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CASE SUMMARY PREPARED BY JAMES F LINEBACK, M.D. This case summary is also available for reading in pdf form at: https://kaiserpapers.com/legalstuff/pdfs/Noval-Victorino-1012-Case-Summary.pdf
This case summary below has been copied into this web page exactly as it appears in the pdf version.
JAMES F. LINEBACK, M.D., F.C.C.P. A Medical Corporation Fellow American College of Chest Physicians 400 Newport Center Drive, Suite 401 Newport Beach, California 92660-5303 Phone: (949) 610-0036 Fax: (949) 721-9121 Email: linebackmd@ cox.net
Diplomate in Internal Medicine
October 12, 2012
Re: Victorino Noval (Deceased)
This 78-year-old male was hospitalized at Kaiser on 4/28/10 with symptoms of shortness of breath. The patient developed progressive respiratory insufficiency and required endotracheal intubation and mechanical ventilation. His respiratory symptoms were subsequently felt to be related to aspiration pneumonia.
The patient was treated with intravenous antibiotics and continued to require mechanical ventilation over the next several days. Eventually, his lung function began improving and his requirements for supplemental oxygen eventually decreased.
During the time of this patient’s stay in the intensive care unit, several decisions were made by the patient’s family that resulted in the final decision to withdraw supportive care. The patient was eventually extubated shortly after noon on 5/7/10. He actually maintained normal vital signs over the next several hours, breathing on his own. However, his clinical status eventually deteriorated later that afternoon and he was pronounced dead at 17:25 on 5/7/10.
Several questions have been raised in this case regarding the issue of this patient’s physiologic status at the time of his extubation. As stated previously, his oxygen requirements improved significantly between the morning of 5/6/10 and the morning of 5/7/10. The patient eventually suffered a fatal respiratory arrest due to the fact that intravenous morphine had been administered.
This patient had undergone an echocardiogram during his acute hospitalization that demonstrated normal left ventricular function. He had previously undergone pulmonary function tests that had demonstrated evidence of moderate airflow obstruction. The patient apparently did carry a diagnosis of Parkinson’s disease, though reportedly was managing his own finances (which apparently were more than considerable) just prior to his illness. Based on the physiologic data in this case, it is more probable than not (reasonably medically probable) that this patient would have survived his acute hospitalization in May of 1020 had supportive care been continued. The basis for these conclusions is provided by the patient’s echocardiogram, pulmonary function tests and functional neurologic status prior to his demise. There is no physiologic evidence in these medical records that this patient would have died in the foreseeable future after surviving his acute hospitalization in May of 2010.
If any further questions should arise regarding this complex case, please feel free to contact this office.
Sincerely,
James F. Lineback, M.D., F.C.C.P.
Diplomate American Board of Internal Medicine
Diplomate Subspecialty Board of Pulmonary Disease
Diplomate American Board of Anti-Aging Medicine
Clinical Associate Professor of Medicine
Department of Internal Medicine
UCLA School of Medicine
Qualified Medical Examiner
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