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HomeMy WebLinkAbout07-0187IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. CIVIL ACTION - MEDICAL PROFESSIONAL LIABILITY DONALD L. MORRISON and, ROBERT P. BORAN, JR, M.D. SHARON A. MORRISON, his wife Good Samaritan Regional Medical Center 1942 Reservoir Drive 700 East Norwegian Street Carlisle, PA 17013 Pottsville, PA 17901 O Rt tN !! APPALACHIAN ORTHOPEDIC CENTER, LTD. 1 Dunwoody Drive Carlisle, PA 17015 Plaintiffs versus Defendants PRAECIPE FOR WRIT OF SUMMONS TO THE PROTHONOTARY OF SAID COURT: Please issue a writ of summons in the above-captioned action. X Writ of Summons shall be issued and forwarded to Sheriff. Michael J. Navitsky, Esquire I.D. No. 58803 Duane S. Barrick, Esquire I.D. No. 77400 Navitsky, Olson & Wisneski LLP 2040 Linglestown Road, Suite 303 Harrisburg, PA 17110 (717) 541-9205 Dated: Sign e of Attorney n N C? O N N N -p i71 SHERIFF'S RETURN - REGULAR t CASE NO: 2007-00187 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND MORRISON DONALD L ET AL VS BORAN ROBERT P JR MD ET AL MICHAEL BARRICK , Sheriff or Deputy Sheriff of Cumberland County,Pennsylvania, who being duly sworn according to law, says, the within WRIT OF SUMMONS APPALACHIAN ORTHOPEDIC CENTER was served upon DEFENDANT the at 1501:00 HOURS, on the 17th day of January-, 2007 11 at 1 DUNWOODY DRIVE CARLISLE, PA 17015 by handing to MARCIA HECKERT, OFFICE MANAGER 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 6.00 Service 4.40 . Affidavit .00 Surcharge 10.00 R. Thomas Kline .00 20.40',x 01/25/2007 %J3f?0 7 NAVITSKY OLSON I - -?- Sworn and Subscibed to By:, before me this day Deputy Sheriff'---, of A. D. SHERIFF'S RETURN - OUT OF COUNTY CASE NO: 2007-00187 P COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND MORRISON DONALD L ET AL VS BORAN ROBERT P JR MD 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: BORAN ROBERT P JR M D but was unable to locate Him in his bailiwick. He therefore deputized the sheriff of SCHUYLKILL serve the within WRIT OF SUMMONS County, Pennsylvania, to On January 25th , 2007 , this office was in receipt of the attached return from SCHUYLKILL Sheriff's Costs: So answe Docketing 18.00 Out of County 9.00 Surcharge 10.00 R. Thomas Kli Dep Schuylkill Co 44.20 Sheriff of Cumberland County Postage 1.02 82.22 ,/ j13 07 ??.. 01/25/2007 NAVITSKY OLSON WISNESKI Sworn and subscribe to before me this day of , A. D. 1% The Court of Common Pleas of Cumberland County, Pennsylvania Donald L. Morrison et al vs. Robert P. Boran Jr MD No. 07-187 civil January 12, 2007 Now, , I, SHERIFF OF CUMBERLAND COUNTY, PA, do hereby deputize the Sheriff of Schuylkill County to execute this Writ, this deputation being made at the request and risk of the Plaintiff. Sheriff of Cumberland County, PA Affidavit of Service Now, , 20 , at within upon at by handing to a copy of the original and r .dde kn0?vn to the contents thereof. C) z J Q CD So answers, ?u N czn Sheriff of County, PA Sworn and subscribed before me this day of , 20 o' clock M. served the COSTS SERVICE MILEAGE _ AFFIDAVIT Wed Jan 24 2007 09:48AM PLAINTIFF: MORRISON,DONALD V S DEFENDANT: BORAN JR,ROBERT P MD SHERIFF'S DEPARTMENT OF SCHUYLKILL COUNTY SCHUYLKILL COUNTY COURT HOUSE POTTSVILLE, PENNSYLVANIA 17901 (570) 622-5570 ** A F F I D A V I T O F R E T U R N ** DEPUTIZED FROM CUMBERLAND COUNTY COURT NUMBER 07-187 CIVIL TERM FILED BY NAVITSKY,MICHAEL J TYPE OF PAPER WRIT OF SUMMONS SERVING NUMBER 46071 PAGE: 1 ATTORNEY: NAVITSKY,MICHAEL J PRO FILE DATE 01/10/2007 EXPIRATION 02/09/2007 2040 LINGLESTOWN ROAD SHF RECEIVED 01/17/2007 SUITE 303 DEP RETURNED 01/24/2007 HARRISBURG, PA 17110 ------------------------------------------------------------------------------------------------------------------------------------- (P E 0 P L E T O B E S E R V E D) NAME ADDRESS 1 ADDRESS 2 CITY ST ZIP DEPUTY -------------------- -------------------- -------------------- -------------------- -- ----- ------------------ Service for BORAN JR,ROBERT P MD 700 E NORWEGIAN ST POTTSVILLE PA 17901 DRIES, C (A T T E M P T S A T S E R V I C E) SEQ DATE TIME SERVED TO ADDRESS 1 ADDRESS 2 CITY ST ZIP MILES COST --- ---------- ----- -------------------- -------------------- --------------- --------------- -- ----- ----- ------------ 1 01/23/2007 14:14 KAYANNE BARBER 700 E NORWEGIAN POTTSVILLE PA 17901 MINIM 9.70 * REMARKS : SERVICE MADE BY DEPUTY DRIES, C ------------ Total 9.70 Total Mileage Charge for all Services : 9.70 Wed Jan 24, 2007 09:48AM PAGE: 2 SHERIFF'S DEPARTMENT OF SCHUYLKILL COUNTY SCHUYLKILL COUNTY COURT HOUSE POTTSVILLE, PENNSYLVANIA 17901 (570) 622-5570 ** A F F I D A V I T O F R E T U R N ** I hereby CERTIFY and RETURN that service was made by handing a TRUE and ATTESTED COPY to : KAYANNE BARBER (ADMIN SEC) 700 E NORWEGIAN POTTSVILLE PA ON 01/23/2007 at 14:14 SWORN and subscribed before me thi SO ANSWERS day of (Deputy Sheriff) (Proth of ry 1 (Sheriff of Schuylkill County) ------------- End - of - Return (X-20-2007) IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. n f7 j ')' 1 u c C'7 ." CIVIL ACTION - MEDICAL PROFESSIONAL LIABILITY DONALD L. MORRISON and, SHARON A. MORRISON, his wife 1942 Reservoir Drive Carlisle, PA 17013 Plaintiffs versus ROBERT P. BORAN, JR, M.D. Good Samaritan Regional Medical Center 700 East Norwegian Street Pottsville, PA 17901 'ORMS R, APPALACHIAN ORTHOPEDIC CENTER, LTD. 1 Dunwoody Drive Carlisle, PA 17015 Defendants 'OF SUMMONS TO THE ABOVE NAMED DEFENDANT: YOU ARE NOTIFIED THAT THE ABOVE-NAMED PLAINTIFF AN ACTION AGAINST YOU. Prothonotary COMMENCED ry Dated: ` U 2nn uty KILCOYNE & NESBITT, LLC BY: JOHN F. McGREEVEY ATTY. ID. #64610 630 W. GERMANTOWN PIKE, SUITE 121 PLYMOUTH MEETING, PA 19462 610.825.2833 DONALD L. MORRISON and SHARON A. MORRISON, his wife, Plaintiffs V. ROBERT B. BORAN, JR., M.D. and APPALACHIAN ORTHOPEDIC CENTER, LTD.,: Defendants ATTORNEY FOR DEFENDANT, ROBERT P. BORAN, JR., M.D. COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA No. 07-187 Civil Term JURY TRIAL DEMANDED ENTRY OF APPEARANCE AND JURY TRIAL DEMAND TO THE PROTHONOTARY: Kindly enter our appearance on behalf of defendant, ROBERT B. BORAN, JR., M.D., only in connection with the above-captioned matter. A jury trial consisting of a panel of twelve (12) jurors is hereby demanded. KILCOYNE & NESBITT, LLC F. McGR Y J _` -ul KILCOYNE & NESBITT, LLC BY: JOHN F. McGREEVEY ATTY. ID. #64610 630 W. GERMANTOWN PIKE, SUITE 121 PLYMOUTH MEETING, PA 19462 610.825.2833 DONALD L. MORRISON and SHARON A. MORRISON, his wife, Plaintiffs ATTORNEY FOR DEFENDANT, ROBERT P. BORAN, JR., M.D. COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA No. 07-187 Civil Term V. ROBERT B. BORAN, JR., M.D. and APPALACHIAN ORTHOPEDIC CENTER, LTD.,: Defendants JURY TRIAL DEMANDED PRAECIPE TO FILE COMPLAINT TO THE PROTHONOTARY: Please enter a rule upon plaintiffs, DONALD L. MORRISON and SHARON A. MORRISON, his wife, to file a Complaint within twenty (20) days hereof or suffer the entry of a Judgment of Non Pros. BI T, LLC KILCOYNE & NEES4-71APAPIJ, JOIN F. McGREEVTEY Attorney for Defendants ROBERT P. BORAN, JR., N?-p RULE TO FILE COMPLAINT AND NOW, this 9Vkday of"'? 2007, a Rule is hereby granted upon plaintiffs, DONALD L. MORRISON and SHARON A. MORRISON, his wife, to file a Complaint herein within twenty (20) days after service hereof or suffer the entry of a Judgment of Non Pros. C of '4 ?-',A PR HONOTA " C,. -?- rY"1 ?' (?'a Y xt? ?T i ? ? -? y ? r' ?_ .. ??. ? ? DONALD L. MORRISON, and SHARON A. MORRISON, his wife, Plaintiffs, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA NO. 2007-00187 VS. CIVIL ACTION MEDICAL PROFESSIONAL LIABILITY ROBERT P. BORAN, JR., M.D., and APPALACHIAN ORTHOPEDIC CENTER, LTD.,: JURY TRIAL DEMANDED Defendants ' ". ?--4 NOTICE YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this Complaint and Notice are served, by entering a written appearance personally or by attorney and filing in writing with the Court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the Court without further notice for any money claimed in the Complaint or for any other claim or relief requested by the Plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. Cumberland County Bar Association 2 Liberty Avenue Carlisle, PA 17013 (717) 249-3166 DONALD L. MORRISON, and SHARON A. MORRISON, his wife, Plaintiffs, VS. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA NO. 2007-00187 CIVIL ACTION MEDICAL PROFESSIONAL LIABILITY ROBERT P. BORAN, JR., M.D., and APPALACHIAN ORTHOPEDIC CENTER, LTD.,: JURY TRIAL DEMANDED Defendants AVISO USTED HA SIDO DEMANDADO EN LA CORTE. Si usted desea defenderse de las quejas expuestas en las paginas siguientes, debe tomar accibn dentro de veinte (20) dias a partir de la fecha en que recibi6 la demanda y el aviso. Usted debe presentar comparecencia escrita en persona o por abogado y presentar en la Corte por escrito sus defensas o sus objeciones a las demandas en su contra. Se le avisa que si no se defiende, el caso puede proceder sin usted y la Corte puede decidir en su contra sin mas aviso o notificacibn por cualquier dinero reclamado en la demanda o por cualquier otra queja o compensacibn reclamados por el Demandante. USTED PUEDE PERDER DINERO, O PROPIEDADES U OTROS DERECHOS IMPORTANTES PARA LISTED. LLEVE ESTA DEMANDA A UN ABOGADO INMEDIATAMENTE. SI USTED NO TIENE O NO CONOCE UN ABOGADO, VAYA O LLAME A LA OFICINA EN LA DIRECCION ESCRITA ABAJO PARA AVERIGUAR DONDE PUEDE OBTENER ASISTENCIA LEGAL. Cumberland County Bar Association 2 Liberty Avenue Carlisle, PA 17013 (717) 249-3166 2 DONALD L. MORRISON, and SHARON A. MORRISON, his wife, Plaintiffs, VS. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA NO. 2007-00187 ROBERT P. BORAN, JR., M.D., and APPALACHIAN ORTHOPEDIC CENTER, LTD.,: Defendants CIVIL ACTION MEDICAL PROFESSIONAL LIABILITY JURY TRIAL DEMANDED COMPLAINT 1. Plaintiff Donald L. Morrison is an adult individual who resides in Carlisle, Cumberland County, Pennsylvania. 2. Plaintiff Sharon A. Morrison, wife of Donald L. Morrison, is an adult individual who resides in Carlisle, Cumberland County, Pennsylvania. 3. Defendant Robert P. Boran, Jr., M.D., (hereinafter referred to as Defendant Boran) is an adult individual licensed to practice medicine in the Commonwealth of Pennsylvania, who at all relevant times herein, engaged in the practice of orthopedic surgery with an office in Carlisle, Cumberland County, Pennsylvania. 4. Plaintiffs are asserting a professional liability claim against Defendant Boran. 5. Upon information and belief, Defendant Boran was an agent, apparent agent, member, partner, shareholder, servant, and/or employee of Appalachian Orthopedic Center, Ltd. during the relevant times of this action. 6. Defendant Appalachian Orthopedic Center, Ltd. (hereinafter referred to as Appalachian Orthopedic) is a Pennsylvania professional corporation duly organized and registered in Pennsylvania who at all 3 relevant times herein engaged in the business of providing orthopedic services to the public with its place of business in Carlisle, Cumberland County, Pennsylvania. 7. Plaintiffs are asserting a professional liability claim against Defendant Appalachian Orthopedic by virtue of the actions and/or inactions of Defendant Boran and all such other health care/clerical agents, apparent agents, servants, and/or employees from their office who were involved with the care of Mr. Morrison during the relevant dates of his hospitalization at Carlisle Regional Medical Center from 1/24/05 thru 2/2/05, in particular, regarding the inactions/actions from 1/24/05 through 1/26/05. 8. At all relevant times herein, Defendant Boran and all such other health care/clerical agents from Defendant Appalachian Orthopedic who were involved with the care of Mr. Morrison at Carlisle Regional Medical Center from 1/24/05 through 1/26/05 were furthering the economic and financial interests of Defendant Appalachian Orthopedic and were acting within the scope of their employment with Defendant Appalachian Orthopedic and therefore created vicarious liability. 9. At all relevant times herein, Donald L. Morrison was married to and continues to be married to Plaintiff Sharon A. Morrison, his wife. 10. Mr. Morrison had a history of having had a left total knee replacement in 2001, by an employee/agent of Defendant Appalachian Orthopedic, and also left knee surgery by Defendant Boran in 2004, from which Mr. Morrison did not have complaints of numbness, tingling, coolness or extreme pain postoperatively in the operated-on left lower extremity. 11. In his other leg, on January 24, 2005, Mr. Morrison underwent a Legacy right total knee arthroplasty by Defendant Boran, at the Carlisle Regional Medical Center. 12. At the conclusion of Mr. Morrison's operative note, Defendant Boran reported, "neurovascularly 4 intact to the right lower extremity." 13. However, post-operatively, Mr. Morrison developed signs and symptoms of decreased vascular supply to his right lower extremity. 14. Defendant Boran did not order a vascular consult or arteriogram until approximately two (2) days after Mr. Morrison developed signs and symptoms of decreased vascularzation of his right lower extremity. 15. Plaintiffs aver that this two-day delay in diagnosis and treatment of Mr. Morrison's right lower extremity thrombus (blood clot) caused Mr. Morrison to undergo multiple fasciotomies to his right lower extremity and necessitated him to undergo several plastic surgical procedures to his right lower extremity. 16. According to the records of Carlisle Regional Medical Center, Mr. Morrison left the operating room following his right total knee replacement by Defendant Boran at 10:37 a.m. on 1/24/05 and arrived in the PACU at 10:38 a.m. 17. Mr. Morrison was ordered Morphine and Percocet (Oxycodone APAP) prn for pain. 18. At 11:40 a.m., Mr. Morrison was medicated with Morphine for pain in the PACU. 19. Mr. Morrison was discharged to the floor at 12 Noon on 1/24/05. 20. Mr. Morrison's post-op orders included the daily administration of Coumadin on a sliding scale. 21. According to the nursing documentation form, at 12 Noon on 1/24/05, it was noted that Mr. Morrison was received from the PACU and that his pedal pulse was diminished, palpable. 22. Mr. Morrison's right toes were noted to be warm and pink with capillary refill less than 3 seconds. 23. However, three (3) hours later, at 3:00 p.m. on 1/24/05, the same nurse noted that Mr. Morrison's toes were cool, pale and that Mr. Morrison stated that his toes were numb to touch. 24. His immobilizer was removed and ace bandage loosened, and again, it was noted that his right pedal pulse was diminished, but palpable. 25. Importantly, it was noted that Mr. Morrison's right pedal pulse was not as strong as his left pedal pulse. 26. The records reflect that Mr. Morrison was medicated for pain with Percocet (Oxycodone APAP) at both 1:30 p.m. and 2:00 p.m.. 27. At 3:30 p.m. on 1/24/05, a different nurse documented that Mr. Morrison's right foot was pale, slightly cool, and had a decreased pedal pulse. 28. At 4:00 p.m., Mr. Morrison received another injection of Morphine for pain. 29. At 5:15 p.m., on 1/24/05, the same nurse noted that Mr. Morrison complained that the top of his right foot and toes were numb and it was noted that he had decreased pedal pulse. 30. The nurse recorded that they were unable to hear the pulse with a Doppler and recorded that they would notify Dr. Boran. 31. Forty-five minutes later, at 6:00 p.m. on 1/24/05, it is noted that Defendant Boran was notified with orders received. 32. The records reflect that Mr. Morrison's immobilizer had been removed and had not been reapplied since 3:00 p.m. It was also noted that the post-operative dressing was loosened and rewrapped at 3:00 p.m. 33. The plan was to continue to note the color of Mr. Morrison's foot. 34. Mr. Morrison's toes continued to appear pale and slightly dusky, and Defendant Boran was noted to be aware. 35. Mr. Morrision received his first dose of Coumadin, 10mg at 6:00 p.m. on 1/24/05. 6 36. Fifty minutes later at 6:50 p.m., the same nurse noted that Mr. Morrison still had decreased sensation in his right foot and complained of slight tingling on the sole of his right foot. 37. Mr. Morrison's post-operative dressing was again removed to check for any constrictive dressings, but it was noted that there were none. 38. It was noted that Mr. Morrison's right foot remained cool with decreased pulse, whereas his left foot was warm and had a positive pedal pulse. 39. Importantly, it was noted that the Ace bandage was on loosely but that Mr. Morrison's right toes remained dusky. 40. At 9:35 p.m., Mr. Morrison was medicated for pain with another Morphine shot. 41. At 10:15 p.m. on 1/24/05, it was noted that Mr. Morrison dangled, stood and might have more feeling in his right foot. 42. However, it was noted that Mr. Morrison's pulse remained decreased and his right foot was pale, and his toes were slightly dusky. 43. Mr. Morrison's dressing was removed down to the 4x4 and re-dressed loosely, and he was encouraged to do frequent ankle pumps. 44. At 11:15 p.m. on 1/24/05, it was noted that Defendant Boran was in to see Mr. Morrison and examined his right leg and foot and that no new orders were given. 45. The nurse noted that Mr. Morrison's pedal pulse was decreased, his toes were cool and dusky, and that he had some tingling in his toes. 46. At 3:50 a.m. on 1/25/05, the nursing documentation form reflects that Mr. Morrison had a positive but decreased right pedal pulse and that Mr. Morrison stated that he had both numbness and tingling in his right great toe and that his right foot was warm to the touch but his toes were still cool. 7 47. It also appears that at 3:50 a.m., Mr. Morrison received another dose of Percocet (Oxycodone APAP) for pain. 48. At 6:00 a.m. on 1/25/05, the nurse noted that Mr. Morrison stood at the side of his bed with a walker and was still complaining of numbness in his great toe. 49. At 7:15 a.m. on 1/25/05, Mr. Morrison was still noted to have diminished pedal pulse. 50. At 8:10 a.m., Mr. Morrison was medicated for pain again with Percocet (Oxycodone APAP). 51. At 9:45 a.m. on 1/25/05, it was noted that Defendant Boran was notified and aware of the numbness in Mr. Morrison's right foot. 52. At 10:00 p.m., Mr. Morrison was given a shot of Morphine for pain. 53. At 10:30 a.m. on 1/25/05, the CPM machine was started at 30° on Mr. Morrison's right leg. 54. At 12:30 p.m. on 1/25/05, Mr. Morrison was also administered another dose of the pain medication Percocet (Oxycodone APAP) and the nurse noted that Mr. Morrison had less numbness in his right foot. 55. At 4:30 p.m. on 1/25/05, the nurse noted that Mr. Morrison was still complaining of slight tingling and decreased sensation in his right foot. 56. At 5:00 p.m., Mr. Morrison was medicated again for pain with Percocet (Oxycodone APAP) 57. At 6:00 p.m. on 1/25/05, Mr. Morrison received a second dose of Coumadin 10 mg, based on an INR of 1.0. 58. At 8:50 p.m. on 1/25/05, the nurse noted decreased sensation and decreased dorsi-flexion noted in Mr. Morrison's right foot, and that his right foot was still cool to the touch. 59. At 10:10 p.m., Mr. Morrison was medicated again for pain with Percocet (Oxycodone APAP). 60. At 10:50 p.m., Mr. Morrison was given another shot of Morphine for pain. 8 61. At 12:30 a.m. on 1/26/05, the night nurse noted that Mr. Morrison had pain right shin down to foot, that his toes remained cool to the touch, and that he had diminished right pedal pulse and decreased dorsi-flexion of the right foot. 62. It was also recorded that Mr. Morrison's tingling persisted and that edema was present in his right leg and foot. 63. At 7:45 a.m. on 1/26/05, the day nurse noted that Mr. Morrison's right dorsalis pedis and posterior tibial pulses were very diminishing as compared to the left pulses. 64. Additionally, it was noted that Mr. Morrison's right foot was cool and pale and that he was complaining of soreness in his right lateral calf, but denied tenderness to the right posterior calf. 65. Mr. Morrison reported that it felt like his right foot was "falling asleep." His right toe remained numb along the medial side back to the heel. 66. At 8:00 a.m., Mr. Morrison was given another dose of Percocet (Oxycodone APAP) for the pain. 67. At 9:45 a.m. on 1/26/05, the records reflect that Defendant Boran was called and updated on Mr. Morrison's condition by the nurse. 68. At 11:20 p.m., Mr. Morrison received another shot of Morphine for the pain. 69. At 12:40 p.m. on 1/26/05, Mr. Morrison was seen by Defendant Boran and by vascular surgeon, Dr. Campbell. 70. At 2:00 p.m., Mr. Morrison was given another dose of Percocet (Oxycodone APAP) for the pain. 71. At 3:35 p.m. on 1/26/05, the nurses noted that Mr. Morrison was NPO and awaiting an arteriogram. 72. According to the nursing documentation form, at 4:30 p.m. on 1/26/05, a STAT prothrombin time was drawn and approximately two (2) hours later, at 6:00p.m., Mr. Morrison was sent to radiology for the arteriogram. 9 73. Dr. Campbell's impression from the arteriogram of Mr. Morrison's right lower extremity was popliteal artery occlusion, probably due to thrombosis, with reconstitution of the posterior tibial vessel. 74. Mr. Morrison's coagulation studies were as follows on 1/26/05: PT was 18.1 (high), and his INR was reported high at 1.7. 75. Subsequently, a STAT blood draw at 4:25 p.m. on 1/26/05 produced results of a PT of 14.0 (high) and an INR of 1.3 (high). 76. Thereafter, Mr. Morrison was taken to the operating room at 7:50 p.m. on 1/26/05, and a right popliteal thrombectomy, with repair of right superficial artery and right distal medial and lateral fasciotomies consisting of four-compartment fasciotomies of the right lower leg were performed by Dr. Campbell. 77. At the time of the surgery on 1/26/05, Dr. Campbell noted in his operative report that the lateral and anterior compartments appeared to be very tense, necessitating four-compartment fasciotomies. 78. When the anterior compartment was opened, there appeared to be ischemic muscle that would not contract with stimulation with the Bove. 79. Since the four-compartment fasciotomy of Mr. Morrison's right lower leg on 1/26/05, Mr. Morrison has undergone multiple plastic surgery procedures to improve the appearance of his right lower extremity. 80. Mr. Morrison still has swelling in his right lower extremity and continues to have numb toes and decreased movement in his right lower extremity. 81. Plaintiffs aver that the classic signs of poor arterial blood flow are referred to as the five "Ps" and Mr. Morrison demonstrated all five (5) of them. 10 82. Mr. Morrison demonstrated (1) pain, (2) pulselessness, (3) pallor, (4) paresthesias and (5) polar. 83. The presence of all of these five (5) signs of ischemia should have prompted Defendant Boran to more active intervention as soon as such signs were noted, but unfortunately none was accomplished by Defendant Boran until approximately 48 hours after the symptoms began post-operatively. 84. Plaintiffs further aver that extremities subjected to poor arterial blood flood (ischemia) become more irretrievably damaged the longer it takes to restore circulation. 85. Nerve tissue is particularly vulnerable to ischemia. 86. If a patient's nerves are deprived of blood flow for longer than six (6) hours, there is significant chance of permanent damage and loss of either sensory or motor function. 87. Plaintiffs aver that the delay in diagnosis of ischemia in Mr. Morrison's right lower extremity significantly increased the damage to the nerves of his right leg. 88. The residual neurological impairment Mr. Morrison has suffered, would have been lessened or entirely avoided had revascularization of his right leg been done within a few hours instead of two (2) days later. 89. Furthermore, Plaintiffs aver that the delay in intervention also created the need for Mr. Morrison to undergo fasciotomies. 90. If a patient's leg is revascularized within the time frame mentioned (six hours or so), there is rarely a need for fasciotomies. 91. Because, in this case, the ischemia had gone on for so long, the fasciotomies were necessitated to prevent the occurrence of compartment syndrome (damage to nerves and muscles as the blood flow is restored and the muscles swell uncontrollably inside the non-elastic fascial covering). 92. Plaintiffs aver that fasciotomies are an additional component of morbidity in that Mr. Morrison now 11 has suffered large gaping wounds and scarring to his right lower extremity, which have required multiple plastic surgical procedures and skin grafts to close. Such wounds have caused significant disfigurement to Mr. Morrison's right lower extremity. 93. As a direct and proximate result of Defendants' negligence, as specified herein, Mr. Morrison was placed at an increased risk of harm due to the ischemia, including tissue and muscle damage, nerve injury, extensive surgery and prolonged hospitalization, and a claim is made therefor. 94. As a direct and proximate result of Defendants' negligence as stated herein, a significant delay occurred in diagnosing and treating Mr. Morrison's ischemia/thrombosis in his right lower extremity, and a claim is made therefor. 95. The injuries suffered by Plaintiffs are a direct and proximate result of the negligence as stated specifically herein of Defendants, Robert P. Boran, Jr., M.D., and Appalachian Orthopedic Center, Ltd.. 96. The substandard care of Defendants and their health care/clerical agents, apparent agents, servants, and/or employees who were involved with the care of Mr. Morrison and/or had contact with him during the relevant times of his admission, in particular, 1/24/05 thru 1/26/05, as specified above, increased the risk of harm to Plaintiffs. 97. Defendants are jointly and severally liable for the injuries and damages set forth herein. 98. As a direct and proximate result of Defendants' negligence as stated herein, Mr. Morrison endured extreme pain and suffering and claim is made therefor. 99. As a direct and proximate result of Defendants' negligence as stated herein, Mr. Morrison continues to have decreased movement, numbness and swelling in his right lower extremity, and a claim is made therefor. 12 100. As a direct and proximate result of Defendants' negligence as stated herein, Mr. Morrison is no longer able to stand for any length of time without developing swelling and pain in his right lower extremity. 101. As a direct and proximate result of Defendants' negligence as stated herein, Mr. Morrison endured hospitalization, transfusions, multiple surgical procedures, and months of intensive dressing changes and medication therapies related to the delay in diagnosing the ischemia/thrombus in his right lower extremity, and a claim is made therefor. 102. As a direct and proximate result of Defendants' negligence as stated herein, Plaintiffs have incurred and in may in the future incur medical bills and expenses and a claim is made therefor. 103. As a direct and proximate result of Defendants' negligence as stated herein, Plaintiffs have suffered and will in the future suffer lost wages, and decreased earning capacity, and a claim is made therefor. 104. As a direct and proximate result of Defendants' negligence as stated herein, Mr. Morrison has undergone and in the future will undergo great physical and mental pain and suffering, great inconvenience in carrying out his daily activities, and loss of life's pleasures and enjoyment, and a claim is made therefor. 105. As a direct and proximate result of Defendants' negligence as stated herein, Mr. Morrison has sustained extensive scarring and disfigurement to his right lower extremity and a claim is made therefor. 106. As a direct and proximate result of Defendants' negligence as stated herein, Mr. Morrison has been and in the future will be subjected to great humiliation and embarrassment and claim is made therefor. 13 107. As a direct and proximate result of Defendants' negligence as stated herein, Mr. Morrison will continue to have medical problems due to the swelling, numbness and decreased movement in his right lower extremity, which may require future medical treatment and a claim is made therefor. 108. As a direct and proximate result of Defendants' negligence as stated herein, Mr. Morrison's wife, Sharon A. Morrison, has suffered the loss of companionship, society and comfort of her husband, Donald Morrison, in the past and will suffer same in the future, and a claim is made therefor. COUNTI Donald L. Morrison and Sharon A. Morrison, his wife vs. Robert P. Boran, Jr., M.D. 109. Paragraphs one through one hundred eight of this Complaint are incorporated herein by reference as if set forth at length. 110. During the above-referenced dates of Mr. Morrison's admission to Carlisle Regional Medical Center, Defendant Boran was acting as an agent, apparent agent, member, servant, partner, and/or employee of Defendant Appalachian Orthopedic Center, Ltd. 111. As a direct and proximate result of his negligence as set forth below, Defendant Boran is liable to Plaintiffs for the injuries and damages alleged herein. 112. Plaintiffs' injuries and damages were directly and proximately caused by Defendant Boran's negligence in: a. failing to timely diagnose ischemia in Mr. Morrison's right lower extremity; b. failing to timely diagnose thrombus (blood clot) in Mr. Morrison's right lower extremity; c. failing to timely perform the necessary diagnostic tests to rule in or rule out ischemia and occlusion by thrombus in Mr. Morrison's right lower extremity; 14 d. failing to timely order or recommend the performance of an arteriorgram/angiogram of Mr. Morrison's right lower extremity; e. failing to timely order a vascular consult on Mr. Morrison; f. failing to timely perform laboratory studies to rule in or rule out the presence of a thrombus/ischemia in Mr. Morrison; g. failing to treat the ischemia/thrombus in Mr. Morrison's right lower extremity until after Mr. Morrison suffered from the symptoms for two (2) days; h. failing the limit the severity of Mr. Morrison's ischemic process in his right lower extremity; i. failing to properly maintain complete and accurate records for Mr. Morrison during the relevant times of his admission; j. failing to make Mr. Morrison aware of the potential harm he could suffer from having an undiagnosed and untreated thrombus in his right lower extremity; k. reassuring Mr. Morrison that the problems in his right lower extremity were due to normal post-operative findings and not due to an ischemic/thrombotic process; 1. failing to properly follow-up with Mr. Morrison regarding his post-operative right lower extremity complaints and signs of ischemia; in. failing to properly follow-up on the concerns of the Carlisle Regional Medical Center's nursing staff regarding Mr. Morrison's post-operative right lower extremity signs and symptoms of ischemia; n. delaying the diagnosis of the thrombus in Mr. Morrison's right lower extremity, which increased the risk that he would suffer significant ischemia and necessitate the need for fasciotomies, thrombectomy, and plastic surgery procedures; 15 o. allowing the thrombotic process in Mr. Morrison's right lower extremity to progress to complete occlusion; p. failing to appreciate the significance of Mr. Morrison's post-operative signs of ischemia, as reported by the Carlisle Regional Medical Center's nurses; and q. failing to make any effort to look for the cause of Mr. Morrison's poor arterial blood flow in his right lower extremity, in particular the five "Ps" - pain, pulselessness, pallor, paresthesia and polar. 113. As a direct and proximate result of the negligence of Defendant Boran as stated herein, Plaintiffs have sustained injuries and damages, as set forth in the paragraphs above, which are incorporated herein by reference as if set forth at length, and a claim is made therefor. WHEREFORE, Plaintiffs, Donald L. Morrison and Sharon A. Morrison, his wife, demand judgment against Defendant Robert P. Boran, Jr., M.D., for compensatory damages in an amount in excess of Fifty Thousand ($50,000.00) Dollars exclusive of interests, costs, and in excess of any jurisdictional amount requiring compulsory arbitration. COUNT II Donald L. Morrison and Sharon A. Morrison, his wife, vs. Appalachian Orthopedic Center, Ltd. 114. Paragraphs one through one hundred eight and Count I of this Complaint are incorporated herein by reference as if set forth at length. 115. At all relevant times herein, Defendant Appalachian Orthopedic and its health care providers and clerical staff to include Defendant Boran who were involved in Mr. Morrison's orthopedic care during his Carlisle Regional Medical Center admission of 1/24/05 through 2/2/05, in particular, on 16 the dates of 1/24/05 through 1/26/05, were acting as agents, apparent agents, servants and/or employees of Defendant Appalachian Orthopedic. 116. Plaintiffs reasonably relied upon the staff of Defendant Appalachian Orthopedic, to include Defendant Boran and all such other health care/clerical agents, apparent agents, servants and/or employees of Defendant Appalachian Orthopedic who were involved in Mr. Morrison's orthopedic care from 1/24/05 through 1/26/05 and their apparent expertise, apparent competence, diagnostic abilities, interpretations, conclusions, treatment decisions, knowledge of anatomy and physiology and authority in ruling out ischemia/thrombosis in Mr. Morrison's right lower extremity. 117. Defendant Appalachian Orthopedic is vicariously liable for the acts and/or omissions of Defendant Boran and all such other health care/clerical agents, apparent agents, servants, and/or employees of Defendant Appalachian Orthopedic who were involved in Mr. Morrison's orthopedic care from 1/24/05 through 1/26/05. 118. At all relevant times herein, Defendant Appalachian Orthopedic had a duty and right to exercise control, authority, and supervision over all of the staff at Defendant Appalachian Orthopedic to include Defendant Boran and all such other health care/clerical agents, apparent agents, servants, and/or employees of Defendant Appalachian Orthopedic who were involved in Mr. Morrison's orthopedic care from 1/24/05 through 1/26/05. 119. Defendant Appalachian Orthopedic, through the negligence of Defendant Boran and also such other healthcare/clerical agents, apparent agents, servants, and/or employees of Defendant Appalachian Orthopedic who were involved in Mr. Morrison's orthopedic care at Carlisle Regional Medical Center from 1/24/05 through 1/26/05, is liable to Plaintiffs for injuries and damages proximately caused by the negligence of its agents/employees in: 17 a. failing to timely diagnose ischemia in Mr. Morrison's right lower extremity; b. failing to timely diagnose thrombus (blood clot) in Mr. Morrison's right lower extremity; c. failing to timely perform the necessary diagnostic tests to rule in or rule out ischemia and occlusion by thrombus in Mr. Morrison's right lower extremity; d. failing to timely order or recommend the performance of an arteriorgram/angiogram of Mr. Morrison's right lower extremity; e. failing to timely order a vascular consult on Mr. Morrison; f. failing to timely perform laboratory studies to rule in or rule out the presence of a thrombus/ischemia in Mr. Morrison; g. failing to treat the ischemia/thrombus in Mr. Morrison's right lower extremity until after Mr. Morrison suffered from the symptoms for two (2) days; h. failing the limit the severity of Mr. Morrison's ischemic process in his right lower extremity; i. failing to properly maintain complete and accurate records for Mr. Morrison during the relevant times of his admission; j. failing to make Mr. Morrison aware of the potential harm he could suffer from having an undiagnosed and untreated thrombus in his right lower extremity; k. reassuring Mr. Morrison that the problems in his right lower extremity were due to normal post-operative findings and not due to an ischemic/thrombotic process; 1. failing to properly follow-up with Mr. Morrison regarding his post-operative right lower extremity complaints and signs of ischemia; m. failing to properly follow-up on the concerns of the Carlisle Regional Medical Center's nursing staff regarding Mr. Morrison's post-operative right lower extremity signs and 18 symptoms of ischemia; n. delaying the diagnosis of the thrombosis in Mr. Morrison's right lower extremity, which increased the risk that he would suffer significant ischemia and necessitate the need for fasciotomies, thrombectomy, and plastic surgery procedures; o. allowing the thrombotic process in Mr. Morrison's right lower extremity to progress to complete occlusion; p. failing to appreciate the significance of Mr. Morrison's post-operative signs of ischemia, as reported by the Carlisle Regional Medical Center's nurses; and q. failing to make any effort to look for the cause of Mr. Morrison's poor arterial blood flow in his right lower extremity, in particular the five "Ps" - pain, pulselessness, pallor, paresthesia and polar. 120. As a direct and proximate result of the negligence of Defendant Appalachian Orthopedic, as stated herein, Plaintiffs have sustained injuries and damages, as set forth in the paragraphs above, which are incorporated herein by reference as if set forth at length, and a claim is made therefor. WHEREFORE, Plaintiffs Donald L. Morrison and Sharon A. Morrison, his wife, demand judgment against Defendant Appalachian Orthopedic Center, Ltd., for compensatory damages in an amount in excess of Fifty Thousand ($50,000.00) Dollars exclusive of interests and costs, and in excess of any jurisdictional amount requiring compulsory arbitration. COUNT III Sharon A. Morrison, his wife, vs. Robert P. Boran, Jr., M.D., and Appalachian Orthopedic Center, Ltd. 19 121. Paragraphs one through one hundred eight and Counts I-II of this Complaint are incorporated herein by reference as if set forth at length. 122. Plaintiff Sharon A. Morrison is the wife of Donald L. Morrison. 123. As a direct and proximate result of the negligence as stated herein of the Defendants and the injuries caused thereby to her husband, Donald L. Morrison, Sharon A. Morrison has suffered the loss of her husband's society, comfort, services, consortium and companionship and will so in the future, and a claim is made therefor. 124. All Defendants are jointly and severally liable to Sharon A. Morrison for the injuries and damages set forth herein. WHEREFORE, Plaintiff Sharon A. Morrison, the wife of Donald L. Morrison, demands judgment against Defendants Robert P. Boran, Jr., M.D. and Appalachian Orthopedic Center, Ltd. for compensatory damages in an amount in excess of Fifty Thousand ($50,000.00) Dollars exclusive of interest s and costs and in excess of any jurisdictional amount requiring compulsory arbitration. Respectfully submitted, NAVITSKY, OLSON & WISNESKI LLP D ane S. Barrick, Esquire I.D. No. 77400 Michael J. Navitsky, Esquire I.D. No. 58803 2040 Linglestown Road, Suite 303 Harrisburg, PA 17110 717/541-9205 Counsel for Plaintiffs Date: 21-2916 7 20 VERIFICATION I, Donald L. Morrison, verify that the facts set forth in the foregoing Complaint are true and correct to the best of my knowledge, information, and belief. I understand that this Verification is made subject to the provisions of 18 Pa. C.S.A. §4904, relating to unsworn falsification to authorities. WITNESS Donald L. Morrison VERIFICATION I, Sharon A. Morrison, verify that the facts set forth in the foregoing Complaint are true and correct to the best of my knowledge, information, and belief. I understand that this Verification is made subject to the provisions of 18 Pa. C.S.A. §4904, relating to unsworn falsification to authorities. WITNESS Sharon A. Morrison CERTIFICATE OF SERVICE I, Jessie K. Walsh, an employee of the law firm of Navitsky, Olson & Wisneski LLP, do hereby certify that I am this 29th day of March, 2007 serving a true and correct copy of Plaintiffs' Complaint upon all counsel of record via postage prepaid first class United States mail addressed as follows: John F. McGreevey, Esquire Kilcoyne & Nesbitt, LLC Plymouth Meeting Executive Campus 630 West Germantown Pike, Suite 121 Plymouth Meeting, PA 19462 Counsel for Defendant Boran Dean F. Piermattei, Esquire Rhoads & Sinon, LLP M&T Bank Building -12th Floor One South Market Square P.O. Box 1146 Harrisburg, PA 17108-1146 Counsel for Defendant Appalachian Jessie K. Walsh 21 4_ 9 C- v • I Vl., 4, V ? 1.,, %l L:,ail a?i JO DONALD L. MORRISON, and SHARON A. MORRISON, his wife, Plaintiffs, VS. ROBERT P. BORAN, JR., M.D., and APPALACHIAN ORTHOPEDIC CENTER, LTD.,: Defendants IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. NO. 2007-00187 CIVIL ACTION MEDICAL PROFESSIONAL LIABILITY JURY TRIAL DEMANDED OR& 40 Y CERTIFICATE OF MERIT AS TO DEFENDANT APPALACHIAN ORTHOPEDIC CENTER. LTD. I, Duane S. Barrick, Esquire, 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, 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; AND/OR the claim that this defendant deviated from an acceptable professional standard is based solely on allegations that other licensed professionals for whom this defendant is responsible deviated from an acceptable professional standard and an appropriate licensed professional has supplied a written statement to the undersigned that there is a basis to conclude that the care, skill or knowledge exercised or exhibited by the other licensed professionals in the treatment, practice or work that is the subject of the complaint, fell outside acceptable professional standards and that such conduct was a cause in bringing about the harm; OR ? expert testimony of an appropriate licensed professional is unnecessary for prosecution of the claim against this defendant. Date: 31 L 9107 Respectfully submitted, NAVITSKY, OLSON & WISNESKI LLP 6 2 Duane S. Barrick, Esquire I.D. No. 77400 Michael J. Navitsky, Esquire I.D. No. 58803 2040 Linglestown Road, Suite 303 Harrisburg, PA 17110 717/541-9205 Counsel for Plaintiffs CERTIFICATE OF SERVICE I, Jessie K. Walsh, an employee of the law firm of Navitsky, Olson & Wisneski LLP, do hereby certify that I am this 29th day of March, 2007 serving a true and correct copy of Certificates of Merit upon all counsel of record via postage prepaid first class United States mail addressed as follows: John F. McGreevey, Esquire Kilcoyne & Nesbitt, LLC Plymouth Meeting Executive Campus 630 West Germantown Pike, Suite 121 Plymouth Meeting, PA 19462 Counsel for Defendant Boran Dean F. Piermattei, Esquire Rhoads & Sinon, LLP M&T Bank Building -12th Floor One South Market Square P.O. Box 1146 Harrisburg, PA 17108-1146 Counsel for Defendant Appalachian ?s e Jessie K. Walsh 0C :1 ild 6Z ?- °Y L 0 0 Z :. r DONALD L. MORRISON, and IN THE COURT OF COMMON PLEAS SHARON A. MORRISON, his wife, CUMBERLAND COUNTY, PENNA Plaintiffs, NO. 2007-00187 vs. CIVIL ACTION MEDICAL PROFESSIONAL LIABILITY ROBERT P. BORAN, JR., M.D., and APPALACHIAN ORTHOPEDIC CENTER, LTD.,: JURY TRIAL DEMANDED Defendants " CERTIFICATE OF MERIT AS TO DEFENDANT ROBERT P. BORAN, JR., M.D. I, Duane S. Barrick, Esquire, 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, 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; AND/OR ? the claim that this defendant deviated from an acceptable professional standard is based solely on allegations that other licensed professionals for whom this defendant is responsible deviated from an acceptable professional standard and an appropriate licensed professional has supplied a written statement to the undersigned that there is a basis to conclude that the care, skill or knowledge exercised or exhibited by the other licensed professionals in the treatment, practice or work that is the subject of the complaint, fell outside acceptable professional standards and that such conduct was a cause in bringing about the harm; OR ? expert testimony of an appropriate licensed professional is unnecessary for prosecution of the claim against this defendant. Respectfully submitted, NAVITSKY, OLSON & WISNESKI LLP Duane S. Barrick, Esquire I.D. No. 77400 Michael J. Navitsky, Esquire I.D. No. 58803 2040 Linglestown Road, Suite 303 Harrisburg, PA 17110 717/541-9205 Counsel for Plaintiffs Date: ? /7- qU 7 ?!-'y} x? r%.iR? ?? ?? . ? ? ? ._ ??? ? l kr?d 6Z ??? l??-?i J"1_??"` KILCOYNE & NESBITT, LLC BY: JOHN F. McGREEVEY ATTY. ID. #64610 630 W. GERMANTOWN PIKE, SUITE 121 PLYMOUTH MEETING, PA 19462 610.825.2833 DONALD L. MORRISON and SHARON A. MORRISON, his wife, Plaintiffs V. : ROBERT B. BORAN, JR., M.D. and APPALACHIAN ORTHOPEDIC CENTER, LTD.,: Defendants ATTORNEY FOR DEFENDANT, ROBERT P. BORAN, JR., M.D. COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA No. 07-187 Civil Term JURY TRIAL DEMANDED CERTIFICATE OF SERVICE I, John F. McGreevey, Esquire, hereby certify that a true and correct copy of the Certificate of Service relative to the above matter was forwarded by first-class mail, postage prepaid to the following: Michael J. Navitsky, Esquire Navitsky, Olson & Wisneski, LLP 2040 Linglestown Road, Suite 303 Harrisburg, PA 17110 Appalachian Orthopedic Center, Ltd. Attention: Practice Manager 1 Dunwood Drive Carlisle, PA 171015 (,14, F7&,9,,, O F. McGREEVEY, ESQUIRE DATED: March 27, 2007 ? ? ? -3 ,? r' ?'`? ?; s, r/3 u? r?C..? ?" mS"ii ?-' ? C- ? ? ?t ? L;" , Dean F. Piermattei, Esquire Attorney I.D. No. 53847 Vincent L. Champion Attorney I.D. No. 88411 RHOADS & SINON LLP One South Market Square, 12th Floor P.O. Box 1146 Harrisburg, PA 17108-1146 (717) 233-5731 Attorneys for Defendant DONALD L. MORRISON AND SHARON A. MORRISON, his wife IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA V. ROBERT B. BORAN, JR., M.D. and APPALACHIAN ORTHOPEDIC CENTER, LTD. NO. 07-187 CIVIL TERM JURY TRIAL DEMANDED PETITION FOR COURT TO APPROVE STIPULATION OF DISMISSAL AND TO ENTER DISCONTINUANCE AS TO APPALACHIAN ORTHOPEDIC CENTER, LTD. NOW COMES, Appalachian Orthopedic Center, Ltd. ("Appalachian"), by and through its attorneys, Rhoads & Sinon LLP and files the within Petition for Court to Approve Stipulation of Dismissal and to Enter Discontinuance as to Appalachian Orthopedic Center, Ltd. as follows: 1. On January 10, 2007 Plaintiffs, Donald L. Morrison and Sharon A. Morrison (the "Plaintiffs") instituted this action by filing a Praecipe for Writ of Summons in the Court of Common Pleas for Cumberland County, Pennsylvania. 2. Accordingly, a Writ of Summons was issued and served upon Defendants Robert B. Boran, Jr., M.D. and Appalachian Orthopedic Center, Ltd. in their capacity as party defendants. 651768.1 3. On or about February 23, 2007, Defendant Robert B. Boran, Jr., M.D. filed a Praecipe to File a Complaint in the Court of Common Pleas for Cumberland County, Pennsylvania. 4. On March 29, 2007 the Plaintiffs filed their Complaint against the Defendants. 5. After filing the Complaint, Appalachian contacted the Plaintiffs to ascertain whether they would be willing to voluntarily discontinue this matter as to Appalachian. 6. The Plaintiffs indicated that they would discontinue this matter as to Appalachian once they confirmed that Dr. Boran had insurance coverage for the time period implicated in this suit. 7. Additionally, Appalachian was not involved in the relevant events alleged to have occurred giving rise to the claim. 8. On or about April 3, 2007, Duane S. Barrick, counsel for the Plaintiffs, was provided with confirmation that Dr. Boran was insured during the relevant time period. 9. Consequently, the Plaintiffs and Dr. Boran executed Stipulations dismissing Appalachian with prejudice from this action. The Stipulations of Dismissal are attached hereto as Exhibits "A" and "B," respectively. 10. Pursuant to Rule 229(b)(1) of the Pennsylvania Rules of Civil Procedure, a discontinuance may not be entered as to less than all Defendants except upon the written consent of all parties and leave of Court after notice to all parties. Pa.R.Civ.P. No. 229(b)(1). 