Preview
Filing # 142904831 E-Filed 01/28/2022 07:20:00 PM
IN THE CIRCUIT COURT OF THE 19TH
JUDICIAL CIRCUIT IN AND FOR
MARTIN COUNTY, FLORIDA
FREDERIC CHARLES GREER III
and MELISSA ANNE GREER, as
Husband and Wife, and FREDERIC
CHARLES GREER III and MELISSA
ANNE GREER, individually,
Plaintiffs,
Case No. 2019CA000015
v.
MARTIN MEMORIAL MEDICAL
CENTER, INC., d.b.a. MARTIN
MEDICAL CENTER, a Florida Cor-
poration, KUNAL CHAUDHRY,
M.D., and CARDIOLOGY
P Y
O
ASSOCIATES OF STUART, P.A., a
Florida Profit Corporation,
Defendants.
C
__________________________________/
PLAINTIFFS’ RESPONSE TO DEFENDANT MARTIN MEMORIAL MEDICAL
CENTER’S MOTION FOR PARTIAL SUMMARY JUDGMENT AS TO COUNT I OF
PLAINTIFFS’ SECOND AMENDED COMPLAINT
Plaintiffs Frederic Charles Greer III and Melissa Anne Greer, as husband and wife, and
Frederic Charles Greer III and Melissa Anne Greer, individually, file this response to Martin Me-
morial Hospital’s Motion for Partial Summary Judgment as to Count I of Plaintiffs’ Second
Amended Complaint.
I. PROCEDURAL BACKGROUND
Mr. Greer presented to Tradition Hospital with shortness of breath on September 1, 2017.
An ER doctor there evaluated him and determined that Mr. Greer had suffered a heart attack. The
ER doctor consulted with Dr. Chaudry, a defendant with whom Plaintiffs settled, at defendant
Hospital, and they did not deem the situation to require a STEMI alert at that time. Both Tradition
Hospital and defendant Hospital are part of the same hospital system.
Because Mr. Greer needed a cardiac catheterization and the Hospital was better equipped
to provide that procedure, Tradition Hospital transferred Mr. Greer to the Hospital via ambulance.
Dr. Chaudry was the accepting physician at the Hospital.
When Mr. Greer arrived at the Hospital, he went directly to the Hospital’s cardiac cath lab.
There, Mr. Greer came under the care of Dr. Chaudry. The doctor, with the assistance of Hospital
nurses, performed a cardiac cath, which is an interventional cardiology diagnostic procedure, of
the left and right ventricles. The cardiac cath revealed diffuse coronary artery disease.
P Y
Based on those results, Dr. Chaudry, assisted by Hospital nurses and technicians, attempted
a balloon angioplasty, which is an interventional cardiology treatment procedure. Plaintiffs allege
C O
that Dr. Chaudry and the Hospital’s nurses and technicians went ahead with this attempt “without
consulting or going up the chain of command to obtain a cardiac surgery consult with Dr. Crouch.”
(Pls.’ 2nd Am. Compl. at 11, ¶ 68.)
Plaintiffs allege in Count I of the Second Amended Complaint that the nurses and techni-
cians were negligent for failing to go up the nursing chain of command to stop Dr. Chaudry from
performing a balloon angioplasty on Mr. Greer without that consult, which was required by the
Hospital policy and procedure “Cardiac Transfers Decision Tree From Tradition Medical Center
(TMC) Interventional Lab.” (Id. at 18–21.)
The Hospital has now moved for summary judgment on Count I arguing that Plaintiffs
cannot prove causation with respect to its employees’ alleged negligence.
II. STATEMENT OF THE FACTS
1. The Cardiac Transfers Decision Tree from Tradition Medical Center (TMC) Inter-
ventional Lab requires that, if a cardiac cath shows diffuse disease, the doctor needs to obtain a
2
cardiac surgical consult. (See Ex. A, Cardiac Transfers Tree.)
2. For the purposes of this motion, it does not appear that the Hospital disputes that
Dr. Chaudry failed to obtain a cardiac surgical consult when the cardiac cath of Mr. Greer showed
diffuse coronary artery disease.
3. Plaintiffs’ nursing expert Nurse Bailey Estes has testified that the standard of care
required the Hospital’s employees to go up the chain of command to stop Dr. Chaudry from per-
forming the balloon angioplasty, which they failed to do. (See Ex. B, Estes dep. at, e.g., 38–39,
122–23.)
4.
Y
Andrew Selwyn, M.D., Plaintiffs’ expert on interventional cardiology, will be
P
providing an affidavit in which he states: He has reviewed Nurse Estes’ deposition testimony and,
C O
based on that testimony and the Cardiac Transfers Decision Tree, opines that the Hospital employ-
ees’ failures caused or substantially contributed to cause damages to Mr. Greer. Had the consult
occurred, Dr. Selwyn will aver, referring to his deposition testimony of November 25, 2019, that
the standard of care required not a balloon angioplasty, but a bypass surgery. (See also Ex. C,
Selwyn dep. at 38, 48, 113, 121.)
5. George Tolis, M.D., Plaintiffs’ expert on cardiovascular surgery will be providing
an affidavit in which he states: He has reviewed Nurse Estes’ deposition testimony and, based on
that testimony and the Cardiac Transfers Decision Tree, opines that the Hospital employees’ fail-
ures caused or substantially contributed to cause damages to Mr. Greer. Had the consult occurred,
Dr. Tolis will aver, referring to his deposition testimony of November 26, 2019, that Mr. Greer
would not have received a balloon angioplasty but received other treatment and, ultimately, a by-
pass. (See also Ex. F, Tolis dep. at 32–33, 50, 251, 261, 265.)
3
III. SUMMARY-JUDGMENT STANDARD
This year, the Supreme Court of Florida amended rule 1.510 to adopt the federal summary-
judgment standard. In re Amendments to Fla. R. Civ. P. 1.510 (In re Amendments I), 309 So. 3d
192 (Fla. 2020) (mem.). Rule 1.510 now says, in part: “The court shall grant summary judgment
if the movant shows that there is no genuine dispute as to any material fact and the movant is
entitled to judgment as a matter of law.” Fla. R. Civ. P. 1.510(a).
Under the amended rule, the “moving party that does not bear the burden of persuasion at
trial can obtain summary judgment without disproving the nonmovant’s case.” In re Amendments
P Y
II, 317 So. 3d at 75. To satisfy its initial burden of production, the moving party can either produce
evidence that the fact the nonmoving party must establish at trial is not so or point out that the
C O
nonmoving party lacks evidence to prove that fact. Id.
“A fact is ‘material’ if it has the potential of affecting the outcome of the case. And to raise
a ‘genuine’ dispute, the nonmoving party must point to enough evidence that a reasonable jury
could return a verdict for him.” Shaw v. City of Selma, 884 F.3d 1093, 1098 (11th Cir. 2018)
(cleaned up).
The court must view the evidence in the light most favorable to the nonmoving party and
draw all reasonable inferences in that party’s favor. Jones v. UPS Ground Freight, 683 F.3d 1283,
1291–92 (11th Cir. 2012). The court cannot weigh conflicting evidence or make credibility
determinations. Id. at 1292. If there is a genuine dispute of material fact, the court must deny
summary judgment and proceed to trial. Id. However, a court should not adopt a version of the
facts put forward by a party that is blatantly contradicted by the record, so that no reasonable jury
could believe it. In re Amendments II, 317 So. 3d at 75–76.
If the moving party shows that there is no genuine dispute of material fact, the burden shifts
4
to the nonmoving party to come forward with specific facts showing that there is a genuine issue
for trial. Shaw, 884 F.3d at 1098. The nonmoving party does not satisfy this burden “if the rebuttal
evidence is merely colorable, or is not significantly probative of a disputed fact.” Jones, 683 F.3d
at 1292 (cleaned up). The nonmoving party must “make a showing sufficient to establish the
existence of an element essential to that party’s case, and on which that party will bear the burden
of proof at trial.” Id. (cleaned up).
IV. ARGUMENT
“To prevail in a medical malpractice case a plaintiff must establish the following: the stand-
P Y
ard of care owed by the defendant, the defendant’s breach of the standard of care, and that said
breach proximately caused the damages claimed.” Gooding v. Univ. Hosp. Bldg., 445 So. 2d 1015,
C O
1018 (Fla. 1984) (citation omitted). As to causation, “[t]he plaintiff must show that the injury more
likely than not resulted from the defendant’s negligence in order to establish a jury question on
proximate cause. In other words, the plaintiff must show that what was done or failed to be done
probably would have affected the outcome.” Id. at 1020.
A reasonable jury could find that the Hospital’s employees’ deviations from the standard
of care—their failure to go up the chain of command to stop Dr. Chaudry from performing a bal-
loon angioplasty without first getting a surgical consult—caused or substantially contributed to the
injuries and damages Mr. Greer has suffered. That is, the employees failed to do something (going
up the chain of command) that probably would have affected the outcome. Had they gone up the
chain of command, and Dr. Chaudry gotten the surgical consult, according to both Drs. Selwyn
and Tolis, Mr. Greer probably would have received a bypass, not the balloon angioplasty that went
disastrously wrong and required a heart transplant.
5
V. CONCLUSION
For the above reasons, Plaintiffs ask the Court to deny Martin Memorial Hospital’s Mo-
tion for Partial Summary Judgment as to Count I of Plaintiffs’ Second Amended Complaint.
CERTIFICATE OF SERVICE
I HEREBY CERTIFY that a true copy of the foregoing was furnished to all counsel on the
attached service list by e-mail on January 28, 2022.
Geoffrey N. Fieger, Esq.
FIEGER LAW
19390 West Ten Mile Road
Southfield, MI 48075
P Y
G.Fieger@Fiegerlaw.com
S.Teal@Feigerlaw.com
and
O
Peter J. Somera, Jr., Esq.
Paul M. Silva, M.D., Esq.
C SOMERA & SILVA, LLP
2255 Glades Road, Suite 232 West
Boca Raton, FL 33431
pleadings@somerasilva.com
litigation@somerasilva.com
and
BURLINGTON & ROCKENBACH, P.A.
Courthouse Commons/Suite 350
444 West Railroad Avenue
West Palm Beach, FL 33401
(561) 721-0400
Attorneys for Plaintiffs
ajr@FLAppellateLaw.com
fa@FLAppellateLaw.com
By: /s/ Adam Richardson
ADAM RICHARDSON
Florida Bar No. 94886
6
SERVICE LIST
Thomas G. Aubin, Esq.
Matthew S. Podolnick, Esq.
STEARNS, WEAVER MILLER WEISSLER
ALHADEFF & SITTERSON, P.A.
200 East Las Olas Blvd., Suite 2100
Fort Lauderdale, FL 33301
taubin@stearnsweaver.com
mpodolnick@stearnsweaver.com
Counsel for Defendant Martin Memorial Medical Center, Inc.
d.b.a. Martin Memorial Medical Center
Keith J. Puya, Esq.
Hector R. Buigas, Esq.
LAW OFFICES OF KEITH J. PUYA, P.A.
4880 Donald Ross Road, Suite 225
Palm Beach Gardens, FL 33418
eservice@puyalaw.com
P Y
O
kpuya@puyalaw.com
Counsel for Defendants Kunal Chaudhry, M.D., and Cardiology
Associates of Stuart, P.A.
Dinah Stein, Esq. C
HICKS, PORTER, EBENFELD & STEIN, P.A.
