Free Motion for Summary Judgment - District Court of Connecticut - Connecticut

Case 3:03-cv-00544-WWE

Document 53-6

Filed 05/23/2005

Page 1 of 18

UNITED STATES DISTRICT COURT DISTRICT OF CONNECTICUT PRISONER : CIVIL NO. 3:04CV1067(CFD)(TPS) : : April 21, 2005

ROBERT POCEVIC v. DR. MINGZER TUNG, ET AL.

AFFIDAVIT OF DR. EDWARD BLANCHETTE I, Edward Blanchette, being duly sworn, depose and say that: 1. I am over the age of eighteen years and understand the obligations of an

oath. I was awarded an M.D. from the University of Vermont College of Medicine in 1974. 2. I completed my residency in Medicine at Saint Francis Hospital, Hartford,

Connecticut, in 1977, and completed a Fellowship in Infectious Disease and Microbiology from the University of Connecticut School of Medicine in 1979. I am board certified in Infectious Diseases. 3. From 1979 to the present, I have been engaged in private practice as an

Infectious Disease Consultant in Hartford, Connecticut. 4. From 1984 to 1990, I was employed as the Hospital Clinical Director at

the Connecticut Correctional Institution at Somers ("CCI-Somers"). 5. I am currently the Director of Clinical Services for the Connecticut

Department of Correction. 6. According to his health services record, Mr. Pocevic was transferred to

Garner Correctional Institution from Bridgeport Correctional Center on or about May 6, 2003 for having active suicidal thoughts. It is my understanding that Mr. Pocevic was

Case 3:03-cv-00544-WWE

Document 53-6

Filed 05/23/2005

Page 2 of 18

suicidal because he had been arrested for murdering his mother for money to buy crack cocaine. 7. Given this, according to his health services record, Mr. Pocevic was seen

by mental health staff every day, often times several times during the day, from May 6, 2003 to July 8, 2003. Unless, I specify otherwise, the following statements are made based upon my review plaintiff's health services chart. 8. On May 13, 2003, Dr. Giarrantana saw plaintiff who advised he had a

history of kidney stones with a history of right flank pain. Plaintiff advised he had difficulty urinating. 9. On May 14, 2003, Dr. Giarrantana saw the plaintiff and noted that his

urine had blood in it. According to his note, he advised the plaintiff to screen all urine, and to increase his water intake. Dr. Giarrantana also prescribed Tylenol #3 for 8 days as pain medication but wrote that staff should hold them unless plaintiff complained. 10. Plaintiff was given Tylenol #3 on May 15, 2003 after stating that his

kidney stones were acting up. The nurse noted that plaintiff did not appear to be in any acute distress and that there was no guarding or facial grimaces. This is significant because usually, kidney stone pain is very severe, sometimes compared to the pain associated with child birth. 11. 12. Plaintiff was given Tylenol #3 for complaints of pain on May 17, 2003. On June 6, 2003, plaintiff complained of dental pain, had a tooth extracted

and received Tylenol #3 for it. 13. 14. On June 14, 2003, a nursing note states that plaintiff had no complaints. On June 17, 2003, plaintiff indicated that he slept lousy, his sinuses hurt, Plaintiff was given Tyelenol #3 on June 17, 18 and 19,

had a stuffy nose and tooth pain.

2003 when he complained of tooth pain.

Case 3:03-cv-00544-WWE

Document 53-6

Filed 05/23/2005

Page 3 of 18

15.

On or about June 19, 2003, plaintiff complained of urinary delay which

Registered Nurse Valerie Cote questioned whether it was due to medication or kidney stone. 16. On June 20, 2003, plaintiff was seen by the dentist who ordered Tylenol

#3 to be given on a pain as needed basis for 48 hours and indicated plaintiff would have another tooth extraction in 2 weeks. 17. Later that day, it was noted that plaintiff was calm and quiet and requested

Tylenol #3 for tooth pain. 18. On June 21, 2003, plaintiff requested Tylenol #3 for tooth pain but was

calm and quiet. 19. On June 22, 2003, plaintiff asked for Tylenol #3 saying, "it f---ing hurts!