11. In light of the signed Stipulations, Appalachian now files the within Petition to have the Stipulation of Dismissal approved and a discontinuance entered as to Appalachian. WHEREFORE, Appalachian Orthopedic Center, Ltd. respectfully requests that this Court (i) approve the Stipulation of Dismissal; and (ii) enter an order discontinuing with prejudice this action against Appalachian Orthopedic Center, Ltd. Respectfully submitted, BROADS & SINON LLP By: '?/- Dean F. Piermattei Vincent L. Champion One South Market Square P. O. Box 1146 Harrisburg, PA 17108-1146 (717) 233-5731 Attorneys for Appalachian Orthopedic Center, Ltd. EXHIBIT "A" Dean F. Piermattei, Esquire Attorney I.D, No. 53847 RHOADS & SINON L.L•P One South Market Square, 12th Floor P.O. Box 1146 Harrisburg, PA 17108-1146 (717) 233-5731 Attorneys for Defendant DONALD L. MORRISON AND SHARON A. MORRISON, his wife v. ROBERT B. BORAN, JR., M.D. and APPALACHIAN ORTHOPEDIC CENTER, LTD. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA NO. N0.07-187 CIVIL TERM JURY TRIAL DEMANDED STIPULATION AND NOW COMES, the parties through their undersigned counsel and hereby stipulate to the dismissal of this action with prejudice as it relates to Appalachian Orthopedic Center, Ltd.. However, the action against Robert B. Boran, Jr., M.D. will continue. This Stipulation may be executed in one or more counterparts, each of which shall be deemed an original and all of which taken together shall constitute one and the same Stipulation. NAVITSKY, OLSON & WISNESKI, LLP By _ Duane Barrick, Esq. on behalf of Donald L. Morrison and Sharon A. Morrison, h/w KILCOYNE & NESBITT, LLC By: John F. McGreevey, Esq. on behalf of Robert B. Boran, Jr., M.D. Date: SI -q ? Date: 649383 1 RHOADS & SINON LLP By: Dean F. Piermattei, Esq., on behalf of Appalachian Orthopedic Center, Ltd. Date: EXHIBIT "B" Dean F. Piennattei, Esquire Attorney I.D. No. 53847 RHOADS & SINON UP One South Market Square, 12th Floor P.O. Box 1146 Harrisburg, PA 17108-1146 (717) 233-5731 Attorneys for Defendant DONALD L. MORRISON AND SHARON A. MORRISON, his wife v. ROBERT B. BORAN, JR., M.D. and APPALACHIAN ORTHOPEDIC CENTER, LTD. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA NO. NO. 07-187 CIVIL TERM JURY TRIAL DEMANDED STIPULATION AND NOW COMES, the parties through their undersigned counsel and hereby stipulate to the dismissal of this action with prejudice as it relates to Appalachian Orthopedic Center, Ltd. However, the action against Robert B. Baran, Jr., M.D. will continue. This Stipulation may be executed in one or more counterparts, each of which shall be deemed an original and all of which taken together shall constitute one and the same Stipulation. NAVITSKY, OLSON & WISNESKI, LLP By: Duane Barrick, Esq. on behalf of Donald L. Morrison and Sharon A. Morrison, h/w KILCOYNE & NESBITT, LLC B John F. cGreevey, Esq. on ehalf of Robert B. Boran, Jr., M.D. Date: Date: , ELI s?a 7 649383 1 RHOADS & SINON LLP B• Piermattei, Esq., on behalf of Appalachian Orthopedic Center, Ltd. Date: S- - Z-3-0-7 CERTIFICATE OF SERVICE I hereby certify that on this 7th day of June, 2007, a true and correct copy of the foregoing Petition for Court to Approve Stipulation of Dismissal and to Enter Discontinuance as to Appalachian Orthopedic Center, Ltd. was served by means of United States mail, first class, postage prepaid, upon the following: Duane S. Barrick, Esquire Navitsky Olson and Wisneski LLP 2004 Linglestown Road Suite 303 Harrisburg, PA 17110 John F. McGreevey, Esquire Kilcoine and Nesbitt LLC Plymouth Meeting Executive Campus 630 West Germantown Pike, Suite 121 Plymouth Meeting, PA 19462 ` -tt ? ? l ? -' C . ?:: wr, :::, F 1 - ?? ;t' ?' . . y ? ,?? ' , ' ? ...- ? ._ ? JUN 0 8 2007'0 DONALD L. MORRISON AND SHARON A. MORRISON, his wife v. ROBERT B. BORAN, JR., M.D. and APPALACHIAN ORTHOPEDIC CENTER, LTD. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA NO. 07-187 CIVIL TERM JURY TRIAL DEMANDED ORDER AND NOW, this day of :1 LA -t? L* , 2007, upon consideration of the foregoing Petition for Court to Approve Stipulation of Dismissal and to Enter Discontinuance as to Appalachian Orthopedic Center, Ltd., it is HEREBY ORDERED, the Stipulation of Dismissal as to Appalachian Orthopedic Center, Ltd. is APPROVED; and This matter is DISCONTINUED with PREJUDICE as to Appalachian Orthopedic Center, Ltd. BY THE COURT: J. C?s Lt-.J Cl- -• Q f`?-+ .?? mod. C? f-,..1 CV f KILCOYNE & NESBITT, LLC BY: JOHN F. McGREEVEY ATTY. ID. 464610 ATTORNEY FOR DEFENDANT, ROBERT P. BORAN, JR., M.D. 630 W. GERMANTOWN PIKE, SUITE 121 PLYMOUTH MEETING, PA 19462 610.825.2833 DONALD L. MORRISON and SHARON A. MORRISON, his wife, Plaintiffs COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA No. 07-187 Civil Term V. ROBERT P. BORAN, JR., M.D. and APPALACHIAN ORTHOPEDIC CENTER, LTD.,: Defendants JURY TRIAL DEMANDED NOTICE TO PLEAD TO: Michael J. Navitsky, Esquire Duane S. Barrack, Esquire Navitsky, Olson & Wisneski, LLP 2040 Linglestown Road, Suite 303 Harrisburg, PA 17110 You are hereby notified to plead to the enclosed Answer and New Matter within twenty (20) days from service thereof or a default judgment may be entered against you. KILCOYNE & NESBITT, LLC if BY: JO F. MCGREEVE , ESQUIRE KILCOYNE & NESBITT, LLC ATTORNEY FOR DEFENDANT, BY: JOHN F. McGREEVEY ROBERT P. BORAN, JR., M.D. ATTY. ID. #64610 630 W. GERMANTOWN PIKE, SUITE 121 PLYMOUTH MEETING, PA 19462 610.825.2833 DONALD L. MORRISON and COURT OF COMMON PLEAS SHARON A. MORRISON, his wife, CUMBERLAND COUNTY, PA Plaintiffs No. 07-187 Civil Term V. ROBERT P. BORAN, JR., M.D. and APPALACHIAN ORTHOPEDIC CENTER, LTD.,: Defendants JURY TRIAL DEMANDED ANSWER WITH NEW MATTER OF DEFENDANT, ROBERT P. BORAN, JR., M.D., TO PLAINTIFFS' COMPLAINT Defendant, Robert P. Boran, Jr., M.D., by and through his attorneys, Kilcoyne & Nesbitt, LLC, hereby answers Plaintiffs' Complaint as follows: 1. Denied. After reasonable investigation, Answering Defendant is without sufficient knowledge or information to allow him to form a belief as to the truth of the averments in paragraph 1 of Plaintiffs' Complaint and, therefore, Defendant demands strict proof thereof at trial, if relevant. 2. Denied. After reasonable investigation, Answering Defendant is without sufficient knowledge or information to allow him to form a belief as to the truth of the averments in paragraph 2 of Plaintiffs' Complaint and, therefore, Defendant demands strict proof thereof at trial, if relevant. 3. Admitted. 4. Admitted. 5. Admitted in part. Denied in part. It is admitted that Answering Defendant, Robert P. Boran, Jr., M.D., was an employee of Defendant, Appalachian Orthopedic Center, Ltd., during the relevant times of this action. The remaining allegations are denied pursuant to PA. R.C.P. 1029(e). 6. The allegations contained in paragraph 6 do not apply to Answering Defendant. 7. The allegations contained in paragraph 7 do not apply to Answering Defendant. 8. Admitted in part. Denied in part. It is admitted that at all times relevant herein, Answering Defendant, Robert P. Boran, Jr., M.D., was an employee of Defendant, Appalachian Orthopedic Center, Ltd., and was acting within his scope of employment while treating Plaintiff, Donald L. Morrison. The remaining allegations are denied pursuant to PA. R.C.P. 1029(e). 9. Denied. After reasonable investigation, Answering Defendant is without sufficient knowledge or information to allow him to form a belief as to the truth of the averments in paragraph 9 of Plaintiffs' Complaint and, therefore, Defendant demands strict proof thereof at trial, if relevant. 10.408. Denied. Pursuant to Pennsylvania Rule of Civil Procedure 1029(e), no further response is required. WHEREFORE, Defendant, Robert P. Boran, Jr., M.D., demands judgment in his favor and against Plaintiffs together with attorneys' fees and costs. COUNTI Donald L. Morrison and Sharon A. Morrison, his wife, v. Robert P Boran, Jr., M.D. 109. Answering Defendant hereby incorporates paragraphs 1 through 108 inclusive as though fully set forth at length herein. 110. Admitted in part. Denied in part. It is admitted that at all times relevant to Mr. Morrison's admission to Carlisle Regional Medical Center, Defendant, Robert P. Boran, Jr., M.D., was an employee of Defendant, Appalachian Orthopedic Center, Ltd. The remaining allegations area denied pursuant to PA. R.C.P. 1029(e). 111.-113. Denied. Pursuant to Pennsylvania Rule of Civil Procedure 1029(e), no further response is required. WHEREFORE, Defendant, Robert P. Boran, Jr., M.D., demands judgment in his favor and against Plaintiffs together with attorneys' fees and costs. COUNT II Donald L Morrison and Sharon A Morrison v. Appalachian Orthopedic Center, Ltd. 114. Answering Defendant hereby incorporates paragraphs 1 through 1.13 inclusive as though fully set forth at length herein. 115. - 120. The allegations contained in paragraphs 115 through 120 do not apply to Answering Defendant. WHEREFORE, Defendant, Robert P. Boran, Jr., M.D., demands judgment in his favor and against Plaintiffs together with attorneys' fees and costs. COUNT III Sharon A. Morrison v. Robert P. Boran, Jr., M.D., and Appalachian Orthopedic Center, Ltd. 121. Answering Defendant hereby incorporates paragraphs 1 through 120 inclusive as though fully set forth at length herein. 122. - 124. Denied. Pursuant to Pennsylvania Rule of Civil Procedure 1029(e), no further response is required. WHEREFORE, Defendant, Robert P. Boran, Jr., M.D. demands judgment in his favor and against Plaintiffs together with attorneys' fees and costs. NEW MATTER 125. At all times material hereto, Answering Defendant's treatment of the Plaintiff was in accordance with accepted standards of medical care at the time and place of the treatment. 126. The Complaint, in whole or in part, fails to state a cause of action upon which relief can be granted. 127. Plaintiffs' claims are barred by operation of the applicable statute of limitations. 128. If Plaintiffs sustained the injuries alleged, which injuries are specifically denied, said injuries may have been the result of the negligent or careless acts and/or omissions of Plaintiff and/or other persons and/or entities over whom Answering Defendant exercised no control. 129. Plaintiffs' claims may be barred or the amounts recoverable therefrom reduced by operation of the Pennsylvania Comparative Negligence Act 42 Pa. C.S.A. Section 7102 et seq. 130. Plaintiffs' claims may be barred by the doctrine of assumption of risk. 131. Plaintiffs' claims may be barred by the doctrine of superseding and/or intervening cause. 132. Plaintiff gave a fully informed consent to the medical treatment rendered by Answering Defendant. 133. Plaintiffs' claims are subject to, and limited by, the Healthcare Services Malpractice Act of 1975, as amended. 134. Plaintiffs' claims are subject to, and limited by, the MCare Act of 2003. 135. If there is a judicial determination that Pa. R.C.P. 238 is unconstitutional, said constitutionality being expressly challenged as a violation of the due process and the equal protection clauses of the 140i Amendment of the United States Constitution; 42 U.S.C. Section 1983; Article I, Section 1, 6, 11, 26; and Article V, Section 10 (c) of the Pennsylvania Constitution, then payment of interest shall be suspended for any period of delay not occasioned by Answering Defendant. 136. Plaintiffs' claim is barred by the doctrine of release. WHEREFORE, Defendant, Robert P. Boran, Jr., M.D., demands judgment in his favor and against Plaintiffs together with attorneys' fees and costs. Respectfully submitted, KILCOYNE & NESBITT, LLC BY: F. McGREEVEY Attorney for Defendant, Robert P Bor , Jr., M.D. DATED: r/10 -7 VERIFICATION I, Robert P. Boran, Jr., M.D., make this verification subject to the penalties of 18 Pa. C.S.A. Section 4904 relating to unworn falsification to authorities. The attached Answer with New Matter to Plaintiffs' Complaint is based upon information which I have furnished to my counsel and information which has been gathered by counsel in preparation for the defense of this lawsuit. The language contained in the Answer to Plaintiffs' Complaint is that of my counsel and not of me. I have read the Answer to Plaintiffs' Complaint, and, to the extent that it is based upon information which I have given to my counsel, it is true and correct to the best of my knowledge, information and belief. To the extent that the contents of the Answer are that of counsel, I have relied upon my counsel in making this verification. ROBERT P. BORAN, JR., KILCOYNE & NESBITT, LLC BY: JOHN F. McGREEVEY ATTY. ID. #64610 ATTORNEY FOR DEFENDANT, ROBERT P. BORAN, JR., M.D. 630 W. GERMANTOWN PIKE, SUITE 121 PLYMOUTH MEETING, PA 19462 610.825.2833 DONALD L. MORRISON and SHARON A. MORRISON, his wife, Plaintiffs COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA No. 07-187 Civil Term V. ROBERT P. BORAN, JR., M.D. and APPALACHIAN ORTHOPEDIC CENTER, LTD.,: Defendants JURY TRIAL DEMANDED CERTIFICATE OF SERVICE I, John F. McGreevey, Esquire, hereby certify that a true and correct copy of the Answer with New Matter of Defendant, Robert P. Boran, Jr., M.D., to Plaintiffs' Complaint, was served upon all counsel of record via first class United States Mail, postage prepaid. Michael J. Navitsky, Esquire Duane S. Barrack, Esquire Navitsky, Olson & Wisneski, LLP 2040 Linglestown Road, Suite 303 Harrisburg, PA 17110 F. McGREEVEY, ESQUIRE A*? DATED: 9/D 7 N a4 " ?J y? ' C,1 J' ? .. ...E '% Co 'J DONALD L. MORRISON, and SHARON A. MORRISON, his wife, Plaintiffs, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA NO. 2007-00187 vs. ROBERT P. BORAN, JR., M.D., Defendant CIVIL ACTION MEDICAL PROFESSIONAL LIABILITY JURY TRIAL DEMANDED PLAINTIFFS' REPLY TO DFFENDANT'S NEW MATTER AND NOW, come the Plaintiffs, Donald L. Morrison and Sharon A. Morrison, his wife, by and through their attorneys, Navitsky, Olson & Wisneski LLP, to hereby enter the following Reply to New Matter of Defendant, Robert P. Boran, Jr., M.D., to Plaintiffs' Complaint: 125. This allegation states a conclusion of law to which no reply is necessary. By way of further response, it is specifically denied that answering Defendant's treatment of Plaintiff was in accordance with the acceptable standards of care at the time and place of the treatment. 126. This allegation states a conclusion of law to which no response is necessary. By way of further response, it is specifically denied that the Complaint, in whole or in part, fails to state a cause of action upon which relief can be granted. 127. This allegation states a conclusion of law to which no response is necessary. By way of further response, it is specifically denied that Plaintiffs' claims are barred by operation of the applicable statute of limitations. 128. This allegation states conclusions of law to which no responses are necessary. By way of further response, it is specifically denied that Plaintiffs' injuries were in any way caused by Plaintiffs, and/or other persons and/or entities over whom answering Defendant exercised no control. 129. This allegation states a conclusion of law to which no response is necessary. By way of further response, it is specifically denied that Plaintiffs' claims may be barred or the amounts recoverable therefrom reduced by operation of the Pennsylvania Comparative Negligence Act. 130. This allegation states a conclusion of law to which no response is necessary. By way of further response, it is specifically denied that Plaintiffs' claims may be barred by the Doctrine of Assumption of Risk. 131. This allegation states a conclusion of law to which no response is necessary. By way of further response, it is specifically denied that Plaintiffs' claims may be barred by the Doctrine of Superceding and/or Intervening Cause. 132. This allegation states a conclusion of law to which no response is necessary. By way of further response, it is specifically denied that informed consent is any defense to the negligence of Dr. Boran and the injuries caused thereby to Plaintiffs. 133. This allegation states a conclusion of law to which no response is necessary. By way of further response, it is specifically denied that Plaintiffs' claims are subject or in any way limited by the Health Care Services Malpractice Act of 1975. 134. This allegation states a conclusion of law to which no response is necessary. By way of further response, it is specifically denied that Plaintiffs' claims are in any way limited by the MCARE Act of (2003) 2002. 135. This allegation states conclusions of law to which no responses are necessary. By way of further response, it is specifically denied that Plaintiffs' claims or damages are barred or in any way limited by Pennsylvania Rule of Civil Procedure 238. 136. This allegation states a conclusion of law to which no response is necessary. By way of further response, it is specifically denied that Plaintiffs' claims are barred by the Doctrine of Release. WHEREFORE, Plaintiffs, Donald L. Morrison and Sharon A. Morrison, his wife, request that paragraphs 125-136 of Defendant's New Matter be stricken for failure to comply with Pennsylvania Rule of Civil Procedure 1030. Furthermore, Plaintiffs respectfully request this Honorable Court to dismiss Defendant's New Matter and that judgment be entered in favor of Plaintiffs. Respectfully submitted, NAVITSKY, OLSON & WISNESKI LLP Du S. Barrick, Esquire I.D. No. 77400 Michael J. Navitsky, Esquire I.D. No. 58803 2040 Linglestown Road, Suite 303 Harrisburg, PA 17110 717/541-9205 Counsel for Plaintiffs Date: COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS I, DUANE S. BARRICK, being duly sworn according to law, depose and say that I am counsel for Plaintiffs, Donald L. Morrison and Sharon A. Morrison, his wife, and I am authorized to make this affidavit on behalf of said Plaintiffs, and verify that the facts set forth in the foregoing Reply to New Matter are true and correct to the best of my knowledge, information and belief, or are true and correct based on the information obtained from Plaintiffs. S 60t? UANE S. BARRICK Sworn and subscribed before me this day of 52007. Notary Public Notarial Seal EALfi OF PEN12;8,?12009 Lois E. Stauffer, Notary, y of Wani:burp, Dauppn Llp Commission Expires Mar. CERTIFICATE OF SERVICE I, Jessie K. Walsh, an employee of the law firm of Navitsky, Olson & Wisneski LLP, do hereby certify that I am this )6" day of July, 2007 serving a true and correct copy of Plaintiffs' Reply to Defendant's New Matter upon all counsel of record via postage prepaid first class United States mail addressed as follows: John F. McGreevey, Esquire Kilcoyne & Nesbitt, LLC Plymouth Meeting Executive Campus 630 West Germantown Pike, Suite 121 Plymouth Meeting, PA 19462 Counsel for Defendant Boran r Jessie K. Walsh r? -n ? FT-, fa.) - f. (rl 3 (,J j ORIGINAL CERTIFICATE PREREQUISITE TO SERVICE OF A SUBPOENA PURSUANT TO RULE 4009.22 IN THE MATTER OF: MORRISON -VS- BORAN COURT OF COMMON PLEAS TERM, CUMBERLAND CASE NO: 07-187 As a prerequisite to service of a subpoena for documents and things pursuant to Rule 4009.22 MCS on behalf of JOHN MCGREEVEY, ES certifies that (1) A notice of intent to serve the subpoena with a copy of the subpoena attached thereto was mailed or delivered to each party at least twenty days prior to the date on which the subpoena is sought to be served, (2) A copy of the notice of intent, including the proposed subpoena, is attached to this certificate, (3) No objection to the subpoena has been received, and (4) The subpoena which will be served is identical to the subpoena which is attached to the notice of intent to serve the subpoena. DATE: 07/31/2007 on behalf of G torney for EFE ANT R1.35 133-H DE11-0701809 99210-LO1 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND MORRISON vs. BORAN File No. 07-187 SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: Custodian of Records for WILLIAM J PHELAN M.D. (Name of Person or Entity) Within twenty (20) days after service of this subpoena, you are ordered by the court to produce the following documents or things: **** SEE ATTACHED RIDER **** at The MCS Group, Inc- 1601 Market Street. Suite 800. Philadelphia- PA 19103 You may deliver or mail legible copies of the documents or produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek, in advance, the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days after its service, the party serving this subpoena may seek a court order compelling you to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: NAME: JOHN MCGREEVEY. ESO. ADDRESS: 630 WEST GERMANTOWN PIKE SUITE 121 PLYMOUTH MEETING. PA 19462 TELEPHONE: (215) 246-0900 SUPREME COURT ID #: ATTORNEY FOR: Defendant BY THE COURT: S Lie-Athonotary/Clerk, Civil vision Date: JUL 3 1 2007 Deputy "? 1007 Seal of the Court 99210-01 EXPLANATION OF REQUIRED RECORDS TO: CUSTODIAN OF RECORDS FOR: WILLIAM J. PHELAN, M.D. TWO TYLER COURT CARLISLE, PA 17013 RE: 99210 DONALD L. MORRISON Prior approval is required for fees in excess of $150.00 for hospitals, $100.00 for all other providers. XRAY INVENTORY Entire medical, billing, and diagnostic file, including but not limited to any and all records, correspondence to and from the consulting and/or treating physicians, files, memoranda, handwritten notes, history and physical reports, medication/prescription records, medical billing and payment records, x-ray films and tests with subsequent reports, including any and all such items as may be stored in a computer database or otherwise in electronic form, relating to any examination, consultation, diagnosis, care or treatment pertaining to: Dates Requested: up to and including the present. Subject : DONALD L. MORRISON 1942 RESERVOIR DRIVE, CARLISLE, PA 17013 Social Security #: XXX-XX-4071 Date of Birth: 01-14-1942 R1.35S 133-H SU10-0694588 99210-LO1 'AlGINAL CERTIFICATE PREREQUISITE TO SERVICE OF A SUBPOENA PURSUANT TO RULE 4009.22 IN THE MATTER OF: MORRISON -VS- BORAN COURT OF COMMON PLEAS TERM, CUMBERLAND CASE NO: 07-187 As a prerequisite to service of a subpoena for documents and things pursuant to Rule 4009.22 MCS on behalf of JOHN MCGREEVEY, ESQ. certifies that (1) A notice of intent to serve the subpoena with a copy of the subpoena attached thereto was mailed or delivered to each party at least twenty days prior to the date on which the subpoena is sought to be served, (2) A copy of the notice of intent, including the proposed subpoena, is attached to this certificate, (3) No objection to the subpoena has been received, and (4) The subpoena which will be served is identical to the subpoena which is attached to the notice of intent to serve the subpoena. DATE: 07/31/2007 R1.35 133-H C on b half of ttorney fo DEFE ANT DE11-0701810 99210-L02 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND IN THE MATTER OF: MORRISON -VS- BORAN COURT OF COMMON PLEAS TERM, CASE NO: 07-187 NOTICE OF INTENT TO SERVE A SUBPOENA TO PRODUCE DOCUMENTS AND THINGS FOR DISCOVERY PURSUANT TO RULE 4009.21 [ Note: see enclosed list of locations TO: MICHAEL J. NAVITSKY, ESQ., PLAINTIFF COUNSEL MCS on behalf of JOHN MCGREEVEY, ESQ. intends to serve a subpoena identical to the one that is attached to this notice. You have twenty (20) days from the date listed below in which to file of record and serve upon the undersigned an objection to the subpoena. If the twenty day notice period is waived or if no objection is made, then the subpoena may be served. Complete copies of any reproduced records may be ordered at your expense by completing the attached counsel card and returning same to MCS or by contacting our local MCS office. DATE: 07/11/2007 CC: JOHN MCGREEVEY, ESQ. - 185-157 MCS on behalf of JOHN MCGREEVEY, ESQ. Attorney for DEFENDANT Any questions regarding this matter, contact THE MCS GROUP INC. 1601 MARKET STREET #800 PHILADELPHIA, PA 19103 (215) 246-0900 R1.35S 133-H DE02-0368073 99210-COl >>> LOCATION LIST <<< LOCATION NAME RECORDS REQUESTED WILLIAM J. PHELAN-, M.D. MEDICAL, BILLING, AND X- RAY(S) VASCULAR ASSOCS.P.C. MEDICAL, BILLING, AND X- RAY(S) JOHN STRATIS, M.D. MEDICAL, BILLING, AND X- RAY(S) CARLISLE REGIONAL MEDICAL CNTR MEDICAL RECORDS CARLISLE REGIONAL MEDICAL CTR. BILLING ONLY CARLISLE REGIONAL MEDICAL CTR. X-RAY ON LY PINNACLE HOME HEALTH HOSPICE MEDICAL, BILLING, AND X- RAY(S) PENNSWOO D PHYSICAL THERAPY MEDICAL, BILLING, AND X- RAY(S) PAGE: 1 R1.35S 133-H DE02-0368073 99210-COl COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND MORRISON vs. BORAN File No. 07-187 SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: Custodian of Records for VASCULAR ASSOCS P C (Name of Person or Entity) Within twenty (20) days after service of this subpoena, you are ordered by the court to produce the following documents or things: **** SEE ATTACHED RIDER **** at The MCS Group. Inc., 1601 Market Street, Suite 800. Philadelphi PA 19103 You may deliver or mail legible copies of the documents or produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek, in advance, the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days after its service, the party serving this subpoena may seek a court order compelling you to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: NAME: JOHN MCGREEVEY. ES ADDRESS: 630 WEST GERMANTO` PLYMOUTH MEETING. PA 19462 TELEPHONE: (215) 246-0900 SUPREME COURT ID #: ATTORNEY FOR: _ Defendant JUL 31 2007 Date: Seal of the Court BY THE COURT: s K-. othonotary/Clerk, Civil ivision -Lba.k &- I t --F Deputy 99210-02 EXPLANATION OF REQUIRED RECORDS T0: CUSTODIAN OF RECORDS FOR: VASCULAR ASSOCS.P.C. 800 POPLAR CHURCH RD. CAMPHILL, PA 17011 RE: 99210 DONALD L. MORRISON Prior approval is required for fees in excess of $150.00 for hospitals, $100.00 for all other providers. XRAY INVENTORY Entire medical, billing, and diagnostic file, including but not limited to any and all records, correspondence to and from the consulting and/or treating physicians, files, memoranda, handwritten notes, history and physical reports, medication/prescription records, medical billing and payment records, x-ray films and tests with subsequent reports, including any and all such items as may be stored in a computer database or otherwise in electronic form, relating to any examination, consultation, diagnosis, care or treatment pertaining to: Dates Requested: up to and including the present. Subject : DONALD L. MORRISON 1942 RESERVOIR DRIVE, CARLISLE, PA 17013 Social Security #: XXX-XX-4071 Date of Birth: 01-14-1942 R133-H SU10-0694590 99210-L02 ORIGIN CERTIFICATE PREREQUISITE TO SERVICE OF A SUBPOENA PURSUANT TO RULE 4009.22 IN THE MATTER OF: MORRISON -VS- BORAN COURT OF COMMON PLEAS TERM, CUMBERLAND CASE NO: 07-187 As a prerequisite to service of a subpoena for documents and things pursuant to Rule 4009.22 MCS on behalf of JOHN MCGREEVEY, ESQ. certifies that (1) A notice of intent to serve the subpoena with a copy of the subpoena attached thereto was mailed or delivered to each party at least twenty days prior to the date on which the subpoena is sought to be served, (2) A copy of the notice of intent, including the proposed subpoena, is attached to this certificate, (3) No objection to the subpoena has been received, and (4) The subpoena which will be served is identical to the subpoena which is attached to the notice of intent to serve the subpoena. DATE: 07/31/2007 of AQ J C ZUG torney fo EFE R1.35 133-H DE11-0701811 99210 -L03 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND IN THE MATTER OF: MORRISON -VS- BORAN COURT OF COMMON PLEAS TERM, CASE NO: 07-187 NOTICE OF INTENT TO SERVE A SUBPOENA TO PRODUCE DOCUMENTS AND THINGS FOR DISCOVERY PURSUANT TO RULE 4009.21 [ Note: see enclosed list of locations ] TO: MICHAEL J. NAVITSKY, ESQ., PLAINTIFF COUNSEL MCS on behalf of JOHN MCGREEVEY, ESQ. intends to serve a subpoena identical to the one that is attached to this notice. You have twenty (20) days from the date listed below in which to file of record and serve upon the undersigned an objection to the subpoena. If the twenty day notice period is waived or if no objection is made, then the subpoena may be served. Complete copies of any reproduced records may be ordered at your expense by completing the attached counsel card and returning same to MCS or by contacting our local MCS office. DATE: 07/11/2007 CC: JOHN MCGREEVEY, ESQ. - 185-157 Any questions regarding this matter, contact MCS on behalf of JOHN MCGREEVEY, ESQ. Attorney for DEFENDANT THE MCS GROUP INC. 1601 MARKET STREET #800 PHILADELPHIA, PA 19103 (215) 246-0900 IR1.35S 133-H DE02-0368073 99210-C01 >>> LOCATION LIST <<< PAGE: 1 LOCATION NAME RECORDS REQUESTED WILLIAM J. PHELAN, M.D. VASCULAR ASSOCS.P.C. JOHN STRATIS, M.D. CARLISLE REGIONAL MEDICAL CNTR CARLISLE REGIONAL MEDICAL CTR. CARLISLE REGIONAL MEDICAL CTR. PINNACLE HOME HEALTH HOSPICE PENNSWOOD PHYSICAL THERAPY MEDICAL, BILLING, AND X-RAY(S) MEDICAL, BILLING, AND X-RAY(S) MEDICAL, BILLING, AND X-RAY(S) MEDICAL RECORDS BILLING ONLY X-RAY ONLY MEDICAL, BILLING, AND X-RAY(S) MEDICAL, BILLING, AND X-RAY(S) R1.35S 133-H DE02-0368073 99210-COl COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND MORRISON vs. BORAN File No. 07-187 SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: Custodian of Records for JOHN STRATIS. M.D. (Name of Person or Entity) Within twenty (20) days after service of this subpoena, you are ordered by the court to produce the following documents or things: **** SEE ATTACHED RIDER **** at The MCS Group. Inc., 1601 Market Street Suite 800, Philadelphia, PA 19103 You may deliver or mail legible copies of the documents or produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek, in advance, the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days after its service, the party serving this subpoena may seek a court order compelling you to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: NAME: JOHN MCGREEVEY. ES ADDRESS: 630 WEST CTERMANT01 TELEPHONE: (215) 246-0900 SUPREME COURT ID #: ATTORNEY FOR: Defendant Date: JUL 81 2007 Seal of the Court BY THE COURT: Pv6thonotary/Clerk Civil n Deputy 99210-03 EXPLANATION OF REQUIRED RECORDS TO: CUSTODIAN JOHN STRATIS, 816 BELVEDERE CARLISLE, PA RE: 99210 DONALD L. MORI OF RECORDS FOR: M.D. STREET 17013 BISON Prior approval is required for fees in excess of $150.00 for hospitals, $100.00 for all other providers. XRAY INVENTORY Entire medical, billing, and diagnostic file, including but not limited to any and all records, correspondence to and from the consulting and/or treating physicians, files, memoranda, handwritten notes, history and physical reports, medication/prescription records, medical billing and payment records, x-ray films and tests with subsequent reports, including any and all such items as may be stored in a computer database or otherwise in electronic form, relating to any examination, consultation, diagnosis, care or treatment pertaining to: Dates Requested: up to and including the present. Subject : DONALD L. MORRISON 1942 RESERVOIR DRIVE, CARLISLE, PA 17013 Social Security #: XXX-XX-4071 Date of Birth: 01-14-1942 R1.35S 133-H SU10-0694592 99210-LO3 CERTIFICATE PREREQUISITE TO SERVICE OF A SUBPOENA PURSUANT TO RULE 4009.22 ORIGINAL IN THE MATTER OF: COURT OF COMMON PLEAS MORRISON TERM, CUMBERLAND -VS- CASE NO: 07-187 BORAN As a prerequisite to service of a subpoena for documents and things pursuant to Rule 4009.22 MCS on behalf of JOHN MCGREEVEY, ESQ. certifies that (1) A notice of intent to serve the subpoena with a copy of the subpoena attached thereto was mailed or delivered to each party at least twenty days prior to the date on which the subpoena is sought to be served, (2) A copy of the notice of intent, including the proposed subpoena, is attached to this certificate, (3) No objection to the subpoena has been received, and (4) The subpoena which will be served is identical to the subpoena which is attached to the notice of intent to serve the subpoena. DATE: 07/31/2007 R1.35 133-H ?? on b alf of torney forUFEFENW 11 DE11-0701812 99210-L04 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND IN THE MATTER OF: MORRISON -VS- BORAN COURT OF COMMON PLEAS TERM, CASE NO: 07-187 NOTICE OF INTENT TO SERVE A SUBPOENA TO PRODUCE DOCUMENTS AND THINGS FOR DISCOVERY PURSUANT TO RULE 4009.21 ( Note: see enclosed list of locations TO: MICHAEL J. NAVITSKY, ESQ., PLAINTIFF COUNSEL MCS on behalf of JOHN MCGREEVEY, ESQ. intends to serve a subpoena identical to the one that is attached to this notice. You have twenty (20) days from the date listed below in which to file of record and serve upon the undersigned an objection to the subpoena. If the twenty day notice period is waived or if no objection is made, then the subpoena may be served. Complete copies of any reproduced records may be ordered at your expense by completing the attached counsel card and returning same to MCS or by contacting our local MCS office. DATE: 07/11/2007 CC: JOHN MCGREEVEY, ESQ. - 185-157 Any questions regarding this matter, contact MCS on behalf of JOHN MCGREEVEY, ESQ. Attorney for DEFENDANT THE MCS GROUP INC. 1601 MARKET STREET #800 PHILADELPHIA, PA 19103 (215) 246-0900 R1.35S 133-H DE02-0368073 99210-COl >>> LOCATION LIST <<< LOCATION NAME RECORDS PAGE: 1 WILLIAM J. PHELAN, M.D. VASCULAR ASSOCS.P.C. JOHN STRATIS, M.D. CARLISLE REGIONAL MEDICAL CNTR CARLISLE REGIONAL MEDICAL CTR. CARLISLE REGIONAL MEDICAL CTR. PINNACLE HOME HEALTH HOSPICE PENNSWOOD PHYSICAL THERAPY MEDICAL, BILLING, MEDICAL, BILLING, MEDICAL, BILLING, MEDICAL RECORDS BILLING ONLY X-RAY ONLY MEDICAL, BILLING, MEDICAL, BILLING, AND X-RAY(S) AND X-RAY(S) AND X-RAY(S) AND X-RAY(S) AND X-RAY(S) R1.35S 133-H DE02-0368073 99210-COl COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND MORRISON VS. BORAN File No. 07-187 SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: Custodian of Records for CARLISLE REGIONAL MEDICAL CNT (Name of Person or Entity) Within twenty (20) days after service of this subpoena, you are ordered by the court to produce the following documents or things: **** SEE ATTACHED RIDER **** at The MCS Group Inc 1601 Market Street Suite 800?Philadelphia, PA 19103 - You may deliver or mail legible copies of the documents or produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek, in advance, the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days after its service, the party serving this subpoena may seek a court order compelling you to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: NAME: JOHN MCGREEVEY. ESQ. ADDRESS: 630 WEST GERMANTOWN PIKE SUITE 121 PLYMOUTH MEETING PA 19462 TELEPHONE: (215) 246-0900 SUPREME COURT ID #: ATTORNEY FOR: Defendant Date: 1/6/ 07 u JUL 9 1 28n3 Seal of the Court BY THE COURT: P. 'P othonotary/IC/lerk, Civil D' n ??' Deputy x 99210-04 EXPLANATION OF REQUIRED RECORDS TO: CUSTODIAN OF RECORDS FOR: CARLISLE REGIONAL MEDICAL CNTR 361 ALEXANDER SPRING RD MEDICAL RECORDS CARLISLE, PA 17015 RE: 99210 DONALD L. MORRISON Prior approval is required for fees in excess of $150.00 for hospitals, $100.00 for all other providers. Entire hospital medical file, including but not limited to any and all records, correspondence to and from the consulting and/or treating physician, files, memoranda, handwritten notes, history and physical reports, medication/ prescription records, nurse's notes, doctor's comments, dietary restrictions, and all patient consent or refusal of treatment, procedures, test, and/or medication, lab and diagnostic test results, including any and all such items as may be stored in a computer database or otherwise in electronic form, relating to any examination, consultation, diagnosis, care, treatment, admission, discharge, or emergency care pertaining to: Dates Requested: up to and including the present. Subject : DONALD L. MORRISON 1942 RESERVOIR DRIVE, CARLISLE, PA 17013 Social Security #: XXX-XX-4071 Date of Birth: 01-14-1942 R1.35S 133-H SU10-0694594 99210-L04 ORIGM '"' CERTIFICATE PREREQUISITE TO SERVICE OF A SUBPOENA PURSUANT TO RULE 4009.22 IN THE MATTER OF: MORRISON -VS- BORAN COURT OF COMMON PLEAS TERM, CUMBERLAND CASE NO: 07-187 As a prerequisite to service of a subpoena for documents and things pursuant to Rule 4009.22 MCS on behalf of JOHN MCGREEVEY, ESQ. certifies that (1) A notice of intent to serve the subpoena with a copy of the subpoena attached thereto was mailed or delivered to each party at least twenty days prior to the date on which the subpoena is sought to be served, (2) A copy of the notice of intent, including the proposed subpoena, is attached to this certificate, (3) No objection to the subpoena has been received, and (4) The subpoena which will be served is identical to the subpoena which is attached to the notice of intent to serve the subpoena. DATE: 07/31/2007 151 C on half of R 0"64 11 ttorney f DE D R1.35 133-H DE11-0701813 99210-L05 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND IN THE MATTER OF: MORRISON -VS- BORAN COURT OF COMMON PLEAS TERM, CASE NO: 07-187 NOTICE OF INTENT TO SERVE A SUBPOENA TO PRODUCE DOCUMENTS AND THINGS FOR DISCOVERY PURSUANT TO RULE 4009.21 [ Note: see enclosed list of locations ] TO: MICHAEL J. NAVITSKY, ESQ., PLAINTIFF COUNSEL MCS on behalf of JOHN MCGREEVEY, ESQ. intends to serve a subpoena identical to the one that is attached to this notice. You have twenty (20) days from the date listed below in which to file of record and serve upon the undersigned an objection to the subpoena. If the twenty day notice period is waived or if no objection is made, then the subpoena may be served. Complete copies of any reproduced records may be ordered at your expense by completing the attached counsel card and returning same to MCS or by contacting our local MCS office. DATE: 07/11/2007 CC: JOHN MCGREEVEY, ESQ. - 185-157 Any questions regarding this matter, contact MCS on behalf of JOHN MCGREEVEY, ESQ. Attorney for DEFENDANT THE MCS GROUP INC. 1601 MARKET STREET #800 PHILADELPHIA, PA 19103 (215) 246-0900 R1.35S 133-H DE02-0368073 99210-CO1 >>> LOCATION LIST <<< LOCATION NAME RECORDS REQUESTED PAGE: 1 WILLIAM J. PHELAN, M.D. VASCULAR ASSOCS.P.C. JOHN STRATIS, M.D. CARLISLE REGIONAL MEDICAL CNTR CARLISLE REGIONAL MEDICAL CTR. CARLISLE REGIONAL MEDICAL CTR. PINNACLE HOME HEALTH HOSPICE PENNSWOOD PHYSICAL THERAPY R1.35S 133-H MEDICAL, BILLING, AND X-RAY(S) MEDICAL, BILLING, AND X-RAY(S) MEDICAL, BILLING, AND X-RAY(S) MEDICAL RECORDS BILLING ONLY X-RAY ONLY MEDICAL, BILLING, AND X-RAY(S) MEDICAL, BILLING, AND X-RAY(S) DE02-0368073 99210-COl COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND MORRISON VS. BORAN File No. 07-187 SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: Custodian of Records for CARLISLE REGIONAL MEDICAL C'TR (Name of Person or Entity) Within twenty (20) days after service of this subpoena, you are ordered by the court to produce the following documents or things: **** SEE ATTACHED RIDER **** at The MCS Group Inc 1601 Market Street Suite 800, Philadelphia, PA 19103 You may deliver or mail legible copies of the documents or produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek, in advance, the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days after its service, the party serving this subpoena may seek a court order compelling you to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: NAME: JOHN MCGREEVEY. ESQ. ADDRESS: 630 WEST GERMANTOWN PIKE SL TTTF 121 PLYMOUTH MEETING, PA 19462 TELEPHONE: (215) 246-0900 SUPREME COURT ID #: ATTORNEY FOR: Defendant BY THE COURT: r thonotary/Clerk, Civil vision ?P? I A. - /)",J-. / Lo JUL 3 1 2007 Deputy Date: ''l/? `I Seal of the Court 99210-05 EXPLANATION OF REQUIRED RECORDS TO: CUSTODIAN OF RECORDS FOR: CARLISLE REGIONAL MEDICAL CTR. 361 ALEXANDER SPRING RD BILLING DEPT CARLISLE, PA 17013 RE: 99210 DONALD L. MORRISON Prior approval is required for fees in excess of $150.00 for hospitals, $100.00 for all other providers. Any and all billing, insurance claims, payments, outstanding and/or delinquent invoices, including any and all such items as may be stored in a computer database or otherwise in electronic form, relating to any examination, consultation, diagnosis, care or treatment pertaining to: Dates Requested: up to and including the present. Subject : DONALD L. MORRISON 1942 RESERVOIR DRIVE, CARLISLE, PA 17013 Social Security #: XXX-XX-4071 Date of Birth: 01-14-1942 f R1.35S 133-H SU10-0694596 99210-L05 CERTIFICATE PREREQUISITE TO SERVICE OF A SUBPOENA PURSUANT TO RULE 4009.22 ^9/GINq[ IN THE MATTER OF: COURT OF COMMON PLEAS MORRISON TERM, CUMBERLAND -VS- CASE NO: 07-187 BORAN As a prerequisite to service of a subpoena for documents and things pursuant to Rule 4009.22 MCS on behalf of JOHN MCGREEVEY, ESQ. certifies that (1) A notice of intent to serve the subpoena with a copy of the subpoena attached thereto was mailed or delivered to each party at least twenty days prior to the date on which the subpoena is sought to be served, (2) A copy of the notice of intent, including the proposed subpoena, is attached to this certificate, (3) No objection to the subpoena has been received, and (4) The subpoena which will be served is identical to the subpoena which is attached to the notice of intent to serve the subpoena. DATE: 07/31/2007 R1.35 133-H NS on &bhalf of 0 torney fo DEFE ANT DE11-0701814 99210-L06 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND IN THE MATTER OF: MORRISON -VS- BORAN COURT OF COMMON PLEAS TERM, CASE NO: 07-187 NOTICE OF INTENT TO SERVE A SUBPOENA TO PRODUCE DOCUMENTS AND THINGS FOR DISCOVERY PURSUANT TO RULE 4009.21 [ Note: see enclosed list of locations TO: MICHAEL J. NAVITSKY, ESQ., PLAINTIFF COUNSEL MCS on behalf of JOHN MCGREEVEY, ESQ. intends to serve a subpoena identical to the one that is attached to this notice. You have twenty (20) days from the date listed below in which to file of record and serve upon the undersigned an objection to the subpoena. If the twenty day notice period is waived or if no objection is made, then the subpoena may be served. Complete copies of any reproduced records may be ordered at your expense by completing the attached counsel card and returning same to MCS or by contacting our local MCS office. DATE: 07/11/2007 CC: JOHN MCGREEVEY, ESQ. - 185-157 Any questions regarding this matter, contact MCS on behalf of JOHN MCGREEVEY, ESQ. Attorney for DEFENDANT THE MCS GROUP INC. 1601 MARKET STREET #800 PHILADELPHIA, PA 19103 (215) 246-0900 R1.35S 133-H DE02-0368073 99210-COl >>> LOCATION LIST <<< LOCATION NAME WILLIAM J. PHELAN, M.D. VASCULAR ASSOCS.P.C. JOHN STRATIS, M.D. CARLISLE REGIONAL MEDICAL CNTR CARLISLE REGIONAL MEDICAL CTR. CARLISLE REGIONAL MEDICAL CTR. PINNACLE HOME HEALTH HOSPICE PENNSWOOD PHYSICAL THERAPY R1.35S 133-H PAGE: 1 RECORDS REQUESTED MEDICAL, BILLING, MEDICAL, BILLING, MEDICAL, BILLING, MEDICAL RECORDS BILLING ONLY X-RAY ONLY MEDICAL, BILLING, MEDICAL, BILLING, AND X-RAY(S) AND X-RAY(S) AND X-RAY(S) AND X-RAY(S) AND X-RAY(S) DE02-0368073 99210-COl COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND MORRISON File No. 07-187 VS. BORAN SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: Custodian of Records for CARLISLE REGIONAL MEDICAL C'RR (Name of Person or Entity) Within twenty (20) days after service of this subpoena, you are ordered by the court to produce the following documents or things: **** SEE ATTACHED RIDER **** at The MCS Grg Inc 1601 Market Street Suite 800, iladelnbia PA 19193 You may deliver or mail legible copies of the documents or produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek, in advance, the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days after its service, the party serving this subpoena may seek a court order compelling you to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: NAME: JOHN MCGREEVEY. ESQ. ADDRESS: 630 WEST GERMANTOWN PIKE SUITE 121 PLYMOUTH MEETING. PA 19462 TELEPHONE: 246-0900 SUPREME COURT ID #: ATTORNEY FOR: Defendant BY THE COURT: S i R thonotary/Clerk, Civil Division L6& k1 &'t , '6" It, Al 7 JUL 31 2007 Deputy Q Date: Seal of the Court 99210-06 EX-PLANATION OF REQUIRED RECORDS TO: CUSTODIAN OF RECORDS FOR: CARLISLE REGIONAL MEDICAL CTR. 361 ALEXANDER SPRING RD RADIOLOGY DEPT CARLISLE, PA 17013 RE: 99210 DONALD L. MORRISON Prior approval is required for fees in excess of $150.00 for hospitals, $100.00 for all other providers. XRAY INVENTORY Any and all x-ray films and reports, including any and all such items as may be stored in a computer database or otherwise in electronic form, pertaining to: Dates Requested: up to and including the present. Subject : DONALD L. MORRISON 1942 RESERVOIR DRIVE, CARLISLE, PA 17013 Social Security #: XXX-XX-4071 Date of Birth: 01-14-1942 R1.35S 133-H SU10-0694598 99210-LO6 ORIGINAL CERTIFICATE PREREQUISITE TO SERVICE OF A SUBPOENA PURSUANT TO RULE 4009.22 IN THE MATTER OF: MORRISON COURT OF COMMON PLEAS TERM, CUMBERLAND -VS- BORAN CASE NO: 07-187 As a prerequisite to service of a subpoena for documents and things pursuant to Rule 4009.22 MCS on behalf of JOHN MCGREEVEY, ES certifies that (1) A notice of intent to serve the subpoena with a copy of the subpoena attached thereto was mailed or delivered to each party at least twenty days prior to the date on which the subpoena is sought to be served, (2) A copy of the notice of intent, including the proposed subpoena, is attached to this certificate, (3) No objection to the subpoena has been received, and (4) The subpoena which will be served is identical to the subpoena which is attached to the notice of intent to serve the subpoena. C, on behalf of DATE: 07/31/2007 is E ttorney fo DEFE ANT R1.35 133-H DE11-0701815 99210-L07 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND IN THE MATTER OF: MORRISON -VS- DORAN TERM, CASE NO: 07-187 NOTICE OF INTENT TO SERVE A SUBPOENA TO PRODUCE DOCUMENTS AND THINGS FOR DISCOVERY PURSUANT TO RULE 4009.21 [ Note: see enclosed list of locations TO: MICHAEL J. NAVITSKY, ESQ., PLAINTIFF COUNSEL MCS. on behalf of JOHN MCGREEVEY, ESQ. intends to serve a subpoena identical to the one that is attached to this notice. You have twenty (20) days from the date listed below in which to file of record and serve upon the undersigned an objection to the subpoena. If the twenty day notice period is waived or if no objection is made, then the subpoena may be served. Complete copies of any reproduced records may be ordered at your expense by completing the attached counsel card and returning same to MCS or by contacting our local MCS office. DATE: 07/11/2007 CC: JOHN MCGREEVEY, ESQ. - 185-157 Any questions regarding this matter, contact COURT OF COMMON PLEAS MCS on behalf of JOHN MCGREEVEY, ESQ. Attorney for DEFENDANT THE MCS GROUP INC. 1601 MARKET STREET #800 PHILADELPHIA, PA 19103 (215) 246-0900 R1.35S 133-H DE02-0368073 99210-C01 >>> LOCATION LIST <<< LOCATION NAME RECORDS REQUESTED PAGE: 1 WILLIAM J. PHELAN, M.D. VASCULAR ASSOCS.P.C. JOHN STRATIS, M.D. CARLISLE REGIONAL MEDICAL CNTR CARLISLE REGIONAL MEDICAL CTR. CARLISLE REGIONAL MEDICAL CTR. PINNACLE HOME HEALTH HOSPICE PENNSWOOD PHYSICAL THERAPY MEDICAL, BILLING, AND X-RAY(S) MEDICAL, BILLING, AND X-RAY(S) MEDICAL, BILLING, AND X-RAY(S) MEDICAL RECORDS BILLING ONLY X-RAY ONLY MEDICAL, BILLING, AND X-RAY(S) MEDICAL, BILLING, AND X-RAY(S) R1.35S 133-H DE02-0368073 99210-COl COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND MORRISON File No. 07-187 VS. BORAN SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO: Custodian of Records for PINNACLE HOME HEALTH HOSPICE (Name of Person or Entity) Within twenty (20) days after service of this subpoena, you are ordered by the court to produce the following documents or things: **** SEE ATTACHED RIDER **** at The MCS Groun Inc., 1601 Market Street. Suite 800 Philadelphia PA 19103 You may deliver or mail legible copies of the documents or produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek, in advance, the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days after its service, the party serving this subpoena may seek a court order compelling you to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: NAME: JOHN MCGREEVEY, ESO. ADDRESS: 630 WEST GERMANTOWN PIKE SUITE 121 PLYMOUTH MEETING. PA 19462 TELEPHONE: (215) 246-0900 SUPREME COURT ID #: ATTORNEY FOR: Defendant Date: JUL 31 2007 Seal of the Court BY THE COURT: 4F " . &In - thonotary/Clerk, Ci Division L., '(? A-* Deputy 99210-07 EXPLANATION OF REQUIRED RECORDS TO: CUSTODIAN OF RECORDS FOR: PINNACLE HOME HEALTH HOSPICE 3705 ELMWOOD DR. HARRISBURG- PA 17110 RE: 99210 DONALD L. MORRISON Prior approval is required for fees in excess of $150.00 for hospitals, $100.00 for all other providers. XRAY INVENTORY Entire medical, billing, and diagnostic file, including but not limited to any and all records, correspondence to and from the consulting and/or treating physicians, files, memoranda, handwritten notes, history and physical reports, medication/prescription records, medical billing and payment records, x-ray films and tests with subsequent reports, including any and all such items as may be stored in a computer database or otherwise in electronic form, relating to any examination, consultation, diagnosis, care or treatment pertaining to: Dates Requested: up to and including the present. Subject : DONALD L. MORRISON 1942 RESERVOIR DRIVE, CARLISLE, PA 17013 Social Security #: XXX-XX-4071 Date of Birth: 01-14-1942 R1.35S 133-H SU10-0694600 99210-LO7 CERTIFICATE PREREQUISITE TO SERVICE OF A SUBPOENA PURSUANT TO RULE 4009.22 IN THE MATTER OF: MORRISON -VS- BORAN ORIGINA1 COURT OF COMMON PLEAS TERM, CUMBERLAND CASE NO: 07-187 As a prerequisite to service of a subpoena for documents and things pursuant to Rule 4009.22 MCS on behalf of JOHN MCGREEVEY, ESQ. certifies that (1) A notice of intent to serve the subpoena with a copy of the subpoena attached thereto was mailed or delivered to each party at least twenty days prior to the date on which the subpoena is sought to be served, (2) A copy of the notice of intent, including the proposed subpoena, is attached to this certificate, (3) No objection to the subpoena has been received, and (4) The subpoena which will be served is identical to the subpoena which is attached to the notice of intent to serve the subpoena. DATE: 07/31/2007 C. on half of , torney fblr DEkiNDAIV R1.35 133-H DE11-0701816 99210-L08 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND IN THE MATTER OF: MORRISON -VS- BORAN COURT OF COMMON PLEAS TERM, CASE NO: 07-187 NOTICE OF INTENT TO SERVE A SUBPOENA TO PRODUCE DOCUMENTS AND THINGS FOR DISCOVERY PURSUANT TO RULE 4009.21 [ Note: see enclosed list of locations ] TO: MICHAEL J. NAVITSKY, ESQ., PLAINTIFF COUNSEL MCS on behalf of JOHN MCGREEVEY, ESQ. intends to serve a subpoena identical to the one that is attached to this notice. You have twenty (20) days from the date listed below in which to file of record and serve upon the undersigned an objection to the subpoena. If the twenty day notice period is waived or if no objection is made, then the subpoena may be served. Complete copies of any reproduced records may be ordered at your expense by completing the attached counsel card and returning same to MCS or by contacting our local MCS office. DATE: 07/11/2007 CC: JOHN MCGREEVEY, ESQ. - 185-157 Any questions regarding this matter, contact R1.35S 133-H MCS on behalf of JOHN MCGREEVEY, ESQ. Attorney for DEFENDANT THE MCS GROUP INC. 1601 MARKET STREET #800 PHILADELPHIA, PA 19103 (215) 246-0900 DE02-0368073 99210-C01 >>> LOCATION LIST <<< LOCATION NAME WILLIAM J. PHELAN, M.D. VASCULAR ASSOCS.P.C. JOHN STRATIS, M.D. CARLISLE REGIONAL MEDICAL CNTR CARLISLE REGIONAL MEDICAL CTR. CARLISLE REGIONAL MEDICAL CTR. PINNACLE HOME HEALTH HOSPICE PENNSWOOD PHYSICAL THERAPY R1.35S 133-H RECORDS REOUESTED MEDICAL, BILLING, AND X-RAY(S) MEDICAL, BILLING, AND X-RAY(S) MEDICAL, BILLING, AND X-RAY(S) MEDICAL RECORDS BILLING ONLY X-RAY ONLY MEDICAL, BILLING, AND X-RAY(S) MEDICAL, BILLING, AND X-RAY(S) PAGE: 1 DE02-0368073 99210-COl COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND MORRISON vs. BORAN File No. 07-187 SUBPOENA TO PRODUCE DOCUMENTS OR THINGS FOR DISCOVERY PURSUANT TO RULE 4009.22 TO Custodian of Records for PENNSWOOD PHYSICAL THERAPY (Name of Person or Entity) Within twenty (20) days after service of this subpoena, you are ordered by the court to produce the following documents or things: **** SEE ATTACHED RIDER **** at The MCS GrojW Inc., 1601 Market Street Suite 800, P ilade42 is PA 19103 You may deliver or mail legible copies of the documents or produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek, in advance, the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days after its service, the party serving this subpoena may seek a court order compelling you to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: NAME: JOHN MCGREEVEY. ESO. ADDRESS: 630 WEST GERMANTOWN PIKE -SUITE 121 PLYMOUTH MEETING. P 19462 TELEPHONE: (215) 246-0900 SUPREME COURT ID #: ATTORNEY FOR: Defendant BY THE COURT: AS/ P otf h? /ClerCi Division L6a- k1 Date: '71ab, JUL 3 1 2007 Deputy Seal of the Court 99210-08 EXPLANATION OF REQUIRED RECORDS TO: CUSTODIAN OF RECORDS FOR: PENNSWOOD PHYSICAL THERAPY 419 VILLAGE DRIVE SUITE 3 CARLISLE, PA 17013 RE: 99210 DONALD L. MORRISON Prior approval is required for fees in excess of $150.00 for hospitals, $100.00 for all other providers. XRAY INVENTORY Entire medical, billing, and diagnostic file, including but not limited to any and all records, correspondence to and from the consulting and/or treating physicians, files, memoranda, handwritten notes, history and physical reports, medication/prescription records, medical billing and payment records, x-ray films and tests with subsequent reports, including any and all such items as may be stored in a computer database or otherwise in electronic form, relating to any examination, consultation, diagnosis, care or treatment pertaining to: Dates Requested: up to and including the present. Subject : DONALD L. MORRISON 1942 RESERVOIR DRIVE, CARLISLE, PA 17013 Social Security #: XXX-XX-4071 Date of Birth: 01-14-1942 R1.35S 133-H SU10-0694602 99210-L08 y .