or muscle wasting. Endocrine review is positive for steroid treatment in the form of epidurals and weight change. Kidney and bladder is positive for infections and urge incontinence. She denies full incontinence when awake or asleep. Cancer history is negative. She did in the past have irregularity in her menstrual cycle. General review is negative for fainting, dizziness, head injuries or headaches. On physical examination today, she is awell-developed, well-nourished sitting in the exam chair today and does appear to be in mild distress especially when moving around the chair and standing up and walking about the room. Her vital signs are blood pressure 120/62, pulse 60 and regular, weight 130 pounds, and height 62". She does keep good personal hygiene. She does have pain with right straight leg raising. Of note, she also has decreased full extension of the right knee, which maybe adding to her pain in the hamstring muscles. She does have tenderness on palpation of the low back musculature, right side greater then left. She does have tenderness on palpation in the right buttock along the sciatic area and she states that this does cause pain in the proximal right posterior thigh. She does have some tenderness in the area of the SI joint, not as bad as on the right side. Sensation is intact throughout with no sensory levels detected. DTR's show 2+ at the patellas and 1+ at the achilles bilaterally. Strength testing with knee flexion extension and ankle dorsiflexion, plantar flexion, inversion and eversion was 5%5 ,~ James McMillen, MD RE: Ritter, Janet Page 3 bilaterally. Her skin is arm and dry without rashes or lesions. Peripheral pulses are intact. She does bring with her today the most recent MRI of the lumbar spine which was done on August 18, 2005 at Walnut Bottom Radiology, which was done without contrast. I essentially do not agree with the interpretation of the various radiologists' over the years and do not think that there is any evidence of a surgical lesion that requires any form of decompression. The fact that she has a constant pain syndrome and that the pain is more deep, burning and aching in nature and does have a significant component involving her buttock and thigh area as opposed to only being in her low back area, that this picture makes her a good candidate for at least a trial of epidural spinal cord stimulation. I suspect that there is about atwo-thirds chance that we would be able to reduce her buttock and thigh pain by about 50% and the chances of reducing her low back pain are much more variable. I went over the procedure itself as well as the risks and benefits. The biggest risk is that it essentially does not help. The other risks are those that are very similar to a standard epidural steroid injection. I emphasized to her that if this does help her she is not committed to having an implant, but at least she will be aware of how this can help her so that she can make an informed decision. I consider spinal cord stimulation as being similar to adding another medication onto the medical therapy that she already is receiving. I wilt not manage her medications in any way. I would manage her spinal cord stimulation dosages, however. She is quite anxious to go ahead with the trial and we will try to provide this for her in the upcoming weeks. i. Yours since ely~ / ;' ~.v/'~ Peter A. PaIZ piar 11,11~1D, FRCSC Amber L. Thomas, PA-C PAP,'ALT: gdp SHERIFF'S RETURN - REGULAR CASE NO: 2006-05424 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND RITTER JANET L VS KAPOOR ARUN SHANNON SHERTZER Sheriff or Deputy Sheriff of Cumberland County,Pennsylvania, who being duly sworn according to law, says, the within WRIT OF SUMMONS was served upon KAPOOR ARUM the DEFENDANT at 1314:00 HOURS, on the 20th day of September, 2006 at 31 SPRINT DRIVE CARLISLE, PA 17013 by handing to DARCEY SWARNER, SECRETARY, ADULT IN CHARGE a true and attested copy of WRIT OF SUMMONS together with and at the same time directing Her attention to the contents thereof. Sheriff"s Costs: So Answers: Docketing 18.00 Service 4 .4 0 ~%i~~ ~ ~~~=~-'~ Postage .39 Surcharge 10.00 R. Thomas Kline 32.79 09/21/2006 /~/o4~~G~, JANET L RITTER Sworn and Subscibed to By: l before me this day Deputy Sheriff of A.D. Janet L Ritter COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff DOCKET NO 06-5424 CIVIL ACTION-LAW v Arun Kapoor MD Defendant JURY TRIAL DEMANDED PRAECIPE FOR ENTRY OF APPEARANCE TO THE PROTHONOTARY OF CUMBERLAND COUNTY: Kindly enter the appearance of (Janet L Ritter) pro sec for Plaintiff in referenced matter. Respectfully submitted, By Janet L Ritter 55 William Drive Carlisle, Pa 17013 Counsel for Plaintiff pro sec ~"? ~ D cr ~ -.., ~ ~'? i-C ~- "~ ~, _ `" _? ~-, i ~ -z - _, _.f: f.. J • ~ "~ J " . `~ ~y ..` MICHAEL M. BADOWSKI, ESQUIRE Pa. Supreme Court I.D. No. 32646 MARGOLIS EDELSTEIN 3510 Trindle Road Camp Hill, Pennsylvania 17011 General Telephone: (7171975-8114 Direct Dial: [717] 760-7500 Fax: [n7J 975-8124 E-Mail: mbadowslri®margolisedelstein.com JANET L. BITTER, Attorney for Defendant ARUN KAPOOR, M.D. Plaintiff COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -LAW v. ARUN KAPOOR, M.D., Defendant No. 06-5424 JURY TRIAL DEMANDED 1'~`t31\L fJF DDA.NT, ARUN KA"O!t?ft M.D,, 'F'O ~'~ ~AII~'iFF'S R.'T~F~CA'~ C?F 1~+~'ER' Alm ~TR~ ~' 1. Plaintiff, Janet L. Ritter ("Plaintiff"), who is acting pro se, commenced the above-captioned action by the filing of a Praecipe for Writ of Summons. 2. Pursuant to a Rule to File a Complaint, Plaintiff filed her Complaint on or about October 30, 2006. A copy of Plaintiff's Complaint is attached hereto, incorporated herein by reference and marked as Exhibit A. 3. On or about November 1, 2006, Plaintiff filed an Amended Complaint. A copy of said Amended Complaint is attached hereto, incorporated herein by reference and marked as Exhibit B. 4. Neither the Complaint nor the Amended Complaint included the required Notice to Defend or Cextificate of Service. 5. Pa. R.C.P. No.1042.3(a) provides: In any action based upon an allegation that a licensed professional deviated from an acceptable professional standard ... the Plaintiff if not represented, shall file with the complaint or within sixty days after the filing of the complaint, a certificate of merit signed by the ... party that either (1) an appropriate licensed professional has supplied a written statement that there exists a reasonable probability that the care, skill or knowledge exercises or exhibited in the treatment, practice or work that is the subject of the complaint, fell outside acceptable professional standards and that such conduct was a cause in bringing about the harm or (3) expert testimony of an appropriate licensed professional is unnecessary for prosecution of the claim. 6. At no time prior to the expiration of 60 days after the filing of the original Complaint, October 30, 2006, did Plaintiff serve upon counsel for Defendant, Arun Kapoor ("Dr. I<apoor"), a Certificate of Merit as required by the aforesaid Rule of Civil Procedure. 7. Prior to preparing and filing a Praecipe for Judgment Non Pros based upon Plaintiff's failure to comply with the aforesaid Rule of Civil Procedure, counsel checked the docket in this matter and determined, for the first time, that Plaintiff filed what purports to be a Certificate of Merit which document appears to have been filed on or about November 15, 2006. However, the Certificate of Merit does not include a Certificate of Service. A copy of the purported Certificate of Merit together with letters from Mark P. Holencik, D.O. ("Dr. Holencik") and Peter A. Pahapill, M.D. ("Dr. Pahapill) are attached hereto, incorporated herein by reference and marked as Exhibit c. 8. In paragraph number 2 of Plaintiff's purported Certificate of Merit, Plaintiff suggests that expert testimony is unnecessary for the prosecution of her claim against Defendant. 9. In a reading of the Amended Complaint, however, Plaintiff appears to be alleging that Dr. Kapoor did not obtain Plaintiff's informed consent with regard to the steroidal injection of Depo Medrol; that Depo Medrol is not approved for use by the Food and Drug Administration for use in the spine; that Dr. Kapoor was negligent in his care of Plaintiff and that such negligence and failure to obtain informed consent resulted in Plaintiff suffering from arachnoiditis. 