For tooth extraction site." 20. On June 23, 2004 it was noted that plaintiff stated he was hanging in there

and was quiet, resting and ate 100% of his dinner. 21. On June 24, 2003, plaintiff was reported as either sleeping or out for

recreation, walking around talking to other inmates. 22. On June 25, 2003, plaintiff indicated he was doing really well after earlier

in the day indicating that he had flashbacks and initially expressing the idea of suicide. 23. On June 26, 2003, plaintiff complained upon his return from court of not

getting lunch. Additionally it was noted that plaintiff had marks around his ankles from the leg irons and the nurse indicated she would have the doctor evaluate tomorrow. 24. On June 27, 2003, Dr. Tung saw plaintiff. Dr. Tung noted plaintiff's

complaints of a right leg rash.. Dr. Tung noted that he had a small visible defoliation lesion in a circular fashion on his right lower leg and ordered _______ cream to be used twice a day for 30 days.

Case 3:03-cv-00544-WWE

Document 53-6

Filed 05/23/2005

Page 4 of 18

25.

Later that day, in a subsequent entry, Dr. Thankappan notes that plaintiff

indicated he had difficulty going to urinate. Dr. Thankappan discontinued plaintiff's Zoloft thinking that may have caused plaintiff's urinary delay. 26. The next day on June 28, 2003, it was noted that plaintiff was calm, quiet,

with no complaints. 27. On June 29, and 30, 2003 it was noted that plaintiff was reading, calm,

quiet and pleasant. 28. On July 1, 2003, plaintiff saw his psychiatrist, Dr. Thankappan and told

him if you move me out of this block I will go kill myself. I am not ready to move. Dr. Thankappan ordered Wellbutrin 100 mg by mouth twice a day. 29. On July 2, 2003 it was noted in his chart that plaintiff stated, "Thanks" the

Zoloft was stopping me from going to the BR, so now I'm on Wellbutin. 30. On July 2, 2003, Dr. Tung saw plaintiff again. Dr. Tung noted that

plaintiff said, "You need to give me a bottom bunk, I will be discharged from IPM [in patient mental health unit] today, I've knee problem." Dr. Tung noted that plaintiff was in no acute distress, and his gait was ________ and _____. Dr. Tung denied plaintiff's request for bottom bunk pass because there was no medical indication that one was needed. 31. Later that day, it was noted that plaintiff was quite, that he had been to the

dentist for tooth extraction. Around 6 PM on July 2, 2003, plaintiff stated "I get motrin later." The nurse noted, "Inmate was not given motrin as motrin order was discontinued. Inmate was given tyelnol as ordered." 32. On July 3, 2003, it was noted that plaintiff was told the dentist changed the

order from motrin to Tylenol because plaintiff had complained that the motrin was not good for his kidney stones.

Case 3:03-cv-00544-WWE

Document 53-6

Filed 05/23/2005

Page 5 of 18

33.

On July 4, 2003, a nurse indicated that plaintiff stated his tooth hurt really

bad and requested some medicine. Plaintiff was given motrin. 34. On July 5, 2003, plaintiff complained that the place where his wisdom

tooth was pulled was swollen. The on call doctor was notified who ordered penicillin and Tylenol. 35. 36. Plaintiff was seen by dental on July 6, 2003. Plaintiff was transferred to G block on July 7, 2003 from the IPM.

According to his health services record, plaintiff was seen by psychiatry or mental health on July 9, 14, and 16, 2003. 37. Dr. Tung saw plaintiff on July 21, 2003 at this time plaintiff complained

that his ear hurt and his right abdomen hurt. Dr. Tung noted that plaintiff had a small raised rash on his scalp and ______ left ear and that his abdomen was ______. 38. 2003. 39. Dr. Tung saw plaintiff on July 28, 2003 when he complained "I can't pea Thereafter, plaintiff was seen by psychiatry or mental health on July 24,

since yesterday, it drips out, it's from Zoloft." Dr. Tung noted that plaintiff was in no acute distress, was alert and oriented as to person, place and time, his gait was normal. Dr. Tung also noted _______ which means ______. Dr. Tung noted that plaintiff was able to urinate in drips with no complaints of pain. Dr. Tung advised the plaintiff to discuss the issue with his psychiatrist. 40. Plaintiff saw Dr. Beaudoin on July 30, 2003 who noted that plaintiff was

complaining of dysuria in varying degrees for past 6 weeks and that Zoloft was discontinued and there was no change in symptoms. Dr. Beaudoin then noted plaintiff had a history of kidney stones. 41. Dr. Tung saw plaintiff on August 4, 2003 at which time he reviewed

plaintiff's x-ray from May 2003 which showed a left kidney stone with a questionable

Case 3:03-cv-00544-WWE

Document 53-6

Filed 05/23/2005

Page 6 of 18

right large stone. Dr. Tung told plaintiff to increase his fluid intake and to return to clinic _______. 42. Plaintiff refused medical sick call one week later on August 11, 2003.

