HomeMy WebLinkAbout94-06662
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BRUCE J. BISHOFF and
BETTY J. BISHOFF,
his wife,
#29
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
Plaintiffs
v.
PHYSICIANS UNLIMITED,
P.C. t/d/b/a APPLE-A-DAY
And HUGH T. KNIGHT, M.D.,
Defendants NO. 94-6662 CIVIL TERM
IN RE: PRETRIAL CONFERENCE
A pretrial conference was held in the chambers
of Judge Oler in the above-captioned case on Wednesday, June 21,
2000. Present on behalf of Plaintiffs was Anthony Stefanon,
Esquire. Present on behalf of Defendants was Daniel L. Grill,
Esquire.
This is a medical malpractice action arising out
of Defendant's treatment of a head injury suffered by Plaintiff
Bruce J. Bishoff on November 28, 1992. Defendants allegedly
failed to take special measures needed because of Plaintiff's
hemophilia condition, with the result that he suffered a
subdural hematoma and various physical and financial
consequences thereof.
This will be a jury trial in which each side
will have four peremptory challenges, for a total of eight. The
estimated duration of trial is three days.
To the extent that any videotape deposition
testimony to be shown or read to the jury contains objections
being pursued by counsel, counsel are directed to furnish copies
of the testimony with the areas of objection highlighted and
brief memoranda in support of their respective positions on the
objections at least five days prior to commencement of the trial
term at which this case is tried.
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Issues
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ANnIONY STEFANON JIIU. mIbO
ATTORNEY AT LAW ~
. 407 NQRTH FRONT STR1!BT
. FOST OFFICB 80X UO:ol7
HARRIS8URG, 1'llNNSYLVANIA 17108-:010:017
"
BRUCE J. BISHOFF and
BETTY J. BISHOFF, fY
his wife, v. l'J~-,
#29
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
PHYSICIANS UNLIMITED,
P.C, t/d/b/a APPLE-A-DAY
~nd HUGH T. KNIGHT, M.D.,
\} Defendants
NO. 94-6662 CIVIL TERM
IN RE:
PRETRIAL CONFERENCE
A pretrial conference was held in the chambers
of Judge Oler in the above-captioned case on Wednesday, June 21,
2000. Present on behalf of Plaintiffs was Anthony Stefanon,
Esquire. Present on behalf of Defendants was Daniel L. Grill,
Esquire.
This is a medical malpractice action arising out
of Defendant's treatment of a head injury suffered by Plaintiff
Bruce J. Bishoff on November 28, 1992. Defendants allegedly
failed to take special measures needed because of Plaintiff's
hemophilia condition, with the result that he suffered a
subdural hematoma and various physical and financial
consequences thereof.
This will be a jury trial in which each side
will have four peremptory challenges, for a total of eight. The
estimated duration of trial is three days.
To the extent that any videotape deposition
testimony to be shown or read to the jury contains objections
being pursued by counsel, counsel are directed to furnish copies
of the testimony with the areas of objection highlighted and
brief memoranda in support of their respective positions on the
objections at least five days prior to commencement of the trial
term at which this case is tried.
BRUCE J. BISHOFF and
BETTY J. BISHOFF, his wife,
Plaintiffs
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
v.
.
.
I No. 94-6662 Civil Term
I
I
I
I
PHYSICIANS UNLIMITED, P.C.
t/d/b/a APPLE-A-DAY and
HUGH T. KNIGHT, M.D.,
Defendants
JURY TRIAL DEMANDED
PLAINTIFFS' PRETRIAL MEMORANDUM
I. STATEMENT OF BASIC FACTS AS TO LIABILITY
This medical malpractice action relates to care and treatment
provided by Hugh T. Knight, M.D., as an employee of Defendant
Physicians Unlimited, P.C., t/d/b/a Apple-A-Day. Plaintiff Bruce
J. Bishoff was injured on November 28, 1992 when he was struck on
the head by a falling ladder, suffering trauma to his head and a
7.5 centimeter laceration to the occipital region of his scalp.
At the time that he injured, Plaintiff suffered from a
condition known as hemophilia, and specifically from a factor VIII
defect. That condition impairs the clotting of the blood. Dr.
Knight was advised of this condition at the time that Mr. Bishoff
sought care and treatment from Dr. Knight.
Despite having actual knowledge of the Plaintiff's medical
condition, Dr. Knight tool, no steps to provide any prophylactic
1
treatment to Mr. Bishoff for his bleeding disorder, or to refer Mr.
Bishoff for such prophylactic treatment.
Because of hie factor VIII defect, Mr. Bishoff was at great
riek of developing internal bleeding in the nature of subdural
hematoma. The standard of care in the medical community at that
time required that the treating phyeician either provide
prophylactic factor VIII treatment to prevent internal bleeding or
make arrangements for the Plaintiff to receive such treatment. Dr.
Knight took no steps to obtain that treatment for Mr. Biehoff.
Dr. Knight's initial treatment of Mr. Bishoff took place on
November 28, 1992. Subsequently, on the morning of November 29,
1992, Mr. Bishoff was again seen by Dr. Knight and reported to Dr.
Knight eymptoms which suggested the early development of a eubdural
hematoma. Thereafter, on the evening of November 29, 1992, a
telephone call was made by Mr. and Mrs. Bishoff to Dr. Knight,
reporting worsening eymptome of a subdural hematoma. Deepite these
multiple reports, Dr. Knight took no steps to obtain diagnostic
tests or treatment for Mr. Bishoff, or to refer him for the
necessary factor VIII treatment.
As the result of the failure of Dr. Knight to treat Mr.
Bishoff, Mr. Bishoff suffered a massive subdural hematoma which
brought him to the brink of death. He was transported to Hershey
Medical Center by helicopter and undergo emergency brain eurgery.
As the result of his injuries, Mr. Bishoff suffered an extended
2
recuperation period after the surgery, resulting in the damages
listed below.
Mrs. Bishoff presents claims for loss of consortium.
II. STATBHBNT OF BASIC FACTS AS TO DAMAGES
Plaintiffs' damages include both special damages for medical
expenses in the amount of $138,306.78, plus earnings loss in the
total amount of $9,271. 50. Plaintiff suffered general damages
during his illness and injury including the pain, suffering,
fright, shock, aggravation and inconvenience of his initial illness
and extended recuperation period, as well as residual deficits with
regard to his cognitive processes which continued for many months
after his discharge from the hospital.
Mrs. Bishoff claims damages for loss of consortium.
III. STATBHBNT AS TO PRINCIPAL ISSUES OF LIABILITY AND DAMAGES
Plaintiff's expert, Dr. M. Elaine Eyster, M.D. has testified
by deposition to the standard of care; Dr. Knight's breach of the
standard of care; and to the causation of Mr. Biehoff' s injuries by
that breach. Dr. Eyster's testimony is summarized in her reports,
copies of which are attached hereto as Exhibit A.
Attached as Exhibit "B" is a Stipulation of Counsel regarding
the reasonableness and necessity of the medical treatment which
Plaintiff received as the result of the subdural hematoma.
IV. SUMMARY OF LEGAL ISSUES
This case presents no unusual legal issues.
3
V. WITNESSES
1. Bruce J. Bishoff
2. Betty J. Bishoff
3. Bonnie Bishoff
4. Hugh T. Knight, M.D. (by deposition)
5. M. Elaine Eyster, M.D. (by deposition)
6. John D. Ricks, M.D. (aB of cross)
VI. LIST OF EXHIBITS
1. MBdica1 treatment records
2. Medical expense records
3. Deposition transcripts of all witnesses
4. Bruce J. Bishoff Hemophilia Registration Card
5. Bonnie Bishoff handwritten notes
VII. STATUS OF SETTLEMENT NEGOTIATIONS
Plaintiffs have presented the demand in the amount of
$390,000.00. No offer has been received from the defense.
By
Street
17108-2027
DATE:
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College of Medicine
University Hospital' Children's Hospital
The Milton S. Hershey Medical Center
lXflunlUl.'nt ul ~11.'1,hl.:ll1..:,HCI1l~lhlhl~>' Oi\I'''11I
June 1, 1994
P.O. 60' K~ll
HCr.lhc,. Pco",vlvoni. 17033
17171 ~)I.KJlj'i
J. Paul Helvy, Esquire
Killian , Gephar~
218 pine street
Box 886
Harrisburg, PA 17108
RE: Bruce Bishoff
Dear Mr. Helvy:
Based on the information you provided me, it is my opinion
that Mr. Bishoff should have received treatment as soon as
posaible after his head trauma. One can argue whether Factor
VIII concentrate was indicated initially or whether Desmopressin
(dDAVP) would have sufficed in a mild hemophiliac without
symptoms at the time of his initial visit to Dr. Hugh T. Knight
at Apple-A-Day on November 28, 1992.
Dr. Knight's notes state that he knew the patient had "a
Factor VIII deficit" and that head trauma instructions were
given. There is no mention in his initial note of November 28,
or in his follow-up note of November 29, that Mr. Bishoff was
experiencing dizziness. Neither is there any notation that Mrs.
Bishoff called on the evening of November 29 to inform Dr. Knight
of nausea and continued dizziness as stated in your letter of
May 26, 1994.
According to the Hershey Medical Center records which you
provided me, Mr. Bishoff began to vomit during the night and then
became unresponsive. upon arrival at the Medical Center at 5:40
a.m. November 30 he was unconscious and his right pupil was
larger than his left. A CT scan showed evidence of a large left
frontal parenchymal hemorrhage with an associated large left
subdural hematoma. Factor VIII concentrate was administered and
a left-sided craniotomy was performed with the evacuation of the
subdural hematoma. Mr. Bishoff was treated with Factor VIII
concentrate on an B to 12 hour basis throughout his
hospitalization from November 30 through December 9. Following
discharge he received daily doses of Factor VIII concentrate
through December 20.
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J. Paul Helvy, Esquire
June 1, 1994
Page 2
RE: Bruce Bishoff
The Hershey Medical Center recnrd also states that the
patient had been followed at the pittsburgh Hemophilia Center
prior to moving to this area. A phone call from one of the
Chaplains in Pastoral Services shortly after admission elicited
the information that Mr. Bishoff had a deticiency of Factor VIII
with a 15t level.
Symptoms of increased intracranial pressure such as naus.a
and vomiting are often d.laye~ tc= 24 hcurs or more in persor~
with hemophilia who sustain head injuries. Early treatment
prevents or attenuates intracranial bleeding by accelerating
blood clotting which is delayed because ot a clotting tactor
deficiency.
In my opinion, if Dr. Knight was told on November 29 that
Mr. Bishoff was dizzy and nauseated, he should have referred him
immediately tor further evaluation with a CT scan and treatment
with Factor VIII concentrate.
In reply to your questions, one cannot predict medical
outcomes with certainty. However, it is highly probable that Hr.
Bishoff's period of hospitalization and total Factor VIII usage
would have be.n substantially shortened had the appropriate
treatment been given earlier.
SinCere~y yo~ ~
~t~ ~t
M. Elaine Eyster, M.D.
Professor ot Medicine
and Director, Hemophilia Center of
Central Pennsylvania
HEE/lmn
. JUL S 1994
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CoIlege of Medicine
University Hospital' Children's Hospital
The Milton S. Hershey Medical C~mer
D~panl11"'11I \11 ~1...~icin.:,H"'In:JIUlll~>' Oi\ I'HIIt
P.O. all' /ljO
H~r.;hc'. P~nnSYIYlllIIll 17033
17171 j) I.M3Y9'
June 30, 1994
J. Paul Helvy, Esquire
The Law Firm of Killian , Gephart
219 Pine street
P. o. Box 996
Harrisburg, PA 17109-0996
Dear Mr. Helvy:
RE: Bruce Bishoff
I would offer the following replies to the questions posed
in your letter of June 29, 1994.
1. Q: Did Dr. Knight ever ascertain the specific type and
severity of Mr. Bishoff'S clotting deficit?
A: Not to my knowledge.
2. Q: Did Dr. Knight fail to exercise reasonable care when he
failed to ascertain the specific type and severity of Mr.
Bishoff's clotting deficit? If your answer to this
question is in the affirmative, please explain how Dr.
Knight could have obtained this information.
A: Yes. He could have obtained it by calling the Hemophilia
Center of Western Pennsylvania in Pittsburgh.
3. Q: Did Dr. Knight fail to exercise reasonable care when he
failed to refer Mr. Bishoff for further evaluation and
treatment? If your answer to this question is in the
affirmative, please indicate what type of actions would
have been reasonable for Dr. Knight to take in this
situation.
A: Yes. He should have initiated some form of prophylactic
treatment (Factor VIII concentrate or possibly
Desmopressin) at the time of Mr. Bishoff's initial visit.
..
01 EXHIBIT
,~
\n Equal Opponunn~ Unl\lcnllY
~
J. Paul Helvy, Esquire
June 30, 1994
Page 2
REI Bruce Bishott
4. QI Did Dr. Knight tail to exercise reasonable care whan he
failed to consult other physicians regarding Hr.
Bishoff's case? If your answer to this que.tion is in
the affirmative, please indicate what resource. were
available to Dr. Knight for consulting regarding
problems of this kind.
Yes. He could have consulted with a Phrsician
knowledgeable in the care of persons w th hemophilia, or
referred him to the Central Pennsylvania Hemophilia
Center located in Hershey.
AI
5. QI With a reasonable degree of medical certainty, did Dr.
Knight's failure to: a) ascertain the specific type and
severity of Hr. Bishoff's Clotting deficitf b) rsfer Hr.
Bishoff tor further evaluation and treatmentf and c)
consult other physicians regarding Hr. Bishoff's
treatment, increase the risk that Hr. Bishoff would
develop intracranial bleeding and experience associated
neurological difficulties?
AI Yes.
6. QI Are hemophiliacs who sutfer trauma to the head at
significant risk of sustaining a subdural hematoma and
neurological damage without appropriate medical care?
AI Yes.
7. Q: If Hr. Bishoff had received appropriate medical treatmmlt
from Dr. Knight would the risk of intracranial bleeding
and associated neurological difficulties have been
greatly reduced or prevented?
A: Yes.
Sincerely yours,
~~~~
M. Elaine Eyster, M.D.
Distinquished Professor ot Medicine
Chief, Division ot Hematoloqy
HEE/lmn
BRUCE J. BISHOFF and
BETTY J. BISHOFF, his wife,
Plaintiffs
:
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
.
v.
No. 94-6662 Civil Term
PHYSICIANS UNLIMITED, P.C.
t/d/b/a APPLE-A-DAY and
HUGH T. KNIGHT, M.D.,
Defendants
JURY TRIAL DEMANDED
S~IPULA~ION OF COUNSEL
The undersigned, being counsel of record for all parties to
this C4se, do stipulate and agree that:
1. Plaintiff Bruce J. Bishoff rsceived care and treatment
for his subdural hemat;oma from the following providers on the
following dates:
(a) Silver Spring Ambulance - 11/30/92;
(b) West Shore Advanced Life Support
11/30/92;
(e) Hershey Medical Center
University
Hospital - Life Lion Transport - 11/30/92;
(d) Hershey Medical Center
University
Hospital - Inpatient - t1/30/92 to 12/9/92;
(e) Hershey Medical Center Outpatient
12/15/92, 1/22/93, 3/1/93, 2/2/93, 3/30/93;
(f) Professional Home Heslth Care Agency'
(Daily Administration of IV Factor XIII)
12/9/92 to 1/4/93;
(g) Holy Spirit Hospital Outpatient Emergency
Room - 12/10/92.
2. The care and treatment of Plaintiff Bruce J. Bishoff by
each of the providers named in the foregoing subparagraphs was
reasonable and necessary for the care and treatment of the subdural
hematoma suffered by PLaintiff Bruce J. Bishoff.
J. The fees charged by each of the above named providers
were reasonable and customary for the services provided.
4 .
The partieh
stipulate to the authenticity and
admissibility of the medical records for each of the above
referenced medical care pr.oviders.
RESPECTFULLY SUBMITTED,
.
By
Anthony Stefanon, Esquire
'25497
407 North Front Street
P.O. Box 12027
Harrisburg, PA 17108-2027
(717) 232-0511
DATE:
By
Daniel L. Grill, Enquire
PORR & ASSOCIATES, P.C.
1850 William Penn Way
Suite 209
P.O. Box 10696
Lancaster, PA 17605-0696
(717) 390-3020
DATE:
t'
~~
JUN 15 2000tP
PORR & ASSOCIATES, P.C.
BY: Daniel L. Grill
Identification No. 65339
60,266
Attorneys for Defendants:
Hugh T. Knight, M.D. and
Physicians Unlimited, P.C.
1850 William Penn Way
Suite 209
P.O. Box 10696
Lancaster, PA 17605-0696
(717) 390-3020
BRUCE J. BISHOFF and BETTY
J. BISHOFF, his wife
COURT OF COMMON PLEAS
CUMBERLAND COUNTY
v.
No. 94-6662 Civil Term
PHYSICIANS UNLIMITED, P.C.
lIdlb/a APPLE-A-DAY
and
HUGH T. KNIGHT, M.D.
JURY TRIAL DEMANDED
PEFENDANTS' PRETRIAL MEMORANDUM
I. Statement of Basic Facts as to Llabllltv:
,
This medical malpractice action relates to the care and treatmentth~ above-
captioned Defendants provided to Plaintiff, Bruce J. Bishoff. The care and treatment of
Plaintiff which is at issue began on November 28, 1992, when Plaintiff, as a result of falling
from a ladder, sought treatment from Dr. Knight at the Apple-A-Day clinic.
As a result of the ladder fail, the Plaintiff suffered head trauma and a scalp
laceration. Plaintiffs claim that Dr. Knight deviated from the standard of care by failing to
follow up with appropriate treatment for the Plaintiff. Specifically, Plaintiff claims that Dr.
Knight was aware that Plaintiff suffered from a Factor VIII defect (mild hemophilia) and he
failed to properly treat his Injury due to that condition. Moreover, it is further claimed that
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over the next few days, Plaintiff wife contacted Dr. Knight about the ongoing symptoms that
Mr. Bishoff was suffering from, and Dr. Knight failed to follow this up and thereby deviated
from the standard of care.
As a consequence, it is claimed that Plalnllff needed to go to Hershey medical
canter where he underwent brain surgery to treat a massive subdural hematoma. Plalnllff,
in his complaint, has claimed that as a result of Dr. Knight's failure to properly treat the
situation that he suffered from problems relallng to impaired vision, Impaired balance,
cognillve defects, memory loss, as well as a lost earnings claim. Defendants, in prior
responsive pleadings, have denied all allegallons of negligence concerning the care and
traatment rendered in this mailer.
Additionally, Defendant Dr. Hugh T. Knight, has died since the onset of this
Iillgatlon. The administrator of his estate Is the Heritage Valley Credit Union.
II. Statement of the Basic Facts as to Damaaes:
Please see Plaintiffs Pretrial Memorandum. In addition, Plainllffs have previously
indicated that medical bills totaled $138,306.78, and lost earnings amounted to $9271.50.
III. Statement as to Prlncloallssues of L1abllltv and Damaaes:
The principal issues involved in the case are whether Dr. Knight deviated from the
applicable standard of care in his care and treatment of Plaintiff Bruce J. Bishoffs head
trauma, and if so, whether any alleged deviation by Dr. Knight was the cause of any of the
alleged damages suffered by the Plaintiffs.
IV. SummarY of Leaallssues:
1) Standard issues of duty, breach, causation, and damages are present in this
case.
"
2) Because the insurance coverages on Defendants is provided pursuant to
statute by the Pennsylvania Property & Casualty Insurance Guaranty Association, the Non-
Duplication of Recovery provisions of 40 P.S. ~ 991.1817 apply to offset the liability of
these Defendants (and their insurance concern) to the extent that other sourcas of
insurance have provided any payment, whether for medical bills, disability or otherwise. It
Is believed that the amount of the non-duplicatlon provision applicable :n this case Is
$138,306.78. As an evidentiary Issue, there is no reason this number needs to be
presented to the jury. As a matter of course, should there be a verdict against the moving
Defendants, It Is the intention of counsel to motion the Court to mold the verdict to renect a
reduction of $138,306.78 of any verdict against the moving Defendants.
