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Jeff Vaughnv.
Kentuckiana Colon & Rectal Surgery and
Dr. Wayne Tuckson
Dr. Tuckson cut out Jeff’s “Benign”46 year old colon •Jeff’s rectal bleeding in September 01 had been caused by
hemorrhoids PROVEN FACTS
•FAP = death from cancer unless colon is cut out
•Jeff did not have FAP and Dr. Tuckson’s documents did not support FAP
•Jan 30, 2002 = sole office visit with Dr. Tuckson before surgery
•March 19, 2002 = Dr. Tuckson cut out colon with “presumed” diagnosis -Discharge Summary (Ex. 28)
-Dr. Tuckson’s April 17, 2002 letter (Ex. 29)
Credibility
3 Key Facts the Defense Fought with Fiction
●FAP Misdiagnosis – was Jeff misdiagnosed with FAP?
●Hemorrhoids – did they cause Jeff’s rectal bleeding?
●Litigation Fear – is this why Jeff not told he had AFAP?
Dr. Tuckson cut based on hearsay from patient Jeff•Dr. Tuckson cut with Jeff’s statement and 4 documents
Dr. Tuckson had 4 reports - that identified a total of 2 polyps:
•Standard of Care:
Jeff’s statement alone is NOT an acceptable way for Dr. Tuckson to confirm FAP diagnosis.
1. EGD Path Report – not consistent with FAP
2. EGD Report – not consistent with FAP
3. Colonoscopy Path Report – unclear at best
4. Colonoscopy Report – not consistent with FAP
January 31, 2002 Office Visit: - Jeff said Dr. Haider said Jeff had:
•“familial polyposis” •more than 100 polyps
Sept 21, 2001 to Jan 30, 2002 March 19, 2002 to Jan 20, 2004
______________ ______________
(45 + Days)
Dr. TucksonChart
4 reports,1 letter,
andJeff says FP
____0
Dr. Tuckson●Scopes,
●DNA Tests,
●to collect
documentsdiagnosing
FAP
HealthSouth Surgery Chart
☻Photos b4 litigation?
Dr. Kashif Haider Chart
☻ Includes Dr. Lee’s Path
☻ Includes Hardin CT Scan
Hardin Hospital Chart
☻ Includes Dr. Lee’s UK Path
Dr. Tuckson Chart
Surgery Report
2 Office Visits
●No mention of AFAP
Jewish Hospital Chart
●No mention of AFAP
Mayo Clinic – 1/20/04
●Jeff’s lawyer gets DNA tested
Documents - FAP Misdiagnosis/Surgery
(4 + months) (1 year and 10 months)
1. EGD Path = Inconsistent with FAP•1/22/02 Pathology Report faxed to Dr. Tuckson on Jan 30th
Infectious Organisms Not Seen
Stain for Bacteria Negative
Heartburn
• Fax received at 10:01p.m.
2. EGD = Heartburn, not FAP•1/22/02 Operative Report faxed to Dr. Tuckson on Jan 30th
Before Scope Diagnosis1. Persistent heartburn2. Possible familial polyposis
After Scope Diagnosis1. Heartburnnot familial polyposis
• Fax received at 1:23p.m.
3. Colonoscopy Path = Unclear at Best•10/12/01 Pathology Report faxed to Dr. Tuckson on Jan 30th
Low to High Grade Dysplasia?•Either low or high•not both
Moderate to Severe Dysplasia?•no more “moderate”•Either low or high
• Fax received at 1:23p.m.
1 documented polyp
4. Colonoscopy Report = Inconsistent with FAP•10/11/01 Report faxed to Dr. Tuckson on Jan 30th
Before Scope Diagnosis1. Rectal Bleeding
After Scope Diagnosis1. Hemorrhoids 2. Colon Polyp x 2
• Fax received at 1:23p.m.
Dr. Tuckson never told Dr. Haider the surgery date
Red Flags
•Index Case = no familyHistory
•Polyps Not Evenly Distributed
•Low to High = Severe?
Jeff’s did not have a deadly disease, he had Hemmorhoids
_________________________________
Dr. Tuckson’s Fault
•Dr. Tuckson failed to exercise reasonable care in treating Jeff because he failed to confirm the diagnosis before cutting.
•Dr. Tuckson was required by standard of care to confirm diagnosis:
(1) Contact Dr. Haider
(2) Order DNA testing
(3) Take a look himself
Dr. Rex.GIIU
Dr. SussmanSurgical Oncologist
UC
(1) Contact Dr. Haider - what would a have revealed?
Dr. Lee had argued “no way” Jeff had FAP in early Jan 02 – p. 21
Dr. Haider said Jeff had less than 100 polyps and no history – p. 39
_______________________
____________________________________________
Polyposis not on Lee’s mind
p. 45
(2) DNA Testing - what would a “Mayo” test have shown?
