On September 12, 2016 a
Motion,Ex Parte
was filed
involving a dispute between
Cheryl Kausner,
Thomas Kausner,
and
Andrew Cappuccino M.D.,
Buffalo Spine Surgery, Pllc,
Eastern Niagara Hospital, Inc.,
Eastern Niagara Radiology And Nuclear Medicine Associates Pc,
Eric Dean Rpa-C,
Harnath B. Clerk M.D.,
Harnath B. Clerk, M.D., P.C.,
Robert E. Lutnick M.D.,
for Torts - Medical, Dental, or Podiatrist Malpractice
in the District Court of Niagara County.
Preview
FILED: NIAGARA COUNTY CLERK 09/10/2020 12:37 PM INDEX NO. E159518/2016
NYSCEF DOC. NO. 136 RECEIVED NYSCEF: 09/10/2020
Exhibit A
FILED: NIAGARA COUNTY CLERK 09/10/2020 12:37 PM INDEX NO. E159518/2016
NYSCEF DOC. NO. 136 RECEIVED NYSCEF: 09/10/2020
#5
Eastern Niagara Hosphal em
O Lockport D Newfans no I
US Lackpost, NY 140s4
East Ave, 2e00 WNam NY 1410s
et, Newisne, M.aGML B
: 9EIeLZTA
Physician's Order Sheet
anc ner mans esous.n=•posiasweeiv•Imm.
• wansepenevessessenseegnei•
ALLERGIES:
Weight
DO NOT USE THERE UNSAFE BREVIATIONS:
"U" "IU" "Ug" "QD" OD"
seenesse AND should be unit, should be mog, shouM be dei¾ "Q shouM be every
W•lght "OD"
other day, "AU", "A5", AD", "OU", "08", and simuM be wrilton out in full.Conect Use of
and Zeme - Always Never A shouM be 0A and 19 should bei
Leading Trailing Leading Tralling
emes Time
O Reglan 10 mg IV x 1
O Zetan 4 mg N x 1
O Compezine 10 mg N x 1
O Decedron 4 mg N x 1
For Allergic Reactions:
O Benedryl 26 mg N- may repeat in 30 minutes W needed
O Epinephrine 0.1 mg eq for severe ellergicreactions
For Wheezing:
O Albuterol breathing treatment
O Xpperlex tNaseling treatment
a O Duoneb tireathingtreatment
For Lavyngoopaem:
O VaponeMn tweathing teetment
For Posteparadve Pain:
O Morphine Sulfate my
N- repeat in30 minutes IIneeded forpain
may
O Morphina Sulfate IM - repeat In 30 minutes If needed forpain
mg may
O Demerol IV - repeat in 30 minutes ifneeded forpoin
mg may
O Demerol lM - repeat in30 minutes if needed forpain
ing may
O Dilaudid N- may repeat in30 minulso if needed forpain
mg
O DIaudid IM - repeat in 30 minutes If needed forpain
mg may
For Pulmonary Edoma;
O Leeix 80 mg N
O Or 6 W "
O semiding position
O CeB anestheela
P icianSignature
4 P.
FILED: NIAGARA COUNTY CLERK 09/10/2020 12:37 PM INDEX NO. E159518/2016
NYSCEF DOC. NO. 136 RECEIVED NYSCEF: 09/10/2020
45 """ 3 ' ma"
Eastem Niagara Hospital
O Lookport D Newfene
s21 Eat Aue, Le pon, NT 140s4 2s00 WHem NY 14tdB
st, Naseqe, g,egg, g
eElm.2IA
Physician's Order Sheet
anuaremed esas mempounner equneies,
4 Amyb9 asyneed emen chagkgf hpm
ALLERGIES:,
DO
W
NDT UaE THI SE UNSAFE ABBREVIATIONS:
"u" "Ug" "QDP "QDDP
names AND shouM to Unt, sham be meg, shouM be dedy, sham tm overy
weium- oeur day, "AU", "A8", "AD", "0U", "OS", end
"0D"
shouM be waten out in fulL Conect Use of
and Zeros -Alesys Never .1should be 0.1 end 1.0 shouM be1
Leading Trolling Leading TraiRng
cateItone
or Post-operative naub•e and vomitine:
O 10 mg N x 1
O 4 mg N x 1
D Compezine 10 mg N x 1
O Decadron 4 mg N x1
For Algergic Reacdons:
O Bimedryl 25 N- repeat In 30minulsoWneeded
mg may
O Epinephrine0.1 mg eq forsevere eAergic reactions
For Wheeming:
O Aibuteral breathing treatment
O Xopenex breathing treatment
me O Duoneb breathing treatment
For Laryngeopaem:
Oveponeatn excoming neeament
I For Post-operative Poin:
O Morphine Sulfate mg
N- repeat in30 minupup ifneeded for pain
may
O Morphine Sulfate lM - repeat In30 minutes if needed forpain
mg may
‰• O Demerol my
N- may sepeat In30 mieules IIneed9d forpain
O Domeml mg IM-may repeat in30 minutet Wneoped forpain
O Dileudld mg W- may tapest in80 minutes If needed forpain
O Di id m ·lM-me re 30 minutes if Ibr in
For Pu 6 :
O Leeix 80 mg IV
O Obtain Cheet x-ray stat
O Conliec estymes
O Or 6 IAA
O gemi-siting poemon
O
..