V. Witnesses:
1) Bruce J. Bishoff, as of cross.
2) Betty J. Bishoff, as of cross.
3) John D. Ricks, M.D., of PHYSICIANS UNLIMITED, P.C., Udlbla APPLE-A-
DAY, HealthSouth, 1124 Harrisburg Pike, Carlisle, PA 17013.
4) Hugh T. Knight, M.D., by deposition.
S) S. Elaine Eyster, M.D., by videotaped deposition.
Defendants respectfully reserve the right to call witnesses identified by the Plaintiff.
Defendants further respectfully reserve the right to supplement this response with
reasonable notice to counsel.
VI. list of Exhibits:
1) Medical records, charts, diagrams, and anatomical models,
Including enlarged copies of pages from the medical records.
CERTIFICATE OF SERVICE
I hereby certifY that on this date I caused a true and correct copy of the foregoing document to be
served upon the individual named below by tirst class mail.
Anthony Stefanon, Esquire
407 North Front Street
P.O. Box 12027
Harrisburg, P A 17108-2027
PORR & ASSOCIATES, P.C.
By:
DJ /.
/Y-~~~
Daniel L. Grill
Attorney for Defendants
Date:
eJtf
I
BRUCE J. BISHOFF and BETTY J.
BISHOFF, his wife,
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY PENNSYLVANIA
Plaintiffs
v.
CIVIL ACTION LAW
NO. 1tt fAA,P;( CD LtL{LJ~
PHYSICIANS
APPLE-A-DAY
M.D.,
UNLIMITED P.C. t/d/b/a
and HUGH T. KNIGHT,
.
Defendants
: JURY TRIAL DEMANDED
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 is 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 OR CANNOT AFFORD ONE, GO TO OR TELEPHONE THE
OFFICE SET FORTH BELOW TO FIND OUT WHERE YOU CAN GET LEGAL HELP.
Court Administrator
4th Floor
Cumberland County Courthouse
Carlisle, PA 17013
(717) 240..6200
BRUCE J. BISHOFF and BETTY J. I IN THE COURT OF COMMON PLEAS
BISHOFF, his wife, I CUMBERLAND COUNTY PENNSYLVANIA
Plaintiffs I
I
V. I CIVIL ACTION LAW
I NO. (1'1- , t t..l ~ r ..u-
PHYSICIANS UNLIMITED P.C. t/d/b/a I
APPLE-A-DAY and HUGH T. KNIGHT, I
M.D., I
Deffmdants I JURY TRIAL DEMANDED
COMPLAINT
1. Plaintiffs are BRUCE J. BISHOFF and BETTY J. BISHOFF,
adult individuals, husband and wife, who reside at 23 East Willow
Terrace Drive, Mechanicsburg, Cumberland County, Pennsylvania.
2. Defendant PHYSICIANS UNLIMITED P.C. t/d/b/a APPLB-A-DAY,
(hereinafter Apple-A-Day) is a corporation organized and existing
under the laws of the Commonwealth of Pennsylvania with offices or
principal place of business located at 6230 Carlisle Pike,
Mechanicsburg, Cumberland County, Pennsylvania 17055.
3. Defendant HUGH T. KNIGHT, M.D., (hereinafter Dr. Knight)
is an adult individual holding himself out to be a medical doctor
and licensed practitioner of the healing arts, with offices or
principal place of business located at 6230 Carlisle Pike,
Mechanicsburg, Cumberland County, Pennsylvania 17055.
4. At all times relevant hereto, Dr. Knight acted as the
authorized servant, agent, employee, and representative of Apple-A-
1
Day, acting within the scope of his authority on behalf of said
corporation.
S. On Saturday, November 28, 1992, Mr. Bishoff, while
performing maintenance activities on his family home, fell from a
ladder and was struck on the head, suffering a 7. S cm laceration to
the occipital region of his scalp and a .5 em laceration to the
dorsum of his left hand.
6. On November 28, 1992, at or about 6100 p.m., both
Plaintiffs Bruce J. Biahoff and Betty J. Bishoff travelled to the
medioal facilities of Defendant Apple-A-Day for the purpose of
obtaining medical care and treatment of the injuries suffered by
Mr. Bishoff.
7. Mr. Bishoff had been a patient of Apple-A-Day prior to the
time of his injuries on November 28, 1992, and had been treated by
physicians at Apple-A-Day at least since June 6, 1992.
8. On November 28, 1992, Mr. Bishoff was treated by Dr.
Knight, aoting for and on behalf of Apple-A-Day.
9. On November 28, 1992 when Dr. Knight provided oare and
treatment to Mr. Bishoff, Dr. Knight was aware that Mr. Bishoff
suffered from hemophilia and specifically from a Faotor VIII
defect.
10. On November 28, 1992, when Dr. Knight treated Mr. Bishoff,
he was aware that Mr. Bishoff had suffered head trauma and a scalp
laceration.
11. On November 28, 1992, Dr. Knight provided no treatment for
Mr. Bishoff other than to cleanse and suture the scalp wound.
2
12. On November 2B, 1992, Dr. Knight requaeted Mr. Bishoff to
return to the clinic on the morning of November 29, 1992.
13. On the morning of November 29, 1992, both Mr. And Mrs.
Bishoff returned to Apple-A-Day to see Dr. Knight. During the
COHrse of thAt examination, Mrs. Bishoff advised Dr. Knight that
Mr. Bishoff was suffering cold sweAts, queasiness, a "blah" affect,
And WAS very subdued.
14. Despite receiving these complaints from Mrs. Bishoff, Dr.
Knight performed absolutely no diagnostic testing on tfr. Bishoff on
November 29, 1992 and merely changed the dressing on the scalp
laceration.
15. Throughout the day on November 29, 1992, Mr. Bishoff
continued to experience queasiness, cold sweats, and episodes of
vomiting which conditions were witnessed by Mrs. Bishoff.
16. ~t or about 7:00 p.m. on the evening of November 29, 1992,
Mr. Bishoff called App1e-A-Day and spoke with Dr. Knight, advising
him of the symptoms which he was experiencing.
17. During this same telephone conversation with Dr. Knight,
Mrs. Bishoff questioned Dr. Knight about whether the symptoms which
Mr. Bishoff was suffering could be related to the head injury. Dr.
Knight responded "No".
lB. Mr. Bishoff continued to euffer cold sweats and vomiting
through the early morning hours of Monday, November 30, 1992. He
fell asleep at approximately 3:00 in the morning on November 30,
1992. At 4:30 in the morning, Mrs. Bishoff attempted to awaken Mr.
Bishoff and was unable to arouse Mr. Bishoff, he became
3
unresponsive, pulseless, his pupils were of unequal size, and were
not reactive to light.
1.9. Immediately upon discovering her husband's condition, Mrs.
Bishoff called for emergency medical care which call was met by
responses from both Basic Life Support and Advanced Life Support
Units.
20. Mr. Bishoff was ultimately transferred by Life Lion
helicopter to the Hershey Medical Center where he was diagnosed as
suffering from a massive subdural hematoma and underwent emergency
brain surgery to alleviate that condition.
21. Beginning November 30, 1992, and continuing up to the
present date, Mr. Bishoff has undergone an extensive course of
medical care and treatment on an in-patient and out-patient basis
including eurgical procedures, physical therapy, and rehabilitation
therapy designed to treat the subdural hematoma and the physical
and mental difficulties resulting from that condition.
22. Plaintiffs have incurred medical expenses for the care and
treatment of the injuries suffered by Mr. Bishoff in the total
amount of $138,306.78.
23. As the result of the injury to his brain caused by the
subdural hematoma, Mr. Bishoff has suffered temporary and permanent
impaired vision, impaired balance, cognitive deficits, memory loss,
headaches, pain in the extremities, along with generalized pain,
suffering aggravation, inconvenience, and the loss of life's
pleasures.
4
24. As ths rssult of the aforesaid injuries, Mr. Bishoff has
suffered the temporary and permanent disability; past and futurB
loss of earnings; and permanent reduction of future earning
capacity.
25. As the result of the injuries aforesaid, Mrs. Bishoff has
suffered the loss of the services, society, comfort, and counsel of
her husband.
COURT I
PLAINTIPPS V. DR. KNIGHT
26. The avermente of the foregoing paragraphs 1 through 25 are
incorporated hsrein by reference.
27. At all times relevant hereto, Plaintiffs relied upon the
professional judgment, ability, and knowledge of Dr. Knight in
seeking treatment for Mr. Bishoff's medical condition.
28. Dr. Knight was negligent in the care and treatment which
he provided to Mr. Bishoff in that he failed to have and use the
same knowledge and skill, and to exercise the same care as that
which is usually had and exercised by physicians in his field in
the following particulars:
He failed to make inquiry
type and severity of
deficit; and
(b) He fillled to initiate some form of prophylactic
tr~atment for the clotting deficit, either Factor
VIII or Desmopressin at the time of Mr. Bishoff's
initial visit, or at any time thereafter; and
to ascertain the specific
Mr. Bishoff's clotting
(a)
5
(c)
(d)
(e)
(f)
(g)
(h)
He failed to consult with a physician knowledgeable
in the care of persons with hemophilia at the time
of Hr. Bishoff's initial visit and at any time
thereafter, and
He failed to order appropriate diagnostic tests or
examinations to determine whether Hr. Bishoff
suffered from intercranial bleeding; and
Ho failed to recognize that the complaints voiced
by Hr. and Hrs. Bishoff on November 29, 1992 were
symptomatic for neurologic difficulties related to
intercranial bleeding; and
He failed to alert Hr. and Hrs. Bishoff to the fact
that Hr. Bishoff was at risk for the development of
intercranial bleeding, and failed to advise them to
seek further medical care and treatment for Hr.
Bishoff from qualified specialists; and
He failed to examine Hr. Bishoff on November 29,
1992 at 7100 p.m. when he was called by Hr. and
Hrs. Bishoff complaining of symptoms consistent
with neurologic deficiencies; and
He failed to recognize the increased risk that Hr.
Bishoff would suffer subdural hematoma due to his
known Factor VIII defect and failed to take
reasonable and necessary precautions to avoid the
development of subdural hematoma.
29. As a direct and proximate result of the aforesaid
negligence of Dr. Knight, Hr. Bishoff suffered a massive subdural
hematoma which caused the injuries and damages complained of
herein.
30. The aforesaid negligence of Dr. Knight caused and was a
substantial contributing factor to the occurrence of Hr. Bishoff's
subdural hematoma and to the injuries and damages complained of by
Plaintiffs in this action.
lfHBREFORE, Plaintiffs demand judgment against Defendant Knight
for special damagee in the amount of $138,306.78 plus general
6
damages in an unliquidated amount in excess of $20,000.00, which
amounts exceed the limit for compulsory arbitration under the Local
Rules of the Court of Common pleas of Cumberland County,
Pennsylvania plus interest and costs of suit.
COUNT II
PLAINTIFFS V. PHYSICIANS UNLIMITED, P.C.,
t/d/b/a APPLE-A-DAY
31. The averments of the foregoing paragraphs 1 through 30 are
incorporated herein by reference.
32. Defendant Apple-A-Day is vicariously liable for the
negligent acts and omissions of its servant, agent, employee, and
representative, Dr. Knight.
33. Apple-A-Day undertook to provide care and treatment to Mr.
Bishoff and to the public in general.
34. Apple-A-Day was negligent in providing care and treatment
to Mr. Bishoff in each of the following respects I
(a) It failed to select and retain only competent
physicians on its staff; and
(b) It failed to oversee the performance of all persons
practic3.ng medicine within its walls, and
specifically failed to oversee the conduct of Dr.
Knight with regard to his negligent actions
described in the foregoing paragraphs; and
(c) It failed to formulate, adopt, and enforce adequate
rules and policies to insure that its patients
received quality care; and
(d) It failed to require physicians providing services
at its institution to uphold the proper and
accepted standards of medical care owed to its
7
(e)
patients; and
It failed to take reasonable and appropriate action
to protect and treat its patients when it knew or
should have known that the attending the physicians
had failed to act appropriately on behalf of the
patient; and
It failed to adequately train and instruct its
employees in the care and treatment of its patients
(f)
35. At all times relevant hereto, Apple-A-Day retained the
right to control the activities of its servants, employees, and
representatives, including Dr. Knight, and failed to exercise that
control to prevent the injuries and damages suffered by Plaintiffs.
36. The aforesaid negligence of Apple-A-Day caused and was a
substantial contributing factor to the injuries and damages alleged
by Plaintiffs in this Complaint.
WHEREFORE, Plaintiffs demand judgment against Defendant
Physicians Unlimited, P.C. t/d/b/a Apple-A-Day for special damages
in the amount of $138,306.78 plus general damages in an
unliquidated amount in excess of $20,000.00, which amounts exceed
the limit for compulsory arbitration under the Local Rules of the
Court of Conunon pleas of Cumberland County, Pennsylvania plus
interest and costs of suit.
COUNT I II
JOINT AND SEVERAL LIABILITY
37. The averments of the foregoing paragraphs 1 through 36 are
incorporated herein by reference.
8
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6. Denied. After reasonable investigation, Defendants are
without knowledge or information sufficient to form a belief as to
the truth of the averments in paragraph six (6), and therefore,
demand strict proof thereof at trial, if relevant.
7. Denied as stated. However, it is admitted that Plaintiff
had treated with physicians at Apple-A-Day on June 6, 1992 and
several other occasions prior to the November 28, 1992 visit.
8, Admi tted.
9. Admi tted.
10. Denied as stated, See medical records of Defendant, Hugh
T. Knight, M.D., dated November 28, 1992. It is admitted that a
scalp laceration was treated and head trauma instructions were
given.
11. Denied as stated. See medical records dated November 28,
1992, which outlines the examination and treatment which is in
writing and speaks for itself.
12. Admitted.
13. Denied as statsd and generally pursuant to Pa.R.C.P.
1029(e).
14. Denied as stated. Defendant, Hugh T. Knight, M.D.,
responded appropriately to all complaints and conditions which
presented themselves on November 29, 1992. It is admitted that no
diagnostic testing was performed, because none was needed. It is
admitted that the scalp was re-dressed.
15. Denied. After reasonable investigation, Defendants are
without knowledge or information sufficient to form a belief as to
2
the truth of the averments in paragraph fifteen (15) , and
therefore, demand strict proof thereof at trial, if relevant.
16. Denied generally pursuant to Pa.R.C.P. 1029 (e) .
17. Denied generally pursuant to Pa.R.C.P. 1029(e).
lB. Denied. After reasonable investigation, Defendants are
without knowledge or information sufficient to form a belief as to
the truth of the averments in paragraph eighteen (18), and
therefore, demand strict proof thereof at trial, if relevant.
19, Denied. After reasonable investigation, Defendants are
without knowledge or information sufficient to form a belief as to
the truth of the averments in paragraph nineteen (19), and
therefore, demand strict proof thereof at trial, if relevant.
20. Denied. After reasonable investigation, Defendants are
without knowledge or information sufficient to form a belief as to
the truth of the averments in paragraph twenty (20), and therefore,
demand strict proof thereof at trial, if relevant.
21. Denied. After reasonable investigation, Defendants are
without knowledge or information sufficient to form a belief as to
the truth of the averments in paragraph twenty-one (21), and
therefore, demand strict proof thereof at trial, if relevant.
22, Denied. After reasonable investigation, Defendants are
without knowledge or information sufficient to form a belief as to
the truth of the averments in paragraph twenty-two (22), and
therefore, demand strict proof thereof at trial, if relevant.
23. Denied. After reasonable investigation, Defendants are
without knowledge or information sufficient to form a belief as to
3
the truth of the averments in paragraph twenty-three (23), and
therefore, demand strict proof thereof at trial, if relevant.
24. Denied. After reasonable investigation, Defendants are
without knowledge or information sufficient to form a belief as to
the truth of the averments in paragraph twenty-four (24), and
therefore, demand strict proof thereof at trial, if relevant.
25. Denied. The allegations contained in paragraph twenty-
five (25) of the Complaint are conclusions of law to which the
Pennsylvania Rules of civil Procedure require no responsive
pleading, are therefore denied, and strict proof thereof is
demanded at trial, if relevant.
COUNT I
PLAINTIFFS v. HUGH T. RNIGHT. M.D.
26. Defendants, Hugh T. Knight, M.D. and Physicians
Unlimited, P.C., incorporate herein by reference the averments
contained in paragraphs one (1) through twenty-five (25) of the
foregoing Answer as if fully set forth herein.
27. Denied. After reasonable investigation, Defendants are
without knowledge or information sufficient to form a belief as to
the truth of the averments in paragraph twenty-seven (27), and
therefore, demand strict proof thereof at trial, if relevant.
28. Denied as a conclusion of law. It is specifically denied
that Hugh T. Knight, M.D. was careless or negligent in any of the
following respects:
4
a. He failed to make inquiry to ascertain the
specific type and severity of Mr. Bishoff's
clotting deficit;
b. He failed to initiate some form of prophylactic
treatment for the clotting deficit, either
Factor VIII or Desmopressin at the time of Mr.
Bishoff's initial visit, or at any time
thereafter;
c. He failed to consult with a physician
knowledgeable in the care of persons with
hemophilia at the time of Mr. Bishoff's
initial visit and at any time thereafter;
d. He failed to order appropriate diagnostic
tests or examinations to determine whether Mr.
Bishoff suffered from intercranial bleeding;
e. He failed to recognize that the complaints
voiced by Mr. and Mrs. Bishoff on November 29,
1992 were symptomatic for neurologic
difficulties related to intercranial bleeding;
f. He failed to alert Mr. and Mrs. Bishoff to the
fact that Mr. Bishoff was at risk for the
development of intercranial bleeding, and
failed to advise them to seek further medical
care and treatment for Mr. Bishoff from
qualified specialists;
5
g. He failed to examine Mr. Bishoff on November
29, 1992 at 7:00 p.m. when he was called by
Mr. and Mrs. Bishoff complaining of symptoms
consistent with neurological deficiencies; and
h. He failed to recognize the increased risk that
Mr. Bishoff would suffer subdural hematoma due
to his known Factor VIII defect and falled to
take the reasonable and necessary precautions
to avoid the development of subdural hematoma.
29. Denied. It is specifically denied that Defendants, Hugh
T. Knight, M.D. and Physicians Unlimited, P.c., were negligent and
careless in their care and treatment of plaintiff. To the
contrary, Defendants, Hugh T. Knight, M.D. and Physicians
Unlimited, P.c., were at no time negligent and tended to the
plaintiff competently in accordance with accepted standards of care
consistent with the standards of the medical profession within the
community. Moreover, the allegations contained in paragraph
twenty-nine (29) are conclusions of law to which the Pennsylvania
Rules of civil Procedure require no responsive pleading, are
therefore denied, and strict proof is demanded at trial, if
relevant. Additionally, all allegations of causation and
consequential injury are specifically denied as improper legal
conclusions and strict proof is demanded at trial. With respect to
plaintiff's allegations of injury, after reasonable investigation,
Defendants are without knowledge or information sufficient to form
a belief as to the truth of the averments in paragraph twenty-nine
6
(:19) and therefore, demand strict proof thereof at trial, if
relevant.
30. Denied. It is specifically denied that Defendants, Hugh
T. J<night, H.D. and Physicians Unlimited, P.c., were negligent and
careless in their care and treatment of plaintiff. To the
contrary, Defendants, Hugh T. J<night, M.D. and Physicians
Unlimited, P.c., were at no time negligent and tended to the
plaintiff competently in accordance with accepted standards- of care
consistent with the standards of the nledical profession within the
community. Moreover, the allegations contained in paragraph thirty
(30) are conclusions of law to which the pennsylvania Rules of
civil Procedure require no responsive pleading, are therefore
denied, and strict proof is demanded at trial, if relevant.
AdcHtionally, all allegations of causation and consequential injury
are specificallY denied as improper legal conclusions and strict
proof is demanded at trial. with respect to plaintiff'S
allegations of injury, after reasonable investigation, Oefendants
are without knowledge or information sufficient to form a belief as
to the truth of the averments in paragraph thirty (30) and
therefore, demand strict proof thereof at trial, if relevant.
