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HomeMy WebLinkAbout96-00974 ~j ,..... .) ~ 1 01 u,J .J -7' I j >, , ~ <j N , i ~ j j,l I J I ., i I 'i J I 1 I j :r r 0- ...5 0- , . ,~ j 3. Whac are Plaintiff'," damd'Je3.' rv. SUMMARY QE' LEGAL rS311f:S There are no legal issues known at thi3 time other than the evidentiary issues normally encountered by this ~ourt. V, THE rDENTITY OE' WrTNESSES TO BE CALLED A, Expert witnesses: 1. "rederick H, Kass, rrr, M.D. - a copy of Dr. Kass' report and curriculum vitae is attached hereto, incorporated herein by reference and labeled Exhibit "A." 2, Christine Bachorz, R,N. - a copy ot Ms, Bachorz' expert report and curriculum vitae is attached hereto, incorporated herein by reference and labeled "B," B. Fact witnesses: 1. Paul Zucker 2. Patricia Carey Zucker 3, Steven Zucker 4, Robert Gordon, M.D. 5, KLmberl y Mart in-Alexander, R,N. 6, Donnie Asbury 7. Deborah Kelley 8. Dixie Lebo 3 9, Walter Wi.lson 10. Cynthia Walch 11, Lawrence Thompson. M.D. 12. All witnesses listeu in PlaintiEE's Pretrial ConEere~ce Memorandum 13. DeEendants reserve the right to supplement this witness list prior to trial, VI, EXHIBITS 1, Medical records of health care providers, 2. Consent form signed by Mr, Zucker prior to the administration of chemotherapy, 3. InEormation sheets provided to Mr, Zucker concerning the chemotherapeutic agents that were administered. 4, Videotape depicting treatment rooms at CMA. 5, Anatomical drawings of relevant anatomy, 6. Relevant texts. 7, DeEendants reserve the right to supplement this Exhibit List prior to trial. VII, STIPULATION 1. Parties have agreed to exclude any and all testimony concerning problems Ms, Martin-Alexander was experiencing with personal relationships as well as Mr, Zucker's statement contained in the medical records 4 OIlS. NF.WMAN, WOOSTER, KASS. BRADfORD AND MCCORMACK. P.A. 11110 MEDICAl. CAMPUS ROAD SUITE 130 HAGERSTOWN. MARY\.,o\:..O 21742 l'liUl'HON!~1) 1lJ,l6QO CiORCI C. N_.II. 'I~ D. ...D. .. D"lGKT ~tJP. M.D. P,;,,:.. 'alDIIll<:IL 1lAJ~ to. M.l), ..\MiIA 'OlIll1AD1'oau,...o. M:C1Io\li.L). M<.COaw.<:1l. M.D. I.Th'THIo\ 1II1TT1'l'''SANDS. .." )..101I$ II, KNolI'IIJUoW" CIU'l' Il'lTUNAI. MiDICIN. PVLMONMY D1UAlII ONCOU:X;V .1 U!Mo\l'OLUG"t INTIIU'lAL MIIlIWlI ONCOlOGY. IHrllU'li\l. "':DICli'II U.KlATIlCS . INT!IU'lAl. MiDICII'lI NU1S1 PMCTITIONII OctDber 5, 1998 Allynol41. , Havas Ms. L.auralee B. Baker 101 Pine Street P.O. BOll 932 Harri.burg, Pennsylvania 17108-0932 AE: ZUCKEA v, COWL.EY MEOICAL ASSO"P.C.,et al R&H File No, 3328-1 Oear Ms, Bake': I have reviewed the medical recor41. regarding tne care of Paul Zucker, In conjunction wIth Zucker v, Cowley Medical Associates, P.C. Specifically, I have revIewed tho follDwlng records: 1, PlaIntiff's complaint 2. Oeposltion of Paul Zucker 3, Oepositlon of Kimberly Martin-Alexander, R.N. 4, Deposition of Oillle L.ee L.ebo, R.N. 5. Deposition of Lawrence 1(, Thompson,lIl.M,D, .. Deposltlon of Donnie M, Asbury 7. Deposition of Walter G. Wilson a, Oepoaition of Robert A, Gordon, M.D, 9. Medical recorda of L.awroncs 1(, Thompson,llI ,M,D, 10, MedIcal records of Cowley Medical Associates 11. Medical recorde from Harrlsbur9 Hospital 12. Medical record. of Raymond Kostln, M.D, 13. Medical records of Stanley R, Goldman, M.D, 14, Statement 01 plaintiff's expert witness, David T. Harris, M,D. Mr. Paul Zucker I, a '7-year-old male diagnosed in September of 1994, with non-small cell carcinoma (poorly differentiated squamous cell carcinoma). At presentation, he had clinical Stage III-B disease (8 em anterior mediastinal masa) and therefore, was not an operative candidate, He was managed with combination cllemotherapy, Initially receiving platinum and VP-18. He received two couran 01 this chemotherapy (October, November 1994). In Docember of 19;4, his cllemotherapy was changed to Mltomycin-C, vinblastln, Platinum. His first course 01 this chemotherapy wn admlnlatllred Oecember 19, 1994, through an I,V, site In hi. rigllt hand. The Mltomycin-C and Vlnblastln were given I.V, push and the Platinum was given as an Infusion over two hours. The pationt received an additional two houra of I.V. lIuld Inluslon, The note from Kimberly Martin states the chemotherapy was administered Lauralee 8, Baker Page 2 RE: ZUCKER v. COWLEY MEDICAL ASSOCIATES without difficulty and there was excellent blood return from the I.V, .lte, On December 23, Mr. Zucker returned complaining or discomfort in his proximal right forearm. On examination, he had swelling, edema and erythema In that region. This reaction was attributed by Dr. Gordon to a chemotherapy extravasation and WII managed with Ice. .Ievatlon and a sling, On January 3, 11195, a right aubclavlan medlport was placed for further chemotherapy. A second eoura. of MVP was administered through the medlport an January 111, 18115, Mr, Zucker had no further complaint about hla right forearm until February 27, 1995. when he presented with Induration and a 3 cm arOl of necrosla in the right forearm, He was Immediately referred to Or. L.awrence Thompson for surgical management. The cause of Mr, Zueker'a necrotic uleeratlon and the time at whIch it began Is uneertaln. HI' chemotherapy on December 19th waa a prolonged treatment and was administered without difficulty, An experienced oncology nurae (like Kimberly Martin, R.N.) would have dlacontlnued chemotherapy Immedla.oly had thore been any complainta of pain or discomfort' In the right arm, The fact that the patient received a prolonged infusion and that Mltomycln-C and vinblastln were given I,V, push indicate that extravasation did not occur during the time of chemothr.rapy. It is possible .ubsequent to chemotherapy that the patient experienced olltravasatlon In hi. right forearm. Factors contributing to this would be anticoagulation (Coumadlnl, altered thoracic venous circulation due to I thoracic malignancy and left subclavian thrombosIs. Mr, Zucker'a medical care on Oecember ll1th was appropriate. Thore was no Indication of extravaaation and hence, no treatment waa Indicated, Management (local measures) whon the patient returned on December 23rd with right forearm discomfort and swelling was appropriate. I must anume that the patIent's condItion relponded to these measures in that he did not complain about his right forearm until two months later, and he was seen regularly during the Interim. Ourlng thIs time, he received additional chemotherapy (MVPI through hla rIght-sided medlport. From this Inrormatlon, I conclude that Mr, Zucker's right arm ulceration cannot be attributed to the chemotherllpy he received December 19, 19114, or to the technique that that treatment was . admlniatered. His nursing care on that date wae Ipproprlate, I believe that Ur, Zucker's ulceration waa due to delayed Das. NEWMAN. WOOSTER. I<Ass, BRADFORD AND MCCORMACK, P.A. IllID MEDICAL CAMPUS WID sUITE 130 HAGWTOWN, MARYLAND 21742 TJUPKOIll(lOI) 7\1-1400 'IOIQIC. NlWMAN.D. PlLD.101 g, L WWKl' f/OOSTD.lol.ll.. '.c.c.. .lliOWC II. lASS, DL M,D. ....\IIIA _ wllfUlll), M.D. hIICKo11L~ ~ MP, C'/NTIlIh lIlJTTNa&oSr\NDS. M.D. )No4li.I H.IfAWVUMALl t;llNt CURRICULUM VITAE INTUJ'/AL IoIiDICINi PU1.MOI'WlY llISWU ONCOLO(,.... .lIIMo{roLoc:Y 1N'rtl/W. MlDU:INI ONCOI.OGt. INTIIlNAL /oliI)ll;l1ll COllIlL\TIlCS .lNTPl'IAI. MlDlCINI NUIWI ,MCnTIONU NAME: Fr.d.rlc H. Knl, III, M.O ADDRESS: Horn. . 12804 Cov.nant Way Hagerltown, Maryland a114~ Ottlc. - 11110 M.dicII Clmpu. Road, Suit. 130 Hag.rstown, Maryland 21742 DATE OF BIRTH: February 21, 1948 EDUCATION: May, 11170 - e,A. deg"e, Colgat. Univeralty, Hamilton, New York May, 1874 - M,D. degroe, aeorge Washington Unlverelty, Washington, D,C, Honor aocletl..: 1174 Alpha Omega Alpha PROFESSIONAL TRAININQ: 1174-11175 - Intern.hlp, Medll;11 Servlc., Unlverllty of VirgInia Ho.pltal, Charlottesville, Virginia 1975-1977 - Residency. Medical Service, Unlverelty of Virginia Hospital, Charlottesville, Virginia 1917-111711 - Hematology, oncology Fellowship, Georg. washington University Medical Cent.r, Waahlngton, D.C. BOARD CERTIFICATION: 1977 - American Board of Internll MedicIne 11178 - American Board of Internal MedIcine - Medical Oncology PROFESSIONAL SOCIETIES: Amerlean Colleg. of Phy.lc:ianl American Society of Clinlcll Oncology ....dlcal and Chlrugicll Faculty of Stat. of Maryland LICENSE: Mar yland, 19711 MEDICAL. DIRECTOR: John Marah Cancer Center, Hallerstown, Maryland CHAIRMAN: Cancer Committee, washington County Hospital, Hallerstown, Maryland MEDICAL. DIRECTOR: Hospice of washington County, Hager.town, Maryland ~ / Clui.1il1o Bachol7, RN, OCN 436 EaSl Oregon Road Liti~ PA 11543 Oclubq I, 1998 Dear Ms. Baker. A1 your request I IllIvc revillWc:d lhe case of Mr. Paul Zucker vs. Cowley Medical AasocUlICI, P,C, IIId Kiwb",ly Mar1iD RN. In pn.:parinS this lCpOI1, I :.~vo roviowed lhe mulil:lll rucords aud th&: <IqlU:riliulI lr'dD.'IClillU of Killlbl:rly MartW, Paul Zul:kl.'r, DWo Ltbn, Cunni. A.!ibury, Wall Willil/D, Rubllf\ GoMUa, MD and lawreuco Tblllnp>lUn, MD., as well.. lb. ""pM repcut~ lIubmilWlI by M3. LiIo;e1y, MJ', Zucker was diagtloS<ld wi!h non-small ccJlling Cilriuolua, poorly dilTlrQ1\Ialcd in Scplcmba 1994. Un.... tho Carll or Dr. Robort Oonloll, lhe pllliu'Ilx:ll'U1 treltl1lall Cur hill C""Clll' II C<lw1lo'Y Mulk:al Associalat on OclOblll' 17, 1994. The patiCIII recovat fuur lIUlIllII of IV Platillul 1I11d ural EIopnsUle lIulQ Octublll' 10'" thmullh Nllvl1tllber 21. 1994. OIuiI'S Ihilllimo the pati\1llll1lpcriCll(;cd a lbrowbu.y uf Ihlllllft bl'ill.:hioccpballc v1:in which rll51l'idatlhe WIO uf tho limb for iIIly prucullllCll. Duo IIIlhl! di>>cuvltY uf a IIllW cavicallywph nude, believed to bo WCla;,tlllie dilll-dso, tho chClDlltllaapy trwtmalt \Val changed 10 a tqlimcn uf IV Platillol, M1hllll)'\;in ami Vinblasliu. Tho; p~tir.;D1 had blood work llrawu 6'u1D the Ii&bt anlecubital an:a priUrlO rcceillwglhun..w l:humothctallY l'\:gimlD UD Dec:emhct 19, 19'J4, The chcmothlr.lp)' Will giVl:II througl1 an IV silo in Ihllllul1U111 otd\Q rlahl bllllll. Mll, MiIlTiD'llIO~ iDlIieall'll thai t11.:Je \VOZUDO pmblcwa durillg tho W\lQO of tho iofllliuD by oolins. .. .cdL:Il1 bluud ""wn, <;bcmo given as pill' now~.1\ ill lluring this llealmCUI that llic pUlil:llt uUeaClS an CAll"il1lilll31iun oflbe cl1cwotl1criI(IY oc.cun'ed. Somo commoll side elrcct.l of chCUlOlba-apy may include nausea, vomilin& coDSlipalioll, myelu.'UppressioD, ClIU'lIYlISation, hnirloss, and Jluiph~dl DCUlUpathy. lWrav""Uliun i.:s dcfilllld as tho: infiltratiou at lcaka&e uf an inllllVCIIOUI (IV) iIIIlillWplllllic ag&!lll1.u1O dw lucallillllllc' Vc:W:aII& aga1lA an: ally .g~1iI that may produce pain IIIId ;nfl.mm.'ipu lithe allmini.:ltratiuD silO or AY'll4'lllic:any, Both Mi10mycin IDId Vmbla5lillo: am clllllsificd illl nsiciIIll agcutA. tho: pullsibililY uf .lrallasalk'o QllGI aee.pled risle of both Mitnlllycln and Viub1a5lillc. This rUk _ clUlllly idallilicd au the cl,,,'\Iu!hctllpY COIUCII\ r"nl~ t Wllulll agree will1 the plaiutill's cxpm wilDen. M3. Lik.:.ly, ulIlhll :IIep$ that would he llIkloll in tho llVCBt uf an ex1lavasatioD. Dull to the lack. of my Ri&l1I UflIYlOpWms of elIInIVa.~atiUIl wrin, ur imm...lI~ldy lI1l... tho:.:.IU:JIIUthcrdpy treatmCU\ au DCCl"nbl:l' Ill, 1994, llealmall for t:lW"oIYusation '11I11 1101 iudil:all:ll. Upon rwicw orlbe wedical rllCOnI3, I was wublo 10 determine thaI m .tnvumion ufMitoDlycin at Vinbhll..tine did occur 011 Ol:Ccmhlll' 19, 1994. TIle IRcdicul rOl:Ords illdicllled an ...cclhml blood retUlll IhInuglwllllh. chClllllthcrapy lIQ1lIllQlI. Thlll'O was WI C\lidcnce ofrllllnUSll, bumiug at 5wl:lliull urthu YCllOu.~ me ur lI111ec:llbita! sito, which would mdicalo u JlO5.oUb1c cxlnlv_tiuu. Tho PIUWI did ""un. 10 C<lwl..'Y Mulical AuocialCllwo daya Isla'1O n:porI di:;cowlUl'l ill hi.:s riQllt antecubital sPa&;i:. Pby:;i4;41 exam ofthl! site r..'Vllulal rlldness and WWlth uf tho sito. DclayOl1 si8llS IlIIll l)/D1plums of an ClIU'lIVa....wUIl arc II rloWgni~ comp1il:lliUlI with 1110 USO of dll1lllulhloTllpCUlic agcnll. 11 would Dul bll Uppruprillh: 10 . admilll.~CI' an 3IItitlulll two days a1\cr lhc chclIwthmpy wa.~ adlllinbtl:tal. Rilther, tre:.l m~Il' wuuld "41nsm IIf iCIl ur heat, clovilWlIllIll to nutifY tho phYliJ.;ian, which was done in this ca..", II WllUItlOOI be possible 111 detCl1lliw: wbio.:h I1ruS iIIfiltralOl1 ill t1W puinl, SclOClioD Ofthll iDII1sion sile is dcpmdcnt upoo many faClon. To prcserve vcu.ous inI"l!rity over timo the lI1It.c 'lhlluld begiD distally mLl work pruximnl1y if posllibl~. Venipuncturo sillS wnwl be alteral "'hro ptllllliblo. HnWC\l.:J in KJme cases this Is 001 always pOllSiblo.lu gall;ral, Vl:illli ufthe dol'SUW of 1111: hallll ore pretcttcd ba:lIWIu thllY are easy III visuall~.u iUldslubi1i:l.c, and iL ill thl:l'llfure easy III sco: uf 1IIll,;ll1nlV.lliatiull bas 11Ik12l place. The forCMlIl is !he fllVorilo site fot Vl:liiCIIII al!millistntioo, wilh 11111 hand bang tho: 5l:l:UIu! prcfe"'1\ situ. The OMIll' of adlllini.lralillll, Yl:.iicant OlllUlllll:llil:llllt, remain a lXllllrovl,;tsial i""~lll in IU.bnini.1l11lioD Orc1...,uuth~lpy. Either practice is ilCCl'Pl.lble. '. ~ CHRISTINE BACBORZ, RN. OCN 436 !!all On:aon RlIId Uli~ PA 17543 Home phone; (111) 569-5559 Bar c#J.~ PROnsSIONAL IXPEImNCE · Nune MaJlan~. Lucutcr Geaeral BCllplta!, Laacuttr. fA 0I:10bct 1996 10 pRICIIl- NunG Mmiga at i 27 bad ~logylMc:dicaI.SurgluI unit Including iDpIlicDt IIld O1lIpItiCIIt ICIVlccI, c- RegistJy aud Oncology Rca:arch Nune. Mauagcr of IV ~CCI afIlIc:tiw October 1997. 1lcspolliibilillca Indudll dally operalions COlISIItina at mmn, I-. statf cduealion, budV'ln& C1nployee cvaI~ birfll&'firlng. staa mectinp. 1DIu.riDa eomplliwa 10 human _ po11clct and proccdum. ICIPOnslbIe for Ila.lJ'mcctina cmplOJlllClll rcqultcmcnta, "';"Iog with paliw mll'amily iSlllCl, iDcreqscd committee IllCmbenhlps ml increaIcd c:aIIaboraIion with physlclanJ in ordor to alhancc Ib,OJll;Ology program with pbysicianL · A~tlal! Nune MlIDlIle~. Laacutcr Ccac~1I BOlI'UaI. Luc.utu. fA October 199j to Octcbcr 1996 - ActIug NUIK M.IInagrr at i1$ bad <m.o!ogylMcdlcal.SurJ:ical 1IIIi! lncIudiIJC iDpaIiCDt and 0IItpQIicD11C1Vka, Cancer ReJ:!stty 1114 0nc010llY Reseazch NUISI. RapoDSlbilillca1istecl above. · Actinll OacolollY llasean:1I Nunc. Lucalter Gcaual BalplW, Lucasler, PA June 1996 to Oc;tllbc:r 1996 and JlIIIWII')' 199710 A\IiIISl1997 - R\:IpomIblIlIlcs iDcludl:d Idellli1)llll plliCD1'1 for CIII1lI1wl:n1 in R:IClIrdI protocoli, collection at dill, dalil c:nlry, patlelll follow-up. IIICClina aud malnt3la.lDa roguhllol)' ~lll of rucarch lludiCllIDd lialJou bclWCCD pbysIQaAs and llUdy Iponset$. · AJ5lStllllt Nurse MIlIISIler, Laaeuter GcIIInl Bosplla!, LlIICutcr, PA D-o\:-onbeo' 1992 to December 199'. As&litaIlL Nune MaDagcr on Z' bed O.lll:OlogylMcdh:a1- Surpca1 ualt Rcsponsibllll.lu Iadudcd statf 1dItdu1ln& committee lI1volvcmcnl, ad cw1uat1ol11, dilposition at i11clclcat repottS, s1gnina offphyslcIan orl1c:rs,1laisou bclwccn .t.1If, pallent'.1I14 physicIalll. · Chlll'l!e Nurse, Luculer eueraIllo.plW, Lucaster, PA Sept""'be' 199010 Novewbcr 199Z - E\'clliD& Ihi1\ c:harp IIIItse on a 2' bed 01lco10811 MIdIa1-5uraicallllll1. Re5poftll'bilil.lu iIIcludcd slJDiDll off physician orders, pat!ClI1 plll(;ClIlenl, liaiSOD bctwcCD .laIr, paticnt'sllld physicians. ~licm= In the Oulpa1lcnl Onc:ology ScMc:cs CcpartIIlC11t u the primary can:Ji- prov1dinSlhort procedures, 'N medication admlnislmllon, . blood procIuct admlnIstnllion, OUlpallcm CValualiOD lor pbyslclans, Chemotherapy admInisttation IIld stalW the OncololY Hoillnc wIsIiuj: paIIenL'. wilh appropdalc ItWlo'lgeDlCDt at c!IcmotbIrapy side clJ'CClI and qucstions rce;m1lllg cancer. . Staft'Nurse, Laacuter General Hospital, LllIIUSlU, PA Jarwary 1990 10 September 19!1O - SlaIfnurse on a UrololYlMcdIcal.Surgical unit · Staff Nurse., Latrobe Ana Bospllal, Lalrobe, PA March 198810 Oc;tobcr 1989-Stall'nllliCon a21 bed Oncology unit. · Starr Nune, WutCI'll P&DIUylvanla Hospilal or PIII.bul1b, Pllt.lbu'llh, PA July 198610 March 1988 - Slaffnwsc ORa 40 lxld Oocology unit. Pallllon . .. WRITT!N .XP!RT R.PORT ~, expert reports and curriculum vitae of David T, Harris, M.D. and Kelly Likly, R,N., which are attached hereto as Exhibits "B and C'. Defendants furnished their expert reports to Plainti!! on October 8, 1998. Plaintiff's experts' rebuttal reports will be supplied to all parties prior to trial. r. STIPULATION or THB PARTI!S: Ir ANY Plaintiff requests that the parties stipulate to the authenticity of the medical records and medical bills so as to obviate the need for the testimony of records custodians, Plaintiff also requests that Defendants stipulate to the amount ot the medical expenses incurred by Plaintiff to treat the injury in the event that liability is found. G. ISTIHATID LINGTH or TRIAL Approximately 4 days. B. 8eB.DOLING ~ROBLIM8 This case was initially listed tor trial during the November, 1998 Cumberland county Trial Term. Because the case was not reached at that time, the Court subsequently issued an Order granting this case priority on the February 1, 1999, Cumberland County Trial List. The Order further indicates that it is not necessary for the parties to attend the Call to the List or any Pretrial Conference. A copy of the Court's Order of November 13, 1998, is attached hereto as Exhibit "0", 4 - '", . ~......d.l!l ~..~'Iil~~fti~~x::r~.~t:f.:;W~,~"j IXHIBIT A ' i .~"...~ . " " . , . 'e', " ~: : "" . , I ,. 'l. '\. .. "fI , . . 11". . "~i-~' ..,,' , . .-.;:;- " ';,; .' , ~. f ,',~ ...... " . . I , , ! I "" l. , - ",<~'. .........,.. '/:,& "1'. ~ ,'fl:' 'c "I , ;:rl If i """".".+o!!'!,,J~CJ,. ". jl\r ~ . IXHI8IT . ,~,~_,"'~."J_ . ~""""'-- ,. PcnnJyIVUlia, 1979- 1 914 Director, Medical Studelll Elective Proaram. FOll Chase C&Mer CelIIer, PhiWlelphia, Pennsy/vulia, 1 979- 1 914 Director, Medical OIIc:ololY faUowship Tr&inini Program, folt Chue Canc;cr Cemer, Philadelphia, Pennl}llvania, 1979-' 983 Director, Outpatient HematoloBY LAboratory. FOll Chasa Cancer Cantar, Philadelphia, PeJWyIvania, 1980-1984 Anodat' Direc:for, Onc:olosy llervic:e, Lanlcenau Cancer Treatment Centar Wynncwooc1, Perml}llvaoia, 1914-1993 Auoc:iata Phy1ician, Department of Medicine, Divilion of Hemarology/Onc:olosy, The Lankcnau HOSpital, Wynnl;Wood, Perm sylvania, 1984-preSt.\t HUfIW\ Subjects Committee, The Wister Institute, PhiWlelphia, PelUlsylvallia, 1m-present Legialarive Committee, Philadelphia County Medical Society, Philadelphia. Permsylvania, 1992- I 993 Clinical Competency Comnuttee, Department of Medicine, Lanlcenau Hospital, WylIMWood, Penniylvarua, 1994-1995 Preceptor for IntemaJ Medicine Residency Program 1994-1995, 1997-prescnt Canc;cr Committee, Lankcnau Hospital, 1994-prescm Chairman, Research Protocol Subcommittee, 1995-present Gastrointestinal Cancer Subcommittee, 1995-presenl Oenitourinuy Cancer Subcommittee. J 99S-present Bioethics Committee, Lankcnau Hospital, Wynnewood, Pennsyivaoia, 1995-presem Communrty Clinical Oncology Program Committee, Main Line Health System, Radoor, PenIlIYlvania, 1994-present Vaccine WorkiDa Group, Division of Neoplastic Diseases, Thomas Jefferson Uoivenity, Philade1phia, Pallll}llvania, 1995-presellt Clinical Oastroimestinal Oncology Group, Colorectal Subconunittee, Division of Neoplastic Diseases, Thomas Jelferson University, Philadelphia, Pennsylvania, 1995-1996 Expert Advisory Panel on Hematologic and Oncologic Disea.se, General Committee of ,'Y.: , , , i \ \ ' '~I t ! I' ~ (') I . -' (. i , '. i i I I, Ii, I I ........ U N 1 V E R SIT 't. \) F MEDICINE '1 REATMENT CENTEB ~I E Ole ALe E :-.; T E R 601 Elmwood ^vcnuc, eo. 61- RochcnCl', New Yor. I46<4Z (7t6) Z1'.OO38 KeUy M. Likly, RN, MS University of Rochester . Strong Memorial Hospital Box 610 601 Elmwood Avenue Rochester, New York 14642 November 12, 1997 Dear Mr. Wisneski: Thank you for allowing me to review the case of Mr. Paul Zucker vs. Cowley Medical Associates, P.C. and Kimberly Martin, R.N. I have reviewed the medical records and the deposition transcripts of Lawrence K. Thompson, Donnie M. Asbury, Dixie Lee Lebo, Cynthia Walch, Debra L. Kelley, Paul Zucker, Kimberly Mlirtin-A1exander, Dr.Gordon and Walter G.Wislon. I offer the following evaluation from a nursing perspective. Both Mitomycin and Vmblastine are vesicant chemotherapeutic agents. Vesicant agents have the potential to cause cellular damage or tissue destruction if leakag<<l occurs into the tissue. When a patient is receiving a vesicant agent he should be instructed to notii)' the RN if there is any burning or pain with the chemotherapy infusion. Mitomycin and Vinblastine each have a specific protocol to treat an extravasation. With both vesicant agents the first measure to be taken if an extravasation has occurred, is suspected or if the patient complains of burning or pain with the infusion is to stop the IV infusion immediately. The next step to treat an extravasation with both of these agents is to aspirate from the IV tubing as much of the agent as possible. The third step common to the treatment of an extravasation with both Mitomycin and Vmblastine it to notify the physician. With Mitomycin, an ice pack is then applied immediately and the patient should be instructed to apply to ice pack for :l0-30 minutes on lU1d 20-30 minutes off for approximately 48 hours. With vinblastine, you immediately inject Hyaluronidase subcutaneously into the extravasated site with multiple injections. Warm compresses are immediately applied, initially for 30-60 minutes and then on and off every 15 minutes for approximately 24 hours. With both medications the extremity can be elevated to reduce swelling if there is swelling in the extremity. Infusion site selection is one of the most important decisions the Oncolosy nurse makes when administering vesicant chemotherapeutic agents. The distal forearm is usually the site of choice to administer vesicant agents in an attempt to avoid nerve and tendon sites that could be damaged by a vesicant extravasation. Care should be taken to avoid areas of recent venipuncture or IV sites. If there have been recent veinapuncture or IV sites the vein selection should be proximal ( or above ) these areas as an IV site chosen below a recent veinapuncture site could cause leakage into the area of the old IV/veinapuncture site. Vesicant chemotherapeutic agents should be administered first, after patent IV access has been established. They should be . .,tmini~ered IV push and blood return should be checked frequently throughout the push to determine vein patency. In reviewing the medical records and the deposition transcripts the following deviations from the appropriate standards of care for the administration of vesicant chemotherapeutic agents are noted to have occurred: 1. Vein selection was inappropriatt. The IV was inserted distally to a previous veinapunctUre site. 2. When the patient complained ofbuming and pain at the IV site the infusion was not stopped. 3. Appropriate immediate treatment such as aspiration of the chemotherapeutic agents, administration of Hyaluronidase and the use of warm compresses were not performed. 4. Notification of the MD should have been at the time of the pain and burning with the infusion or at the first time the patient presented with the pain and redness in his arm. 5. Measuremenu of the area should have been taken and thorough documentation in the nurses progress notes should have been completed with detailed patient instructions and follow-up outlined. 6. A patient call system should have been made available for the patient and/or the RN should have been in the room during the infusion. It is my opinion, with a reasonable degree of professional certainty in the field of nursing, that the care rendered to Mr. Zucker by nurse Martin and Cowley Medical Associates, P.C. fell below the appropriate standards of care for the above noted reasons. It is aiM! my opinion, with a reasonable degree ofprofessionaJ certainty, that Mr. Zucker's necrotic tissue damage was a result of such deviations from the appropriate standards of care. I hope that this inf.umation will be helpful. Please do not hesitate to call me with any questions at ( 716 ) 27S-0038 Monday. Friday 8:30-5:00 p.m. Sin<mly, -h R,J}A!> ~UJdY' R.N.. M.S. - - EXHIBIT D , ., LII~ AND TYPB O. DAMAGES CLAIMED Plaintitt incurred approximately $1,144.54 in medical exp4nses in order to treat his injuries. ~,medical bill summary attached hereto as Exhibit "A". Plaintitt also seeks general damages, such as mental and physical pain and suttering, embarrassment and humiliation, distigurement, and loss ot life's pleasures and enjoyment. c. LIST O. MANZS AND ADDRESSES O. ALL PERSON WHOM MAY BE CALLED AS WITHESSIlS Paul Zucker 1523 Kay street HarriSburg, PA 17109 (liability and damage.) Kimberly Martin, R,N, 101 Pine Street HarriSburg, PA 17101 (liability - Defendant a. on cros.) David T, Harris, M,D. (plaintitf's medical expart) The Lankenau Cancer Center 100 Lancaster Avenue Wynnewood, PA 19096 (liability and damag..) Kelly Likly, R,N. (Plaintiff's nursing expert) University of Rochester strong Memorial Hospital Box 610, 601 Elmwood Avenue Rochester, NY 14642 (liability and damag..) Lawrence K, Thompson, M.D. 4700 Union Deposit Road HarriSburg, PA 17111 (d..ag.s) Dixie Lee Lebo 2677 Ritner Highway Carlisle, PA 17013 (liability) patricia Zucker 27 North Front Street Harrisburg, PA 17108 ('\ialllages) Stephen Zucker 6213 Edgeware Road Mechanicsburg, PA 17055 (dalllag..) Robert A, Gordon, M.D. 500 University Avenue Hershey, PA 17033 (liability and damag..) Debra L. Kelley 3221 Maple Lane Harrisburg, PA 17110 (liability) Walter G, Wilson 811 Conodoquinet Drive Camp Hill, PA 11011 (UaJ:lUity) Cynthia Walch 310 Lumber Street Middletown, PA 11057 (liaJ:lUity) Donnie Marie Asbury 314 West Marbl. Street Mechanicsburg, PA 17055 (liGUity) Medical Records Custodians All witnesses identifiod by the Defendants Plaintiff reserves the right to supplement this list in a timely fashion prior to trial, D. BUIBITS Medical records of Paul Zucker Medical bills of Paul Zucker Medical bill summary Photographs of Plaintiff's injury Report.s of Plaintiff's experts Curriculum Vitae of Plaintiff's experts VideO/diagram of Cowley Medical Associates layout Anatomical models and diagrams Medical and nursing texts Labeling, insert and handout information pertaining to Mitomycin and Vinblastine Plaintiff reserves the right to supplement this list in a timely fashion prior to trial, B. WRITTEN EXPERT REPORT ~, expert reports and curriculum vitae of David T, Harris, M,o. and Kelly Likly, R,N., which are attached hereto as Exhibits "B and C". Defendants furnished their expert reports to Plaintiff on October 8, 1998, Plaintit f' s experts' rebuttal reports will be supplied to all parties prior to trial. w. STIPULATION or THE PARTIES: IW ANY Plaintiff requests that the parties stipulate to the authenticity of the medical records and medical bills so as to - , '4< '# ...." It .-'. 'h"_~1lo< ,__.__-"" .,,,.~~..~,._,~""-"" ,_if_'" ,-_,p"O , " . .!I" .... .~ ;. . , iI' e.. '.If : ,".. -.." .t~~. '1" . ".... t.'- " . ., ; - " , 'AUL SUC." DOB. U/07/30 DOAI 12/11/14 BILL SUJOUUtY S~anl.v Goldman , Associate. 02/"a/95 otUce note to reter to Thompson H/C 03/30/95 ottice note tor reter to stratis tor burns H/C Subtotal $ Dr. ThomDson 02/38/95 ottice visit 03/03/95 ottice visit Plastic tigure ot arm Est, briet, phys 03/06/95 ottice visit Supplies Tax 03/09/95 ottice visit 03/14/95 ottice visit 03/23/95 ottice visit 03/31/95 ottice visit 04/06/95 ottice visit 04/17/95 Otfice visit 04/24/95 ottice visit 05/04/95 ottice visit 05/12/95 Debridement skin 05/36/95 ottice visit 06/03/95 Ottice visit 06/16/95 ottice visit 07/07/95 ottice visit 08/07/95 ottice visit 08/14/95 ottice visit 09/18/95 ottice visit 11/09/95 Ottice visit 04/08/97 otfice visit 50,00 50.00 100,00 30,00 20,00 9,00 ,54 40,00 20,00 40,00 20.00 20,00 20,00 20.00 20.00 450,00 20.00 20,00 20,00 20,00 20,00 20,00 40,00 20,00 20,00 $1,099,54 Subtotal Cowlev Medical Assoc (4!d no~ inolu4e oharge. pre 12/1'/'.1 12/23/94 Ottice visit 45.00 TOTAL $1,144.54 136933/ID. - - DHI8IT . , %'1/ l~: ....- " ' I; 'iV :i *1'): \'J ; .,,'t- h,~J , , r~-;f~~' - i::{ r:,i13 I. !~, i1!'F.<- .:' "m~';\t,"\,,,,,,";-_P.,,~,, . . p J '\ f ( ~ , ,. S' 1 It f! - r' . exHIBIT C , ,-., .:;~~:;~~~~(l :.. ~ ~: '" ., t I ; i , . "t 1 \ h 1 i I ; t , ... ..~ 1:'~':' t .- , ~ "';~"'- .'.-~\~"-. ."",.-, , ~ ~ U N I V E R SIT 'r ,) F MEDICINE '1 REATMENT CENTER \1 E n I c: ..\ L c: E :\ T E R 601 Ermwocxl Avcnue, 110. 610 Rochcller, Ncw York 14M2 (716) 275.ooJ8 Kelly M. Likly, RN, MS University of Rochester. Strong Memorial Hospital Box 610 601 Elmwood Avenue Rochester, New York 14642 November 12, 199'/ Dear Mr. Wisneski: Thank you for allowing me to review the case of Mr. Paul Zucker vs. Cowley Medical Associates, P.C. and Kimberly Manin, R.N. I have reviewed the medical records and the depoaition transcripts of LAwrence K. Thompson, Donnie M. Asbury, Dixie Lee Lebo, Cynthia Walch, Debra L. Kelley, Paul Zucker, Kimberly Manin-A1ellander, Dr. Gordon and Walter G. Wislon. I offer 1he following evaluation from a nursing perspective. Both Mitomycin and Vinblastine are vesicant chemotherapeutic agents. Vesicant agents have the potential to cause cellular damage or tissue destruction ifleakage occurs into the tissue. When a patient is receiving a vesicant agent he should be instructed to notifY the RN if there is any burning or pain with the chemotherapy infusion. Mitomycin and Vinblastine each have a specific protocol to treat an extravasation. With both vesicant agents the first measure to be taken if an elltravasation has occurred, is suspected or if the patient complains of burning or pain with the infusion is to stop the IV infusion immediately. The next step to treat an elltravasation with both of these agents is to aspirate from the IV tubing as much of the agent as possible. The third step common to the treatment of an extravasation with both Mitomycin and Vinblsstine it to notifY the physician. With Mitomycin, an ice pack is then applied immediately and the patient should be instructed to apply to ice pack for 20-30 minutes on and 20-30 minutes olffor approximately 48 hours. With vinblastine, you immediately inject Hyaluronidase subcutaneously into the extravasated site with multiple injections. Warm compresses ere immediately applied, initially for 30-60 minutes and then on and off every IS minutes for approximately 24 hours. With both medications the elltremity can be elevated to reduce swelling if there is swelling in the eldremity. Infusion site selection is one of the most important decisions the Oncology nurse makes when administering vesicant chemotherapeutic agents. The distal foreann is usually the site of choice to administer vesicant agents in an altempt to avoid nerve and tendon sites that could be damaged by a vesicant eldravasation. Care should be taken to avoid areas of recent venipuncture or IV sites. If there have been recent veinapuncture or IV sites the vein selection should be proximal ( or above) these areas as an IV site chosen below a recent veinapuncture site could cause leakage into the area of the old IV/veinapuncture site. Vesicant chemotherapeutic agents should be administered first, after patent IV access has been established. They should be 3. What are Plaintiff's damages? I V . SUMMAR Y 0 I" LEGAL I S SUES There are no legal issues known at this time other than the evidentiary issues normally encountered by this Court. V. THE IDENTITY 01" WITNESSES TO BE CALLEQ A. Expert witnesses: 1. I"rederick H. Kass, III, M.D. - a copy of Dr. Kass' report and curriculum vitae is attached hereto, incorporated ~erein by reference and iabeled Exhibit "A." 2. Christine Bachorz, R.N. - a copy of Ms, Bachorzl expert report and curriculum vitae is attached hereto, incorporated herein by reference and labeled "B." B. I"act witnesses: 1. Paul Zucker 2 . Patricia Carey Zucker 3. Steven Zucker 4 . Robert Gordon, M. D. 5. Kimberly Martin-Alexander, R.N. 6. Donnie Asbury 7 . Deborah Kelley 8 . Dixie Lebo 3 9. Walter Wilson 10. Cynthia Walch 11. Lawrence Thompson, M,D. 12. All witnesses listed in Plaintiff's Pretrial Conference Memorandum 13. Defendants reserve the right to supplement this witness list prior to trial. VI. EXHIBW 1. Medical records of health care providers. 2. Consent form signed by Mr. Zucker prior to the administration of chemotherapy. 3. Information sheets provided to Mr. Zucker concerning the chemotherapeutic agents that were administered. 4. Videotape depicting treatment rooms at CMA, 5. Defendants reserve the right to supplement this Exhibit List prior to trial. VII. STIPULATION 1. Parties have agreed to exclude any and all testimony concerning problems Ms. Martin-Alexander was experiencing with personal relationships as well as Mr. Zucker's statement contained in the medical records that "If Ms. Martin would go out to dinner with him, he would not sue." Both parties have agreed that this <1 DRS. NEWMAN, WOOSTER, K~:;s, BRADfORD AND MCCOIU1ACK, P.A. 11110 MEDICAL C\MI'L'\ RUAlJ SU ITE IJO HAGERSTOWN. ~IARYL\ND ! 17.i! l'[lErHI)Nf,I_ltl!l 'II ..11.lll) fiEORljE C NEW,\t.\N. II. 111I [), M () L OUiIGHT W()OSTER. MD., Fe c I' flutJEnH.: II. WS, HI, M D PAMEl\ FOX UfWJFORU, M LJ Mln..lAEL J. Mt.L.;Ow.,W.]{. ,"I n c.."'VNTIlL\ KUTTNER.SANDS, M 1) lAMES II. I t\WVERMAlE. CRN" INTERN.\!. MEDICINE Pl.JL\tuNARY 0I5E.-UES ONGll(}(iY. HE!\.tATOLOGY INTEIINt\L MEDICINE ~)N(:llll)(;V .IN"TEI1NAL MEDIt:lNE (;EI1IM~IVl .INTERNM. ,"'UiPI(lNE Nl:R\E PR.\CTl nuNER Sep tem be r 30, 1998 Reynolds & Havas Ms. Lauralee B. Baker 101 Pine Street P.O. Box 932 Harrisburg, Pennsylvania 17108-0932 RE: ZUCKER v. COWLEY MEDICAL ASSO.,P.C.,et al R&H File No. 3328-1 Dear Ms. Baker: I have reviewed the medical records regarding the care of Paul Zucker, in conjunction with Zucker v. Cowley Medical Associates, P.C. specifically, I have reviewed the following records: 1. Plaintiff's complaint 2. Deposition of Paul Zucker 3. Deposition of Kimberly Martin-Alexander, R.N. 4. Deposition of Dixie Lee Lebo, R.N. S. Deposition of Lawrence K. ihompson,III,M.D. 6. Deposition of Donnie M. Asbury 7. Deposition of Walter G. Wilson 8. Deposition of Robert A. Gordon, M.D. 9. Medical records of Lawrence K. Thompson,III,M.D. 10. Medical records of Cowley Medical Associates 11. Medical records from Harrisburg Hospital 12. Medical records of Raymond Kostin, M.D. 13. Medical records of Stanley R. Goldman, M.D. Mr. Paul Zucker is a 67-year-old male diagnosed in September of 1994, with non-small cell carcinoma (poorly differentiated squamous cell carcinoma). At presentation, he had clinical Stage 111-&, disease (6 cm anterior mediastinal mass) and therefore, was not an operative candidate. He was managed with combination chemotherapy, initial'y receiving platinum and VP-16. He received two courses of this chemotherapy (October, November 1994). In December of 1994, his chemotherap y was changed to Mitomycin-C, Vinblastin, Platinum. His first course of this chemotherapy was administered December 19, 1994, through an I.V. site in his right hand. The Mitomycin-C and vinblastin were given I.V. push and tne Platinum was given as an infusion over two hours. ihe patient received an additional two hours of I.V. fluid infusion. The note fronl Kimberly Martin states the chemotherapy was administered Lauralee B. Baker Page 2 RE: ZUCKER v. COWLEY MEDICAL ASSOCIATES without difficulty and there was excellent blood return from the I.V. site. On December 23, Mr. Zucker returned complaining of discomfort In his proximal right forearm. On examination, he had swelling, edema and erythema in that region. This reaction was attributed by Or. Gordon to a chemotherapy extravasation and was managed with ice, elevation and a sling. On January 3, 1995, a right subcla~ian mediport was placed for further chemotherapy. A second course of MVP was administered through the medlport on January 16, 1995. Mr. Zucker had no further complaint about his right forearm until February 27, 1995, when he presented with Induration and a 3 em area of necrosis In the right forearm. He was Immediately referred to Or. Lawrence Thompson for surgical management. The cause of Mr. Zuc~er's necrotic ulceration and the time at which it began is uncertain. His chemotherapy on December 19th was a prolonged treatment and was administered without difficulty. An experienced oncology nurse (like Kimberly Martin, R.N.) would have discontinued chemotherapy immediately had there been any complaints of pain or discomfort in the right arm. The fact that the patient received a prolonged infusion and that Mitomycin-C and Vinblastin were given I.V. push indicate that extravasation did not occur during the time of chemotherapy. It is possible subsequent to chemotherapy that the patient experienced extravasation in his right forearm. Factors contributing to this would be anticoagulation (Coumadln), altered thoracic venous circulation due to a thoracic mali9nancy and left subclavian thrombosis. Mr. Zucker's medical care on December 19th was appropriate. There was no indication of extravasation and hence, no treatment was indicated. Management (local measures) when the patient returned on December 23rd with right forearm discomfort and swelling was appropriate. I must assume that the patient's condition responded to these measures in that he did not complain about his right forearm until two months later, and he was seen regularly during the interim. During this time, j,e received additional chemotherapy (MVP) through his right-sided mediaor!. From this information, I conclude that Mr. Zucker's right arm ulceration cannot be attributed tG the chemotherapy he received December 19, 1994, or to the technique that that treatment was administered. His nursing care on that date was appropriate. I believe that Mr. Zucker's ulceration was due to delayed ocr- 6-98 TUE [:15 PM DRS NE~~AN WOOSTER FAX 110. 3017338627 P. 4 ;",;, -- . DItS. NEWMAN, WOOSTER, KAss, BRADFORD AND MCCORMACK. P.A. 11110 MEDICAL CAMPUS ROAl> ~urrE 130 HAGERSTOWN. MARYlAND 21741 T!l.lPHOI'II(01) 111."00 GIlOIOI C. NNM,\/II, n. /I LD..1ol D. ~ ll'OIlGKT tIIlOSTD. MD. '.C.c.. IlliDOlC H. W! IU. 1010. -... PUlClllAllfUlID. MD. lolICHAIl. ~ Mo.Cll-..... MLl, (:'IlmII,\ IllinNEl\.lo\NDtII. ,..0. )No\lIS Il HA'r/VUMAI.I. ~lINP CURRICULUM VITAE INnUlAl. MIWIC!N' PlltMO/lAllY DlIWU OI'lCOLQ(,'Y. _\rotOCf l,.,rllll'lAl. Ml.01ClNA ON'OLOCf .ll'lTiIlI'lAI. MIllll:l,.,' QIlIATI\ICI.INTPNAL MIIlICII'" ,.,um'McnnUNU NAME: Frederic H. Kass, III, M.O AODR!SS: Home ~ 12804 Covenant Way Hagerstown, Maryland ~1742 Office - 11110 Medical Campus Road, Suit. 130 Hagerstown, Maryland 21742 OATE OF BIRTH: February 21, 1948 EDUCATION: May, 1910 - B.A. degree, Colgate University, Hamilton. New York May, 1974 - M.D. degree, George Washington University, Washington, O,C, Honor socletln: 1814 Alpha Omega Alpha PROFESSIONAL TRAINING: 1814-1975 - Intorn.hlp, Medical Service, University of VirgInIa Hospital, Charlottesville, Virginia 1975-1977 - Residency, Medical Service, University of Virginia Hospital, Charlottesville, Virginia 1917-HI19 - Hematology, Oncology Fellowship, George WashIngton University Medical center, Wuhlnlllon, D.C. BOARO CERTIFICATION: 1971 - American Board of Internal Medicine 1979 - American Board of Internal Medicine - Medical Oncology PROFESSIONAL SOCIETIES: American College of Phy.lcians American Society of Clinical Oncology Medical and Chlrugical Faculty of State of Maryland LICENSE: Maryland, 1919 MEDICAL DIRECTOR: John Marsh Cancer Center, Hagerstown, Maryland CHAIRMAN: Cancer Committee, washington County Hospital, Hagerstown, Maryland MEDICAl. DIRECTOR: Hospice of washington County, Hagerlltown, Maryland OCT- 2-98 FRI 12: 39 LGH - ONCOLOGY FA:{ NO. 71729! 9 107 P. 02 ;-;.:\r / ~J ~ ClIn.lIll. Bachon, R.'I, OCN 436 !as1 On:p Ro.ad Lil1Ul, PAl n4J ()o;tubgo 1, 1998 OI:iII'Ms. Baker, AL your rColucstll1llvt rfiillwal the cale uf Mr. Paul Zuo;kc;r vs. Cowley MaI~al Auoci.tlcs, P.C. md Kiwhutly MaI1iD 1tN. Ia pn:pllrin.lhiI Rp<lI1, J havo r<wi_lId 1IIClIDIOIio:all'\ll:Ol'dllllld IIlllllqlullil1lln lI'lUI.U:rillllll( Khnbl:rly Milltw, Paul Zui:kll', DIJLie Ldlo, DUPlli. A:ibury, Wall W;hiuD, l'ubllfl Goldllll, MD~" LI\llNW:Cl T1.uUlpIlCln, MD., ill woJI .. lit.. UllP\'ll r~ subm..1lld by Ms. WI..:!)'. Mr. Zuo;k. Will diagnollld willl nou-sm.1I cclI lina t.lrDlOIua, po~ly dilTon:nli.laI in Scplanbv t 994. tln<lw die CiltCl oC 01'. Rubort Gordoll, lho potiwl b~llill\ treatlllClllliJr bili CiUlC. .1 Cowk.-y MWil:al AssocIiIIQJ OD Oclobc 17, 1994. Tho pllfilllll recci..oJ1lbur doM of IV .P1a1illlll lIlId u~1 EtoposidIlUU'D OI;Iubc 10"' I1uoUllh NllvOlllber 21, 1994. Durilllllhillimo tile palilo1l\ Impcriall;lllI.l1uuwbwl urthllluO bracl\.incqlllalil; vlliu wJIil:b rClItdaallb.. IIlIIlllf lbe limb Cor any ptllI:WlIll:l. Due \0 llie diocuv\J}Illf .