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5 JOSEPH M. ELIE, ESQ Arthur Court 2 Roseville, CA Telephone: (916) Facsimile: (916) Arbitrator 8 IN THE MATTER OF THE ARBITRATION OF 9 10 II 12 Claimants, ARBITRATION NO ORDER ON MOTION FOR SUMMARY JUDGMENT vs. Date: Time: Location: August 12, :00 p.m. Via Phone Respondents. Dial In : Passcode: Arbitrator: ( ) # Joseph Elie, Esq In May 2013, Respondents filed their Motion for Summary Judgment, pursuant to Code of 20 Civil Procedure 437c. The motion was supported by a Separate Statement of Undisputed 21 Material Facts in Support of the Motion together with supporting evidence in the form of 22 Claimants' discovery responses, hospital records and the declaration of neurosurgeon, 23, M.D. 24 In response to the motion for summary judgment, claimant sent 25 an to the arbitrator and counsel for Respondents on July 30, 2013 with the following 26 entitled attachments: Exhibit 1.1, Exhibit 1.2, Exhibit 1.3, Response pages 1-3 and Response 27 pages 4-7. The documents entitled Response pages 1-3 and 4-7 comprised of Respondents' 28 Separate Statement of Undisputed Material Facts in Support of the Motion, with Claimants' ORDER ON MOTION FOR SUMMARY JUDGMENT

6 handwritten notes stating whether the fact was disputed or undisputed. Exhibit 1.2 could not be 2 opened or accessed because it was password protected. Claimants did not serve the opposition 3 papers by any other method other than , and did not respond to Respondents' counsel who 4 advised Ms. that Exhibit 1.2 could not be opened. 5 In Respondents' moving papers, it is established as a matter of law by proper and 6 sufficient evidence that Respondents' care and treatment of the decedent, 7 upon which Claimants' claims are based, was within the accepted standard of care. The decedent 8 suffered a severe diffuse brain injury (as well as other injuries) and arrived at with a 9 Glascow Coma Scale of 3, indicating no evidence of neurologic function. The severity of the 10 decedent's condition was evident on the CT images of the head which showed punctate II hemorrhages scattered throughout the patient's brain. The patient's intracranial pressure and 12 swelling was medically managed in an effort to reduce swelling and profuse the brain with blood 13 to keep it alive. An intracranial pressure monitor was placed in the brain to monitor pressure. 14 The patient was given Mannitol, a diuretic that pulls fluid out of the brain in the hope of reducing 15 the ICP by reducing swelling and fluid volume within the brain. He was further managed with 16 ventilation support which lowers the partial pressure of C02 in the blood which causes 17 vasoconstriction thereby reducing ICP. The head of his bed was raised degrees to help 18 reduce swelling and ICP. He was also managed with osmolar therapy which elevates sodium in a 19 further attempt to reduce swelling. The declaration of DR. establishes that these 20 measures were appropriate and complied with the community standard of care. Notwithstanding 21 Claimants' unsupported claims to the contrary, standard of care did not require a decompressive 22 craniectomy be performed. 23 In addition, the uncontroverted evidence established that the patient died from a lethal 24 head injury as a result of the motor vehicle accident, and not from an act or omission by 25 Respondents. The patient's GCS score of "3" correlated with the worst possible condition and 26 prognosis and the evidence established that it was unlikely medical treatment could have saved 27 him. 28 Ill 2 ORDER ON MOTION FOR SUMMARY JUDGMENT

7 Claimants' responding papers were not timely filed or properly served, and were 2 incomplete. Nevertheless, the responding papers do not in any manner establish that there was a 3 breach of the accepted standard of care in Respondents' care and treatment of the decedent, or 4 that an act or omission by Respondents caused his death. 5 Respondents' objection to Claimants evidence in support of the opposition papers is 6 sustained as the records were not properly served, portions were incomplete and not inaccessible, 7 and they were not properly authenticated. 8 Respondents' objection to a later filed declaration by an expert for Claimants is moot and 9 therefore overruled without prejudice given that Claimants did not submit an expert declaration in 10 opposition to the motion for summary judgment. 11 It is the decision of the Arbitrator that the prevailing party in this arbitration is 12 Respondents and that Claimants shall recover nothing. The arbitration scheduled for September 13 17, 2013 is vacated. 14 Nothing in this arbitration decision prohibits or restricts the enrollee from discussing 15 or reporting the underlying facts, results, terms, and conditions of this decision to the 16 Department of Managed Health Care Dated: August I~, ORDER ON MOTION FOR SUMMARY JUDGMENT

8 Attorneys for Respondents 6 a Non-Profit Corporation; 7 a Non-Profit Corporation; and 8 a Professional Corporation 9 I.,.., 10 IN RE THE MAITER OF ARBITRATION BETWEEN of (a minor), ~d (a minor), on behalf of the Estate Arbitration No.: Claimants, ARBITRATION AWARD UPON ORDER 15 v. GRANTING SUMMARY JUDGMENT , a Non-Profit Corporation; Corporation; and Corporation; through 50, inclusive, _.. : ~- - : ~ ~ ~ ~o_n-pro fi t., a Professional :; and DOES 1 Respondents. Arbitration: November 5, 2013 Respondents' duly noticed Motion for Summary Judgment/Disposition of claimant's claim was heard via telephonic conference on August 9, Claimants, and appeared. Respondents appeared by, Esq. of' The motion for summary judgment is GRANTED

