Motion for Change of Venue in ROZ C LYLES vs. SSC MCKINNEY OPERATING COMPANY, LLCet al| Trellis.Law

On July 10, 2020 a Motion,Ex Parte was filed involving a dispute between Lyles, Roz C, and Frazier, Allen J, Rn, Keng, Jr., Moses J, Md, Mobile Md Pa, Mpd Operators Mckinney, Llc, Ssc Mckinney Operating Company, Llc, Zafar, Zahid N, Md, for MEDICAL MALPRACTICE in the District Court of Dallas County.

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FILED
9/1/2020 3:31PM
FELICIA PITRE
DISTRICT CLERK
DALLAS CO.,TEXAS
Debra ClarkDEPUTY

CAUSE NO. DC-20-09420

ROZ C. LYLES, INDIVIDUALLY AND AS § IN THE DISTRICT COURT
REPRESENTATIVE OF THE ESTATE OF §
WILLIAM LYLES, DECEASED §
§
V. §
44TH JUDICIAL DISTRICT
§
SSC MCKINNEY OPERATING §
COMPANY, LLC d/b/a NORTH PARK §
HEALTH AND REHABILITATION CENTER; §
MPD OPERATORS MCKINNEY, LLC d/b/a §
BELTERRA HEALTH & REHAB; ZAHID N. §
ZAFAR, MD; MOBILE MD PA; MOSES J. §
KENG, JR, MD, and ALLEN J. FRAZIER, RN § DALLAS COUNTY, TEXAS

DEFENDANTS MPD OPERATORS MCKINNEY, LLC d/b/a BELTERRA HEALTH &
REHAB and ALLEN J. FRAZIER, RN’S OBJECTIONS TO PLAINTIFF’S CHAPTER
74 EXPERT REPORTS SUBJECT TO DEFENDANTS’
MOTION TO TRANSFER VENUE

TO THE HONORABLE JUDGE OF SAID COURT:

COME NOW Defendant MPD Operators McKinney, LLC d/b/a Belterra Health & Rehab
and Allen J. Frazier, RN and ﬁle their Obj ections t0 Plaintiff’s Chapter 74 Expert Reports Subject

t0 Defendants’ Motion t0 Transfer Venue pursuant t0 Section 74.35 1 0f the Texas Civil Practice

& Remedies Code. In support thereof, Defendants would respectfully show the Court as follows:

INTRODUCTION
This is a health care liability claim involving allegations against MPD Operators

McKinney, LLC d/b/a Belterra Health & Rehab and Allen J. Frazier, RN. As such, it isgoverned

by Chapter 74 of the Texas Civil Practice & Remedies Code.

DEFENDANTS MPD OPERATORS MCKINNEY, LLC d/b/a BELTERRA HEALTH & REHAB AND
ALLEN J. FRAZIER, RN’S OBJECTIONS TO PLAINTIFF’S CHAPTER 74 EXPERT REPORTS SUBJECT
TO DEFENDANTS’ MOTION TO TRANSFER VENUE - Page 1
The facts according t0 Plaintiffs’ experts’ reports are as follows. This case involves the

care and treatment 0f William Lyles. Mr. Lyles was 86-years 01d and had an extensive medical

history including congestive heart failure, coronary artery disease With stents, pacemaker,

deﬁbrillator, dementia, colon cancer, chronic kidney disease, and hip surgery. In May of 2019

Mr. Lyles suffered another hip fracture and was transferred to Medical City Hospital for treatment.

After surgery and four days at Medical City, Mr. Lyles was discharged to Belterra for rehabilitation

on May 29, 2019. Upon arrival at Belterra, Mr. Lyles was assessed by the Director 0f Nursing

Allen Frazier, R.N.