- ccrviclll)/wpb II..do:, hWeved 10 be lII"'....I..ie .Ii.......... 11I0 1:II000000lllQ'llpy lrwtllll:lll Wa.! cbaugallll U Jqim", llf IV PWiDIll, !t4ItOlllyl:in ;md ViIlllbMiu. n.: pllli~ \lad blood worlL llntwu bm lb. riKJu autccubil.lII U'I:lI prillr III reccivill81hu D\.'W l:JIulUClth<<a.llY n:gillllD un Doccwba' 19, 19')4. Thll chemotberapy WIliKiV\lII tbrcup llIlN Iik1 ill ,IIu lJuoolm of1lul dgb\ bllllAl. ~'" MlIITiD's 110\(1 in~i..alW thatlltau W\I'll 1IO JIIOblllllll durlI'll"'e cuun. of tho iWUlillll by nulinlo .. lIlICdlcw bluud NUI'1I, chcmo givcn IS pa' fIow..ll i11llurinlllhilll'eaUIIIlW lhallh~ pulic:nt ~l1ea. au CAlrolvallaliun of the cI1cuwlhcriI'Y occurred. Some COllllllOD si"- dTecII oC chcuIolho:npy alay includa DaU$CIi, vomilin& CllDSlipilioD, my~Iu"lIppnlUiou, CllII'llvl1IIIItion, bairloss, and paiplll':l'II1 awrupalby.lWtav""alilln illllllnlllld as Ibu infiltraliou or lcaka&c uf an inU'llVCI1IlUJ (IV) lUIlinwptalllic 'CfIII wlO Ihu l~lIIlil1liUc. VClli';aoI;aaU1la an: allY llp18l\tat ay prndUCll paia llIllI iD1Ial1lll1aliou ... lhlllKlmiDi:ittatillD lito lIr A)'Ill4;lllill<lUy. Butb MllllW)'\:in and Vlllblastillu arc c1Qlj~ilio:U ;Ulvl:SicllIlI ;aa.:nlSi. The pullaibi1ity of GUowilSiltilla ill an acceptal ri.k of bolli Mitnllly.ill and Vi1Iblasliue. Thli rWr. Wll:l oJllUly idCll1liJ1a1 oulhc ch\.'lIuIbCl'"dp)' allua.u f..nlL 1 Wllw,t alVW with tho plalutilTs ""pal wiIDIlIS, Ms. Li1r..:Iy, ulllbll :naps tb.1l would he llIk,'f1 illlhu filll1l ll1 all exvavuaLioD. Due Iu the Iaclr. lIf my lIiaIlI ufllympWDJI of MIfl1vasaliuII duriD'lll ;mmNlIJlo:ly IIIlL:l' 1I1u cl1I:loolIll:rdpy treatmcl1l au o.:c.:rnbllt 19, 1994, lrcI1llDalllilr Clllrolvasalion WiIIlM.1 i1lllicah;d. Upon rmew of lha wodical rocon!s, I WU wlabllllO dctcnuinc lballl1llllfnv'5alioa llfMilomyan or Vinbla:nilla did occur Oil Dc;clllDher 19, 1994. T1lll.nwuall no:ords iDdic:alal ill ....co:lllll'lt blood r~\U11 I\u'l'luglwul Ih-.:hemJl\u:rapy trQllIIIl;DI. Tho was IlO ClV idCllce or 1l~lnllSll, buruillg lIr AWo:l1iua ul' Ulu veuoua .'Iil~ 1ll.ntecubiti1l silo, whio:h wuuJd iadiQ~ a I111Wblc cxlnvWllillD. Tbe p'UCIII did n.1urn III Cowl'>, MWio:al Amaalc:a two day~ lallii' to rcpolI diliwwWlt in bill rillld aIltOl:ubi1al SP;U;l:. Phy:;io;al llXaJI1 ofl!1o: I<ilc rwualal fllIlDeu aud Wlnlllb lle Ibosilo. Delayed Ai&llll m~ symplllms of an lllllrav.....uuo IlI'C a r~&/liud ~m\llicaliuD witb Ill, us, or WCl\lulh\TiIpcutil: ageo.ll. It would nul be IIppruptinle 10 . admiltl.llllt an aI1lidllllllWO days alla the chcllllllhmpy Wa.~ admini>l..w. \taibI:!', l1'eallllCU1 woukl wn.illl ur ice or heat, e1ovilliul1 and lllnulity tho ph),j,:i;w. which wu dODa ill thJs ca..a. II wlIUllllllll ba possible II. d~umiw: whU;h I\nal inII1ll;Jlal i11hat puiOI. Scl.a;tillD oCdle iIII'usioD site is dcpmdml upoa many fadon. To prcscrva VWOUl iI1tcgrity ov...liruc tho UutiiC ,,"nuld be&iD dist.Uy anI! wurk prullima1ly it. pouiblu. Vo:nipuDcfuro lit.. libuwd be .lIom .. bw. puSllible. Howcvo:r in 'fUme cases lhls 11 IIUIslway. pO.$ible. Ju 1011:1'.1, veins uflbe dol'SWII of Ih~ hand 11ft pretaf1.:d 1>0:0:_.. IhllY lU'1l .asy \0 vU;uali'Al aDd .IlIbUbo, awl it ilI111=tu... eaJy 10 sce "C liD ClIlnviWatiuu ltas Ipm plate. The Cllrcann i"lhu favori14 sile Cor VClIklllll ildmilIislralioD, with llt. haIld btin& the s\>:u.1d prcCcrrul tril... The order of adllli....lnlion, vesu:lli1f 01' IIllnvo::oi""n~ remain a Clll1liUv...i.l iSlltIC in ItlJrnuti>1t:Ilioa oC ch.,lllIllt""IPY. Eimer pra.ti&.:o i. lIC4:\'Pl.lblc. OCT- 2-98 FRI 12:40 LGH - ONCOLOGY FAX NO. 7172919107 '. , CHRISTINE BACBORZ, RN. DCN 436 !all OIeJOll RaId UtitJ, PA 17H3 Home phone: (711) 369 - $H9 - '1l0RSSIONAL IXl'IJlmNCJ: · Nune M.I.IIuu. LalIc:ua:r Ccaeral BOIpltal, Lac..r. PA OI:tober 1996 lD ~ - NUl1ll MaDeJII' ot a11 bed Oal;ologylMcdica1-Surglcal WIillncludii1i lDpaliaIf and OUIpItlCDIII:I'Vkea, c- Rcgislly all4 0nc01081 Rcal:arch Nune. M:wagcr ot IV IeMCIU e&c:tM Oc1Gbcr 1991. RcapglliibililW lD&:lude dally operaIlDlII colllillina ot IIatDn& iII1lCI, IIlItf educalioll, "'TIPS. mtplOYM avalUo1llool. birl/l&'ftrins. IIaO' 1III1CtInp, eIIIlIrina compllanclllD bwDan n:IOlIIl:Il pgllclca IIId ~W'eI. telpQnslb1e lor IIaJ]' IlICC1lna GmplO)'llWll fIlq\IllQmonll, ...ictiDa ",ilh pallcot IIId family iSlllCl, Increased committee IIlClmbenhlpsllld Increared lXlUaboraIlon wilh pb,yslclanl in ordlr to a1llanu II.. Oru;olo81 propn with physlclaDa. · A.lInll Nu..... MUllleV'. Llutc:uau Caer" BOIpllII, r ....ut....'A O;toller 199$ lD Ocl.cbcr 1996 - AaIu8 NW1II MInager ot a 2j bod OII\:OlogylMcdical-Surgica1 W1itlncludiq inpaI.\eIIt and oulpQlicut seMCCI, Cancer RslJlstly and Oncology Research NIlIII. Ilapollllbilltilll liIIaI above. · Adlnll On.olollY "'seanla Nune, Lucuau GcauallIoIpltaJ, Lucuter, PA June 199610 Oc;tobcr 1996l111d Jamwy 199710 A1IJIISl1991. RcIponslbllilll:S IDchllll:d ldend1)\D& pa1iCDI'alor cnro1lmcn1 in RICiIlCh prolOCOla. colllCtlon ot dal" dalll entry, palleJII follow-up, DlCI.'Ilna and m.,lnt.lnlnlI08Ulalory nqulrcmcu\ll of mean:h Sludics lIIId liaison bclwceo pllyliclans IIId IIwIy 1pOnsen. ,. · AssIstant Nur. Manuer.l.anl:uau Ceaent DOIplta!, LlIIICuter, PA [l-A'n...... 1991lD n.,..."'bcto' 199$ - AulIIa&ll NW1II Manager on l' bo:d Ong)logylMc4i!:al. Suflica1 unit Ilcsponsibllillea lDdudc4slalf ...h"'uIin& COIIlIlIItIcCIlnvolvcmcnl, If&ff cvaluaUoIll, dlaposltJon ot 1I1cldcnt reports, upio. olrphyslclan onkrs, lialsau bclWllcn aid. patieat'a and phyllclana. · Chlll'l!e Nuree, Luculer Central Bo.pltal, Luclstu, PA Scptanbcr 1990 10 NO\'ewbcr 1991- E~enin& alW\ charp lWtae on a 2' bed Oncologyl Mcdlca1-Surtlicul unl1 RelpOnsibilities iDdudc4l1pilli olr physician orders. JliIl!esll pll1f;CmcDl, liaisoo between IlaIF, patient's and phyaicians. PwlcUoncd in lhe Oulpaliall Oncology ScMw Depanmcnt u lhe primary carcpwr provillinS ahort pl'llCeduRs, IV med1ca11on adminiSlrdlion, . blood product adl . inI51r11ion, OUlplUenl evaluation lor physicians, Chemotherapy adll1iniSllatiOll and IIafI'cd the Oncolo81 HotJl.le IWlIllnj: patiCllI'. willi approprlalC maoagcment ot chcmolhempy side clI'1ldJ and q1ll:lliCIIS 1Ile;udln, =. · Staff Nurse, Lancuter Cueral Bospltal, LanculU, PA January 1990 10 September 19!1O - SlalTnurse on a UrolollYlMcdJcat.Surgica\ wlit · Std Nurse, Latrobe Ana Hospital, Lalrobe, 'A Mat,h 198810 Ot;tobcr 1989 - SratrnutiCl on a 21 bed On,0108), unil. · SlaIl NUn<!, Westcrn Pennsylvania BO'llllal or Pltt.bul'1lb, PlltJbul'ih, PA July 198610 Mar,h 1988 - Slalfnurse on. 40 bed Oncology unit. P's' I oU P.04 - employee of Defendant Cowley Medical Associates, P,C" and was acting in such capacity, 7, In September of 1994, Plaintiff Paul Zucker was diagnosed as suffering from non-small cell lung cancer. S, Plaintiff Paul Zucker elected to undergo concurrent radiation therapy and chemotherapy in an attempt to treat the lung cancer, 9. On October 17, 1994, Plaintiff Paul Zucker began a course of chemotherapy with Defendant Cowley Medical Associates, P,C, 10, On or about December 19, 1994, Defendant Cowley Medical Associates, P,C" administered Mitomycin, an anti-tumor antibiotic, to Plaintiff Paul Zucker. 11, On or about December 19, 1994, Defendant Cowley Medical Associates, P, C. , administered the chemotherapeutic agent Vinblastine to Plaintiff Paul Zucker. 12, The Mitomycin and Vinblastine were infused intravenously through a site on the back of Plaintiff Paul Zucker's right hand. 13. As the Mitomycin and/or Vinblastine were being infused, Plaintiff Paul Zucker began to experience pain and a burning sensation in his right arm and noticed that the Mitomycin and/or Vinblastine were leaking out of a previous injection site located near his elbow, 14, Plaintiff Paul Zucker reported the pain, burning sensation and leakage to the nurse who was attending to him and repeatedly asked her to apprise the head nurse, Defendant Kimberly Martin, R.N" of the situation. 2 15. After being notified of Plaintiff Paul Zucker's complaints, Def.endant Kimberly Martin, R,N" advised Plaintiff Paul Zucker that nothing was wrong, and that he was to let the Mitomycin and/or Vinblastine continue to infuse. 16. Plaintiff Paul Zucker continued to complain of pain, burning and leakage for approximately three and one-half hours, but was ignored, during which time the infusions were allowed to continue. 17, Defendants permitted the Mitomycin and/or Vinblastine to continue to infuse into Plaintiff Paul Zucker's right arm for several hours after his initial complaints of pain, burning and leakage from the previous injection site. 18. As a direct and proximate result of extravasation of the chemptherapy agent Mito~ycin and/or the chemotherapy agent Vinblastine, Plaintiff Paul Zucker suffered serious injuries, including, but not limited to, extensive necrotic damage to his right forearm, co UN'l' I Paul Zucker v. KimberlY Martin. R.N. 19, Paragraphs one through 18 of this Complaint are incorporated herein by reference. 20, As a direct and proximate result of her negligence as set forth in paragraphs 21 through 31 below, Defendant Kimberly Martin, R,N" is liable to Plaintiff Paul Zucker for the injuries alleged herein, 3 21, Defendar.t Kimberly Martin, R.N., failed, prior to the date of Plaintiff Paul Zucker's injury, to familiarize herself with the proper techniques for the administration of Mitomycin and Vinblastine. 22, Defendant Kimberly Martin, R,N., failed to familiarize herself with the signs and symptoms of extravasation of Mitomycin and/or Vinblastine prior to the administration of the drug to Plaintiff Paul Zucker on or about December 19, 1994, 23, Defendant Kimberly Martin, R.N" failed to familiarize herself with the proper techniques for treating and/or minimizing necrotic tissue damage as a result of extravasation of Mitomycin and/or Vinblastine prior to administering the drug to Plaintiff Paul Zucker on or about December 19, 1994, 24, Defendant Kimberly Martin, R,N" failed to halt the administration of the Mitomycin to Plaintiff Paul Zucker immediately upon learning of his complaints of pain, burning and leakage from a previous injection site. 25, Defendant Kimberly Martin, R.N" failed to halt the administration of the Vinblastine to Plaintiff Paul Zucker immediately upon learning of his complaints of pain, burning and leakage from a previous injection site. 26. Defendant Kimberly Martin, R.N., instructed Plaintiff Paul Zucker and/or the nurse attending to Mr, Zucker to permit the Mitomycin and/or Vinblastine to continue to infuse into Mr, Zucker's right arm, despite the fact that she had been apprised of 4 Mr. Zucker's complaint of pain, burning and leakage from a previous injection site. 27. Defendant Kimberly Martin, R.N. permitted the Mitomycin and/or Vinblastine to continue to infuse into Mr, Zucker's right arm after learning of his complaints of pain, burning and leakage from a previous injection site. 28, Defendant Kimberly Martin, R.N., failed to treat Mr, Zucker for extravaRation of the Mitomycin and/or Vinblastine immediately upon learning of his complaints of pain, burning and leakage from a previous injection site, 29. Defendant Kimberly Martin, R.N" failed to immediately consult or request a consultation from, a physician, oncologist and/or medical specialist familiar with Mitomycin and Vinblastine, upon being apprised of Mr. Zucker's complaints of pain, burning and leakage from a previous injection site. 30. Defendant Kimberly Martin, R. N. failed, after being apprised of Mr, Zuckar's complaints of pain, burning and/or leakage from a previous injection site, to immediately discontinue the administration of Vinblastine, to attempt to aspirate any residual drug remaining in the tissues in order to extract the drug, to administer Hyaluronidase, and to apply heat to activate the Hyaluronidase. 31. Defendant Kimberly Martin, R.N. failed, after being apprised of Mr, Zucker's complaints of pain, burning and/or leakage from a previous injElction site, to immediately discontinue the administration of Mitomycin, to attempt to aspirate any residual 5 drug remaining in the tissues in order to extract the drug, and to instruct Mr, Zucker to apply ice for 15 to 20 minutes at least four times per day and to elevate the affected extremity during the first 24 to 48 hours following the extravasation, 32. As a direct and proximate ~esult of the negligence of Kimberly Martin, R.N., as set forth above, Plaintiff Paul Zucker sutfered serious injuries including, but not limited to, necrotic tissue damage to his right forearm. 33, As a direct and proximate result of the aforesaid injuries, Plaintiff Paul Zucker has incurred, and will in the future incur, medical and rehabilitative expenses, and claim is made therefor. 34, As a direct and proximate result of the aforesaid injuries, Plaintiff Paul Zucker has been, and in the future will be, subject to great humiliation and ridicule, and claim is made therefor. 35, As a direct and proximate result of the aforesaid injuries, Plaintiff Paul Zucker has undergone, and in the future will undergo, great mental and physical pain and suffering, great inconvenience in carrying out his daily activities, and a loss of life's pleasures and enjoyment, and claim is made therefor, 36, As a direct and proximate result of the aforesaid injuries, Plaintiff Paul Zucker has sustained loss of earning power and earning capacity, and claim is made therefor, WHEREFORE, Plaintiff Paul Zucker demands jUdgment against Defendant Kimberly Martin, R.N., in an amount in excess of Twenty- 6 Five Thousand ($25,000) Dollars, exclusive of interest and costs, and in excess of any jurisdictional .,'..Dount requiring compulsory arbitration, COUNT rr Paul Zucker v, Cowlev Medical Assooiates, P,C. 37. Paragraphs one through 18 of this Complaint are incorporated herein by reference. 38, As a direct and proximate result of negligence of its servants, agents, apparent agents, and/or employees, including, but not limited to, Kimberly Martin, R.N" and its nursing staff, as set forth in paragraphs 39 through 49 below, Defendant Cowley Medical Associates, P,C" is liable to Plaintiff Paul Zucker for the injuries alleged herein, 39, Said servants, agents, apparent agents and/or employees failed, prior to the date of Plaintiff Paul Zucker's injury, to familiarize themstilves with the proper techniques for the administration of Mitomycin and Vinblastine, 40, Said servants, agents, apparent agents and/or employees failed to familiarize themselves with the signs and symptoms of extravasation of Mitomycin and/or Vinblastine prior to the administration of the drug to Plaintiff Paul Zucker on or about December 19, 1994. 41. Said servants, agents, apparent agents and/or empl~~ees failed to familiarize themselves with the pro~~r ~echniques for treating and/or minimizing necrotic tissue damage as a result of extravasation of Mitomycin and/or Vinblastine prior to 7 administering the <:irug to Plaintiff Paul Zucker on or about December 19, 1994, 42, Said servants, agents, apparent agents and/or employees tailed to halt the adminis~ration of the Mitomycin to Plaintiff Paul Zucker immediately upon learning of his complaints of pain, burning and leakage from a previous injection site, 43. Said servants, agents, apparent agents and/or employees failed to halt the administration of the Vinblastine to Plaintiff Paul Zucker immediately upon learning of his complaints of pain, burning and leakage from a previous injection site. 44, Said servants, agents, apparent agents and/or employees instructed Plaintiff Paul Zucker to permit the Mitomycin and/or Vinblastine to continue to infuse, despite the fact that they had been apprised of Mr, Zucker's complaint of pain, burning and leakage from a previous injection site. 45, Said servants, agents, apparent agents and/or employees permitted the Mitom~cin and/or Vinblastine to continue to infuse into Mr, Zucker's right arm after learning of his complaints of pain, burning and leakage from a previous injection site, 46, Said servants, agents, apparent agents and/or employees failed to treat Mr, Zucker for extravasatio:'l of the Mitomycin and/or Vinblastine immediately upon learning of his complaints of pain, burning and leakage from a previcus injection site, 47. Said servants, agents, apparent agents and/or employees failed to immediately consult or request a consultation from, a physician, oncologist and/or medical specialist familiar with 8 ! , j I 1 I ! 1" ; Mitomycin and Vinblastine, upon being apprised ot Mr. Zucker's complaints ot pain, burning and leakage trom a previous injection ,. site. \ 48. Said servants, agents, apparent agents and/or employees tailed, after being apprised ot Mr. Zucker's complaints of pain, burning and/or leakage trom a previous injection site, to immediately discontinue the administration ot Vinblastine, to attempt to aspirate any residual drug remaining in the tissues in orc:1er to extract the dr-<1g, to administer Hyaluronidase, and to apply heat to activate the Hyaluronidase, 49. Said servants, agents, apparent agents and/or employees tailed, atter being apprised ot Mr. Zucker's complaints ot pain, burning and/or leakage trom a previous injection site, to immediately discontinue the administration ot Mitomycin, to attempt to aspirate any residual drug remaining in the tissues in order to extract the drug, and t,. instruct Mr. Zucker to apply ice for 15 to 20 minutes at least four times per day and to elevate the atfected extremity during the first 24 to 48 hours tollowing the extravasation, 50. As a direct and proximate result of the negligence ot said serva~~s, ag~nts, apparent agents and/or employees of Defendant Cowley Medical Associates, P.C" as set forth above, Plaintiff Paul Zuckel' suffered seriuus injuries including, but not limited to, necrotic tissue damage to his right forearm, 51. As a direct and proximate result of the aforesaid injuries, Plaintiff Paul Z'lcker has incurred, and will in the 9 (1) identify the agent by name or appropriate description; (2) sat forth the agent's authority, and how the tortious acts of that agent fall within the scope of that authority. Alumni Association. et al. v. Sullivan, 369 Pa. Super. 596, 535 A.2d 1095 (1987); Mau v. Roth, 114 Dauph. Co. Rep. 297 (1994). 8. Without further facts to substantiate the identity of the "servants, agents, apparent agents and/or employees" identified in Count II of Plaintiff's Complaint who allegedly committed the negligent acts, CMA is without notice as to what the Plaintiff's claim is and the grounds upon which it is based. WHEREFORE, Defendants, Cowley Medical Associates, P.C., and Kimberly Martin, R.N., respectfully request this Honorable Court to strike Count II of Plaintiff's Complaint in its entirety. Alternatively, CMA requests this Court to order Plaintiff to file a more specific pleading addressing the identity of the "servants, agents, apparent agents and/or employees" so as to adequately inform CMA of the factual issues and theories of liability it must be prepared to meet in its defense at trial. REYNOLDS & HAVAS A Professional Corporation Date: 31~'1" BY'~ f:,.L ~ LA LEE B. BAKER-STARR torneys for Defendants - 3 - !~} Exhibit A , '" I, I;, - .,.~ employee ot Detendant Cowley Medical Associates, P. C" and was acting in such capacity, 7, In september ot 19~4, Plaintitt Paul Zucker was diagnosed as suttering from non-small cell lung cancer. 8, Plaintift Paul Zucker elected to undergo concurrent radiation therapy and chemotherapy 4n an attempt to treat the lung cancer, 9. On October 17, 1994, Plaintitf Paul Zucker began a course of chemotherapy with Defendant Cowley Medical Associates, P,C. 10, On or about December 19, 1994, Detendant Cowley Medical Associates, P,c" administered Mitomycin, an anti-tumor antibiotic, to Plaintitf Paul Zucker, 11. On or about Oecember 19, 1994, Defendant Cowley Medical Associates, P,C., administered the chemotherapeutic agent Vinblastine to Plaintiff Paul Zucker, 12, The Mitomycin and Vinblastine were intused intravenously through a site on the back of Plaintiff Paul Zucker's right hand, 13. As the Mitomycin and/or Vinblastine were being infused, Plaintiff Paul Zucker began to experience pain and a burning sensation in his right arm and noticed that the Mitomycin and/or Vinblastine were leaking out of a previous injection site located near his elbow. 14, Plaintiff Paul Zucker reported the pain, burning sensation and leakage to the nurse who was attending to him and repeatedly asked her to apprise the head nurse, Defendant Kimberly Martin, R.N., of the situation. 2 15, Atter being notitied ot Plaintitt Paul Zucker's complaints, Detendant Kimberly Martin, R.N" advised Plaintitt Paul Zucker that nothing was wrong, and that he was to let the Mitomycin and/or Vinblastine continue to infuse, 16. Plaintift Paul Zucker continued to complain of pain, burning and leakage tor approximately three and one-half hours, but was ignored, during which time the in!u,ions were allowed to continue, 17. Detendants permitted the Mitomycin and/or Vinblastine to continue to intuse into Plaintiff Paul Zucker's right arm for several hours after his initial complaints ot pain, burning and leakage from the previous injection site, 18. As a direct and proximate result ot extravasation of the chemptherapy agent Mitomycin and/or the chemotherapy agent Vinblastine, Plaintift Paul Zucker suftered serious injuries, including, but not limited to, extensive necrotic damage to his right f~rearm, COUNT I Paul Zucker v, Kimberlv Martin. R,N, 19, Paragraphs one through 18 of this Complaint are incorporated herein by reference. 20, As a direct and proximate result of her negligence as set torth in paragraphs 21 through 31 below, Defendant Kimberly Martin, R,N" is liable to Plaintitf Paul Zucker tor the injuries alleged herein, 3 ...... 