10. Obviously, under Pennsylvania law, all of the allegations with regard to informed consent, standard of care, breach of that standard and causation require expert testimony. Accordingly, paragraph 2 of Plaintiff's purported Certificate of Merit is untrue and must be stricken. 11. In paragraph 1 of her purported Certificate of Merit, Plaintiff states that she has received reports from two licensed professionals who state that the care rendered by Dr. Kapoor fell below acceptable professional standards. 12. Attached to Plaintiff's filing, which was never served upon Dr. Kapoor, are letters from Dr. Holencik and Dr. Pahapill. 13. In the letter from Dr. Holencik dated January 14, 2004 (more than two years before Plaintiff commenced the instant action), Dr. Holencik does not mention Dr. Kapoor's name, nor does he discuss in any manner Dr. Kapoor's treatment or that any treatment rendered by Dr. Kapoor fell below any acceptable standard of care. 14. Similarly, in the letter from Dr. Pahapill dated September 8, 2005, neither Plaintiff in a recounted history, nor Dr. Pahapill mention Dr. Kapoor or that any care rendered by Dr. Kapoor was substandard. In fact, to the extent Dr. Pahapill questions any physician's treatment, he questions radiographic interpretations of "various radiologists over the years' and he disagrees with any assessment that Plaintiff has a cervical lesion. 15. The document filed by Plaintiff which purports to be a Certificate of Merit does not comply with the spirit of Pa.R.C.P. No. 1042.3, as she has not filed a document which establishes that any healthcare professional has issued a statement that any care rendered by Dr. Kapoor fell below the applicable standard of care. 16. Pennsylvania law is well settled that a Certificate of Merit which complies with Pa.R.C.P. No. 1042.3 must be filed within sixty (60) days after the filing of the complaint. 17. As the purported Certificate of Merit filed by Plaintiff does not comply with Pennsylvania law, it is a nullity and therefore, this document should be stricken and Judgment Non Pros entered in favor of Dr. Kapoor and against Plaintiff. 18. The fact that Plaintiff is acting pro se does not excuse failure to comply with the procedural requirements of Pennsylvania law. Warner v. Univ. of Pa. Health System 874 A.2d, 644 (Pa Super. 2005). WHEREFORE, Defendant, Arun Kapoor, M.D., prays this Honorable Court enter an Order striking the Certificate of Merit filed by Plaintiff on or about November 15, 2006, but not served upon Defendant, for failure to comply with Pa.R.C.P. No. 1042.3 and entering Judgment Non Pros for failure to comply with the requirements of the aforesaid rule of civil procedure. Date: ~ ~7 By: Esquire Arun Kapoor, M.D. Supreme Court ID #32646 Attorneys for Defendant CERTIFICATE OF SERVICE I HEREBY CERTIFY that I served a true and correct copy of the foregoing on all counsel/ parties of record by placing the same in the United States mail at Camp Hill, c` Pennsylvania, first class postage prepaid, on the day o f J anu ary, 200 7, and addressed as follows: Janet L. Ritter 55 William Drive Carlisle, PA 17013 Pro Se Plaintiff MARGOLIS EDELSTEIN a Angela ayman, Secre y E.~chi ~i+ A s~ JANET L. BITTER COURT OF COMMON PLEAS OF Plaintiff ctT~F~r~ cot1N'i'~, ~axsvLVAxLa CIVIL ACTION- LAW v NO.06-5424 ARUN KAPOOR Defendant COMPLAINT JURY TRIAL DEiMANDED 'v n~;~t: ~`< ~~~ The plaintiff Janet L. Ritter a citizen of the County of Ccnnberiaad, and Sta#e of Pennsylvania , residing at SS William Drive ,Carlisle. Pa , wishes to $le a complaint under Title No Rule S~ y N ~~ ~_ 0 ri w ,~ rr. 0 c,r~ The defendant ARUN KAPOOR , M.D ,located at the Carlisle Surgery and Pain Mtg Clinic address lariown as 31 Sprint Drive Carlisle. Pa 17013. Breach of Contract 2/9/00 Breach of Duty Failure to warn Risk of Product( did not sign consent form}. Failure to I3iaga~osc~,reut~tust,befor+e procedure Harassed by telephone .Med Malpractice Personal InJmY (SPA ~Jm'Y) Does not have a report of my visits Drvcloped Adhesive Aarachnoiditis, from( Depo Medrol} used for ESI (Sciatica) (not FDA approved for the spine) This condition was was not revealed to me ti117J05, by the same PCP that sent me for the injections for sciatiea(treatlnent should have been icx, heat, rest, pain fined for a few days or a few weeks, While trying to fend the source of the pain and .what was wrong with me Y went to 29 Dr ~~~~~~ g-] ~at~y.•y-d a~~.~ n ~~ -il C~ i, ~...! 'T ~~~ Q{~ took 33 Pain Meds, 2 CT scans, 2 ~ .EmB lest ,Bane scan ~ierve block wl Depo Medral did not know tins till i picked np all reports, I was asked when i had '7'~ Mri,s in 3an/06 at another locations if I ever had epidural Steriod in,~ections I said yes 2, when she injected the gangelion in my wrist, I asked why this was done, was told to see if i had a herniated disk or Scat tissae ,i told her the latter, no one ever in all my tests ever asked me this. On my pain clinic reports in Jan/00 states i had a herniated disk and sciatica that was a bad guess, and Feb.00 reports states i had spinal Stcnosis and sciatica, and 2 surgeons said i do not have either (another lie) Here is a copy of the DepoMedrol MSDS ALSO a website where I Iearned about this AA after being told on July i 6~' .OS x1129 Drs knew this and kept this information from me so i would or could not file a legal suit lots of mare infor 3anet Ritter C CL c.:2~~.Qzi., ~c.~ / -1 ~ ~;~ 10f3012006 13:01 7172434512 ~aTAPLES PAGE 05/@7 .4~uAw~VSa~. ~J\..1a~n~au-6. 1V1rbW vey1 .~ i 1~41~ ~c'~atiii![ ~ ~ r-coepZ8IICe t'PQ~ t'!JA for ... k'a~ l ~t ~~ _ ~ Y'ww.d~eporn®~, Mlles 3cisntl[~c Ra~eehrn i'lOnc~ Premorlcet NotlAaatlott Accoptar~ Erorn for Canpu~lo (TM) ~om~rter ConbbNet~ Infi~iwl Ptanp Company to ~+ursue Strategic Re2ationshipa 1~f.th Marketing 7•s~tlers in Medical field . 7• LZVINGS'ION, N,J., Juxy 13 /PRntevaa~r~.re-FirstCa~,l/ --- Astone scientific inc. iAmex: ~, which develops, manufact and market 'intell3geat' computer car~trolled local anesthetic d systems, today announced that it has received ~A 510 (k) Prcraxrk~ icat~.on acceptance for thv market~.~g and sale of its CompuFlo (~'M) Cos~wtt~s ContzoxJ.ed Trttusion Pt1mp . The CompuFlo Costputer Controlled Infusion ~'ump utilises pro~3uxe feedback data to monftar end regulate the del~.very to patients of local a!lesthesia, medications and other fluids, and wixl serve as the foundattion for the dtvelopmsnt of sigriif:~ant new modiaal and dental devices at Milestone 5cicntifxc Inc. "The receipt of gl0tkl acceptance from the FDA represents a major at®p !or Milestone in the coymnexcialization process for our patsntad Comput~lo tecbnolo~y," stated C sciQntiff.c Inc. "We are nt y seeking partnership 4ppox~tunities witl3 major companies in the ate , especially in applications v ~cesa. ~s plan to init~,al~1y ta~tget the S2oO million-pig annual rasrket for epidural fnae~ctiors that are ~•~~ adsni,nxstered to woaen dux~i'rg childbirth procedutres iA the tS.S. Such injeatioas are also used in thQ treatment of Sow back pain and pain ~ the ~_,- lotrer ~sxtreat~.ties. CvwpuFlo's pressure sensing technology c1a=rly ~ -- '~ identifies tk~e ep~l~,cTaaral space for tht dodtor, Chereby greatly reducing t ris7~paralysis and other coiaplications tt~tt can occur when Qhysic at a3. space vaing tactile sertaes." N oral injections, it is CritiaaZ to zecogni rink aaso,ciated Frith the introduction of potentially neurotoxi.c subs intoe subaraChn4id space, fray vhieh 40~ p~ gptnal f~.uid f.s pt Zoeal ams9thesis is injected into this apace, instead of the epido apace, Che patient may face a lifetfine of agony due to adhesive • arxctjnoid~ttis. Th~.s represents a potential rfsk for any patient rs~M~ia~ ah epi~dura3. injection today, because doctors ravst rtly upon tact eel to idec~tify the epiduxa~. space . ,. "clinical studies using M#,iestone TAfusi in hi$~x, 4ncouragi.n~_~ul s " to operat ng car of Che Company. "TiQe believe that, because ~k aaaociatvd with curr~tt epidural inlectiort tsch~q~ies, Campo as the potential t ~ _ + pxOfesaioa. Our next step ~.s to d n relationahipa with one or saaro ~ark~txnq lea~,r~ i ~ ~~-- Ica •• vine field," '~ "The now-approved CompuFl a depment of our Singls,Tooth ~tnestheaia ( Qaice," con' 3yexiove the STA device can rev~alise ur asresthe'tie delivery sy=tams and promote signiti~t7,y inc ,ge o our systenta ,~ and their sfagle-u ~~ ~ ' y 1~'~~ k J' L~* c ~ ' ~-' ~t t <~; About Milest - ' ~~ ~,,,f, ~. {.