Plaintiff was seen by psychiatry or mental health on August 8, 2003, August 12, 2003, and August 14, 2003. He discussed his anxiety over going to court and did not mention his kidney stone or that he was in pain. 43. Dr. Tung saw plaintiff on August 18, 2003 and August 25, 2003, for his

complaints of a rash on his right leg or ankle. Dr. Tung prescribed cream for the plaintiff. Plaintiff did not mention that he was having any difficulty urinating or any pain from his kidney stone. 44. Plaintiff made no other complaints to Dr. Tung at this time. Plaintiff was seen by mental health on August 25, 2003 as he was

"stressing" over going to court. He was transferred from G Block to IPM and placed on 15 minute checks per Dr. Thankappan's order. 45. The next day plaintiff was angry that he was placed in a ferguson gown on

fifteen minute watches and said he didn't want Dr. T to be his doctor. 46. his wellbutrin. 47. 48. Dr. Thankappan saw him again on September 5, 2003 and ________. Dr. Thankappan saw him on Spetember 10, 2003 and noted that plaintiff Dr. Thankappan saw him on September 3, 2003 and ______ and increased

had flashbacks at night of his crime and ______. 49. Plaintiff was seen by mental health staff on September 16, 2003, discussed

a letter he had received from his sister, how his flashbacks had improved since starting _____ and that he had started using DBT skills and found them helpful. 50. Dr. Tung saw plaintiff on September 22, 2003 at which time he

complained of knee pain. Dr. Tung noted that plaintiff's range of motion was normal in both knees, ________ that there was no obvious injury or gross deficiency noted. Dr.

Case 3:03-cv-00544-WWE

Document 53-6

Filed 05/23/2005

Page 7 of 18

Tung ordered Tylenol ____ mg every six hours for thirty days and isometric exercises for both knees for thirty days. Dr. Tung told the plaintiff to return to clinic _____. Plaintiff made no other complaints to me at this time. 51. On September 29, 2003, plaintiff was seen by Dr. Thankappan who noted

that he was doing better, was not psychotic and ______ and had no suicidal thoughts. 52. On October 7, 2003, plaintiff was seen by a mental health case worker

who noted that plaintiff was depressed and agitated and felt like he would "lose it" on someone, no one in particular. The case worker noted that plaintiff was frustrated with the court system and his family's lack of support. Plaintiff stated he was not suicidal but wished that he had died when he thought of what he did. 53. he was okay. 54. On October 20, 2003, Dr. Tung saw plaintiff because he complained that On October 12, 2003, plaintiff was seen by mental health and reported that

his rash on his right ankle had come back. Dr. Tung prescribed ______ for plaintiff and told him to return to sick call ______. Plaintiff made no other complaints to Dr. Tung at this time. 55. On October 29, 2003, plaintiff was seen by Dr. Thankappan who noted the

plaintiff was doing fair and ______. 56. 57. On November 13, 2003, plaintiff was given a flu shot. On November 20, 2003. Dr. Tung saw plaintiff who complained that his

right lower leg was still the same. Dr. Tung noted that plaintiff had a flat rash and scratch mark on his right lower leg. Dr. Tung noted _______. Dr. Tung ordered _____. Plaintiff made no other complaints to me at this time. 58. On December 11, 2003, plaintiff was seen by mental health staff who

noted that his lawyer would not let him talk to the judge about his case. The plaintiff noted that the doctor had put him on new medication for his anger. The Clinical Social

Case 3:03-cv-00544-WWE

Document 53-6

Filed 05/23/2005

Page 8 of 18

Worker noted that plaintiff's sleeping and eating habits are good. Plaintiff reported he had flashbacks of his crimes at times and at times woke up in a cold sweat screaming. 59. On November 28, 2003, Dr. Thankappan saw him and noted ____. He

prescribed ______ 60. On December 22, 2003, Dr. Tung saw plaintiff who stated that the rash on

his leg was better. Dr. Tung noted ______. Dr. Tung prescribed ______. Plaintiff made no other complaints to Dr. Tung at this time. 61. On December 23, 2003, Dr. Thankappan saw plaintiff and noted______.

