United States District Court, D. Hawaii
MARITES CAMPANO and RAPHAEL CAMPANO, Individually and as the Court-Appointed Next Friend for the Minor Children R.M.B.C, R.B.B.C., and M.R.B.C., Plaintiffs,
UNITED STATES OF AMERICA, Defendant.
FINDINGS OF FACT AND CONCLUSIONS OF LAW
S.C. Chang United States Magistrate Judge.
Court conducted a jury-waived trial in this matter on
December 5 to 8 and 11 to 12, 2017. L. Richard Fried, Jr.,
Esq., John D. Thomas, Jr., Esq., and Geoffrey K.S. Komeya,
Esq., appeared on behalf of Plaintiffs Marites and Rafael
Campano, individually and as the court-appointed
next friend for the minor children R.M.B.C., R.B.B.C., and
M.R.B.C. (collectively “Plaintiffs”). Assistant
U.S. Attorney Harry Yee appeared on behalf of Defendant
United States of America (“Defendant”). The Court
has considered all the evidence presented, observed the
demeanor of witnesses and evaluated their credibility and
candor, considered the arguments of counsel, and considered
the applicable law. Pursuant to Federal Rule of Civil
Procedure 52, the Court makes the following Findings of Fact
and Conclusions of Law, and CONCLUDES, for the reasons
articulated below, that Plaintiffs are entitled to
$24, 743, 668.53 in damages. Any finding of
fact that should more properly be deemed a conclusion of law
and any conclusion of law that should more properly be deemed
a finding of fact shall be so construed.
is a medical negligence case involving severe and permanent
injuries to Plaintiff Marites Campano
(“Marites”), including end-stage renal disease
(“ESRD”) requiring hemodialysis, multiple renal
transplants, and immunosuppressant medication to prevent
rejection of the transplant, all for the remainder of
Marites was severely and permanently injured as a result of
sepsis caused by a group A streptococcus (“GAS”)
bacterial infection that was not timely diagnosed or treated
with antibiotic therapy by her physicians and care providers
at Tripler Army Medical Center (“Tripler” or
Plaintiffs initiated this action against Defendant under the
Federal Tort Claims Act (“FTCA”), 28 U.S.C.
§§ 1346(b) and 2671 et seq., alleging that
Marites' care and treatment at Tripler starting on July
22, 2013, fell below the requisite standard of care, and that
as a result of this violation by Tripler of its duty of care,
Marites suffered severe and permanent injuries.
Plaintiffs filed their administrative claims on September 8,
2014, under the provisions of the FTCA. The claims were
received by the Department of the Army on September 10, 2014.
Plaintiffs commenced the instant lawsuit on October 20, 2015,
after Defendant failed to either admit or deny said
administrative claims within six months of the filing
Plaintiffs have complied with all jurisdictional and
procedural prerequisites to suit. They have timely and
properly presented their claims under the FTCA to the
appropriate Federal agency.
all times relevant to this action, Plaintiffs were domiciled
in and citizens of the City and County of Honolulu, State of
Marites was born in 1976 in Ilocos Norte, a province in the
Philippines. [Testimony of Marites B. Campano in Transcript
of Non-Jury Trial Before the Honorable Kevin S.C. Chang,
United States Magistrate Judge on Tuesday, December 12, 2017
(“Marites 12/12”) at 39:13, 14-17.]
1993, Marites graduated from St. Joseph High School in
Dingras, Ilocos Norte. [Id. at 40:10-20.]
1998, Marites obtained an Associate's Degree in
Computer/Secretarial Science from the Divine Word College of
Laoag in Laoag City, Philippines. [Id. at
Marites was employed as a sales clerk at a store called
Fashion and Decor in Ilocos Norte and as a cashier at SM, the
biggest shopping center in the Philippines, located in
Manila. [Id. at 48:1-7.]
Marites also led hundreds of young people for seven to eight
years as an “SK Chairman, ” an elected youth
governmental official in her area in the Philippines.
[Id. at 48:11-49:2.]
November 2007, Marites came to the United States.
[Id. at 39:19.]
From 2008 to 2010, Marites was a cashier at Golden Coin
restaurant. [Id. at 43:18-21.]
2010, Marites obtained a Certified Nursing Assistant
certification from Healthcare Training and Career
Consultants, Inc. [Id. at 41:10-42:1.]
