Case 3:12-cv-01914-GAG-CVR Document 225 Filed 11/08/13 Page 1 of 11

N.I. 12-S-859 N.S. 12-14005-M/V IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF PUERTO RICO LUZ MIRIAM TORRES, GENNIFER CIVIL NO. 12-CV-1914 (GAG) NEGRON, YANIRA TORRES-CRUZ, AGNES SANTOS AND CRYSTAL TORRES RE: TORT ACTION FOR MEDICAL Plaintiffs, v

MAL PRACTICE PURSUANT TO ARTS 1802 AND 1803, 31 P.R. Laws Ann 5141 AND 5142

MENNONITE GENERAL HOSPITAL, INC. dba: HOSPITAL MENONITA CIDRA and HOSPITAL MENONITA CAYEY; ABC JURY TRIAL DEMANDED INSURANCE CO., INC; DR. RUBEN MENDEZ BENABE; DR. YESSI CARABALLO LOPEZ; DR. ANTONIO A. REYES VIZCARRONDO; DR. SONIA M. CORREA MARA; DR. ERIC AVILES; DR. OMAR NIEVES EFG INSURANCE CO., INC JOHN DOE; JAMES ROE; MOE-FOE CONJUGAL PARTNERSHIPS I-X; SINDICATO DE ASEGURADORES PARA LA SUSCRIPCION CONJUNTA DEL SEGURO DE RESPONSABILIDAD PROFESIONAL MEDICO-HOSPITALARIA (SIMED): XYZ INSURANCE CO. Defendants

STATEMENT OF UNCONTESTED FACTS TO THE HONORABLE COURT: COMES NOW, defendant, Dr. Sonia M. Correa Mara (Dr. Correa), through its undersigned counsel and very respectfully submitts her statement of uncontested facts as follows:

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1.

Mr. Ivan Torres and his wife Mrs. Luz Miriam Torres, long time

residents of Conneticut came to Puerto Rico on November 23, 2011 for vacations (Dp. Mrs. Torres at 91 Exh I). 2. Prior to coming to Puerto Rico Mr. Torres, who was a prostate

cancer patient was going to have a penile implant or what is called a penile pump. (Report Dr. Arnold Rivera Exh II). 3. On October 5, 2011 Mr. Torres was evaluated by Dr. Stephen

Woodworth, a cardiologist. As per the report of Dr. Woodworth Mr. Torres had a history of high blood pressure and diabetes mellitus. Mr. Torres, stated than during a surgery two years prior, he was noted to have low oxygen saturation and a difficult preoperative period. He further stated that he had some

dyspnea on exertion and occasional episodes of vertigo (Report of Dr. Woodworth Exh. III). 4. Dr. Woodworth assessment of the patient was that Mr. Torres had

an abnormal EKG as it showed an incomplete right bundle branch block and poor R wave progression for which he ordered other exams and did not cleared the patient for surgery (Exh III). 5. On December 10, 2011 Mr. Torres presented himself to the

Mediko clinic in Caguas with a complaint of cough, myralgia, sore throat, fever and headache. A CBC made found the patient with 11,900 white cells and hemoglobin of 10.2 although other laboratories and an XRay were ordered apparently he did not have them made (Record of Mediko Exh IV) (First Deposition Dr. Adams at P. 118-119).

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6.

On December 12, 2011 at 4:30 a.m. Mr. Torres presented to

Hospital Menonita Cidra, with a complaint of respiratory difficulty, shortness of breath due to cough of several days of evolution. After evaluation of the patient a working diagnosis of shortness of breath, bronchospasm and atypical chest pain was made (Exh V partial record of Hospital Menonita Cidra). 7. Treatment ordered was albuterol theraphy, solumedrol, bendaryl, A complete blood count, a

antitusive, prelom and oxygen by nasal canulal.

basic metabolic panel, a CPK, CKMB, and troponins were ordered (Exh V). 8. The troponins, the CPK and CKMB showed elevated values, and an

abnormal EKG for which a diagnosis of Acute Coronary Syndrome was made and the patient was transferred to Hospital Menonita Cayey (Exh V). 9. The patient was evaluated at the Emergency Room of Hospital

