Preview
017-265501-13 FILED
TARRANT COUNTY
9/11/2017 3:53 PM
THOMAS A. WILDER
CAUSE NO. 017-265501-13 DISTRICT CLERK
DARYL WILEY AS NEXT FRIEND § IN THE DISTRICT COURT
OF MIKAYLA M. WILEY AND §
THOMAS F. WILEY, MINOR §
CHILDREN, AND THE §
INDEPENDENT ADMINISTRATOR §
OF THE ESTATE OF KIOWANA §
HAYNES, DECEASED, DEBORAH §
HARRIS, INDIVIDUALLY, AS NEXT §
KIN OF KIOWANA HAYNES, §
DECEASED AND CLARENCE §
HAYNES, INDIVIDUALLY, AS §
NEXT OF KIN OF KIOWANA §
HAYNES, DECEASED §
§ 17TH JUDICIAL DISTRICT
VS. §
§
BRIAN BIRMINGHAM, CRNA, §
ADAM LENZ, M.D., NORTHSTAR §
ANESTHESIA, P.A., RAJA §
SAWHNEY, M.D. AND BAYLOR §
ALL SAINTS MEDICAL CENTER §
AT FORT WORTH § TARRANT COUNTY, TEXAS
DEFENDANTS BRIAN BIRMINGHAM, CRNA, ADAM LENZ, M.D., AND
NORTHSTAR ANESTHESIA, P.A.’S RESPONSE TO PLAINTIFF’S NO
EVIDENCE MOTION FOR SUMMARY JUDGMENT
TO THE HONORABLE JUDGE OF SAID COURT:
COME NOW, Brian Birmingham, CRNA, Adam Lenz, M.D., and Northstar
Anesthesia, P.A., hereinafter referred to as “Defendants” in the above-styled and numbered
cause, and files this Response to Plaintiff’s No Evidence Motion for Summary Judgment,
and would respectfully show the following:
Defendants’ Response To Plaintiff’s No Evidence Motion For Summary Judgment – Page 1
I. Pleadings
Plaintiffs filed suit on April 22, 2013, alleging medical negligence. Defendants filed
and served their First Amended Answer on November 7, 2014. Subsequently, Defendants
amended that answer and served their Second Amended Answer on July 20, 2015.
Plaintiffs filed their No Evidence Motion for Summary Judgment on August 22, 2017,
asserting Defendants have produced no evidence of certain affirmative defenses pleaded in
their First Amended Answer. Plaintiffs’ No Evidence Motion for Summary Judgment, p. 2.
“Amended pleadings supersede and supplant previous pleadings.” Smith Detective
Agency & Nightwatch Serv., Inc. v. Stanley Smith Sec., Inc., 938 S.W.2d 743, 747 (Tex.
App.—Dallas 1996, writ denied); Radelow–Gittens Real Property Management v. Pamex
Foods, 735 S.W.2d 558, 559 (Tex.App.—Dallas 1987, writ ref'd n.r.e.). Therefore, any
challenge to Defendants’ First Amended Answer is moot.
II. Plaintiffs Failed to Satisfy Rule 166a(i)
A no-evidence motion for summary must state the elements to which there is no
evidence. Tex. R. Civ. P. 166a(i). “In this regard, “[a] no-evidence motion for summary
judgment that does not challenge a specific element of [the non-movant's] claim is not
reviewed as a no-evidence motion.” Kadhum v. Homecomings Fin. Network, Inc., 01-05-
00705-CV, 2006 WL 1125240, at *4 (Tex. App.--Houston [1st Dist.] Apr. 27, 2006, pet.
denied). To the contrary, “[w]hen a no-evidence motion for summary judgment does not
specifically state which elements lack evidence, the motion should be treated as a motion
for a 166a(c) summary judgment.” Id.; see Amouri v. Sw. Toyota, Inc., 20 S.W.3d 165, 168
(Tex. App.--Texarkana 2000, pet. denied).
Defendants’ Response To Plaintiff’s No Evidence Motion For Summary Judgment – Page 2
In Plaintiffs’ motion, there are no specific elements of the challenged defenses
mentioned by Plaintiffs. Therefore, Plaintiffs’ motion fails to satisfy Rule 166a(i), and
should not be considered a no-evidence motion. Furthermore, to the extent Plaintiffs seek
a dispositive ruling through their motion, only fact issues are challenged. Plaintiffs have
not set forth sufficient evidence to prevail on a Rule 166a(c) summary judgment.
III. Affirmative Defenses
Plaintiffs claim Defendants have not and cannot produce any evidence of the
following defenses:
(1) Plaintiff’s injuries were caused by superseding and/or intervening acts
that disrupted the chain of causation and were beyond the control of
Defendants;
(2) The damages claimed were brought about by new and independent causes
not reasonably foreseeable by Defendant;
(3) The damages claimed by Plaintiff were unavoidable and unforeseeable;
and
(4) That Plaintiff suffered from problems and/or medical conditions which
pre-existed the date of the incident in question.
Plaintiffs frame these defenses as affirmative defenses; they are not. Instead, each
pleaded defense mentioned above is an inferential rebuttal. See Cooper v. Boyar, 567
S.W.2d 555, 559 (Tex. Civ. App.—Waco 1978, writ ref'd n.r.e.). Inferential rebuttal
defenses are distinct from affirmative defenses in that they rebut part of the plaintiff's cause
of action, while an affirmative defense relieves the defendant of liability even if all the
elements of a plaintiff's cause of action are established. See Moulton v. Alamo Ambulance
Serv., Inc., 414 S.W.2d 444, 448 (Tex.1967); Buls v. Fuselier, 55 S.W.3d 204, 211
Defendants’ Response To Plaintiff’s No Evidence Motion For Summary Judgment – Page 3
(Tex.App.-Texarkana 2001, no pet.). “As such, inferential rebuttals need not be specifically
pleaded.” Perez v. DNT Glob. Star, L.L.C., 339 S.W.3d 692, 699–700 (Tex. App.—
Houston [1st Dist.] 2011, no pet.). “The burden of proof is on the plaintiff to establish the
nonexistence of the rebuttal issue,” not on the Defendants. Liveoak v. Ingham, 644 S.W.2d
566, 568 (Tex. App.—El Paso 1982, writ ref'd n.r.e.).
The defenses which make the subject of Plaintiffs’ motion are simply challenges to
the proximate cause element of negligence. Defendants intend to show, among other things,
the damages Plaintiffs allege were not caused by the Defendants, and instead, were brought
about by forces or conditions not under their control. As shown below, each of the
challenged defenses have been specifically held to be inferential rebuttals, not defenses
which any authority requires evidence of before trial.
A. Superseding and/or Intervening Acts and New and Independent Causes
New and independent causes, also called superseding and intervening causes, are
acts or omissions of a separate and independent agency that destroys the causal connection
between the negligent act or omission of the defendant and the injury complained of, and
thereby becomes the immediate cause of such injury. See Rodriguez v. Moerbe, 963 S.W.2d
808, 820 (Tex.App.-San Antonio 1998, pet. denied) (citing Young v. Massey, 128 Tex. 638,
101 S.W.2d 809, 810 (1937)). “The doctrine of ‘new and independent cause’ is not an
affirmative defense; it is one element to be considered by a fact finder in determining
whether proximate cause exists.” Dallas Ry. & Terminal Co. v. Bailey, 151 Tex. 359, 250
S.W.2d 379, 383 (1952); Hall v. Huff, 957 S.W.2d 90, 96 (Tex.App.-Texarkana 1997, pet.
denied).
Defendants’ Response To Plaintiff’s No Evidence Motion For Summary Judgment – Page 4
To establish a claim of negligence, Plaintiffs must show Defendants’ action was a
proximate cause of the damages complained of. First Assembly of God, Inc. v. Texas
Utilities Elec. Co., 52 S.W.3d 482, 491 (Tex. App.—Dallas 2001, no pet.); El Chico Corp.
v. Poole, 732 S.W.2d 306, 311 (Tex.1987). Asserting a new and independent cause defense
allows the fact finder to determine if the intervening act brought about harm different from
what would otherwise have resulted. Dew v. Crown Derrick Erectors, Inc., 208 S.W.3d,
448, 451-52 n.3 (Tex. 2006). This defense is plainly not an affirmative defense upon which
the Defendants bear the burden of proof.