WHEREFORE, Defendants, Hugh T. J<night, M.D. and Physicians
Unlimited, P.C., respectfully request that this Court grant
judgment in their favor and against the plaintiffs on the
Complaint, together with costs, expenses and attorney's fees.
7
COmrLll
PLAINTIPFS v. PHYSICIANS UNLIMITED. P.C..
t/d/b/a APPLE-A-DAY
31. Defendants, Hugh T. Knight, M.D. and Physicians
unlimited, P.C., incorporate herein by reference the averments
contained in paragraphs one (1) through thirty (30) of the
foregoing Answer as if fully set forth herein.
32. Denied. The allegations contained in paragraph thirty-
two (32) of the Complaint are conclusions of law to which the
Pennsylvania Rules of civil Procedure require no responsive
pleading, are therefore denied, and strict proof thereof is
demanded at trial, if relevant.
33. Denied as stated. It is admitted that Mr. Bishoff came
to Apple-A-Day on November 29, 1992 for treatment.
34. Denied as a conclusion of law. It is specifically denied
that Defendant, Physicians Unlimited, P.C. was careless or
negligent in the following respects:
a. It failed to select and retain only competent
physicians on its staff;
b. It failed to oversee the performance of all
persons practicing medicine within its walls,
and specifically failed to oversee the conduct
of Dr. Knight with regard to his negligent
actions described in the foregoing paragraphs;
8
c. It failed to formulate, adopt and enforce
adequate rules and policies to insure that its
patients received quality care;
d. It failed to require physicians providing
services at its institution to uphold the
proper and accepted standards of medical care
owed to its patients;
e. It failed to take reasonable and appropriate
action to protect and treat its patients when
it knew or should have known that the
attending physicians had failed to act
appropriately on behalf of the patient; and
f. It failed to adequately train and instruct its
employees in the care and treatment of its
patients.
35. Denied. The allegations contained in paragraph thirty-
five (35) of the Complaint are conclusions of law to which the
Pennsylvania Rules of civil Procedure require no responsive
pleading, are therefore denied, and strict proof thereof is
demanded at trial, if relevant.
36. Denied. The allegations contained in paragraph thirty-
six (36) of the Complaint are conclusions of law to which the
Pennsylvania Rules of civil Procedure require no responsive
pleading, are therefore denied, and strict proof thereof is
demanded at trial, if relevant.
9
WHEREFORE, Defendants, Hugh T. Knight, M.D. and Physicians
Unlimited, P.C., respectfully request that this Court grant
jUdgment in their favor and against the Plaintiffs on the
Complaint, together with costs, expenses and attorney's fees.
COUNT III
JOINT AND SEVERAL LIABILITY
37. Defendants, Hugh T. Knight, M.D. and Physicians
Unlimited, P.C., incorporate herein by reference the averments
contained in paragraphs one (1) through thirty-six (36) of the
foregoing Answer as if fully set forth herein.
38. Denied. The allegations contained in paragraph thirty-
eight (38) of the Complaint are conclusions of law to which the
Pennsylvania Rules of civil Procedure require no responsive
pleading, are therefore denied, and strict proof thereof is
demanded at trial, if relevant.
WHEREFORE, Defendants, Hugh T. Knight, M.D. and Physicians
Unlimited, P.C., respectfully request that this Court grant
judgment in their favor and against the Plaintiffs on the
Complaint, together with costs, expenses and attorney's fees.
NEW HATTER
39.
Unlimi ted,
Defendants, Hugh T. Knight, M.D. and Physicians
P. C., incorporate herein by reference the averments
10
contained in paragraphs one (1) through thirty-nine (39) of the
foregoing Answer as if fully set forth herein.
40. The Plaintiffs' Comp,laint fails to state a claim upon
which relief can be granted.
41. Plaintiffs' claims are barred in whole or in part by the
doctrines of contributory/comparative negligence and assumption of
risk.
42. Plaintiffs' claims are barred in whole or in part because
Plaintiffs' alleged injuries, if any, were not caused by the
actions of Defendants, Hugh T. Knight, M.D. and Physicians
Unlimited, P.C.
43. Plaintiffs' claims are barred by the applicable statute
of limitations.
44. Plaintiffs' may have entered into a release which
incorporates the allegations in the instant matter.
WHEREFORE, Defendants, Hugh T. Knight, M. D. and Physicians
Unlimited, P.c., respectfully request that this Court grant
judgment in their favor and against the Plaintiffs on the
Complaint, together with costs, expenses and attorneys' fees.
Respectfully submitted,
MICHAEL W. McGUCKIN & ASSOCIATES, P.C.
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By:
cGUCKIN
LLIS
Attorneys f r Defendants,
Hugh T. K ght, M.D. and
Physicians Unlimited, P.C.
t/d/b/a Apple-A-Day
11
MICHAEL W. McGUCKIN & ASSOCIATES,
BY: Michael W. McGuckin
Identification No. 49464
Leigh A.J. Ellis
Identification No. 53229
1850 William Penn Way
suite 209
P.O. BoX 10696
Lancaster, PA 17605-0696
(717) 390-3020
P.C. 60,266
Attorneys for Defendants:
Hugh T. Knight, M.D. and
Physicians Unlimited, P.C.
BRUCE J. BISHOFF and BETTY
J. BISHOFF, his wife
COURT OF COMMON PLEAS
CUMBERLAND COUNTY
v.
No. 94-6662 civil Term
PHYSICIANS UNLIMITED, p.e.
t/d/b/a APPLE-A-DAY
and
HUGH T. KNIGHT, M.D.
JURY TRIAL DEMANDED
CERTIFICATE OF SERVICE
I, Leigh A.J. Elllis, Esquire, do hereby certify that I caused
a copy of the foregoing Answer and New Matter of Defendants, Hugh
T. Knight, M.D. and Physicians Unlimited, P.C. To Plaintiffs'
Complaint, to be served this day by United States first class mail,
postage prepaid to:
Anthony Stefanon, Esquire
STEFANON & GLACE
407 North Front Street
P.O. Box 12027
Harrisburg, PA 17108-2027
J. Paul Helvy, Esquire
KILLIAN & GEPHART
218 pine Street
Harrisburg, PA 17101
MICHAEL W. McGUCKIN & ASSOCIATES, P.C.
DATED:
MICHAEL W
LEIGH A.
Attorney
Hugh T. night, M.D. and
Physicians Unlimited, P.C.
t/d/b/a Apple-A-Day
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PORR & ASSOCIATES, P.C.
BY: Linda Porr Sweeney
Identification No. 34811
60,266
Attorneys for Defendants:
Hugh T. Knight, M.D. and
Physicians Unlimited, P.C.
1850 William Penn Way
Suite 209
P.O. Box 10696
Lancaster, PA 17605-0696
(717) 390-3020
BRUCE J. BISHOFF and BETTY
J. BISHOFF, his wife
COURT OF COMMON PLEAS
CUMBERLAND COUNTY
v.
No. 94-6662 civil Term
PHYSICIANS UNLIMITED, P.C.
t/d/b/a APPLE-A-DAY
and
HUGH T. KNIGHT, M.D.
JURY TRIAL DEMANDED
ENTRY OF APPEARANCE
TO THE PROTHONOTARY:
Kindly enter my appearance on behalf of Defendants, Hugh T.
Knight, M.D. and Physicians Unlimited, P.C., t/d/b/a Apple-A-Day,
in reference to the above-captioned action.
PORR & ASSOCIATES, P.C.
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Attorney for Defendants,
Hugh T. Knight, M.D.
Physicians Unlimited
t/d/b/a Apple-A-Day
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PORR & ASSOCIATES, P.C.
BY: Daniel L. Grill
Identification No. 65339
1850 William Penn Way
suite 209
P.O. Box 10696
Lancaster, PA 17605-0690
(717) 390-3020
60,266
Attorneys for Defendants:
Hugh T. Knight, M.D. and
Physicians Unlimited, P.C.
BRUCE J. BISHOFF and BETTY
J. BISHOFF, his wife
COURT OF COMMON PLEAS
CUMBERLAND COUNTY
v.
PHYSICIANS UNLIMITED, P.C.
t/d/b/a APPLE-A-DAY
and
HUGH T. KNIGHT, M.D.
No. 94-6662 civil Term
JURY TRIAL DEMANDED
AMENDED NEW MATTER TO PLAINTIFFS' COMPLAINT OF DEFENDANTS
HUGH T. XNIGHT. M.D. AND PHYSICIANS UNLIMITED. P.C.
Defendants, Hugh T. Knight, M.D. and Physicians Unlimited,
P.c., hereby amend their New Matter to Plaintiffs' Complaint (or
Amended Complaint) to include the fOllowing averments:
1. Defendants were insured under a policy issued by
Physicians Insurance Company (PIC).
2. The Commonwealth Court of Pennsylvania entered an Order
of Liquidation with a finding of insolvency against PIC effective
January 21, 1998.
3. As a result of the Liquidation Order, the provisions of
40 P.S. S 991.1817 (a) apply to the plaintiffs' claim. This
provision provides, in relevant part, that:
Any person having a claim under an insurance
policy shall be required to exhaust first his
right under such policy. For purposes of
this section, a claim under an insurance
policy shall include a claim under any kind
of insurance, whether it is first-party or
third-party claim, and shall include, without
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L \ CJ (_1
CERTIFICATE OF SERVICE
I hereby certify that on this date I caused a true and correct copy of the foregoing
doeumentto be served upon the individual named below by first class mail.
Anthony Stefanon, Esquire
407 North Front Street
P.O. Box 12027
Harrisburg, PA 17108-2027
By:
PO & ASSOCI T , P.C.
,
Daniel L. Grill
Attorney for Defendants
Hugh T. Knight, M.D. and
Physicians Unlimited, P.C.
Date: ? J rr
"
2. Under all ofthe evidence, your verdict must be in favor ofthe Defendants Physicians
Unlimited, P.C.
3. If a patient should sustain an injury while undergoing medical care and that injury
results from the physician's lack of knowledge or ability or from his failure to exercise reasonable
care or to use his best judgment, then he is responsible for the injuries which are a result of his acts.
If, on the other hand, he has used his best judgment and he has exercised reasonable care and
has a requisite knowledge or ability, even though complications resulted, the physician would not
be responsible. Smith v, Yohe. 412 Pa. 94, 194 A.2d 167 (1963).
If Dr. Knight possessed and exercised the average degree of skill, care and diligence
possessed and exercised by other members of his profession and acted reasonably under the
circumstance, he is not liable in negligence should you find that his judgment was incorrect merely
by hindsight. Smith v. Yohe, IDm.r.Jl.
4. The rule requiring a physician to use his best judgment does not make the physician
liable for a mere error injudgment provided he does what he thinks best aner a careful examination.
The rule of reasonable care does not require the exercise of the highest possible degree of care. It
requires only that he exercise that degree of care that a reasonably prudent physician would exercise
under the same circumstances. 1lI., see also, Kubrick v. United States, 435 F. Supp. 166 (E.n. Pa.
1977), affinned and remanded, 581 F.2d 1092 (3dCir. 1978), reversed, 444 U.S. III, 100 S. Ct. 352,
62 L.Ed. 2d 259 (1979), remanded, 614 F.2d 770 (3'd Cir. 1980); Graham v. Alcoa S.S. Co., 201
F.2d 423 (3d Cir. 1953), cert. denied, 346 U.S. 832.
6. The mere occurrence of an injury docs not prove negligence and a negligent act does
not necessarily entail liability; rather, even when it is established that a defendant breached some
duty of care owed to the plaintiff, it is incumbent on the plaintiff to establish a causal relationship
between the defendant's conduct and the plaintifrs injury. Stated another way, the defendant's
conduct must be shown to have been the proximate cause ofplaintifrs injury. Proximate cause is
a tenn of art denoting the point at which legal responsibility attaches for haon to another arising out
of some act or failure to act by defendant that was a substantial factor in bringing about plaintifrs
hann. The defendant's negligent conduct may not, however, be found to be a substantial cause
where the plaintifrs injury would have been sustained even in the absence of the defendant's
negligence. Hamil v. Bashline, 481 Pa. 256, 392 A.2d 1280 (1978).
7. With respect to the substantial factor requirements, the Collowing considerations are
important in detennining whether conduct constitutes such a factor: the number of other factors
which contribute in producing the harm and the extent of the effect which they have in producing;
whether the conduct has created a force or series of forces which are in continuous and active
operation up to the time. or has created a situation hllnnless unless acted upon by other forces for
which the actor is not responsible; and lupse oftime. Humil v. Bashlin~. 481 Pa. 256, 392 A.2d 1280
(1978).
8. PlaintifThas the burden of proving that the defendants' conduct increased the risk of
harm toplaintifT. Hamil v. Bashlinc.481 Pa. 256. 392 A.2d 1280 (1978); Clayton v. Sabeh. 406 Pa.
Super. 335. 594 A.2d 365 (1991).
9. Oncc u pluintilThus introduccd cvidencc thut a dcfcndant's ncgligcnt act or omission
increuscd the risk ofhunn to pluintilT, and thut thc hnrI11 wus in fact sustuined, it bccomcs u qucstion
for you thc jury us to whcthcr or not thut incrcased risk wus u substuntiul factor in producing the
hann to thc plaintiff. Hamil v. Bashlinc, 481 Pa. 256, 392 A.2d 1280, 1288 (1978).
10. I charge YOll that the defendants in a medical malpractice action are to bejudged on
the facts as they existed at the time and not in retrospect in light of subsequent known events.
15. Damages are nothing more than compensation. It is the cffort thc law makes to
approximate, in dollar amount, the injury suffered by a person, by reason of the legal wrongdoing
of another. The purpose of damages is to restore the injured person to where he or she would have
been had malpractice or negligcnce not occurred. Incollinl;lo v. Ewin\,l. 444 Pa. 263, 282 A.2d 206
(1971); Span\,ller v, Helm's New York. Pillsbur\,lh Motor Exp., 396 PD. 482, 153 A.2d 490 (1959).
16. Damages are not punishment, and the amount of damages should not be viewed as
intended to punish Dr. Knight. Nor should damages be viewed as a reward. You may not reward
someone just for having undergone an experience, no mailer how un fortunate that experience might
have been. YOll are to award damages as compensation only for those items of damages for which
the law grants compensation. Incollil1l!O v. Ewing, 444 Pa. 263, 282 A.2d 206 (1971); Mancini Y..
Morrow, 312 Pa. Super. 192,458 A.2d 580 (1983).
18. If you find that, considering the nature ofBruccJ. Bishoffs condition, he would have
had some pain and suffering even with the treatment being proper and within the standard of care,
then plaintiff may not recover for that pain and suffering.
5.03
Number of witnesses
5.04
Conflicting testimony
5.30
Expert testimony - credibility
generally
5.31
Expert testimony - basis for opinion generally
5.32
Hypothetical questions
5.33
Weighing conflicting expert
testimony
5.40
Cautionary Charge - Jury Not to Assume Judge Has
Expressed an Opinion on the Evidence
5.50
Burden of proof
6.00
Damages
6.30
Concurring causes
10.02
Professional negligence of physician - definition
1O.03A
Standard of care - physicians
10.038
Legal cause - physitians
10.04
Differing schools of thought
Doctrine
20.00
Concluding Instructions
In addition to the above-referenced general charges, the Defendants propose the attached
supplemental charges:
3. If a patient should sustain an injury while undergoing medical care and that injury
results from the physician's lack ofknowlcdge or ability or from his failure to exercise reasonable
care or to use his best judgment, then he is responsible for the injuries which are a result of his acts.
If, on the other hand, he has used his best judgment and he has exercised rensonablecare and
has a requisite knowledge or ability, even though complications resulted, the physician would not
be responsible. Smith v. Yohe, 412 Pa. 94,194 A.2d 167 (1963).
If Dr. Knight possessed and exercised the average degree of skill, care and diligence
possessed and exercised by other members of his profession and acted reasonably under the
circumstance, he is not liable in negligence should you find that his judgment was incorrect merely
by hindsight. Smith v. Yohe, mmm.
,.
14. Evidence of a (lersoll's habit or custom is admissible to show that the person acted
in accordance with the huhit or custom OIlU given occasion. In Re Ciaffoni's Estate. 498 Pa. 267.
466 A.2d 115 (1982), dk!Uu I'nckel & Poulin. Pennsvlvania Evidence at 185 (1987).
18. If you find that, considering the nature of Bruce J. Bishofrs condition, he would have
had some pain and suffering even with thc trcatmcnt being proper and within thc stlll1dard of care,
thcn plaintifTmay not recover for that pain and suffcring.
CERTIFICATE OF SERVICE
I hereby certify that on this date I caused a true and correct copy oflhe foregoing document
to be served upon the individual named bclow by first class mail.
Anthony Stefanon, Esquire
407 North Front Street
P.O. Box 12027
Harrisburg, P A 17108-2027
PORR & ASSOCI TE ,P.C. I
. 1-/'/
By:
\
Daniel . Grill
Attorney for Defendants,
Hugh T. Knight, M.D. and
Physicians Unlimited, P.C.
Date: 7/ j' liP
I ,
If you answered "No", you have found in favor of Defendants Dr. Knight and Physicians
Unlimited, P.C. and you should sign and date this Verdict Fonn and retum to the
courtroom.
If you answered "Yes", proceed to Question No.3.
3. Please state the total amount of damages, ifany, you award to Plaintiff, Bruce
Bishoff: $
4. Please state the amount of damages, if any, you award to Plaintiff, Belly Bishoff
for Loss of Consortium $
Dated:
Signature of Jury Foreperson
PORR & ASSOCIATES, P.C.
BY: Daniel L. Grill
Identification No. 65339
60,266
Attorneys for Defendants:
Hugh T. Knight, M.D. R!1d
Physicians Unlimited, P.C.
1850 William Penn Way
Suite 209
P.O. Box 10696
Lancaster, PA 17605-0696
(717) 390-3020
BRUCE J. BISHOFF and BETTY
J. BISHOFF, his wife
COURT OF COMMON PLEAS
CUMBERLAND COUNTY
v.
No. 94-6662 Civil Tenn
PHYSICIANS UNLIMITED, P.C.
tld/b/a APPLE-A-DA Y
and
HUGH T. KNIGHT, M.D.
JURY TRIAL DEMANDED
PROPOSED JURY VERDICT FORM OF
DEFENDANTS HUGH T. KNIGHT, M.D.
AND PHYSICIANS UNLIMITED. P.C.
I. Do you find that the medical care provided by Dr. Knight was below the
appropriate standard of care?
Ye~
No
If you answered "No", you have found in favor of Defendants Dr. Knight and Physicians
Unlimited and you should sign and date this Verdict Fonn and return to the courtroom.
If you answered "Yes", proceed to Question No.2.
2. Was the medical care and treatment provided by Dr. Knight a substantial factor in
causing harm to Plaintiff Bruce J. Bishof17
Yes
No
Dated:
If you answered "No", you have found in favor ofDcfcndants Dr. Knight and Physicians
Unlimited, P.C. and you should sign and datc this Verdict Fonn and return to thc
courtroom.
i
U
I'
,I
Ii
!
.
l
t
i
'r
I
.!
If you answered "Yes", procccd to Question No.3.
3.
Please stute thc total amount of damagcs, if any, you award to Plaintiff, Brucc
Bishoff: $
;,'
1',
4. Please stale thc amount ofdamagcs, ifuny, you award to Plaintiff, BClly Bishoff
for Loss of Consortium $
Signature of Jury Foreperson
.
.
24
1 Q Okay. Thank you. How long have you been
2 director of the hemophilia center?
3 A Since it was established in 1973.
4 Q Do you ever treat or see trauma patients at
5 their initial presentations to the emergency room or to
6 the hospital?
7 A I'm sometimes called to the emergency room to
8 see a person with hemophilia in the emergency room.
9 Q And how often does that occur?
10 A Well, when I'm on service, which is a couple
11 months out of the year, it can occur several times in that
12 month.
13 Q Okay. And you are Board certified in
14 hematology, correct?
15 A Correct.
16 MS. KING: Objection. Off camera.
17 THE VIDEOTAPE SPECIALIST: We are going off
18 camera. The time of day is 10:37.