~~~.~: t 10f 38/2086 13: 81 7172434512 STAPLES rvssizKe uepo-~+actuoi ratat~uea cuss ~;txon lawatu~ submit your rbmpkZint to a 1$wy~z. Depo-Medrol Depo-Medrol (Methylprednfsolone acetatey is an anti-inflammatory giuaoc~orticaid that is administered to reiieve pain from rheumatoid arti•n•itis and bursitis, were lower beck pain or dermatvioyic disorders. The FDA has applvved use of the Cortico5t8ro#d injection intio a muscle, a ,point, or a lesion. The FDA has not approvsd the use of Depo-Medroi as an epidural Injection for low back pain ar sdatiCe, though many physicians st(II administer M through thes ~f-label use. It is alleged that there have been 356 deaths and 15,000 advttae events attributed to Depo-Medrol between 1998 and 2002. Pfl~er, the maker 4f Depo-~ Msdrol, does not advise Epidural/intrathecal administration (injtctioh into spinal cord tir vein) of DepwMedrol and reports the foflowing severe medkal events associatEd with this uxa9e: Arachnoiditis, Mtrningftis, i~reperasis/paraplegia, bowel/bladder dysfunction, seizures, headaches, arld more. Other repart~ side CffecLa of DEpo-Medrol include t~ngestlve heart failure, osteoporosis. peptic ulcer, and convulsions. Depo-Medrol was originally In#roduced for reitevittg pain in anirr~ls; tfie drug is sail used by veterfnetiarrs to reifave seesonsl Itching arrd inflammation in pets - primartly dogs! ?fixer, wha manufacturers and mariceq D~spo-Medrol {previously Pharmacia and Upiohi~) recommends i3apo-Medrol br a wide range of disorders including: Respiratory diseases, endocrine disorders, dern~atalog{c disease9 such as Stevena- )ohnson syndrome (SJS}, osteoarthrftis, rheurnatold arthrfds, bursitis, severe asthma, allergic rhinitis~ dni9 hypersensitivity reettions, leukemia, lymphoma, systemic lupus, hematologic disorders, and mare. For morn lnformatlan vn Depo-Medrol prescrlptipns, please [e~le tMrs] Register your Depo-M~drol Complaint if Y~ pr a touted one has su€fered from severe side effects or death, you may qualify for d~lmages w' remedies that may be amrarded in a possible class action lawsuit. Please dlidc the link below to submit yo~rr compli3lnt and we wit! have a lawyer review your Depo-Medroi complaint. At LawyersandSettJements,oom, It is our goat to keep you informed about lrnportarrt feQal cases and settlements. We are dedicated to helping you resolve your legal complaints. Click h~C.to sub_~ilt:Y..our camJ~~ait7t thrQug~,i a. 9ecur~ kl+~n. Pw~t~ed on Nov•4••OS PAGE 06107 Page 1 of i * Homs ~~_~ !rasa! MNp r Frhe rase evalur~lon • status • Ndwsleitws • Farums E+nall this Paper a !Mend ^ Kudos Resources » Clss` Action ~ La1M Fi11Y1 Dit~Ct Services for lawyers ASS • what Ilia accus hss to gay FaQ J T0.5 (P~ivacy Policy l DlstJalMer f About DI.M i Conbct OI.M ! A~dvsetisa l Ai'Riiat~ l link to ol,>y i SlOe Map C2001,1Nf6 Online e.~pal Mallnq Ltd. All tl~hb r+taserrW. http:/1www.Iawye~sgndsett~emcnts.comtc~$cldepo r~nEaci~+ol 2/24/2Q46 18138/2885 13:81 7172434512 STAPLES PAGEr 07/87 r L ~ • ~ ~..~~ qtr 'N . V7~ ~ ~ . . .. Lhre News Aaso~ur+rle . ~recl~+e* • '~~ . lta satirie * Resulars • Nagonai ~- Deihl, i~,y 17 (P7i) A US-bated doer, i~ht~ a medt~i n+~giiQvnce can aisa of a whopping Rs 77.78 c today Iliad a oomplaEs bnsaic-~ oi` his detm end xwgtrt Rs 66.32 ~ rrprs ~ interest. Avik Duda, oounsei fvr comp~ttrant iGa~ai 3aha, body eubanittad the ttaim patron with sDme supportM~ vordicb of the Suprarne and some othw t1S ca~fis and p~aded Ibr the 9rent of Ra 143.08 a+vre inelead of Rs 77.?8 a~ae a vvtr~es~t poti~an ssei~ inter+eak ~ the rate of 9 Z par canton the otaYrt amount ibr the seven y~ for which the case ~ 7'ha cam was tlted M t99S. Fauiler, a Nationai< C~ansaanar Diapubss Redressvi Comrrrtrsbrt Bench preskisd Justice MB8hah, Jusdoe K S C3uplta and Memt>~ Rs~ya LaiarhrrN, on tfie oandueion of ~ ~, eslaod ~brr~it !ha daYnand palklon within twa da~rs and reserved its Verdict. Itt his ovmplatrrt, Saha had aNeQed !flat doct AMRI- Apollo Hospiit~ ih Kotiaa~ admtMsisesd an "utiscianthfc otisreiosa df t~fiiy iivxio sbroid" to his wigs Anur~r had acquimd Took f.~idertnai Necrolysh (T'EN), an scuba skin aiis~, on her vf'iit tie India. Fiv+s tCoit doctors - Suiaamar Mukiwrjee, B>~ram Prasad, Kaushkc Nandi. A+-ani Roy Chsudhary, a~ of AdVant~d Msdicsl R instt#ute (AABtI) Apollo Hospilod and Vaidyanath Haddhar ar+e ttiebng n~gtle parries to the case. Baha had ~6gad that hie vr~ sut~ered TEN. an aarta~ madbat oondi#a~ in which a larr++~~e portion of tie upperma the skin peNs oif as a naa,lt of "dntA ans~y". Ha trod said the donors "anrorigy" admirristsnd an avrrdosaya of wash ia~l~oeryttat»'fio ~t1 y 11 bo 18,1988, and~w~ag i~f bend ba B+~ss~t cease of asthma acrd ~trthr~, Anucadf to ah s and~l h~pitai fn a rr>Qritxind vonditlon any aiodl. ~n- uanaed seals on ~o+' Vlslting Da1hiP tend Desfi ~ Rem You can save up m 4G9b oA hour New DeNelopma~ 1n ~~P savh~q anyway 4 , HvEel Rewewral ,Cheep rltghts To bull! Oode'Y. wlmrastment 1be Home o p Outlook Publkhinp (rnd-a) Private Umlbed ~tlp://`www.outlooki~c~dia.cart~/pti,~in~.asp?id~384X 2'I 71812006 ~xh;b~+ 8 ,. ,.. COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA JANET L RTf1'ER, Plaintiff.. v ARUM KAPOOR, M.D: Defendant... CIVIL ACTIN-LAW Medical Professional Liability Action la ~nn~NOED COMPLAINT Plaixitiffherehy declares the following: ~J c~ c~~~ .~ ~ y~ o ~~ ~ ~ . rr- ~ ~ t'11~ . l~r., ~ lc~~ z ~ ~-~ ~~ t, ~ - 'N N t~ ~ The plaintiff, Janet L. Ritter, resides at the following address 55 William Drive, Carlisle, PA 27013. The defendant, Anus Kapoor, M. D. doing business at Carlisle Surgery and Pain Clinic located at 31 Sprint Drive , Carlisle, PA 17015, previous address was 5 Sprint Drive, Carlisle, PA 1 ?013. The defendant is contracted by the Carlisle Regional Medical Center located at 361 Alexander Spring Road, Carlisle, PA 17015, previous address was ~ Sprirrt Drive, Carlisle, PA 37013. The defendant is associated with Blue Mountain Anesthesia Associates located at P.O. Box 947, Chambersburg, PA 17201. ~.. Plaintiff has a claim against the defendant based on the following: • Breach of Contract • Breach of Duty • Failure to disclose risks associated wig medications/procedures (no consent form signed) • Failure to properly diagnose plaintiff before procedure by running tests, exams etc... • Harassment via telephone • Medical malpractice • Personal In3m'Y (Spy Injury} • Failure to disclose medical reports to plaintiff when requested • Developed debilitating Adhesive arachnoiditis after receiving medication, Depo Medrol, via epidural spinal injection'by defendant. Depo Medrol is not approved by the FDA for use in the spine. 'VERIFICATION I hereby certify that all statements made in the foregoing civil complain are true to the best of my knowledge and belief, I am aware that willful false statements can subject me to punishment under the law. ' s sigoabuc ... Plaintiffs Address Dom` ( (. Plaintiffs Telephone .~~ 7.~ a d. ~ ~-~ ~ ~.