ACCEPTED
03-15-00596-CV
7771576
THIRD COURT OF APPEALS
AUSTIN, TEXAS
11/10/2015 3:54:12 PM
JEFFREY D. KYLE
CLERK
NO. 03-15-00596-CV
FILED IN
3rd COURT OF APPEALS
IN THE COURT OF APPEALS AUSTIN, TEXAS
THIRD DISTRICT OF TEXAS, AUSTIN
11/10/2015 3:54:12 PM
JEFFREY D. KYLE
Clerk
GRACY WOODS I NURSING HOME
Appellant,
v.
MARTHA MAHAN, AS THE REPRESENTATIVE
OF THE ESTATE OF MARY RIVERA
Appellee.
ON INTERLOCUTORY APPEAL FROM
THE 250TH
JUDICIAL DISTRICT, TRAVIS COUNTY, TEXAS
APPELLANT’S BRIEF
EMILY J. DAVENPORT
STATE BAR NO. 24012501
REED, CLAYMON, MEEKER
& HARGETT, PLLC
5608 PARKCREST DRIVE, SUITE 200
AUSTIN, TEXAS 78731
(512) 660-5960 TELEPHONE
(512) 660-5979 FACSIMILE
ATTORNEYS FOR APPELLANT
ORAL ARGUMENT REQUESTED
IDENTITY OF PARTIES AND COUNSEL
Pursuant to TEX. R. APP. 38.1(a), Appellant certifies that the
following is a complete list of all parties to this litigation and the names
and addresses of all counsel.
Party Appellate Counsel Trial Counsel
Gracy Woods I Emily J. Davenport Emily J. Davenport
Nursing Home, Janice Byington Janice Byington
Appellant Reed, Claymon, Meeker & Reed, Claymon, Meeker &
Hargett, PLLC Hargett, PLLC
5608 Parkcrest Drive 5608 Parkcrest Drive
Suite 200 Suite 200
Austin, Texas 78731 Austin, Texas 78731
edavenport@rcmhlaw.com edavenport@rcmhlaw.com
jbyington@rcmhlaw.com jbyington@rcmhlaw.com
Martha Mahan, as Jack Modesett, III
the Representative ModesettWilliams, PLLC
of the Estate of Mary 515 Congress Avenue
Rivera, Suite 1650
Appellee Austin, Texas 78701
jack@modesettlaw.com
i
TABLE OF CONTENTS
Page
IDENTITY OF PARTIES AND COUNSEL .............................................. i
TABLE OF CONTENTS ............................................................................ ii
INDEX OF AUTHORITIES ...................................................................... iv
ABBREVIATIONS AND RECORD REFERENCES ............................. viii
APPENDIX ................................................................................................ ix
STATEMENT OF THE CASE .................................................................. x
STATEMENT REGARDING ORAL ARGUMENT .................................. 1
STATEMENT OF JURISDICTION .......................................................... 1
ISSUE PRESENTED ................................................................................ 1
Does Dr. Lipson’s report represent a good faith effort to
comply with TEX. CIV. PRAC. & REM. CODE §74.351?
STATEMENT OF FACTS ......................................................................... 2
SUMMARY OF THE ARGUMENT .......................................................... 4
ARGUMENT AND AUTHORITIES ......................................................... 6
I. Standard of Review ................................................................. 6
II. The Expert Report Requirement ............................................ 7
III. The Four Corners Rule .......................................................... 10
IV. Dr. Lipson is Not Qualified to Offer the Opinions
Asserted in His Report ........................................................... 11
ii
A. Dr. Lipson is Not Qualified to Offer Causation
Opinions, Particularly That a Sexual Assault
Occurred ............................................................................. 11
B. Dr. Lipson is Not Qualified to Offer Opinions
Concerning Gracy Woods’ Standard of Care or
Alleged Breach ................................................................... 13
1. The expert must be qualified on standard of care
and breach ..................................................................... 13
2. Dr. Lipson did not establish his qualification ............. 17
V. Dr. Lipson’s Report is Conclusory, Based on Assumption
and, Therefore, Deficient ....................................................... 20
A. Dr. Lipson’s Report is Deficient as to the Element of
Breach ................................................................................ 20
B. Dr. Lipson’s Report is Deficient as to the Element of
Causation ........................................................................... 23
CONCLUSION ......................................................................................... 27
PRAYER .................................................................................................... 28
CERTIFICATE OF COMPLIANCE ........................................................ 30
CERTIFICATE OF SERVICE.................................................................. 31
iii
INDEX OF AUTHORITIES
Page
CASES
Am. Transitional Care Ctrs. v. Palacios, 46 S.W.3d 873
(Tex. 2001) ............................. 5, 6, 7, 9, 10, 15, 20, 21, 22, 23, 24,28
Austin Heart, P.A. v. Webb, 228 S.W.3d 276
(Tex.App. –Austin 2007, no pet.) .......................................... 9, 10, 20
Bowie Memorial Hosp. v. Wright, 79 S.W.3d 48
(Tex. 2002) ......................................................................... 6, 9, 10, 23
Broders v. Heise, 924 S.W.2d 148 (Tex. 1996) .................. 4, 10, 11, 12, 13
Certified EMS, Inc. v. Potts, 392 S.W.3d 625 (Tex.2013) ................... 6, 26
Christus Health Southeast Texas v. Broussard, 267 S.W.3d 531
(Tex.App. –Beaumont 2008, no pet.) .............................................. 16
Cooper v. Arizpe, 2008 WL 940490
(Tex.App. –San Antonio 2008, pet. denied) ................................ 6, 26
Cortez v. Tomas, 2012 WL 407382
(Tex.App. –Fort Worth 2012, no pet.) ............................................. 13
Costello v. Christus Santa Rosa Health Care Corp., 141 S.W.3d 245
(Tex.App. –San Antonio 2004, no pet.) ........................................... 25
Earle v. Ratliff, 998 S.W.2d 882 (Tex. 1999) ............................................. 9
Foster v. Zavala, 214 S.W.3d 106
(Tex.App.—Eastland 2006, pet. denied) ......................................... 19
Fung v. Fischer, 365 S.W.3d 507
(Tex.App.-Austin 2012, no pet.) .................................................. 6, 26
iv
Hutchinson v. Montemayor, 144 S.W.3d 614
(Tex.App. –San Antonio 2004, no pet.) ........................................... 26
In re Samonte, 163 S.W.3d 229
(Tex.App. –El Paso 2005, orig. proceeding) ........................ 11, 15, 28
In re Windisch, 138 S.W.3d 507
(Tex.App. –Amarillo 2004, orig. proceeding) .................................. 28
Jelinek v. Casas, 328 S.W.3d 526
(Tex. 2010) ............................................... 5, 6, 7, 9, 20, 23, 24, 27, 28
Jones v. King, 255 S.W.3d 156
(Tex.App. –San Antonio 2008, pet. denied))................................... 10
Kerlin v. Arias, 274 S.W.3d 666, 668 (Tex. 2008) ................................... 22
Kettle v. Baylor Med. Ctr., 232 S.W.3d 832
(Tex.App. –Dallas 2007, pet. denied) .......................................... 7, 10
Lenger v. Physician’s Gen. Hosp., 455 S.W.2d 703 (Tex. 1970) ............. 23
Lewis v. Funderburk, 253 S.W.3d 204 (Tex. 2008) ................................... 8
Ly v. Austin, 2007 WL 2010757
(Tex.App. –Austin 2007, no pet.) ................................ 4, 6, 10, 15, 18
Methodist Hosp. Levelland v. Kimbrell, 2009 WL 3101315
(Tex.App. –Amarillo 2009, no pet.) ................................................. 15
Murphy v. Mendoza, 234 S.W.3d 23
(Tex.App. –El Paso 2007, no pet.) ................................................... 26
Nacogdoches County Hosp. Dist. v. Felment, 2013 WL 6207838
(Tex.App. –Tyler 2013, no pet.)........................................... 16, 18, 19
Nexion Health v. Treybig, 2014 WL 7499373
(Tex.App. –Dallas 2014, no pet.) ................................. 5, 7, 16, 19, 28
v
Pediatrix Med. Servs. Inc. v. De La O, 368 S.W.3d 34
(Tex.App.–El Paso 2012, no pet.) .................................................... 13
Reed v. Granbury Hosp. Corp., 117 S.W.3d 404
(Tex. App. – Ft. Worth 2003, no pet.) ................................... 5, 16, 19
Samlowski v. Wooten, 332 S.W.3d 404 (Tex. 2011) ................................ 20
Scoresby v. Santillan, 346 S.W.3d 546 (Tex. 2011) ............................. 9, 10
Senior Care Centers, LLC v. Shelton, 459 S.W.3d 753
(Tex.App. –Dallas 2015, no pet.) ..................... 5, 6, 21, 22, 23, 24, 27
Shelton v. Sargent, 144 S.W.3d 113
(Tex. App. – Ft. Worth 2004, pet. denied) ................................ 17, 19
Tenet Hosps. Ltd v. Love, 347 S.W.3d 743
(Tex.App. –El Paso 2011, no pet.) ............. 5, 7, 16, 18, 19, 23, 24, 28
Tomasi v. Liao, 63 S.W.3d 62
(Tex.App. –San Antonio 2001, no pet.) ..................................... 15, 18
Walker v. Packer, 827 S.W.2d 833 (Tex. 1992) ......................................... 6
STATUTES
TEX. CIV. PRAC. & REM. CODE § 51.014(a)(9) ............................................ 1
TEX. CIV. PRAC. & REM. CODE § 74.351 ........................................... passim
TEX. CIV. PRAC. & REM. CODE § 74.351(a) ............................................ 3, 7
TEX. CIV. PRAC. & REM. CODE § 74.351(b) ............................................ 1, 7
TEX. CIV. PRAC. & REM. CODE § 74.351(c) ................................................. 7
TEX. CIV. PRAC. & REM. CODE § 74.351(l) ........................................... 8, 28
vi
TEX. CIV. PRAC. & REM. CODE § 74.351(r)(5) ...................................... 4, 14
TEX. CIV. PRAC. & REM. CODE § 74.351(r)(6) .... 5, 9, 10, 20, 23, 24, 27, 28
TEX. CIV. PRAC. & REM. CODE § 74.402 ..... 4, 10, 13, 14, 15, 16, 18, 19, 28
TEX. CIV. PRAC. & REM. CODE § 74.403 ............................. 4, 10, 11, 13, 28
TEX. R. EVID. 702 ...................................................................... 4, 12, 13, 28
vii
ABBREVIATIONS AND RECORD REFERENCES
Abbreviations:
Appellee, Martha Mahan, as the Representative of the Estate of Mary
Rivera, will be referred to as “Mahan.”
Mary Rivera will be referred to as “Ms. Rivera.”
Appellant, Gracy Woods I Nursing Home,1 will be referred to as “Gracy
Woods.”
The Texas Medical Liability Act will be referred to as “TMLA.” TEX. CIV.
PRAC. & REM. CODE §74.001-§74.507.
Record References:
References to the Clerk’s Record are in the form of “CR _____.”
References to the Clerk’s Supplemental Record are in the form of “Supp.
CR ___.”
References to the Reporter’s Record are in the form of “RR ___.”
References to Appendix items attached to the Brief are in the form of
“App. ___.”
1Gracy Woods was sued as “Gracy Woods I Nursing Home.” Appellant is actually known as PM
Management – Austin NC, LLC d/b/a Gracy Woods Nursing Home (also referred to herein as “Gracy
Woods”). (CR 8).
viii
APPENDIX
Order Denying Defendant’s Motion to Dismiss ....................... Appendix 1
Defendant’s Motion to Dismiss ................................................. Appendix 2
Plaintiff’s Response to Defendant’s Motion to Dismiss ........... Appendix 3
Defendant’s Objections to Plaintiff’s Expert Report
and Curriculum Vitae ............................................................... Appendix 4
Report of Loren Lipson, M.D. .................................................... Appendix 5
Curriculum Vitae of Loren Lipson, M.D................................... Appendix 6
ix
STATEMENT OF THE CASE
Nature of the Case This is a health care liability claim. (CR
3, 4). Gracy Woods is a nursing home
where Ms. Rivera resided. Id. Mahan
has sued on behalf of Ms. Rivera’s
estate. Id. Mahan claims that Ms.
Rivera was sexually assaulted at Gracy
Woods. (CR 4).
Trial Court 200th District Court, Travis County,
Texas, Honorable Gisela D. Triana,
Presiding.
Filed in 250th District Court, Travis
County, Texas.
Course of the Proceedings and Disposition
December 11, 2014: Mahan filed suit. (CR 3).
December 12, 2014: Gracy Woods filed its Original Answer.
(CR 8).
January 30, 2015: Mahan served the report and
curriculum vitae of Loren Lipson, M.D.
(CR 11).
February 20, 2015: Gracy Woods filed its objections to Dr.
Lipson’s report and curriculum vitae.
(CR 101).
x
April 11, 2015: The 120-day expert report deadline
expired. (CR 8). TEX. CIV. PRAC. & REM.
CODE §74.351(a).
August 12, 2015: Gracy Woods filed its Motion to
Dismiss.2 (CR 301).
August 24, 2015: Mahan filed her response. (CR 376).
August 25, 2015: The trial court heard oral argument.
(CR 374, RR 1).
September 1, 2015: The trial court denied Gracy Woods’
Motion to Dismiss. (CR 446).
September 17, 2015: Gracy Woods filed its Notice of
Accelerated Appeal. (CR 447).
2Proceedings against Gracy Woods were abated for 60 days on March 4, 2015 pursuant to TEX. CIV.
PRAC. & REM. CODE §74.052 due to Mahan’s failure to identify physicians and health care providers in
her presuit notice and authorization. (CR 196, 269). TEX. CIV. PRAC. & REM. CODE §74.052.
xi
STATEMENT REGARDING ORAL ARGUMENT
Gracy Woods requests oral argument pursuant to TEX. R. APP. P
39.1 and respectfully submits that oral argument would aid the Court in
determining the legal and factual issues presented in this appeal.
STATEMENT OF JURISDICTION
Gracy Woods seeks interlocutory relief from an order denying a
motion to dismiss pursued under Section 74.351(b) of the Texas Civil
Practice and Remedies Code. (CR 446). TEX. CIV. PRAC. & REM. CODE
§74.351(b). This Court has jurisdiction pursuant to Section 51.014(a)(9)
of the Texas Civil Practice and Remedies Code. TEX. CIV. PRAC. & REM.
CODE §51.014(a)(9).
ISSUE PRESENTED
Does Dr. Lipson’s report represent a good faith effort to comply with
TEX. CIV. PRAC. & REM. CODE §74.351?
1
STATEMENT OF FACTS
Gracy Woods is a nursing home. (CR 3-4). Ms. Rivera, now
deceased, was a resident of Gracy Woods. Id. Mahan, Ms. Rivera’s
daughter, has sued Gracy Woods on behalf of Ms. Rivera’s estate.3 Id.
Mahan filed suit on December 11, 2014, alleging that Ms. Rivera
was sexually assaulted at Gracy Woods on November 10, 2012.4 (CR 3-4).
Mahan claims that she discovered the alleged assault, based on what
Mahan describes as “signs of a struggle in her mother’s room” and “bloody
tissue in the bathroom trash can.” Id. at 4. In her petition, Mahan claims
that a Sexual Assault Nurse Examination (referred to herein as the
“SANE nurse report”) “indicated sexual assault on Ms. Rivera.”5 Id.
3 Mahan was appointed guardian of Ms. Rivera in June 2013. Ms. Rivera objected to
Mahan’s appointment. According to the Order Appointing Permanent Guardian,
Mahan was prohibited from removing Ms. Rivera from Gracy Woods without further
order from that court. (CR 69).
4 The petition asserts that a sexual assault occurred on November 10, 2012. (Supp.
CR 4). Dr. Lipson’s report implies that an assault allegedly occurred on the night of
November 8, 2013. (CR 17). The SANE report, reviewed by Dr. Lipson and filed with
his report, contends that the date and time of the alleged assault were unknown and
occurred “perhaps early 11/8/13.” (CR 92).
5 According to the SANE nurse report, Ms. Rivera recalled no sexual contact. (CR 96).
2
Mahan alleges that Gracy Woods failed to protect Ms. Rivera from sexual
assault.6 (CR 5). (Supp. CR 4).
Gracy Woods denies Mahan’s allegations. (CR 8). Gracy Woods filed
its Original Answer on December 12, 2014. Id.
Mahan served the report and curriculum vitae of Loren Lipson,
M.D., on January 30, 2015, in an attempt to comply with the 120-day
expert report deadline. (CR 11). TEX. CIV. PRAC. & REM. CODE §74.351.
Gracy Woods timely filed objections to the report and curriculum vitae on
February 20, 2015. (CR 101). TEX. CIV. PRAC. & REM. CODE §74.351(a).
The 120-day deadline for Mahan to serve a compliant expert report
expired on April 11, 2015. (CR 8). TEX. CIV. PRAC. & REM. CODE
§74.351(a).
Gracy Woods filed its Motion to Dismiss on August 12, 2015. (CR
301). Mahan filed her response on August 24, 2015. (CR 376). The
Honorable Gisela Triana heard oral argument on August 25, 2015. (CR
374, RR 1).
6On behalf of Ms. Rivera’s estate, Mahan seeks punitive damages and damages for
pain, suffering, mental anguish, disability, reasonable and necessary medical
expenses, lost earning capacity, loss of household services, and past and future
medical care. (CR 5). (Supp. CR 5).
3
Judge Triana denied Gracy Woods’ Motion to Dismiss on September
1, 2015. (CR 446). Gracy Woods filed its Notice of Accelerated Appeal on
September 17, 2015. (CR 447).
SUMMARY OF THE ARGUMENT
Dr. Lipson’s report is deficient and does not satisfy the expert report
requirement set forth in TEX. CIV. PRAC. & REM. CODE §74.351.
Qualification on Sexual Assault
Dr. Lipson is not qualified to offer the opinion that Ms. Rivera was
sexually assaulted. Dr. Lipson lacks the requisite knowledge, skill,
experience, training or education regarding the diagnosis or treatment of
sexual assault to opine that an assault occurred. TEX. CIV. PRAC. & REM.
CODE §74.351(r)(5)(C), §74.403; TEX. R. EVID. 702; Broders v. Heise, 924
S.W.2d 148, 153 (Tex. 1996); Ly v. Austin, 2007 WL 2010757, at *2
(Tex.App. –Austin 2007, no pet.).
Qualification on Nursing Home Standards of Care
Dr. Lipson has not shown that he is qualified by training or
experience to offer the standard of care opinions at issue. TEX. CIV. PRAC.
& REM. CODE §74.351(r)(5)(C), §74.402; Ly, 2007 WL 2010757, at *5
(generalized, conclusory statements do not establish an expert’s
4
qualification); Nexion Health at Garland, Inc. v. Treybig, 2014 WL
7499373, at *4 (Tex.App. –Dallas 2014, no pet.); Reed v. Granbury Hosp.
Corp., 117 S.W.3d 404, 411-414 (Tex. App. – Ft. Worth 2003, no pet.).
Opinions on Breach
Dr. Lipson’s report is deficient as to the element of breach. (CR 15-
21). Dr. Lipson’s report offers no explanation based in fact as to when the
alleged assault occurred, where the alleged assault occurred, who
committed the alleged assault, or how Gracy Woods departed from its
applicable standards of care to prevent the alleged assault. (CR 15-21).
Am. Transitional Care Ctrs. v. Palacios, 46 S.W.3d 873, 880 (Tex.
2001)(breach cannot be inferred exclusively from an alleged injury);
Senior Care Centers, LLC v. Shelton, 459 S.W.3d 753, 758 and 760
(Tex.App. –Dallas 2015, no pet.)(plaintiff’s affidavit does not supply a
basis any greater than the expert’s own conclusions).
Opinions on Causation
Dr. Lipson’s report is deficient as to the element of causation. Dr.
Lipson offers no explanation to link his conclusions to the facts. TEX. CIV.
PRAC. & REM. CODE §74.351(r)(6); Jelinek v. Casas, 328 S.W.3d 526, 539-
40 (Tex. 2010); Tenet Hosps. Ltd v. Love, 347 S.W.3d 743, 755 (Tex.App.
5
–El Paso 2011, no pet.) (“… causation cannot be inferred; it must be
clearly stated.”). Dr. Lipson’s opinions are based on assumption. Fung v.
Fischer, 365 S.W.3d 507, 533-34 (Tex.App.-Austin 2012, no pet.),
overruled on other grounds by Certified EMS, Inc. v. Potts, 392 S.W.3d
625 (Tex.2013); Cooper v. Arizpe, 2008 WL 940490, at *3-4 (Tex.App. –
San Antonio 2008, pet. denied). He fails to explain how – if at all – he
eliminated causes other than sexual contact. (CR 15-21). Jelinek, 328
S.W.3d at 536; Senior Care Centers, LLC, 459 S.W.3d at 759.
ARGUMENT AND AUTHORITIES
I. Standard of Review.
A challenge to a trial court’s decision concerning the sufficiency of
an expert report is reviewed for abuse of discretion. Am. Transitional
Care Ctrs. v. Palacios, 46 S.W.3d 873, 875, 877-78 (Tex. 2001). An abuse
of discretion occurs when a trial court acts in an arbitrary or
unreasonable manner or without reference to any guiding rules or
principles. Bowie Memorial Hosp. v. Wright, 79 S.W.3d 48, 52 (Tex.
2002). A clear failure by the trial court to analyze or apply the law
correctly constitutes an abuse of discretion. Walker v. Packer, 827 S.W.2d
833, 840 (Tex. 1992); Ly, 2007 WL 2010757, at *3.
6
A court has no discretion to find that a conclusory report is
sufficient. Palacios, 46 S.W.3d at 880; Jelinek v. Casas, 328 S.W.3d 526,
540 (Tex. 2010); Kettle v. Baylor Med. Ctr., 232 S.W.3d 832, 837
(Tex.App. –Dallas 2007, pet. denied). It is an abuse of discretion to
overrule a defendant’s objection when qualification is not demonstrated
in the report. Nexion Health v. Treybig, 2014 WL 7499373, at * (Tex.App.
–Dallas 2014, no pet.); Tenet Hosps. Ltd., 347 S.W.3d at 752.
II. The Expert Report Requirement.
Section 74.351 of the Texas Civil Practice and Remedies Code
requires a health care liability claimant to serve on each defendant one
or more expert reports, with corresponding curricula vitae, no later than
120 days of the date the original answer was filed. TEX. CIV. PRAC. & REM.
CODE §74.351(a). Section 74.351 provides:
(a) In a health care liability claim, a claimant shall, not later
than the 120th day after the date each defendant’s
original answer is filed, serve on that party or the party’s
attorney one or more expert reports, with a curriculum
vitae of each expert listed in the report for each physician
or health care provider against whom a liability claim is
asserted. ...
(b) If, as to a defendant physician or health care provider,
an expert report has not been served within the period
specified by Subsection (a), the court, on the motion of
7
the affected physician or health care provider, shall,
subject to Subsection (c), enter an order that:
(1) awards to the affected physician or health care
provider reasonable attorney’s fees and costs of court
incurred by the physician or health care provider; and
(2) dismisses the claim with respect to the physician or
health care provider, with prejudice to the refiling of
the claim.
(c) If an expert report has not been served within the period
specified by Subsection (a) because elements of the
report are found deficient, the court may grant one 30-
day extension to the claimant in order to cure the
deficiency. …
TEX. CIV. PRAC. & REM. CODE §74.351(a)-(c).
Dismissal is mandatory if no report is served within the 120-day
deadline. Id. at §74.351(b). A deficient report, even if timely served, does
not satisfy the statute. Lewis v. Funderburk, 253 S.W.3d 204, 207-08
(Tex. 2008). A report is deficient when it “does not represent an objective
good faith effort to comply with the definition of an expert report.” TEX.
CIV. PRAC. & REM. CODE §74.351(l).
The statute defines “expert report” as:
a written report by an expert that provides a fair summary of
the expert’s opinions as of the date of the report regarding
applicable standards of care, the manner in which the care
rendered by the physician or health care provider failed to
8
meet the standards, and the causal relationship between that
failure and the injury, harm, or damages claimed.
Id. at §74.351(r)(6).
To qualify as a “good faith effort” and satisfy the statute, the report
must provide enough information to fulfill two purposes. First, the report
must inform the defendant of the specific conduct the plaintiff has called
into question. Second, and equally important, the report must provide a
basis for the trial court to conclude that the claims have merit. Scoresby
v. Santillan, 346 S.W.3d 546, 556 (Tex. 2011), citing Am. Transitional
Care Ctrs of Tex., Inc. v. Palacios, 46 S.W.3d 873, 879 (Tex. 2001). The
report or reports must include the expert’s opinion on all three elements
– standard of care, breach and causation. Scoresby, 346 S.W.3d at 556;
Palacios, 46 S.W.3d at 878-79.
A report cannot merely state the expert’s conclusions about the
elements, but rather, the expert must explain the basis of his statements
to link his conclusions to the facts. Jelinek v. Casas, 328 S.W.3d at 539;
Bowie v. Wright, 79 S.W.3d 48, 52 (Tex. 2002)(quoting Earle v. Ratliff,
998 S.W.2d 882, 890 (Tex. 1999); Palacios, 46 S.W.3d at 879; Austin
Heart, P.A. v. Webb, 228 S.W.3d 276, 279 (Tex.App. –Austin 2007, no
pet.). It is not enough that the report “provide insight” about the
9
plaintiff’s claims. Jones v. King, 255 S.W.3d 156, 159 (Tex.App. –San
Antonio 2008, pet. denied).
Also, the author of the report must be qualified. TEX. CIV. PRAC. &
REM. CODE §74.351(r)(6), §74.402 (defining qualifications of an expert
witness as to departures from the standard of care), and §74.403 (defining
the qualifications of an expert on causation); Broders, 924 S.W.2d at 153;
Ly v. Austin, 2007 WL 2010757, at *2 (Tex.App. –Austin 2007, no
pet.)(“an ‘expert report’ first must be a ‘written report by an
expert.’”)(emphasis in original).
III. The Four Corners Rule.
When evaluating the report, the court must not fill gaps or draw
inferences with respect to opinions or qualification.7 Scoresby, 346
S.W.3d at 556; Wright, 79 S.W.3d at 53; Palacios, 46 S.W.3d at 878 (“…
the only information relevant to the inquiry is within the four corners of
the report.”); Austin Heart, P.A., 228 S.W.3d at 279 (the four corners rule
“precludes a court from filling gaps in a report by drawing inferences or
guessing as to what the expert likely meant or intended to say.”); Ly v.