19 (Whereupon, a discussion was held off the
20 videotape record as follows:
21 MS. KING: I'd just like to place an objection
22 on the record as to her qualifications giving an expert
23 opinion to the standard of care of a family doctor
24 considering her specialty in hematology.
25 MR. STEFANON: Your objection is noted.
.
25
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
MS. KING: Okay. Back on.)
THE VIDEOTAPE SPECIALIST: We are back on
camera. The time of day is 10:38.
BY MS. KING:
Q Would you agroe, Doctor, that as a hematolagiet
or having a specialty in hematology that your
qualifications are different from those of a general
practitioner?
A Yes, I would.
Q Could you tell me how much -- if you're being
paid to give your testimony today?
A I will be submitting a bill.
Q Bow much will that bill be for?
A The bill will be for $400 an hour, and the
request will be made to pay that amount to Penn State
University for the purpose of hemophilia research.
Q And is my understanding from your earlier
testimony that you were not directly involved in Mr.
Bishoff's care1 is that correct?
A To the best of my recollection.
Q All right. It's also my understanding from
reviewing the records that Mr. Bishoff has participated in
a clinical research study under your direction1 is that
true?
A I believe that Mr. Bishoff signed the consent
~ ..
I~NDA PORR SWf.ENEY
U.WREN(,~ R, BERCER. III
R1WAllD T. CURI.EY
DANIEL L. GRIll.
DONAlD II. Bl.ACKWI:lJ,
CIIRI'''Orm:R F. WilSON
PORR Be AsSOCIATES, p.e.
AnOkNt.lS AI' I.AW
lH50 WII.!.IAM PENt.; WAI', Surn: :!09
1'. O. IInx 1Oti91i
lANCASTER, I'A 17IiOr..()(;!)(i
717-390.3020 . FAX 717-390-3021
Info@l'oITlilW,WIll
July 5, 2000
Alll:NTOWN OHI(:.::
Mli HAMilTON STREET, SUITE 211
I'. 0, lIox I f>50
A!.I.ENTlIII'N, l'A 18IOr,-1550
lill~H21.\lr,ll . FAx lllO.H2I,\l512
l'olrlawi~cpix.IICl
The Honorable J. Wesley Oler, Jr.
Court of Common Pleas of Cumberland County
1 Courthouse Square
Carlisle, PA 17013
Ro: Blshoffv. Hugh T. Knight, M.D.
94-6662
Dear Judge Oler:
This will constitute defendants' objections to the deposition transcripts plaintiffs
plan to read Into evidence, Including the July 9, 1997 deposition of now deceased
defendant, Hugh T. Knight, M.D., and the May 15,1997 videotaped deposition of
plaintiffs expert, Elaine Eyster, M.D.
1. Dr. Knight's Deposition
A. 31: 13-20 .
Basis: Dr. Knight gave speculative testimony outside the area of his expertise.
His answer explicitly states this by using the word "assume". This Is not factual
Information and, to the extent that It can be considered an expert admission, the
question was leading and Invited Dr. Knight's speculation. He was permitted to answer
the question because of the nature of the discovery deposition, but his testimony should
not be read to the jury.
2. Videotaped deposition of Dr. Eyster
A, 24:21-24
Basis: Defense counsel has preserved an objection to Dr. Eyster's qualifications
to give any opinion on the standard of care for family physicians such as Dr. Knight,
given her specialty In hematology.
.
24
1 Q Okay. Thank you. How long have you been
2 director of the hemophilia center?
3 A Since it was established in 1973.
4 Q Do you ever treat or see trauma patients at
5 their initial presentations to the emergency room or to
6 the hospital?
7 A I'm sometimes called to the emergency room to
8 see a person with hemophilia in the emergency room.
9 Q And how often does that occur?
10 A Well, when I'm on service, which is a couple
11 months out of the year, it can occur several times in that
12 month.
13 Q Okay. And you are Board certified in
14 hematology, correct?
15 A Correct.
16 MS. KING: Objection. Off camera.
17 TBE VIDEOTAPE SPECIALIST: We are going off
18 camera. The time of day is 10:37.
19 (Whereupon, a discussion was held off the
20 videotape record as follows:
21 MS. KING: I'd just like to place an objection
22 on the record as to her qualifications giving an expert
23 opinion to the standard of care of a family doctor
24 considering her specialty in hematology.
25 MR. STEFANON: Your objection is noted.
.
.. l-
25
1
2
3
4
5
6
7
8
9
10
11
12
13
14
IS
16
17
18
19
20
21
22
23
24
25
MS. KING: Okay. Back on.)
THE VIDEOTAPE SPECIALIST: We are back on
camera. The time of day is 10:38.
BY MS. KING:
Q Would you agree, Doctor, that as a hematologist
or having a specialty in hematology that your
qualifications are different from those of a general
practitioner?
A Yes, I would.
Q Could you tell me how much -- if you're being
paid to give your testimony today?
A I will be submitting a bill.
Q Bow much will that bill be for?
A The bill will be for $400 an hour, and the
request will be made to pay that amount to Penn State
University for the purpose of hemophilia research.
Q And is my understanding from your earlier
testimony that you were not directly involved in Mr.
Bishoff's care1 is that correct?
A To the best of my recollection.
Q All right. It's also my understanding from
reviewing the records that Mr. Bishoff has participated in
a clinical research study under your direction1 is that
true?
A I believe that Mr. Bishoff signed the consent
.
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PORR & ASSOCIATES, P.C.
BY: Daniel L, Grill
Identification No, 65339
60,266
Attorneys for Defendants:
Hugh T. Knight, M.D, and
Physicians Unlimilcd, P.C.
1850 William Pcnn Way
Suite 209
P,O. Box 10696
Lancastcr, PA 17605-0696
(717) 390-3020
BRUCE J. BISHOFF and BETTY
J. BISHOFF, his wifc
COURT OF COMMON PLEAS
CUMBERLAND COUNTY
v,
No. 94-6662 Civil Tenn
PHYSICIANS UNLIMITED, P.C.
tld/b/a APPLE-A-DA Y
and
HUGH T. KNIGHT, M.D.
JURY TRIAL DEMANDED
PROPOSED VOIR DIRE OF DEFENDANTS
HUGH T. KNIGHT, M.D. AND
PHYSICIANS UNLIMITED. P.C.
Defendants Hugh T. Knight, M.D., and Physicians Unlimited, P.C. respectfully request
that the Court include the following questions in its gJ.!im of the prospective jurors for the trial
of this case, in addition to those qucstions provided in the local rules.
1. Are you personally acquainted with the Plaintiffs Bruce J. Bishoffand Betty J.
Bishoff, or Defendants Hugh T. Knight, M.D. or Physicians Unlimited, P.C., or do you or any
member of your immcdiate family have any relationship of any kind with the Plaintiffs or
Defendants?
11
2. Are you personally acquainted with any of the witnesscs anticipated 10 testify? (It is
respectfully requcstcd thatthc Court at this timc set forth the names of thc witncsses listcd by the
parties,) Those witncsses include:
I. Plaintiff, Bruce J. Bishoff;
2. Plaintiff, Belly J. Bishoff;
3. Plaintiffs' daughler, Bonnic Bishoff;
4. Elaine Eyster, M.D. (plaintiffs expcrt) aIkIa Elaine Dye;
5. Hugh T. Knight, M,D., dcceased; and
6. John Ricks, M.D.
Dcfcndants rcscrve the right to call any witness idcntified by any othcr party. In addition,
Defcndants rescrve the right to scasonably supplement this list prior to trial.
3. Do you know counsel for the Plaintiff, Anthony Stefanon, Esquirc or Paul HeIny,
Esquire or counsel for thc Defendants, Daniel L. Grill, Esquire and Porr & Associates, P.C.?
4. Has any lawyer in this case acted as your attorney, or the attorney for any ofycur
immediate family members or close friends, to your knowledge?
S. Have you ever becn ajuror in a trial before? If yes, where, when, and what type
of case, civil or criminal? Did the jury reach a verdict?
6. Have you or any member of your immcdiate family ever bcen a party in a civil
suit? If so, please describe the claim and whethcr you were plaintiff or defendant.
7. Havc you or any member of your immcdiate family ever asserted a medical
malpractice claim against n doctor, hospital or other healthcare professional? If so, pleasc
describe the nature of thc claim.
8. Have you or any member of your family ever testified in Court before? Ifso, in
what capacity?
~
14. Do you have a problcm with your hearing, your eyesight, or any other physical
disability which would in any manner prcvent you from either hearing or sccing the evidence as
nonnally presented at trial?
15. Do you know of any rcason why you could not bc a completcly fair and impartial
juror and render a verdict based solcly upon thc evidcncc you hear in this courtroom and thc law
as the Judge instructs? If yes, please cxplain.
Dated: 7 J }/b~
I I
By:
\
Daniel L. Grill, Esquire
Attorney for Defendants
Hugh T. Knight, M.D. and
Physicians Unlimited, P.C.
t
PO ASSOCIATES, P.C.
.
,
CERTIFICATE OF SERVICE
I hercby certify that on this date I caused a true and correct copy ofthc forcgoing
docllment to be served upon the individual named below by first class mail.
Anthony Stcfanon, Esquire
407 North Front Strect
P.O. Box 12027
Harrisburg, PA 17108.2027
PO & ASSOCI T , P.C.
By:
,
Daniel L. Grill
Attorney for Defendants
Hugh T. Knight, M.D. and
Physicians Unlimited, P.C.
Date: ') J rr
y
"
3. If a patient should sustain an injury while undergoing mcdical care and that injury
results from thc physician's lack ofknowlcdgc or ability or from his failure 10 cxercisc rcasonable
care or to usc his bestjudgmcnt, thcn he is rcsponsiblc for thc injuries which urc a rcsult of his acls.
If, on thc other hand, hc has uscd his best judgment und hc has excrcised rcasonable care and
has a requisite knowledge or ability, cven though complications rcsulted, thc physician would not
bc responsiblc. Smith v. Yohc, 412 Pa. 94,194 A.2d 167 (1963).
If Dr. Knight posscsscd and exercised the avcragc degrec 'of skill, carc and diligence
posscssed and excrcised by olhcr mcmbcrs of his profession and actcd reasonably under the
circumstance, he is not liable in negligcncc should you find that his judgmcnt was incorrect merely
by hindsight, Smith v. Yohe, H.I!lllll.
,.
9. Once a plaintiffhas introduced cvidcncc that a dcfendant's negligcnt act or omission
incrcased the risk ofhann to plaintiff, and lhallhe hann was in fact sustained, it becomes a qucstion
for you the jury as to whclher or nolthat incrcased risk was a subslantial factor in producing the
harm to lhc plaintiff. l:.I.ilmil v. Bashlinc. 481 Pa, 2:'16, 392 A,2d 1280, \288 (\978),
.
13. In detennining the facts, you must not indulge in any guesswork or speculation. The
plaintiffis not entitled to inferences drawn in herbchalfwhich amount to merely guess orconjeclure.
If you find that you are unablc to dccidc the qucstions of liability and lor legal cause without
resorting to guesswork, supposition or conjecturc, thcn the plaintiff, having the burden of proof, has
not met her burden, and your vcrdicl must be in favor of the defendants, Thomas Morena v. South
Hills Hcalth Svstem, 501 Pa, 634,462 A.2d 680 (1983); Smith v. Bcll Telephonc Co., 397 Pa, 134,
153 A,2d 477 (1959); Thomas v, Duqucsne Lig\1l....CQ." 376 Pa. Super. 1,545 A.2d 289 (1988);
Krnvinskv v. Glover, 263 Pa. Super. 8, 396 A,2d 1349 (1979); Smith v, Coca Cola Bottling Co. of
Philadelphia, 152 Pa. S:uper. 455, 33 A.2d 488 (1943).
I'
17. Plaintiff may not rccover any amount on account of any expcnses,losscs, injurics or
pain and suffering which she would havc expericnccd or undcrgone evcn in the absence of
negligence. Whitner v, Bon Hinz, 437 Pa. 448, 263 A.2d 889 (1970),
CERTIFICATE OF SERVICE
I hcreby ccrtify that on this date I caused a true and correct copy of the foregoing document
to be served upon the individual named bclow by first class mail.
Anthony Stcfanon, Esquirc
407 North Front Strect
P.O. Box 12027
Harrisburg, P A 17108-2027
PORR & ASSOCIATES, P.C.
By:
~ Y 7. {;Lvu{
Daniel L. Grill
Attorney for Defendants
Date:
PORR Be AsSOCIATES, p.e.
AnORNE\S AT UW
LINDA PORR SWEF.NEV
UW'.ENCE R, IIERGEIl, III
R1C1lAJlD T. CURl.EY
DANIEL L. GRlIJ,
DONAW H BI.ACKll'ElJ,
CIIRlSHlI'IIER F, WilSON
1850 WIl.IJAM PENN WAI', SunE 209
1'. O. lIox IOti91i
1.\NC:'\STER, PA 17ti05-0ti!lti
717-3!lo.3020 . FAX 717-390.3021
info@porrlaw.com
AJ.u:NTO\\'N OmcE:
546 IIAMII.TON STREET, SUITE 211
(', O. lIox 1550
AI.l.ENTO\\'N,I'A 18105-1550
611).821,9511 . FAX lilO,821,9512
pCJrrhlW@cpix,nct
July 5, 2000
The Honorable J. Wesley Oler, Jr.
Court of Common Pleas of Cumberland County
1 Courthouse Square
Carlisle, PA 17013
Re: BIshoff v. Hugh T. KnIght, M.D.
94-6662
Dear Judge Oler:
This will constitute defendants' objections to the deposition transcripts plaintiffs
plan to read Into evidence, Including the July 9, 1997 deposition of now deceased
defendant, Hugh T. Knight, M.D., and the May 15,1997 videotaped deposition of
plaintiffs expert, Elaine Eyster, M.D.
1. Dr. Knight's Deposition
A. 31: 13-20
Basis: Dr. Knight gave speculative testimony outside the area of his expertise.
His answer explicitly states this by using the word "assume". This Is not factual
Infonnatlon and, to the extent that It can be considered an expert admission, the
question was leading and Invited Dr. Knight's speculation. He was permitted to answer
the question because of the nature of the discovery deposition, but his testimony should
not be read to the jury.
2. Videotaped deposition of Dr. Eyster
A. 24:21-24
Basis: Defense counsel has preserved an objection to Dr. Eyster's qualifications
to give any opinion on the standard of care for family physicians such as Dr. Knight,
given her specialty In hematology.
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2 done from, isn't it?
MR. ELLIS: I guess that's where the billing is
)
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4 BY MR. STEFANON:
THE WITNESS: The billing is don~ there.
6 other?
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Are the records maintained at one office or the
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Well, both.
Now, were you aware that for someone with a
Q
9 factor 8 defect, the addition of the factor 8 to the blood
10 circulation would raise their clotting level to normal?
11 Do you know that?
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What was this?
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Do you know that someone who has a factor 8
14 defect can have their clotting levels raised to normal
15 almost immediately by the addition of the factor 8 to the
16 blood?
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I would assume so, yes.
This is something you knew back in November of
Yes.
22 instruction regarding what a factor 8 defect is?
Did you ever receive any education or
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Well, just generally, as you do in medicine,
24 but not specifically. I do not set myself as a expert in
25 this field, and that's why I insisted, and insist again
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Q Okay. Thank you. How long have you been
director of the hemophilia center?
A Since it was established in 1973.
Q Do you ever treat or see trauma patientu at
their initial presentations to the emergency room or to
the hospital?
A I'm sometimes called to the emergency room to
see a person with hemophilia in the emergency room.
Q And how often does that occur?
A Well, when I'm on service, which is a couple
months out of the year, it can occur several times in that
month.
Q Okay. And you are Board certified in
hematology, correct?
A Correct.
MS. KING: Objection. Off camera.
TBE VIDEOTAPE SPECIALIST: We are going off
camera. The time of day is 10:37.
(Whereupon, a discussion was held off the
videotape record as follows:
MS. KING: I'd just like to place an objection
on the record as to her qualifications giving an expert
opinion to the standard of care of a family doctor
considering her specialty in hematology.
MR. STEFANON: Your objection is noted.
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MS. KING: Okay. Back on.)
THE VIDEOTAPE SPECIALIST: We are back on
3 camera. The time of day is 10138,
4 BY MS. KING:
5
Q
Would you agree, Doctor, that as a hematologist
6 or having a specialty in hematology that your
7 qualifications are different from those of a general
8 practitioner?
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A Yes, I would.
Q Could you tell me how much -- if you're being
paid to give your testimony today?
A I will be submitting a bill.
Q How much will that bill be for?
A The bill will be for $400 an hour, and the
15 request will be made to pay that amount to Penn State
16 University for the purpose of hemophilia research.
17
And is my understanding from your earlier
Q
18 testimony that you were not directly involved in Mr.
19 Bishoff's care1 is that correct?
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To the best of my recollection.
All right. It's also my understanding from
A
Q
22 reviewing the records that Mr. Bishoff has participated in
23 a clinical research study under your direction1 is that
24 true?
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I believe that Mr. Bishoff signed the consent
A
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ANTHONY STEFANON
ATIORNEY AT LAW
407 NORTIi FRONT STREET
POST OFFICE HOX 12027
HAIIRISHURG, PENNSYLVANIA 1710H-2027
PHONE 717-232-0511
TELEFAX 717-233-2657
July 6, 2000
Honorable J. Wesley Oler, Jr.
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013-3387
VIA HAND DELIVERY
RE: Bishoff v. Knight, et al
No. 94-6662 civil Term
My File No.: 9411.8
Dear Judge Oler:
You requested our position with regard to objections in the
videotape deposition. The only videotape deposition for this case
is that of M. Elaine Eyster, M.D., the Plaintiffs' expert. A copy
of the transcript of that deposition is enclosed.
Plaintiffs made numerous objections to questions presented on
the cross examination of Dr. Eyster. Most of those objections are
waived, as the objectionable material was cured by the later
testimony of the witness.
Plaintiffs would rely on the objection at page 40 line 25, as
the question presented to the doctor an impr~per characterization
of Dr. Eyster's analysis of the case.
Plaintiffs also assert the objection at page 43 line 20, as
the question is a mischaracterization of the prior testimony and
the letters presentfld to the doctor. The objection at page 45 line
14 addresses the same issue, however the testimony of the witness
beginning at page 45 line 20 clarifies the matter.
with regard to the Defendant's objection to the qualifications
of Dr. Eyster to testify, Plaintiffll would point out that Dr.
Eyster has testified that the treatment which she proposed was
standard medical practice in November of 1992 (Eyster Deposition
page 13, 22).
JUl '6
atv
Honorable J. Wesley 01er, Jr.
Page TWO
July 6, 2000
It is abundantly clear from the Pennsylvania cases that an
expert does not have to be of the same specialty as the Defendant
where the question at hand is within the knowledge of the expert.
An expert in one area of medicine may be found to be qualified to
address other areas of specialization where specialties overlap or
where the specialist has had experience in the select field of
medicine at hand. See Pratt v. Stein, 444 A.2d 674 (pa Super
1982)1 Estate of Pew, 598 A.2d 65 (pa Super 1991).
It should also be noted in this case that Dr. Knight has
testified that he knew the import of a factor VIII defect, and he
knew that immediate treatment was required. In essence, Dr. Knight
has admitted the standard of care to which Dr. Eyster has
testified.
While Dr. Knight testified that he told Mr. Bishoff to go see
his own hematologist, that testimony is contradicted by the
witnesses for plaintiffs. However, the fundamental standard of
care to which Dr. Eyster testified is admitted by Dr. Knight in his
deposition.
On the question of Dr. Knight's testimony regarding his
knowledge of the immediate effect of Factor VIII (Knight deposition
page 31 line 13 et seq.), Defendant's objection is not well taken,
as Dr. Knight's testimony is not equivocal.
with regard to the testimony of Dr. Eyster about her billing
for the evaluation of the case, Plaintiffs would point out that Dr.
Eyster was deposed as an expert for use at trial, and no objection
was raised to that testimony at the deposition. under these
circumstances, any objection by the defen is waived.
As/kr
pc: Daniel L. Grill, Esqu (w/o enclosure)
(via Telefax and First Class Mail)
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RUCE J.