~ ~` COURT OF COMMON PLEAS OF C i V i tr ACT1 o~J CUMBERLAND COUNTY PENNSYLVI~tIA 1NiE,DtCA1, t~R.ofE55ton-A~L, u~~t-rtzj !4 tat o1J CERTIFATE OF MERIT as to ARUM KAFU4R I ar~o~' certify, that laintii~ [1] Plaintiff has in her possession reports from two licensed professionals that state to their knowledge, and belief the care and treatment by the defendant, in the practice of medicine, skill and knowledge, exercised and exhibited fell outside acceptable professional standards and that such conduct was just cause in bringing about the harm, that is the subject of this complaint . ~vD~o2 [2] Expert testimony or appearance of these licensed professionals mentioned above are unnecessary for prosecution of the claim against the defendant. Date i Pro Sec -st C? G ~ ~' ~` ^' ~•'. ~1 ~' ! , ..f} ... ~-: V~ :~a,- ;~{~- X13 © -< «~ i3'~ CON$ERyA,TIYk~ Mork P. Holencik, D.O. 49 Brookwood Avenue Carlisle. PA 17013 Phone: (717) 243-0241 {~ 17) 243,4395 Fax: (717) 243-4019 January I4, 2004 RE: Janet Ritter SS: 206-32-I 820 To Whom It May Concern: Ur~~Ne Janet Ritter is a 61-year-old female who is doing miserably after two successive relatively recent lumbar surgical procedures. She has seen a dozen doctors over the course of the last several years and simply "saw my opening of practice advertisement in the paper and decided to give me a try as she does not want surgery and knows I no longer perform it". This lady is otherwise in fairly good health and worked for many years stocking floors and in the central supply aspect of the Carlisle Hospital. She developed low back and radiative right lower extremity pain in a sciatic distribution and was sent by Drs. Dell and Daniels, her family physician, for diagnostic studies and subsequent treatment, ending up at the Hershey Medical Center under treatment of Dr. Gelb, since moved to Maryland, and undergoing a decompression laminectomy from L3 to LS with partial fascectomy as I have reviewed the information. This was dated 5/2!2000. She received absolutely no relief at all and was actually worse after the surgery. The spine doctor told her that he did not know what was wrong and told her to "go back to her family doctor" and she was placed on strong pain pills and somewhere along the line received an epidural iLjecuon that did not hClp. She went back to Hershey this time to a new physician, an orthopedist named Dr. Weiner and she was told that she had spondylolisthesis or abnormal motion at L4-5 and that she needed a fusion. I looked at the same x-rays they did, I believe, and s.~e only abo~t'2-3 ~mm of translational change at that level but the dictation states that left iliac bone graft was placed posteroiaterally and that a fusion was performed without instrumentation. She was braced for only a very short period and immediately placed back on a ,~ ~,~ Page 2 RE: Janet Ritter SS: 206-32-1820 treadmill and advised to exercise at home, she states, and she states that within 2 weeks after surgery her pain was back again worse than ever. The only place she feels good is in a hot tub. Her right lower extremity symptoms persist. She has tried a variety of nonsteroidal medications and a variety of narcotic medications. She has tried Neurontin. She most recently has been given Zonogxan 100 mg 2 pills at bedtime and has been seeing Dr. McMillan for pain management here locally. She has another appointment to go back to Hershey. Current medications include Hydrochlorothiazide for her blood pressure and Zocor Y O mg 1 a day. She takes Zoloft 100 mg 1 a day in the morning, Valium 5 mg 1-2 daily and Premarin 0.625 mg I a day. Her systems review demonstrates a history of hypertension for which she takes medication. No history of heart attack, murmur, yr peripheral edema. There is no history of liver or kidney disease or blood dyscrasia. There is no history of diabetes or thyroid disease and no history of seizure or stroke. No history of ulcer, hematemesis, or rectal bleeding. No history of dysuria, hematuria, or incontinence. She has had 6 pregnancies with S living children. She ambulates with a single point cane. No history of transfusion, hepatitis, HIV, or cancer. She had two back surgeries an also a hysterectomy and some vocal cord nodes excised. She has undergone a bladder suspension. Father is deceased of a heart attack and mother deceased of bowel cancer, She has four sisters who aze still alive and two deceased brothers, one age 46 of a myocardial infarction and one deceased at age 5$ of lung cancer with three brothers remaining alive. She is a retired homemaker and married with five children and she lives with her husband at home. She smokes 1 pack of cigarettes per day and does not drink. Clinically she is S feet 2 inches tall and weighs 145 pounds and is 61 years of age. Her physical exam is mar__ kedly abnormal. In a level stance phase a plumb line from the base of her skull falls -~ ~ u~ ~ ~~ ~a~ Page 3 ' R~E: Janet Ritter SS: 206-32-1820 through the mid right gluteal fold and she has mazked right sided paraspinal spasm and perhaps this represents a chronic right sciatic scoliosis convex away from the radicular side but she certainly has marked postural asymmetry and 4+ thoracoiumbar paraspinal spasm. She is virtually unable to heel and toe walk secondary to weakness and pain and is able to flex in a level stance phase bringing her fingertips to the proximal thigh before diffuse nudline and right sided low back pain intervenes. Extension is possible to 15 degrees shy of neutral again with a midline low back pain endpoint. She has marked weakness of her left hip flexors and also has pain to internal rotation of the left hip and I have to wonder if she has some degree of osteoarthritis there as she daes not have hip radiographs today. What also concerns me is that she has rather marked hyper-reflexia at the patellar jerk level at Sf4+ bilaterally an,d absent Achilles reflexes with negative straight leg raise bilaterally. She has no signs of pigmentation or ulceration of the legs and no signs of cutaneous abnormality associated with poor circulation. I believe this Iady deserves diagnostic testing to at least establish a firm diagnosis before further treatment is offered. I am sending her for a low pelvic AP radiograph with bilateral frog x-rays of the hips. I am sending her for a cervical and thoracic MRI looking for possible cord compression of those areas as I am not at all impressed with either her pre or postoperative lumbar MRI's relativc to degree of stenosis of either foramen or central canal. If she did not get any better at all after surgery even for a brief time I would have to wonder what the surgical objective was and she certainly does not have anything that resembles a degree of translational change necessary in my former surgical practice to have required a posterolateral fixsion and I may be missing something or missing some of the salierrt or pertinent radiographs. Page 4 RE: Janet Ritter SS: 206-32-1820 DIAGNOSIS: Post laminectomy syndrome with persistent right lower extremity sciatic pain as well as left hip pain of possible articular origin and bilateral hyper-refleiia of the knees unexplained. Sincerely, ~~P~~ Mark P. Holencik, DO MPHldlb Dictated but not read cc: Janet Ritter ._' I~ t 1~ . i~ ~ ~~/v '~ V PHN~ ;:~ '''' Pennsylvania Neurosurgery 8 Neuroacienc® [nstilute, Inc. September 8, 2005 James McMillen, MD 1001 S. Market Street, Suite D Mechanicsburg, PA 1 ?055 RE: Ritter, Janet SS: 206-32-1820 BD: 9/8/ 1942 Dear Doctor Mc11~'Nen: ~' r•-+Y We had the pleasure of seeing your patient, Janet Ritter, in the Neurosurgery clinic today. She comes in for evaluation of her persistent low back pain. She was seen in conjunction with Amber L. 