7 Reports should not be construed in favor of the claimant. Kettle v. Baylor Med. Ctr.,
232 S.W.3d 832, 837 (Tex.App. –Dallas 2007, pet. denied (emphasis supplied);
Palacios, 46 S.W.3d at 877 (directing courts not to indulge in reasonable inferences
in favor of the nonmovant).
10
Austin, 2007 WL 2010757, at *2; In re Samonte, 163 S.W.3d 229, 234
(Tex.App. –El Paso 2005, orig. proceeding).
IV. Dr. Lipson is Not Qualified to Offer the Opinions Asserted in His
Report.
A. Dr. Lipson is Not Qualified to Offer Causation Opinions,
Particularly That a Sexual Assault Occurred.
Ms. Rivera did not claim that she was sexually assaulted. (CR 15-
22). According to the records Dr. Lipson reviewed, Ms. Rivera did not
recall having any sexual contact. (CR 16, 96). Dr. Lipson is not qualified
to conclude that Ms. Rivera’s alleged injuries and behavior were the
result of sexual assault. TEX. CIV. PRAC. & REM. CODE §74.403(a);
Broders, 924 S.W.2d at 152-53.
The TMLA provides that “… a person may qualify as an expert on
the issue of the causal relationship between the alleged departure from
accepted standards of care and the injury, harm or damages claimed only
if the person is a physician and is otherwise qualified to render opinions
on that causal relationship under the Texas Rules of Evidence.” TEX. CIV.
PRAC. & REM. CODE §74.403(a).
The Texas Rules of Evidence state that “[i]f scientific, technical, or
other specialized knowledge will assist the trier of fact to understand the
11
evidence or to determine a fact in issue, a witness qualified as an expert
by knowledge, skill, experience, training, or education may testify thereto
in the form of an opinion or otherwise.” TEX. R. EVID. 702.
Every licensed doctor is not automatically qualified to testify as an
expert on every medical question. Broders, 924 S.W.2d at 152. “What is
required is that the offering party establish that the expert has
‘knowledge, skill, experience, training, or education’ regarding the
specific issue before the court which would qualify the expert to give an
opinion on that particular subject.” Id. (emphasis supplied).
Dr. Lipson does not claim to have any expertise in the diagnosis of
sexual assault. (CR 15-67). Dr. Lipson’s report does not show that he has
ever examined a patient for sexual assault, diagnosed a patient with
sexual assault, or treated a patient for sexual assault. Id. Dr. Lipson’s
report does not reveal that he has any experience treating any injury or
conditions of the female genitalia or even performing pelvic
examinations. Id.
Dr. Lipson’s opinions do not rise above mere speculation. He simply
lacks the special knowledge, skill, experience, training, or education to
testify that Ms. Rivera’s alleged injuries were caused by sexual assault.
12
(CR 15-67). TEX. CIV. PRAC. & REM. CODE §74.403; TEX. R. EVID. 702;
Broders, 924 S.W.2d at 152-54 (finding that an emergency medicine
physician was not qualified to offer opinions that earlier diagnosis and
treatment of a head injury would have prevented the patient’s death due
to lack of experience treating head injuries); Cortez v. Tomas, 2012 WL
407382, at *3, 6 (Tex.App. –Fort Worth 2012, no pet.)(finding that a
Board-certified OB/GYN was not qualified to offer causation opinions
concerning the outcome of an ovarian surgery due to lack of experience
performing the surgery); Pediatrix Med. Servs. Inc. v. De La O, 368
S.W.3d 34, 39-40 (Tex.App.–El Paso 2012, no pet.) (finding that a Board-
certified neonatologist and pediatrician was not qualified to render
opinions as to the cause of a baby’s blindness).
B. Dr. Lipson is Not Qualified to Offer Opinions Concerning Gracy
Woods’ Standard of Care or Alleged Breach.
1. The expert must be qualified on standard of care and breach.
To offer opinions on the issue of whether a health care provider
departed from the accepted standards of health care, the expert must
satisfy the requirements of TEX. CIV. PRAC. & REM. CODE §74.402:
(b) In a suit involving a health care liability claim against a
health care provider, a person may qualify as an expert
witness on the issue of whether the health care provider
13
departed from accepted standards of care only if the
person:
(1) is practicing health care in a field of practice that
involves the same type of care and treatment as that
delivered by the defendant health care provider, if the
defendant health care provider is an individual, at
the time the testimony is given or was practicing that
type of health care at the time the claim arose;
(2) has knowledge of accepted standards of care for
health care providers for the diagnosis, care, or
treatment of the illness, injury, or condition involved
in the claim; and
(3) is qualified on the basis of training or experience to
offer an expert opinion regarding those accepted
standards of health care.
(c) In determining whether a witness is qualified on the
basis of training or experience, the court shall consider
whether, at the time the claim arose or at the time the
testimony is given, the witness:
(1) is certified by a licensing agency of one or more states
of the United States or a national professional
certifying agency, or has other substantial training or
experience, in the area of health care relevant to the
claim; and
(2) is actively practicing health care in rendering health
care services relevant to the claim.
TEX. CIV. PRAC. & REM. CODE §74.402(b) and (c), §74.351(r)(5)(B).
14
“Practicing health care” includes:
(1) training health care providers in the same field as the
defendant health care provider at an accredited
educational institution; or
(2) serving as a consulting health care provider and
being licensed, certified, or registered in the same
field as the defendant health care provider.
Id. at §74.402(a).
Generalized, conclusory statements do not establish an expert’s
qualification; the report must provide specific details regarding the
expert’s training and experience. Ly, 2007 WL 2010757, at *5 (emphasis
supplied); Tomasi v. Liao, 63 S.W.3d 62, 66 (Tex.App. –San Antonio 2001,
no pet.); Methodist Hosp. Levelland v. Kimbrell, 2009 WL 3101315, at *2
(Tex.App. –Amarillo 2009, no pet.)(“… we must know not only what the
nurse was obligated to do but also how the expert knew that.”); In re
Samonte, 163 S.W.3d at 234; see Palacios, 46 S.W.3d at 879 (“the only
information relevant to the inquiry is within the four corners of the
document.”).
Experience as a physician – even experience as a physician who
treats geriatric patients in nursing homes – does not automatically
establish expertise on nursing home standards of care. TEX. CIV. PRAC. &
15
REM. CODE §74.402(b); Nexion Health at Garland, Inc. v. Treybig, 2014
WL 7499373, at *4 (Tex.App. –Dallas 2014, no pet.)(a physician’s
statement that he has provided primary care to patients in nursing
homes did not establish the physician’s familiarity with nursing home
standards of care); Nacogdoches County Hosp. Dist. v. Felment, 2013 WL
6207838, at *3-4 (Tex.App. –Tyler 2013, no pet.)(a physician who served
on hospital ethics and bylaws committees was not qualified to offer
opinions concerning hospital protocols); Tenet Hosps. Ltd. v. Love, 347
S.W.3d 743, 750-51 (Tex.App. –El Paso 2011, no pet.) (“merely working
for a hospital does not automatically qualify an expert with experience in
running a hospital, nor does serving on a committee without further
explanation as to whether those committees involved determining
hospital policies and procedures…”); Christus Health Southeast Texas v.
Broussard, 267 S.W.3d 531, 536 (Tex.App. –Beaumont 2008, no
pet.)(“[t]he fact that [Dr.] Peters is on staff at a hospital and serves on
the hospital’s credentials committee does not establish that he possesses
specialized knowledge of the protocols, policies, or procedures a hospital
of ordinary prudence would have in place … .”); Reed v. Granbury Hosp.
Corp., 117 S.W.3d 404, 411-414 (Tex. App. – Ft. Worth 2003, no pet.)(a
16
board certified emergency medicine physician and neurologist with thirty
years of experience treating stroke patients was not qualified to offer
opinions on standards of care for hospital policy relating to
administration of stroke therapy); Shelton v. Sargent, 144 S.W.3d 113,
123 (Tex. App. – Ft. Worth 2004, pet. denied) (a physician’s experience
on tumor boards and staffs of various hospitals did not qualify the
physician to offer opinions on hospital standards of care relating to the
diagnosis of cancer).
2. Dr. Lipson did not establish his qualification.
Dr. Lipson describes his experience as follows:
I am familiar with the problem of sexual assault in the
nursing home setting. I am familiar with the standard of care
for preventing such assaults. I continue to treat patients in
the long term care setting and have done so for more than
thirty years. I am familiar with the standard of care for the
treatment of patients like Mary Rivera and familiar with the
required training of employees providing care to residents like
Mary Rivera.
(CR 16).
Dr. Lipson does not explain the foundation for his familiarity with
sexual assault in nursing homes, or how he knows the standard of care
to prevent sexual assault in nursing homes. (CR 16). Further, Dr. Lipson
does not explain how or why he knows the standard of care for training
17
employees in nursing homes. (CR 16). Dr. Lipson cannot utilize
generalized, conclusory statements to establish his qualification. Ly,
2007 WL 2010757, at *5; Tomasi, 63 S.W.3d at 66; see also TEX. CIV.
PRAC. & REM. CODE §74.402. He must provide specific details of his
training and experience and relate that to the specific issue in this case.
Ly, 2007 WL 2010757, at *5; Tenet Hosps. Ltd., 347 S.W.3d at 750-51;
Tomasi, 63 S.W.3d at 66; Nacogdoches County Hosp. Dist., 2013 WL
6207838, at *3-4.
Dr. Lipson asserts that the standard of care requires nursing staff
to be in each resident’s room, the adjacent room, or moving through the
hall next to the room at all times. (CR 20). Dr. Lipson also asserts that
nursing staff should have be walking the halls at intervals not to exceed
ten minutes and documenting “regular checks” in residents’ charts. Id.
Dr. Lipson provides no basis or explanation as to how or why he
allegedly knows these measures were required by the standard of care
for nursing home staffing and documentation. (CR 15-67). Dr. Lipson’s
report does not establish that he has ever participated in determining
nursing home staffing levels or supervising nursing home staff, or that
he has any expertise to opine that the standard of care requires nursing
18
staff to walk the halls at intervals not to exceed ten minutes. Id. Dr.
Lipson’s report does not show any basis, nor does he offer any
explanation, as to how he would know the documentary requirements for
nursing home staff, generally, or in relation to performing “regular
checks” on residents. Id.
Dr. Lipson’s report does not establish that he has the requisite
expertise to offer opinions on the alleged nursing home standards of care
at issue or as set forth in his report, and consequently, his report is
deficient. (CR 15-67). TEX. CIV. PRAC. & REM. CODE §74.402; Treybig, 2014
WL 7499373, at *4-6; Nacogdoches County Hosp. Dist., 2013 WL
6207838, at *3-4; Tenet Hosps. Ltd., 347 S.W.3d at 750-51; Christus
Health Southeast Texas, 267 S.W.3d at 536; see also Reed, 117 S.W.3d at
411-414; Shelton v. Sargent, 144 S.W.3d at 123; Foster v. Zavala, 214
S.W.3d 106, 116 (Tex.App.—Eastland 2006, pet. denied)(concluding that
an expert report by a person not qualified to testify regarding the
standard of care does not represent a good faith effort to comply with the
statute.).
19
V. Dr. Lipson’s Report is Conclusory, Based on Assumption and,
Therefore, Deficient.
To satisfy the “good faith effort” requirement, the report must
include all the required elements and explain their connection to the
defendant’s conduct in a non-conclusory fashion. Samlowski v. Wooten,
332 S.W.3d 404, 410 (Tex. 2011); Jelinek, 328 S.W.3d at 539; Palacios, 46
S.W.3d at 879. The trial court’s analysis is limited to the four corners of
the report, and the court may not consider extrinsic evidence or supply
omissions by inference. Bowie Mem’l Hosp. v. Wright, 79 S.W.3d 48, 53
(Tex. 2002); Palacios, 46 S.W.3d at 878.
A. Dr. Lipson’s Report is Deficient as to the Element of Breach.
Dr. Lipson’s report is deficient as to the element of breach because
he offers only conclusory opinions without the requisite factual basis and
explanation. (CR 15-21). TEX. CIV. PRAC. & REM. CODE §74.351(r)(6).
Consequently, the report does not provide the court with a reasonable
basis to conclude the claims have merit. (CR 15-21). Palacios, 46 S.W.3d
at 878-9; Austin Heart, P.A. v. Webb, 228 S.W.3d 276, 279 (Tex.App. –
Austin 2007, no pet.)(the trial court is precluded from drawing inferences
or filling gaps).
20
Dr. Lipson alleges that “[t]he facility breached the standard of care
by not providing twenty-four hour skilled nursing care. The nursing staff
was not present in the halls or her room to prevent the sexual assault of
Ms. Rivera.” (CR 20). Dr. Lipson offers no factual basis for these opinions,
and therefore, they are deficient. (CR 15-21). Palacios, 46 S.W.3d at 879.
The opinions are further conclusory because they require the court
to infer that a breach occurred based solely on the alleged injury. (CR 20).
A finding of negligence may not be inferred solely on evidence of an
alleged injury. Palacios, 46 S.W.3d at 880 (breach cannot be inferred from
the existence of an injury alone because the doctrine of res ipsa loquitur
generally does not apply in health care liability claims); Senior Care
Centers, LLC v. Shelton, 459 S.W.3d 753, 758 (Tex.App. –Dallas 2015, no
pet.); see also TEX. CIV. PRAC. & REM. CODE §74.303(e)(2)(jury instruction
for health care liability claims) and §74.201 (provision limiting
application of res ipsa loquitur).
Dr. Lipson also asserts that “[t]he facility breached the standard of
care by not preventing access to her room by unsupervised males.” (CR
20). Dr. Lipson does not explain – with any basis in fact – when the
assault allegedly occurred, where the assault allegedly occurred, or who
21
allegedly assaulted Ms. Rivera. (CR 15-21). His allegations that the
facility allowed access to Ms. Rivera’s room by unsupervised males is
merely conclusory and, therefore, deficient. Id.; Palacios, 46 S.W.3d at
879.
Dr. Lipson alleges that “[t]he records do not indicate any checks on
Ms. Rivera the night she was assaulted.” (CR 20). Dr. Lipson does not
provide any factual basis as to which night he claims the alleged assault
occurred. (CR 15-21). The court must infer that date based on Dr.
Lipson’s reliance on Mahan’s affidavit regarding broken Christmas
ornaments.8 (CR 17).
Dr. Lipson also asserts that “[t]he facility breached the standard of
care by not moving Ms. Rivera to a room close to the nursing station
where no unsupervised males could enter her room.” (CR 20). Dr. Lipson
does not identify the location of Ms. Rivera’s room or its proximity to the
nursing station, nor does he describe where Ms. Rivera allegedly should
have been moved in relation to the nursing station. (CR 15-21).
8Mahan’s allegations and affidavit do not supply Dr. Lipson with the necessary
rational basis for his opinion to any greater degree than if they were his own belief
about the facts. Senior Care Centers, LLC, 459 S.W.3d at 760, citing Kerlin v. Arias,
274 S.W.3d 666, 668 (Tex. 2008).
22
Dr. Lipson’s opinions concerning Gracy Woods’ alleged breach are
deficient because they do not include the requisite explanation and
connection to the facts. TEX. CIV. PRAC. & REM. CODE §74.351(r)(6);
Jelinek, 328 S.W.3d at 539-40; Palacios, 46 S.W.3d at 879-80. Dr. Lipson’s
bare conclusions do not provide the court with a reasonable basis to
conclude that the claim has merit. Palacios, 46 S.W.3d at 879-80.
B. Dr. Lipson’s Report is Deficient as to the Element of
Causation.
Causation cannot be inferred; it must be clearly stated. Senior Care
Centers, LLC v. Shelton, 459 S.W.3d 753, 760 (Tex.App. –Dallas 2015, no
pet.); Tenet Hosps. Ltd. v. Love, 347 S.W.3d 743, 755 (Tex.App. –El Paso
2011, no pet.).
The causal connection in health care liability claims must be made
“beyond the point of conjecture” and “must show more than a possibility.”
Lenger v. Physician’s Gen. Hosp., 455 S.W.2d 703, 706 (Tex. 1970); see
Wright, 79 S.W.3d at 53; algreen Co. v. Hieger, 243 S.W.3d 183, 186-87
(Tex.App. –Houston [14th Dist.] 2007, pet. denied)( report stating that the
patient had symptoms “consistent with” known side effects of medication
was insufficient to demonstrate causal link).
23
An expert report cannot simply opine that the breach caused the
injury. Jelinek v. Casas, 328 S.W.3d 526, 539 (Tex. 2010). Otherwise, the
report does not give the trial court any reasonable basis for concluding
that the claims have merit. Id.; Palacios, 46 S.W.3d at 879; Jelinek, 328
S.W.3d at 539-40 (reiterating that the expert must explain, to a
reasonable degree, how and why the breach caused the injury based on
the facts presented); Senior Care Centers, LLC, 459 S.W.3d at 760
(holding that the statement “neglect of [the patient] … caused her to
aspirate food into her airway, causing acute respiratory failure and is the
proximate cause of her death,” was insufficient to satisfy the element of
causation); Tenet Hosps. Ltd. v. Love, 347 S.W.3d 743, 755 (Tex.App. –El
Paso 2011, no pet.).
Dr. Lipson does not explain, to any reasonable degree, how an
alleged breach by Gracy Woods caused the injuries, damages or harm
asserted in this litigation. (CR 15-21). TEX. CIV. PRAC. & REM. CODE
§74.351(r)(6). He simply states “[s]he was sexually assaulted.” (CR 20).
Dr. Lipson does not explain how an alleged failure to conduct
hallway surveillance every ten minutes caused the alleged assault. (CR
15-21). Dr. Lipson does not explain how or why the alleged assault would
24
have been prevented but for such surveillance. Id.; see e.g., Costello v.
Christus Santa Rosa Health Care Corp., 141 S.W.3d 245, 249 (Tex.App.
–San Antonio 2004, no pet.)(the report was deficient because it failed to
explain how the alleged breach was a substantial factor in bringing about
the injury, without which the injury would not have occurred).
Similarly, Dr. Lipson does not explain how the location of Ms.
Rivera’s room in proximity to the nursing station caused the alleged
sexual assault. (CR 15-21). Dr. Lipson does not explain how an
unidentified, unsupervised male allegedly accessed Ms. Rivera’s room,
nor does he explain how moving Ms. Rivera to a different room would
have prevented that alleged access. Id. Accordingly, the report does not
provide the court with a reasonable basis to conclude the claim has merit.
Dr. Lipson’s report is equally conclusory as to the question of
whether sexual contact occurred. (CR 15-21). Dr. Lipson does not explain
how he concluded that the alleged injuries were sexual in origin. Id. Dr.
Lipson does not explain how he determined that Ms. Rivera’s alleged
presentation as “tearful and afraid” was the result of sexual assault
rather than her depression and dementia, which was documented in his
report. (CR 17, 20). Dr. Lipson does not explain how he concluded that
25
the physical findings were caused by sexual contact rather than medical
examination or routine perineal care.9 (CR 15-21). (RR 11).
Connecting the opinion to the facts is key. Reports based on
assumption, speculation, conjecture or contradictory statements do not
provide the trial court with a basis to conclude the claim has merit. Fung
v. Fischer, 365 S.W.3d 507, 533-34 (Tex.App.-Austin 2012, no
pet.)(opinion was deficient because it turned on assumption unsupported
by the report), overruled on other grounds by Certified EMS, Inc. v. Potts,
392 S.W.3d 625 (Tex.2013); Cooper v. Arizpe, 2008 WL 940490, at *3-4
(Tex.App. –San Antonio 2008, pet. denied)(report was deficient because
it relied on the assumption of what was contained in the emergency
department chart); Murphy v. Mendoza, 234 S.W.3d 23, 28 (Tex.App. –El
Paso 2007, no pet.)(report was deficient because it was based on an
assumption that recuts of pathology slides were identical to the
originals)(emphasis in original); Hutchinson v. Montemayor, 144 S.W.3d
614, 617-18 (Tex.App. –San Antonio 2004, no pet.)(report was deficient
because it did not show more than possibility and speculation that the
9 Ms. Rivera had an extensive list of physicians and health care providers, but Dr.
Lipson limited his analysis of medical records to Gracy Woods and St. David’s
Hospital. (CR 16, 282-92). See also CR 105 (Gracy Woods’ objection to Dr. Lipson’s
limited review of Ms. Rivera’s medical records).
26
patient would have had a better outcome had an arteriogram been
performed).
When the facts support equal inferences from which different
conclusions could be drawn, the expert must explain how he eliminated
the possibilities not chosen to reach his conclusion. Senior Care Centers,
LLC, 459 S.W.3d at 753, citing Jelinek, 328 S.W.3d at 536. A conclusion
should be rejected if it is not accompanied by an explanation
demonstrating why the other, rational possibilities are inferior to the
chosen conclusion. Jelinek, 328 S.W.3d at 536; Senior Care Centers, LLC,
459 S.W.3d at 759-60.
Dr. Lipson assumes that Ms. Rivera experienced sexual contact,
without excluding other, innocuous causes. Consequently, his report is
deficient. Jelinek, 328 S.W.3d at 536; Senior Care Centers, LLC, 459
S.W.3d at 759-60.
CONCLUSION
Dr. Lipson’s report does not represent a good faith effort to comply
with TEX. CIV. PRAC. & REM. CODE §74.351(r)(6).
Dr. Lipson is not qualified to render the opinions contained in his
report, as to the standard of care, alleged breach, or the purported causal
27
relationship. (CR 15-67). TEX. CIV. PRAC. & REM. CODE §74.402, §74.403;
TEX. R. EVID. 702. As such, the trial court abused its by overruling Gracy
Woods’ objections to Dr. Lipson’s lack of qualification. Nexion Health v.
Treybig, 2014 WL 7499373, at * (Tex.App. –Dallas 2014, no pet.); Tenet
Hosps. Ltd., 347 S.W.3d at 752; In re Samonte, 163 S.W.3d 229, 237-38
(Tex.App. –El Paso 2005, orig. proceeding); In re Windisch, 138 S.W.3d
507, 514 (Tex.App. –Amarillo 2004, orig. proceeding).
Additionally, the trial court abused its discretion in finding Dr.
Lipson’s report satisfies TEX. CIV. PRAC. & REM. CODE §74.351(r)(6)
because the report is conclusory and, therefore, deficient as to the
elements of breach and causation. (CR 15-21). TEX. CIV. PRAC. & REM.
CODE §74.351 (l), (r)(6); Palacios, 46 S.W.3d at 880; Jelinek v. Casas, 328
S.W.3d at 540.
PRAYER
Gracy Woods prays that the Court reverse the trial court’s Order
Denying Defendant’s Motion to Dismiss and that the Court render
dismissal of all claims against Gracy Woods with prejudice to their re-
filing. Gracy Woods seeks such other relief that the Court deems
appropriate.
28
Respectfully submitted,
By: /s/ Emily J. Davenport
EMILY J. DAVENPORT
State Bar No. 24012501
JANICE M. BYINGTON
State Bar No. 24006938
REED, CLAYMON, MEEKER
& HARGETT, PLLC
5608 Parkcrest Drive, Suite 200
Austin, Texas 78731
(512) 660-5960 Telephone
(512) 660-5979 Facsimile
ATTORNEYS FOR APPELLANT
29
CERTIFICATE OF COMPLIANCE
I hereby certify that the foregoing brief has been compiled using a
computer program in Word with 14-point font conventional typeface for
the body of this brief. Excluding the portions of the brief exempted
pursuant to rule 9.4 of the Texas Rules of Appellate Procedure, this
petition for writ of mandamus contains 6,113 words.
/s/ Emily J. Davenport
Emily J. Davenport
30
CERTIFICATE OF SERVICE
Pursuant to rule 9.5 of the Texas Rules of Appellate Procedure, I
hereby certify that a true and correct copy of the foregoing instrument
has been served electronically through the electronic filing manager or
sent by e-mail, if possible, and also by certified mail, return receipt
requested on the Appellee this 10th day of November, 2015:
Jack Modesett, III
ModesettWilliams, PLLC
515 Congress Ave., Suite 1650
Austin, Texas 78701
jack@jmodesettlaw.com
/s/ Emily J. Davenport
Emily J. Davenport
31
DC BK15246 PG179
Filed in The District Court
of Travis County, Texas
SEP - 1 2015
CAUSE NO. D-1-GN-14-005169
MARTHA MAHAN, AS THE REPRE- §
SENTATIVE OF THE ESTATE OF §
MARY RIVERA, § TRAVIS COUNTY, TEXA
§
v. §
§
PM MANAGEMENT- AUSTIN NC, LLC §
d/b/a GRACY WOODS I NURSING HOME § 250TH JUDICIAL DISTRICT
ORDER DENYING
DEFENDANT'S MOTION TO DISMISS
On~c~ ~~fi.eard Defendant's Motion to Dismiss in this matter.
Having heard the evidence and arguments of counsel in this matter the Court hereby denies
in all things Defendant's motion.
5~/J --k L rL~ ~~ .2G1>
0 ~ k1wA.. £) ~
J6DGEPRESIDING
1111111111111111111111111111111111111111111111111111111
004195097
APPENDIX 1 ®!J 446
8/12/2015 4:05:13 PM
Velva L. Price
District Clerk
Travis County
CAUSE NO. D-1-GN-14-005169 D-1-GN-14-005169
Tamara Franklin
MARTHA MAHAN, AS THE § IN THE DISTRICT COURT
REPRESENTATIVE OF THE §
ESTATE OF MARY RIVERA §
§
v. § TRAVIS COUNTY, TEXAS
§
GRACY WOODS I NURSING HOME § 250TH JUDICIAL DISTRICT
DEFENDANT'S MOTION TO DISMISS
TO THE HONORABLE COURT:
NOW COMES Defendant Gracy Woods I Nursing Home, actually known as PM
Management- Austin NC, LLC d/b/a Gracy Woods Nursing Center ("Defendant"), and files its
Motion to Dismiss pursuant to TEX. Crv. PRAC. & REM. CODE §74.351(b) and would respectfully
show:
I.
This is a motion to dismiss a health care liability claim pursuant to TEX. Crv. PRAC. &
REM. CODE. §74.351(b). Plaintiff filed suit on December 11, 2014, alleging that Ms. Rivera was
sexually assaulted while a resident at Gracy Woods. Defendant filed its answer the next day,
December 12, 2014, denying Plaintiff's allegations. Plaintiff served the report and curriculum
vitae of Loren Lipson, M.D., on January 30, 2015 in an effort to comply with the 120-day expert
report rule. 1 Gracy Woods timely filed its objections? In summary, Defendant objected that Dr.