A mutation was NOT detected
________________________________________________________
(3) Look Inside Colon First – what would Dr. T have seen?
No adenoma or carcinoma Benign segment of colon
Benign segment of colon
Dr. Haider’s Fault
•What have the Defendants proven as to Dr. Haider’s fault?
$1 million award - effect of 50/50 split100 % Fault Pie
Tuckson 50% Haider 50%
Apportionment of Fault and Jeff’s Damages•Example of effect of “apportionment” on damages awarded
Defendants Pay
Total Damages $1,000,000Dr. T Fault x 50%Dr. T Owes Jeff $500,000
Verdict Reduced •$1,000,000 total damages award reduced by $500,000for Dr. H 50% share of fault
•Jeff collects $500,000 from $1,000,000 awarded in this 50/50 example.
THIS CASE IS ABOUT AFAP
About Defendants•A =
•F =
•A =
•P =
Faulting
Another
Person = Dr. Haider
THIS CASE IS ABOUT AFAP
About Defendants•A =
•F =
•A =
•P =
Fabricating
A
Polyposis = AFAP
Attenuated FAP = Defense born by law suit•Dr. Tuckson never mentioned it but now says Jeff had “A”FAP
Time Line - Jeff not told he had “A”FAP at:
•Jan 30, 2002 - Office Visit with Dr. Tuckson
•March 19, 2002 - Surgery with Dr. Tuckson
•April 17, 2002 - Office Visit with Dr. Tuckson
•July 3, 2002 Office - Visit with Dr. Tuckson
•No mention of “A”FAP in medical records
•July 15, 2003 Dr. Tuckson Deposition Jeff hears “A”FAP a year after his last Office Visit
FAP and AFAP – very rare and even rarer
Entire Population = 100% Colon cancer = 5%
FAP = < 1% of 5%
AFAP = 2% of < 1% of 5%
AFAP with Desmoids = 3% of 2% of < 1% of 5%.
_________________
What does the Mayo Clinic say about AFAP?
None of the listed mutations were detected
_____________________________________________________
•Fundic Gland polyps are nearly always associated with AFAP and may precedethe development of colorectal polyps.
•AFAP article, p. 130, January 2002 Dr. Church did not mention of “controversy” in commentary
•Jeff did NOT have Fundic Gland PolypsUndisputed Fact per EGD
What does Dr. Church’s article say about AFAP?
•In addition, screening with flexible sigmoidoscopy the recommended modality for FAP, is inadequate, because the majority of colonic lesions in patients with AFAP are right sided.
•AFAP article, p. 130 January 2002 Left sided Polyps and AFAP not discussed in Dr. Church’s commentary
What else does the article say about AFAP?
•Jeff had left sided polyps
Jeff had 3 Small Low Grade Adenomas •3 ant size adenomas do not equal AFAP
1. Colonoscopy – 2 polyps •10/11/01 Dr. H rectum scope
Dr. Fenoglio-Preiser•2 low grade
ant-size adenomas
Specimen to Pathology•1 piece of tan tissue
(.6 x .02 x .02 cm)
Specimen to Pathology•6 tan fragments
(2.0 mm each)
_________________________________________________________
Dr. Fenoglio-Preiser
•1 low gradeant-size adenoma
2. Flex Sig - 4 polyps •11/5/01 Dr. H rectum scope
3. Colon Removal •3/19/02 Dr. T surgery
Specimen to Pathology•Jeff’s Colon
3 feet approximately
Dr. Fenoglio-Preiser0 adenomas
Jewish PathologyBenign ColonNo adenomas
No carcinomas
_________________________________________________________
= COMMON
= COMMON
___________________________________________________
______________________________________________________________________________________________________________________
DNA testing is powerful tool to be used to confirmdiagnosis in an atypical patient like Jeff
__________Hardin Memorial Request for 2nd Pathology Opinion from Dr. Lee
Dr. Church Primer, Chapter 9, Page 71
Jeff’s damages – the unnecessary surgery
Jeff’s pain and suffering since surgery
10 Bowel Movements a Day
X 365 Days in a Year
X 28 Years of Life Expectancy
102,200 Bowel Movements Left
• Jeff Can Not Eat Normally
• Jeff Wakes Up In Pain Every Day
• Jeff Can Not Control His Gas
• Jeff Has “Accidents”
• Jeff Carries A Diaper Bag
• Jeff Defecates Over A Dozen Times Per Day
•Jeff Has To Work More Hours To Do His Job
•Dr. Lynch says a “gross” deviationfrom a minimally acceptable standard of care has turned
Jeff into a bowel cripple
•Dr. Tuckson operated the scapelwhich, according to him, was
the “Truck In This Case”