You are on page 1of 56

FILED

DALLAS COUNTY
2 CIT ES / JURY DEMAND 11/8/2017 9:37 AM
FELICIA PITRE
DISTRICT CLERK

Manuel Rodriguez
DC-17-15398
CAUSE NO. _________

JULI TREADWELL AND BRYAN IN THE DISTRICT COURT


STEINBORN, Individually, and as
Personal Representatives of the Estate of
O.S.,

Plaintiffs,
______ JUDICIAL DISTRICT
v.

EXCEL ER, LLC d/b/a
EXCEL ER KELLER; AND
BRANDON BAKER MORSHEDI, M.D.,

Defendants. OF DALLAS COUNTY, TEXAS

PLAINTIFFS ORIGINAL PETITION

TO THE HONORABLE JUDGE OF SAID COURT:

NOW COME Juli Treadwell and Bryan Steinborn, individually, and as parents, and

personal representatives of the estate of O.S., their minor daughter at the time of her death,

hereinafter called Plaintiffs, complaining of and Excel ER, LLC d/b/a Excel ER Keller (Excel

ER) and Brandon Baker Morshedi, M.D., hereinafter called Defendants, and for cause of

action would show unto the Court the following:

I. REQUEST FOR LEVEL 3 DISCOVERY CONTROL PLAN

1.01 Pursuant to Tex. R. Civ. P. 190.1, Plaintiffs hereby request that discovery be

conducted under Level 3 of the Texas Rules of Civil Procedure, Tex. R. Civ. P. 190.4.

1.02 Further, Plaintiffs move for an order that discovery be conducted in accordance

with a discovery control plan tailored to the circumstances of this specific case, pursuant to Rule

190.4(a) of the Texas Rules of Civil Procedure.

Plaintiffs Original Petition Page 1


1049208
II. PARTIES AND SERVICE

2.01 Plaintiffs are residents of Tarrant County, Texas, and Plaintiffs address is 4924

Cargill Circle, Keller, Texas 76244.

2.02 In compliance with Tex. Civ. Prac. & Rem. Code 30.014, Plaintiff Juli

Treadwell states the last three digits of her social security number are 113, and the last three

digits of her Texas drivers license number are 753. Plaintiff Bryan Steinborn states the last

three digits of his social security number are 684, and the last three digits of his Texas drivers

license number are 920.

2.03 Defendant Excel ER, LLC d/b/a Excel ER Keller is a Domestic Limited Liability

Corporation with its principle place of business at 55 Republic Dr. Suite 109, Plano, TX 75074-

5427 , and may be served by serving its registered agent, Christopher Kwon, at 4523 Marbrook

Meadow Lane, Katy, TX 77494.

2.04 Defendant Brandon Baker Morshedi, M.D., an Individual who is a resident of

Texas, may be served with process at his home, 1818 Mesa Ct., Garland, TX 754040-8288, or

his place of employment at the following address: 5323 Harry Hines Blvd., Suite E4.300,

Dallas, TX 75390-8288, or wherever he may be found.

III. JURISDICTION AND VENUE

3.01 Jurisdiction is proper because the damages sought are within the jurisdictional

limits of this Court. Tex. R. Civ. P. 47.

3.02 Venue in Dallas County is proper in this cause under Section 15.002(a)(2) of the

Texas Civil Practice and Remedies Code because Defendant Morshedi is a resident of, and his

primary place of employment is located in, Dallas County, Texas.

Plaintiffs Original Petition Page 2


1049208
IV. TEX. R. CIV. P. 47 STATEMENT

4.01 Plaintiffs state that they seeks monetary relief over $1,000,000 and a demand for

judgment for all the other relief to which the Plaintiffs may deem themselves to be justly

entitled.

V. TEXAS CIVIL PRACTICES AND REMEDIES CODE 74.351


EXPERT REPORT REQUIREMENT

5.01 Pursuant to Texas Civil Practices and Remedies Code, Section 74.351, the

following expert reports and curriculum vita are attached hereto and apply to Defendants

Morshedi and Excel ER, and are being served simultaneously with this Original Petition.

(a) Expert report of Kenneth Corre, M.D., attached hereto as Exhibit 1;

(b) Curriculum vitae of Kenneth Corre, M.D., attached hereto as Exhibit 2;

(c) Expert report of Armando Correa, M.D., attached hereto as Exhibit 3; and

(d) Curriculum vitae of Armando Correa, M.D., attached hereto as Exhibit 4.

VI. FACTS

6.01 The minor child, O.S., was 4-years-old when she presented by her parents to the

Excel ER - Keller, a freestanding Emergency Room (ER) in Texas, on 8/7/16 at approximately

1:58 AM. She was triaged by the nursing staff at 0214 with a Chief Complaint of fever,

although she was afebrile (without fever) in the ER. The nursing assessment further notes that

O.S. had normal skin turgor, was not crying, has no mental deficits but is nonverbal and has

limited signing skills. On the Patient Safety Screening, O.S. was not developmental age

appropriate deaf, nonverbal, limited signing ability.

6.02 O.S. was then examined and cared for by Dr. Brandon Morshedi, who was

moonlighting at the Excel ER during his third year of residency in emergency medicine. There

Plaintiffs Original Petition Page 3


1049208
was no evidence in the medical records that any other supervising physician was present at

Excel ER- Keller, much less participated in the care of O.S. in any way whatsoever.

6.03 The date and time that Dr. Morshedi completed his records is not clear. Dr.

Moshedi acknowledges the childs fever at home, but does not document the maximum

temperature that had been reached at home (Tmax). Dr. Morshedi notes O.S. had vomited only

once the morning before coming to the ER, with no diarrhea. He notes that O.S. had a right-

sided cochlear implant and a history of multiple acute ear infections, known as AOM or

Acute Otitis Media, which were frequently treated with antibiotic ear drops. O.S. does not

normally react to her ear infections with ear pulling, but will typically actively have purulent

(pus) drainage from the ear during the infections. O.S.s parents had not reported any recent ear

drainage. The childs last dose of Tylenol (APAP) prior to presentation to Excel ER- Keller was

about 6 hours ago, with no measured fever since the previous night.

6.04 O.S. was taking little fluids by mouth, but was tolerating them well when she did

take them. Dr. Morshedis ROS (Review of System) was negative for skin rash, and O.S. was

noted to have decreased activity.

6.05 On physical exam, the childs vital signs were as follows: pulse 160 (a

significant abnormal elevation known as tachycardia), respiratory rate 52 (a significantly

abnormal elevation, known as tachypnea), pulse oximetry 95% on room air, temperature of

97.9, pain rated 4 on a scale of 0-10. There is no note of O.S. crying at the time these vitals were

obtained. She certainly met Systemic Inflammatory Response Syndrome (SIRS) criteria. Her

left tympanic membrane (ear drum) was negative for redness, but the right ear had a

tympanostomy tube in place, was red, but was void of discharge. O.S. was found to be alert,

awake, consolable, able to track and not confused or agitated.

Plaintiffs Original Petition Page 4


1049208
6.06 Dr. Morshedis listed primary differential diagnostic considerations were, in this

order: Dehydration, Electrolyte disorder, Otitis Media, UTI and Viral Syndrome. There was no

mention of SIRS or meningitis.

6.07 Dr. Morshedi ordered lab tests including a CBC and comprehensive metabolic

panel. Additionally, an in/out catheter was utilized to get a sterile specimen for urinalysis. No

blood cultures were obtained. The child was hydrated with a total of 40cc/kg of normal saline or

520cc over the course of her stay, with 50cc total of urine output, although some urine was lost

around an initial urine bag. This is very concerning as there should be more significant urine

output, given the amount of fluids she had been given. No IV or oral antibiotics were ordered

or given. The CBC lab results revealed a marked leukopenia (abnormally low white blood count

or WBC) of 1,100 (normal = 3,500 to 10,000) which was left-shifted. O.S.s blood was also

notably thrombocytopenic (abnormally low platelet count) at 78,000 (normal = 100,000 to

400,000). Her urine manifested no infection and had a specific gravity of 1.015.

6.08 Despite aggressive IV hydration and no vomiting or diarrhea at Excel ER, O.S.

remained tachycardic and tachypneic, and with the above total urine output and no

documentation of significant urine loss around the initial urine bag. On discharge, O.S. was

tachycardic (161), tachypneic (38), and was beginning to be hypothermic (97.4) (her

temperature had actually fallen), with a blood pressure in the normal range, although a fall from

an earlier measurement. O.S. was discharged home at 4:44 AM.

6.09 At around 9:45 AM, O.S.s father found her cold and blue with vomitus

around her face. O.S.s parents immediately transported her back to the Excel ER (which was

miutes from their home), arriving slightly before 10:00 AM, where she was found be in full

Plaintiffs Original Petition Page 5


1049208
cardiopulmonary arrest and again treated by Dr. Morshedi. Resuscitation efforts were

unsuccessful and she was pronounced deceased at 10:28 AM on 8/7/16.

6.10 The subsequent autopsy by the Tarrant County Examiner showed pneumococcal

meningitis as the primary cause of her death. The autopsy also revealed the presence of a

petechial rash.

VII. CLAIMS FOR RELIEF

A. Negligence of Excel ER, LLC d/b/a Excel ER Keller

7.01 Plaintiffs allege that the Defendant, Excel ER, LLC d/b/a Excel ER Keller,

violated the duty of care they owed to O.S. to exercise that degree of care, skill, supervision,

and diligence ordinarily possessed and used by nurses and health care providers under the same

or similar circumstances. Defendant, Excel ER, LLC d/b/a Excel ER Keller, by and through its

nurses, physicians, agents, employees, and apparent and/or ostensible agents was willfully and

wantonly negligent in the following respects and particulars among others:

(a) Failing to properly staff its facility with appropriately qualified and experienced
physicians;

(b) Failing to properly evaluate the condition of O.S., when she presented to the
Excel ER Keller facility;

(c) Failing to properly transfer O.S. to a hospital or health care facility, on a stat
basis, which was capable of handling the condition of this child;

(d) Improperly discharging O.S. home, in spite of numerous signs and symptoms of
a significant illness and ongoing systemic infection;

(e) Failing to institute the chain of command when it became apparent that Dr.
Morshedi did not appreciate and treat the immediate distress suffered by O.S.;
and

(f) Others acts and omissions anticipated to be discovered.

Plaintiffs Original Petition Page 6


1049208
7.02 Plaintiffs would show that each and every aforementioned act or omission,

singularly and severally, constitute negligence on the part of Defendant Excel ER, LLC d/b/a

Excel ER - Keller, which was a direct and proximate cause of the death of O.S., as well as the

injuries and damages sustained by Plaintiffs.

7.03 Any and all acts or omissions constituting negligence and/or malpractice by the

nurses and defendant Brandon Baker Morshedi, M.D., are imputed to Excel ER, LLC d/b/a

Excel ER Keller under theories of master-servant relationship, principal agent relationship,

other agency theories, and/or respondeat superior.

B. Negligence of Brandon Baker Morshedi, M.D.

7.04 Defendant, Brandon Baker Morshedi, MD, provided medical care and treatment

to O.S. while at Excel ER Keller. Defendant, Brandon Baker Morshedi, MD, violated the duty

of care he owed to O.S. to exercise that degree of care, skill, supervision, and diligence

ordinarily possessed and used by other physicians under the same or similar circumstances.

Brandon Baker Morshedi, MD was willfully and wantonly negligent in the following respects

and particulars among others:

(a) Failing to properly diagnose and treat the meningitis of O.S. and failing to
consider the cochlear ear implant in light of O.S.s condition;

(b) Failing to properly evaluate the condition of O.S., when she presented to the
Excel ER Keller facility;

(c) Failing to properly transfer O.S. to a hospital or health care facility, on a stat
basis, which was capable of handling the condition of this child;

(d) Improperly discharging O.S. home, in spite of numerous signs and symptoms of
a significant illness and ongoing systemic infection;

(e) Failing to notify a supervising physician of the condition of the child; and

(f) Others acts and omissions anticipated to be discovered.

Plaintiffs Original Petition Page 7


1049208
7.05 Plaintiffs would show that each and every aforementioned act or omission,

singularly and severally, constitute negligence on the part of Defendant Brandon Baker

Morshedi, MD, which was a direct and proximate cause of the death of O.S., as well as the

injuries and damages sustained by Plaintiffs.