On June 11, 2019, X-ray imaging revealed Mr. Lyles’ “hip [was] out 0f socket.” The

provider ordered Mr. Lyles be transferred to Medical City for treatment. The dislocation was

treated in the emergency department, and Mr. Lyles was admitted for treatment 0f an infection

with IV antibiotics. He was discharged back t0 Belterra 0n June 14, 2019 with orders for the use

of a knee immobilizer and hip precautions. Documentation reveals these precautions were

implemented, but despite such, Mr. Lyles’ hip again became dislocated and 0n June 26, 2019 he

was again transferred to Medical City for treatment. Unfortunately, the hip could not be reduced

(corrected) in the emergency department and Mr. Lyles required admission.

Surgery was again required and Mr. Lyles underwent a prostheses revision due t0

“recurrent dislocation. .
.” After a week-long admission, Mr. Lyles was again transferred back to

Belterra for post-operative rehabilitation 0n July 2, 2019. More than a month later, on August 11,

2019, Mr. Lyles called for assistance and was found sitting 0n the ﬂoor beside his bed. He did

not know how he got there but reported n0 complaints 0f pain. The providers and family were

notiﬁed and Mr. Lyles was examined, but no fractures/injuries were discovered.

DEFENDANTS MPD OPERATORS MCKINNEY, LLC d/b/a BELTERRA HEALTH & REHAB AND
ALLEN J. FRAZIER, RN’S OBJECTIONS TO PLAINTIFF’S CHAPTER 74 EXPERT REPORTS SUBJECT
TO DEFENDANTS’ MOTION TO TRANSFER VENUE - Page 2
The following month, it was learned Mr. Lyles again had a hip dislocation. His surgeon

advised surgery was not an option and Mr. Lyles was essentially placed on palliative care. Mr.

Lyles was admitted to hospice care on October 28, 2019 and passed away on November 2, 2019.

II.

OBJECTIONS

Dr. Fanny’s report fails t0 ever offer any mention 0f Belterra, and as such should be

considered n0 report at all as t0 Belterra; however, in an abundance 0f caution, Defendants object

t0 the qualiﬁcations 0f Dr. Fanny, as well as t0 his report as being insufﬁcient as t0 the elements

0f standard 0f care, breach, and causation with respect to Defendants Belterra and Frazier, R.N.

Doctor Fanny’s report is attached as Exhibit 1.

Defendants assert the following objections as t0 Dr. Warshawsky’s report, attached as

Exhibit 2.

gQualiﬁcations:

Plaintiff has asserted both direct negligence and Vicarious liability claims against

Defendant Belterra. Belterra is a rehabilitation facility. Dr. Warshawsky’s curriculum Vitae and

report fail to show how he isqualiﬁed, pursuant t0 TeX. CiV. Prac. & Rem. Code 74.402 to opine

as to the standard of care and breach of a rehabilitation facility, either in claims of direct

negligence, as well as Vicarious liability for the facility’s staff.

Allen Frazier, R.N. was acting as a Director of Nursing for Belterra at the time 0f the care

in question. A DON is an administrative role. Dr. Warshawsky offers no evidence in his

curriculum Vitae or report t0 support he isqualiﬁed to opine as t0 the role 0f Director of Nursing

at a rehabilitation facility. Furthermore, Dr. Warshawsky is critical 0f the nursing staff; however,

DEFENDANTS MPD OPERATORS MCKINNEY, LLC d/b/a BELTERRA HEALTH & REHAB AND
ALLEN J. FRAZIER, RN’S OBJECTIONS TO PLAINTIFF’S CHAPTER 74 EXPERT REPORTS SUBJECT
TO DEFENDANTS’ MOTION TO TRANSFER VENUE - Page 3
he fails to meet the burden t0 show his qualiﬁcations to opine as to the standard 0f care for the

identiﬁed employees of Belterra.

Furthermore, Dr. Warshawsky fails to show himself qualiﬁed to opine as to the causal link

between Defendants’ alleged negligence and Plaintiffs’ claimed damages.

Dr. Warshawsky fails to show himself adequately qualiﬁed to opine 0n the relevant issues

and Defendants object.