In the alternative, if this Court decides Defendants’ asserted defense of superseding
or new and intervening causes should be classified as an affirmative defense, Defendant
has produced competent summary judgment evidence sufficient to raise a fact issue.
Specifically, the investigator’s report from the Tarrant County Medical Examiner’s Office
indicates “no trauma or foul play associated with this case per Jennifer Clark, RN.” See
Exh. A. Further, several comorbidities were listed in the medical history portion of the
report, and the death event was described as “cardiac arrest during an emergency
tracheotomy performed in response to developing subcutaneous emphysema.” Id. at 3.
There is no mention of medical negligence, an ill-advised procedure, or any activity
requiring further investigation. See id.
This case revolves around an intubation procedure; Plaintiffs allege Defendants
negligently perforated Kiowana Haynes’ trachea with an endotracheal tube just below her
vocal cords, resulting in death. Dr. Neal Gerstein, Plaintiffs’ causation expert, testified that
if the tube did not reach past Ms. Haynes’ vocal cords, the endotracheal tubes could not
Defendants’ Response To Plaintiff’s No Evidence Motion For Summary Judgment – Page 5
have caused her injury. See Exh. B, p. 82. Defendant Brian Birmingham, the CRNA who
attempted the initial intubation, testified that he could not get a No. 6 tube to go past the
vocal cords. Exh. C, P. 70 L. 25 – 71 L. 6. Dr. Lenz, the Anesthesiologist, testified Ms.
Haynes started to desaturate with oxygen during the initial attempt at intubation, and before
any endotracheal tube ever reached below the vocal cords. Exh. D, P. 89 L. 12 – P. 92 L.
15. Dr. Lenz also testified that he does not believe her trachea was perforated at that time.
See id.
Dr. Lenz went on to testify the No. 7 tube was also used, but it never got past the
vocal cords. Exh. D, P. 97 L. 4 – P. 103 L. 21. Dr. Lenz also testified he does not believe a
No. 8 tube was used. Id. Therefore, taking Dr. Lenz’s testimony with Brian Birmingham
and Dr. Gerstein’s testimony, there are significant fact issues for the jury to determine,
which competent summary judgment evidence has been supplied to demonstrate.
B. Unavoidable and Unforeseeable Causes
Generally, the defense of unavoidable accident, also called unforeseeable causes, is
used by a defendant to attack the causal effect of some physical condition or circumstance
such as fog, snow, sleet, wet or slick pavement, or obstruction of view. Reinhart v. Young,
906 S.W.2d 471, 472 (Tex.1995). In medical malpractice litigation, an unavoidable
accident “is an event not proximately caused by the negligence of any party to it.” Id.
(quoting Dallas Ry. & Terminal Co. v. Bailey, 151 Tex. 359, 250 S.W.2d 379, 385 (1952));
Young v. Thota, 271 S.W.3d 822, 836–37 (Tex.App.-Fort Worth 2008, pet. denied).
Chesser v. LifeCare Mgmt. Services, L.L.C., 356 S.W.3d 613, 635 (Tex. App.—Fort Worth
2011, pet. denied).
Defendants’ Response To Plaintiff’s No Evidence Motion For Summary Judgment – Page 6
In both contexts, an unavoidable accident defense “is not an alternative theory of
liability but is an inferential rebuttal issue that requires plaintiffs to prove the nonexistence”
of the defense. Lemos v. Montez, 680 S.W.2d 798, 800 (Tex.1984), Specifically, this
inferential rebuttal “seeks to disprove the existence of an essential element submitted in
another issue,” Select Ins. Co. v. Boucher, 561 S.W.2d 474, 477 (Tex.1978). Bed, Bath &
Beyond, Inc. v. Urista, 211 S.W.3d 753, 756 (Tex. 2006). Simply stated, this defense is an
attack on the proximate cause element of negligence; it is not an affirmative defense which
Defendants bear the burden on.
In the alternative, if this Court decides this defense should be treated as an
affirmative defense, Defendants have produced competent summary judgment evidence to
raise a fact issue. Specifically, the medical examiner report and the deposition testimony,
together and separately, tend to demonstrate Plaintiff’s injury was not proximately caused
by the negligence of any actor made a part of this case, but instead, an unexpected and
unforeseeable reaction to intubation. See Exh. A, B, C, D.
C. Preexisting Conditions
Defendants pleaded that any injuries or damages complained of by Plaintiffs are the
result of preexisting or subsequently occurring conditions. Again, that defensive theory is
an inferential rebuttal, not an affirmative defense. In re Nance, 143 S.W.3d 506, 512–13
(Tex. App.—Austin 2004, no pet.) (citing R.K. v. Ramirez, 887 S.W.2d 836, 843
(Tex.1994); see also Tex. R. Civ. P. 277. Furthermore, there is ample evidence that Plaintiff
had tracheal stenosis, a narrowing of the trachea, asthma, right lower lobe infiltrate,
diabetes, hypertension, morbid obesity. Exh. B, p. 10-11; Exh. E. Defendants merely assert
Defendants’ Response To Plaintiff’s No Evidence Motion For Summary Judgment – Page 7
these conditions contributed to or caused Plaintiffs’ damages. This defense is an attack on
the proximate cause element of negligence, not an affirmative defense upon which the
Defendants bear the burden.
WHEREFORE, PREMISES CONSIDERED, Defendants pray the Court deny
Plaintiffs’ No Evidence Motion for Summary Judgment. Defendants pray for such other
and further relief, either at law or in equity, to which Defendants may be justly entitled.
Respectfully submitted,
CHAMBLEE RYAN, P.C.
By: /s/ Douglas R. Lewis
William H. Chamblee
wchamblee@cr.law
State Bar No. 04086100
Douglas R. Lewis
dlewis@cr.law
State Bar No. 12275800
2777 Stemmons Freeway, Suite 1157
Dallas, Texas 75207
(214) 905-2003
(214) 905-1213 (Facsimile)
ATTORNEYS FOR DEFENDANTS
Brian Birmingham, CRNA, Adam Lenz,
M.D. and Northstar Anesthesia, P.A.
Defendants’ Response To Plaintiff’s No Evidence Motion For Summary Judgment – Page 8
CERTIFICATE OF SERVICE
I do hereby certify that on September 11, 2017 a true and correct copy of the above
and foregoing document has been served via the court’s efiling/eservice system to all
counsel of record.
/s/ Douglas R. Lewis
Douglas R. Lewis
Defendants’ Response To Plaintiff’s No Evidence Motion For Summary Judgment – Page 9
EXHIBIT "A"
.,.,,..···· ·
TARRANtCOUNTY MEDICALEXAMINER'S DISTRICT
SERVINGTARRANT,.PARKER, & DENTON COUNTIES
Investigator's Report
CASE.Jf! 11.01911 Tarrant" TYPE: Jurisdiction lDENTITY: identi:i1ed·
:N}ZAM J>EER WAN!, M.D. ;MICHAEL PLO\'i)
. CHIEF MEOICAL EXAMINER CHIEFFORENS1¢DEAt1-1·rNvE$'ndATOR
DEQE,ASED: ki~waria Hayrid.
ADDIU!SS; 190 I Park Place Blvd:, #:110, Bedford; Texas 7602 l
AGE: 33' .!31RT1_:I PATE: 10/23(1977 MARITAL STATUS: Siugfo
Pf{QNE;.(682)367~2238 RACE ORCOLOR: Black SEX:,F·
~EI.GHT: WEIGHT:
SSN :. 466-4 5a3 613· MANNER OF DRESS:
l , OCCU.flATJON:
:i
")
PLACE OF EMPLOYEMENT:
'.
DATE.OF DEATH: 2/11/20.1 i TIME OF DEATH: 14:05
PLACE OF DEATH DESCRIPT.iON: 'Bayior All Saints Medical Cc~ter
ADDRESS OF DEATH: 1400 8th Av~nue, Fort Worth, Texas 76104
. HOSPITALIZED: Yes .
ADMITDATE:-2110/201 L ADM1TTIME: 18:0S
ENVIRONMENi:' CONDITION: HYAC controlled·
CHARACTERISTIC OF PREMISES: ICU .
DATE/TIME M.E. NOTIFIED: 2/ 11/2011 14:32.
ARRJ\TE.D:
il JZEPORTTNG PERSON:-·.iennifer Clark, -R.:N.
l
! REPORTING AGENCY: Baylor All Saints Medical CeJ;1ler
J ADDRESS: 1400 .8th Avenue, Fol't\Vorth,. Texas 7(';·104:
'i .PHONE: (817)922-7301 . .