From 2010 until her injury at Tripler in July 2013, Marites
was employed as a full-time Certified Nursing Assistant at
The Plaza at Mililani. [Id. at 42:13-17; 50:15-17.]
Plaintiff Rafael Castro Campano (“Rafael”) was
born in 1976 in Ilocos Norte. [Rafael 12/7 at 131:6-14.]
1993, Rafael graduated from high school in the Philippines.
[Id. at 131:17-20.]
1996, Rafael received a Diploma of Technology in Automotive
Mechanics from the Mariano Marcos State University Institute
of Technology in Laoag City, Philippines. [Id. at
2001, Rafael received a Bachelor's Degree in Physical
Therapy from the Mariano Marcos State University in Batac
City, Ilocos Norte. [Id. at 132:11-21.]
September 2004, Rafael moved to Hawaii. [Id. at
After arriving in Hawaii, Rafael was briefly employed as a
building maintenance worker, then as a physical therapy aide.
[Id. at 135:24-136:18.]
October 2005, Rafael enlisted in the U.S. Navy, and remains
in the Navy's employ. [Id. at 136:19-24.]
December 2013, Rafael received a Bachelor of Science in
Nursing from Hawaii Pacific University. [Id. at
January 2014, Rafael became a licensed Registered Nurse in
Hawaii. [Id. at 135:4-7.]
Rafael hopes to obtain a Master's Degree in Nursing, but
Marites' injuries have prevented him from doing so.
[Id. at 133:13-20.]
Marites not suffered the injuries from the subject incident,
Rafael believes that he would have entered a Master's
Degree program and possibly already obtained a degree.
[Id. at 133:18-25.]
Master's Degree in Nursing would improve Rafael's
chances for promotion in the Navy because such
accomplishments factor into career advancement. [Id.
at 134:3-13, 17-19.]
Rafael also aspires to be an Advanced Practice Registered
Nurse. [Id. at 134:20-135:3.]
Rafael's current rank is Lieutenant Junior Grade, and his
promotion to full Lieutenant is expected in December 2017.
[Id. at 134:14-16; 136:25-137:6.]
The Campano Family
Marites and Rafael have been together since 1998, and were
married on April 8, 2005. [Marites 12/12 at 49:21-22, 24.]
Marites and Rafael's eldest son, Plaintiff R.M.B.C., was
born in 1999 in the Philippines. He came to Hawaii in 2004
with Rafael, but returned to the Philippines until 2007, at
which time he moved to Hawaii with Marites and his younger
brother, Plaintiff R.B.B.C. [R.M.B.C. 12/7 at 87:23-88:8,
R.M.B.C. attends high school in San Diego and is currently a
senior with a 4.0 grade point average. [Id. at
R.M.B.C. plans to attend college at the University of Hawaii
at Manoa, Northern Arizona University, or Washington State
University. [Id. at 106:10-13.]
R.M.B.C. aspires to become a fighter pilot in the Air Force.
[Id. at 106:14-19.]
Marites and Rafael's younger son, R.B.B.C., was born in
2001 in the Philippines. He is presently attending high
school in San Diego and has a 3.6 grade point average.
[R.B.B.C. 12/7 at 116:9-25, 127:1-5.]
R.B.B.C. is considering majoring in mechanical engineering
and would like to join the Navy as a mechanical engineer.
[Id. at 128:13-17.]
Marites and Rafael's youngest child and daughter,
Plaintiff M.R.B.C, was born during the incident at Tripler.
[Rafael 12/7 at 140:6-15; Ex. J-1, TAMC2 3679-81, 3838-39,
5059; Ex. J-2, TAMC 2057-59, 3054.]
Rafael recently relocated to San Diego, California, to be
trained at Balboa Naval Hospital. [Rafael 12/7 at 142:1-10.]
Prior to the relocation, the Campano family lived in Mililani
with Rafael's brother, Paquito, and Marites' mother.
[Id. at 142:14-20.]
Rafael hopes to serve in the Navy for eight more years, at
which time he will be eligible for retirement. [Id.
Following Rafael's retirement, Plaintiffs intend to
return to Hawaii. [Id. at 146:3-8.]
the event Marites requires hemodialysis again, the Campanos
would return to Hawaii because of the required family
support, even if it means that Rafael is forced to leave the
Navy prior to his eligibility for retirement. [Id.