VIII. GROSS NEGLIGENCE

8.01 The above cited acts and/or omissions by Defendants amount to gross negligence

because, when viewed objectively from Defendants standpoint at the time in question, such

acts and/or omissions involved an extreme degree of risk, considering the probability and

magnitude of potential harm, of which Defendants had actual, subjective awareness of the risk

involved, but nevertheless proceeded with conscious indifference and/or malice with regard to

the rights, safety, or welfare of others. For gross negligence, Plaintiffs seek exemplary damages,

in addition to economic and noneconomic damages, in an amount within the jurisdictional limits

of this Court.

8.02 The gross negligence of the Defendants was a proximate cause of the injuries

and damages suffered, and death of O.S., as well as injuries and damages to the Plaintiffs,

including loss of love, companionship, and enjoyment of their daughter, O.S.

IX. DAMAGES

9.01 As a direct and proximate result of the negligent acts and/or omissions of the

Defendants as set out above, O.S. suffered severe and permanent physical and emotional

injuries and death. Plaintiffs seek recovery for past medical expenses, including funeral and

burial expenses, physical pain and mental anguish and loss of love, companionship, and

enjoyment of their daughter, O.S.

Plaintiffs Original Petition Page 8


1049208
9.02 As a direct and proximate result of the negligent acts and/or omissions of the

Defendants as set out above, Plaintiff Juli Treadwell, as the biological mother of O.S., deceased,

has suffered damages of a pecuniary nature, including reasonable and necessary medical

expenses incurred in the care and treatment of herself. Mrs. Treadwell has also incurred the loss

of other services of a pecuniary nature reasonably expected from a child up and until the age of

majority, and any contributions of a monetary value a parent might reasonable expect to receive

from her child after the child reaches the age of majority. Mrs. Treadwell has also suffered in

the past, and reasonably expects to continue suffering in the future mental anguish and loss of

companionship and society. Mrs. Treadwell seeks to recover all personal injury damages

available to her under the Texas Wrongful Death Statute within the jurisdictional limits of this

court.

9.03 As a direct and proximate result of the negligent acts and/or omissions of the

Defendants as set out above, Plaintiff Bryan Steinborn, as the biological father of O.S.,

deceased, has suffered damages of a pecuniary nature, including the other services reasonably

expected from a child of a pecuniary nature up and until the age of majority, and any

contributions of a monetary value a parent might reasonable expect to receive from his child

after the child reaches the age of majority. Mr. Steinborn has also suffered in the past, and

reasonably expects to continue suffering in the future mental anguish and loss of companionship

and society. Mr. Steinborn seeks to recover all personal injury damages available to him under

the Texas Wrongful Death Statute within the jurisdictional limits of this court.

9.04 Plaintiffs seek punitive and exemplary damages to which they are entitled.

9.05 All of the above have resulted in damages which are within the jurisdictional

limits of this Court, for which Plaintiffs now plead against Defendants.

Plaintiffs Original Petition Page 9


1049208
X. DISCOVERY

10.01 Pursuant to TEX. R. CIV. P. 194, Plaintiffs request disclosure for each and every

Defendants of those items contained in 194.2 (a)-(l). Upon service of citation, along with this

Original Petition and Request for Disclosure, Defendants are required to respond to this Request

for Disclosure within FIFTY (50) days hereafter.

XI. JURY DEMAND

11.01 Plaintiffs respectfully request that the trial of this cause be by jury and Plaintiffs

will tender the jury fee.

XII. PRAYER

12.01 Plaintiffs pray that the Defendants be cited to appear and answer herein, and that

upon final determination of these causes of action, Plaintiffs receive a judgment against

Defendants, awarding Plaintiffs as follows:

(a) Actual damages alleged herein, in an amount within the jurisdictional limits of

the Court;

(b) Exemplary damages in an amount within the jurisdictional limits of the Court;

(c) Costs of court;

(d) Prejudgment interest at the highest rate allowed by law from the earliest time

allowed by law;

(e) Interest on the judgment at the highest legal rate from the date of judgment until

collected; and

(f) All such other and further relief at law and in equity to which the Plaintiffs may

show themselves to be justly entitled.

Plaintiffs Original Petition Page 10


1049208
Respectfully submitted,

MILLER WEISBROD, L.L.P.

/s/ Les Weisbrod


LES WEISBROD
State Bar No. 21104900
lweisbrod@millerweisbrod.com
ROBERT WOLF
State Bar No. 24028234
rwolf@millerweisbrod.com
SAM BALDWIN
State Bar No. 24103562
sbaldwin@millerweisbrod.com
11551 Forest Central Drive
Forest Central II, Suite 300
Dallas, Texas 75243
(214) 987-0005/phone
(214) 987-2545/fax

ATTORNEYS FOR PLAINTIFFS

Plaintiffs Original Petition Page 11


1049208
EXHIBIT 1
Kenneth A. Corre, M.D., FACEP
P.O. Box 48771
Los Angeles, CA 90049

October 16, 201 7

Les Weisbrod, Esq.


Miller Weisbrod, LLP
11551 Forest Central Drive, Suite 300
Dallas, Texas 75243

Re: Olivia Steinborn

Dear Mr. Weisbrod:

Thank you for allowing me to review the Olivia Steinbom case and proffer objective
opinions based on the standard of care and reasonable medical probability. I have attached to my
report a copy 0f my curriculum Vitae that sets forth my qualications as an expert in this case. I

have been in the continuous practice 0f emergency medicine for over 30 years. I received my
medical degree at the University of California at Los Angeles (UCLA) in 1980. After
graduation, I completed my rotating internship at HarborUCLA Medical Center, California.
After my completed a residency in Emergency Medicine ending in 1983, at the
internship, I

same institution. Immediately thereafter, I entered the private practice of emergency medicine
and have practiced fulltime, handson clinical emergency medicine to the current time.

I concomitantly served as the Medical Director of the emergency department at Simi


Valley Hospital in Simi Valley, California from 19932003. I am currently an Associate Clinical
Professor 0f Medicine at CedarSinai Medical Center through UCLA since 2005 With frequent
clinical instruction to residents, physician assistants, and nurse practitioners who rotate through
the ER. I also participate in the clinical training of nurses. Ihave expectations of and rely on
nurses and others, and I supervise the nurses. I am familiar with the standard 0f care as it relates
to nursing, in this regard.

Over the years I have served 0n numerous hospital-based, as well as county, committees.
I have served as a reviewer for the Medical Board 0f California. From 2006 to 201 1, I served as
a reviewer for Medicare federal review agencies. Additionally, I became board certied in
health care quality management in 1990 and sat 0n their Ethics Committee until 2016, formerly a
CoChair.

I was originally board certied by the American Board 0f Emergency Medicine in 1983

and since that time I have recertied three times, with my last 10-year recertication in 2013. I
have authored medical articles that have been published in peer reviewed journals, most recently
2009. I have never been disqualied as an expert in court when rendering an expert opinion.
As an emergency department physician, who was emergency physician
practicing as an
in August 2016, I am also familiar with the standard of care as emergency medicine
it applies to
for hospitals, emergency department physicians, nurses, physician assistants, and other ancillary
personnel, including the standard of care for treating a child with a cochlear implant in an
emergency department setting. I work with emergency physicians, nurses, physician assistants,
and ancillary personnel nearly on a daily basis and I am therefore familiar with the standard 0f
care and expectations for nurses When a patient similar to Olivia Steinborn is being seen and
treated in the ER.

Records Reviewed

have reviewed and relied uponthe following materials in connection with this matter,
I

which are the type reasonably relied upon by experts in the eld of emergency medicine of
patients presenting with a dislodged tracheostomy:

1. Excel ER ~ Keller 08/07/ 16

2. Autopsy Report

3. Statement of Juli Treadwell

4. Statement of Bryan Steinborn

Histogx

Olivia Steinbornwas 4-yearsold when she presented by her parents to the Excel ER, a
freestanding ER in Texas,on 8/7/16 about 1:58 AM. She was triaged by the nursing staff at 0214
with a Chief Complaint of fever, although she was afebrile in the ER. The nursing assessment
funher notes that the child had normal skin turgor, was not crying, has no mental decits but is
nonverbal and has limited signing skills. On the Patient Safety Screening, the child was n_ot
developmental age appropriate. .. deaf, nonverbal, limited signing ability. Unable to fully
assess,

The child was then examined and cared by Dr. Brandon Morshedi, moonlighting at
for
the Excel ER during his third year of residency in emergency medicine. The date and time that
he completed his records is not clear. Dr. Moshedi acknowledges the fever at home, but does not
document the maximum temp that had been reached at home (Tmax). Dr. Morshedi notes the
child had vomited only once the morning before coming to the ER, no diarrhea. He notes that the
child had a rightsided cochlear implant and a history of multiple acute ear infections (AOM =
Acute Otitis Media) equently treated with antibiotic ear drops. Thechild does not normally
react to the AOM with ear pulling, but will actively have purulent (pus) drainage from the ear at
times. The parents had n_ot reported any recent ear drainage. Last dose of Tylenol (APAP) was
about 6 hours ago, With no measured fever since the previous night.
The child was taking little PO
(by mouth) uids, but tolerating them well when she does
take them. The ROS (Review of System) was negative for skin rash, and the child was noted to
have decreased activity; the rest of the systems negative. The Past Medical History was positive
for deafness and recurrent otitis (AOM).

On physical exam, the Vitals were: pulse l_6_0 (a signicant abnormal elevation),
; (a signicant abnormal elevation), pulse oximetry 95% 0n room air (normal),
respiratory rate
temperature 97.9, pain rated 4 on a scale of 0-10. There is no note of the child crying at the time
these Vitals were obtained. She certainlymet SIRS criteria. The neck was documented to be void
0f adenopathy and meningeal signs. The nose and oral membranes were normal. The left
tympanic membrane (ear drum) was negative for redness, but the right had a tympanostomy tube
in place, was red, but was void 0f discharge. The childs eyes were documented as normal. The
heart was tachycardic (abnormally fast heart rate) and she was tachypneic (abnormally fast
breathing 0r respiratory rate), but no increased work 0f breathing. No swollen lymphnodes
(adenopathy) were found anywhere. Skin turgor was documented as normal. The child was
found t0 be alert, awake, consolable, able t0 track and not confused or agitated.

Dr. Morshedis listed primary differential diagnostic considerations were, in this order:
Dehydration, Electrolyte disorder, Otitis Media, UTI and Viral Sydrome.

Lab tests were obtained including blood for CBC and comprehensive metabolic panel and
an in/out catheter was utilized to get a sterile specimen for urinalysis. No blood cultures were
obtained. The child was hydrated with a total of 40cc/kg of normal saline or 520cc over the
course of her stay, With 500C total 0f urine output, although some urine was lost around an initial

urine bag.
(abnormally
No IV
low white blood count 0r WBC) 0f w
or oral antibiotics were given. The CBC revealed a marked leukopenia
(normal = 3,500 to 10,000) which was
left-shjfted. The patients blood was also notably thrombocytopenic (abnormally low platelet

count) at 78,000 (normal = 100,000 t0 400,000). The urine manifested n0 infection and had a
specic gravity of 1.015.

Despite aggressive IV hydration and n0 vomiting 0r diarrhea, the child remained


tachycardic and tachypneic, and With the above total urine output and no documentation of
signicant urine loss around the initial urine bag. On discharge, the child was tachycardic (161),
tachypneic (3 8), hypothermic (97.4) (the temperature had actually fallen), with a blood pressure
in the normal range, although a fall from an earlier measurement. Olivia Steinbom was
discharged home at 4:44 AM.

At around 9:45 AM the father found Olivia cold and blue with vomitus around her
face. The parents transported the child back t0 the Excel ER, arriving around 10:00 AM, Where
she was found be in full cardiopulmonary arrest and again treated by Dr. Morshedi. Resuscitation
efforts were unsuccessful and she was pronounced deceased at 10:28 on 8/7/16. AM
The subsequent autopsy by the Tarrant County Examinr showed the presence of
pneumococcal meningitis. Also found were Otitis Media and a Petechial rash.
EXHIBIT 1
The following additional actions were required to be ordered by Dr. Morshedi in order to
meet the standard 0f care (but which did not occur):

STAT lumbar spinal tap


Blood + urine cultures
Blood for coagulation studies
STAT chest Xray
STAT IV antibiotics
STAT infectious disease consultation
STAT transfer to a higher level of care
Antibiotic prophylaxis to the childs parents, ER staff and physician

Failure to Met the Standard of Care Dr. Brandon Morshedi

When Olivia entered the Excel ER


on 8/7/16, she was critically ill and this would have
been obvious (and frightening) to an emergency physician practicing at the standard 0f care. She
had only one day of illness, a history of fever (Tmax not documented), possibly under the
treatment inuence of Tylenol. She was signicantly tachycardic and tachypneic, especially
notable in the absence of fever and signicant dehydration. Olivia was deaf, minimally
communicative, young (4yo) and, at least according to the RN, not developmentally appropriate
for her age. These factors also make it much more important t0 err 0n the side of patient safety.
Further, her presentation here for AOM was 1191 her typical presentation for AOM.
Moreover, Olivia, in particular, was at risk for meningitis and sepsis given her acute and
multiple recurrent OM infections / chronic right ear infections prompting a right tympanostomy
tube and the presence of a right cochlear implant.

