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The Gary Rushford Arbitration  
This is a small portion of an actual arbitration between a Kaiser Victim and Kaiser Foundation Hospital and the Permanente.  It is copied verbatim though the formatting has been changed for the web viewer.

Dr. Deborah Shih, CA License #A51754, current status Delinquent, was the primary care physician in this case. She was the one who asked if Gary Rushford wanted pain killers instead of seeing her.
She did however, after several months, refer Gary to a podiatrist who in turn referred Gary to a nurse practitioner, who told Gary to do exercises for
his back. After 4 months of pain Gary finally went to the emergency room where his arterial clot was diagnosed. He was then referred to the
surgery clinic where Dr. Richard Lynn Frazier, CA License #C41940, took over his care. Dr. Frazier was the one who amputated Gary's leg about a month later.
He was the one whose treatment the arbitrator found "fell below the standard of care", but ruled he was convinced Gary
had a vasculitis such as  Buerger's Disease or some other overlapping syndrome so the outcome of amputation would have been the same,
so hence no medical malpractice. We now know Gary did have a hypercoaguable state since one month after the arbitration ended Gary
tested positive for Anticardiolipin Antibody.
Note that none of Gary's treating doctors ever told  him he had Buerger's disease, a fact the arbitrator knew.

Mr. Rushford, the victim who the doctor didn't feel needed to know what was wrong with him had to have his leg hacked off.
He did not come out ahead in this case.  Kaiser got off on a technicality.  Mr. Rushford is not able to obtain private insurance that is
affordable because of the medical care that he received at Kaiser.

At this time because he has no other choice he is forced to remain "In The Hands of Kaiser."

DOES 1 through 50,

Heard Before Arbitrator:
Judge Allan J. Bollhoffer, Ret.

Friday, November 9, 2003
60 North San Mateo Drive

San Mateo, CA 95113

Reported by:
Donna Cohn
CSR Ho. 2395
Our File No. 42548

Madeline M. Freda
Certified Shorthand Reporters
555 Veterans Blvd., Suite 115
P.O. BOX 3119
Redwood City, CA 94063

We begin on page 141
clotting, recurrent, clotting, correct?

A.  Of Course, at that point, yes.

Q.  But you know it had caused recurrent clotting multiple times during July, right?

A. Correct.  In the one leg, correct.

Q.  Are you saying you didn't know he had an obstruction in his left leg?

A.  Correct.

Q.  Nobody told you about the June 29th angiogram having an obstruction in that leg?

A.  Well, there was no --  He still had a very good pulse in that leg.

Q.  Right.

A.  In terms of saying he had an embolic or embolus in that leg, no, that was really not discussed with me.

Q.  So you think he might have systemic asculitis that causes clotting, right?

A.  Correct.

Q.  And we know that you knew that he had something that was an obstruction in his left leg as well, correct?

A.  Let me go back and refer to that report.

Q.  June 29th embolism, Dr. Airing's radiology report.

      MR. SIMONSON:   It's at the beginning there, yes.

      MS. CANNISTRACI:  Q.  I'll specifically refer you to the first page --

      MR. SIMONSON:  Here it is.

      MS. CANNISTRACI:  Q.   -- of the angiogram, June 29th, last full paragraph.  Last line or second to the
       last line where it says the left anterior tibial artery  is occluded.

 A.  Okay.  So, well, so in reference again to that, I  mean, we didn't really, as I recall, --
       I mean, we didn't really -talk much about that particular part because his left leg had been clinically stable.

  Q.  So you wait until it's to the clinically unstable  to  treat  it;  Is  that what you're  saying?

  A.  Correct.

  Q.  So what does that mean?  Do you wait until the pulse  is lost before you start treating it, or what do you do?

  A.  Right.  In general, even in other cases of  peripheral vascular disease, people can have moderate
         decreased circulation in the leg.  And unless they have symptoms of clotication and pain, then generally,
         right, not much is done about it.