799 Brickell Plaza, 9th Floor
Miami, FL 33131
dstein@mhickslaw.com
akozub@mhickslaw.com
eclerk@mhickslaw.com
Counsel for Defendants Kunal Chaudhry, M.D., and Cardiology
Associates of Stuart, P.A.
7
MARTIN HEALTH SYSTEM
TITLE: CARDIAC TRANSFERS DECISION TREE FROM TRADITION MEDICAL CENTER(TMC)INTERVENTIONAL LAB
POLICY NO.:
ISSUED FOR: [X]Entire Health System [ ]Medical Center [ ]MFMI
[ ]Medical Group [ ]Coastal Care []Foundation
[ ]South Hospital [ ]Tradition Medical Center
1. PURPOSE: Cardiac cath lab decision tree to safely transfer patients to MC Hospital who need to have cardiac
interventions performed.
Cardiac Cath Lab Decision Tree
B
v Disease needs PCI
B
v Sheath pulled groin/radial stable
• Stable and schedule next day
• Phase II for recovery and admit orders
v
B
B
P Y
Admit to inpatient and call TX center for move to MC Cardiac Cath Lab
v Pre procedure orders per MD and Transfer orders for following day
2. PROCEDURE:
Disease needs PCI
C O
1. Urgent/Emergent----patient stable
2. Sheath left in place
3. IR/Cath Lab nurse will take patient to Phase 1 to monitor and await transfer to
MC Cath Lab.
4. MD places correct orders (procedure and transfer)
5. IR/Cath nurse will call transfer center /coastal for transport/ notify ADON
6. MC Cath nurse notifies bed control of direct transfer to MC Cardiac Cath Lab
7. Bed control makes arrangements for bed post procedure
8. IR/Cath Lab nurse calls report to MC Cardiac Cath Lab
9. IR/Cath Lab nurse Tradition lab accompanies patient to MC Cardiac Cath Lab
for PCI
10 Coastal Care transport returns IR/Cath Lab nurse to Tradition Medical Center.
Disease needs immediate intervention IABP placed
1. MD decision to transfer to ICU at Tradition or transfer to North
2. IR/Cath Lab nurse will take patient to Tradition ICU.
3. If transfer to MC Cardiac Cath
a. MD places correct orders
b. IR/Cath nurse will call transfer center / coastal care and notify bed
control, SLC 911 for transport with Tradition RN.
c. Tradition RN calls report to MC Cardiac Cath
d. Verify with bed control available ICU bed at MC Hospital
e. Direct transfer to MC Cardiac Cath Lab, handoff
f. SLC and RN return to Tradition
EXHIBIT A
Cardiac Cath = Diffuse disease needs cardiac surgical consult
1. Sheath pulled groin intact
2. IR/Cath lab nurse will take patient to TMC Phase I I recovery
3. MD places correct orders to be admitted to MC Hospital as inpatient and await
transfer to North
OR
Transfer to MC North inpatient for surgical consult for CABG
3. REFERENCES:
AHCA FS 408.0361:
http://www.led.state.ffus/Statutes/index.cfm?App mode=Display Statute&Search Strin
Y
cr=&URL=0400-0499/0408/Sections/0408.0361.html
P
C O
EXHIBIT A
·1· FREDERIC CHARLES GREER,· · · ) IN THE CIRCUIT COURT OF
· · III and MELISSA ANNE· · · · ·) THE 19TH JUDICIAL CIRCUIT
·2· GREER, as Husband and· · · · ) IN AND FOR MARTIN COUNTY,
· · Wife, and FREDERIC CHARLES· ·) FLORIDA
·3· GREER, III and MELISSA· · · ·)
· · ANNE GREER, individually,· · ) CASE NO: 2019CA000015
·4· · · · · · · · · · · · · · · ·)
· · · · · · ·Plaintiffs,· · · · ·)
·5· · · · · · · · · · · · · · · ·)
· · VS.· · · · · · · · · · · · · )
·6· · · · · · · · · · · · · · · ·)
· · MARTIN MEMORIAL MEDICAL· · · )
·7· CENTER, INC., D/B/A MARTIN· ·)
· · MEDICAL CENTER, a Florida· · )
·8· Corporation, KUNAL· · · · · ·)
· · CHAUDHRY, MD, and· · · · · · )
Y
·9· CARDIOLOGY ASSOCIATES OF· · ·)
· · STUART, P.A., a Florida· · · )
P
10· Profit Corporation,· · · · · )
· · · · · · · · · · · · · · · · ·)
O
11· · · · · ·Defendants.· · · · ·)
C
12
13· · · · · · ·-----------------------------------
14· · · · · · · ORAL AND VIDEOTAPED DEPOSITION OF
15· · · · · · · · · BAILEY ESTES, BSN, RN-BC
16· · · · · · · · · · · NOVEMBER 25, 2020
17· · · · · · ·-----------------------------------
18
19
20· · · ·ORAL AND VIDEOTAPED DEPOSITION OF BAILEY ESTES,
21· BSN, RN-BC, produced as a witness at the instance of the
22· PLAINTIFF, and duly sworn, was taken in the above-styled
23· and numbered cause on November 25, 2020, from 9:19 a.m.
24· to 1:07 p.m., via Zoom, before Brandi Schmitz, CSR in
25· and for the State of Texas, reported by machine
EXHIBIT B
·1· shorthand, at 1641 South 15th Street, Abilene, Texas
·2· 79602, pursuant to the Florida Rules of Civil Procedure,
·3· the 22nd Emergency Order Sections 3 (c) and (d), and the
·4· provisions stated on the record or attached hereto.
·5
·6
·7
·8
Y
·9
P
10
O
11
C
12
13
14
15
16
17
18
19
20
21
22
23
24
25
EXHIBIT B
·1· · · · · · · · · · A P P E A R A N C E S
·2· FOR THE PLAINTIFFS:
·3· · · ·PAUL M. SILVA, M.D.
· · · · ·PETER J. SOMERA, JR.
·4· · · ·SOMERA & SILVA, LLP
· · · · ·One Boca Place
·5· · · ·2255 Glades Road, Suite 232W
· · · · ·Boca Raton, Florida 33431
·6· · · ·Phone:(561)981-8881
· · · · ·Fax:(561)981-8887
·7· · · ·depos@somerasilva.com
·8
· · FOR THE DEFENDANT MARTIN MEMORIAL MEDICAL CENTER, INC.,
Y
·9· D/B/A MARTIN MEDICAL CENTER, a Florida Corporation:
P
10· · · ·MATTHEW PODOLNICK
· · · · ·STEARNS WEAVER MILLER WEISSLER
O
11· · · ·ALHADEFF & SITTERSON, P.A.
· · · · ·200 East Las Olas Blvd.
C
12· · · ·Suite 2100
· · · · ·Fort Lauderdale, Florida 33301
13· · · ·Phone:(954)462-9543
· · · · ·mpodolnick@stearnsweaver.com
14
15· FOR THE DEFENDANTS KUNAL CHAUDHRY, MD, and CARDIOLOGY
· · ASSOCIATES OF STUART, P.A., a Florida Profit
16· Corporation:
17· · · ·HECTOR R. BUIGAS
· · · · ·LAW OFFICES OF KEITH J. PUYA,
18· · · ·P.A.
· · · · ·4880 Donald Ross Road
19· · · ·Suite 225
· · · · ·Palm Beach Gardens, Florida
20· · · ·33418
· · · · ·Phone:(561)408-3772
21· · · ·hbuigas@puyalaw.com
22
23
· · ALSO PRESENT:
24· · · ·Roy Perez - Videographer
25
EXHIBIT B
·1· · · · · · · · · · · · · · INDEX
· · · · · · · · · · · · · · · · · · · · · · · · · · · · PAGE
·2
· · Appearances.........................................· ·3
·3· Signature and Changes............................... 184
· · Reporter's Certificate.............................. 186
·4
·5· BAILEY ESTES, BSN, RN-BC
·6· · · ·EXAMINATION BY DR. SILVA........................ 6
· · · · ·EXAMINATION BY MR. PODOLNICK.................... 43
·7· · · ·EXAMINATION BY MR. BUIGAS.......................164
· · · · ·EXAMINATION BY DR. SILVA........................164
·8· · · ·EXAMINATION BY MR. PODOLNICK....................175
· · · · ·EXAMINATION BY DR. SILVA........................178
Y
·9
P
10
· · · · · · · · · · · · · ·EXHIBITS
O
11· NO.· ·DESCRIPTION· · · · · · · · · · · · · · · · · PAGE
· · 1· · ·Expert Opinions.............................· · 48
C
12· 2· · ·Cross-Notice of Deposition Duces Tecum......· · 51
· · 3· · ·Correspondence between Nurse Estes and
13· · · · Somera & Silva, LLP.........................· · 53
· · 4· · ·Nurse Estes' Copy of the Cardiac Cath
14· · · · Event Log with Notes........................· · 56
· · 5· · ·Nurse Estes' File...........................· · 60
15· 6· · ·Fee Schedule................................· · 79
· · 7· · ·CV..........................................· · 81
16· 8· · ·Twitter Profile.............................· · 87
· · 9· · ·CLI Article.................................· · 95
17· 10· · Plaintiffs' Fifth Amended Fact and Expert
· · · · · Witness List................................· ·109
18· 11· · Cardiac Transfer Decision Tree from
· · · · · Tradition Medical Center Interventional
19· · · · Lab.........................................· ·158
20
21· · (Exhibits 3 through 6 to be provided by the witness,
· · · · · · · · · ·Bailey Estes, BSN, RN-BC)
22
23
24
25
EXHIBIT B
·1· · · · · · · · · · P R O C E E D I N G S
·2· · · · · · · · THE COURT REPORTER:· Today's date is
·3· November 25, 2020.· The time is 9:19 a.m.
·4· · · · · · · · This is the oral deposition of BAILEY
·5· ESTES, BSN, RN-BC.· This is the oral -- oh, sorry -- and
·6· it is being conducted remotely in accordance with the
·7· current emergency order regarding the COVID-19 State of
·8· Disaster, Sections 3 (c) and (d).
Y
·9· · · · · · · · The witness is located at 1641 South 15th
P
10· Street, Abilene, Texas 79602.
O
11· · · · · · · · My name is Brandi Schmitz, CSR No. 8093. I
C
12· am administering the oath and reporting the deposition
13· remotely by stenographic means from my residence within
14· the state of Texas.· The witness has been identified to
15· me through attestation of counsel.
16· · · · · · · · Would counsel please state who they
17· represent and their location for the record?
18· · · · · · · · DR. SILVA:· Attorney Paul Silva for the
19· Greer family, and I agree to any stipulations for this
20· Zoom video depo.
21· · · · · · · · MR. PODOLNICK:· This is Matt Podolnick from
22· Stearns Weaver Miller on behalf of the defendant, Martin
23· Memorial Medical Center.
24· · · · · · · · MR. BUIGAS:· This is Hector Buigas on
25· behalf of Dr. Chaudhry and his practice, and I consent.
EXHIBIT B
·1· · · · · · · · MR. SOMERA, JR.:· Peter Somera for the
·2· plaintiff, consent.
·3· · · · · · · · · BAILEY ESTES, BSN, RN-BC,
·4· having been first duly sworn, testified as follows:
·5· · · · · · · · · · · · ·EXAMINATION
·6· BY DR. SILVA:
·7· · · ·Q.· Good morning, ma'am.· Give us your full name
·8· for the record.