21. Defendant Kimberly Martin, R.N., tailed, prior to the date ot Plaintiff Paul Zucker's injury, to familiarize herself with the proper techniques for the adl1linistration of Mitomycin and Vinblastine, 22. Detendant Kimberly Martin, R.N., tailed to familiarize herselt with the signs and symptoms of extravasation of Mitomycin and/or Vinblastine prior to the administration co: the drug to Plaintitf Paul Zucker on or about December 19, 1994. 23. Defendant Kimbf.lrly Martin, R.N., failed to familiarize herself with the proper techniques for treating and/or minimiZing necrotic tissue damage as a result of extravasation of Mitomycin and/or Vinblastine prior to administering the drug to Plaintiff Paul Zucker on or about December 19, 1994, 24. Defendant Kimberly Martin, R,N" tailed to halt the administration of the Mitomycin to Plaintiff Paul Zucker immediately upon learning of his complaints of pain, burning and leakage from a previous injection site. 25, Defendant Kimberly Martin, R.N" failed to halt the administration of the Vinblastine to Plaintiff Paul Zucker immediately upon learning of his complaints of pain, burning and leakage from a previous injection site. 26, Defendant J<:imberly Martin, R,N" instructed Plaintiff Paul Zucker and/or the nurse attending to Mr, Zucker to permit the Mitomycin and/or Vinblastine to continue to infuse into Mr, Zucker's right arm, despite the fact that she had been apprised of 4 Mr. Zucker'. complaint of pain, burning and leakage from a previous injection site. 37, Defendant Kimberly Martin, R.N. permitted the Mitomycin and/or Vinblastine to continue to infuse into Mr, Zucker's right arm after learning of hi. complaints of pain, burning and leakage from a previous injection site. 38, Defendant Kimberly Martin, R.N., tailed to tre..t: Mr, Zucker for extravasation of the Mitomycin and/or Vinblastine immediately upon learning of his complaints of pain, burning and leakage from a previous injection site, 39, Defendant Kimberly Martin, R,N" failed to immediately consult or request a consultation from, a physician, oncologist and/or medical specialist tamiliar with Mitomycin and Vinblastine, upon being apprised of Mr, Zucker's complaints ot pain, burning and leakage trom a previous injection ~ite, "0. Defendant l(imberly Martin, R,N, tailed, after being apprised ot Mr. Zucker's complaints ot pain, burning and/or leakage trom a previous injection site, to immediately discontinue the administration of Vinblastine, to attempt to aspirate any residual drug remaining in the tissues in order to extract the drug, to administer Hyaluronidase, and to apply heat to activate the Hyaluronidase. 31, Defendant l(imberly Martin, R.N, failed, after being apprised of Mr, Zucker's complaints ot pain, burning and/or leakage trom a previous injection site, to immediately discontinue the administration of Mitomycin, to attempt to aspirate any residual 5 drug remaining in the tissues in order to extract the drug, and to instruct Mr. Zucker to apply ice for ~5 to 20 minutes at least four times per day ancl to elevate the affected extremity during the first 24 to 48 hours fOllowing the extravasation. 32. As a direct and proximate result of the negligence of Ximberly Martin, R,N., as set forth above, plaintiff Paul Zucker suffered serious injuries including, but not limited to, necrotic tissue damage to his right forearm, 33, As a direct and proximate result of the aforesaid injuries, Plaintiff Paul Zucker has incurred, and will in the future incur, medical and rehabilitative expenses, and claim is made therefor, 34, As a direct and proximate result of the aforesaid , injuries, Plaintiff Paul Zucker has been, and in the future will be, subject to great humiliation and ridicule, and claim is made therefor, 35, As a direct and proximate result of the aforesaid injuries, Plaintiff Paul Zucker has undergone, and in the future will undergo, great mental and physical pain and sUffering, great inconvenience in carrying out his daily activities, and a loss of life's pleasures and enjoyment, and claim is made therefor. 36, As a direct and proximate result of the aforesaid injuries, Plaintiff Paul Zucker has sustained loss of earning power and earning capacity, and claim is made therefor, WHEREFORE, Plaintiff Paul Zucker demands judgment against Defendant Ximberly Martin, R.N., in an amount in excess of Twenty- 6 Five Thousand ($25,000) Dollars, exclusive of interest and costs, and in excess of any jurisdictional amount requiring compulsory arbitration. COUH'l' I I Paul Zucker v. Cowlev Me4ical Associates. P.C, 37, Paragraphs one through 18 of this Complaint are incorporated herein by reference, 38, As a direct and proximate result of negligence of its servants, agents, apparent agents, and/or employees, including, but not limited to, Kimberly Martin, R,N., and its nursing staff, as set forth in paragraphs 39 through 49 belew, Defendant cowley Medical Associates, P.c" is liable to Plain~iff Paul Zucker for the injuries alleged herein, 39, Said servants, agents, apparent agents and/or employees failed, prior to the date of Plaintiff Paul Zucker's injury, to familiarize themselves with the proper techniques for the administration of Mitomycin and Vinblastine, 40, Said servants, agents, apparent agents and/or employees failed to familiarize themselves with the signs and symptoms of extravasation of Mitomycin and/or Vinblastine prior to the administration of the drug to Plaintiff Paul Zucker on or about December 19, 1994. 41, Said servants, agents, apparent agents and/or employees failed to familiarize themselves with the proper techniques for treating and/or minimizing necrotic tissue damage as a result of extravasation of Mitomycin and/or vinblastine prior to 7 administering the drug to Plainti!! Paul Zucker on or about December 19, 1994, 42. Said servants, agents, apparent agents and/or employees tailed to halt the administration of the Mitomycin to Plaintiff Paul Zucker immediately upon learning ot hi. complaints ot pain, burnin; and leakage from a previous injection site, 43, Said servants, agents, apparent agents and/or employees tailed to halt the administration ot the Vinblastine to plaintiff Paul Zucker immediately upon learning ot his complaints of pain, burning and leakage from a previous injection site. 44, Said servants, agents, apparent agents and/or employees instructed Plaintitf Paul Zucker to permit the Mitomycin and/or Vinblastine to continue to infuse, desp~te the fact that they had been apprised ot Mr, Zucker's complaint ot pain, burning and leakage from a previous injection site, 45, Said servants, agents, apparent agents and/or employees permitted the Mitomycin and/or Vinblastine to continue to intuse into Mr, Zucker's right arm atter learning ot his complaints ot pain, burning and leakage from a previous injection site, 46. Said servants, agents, apparent agents and/or employees tailed to treat Mr, Zucker tor extravasation ot the Mitomycin and/or Vinblastine immediately upon learning of his complaints of pain, burning and leakage from a previous injection site, 47, Said servants, agents, apparent agents and/or employees failed to immediately consult or request a conyultation from, a physician, oncologist and/or medical specialist tamiliar with 8 Mitomycin and Vinblastine, upon being apprised of Mr. Zucker's complaints of pain, burning and leakage from a previous injection site. 48. Said servants, agents, apparent agents and/or employees failed, after being apprised of Mr. Zucker's complaints of pain, burning and/or leakage from a previous injection site, to immediately discontinue the administration of Vinblastine, to attempt to aspirate any residual drug remaining in the tissues in order to extract the drug, to administer Hyaluronidase, and to apply heat to activate the Hyaluronidase. 49. Said servants, agents, apparent agents and/or employees failed, after being apprised of Mr, Zucker's complaints of pain, burning and/or leakage from a previous injection site, to immediately discontinue the administration of Mitomycin, to attempt to aspirate any residual drug remaining in the tissues in order to extract the drug, and to instruct Mr. Zucker to apply ice for 15 to 20 minutes at least four times per day and to elevate the affected extremity during the first 24 to 48 hours following the extravasation. 50, As a direct and proximate result of the negligence of said servants, agents, apparent agents and/or employees of Defendant Cowley Medical Associates, P.C" as set forth above, Plaintiff Paul Zucker suffered serious injuries including, but not limited to, necrotic tissue damage to his right forearm, 51. As a direct and proximate result of the aforesaid injuries, Plaintiff Paul Zucker has incurred, and will in the 9 .. .' future incur, medical and rehabilitative expenses, and claim i8 made therefor. 52. As a direct and proximate result of the aforesaid injuries, Plaintiff Paul Zucker has been, and in the future will be, subject to qreat humiliation and ridicule, and claim ia made therefor. 5]. Aa a direct and proximate result of the aforesaid injuries, Plaintiff Faul Zucker has underqone, and in the future will underqo, qreat mental and physical pain and sufferinq, qreat inconvenience in carryinq out his daily activities, and a loss of life's pleasures and enjoyment, and claim is made therefor. 54. As a di:t'ect and proximate result of the aforesaid injuries, Plaintiff Paul Zucker has sustained loss of earninq power and earninq capacity, and claim is made therefor. WHEREFORE, Plaintiff Paul Zucker demands judqment aqainst Defendant Cowley Medical Associates, P.c., in an amount in excess of Twenty-Five Thousand ($25,000) DOllars, exclusive of interest and costs, and in excess of any jurisdictional amount requirinq compulsory arbitration. ;). / ;)0/9 &, David S. W snes I.D. No. 58796 450] N. Front street Harrisburq, PA 17110 (717) 2]8-6791 Counsel for Plaintiff e r. 10 6. At all times relevant to this Complaint, Defendant Kimberly Martin, R.N., was a servant, agent, apparent agent and/or employee of Defendant Cowley Medical Associates, P.c., and was acting in such capacity. 7. In September of 1994, Plaintiff Paul Zucker was diagnosed aa slIffering from non-small cell lung cancer. 8. Plaintiff Paul Zucker elected to undergo concurrent radiation therapy and chemotherapy in an attempt to treat the lung cancer. 9. On October 17, 1994, Plaintiff Paul Zucker began a course of chemotherapy with Defendant Cowley Medical Associates, P.C. 10. On or about December 19, 1994, Defendant Cowley Medical Associates, P.C., administered Mitomycin, an anti-tumor antibiotic, to Plaintiff Paul Zucker. 11. On or about December 19, 1994, Defendant Cowley Medical ASRociates, P.c., administered the chemotherapeutic agent Vinblastine to Plaintiff Paul Zucker. 12. The Mitomycin and Vinblastine were infused intravenously through a site on the back of Plaintiff Paul Zucker's right hand. 1]. As the Mitomycin and/or Vinblastine were being infused, Plaintiff Paul Zucker began to experience pain and a burning sensation in his right arm and noticed that the Mitomycin and/or Vinblastine were leaking out of a previous injection site located near his elbow. 2 14. Plaintiff Paul Zucker reported the pain, burning sensation and leakage to the nurse who was attending to him and ~epeatedly asked her to apprise the head nurse, Defendant Kimberly Martin, R.N., of the situation. 15. After being notified of Plaintiff Paul Zucker's complaints, Defendant Kimberly Martin, R.N., advised Plaintiff Paul Zucker that nothing was wrong, and that he was to let the Mitomycin and/or Vinblastine continue to infuse. 16. Plaintiff Paul Zucker continued to complain of pain, burning and leakage for approximately three and one-half hours, but was ignored, during which time the infusions were allowed to continue. 17. Defendants permltted the Mitomycin and/or Vinblastine to continue to infuse into Plaintiff Paul Zucker's right arm for several hours after his initial complaints of pain, burning and leakage from the previous injection site. 18. As a direct and proximate result of extravasation of the chemotherapy agent Mitomycin and/or the chemotherapy agent Vinblastine, Plaintiff Paul Zucker suffered serious injuries, including, but not limited to, extensive necrotic damage to his right forearm. ] COUN'l' I Paul Zucker v. Kiaber1v Martin. R.N. 19. Paragraphs one through 18 of this Complaint are incorporated herein by reference. 20. As a direct and proximate result of her negligence as set forth in paragraphs 21 through ]1 below, Defendant Kimberly Martin, R.N., is liable to Plaintiff Paul Zucker for the injuries alleged herein. 21. Defendant Kimberly Martin, R.N., failed, prior to the date of Plaintiff Paul Zucker's injury, to familiarize herself with the proper techniques for the administration of Mitomycin and Vinblastine. 22. Defendant Kimberly Martin, R.N., failed to familiarize herself with the signs and symptoms of extravasation of Mitomycin and/or Vinblastine prior to the administration of the drug to Plaintiff Paul Zucker on or about December 19, 1994. 2]. Defendant Kimberly Martin, R.N., failed to familiarize herself with the proper techniques for treating and/or minimizing necrotic tissue damage as a result of extravasation of Mitomycin and/or Vinblastine prior to administering the drug to Plaintiff Paul Zucker on or about December 19, 1994. 24. Defendant Kimberly Martin, R.N., failed to halt the administration of the Mitomycin to Plaintiff Paul Zucker immediately upon learning of his complaints of pain, burning and leakage from a previous injection site. 4 25. Defendant Kimberly Martin, R.N.. failed to halt the administration of the Vinblastine to Plaintiff Paul Zucker immediately upon learning of his complaints of pain, burning and leakage from a previous injection site. 26. Defendant :Kimberly Martin, R.N., instructed Plaintiff Paul Zucker and/or the nurse attending to Mr. Zucker to permit the Mitomycin and/or Vinblastine to continue to infuse into Mr. Zucker's right arm, despite the fact that she had been apprised of Mr. Zucker's complaint of pain, burning and leakage from a previous injection site. 27. Defendant Kimberly Martin, R.N. permitted the Mitomycin and/or Vinblastine to continue to infuse into Mr. Zucker's right arm after learning of his complaints of pain, burning and leakage from a previous injection site. 28. Defendant :Kimberly Martin, R.N., failed to treat Mr. Zucker for extravasation of the Mitomycin and/or Vinblastine immediately upon learning of his complaints of pain, burning and leakage from a previous injection site. 29. Defendant Kimberly Martin, R.N., failed to immediately consult or request a consultation from, a physician, oncologist and/or medical specialist familiar with Mitomycin and Vinblastine, upon being apprised of Mr. Zucker's complaints of pain, burning and leakage from a previous injection site. 5 30. Defendant Kimberly Martin, R.N. tailed, after being apprised of Mr. Zucker's complaints of pain, burning and/or leakage from a previous injection site, to immediately discontinue the administration of Vinblastine, to attempt to aspirate any residual drug remaining in the tissues in order to extract t.he d!'"ug, to administer Hyaluronidase, and to apply heat to activate the Hyaluronidase. ]1. Defendant Kimberly Martin, R.N. failed, after being apprised of Mr. Zucker's complaints of pain, burning and/or leakage from a previous injection site, to immediately discontinue the administration of Mitomycin, to attempt to aspirate any residual drug remaining in the tissues in order to extract the drug, and to instruct Mr. Zucker to apply ice for 15 to 20 minutes at least four times per day and to elevate the affected extremity during the first 24 to 48 hours following the extravasation. ]2. As a direct and proximate result of the negligence of Kimberly Martin, R.N., as set forth above, Plaintiff Paul Zucker suffered serious injuries inClUding, but not limited to, necrotic tissue damage to his right forearm. ]3. As a direct and proximate result of the aforesaid injuries, Plaintiff Paul Zucker has incurred, and will in the future incur, medical and rehabilitative expenses, and claim is made therefor. 6 34. As a direct and proximate result of the aforesaid injuries, Plaintiff Paul Zucker has been, and in the future will be, subject to great humiliation and ridicule, and claim is made therefor. ]5. As a direct and proximate result of the aforesaid injuries, Plaintiff Paul Zucker has undergone, and in the future will undergo, great mental and physical pain and suffering, great inconvenience in carrying out his daily activities, and a loss of life's pleasures and enjoyment, and claim is made therefor. ]6. As a direct and proximate result of the aforesaid injuries, Plaintiff Paul Zucker has sustained loss of earning power and earning capacity, and claim is made therefor. WHEREFORE, Plaintiff Paul Zucker demands judgment against Defendant Kimberly Martin, R.N., in an amount in excess of Twenty- Five Thousand ($25,000) Dollars, exclusive of interest and costs, and in excess of any juriSdictional amount requiring compulsory arbitration. COUN'l' II ,au1 Zuoker v. Co.lev Medical Associates. P.C. ]7. Paragraphs one through 18 of this Complaint are incorporated herein by reference. ]8. At all times relevant to this Complaint, Defendant Kimberly Martin, R.N., was a servant, agent, apparent agent and/or employee of Defendant Cowley Medical Associates, P.c., and was acting in such capacity. 7 ]9. At the time of the incident (set forth in paragraphs 10- 18) that is the subject of this Complaint, Plaintiff Paul Zucker received medical care and attention from nurses and/or nurses' aides who were servants, agents, apparent agents, and/or employees of Defendant Cowley Medical Associates, P.C. and who were acting in such capacity. 40. The names of the aforesaid nurses and/or nurses' aides are unknown to Plaintift Paul Zucker and are better known to the Defendants. 41. As a direct and proximate result ot the negligence, as as set forth in paragraphs 42 through 52 below, ~f Kimberly Martin, R.N., and its nursing staff, who were at all relevant times acting as its servants, agents, apparent agents, and/or employees, Defendant Cowley Medical Associates, P.C., is liable to Plaintiff ?aul Zucker for the injuries alleged herein. 42. Said servants, agents, apparent agents and/or employees failed, prior to the date of Plaintiff Paul Zucker's injury, to familiarize themselves with the proper techniques for the administration of Mitomycin and Vinblastine. 43. Said servants, agents, apparent agents and/or employees failed to familiarize themselves with the signs and symptoms of extravasation of Mitomycin and/or Vinblastine prior to the administration of the drug to Plaintiff Paul Zucker on or about December 19, 1994. 8 44. Said .ervant., agents, apparent agents and/or .mploye.. failed to famlliarize themselves with the proper techniques for treating and/or minimizing necrotic tissue damage as a result of extravasation of Mitomycin and/or Vinblastine prior ~o administering the drug to Plaintiff Paul Zucker on or about December 19, 1994. 45. Said servants, agents, apparent agents and/or employees failed to halt the administration of the Mitomycin to Plaintiff Paul Zucker immediately upc~ l~arning of his complaints of pain, burning and leakage from a previous injection site. 46. Said servants, agents, apparent agents and/or employees failed to halt the administration of the Vinblastine to Plaintiff Paul Zucker immediately upon learning of his complaints of pain, burning and leakage from a previous injection site. 47. Said servants, agents, apparent agents and/or employees instructed Plaintiff Paul Zucker to permit the Mitomycin and/or Vinblastine to continue to infuse, despite the fact that they had been apprised of Mr. Zucker's complaint of pain, burning and leakage from a previous injection site. 48. Said servants, agents, apparent agents and/or employees permitted the Mitomycin and/or Vinblastine to continue to infuse into Mr. Zucker's right arm after learning of his complaints of pain, burning and IQakage from a previous injection site. 9 49. Said servants, agents, apparent agents and/or employees failed to treat Mr. Zucker for extravasation of the Mitomycin and/or Vinblastine immediately upon learninq of his complaints of pain, burning and leakage from a previous injection site. 50. Said servants, agents, apparent agents and/or employees failed to immediately consult or request a consultation from, a physician, oncologist and/or medical specialist familiar with Mitomycin and Vinblastine, upon being apprised of Mr. Zucker's complaints of pain, burning and leakage from a previous injection site. 51. Said servants, agents, apparent agents and/or employees failed, after being apprised of Mr. Zucker's complaints of pain, burning and/or leakage from a previous injection site, to immediately discontinue the adwj~',stration of Vinblastine, to attempt to aspirate any residual drug remaining in the tissues in order to extract the drug, to administer Hyaluronidase, and to apply heat to activate the Hyaluronidase. 