Lipson is not qualified to offer the opinions stated in his report, that Dr. Lipson's opinions are
conclusory and speculative, and that Dr. Lipson relies on and incorporates causation opinions
1
True and correct copies of Dr. Lipson's report and curriculum vitae are attached hereto as Exhibits A and B,
respectively, and incorporated herein for all purposes.
2
Defendant previously filed its Objections to Plaintiffs Expert Report and Curriculum Vitae. Defendant
incorporates its Objections to Plaintiffs Expert Report and Curriculum Vitae herein by reference pursuant to Rule
58 of the Texas Rules of Civil Procedure.
1
APPENDIX 2 301
from witnesses who are barred from offering opinions pursuant to TEX. Crv. PRAC. & REM. CODE
§74.402 and §74.403. More than 120 days have expired since Defendant filed its original answer
on December 12, 2014, and Defendant seeks dismissal pursuant to TEX. Crv. PRAC. & REM.
CODE §74.351(b).
II.
Section 74.351 of the Texas Civil Practice and Remedies Code provides:
(a) In a health care liability claim, a claimant shall, not later than the 120th day
after the date each defendant's original answer is filed, serve on that party or
the party's attorney one or more expert reports, with a curriculum vitae of
each expert listed in the report for each physician or health care provider
against whom a liability claim is asserted. The date for serving the report may
be extended by written agreement of the affected parties. Each defendant
physician or health care provider whose conduct is implicated in a report must
file and serve any objection to the sufficiency of the report not later than the
later of the 21st day after the date the report is served or the 21st day after the
date the defendant's answer is filed, failing which all objections are waived.
(b) If, as to a defendant physician or health care provider, an expert report has not
been served within the period specified by Subsection (a), the court, on the
motion of the affected physician or health care provider, shall, subject to
Subsection (c), enter an order that:
(1) awards to the affected physician or health care provider reasonable
attorney's fees and costs of court incurred by the physician or health care
provider; and
(2) dismisses the claim with respect to the physician or health care provider,
with prejudice to the refiling of the claim.
(c) If an expert report has not been served within the period specified by
Subsection (a) because elements of the report are found deficient, the court
may grant one 30-day extension to the claimant in order to cure the
deficiency ....
TEX. Crv. PRAC. & REM. CODE §74.351(a)-(c).
III.
A report "has not been served" under the statute when it has been physically and timely
served but is found deficient by the trial court. Lewis v. Funderburk, 253 S.W.3d 204, 207-08
2
302
(Tex. 2008). A report is deficient when it "does not represent an objective good faith effort to
comply with the [statute's] definition of an expert report." Tex. Civ. Prac. & Rem. Code §74.351
(!). The statute defines "expert report" as "a written report by an expert that provides a fair
summary of the expert's opinions as of the date of the report regarding applicable standards of
care, the manner in which the care rendered by the physician or health care provider failed to
meet the standards, and the causal relationship between that failure and the injury, harm, or
damages claimed." !d. §74.351(r)(6).
IV.
To qualify as a "good faith effort," the report must provide enough information to fulfill
two purposes. First, the report must inform the defendant of the specific conduct the plaintiffhas
called into question. Second, and equally important, the report must provide a basis for the trial
court to conclude that the claims have merit. Scoresby v. Santillan, 346 S.W.3d 546, 556 (Tex.
2011), citing Am. Transitional Care Ctrs of Tex., Inc. v. Palacios, 46 S.W.3d 873, 879 (Tex.
2001). No particular words or formality are required, but bare conclusions will not suffice.
Palacios, 46 S.W.3d at 879. The report must address all elements, and omissions may not be
supplied by inference. !d.; Bowie Mem 'l Hasp. v. Wright, 79 S.W.3d 48, 53 (Tex. ("[t]he report
must include the required information within its four comers."). The trial court is precluded from
filling gaps by drawing inferences or guessing as to what the expert likely meant or intended to
say. Austin Heart P.A. v. Webb, 228 S.W.3d 276, 279 (Tex.App. -Austin 2007, no pet.).
v.
OBJECTIONS TO QUALIFICATIONS
An expert report is not adequate unless the author is qualified. Ly v. Austin, 2007 WL
2010757, at *2 (Tex.App. -Austin 2007, no pet.) ("an 'expert report' must first be a 'written
report by an expert."') (emphasis in original); In re Windisch, 138 S.W.3d 507, 511 (Tex.App.-
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Amarillo 2004, orig. proceeding). The author must be qualified to offer opinions regarding the
care which is the specific subject of the claim against the defendant. Broders v. Heise, 924
S.W.2d 148, 153 (Tex. 1996); Cortez v. Tomas, 2012 WL 407382, at *3. Analysis of the expert's
qualification is limited to the four comers of the report and the expert's CV. Cortez, 2012 WL
407382, at *3; Ly v. Austin, 2007 WL 2010757, at *2 (reiterating that the "report itself must
establish the expert's qualifications on the basis of training and experience"); Foster v. Zavala,
214 S.W.3d 106 (Tex.App. -Eastland 2006, pet. denied); In re Samonte, 163 S.W.3d 229, 234
(Tex.App. -El Paso 2005, orig. proceeding); In re Windisch, 138 S.W.3d at 511; Palacios, 46
S.W.3d at 879.
VI.
For someone offering opinion testimony regarding the standard of care and alleged
breach, the statute defines an "expert" as follows:
(a) For the purposes of this section, "practicing health care" includes:
(1) training health care providers in the same field as the defendant health care
provider at an accredited educational institution; or
(2) serving as a consulting health care provider and being licensed, certified,
or registered in the same field as the defendant health care provider.
(b) In a suit involving a health care liability claim against a health care provider, a
person may quality as an expert witness on the issue of whether the health
care provider departed from accepted standards of care only if the person:
(1) is practicing health care in a field of practice that involves the same type
of care and treatment as that delivered by the defendant health care
provider, if the defendant health care provider is an individual, at the time
the testimony is given or was practicing that type of health care at the time
the claim arose;
(2) has knowledge of accepted standards of care for health care providers for
the diagnosis, care, or treatment of the illness, injury, or condition
involved in the claim; and
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(3) is qualified on the basis of training or experience to offer an expert
opinion regarding those accepted standards ofhealth care.
(c) In determining whether a witness is qualified on the basis of training or
experience, the court shall consider whether, at the time the claim arose or at
the time the testimony is given, the witness:
(1) is certified by a licensing agency of one or more states of the United States
or a national professional certifying agency, or has other substantial
training or experience, in the area ofhealth care relevant to the claim; and
(2) is actively practicing health care in rendering health care services relevant
to the claim.
TEX. Crv. PRAC. & REM. CODE §74.351(r)(5)(B), §74.402.
VII.
For someone offering opinion testimony as to the alleged causal relationship, the statute
defines "expert" as a physician who is otherwise qualified to render opinions on such causal
relationship under the Texas Rules of Evidence. !d. at §74.351(r)(5)(C), §74.403 (" ... a person
may qualify as an expert witness on the issue of the causal relationship between the alleged
departure from accepted standards of care and the injury, harm, or damages claimed only if the
person is a physician and is otherwise qualified to render opinions on that causal relationship
under the Texas Rules of Evidence."); TEX. R. Evm. 702 ("If scientific, technical, or other
specialized knowledge will assist the trier of fact to understand the evidence or to determine a
fact in issue, a witness qualified as an expert by knowledge, skill, experience, training or
education may testify thereto in the form of an opinion or otherwise."). The expert must have
knowledge, skill, experience, training, or education regarding the specific issue before the court
that would qualify the expert to give an opinion on that particular subject. Broders v. Heise, 924
S.W.2d 148, 153 (Tex. 1996).
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VIII.
A. LOREN LIPSON, MD, IS NOT QUALIFIED TO OFFER CAUSATION
OPINIONS.
Dr. Lipson does not claim to have any special training or experience in the diagnosis or
treatment of gynecological illnesses or injuries, nor does he claim to have any special
knowledge, skill, experience, training or education in the diagnosis or treatment of sexual
assault. Exhibits A and B. Nothing in Dr. Lipson's report or curriculum vitae indicates that he
has ever diagnosed a sexual assault or rendered any treatment to a patient following an alleged
sexual assault. !d. Nothing in Dr. Lipson's curriculum vitae or his report indicates that he
lectures on sexual assault or gynecological illnesses or injuries relevant to this claim or that Dr.
Lipson has any other special knowledge in the diagnosis or treatment of sexual assault. !d.
Dr. Lipson has failed to establish that he has any special knowledge, skill, experience,
training or education on the specific issues in this case: whether Ms. Rivera sustained injuries
and whether those injuries, if any, were caused by a sexual assault. Exhibits A and B; TEX. Crv.
PRAC. & REM. CODE §74.403; TEX. R. Evm. 702; Broders, 924 S.W.2d at 152-54. Although Dr.
Lipson is a physician, his opinions on causation do not rise above mere speculation. !d. at 153.
Dr. Lipson is not qualified to offer the opinions asserted in his report concerning Ms. Rivera's
alleged sexual assault, and consequently, his report is deficient. TEX. Crv. PRAC. & REM. CODE
§74.351, §74.403; TEX. R. Evm. 702; Broders, 924 S.W.2d at 152-54 (finding that an
emergency medicine physician was not qualified to offer opinions regarding causation in a head
injury case); Pediatrix Med. Servs. Inc. v. De La 0, 368 S.W.3d 34, 39-40 (Tex.App.-El Paso
2012, no pet.) (finding that a Board-certified neonatologist and pediatrician was not qualified to
render an expert opinion as to the cause of a baby's blindness); Cortez, 2012 WL 407382, at *3,
6 (finding that a Board-certified OB/GYN was not qualified to offer causation opinions
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concemmg an ovanan surgery because the physician lacked surgical expenence removmg
ovaries and relating to injury to the patient's bowel).
B. JENNY BLACK, RN, IS NOT QUALIFIED TO OFFER CAUSATION OPINIONS.
Plaintiff served a statement by Jenny Black, RN, but failed to serve any corresponding
curriculum vitae. According to her statement, Ms. Black is a nurse but not a physician.
Therefore, she is not qualified to make medical diagnoses or offer causation opinions in this
litigation? TEX. Crv. PRAC. & REM. CODE §74.351(r)(5)(C), §74.403 (limiting causation opinions
only to physicians who are otherwise qualified pursuant to the Texas Rules of Evidence); TEX. R.
Evm. 702; Costello v. Christus Santa Rosa Health Care, 141 S.W.3d 245, 248-49 (Tex.App. -
San Antonio 2004, no pet.)( discussing nurses' lack of qualification to render medical opinions in
expert reports).
C. LOREN LIPSON, MD, IS NOT QUALIFIED TO OFFER LIABILITY OPINIONS.
Dr. Lipson has failed to establish that he has the requisite knowledge, training or
experience in the operation, management or supervision of nursing homes to offer the opinions
asserted in his report. TEX. Crv. PRAC. & REM. CODE §74.402.
Dr. Lipson claims that he continues to treat patients in the long term care setting, but
neither his report nor his CV identifies a medical practice or a long term care facility where such
treatment occurs. Exhibits A and B. Dr. Lipson does not explain how that alleged experience or
experience in geriatric medicine qualify him to offer opinions relating to nursing home standards
of care. !d. Dr. Lipson does not appear to have any current Board Certification in geriatric
medicine. Exhibit A at 1.
3
Dr. Lipson's reliance on Ms. Black's opinion does not qualify it for the purposes of TEX. Crv. PRAC. & REM. CODE
§74.403 and TEX. R. Evm. 702, because Dr. Lipson is not qualified by his own special knowledge, skill, experience,
training or education in the diagnosis and treatment of sexual assault. See, e.g., Kelly v. Rendon, 255 S.W.3d 665
(Tex.App. -Houston [141h Dist.] 2008, no pet.) (finding that "[w]hile a nurse's report, standing alone, is inadequate
to meet the requirements of the statute as to medical causation, nothing in the health care liability statute prohibits an
otherwise qualified physician from relying on a nurse's report in the formation of the physician's own opinion.")
(emphasis added).
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Dr. Lipson's report and CV do not describe events in the last decade where he has had
responsibility for the operation or management of a nursing home, nor does he appear to have
had the responsibility as the medical director of any nursing home. !d. Dr. Lipson offers
conclusory statements regarding his alleged familiarity with the standard of care by stating "I am
familiar with the standard of care for the treatment of patients like Mary Rivera and familiar with
the required training of employees providing care to residents like Mary Rivera," but he provides
no facts in support of those assertions. Exhibit A at 2.
Dr. Lipson's conclusory statements do not establish qualification on the specific issues in
this case. "An expert cannot rely on generalized, conclusory statements to establish [his]
qualifications; [he] must provide specific details of [his] training and experience." Ly v. Austin,
2007 WL 2010757, at *5 (Tex.App. -Austin 2007, no pet.) (affirming the trial court's decision
that a Board Certified Physical Medicine and Rehabilitation physician who treated stroke
patients was not qualified to offer expert opinions concerning standards of care for the
emergency care of acute stroke patients).
Dr. Lipson has failed to establish that he has experience in the specific issue before this
court- nursing home standards of care to prevent sexual assault. TEX. Crv. PRAC. & REM. CODE
§74.402. Even if it is recent, Dr. Lipson's experience in geriatric medicine does not quality him
to offer opinions relating to nursing facility standards of care. Reed v. Granbury Hasp. Corp.,
117 S.W.3d 404, 411-414 (Tex. App. - Ft. Worth 2003, no pet.)(a board certified emergency
medicine physician and neurologist with thirty years of experience treating stroke patients not
qualified to offer opinions on standards of care for hospital policy relating to administration of
stroke therapy); Shelton v. Sargent, 144 S.W.3d 113, 123 (Tex. App. - Ft. Worth 2004, pet.
denied). Dr. Lipson has failed to demonstrate that he has the relevant, recent experience required
to offer opinions relating to Gracy Woods' standards of care and alleged breach, meaning that his
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report is deficient. TEX. Crv. PRAC. & REM. CODE §74.402; Ly v. Austin, 2007 WL 2010757
(Tex.App. -Austin 2007, no pet.) (concerning Chapter 74's predecessor, TEX. REv. Crv. STAT.,
art. 4590i).
IX.
OBJECTIONS TO THE REPORT
A report is deficient, and dismissal is mandatory, if the report does not represent an
objective good faith effort to comply with the definition of an expert report as set out in TEX.
Crv. PRAC. & REM. CODE §74.351 (r)(6). TEX. Crv. PRAC. & REM. CODE §74.351 (b), (1) and
(r)(6). To constitute a good faith effort to comply with the statute, the report must provide
enough information to fulfill two purposes: (1) inform each defendant of the specific conduct the
plaintiff has called into question; and (2) provide a basis for the trial court to conclude that the
claims have merit. Palacios, 46 S.W.3d at 878. A report cannot merely state the expert's
conclusions about the elements, but rather, the expert must explain the basis of his statements to
link his conclusions to the facts. Jelinek v. Casas, 328 S.W.3d 526, 539 (Tex. 2010); Bowie v.
Wright, 79 S.W.3d 48, 52 (Tex. 2002)(quoting Earle v. Ratliff, 998 S.W.2d 882, 890 (Tex.
1999); Palacios, 46 S.W.3d at 879. "A report that merely states the expert's conclusions about
the standard of care, breach and causation does not fulfill the two purposes of the good-faith
effort." Jelinek, 328 S.W.3d at 539.
When assessing the sufficiency of an expert report, the trial court's review is limited
exclusively to the four comers of the report, and the court may draw no inferences as to what the
expert meant or intended to say. Gray v. CHCA Bayshore, L.P., 189 S.W.3d 855, 859 (Tex.App.
-Houston [1st Dist.] 2006, no pet.)(citing Palacios, 46 S.W.3d at 879 (Tex. 2001)); Wright, 79
S.W.3d at 53; Austin Heart, P.A. v. Webb, 228 S.W.3d 276, 279 (Austin 2007, no pet.); see also
Garcia v. Marichalar, 198 S.W.3d 250, 254 (Tex.App. -San Antonio 2006, no pet.)(holding that
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the trial court could not consider counsel's argument or any evidence brought forward at the
hearing).
A report cannot merely state the expert's conclusions about the elements, but rather, the
expert must explain the basis of his statements to link his conclusions to the facts. Jelinek, 328
S.W.3d at 539 (Tex. 2010); Bowie, 79 S.W.3d at 52 (Tex. 2002); Palacios, 46 S.W.3d at 870. "A
report that merely states the expert's conclusions about the standard of care, breach and
causation does not fulfill the two purposes of the good faith effort," which is to put the defendant
on notice of the specific claims against it and to give the trial court a reasonable basis to
conclude the claim has merit. Jelinek, 328 S.W.3d at 539; Palacios, 46 S.W.3d 873.
For example, it is conclusory to say that a health care provider's breach in "reasonable
medical probability, resulted in a prolonged hospital course and increased pain and suffering."
Jelinek, 328 S.W.3d at 539. An expert cannot simply opine that a breach caused the injury. !d.
Stated so briefly, the report fails to satisfy the second prong of the good faith effort in that it does
not give the trial court a reasonable basis to conclude the case has merit. !d.; Palacios, 46 S.W.3d
at 879. Instead, the expert must go further and explain "to a reasonable degree, how and why the
breach caused the injury based on the facts presented." Jelinek, 328 S.W.3d at 539-40.
A. DR. LIPSON'S REPORT IS DEFICIENT AS TO BREACH.
Dr. Lipson's report is deficient because he offers only broad, conclusory opmwns,
without the requisite factual basis and explanation. TEX. Crv. PRAC. & REM. CODE §74.351(r)(6).
For example, Dr. Lipson asserts that "[t]he facility breached the standard of care by not
providing twenty-four hour skilled nursing care." Exhibit A, at 6. Dr. Lipson offers no
explanation or factual basis for his opinion. This assertion does not inform Defendant of the
specific conduct Plaintiff has called into question with respect to twenty-four hour skilled
nursing care, nor does it give the court a reasonable basis to conclude that the claim has merit.
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This is merely a bare, conclusory statement, and it does not reflect a good faith effort to comply
with TEX. Crv. PRAC. & REM. CODE §74.351. TEX. Crv. PRAC. & REM. CODE §74.351; Jelinek,
328 S.W.3d at 539; Palacios, 46 S.W.3d 873.
Similarly, Dr. Lipson concludes that "[t]he nursing staff was not present in the halls or
her room to prevent the sexual assault of Ms. Rivera." Exhibit A, at 6. Dr. Lipson does not
identify when or how the alleged sexual assault occurred or who the alleged perpetrator was. He
does not explain the basis for his conclusion that staff were not present in the halls or Ms.
Rivera's room. Dr. Lipson does not offer an explanation from which Gracy Woods could
determine how Dr. Lipson believes the events allegedly occurred, so as to put Gracy Woods on
notice of the claim, nor does Dr. Lipson offer a reasonable basis for a court to conclude this
claim has merit. TEX. Crv. PRAC. & REM. CODE §74.351. TEX. Crv. PRAC. & REM. CODE §74.351;
Jelinek, 328 S.W.3d at 539; Palacios, 46 S.W.3d 873.
Dr. Lipson's report claims that "[t]he facility breached the standard of care by not
preventing access to her room by unsupervised males." Exhibit A at 6. Dr. Lipson does not
identify any factual basis for his assertion that Ms. Rivera's room was accessed by any
unsupervised males. He does not identity the time at which the alleged access occurred, nor does
he make any effort to identify the person who he claims accessed Ms. Rivera's room. This is
merely a bare assertion, with no factual basis. It does not provide enough information to inform
Defendant of the specific conduct Plaintiff has called into question, nor does it give the trial
court a reasonable basis to conclude this claim has merit. TEX. Crv. PRAC. & REM. CODE
§74.351. TEX. Crv. PRAC. & REM. CODE §74.351; Jelinek, 328 S.W.3d at 539; Palacios, 46
S.W.3d 873.
Similarly, Dr. Lipson asserts that "[t]he facility breached the standard of care by not
moving Ms. Rivera to a room close to the nursing station where no unsupervised males could
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enter her room." Exhibit A at 6. Dr. Lipson offers no explanation or factual basis for his opinion.
He does not describe the location of Ms. Rivera's room as it relates to the nursing station. As
discussed above, he offers no information concerning the alleged access to Ms. Rivera's room by
any unsupervised male. This conclusory statement does not provide the trial court a reasonable
basis to conclude this claim has merit. TEX. Crv. PRAC. & REM. CODE §74.351. TEX. Crv. PRAC.
& REM. CODE §74.351; Jelinek, 328 S.W.3d at 539; Palacios, 46 S.W.3d 873.
B. DR. LIPSON'S REPORT IS DEFICIENT AS TO CAUSATION.
Dr. Lipson does not offer an explanation or factual basis concerning a causal relationship
between an alleged breach by Gracy Woods and an alleged sexual assault of Ms. Rivera. Exhibit
A. Dr. Lipson's report does not provide the trial a reasonable basis to conclude that this claim
has merit. TEX. Crv. PRAC. & REM. CODE §74.351. TEX. Crv. PRAC. & REM. CODE §74.351;
Jelinek, 328 S.W.3d at 539; Palacios, 46 S.W.3d 873.
Dr. Lipson does not explain the basis for his conclusion that a sexual assault occurred.
Exhibit A. His opinion on this is based on assumption and speculation, and therefore, it is
deficient.
Dr. Lipson states that he has considered "other causes of this injury," but he does not
indicate that the "other causes" are by any means exhaustive. Exhibit A at 7. Dr. Lipson
considers no alternative to sexual assault, except that the alleged injury might have been self-
inflicted. !d.
When facts support equal references from which different conclusions could be drawn, it
is incumbent on the expert to explain to a reasonable degree of medical probability how the
expert eliminated the possibilities not chosen and derived his conclusion. Jelinek, 328 S.W.3d at
536; Senior Care Centers, LLC v. Shelton, 459 S.W.3d 753, 759-60 (Tex.App. -Dallas 2015, no
pet.). Here, Dr. Lipson failed to consider and eliminate other causes - particularly those
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incidental to the patient's care or underlying conditions. Exhibit A. An expert's conclusion not
accompanied by a rational explanation demonstrating why the other possibilities are inferior to
the expert's chosen conclusion is a conclusory opinion based solely on the ipse dixit of a
credentialed witness, and the Texas Supreme Court has instructed that such opinions be rejected.
Jelinek, 328 S.W.3d at 536; Shelton, 459 S.W.3d at 759-60.
Dr. Lipson's opinions are merely speculative and, therefore, deficient. Dr. Lipson's
causation opinions do not provide the court with a reasonable basis to conclude this claim has
merit. Consequently, this report does not constitute a good faith effort to comply with TEX. Crv.
PRAC. & REM. CODE §74.351. TEX. Crv. PRAC. & REM. CODE §74.351; Jelinek, 328 S.W.3d at
539; Palacios, 46 S.W.3d at 878 (Tex. 2001).
X.
OBJECTIONS TO THE ATTACHMENTS TO THE REPORT
Defendant reiterates its objections to Dr. Lipson's report to the extent it incorporates
statements, medical records and other attachments and would require the Court to draw
inferences and fill gaps in violation of the four comers rule. Exhibit A. Am. Transitional Care v.
Palacios, 46 S.W.3d 873, 878 (Tex. 2001).
XI.
Defendant objects to Ms. Black's statement or other documentation attached to and
referenced in Dr. Lipson's report to the extent Plaintiff asserts those items, individually,
constitute expert reports, which they do not. 4 Defendant reasserts its objections that Ms. Black
lacks the qualification to offer expert opinions regarding causation because she is not a licensed
physician. TEX. Crv. PRAC. & REM. CODE §74.403; TEX. R. Evm. 702. Defendant objects that no
4
Exhibit 3 to Dr. Lipson's report, documents bearing the names of Austin/Travis County and St. David's Medical
Center, are attached hereto as Exhibit F and incorporated herein for all purposes. Defendant attaches these
documents for the purpose of objecting to them pursuant to TEX. Crv. PRAC. & REM. CODE §74.351. Defendant
objects to the admissibility of these documents pursuant to TEX. R. Evm. 802.
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curriculum vitae was provided with respect to Ms. Black. TEX. Crv. PRAC. & REM. CODE
§74.351, §74.402 and §74.403. Defendant objects that Ms. Black is not qualified to offer
standard of care or breach opinions relating to Defendant. TEX. Crv. PRAC. & REM. CODE
§74.402. Defendant further objects to Ms. Black's statement and all other documents authored by
Ms. Black that are attached to Dr. Lipson's report because they are conclusory and do not
provide the required explanation or factual bases to represent a good faith effort to comply with
Section 74.351. TEX. Crv. PRAC. & REM. CODE §74.351; Bowie Mem'l Hasp. v. Wright, 79
S.W.3d 48, 52-53 (Tex. 2002); Palacios, 46 S.W.3d 873, 878 (Tex. 2001).
XII.
Defendant reiterates its objections to the Affidavit of Martha Mahan to the extent
Plaintiff asserts that Ms. Mahan's affidavit constitutes an expert report, which it does not.
Plaintiff provided no curriculum vitae. Plaintiff lacks the knowledge, skill, training, education or
experience to offer opinions regarding Defendant's standard of care, alleged breach or the
alleged causal relationship. TEX. Crv. PRAC. & REM. CODE §74.351, §74.402 and §74.403.
Defendant further objects to the Affidavit of Martha Mahan because it is conclusory, speculative,
and does not constitute a good faith effort to comply with TEX. Crv. PRAC. & REM. CODE
§74.351. Additionally, Ms. Mahan's affidavit does not supply Dr. Lipson with the necessary
rational basis for his medical opinion to any greater degree than the beliefs stated in Ms.
Mahan's affidavit were his own beliefs. An affiant's beliefs about what the facts are does not
make those beliefs facts nor constitute personal knowledge of the believed facts. Shelton, 459
S.W.3d at 760.
XIII.
Defendant reiterates its objections to the records attached as Exhibit 3 to Dr. Lipson's
report because they do not constitute an expert report. TEX. Crv. PRAC. & REM. CODE §74.351.