ETTY J.
BISHOFF AND
BISHOFF,
PLAINTIFFS,
:
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:
HYSICIANS UNLIMITED :
.C. T/D/B/A APPLE-A-DAYI
ND HUGH T. KNIGHT, M.D.:
DEFENDANTS :
vs.
VIDEOTAPE DEPOSITION OF:
TAKEN BY:
BEFORE:
DATE:
PLACE:
PEARANCES:
,...,
IN THE COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
CIVIL ACTION - LAW
NO. 94-6662 CIVIL
JURY TRIAL DEMANDED
M. ELAINE EYSTER, M.D.
PLAINTIFFS
DENISE SAMPSON, REPORTER
NOTARY PUBLIC
MAY 13, 1997, 10:02 A.M.
STEFANON & GLACE
407 N. FRONT STREET
HARRISBURG, PENNSYLVANIA
STEFANON & GLACE
BY: ANTHONY STEFANON, ESQUIRE
AND
KILLIAN & GEPHART
BY: J. FAUL HELVY, ESQUIRE
FOR - PLAINTIFFS
LEIGH A.J. ELLIS & ASSOCIATES, P.C.
BY: DARLENE K. KING, ESQUIRE
FOR - DEFENDANTS 0 RIG I NAL
ALSO PRESENT: DAVID MANIFOLD, VIDEO IMAGES
~ 7llbriglzt, 'Foltz !r JVaUlk :Reporting &n'ice, 8nc.
115 PINE STREET' HARRISBURG. PA 17101
Ha",sburg 717.232,5644 Fa. 717,232,9637 Laneasl.r 717.393,5101
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Q.!!!~CT fROSS
REDIR~CT RECROSS
illliES2
M. ELAINE EYSTER, M.D.
BY: MR. STEFANON
BY: MS. KING
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46
22
EXH!!llT2
DEROSI!IO~~~MIBI! NO~
1 Letter dated 5/26/94
2 Letter dated 6/1/94
3 Letter dated 6/28/94
4 Letter dated 6/30/94
PRQ.Q!!f~& MARK.I!Q
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1 THE VIDEOTAPE SPECIALIST: My name is David
2 Manifold. I represent Video Images, 3004 Black Oak Drive,
3 Red Lion, Pennsylvania. Today's date ~s May 13th, 1997.
4 The time of day is 10102. This deposition was videotaped
5 at 407 North Front Street, Harrisburg, PAt
6 The caption of the case is Bruce J. Bishoff and
7 Betty J. Bishoff, his wife, versus Physicians Unlimited,
8 P.C., t/d/b/a Apple-a-Day and Hugh T. Knight, M.D., Case
9 No. 94-6662. The name of the witness is M. Elaine Eyster,
10 M.D. This deposition is being videotaped on behalf of the
11 Plaintiff. Counsel will now please introduce themselves.
12 MR. STEFANON: Anthony Stefanon on behalf of
13 the Plaintiffs.
14 MS. KING: And Darlene King on behalf of Dr.
15 Knight and the Defendant corporation.
16 TBE VIDEOTAPE SPECIALIST: The court reporter
17 will now please identify herself and swear in the witness.
18 M. ELAINE EYSTER, M.D., called as a witness,
19 being duly sworn, testified as follows:
20 DIRECT EXAMINATION
21 BY MR. STEFANON:
22 Q Dr. Eyster, would you state your full name for
23 the record, please?
24 A Mary Elaine Eyster, and my married name is Dye,
25 D-y-e.
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Q And what's your occupation or profession,
Doctor?
A I'm a physician.
Q And where are you employed?
A By Penn state University at the Hershey Medical
Center.
Q How long have you been at the Hershey Medical
Center?
A Since 1970.
Q What's your current position at the medical
center?
A I'm a professor of medicine in the division of
hematology and oncology.
Q And how long have you been a hematologist?
A A little over 30 years.
Q Where did you take your medical school
training?
A Duke University.
Q When did you graduate there?
A 1960.
Q And did you do an internship after that?
A Yes, I did internship and residency at the New
York Hospital Cornell Medical Center.
Q When did you complete that residency?
A In 1973.
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1 Q And are you Board certified in hematology?
2 A Yes, I did a fellowship after that and then
3 became Board certified in hematology.
4 Q Where did you do your fellowship?
5 A Cornell New York Bospital.
6 Q Are you licensed to practice by any state?
7 A Pennsylvania and inactive in North Carolina and
8 New York State.
9 Q You indicated that you were with the
10 Pennsylvania State University at the Hershey Medical
11 Center now. I don't know if I asked you for your title.
12 What's your title?
13 A Professor of medicine.
14 Q And just briefly, Doctor, for the jury's sake
15 can you tell the jury what hematology is about?
16 A I should also tell you that in reply to your
17 last question I'm also the director of the Central
18 Pennsylvania Hemophilia Center,. which is located at the
19 Hershey Medical Center. The discipline of hematology is
20 about the study of blood diseases.
21 Q And you mentioned hemophilia. What is
22 hemophilia?
23 A Hemophilia is an inherited disorder. It
24 affects primarily males in which the one of the blood
25 clotting elements is deficient so that blood clotting
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occurs slower than normal.
o And is there some particular blood clotting
element that's involved in hemophilia?
A The most common form of hemophilia involves a
deficiency of Factor VIII, which is otherwise known as the
antihemophilic factor HF.
o How does the Factor VIII deficit affect the
patient, a person who has it? What's the effect on them?
A They tend to bleed sometimes spontaneously
depending on the degree of severity, other times
excessively in association with injuries. And the
bleeding characteristically tends to be in soft tissues or
joints or other internal places and rath~r than being
excessive external bleeding.
o Now, are you familiar with the Plaintiff in
this case, Bruce Bishoff?
A Yes, I am.
o And are you familiar with the fact that he
received care and treatment at the Hershey Medical Center
on and after November 30 of '92?
A Yes.
o And are you aware that Mr. Bishoff was treated
for a subdural hematoma?
A Yes, I am.
o And just in general whal was your involvement
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7
1 in Mr. Bishoff's case if you can tell me?
2 A I don't recall that I had any direct
3 involvement in his case. As director of the hemophilia
4 center I was aware of his problem and visited him on
5 rounds as part of a group.
6 0 And you have with you today copies of the
7 charts from the hospital on Mr. Bishoff's care and
8 treatment1 is that correct?
9 A That's correct.
10 0 Have you had an opportunity to review those
11 charts before today?
12 A Yes, I have.
13 0 And let me ask you, if you can tell me, how it
14 first became known at the Hershey Medical Center that Mr.
15 Bishoff suffered from hemophilia, the Factor VIII defect?
16 A The record states that he was admitted through
17 the emergency room with bleeding within his head and was
18 treated on an emergency basis with Factor VIII prior to
19 being taken to surgery where a subdural hematoma was
20 evacuated.
21 Q Now, before the treatment with Factor VIII was
22 there any inquiry made by the hospital to determine what
23 type of hemophilia Mr. Bishoff suffered, if you will?
24 A It was apparently known at that time that he
25 had a Factor VIII deficiency because he was given Factor
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1 VIII concentrate.
2 Q Let me refer you to a portion of the chart and
3 I'll show you a copy of mine, Doctor, which is a record of
4 a paatoral services call to the pittsburgh Bemophilia
5 Center. I'm not sure where that is in your chart, but
6 I'll just refer you to that briefly in our chart. Do you
7 see what I'm referring to there?
8 A Yes, I do.
9 Q Okay. Now, before we get into the details do
10 you know what the pittsburgh Bemophilia Center is?
11 A Yes, I do.
12 Q What is it?
13 A It's one of six or eight state supported
14 centers which provide comprehensive care and treatment for
15 persons with hemophilia.
16 Q And this telephone call from the pastoral
17 services to the pittsburgh center for Mr. Bishoff, what
18 was the purpose of that call?
19 A To ascertain the exact nature of his
20 hemophilia.
21 MS. KING: Off camera.
22 THE VIDEOTAPE SPECIALIST: We are going off
23 camera. The time of day is 10:10.
24 (Whereupon, a discussion was held off the
25 videotape record as follows:
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1 MS. KING: I assume you're offering her as an
2 exper.t and I need the opportunity to question her
3 concerning her qualifications.
4 MR. STEFANON: Do you want to do that now? I
5 was going to give you that opportunity obviously when you
6 cross-examine her.
7 MS. KING: All right. I'll reserve that for
8 that time.)
9 THE VIDEOTAPE ~PECIALIST: We are back on
10 camera. The time of day is 10:10.
11 BY MR. STEFANON:
12 Q Back to where we were, Doctor, on the question
13 of the registration at pittsburgh, the information from
14 pittsburgh was available then over the telephone?
15 A The record states that the Chaplin obtained the
16 information from Pittsburgh. He states, "I contacted the
17 pittsburgh Hemophilia Center to get needed information
18 about his type hemophilia (Factor VIII, 15% level, no
19 known inhibitors)." This information was related to the
20 doctors. And the time of that is 5:20 a.m. on November
21 the 30th, 1992.
22 Q Now, with regard to that Factor VIII deficit
23 that's described there, is there some general description
24 you can give to the jury so it will understand what that
25 means in terms of the degree of Mr. Bishoff's Factor VIII
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1 deficit? How bad was it?
2 A It was a mild degree of deficiency.
3 Q Now, you indicated that he was treated with
4 Factor VIII before he went into surgery at the hospital1
5 is that right?
6 A That's correct.
7 Q What's the purpose of doing that?
8 A To attempt to treat the problem which he
9 presented with, mainly a subdural hematoma, and to make it
10 possible for him to have surgery.
11 Q Okay. What does the -- what is the Factor VIII
12 treatment? What's actually given to the patient?
13 A Factor VIII is -- the type that he received is
14 derived from human blood plasma. It is pulled, the
15 plasma, from many thousands of donors, is pulled in
16 commercially a concentrate of Factor VIII, which is
17 present in very small amounts and the plasma is prepared.
18 This is freeze dried and placed in a vile. And then the
19 vile is reconstituted with a diluent so it then goes into
20 solution.
21 It's placed in a syringe and is injected
22 directly into the vein of the person with hemophilia to
23 provide him with an appropriate level of Factor VIII so
24 that bleeding stops and so that surgery is able to be
25 performed.
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1 Q Now, how long does it take for this Factor VIII
2 concentrate to work in a patient such as Mr. Bishoff?
3 A It works basically immediately as soon as it's
4 into the circulation, in a matter of minutes 15, 30
5 minutes.
6 Q And does it -- how does it work to stop the
7 bleeding?
8 A It raises the level of Factor VIII to a level
9 at which clotting can occur. Blood must clot in order to
10 stem the flow of blood. without it blood continues to
11 flow from small vessels until such time as the Factor VIII
12 level is raised to the point where an adequate clot can
13 form.
14 Q Now, in Mr. Bishoff's case, did he continue on
15 the Factor VIII after the time of his surgery at the
16 Hershey Medical Center?
17 A Yes, part of the treatment is that Factor VIII
18 doesn't survive that long in the circulation. It must be
19 replaced on a regular basis. And he got treatments twice
20 a day throughout his hospitalization and following
21 discharge until wound healing was complete.
22 Q Now, are you familiar with the type of surgery
23 he had at the Hershey Medical Center?
24 A I'm not a neurosurgeon. I know that he had
25 what's known as a subdural hematoma. In fact, he had two
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1 of them, which are two large blood clots under the skull
2 and which were compressing his brain tissue and causing
3 him to lose consciousness. These were evacuated
4 surgically at the time of the operation.
5 Q Now, Doctor, in the days preceding Mr.
6 Bishoff's presentation at the Hershey Medical Center, are
7 you aware that he had suffered a head injury some days
8 before?
9 A The record when he was seen in the emergency
10 room states, "Approximately 50-year-old male with
11 hemophilia, questionable type, fell off a ladder Saturday
12 p.m., hit head, without subsequent headache or nausea,
13 wife unable to awaken patient this morning via EMS,"
14 that's Emergency Medical Services. And then it goes on to
15 describe his condition.
16 Q Now, recognizing that you were not involved in
17 his care at any time before November 30 of 1992, I'm going
18 to ask you to assume a couple of facts which we know from
19 records which are not available to you at the Bershey
20 Medical Center regarding the injury.
21 First of all, assume that Mr. Bishoff was
22 involved in an accident which involved falling from a
23 ladder. And assume that he had a laceration to his scalp,
24 a 7.5 centimeter laceration to the of occipital region of
25 his scalp which was closed by sutures.
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1 Assume also that he was given head trauma
2 instructions, and assume that the doctor was aware that he
3 had a Factor VIII deficit. In your opinion, Doctor, would
4 the standard of medical practice require some response
5 with regard to the Factor VIII deficit by the treating
6 physician at the time of the initial injury?
7 A In my opinion it would.
8 Q And what response would be appropriate given
9 what was known about the patient?
10 A A person with a known Factor VIII deficiency
11 who sustains a head injury should receive some sort of
12 treatment either in the form of Factor VIII or possibly a
13 synthetic product known as Desmopressin depending on the
14 severity and nature of the injury and the severity of the
15 clotting deficiency.
16 Q Now, with regard to the receipt of the Factor
17 VIII or the Desmopressin, what do you have to know in
18 order to know which is appropriate?
19 A Desmopressin is used for persons with mild
20 deficiency to raise their levels two or three fold.
21 Bowever, one cannot achieve high levels which are
22 necessary for a significant head injury with Desmopressin.
23 And one cannot sustain those levels over a long period of
24 time with Desmopressin.
25 Q Now, with regard to an availability of either
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1 the Factor VIII or the Oesmopressin, is that something
2 that's readily available in the Barrisburg area?
3 A It's readily available at a center that treats
4 persons with hemophilia. I can't speak for how readily
5 available it is at a practice site or a community
6 hospital.
7 Q Now, is there a center that treats hemophiliacs
8 in the Harrisburg area?
9 A Yes.
10 0 Where is that?
11 A Hershey Medical Center.
12 Q And is this -~ the existence of your hemophilia
13 center something that's generally known in the medical
14 community?
15 A I believe it is.
16 Q Do you do anything to try to make it generally
17 known?
18 A We don't advertise if that's what you're asking
19 me/ but we do care for a large population of persons with
20 hemophilia and we see them on a regular basis.
21 educate and their families in the nature of the illness
22 and how it should be treated. We do educational programs
23 in schools. We work with employers.
24 Q And what is the risk to the patient with a
25 Factor VIII defect and head trauma if you don't address
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1 the Factor VIII deficiency? What risk does he run?
2 A He runs the risk that there will continue to be
3 internal bleeding. And when it occurs within a closed
4 space such as within the skull, pressure builds slowly and
5 as that happened brain tissue is compressed and there is
6 impairment of mental function.
7 0 Now, you mentioned before, Doctor, that the
8 bleeding happens internally rather than externally. Is
9 there some reason for that?
10 A I didn't mean to imply it only happened
11 internally. What I meant to imply was that the
12 consequences of internal bleeding are such that they are
13 sometimes devastating. And internal bleeding is not
14 readily recognized, external bleeding is. And usually in
15 the person with hemophilia, simple pressure and often
16 sutures in the case of a person with mild hemophilia will
17 suffice to take care of the problem.
18 0 On the external?
19 A On the external side.
20 0 But the internal side is another matter?
21 A Internal side is another matter.
22 0 And in your capacity as a professor of medicine
23 do you teach medical students about the risks of head
24 injuries to a hemophiliac?
2S A Yes, we do.
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1 0 What's the purpose in doing that?
2 A To prevent complications which can occur when a
3 head injury is not promptly treated.
4 0 Do you know if that's standard practice at
5 other medical schools to teach that 4isk of head injuries
6 in hemophiliacs?
7 A If the medical student receives a lecture which
8 addresses the issue of hemophilia, it's likely that that
9 would be included.
10 0 Now, in your experience with regard to the type
11 of internal bleeding that can happen after a head wound to
12 a hemophiliac, is a subdural hematoma the likely result if
13 the hemophiliac does not receive Factor VIII or
14 Desmopressin or some treatment for the clotting
15 deficiency?
16 A It's one of the more common types of bleeding
17 that we see when a person with hemophilia has sustained a
18 significant head injury.
19 0 And with regard to the effectiveness of either
20 Factor VIII or Desmopressin, can you give the jury some
21 idea of how effective those medications would be in
22 preventing the occurrence of t~e subdural hematoma?
23 A In the absence of the inhibitor -- excuse me
24 which would interfere with the activity of the Factor
25 VIII, Factor VIII is very effective because one can
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1 essentially replace it on an as-needed basis and
2 essentially convert the person with hemophilia into a
3 normal person.
4 And that is the approach that we use to try and
5 prevent bleeding in a person who has had a severe head
6 injury. DDAVP, as I've said before, is a drug rather than
7 a blood product. It will increase the base line Factor
8 VIII level two or three fold, but it will no~ raise the
9 level as high as you can raise it with the clotting
10 factor. And it cannot be used on a repetitive basis to
11 sustain a high level.
12 Q So if you have the Factor VIII you can return
13 the patient's clotting to a basically normal level and
14 keep it there by repeat doses?
15 A By repeat doses ove~ -- repeat doses on every
16 eight-hour I'm sorry -- every eight to twelve hours
17 over many, many, many days. Whereas, with DDAVP you may
18 be able to get a repeat dose once or twice, but you can't
19 do this indefinitely without problems.
20 Q And I believe there's an indication in that
21 Chaplin's note from the consult with the Pittsburgh center
22 that there were no known inhibitors I is that correct?
23 A That's correct.
24 Q And just tell the jury what that means with
25 regard to the effectiveness of Factor VIII?
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A Some persons with hemophilia after repeated
exposure to what then is a foreign protein because they
don't make this protein will develop an antibody which
will destroy the ~rotein at the time that it is infused.
Therefore, it is ineffective, it will not raise the level.
Q But Mr. Bishoff didn't have any such inhibitors
at least that were known at the time?
A That's correct.
Q And with regard to the failure to give either
Desmopressin or Factor VIII, would that increase the risk
that he would develop a subdural hematoma?
A Yes, it would.
Q Now, assuming that the laceration on the scalp
was a 7.5 centimeter laceration in the occipital region on
the right side and that the gentleman had been involved in
an accident involving falling from a ladder would you
consider that to be a significant head injury?
A ! didn't see Mr. Bishoff at the time. I think
it's more important what the impact to the skull was
rather than the size of the laceration and whether he had
any symptoms relating to this at the time of the
occurrence or in the immediate period following that.
Q Now, and as you've said, you did not see him
immediately after the accident. And as a matter of fact
he didn't get to the hospital until about two days later.
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1 Do you recall talking or reviewing a chart and seeing
2 anything in the chart that suggested to you that this was
3 a serious head injury one way or another?
4 A Well, by the time he got to the emergency room
5 his one pupil was dilated and he was exhibiting -- he was
6 unconscious and was exhibiting features of severe bleeding
7 with pressure on his brain.
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13 continue to follow Mr. Bishoff's case then after he was
14 discharged from the Hershey Medical Center?
15 A Yes, one of my colleagues did.
16 Q And what did he continue to receive the
17 Factor VIII for some period of time after discharge?
18 A Yes, he did.
19 Q Is there anything in the chart that indicates
20 when that Factor VIII stopped after discharge?
21 A Yes, I believe there is. I note that he was
22 seen by Dr. Amondry on December the 15th. And Dr. Amondry
23 states that he was operated on December the 1st, that he
24 was discharged on the 7th, and that he should continue to
25 receive Factor VIII daily for another five days, which
Q So that was
A By the time he got --
Q by the time he got to the hospital --
A By the time he got to the emergency room.
Q Did you or someone from the hemophilia center
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1 would have been a total of three weeks treatment.
2 Q Now, with regard to the Factor VIII treatment
3 that Mr. Bishoff received, was there any suggestion at the
4 time of discharge that he had any problem with bleeding or
5 was the Factor VIII treatment effective? Can you tell me
6 one way or another?