52. Said servants, agents, apparent agents and/or employees failed, after being apprised of Mr. Zucker's complaints of pain, burning and/or leakage from a previous injection site, to immediately discontinue the administration of Mitomycin, to attempt to aspirate any residual drug remaining in the tissues in order to 10 extract the drug, and to instruct Mr. Zucker to apply ice for 15 to 20 minutes at least four times per day and to elevate the affected extremity during the first 24 to 48 hours following the extravasation. 53. As a direct and proximate result of the negligence of said servants, agents, apparent agents and/or employees of Defendant Cowley Medical Associates, P.c., as set forth above, Plaintiff Paul Zucker suffered serious injuries inclUding, but not limited to, necrotic tissue damage to his right forearm. 54. As a direct and proximate result of the afo.l'esaid injuries, Plaintiff Paul Zucker has incurred, and will in the future incur, medical and rehabilitative expenses, and claim is made therefor. 55. As a direct and proximate result of the aforesaid injuries, Plaintiff Paul Zucker has been, and in the future will be, subject to great humiliation and ridicule, and claim is made therefor. 56. As a direct and prol(imate result of the aforesaid injuries, Plaintiff. Paul Zucker has undergone, and in the future will undergo, great mental and physical pain and SUffering, great inconvenience in carrying out his daily activities, and a loss of life's pleasures and enjoyment, and claim is made therefor. 57. As a direct and proximate result of the aforesaid injuries, Plaintiff Paul Zucker has sustained loss of earning power and earning capacity, and claim is made therefor. 11 9. Admitted. 10-11. Admitted. 12. Denied as stated. The Mitomycin and Vinblastine were infused intravenously through a site on the dorsal portion of Plaintiff's right hand. 13. Denied. It is specifically denied that as the Mitomycin and Vinblastine were being infused, Plaintiff began to experience pain and burning sensation in his right arm. As to the remainder of the averments in the corresponding paragraph of Plaintiff's First Amended Complaint, Defendants are without knowledge to verify the accuracy or inaccuracy of the averments and the same are accordingly denied and strict proof thereof is demanded at trial. 14. Denied. After reasonable investigation, Defendants are without information to verify the accuracy or inaccuracy of the corresponding averment of Plaintiff's First Amended Complaint and the same is accordingly denied and strict proof thereof is demanded at the time of trial. 15. Denied. It is specifically denied that after being notified of Plaintiff's complaints, Ms. Martin advised Plaintiff that nothing was wrong and that he was to let the Mitomycin and Vinblastine continue to infuse. To the contrary, Ms. Martin is unaware that such complaints were voiced. - 2 - - 16. Denied. It is specifically denied that Plaintiff continued to complain of pain, burning and leakage for approximately 3~ hours but was ignored during this time frame. To the contrary, Cowley is unaware that such complaints were voiced. By way of further answer, at all times relevant hereto Plaintiff received appropriate nursing ~are as required under the circumstances. 17. Denied. It is specifically denied that Defendants permitted the Mitomycin and/or Vinblastine to continue to infuse for several hours despite complaints. To the contrary, the Mitomycin and/or Vinblastine was fully administered within minutes of the commencement of the chemotherapeutic treatment. 18, Denied. The corresponding averment of Plaintiff's First Amended Complaint represents a conclusion of law which is deemed to be denied by operation of law and, accordingly, no response is required. By way of further answer, it is specifically denied that the actions or conduct of Defendants in any way caused and/or contributed to Plaintiff's alleged injuries. COUNT I PAUL ZUCKER VS. KIMBERLY MARTIN. R.N. 19. The foregoing paragraphs of this Answer are incorporated herein by reference as though set forth fully at length. - 3 - 20. Denied. The corresponding averment of Plainti ff' s First Amended Complaint represents a conclusion of law which is deemed to be denied by operation of law and, accordingly, no response is required. By way of further answer, it is further specifically denied that Ms. Martin was negligent or in any way contributed to cause Plaintiff's alleged injuries. To the contrary, at all times relevant hereto, Ms. Martin complied with the requisite standard of care applicable under like circumstances. 21. Denied. It is specifically denied that Ms. Martin failed to familiarize herself with the proper technique for the administration of Mitomycin and Vinblastine. To the contrary, Ms. Martin was very familiar with and competent in the administration of Mitomycin and Vinblastine. 22. Denied. It ts specifically denied that Ms. Martin failed to familiarize herself with the signs and syroptoms of extravasation of Mitomycin and/or Vinblastine prior to the administration of the drug to Plaintiff. To the contrary, at all times relevant hereto, Ms. Martin was very familiar with the signs and symptoms of extravasation of Mitomycin and/or Vinblastine. 23. Denied. It is specifically denied that Ms. Martin failed to familiarize herself with the proper techniques for treating and/or minimizing necrotic tissue damage as a result of . 4 - extravasation of Mitomycin and/or Vinblastine prior to administering the drug to Plaint if f. To the contrary. at all times relevant hereto, Ms. Martin was very familiar with the proper techniques Eor treating and/or minimizing necrotic tissue damage as a result of extravasation of Mitomycin and/or Vinblastine. 24. Admitted in part and denied in part. It is admitted that Ms. Martin failed to halt the administration of Mitomycin. It is specifically denied that there was any reason to halt the administration of the Mitomycin. 25. Admitted in part and denied in part. It is admitted that Ms. Martin failed to halt the administration of Vinblastine. It is specifically denied that there was any reason to halt the administration of the Vinblas(ine. 26. Denied. It is specifically denied that Ms. Martin instructed Plaintiff and/or the nurse attending to Mr. Zucker to permit the Mitomycin and/or Vinblastine to continue to infuse despite Plaintiff's complaints. To the contrary, the Mitomycin and/or Vinblastine had been infused within minutes of the commencement of the chemotherapeutic treatment and there were no such complaints at that time. 27. Admitted in part and denied in part. It is admitted that Ms. Martin failed to halt the administration of - 5 - Mitomycin. It is specifically denied that thet.e was any reallon to halt the administration of the Mitomycin. 28. Admitted in part and denied in part. It is admitted that Ms. Mart in did not treat Mr. Zucker for extravasation of the Mitomycin and/or Vinblastine on December 19, 1994. To the extent this paragraph implies that there was any reason for Ms. Martin to treat Plaintiff for extravasation of Mitomycin and/or Vinblastine on December 19, 1994, this averment is denied. To the contrary, there was absolutely no evidence of extravasation of the Mitomycin and/or Vinblastine on said date of administration. 29. Admitted in part and denied in part. It is admitted that Ms. Martin did not immediately consult or request a consu~.tation from a physician, oncologist and/or medical specialist after being apprised of Mr. Zucker's complaints of pain, burning and leakage. To the extent the averments contained in the corresponding paragraph of Plaintiff's First Amended Complaint imply that such a consultation was necessary on December 19, 1994, said averments are denied. To the contrary, there were no such complaints and no evidence of extravasation was present on said date. 30. Admitted. There was no sign of extravasation and no such interventions were necessary. . 6 - 31. Admitted. The~e was no sign of ext~avasation and no such inte~ventions we~e necessa~y. 32-36. Denied. The averments contained in the cor~esponding parag~aphs of Plaintiff's First Amended Complaint ~ep~esent concluslons of law to which a~e deemed to be denied by operation of law and, accordingly, no response is necessary. By way of fu~ther answe~, it is specifically denied that Ms. Martin was negligent or that her conduct in any way caused or contributed to Plaintiff's alleged injuries. As to the remainder of the averments contained in the corresponding paragraphs of Plaintiff's First Amended Complaint, after reasonable investigation, Defendants are unable to verify the accuracy or inaccuracy of said averments and the same are accordingly denied and strict proof thereof is demanded at the time of trial. WHEREFORE, Defendant, Kimberly Martin, R.N., demands judgment in her favor and against Plaintiff. COUNT II .PAUL ZUCKER VS. COWLEY MEPICAL ASSOCIATES. P.C. 37. The foregoing paragraphs of this Answer are incorpor~ted here~n by reference as though fully set forth at length. 38. Admitted. 39. Admitted. - 7 - 40. Denied. Aftec reasonable investigation, Defendants are without information to verify the accuracy or inaccuracy of the averments contained in the co=cesponding paragraph of Plaintiff's First Amended Complaint and the same are accordingly denied. By way of further answer, Cowley is aware of the identity of nurses and/oc nurse's aides who are under its employ. 41. Denied. The averment contained in the corresponding paragraph of Plaintiff's First Amended Complaint represents a conclusion of law which is deemed to be denied by operation of law and the same is accordingly denied. It is further specifically denied that Kimberly Martin or any of the Cowley staff were negligent. To the contrary, all the treatment and medical care provided to Plaintiff was provided within the applicable standards of care required under the circumstances. 42. Denied. It is specifically denied that Cowley's servants, agents, apparent agents and/or employees failed to familiarize themselves with the proper technique for the administration of Mitomycin and Vinblastine. To the contrary, Cowley'S servants, agents, apparent agents and/or employees were very familiar with and competent in the administration of Mitomycin and Vinblastine. 43. Denied. It is specifically denied that Cowley's servants, agents, apparent agents and/or employees failed to . 8 familiarize themselves with the signs and symptoms of extravasation of Mitomycin and/or Vinblastine prior to the administration of the drug to Plaintiff. To the contrary, at all times relevant hereto, Cowley's servants, agents, apparent agents and/or employees were well familiarized with the signs and symptoms of extravasation of Mitomycin and/or Vinblastine. 44. Denied. It is specifically denied that Cowley's servants, agents, apparent agents and/or employees failed to familiarize themselves with the proper techniques for treating and/or minimizing necrotic tissue damage as a result of extravasation of Mitomycin and/or Vinblastine prior to administering the drug to Plaintiff. To the contrary, at all times relevant hereto, Cowley's servants, agents, apparent agents and/or employees were very familiar with the proper techniques for treating and/or minimizing necrotic tissue damage as a result of extravasation of Mitomycin and/or Vinblastine. 45. Admitted in part and denied in part. It is admitted that Cowley's servants, agents, apparent agents and/or employees failed to halt the administration of Mitomycin. It is specifically denied that there was any reason to halt the administration of the Mitomycin. 46. Admitted in part and denied in part. It is admitted that Cowley's servants, agents, apparent agents and/or employees failed to halt the administration of Vinblastine. It - 9 - is specifically denied that there was any reason to halt the administration of the Vinblastine. 47. Denied. It \s specifically denied that Cowley's servants, agents, apparent agents and/or employees instructed ~laintiff to permit the Mitomycin and/or Vinblastine to continue to infuse despite Plaintiff's complaints. To the contrary, the Mitomycin and/or Vinblastine had been infused within minutes of the commencement of the chemotherapeutic treatment and there were no such complaints at that time. 48. Admitted in part and denied in part. It is admitted that Cowley's servants, agents, apparent agents and/or employees failed to halt the administration of Mitomycin. It is specifically denied that there was any reason to halt the administration of the Mitomycin. 49. Admitted in palt and denied in part. It is admitted that Cowley's servants, agents, apparent agents and/or employees did not treat Mr. Zucker for extravasation of the Mitomycin and/or Vinblastine on December 19, 1994. To the extent this paragraph implies that there was any reason for Cowley's servants, agents, apparent agents and/or employp.es to treat ~laintiff for extravasation of Mitomycin and/or Vinblastine on December 19, 1994, this averment is denied. To the contrary, there was absolutely no evidence of extravasation of the Mitomycin and/or Vinblastine on said date of administration. - 10 - 50. Admitted in part and denied in part. It is admitted that Cowley's servants, agents, apparent agents and/or employees did not immediately consult or request a consultation from a physician, oncologist and/or medical specialist after being apprised of Mr. Zucker's complaints of pain, burning and leakage. To the extent the averments contained in the corresponding paragraph of ~laintiff's First Amended Complaint imply that such a consultation was necessary on December 19, 1994, said averments are denied. To the contrary, there were no such complaints and no evidence of extravasation was present on said date. 51. Admitted. There was no sign of extravasation and no such interventions were necessary. 52. Admitted. There was no sign of extravasation and no such interventions were necessary. 53-57. Denied. The averments contained in the corresponding paragraphs of Plaintiff's First Amended Complaint represent conclusions of law to which are deemed to be denied by operation of law and, accordingly, no response is necessary. By way of further answer, it is specifically denied that Cowley's servants, agents, apparent agents and/or employees were negligent or that their conduct in any way caused or contributed to Plaintiff's alleged injuries. As to the remainder of the averments contained in the corresponding paragraphs of - 11 - Plaintiff's First Amended Complaint, after reasonable investigation, Defendants are unable to verify the accuracy or inaccuracy of said averments and the same are accordingly denied and strict proof thereof is demanded at the time of trial. WHEREFORE, Defendant, Cowley Medical Associates, P.C., demands judgment in its favor and against Plaintiff. NEW MATTBR 58. To the extent the foregoing paragraphs state affirmative defenses, these affirmative defenses are incorporated herein by reference as though set forth fully at length. 59. Prior to the administration of chemotherapy, Plaintiff endorsed a Consent for Administration of Cancer Chemotherapy in which he acknowledged the possibility that leakage of a chemotherapeutic drug "out of the vein into adjacent tissues may inadvertently occur, resulting in local tissue damage. Local agents will be administered to minimize the damage, but consultation with a plastic surgeon may be required." A copy of said Consent for Administration of Cancer Chemotherapy is attached hereto, incorporated herein by reference and labeled Exhibit "A." 60. To the extent currently applicable or to the extent that it may become applicable at some later time, Defendants plead the statute of limitations to preserve this affirmative defense for the record. - 12 - CONSENT fOR ADMI:-lISTRA nON OF CA.-ICER CHEMOTHERAPY My docto~ ~aa info~d me t~at I ~ave a maLLgnancy w~ic~ Le beet treated at t~ia tLme wit~ anti-cancar d~uga. My doctor ~aa outLined alte~nati.. foem. of treatment and t~e materiaL ~iaka of t~oae aLternative t~ea~nta and ~aa, to my aatlafactlon, made clea~ the advlaablLity of ch.-atherapy for now. I have ~eceived wrltten lnatructlone regardlng t~e material aide effeota of the chemotherapy whlch wiLL be adainiatered, T~e mo.t c~n .nd the moat aerloua potentlaL aide affecta are' Bone Marrow Suoor...lonl Low white cell counta can Lead to life-threatening lnfection. I have been inatructed to call the number below .t any time to raport fever or any other aymptome .uggeatlve of lnfection, reallalng t~at I may have to be hoapitali.ad for aaminiatratlon of antibiotlca. Low platelet. can lead to life-threatening hemorrhage. I have been lnatructad to avold aepirin and aaplrin-contalnlng producta, which can woraen luch a bLeeding tendency. I reall.e that I may need tranlfuelon. under thele circum.tancea. Vein or Ti..ue Oamaae at the Site ot In1ectior.J Some drugs will cauae damage to the inaide of vaina, lwavinq a tender, diacolored vein which of tan cannot be uaed for aubs.quent injection.. Should I need repeat ad treatment a and acce.lability of vein. become. a problem, I have been made to underatand that placement of a venoua acce.. device by a lurgeon may become neces.ary, requiring .eparate con.ent at that time. I alao am aware that the oncology nur.es are .killed and experienced in the admini.tratJ.on of chemotherapy, but that leakage of drug out of the vein into adjacent tia.ue. may inadvertantly occur, reaulting ln local ti.aue damage. Local agent. wiLL be adminietered to minimi.e the damage, but con.ultation with a pLa.tic surgeon may be requlred. Oraan Damaae Repeated administration of chemotherapeutic agent I may, depending on the drug and individual, resuLt in reversibLe or irreversibLe organ damag~. I havs been informed that my doctor will administer doses of chemotherapy not likely to cause organ damage and wiLL monitor tests of organ function in order to modify doses and intervals of treatment within lafe limitl, NonethslQI., I realizs that occasionaL miLd organ damage may occur in the cours. of treatment of a malignancy, and that rarely more serioul damage may occur, delpits alL precaution.. Examples ot such organ damage are: Heart - Adriamycin Nerves - Cisplatln, Vincristine Kidneys - ~ethotrexate. Cisplaein, Mitomycin H9ar~~q - ~~aol~t~~ ...~r:gu - 3c~r:, 5:'ldcm'lc~::. ~e'::-:::.=OXo.l':.O. :-1.:..':.::~'l=:":". Ce~tatn d~uga, eapectatty wnen gtven repeatedly, witt reault in ate~iltty. p~~ examplea ot theee d~uga are Hltroqen Huatard and Prooa~b..tne. Younger ~n may r...ln tertlle. aecau.e ot vartabtltty ln tot.l doeage .nd lndlvldu.l ettuetlone, aexuelly .ctlve lndlvlduale ~ecel.ing che.o- the~.py ehould continue to .-ploy .n ettectlve ..thod ot cont~.ceptlcn. Blrth detect. .re moet c~n when ch.-other.py 1. gtven during the tirat t~~ater ot prS9n.ncy. H.n may wl.h to m.ke u.. ot . eperm bank prlor to t~eat..nt, .lthough current technlque. h.ve . low .ucce.. r.te to~ tuture impreqn.tlon. second Mallanancl.. Thoe. drug. ...ool.ted wlth blrth detect. and .terllity may .l.c c.u.. leuk..l., lymphoma .nd rel.ted bone marrow dl.order.. The riek becomee appreclable ln c.... where the drug. mu.t be glv.n over prolonged perlod. ot tlme, .. ln rel.p.ed malignancie.. I h.ve be.n provid.d, or .t lee.t m.d. .w.re ot, the .vailability ot liter.ture .pecitic.lly detailing which druga I am to receiv., thetr major alde-ettect., and .ction. I can take to mlnlmi.e th..e elde-ettect.. I under.t.nd and accept the ri.ke a..ooiated wlth chemoth.rapy, accepting my doctor'. judgment that the po..ible benetlt ahould outweigh the poeeible ha.ard. ot ther.py. Hy dootor hae explained that he, hi. a..ooi.tee, and the nur.ee .t COWley A..ooi.tee will c.retully .upervi.e the chemother.py, will e~amin. me, .nd wlll carry out laboratory te.t. in order to minlml.e the po..ible eid. ettect. .e well a. to determine whether the chemother.py ie helping me. It I h..e que.tion. regarding this tre.tment or .ide ettect., I can con- tact my doctor at 761-7400. It at .ny time t chooae not to continue with chemotherapy, ~octor. would continue to care for me. Likewi.e, my d~ may,;'t _ilater d te, determine that the tre.tment 1. not working or i. unde.~rable 'becau.. t toxicity or other r.a.on. and wlll inform me in the.'ev8at ~h_tqher h8lll0t:henpy 1. lnadviaable. ~ \ ,I' .~'\ \ '~. , \ ~.\ '",. )-' ~)v _ / \ \ I 'v .J\ I -" PatieDt 'Slgnature .~ 'J ~ ) ~ ~ 1\. ~ _ \ ;"-,,,: L; [. /0 , \ .,..--" Typed or printed j Cate _-Jv.~/,I..i..A..LU..." .... ' H _J./I,"I.,,,-_~,~ _ Witne.. Signature '\ .. ,: i,,- i- f .' " l ,f ...' ...'