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”