   Q. So this gentleman just gets his leg cut off off on July 21.  You all believe that he's got some kind of systemic vasculitis that
         causes recurrent clotting.  And you know that he's got an obstruction, total occlusion in his left anterior tibial artery.
        And you decide, based upon that, that you're not going to treat him with anticoagulation medication?

         MR. SIMONSON;   Your Honor, it's an argumentative question.  In addition, it misstates the evidence.

         JUDGE BOLLHOFFER:  It's a hypothetical; it's not argumentative.  And it's not really asking for an
         expert opinion.  It's asking for what she did.


         THE WITNESS:  A.  Well, again, given that: the leg had no symptoms with regard to pain and the pulse
         was normal in that leg, I mean, again the issue at that time was whether or not, if there was a vasculitis component,
          if you gave him the Prednisone or some other type of treatment for the vasculitis, then perhaps no clot would be formed.
         That would be the working  hypothesis would be you want to treat the underlying problem.
         And that if a symptom of a clot appeared, that you would treat that.

          But he did not have a symptom of that clot in that. leg.   So that's why a lot of the questioning or the investigation at that
          point was really to figure out whether or not he needed some other treatment for the vasculitis so that the vasculitis itself would regress
          and that you would not -- I mean, and I'm speaking again before the other D.V.T. that happened.

  MS. CANNISTRACI:  Q.  But he has an occlusion of an entire artery, that's the one near his foot, the tibial artery?

  A.      Right.

  Q.     And he's just lost his leg.   You know it's totally obstructed.  You're saying that it's your position that you don't --
            I mean, let ne ask this question.

             Isn't it true that occlusions, whatever is blocking that artery from getting blood flow to that
             foot in this anterior tibial artery, that blockage can cause  stagnation, right?  And blood clots can grow bigger, right?

  A.      Correct.  And usually, symptoms would be produced at that point.  But people can have occlusions
             of arteriosclerotic types and other types in the smaller blood vessels of the leg.  If there's other good
             collateral blood flow, the leg is still functioning or getting circulation adequately to the entire leg, then
             treatment is not done for that.

  Q.        But this isn't your normal situation, right?  I mean, ---

  A.        But you're asking me hypothetically in a patient that has an occlusion of an anterior tibial artery in a peripheral vascular disease situation,
              do they always get treated?

  Q.        No, I'm not asking.  I'm talking about this patient here, who's just lost his only  -- his right leg.
              Now he has one leg left. It's got an obstruction in it.  We know that the clot can grow.

  A.        Again, the issue with that part, is that a clot.?  I'm not sure.  Again, it could just be vascular inflammation and narrowing of the blood vessel.

   Q.       And that can cause clotting, right?

   A.        Well, correct:, that's how --  that's what happened in the other leg.  The issue with that though is again there were no symptoms in that leg.
               And as you will recall from the other notes, the recomnendations were for us to watch for symptoms in other limbs and then to treat appropriately.

                And the other question we were trying to answer was, okay, if it is a vasculitis in fact of his legs, then you would want to treat the vasculitis.  And how to
                treat that.

   Q.         It's fair to say you never discussed with Gary  the obstruction in his left leg, correct?

   A.         Right, we just talked about -- I mean, we did the clinical exams of that leg at every visit to ensure --

   Q.        You never told him he had an obstruction in that leg?

   A.         Well, we never talked about that particular issue; that's correct.

   Q.         Don't you think that's something that somebody who just lost their right leg might want to know?

   A.        That would be speculation on my part.

   Q.        Well, as a clinician, isn't that something that  you feel that you're bound to disclose to your patient?

              MR. SIMONSON:  That's an expert witness question.

              JUDGE BOLLHOFFER:  Sustained.

              MS. CANNISTRACI:  Q.  It's also true that you  never put anything in your notes that Gary had Buerger's disease, correct?

   A.        That's correct.

   Q.        And that you never treated Gary for Buerger's disease, right?

   A.        Well, there's no real treatment for Buerger's disease, except stopping smoking and aspirin.

   Q.        And it's fair to say you never - told him to stop smoking during that period?

Certified Shorthand Reporters