RICH, BRYANT A., SUCCESSOR EXECUTOR FOR THE ESTATE Et Al v. HARTFORD HOSPITAL, HHD-CV21-6140582-S, 20543704 (Conn. Super. Ct. Apr. 13, 2021) (2024)

RETURN DATE: MAY4,2021
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`:
`
`SUPERIOR COURT
`
`BRYANTA. RICH, SUCCESSOR EXECUTOR:
`FOR THE ESTATE OF TRACYL. RICH,
`:
`(DECEASED) AND
`VANESSA L. BRYANT
`
`JUDICIAL DISTRICT
`OF HARTFORD
`
`HARTFORD HOSPITAL
`
`:
`:
`
`:
`
`AT HARTFORD
`
`MARCH31, 2021
`
`COUNTONE:
`BRYANTA. RICH, SUCCESSOR EXECUTOR FOR THE ESTATEOF TRACYL.
`RICH, (DECEASED) v. HARTFORD HOSPITAL
`
`COMPLAINT
`
`On or about September 23, 2019 the plaintiff, BRYANT A. RICH, SUCCESSOR
`
`EXECUTOR FOR THE ESTATE OF TRACYL. RICH, (DECEASED), was appointed
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`by Simsbury Regional, Probate Court. A copy of said appointmentis attached hereto as
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`Exhibit A.
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`This wrongful death claim is being brought pursuant to Connecticut General Statute
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`$52-555.
`
`At all times mentioned herein, the defendant, HARTFORD HOSPITAL,wasa specially
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`chartered corporation organized and existing under the laws of the State of Connecticut
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`operating a hospital in Hartford, Connecticut providing Emergency Medicine physicians,
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`medical doctors, surgeons, physician assistants, nurses, hospitalists, and other healthcare
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`professionals to the general public and more specifically to the plaintiff's decedent,
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`TRACYL. RICH.
`
`

`At all times mentioned herein, Matthew K. Griswold was a servant, agent, apparent agent
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`and/or employee of the defendant, HARTFORD HOSPITAL.
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`Atall times mentioned herein, Josephine Contrino was a servant, agent, apparent agent
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`and/or employee of the defendant, HARTFORD HOSPITAL.
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`Atall times mentioned herein, Kelly A. Donovan was a servant, agent, apparent agent
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`and/or employee of the defendant, HARTFORD HOSPITAL.
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`At all times mentioned herein, Brendan T. Leahy was a servant, agent, apparent agent
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`and/or employee of the defendant, HARTFORD HOSPITAL.
`
`Commencing on or about July 31, 2019 and continuously to on or about August 1, 2019,
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`for the same or similar condition, the defendant, HARTFORD HOSPITALand/ortheir
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`servants, agents, apparent agents and/or employees, undertook the care,
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`treatment,
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`monitoring, diagnosing and supervision ofthe plaintiffs decedent, TRACY L. RICH .
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`While underthe care, treatment, monitoring, diagnosing, and supervision of HARTFORD
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`HOSPITAL and/or their servants, agents, apparent agents and/or employees, TRACY L.
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`RICH suffered severe, serious, painful, and permanentinjuries all leading to his death on
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`August |, 2019 as herein after set forth in paragraph 11.
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`The said injuries and death suffered by TRACY L. RICH were caused bythe failure of
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`HARTFORDHOSPITALand/ortheir servants, agents, apparent agents and/or employees,
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`to exercise reasonable care underall of the facts and circ*mstances then and there present
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`in that they:
`
`

`failed to adequately and properly care for, treat, diagnose, monitor, and
`supervise TRACYL. RICH;
`
`failed to properly review and interpret the electrocardiograms of TRACY
`L. RICH;
`
`failed to properly compare current electrocardiogramswith prior
`electrocardiograms;
`
`failed to recognize abnormal findings on the electrocardiograms;
`
`failed to recognize the QT/QTcinterval was prolonged;
`
`failed to recognize that TRACY L. RICH wasatincreased risk of a
`cardiac arrhythmias;
`
`failed to recognize that TRACY L. RICH was atincreased risk of sudden
`death;
`
`failed to properly treat TRACY L. RICHin view of abnormal findings on
`the electrocardiograms;
`
`administered medications that increased the risk of fatal cardiac
`arrhythmias;
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`ordered and administered medications knownto increase the QT/QTc
`interval;
`
`failed to order alternative medications that would not increase the risk of
`arrhythmias;
`
`failed to order medications that would not prolong his QT/QTcinterval;
`
`failed to recognize that combining multiple medications known to prolong
`the QT/QTcinterval was contraindicated and dangerous;
`
`failed to recognize that TRACY L. RICH required cardiac monitoring;
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`failed to appropriately monitor TRACY L. RICH’S cardiacstatus;
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`failed to admit TRACYL. RICHto the hospital where he would receive
`continuous cardiac monitoring;
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`failed to order and place TRACYL. RICH on a cardiac monitor;
`
`failed to properly monitor TRACYL. RICH;
`
`