--., signeime
FAT1UUCH,HANY, MD on 10/10/16
at 1114
new OtMle drenlemmeonhanestheelepostop
de
FILED: NIAGARA COUNTY CLERK 09/10/2020 12:37 PM INDEX NO. E159518/2016
NYSCEF DOC. NO. 136 RECEIVED NYSCEF: 09/10/2020
r MO9898
g9/o1f lb LWOBFEpl il
EasternNiagaraHospital Io.ee
ÓLockport
521 East Avgf,Locilport, NY 14094
Post Anesthesia Recovery Record
ALLERGES O None . List:.
Weight;
Date: Antual Time: / 4f / Surgeon: . .,-,vo
Anselhfit . . t*J480 pAQ 34D4 CRNA Anesthetic Technique: D Local
aivunc a seD oEpmmes Ospinal aRegionai Type: .
Pergnent PmAnta Operative Information: o - >
B2
EYAntlembolIern Slocidnge C$8CD Stockinge on Temp on
Opensive Sile (description): &Dry BiertleDressing D Pacidng Adheelve O Other.
O Wet to
Dry O Locallon:8.†t... O NfA
INTAKE OUTPUT
CrystalloMs: alood PeoducIa: UWne: other'
D Mn a Nans
gi a ,g AORTolph ORTolub
PAcU
a. a serpeninsposeniandonsumum
O cv Line:
'''' olher: T-Tube:-
ArlfLIns: NG
o NIA PAOU Toink • o NIA PACV TsInt
. a
TolmIPACU r OR Intelies TagalPAGU f onoutput:
EPID O Filler
On O Label On D Cap On Check OK Solutior¾Rain
O continuous O Intermillent a See PeInFIcur sheet
E5ect Legend-
aicra Analgesic (A.N.A. E5ect)
z 0- Poor or No Efract 2 - Moderate Effect NfA = Not Applicable If App=lf Applicable
O 1- MildEAnot 3 - Effective init= Initials
164 Signature De RN Signature Date
IIAIIIAME
PARR
Rev MIB. 08/t4 Page 1 of 4 omfecNecoverygucan1
Document Filed Date
September 10, 2020
Case Filing Date
September 12, 2016
Category
Torts - Medical, Dental, or Podiatrist Malpractice
Status
Disposed-Court Date/Application Pending
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Preview
FILED: NIAGARA COUNTY CLERK 09/10/2020 12:37 PM INDEX NO. E159518/2016 NYSCEF DOC. NO. 136 RECEIVED NYSCEF: 09/10/2020 Exhibit A FILED: NIAGARA COUNTY CLERK 09/10/2020 12:37 PM INDEX NO. E159518/2016 NYSCEF DOC. NO. 136 RECEIVED NYSCEF: 09/10/2020 #5 Eastern Niagara Hosphal em O Lockport D Newfans no I US Lackpost, NY 140s4 East Ave, 2e00 WNam NY 1410s et, Newisne, M.aGML B : 9EIeLZTA Physician's Order Sheet anc ner mans esous.n=•posiasweeiv•Imm. • wansepenevessessenseegnei• ALLERGIES: Weight DO NOT USE THERE UNSAFE BREVIATIONS: "U" "IU" "Ug" "QD" OD" seenesse AND should be unit, should be mog, shouM be dei¾ "Q shouM be every W•lght "OD" other day, "AU", "A5", AD", "OU", "08", and simuM be wrilton out in full.Conect Use of and Zeme - Always Never A shouM be 0A and 19 should bei Leading Trailing Leading Tralling emes Time O Reglan 10 mg IV x 1 O Zetan 4 mg N x 1 O Compezine 10 mg N x 1 O Decedron 4 mg N x 1 For Allergic Reactions: O Benedryl 26 mg N- may repeat in 30 minutes W needed O Epinephrine 0.1 mg eq for severe ellergicreactions For Wheezing: O Albuterol breathing treatment O Xpperlex tNaseling treatment a O Duoneb tireathingtreatment For Lavyngoopaem: O VaponeMn tweathing teetment For Posteparadve Pain: O Morphine Sulfate my N- repeat in30 minutes IIneeded forpain may O Morphina Sulfate IM - repeat In 30 minutes If needed forpain mg may O Demerol IV - repeat in 30 minutes ifneeded forpoin mg may O Demerol lM - repeat in30 minutes if needed forpain ing may O Dilaudid N- may repeat in30 