'Iromas, PA-C and the attending physician, Dr. Peter A. Pahapill. She states that she has had this low back pain since 2000. She states that she has constant low back pain that is sharp with constant right buttock and proximal right posterior thigh pain. She states that nothing makes this better. She states that she has had three surgeries and this seems to be progressively getting worst after each of these surgeries. She states that she is very tired of having to take medication constantly for this and it not helping. She denies any numbness or tingling in her legs. She denies any bowel or bladder control issues with the exception of urge incontinence. She denies any weakness of the lower extremities. She denies har•ing any falls. She does not walk with a cane or a walker. She had had epidural injections recently and she states that these did not help and in fact she thinks they made her worse. Surgical history includes a hysterectomy in 1970, bladder tuck in 1992, one back surgery in 2000 and another one in 2003 and another one in 2004. Stephen K. Powers. M.D., F.A.C.S. David Black, MA. PA-C 4310 Londonderry Road • Hamsburg. PA 17109 Peter A. Pahapill, M.D., Ph.D., F.R.C.S.C. Amber L. Thomas. PA•C ie1: (717) 920-PNNi (766.1) • toll tree: (888) 920.4360 Barbara iC. O'Connell, M.Q. fax: (717) 920-4361 • email: inbt~pnni.org www.pnni.org . y ' James McMillen, MD RE: Ritter, Janet Page 2 Current medications include Valium (5 mg, as needed}, Zoloft (100 mg, qd), and HCTZ (25 mg, qd), Premarin (0.625 mg, qd), Zocor (40 mg, qd) and she states that she stopped this two months ago. She also takes Fish Oil, Garlique, B l2, and Glucosamine/Chondroitin (qd). She has no known drug allergies. She does have an adverse reaction to D Medrol. Family history is positive for hypertension in her mother, diabetes in her sister and cazdiac disease in her father and brother. She also has a family history positive of cancer in her brother and mother of the lump, colon and Iiver type. She denies a family history of neurosurgical problems. . Social history shows that she does smoke approximately 1 pack or less per day. She does not drink alcohol and does not use illicit drugs. She is currently a housewife and is not working due to her chief complaint. She does state that she wants to return back to work. She is monied with five children and several grandchildren. Her past medical history is positive for bronchitis, sore throat and sleep disturbance as well as dentures. She denies any neurologic problems. She does have a history of high blood pressure. She does have a history also of diarrhea, constipation and a blood transfusion. Nervous review is positive for numbness and weakness as described in the HPI and she denies any other seizures, epilepsy, paralysis, stroke, TIA, increased sensation or muscle wasting. Endocrine review is positive for steroid treatment in the form of epidurals and weight change. Kidney and bladder is positive for infections and urge incontinence. She denies full incontinence when awake or asleep. Cancer history is negative. She did in the past have irregularity in her menstrual cycle. General review is negative for fainting, dizziness, head injuries or headaches. On physical examination today, she is swell-developed, well-nourished sitting in the exam chair today and does appear to be in mild distress especially when moving around the chair and standing up and walking about the room. Her vital signs are blood pressure 120!62, pulse 60 and regular, weight 130 pounds, and height 6~". She does keep good personal hygiene. She does have pain with right straight leg raising. Of note, she also has decreased full extension of the right knee, which maybe adding to her pain in the hamstring muscles. She does have tenderness on palpation of the low back musculature, right side greater then left. She does have tenderness on palpation in the right buttock along the sciatic area and she states that this does cause pain in the proximal right posterior thigh. She does have some tenderness in the area of the SI joint, not as bad as on the right side. Sensation is intact throughout with no sensory levels detected. DTR's show 2+ at the patellas and I+ at the achilles bilaterally. Strength testing with knee flexion/extension and ankle dorsiflexion, plantar flexion, inversion and eversion was Sly . , ~ -- .~ James McMillen, MD RE: Ritter, Janet Page 3 bilaterally. Her skin is arm and dry without rashes or Lesions. Peripheral pulses are intact. She does bring with her today the most recent MRI of the lumbar spine which was done on August 1 S, 2005 at Walnut Bottom Radiology, which was done without contrast. I essentially do not agree with the interpretation of the various radiologists' over the years and do not think that there is any evidence of a surgical lesion that requires any form of decompression. The fact that she has a constant pain syndrome and that the pain is more deep, burning and aching in nature and does have a significant component involving her buttock and thigh area as opposed to only being in her low back area, that this picture makes her a good candidate for at least a trial of epidural spinal cord stimulation. I suspect chat there is about atwo-thirds chance that we would be able to reduce her buttock and thigh pain by about 50°./o and the chances of reducing her low back pain are much more variable. I went over the procedure itself as well as the risks and benefits. The biggest risk is that it essentially does not help. The other risks are those that are very similar to a standard epidural steroid injection. I emphasized to her that if this does help her she is not committed to having an implant, but at least she will be aware of how this can help her so that she can make an informed decision. I consider spinal cord stimulation as being similar to adding another medication onto the medics! therapy that she already is receiving. I will not manage her medications in any way. I would manage her spinal cord stimulation dosages, however. She is quite anxious to go ahead with the trial and we wilt try tv provide this for her in the upcoming weeks. Yours since~e~y,/~ Peter A. Pah~ll,1V1D, FRCSC Amber L. Thomas, PA-C PAP~'ALT: gdp f"1 Cv` -v c ~' „~ . .~ ~7 ~'[' , G.3 ~~' v 'b ,-4r.~ -°~- - ; "~ ~_~ `~ ' "" ~ £~ } , ~ lg °~ JANET L. BITTER 1N THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA V. ARUN KAPOOR, M.D. N0.2006 - 5424 CIVIL TERM ORDER OF COURT AND NOW, this 7TH day of FEBRUARY, 2007, this matter may be listed for argument court by either party. t e C urt, Edward E. Guido, J. Janet L. Ritter 55 William Drive Carlisle, Pa. 17013 Michael M. Badowski, Esquire 3510 Trindle Road Camp HiII, Pa. 17011 :sld . , _ ,~~ EI ~~ ~h PRAECIPE FOR LISTING CASE FOR ARGUMENT (Must be typewritten and submitted in duplicate) TO THE PROTHONOTARY OF CUMBERLAND COUNTY: Please list the within matter for the next Argument Court. CAPTION OF CASE (entire caption must be stated in full) ~ _ (U ~~ ~ ~ 1 / 7 C~~ (Plaintiff) vs. No. ~(o -5~a~ , 1. State matter to be argued (i.e., plaintiff s motion for new trial, defendant's demurrer to complaint, etc.): ~/~~^ p~ 1 ~ ~~ _ Term 2. Identify counsel who will argue cases: (a) for plaintiffs (/ (Name and Address) (b) for defencj~nt: ~ ~ /1 ,~ a _ n ~ r_ (Name and ~., ! 3. I will notify all parties in writing within two days that this case has been listed for argument. 4. Argument Court Date: ~ ~~D~ Signature pp Print your name ~'~ ~, ~iNy ~~~ Date: ~ ~/2IO`7 Attorney for f~ ° ~i -~rt ~ ~~ ~ ~ -~ ~ _ ~;°. ~„ N ~ '~' -v ~ . ~ ~ ~-~ _ .:, ~ ~ , ys ~= t; 3 --~ ,~ u, ~ r'~ ~, I~° o ~-s4°a9 ~ ~~a''i C0"'' w ~ ~~, ~`~°~ % ^ Corrtplslr Rents 1. ~, and 3. Also contpisN item 4 N Rsalrichd 'Y h detY~+sd. ^ Print your rents and addraes on the reveres so find tun cart stun the card to you. ^ Attaoh this Card b Uts bads of the meNplece, or on the frvttt if space perntks. X ®. ~s 1. Article Addressed to: D. Is delivery address difrFerent from item 17 ^ Yes If YF~, enter delivery address t>ebw: ^ No 3. Servbe lype '~C~MM IiYN ~ ~s MeY v tU~Nree a l~M~- Rro.Ipc 1br Mer~d,r,dl.. o rnaaaa w o caa. 4. RaeMDbd DriMr.rfR i~+>~ ^ Ybs 2• ~'~'"r'bsr 7DD4 1350 DDD3 7146 2685 (fisrrAr tlom - PS Form 3411, February 2004 Dorn..Afc Ream F1.cdpt ,~aax-to-isao _., ~ .*,t rn~: ~ 1 , ~ . ~ ~ ~ ~~, ~ ~'{) ~ ~tl i .~' tom' ~~ (I~ 3ANET L. BITTER COURT OF COMMON PLEAS ' CUMBERLAND COUNTY, PENNSYLVANIA Plaintiff MEDICAL PROFESSIONAL LIABILITY CIVIL-LAW ~ ~ 5~a~ V N0. -~~F~-AEr43- ARUN I~APOOR M.D. JURY TRIAL DEMANDED Alias Arum Defendant MOTION FOR CONTINUANCE AND NOW, comes JANET L. BITTER, pro sec and in support of this Motion avers as follows: 1. The above -captioned case was listed for argument on April 04 2007. 2. Reason for request for continuance, issue of Certificate of Merit. Pa.R.C.P. N0..1042.3 3. This case has not been previously continued.. Wherefore, the Plaintiff respectfully requests that the above-captioned case be Continued. Respectfully submitted, Date 2,a b~ et L. Ritter pro sec 55 William Drive #717 422-5164 Carlisle, Pa 17013 JANET L. BITTER Plaintiff V COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA. MEDICAL PROFESSIONAL LIABILITY CIVIL-LAW TERM No. 06-5424 ARUN KAPOOR M.D. Alias Arum Defendant, CERTIFICATE OF SERVICE I, Janet L. Ritter, pro sec, Plaintiff do hereby certify that I this day Wednesday March 21, 2007 served a copy of the Motion For Continuation upon the following by depositing same in the mail, postage prepaid at Carlisle, Pennsylvania, address as follows: Michael M. Badowski, Esquire 3510 Trindle Road Camp Hill, Pa 17011 Date ~ oZ ,~_~ ~.,~- ~--~~..