PRONOUNCED DEAD DY: Dr. folln Burk
PRONOUNCING AGENCY: Baylor All Saints Medical Center
LAST TREATED BY: br. John Burk
i DATErrIME OF OCCURENCE; 2/11/2011
INJURY AT WORK: NO-
13:00
-PLACE OF OCCUR.ENCE: Baylor AH Saints Medical Center;. Surgery Suite
i LOCATION: 1400 8th Avenue, Fort Worth, Texas 76104
r.
!:
TRAUMA RELATED: No
I IDENTIFIED BY: ·Brittany Dodson
i
!,. IDENTIFICATION TYPE: Viouul
DA:rE/TJME OF IDENTIFICATION: 2/1 J/201l ~Time: 14:32
IDENTIFICATION STATUS: Positive ID
COMMENTS: Decedent identified positively to 13. Dodson.by Jennifer Clnrk,J.N.
:ADDRESS:
JlHONE:
NEXT .OF KIN NOTIFICATI.QN ·DATEffiME:-2/11/2011 J$:OO
NOTIFIED BY: Di. Burk'
.N OTIFYING AGENCY: Baylor AU Saints Hospita l
NEXT OF KrN NAME: Debra·Hanis
RELA TIONSHJP: Mother
COMMEN1:S:
ADDRESS: 190 I Park Place Blvd., # 110, 'Bedford, 76021 Texas
PHONE: (682)367-2238
BODY TO:·Ta1Tai1t C0tinty Medical Examiner's -Office
. CONVEYANCE:
2/15/201 1
Page I
TARRANT COUNTY MEDICAL EXAMINER'S DISTRICT
SE:RVING TARRANT, PARKER, & DENTON COUNTIES.
Investigator's Report.
GA$E-fl:: I 101911 Tan:anl TYPE: Jut'j~diction IDENTlT.Y :.Identified
NIZAM PEERWANI, M.D. MICHAEL FLOYD
CHIEF MEDICAL EXAMINER CHIEF FORENSIC DEATiflNVESTIGATOR.
.FUNERAL HOME: Unknown
NAME.OFRELEASlNG AUTHORITY:
RELATIONSHIP:
DISPOSITION OF PROPER'fY:
MEDfCAL INVESTJGATOR:.
Micli~e1'r-:1oyd . . ..
2/LS/2011
Page -2:
TARRANT COUNTY MEDICAL t:X'Al\1INER!S DISTRICT.
SERVING TARRANT; l:'AlUillR, & DENl'ON COUNTiES
lNVES1JGAT0R'~.REPOR'.f
.!.
NIZAM PEERWANI~ MD. MIC}IABL FLOYD
S!'II~f MEDiCAL EXAMfNER CHIEF:-FORENSIC DEATH INVESTfGATOR
.. ·
. Case Nimiber:. UQ.J91 t Case type: Jµrisdittion
,,
' DECEDENT'S.NAME: Kiowana Hayoes AGE:33
ADDRESS: 1901 ParkPlace Blvd'., #1 IO, .Bedford,Texas 76021
BIRTH DATE: 1.0/23/1977 MARITALSTATUS: Single PHONE: (6.~_2)~67-223'8
CASE'NO. ll0.l9l.1 Tarr~nt
.j:
The ;dec~dent;a ).3-year-old Biatk female:with. a repor,ted medical ·'1isto1y cr(tracneal steriosfa; ,asthma, rtgbt:
.towet; Jdbe -infiltrate; thyroidectomy, diabetes, ·hypertension, and morbid obysity, becan:i.e unre,spc;ms,iv,e.dui:jng
f1.n e11do$cppic pro~edure and, subsequently, developed pulseless cardiac electdcal.actlv'ity and subcutai:1eous'
emphysema. . . .
DESCRIPTION OF BODY:
The decedent is not viewed as the remains are not present at the morgue prior to the completforr·ofthfa
0
inycstigat.i.v.SY REPORT
: N~me: Kiowana Haynes CA$E NO.; 11.019.11
'.~
i. :Approximate Age:, 33 Yeats Sex: Female.
i"
,· . Heigf:,f: 6Q~S }nche.s Welgh't: 249.t Pc,(fntjs
'
l her~by certify that on the 16~h day of February 2011, beginning. at ·10:15 .hours;,··.
:1,, :.GaryL ·Sisler, D.O., ptirsuant to Statute 49.25 of Texas Criminai .Cog_e, .
performed a complete autopsy on the body of Kiowana Haynes at th't3TE1t(ant ·
.county Mecfical Examiner's 'District Morgue in Fort, ·worth. Texas: :and ,upon
·Jnvestrgation :ofthe essentiaf fc3cts·concerning the. circumstances of the death and
·history: of .tfJe case ~-s known to rne, I am of the qpinion thatthe findings, ·qa4se ·
.:a hd. manner
. of death
. . are as. follows:
'.FiNDINGS:
I) Admitted to local h.ospjtal with history of Worsening respiratory distress· oy~r. •
a five .d ay period of time with suspected rec~t ren'c e ·pf a '.trJ~ch.~.i;IJ_$J~no~i~ :·
·. and, admitted for surgical' correction and· expired approximate_fy· twenty
hours: after admission
II) Perforation of trachea with subcutaneous emphysema of faqe; ·neck; :
shoulders, arms, and hands
Tracheal stenosis with erythema an;cl eo~rna of vocal. cords
I fl:) .
IV) Pulmonary congestion and edema; marked·, with collapse of left lung
· V) Status· po~t operative procedures.: ·
;;i)Tracheostomy
b) .Place.ment of left chest tube Jn the. ieft. breast and right che ·.
into ri ht leural .cavi · - ·
Pa,ge:2. qf 6
,. Kiowana Haynes .
;!.
:,
i
!C.AU_ Sf= OF DEATH: PERFORATION OF TRACHEA
'!MANNER OF DEATH: ACCIDENT . Ii
;
.•
"
::.
•:, Gary L.Sisl.~r.;.O. Q.~
,;.
Deputy :Medical.Examiner
'i
:;
,:,
;
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:!
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i.
A complete autopsy .is carried out at the.Tarrant County Medical Extiirliner·~
Morgue.
L CLOTHING AND PERSONAL EFFECTS: The. body is present~d 'tothe
Morgue wrapped in a white sheet and cream-colored blanket and clad in:
1.i Hospital gown
II. THERAPEUTIC INTERVENTION:
1. Trache9stomy located 1o inches ·below the. .top of the head over the
m(tjline of the anterior nec::k with two· hemo·sta~s. l_
ocated aiong the right
margin, and contains a #6 endotracheal tube. The length is 1 inch.
'2. IV lln·e entering the left arm region.
·3·_ Left and .right chest tubes
4. One ·gastric tube
;.
Ill,. EXTERNAL BODY D.ESCRIPTION: The ·body J~' ,that of ·a :norni~l!Y:
developed African American female appearing the -stated age of :33 years with. a: ,
body 1~·ngth of 66:5 inches and body weighto't 249.2 pounds·. The body presents,
large. buiid with average nutriti_on, normal hydrc;ltion, ar.id good presetv~ti9n ..
Rigor mortis is fading, and llvidity is developed over the po~terio_r region qf 'the
body. The body is cold to touch post refrigeration. The head i.s co.ver~d .byshort
( .wavy black hair with a non-receding. hairline.. There is average body .hair of
1;
~ female pattern distribution. There is subcutaneous: emphysema of the face~
s.ho~.tlcfers, neck, arriJ.f,,and hands. The: eyes.:a.re closed with clear lbuibanmd
.,L
.
palpebral conjunctivae. Trie lrioes are brown with white.sclerci~,. T'1¢i'e:" ;~re no
'
:,'!
,j
cataracts. or a.rcus pre.sent. Pupils are.equal at5 mm. The orbits appear normal,.
j
=i
The nasal cavities are unremarkable. with intact septum. The oral ca.vity presents;
,! natural teeth with good oral hygiene. ·The .ears are unremarkable wlth .no.
.,j
:i her:norrhage ·in the external auditory canai. Ears ar.e. pierqed x t...th~ 11eck·is
.,., supple. and palpation non--reveali.ng, The chest .is symmetric and presents We.II.