Y
·9· · · ·A.· Bailey Ann Estes.
P
10· · · ·Q.· And can you tell us, are you a nurse?
O
11· · · ·A.· Yes, I am.
C
12· · · ·Q.· All right.· I have a copy of your CV with me
13· and it has a lot of different designations after your
14· name.· So could you please go through those designations
15· and describe what they are to us?
16· · · ·A.· Yes.· I am a registered nurse.· I'm also board
17· certified in cardiovascular nursing.· I have my
18· bachelor's degree in nursing.· I am a certified first
19· assistant and certified in perioperative nursing as well
20· as a registered cardiovascular invasive specialist.
21· · · ·Q.· Okay.· Let me start with BSN after your name,
22· that designation, what does that stand for?
23· · · ·A.· My bachelor's of science in nursing.
24· · · ·Q.· Where did you obtain your bachelor's of science
25· in nursing?
EXHIBIT B
·1· · · ·A.· University of Texas at Arlington.
·2· · · ·Q.· Was that a four-year degree?
·3· · · ·A.· Yes.
·4· · · ·Q.· When did you complete that BSN?
·5· · · ·A.· I completed that in 2018.
·6· · · ·Q.· Okay.· Then you have RN-BC after your name.
·7· What does that stand for?
·8· · · ·A.· It stands for registered nurse-board certified
Y
·9· for cardiovascular nursing.
P
10· · · ·Q.· Okay.· How did you -- what did you have to do
O
11· to obtain board certification cardiovascular nursing?
C
12· · · ·A.· I took an examination.
13· · · ·Q.· When did you take --
14· · · ·A.· That was --
15· · · ·Q.· When?
16· · · ·A.· That was -- that was in 2018 as well.
17· · · ·Q.· What -- what did you have to do in order to sit
18· for this board as far as any type of experience or any
19· type of on-the-job training?
20· · · ·A.· Yes.· At least two years of cardiovascular
21· nursing experience.
22· · · ·Q.· And describe to us what that two years of
23· cardiovascular nursing experience entailed.· How did you
24· get that?
25· · · ·A.· I had worked -- whenever I was a licensed
EXHIBIT B
·1· practical nurse I worked for -- on telemetry and cardiac
·2· ICU taking care of post-cath patients, general cardiac
·3· patients.· I've also worked in the cardiac cath lab to
·4· gain my experience.
·5· · · ·Q.· Okay.· And we'll -- we'll go through that a
·6· little more later, but I want to continue with the
·7· designations after your name.· RNFA, what does that
·8· stand for?
Y
·9· · · ·A.· Registered nurse first assistant.
P
10· · · ·Q.· And what does a registered nurse first
O
11· assistant do?
C
12· · · ·A.· It gives me privileges to assist in surgeries,
13· or I get to assist in the cardiac cath lab.
14· · · ·Q.· And what types of procedures do you assist in
15· the cardiac cath lab?
16· · · ·A.· Your regular diagnostic cardiac caths,
17· intervention, pacemaker insertions, TAVR, peripheral
18· vascular interventions.
19· · · ·Q.· Does that include balloon angioplasties?
20· · · ·A.· It does.
21· · · ·Q.· Does it include diagnostic cardiac
22· catheterizations with the measurement of ejection
23· fractions?
24· · · · · · · · MR. PODOLNICK:· Form.
25· · · ·A.· Yes.
EXHIBIT B
·1· · · ·Q.· (BY DR. SILVA)· The CNOR designation, what does
·2· that stand for?
·3· · · ·A.· It is a perioperative nursing certification. I
·4· obtained that with my first assist certification.
·5· · · ·Q.· And what does that certification allow you to
·6· do?
·7· · · ·A.· It doesn't allow me to do anything.· It's just
·8· an examination that I took having at least two years
Y
·9· worth of perioperative nursing experience, which I
P
10· obtained in the cath lab.
O
11· · · ·Q.· The RCIS designation, what does that stand for?
C
12· · · ·A.· Registered cardiovascular invasive specialist.
13· · · ·Q.· And what -- what does that designation allow
14· you to do?
15· · · ·A.· In my cath lab it doesn't allow me any extra
16· privileges.· It's just a certification which I obtained
17· after having almost two years of experience in the
18· cardiac cath lab.· At the time I took the exam I had to
19· have at least 1500 cases in experience.
20· · · ·Q.· How many cases in the cardiac cath lab have you
21· participated in in your career?
22· · · ·A.· Right over 5,000.
23· · · ·Q.· Can you describe to me your work history in the
24· medical field starting from the very first job you had
25· in the medical field?
EXHIBIT B
·1· · · ·A.· I started out as a certified nurse assistant
·2· that I worked for one year at Lubbock Heart Hospital. I
·3· have two years of experience as a --
·4· · · ·Q.· Hold on.· Stop.· Can you give me the years when
·5· you did those things, also, okay?
·6· · · ·A.· Okay.· Let me see.· That year was -- I did that
·7· from 2010 to 2011.
·8· · · ·Q.· Okay.· Continue.
Y
·9· · · ·A.· Then I worked as a -- as a licensed vocational
P
10· nurse at Hendrick Medical Center with telemetry, CICU.
O
11· That was from 2013 to 2015.· Then I worked as a
C
12· registered nurse in the cardiac cath lab at Hendrick
13· Medical Center from October 2015 to November 2019. I
14· now work directly for a physician at Hendrick Provider
15· Network, an interventional cardiologist, and assist in
16· his procedures in the cardiac cath lab from 2019 to
17· present.
18· · · ·Q.· And when you stated earlier that you worked in
19· the telemetry, CICU from 2013 to 2015, what does CICU
20· stand for?
21· · · ·A.· Cardiac intensive care unit.
22· · · ·Q.· In your work --
23· · · · · · · · MR. PODOLNICK:· That's the videographer.
24· · · · · · · · DR. SILVA:· All right.
25· · · · · · · · MR. PODOLNICK:· We'll -- we'll -- we'll
EXHIBIT B
·1· record my questions.
·2· · · · · · · · DR. SILVA:· That's fine.
·3· · · ·Q.· (BY DR. SILVA)· In your experience in the
·4· cardiac cath lab, can you tell us the first year that
·5· you started working in the cardiac cath lab in any
·6· capacity?
·7· · · ·A.· In October 2015 is when I started.
·8· · · ·Q.· Okay.· And during the time that you worked in
Y
·9· the cath lab from 2015 to the present, have you
P
10· participated as a documenter during a procedure?
O
11· · · ·A.· Yes, I have.
C
12· · · ·Q.· Have you participated as a circulator during a
13· cardiac cath procedure?
14· · · ·A.· Yes, I have.
15· · · ·Q.· Have you participated as a scrub tech during a
16· cardiac cath procedure?
17· · · ·A.· Yes, I have.
18· · · ·Q.· Have you participated as a assistant or first
19· assistant during a cardiac cath procedure or
20· interventional procedure?
21· · · ·A.· Yes, I have.
22· · · ·Q.· So you've participated in all the different
23· functions that nursing personnel or medical providers
24· would provide during a cardiac cath or during a cardiac
25· interventional procedure?
EXHIBIT B
·1· · · · · · · · MR. PODOLNICK:· Form --
·2· · · ·A.· That is correct.
·3· · · · · · · · MR. PODOLNICK:· Form, leading, compound.
·4· · · ·Q.· (BY DR. SILVA)· Can you describe to us all the
·5· different functions and capacities that you've -- have
·6· experience in in a cardiac cath lab from the time that
·7· you started in 2015 up until today?
·8· · · ·A.· I have functioned at a circulator, a monitor, a
Y
·9· scrub nurse and x-ray technician and first assist.
P
10· · · ·Q.· Okay.· So describe for us what duties or the
O
11· functions are of each one of those different capacities
C
12· you've just described.
13· · · ·A.· Okay.· The circulating nurse is responsible
14· mainly for the patient.· They -- we provide moderate
15· sedation, monitor the vital signs, give other
16· medications per the physician.· The monitor documents
17· everything in the case.· It also keeps up with
18· hemodynamic.· The scrub assists the physician in
19· anything that he or she needs during the case, and for
20· x-ray drive the table and move the C-arm as needed for
21· angiography.
22· · · ·Q.· Okay.· And who -- which one of those people is
23· responsible for documenting conversations between the
24· interventional cardiologists and -- and consults between
25· the interventional cardiologists and other physicians?
EXHIBIT B
·1· · · ·A.· The --
·2· · · · · · · · MR. PODOLNICK:· Form -- I'm sorry,
·3· Ms. Estes, I'm -- I'm sorry to interrupt you, but
·4· sometimes I need to make a legal objection.· You can
·5· still answer the question.· I just want to get my
·6· objection in.· I'm not interrupting you on purpose,
·7· okay?· So --
·8· · · · · · · · THE WITNESS:· No worries.
Y
·9· · · · · · · · MR. PODOLNICK:· -- form, predicate.
P
10· · · ·Q.· (BY DR. SILVA)· Go ahead.
O
11· · · ·A.· That is correct.· It's the -- it's the monitor.
C
12· Sorry.
13· · · ·Q.· Can you describe to us your experience in
14· regards to documenting conversations between the
15· interventional cardiologists and other physicians in the
16· cardiac cath lab?
17· · · ·A.· Yes.· Typically any time a doctor has talked
18· about the case with another physician, that is
19· documented within the cardiac catheter report.
20· · · ·Q.· And whose job or responsibility is it to
21· document that within the cardiac cath event log?
22· · · ·A.· The monitor.
23· · · ·Q.· Does -- you said when those conversations
24· occur, does that include in-person conversations,
25· telephone conversations and consults?
EXHIBIT B
·1· · · ·A.· It does.
·2· · · ·Q.· Is that the standard of care in the cardiac
·3· cath lab?
·4· · · ·A.· Yes, it is.
·5· · · ·Q.· Is that the standard of care in this country in
·6· a cardiac cath lab?
·7· · · ·A.· Yes, it is.
·8· · · ·Q.· Is that what you were taught in nursing school
Y
·9· or during your training in the cardiac cath lab?
P
10· · · · · · · · MR. PODOLNICK:· Form.
O
11· · · ·A.· Yes, that is correct.
C
12· · · ·Q.· (BY DR. SILVA)· Can you tell us what training
13· and where you received that training that conversations
14· between -- and consults between the interventional
15· cardiologists and other physicians has to be documented
16· in the cardiac cath event log?
17· · · ·A.· I was taught --
18· · · · · · · · MR. PODOLNICK:· Form.
19· · · ·A.· I was taught that while I was training in the
20· cardiac cath lab for the monitor position.
21· · · ·Q.· (BY DR. SILVA)· Can you describe to us your
22· experience in regards to the various participants in the
23· cardiac cath lab documenting in a cardiac cath event log
24· any complications that occur during a procedure?
25· · · ·A.· Yes, complications are supposed to be
EXHIBIT B
·1· documented in the cardiac event log.
·2· · · ·Q.· And of -- of those various different roles in
·3· the cardiac cath lab, which person is responsible for
·4· documenting complications that occur in the cardiac cath
·5· lab?
·6· · · · · · · · MR. PODOLNICK:· Form.
·7· · · ·A.· The monitor.
·8· · · ·Q.· (BY DR. SILVA)· Is that -- is it the standard
Y
·9· of care for a monitor to document complications that
P
10· occur during a procedure in the cardiac cath lab?
O
11· · · ·A.· Yes.
