COMMONWEALTH OF KENTUCKY PULASKI CIRCUIT COURT DIVISION I CIVIL ACTION NO. 17-CI ELECTRONICALLY FILED PRE-TRIAL MEMORANDUM OF DEFENDANT

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1 COMMONWEALTH OF KENTUCKY PULASKI CIRCUIT COURT DIVISION I CIVIL ACTION NO. 17-CI ELECTRONICALLY FILED ESTATE OF LULA MAE WHITE, BY AND THROUGH ITS ADMINISTRATRIX, TONYA MEECE AND JOHN WHITE PLAINTIFFS V. DEFENDANTS PRE-TRIAL MEMORANDUM OF DEFENDANT ***** ***** ***** Come the Defendant, Cumberland Gastroenterology, PSC, by and through counsel, and pursuant to this Court s order hereby submit the following Pre-Trial Memorandum: I. Facts: Lula Mae White Lou was a resident of Russell Springs, Kentucky. She was married to John and had one daughter, Tonya Meece. She was 71 years old when she initially presented to Cumberland Gastroenterology. She had a history of fatigue, swelling of the ankles, heartburn, stokes, depression, bleeding/bruising tendency, anemia. She had previously had a hysterectomy and had angioplasty with 2 stents. She was on Norvasc, Lipitor, Aspirin, Plavix, Celexa, Valium, Coreg, Prilosec, Flexeril, and Benefiber. She was a previous smoker, quit in She was 5 4 tall and weighed around 150 lbs. September 21, 2016 was Mrs. White s initial visit with Cumberland Gastroenterology, she was seen by Jason Dixon, APRN. Mrs. White was referred by PCP Dr. John Kilgallin for anemia PC : of

2 and diffuse abdominal pain. She reported she had abdominal pain for her whole life. She had recently been in the hospital and was found to be anemic with a HGB of 7.9. She was treated with PO Iron and her HGB has risen to She was scheduled for a carotid endarterectomy on 10/05. She was on Plavix and Aspirin. The plan was to do EGD and Colonoscopy after receiving cardiac clearance and follow up after the diagnostic procedures. On September 27, 2016 a letter was received from Dr. Thannoli regarding cardiac clearance, indicating moderate risk of developing complications. Mrs. White was to stop taking Plavix 5 days prior to procedure. On October 17, 2016 an EGD and colonoscopy were done per Dr. Bryson. EGD showed possible Barrett s Esophagus (confirmed by biopsy), Schatzki s ring in the distal third of the esophagus, a hiatus hernia in the cardia, erosive gastritis in the antrum and possible angioectasia/avm of the second portion of the duodenum. Colonoscopy showed small external hemorrhoids, normal terminal ileum, angioectasia/avm of ascending colon and mild diverticulosis in descending colon. At Mrs. White s November 3, 2016 follow up visit with Jason Dixon, APRN. Mrs. White reported she was doing better and her abdominal pain had resolved. Her exam was normal. She was educated about Barrett s esophagus and the plan was to continue daily PPI and do follow up EGD in 1 year. It was thought that the gastritis was the cause of the anemia more so than the AVM. On December 14, 2016, Ms. White returned to the office with complaints of abdominal pain and constipation. She reported she had the symptoms for about two weeks. She also reported nausea. Jason Dixon, APRN suggested she try Amitiza for constipation. He also ordered CT of the Abdomen/Pelvis along with CBC and CMP. Plan was to follow up after these diagnostic tests had been done. PC : of

3 The records indicate that Mrs. White presented to the ER at Russell County with severe abdominal pain. Following a CT scan, Mrs. White was diagnosed with a microperforation of the sigmoid colon. Dr. Dasen Ritchey, surgery, was consulted and admitted Mrs. White. Dr. Ritchey testified that since this was a microperforation and Mrs. White was stable and not yet septic, he believed that this could be treated without surgical intervention. Unfortunately, Mrs. White destabilized on the 17 th and was taken to for emergency surgery. Dr. Ritchey performed a colon resection with colostomy. He diagnosed Mrs. White with a perforation caused by a microperforation of a diverticulum. This diagnosis was confirmed on pathology. Mrs. White initially did well following surgery and was able to be weened from ventilator support. However, her condition worsened significantly on the 19 th and she was transferred to Lake Cumberland Regional Hospital. At Lake Cumberland Regional Hospital, Mrs. White was diagnosed with sepsis and multiorgan failure. She received ICU management for nearly two weeks but unfortunately passed away. II. ISSUES OF LAW AND/OR EVIDENCE The main source of disagreement on the facts is whether Mrs. White received a physical examination from Jason Dixon. Tonya Meece, daughter of Mrs. White, testified that she was present in the room and that Jason Dixon never put a hand on her mother. Jason Dixon claims that he performed the examination while Mrs. White was seated in the chair. The time and date stamped medical record reflects a benign physical examination performed while Mrs. White was in the office. Our experts are fully supportive of Mr. Dixon s care and do not believe that her condition as reflected in the office note warranted urgent follow up. PC : of

4 Respectfully submitted, ROBINSON & HAVENS, PSC 101 Prosperous Place, Suite 100 Lexington, KY Ph: (859) Fx: (859) _/s/ Clayton L. Robinson CLAYTON L. ROBINSON, ESQ. ADAM W. HAVENS, ESQ. COUNSEL FOR DEFENDANT, CERTIFICATE OF SERVICE It is hereby certified that the foregoing was served upon the parties by mailing a true copy of same to their attorney of record on this 26 th day of October 2018, as follows: Hans G. Poppe Scarlette R. Burton The Poppe Law Firm 8700 Westport Road, Suite 201 Louisville, KY COUNSEL FOR PLAINTIFFS hans@poppelawfirm.com scarlette@poppelawfirm.com jamie@poppelawfirm.com _/s/ Clayton L. Robinson CLAYTON L. ROBINSON, ESQ. ADAM W. HAVENS, ESQ. PC : of

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