]
) . formed and well preseNed medium breasts without · palpable :masses.. The
'I
abdomen is·moderately protuberant .and _palpation nbn-revealing .
I
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1
7
Page 4 of!3
l
i The upper and.lower extremities are equal and symmetrical presenJihg c;yanoli,c;
·i, . n~.ii' .!)eds w_ ithout clubbing or edemi:l. There are no: . ·fractures, . injuries,
f. q~fotm.iii.e~. or amputations present. .External. genitalia are tho$e: of an 'adult
i:
l: female.with. intact.vulva and vagina.. The back reveals depentjer,_ t ,fi\/idJtY
With
I .
i.
cdrifacf ·pallor: The butto¢k$ are attaur,nat,c,. ·and ·tlie anus is intact Th.e
iiit~g1..1mentis: of normal color.
!
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;·' .
IV~ INTERNAL.EXAMINATION
!
i
1.-, INTEGUMENT: A Y-shaped thorac.oabdominal incision is made and the·
I·
I .orgqns are examined in-situ and eviscerated in the usuai fashion.,. The
i. subcutaneous· fat is normally distribLJted, moist, and bright y~How. The
):
j! JhtJSGUJature of the .chest and abdominal.area is·of normal color and texture:.
i
·2. SEROUS CAVITIES: The chest wall .is· :intact without rib~ sternai, or
clavlcular fractures. The pleura :and pe(itoneum· ar~ ~ong_esteq, smoqth
_glist~ning, a!1d essenti.a.lly dry, devoid of adhesions or effusion,, There is no
scoiit>sis., kyphosis, or·l.ordo.sis present, The left-and .rlgbt diaphragms ,are .l.n their
norr.n~I location and appear grossly unremarkable. The pericardia! sac is ·1ntacti
·smooth., glistening and contains normal amounts>of serous flUid.
3., CARDIOVASCULAR SYSTEM: The heart weighs 312 gms and. there Js ·
no ct,amber hypertrophy or dilatation. The left ventricular wall is 1 cm and..°the ·
right 0.4 cm. The cardiac valves appear unremarkable.. The coronary ostia are·
'in the normal anatomical location leading into widely· pat~nt c9rOnary :acted~~.
Hight dominant circulation· is present. The endocardial -surface .is smo,oth without
thrombi or ,inflammation. Sectioning of the myocardium, presents no ,gross
evid~nce·.of ischemic changes either. of recent or. remote origin. The aortic arch
along with. the great vessels appears :grossly unremarkable.
it PULMONARY SYSTEM: The heck. presents an intact hyoid bone as well
a$ thyroict i:l[ld cticoid cartHages. The.vocal cords are edematous with erytherna.
The epiglottis is edematous and is a characteristic plate-like structure· without
tr:auma or pathological lesions. Both the musculature and the. vasculature. of the
anterior neck are unremarkable. There is a tracheal .stenosis. 5 cm b·(?toW the
vocal, cords. There is a tracheal stenosis 5 Gm be.low the vocal cords. Usihg
kriown diameter plastic tubing as, a gauge, the stenotic,region measured 1.1 mm
in- diameter and the trachea above and below· the: stenosis measured 19. mm 1n
diameter. Directly opposite· the stenosis IS a2 cm x 2 ,drn p~rf9r.atid11 .bf the
posferioY Wall of the trachea;
.···---•..
;!/;$£.~~. 1:101911
'Kiowana HayhJis
The. left lung weighs 366 gnis and is coliapsed;. with the right -lung weighing
1035: .Qms. Both the lungs .appear moderately to severely cong,ested and.
ed¢mqto:us.. There are no gross pneumonic lesions or abnormcll trJq$~~~
identified. The .Pulmonary arterial system is int~ct and grossly .unremarkable.
The pleural ·surfaces are pink and smooth with focal mild: anthracosis.
5. GASTROINTESTINAL SYSTEM: The esophagus is·· inta.Gt with n.ormal
gastroesophagea·1junction~ and without. erosi9ns or vari¢es .. The -stoinachis:aiso
normal wHbout gq$trlti$ ·or ulcers, and. the stomach is· devoid of-food partlcl~s,
Loops of small and large bowel appear grossly unremarkable.: Th.e cipper,_dix is
,unremarkable. ·
The liver weighs 1383 gms presenting a brown smooth~glistening surfa~e. 01'1
se.clioning; the hepatic parenchyma is red~brown and cot1ge$ted! The
gc1UbJadder·is absent. The biliary tree is patent. . The pancn:~as weighs '161 gms·
and presents a lobulated yellow cut surface. · ·
. 6. GENITOURINARY SYSTEM: The left kidney weighs 134 gms; .and· Joe
right ki.c:iney weighs 130 gms. On sectioning, the 9qrtex prE?serjts la norn:ial
thickness ·above the· medulla. The renaf :column.s of Bertin e:xtend' between, the·
well-demarcated pyramids and appear unr~markable. The medulla. presents
normal renal pyrc1rnids with unremarkable papillae. The pelvis .is of normaf,~,z~
;:1nd' lih~d by gray glistening mucosa. There. are no CalcylL Renpi art~ri~~ ah,i;:f
veins , .are normal.
· The ureter$ .are of normal caliber lying in their course within the .retroperitoneum
and •drainin~ into an unremarkable urinary bladder containing 30 mL .of~rine.
External g·enitalia are those of an adult female witl1 -intact vuhra arid.;yagina. The·
uterus, cervix, fallopian tubes, and ovaries are unremarkable.
7.. HEMATOPOIETIC SYSTEM: The spleen weighs 216 :gms,. presenting ·a
:gray-pink intact capsule and a dark red parenchyr;na.. There :js ho
Jymphadenopathy. The thymus giand is invoiute,d.
8. ENDOCRINE· SYSTEM: Thyroid gland is surgically absent.. The adrena·I
,glqqds are. .of normal size and · shape and· sectioning present. no gtoss
pathological lesions, ,
. .. ·· ,-
,
Page q o,f 6
9. :CENTRAL NERVOUS SYSTEM: -A sc~Jp it')cisJon, craniotomy, :a.nd
evacuation;of
. -·. .. the brain are carded
. .
outin
. ·- . the usual
. . fashion .
ttie ,$dalp ·:is intact without contusions or laceratio_11s, Th!3' ca·lvclriuil:ijs likewise.
ihtactwithout bony abnormalities or fractures.
The- br?in weighs 11°80 gms presenting moderate congesti9n ,of ·-tt.113
lept9.r.n:eninge_s·. · Overlying dura ·1s intact _
and unte.mi:itkal:>le. ·Cerebral ;
hemispheres reveal a riormal gyral paJt~rn With m.ocfer~te, to severe. .global
·edema. The brainstem $nd cetebelli are normal' ih appearance with no .evidence.
o( -cerebeilar tonsillar notching. The Circle ·of Willis- 1s patE?t,t;. pr.$sen.ting JJQ.
evidence·of thrombosis or berry aneurysm. 011 coronal -:sectioniqg_:of the brain_,
the: ventricular system is symmetrical aoc:f contains. clear cerebrospinat fluid :·
rhere are no space occupyfng·. 1esions present. Spinal cord ts not examined~ ·
1. 30 ml bfaortic blood, 15 rnL ofsubclavian blood, 30 ml ofutine and 5:mL
of vitreous for possible further examination '.
2. Representative tissue sections in formalin.for pos$ible further examin~tion
3. Blood.card
·4. Representative photographs
:EDC: 3/15/11
Dictated: 3/1/11
Transcribed: 3/4/11
Completed: 3/4/.11
GLS::caa
M$3 I REV. 7/06.
0. ~"..; of Chief Medical E 1n..._..1er
Tarrant, Denton and Parker Counties, Te~as
200 Feliks Gwozdz Place, Fort. Worth, Texas 76104-:4919 • (817)'920°5700 ·
.,
ME-l!IA GP.C-l9Sj Rev. 7/06.
0~ i~'"' of Chief fytedjcal L_..am . .....ter
Tarrant, Denton and. Parker Counties., Texas
20_9-feliks ~wozdz Place, Fort Worth, Texas 76104-4919 .:.- ~17) 9.20-5700
·Examine1:: lJ(. S~ k°"'°', Autop$y No. / I/ 0 12 {)
J
·rur·
C ):.
......