-., : - G) f'Ti 1X , N Q ? C3 rn ti ? Z _ IN THE MATTER OF: MORRISON -VS- BORAN As a prerequisite to to Rule 4009.22 MCS on (1) A notice of attached th twenty days served, CERTIFICATE ?? ISITE TO SERVICE OF A SUBPOENA iiGI PURSUANT TO RULE 4009.22 COURT OF COMMON PLEAS TERM, CUMBERLAND CASE NO: 07-187 of a subpoena for documents and things pursuant if of JOHN MCGREEVEY, ESQ. certifies that tent to serve the subpoena with a copy of the subpoena to was mailed or delivered to each party at least for to the date on which the subpoena is sought to be (2) A copy of the notice of intent, including the proposed subpoena, is attached to his certificate, (3) No objection to the subpoena has been received, and (4) The subpoenalwhich will be served is identical to the subpoena which is attached to the notice of intent to serve the subpoena. DATE: 09/13/2007 on blf f /!J I? i JOHN MCGREfiVEY, ES Attorney for DEFENDANT R1.42 133-H DE11-0710704 99210-L09 CQMMONWEALTH OF PENNSYLVANIA ERLAND COUNTY OFCUN MORRISON VS. BORAN File No. 07-187 TO: Custodian of Records for ' KEYSTONE HEALTH PLAN CENTRAL (Name of Person or Entity) Within twenty (20) days after documents or things: **** of this subpoena, you are ordered by the court to produce the following CTACHED BIDER **** - -- -- - at The MCS , IM.- 1601 Market Street. Suite 800, P i e hia. PA 19103 You may deliver or mail legible copies of the documents or produce things requested by this subpoena, together with the certificate of compliances to the party making this request at the address listed above. You have the right to seek, in advance, the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days after its service, the party serving this subpoena may seek a court order compelling you to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: NAME: JOHN SO. ADDRESS: 630 WEST GERM PIKE SUITE 121 sj MEETING- to 19462 TELEPHONE: (215) 246-0900 SUPREME COURT ID #: ATTORNEY FOR: Defendant Date: BY THE COURT: Prothonotary/Clerk, Civil ivision Depu 99210-09 EXPI.ANATION OF REQUIRED RECORDS TO: CUSTODIAN OF RECORDS FOR: KEYSTONE HEALTH PLAN CENTRAL 2500 ELMERTON AVENUE HARRISBURG. PA 17177 RE: 99210 DONALD L. MORRISON Prior approval is required for fees in excess of $150.00 for hospitals, $100.00,for all other providers. POLICY AGREEMENT #x.92300492 Any and all insurance records and PIP files, including but not limited to medical reports and/or records, claims, any and all correspondence, documentation supporting plaintiff's claim, payments including dates of payments, payee and reasons for payments, including any and all such items as may be stored in a computer database or otherwise in electronic form, pertaining to: Dates Requested: 4p to and including the present. Subject : DONALD L; MORRISON 1942 RES$RVOIR DRIVE, CARLISLE, PA 17013 Social Security #:',XXX-XX-4071 Date of Birth: 01-14-1942 R1.41S 133-H SU10-0701912 99210-LO9 IN THE MATTER OF: MORRISON E'*)Wyz1 CERTIFICATE PREREQUISITE TO SERVICE OF A SUBPOENA PURSUANT TO RULE 4009.22 COURT OF COMMON PLEAS TERM, CUMBERLAND -VS CASE NO: 07-187 As a prerequisite to service of a subpoena for documents and things pursuant to Rule 4009.22 MCS onlbehalf of JOHN MCGREEVEY, ESQ. certifies that (1) A notice of intent to serve the subpoena with a copy of the subpoena attached thereto was mailed or delivered to each party at least twenty days prior to the date on which the subpoena is sought to be served, (2) A copy of they notice of intent, including the proposed subpoena, is attached to this certificate, (3) No objection,to the subpoena has been received, and (4) The subpoena ',which will be served is identical to the subpoena which is attached to the notice of intent to serve the subpoena. DATE: 09/13/2007 I S n bf V1 I HN MCGREEVEY, ESQ. Attorney for DEFENDAlfT R1.42 133-H DE11-0710705 99210-L10 OF PENNSYLVANIA OF CUMBERLAND IN THE MATTER OF: MORRISON -VS BORAN COURT OF COMMON PLEAS TERM, CASE NO: 07-187 KEYSTONE HEALTH PLAN CENTRAL INSURANCE MEDICARE INSURANCE FAMILY HOME MEDICAL, INC. MEDICAL RECORDS & BILLING GIANT FOODS LLC LEGW DEPT PRESCRIPTION/PHARMACEUTICAL RECORDS TO: MICHAEL J. NAVITSKY, ESQ., PLAINTIFF COUNSEL MCS on behalf of JOHN "REEVEY, ESQ. intends to serve a subpoena identical to the one that is attached to this notice. You have twenty (20) days from the date listed below in which to file of record and serve upon the undersigned an objection to the subpoena. If the twenty day notice period is waived or if no objection is made, then the subpoena may be served. Complete copies of any reproduced records may be ordered at your expense by completing the attached counsel card and returning same to MCS or by contacting our local MCS office. DATE: 08/24/2007 MCS on behalf of JOHN MCGREEVBY, ESQ. Attorney for DEFENDANT CC: JOHN MCGREEVEY, ESQ. - 155-157 i Any questions regardin this matter, R1.41S 133-H contact THE MCS GROUP INC. 1601 MARKET STREET #800 PHILADELPHIA, PA 19103 (215) 246-0900 D902-0372354 99210-COl COUNTY OF CUMBERLAND MORRISON VS. BORAN File No. 07-187 TO: Custodian of Records forj MEDICARE. (Name of Person or Entity) Within twaity (20) days after documents or things: **** of this subpoena, you are ordered by the court to produce the following rr.ACHED RIDER j**** at The MCS C.= Lnc ,1601] Market Street Suite 800 P PWb*%t, PA 19103 You may deliver or mail legible (copies of the documents or produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek, in advance, the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the documents or things required by this subpoena within twenty (20) days after its service, the party serving this subpoena may seek a court order compelling you to comply with it. THIS SUBPOENA WAS ISSUED AT THE REQUEST OF THE FOLLOWING PERSON: NAME: JOHN M VEY. M. ADDRESS: 630 WEST GER OWN PIKE SUITE 121 PL•YMOCTi_'Ii MEETING. PA 19462 TELEPHONE: (215) 246-0400 SUPREME COURT ID #: ATTORNEY FOR: Defendaot Date: BY THE COURT: /S/ & 6 'OeOzAa rge Prothonotary/Clerk, Ci Division Depu 99210-10 EXPLANATION OF REQUIRED RECORDS TO: CUSTODIAN OF RECORDS FOR: MEDICARE P.O. BOX 890413 CAMP HILL. PA 17069 RE: 99210 DONALD L. MORRISON' Prior approval is required for fees in excess of $150.00 for hospitals, $100.00 for all other providers. Any and all insurance records and PIP files, including but not limited to medical reports and/or records, claims, any and all correspondence, documentation supporting plaintiff's claim, payments including dates of payments, payee and reasons for payments, including any and all such items as may be stored it, a computer database or otherwise in electronic form, pertaining to: Dates Requested: up to and including the present. Subject : DONALD LI. MORRISON 1942 RESERVOIR DRIVE, CARLISLE!, PA 17013 Social Security #:'1161-34-4071 Date of Birth: 01-14-1942 R1.41S 133-H SU10-0701914 99210-L10 IN THE MATTER OF: MORRISON BORAN CERTIFICATE cy PREREQUISITE TO SERVICE OF A SUBPOENA PURSUANT TO RULE 4009.22 I COURT OF COMMON PLEAS TERM, CUMBERLAND -VS it CASE NO: 07-187 As a prerequisite to service of a subpoena for documents and things pursuant to Rule 4009.22 MCS on behalf of JOHN MCGREEVEY, ESQ. certifies that (1) A notice of intent to serve the subpoena with a copy of the subpoena attached thereto was mailed or delivered to each party at least twenty days prior to the date on which the subpoena is sought to be served, (2) A copy of thelnotice of intent, including the proposed subpoena, is attached to this certificate, (3) No objection to the subpoena has been received, and (4) The subpoena which will be served is identical to the subpoena which is attached to the notice of intent to serve the subpoena. DATE: 09/13/2007 I S n ? OHN MCGREEVE ES Q. Attorney for DEFEND 81.42 133-H I DE11-0710706 99210-L11 IN THE MATTER OF: MORRISON -VS- BORAN TERM, CASE NO: 07-187 KEYSTONE HEALTH PLAN CENTRAL INSURANCE MEDICARE INSURANCE FAMILY HOME MEDICAL, INC. MEDICAL RECORDS & BILLING GIANT FOODS LLC LEGAL !,DEPT PRESCRIPTION/PHARMACEUTICAL RECORDS TO: MICHAEL J. NAVITSKY, ESQ., PLAINTIFF COUNSEL MCS on behalf of JOHN Mq REEVEY, ESQ. intends to serve a subpoena identical to the one that is attached to this notice. You have twenty (20) days from the date listed below in which to file of record and serve upon the undersigned an objection to the subpoena. If the twenty day notice period is waived or if no objection is made, then the subpoena may be served. Complete copies of any reproduced records may be ordered at your expense by completing the attached counsel card and returning same to MCS or by contacting our local MCS office. DATE: 08/24/2007 MCS on behalf of JOHN MCGREEVEY, ESQ. Attorney for DEFENDANT CC: JOHN MCGREEVEY, ESO. - 185-157 Any questions regarding this matter, R1.41S 133-H COMMONWEALTH CO OF PENNSYLVANIA OF CUMBERLAND COURT OF COMMON PLEAS contact THE MCS GROUP INC. 1601 MARKET STREET #800 PHILADELPHIA, PA 19103 (215) 246-0900 DB02-0372354 99210-CO1 COUNTY OF CUMBERLAND MORRISON VS. BORAN TO: Custodian of Records Within twenty (20) days after documents or things: **** File No. 07-187 (Name of Person or Entity) of this subpoena, you are ordered by the court to produce the following FACHEID RIDER **** at You nay deliver or nail legible copies of the documents or produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek, in advance, the reasonab a cost of preparing the copies or producing the things sought. If you fail to produce the docum is 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. i THIS SUBPOENA WAS ISSUE AT THE REQUEST OF THE FOLLOWING PERSON: NAME: ADDRESS: TELEPHONE: SUPREME Ca ATTORNEYF BY THE COURT: /s/ 4.4 .c° geftg Prothonotary/Clerk, civi'lFKrision Depu Date: 99210-11 EXPLANATION OF REQUIRED RECORDS TO: CUSTODIAN OF RECORDS FOR: FAMILY HOME MEDICAL, INC. 1 SPRINT DRIVE CARLISLE, PA 170113 RE: 99210 DONALD L. MORRISON Prior approval is *equired for fees in excess of $150.00 for hospitals, $100.001 for all other providers. Entire medical and billing file including but not limited to any and all records, corresponjdence to and from the consulting and/or treating physicians, files, memoranda, handwritten notes, history and physical reports, medication/ prescription records, including any and all such items as may be stored in a computer database,or otherwise in electronic form, relating to any examination, consultation, diagnosis or treatment pertaining to: Dates Requested: up to and including the present. Subject : DONALD u. NORRISON 1942 RHOERVOIR DRIVE, CARLISLE, PA 17013 Social Security #:I XXX-XX-4071 Date of Birth: 01714-1942 R1.41S 133-H SU10-0701916 99210-Lll IN THE MATTER OF: MORRISON BORAN As a prerequisite to to Rule 4009.22 TERM, CUMBERLAND CASE NO: 07-187 of a subpoena for documents and things pursuant MCS onlbehalf of JOHN MCGREEVEY, ESQ. certifies that I (1) A notice of ntent to serve the subpoena with a copy of the subpoena attached the eto was mailed or delivered to each party at least twenty days rior to the date on which the subpoena is sought to be served, (2) A copy of th notice of intent, attached to this certificate, including the proposed subpoena, is (3) No objection!,to the subpoena has been received, and (4) The subpoenalwhich will be served is identical to the subpoena which is attached to the notice of intent to serve the subpoena. DATE: 09/13/2007 CERTIFICATE yr P V SITS TO SERVICE OF A SUBPOENA 'IN ' ? 1 PURSUANT TO RULE 4009.22 COURT OF COMMON PLEAS -VS n be OHN MCGRS ESQ. Attorney for DEFENDANT R1.42 133-H DE11-0710707 99210-L12 H OF PENNSYLVANIA IN THE MATTER O] MORRISON OF CUMBERLAND COURT OF COMMON PLEAS TERM, CASE NO: 07-187 BORAN KEYSTONE HEALTH PLAN CENTRAL INSURANCE MEDICARE INSURANCE FAMILY HOME MEDICAL, C. MEDICAL RECORDS & BILLING GIANT FOODS LLC LEGAeDEPT PRESCRIPTION/PHARMACEUTICAL RECORDS TO: MICHAEL J. NAVITSK , ESQ., PLAINTIFF COUNSEL MCS on behalf of JOHN CGREEVEY, ESQ. intends to serve a subpoena identical to the one that is attached to this notice. You have twenty (20) days from the date listed below in which to file of record and serve upon the undersigned an objects n to the subpoena. If the twenty day notice period is waived or if no object on is made, then the subpoena may be served. Complete copies of any reproduc d records may be ordered at your expense by completing the attached counsel c rd and returning same to MCS or by contacting our local MCS office. DATE: 08/24/2007 ill MCS on behalf of CC: JOHN MCGREEVEY, ESQ. Any questions f R1.41S 133-H 185-157 this matter, contact JOHN MCGREEVEY, ESQ. Attorney for DEFENDANT THE MCS GROUP INC. 1601 MARKET STREET #800 PHILADELPHIA, PA 19103 (215) 246-0900 D802-0372354 99210 -CO1 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND MORRISON VS. BORAN TO: Custodian of Records Within twenty (20) days after documents or things: **** at File No. 07-187 (Name of Person or Entity) of this subpoena, you are ordered by the court to produce the following rrACHED RIDER **** You may deliver or mail legible] copies of the documents or produce things requested by this subpoena, together with the certificate of compliance, to the party making this request at the address listed above. You have the right to seek, in advance, the reasonable cost of preparing the copies or producing the things sought. If you fail to produce the is 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: JOHN MCGREEVEY. ESQ. ADDRESS: 630 WEST GERMANTOWN PIKE TELEPHONE:. 215) -•--,- SUPREME COURT ID #: ATTORNEY FOR: Defend int BY THE COURT: Prothonotary/Clerk, Civil 19vision Date: Dep Seal of the Court 99210-12 E) MANATION OF REQUIRED RECORDS II i TO: CUSTODIAN OF RECORDS FOR: GIANT FOODS LLC L GAL DEPT 1149 HARRISBURG PI E CARLISLE, PA 17013 RE: 99210 DONALD L. MORRISONj Prior approval is required for fees in excess of $150.00 for hospitals, $100.00 for all other providers. STORE #112.255 S.?SPRING GARDEN STREET, CARLISLE, PA 17013 Entire prescripts n and/or pharmaceutical file, including but not limited to any and all records, reports, correspondence, memoranda, complete history and payment records, ncluding any and all such items as may be stored in a computer databasel,or otherwise in electronic form, pertaining to: Dates Requested: up to and including the present. Subject : DONALD 4. MORRISort 1942 RESERVOIR DRIVE, CARLISLE, PA 17013 Social Security #? XXX-XX-4071 Date of Birth: 01114-1942 R1.41S 133-H SU10-0701918 99210-L12 ra t? -?s ? ?`? ?f ;? „- fia? -3 ?=i ti:? -t3 ?;? C? C?; N ?. ? ? N :?. DONALD L. MORRISON, and IN THE COURT OF COMMON PLEAS SHARON A. MORRISON, his wife, CUMBERLAND COUNTY, PENNA Plaintiffs, NO. 2007-00187 VS. CIVIL ACTION MEDICAL PROFESSIONAL LIABILITY ROBERT P. BORAN, JR., M.D., JURY TRIAL DEMANDED Defendant PLAINTIFFS' MOTION REQUESTING THE COURT TO SCHEDULE A CASE MANAGEMENT CONFERENCE AND TO ISSUE A SCHEDULING ORDER PURSUANT TO PA. R.C.P. 1042.41 AND NOW, come the Plaintiffs, Donald L. Morrison and Sharon A. Morrison, his wife, by and through their attorneys, Navitsky, Olson & Wisneski LLP and hereby move Your Honorable Court to schedule a Case Management Conference and to issue a Scheduling Order in the above-captioned case for the following reasons: 1. This is a medical negligence action that was commenced via the filing of a Writ of Summons on or about January 8, 2007. 2. Plaintiff's Complaint was filed on or about March 29, 2007. 3. Defendant's Answer to Plaintiffs' Complaint was filed on or about July 11, 2007. A copy of the Answer, including the Certificate of Service, is attached hereto as Exhibit "A". 4. Discovery in this case has been ongoing. 5. Pursuant to Pa. R.C.P. 1042.41, Plaintiffs respectfully request that the Court schedule a Case Management Conference in order to set a timetable for the completion of discovery and the production of expert reports. 6. Plaintiffs believe that it would also be beneficial, given counsels' trial calendars and the necessity of scheduling expert witnesses, to discuss possible trial dates during the course of such a conference. WHEREFORE, Plaintiffs respectfully request Your Honorable Court to schedule a Case Management Conference in the above-captioned case, and, following such Conference, to issue a Scheduling Order. Respectfully submitted, NAVITSKY, OL$PN & WISNESKI LLP David S. Wisneski, Esquire I.D. No.58796 2040 Linglestown Road, Suite 303 Harrisburg, PA 17110 717/541-9205 Counsel for Plaintiffs Date: September 9, 2008 71 -01) KILCOYNE & NESBITT, LLC BY: JOHN F. McGREEVEY ATTY. ID. #64610 630 W. GERMANTOWN PIKE, SUITE 121 PLYMOUTH MEETING, PA 19462 610.825.2833 DONALD L. MORRISON and SHARON A. MORRISON, his wife, Plaintiffs ATTORNEY FOR DEFENDANT, ROBERT P. BORAN, JR., M.D. COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA No. 07-187 Civil Term V. ROBERT P. BORAN, JR., M.D. and ; APPALACHIAN ORTHOPEDIC CENTER; LTD.,: Defendants JURY TRIAL DEMANDED NOTICE TO PLEAD TO: Michael J. Navitsky, Esquire Duane S. Barrack, Esquire Navitsky, Olson & Wisneski, LLP 2040 Linglestown Road, Suite 303 Harrisburg, PA 17110 You are hereby notified to plead to the enclosed Answer and New Matter within twenty (20) days from service thereof or a default judgment may be entered against you. KILCOYNE & NESBITT, LLC BY: JO F. McGREEVE , ESQUIRE KILCOYNE & NESBITT, LLC ATTORNEY FOR DEFENDANT, BY: JOHN F. McGREEVEY ROBERT P. BORAN, JR., M.D. ATTY. ID. #64610 630 W. GERMANTOWN PIKE, SUITE 121 PLYMOUTH MEETING, PA 19462 610.825.2833 DONALD L. MORRISON and COURT OF COMMON PLEAS SHARON A. MORRISON, his wife, CUMBERLAND COUNTY, PA Plaintiffs No. 07-187 Civil Term V. ROBERT P. BORAN, JR., M.D. and APPALACHIAN ORTHOPEDIC CENTER, LTD.,: Defendants JURY TRIAL DEMANDED ANSWER WITH NEW MATTER OF DEFENDANT, ROBERT P. BORAN, JR., M.D., TO PLAINTIFFS' COMPLAINT Defendant, Robert P. Boran, Jr., M.D., by and through his attorneys, Kilcoyne & Nesbitt, LLC, hereby answers Plaintiffs' Complaint as follows: 1. Denied. After reasonable investigation, Answering Defendant is without sufficient knowledge or information to allow him to form a belief as to the truth of the averments in paragraph 1 of Plaintiffs' Complaint and, therefore, Defendant demands strict proof thereof at trial, if relevant. 2. Denied. After reasonable investigation, Answering Defendant is without sufficient knowledge or information to allow him to form a belief as to the truth of the averments in paragraph 2 of Plaintiffs' Complaint and, therefore, Defendant demands strict proof thereof at trial, if relevant. 3. Admitted. 4. Admitted. 5. Admitted in part. Denied in part. It is admitted that Answering Defendant, Robert P. Boran, Jr., M.D., was an employee of Defendant, Appalachian Orthopedic Center, Ltd., during the relevant times of this action. The remaining allegations are denied pursuant to PA. R.C.P. 1029(e). 6. The allegations contained in paragraph 6 do not apply to Answering Defendant. 7. The allegations contained in paragraph 7 do not apply to Answering Defendant. 8. Admitted in part. Denied in part. It is admitted that at all times relevant herein, Answering Defendant, Robert P. Boran, Jr., M.D., was an employee of Defendant, Appalachian Orthopedic Center, Ltd., and was acting within his scope of employment while treating Plaintiff, Donald L. Morrison. The remaining allegations are denied pursuant to PA. R.C.P. 1029(e). 9. Denied. After reasonable investigation, Answering Defendant is without sufficient knowledge or information to allow him to form a belief as to the truth of the averments in paragraph 9 of Plaintiffs' Complaint and, therefore, Defendant demands strict proof thereof at trial, if relevant. 10.408. Denied. Pursuant to Pennsylvania Rule of Civil Procedure 1029(e), no further response is required. WHEREFORE, Defendant, Robert P. Boran, Jr., M.D., demands judgment in his favor and against Plaintiffs together with attorneys' fees and costs. COUNTI Donald L. Morrison and Sharon A. Morrison, his wife, v. Robert P. Boran, Jr., M.D. 109. Answering Defendant hereby incorporates paragraphs 1 through 108 inclusive as though fully set forth at length herein. 110. Admitted in part. Denied in part. It is admitted that at all times relevant to Mr. Morrison's admission to Carlisle Regional Medical Center, Defendant, Robert P. Boran, Jr., M.D., was an employee of Defendant, Appalachian Orthopedic Center, Ltd. The remaining allegations area denied pursuant to PA. R.C.P. 1029(e). 111.-113. Denied. Pursuant to Pennsylvania Rule of Civil Procedure 1029(e), no further response is required. WHEREFORE, Defendant, Robert P. Boran, Jr., M.D., demands judgment in his favor and against Plaintiffs together with attorneys' fees and costs. COUNT II Donald L. Morrison and Sharon A. Morrison v Appalachian Orthopedic Center, Ltd 114. Answering Defendant hereby incorporates paragraphs 1 through 113 inclusive as though fully set forth at length herein. 115. - 120. The allegations contained in paragraphs 115 through 120 do not apply to Answering Defendant. WHEREFORE, Defendant, Robert P. Boran, Jr., M.D., demands judgment in his favor and against Plaintiffs together with attorneys' fees and costs. COUNT III Sharon A. Morrison v. Robert P. Boran, Jr., M.D., and Appalachian Orthopedic Center, Ltd 121. Answering Defendant hereby incorporates paragraphs 1 through 120 inclusive as though fully set forth at length herein. 122. - 124. Denied. Pursuant to Pennsylvania Rule of Civil Procedure 1029(e), no further response is required. WHEREFORE, Defendant, Robert P. Boran, Jr., M.D. demands judgment in his favor and against Plaintiffs together with attorneys' fees and costs. NEW MATTER 125. At all times material hereto, Answering Defendant's treatment of the Plaintiff was in accordance with accepted standards of medical care at the time and place of the treatment. 126. The Complaint, in whole or in part, fails to state a cause of action upon which relief can be granted. 127. Plaintiffs' claims are barred by operation of the applicable statute of limitations. 128. If Plaintiffs sustained the injuries alleged, which injuries are specifically denied, said injuries may have been the result of the negligent or careless acts and/or omissions of Plaintiff and/or other persons and/or entities over whom Answering Defendant exercised no control. 129. Plaintiffs' claims may be barred or the amounts recoverable therefrom reduced by operation of the Pennsylvania Comparative Negligence Act 42 Pa. C.S.A. Section 7102 et seq. 130. Plaintiffs' claims may be barred by the doctrine of assumption of risk. 131. Plaintiffs' claims may be barred by the doctrine of superseding and/or intervening cause. 132. Plaintiff gave a fully informed consent to the medical treatment rendered by Answering Defendant. 133. Plaintiffs' claims are subject to, and limited by, the Healthcare Services Malpractice Act of 1975, as amended. 134. Plaintiffs' claims are subject to, and limited by, the MCare Act of 2003. 135. If there is a judicial determination that Pa. R.C.P. 238 is unconstitutional, said constitutionality being expressly challenged as a violation of the due process and the equal protection clauses of the 14'h Amendment of the United States Constitution; 42 U.S.C. Section 1983; Article I, Section 1, 6, 11, 26; and Article V, Section 10 (c) of the Pennsylvania Constitution, then payment of interest shall be suspended for any period of delay not occasioned by Answering Defendant. 136. Plaintiffs' claim is barred by the doctrine of release. WHEREFORE, Defendant, Robert P. Boran, Jr., M.D., demands judgment in his favor and against Plaintiffs together with attorneys' fees and costs. Respectfully submitted, KILCOYNE & NESBITT, LLC BY: F. McGREEVEY Attorney for Defendant, Robert P Bor , Jr., M.D. DATED: ' Iq/©-7 VERIFICATION I, Robert P. Boran, Jr., M.D., make this verification subject to the penalties of 18 Pa. C.S.A. Section 4904 relating to unworn falsification to authorities. The attached Answer with New Matter to Plaintiffs' Complaint is based upon information which I have furnished to my counsel and information which has been gathered by counsel in preparation for the defense of this lawsuit. The language contained in the Answer to Plaintiffs' Complaint is that of my counsel and not of me. I have read the Answer to Plaintiffs' Complaint, and, to the extent that it is based upon information which I have given to my counsel, it is true and correct to the best of my knowledge, information and belief. To the extent that the contents of the Answer are that of counsel, I have relied upon my counsel in making this verification. ROBERT P. BORAN, JR., MJb. KILCOYNE & NESBITT, LLC BY: JOHN F. McGREEVEY ATTY. ID. #64610 630 W. GERMANTOWN PIKE, SUITE 121 PLYMOUTH MEETING, PA 19462 610.825.2833 DONALD L. MORRISON and SHARON A. MORRISON, his wife, Plaintiffs V. ATTORNEY FOR DEFENDANT, ROBERT P. BORAN, JR., M.D. COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA No. 07-187 Civil Term ROBERT P. BORAN, JR., M.D. and APPALACHIAN ORTHOPEDIC CENTER, LTD.,: Defendants JURY TRIAL DEMANDED CERTIFICATE OF SERVICE I, John F. McGreevey, Esquire, hereby certify that a true and correct copy of the Answer with New Matter of Defendant, Robert P. Boran, Jr., M.D., to Plaintiffs' Complaint, was served upon all counsel of record via first class United States Mail, postage prepaid. Michael J. Navitsky, Esquire Duane S. Barrack, Esquire Navitsky, Olson & Wisneski, LLP 2040 Linglestown Road, Suite 303 Harrisburg, PA 17110 F F. McGREE QVEY, ESQUIRE DATED: ?%/0 7 CERTIFICATE OF SERVICE I, Lois E. Stauffer, an employee of the law firm of Navitsky, Olson & Wisneski LLP, do hereby certify that I am this 6N1 day of September, 2008 serving a true and correct copy of Plaintiffs' Motion Requesting the Court to Schedule a Case Management Conference and to Issue a Scheduling Order Pursuant to Pa. R.C.P. 1042.41 upon all counsel of record via postage prepaid first class United States mail addressed as follows: John F. McGreevey, Esquire Kilcoyne & Nesbitt, LLC Plymouth Meeting Executive Campus 630 West Germantown Pike, Suite 121 Plymouth Meeting, PA 19462 Counsel for Defendant Boran Lois E. Stauffer E'? :. -?r , : ? --? ....,. c? - r, .,? ??'- ?,-' r'' i? . . r•? i^`7 n, ? DONALD L. MORRISON, and SHARON A. MORRISON, his wife, Plaintiffs, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA NO. 2007-00187 vs. CIVIL ACTION MEDICAL PROFESSIONAL LIABILITY ROBERT P. BORAN, JR., M.D., JURY TRIAL DEMANDED Defendant PLAINTIFFS' AMENDED MOTION REQUESTING THE COURT TO SCHEDULE A CASE MANAGEMENT CONFERENCE AND TO ISSUE A SCHEDULING ORDER PURSUANT TO PA. R.C.P. 1042.41 AND NOW, come the Plaintiffs, Donald L. Morrison and Sharon A. Morrison, his wife, by and through their attorneys, Navitsky, Olson & Wisneski LLP and hereby move Your Honorable Court to schedule a Case Management Conference and to issue a Scheduling Order in the above-captioned case for the following reasons: This is a medical negligence action that was commenced via the filing of a Writ of Summons on or about January 8, 2007. 2. Plaintiff's Complaint was filed on or about March 29, 2007. 3. Defendant's Answer to Plaintiffs' Complaint was filed on or about July 11, 2007. A copy of the Certificate of Service for the Answer is attached hereto as Exhibit "A". 4. Discovery in this case has been ongoing. 5. Pursuant to Pa. R.C.P. 1042.41, Plaintiffs respectfully request that the Court schedule a Case Management Conference in order to set a timetable for the completion of discovery and the production of expert reports. 6. Plaintiffs believe that it would also be beneficial, given counsels' trial calendars and the necessity of scheduling expert witnesses, to discuss possible trial dates during the course of such a conference. 7. The Honorable Wesley J. Oler, Jr. previously ruled on a Stipulation to Dismiss Defendant Appalachian Orthopedic Center, Ltd. from this case. 8. Plaintiff sought the concurrence of John F. McGreevey, Esquire, who is counsel for Defendant, Robert P. Boran, Jr., M.D., on September 24, 2008, and Attorney McGreevey granted his concurrence to this Motion. WHEREFORE, Plaintiffs respectfully request Your Honorable Court to schedule a Case Management Conference in the above-captioned case, and, following such Conference, to issue a Scheduling Order. Respectfully submitted, NAVITSKY, OLS„ON & WISNESKI LLP David S. Wisiieski, Esquire I.D. No.58796 2040 Linglestown Road, Suite 303 Harrisburg, PA 17110 717/541-9205 Counsel for Plaintiffs Date: September 25, 2008 -2- KILCOYNE & NESBITT, LLC BY: JOHN F. McGREEVEY ATTY. ID.#64610 ATTORNEY FOR DEFENDANT, ROBERT P. BORAN, JR., M.D. 630 W. GERMANTOWN PIKE, SUITE 121 PLYMOUTH MEETING, PA 19462 610.825.2833 DONALD L. MORRISON and SHARON A. MORRISON, his wife, Plaintiffs COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA V. No. 07-187 Civil Term ROBERT P. BORAN, JR., M.D. and APPALACHIAN ORTHOPEDIC CENTER, LTD.,: Defendants JURY TRIAL DEMANDED CERTIFICATE OF SERVICE I, John F. McGreevey, Esquire, hereby certify that a true and correct copy of the Answer with New Matter of Defendant, Robert P. Boran, Jr., M.D., to Plaintiffs' Complaint, was served upon all counsel of record via first class United States Mail, postage prepaid. Michael J. Navitsky, Esquire Duane S. Barrack, Esquire Navitsky, Olson & Wisneski, LLP 2040 Linglestown Road, Suite 303 Harrisburg, PA 17110 F Q F. McGREEVEY, ESQUIRE DATED: ?9/D 7 CERTIFICATE OF SERVICE I, Lois E. Stauffer, an employee of the law firm of Navitsky, Olson & Wisneski LLP, do hereby certify that I am this 25th day of September, 2008 serving a true and correct copy of Plaintiffs' Amended Motion Requesting the Court to Schedule a Case Management Conference and to Issue a Scheduling Order Pursuant to Pa. R.C.P. 1042.41 upon all counsel of record via postage prepaid first class United States mail addressed as follows: John F. McGreevey, Esquire Kilcoyne & Nesbitt, LLC Plymouth Meeting Executive Campus 630 West Germantown Pike, Suite 121 Plymouth Meeting, PA 19462 Counsel for Defendant Boran Lois E. Stauffer ? i C., ? ? ?_ ^?1 ?`, ?? S- ' V '.,,a S'_ , ??? •, j. DONALD L. MORRISON and IN THE COURT OF COMMON PLEAS OF SHARON A. MORRISON, CUMBERLAND COUNTY, PENNSYLVANIA his wife, : Plaintiffs V. CIVIL ACTION - LAW ROBERT P. BORAN, JR., M.D., Defendant NO. 07-187 CIVIL TERM ORDER OF COURT AND NOW, this P day of October, 2008, upon consideration of Plaintiffs' Motion and Amended Motion Requesting the Court To Schedule a Case Management Conference and To Issue a Scheduling Order Pursuant to Pa. R.C.P. 1042.41, a status conference is scheduled in chambers of the undersigned judge for Thursday, December 4, 2008, at 2:30 p.m. BY THE COURT, /David S. Wisneski Esq. 2040 Linglestown Road Suite 303 Harrisburg, PA 17110 A orney for Plaintiffs John F. McGreevey, Esq. 630 W. Germantown Pike Suite 121 Plymouth Meeting, PA 19462 Attorney for Defendant :rc ap I ES r &C-L . £ :I Wd E-130 8002 X1(1 v i` lip 3Hi --'SO 3011?_?i -031Y '. R DONALD L. MORRISON and IN THE COURT OF COMMON PLEAS OF SHARON A. MORRISON, CUMBERLAND COUNTY, PENNSYLVANIA Plaintiffs V. CIVIL ACTION - LAW ROBERT P.B ORAN,JR., M.D., : Defendant 07-187 CIVIL TERM ORDER OF COURT AND NOW, this 4th day of December, 2008, upon consideration of Plaintiffs' Motion and Amended Motion Requesting the Court To Schedule a Case Management Conference and To Issue a Scheduling Order Pursuant to Pa. R.C.P. 1042.41 and following a status conference held in the chambers of the undersigned judge on this date in which Plaintiffs were represented by David S. Wisneski, Esquire, and Defendant was represented by Mark J. Hermanovich, Esquire, standing in for John J. McGreevey, Esquire, and pursuant to an agreement of counsel it is ordered and directed as follows: 1. General discovery in this case shall be complete as of March 1, 2009; 2. Any expert report of Plaintiffs' shall be furnished to Defendant's counsel on or before May 1, 2009; 3. Any expert report of Defendant shall be furnished to Plaintiffs' counsel on or before July 1, 2009; 4. Any rebuttal expert report of Plaintiffs' shall be furnished to Defendant's counsel on or before August 1, 2009; and 5. Either counsel may list this case for trial at any time after August 1, 2009. By the Court, t ' 1 :9 WV 01 030 OOZ ?kldl(}i%r-t?ucci lu Jo 301:440-? w David S. Wisneski, Esquire 2040 Linglestown Road Ste. 303 Harrisburg, PA 17110 For the Plaintiffs Mark J. Hermanovich, Esquire e.? 630 W. Germantown Pike Ste 121 Plymouth Meetin For the Defendant PA 19462 pcb PRAECIPE FOR LISTING CASE FOR TRIAL (Must be typewritten and submitted in triplicate) TO THE PROTHONOTARY OF CUMBERLAND COUNTY 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) (check one) DONAID L. MDRRI90N and IRON A. 0 Civil Action - Law M WI90N, bis wife ? Appeal from arbitration (other) (Plaintiff) vs. The trial list will be called on October 20, 2009 and ROBERT P. DORAN, JR., M.D. Trials commence on November 16, 2009 (Defendant) Pretrials will be held on October 28, 2009 VS. (Briefs are due S days before pretrials No. 2007-00187 Term Indicate the attorney who will try case for the party who files this praecipe: David S. Wisneski, Esquire Indicate trial counsel for other parties if known: John F. McGreevey, Esquire This case is ready for trial. Signed: Print Name: David S. Wisneski Date: ` - 18-o 9 Attorney for: Plaintiffs r SV' OF 7VI PRAECIPE FOR LISTING CASE FOR TRIAL (Must be typewritten and submitted in triplicate) TO THE PROTHONOTARY OF CUMBERLAND COUNTY 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) (check one) DO1" L. MIRRISQJ, and SHARON A. ? Civil Action - Law MOMISOT, his rife ? Appeal from arbitration ® Civil ActiM - Medical (other) Prafessic ml Liability (Plaintiff) vs. RDBERT P. BORAN, JR., M.D. VS. (Defendant) The trial list will be called on JaMa y 5, 2010 and Trials commence on February 1, 2010 Pretrials will be held on January 13, 2010 (Briefs are due S days before pretrials No. 2007-00187 Term Indicate the attorney who will try case for the party who files this praecipe: David Wisneski, Esquire Indicate trial counsel for other parties if known: John F. McGreevey, Esquire This case is ready for trial. Signed: l OLI V Davi S. Wisneski Print Name: Date: October 20, 2009 Plaintiffs Attorney for: Cn/ TI FILED-1-1 OF - 1 f „J 2004 OCT 21 PAS J• 0 Ca.aPti? ? LV. I, 'N m Po N CO 1l56to gr* a3a343. DONALD L. MORRISON AND SHARON A. MORRISON, HIS WIFE, Plaintiffs V ROBERT P. BORAN, JR., M.D., Defendant No. 13 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW 07-187 CIVIL TERM IN RE: CASE STRICKEN FROM LIST ORDER OF COURT AND NOW, this 20th day of October, 2009, upon consideration of the call of the civil trial list, and counsel for the Defendant in the above-captioned matter having requested a continuance of the trial, and counsel for the Plaintiff in the person of David S. Wisneski, Esquire, having indicated his acquiesce in that request, the case is stricken from the trial list, and counsel are directed to relict it as such time as they deem appropriate. By the Court, David S. Wisneski, Esquire 2040 Linglestown Road Suite 303 Harrisburg, PA 17110 For Plaintiff John F. McGreevey, Esquire Hickory Pionte Suite 216 2250 Hickory Road Plymouth Meeting, PA 19462 For Defendant Court Administrator : mae (20PI " r t , OF 7HE PROTHONOTARY 209 OCT 26 AN 10, 16 KILCOYNE & NESBITT, LLC BY: ELAINE M. ROSS ATTY. ID. #46031 630 W. GERMANTOWN PIKE, SUITE 121 PLYMOUTH MEETING, PA 19462 610.825.2833 DONALD L. MORRISON and SHARON A. MORRISON, his wife ATTORNEY FOR DEFENDANT, ROBERT P. BORAN, JR., M.D. COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA V. NO. 07-187 Civil Term ROBERT B. BORAN, JR., M.D. and JURY TRIAL DEMANDED APPALACHIAN ORTHOPEDIC CENTER, LTD. WITHDRAWAL OF APPEARANCE TO THE PROTHONOTARY: Kindly withdraw of appearance on behalf of defendant, ROBERT B. BORAN, JR., M.D., in connection with the above-captioned matter. KILCOYNE & NESBITT, LLC By: JA 4E P. KILCOYNE, ES Date: 1 lz?ld QUIRE ENTRY OF APPEARANCE TO THE PROTHONOTARY: Kindly enter my appearance on behalf of defendant, ROBERT B. BORAN, JR., M.D., in connection with the above-captioned matter. KILCOYNE & NESBITT, LLC By: ELAINE M. ROSS, ESQUIRE Date: ,d' G' KILCOYNE & NESBITT, LLC BY: ELAINE M. ROSS ATTY. ID. #46031 630 W. GERMANTOWN PIKE, SUITE 121 PLYMOUTH MEETING, PA 19462 610.825.2833 DONALD L. MORRISON and SHARON A. MORRISON, his wife vi. ; ROBERT B. BORAN, JR., M.D. and APPALACHIAN ORTHOPEDIC CENTER, LTD. ATTORNEY FOR DEFENDANT, ROBERT P. BORAN, JR., M.D. COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA NO. 07-187 Civil Term JURY TRIAL DEMANDED CERTIFICATE OF SERVICE I, Elaine M. Ross, Esquire, hereby certify that a true and correct copy of the foregoing Withdrawal of Appearance and Entry of Appearance, was forwarded to the following counsel of record by first-class mail, postage prepaid: Michael J. Navitsky, Esquire Navitsky, Olson & Wisneski, LLP 2040 Linglestown Road, Suite 303 Harrisburg, PA 17110 KILCOYNE & NESBITT, LLC By: Date: ELAINE M. ROSS, ESQUIRE ?? 61 FUQ, ?CE- 2099 DEC 30 PH, 1: 2 t, Cully" t v4, Y { S.?. T4i,'i i,Grl..l?ib'?•?`U it . KILCOYNE & NESBITT, LLC BY: ELAINE M. ROSS ATTY. ID. #46031 By: MARK J. HERMANOVICH ATTY. ID. #200812 630 W. GERMANTOWN PIKE, SUITE 121 PLYMOUTH MEETING, PA 19462 610.825.2833 DONALD L. MORRISON and SHARON A. MORRISON, his wife, Plaintiffs Vi. ATTORNEY FOR DEFENDANT, ROBERT P. BORAN, JR.,X.D^, K a! ?D C-' ,L rn 4ul COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA No. 07-187 Civil Term ROBERT P. BORAN, JR., M.D. and APPALACHIAN ORTHOPEDIC CENTER, LTD.,: Defendants Assigned to the Honorable J. Wesley Oler, J. JURY TRIAL DEMANDED PETITION FOR CONTINUANCE OF TRIAL, FILED ON BEHALF OF DEFENDANT, ROBERT P. BORAN, JR., M.D. AND NOW, come the Petitioning Defendant, Robert P. Boran, Jr., M.D., by and through his counsel, Kilcoyne & Nesbitt, LLC, respectfully request a Continuance of the Trial in the instant matter, currently scheduled to commence on February 1, 2101, and in support thereof, aver as follows: 1. This is a medical malpractice case arising out of the treatment of Plaintiff- husband by Dr. Boran at Carlisle Regional Medical Center for right total knee arthroplasty. 2. Trial in this matter is scheduled to commence with jury selection on February 1, 2101. The attachment was entered by order per call of the Trial list on January 5, 2010. At that time, trial counsel, Elaine M. Ross, informed the Court that the she was already attached in two other matters, one beginning on February 1, 2010 (Snyder v. Respet, M.D., et. al., Lehigh Co. CCP No. 2007-C-1270) and another on February 2, 2010 (McCormick v. Gupta, M.D, et. al., Monroe Co. No. 10391 CIVIL 2004). 3. Moreover, besides Attorney Ross' three (3) Trial attachments between 2/1/10 and 2/2/10 (i.e., Morrison v Boran, M.D., Snyder v. Respet, M.D. and McCormick v. Gupta, M.D.,), the remaining three (3) Trial attorneys at Kilcoyne & Nesbitt, LLC are attached for the following five (5) Trials which commence between 1/25/10 and 2/05/10: (1) 1/25/10 - Bohnhorst v. Mackell, M.D., et. al., Bucks Co. No. 07-10093; (2) 2/01/10 - Zullo v. Stahl, M.D., et. al., Luzerene Co. CCP No. 1998 C 2003; (3) 2/01/10 - Est. of Parker v. Hartley, M.D., et al., Lancaster Co. CCP No. CI-07- 05634; (4) 2/1/10 - Nace v Westphal, Lancaster Co. CCP No. CI-06-06041; and, (5) 2/05/10 - Schlenger v. Doghramji, M.D., et al. Philadelphia Co. C.C.P. No. 07- 03040. 4. Accordingly, it is clear that Attorney Ross and the remaining Trial attorneys from Kilcoyne & Nesbitt, LLC are unavailable due to previous Trial attachments. 5. Additionally, Dr. Boran cannot find a physician who can cover his office hours and other duties, as he is a solo-practitioner. Dr. Boran's patients, office visits and surgeries are booked 6 weeks in advance, i.e., through the end of February 2010. As such, ordering that Dr. Boran close his practice for a week long trial would be unreasonable and an undue burden on Dr. Boran, and more importantly, Dr. Boran's patients will suffer as well. 6. Pennsylvania Rule of Civil Procedure 216(A)(4) permits a continuance of trial based upon "such special ground as may be allowed in the discretion of the court." 7. It is respectfully submitted that the above-detailed conflict as well as the undue burden of closing of Defendant's practice qualify as a special ground upon which this Honorable Court may grant a continuance of trial. 8. Undersigned counsel respectfully requests that this Honorable Court grant the instant Petition for Continuance of Trial and direct that a conference be scheduled to determine a date certain for the trial of this matter that is suitable for all parties. 