9 l Claimant's Allegations On August 23, 2012, Claimants (a minor), and (a minor), on behalf of the Estate of:, filed a Demand for Arbitration alleging delayed diagnosis and negligent treatment ofliver cancer resulting in Mr. 's death. Respondent's contentions Respondents denied said claims. It is Respondents' position that there was no breach of the standard of care that caused injury or death to Mr. From 6/20/12-6/26/12, Mr. was hospitalized. He was admitted with upper GI bleed. Upper GI endoscopy showed esophageal and gastric varices; the esophageal varices were banded. CT of the abdomen during this hospitalization showed rapid advancement of tumor burden since March, an approximately 10 em tumor in left lobe of the liver, multiple smaller tumors in the right lobe of liver, tumor invasion of the portal venous system, and presence of pulmonary emboli (tumor vs clot). Dr.. oflntetventional Radiology concluded that ('... because of the multiple comorbid factors, patient is not felt to be suitable candidate for percutaneous intervention". The palliative care service became involved in the patient's care. Resuscitation status was changed to DNR according to the patient's wishes and he was discharged home on hospice. The discharge summary stated that the patient's wife was coming to grips with the patient's prognosis. On 7/9/12, when seen by the oncologist, it was noted that Mr. was capable of only limited self-care, confined to bed or chair more than 50% of waking hours; not a candidate for chemoembolization per IR; It was recommend that he continue with hospice and the doctor documented that his wife was frustrated with her recommendation to continue hospice but that Mr. was comfortable with the treatment plan. From 7/22/12-7/24/12, Mr. was again hospitalized with hepatic encephalopathy after his wife called 911 given change in mental status. His mental status improved with lactulose. On discharge, it was documented that he continued to request DNR status and wanted to be discharged home with hospice, understanding that he was going to die. It was also documented that his wife continued to disagree with hospice and wanted more aggressive care for the patient. The doctor also documented the explanation to the wife regarding the obligation of everyone to obey the patient's wishes. On 7/30/12, Mr. was seen in the clinic for follow up. He confirmed during this visit that he wanted to continue with hospice care. On 7/31112, Mr. underwent therapeutic paracentesis for progressive ascites/edema. From 8/ /20112 Mr. was again hospitalized. He was admitted with worsening renal failure and persistent nausea/vomiting. After discussion with nephrology, patient, and wife, Dr. (admitting HBS) ordered IV fluids in case the renal failure was due to hypovolemia, although the concern was that the patient had hepato-renal syndrome in the setting of extensive liver tumor burden and recent large-volume paracentesis. The renal failure and hyperkalemia did not respond to medical management and Mr. expired. Respondents ' Evidence is Uncontradicted Claimant did not file expert testimony or proper evidence. The arbitrator, having now read and considered Respondents' Motion and supporting papers, first determines that, upon proper evidentiary showing, stlmmary disposition in arbitration proceedings is within the arbitrator's sound discretion.(schlessinger v. Rosenfelt, Meyer & Susman (1995) 40 Cal. App. 4 1 h 1096, )

10 In the instant case, respondents' showing, evidentiary and otherwise, establishes that the care and treatment rendered to Mr. was within the standard of care and did not cause him injury or death and that, absent contrary showing by claimant, respondents are entitled to award in their favor as a matter of law. Claimant has had substantial notice of respondents' Motion but.has failed to present any proper conflicting evidence demonstrating there is a triable issue. Based on the above, respondents' Motion for Summary Disposition of claimant's claim should be, and it is hereby, granted; the arbitration award should be entered jn favor of the respondents. Arbitration Award For the foregoing reasons, arbitration is hereby entered in favor of respondents and against claimant. Nothing in this a1 bitration decision prohibits o:r restricts the enrollee from discussing or reporting the underlying facts, results, terms and conditions of this decision to the Departrnent of Managed Health Care August llf Jose~ Arbifrator -3-

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14 vs. Claimant, ARBITRATION ORDER GRANTING MOTION FOR SUMMARY JUDGMENT ON BEHALF RESPONDENTS,a Date: May 15, 2015 non-profit corporation;. Time: 1 :30 p.m., a nonprofit corporation; and Arbitrator: Joseph M. Elie, Esq.., a professional corporation, Demand For Arbitration Dated: 2/27/2014 Arbitration Hearing: 6/16-17/2015 Respondents. 17 The Motion for Summary Judgment brought by Respondents 18,AND 19 was scheduled for telephonic hearing on May 15, 2015 before the 20 undersigned. Oral argument was waived. 21 Respondents and moving parties., 22,AND were 23 represented by, Esq. of. Claimant 24 is in pro per. 25 No Opposition was served on behalf of claimant. 26 On proof having been made to the satisfaction of this Arbitrator, and good cause 27 appearing therefor: 28

15 l IT IS HEREBY ORDERED that the Motion for Summary Judgment brought by 2 Respondents ,AND is GRANTED, as no triable issues of material fact exist upon which to establish Claimant's Causes of Action for negligence and other inappropriate medical care and treatment. The arbitrator concludes that respondents and their physicians and staff met the applicable standard of care, and that no act or failure to act on the part of respondents caused or contributed to claimant's alleged injwies. IT IS FURTHER ORDERED that judgment may be entered in favor of Respondents,AND. and against Claimant in this matter. Nothing in this arbitration decision prohibits or restricts the enrollee from discussing or reporting the underlying facts, results, terms and conditions of this decision to the Department of Managed Health Care. IT IS SO ORDERED and the Arbitration scheduled for June 15, 2015 is hereby vacated. _.,. DATED: May I tj 2015 JOSE ELIE, ESQ. Neutr 1 Arbitrator

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