Stipulation as to Liability
parties stipulated to Defendant's sole liability for the
injuries sustained by Marites in the July 22, 2013
hospitalization at Tripler. [Doc. No. 123.] The parties
additionally stipulated that they shall not elicit any
testimony or offer any proof at trial on the issue of
Stipulation as to Expert Qualifications
parties stipulated that the knowledge, skill, experience,
training and/or education of the following witnesses satisfy
Federal Rule of Evidence ("FRE") 702's
standards for expert qualifications in their respective
fields of expertise as set out in the table below:
Field of Expertise
Ching, Jeffrey D.S., M.D.
Emergency and Internal Medicine
Life Care Planning
Klein, Keith L., M.D.
Nephrology, Internal Medicine, Life Expectancy
Loudat, Thomas A., Ph.D.
Marvit, Robert C, M.D.
Psychiatry, General Medicine
Meyers, Jeffrey E.
Economic Loss Projections and Statistics
Ponce, Danilo E., M.D.
Riddick-Grisham, Susan R.N.
Life Care Planning, Case Management
Smith, Eric S., Ph.D.
parties were not required to present oral testimony at trial
regarding the qualifications of the above witnesses for
purposes of establishing FRE Rule 702 qualifications. [Doc.
Stipulation as to Past and Future Wage Loss
parties stipulated that the incident caused Marites to suffer
$538, 092.00 in past and future wage loss, as reflected in
the table below:
Net Income Taxes
Total Net Wage Loss
Past Wage Loss
Present Value Future Wage Loss
Stipulations as to Exhibits
parties stipulated to the admissibility for all purposes of
all exhibits on the joint exhibit list, Exhibits J-l through
J-91, and to the authenticity of Plaintiffs' Exhibits
P-56 through 71. [Doc. No. 115.]
parties stipulated to the admissibility for all purposes of
Joint Exhibits J-92A and J-92B. [Doc. No. 130.]
Marites' estimated due date was July 24, 2013. Despite
Marites' advanced maternal age, her pregnancy was
uncomplicated. There was no indication of issues with Marites
or M.R.B.C., or anticipation of problems with the birth. [Ex.
J-l at TAMC2 2523, 2533-34, 7323-24, 7380-82; Ex. J-3 at TAMC
(CHRONO) 153-54; Ex. J-ll at MAKALAPA 927-28, 984-86].
Marites presented to Tripler at 11:40 a.m. on July 22, 2013,
and was admitted to labor and delivery. Labor was thereafter
induced. [Ex. J-l at TAMC2 3669, 3830; Ex. J-2 at TAMC
Within hours of arrival, Marites became clammy and pale, and
experienced intermittent episodes of hypotensive low blood
pressure and a tachycardic heart rate ranging from 120 to 150
beats per minute. Notwithstanding the administration of
multiple fluid boluses and an IV, Marites' symptoms did
not improve. [Ex. J-1 at TAMC2 3673-77, 3834-37, 4469,
5057-59; Ex. J-2 at TAMC 1117, 1888, 2049-57, 2505.]
M.R.B.C. was born at 1:10 a.m. on July 23, 2013. [Ex. J-1 at
TAMC2 3679-81, 3838-39; Ex. J-2 at TAMC 2057-59.]
Marites experienced repeated and increasing episodes of
hypotension and tachycardia after her transfer to the
postpartum unit. [Ex. J-1 at TAMC2 3185, 3190, 3198, 3218;
Ex. J-2 at TAMC 1404, 1409, 1417, 1437.]
number of measures were taken to alleviate Marites'
fluctuating level of pain. [Exs. J-1, J-2.]
Marites was not producing urine due to her failing kidneys.
As a result, she was catheterized at least eight times to
drain her bladder. [Ex. J-2 at TAMC 1117, 1120-21, 3496.]
approximately 5:45 a.m. on July 24, 2013, the Tripler Rapid
Response Team independently noticed Marites' condition.
[Ex. J-2 at TAMC 3477-80; Rafael 12/7 at 149:25-150:10.]
the time the Rapid Response Team intervened, Marites had been
in near constant pain for approximately 48 hours and her
condition deteriorated into sepsis. [Ex. J-1 at TAMC2
5927-28, 6885-86; Ex. J-2 at TAMC 458; Ex. J-11 at MAKALAPA
Despite her need for immediate escalation of care and acute
intervention, Marites' admission to the intensive care
unit (“ICU”) was delayed for another two hours.