Given of the above factors, prior t0 testing, not only should Dr. Morshedis
all

differential diagnoses have included Sepsis and Meningitis, but also these conditions should have
been prioritized to the top 0f the differential diagnosis list and ruled out. Inexplicably, none of
this happened.

Olivia Steinborns test results were ominous. The WBC was profoundly low or
neutropenic at 1,100 with a predominance of neutrophils, although the absolute neutrophil count
was markedly 10w at 645. The platelets were similarly depressed. All this was indicative of
meningitis/sepsis, until proven otherwise. Dr. Morshedi failed to meet the accepted standard of
care by failing t0 take these critical values into account When providing care and treatment to this
patient.

Further, urine output was paltry (taking into account urin lost around the urine bag)
considering the child was given over onehalf liter IV
crystalloid hydration by bolus. There was
no mechanism for this child to have had any signicant dehydration; no stigmata of signicant
dehydration were found on the exam; the urine was fairly dilute With a specic gravity 0f 1.015;
the ketones were negative. All this further pointed to meningitis/sepsis and away from volume
depletion as the source of her abnormalities.
Additionally, Dr. Morshedi failed to take into account the increased risk of meningitis for
children who have cochlear implants, such as the one implanted in the ear 0f Olivia Steinborn.

Olivia remained tachycardic and tachypneic in the ER up to the time of discharge. The
childs temperature actually fell to 97.4 as did the blood pressure. These items (as well as all
those above) trump any improvement that Dr. Morshedi felt occurred during her course in the
department.

Dr. Morshedi further failed t0 meet the standard of care by failing to order blood and
urine cultures, by failing to obtain blood for coagulation studies, and for failing to order a stat
chest x-ray, stat IV antibiotics, and a' stat infectious disease consultation. If any of these were
unavailable to Dr. Morshedi in the Excel ER, that is further reason Why he should have
immediately ordered a stat transfer to a higher level 0f care.

Olivias condition in the ER


and the most likely source of infection did 1391 warrant
shared patient decision making in the treatment and prognosis with the parents. It did require
Dr. Morshedi to practice at the standard of care, to be decisive and proactive in expediting
Olivias proper workup, treatment, and disposition. This did not happen.

Olivia was discharged from the rst ER visit to Dr. Morshedi with the following
diagnoses: Serous Otitis Media of the right ear; Fever; Dehydration. Instead she should have
been diagnosed as follows: Meningitis; Sepsis; Right Otitis Media. Dr. Morshedi failed t0 meet
the standard of care by failing t0 transfer Olivia to a higher level 0f care (to a PICU), and by
instead discharging her home.

Standard 0f Care and Actions Required to Meet the Standard of Care Nurses at Excel
ER

The standard 0f care required the nurses to do the following, Which they did not perform:

o Identify a critically sick/ill child


o Realize that the child was not signicantly dehydrated
o Properly understand and report the CBC

The following additional actions were required in the ER on 8/7/16 to meet the standard and did
not occur:

Notify the physician regarding the above abnormalities I

Go up the chain of command should the physician disagree


Advocate for mher testing and IV antibiotics

Refuse to discharge this child in favor 0f admission/transfer


Failure to Meet the Standard of Care Nurses

When Olivia entered the Excel ER 0n 8/7/16, she was critically ill and would have
this

been obvious (and frightening) to an emergency nurse practicing at the standard of care. She had
only one day of illness, a history of fever (Tmax not documented) but possibly under the
treatment inuence 0f Tylenol. She was signicantly tachycardic and tachypneic, especially
notable in the absence of fever and signicant dehydration. Olivia was deaf, minimally
communicative, young (4y0) and, not developmentally appropriate for her age. The nursing
assessment further notes that the child had normal skin turgor, not crying, has no mental decits
but is nonverbal and has limited signing skills. On the Patient Safety Screening, the child was
n_ot developmental age appropriate... deaf, nonverbal, limited signing ability. Unable to fully
assess. These factors make the diagnosing that much more difcult and, thus, more important to
'

err on the side of patient safety.

Despite aggressive IV hydration and n0 vomiting or diarrhea in the ER, the child
remained tachycardic and tachypneic, and With the above total urine output and no
documentation of signicant urine loss around the initial urine bag. On discharge, the child was
tachycardic (161), tachyp'neic (38), hypothennic (97.4) (the temperature had actually fallen),
With a blood pressure in the normal range, although a fall from the earlier measurement. Olivia
Steinborn was discharged home at 4:44 AM. Practicing at the standard 0f care, the nurses would
have known that Morshedis diagnosis of Dehydration was erroneous, that Olivia was not
signicantly dehydrated. Further, her response to aggressive IV hydration was poor. Her
tachycardia and tachypnea had to be relegated t0 a serious cause, one mitigating against
discharge.

The test results were ominous. The WBC was profoundly 10W or neutropenic at 1,100
with a predominance of neutrophils, although the absolute neutrophil count was markedly 10W at
645. The platelets were similarly depressed. The abnormality of these lab values was further
emphasized as being outside of the normal ranges as provided 0n the lab result report. All this
was indicative of a serious infection, until proven otherwise.

Further, unine output was paltry (taking into account urine lost around the urine bag)
considering the child was given over one-half liter IV crystalloid hydration by bolus. There was
no mechanism for this child t0 have had any signicant dehydration; no stigmata 0f signicant
dehydration were found on the exam; the urine was fairly dilute with a specic gravity of 1.015;
the ketones were negative. All this further pointed t0 a serious infection, until proven otherwise.

Given all 0f the above, the nurses at Excel ER failed to meet the accepted standard of
care When they inappropriately discharged Olivia Steinborn home. Instead, in order t0 meet the
accepted standard of care, the nurses should have advocated! for a transfer to a higher level of
care for this sick child. The nurses should have initiated the chain of command when Dr.
Morshedi discharged the patient home, if he were not amenable to changing his plans.
Specically, the nurses should have had a discussion with Dr. Morshedi and advocated for the
patient t0 have a further workup (lumbar puncture), treatment (IV antibiotics), and to be
transferred to a higher level of care on a stat basis. If Dr. Morshedi failed t0 take such
appropriate actions, then the nurses were required (and failed) t0 discuss the inappropriate
discharge With the nursing supervisor/charge nurse and/or the Director of Nursing. Additionally,
in order to meet the accepted standard of care, the nurse and/or nurse supervisor/charge
nurse/Director 0f Nursing should have contacted the Excel ED Medical Director t0 intervene,
including possibility of coming in to evaluate this patient immediately. The nurses at Excel ER
failed to initiate and perform this chain of command and as such violated the accepted standard
0f care.

Medical causation

was predictable and foreseeable given the negligent and grossly


Sadly, Olivias outcome
negligent deciencies in her care by Dr. Morshedi and the nurses at Excel ER. When it comes t0
bacterial infections such as meningitis and/or sepsis, the longer it takes to negotiate appropriate
IV antibiotic treatment, the worse the Outcome for a child.

It is well-known in medical literature (and common medical sense) that children with
cochlear implants are at an increased risk of meningitis from bacteria. The blood culture report
from Olivia Steinborns autopsy indicated a heavy growth of streptococcus pneumonia and
showed a gram stain With many gram-positive cocci in chains. This is clear evidence of a severe
infection present at the time the blood was collected at autopsy. In reasonable medical
probability, the infection was present at the time of the childs rst admission to Excel ER on
August 7, 2016, but grew and worsened during her Visit at the facility as well as after her
discharge.

Without the administration of appropriate antibiotics, this bacteria present in the childs
body is permitted to grow unfettered and in reasonable medical probability crossed the
blood/brain barrier. Once the bacteria crossed the blood/brain barrier, the childs brain was
unable to function appropriately, also affecting her other organ systems.

If Dr. Morshedi ordered the and further workup himself, or if Olivia was
antibiotics
transferred on a stat basis t0 a higher level of care (in which stat antibiotics would have been
ordered for her), then antibiotics would have been able to begin the process 0f eradicating the
bacteria Which was growing out of control in Olivia Steinborns body. The ability for the growth
of the bacteria would have been discontinued, and existing bacteria would have been eradicated.

Therefore, in reasonable medical probability, had Dr. Morshedi and the nurses at Excel
ER 9g discharged Olivia Steinborn and had they instead kept her at Excel ER to administer stat
antibiotics and transferred her to a higher level of care, Olivia Steinborns streptococcus
pneumonia would have stopped growing and would have begun the process of
bacterial infection
eradication/healing. Then, Within reasonable medical probability, Olivia Steinbom would not
have suffered her cardiopulmonary arrest and ultimate, untimely death.

The management of Olivia Steinbom on 8/7/16 by Dr. Morshgdi at Excel ER Keller, as


set forth above, was grossly negligent based on the above denitions, and represented willful and
wanton mismanagement of care, which directly resulted in the failure to delay the diagnosis and
treatment 0f the childs meningitis/sepsis. The failure 0f Dr. Morshedi to acknowledge the
profoundly neutropenic WBC count at 1,100, along with a markedly 10w platelet count and
neutrophil count as being consistent with sepsis was grossly negligent. Additionally, this was
not a child who was merely dehydrated with an ear infection her temperature continued t0
decrease at the facility, her urine was fairly dilute and ketones were negative this is not
consistent with dehydration, and her clinical picture was of a more serious problem
clearly that
(meningitis) for a child with a cochlear implant. Dr. Morshedi then decided to discharge the
childhome, as opposed t0 sending her to a higher level of care on a stat basis, Which was willful
and wanton negligence, and a complete disregard for the rights, safety, and welfare of this child.
The negligence and gross negligence of Dr. Morshedi proximately caused Olivias
cardiopulmonary arrest and demise.

The management of Olivia Steinborn 0n 8/7/16 by the nurses at Excel ER Keller, as set
forth above, was grossly negligent based on the above denitions, and represented willful and
wanton mismanagement of care, Whichdirectly resulted in the failure t0 delay the diagnosis and
treatment of the childs meningitis/sepsis. The role 0f the nurses is t0 advocate for their patients.
In this situation, the nurses were presented With an acutely ill child, With a profoundly low WBC,
neutrophil count, and platelet count. The nurses also were presented With a child Whose
temperature continued to fall at Excel ER. This is not the type of child Who should be
discharged home, yet the nurses discharged the patient without questioning the order or serving
as an advocate for this child, which was willful and wanton negligence and a complete disregard
for the rights, safety, and welfare of this child. The negligence and gross negligence of the
nurses of Excel ER proximately caused Olivias cardiopulmonary arrest and demise.

But and gross negligence of Dr. Morshedi and the nurses at Excel ER;
for the negligence
Olivia Steinborn would not have suffered her cardiopulmonary arrest and untimely death, in
reasonable medical probability.

My opinions are expressed to a reasonable degree of medical probability based on the


information provided to me as of the date of this report, listed above. I reserve the right to change
or supplement this report as additional materials become available.

Respectfully,

/4/9
Kenneth A. Corre, MD, FACEP
EXHIBIT 2
CURRICULUM VITAE

KENNETH A. CORRE, M.D., F.A.C.E.P.

Date of birth: June 29, 1953


Place of birth: Long Beach, California
Nationality: U.S.A.
Marital Status: Married (1978: Bonnie Corre, Ph.D.)
Children: Four

EDUCATION

Resident, Emergency Medicine, Harbor-UCLA Medical Center, 1981-1983


Intern, Flexible, harbor-UCLA Medical Center, 1980-1981
University of California at Los Angeles, School of Medicine: MD, 1980.
University of California at Los Angeles: BA, Biology

HOSPITAL-BASED POSITIONS

Full-time Attending Staff, Emergency Department, Cedars-Sinai Medical Center


(Los Angeles), 1/04 - current. Major teaching and service hospital. Level I
Trauma Center, Pediatric Trauma Center, Pediatric Medical Center, and EDAP,
with over 75,000 visits yearly. Resident, PA, and NP teaching responsibilities,
including chart reviews. Member of the ED Department with meetings that
include CME, QA responsibilities including peer review, chart reviews, policies

Part-time Attending Staff, Emergency Department, Queen of the Valley Hospital,


(West. Covina, CA) 2/10 to 2012. Level II, approx. 50,000 visits per year.