Causation:

Dr. Warshawsky’s opinions 0n causation are conclusory and based 0n speculation. Dr.

Warshawsky fails t0 explain the requisite “how and why” regarding his opinions with respect t0

the alleged breaches in the standard 0f care and the injury.

Dr. Warshawsky’s opinions as t0 causation are conclusory, speculative, and insufﬁcient

under Tex. CiV. Prac. & Rem. Code 74.35 1, and Defendants object.

III.

REQUEST FOR RELIEF
WHEREFORE, PREMISES CONSIDERED, Defendants MPD Operators McKinney,

LLC d/b/a Belterra Health & Rehab and Allen J.Frazier, RN respectfully request the Court grant
Defendants’ Motion t0 Transfer Venue previously ﬁled with the Court and, subj ect thereto, sustain

Defendants’ objections, strike the reports 0f Dr. Fanney and Dr. Warshawsky, and for such other

and further relief, both at law and in equity, to which these Defendants may show themselves to

be justly entitled.

/s/ Casey C. Campbell
SUSAN C. COOLEY
State Bar No. 00793546
scoolev®schellcoolev.com
CASEY C. CAMPBELL
State Bar N0. 24064997
ccampbell@schellcoolev.com
CALEB D. ARCHER
State Bar No. 24084658
carcher@schellcoolev.c0m

SCHELL COOLEY RYAN CAMPBELL LLP
5057 Keller Springs Road, Suite 425
Addison, Texas 75001
(214) 665-2000
(214) 754-0060 FAX

ATTORNEYS FOR DEFENDANTS
MPD OPERATORS MCKINNEY d/b/a
BELTERRA HEALTH & REHAB and
ALLEN FRAZIER, RN

I hereby certify that a true and correct copy 0f the above and foregoing document was
served electronically 0n all counsel 0f record in accordance with the Texas Rules of Civil
Procedure, on this 1st day of September 2020.

/S/ Casey C. Campbell
Casey C. Campbell

Via eFile:

Ms. Maria Wormington
Ms. Amy Bryant Lauten
Wormington & Bollinger
212 East Virginia Street
McKinney, TX 75069
maria@w0rmingt0nlegal.com
amy@w0rmingt0nlegal.com

Via eFile:

Ms. Heather A. Kanny
Ms. Ashley E. Miller
Mayer LLP
750 N. Saint Paul St, Ste. 900
Dallas, TX 75201
hkanny@mayerllp.com
amiller@mayerllp.c0m

Via eFile:

Ms. Kimberly L. Cormier
Mrs. Courtney Boes Huber
Beard Kultgen Brophy Bostwick & Dickson, PLLC
15 1 50 Preston Rd, Ste. 230

Dallas, TX 75248
kcorm ier@thetexasﬁrm. com
huber@thetexasﬁrm.com

DEFENDANTS MPD OPERATORS MCKINNEY, LLC d/b/a BELTERRA HEALTH & REHAB AND
ALLEN J. FRAZIER, RN’S OBJECTIONS TO PLAINTIFF’S CHAPTER 74 EXPERT REPORTS SUBJECT
TO DEFENDANTS’ MOTION TO TRANSFER VENUE - Page 6
EXHIBIT 1
DARYL R. FANNEY, M.D.
Diplomate of the American
Board of Radiology
4204 Sandy Bay Drive
Virginia Beach, Virginia 23455

August 14, 2019

Maria Wormington, RN JD
Wormington and Bollinger
212 East Virginia Street
McKinney Texas 75069
972-569-3930
972-547-6440 fax

Re: William Lyles

Dear Ms. Wormington:

At your request, | have reviewed the following Imaging studies and documents:

o North Park Health and Rehabilitation (including but not limited to physical therapy
records)
o Medical City McKinney
o Mobilex Imaging
o 5/23/19: Right hip x-ray