- - - w_ '_ .~ __ "-_ / ., "r.' -... l.:C '-1- 'Xl \- Phye.cian s~gnature -.. lfi\. (...~.. LA.. ; ,I 'll-:---. ~ : Typed or printed . . ~ .:.:. t.. ,,:' i -: ,. ~ L r :...1.:.; ( Typed or printed L" "; Chemotherapy, a copy of which is attached to Defendants' Answer with New Matter as "Exhibit A." The Consent for Adminl.stration of Cancer Chemotherapy speaks for itself, and all other statements and inferences contained in paragraph 59 of Defendants' New Matter are therefore denied. Any inference that the incident that is the subject of Plaintiff's First Amended Complaint was the result of inadvertent leakage of a chemotherapeutic drug out of a vein into adjacent tissues is specifically denied. Plaintiff's extravasation was not at an adjacent tissue site, but rather a previous injection site near his elbow. Additionally, Plaintiff's injuries resulted not from an inadvertent leakage, but rather solely from the negligence of the named Defendants as set forth in Plaintiff's First Amended Complaint, which is incorporated herein by reference. By way of further response, Defendants failed to administer the , agents (to minimize the damage) referred to in the consent form and otherwise negligently failed to halt and/or treat the extravasation that took place. 60. Denied. The incident that is the subject of this litigation took place on or about December 19, 1994. Plaintiff's Complaint was filed on February 22, 1996 and service was effectuated upon Defendants on February 26, 1996, well within the applicable two year statute of limitations. 61. Paragraph 61 of Defendants' New Matter states a conclusion of law to which no responsive pleading is required. To the extent that a response is deemed necessary, the averments 2 contained in paragraph 61 of Defendants' New Matter are denied. For the reasons set forth in Plaintiff's First Amended complaint, which i. incorporated herein by reference, Defendants acted negligently in providing chemotherapy nursing care and tr'!latment to Plaintiff Paul Zucker, and such care was not commeasurate with the standard of care applicable under the same or similar circumstances. 62. Paragraph 62 of Defendants' New Matter states a conclusion of law to which no responsive pleading is required. To the extent that a response is deemed necessary, the averments contained in paragraph 62 of Defendants' New Matter are denied. Plaintiff's injuries as alleged in Plaintiff's First Amended Complaint were solely a direct and proximate result of the negligence of the named Defendants as set forth in Plaintiff's First Amended Complaint, which is incorporated herein by reference. 63. Paragraph 6] of Defendants' New Matter states a conclusion of law to which no response of pleading is required. To the extent that a response is deemed necessary, the averments contained in paragraph 63 of Defendants' New Matter are denied. Plaintiff was in no manner negligent, comparatively negligent, or contributorily negligent with regard to the nursing and chemotherapy care and treatment that he received, nor did he assume the risk of his injuries. 3 ~. .::r ;;- ," >0' a. "::;:'1 t c: :!C ~~ :-~ , ? ~ :,-;.j ~.. .~ -.!) '1~~ l~' - .'~~ if" r..; ~. ~" '-.:'.- c;:: II. \.(1 .:.1 0 U' -, ,"I , ,- II' , , " , . , .. , , , I l" ,. r" / . ".0. ~ Each answer shall admit or deny the matter or set forth in detail the reason(s) why an admission or denial cannot truthfully be .ade. A denial of any matter shall fairly meet the substance of the requested admission. When qood faith requires Defendants to qualify their answer, or deny only a part of the matter of which an admission is requested, the Defendants shall speci:y so much of the requested admission as is truth and qualify or deny the remainder. Defendants may not give lack of knowledge or information as a reason for failure to admit or deny unless they state that they have made reasonable inquiry and that the information known or readily obtained is insufficient to enable them to admit or deny the requested admission. Defendants may not object to a requested admission on grounds that the request presents a genuine issue for trial. Plaintiff, by his attorneys, Angino , Rovner, P.C., hereby requests that Defendants Cowley Medical Associates, P.C. and Kimberly Martin, R.N. admit the following facts pursuant to Rule 4014 of the Pennsylvania Rules of Civil Procedure: 1. On December 19, 1994, Defendant Cowley Medical Associates, P. C., through its nursing staff, administered the chemotherapeutic agents Vinblastine and Mitomycin to Plaintiff Paul Zucker. 2 2. Plaintiff Paul Zucker suffered necrotic tissue damage to the inside of his right forearm as a direct and proximate result of extravasation of the Mitomycin and/or Vinblastine that was aa.iniatered by Defendant Cowley Medical Associates, P.C. on December 19, 1994. ]. The copy of the photograph which lS attached hereto as Exhibit "A" depicts the necrotic tissue damage that Plaintiff Paul ZUCker suffered as a direct and proximate result of the extravasation of the Mitomycin and/or Vinblastine that was administered by Defendants Cowley Medical Associates, P.C. on December 19, 1994. 4. Cowley Medical Associates, P.C.'s "Consent for Aa.inistration of Cancer Chemotherapy" form signed by Paul Zucker, which is attached hereto as Exhibit "B" provides, that in the event that release of a chemotherapeutic drug out of the vein into adjacent tissues inadvertently occurs, resulting in local tissue damage, "Local agents will be administered to minimize the damage, but, consultation with a plastic surgeon may be required." 5. The "local agents" referred to in the "Consent for Administration of Cancer Chemotherapy" form are steroids and Hyaluronidase. (~, Dr. Gordon deposition, page 50). ] - . . .i",~~ .~ ." A ~1J"'jjlJI ..&&~;Ijt..t~~tT~l"'~""::>:""'^' -",....~ . , , '.'.. .. ';,.' 'j- '. " ,..".. ~ '.I I', '1' ':', . ;-;" ~ '" ,'-' ',f , ~ I f' .~II.( t \,' ., ," ... 't-iI , , 'f'. _ ':,-~ · "',.~ " . J ,I ,ol , ',,'1"" '.', J \ t. I , . , '<. '. I., . ! f I - . .. . , ~. '_:....r~'..r..'.,."."- , ) ~~~IM'V"""". IXHI8fT . ....-',,""". ...,.--,,,,,-.,,,~. ) :f: ( I 0;:: ~' .;i,.::- ., ';;/ \ i ~t::.' t~;~1 H li,;" I f; 71 ~..i<$!~; . r":. .,c . ' " ;. CONSENT FOR ADMlNISTRA nON OF CANCER CHEMOTHERAPY Hy dacta~ ha. lnfa~med me that t have a malignancy whlch le be.t t~eated at thie time wlth antl-cancer d~ug.. My docta~ ha. outlined alte~natlye form. of t~eatment and the materlal ~l.k. of tha.e alte~natlve treatment. and ha., to my .ati.factlan, made clea~ the advl.abl1lty of chemothe~apy fo~ now. 1 have ~ecelved w~ltcen In.t~uctlon. ~ega~ding the mate~lal alde effecta of the chemothe~apy which will be admlnl.te~ad. The mo.t common and the moct .e~lou. potential .ide effect. a~el 8on. Marrow SUDor...ionl Low whlte oell count. can lead to I1fa-thzeatenlng infectlon. I haya bean In.t~uctad to call the nWllllar below at any tlma to report fever or any othar aymptom. augge.tlye of lnfectlon, reall.1ng that I ~y hava to be ho.pltall.ad for admlnl.t~atlon of antiblotlca. Low platelete can laad to 11fe-threatenlng hemorrhage. I have be.n In.tructed to avold aaplrln and a.plrln-contalnlng product., wnlch can wor.en such a bleedlng tendency. I r.all.. that I may need t~an.fu.lon. under the.e clrcumatance.. Vein or Ti..ue Dam.a. at the site of In1.cti~n1 Some drug. will cau.e damage to the In.lde of veln., leavlng a tender, dl.colored vein which often cannot be u.ed for sub.equent lnjection.. Should I need repeat ad treatment. and .cce..ability of velna become. a problam, I have been made to under.tand that placement of . venous accea. device by a .urgeon may become nece..ery, ~equiring aeparete con.ent at that time. I al.o am aware that the oncology nur.e. are akilled and experienced in the admini.tration of chemotherapy, but that leakage of drug out of the vein lnto adjacent ti..u.. may lnadvertantly occur, ~e.ultlng ln local ti..ue damage. Local agent. will be admini.te~.d to minimi.e the damage, but can.ultation with a pla.tic aurgeon may be r.quired. Orean Damaa. Repeated admini.tration of chemothe~apeutic agent. may, depending on the drug and individual, re.ult in ~eve~.ible or lrrev.r.ible organ damage. I have been informed that my doctor will admini.ter do.e. of chemotherapy not likely to cauee organ damage and will monitor t.et. of organ functlon in order to modify do.e. and interval. of treatment withln aafe limit.. Nonethele.., I reali.e that occa.ional mild organ damage may occur in the cour.e of t~.atment of a malignancy, and that ~arely more .e~iou. damage may occu~, deepite all precaution.. Example. of .uch organ damage are' Heart - Ad~i&mycin N.rve. - Ci.platin, Vincristine Kidney. - Methotrexate, ci.platin, Mitomycin Hearlng - Ci.platin Lung. - BCNU, Bleomycin, Methotrexate, Mitomycin J ( Ce~t.in d~ug" e.peci.ily when given ~epe.tedly, will ~e.ult in .te~ility. .~u.. e.ample. of the.e d~ug. .~e Nit~oqen "u.t.~d .nd .~oo.~b.aine. Younge~ women ..y eemain feetile. aec.u.e of v.eiability in tot.l do.,ge end individu.l .itu.tion., ...u.lly .ctive individu.l. ~eceiving chemo- thee.py .hould continue to employ .n effective ..thod of conte.c.ption. aieth d.fect. .e. mo.t common wh.n chemothee.py i. given dueing the fie.t t~u..et.~ of p~egn.ncy. Ken ..y wi.h to ..ke u.e of . .parm b.nk p~io~ to teeet..nt, .lthough cu~~ent technique. h.ve . low .ucce.e ~.te fo~ futuee 1mp~.gnation. ..cond Kaliananal.. Tho.e d~ug. ...oci.ted with birth aQf.ct. and .t.~ility ..y el.o cau.. leukemia, lymphoma and ~elated bone mazcow di.o~d.c.. The ~i.k beoome. appcec:iable in c.... whece the drug. .u.t be ghen ove~ p~olonged pe~iod. of t1me, a. in ~.lap.ed ..lignancie.. I have been pcovid.d, oe at le..t ..de awa~e of, the aveilability of lite~.tuce .pacifically det.iling which dcug. I all to ~ec:ei.e, thei~ ..jo~ .ide-effect., end action. I can take to min1mia. the.e .ide-eff.ct.. I unde~.tand .nd .ccept the ~i.k. a..ooi.ted with chemothe~apy, accepting my doctoe" jud9llent that the po..ible benefit .hould outweigh the po..Lble h.aaed. of thee.py. "y doctoe h.. explained that he, hi. a..ooiat.., and the nu~.e. at COWl.y A..ociate. will c.eefully .upaevi.e the chemothee.py, will examine me, and will ca~ey cut laboeatory t..t. in o~d.~ to .in1mi.e the po..Lble .ide effect. a. well a. to determine whethee the chemotheeapy i. helping me. If I have que.tion. ~egaeding thi. teeatment oc .ide effeat., I can con- tact my doctoe at 761-7400. If at any time I choo.. not to continue with chelllOthe~apy, octon would continue to cue foe me. Likewbe, my d~ .ay, t a latec d te, determine that the tc.atment i. not wocking o~ ~~_~nde.;e le becau.e f toxicity oe oth.c c.a.on. and will inform .e in the,eveat hat hee hemotheeapy i. inadvi.able. \/ r I . I \ A / I \ ( ~\J J'. \ \J~\ I '-up '// t!-- pa~i'Jt Si\)natuceJ ',' 1~1v\ t:-Jc/!'i( Typed oe pcinted ~ I Date <)y'-u;~j H(;JXIi~ j Witn... Si~n.tuce U'-lxaft. ~(alcfu~ Phy.ician Signatuce 1/" <'r h,.I...: l' At, \(.K.. ~ ...:. V Iw ~ l ~ I Typed oe p int.d . V_c.l~ti .;.. c"ur Jar. Typed oc pcinted ll'. / ,- , OHICIHvr Er. 0 r::; ...' I-' .. J..;," W(",1 N .)~-; ~.. :r.: ) ~<~ '- ~_ i ~t ('- \...:_! .'-- r- ' (11 i.." N '1 ::.: ,r ~ iiv -.I : "'iTI 0::- ~ f.~! 0... ..: l>- CO ::> 0 0" U - .. ..~,:.__r:~_:,~~~~~~!~.~~~;t9~_'?r'..;~~~,,,,,!~~,:lt;'!#"""'~'w,;"""""",,,~,-~, --'".. IX""" A , "".';~' ,. \ ( . I :\ . (t''.' i ! l ,. . r. . I ..... ! I [,' i I -..,., .._~p. ~!.,.", '_n,~.: \.' I ,/ I ~J ~,oC! r f' :'1 ..~_ t, .~,l'....' -,,.,.. -"1"'- . , j , i ;4""-' . .' exhibit A ~" 0, f J'l 'J I I , , b I I , .... J. PAUL ZUCKER, . . . . Plaintiff . . . . v. : . . COWLEY MEDICAL ASSOCIATES, . . P.C., and KIMBERLY MARTIN, . . R.N. , . . I Defendant. . . IN THE COURT OF COMMON PLEAS CUMBERLAND CO., PENNSYLVANIA CIVIL ACTION - LAW NO. JURY TRIAL DEMANDED COMPLAINT 1. Plaintiff Paul ZUCKer is an adult individu~l who resides in HarriSburg, Dauphin County, Pennsylvania. 2. Defendant Cowley Medical Associates, P.C., i. a professional corporation organized pursuant to the laws of the Commonwealth of Pennsylvania. ]. At all times relevant to this Complaint, Defendant Cowley Medical Associates, P.C., maintained an office and reqular place of business in Camp Hill, cumberland County, Pennsylvania. 4. Defendant Ximberly Martin, R.N., is currently, and was at all times relevant to this Complaint, a registered nurse licensed to practice nursing in the Commonwealth of Pennsylvania. 5. At all times relevant to this Complaint, Defendant Ximberly Martin, R.N., held herself out to the public as a specialist in oncology nursing. 6. At all times relevant to this Complaint, Defendant Kimberly Martin, R.N., was a servant, agent, apparent agent and/or 79926ILAS ~....... -. .lllploye. of Oefendant Cowley Medical Associates, P.c., and was acting in such capacity. 7. In September of 1994, Plaintiff Paul Zucker was diagnosed as suffering from non-small cell lung cancer. 8. Plaintiff Paul Zucker elected to undergo concurrent radiation therapy and chemotherapy ~n an attempt to treat the lung cancer. 9. On October 17, 1994, Plaintiff Paul Zucker began a course of chemotherapy with Defendant Cowley Medical Associates, P.C. 10. On or about December 19, 1994, Defendant Cowlny Medical AlIsociates, P.c., administered Mitomycin, an anti-tumor antibiotic, to Plaintiff Paul Zucker. 11. On or about December 19, 1994, Defendant Cowley Medical Associates, P.c., administered the chemotherapeutic agent Vinblastine to Plaintiff Paul Zucker. 12. The Mitomycin and Vinblastine were infused intravenously through a site on the back of Plaintiff Paul Zucker's right hand. 1]. As the Mitomycin and/or Vinblastine were being infused, Plaintiff Paul Zucker began to experience pain and a burning sensation in his right arm and noticed that the Mitomycin and/or Vinblastine were leaking out of a previous injection site located near his elbc.w. 14. Plaintiff Paul Zucker reported the pain, burning sensation and leakage to the nurse who was attending to him and repeatedly asked her to apprise the head nurse, Defendant Kimberly Martin, R.N., of the situation. 2 15. After being notified of Plaintiff Paul Zucker's complaints, Defendant Kimberly Martin, R.N., advised Plaintiff Paul Zucker that nothing was wrong, and that he was to let the Mitomycin and/or Vinblastine continue to infuse. 16. Plaintiff Paul Zucker continued to complain of pain, burning and leakage for approximately three add one-half hour., but was ignored, during which time the inCu1ions were allowed to continue. 17. Defendants permitted the Mitomycin and/or Vinblastine to continue to infuse into Plaintiff Paul Zucker'. right arm for several hours after his initial complaints of pain, burning and leakage from the previous injection site. 18. As a direct and proximate result of extravasation of the chemptherapy agent Mitomycin and/or the chemotherapy agent Vinblastine, Plaintiff Paul Zucker suffered serious injuries, including, but not limited to, extensive necrotic damage to his right forearm. COtnl'l' I Paul Zucker v. Kimberlv Martin. R.N. 19. Paragraphs one through 18 of this Complaint are incorporated herein by reference. 20. As a direct and proximate result of her negligence as set forth in paragraphs 21 through ]1 below, Defendant Kimberly Martin, R.N., is liable to Plaintiff Paul Zucker tor the injuries alleged herein. ] 21. Defendant Rimberly Martin, R.N., failed, prior to the date of Plaintiff Paul Zucker'. injury, to familiarize herselt with the proper techniques for the administration of Mitomycin and Vinblastine. 22. Defendant Rimberly Martin, R.N., failed to familiarize herself with the signs and symptoms of extravasation of Mitomycin and/or Vinblastine prior to the administration co: the drug to Plaintiff Paul Zucker on or about December 19, 1994. 23. Defendant Kimberly Martin, R.N., failed to familiarize herself with the proper techniques for treating and/or minimizing necrotic tissue damage as a result of extravasation of Mitomycin and/or Vinblastine prior to administering the drug to plaintift Paul Zucker on or about December 19, 1994. 24. Defendant Rimberly Martin, R.N., failed to halt the administration of the Mitomycin to plaintiff Paul Zucker immediately upon learning of his complaints of pain, burning and leakage from a previous injection site. 25. Defendant Rimberly Martin, R.N., failed to halt the administration of the Vinblastine to Plaintift Paul Zucker immediately upon learning ot his complaints of pain, burning and leakage from a previous injection site. 26. Defendant Kimberly Martin, R.N., instructed Plaintift Paul Zucker and/or the nurse attending to Mr. Zucker to permit the Mitomycin and/or Vinblastine to continue to infuse into Mr. Zucker's right arm, despite the fact that she had been apprised ot 4 Mr. Zucker's complaint of pain, burning and leakage from a previous injection site. 37. Oefendant Kimberly Martin, R.N. permitted the Mitomycin and/or Vinblastine to continue to infuse into Mr. Zucker's right arm after learning of his complaints of pain, burning and leakage from a previous injection site. 28. Defendant Kimberly Mart.tn, R.N., failed to tre..'C Mr. Zucker for extravasation of the Mitomycin and/or Vinblastine immediately upon learning of his compla~nts of pain, burning and leakage from a previous injection site. 29. Defendant Kimberly Martin, R.N., failed to immediately consult or request a consultation from, a physician, oncologist and/or medical specialist familiar with Mitomycin and Vinblastine, upon being apprised of Mr. ZUCKer's complaints of pain, burning and leakage from a previous injection site. 30. Defendant Kimberly Martin, R.N. failed, after being apprised of Mr. Zucker's complaints of pain, burning and/or leakage from a previous injection site, to immediately eliscontinue the administration of Vinblastine, to attempt to aspirate any residual drug remaining in the tissues in order to extract the drug, to administer Hyaluronielase, and to apply heat to activate the Hyaluronidase. 31. Defendant Kimberly Martin, R.N. failed, after being apprised of Mr. Zucker's complaints of pain, burning and/ol' leakagEl from a previous injection site, to immediately discontinue the administration of Mitomycin, to attempt to aspirate any residual 5 drug remaining in the tissue. in order to extract the drug, and to instruct Mr. Zucker to apply ice for 15 to 20 minutes at least tour times per day and to elevate the affected extremity during the first 24 to 48 hours following the extravasation. ]2. As a direct and proximate result of the negligence of Ximberly Martin, R.N., as set forth above, Plaintiff Paul Zucker suffered serious injuries including, but not limited to, necrotic tissue damage to his right forearm. ]]. As a direct and proximate result of the aforesaid injuries, Plaintiff Paul Zucker has incurred, and will in the future incur, medical and rehabilitative expensss, and claim is made therefor. 34. As a direct and proximate result of the aforesaid injuries, Plaintiff Paul Zucker has been, and in the future will be, subject to great humiliation and ridicule, and claim is made therefor. ]5. As a direct and proximate result of the aforesaid injuries, Plaintiff Paul Zucker has undergone, and in the future will undergo, great mental and physical pain and SUffering, great inconvenience in carrying out his daily activities, and a loss of life's pleasures and enjoyment, and claim is made therefor. ]6. As a direct and proximate result of the aforesaid injuries, Plaintiff Paul Zucker has sustained loss of earning power and earning capacity, and claim is made therefor. WHEREFORE, Plaintiff Paul Zucker demands judqment against Defendant Ximberly Martin, R.N., in an amount in excess of Twenty- 6 ,ive Thousand ($25,000) Dollars, exclusive of interest and costs, and in excess of any jurisdictional amount requiring compulsory arbitration. COt1JlT II ..ul luaker v. Cowlev ..diaal a..oot.tea. v.e. ]7. Paraqraphs one through 18 of this Complaint are incorporated herein by reference. ]8. As a direct and proximate result of negligence of its .ervants, agents, apparent agents, and/or employees, includinq, but not limited to, Kimberly Martin, R.N., and its nur~inq staff, as set forth in paragraphs ]9 throuqh 49 below, Defendant Cowley Medical Associates, P.C., is liable to Plaintiff Paul Zucker for the injuries alleged herein. 39. Said servants, agents, apparent agents and/or employees failad, prior to the date of Plaintiff Paul Zucker's injury, to familiarize themselves with the proper techniques for the administration of Mitomycin and Vinblastine. 40. Said servants, agents, apparent aqents and/or employees failed to familiarize themselves with the signs and symptoms of extravasation of Mitomycin and/or VinJlastine prior to the administration of the drug to Plaintiff Paul Zucker on or about December 19, 1994. 