Part-time Attending Staff, Emergency Department, Little Company of Mary


Hospital (Torrance, CA) 3/05 to 11/07. Level II, approx. 50,000 visits per year.

Asst. Medical Director, Emergency Services, Simi Valley Hospital, 11/02 to


10/03.

Medical Director, Emergency Services, Simi Valley Hospital. 4/93 to 11/02.


Level II paramedic and helicopter-receiving facility seeing 2100 patients per
month. Full-time clinical work plus responsible for overall functioning of the
department including meeting and exceeding JCAHO and EMTALA ever-
changing requirements.

Assistant Medical Director, Department of Emergency Medicine, Midway Hospital


Medical Center (1988-2002) and Valley Presbyterian Hospital (1990-2001) April
1993 to 11/02 . Full-time clinical work throughout.
Full-time Attending Staff, Department of Emergency Medicine, Cedars-Sinai
Medical Center, 1983 - 1988. Major teaching and service hospital. Level I
Trauma Center, with Resident teaching responsibilities. Included training
programs for nurses, house staff, paramedics.

Part-time Attending Staff, Department of Emergency Medicine, Queen of the


Valley Hospital, West Covina California, 2010-2012. Level II, approx 50,000
visits per year.

Part-time Attending Staff, Department of Emergency Medicine, Pioneer Hospital


Medical Center, 9/88 - 6/90.

Part-time Attending Staff, Department of Emergency Medicine, Doctor's Hospital


of Lakewood, 1983 1989.

Part-time Attending Staff, Department of Emergency Medicine, California


Hospital Medical Center, 1981 1983.

Part-time Attending Staff, Department of Emergency Medicine, Beverly Hills


Medical Center, 1981 - 1982.

Research Assistant, Physiology, Department of Cardiovascular and Thoracic


Surgery, summers 1978 and 1979.

Emergency Room Technician, Santa Monica Hospital Medical Center and


Beverly Hills Medical Center, 1973 1978.

NON-HOSPITAL BASED POSITIONS

Chief Financial Officer, Equality Emergency Medical Group, Inc. which


contracted full Emergency Medical Services at Midway Hospital Medical Center
in Los Angeles (8/1/88-2003), Valley Presbyterian Hospital in Van Nuys ( 7/1/90-
1999), and Simi Valley Hospital (4/01/93 to 10/04). Co-managing partner
responsibilities with full management of group billing, peer review, chart reviews.

Medical Director for United Insurance Company of America (Woodland Hills,


CA)-- primary insurer and third party administrator. Responsible for retrospective
utilization review of physician billings from across the U.S. based on standard of
care, medical necessity determination, contractual terms; appeals; surgical pre-
authorization; participation in discussions on experimental procedures and
protocols. Member of Claims Review Committee. Chart review major
component to responsibilities. 1986 - 1997.
Medical Consultant for Escobar Diversified Services (Torrance, CA). UR and
case management for a middle-sized, third party administrator, 1988 - 1989.

Medical Consultant for Oaktree Administrators, Inc. (Paramount, CA). UR and


case management for third party administrator, 1988-1989.

Co-Chairman, Ethics Committee, American College of Medical Quality, 1992


1999 and, sit on committee starting 2011-15.

ASSOCIATED HOSPITAL EXPERIENCE

Emergency Department, Cedars Sinai Medical Center


Quality Assurance Committee, Cedars Sinai Medical Center (past)

Chairman, Department of Emergency Services Medical Committee, Simi Valley


Hospital (past)
Medical Executive Committee, Simi Valley Hospital (past)
Quality Assurance Committee, Simi Valley Hospital (past)
Medical Advisory Committee, Ventura County Health Care Agency,
Ventura County (past)
Paramedic Services Subcommittee, Ventura County Health Care Agency,
Ventura County (past)
Emergency Advisory Committee, Midway Hospital Medical Center (past)
Utilization Review Committee, Midway Hospital Medical Center (past)
Emergency Advisory Committee, Cedars-Sinai Medical Center (past)
Physician Liaison, Volunteer Program, Cedars-Sinai Emergency Department
Volunteers (past)

CERTIFICATIONS

Board Certified, American Board of Emergency Medicine, 1984. Recertified


1993; 2003; 2013.

ATLS Certification 2006.

Board Certified by the American Board of Quality Assurance and Utilization


Review Physicians, October 1990. Fellow of the American College of Medical
Quality, 1993; past Co-chairman of the Ethics Committee, member of the Ethics
Committee many years, ending 2016.

Licensed Physician and Surgeon in the State of California. (G44944); 1981


Pre-hospital Care Medicine and Base Station Certification, ACEP

FACULTY POSITIONS

Assistant Clinical Professor of Medicine at UCLA School of Medicine, 1985


1988; 2005 - current.

OTHER CONSULTING EXPERIENCE


Medicolegal consultations for law firms; as well as the State of California 1983 to
199? or 200?.

Medical consultant to ABC for series The Fosters, 9/2016 to current.

Medical consultant to CBS for series Code Black, 7/2016 to 9/2016.

Medical consultant to NBC for series Royal Pains, 6/2015 to 9/2015.

Medical Reviewer for HSAG (Health Services Advisory Group), 2011.

Medical Reviewer for Lumetra (federal review agency for Medicare), 2006 to
2008.

Medical Reviewer for the California Medical Board, 2006 to 2009.

Medic Alert Foundation, Research Board, 1991 1992

PAST HOSPITAL AFFILIATIONS


Midway Hospital Medical Center
Valley Presbyterian Hospital
UCLA
Harbor-UCLA Medical Center
Santa Monica Medical Center
Beverly Hills Medical Center
Pioneer Hospital Medical Center
California Hospital
Doctor's Hospital of Lakewood
Little Company of Mary
Queen of the Valley Hospital

PUBLICATIONS
KA Corre and A Arnold. Iatrogenic Digital Compromise with Tubular Dressings
(Case Report). West J EM, vol. X, No 3, August 2009.

A number prior to 1985


EXHIBIT 3
ARMANDO G.
G. CORREA,
COHREA, MD, FAAP
1620 S.
S. Friendswood Dr.
Dr. #133
#1 33
Friendswood,
Friendswood, TX 77546
(832)
(832) 569-4663 {832)
(832) 825-3435 Fax

October
October 24,
24, 2017
201 7

Les
Les Weisbrod
Miller
Miller Weisbrod LLP
11551
I Forest Central
1551 Forest Central Dr.
Dr. Ste.
Ste. 300
Dallas,
Dallas, TX 75243
75243

Dear Mr.
Mr. Weisbrod:
Weisbmd.

Thank
Thank you
you for
for asking
asking me to
to review
review the records of
the records of Olivia
Olivia Steinborn
Steinbom regarding
regarding her emergency room
her emergency
visits
visits on
0n August 7,
7, 2016.
2016.

II am aa licensed
licensed physician
physician and
and am board-certified
boardcertied in pediatrics, with
in pediatrics. with board
board certification
certication (sub-board)
(sub-board)
in
in pediatric infectious disease.
pediatric infectious disease.

Currently, and
Cunently, and in August of
in August 0f 2016, as part
2016, as part of
of my daily,
daily, full-time practice, I provide
fulltime practice, provide care
l care and
and
treatment to
treatment pediatric patients
to pediatric patients who present
present with
with signs
signs and
and symptoms similar
similar or
or identical to Olivia
identical to Olivia Steinborn.
Steinbom.

I am further
I familiar with
further familiar with the
the standard
standard of care
care for
for both
both attending
attending physicians
physicians who take
take care
care of
0f
pediatric patients as well as for nurses caring
pediatric patients as well as for nurses caring for for pediatric
pediatric patients.
patients. Further, because
Further, because of my specialized
specialized
training (and sub-board
training (and sub-board certification)
certication) in
in pediatric
pediatric infectious diseases, I am familiar
infectious diseases, I familiar with
with the
the sequalae
sequalae and
and
the
the injuries
injuries that
that can
can be caused by
be caused by a
a failure
failure to
to timely
timely treat
treat pneumococcal meningitis in
pneumococcal meningitis in pediatric
pediatric patients.
patients.

II can
can and am willing
willing toto testify
testify concerning
concerning my qualifications,
qualications, education, training and experience,
education, training experience,
and
and will
wiil incorporate
incorporate that
that education,
education, training,
training, and experience
experience into
into my opinions
opinions related
related to
t0 the
the applicable
applicable
standards of care
standards 0f care that
that apply
apply in
in this
this case.
case. I
l have
have attached
attached a
a copy
copy of
of my curriculum
curriculum vitae
vitae as
as Exhibit
Exhibit A and
and
incorporated
incorporated herein
herein for
for all purposes. My opinions
all purposes. opinions are
are based
based upon
upon my education,
education, training,
training, experience,
experience, and
pertinent
pertinent medical
medical literature, as well
literature, as well as
as my review
review of
of the
the relevant
relevant medical
medical records
records of Olivia Steinborn.
of Olivia Steinborn. My
opinions
opinions in this case
in this case will
will be
be based
based upon a a reasonable
reasonable degree
degree of
of medical
medical probability.
probability.

Records Reviewed:
Reviewed:

As 0f
of the
the time
time of
0f drafting
drafting this
this report,
report, II have
have reviewed the following
reviewed the following records
records related to this
related to this matter:
matter:

(1) Excel ER -A Keller


(1) Excel Keller 8/7/16
8/7/16
(2)
(2) Autopsy Report
Report (Tarrant
(Tarrant Co.
Co. Medical Examiner) 8/7/16 to 1111116
8/7/16 to 11/1l16
(3) Statement of
(3) Juli Treadwell
ofJuli

Brief
Brief Summary
Summau ofPertinent
of Pertinent Records:
Records:

Olivia
Olivia Steinborn
Steinbom was a a 4-year-old
4-yearold female
female who presented
presented to Excel ER Center
to Excel Center around 1:58 AM on
around 1:58AM on
8/7/16 with a one day history of fever, vomiting, diarrhea, decreased activity and decreased
8/7/16 with a one day history of fever, vomiting, diarrhea, decreased activity and decreased oral intake. oral intake.
Olivia
Olivia had
had a history of
a history of deafness
deafness and a a cochlear
cochlear implant.
implant. The records
records indicate
indicate that
that she
she had tachycardia
tachycardia (heart
(heart
rate of
rate of 160
EGO beats/min)
beats/min) and tachypnea
tachypnea (respiratory
(respiratory rate
rate of 52/min).
52/min). The infant
infant was given
given anan IV
[V bolus
bolus of fluid
uid
and
and aa complete
complete blood count (CBC)
blood count (CBC) and
and electrolytes
electrolytes were obtained. No blood
were obtained. bland cultures
cultures or
or IV antibiotics
antibioticg
were ordered.
were The CBC showed
ordered. The showed a a markedly
markedly abnormal
abnormal white
white count
count of 1.1
.1 and platelet
I platelet count
count of 78,000.
78,000. Her
potassium
potassium was also
also low at
at 3.0.
3.0.
By
By 4:43 AM that
4:43AM that same day, Olivia remained
day, Olivia remained tachycardic
tachycardia and
and tachypneic
lachypneic despite
despite fluid
uid bolus
bolus and
and non0
further
further vomiting.
vomiting. Even in
in the
the presence
presence of these abnormal
ofthese abnormai fmdings,
ndings. Olivia
Olivia was discharged
discharged home and and arrived
arrived
there
there around
around 55 AM, at
at which time
time all
a1] the
the family
family went toto sleep.
sleep. The father
father woke up around
around 9:45
9:45 Am, to to find
nd
her "cold and
her cold and blue" with
blue with emesis
emesis around
around her
her face.
face. They transported
transported her
her in
in their
their vehicle
vehicle back
back toto Excel
Excel ER-
Keller where she
Kcller where she arrived around 10
arrived around 10 AM in in full
full cardiovascular
cardiovascular arrest.
arrest. Despite
Despite resuscitation
resuscitation efforts,
efforts, she was
she was
pronounced dead
pronuunced dead at
a1 10:28
10:28 AM on 0n 8/7/16.
8/7/1 6.

An autopsy done by
autopsy done the Tarrant
by the County Medical
Tarl'aut County Medical Examiner confirmed
conrmed the
the presence
presence of
of
pneumococcal
pneumococca] meningitis
meningitis as the cause
as the cause of
0f her
her demise.
demise.