C
12· · · ·Q.· And is that the standard of care throughout the
13· United States of America, the nurse -- the nursing or
14· the cardiac personnel standard of care?
15· · · ·A.· Yes.
16· · · · · · · · MR. PODOLNICK:· Form on the last one.
17· · · ·Q.· (BY DR. SILVA)· Can you describe to us where
18· you obtained the training and education that requires
19· the monitor to document complications that occur in the
20· cardiac cath lab in the event log?
21· · · ·A.· On-the-job training.
22· · · ·Q.· Who -- the hospital that you work at, can you
23· give us the name of that hospital?
24· · · ·A.· Hendrick Medical Center.
25· · · ·Q.· At Hendrick Medical Center, what city is that
EXHIBIT B
·1· located in?
·2· · · ·A.· It's in Abilene, Texas.
·3· · · ·Q.· Does Hendrick Medical Center have a cardiac
·4· cath lab?
·5· · · ·A.· Yes.
·6· · · ·Q.· Does Hendrick Medical Center have providers
·7· that perform cardiac catheterizations and interventional
·8· procedures?
Y
·9· · · ·A.· Yes, they do.
P
10· · · ·Q.· Does Hendrick Medical Center have the ability
O
11· to perform an emergency or a routine coronary artery
C
12· bypass grafting surgery?
13· · · ·A.· Yes, they do.
14· · · ·Q.· So this hospital also has heart surgeons or
15· cardiovascular surgeons on staff?
16· · · ·A.· Yes, that's correct.
17· · · · · · · · MR. PODOLNICK:· Form on the last one.
18· · · ·Q.· (BY DR. SILVA)· Does the hospital that you work
19· at Hendrick, do they also have interventional
20· cardiologists?
21· · · ·A.· Yes, they do.
22· · · ·Q.· Okay.· Are you -- do you have any licenses in
23· the state of Texas?
24· · · ·A.· A registered nurse license.
25· · · ·Q.· Is that up to date?
EXHIBIT B
·1· · · ·A.· Yes, it is.
·2· · · ·Q.· Do you have any licenses in any other states
·3· throughout the United States?
·4· · · ·A.· No, I do not.
·5· · · ·Q.· On your CV you have a compact license.· What is
·6· that?
·7· · · ·A.· That basically means that the state of Texas,
·8· and there's various other states that have agreements on
Y
·9· nursing license.· So if I were to move to another state
P
10· it's easier for me to transfer my licensure to that
O
11· state and register there.
C
12· · · ·Q.· Okay.· Are you certified in advanced cardiac
13· life support?
14· · · ·A.· Yes, I am.
15· · · ·Q.· Are you certified in basic life support?
16· · · ·A.· Yes, I am.
17· · · ·Q.· Can you tell us what professional memberships
18· and appointments you have?
19· · · ·A.· I'm part of the membership for The American
20· College of Cardiology, CLI Global Society, the American
21· Nurses Association, the Texas Nurses Association,
22· Society of Cardiovascular Angiography and Interventions.
23· I hold appointments in the CLI Global Society,
24· Membership and Social Media Committee, and then I also
25· hold an appointment for the ACC Cardiovascular Team.
EXHIBIT B
·1· · · ·Q.· And what is the ACC Cardiovascular Team
·2· appointment?
·3· · · ·A.· That one is for chairman of the communications
·4· committee.· That one just started this month, so --
·5· · · ·Q.· Okay.· And are you on any editorial boards or
·6· are you a journal reviewer?
·7· · · ·A.· Yes.· Editorial board for the Cath Lab Digest
·8· and I'm a reviewer for Cardiovascular Disease Management
Y
·9· and as well as the Cath Lab Digest.· I'm a reviewer for
P
10· them as well.
O
11· · · ·Q.· Can you describe to us, what is Cath Lab
C
12· Digest?
13· · · ·A.· Cath Lab Digest is a free kind of open access
14· journal that is provided to -- it has -- it's a free
15· subscription for people who are in the cardiac cath lab.
16· Basically it just has case reports, information on new
17· studies, new technology.
18· · · ·Q.· And what about Vascular Disease Management,
19· what kind of -- is that a journal or --
20· · · ·A.· It's -- it's more online.· It is a journal, but
21· it doesn't come in print.· And it's basically the same,
22· but more focused on peripheral vascular disease.
23· · · ·Q.· Okay.· And do you have publications that you've
24· authored?
25· · · ·A.· Yes.· I have multiple.
EXHIBIT B
·1· · · ·Q.· How many publications have you authored?
·2· · · ·A.· I have been an author on ten publications.
·3· · · ·Q.· Are there any publications that are germane or
·4· specific to the issues in this case that you have?
·5· · · ·A.· There are not.
·6· · · ·Q.· Okay.· And then the Abstract Presentations,
·7· what do those entail?
·8· · · ·A.· Those are basically from research that I've
Y
·9· done within my hospital or case reviews that were
P
10· presented at -- sorry -- that were presented at places
O
11· like the American Cardio -- College of Cardiology,
C
12· Scientific Sessions, major meetings.
13· · · ·Q.· The -- we're here for a patient today,
14· Mr. Frederick Greer.· Did our law firm contact you to
15· ask you to render opinions regarding his care at Martin
16· Medical Center in this case?
17· · · ·A.· Yes, they did.
18· · · ·Q.· And can you tell us when you were first
19· contacted?
20· · · ·A.· In May of 2020.
21· · · ·Q.· And were you sent various documents to arrive
22· at your opinions in this matter?
23· · · ·A.· Yes, I was.
24· · · ·Q.· Were you sent Martin Medical Center records for
25· Mr. Greer?
EXHIBIT B
·1· · · ·A.· Yes, I was.
·2· · · ·Q.· Were you sent the cardiac cath lab event log
·3· for Mr. Greer?
·4· · · ·A.· Yes.
·5· · · ·Q.· Were you sent the deposition transcript of
·6· Dr. Tolis, T-O-L-I-S?
·7· · · ·A.· Yes.
·8· · · ·Q.· Sent the deposition transcript of Dr. Selwyn,
Y
·9· S-E-L-Y-W-Y-N?
P
10· · · ·A.· Yes.
O
11· · · ·Q.· Sent the deposition transcript of Dr. Gelfand,
C
12· G-E-L-F-A-N-D?
13· · · ·A.· Yes.
14· · · ·Q.· Sent the deposition transcript of Dr. Chaudhry,
15· C-H-A-U-D-H-R-Y?
16· · · ·A.· Yes.
17· · · ·Q.· Sent the deposition transcript of Dr. Crouch,
18· C-R-O-U-C-H?
19· · · ·A.· Yes.
20· · · ·Q.· Sent the deposition transcript of Nurse Tilley,
21· T-I-L-L-E-Y?
22· · · ·A.· Yes.
23· · · ·Q.· Sent the deposition transcript of Brian
24· Carroll?
25· · · ·A.· Yes.
EXHIBIT B
·1· · · ·Q.· Sent the deposition transcript of Cynthia
·2· Silva?
·3· · · ·A.· Yes.
·4· · · ·Q.· And the transcript of Katherine Fournier,
·5· F-O-U-R-N-I-E-R?
·6· · · ·A.· Yes.
·7· · · ·Q.· Deposition transcript of Jacob Bennett,
·8· B-E-N-N-E-T-T?
Y
·9· · · ·A.· Yes.
P
10· · · ·Q.· And then you were sent the various policies and
O
11· procedures from the Martin Medical Center cardiac cath
C
12· lab, including the cardiac transfers decision tree?
13· · · ·A.· Yes.
14· · · ·Q.· The balloon angioplasty?
15· · · ·A.· Yes.
16· · · ·Q.· Cardiac stent?
17· · · ·A.· Yes.
18· · · ·Q.· Left heart catheterization?
19· · · ·A.· Yes.
20· · · ·Q.· STEMI cardiac alert?
21· · · ·A.· Yes.
22· · · ·Q.· Description of roles of cath lab personnel?
23· · · ·A.· Yes.
24· · · ·Q.· Roles of cath lab personnel?
25· · · ·A.· Yes.
EXHIBIT B
·1· [ Video recording now ]
·2· · · ·Q.· And have you had -- well, let me -- strike
·3· that.
·4· · · · · · · · Have you also been sent the -- a portion of
·5· the alleged audit trail with various redactions?
·6· · · ·A.· Yes.
·7· · · ·Q.· Have you been sent the two versions of the --
·8· of the cardiac result six-page reports of Dr. Chaudhry?
Y
·9· · · ·A.· Yes.
P
10· · · ·Q.· Have you been provided with the expert opinions
O
11· as you relayed those to our law firm prior to today?
C
12· · · ·A.· Yes.
13· · · ·Q.· How many pre-deposition conferences did you
14· have with our law firm?
15· · · ·A.· About four or five.
16· · · ·Q.· And when did those occur?
17· · · ·A.· They've occurred periodically throughout the
18· past month and a half.
19· · · ·Q.· Okay.· Once you received all of the information
20· that we just went through, did you review it?
21· · · ·A.· Yes.
22· · · ·Q.· And approximately how much time did you spend
23· in reviewing the documentation that you were provided
24· with?
25· · · ·A.· It was around 15 hours.
EXHIBIT B
·1· · · ·Q.· Okay.· Once you reviewed all the information
·2· that we've discussed, did you arrive at opinions in this
·3· matter?
·4· · · ·A.· Yes, I did.
·5· · · ·Q.· Did you relay those opinions to myself and
·6· Mr. Somera during our pre-deposition conferences?
·7· · · ·A.· Yes, I did.
·8· · · ·Q.· Did our law firm memorialize those opinions in
Y
·9· written form that have been titled Expert Opinions that
P
10· are -- that I've sent over to opposing counsel today?
O
11· · · ·A.· That is correct.
C
12· · · ·Q.· Is everything on this expert opinion document
13· your opinions except for the definition of Florida
14· statute reckless disregard?
15· · · ·A.· That is correct.
16· · · ·Q.· Have the attorneys or anyone else influenced
17· any of your opinions that are written on this document?
18· · · ·A.· No, they have not.
19· · · ·Q.· Have you consulted with any colleagues or any
20· other experts to arrive at these opinions that are
21· memorialized?
22· · · ·A.· No.
23· · · ·Q.· Do you need any other information that you
24· haven't received up until today to arrive at these
25· opinions?
EXHIBIT B
·1· · · ·A.· No.
·2· · · ·Q.· If there is additional information that is
·3· provided to you during discovery after today, would you
·4· reserve the right to change or add to your opinions?
·5· · · · · · · · MR. PODOLNICK:· Form.
·6· · · ·A.· Yes, I do.
·7· · · ·Q.· (BY DR. SILVA)· Okay.· The -- were you also
·8· provided with a response by Michael Mittelmark, Esquire,
Y
·9· on April 8, 2019 in regards to a request to produce by
P
10· the plaintiff for all cardiothoracic surgery policies
O
11· and procedures, and the answer was none?
C
12· · · ·A.· Correct.
13· · · · · · · · MR. PODOLNICK:· Form, misstates the
14· document.
15· · · ·Q.· (BY DR. SILVA)· Were you also provided with an
16· answer, Number 18 on a plaintiff's request to produce
17· for all policies and procedures in coronary artery
18· bypass grafting, and the response was:· Objection; vague
19· and overbroad.· Without waiving any objection and after
20· diligent inquiry, the answer was none.
21· · · · · · · · Were you provided with that?
22· · · ·A.· That's correct.