9. The reasons set forth herein are valid and not interposed for the purpose of delay or inconvenience. WHEREFORE, the Petitioning Defendant, Robert P. Boran, Jr., M.D., respectfully request that this Honorable Court grant the instant Petition and issue a Continuance of the Trial in this matter. Respectfully submitted, KILCOYNE & NESBITT, LLC BY: ELAINE M. ROSS ESQUIRE MARK J. HERMANOVICH, ESQUIRE Attorneys for Defendant, Robert P. Boran, Jr., M.D. Date: VERIFICATION I, Mark J. Hermanovich, Esquire, hereby depose and state that I am the attorney for the Defendant, Robert P. Boran, Jr., M.D., in the action herein, that I have reviewed the Petition for a Continuance and that the facts contained therein are true and correct to the best of my information and belief. I understand that the statements made herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsifications to authorities. MARK J. HERMANOVICH, ESQUIRE DATE: KILCOYNE & NESBITT, LLC BY: ELAINE M. ROSS ATTY. ID. #46031 By: MARK J. HERMANOVICH ATTY. ID. #200812 630 W. GERMANTOWN PIKE, SUITE 121 PLYMOUTH MEETING, PA 19462 610.825.2833 ATTORNEY FOR DEFENDANT, ROBERT P. BORAN, JR., M.D. DONALD L. MORRISON and COURT OF COMMON PLEAS SHARON A. MORRISON, his wife, CUMBERLAND COUNTY, PA Plaintiffs No. 07-187 Civil Term vii. ROBERT P. BORAN, JR., M.D. and APPALACHIAN ORTHOPEDIC CENTER, LTD.,: Defendants JURY TRIAL DEMANDED CERTIFICATE OF SERVICE I, Mark J. Hermanovich, Esquire, hereby certify that a true and correct copy of the Pre- Trial Memorandum of Defendant, Robert P. Boran, Jr., M.D., was served by first class mail, postage prepaid upon the following on the date below: Michael J. Navitsky, Esquire Duane S. Barrack, Esquire Navitsky, Olson & Wisneski, LLP 2040 Linglestown Road, Suite 303 Harrisburg, PA 17110 Counsel for Plaintiff MARK J. HERMANOVICH DATED: DONALD L. MORRISON, and SHARON A. MORRISON, his wife, Plaintiffs, IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA NO. 2007-00187 VS. CIVIL ACTION MEDICAL PROFESSIONAL LIABILITY ROBERT P. BORAN, JR., M.D., JURY TRIAL DEMANDED Defendant PRAECIPE FOR ENTRY OF APPEARANCE Please enter my appzarance as co-counsel for the Plaintiffs in the above-captioned action. Respectfully submitted, Date: January 11, 2010 NAVITSKY, OLSON & WISNESKI LLP 7c Jos . Melillo I. o. 26211 2040 Lin lestown Road Suite 303 < `= ° " Harrisburg, PA 17110 - :z r„Z 717/541-9205 "-` .) r Counsel for Plaintiffs M1j W = rri , CERTIFICATE OF SERVICE I, Lois E. Stauffer, an employee of the law firm of Navitsky, Olson & Wisneski LLP, do hereby certify that I am this 11th day of January serving a true and correct copy of Praecipe for Entry of Appearance upon all counsel of record via postage prepaid first class United States mail and via facsimile addressed as follows: Elaine M. Ross Kilcoyne & Nesbitt, LLC Plymouth Meeting Executive Campus 630 West Germantown Pike, Suite 121 Plymouth Meeting, PA 19462 Counsel for Defendant Boran Lois E. Stauffer DONALD L SHARON A wife, MORRISON and MORRISON, his Plaintiffs v IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW 07-187 CIVIL TERM ROBERT P. BORAN, JR., M.D.: and APPALACHIAN ORTHOPEDIC: CENTER, LTD., Defendants JURY TRIAL DEMANDED IN RE: ORAL MOTION FOR CONTINUANCE ORDER OF COURT n N ^? O =a Cn xi AND NOW, this 13th day of January, 2010, upon consideration of an oral motion of Defendants' counsel for a continuance of trial in this case, the motion is granted, conditioned upon Defendants filing a notice on or before the close of business on Tuesday, January 19, 2010, that Defendants are willing to submit to nonbinding mediation proceedings in this case in the interim. In the absence of such a filing, the Defendants' motion for a continuance is to be deemed denied without further Order of Court. Counsel are advised that they will need to relist this case for trial during the succeeding term of court if it is continued. Pursuant to an agreement of counsel, both counsel are attached for trial in this case during the April 2010 term of court if the case is continued from the forthcoming term. By the Court, ? / eph M. Melillo, Esquire 2040 Linglestown Road Suite 303 Harrisburg, PA 17110 For Plaintiffs Elaine M. Ross, Esquire 630 W. Germantown Pike Suite 121 Plymouth Meeting, PA 19462 For Defendants Court Administrator :mae m1a t DONALD L. MORRISON and SHARON A. MORRISON, his wife, Plaintiffs v ROBERT P. BORAN, JR., M.D.: and APPALACHIAN ORTHOPEDIC: CENTER, LTD., Defendants IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA CIVIL ACTION - LAW c>= CE iD '? 07-187 CIVIL TERM t? i- JURY TRIAL DEMANDED ° ' j 4X1 IN RE: PRETRIAL CONFERENCE A pretrial conference was held in the chambers of Judge Oler in the above-captioned case on Wednesday, January 13, 2010. Present on behalf of the Plaintiffs was Joseph M. Melillo, Esquire; present on behalf of Defendants was Elaine M. Ross, Esquire. This is a medical malpractice action for personal injury arising out of an allegedly delayed diagnosis and treatment of a decreased blood flow in Plaintiff Donald L. Morrison's lower right leg following knee surgery by Defendant. Plaintiff Sharon A. Morrison sues for loss of consortium This will be a jury trial in which, pursuant to an agreement of counsel, each side will have 4 peremptory challenges, for a total of 8. The estimated duration of trial is 4 days. To the extent that any deposition testimony will be shown or read to the jury, and requires rulings by the trial court, counsel are directed to submit to the Court a copy of the affected transcript, with the areas of objection being pursued highlighted, and with brief memoranda in support of their respective positions on the objections, at least 5 days prior to commencement of the trial in the case. Defendants' counsel has orally requested a s continuance of the trial to the succeeding trial term based upon her attachment during the forthcoming trial term in another county, and based upon Defendant's schedule with respect to surgery on patients. Plaintiffs' counsel has indicated that he does not object to such a continuance, provided that Defendants will in the interim submit to nonbinding mediation. Defendants' counsel has indicated that she will file on or before the close of business on Tuesday, January 19, 2010, a notice indicating whether Defendant is willing to submit to such mediation efforts. By separate Order of Court, the Court will grant a continuance to the Defendants, but only on the condition that they file a timely notice of willingness to submit to nonbinding mediation efforts. With respect to settlement negotiations, Plaintiffs have made a demand for a rather substantial amount, but Defendants have not yet responded to that demand. By the Court, e esley O , ,,,Xi5oseph M. Melillo, Esquire 2040 Linglestown Road Suite 303 Harrisburg, PA 17110 For Plaintiffs laine M. Ross, Esquire 630 W. Germantown Pike Suite 121 Plymouth Meeting, PA 19462 For Defendants Court Administrator :mae KILCOYNE & NESBITT, LLC BY: ELAINE M. ROSS ATTY. ID. #46031 By: MARK J. HERMANOVICH ATTY. ID. 4200812 630 W. GERMANTOWN PIKE, SUITE 121 PLYMOUTH MEETING, PA 19462 610.825.2833 DONALD L. MORRISON and SHARON A. MORRISON, his wife, Plaintiffs V. ROBERT P. BORAN, JR., M.D. and APPALACHIAN ORTHOPEDIC CENTER, LTD.,: Defendants P-o ATTORNEY FOR DEFEN7° " JR. rNi;D. ROBERT P. BORAN , , -rim . ; r c=? ra rri COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA No. 07-187 Civil Term Assigned to the Honorable J. Wesley Oler, J. JURY TRIAL DEMANDED NOTICE OF AGREEMENT TO NEGOTIATION AND MEDIATION AND NOW, come the Defendant, Robert P. Boran, Jr., M.D., by and through his counsel, Kilcoyne & Nesbitt, LLC, hereby provides this Notice of Agreement to Negotiation and Mediation and avers as follows: 1. This is to certify that Defendant, Robert P. Boran, Jr., M.D., as agreed to participate in a Mediation with Plaintiffs on February 18, 2010. 2. Accordingly, it is respectfully requested that this Honorable Court remove this matter from the February 2010 Trial list and place it on the April Trial list. WHEREFORE, Defendant, Robert P. Boran, Jr., M.D., respectfully requests that this Honorable Court remove this matter from the February 2010 Trial list and place it on the April 2010 Trial list as the parties have agreed to Mediate this matter on February 18, 2010. Respectfully submitted, KILCOYNE & NNEESBIT , LC BY: ""O? " < ELAINE M. ROSS, ESQUIRE MARK J. HERMANOVICH, ESQUIRE Attorneys for Defendant, Date: Robert P. Boran, Jr., M.D. VERIFICATION I, Mark J. Hermanovich, Esquire, hereby depose and state that I am the attorney for the Defendant, Robert P. Boran, Jr., M.D., in the action herein, that I have reviewed the foregoing Notice of Agreement to Negotiation and Mediation and that the facts contained therein are true and correct to the best of my information and belief. I understand that the statements made herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsifications to authorities. /I - ?? Z/ /? Z? ? ? MARK J. HERMANOVICH, ESQUIRE DATE: f - / ???d KILCOYNE & NESBITT, LLC BY: ELAINE M. ROSS ATTY. ID. #46031 By: MARK J. HERMANOVICH ATTY. ID. #200812 630 W. GERMANTOWN PIKE, SUITE 121 PLYMOUTH MEETING, PA 19462 610.825.2833 DONALD L. MORRISON and SHARON A. MORRISON, his wife, Plaintiffs V1. ROBERT P. BORAN, JR., M.D. and APPALACHIAN ORTHOPEDIC CENTER, LTD.,: Defendants ATTORNEY FOR DEFENDANT, ROBERT P. BORAN, JR., M.D. COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA No. 07-187 Civil Term JURY TRIAL DEMANDED CERTIFICATE OF SERVICE I, Mark J. Hermanovich, Esquire, hereby certify that a true and correct copy of the Notice of Agreement to Negotiation and Mediation on Behalf of Defendant, Robert P. Boran, Jr., M.D., was served by Overnight Priority Mail, postage prepaid and via Facsimile upon the following on the date below: Joseph M. Melillo, Esquire Navitsky, Olson & Wisneski, LLP 2040 Linglestown Road, Suite 303 Harrisburg, PA 17110 Counsel for Plaintiff The Honorable J. Wesley Oler, Jr. Court of Common Pleas of Cumberland County One Courthouse Square Carlisle, PA 17013 MARK J. HERMANOVICH DATED: / r / S--/J -1 -VII0 PRAECIPE FOR LISTING CASE FOR TRIAL i r ZQIQ J.`,I? ZQ P2: S (Must be typewritten and submitted in triplicate) TO THE PROTHONOTARY OF CUMBERLAND COUNTY 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) (check one) DONALD L. MQRR15ON and SHARON A. ? Civil Action - Law NORRTSON, his wife ? Appeal from arbitration ® Civil Action - Medical Professional ;other) lity (Plaintiff) vs. The trial list will be called on March 30, 2010 ROBERT P. KORAN, JR., M.D. and Trials commence on April 26, 2010 (Defendant) Pretrials will be held on April 7, 2010 vs. (Briefs are due S days before pretrials No 2007-00187 Term Indicate the attorney who will try case for the party who files this praecipe: Joseph M. Melillo, Esquire Navitsky, Olson & Wisneski LLP, 2040 Lingle fawn Road, Suite 303 Harrisburg, PA 1.711.0 Indicate trial counsel for other parties if known: Elaine M. Ross, ]Squire Rileoyne & Nesbitt, 1W, Plymouth Meeting Exemitive (bus, 630 West Germantown Pike, Ste. 171, Plymouth IV in 7?:? <, This case is ready for trial. Signed: ?? Date: January 18, 2010 V Joteph M. Melillo Print Name: Attorney for: Plaintiffs 5.2s.oo ?cLr4? i2-lf- .2-3Z.9y1 CA- e4-- `T DONALD L. MORRISON and IN THE COURT OF COMMON PLEAS OF SHARON A. MORRISON, CUMBERLAND COUNTY, PENNSYLVANIA his wife, : Plaintiffs V. : CIVIL ACTION - LAW ROBERT P. BORAN, JR., M.D., and APPALACHIAN ORTHOPEDIC CENTER, LTD., Defendants NO. 07-187 CIVIL TERM ORDER OF COURT AND NOW, this 19'h day of January, 2010, upon consideration of the Petition for Continuance of Trial, Filed on Behalf of Defendant, Robert P. Boran, Jr., M.D., on January 13, 2010, and the court having issued an order on January 13, 2010, based upon an oral motion for a continuance made by the said Defendant's counsel at a pretrial conference on that date without being aware that a formal written motion had been filed, the written motion is deemed moot and the order issued on January 13, 2010, regarding a continuance shall remain in full force and effect. BY THE COURT, Michael J. Navitsky, Esq. Duane S. Barrack, Esq. 2040 Linglestown Road Suite 303 Harrisburg, PA 17110 Attorneys for Plaintiffs J. ., _ ? n v'1~ laine M. Ross, Esq. Mark J. Hermanovich, Esq. 630 W. Germantown Pike Suite 121 Plymouth Meeting, PA 19462 Attorney for Defendant Robert P. Boran, Jr., M.D. :rc c LEES entl-I L LC I 1. KILCOYNE & NESBITT, LLC BY: ELAINE M. ROSS ATTY. ID. 446031 By: MARK J. HERMANOVICH ATTY. ID. #200812 630 W. GERMANTOWN PIKE, SUITE 121 PLYMOUTH MEETING, PA 19462 610.825.2833 ATTORNEY FOR DEFENDANT, ROBERT P. BORAN, JR., M.D. DONALD L. MORRISON and SHARON A. MORRISON, his wife, 1 ' 'ff COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA P amts s ,. No. 07-187 Civil Terms vs. ROBERT P. BORAN, JR., M.D. and APPALACHIAN ORTHOPEDIC CENTER, LTD.,: -? Defendants JURY TRIAL DEMAI4PED cc MOTION IN LIMINE OF DEFENDANT, RICHARD P. BORAN, JR., M.D., TO PRECLUDE THE TESTIMONY OF LOUIS KOZLOFF, M.D. Defendant, Robert P. Boran, Jr., M.D., (hereinafter "Moving Defendant"), by and through his attorneys, Kilcoyne & Nesbitt, LLC, hereby files this Motion in Limine to Preclude the testimony of Louis Kozloff, M.D. pursuant to 40 P.S. § 1303.512, and in support thereof avers the following: 1. The Complaint was filed on or about March 29, 2007 and alleges negligence in the care and treatment of Plaintiff against Robert P. Boran, Jr., M.D. See Complaint at Exhibit "A „ 2. Plaintiffs' claims against Dr. Boran involve allegations of medical negligence from treatment rendered to him at Carlisle Regional Medical Center from January 24, 2006 through January 26, 2006. 3. As of the filing of this Motion, Plaintiff has produced the reports and C.V. of Louis Kozloff, M.D., a vascular surgeon. Dr. Kozloff is critical of the care rendered by Moving Defendant. See Dr. Kozloff s C. V. and Reports at Exhibit "B ". 4. Plaintiffs have also produced the Reports and C.V. of Gregory B. Shankman, M.D. an orthopedic surgeon. See Dr. Shankman's C. V. and Reports at Exhibit "C". 5. However, pursuant to Section 512 of the MCARE Act, Dr. Kozloff is not qualified to give expert testimony as to the standard of care against Moving Defendant because Dr. Boran is an orthopedic surgeon. 6. There is an irrefutable distinction between the standard of care of a vascular surgeon versus the standard of care of an orthopedic surgeon. 7. Accordingly, the instant Motion in Limine has been filed to preclude Dr. Kozloff from offering incompetent testimony against Dr. Boran because the Medical Care Availability and Reduction of Error Act (MCARE), 40 P.S. § 1303 et sea., prohibits expert witnesses from offering expert medical opinions in medical professional liability actions against physicians unless the person possesses sufficient education, training, knowledge and experience to provide credible, competent testimony. See 40 P.S. § 1303.512(a). 8. Plaintiffs may argue that Dr. Kozloff is qualified to testify as to standard of care against Moving Defendant under §512(d). However, even if this argument is made, Dr. Kozloff should still be precluded from testifying, as his report is cumulative of Dr. Gregory Shankman's anticipated testimony. 9. Plaintiffs should not be permitted to offer multiple expert witnesses on the standard of care, particularly since Dr. Kozloff is a vascular surgeon. Expert testimony as to Dr. Boran's standard of care by Dr. Shankman and Dr. Kozloff would amount to cumulative testimony. 10. Although relevant, evidence may be precluded if its probative value is outweighed by the danger of unfair prejudice, confusion of the issues, misleading the jury, or by considerations of undue delay, waste of time, or needless presentation of cumulative evidence. See Pa.R.E. 403. 11. Plaintiffs should be precluded from offering both Dr. Shankman and Dr. Kozloff as expert witnesses against Moving Defendant. Plaintiff should be limited to one standard of care expert. Allowing Plaintiffs to call multiple standard of care experts against Moving Defendant is not only cumulative and prejudicial to Moving Defendant, but results in the needless repetition of testimony. WHEREFORE, Defendant, Richard P. Boran, Jr. M.D., respectfully requests this Honorable Court grant his instant Motion and enter an Order in the form attached. Respectfully submitted, KILCOYNE & NESBITT, LLC BY: " ELAINE M. ROSS, ESQUIRE MARK J. HERMANOVICH, ESQUIRE Attorney for Defendant, Date: j/ U Richard P. Boran, Jr., M.D. KILCOYNE & NESBITT, LLC BY: ELAINE M. ROSS ATTY. ID. #46031 By: MARK J. HERMANOVICH ATTY. ID. #200812 630 W. GERMANTOWN PIKE, SUITE 121 PLYMOUTH MEETING, PA 19462 610.825.2833 ATTORNEY FOR DEFENDANT, ROBERT P. BORAN, JR., M.D. DONALD L. MORRISON and SHARON A. MORRISON, his wife, Plaintiffs vs. ROBERT P. BORAN, JR., M.D. and APPALACHIAN ORTHOPEDIC CENTER, LTD.,: Defendants COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA No. 07-187 Civil Term JURY TRIAL DEMANDED MEMORANDUM OF LAW IN SUPPORT OF THE MOTION INLIMINE OF DEFENDANT, RICHARD P. BORAN, JR., M.D., TO PRECLUDE THE TESTIMONY OF LOUIS KOZLOFF, M.D. Defendant, Richard P. Boran, Jr., M.D., (hereinafter "Moving Defendant"), by and through his attorneys, Kilcoyne & Nesbitt, LLC, hereby files this Memorandum of Law in support of his Motion in Limine: 1. FACTUAL AND PROCEDURAL BACKGROUND The Complaint was filed on or about March 29, 2007 and alleges negligence in the care and treatment of Plaintiff against Robert P. Boran, Jr., M.D. See Complaint at Exhibit "A ". Plaintiffs' claims against Dr. Boran involve allegations of medical negligence from treatment rendered to him at Carlisle Regional Medical Center from January 24, 2006 through January 26, 2006. As of the filing of this Motion, Plaintiff has produced the Reports and C.V. of Louis Kozloff, M.D., a vascular surgeon. Dr. Kozloff is critical of the care rendered by Moving Defendant, an orthopedic surgeon. See Dr. Kozloff's C. V. and Reports at Exhibit "B ". Plaintiffs have also produced the Reports and C.V. of Gregory B. Shankman, M.D. an orthopedic surgeon. See Dr. Shankman's C. V. and Reports at Exhibit "C". Dr. Shankman is also critical of Moving Defendant's care. II. STATEMENT OF QUESTION INVOLVED Whether a vascular surgeon (Dr. Kozloff) should be precluded from offering expert testimony against an orthopedic surgeon (Richard P. Boran, Jr., M.D.) since a vascular surgeon is not qualified to offer such evidence under MCARE, or in the alternative, because Dr. Kozloff s testimony is cumulative of Dr. Shankman's anticipated testimony? Suggested Answer: Yes III. ARGUMENT On May 19, 2002, the expert qualifications sections of the Medical Care Availability and Reduction of Error Act ("MCARE") became effective. See Wexler v. Hecht, 2004 Pa. Super. 1995, ¶21. Section 512 of MCARE, "Expert Qualifications," provides: (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) 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. See 40 P.S. § 1303, 512 (emphasis added). In the instant matter, Plaintiffs produced the Reports and C.V. of Louis Kozloff, M.D., a vascular surgeon. See Exhibit "B ". However, it is clear that pursuant to Section 512 of the MCARE Act, Dr. Kozloff is not qualified to give expert testimony against Moving Defendant because Dr. Kozloff is a vascular surgeon Dr. Boran is an orthopedic surgeon. This is so because there is an irrefutable distinction between the standard of care of a vascular surgeon and an orthopedic surgeon. Accordingly, pursuant to MCARE, Dr. Kozloff is clearly qualified to offer opinions regarding the standard of care for a vascular surgeon, and as such, he should be precluded from offering any expert medical opinions against Moving Defendant at trial. Plaintiffs may argue that Dr. Kozloff is qualified to testify as to standard of care against Moving Defendant under §512(d). However, even if this argument is made, Dr. Kozloff should still be precluded from testifying, as his report is cumulative of Dr. Shankman's anticipated testimony. Plaintiffs should not be permitted to offer multiple expert witnesses on the standard of care, particularly since only Dr. Shankman is an orthopedic surgeon. Expert testimony as to Dr. Boran's standard of care by Dr. Shankman and Dr. Kozloff would amount to cumulative testimony. Although relevant, evidence may be precluded if its probative value is outweighed by the danger of unfair prejudice, confusion of the issues, misleading the jury, or by considerations of undue delay, waste of time, or needless presentation of cumulative evidence. See Pa.R.E. 403. In this regard, Plaintiffs should be precluded from offering both Dr. Shankman and Dr. Kozloff as expert witnesses against Moving Defendant. Plaintiff should be limited to one standard of care expert. Allowing Plaintiffs to call multiple standard of care experts against Moving Defendant is not only cumulative and prejudicial to Moving Defendant, but results in the needless repetition of testimony. IV. CONCLUSION For all of the forgoing reasons, Defendant, Richard P. Boran, Jr., M.D., respectfully requests this Honorable Court grant his instant Motion and enter an Order in the form attached. Respectfully submitted, Date: ? 0 10 KILCOYNE & NESBITT, LLC BY: ELAINE M. ROSS, ESQUIRE MARK J. HERMANOVICH, ESQUIRE Attorneys for Defendant, Richard P. Boran, Jr., M.D. VERIFICATION I, MARK J. HERMANOVICH, ESQUIRE, hereby depose and state that I am the attorney for Defendant, Richard P. Boran, Jr., M.D., in the action herein, and that I have reviewed the foregoing Motion in Limine, and that the facts contained therein are true and correct to the best of my information and belief. I understand that the statements made herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsifications to authorities. MARK J. HERMANOVICH, ESQUIRE DATE: y?? / 0 KILCOYNE & NESBITT, LLC BY: ELAINE M. ROSS ATTY. ID. #46031 By: MARK J. HERMANOVICH ATTY. ID. #200812 630 W. GERMANTOWN PIKE, SUITE 121 PLYMOUTH MEETING, PA 19462 610.825.2833 DONALD L. MORRISON and SHARON A. MORRISON, his wife, Plaintiffs vs. ROBERT P. BORAN, JR., M.D. and APPALACHIAN ORTHOPEDIC CENTER, LTD.,: Defendants ATTORNEY FOR DEFENDANT, ROBERT P. BORAN, JR., M.D. COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA No. 07-187 Civil Term JURY TRIAL DEMANDED CERTIFICATE OF SERVICE 1, MARK J. HERMANOVICH, hereby certify that a true and correct copy of the foregoing Motion in Limine, was forwarded to the following counsel of record by first-class mail, postage prepaid: Michael J. Navitsky, Esquire Navitsky, Olson & Wisneski, LLP 2040 Linglestown Road, Suite 303 Harrisburg, PA 17110 KILCOYNE & NESBITT, LLC By: l C //-- Date: 'y Q MARK J. HERMANOVICH EXHIBIT A DONALD L. MORRISON, and SHARON A. MORRISON, his wife, Plaintiffs, ?K--/?7 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA NO. 2007-00187 VS. CIVIL ACTION MEDICAL PROFESSIONAL LIABILITY ROBERT P. BORAN, JR., M.D., and APPALACHIAN ORTHOPEDIC CENTER, LTD.,: JURY TRIAL DEMANDED Defendants NOTICE YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this Complaint and Notice are served, by entering a written appearance personally or by attorney and filing in writing with the Court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the Court without further notice for any money claimed in the Complaint or for any other claim or relief requested by the Plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. Cumberland County Bar Association 2 Liberty Avenue Carlisle, PA 17013 (717) 249-3166 DONALD L. MORRISON, and SHARON A. MORRISON, his wife, Plaintiffs, VS. ROBERT P. BORAN, JR., M.D., and APPALACHIAN ORTHOPEDIC CENTER, LTD., Defendants IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA NO. 2007-00187 CIVIL ACTION MEDICAL PROFESSIONAL LIABILITY AVISO JURY TRIAL DEMANDED USTED HA SIDO DEMANDADO EN LA CORTE. Si usted desea defenderse de las quejas expuestas en Ins pbginas siguientes, debe tomar accibn dentro de veinte (20) dias a partir de la fecha en que recibib la demanda y el aviso. Usted debe presenter comparecencia escrita en persona o por abogado y presentar en la Corte por escrito sus defensas o sus objeciones a las demandas en su contra. Se le avisa que si no se defiende, el caso puede proceder sin usted y la Corte puede decidir en su contra sin mas aviso o notificacibn por cualquier dinero reclamado en la demanda o por cualquier otra queja o compensacibn reclamados por el Demandante. USTED PUEDE PERDER DINERO, O PROPIEDADES U OTROS DERECHOS IMPORTANTES PARA USTED. LLEVE ESTA DEMANDA A UN ABOGADO INMEDIATAMENTE. SI USTED NO TIENE O NO CONOCE UN ABOGADO, VAYA O LLAME A LA OFICINA EN LA DIRECCION ESCRITA ABAJO PARA AVERIGUAR DONDE PUEDE OBTENER ASISTENCIA LEGAL. Cumberland County Bar Association 2 Liberty Avenue Carlisle, PA 17013 (717) 249-3166 2 DONALD L. MORRISON, and IN THE COURT OF COMMON PLEAS SHARON A. MORRISON, his wife, CUMBERLAND COUNTY, PENNA Plaintiffs, NO. 2007-00187 vs. CIVIL ACTION MEDICAL PROFESSIONAL LIABILITY ROBERT P. BORAN, JR., M.D., and APPALACHIAN ORTHOPEDIC CENTER, LTD.,: JURY TRIAL DEMANDED Defendants COMPLAINT 1. Plaintiff Donald L. Morrison is an adult individual who resides in Carlisle, Cumberland County, Pennsylvania. 2. Plaintiff Sharon A. Morrison, wife of Donald L. Morrison, is an adult individual who resides in Carlisle, Cumberland County, Pennsylvania. 3. Defendant Robert P. Boran, Jr., M.D., (hereinafter referred to as Defendant Baran) is an adult individual licensed to practice medicine in the Commonwealth of Pennsylvania, who at all relevant times herein, engaged in the practice of orthopedic surgery with an office in Carlisle, Cumberland County, Pennsylvania. 4. Plaintiffs are asserting a professional liability claim against Defendant Boran. 5. Upon information and belief, Defendant Boran was an agent, apparent agent, member, partner, shareholder, servant, and/or employee of Appalachian Orthopedic Center, Ltd. during the relevant times of this action. 6. Defendant Appalachian Orthopedic Center, Ltd. (hereinafter referred to as Appalachian Orthopedic) is a Pennsylvania professional corporation duly organized and registered in Pennsylvania who at all 3 relevant times herein engaged in the business of providing orthopedic services to the public with its place of business in Carlisle, Cumberland County, Pennsylvania. 7. Plaintiffs are asserting a professional liability claim against Defendant Appalachian Orthopedic by virtue of the actions and/or inactions of Defendant Boran and all such other health care/clerical agents, apparent agents, servants, and/or employees from their office who were involved with the care of Mr. Morrison during the relevant dates of his hospitalization at Carlisle Regional Medical Center from 1/24/05 thru 2/2/05, in particular, regarding the inactions/actions from 1/24/05 through 1/26/05. 8. At all relevant times herein, Defendant Boran and all such other health care/clerical agents from Defendant Appalachian Orthopedic who were involved with the care of Mr. Morrison at Carlisle Regional Medical Center from 1/24/05 through 1/26/05 were furthering the economic and financial interests of Defendant Appalachian Orthopedic and were acting within the scope of their employment with Defendant Appalachian Orthopedic and therefore created vicarious liability. 9. At all relevant times herein, Donald L. Morrison was married to and continues to be married to Plaintiff Sharon A. Morrison, his wife. 10. Mr. Morrison had a history of having had a left total knee replacement in 2001, by an employee/agent of Defendant Appalachian Orthopedic, and also left knee surgery by Defendant Boran in 2004, from which Mr. Morrison did not have complaints of numbness, tingling, coolness or extreme pain postoperatively in the operated-on left lower extremity. 11. In his other leg, on January 24, 2005, Mr. Morrison underwent a Legacy right total knee arthroplasty by Defendant Boran, at the Carlisle Regional Medical Center. 12. At the conclusion of Mr. Morrison's operative note, Defendant Boran reported, "neurovascularly 4 intact to the right lower extremity." 13. However, post-operatively, Mr. Morrison developed signs and symptoms of decreased vascular supply to his right lower extremity. 14. Defendant Boran did not order a vascular consult or arteriogram until approximately two (2) days after Mr. Morrison developed signs and symptoms of decreased vascularzation of his right lower extremity. 15. Plaintiffs aver that this two-day delay in diagnosis and treatment of Mr. Morrison's right lower extremity thrombus (blood clot) caused Mr. Morrison to undergo multiple fasciotomies to his right lower extremity and necessitated him to undergo several plastic surgical procedures to his right lower extremity. 16. According to the records of Carlisle Regional Medical Center, Mr. Morrison left the operating room following his right total knee replacement by Defendant Boran at 10:37 a.m. on 1/24/05 and arrived in the PACU at 10:38 a.m. 17. Mr. Morrison was ordered Morphine and Percocet (Oxycodone APAP) prn for pain. 18. At 11:40 am., Mr. Morrison was medicated with Morphine for pain in the PACU. 19. Mr. Morrison was discharged to the floor at 12 Noon on 1/24/05. 20. Mr. Morrison's post-op orders included the daily administration of Coumadin on a sliding scale. 21. According to the nursing documentation form, at 12 Noon on 1/24/05, it was noted that Mr. Morrison was received from the PACU and that his pedal pulse was diminished, palpable. 22. Mr. Morrison's right toes were noted to be warm and pink with capillary refill less than 3 seconds. 23. However, three (3) hours later, at 3:00 p.m. on 1/24/05, the same nurse noted that Mr. Morrison's toes were cool, pale and that Mr. Morrison stated that his toes were numb to touch. 5 24. His immobilizer was removed and ace bandage loosened, and again, it was noted that his right pedal pulse was diminished, but palpable. 25. Importantly, it was noted that Mr. Morrison's right pedal pulse was not as strong as his left pedal pulse. 26. The records reflect that Mr. Morrison was medicated for pain with Percocet (Oxycodone APAP) at both 1:30 p.m. and 2:00 p.m.. 27. At 3:30 p.m. on 1/24/05, a different nurse documented that Mr. Morrison's right foot was pale, slightly cool, and had a decreased pedal pulse. 28. At 4:00 p.m., Mr. Morrison received another injection of Morphine for pain. 29. At 5:15 p.m., on 1/24/05, the same nurse noted that Mr. Morrison complained that the top of his right foot and toes were numb and it was noted that he had decreased pedal pulse. 30. The nurse recorded that they were unable to hear the pulse with a Doppler and recorded that they would notify Dr. Boran. 31. Forty-five minutes later, at 6:00 p.m. on 1/24/05, it is noted that Defendant Boran was notified with orders received. 32. The records reflect that Mr. Morrison's immobilizer had been removed and had not been reapplied since 3:00 p.m. It was also noted that the post-operative dressing was loosened and rewrapped at 3:00 p.m. 33. The plan was to continue to note the color of Mr. Morrison's foot. 34. Mr. Morrison's toes continued to appear pale and slightly dusky, and Defendant Boran was noted to be aware. 35. Mr. Morrision received his first dose of Coumadin, 10mg at 6:00 p.m. on 1/24/05. 6 36. Fifty minutes later at 6:50 p.m., the same nurse noted that Mr. Morrison still had decreased sensation in his right foot and complained of slight tingling on the sole of his right foot. 37. Mr. Morrison's post-operative dressing was again removed to check for any constrictive dressings, but it was noted that there were none. 38. It was noted that Mr. Morrison's right foot remained cool with decreased pulse, whereas his left foot was warm and had a positive pedal pulse. 39. Importantly, it was noted that the Ace bandage was on loosely but that Mr. Morrison's right toes remained dusky. 40. At 9:35 p.m., Mr. Morrison was medicated for pain with another Morphine shot. 41. At 10:15 p.m. on 1/24/05, it was noted that Mr. Morrison dangled, stood and might have more feeling in his right foot. 42. However, it was noted that Mr. Morrison's pulse remained decreased and his right foot was pale, and his toes were slightly dusky. 43. Mr. Morrison's dressing was removed down to the 4x4 and re-dressed loosely, and he was encouraged to do frequent ankle pumps. 44. At 11:15 p.m. on 1/24/05, it was noted that Defendant Boran was in to see Mr. Morrison and examined his right leg and foot and that no new orders were given. 45. The nurse noted that Mr. Morrison's pedal pulse was decreased, his toes were cool and dusky, and that he had some tingling in his toes. 46. At 3:50 a.m. on 1/25/05, the nursing documentation form reflects that Mr. Morrison had a positive but decreased right pedal pulse and that Mr. Morrison stated that he had both numbness and tingling in his right great toe and that his right foot was warm to the touch but his toes were still cool. 7 47. It also appears that at 3:50 a.m., Mr. Morrison received another dose of Percocet (Oxycodone APAP) for pain. 48. At 6:00 a.m. on 1/25/05, the nurse noted that Mr. Morrison stood at the side of his bed with a walker and was still complaining of numbness in his great toe. 49. At 7:15 a.m. on 1/25/05, Mr. Morrison was still noted to have diminished pedal pulse. 50. At 8:10 a.m., Mr. Morrison was medicated for pain again with Percocet (Oxycodone APAP). 51. At 9:45 a.m. on 1/25/05, it was noted that Defendant Boran was notified and aware of the numbness in Mr. Morrison's right foot. 52. At 10:00 p.m., Mr. Morrison was given a shot of Morphine for pain. 53. At 10:30 a.m. on 1/25/05, the CPM machine was started at 30° on Mr. Morrison's right leg. 54. At 12:30 p.m. on 1/25/05, Mr. Morrison was also administered another dose of the pain medication Percocet (Oxycodone APAP) and the nurse noted that Mr. Morrison had less numbness in his right foot. 55. At 4:30 p.m. on 1/25/05, the nurse noted that Mr. Morrison was still complaining of slight tingling and decreased sensation in his right foot. 56. At 5:00 p.m., Mr. Morrison was medicated again for pain with Percocet (Oxycodone APAP). 57. At 6:00 p.m. on 1/25/05, Mr. Morrison received a second dose of Coumadin 10 mg, based on an INR of 1.0. 58. At 8:50 p.m. on 1/25/05, the nurse noted decreased sensation and decreased dorsi-flexion noted in Mr. Morrison's right foot, and that his right foot was still cool to the touch. 59. At 10:10 p.m., Mr. Morrison was medicated again for pain with Percocet (Oxycodone APAP). 60. At 10:50 p.m., Mr. Morrison was given another shot of Morphine for pain. 61. At 12:30 a.m. on 1/26/05, the night nurse noted that Mr. Morrison had pain right shin down to foot, that his toes remained cool to the touch, and that he had diminished right pedal pulse and decreased dorsi-flexion of the right foot. 62. It was also recorded that Mr. Morrison's tingling persisted and that edema was present in his right leg and foot. 63. At 7:45 a.m. on 1/26/05, the day nurse noted that Mr. Morrison's right dorsalis pedis and posterior tibial pulses were very diminishing as compared to the left pulses. 64. Additionally, it was noted that Mr. Morrison's right foot was cool and pale and that he was complaining of soreness in his right lateral calf, but denied tenderness to the right posterior calf. 65. Mr. Morrison reported that it felt like his right foot was "falling asleep." His right toe remained numb along the medial side back to the heel. 66. At 8:00 a.m., Mr. Morrison was given another dose of Percocet (Oxycodone APAP) for the pain. 67. At 9:45 a.m. on 1/26/05, the records reflect that Defendant Boran was called and updated on Mr. Morrison's condition by the nurse. 68. At 11:20 p.m., Mr. Morrison received another shot of Morphine for the pain. 69. At 12:40 p.m. on 1/26/05, Mr. Morrison was seen by Defendant Boran and by vascular surgeon, Dr. Campbell. 70. At 2:00 p.m., Mr. Morrison was given another dose of Percocet (Oxycodone APAP) for the pain. 71. At 3:35 p.m. on 1/26/05, the nurses noted that Mr. Morrison was NPO and awaiting an arteriogram. 72. According to the nursing documentation form, at 4:30 p.m. on 1/26/05, a STAT prothrombin time was drawn and approximately two (2) hours later, at 6:00p.m., Mr. Morrison was sent to radiology for the arteriogram. 9 73. Dr. Campbell's impression from the arteriogram of Mr. Morrison's right lower extremity was popliteal artery occlusion, probably due to thrombosis, with reconstitution of the posterior tibial vessel. 74. Mr. Morrison's coagulation studies were as follows on 1/26/05: PT was 18.1 (high), and his INR was reported high at 1.7. 75. Subsequently, a STAT blood draw at 4:25 p.m. on 1/26/05 produced results of a PT of 14.0 (high) and an INR of 1.3 (high). 76. Thereafter, Mr. Morrison was taken to the operating room at 7:50 p.m. on 1/26/05, and a right popliteal thrombectomy, with repair of right superficial artery and right distal medial and lateral fasciotomies consisting of four-compartment fasciotomies of the right lower leg were performed by Dr. Campbell. 77. At the time of the surgery on 1/26/05, Dr. Campbell noted in his operative report that the lateral and anterior compartments appeared to be very tense, necessitating four-compartment fasciotomies. 78. When the anterior compartment was opened, there appeared to be ischemic muscle that would not contract with stimulation with the Bove. 79. Since the four-compartment fasciotomy of Mr. Morrison's right lower leg on 1/26/05, Mr. Morrison has undergone multiple plastic surgery procedures to improve the appearance of his right lower extremity. 80. Mr. Morrison still has swelling in his right lower extremity and continues to have numb toes and decreased movement in his right lower extremity. 81. Plaintiffs aver that the classic signs of poor arterial blood flow are referred to as the five "Ps" and Mr. Morrison demonstrated all five (5) of them. 10 82. Mr. Morrison demonstrated (1) pain, (2) pulselessness, (3) pallor, (4) paresthesias and (5) polar. 83. The presence of all of these five (5) signs of ischemia should have prompted Defendant Boran to more active intervention as soon as such signs were noted, but unfortunately none was accomplished by Defendant Boran until approximately 48 hours after the symptoms began post-operatively. 84. Plaintiffs further aver that extremities subjected to poor arterial blood flood (ischemia) become more irretrievably damaged the longer it takes to restore circulation. 85. Nerve tissue is particularly vulnerable to ischemia. 86. If a patient's nerves are deprived of blood flow for longer than six (6) hours, there is significant chance of permanent damage and loss of either sensory or motor function. 87. Plaintiffs aver that the delay in diagnosis of ischemia in Mr. Morrison's right lower extremity significantly increased the damage to the nerves of his right leg. 88. The residual neurological impairment Mr. Morrison has suffered, would have been lessened or entirely avoided had revascularization of his right leg been done within a few hours instead of two (2) days later. 89. Furthermore, Plaintiffs aver that the delay in intervention also created the need for Mr. Morrison to undergo fasciotomies. 90. If a patient's leg is revascularized within the time frame mentioned (six hours or so), there is rarely a need for fasciotomies. 91. Because, in this case, the ischemia had gone on for so long, the fasciotomies were necessitated to prevent the occurrence of compartment syndrome (damage to nerves and muscles as the blood flow is restored and the muscles swell uncontrollably inside the non-elastic fascial covering). 92. Plaintiff's aver that fasciotomies are an additional component of morbidity in that Mr. Morrison now 11 has suffered large gaping wounds and scarring to his right lower extremity, which have required multiple plastic surgical procedures and skin grafts to close. Such wounds have caused significant 'disfigurement to Mr. Morrison's right lower extremity. 93. As a direct and proximate result of Defendants' negligence, as specified herein, Mr. Morrison was placed at an increased risk of harm due to the ischemia, including tissue and muscle damage, nerve injury, extensive surgery and prolonged hospitalization, and a claim is made therefor. 94. As a direct and proximate result of Defendants' negligence as stated herein, a significant delay occurred in diagnosing and treating Mr. Morrison's ischemia/thrombosis in his right lower extremity, and a claim is made therefor. 95. The injuries suffered by Plaintiffs are a direct and proximate result of the negligence as stated specifically herein of Defendants, Robert P. Boran, Jr., M.D., and Appalachian Orthopedic Center, Ltd.. 96. The substandard care of Defendants and their health care/clerical agents, apparent agents, servants, and/or employees who were involved with the care of Mr. Morrison and/or had contact with him during the relevant times of his admission, in particular, 1/24/05 thru 1/26/05, as specified above, increased the risk of harm to Plaintiffs. 97. Defendants are jointly and severally liable for the injuries and damages set forth herein. 98. As a direct and proximate result of Defendants' negligence as stated herein, Mr. Morrison endured extreme pain and suffering and claim is made therefor. 99. As a direct and proximate result of Defendants' negligence as stated herein, Mr. Morrison continues to have decreased movement, numbness and swelling in his right lower extremity, and a claim is made therefor. 12 100. As a direct and proximate result of Defendants' negligence as stated herein, Mr. Morrison is no longer able to stand for any length of time without developing swelling and pain in his right lower extremity. 101. As a direct and proximate result of Defendants' negligence as stated herein, Mr. Morrison endured hospitalization, transfusions, multiple surgical procedures, and months of intensive dressing changes and medication therapies related to the delay in diagnosing the ischemia/thrombus in his right lower extremity, and a claim is made therefor. 102. As a direct and proximate result of Defendants' negligence as stated herein, Plaintiffs have incurred and in may in the future incur medical bills and expenses and a claim is made therefor. 103. As a direct and proximate result of Defendants' negligence as stated herein, Plaintiffs have suffered and will in the future suffer lost wages, and decreased earning capacity, and a claim is made therefor. 104. As a direct and proximate result of Defendants' negligence as stated herein, Mr. Morrison has undergone and in the future will undergo great physical and mental pain and suffering, great inconvenience in carrying out his daily activities, and loss of life's pleasures and enjoyment, and a claim is made therefor. 105. As a direct and proximate result of Defendants' negligence as stated herein, Mr. Morrison has sustained extensive scarring and disfigurement to his right lower extremity and a claim is made therefor. 106. As a direct and proximate result of Defendants' negligence as stated herein, Mr. Morrison has been and in the future will be subjected to great humiliation and embarrassment and claim is made therefor. 13 107. As a direct and proximate result of Defendants' negligence as stated herein, Mr. Morrison will continue to have medical problems due to the swelling, numbness and decreased movement in his right lower extremity, which may require future medical treatment and a claim is made therefor. 108. As a direct and proximate result of Defendants' negligence as stated herein, Mr. Morrison's wife, Sharon A. Morrison, has suffered the loss of companionship, society and comfort of her husband, Donald Morrison, in the past and will suffer same in the future, and a claim is made therefor. COUNTI Donald L. Morrison and Sharon A. Morrison, his wife vs. Robert P Boran, Jr., M.D. 109. Paragraphs one through one hundred eight of this Complaint are incorporated herein by reference as if set forth at length. 110. During the above-referenced dates of Mr. Morrison's admission to Carlisle Regional Medical Center, Defendant Boran was acting as an agent, apparent agent, member, servant, partner, and/or employee of Defendant Appalachian Orthopedic Center, Ltd. As a direct and proximate result of his negligence as set forth below, Defendant Boran is liable to Plaintiffs for the injuries and damages alleged herein. 112. Plaintiffs' injuries and damages were directly and proximately caused by Defendant Boran's negligence in: a. failing to timely diagnose ischemia in Mr. Morrison's right lower extremity; b. failing to timely diagnose thrombus (blood clot) in Mr. Morrison's right lower extremity; c. Wing to timely perform the necessary diagnostic tests to rule in or rule out ischemia and occlusion by thrombus in Mr. Morrison's right lower extremity; 14 d. failing to timely order or recommend the performance of an arteriorgram/angiogram of Mr. Morrison's right lower extremity; e. failing to timely order a vascular consult on Mr. Morrison; f. failing to timely perform laboratory studies to rule in or rule out the presence of a thrombus/ischemia in Mr. Morrison; g. failing to treat the ischemia/thrombus in Mr. Morrison's right lower extremity until after Mr. Morrison suffered from the symptoms for two (2) days; h. failing the limit the severity of Mr. Morrison's ischemic process in his right lower extremity; i. failing to properly maintain complete and accurate records for Mr. Morrison during the relevant times of his admission; j. failing to make Mr. Morrison aware of the potential harm he could suffer from having an undiagnosed and untreated thrombus in his right lower extremity; k. reassuring Mr. Morrison that the problems in his right lower extremity were due to normal post-operative findings and not due to an ischemic/thrombotic process; 1. failing to properly follow-up with Mr. Morrison regarding his post-operative right lower extremity complaints and signs of ischemia; m. failing to properly follow-up on the concerns of the Carlisle Regional Medical Center's nursing staff regarding Mr. Morrison's post-operative right lower extremity signs and symptoms of ischemia; n. delaying the diagnosis of the thrombus in Mr. Morrison's right lower extremity, which increased the risk that he would suffer significant ischemia and necessitate the need for fasciotomies, thrombectomy, and plastic surgery procedures; 15 o. allowing the thrombotic process in Mr. Morrison's right lower extremity to progress to complete occlusion; p. failing to appreciate the significance of Mr. Morrison's post-operative signs of ischemia, as reported by the Carlisle Regional Medical Center's nurses; and q. failing to make any effort to look for the cause of Mr. Morrison's poor arterial blood flow in his right lower extremity, in particular the five "Ps" - pain, pulselessness, pallor, paresthesia and polar. 113. As a direct and proximate result of the negligence of Defendant Boran as stated herein, Plaintiffs have sustained injuries and damages, as set forth in the paragraphs above, which are incorporated herein by reference as if set forth at length, and a claim is made therefor. WHEREFORE, Plaintiffs, Donald L. Morrison and Sharon A. Morrison, his wife, demand judgment against Defendant Robert P. Boran, Jr., M.D., for compensatory damages in an amount in excess of Fifty Thousand ($50,000.00) Dollars exclusive of interests, costs, and in excess of any jurisdictional amount requiring compulsory arbitration. COUNT H Donald L. Morrison and Sharon A. Morrison, his wife, vs Appalachian Orthopedic Center, Ltd. 114. Paragraphs one through one hundred eight and Count T of this Complaint are incorporated herein by reference as if set forth at length. 115. At all relevant times herein, Defendant Appalachian Orthopedic and its health care providers and clerical staff to include Defendant Boran who were involved in Mr. Morrison's orthopedic care during his Carlisle Regional Medical Center admission of 1/24/05 through 2/2/05, in particular, on 16 the dates of 1/24/05 through 1/26/05, were acting as agents, apparent agents, servants and/or employees of Defendant Appalachian Orthopedic. 116. Plaintiffs reasonably relied upon the staff of Defendant Appalachian Orthopedic, to include Defendant Boran and all such other health care/clerical agents, apparent agents, servants and/or employees of Defendant Appalachian Orthopedic who were involved in Mr. Morrison's orthopedic care from 1/24/05 through 1/26/05 and their apparent expertise, apparent competence, diagnostic abilities, interpretations, conclusions, treatment decisions, knowledge of anatomy and physiology and authority in ruling out ischemia/thrombosis in Mr. Morrison's right lower extremity. 117. Defendant Appalachian Orthopedic is vicariously liable for the acts and/or omissions of Defendant Boran and all such other health care/clerical agents, apparent agents, servants, and/or employees of Defendant Appalachian Orthopedic who were involved in Mr. Morrison's orthopedic care from 1/24/05 through 1/26/05. 118. At all relevant times herein, Defendant Appalachian Orthopedic had a duty and right to exercise control, authority, and supervision over all of the staff at Defendant Appalachian Orthopedic to include Defendant Boran and all such other health care/clerical agents, apparent agents, servants, and/or employees of Defendant Appalachian Orthopedic who were involved in Mr. Morrison's orthopedic care from 1/24/05 through 1/26/05. 