MEDICAL ABSTRACT OF .DEATH CERTIFICATE
STATE·OF TExAS STATE·F_ILE NUMBER
ENTER:NAME OF DECEASED AND PLACE OF DEATH EXACTLY AS SHOWN ON THE ORIGINAL DEATH CERTIFICATE
' ! . ~EOAL·NAt.lE Of OECEASW (lnctude N'.A's, 11 ony) (F~sl, Mlodl•, Lasl) OATE"OF DEATH
.· KI.OYIJANA ROSHANDA HAYNES ·~211112011
PLACE OF OEATH(CITYOR.TOl'IW AND COUNTY) IS THE 01\TE Of
Preview
017-265501-13 FILED TARRANT COUNTY 9/11/2017 3:53 PM THOMAS A. WILDER CAUSE NO. 017-265501-13 DISTRICT CLERK DARYL WILEY AS NEXT FRIEND § IN THE DISTRICT COURT OF MIKAYLA M. WILEY AND § THOMAS F. WILEY, MINOR § CHILDREN, AND THE § INDEPENDENT ADMINISTRATOR § OF THE ESTATE OF KIOWANA § HAYNES, DECEASED, DEBORAH § HARRIS, INDIVIDUALLY, AS NEXT § KIN OF KIOWANA HAYNES, § DECEASED AND CLARENCE § HAYNES, INDIVIDUALLY, AS § NEXT OF KIN OF KIOWANA § HAYNES, DECEASED § § 17TH JUDICIAL DISTRICT VS. § § BRIAN BIRMINGHAM, CRNA, § ADAM LENZ, M.D., NORTHSTAR § ANESTHESIA, P.A., RAJA § SAWHNEY, M.D. AND BAYLOR § ALL SAINTS MEDICAL CENTER § AT FORT WORTH § TARRANT COUNTY, TEXAS DEFENDANTS BRIAN BIRMINGHAM, CRNA, ADAM LENZ, M.D., AND NORTHSTAR ANESTHESIA, P.A.’S RESPONSE TO PLAINTIFF’S NO EVIDENCE MOTION FOR SUMMARY JUDGMENT TO THE HONORABLE JUDGE OF SAID COURT: COME NOW, Brian Birmingham, CRNA, Adam Lenz, M.D., and Northstar Anesthesia, P.A., hereinafter referred to as “Defendants” in the above-styled and numbered cause, and files this Response to Plaintiff’s No Evidence Motion for Summary Judgment, and would respectfully show the following: Defendants’ Response To Plaintiff’s No Evidence Motion For Summary Judgment – Page 1 I. Pleadings Plaintiffs filed suit on April 22, 2013, alleging medical negligence. Defendants filed and served their First Amended Answer on November 7, 2014. Subsequently, Defendants amended that answer and served their Second Amended Answer on July 20, 2015. Plaintiffs filed their No Evidence Motion for Summary Judgment on August 22, 2017, asserting Defendants have produced no evidence of certain affirmative defenses pleaded in their First Amended Answer. Plaintiffs’ No Evidence Motion for Summary Judgment, p. 2. “Amended pleadings supersede and supplant previous pleadings.” Smith Detective Agency & Nightwatch Serv., Inc. v. Stanley Smith Sec., Inc., 938 S.W.2d 743, 747 (Tex. App.—Dallas 1996, writ denied); Radelow–Gittens Real Property Management v. Pamex Foods, 735 S.W.2d 558, 559 (Tex.App.—Dallas 1987, writ ref'd n.r.e.). Therefore, any challenge to Defendants’ First Amended Answer is moot. II. Plaintiffs Failed to Satisfy Rule 166a(i) A no-evidence motion for summary must state the elements to which there is no evidence. Tex. R. Civ. P. 166a(i). “In this regard, “[a] no-evidence motion for summary judgment that does not challenge a specific element of [the non-movant's] claim is not reviewed as a no-evidence motion.” Kadhum v. Homecomings Fin. Network, Inc., 01-05- 00705-CV, 2006 WL 1125240, at *4 (Tex. App.--Houston [1st Dist.] Apr. 27, 2006, pet. denied). To the contrary, “[w]hen a no-evidence motion for summary judgment does not specifically state which elements lack evidence, the motion should be treated as a motion for a 166a(c) summary judgment.” Id.; see Amouri v. Sw. Toyota, Inc., 20 S.W.3d 165, 168 (Tex. App.--Texarkana 2000, pet. denied). Defendants’ Response To Plaintiff’s No Evidence Motion For Summary Judgment – Page 2 In Plaintiffs’ motion, there are no specific elements of the challenged defenses mentioned by Plaintiffs. Therefore, Plaintiffs’ motion fails to satisfy Rule 166a(i), and should not be considered a no-evidence motion. Furthermore, to the extent Plaintiffs seek a dispositive ruling through their motion, only fact issues are challenged. Plaintiffs have not set forth sufficient evidence to prevail on a Rule 166a(c) summary judgment. III. Affirmative Defenses Plaintiffs claim Defendants have not and cannot produce any evidence of the following defenses: (1) Plaintiff’s injuries were caused by superseding and/or intervening acts that disrupted the chain of causation and were beyond the control of Defendants; (2) The damages claimed were brought about by new and independent causes not reasonably foreseeable by Defendant; (3) The damages claimed by Plaintiff were unavoidable and unforeseeable; and (4) That Plaintiff suffered from problems and/or medical conditions which pre-existed the date of the incident in question. Plaintiffs frame these defenses as affirmative defenses; they are not. Instead, each pleaded defense mentioned above is an inferential rebuttal. See Cooper v. Boyar, 567 S.W.2d 555, 559 (Tex. Civ. App.—Waco 1978, writ ref'd n.r.e.). Inferential rebuttal defenses are distinct from affirmative defenses in that they rebut part of the plaintiff's cause of action, while an affirmative defense relieves the defendant of liability even if all the elements of a plaintiff's cause of action are established. See Moulton v. Alamo Ambulance Serv., Inc., 414 S.W.2d 444, 448 (Tex.1967); Buls v. Fuselier, 55 S.W.3d 204, 211 Defendants’ Response To Plaintiff’s No Evidence Motion For Summary Judgment – Page 3 (Tex.App.-Texarkana 2001, no pet.). “As such, inferential rebuttals need not be specifically pleaded.” Perez v. DNT Glob. Star, L.L.C., 339 S.W.3d 692, 699–700 (Tex. App.— Houston [1st Dist.] 2011, no pet.). “The burden of proof is on the plaintiff to establish the nonexistence of the rebuttal issue,” not on the Defendants. Liveoak v. Ingham, 644 S.W.2d 566, 568 (Tex. App.—El Paso 1982, writ ref'd n.r.e.). The defenses which make the subject of Plaintiffs’ motion are simply challenges to the proximate cause element of negligence. Defendants intend to show, among other things, the damages Plaintiffs allege were not caused by the Defendants, and instead, were brought about by forces or conditions not under their control. As shown below, each of the challenged defenses have been specifically held to be inferential rebuttals, not defenses which any authority requires evidence of before trial. A. Superseding and/or Intervening Acts and New and Independent Causes New and independent causes, also called superseding and intervening causes, are acts or omissions of a separate and independent agency that destroys the causal connection between the negligent act or omission of the defendant and the injury complained of, and thereby becomes the immediate cause of such injury. See Rodriguez v. Moerbe, 963 S.W.2d 808, 820 (Tex.App.-San Antonio 1998, pet. denied) (citing Young v. Massey, 128 Tex. 638, 101 S.W.2d 809, 810 (1937)). “The doctrine of ‘new and independent cause’ is not an affirmative defense; it is one element to be considered by a fact finder in determining whether proximate cause exists.” Dallas Ry. & Terminal Co. v. Bailey, 151 Tex. 359, 250 S.W.2d 379, 383 (1952); Hall v. Huff, 957 S.W.2d 90, 96 (Tex.App.