23· · · ·Q.· The policy and procedure regarding the cardiac
24· transfers decision tree that you received from our law
25· firm, does the plaintiff exhibit date indicate that it
EXHIBIT B
·1· was provided on March 6th, 2020?
·2· · · ·A.· Yes.
·3· · · ·Q.· Do you know why the defendant hospital would
·4· not have provided this cardiac transfers decision tree
·5· policy and pro
Preview
Filing # 142904831 E-Filed 01/28/2022 07:20:00 PM IN THE CIRCUIT COURT OF THE 19TH JUDICIAL CIRCUIT IN AND FOR MARTIN COUNTY, FLORIDA FREDERIC CHARLES GREER III and MELISSA ANNE GREER, as Husband and Wife, and FREDERIC CHARLES GREER III and MELISSA ANNE GREER, individually, Plaintiffs, Case No. 2019CA000015 v. MARTIN MEMORIAL MEDICAL CENTER, INC., d.b.a. MARTIN MEDICAL CENTER, a Florida Cor- poration, KUNAL CHAUDHRY, M.D., and CARDIOLOGY P Y O ASSOCIATES OF STUART, P.A., a Florida Profit Corporation, Defendants. C __________________________________/ PLAINTIFFS’ RESPONSE TO DEFENDANT MARTIN MEMORIAL MEDICAL CENTER’S MOTION FOR PARTIAL SUMMARY JUDGMENT AS TO COUNT I OF PLAINTIFFS’ SECOND AMENDED COMPLAINT Plaintiffs Frederic Charles Greer III and Melissa Anne Greer, as husband and wife, and Frederic Charles Greer III and Melissa Anne Greer, individually, file this response to Martin Me- morial Hospital’s Motion for Partial Summary Judgment as to Count I of Plaintiffs’ Second Amended Complaint. I. PROCEDURAL BACKGROUND Mr. Greer presented to Tradition Hospital with shortness of breath on September 1, 2017. An ER doctor there evaluated him and determined that Mr. Greer had suffered a heart attack. The ER doctor consulted with Dr. Chaudry, a defendant with whom Plaintiffs settled, at defendant Hospital, and they did not deem the situation to require a STEMI alert at that time. Both Tradition Hospital and defendant Hospital are part of the same hospital system. Because Mr. Greer needed a cardiac catheterization and the Hospital was better equipped to provide that procedure, Tradition Hospital transferred Mr. Greer to the Hospital via ambulance. Dr. Chaudry was the accepting physician at the Hospital. When Mr. Greer arrived at the Hospital, he went directly to the Hospital’s cardiac cath lab. There, Mr. Greer came under the care of Dr. Chaudry. The doctor, with the assistance of Hospital nurses, performed a cardiac cath, which is an interventional cardiology diagnostic procedure, of the left and right ventricles. The cardiac cath revealed diffuse coronary artery disease. P Y Based on those results, Dr. Chaudry, assisted by Hospital nurses and technicians, attempted a balloon angioplasty, which is an interventional cardiology treatment procedure. Plaintiffs allege C O that Dr. Chaudry and the Hospital’s nurses and technicians went ahead with this attempt “without consulting or going up the chain of command to obtain a cardiac surgery consult with Dr. Crouch.” (Pls.’ 2nd Am. Compl. at 11, ¶ 68.) Plaintiffs allege in Count I of the Second Amended Complaint that the nurses and techni- cians were negligent for failing to go up the nursing chain of command to stop Dr. Chaudry from performing a balloon angioplasty on Mr. Greer without that consult, which was required by the Hospital policy and procedure “Cardiac Transfers Decision Tree From Tradition Medical Center (TMC) Interventional Lab.” (Id. at 18–21.) The Hospital has now moved for summary judgment on Count I arguing that Plaintiffs cannot prove causation with respect to its employees’ alleged negligence. II. STATEMENT OF THE FACTS 1. The Cardiac Transfers Decision Tree from Tradition Medical Center (TMC) Inter- ventional Lab requires that, if a cardiac cath shows diffuse disease, the doctor needs to obtain a 2 cardiac surgical consult. (See Ex. A, Cardiac Transfers Tree.) 2. For the purposes of this motion, it does not appear that the Hospital disputes that Dr. Chaudry failed to obtain a cardiac surgical consult when the cardiac cath of Mr. Greer showed diffuse coronary artery disease. 3. Plaintiffs’ nursing expert Nurse Bailey Estes has testified that the standard of care required the Hospital’s employees to go up the chain of command to stop Dr. Chaudry from per- forming the balloon angioplasty, which they failed to do. (See Ex. B, Estes dep. at, e.g., 38–39, 122–23.) 4. Y Andrew Selwyn, M.D., Plaintiffs’ expert on interventional cardiology, will be P providing an affidavit in which he states: He has reviewed Nurse Estes’ deposition testimony and, C O based on that testimony and the Cardiac Transfers Decision Tree, opines that the Hospital employ- ees’ failures caused or substantially contributed to cause damages to Mr. Greer. Had the consult occurred, Dr. Selwyn will aver, referring to his deposition testimony of November 25, 2019, that the standard of care required not a balloon angioplasty, but a bypass surgery. (See also Ex. C, Selwyn dep. at 38, 48, 113, 121.) 5. George Tolis, M.D., Plaintiffs’ expert on cardiovascular surgery will be providing an affidavit in which he states: He has reviewed Nurse Estes’ deposition testimony and, based on that testimony and the Cardiac Transfers Decision Tree, opines that the Hospital employees’ fail- ures caused or substantially contributed to cause damages to Mr. Greer. Had the consult occurred, Dr. Tolis will aver, referring to his deposition testimony of November 26, 2019, that Mr. Greer would not have received a balloon angioplasty but received other treatment and, ultimately, a by- pass. (See also Ex. F, Tolis dep. at 32–33, 50, 251, 261, 265.) 3 III. SUMMARY-JUDGMENT STANDARD This year, the Supreme Court of Florida amended rule 1.510 to adopt the federal summary- judgment standard. In re Amendments to Fla. R. Civ. P. 1.510 (In re Amendments I), 309 So. 3d 192 (Fla. 2020) (mem.). Rule 1.510 now says, in part: “The court shall grant summary judgment if the movant shows that there is no genuine dispute as to any material fact and the movant is entitled to judgment as a matter of law.” Fla. R. Civ. P. 1.510(a). Under the amended rule, the “moving party that does not bear the burden of persuasion at trial can obtain summary judgment without disproving the nonmovant’s case.” In re Amendments P Y II, 317 So. 3d at 75. To satisfy its initial burden of production, the moving party can either produce evidence that the fact the nonmoving party must establish at trial is not so or point out that the C O nonmoving party lacks evidence to prove that fact. Id. “A fact is ‘material’ if it has the potential of affecting the outcome of the case. And to raise a ‘genuine’ dispute, the nonmoving party must point to enough evidence that a reasonable jury could return a verdict for him.” Shaw v. City of Selma, 884 F.3d 1093, 1098 (11th Cir. 2018) (cleaned up). The court must view the evidence in the light most favorable to the nonmoving party and draw all reasonable inferences in that party’s favor. Jones v. UPS Ground Freight, 683 F.3d 1283, 1291–92 (11th Cir. 2012). The court cannot weigh conflicting evidence or make credibility determinations. Id. at 1292. If there is a genuine dispute of material fact, the court must deny summary judgment and proceed to trial. Id. However, a court should not adopt a version of the facts put forward by a party that is blatantly contradicted by the record, so that no reasonable jury could believe it. In re Amendments II, 317 So. 3d at 75–76. If the moving party shows that there is no genuine dispute of material fact, the burden shifts 4 to the nonmoving party to come forward with specific facts showing that there is a genuine issue for trial. Shaw, 884 F.3d at 1098. The nonmoving party does not satisfy this burden “if the rebuttal evidence is merely colorable, or is not significantly probative of a disputed fact.” Jones, 683 F.3d at 1292 (cleaned up). The nonmoving party must “make a showing sufficient to establish the existence of an element essential to that party’s case, and on which that party will bear the burden of proof at trial.” Id. (cleaned up). IV. ARGUMENT “To prevail in a medical malpractice case a plaintiff must establish the following: the stand- P Y ard of care owed by the defendant, the defendant’s breach of the standard of care, and that said breach proximately caused the damages claimed.” Gooding v. Univ. Hosp. Bldg., 445 So. 2d 1015, C O 1018 (Fla. 1984) (citation omitted). As to causation, “[t]he plaintiff must show that the injury more likely than not resulted from the defendant’s negligence in order to establish a jury question on proximate cause. In other words, the plaintiff must show that what was done or failed to be done probably would have affected the outcome.” Id. at 1020. A reasonable jury could find that the Hospital’s employees’ deviations from the standard of care—their failure to go up the chain of command to stop Dr. Chaudry from performing a bal- loon angioplasty without first getting a surgical consult—caused or substantially contributed to the injuries and damages Mr. Greer has suffered. That is, the employees failed to do something (going up the chain of command) that probably would have affected the outcome. Had they gone up the chain of command, and Dr. Chaudry gotten the surgical consult, according to both Drs. Selwyn and Tolis, Mr. Greer probably would have received a bypass, not the balloon angioplasty that went disastrously wrong and required a heart transplant. 