`S.
`
`t.
`
`u.
`
`v.
`
`w.
`
`x.
`
`y.
`
`Zz.
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`failed to have discussions between the emergency departmentstaff and the
`hospitalist staff concerning the need for TRACYL. RICH to have
`continuous cardiac monitoring;
`
`failed to have a system in placeto facilitate communication between
`emergency departmentstaff and hospitalist staff concerning the need for
`continuous cardiac monitoring for patients such as TRACYL. RICH:
`
`failed to have a system in place to facilitate the easy review and
`comparison ofcurrent and prior electrocardiograms by physicians caring
`for patients such as TRACYL. RICH;
`
`failed to have appropriate systemsin place to diagnose andtreatpatients
`such as TRACY L. RICH whohad abnormalfindings on their
`electrocardiograms;
`
`failed to adequately and properly supervise the physician assistants;
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`failed to provide physicians and surgeons who possessthe requisite
`knowledge,skill, and experience to adequately and properly carefor,treat,
`diagnose, monitor, and supervise patients such as TRACY L. RICH;
`
`failed to promulgate and/or enforcerules, regulations, standards, and
`protocols for the transition of care from the emergency departmentto
`hospital admission for patients such as TRACY L. RICH;
`
`failed to promulgate and/or enforce rules, regulations, standards, and
`protocols for the care and treatment ofpatients such as TRACYL. RICH.
`
`As a result of the carelessness and negligence of HARTFORD HOSPITAL and/ortheir
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`servants, agents, apparent agents, and/or employees, TRACY L. RICH suffered the
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`followingsevere, serious, painful, and permanentinjuries:
`
`a.
`
`b.
`
`c.
`
`d.
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`further prolongation of the QT/QTcinterval:
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`cardiac arrhythmias;
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`psychological, neurological and physiological sequalae;
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`sudden death.
`
`

`As a result of the aforementioned injuries and death, TRACY L. RICH has been
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`permanently deprived of his ability to carry on and enjoylife’s activities and his earning
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`capacity has been permanently destroyed.
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`As further result of the aforementioned injuries and death, the ESTATE OF TRACYL.
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`RICH has incurred expenses for medical care and treatment and funeral costs all to its
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`financial loss.
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`COUNT TWO:
`VANESSA L. BRYANT v. HARTFORD HOSPITAL
`(LOSS OF CONSORTIUM AND COMPANIONSHIP)
`
`1-11. Paragraphs | through 11 of COUNT ONEare hereby incorporated and made paragraphs|
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`through 11 of COUNT TWO.
`
`At all
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`times mentioned herein,
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`the plaintiff, VANESSA BRYANT, was the wife of
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`TRACYL. RICH.
`
`As aresult of the aforesaid occurrences to TRACY L. RICH, VANESSA BRYANThas
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`been deprived of the companionship and society of her husbandall to her damage,
`
`

`WHEREFORE,THE PLAINTIFFS, BRYANTA. RICH, SUCCESSOR EXECUTOR FOR
`
`THE ESTATE OF TRACYL. RICH, (DECEASED) AND VANESSA L. BRYANT HEREBY
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`CLAIMS MONETARY DAMAGESIN EXCESS OF FIFTEEN THOUSAND DOLLARS &
`
`00/100 ($15,000.00) AND THIS MATTERIS WITHIN THE JURISDICTION OF THIS
`
`COURT.
`
`