Medical City McKinney, CD # 1

o 5/24/19: Echo, CT head, CT C spine, Pelvis AP, Femur 2 view, right hip, chest x-
ray
o 5/27/19: Pelvis AP
Qualifications and Knowledge of Standard of Care.

| am a medical doctor licensed in the State of Virginia with expertise in Diagnostic
Radiology. After completing a Bachelor of Science degree at the University of North
Carolina at Chapel Hill, | was accepted into the University of Virginia Medical School.
After completing four years of medical school in 1985, |was accepted into the Diagnostic
Radiology Program at the University of Miami in Miami, Florida. | was named Chief
Resident in my fourth year. Following my residency, |completed a one-year fellowship in

Body Imaging at Georgetown Hospital in Washington, DC. | became board certified in
Diagnostic Radiology in 1989 and have practiced diagnostic radiology in Virginia since
1990. In my career | have presided over, and interpreted, tens of thousands of
radiographic studies, including fluoroscopic studies such as that involved in this case.

During my medical career | have enjoyed several appointments pertaining to

radiology. |was an assistant instructor of Radiology in the late 1980's at the University of
Miami School of Medicine, as well as a member of the curriculum committee at the same
institution. In the 1990's | served in various capacities at Chesapeake General Hospital
including Director of Magnetic Resonance Imaging, Ultrasound, and Nuclear Medicine,
Radiation Safety Officer, and Chairman of the Radiation Safety Committee, and finally as
Secretary of the Department of Radiology for 7 years. |am currently the Medical Director
and Chief of Body and Vascular Imaging at MRI & CT Diagnostics in Virginia Beach VA |

have published, co- authored several publications all dealing with radiology-related
subject matter. In addition, | have presented findings in various formats to radiology-
focused groups. A copy of my C.V. is attached to this report.

| have interpreted thousands of radiographic studies including hip radiographs at
issue in this case for a variety of reasons including, but not limited to, hip pain. As a
result of my active medical practice, training, education, and experience in radiologic
medicine, |am knowledgeable of the typical findings of femoral neck fractures at issue
in this case. It is a routine part of my practice to determine if fracture injuries are
traumatic in nature or arise from some other etiology (such as pathologic fractures). |

am qualified through my education and training to determine ifa femoral neck fracture
is acute and to provide a time frame during which is must have occurred given the
patient’s condition and functional status before and after.

The materials and information that | have taken into account are of a type that are
reasonably relied upon by medical experts in arriving at opinions and in drawing
inferences in analysis of standard of care and causation issues. The opinions that |

express in this case are based on reasonable medical probability, which is, in turn, based
on my education, training, and experience as a physician specializing in the area of
radiology.

Factual Background

Mr. Lyles is an 86-year-old man with past medical history of: CHF, CAD, stents
2006, Pacemaker, defibrillator, anxiety, dementia, colon cancer 2009, right

hemicolectomy 2009, CKD, dementia, and GERD. On 2/22/19, he became a resident at
North Park Health and Rehabilitation. On 5/23/19, nursing noted that he complained of
pain to the right hip during care. The physician was notified and a right hip x-ray was
obtained which showed an acute mild superiorly displaced subcapital femoral neck
fracture. The patient was transferred to Medical City McKinney where Dr. McKeIIar
performed surgery on Mr. Lyles on 5/27/19. The procedure included right cemented
hemiarthroplasty. The surgeon was concerned about the condition of the femoral head

2
and sent a sample to pathology Findings included infiltrative tissue in femoral head
(finding either necrotic or caseous material at the fracture line and adjacent soft tissue)
and sent a sample to be cultured as well as to pathology to determine if there was a
metastatic lesion or chronic infection. Pathology indicated only bone and articular

cartilage with degenerative changes. Culture was “Anaerobic, no growth after 5 day;
gram stain, no WBCs, epithelial cells, or organisms seen; fungal, no fungi after 4 weeks;
wound, no growth after 72 hours). This ruled out a pathologic fracture or cancer. On
5/29/19, he was discharged to Belterra Rehabilitation Center where he continues to

reside.