5 V. CONCLUSION For the above reasons, Plaintiffs ask the Court to deny Martin Memorial Hospital’s Mo- tion for Partial Summary Judgment as to Count I of Plaintiffs’ Second Amended Complaint. CERTIFICATE OF SERVICE I HEREBY CERTIFY that a true copy of the foregoing was furnished to all counsel on the attached service list by e-mail on January 28, 2022. Geoffrey N. Fieger, Esq. FIEGER LAW 19390 West Ten Mile Road Southfield, MI 48075 P Y G.Fieger@Fiegerlaw.com S.Teal@Feigerlaw.com and O Peter J. Somera, Jr., Esq. Paul M. Silva, M.D., Esq. C SOMERA & SILVA, LLP 2255 Glades Road, Suite 232 West Boca Raton, FL 33431 pleadings@somerasilva.com litigation@somerasilva.com and BURLINGTON & ROCKENBACH, P.A. Courthouse Commons/Suite 350 444 West Railroad Avenue West Palm Beach, FL 33401 (561) 721-0400 Attorneys for Plaintiffs ajr@FLAppellateLaw.com fa@FLAppellateLaw.com By: /s/ Adam Richardson ADAM RICHARDSON Florida Bar No. 94886 6 SERVICE LIST Thomas G. Aubin, Esq. Matthew S. Podolnick, Esq. STEARNS, WEAVER MILLER WEISSLER ALHADEFF & SITTERSON, P.A. 200 East Las Olas Blvd., Suite 2100 Fort Lauderdale, FL 33301 taubin@stearnsweaver.com mpodolnick@stearnsweaver.com Counsel for Defendant Martin Memorial Medical Center, Inc. d.b.a. Martin Memorial Medical Center Keith J. Puya, Esq. Hector R. Buigas, Esq. LAW OFFICES OF KEITH J. PUYA, P.A. 4880 Donald Ross Road, Suite 225 Palm Beach Gardens, FL 33418 eservice@puyalaw.com P Y O kpuya@puyalaw.com Counsel for Defendants Kunal Chaudhry, M.D., and Cardiology Associates of Stuart, P.A. Dinah Stein, Esq. C HICKS, PORTER, EBENFELD & STEIN, P.A. 799 Brickell Plaza, 9th Floor Miami, FL 33131 dstein@mhickslaw.com akozub@mhickslaw.com eclerk@mhickslaw.com Counsel for Defendants Kunal Chaudhry, M.D., and Cardiology Associates of Stuart, P.A. 7 MARTIN HEALTH SYSTEM TITLE: CARDIAC TRANSFERS DECISION TREE FROM TRADITION MEDICAL CENTER(TMC)INTERVENTIONAL LAB POLICY NO.: ISSUED FOR: [X]Entire Health System [ ]Medical Center [ ]MFMI [ ]Medical Group [ ]Coastal Care []Foundation [ ]South Hospital [ ]Tradition Medical Center 1. PURPOSE: Cardiac cath lab decision tree to safely transfer patients to MC Hospital who need to have cardiac interventions performed. Cardiac Cath Lab Decision Tree B v Disease needs PCI B v Sheath pulled groin/radial stable • Stable and schedule next day • Phase II for recovery and admit orders v B B P Y Admit to inpatient and call TX center for move to MC Cardiac Cath Lab v Pre procedure orders per MD and Transfer orders for following day 2. PROCEDURE: Disease needs PCI C O 1. Urgent/Emergent----patient stable 2. Sheath left in place 3. IR/Cath Lab nurse will take patient to Phase 1 to monitor and await transfer to MC Cath Lab. 4. MD places correct orders (procedure and transfer) 5. IR/Cath nurse will call transfer center /coastal for transport/ notify ADON 6. MC Cath nurse notifies bed control of direct transfer to MC Cardiac Cath Lab 7. Bed control makes arrangements for bed post procedure 8. IR/Cath Lab nurse calls report to MC Cardiac Cath Lab 9. IR/Cath Lab nurse Tradition lab accompanies patient to MC Cardiac Cath Lab for PCI 10 Coastal Care transport returns IR/Cath Lab nurse to Tradition Medical Center. Disease needs immediate intervention IABP placed 1. MD decision to transfer to ICU at Tradition or transfer to North 2. IR/Cath Lab nurse will take patient to Tradition ICU. 3. If transfer to MC Cardiac Cath a. MD places correct orders b. IR/Cath nurse will call transfer center / coastal care and notify bed control, SLC 911 for transport with Tradition RN. c. Tradition RN calls report to MC Cardiac Cath d. Verify with bed control available ICU bed at MC Hospital e. Direct transfer to MC Cardiac Cath Lab, handoff f. SLC and RN return to Tradition EXHIBIT A Cardiac Cath = Diffuse disease needs cardiac surgical consult 1. Sheath pulled groin intact 2. IR/Cath lab nurse will take patient to TMC Phase I I recovery 3. MD places correct orders to be admitted to MC Hospital as inpatient and await transfer to North OR Transfer to MC North inpatient for surgical consult for CABG 3. REFERENCES: AHCA FS 408.0361: http://www.led.state.ffus/Statutes/index.cfm?App mode=Display Statute&Search Strin Y cr=&URL=0400-0499/0408/Sections/0408.0361.html P C O EXHIBIT A ·1· FREDERIC CHARLES GREER,· · · ) IN THE CIRCUIT COURT OF · · III and MELISSA ANNE· · · · ·) THE 19TH JUDICIAL CIRCUIT ·2· GREER, as Husband and· · · · ) IN AND FOR MARTIN COUNTY, · · Wife, and FREDERIC CHARLES· ·) FLORIDA ·3· GREER, III and MELISSA· · · ·) · · ANNE GREER, individually,· · ) CASE NO: 2019CA000015 ·4· · · · · · · · · · · · · · · ·) · · · · · · ·Plaintiffs,· · · · ·) ·5· · · · · · · · · · · · · · · ·) · · VS.· · · · · · · · · · · · · ) ·6· · · · · · · · · · · · · · · ·) · · MARTIN MEMORIAL MEDICAL· · · ) ·7· CENTER, INC., D/B/A MARTIN· ·) · · MEDICAL CENTER, a Florida· · ) ·8· Corporation, KUNAL· · · · · ·) · · CHAUDHRY, MD, and· · · · · · ) Y ·9· CARDIOLOGY ASSOCIATES OF· · ·) · · STUART, P.A., a Florida· · · ) P 10· Profit Corporation,· · · · · ) · · · · · · · · · · · · · · · · ·) O 11· · · · · ·Defendants.· · · · ·) C 12 13· · · · · · ·----------------------------------- 14· · · · · · · ORAL AND VIDEOTAPED DEPOSITION OF 15· · · · · · · · · BAILEY ESTES, BSN, RN-BC 16· · · · · · · · · · · NOVEMBER 25, 2020 17· · · · · · ·----------------------------------- 18 19 20· · · ·ORAL AND VIDEOTAPED DEPOSITION OF BAILEY ESTES, 21· BSN, RN-BC, produced as a witness at the instance of the 22· PLAINTIFF, and duly sworn, was taken in the above-styled 23· and numbered cause on November 25, 2020, from 9:19 a.m. 24· to 1:07 p.m., via Zoom, before Brandi Schmitz, CSR in 25· and for the State of Texas, reported by machine EXHIBIT B ·1· shorthand, at 1641 South 15th Street, Abilene, Texas ·2· 79602, pursuant to the Florida Rules of Civil Procedure, ·3· the 22nd Emergency Order Sections 3 (c) and (d), and the ·4· provisions stated on the record or attached hereto. ·5 ·6 ·7 ·8 Y ·9 P 10 O 11 C 12 13 14 15 16 17 18 19 20 21 22 23 24 25 EXHIBIT B ·1· · · · · · · · · · A P P E A R A N C E S ·2· FOR THE PLAINTIFFS: ·3· · · ·PAUL M. SILVA, M.D. · · · · ·PETER J. SOMERA, JR. ·4· · · ·SOMERA & SILVA, LLP · · · · ·One Boca Place ·5· · · ·2255 Glades Road, Suite 232W · · · · ·Boca Raton, Florida 33431 ·6· · · ·Phone:(561)981-8881 · · · · ·Fax:(561)981-8887 ·7· · · ·depos@somerasilva.com ·8 · · FOR THE DEFENDANT MARTIN MEMORIAL MEDICAL CENTER, INC., Y ·9· D/B/A MARTIN MEDICAL CENTER, a Florida Corporation: P 10· · · ·MATTHEW PODOLNICK · · · · ·STEARNS WEAVER MILLER WEISSLER O 11· · · ·ALHADEFF & SITTERSON, P.A. · · · · ·200 East Las Olas Blvd. C 12· · · ·Suite 2100 · · · · ·Fort Lauderdale, Florida 33301 13· · · ·Phone:(954)462-9543 · · · · ·mpodolnick@stearnsweaver.com 14 15· FOR THE DEFENDANTS KUNAL CHAUDHRY, MD, and CARDIOLOGY · · ASSOCIATES OF STUART, P.A., a Florida Profit 16· Corporation: 17· · · ·HECTOR R. BUIGAS · · · · ·LAW OFFICES OF KEITH J. PUYA, 18· · · ·P.A. · · · · ·4880 Donald Ross Road 19· · · ·Suite 225 · · · · ·Palm Beach Gardens, Florida 20· · · ·33418 · · · · ·Phone:(561)408-3772 21· · · ·hbuigas@puyalaw.com 22 23 · · ALSO PRESENT: 24· · · ·Roy Perez - Videographer 25 EXHIBIT B ·1· · · · · · · · · · · · · · INDEX · · · · · · · · · · · · · · · · · · · · · · · · · · · · PAGE ·2 · · Appearances.........................................· ·3 ·3· Signature and Changes............................... 184 · · Reporter's Certificate.............................. 186 ·4 ·5· BAILEY ESTES, BSN, RN-BC ·6· · · ·EXAMINATION BY DR. SILVA........................ 6 · · · · ·EXAMINATION BY MR. PODOLNICK.................... 43 ·7· · · ·EXAMINATION BY MR. BUIGAS.......................164 · · · · ·EXAMINATION BY DR. SILVA........................164 ·8· · · ·EXAMINATION BY MR. PODOLNICK....................175 · · · · ·EXAMINATION BY DR. SILVA........................178 Y ·9 P 10 · · · · · · · · · · · · · ·EXHIBITS O 11· NO.· ·DESCRIPTION· · · · · · · · · · · · · · · · · PAGE · · 1· · ·Expert Opinions.............................· · 48 C 12· 2· · ·Cross-Notice of Deposition Duces Tecum......· · 51 · · 3· · ·Correspondence between Nurse Estes and 13· · · · Somera & Silva, LLP.........................· · 53 · · 4· · ·Nurse Estes' Copy of the Cardiac Cath 14· · · · Event Log with Notes........................· · 56 · · 5· · ·Nurse Estes' File...........................· · 60 15· 6· · ·Fee Schedule................................· · 79 · · 7· · ·CV..........................................· · 81 16· 8· · ·Twitter Profile.............................· · 87 · · 9· · ·CLI Article.................................· · 95 17· 10· · Plaintiffs' Fifth Amended Fact and Expert · · · · · Witness List................................· ·109 18· 11· · Cardiac Transfer Decision Tree from · · · · · Tradition Medical Center Interventional 19· · · · Lab.........................................· ·158 20 21· · (Exhibits 3 through 6 to be provided by the witness, · · · · · · · · · ·Bailey Estes, BSN, RN-BC) 22 23 24 25 EXHIBIT B ·1· · · · · · · · · · P R O C E E D I N G S ·2· · · · · · · · THE COURT REPORTER:· Today's date is ·3· November 25, 2020.· The time is 9:19 a.m. ·4· · · · · · · · This is the oral deposition of BAILEY ·5· ESTES, BSN, RN-BC.· This is the oral -- oh, sorry -- and ·6· it is being conducted remotely in accordance with the ·7· current emergency order regarding the COVID-19 State of ·8· Disaster, Sections 3 (c) and (d). Y ·9· · · · · · · · The witness is located at 1641 South 15th P 10· Street, Abilene, Texas 79602. O 11· · · · · · · · My name is Brandi Schmitz, CSR No. 8093. I C 12· am administering the oath and reporting the deposition 13· remotely by stenographic means from my residence within 14· the state of Texas.· The witness has been identified to 15· me through attestation of counsel. 16· · · · · · · · Would counsel please state who they 17· represent and their location for the record? 18· · · · · · · · DR. SILVA:· Attorney Paul Silva for the 19· Greer family, and I agree to any stipulations for this 20· Zoom video depo. 21· · · · · · · · MR. PODOLNICK:· This is Matt Podolnick from 22· Stearns Weaver Miller on behalf of the defendant, Martin 23· Memorial Medical Center. 24· · · · · · · · MR. BUIGAS:· This is Hector Buigas on 25· behalf of Dr. Chaudhry and his practice, and I consent. EXHIBIT B ·1· · · · · · · · MR. SOMERA, JR.:· Peter Somera for the ·2· plaintiff, consent. ·3· · · · · · · · · BAILEY ESTES, BSN, RN-BC, ·4· having been first duly sworn, testified as follows: ·5· · · · · · · · · · · · ·EXAMINATION ·6· BY DR. SILVA: ·7· · · ·Q.· Good morning, ma'am.· Give us your full name ·8· for the record. Y ·9· · · ·A.· Bailey Ann Estes. P 10· · · ·Q.· And can you tell us, are you a nurse? O 11· · · ·A.· Yes, I am. C 12· · · ·Q.· All right.· I have a copy of your CV with me 13· and it has a lot of different designations after your 14· name.· So could you please go through those designations 15· and describe what they are to us? 16· · · ·A.· Yes.· I am a registered nurse.· I'm also board 17· certified in cardiovascular nursing.· I have my 18· bachelor's degree in nursing.· I am a certified first 19· assistant and certified in perioperative nursing as well 20· as a registered cardiovascular invasive specialist. 