Standard of Care and Actions


Standard of Actions Required
Reouired to
to Meet the
the Standard of
of Care Dr.
-Dr. Brandon Morshedi

1.
I. The standard
standard of of care
care required
required Dr.
Dr. Brandon
Brandon Morshedi
Morshedi to
lo be
be able
able to
to identify
identify when patients
patients are
are
appropriate
appropriate candidates
candidates forfor discharge
discharge from
from the
the Emergency Center.
Center. The standard
standard of
0f care
care required
required
Dr.
Dr. Morshedi
Morshedi to to only
only discharge
discharge aa pediatric
pediatric patient
patient when appropriate
appropriate and
and safe to do so,
safe to so, when that
that
pediatric
pediatric patient
patient has
has appropriate
appropriate vital
vital signs
signs and
and bloodwork. standard of
bloodwork. The standard of care
care required
required Dr.
Dr.
Morshedi,
Morshedi, asas aa physician
physician ordering
ordering lab
lab tests such as
tests such as CBC, to
to identify
identify abnormalities
abnormalities suggestive
suggestive of aa
serious
serious bacterial
bacterial infection,
infection. such
such as
as marked leukopenia
leukopenia (low
(low white
white count)
count) and
and thrombocytopenia
thrombocytopenia
(low
(low platelet
platelet count).
count).

2.
2. The standard
standard ofof care
care required
required Dr.
Dr. Brandon Morshedi to Io appropriately
appropriately evaluate,
evaluate, treat
treat and refer
refer for
for
hospitalization
hospiialization a a pediatric
pediatric patient
patient who meet
meet the
the criteria
criteria for
for Systemic
Systemic Inflammatory
Inammatory Response
Response
Syndrome
Syndrome (SIRS),
(SIRS), hashas signs
signs and symptoms of
and symptoms of aa bacterial
bacterial infection,
infection. grossly
grossly abnormal
abnormal bloodwork
bloodwork
and
and a history of
a history cochlear implant.
ofcochlear implant. Specifically,
Specically, the
the standard
standard of care
care required
required Dr.
Dr. Brandon Morshedi
to perform aa diagnostic
to perform diagnostic evaluation
evaluation (including
(including blood
blood culture
culture and
and lumbar puncture),
puncture). toto transfer
transfer the
the
patient
patient for
f'or admission
admission to to the
the hospital
hospital and
and to
to treat the patient
treat the patient with
with IV antibiotics
antibiotics until
until aa serious
serious
bacterial
bacterial infection
infection cancan be
be excluded.
excluded.

Failure
Failure to
t0 Meet the Care Dr.
the Standard of Care- Dr. Brandon Morshedi

1.
l. Dr.
Dr. Brandon
Brandon Morshedi
Morshedi failed to meet
failed to meet the
the standard
standard of care
care by
by inappropriately
inappropriately discharging
discharging Olivia
Olivia
Steinborn
Steinbom when it it was
was unsafe
unsafe toto do
do so.
so. Dr.
Dr. Brandon
Brandon Morshedi failedfailed to
to meet the
[he standard
standard of 0f care
care
by
by failing
Failing to
to appreciate
appreciate the
the significance
signicance of
of a
a grossly
grossly abnormal
abnormal white
while count
count and
and platelet
platelet count
count in
in

Olivias's
Olivias's labwork, particularly in
labwork. particularly in the
the setting of a patient
setting ofa patient with
with a cochlear implant
a coohlear implant which significantly
signicantly
increased
increased the
the risk
risk for
for bacterial
bacterial meningitis.
meningitis. Dr.
Dr. Morshedi
Morshedi failed
failed to
to order
order IV antibiotics,
antibiotics. to
to transfer
transfer
her
her for
for hospitalization,
hospitalization, and
and toIo perform
perform a a blood
blood culture
culture and
and lumbar
lumbar puncture,
puncture, which
which were
were all
all required
required
in
in order
order toto meet
meet the standard of
the standard of care.
care. Instead,
Instead, hehe discharged
discharged Olivia,
Olivia, and
and ordered
ordered only
only aa topical
topical
antibiotic (Ciprodex)
antibiotic (Ciprodex) for for otitis
otilis media.
media.

With
With regard
regard to
to the
the nurses
nurses at
at Excel
Excel ER,
ER I incorporate
incorporate the
l opinions of
the opinions 0f Dr.
Dr. Kenneth
Kenneih Corre
Corre related
related to
to
the standard of
1he standard of care
care and violations
violations of the
ofthe standard
standard of
of care
care of those
oftllose nurses
nurses at
a1 Excel
Excel ER.
ER.
Medical
Medical Causation
Causation

The management of of Olivia


Olivia Steinborn by Dr.
Steinbom by Dr. Brandon
Brandon Morshedi and the
Morshedi and the nurses
nurses at
at Excel
Excel ER-
ER- Keller
Keller
on
on August
August 7,
7, 2016,
2016, proximately
proximately caused
caused her
her cardiorespiratory
cardiorespiratory arrest
arrest and
and subsequent
subsequent demise.
demise.

At
At the
the time
time ofof her
her discharge
discharge on on August
August 7,7, 2016.
2016, Olivia
Olivia Steinbom
Steinborn had
had aa rapidly
rapidly progressing
progressing
infectious
infectious process
process within
within her
her central
central nervous system. Blood
nervous system. count revealed
Blood count revealed aa grossly
grossly abnonnal
abnormal white
white count
count
and platelet
platelet count,
count. which
which were
were indicative of an
indicative of an overwhelming
overwhelming bacterial
bacterial infection.
infection. Antibiotics
Antibiotics are
are utilized
utilized
to
to treat
treat bacterial
bacterial central
central nervous
nervous infections, and antibiotics
infections, and act by
antibiotics act by destroying
destroying and
and eradicating
eradicating such
such bacteria.
bacteria.
If
If antibiotics
antibiotics are
are not
not given
given toto a
a pediatric
pediatric patient such as
patient such as Olivia
Olivia Steinbom,
Steinborn, then
then in
in reasonable
reasonable medical
medical
probability,
probability, the
the infection
infection will continue to
will continue to grow out of control.
out of control.

In
In reasonable
reasonable medical
medical probability, based upon
probability, based the medical
upon the medical records
records available
available in in this
this case,
case, Olivias
Olivia's
infection
infection continued
continued toto grow and progress
progress asas a direct result
a direct result 0f
of her
her being
being discharged
discharged homehome andand not
not having
having
appropriate
appropriate antibiotic treatment. As the
antibiotic treatment. the untreated
untreated infection grew, it led
infection grew, led to
it to further
further swelling
swelling ofthc
of the brain.
brain. As
As
aa direct result of
direct result of this
this untreated
untreated pneumococcal meningitis, and
pneumococcal meningitis. and continued
continued swelling
swelling of of her
her brain.
brain, Olivia
Olivia
suffered
suffered a a cardiorespiratory
cardiorespiratory arrest that led
arrest that led to her demise
to her demise approximately
approximately 55 hours
hours after
after her
her discharge.
discharge. HadHad
the standard of
the standard of care
care been followed
followed and appropriate
appropriate antibiotics
antibiotics and
and transfer
transfer to to aa hospital
hospital been
been provided
provided toto
Olivia, in
Olivia, in reasonable
reasonable medical
medical probability
probability she
she would not not have
have suffered
suffered aa cardiorespiratory
cardiorespiratory arrest
arrest and
and in
in
reasonable
reasonable medical
medical probability,
probability, she
she would have recovered.
recovered. Had the standard
Had the standard of of care
care been
been followed,
followed, even
even
if a cardiorespiratory
ifa cardiorespiratory arrest
arrest had occurred,
occurred, it would have taken
it taken place
place in
in aa hospital
hospital setting
setting where
where inin reasonable
reasonable
medical
medical probability,
probability, she
she would have had a a successful resuscitation as
successful resuscitation as opposed
opposed to to having
having aa code
code inin the
the home
home
setting,
setting, where it actually
it actually occurred.
occurred.

I have
I have been
been provided
provided the
the following
following defmitions:
denitions:

"NEGLIGENCE,"
"NEGLIGENCE." when used used with
with respect to the
respect to the conduct
conduct ofof Dr.
Dr. Brandon Morshedi and
Brandon Morshedi and the
the nurses
nurses
at
at Excel
Excel ER,
ER, means failure
failure to
lo use ordinary care.
use ordinary care, that
that is,
is, failing
failing to
to do
do that
that which
which aa
physician/nurse/healthcare
physician/nurse/healthcare provider
provider ofof ordinary
ordinary prudence
prudence would
would have
have done
done under
under the
the same
same oror
similar
similar circumstances
circumstances or
or doing that
that which a
a physician/nurse
physician/nurse /healthcare
/healthcare provider
provider of
of ordinary
ordinary
prudence would not
not have done under the
the same oror similar
similar circumstances.
circumstances.

"ORDINARY CARE,"
"ORDINARY CARE." when used with
with respect to the
respect to the conduct
conduct of'
of Dr.
Dr. Morshedi
Morshedi and
and the
the nurses
nurses at
at
Excel
Excel ER,
ER, means that
that degree of care
care that
that aa physician/nurse/healthcare
physician/nurse/healthcare provider
provider of
of ordinary
ordinary
prudence would use
use under the
the same or
or similar
similar circumstances.
circumstances.

"PROXIMATE CAUSE,"CAUSE." when used with with respect to the


respect to the conduct
conduct ofof Dr.
Dr. Morshedi
Morshedi andand the
the nurses
nurses
at
at Excel
Excel ER,
ER, means aa cause that
that was a
a substantial
substantial factor
factor in
in bringing
bringing about
about anan occurrence
occurrence oror injury,
injury,
and without
without which cause
cause such occurrence or
such occurrence or injury would not
injury would not have
have occurred.
occurred. InIn order
order to
to be
be aa
proximate cause, the act
cause, the or omission
act or omission complained of must be
complained ofmust be such
such that
that aa physician/nurse/healthcare
physician/nurse/healthcare
provider
provider using
using ordinary
ordinary care would have foreseen
foreseen that
that the
the event.
event, or
or some
some similar
similar event.
event, might
might
reasonably
reasonably result
result there
there from. There may be be more than
than one
one proximate
proximate cause
cause ofofan
an event-
event.

GROSS NEGLIGENCE,"
"GROSS NEGLIGENCE. when used with respect respect to
to the
the conduct
conduct ofDr.
of Dr. Morshedi
Morshedi and
and the
the nurses
nurses
at
at Excel ER, means an act
Excel ER, act or omission,
omission, which when viewed
viewed objectively
objectively from
from the
the standpoint
standpoint ofofthe
the
actor
actor at
at the timc of its
the time its occurrence involves an
an extreme
extreme degree
degree ofof risk,
risk, considering
considering the
the probability
probability
and magnitude of of the
the potential to others;
potential harm to others; and
and of
of which
which the
the actor
actor has
has actual,
actual, subjective
subjective
awareness of the risk
ofthe risk involved,
involved. but nevertheless proceeds with conscious indifference to
proceeds with conscious indierence to the
the rights.
rights,
safety. or welfare of others.
safety, others.
Based
Based upon
upon these
these defmitions
denitions provided,
provided. it is my
it is my opinion
opinion that
that within
within reasonable
reasonable medical
medical certainty,
certainty,
Dr. Morshedi was grossly negligent in his management of the care of Olivia Steinborn,
Dr. Morshedi was grossly negligent in his management of the care of Olivia Steinbom, and that each and that each and
and
every one of
every one the acts
ofthe acts of
ofnegligence
negligence and/or
and/or gross
gross negligence,
negligence, asas set
set forth
forth in
in the
the failures
failures of
ofDr.
Dr. Morshedi
Morshedi andand
the
the nurses
nurses atat Excel
Excel ER,
ER. to
to meet
meet the
the accepted
accepted standard
standard ofof care.
care, were
were aa proximate
proximate cause
cause of
of the
the demise
demise of of
Olivia
Olivia Steinborn,
Steinborn, for
for the
the reasons
reasons set
set forth
forth herein.
herein. Dr.
Dr. Morshedi
Morshedi was was well
well aware
aware ofof the
the grossly
grossly abnormal
abnormal
blood
blood count
count and
and Olivia's
Olivias high
high risk
risk for
for bacterial meningitis, but
bacterial meningitis, but decided
decided toto discharge
discharge her
her home
home anyway.
anyway.
This
I'his gross negligence was a proximate cause
gross negligence was a proximate cause of of Olivia's
Olivias cardiovascular arrest and her
cardiovascular arrest and her death.death.

Dr.
Dr. Morshedi
Morshedi also
also failed
failed to
to timely
timely and
and appropriately follow up
appropriately follow up on
on the
the abnormal
abnormal laboratory
laboratory results,
results,
and
and to
to timely
timely order
order antibiotics
antibiotics to
t0 treat
treat the
the infection, arrange transfer
infection, arrange transfer to
to the
the hospital,
hospital, and
and perform
perform additional
additional
diagnostic
diagnostic studies
studies which
which was
was gross
gross negligence
negligence that
that was
was aa proximate cause 0f
proximate cause of Olivias
Olivia's cardiorcspiratory
cardiorespiratory
arrest
arrest and
and death.
death.