Menonita Cayey and at the nursing evaluation the patient complained of respiratory difficulty of three days of evolution (Exh VI excerpt of record of Hospital Menonita Cayey). 10. As per the record the patient had no pain, his vital signs were A dextrostick

temperature 37.5; pulse 98; respiratory rate 19; BP 109/57.

showed blood sugar of 458, thereafter the patient was placed at the cardio and trauma area with oxygen by nasal canula, a cardiac monitor was placed and an EKG was done (Exh VI). 11. The medical evaluation and physical exam showed that the patient

had cough but denied chest pain or other cardiovascular symptoms. (Exh VI).

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12.

Dr. Correa is a family physician and member of the medical staff of

Hospital Menonita de Cayey. Dr. Correa is attached to the Internal Medicine Department and on that day was covering the unattached patients (Deposition of Dr. Correa at P. 16-17 and 45). 13. Dr. Correa was consulted at 5:40 p.m. She came and evaluated

the patient and placed orders at 7:00 p.m. Dr. Correa admitted the patient with a provisional diagnosis of shortness of breath as the patient did not had chest pain at the time of evaluation (See Exh VII the medical history and physical examination). 14. As the patient had elevated CPK and troponins also an abnormal

EKG she ordered the application of the acute non stemi protocol for Mr. Torres at 7:00 p.m., which included: 1. Admission to telemetry; 2. Bed rest; 3. An order to notify changes in heart rate and blood pressure; 4. Nothing per or 5. Oxygen by canula; 6. EKG daily for three; 7. Cardiac markers every eigh hours; 8. PT, PTT, Lipid profile and CMP; 9. Nitroglycerin; 10. Aspirin; 11. Plavix; 12. Lovenox; and 13. Consult with cardiologist (See Exh VIII). 15. Dr. Correa as the chest XRay showed lung infiltrates also ordered

treatment for the pulmonary condition of (Exh IX). 16. At 7:00 p.m., Dr. Correa placed and personally notified the

cardiology consult to Dr. Eric Aviles as she understood that the patient had to be treated by a subspecialist (Exh X). Dr. Aviles stated that he was in the

hospital and that he would come to see the patient (Exh XII First Deposition Dr. Correa at P. 100).

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17.

Dr. Aviles decided to answer the consult in the morning of

December 13, 2011 (Exh X). 18. At 7:00 p.m. Dr. Correa also ordered the Insulin Protocol as the

patient was a diabetic and had high blood sugar of 458 (Exh XI). 19. At 1:00 a.m. December 13, 2011 the nursing personnel called Dr.

Correa to inform her that the patient was restless and anxious, for which she ordered the administration of Ativan (Exh XIII First deposition of Dr. Correa at P. 107). 20. At 3:35 p.m. Dr. Correa ordered the administration of Integrilin to

the patient, which had not been ordered with the Non Stemi Protocol (Exh. XII Dp. Dr. Correa at p. 110). 21. Dr. Aviles informed Dr. Correa in the morning of December 13,

2011 that he had evaluated the patient and that he would do a catheterization that day (Exh XII Dp. of Dr. Correa p. 104). 22. Dr. Correa evaluated Mr. Torres in the morning of December 13,

2011 at 9:00 a.m. she found the patient with no chest pain, but with shortness of breath and signs of pulmonary edema for which she ordered the increase of the Tridil morphine, Lasix and arterial blood gases (Exh XII Dp. of Dr. Correa P. 143). 23. At 9:00 a.m. Dr. Correa notified Dr. Aviles that the patient was

showing respiratory difficulty once again and Dr. Aviles told her that the patient had possibly developed pulmonary edema for which treatment was