21· · · ·Q.· Okay.· Let me start with BSN after your name, 22· that designation, what does that stand for? 23· · · ·A.· My bachelor's of science in nursing. 24· · · ·Q.· Where did you obtain your bachelor's of science 25· in nursing? EXHIBIT B ·1· · · ·A.· University of Texas at Arlington. ·2· · · ·Q.· Was that a four-year degree? ·3· · · ·A.· Yes. ·4· · · ·Q.· When did you complete that BSN? ·5· · · ·A.· I completed that in 2018. ·6· · · ·Q.· Okay.· Then you have RN-BC after your name. ·7· What does that stand for? ·8· · · ·A.· It stands for registered nurse-board certified Y ·9· for cardiovascular nursing. P 10· · · ·Q.· Okay.· How did you -- what did you have to do O 11· to obtain board certification cardiovascular nursing? C 12· · · ·A.· I took an examination. 13· · · ·Q.· When did you take -- 14· · · ·A.· That was -- 15· · · ·Q.· When? 16· · · ·A.· That was -- that was in 2018 as well. 17· · · ·Q.· What -- what did you have to do in order to sit 18· for this board as far as any type of experience or any 19· type of on-the-job training? 20· · · ·A.· Yes.· At least two years of cardiovascular 21· nursing experience. 22· · · ·Q.· And describe to us what that two years of 23· cardiovascular nursing experience entailed.· How did you 24· get that? 25· · · ·A.· I had worked -- whenever I was a licensed EXHIBIT B ·1· practical nurse I worked for -- on telemetry and cardiac ·2· ICU taking care of post-cath patients, general cardiac ·3· patients.· I've also worked in the cardiac cath lab to ·4· gain my experience. ·5· · · ·Q.· Okay.· And we'll -- we'll go through that a ·6· little more later, but I want to continue with the ·7· designations after your name.· RNFA, what does that ·8· stand for? Y ·9· · · ·A.· Registered nurse first assistant. P 10· · · ·Q.· And what does a registered nurse first O 11· assistant do? C 12· · · ·A.· It gives me privileges to assist in surgeries, 13· or I get to assist in the cardiac cath lab. 14· · · ·Q.· And what types of procedures do you assist in 15· the cardiac cath lab? 16· · · ·A.· Your regular diagnostic cardiac caths, 17· intervention, pacemaker insertions, TAVR, peripheral 18· vascular interventions. 19· · · ·Q.· Does that include balloon angioplasties? 20· · · ·A.· It does. 21· · · ·Q.· Does it include diagnostic cardiac 22· catheterizations with the measurement of ejection 23· fractions? 24· · · · · · · · MR. PODOLNICK:· Form. 25· · · ·A.· Yes. EXHIBIT B ·1· · · ·Q.· (BY DR. SILVA)· The CNOR designation, what does ·2· that stand for? ·3· · · ·A.· It is a perioperative nursing certification. I ·4· obtained that with my first assist certification. ·5· · · ·Q.· And what does that certification allow you to ·6· do? ·7· · · ·A.· It doesn't allow me to do anything.· It's just ·8· an examination that I took having at least two years Y ·9· worth of perioperative nursing experience, which I P 10· obtained in the cath lab. O 11· · · ·Q.· The RCIS designation, what does that stand for? C 12· · · ·A.· Registered cardiovascular invasive specialist. 13· · · ·Q.· And what -- what does that designation allow 14· you to do? 15· · · ·A.· In my cath lab it doesn't allow me any extra 16· privileges.· It's just a certification which I obtained 17· after having almost two years of experience in the 18· cardiac cath lab.· At the time I took the exam I had to 19· have at least 1500 cases in experience. 20· · · ·Q.· How many cases in the cardiac cath lab have you 21· participated in in your career? 22· · · ·A.· Right over 5,000. 23· · · ·Q.· Can you describe to me your work history in the 24· medical field starting from the very first job you had 25· in the medical field? EXHIBIT B ·1· · · ·A.· I started out as a certified nurse assistant ·2· that I worked for one year at Lubbock Heart Hospital. I ·3· have two years of experience as a -- ·4· · · ·Q.· Hold on.· Stop.· Can you give me the years when ·5· you did those things, also, okay? ·6· · · ·A.· Okay.· Let me see.· That year was -- I did that ·7· from 2010 to 2011. ·8· · · ·Q.· Okay.· Continue. Y ·9· · · ·A.· Then I worked as a -- as a licensed vocational P 10· nurse at Hendrick Medical Center with telemetry, CICU. O 11· That was from 2013 to 2015.· Then I worked as a C 12· registered nurse in the cardiac cath lab at Hendrick 13· Medical Center from October 2015 to November 2019. I 14· now work directly for a physician at Hendrick Provider 15· Network, an interventional cardiologist, and assist in 16· his procedures in the cardiac cath lab from 2019 to 17· present. 18· · · ·Q.· And when you stated earlier that you worked in 19· the telemetry, CICU from 2013 to 2015, what does CICU 20· stand for? 21· · · ·A.· Cardiac intensive care unit. 22· · · ·Q.· In your work -- 23· · · · · · · · MR. PODOLNICK:· That's the videographer. 24· · · · · · · · DR. SILVA:· All right. 25· · · · · · · · MR. PODOLNICK:· We'll -- we'll -- we'll EXHIBIT B ·1· record my questions. ·2· · · · · · · · DR. SILVA:· That's fine. ·3· · · ·Q.· (BY DR. SILVA)· In your experience in the ·4· cardiac cath lab, can you tell us the first year that ·5· you started working in the cardiac cath lab in any ·6· capacity? ·7· · · ·A.· In October 2015 is when I started. ·8· · · ·Q.· Okay.· And during the time that you worked in Y ·9· the cath lab from 2015 to the present, have you P 10· participated as a documenter during a procedure? O 11· · · ·A.· Yes, I have. C 12· · · ·Q.· Have you participated as a circulator during a 13· cardiac cath procedure? 14· · · ·A.· Yes, I have. 15· · · ·Q.· Have you participated as a scrub tech during a 16· cardiac cath procedure? 17· · · ·A.· Yes, I have. 18· · · ·Q.· Have you participated as a assistant or first 19· assistant during a cardiac cath procedure or 20· interventional procedure? 21· · · ·A.· Yes, I have. 22· · · ·Q.· So you've participated in all the different 23· functions that nursing personnel or medical providers 24· would provide during a cardiac cath or during a cardiac 25· interventional procedure? EXHIBIT B ·1· · · · · · · · MR. PODOLNICK:· Form -- ·2· · · ·A.· That is correct. ·3· · · · · · · · MR. PODOLNICK:· Form, leading, compound. ·4· · · ·Q.· (BY DR. SILVA)· Can you describe to us all the ·5· different functions and capacities that you've -- have ·6· experience in in a cardiac cath lab from the time that ·7· you started in 2015 up until today? ·8· · · ·A.· I have functioned at a circulator, a monitor, a Y ·9· scrub nurse and x-ray technician and first assist. P 10· · · ·Q.· Okay.· So describe for us what duties or the O 11· functions are of each one of those different capacities C 12· you've just described. 13· · · ·A.· Okay.· The circulating nurse is responsible 14· mainly for the patient.· They -- we provide moderate 15· sedation, monitor the vital signs, give other 16· medications per the physician.· The monitor documents 17· everything in the case.· It also keeps up with 18· hemodynamic.· The scrub assists the physician in 19· anything that he or she needs during the case, and for 20· x-ray drive the table and move the C-arm as needed for 21· angiography. 22· · · ·Q.· Okay.· And who -- which one of those people is 23· responsible for documenting conversations between the 24· interventional cardiologists and -- and consults between 25· the interventional cardiologists and other physicians? EXHIBIT B ·1· · · ·A.· The -- ·2· · · · · · · · MR. PODOLNICK:· Form -- I'm sorry, ·3· Ms. Estes, I'm -- I'm sorry to interrupt you, but ·4· sometimes I need to make a legal objection.· You can ·5· still answer the question.· I just want to get my ·6· objection in.· I'm not interrupting you on purpose, ·7· okay?· So -- ·8· · · · · · · · THE WITNESS:· No worries. Y ·9· · · · · · · · MR. PODOLNICK:· -- form, predicate. P 10· · · ·Q.· (BY DR. SILVA)· Go ahead. O 11· · · ·A.· That is correct.· It's the -- it's the monitor. C 12· Sorry. 13· · · ·Q.· Can you describe to us your experience in 14· regards to documenting conversations between the 15· interventional cardiologists and other physicians in the 16· cardiac cath lab? 17· · · ·A.· Yes.· Typically any time a doctor has talked 18· about the case with another physician, that is 19· documented within the cardiac catheter report. 20· · · ·Q.· And whose job or responsibility is it to 21· document that within the cardiac cath event log? 22· · · ·A.· The monitor. 23· · · ·Q.· Does -- you said when those conversations 24· occur, does that include in-person conversations, 25· telephone conversations and consults? EXHIBIT B ·1· · · ·A.· It does. ·2· · · ·Q.· Is that the standard of care in the cardiac ·3· cath lab? ·4· · · ·A.· Yes, it is. ·5· · · ·Q.· Is that the standard of care in this country in ·6· a cardiac cath lab? ·7· · · ·A.· Yes, it is. ·8· · · ·Q.· Is that what you were taught in nursing school Y ·9· or during your training in the cardiac cath lab? P 10· · · · · · · · MR. PODOLNICK:· Form. O 11· · · ·A.· Yes, that is correct. C 12· · · ·Q.· (BY DR. SILVA)· Can you tell us what training 13· and where you received that training that conversations 14· between -- and consults between the interventional 15· cardiologists and other physicians has to be documented 16· in the cardiac cath event log? 17· · · ·A.· I was taught -- 18· · · · · · · · MR. PODOLNICK:· Form. 19· · · ·A.· I was taught that while I was training in the 20· cardiac cath lab for the monitor position. 21· · · ·Q.· (BY DR. SILVA)· Can you describe to us your 22· experience in regards to the various participants in the 23· cardiac cath lab documenting in a cardiac cath event log 24· any complications that occur during a procedure? 25· · · ·A.· Yes, complications are supposed to be EXHIBIT B ·1· documented in the cardiac event log. ·2· · · ·Q.· And of -- of those various different roles in ·3· the cardiac cath lab, which person is responsible for ·4· documenting complications that occur in the cardiac cath ·5· lab? ·6· · · · · · · · MR. PODOLNICK:· Form. ·7· · · ·A.· The monitor. ·8· · · ·Q.· (BY DR. SILVA)· Is that -- is it the standard Y ·9· of care for a monitor to document complications that P 10· occur during a procedure in the cardiac cath lab? O 11· · · ·A.· Yes. C 12· · · ·Q.· And is that the standard of care throughout the 13· United States of America, the nurse -- the nursing or 14· the cardiac personnel standard of care? 15· · · ·A.