119. Defendant Appalachian Orthopedic, through the negligence of Defendant Boran and also such other healthcare/clerical agents, apparent agents, servants, and/or employees of Defendant Appalachian Orthopedic who were involved in Mr. Morrison's orthopedic care at Carlisle Regional Medical Center from 1/24/05 through 1/26/05, is liable to Plaintiffs for injuries and damages proximately caused by the negligence of its agents/employees in: 17 a. failing to timely diagnose ischemia in Mr. Morrison's right lower extremity; b. failing to timely diagnose thrombus (blood clot) in Mr. Morrison's right lower extremity; c. failing to timely perform the necessary diagnostic tests to rule in or rule out ischemia and occlusion by thrombus in Mr. Morrison's right lower extremity; d. failing to timely order or recommend the performance of an arteriorgram/angiogram of Mr. Morrison's right lower extremity; e. failing to timely order a vascular consult on Mr. Morrison; f failing to timely perform laboratory studies to rule in or rule out the presence of a thrombus/ischemia in Mr. Morrison; g. failing to treat the ischemia/thrombus in Mr. Morrison's right lower extremity until after Mr. Morrison suffered from the symptoms for two (2) days; h. failing the limit the severity of Mr. Morrison's ischemic process in his right lower extremity; i. failing to properly maintain complete and accurate records for Mr. Morrison during the relevant times of his admission; j. failing to make Mr. Morrison aware of the potential harm he could suffer from having an undiagnosed and untreated thrombus in his right lower extremity; k. reassuring Mr. Morrison that the problems in his right lower extremity were due to normal post-operative findings and not due to an ischemic/thrombotic process; 1. failing to properly follow-up with Mr. Morrison regarding his post-operative right lower extremity complaints and signs of ischemia; m. failing to properly follow-up on the concerns of the Carlisle Regional Medical Center's nursing staff regarding Mr. Morrison's post-operative right lower extremity signs and 18 symptoms of ischemia; n. delaying the diagnosis of the thrombosis in Mr. Morrison's right lower extremity, which increased the risk that he would suffer significant ischemia and necessitate the need for fasciotomies, thrombectomy, and plastic surgery procedures; o. allowing the thrombotic process in Mr. Morrison's right lower extremity to progress to complete occlusion; p. failing to appreciate the significance of Mr. Morrison's post-operative signs of ischemia, as reported by the Carlisle Regional Medical Center's nurses; and q. failing to make any effort to look for the cause of Mr. Morrison's poor arterial blood flow in his right lower extremity, in particular the five "Ps" - pain, pulselessness, pallor, paresthesia and polar. 120. As a direct and proximate result of the negligence of Defendant Appalachian Orthopedic, as stated herein, Plaintiffs have sustained injuries and damages, as set forth in the paragraphs above, which are incorporated herein by reference as if set forth at length, and a claim is made therefor. WHEREFORE, Plaintiffs Donald L. Morrison and Sharon A. Morrison, his wife, demand judgment against Defendant Appalachian Orthopedic Center, Ltd., for compensatory damages in an amount in excess of Fifty Thousand ($50,000.00) Dollars exclusive of interests and costs, and in excess of any jurisdictional amount requiring compulsory arbitration. COUNT III Sharon A. Morrison, his wife, vs Robert P. Boran, Jr., M.D., and Appalachian Orthopedic Center, Ltd. 19 121. Paragraphs one through one hundred eight and Counts I-II of this Complaint are incorporated herein by reference as if set forth at length. 122. Plaintiff Sharon A. Morrison is the wife of Donald L. Morrison. 123. As a direct and proximate result of the negligence as stated herein of the Defendants and the injuries caused thereby to her husband, Donald L. Morrison, Sharon A. Morrison has suffered the loss of her husband's society, comfort, services, consortium and companionship and will so in the future, and a claim is made therefor. 124. All Defendants are jointly and severally liable to Sharon A. Morrison for the injuries and damages set forth herein. WHEREFORE, Plaintiff Sharon A. Morrison, the wife of Donald L. Morrison, demands judgment against Defendants Robert P. Boran, Jr., M.D. and Appalachian Orthopedic Center, Ltd. for compensatory damages in an amount in excess of Fifty Thousand ($50,000.00) Dollars exclusive of interest s and costs and in excess of any jurisdictional amount requiring compulsory arbitration. Respectfully submitted, NAVITSKY, OLSON & WISNESKI LLP DD,d?e S. Bamck> Esquire I.D. No. 77400 Michael J. Navitsky, Esquire I.D. No. 58803 2040 Linglestown Road, Suite 303 Harrisburg, PA 17110 717/541-9205 Counsel for Plaintiffs Date: 31-? 9/6 7 20 VERIFICATION. I, Donald L. Morrison, verify that the facts set forth in the foregoing Complaint are true and correct to the best of my knowledge, information, and belief. I understand that this Verification is made subject to the provisions of 18 Pa. C.S.A. §4904, relating to unsworn falsification to authorities. Z?? cI WITNESS Donald L. Morrison VERIFICATION I, Sharon A. Morrison, verify that the facts set forth in the foregoing Complaint are true and correct to the best of my knowledge, information, and belief. I understand that this Verification is made subject to the provisions of 18 Pa. C.S.A. §4904, relating to unswom falsification to authorities. ??? man Q . i??vt.c? WITNESS Sharon A. Morrison CERTIFICATE OF SERVICE I, Jessie K. Walsh, an employee of the law firm of Navitsky, Olson & Wisneski LLP, do hereby certify that I am this 29th day of March, 2007 serving a true and correct copy of Plaintiffs' Complaint upon all counsel of record via postage prepaid first class United States mail addressed as follows: John F. McGreevey, Esquire Kilcoyne & Nesbitt, LLC Plymouth Meeting Executive Campus 630 West Germantown Pike, Suite 121 Plymouth Meeting, PA 19462 Counsel for Defendant Boran Dean F. Piermattei, Esquire Rhoads & Sinon, LLP M&T Bank Building -12'h Floor One South Market Square P.O. Box 1146 Harrisburg, PA 17108-1146 Counsel for Defendant Appalachian ? . 6) 1 -? ; Jessie K. Walsh 21 EXHIBIT B CURRICULUM VITAE Louis Kozloff, M.D. BORN: Nashville, Tennessee EDUCATION: June 26, 1944 University of Pennsylvania - B.A. cum laude (with distinction in chemistry) May, 1965 University of Pennsylvania School of Medicine - M.D. May, 1969 HOBBIES: Basketball Skiing Swimming (US Masters Program) Travel Photography Computers COLLEGIATE HONORS: Freshman basketball (1961-1962, Captain) JV and Varsity basketball (1962-1963) Varsity swimming (1962-1965; Captain 1964-1965) Ranked third in world, 50 yard freestyle -1965 Dean's List (1961-1965) Phi Kappa Beta Junior Honor Society Friars' Senior Honor Society MARITAL STATUS: Married since 1967 - Rene (nee Chaffin) Kozloff CHILDREN: Laurie Robin Kozloff - born November 25, 1970 Advertising Executive, BBD Needham; Chicago, IL Howard Jeffrey Kozloff - born April 27, 1975 . Real Estate Developer- The Martin Group, Santa Monica, CA 1 CURRENT ADDRESSES: Office: 8218 Wisconsin Avenue Bethesda, Maryland 20814 (301) 652-1208 voice (301) 951-8425 fax Email: Ikozloff(avascassoc.com Home: 11313 Marcliff Road Rockville, Maryland 20852 (301) 493-5411 voice (301) 530-3713 fax Email: IkO-Ikozioff.com AWARDS: "Golden Apple" Award (from senior medical school class to outstanding clinical instructor), George Washington Medical School, 1973 Gold Medal Paper, University Surgical Residents' Seventeenth Annual Conference Rochester, Minnesota, 1975 Meritorious Service Medal, U.S. Army, 1977 Certificate of Appreciation, American College of Surgeons, for scientific exhibit, 1978 Army Commendation Medal, U.S. Army, 1979 University of Pennsylvania Sports Hall of Fame - inducted November, 2000 CERTIFICATION: American Board of Surgery, 1976 - General Surgery (#22000) Recertification, 1989 (#23838 - Exp..7/1100) General Vascular Surgery, 1990 (#826 - Exp. 7/1/00) Recertification, 1999 (#826 - Exp. 7/1/10) POSTGRADUATE EDUCATION: Internship (surgical), George Washington University Hospital Washington, D.C., 1969-1970 Residency in general surgery, George Washington University Hospital Washington, D.C., 1970-1973 Fellowship in surgical research, George Washington University Hospital Washington, D.C., 1973-1974 2 Chief Residency in general surgery, George Washington University Hospital Washington, D.C., 1974-1975 Fellowship in peripheral vascular surgery, Walter Reed Army Medical Center Washington, D.C., 1977-1978 MILITARY: United States Army Medical Research and Development Command Surgical Research Directorate, 1975-1977 Fellow in Peripheral Vascular Surgery, Walter Reed Army Medical Center 1977-1978 Staff, Peripheral Vascular and General Surgery Services, Walter Reed Army Medical Center, 1978-1979 Assistant Chief, Peripheral Vascular Surgery Service, Walter Reed Army Medical Center, 1978-1979 SOCIETIES: Alpha Chi Sigma National Chemical Honor Society, 1964 Alpha Epsilon Delta Pre-medical Honor Society, 1965 Alpha Omega Alpha Medical Honor Society, 1969 Chesapeake Vascular Society, 1977 Program Chairman, 1983-1985 Secretary-Treasurer, 1985-1987 President, 1988 Executive Council, 1989-1992 Association of Military Surgeons of the United States, 1978 Southeastern Surgical Congress, 1979 Maryland Medical and Chirurgicai Society, 1979 International Cardiovascular Society, 1980 Surgical Associates, Uniformed Services' University of the Health Sciences (Secretary-Treasurer), 1980 Peripheral Vascular Surgical Society, 1980 Fellow, American College of Surgeons, 1982 Southern Medical Association, 1984 Eastern Vascular Society, 1987 3 CLINICAL STAFF ASSIGNMENTS: Instructor in Surgery, George Washington University Hospital and Medical School 1974 - 1975 Clinical Co-ordinator, George Washington University Physicians' Assistants Program, 1973 - 1975 Assistant Professor of Surgery, Uniformed Services' University of the Health Sciences, 1978 Assistant Clinical Professor of Surgery, George Washington Un€versity 1979 - 1984 Associate Clinical Professor of Surgery, Uniformed Services' University of the Health Sciences, 1981 - present Associate Clinical Professor of Surgery, George Washington University 1984 - 1995 Clinical Professor of Surgery, George Washington University 1995 - present Consultant in Vascular Surgery, The Clinical Center, National Institutes of Health, Bethesda, Md., 1980 - present ACADEMIC POSITIONS Editorial Board, Maryland State Medical Journal, 1983 - 1989 Member, Middle Atlantic Alumni Board of Trustees, University of Pennsylvania 1990 - present Member, National Alumni Council, University of Pennsylvania School of Medicine 1994 - present Twenty-first Century Endowed Scholars Advisory Council, University of Pennsylvania School of Medicine 1994 - present HOSPITAL ASSIGNMENTS: Staff, General and Vascular Surgery, Holy Cross Hospital of Silver Spring Silver Spring, Maryland, 1979 - present Chief, Vascular Surgery Subsection, 1985, 1988, 1992 Staff, General and Vascular Surgery, Suburban Hospital Bethesda, Maryland, 1979 - present Director, Non-invasive Vascular Laboratory, 1980 - present Staff, General and Vascular Surgery, Montgomery General Hospital Olney, Maryland, 1979 - 1983 Staff, General and Vascular Surgery, Shady Grove Adventist Hospital Gaithersburg, Maryland, 1979 - 1983 4 Staff, General and Vascular Surgery, Sibley Memorial Hospital Washington, D.C., 1983 - present Staff, General and Vascular Surgery, George Washington University Medical Center, Washington, D.C., 1979 - present Consultant in Vascular Surgery, National Institutes of Health Bethesda, Maryland, 1979 - present Staff, General and Vascular Surgery, Kent and Queen Anne's Hospital Chestertown, Maryland, 1990 - 1997 Staff, General and Vascular Surgery, Washington Adventist Hospital Tacoma Park, Maryland - 1999 - 2002 HOSPITAL COMMITTEES: Intensive Care Committee, Shady Grove Adventist Hospital, 1980 Trauma Committee, Shady Grove Adventist Hospital, 1980 Director, Nan-invasive Vascular Laboratory, Suburban Hospital, 1980 - present Medical Disaster Committee, Holy Cross Hospital, 1981 Intensive Care Committee, Holy Cross Hospital, 1982 - 1988 Intensive Care Committee, Suburban Hospital, 1982 - 1988 Medical Research Committee, Shady Grove Adventist Hospital, 1983 Executive Committee, Suburban Hospital, 1987 - present Quality Care Committee, Holy Cross Hospital, 1988 Continuing Medical Education Committee, Holy Cross Hospital, 1990 - 1992 Vice Chairman, Capital Campaign, Suburban Hospital -1992 MEDICAL LICENSURE: District of Columbia 1970 Number 000033165;Controt number 920031797 Maryland 1979 Number D23019 BNDD(DEA) NUMBERS: District of Columbia AK 8483733 Maryland (federal) AK 8551207 Maryland (state) M 11712 5 SPEAKING ENGAGEMENTS: Martinsburg Veterans' Hospital, Martinsburg, West Virginia "Intravenous Hyperalimentation", 1975 Armed Forces Joint Medical Research Committee, The Pentagon, Arlington, Virginia, "Vascular Surgery", 1975 Halsted Society, Washington, D.C.,"Jejunoileal Bypass",1976 Holy Cross Hospital, Silver Spring, Maryland, "Non-invasive Vascular Examination", 1978 Suburban Hospital, Bethesda, Maryland, "Cerebrovascular Disease", 1979 National Academy of Physicians' Assistants, Washington, D.C., "Incidentally, I heard a Bruit",1989 Board Review Seminar, Physicians' Assistants Program, George Washington University, Washington, D.C. "Cerebrovascular Disease", 1991 PARTICIPATION IN SCIENTIFIC PROGRAMS: Southeastern Surgical Congress, Atlanta, Georgia, "Transduodenal Sphincteroplasty" 1974 University Surgical Residents' Seventeenth Annual Conference, Mayo Clinic Rochester, Minnesota, "Jejunoileal Bypass", 1975 Southern Thoracic Surgical Society, New Orleans, Louisiana, "Thoracic Trauma" 1975 Association for Academic Surgery, Minneapolis, Minnesota, "Jejunoileal Bypass" 1975 Peripheral Vascular Surgery Seminar and Meeting of Military Vascular Surgeons Walter Reed Army Medical Center, Washington, D.C. Topics: 1976 - Ocular Pneumoplethysmography 1977 - Graft Dilatation 1978 - Long-term Total Parenteral Nutrition 1979 - Non-invasive Arterial Diagnosis 1980 - Aorto-enteric Fistulas 1981 - Carotid Artery Aneurysms 1982 - Carotid Endarterectomy under Local Anesthesia 1983 - Subclavian Artery Aneurysms 1984 - Buerger's Disease International Vascular Symposium, Obergurgl, Austria "One Hundred Consecutive Carotid Endarterectomies under Local Anesthesia", 1984 Southern Vascular Surgical Congress, San Juan, Puerto Rico, "Arterial-enteric Fistulae Following Radiation Therapy", 1986 6 International Vascular Symposium, St. Moritz, Switzerland, "Arterial-enteric Fistulae Following Radiation Therapy", 1986 BIBLIOGRAPHY (Films): 1. Collins,JT, Clagett,GP, Kozloff,L, Collins,GJ, and Rich,NM: Innominate Artery Reconstruction, 1980 BIBLIOGRAPHY (Abstracts): 1. Jackson,MJ, and Joseph,WL: Changes in Intestinal Function Following Jejunoileal Bypass in Primates (Abstr). Gastroenterology. 68:A-72,1975 2. McDonald, PT, Rich,NM, Collins,GJ, and Kozloff,L: Vascular Trauma Secondary to Diagnostic and Therapeutic Procedures:Laparoscopy (Abstr). Gen Surg Digest. 1979 BIBLIOGRAPHY (Books): 1. Kozloff,L (Ed.): Microaggregates:Experimental and Clinical Aspects. Government Printing Office, 1979 BIBLIOGRAPHY (Chapters in books): 1. McDonald,PT, Collins,GJ, Rich,NM, Kozloff,L, Clagett,GP, and Collins,JT: Ocular Pneumoplethysmography:Pitfalls in Testing and Tracing Interpretation. Proc Intl Cardiovasc Congress. 1979 2. Collins,GJ, Rich,NM, McDonald,PT, Kozloff,L, Clagett,GP, and Collins,JT: Phleborheographic Diagnosis of Venous Obstruction. Proc Intl Cardiovasc Congress. 1979 3. Collns,GJ, Rich,NM, McDonald,PT, Kozloff,L, Clagett,GP, and Collins,JT: Phleborheographic Diagnosis of Venous Obstruction. In Non- Invasive Cardiovascular Diagnosis. Second Edition. By Edward G. Dietrich, Editor. 1981 4. Kozloff,L: Arterial-Venous Fistulas. In Basic Science in Vascular Surgery. by Joseph M. Giordano, Editor. Futura Press. Philadelphia. 1988 5. Trout,HH, Kozloff,L, and Felnberg,RL: Vascular Anomalies. In Vascular Surgery. by L.Hollier, Editor. Saunders Publishers. Philadelphia. 1988 6. Trout,HH, Feinberg,RL, and Kozloff,L: Remote Bypasses for Graft Infections. In Vascular Graft Infections. by T.J.Bunt, Editor. Futura Publishing Co. Philadelphia. 1994 7. Trout,HH, Feinberg,RL, and Kozloff,L: Staging Remote Bypasses for Graft Infections, Graft-enteric Fistulae, and Erosions. In Vascular Graft Infections. by T.J.Bunt, Editor. Futura Publishing Co. Philadelphia. 1994 8. Trout,HH, Feinberg,RL, and Kozloff,L: Management of Aortoenteric Commun- ications. In Vascular Graft Infections. by T.J.Bunt, Editor. Futura Pub- lishing Co. Philadelphia. 1994 7 Trout,HH, Feinberg,RL, and Kozloff,L: Cost-benefit Analysis of Carotid Endarterectomy: A Surgical Perspective. In Surgery for Cerebrovascular Disease. by W.S. Moore, Editor. Saunders Publishers. Philadelphia. 1996 BIBLIOGRAPHY (Original articles). 1. Kozloff,L and Joseph,WL: Cystic Dilatation of the Common Bile Duct in Adults. Med Ann DC. 42:595, 1973 2. Kozloff,L and Joseph,WL: Transduodenal Sphincteroplasty for Biliary Tract Disease. Amer Surg. 41:125,1975 3. Kozloff,L, Jackson,MJ, and Joseph,WL: Changes in Intestinal Function Following Jejunoileal Bypass in Primates. Rev Surg. 33:64, 1976 4. Kozloff,L, Jackson,MJ, and Joseph,WL: Changes in Intestinal Function Following Jejunoileal Bypass in Primates. J Surg Res. 20:607,1976 5. Kish,G, Kozloff,L, Joseph,WL, and Adkins,PC: Indications for Early Thoracotomy in the Management of Chest Trauma. Ann ThorSurg. 22:23,1976 6. McDonald,PT, Rich,NM, Collins,GJ, and Kozloff,L: Vascular Trauma Secondary to Diagnostic and Therapeutic Procedures:Laparoscopy. AmerJ Surg. 135:651,1978 7. Rich,NM, Coliins,GJ, McDonald, PT, and Kozloff,L: Lower Extremity Vascular Injuries:A Continuing Civilian and Military Problem. Rivisfa de Medicina i Chirurgia. (ifal). 1:11,1978 8.. Rich„NM, Collins,GJ, Andersen,CA, McDonald,PT, Kozloff,L, and Ricotta,JJ: Missile Emboli. J Trauma. 18:236,1978 9. McDonald,PT, Rich,NM, Collins,GJ, and Kozloff,L: Femoral-femoral Grafts: The Role of Concomitant Extended Profundaplasty. Amer J Surg. 136:622,1978 10. McDonald,PT, Rich,NM, Collins,GJ, and Kozloff,L: Doppler Cerebro- vascular Examination, Oculoplethysmography, and Ocular Pneumoplethysmography:Use in Detection of Carotid Disease. A Prospective Clinical Study. Arch Surg. 113:1341,1978 11. McDonald,PT, R1ch,NM, Collins,GJ, Andersen;CA, and Kozloff,L: Cerebro- vascular Screening by Ocular Pneumoplethysmography (OPG-Gee). Ann Surg. 189:44,1979 12. Collins,GJ, Rich,NM, Andersen,CA, Hobson,RW, McDonald,PT, and Kozloff,L: Acute Hemodynamic Effects of Lumbar Sympathectomy. Amer J Surg. 136:714,1978 13. McDonald,PT, Lichtmann,MW, Kozloff,L, Collins,GJ, Rich,NM, Collins,JT, andClagett,GP: Intraoperative Circulatory Collapse Secondary to Rapid Infusion of Plasmanate. Milit Med. 144:226,1979 14. Kozloff,L, Collins,GJ, Rich,NM, McDonald,PT, Collins,JT, and Clagett,GP: TheFallibility of Postoperative Doppler Ankle Pressures in Determining Adequacy of Proximal Arterial Revascularization. AmerJ Surg. 139:326,1980 8 BIBLIOGRAPHY {Original articles} - continued 15. Collins,GJ, Rich,NM, Andersen,CA, McDonald,PT, and Kozloff,L: Phlebo- rheographic Diagnosis of Venous Obstruction. Ann Surg. 189:25,1979 16. Kozloff,L, Rich,NM, McDonald,PT, Collins,GJ, Collins,JT, and Clagett,GP: Vascular Trauma Secondary to Diagnostic and Therapeutic Procedures:Cardiopulmonary Bypass and Intra-aortic Balloon Pumping. AmerJ Surg. 140:302,1980 17. Kozloff,L, Rich,NM, McDonald,PT, Collins,GJ, Collins,JT, and Clagett,GP:Total Parenteral Nutrition at Home:An Eleven Year Fallow-up.Milit Med. 144:730,1979 18. Guba,AM, Collins,GJ, Rich,NM, Kozloff,L, and McDonaki,PT: Non-dialysis Uses for Vascular Access Procedures. Ann Surg. 190:72,1979 19. McDonald,PT, Easterbrook,JA, Rich,NM, CoIIIns,GJ, Kozloff,L, Clagett,GP, and Collins,JT: Popliteal Artery Entrapment Syndrome:Clinical, Non-invasive and Angiographic Diagnosis. AmerJ Surg. 139: 318,1980 20. McDonald,PT, Kozloff,L, Collins,JT, Collins,GJ, Rich,NM, and Clagett, GP: Internal Carotid Occlusion: Detection by Direct Doppler Examination. Milit Med. 145:239,1980 21. Rich,NM, Collins,GJ, McDonald,PT, Kozloff,L, Clagett,GP, and Collins,JT: Popliteal Vascular Entrapment.its Increasing Interest. Arch Surg. 114:1377,1979 22. Collins,GJ, Lough,F, Rich,NM, Kozloff,L, Clagett,GP, and Coliins,JT: An Expedient Shunt for the Small Internal Carotid Artery. Amer J Surg. 139:880,1980 23. Trout,HH, Kozloff,L, and Giordano,JM: Priority of Revascularization in Patients with Graft-enteric Fistulas, Infected Arteries, or Infected Arterial Prostheses. Ann Surg. 199:669,1984 24. Giordano,JM, Trout,HH, Kozloff,L, and DePalma,RG: Timing of Carotid Artery Endarterectomy after Stroke. J Vasc Surg. 2:250,1985 25. Vetto,JT, Culp,SC, Smythe,TB, Chang,AE, Sindelar,WF, Sugarbaker,PH, Heit,HA, Giordano,JM, and Kozloff,L: Iliac Arterial-enteric Fistulas Occurring after Pelvic Irradiation. Surg.101:643,1987 26. Kozloff,L: Reconsidering Contraindications for Carotid Endarterectomy. Cardiology Review. 19:27, 2002. 27. Kozioff,L: Should postoperative troponin elevation change patient management?. Cardiology Review. 21:40, 2004. 28. Patino,WD, Mian,OY, Kang,JG, Matoba,S, Bartlett,LD, Holbrook,B, Trout,HH, Kozloff,L, and Hwang,PM: FOS as a Novel Marker of Atherosclerosis. Submitted for publication, 2004. 9 29. Kozloff,L: Are statins cardioprotective in patients undergoing major vascular surgery? Cardiology Review 25:40, 2008. 30. Fujimura,Y, Hwang, PM, Trout 111, HH, Kozloff,L, Imaizumi,M, Innis, RB, and Fujita, M: Increased Peripheral benzodiazepine receptors in arterial plaque of patients with atherosclerosis: An autoradiographic study with [3H]PK 11195. Atherosclerosis. 201:108, 2008. 10 Louis KOZLOFF, M.D., F.A.C.S. 8218 WiscoNsm AVEHuE SurrE 204 BETHESDA, MD. 20814 January 16, 2007 SURGERY R EVALUAno" Mr. Duane S. Barrick, Esq. Navitsky,.Olson & Wisneski, LLP 2040 Linglest6Wn 'Road Suite 303 Harrisburg, PA 17110 PHOMM0006524208 FAX000951$425 E4AA1L'tXOZLOF7??VASC,ASSOC.COM Re: Donald Morrison Dear Mr. Barrick: In reviewing this case, I examined the hospital records from. the Carlisle Regional Medical Center (1124105 - 2/2!05), as well as two separate sets of x-rays, namely the angiogram of the right leg done on 1/26/05 as well as the intra-operative angiogram done later that same day. My summary of the case is as follows. Mr. Morrison underwent a right total knee replacement on the morning of January 24, 2005. He returned to the post-anesthesia care unit (the PACU) at 10:38 am, and was subsequently discharged to the floor at approximately noon that same day.The nursing notes at noon report a diminished pulse in Mr. Morrison's right foot, although his right toes are described as warm and pink with good capillary refill at that time. Three hours later, however, Mr. Morrison's foot is described as coot and pale, with the patient complaining of numbness in the toes of that foot. In response, the dressings were loosened, but two hours later nursing notes document a failure to find a doppler pulse in Mr. Morrison's foot. At 11:15 that evening, Dr. Boran is reported to have seen Mr. Morrison, although there are no dated or timed progress notes to confirm that. Mr. Morrison's foot is again reported to be cool and dusky with diminished pulses. . On January 25th, Mr. Morrison is reported to-have continued decreased sensation. as well as impaired dorsiflexion of the foot. There are no doctor's notes confirming this. The first note by Dr. Boran after the operative note is from the following day, January 25th, and I suspect this was written during morning rounds on the 25th because of the references to lab results and Foley catheter removal. The next note by Dr. Boran is on January 26th, and describes pallor of the foot and decreased blood flow. A vascular surgical consultation is obtained at that time, which is now approximately two (2) full days after the completion of the surgery and the onset of symptoms of compromised blood flow. The vascular surgeon, Dr. Campbell, documents severe diminution of arterial blood flow in the foot and a tentative diagnosis of popliteal artery occlusion is made. Urgent angiography confirms this, and Mr. Morrison is then expeditiously brought to the operating room, where successful thrombectomy of his right popliteal artery is performed. Because of the presumed lengthy ischemic time, multi-compartment fasciotomies are performed concurrently. Post procedure angiography shows restored patency of the popliteal artery with good distal runoff via the posterior tibial artery. At this point, all appropriate measures have been done to salvage the limb from a vascular surgical standpoint. The patient's course thereafter is essentially uneventful with regard to the vascular surgery. He has a restored posterior tibial pulse in the right foot, and his dorsiflexion is reportedly improved. Mr. Morrison was discharged on February 2, 2005 to be followed as an outpatient by plastic surgery, for skin grafting over the area of the fasciotomies. There are several issues in question regarding this patient's course and care. 1. The nursing evaluation of Mr. Morrison's right lower extremity appears to be adequate. The nursing staff at Carlisle Regional Medical Center noted the diminution of the arterial blood flow quickly and informed the attending staff (Dr. Boran) in an appropriate amount of time. 2. The immediate response to the appearance of ischemia in Mr. Morrison's limb was to loosen the dressings and hopefully relieve external compression of the blood supply to the leg and foot. This is entirely appropriate, and was done, however it failed to improve the status of Mr. Morrison's extremity. At that time, further intervention should have been considered by Dr. Boran. The classic signs of poor arterial blood flow are referred to as "the five P's', and Mr. Morrison demonstrated all five of them - pain (although much of this could be attributed to the surgery); pulselessness (documented by the nursing staff); pallor (also documented); paresthesias or numbness (reported by the patient and.documented), and polar (documented coolness of the affected extremity). The presence of=all of these signs of ischemia should have prompted more active intervention as soon as noted, but none was accomplished by Dr. Boran until approximately 48 hours post operatively. 3. Extremities subjected to poor arterial blood flow (ischemia) become more irretrievably damaged the longer it takes to restore circulation. Nerve tissue is particularly vulnerable to ischemia. If the nerves are deprived of blood flow for longer than six hours, there is a significant chance of permanent damage and loss of either sensory or motor function. The delay in diagnosis of ischemia in Mr. Morrison's right lower extremity caused significantly increased damage to the nerves of the leg. The residual neurological impairment Mr. Morrison has suffered, would have been lessened or even entirely avoided had revascularization of his leg been done within a few hours of the incident instead of two (2) days later. 4. Delay in intervention also created the need for Mr. Morrison to undergo the fasciotomies. If a leg is revascularized within the time frame mentioned (six hours or so), there is rarely a need for fasciotomies. Because in this case the ischemia had gone on for so long, the fasciotomies were clearly indicated to prevent the occurrence of compartment syndrome (damage to nerves and muscles as the blood flow is restored and the muscles swell uncontrollably inside the nonelastic fascial covering). Fasciotomies are an additional component of morbidity in that Mr. Morrison now has large, gaping wounds which will require multiple plastic surgical procedures to close via skin grafting. Such wounds are also cosmetically disfiguring. In summary, my opinion to a reasonable degree of medical certainty is that the orthopedic surgeon, Dr. Boran, deviated from the standard of care in his post operative management of Mr. Morrison. More exacting evaluation and more prompt vascular consultation should have been done by Dr. Boran. For him not to have done so represented a deviation from the accepted standards of care. Mr. Morrison would have been revascularized more quickly with a significantly lower risk for long term impairment and more likely than not, lesser procedures would have been done when the artery was repaired. A delay of two (2) full days before definitive intervention was done is simply too long. All of the above opinions have been rendered to a reasonable degree of medical certainty. If you have any further questions regarding my review of this case, please feel free to contact me at your convenience. Yours truly, Louis Kozloff, MD, FACS Clinical Professor of Surgery, GWUMC 1 i Louis KOZtwFF, M.D., F.A.C.S. 8218 Wiscomsim AvEmE SME 204 BEI'HESDA, MD. 20814 ASCUL AR Sung VASCULAR EVAWATWH May 21, 2009 Mr. Duanb S. BbM6k, 1=sq. Navitsky, Olson & Wisneski, LLP 2040 Linglestown Road Suite 303 Harrisburg, PA 17110 . PHCWK: C300 6524 208 PAx:(901)9E1-8425 E- fAU h wcon,o?r@rrwnc?u5r9oc QOM Re: Donald Morrison Dear Mr. Barrick: 1 haye.finish ed.reviewin -the additional informaton'you sent me regarding the;Donald. Morrison case. This irWuded the depositions from both Mr: and.. Mrs... Morrison..as:well-as the. deposition from'Df. Boran, theAdppositionsof Nurses Ruth. Albright,.SharonfLattirop and Tami Burke-Helder, and Mr. Morrison's-medical records from Dr. Campbell's office, Dr. Phelan's office, Pennswood PT, and Dr. Stratis' office. My opinion regarding the case after reviewing this additional information is as follows. I.. continue to believe that Dr. Boran deviated from the usual and accepted, standard of care by undue delay in recognizing Mr. Morrison's severe ischemia, as mentioned in my earlier letter to. you of January 16, 2001, and that.he therefore caused the resultant delay in the diagnosis and treatment 8# iota li> i aitei : tfi hi vsia:. is:.dia al"fly caused increased morbidity and prolonged discomfort 'pain for Mr: Morrison as well as directly causing long term deficits in the function of his right leg. In addition, several statements made by Dr. Boran in his deposition I find inaccurate and in fact incorrect, as noted below. 1. On page 19, in response to Mr. Wisneski's question regarding "the five P's" as signs of ischemia [discussed in my previous letter], Dr. Boran asserts that "you have. to have :them all togetFiei 1, meaning that unless all five of the symptoms are present, the patients ischemia_ is .either not present or at least not critical. This is absolutely incorrect:. In my more tl4an thirty years' of experience- in -vascularsurgery'and in particular my more than "I I ? ? a thousand encounters with patients with limb ischemia, I find that in the majority of such cases, not all five of the findings are present. To determine that a patients ischemia is not critical or limb threatening because any one of these findings is absent is clearly below the standard of care. 2. On the same page, continuing onto the next page, Dr. Boran defines "timely" as between 12 and 24 hours, which I find unacceptable. Critical limb ischemia should be treated and appropriate intervention undertaken essentially immediately. In fact, once the vascular surgeon was consulted (two days later), his evaluation and intervention was rapid and nearly immediate. 3. On page 21, Dr. Boran once again states that all five of the symptoms need to be present to warrant arteriography. Once again, this is just wrong. Any change in the patient's dis ?1 arteylai 5fatras after--thesurg" which s:adone should trigger uxwnt _(-at least within a few hours) arteriography or other imaging evaluation of the vasculature of the affected limb. In my own practice, I have been'called to the recovery room numerous times to evaluate such patients before they leave the recovery room area. In fact, in the ' majority of such cases, I am called into the operating room to evaluate the patient even before he or she is awakened and. taken to the recovery area. This is clear testimony to the urgency of the situation and the need for prompt action. 4. On page 36, Dr. Boran once again makes incorrect statements regarding the clinical evaluation of Mr. Morrison's circulation. In particular, he states that "if you have complete arterial occlusion, the foot is not dusky, its white and the entire foot is cold, not just the toes." In truth, once a foot becomes critically ischemic, it most frequently becomes dusky first, then - more uncommonly - white only if there is absolutely no blood flow. A foot which has progressed from dusky to chalk white is a foot which has been ignored too long. The duskiness of the foot should have prompted intervention or at least further evaluation. Additionally, depending on the extent of ischemia, the toes may very well become cool or pale first.. As. the ischemia worsens, the skin changes will then progress more proximally, but waiting until that happens is also an unacceptable course. 5. On page 39, Mr. Wisneski quotes the notes as saying "unable to hear pulse with Doppler." This is a cause for immediate alarm and reaction. In some cases, re- examirrai6orrt3y amore a +e c i tbi tnWfug ate_euslible pulae witch." Doppler, but unless that takes place, one must presume that this is a severely and critically. ischemic foot and must be resolved. 6. On page 63 - the thrombus is described 'as being at the level of the adductor hiatus, which is above the actual area of the surgery. This makes me think that the cause of the thrombosis is unlikely to have been direct trauma to the artery. It is, however, the site of application of an intraoperative'tourniquet, and that may have been the etiology. In any event, the exact cause of the thrombosis is moot. The issue is the less than prompt diagnosis and delayed treatment of the problem. Finally, it should be mentioned that the need for fasciotomy, in my opinion, was directly related to the delay in treatment. As noted above, in more than a thousand such cases in my own experience, I would put the need for fasciotomy at less than I% when ischemia is treated in a timely manner. In this case timely would have been anywhere up to six or eight hours after Mr. Morrison's symptoms of ischemia continued in spite of his dressings being loosened. The addition of the fasciotomy prolonged the patient's convalescence and ultimately generated the need for additional surgery (skin grafting) to close the resultant wound defects. Had the thrombosed artery been re-opened within the first few hours, no fasciotomy would have been necessary, the leg should have been restored to its preoperative state, and recovery would have been greatly hastened and facilitated. No further intervention would have been needed and the sequelae that Mr. Morrison experienced would have been avoided. All of the above opinions fiavetbeeri -r6ndere'd`o wftatona We.degree at mediel certainty if you have any questions, I would be happy to discuss this with you at your convenience. Yours truly, 4wt> lz?? Louis Kozioff, MD, FACS Clinical Professor of Surgery, GWUMC Jan 06 ,10 04:38p NOW LLP 7175419206 P-3 January 5, 2010 Louis KozLOFW, M.D., F.A.C.S. 821 d. W000M9W ,0kV=9 7B SUM 904 »ItsHBwDw, MD. Me 14 r Kamm &VAARATMN poomqq?!O 68WIS" Fi?? WQ?11?sf-d3=8 .cow Re: Donald Morrison Mr. Duane Bar rick, Esq. 2040 l_inglestown Road Suite 303 Harrisburg, PA 17110 Dear Mr. Barrick: 1 have reviewed the reports of Drs. Smith and Amin. These reports do not In any way change my previous opinions in this natter, Regarding Dr. Smith's opinions via two letters; the fiat dated October 5, 2408, and the second dated October 13, 2009, 1 offer the toliowing remarks; • Dr. Smith notes via his letter of October 5, 2049, Page two, paragraphs 4 and 5: there Is documentation of gb@M in Mr. Mormon's pubes status. This should have been =Use far aWm to any reasonable surgeon who has just operated on the extremity evidencing the change in pulse status. • Page two, paragraph T a nurse noting that the pulse was diminished and that the foot was pate and dusky on the operatim extremity is also cause for enhanced attention and evakmtlon. • Page three, paragraphs 2 acid 3: Dr. Smith calls athmfion, to the fact that Mr. Morrison's symptoms became greater with lying down and lessened with dependency of the leg. This is a classic indication of ischernle. Pain after knee replacement Is usually worsened with dependency, since that would tend to increase postoperative swelling. In my own pracdloe, I find it quite worrisome when a patient tells me that he or she has worsened pain at night with the leg elevated. Often the patient or a spouse will admit to Jan 06 10 04:38p NOW LLP 7175419206 p•4 having to sleep with the leg dangling cues the bed or even in a chair. This produces a slight Increase In arterial blood flaw via gravity, and occasionally is enough for moderate relief of the Ischemic pain, Any reasonable physician beating patients at risk for possible vascular sequela knowa that this clinical picture is one of cdTcal arterial Ischernia and should be treated expeditI usly. Page three, rural paragraph: Dr. Smith notes that "a four compartment fasciotomy of the right log was performed by Dr. Campbell." This is a significant observation by Dr. Smith regarding Mr. Morrison's damages because it is contrary to his staternent In his October 10 letter, page two, paragraph 4, that, "Dr. Koziafts claim that the plaintiff I... now has large gaping wounds which will require multiple plastic surgical procedures to close via skin grafting.' is not at all supported by the records in tits case." In fact, Or Smith states in his first letter page four, paragraphs 3 and 5 that "Consultation was 'Also obtained with John. P. Sirens, MD, for skin grafting of the tasciotonv wounds' and also that "Mr. Morrison was returned to the Operating Room at the Carlisle Regional Medical Center by Dr. John P. Straus, on February 8, 2006, when wound debridement and skin grafting was performed ' This is obvious evidence that my strrtertnent is true and appropriate.. Mr. Morrison did require additional Incisions, was left with open gaping wounds, and did require further plastic surgical procedures to dose them. Page five, paragraph 3: Dr. Smith etWes that "Patients not inhequerftltr will complain of some numbness and weakness in the foot following total knee replacement arthropleaty as a result of the thigh tourrilquet used to prevent intreoperative bleeding' This is true, However, Dr. Smith fails to mention that these symptome almost always resolve within minutes of tourniquet release. Page five, paragraph S:. The statement that lachernia longer than six hours In duration mas a rule, renders a limb unsaingeabler' Is an oversimplification and is inaccurate. I have seen )hobs W emic for 48 hours which are salvageable, and 1 have also seen limbs ischemictor less than six hours become unselvageable. There Is no black and white dichotomy, but rather a continuous spectrum of degree of iscttemis versus limb salageability. The longer a patieant's ischernia goes untreated, the higher the risk that the patient will be left with permanent neurological deficit, as was the case wrkh Mr. Morrison. Page one of the October IP letter, paragraph thme: the ImIgn" appearance of the patient's right toot is a mischaradeftation of the facts. Any physician knows that a dusky, cool, pulseless foot is anything but benign. Dr: Smith also poses the question as to whether the reriemnc es In my report were to similar patient experiences as Mr. Morrison's and Involved total knee replacements, In a word, 'rtes". I am referring to patients who have undergone total knee replacements. I have been surnrnoned for a vascular evaluatibn of such patients on many occasions. Jan 06 10 04:36p HOW LLP 7175419206 p.5 Page two of the October le letter, paragraph two: Dr. Smith notes that I did "not discuss the probability of dusky appearing toes or toot from the reactive hyperemia. almost always seen In a limb afmr use of a toumiqueL" There is a very good reason for V-WL This statement by Dr. Smith Is bath incorrect and bizarre. Any reasonable physician knows that reactive hyperemia Is by definite a red, warm, hypervascxrlar phenomenon. It is r over defined or described as dusky. Hence my lack of discussion. Page two of the October 13"' letter, paragraph 5: Dr. Smith's contention that this is a rare event following total knee replacement is co rect. However, Dr. Smith completely Ignores the obvious, which Is that a high degree of suspicion Is certainly Indicated when there is a documented change in the character of the patient's pulse or vascular status postoperatively. Particularly when the change Is present in the patleas. operative extremity, which was the case with Mr. Morison. So Dr. Shankman's statement is a bit spurious taken out of context, but is quite appropriats in this particular case. The following are my rernadw regarding the comments of Dr. Amin via his letter dated October 10, 2009.- • Page nine, number 2: Dr. Amin disagrees that Mr. Morrison had all five signs of poor arterial blood flow. This is basically irrelevant since any one of the signs should have at least been cause for concern and further attention. His statement, however, is still wrong. The "five Pe of ischemla include pain (which was present), pulselessness (which was prase no, parealheshm (which were present). pMw (which was present), and polar, meaning coolness (which was present). Mr. Morrison did indeed have all five signs. Later In the same paragnaph,'Dr. Amin quotes a progress note which said that there vms'decrease pulse, unable to hear pulse with Doppler." This is a v_M alarming observation and should have prompted immediate re-assessment at the very feast. Dr. Borah failed In this regard. • Page nine, nurriber 2, Inter in the same paragraph: Dr. Amin's contenion that the leg could not have been vlable if it tied been Achemio for two Rill days is uninformed and incorrect. As mentioned earlier. there are manly levels of isc therms, and limb lose cannot be deemed Inevitable based solely on the length of Ischemik but must be Individually assessed- • Page ten, number three: Dr. Amin makes "same circxtlar reasoning mistake in saying that it the limb were Isc hemic for the length of time suggested, it could not have been salvaged. Bence, since It was salvaged, It was not ischemic. Again, as mentioned previously, there are varying degrees of both Ischernia and sakWeablity. Dr. Amin surely cannot dispute that the longer the patienrs lschemie goes untreated, the greater the risk of permanent injury to the patient. All of the above opinions are expressed with a reasonable degree of medical certainty. The opinions contained In my previous reports remain unchanged. I hope that the above Jan 06 10 04:39p NOW LLP 7175419206 p.6 observations answer any questions which may have arisen based on the reports of Drs. Smith and Amin. if you need any ;further explanation or elaboration, please do not hesitate to contsrt me. Yours truly, Loul$ Kozioff, Mb. FAGS Clinical Professor of Surgery, GWUMC EXHIBIT C CURRICULUM VITAE GREGORY B. SHANKMAN, M.D. University of Denver Denver, Colorado 9/65 - 6/69 Bachelor of Science University of Maryland Baltimore, Maryland 9/69 - 6/73 Doctor of Medicine Cincinnati General Hospital Cincinnati, Ohio 6/73-6n4 Internship Resident General Surgery Cincinnati, Ohio 7/74 - 7/75 Jr. Resident Orthopaedic Surgery Cincinnati, Ohio 7/75 - 7/76 Sr. Resident Orthopaedic Surgery Cincinnati, Ohio 7/76 - 7/77 Chief Resident Orthopaedic Surgery Cincinnati, Ohio 7/77 - 7/78 Orthopaedic Surgeon in Private Practice Utica, NY 1978 - Present Board Certified American Board of Orthopaedic Surgeons 9/10/83-Present St. Luke's Hospital, Utica, New York Chairman of Orthopaedic Surgery 1990 - 2002 Vice Regent, International College of Surgeons Case Report of Dislocated Trapezoid: Dr. Gregory B. Shankman and Dr. Mark Goodman Spinal Stenosis Definition and Review: Paper presented at the Freiburg Society by Dr. Gregory B. Shankman Page 2 Gregory B. Shankman, M.D. Curriculum Vitae Facet Syndrome: Presented by Gregory B. Shankman, M.D. at the World Congress of Surgery in Milan, Italy. Foraminal Stenosis: Presented by Gregory B. Shankman, M.D. at the NYSOS in Grand Cayman Island, April 1992. Foraminal Stenosis: Presented by Gregory B. Shankman, M.D. at the Hungarian Orthopaedic Society, Hungary, August 1992. Use of the Arthroscope for Visualization in Open Discectomies: Written by Frank H. Boehm, M.D. and Gregory B. Shankman, M.D. Presented by Gregory B. Shankman, M.D. at the NYSOS in Puerto Rico, April 1993. Use of the Arthroscope for Visualization in Open Discectomies: Presented by Gregory B. Shankman, M.D., at the Ortho-Neuro Society in September, 1993. Use of the Arthroscope for Visualization in Open Discectomies: Accepted for presentation by Gregory B. Shankman, M.D. at the 8th Annual Conference of Pakistan Orthopaedic Association, Bahawalpur, Pakistan, November 1993. Interpedicular Screw Fixation: Presented at the International College of Surgeons, London, England, by Gregory B. Shankman, M.D., November 1994. 