See Also

Drawing Practice Exercises

`The medical records indicate Mr. Rich wastriaged into the Hartford Hospital
`Emergency Department(ED) at 5:24 am on July.31, 2019. He was reporting lethargy,
`nausea, vomiting, inability to eat andhiccups. He was G7years oldand hada past
`medical history of hypertension, left bundle branch block (LBBB), deep vein thrombosis,
`pulmonary emboli, polymyalgia rheumatica,iron deficiency and B12 deficiency. In
`addition, Mr, Rich had had hiccupsintermittently over the past year and oncefollowing a
`colonoscopy. He had a low-grade fever (100.5), othenvisehis vital signswere stable. The
`firstproviderto evaluate Mr.-Rich wasphysician assistantBrendan Leahy. Mr. Leahy
`performed a physician examination, the results of which were within normallimits. Mr.
`Leahy ordered blood work, including a troponin level. An electrocardiogram (ECG) was
`ordered by both Mr. Leahy and his supervising attending, Dr. Griswold. Perhis clinical
`impression note, Mr. Leahy indicated thatMr. Rich had a fong history of LBBB and the
`ECG that Mr. Leahy ordered and reviewed was “slightly differentin appearance” according
`to his note. Mr. Leahy had a discussion with cardiologist Dr. Kunkes and Mr. Leahy's note
`indicates that Dr. Kunkes reviewed the ECG and “suspects negative deflection is a PAC."
`PAC is a medical abbreviation for premature atria! contraction.
`The attending,Dr. Griswold, also evaluated Mr. Rich. According to Dr. Griswoid’s
`atiesiation note, he oblained ahistory, performed an examination , reviewedfindings and
`supervised the managementofthe patient. Dr. Griswold noted that Mr. Rich wasactively
`vomiting, and he ordered an antiemetic, Zofran. Dr. Griswold did notfind any gross
`abnormality in the blood work. He planned on obtaining another troponin level anda CT
`scan of Mr. Rich’s abdomen/pelvis, as well as, providing Baclofen andProtonix for his
`hiccups. The record does notinclude anote by Dr. Griswoldwith bis owninterpretation of
`the ECG, which appears to have been ordered in duplicate. Dr. Griswold signed outto the
`oncoming team with imaging and re-evaluation pending.
`With the changeofshifts, the patientwas signed out to Kelly Donovan PA-C. Ms.
`Donovan noted the CT scan was consistentwith developing pneumonia. She initiated an
`admission tothe hospital forintravenous antibiatictherapy. Mr. Rich was admitted to the
`General Medicine service. Dr. Contrino, from the hospitalist service, saw Mr. Rich and
`completed an admitting history and physical examination. Dr. Contrino broughtin an
`infectious disease consultantfor treatment of Mr. Rich's pneumonia.
`
`

`Approximately 12 hours after his presentation to the hospital, Mr. Rich was found
`unresponsive. Hewas pulsefess and'breathless. Despite resuscitativeefforts, he died.
`Mr. Rich presentedto the ED with complaints of hiccupping, nausea, and fatigue,
`whichare consistentwith chest pain equivalentsymptoms. The patienthad an ECG done
`on presentation. The ECG demonstrates LBBS, ectopy in the form of a premature atrial
`contraction, and a prolonged QTinterval. The computer automatically calculated the QT
`interval and noted it-on ‘the upperleft-hand comerofthe ECG. In addition, the computer
`calculated ihe.QTc,theQT interval-cornected for the patient's heartvate. On this ECG,the
`calculated QT/QTc is 486/528 ms respectively. This information wasavailable to PA
`Leahy uponhis interpretation of the ECG.
`An abnormalQTe(in males) measures greater than 470ms. Thus, Mr. Rich's QTc
`interval should have been.considered prolonged and the standard of care required PA
`Leahyto recognizethai the OTe interval was prolonged. There is ne evidence that PA
`Leahy recognizedthatthe patient's QTc interval was prolonged,therefore, he deviated
`from the applicable standard of care of a certified Physician Assistant.
`Because QTc prolongationis associated with an increasedrisk oflife-threatening
`cardiac amhyihmias, suchaspolymorphic venticulartachycardia (a/k/a torsades de
`‘paintes),PA Leahyhad thevesponsibility todiscussthepatient'sprotonged QTc with his
`attending physician,Dr. Griswold. Thereis no evidence that PA Leahydiscussed the
`prolonged QTc with Dr. Griswold, therefore, PA Leahy deviated from the applicable
`standard of care of a certified Physician Assistant.
`In the managementof patients with prolonged QTc, extreme care must be takento
`prevent further prolongation. Safety measures include identifying medications that'are
`knownto prolong the QTinterval and avoiding the administration of these medications,
`particularly in combination. The medical records indicate a number of medications known
`to prolong the QT were given to Mr. Rich while underthe care of PA Leahy. These
`medicationsincludeOndansetron {Zofran), Ketorolac (Toradol), Baclofen (Lioresal).and
`Pantoprazole(Protonix). PALeahydeviated from the applicable standard of care of a
`certified Physician Assistant by ordering medications knownto prolong the QTcintervalto
`be ordered and administered to Mr. Rich.
`In the eventthat the above named medications could not be substituted for
`medications that are not associated with QT prolongation, the applicable standard of care
`
`