-Texarkana 1997, pet. denied). Defendants’ Response To Plaintiff’s No Evidence Motion For Summary Judgment – Page 4 To establish a claim of negligence, Plaintiffs must show Defendants’ action was a proximate cause of the damages complained of. First Assembly of God, Inc. v. Texas Utilities Elec. Co., 52 S.W.3d 482, 491 (Tex. App.—Dallas 2001, no pet.); El Chico Corp. v. Poole, 732 S.W.2d 306, 311 (Tex.1987). Asserting a new and independent cause defense allows the fact finder to determine if the intervening act brought about harm different from what would otherwise have resulted. Dew v. Crown Derrick Erectors, Inc., 208 S.W.3d, 448, 451-52 n.3 (Tex. 2006). This defense is plainly not an affirmative defense upon which the Defendants bear the burden of proof. In the alternative, if this Court decides Defendants’ asserted defense of superseding or new and intervening causes should be classified as an affirmative defense, Defendant has produced competent summary judgment evidence sufficient to raise a fact issue. Specifically, the investigator’s report from the Tarrant County Medical Examiner’s Office indicates “no trauma or foul play associated with this case per Jennifer Clark, RN.” See Exh. A. Further, several comorbidities were listed in the medical history portion of the report, and the death event was described as “cardiac arrest during an emergency tracheotomy performed in response to developing subcutaneous emphysema.” Id. at 3. There is no mention of medical negligence, an ill-advised procedure, or any activity requiring further investigation. See id. This case revolves around an intubation procedure; Plaintiffs allege Defendants negligently perforated Kiowana Haynes’ trachea with an endotracheal tube just below her vocal cords, resulting in death. Dr. Neal Gerstein, Plaintiffs’ causation expert, testified that if the tube did not reach past Ms. Haynes’ vocal cords, the endotracheal tubes could not Defendants’ Response To Plaintiff’s No Evidence Motion For Summary Judgment – Page 5 have caused her injury. See Exh. B, p. 82. Defendant Brian Birmingham, the CRNA who attempted the initial intubation, testified that he could not get a No. 6 tube to go past the vocal cords. Exh. C, P. 70 L. 25 – 71 L. 6. Dr. Lenz, the Anesthesiologist, testified Ms. Haynes started to desaturate with oxygen during the initial attempt at intubation, and before any endotracheal tube ever reached below the vocal cords. Exh. D, P. 89 L. 12 – P. 92 L. 15. Dr. Lenz also testified that he does not believe her trachea was perforated at that time. See id. Dr. Lenz went on to testify the No. 7 tube was also used, but it never got past the vocal cords. Exh. D, P. 97 L. 4 – P. 103 L. 21. Dr. Lenz also testified he does not believe a No. 8 tube was used. Id. Therefore, taking Dr. Lenz’s testimony with Brian Birmingham and Dr. Gerstein’s testimony, there are significant fact issues for the jury to determine, which competent summary judgment evidence has been supplied to demonstrate. B. Unavoidable and Unforeseeable Causes Generally, the defense of unavoidable accident, also called unforeseeable causes, is used by a defendant to attack the causal effect of some physical condition or circumstance such as fog, snow, sleet, wet or slick pavement, or obstruction of view. Reinhart v. Young, 906 S.W.2d 471, 472 (Tex.1995). In medical malpractice litigation, an unavoidable accident “is an event not proximately caused by the negligence of any party to it.” Id. (quoting Dallas Ry. & Terminal Co. v. Bailey, 151 Tex. 359, 250 S.W.2d 379, 385 (1952)); Young v. Thota, 271 S.W.3d 822, 836–37 (Tex.App.-Fort Worth 2008, pet. denied). Chesser v. LifeCare Mgmt. Services, L.L.C., 356 S.W.3d 613, 635 (Tex. App.—Fort Worth 2011, pet. denied). Defendants’ Response To Plaintiff’s No Evidence Motion For Summary Judgment – Page 6 In both contexts, an unavoidable accident defense “is not an alternative theory of liability but is an inferential rebuttal issue that requires plaintiffs to prove the nonexistence” of the defense. Lemos v. Montez, 680 S.W.2d 798, 800 (Tex.1984), Specifically, this inferential rebuttal “seeks to disprove the existence of an essential element submitted in another issue,” Select Ins. Co. v. Boucher, 561 S.W.2d 474, 477 (Tex.1978). Bed, Bath & Beyond, Inc. v. Urista, 211 S.W.3d 753, 756 (Tex. 2006). Simply stated, this defense is an attack on the proximate cause element of negligence; it is not an affirmative defense which Defendants bear the burden on. In the alternative, if this Court decides this defense should be treated as an affirmative defense, Defendants have produced competent summary judgment evidence to raise a fact issue. Specifically, the medical examiner report and the deposition testimony, together and separately, tend to demonstrate Plaintiff’s injury was not proximately caused by the negligence of any actor made a part of this case, but instead, an unexpected and unforeseeable reaction to intubation. See Exh. A, B, C, D. C. Preexisting Conditions Defendants pleaded that any injuries or damages complained of by Plaintiffs are the result of preexisting or subsequently occurring conditions. Again, that defensive theory is an inferential rebuttal, not an affirmative defense. In re Nance, 143 S.W.3d 506, 512–13 (Tex. App.—Austin 2004, no pet.) (citing R.K. v. Ramirez, 887 S.W.2d 836, 843 (Tex.1994); see also Tex. R. Civ. P. 277. Furthermore, there is ample evidence that Plaintiff had tracheal stenosis, a narrowing of the trachea, asthma, right lower lobe infiltrate, diabetes, hypertension, morbid obesity. Exh. B, p. 10-11; Exh. E. Defendants merely assert Defendants’ Response To Plaintiff’s No Evidence Motion For Summary Judgment – Page 7 these conditions contributed to or caused Plaintiffs’ damages. This defense is an attack on the proximate cause element of negligence, not an affirmative defense upon which the Defendants bear the burden. WHEREFORE, PREMISES CONSIDERED, Defendants pray the Court deny Plaintiffs’ No Evidence Motion for Summary Judgment. Defendants pray for such other and further relief, either at law or in equity, to which Defendants may be justly entitled. Respectfully submitted, CHAMBLEE RYAN, P.C. By: /s/ Douglas R. Lewis William H. Chamblee wchamblee@cr.law State Bar No. 04086100 Douglas R. Lewis dlewis@cr.law State Bar No. 12275800 2777 Stemmons Freeway, Suite 1157 Dallas, Texas 75207 (214) 905-2003 (214) 905-1213 (Facsimile) ATTORNEYS FOR DEFENDANTS Brian Birmingham, CRNA, Adam Lenz, M.D. and Northstar Anesthesia, P.A. Defendants’ Response To Plaintiff’s No Evidence Motion For Summary Judgment – Page 8 CERTIFICATE OF SERVICE I do hereby certify that on September 11, 2017 a true and correct copy of the above and foregoing document has been served via the court’s efiling/eservice system to all counsel of record. /s/ Douglas R. Lewis Douglas R. Lewis Defendants’ Response To Plaintiff’s No Evidence Motion For Summary Judgment – Page 9 EXHIBIT "A" .,.,,..