60th Annual Surgical Update: Paper sent on Diagnostic use of Discograms in Planning Spine Surgery - Maui, Hawaii - June 17-21, 1998 NY State Society of Orthopedic Surgeons, Inc. - Joint Annual Spring Meeting: Paper sent on Diagnostic use of Discograms in Planning Spine Surgery - Four Seasons Resort, Nevis, West Indies - April 20-25, 1999 19th Annual Alumni Day - Department of Orthopedic Surgery - SUNY Health Science Center: Paper sent on Diagnostic Use of Discograms in Planning Spine Surgery - June 11, 1999 Page 3 Gregory B. Shankman, M.D. Curriculum Vitae 36th North American Federation Congress: Paper sent on Diagnostic Use of Discograms in Planning Spine Surgery - Ritz-Carlton Cancun- Cancun, Mexico - June 23-27,1999 IITS/iSMISS Combined Meeting: Paper sent on Diagnostic Use of Discograms in Planning Spine Surgery - Cambridge,. England - August 1-5, 1999 Spine Society of Europe: Paper sent on Diagnostic Use of Discograms in Planning Spine Surgery - Munchen Park Hilton Hotel Munich/Germany - September 7-11, 1999 Department of Orthopedic Surgery Alumni Day: Diagnostic Use of Discograms in Planning Spine Surgery - Brass Court Radisson Plaza, The Hotel Syracuse, Syracuse, NY June 9, 2000. Gregory B. Shankman, MD., PC. Orthopedic Surgeon P.O. Boat 9190 Utica, NY 13505 Phone (315) 797-0111 Fax (315) 735-3454 May 26, 2009 Duane S. Barrick Navitsky, Olson & Wisneski, LLP Attorneys at Law 2040 Linglestown Road, Suite 303 Harrisburg, PA 17110 Re: Donald MOrdyea Dear Mr. Baniok I am a board certified orthopaiie surgeon. At your request, l have reviewed the medical records and depositions regarding this ease. These inchWla Mr.'Morrison's medical records from Carlisle Regional Medical Center and the, depositions of Dr. Boran, Mr. and Mrs. Morrison, and Nunes Ruth Albright, Tami Burke-Heckler and Sharon Lathrop. Mr. Morrison underwent a right Legacy total knee arthroplasty on January 24, 2005 at the Carlisle Regional Medical Cater. This was performed by Dr. Robert P. Boran, Jr., an orthopedic surgeon. At the conclusion of the operadve note, Dr. Doran recorded "neurovascularly intact to the right lower extremity." However, post-opc atively, Mr. Morrison developed signs and symptoms of decreased vasaalar supply to his right lower extremity. Dr. Doran did not order a vascular consult: or arteriogran until approximately two (2) days after She signs and symptoms of decreased vascularizatlon of Mr. Morrison's right lower extremity began. This was a deviation from the accepted standard of orthopedic care. According to the records of the Carlisle Regional Medical Center, Mr. Morrison left the operating room following his right total knee replacement by Dr. Doran at 10:37am and arrived in the PACU at I (:38am. He was discharged to the float- at 12 noon on January 24, 2005. Mr. Morrison's Post-Op Orden included the daily administration of Coumadin on a sliding scale. According to the musing documentation form, at 12 noon on January 24, 2005, it was noted that Mr. Morrison was received from the PACU and that his pedal pulse was diminished, but palpable. His right toes were noted to be warm and pink with capillary refill less thou 3 seconds. Thrce hours later, at 3pm on January 24, 2005, the some nurse noted that Mr. Morrison's toes were cool, pale and that Mr. Morrison stated his toes were numb to touch The immobilizer was removed and the ace bandage loosened, and again, it was noted that his right pedal pulse was diminished, but palpable. However, it was noted that the right pedal pulse was not as strong as the left pedal pulse. At 3:30pm, a different nurse noticed that Mr. Morrison's right foot was pale, slightly cool, had a decreased pedal pulse, but has positive sensation and motion. One hour and 45 minutes later, the muse toted that Mr. Morrison stated that the top of his foot and toes were numb. It it noted that Mr. Morrison had positive sensation on the right side and bottom of his right foot, but had decreased pedal pulse. The nurse recorded that they were unable to hear the pulse with a doppler and recorded that they would notify Dr. Boren. Forty-five minutes later. at 6pm, it is noted that Dr. Boran was notified with orders received. The immobilizer had been removed, and had not been reapplied since 3pm. It was noted that the post-operative dressing had been loosened and rewrapped at 3pm. The plan was to continue to note the color of his foot. Mr. Morrison's toes continued to appear pale and slightly dusky, and Dr. Boran was noted to be aware. Mr. Morrison received his fast dose of Countadin 10mg at 6pm. Fifty minutes later. at 6:50pm the same nurse rioted that Mr. Morrison still had decreased sensation in his right foot, complaints of slight tingling on the sole of his foot. Mr. Morrison's post-operative dressing was .removed to check for any constrictive dressings, but it was noted that there were none. His right . foot remained cool with decreased pulse, whereas his left foot was warm and had a positive pedal pulie. It was also noted that the ace bandage was on loosely and that his roes remained dusky. At 10:15pm on January 24, 2005, it was noted that Mr. Morrison dangled, stood, and tolerated it well. It was noted that Mr. Morrison thought he might have more feeling in his right foot. However, his pulse remained decreased, and his foot was pale, and toes were slightly dusky. He did have positive motion of his right foot. Mr. Morrison's dressing was removed down to the 4x4's and re-dressed loosely, and he was encouraged to do $bquent ankle pumps. At 1 I :15pm, it was noted that Dr. Horan was in to see the patient and examined Mr. Morrison's right leg and foot, and no new orders were given. The nurse noted that Mr. Morrison's pedal pulse was decreased, his toes were cool and dusky, and that Mr. Morrison denied numbness, but had some tingling in his toes At 3:50am on January 25, 2005, the nursing documentation form rcflects that Mr. Morrison had a positive but decreased right pedal pulse, and that Mr. Morrison stated that he had numbness and tingling mostly in the great toe, and that his foot was warn to the touch, but the toes were still cool. At 6am on January 25, 2005, the nurse noted that Mr. Morrison stood at the side of his bed with a walker and was still complaining of numbness in his great toe. At 7:15am on ]snowy 25,;ZO05; Mr. Morrison was still noted to have a•diminishcd pedal pulse. At 9:45am, it was noted that Dr. Boran was notified and aware of the numbness of Mr. Morr ison's right foot. At l 0:30arn, the, CPU machine was started at 30 degrees, and Mr. Morrison was tolerating it well. At 12:30pm6 the nurse noted that Mr. Morrison had low numbneess in his right foot. At 1:45 p.m., it is noted that the patient ambulated with-walker with patient tolerating it well. At 4:30pm, the nurse recorded that Mr. Morrison was still complaining of slight tingling and decreased sensation in his right foot. At 6pm, Mr. Morrison received the second dose of Coumadin 1.0mg, based upon an INR of 1.0. At 8:50pm, the nurse noted decreased sensation and decreased dorsi- flexion noted in Mr. Morrison's right foot, and that his foot was still cool to the touch. ti ' At 12:30arn on January 26.2005, the night nurse noted that Mr. Morrison's toes remained cool to the touch, and he had diminished right pedal pulse and decreased dorsi-flexion of the right foot. The tingling persisted, and edema was present in the right leg and hoot. At 7:45arn on January 26, 2005, the day nurse noted that Mr. Morrison's right dorsalis pedis and posterior tibial pulses were very diminished as compared to the left pulses. It was noted that his right foot was cool and pale, and that Mr. Morrison was complaining of soreness in his right lateral calf, but denied tenderness to the right posterior calf. it was noted that Mr. Morrison stated that it felt like his right foot was "falling asleep". His right great toe remained numb along the medial side back to the heel. At 9:45am, it is noted that Dr. Horan had been called and updated on Mr. Morrison's-condition by the nurse. At 12:10pm, the records reflected that Mr. Morrison was seen by Or. Horan and Dr. Campbell, a vascular surgeon. At 3:35pm, the nurses noted that Mr. Morrison was NPO and awaiting an arteriogratn. According to the nursing documentation form, at 4:30pn% a STAT prothrombin time was drawn and approximately 2 hours later, at 6:10 pm, Mr. Morrison was sent to radiology for the arteriogram. Dr. Campbell's impression from the arteriogram of Mr. Morrison's right lower extremity was popliteal artery occlusion, probably due to thrombosis, with reconstitution of the posterior tibial vessel. Mr. Monison's coagulation studies were as follows at 6:25am on January 27, 2005: PT was t8.1 (high), and his INR was reported as 1.7 (high). Subsequently, a STAT blood draw at 4:24pm on January 26, 2005, produced results of a PT of 14.0 (high) and an 1NR of 1.3 (high). Thereafter, Mr. Morrison was taken to the operating room at 7:50pm on January 26, 2005, and a right poptiteal thmmbectomy, with repair of right superficial artery and right distal medial and lateral fasciotomies consisting of 4-compartment faseiotomies of the right lower leg, were performed by Dr. Campbell. At the time of the surgery on January 26, 2005, Dr. Campbell noted in his operative note that the lateral and anterior compotUnents appeared to be very ten", necessitating 4-compartment faseiotomies. When the anterior compartment was opened, there appeared to be ischaxnic muscle that did not contract with stimulation with the Bovie. Since the 4-compartment fasciotomy of Mr. Morrison's right lower leg on January 26, 2005, he has undergone plastic surgay to improve the appearance of his fight lower extretity. To date, Mr. Morrison still has swelling in his right lower extremity and continues to have aurnb toes and lack of movement in the right loaner extremity. It is my opinion, to a reasonabic degree of medical certainty, that Dr. Horan deviated from the accepted standard of orthopedic care in his treatment of Mr. Morrison. It was a deviation from the standard of care for Dr. Boran to wait approximately two (2) days before ordering a vascular consult and/or in arteriogmm of Mr_ Morrison's right lower extremity in light of the findings ofde ceased vascularity in Mr. Morrison•s right kg that began almost immediately after the right. total knee replacement on January 24, 2005. That has to be a high index of suspicion for this type ofproblem after a total knee replacement and one has to act immediately on it when it is recognized, Dr. Horan's statement that all five l's must be present simultaneously in a patient before a vascular consult and/or artchogram should be ordered is incorrect. As soon as the patient exhibits any of the classic signs or symptoms of a blood clot following this type of surgery, further evaluation by arteriogram and/or vascular consult is required. It is standard practice that the "sun should not rise or set" on a blood clot in a patient's leg. Dr. Boran should have recognized that Mr. Morrison was experiencing signs and symptoms of a thrombosis, and ordered a vascular consult aad/Or arteriogtank, before the eM of the day on January 24. 2005- His failure to do so significantly increased Mr. Morrison's risk of harm, including his need for extensive fasciotomies and drombectorny with arterial repair. Urgent diagnosis and intervention would have resulted in Mr. Morrison not needing any fasciotomies at all. Additionally, earlier intervention by Dr. Boran would have significantly decreased the chances of Mr. Morrison developing the disfigurement and permanent neurological symptoms that he is left with today. The nurses at Carlisle Regional Medical Center acted appropriately in notifying Dr, Boran of their concerns regarding the signs of abnormal vascularity of Mr. Morrison's right lower exhvinity in the post-operative period. All of my opinions have been rendered to a reasonable degree of medical certainty. If 1 can be of any further help in this matter, do not hesitate to contact me, Gregory B. Shankman. M.D. GBSJcap Jan 06 10 04:39p NOW LLP 7175419206 p.7 Page I or 7 Gregory B. Shankman, M.D., PC. Orthopedic Surgeon P.O. Box 8190 Utica, NY 13505 Phone: (315) 797-0111 Fax (315) 735-3459 January 6, 2010 Duane Barriok, Attorney Navitsky, Olson 8 Wisneski, U.P 2040 Unglestown Road Suite 303 Harrisburg, PA 17110 RE: Donald Morrison Dear Mr: Barrick, I reviewed the expert reports of Dr. Steven Smith and I an in disagreement with his opinions. As I stated in my report to you on 512101t}9, it was a deviation in the standard of care for Dr. Boren to wait approximately two days before ordering a vascular consuA and/or obtaining an aderiograrn for Mr. Morrison regarding the postoperative vascular change in his right tower extremity. Specifically, the vascular changes present in the same extremity on which Dr. Boren had just performed a total knee arthroplasty. The signs and symptoms that Mr. Morrison was having in the postoperative period were those of vascular insufficiency to the I"er extremity, It is a well known fact that the longer a patient goes without sufficient blood supply. the more difficult it is to restore function and the risk for permanent damage is increased. In this case, waiting two days was unreasonable and inappropriate- The reason that a patient's blood supply is checked frequently -and Is of concern during the postoperative perW is that with total knee replacement. one is using a tourniquet and working In the vicinity of the popl'iteal artery, which can easily be damaged Therefore, if a total knee patient displays a change in vascular status postoperatively that is not abated promptly by a loosening of the dressing, vascular compromise should be suspected and an arteriogram and/or Vascular consult ordered immediately. The sooner a thrombus is diagnosed and a thrombectomy performed, the better the results will be. Therefore. I disagree with Dr. Smith's opinion that it was okay to wait two days. The purpose of having the patient in the hospital and, under observation is so that these problems can be handled with dispatch. 1 recognize that a thrombus after a total knee replacement is a recognized complication, but immediate treatment is required and is where the deviation occurred in this case. I am also in disagreement with the assertion that the problems were insidious and progressive. Mr. Morrison's difficulty was apparent as of 3:00 p.m. on the.day of the surgery, and therefore one would have to have a high level of suspicion that this Jan 06 10 04:39p NOW LLP 7175419206 p.8 Page 2of2 condition may have been the result of a' blood clot and be aware of the necessity for urgent operative intervention if loosening of the dressing did not promptly resolve the patient's signs and symptoms. Having reviewed the letters of Dr. Smith dated 10/512009 and 90113/2009, it remains my opinion that Dr_ Boran deviated from the -accepted standard of orthopedic care by waiting approximately two days to on3er a vascular consult and/or an arterbgram for Mr. Morrison. AN of my opinions have been rendered; to a reasonable degree of medical certainty. I stand ready to explain all of my findings to a jury. If l can be of any further help.,do not hesitate to contact me. B. Shankrman, M.D. n DONALD L. MORRISON AND SHARON A. MORRISON, his wife, PLAINTIFFS V. ROBERT P. BORAN, JR., M.D. AND APPALACHIAN ORTHOPEDIC CENTER, LTD., DEFENDANTS IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA 07-187 CIVIL TERM -71 T IN RE: PRETRIAL CONFERENCE A pretrial conference was held on April 7, 2010, plaintiffs' counsel- Joseph Melillo, Esquire was present and, by agreement, defense counsel, Elaine?'tV Rog , Esquire, participated via telephone. Li M . This is a medical malpractice action for personal injury arising out of an allegedly delayed diagnosis and treatment of a decreased blood flow in plaintiff Donald L. Morrison's lower right leg following knee surgery by defendant. Plaintiff Sharon A. Morrison sues for loss of consortium. As agreed upon in the pretrial conference held before Judge Oler on January 13, 2010, each side will have four peremptory challenges. It is estimated that the trial will last four days. The parties are agreeable to the suggestion by the court that the jurors be permitted to takes notes during the presentation of evidence but be precluded from doing so during opening statements, closing arguments and the charge by the court. The parties request a date certain start of April 26, 2010. If the following outstanding issues are not resolved by agreement before trial, counsel has been advised to present to the court a brief legal memorandum on each issue prior to trial: J (1) Defendant intends to file a motion in limine to preclude plaintiffs' expert vascular surgeon from rendering an opinion on the standard of care for the treatment of plaintiff. At issue is whether the MCARE Act prohibits an expert from a different specialty from giving an opinion. Plaintiff contends that because it was the treatment after the surgery and not the orthopedic surgery itself which gave rise to the claim, the overlap between vascular and orthopedic experts would permit either to render an opinion on the post-operative treatment. (2) The issue of whether deposition testimony by nurses may be read or shown to the jury was raised by plaintiff. Defendant contends nurse deposition are not readable. The parties intend to research and resolve this case. (3) All of plaintiff medical expenses have been paid to date and no lien has been asserted. Plaintiff may submit related bills under the MCARE Act. Defendant is agreeable to this as long as the figures are consistent with what was paid for the medical services as opposed to what was charged. (4) It appears that the parties will stipulate as to the authenticity of medical records. (5) Defendant has not determined whether or not a videotape deposition is necessary of the treating vascular surgeon, Joseph Campbell, M.D. If that is necessary, it will not impact the trial schedule. I The parties did attend a mediation conference following the January pretrial conference. There appears to be a substantial difference in the valuation of this case by both sides. Even if that is resolved, settlement of this case is unlikely due to non- financial issues. By the Court, " Albert H. Masland, J. Joseph M. Melillo, Esquire For Plaintiffs Elaine M. Ross, Esquire For Defendants Court Administrator sal KILCOYNE & NESBITT, LLC BY: ELAINE M. ROSS ATTY. ID. #46031 By: DAVID W. RINGLABEN ATTY. ID. #206836 630 W. GERMANTOWN PIKE, SUITE 121 PLYMOUTH MEETING, PA 19462 610.825.2833 ATTORNEY FOR DEFENDANT, ROBERT P. BORAN, JR., M.D. DONALD L. MORRISON and SHARON A. MORRISON, his wife, Plaintiffs vs. ROBERT P. BORAN, JR., M.D. and APPALACHIAN ORTHOPEDIC CENTER, LTD.,: Defendants COURT OF COMMON P EAF , CUMBERLAND COUNP `. TT No. 07-187 Civil Term - J w 3? JURY TRIAL DEMANDED { =< - SUPPLEMENTAL MOTION INLIMINE OF DEFENDANT ROBERT P. BORAN JR, M.D., TO PRECLUDE THE TESTIMONY OF LOUIS KOZLOFF, M.D. Defendant, Robert P. Boran, Jr., M.D., (hereinafter "Moving Defendant"), by and through his attorneys, Kilcoyne & Nesbitt, LLC, hereby files this Supplemental Motion in Limine to Preclude the testimony of Louis Kozloff, M.D. pursuant to 40 P.S. § 1303.512, and in support thereof avers the following: 1. The Complaint was filed on or about March 29, 2007 and alleges negligence in the care and treatment of Plaintiff against Robert P. Boran, Jr., M.D., a Board certified orthopedic surgeon. See Complaint at Exhibit "A". 2. Plaintiffs' claims against Dr. Boran involve allegations of medical negligence from orthopedic treatment rendered to him by Dr. Boran at Carlisle Regional Medical Center from January 24, 2006 through January 26, 2006. 3. In the course of this litigation, Plaintiff has identified Louis Kozloff, M.D., as an expert in the field of general/vascular surgery.' A true and correct copy of Dr. Kozloff s expert reports are attached hereto as Exhibits "B", "C", and "D". 4. General Surgery/Vascular Surgery are the only areas of expertise listed on Dr. Kozloff's Curriculum Vitae. A true and correct copy of Dr. Kozloff's Curriculum Vitae is attached hereto as Exhibit "E". 5. Indeed, Dr. Kozloff's residency training was in general surgery and he is currently employed as a General/Vascular Surgeon in private practice in Washington, D.C. See Exhibit «E", 6. Despite the fact that Dr. Kozloff has identified himself as an expert only in the fields of general/vascular surgery, he purports to render opinions in the field of orthopedic surgery. See Exhibits `B, "C", and "D". 7. It is well-established under Pennsylvania law that a witness with neither experience nor education in a particular subject matter may not qualify as an expert. Dambacher v. Mallis, 336 Pa. Super. 22, 42-3, 485 A.2d 408, 418-9 (1984). See also Dierolf v. Slade, 399 Pa. Super. 9, 581 A.2d 649 (1990). 8. Further, pursuant to 40 Pa.C.S.A. § 1303.512(c), an expert testifying as to a physician's standard of care must also 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 [...]. See 40 Pa.C.S.A. § 1303.512(c) (emphasis added). 9. A thorough review of Dr. Kozloff's Curriculum Vitae reveals that all of his postgraduate training, academic appointments and past employment positions have been in the area of general and vascular surgery. See Exhibit "E." 10. There is absolutely nothing in Dr. Kozloff's Curriculum Vitae which shows that he has "any reasonable pretension to specialized knowledge" with respect to the standard of care for an orthopedic surgeon in the post-operative care of a total knee replacement surgery patient. See Exhibit "E". 11. Further, there is nothing in Dr. Kozloff's Curriculum Vitae which establishes that he practices in the same subspecialty as Defendant, Dr. Boran, as required by 40 Pa.C.S.A. § 1303.512(c)(2). See Exhibit "E". 12. Finally, Dr. Kozloff is not board-certified in Orthopedic Surgery. See Exhibit "E". 13. Dr. Boran is board-certified in Orthopedic Surgery. A true and correct copy of Dr. Boran's Curriculum Vitae is attached as Exhibit "F" 14. Pursuant to 40 Pa.C.S.A. § 1303.512(c)(3), an expert testifying as to a physician's standard of care must be board certified by the same or similar approved board as the physician being criticized. See 40 Pa.C.S.A. § 1303.512(c)(3). 15. Because Dr. Kozloff does not have a board certification in orthopedic surgery, he cannot testify as to the standard of care for Dr. Boran, a board-certified orthopedic surgeon. 16. Further, because Dr. Kozloff lacks the knowledge and experience necessary to render expert criticism in the field of orthopedic surgery, he should be precluded from doing so at the time of trial. 17. Plaintiffs may argue that Dr. Kozloff is qualified to testify as to standard of care against Moving Defendant under §512(d). However, even if this argument is made, Dr. Kozloff should still be precluded from testifying as to issues regarding the breach of the standard of care of an orthopedic surgeon, as his reports are cumulative of Plaintiff's orthopedic surgery expert, Dr. Gregory Shankman. Dr. Shankman's reports are attached as Exhibits "G" and "H" and his C.V. is attached as Exhibit "I". 18. Plaintiffs should not be permitted to offer multiple expert witnesses on the issue of standard of care in the field of orthopedics, particularly since Dr. Kozloff is a vascular surgeon. Expert testimony as to Dr. Boran's standard of care by Dr. Shankman and Dr. Kozloff would amount to cumulative testimony. 19. Although relevant, evidence may be precluded if its probative value is outweighed by the danger of unfair prejudice, confusion of the issues, misleading the jury, or by considerations of undue delay, waste of time, or needless presentation of cumulative evidence. See Pa.R.E. 403. 20. Plaintiffs should be precluded from offering both Dr. Shankman and Dr. Kozloff as expert witnesses against Moving Defendant. Plaintiff should be limited to one standard of care expert. Allowing Plaintiffs to call multiple standard of care experts against Moving Defendant is not only cumulative and prejudicial to Moving Defendant, but results in the needless repetition of testimony. WHEREFORE, Defendant, Robert P. Boran, M.D., respectfully requests that this Honorable Court limit plaintiffs expert, Louis Kozloff, M.D., a general/vascular surgeon from rendering expert opinions in the field of orthopedic surgery at the time of trial. Respectfully submitted, KILCOYNE & NESBITT, LLC BY: ELAINE M. ROSS, ESQUIRE DAVID W. RINGLABEN, ESQUIRE Attorney for Defendant, Date: Z U Robert P. Boran, Jr., M.D. KILCOYNE & NESBITT, LLC BY: ELAINE M. ROSS ATTY. ID. #46031 By: DAVID W. RINGLABEN ATTY. ID. #206836 630 W. GERMANTOWN PIKE, SUITE 121 PLYMOUTH MEETING, PA 19462 610.825.2833 ATTORNEY FOR DEFENDANT, ROBERT P. BORAN, JR., M.D. DONALD L. MORRISON and SHARON A. MORRISON, his wife, Plaintiffs vs. ROBERT P. BORAN, JR., M.D. and ; APPALACHIAN ORTHOPEDIC CENTER, LTD.,: Defendants COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA No. 07-187 Civil Term JURY TRIAL DEMANDED MEMORANDUM OF LAW IN SUPPORT OF THE SUPPLEMENTAL MOTION IN LIMINE OF DEFENDANT, ROBERT P. BORAN, JR., M.D., TO PRECLUDE THE TESTIMONY OF LOUIS KOZLOFF, M.D. 1. INTRODUCTION Defendant, Robert P. Boran, M.D., moves to limit the testimony of Plaintiffs expert, Louis Kozloff, M.D. Dr. Kozloff has identified himself as an expert in the fields of general and vascular surgery and yet he purports to render opinions as to the standard of care in the field of orthopedic surgery. See Exhibits "B", "C", and "D". Under Pennsylvania law, an expert must have experience and education in a particular subject matter in order to render an opinion thereon. A careful review of Dr. Kozloff's Curriculum Vitae reveals that he has no education and no "reasonable pretension to specialized knowledge" in these fields. Further, Dr. Kozloff is not currently practicing in the fields of orthopedic surgery nor does it appear that he has ever practiced in this field. Dr. Kozloff does not have a board certification in orthopedic surgery as required by statute in order for an expert to be critical of a board-certified orthopedic surgeon. Accordingly, moving Defendants respectfully request that Dr. Kozloff be precluded from testifying on areas that are outside his field of specialty as more specifically set forth herein. II. FACTUAL AND PROCEDURAL BACKGROUND The Complaint was filed on or about March 29, 2007 and alleges negligence in the orthopedic care and treatment of Plaintiff against Robert P. Boran, Jr., M.D. See Complaint at Exhibit "A". Plaintiffs' claims against Dr. Boran involve allegations of medical negligence from orthopedic treatment rendered to him at Carlisle Regional Medical Center from January 24, 2006 through January 26, 2006. As of the filing of this Motion, Plaintiff has produced the Reports and C.V. of Louis Kozloff, M.D., a vascular surgeon. Dr. Kozloff is critical of the care rendered by Moving Defendant, an orthopedic surgeon. See Dr. Kozloff's C.V. at Exhibit "E" and Reports at Exhibits "B", "C", and "D". Plaintiffs have also produced the Reports and C.V. of Gregory B. Shankman, M.D. an orthopedic surgeon. See Dr. Shankman's Reports at Exhibits "G" and "H" and his C.V. at Exhibit "I". Dr. Shankman is also critical of Moving Defendant's care. Despite the fact that Dr. Kozloff's areas of specialty are apparently limited to general and vascular surgery, he purports to render opinions in the fields of orthopedic surgery. In the absence of education and experience within these fields, Dr. Kozloff is not qualified to render expert opinions under Pennsylvania law. As such, Dr. Kozloff's testimony should be limited to the fields of general and vascular surgery and he should be precluded from rendering opinions in the fields of orthopedic surgery. III. STATEMENT OF QUESTION INVOLVED Whether a vascular surgeon (Dr. Kozloff) should be precluded from offering expert testimony as to the standard of care of an orthopedic surgeon (Robert P. Boran, Jr., M.D.) since a general and vascular surgeon is not qualified to offer such evidence under MCARE, or in the alternative, because Dr. Kozloff s testimony is cumulative of Dr. Shankman's anticipated testimony? Suggested Answer: Yes IV. ARGUMENT A. Dr. Kozloff Should Be Precluded From Renderin Opinions In The Fields of Orthopedic Surgery. It is well-established under Pennsylvania law that a witness with neither experience nor education in a particular subject matter may not qualify as an expert. Dambacher v. Mallis, 336 Pa. Super. 22, 42-3, 485 A.2d 408, 418-9 (1984). See also Dierolf v. Slade, 399 Pa. Super. 9, 581 A.2d 649 (1990). An expert witness must have a "reasonable pretension to specialized knowledge on the subject under investigation." Bindschusz v. Phillips, 771 A.2d 803 (Pa. Super. 2001). In this case, Louis Kozloff, M.D., plaintiffs expert in the fields of general and vascular surgery has clearly gone beyond the bounds of his experience and education in rendering standard of care opinions in the field of orthopedic surgery. See Exhibits "B"," "C," and "D." Specifically, Dr. Kozloff renders the following, opinions and others: "In summary, my opinon to a reasonable degree of medical certainty is that the orthopedic surgeon, Dr. Boran, deviated from the standard of care in his post-operative management of Mr. Morrison. More exacting evaluation and more prompt vascular consultation should have been done by Dr. Boran. For him not to have done so represented a deviation from the accepted standards of care ..." Report of January 16, 2007. "I continue to believe that Dr. Boran deviated from the usual and accepted standard of care by undue delay in recognizing Mr. Morrison's severe ischemia, as mentioned in my earlier letter to you of January 16, 2007 and that he therefore caused the resultant delay in the diagnosis and treatment of the popliteal artery thrombosis.... (I)n my more than thirty years of experience in vascular surgery and in particular my more than a thousand encounters in patients with limb ischemia, I find that in the majority of such cases, not all five of the findings are present. To determine that a patient's ischemia is not critical or limb threatening because any one of these findings is absent is clearly below the standard of care ..." Report of May 21, 2009. "Regarding Dr. Smith's (defense orthopedic expert) opinions via two letters ..." Report of January 10, 2010. All of these opinions and/or criticisms encompass areas of expertise for which Dr. Kozloff has neither education nor experience. As such, Dr. Kozloff should be precluded from asserting these opinions and/or other standard of care in orthopedic and knee replacement surgery criticisms at the time of trial. It is well-settled under Pennsylvania law that a witness with neither experience nor education in a particular subject matter may not qualify as an expert. Dambacher v. Mallis, 336 Pa. Super. 22, 42-3, 485 A.2d 408, 418-9 (1984). See also Dierolf v. Slade, 399 Pa. Super. 9, 581 A.2d 649 (1990). Dr. Kozloff s Curriculum Vitae purports to demonstrate expertise in the fields of general and vascular surgery only. Nowhere in his report does Dr. Kozloff purport to be an expert in the fields of orthopedic and knee replacement surgery. Dr. Kozloff's attempts to proffer opinions outside his stated area of expertise is contrary to Pennsylvania law. In connection with this case, Dr. Kozloff has provided his Curriculum Vitae. See Exhibit "E". However, a thorough review of Dr. Kozloff s Curriculum Vitae reveals that all of his postgraduate and medical training have been in the fields of general and vascular surgery. See Exhibit "E". In fact, there are no articles, professional associations or Board certifications that evidence any education or experience in the fields of orthopedic or joint replacement surgery. See Exhibit "E." It is therefore incredible that Dr. Kozloff would purport to render opinions in areas of specialty for which he has little to no expertise. Under Pennsylvania law, in order to have the privilege of explaining scientific or technical evidence to the jury, the expert must be qualified by "knowledge, skill, experience, training or education." See Pa.R.E. 702. This requirement has been explained by the Courts as requiring a "reasonable pretension to specialized knowledge." See Miller v. Brass Rail Tavern, Inc., 541 Pa. 474, 480-81, 664 A.2d 525, 528 (1995). Dr. Kozloff clearly fails to meet these expert standards in the fields of orthopedic and joint replacement surgery. As such, moving Defendant respectfully requests that this Honorable Court preclude Dr. Kozloff from offering any opinions in the fields of orthopedic and/or joint replacement surgery and from offering any opinions in areas of expertise which are outside his stated areas of specialty, general and vascular surgery. Pennsylvania has enacted the Medical Care Availability and Reduction of Error Act. See 40 Pa.C.S.A. § 1303.101 et seq. This Act outlines very specific requirements for expert qualifications in the context of a medical professional liability action against a physician. Section 1303.512 states the following 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. See 40 Pa.C.S.A. § 1303.512(a). There are multiple expert requirements pursuant to the act. Preliminarily, the proposed expert must possess an unrestricted physician's license from any state or the District of Columbia. See 40 Pa.C.S.A. § 1303.512(b)(1). The proposed expert must also be engaged in or retired within the previous five years from active clinical practice or teaching. See 40 Pa.C.S.A. § 1303.512(b)(2). Additional requirements apply for an expert to testify as to the standard of care in a medical malpractice action. An expert testifying to a physician's standard of care must also 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 [...]. (3) In the event the defendant physician is certified by an approved board, be board certified by the same or a similar approved board [...]. See 40 Pa.C.S.A. § 1303.512(c). Dr. Kozloff has clearly failed to meet the requirements of 40 Pa.C.S.A. § 1303.512(c)(2) and (3). He does not practice in the same subspecialty (orthopedic surgery and joint replacement surgery) as Dr. Boran. Further, it can not be said that general and vascular surgery have a "substantially similar standard of care" as a board-certified orthopedic and joint replacement surgeon. Although a court may waive this requirement if the proposed expert is trained in the diagnosis or treatment of the condition at issue, See 40 Pa.C.S.A. § 1303.512(d)(1), it appears that Dr. Kozloff has no such training. See Exhibit "E." There is absolutely nothing in Dr. Kozloff s Curriculum Vitae which shows that he has "any reasonable pretension to specialized knowledge" with respect to the standard of care for an orthopedic patient responding to post-operative complaints of a total knee replacement patient. See Exhibit «E» Finally, Dr. Kozloff is not board-certified in Orthopedic Surgery as required by 40 Pa.C.S.A. § 1303.512(c)(3). See Exhibit "E." On the other hand, Dr. Boran is a Board-certified orthopedic surgeon who performs joint replacement surgery. A true and correct copy of Dr. Boran's Curriculum Vitae is attached as Exhibit "F." Because Dr. Kozloff does not have a board certification in orthopedic surgery and/or joint replacement surgery, he can not testify as to the standard of care for Dr. Boran, a board-certified orthopedic and joint replacement surgeon. B. Dr. Kozloff s criticisms of Dr. Boran in the field of orthopedic surgery are cumulative to the opinions of Dr. Shankman, Plaintiffs orthopedic surgery expert Plaintiffs may argue that Dr. Kozloff is qualified to testify as to standard of care against Moving Defendant under §512(d). However, even if this argument is made, Dr. Kozloff should still be precluded from testifying as to breach of the standard of care in the field of orthopedic surgery, as his report is cumulative of Dr. Shankman's anticipated testimony. Plaintiffs should not be permitted to offer multiple expert witnesses on the standard of care, particularly since only Dr. Shankman is an orthopedic surgeon. Expert testimony as to Dr. Boran's standard of care by Dr. Shankman and Dr. Kozloff would amount to cumulative testimony. Although relevant, evidence may be precluded if its probative value is outweighed by the danger of unfair prejudice, confusion of the issues, misleading the jury, or by considerations of undue delay, waste of time, or needless presentation of cumulative evidence. See Pa.R.E. 403. In this regard, Plaintiffs should be precluded from offering both Dr. Shankman and Dr. Kozloff as expert witnesses against Moving Defendant. Plaintiff should be limited to one standard of care expert. Allowing Plaintiffs to call multiple standard of care experts against Moving Defendant is not only cumulative and prejudicial to Moving Defendant, but results in the needless repetition of testimony. V. CONCLUSION For the foregoing reasons, Defendant, Robert P. Boran, M.D., respectfully requests this Honorable Court to preclude Dr. Kozloff from offering any standard of care opinions in the fields of orthopedic and/or joint replacement surgery and from offering any opinions in areas of expertise which are outside his stated areas of specialty, general and vascular surgery. Respectfully submitted, KILCOYNE & NESBITT, LLC BY: ELAINE M. ROSS, ESQUIRE DAVID W. RINGLABEN, ESQUIRE Attorneys for Defendant, y Date: 0 Robert P. Boran, Jr., M.D. l ? Z VERIFICATION I, DAVID W. RINGLABEN, ESQUIRE, hereby depose and state that I am the attorney for Defendant, Robert P. Boran, Jr., M.D., in the action herein, and that I have reviewed the foregoing Supplemental Motion in Limine, and that the facts contained therein are true and correct to the best of my information and belief. I understand that the statements made herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsifications to authorities. r DAVID W. RINGLAAB((EN, ESQUIRE DATE: Z U EXHIBIT A DONALD L. MORRISON, and SHARON A. MORRISON, his wife, Plaintiffs, vs. ?9-/W ri IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA NO. 2007-00187 CIVIL ACTION MEDICAL PROFESSIONAL LIABILITY ROBERT P. BORAN, JR., M.D., and APPALACHIAN ORTHOPEDIC CENTER, LTD.,: JURY TRIAL DEMANDED Defendants NOTICE YOU HAVE BEEN SUED IN COURT. If you wish to defend against the claims set forth in the following pages, you must take action within twenty (20) days after this Complaint and Notice are served, by entering a written appearance personally or by attorney and filing in writing with the Court your defenses or objections to the claims set forth against you. You are warned that if you fail to do so the case may proceed without you and a judgment may be entered against you by the Court without further notice for any money claimed in the Complaint or for any other claim or relief requested by the Plaintiff. You may lose money or property or other rights important to you. YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW. THIS OFFICE CAN PROVIDE YOU WITH INFORMATION ABOUT HIRING A LAWYER. IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE. Cumberland County Bar Association 2 Liberty Avenue Carlisle, PA 17013 (717) 249-3166 DONALD L. MORRISON, and SHARON A. MORRISON, his wife, Plaintiffs, VS. IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. NO. 2007-00187 CIVIL ACTION MEDICAL PROFESSIONAL LIABILITY ROBERT P. BORAN, JR., M.D., and APPALACHIAN ORTHOPEDIC CENTER, LTD.,: JURY TRIAL DEMANDED Defendants AVISO USTED HA SIDO DEMANDADO EN LA CORTE. Si usted desea defenderse de las quejas expuestas en las pitginas siguientes, debe tomar accibn dentro de veinte (20) dias a partir de la fecba en que recibid la demanda y el aviso. Usted debe presentar comparecencia escrita en persona o por abogado y presentar en la Corte por escrito sus defensas o sus objeciones a las demandas en su contra. Se le avisa que si no se defiende, el caso puede proceder sin usted y la Corte puede decidir en su contra sin mas aviso o nodficacion por cualquier dinero reclamado en la demanda o por cualquier otra queja o compensacion reclamados por el Demandante. USTED PUEDE PERDER DINERO, O PROPIEDADES U OTROS DERECHOS IMPORTANTES PARA USTED. LLEVE ESTA DEMANDA A UN ABOGADO INMEDIATAMENTE. SI USTED NO TIENE O NO CONOCE UN ABOGADO, VAYA O LLAME A LA OFICINA EN LA DIRECCION ESCRITA ABAJO PARA AVERIGUAR DONDE PUEDE OBTENER ASISTENCIA LEGAL. Cumberland County Bar Association 2 Liberty Avenue Carlisle, PA 17013 (717) 249-3166 2 DONALD L. MORRISON, and SHARON A. MORRISON, his wife, Plaintiffs, VS. ROBERT P. BORAN, JR., M.D., and APPALACHIAN ORTHOPEDIC CENTER, LTD., Defendants IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA NO. 2007-00187 CIVIL ACTION MEDICAL PROFESSIONAL LIABILITY JURY TRIAL DEMANDED COMPLAINT 1. Plaintiff Donald L. Morrison is an adult individual who resides in Carlisle, Cumberland County, Pennsylvania. 2. Plaintiff Sharon A. Morrison, wife of Donald L. Morrison, is an adult individual who resides in Carlisle, Cumberland County, Pennsylvania. 3. Defendant Robert P. Boran, Jr., M.D., (hereinafter referred to as Defendant Boran) is an adult individual licensed to practice medicine in the Commonwealth of Pennsylvania, who at all relevant times herein, engaged in the practice of orthopedic surgery with an office in Carlisle, Cumberland County, Pennsylvania. 4. Plaintiffs are asserting a professional liability claim against Defendant Boran. 5. Upon information and belief Defendant Boran was an agent, apparent agent, member, partner, shareholder, servant, and/or employee of Appalachian Orthopedic Center, Ltd. during the relevant times of this action. b. Defendant Appalachian Orthopedic Center, Ltd. (hereinafter referred to as Appalachian Orthopedic) is a Pennsylvania professional corporation duly organized and registered in Pennsylvania who at all relevant times herein engaged in the business of providing orthopedic services to the public with its place of business in Carlisle, Cumberland County, Pennsylvania. 7. Plaintiffs are asserting a professional liability claim against Defendant Appalachian Orthopedic by virtue of the actions and/or inactions of Defendant Boran and all such other health care/clerical agents, apparent agents, servants, and/or employees from their office who were involved with the care of Mr. Morrison during the relevant dates of his hospitalization at Carlisle Regional Medical Center from 1/24/05 thru 2/2/05, in particular, regarding the inactions/actions from 1/24/05 through 1/26/05. 8. At all relevant times herein, Defendant Boran and all such other health care/clerical agents from Defendant Appalachian Orthopedic who were involved with the care of Mr. Morrison at Carlisle Regional Medical Center from 1/24/05 through 1/26/05 were furthering the economic and financial interests of Defendant Appalachian Orthopedic and were acting within the scope of their employment with Defendant Appalachian Orthopedic and therefore created vicarious liability. 9. At all relevant times herein, Donald L. Morrison was married to and continues to be married to Plaintiff Sharon A. Morrison, his wife. 10. Mr. Morrison had a history of having had a left total knee replacement in 2001, by an employee/agent of Defendant Appalachian Orthopedic, and also left knee surgery by Defendant Boran in 2004, from which Mr. Morrison did not have complaints of numbness, tingling, coolness or extreme pain postoperatively in the operated-on left lower extremity. 11. In his other leg, on January 24, 2005, Mr. Morrison underwent a Legacy right total knee arthroplasty by Defendant Boran, at the Carlisle Regional Medical Center. 12. At the conclusion of Mr. Morrison's operative note, Defendant Boran reported, "neurovascularly 4 intact to the right lower extremity." 13. However, post-operatively, Mr. Morrison developed signs and symptoms of decreased vascular supply to his right lower extremity. 14. Defendant Boran did not order a vascular consult or arteriogram until approximately two (2) days after Mr. Morrison developed signs and symptoms of decreased vascularzation of his right lower extremity. 15. Plaintiffs aver that this two-day delay in diagnosis and treatment of Mr. Morrison's right lower extremity thrombus (blood clot) caused Mr. Morrison to undergo multiple fasciotomies to his right lower extremity and necessitated him to undergo several plastic surgical procedures to his right lower extremity. 16. According to the records of Carlisle Regional Medical Center, Mr. Morrison left the operating room following his right total knee replacement by Defendant Boran at 10:37 a.m. on 1/24/05 and arrived in the PACU at 10:38 a.m. 17. Mr. Morrison was ordered Morphine and Percocet (Oxycodone APAP) prn for pain. 18. At 11:40 am., Mr. Morrison was medicated with Morphine for pain in the PACU. 19. Mr. Morrison was discharged to the floor at 12 Noon on 1/24/05. 20. Mr. Morrison's post-op orders included the daily administration of Coumadin on a sliding scale. 21. According to the nursing documentation form, at 12 Noon on 1/24/05, it was noted that Mr. Morrison was received from the PACU and that his pedal pulse was diminished, palpable. 22. Mr. Morrison's right toes were noted to be warm and pink with capillary refill less than 3 seconds. 23. However, three (3) hours later, at 3:00 p.m. on 1/24/05, the same nurse noted that Mr. Morrison's toes were cool, pale and that Mr. Morrison stated that his toes were numb to touch. 24. His immobilizer was removed and ace bandage loosened, and again, it was noted that his right pedal pulse was diminished, but palpable. 25. Importantly, it was noted that Mr. Morrison's right pedal pulse was not as strong as his deft pedal pulse. 26. The records reflect that Mr. Morrison was medicated for pain with Percocet (Oxycodone APAP) at both 1:30 p.m. and 2:00 p.m.. 27. At 3:30 p.m. on 1/24/05, a different nurse documented that Mr. Morrison's right foot was pale, slightly cool, and had a decreased pedal pulse. 28. At 4:00 p.m., Mr. Morrison received another injection of Morphine for pain. 29. At 5:15 p.m., on 1/24/05, the same nurse noted that Mr. Morrison complained that the top of his right foot and toes were numb and it was noted that he had decreased pedal pulse. 30. The nurse recorded that they were unable to hear the pulse with a Doppler and recorded that they would notify Dr. Boran. 31. Forty-five minutes later, at 6:00 p.m. on 1/24/05, it is noted that Defendant Boran was notified with orders received. 32. The records reflect that Mr. Morrison's immobilizer had been removed and had not been reapplied since 3:00 p.m. It was also noted that the post-operative dressing was loosened and rewrapped at 3:00 p.m. 33. The plan was to continue to note the color of Mr. Morrison's foot. 34. Mr. Morrison's toes continued to appear pale and slightly dusky, and Defendant Boran was noted to be aware. 35. Mr. Morrision received his first dose of Coumadin, 10mg at 6:00 p.m. on 1/24/05. 6 36. Fifty minutes later at 6:50 p.m., the same nurse noted that Mr. Morrison still had decreased sensation in his right foot and complained of slight tingling on the sole of his right foot. 37. Mr. Morrison's post-operative dressing was again removed to check for any constrictive dressings, but it was noted that there were none. 38. It was noted that Mr. Morrison's right foot remained cool with decreased pulse, whereas his left foot was warn and had a positive pedal pulse. 39. Importantly, it was noted that the Ace bandage was on loosely but that Mr. Morrison's right toes remained dusky. 40. At 9:35 p.m., Mr. Morrison was medicated for pain with another Morphine shot. 41. At 10:15 p.m. on 1/24/05, it was noted that Mr. Morrison dangled, stood and might have more feeling in his right foot. 42. However, it was noted that Mr. Morrison's pulse remained decreased and his right foot was pale, and his toes were slightly dusky. 43. Mr. Morrison's dressing was removed down to the 4x4 and re-dressed loosely, and he was encouraged to do frequent ankle pumps. 44. At 11:15 p.m. on 1/24/05, it was noted that Defendant Boran was in to see Mr. Morrison and examined his right leg and foot and that no new orders were given. 45. The nurse noted that Mr. Morrison's pedal pulse was decreased, his toes were cool and dusky, and that he had some tingling in his toes. 46. At 3:50 a.m. on 1/25/05, the nursing documentation form reflects that Mr. Morrison had a positive but decreased right pedal pulse and that Mr. Morrison stated that he had both numbness and tingling in his right great toe and that his right foot was warm to the touch but his toes were still cool. 7 47. It also appears that at 3:50 a.m., Mr. Morrison received another dose of Percocet (Oxycodone APAP) for pain. 48. At 6:00 a.m. on 1/25/05, the nurse noted that Mr. Morrison stood at the side of his bed with a walker and was still complaining of numbness in his great toe. 49. At 7:15 a.m. on 1/25/05, Mr. Morrison was still noted to have diminished pedal pulse. 50. At 8:10 a.m., Mr. Morrison was medicated for pain again with Percocet (Oxycodone APAP). 51. At 9:45 a.m. on 1/25/05, it was noted that Defendant Boran was notified and aware of the numbness in Mr. Morrison's right foot. 52. At 10:00 p.m., Mr. Morrison was given a shot of Morphine for pain. 53. At 10:30 am. on 1/25/05, the CPM machine was started at 30° on Mr. Morrison's right leg. 54. At 12:30 p.m. on 1/25/05, Mr. Morrison was also administered another dose of the pain medication Percocet (Oxycodone APAP) and the nurse noted that Mr. Morrison had less numbness in his right foot. 55. At 4:30 p.m. on 1/25/05, the nurse noted that Mr. Morrison was still complaining of slight tingling and decreased sensation in his right foot. 56. At 5:00 p.m., Mr. Morrison was medicated again for pain with Percocet (Oxycodone APAP). 57. At 6:00 p.m. on 1/25/05, Mr. Morrison received a second dose of Coumadin 10 mg, based on an INR. of 1.0. 58. At 8:50 p.m. on 1/25/05, the nurse noted decreased sensation and decreased dorsi-flexion noted in Mr. Morrison's right foot, and that his right foot was still cool to the touch. 59. At 10:10 p.m., Mr. Morrison was medicated again for pain with Percocet (Oxycodone APAP). 60. At 10:50 p.m., Mr. Morrison was given another shot of Morphine for pain. 8 61. At 12:30 a.m. on 1/26/05, the night nurse noted that Mr. Morrison had pain right shin down to foot, that his toes remained cool to the touch, and that he had diminished right pedal pulse and decreased dorsi-flexion of the right foot. 62. It was also recorded that Mr. Morrison's tingling persisted and that edema was present in his right leg and foot. 63. At 7:45 a.m. on 1/26/05, the day nurse noted that Mr. Morrison"s right dorsalis pedis and posterior tibial pulses were very diminishing as compared to the left pulses. 64. Additionally, it was noted that Mr. Morrison's right foot was cool and pale and that he was complaining of soreness in his right lateral calf, but denied tenderness to the right posterior calf. 65. Mr. Morrison reported that it felt like his right foot was "falling asleep." His right toe remained numb along the medial side back to the heel. 66. At 8:00 a.m., Mr. Morrison was given another dose of Percocet (Oxycodone APAP) for the pain. 67. At 9:45 a.m. on 1/26/05, the records reflect that Defendant Boran was called and updated on Mr. Morrison's condition by the nurse. 