· Yes. 16· · · · · · · · MR. PODOLNICK:· Form on the last one. 17· · · ·Q.· (BY DR. SILVA)· Can you describe to us where 18· you obtained the training and education that requires 19· the monitor to document complications that occur in the 20· cardiac cath lab in the event log? 21· · · ·A.· On-the-job training. 22· · · ·Q.· Who -- the hospital that you work at, can you 23· give us the name of that hospital? 24· · · ·A.· Hendrick Medical Center. 25· · · ·Q.· At Hendrick Medical Center, what city is that EXHIBIT B ·1· located in? ·2· · · ·A.· It's in Abilene, Texas. ·3· · · ·Q.· Does Hendrick Medical Center have a cardiac ·4· cath lab? ·5· · · ·A.· Yes. ·6· · · ·Q.· Does Hendrick Medical Center have providers ·7· that perform cardiac catheterizations and interventional ·8· procedures? Y ·9· · · ·A.· Yes, they do. P 10· · · ·Q.· Does Hendrick Medical Center have the ability O 11· to perform an emergency or a routine coronary artery C 12· bypass grafting surgery? 13· · · ·A.· Yes, they do. 14· · · ·Q.· So this hospital also has heart surgeons or 15· cardiovascular surgeons on staff? 16· · · ·A.· Yes, that's correct. 17· · · · · · · · MR. PODOLNICK:· Form on the last one. 18· · · ·Q.· (BY DR. SILVA)· Does the hospital that you work 19· at Hendrick, do they also have interventional 20· cardiologists? 21· · · ·A.· Yes, they do. 22· · · ·Q.· Okay.· Are you -- do you have any licenses in 23· the state of Texas? 24· · · ·A.· A registered nurse license. 25· · · ·Q.· Is that up to date? EXHIBIT B ·1· · · ·A.· Yes, it is. ·2· · · ·Q.· Do you have any licenses in any other states ·3· throughout the United States? ·4· · · ·A.· No, I do not. ·5· · · ·Q.· On your CV you have a compact license.· What is ·6· that? ·7· · · ·A.· That basically means that the state of Texas, ·8· and there's various other states that have agreements on Y ·9· nursing license.· So if I were to move to another state P 10· it's easier for me to transfer my licensure to that O 11· state and register there. C 12· · · ·Q.· Okay.· Are you certified in advanced cardiac 13· life support? 14· · · ·A.· Yes, I am. 15· · · ·Q.· Are you certified in basic life support? 16· · · ·A.· Yes, I am. 17· · · ·Q.· Can you tell us what professional memberships 18· and appointments you have? 19· · · ·A.· I'm part of the membership for The American 20· College of Cardiology, CLI Global Society, the American 21· Nurses Association, the Texas Nurses Association, 22· Society of Cardiovascular Angiography and Interventions. 23· I hold appointments in the CLI Global Society, 24· Membership and Social Media Committee, and then I also 25· hold an appointment for the ACC Cardiovascular Team. EXHIBIT B ·1· · · ·Q.· And what is the ACC Cardiovascular Team ·2· appointment? ·3· · · ·A.· That one is for chairman of the communications ·4· committee.· That one just started this month, so -- ·5· · · ·Q.· Okay.· And are you on any editorial boards or ·6· are you a journal reviewer? ·7· · · ·A.· Yes.· Editorial board for the Cath Lab Digest ·8· and I'm a reviewer for Cardiovascular Disease Management Y ·9· and as well as the Cath Lab Digest.· I'm a reviewer for P 10· them as well. O 11· · · ·Q.· Can you describe to us, what is Cath Lab C 12· Digest? 13· · · ·A.· Cath Lab Digest is a free kind of open access 14· journal that is provided to -- it has -- it's a free 15· subscription for people who are in the cardiac cath lab. 16· Basically it just has case reports, information on new 17· studies, new technology. 18· · · ·Q.· And what about Vascular Disease Management, 19· what kind of -- is that a journal or -- 20· · · ·A.· It's -- it's more online.· It is a journal, but 21· it doesn't come in print.· And it's basically the same, 22· but more focused on peripheral vascular disease. 23· · · ·Q.· Okay.· And do you have publications that you've 24· authored? 25· · · ·A.· Yes.· I have multiple. EXHIBIT B ·1· · · ·Q.· How many publications have you authored? ·2· · · ·A.· I have been an author on ten publications. ·3· · · ·Q.· Are there any publications that are germane or ·4· specific to the issues in this case that you have? ·5· · · ·A.· There are not. ·6· · · ·Q.· Okay.· And then the Abstract Presentations, ·7· what do those entail? ·8· · · ·A.· Those are basically from research that I've Y ·9· done within my hospital or case reviews that were P 10· presented at -- sorry -- that were presented at places O 11· like the American Cardio -- College of Cardiology, C 12· Scientific Sessions, major meetings. 13· · · ·Q.· The -- we're here for a patient today, 14· Mr. Frederick Greer.· Did our law firm contact you to 15· ask you to render opinions regarding his care at Martin 16· Medical Center in this case? 17· · · ·A.· Yes, they did. 18· · · ·Q.· And can you tell us when you were first 19· contacted? 20· · · ·A.· In May of 2020. 21· · · ·Q.· And were you sent various documents to arrive 22· at your opinions in this matter? 23· · · ·A.· Yes, I was. 24· · · ·Q.· Were you sent Martin Medical Center records for 25· Mr. Greer? EXHIBIT B ·1· · · ·A.· Yes, I was. ·2· · · ·Q.· Were you sent the cardiac cath lab event log ·3· for Mr. Greer? ·4· · · ·A.· Yes. ·5· · · ·Q.· Were you sent the deposition transcript of ·6· Dr. Tolis, T-O-L-I-S? ·7· · · ·A.· Yes. ·8· · · ·Q.· Sent the deposition transcript of Dr. Selwyn, Y ·9· S-E-L-Y-W-Y-N? P 10· · · ·A.· Yes. O 11· · · ·Q.· Sent the deposition transcript of Dr. Gelfand, C 12· G-E-L-F-A-N-D? 13· · · ·A.· Yes. 14· · · ·Q.· Sent the deposition transcript of Dr. Chaudhry, 15· C-H-A-U-D-H-R-Y? 16· · · ·A.· Yes. 17· · · ·Q.· Sent the deposition transcript of Dr. Crouch, 18· C-R-O-U-C-H? 19· · · ·A.· Yes. 20· · · ·Q.· Sent the deposition transcript of Nurse Tilley, 21· T-I-L-L-E-Y? 22· · · ·A.· Yes. 23· · · ·Q.· Sent the deposition transcript of Brian 24· Carroll? 25· · · ·A.· Yes. EXHIBIT B ·1· · · ·Q.· Sent the deposition transcript of Cynthia ·2· Silva? ·3· · · ·A.· Yes. ·4· · · ·Q.· And the transcript of Katherine Fournier, ·5· F-O-U-R-N-I-E-R? ·6· · · ·A.· Yes. ·7· · · ·Q.· Deposition transcript of Jacob Bennett, ·8· B-E-N-N-E-T-T? Y ·9· · · ·A.· Yes. P 10· · · ·Q.· And then you were sent the various policies and O 11· procedures from the Martin Medical Center cardiac cath C 12· lab, including the cardiac transfers decision tree? 13· · · ·A.· Yes. 14· · · ·Q.· The balloon angioplasty? 15· · · ·A.· Yes. 16· · · ·Q.· Cardiac stent? 17· · · ·A.· Yes. 18· · · ·Q.· Left heart catheterization? 19· · · ·A.· Yes. 20· · · ·Q.· STEMI cardiac alert? 21· · · ·A.· Yes. 22· · · ·Q.· Description of roles of cath lab personnel? 23· · · ·A.· Yes. 24· · · ·Q.· Roles of cath lab personnel? 25· · · ·A.· Yes. EXHIBIT B ·1· [ Video recording now ] ·2· · · ·Q.· And have you had -- well, let me -- strike ·3· that. ·4· · · · · · · · Have you also been sent the -- a portion of ·5· the alleged audit trail with various redactions? ·6· · · ·A.· Yes. ·7· · · ·Q.· Have you been sent the two versions of the -- ·8· of the cardiac result six-page reports of Dr. Chaudhry? Y ·9· · · ·A.· Yes. P 10· · · ·Q.· Have you been provided with the expert opinions O 11· as you relayed those to our law firm prior to today? C 12· · · ·A.· Yes. 13· · · ·Q.· How many pre-deposition conferences did you 14· have with our law firm? 15· · · ·A.· About four or five. 16· · · ·Q.· And when did those occur? 17· · · ·A.· They've occurred periodically throughout the 18· past month and a half. 19· · · ·Q.· Okay.· Once you received all of the information 20· that we just went through, did you review it? 21· · · ·A.· Yes. 22· · · ·Q.· And approximately how much time did you spend 23· in reviewing the documentation that you were provided 24· with? 25· · · ·A.· It was around 15 hours. EXHIBIT B ·1· · · ·Q.· Okay.· Once you reviewed all the information ·2· that we've discussed, did you arrive at opinions in this ·3· matter? ·4· · · ·A.· Yes, I did. ·5· · · ·Q.· Did you relay those opinions to myself and ·6· Mr. Somera during our pre-deposition conferences? ·7· · · ·A.· Yes, I did. ·8· · · ·Q.· Did our law firm memorialize those opinions in Y ·9· written form that have been titled Expert Opinions that P 10· are -- that I've sent over to opposing counsel today? O 11· · · ·A.· That is correct. C 12· · · ·Q.· Is everything on this expert opinion document 13· your opinions except for the definition of Florida 14· statute reckless disregard? 15· · · ·A.· That is correct. 16· · · ·Q.· Have the attorneys or anyone else influenced 17· any of your opinions that are written on this document? 18· · · ·A.· No, they have not. 19· · · ·Q.· Have you consulted with any colleagues or any 20· other experts to arrive at these opinions that are 21· memorialized? 22· · · ·A.· No. 23· · · ·Q.· Do you need any other information that you 24· haven't received up until today to arrive at these 25· opinions? EXHIBIT B ·1· · · ·A.· No. ·2· · · ·Q.· If there is additional information that is ·3· provided to you during discovery after today, would you ·4· reserve the right to change or add to your opinions? ·5· · · · · · · · MR. PODOLNICK:· Form. ·6· · · ·A.· Yes, I do. ·7· · · ·Q.· (BY DR. SILVA)· Okay.· The -- were you also ·8· provided with a response by Michael Mittelmark, Esquire, Y ·9· on April 8, 2019 in regards to a request to produce by P 10· the plaintiff for all cardiothoracic surgery policies O 11· and procedures, and the answer was none? C 12· · · ·A.· Correct. 13· · · · · · · · MR. PODOLNICK:· Form, misstates the 14· document. 15· · · ·Q.· (BY DR. SILVA)· Were you also provided with an 16· answer, Number 18 on a plaintiff's request to produce 17· for all policies and procedures in coronary artery 18· bypass grafting, and the response was:· Objection; vague 19· and overbroad.· Without waiving any objection and after 20· diligent inquiry, the answer was none. 21· · · · · · · · Were you provided with that? 22· · · ·A.· That's correct. 23· · · ·Q.· The policy and procedure regarding the cardiac 24· transfers decision tree that you received from our law 25· firm, does the plaintiff exhibit date indicate that it EXHIBIT B ·1· was provided on March 6th, 2020? ·2· · · ·A.· Yes. ·3· · · ·Q.· Do you know why the defendant hospital would ·4· not have provided this cardiac transfers decision tree ·5· policy and pro