41. Said servants, agents, apparent aqents and/or employees failed to familiarize themselves with the proper techniques for treatinq and/or minimizing necrotic tissue damage as a result of extravasation of Mitomycin and/or Vinblastine prior to 7 administering the drug to Plaintiff Paul Zucker on or about December 19, 1994. 42. Said servants, agents, apparent agents and/or employees failed to halt the administration of the Mitomycin to Plaintiff Paul Zucker immediately upon learning of his complaints of pain, burning and leakage from a previous injection site. 4]. Said servants, agents, apparent agents and/or employees failed to halt the administration of the Vinblastine to Plaintiff Paul Zucker immediately upon learning of his complaints of pain, burning and leakage from a previous injection site. 44. Said servants, agents, apparent agents and/or employees instructed Plaintiff Paul Zucker to permit the Mitomycin and/or Vinblastine to continue to infuse, despite the fact that they had been apprised of Mr. Zucker's complaint of pain, burning and leakage from a previous injection site. 45. Said servants, agents, apparent agents and/or employees permitted the Mitomycin and/ur Vinblastine to continue to infuse into Mr. Zucker's right arm after learning of his complaints of pain, burning and leakage from a previous injection site. 46. Said servants, agents, apparent agents and/or employees failed to treat Mr. Zucker for extravasation of the Mitomycin and/or Vinblastine immediately upon learning of his complaints of pain, turning and leakage from a previous injection site. 47. Said servants, agents, apparent agents and/or employees failed to immediately consult or request a consultation from, a physician, oncologist and/or medical specialist familiar with 8 Mitomycin and Vinblastine, upon being apprised of Mr. Zucker's complaints of pain, burning and leakage from a previous injection site. 48. Said servants, agents, apparent agents and/or employees failed, after being apprised of Mr. Zucker's complaints of pain, burning and/or leakage from a previous injection site, to immedilltely discontinue the administration of Vinblastine, to attempt to aspirate any residual drug remaining in the tissues in order to extract the drug, to administer Hyaluronidase, and to apply heat to activate the Hyaluronidase. 49. Said servants, agents, apparent agents and/or employees failed, after being apprised of Mr. Zucker's complaints of pain, burning and/or leakage from a previous injection site, to immediately discontinue the administration of Mitomycin, to attempt to aspirate any residual drug remaining in the tissues in order to extract the drug, and to instruct Mr. Zucker to apply ice for 15 to 20 minutes at least four times per day and to elevate the affected extremity during the first 24 to 48 hours following the extravasatiorl. 5D. As a direct and proximate result of the negligence of said servants, agents, apparent agents and/or employees of Defendant Cowley Medical Associates, P.C., as set forth above, Plaintiff Paul Zucker suffered serious injuries including, but not limited to, necro~ic tissue damage to his right forearm. 51. As a direct and proximate result of the aforesaid injuries, Plaintiff Paul Zucker has incurred, and will in the 9 tutu~e incur, medical and rehabilitative expenses, and claim i. made therefo~. 52. As a direct and proximate result of the aforesaid injuries, Plaintiff Paul ZUCker has been, and in the future will be, subject to great humiliation and ridicule, and claim is made therefo~. 53. As a direct and proximate result of the aforesaid injuries, Plaintiff Paul Zucker has undergone, and in the future will undergo, great mental and physical pain and suffering, great inconvenience in carrying out his daily activities, and a loss of life'. pleasures and enjoyment, and claim is made therefor. 54. As a direct and proximate result of the aforesaid injuries, Plaintiff Paul Zucker has sustained loss of earning power and ea~ning capacity, and claim is made therefor. WHEREFORE, Plaintiff Paul Zucker demands judqment against Defendant Cowley Medical Associates, P.C., in an amount in excess of Twenty-Five Thousand ($25,000) Dollars, exclusive of interest and costs, and in excess of any jurisdictional amount requiring compulsory arbitration. ;;.j;;0/9&, David s. W snes I.D. No. 58796 450] N. Front street Harrisburg, PA 17110 (717) 2]8-6791 Counsel for Plaintiff 10 ,:3USLn'l dn ~:(t.L.1l/d.:3dt:.~n :.n~iJr'i !".'I ~!r:. '::~i.'.~)(e,rJ ci.qht C)Cedcm. A I":OPY ,]f ?Lal.ntl.ff's '.:)mpL.1l.nt 1.3 atr.,i.~np,i 1-..?r':'Jt'J, l.n,~,)'pl)r3t.ed herein by reference and Labeled ExhLbL~ "A." 3. On or about .l\\lCJusr. :, l'198, Ms. Martin received notification that PlaLntiff has Listed thLS case for trlal. Upon learning of thiS trLal Listing, counsel for Ms. Martin contacted her expert, and learned that he was not available for attendance of trial during the September 14, 1998 tnal term. 4. Upon learning of this fact, Ms. Martin's counsel contacted Plaintiff's counsel and indicated that a continuance to the November, 1998 trial term would be requested. 5. Plaintiff's counsel, David Wlsneski, Esquire, indicated that he would not object to Ms. Martin's request for a continuance. 6. This is the first time this case has been listed for trial and, accordingly, the first time a continuance has been requested. WHEREFORE, Defendants, Kimberl, Martin Alexander, R.N., and Cowley Medical Associates, P.C., respectfully request this Court PAUL ZUCICER, IN THE COURT or COMMON PLEAS CUMBERLAND CO., PENNSYLVANIA Plll1ntit f v. CIVIL ACTION - LAW : NO. COWLEY MEDICAL ASSOCIATES, P.C., and KIMBERLY MARTIN, R.N. , Defendants JURY TRIAL DEMANDED COMPLAINT 1. Plaintiff Paul Zucker is an adult individual who resides in HarriSburg, Dauphin County, Pennsylvania. :3. Defendant Cowley Medical Associates, P. C. , i. a protessional corporation organized pursuant to the laws at the Commonwealth ot Pennsylvania. 3. At all times relevant to this complaint, Detendant Cowley Medical Associates, P.c., maintained an ottice and regular place ot business in Camp Hill, CUmberland county, Pennsylvania. 4. Defendant Kimberly Martin, R.N., is currently, and was at all times relevant to this Complaint, a registered nurse licensed to practice nursing in the Commonwealth ot Pennsylvania. 5. At all times relevant to this Complaint, Defendant Ximberly Martin, R.N., held herselt out to the public as a specialist in oncology nursing. 6. At all times relevant to this Complaint, Defendant Kimberly Martin, R.N., was a servant, agent, apparent agent and/or 79926/LAS employee of Defendant Cowley Medical Associates, P.C., and was acting in such capacity. 7. In September of 1994, Plaintift Paul Zucker was diagnosed as suffering from non-small cell lung cancer. 8. Plaintift Paul Zucker elected to undergo concurrent radiation therapy and chemotherapy ~n an attempt to treat the lung cancer. 9. On October 17, 1994, Plaintitt Paul Zucker began a course of chemotherapy with Defendant Cowley Medical Associates, P.C. 10. On or about December 19, 1994, Defendant Cowley Medical Associates, P. C., administered Mitomycin, an anti-tum~r antibiotic, to Plaintiff Paul Zucker. 11. On or about Oecember 19, 1994, Oefendant Cowley Medical Associates, P.C., administered the chemotherapeutic agent Vinblastine to Plaintiff Paul Zucker. 13. The Mitomycin and Vinblastine were infused intravenously through a site on the back of Plaintiff Paul Zucker's right hand. 13. As the Mitomycin and/or Vinblastine were being intused, Plaintiff Paul Zucker began to experience pain and a burning sensation in his right arm and noticed that the Mitomycin and/or Vinblastine were leaking out ot a previous injection site located near his elbow. 14. Plaintift Paul Zucker reported the pain, burning sensati~n and leakage to the nurse who was attending to him and repeatedly asked her to apprise the head nurse, Defendant Kimberly Martin, R.N., of the situation. 2 " 15. After being notified of Plaintiff Paul Zucker's complaints, Defendant Ximberly Martin, R.N., advised Plaintiff Paul Zucker that nothing was wrong, and that he was to let the Mitomycin and/or Vinblastine continue to infuse. 16. ~laintitf Paul Zucker continued to complain of pain, burning and leakage for approximately three and one-half hours, but was ignorfld, during which time the in!u"1ions were allowec\ to continue. 17. Defendants permitted the Mitomycin and/or Vinblastine to continue to infuse into Plaintitt Paul Zucker'. right arm tor several hours after his initial complaints of pain, burning and leakage from the previous injection site. 18. As a ~irect and proximate result of extravasation of the chemptherapy agent ~itomycin and/or the chemotherapy agent Vinblastine, Plaintift Paul Zucker suffered serious injuries, incLuding, but not limited to, extensive necrotic damage to his right f~rearm. COtl'N'l' I Paul Zucker v. Kimberlv Martin. R.N. 19. Paragraphs one through 18 of this Complaint are incorporated herein by reterence. 20. As a direct and proximate result ot her negligence as set forth in paragraphs 21 through 31 below, Defendant Kimberly Martin, R.N., is liable to Plaintitt Paul Zucker tor the injuries alleged herein. 3 ~1. Defendant Kimberly Mar~in, R.N., failed, prior to the date of Plaintiff Paul Zucker'. injury, to familiarize her.elf with the proper techniques for the administration of Mitomycin and Vinblastine. 22. Defendant Kimberly Martin, R.N., failed to familiarize herself with the signs and symptoms of extravasation of Mitomycin and/or Vinblastine prior to the administration C': the drug to Plaintiff Paul Zucker on or about Oecember 19, 1994. 23. Oetendant Kimberly Martin, R.N., failed to familiarize herself with the proper techniques for treating and/or lIinimhing necrotic tissue damage as a result of extrava.ation of Mitomycin and/or Vinblastine prior to adminis~ering the drug to Plaintiff Paul Zucker on or about Oecember 19, 1994. 24. Oefendant Kimberly Martin, R.N., failed to halt the administration of the Mitomycin to Plaintiff Paul Zucker immediately upon learning of his complaints of pain, burning and leakage from a previous injection site. 25. Oefendant Kimberly Martin, R.N., failed to halt the administration ot the Vinblastine to Plaintitf Paul Zucker immediately upon learning of his complaints ot pain, bur.ning and leakage from a previous injection site. 26. Oetendant Kimberly Martin, R.N., instructed Plaintift Paul 2ucker and/or the nurse attending to Mr. Zucker to permit the Mitomycin and/or Vinblastine to continue to intuse into Mr. Zucker's right arm, despite the tact that she had been apprised of 4 Mr. Zucker's complaint of pain, bUl'ninq and leakage trom a pl'evioul injec1:ion site. 27. Defendant Kimberly Martin, R.N. permitted the Mitomycin and/or Vinblastine to continue to infuse into Mr. Zucker', right arm after learning of his complaints of pain, burning and leakage from a previous injection site. 28. Defendant Kimberly Martin, R.N., tailed to tre..~ Mr. Zucker tor extravasation ot the Mitomycin and/or Vinblastine immediately upon learning of his complaints of pain, burning and leakage from a previous injection site. 29. Oefendant Rimberly Martin, R.N., failed to immediately consult or request a consultation from, a physician, oncologist and/or medical specialist familiar with Mitomycin and Vinblastine, upon being apprised of Mr. Zucker's complaints of pain, burning and leakage tram a previous injection site. 30. Defendant Kimberly Martin, R.N. tailed, after being apprised of Mr. Zucker's complaints of pain, burning and/or leakage from a previous injection site, to immediately discontinue the administration of Vinblastine, to attempt to aspirate any residual drug remaining in the tissues in order to extract the drug, to administer Hyaluronidase, and to apply heat to activate the Hyaluronidase. 31. Oefendant Kimberly Martin, R.N. tailed, after being apprised of Mr. Zucker's complaints of pain, burning and/or leakage trom a previous injection site, to immediately discontinue the administration of Mitomycin, to attempt to aspirate any residual 5 dTU9 remaining in the tissues in order to extract the dTUg, and to instTUct M~. Zucker to apply ice for 15 to 20 minutes at le.st four times per day and to elevate the affected extremity durin9 the first 24 to 48 hours followin9 the extravasation. 32. As a direct ana proximate result of the negligence of Ximberly Martin, R.N., as set forth above, Plaintiff Paul Zucker suffered serious injuries including, but not limited to, necrotic tissue damage to his right forearm. 33. As a direct and proximate rssul t of the aforesaid injuries, Plaintiff Paul Zucker has incurred, and will in Ue future incur, medical and rehabilitative expenses, and claim is made therefor. 34. As a direct and proximate result of the aforesaid injuries, Plaintiff Paul Zucker has been, and in the future will be, subject to great humiliation and ridicule, and claim is made therefor. 35. As a direct and proximate result of the aforesaid injuries, Plaintiff Paul Zucker has undergone, and in the tuture will undergo, great mental and physical pain and suffering, great inconvenience in carrying out his daily activities, and a loss of life's pleasures and enjoyment, and claim is made therefor. 36. As a direct and proximate result ot the aforesaid injuries, Plaintiff Paul Zucker has sustained loss at earning power and earnin9 capacity, and claim is made therefor. WHEREFORE, Plaintiff Paul Zucker demands jud91llent against Oetendant Kimberly Martin, R.N., in an amount in excess of Twenty- 6 rive Thousand ($35,000) Dollars, exclusive of interest and cos~s, 5nd in exces. of any jurisdic~ional amoun~ requiring compulsory arbitration. COllVl.' II ..ul luck.~ Y. Covl.v Xedical A..oai.t..~ ..c. 37. Paragraphs one through 18 of this Complaint are incorporated herein by reference. 38. As a direct and proximate result of negligence of its servants, agents, apparent agents, and/or employee., including, but not limited to, Kimberly Martin, R.N., and its nursing staff, as set forth in paragraphs 39 through 49 below, Defendant Cowley Medical As.ociates, P.c., is liable to Plaintiff Paul Zucker for the injuries alleged herein. 39. Said servants, agents, apparent agents and/or employ.es failed, prior to the date of Plaintiff Paul Zucker's injury, to familiarize themselves with the proper techniques for the administration of Mitomycin and Vinblastine. 40. Said servants, agents, apparent agents and/or employees failed to familiarize themselves with the si9ns and symptoms of extravasation of Mitomycin and/or Vinblastine prior to the administration of the drug to Plaintiff Paul Zucker on or about Oecember 19, 1994. 41. Said servants, agents, apparent agents and/or employees tailed to tamiliarize themselves with the proper teChniques for treating and/or minimizing necrotic tissue damage as a result of extravasation of Mitomycin and/or Vinblastine prior to 7 administerinq the druq to PlaintUf Paul Zucker on or about December 19, 1994. 42. Said servants, agents, apparent agents and/or employee. failed to halt the administration ot the Mitomycin to Plaintift Paul Zucker immediately upon learning of hi. complaints of pain, burninq and leakaqe from a previous injection site. 43. Said servants, agents, apparent agents and/or employees failed to halt the administration of the Vinblastine to Plaintiff Paul Zucker immediately upon learning ot his complaints of pain, burning and leakage trom a previous injection site. 44. Said servants, agents, apparent agents and/or employees instructed Plaintiff Paul Zucker to permit the Mitomycin and/or Vinblastine to continue to infuse, despite the fact that they had been apprised ot Mr. Zucker's complaint of pain, burning and leakage from a previous injection site. 45. Said servants, aqents, apparent agents and/or employees permitted the Mitomycin and/or Vinblastine to continue to intuse into Mr. Zucker's right arm after learning ot his complaints of pain, burning and leakage from a previous injection site. 46. Said servants, agents, apparent agents and/or employees tailed to treat Mr. Zucker for extravasation of the Mitomycin and/or Vinblastine immediately upon learning of his complaints of pain, burning and leakage tram a previous injection site. 47. Said servants, agents, apparent agents and/or employees failed to immediately consult or request a consultation from, a physician, oncologist and/or medical specialist tamiliar with 8 Mitomycin and Vinblastine, upon being apprised of Mr. Zucker's complaints of pain, burning and leakage from a previous injection site. 48. Said servants, agents, apparent agents and/or employees failed, after bei~g apprised of Mr. Zucker's complaints of pain, burning and/or leakage from a previous injection site, to i_ed1ately discontinue the administration of Vinblastine, to attempt to aspirate any residual drug remaining in the tissues in order to extract the drug, to administer Hyaluronidase, and to apply heat to activate the Hyaluronidase. 49. Said servants, agents, apparent agents and/or employees tailed, after being apprised ot Mr. Zucker's complaints of pain, burning and/or leakage from a previous injection site, to immediately discontinue the administration of Mitomycin, to attempt to aspirate any residual drug remaining In the tissues in order to extract the drug, and to instruct Mr. Zucker to apply ice tor 15 to 20 minutes at least four times per day and to elevate the aftected extremity during the first 24 to 48 hours following the extravasation. 50. As a direct and proximate result of the negligence ot said servants, agents, apparent agents and/or employees ot Oefendant Cowley Medical Associates, P.c., as set forth above, Plaintitt Paul Zucker suffered serious injuries including, but not limited to, necrotic tissue damage to his right torearm. 51. As a direct and proximate result of the aforesaid injuries, Plaintift Paul Zucker has incurred, and will in the 9 tuture incur, medical and rehabilitative expenses, and claim is made therefor. 52. As a direct and proximate result of the afore.aid injuries, Plaintift Paul Zucker has been, and in the future will be, subject to great humiliation and ridicule, and claim is made therefor. 53. As a direct and proximate result of the afore.aid injuries, Plaintiff Paul Zucker has undergone, and in the tuture will undergo, great mental and physical pain and suttering, great inconvenience in carrying out his daily activities, and a loss of life's pleasures and enjoyment, and claim is made therefor. 54 . As a direct and proximate result of the atore.aid injuries, Plaintiff Paul Zucker has sustained loss ot earning power and earning capacity, and claim is made theretor. WHEREFORE, PlalnUtt Paul Zucker demands judgment against Defendant Cowley Medical Associates, P.c., in an amount in excess of Twenty-Five Thousand ($25,000) Oollars, exclusive of interest and costs, and in excess of any jurisdictional amount requiring compulsory arbitration. ~I ;;.o} 9~ Dav d S. W snes 1.0. No. 58796 4503 N. Front street Harrisburg, PA 17110 (717) 238-6791 Counsel tor Plaintitt e 10 causing an extravasation Lnj\lr, to Mr. 3ucker's right rorearm. A copy of Plaintiff's Complaint Ls attached hereto, incorporated herein by reference and labeled Exhibit "A." 3. On or about August 2, 1998, t1s. MartLn received notification that Plaintiff has listed thLs case for trial. Upon learning of this trial listing, counsel for Ms. Martin contacted her expert, and learned that he was not available for attendance of trial during the September 14, 1998 trial term. 4. Upon learning of this fact, Ms. Martin's counsel contacted Plaintiff's counsel and indicated that a continuance to the November, 1998 trial term would be requested. 5. Plaintiff's counsel, David Wisneski, Esquire, indicated that he would not Object to Ms. Martin's request for a continuance. 6. This is the first time this case has been listed for trial and, accordingly, the first time a continuance has been requested. WHEREFORE, Defendants, Kimberly Martin Alexander, R.N., and Cowley Medical Associates, P.C., respectfully request this Court PAUL ZtICICER, Plaintiff IN THE COURT OF COMMON PLEAS CUMBERLAND CO., PENNSYLVANIA CIVIL ACTIOM - LAW NO. v. COWLEY MEDICAL ASSOCIATES, P.C., and KIMBERLY MARTIN, R.N. , Defendants JURY TRIAL DEMANDED COMPLAINT 1. Plaintiff Paul Zucker is an adult individual who resides in Rarrisburg, Oauphin County, Pennsylvania. 2. Defendant Cowley Medical Associates, P. C., is a protessional corporation organized pursuant to the laws of the Commonwealth of Pennsylvania. 3. At all times relevant to this Complaint, Oefendant Cowley Medical Associates, P.C., maintained an office and regular place of business in Camp Hill, CUmberland County, Pennsylvania. 4. Oefendant Kimberly Martin, R.N., is currently, and was at all times relevant to this Complaint, a registered nurse licensed to practice nursing in the Commonwealth ot Pennsylvania. 