68. At 11:20 p.m., Mr. Morrison received another shot of Morphine for the pain. 69. At 12:40 p.m. on 1/26/05, Mr. Morrison was seen by Defendant Boran and by vascular surgeon, Dr. Campbell. 70. At 2:00 p.m., Mr. Morrison was given another dose of Percocet (Oxycodone APAP) for the pain. 71. At 3:35 p.m. on 1/26/05, the nurses noted that Mr. Morrison was NPO and awaiting an arteriogram. 72. According to the nursing documentation form, at 4:30 p.m. on 1/26/05, a STAT prothrombin time was drawn and approximately two (2) hours later, at 6:00p.m., Mr. Morrison was sent to radiology for the arteriogram. 9 73. Dr. Campbell's impression from the arteriogram of Mr. Morrison's right lower extremity was popliteal artery occlusion, probably due to thrombosis, with reconstitution of the posterior tibial vessel. 74. Mr. Morrison's coagulation studies were as follows on 1/26/05: PT was 18.1 (high), and his HNR was reported high at 1.7. 75. Subsequently, a STAT blood draw at 4:25 p.m. on 1/26/05 produced results of a PT of 14.0 (high) and an 1NR of 1.3 (high). 76. Thereafter, Mr. Morrison was taken to the operating room at 7:50 p.m. on 1/26/05, and a right popliteal thrombectomy, with repair of right superficial artery and right distal medial and lateral fasciotomies consisting of four-compartment fasciotomies of the right lower leg were performed by Dr. Campbell. 77. At the time of the surgery on 1/26/05, Dr. Campbell noted in his operative report that the lateral and anterior compartments appeared to be very tense, necessitating four-compartment fasciotomies. 78. When the anterior compartment was opened, there appeared to be ischemic muscle that would not contract with stimulation with the Bove. 79. Since the four-compartment fasciotomy of Mr. Morrison's right lower leg on 1/26/05, Mr. Morrison has undergone multiple plastic surgery procedures to improve the appearance of his right lower extremity. 80. Mr. Morrison still has swelling in his right lower extremity and continues to have numb toes and decreased movement in his right lower extremity. 81. Plaintiffs aver that the classic signs of poor arterial blood flow are referred to as the five "Ps" and Mr. Morrison demonstrated all five (5) of them. 10 82. Mr. Morrison demonstrated (1) pain, (2) pulselessness, (3) pallor, (4) paresthesias and (5) polar. 83. The presence of all of these five (5) signs of ischemia should have prompted Defendant Boran to more active intervention as soon as such signs were noted, but unfortunately none was accomplished by Defendant Boran until approximately 48 hours after the symptoms began post-operatively. 84. Plaintiffs further aver that extremities subjected to poor arterial blood flood (ischemia) become more irretrievably damaged the longer it takes to restore circulation. 85. Nerve tissue is particularly vulnerable to ischemia. 86. If a patient's nerves are deprived of blood flow for longer than six (6) hours, there is significant chance of permanent damage and loss of either sensory or motor function. 87. Plaintiffs aver that the delay in diagnosis of ischemia in Mr. Morrison's right lower extremity significantly increased the damage to the nerves of his right leg. 88. The residual neurological impairment Mr. Morrison has suffered, would have been lessened or entirely avoided had revascularization of his right leg been done within a few hours instead of two (2) days later. 89. Furthermore, Plaintiffs aver that the delay in intervention also created the need for Mr. Morrison to undergo fasciotomies. 90. If a patient's leg is revascularized within the time frame mentioned (six hours or so), there is rarely a need for fasciotomies. 91. Because, in this case, the ischemia had gone on for so long, the fasciotomies were necessitated to prevent the occurrence of compartment syndrome (damage to nerves and muscles as the blood flow is restored and the muscles swell uncontrollably inside the non-elastic fascial covering). 92. Plaintiffs aver that fasciotomies are an additional component of morbidity in that Mr. Morrison now 11 has suffered large gaping wounds and scarring to his right lower extremity, which have required multiple plastic surgical procedures and skin grafts to close. Such wounds have caused significant disfigurement to Mr. Morrison's right lower extremity. 93. As a direct and proximate result of Defendants' negligence, as specified herein, Mr. Morrison was placed at an increased risk of harm due to the ischemia, including tissue and muscle damage, nerve injury, extensive surgery and prolonged hospitalization, and a claim is made therefor. 94. As a direct and proximate result of Defendants' negligence as stated herein, a significant delay occurred in diagnosing and treating Mr. Morrison's ischemia/thrombosis in his right lower extremity, and a claim is made therefor. 95. The injuries suffered by Plaintiffs are a direct and proximate result of the negligence as stated specifically herein of Defendants, Robert P. Boran, Jr., M.D., and Appalachian Orthopedic Center, Ltd.. 96. The substandard care of Defendants and their health care/clerical agents, apparent agents, servants, and/or employees who were involved with the care of Mr. Morrison and/or had contact with him during the relevant times of his admission, in particular, 1/24/05 thru 1/26/05, as specified above, increased the risk of harm to Plaintiffs. 97. Defendants are jointly and severally liable for the injuries and damages set forth herein. 98. As a direct and proximate result of Defendants' negligence as stated herein, Mr. Morrison endured extreme pain and suffering and claim is made therefor. 99. As a direct and proximate result of Defendants' negligence as stated herein, Mr. Morrison continues to have decreased movement, numbness and swelling in his right lower extremity, and a claim is made therefor. 12 100. As a direct and proximate result of Defendants' negligence as stated herein, Mr. Morrison is no longer able to stand for any length of time without developing swelling and pain in his right lower extremity. 101. As a direct and proximate result of Defendants' negligence as stated herein, Mr. Morrison endured hospitalization, transfusions, multiple surgical procedures, and months of intensive dressing changes and medication therapies related to the delay in diagnosing the ischemia/thrombus in his right lower extremity, and a claim is made therefor. 102. As a direct and proximate result of Defendants' negligence as stated herein, Plaintiffs have incurred and in may in the future incur medical bills and expenses and a claim is made therefor. 103. As a direct and proximate result of Defendants' negligence as stated herein, Plaintiffs have suffered and will in the future suffer lost wages, and decreased earning capacity, and a claim is made therefor. 104. As a direct and proximate result of Defendants' negligence as stated herein, Mr. Morrison has undergone and in the future will undergo great physical and mental pain and suffering, great inconvenience in carrying out his daily activities, and loss of life's pleasures and enjoyment, and a claim is made therefor. 105. As a direct and proximate result of Defendants' negligence as stated herein, Mr. Morrison has sustained extensive scarring and disfigurement to his right lower extremity and a claim is made therefor. 106. As a direct and proximate result of Defendants' negligence as stated herein, Mr. Morrison has been and in the future will be subjected to great humiliation and embarrassment and claim is made therefor. 13 107. As a direct and proximate result of Defendants' negligence as stated herein, Mr. Morrison will continue to have medical problems due to the swelling, numbness and decreased movement in his right lower extremity, which may require future medical treatment and a claim is made therefor. 108. As a direct and proximate result of Defendants' negligence as stated herein, Mr. Morrison's wife, Sharon A. Morrison, has suffered the loss of companionship, society and comfort of her husband, Donald Morrison, in the past and will suffer same in the future, and a claim is made therefor. COUNTI Donald L. Morrison and Sharon A. Morrison, his wife vs Robert P Boran, Jr., M.D. 109. Paragraphs one through one hundred eight of this Complaint are incorporated herein by reference as if set forth at length. 110. During the above-referenced dates of Mr. Morrison's admission to Carlisle Regional Medical Center, Defendant Boran was acting as an agent, apparent agent, member, servant, partner, and/or employee of Defendant Appalachian Orthopedic Center, Ltd. 111. As a direct and proximate result of his negligence as set forth below, Defendant Boran is liable to Plaintiffs for the injuries and damages alleged herein. 112. Plaintiffs' injuries and damages were directly and proximately caused by Defendant Boran's negligence in: a. failing to timely diagnose ischemia in Mr. Morrison"s right lower extremity; b. failing to timely diagnose thrombus (blood clot) in Mr. Morrison's right lower extremity; c. failing to timely perform the necessary diagnostic tests to rule in or rule out ischemia and occlusion by thrombus in Mr. Morrison's right lower extremity; 14 d. failing to timely order or recommend the performance of an arteriorgram/angiogram of Mr. Morrison's right lower extremity; e. failing to timely order a vascular consult on Mr. Morrison; f. failing to timely perform laboratory studies to rule in or rule out the presence of a thrombus/ischemia in Mr. Morrison; g. failing to treat the ischemia/thrombus in Mr. Morrison's right lower extremity until after Mr. Morrison suffered from the symptoms for two (2) days; h. failing the limit the severity of Mr. Morrison's ischemic process in his right lower extremity; i. failing to properly maintain complete and accurate records for Mr. Morrison during the relevant times of his admission; j. failing to make Mr. Morrison aware of the potential harm he could suffer from having an undiagnosed and untreated thrombus in his right lower extremity; k. reassuring Mr. Morrison that the problems in his right lower extremity were due to normal post-operative findings and not due to an ischemic/thrombotic process; 1. failing to properly follow-up with Mr. Morrison regarding his post-operative right lower extremity complaints and signs of ischemia; m. failing to properly follow-up on the concerns of the Carlisle Regional Medical Center's nursing staff regarding Mr. Morrison's post-operative right lower extremity signs and symptoms of ischemia; n. delaying the diagnosis of the thrombus in Mr. Morrison's right lower extremity, which increased the risk that he would suffer significant ischemia and necessitate the need for fasciotomies, thrombectomy, and plastic surgery procedures; 15 o. allowing the thrombotic process in Mr. Morrison's right lower extremity to progress to complete occlusion; p. failing to appreciate the significance of Mr. Morrison's post-operative signs of ischemia, as reported by the Carlisle Regional Medical Center's nurses; and q. failing to make any effort to look for the cause of Mr. Morrison's poor arterial blood flow in his right lower extremity, in particular the five "Ps" - pain, pulselessness, pallor, paresthesia and polar. 113. As a direct and proximate result of the negligence of Defendant Boran as stated herein, Plaintiffs have sustained injuries and damages, as set forth in the paragraphs above, which are incorporated herein by reference as if set forth at length, and a claim is made therefor. WHEREFORE, Plaintiffs, Donald L. Morrison and Sharon A. Morrison, his wife, demand judgment against Defendant Robert P. Boran, Jr., M.D., for compensatory damages in an amount in excess of Fifty Thousand ($50,000.00) Dollars exclusive of interests, costs, and in excess of any jurisdictional amount requiring compulsory arbitration. COUNT H Donald L. Morrison and Sharon A. Morrison, his We. vs Appalachian Orthopedic Center, Ltd. --' 114. Paragraphs one through one hundred eight and Count I of this Complaint are incorporated herein by reference as if set forth at length. 115. At all relevant times herein, Defendant Appalachian Orthopedic and its health care providers and clerical staff to include Defendant Boran who were involved in Mr. Morrison's orthopedic care during his Carlisle Regional Medical Center admission of 1/24/05 through 2/2/05, in particular, on 16 the dates of 1/24/05 through 1/26/05, were acting as agents, apparent agents, servants and/or employees of Defendant Appalachian Orthopedic. 116. Plaintiffs reasonably relied upon the staff of Defendant Appalachian Orthopedic, to include Defendant Boran and all such other health care/clerical agents, apparent agents, servants and/or employees of Defendant Appalachian Orthopedic who were involved in Mr. Morrison's orthopedic care from 1/24/05 through 1/26/05 and their apparent expertise, apparent competence, diagnostic abilities, interpretations, conclusions, treatment decisions, knowledge of anatomy and physiology and authority in ruling out ischemia/thrombosis in Mr. Morrison's right lower extremity. 117. Defendant Appalachian Orthopedic is vicariously liable for the acts and/or omissions of Defendant Boran and all such other health care/clerical agents, apparent agents, servants, and/or employees of Defendant Appalachian Orthopedic who were involved in Mr. Morrison's orthopedic care from 1/24/05 through 1/26/05. 118. At all relevant times herein, Defendant Appalachian Orthopedic had a duty and right to exercise control, authority, and supervision over all of the staff at Defendant Appalachian Orthopedic to include Defendant Boran and all such other health care/clerical agents, apparent agents, servants, and/or employees of Defendant Appalachian Orthopedic who were involved in Mr. Morrison's orthopedic care from 1/24/05 through 1/26/05. 119. Defendant Appalachian Orthopedic, through the negligence of Defendant Boran and also such other healthcare/clerical agents, apparent agents, servants, and/or employees of Defendant Appalachian Orthopedic who were involved in Mr. Morrison's orthopedic care at Carlisle Regional Medical Center from 1/24/05 through 1/26/05, is liable to Plaintiffs for injuries and damages proximately caused by the negligence of its agents/employees in: 17 a. failing to timely diagnose ischemia in Mr. Morrison's right lower extremity; b. failing to timely diagnose thrombus (blood clot) in Mr. Morrison's right lower extremity; c. failing to timely perform the necessary diagnostic tests to rule in or rule out ischemia and occlusion by thrombus in Mr. Morrison's right lower extremity; d. failing to timely order or recommend the performance of an arteriorgram/angiogram of Mr. Morrison's right lower extremity; e. failing to timely order a vascular consult on Mr. Morrison; f. failing to timely perform laboratory studies to rule in or rule out the presence of a thrombus/ischemia in Mr. Morrison; g. failing to treat the ischemia/thrombus in Mr. Morrison's right lower extremity until after Mr. Morrison suffered from the symptoms for two (2) days; h. failing the limit the severity of Mr. Morrison's ischemic process in his right lower extremity; i. failing to properly maintain complete and accurate records for Mr. Morrison during the relevant times of his admission; j. failing to make Mr. Morrison aware of the potential harm he could suffer from having an undiagnosed and untreated thrombus in his right lower extremity; k. reassuring Mr. Morrison that the problems in his right lower extremity were due to normal post-operative findings and not due to an ischemic/thrombotic process; 1. failing to properly follow-up with Mr. Morrison regarding his post-operative right lower extremity complaints and signs of ischemic; m. failing to properly follow-up on the concerns of the Carlisle Regional Medical Center's nursing staff regarding Mr. Morrison's post-operative right lower extremity signs and 18 symptoms of ischemia; n. delaying the diagnosis of the thrombosis in Mr. Morrison's right lower extremity, which increased the risk that he would suffer significant ischemia and necessitate the need for fasciotomies, thrombectomy, and plastic surgery procedures; o. allowing the thrombotic process in Mr. Morrison's right lower extremity to progress to complete occlusion; P. failing to appreciate the significance of Mr. Morrison's post-operative signs of ischemia, as reported by the Carlisle Regional Medical Center's nurses; and q. failing to make any effort to look for the cause of Mr. Morrison's poor arterial blood flow in his right lower extremity, in particular the five "Ps" -- pain, pulselessness, pallor, paresthesia and polar. 120. As a direct and proximate result of the negligence of Defendant Appalachian Orthopedic, as stated herein, Plaintiffs have sustained injuries and damages, as set forth in the paragraphs above, which are incorporated herein by reference as if set forth at length, and a claim is made therefor. WHEREFORE, Plaintiffs Donald L. Morrison and Sharon A. Morrison, his wife, demand judgment against Defendant Appalachian Orthopedic Center, Ltd., for compensatory damages in an amount in excess of Fifty Thousand ($50,000.00) Dollars exclusive of interests and costs, and in excess of any jurisdictional amount requiring compulsory arbitration. COUNT III Sharon A. Morrison, his wife, vs Robert P Boran. Jr., M.D, and Appalachian Orthopedic Center, Ltd 19 121. Paragraphs one through one hundred eight and Counts I-H of this Complaint are incorporated herein by reference as if set forth at length. 122. Plaintiff Sharon A. Morrison is the wife of Donald L. Morrison. 123. As a direct and proximate result of the negligence as stated herein of the Defendants and the injuries caused thereby to her husband, Donald L. Morrison, Sharon A. Morrison has suffered the loss of her husband's society, comfort, services, consortium and companionship and will so in the future, and a claim is made therefor. 124. All Defendants are jointly and severally liable to Sharon A. Morrison for the injuries and damages set forth herein. WHEREFORE, Plaintiff Sharon A. Morrison, the wife of Donald L. Morrison, demands judgment against Defendants Robert P. Boran, Jr., M.D. and Appalachian Orthopedic Center, Ltd. for compensatory damages in an amount in excess of Fifty Thousand ($50,000.00) Dollars exclusive of interest s and costs and in excess of any jurisdictional amount requiring compulsory arbitration. Respectfully submitted, NAVITSKY, OLSON & WISNESKI LLP DD anarrick Esquire I.D. No. 77400 Michael J, Navitsky, Esquire I.D. No.58803 2040 Linglestown Road, Suite 303 Harrisburg, PA 17110 717/541-9205 Counsel for Plaintiffs Date: 9/0 7 20 VERIFICATION. I, Donald L. Morrison, verify that the facts set forth in the foregoing Complaint are true and correct to the best of my knowledge, information, and belief I understand that this Verification is made subject to the provisions of 18 Pa. C.S.A. §4904, relating to unworn falsification to authorities. WITNESS V2 Donald L. Morrison VERIFICATION I, Sharon A. Morrison, verify that the facts set forth in the foregoing Complaint are true and correct to the best of my knowledge, information, and belief. I understand that this Verification is made subject to the provisions of 18 Pa. C.S.A. §4904, relating to unworn falsification to authorities. WITNESS Sharon A. Morrison CERTIFICATE OF SERVICE I, Jessie K. Walsh, an employee of the law firm of Navitsky, Olson & Wisneski LLP, do hereby certify that I am this 29th day of March, 2007 serving a true and correct copy of Plaintiffs' Complaint upon all counsel of record via postage prepaid first class United States mail addressed as follows: John F. McGreevey, Esquire Kilcoyne & Nesbitt, LLC Plymouth Meeting Executive Campus 630 West Germantown Pike, Suite 121 Plymouth Meeting, PA 19462 Counsel for Defendant Boran Dean F. Piermattei, Esquire Rhoads & Sinon, LLP M&T Bank Building -12'' Floor One South Market Square P.O. Box 1146 Harrisburg, PA 17108-1146 Counsel for Defendant Appalachian t Jessie K. Walsh 21 EXHIBIT B Loins KoZLOFF, M.D., F.A.C.S. 8218 WISCONSIN AwNue SUITE 204 BETHESDA, MD. 20814 January 16, 2007 SURGERY R EVALUATION Mr. Duane S. Barrick, Esq. Navitsky,,Olson & Wisneski, LLP 2040 Linglestown Road Suite 303 Harrisburg, PA 17110 PHORMC300652A208 FAXC301)951 e425 E44AIL:LKGZLOFF6VASCA89OC.COM Re: Donald Morrison Dear Mr. Barrick: In reviewing this case, I examined the hospital records from, the Carlisle Regional Medical Center (1/24/05 - 212/05), as well as two separate sets of x-rays, namely the angiogram of the right leg done on 1/26/05 as well as the intra-operative angiogram done later that same day. My summary of the case is as follows. Mr. Morrison underwent a right total knee replacement on the morning of January 24, 2005. He returned to the post-anesthesia care unit (the PACU) at 10:38 am, and was subsequently discharged to the floor at approximately noon that same day.The nursing notes at noon report a diminished pulse in Mr. Morrison's right foot, although his right toes are described as warm and pink with good capillary refill at that time. Three hours later, however, Mr. Morrison's foot is described as cool and pale, with the patient complaining of . numbness in the toes of that foot. In response, the dressings were loosened, but two hours later nursing notes document a failure to find a doppler pulse in Mr. Morrison's foot. At 11:15 that evening, Dr. Boran is reported to have seen Mr. Morrison, although there are no dated or timed progress notes to confirm that. Mr. Morrison's foot is again reported to be cool and dusky with diminished pulses. . On January 25th, Mr. Morrison is reported to- have continued decreased sensation. as well as impaired dorsiflexion of the foot. There are no doctor's notes confirming this. The first note by Dr. Boran after the operative note is from the following day, January 25th, and I suspect this was written during morning rounds on the 25th because of the references to lab results and Foley catheter removal. The next note by Dr. Boran is on January 26t', and describes pallor of the foot and decreased blood flow. A vascular surgical consultation is obtained at that time, which is now approximately two (2) full days after the completion of the surgery and the onset of symptoms of compromised blood flow. The vascular surgeon, Dr. Campbell, documents severe diminution of arterial blood flow in the foot and a tentative diagnosis of popliteal artery occlusion is made. Urgent angiography confirms this, and Mr. Morrison is then expeditiously brought to the operating room, where successful thrombectomy of his right popliteal artery is performed. Because of the presumed lengthy ischemic time, multi-compartment fasciotomies are performed concurrently. Post procedure angiography shows restored patency of the popliteal artery with good distal runoff via the posterior tibial artery. At this point, all appropriate measures have been done to salvage the limb from a vascular surgical standpoint. The patient's course thereafter is essentially uneventful with regard to the vascular surgery. He has a restored posterior tibial pulse in the right foot, and his dorsiflexion is reportedly improved. Mr. Morrison was discharged on February 2, 2005 to be followed as an outpatient by plastic surgery, for skin grafting over the area of the fasciotomies. There are several issues in question regarding this patient's course and care. 9. The nursing evaluation of Mr. Morrison's right lower extremity appears to be adequate. The nursing staff at Carlisle Regional Medical Center noted the diminution of the arterial blood flow quickly and informed the attending staff (Dr. Boran) in an appropriate amount of time. 2. The immediate response to the appearance of ischemia in Mr. Morrison's limb was to loosen the dressings and hopefully relieve external compression of the blood supply to the leg and foot. This is entirely appropriate, and was done, however it failed to improve the status of Mr. Morrison's extremity. At that time, further intervention should have been considered by Dr. Boran. The classic signs of poor arterial blood flow are referred to as "the five P's", and Mr. Morrison demonstrated all five of them - pain (although much of this could be attributed to the surgery); pulselessness (documented by the nursing staff); pallor (also documented); paresthesias or numbness (reported by the patient and .documented), and polar (documented coolness of the affected extremity). The presence of=all of these signs of ischemia should have prompted more active intervention as soon as noted, but none was accomplished by Dr. Boran until approximately 48 hours post-operatively. 3. Extremities subjected to poor arterial blood flow (ischemia) become more irretrievably damaged the longer it takes to restore circulation. Nerve tissue is particularly vulnerable to ischemia. If the nerves are deprived of blood flow for longer than six hours, there is a significant chance of permanent damage and loss of either sensory or motor function. The delay in diagnosis of ischemia in Mr. Morrison's right lower extremity caused significantly increased damage to the nerves of the leg. The residual neurological impairment Mr. Morrison has suffered, would have been lessened or even entirely avoided had revascularization of his leg been done within a few hours of the incident instead of two (2) days later. 4. Delay in intervention also created the need for Mr. Morrison to undergo the fasciotomies. If a leg is revascularized within the time frame mentioned (six hours or so), there is rarely a need for fasciotomies. Because in this case the ischemia had gone on for so long, the fasciotomies were clearly indicated to prevent the occurrence of compartment syndrome (damage to nerves and muscles as the blood flow is restored and the muscles swell uncontrollably inside the nonelastic fascial covering). Fasciotomies are an additional component of morbidity in that Mr. Morrison now has large, gaping wounds which will require multiple plastic surgical procedures to close via skin grafting. Such wounds are also cosmetically disfiguring. In summary, my opinion to a reasonable degree of medical certainty is that the orthopedic surgeon, Dr. Boran, deviated from the standard of care in his post-operative management of Mr. Morrison. More exacting evaluation and more prompt vascular consultation should have been done by Dr. Boran. For him not to have done so represented a deviation from the accepted standards of care. Mr. Morrison would have been revasculadzed more quickly with a significantly lower risk for long term impairment and more likely than not, lesser procedures would have been done when the artery was repaired. A delay of two (2) full days before definitive intervention was done is simply too long. All of the above opinions have been rendered to a reasonable degree of medical certainty. If you have any further questions regarding my review of this case, please feel free to contact me at your convenience. Yours truly, -? ?2 F ? ??? Louis Kozloff, MD, FACS Clinical Professor of Surgery, GWUMC EXHIBIT C ! LOUIS KOZLOFF, M.D., F.A.C.S. 43218 wlscoimsm AvENue 1 sums 204 n jAS'? SEMESDA, MD. 20814 SURGERY F MIC (30 0 882-1 208 vwsccn wR EVALUATION FA=(s013981. MS 2-M??.xourorr@vwscxs?oc.cora May 21, 2009 Mr. Duanb S.. Bai rick, 15sq. Navitssky, Olson & Wisneski, LLP 2040 Linglestown Road Suite 303 Harrisburg, PA 17110 . Re: Donald Morrison Dear Mr. Barrick: I. have, finished reviewing'the additional information'you sent me regarding the;l?onold . Morrison case. This included the depositions from both-Ur and: Mrs..Morrison,•aswell• as the deposition from bf. Boran, the' depositions of Nurses Ruth. Albright, :Sharon 'Lattirop and Tami Burke-Heckler; and Mr. Morrison's*medical records from Dr. Campbell's office, Dr. Phelan's office, Pennswood PT, and Dr. Stratis' office. My opinion regarding the case after reviewing this additional information is as follows. I.. continue to believe that Dr. Boran deviated from the usual and accepted. standard of care by undue delay in recognizing Mr. Morrison's severe ischemia, as mentioned in my earlier letter to you of January 16, 2007, and that .he: therefore caused the resultant delay in the diagnosis and treatment 6f tho. ?I F i r#ery: tl as ni asie::Thi4:4+ y<u!e rly caused increased morbidity and prolonged discomfort andpain for Mr. Morrison as well as directly causing long term deficits in the function., of his right leg. In addition, several statements made by Dr. Boran in his deposition I find inaccurate and in fact incorrect, as noted below. 1. On page 19, in response to Mr. Wisneskrs question regarding "the five P's" as signs of .,ischemia [discussed in my previous letter], Dr. Boran asserts that "you have. to have :them all together", :meaning that unless all five of the symptoms are present, the patients iscltemia: is .e'?ther not present or at least not critical: This is absolutely incorrect: In my more Ilan thirty years' of experience- in vascular'surgery'and in partipular my more than a thousand encounters with patients with limb ischemia, I find that in the majority of such cases, not all five of the findings are present. To determine that a patient's ischemia is not critical or limb threatening because any one of these findings is absent is clearly below the standard of care. 2. On the same page, continuing onto the next page, Dr. Boran defines "timely" as between 12 and 24 hours, which I find unacceptable. Critical limb ischemia should be treated and appropriate intervention undertaken essentially immediately. In fact, once the vascular surgeon was consulted (two days later), his evaluation and intervention was rapid and nearly immediate. 3. On page 21, Dr. Boran once again states that all five of the symptoms need to be present to warrant arteriography. Once again, this is just wrong. Any change in the patient's iiisthi 4 rl9etfai Status aOer-the surgery which s+done should trigger W gent .(at least within a few hours) arteriography or other imaging evaluation of the vasculature of the affected limb. In my own practice, I have been: called to the recovery room numerous times to evaluate such patients before they leave the recovery room area. In fact, in the majority of such cases, I am called into the operating room to evaluate the patient even before he or she is awakened and. taken to the recovery area. This is clear testimony to the urgency of the situation and the need for prompt action. 4. On page 36, Dr. Boran once again makes incorrect statements regarding the clinical evaluation of Mr. Morrison's circulation. In particular, he states that "if you have complete arterial occlusion, the foot is not dusky, its white and the entire foot is cold, not just the toes." In truth, once a foot becomes critically ischemic, it most frequently becomes dusky first, then - more uncommonly - white only if there is absolutely no blood flow. A foot which has progressed from dusky to chalk white is a foot which has been ignored too long. The duskiness of the foot should have prompted intervention or at least further evaluation. Additionally, depending on the extent of ischemia, the toes may very well become cool or pale first.. As. the ischemia worsens, the skin changes will then progress more proximally, but waiting until that happens is also an unacceptable course. 5. On page 39, Mr. Wisneski quotes the notes as saying "unable to hear pulse with Doppler." This is'a cause for immediate alarm and reaction. In some cases, re- exanlinaftor't'oy a. M068-ex'pewd4itt'raan may-tam up .an.av. lible..Pulse with the Doppler, but unless that takes place, one must presume that this is a severely and critically. ischemic foot and must be resolved. 6. On page 63 - the thrombus is described *as being at the level of the adductor hiatus, which is above the actual area of the surgery. This makes me think that the cause of the thrombosis is unlikely to have been direct trauma to the artery. It is, however, the site of application of an intraoperative tourniquet, and that may have been the etiology. In any event, the exact cause of the thrombosis is moot. The issue is the less than prompt diagnosis and delayed treatment of the problem. Finally, it should be mentioned that the need for fasciotomy, in my opinion, was directly related to the delay in treatment. As noted above, in more than a thousand such cases in my own experience, I would put the need for fasciotomy at less than 1 % when ischemia is treated in a timely manner. In this case timely would have been anywhere up to six or eight hours after Mr. Morrison's symptoms of ischemia continued in spite of his dressings being loosened. The addition of the fasciotomy prolonged the patient's convalescence and ultimately generated the need for additional surgery (skin grafting) to close the resultant wound defects. Had the thrombosed artery been re-opened within the first few hours, no fasciotomy would have been necessary, the leg should have been restored to its preoperative state, and recovery would have been greatly hastened and facilitated. No further intervention would have been needed and the sequelae that Mr. Morrison experienced would have been avoided. _. All of the, above opinion's have eri -rendered'.to w reasonable. degree of medical certainty. If you have any questions, I would be happy to discuss this with you at your convenience. Yours truly, "Louis Kozloff, MD, FACS Clinical Professor of Surgery, GWUMC EXHIBIT D Jan 06 10 04:38p NOW LLP 7175419206 p.3 Lain K6=.Q 7, M.D., F.A.c.r3. 82! 6' WgCCr?p?! AYS?iuE l stm 204 ,{1 aKTmow, MD. AM 14 r YAaCHiAir sYAlJfA710P1 Fem.. ???, ? ??? ANO/I?I?C.COtI January 5, 2010 Re: Donald Morrison Mr. Duane Barrick, Esq. 2D40 i_inglestown Road Suite 303 Harrisburg, PA 47110 Dear Mr. Berrick: I have reviewed the reports of Drs. Smith and Amin. These reports do not In any way change my previous opinions in this matter Regarding Dr. Smith's opinions via two letters; the 4W defied October 3, 2009, and the second darted October 13, 2009, t offer the following remarks; Dr. Smith notes via his letter of October 5, 2009, Page two, paragraphs 4 and 5: there Is documentation of chame In Mr. Morrison's pulse status. This should have been 'Pause fcr aldfrn to any reasonable surgeon who has just operated on the extremity evidencing the change in pulse status. Page two, paragraph T. a nurse noting that the pulse was diminished and that the foot was pale and dusky on the operative extremity is also cause for enhanced attention and evaluation. Page three. paragraphs 2 and 3: Dr. Smith calls attention to the fact that Mr. Morrison's symptoms became greater with lying down and lessened with dependency of the teg.:Thls is a classic indication of Ischernia. Pain after knee replacement Is usually Worsened with dependency. since that would tend to increase postoperative swelling. In my own prac**, I find it quite worrisome when a patient tells me that he or she two worsened pain at night with the leg elevated. Often the patient or a spouse wfll admit to Jan 06 10 04:38p NOW LLP 7175419206 p.4 having to sleep with the leg dangling aver the bed or even in a chair. This produces a slight Increase in arterial blood now via gravity, and occasionally is enough for modareta relief of the Ischemic pain, Any reasonable physician treating patients at risk for possible vascular sequels knows that this clinical picture is one of critkxil arterial ischemia and should be treaded expedlt?usly. Page three, final paragraph: Dr. Smith notes that's four compartment fascotomy of the tight leg was perkmned by Dr. Campber' This is a significant observation by Dr. Smith regarding Mr. Morrieon'a damages because it is contrary to his statement In hie October 13°1 letter, page two, paragraph 4, that. `Dr. KozWs dank that the plaintiff'...now has large gaping wounds which will require multiple plastic Strrgk:al procedures to . close via skin grafting: 1s not at all supported by the records in this case." In fact, Dr Smith states n his first letter page four, paragraphs 3 and 5 that "Consultation was also obtained with John. P. Stabs, MD, for skin grafting of the fascbtomy wounds' and also that 'Mr. Morrison was returned to the Operating Room at the Carlisle Regional Medical Center by Dr. John P. Strath, an February 8, 2005, when wound debridement end skin grafting was performed." This in obvious evidence that my statement is true and appropriate.. Mr. Morrison did require additional incisions, was left with open gaping wounds, and did require further plastic surgical procedures to close them. Page five. paragraph 3: Dr. Smith states that "Patients not infrequently will complain of some rwmbness and weakness in the foot following toted knee replacsrrrent arthropiady as a result of the thigh toumiquet used to prevent intraoperatfve bleeding.' This Is true. However, Dr. Smith fails to mention that these symptoms almost always resolve within minutes of toumique!t release. Page five, paragraph 5:. The staternent that ischemia longer than six hours In duration "as a rule, renders a limb unsaivageaW Is an oversimplification and is inaccurate. I havd seen Itnbe ischemic for 48 hours which are salvageable, and i have also seen limbs ischemic1br loss than six hours become unsalvageable There is no black and white dichotomy, but rather a contkwous spectrum of degree of ischeenia versus limb saivageabilky. The kxW a pathrnt's Ischemia goes untreated. the higher the risk that the patient will be left with permanent neurological deficit, as was the case with Mr. Mormon. Page one of the October I P letter, paragraph three: the 'benign" appearance of the patients right foot Is a mischaraderization of the facts, Any physician knows that a dusky, cool, pulselless foot Is anything but benign. Dr: Sn*h also poses the question as to whether the references in ff y report were to similar patient experiences as Mr. Morrison's and involved total knee replacements. In a Word, 'rtes". I am referring to patients who have undergone total knee replacements. I have been sunnmoned 1br a vascular evaluatibn of such patients on many occasions. Jan 06 10 04:38p NOW LLP 7175419206 p.5 Page two of the October le 18ttet, paragraph two: Dr. Smith notes that I did "not discuss the probabitity of dusky appearing tors or foot from the reactive hyperemia. almost always seen In a limb af4ar use of a tounuquet." There is a very good reason for that. This statement by Dr. Smith is both incorrect and bizarre. Arty reasonable physician knows that reactive hyperemia I1 g by defines a tad, warn, hyPervascular phenomethan. It is r wet defined or described as dusky. Hence my kick of discussion, * Page two of the October 131' 1e ter, paragraph 5: Dr. Smith's contention that this is a rate event fbilowing total knee replacement is erect However, Dr. Smith completely ignoree the obvious, which is that a high degree of suspicion Is certainly indicated when fihere is a documented change in the character of the patient's pulse or vascular status postoperatively. Particularly when the change is present in the patient's operative extremity, which was the cute with Mr. Morrison. So Dr. Shankman's statement is a bit spurious taken out of context, but Is quite appropriate In thlsi particular case. The following are my rernarke regarding the comments of Dr. Amin via his letter dated October 10, 2009: Page nine, number 2: Or. Amin disagrees that Mr. Morrison had all five signs of poor arterial blood Host This is basically imlevaK since any one of the suns should have at leint risen cause for concern and further adention. His statemeni, however, is still wrong. The "five P's' of Ischemia include pain (which was present), puisetessneas (which was prew"t), paroatheshm (which w6w present). Pallor (which was present), and polar, meaning cook (which was present). Mr. Morrison did indeed have all five signs. Laler in the game paragraph,'Dr. Amin quotes a progress note which said that there was "decrease pulse, unable to hear pulse with Doppler." This Is a M alarming observation and should have prompted immediate re-assessment at the very least. Dr. Boran failed in this regard. Page nk*, number 2, k t+sr in the name paragraph: Dr. Arrin`s contention that the leg could not have been viable IF it had been ischemic for two fulti days is uninformed and Incorrect. As mentioned earlier, theta are many levels of isc hemta, and limb loss cannot be deemed Inevitable based solely on the length of Ischemid, but, must be Indihddual1y assessed- Page tale, number three: Dr. Amin makes "same cimaular reasoning mistake in saying that it the limb were ischemic for the length of time suggested, it could not have been salvaged. Hence, stchcs It was salvaged, It was not ischemic. Again, as mentioned previously, there are varying degrees of both Ischemia and salvegeabiliity. M Amin surely cannot dispute that the longer the patients ischemle goes untreaW, the greater the risk of permanent inJury to the patient. All of the abovo opinions are expressed with a reasonable degree of medical certainty. The opinions contained in my previous reports remain unchanged. I hope tIW the above Jan 06 10 04:39p NOW LLP 7175419205 p.6 observations answer any questions which may have arisen based on the reports of Drs, Smith and Amin, if you need any !further explanation or elaWration, please do not hesitate to contact me, Yours truly, c-s 4A. Louie; Kozioff, MD. FAGS Clinical Professor of Surgery, GWUMC EXHIBIT E CURRICULUM VITAE Louis Kozloff, M.D. BORN: Nashville, Tennessee EDUCATION: June 26, 1944 University of Pennsylvania - B.A. cum laude (with distinction in chemistry) May, 1965 University of Pennsylvania School of Medicine - M.D. May, 1969 HOBBIES: Basketball Skiing Swimming (US Masters Program) Travel Photography Computers COLLEGIATE HONORS: Freshman basketball (1961-1962, Captain) JV and Varsity basketball (1962-1963) Varsity swimming (1962-1965; Captain 1964-1965) Ranked third in world, 50 yard freestyle - 1965 Dean's List (1961-1965) Phi Kappa Beta Junior Honor Society Friars' Senior Honor Society MARITAL STATUS: Married since 1967 - Rene (nee Chaffin) Kozloff CHILDREN: Laurie Robin Kozloff - born November 25, 1970 Advertising Executive, BBD Needham; Chicago, IL Howard Jeffrey Kozloff - born April 27, 1975 . Real Estate Developer- The Martin Group, Santa Monica, CA 1 CURRENT ADDRESSES: Office: 8218 Wisconsin Avenue Bethesda, Maryland 20814 (301) 652-1208 voice (301) 951-8425 fax Email: lkozloff(@vascassoc.com Home: 11313 Marcliff Road Rockville, Maryland 20852 (301) 493-5411 voice (301) 530-3713 fax Email: I kO-I kozloff. com AWARDS: "Golden Apple" Award (from senior medical school class to outstanding clinical instructor), George Washington Medical School, 1973 Gold Medal Paper, University Surgical Residents' Seventeenth Annual Conference Rochester, Minnesota, 1975 Meritorious Service Medal, U.S. Army, 1977 Certificate of Appreciation, American College of Surgeons, for scientific exhibit, 1978 Army Commendation Medal, U.S. Army, 1979 University of Pennsylvania Sports Hall of Fame - inducted November, 2000 CERTIFICATION: American Board of Surgery, 1976 - General Surgery (#22000) Recertification, 1989 (#23838 - Exp. 7/1/00) General Vascular Surgery, 1990 (#826 - Exp. 7/1100) Recertification, 1999 (#826 - Exp. 7/1/10) POSTGRADUATE EDUCATION: Internship (surgical), George Washington University Hospital Washington, D.C., 1969-1970 Residency in general surgery, George Washington University Hospital Washington, D.C., 1970-1973 Fellowship in surgical research, George Washington University Hospital Washington, D.C., 1973-1974 2 Chief Residency in general surgery, George Washington University Hospital Washington, D.C., 1974-1975 Fellowship in peripheral vascular surgery, Walter Reed Army Medical Center Washington, D.C., 1977-1978 MILITARY: United States Army Medical Research and Development Command Surgical Research Directorate, 1975-1977 Fellow in Peripheral Vascular Surgery, Waiter Reed Army Medical Center 1977-1978 Staff, Peripheral Vascular and General Surgery Services, Walter Reed Army Medical Center, 1978-1979 Assistant Chief, Peripheral Vascular Surgery Service, Walter Reed Army Medical Center, 1978-1979 SOCIETIES: Alpha Chi Sigma National Chemical Honor Society, 1964 Alpha Epsilon Delta Pre-medical Honor Society, 1965 Alpha Omega Alpha Medical Honor Society, 1969 Chesapeake Vascular Society, 1977 Program Chairman, 1983-1985 Secretary-Treasurer, 1985-1987 President, 1988 Executive Council, 1989-1992 Association of Military Surgeons of the United States, 1978 Southeastern Surgical Congress, 1979 Maryland Medical and Chirurgical Society, 1979 International Cardiovascular Society, 1980 Surgical Associates, Uniformed Services' University of the Health Sciences (Secretary-Treasurer), 1980 Peripheral Vascular Surgical Society, 1980 Fellow, American College of Surgeons, 1982 Southern Medical Association, 1984 Eastern Vascular Society, 1987 3 CLINICAL STAFF ASSIGNMENTS: Instructor in Surgery, George Washington University Hospital and Medical School 1974 - 1975 Clinical Co-ordinator, George Washington University Physicians' Assistants Program, 1973 - 1975 Assistant Professor of Surgery, Uniformed Services' University of the Health Sciences, 1978 Assistant Clinical Professor of Surgery, George Washington University 1979 - 1984 Associate Clinical Professor of Surgery, Uniformed Services' University of the Health Sciences, 1981 - present Associate Clinical Professor of Surgery, George Washington University 1984 - 1995 Clinical Professor of Surgery, George Washington University 1995 - present Consultant in Vascular Surgery, The Clinical Center, National Institutes of Health, Bethesda, Md., 1980 - present ACADEMIC POSITIONS Editorial Board, Maryland State Medical Journal, 1983 -1989 Member, Middle Atlantic Alumni Board of Trustees, University of Pennsylvania 1990 - present Member, National Alumni Council, University of Pennsylvania School of Medicine 1994 - present Twenty-first Century Endowed Scholars Advisory Council, University of Pennsylvania School of Medicine 1994 - present HOSPITAL ASSIGNMENTS: Staff, General and Vascular Surgery, Holy Cross Hospital of Silver Spring Silver Spring, Maryland, 1979 - present Chief, Vascular Surgery Subsection, 1985, 1988, 1992 Staff, General and Vascular Surgery, Suburban Hospital Bethesda, Maryland, 1979 - present Director, Non-invasive Vascular Laboratory, 1980 - present Staff, General and Vascular Surgery, Montgomery General Hospital Olney, Maryland, 1979 - 1983 Staff, General and Vascular Surgery, Shady Grove Adventist Hospital Gaithersburg, Maryland, 1979 - 1983 4 Staff, General and Vascular Surgery, Sibley Memorial Hospital Washington, D.C., 1983 - present Staff, General and Vascular Surgery, George Washington University Medical Center, Washington, D.C., 1979 - present Consultant in Vascular Surgery, National Institutes of Health Bethesda, Maryland, 1979 - present Staff, General and Vascular Surgery, Kent and Queen Anne's Hospital Chestertown, Maryland, 1990 - 1997 Staff, General and Vascular Surgery, Washington Adventist Hospital Tacoma Park, Maryland - 1999 - 2002 HOSPITAL COMMITTEES: Intensive Care Committee, Shady Grove Adventist Hospital, 1980 Trauma Committee, Shady Grove Adventist Hospital, 1980 Director, Non-invasive Vascular Laboratory, Suburban Hospital, 1980 - present Medical Disaster Committee, Holy Cross Hospital, 1981 Intensive Care Committee, Holy Cross Hospital, 1982 - 1988 Intensive Care Committee, Suburban Hospital, 1982 - 1988 Medical Research Committee, Shady Grove Adventist Hospital, 1983 Executive Committee, Suburban Hospital, 1987 - present Quality Care Committee, Holy Cross Hospital, 1988 Continuing Medical Education Committee, Holy Cross Hospital, 1990 - 1992 Vice Chairman, Capital Campaign, Suburban Hospital - 1992 MEDICAL LICENSURE: District of Columbia 1970 Number 000033165;Control number 920031797 Maryland 1979 Number D23019 BNDD(DEA) NUMBERS: District of Columbia AK 8483733 Maryland (federal) AK 8551207 Maryland (state) M 11712 5 SPEAKING ENGAGEMENTS: Martinsburg Veterans' Hospital, Martinsburg, West Virginia "Intravenous Hyperalimentation", 1975 Armed Forces Joint Medical Research Committee, The Pentagon, Arlington, Virginia, "Vascular Surgery", 1975 Halsted Society, Washington, D.C.,"Jejunoileal Bypass",1976 Holy Cross Hospital, Silver Spring, Maryland, "Non-invasive Vascular Examination", 1978 Suburban Hospital, Bethesda, Maryland, "Cerebrovascular Disease", 1979 National Academy of Physicians' Assistants, Washington, D.C., "Incidentally, I heard a Bruit",1989 Board Review Seminar, Physicians' Assistants Program, George Washington University, Washington, D.C.,"Cerebrovascular Disease",1991 PARTICIPATION IN SCIENTIFIC PROGRAMS: Southeastern Surgical Congress, Atlanta, Georgia, 'Transduodenal Sphincteroplasty" 1974 University Surgical Residents' Seventeenth Annual Conference, Mayo Clinic Rochester, Minnesota, "Jejunoileal Bypass", 1975 Southern Thoracic Surgical Society, New Orleans, Louisiana, "Thoracic Trauma" 1975 Association for Academic Surgery, Minneapolis, Minnesota, "Jejunoileal Bypass" 1975 Peripheral Vascular Surgery Seminar and Meeting of Military Vascular Surgeons Walter Reed Army Medical Center, Washington, D.C. Topics: 1976 - Ocular Pneumoplethysmography 1977 - Graft Dilatation 1978 - Long-term Total Parenteral Nutrition 1979 - Non-invasive Arterial Diagnosis 1980 - Aorto-enteric Fistulas 1981 - Carotid Artery Aneurysms 1982 - Carotid Endarterectomy under Local Anesthesia 1983 - Subclavian Artery Aneurysms 1984 - Buerger's Disease International Vascular Symposium, Obergurgl, Austria "One Hundred Consecutive Carotid Endarterectomies under Local Anesthesia", 1984 Southern Vascular Surgical Congress, San Juan, Puerto Rico, "Arterial-enteric Fistulae Following Radiation Therapy", 1986 6 International Vascular Symposium, St. Moritz, Switzerland, "Arterial-enteric Fistulae Following Radiation Therapy", 1986 BIBLIOGRAPHY (Films): 1. Collins,JT, Clagett,GP, Kozloff,L, Collins,GJ, and Rich,NM: Innominate Artery Reconstruction, 1980 BIBLIOGRAPHY (Abstracts): 1. Jackson,MJ, and Joseph,WL: Changes in Intestinal Function Following Jejunoileal Bypass in Primates (Abstr). Gastroenterology. 