Opinions

| initially reviewed the right hip radiographs from North Park Health and
Rehabilitation Center dated May 23, 2019 at 11:46pm. The study consists of AP and
lateral radiographs. There is a displaced subcapital fracture with cephalad migration of
the distal femoral component. There is mild indistinctness and sclerosis of the fracture
margins but no surrounding callus or heterotopic ossification is seen. No underlying bony
lesion is seen to indicate a pathologic fracture. The findings indicate a subacute fracture
probably 3 to 5 weeks old that occurred as a result of a trauma, likely a fall. This would
be in accordance with and account for the identification of “either necrotic or caseous
material at the fracture line” during the hemiarthroplasty. Simply put, the fracture had
started to heal by the time this x-ray was taken but had not completely healed indicating
that itis a subacute fracture.

Lateral

Conclusion

| have reviewed the records that discuss Mr. Lyle’s functional mobility and note
that he was able to ambulate prior to 4/23/19. Specifically, the fall risk evaluations of
2/22/1 9 and 3/1 5/1 9 states that he is “ambulatory and continent” but the fallrisk evaluation
of 5/21/19 states that he is “chair bound” and no longer ambulatory. This is a significant
change in his condition which is confirmed by the physical therapy notes which state that
on 3/23/19 he was able to ambulate 6O feet; on 4/23/19 he was able to ambulate 75 feet
with a wheeled walker; but by 4/29/19 the physical therapy documentation indicates
“attempted gait training in hallway, however, patient was unable to stand without
maximum assist x 2”. It does not appear that he ambulated after by 4/24/19 when the
physical therapist noted “gait training in hallway with FWW and emphasis on longer
strides and knee/hip flexion”. Moreover, on the initialTransfer Evaluation done on 2/22/1 9
he was noted to have “no difficulty standing” and was “full weight bearing”. Yet, by the
next Transfer Evaluation done on 5/22/19 he was noted to have “difficulty standing”.

A patient with a fracture of the femoral neck as noted in the above x-rays will not
be able to ambulate. Therefore, itis my opinion that this fracture most likely occurred as
a result of a traumatic injury (meaning a fall) 3-5 weeks before May 23, 201 9 and at some
point after the last date he was noted to ambulate which was April 24, 2019. |have ruled
out pathologic fracture and an infection weakened bone as the cause of this fracture due
to the pathology and culture results discussed above.

l hold these opinions to a reasonable degree of medical probability. |also reserve
the right to amend them should additional information or documents be provided to me.

7? Sincerely,

Daryl Fanney M. D.
EXHIBIT 2
Paul O. Warshawsky, M.D.
2322 Winnetka Road
Northfield, Illinois 60093

August 4, 2020

Wormington & Bollinger
212 East Virginia Street
McKinney, TX 75069

Re: William Lyles

Dear Ms. Wormington:

I have been asked to review the medical records pertaining to William Lyles and to opine
on the care that he received while he was a patient at Belterra Nursing and Rehabilitation from
5/29/19-6/1 1/19 and 6/14/19-6/26/19. Speciﬁcally, I have been asked to opine on whether the
standard of care was adhered to by the nursing staff at Belterra Nursing and Rehabilitation and by
Dr. Zahid Zafar and Dr. Moses Keng and whether his right hip dislocations that occurred on
6/1 1/ 19 and 6/25/ 19 could have been prevented. Ihave also been asked to opine as to whether the
hip fracture Caused by the negligence 0f the nursing staff at North Park Health and Rehabilitation
Center as a proximate cause of Mr. Lyles’ death; Please See my earlier report as to this entity as it
relates to the fall that he experienced at this facility and how this fall was the cause of the initial

hip fracture that required surgical repair at Medical City McKinney on 5/27/1 9.