~~~ J t L. Ritter, pro sec VERIFICATION I verify that the statements made in the forgoing documents are true and correct. I understand that false statements herein are made subject to the penalties of 18 Pa. Cons. Stat 4904 relating to unsworn falsification to authorities.. J et L. Ritter, Plaintiff rv ~ ~ -n ,~, „~ ~A --.+ : ~ R~ ~r .. . '~ '~~ r~r_~ ~ ~ ~ 4 r JANET L. BITTER, Plaintiff v. ARUN KAPOOR, M.D., Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -LAW NO. 06-5424 CIVIL TERM ORDER OF COURT AND NOW, this 27th day of March, 2007, upon consideration of Plaintiff s Motion for Continuance, and Defendant's counsel having related his opposition to the motion, the motion is denied. net L. Ritter 55 William Drive Carlisle, PA 17013 Plaintiff, pro Se ~chael M. Badowski, Esq. 3510 Trindle Road Camp Hill, PA 17011 Attorney for Defendant Court Administrator ~- /?d-''~`~ G~ua°~'~-~'-~ :rc BY THE COURT, ,- ~ :~ ~~~~ ~ ~~ ~~~Z ~.~. a-,: JANET L. BITTER, Plaintiff v. ARUN KAPOOR, M.D., Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -LAW NO.06-5424 CIVIL TERM IN RE: DEFENDANT'S MOTION TO STRIKE PLAINTIFF'S CERTIFICATE OF MERIT AND FOR ENTRY OF JUDGMENT OF NON PROS BEFORE OLER and EBERT, JJ. ORDER OF COURT AND NOW, this 3 r~ day of May, 2007, upon consideration of the Motion of Defendant, Arun Kapoor, M.D., To Strike Plaintiff s Certificate of Merit and [for) Entry of Judgment [ofJ Non Pros-Pa. R.C.P. 1042.3, and for the reasons stated in the accompanying opinion, Plaintiff's certificate of merit is stricken and a judgment of non pros is entered against Plaintiff and in favor of Defendant. The Prothonotary shall give notice of this order pursuant to Pa. R.C.P. 236. BY THE COURT, ~et L. Ritter 55 William Drive Carlisle, PA 17013 Plaintiff, pro se 1 ichael M. Badowski, Esq. 3510 Trindle Road Camp Hill, PA 17011 Attorney for Defendant J. esley Oler, ., J. ` .4~ '' G`~ '''~~~ fl..? ~~, ~. ;.z = t~~"~~ 1. ~ ~, ~ '~_~u ~.,~ 3 ~,I. ~ ~,~ , ,. ,~ r.,~,._._ .. ~ ,-~ ~° JANET L. BITTER, Plaintiff v. ARUN KAPOOR, M.D., Defendant IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION -LAW N0.06-5424 CIVIL TERM IN RE: DEFENDANT'S MOTION TO STRIKE PLAINTIFF'S CERTIFICATE OF MERIT AND FOR ENTRY OF JUDGMENT OF NON PROS BEFORE OLER and EBERT, JJ. OPINION and ORDER OF COURT Oler, J., May 4, 2007. In this medical malpractice case a pro se plaintiff has alleged that a physician acted negligently in connection with the administration of injections of "Depo-Medrol," that he failed to obtain Plaintiff s informed consent for these injections, and that these injections resulted in Plaintiff's development of arachnoiditis.' Plaintiff filed a certificate of merit asserting that she had in her possession reports from two licensed professionals who stated that Defendant's care fell outside acceptable professional standards.2 Alternatively, Plaintiff s certificate of merit asserted that expert testimony was unnecessary to her case.3 Defendant has filed a motion (a) to strike Plaintiff s certificate of merit on the grounds that Plaintiff allegedly failed to serve the certificate of merit on Defendant and that the certificate of merit was inadequate under Pennsylvania Rule of Civil Procedure 1042.3,4 and (b) for entry of a judgment of non pros. ' Plaintiff s Admended [sic] Complaint, filed November 1, 2006. Z Certificate of Merit, filed November 15, 2006. 31d. a Motion of Defendant, Arun Kapoor, M.D., To Strike Plaintiff's Certificate of Merit and [for] Entry of Judgment (ofJ Non Pros - Pa. R.C.P. N. 1042.3, filed January 31, 200? (hereinafter Defendant's Motion To Strike). For the reasons stated in this opinion, Defendant's motion will be granted and a judgment of non pros in favor of Defendant will be entered. STATEMENT OF FACTS The gist of Plaintiff s pro se complaint may be summarized as follows:s Plaintiff Janet L. Ritter resides at 55 William Drive, Carlisle, Cumberland County, Pennsylvania.6 Defendant Arun Kapoor, M.D., is employed at the Carlisle Surgery and Pain Clinic, located at 31 Sprint Drive, Carlisle, Cumberland County, Pennsylvania.? Defendant committed medical malpractice with respect to his treatment of Plaintiff by failing to properly diagnose her, improperly administering injections of "Depo- Medrol," and failing to obtain her informed consent for the injections by advising of the risks associated with the treatment.g As a result of the treatment, Plaintiff "[d]eveloped ... [a]dhesive arachnoiditis."9 Plaintiff filed with the Prothonotary a Certificate of Merit with two letters from licensed professionals attached to the certificate.10 Defendant has alleged that the Certificate of Merit was not served on him." The Certificate of Merit states: [ 1) Plaintiff has in her possession reports from two licensed professionals that state to their knowledge, and belief the care and treatment by the defendant, in the practice of medicine, skill and knowledge,. exercised and exhibited fell outside acceptable professional standards and that such conduct was just cause in bringing about the harm, that is the subject of this complaint. Andlor s In reciting Plaintiff s allegations, the court is not expressing any opinion as to their accuracy. 6 Plaintiff's Admended [sic] Complaint, filed November 1, 2006. Id. a Id. 9 Id. 10 Certificate of Merit, filed November 15, 2006. " Defendant's Motion To Strike, ¶6. 2 [2] Expert testimony ar appearance of these licensed professionals mentioned above are unnecessary for prosecution of the claim against the defendant.' Z The first letter attached to the Certificate bears the signature of Mark P. Holenick, D.O., is dated January 14, 2004, and notes that Plaintiff "has seen a dozen doctors aver the course of the last several years ...."13 The letter does not mention Defendant, breach of any appropriate standard of care by Defendant, "Depo-Medrol," arachnoiditis, or informed consent.14 In its entirety, the letter reads as follows: To Whom It May Concern: 3anet Ritter is a 61-year-old female who is doing miserably after two successive relatively recent lumbar surgical procedures. She has seen a dozen doctors over the course of the last several years and simply "saw my opening of practice advertisement in the paper and decided to give me a try as she does not want surgery and knows I no longer perform it". This lady is otherwise in fairly good health and worked for many years stocking floors and in the central supply aspect of the Carlisle Hospital. She developed low back and radiative right lower extremity pain in a sciatic distribution and was sent by Drs. Dell and Daniels, her family physician, for diagnostic studies and subsequent treatment, ending up at the Hershey Medical Center under treatment of Dr. Gelb, since moved to Maryland, and undergoing a decompression laminectomy from L3 to LS with partial fascectomy as I have reviewed the information. This was dated 5!2/2000. She received absolutely no relief at all and was actually worse after the surgery. The spine doctor told her that he did not know what was wrong and told her to "go back to her family doctor" and she was placed on strong pain pills and somewhere along the line received an epidural injection that did not help. She went back to Hershey this time to anew physician, an orthopedist named Dr. Weiner and she was told that she had spandylolisthesis or abnormal motion at L4-5 and that she needed a fusion. I looked at the same x-rays they did, I believe, and see only about 2-3 mm of translational change at that level but the dictation states that left iliac bone graft was placed posterolaterally and that a fusion was performed without instrumentation. She was braced for only a very short period and immediately placed back on a treadmill and advised to exercise at home, she states, and she states that within 2 weeks after surgery her pain was back again worse than ever. The only place she feels good is in