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ordered. (Exh XII Deposition of Dr. Correa at P. 144) (Second deposition of Dr. Correa at P. 15). 24. At around 9:30 a.m. Dr. Correa asked Dr. Omar Nieves, a

cardiologist, who was attending another patient if he could check Mr. Torres as Dr. Aviles was not available and the patient had become more complicated Dr. Nieves complied. (Exh XII Second deposition of Dr. Correa at P. 18-19). 25. Dr. Nieves evaluated Mr. Torres and decided to perform another

EKG after he examined the EKG, done at 10:00 a.m. as per Dr. Correas order. This EKG was also abnormal and showed a slight elevation of the ST waves with a possible posterior infarct (Exh XII Second deposition of Dr. Correa at P. 29-30). 26. The EKG performed by Dr. Nieves showed a posterior infarct with Dr. Nieves

sinus tachycardia and slight elevation in the inferior leads.

informed her that the patient had an acute posterior infarct and that the lungs were compromised with edema and that the appropriate treatment was thrombolytic therapy (Exh XII Second deposition of Dr. Correa at P. 31-32). 27. Dr. Nieves talked to the family of Mr. Torres regarding the

administration of thrombolytic and he ordered the treatment (Exh XII Second deposition of Dr. Correa at P. 40). 28. Dr. Correa was present with the patient when the thrombolytic

therapy was started and was there all the time (Exh XII Second deposition Dr. Correa at P. 48). Dr. Correa has never administered thrombolytic therapy (Exh Second deposition Dr. Correa at P. 53).

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29.

Dr. Correa as a family doctor is not qualified to determine if the

administration of thrombolytic therapy is indicated or not. It is the cardiologist decision and if the cardiologist tells her that it is the only way to deal with the patients complication, she follows the recommendation (Exh XII Second deposition of Dr. Correa at P. 57). 30. The thrombolytic therapy was started at 11:30 a.m. and at the

initiation of the therapy Mr. Torres had improved from his respiratory distress and was a little better, he was alert and oriented and did not had pain. At the start of the therapy samples were taken, heart rate was monitored, his blood pressure was taken and some EKG leads were performed (Exh XII Deposition of Dr. Correa at P. 60-61). 31. The patient was stable within his condition and approximately 30

to 45 minutes after initiation of the therapy Dr. Correa observed that the patient started to bleed through the foley and she stopped the therapy. Later the patient started to bleed in his gums and started to present more respiratory difficulty, for which she decided to order the intubation of Mr. Torres (Exh XII Second deposition of Dr. Correa at 61-62). 32. Dr. Correa ordered the administration of fresh frozen plasma and

platelets in order to turn back the therapy which treatment could not be administered (Exh XII Dp. of Dr. Correa at P. 62 and 64). She also ordered four units of blood (P. 66).

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33.

Dr. Correa also ordered a consultation to the pulmonologist and

the transfer of Mr. Torres to ICU (Exh XII Second deposition of Dr. Correa at P. 69). 34. Arround 4:00 p.m. the patient arrested and did not responded to

the ACLS and CPR and was declared dead (Exh XII Second deposition Dr. Correa at P. 80-81). 35. Plaintiffs have announced as expert Dr. Carl W. Adams. Dr.

Adams qualifications are: 1. Medicine, Texas University Medical School 1981; 2. Internship at Tripler Army Medical Center in Honolulu 1982; 3. Four years of General Surgery at Book Army Medical Center in Colorado; 4. One year Trauma Surgery at Fort Org in Monterrey California; 5. Two years of Cardiovascular Thoracic Surgical Care in Pediatrics; 6. One year Pediatric at Texas Heart Institute; 7. Tripler Army Medical Center (Exh XIII Deposition of Dr. Adams at P. 16). 36. He works 15 day a month at Saint Joseph Heart Institute, doing

cardiovascular, thoracic, trauma surgery and critical surgical care (Exh XIII Deposition of Dr. Adams at P. 18-19). 37. St. Josephs Hospital is a specialized heart hospital which in its

facilities has four catheterization labs, two open heart surgical set of rooms and an ICU of 16 beds (Exh XIII Deposition Dr. Adams at P. 21). 38. Dr. Adams considers himself an expert in cardiovascular; thoracic;

surgical critical care; trauma surgery; cardiovascular disease and as expert has

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evaluated over six thousand cases and considers himself superior intraining that an ER Physician (Exh XIII Deposition of Dr. Adams at P. 30-31). 39. Dr. Adams stated that the training of an Internal Medicine

