Jeff Vaughn v. Kentuckiana Colon & Rectal Surgery and Dr. Wayne Tuckson

1. Jeff Vaughn v. Kentuckiana Colon & Rectal Surgery and Dr. Wayne Tuckson

2. 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  •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) •Jeff did not have FAP and Dr. Tuckson’s documents did not support FAP

3. 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? 

4. Dr. Tuckson cut based on hearsay from patient Jeff •Dr. Tuckson cut with Jeff’s statement and 4 documents January 31, 2002 Office Visit: - Jeff said Dr. Haider said Jeff had: •“familial polyposis” •more than 100 polyps   Dr. Tuckson had 4 reports - that identified a total of 2 polyps: 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 •Standard of Care: Jeff’s statement alone is NOT an acceptable way for Dr. Tuckson to confirm FAP diagnosis.

5. Documents - FAP Misdiagnosis/Surgery  (45 + Days) Dr. Tuckson Chart 4 reports, 1 letter, and Jeff says FP ____ 0 Dr. Tuckson ●Scopes, ●DNA Tests, ● to collect documents diagnosing FAP Sept 21, 2001 to Jan 30, 2002 March 19, 2002 to Jan 20, 2004 ______________ ______________       (4 + months) (1 year and 10 months) Dr. Kashif Haider Chart  ☻Includes Dr. Lee’s Path ☻Includes Hardin CT Scan Dr. Tuckson Chart Surgery Report 2 Office Visits ●No mention of AFAP Hardin Hospital Chart  ☻Includes Dr. Lee’s UK Path Jewish Hospital Chart ●No mention of AFAP HealthSouth Surgery Chart ☻Photos b4 litigation? Mayo Clinic – 1/20/04 ●Jeff’s lawyer gets DNA tested

6. 1. EGD Path = Inconsistent with FAP •1/22/02 Pathology Report faxed to Dr. Tuckson on Jan 30th • Fax received at 10:01p.m.   Heartburn Infectious Organisms Not Seen Stain for Bacteria Negative

7. 2. EGD = Heartburn, not FAP •1/22/02 Operative Report faxed to Dr. Tuckson on Jan 30th • Fax received at 1:23p.m.  Before Scope Diagnosis 1. Persistent heartburn 2. Possible familial polyposis   • After Scope Diagnosis • Heartburn • not familial polyposis

8. 3. Colonoscopy Path = Unclear at Best •10/12/01 Pathology Report faxed to Dr. Tuckson on Jan 30th • Fax received at 1:23p.m.   1 documented polyp  Low to High Grade Dysplasia? •Either low or high •not both Moderate to Severe Dysplasia? •no more “moderate” •Either low or high

9. 4. Colonoscopy Report = Inconsistent with FAP •10/11/01 Report faxed to Dr. Tuckson on Jan 30th • Fax received at 1:23p.m.  Before Scope Diagnosis 1. Rectal Bleeding   After Scope Diagnosis 1. Hemorrhoids 2. Colon Polyp x 2

10. Dr. Tuckson never told Dr. Haider the surgery date Red Flags •Index Case = no family History •Polyps Not Evenly Distributed •Low to High = Severe? 

11. Jeff’s did not have a deadly disease, he had Hemmorhoids _________________________________

12. 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. SussmanSurgical Oncologist UC Dr. Rex.GI IU

13. (1) Contact Dr. Haider - what would a have revealed? Dr. Lee had argued “no way” Jeff had FAP in early Jan 02 – p. 21 Polyposis not on Lee’s mind _______________________ Dr. Haider said Jeff had less than 100 polyps and no history – p. 39 ___________________________ _________________     p. 45

14. (2) DNA Testing - what would a “Mayo” test have shown?  A mutation was NOT detected ________________________________________ ________________

15. (3) Look Inside Colon First – what would Dr. T have seen?  Benign segment of colon  No adenoma or carcinoma  Benign segment of colon

16. Dr. Haider’s Fault •What have the Defendants proven as to Dr. Haider’s fault?

17. Apportionment of Fault and Jeff’s Damages •Example of effect of “apportionment” on damages awarded Defendants Pay Total Damages $1,000,000 Dr. T Faultx 50% Dr. T Owes Jeff $500,000  Verdict Reduced •$1,000,000 total damages award reduced by $500,000 for Dr. H 50% share of fault •Jeff collects $500,000 from $1,000,000 awarded in this 50/50 example.

18. THIS CASE IS ABOUT AFAP About Defendants •A = Faulting •F = Another •A = Person = Dr. Haider •P =

19. THIS CASE IS ABOUT AFAP About Defendants •A = Fabricating •F = A •A = Polyposis = AFAP •P =

20. 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

21. 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%.

22. What does the Mayo Clinic say about AFAP?  None of the listed mutations were detected ________________________________________________ _____

23. What does Dr. Church’s article say about AFAP? •Fundic Gland polyps are nearly always associated with AFAP and may precede the development of colorectal polyps. •Jeff did NOT have Fundic Gland Polyps Undisputed Fact per EGD •AFAP article, p. 130, January 2002 Dr. Church did not mention of “controversy” in commentary

24. What else does the 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. •Jeff had left sided polyps  •AFAP article, p. 130 January 2002 Left sided Polyps and AFAP not discussed in Dr. Church’s commentary

25. Jeff had 3 Small Low Grade Adenomas •3 ant size adenomas do not equal AFAP Dr. Fenoglio-Preiser •1 low grade ant-size adenoma Specimen to Pathology •1 piece of tan tissue (.6 x .02 x .02 cm) 1. Colonoscopy – 2 polyps •10/11/01 Dr. H rectum scope   _________________________________________________________ 2. Flex Sig - 4 polyps •11/5/01 Dr. H rectum scope Specimen to Pathology •6 tan fragments (2.0 mm each) Dr. Fenoglio-Preiser •2 low grade ant-size adenomas   = COMMON _________________________________________________________ Dr. Fenoglio-Preiser 0 adenomas Jewish Pathology Benign Colon No adenomas No carcinomas 3. Colon Removal •3/19/02 Dr. T surgery Specimen to Pathology •Jeff’s Colon 3 feet approximately   = COMMON

26. DNA testing is powerful tool to be used to confirm diagnosis in an atypical patient like Jeff Hardin Memorial Request for 2nd Pathology Opinion from Dr. Lee __________ _____________________ ______________________________ Dr. Church Primer, Chapter 9, Page 71 _____________________________________________________________________ _________________________________________________

27. Jeff’s damages – the unnecessary surgery 

28. 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

29. •Dr. Lynch says a “gross” deviation from a minimally acceptable standard of care has turned Jeff into a bowel cripple

30. •Dr. Tuckson operated the scapel which, according to him, was the “Truck In This Case”