[Ex. J-1 at TAMC2 5269.]
the time she was finally admitted to the ICU, Marites'
blood tests indicated she was in metabolic acidosis with
accompanying compensatory respiratory alkalosis. [Ex. J-2 at
TAMC 3478, 3542-44.]
respiratory alkalosis caused her respiratory rate to increase
in an effort to compensate for the increased acidosis, which
in turn led to a decreased level of carbon dioxide in her
bloodstream. [Id. at TAMC 3477-79, 3543.]
After arriving at the ICU, Marites was intubated due to
worsening respiratory distress. [Id. at TAMC 3604.]
Concerned with vaginal bleeding in the afternoon of July 24,
2013, the OB/GYN team decided that Marites should undergo a
dilation and curettage (“D&C”) procedure.
[Id. at TAMC 3569-70.]
same day, Drs. Tamarin McCartin and Jason Patzwald performed
the D&C procedure. Although they did not identify any
sources of bleeding or infection, they remarked that
Marites' acute renal failure and disseminated
intravascular coagulation (“DIC”) were presumed
to be secondary to sepsis and that her condition was
critical. [Ex. J-1 at TAMC2 2332-33; Ex. J-2 at TAMC 3067-68,
3460, 3599, 3581-82.]
Bradford Whitcomb, a gynecologic oncologist, evaluated
Marites in the operating room and noted her overwhelming
sepsis and renal failure. [Ex. J-2 at TAMC 3583.]
Jeffrey Ching described Marites' hospital stay as a
“stormy ICU and hospital course” during which her
condition deteriorated to “classic sepsis and
disseminated intravascular coagulopathy (DIC) with markedly
abnormal labs, positive blood cultures and eventually
multi-organ injury.” [Dr. Ching 12/11 at 102:14-18,
103:10-12; Ex. J-47 (Dr. Jeffrey Ching Report) at 2].
further complicated Marites' condition. DIC is a complex
reaction, usually from a very serious infection, where blood
functions stop working, which eventually leads to multi-organ
failure or multi-organ damage. [Dr. Ching 12/11 at
Marites suffered many of the typical complications of DIC
including multi-organ system failure and permanent
multi-organ damage of her kidneys. [Id. at 103:4-9.]
Marites also sustained adult respiratory distress syndrome, a
complication related to DIC where the lungs fill with fluid,
making it difficult to breathe. Marites had to be placed on a
respirator as a result. [Id. at 103:13-104:2.]
Marites required multiple red blood cell and platelet
transfusions as a result of the DIC. [Id. at
Nealanjon Das, a nephrologist, evaluated Marites during the
night on July 24, 2013. He opined that Marites had suffered
permanent and irreversible kidney damage from the sepsis and
determined that her prognosis for regaining
dialysis-independent renal function was “very
grim”. [Ex. J-1 at TAMC2 2993; Ex. J-2 at TAMC 454,
Das ordered Marites to be placed on continuous renal
replacement therapy (“CRRT”), or kidney dialysis.
[Ex. J-1 at TAMC2 2993, 3699; Ex. J-2 at TAMC 454, 2073.]
infectious disease consult confirmed that Marites' sepsis
was related to a GAS infection leading to bacteremia, toxic
shock syndrome, and puerperal sepsis. [Ex. J-1 at TAMC2
2999-3001; Ex. J-2 TAMC 460-62.]
Marites required heavy sedation while intubated. She had an
abnormal heart rhythm, her lungs were compromised by the
infection, and she was agitated. [Ex. J-1 at TAMC2 3002-06;
Ex. J-2 at TAMC 463-64, 466-67.]
July 27, 2013, Marites extubated herself and oxygen was
administered via mask. [Ex. J-1 at TAMC2 4641-42; Rafael 12/7
While off the ventilator, Marites experienced issues with
oxygen saturation and her mental status declined. She was
agitated, confused, and disoriented. [Ex. J-1 TAMC2 2557-60;
Ex. J-2 TAMC 18-20].
Marites had to be reintubated due to oxygen saturation
issues. [Ex. J-1 at TAMC2 2563.]
August 4, 2013, Marites was transferred to the Progressive
Care Unit (“PCU”). [Ex. J-1 at TAMC2 2625.]