`required PA Leahyfo place Mr. Rich on a cardiac monitor while in the ED. Cardiac
`monitoring wouldalfow thestaff to. timely detect andtreaf cardiac arhythmias: There is no
`evidence in the records that Mr: Rich was placed-on cardiac monitoringwhile in the ED. In
`this regard, PA Leahy deviated from the applicable standardofcare.
`From blood work drawnin the ED, Mr. Rich’s potassium level was 4.4. This blood
`test was reported to be slightlyhemolyzed. The importance of an accurate potassium level
`when dealing with cardiacetiology, and especially-with a pafientwho has prolonged QT,is
`widelyunderstood. When a patienthas a hemolyzed blood specimen, the potassium may
`be falsely elevated. To meetthe standard of care applicable to him,it was PA Leahy’s
`responsibility to recognize the importanceof this result, in the setting of a prolonged QTc,
`and the effect that potassium has on keeping cardiac rhythm stable. The applicable
`standard of care required PA Leahy to recognize this and fore-order the potassiumlevef.
`Thereis no indication from the medical records that-PA Leahy recognized the blood.
`sample was hemolyzed. Further, there is no indication PA Leahy repeated a potassium
`level.
`In these regards, PA Leahy deviated from the standard of care applicable to him.
`Further, the standard of care applicable to PA Leahy required himto report Mr.
`Rich's prolonged OY/QTsc .at sign-outto PA Donovan. There'is no'indication that this
`clinically significantinfornation was shared with PADonovan, therefore, PA Leahy
`deviated from the applicable standard of care.
`In hercare and treatment of Mr. Rich, the applicable standard of care required PA
`Donovanfo review the tests, fabs, andimaging thatwere done on Mr. Rich. She should
`have recognized that Mr. Rich. hada profongedQT/QTc. There is-no-evidence in the
`record that PA Donovanrecognizedthis prolonged interval on the ECG, therefore, she
`deviated from the applicable standard of care.
`While under the care and treatment of PA Donovan, Mr. Rich continued to
`experience nausea and vomiting. PADonovan ordered Ondansetron (Zofran) to control
`Mr. ‘Rich'svomiting. This medication ,well known to prolong the QT intervalwas
`administeredihree-times: at 1:24pm, 8:33-pm and 2:30 am on August1®=. PA Donovan
`additionally ordered Azithromycin (Zithromax) for the patient's pneumonia. This
`medication is also associated with prolonging the QT interval. PA Donovan deviated from
`the applicable standard ofcare by ordering Ondansetron and Azithromycin in the setting of
`an already prolonged QT/QTcinterval:
`
`

`
`
`The applicable standard of care required PA Donovanto review the ECG donein
`the ED;to recognizeMr. Rich had'a profanged'QT/Qfc, and to-order cardiac monitoring
`while in the ED,particutarty in thesetting of the administration of medicationsknawnito
`further prolong the QT. Cardiac monitoring was not ordered; in this regard, PA Donovan
`deviated from the applicable standard of care.
`Further, PA Donovan wasinvolvedin getting Mr. Rich admitted to the hospital.
`BecauseMr.Rich had a prolonged QT/QTc and wasreceiving.medicationsthatare known
`to prolong the QTinterval, the applicabte standard of care required PA Donovanto request
`that Mr. Rich be admitted to the hospital with telemetry monitoring. Mr. Rich was admitted
`to a general medicalfloorforpneumonia andthere is no evidence in the record that he
`received telemetry monitoring. PA Donovan deviated from the applicable standard of care
`by allowing Mc. Rich to beadmittedwithouttelemety monitoringand/or, at minimum, By
`failing to documentthat she hada discussion with the hospitalist, Dr. Contrino, that Mr.
`Rich required telemetry monitoring.
`| hold the opinions expressed herein to a reasonable degree of probability. Based
`upon my review ofthe above,it is my opinion thatthere is evidence of medical negligence
`on the partofBrendanLeahy,PAGKellyDonovan,PA-C-andHartfordHospital. Both
`physician assistantsdeviated from the standard ofcare applicable to them as certified
`Physician Assistants in theirassessment andtreatmentof Mr. Rich in the mannersetforth
`herein. Their deviations from the applicable standard of care were a proximate cause of
`Mr. Rich’s cardiopulmonary arrest and death. The opinionsstated herein are based upon
`the information availableto meatthis.time. Shoufdather informationand’evidence
`become available, | reserve the rightto supplementand/oramend thisopinion.
`
`