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Defendant objects that no curricula vitae of the records' authors were produced. Defendant
objects that the authors of the records attached as Exhibit 3 to Dr. Lipson's report are not
qualified to offer opinions regarding Defendant's standard of care, alleged breach or the alleged
causal relationship. TEX. Crv. PRAC. & REM. CODE §74.351, §74.402 and §74.403. Defendant
further objects to the records attached to Dr. Lipson's report as Exhibit 3 because the opinions
contained therein, if any, are conclusory and do not constitute a good faith effort to comply with
TEX. Crv. PRAC. & REM. CODE §74.351.
XIV.
CONCLUSION
Defendant object to Dr. Lipson's report because he has not demonstrated that he is
qualified to offer opinions concerning Defendant's standard of care or alleged breach. TEX. Crv.
PRAC. & REM. CODE §74.402. Defendant further objects to Dr. Lipson's report because Dr.
Lipson lacks the requisite experience to offer opinions concerning the diagnosis of sexual assault
or opinions concerning the alleged causal relationship. TEX. Crv. PRAC. & REM. CODE §74.403;
TEX. R. Evm. 702. Defendant further objects to Dr. Lipson's report because Dr. Lipson offers no
explanation or factual basis to support his breach opinions, meaning that they are merely
conclusory and, therefore, deficient. TEX. Crv. PRAC. & REM. CODE §74.351(!), (r)(6); Jelinek,
328 S.W.3d at 539; Palacios, 46 S.W.3d 873. Finally, Defendant objects to Dr. Lipson's report
because it offers no factual basis or explanation of the causal relationship between Defendant's
alleged breach and the injuries, damages or harm asserted in this litigation, and because Dr.
Lipson fails to exclude other reasonable causes for Ms. Rivera's presentation. TEX. Crv. PRAC. &
REM. CODE §74.351(!), (r)(6); Jelinek, 328 S.W.3d at 536, 539; Palacios, 46 S.W.3d 873;
Shelton, 459 S.W.3d at 759-60.
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WHEREFORE, Defendant Gracy Woods I Nursing Home, actually known as PM
Management - Austin NC, LLC d/b/a Gracy Woods Nursing Center, respectfully requests that
its objections to Plaintiff's expert report be sustained, that all claims against it be dismissed with
prejudice to their refiling, that it be awarded its reasonable attorneys' fees and costs of court, and
that it be granted such further relief to which it may show itself justly entitled.
REED, CLAYMON, MEEKER & HARGETT, PLLC
5608 Parkcrest Dr., Suite 200
Austin, Texas 78731
(512) 660-5960
(512) 660-5979 (facsimile)
edavenport@rcmhlaw.com
jbyington@rcmhlaw.com
By: /s/ Emily J. Davenport
Emily J. Davenport
State Bar No. 24012501
Janice M. Byington
State Bar No. 24006938
ATTORNEYS FOR DEFENDANT
GRACY WOODS I NURSING HOME
A/KIA PM MANAGEMENT - AUSTIN NC, LLC
DIB/A GRACY WOODS NURSING CENTER
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CERTIFICATE OF SERVICE
I hereby certify that a true and correct copy of the foregoing document has been served in
accordance with TRCP 21a on the 12th day of August, 2015 to the following:
Jack Modesett III
Walter V. Williams
ModesettWilliams, PLLC
2202 Lake Austin Blvd.
Austin, TX 78703
j ack@jmodesettlaw.com
/s/ Emily J. Davenport
Emily J. Davenport
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8/24/2015 3:25:36 PM
Velva L. Price
District Clerk
Travis County
CAUSE NO. D-1-GN-14-005169 D-1-GN-14-005169
Jonathan Sanders
MARTHA MAHAN, AS THE REPRE- § IN THE DISTRICT COURT OF
SENTATIVE OF THE ESTATE OF §
MARY RIVERA, §
§
v. § TRAVIS COUNTY, TEXAS
§
PM MANAGEMENT- AUSTIN NC, LLC §
d/b/a GRACY WOODS I NURSING HOME § 250TH JUDICIAL DISTRICT
PLAINTIFF'S RESPONSE TO
DEFENDANT'S MOTION TO DISMISS
COMES NOW Plaintiff Martha Mahan, as the Representative of the Estate of Mary Rivera,
and files this her response to Defendant's Motion to Dismiss and would respectfully show the
Court the following:
I.
INTRODUCTION
On November 8, 2013, 78 year-old demented Mary Rivera was sexually assaulted in her
room, while a resident at Defendant's nursing home facility. The rape occurred after regularly
scheduled events at the nursing home during which alcohol was served. Mrs. Rivera's daughter,
Martha Mahan, had previously complained to the facility that younger male residents had behaved
inappropriately towards Mrs. Rivera. Defendant took no action.
Early in the morning of November 9, 2013, Ms. Mahan went to visit her mother in the
nursing home. Ms. Rivera was distressed. Ms. Mahan noted broken glass on the floor of her
room. When she took her mother to the bathroom, Ms. Rivera attempted to urinate standing up,
which was unusual. Ms. Mahan also found a wad of bloody rags in Mrs. Rivera's trash can. Ms.
Mahan showed this evidence to nursing home employees, who destroyed it. Ultimately, Mrs.
Rivera was taken to St. David's Medical Center where a Sexual Assault Nurse Examiner (SANE)
performed a post-rape examination. This SANE nurse found bruising to posterior fourchette and
APPENDIX 3 376
periurethral areas of Mrs. Rivera's vulva as well as bruising on her posterior vaginal wall.
According to the SANE nurse, this definitively indicated penetration of the female sexual organ.
In general, Defendant's motion complains that Plaintiffs expert is not qualified to opine
that a nursing home should take reasonable steps to protect its residents from sexual assault and
failed in that responsibility to Ms. Rivera. This, of course, is just common sense.
II.
WHY DEFENDANT'S MOTION SHOULD BE DENIED
:::} Defendant's criticism ofDr. Lipson's qualifications is misplaced. Dr. Loren Lipson is one
of the most qualified experts in the nation in geriatric medicine and elder abuse. His
experience is broad and deep. His 44 page CV makes the point. In addition to his education
and teaching, he consults with numerous governmental agencies concerning the standard
of care for nursing homes, including elder abuse.
:::} Contrary to Defendant's straw man assertion, there is no need for an expert on
"gynecological illnesses." Ms. Rivera was raped while a resident in Defendant's facility.
Rape is not an illness. It is a physical, sexual assault. Dr. Lipson's report on the standard
of care for a nursing home to not let their residents be sexually assaulted, in light of the
facts contained in the Mrs. Rivera's medical records, witness statements, Defendant's
records and the unassailable statistical data concerning sexual assault in nursing homes, is
on point and remains unrefuted.
:::} Defendant's other criticism of Dr. Lipson's report is equally misplaced. It is axiomatic
that experts may rely on a patient's medical records for purposes of a Chapter 74 report.
Experts can even rely on the pleadings to support a Chapter 74 report. Defendant's
objections are really evidentiary and wholly inappropriate in connection with a Chapter 74
report.
:::} Defendant's criticism about the detail in the report- that it is "conclusory," is betrayed by
a simple reading of the report itself.
III.
DR. LOREN LIPSON- NATIONALLY PROMINENT PHYSICIAN,
PROFESSOR, LECTURER, CONSULTANT IN GERIATRIC MEDICINE,
ELDER ABUSE AND RELATED TOPICS
1. Plaintiff retained the services ofDr. Loren Lipson to evaluate and opine on the facts
of this case. Dr. Lipson's 7 page report and 44 page CV is attached as Exhibit 1.
Plaintiff's Response to Defendant's Motion to Dismiss Page2
377
A. Dr. Lipson- Educational Background in Geriatric Medicine
2. Dr. Lipson is a graduate of UCLA and The John Hopkins University School of
Medicine (See CV). Dr. Lipson did his internship and residency at The John Hopkins Hospital.
Dr. Lipson has fellowships from Harvard (Geriatric Medicine), Beth Israel Hospital
(Gerontology), Brigham-Women's Hospital (Gerontology), Hebrew Rehabilitation Center
(Geriatric Medicine) and John Hopkins (Clinical Fellow) among others (See CV).
B. Dr. Lipson - Certification in Geriatric Medicine
3. He is boarded in Internal Medicine and Quality Assurance and Utilization Review
and holds a Certificate of Expertise in Geriatric Medicine from the American Board of Internal
Medicine (See CV). Quality assurance is the study and implementation of improvements to care
provided, in Dr. Lipson's case, for the elder population in both the nursing home and hospital
setting (See CV).
C. Dr. Lipson- Twenty Seven Academic Appointments in Geriatric Medicine
4. Dr. Lipson has received twenty-seven academic appointments to include John
Hopkins, Harvard Medical School (Scholar Geriatric Medicine), Massachusetts General Hospital,
USC (Associate Professor-Geriatric Medicine), USC (Chief-Division of Geriatric Medicine),
Brigham-Women's Hospital (Geriatric Medicine), Beth Israel (Geriatric Medicine), USC
(Gerontology Research Institute) and University of Alaska (Geriatrics). His teaching
responsibilities include USC-Fellowship Program-Geriatric Medicine, USC-Development and
Improvement of Geriatric Medical Curriculum, USC-Steering Committee-Pacific Geriatric
Education Center, and USC-Ethel Percy Andrus Gerontology-Director and lecturer. His
Plaintiff's Response to Defendant's Motion to Dismiss Page3
378
teaching responsibilities at the University of Alaska also include Director-Care of Elderly, Co-
Director in Geriatric Education and Faculty Consultant to Geriatric residents.
D. Dr. Lipson - Geriatric Administrative Positions, Including Directorships
5. Dr. Lipson has further served innumerous administrative positions to include Chief
ofDivision Geriatric Medicine, Senior Staff Physician-Geriatric Programs, Director of the USC
Ambulatory Health Center Japanese Retirement Homes, Director-Geriatric Medicine VA Clinic,
Director of USC Teaching Nursing Home Program, Director of Senior Cancer Center, Director
of Senior Care Program-USC, Co-Director-Adult Protective Team-Geriatric Medicine
Program-LAC/USC, Medical Director-Alaska Geriatric Education Center and Medical
Director National Resource Center for Studies in Native American, Alaskans and Hawaiian
Elders, University of Alaska.
E. Dr. Lipson - Geriatric Consultancies: Boards, Program Development
6. His public service includes Consultant-Geriatric Medicine-State of Alaska,
Board of Directors, California Association ofMedical Directors, and Task Force on Elder Abuse,
City of Los Angeles.
7. Dr. Lipson's consultancies include Geriatric Medicine-Silverado Senior Living
Centers, Geriatric Medicine-Glendale Adventist Medical Center, Geriatric Program
Development-Bay Shores Medical Group, Geriatric Program Development-San Dimas
Community Hospital, Geriatric Program Development and Long Term Care-The Motion Picture
& Television Home, Long Term & Geriatric Medicine- State of California, Elder Abuse &
Geriatric Medicine - State of California, Office of the Attorney General, Long Term Care, Elder
Abuse and Geriatric Medicine-State of California-Office of the Attorney General - Medicaid
Fraud, Geriatric Medicine and Elder Abuse-State ofNew Mexico, Geriatric Medicine and Elder
Plaintiff's Response to Defendant's Motion to Dismiss Page4
379
Abuse-United States of America-Department of Justice, and Long Term Care, Geriatric Medicine
and Elder Abuse-United States of America-Department of Health and Human Services-Office of
the Inspector General (See CV).
F. Dr. Lipson's Lectures on Elder Abuse: Washington U; Harvard; Stanford; Yale;
Brown; Baylor, etc.
8. Dr. Lipson has lectured all over the country on issues involving geriatrics, long
term care, and elder abuse (See CV). The lectures include Washington University, Harvard, Yale,
the University of New Brunswick, the University of Florida, Stanford, University of Pittsburgh,
University of Hawaii, University of California San Francisco, Brown, University of Nevada,
University of Guam, Kansas University, Baylor, Chicago Medical College, University of
Oklahoma, University of Colorado, University of Kentucky, University of Utah, Southern Illinois
Medical School, Allegheny Medical School, University of Arizona as well as many others (CV).
9. Dr. Lipson has published numerous peer reviewed articles, book chapters and
monograms dealing with the care of the elderly (See CV).
10. In short, Dr. Lipson is a nationally prominent physician, professor, lecturer and
consultant in geriatric medicine, abuse of the elderly and related topics. Indeed, he may be the
most qualified expert in the country and the one the United States Department of Justice and the
United States Department of Health and Human Services retain when they are in need of this type
of expertise.
IV.
DR. LIPSON'S REPORT EXCEEDS CHAPTER 74's REQUIREMENTS
A. Dr. Lipson's Review of Pertinent Medical and Other Record
11. Dr. Lipson's report sets out in detail the information he reviewed in order to render
his opinions. They include:
Plaintiff's Response to Defendant's Motion to Dismiss PageS
380
a. The statement of the daughter Martha Mahan;
b. The Gracy Woods nursing home records;
c. The SANE nurse report;
d. The SANE nurse statement;
e. The St. David's Hospital records;
f. The guardianship records regarding Mrs. Rivera; and
g. The Texas Department of Aging and Disability Services Report.
B. Dr. Lipson Sets Out Facts Leading to Ms. Rivera's Rape
12. Dr. Lipson analyzes the facts leading up to the rape of Mrs. Rivera. Dr. Lipson
notes that several months before Mrs. Rivera's incident another complaint of sexual assault was
made in the same facility. He opines this should place the facility on heightened alert for this type
of problem.
13. Dr. Lipson reviews the citations issued by the State against the nursing home
including the failure to implement written policies and the failure to report the prior incident to the
proper law enforcement authorities.
14. Dr. Lipson then reviews the guardianship records of Mrs. Rivera, which place her
under the guardianship of her daughter, Martha Mahan. Judge Herman, based on medical exams,
found Mrs. Rivera was a "totally incapacitated person without capacity to care for herself." Dr.
Lipson opines this finding is consistent with the records from the nursing home.
C. Dr. Lipson Carefully Reviews Nursing Home Chart and Ms. Mahan's
Statement
15. Dr. Lipson then conducts a careful review of the nursing home chart to establish
the fact that Ms. Rivera had very poor short and long term memory problems and often did not
Plaintiff's Response to Defendant's Motion to Dismiss Page6
381
remember people or where her room was. Dr. Lipson goes on to opine that due to her significant
mental limitations, Mrs. Rivera required careful monitoring by the staff.
16. Dr. Lipson then reviews the statement of Martha Mahan, Mrs. Rivera's daughter
and guardian. Ms. Mahan's statement discussed parties on Friday afternoons where alcohol is
served to the residents. Ms. Mahan reports that certain male residents acted inappropriately
towards Mrs. Rivera and that this fact was reported to the management.
17. Dr. Lipson then reviews the facts surrounding the discovery of the broken glass,
bloody rags and distressed Mrs. Rivera. He then notes that an external head to toe exam was done
on Mrs. Rivera which found no exterior wounds. No vaginal exam was done.
18. Dr. Lipson then discusses the calling of the police and the examination done at St.
David's Hospital by SANE nurse Jenny Black. Dr. Lipson notes the injuries to both the posterior
and anterior portions of the vagina. He further reviewed the statement of the SANE nurse
indicating definitive "penetration of the female sexual organ".
D. Dr. Lipson Reviews Literature on Sexual Assaults in Texas
19. Dr. Lipson then cites literature for the disturbing fact that in the four years leading
up to Mrs. Rivera's assault nearly 400 sexual assaults were reported in Texas nursing homes. Dr.
Lipson further relates the fact that those who suffer from dementia are at particularly high risk for
this type of abuse as they are very poor historians.
20. Dr. Lipson then goes on to discuss how these assaults can be prevented. He notes
that these facilities all provide 24 hour skilled nursing care as required by law. This means the
facility must have skilled nurses as well as certified nursing aides on staff twenty-four hours a day
three hundred and sixty-five days a year.
Plaintiff's Response to Defendant's Motion to Dismiss Page 7
382
21. Dr. Lipson goes on to review the literature and reports that most of these assaults
occur at night and if a facility has a history of reported assaults they are at a greater risk for
additional incidents. He then reviews the history of reported assault, non-compliance and
management awareness of these issues. Dr. Lipson reviews the general knowledge within the
industry of these assaults and the press coverage regularly offered this issue.
E. Dr. Lipson - Ms. Rivera's Injury Foreseeable and Defendant Owed Duty to Ms.
Rivera
22. He then opines that with the significant number of assaults in Texas nursing
homes, the recent history of reported assault in Defendant's facility and the complaints of the
daughter Martha Mahan that it is foreseeable assaults would occur if precautions are not taken.
He then opines a nursing home owes a duty of protection to patients suffering from mental
incapacity. He then writes that such patients require enhanced supervision and additional staff
time to protect them from others. This is particularly true, he states, in a facility with a history of
reported assault and a history of family complaints of inappropriate behavior towards Ms. Rivera.
F. Dr. Lipson Sets Out Standard of Care
23. After pages of detail concerning the facts, the records and the foreseeability, Dr.
Lipson then sets out the standard of care.
a. The standard of care requires the nursing home provide twenty-four hour a day
skilled nursing care. The practical result of this requirement is that the staff must
be moving through the halls and the rooms of the residents all night long. There
should never be a time when a staff member is not in the next room or moving
through the halls next to a resident's room.
b. The standard of care requires that following the report of an assault at a nursing
facility that the facility control unsupervised access to the rooms of residents at risk.
The standard of care requires the facility take note of the families' concerns of
inappropriate behavior and eliminate access to the patient by unsupervised males.
Residents at risk include women with significant dementia such as Ms. Rivera. In
light of the family's expressed concern of inappropriate advances to Ms. Rivera,
Plaintiff's Response to Defendant's Motion to Dismiss Page8
383
the standard requires heightened scrutiny to include regular walks through the entire
hall at intervals not to exceed ten minutes to prevent access to her room by males.
The standard of care requires the nursing staff document the fact that it is
performing the regular checks in the patients' charts. In addition, the standard of
care requires Ms. Rivera be moved to a room in close proximity to the nursing
station following complaints of inappropriate contact with Ms. Rivera.
G. Dr. Lipson Identifies Breaches of Standard of Care
24. Dr. Lipson then set out the breaches of the standard of care.
a. The facility breached the standard of care by not providing twenty-four hour skilled
nursing care. The nursing staff was not present in the halls or her room to prevent
the sexual assault of Ms. Rivera.
b. The facility breached the standard of care by not preventing access to her room by
unsupervised males. The records do not indicate any checks on Ms. Rivera the
night she was assaulted. The facility breached the standard of care by not moving
Ms. Rivera to a room close to the nursing station where no unsupervised males
could enter her room.
H. Dr. Lipson Identifies the Harm to Ms. Mahan
25. Dr. Lipson then sets out the harm caused. The harm caused Ms. Rivera is
significant. She was sexually assaulted. The injuries to her vagina are well documented in the
SANE nurse report and above. The daughter reports she was tearful and afraid. This is a
common response in sexual assault victims. The daughter reports this behavior of fear continued
even after Ms. Rivera was removed from the facility. The fact she suffered from dementia does
not lessen the harmful mental effects of sexual assault. Even an animal can remember when it
has been abused. In many ways Ms. Rivera was like a small child - confused and afraid as a
result of this sexual assault. The history of problems together with the decision to ignore the
families' complaints and eliminate unsupervised males from Ms. Rivera's room indicates a
conscious disregard for the well-being of Ms. Rivera by the facility's management.
I. Dr. Lipson Eliminates Other Causes of Injury
Plaintiff's Response to Defendant's Motion to Dismiss Page9
384
26. Dr. Lipson then considers other potential causes of this injury. He considers
whether the injuries may be self-inflicted, but discards this idea after a chart review found no
indications of sexual self-stimulation or self-abuse. He further considered whether the family
might have caused these injuries but again discards this idea after a chart review indicates the
family was nothing but supportive. Dr. Lipson further notes Mrs. Rivera was in the nursing home
at all relevant times and there was no indication she was assaulted on the way to the hospital to
check to see if she had been sexually assaulted.
27. In short, Dr. Lipson explains the background facts, his review of the medical and
factual history, explains the problem with sexual assaults in nursing homes, explains the standard
of care, the breaches of the standard of care as well as the harm caused. His report explains the
Defendant's conduct called into question and provides detailed information for this Court to
determine the claims have merit.
v.
ARGUMENT AND AUTHORITIES
A. The Legal Standard for Qualifications and Reports
Defendant complains that Dr. Lipson is not qualified under TEX. CIV. PRAc. & REM. CODE
§74.402 (be a healthcare provider or consultant in "same field" as a defendant, knowledge of the
standard of care and qualified on basis of training or experience) and §74.403 (i.e., be a physician
and be otherwise qualified). Dr. Lipson's qualifications are unassailable.
Defendant also complains that Dr. Lipson's report does not provide it adequate notice
("good faith effort") under TEX. CIV. PRAc. & REM. CODE §74.351(1). Scoresby v. Santillan, 346
S.W.3d 546, 556 (Tex. 2011)(To qualify as a good faith effort, it must inform the defendant of the
Plaintiff's Response to Defendant's Motion to Dismiss Page 10
385
conduct called into question and provide a basis for the trial court to conclude the claims have
merit.). The Supreme Court's position on expert reports is well described.
"The expert report must represent only a good faith effort to provide a fair summary
of the expert's opinions. A report need not marshall all the plaintiffs proof, but it
must include the expert's opinion on each of the elements identified in the statute.
Am. Transitional Care Ctrs. OfTex., Inc. v. Palacios, 46 S.W.3d 873, 878.
Dr. Lipson's detailed report exceeds this standard.
A. Dr. Lipson Well-Qualified to Opine on Preventable Sexual Assault in Nursing Home
Defendant complains Dr. Lipson is not qualified to issue opinions about whether Ms.
Mahan suffered from a "gynecological illness." Rape is not a gynecological illness. It is an
assault. The assault has been copiously documented by the SANE nurse and a doctor and
reviewed by Dr. Lipson. The argument that Dr. Lipson cannot rely on other medical
professionals' records for his opinions strains credulity. That's like saying a surgeon couldn't
rely on a radiologist's reading of an MRI to provide the opinion that a patient had a brain tumor.
The Court's inquiry should focus on whether the expert has the "knowledge, skill, experience,
training or education regarding the specific issue before the Court which would qualify the expert
to opine on a particular subject." Tenet Hosp. Ltd. v. Love, 347 S.W.3d 743, 749-50 (Tex. App.
- El Paso 2011, no pet.)
The relevant issues addressed by Dr. Lipson are: what do the records say about Ms.
Mahan's assault; what is the standard of care with respect to the assault; did Defendant breach the
standard of care concerning the assault; and, was Ms. Mahan injured as a result of that breach. In
short, should this nursing home have prevented Ms. Rivera's sexual assault? Dr. Lipson is well-
qualified to render those opinions.
Plaintiff's Response to Defendant's Motion to Dismiss Page 11
386
1. Defendant's Straw Man Argument- Whether Sexual Assault Occurred
After setting up the straw man- that the required opinions should include whether a sexual
assault occurred at all - Defendant takes a swing at the medical records that establish the sexual
assault. Defendant misses. Defendant argues Dr. Lipson may not rely upon the SANE nurse
report or the medical records in this matter. Defendant cites TEX. CIV. PRAC. & REM. CoDE§
74.402 & § 74.403 and Texas Rules of Evidence 702 for this proposition. Defendant's reliance is
misplaced. §74.402(b)(3) and (c)(2) set out in relevant part:
(b)(3) (an expert may qualify if he) is qualified on the basis of training or
experience to offer an expert opinion regarding those accepted standards of health
care
(c)(2) is actively practicing health care in rendering health care services relevant to
the claim.
§ 74.403 deals with the qualification of a retained expert witness to render
opmwns. It sets out in part:
A person may qualify as an expert witness on the issue of causal
relationship between the alleged departure from the accepted standard of
care and the injury, harm or damages claimed only if the person is a
physician ...
This section does apply to Dr. Lipson. It does not apply to the medical records or
statements. Only Dr. Lipson addresses the issues of "causal relationships" and "departure from
the accepted standard of care". Expert witnesses must be able to rely upon the medical records to
render opinion. Expert witnesses may rely on witness statements. If one follows Defendant's
argument to its logical conclusion, experts could not rely on the nursing home chart (made mostly
by nurses), the medical records (made by nurses and treating doctors whose resumes are not
available). This is not the law in Texas. Defendant knows this because it cites a case for this
very proposition in a footnote of its motion. See Motion at 7 fn 3.
Plaintiff's Response to Defendant's Motion to Dismiss Page 12
387
Indeed, the Texas Supreme Court has expressly stated that expert reports would likely be
inadequate if they did not look at the medical records. Loaisiga v. Cerda, 379 S.W.3d 248, 261
(Tex. 2012). This is a case which involved the sexual assault of patients. The Supreme Court
also held in the same case that experts could rely upon the pleadings on file in the case to render
expert opinions. Id. A reading of the statute and the relevant case lawmake it clear that§ 74.402
and§ 74.403 do not apply to the underlying information reviewed by experts, such as the medical
records or SANE nurse examination. The Defendant's objection to the review ofthe statement of
Martha Mahan is unfounded for the same reason.
B. Dr. Lipson- Well-Qualified to Opine on Nursing Home Elder Abuse
Defendant has closely scrutinized the Plaintiff's report, but appears to have overlooked the
pages and pages of Dr. Lipson's CV setting out his experience teaching future nursing horne
directors at multiple Tier 1 universities and governmental entities. In Dr. Lipson's CV, there are
at least 9 references to lectures, courses and papers relating to "Elder Abuse." There are over 30
references to geriatrics, including fellowships at Harvard. There are multiple references to his
directorships over programs and facilities involving care for the elderly. His experience includes
consulting at nursing homes and governmental entities on the operation of nursing homes. He is
board certified in Quality Assurance. He has spent a many years learning, lecturing, writing and
testifying on nursing horne abuse issues.
v.
CONCLUSION
Over the course of its 16 page motion, Defendant strains mightily to copy and paste pages
of black letter law on Chapter 74 claims. This larding of citations attempts to serve as a
substitution for actual analysis of Dr. Lipson's report. Defendant ignores the details ofthe report,
Plaintiff's Response to Defendant's Motion to Dismiss Page 13
388
cherry-picking quotes to create a false sense that the report is conclusory and has otherwise failed
to make any meaningful criticism. The report from this nationally recognized physician is
detailed on the facts, causation and harm. Defendant knows exactly what the claims are against
it: A helpless old woman got raped in her room after alcohol was served on its premises, and after
being put on notice of inappropriate conduct towards Mr. Rivera. It should have never happened.