August 5, 2013, sonogram and ultrasound studies indicated
that Marites likely had gallstones that would require
surgical attention, but her compromised condition prevented
her from tolerating a surgical procedure. [Id. at
Marites experienced intense pain in her abdomen related to
her gallbladder and stones. On August 6, 2013, an endoscopic
retrograde cholangiopancreatography (“ERCP”)
procedure was performed to stent her biliary duct in an
effort to relieve her pain. [Ex. J-1 at TAMC2 3850-51; Ex.
J-2 at TAMC 493-95, 502-03.]
ERCP procedure also revealed that Marites had a large
duodenal ulcer, which was likely a stress ulcer from her
condition at the time. [Ex. J-1 at TAMC2 2391-92, 7651-52;
Ex. J-2 at TAMC 3019-20; Ex. J-11 at MAKALAPA 1251-52; Dr.
Ching 12/11 at 109:4-8.]
August 7, 2013, Marites began hallucinating and experienced
increased confusion and changes to her mental status. She was
unaware of her whereabouts and could not recognize Rafael.
[Ex. J-1 TAMC2 2676, 3852-53; Ex. J-2 TAMC 504-05.]
Marites' physicians contemplated transfer to Queen's
Medical Center (“Queen's”) due to concerns
that Marites may need a liver transplant. However, Dr. Linda
Wong, a transplant surgeon at Queen's, rejected Marites
because she believed that Marites' condition was merely
cholestasis. [Ex. J-1 at TAMC2 2683-87.]
Marites was alert and oriented only to herself, and was
uncooperative with nursing assessments. She stated
“I'm going to die, ” became increasingly
clingy with Rafael, and had limited interaction with visitors
and her sons. The ongoing changes to Marites' mental
status prevented her from identifying herself or Rafael at
times. [Id. at TAMC2 2692-93.]
August 8, 2013, Marites had to be placed in wrist restraints
because she continually attempted to pull out her nasogastric
feeding tube. [Id. at TAMC2 2693-94.]
Because the precise neurological cause for Marites'
neurological abnormalities could not be identified, she
underwent a lumbar puncture to check for causes such as
meningitis. [Id. at TAMC2 2704.]
results of the tests of Marites' cerebrospinal fluid were
not consistent with meningitis. [Id. at TAMC2
From August 9 to 10, 2013, Marites alternated from distant
and random stares, to chattiness with repetition of certain
phrases, to constantly opening her eyes, to constantly
closing her eyes. [Id. at TAMC2 2705, 2720-21,
Although an MRI showed increased reactivity in the pituitary
gland, Marites' providers concluded that her altered
mental status was most likely attributable to bilirubin
encephalopathy. [Id. at TAMC2 2728, 3881-84,
7273-77; Ex. J-11 at MAKALAPA 877-81.]
Marites' mental status slowly improved in the days that
followed, but she continued to suffer from multiple medical
conditions, including a bleeding duodenal ulcer, gallstones,
and impaired renal function. [Ex. J-1 at TAMC2 3906-07, 7258;
Ex. J-2 at TAMC 558-59; Ex. J-3 at TAMC CHRON 87; Ex. J-11 at
August 15, 2013, Marites was referred for a permanent
catheter placement to facilitate her hemodialysis. [Ex. J-1
at TAMC2 2421-23.]
August 17, 2013, Marites was transferred from the PCU to the
Mother Baby ward. [Id. at TAMC2 2786.]
August 24, 2013, Marites was discharged from Tripler.
[Id. at TAMC2 2791.]
Marites began receiving outpatient dialysis three times a
week at Pearlridge Dialysis Clinic on August 27, 2013.
[Id. at TAMC2 2988-89; Ex. J-2 at TAMC 449-50.]
September 4, 2013, Marites went to the emergency department
at Tripler with intense abdominal pain. [Ex. J-1 at TAMC2
Radiological studies indicated that Marites continued to have
symptomatic cholecystitis (gallstones), but she also had
ascites, or a large collection of fluid in the abdomen.
Ching attributed Marites' ascites to her experience at
Tripler. [Dr. Ching 12/11 at 108:15-22.]
Marites was admitted to the PCU and scheduled for a
paracentesis procedure to drain fluid from her abdomen. [Ex.
J-1 at TAMC2 7208-10; Ex. J-3 at TAMC CHRON 36-38, 352-57;
Ex. J-11 at MAKALAPA 811-15.]
Blood cultures returned positive for bacterial peritonitis,
but because of her acute condition, Marites' providers
were reluctant to subject her to invasive procedures. [Ex.