`PHYSICIAN'S OPINION
`PURSUANTTO C.G.S. § 52-190a
`
`[NOT SUBJECT TO GENERAL DISCLOSURE]
`
`Dear Mr. Horwitz:
`
`|
`
`Thank you for asking me to review the case of Tracy Rich. As you know, | am
`board certified in Emergency Medicine with a subspecialty board in Medical Toxicology.
`have beenin practice for more than sixteen years.
`| am an attending physician in the
`Department of Emergency Medicine in an academic teaching hospital.
`In addition, | am an
`Adjunct Associate Professorof Clinical Emergency Medicine.
`This case involves the care and treatment rendered at Hartford Hospital by Matthew
`K. Griswold, M.D., and the Emergency Department Physician Assistants. You have
`advised me that Dr. Griswold was board certified in Emergency Medicine at the time of the
`events herein. The medical records indicate Dr. Griswold was the attending physician in
`the Hartford Hospital Emergency Department when Mr. Rich presented on July 31, 2019.
`am familiar with the standard of care in 2019, in the United States, including Connecticut,
`for board certified Emergency Medicine physicians who care for and treat patients such as
`Mr. Rich.
`
`|
`
`| have read and reviewed the following records and reports pertaining to Tracy Rich:
`1) Hartford Hospital Emergency Department and admission records, dated July
`31, 2019, to August 1, 2019;
`
`2) Autopsy report.
`According to the medical records, Tracy Rich presented to the Hartford Hospital
`Emergency Department (ED) at 5:24 a.m. on July 31, 2019, for nausea, vomiting and
`intractable hiccups. At that time, Mr. Rich was a 67 year old man with a past medical
`history of hypertension, left bundle branch block (LBBB), deep vein thrombosis, pulmonary
`emboli, polymyaigia rheumatica, hiccups following a colonoscopy a number of years
`before, iron deficiency and B12 deficiency. Mr. Rich reported being unable to eat or drink
`for the previous forty-eight hours. He was also experiencing weaknessandlethargy.
`Mr. Rich was seen and evaluated by the ED physician assistant (PA) Brendan
`Leahy, as well as by Dr. Griswold. On examination, Mr. Rich was actively vomiting. Their
`
`

`work-up included radiology studies, electrocardiogram (ECG) and laboratory studies. The
`laboratory studies including serial troponin and ECG ruled out an acute coronary process
`such as myocardial infarction. Mr. Rich’s laboratories identified a sérum potassium of 4.4
`mEq/L, a blood urea nitrogen of 11 mg/dL, a serum creatinine of 1.1 mg/dL. In addition,
`urinalysis showed an elevated specific gravity 1.045 (normal 1.005-1.030) demonstrating
`significant dehydration and also ketones present in the urine demonstrating noteating.
`Noteating and drinking and persistent vomiting put Mr. Rich atrisk of electrolyte
`abnormalities including hypokalemia and hypomagnesemia putting Mr. Rich at increased
`risk for cardiac dysrhythmia particularly in setting of intraventricular conduction delay eg,
`LBBB. The chestx-ray/chest CT Scan were suggestive of pneumonia.
`PA Leahy madenote of the patient's history of LBBB. He documented that the
`ECG, taken at 6:17 a.m., showed LBBB. Thereis no note in the record by Dr. Griswold
`that he personally reviewed the ECG even though he wrote an orderforit.
`While in the ED, Mr. Rich wastreated with ondansetron (Zofran®), pantoprazole
`(Protonix®), and baclofen. These medications were ordered by Dr. Griswold.
`in addition,
`ceftriaxone (Rocephin®) and azithromycin (Zithromax®) were given. Of note, azithromycin
`(Zithromax®) can prolong QTcintervals on ECG. In addition, a second dose of
`ondansetron (Zofran®) was given. Ondansetron (Zofran®)is reported to increase QTc
`intervals. The combination of multiple potential QTc prolonging medicationsin patients with
`relative bradycardia, intraventricular conduction delay, premature supraventricular
`contractions, and potential for electrolyte abnormalities increases the risk of cardiac
`dysrhythmia eg, TdP (Torsades de Pointes). These medications were ordered by the ED
`PA Kelly Donovan who took over at the changeof shifts. Mr. Rich was held in the ED until
`sometime in the afternoon on July 31, 2019, when he was admitted to a general medical
`floor.
`
`Onthe inpatient unit, Mr. Rich was seen and evaluated by the hospitalist, Dr.
`Contrino, who ordered metoclopramide (Reglan®), which aiso is associated with
`prolonging the QTc and TdP andalso given ondansetron (Zofran®). Mr. Rich waslast
`medicated with ondansetron (Zofran®) at 2:30 a.m. on August 1, 2019. Several hours
`later, Mr. Rich was found unresponsive. Cardiopulmonary resuscitation was performed,
`however, Mr. Rich failed to have return of spontaneouscirculation and he died. An
`
`