a 12 Certificate of Merit, filed November 15, 2006. ~ s Id. ~ a Id. 3 hot tub. Her right lower extremity symptoms persist. She has tried a variety of nonsterodial medications and a variety of narcotic medications. She has tried Neurontin. She most recently has been given Zonogran 100 mg 2 pills at bedtime and has been seeing Dr. McMillan for pain management here locally. She has another appointment to go back to Hershey. Current medications include Hydrochlorothiazide for her blood pressure and Zocor 10 mg 1 a day. She takes Zoloft 100 mg 1 a day in the morning, Valium 5 mg 1-2 daily and Premarin 0.625 mg 1 a day. Her systems review demonstrates a history of hypertension for which she takes medication. No history of heart attack, murmur, or peripheral edema. There is no history of liver or kidney disease or blood dyscrasia. There is no history of diabetes or thyroid disease and no history of seizure or stroke. No history of ulcer, hematemesis, or rectal bleeding. No history of dysuria, hematuria, or incontinence. She has had 6 pregnancies with S living children. She ambulates with a single point cane. No history of transfusion, hepatitis, HIV, or cancer. She had two back surgeries an also a hysterectomy and some vocal cord nodes excised. She has undergone a bladder suspension. Father is deceased of a heart attack and mother deceased of bowel cancer. She has four sisters who are still alive and two deceased brothers, one age 46 of a myocardial infarction and one deceased at age 58 of lung cancer with three brothers remaining alive. She is a retired homemaker and married with five children and she lives with her husband at home. She smokes 1 pack of cigarettes per day and does not drink. Clinically she is 5 feet 2 inches tall and weighs 145 pounds and is 61 years of age. Her physical exam is markedly abnormal. In a level stance phase a plumb line from the base of her skull falls through the mid right gluteal fold and she has marked right sided paraspinal spasm and perhaps this represents a chronic right sciatic scoliosis convex away from the radicular side but she certainly has marked postural asymmetry and 4+ thoracolumbar paraspinal spasm. She is virtually unable to heel to toe walk secondary to weakness and pain and is able to flex in a level stance phase bringing her fingertips to the proximal thigh before diffuse midline and right sided low back pain intervenes. Extension is possible to 15 degrees shy of neutral again with a midline low back pain endpoint. She has marked weakness of her left hip flexors and also has pain to internal robation of the left hip and I have to wonder if she has some degree of osteoarthritis there as she does not have hip radiographs today. What also concerns me is that she has rather marked hyper-reflexia at the patellar jerk level at 5/4+ bilaterally and absent Achilles reflexes with negative straight leg raise bilaterally. She has no signs of pigmentation or ulceration of the legs and no signs of cutaneous abnormaility associated with poor circulation. 4 I believe this lady deserves diagnostic testing to at least establish a firm diagnosis before further treatment is offered. I am sending her for a low pelvic AP radiograph with bilateral frog x-rays of the hips. I am sending her for a cervical and thoracic MRI looking for possible cord compression of those areas as I am not at all impressed with either her pre or postoperative lumbar MRI's relative to degree of stenosis of either foramen or central canal. If she did not get any better at all after surgery even for a brief time I would have to wonder what the surgical objective was and she certainly does not have anything that resembles a degree of translational change necessary in my former surgical practice to have required a posterolateral fusion and I may be missing something or missing some of the salient or pertinent radiographs. DIAGNOSIS: Post laminectomy syndrome with persistent right lower extremity sciatic pain as well as left hip pain of possible articular origin and bilateral hyper-reflexia of the knees unexplained. is The second letter attached to the certificate of merit bears the signature of Peter A. Pahapill, MD, FRCSC, is dated September 8, 2005, and is in the nature of a report to one of Plaintiff's treating physicians.16 The letter does not mention Defendant, breach of any appropriate standard of care by Defendant, arachnoiditis, or informed consent.' The letter notes that Plaintiff has "an adverse reaction to Depro-Medrol."18 In its entirety, this correspondence reads as follows: Dear James: We had the pleasure of seeing your patient, Janet Ritter, in the Neurosurgery clinic today. She comes in for evaluation of her persistent low back pain. She was seen in conjunction with Amber L. Thomas, PA- C and the attending physician, Dr. Peter A. Pahapill. She states that she has had this low back pain since 2000. She states that she has constant low back pain that is sharp with constant right buttock and proximal right posterior thigh pain. She states that nothing makes this better. She states that she has had three surgeries and this seems to be progressively getting worst after each of these surgeries. She states that she is very tired of having to take medication constantly for this and it not helping. She denies any numbness or tingling in her legs. She denies any bowel or bladder control issues with the exception of urge incontinence. 15 Id. (emphasis added). ~b Id. " Id. i s Id. She denies any weakness of the lower extremities. She denies having any falls. She does not walk with a cane or a walker. She had had epidural injections recently and she states that these did not help and in fact she thinks they made her worse. Surgical history includes a hysterectomy in 1970, bladder tuck in 1992, one back surgery in 2000 and another one in 2003 and another one in 2004. Current medications include Valium (5 mg, as needed), Zoloft (100 mg, qd), and HCTZ (25 mg, qd), Premarin (0.625 mg, qd), Zocor (40 mg, qd) and she states that she stopped this two months ago. She also takes Fish Oil, Garlique, B 12, and Glucosamine/Chondroitin (qd). She has no known drug allergies. She does have an adverse reaction to Depro-Medrol. Family history is positive for hypertension in her mother, diabetes in her sister and cardiac disease in her father and brother. She also has a family history positive of cancer in her brother and mother of the lump, colon and liver type. She denies a family history of neurosurgical problems. Social history shows that she does smoke approximately 1 pack or less per day. She does not drink alcohol and does not use illicit drugs. She is currently a housewife and is not working due to her chief complaint. She does state that she wants to return back to work. She is married with five children and several grandchildren. Her past medical history is positive for bronchitis, sore throat and sleep disturbance as well as dentures. She denies any neurologic problems. She does have a history of high blood pressure. She does have a history also of diarrhea, constipation and a blood transfusion. Nervous review is positive for numbness and weakness as described in the HPI and she denies any other seizures, epilepsy, paralysis, stroke, TIA, increased sensation or muscle wasting. Endocrine review is positive for steroid treatment in the form of epidurals and weight change. Kidney and bladder is positive for infections and urge incontinence. She denies full incontinence when awake or asleep. Cancer history is negative. She did in the past have irregularity in her menstrual cycle. General review is negative for fainting, dizziness, head injuries or headaches. On physical examination today, she is awell-developed, well-nourished sitting in the exam chair today and does appear to be in mild distress especially when moving around the chair and standing up and walking about the room. Her vital signs are blood pressure 120!62, pulse 60 and regular, weight 130 prounds, and height 62". She does keep good personal hygiene. She does have pain with right straight leg raising. Of note, she also has decreased full extension of the right knee, which may be adding