My
My opinions
opinions in
in this
this report
report are
are expressed
expressed to
to a reasonable degree
a reasonable degree of
of medical
medical probability
probability based
based upon
upon

W9
the
the information
information provided to me
provided to me as
as of
of the
the date of this
date of this report.
report. II reserve
reserve the
the option
option to
to amend
amend and
and supplement
supplement
this
this report
report in
in the
the event
event that
that additional
additional materials
materials become available.
become available.

Respectfully
Respectfully submitted,
submitted,

Armando G.
Armando G. Correa,
Correa, M.D.,
M.D., FAAP
FAAP
EXHIBIT 4
CURRICULUMVITAE
I.GENERALBIOGRAPHICALINFORMATION
A. Personal
1. Name:ArmandoG.Correa
2. Citizenship:U.S.A.

B. Education:
1. MedicalEducationorGraduateEducation:
1987 DoctorofMedicine(withHonors)
InstitutoTecnologicodeMonterrey
Monterrey,Mexico

2. PostgraduateTraining:
19881989 Internship
Pediatrics
ChildrensHospitalofAustin
Austin,Texas

19891991 Residency
Pediatrics
ChildrensHospitalofAustin
Austin,Texas

19901991 Residency(ChiefResident)
Pediatrics
ChildrensHospitalofAustin
Austin,Texas

19911993 Fellowship
PediatricInfectiousDiseases
BaylorCollegeofMedicine
Houston,Texas

C. AcademicAppointments
1. FacultypositionsatBCM:
2005Present AssistantProfessor
DepartmentofPediatrics

19932002 AssistantProfessor
DepartmentofPediatrics

2. Previousfacultypositionsatotherinstitutions:
20022005 SeniorAssociateConsultant
DepartmentofPediatricsandAdolescentMedicine
DepartmentofInternalMedicine
MayoClinic
Rochester,Minnesota

20022005 AssistantProfessorinPediatrics
MayoMedicalSchool
Rochester,Minnesota


3. FacultyappointmentsatotherinstitutionswhileatBCM:
1994 VisitingConsultant
SaudiUSUniversitiesProject
KingFaisalSpecialistHospital&ResearchCentre
Riyadh,KingdomofSaudiArabia

E.Otherinformation
1. Awards:
20002001 AwardforExcellenceinTeachingasGeneralPediatric
AttendingontheBenTaubInpatientService
BaylorCollegeofMedicine

19901991 ResidentoftheYear,ChildrensHospitalofAustinatBrackenridge

19961997 TheBestDoctorsinAmerica:CentralRegion

1998 TheBestDoctorsinAmerica,4thlisting

20112012 TheBestDoctorsinAmerica

2016 Fullbright&JaworskiFacultyExcellenceAwardforTeachingand
Evaluation,BaylorCollegeofMedicine

2016 Induction,AcademyofDistinguishedEducators,BaylorCollege
ofMedicine

2. BoardEligibility/Certification:
1989present TexasStateBoardofMedicalExaminers

20022006 MinnesotaBoardofMedicalPractice

1988 EducationCommissionforForeignMedicalGraduates

1991 AmericanBoardofPediatrics
1999 Recertification
2007 Recertification
2016 Recertification

1994 PediatricInfectiousDiseasesSubBoard Recertification


2001 Recertification
2008 Recertification

3. Othernonacademicpositions:
19972002 CoDirector,ChildrensTuberculosis
Clinic,BenTaubGeneralHospital,
Houston,Texas

1993Present AttendingPhysician
TexasChildren'sHospital
Houston,Texas

1993Present AttendingPhysician,
BenTaubGeneralHospital
Houston,Texas

19932002 ConsultingPhysician
WomansHospitalofTexas
Houston,Texas

19942002 ConsultingPhysician,
TheMethodistHospital
Houston,Texas

19962002 ConsultingPhysician
ShrinersHospitalforChildren,
Houston,Texas

II.RESEARCHINFORMATION
A.NationalScientificParticipation
1.JournalEditorialBoards:
19962002 SeminarsinPediatricInfectiousDiseases
EditorialBoardMember

2002 2003RedBook:ReportoftheCommittee
onInfectiousDiseasesAAP
PrimaryReviewer

2005 2006RedBook:ReportoftheCommittee
onInfectiousDiseasesAAP
PrimaryReviewer

2.ProfessionalSocieties:
1988 AmericanAcademyofPediatrics

1993 PediatricInfectiousDiseaseSociety

1994 InfectiousDiseasesSocietyofAmerica

1995 Fellow,AmericanAcademyofPediatrics

3.InvitedLectures:
Neonatal sepsis. Pediatric Grand Rounds, Texas Tech University Health
ScienceCenteratAmarillo,July21,1992;Amarillo,TX.

The cephalosporin maze. 1992 Fall Seminar of the Panhandle Chapter of
theTexasAcademyofFamilyPhysicians,October25,1992;Amarillo,TX.

Neonatal sepsis. Pediatric Grand Rounds, Central Texas Medical
Foundation,April16,1993;Austin,TX.

Current concepts in the diagnosis and treatment of sinusitis and its
complications. Evaluation and treatment of supraglottitis and
laryngotrachobronchitis. Actualizacion en el manejo de las infecciones de
cabeza y cuello, Hospital Clinica del Parque, September 25, 1993;
Chihuahua,MEXICO.

Antimicrobial update: Drug selection and cost effectiveness. Pediatric
Postgraduate Symposium, Baylor College of Medicine, April 16, 1994;
Houston,TX.

Management of the patient with drugresistant tuberculosis. Early
diagnosis and treatment of congenital infections. Segundas Jornadas del
ColegiodeMedicosGenerales,May67,1994;Chihuahua,MEXICO.

The cephalosporin maze. Pediatric Grand Rounds, The University of Texas
HealthScienceCenteratHouston,June14,1994;Houston,TX.

Osteomyelitis and osteoarthritis in the newborn. Pediatric Grand Rounds,
KingFaisalSpecialistHospital&ResearchCentre,August24,1994;Riyadh,
SAUDIARABIA.

Interesting cases in pediatrics. Southeast Texas Pediatric Society, January
24,1995;Beaumont,TX.

Antibiotic use in times of resistant strains. Pediatric Postgraduate
Symposium,BaylorCollegeofMedicine,April20,1995;Houston,TX.

Antibiotics in the outpatient setting. Pediatric Grand Rounds, Memorial
Hospital,May2,1995;MemorialCity,TX.

Disease transmitted from animals to humans. Grand Rounds, Park Plaza
Hospital,June28,1995;Houston,TX.

Antimicrobial update. Pediatric Grand Rounds, Southwest Memorial
Hospital,July27,1995;Houston,TX.

Periodicfeversyndromes.Antibioticuseintheeraofbacterialresistance.
Infections in the child with underlying pathology. Ambulatory use of
antibiotics. X Congreso Nacional de Pediatria, September 1015, 1995;
Maracaibo,VENEZUELA.

Childhoodtuberculosisinthe90s.ChildrensHospitalAssociationofTexas,
SecondAnnualNursingConference,October6,1995;Dallas,TX.

Pediatric TB Diagnosis and management. Clinical Management and
Control of Tuberculosis, National Jewish Center for Immunology and
RespiratoryMedicine,October18,1995;Denver,CO.

Penicillinresistantpneumococci:perspectivesandtreatment.XIJornadas
CientificasdelaClinicaMerida,October20,1995;Merida,MEXICO.

Update on Mycobacterium tuberculosis and other mycobacteria. Third
Annual Update in Infectious Diseases, Baylor College of Medicine,
November3,1995;Houston,TX.

Immunoglobulin prophylaxis and treatment in newborn sepsis. Use of
immunomodulators in neonatal sepsis. Resistant pneumococci: A new
challenge. XIV Congreso Interamericano de Infectologia Pediatrica,
November30December2,1995,CD.Juarez,MEXICO.

AntibioticResistance.SelectedtopicsinInfectiousDiseases,BaylorCollege
ofMedicine,January27,1996;Houston,TX.

Outbreak! Hepatitis, TB and meningitis. Issues in the Primary Care of
Families,HACNAPNAP,February10,1996;Houston,TX.

Infectious disease control in the school of setting. Pediatric Postgraduate
Symposium,BaylorCollegeofMedicine,March22,1996,Houston,TX.

PediatricTBDiagnosisandmanagement.ClinicalManagementandControl
of Tuberculosis, National Jewish Center for Immunology and Respiratory
Medicine,April24,1996;Denver,CO.

Antimicrobialtherapyintheeraofbacterialresistance.Acuteintervention:
Thefirsttwentyfourhours,KnappMedicalCenter,April26,1996;McAllen,
TX.

WhatshouldIdoaboutantibioticresistance?BugsandDrugs:Updatein
theofficepracticeofInfectiousDiseases,St.LukesEpiscopalHospital,May
11,1996;Houston,TX.

Tuberculosis: an emerging problem. Comprehensive review course in
InternalMedicine,BaylorCollegeofMedicine,July9,1996;Houston,TX.

Periodic fever syndromes. Penicillinresistant pneumococci: perspectives
and treatment. Management of multidrug resistant tuberculosis in
children. 5 Congreso de Infectologia Pediatrica del Pacifico, August 810,
1996;Mazatlan,MEXICO.

Infectious disease problems in the school setting. 1st. Annual Infectious
Disease Seminar, Driscoll Childrens Hospital, October 19, 1996; Corpus
Christi,TX.

Tuberculosisinchildren.Unidos96:UnitedintheFightAgainstInfectious
Diseases,November13,1996;LasCruces,NM.

Antibiotic choices in an era of bacterial resistance. 17th Annual SWAHAP
EducationCongress,November8,1996;ElPaso,TX.

Updateinthemanagementofneonatalsepsis.Meningitisandventriculitis.
Resurgence of congenital syphilis. Osteomyelitis and septic arthritis. 4th
Annual Convention of the Pediatric Infectious Diseases Society of the
Philippines,February1112,1997;Manila,PHILIPPINES.

Hepatitis:fromAtoE.PediatricPostgraduateSymposium,BaylorCollege
ofMedicine,April11,1997;Houston,TX.

Periodic fever syndromes. Use of antibiotics in the era of resistance. VI
JornadasInternacionalesdeAvancesenPediatria,HospitalMaternoInfantil
delasPalmas,May58,1997;LasPalmasdeGranCanaria,SPAIN.

Group A Streptococcus: 1997. Hepatitis: Where are we in the alphabet?
Acuteworkupofthetraveler.AcuteCarePediatrics:ReviewandUpdate
oftheStateoftheArt,BaylorCollegeofMedicine,June913,1997;Hilton
HeadIsland,SC.

Newantibioticchoicesintheeraofbacterialresistance.SchumpertMedical
Center,September10,1997;Shreveport,LA.

Antibiotic resistance in border communities. 13th Annual Update in
Medicine Conference, University of Texas Health Science Center in San
Antonio,November8,1997;Laredo,TX.

Hepatitis: from A to G. Reunion Pediatrica Latinoamericana, Clinica de
Merida,November22,1997;Merida,Yucatan,MEXICO.

Emergence of bacterial resistance. Driscoll Childrens Hospital Grand
Rounds,December19,1997;CorpusChristi,TX.

Casepresentations.13thRegionalCysticFibrosisConference,BaylorCollege
ofMedicine,March28,1998;Houston,TX.

ReviewofTBinthepediatricpopulation.IVBinationalInfectiousDisease&
MicrobiologySymposium,August21,1998,CiudadJuarez,MEXICO.

Tropical Medicine in South Texas. Pediatric Grand Rounds, Driscoll
ChildrensHospital,January22,1999;CorpusChristi,TX.

Correa AG: An Overview of Tropical Infections and Parasitology in South
Texas. Infectious Disease Update, McAllen Medical Center, April 24, 1999;
McAllen,TX.

Hepatitis: A to G. Controversies in Hepatitis B vaccine. The impact of
antimicrobial resistance in children. XI Congreso Nacional de Pediatra,
September1316,1999;Caracas,VENEZUELA.

Update on Sepsis syndrome. Immunizations in special circumstances.
Vaginal discharge in children. Childhood meningitis. IX Postgraduate
Course.St.LukesMedicalCenter,October46,1999;Manila,PHILIPPINES.

Pediatric Tuberculosis. 4th Annual Infectious Disease Seminar, Driscoll
ChildrensHospital,October16,1999;CorpusChristi,TX.