5. At all times relevant to this Complaint, Oetendant Ximberly Martin, R.N., held herself out to the public as a specialist in oncology nursing. 6. At all times relevant to this Complaint, Detendant Kimberly Martin, R.N., was a servant, agent, apparent agent and/or 19926/LAS employee of Defendant Cowley Medical ASlIociates, P.c., and wall acting in such capacity. 7. In September of 1994, Plaintitt Paul Zucker was diagnolled aa suttering from non-small cell lung cancer. 8. Plaintitt Paul Zucker elected to undergo concurrent radiation therapy and chemotherapy ~n an attempt to treat the lung cancer. 9. On October 17, 1994, Plaintift Paul Zucker began a course of chemotherapy with Oefendant Cowley Medical Associates, P.C. 10. On or about Oecember 19, 1994, Oefendant Cowley Medical Associates, P.C., administered Mitomycin, an anti-tumor antibiotic, to Plaintitt Paul Zucker. 11. On or about Oecember 19, 1994, Oefendant Cowley Medical Associates, P.C., administered the chemotherapeutic agent Vinblastine to Plaintiff Paul Zucker. 12. The Mitomycin and Vinblastine were infused intravenously through a site on the back of Plaintitf Paul Zucker's right hand. 13. As the Mitomycin and/or Vinblastine were being infused, Plaintitt Paul ZUCker began to experience pain and a burning sensation in his right arm and noticed that the Mitomycin and/or Vinblastine were leaking out ot a previous injection site located near his elbow. 14. Plaintift Paul Zucker reported the pain, burning sensation ana leakage to the nurse who was attending to him and repeatedly asked her to apprise the head nurse, Defendant Kimberly Martin, R.N., ot the situation. 2 15. After being notitied of Plaintiff Paul Zucker'. complaints, Defendant Kimberly Martin, R.N., advised Plaintiff Paul Zucker that nothing was wrong, and that he was to let the Mitomycin and/or Vinblastine continue to intuse. 16. Plaintiff Paul Zucker continued to complain ot pain, burning and leakage for approximately three and one-halt hours, but was ignored, during which time the inru'ions were allowed to continue. 17. Oefendants permitted the Mitomycin and/or Vinblastine to continue to intuse into Plaintitf Paul Zucker's right arm for several hours atter his initial complaints of pain, burning and leakage from the previous injection site. 18. As a direct and proximate result ot extravasation of the chemptherapy agent Mitomycin and/or the chemotherapy agent Vinblastine, Plaintiff Paul Zucker suttered serious injuries, incLuding, but not limited to, extensive necrotic damage to his right f'lrearm. COON'l' I Paul Zucker v. Kimberlv Martin. R.N. 19. Paragraphs one through 18 ot this Complaint are incorporated herein by reference. 20. As a direct and proximate result of her negligence as set torth in paragraphs 21 through 31 below, Oetendant Kimberly Martin, R.N., is liable to Plaintift Paul Zucker tor the injuries alleged herein. 3 21. Detendant Kimberly Martin, R.N., faUed, prior to the date of Plaintift Paul Zucker'. injury, to familiarize herself with the proper techniques for the administration ot Mitomycin and Vinblastine. 22. Defendant Kimberly Martin, R.N., failed to familiarize herself with the siqns and symptoms of extravasation of Mitomycin and/or Vinblastine prior to the administration C': the druq to Plaintiff Paul Zucker on or about December 19, 1994. 23. Detendant Kimberly Martin, R.N., failed to familiarize herself with the pr~per techniques for treating and/or minimizing necrotic tissue damaqe as a result of extravasation of Mitomycin and/or Vinblastine prior to administering the druq to Plaintitr Paul Zucker on or about December 19, 1994. 24. Defendant Kimberly Martin, R.N., tailed to halt the administration of the Mitomycin to Plaintiff Paul Zucker immediately upon learning of his complaints ot pain, burning and leakage trom a previous injection site. 25. Defendant Kimberly Martin, R.N., failed to halt the administration ot the Vinblastine to Plaintitt Paul Zucker immediately upon learning ot his complaints of pain, burning and leakage trom a previous injection site. 26. Defendant Kimberly Martin, R.N., instructed Plaintitt Paul Zucker and/or the nurse attendinq to Mr. Zucker to permit the Mitomycin and/or Vinblastine to continue to infuse into Mr. Zucker's riqht arm, despite the fact that she had been apprised of 4 Mr. Zucker's complaint of pain, burning and leakaqe trom a previous injection site. 37. Defendant ~imberly Martin, R.N. permitted the Mitomycin and/or Vinblastine to continue to infuse into Mr. Zucker's riqht arm after learning of his complaints of pain, burning and leakage from a previous injection site. 28. Defendant Kimberly Martin, R.N., tailed to tre..c Mr. Zucker for extravasation of the Mitomycin and/or Vinblastine immediately upon learning of his complaints of pain, burning and leakage tram a previous injection site. 29. Detendant Kimberly Martin, R.N., failed to immediately consult or request a consultation trom, a physician, oncoloqist and/or medical specialist tamiliar with Mitomycin and Vinblastine, upon being apprised of Mr. Zucker's complaints of pain, l:lurning and leakage trom a previous injection site. 30. Defendant Kimberly Martin, R.N. tailed, after beinq apprised of Mr. Zucker's complaints ot pain, burning and/or leakage trom a previous injection site, to immediately discontinue the administration of Vinblastine, to attempt to aspirate any residual drug remaining in the tissu.s in order to extract the drug, to administer Hyaluronidase, and to apply heat to activate the Hyaluronidase. 31. Defendant Kimberl)' Martin, R.N. tailed, after being apprised of Mr. Zucker's complaints of pain, burning and/or leakaqe from a previous injection site, to immediately discontinue the administration of Mitomycin, to attempt to aspirate any residual 5 drug remaining in the tissues in order to extract the drug, and to inatruct Mr. Zucker to apply ice for 15 to 20 minutes at least four times per day and to elevate the affected extremity during the first 24 to 48 hours following the extravasation. 32. As a direct and proximate result ot the negligence of Kimberly Martin, R.N., as set forth above, plaintitt Paul Zucker suffered serious injuries incLuding, but not limited to, necrotic tissue damage to his right forearm. 33. As a direct and proximate result of the aforesaid injuries, Plaintiff Paul Zucker has incurred, and will in the future incur, medical and rehaDilitative expenses, and claim is made theretor. 34. As a direct and proximate result of the aforesaid injuries, Plaintiff Paul Zucker has been, and in the future will be, subject to great humiliation and ridicule, and claim is made therefor. 35. As a direct and proximate result ot the aforesaid injuries, Plaintlft Paul Zucker has undergone, and in the tuture will undergo, great mental and physical pain and suftering, great inconvenience in carrying out his daily activities, and a loss of life's pleasures and enjoyment, and claim is made therefor. 36. As a direct and proximate result of the aforesaid injuries, Plaintitf Paul Zucker has sustained loss of earning power and earning capacity, and claim is made therefor. WHEREFORE, Plaint1tt Paul Zucker demands judgment against Detendant Kimberly Martin, R.N., in an amount in excess of Twenty- 6 rive Thousand ($25,000) Dollars, exclusive of interest and costs, and in excess of any jurisdictional amount requiring compulsory arbitration. COtTN'r II taut luaker 9. cowl.. ..dia.! As.oclat... P.C. 37. Paragraphs one through 18 of this Complaint are incorporated herein by reference. 38. As a direct and proximate result ot negligence of its servants, agents, apparent agents, and/or employees, including, but not limited to, Kimberly Martin, R.N., and its nursing staff, as set forth in paragraphs 39 through 49 below, Defendant Cowley Medical Associates, P.C., is liable to Plaintiff Paul Zucker for the injurie. alleged herein. 39. Said servants, agents, apparent agents and/or employees failed, prior to the date of Plaintiff Paul Zucker's injury, to familiarize themselves with the proper techniques for the administration of Mitomycin and Vinblastine. 40. Said servants, agents, apparent agents and/or employees failed to tamiliarize themselves with the signs and sjmptoms ot extravasation ot Mitomycin and/or Vinblastine prior to the administration ot the drug to Plaintitt Paul Zucker on or about December 19, 1994. 41. Said servants, agents, apparent agents and/or employees failed to familiarize themselves with the proper techniques for treating and/or minimizing necrotic tissue damage as a result at extravasation of Mitomycin and/or Vinblastine prior to 7 administering the drug to Plaintiff Paul Zucker on or aDout December 19, 1994. 42. Said servants, agents, apparent agents and/or employees failed to halt the administration of the Mitomycin to Plaintift Paul Zucker iamediately upon learning of his complaints of pain, burning and leakage from a previous injection site. 43. Said servants, agents, apparent agents and/or employees failed to halt the administration of the Vinblastine to Plaintiff Paul Zucker immediately upon learning of his complaints of pain, burning and leakage from a previous injection site. 44. Said servants, agents, apparent agents and/or employees instructed Plaintift Paul Zucker to permit the Mitomycin and/or Vinblastine to continue to infuse, despite the fact that they had been apprised ot Mr. Zucker's complaint ot pain, burning and leakage from a previous injection site. 45. Said servants, agents, apparent agents and/or employees permitted the Mitomycin and/or Vinblastine to continue to infuse into Mr. Zucker's right arm after learning of his complaints of pain, burning and leakage trom a previous injection site. 46. Said servants, agents, apparent a''Ients and/or employees failed tc treat Mr. Zucker for extravasation of the Mitomycin and/or Vinblastine immediately upon learning of his complaints of pain, burning and leakage trom a previous injection site. 47. SaJ.d servants, agents, apparent agents and/or employees tailed to immediately consult or request a consultation tram, a physician, oncologist and/or medical specialist tamiliar with 8 Mitomycin and Vinblastine, upon being apprised of Mr. Zucker's complaints of pain, burning and leakage from a previou~ inj5ction site. 48. Said servants, agents, apparent agents and/or employees failed, after being apprised of Mr. Zucker's complaints of pain, burning and/or leakage from a previous injection site, to ll111ediately discontinue the administration of Vinblastine, to attempt to aspirate any residual drug remaining in the tissue. in order to extract the drug, to a3inister Hyaluronidase, and to apply heat to activate the Hyaluronidase. 49. Said servants, agents, apparent agents and/or employees failed, after being apprised of Mr. Zucker's complaints of pain, burning and/or leakage from a previous injection site, to immediately discontinue the administration of Mitomycin, to attempt to aspirate any residual drug remaining in the tissues in order to extract the drug, and to instruct Mr. Zucker to apply ice for 15 to 20 minutes at least four times per day and to elevate the affected extremity during the first 24 to 48 hours tollowing the extravasation. 50. As a direct and proximate result of the negligence of said servants, agents, apparent agents and/or employees ot Oefendant Cowley Medical Associates, P.c., as set torth above, Plaintiff Paul Zucker surfered serious injuries including, but not limited to, necrotic tissue damage to his right torearm. 51. As a direct and proximate result of the aforesaid injuries, Plalntift Paul Zucker has incurred, and will in the 9 future incur, medical and rehabilitative expense., and claim is sade therefor. 5:3. As a direct and proximate result 011 the aforesaid injuries, Plaintiff Paul Zucker has b~en, and in the future will be, subject to great humiliation and ridicule, and claim is made therefor. 53. Aa a direct and proximate result of the aferesaid injurie., Plaintiff Paul Zucker has undergone, and in the future will undergo, great mental and physical pain and .uftering, great inconvenience in carrying out his daily activiti~s, and a lo.s of life's pleasures and enjoyment, and claim is made therefor. 54. Aa a direct and proximate result of the aforesaid injuries, Pllllntitt Paul Zucker has .ustained loss of earning power and earning capacity, and claim is made therefor. WHEREFORE, Plaintiff Paul Zucker demands judgment against Detendant Cowley Medical Associates, P.c., in an amount in exce.. ot Twenty-Five Thousand ($25,000) Dollars, exclusive at interest and costs, and in excess of any jurisdictional amount requiring compulsory arbitration. ;). / ~o 19 ~ Oavid S. W snes , Es I.D. No. 58796 4503 N. Front Street Harrisburg, PA 17110 (717) 238-6791 Counsel tor Plaintitf e 10 - .. , ........'~l"""""'.......'-. .- <~-".'.""';"'''"' ....,. ~ I , 1'- I :, i' ! ~ .' i r r , .1 ~ . r .. ':J#.' . ...... tf , 'f , (1,.... ~,. , I. i f ~ . ". l~ I t j 1 ! i, , 4. You are specifically instructed that a health care provider is neither a warrantor of a cure nor a guarantor of the result of treatment and that there ls no presumption or inference of negligence merely because the medLcal care provlded by a nurse termLnated in an unfortunate result, which may very well have occurred regardless of the degree of care and skill exercised. Gravel v. Aiwaln, 252 Pa. Super. 534, 381 A.2d 975 (1977); Pa. S.S.J. I. ICiv.J 10.01 (1981). The mere occurrence or development of an injury does not prove negligence or causation. The mere fact that Plaintiff may have experienced an injury, in and of itself, does not mean that he is entltled to recover damages from the Defendants. The mere development of an injury, or the existence of an opportunity for it to happen, does not entitle Plaintiff to recover without further evidence of neglLgence on the part of the Defendants. Novak v. Neff, 399 Pa. 193, 159 A.2d 707 (1960); Hamil v. Bashline, 481 Pa. 256, 392 A.2d 1280 (1978). 5 1..<< 5. By undertaklnq protessLonal serVLce to a patLent, a health care provider repre3~nts that she possesses, and Lt is her duty to possess, only that degree at LearnLnq and skill ordinarily possessed by similar nurses of good standing, practicing nursLng in the same or simLlar community, under similar circumstances. It is her further duty to use the care ordLnarily exercised in like cases by reputable members of her profession practiclng in the same or a slmLlar locality and under sLmilar circumstances, and to use reasonable diliger.,-e and her best judgment in the exercise of their skill and the application of her learning, in an effort to accompllsh the purpose of which he was employed. The law does not require perfect lon, prophetic insight or infallible judgment by any health care provider. Rather, the law requires that a health care provider possess a reasonable average ability to carry out hLs professional work and that she exercise reasonabl.e care, skLll and judgment in so doing. Pratt v. Stein, 2'18 Pa. Super. 9~, 444 A.2d 674 (l982); Incollin<Jo v. Ewincr, 444 Pa. 263, 282 A.2d 206 (l97l); Powell v. Risser, 375 Pa. 60, 99 A.2d 454 (1953). /.1'----. 6 12. I f you bel ieve from the evidence that the conditions and thlngs of which the PLaLntiff complains were caused or occasioned by or from any cause or causes over whLch the D~fendants had no reasonable control, or for whicn they were not responsible, your verdict must be Ln favor of the Defendants. It Ls for you to determlne to what extent, If any, the Plaintiff was actually injured as a direct result of the Defendants' conduct. In other words, you may find that Plaintiff has an injury, but that such injury, in whole or in part, was not due to the negligent conduct of the Defendants or that the entirety of the evidence before you is inconclusive or conjectural. You are not permitted to speculate as to the cause of the injuries, if any, in thLs case. Again, it is Plaintiff's burden to prove, by a preponderance of the evldence, not only that the Defendants were npgligent, but also that the Defendants' conduct was a substantial factor in causing the harm of which Plaintiff complains. If you believe that it cannot be determined with reasonable certainty whether the conditions of which Plaintiff complains were or were not caused by any negligent act or omission by the Defendants, or by anything over which the Defendants had reasonable control, your verdict must be in favor of the Defendant. Hamil v. Ba,,;hline, 481 Pa. 256, 392 A.2d 1280 (1978) . If the evidence is such that some crucial fact is not established, or if the evidence is uncertain or contradictory 14 . . . POINT FOR CHARGE NO.6 A nurse must have and use the same knowledge and skill and exercise the same care as that which is usually had and exercised in the nursing profession. A nurse whose conduct does not meet this professional standard of care is negligent. In this particular case, ~imberly Martin held herself out as a specialist in oncology nursing. A nurse who holds herself out as a specialist in a particular field of medicine must have and use the same knowledge and skill and exercise the same care as that which is usually had and exe~cised by other specialists in that same nursing specialty. A specialist whose conduct does not meet this protessional standard of care is negligent. A nurse must also use the same degree of care as would a reasonable person under the circumstances, and if she fails to do so she is negligent. You must decide whether the Defendants were negligent in any ot these aspects. It you find that they were negligent in any of these respects, then you must determine whether the Defendants' negligence was a substantial contributing factor in bringing about the Plaintiff's injuries. If you so tind, you may return a verdict in favor of the Plaintiff and against the Defendants. Pa. SSJI (Civ) S10.03a ( 4 POINT FOR CHARGE NO.7 (a) The Defendant-nurse is legally responsible or liable for the injuries suffered by her patient if the Defendant's negligent conduct is a legal cause of those injuries. In order for the negligent conduct to be a legal cause (proximate cause), that conduct must have been a substantial factor in bringing about the injuries in question. It the injuries in questions would have been sustained even it the nurse had not been negligent, then the negligent conduct of the Defendant-nurse would not be a substantial tactor in causing the injuries in question. stated differently, the negligent conduct ot the Defendant is a substantial f3ctor in causing her patient's injuries if those injuries would not have been sustained, had the nurse not acted in a negligent manner. (b) When a Defendant-nurse negligently tails to act, or negligently delays in employing indicated diagnostic or therapeutic measures, and her negligence is a substantial contributing factor in causing injuries to her patient, the Plaintift does not have to prove to a certainty that proper care would have, as a medical tact, prevented the injuries in question. If a Defendant- physician's negligent action or inaction has effectively terminated her patient's chances of avoiding injuries, she may not raise conjectures as to the measure of the chances that she has put beyond the possibility of realization. If there was any substantial possibility of avoiding injuries and the Defendant has destroyed that possibility, she is liable to the Plaintiff. POINT FOR CHARGE NO. 12 In civil cases such as this one, tlle Plail~tHts have the burden of proving those contentions which entitl~ them to relief. When a party has the burden of proof on a particular issue, his contention on that issue must be established by a fair preponderance of the evidence. The evidence establishes a contention by a fair preponderance of the evidence if you are persuaded that it is more probably accurate and true than not. To put it another way, think, if you will, of an ordinary balance scale, with a pan on each aide. Onto one side ot the scale, place all of the evidence favorable to the Plaintitf; onto the other, place all of the evidence favorable to the Defendants. If, after considering the comparable weight of the evidence, you fe.l that the scales tip, ever so slightly or to the slightest degree, in favor of Plaintiff, your verdict must be tor the Plaintift. If the scales tip in favor of the Detendants, or are equally balanced, your verdict must be for the Defendants. In this case, the Plaintiff has the burden of proving the following propositions: that Defendant Martin was negligent and that that negligence was a substantial factor in bringing about the harm suffered by Plaintiff. It, after considering all of the evidence, you feel persuaded that these propositions are more probably true than not true, your verdict must be for the Plaintift. Otherwise, your verdict should be for the Detendants. Pa. SSJI (civl 55.50 ,I .. ..-.~~