I, John, M.D., M.S., am a licensed physician board certified in Family Practice, Emergency Medicine and Forensic Medicine. I am a physician certified to practice medicine in all its branches. I currently practice or teach is the areas of medicine applicable to this case. I am familiar with the standard of care for medical practices that currently relate to issues of care and treatment of patients such as. I am familiar with the standard of care in this case by my training, education and experience of over 25 years in the same field and/or related healthcare field as the physicians and healthcare providers practiced when treating. Board of Family Medicine, Geriatrics, Emergency Medicine, Internal Medicine and Geriatric Nursing share the same knowledge, training and experience when treating a 56-year-old male patient like Brad. I can fairly evaluate the quality of care that was provided. Attached is a copy of my current Curriculum Vitae.

I have reviewed the records of Brad. These include the following:

1.       Hospital Medical Records

2.       Hospital Medical Billing Records

3.       Bills

4.       Center Bills

5.       Center Records

I have the expertise to evaluate the reliability of these records. These records are the type usually relied upon by reviewers such as myself. As healthcare becomes increasingly complex, it is important for reviewers like myself to keep the documented interaction between a patient, healthcare institution and healthcare providers including physicians at the heart of the review process. As a physician reviewer of these medical records and documents, I have utilized proven techniques of medical record analysis to examine care provided to Brad.  While it is true some extent that all patient interactions are unique, however, there are specific medical practices that a treating physician and treating institution would be expected to provide to meet the applicable standard of care. I have specifically reviewed these records to determine whether within reasonable degree of medical certainty that the standard of care was met.

The above records disclose the following facts in summary:

In brief Brad was a 56-year-old male with a history of diabetes, hypertension with a recent CVA with a left sided weakness who was admitted to the Hospital. Mr. Brad was admitted to the emergency department with tachycardia and leukocytosis and had experienced a recent fall at home. Recent fall occurred when he spontaneously lost his balance and fell backward landing on his sacrum. No complications form that fall were documented.

Mr. Brad was admitted to the Hospital from the emergency department where he was noted to have a persistent tachycardia, an elevated white blood cell count, and a D-dimer greater than 5,000. He was admitted for further evaluation and treatment. Notably since Mr. Brad recent CVA, he had experience d a series of falls at home where he would spontaneously lose his balance.

Mr. Brad developed a fever with no specific symptoms. His potassium was low and was replaced. His magnesium and was replaced. During the day Mr. Brad apparently got up on his own to use the bedside commode. He was trying to clean up and finish his bowel movement and move back to his bed when he accidentally slid off the bedside commode. He landed on his left hip, immediately complaining of severe pain in his left hip. X-rays demonstrated a new interochanteric fracture of the left hip. Dr. Poe orthopedics, was consulted and he was scheduled for surgery the following day.

Mr. Brad was taken to the operating room by Dr. Poe. Post operatively his white blood cell count continued to decrease to 14.9. Hemoglobin was stable at 10.2. Patient was started for a possible respiratory illness/pneumonia.

Mr. Brad was started on. He was also evaluated by physical therapy. Weight bearing to the left hip was 50%. Left upper extremity weakness was also evaluated by occupational therapy.  Mr. Brad was examined by Dr. Poe. Mr. Brad continued to improve. Foley catheter was removed on the Xth and subsequently the patient was found to be voiding well.  M.D. continued treatment for Mr. Brad. Several social service issues were addressed. A rehabilitation bed was found for him at the  Nursing Home and he was subsequently discharged to that facility for further rehabilitation.

Mr. Brad was discharged from the Hospital in stable, satisfactory condition. Patient was discharged to the Nursing Home for continued rehabilitation. Follow-up with Dr. Poe was scheduled for 2 weeks. General medical care to be followed by a primary care physician Dr. Poe. Discharge diagnosis included:

1.       Left intertrochanteric hip fracture

2.       Fall in Hospital

3.       Fall at Home

4.       Diabetes Mellitus

5.       Tachycardia

6.       Leukocytosis

It is my professional opinion that the Hospital, through its agents, staff, apparent agents and employees deviated from the standard of care by:

1.Failure to develop, implement and updated adequate appropriate patient care plant to meet the needs of including fall risk management and fall prevention. On admission, the Hospital staff conducted a full assessment of Mr. Brad medical, nursing, social, nutritional, activity and psychological condition after which Mr. Brad was determined to be an appropriate patient for the admission to Hospital. The Hospital staff specifically agreed to accept Mr. Brad as a patient at their facility and entered a relationship that they would be able to care for his full needs. At no time did the Hospital staff document that they were unable to care for Mr. Brad as his condition required. Specifically, Hospital was aware that Mr. Brad was at high risk for falls, given his advanced age; medical diagnosis including recent CVA with left sided weakness; hypertension; degenerative joint disease; and a recent history of recurrent falls.

Despite Hospital’s knowledge of need for specialized care and services the Hospital staff repeatedly failed to take appropriate actions; failed to obtain proper equipment; and failed to ensure proper nursing, medical and basic care and services were provided resulting in the patient attempting to use bedside commode alone with subsequent slip and fall complicated by left hip interochanteric fracture.

The comprehensive care plan must include measurable objectives and time tables to meet the resident’s medical, nursing, mental and psychological needs that are identified in the comprehensive nursing assessment. Similar treatment and care plan should be identified in the areas of fall risk management and fall prevention.

The medical record demonstrates the failure to provide adequate, appropriate healthcare and supportive measures to protect Mr. Brad from the development of falls complicated by fractures. Standard of care requires and the purpose of the care plan is to ensure that:

A. A patient such as Mr. Brad who enters the facility with known fall risk does not experience falls resulting in fractures.

B. A patient such as Mr. Brad with a high risk for developing a mechanical fall receives necessary, timely treatment and services to prevent falls from occurring.

2. Failure to adequately monitor and document the health and condition of Mr. Brad so as to recognize significant risk factors for falls existed and to take actions as required to prevent falls.

3. Failure to obtain the necessary, appropriate consultation such as occupational and physical therapy to assist in the prevention of falls with injuries.

It is my professional opinion, based upon a reasonable degree of medical certainty that the Hospital staff, agents and apparent agents did not provide such acre to Mr. Brad that would be provided by a prudent similar facility caring for a similar patient under similar circumstances. Furthermore, it is my opinion that these failures and deviations from the standard of care were direct and proximal causes contributing to the deterioration and further decline of. As a direct result of the fracture experienced, Mr. Brad experienced a significant decline in his overall medical condition as documented in the medical records including cognitive, behavioral and nutritional. Mr. Brad is no longer able to live at home alone. Following the left hip fracture, Mr. Brad never regained his baseline functional abilities. As a result of the left hip fracture that occurred in Mr. Brad demonstrated a deterioration and worsening in his overall medical condition which continues to this day. Clearly Mr. Brad fracture played a significant role in the patient’s overall medical deterioration.

I have reviewed the medical treatment and expenses caused by the negligence of Hospital. I am prepared to review these medical treatments and associated expenses that are directly and proximately caused by the negligence of Hospital.

As a direct and proximal result of the injuries experienced as a result of the negligence of Hospital, Mr. Brad continues to experience physical, behavioral, emotional and psychological disability as a result of the injuries he experienced from the fall that occurred and the associated left hip fracture that is documented.

I specifically reserve the right to add to, amend or subtract from this report as new evidence comes into discover or as new evidence or additional records become available or as my new opinions are formulated. This preliminary report based upon the available medical records in discover to date are not meant to be taken as full and complete documentation of the onions that I hold in this case.

Respectfully Submitted,

M.D., M.S

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