Maternal infection in pregnancy. Association of Trail Lawyers of America
MidWinterConference,January23,2000;SanJuan,PUERTORICO.

Pediatric TB. TB in the 21st Century, Texas Department of Health, April 14,
2000;SouthPadreIsland,TX.

HepatitisAtoG.22ndAnnualPediatricPostgraduateSymposiumPediatrics
2000,BaylorCollegeofMedicine,April27,2000;Houston,TX.

Hepatitis from A to Z. 1st International Pediatric PostGraduate TeleCast.
Texas Childrens Hospital/Baylor College of Medicine, June 2, 2000;
Houston,TX.

Antibioticandantibioticresistance.ThePractitionersGuidetoOtitisMedia.
St.JosephRegionalHealthCenter,June3,2000;CollegeStation,TX.

The impact of bacterial resistance in Pediatrics, Pediatric Grand Rounds,
ChildrensHospitalofAustin,June8,2000;Austin,TX.

Antifungal therapy update. Pediatric Grand Rounds, Driscoll Childrens
Hospital,June9,2000;CorpusChristi,TX.

Management of postsurgical infections. Neonatal sepsis and adjunctive
therapy.Nosocomialinfectionsintheneonate.SegundoCursoInternacional
deNeonatologia,June1517,2000,Puebla,MEXICO.

Theimpactofantimicrobialresistanceinclinicalpractice.HardinMemorial
Hospital,September13,2000;Elizabethtown,KY.

Pediatric TB. Tuberculosis Management in the Community. Texas
DepartmentofHealth,September29,2000;Waco,TX.

Update on the impact of antimicrobial resistance. 16th Annual Update in
Medicine Conference. Area Health Education CenterUTHSC, October 7,
2000;Laredo,TX.

Experience in the treatment of chronic hepatitis B with lamivudine. III
Jornadas de Cientficas de Hematologa Peditrica, October 2628, 2000;
Caracas,VENEZUELA.

Antimicrobial therapy in patients with severe neutropenia. III Jornadas de
Cientficas de Hematologa Peditrica, October 2628, 2000; Caracas,
VENEZUELA.

New antivirals in HIV. XVII Curso de Actualizacin en Pediatra, Hospital
GeneraldeOccidente.January24,2001;Guadalajara,MEXICO.

New preventive and therapeutic approaches for the newborn of HIV
infectedmothers.XVIICursodeActualizacinenPediatra,HospitalGeneral
deOccidente.January24,2001;Guadalajara,MEXICO.

Tuberculosis, the great mimicker. Cyberpediatrics: maximizing access to
health care38th Annual Convention of the Philippine Pediatric Society.
April14,2001;Manila,PHILIPPINES.

Immunization in children: domestic and international issues.
Cyberpediatrics:maximizingaccesstohealthcare38thAnnualConvention
ofthePhilippinePediatricSociety.April14,2001;Manila,PHILIPPINES.

Immunizations Workshop. 23rd Annual Pediatric Postgraduate Symposium.
BaylorCollegeofMedicine.April20,2001;Houston,TX

HepatitisUpdate.VJornadasdeSaluddelaClinicaVidriera.April28,2001;
Monterrey,MEXICO.

Vaccine recommendations for children and adults. CME Grand Rounds,
NortheastMedicalCenterHospital.May9,2001;Houston,TX.

Otitis media. 2nd Annual Texas Childrens Hospital International Pediatric
PostgraduateSymposium.May18,2001;Houston,TX.

Tropical Diseases in the U.S. Acute Care Pediatrics. Baylor College of
Medicine.June1115,2001;HiltonHeadIsland,SC.

Thefirstlineofantibioticsforfivecommonpediatricproblems.AcuteCare
Pediatrics.BaylorCollegeofMedicine.June1115,2001;HiltonHeadIsland,
SC.

Tuberculosis Update. Acute Care Pediatrics. Baylor College of Medicine.
June1115,2001;HiltonHeadIsland,SC.

New antifungals, antivirals and antibiotics. Acute Care Pediatrics. Baylor
CollegeofMedicine.June1115,2001;HiltonHeadIsland,SC.

Infections in the burned patient. 1er Simposium Internacional de
Infecciones Graves en el Paciente Criticamente Enfermo,
Inmunocomprometido y Receptor de Transplante. Hospital Infantil de
Mexico.July9,2001;MexicoCity,MEXICO.

Tuberculosis: Current diagnosis and treatment. 17th Annual Pediatric &
Primary Care Update 2001. Texas Tech University Health Science Center.
October4,2001;Odessa,TX.

Hepatitis A to G. Pediatric Grand Rounds. Childrens Hospital of Illinois.
October18,2001;Peoria,IL.

Update on Influenza. Pediatric Grand Rounds. The University of Texas
HoustonHealthScienceCenter.January15,2002;Houston,TX.

UpdateonImmunizationsinChildren.PediatricGrandRounds.MedicalCity
DallasHospital.March5,2002;Dallas,TX.

Update on Pediatric Tuberculosis. Pediatric Grand Rounds. Mayo Clinic.
March1,2002;Rochester,MN.

Update in the treatment of otitis media in children. Grand Rounds.
UniversityofWyomingMedicalCenter.April16,2002;Casper,WY.

Challenging Immunization Decisions. 24th Annual Pediatric Postgraduate
Symposium;BaylorCollegeofMedicine.April26,2002;Houston,TX.

Confirming the Diagnosis. Controlling Pertussis in 2002 Workshop. Texas
DepartmentofHealth.June22,2002;Austin,TX.

Otitis Media. PediaForum. The University of North Texas Health Science
CenteratFortWorth.July13,2002;NewOrleans,LA.

Pertussis Update. Charting a Course for Our Kids. Oklahoma Chapter,
AmericanAcademyofPediatrics.August23,2002;OklahomaCity,OK.

BCG Vaccine. XXII Congreso Centroamericano y del Caribe de Pediatria.
September1114,2002;Managua,NICARAGUA.

Controversies in polio vaccination. XXII Congreso Centroamericano y del
CaribedePediatria.September1114,2002;Managua,NICARAGUA.

Controversies and novelties in pediatric immunizations. XXII Congreso
Centroamericano y del Caribe de Pediatria. September 1114, 2002;
Managua,NICARAGUA.

Periodic fever syndromes. XXII Congreso Centroamericano y del Caribe de
Pediatria.September1114,2002;Managua,NICARAGUA.

Update on Pertussis. Cruising with Our Kids. Oklahoma Chapter, American
AcademyofPediatrics.November9,2002;Tulsa,OK.

Hepatitis: from A to G. XXI Congreso Interamericano de Infectologia
Pediatria.November2730,2002;Chihuahua,MEXICO.

Periodic fever syndromes. XXI Congreso Interamericano de Infectologia
Pediatria.November2730,2002;Chihuahua,MEXICO.

Bacterial, viral and fungal infections. BMT Training Program. Phoenix
ChildrensHospital.January24,2003;Phoenix,AZ.

Osteomyelitisinchildren.Pediatric/AdolescentPotpourri.St.CloudHospital.
February69,2003;Nisswa,MN.

Toxinmediatedbacterialdiseases.Pediatric/AdolescentPotpourri.St.Cloud
Hospital.February69,2003;Nisswa,MN.

Staphylococcal necrotizing fasciitis and other skin diseases.
Pediatric/Adolescent Potpourri. St. Cloud Hospital. February 69, 2003;
Nisswa,MN.

Hepatitis: from A to G. Pediatric Grand Rounds. Mayo Clinic. March 21,
2003;Rochester,MN.

Updateonpediatrictuberculosis.PediatricGrandRounds,DriscollChildrens
Hospital,August8,2003;CorpusChristi,TX.

Pediatric antibiotic resistance. Clinical Relevance of Bacterial Resistance.
ConwayRegionalHealthSystem,September19,2003;Conway,AR.

Communityacquired MRSA. XXII Congreso Interamericano de Infectologia
Pediatrica.November1922,2003;Guadalajara,MEXICO.

HepatitisfromAtoG:Newtreatments.ICursodeAvancesenInfectologa
Peditrica. Instituto Nacional de Pediatra. April 2223, 2004; Mexico City,
MEXICO.

Newguidelinesinthemanagementofotitismedia.ICursodeAvancesen
Infectologa Peditrica. Instituto Nacional de Pediatra. April 2223, 2004;
MexicoCity,MEXICO.

Communityacquired MRSA. I Curso de Avances en Infectologa Peditrica.
InstitutoNacionaldePediatra.April2223,2004;MexicoCity,MEXICO.

The impact of bacterial resistance in pediatrics. Pediatric Grand Rounds.
ImmanuelSt.JosephsHospital.October12,2004;Mankato,MN.

Update on pediatric tuberculosis. 9th Annual Infectious Diseases Seminar.
DriscollChildrensHospital.October23,2004;CorpusChristi,TX.

Treatmentofneonatalsepsis.XXIIICongresoInteramericanodeInfectologia
Pediatrica.November1013,2004;Acapulco,MEXICO.

Bronchiolitis. XLIV Congreso de Pediatria. Sociedad Chilena de Pediatria.
November1620,2004;Rancagua,CHILE.

Update on antibiotic choices for the treatment of common pediatric
infections. 19th Annual Family Medicine Today. HealthPartners. March 10,
2005;St.Paul,MN.

Practical approach to the patient with suspected tuberculosis. 19th Annual
FamilyMedicineToday.HealthPartners.March10,2005;St.Paul,MN.

MeticillinResistant Staphylococcus Partners in Pediatrics CME
Conference.Plymouth,MNDecember8,2005

PediatricTuberculosisUpdate.GrandRoundsDriscollChildrensHospital
CorpusChristi,TexasJanuary13,2006

Update on Pertussis. St. Marys Hospital Grand Rounds Grand Junction,
COJanuary24,2006

Hepatitis A vaccine. VII Congreso de Pediatria. Confederacion Nacional de
Pediatria.March2225,2006;SanLuisPotosi,MEXICO.

Tuberculosis in pediatrics: diagnosis and treatment. VII Congreso de
Pediatria.ConfederacionNacionaldePediatria.March2225,2006;SanLuis
Potosi,MEXICO.

XVPediatricIntensiveCareCoursethefollowingtopics:1.Useofsteroidin
septic shock 2. Nutrition in septic shock 3. Management of complicated
pneumonia.Puebla,MEXICO,July1314,2006

HAART therapy during pregnancy. IV Congreso atencion Integral del
VIH/SIDA.August2426,2006;Guadalajara,MEXICO

Update on tropical diseases. Texas Academy of Physician Assistance Fall
RegionalConference.September22,2006;Houston,TX

Expertpanel:Inappropriateuseofantibioticsintheoffice.SegundaReunion
Acadmica del la Sociedad Mexicana de Pediatria. April 29May 1, 2007;
MexicoCity,MEXICO

Infectious criteria in children with recurrent infections. Segunda Reunion
Acadmica del la Sociedad Mexicana de Pediatria. April 29May 1, 2007;
MexicoCity,MEXICO

KeynoteSpeaker:TheimpactofantimicrobialresistanceinPediatrics.XXVI
CongresoInteramericanodeInfectologaPeditrica.November2123,2007;
Juriquilla,MEXICO

Travel Medicine for the Pediatrician. Pediatric Grand Rounds. Driscoll
ChildrensHospital.January11,2008;CorpusChristi,TX.

Thechallengeofresistanceinpediatrictuberculosis.XXXCongresoNacional
dePediatra.April30May3,2008;Monterrey,MEXICO.

Skin and soft tissue infections: new challenges. XXX Congreso Nacional de
Pediatra.April30May3,2008;Monterrey,MEXICO.

Autism and vaccines. 1er Simposio Internacional de Actualizacin en
Pediatra. Colombian Pediatric Society. July 35, 2008; Cartagena,
COLOMBIA

Multiple and simultaneous vaccinations: controversies. 1er Simposio
Internacional de Actualizacin en Pediatra. Colombian Pediatric Society.
July35,2008;Cartagena,COLOMBIA

RoundTable:Theresurgenceofvaccinepreventableinfections.1erSimposio
Internacional de Actualizacin en Pediatra. Colombian Pediatric Society.
July35,2008;Cartagena,COLOMBIA

Hepatitis:AthruZ.1erSimposioInternacionaldeActualizacinenPediatra.
ColombianPediatricSociety.July35,2008;Cartagena,COLOMBIA

Vaccines in the immunocompromised host. 1er Simposio Internacional de
Actualizacin en Pediatra. Colombian Pediatric Society. July 35, 2008;
Cartagena,COLOMBIA

Aserioustalkaboutotitismedia.PriMedSouthwest:CurrentClinicalIssues
in Primary Care. Harvard Medical School & Baylor College of Medicine.
March19,2009;Houston,TX

Controversiesinimmunizations.3rdCongresoNacionaldePediatriaMaster
Class.May2427,2009;Acapulco,MEXICO.