He prescribed ______. 62. On December 30, 2003, Dr. Tung saw the plaintiff who stated that he had

kidney stones and he pointed to his right _____ area. Dr. Tung noted that plaintiff was in no acute distress, was alert and oriented as to time, person and place and that his gait was normal. Dr. Tung noted plaintiff had an x-ray taken on May 29, 2003 which showed a left kidney stone and questioned whether he had a right stone. Dr. Tung ordered a urine analysis and indicated that he would follow up with plaintiff if the results indicated it was warranted. 63. On January 5, 2004 Dr. Tung noted that he received plaintiff's laboratory

results from UConn. Dr. Tung noted that his urine anaylsis was __________. In order to rule out a urinary tract infection, Dr. Tung prescribed plaintiff _______ for 14 days and ordered that plaintiff increase his fluid intake. Dr. Tung indicated that plaintiff should return to sick call as needed. 64. According to his health service record, plaintiff was not seen again until

January 20, 2004 when he was seen by Dr. Thankappan who noted that plaintiff was doing very well and was not depressed. He also noted ______ and increased plaintiff's _____ to ____ twice a day.

Case 3:03-cv-00544-WWE

Document 53-6

Filed 05/23/2005

Page 9 of 18

65.

On January 20, 2004, plaintiff saw a clinical social worker and reported

that he wanted to talk about being transported to court. Specifically, he said he fears for his safety when he is in the bullpen at Bridgeport Corrections. 66. The next entry in plaintiff's health services record was on Feburary 5,

2004, when he reported to a mental health clinical social worker, "They offered me 35 to 40 years and if I take it to trial, I can get 120 years." Plaintiff indicated he has a rough time sleeping due to nightmares which he had a couple of weeks before court and a couple of weeks after court. It was noted that he was oriented to person, place and time, that he had appropriate mood and appropriate affect and his speech was normal. 67. On February 9, 2004, Dr. Tung saw the plaintiff again who complained

"my bump on my head came back." I noted that plaintiff was in no acute distress, that he had a flaky scalp with small _____ rash approximately .3 to .4 cm _____. Dr. Tung diagnosed plaintiff as having seborrhea or dandruff and prescribed T-gel shampoo for ________ and told plaintiff to return to sick call ______. 68. _____. 69. Plaintiff was transferred to the in-patient mental health unit on March 1, On March 1, 2004, plaintiff was seen by Dr. Thankappan who noted

2004 pursuant to Dr. Thankappan's orders. 70. Staff checked on plaintiff several times on March 2, 2004. Plaintiff stated

he did not need to be there, expected to get 30 to 40 years when sentenced for his crime, admits to suicidal and homicidal ideations all the time but stated he would not act on them. 71. 72. ________. On March 3, 2004, plaintiff was transferred out of IPM to G Block. Plaintiff was seen on March 11, 2004 by Dr. Thankappan who noted

Case 3:03-cv-00544-WWE

Document 53-6

Filed 05/23/2005

Page 10 of 18

73.

Plaintiff was seen on March 21, 2004 by mental health when he asked

them all of the side effects of his medication. 74. On March 22, 2004, Dr. Tung saw plaintiff who complained that his face

rash was "still there." I noted that _____________________________________. I diagnosised plaintiff as having __________. I ordered _______________. 75. Dr. Tung saw plaintiff again on March 29, 2004 at which time plaintiff

complained, "I have a kidney stone." Dr. Tung noted that plaintiff was in no acute distress, his gait was within normal limits and ______ difficulty. No tenderness on ________ bilaterally. Dr. Tung noted that plaintiff had a history of left kidney stone from a May 2003 x-ray and thus he needed to rule out whether he had a kidney stone. I ordered a urine analysis (chem. 9) for evaluation. Plaintiff told Dr. Tung he was unable to produce a urine sample at this time. Plaintiff then sat in the waiting room for one hour and 50 minutes so we could get a urine sample. He stated he was still unable to produce one. Dr. Tung noted that he was in no acute distress, was socializing with other inmates. Accordingly, Dr. Tung noted that he would follow up with plaintiff if his urine analysis result warranted it. In the interim Dr. Tung prescribed Tylenol ____ every 6 hours for 10 days for discomfort. 76. stones. 77. _________. 78. On April 1, 2004, at approximately 8:30 Am plaintiff provided a urine On March 31, 2004, plaintiff was seen by Dr. Thankappan who noted On March 30, 2004, Dr. Tung ordered a urine analysis to rule out kidney