J-1 at TAMC2 208-09.]
a compromise, on September 7, 2013, a percutaneous
cholecystostomy was performed, which involves the insertion
of a drainage catheter into the gallbladder lumen under
radiologic guidance to provide temporary relief from
accumulated fluid and sludge until definitive surgical
treatment can be performed. [Id. at TAMC2 222-23,
6848-51, 7644-745; Ex. J-2 TAMC 3038-39, 3285-87; Ex. J-11 at
The percutaneous cholecystostomy immediately improved
Marites' symptoms, but her condition deteriorated over
the next ten days. The increasing abdominal pain prompted an
ultrasound on September 17, 2013, which revealed several foci
of ascites. [Ex. J-1 at TAMC2 305-07.]
September 18, 2013, Marites' providers recommended a
full-blown diagnostic abdominal laparotomy and washout
surgery, along with a surgical cholecystostomy (gallbladder
removal), having determined that her condition could not be
resolved with percutaneous drainage. [Id. at TAMC2
Two liters of ascites fluid were drained from Marites'
abdomen during the surgery. [Id. at TAMC2 9-11,
314-16, 417, 7631-33; Ex. J-2 at TAMC 3023-25, 3094-95; Ex.
J-11 at MAKALAPA 1231-33.]
While Marites initially showed signs of improvement, she
developed an ileus in her intestine and was unable to consume
food by mouth. [Id. at TAMC2 541-42, 548-50.]
Upon discovery of a bile leak, Marites underwent an ERCP
procedure to install a biliary stent. [Id. at TAMC2
556, 560-61, 7642-43.]
Post-operative attempts to return Marites to food by mouth
were unsuccessful, resulting in persistent nausea and
vomiting. [Id. at TAMC2 379-81.]
Marites was finally discharged on October 3, 2013.
Issues Following Second Hospitalization
the weeks that followed, Marites had difficulty adjusting to
her condition and being a new mother to M.R.B.C. [Ex. J-13 at
Marites required a wheelchair and four-wheel walker for
mobility which, in a small multi-level townhouse living with
six other people, proved to be especially challenging.
Marites became depressed and suffered from insomnia.
[Id. at DSI 50-51.]
December 25, 2013, Rafael took Marites to the Pali Momi
emergency department because she was experiencing
intermittent severe dizziness. Marites was diagnosed with
vertigo. [Ex. J-14 at PALI MOMI 8-14, 20-21, 39.]
January 16, 2014, a repeat paracentesis was performed and two
liters of fluid were removed. [Ex. J-1 at TAMC2 7070-72,
7584-87; Ex. J-2 at TAMC 3189-92; Ex. J-11 at MAKALAPA
674-76; Ex. J-16 at SURG ASSO 35-36.]
January 17, 2014, Marites returned to the Makalapa Clinic for
pain at her permacath site and was provided additional
antibiotics to address community-acquired MRSA. [Ex. J-3 at
TAMC CHRON 253-55; Ex. J-11 at MAKALAPA 671-73.]
January 22, 2014, Marites was diagnosed with cellulitis at
the catheter insertion site. [Ex. J-1 at TAMC2 7061-65; Ex.
J-3 at TAMC CHRON 246-51; Ex. J-11 at MAKALAPA 665-69.]
February 19, 2014, Marites underwent another paracentesis.
The procedure was unsuccessful due to suspected adhesions
that impaired the ability to drain fluid. [Ex. J-1 at TAMC2
7048-52; Ex. J-3 at TAMC CHRON 231-36; Ex. J-11 at MAKALAPA
Marites was referred to Queen's transplant program for
evaluation of candidacy for a kidney transplant, and was
accepted into the program on February 28, 2014. [Ex. J-12 at
QMC 120, 131, 139-48.]
Marites subsequently began experiencing episodes of
hypertension. [Ex. J-1 at TAMC2 7041-44; Ex. J-3 at TAMC
CHRON 224-27; Ex. J-11 at MAKALAPA 645-48.]
Marites' nephrologist, Dr. Noah Solomon, suspected that
her continuing insomnia stemmed from her depression and
post-traumatic stress disorder (“PTSD”) related
to the incident. He recommended psychiatric evaluation and
treatment. [Ex. J-15 at NOKS 53-54, 188-89.]
Dr. Solomon further recommended that Marites proceed with an
AV fistula installation by a vascular surgeon due to the
extended time of her need for dialysis and the lack of any
indication that she would ...