to her pain in the hamstring muscles. She does have tenderness on palpation of the low back musculature, right side greater then left. She 6 does have tenderness on palpation in the right buttock along the sciatic area and she states that this does cause pain in the proximal right posterior thigh. She does have some tenderness in the area of the SI joint, not as bad as on the right side. Sensation is intact throughout with no sensory levels detected. DTR's show 2+ at the patellas and 1+ at the achilles bilaterally. Strength testing with knee flexion/extension and ankle dorsiflexion, plantar flexion, inversion and eversion was 5/5 bilaterally. Her skin is arm and dry without rashes or lesions. Peripheral pulses are intact. She does bring with her today the most recent MRI of the lumbar spine which was done on August 18, 2005 at Walnut Bottom Radiology, which was done without contrast. I essentially do not agree with the interpretation of the various radiologists' over the years and do not think that there is any evidence of a surgical lesion that requires any form of decompression. The fact that she has a constant pain syndrome and that the pain is more deep, burning and aching in nature and does have a significant component involving her buttock and thigh area as opposed to only being in her low back area, that this picture makes her a good candidate for at least a trial of epidural spinal cord stimulation. I suspect that there is about atwo-thirds chance that we would be able to reduce her buttock and thigh pain by about 50% and the chances of reducing her low back pain are much more variable. I went over the procedure itself as well as the risks and benefits. The biggest risk is that it essentially does not help. The other risks are those that are very similar to a standard epidural steroid injection. I emphasized to her that if this does help her she is not committed to have an implant, but at least she will be aware of how this can help her so that she can make an informed decision. I consider spinal cord stimulation as being similar to adding another medication onto the medical therapy that she already is receiving. I will not manage her medications in any way. I would manage her spinal cord stimulation dosages, however. She is quite anxious to go ahead with the trial and we will try to provide this for her in the upcoming weeks.19 Upon discovering that Plaintiff had filed a certificate of merit and of its substance, Defendant filed a moton to strike the filing, based upon Plaintiff's failure to serve it and for substantive reasons.20 In the latter regard, Defendant contended that the certificate was not compatible with Pennsylvania Rule of Civil Procedure 1042.3, inasmuch as Plaintiff had "not filed a document which establishes that any healthcare professional has issued a statement that any care rendered by Dr. Kapoor fell below the applicable ' 91d. 20 Defendant's Motion To Strike. 7 standard of care."21 As a consequence of these deficiencies, Defendant requested that a judgment of non pros be entered with respect to Plaintiff's claim.22 Defendant's motion was argued before an en Banc court on April 4, 2007. Plaintiff failed to submit a brief for the argument. DISCUSSION Pennsylvania Rule of Civil Procedure 1042.3 relates to malpractice claims and requires that allegations of professional malpractice be accompanied by the filing of a certificate of merit. The rule provides, in material part: (a) In any action based upon an allegation that a licensed professional deviated from an acceptable professional standard, the attorney for the plaintiff, or the plaintiff if not represented, shall file with the complaint or within sixty days after the filing of the complaint, a certificate of merit signed by the attorney or party that either (1) an appropriate licensed professional has supplied a written statement that there exists a reasonable probability that the care, skill or knowledge exercised or exhibited in the treatment, practice or work that is the subject of the complaint, fell outside acceptable professional standards and that such conduct was a cause in bringing about the harm, or (2) the claim that the defendant deviated from an acceptable professional standard is based solely on allegations that other licensed professionals for whom this defendant is responsible deviated from an acceptable professional standard, or (3) expert testimony of an appropriate licensed professional is unnecessary for prosecution of the claim. Pa. R.C.P. 1042.3. The purpose behind the certificate of merit requirement is to "assure that the plaintiff has a reasonable basis for pursuing a claim...." Salamoni v. Karoly, 74 Pa. D. & C.4th 378, 387 (Lehigh Cty. 2005); see also Womer v. Hilliker, 589 Pa. 256, 908 A.2d Z' Defendant's Motion To Strike, ¶15. Zz See generally, id. 8 269, 275 (2006). Failure to file a proper certificate of merit warrants entry of a judgment of non pros. Pa. R.C.P. 1042.6.23 To establish a prima facie case of medical malpractice expert testimony is generally necessary. Hoffman v. Mogil, 445 Pa. Super. 252, 258, 665 A.2d 478, 481 (1995); Lira v. Albert Einstein Medical Center, 384 Pa. Super. 503, 559 A.2d 550 (1989). Expert testimony is also generally necessary to establish an informed consent claim. With regard to informed consent, it may be noted that, under the Medical Care Availability and Reduction of Error Act, expert testimony is "required to determine whether the procedure constituted the type of procedure [requiring informed consent] and to identify the risks of that procedure, the alternatives to that procedure and the risks of these alternatives." Act of March 20, 2002, P.L. 154, §504, 40 P.S. §1303.504(c). A physician has a duty to "obtain the informed consent of the patient" for the following procedures: (1) Performing surgery, including the related administration of anesthesia. (2) Administering radiation or chemotherapy. (3) Administering a blood transfusion. (4) Inserting a surgical device of appliance. (5) Administering an experimental medication, using an experimental device or using an approved medication or device in an experimental manner. Act of March 20, 2002, P.L. 154, §504, 40 P.S. § 1303.504(a). In this case, Plaintiff s certificate of merit alleged that she had in her possession reports of two licensed professionals to the effect that Defendant's care and treatment fell outside the acceptable professional standards. An examination of the attachments to the certificate, however, reveals that this was a patent misrepresentation. Alternatively, Plaintiff's certificate of merit asserted that no expert testimony was necessary to support her complaint. However, an indicated above, Pennsylvania law holds otherwise.2a z3 With respect to a claimant's failure to serve a properly filed certificate of merit, see Salamoni v. Karoly, 74 Pa. D. & C.4~'' 378, 387 (Lehigh Cty. 2005); Helfrick v. UPMC Shadyside Hospital, 65 Pa. D. & C.4`n 420, 426 (Allegheny Cty. 2005). za In view of the court's disposition of Defendant's motion upon these grounds, it would be superfluous to further consider the issues of (a) whether a claim based upon informed consent is legally cognizable 9 For the foregoing reasons, the following order will be entered: ORDER OF COURT AND NOW, this 4`h day of May, 2007, upon consideration of the Motion of Defendant, Arun Kapoor, M.D., To Strike Plaintiff s Certificate of Merit and [for] Entry of Judgment [of] Non Pros-Pa. R.C.P. 1042.3, and for the reasons stated in the accompanying opinion, Plaintiff s certificate of merit is stricken and a judgment of non pros is entered against Plaintiff and in favor of Defendant. The Prothonotary shall give notice of this order pursuant to Pa. R.C.P. 236. BY THE COURT, s/ J. Wesley Oler, Jr. J. Wesley Oler, Jr., J. Janet L. Ritter 55 William Drive Carlisle, PA 17013 Plaintiff, pro se Michael M. Badowski, Esq. 3510 Trindle Road Camp Hill, PA 17011 Attorney for Defendant where the treatment alleged involves epidural injections of Depo-Medrol, and (b), whether a plaintiff's failure to serve a certificate of merit upon a defendant is fatal to the plaintiff's claim. 10