Plaintiff has met and exceeded the standard for expert qualifications and reports. Defendant's
motion should be denied in all things.
Respectfully Submitted,
MODESETTWILLIAMS, PLLC
515 Congress Avenue, Suite 1650
Austin, Texas 78701
512.472.6097- Telephone
512.481.0130- Telecopier
jack@jmodesettlaw.com
By:
J ck Modesett, III
1
/ t'exas Bar No. 14244337
VWalter V. Williams
Texas Bar No. 21584800
Plaintiff's Response to Defendant's Motion to Dismiss Page 14
389
CERTIFICATE OF SERVICE
I hereby do certify that in compliance with the provisions of Rule 21a, a true and correct
copy of the above and foregoing has been served via ProDocs electronic service on this day
of July, 2015 as follows:
Emily J. Davenport
Kemp Smith, LLP
816 Congress Avenue, Suite 1260
Austin, Texas 78701-2443
Emily.davenport@kempsmith.com
Plaintiff's Response to Defendant's Motion to Dismiss PagelS
390
2/20/2015 12:36:17 PM
Velva L. Price
District Clerk
Travis County
CAUSE NO. D-1-GN-14-005169 D-1-GN-14-005169
MARTHA MAHAN, AS THE § IN THE DISTRICT COURT
REPRESENTATIVE OF THE §
ESTATE OF MARY RIVERA §
§
v. § TRAVIS COUNTY, TEXAS
§
GRACY WOODS I NURSING HOME § 250TH JUDICIAL DISTRICT
DEFENDANT'S OBJECTIONS TO
PLAINTIFF'S EXPERT REPORT AND CURRICULUM VITAE
TO THE HONORABLE COURT:
NOW COMES Defendant Gracy Woods I Nursing Home, actually known as PM
Management- Austin NC, LLC d/b/a Gracy Woods Nursing Center, and files its Objections to
Plaintiff's Expert Report and Curriculum Vitae pursuant to TEX. Crv. PRAC. & REM. CODE
§74.351(a) and would respectfully show:
I.
This is a health care liability claim. On January 30, 2015, Plaintiff served the report and
curriculum vitae of Loren G. Lipson, M.D., in an attempt to comply with Section 74.351 of the
Texas Civil Practice and Remedies Code. True and correct copies of Dr. Lipson's report and
curriculum vitae are attached here to as Exhibits A and B, respectively, and incorporated herein
for all purposes.
II.
OBJECTIONS TO QUALIFICATIONS
Defendant objects to Dr. Lipson's report and curriculum vitae because Dr. Lipson has
failed to establish that he has any expertise to offer opinions that an alleged sexual assault
occurred. TEX. Crv. PRAC. & REM. CODE §74.403; TEX. R. EVID. 702; Broders v. Heise, 924
1
APPENDIX 4 101
S.W.2d 148, 152-54 (Tex. 1996). Neither Dr. Lipson's report nor his curriculum vitae indicates
that he has any education, training, skill or experience in the diagnosis or treatment of sexual
assault; the diagnosis or treatment of gynecological injury, conditions or disease; or
gynecological care or treatment of patients like Mary Rivera. Exhibits A and B. Broders, 924
S.W.2d at 152-54; Thomas v. Alford, 230 S.W.3d 853, 857 (Tex. App.-Houston [14th Dist.]
2007, no pet.); Pediatrix Med. Servs. Inc. v. De La 0, 368 S.W.3d 34, 39-40 (Tex.App.-El Paso
2012, no pet.); Cortez v. Tomas, 2012 WL 407382, at *3, 6 (Tex.App. -Fort Worth 2012, no
pet.). Dr. Lipson lacks the requisite expertise regarding the specific issue before the court that
would qualify him to offer the opinions asserted in his report. TEX. Crv. PRAC. & REM. CODE
§74.403; TEX. R. Evm. 702; Broders, 924 S.W.2d at 152-54.
III.
Defendant objects to Dr. Lipson's report to the extent it relies on the conclusions of non-
physicians. 1 Dr. Lipson relies on the observations and conclusions of Plaintiff and a registered
nurse, neither of whom is qualified to offer diagnoses or medical causation opinions. 2 Exhibit A.
TEX. Crv. PRAC. & REM. CODE §74.403(a) (limiting causation opinions to physicians otherwise
qualified according to TEX. R. Evm. 702); TEX. R. Evm. 702. Exhibits D, E. Dr. Lipson relies on
the statement of Jenny Black, R.N. Ms. Black is a registered nurse, not a licensed physician.
Exhibit E. Registered nurses are expressly prohibited from rendering medical diagnoses, and
they lack the medical expertise required to offer causation opinions. TEX. Occ. CODE
§301.002(2)( excluding "acts of medical diagnosis" from the definition of "professional
1
Defendant also respectfully objects to Exhibit 1 to Dr. Lipson's report to the extent Plaintiff or Dr. Lipson attempts
to rely upon the opinion of a non-physician for a medical causation opinion in a health care liability claim. TEX. CN.
PRAC. & REM. CODE §74.403(a); TEX. R. Evm. 702. A true and correct copy of the Order Appointing Permanent
Guardian is attached hereto as Exhibit C and incorporated herein for all purposes.
2
A true and correct copy of the Affidavit of Martha Mahan is attached hereto as Exhibit D and incorporated herein
for all purposes. A true and correct copy of the Statement of Jenny Black is attached hereto as Exhibit E and
incorporated herein for all purposes.
2
102
nursing"); TEX. Crv. PRAC. & REM. CODE §74.403(a); TEX. R. Evm. 702; Costello v. Christus
Santa Rosa Health Care, 141 S.W.3d 245, 248-49 (Tex.App. -San Antonio 2004, no
pet)(regarding nurses' lack of qualification to render medical opinions in expert reports); Jones v.
King, 255 S.W.3d 156, (Tex.App. -San Antonio 2008, pet. denied)(regarding application of the
four comers rule when an expert report attempts to rely on the opinions of a physician whose
qualifications were not established in the report).
IV.
Defendant further objects to Dr. Lipson's report because Dr. Lipson has failed to
establish that he has the requisite knowledge, training or experience in the operation,
management or supervision of nursing homes to offer the opinions on standard of care and
breach asserted in his report. TEX. Crv. PRAC. & REM. CODE §74.402; Reed v. Granbury Hasp.
Corp., 117 S.W.3d 404, 411-414 (Tex. App. - Ft. Worth 2003, no pet.)(a board certified
emergency medicine physician and neurologist with thirty years of experience treating stroke
patients not qualified to offer opinions on standards of care for hospital policy relating to
administration of stroke therapy); Shelton v. Sargent, 144 S.W.3d 113, 123 (Tex. App. - Ft.
Worth 2004, pet. denied). Dr. Lipson's conclusory statements about his alleged familiarity with
the standard of care do not establish that he has the knowledge, training or experience on the
specific issues in this case.
v.
OBJECTIONS TO THE REPORT
Defendant objects to Dr. Lipson's conclusion that "[t]he facility breached the standard of
care by not providing twenty-four hour skilled nursing care." Exhibit A, at 6. Dr. Lipson offers
no explanation or factual basis for his opinion. This conclusory statement does not put Defendant
3
103
on notice of the conduct complained of, nor does it constitute a good faith effort to comply with
TEX. Crv. PRAC. & REM. CODE §74.351.
VI.
Defendant objects to Dr. Lipson's conclusion that "[t]he nursing staff was not present in
the halls or her room to prevent the sexual assault of Ms. Rivera." Exhibit A, at 6. Dr. Lipson
offers no explanation or factual basis for his opinion. This is a mere conclusion, and it does not
constitute a good faith effort to comply with TEX. Crv. PRAC. & REM. CODE §74.351.
VII.
Defendant objects to Dr. Lipson's conclusion that "[t]he facility breached the standard of
care by not preventing access to her room by unsupervised males." Dr. Lipson offers no
explanation or factual basis for his opinion. This conclusory statement does not put Defendant on
notice of the conduct complained of, nor does it constitute a good faith effort to comply with
TEX. Crv. PRAC. & REM. CODE §74.351.
VIII.
Defendant objects to Dr. Lipson's conclusion that "[t]he facility breached the standard of
care by not moving Ms. Rivera to a room close to the nursing station where no unsupervised
males could enter her room." Dr. Lipson offers no explanation or factual basis for his opinion.
This conclusory statement does not put Defendant on notice of the conduct complained of, nor
does it constitute a good faith effort to comply with TEX. Crv. PRAC. & REM. CODE §74.351.
IX.
Defendant objects to Dr. Lipson's conclusion that Ms. Rivera was sexually assaulted. Dr.
Lipson offers no explanation or factual basis to support his conclusion that a sexual assault
occurred. Dr. Lipson offers no explanation or factual basis in support of his conclusion that the
4
104
alleged injury was due to sexual contact. Dr. Lipson offers no explanation or factual basis to
support his conclusion that the alleged assailant was male. Dr. Lipson's opinions are merely
speculative and, therefore, deficient. 3 Accordingly, Defendant objects to Dr. Lipson's report
because his statements regarding the alleged sexual assault are merely conclusory, do not put
Defendant on notice of the claim against it, do not give the trial court a reasonable basis to
conclude that this claim has merit, and do not constitute a good faith effort to comply with TEX.
Crv. PRAC. & REM. CODE §74.351. TEX. Crv. PRAC. & REM. CODE §74.351; American
Transitional Care Ctrs. v. Palacios, 46 S.W.3d 873, 878 (Tex. 2001).
X.
OBJECTIONS TO THE ATTACHMENTS TO THE REPORT
Defendant objects to the report, generally, to the extent it incorporates statements,
medical records and other attachments and would require the Court to draw inferences and fill
gaps in violation of the four comers rule. Exhibit A, C, D, E and F. Am. Transitional Care v.
Palacios, 46 S.W.3d 873, 878 (Tex. 2001).
XI.
Defendant objects to Ms. Black's statement or other documentation attached to and
referenced in Dr. Lipson's report to the extent Plaintiff asserts those items, individually,
constitute expert reports, which they do not. 4 Defendant reasserts its objections that Ms. Black
lacks the qualification to offer expert opinions regarding causation because she is not a licensed
physician. TEX. Crv. PRAC. & REM. CODE §74.403; TEX. R. EVID. 702. Defendant objects that no
curriculum vitae was provided with respect to Ms. Black. TEX. Crv. PRAC. & REM. CODE
3
In fact, it appears that Dr. Lipson failed to review all of Ms. Rivera's medical records.
4
Exhibit 3 to Dr. Lipson's report, documents bearing the names of Austin/Travis County and St. David's Medical
Center, are attached hereto as Exhibit F and incorporated herein for all purposes. Defendant attaches these
documents for the purpose of objecting to them pursuant to TEX. Crv. PRAC. & REM. CODE §74.351. Defendant
objects to the admissibility of these documents pursuant to TEX. R. Evm. 802.
5
105
§74.351, §74.402 and §74.403. Defendant objects that Ms. Black is not qualified to offer
standard of care or breach opinions relating to Defendant. TEX. Crv. PRAC. & REM. CODE
§74.402. Defendant further objects to Ms. Black's statement and all other documents authored by
Ms. Black that are attached to Dr. Lipson's report because they are conclusory and do not
provide the required explanation or factual bases to represent a good faith effort to comply with
Section 74.351. TEX. Crv. PRAC. & REM. CODE §74.351; Bowie Mem'l Hasp. v. Wright, 79
S.W.3d 48, 52-53 (Tex. 2002); Palacios, 46 S.W.3d 873, 878 (Tex. 2001).
XII.
Defendant objects to the Affidavit of Martha Mahan to the extent Plaintiff asserts that
Ms. Mahan's affidavit constitutes an expert report, which it does not. Plaintiff provided no
curriculum vitae. Plaintiff lacks the knowledge, skill, training, education or experience to offer
opinions regarding Defendant's standard of care, alleged breach or the alleged causal
relationship. TEX. Crv. PRAC. & REM. CODE §74.351, §74.402 and §74.403. Defendant further
objects to the Affidavit of Martha Mahan because it is conclusory, speculative, and does not
constitute a good faith effort to comply with TEX. Crv. PRAC. & REM. CODE §74.351.
XIII.
Defendant objects to the records attached to Dr. Lipson's report as Exhibit 3 because they
do not constitute an expert report. TEX. Crv. PRAC. & REM. CODE §74.351. Defendant objects that
no curricula vitae of the records' authors were produced. Defendant objects that the authors of
the records attached as Exhibit 3 to Dr. Lipson's report are not qualified to offer opinions
regarding Defendant's standard of care, alleged breach or the alleged causal relationship. TEX.
Crv. PRAC. & REM. CODE §74.351, §74.402 and §74.403. Defendant further objects to the records
attached to Dr. Lipson's report as Exhibit 3 because the opinions contained therein, if any, are
6
106
conclusory and do not constitute a good faith effort to comply with TEX. Crv. PRAC. & REM.
CODE §74.351.
WHEREFORE, Defendant Gracy Woods I Nursing Home, actually known as PM
Management - Austin NC, LLC d/b/a Gracy Woods Nursing Center, respectfully requests that
its Objections be sustained and that it be granted such further relief to which it may show itself
justly entitled.
Respectfully submitted,
KEMP SMITH LLP
816 Congress Avenue, Suite 1260
Austin, Texas 78701-2443
512-320-5466
512-320-5431 (facsimile)
emily.davenport@kempsmith.com
By: /s/ Emily J. Davenport
Emily J. Davenport
State Bar No. 24012501
ATTORNEYSFORDEFENDANT
GRACY WOODS I NURSING HOME
A/KIA PM MANAGEMENT - AUSTIN NC,
LLC D/B/A GRACY WOODS NURSING
CENTER
7
107
CERTIFICATE OF SERVICE
I hereby certify that a true and correct copy of the foregoing document has been served in
accordance with TRCP 21a on the 20th day of February, 2015 to the following:
Jack Modesett III
Walter V. Williams
ModesettWilliams, PLLC
2202 Lake Austin Blvd.
Austin, TX 78703
j ack@jmodesettlaw.com
/s/ Emily J. Davenport
Emily J. Davenport
8
108
DECLARATION OF LOREN G. LIPSON, M.D.
I, Loren G. Lipson, M.D., declare as follows:
I am a licensed physician in the State of California. I am Board-Certified in Internal
Medicine, as well as in Quality Assurance and Utilization Review. I have been board certified in
Geriatric Medicine.
My curriculum vitae, attached hereto as Exhibit 1 accurately reflects my education, training
and experience as a Medical Doctor, Professor Emeritus of Medicine at the Keck School of
Medicine at the University of Southern California, Los Angeles, California, Affiliate Professor in
the Biomedical WWAMI Program, College of Arts and Sciences, and Affiliate Professor at the
College of Health and Social Welfare both at the University of Alaska Anchorage. I am the
former chief of the section of Geriatric Medicine and Associate Professor of Medicine,
Gerontology, Clinical Pharmacy, Medical Dentistry and Public Health, and Occupational Science
and Occupational Therapy, all at the University of Southern California where I have been on the
faculty for over 29 years.
In addition, I am a consultant to the Department of Justice United States and the States of
California and New Mexico, and the Office ofthe Inspector General, U.S. Department of Health
and Human Services in areas of geriatric care and elder abuse. I have served as a Consultant to
the Departments of Administration, Health and Social Services and Law, State of Alaska, in the
areas of geriatric medicine and long term care. I also have been the Physician Advisor to USC
University Hospital in areas of utilization management and quality assurance.
I have extensive personal experience in primary medical care as well as subspecialty
consultation and long-term care. I personally have provided care for patients in addition to my
academic teaching, research and administrative responsibilities. My background is more fully
DECLARATION OF LOREN G. LIPSON, M.D. PAGE 1
APPENDIX 5 15
described in my curriculum vitae attached hereto as Exhibit A.
I am familiar with the problem of sexual assault in the nursing home setting. I am familiar
with the standard of care for preventing such assaults.
I continue to treat patients in the long term care setting and have done so for more than
thirty years. I am familiar with the standard of care for the treatment of patients like Mary Rivera
and familiar with the required training of employees providing care to residents like Mary Rivera.
I have reviewed the following records. They formulate a basis for my opinions in this
matter.
1. The statement of the daughter, Martha Mahan;
2. The Gracy Woods I records;
3. The SANE Nurse Report;
4. The SANE Nurse Statement
5. The St. David's Hospital Records
6. The guardianship records regarding Ms. Rivera; and
7. Texas Department of Aging and Disability Services' Reports.
The nursing home had a complaint of a sexual assault of a resident several months before
the assault of Ms. Rivera. This report should place the facility on a heightened alert for this
problem. The facility was cited by DADS for:
1. Failing to implement written policies that protect against this activity; and
2. Failing to report the incident to law enforcement.
On June 20, 2013, Ms. Mary Rivera was placed under the guardianship of her daughter,
Martha Mahan, by Judge Guy Herman. Judge Herman determined that Mary Rivera was a
"totally incapacitated person without capacity to care for herself." (Ex. 1)
DECLARATION OF LOREN G. LIPSON, M.D. PAGE2
16
The findings of Judge Herman are consistent with the records from Gracy Woods I, (the
nursing home) where Ms. Rivera was a long term resident.
When Ms. Rivera admitted to the nursing home she carried a diagnosis of dementia. A
review of the nursing home chart indicates that Ms. Rivera's short- and long-term memory
declined over the time of her residency. The chart indicated she frequently did not know the
location ofher room, the season of the year or recognize staff members. This is confirmed in the
appointment of her guardian when Judge Herman finds Ms. Rivera as "totally incapacitated" due
to mental as well as physical limitations.
The nursing home chart describes an individual who, while able to ambulate, clearly
required careful monitoring due to significant mental limitations. The nursing home chart further
indicates Ms. Rivera suffered from depression secondary to the diagnosis of dementia as well as
due to her admission to the nursing home, an admission she likely did not fully understand.
The daughter of Ms. Rivera describes in her statement alcohol parties that the nursing home
had on Friday afternoons. (Ex. 2) She states that another male resident would inappropriately
touch or speak to Ms. Rivera. (Ex. 2) The daughter reported this concern to the management of
the nursing home. The nurses caring for Ms. Rivera were aware of this behavior. (Ex. 2)
Early on November 9, 2013, a Saturday morning, the daughter visited her mother at the
nursing home. She found her more confused than usual and crying. The daughter also found
broken Christmas ornaments on the floor. She took her mom to the bathroom, and she appeared
to be in pain. Ms. Rivera urinated standing up, which was unusual. After she put her mom back
to bed, the daughter used the restroom herself. When she was discarding a paper towel she noted
there was a pile of bloody rags in the trash.
DECLARATION OF LOREN G. LIPSON, M.D. PAGE3
17
Concerned that her mother had fallen, she took the rags to the charge nurse, Wendy, who
did a head-to-toe skin examination. The nursing home records confirm that no open wounds were
found. The daughter ultimately took her mother to the hospital where they found bruising to her
back. No vaginal exam was done at that time.
The daughter reports Ms. Rivera continued to act like she was afraid. She noted bleeding
from her mother's vagina. The daughter began to suspect sexual assault. The police were
notified.
Ms. Rivera was taken to St. David's Hospital. An examination was done by a Sexual
Assault Nurse Examiner (SANE Nurse). The SANE nurse told Ms. Rivera that her mother had
suffered vaginal trauma. The SANE nurse exam specifically found trauma to the posterior
fourchette/fossa navicularis as well as trauma to the periurethral area of the vagina. (Ex. 3) In
other words, she found bruising to both the front of the vagina as well as the posterior of the vaginal
wall. (Ex. 3) The statement of the SANE nurse indicates the findings "definitively indicate
penetration of the female sexual organ." (Ex. 4) As referenced above, Ms. Rivera was
incompetent. In other words, she was sexually assaulted as she is unable to give consent to sexual
contact.
Sexual assault in the nursing home environment is a very serious problem. In the four
years leading up to this assault, nearly four hundred sexual assaults were reported in Texas nursing
homes. At high risk are seniors such as Ms. Rivera who suffer from dementia. They are poor
historians due to their illness and many suffer from impaired communication skills. As such they
are extremely vulnerable.
The good news is that, if the nursing home takes a few simple steps, the assaults can be
prevented. Facilities such as this nursing home are 24 hour skilled nursing facilities. This means
DECLARATION OF LOREN G. LIPSON, M.D. PAGE4
18
they are required by law to have skilled nursing staff as well as certified nurses' aides on duty and
providing care to the residents twenty-four hours a day, seven days a week, three hundred and
sixty five days a year. The nursing home in question has one hundred and eighteen beds in the
entire facility. These types of assaults, according to most reports in the literature, occur at night.
The literature indicates that facilities with a history of abuse and noncompliance are more
likely to have future incidents of abuse. This nursing facility has a history of reported abuse and
sexual abuse and was cited by the state for several indications of neglect leading up to the assault
of Ms. Rivera. The nursing home management and owners are aware of this history of abuse and
are obligated to take steps to prevent future abuse. Everyone in the nursing home business is
aware of the problem of sexual assault. It is well discussed in the literature and the press. Given
the history of problems in the facility and the complaints of the daughter, it is foreseeable assaults
like this would occur without the proper precautions.
This nursing home owes a duty of protection to patients suffering from mental incapacity
due to decreased cognitive abilities. This duty includes monitoring the physical and mental
conditions of the patients and meeting the fundamental care needs of the residents. Nursing
homes are required to assess each resident's needs and capabilities. Some residents, like Ms.
Rivera, require enhanced supervision and additional staff to protect them from others. The
nursing home must take reasonable precautions to protect Ms. Rivera from the foreseeable
consequences of her impairment including sexual assault. This is particularly true when there is
a previously reported assault and the patient's family has voiced concerns of inappropriate
behavior towards their mother.
DECLARATION OF LOREN G. LIPSON, M.D. PAGES
19
STANDARDS OF CARE
1. The standard of care requires the nursing home provide twenty-four hour a day
skilled nursing care. The practical result of this requirement is that the staff must
be moving through the halls and the rooms of the residents all night long. There
should never be a time when a staff member is not in the next room or moving
through the halls next to a resident's room.
2. The standard of care requires that following the report of an assault at a nursing
facility that the facility control unsupervised access to the rooms of residents at risk.
The standard of care requires the facility take note of the families' concerns of
inappropriate behavior and eliminate access to the patient by unsupervised males.
Residents at risk include women with significant dementia such as Ms. Rivera. In
light of the families expressed concern of inappropriate advances to Ms. Rivera, the
standard requires heightened scrutiny to include regular walks through the entire
hall at intervals not to exceed ten minutes to prevent access to her room by males.
The standard of care requires the nursing staff document the fact that it is
performing the regular checks in the patients' charts. In addition, the standard of
care requires Ms. Rivera be moved to a room in close proximity to the nursing
station following complaints of inappropriate contact with Ms. Rivera.
BREACH OF STANDARD OF CARE
1. The facility breached the standard of care by not providing twenty-four hour skilled
nursing care. The nursing staff was not present in the halls or her room to prevent
the sexual assault of Ms. Rivera.
2. The facility breached the standard of care by not preventing access to her room by
unsupervised males. The records do not indicate any checks on Ms. Rivera the
night she was assaulted. The facility breached the standard of care by not moving
Ms. Rivera to a room close to the nursing station where no unsupervised males
could enter her room.
HARM
The harm caused Ms. Rivera is significant. She was sexually assaulted. The injuries to
her vagina are well documented in the SANE nurse report and above. The daughter reports she
was tearful and afraid. This is a common response in sexual assault victims. The daughter
reports this behavior of fear continued even after Ms. Rivera was removed from the facility. The
fact she suffered from dementia does not lessen the harmful mental effects of sexual assault. Even
DECLARATION OF LOREN G. LIPSON, M.D. PAGE6
20
an animal can remember when it has been abused. In many ways Ms. Rivera was like a small
child - confused and afraid as a result of this sexual assault. The history of problems together
with the decision to ignore the families' complaints and eliminate unsupervised males from Ms.
Rivera's room indicates a conscious disregard for the well-being of Ms. Rivera by the facility's
management.
I have considered other causes of this injury. I considered if the vaginal injuries were self-
inflicted. There is no evidence in Ms. Rivera's chart to indicate she engaged in either sexual self-
stimulation or self-abuse. I considered the injury may have been inflicted by someone outside the
facility or even a family member. There is no evidence to support this approach. There is no
record the family was anything other than supportive. The timeline in the chart indicates she was
the facility at all relevant times save during transfer to the hospital. There is no evidence anyone
sexually assaulted her when she was being transferred to the hospital to have her examined for
InJuries.
DECLARATION OF LOREN G. LIPSON, M.D. PAGE7
21
I declare under the penalty of perjury under the laws of the State of California that the
foregoing is true and cotteot.
Executed this R~oy of~ , 2015.
~
I
II
DECLARATION OF LOREN G. UPSON, M.D. PAGES
22
CURRICULUM VITAE
JLoren G. Lipson~ M.D.
August 1, 2009
A. :lle.I·sonallnfol'lllation
L Nrurie; Loren G. Lipson, M.D.
2. Titles! Professor Emeritns of Medicine at the Keele School
of Medicine of the University of Southe.m
California, Los Angeles, Califonrla; and AffiJiate
Professor~ Biomedical WWA'M1 Program, College
of Atts and Sciences, and Affiliate Professor,
College of Health and Social Welfare at the
University of Alaska Anchorage.
3. Mailing Address: P.O.BoxJ
South Pasadena, California 91031
4. Business Telephone: 626-403-0169
5. Fax: 626-403~0165
6. Pager! 800-209-2380 (Nume1io Only)
B. Education.
1. High School- Birmingham Bigh School, Van Nuys, California.
Graduated, June 1961.
2. University- U.C.L.A.: B.S. in Chemistry with a minor in Math
and English.
(Summa Cmn. Laude) 1 June 1965.
3. Medical School - The Johns Hopkins University Schqol of
Medicin(;}, Baltimore. Maryland: M.D., June 1969
4. Internship- The Johns Hopldns Hospifu11 Osler Medical Service~
1969-1970.
5. Residency The Joh11s Hopkins Hospital) Osler Medical Service~
H
1970-1971
"ld. ~~ '
APPENDIX 6 24
6. Fellowships:
a. TI1e Johns Hopkins University School of Medicine~
Baltimore, Maryland: Clinical Fellow in Medi USC~ Los Angeles, California: Senior Research
Associate. 1985-1989.