The following medical records were provided to me and were utilized in this review:
Baylor Scott & White Medical Center McKinney
Belterra Nursing and Rehabilitation
Medical City McKinney
North Park Health and Rehabilitation Center.

In addition, I have read the following deﬁnitions that were supplied to me by your ofﬁce and
have applied them to my opinions:

o “Negligence,” when used with respect to the conduct of the nursing staff at a
rehabilitation center means failure t0 use ordinary care, which is, failing to do that
which the nursing staff at a rehabilitation center of ordinary prudence would have
done under the same or similar circumstances or doing that nursing staff at a
rehabilitation center of ordinary prudence would not have done under the same or
'
'

similar circumstances.

o “Ordinary care,” when used with respect to the conduct of the nursing staff at a
rehabilitation center means that degree of care that the nursing staff at- a
rehabilitation center
I
of ordinary prudence would use under the same or similar
circumstances.

Page 1 of 25
o “Proximate cause,” when used with respect to the conduct of the nursing staff at a
rehabilitation center means a cause that was a substantial factor in bringing about
an occurrence or injury, and without which cause such occurrence or injury would
not have occurred. In order, to be a proximate cause, the act or omission complained
of must be such that the. nursing staff at a rehabilitation center using ordinary care
would have foreseen that the occurrence or injury, 0r some similar occurrence or
injury, might reasonably result therefrom. There may be more than one proximate
cause of an occurrence or injury.

Qualiﬁcations

I am a physician licensed to practice medicine in the State of Illinois. Iam actively
practicing medicine in my specialty area of internal medicine. I am qualiﬁed to offer opinions in

this case by virtue of my training and experience in the ﬁeld of internal medicine as well as my
experience in training, educating, supervising, and evaluating nursing staffs in various settings
including that of rehabilitation facilities. I completed residency training in internal medicine and
have been awarded board certiﬁcation by the American Board of Internal Medicine. I have
practiced internal medicine on a continuous and full-time basis since completion of my internal

medicine residency in 1987. My curriculum Vitae provides greater detail regarding my
qualiﬁcations and experience. Rather than duplicate my C.V. in its entirety Iwill simply refer to
and incorporate its contents into this report. Attached to this letter as Exhibit "A", is a true and
correct copy of my curriculum vitae, which reﬂects my qualiﬁcations, experience, education,
board certiﬁcation, bibliography, and appointments pertinent to my medical practice.
I am qualiﬁed to opine. on the cause 0f Mr. Lyles’ right hip dislocations that occurred on

6/1 1/19 and 6/25/19 and howthey could have been prevented. I am qualiﬁed. to opine on the
standard of care required of the rehabilitation facility staff and physicians in regard to the
assessment of and care of a patient like Mr. Lyles, with a medical history including congestive
heart failure, coronary artery disease, stents placed in 2006, pacemaker, deﬁbrillator, anxiety,
dementia, colon cancer 2009, right hemicolectomy 2009, chronic kidney disease, left percutaneous
hip pinning 5/16/18, right cemented hemiarthroplasty on 5/27/‘1 9, and GERD.
'

As a typical and integral part of my medical practice, I am called upon to make
determinations regarding the causal mechanism of injury to patients so that appropriate medical
care can be provided. In formulating my opinions, I have relied on my education and experience
in dealing with patients similar to Mr. Lyles with a variety of comorbidities that must be considered
simultaneously and that require multi-system medical management. Each of the opinions
expressed in this report is based upon reasonable medical probability, which is,in turn, based on
my education, training and clinical experience within the ﬁeld of medicine in general and internal
medicine speciﬁcally.

My internal medicine practice involves direction of patient care in a variety of settings.