···· · TARRANtCOUNTY MEDICALEXAMINER'S DISTRICT SERVINGTARRANT,.PARKER, & DENTON COUNTIES Investigator's Report CASE.Jf! 11.01911 Tarrant" TYPE: Jurisdiction lDENTITY: identi:i1ed· :N}ZAM J>EER WAN!, M.D. ;MICHAEL PLO\'i) . CHIEF MEOICAL EXAMINER CHIEFFORENS1¢DEAt1-1·rNvE$'ndATOR DEQE,ASED: ki~waria Hayrid. ADDIU!SS; 190 I Park Place Blvd:, #:110, Bedford; Texas 7602 l AGE: 33' .!31RT1_:I PATE: 10/23(1977 MARITAL STATUS: Siugfo Pf{QNE;.(682)367~2238 RACE ORCOLOR: Black SEX:,F· ~EI.GHT: WEIGHT: SSN :. 466-4 5a3 613· MANNER OF DRESS: l , OCCU.flATJON: :i ") PLACE OF EMPLOYEMENT: '. DATE.OF DEATH: 2/11/20.1 i TIME OF DEATH: 14:05 PLACE OF DEATH DESCRIPT.iON: 'Bayior All Saints Medical Cc~ter ADDRESS OF DEATH: 1400 8th Av~nue, Fort Worth, Texas 76104 . HOSPITALIZED: Yes . ADMITDATE:-2110/201 L ADM1TTIME: 18:0S ENVIRONMENi:' CONDITION: HYAC controlled· CHARACTERISTIC OF PREMISES: ICU . DATE/TIME M.E. NOTIFIED: 2/ 11/2011 14:32. ARRJ\TE.D: il JZEPORTTNG PERSON:-·.iennifer Clark, -R.:N. l ! REPORTING AGENCY: Baylor All Saints Medical CeJ;1ler J ADDRESS: 1400 .8th Avenue, Fol't\Vorth,. Texas 7(';·104: 'i .PHONE: (817)922-7301 . . PRONOUNCED DEAD DY: Dr. folln Burk PRONOUNCING AGENCY: Baylor All Saints Medical Center LAST TREATED BY: br. John Burk i DATErrIME OF OCCURENCE; 2/11/2011 INJURY AT WORK: NO- 13:00 -PLACE OF OCCUR.ENCE: Baylor AH Saints Medical Center;. Surgery Suite i LOCATION: 1400 8th Avenue, Fort Worth, Texas 76104 r. !: TRAUMA RELATED: No I IDENTIFIED BY: ·Brittany Dodson i !,. IDENTIFICATION TYPE: Viouul DA:rE/TJME OF IDENTIFICATION: 2/1 J/201l ~Time: 14:32 IDENTIFICATION STATUS: Positive ID COMMENTS: Decedent identified positively to 13. Dodson.by Jennifer Clnrk,J.N. :ADDRESS: JlHONE: NEXT .OF KIN NOTIFICATI.QN ·DATEffiME:-2/11/2011 J$:OO NOTIFIED BY: Di. Burk' .N OTIFYING AGENCY: Baylor AU Saints Hospita l NEXT OF KrN NAME: Debra·Hanis RELA TIONSHJP: Mother COMMEN1:S: ADDRESS: 190 I Park Place Blvd., # 110, 'Bedford, 76021 Texas PHONE: (682)367-2238 BODY TO:·Ta1Tai1t C0tinty Medical Examiner's -Office . CONVEYANCE: 2/15/201 1 Page I TARRANT COUNTY MEDICAL EXAMINER'S DISTRICT SE:RVING TARRANT, PARKER, & DENTON COUNTIES. Investigator's Report. GA$E-fl:: I 101911 Tan:anl TYPE: Jut'j~diction IDENTlT.Y :.Identified NIZAM PEERWANI, M.D. MICHAEL FLOYD CHIEF MEDICAL EXAMINER CHIEF FORENSIC DEATiflNVESTIGATOR. .FUNERAL HOME: Unknown NAME.OFRELEASlNG AUTHORITY: RELATIONSHIP: DISPOSITION OF PROPER'fY: MEDfCAL INVESTJGATOR:. Micli~e1'r-:1oyd . . .. 2/LS/2011 Page -2: TARRANT COUNTY MEDICAL t:X'Al\1INER!S DISTRICT. SERVING TARRANT; l:'AlUillR, & DENl'ON COUNTiES lNVES1JGAT0R'~.REPOR'.f .!. NIZAM PEERWANI~ MD. MIC}IABL FLOYD S!'II~f MEDiCAL EXAMfNER CHIEF:-FORENSIC DEATH INVESTfGATOR .. · . Case Nimiber:. UQ.J91 t Case type: Jµrisdittion ,, ' DECEDENT'S.NAME: Kiowana Hayoes AGE:33 ADDRESS: 1901 ParkPlace Blvd'., #1 IO, .Bedford,Texas 76021 BIRTH DATE: 1.0/23/1977 MARITALSTATUS: Single PHONE: (6.~_2)~67-223'8 CASE'NO. ll0.l9l.1 Tarr~nt .j: The ;dec~dent;a ).3-year-old Biatk female:with. a repor,ted medical ·'1isto1y cr(tracneal steriosfa; ,asthma, rtgbt: .towet; Jdbe -infiltrate; thyroidectomy, diabetes, ·hypertension, and morbid obysity, becan:i.e unre,spc;ms,iv,e.dui:jng f1.n e11do$cppic pro~edure and, subsequently, developed pulseless cardiac electdcal.actlv'ity and subcutai:1eous' emphysema. . . . DESCRIPTION OF BODY: The decedent is not viewed as the remains are not present at the morgue prior to the completforr·ofthfa 0 inycstigat.i.v.SY REPORT : N~me: Kiowana Haynes CA$E NO.; 11.019.11 '.~ i. :Approximate Age:, 33 Yeats Sex: Female. i" ,· . Heigf:,f: 6Q~S }nche.s Welgh't: 249.t Pc,(fntjs ' l her~by certify that on the 16~h day of February 2011, beginning. at ·10:15 .hours;,··. :1,, :.GaryL ·Sisler, D.O., ptirsuant to Statute 49.25 of Texas Criminai .Cog_e, . performed a complete autopsy on the body of Kiowana Haynes at th't3TE1t(ant · .county Mecfical Examiner's 'District Morgue in Fort, ·worth. Texas: :and ,upon ·Jnvestrgation :ofthe essentiaf fc3cts·concerning the. circumstances of the death and ·history: of .tfJe case ~-s known to rne, I am of the qpinion thatthe findings, ·qa4se · .:a hd. manner . of death . . are as. follows: '.FiNDINGS: I) Admitted to local h.ospjtal with history of Worsening respiratory distress· oy~r. • a five .d ay period of time with suspected rec~t ren'c e ·pf a '.trJ~ch.~.i;IJ_$J~no~i~ :· ·. and, admitted for surgical' correction and· expired approximate_fy· twenty hours: after admission II) Perforation of trachea with subcutaneous emphysema of faqe; ·neck; : shoulders, arms, and hands Tracheal stenosis with erythema an;cl eo~rna of vocal. cords I fl:) . IV) Pulmonary congestion and edema; marked·, with collapse of left lung · V) Status· po~t operative procedures.: · ;;i)Tracheostomy b) .Place.ment of left chest tube Jn the. ieft. breast and right che ·. into ri ht leural .cavi · - · Pa,ge:2. qf 6 ,. Kiowana Haynes . ;!. :, i !C.AU_ Sf= OF DEATH: PERFORATION OF TRACHEA '!MANNER OF DEATH: ACCIDENT . Ii ; .• " ::. •:, Gary L.Sisl.~r.;.O. Q.~ ,;. Deputy :Medical.Examiner 'i :; ,:, ; ll'! i j. :! .! •i i :1 I i. A complete autopsy .is carried out at the.Tarrant County Medical Extiirliner·~ Morgue. L CLOTHING AND PERSONAL EFFECTS: The. body is present~d 'tothe Morgue wrapped in a white sheet and cream-colored blanket and clad in: 1.i Hospital gown II. THERAPEUTIC INTERVENTION: 1. Trache9stomy located 1o inches ·below the. .top of the head over the m(tjline of the anterior nec::k with two· hemo·sta~s. l_ ocated aiong the right margin, and contains a #6 endotracheal tube. The length is 1 inch. '2. IV lln·e entering the left arm region. ·3·_ Left and .right chest tubes 4. One ·gastric tube ;. Ill,. EXTERNAL BODY D.ESCRIPTION: The ·body J~' ,that of ·a :norni~l!Y: developed African American female appearing the -stated age of :33 years with. a: , body 1~·ngth of 66:5 inches and body weighto't 249.2 pounds·. The body presents, large. buiid with average nutriti_on, normal hydrc;ltion, ar.id good presetv~ti9n .. Rigor mortis is fading, and llvidity is developed over the po~terio_r region qf 'the body. The body is cold to touch post refrigeration. The head i.s co.ver~d .byshort ( .wavy black hair with a non-receding. hairline.. There is average body .hair of 1; ~ female pattern distribution. There is subcutaneous: emphysema of the face~ s.ho~.tlcfers, neck, arriJ.f,,and hands. The: eyes.:a.re closed with clear lbuibanmd .,L . palpebral conjunctivae. Trie lrioes are brown with white.sclerci~,. T'1¢i'e:" ;~re no ' :,'! ,j cataracts. or a.rcus pre.sent. Pupils are.equal at5 mm. The orbits appear normal,. j =i The nasal cavities are unremarkable. with intact septum. The oral ca.vity presents; ,! natural teeth with good oral hygiene. ·The .ears are unremarkable wlth .no. .,j :i her:norrhage ·in the external auditory canai. Ears ar.e. pierqed x t...th~ 11eck·is .,., supple. and palpation non--reveali.ng, The chest .is symmetric and presents We.II. ] ) . formed and well preseNed medium breasts without · palpable :masses.. The 'I abdomen is·moderately protuberant .and _palpation nbn-revealing . I i I l 1 7 Page 4 of!3 l i The upper and.lower extremities are equal and symmetrical presenJihg c;yanoli,c; ·i, . n~.ii' .!)eds w_ ithout clubbing or edemi:l. There are no: . ·fractures, . injuries, f. q~fotm.iii.e~. or amputations present. .External. genitalia are tho$e: of an 'adult i: l: female.with. intact.vulva and vagina.. The back reveals depentjer,_ t ,fi\/idJtY With I . i. cdrifacf ·pallor: The butto¢k$ are attaur,nat,c,. ·and ·tlie anus is intact Th.e iiit~g1..1mentis: of normal color. ! i· ;·' . IV~ INTERNAL.EXAMINATION ! i 1.