`autopsy was obtained thatidentified a left upper lobe pneumonia, a 590-gm heart, and
`
`some degree of coronary artery disease, without evidence of myocardial infarction.
`
`In my opinion, the care and treatment Mr. Rich received in the ED fell below the
`
`standard of care applicable to board certified Emergency Medicine physicians. Both Dr.
`
`Griswold and PA Leahy ordered the ECG. Whena test, such as an ECGis ordered, the
`
`applicable standard of care requires the practitioner to review the ECG andidentify any
`
`abnormalities.
`
`In this case, the ECG showeda ventricular rate of 71 beats per minute and
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`prolonged QTcinterval of 528 milliseconds. The slower the heart rate or relative
`
`bradycardia, 71 beats per minute in this case, increases the risk of Torsade de Pointes
`
`(TdP). Review of vital signs while in the emergency department show heart rates as fow as
`
`59 to 61 beats per minute. A prolonged QTcinterval and siower heart rate puts the patient
`
`at increasedrisk of fata! cardiac arrhythmias such as TdP particularly if multiple potentially
`
`QTc prolonging medications are given in patients at risk for electrolyte abnormalities from
`
`not eating and drinking and with intraventricular conduction delay. The ECG also shows
`
`premature supraventricular complexes, which can suggest myocardialirritability and risk
`
`for cardiac dysrhythmia. There is no evidence that Dr. Griswold reviewed the ECG himself
`
`and, in this regard, he violated the standard of care applicable to him as a board certified
`
`Emergency Medicine physician.
`
`Had Dr. Griswold reviewed the ECG, the applicable standard of care required him to
`
`have identified Mr. Rich’s prolonged QTcinterval. Dr. Griswold ordered medications that
`
`are knownto prolong the QTcinterval eg, ondansetron (Zofran®), azithromycin
`
`(Zithromax®). The applicable standard of care required Dr. Griswold to recognize that the
`
`QTcinterval was not only prolonged, but also that caution was required when prescribing
`
`medications that further prolong the QT interval. Dr. Griswold did not recognize the QTc
`
`interval was prolonged and he ordered medications that potentially further prolonged the
`
`QTcinterval; in these regards, Dr. Griswold violated the standard of care applicable to him
`
`as a board certified Emergency Medicine physician.
`
`Having prescribed medications that can prolong the QTinterval, the standard of
`
`care applicable to Dr. Griswold as a board certified Emergency Medicine physician
`
`required that he place Mr. Rich on continuous cardiac monitoring and advocatefor his
`
`admission to a telemetry inpatient unit. Dr. Griswold did not place Mr. Rich on a cardiac
`
`