sample which was sent to the laboratory for analysis. 79. On April 7, 2004, Dr. Tung reviewed the lab results which showed ____

was 11.6 meaning ____, ____ was 124 meaning _______. There was a trace amount of

Case 3:03-cv-00544-WWE

Document 53-6

Filed 05/23/2005

Page 11 of 18

protein, trace amount of leukocyte _______ and a high amount of hemoglobin meaning _______. 80. Dr. Tung ordered Tylenol #3 every six hours as needed for 5 days for pain,

bacterium for ten days for a possible urinary tract infection and told the plaintiff to increase his fluid intake. 81. On April 12, 2004, plaintiff was seen by Dr. Thankapaan who noted

____________________. 82. On April 23, 2004 at approximately 4:30 PM plaintiff asked for a motrin

claiming to have a headache. 83. On April 23, 2004 at approximately 8 PM, plaintiff stated "you have to

call the doctor, I'm in pain since last night" and handed the nurse an emergency grievance. The nurse noted that plaintiff was playing cards, but called Dr. Chouhan who ordered that a urine sample be taken. Dr. Chouhan further instructed the nurse to call him if there was blood in the urine. The nurse noted that plaintiff was unable to give a urine sample at this time and noted that plaintiff had just returned from court after being sentenced to 40 years. 84. On April 23, 2004 at 10:30 PM, the nurse noted that plaintiff's urine was

positive for blood. Plaintiff was given 50 mg of Vistaril and 400 mg of Motrin. The nurse noted that plaintiff was urinating as per usual and stated that "this prn combination works real good." 85. ________. 86. On May 24, 2004, Dr. Tung saw the plaintiff who indicated that he had a On May 12, 2004, plaintiff was seen by Dr. Thankappan who noted

kidney stone and motrin helped. Dr. Tung noted that plaintiff was in no apparent distress, his gait was normal, and plaintiff stated that no way could he give a urine sample at the

Case 3:03-cv-00544-WWE

Document 53-6

Filed 05/23/2005

Page 12 of 18

time. Dr. Tung ordered 400 mg of Motrin every six hours as needed for 10 days and indicated that he would follow up with plaintiff if urine analysis result warranted it. 87. On May 27, 2004, a code blue was called because plaintiff was involved

in a fight with another inmate. Plaintiff was cleared to go to segregation by the psychiatric social worker and the day shift nursing supervisor noted plaintiff had no visible injuries. 88. On June 2, 2004, plaintiff gave a urine specimen which was noted to be

positive for blood but negative for leukocytes. Motrin was give to plaintiff. 89. On June 4, 2004, plaintiff was seen for complaints of right shoulder

discomfort after falling down during an outside football game. 90. On June 8, 2004, at the request of the nursing supervisor, plaintiff was

asked to give a urine specimen. Plaintiff stated that he was unable to give a specimen as he had just urinated. 91. On June 9, 2004, plaintiff banged on his cell window and handed medical

staff a urine sample which had a large amount of blood in it. It was noted that the urination was unwitnessed by staff, but plaintiff would be placed on the list to see the doctor. 92. On June 10, 2004, Dr. Tung saw the plaintiff who indicated that he had a

kidney stone the previous night but that he was okay at that time. Dr. Tung noted that plaintiff was in no acute distress, his gait was normal, his range of motion was normal and that was no tenderness on percussion _________. Plaintiff stated that he was unable to give a urine sample. Dr. Tung noted that this was the case on May 24, 2004 and on March 28, 2004, and that plaintiff only gave unwitnessed urine samples. Nonetheless I ordered bacterium for 10days for a possible infection, Motrin 600 mg every 6 hours as needed for pain and indicated that plaintiff should return to sick call as needed.

Case 3:03-cv-00544-WWE

Document 53-6

Filed 05/23/2005

Page 13 of 18

93.