-, INTEGUMENT: A Y-shaped thorac.oabdominal incision is made and the· I· I .orgqns are examined in-situ and eviscerated in the usuai fashion.,. The i. subcutaneous· fat is normally distribLJted, moist, and bright y~How. The ): j! JhtJSGUJature of the .chest and abdominal.area is·of normal color and texture:. i ·2. SEROUS CAVITIES: The chest wall .is· :intact without rib~ sternai, or clavlcular fractures. The pleura :and pe(itoneum· ar~ ~ong_esteq, smoqth _glist~ning, a!1d essenti.a.lly dry, devoid of adhesions or effusion,, There is no scoiit>sis., kyphosis, or·l.ordo.sis present, The left-and .rlgbt diaphragms ,are .l.n their norr.n~I location and appear grossly unremarkable. The pericardia! sac is ·1ntacti ·smooth., glistening and contains normal amounts>of serous flUid. 3., CARDIOVASCULAR SYSTEM: The heart weighs 312 gms and. there Js · no ct,amber hypertrophy or dilatation. The left ventricular wall is 1 cm and..°the · right 0.4 cm. The cardiac valves appear unremarkable.. The coronary ostia are· 'in the normal anatomical location leading into widely· pat~nt c9rOnary :acted~~. Hight dominant circulation· is present. The endocardial -surface .is smo,oth without thrombi or ,inflammation. Sectioning of the myocardium, presents no ,gross evid~nce·.of ischemic changes either. of recent or. remote origin. The aortic arch along with. the great vessels appears :grossly unremarkable. it PULMONARY SYSTEM: The heck. presents an intact hyoid bone as well a$ thyroict i:l[ld cticoid cartHages. The.vocal cords are edematous with erytherna. The epiglottis is edematous and is a characteristic plate-like structure· without tr:auma or pathological lesions. Both the musculature and the. vasculature. of the anterior neck are unremarkable. There is a tracheal .stenosis. 5 cm b·(?toW the vocal, cords. There is a tracheal stenosis 5 Gm be.low the vocal cords. Usihg kriown diameter plastic tubing as, a gauge, the stenotic,region measured 1.1 mm in- diameter and the trachea above and below· the: stenosis measured 19. mm 1n diameter. Directly opposite· the stenosis IS a2 cm x 2 ,drn p~rf9r.atid11 .bf the posferioY Wall of the trachea; .···---•.. ;!/;$£.~~. 1:101911 'Kiowana HayhJis The. left lung weighs 366 gnis and is coliapsed;. with the right -lung weighing 1035: .Qms. Both the lungs .appear moderately to severely cong,ested and. ed¢mqto:us.. There are no gross pneumonic lesions or abnormcll trJq$~~~ identified. The .Pulmonary arterial system is int~ct and grossly .unremarkable. The pleural ·surfaces are pink and smooth with focal mild: anthracosis. 5. GASTROINTESTINAL SYSTEM: The esophagus is·· inta.Gt with n.ormal gastroesophagea·1junction~ and without. erosi9ns or vari¢es .. The -stoinachis:aiso normal wHbout gq$trlti$ ·or ulcers, and. the stomach is· devoid of-food partlcl~s, Loops of small and large bowel appear grossly unremarkable.: Th.e cipper,_dix is ,unremarkable. · The liver weighs 1383 gms presenting a brown smooth~glistening surfa~e. 01'1 se.clioning; the hepatic parenchyma is red~brown and cot1ge$ted! The gc1UbJadder·is absent. The biliary tree is patent. . The pancn:~as weighs '161 gms· and presents a lobulated yellow cut surface. · · . 6. GENITOURINARY SYSTEM: The left kidney weighs 134 gms; .and· Joe right ki.c:iney weighs 130 gms. On sectioning, the 9qrtex prE?serjts la norn:ial thickness ·above the· medulla. The renaf :column.s of Bertin e:xtend' between, the· well-demarcated pyramids and appear unr~markable. The medulla. presents normal renal pyrc1rnids with unremarkable papillae. The pelvis .is of normaf,~,z~ ;:1nd' lih~d by gray glistening mucosa. There. are no CalcylL Renpi art~ri~~ ah,i;:f veins , .are normal. · The ureter$ .are of normal caliber lying in their course within the .retroperitoneum and •drainin~ into an unremarkable urinary bladder containing 30 mL .of~rine. External g·enitalia are those of an adult female witl1 -intact vuhra arid.;yagina. The· uterus, cervix, fallopian tubes, and ovaries are unremarkable. 7.. HEMATOPOIETIC SYSTEM: The spleen weighs 216 :gms,. presenting ·a :gray-pink intact capsule and a dark red parenchyr;na.. There :js ho Jymphadenopathy. The thymus giand is invoiute,d. 8. ENDOCRINE· SYSTEM: Thyroid gland is surgically absent.. The adrena·I ,glqqds are. .of normal size and · shape and· sectioning present. no gtoss pathological lesions, , . .. ·· ,- , Page q o,f 6 9. :CENTRAL NERVOUS SYSTEM: -A sc~Jp it')cisJon, craniotomy, :a.nd evacuation;of . -·. .. the brain are carded . . outin . ·- . the usual . . fashion . ttie ,$dalp ·:is intact without contusions or laceratio_11s, Th!3' ca·lvclriuil:ijs likewise. ihtactwithout bony abnormalities or fractures. The- br?in weighs 11°80 gms presenting moderate congesti9n ,of ·-tt.113 lept9.r.n:eninge_s·. · Overlying dura ·1s intact _ and unte.mi:itkal:>le. ·Cerebral ; hemispheres reveal a riormal gyral paJt~rn With m.ocfer~te, to severe. .global ·edema. The brainstem $nd cetebelli are normal' ih appearance with no .evidence. o( -cerebeilar tonsillar notching. The Circle ·of Willis- 1s patE?t,t;. pr.$sen.ting JJQ. evidence·of thrombosis or berry aneurysm. 011 coronal -:sectioniqg_:of the brain_, the: ventricular system is symmetrical aoc:f contains. clear cerebrospinat fluid :· rhere are no space occupyfng·. 1esions present. Spinal cord ts not examined~ · 1. 30 ml bfaortic blood, 15 rnL ofsubclavian blood, 30 ml ofutine and 5:mL of vitreous for possible further examination '. 2. Representative tissue sections in formalin.for pos$ible further examin~tion 3. Blood.card ·4. Representative photographs :EDC: 3/15/11 Dictated: 3/1/11 Transcribed: 3/4/11 Completed: 3/4/.11 GLS::caa M$3 I REV. 7/06. 0. ~"..; of Chief Medical E 1n..._..1er Tarrant, Denton and Parker Counties, Te~as 200 Feliks Gwozdz Place, Fort. Worth, Texas 76104-:4919 • (817)'920°5700 · ., ME-l!IA GP.C-l9Sj Rev. 7/06. 0~ i~'"' of Chief fytedjcal L_..am . .....ter Tarrant, Denton and. Parker Counties., Texas 20_9-feliks ~wozdz Place, Fort Worth, Texas 76104-4919 .:.- ~17) 9.20-5700 ·Examine1:: lJ(. S~ k°"'°', Autop$y No. / I/ 0 12 {) J ·rur· C ):. ...... MEDICAL ABSTRACT OF .DEATH CERTIFICATE STATE·OF TExAS STATE·F_ILE NUMBER ENTER:NAME OF DECEASED AND PLACE OF DEATH EXACTLY AS SHOWN ON THE ORIGINAL DEATH CERTIFICATE ' ! . ~EOAL·NAt.lE Of OECEASW (lnctude N'.A's, 11 ony) (F~sl, Mlodl•, Lasl) OATE"OF DEATH .· KI.OYIJANA ROSHANDA HAYNES ·~211112011 PLACE OF OEATH(CITYOR.TOl'IW AND COUNTY) IS THE 01\TE Of