7 A The operative note, which is quite lengthy,
8 describes the removal of the clot, notes that reinspect ion
9 of the wound showed no further evidence of bleeding or
10 oozing and consequently the dura was closed, the bone flap
11 was replaced, and the operation was completed. The
12 patient seemed to have tolerated the procedure well and
13 left the operating room in good condition.
14 Q So that would suggest that his clotting
15 function was working okay at the time he had the surgery
16 inside his brain, correct?
17 A That's correct.
18 Q And thereafter is there anything in the chart
19 that indicates he had a problem with the Factor VIII after
20 that time?
21 A No, the notes indicate th~t his mental status
22 continued to improve and that he was progressing well.
23 Q Okay.
24 A There's no mention of further bleeding that I
25 can see right now.
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1 Q So based on what the chart shows the Factor
2 VIII worked for Mr. Bishoff?
3 A Yes.
4 MR. STEFANON: Off Camera for a second.
5 THE VIDEOTAPE SPECIALIST: We are going off
6 camera. The time of day is 10:30.
7 (Brief recess.)
8 THE VIDEOTAPE SPECIALIST: We are back on
9 camera. The time of day is 10:32.
10 BY MR. STEFANON:
11 Q Doctor, one additional question I did want to
l2 ask you, and also this would go to the hypothetical
13 because these are things which occurred before Mr. Bishoff
14 got to the Milton Hershey Medical Center. with regard to
15 somebody who has the known Factor VIII deficit, has
16 suffered a head injury and then later develops queasiness,
17 nausea, symptoms of that sort, is that significant with
18 regard to the hemophiliac in terms of his care and
19 treatment?
20 A Symptoms of headache, nausea, and vomiting are
21 characteristically symptoms that we see in patients who
22 have subdural hematomas, lethargy, sleepiness, change in
23 behavior.
24 Q with regard to the occurrence of these symptoms
25 in Mr. Bishoff would that be something which would raise a
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flag with regard to his condition for tho treating doctor?
A If those symptoms occur and the treating doctor
were aware of them.
o And what is significant about those symptoms?
A They are associated with increased pressure
within the head. It's called increased intercranial
pressure. It's an expanding mass. In this instance it
would be blood.
Q Now, assuming that the doctor knows of those
symptoms what should he do?
A Treat the patient with Factor VIII or possibly
Desmopressin. Although, if those symptoms were present at
that time the treatment choice would be Factor VIII.
o Now, assuming the doctor doesn't have Factor
VIII, doesn't have desmopressin, what should he do?
A He should send the patient immediately to a
center which has Factor VIII so that the patient could
receive it as quickly as possible.
o And would that be standard medical practice in
November of 1992?
A Yes.
MR. STEFANON: Okay. Doctor, we don't have any
further questions for you. Defense counsel may have some,
and we'll turn you over for cross-examination.
CROSS EXAMINATION
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1 BY MS. KINGI
2 Q Doctor, I didn't have the opportunity to review
3 your CV, your curriculum vitae, prior to your depouition
4 today. Could you tell me what peroentage of your praotioe
5 is devoted to clinical treatmont of patiente as opposed to
6 administrative duties as the direotor of this oenter and
7 also in your olinical researoh studios?
8 A It's constantly ohanging, but I'd say I devote
9 at least or I have for most of my oareer devoted at least
10 a third of my time to olinioal praotioe.
11 Q Would you say that the other two thirds is
12 devoted equally to your administrative duties and your
13 research studies?
14 A Administration, teaching, and research as well
15 as service at thu university are the othsr oompounds.
16 Q And for how long haB your practioe been limited
17 to one third of your praotioo being clinical treatment of
18 patients?
19 A I didn't mean to imply it was limited, but I'd
20 say that for most of my career the bulk of my activity has
21 been in the olinical aroa. And Borne of this is clinical
22 research and some of it iB direct patient care. And the
23 30\ figure that I'm giving you is probably an overall
24 figure for the 30 years. At times it may have been 50 or
25 60 or at times it may have been 20.
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1 Q Okay. Thank you. How long have you been
2 director of the hemophilia center?
3 A Since it was established in 1973.
4 Q Do you ~ver treat or see trauma patients at
5 their initial presentations to the emergency room or to
6 the hospital?
7 A I'm sometimes called to the emergency room to
8 see a person with hemophilia in the emergency room.
9 Q And how often does that occur?
10 A Well, when I'm on service, which is a couple
11 months out of the year, it can occur several times in that
12 month.
13 Q Okay. And you are Board certified in
14 hematology, correct?
15 A Correct.
16 MS. KING: Objection. Off camera.
17 THE VIDEOTAPE SPECIALIST: We are going off
18 camera. The time of day is 10:37.
19 (Whereupon, a discussion was held off the
20 videotape record as follows:
21 MS. KING: I'd just like to place an objection
22 on the record as to her qualifications giving an expert
23 opinion to the standard of care of a family doctor
24 considering her specialty in hematology.
25 MR. STEFANON: Your objection is noted.
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MS. KING: Okay. Back on.)
THE VIDEOTAPE SPECIALIST 1 We are back on
camera. The time of day is 10138.
BY MS. KING:
a Would you agree, Doctor, that as a hematologist
or having a specialty in hematology that your
qualifications are different from those of a general
practitioner?
A Yes, I would.
a Could you tell me how much -- if you're being
paid to give your testimony today?
A I will be submitting a bill.
a How much will that bill be for?
A The bill will be for $400 an hour, and the
request will be made to pay that amount to Penn State
university for the purpose of hemophilia research.
a And is my understanding from your earlier
testimony that you were not directly involved in Mr.
Bishoff's carel ie that correct?
A To tho best of my recollection.
a All right. It's also my understanding from
reviewing the records that Mr. Bishoff has participated in
a clinical reBoarch study under your direction1 is that
true?
A I believe that Mr. Bishoff signed the consent
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1 form at the time when he was seen in hemophilia, in our
2 comprehensive hemophilia clinic. At that time all
3 patients are asked to consider participating generally in
4 the research that's carried out. And I don't have the
5 consent in front of me right now, but I think it's very
6 possible he may have signed such a form.
7 Q Would you have been participating directly with
o him in the clinical research study?
9 A There would have been -- my name would have
10 been on the form along with the other investigators. And
11 the person who presented this to him would have been one
12 of the people who were on the form as well.
13 Q So to your recollection you don't have any
14 remembrance of directly participating in the research
15 study with him?
16 A I do not recall that.
17 Q Doctor, are you aware of Dr. Knight's knowledge
18 of treating hemophiliacs?
19 A No, I'm not.
20 Q Are you aware of his training in dealing with
21 patients who are hemophiliacs?
22 A No, I'm not.
23 Q And you testified earlier that you have
24 reviewed the Hershey Medical Center chart. Bave you also
25 reviewed Dr. Knight's records?
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1 A I was given by Hr. Delvy some information to
2 review some time ago. I don't recall whether they were
3 Dr. Knight's records or his interpretation of Dr. Knight's
4 records.
5 Q All right. I'm going to ask you some questions
6 concerning your opinion lettsr dated June 1st, 1994. In
7 the second paragraph you state, "Dr. Knight's notes state
8 that he knew the patient had a Factor VIII deficit," et
9 cetera. Do you see that?
10 A Yes, I do.
11 Q Does that refresh your recollection as to
12 reviewing Dr. Knight's records?
13 A If that's what I said, then I must have
14 reviewed his records directly.
15 Q And you state, don't you, that Dr. Knight noted
16 that he w~s aware that the patient had a Factor VIII
17 deficit?
18 A My record states that my letters to -- my
19 letter to Mr. Helvy states that, "Dr. Knight's notes state
20 that he knew the patient had "a Factor VIII deficit" and
21 that head trauma instructions were given."
22 Q Thank you. Wouldn't you agree, Doctor, that it
23 was appropriate to give head trauma instructions following
24 an injury such as Mr. Bishoff's?
25 A Definitely.
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Q Can you continue, please, reading what the next
sentence of your note --
A "There is no mention in his initial note of
November 28th or in his follow-up note of November 29th
that Mr. Bishoff was experiencing dizziness."
Q Thank you. Please continue.
A "Neither is there any notation that Mrs.
Bishoff called on the evening of November 29th to inform
Dr. Knight of nausea and continued dizziness as stated in
your letter of May 26, 1994."
Q Thank you. Doctor, do you have the letter from
Mr. Belvy of May 26, 1994 with you?
A Do you have that one?
MR. HELVY: I don't have it with me.
A Could you provide it for me?
Q I don't have a copy of that letter. Do you
recall any of the substance of that letter?
A May 26th, 1994. I must have been replying to
some information that he provided me.
MS. KING: Okay. Off camera.
THE VIDEOTAPE SPECIALIST: We are going off
camera. The time of day is 10:43.
(Whereupon, a discussion was held off the
videotape record as follows:
MS. KING: There's two letters here, the May
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1 26th letter and the June 28th, 1994 letter. I'd like to
2 get a copy of both of those letters. And I'd like to also
3 reserve the right to --
4 MR. STEFANON: Well, hang on. Maybe we can get
5 you copies of those letters, although, I don't know if
6 I've got all of them.
7 MR. HELVY: Which two dates?
8 MS. KING: May 26th and June 28th, both 1994.
9 THE WITNESS: I have a copy of my letter on
10 June 30th referring to his letter on June 28th, which must
11 have been the questions. And the questions are listed in
12 thG reply.
13 MS. KING: I have that. I'd like to see the
14 letters though if you have them.
15 MR. STEFANON: Off the record.)
16 (Brief recess.)
17 THE VIDEOTAPE SPECIALIST: We are back on
18 camera. The time of day is 10:58.
19 BY MS. KING:
20 Q Doctor, as you've indicated earlier your
21 opinion letter of June 1st, 1994 indicates that you
22 reviewed Dr. Knight's notes1 is that correct?
23 A My opinion letter June 1st, 1994 says, "Based
24 on the information you have provided me it is my
25 opinion--
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Q Okay. In the second paragraph where it says,
"Dr. Knight's notes state," and et cetera, that indicates
to me that you reviewed Dr. Knight's notes1 is that
correct?
A That's correct.
Q I'd like to give you a copy of the typed note
of November 28th and November 29th from Dr. -- of Dr.
Knight's office.
A Could I mention that I had reviewed Dr.
Knight's notes that were provided to me?
Q Okay. Do you recall if you reviewed those two
office notes based on what you've written in your letter?
A This letter was written in June of 1994.
Q I understand, but based on what you've written
in your opinion letter can you tell whether you've
reviewed those two notes?
A "Dr. Knight's notes state that he knew the
patient had a Factor VIII deficit." This note says the
patient has a Factor VIII deficit. And the head trauma
instructions were given and this note says, "Bead trauma
instructions."
Q So does that indicate to you that you probably
reviewed Dr. Knight's notes?
A I obviously reviewed Dr. Knight's notes.
Whether I reviewed this specific typewritten note or
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1 whether they were handwritten notes I can't recall but tha
2 information here appears to coincide with what I said I
3 reviewed.
4 Q If I would represent to you that there are
5 handwritten noteo and the dictated notes mirror the
6 handwritten notes, can we assume that for the now?
7 MR. STEFANON: Well, I'd have to object to
8 that. And the basis of the objection is that I just
9 haven't read them word for word. I'll admit there are
10 handwritten notes. I'll admit there's a typewritten
11 transcription, but whether that typewritten transcription
12 agrees word for word, I can't stipulate to that.
13 I don't think the doctor can either without
14 making an in-depth review, but we will stipulate there's
15 both a handwritten note from November 29, 1992 and a
16 typewritten note. And there's a handwritten note from
17 November 29 and a typewritten note. We don't have any
18 independent knowledge about how those were created or
19 anything about those details.
20 And I think it's unfair to suggest to the
21 doctor that she does, but if we understand ourselves we
22 can go ahead.
23 MS. KING: Okay, Fine.
24 BY MS. KING:
25 Q And you did indicate earlier to me that what
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1 you see in your June 1st letter is also found in the note
2 that you have in front of you, correct?
3 A That's correct.
4 Q All right. Now, looking at the November 28th
5 note of Dr. Knight's, it indicates, does it not, that head
6 trauma instructions were given?
7 A It says, "Head trauma instructions, report any
8 bleeding."
9 Q Would you agree that it was appropriate for Dr.
10 Knight to instruct the patient to report any bleeding
11 after this head injury?
12 A Yes.
13 Q And underneath the sentence or the phrase
14 report any bleeding, the abbreviation is, "RTC-AM"?
15 A That probably means return to clinic in the
16 morning.
17 Q Thank you. Would you agree that it was
18 appropriate to recheck this patient in the morning?
19 A Yes.
20 Q Thank you. If you also take another look at
21 that note, does the record -- does the note reflect that a
22 physical exam appears to have been done on this patient?
23 A The note reflects that the -- a brief
24 neurological examination was performed and that the eyes
25 were checked and that the scalp laceration w~s sutured and
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that there were other observations such as he had a
hematoma with a small laceration on the back of his left
hand as well as the scalp laceration.
Q Thank you. Is there any indication in th& note
that Mr. Bishoff had -- was suffering from u headache?
A It states, "The patient was getting down from a
ladder, the ladder slipped, fell and hit him on the head
and dorsum of left hand." There's no other notation here
about the patient's history or symptoms.
o Or that he had a headache?
A Or that he had a headache.
o Is there any note that he was experiencing
nausea?
A
No, there is not.
Is there any note that he was experiencing
Q
vomiting?
A No, there is not.
Q And you indicated earlier other classic
symptoms of possible subdural hematoma might be lethargy.
Is there any indication that Mr. Bishoff was lethargic at
this time?
A There is no indication that he was experiencing
any symptoms -- that he was or was not experiencing any
symptoms.
Q Is there anything in the notes to indicate that
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5 there indication in that note that Mr. Bishoff was
6 reporting headache?
7 A No, there's not.
8 Q And there's no indication that Mr. Bishoff was
9 reporting any nausea, is there?
10 A That's correct.
11 Q And there's no indication that he was reporting
12 vomiting, is there?
13 A That's correct.
14 Q Is there any indication he was reporting
15 lethargy or sleepiness?
16 A No, there is no indication that he had any of
17 those -- that he was experiencing any of those symptoms in
18 Dr. Knight's note from November 29th.
19 Q Wouldn't it be true, Doctor, that as a
20 physician treating the special condition of hemophiliacs
21 that you learn to rely on your patient to inform you of
22 symptoms that are not physically evident?
23 A Well, I think any individual must take
24 responsibility, a certain degree of responsibility for
25 their own care in reporting certain symptoms, yes.
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he had any change in behavior?
A There's nothing in the note to indicate that he
was or WAS not having any change in behavior.
Q And going to the note of November 29th, 1992 is
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1 Q And you believe your patients when they relate
2 these symptoms to you, don't you?
3 MR. STEFANON: Well, I'd have to object on the
4 grounds of relevancy, but you can answer the question with
5 the objection.
6 A One establishes -- attempts to establish a good
7 physician/patient relationship. In that setting if the
8 patient is in a condition to give a history, one tends to
9 rely on it unless there is evidence contradicting that
10 from another source.
11 Q Well, in this case there's no indication in the
12 office notes of Dr. Knight that Mr. Bishoff was reporting
13 headache, nausea, vomiting, lethargy, sleepiness, or
14 change in behavior. Do you have information from another
15 source that he was reporting these symptoms to Dr. Knight?
16 A The admission narrative summary from his
17 admission states, "This patient is a 50-year-old known
18 hemophiliac who apparently fell on Saturday evening and
19 began vomiting and having headache the following day that
20 progressively worsened. The patient developed progressive
21 headache, nausea, and vomiting throughout the evening. Be
22 went to sleep at 3:00 a.m. The wife tried to awaken him
23 at 4:30 a.m. and could not awaken him, found him
24 unresponsive and arousable. Be was found unresponsive and
25 arousable by the EMT." Then it goes on to describe the
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1 condition.
2 Q Does that narrative summary indicate that those
3 symptoms were related to Dr. Knight?
4 A It's simply a description of the history that
5 was obtained at the time of admission that the patient
6 began having these problems. It does not state whether or
7 not he conveyed those to Dr. Knight.
8 Q Okay. Do you have information from any other
9 source that Mr. Bishoff would have related these symptoms
10 to Dr. Knight?
11 A I think I've reviewed -- re-reviewed the
12 information that was provided to me. And there's no
13 indication in Mr. -- in Dr. Knight's records from the 29th
14 or the 28th that that was the case.
15 Q All right. If you'll turn to your opinion
16 letter of June 1st, 1994, the second to the last paragraph
17 on the second page, isn't it true, Doctor, that you state,
18 "In my opinion if Dr. Knight was told on November 29th
19 that Mr. Bishoff was dizzy and nauseated, he should have
20 referred him immediately for further evaluation with a CT
21 scan and treatment with Factor VIII concentrate"?
22 A That is what I wrote.
23 Q And you have just told me, Doctor, that your
24 review of the notes -- or your review of the records does
25 not show anywhere that Dr. Knight was told on November
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1 28th of Mr. Bishoff's dizziness and nausea/ isn't that
2 true?
3 A The two records which were provided to me by
4 you do not indicate that he was informed of that.
5 Q Do you have any other records that indicate
6 that he was informed of that?
7 A I only have records that were provided to me.
a And to my knowledge I don't have a record that indicates
9 anything other than what we have discussed.
10 Q All right. Earlier in your testimony on direct
11 examination you indicated when questioned whether this
12 would be a significant head injury, your answer included
13 that it was important to you what the symptoms were
14 immediately following the injury and later?
15 A That's correct.
16 Q And you also indicated that the classic
17 symptoms that a physician would be looking for would be
1a headache, nausea, vomiting, lethargy, sleepiness, and
19 change of behavior1 is that correct?
20 A That's correct.
21 Q And you also indicated that Mr. Bishoff was
22 exhibiting these symptoms upon your review of the records
23 when he presented to the emergency room?
24 A That's
25 MR. STEFANON: I'd have to objection to that.
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1 I think that'a a mischaracterization of the testimony.
2 MS. KING: All right.
3 MR. STEFANON: I believe when he presented at
4 the emergency room he was unconscious with unequal pupils.
5 And I don't believe he was talking at all.
6 BY MS. KING:
7 0 When Mr. Bishoff presented to the emergency
8 room at Hershey Medical Center1 isn't it true that he was
9 exhibiting classic symptoms of subdural hematoma?
10 A That's correct.
11 0 Thank you. In your opinion letter of June 1st,
12 1994 you reference a letter from Plaintiff's attorney,
13 Paul Helvy dated May 26th, 1994. And I have a copy of
14 that May 26th, 1994 letter in front of me. Do you have a
15 copy of that also?
16 A I do now.
17 0 Okay. In that letter Mr. Belvy enclosed copies
18 of Mr. Bishoff's medical records from Apple-a-Day and from
19 the Hershey Medical Center. Isn't that what is indicated
20 in the first paragraph?
21 A "As per our recent telephone conversation I've
22 enclosed copies of Bruce Bishoff's medical records from
23 Apple-a-Day and from Hershey Medical Center."
24 0 And later in the letter on the bottom two
25 paragraphs of that first page, Mr. Helvy indicates some
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1 conversation that was related by Mrs. Bishoff to Dr.
2 Knight and later from Mr. Bishoff to Dr. Knight on the
3 days of November 29th -- the day of November 29th, 1992.
4 Do you see where that's set forth?
5 A I see that it states that according to Mrs.
6 Bishoff who was along on the visit they reported to Dr.
7 Knight the fact that Mr. Bishoff had felt dizzy, had
8 experienced cold sweats, and was feeling weak during the
9 past 24 hours. And--
10 Q Thank you. Stop there.
11 A this refers to November 29th.
12 Q Do you see anything in Dr. Knight's notes to
13 indicate that those things were reported to him?
14 A I think that we covered that before in my
15 opinion letter and also in my answers to your questions
16 that, "There is no mention in his note of November 28th or
17 his follow-up note of November 29th that Mr. Bishoff was
18 experiencing dizziness. Neither is there any notation
19 that Mrs. Bishoff called on the evening on November 29th
20 to inform Dr. Knight of nausea and continued dizziness as
21 stated in your letter of May 26th."