Plaintiff was seen by a clinical social worker on June 18, 2004 and

plaintiff indicated he wanted the CSW to become his case worker. Later that day, plaintiff was seen by Dr. Thankappan who noted _________. 94. Plaintiff was seen on June 25, 2004, asking staff to document that the 1st

shift nurse refused to give him his 2:00 PM medication. It was noted that plaintiff was irritable. 95. On July 5, 2004, plaintiff asked the nurse to test his urine as "it hurts

again." Plaintiff told the nurse to not bother calling the on call doctor. The nurse noted that plaintiff's urine was dark yellow and had a small amount of white blood cells, a large amount of blood, protein ___, glucose negative, ketones negative, urobilinogen 1, bilirubin negative. Plaintiff indicated that he will request to see the doctor when he wished. 96. Plaintiff was seen by Dr. Mennesson a psychiatrist on July 16, 2004.

Plaintiff reportedly stated that he had an anger problem. Dr. Mennesson noted that plaintiff was in no acute distress. Dr. Mennesson noted that plaintiff should be reevaulated in 1 month, that he may taper plaintiff's Vistaril and Geodon (for depression). In addition, Dr. Mennesson ordered that plaintiff's tegretol level be checked and then discontinued if _____. 97. On July 19, 2004, plaintiff was seen after requesting to speak with a

clinical social worker. Plaintiff indicated that he had built up anger and rage at himself for killing his own mother. Plaintiff was advised to continue to talk to psychiatric social workers to worth thru this issue. 98. On July 30, 2004, plaintiff was seen by mental health and stated that he

kept getting flashbacks with all of the blood from killing his mother. Plaintiff was advised to continue in his anger management group and with his substance abuse treatment.

Case 3:03-cv-00544-WWE

Document 53-6

Filed 05/23/2005

Page 14 of 18

99.

On August 2, 2004, plaintiff saw a clinical social worker and asked that

she call his sister to find out why the sister has not been visiting. Plaintiff indicated that he was frustrated due to lack of family support and contact due to the nature of his crime. Plaintiff was encouraged to continue attending his groups. 100. 101. On August 17, 2004, a PPD was planted to test for tuberculosis. On September 8, 2004, plaintiff presented to medical complaining of

chronic right upper quadrant pain. Plaintiff denied fever or chills and was unable to give a urine sample indicating that he just want. Plaintiff also complained of a right ankle rash. Dr. O'Halloran ordered a urine analysis and gave plaintiff motrin. 102. On September 14, 2004, plaintiff used profanity stating "Im not doing that

f ------ shit. F--- you! When asked to urinate in a specimen cup with a male officer watching. 103. On September 16, 2004, a urine specimen was collected with the urine

officer watching . 104. On September 30, 2004, plaintiff was seen by Dr. Hoffler who noted that

plaintiff stated he was "still snapping at people" and complained of irritability. Dr. Hoffler increased plaintiff's tegretol and ordered that plaintiff be seen again on October 28, 2004. 105. On September 29, 2004, Dr. O'Halloran submitted a URC request for a

urology consult for lithotripsy. Dr. O'Halloran attached a copy of plaintiff's bridgport hospital record. 106. The request was denied on October 12, 2004.

On September 28, 2004, plaintiff was x-rayed. The x-ray report

transcribed on September 30, 2004 stated, "There is a 2 cm round calcific density overlying the mid pole of the right kidney and there is a 3 mm calcific density overlying the lower pole of the left kidney. These are both very suspicious for renal stones and they

Case 3:03-cv-00544-WWE

Document 53-6

Filed 05/23/2005

Page 15 of 18

were both seen on the prior exam of two years previous. Soft tissues are unremarkable. The bones are within normal limits." 107. On October 18, 2004, plaintiff was advised of URC's decision. Plaintiff

was frustrated and stated that he has intermittent flank pain and blood in his urine. Dr. O'Halloran indicated that he would resubmit a request for urology consult. 108. On November 8, 2004, plaintiff saw Dr. O'Halloran complaining of blood

in his urine and flank pain. 109. On November 8, 2004, plaintiff reported severe pain to the correctional

officer and nurse who indicated that his pain was 10 out of 10. In addition, the nurse noted that plaintiff was tearful from pain. The nurse called the doctor on call and received an order for Toradol to be given by injection for pain. 110. On November 9, 2004, Dr. O'Halloran updated his previous request to