7. Honors and Award
TI '
... & • ..
25
1965 Phi Beta Kappa; Recipient of Merck Award
I
in Chemistry;
i Outstanding Underg1•aduate in Chemistry
!·
Award of Phi Lambda Upsilon; Medal for
Soholarshlp of the American Institute of
Chemists; The Ramsey Prize in Physical
Chemistry; Sigma XI-
All at U.C.L.A.
1968-1969 . Heruy Strong Denison Scholarship for
Research. in Medicine, The Johns Hopkins
University School of Medicine.
1975 -1977 National Research Service Award in
Diabetes (NIAMDD), National Institutes of
Health.
1975-1978 Daland ·FelLowship in Clinical Medicine,
American Philosophical Society.
1977 -·1978 Clinical Investigator Award in Diabetes,
NIAMDD, National Institutes ofHealth.
1984-1985 John A. Hartfo1·d Seniot Scholat· Award in
Geriatric Medicine, Division of Aging,
Harvard. Medical School.
1989 The Genesis Awru:d, For Innovative Health
Care Delive1y, Los Angeles Bush1ess
Journal.
1989 Professional Leadership Progxam Award,
Volunteer Center of Los Angeles.
1999 One of Top 20 Physicians in the G1'eater Los
Angeles Atea (and only Gerlatl'ician
named), Los Aflgeles Business Joumal.
2000 One of Top Primary~Care Physicians in the
U.S.~
Tow.n an.d Country Magazine.
2002 One of Top Ten Physicians in Los Angeles,
Ametica.-On-Line.
8. Licensure: California.
.. , . ; ~ . ..
26
9. Boards: American Board oflnternal Medicine, 1974.
Am.edcan Boatd of Quality Assurance ru.td Utilization Revlew
Physicians, 1995
Certificate of Expertise in Geriatric Medicine, American Board of
Internal Medicine, 1996
C. Professional Baclcground
l. Academic Appointments
a. The Jolms Hopkins University School of Medicine~ Baltimore,
Maryland; Clinical Fellow in Medicine, 1969"1971.
b. Massachusetts General Hospital7 Boston, Massachusetts; Clinical
and Research Fellow in Medicine (Endocrinology !ll1d
Metabolism), 1973"1976.
c. Harvard Medical School, Boston, Massachusetts; Clinical and
Research Fellow in Medioitte (Eltdoctinology and Metabolism),
1973H1975,
d. Harvard Medical School, Boston. Massachusetts; fustructor in
Medioine (Diabetes), 1975"1978.
e. Massachusetts General Hospital1 Boston1 Massachusetts; Clinical
Assistant in Medicine (Diabetes Unit), 1976-1978.
University of Southern California School of Medicine; Los
Angeles, Califonrla; Assistant Professor of Medicine (Diabetes
Division)~ 197 8~ 1981.
g, University of Southern California School of Medicine~ Los
Angelesj California; Assistant Professor of M~.dicine. with tenure
(Division of Diabetes and Clinical Nutrition); 1981 - January
1984.
h. Los Angeles County/University of Southem Califomia Medical
Center, Los Angeles. Califomia~ Staff Physician 1:n Medicine
(Diabetes Service), 1978 ~January 1984
i. University of Southern California School of Medicine, Los
Angeles, California; Associate Professor of Medicine (Division of
Geriatric Medicine), January 1984- September 2006.
4
... 4 ~
... J •
27
j. Univel'Sity of Southern California Schbol of Medicine, Los
Angeles, California; Chief, Division of Geriatric Medicine in the
Department of Medicine.~ January 19&4- 2005.
k. University of Southern Califotnhb Los Angeles, California;
Associate Professor of Gerontology, Leonard Davis School of
Gerontology, Ethel Percy Andrus Gerontology Center, January
1984- September 2006.
1. University of Southern Califomia1 Los Angeles, · California;
Associate P1'ofessor of Clinical Pharmacy, U.S.C. School of
Pharmacy, October 1989 ~ September 2006.
m. Los Angeles County/University of Southe.rn California Medical
Center~ Los Angeles, California; Staff Physician in Medicine,
(Geriattic Medicine), 1984~2004.
u. Sabbatical Leave, Harvard Medical School, Boston,
Massachusetts; Division of Aging~ John A. Hartford Senior
ScholarinGeriatdcMedicine~ 1984-1985.
o. Brigham & Women's Hospital, Boston> Massachusetts; Clinical
Fellow in Medicine (Geriatric Medicine), 1984 ·1985.
p. Beth Israel Hospital, Boston, Massachusetts; Clinical Fellow in
Medicine (Geriatric Medicine), 1984-1985
q. University of Southern California, Los Angeles~ California; Senior
Research Associate~ Getontology Research Institute, Ethel Percy
Andrus Gerontology Center, 1985- 1989.
r. University of Southern Callfomi~ Los Angeles) California; Fellow
Institute of Advance Study, Ethel Percy And1us Gerontology
Center, 1985 -1987.
s. University of Southern California University Hospital, Los
Angeles~ California; Chief of Geriatric Medicine, 1991~ 2005
t. University of Southern California ~ School of Dentisb:y
Associate Professor of Medical Dentistry and Public Health, l994
i
- September 2006.
u. Uni-versity of Sottthem California- School ofindependent Health
_Pl'ofessionals - Associate Professor of Occupational Science and
Occupational 'Therapy, 1998- S~ptember 2006.
I
'I
I
f
t
5 j I
~~~~·--·--~-~ --- -1. ·-·+
!
l
~ .. ~A •
I
28 I
v. University of Alaska, Anchorage~ Adju11ct Associate Professor of
Human Biology, 2001- September 2006,
w. Unive.r:sity of Alaska Southeast, Sitka ~· Adjunct Associate
Professor of Human Studies, 2001 ~ 2006.
x, University of Alaska, Attchomge, Affiliate Professor, College of
Health and Social Welfare, 2006- Present.
y, University of Alaska Anchorage, Afftliate Professo:t•, Biomedical
W\VAMI Program, College of Arts and Sciences, 2006- Present.
z. University of Alaska~ Anchorage~ Faculty Consultant in Geriatdcs,
Alaska Family Medical Residency, September 2006- Present.
aa. Univel'sity of Southern California, Keck School of Medicine,
Professor Emeritus of Medicine, September 2006 -Present.
2A. Teaching Responsibilities (University of Southern California) ·
a. Attenditl.g Staff :Physician LAC/USC Medical Centel' o1t the General
Medical Service- teaching and supervising patient care1 both inpatient
and outpatient to house staff and students 1985 - 2004.
b. Attending Staff Physician at USC University Hospital in Geriatric
Medicine for Medical House Staff and students. 1991-2005.
c. Xn charge of the Fellowship Program - Geriatric Medicine. 1985 -
2004.
d. Development and improvement of Geriatric Medical Curriculum ill the . ,,
Medical School- Univ~t·sity of Southem California. 1985-2004
e. Development of Oel'iatdc Medical Core Curriculum for the Medical
House Staff- LAC/USC Medical Center, 1985-2004
f. Member of Steering Committee~ Key Faculty and Study Site
Cootdi11ator - Pacific Geriatric Education Center at the University of
Southern California (DHHS), 1984-1993.
g. Attending Physician Year III Medicine Rotation, 1992.
h. Dit:eotor and lecturer in various courses at the Eth6l Pel'cy Andrus
Gerontology Center including Gerontology 599 - Geriatric Health
Issues.
6 .. --~--~·-~---·--. -- -· ·--- ------· ----'--------:-~--:-----;--:-~-'-;-------,
'"{j. ·q. ., l .
29
i. Director- Geriatrics Update- A Board Review Course.
j. Director - History of Medicine in the Healtll Sciences Program, 1994
-200L
2B. · Teaching Responsibilities (University of Alaska)
a. Director- Care of the Elderly Conference,
University of Alaska, Southeast- Sitka>
1994- Present
b. Instructor - Promoting Best Practices in Aging, University of
Alaska, Anchorage,
2006- Present
c. Co~Director - University of Washington Medical School 596-
Human Biology - Course for Alaskan Students.- Multi"
Disciplinary and Ethnicity in Gerontology and Geriatdcs,
(Univetsity of Alaska, Anchol'age- Spring and Fall, 2009 and then
yeat'ly).
d. Co~Director in Geriatric Education to Alaskan Medical Stgdentll in
the University of Washington Medical School WW AMI Progt·am,
Ulliversity of Alaska, Anchorage, 2006- Present
e. Faculty consultant in Geriatrics to Residents of the Alaska :Family
Medicine Residency Program. 2006- Present.
3. Administrative Responsibilities
a. Chief of the Division of Geriatric Medicine. Department of Medicine,
University of Southern Califom1a School of MG:e:Iicine, In charge of
staff arid feliow recruitment and training; divisional budge;'lt; gtatlt
procurement; progrw:u development and supervision of research and
clinical activity. 1984- 2005.
b. Study Site Coordinator and Key Faculty .of the Pacific Geriatrlc
Educatio.tl Center, University of Southern California School of
Medicine, 1984-1993.
c. Senior Staff Physician in charge of Geriatric Programs at Los Angeles
County/University of Southern California Medical Center, 1985 -
2004.
d. Chief of Geriatric Medicine at the USC University Hospital~ 1991 -
2004.
-·-1 :
'
~----~---·-~-
!
'
... -~ .. ~ . 11 ' -l.l. I
i
30
e. Faculty liaison between Geriatric Medicine and University flffiliated
hospitals and long term care :fucillties. Director of Geriatric Medicine
Priv1l.te Practice Plan. 1984 ~ 2004
f. Director of the USC Ambulatory Health Center sites at the Japanese
Retil'emen.t Homes and Angelus Plaza, 1985- 1993.
g. Dit·ectot of the Division of Geriatric Medicine's Program at the V.A.
Outpatie1lt Clinic in downtown Los Angeles, 1986- 2001.
h. Director of the USC Teaching Nursing Home Program at Hollenbeck
:Home and. Atherton Baptist Home, 1999-2005.
i; Dh·ector of the Senior Cancer Center at Norris Comprehensive Cancer
Centel' and Hospital, 1999 - 200 1.
j. Dh-ector of the Senior Cal.'e Program- USC Care and USC Physicians.
199& -2002,•.
k. Co~Director- Adult :Protective Team - Oerlatd.c Medicine Program -
LAC/USC Medical Center, 2000 - 2004.
1. Director - Cate of the Elderly Conference) University of Alaska
Southeast~ Sitka, 1994- Present.
m. Co~Director - Geriatrio Education for Alaskan Medica[ Stndents in the
WWAMI Program1 University of Alaska1 Anchorage. 2006- Present,
n. Medical Directo1·- Alaska Geriatdo Education Center, University of
Alaska, Anchorage. 2005 -Present.
o. Medical Director- National Resource Centel' for Studies in Native
American~ Alaskan, and Hawaiian Elders, University of Alaska,
Anchorage, 2006 ~Present
4. Service
A. University Service
a. Medical Executive Cotll.lllittee, Department of Medicine, USC 1985-
2003.
b. Utilization Management Committee) USC University Hospital, 1991-
1999, 2003- Present, Chairman of this Co:mmittee, 1994 ~ 1999.
a • "6 • "'4 • ·u.
31
c. Phru:maoy and Therapeutics Committee, LAC/USC Medical Center1
200[- 2004.
d. Pharmacy and Therapeutics Conunittee1 USC University Hospital,
1991 - 2005, Chairman, 1996- 2000.
e. Patient Care Evaluation Committee, USC University Hospiial, 1994-
1999.
f. Lecturer in School of Pharmacy, University of Southern Californhi.,
1985 ~2004.
g. Continuing Medical Post~Graduate Edt.tcation Lectures at outlying
hospitals~ 1919-2004.
h. Core Ctu'l'icl.llum. Conunittee for the New Medical School Oluiculum,
USC School of Medicine, 1998 ~ 2002
L County Operations Committee, Department of Medicine, LAC/USC
Medical Center, 1997- 2000
j. Development Cotnmittee, Departm.ent of Medicine, LAC/USC
Medical Center, 1997- 2000.
k. Senior Health Care Program, USC Care, (chair/member), USC 199&-
2002.
L Executive Co:nunittee, USC Norris Comprehensive Cancer Center and
Hospital- Senior Cancer Care Center, 1998 - 200L
m. Co~Director - Adult Protective Team ~ Geriatric Medicine Program-
LACJ{]SC Medical Center~ 2000- 2004.
B. Public Service
a. Consultant in Geriatric Medicine and Long Term Care; State of
Alaska. Depru.'tm.ents of Administration Law, Health and Social Services,
1991 -·2004
b. Consultant in Gerontology and Geriatric Medicine, UniveJ:sity of
Alaska, both at the Anchorage and Sitka campuses~ 1994- present.
c. Board of Directors, California Association of Medical Directors, 1992-
~~ 1999.
32
d, Citizen's Oversight Committee-- California Stem Cell Research &
Cures Act, 2007- Present.
e. Board of Directors, USC Friends ofMusic} 1989-1997.
f. Task Fotce on Elder Abuse, City of Los Angeles, 2001 -2004-.
g. Califomia Rare Fruit Growers, 198 8 - Present.
h. Pennsylvania Horticulture Society, 1992-2007.
i. Affenpinscher Club of Amedca, 2002 ~Present.
j. Kennel Club ofPasadena, 2004-2007.
5, Military Service
1971 ~-1973 Active duty as Surgeon - U.S.F.B.S. serving as Research
Associate (Protein Chemisuy) in the Laboratory of Chemical Biology with
Dr. Robert Goldberger and Dr. Christian Anfmse~ NIAMDD, NIH:
Inactive Resorvc U.S.P.lLS. 1969-1971, 1973- 1979.
6. Other Activities
~
a. Editor for ENDOCRlNOLOGY for Diabetes and Intermediary
Metabolism~ 1985- 1986. I
I
b. Member of the Committee of Interdisciplinary Geriatdc Education,
Association for Ge1·ontology In Highet Education, 2002 -2006.
c. Reviewer for: · AMERJCAN JOURNAL OF l?HYStOLOGY
ANNALS OF INTERNAL MEDICINE
I I
ARCHIVES OF INTERNAL MEDICINE I
BIOCHEMICAL MEDICINE
DIABETES
ENDOCRINILOGY
EXPERIMENTAL GERONTOLOGY
I l
JOURNAL OF CLINICAL ENDOCRINOLOGY
AND METABOLISM
I
JOURNAL OF GERONTOLOGY I
HORMONE AND METABOLISM RESEARCH
JOURNAL OF THE AMERICAN GERIATRICS
SOCffiTY
DRUGS AND AGING
I
j
i
;
l
NEW ENGLAND JOURNAL OF MEDICINE
I
I
~
clO · ·-· ·.-- ---·------·· ·· -- -.---~---~ - ~
--t~~
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D. S()ciety Membe.i•ships
1. Local
Cross Town Endocrine Club
Professional Staff Association of LAC/USC Medical Center
Center Fellow of the UCLMJSC Long Tenn Care Gerontology
Center
Far Eastern Study Centel' USC/UCLA
California ~ssocia.tion of Medical Directors
2. Regional
We.'ltern Society for Clinical Investigation
Western Section of the Amedcan Federation for Clinical Research
3. Nai"ional
Sigma Xi, Phi Beta Kappa, Phi Lam.bda Upsilo11
The Johns Hopldns Medical an.d Surgical Society
The Johns Hopkins flistoty ofMedic1ne Club
The Associates of the Countway Library
The American Association for the History of Medicine
American Federation fot Clinical Research
Amerioan.Diabetes Assocration
The Endocrine Society
American Physiological Society
The Gerontological Society of A1tl.edca
The American Geriatric Society
The American Federation for Aging Research
Atnerican Gerontological Association
American Association of Medical Directors ,;:::.,.,,.
E, Consulta.llltships and Directorships
1. Consultant in Geriatric Medicine and Supewisot of the Oerlatl.'ic Progre.m
at the Veterans Administration Outpatient Clinic in downtown Los
Angeles, 1986-2001.
2. Executive Director of the USC Ambulatoty Health Center at Angelus
Plaza, 1989- 1993. .
3. Board of Diteotors, California Association of Medical Directors, 1992 -
1999.
4. Board of Director, USC friends ofMusic, 1989-1997.
... , .
34
5. Consultant in Geriatric Medicine and Long Term Care- State of Alaska
1991-2004;
a, Department of Administration
b, Department of Health and Social Services
c, Department of Law
d. Mental Health Board
6. Appointments in Gedatdos- University of Alaska:
a. Sitka
I. Adjunct Associate Professor of Human Studies, 2003~
2006.
IL Course Director - Care of the Bldel'ly Conference> 1994
Present
b. Anchorage ·
I. Affiliate Ptofessm~ College of Arts and Sciences,
Biomedical WWAMI FrogramJ 2006 ~Present
II. Consultant1 Co~Founder and Medical Director - Alaska
Gei'iatdc Institute thtough the Alaska Geriatric Education
Center, 2003 -Present.
IIL Consultant ~ rnstitute of Circumpolar Health
IV. Consultant and Medical Director -National Resource
Center for Ar.nedcan Indians, Alaska Natives and Native
Hawaiian Eldets. 2005 -Present.
V. ·Faculty Consultant in Geriatrics, Alaska Family
Reside11cy Program, 2005 ·· Present
VL Affiliate P.F.ofess.or. College of Health a11d Social Welfare.
7. Consultant, BritishColumbiaHealthFoundation, 1994-1999.
8. Consultant in Gel'latdc Medicine and Long Tenn Care, Silverado Senior
Living Centers, San Juan Capistrano, CA 2()01 -2002.
9. Consultant in Geriatric Medicine and Supervisor of the Geriatric Medicine
Medical House Staff Training Program, Ketn Medical Center~ Bakersfield,
CA 1986-2003.
10. Consultant ill Geriatric Medicine and Supervisor of the Geriatl.'ic Family
Medicine House Staff Training Program, Glendal~ Adventist Medical
Center, Glendale, CA 1998-2001
·---. ··-····· --12-···--------·-· ------ --
... 6 • ; ~ .
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11. Consultmt in Geriatric Program Development - Bay Shores Medical
Gronp, Torrance, CA., 1986-1989.
12. Consultant in Geriatric Progratt1 Development- San Dimas Coxnmunlty,
Hospital, 1986-1989.
13. Consultant in Gel'iatrlc Program Development and Long Tenn Care ~
Keiro Services - The Jap$.nese - American Retirement Homes~ Los
Angeles, CA., 1986 ~ 1993,
14. Consultant in Geriatric J?.r:ogram Development and Long Term Care-1'he
Motion Pioture and Television Home, Woodland Hills, CA 1986- 1990.
15. Consultant in Long Term Care and Geriatric Medicine, State of California,
Depru.1thent of Social. Services, 2000- Pt·esent.
./ 16. Consultant in Elder Abuse, Geriatric Medicine and Long Tenn Care, State
of California, Department of Justice, Office of the Attorney General,
Bureau of Medical Fraud and Elder Abuse, 2000 ~Present.
17. Consultant in Long Term Care, Elder Abuse and Geriatric Medicine -
State ofCalifomia, Department of Justice~ Office of the Attorney General,
Bureau of Medical Fraud and Elder Abuse- Operation Gual'dians (nttrsing
homes ~ unaru10unced inspections) 2000- Present.
18. Consultant in Long Term Care, Geriatric Medicine and Elder Abuse ~
State of New Mexico, Department of Justice, Office of the Attorney
General, Medicaid Fraud and Elder Abuse Unit, 2003 ~ Present.
19. Consultant in Long Term Care, Geriatric Medicine and Elder Abuse,
United States of America, Depru:t.tue.nt of Justice, Civil Rights Division,
· .. ·t.~-~""'-··- 2006- Present. · .. '·""""'-.... ··-··
. 20. Consultant in Long Term Care, Geriatric Medicine and Elder Abuse,
United States of America, Department of Health and Human Sclrvices,
0 ffioe of the Inspectur General, 2006 -Present.
21. Board of Directors. Musica Angelica, 2006- Present.
JF. Research Activities
1. Research Interests
a. Use of medications in the senior populations with specific emphasis on
prescribing habits of physicians.
... . JJ..
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36
b. Health care systems and delivery modes for the demented eldedy in
Alaska.
c. D1'Ug interactions it1 the elderly, looking at drug-drug interactions.
changed actions; polypharmacy} misuse' and abuse.
d. Studies In the elderly diabetic patient.
e, Studies in the elderly hypertensive patient.
f. Studies in sexual dysfunction in the eldedy.
g. Studies in elde1' abuse.
h. Maintenance of jndependence of living in frail and demented seniors.
2. Research in Progress: Investigations in man
a. Studies in prescribing habits {If physicians in retirement housing.
b. Studies of adverse drug effects in the aging population with special
emphasis on the most commonly prescribe medication and
psychotropio agents.
c. Studies on care of frail and demented senio~·s in Alaska.
d. Studies on the prevention and early detection of elder abuse.
e. Studies on decreased longevity in th~ Pueblo lndians.
G. Long Tel'm Ca:re Experience
1. Director of the two USC Teaching-Nursing Home Progl·ams, 1999 - 2005
a. Hollenbeck Home- Los Angeles
b. Atherton Baptist Home - Alhlllilbra
2. Member and Member Board of Director, California Association of
Medical DirectOl'S, 1992 ~ 1999.
3. Consultant~ State of Alask~ Department of Administration, Division of
Longevity Services (Aging Progtruns. and State of Alaska Long :r'l;lmtCare
Facilities- the Pioneers' Homes). 1991-2004. ·
4. Affiliate Professor, College of Health atld Social Welfare and College of
Arts and Sciences~ University of Alaska, Anchorage, · Areas of
involvement - Alaska Geriatric Education Center, Geriatric Assessment,
Prewmed and Medical Education~ Long nmn Care, 2006 to Present. .
5. Consultant'- Universtty of Alaska"' Sitka. Areas of involvement- Care of
Elderly Conference- Director, 1994 "Present
~. Consultant in Long Term Care. Elder Abuse and Oerlatdc Medicine -
State of Alaska. Department ofLaw; 2000 - 2003
JA .
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7. Consultant in Long Tenn Care and Geriatric Medicine - State of
California, Department of Social Services.
8. Consultant in Long Tettn Care, Geriatric Medicine and Elder Abuse -
State ofCalifomia, Department of Justice) Office of the Attomey General,
Bureau of Medical Fraud and Elder Abuse~ 2000-2003.
9. Consultant in Long Tenn Care - State of California1 Department of
Justice) Office of the Attomey General, Bureau of Medical Fraud 1:1nd
Elder Abuse - Operation Guardians (nursing home- unannouniY'.Al
inspections), 2000 -·Present.
l 0. Consultant in Long Term Care, Geriatric Medicine and Elder Abuse -
State of New Mexico, Department of Justice~ Office of the Attorney
General, Medicaid Fmud and Elder Abuse Unit} 2003 -Present.
11. Consultant in Long Term Care, Geriatric Medtcine and Elder Abuse,
United States of America~ Department of Justice, Civil Rights Division,
2006- Present.
12. P:dmary cat•e provider for Geriatric Medicine for Long Term Cal'e Patients
-Hollenbeck Home, Los Angeles; California, 1998 - 2004.
13. LACfUSC M(ldioal Center Clinic -Adult Protective Team - Geriatric
Medicine-Clinic Co~director, 2000-2004.
14. Member of the Arn.ericatl Association of Medical Directors.
15. USC - Angeles Plaza - Senior Clinic ~ Founding Director and oare
provider (1989- 1992). (The largest low-income senior l1ousing pl'Oject in
the Western United States).
16. Consultant in Geriatric Medicine and Long Term Care- Silvemdo Senior
Living Centers1 San Juan Capistrano, 2001 -2002.
17. Consultant in Geriatric Program Development and Long Term Care -
K.eiro Services - The Japanese AlUerican Retirement Homes, Los
Angeles, 1986-1994. ·
18. Consultan.t in Geriau:ic Program Development and Long Term Ca.l.'e- The
Motion Picture and Television Home, Woodland Hills~· CA~ 1986 -1990
m. Sigllificant lnvited Lectures (Since JU!ly 1984 - selected flt'Oilll over 3,500
lectures given)
t Harbor General Hospital- U.C.L.A. Medical Center. 7/84 .
.l i -
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Medical Grand Rounds - uew concepts in the treatment of Type II
Diabetes.
2. Harbor General Hospital- U. C.L.A. Medical-center, 7/84.
Endocrine Orand Rounds -The hewer oral agents.
3. Mm:tinLuthel' King Gene~al Hospital, Los Angeles, CA, 7/84
Medical Grand Rounds~ The approach to the pathmt with NIDDM.
4. Nisei Awat:eness Day; Little Tokyo, Los Angeles, CA, 7/84
Health issues for the elderly. Keynote speech.
5. The Cleveland Clinic, 9/84. Symposium on Diabetes Mellitus- -
The T~·eatment ofthe Patient with NIDDM.
6. American Academy of ;Family Practice, Kllnsas City, MO, 10/84
·National Meeting, Invited Speaker:
a. Nutrition in the elderly
b. New concepts in the thet•apy of the Type II diabetic patient.
7. Associates of the Countwa.y Library, Harvard Medical School, 11184.
Biannual History of Medicine lecture - "The Black Death Comes to
AJ.:nedca.~~
8. Washington University of St. Louis and St. Louis V.A. Hospital, 11/84.
Symposium on Diabetes Mellitus - The treatment of hYPertension in the
patient with Diabetes Mellitus.
9. The Jackson Laboratory, Bar Harbor, Maine~ 12/84.
Visitjng Scientist- Insulin seo1·etion in aging.
10. .Gordon Research Conference,.01mat.d, CA, 2/85. The biol 3/85
Endocrine G1·and Rounds -Sex and the diabetic.
15. The Johns Hopkins University Scholl of Medicine, Baltimore, MD) 3185.
Visiting Professor of the History of Medicine. Lectw:e topic- «Black
Death Conte to America.,,
16. Btigham-Women1s Hospital, Boston, MA, 3/85
Endocrine Grand Rounds ~·Insulin secretion in aging.
17. Yale University School ofMedioine, New Have~ CT, 4/85
Endocrine Research ConfetefiCe -Insulin seGretion in aging•
.... t... Hypertension Grand Rounds- Special problems of hypetteusioll fn ~
the diabetic patient. ·
18. University ofFlorida} Gainesville~ FL 4/85
Gedatric Medicine Grand Rounds
.
-The older diabetic
. patient.