22 Q Thank you. Did Mr. Helvy also relate to you
23 that Dr. Knight had a conversation with Mrs. Bishoff's
24 Mr. and Mrs. Bishoff specifically regarding possible
25 complications of the head trauma in regard to Mr.
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1 Bishoff's hemophilia and that they stated the problem
2 would be managed by the physicians who took care of the
3 hemophilia, the hemophilia problem?
4 A I don't recall such information being given to
5 me. I have no recollection of that.
6 0 Do you have any information as to Dr. Knight's
7 story of this case or his testimony concerning this case?
8 MR. STEFANON: I'd have to object to that. You
9 oan answer.
10 A I have had no conversations with Dr. Knight and
11 I have no none -- I have no access to what transpired
12 in the office or what he told the patient other than
13 what's given to me in the record.
14 0 Was anything told to you concerning what Dr.
15 Knight might have said during the office visits other than
16 what's reported by Mr. and Mrs. Bishoff?
17 MR. STEFANON: Objection to what might have
18 said.
19 A All of the information that I believe I've been
20 privileged to is in front of me and I think we discussed
21 it.
22 0 So in other words, Doctor, your forming your
23 opinion of the care in this case without the benefit of
24 Dr. Knight's side of the story?
25 MR. STEFANON: Objection.
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1 A I'm not -- don't mean to imply I'm forming an
2 opinion of the care. I'm stating in response to questions
3 asked to me what in my opinion is the appropriate way to
4 treat a person with hemophilia who sustains a head injury.
5 Q And he reports those symptoms to his treating
6 physician1 would that be correct?
7 A Well, again, one always has to rely on the
8 patient to provide as much history as they are able to
9 provide and also accompanying family members.
10 Q On direct examination Mr. Stefanon gave you a
11 hypothetical in which he included the following facts: A
12 patient who had suffered a fall from a ladder1 who had
13 suffered a laceration to the scalp, which was closed by
14 suture1 who had been given head trauma instructions, which
15 the doctor, the treating physician, was aware of the
16 Factor VIII deficit, the patient is a hemophiliac, and the
l7 patient later develops symptoms of queasiness, nausea, et
18 cetera.
19 If we remove the factor of later developing
20 nausea as being reported to the physician, what should the
21 physician have done on November 29th without those --
22 without a report of those symptoms?
23 MR. STEFANON: Objection. And the reason I
24 object is because it's a mischaracterization of the
25 question that was asked. with that objection on the
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1 record, you can go ahead and answer, Doctor.
2 A I'm sorry. It was a rather lengthy question.
3 Could you kind of rephrase it for me?
4 0 certainly. Mr. Stefanon included in his
5 hypothetical that this patient, who is a hemophiliac, had
6 fallen from a ladder, had suffered a laceration to his
7 scalp which was closed by suture, he had been given head
8 trauma instructions, and the physician was aware of a
9 Factor VIII deficit. Later another fact was added to the
10 hypothetical that the patient developed -- later developed
11 queasiness and nausea.
12 If we remove that final fact -- let me state it
13 differently. If the patient does not report symptoms of
14 queasiness, nausea, vomiting, et cetera, to the treating
15 physician, would that change your opinion that Dr. Knight
16 should have referred Mr. Bishoff immediately for further
17 evaluation with a CT scan and treatment with Factor VIII
18 concentrate? I'm referring to the second to last
19 paragraph.
20 A You're referring to my answer to the third
21 question on the June 30th letter1 is that what you're
22 referring to?
23 Q That -- yes, we'll take it with that.
24 A Okay. The question was, "Did Dr. Knight fail
25 to exercise reasonable care when he failed to refer Mr.
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Bishoff for further evaluation and treatment? If your
answer to this question is in the affirmative, please
indicate what type of actions would have been reasonable
for Dr. Knight to take in this situation."
My response was, "Yes. He should have
initiated some form of prophylactic treatment, (Factor
VIII concentrate or possibly Desmopressin) at the time of
Mr. Bishoff's initial visit."
Q And in your letter of June 1st, 1994, second to
last paragraph, you state, "If Dr. Knight was told on
November 29th that Mr. Bishoff was dizzy and nauseated, he
should have had referred him immediately for further
evaluation with a CT scan and treatment with Factor VIII
concentrate"?
Both of those statements are correct in my
A
opinion.
Q Well, your statement of June 1st, 1994 seems to
qualify it a little bit. You state if Dr. Knight was told
then he should have referred him for further treatment --
MR. STEFANON: Well, I'd have to object to
that. It's clear from the doctor's testimony that these
are two separate statements, two separate opinions she has
expressed. One is in the one letter and there is an
additional letter June 30, which has additional
information. And I think that's where you're confusing
~
~
44
1 the doctor. She's got a letter of June 1 and a letter of
2 June 30, both of which express opinions.
3 MS. KING: And the letter -- off camera.
4 THE VIDEOTAPE SPECIALIST: We are going off
5 camera. The time of day is 11121.
6 (Whereupon, a discussion was held off the
7 videotape record as follows:
8 MR. STEFANON: My objection is this: She said
9 she thought both statements were correct. She's got two
10 different letters, two different statements. You're
11 trying to meld the two and hsr testimony is they are both
12 correct. So that's -- you know, don't confuse the jury on
13 the point.
14 MS. KING: To me the two different statements
15 seem to indicate two different standards of care and maybe
16 that's the question that I should pose.
17 MR. STEFANON: Maybe that's the question you
18 should ask.
19 MS. KING: Okay. The objection is on the
20 record.
21 THE WITNESS: Can you tell me again what you're
22 going to do so I can get prepared for this?
23 MR. STEFANON: Well, let her ask the question.
24 You'll see what the problem is, Doctor.)
25 THE VIDEOTAPE SPECIALIST: We are back on
~
,....,
45
1 camera. The time of day is 11122.
2 BY MS. KING:
3 Q Doctor, in your letter of June 1st, 1994 you
4 seem to indicate that the standard of care dictated if Dr.
5 Knight was told of the symptoms of dizziness and nausea,
6 he should have referred immediately for a CT scan and
7 treatment with Factor VIII concentrate1 is that true?
8 A That's true.
9 Q But then in your letter of June 30th, 1994 you
10 seem to indicate a different standard of care in that you
11 say that he should have been given this treatment on the
12 initial visit prior to any of these symptoms occurring or
13 report of those symptoms to Dr. Knight?
14 MR. STEFANON: I have to object to that just
15 because for formal reason. She mentions in the second
16 letter -- or I should say your question is she mentions a
17 CT scan in the June 30 letter. In Paragraph 3 the answer
18 does not mention a CT scan. It!s a different discussion,
19 if you will.
20 THE WITNESS: I think I can clarify this.
21 MR. STEFAWON: Go ahead, Doctor.
22 THE WITNESS: My letter of June 30th, which was
23 actually the second letter, is referring to prophylactic
24 treatment. In other words, you want to prevent bleeding
25 from occurring if there was a significant head injury. My
~
~
46
1 first letter says that if he were told the symptoms that
2 would imply, that would tell me that bleeding was already
3 occurring. And one would need to document this with a CT
4 scan and treat very aggressively. It would be a different
5 situation. On one instance you're trying to prevent
6 something happening, in the other you're treating the
7 obvious as soon as it's confirmed.
8 And the treatment would be in one instance a
9 single infusion of Factor VIII to prevent bleeding
10 initially, and the treatment in the second instance would
11 be repeated doses of large amounts of Factor VIII, as was
12 done in this situation, to treat bleeding that already
13 occurred and also to take him through surgery.
14 Q Okay. You also indicate in that June 30th
15 letter earlier the question was, "Did Dr. Knight ever
16 ascertain a specific type of severity of Mr. Bishoff's
17 clotting deficit?" And your answer is, "Not to my
18 knowledge." Is that true? That's what the le~ter states?
19 A That's what the letter states.
20 Q All right. And the records indicate that, and
21 I believe you testified earlier, that Mr. Bishoff's
22 clottir-g deficit was mild; is that true?
23 A That information was obtained at the time of
24 the his admission to Hershey Medical Center.
25 Q But his status was mild at all times, wasn't
~
~
47
1 it?
2 A Yes, Mr. Bishoff had what would be considered
3 mild hemophilia.
4 Q All right. Are you aware, Doctor, whether Mr.
5 Bishoff was registered with a hemophilia center prior to
6 November 28th, 1992?
7 A I do not believe that Mr. Bishoff was
8 registered with the hemophilia center prior to this event.
9 MR. STEFANON: Do you mean the center in
10 pittsburgh?
11 MS. KING: Any hemophilia center.
12 THE WITNESS: I'm sorry. I meant ours.
13 BY MS. KING:
14 Q Sorry if my question was unclear. Are you
15 aware whether Mr. Bishoff was registored with any
16 hemophilia center prior to November 28th, 1992?
17 A Well, he had been -- he was known to the
18 hemophilia center in pittsburgh so I assume that he was
19 registered there.
20 Q All right. Are you aware whether he allowed
21 his registration to lapse at the pittsburgh center?
22 A I would have no way of knowing that.
23 Q All right. Finally, Doctor, in your letter of
24 June 1st, 1994 you state final paragraph, "One cannot
25 predict medical outcomes with certainty." That's true,
~
~
48
1 isn't it?
2 A That's true.
3 Q And that would be true in this case as well,
4 wouldn't it?
5 A Yes, it would.
6 MS. KING: Thank you. That's all I have.
7 REDIRECT EXAMINATION
8 BY MR. STEFANON:
9 Q Doctor, just one follow-up question. What's
10 the last sentence in your letter of June 1, 1994?
11 A The last paragraph states, "In reply to your
12 questions one cannot predict medical outcomes with
13 certainty. However, it is highly probable that Mr.
14 Bishoff's period of hospitalization and total Factor VIII
15 usage would have been substantially shortened had the
16 appropriate treatment been given earlier."
17 Q And with regard to a subdural hematoma in a
18 person who's a mild hemophiliac, is that something that
19 and suffers a head trauma -- is that something that
20 develops over a period of time?
21 A The blood accumulation develops over a period
22 of time following a head trauma, yes.
23 Q And that continuing bleeding occuro why?
24 A Because clotting is slower than normal and
25 there is a very slow but progressive accumulation of blood
~
~
49
1 within a closed space.
2 Q If you put in the Factor VIII an~ get the
3 clotting up to normal, what happens?
4 A There's no further bleeding.
5 MR. STEFANON: I don't have any further
6 questions.
7 THE VIDEOTAPE SPECIALIST: This videotape
8 deposition is now concluded. The time of day is 11:28.
9 (Whereupon, a discussion was held off the
10 videotape record as follows:
11 MR. STEFANON: For the record, let's
12 incorporate her letter of June 1 and June 30 and Mr.
13 Helvy's two letters of June 28 and May 26th.
14 THE WITNESS: I might have concluded that too
15 quickly. I said there's no further bleeding. That is
16 assuming that the bleeding is due to the hemophilia. Now,
17 if anybody has a severe enough head injury, whether a
18 hemophiliac or not, you know, giving a Factor VIII is not
19 going--
20 MR. STEFANON: Well, this was not a depressed
21 skull fracture or anything.
22 THE WITNESS: I didn't mean to imply the --
23 MR. STEFANON: You weren't getting into the
24 wrong realm there, Doctor.)
25
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(Letter dated 5/26/94 produced and marked
Deposition Exhibit No. 1.)
(Letter dated 6/1/94 produced and marked
Deposition Exhibit Woo 2. )
(Letter dated 6/28/94 produced and marked
Deposition Exhibit No. 3. )
(Letter dated 6/30/94 produced and marked
Deposition Exhibit No. 4. )
(Whereupon, the videotape deposition was
concluded at 11 :29 a.m. )
~
~
51
1 COUNTY OF LEBANON
:
SS
2 COMMONWEALTH OF PENNSYLVANIA I
3
I, Denise A. Sampson, a Notary Public, authorized
to administer oaths within and for the Commonwealth of
4
5
6
Pennsylvania, do hereby certify that the foregoing is the
testimony of M. Elaine Eyster, M.D.
I further certify that before the taking of said
deposition, the witness was duly sworn, that the questions
and answers were taken down stenographically by the said
Reporter-Notary Public, and afterwards reduced to
typewriting under the direction of the said Reporter.
I further certify that the said deposition was
taken at the time and place specified in the caption sheet
hereof.
7
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I further certify that I am not a relative or
employee or attorney or counsel to any of the parties, or
a relative or employee of such attorney or counsel, or
financially interested directly or indirectly in this
action.
I further certify that the said deposition
constitutes a true record of the testimony given by the
said witness.
IN WITNESS WHEREOF, I have hereunto set my hand
this 16th day of June,
;:,: ::~:i:l.f}~~"~?~~T ~~,~~:~-~~~'i
Multi-Page'" $400 - Bishoff
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HUGHES, ALBRIGHT, FOLTZ & NATALE Index Page I
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30:10
37:7
1:10
4:10
10:10
33:19
13:12
5:6
16:4
23:10
-Q-
qualifications ('1 9:3
24:22 25:7
qualify [1143:18
queasiness (41
41:17 42:11
questionable (II
questioned [II
questions ('1
27:5 29: II
39:15 41:2
49:6 51:8
quickly (11
49:15
quite III 20:7
25:8
12:5
48:12
10:17
(0,17
12:6
24:5
10:9
38:3
15:4
22:5
28:19
36:12
51:3
10:15
8:18
25:16
21:16
42:14
12:11
37:11
22:23
29:11
48:12
22:18
17:8
21:25
15:8
42:2
36:11
14:3
41:23
42:25
16:13
22:18
6:19
16:7
Multi-Page'"
12:9 24:20
27:18 28:24
32:21 37:8
42: 1 44:7
49:10 49:11
records (161
25:22 26:25
27:4 27: 12
36: 13 36:24
37:5 37:7
38:18 38:22
RECROSS II)
Red (II 3:3
REDIRECT ('1
48:7
rcduced(11
refer ['1 8:2
42:25
reference (II
referred ['1
42:16 43:12
45:6
referring [61
29:10 42:18
42:22 45:23
refers [II 39:11
reflect (II 32:21
reflects 11132:23
refresh (II 27:11
regard [1519:22
13: 16 13:25
16:19 17:25
20:2 21:14
21:24 22:1
48:17
regarding [11
39:24
region III 12:24
registered [41
47:8 47:15
registration (11
47:21
regulaf('11I:19
reinspection (II
relate [11 35:1
related(4i 9:19
36:9 39: I
relating [II
relationship [II
relative 121
51:17
relevancy (II
rely ['I 34:21
41:7
remembrancc (II
removal [II
remove (11 41:19
repeat (41 17: 14
17:15 17:18
repeated ('I
46:11
repetitive (II
rephrase (II
"'"
24:22
29:15
40:13
44:20
51:21
12:19
27:3
27:14
37:3
37:22
46:20
2:2
2:2
51:10
8:6
3b:12
36:20
43:19
8:7
42:20
13:5
16:10
18:9
21:18
39:25
12:20
18:14
47:5
47:19
9:13
14:20
20:8
39:22
36:3
18:21
35:7
51:15
35:4
35:9
26:14
20:8
42:12
17:1S
18:1
17:10
42:3
point - runs
M. Elaine B ster, M.D.
rep acc[III7:1
replaced [11
20:11
reply I') 5:16
48:11
replying (II
report ('I 32:7
32:14 41:22
45:13
reported 141
39:13 40:16
rerortcr["
:16 51:11
Rerorter-Notary [II
5 :10
reporting 1lI 34:6
34:9 34:11 34:14
34:25 35:12 35:15
reports [II 41:5
represent ('I
31:4
request [II 25:15
require (II 13:4
research 1'1
23:13 23:14
25:16 25:23
26:8 26:14
reserve ('1 9:7
residency (11
4:24
response [41 13:4
13:8 41:2 43:5
responsibility [11 34:24
34:24
result(11 16:12
return 1'1 17:12
reviewlll 7:10
27:2 31:14
36:24 37:22
reviewed (12)
26:25 27: 14
30:3 30:9
30:16 30:23
30:25 31:3
reviewing ['I
25:22 27:12
right (161 9:7
18: 15 20:25
26:5 27:5
32:4 36:15
38:2 46:20
47:20 47:23
risk ['I 14:24
15:2 16:5
risks [II 15:23
room (III 7:17
19:4 19:11
24:5 24:7
37:23 38:4
rounds [II 7:5
RTC-AM III
run[1l 15:1
runs (II 15:2
11:19
29:12
28:18
32:10
42:13
39:6
41:20
1:10
3:2
23:7
23:22
26:4
29:3
4:22
32:1S
23:2
36:24
26:24
29:22
30:11
30:24
36:11
19:1
10:5
25:21
29:3
37:10
47:4
15:1
18:10
12:10
20:13
24:8
38:8
32:14
Index Page 7
~
Multi-Page'"
f".
sake - today
I' B tcrMD
M. E lIlnc :lya , . .
slluallon ('I 43:4 status ('1 20:21 46:25 suluT:: (') 41:14 42:7
-s- 46:5 46:12 Stefanon (J71 1:12 sutured [1132:25
aix(l1 8:13 1:17 1:17 2:4 sutures 1'1 12:25 1S:16
Sake(11 5:14 Si:Wlll 18:20 3:12 3:12 3:21 swear (II 3:17
Samfson ['1 1:10 9:4 9:11 21:4
51: skull [41 12:1 1S:4 21:10 22:22 24:25 sweats (II 39:8
Saturday ('1 12:11 18:19 49:21 29:4 29:1S 31:7 sworn 121 3:19 51:8
35:18 SlCCPl11 35:22 35:3 37:25 38:3 symptoms [221 18:21
29:23 30:1 slccpiness (41 21:22 40:8 40:17 40:25 21:17 21:20 21:21
says (61 34:15 35:13 37:18 41:10 41:23 42:4 21:24 22:2 22:4
30:18 30:20 32:7
46:1 slipped [1133:7 43:20 44:8 44:17 22:10 22:12 33:9
44:23 45:14 45:21 33:19 33:23 33:24
scalf [11 12:23 12:25 sloW(11 48:25 47:9 48:8 49:5 34:17 34:22 34:25
18: 3 32:25 33:3 slowllr(2) 6:1 48:24 49:11 49:20 49:23 35:2 35: IS 36:3
41:13 42:7 slowly (II 1.1:4 stem (II 11:10 36:9 37:13 37:17
scan (1) 36:21 42:17 small ('1 10:17 11:11 stenographically (II 37:22 38:9 41:5
43:13 45:6 45:17 33:2 51:9 41:17 41:22 42:13
45:18 46:4 soft (II 6:12 stipulate ['I 31:12 45:5 45:12 45:13
school (II 4:16 46:1
schools (1114:23 16:5 solution [II 10:20 31:14 synthetic [II 13:13
19:12 stop ['1 11:6 39:10
sceond (101 21:4 someone (II syringe (II 10:21
27:7 30:1 36:16 sometimes [II 6:9 stopped (I) 19:20
36:17 42:18 43:9 15:13 24:7 stops (II 10:24 -T-
45:15 45:23 46:10 soon ['1 11:3 46:7 story ['1 40:7 40:24
see (16) 8:7 14:20 sony (41 17:16 42:2 Street (1) 1:13 3:5 T(ll 1:5 3:8
16:17 18:18 18:23 47:12 47:14 student (1116:7 tJdIb/a ['1 1:4 3:8
20:25 21:21 24:4 sort ('1 13:11 21:17 students [II 15:23 taking [II 51:7
24:8 27:9 29:13
32:1 39:4 39:5 sourcc (JJ 35:10 35:15 studies (11 23:7 23:13 teach [11 15:23 16:5
39:12 44:24 36:9 study [41 5:20 25:23 teaching (II 23:14
sccing (II 19:1 spacc 1'1 15:4 49:1 26:8 26:1S telephone ('1 8:16
SCCm('1 44:15 45:4 speak (II 14:4 subdural (III 6:23 9:14 38:21
45:10 special (I) 34:20 7:19 10:9 11:25 tend III 6:9
send(11 22:16 SPECIALIST (UI 3:1 16:12 16:22 18:11 tends (11 6:12 35:8
sentence ['I 28:2 3:16 8:22 9:9 21:22 33:19 38:9 terms (11 9:25 21:18
21:5 21:8 24:17 48:17
32:13 48:10 25:2 28:21 29:17 submitting (I) 25:12 testified ('1 3:19
separate (11 43:22 44:4 44:25 49:7 26:23 46:21
subsequent (II 12:12 testimony ['J 25:11
43:22 specialty (11 24:24
serious (1119:3 substance [II 28:17 25:18 37:10 38:1
25:6 substantially (II 48:15 40:7 43:21 44:11
service [11 23: I 5 24:10 specific (11
30:25 such (101 11:2 11:11 51:6 51:21
serviees (21 8:4 46:16 15:4 15:12 18:6 Thank (III 24:1 27:22
8:17 12:14 specifically (II 39:24 26:6 27:24 33:1 28:6 28:11 32:17
set ['1 39:4 51:23 specified (II 51:13 40:4 51:17 32:20 33:4 38:11
selling (II 35:7 spontaneously (II 6:9 suffered (1) 7:15 39:10 39:22 48:6
severaItI124:11 SS(II 51:1 7:23 12:7 21:16 themselves (II 3:11
severe (21 17:5 19:6 standard [61 13:4 41:12 41:13 42:6 thereafter [II 20:18
49:17 16:4 22:19 24:23 suffering (II 33:5 Thercfore[11 18:5
sevcrity (4) 6:10 45:4 45:10 suffeTS (II 48: 19 third (JJ 23:10 23:17
13:14 13:14 46:16 standards (II 44:15 sufficc (I) 15:17 42:20
sheet (II 51:13 state [191 3:22 4:5 suggest [11 20: 14 31:20 thirds [II 23:11
shortened [II 48:15 5:6 5:8 5:10 suggested (I) 19:2 thought (1144:9
show (11 8:3 36:2~ 8:13 25:15 27:7 suggestion (II 20:3 thousands (II 10:15
showed (II 20:9 27:7 2i:15 27:19
30:2 30:17 36:6 summary ['I 35:16 three (21 13:20 17:8
shows (I) 21:1 36:17 42:12 4):10 36:2 20:1
side 1>1 15:19 1S:20 43:18 47:24 supported (II 8:13 through ['1 7:16
15:21 18:15 40:24 statement (II 43:17 surgery [117:19 10:4 46:13
signed (11 25:25 26:6 statements [>1 43:15 10:10 10:24 11:15 throughout (11 11:20
significant (11 13:22 43:22 44:9 44:10 11:22 20:15 46:13 35:21
16:18 18:17 21:17 44:14 surgically (I) 12:4 times [31 6:10 23:24
22:<\ 37:12 45:25 states [131 7:16 9:15 survive (II 11:18 23:25 24:11 46:25
simp III (II 15:15 9:16 12:10 19:23 sustain (2) 13:23 17:11 tissue 121 12:2 15:5
simpIY(1136:4 27:18 27:19 33:6 sustained III 16:17 tissues (II 6:12
35:17 39:5 46:18
single (II 46:9 46:19 48:11 sustains 121 13:11 title 121 5:11 5:12
site (II 14:5 stating (I) 41:2 41:4 today [41 7:6 7:11
HUGHES, ALBRIGHT, FOLTZ & NATALE
717-232-5644\717-393-5101
Multi-Page'"
~ f'-I_ M. Blame Bvatcr, . .