minulso if needed forpain mg O DIaudid IM - repeat in 30 minutes If needed forpain mg may For Pulmonary Edoma; O Leeix 80 mg N O Or 6 W " O semiding position O CeB anestheela P icianSignature 4 P. FILED: NIAGARA COUNTY CLERK 09/10/2020 12:37 PM INDEX NO. E159518/2016 NYSCEF DOC. NO. 136 RECEIVED NYSCEF: 09/10/2020 45 """ 3 ' ma" Eastem Niagara Hospital O Lookport D Newfene s21 Eat Aue, Le pon, NT 140s4 2s00 WHem NY 14tdB st, Naseqe, g,egg, g eElm.2IA Physician's Order Sheet anuaremed esas mempounner equneies, 4 Amyb9 asyneed emen chagkgf hpm ALLERGIES:, DO W NDT UaE THI SE UNSAFE ABBREVIATIONS: "u" "Ug" "QDP "QDDP names AND shouM to Unt, sham be meg, shouM be dedy, sham tm overy weium- oeur day, "AU", "A8", "AD", "0U", "OS", end "0D" shouM be waten out in fulL Conect Use of and Zeros -Alesys Never .1should be 0.1 end 1.0 shouM be1 Leading Trolling Leading TraiRng cateItone or Post-operative naub•e and vomitine: O 10 mg N x 1 O 4 mg N x 1 D Compezine 10 mg N x 1 O Decadron 4 mg N x1 For Algergic Reacdons: O Bimedryl 25 N- repeat In 30minulsoWneeded mg may O Epinephrine0.1 mg eq forsevere eAergic reactions For Wheeming: O Aibuteral breathing treatment O Xopenex breathing treatment me O Duoneb breathing treatment For Laryngeopaem: Oveponeatn excoming neeament I For Post-operative Poin: O Morphine Sulfate mg N- repeat in30 minupup ifneeded for pain may O Morphine Sulfate lM - repeat In30 minutes if needed forpain mg may ‰• O Demerol my N- may sepeat In30 mieules IIneed9d forpain O Domeml mg IM-may repeat in30 minutet Wneoped forpain O Dileudld mg W- may tapest in80 minutes If needed forpain O Di id m ·lM-me re 30 minutes if Ibr in For Pu 6 : O Leeix 80 mg IV O Obtain Cheet x-ray stat O Conliec estymes O Or 6 IAA O gemi-siting poemon O .. --., signeime FAT1UUCH,HANY, MD on 10/10/16 at 1114 new OtMle drenlemmeonhanestheelepostop de FILED: NIAGARA COUNTY CLERK 09/10/2020 12:37 PM INDEX NO. E159518/2016 NYSCEF DOC. NO. 136 RECEIVED NYSCEF: 09/10/2020 r MO9898 g9/o1f lb LWOBFEpl il EasternNiagaraHospital Io.ee ÓLockport 521 East Avgf,Locilport, NY 14094 Post Anesthesia Recovery Record ALLERGES O None . List:. Weight; Date: Antual Time: / 4f / Surgeon: . .,-,vo Anselhfit . . t*J480 pAQ 34D4 CRNA Anesthetic Technique: D Local aivunc a seD oEpmmes Ospinal aRegionai Type: . Pergnent PmAnta Operative Information: o - > B2 EYAntlembolIern Slocidnge C$8CD Stockinge on Temp on Opensive Sile (description): &Dry BiertleDressing D Pacidng Adheelve O Other. O Wet to Dry O Locallon:8.†t... O NfA INTAKE OUTPUT CrystalloMs: alood PeoducIa: UWne: other' D Mn a Nans gi a ,g AORTolph ORTolub PAcU a. a serpeninsposeniandonsumum O cv Line: '''' olher: T-Tube:- ArlfLIns: NG o NIA PAOU Toink • o NIA PACV TsInt . a TolmIPACU r OR Intelies TagalPAGU f onoutput: EPID O Filler On O Label On D Cap On Check OK Solutior¾Rain O continuous O Intermillent a See PeInFIcur sheet E5ect Legend- aicra Analgesic (A.N.A. E5ect) z 0- Poor or No Efract 2 - Moderate Effect NfA = Not Applicable If App=lf Applicable O 1- MildEAnot 3 - Effective init= Initials 164 Signature De RN Signature Date IIAIIIAME PARR Rev MIB. 08/t4 Page 1 of 4 omfecNecoverygucan1