URC indicating that plaintiff reported right flank/groin pain "now constant for approximately 2 months." Plaintiff indicated he had relief with Toradol. On November 9, 2004, Dr. Buchanan approved a urology consult. 111. On November 23, 2004, plaintiff was seen by a urologist who noted that

plaintiff had a ten year history of kidney stones for which he underwent lithotripsy twice and ureteroscopy once. Plaintiff reported intermitten right side pain. Dr. Albertsen noted that plaintiff had a 2 cm renal stone on the right side and 2 6 mm stones on the left kidney. Dr. Albertsen recommended lithotripsy. 112. On November 24, 2004, a URC request was submitted, and the panel

approved the lithotripsy. 113. The most common treatment for stones is expectant treatment; when a

physician waits to see if a patient's pain subsides and thus it is likely that that patient has passed the stone. "Renal stones, which are generally asymptomatic, may be followed

Case 3:03-cv-00544-WWE

Document 53-6

Filed 05/23/2005

Page 16 of 18

conservatively." Portis, AJ and Sundaram, CP. Diagnosis and Initial Management of Kidney Stones,"American Family Physician, 2001;63(7) p. 11. 114. "Stones less than 5 mm in size should be given an opportunity to pass.

Patients can be advised that stones less than 4 mm in size generally pass within one to two weeks. With stones of this size, 80 percent of patients require no intervention beyond analgesia." Id. p. 10. 115. An x-ray report dated September 28, 2004 reports that plaintiff had a "2

cm [.0787 inches] round calcific density overlying the mid pole of the right kidney" and a "3cm [.1181 inches] calcific density overlying the lower pole of the left kidney." 116. Usually, when the kidney stones are in the kidney, they are not painful.

Rather, as the stones come out of the kidney and travel down the ureter is when the individual typically experiences pain. As the x-ray report indicates that the kidney stones are in the kidney, rather than the ureter, I would not expect an individual with these stones to have significant pain. 117. However, in a note dated 11/9/04, Dr. O'Halloran noted that "Currently,

patient has been having intermittent right flank pain radiating to the right ____- since May 03. The pain has become constant in the past 2 weeks." 118. Plaintiff was seen by a urologist at UConn on November 23, 2004 who

noted, "Physical examination today reveals a healthy-looking male. He had no evidence of any punch tenderness or any other abnormality. . . . . My impression is probable right renal stone based on the patient's description of an earlier KUB [Kidneys, Ureters, Bladder
X-ray]."

119.

An Extracorporeal Shock Wave Lithotripsy (ESWL) was done on

Decembre 22, 2004. DR Menina prescribed plaintiff to have percocet 1 to 2 tablets every four hours for pain but noted that facility doctor may use other drugs as available and ordered a follow up KUB test.

Case 3:03-cv-00544-WWE

Document 53-6

Filed 05/23/2005

Page 17 of 18

120.

ESWL is one of four surgical procedures used for kidney stones. This

procedure requires general anesthesia. Acoustic or ultrasonic sound waves are produced outside the body (extracorporeal) and directed at the kidney and the stone to break it up into smaller pieces. It is very common to have blood in your urine as well as back pain and bruising after this procedure. After the procedure it is hoped that the patient will pass the stone which has now been broken up into many smaller stones. 121. On January 3, 2005, plaintiff presented to medical and gave a cup of

stones to medical personnel who sent the stones out for analysis. 122. On January 12, 2005, Dr. O'Halloran noted that the stone analysis showed

plaintiff's stones were calcium stones compromised of 10% calcium oxalate monohydrate, 40% calcium oxalate dehydrate, and 50 % calcium phosphate. 123. On January 18, 2005, plaintiff underwent another KUB x-ray which

showed that the 2 cm right renal stone fragmented into three smaller stones. 124. On April 19, 2005, plaintiff was seen by urologist Dr. Albertsen who

noted that plaintiff passed many fragments uneventfully but needed follow up lithotripsy to get rid of the residual stone fragments 125. Given the sporadic nature of plaintiff's complaints to Dr. Tung and the

radiological findings, it is my opinion beyond a reasonable degree of medical probability that Dr. Tung's conservative management and treatment of plaintiff's kidney stone complaints was in accordance with the applicable standard of care for internal medicine physicians. I have read the foregoing and it is all true and accurate to the best of my knowledge and belief.

__/s/____________________________ Dr. Edward Blanchette

Case 3:03-cv-00544-WWE

Document 53-6

Filed 05/23/2005

Page 18 of 18

Subscribed and sworn to before me this day of April 2005. __/s/_____________________________ Ann E. Lynch Assistant Attorney General