23:4 25:11 tYlf,wntten III 30:25 42:17 43:7 43:13
TodaY'S[11 3:3 1:10 31:11 31:16 45:7 46:9 46:11
tolcrated (II 20:12 31:17 48:14 49:2 49:18
vilc['1 10:18 10:19
too [I) 49:14 -U- visit PI 39:6 43:8
took III 40:2
unablc(1I 12:13 45:12
total [11 20:1 48:14 visited (II 7:4
training 121 4:17 uncleDr[1147:14 visits [II 40:15
26:20 unconscious ['1 19:6 vitlC(11 23:3
transcription ['1 31:11 38:4
31:11 under['1 12:1 25:23 vomiting [II 21:20
transpired (II 40:11 51:11 33:16 34:12 35:13
35:19 35:21 37:18
trauma [141 13:1 undemeath(11 32:13 42:14
14:25 24:4 27:21 understand ['I 9:24 VS(II 1:3
27:23 30:19 30:20 30:14 31:21
32:6 32:7 39:25 unequal [I) 38:4 -W-
41:14 42:8 48:19 unfair[11 31:20
48:22 univenity 1'1 4:5 weak [I) 39:8
trcat('1 10:8 22:11 4:18 5:10 23:15 weeks [I) 20:1
24:4 41:4 46:4 25:16 Whereas [II 17:17
46:12
treated (II 6:22 7:18 unless [II 35:9 WHEREOF [II '1:23
10:3 14:22 16:3 Unlimited ['I 1:4 wife[" 3:7 12:13
treating ('1 13:5 3:7 35:22
22: 1 22:2 26:18 unresfonsive [11 35:24 within [61 7:17 15:3
34:20 41:5 41:15 35:2 15:4 22:6 49:1
42:14 46:6 UP[IJ 49:3 51:4
treatment 1111 6:19 usage [II 48:1S without (11 11:10
7:8 7:21 8:101 used (11 13:19 17:10 12:12 17:19 31:13
10:12 11:17 13:12 usuallY(1J 15:14 40:23 41:21 41:22
16:14 20:1 20:2 witness [141 2:2
20:5 21:19 22:13 -v- 3:9 3:17 3:18
23:5 23:17 36:21 29:9 44:21 45:20
42:17 43:1 43:6 Vein[11 10:22 45:22 47:12 49:14
43:13 43:19 45:7 49:22 51:8 51:22
45:11 45:24 46:8 versus (II 3:7 51:23
46:10 48:16 vessels [II 11:11 word (41 31:9 31:9
treatments (11 11:19 via [II 12:13 31:12 31:12
treats ('1 14:3 14:7 Video ('1 1:25 3:2 words [11 40:22 45:24
TRIAL[I,I:5 videotape [111 1:8 worked [II 21:2
tried [II 35:22 3:1 3:16 8:22 works [II 11:3
8:25 9:9 21:5
true[UI 25:24 34:19 21:8 24:17 24:20 worsened [II 35:20
36:17 37:2 38:8 25:2 28:21 28:24 wound,,) 11:21 16:11
45:7 45:8 46:18 29:17 44:4 44:7 20:9
46:22 47:25 48:2 44:25 49:7 49:7 wrillen (2) 30: 12 30:13
48:3 51:21 49:10 50:9 30:14
try (21 14:16 14:20 videotaped 1'1 3:4 wroog [Ii
17:4 49:24
trying [11 3:10 wrote (II 36:22
44:11 46:5 VIIl[ul 6:5 6:7
tum('1 22:24 36:15 7:15 7:18 7:21
twclve[11 17:16 7:25 8:1 9:18 -x-
twice [11 11:19 17:18 9:22 9:25 10:4 X[II 2:1
two ['01 11:25 12:1 10:11 10:13 10:16
10:23 11:1 11:8
13:20 17:8 18:25 11:11 11:1S 11:17 -y-
23:11 28:25 29:7
30:11 30:16 37:3 13:3 13:5 13:10 year(11 24:11
38:24 43:22 43:22 13:12 13:17 14:1 years ('1 4:15 23:24
14:25 15:1 16:13
44:9 44:10 44:11 16:20 16:25 16:25 York (2) 4:23 5:5
44:14 44:15 49:13 17:8 17:12 I7:2S 5:8
tYPC(11 7:23 9:18 18:10 19:17 19:20
10:13 11:22 12:11 19:2S 20:2 20:5
16:10 43:3 46:16 20:19 21:2 21:15
typcd(ll 30:6 22:11 22:13 22:15
typcS{11 16:16 22:17 27:8 27:16
typewriting (II 51:11 27:20 30:18 30:19
36:21 41:16 42:9
HUGHES, ALBRIGHT, FOLTZ & NATALE
717-232-5644\717-393-5101
Index Page 9
.
ZOO'd
~OBt'ON ~
6S:60 L6/ct/sO
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THe LAW "11I04 0'-
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H~..UIIG. P'''NNIIY,"VANIA '710__
""~ONE. "PI" ..a,-I"',
TD,..C~UI C7'fI ........
JlIAA~ N. ....,.....
....,.... __A:.. '<:tf........".
May 211, 19114
Blain. Erat.r, H.D.
ebi.r, c vie ion of Ke=atalcqy
Herahay Madical Centar
P.O. BoX 81S0
Harah.Y,. p~ 1.7033
... .~aa a. Biahoff
f'.
D.ar Dr. Eyetarl
All p.r our rac.nt. telephone canverlllation, X hava ancla.ad
oopia. of Brua. Biahoft'. =eclic.l. record. fro= Appl.a-A-D.y .nd tram
the Her.h.y Medical Cant..r. X have pleacad th. diaoharqa .~ry in
front at th. r.carda fro:JI the Herah.y MedicDl c.ntar for your
oonvanienclI.
,."
All I hlld incUoated, Mr. Biaharf i. a.h_ophiliac. On Nova=bar
28, 111112 wh.n q.tt1nq down from a l.dder he either t.ll and hit. bi.
h.ad or tha .ladder toll eand hit him on the h.ad (h. haa no
ind.pondent r.call.ation ot thi. .vant). Aa. r..ult. h. r.o.ived
. 7.5 om 1.ceration on tho oooipital r.gion of the .calp. H. want
to Apple-A-Day M.dical center Where he aa,., Dr. Hugh T. Knight. Dr.
KniQht suturad the acalp without takinq .ny diaqnaatio tasta. Aa
you oan a.. trom Appla-A-DaY'a reccrdll dated Nov&1l\l:)er a8, 19512, Dr.
lCniqht "'.. aware of the ract that Mr. Bishoff had . taa1:ar n:l::I:
d.tect. Mr. Bi.hott wa. than r.l....d .tt.r or. Kniqht. qav. him
in.tructiona r.qardin~ head tr.uma.
Mr. Bi.hotf r.turno~ to APple-A-Day and aqain .av Dr. Knight
on November 211, 111~a. Dr. Xniqht removed the dre..inq fram Mr.
Bishoft'. head wound and re-wrapped it. Aocordin~ t.o Hre. Bi.hott
who vae along on the vi.it. they reporte~ to Dr. Knight the faot
~hat Hrl Biehott h.d telt dizzy, had exp.ri.nc.d cold aw.ate, and
was ta.ling weak durinq the paet 24 hour..
That eveninq back at the Biehotta' hou.. Mr. Bi.hott b.oam.
eick to hilS !!Itamach and vomited .t approximatalY 1I100 p.m. At 7100
p.m. Hr. Bi.hott o.lled Dr. Knight and intormed him at hi. nau.ea
a. well .e hi. continu.d dia.in... and oold evaat.. Dr. Knight
disouss.d the posBibility ot a stomach virus .n~ wh.n aaked by Mr..
Bbhoff whether this had anythinq to do with the .ooident Dr.
Knight. .aid "no." That evening Mr. Bi.hott continued to
....
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PEN NSTATE
~
.
College of Medicine
UniversilY Hospital. Children's Hospital
The Millon S. Hershev Medical C~mer
O":llunnu,,'m \II :-'kLlIl':II\1:,H"'l1lillllh)~y DI\ j'ltlll
P.O. Bo, x511
Hmh.... Pcnn"lvnniu 17033
17171 ~;II.H399'
June 1, 1994
J. Paul Helvy, Esquire
Killian & Gephart
218 Pine street
Box 886
Harrisburg, PA 17108
RE: Bruce Bishoff
Deat' Mr. Hel vy:
Based on the information you provided me, it is my opinion
that Mr. Bishoff should have received treatment as soon as
possible after his head trauma. One can argue whether Factor
VIII concentrate was indicated initially or whether Desmopresain
(dDAVP) would have sufficed in a mild hemophiliac without
symptoms at the time of his initial visit to Dr. Hugh T. Imight
at Apple-A-Day on November 28, 1992.
Dr. Knight's notes state that he knew the patient had "a
Factor VIII deficit" and that head trauma instructions were
given. There is no mention in his initial note of November 28,
or in his follow-up note of November 29, that Mr. Bishoff was
experiencing dizziness. Neither is there any notation that Mrs.
Bishoff called on the evening of November 29 to inform Dr. Knight
of nausea and continued dizziness as stated in your letter of
May 26, 1994.
According to the Hershey Medical Center records which you
provided me, Mr. Bishoff began to vomit during the night and then
became unresponsive. Upon arrival at the Medical Center at 5:40
a.m. November 30 he was unconscious and his right pupil was
larger than his left. A CT scan showed evidence of a large left
frontal parenchymal hemorrhage with an associated large left
subdural hematoma. Factor VIII concentrate was administered and
a left-sided craniotomy was performed with the evacuation of the
subdural hematoma. Mr. Bishoff was treated with Factor VIII
concentrate on an 8 to 12 hour basis throughout his
hospitalization from November 30 through December 9. Following
discharge he received daily doses of Factor VIII concentrate
through December 20.
An Equ,tj Opponunlty UnivenllY
.
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"'1lD'NiI\, ~......"..,.,.,~
June 28, 1994
H. Elaina Ey.te~, H.D.
'Chie~, Divia10n ot Hematoloqy
Herahay He~ioal Cantar
P.o. Box 850
Harahey, PA 17033
.a. .ruo. J. aiahott
Sl.ar Dr. Bystarl
(C(Q)~1f
Thank you tor your letter ot June 1, 1994, roqardin'il Bruoe
ai.hart. upon reviewinq that lMttar I have a numbar or quaer-ione
which I naa~ an.wara~ in order to procae4 with Mr. Bishotr'e caee.
The.. quaatian. ara a. to11oW&t
1. Di~ Dzo. xni'ilht evor a.cart.ain tha apacitio t.ype an4
.avarity ot Hr. Biabotr's o1ottinq deticit?
2. Di~ Dr. Kni'ilht tail to exarci.e rea.onabla cara whmn ha
tailed to aeoertain the speoitic typa and aeverity ot Hr. Bishott'a
olottinq daticit? It your 'anawar t.o t;hia queat:ion ia in the
atUrmat.ive, plea.e explain how Dr. xniqht: could hava obtained thie
intoZ'lDllt.ion.
3. Di~ Dr. Kniqht: tail to ax.rci.e rea.onable oare when he
tailad to reter Hr. Biabott tor turther evaluation an~ treatment?
1:t your anawer to thia qu..t10n ia in the attirmative, plea..
in~lcate what type ot actiona would have been rea.onable tor Dr.
xniqht to take in thia aituation.
4. Did Dr. Kniqht tail to axerei.a reasonable care whan he
tailed to consult ather physioian. reqardin'il Mr. Bi.hott'. ca.e?
It your IInawer to thi. question i. in the affirmativ., plea.e
indicate what reeaurelle ware available to Dr. Knight tor conllulting
raqarding prob~em. of thi. kind.
5. Within a reaaonable deqrlle of medical ollrtaint.y, did Dr.
Kniqht'e tailure tot II) a.certain th. apaoitic t.ype and .everity
ot Mr. Bi.hotf'. olottin'il deticit1 bl reter Mr. Biahott for further
evaluation and treatment, lind, cl conault oth.r phyaicillna
..
i EXH'""
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.)1JL 6 1994
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College of Medicine
University Hospi[al' Children's Hospital
The Millon S. Hershey Medical C.:mer
D~pann""I~111l ~h:uil,;in~/Hl.:m.IUlhl~~' DI\ "Hill
P,O, Bu, x5n
HOl'ho", Ponnsvl..n,. 17033
,71715)I.M,199'
June 30, 1994
J. Paul Helvy, Esquire
The Law Firm of Killian & Gephart
218 Pine Street
P. o. Box 886
Harrisburg, PA 17108-0886
Dear Mr. Helvy:
RE: Bruce Bishoff
I would offer the following repliBs to the questions posed
in your letter of June 28, 1994.
1. Q: Did Dr. Knight ever ascertain the specific type and
severity of Mr. Bishoff's clotting deficit?
A: Not to my knowledge.
2. Q: Did Dr. Knight fail to exercise reasonable care when he
failed to ascertain the specific type and severity of Mr.
Bishoff's clotting deficit? If your answer to this
question is in the affirmative, please explain how Dr.
Knight could have obtained this information.
A: Yes. He could havs obtained it by calling the Hemophilia
Center of Western Pennsylvania in pittsburgh.
3. Q: Did Dr. Knight fail to exercise reasonable care when he
failed to refer Mr. Bishoff for further evaluation and
treatment? If your answer to this question is in the
affirmative, please indicate what type of actions would
have been reasonable for Dr. Knight to take in this
situation.
A: Yes. He should have initiated some form of prophylactic
treatment (Factor VIII concentrate or possibly
Desmopressin) at the time of Mr. Bishoff's initial visit.
..
.. EXHIBIT
I
.-\n Equal Opportunuy UnivenllY
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. .
J. Paul Helvy, Esquire
June 30, 1994
Page 2
RE: Bruce Bishoff
4. Q: Did Dr. Knight fail to exercise reasonable care when he
failed to consult other physicians regarding Mr.
Bishoff's case? If your answer to this question is in
the affirmative, please indicate what resources were
available to Dr. Knight for consulting regarding
problems of this kind.
Yes. He could have consulted with a Phrsician
knowledgeable in the care of persons w th hemophilia, or
referred him to the Central Pennsylvania Hemophilia
Center located in Hershey.
A:
5. Q: With a reasonable degree of medical certainty, did Dr.
Knight's failure to: a) ascertain the specific type and
severity of Mr. Bishoff's clotting deficit~ b) refer Mr.
Bishoff for further evaluation and treatment~ and c)
consult other physicians regarding Mr. Bishoff'S
treatment, increase the risk that Mr. Bishoff would
develop intracranial bleeding and experience associated
neurological difficulties?
A: Yes.
6. Q: Are hemophiliacs who suffer trauma to the head at
significant risk of sustaining a subdural hematoma and
neurological damage without appropriate medical care?
A: Yes.
7. Q: If Mr. Bishoff had received appropriate medical treatment
from Dr. Knight would the risk of intracranial bleeding
and associated neurological difficulties have been
greatly reduced or prevented?
A: Yes.
Sincerely yours,
~~ ~4.
M. Elaine Eyster, M.D.
Distinguished Professor of Medicine
Chief, Division of HematolOgy
MEE/lmn
J .
BRUCE J. BISHOFF and
BETTY J. BISHOFF, his wife,
Plaintiffs
v.
I IN THE COURT OF COMMON PLEAS
I CUMBERLAND COUNTY, PENNSYLVANIA
I
I
I No. 94-6662 Civil Term
I
I
PHYSICIANS UNLIMITED, P.C.
t/d/b/a APPLE-A-DAY and
HUGH T. KNIGHT, M.D.,
Defendants
.
.
I JURY TRIAL DEMANDED
STIPULATION OF COUNSEL
The undersigned, being counsel of record for all parties to
this case, do llt-,i,culate and agree that:
7-11 ~ I
1. Plair ;9. .5 d care and treatment
for his subdu ~/) AM~ .ng providers on the
following date ~UJ r ' '30/92;
(a)
(b) , J2I uJ <'&J ~~41.:1
Support
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111
(cl f) ,t~ '?U</ d:- University
, ~d.: V~d4~
Hoi 11/30/92;
I ~/-? ~. tUcIt
(d, University
Hospital - Inpatient - 11/30/92 to 12/9192;
(e) Hershey Medical Center Outpatient
12/15/92, 1122193, 3/1193, 2/2/93, 3/30/93;
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CERTIFICATE OF SERVICE
The undersigned hereby certifies that, on the date below he served a true copy of Plain tilTs'
Praecipe for Settlement and Discontinuance, on each of the persons listed below, at the addresses
set forth, by First Class United States Mail:
DANIEL GRILL, ESQUIRE
PORR & ASSOCIATES
1850 WILLIAMS PENN WAY
SUITE 209, P.O. BOX 10696
LANCASTER, PA 17605-0696
By
nthony Ste
#25497
407 North Fr Street
P.O. 27
Harrisburg, PA 17108-2027
(717) 232-0511
DATE: ~ ~ W -00
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