Specialist is clinical, and surgeons receive intervention training (Exh XIII Deposition of Dr. Adams at P. 57). 40. As per Dr. Adams opinion the cardiologist has more training in

cardiovascular matter and that interventional cardiologists have another level of training (Exh. XIII Deposition Dr. Adams at P. 58-59). 41. As per Dr. Adams opinion Mr. Torres suffered from cardiovascular

disease prior to coming to Hospital Menonita Cidra, and that it appears from studies did in Connecticut on September-October 2011, he had a diastolic heart dysfunction (Deposition Dr. Adams at P. 92 and 97-98). 42. Dr. Adams further opined that Mr. Torres at the stress test

performed on October 2011 had evidence of prior ischemic event and that at that evaluation he could not complete the maximum heart rate because he got fatigued and short of breath and comparing the 2011 study to the previous of 2006 his coadition was getting worse (Exh XIII Deposition of Dr. Adams at P. 101 and 108-109). 43. Dr. Adams opined that when Mr. Torres presented on December

10, 2011 to the Mediko Clinic he was suffering from upper respiratory tract symtomatology (Exh XIII Deposition Dr. Adams at P. 119 and 126). Dr. Correa diagnosed this condition as acute bronchitis for which she also ordered treatment (Exh XII deposition of Dr. Correa at 101-103).

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44.

In the opinion of Dr. Adams the patient should have been

transferred from Cidra to a Heart Hospital (Exh XIII Deposition Dr. Adams at P. 140 and 159). 45. With regards to Dr. Correa, Dr. Adams stated that she answered

the consult properly. He agreed that it was correct of Dr. Correa to start the non stemi protocol; that at evaluation Mr. Torres had a non stemi MI; he agreed with the medications ordered and that it was correct of her to consult the cardiologist (Exh XIII Deposition of Dr. Adams at P. 148-152). 46. That when Dr. Correa evaluated Mr. Torres the next day the

patient had deteriorated considerably and that it was the consulted cardiologist who did not helped her with the patient and actually the only departures Dr. Adams have on the treatment afforded by Dr. Correa was that she should have personally come to revaluate the patient the two times she was called during the night. Dr. Adams assumed for his opinion that Dr. Correa knew that the cardiologist had not evaluated the patient (Exh XIII Deposition of Dr. Adams at P. 154-157). 47. Dr. Adams has no allegations of Departures from standards by Dr.

Correa on the thirteenth of December (Exh XIII Deposition Dr. Adams at P. 158). 48. Dr. Adams further stated that Dr. Correa should not have been

consulted by the ER doctor as he should have been admitted directly to cardiology (Exh XIII Deposition of Dr. Adams at P. 160).

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49.

With regards to the Integrilin, that Dr. Adams had testified that the

order of Dr. Correa to administer it at 3:35 a.m. Dr. Adams further admitted that Integrilin is given if the patient is going to the Cath Lab (Exh XIII deposition of Dr. Adams at P. 166). 50. Dr. Aviles told Dr. Correa in the morning of December 13, 2011

that he was taking Mr. Torres to the Cath Lab. (Exh XII First Deposition of Dr. Correa at P. 104).
RESPECTFULLY SUBMITTED. In San Juan, Puerto Rico, this November 8, 2013.

s\Igor J. Domnguez USDC NO. 120111 Attorney for defendant

Dr. Sonia M. Correa Mara (Dr. Correa)

IGOR J. DOMINGUEZ LAW OFFICES 1225 PONCE DE LEON AVE. SUITE 1105 SAN JUAN, P.R. 00907-3945 TEL. 787-250-0220 FAX. 787-250-0295 E.mail igor@ijdlawpr.com

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