`monitor in the ED and there is no discussion in the medical records indicating Dr. Griswold
`spoke with an oncoming ED physician, the ED PA's or hospitalist for the need to admit Mr.
`
`Rich to a telemetry bed.
`
`In these regards, Dr. Griswold violated the standard of care
`
`applicable to him as a board certified Emergency Medicine physician.
`In this
`It is not uncommon for physician assistants to care for patients in the ED.
`case, the records indicate that Dr. Griswold was the supervising physician for PAs Leahy
`and Donovan. Astheir supervising physician, the standard of care applicable to Dr.
`Griswold required him to review, among otherthings, the work-up conducted by the
`physician assistants.
`In this case, that work-up included the ECG. There is no evidencein
`the record that Dr. Griswold discussed the ECG abnormalities with the PA’s. As part of
`that discussion, the applicable standard of care required Dr. Griswold to caution the PA’s
`
`on their use of medications that prolong the QTinterval and to advise/advocate the need to
`
`provide cardiac monitoring. There is no evidence in the record that Dr. Griswold reviewed
`the ECG or discussed medications and cardiac monitoring with the physician assistants.
`In these regards, Dr. Griswold violated the standard of care applicable to him as a board
`certified Emergency Medicine physician.
`
`| hold the opinions that | have expressed herein to a reasonable degree of medical
`probability. Based upon my review of the above,it is my opinion that there is evidence of
`medical negligence on the part of Matthew Griswold, M.D., and Hartford Hospital. Dr.
`Griswold deviated from the standard of care applicable to him as a board certified
`
`emergency medicine physician in his assessment and treatment of Mr. Rich in the manner
`set forth herein. His deviation from the applicable standard of care was a proximate cause
`of Mr. Rich’s cardiopulmonary arrest and death. The opinions stated herein are based
`
`upon the information available to me at this time. Should other information and evidence
`
`become available, | reserve the right to supplement and/or amend these opinions.
`
`

`PHYSICIAN'S OPINION
`PURSUANT TO C.G.S. § 52-190a
`
`[NOT SUBJECT TO GENERAL DISCLOSURE]
`
`Dear Mr. Horwitz:
`
`| see
`
`Thank you for asking meto review the case of Tracy Rich. As you know, | am
`board certified in Internal Medicine. My practice focus area is inpatient hospital care.
`and care for patients daily who are admitted to the hospital. Also, | have held roles as
`Associate Director of Hospital Medicine, Medical Director of the Hospitalist Cardiac
`Telemetry Unit, Director of Clinical Affairs in the Division of Hospital Medicine as well as an
`Assistant Professorat the hospital’s medical school.
`This case involves the care and treatment rendered at Hartford Hospital, in 2019, by
`Josephine Centrino, M.D. You have advised me that Dr. Contrino was board certified in
`Internal Medicine atthe time of the events herein. The medical records indicate that Dr.
`Contrino was part of the hospitalist service.
`| am familiar with the standard of care,in
`2019,in the United States, including Connecticut, for physicians board certified in Internal
`Medicine who are hospitalists caring for patients such as Mr. Rich.
`| have read and reviewed the following records and reports pertaining to Tracy Rich:
`1) Hartford Hospital Emergency Department and admission records, dated July
`31, 2019, to August 1, 2019;
`2) Autopsy report.
`Mr. Rich was a 67yearold man whopresented to the Hartford Hospital Emergency
`Department (ED)in the early moming hours on July 31, 2019,with fever, nausea,
`vomiting, lethargy, and hiccups. His past medicalhistory included hypertension,left
`bundle branch block (LBBB), deep vein thrombosis, pulmonary emboli, polymyalgia
`rheumatica,iron deficiency, B12 deficiency and hiccups.
`Mr. Rich was seen by a physician assistant and emergency medicine physician.
`Their work-up included laboratory tests, electrocardiogram (ECG), chest x-ray and
`abdominal/pelvic CT Sean.
`
`

`Laboratory tests revealed a mildly elevated glucose level, normalelectrolytes, and
`normal white blood cell count. The CT Scan did not identify any acute intra-abdominal
`process; however, the chest x-ray was suggestive of pneumonia.
`The ECG was noted for LBBB. The computer read-out indicated the QT interval
`(QTc) was prolonged. There were no ischemic changes, troponin was negative and acute
`coronary syndromewasruled out. An official reading of the ECG was completed by a
`cardiologist (Dr. Tally) later in the evening of July 31, 2019. That cardiologistidentified
`LBBB aswell as a prolonged QTintervalof 528 milliseconds.
`Mr. Ric

RICH, BRYANT A., SUCCESSOR EXECUTOR FOR THE ESTATE Et Al v. HARTFORD HOSPITAL, HHD-CV21-6140582-S, 20543704 (Conn. Super. Ct. Apr. 13, 2021) (2024)

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