19. University of California at Los Ang~l~s School of Medicine, 4/85. Fanl.ily
Medicine Grand Rounds- Treatment of diabetes mellitus in tbe elderly.
20. Stanfoi:d University of Medicine~ V.A. Hospital. Menlo Pari; CA, 5/85,
Clinical Conference - Sexual dysfunction in the elderly.
22. University of Pittsburgh School of Medicine, Pittsburgh, PA, 6/85.
Symposium on Diabetes Mellitus -The older diabetic patient.
23~: ,·.:.!W.Jliv.etsity of Hawaii School of Medicine,
Honolulu, HI. 8/85
Medical Orand Rounds- Diabetes in the elderly.
. 24. Department of Public Health and Sooial Welfare1 Guat_n, 8/SS
Special Leotru:e- Wellness and pathology in the elderly.
25. American Academy ofFamily Practice, Anaheim, CA. 10/fiS.
National Meeting -:tn.vited Speaker- Oiabetes in the elderly.
26. University of C111ifornia at San Francisco - Valley Medical Center,
Fresno, CA, 11/85. Endo01ine symposium~ Sexual Dysfunction .in fue
elderly,
27. Mayor's Conference on Aging, Los Angeles, CA. 3/86. treatment of
chronic diseases in the elderly.
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28. V.A. Hospital, Mmtinez, CA and U.C. Davis School afMedidne, 4/86.
Medical Grand RoUll,ds -Treatment of hypertension in diabetic patients.
29. Pasadena Council on Alcoholism, Pasadena, CA, 4/86. Symposium on the
Older Alcoholic Patient. Pathology and normalcy in aging.
30. Brown University Medical School, Providence, RI 4/86. Medical Grauel ·
Rounds- Hypertension in the elderly.
31. Medical Board Drug Review, Sacramento1 CA, 5/86. Invited Speaker -
The new oral agents. ·
32. Conference - Scientific Basis of Sexual Dysfunction - Sponso:red by NIH
and the National Kidney Foundation, Baltimore, MD, 6/86,
. •. ,:33·. F.D.A. Symposium of Bioequivalence of Solid Preparations, Washington,
D.C., 10!86. Itwited Speaker- Oral sulfonyhu:ea agents.
34. University of Nevada, Reno, NV, 2/87. Visiting Professot of Medicine,
Lecture topic ~Sex after 60.
35. University of Guam, .Guam., USA, 4/87. Symposium on Care of the
Elderly - Symposium Leader.
36. National Council on Hypertehsion1 Biannual Meeting, Las Vegas, NV.
4/87. Invited Speaker - Antihypertensive medications and sexual
dysfunction.
37. American Hospital Pha.nnacists Association, Washington, D.C. 5/87.
I~vited Speaker- Aging in America- Wellness vs. Disease.
3S. University of California, Davis- School of Medicine, 6/87. Course on
Medicine, Invited Speaker- f:I;vpertension in the elderly.
39. University of Nevada, Las Vegas, Nevada, 10/87. Visiting Professor of
Medicine, Lecture Topics; Gel'iatric Medicine Todayl' Geriatric Cmu:se
Planning.
40. California Pharmacy Association, San Francisco, CA, 11/87. Invited
Speakeu- Endocrinology of aging.
41. Evanston Hospital~ Northwestern University School of Medicine,
~v:mston> IL, 11/87. Visiting Professor of Medicine, Topic ~ Sex after 60.
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42. Conference on Pathogenesis and Treatment of Pressure Sores. Kansas
City, MO, I/88. Invited Speaker.
43. Conference on ~?What Phannaceuti~als are Needed for the Elderly?"
Phoenix) AZ, 2/88. Invited Speaker.
44: Confert;lnce on "Post Retirement IJealth Care Funding" sponsored by
I.R.L, New York, NY, 3/88. Invited Speaker-The gedatricirnperative.
45. Board Review Com:se: Geriatrics Update, 1988, U.S.C. School of
Medicine, Pasadena, CA, 3/88. Two and one-half day symposium on
geriatrics. Director, Moderator and Presenter for the course.
46. Symposium on Geriatric. Medicine - Motion Picture and Television
Retirement Home And Hospital, Woodland Hills, CA, 4/88. Moderator
and Presenter.
47. American Geriatdc Society National Meeting, Symposium and Physician
- Patient Communication, Aneheim, CA, 5/l.l8. Co-moderator and
presenter.
48. Symposium on Geriatric Medicine, San Dimas Community Hospital~ Sa11
Dimas, CA, 9/88, Moderator attd Presenter.
49. American Society for Enteral and Pa:rental Nutrition Confere:t.lCes: Ethics
and Nutrltion, New York, NY, 10/88
50. Symposium on Nutrition in the Elderly, California Medical Center, Los
Angeles, CAj 12/88. Moderator and Pre~enter~ Topic- Nutrition in the
Elderly.
51. Calif@n.tia Academy of Family Medicine, Annual Meeting, San Fraucigco~ ~ ..~.!1~;l'-"F
Nevada, 2194. Keynote Speake!'~ Sex after 60.
91. University of Cclorado Mfiliated Hospital. Medical Grand RQunds, 3194.
Dnlgs in the Elderly.
92. University of Kentucky Affiliated Hospital. Gerlatdc Medical Orand
RolUlds, Lexington, Kentucky, 4/94. Dementia.
93. Alaska Psychiatric Institute - API 2000 Meeting, Anchorage, Alaska,
6/94. Plans for the Future- C 9/96. Course Director and Lecturer.
116. Boise Health Consortium - Medical Grand Rounds, Boise~ Idaho, 11/96.
Sex. after 60.
117. Symposium on Long Term Cm:e for Providers, Milwaukee; Wisconsin,
2/97. KeynDte Speaker- Drugs in the elderly.
118. Symposium on Geriatric Medicine, Antelope Valley Medical Ce:nter1
Lancaster, CA, 3/97. Course Director and Speaket'.
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119. Osteopathic Medical College, Des Moines, Iowa,· 4/97.· Symposium on
diabetes Mellitus> Keynote Speclcer- Diabetes in the Elderly.
120. University of Southern Illinois Medical School, ChampaigiJ, Urbana,
Illinois, 4/97, Medi:cal House Staff Lectures. Topics - Diabetes in the
Eldedy~ Drugs in the Elderly.
121. Aliegheny Medi(la-1 School, Philadelphia, P.A, 5/97. Keynote Speaker~
Sytnposium on Diabetes and Lipids in the Elderly.
122. State Senior Care Program, Oldahoma City, Oklahoma, 7/97, Keynote
Speaker- State of Oklahoma Senior Care Ptogtam.
123. Eastem Carolina Univel'Sity Medical School, Greensboro, North Carolina,
8/97. Medical Grand Rounds.
124. University of Alaska, Southeast Sitka. Cw;e of the Eldedy Symposium,
Sitka, Alaska) 9/97, Course Director and Lecturer.
125. Unive"J:sity of Colorado, Denver, CO, 10/97. University of Colorado
Affiliated. Programs, Several States, Medical Grimd Rounds.
l
126. Arizona Chapter of the American Gerontologic Society, Phoenix, AZ,
11/97. Sex After 60. l
127. Symposium of Geriatric Medicine, Antelope Valley Medical Centet·, Il
Lancaster, CA, 3/93. Course Din:ctor and Speaker. ! I
128. Medical University of South Carolina, Charleston, South Caroliua, 4!98. i ll!i
Family Medicine Grand Rounds~ Sex After 60. !li
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129, University of Colorado, Denver~ CO~ 4/98, University of Colorado
Affiliated Progrants1 Several Sites, Medical Grand Rounds.
1:30. Eisenhower Medical Center, Rancho Mirage, CA, 4/98. Medical Grand
RoUtlds, Drugs in the Elderly.
131. University of Alaska mid U.S.C., Sitka, Alaska, 9/98. Care ofthe Elderly
Symposium, Course Director and Speaker.
132. University of South Carolina School of Medicine, Charleston, South
Carolina, 10/98. Family Medicine Grand Rounds. Sex After 60.
133. V.A. Outpatient Clinic, Los Angeles, CA1 10/98. Memorial Lecture Set[es,
Medi.cations in the Elderly.
134. V.A. Outpatient Clinic, Los Angeles, CA, 10/98, Memorial Lecture Series . . -
Alzheimer's disease.
135. Visiting Professor of Geriatric Medicine, Alaska Gedatric Institute,
Anchorage, AlMka, April, 1/99. Multiple Lectnres •.
136. Visiting Professor of Geriatric Medicine, University of New Mexico
School of Medicine. Albuquerque, New Mexico, 6/99, Alzheim~r's
disease.
137. UniveJ;Sity of Alaska, Sitka, Alaska, 9/17/99~9119/99. Care of the Elderly
Conferenc~;J, Course Director and Lecturer.
138. Visiting Professor of Geriatric Medicine, University of Arizona Affiliated
Hospitals of Tucson and Phoenix, AZ, 10/20/99-10/23/99.
139. Symposium of the Gerontological Society of America, San Francisco, CA1
11/21/99. Interdisciplinary Approaches to Teaching Geriatrtcs, Invited
Speaker.
140. State of Alaska, Anchorage, Alaska, 2/20/00-2/23/00. Task Force for the
Assessment of Assisted Living in the Pioneers' Homes, Leader and
Spokesperson.
141. Visiting Professor of Geriatric Medicine, University of Colorado School
of Medicine Affiliated Hospitals, Denver, Colorado, 3/7/00-3/8/00.
142. Visiting Professor of Geriatric Medicine, Affiliated Internal Medicine
Programs, El Paso, Texa-,, 4/26/00~4/47/00.
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143. Newport Beaoh1 California) 5/5/00, Alumal Meeting of the California
Association of Medical Directors~ Invited Speaker.
144. Antelope Valley Hospital, Lancaster, California. Medical Gnmd Rounds,
11!17/99, Treatment of Artlu·itic Pain in the Elderly.
145. Kern County Medical Center, Bakersfield, California. Medical Grand
Rotu1ds, 117100. Hazards ofDrugTherapies in the Elderly.
146. Hoag Hospital, Newport Beach, California. Medical Grand Rounds,
3/10/00. Sex After 60.
147. Visiting Professor of Geriatric Medicine, Affiliated Internal Medicine
Programs~ E1 Paso, Texas. 4/26/00A/27/00
148. Arrowhead Medical Center, San Bem~rdino County Hospital, Colt()n,
Ca.Iiforniaj 5/17/00. Medications in the Eiderty.
149. 11
Annual Meeting of the California Association of Medical Directors/j
Invited Speaker, Newpo1t Beach, California. 5/5!00.
150. Riverside General Hospital, Merino Valley, California) 6/16/06. Medical
Gral'l.d Rounds, Medications in the Eldedy.
151. The Elderly Diabetic, Care of the Elderly Conference, University of
Alaska. Sitka) Alaska; 9/21/00.
152. Treatme11t of Artbxitic Pain. Care of the Elderly Conference, University of
Alaska, Sitb, Alaska, 9/21!00.
153. Depression in the Elderly. Care of the Elderly Conference, University of
.n::; ~\.t· ·~ t •....,. Alaska, Sitka, Alaska, 9/21/00. . . '··
154. Treatment of Hypertension in the Elderly. Cro:e of the Elderly
Conference, University of Alaska, Sitka, Alaska. 9/21/00,
155. Medications ln the Elderly. Continuous Quality Improvement (CQI) in 'the
State~Assisted Living Facilities, Depa.rtment of Administration, Stat~ of
Alaska, Anchotag~, Alaska, 11/13/00.
156. Fails in the Elde:dy. Continuous Quality Improvement (CQl) in the State~
Assisted Living Faoilities, Department of Administration, State of Alaska,
Anchorage! Alaska, 11/13/00.
157. Dementia. Memorial Lecture Series, Outpatient Department, Vet~rans
Administration, Los Angeles, California, 112/0 1.
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158. Geropsychiatric Assessment of the Elderly. Bureau of Medi-Cal Fraud and
Elder Abuse) Department of Justice, State of Ca.tifomta, Ontario
California~ 2/22/01.
159. Treating Chronic Pain in the Elderly. Memorial Lecture Sedes, Outpatient
Depruimet1t, Veterans Administration Los Angeles, California. 1/2/01. ·
160. Medications in the Elderly. Continuous Quality Irt>.provemem (CQI) and
the Risk~Plus Program ill the State~Assisted Living Facilities~ Department
of Administration> State of Alaska, Sitka, Alaska, SflfO 1.
161. Falls in the Elderly. Continuous Quality Improvement (CQI) and the
:Risk-Plus Pwgram in the State~Assisted Living Facilities, Depa:t1ment of
Administration) State of Alaska, Sitk~ Alaska, 5/1101.
162. Sexuality. Nol'th American Forum on Women's Health, Los Angeles,
Calif01nia, 6/19/01.
163. Alzheitner~s Disease. North American Forum on Women's Health, Los
Angeles, California~ 6/19/0l
164. Ge:ropsy(:hological Evaluation of Seniors. Symposiu111 on Elder Abuse.
Department of Justice-Bureau of Medical Fraud and Elder Abuse~ Rancho
Mirage, California, 9/7/01
165. Depression in the Elderly. Hoag Hospi1al. Newport Beach, Callfomia,
9/7/01.
' 166. Sleep Disorders iu th" Eldel'ly. Care of the Elderly Conference. Univetsity
Ii of Alaska~ Sitka, Sitka, Alaska, 9/23/01.
"'
! 167. Medications in the Elderly. Memorial Hospital, S;mta Rosq., califo:mia,
10/19/0L
168. Dementia. Medical Orrutd RoundsJ Riverside General Hospital, Marino
Valley, California, 11115/01. ·
169. Dementia in the Elderly. Medical Grand Rounds, Arrowhead Medical
Center, San Bernardino Gene.t:aJ Hospital, Colton, California, 11129/0l.
170. Patient and Family Satisfaction in Long Term. Care. Alaska Pion~tlrs~
Home, Anchorage, Alaska. A site 'ilisit and symposi~ 12/11101~
12/15/01. .
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171. Normal Aging vs. Disease. Symposium on Geriatric Medicine. Annenberg
Center, Rancho Mirage, Califmnl~ 2/202.
172. Medications in the Elderly, Memorial Lecture Series, Outpatient
Department) Veterans Administration, Los Angeles, California, 2/26/02.
173. Life Style Redesign in Elder Care. 2nd Annual North American Forum on
Women's Health, Anaheim, California, 3/1/02.
174. Dementia in the Elderly. Memorial Lecture Series, Outpatient Department,
Vetet·ans Administration, Los Angeles) California, 3/12/02.
175. Diabetes in the Elderly. Endocrine Grand Rounds. Harbor General
Hospital, Torrance, California, 4/l/0/2.
176. Medications in the Elderly. MultiHlecture series~ Commission on Aging,
I- ·•
.···. .. State of Alaska, Anchorage and Fairbanks,' 4112/02~4/26/02.
177. Treatment (!f Pain in the. Elderly. Care of the Eldei'ly Confel'ence;
University of Alaska~ Sitka. Sitka, Alaska, 9/19/02.
178. Treatment of Cardiovascular Risk Factors in the Elderly. Care of the
Eldel'ly Conference, University of Alaska, Sitka, Alaska9/19/02.
179. Special Issues in Long Term Care. Assessment and Evaluation of the
Artchorage Pioneers' Home, Anchorage, Alaska, 12/10-12114/02.
180. Identification and Treatment of Cardiovascular Risk Factors in ihe Elderly
- A symposium Montgomery Cardiology· Programs. Montgomery~
Alabama, 3/21/03.
'··· 181. Medications in the Elderly. Multi~lecture series, Conunissio:n.on Aging,
State of Alaska, Anchorage and Fairbanks1 4/23~4/26/03.
182. Assessment of Mental Competency and Discussion of an Elder Abuse
Case. Symposium on Elder Abuse, Department of Justice ·~ Bureau of
Medi~Cal Fraud and Elder Abuse~ Squaw Valley~ California, 5/21 kS/30/03.
183. Medications in the Elderly. Multi-lecture series, Commission on Aging,
State ofAlaska, Juneau. and Ketchikan, 6J27-6129i03.
i84. Dementia in the Elderly: Medications in the Elderly. Care of the Eldedy
Conference, University of Alaska, Sitk~ Sitka, Alask~ 9/18-9/19103.
185. Dementia. GeriatJ:ic Symposium :.. . St. Mary~s Hospital and Scan~ Lang
Beach. California, 10/4/03. ;
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186. Senior Assessment for the Care Provider. Public Health Fonun- State of
Alaska. Anchorage, Alaska, 12/1/03.
187. Senior Assessment Workshop. Alaska Geriatric Education Center,
University of Alaska, Ancho1·age, Alaska, 1/23/04.
188. Sleep Disorders in the Elderly. Coping with Chronic Disease. Care ofthe
Elderly Conference, University of Alaska1 Anchorage; Alaska, 9/17/04.
189. Elder Abuse. Coping with Chronic Disease. Cardiovasculru: Risk Factors
in the Elderly. Senior Lives Conference~ University of Alaska> Anchorage,
Alaska 6/10/05.
190. Assessment of the Chart in Skilled Not'sing Facilities. Symposium on
t • .t.. , , ....
Eld.er Abuse, Department o~ Justice, Bureau of Medical Fraud and Elder .. .
I Abuse, Long Beach~ California, 6/6-6/9/05. ,,
191. Coping with Chronic Disease. The Chart in the Skilled Nursing Home.
Care·ofthe Elderly Conference, University of Alaska, Sitka, 9/16/0S.
192. Sex After 60. The Chart in the Skilled Nursing Home. Promoting :Best
Practices in Aging Conference, University of Alaska1 Anchorage- 6/8/06
-6/10/06.
193. Medic-al Realities and Diminished Tribal Longevity, New Aspects of Long
Tenn Care. Cate of the Elderly Confetenc~, University of Alaska , Sitka,
9/14/06-9/16/06. .
194. Standw:d of Care, Symposium on Elder Abuse, Depal.iment of Justice,
State of Califomia, Buteau of M~di~CAL Fraud and Elder Abuse~ San.
.. Mateo, California May~M0FJ,..:..
195. futegrated Therapies for Aging. The Thet'apies, Care of the Elderly
Conference, University of Alaska, Southeast; Sitka 9/~5'/0S- 9/27/08.
196. Human Biology 596 Course University of Washington Medical School -
WWAMI Program- Multi-Disciplinary and Bthnicity in Gerontology and
Geriatrics. Lectu.r:es to Alaskan Medical Students, University of Alaska~
Anchorage, Aprll2009.
197. Mental Health and Dementia. Inter-disciplinary l?taciioo in Geriatrics Sex
After 60. Prompting Best Ptactices in Aging Conference, University of
Alaskf4 Anchorag·e, 6/3/09-6/5109.
][, PUBLICAT][ONS
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Papers- Pee1· Review
L McCleverty, J.A, an.d Wilklrtso~ Q, (Submitters), Lipson, L.G., Maddox,
M.D. and Kaesz, H.D. (Checkers): Dichlorotetracarbonyldirhodbm.
Inorganic Synthesis Vol. VHf, oltzclaw, H.F., Jr. (Ed) McGraw-Hill, New
York, 1966, pp.211-214.
2. McCleverty, J.A. and Wilkinson. G. (Submitters), Lipson1 L.G., Maddox~
M.D. and Kaesz1 H.D. (Checkers): Chlorocarbonylbis (uiphenylphospine)
rhodh.un and cblorocarbonylbis (tdpheuylarslne) rhodium. Inorganic
Synthesis Vol. VIII~ Holtzclaw, B.G. Jr. (Ed), McGraw-Hill> New York,
NY 1966, pp214~2l7.
3. Lip~pn, L.G., Capuzzi, C.M. and Margolis, S.M: Effect on method of cell
isol'll.tion on the metabolic activity of. isolated rat liver cells. J. CellSC. · · ·
10:167A179, 1972.
4. Lipson, L.G.: Plague il.t San Francisco in 1900, Atm. Int. Med. 77~303~
310, 1972.
5. Kohler, T.R., Lipson, L.G., Flores~ J.> Witkum, P.A., Fischer, J.B.~ and
Sharp, G. W.O.! Sequence of events in the activation of adenylate cyclase
by cholera toxin. Bull Schweitz, Akad. Med. Wiss. 32·223w23Z, 1976.
6. Beiteins, l.Z., Lipson~ L.G. and McCarthur, J.W.:Luteiniz\ng hormone,
follicle stimulating hormone and their subunits released in cultnre by
hmnanpituitary tumors. J. Clin. Endo. Metab. 45:1271-1280, 1977.
7. Fischer, J.J;3.~ Kohler, T.R., Lipson, L.G.:I Flores,~ J., Witkam. P.A., and
Shru:p_, G.W.G.; Studies on the time course and rat~ limiting steps in the
activation of adenylate cyclase by cholera toxin. Biocltem. J. '173: 59-64.
1978.
8. Lipson, L.G., Beitins, I.Z., Komblith, l?.D.~ McArtluu·. J.W .• Frie~en,
H.G., Kliman, B. and Kjelbexg, R.N.; Tissue cultw:e studies on human
pitultal'y ·tumors: Radioimtnunoa.ssay of ante11or pituitary hotntones in
culture medium. Acta. Endocrln. 88:239-249, 1978.
9. Lipson, L.G. and Shmp~ G.W.G.; 1nsulin sec1'etion in pregnancy: Studies
on adenylate Cyclase, phosphodiestarase, protein kinase and
phosphoprotein phosphotase in Isolated islets of Langerhans of the rat.
Endocrinology 103:1272~1280j 1978.
10. Lipson, L.G., Beitins, I.Z., Kornblith, P.D., McArthur, J.W., Friesen,
H.G.j Klimat~, B. and Kjelberg, R.N.~ Tissue culture studies on hu.tnan
. ·-30--· .... -.. -------~---:: ---"::---.-----:-;·--;------
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53
piMtru.y tumors: Loug~term .r:elease of anterior pituitary hormones. Acta.
Endocrin. 90~421~433, 1979.
lL Lipson~ L.G.~ Siegal, E., Wohlheim, C.B. and Shatp, G.W.G.: Insulin
release in fasting: Studies on adenylate cyclase, phosphodiesU~rase, pr<~tein
kinase and phosphoprotein phosphatase in isolated islets of Langerhans of
the rat Endocrinology 105:702-717, 1979.
12. Lipson, L.G., Bush, M.J., Tietjen, O.E. and Yooll, A.; Role ofthe
adenylate cyclase sy.stem in altered insulin release from. islets of
1angerhans of aging rats. Acta. Endocrin. 96:222·226, 1981.
13. Lipson, L.G., Bobt·ycki~ V.A., Bush, M.J., Tietjen, G.B. and Yoon, A.:
Insulin release in aging: Studies on adenylate cyclase, phosphodiestarase
and protein kiuase iu islolated islet'l on Lange1'hans of the rat.
Endoodnology 108: 602-624> 1981: •.t, ·' ·
14. Lipson, L.G., Moore1 D., Pope, A.M.J Todd, G.J., and Avila. S.: S~xual
dysfull.Ction in Hypertensive diabetic patients. J. Cardiovascular Med. 6:
Supp.l, 30-37,1981.
15. Cotton, D.B., Strassner1 H. G., Lipson, L.G., and Goldstein, D.A.: the
effects ofterbutaline on acid-base, electrolytes and glucose homeostasis
during the managementofpretenn labor. Am. J. Obstet. And Gy:n. 141:
617-624, 1982.
16. Oldhrun, S.B., Upson, L.G. and Tieijen, G.B.: Evidence for the presence
of calmodulin in human parathyroid tissue..Mineral and Electrolyte
Metabolism 7: 273-280, 1982.
17. Lipson, L.G., Oldham, S.B.: The presence of calmodulin- stimulatflb1e
phospho.diestatase in pancl'eatic islets of Langerhans of pregnant and
11011nal female rates. Life Sciences 32! 775-780, 1983.
18. Mircheff, A.C.~ Conteas, C.N., Lu, C.C,, Santiago, N.A., Gray, G.M. ood
Lipson, L.G.: Basal»lateral a.nd intracellular membrane populations of the
rate exorbitallacd.mal gland. Am. J. Pltysiol. 24-5: G 133*142, 19&3.
19. Premdas, F.H., Molina, J.M. and tipso.11; L.G.: Insulint·elease in aging:
Role ofglyce:raldehydes.Acta. Endoorin. 103:539-543, 1983.
20. Lipson, L.G. and Lipso~ M.: Treatment of the obese maturity onset
diabetic patient, Arch. Int. Med. 144: 135-138, 1984.
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21. Oldham, S.B., Molloy, C. and Lipson, L.G.: Calc~um inhibition of
adenylate cyclase in the parathyroid gland. Endoorlnology 114: 207-214,
1984.
22. Lipson,.L.G.: Sexual dysfunction in the diabetic patient with hypertension.
Am. J, Cardiol. 53: 46A~50~ 1934.
23. Lipson, L.G.: Special problems in the treatment of hypertension in the
patient with diabetes mellitus. Arch. Int Med. 144: 1829ul831, 1984.
24. Olclliam, S.B., Rude, R.K., Molloy, C. and Lipson, L.G.~ The effect of
·magnesium on calcium inhibition of parathyroid adenylate cyclase.
Endocrinology. 115: 1883-1890, 1984.
25~ ... Molina, J.M., Prem.das, F.H.• Klenck, R.R. Eddlestone, G., Oldham, S.B:
' or
·and Lipson, L.G.: The dynamic insulin-secretory response isolated .· · ·
pancreatic islets of the diabetic mouse: Evidenoe for a gene dosage effect
on insulin secretion. Diabetes 33: 1120-1123.
26. Bddlestone, G.T.~ Oldham, S.B., Lipson, L.G.~ Premdasl F,B. and
Beigehnan, P.M.: Electrical activity, cAMP concentration and insulin
release in mouse islets ofLangerhans, Am. J. Physiol. 248: C 145-1531
1985. .
27. Molina, J.M., Premdas, F.H. and Lipson, L.G.: Insulin release in aging!
Dynamic response ofisolated islets ofLangerhans of the rat to D~
glyceraldehyde. Endocrinology 116: 821~826, 1985.
28. Oldham, S.B. and Lipson, L.G.: The high affinity c~lcium inhibition of
parathyroid adenylate cyclase is not calmodulin-dependent. Catcif, Tissue
Int. 38: 275-281, 1986.
• ····"t-"i- • • ~.. • • ...,. ' ...