68:A-72,1975 2. McDonald, PT, Rich, NM, Collins,GJ, and Kozloff,L: Vascular Trauma Secondary to Diagnostic and Therapeutic Procedures:Laparoscopy (Abstr). Gen Surg Digest. 1979 BIBLIOGRAPHY (Books): 1. Kozloff,L (Ed.): Microaggregates:Experimental and Clinical Aspects. Government Printing Office, 1979 BIBLIOGRAPHY (Chapters in books): 1. McDonald,PT, Collins,GJ, Rich,NM, Kozloff,L, Clagett,GP, and Collins,JT: Ocular Pneumoplethysmography:Pitfalls in Testing and Tracing Interpretation. Proc Intl Cardiovasc Congress. 1979 2. Collins,GJ, Rich,NM, McDonald,PT, Kozloff,L, Clagett,GP, and Collins,JT: Phleborheographic Diagnosis of Venous Obstruction. Proc Intl Cardiovasc Congress. 1979 3. COIIns,GJ, Rich,NM, McDonald,PT, Kozloff,L, Clagett,GP, and Collins,JT: Phleborheographic Diagnosis of Venous Obstruction. In Non- Invasive Cardiovascular Diagnosis. Second Edition. By Edward G. Dietrich, Editor. 1981 4. Kozloff,L: Arterial-Venous Fistulas. In Basic Science in Vascular Surgery, by Joseph M. Giordano, Editor. Futura Press. Philadelphia. 1988 5. Trout,HH, Kozloff,L, and Feinberg,RL: Vascular Anomalies. In Vascular Surgery. by L.Hollier, Editor. Saunders Publishers. Philadelphia. 1988 6. Trout,HH, Feinberg,RL, and Kozloff,L: Remote Bypasses for Graft Infections. In Vascular Graft Infections. by T.J.Bunt, Editor. Futura Publishing Co. Philadelphia. 1994 7. Trout,HH, Feinberg,RL, and Kozloff,L: Staging Remote Bypasses for Graft Infections, Graft-enteric Fistulae, and Erosions. In Vascular Graft Infections. by T.J.Bunt, Editor. Futura Publishing Co. Philadelphia. 1994 8. Trout,HH, Feinberg,RL, and Kozloff,L: Management of Aortoenteric Commun- ications. In Vascular Graft Infections. by T.J.Bunt, Editor. Futura Pub- lishing Co. Philadelphia. 1994 7 9. Trout,HH, Feinberg,RL, and Kozloff,L: Cost-benefit Analysis of Carotid Endarterectomy: A Surgical Perspective. In Surgery for Cerebrovascular Disease. by W.S. Moore, Editor. Saunders Publishers. Philadelphia. 1996 BIBLIOGRAPHY (Original articles). 1. Kozloff,L and Joseph,WL: Cystic Dilatation of the Common Bile Duct in Adults. Med Ann DC. 42:595, 1973 2. Kozloff,L and Joseph,WL: Transduodenal Sphincteroplasty for Biliary Tract Disease. Amer Surg. 41:125,1975 3. Kozloff,L, Jackson,MJ, and Joseph,WL: Changes in Intestinal Function Following Jejunoileal Bypass in Primates. Rev Surg. 33:64, 1976 4. Kozloff,L, Jackson,MJ, and Joseph,WL: Changes in Intestinal Function Following Jejunoileal Bypass in Primates. J Surg Res. 20:607,1976 5. Kish,G, Kozloff,L, Joseph,WL, and Adkins,PC: Indications for Early Thoracotomy in the Management of Chest Trauma. Ann ThorSurg. 22:23,1976 6. McDonald,PT, Rich,NM, Collins,GJ, and Kozloff,L: Vascular Trauma Secondary to Diagnostic and Therapeutic Procedures:Laparoscopy. AmerJ Surg. 135:651,1978 7. Rich,NM, Collins,GJ, McDonald, PT, and Kozloff,L: Lower Extremity Vascular Injuries:A Continuing Civilian and Military Problem. Rivista de Medicina i Chirurgia. (Ital). 1:11,1978 8_. Rich„NM, Coliins,GJ, Andersen,CA, McDonald,PT, Kozloff,L, and Ricotta,JJ: Missile Emboll. J Trauma. 18:236,1978 9. McDonald,PT, Rich,NM, Collins,GJ, and Kozloff,L: Femoral-femoral Grafts: The Role of Concomitant Extended Profundaplasty. AmerJ Surg. 136:622,1978 10. McDonald,PT, Rich,NM, Collins,GJ, and Kozloff,L: Doppler Cerebro- vascular Examination, Oculoplethysmography, and Ocular Pneumoplethysmography:Use in Detection of Carotid Disease. A Prospective Clinical Study. Arch Surg. 113:1341,1978 11. McDonald,PT, Rich,NM, Collins,GJ, Andersen;CA, and Kozloff,L: Cerebro- vascular Screening by Ocular Pneumoplethysmography (OPG-Gee). Ann Surg. 189:44,1979 12. Collins,GJ, Rich,NM, Andersen,CA, Hobson,RW, McDonald,PT, and Kozloff,L: Acute Hemodynamic Effects of Lumbar Sympathectomy. Amer J Surg. 1136:714,1978 13. McDonald,PT, Lichtmann,MW, Kozloff,L, Collins,GJ, Rich,NM, Collins,JT, andClagett,GP: Intraoperative Circulatory Collapse Secondary to Rapid Infusion of Plasmanate. Milit Med. 144:226,1979 14. Kozloff,L, Collins,GJ, Rich,NM, McDonald,PT, Collins,JT, and Clagett,GP: TheFallibility of Postoperative Doppler Ankle Pressures In Determining Adequacy of Proximal Arterial Revescularization. AmerJ Surg. 139:326,1980 BIBLIOGRAPHY (Original articles) - continued 15. Collins,GJ, Rich,NM, Andersen,CA, McDonald,PT, and Kozloff,L: Phlebo- rheographic Diagnosis of Venous Obstruction. Ann Surg. 189:25,1979 16. Kozloff,L, Rich,NM, McDonald,PT, Collins,GJ, Collins,JT, and Clagett,GP: Vascular Trauma Secondary to Diagnostic and Therapeutic Procedures:Cardiopulmonary Bypass and Intra-aortic Balloon Pumping. AmerJ Surg. 140:302,1980 17. Kozloff,L, Rich,NM, McDonald,PT, Coilins,GJ, Collins,JT, and Clagett,GP:Total Parenteral Nutrition at Home:An Eleven Year Follow-up.Milif Med. 144:730,1979 18. Guba,AM, Collins,GJ, Rich,NM, Kozloff,L, and McDonald,PT: Non-dialysis Uses for Vascular Access Procedures. Ann Surg. 190:72,1979 19. McDonald,PT, Easterbrook,JA, Rich,NM, COIIins,GJ, Kozioff,L, Clagett,GP, and Collins,JT: Popliteal Artery Entrapment Syndrome:Clinical, Non-invasive and Angiographic Diagnosis. Amer J Surg. 139: 318,1980 20. McDonald,PT, Kozloff,L, Collins,JT, Collins,GJ, Rich,NM, and Clagett, GP: Internal Carotid Occlusion: Detection by Direct Doppler Examination. MilitMed. 145:239,1980 21. Rich,NM, Collins,GJ, McDonald,PT, Kozloff,L, Clagett,GP, and Collins,JT: Popliteal Vascular Entrapment.its Increasing Interest. Arch Surg. 114:1377,1979 22. Collins,GJ, Lough,F, Rich,NM, Kozloff,L, Clagett,GP, and Collins,JT: An Expedient Shunt for the Small Internal Carotid Artery. Amer J Surg. 139:880,1980 23. Trout,HH, Kozloff,L, and Giordano,JM: Priority of Revascularization in Patients with Graft-enteric Fistulas, Infected Arteries, or Infected Arterial Prostheses. Ann Surg. 199:669,1984 24. Giordano,JM, Trout,HH, Kozloff,L, and DePalma,RG: Timing of Carotid Artery Endarterectomy after Stroke. J Vasc Surge. 2:250,1985 25. Vetto,JT, Culp,SC, Smythe,TB, Chang,AE, Sindeiar,WF, Sugarbaker,PH, Heit,HA, Giordano,JM, and Kozloff,L: Iliac Arterial-enteric Fistulas Occurring after Pelvic Irradiation. Surg. 101:643,1987 26. Kozloff,L: Reconsidering Contraindications for Carotid Endarterectomy. Cardiology Review. 19:27, 2002. 27. Kozloff,L: Should postoperative troponin elevation change patient management?. Cardiology Review. 21:40, 2004. 28. Patino,WD, Mian,OY, Kang,JG, Matoba,S, Bartlett,LD, Holbrook,B, Trout,HH, Kozloff,L, and Hwang,PM: FOS as a Novel Marker of Atherosclerosis. Submitted for publication, 2004. 9 29. Kozloff,L: Are statins cardioprotective in patients undergoing major vascular surgery? Cardiology Review 25:40, 2008. 30. Fujimura,Y, Hwang, PM, Trout III, HH, Kozloff,L, Imaizumi,M, Innis, RB, and Fujita, M: Increased Peripheral benzodiazepine receptors in arterial plaque of patients with atherosclerosis: An autoradiographic study with [3H]PK 11195. Atherosclerosis. 201:108, 2008. 10 EXHIBIT F Robert P. Boran, Jr. M.D. Seton Medical Group 700 E. Norwegian Street Pottsville, PA 17901 Date of Birth: May 21, 1952 Place of Birth: Pottsville, PA Marital Status: Married Wife's Name: Catherine Virginia (Kling) Boran Children: 3 Education Grade School -1958-1966 St. Vincent de Paul School Minersville, Pennsylvania High School - Graduated 1970 Nativity of the Blessed Virgin Mary Pottsville, Pennsylvania 17901 College - Graduated 1974- cum laude Alpha Sigma Nu - National Jesuit Honor Society St. Joseph's College Philadelphia, Pennsylvania Medical School Doctorate Degree in Medicine -1978 Jefferson Medical College of the Thomas Jefferson University Philadelphia, Pennsylvania Internship Pennsylvania Hospital Department of Sick and Injured Philadelphia, Pennsylvania June 18, 1978 to June 18, 1979 Residency Orthopedic Surgery Thomas Jefferson University Hospital Philadelphia, Pennsylvania July 1, 1979 to July 1, 1983 Residency Chief Resident Allied I DuPont Institute of the Nemours Foundation for Crippled Children Wilmington, Delaware January 1, 1981 to December 31, 1981 Chief Resident United States Veterans Administration Hospital Wilmington, Delaware July 1980 to December 1980 License Pennsylvania, July 2, 1979 Board Certification Board Certified -1989 American Board of Orthopaedic Surgeons Re-certified -1999 - ABOS Hospital Staff Appointments Good Samaritan Regional Medical Center Pottsville, Pennsylvania Active Medical Staff June 2005 - present Membership in Societies Fellow, American College of Surgeons Fellow, American Academy of Orthopaedic Surgeons Member, American Association of Hip and Knee Surgeons Member, Eastern Orthopaedic Association Member, Nominating Committee Eastern Orthopaedic Association 2002 Member, Board of Directors, Eastern Orthopaedic Association (2004 Membership in Societies Member, Pennsylvania Orthopaedic Society Member, Southern Orthopaedic Association Member, International Society for Technology in Arthroplasty Member, North American Faculty of Swiss Association for the Study of International Fixations of Fractures Member, AO North America Member, Delaware Valley Orthopaedic Trauma Consortium Member, Jefferson Orthopaedic Society Member, Alfred I DuPont Institute Alumni Association Member, American Medical Society Member, Pennsylvania Medical Society Member, Southern Medical Association Member, Schuylkill County Medical Society Member, Clinical Adjunct Faculty, Department of Allied Health Science of King's College, Wilkes Barre, Pennsylvania Named to Who's Who in Medicine and Health Care in America First Edition Named to Marquis's Who's Who in America Named to Marquis's Who's Who in the World Member, Thomas Bond Society of the Pennsylvania Hospital Social Organizations Pennsylvania Society Sellersville, Pennsylvania The Union League of Philadelphia Philadelphia, Pennsylvania The Schuylkill Country Club Orwigsburg, Pennsylvania Sky Top Club . Sky Top, Pennsylvania Benevolent & Protective Order of the Elks Frackville Lodge # 1533 EXHIBIT G Gregory B. Shankman, MD., PC. Orthopedic Surgeon P.O. Box 8190 Utica, NY 13505 Phone (315) 797-0111 Fax (315) 735-3459 May 26, 2009 Duane S. Barrick Navitsky, Olson dr Wisneski, LLP Attorney's at Law 2040 Ling1mown Road, Suite 303 Harrisburg, PA 17110 lee: Donald Morrison Doan Mr. Barriak, I am a board certified orthopedic surgeon. At your request, I have reviewed the medical records mid depositions regading this cast. ThM include Mr.'Moirison's medical records from Carlisle Regional Medical Center and the, depositions of Dr. Horan, Mr. and Mrs. Morrison, and Nurses Ruth Albright, Tami Burke-He War and Sharon Lathrop. Mr. Morrison underwent a right Legacy total knee arthroplasty on January 24, 2005 at the Carlisle Regional Medical Canter. This was performed by Dr. Robert P. Horan, Jr., an orthopedic surgeon. At the conclusion of the operative note, Dr. Horan recorded "neurovascularly intact to the right lower extremity." However, post-operatively, Mr. Morrison developed signs and symptor es of decreased vascular supply to his right lower extremity. Dr. Horan did not order a vascular consult or artedogram until approximately two (2) days after She signs and symptoms of decreased vaseularization of Mr. Morrison's right lower extremity began. This was a deviation from the accepted standard of orthopedic care. According to the records of the Carlisle Regional Mexlical Center, Mr. Morrison left the oporating room following his right total knee replacement by Dr. Horan at 10:37am and arrived in the PACU at 10:38am. He was discharged to the floor at 12 noon on January 24, 2005. Mr. Morrison's post-op orders included the daily administration of Coumadin on a sliding scale. According to the nursing documentation form, at 12 noon on January 24, 2005, it was noted that Mr. Morrison was received from the PACU and that his pedal pulse was diminished, but Palpable:. His right toes were noted to be warm and pink with capillary refill lass than 3 seconds. Three hours later, at 3pm on January 24, 2005, the some nurse noted that Mr. Morrison's tees were cool, pale and that Mr. Morrison stated his toes were numb to touch. The immobilizer was removed and the ace bandage loosened, and again. it was noted that his right pedal pulse was diminished, but palpable. However, it was noted that the right pedal pulse was not as strong as the left pedal pulse At 3:30pm, a different nurse noticed that Mr. Morrison's right foot was pale, slightly cool, had a decreased pedal pulse, but has positive sensation and motion. One hour and 45 minutes later, the nurse noted that Mr. Morrison stated that the top of his foot and toes were numb. It is noted that Mr. Morrison had positive sensation on the right side and bottom of his right foot, but had decreased pedal pulse. The nurse recorded that they were unable to hear the pulse with a doppler and recorded that they would notify Dr. Boran. Forty-five minutes later, at 6pm, it is noted that Dr. Boran was notified with orders received. The immobilizer had been removed,-and had riot been reapplied sip= 3pm. It was noted that the post-opcrative dressing had been loosened and rewrapped at 3pm. The plan was to continue to note the color of his foot. Mr. Morrison's toes contittuted to appear pale and slightly dusky, and Dr. Boran was noted to be aware. Mr. Morrison received his first dose of Coumadin IOttng at 6pm. Fifty minutes later, at 6:50pm, the same nurse noted that Mr. Morrison still had deceased sensation in his right foot, complaints of slight tingling on the sole of his foot. Mr. Morrison's post-operative drawing was removed to check for any constrictive dressings, but it was noted that there were none. His right . foot remained cool with decreased pulse, whereas his left foot was warm and had a positive pedal pulse. It was also noted that the ace bandage was on loosely and that his t6es remained dusky. At 10:15pm on January 24, 2005, it was noted that Mr. Morrison dangled, stood, and tolerated it well. It was noted that Mr. Morrison thought he might have more feeling in his right foot. However. his pulse remained decreased and his foot was pale, and toes were slightly dusky. He did have positive motion of his right foot. Mr. Morrison's dressing was removed down to the 4x4's and re-dressed loosely, and he was encouraged to do fluent ankle pumps. At 11: l Spit, it was noted that Dr. Horan was in to sex the patient and examined Mr. Momson's right leg and foot, and no new orders were given. The nurse noted that Mr. Morrison's pedal pulse was decreased, his toes %yere cool and dusky, and that Mr. Morrison denied numbness, but had some tingling in his toes. At 3:50am on January 25, 2005, the nursing docutnaft ion form reflects that Mr. Morrison had a positive but decreased right pedal pulse, and that Mr. Morrison stated that he had numbness and tingling mostly in the great toe, and that his foot was warns to the touch, but the toes were still cool. At 6am on January 25, 2005, the nutrse noted that Mr. Morrison stood at the side of his bed with a walker aid was still complaining of numbness in his great toe. At 7:154m on January 25, ZOOS, Mr. Morrison was still noted to have &-diminished pedal pulse. At 9:45am, it was noted that Dr. Boren was notified and aware of the numbness of Mr Morrison's right foot. At 10:30am, the CPM machine was started at 30 degrees, and Mr. Morrison was tolerating it well. At 12:30WN the nurse toted that Mr. Morrison had less numbness in his right foot. At 1:45 p.m., it is noted that the patient ambulated with-walker with patient tolerating it well. At 4:30pm, the nurse recorded that Mr. Morrison was still complaining of slight tingling and decreased sensation in his right foot. At 6pm, Mr. Morrison received the second dose of Coumadin 1.0mg, based upon an INR of 1.0. At 8:50pm, the nurse noted decreased sensation and decreased dorsi- flexion noted in Mr. Motrison's right foot, and that his foot was still cool to the touch. At 12:30am on January 26, 2005, the night nurse noted that Mr. Morrison's toes remained cool to the touch, and he had diminished right pedal pulse and decreased dorsi-flexion of the right foot. The tingling persisted, and edema was present in the right leg and foot. At 7:45am on January 26, 2005, the day nurse noted that Mr. Morrison's right dorsalis pedis and posterior tibial pulses were very diminished as compared to the left pulses. It was noted that his right foot was cool and pale, and that Mr. Morrison was complaining of soreness in his right lateral calf, but denied tenderness to the right posterior calf. It was noted that Mr. Morrison stated that it felt like his right foot was "falling asleep". His right great toe remained numb along the medial side back to the heel. At 9:45am, it is noted that Dr. Boran had been called and updated on Mr. Morrison's-condition by the nurse. At 1230pm, tho records reflected that Mr. Morrison was seen by Or. Boran and Dr. Campbell, a vascular surgeon. At 3:35pm, the nurses noted that Mr. Morrison was NPO and awaiting an arteriogram. According to the nursing documentation form, at 4:30pm, a STAT prothtornbin time was drawn and approximately 2 hours later, at 6:10 pm, Mr. Morrison was sent to radiology for the artedogram. Dr. Campbell's impression from the arteriogram of Mr. Morrison's right lower extremity was popliteal artery occlusion, probably due to thrombosis, with reconstitution of the posterior tibial vessel. Mr. Morrison's coagulation studies were as follows at 6:25am on January 27, 2005: PT was 18.1 (high), and his INR was reported as 1.7 (high). Subsequently, a STAT blood draw at 4:24pm on January 26, 2005, produced results of a PT of 14.0 (high) and an INR of 1.3 (high). Thereafter, Mr. Morrison was taken to the operating room at 7:50pm on January 26, 2005, and a right popliteal thrombectomy, with repair of right superficial artery and right distal medial and lateral fasciotomies consisting of 4-compartment fasciotomics of the right lower leg, were performed by Dr. Campbell. At the time of the surgery on January 26, 2005, Dr. Campbell noted in his operative note that the lateral and anterior compartumis appeared to be very tense, necessitating 4-compartment fasciotomies. When the anterior compartment was opened, there appeared to be ischernic muscle that did not contract with stimulation with the Bovie. Since the 4-compartment fasciotomy of Mr. Morrison's right lower leg on January 26, 2005, he has undergone plastic surgery to improve the appearance of his iight lower extremity. To date, Mr. Morrison still has swelling in his right lower extremity and continues to have numb toes acid lack of movement in the right loaner extremity. It is my opinion, to a reasonable degree of medical certainty, that M. Koran deviated from the accepted standard of orthopedic care in his treatment of Mr. Morrison. It was a deviation from the standard of care for Dr. Boran to wait approximately two (2) days before ordering a vascular consult and/or in arteriogram of Mr_ Morrison's tight lower extremity in light of the findings of decreased vascularity in Mr. Morrison's right leg that began almost immediately after the right. total knee replacement on January 24, 2005. There has to be a high index of suspicion for this type ofproblem after a total knee replacematt and one has to act immediately on it when it is recognized. Dr. Boran's statement that all five Ps must be. present simultaneously in a patient before a vascular consult and/or arteriogram should be ordered is incorrect. As soon as the patient exhibits any of the classic signs or symptoms of a blood clot following this type of surgery, further evaluation by arteriogram and/or vascular consult is required. It is standard practice that the "sun should not rise or set" on a blood clot in a patient's log. Dr. Boran should have recognized that Mr. Morrison was experiencing signs and symptoms of a thrombosis, and ordered a vascular consult andlor artetiogram, before the end of the day on January 24. 2005_ His failure to do so significantly increased Mr. Morrison's risk of harm, including his need for extensive fasciotomies and thrombectomy with arterial repair. Urgent diagnosis and intervention would have resulted in Mr. Morrison not needing any fasciotomics at all. Additionally, earlier intervention by Dr. Doran would have significantly deeseased the chances of Mr. Morrison developing the disfigurement and permanent neurological symptoms that he is left with today. The nutses at Carlisle Regional Medical Center acted appropriately in notifying Dr, Boran of their concerns regarding the signs of abnormal vascularity of Mr. Monison% right lower extrunity in the post-operative period. All of my opinions have been rendered to a reasonable degree of medical certainty. If 1 can be of any fixther help in this matter, do not hesitate to contact me. Gregory B. Shanbnan, M.D. CBS/cap EXHIBIT H Jan 06 10 04:39p NOW LLP 7175419206 p.7 Page l ur 2 Gregory B. Shankman, M.D., PC. Orthopedic Surgeon PA Box 8190 Utica, NY 13505 Phone: (315) 797-0111 Fax (315) 735-3459 January 6, 2010 Duane Barrick, Attorney Navitsky, Olson 8 VViisneski, LLP 2040 Linglestown Road Suite 303 Harrisburg, PA 17110 RE: Donald Morrison Dear Mr. Barrick, I reviewed the expert reports of Dr. Steven Smith and I am in disagreement with hid opinions. As t stated in my report to you on 5126!09, it was a deviation in the standard of care for Dr. Boren to wait approximately two days before ordering a vascular consult andlor obtaining an artedogram for Mr. Morrison regarding the postoperative vascular change in his right lower extremity. Specifically, the vascular changes present in the same extremity on which Dr. Boren had just performed a total knee arthroplasty. The signs and symptoms that Mr. Morrison was having in me postoperative period were those of vascular insufficiency to the IoWer extremity. N i4 a well known fact that the longer a patient goes without sufficient blood supply. the more difficult it is to restore function and the risk for permanent damage is increased. In this case, waiting two days was unreasonable and inappropriate. The reason that a patient's blood supply is checked frequently -and is of concern during the postoperative period is that with total knee replacement. one is using a tourniquet and working In the vicinity of the popiiteal artery, which can easily be damaged Therefore, if a total knee patient displays a change in vascular status postoperatively that is not abated promptly by a loosening of the caressing. vascular compromise should be suspected and an arteriogram andlor vascular consult ordered immediately. The sooner a thrombus is diagnosed and a thrombectomy performed, the better the results will be. Therefore. I disagree with Dr. SmWe opinion that it was okay to wait two days. The purpose of having the patient in the hospital and: under observation is so that these problems can be handled with dispatch. I recognize that a thrombus after a total knee replacement is a recognized complication, but immediate treatment is required and is where the deviation occurred in this case. I am also in disagreement with the assertion that the problems were insidious and progressive. Mr. Morrison's difficulty was apparent as of 3:00 p.m. on ft, day of the surgery, and therefore one would have to have a high level of suspicion that this Jan 06 10 04:33p NOW LLP 7175419206 p.8 P.ige 2 of 2 condition may have been the result of i blood clot and be aware of the necessity for urgent operative intervention if loosening of the dressing did not promptly resolve the patient's signs and symptoms. Having reviewed the letters of Dr. Smith dated 10/5/2009 and lom/2009, it remains my opinion that Dr. Boran deviated from the accepted standard of orthopedic care by waiting approximately two days to older a vascular consult and/or an artedogram for Mr. Morrison. AN of my opinions have. been rendered; to a reasonable degree of medical certainty. I stand ready to explain all of my findings to a jury. If I can be of any further help. do not hesitate to co(Aact me. B. Shankman, M.D. EXHIBIT I CURRICULUM VITAE GREGORY B. SHANKMAN, M.D. University of Denver Bachelor of Science University of Maryland Doctor of Medicine Cincinnati General Hospital Internship Resident General Surgery Jr. Resident Orthopaedic Surgery Sr. Resident Orthopaedic Surgery Chief Resident Orthopaedic Surgery Orthopaedic Surgeon in Private Practice Board Certified American Board of Orthopaedic Surgeons St. Luke's Hospital, Utica, New York Chairman of Orthopaedic Surgery Vice Regent, International College of Surgeons Denver, Colorado 9/65 - 6/69 Baltimore, Maryland 9/69 - 6/73 Cincinnati, Ohio 6/73-6n4 Cincinnati, Ohio 7/74 - 7/75 Cincinnati, Ohio Cincinnati, Ohio Cincinnati, Ohio Utica, NY 7/75 - 7/76 7/76 - 7/77 7/77 - 7/78 1978 - Present 9/10/83-Present 1990 - 2002 Case Report of Dislocated Trapezoid: Dr. Gregory B. Shankman and Dr. Mark Goodman Spinal Stenosis Definition and Review: Paper presented at the Freiburg Society by Dr. Gregory B. Shankman Page 2 Gregory B. Shankman, M.D. Curriculum Vitae Facet Syndrome: Presented by Gregory B. Shankman, M.D. at the World Congress of Surgery in Milan, Italy. Foramina] Stenosis: Presented by Gregory B. Shankman, M.D. at the NYSOS in Grand Cayman Island, April 1992. Foraminal Stenosis: Presented by Gregory B. Shankman, M.D. at the Hungarian Orthopaedic Society, Hungary, August 1992. Use of the Arthroscope for Visualization in Open Discectomies: Written by Frank H. Boehm, M.D. and Gregory B. Shankman, M.D. Presented by Gregory B. Shankman, M.D. at the NYSOS in Puerto Rico, April 1993. Use of the Arthroscope for Visualization in Open Discectomies: Presented by Gregory B. Shankman, M.D., at the Ortho-Neuro Society in September, 1993. Use of the Arthroscope for Visualization in Open Discectomies: Accepted for presentation by Gregory B. Shankman, M.D. at the 8th Annual Conference of Pakistan Orthopaedic Association, Bahawalpur, Pakistan, November 1993. Interpedicular Screw Fixation: Presented at the International College of Surgeons, London, England, by Gregory B. Shankman, M.D., November 1994. 60th Annual Surgical Update: Paper sent on Diagnostic use of Discograms in Planning Spine Surgery - Maui, Hawaii - June 17-21, 1998 NY State Society of Orthopedic Surgeons, Inc. - Joint Annual Spring Meeting: Paper sent on Diagnostic use of Discograms in Planning Spine Surgery - Four Seasons Resort, Nevis, West Indies - April 20-25, 1999 19th Annual Alumni Day - Department of Orthopedic Surgery - SUNY Health Science Center: Paper sent on Diagnostic Use of Discograms in Planning Spine Surgery - June 11, 1999 Page 3 Gregory B. Shankman, M.D. Curriculum Vitae 36th North American Federation Congress: Paper sent on Diagnostic Use of Discograms in Planning Spine Surgery - Ritz-Carlton Cancun- Cancun, Mexico - June 23-27,1999 IITS/ISMISS Combined Meeting: Paper sent on Diagnostic Use of Discograms in Planning Spine Surgery - Cambridge,. England - August 1-5, 1999 Spine Society of Europe: Paper sent on Diagnostic Use of Discograms in Planning Spine Surgery - Munchen Park Hilton Hotel Munich/Germany - September 7-11, 1999 Department of Orthopedic Surgery Alumni Day: Diagnostic Use of Discograms in Planning Spine Surgery - Brass Court Radisson Plaza, The Hotel Syracuse, Syracuse, NY June 9, 2000. KILCOYNE & NESBITT, LLC BY: ELAINE M. ROSS ATTY. ID. #46031 By: DAVID W. RINGLABEN ATTY. ID. #206836 630 W. GERMANTOWN PIKE, SUITE 121 PLYMOUTH MEETING, PA 19462 610.825.2833 ATTORNEY FOR DEFENDANT, ROBERT P. BORAN, JR., M.D. DONALD L. MORRISON and SHARON A. MORRISON, his wife, Plaintiffs COURT OF COMMON PLEAS CUMBERLAND COUNTY, PA No. 07-187 Civil Term VS. ROBERT P. BORAN, JR., M.D. and APPALACHIAN ORTHOPEDIC CENTER, LTD.,: Defendants JURY TRIAL DEMANDED CERTIFICATE OF SERVICE I, DAVID W. RINGLABEN, hereby certify that a true and correct copy of the foregoing Supplemental Motion in Limine, was forwarded to the following counsel of record by facsimile and first-class mail, postage prepaid: Michael J. Navitsky, Esquire Joseph M. Melillo, Esquire Navitsky, Olson & Wisneski, LLP 2040 Linglestown Road, Suite 303 Harrisburg, PA 17110 KILCOYNE & NESBITT, LLC By: ?a 1?f_ A f D DAVID W. RINGLABE , ESQUIRE Date: DONALD L. MORRISON AND SHARON A. MORRISON, HIS WIFE, PLAINTIFFS V. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ROBERT P. BORAN, JR., M.D., AND APPALACHIAN ORTHOPEDIC CENTER, INC., DEFENDANTS NO. 07-187 CIVIL ORDER OF COURT AND NOW this 14th day of April, 2010, it appearing that this case has now been assigned to Judge Ebert for jury trial starting the week of April 26, 2010, IT IS HEREBY ORDERED AND DIRECTED that Counsel shall file with the Court by 12:00 noon on Thursday, April 22, 2010, the following: 1. A list of the numbered standard jury instructions the party is requesting. If a party is proposing a unique jury instruction or requesting significant modification of a standard instruction, it shall provide the full text of the proposed instruction to the Court. 2. The parties will provide a proposed verdict slip to the Court for review. Joseph Melillo, Esquire For Plaintiff laine N. Ross, Esquire For Defendants bas CoP?ES m?.?l?C, All 14f 116 By the Court, ?tk -? ?-4 1 M. L. Ebert, Jr., J. 0 DONALD L. MORRISON, and SHARON A. MORRISON, his wife, Plaintiffs, VS. ROBERT P. BORAN, JR., M.D., Defendant ' 72 9 IN THE COURT OF COMNO*iPLEAS --,_ r CUMBERLAND COUNTY, fvTN _ NO. 2007-00187 CIVIL ACTION MEDICAL PROFESSIONAL LIABILIT Y JURY TRIAL DEMANDED PLAINTIFFS' RESPONSE TO DEFENDANT'S SUPPLEMENTAL MOTION IN LIMINE TO PRECLUDE THE TESTIMONY OF LOUIS KOZLOFF. M.D. AND NOW, come the Plaintiffs, Donald L. Morrison and Sharon A. Morrison, his wife, by and through their attorneys, Navitsky, Olson & Wisneski LLP, and hereby respond to Defendant's Original Motion in Limine as follows: 1. Admitted. 2. Admitted in part and denied in part. It is admitted that Dr. Boran was charged with medical negligence. To the extent that Defendant Boran has averred that orthopedic surgeons and vascular surgeons apply different standards in recognizing a potential vascular complication of an orthopedic procedure, the allegation is denied. 3. Admitted. 4. Admitted. 5. Admitted. By way of further response, Plaintiffs reference and incorporate herein the extensive qualifications of Dr. Kozloff, at the university teaching level, with the National Institute of Health, and as a practicing surgeon. 6. Denied as stated. The subject matter of Dr. Kozloff's testimony involves recognizing the signs and symptoms of a vascular complication of orthopedic surgery, a matter fully within the province of both the orthopedic and vascular surgical expert. The expert reports authored by all of the retained experts in this case, as well as the testimony of Dr. Boran himself, indicate that both orthpods and vascular surgeons evaluate evolving complications utilizing the same techniques and same knowledge base. 7. Defendant states a conclusion of law which will be discussed in Plaintiffs' brief. 8. Defendant states a conclusion of law which will be discussed in Plaintiffs' brief. 9. Dr. Kozloff's curriculum vitae speaks for itself. 10. Denied. The vascular surgeon utilizes the same body of knowledge as the orthopedic surgeon with respect to recognizing vascular complications of orthopedic surgery. 11. While it is admitted that Dr. Kozloff is board certified in a different specialty than Dr. Boran, with respect to identifying possible vascular complications of orthopedic surgery, their practices overlap. 12. Admitted. 13. Admitted. 14. Defendant states a conclusion of law to which no response is required. Plaintiffs will address this issue in their brief. 15. Denied. See, response to number 14 above. 16. Denied. Dr. Kozloff utilizes the same concepts and knowledge with respect to vascular complications of orthopedic surgery as does Dr. Boran. By way of further response, if this were not so, Dr. Boran would not have submitted his own vascular surgeon, Dr. Amin, as an expert witness for him on the issue of standard of care. Dr. Amin has issued multiple reports on this issue, which have been provided to the Court. A most recent report, is attached hereto as Exhibit "A" for the Court's easy reference. 17. Denied. If the Court were to preclude Dr. Kozloff from testifying on the standard of care, the Court would allow a 3-to-1 ratio in witnesses on this issue, favoring the defense. This is so, because the 2 defense intends to offer Dr. Boran, Dr. Smith (an orthopedic physician), and Dr. Amin (a vascular surgeon), as expert witnesses on the standard of care. 18. Denied. See, response to number 17 above. 19. Defendant states a conclusion of law to which no response is required. 20. Denied. See, Plaintiffs' response to number 17 above. WHEREFORE, Plaintiffs request that the Defendant's Motion to Limit Dr. Kozloffs testimony be denied. Respectfully submitted, NAVITSKY, OLSON & WISNESKI LLP <201 Jos hill. Melillo I. No. 26211 2040 Linglestown Road, Suite 303 Harrisburg, PA 17110 717/541-9205 Counsel for Plaintiffs Date: April 19, 2010 ??,b??' ?x Blaine Ross, Esquire Law Offices oiKi..lcoynae and Nesbitt, LLC Plymouth Meeting Executive Campus 630 West Germantown. Pike Suite 1.21 Plymouth. Meeting, PA 19462 RE: Donald and Sharon Morrison vs. Robert P. Boran, M.D. 3/15/10 I have reviewed the following additional records for Morrison vs. Robert P. Boran, M.D. This is a supplemental report. 1. Expert report for Dr. Kozloff dated Tan 5, 2010 2. Expert report of Dr. Shankm.an dated Jan 6, 201.0 3. Expert report of Dr. Smith dated Oct 5 and Oct 13, 2009 I disagree with opinions of Dr. Kozloff, 1n his supplemental report. Preoperative arteriogram showed evidence of chronic arterial insufficiency with one vessel runoff to the left ..foot and collateral circulation. Based on this artet.logram, and the unknown history ofprio?r arterial insufficiency, the clinical picture became more complex and difficult to diagnose in Mr. Morrison. Mr. Morrison. clinical presentation for complete arterial occlusion was not black and white as suggested by Dr. Kozloff, but rather fluid, and wax and waning tiati.l the morning of 1./26/05. All of my opirj,oais in this jnatter are stated within a reasonable degree of medical certainty and are based on the records that 1 have received to date. I reserve the right to amend any or all of this report upon receipt of any further information in this matter. Sincerely yours, ALI AM N M.D, FACS, >aACC, RVT 301S.7 TH AVE #1070 RF_AD1NG, PA 1961.1 CERTIFICATE OF SERVICE I, Lois E. Stauffer, an employee of the law firm of Navitsky, Olson & Wisneski LLP hereby certify that a true and correct copy of the foregoing Plaintiffs' Response to Defendants' Supplemental Motion in Limine to Preclude the Testimony of Louis Kozloff, M.D. was served upon the following person by first-class United States mail, postage prepaid on April 19, 2010 as follows: Elaine M. Ross, Esquire Kilcoyne & Nesbitt, LLC Plymouth Meeting Executive Campus 630 West Germantown Pike, Suite 121 Plymouth Meeting, PA 19462 Counsel for Defendant (? 7 _J4C I I Lois E. Stauff DONALD L. MORRISON, and IN THE COURT OF COMMON PLEAS SHARON A. MORRISON, his wife, CUMBERLAND COUNTY, PENNA Plaintiffs, NO. 2007-00187 VS. CIVIL ACTION MEDICAL PROFESSIONAL LIABILITY ROBERT P. BORAN, JR., M.D., JURY TRIAL DEMANDED Defendant PLAINTIFFS' RESPONSE TO DEFENDANT'S ORIGINAL MOTION IN LIMINE TO PRECLUDE THE TESTIMONY OF LOUIS KOZLOFF, M.D. AND NOW, come the Plaintiffs, Donald L. Morrison and Sharon A. Morrison, his wife, by and through their attorneys, Navitsky, Olson & Wisneski LLP, and hereby respond to Defendant;?SO Val „ c v ` Motion in Limine as follows: --? ` 1. Admitted. 2. Admitted. , t ; 3. Admitted. ; 4. Admitted. 5. Defendant states a conclusion of law which Plaintiffs will address in their responsive brief. 6. Denied. Both orthopedic surgeons and vascular surgeons diagnose vascular complications of orthopedic surgical procedures. The reports submitted by the experts retained by both parties demonstrate that they utilize the same body of knowledge, terminology, and techniques in identifying a potential vascular occlusion. 7. Defendant states a conclusion of law which will be addressed in Plaintiffs' responsive brief. 8-11. The Court should exercise its discretion in favor of allowing both Dr. Kozloff and Dr. Shankman to testify on the standard of care. If Dr. Kozloff is limited in his testimony, the defense will then gain a 3-to-1 one witness advantage on this issue. The defense intends that Dr. Boran himself, Dr. Smith (a retained orthopedic specialist), and Dr. Amin (a retained vascular specialist) testify on standard of care issues. A copy of Dr. Amin's reports have been submitted to the Court. A copy of his most recent report, was attached to Plaintiffs' response to Defendant's Supplemental Motion in Limine. Defendant intends to take an inconsistent position about both the qualifications of a vascular surgeon to testify on orthopedic standard of care, as well as on whether cumulative testimony should be allowed. Dr. Boran wants his vascular expert to testify about standard of care issues while limiting the Morrisons' vascular physician's testimony. Obtaining a 3-to-1 testimonial edge will allow the defense to argue "weight of the evidence" in summation. Respectfully submitted, NAVITSKY, OLSON & WISNESKI LLP Q?.c??%GGJo h,M. Melillo 1.15. No. 26211 2040 Linglestown Road, Suite 303 Harrisburg, PA 17110 717/541-9205 Counsel for Plaintiffs Date: April 19, 2010 2 CERTIFICATE OF SERVICE I, Lois E. Stauffer, an employee of the law firm of Navitsky, Olson & Wisneski LLP hereby certify that a true and correct copy of the foregoing Plaintiffs' Response to Defendants' Original Motion in Limine to Preclude the Testimony of Louis Kozloff, M.D. was served upon the following person by first-class United States mail, postage prepaid on April 19, 2010 as follows: Elaine M. Ross, Esquire Kilcoyne & Nesbitt, LLC Plymouth Meeting Executive Campus 630 West Germantown Pike, Suite 121 Plymouth Meeting, PA 19462 Counsel for Defendant r. P f 4-L, Lois E. Stauffer U \j DONALD L. MORRISON, and SHARON A. MORRISON, his wife, Plaintiffs, VS. ROBERT P. BORAN, JR., M.D., Defendant IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA NO. 2007-00187 CIVIL ACTION MEDICAL PROFESSIONAL LIABILITY JURY TRIAL DEMANDED IN RE: MOTION IN LIMINE and SUPPLEMENTAL MOTION IN LIMINE ORDER OF COURT AND NOW, this 22nd day of April, 2010, upon consideration of Defendant's Motion in Limine and Supplemental Motion in Limine to limit the testimony of Louis Kozloff, M.D. and Plaintiffs' Answer thereto and the Memorandum of Law submitted by each party, IT IS HEREBY ORDERED AND DIRECTED that Defendant's Motion in Limine and Supplemental Motion in Limine are DENIED. oseph M. Melillo, Esquire Attorney for Plaintiff 2040 Linglestown Road, Suite 303 Harrisburg, PA 17110 laine Ross, Esquire Attorney for Defendant Plymouth Meeting Executive Campus 630 West Germantown Pike, Suite 121 Plymouth Meeting, PA 19462 Co ,;ZS eY b LLj, y?a?/ rv By the Court, M. L. Ebert, Jr., J. n N c o ? CJ".i =C N CO ? C s DONALD L. MORRISON, and SHARON A. MORRISON, his wife, Plaintiffs, NO. 2007-00187 IN THE COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNA. VS. CNIL ACTION MEDICAL PROFESSIONAL LIABILITY ROBERT P. BORAN, JR., M.D., JURY TRIAL DEMANDED Defendant IN RE: POINTS FOR CHARGE ORDER OF COURT AND NOW, this 29th day of April, 2010, upon consideration of the requested Points for Charge filed by the respective parties, IT IS HEREBY ORDERED AND DIRECTED: A. Plaintiff's Proposed Points for Charge: No. 1 - Pa.SSJI (Civ.) 11.09 -Approved. No. 2 - Pa.SSJI (Civ.) 11.00 - Approved. No. 3 - Pa.SSJI (Civ.) 11.01 - Approved. No. 4 - Denied as stated. Generally covered. No. 5 - Denied as stated. Generally covered. No. 6 - Denied as stated. Generally covered. No. 7 - Pa.SSJI (Civ.) 11.02 - Approved. No. 8 - Pa.SSJI (Civ.) 11.11A - Approved. r- o C, 4« ZL No. 9 - Pa.SSJI (Civ.) 6.10 - Approved. t B. Defendant's Requested Points for Charge: No. 1 - Pa. SSJI (Civ.) 1.01 -Approved. No. 2 - Pa. SSJI (Civ.) 2.05 - Approved. No. 3 - Pa. SSJI (Civ.) 2.20 - Denied as unnecessary. No. 4 - Pa. SSJI (Civ.) 3.00 - Approved. No. 5 - Pa. SSJI (Civ.) 3.20 - Denied. No. 6 - Pa. SSJI (Civ.) 5.03 - Approved. No. 7 - Pa. SSJI (Civ.) 5.04 - Approved. No. 8 - Pa. SSJI (Civ.) 5.05 - Approved. No. 9 - Pa. SSJI (Civ.) 5.07 - Approved. No. 10 - Pa. SSJI (Civ.) 5.30 - Approved. No. 11 - Pa. SSJI (Civ.) 5.31 - Approved. No. 12 - Pa. SSJI (Civ.) 5.32 - Approved. No. 13 - Pa. SSJI (Civ.) 5.33 - Approved. No. 14 - Pa. SSJI (Civ.) 11.00 - Approved. No. 15 - Pa. SSJI (Civ.) 11.01 - Approved. No. 16 - Pa. SSJI (Civ.) 11.02 - Approved. No. 17 - Pa. SSJI (Civ.) 11.03 - Approved. No. 18 - Pa. SSJI (Civ.) 11.04 -Withdrawn by Defendant No. 19 - Pa. SSJI (Civ.) 11.11A - Approved. No. 20 - MCARE ACT - No Warranty of Cure - Approved. No. 21 - Denied as stated. Generally covered. No. 22 - Denied as to "error in judgment." Otherwise generally covered. I? No. 23 - Denied as stated. No. 24 - Denied as stated. No. 25 - Denied as stated. No. 26 - Denied as stated. No. 27 - Denied as stated. No. 28 -Denied. Request Generally covered. Generally covered. Generally covered. Generally covered. Generally covered. No. 28 is not an instruction IT IS FURTHER ORDERED AND DIRECTED that the Defendant's Motion for Directed Verdict is DENIED. By the Court, 1%1?,_ M. L. Ebert, Jr., J. Joseph M. Melillo, Esquire Attorney for Plaintiff Elaine M. Ross, Esquire Attorney for Defendant bas LAO,- tN S kf).-15t I 10 DONALD L. MORRISON, and SHARON A. MORRISON, his wife, Plaintiffs, IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA VS. ROBERT P. BORAN, JR., M.D., Defendant : NO. 07-0187 CIVIL VERDICT SLIP 1. Do you find that the conduct of Defendant doctor, Robert P. Boran, M.D., fell below the applicable standard of medical care? In other words, was Defendant, Robert P. Boran, M.D., negligent? Yes No I -"? If you answer Question 1 "No", the plaintiff cannot recover and you should not answer any further questions and should return to the courtroom. 2. plaintiff? Was the negligence of Robert P. Boran, M.D., a factual cause of any harm to the Yes No If you answer Question 2 "No", the plaintiff cannot recover and you should not answer any further questions and should return to the courtroom. 3. State the amount of damages, if any, sustained by the plaintiff, Donald Morrison, as a result of the negligence of Dr. Robert Boran. Past and Future Pain and Suffering Past and Future Loss of Life's Pleasures Past and Future Embarrassment and Humiliation Disfigurement TOTAL $ 4. State the amount of damages, if any, that Sharon Morrison is entitled to receive for loss of consortium. Foreperson Date ? J In the Court of Commons Pleas of Cumberland County, PA., DONALD L. MORRISON AND SHARON Docket No. 2007-187 CIVIL Judge: EBERT --- V S -- ROBERT P. BORAN, JR. M.D. Attorney: J.5,, Mel,, 11G, t Attorney: ?d?! tigC o S S ?`?S4 Date: /??J t o? G aU U JURORS No. Juror # NAMES OF JURORS CALLED CAUSE P D 1 111116111NIIg1661gqqlliIl6 APR26-241 KRAFT, KATHELEEN M 2 Ig6g116111111NN1q161111161q6 APR26-335 BERND, HOWARD P 6-1 6111111?g61g6qlll1611111q11 4 I S Ig11611111116111111gq1161161111 APR26-29 O'BRIEN, MICHELLE 6 Ig66116161gq1661611111HN116 APR26-68 KOVELESKI, PATRICIA 7 Ig6611A161111161611111Nllllg6 APR26-239 STRAW, MICHELLE A g IIIIIIIIIgIIIINIIIIIIIiIIgNlllllllll APR26-194 BIGHAM, SALLY E 9 IIIIIIIIIIIIIINI1116gINlllll61116 APR26-103 KUNKLEMAN, KEITH A 10 Ig66116111p1116Nq?IIINll6gll APR26-272 FOX, FRANZ 11 Ig6g116I6N1616111611?161q6 APR2649 MEAD, CARRIE A 12 IllliglllNllglIIN1116qN1611q11 APR26-33 LEONARD, CHARLES E 13 1116111161111611611111111161111g11 14 111611116111NIIIIIIIIN11616111111 15 Ig6g11166qIIINN61111111161611 APR26 16 Ig66116161111111111NI1111111N1111 APR26-73 WIERCINSKI, NANCY B 17 161161116116111111111N111111111611 AP 18 IIIIIIIII?16111111IIAI1161gllIIII APR26-125 MURPHY, HEIDI A 19 ll 1111IIII 1 i ? IIIIIIIIIIglll611?ll? 16 APPA6-eff 0 *1 th - ii, , 20 Ig11111111116111A111111161Npgll ?j 21 Ig6111161111NiIIIIIIIIIIIIIIIINIIII '? 22 IIIIIIIIIINIIIIIIIIIIIINIIIIIIIIIIgiI APR26-95 ? " DONALD L. MORRISON AND SHARON --VS-- ROBERT P. BORAN, JR. M.D. UR In the Court of Commons Pleas of Cumberland County, PA., Docket No. 2007-187 CIVIL Judge: EBERT Attorney: Attorney: Date: ORS No. Juror # NAMES OF JURORS CALLED CAUSE P D 23 IIIppII1111pNN11111gpglpNllll APR26-21 MERRIS, JOHN B 24 IIIpgII?IgNIIIIIIIIIqNllpqp APR26-134 CARDER, MARCIE A 25 IgppIIBIIIIIINIgqIIIIIqIqNqp APR26-198 BALLEW, KATHLEEN A 26 IIppIlnlggNlqllpllllpNlqp APR26-127 HAYS, BILLYE J 27 IgpgNlpq?lfllpplqlllllqp APR26-280 CUTTING, CAROL A 281gppllpilllgllnplpllqlllNqp - , LL 29 IgNNIIIIIIIIINipglllqllllllqp APR26-262 ROLDAN, DAVID 30 IgppNpuunNlnllmuulNNgp APR26-296 KEEN, BRIGID C 31 Illpglllgllplp?pNlpqlqlqp APR26-275 TAYLOR, DEBORAH A 32 IIIppIInIIpNNplpglllgllllllll APR26-285 FOSCHI, ANTHONY J 33 IgpullAUlplppnfmllNNllpml APR26-167 CONRAD, BEVERLY A 34 Illpglllllllllllpllnlllillllllll APR26-323 MCKELVEY, SUSAN N 35 IIIppIIpIpNIIIIIIIIIIIII?gNgll APR26-196 BASTIAN, HAROLD E 36 IlnlgigplqnqnllllpnqNllp c7NmA",ui mA C 37 IgIIgIIIflII11qqIIINIIINIIINqp APR26-307 HORVATH, WILLIAM A 38 IIIpp11611NIIIgIglpplpllpqN APR26-248 MCMULLEN, JANE P 39 IIIpIIIIIIIIIIIIIpNlpllllllllllllll APR26-171 MICULITA, GARY A 40 Igplllllpgnllllllllllllllllllqp APR26-77 DAY, JO A 41 IgpIIlingplqNlqfqqlplinm APR26-83 BENNETT, KEVIN E 42 I Illlq IIIII Illn VIII IIIN IIIII qll IIII APR26-268 WARNER, DANIEL K 43 IIIIIIIIIIIIIIIIIIIIIpIgIIlNllllilll APR26-81 SHETTEL, LINDA M 44 IIIpfIIIllIUfIIIImIIIIIIIAIIIIIIIII APR26-197 NISSEL, DAVID P DONALD L. MORRISON AND SHARON ---- V S ROBERT P. BORAN, JR. M.D. UR In the Court of Commons Pleas of Cumberland County, PA., Docket No. 2007-187 CIVIL Judge: EBERT Attorney: Attorney: Date: ORS No. Juror # NAMES OF JURORS CALLED CAUSE P D 45 iiiiiininiiiiniiiiiin APR26-96 WOERMANN, CHERYL L 46 APR26-166 GOBAT, ROBYN M 47 148 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66