These settings include, in—patient hospital care, outpatient clinics, ofﬁce practice, nursing homes,
and rehabilitation centers among others. Throughout my medical career I have supervised, trained,
educated, consulted with, and evaluated nurses. This interaction with the nursing profession
continues on a nearly daily basis. I,as an attending, or consulting physician, prescribe or otherwise

Page 2 of 25
order medical and nursing interventions, discuss cases With nurses, explain the rationale for

medical decisions and therapy, instruct nurses as to proper techniques for providing care, and
evaluate the care given in an informal manner. Through this training, education, interaction and
supervision of nursing personnel Ihave become aware of the applicable nursing standard of care
required in facilities such as rehabilitation facilities and have developed expectations ofthe nursing
staff of these facilities based on these standards. I have speciﬁcally, trained, supervised, and
evaluated nurses in rehabilitation settings who are involved in care of patients with complex
medical issues and multiple comorbidities such as those present in Mr. Lyles. The training and
supervision Ihave provided includes the drafting and implementation of a nursing care plan, with
adequate interventions in place for patients who are recovering from hip surgery, and provision of
timely assessments and notiﬁcation of medical providers of a change in patient condition These

are the issues in the situation at hand. My knowledge of the nursing standard of care comes through
my own medical experience, training, and education as well as my interaction with the nursing
profession set forth above.

I am familiar with, and qualiﬁed to opine, regarding the standard of care for the nursing

staff of a rehabilitation facility as it applies to the assessment, documentation, communication,
timeliness of care, and provision of care for patients like Mr. Lyles who have suffered from
congestive heart failure, coronary artery disease, stents placed in2006, pacemaker, deﬁbrillator,
anxiety, dementia, colon cancer 2009, right hemicolebtomy 2009, chronic kidney disease, left

percutaneous hip pinning 5/16/18, right Cemented hemiarthroplasty on 5/27/19, and GERD.
Patients like Mr. Lyles are at a greater risk for hip disloéation due to his history of right cemented
hemiarthroplasty on 5/27/1 9.

I am also a Clinical Assistant Professor at the University of Illinois Medical School,
Introduction to Patient Care Program. I am qualiﬁed by education, training and experience to

evaluate the medical and nursing care that Mr. Lyles received at Belterra Nursing and
Rehabilitation. I am aware of the various sequelae of disease processes, therapies, and failure to

timely and appropriately, assess, monitor, communicate, and treat patients with the constellation
of symptoms that Mr. Lyles exhibited while a patient at Belterra.

Ihave had the experience of acting as the medical director, responsible for the oversight 0f
all aspects of the operation of a large healthcare facility. I was involved in, and therefore,

knowledgeable in issues ranging from licensing, credentialing, accreditation, state and federal

regulatory complianée, quality control, and utilization management. Included within this category
is consultation on, and implementation of, nursing staff policies and procedures dealing with
patient care. Through my education, this administrative experience as well as my experience in

running my own practice and "in interacting with facility administration issues I am conversant
with certain standards 0f care required of facilities for implementing patient care policies, training,
and oversight of facility staffs to assure compliance with these policies.

Factual Summary
Mr. Lyles was, at the time of the incident, an 86-year-old male with-a past medical history
of congestive heart failure, coronary artery disease, stents placed in 2006, pacemaker, deﬁbrillator,

Page 3 of25
anxiety, dementia, colon cancer 2009, right hemicolectomy 2009, chronic kidney disease, left

percutaneous hip pinning
‘
5/16/18, COPD, right cemented hemiarthroplasty on 5/27/19, and
GERD.
Mr. Lyles resided at North Park Health and Rehabilitation Center from 2/22/1 9-5/24/19'.

On 5/24/ 1 9, due to complaint ofright hip pain, right hip x-ray was done and received result.
Conclusion: acute mild superiorly displaced subcapital femoral neck fracture. MD notiﬁed and
new order to send to hospital for evaluation and treatment. Notiﬁed DON via voice massage,
notiﬁed WP via voice msg. Waiting for transportation to Medical City of McKinney.

Medical Citv McKinnev 5/24/19-5/29/19

ED fOr right hip injury. He has dementia and does not remember falling. The nursing home
stated that he fell in December but does not know if he fell again. Right hip x-ray conﬁrmed acute
fracture of the right femoral neck and mildly displaced sub capital neck fracture. Admitted for
surgery by ortho.