29. Bailey, C.J., Day, D., Bray, G.A., Lipson, L.G. and Flatt, P.R.: Role of
adrenal glands in the development of the abnormal glucose and insulin
homeostasis in genetically obese (ob/ob) mice. Hormone and Metabolism
Research. 18~ 357-360, 19&6.
30. Prochazka, M.• Premdas, F.H.y Leiter, E.H. and Lipson, L.G.: Estrone
treatment dissociates primary ve1·sus secondary consequences of
"diab~tes" (DB) gene expression in mice. Diabetes, 35: 725w728, 1986.
31. Lipson, L.G.: Diabetes .in the elderly: Diagnosis~ pathogenesis, and
therapy. Am. J. Med. 80: Supp. SA: 10-21l 1986.
y ~ • ... , '
55
32. Fadda, G.Z., Alanal, M., Premdas, F.H., Lipso11l L.G. andMassry, S.G.;
Insulin release from pancreatic islets! Effects o{CRF and excess PTH.
Kidney 1nt. 33: 1066wl072,1988.
33. Leiter, E. H., Premdas, F.H., Hanison, D.H. and Llpson, L.G.: Aging at:d
glucose homeostasis in C57BL/6Jmale mice. FASEB Joumal. 2: 2807·
2811~ 1988.
34. Fadda, G.Z., Alttnal, M., Lipson, L.G., Soliman, A. andMassry, S.G.:
Correction of glucose into~erance and the impaired insulin release of
chronic nmal failure by verapamil. Kidney lnt 36: 173-770, 1989.
35. Fadda, G,Z., Akmal, M., Lipson, L.d. and Massry, S.G.: Direct effect of
parathyroid homtone secl'etio.n from pancreatic islets. Am. J. Physiol., 258
(Endocrinol. Metab. 21): E975~B984, 19.90.
an.... ·
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36': Mulligan, R.J Lipson, L.G. and Heaton, S. G.: Detecting diabetes in
eldel'ly dental patient population. Special care in Dentistry: Feature
Article: September-October, 142-147, 1990.
37. Xin·Gin, Z., Fad.d~ G.Z,, Lipson, L.G. and Massry. S.G.: Phosphate
depletion impairs insulin secretion by panc~·eatic islets. Kid. Int. 39: 120-
128, 1991.
38. Fadda, G.Z., Hajjar, S.M.~ Perna, A.F., Chau, X.J., Lipson, L.O. and .
Massry, S.G.: On the mechanisms of impaired insulin secretion in chronic
renal failure. Jour. Clin. Invest. 87: 225~261 ~ 1991.
39. Clark, F. Carlson, M., Zhnlce, R., Frank~ 0,, Patterson, K., Lru·son, B.,
Rankin~Martinez, A.) Hobson, L., Crandall, J•• Mandel, D. and Lipson,
L.G.: A qualitative study ofthe life domains and adaptive stmtegies of the
lowincome,.wellelderly. Am. J. Occup. Therapy, 1994
40. Clark F. Carlson, M., Zimke, R., Frank, G., Patterson, K.., Ennevor, B.,
Rankin-Millilnez, A, Hobson, L., Crandall, J., Mandel, D.and Lipson,
L.G.~ Life domains and adaptive strategies of a gl'oup oflow~income, well
older adults. Am. Jt. of Occupational Therapy, 99-108, 1995.
41. Rho, Jay P. and Lipson, L.G.: Focus on acetylcholinestreraseiuhi.bitor for
the treatment of Alzheimer's disease. Fonnulazy, Vol. 32, 677~684, 1997.
42. Clark, F., Azen, S.P., Zemke, R.~ Jackson, J., Carlson1 M., Mandel, D.,
Hay, J., Josephson, K., Cherry, B., Hessle, C.~ Palmer, J. and Lipson, L.G.:
Occupational Therapy for IndependenMjving Older Adults. JAMA, 278:
1321-1326, 1997.
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43. Clm'k 1 F., Azen~ S.P., Cttrlson, M.~ Mandel, D., LaBree, 1., Hay, J..
Zemke, R., Jackson, J. and Lipson, L.G.: Ernbedding health~promoting
changes into the daily lives of independent~ living older adults: Long-tenn
followwup of occ11pational therapy inte1vention. Journal of Gerontology:
Psychological Sciences, 56B, PP- 60"63, 2001. ·
Requested Chapters, Papers, and Monograms
1. Sharp~ G. W.O., Fisher, J.G., Lipson, L.G., Kohler, T.R., Flores, J. and
Witkum, P.A.! Time course studies on the mechanisms of action cholem.
toxin. Hormonal Receptors in Digestive Tract Physiology. In Bonftls, S.~
Fromageot, P., Rosselin. G. (~ds.). Eldevier~North Holland Biomedical
Press, Amdsterdam, pp.447-454, 1976.
2. Sharp, G. W.O., Wiedenkeller1 D.E., Lipson~ L,G., Oldhnm, S.B., I{J;ausz,
1
"'' "'' • ': Y., Janjis) D., PianwSrn.ith, M.C.M. and Wollheim, C.B.: Multiple roled of
calmodulin, the endocrine p~ucrea.s and the control of1nsu1in secretion.
P1·oceedings ofthe 11th Congress of the Intentattonat Dlabetes Federation.
Int. Congress Series #600: Excerpta Medica, Princeton, N.J., Mngola,
En.N. (Ed.) pp 329-336, 1983.
3. Lipson, L.G.: Hypertension and diab~tes rrielUtus. Diabetes forecast
38:53, 1985.
4. Lipson, L.G.: Diabetes mellitus in the elderly: Special problems, special
approaches. Co. Medical, New York, N.Y.j pp. 1-20) l98S.
5. Lipson, L.G.: Diabetes after sb;.ty~five. Diabetes Forecast. VoL 39, No.
7, 54-58, 1986.
6. Lipso~ L.G.: Diabetes in the elderly! A multifaceted problem. A.nl. J.
Med, 80: supp. 5A:1-2, 1986.
7. Lipson, L.G. an.d Bray~ G.A." Energy intake and utilization in aging
man: Chen (ed.), Nutritional Aspects of Aging, Voi. 1, CRCpress.. In.o.,
BocaRaton,J:<"'L. Pp.184-185, 1986.
8. · Lipson, t.G.: Diabetes and aging.lu Beigelman1 P.M.an.d Kuman, D.,
(Eds), Diabetes Mellitus for the house L.G.: Dental problems ill. the diabetic patients. In Beigelmru.t,
P.M. and Kumar, D. (Eds.) Diabetes Mellitus for the House Officer.
Williams and Wilkins~ Baltimore> MD., pp. 181~183, 1986.
11. Lipson, L.G.,: Hypertension in the diabetic patient. In Beigelman, P.M.
and Kumar, D., (Eds.) Diabetes Mellitus for the House Officer. Williams
and Wilkins, Baltimore, MD., pp 160.. 163, 1986.
12. Lipson, L.G.: Hypertension in the diabetic patient. In Beigehnan, P.M.
and Kumar, D., (Eds.), Diabetes Mellitus for the House Officer.
Williams and Wilkins, Balthnore, MD., pp. 173~175, 1986.
13. Dinwiddie, R. and Lipso~ L.G.: Improved control of serum glucose in
obese, new~onset u1sulinopenic non-insulin dependent diabetes mellitus:
Partial respiration of Norman dynamic insulin secretion. Roerlg
Division, pp. l-6, 1986, · :,... ' ·
•••• ,.. ~ •} ·" ., ••. ~ t,r-
14. Lipson1 L.G. and Katow:Patrner1 S.: Diabetes in Asians. Diabetes
Forecast, Vol. 41, No.9, 4Sw51, 1938.
15. Lipson, L.O., Kato-Palmer, S., Boggs, W.L., Moore,D., and ope1 A.:
. Diabetes in the :Slack population. Diabetes Forecast Vol. 41, No.9, pp.
34w38, 1988,
16. Williams; B.R., Nichol, M.B., Lowe, B.F., McCombs, J.S. 1 Yoon, P.S.
and Lipson) L.G.: phru:ruacist intervention residential care faciliti6s. In
Rowet J.W, and Alu·onheim, ,T.C. (Eds.) Annual Review of Geronto:ogy
at1d Geriatrics; Foc·us on Medications and the Elderly. Springer
Publishing Co. New York, N.Y., pp. 150wl62, Vol. 12, 1992.
17. The Use of Medications: A Tmining and Reference Manual Developed
for Staffin.Residential Care Facilities for the Elderly, 1195. Lipson. . ,_,..,
L.G.- Project Co-Director.
18. Weiner, J. and Lipson, L.G.: Human diseases as models of accelerated
aging. In Rose~ C., Glowacld, J. and Bilezikian> J. (Eds.) The Aging
Skeleton1 Academic Press, Chapter ~:.pp. 51~58, 1999.
19. Raghaven1 D.~ Weiner, J. and Lipson, L.G.: Cancer in the elderly:
principles of treatment in Soulbami, R.L. et al (Bds.), Oxford Textbook
Oncology~ znd Edition, Oxford University Press, Oxford1 London) i 999.
Films atld Videos
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1. Discharge Plmming for the Elderly Hospitalized Patient: r. \Vhat to do
wllen you go Home. Hospital Sateiiite Network, 1986. 15 min. L.G.
Lipson- Moderator and Context Exper.
2. Discharged Planning for the Elderly Hospitalized Patient: H. The patient
with acute medical problems after discharge. Hospital Satellite Network
1986, 15 min. L.G. Lipson- Moderator and content expert.
3. Discharge Planning for the Elderly Hospitalized Patient: UI. The
chronically disabled patient. Hospital Satellite Netwotk) 1986, 15 min.
L.O. Lipson- Moderator and content expert.
4. Discharge PlEU11ling for the Elderly Hospitalized Patient: IV. Community
programs for the elderly. Hospital Satellite Network, 19861 15 min. L.G.
Lipson- Moderator m~d content expert.
5. Normal Aging Versus Disease:"l'hysicianJoumai Update. Lifetime
Network, 1987, 15 min. L.G. Lipson- Content expert.
6. Drugs and the Elderly. Physician's Journal Update. Lifetime Network,
1987, 15 min. L.G. Lipson- Content expert.
7~26. Caring for and Aging Soo(ety. 20 videos on various aspects of Geriatrics
gnd Gerontology. Each 30 minutes in length. Producer- Neil Steinbe):g
Produotions1 Executive Producers- Hospital Satellite Network and Age
Wave~ Sponsor- Marion Laborato:des. 1987"1988. L.G. Lipson-
Technical advisor and content exp~rt.
CARING FOR AN AGING SOClETY
SHOW TITLES AND NUMBER
.. , ....... ~~ -
. .....
~SP#. HSN# !lTLE
001 8649X NEW IMAGES OF AGIN"G (F) DYCHTWALD
()02 0462X flOW TO TALK TO YOlJR.'DOCTOR (F) LIPSON
003 57.33X GERIATRIC ASESSMENT (F) BUtLER
Q04 8648X DRUGS AND THB ELDElll,Y (F) :LAMY
005 77l6X ACUTE CARE GERIATRIC NURSING (F) FOLMER
006 5734X HEART DISEASE AND THE ELDERLY (F) SWAN
012 8650X PRINCEPLES OF AGING (F) HAZZARD
013 5735X PRESENTATION OF DISEASE (F) ABRASS
014 5736X GEROl;JSYCHfATRIC FOUNDATIONS (W) OLSEN
.OIS 5737X PltYS!CtA:N'S ROLE IN DRUG THBMPY (F) VESTAL
016 8652X ETHICAL ISSUES lN ELDERCARB (F) CASSEL
017 7717X GEROJ?SYC:HIATRlC NURSlliG (W) WYKLE
018 612SX TBE HUB CONCEPT (W) DYCHTWALD
\l19 6726X ELDBRCARE FlNANClNG (W) DYCH!WALD
.. 4 •
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020 6727){ ELPERCARE: MODELS OF SUCCESS (F) DYCHTWALD
021 5738X DJABBTES IN THE ELDERLY {W) Lrl?SON
022 8651X GERIATRIC DISCHARGE PLANNING (F) WERTHEIMER
023 0473X PROMOTING WELLNESS {W) FARQUJ!Al!.
()24 0475X SELF~MEDXCATWN IN THE ELDERLY (W) StMONSOl\'
02S 0414X FAMILY ROLES lN BEALTHCARE FOR BRATI'ER
THE ELDERLY
27. Medical Checkup; Health Aware11ess '88. Aging in the Black Conunuqtty. A 30 min.
Video. Producer, Mark Alyn Communications) Sponsor- Marion LabOratories) 1988.
L.G. Lipson- Moderator and content expert.
28. Medical Checkup: Health Awareness , 88 Aging in the Hispanic Community. A 30 min.
Video, Producer, Mark Alyn Communications, Sponsor- Marion Lab<>ratories, 1988.
L.G. Lipson- Moderator and content expert.
Medical Checkup: Health Awareness '88. Aging in the Asian Commuuity. A 30 min.
Video. Producer, MarkAlyn Communications~ Sponsor- Mad on'Laboratories, 1988.
L.O. Lipson- Mode1·ator and content expert.
3(). Medical Checkup: Health Awareness '88. Diabetes Mellitus in the Black Community. A
30 min. Video. Producer> Mark Alyn Commonlcations, Sponsor- Madan Labotatories,
1988. L.G. Lipson- Modemtor and content exp~rt.
31. Medical Checkup: Health Awl'll:eness '8 8. Diabetes Mellitus in the Asian Community. A
30 min. Video. Producer7 Mark Alyn Communications~ Sponsor- Marion LaboratotieS1
1988. L.G. Lipson~ Mode1·ator and content expert. ·
32. Medical Checkup: Health Awareness '88. Diabetes Mellitus in the Hispanic Community.
A 30 min. Video. Producer, Mark Alyn Communications1 Sponsor- Marion
Laboratories, 1988. L.G. Lipson- Moderatot and content expe1t.
33~38. Diet and Exexciw-~Lifustyles for Aglng. Hospital Satellite Network. Six lO~minute ''"'
Segments, 1989. L.G. Lipson- conteil.t expett.
39. How to Talk to the Older Patient. Baylor Hospital and Age Wave, 1989. L.G. Lipson-
Medical Moderator and content expert.
40-41. The Aging Skin. Age Wave, 1991. L.G.Lipson- Medical Editor.
42. Diabetes and the Eldel'ly. Living with Diabetes: Diabetes on the Air, 1991.
43. Sex and Sexuality in Seniors- A Documentary, 1999 L.G. Lipson- Guest E:xpert.
I,
Abstracts
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*1. Upson} L.G.~ Margolis, S.M. and Capuzzi, D.M.: Comparison of acetate and amino acid
incorporation in. rat liver cells isolated by three techniques. Fed. Ptoc. 28:336 (absl 607).
1969.
2. Lipson, L.G., Ackerman, I.P. and Klima:n, B.: simultaneous acromegaly and partlally
suppressible adrenocot'tioal function in a patient with a pituitary tumor. Clin. Res. 24:
274A, 1976.
3. Lipson. L.G.) Beitins, I.Z., Kornblith, P.O., McArthur, J, W., Friesen> H.G.• K.liman. B.
and Kjelberg~ R.N. Hormone secretory patterns of human pituitary tumors in tissue
culture. Clin. Res. 328A, 1976.
4. Lipson, L.G.> Fon:istall, C.A. and Shatp, G.W.G. Phosphorylation and dephosphorylation
in the control of the insuliu release: Islet phosphoprotein phosphatase. Diabetes 25: Supp.
1,374 (abst. 213). 1976.
*5. Lipson, L.G., Vachon, C., F6histall, C.A" and Sharp~ G.W.G.: Stimulation of specific
protein phosphorylation in intact rats islets ofLangerhans by both 3-isob\ltyl-1-
methlxanthine and D-glucose. Clin. Res. 26:530A) 1978.
6. Lipson, L.G. and Sharp, G.W.G.: Insulin release in pregnancy; Relatior.ship to ptotein
and phosphorylation. Endocrinology 102: (abst. 711), 1978.
7. Lipson, L.G. Wollhei:m, C.B. and Sharp, O.W.G.: Insulin release in fas1ing. Diabetes 27:
Supp. 2, 489 (abst. 236), 1918.
S. Lipsonl L.G.J Bobrycki, V.A., Bush, M.J •• Gross~ E. and lnouyte1 D.: Role of adenylate
cyclase system in altered insulin release from islets of aged rats, Clin.Res. 28:51A~ 1980,
~'9. Cotton, D.B., Strassner, H.G., Lipson. L.G. and Goldstein, D.A.: Effect ofterbutaHne on
serum concentrations of glucose, insulin, J_Jo'tassium, ionized and total calcium lactate,
and colloid osmotic pressure. Gyecol. Invest. 1980... .·t-:· .•..
*10. Lipson, L.G., Bush, M.:r.~ Tie~ en, .G.E. and Yoon, A.; Insulin release itt aging: the role of
adenylate cyclase system. Endoorinology 106: (abs~. 34)) 1980.
11. Mircheff, a. C., Lipson, L.G.• Bush, MJ., Yoon, A. and Barish, J.J.: Analytical fraction of
B·cells. Diabetes 29: Supp. 2, 109A (abst. 425), 1980
12. Moore, D., Pope, A.M.1 Todd, G.J.:I Rosenquist, R.J.1 and Lipson, L.G.: Treatment of
hypertensive diabetic patients with pl'azosin. Diabetes 29: Supp. 2, 67A (abst. 267) 1980.
*13. Oldham, S.B., Lopson, L.G. and Tiegen. G.B.: Ev-idence for the presence of calmodulin
in human parathyroid tissue. VIII International Conference in Calcium Regulating
Honnones, 1980.
-····· -- ·-ss
' ' "'! . ... 4 •
61
*14. Lipso'n, L.G.• Bush, M.J. and Bobrycki, V.A.: The role of the adenylatecyclase system in
the decreased glucose~stirnulated insulin. release from isolated islets ofLangerhans of .
aging rats. Gordon Research Conference- The Biology of Aging. 1980.
15. Lipson, L.G. Oldham, S.B. and Bush, M.J.; Calmodulin-- stimulatable phosphodiestarase
in isolated islets ofLangerhans oftherat. Clin. Res. 29:56A, 1981.
16. Lips~n. L.G., Moore. 0.1 Pope A.M., Todd, F.J. and Avila, S.: lncidenceofhypertension
in male diabetic populations. Clin. Res. 29:413A. 19tH.
17. Lipson, L.G. and Oldham, S.B ,! Colmodulin~stimulatable phosphodiestarase in pancreatic
islets of the pregnant rat. Clin. Res. 29-413A, 1981.
*18. Conteas, C.N., Lipson. L.G. and Mircheff; A, C.: Basal lateral membranes fl•om rat
parotid acinar cells. Gastroenterology 80: 1128A, 1981.
I
• •• . . . . . t
.. 19 . Lipson, L.G. and Oldham, S.B.: The presence of a calmod"ulin!:stimulatable
phospl10diestarase in pancreatic islets from pregnant and notmal female rats.
Endocrinology 108:343, (abst. 1942), 1981.
20. Lipson, L.G. Bush, M.J. and Najdziuk, J.: lnsulitll'elease in aging: Role of
glyceraldehydes. Diabetes 30: Supp. 1 (abst. 296), 198.1. ·
*21, Lipson, L.G,: Insulin release in aging. Gordon Rese!U'ch Conference- The Biology of
Aging. 1982. ·
22. Lipson. L.G., Moore1 D., Pope, A.M. and Todd, Ci.J,: Sexual dysfunction in hypertensive
diabetic patients: The role ofprazosin in its prevention. Diabetes 31: Sup. 2 (abst. 365)t
1982. )
*23. Oldham, S.D. and Lipson, L.G.: Biphasio inhibition of parathyroid adenylate cyclase
activity by calcium1, ~~llf., Tissue int. 34:843, 1982.
*24. Lipsou, L.G., Premdas, F.H., Molina, J.M.:Studies on dynamic insuli.nr.elease in aging.
The physiologist 25: 288 (abst. 47.8), 1982. ·
*25. Molina, J.M., Premdas, F, H. and Lipson, L.G.! Dynamics ofinsulinsecretion inagirtg
Clin.Res. 31~58A, 1983.
*26. Sharp, G.W.G., Wolheim, C.B., Siegel, E., Lipson,.L.G. and Kraus, Y.: The role of
calmodulin in insulin secretion. International Diabetes Fed. Meeting in Kenya1 November
1982.
*27. Eddlestone, G. T., Oldham, S.B., Lipson, t•.G. and Beigehnan, l? .M.~ Fotskolin inc~:eases
cyclic AMP and potel\tiates electrical activity in the mouse pancreatic B·ce1L Fed. Proc.
42: 897, (abst. 3544), 1983.
' .. 'tl. ..j. -\ d •
62
*28, Eddlestone, o:r., Oldha~ S.B., Lipson, L.G. and Beigelman, P.M.: Forskolin
potentiatiHHS Center Gmnt -· ~·oerlatlic Education Center Gl'ant.'' DFlliS 1031 AH 69000.
$9521000. 10/83 through 9/88. L,G, Lipson, Faculty Coordinator and Membetofthe
Steering Committee.
14. NIH Center Grant~ "Southern California Consortium for the Study of Alzheimer's Disease."
NIA, NIH. 1/85 through 12/89. $750,000/year. L.G. Lipson, Clinical Investigator.
15. John A. Hartford Senior Scholar Award in Geriatric Medicine- at Harvard Medical School.
9/84 tlu·ough 8/85. L.G. Lipson, Award~e.
16. Research Grant from Roerig, Pfizer Pharmaceuticals, ~'Diabetes in Elderly Mexican
Amerlcans ... l/86 through 7/87. $80,000 L.G. Lipson, M.D ..,P.L
17. Research Grantfi.·omRoss Laboratories~ '!Diet and Dementia." 1/88 through 12/89.$37,500.
L.G. Lipson, M.D., P.I.
• •••••••• .. • ol
18. Research Gxant from HoechstPhaw.aoeuticats- "Neuropathy in the Elderly!' 1/83 through
12/89, $27, 500. L.G. Lipson, M.D., P.l.
19. Research Grant fi:om Boehr1n.ge1' Ingelhehn Phannaaccutioals- <'Control of Mild
Hypertension in the Elderly lnnc:r- City Population." 6/88 through 12/8&. $45, 000.
L.G. Lipson, M.D.,P.l.
20. Research Grant from Marion Laboratories- "A New Tl'eatment foJ: Pressure Sores.'' 6/88
through 3/89.$15,000 L.G. Lipson, M.D., P.I. ·
21. Research Gtantfrom Roerig Pharmaceuticals·~ ''Diabetes in the Elderly." 7/1/89-12/31/90.
$15~000, L.G. Lipson, M.D., P.I.
22. Reseru:ch Grant from the John A. HaTtford Foundatiou- '"Prescribing Habits of Physicians in
Retirement Housing." 2/89 through 1/93. $487,000. L.G. Lipson} M.D., P.l.
......... t.~ ...
23. DHHS center Grant- "Geriatric Education Center. u 10/89 through 9/92. $450,000 L.G.
Lipson, M.D. Clinical Site Coordinator, Key Faculty Member, and Member of the
Steering Committee.
24. Gel'iatdc Medicine Fellowship Grant from the Japanese Retirement and Skilled Nursing
Facilities (Keiro Services), 7/88 tiu·ough 7/90, $170,000. L.G. Lipson, M.D., P.I.
2-5. Geriatric Medicine Fellowship Grant from the Motion Picture and Television Retirement
Home and Hospital 7/87 through 6/90. $50,000/year. L.G. Lipson, M:D., P.I.
26. Nffi Research Grant- NIDDK- "Subtle Disturbc:l.nces of Cobalamin Status." 2R01-
DK32640-07. 2/1191 through 1/31/95. $235)827. L,G, Lipson) M.D., Co~Investigator.
, .. ~ l • .., .
66
27. Development Grant- USC Irvine Foundation. Diversity Project. Couxse Development.
!(Diversity in Aging: Roles in Bthnicity, Gender, Biology and Environment.~> 1992·
onward, $5;000, L.G. Lipson, M.D., Course Director and P.r.
28. NIH Research Grant- "Multicenter Ti'ail of Prednisone in Alzheimer's Disease." 1995,
$80,000. L.O. Lipson, M.D., Co-P.I.
29. State ofAlaska- Educational Grant ('Training of Administrators in Long Tenn. Care
Institutions and Health Care Providers and Planners in Special Topics 'of Gerontology
and Gedatrics." 3/l/96- 5120196, $16,000. L.G. Lipson, M.D., Director.
30. Glendale Adventist Medical Center- "Family Practice Residency Training in Geriatric
Medicine!' 7/l/96- 6/30/00, $6,000/year. L.G. Lipson, M.D., DireQtol'.
31. Research Grant from G.D. Searle and Co. ' ·~controll¢d Onset Verapamil Investigation of
Cardiovascular Endpoints." 5/97 through 5/02. $75.000. L.G. Lipson, M.D.~ P.I.
~ ,, ' ...
32. State of Alaska, "Training in Gemphatmacy, Fall P!.'evention, and Quality Assurance in the
frail and demented elderly.'' 4/98~ 111102~ $200~000. L.G. Lipson, M.D .• P.I.
33. Research Grant from Pfizel' Phrumaceuti'9/30/02, $4,000. L.G. Lipson, M.D., P.I.~ 12/31/02.
35, State of Alaska, "Training in Geropharmacy: Quality Assurance in the FtaJ and Demented
Elderly; CQI ofPjoneers' Homes,"l/1/02-12/31/02. $100,000. L.G. Lipson, M.D., P.I.
in
36. State of Alaska, "Training Quality Assuranc~;~ of the Frail and Demented Elderly: CQI of
Pioneers' Homes/' 1/1/03-12/21/03. $100,000 L.G. Lipson, M.D., P.(.
,.,.J;.".. ~IJ...r.l!"'-~,o-.
t ..... •
. 37. State of Alaska- University of Alaska. Alaska Getiatric Education Center~ Consultant
7/1/03 ~ 12/31/04. $18>000.
38. State of Alaska- University of Alaska,. Alaska Geriatric Education Center- Consultant
. 10/1/07- 6/30!08. $10~000.
39. State of Alaska- University of Alaska, Alaska Geriatric Education Center- Consultant
7/1/08-6/30/09. $1 o.ooo.
.. . ... 4 •
"''.
67
Gracy Woods I Nursing Home v. Martha Mahan, as the Representative of the Estate of Mary Rivera
Combined Opinion