H&P: Patient was at the nursing facility, was not moving his right leg pr0perly and hence
further prompted the patient to get ER, attempt to get x—ray, which showed a fracture of the acute
right femoral neck. Subsequently, EMS was called. The patient is unable to give a full history.

Apparently, fell back in December, did not know if the patient fell again. No other fever and no
other chills have been reported. Assessment and Plan:

1. Right hip fracture, most likely related to a fall, unwitnessed, discovered on a
plain ﬁlm at the nursing facility. Possible osteoporosis versus traumatic: CT of the
hip may be needed. we will follow up with the orthopedic. Patient isNPO. for now.
we will follow up preop with the cardiology team for now and then reassess.
2. Atrial ﬁbrillation; suspected in the setting of being in Eliquis: The patient's

Eliquis will be stopped for now. Patient is on Coreg. We will reassess and
cardiology has been consulted.

3 Severe coronary artery disease with a history of stents in the past, no previous
echo’ s available. We will follow up an echo and then reassess.
4. Status post left inguinal hernia repair

5/27/19

Op report by Duncan L. McKellar. Pre and-post-operative diagnosis of right subcapital hip
fracture.'Procedure: right cemented hemiarthroplasty. Findings: inﬁltrative tiSsue in femoral head
and adj acent soft tissue suggesting metastatic lesion or chronic infection.

Indication for procedure: Mr. Lyles is an 86-year-old male who lives in an assisted
living environment. He is marginally ambulatory and had an unwitnessed event that
has led to right subcapital hip fracture. He is brought to surgery at this time for

cemented endoprosthetic replacement.

Page 4 of 25
Description of procedure: Right hip was opened through a linear incision.

Dissection carried down through the fascia lata and the gluteus split in line with its

ﬁbers. The piriformis was identiﬁed. There was soft tissue proliferation, which
released the external rotators and the capsule and the fracture line was identiﬁed.
There was either necrotic or caseous material at the fracture line, atypical for fresh

fracture, implying either chronic fracture or pathological fracture. The neck was
resected and the head and neck were sent in itsentirety to the pathology. The
acetabulum was templated to a size 52. The femoral canal was then broached up to
a size 7 stern placed. The canal was evacuated and cement inj ected. Two

Case Info

Judge

GOLDSTEIN, BONNIE LEE Track Judge’s New Case

Case No.

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Document Filed Date

September 01, 2020

Case Filing Date

July 10, 2020

County

Parties

BOLLINGER, LENNIE F Attorney for the Plaintiff
COOLEY, SUSAN C Attorney for the Defendant
CORMIER, KIMBERLY LAND Attorney for the Defendant
FRAZIER, ALLEN J, RN Defendant
HEFNER, AMY Attorney for the Plaintiff
KANNY, HEATHER A Attorney for the Defendant
KENG, JR., MOSES J, MD Defendant
LAUTEN, AMY B Attorney for the Plaintiff
LYLES, ROZ C Plaintiff
MOBILE MD PA Defendant
MPD OPERATORS MCKINNEY, LLC Defendant
PROCTOR, COLEMAN M Attorney for the Defendant
SSC MCKINNEY OPERATING COMPANY, LLC Defendant
WORMINGTON, MARIA L Attorney for the Plaintiff
ZAFAR, ZAHID N, MD Defendant
Ashley Miller Attorneys for Defendants
Casey Campbell Attorneys for Defendants
Caleb Archer Attorneys for Defendants
Lori Proctor Attorney
Courtney Huber Attorneys for Defendants
William Leeds Attorney
Edwin Krieger Attorneys for Plaintiffs
Susan Periquet Attorney

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Motion,Ex Parte: ROZ C LYLES vs. SSC MCKINNEY OPERATING COMPANY, LLCet al

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