The impact of antimicrobial resistance in Pediatrics. 3rd Congreso Nacional
dePediatriaMasterClass.May2427,2009;Acapulco,MEXICO.

Clinical spectrum of congenital tuberculosis. XXII Curso Internacional de
Perinatologa y Neonatologa. September 14, 2009. Guatemala City,
GUATEMALA.

Complementary treatment in neonatal sepsis. XXII Curso Internacional de
Perinatologa y Neonatologa. September 14, 2009. Guatemala City,
GUATEMALA.

Bacterial resistance and antimicrobial rotation in neonatology. XXII Curso
Internacional de Perinatologa y Neonatologa. September 14, 2009.
GuatemalaCity,GUATEMALA.

Influenza, whats new? Grand Rounds. Centro Medico de Especialidades.
September24,2009.Cd.Juarez,MEXICO.

Theimpactofantimicrobialresistanceinpediatrics.XVCongresoAsociacin
Latinoamericana de Pediatra. November 1520, 2009. San Juan, PUERTO
RICO.

Controversies in immunizations. XV Congreso Asociacin Latinoamericana
dePediatra.November1520,2009.SanJuan,PUERTORICO.

Medical Consultant for Escobar Diversified Services (Torrance, CA). UR and
case management for a middle-sized, third party administrator, 1988 - 1989.

Medical Consultant for Oaktree Administrators, Inc. (Paramount, CA). UR and


case management for third party administrator, 1988-1989.

Co-Chairman, Ethics Committee, American College of Medical Quality, 1992


1999 and, sit on committee starting 2011-15.

ASSOCIATED HOSPITAL EXPERIENCE

Emergency Department, Cedars Sinai Medical Center


Quality Assurance Committee, Cedars Sinai Medical Center (past)

Chairman, Department of Emergency Services Medical Committee, Simi Valley


Hospital (past)
Medical Executive Committee, Simi Valley Hospital (past)
Quality Assurance Committee, Simi Valley Hospital (past)
Medical Advisory Committee, Ventura County Health Care Agency,
Ventura County (past)
Paramedic Services Subcommittee, Ventura County Health Care Agency,
Ventura County (past)
Emergency Advisory Committee, Midway Hospital Medical Center (past)
Utilization Review Committee, Midway Hospital Medical Center (past)
Emergency Advisory Committee, Cedars-Sinai Medical Center (past)
Physician Liaison, Volunteer Program, Cedars-Sinai Emergency Department
Volunteers (past)

CERTIFICATIONS

Board Certified, American Board of Emergency Medicine, 1984. Recertified


1993; 2003; 2013.

ATLS Certification 2006.

Board Certified by the American Board of Quality Assurance and Utilization


Review Physicians, October 1990. Fellow of the American College of Medical
Quality, 1993; past Co-chairman of the Ethics Committee, member of the Ethics
Committee many years, ending 2016.

Licensed Physician and Surgeon in the State of California. (G44944); 1981



Evaluation of the child with recurrent infections. Continuing Medical
EducationConference:PediatricReviewforPrimaryCare.MCEConferences.
December2730,2012;Orlando,FL.

The pediatric traveler. Continuing Medical Education Conference: Pediatric
Review for Primary Care. MCE Conferences. December 2730, 2012;
Orlando,FL.

NewguidelinesforthemanagementofUTIinchildren.ContinuingMedical
EducationConference:PediatricReviewforPrimaryCare.MCEConferences.
December2730,2012;Orlando,FL.

MRSA in Pediatrics. Continuing Medical Education Conference: Pediatric
Review for Primary Care. MCE Conferences. December 2730, 2012;
Orlando,FL.

Antibiotic choices for common pediatric infections. Continuing Medical
EducationConference:PediatricReviewforPrimaryCare.MCEConferences.
December2730,2012;Orlando,FL.

Howtoapproachtheinfantwithfeverwithoutasource.ContinuingMedical
EducationConference:PediatricReviewforPrimaryCare.MCEConferences.
December2730,2012;Orlando,FL.

Immunization update. Continuing Medical Education Conference: Pediatric
Review for Primary Care. MCE Conferences. December 2730, 2012;
Orlando,FL.

Adolescent Vaccinations. Pediatric Grand Rounds. Ventura County Medical


Center.March20,2013;Ventura,CA.

Polyvalent Vaccines: Efficacy, Safely and Future. XIV Congreso Nacional de


Pediatria. Confederacion Nacional de Pediatria de Mexico. April 2528,
2013;Monterrey,Mexico.

Efficacy,ComplicationsandFutureofHPVVaccine.XIVCongresoNacional
de Pediatria. Confederacion Nacional de Pediatria de Mexico. April 2528,
2013;Monterrey,Mexico.

Urinary Tract Infections: New guidelines for management. XXV Reunion


AnualLaAcademiaOpina.AcademiaMexicanadePediatria.October35,
2013;MexicoCity,Mexico.

Evaluation of the child with recurrent infections. Continuing Medical


EducationConference:PediatricReviewforPrimaryCare.MCEConferences.
November29December1,2013;Anaheim,CA.

The pediatric traveler. Continuing Medical Education Conference: Pediatric
Review for Primary Care. MCE Conferences. November 29December 1,
2013;Anaheim,CA.

NewguidelinesforthemanagementofUTIinchildren.ContinuingMedical
EducationConference:PediatricReviewforPrimaryCare.MCEConferences.
November29December1,2013;Anaheim,CA.

MRSA in Pediatrics. Continuing Medical Education Conference: Pediatric
Review for Primary Care. MCE Conferences. November 29December 1,
2013;Anaheim,CA.

Antibiotic choices for common pediatric infections. Continuing Medical


EducationConference:PediatricReviewforPrimaryCare.MCEConferences.
November29December1,2013;Anaheim,CA.

Howtoapproachtheinfantwithfeverwithoutasource.ContinuingMedical
EducationConference:PediatricReviewforPrimaryCare.MCEConferences.
November29December1,2013;Anaheim,CA.

Immunization update. Continuing Medical Education Conference: Pediatric
Review for Primary Care. MCE Conferences. November 29December 1,
2013;Anaheim,CA.
Newguidelinesforthemanagementofurinaryinfections.IIIConferenciade
Actualizacion en Pediatria. Asociacion Latinoamericana de Pediatria.
September36,2014;PuntaCana,DominicanRepublic.

Assessment of the child with recurrent Infections. III Conferencia de
Actualizacion en Pediatria. Asociacion Latinoamericana de Pediatria.
September36,2014;PuntaCana,DominicanRepublic.

Evaluation of the child with recurrent infections. Pediatric and Adult
Infectious Diseases: An evidencebased approach to common problems.
MCEConferences.November2729,2014;Orlando,FL.

Theadultandpediatrictraveler.PediatricandAdultInfectiousDiseases:An
evidencebased approach to common problems. MCE Conferences.
November2729,2014;Orlando,FL.

New guidelines for the management of UTI in children Pediatric and Adult
Infectious Diseases: An evidencebased approach to common problems.
MCEConferences.November2729,2014;Orlando,FL.

Antibiotic choices for common pediatric upper respiratory infections.


Pediatric and Adult Infectious Diseases: An evidencebased approach to
commonproblems.MCEConferences.November2729,2014;Orlando,FL.
EXHIBIT 3

Zika and Chikungunya. Curso Internacional de Pediatria de el Colegio de


PediatrasdeYucatan.September2223,2016,Merida,MEXICO.

CreepyCrawlingBugsInfectiousDiseasesI:Zika&Influenza.NotSoScary
Newborn 2016 Conference. Baptist Health System. October 15, 2016, San
Antonio,TX.

Creepy Crawling Bugs Infectious Diseases II: TORCH & GBS. NotSoScary
Newborn 2016 Conference. Baptist Health System. October 15, 2016, San
Antonio,TX.

ThePediatricTraveler:ItsmorethanjustZika.PediatricsforPrimaryCare.
MCEConferences.November2426,2016,LakeBuenaVista,FL.




B.Publications:
1.Fullpapers:
a.Publishedinpeerreviewjournals:
Rowen JL, Correa AG, Sokol DM, Hawkins, HK, Levy ML, and Edwards
MS:Invasiveaspergillosisinneonates:reportoffivecasesandliterature
review.PediatrInfectDisJ,1992:11:57681.

Correa AG, Edwards MS, Baker CJ: Vertebral osteomyelitis in children.
PediatrInfectDisJ,1993:12:22833.

Correa AG, Baker CJ: Subacute bacterial endocarditis due to
Streptococcus pneumoniae relatively resistant to penicillin. Infect Dis
ClinPract,1994;3:1078.

Correa AG, Baker CJ, Schutze GE, Edwards MS: Immunoglobulin G
enhances C3 degradation on coagulasenegative staphylococci. Infect
Immun,1994,6:23626.

ArisoyES,CorreaAG,SeilheimerDK,KaplanSL:Candidarugosacentral
venouscatheterinfectioninachild.PediatrInfectDisJ,1993;12:9613.

Arisoy AE, Arisoy ES, CorreaCalderon AG, Kaplan SL: Rhizopus
necrotizingcellulitisinapreterminfant:acasereportandreviewofthe
literature.PediatrInfectDisJ,1993;12:102931.

Correa AG: Congenital syphilis: Evaluation, diagnosis and treatment.
SeminarPediatrInfectDis,1994;5:304.
ARMANDO G.
G. CORREA,
COHREA, MD, FAAP
1620 S.
S. Friendswood Dr.
Dr. #133
#1 33
Friendswood,
Friendswood, TX 77546
(832)
(832) 569-4663 {832)
(832) 825-3435 Fax

October
October 24,
24, 2017
201 7

Les
Les Weisbrod
Miller
Miller Weisbrod LLP
11551
I Forest Central
1551 Forest Central Dr.
Dr. Ste.
Ste. 300
Dallas,
Dallas, TX 75243
75243

Dear Mr.
Mr. Weisbrod:
Weisbmd.

Thank
Thank you
you for
for asking
asking me to
to review
review the records of
the records of Olivia
Olivia Steinborn
Steinbom regarding
regarding her emergency room
her emergency
visits
visits on
0n August 7,
7, 2016.
2016.

II am aa licensed
licensed physician
physician and
and am board-certified
boardcertied in pediatrics, with
in pediatrics. with board
board certification
certication (sub-board)
(sub-board)
in
in pediatric infectious disease.
pediatric infectious disease.

Currently, and
Cunently, and in August of
in August 0f 2016, as part
2016, as part of
of my daily,
daily, full-time practice, I provide
fulltime practice, provide care
l care and
and
treatment to
treatment pediatric patients
to pediatric patients who present
present with
with signs
signs and
and symptoms similar
similar or
or identical to Olivia
identical to Olivia Steinborn.
Steinbom.

I am further
I familiar with
further familiar with the
the standard
standard of care
care for
for both
both attending
attending physicians
physicians who take
take care
care of
0f
pediatric patients as well as for nurses caring
pediatric patients as well as for nurses caring for for pediatric
pediatric patients.
patients. Further, because
Further, because of my specialized
specialized
training (and sub-board
training (and sub-board certification)
certication) in
in pediatric
pediatric infectious diseases, I am familiar
infectious diseases, I familiar with
with the
the sequalae
sequalae and
and
the
the injuries
injuries that
that can
can be caused by
be caused by a
a failure
failure to
to timely
timely treat
treat pneumococcal meningitis in
pneumococcal meningitis in pediatric
pediatric patients.
patients.

II can
can and am willing
willing toto testify
testify concerning
concerning my qualifications,
qualications, education, training and experience,
education, training experience,
and
and will
wiil incorporate
incorporate that
that education,
education, training,
training, and experience
experience into
into my opinions
opinions related
related to
t0 the
the applicable
applicable
standards of care
standards 0f care that
that apply
apply in
in this
this case.
case. I
l have
have attached
attached a
a copy
copy of
of my curriculum
curriculum vitae
vitae as
as Exhibit
Exhibit A and
and
incorporated
incorporated herein
herein for
for all purposes. My opinions
all purposes. opinions are
are based
based upon
upon my education,
education, training,
training, experience,
experience, and
pertinent
pertinent medical
medical literature, as well
literature, as well as
as my review
review of
of the
the relevant
relevant medical
medical records
records of Olivia Steinborn.
of Olivia Steinborn. My
opinions
opinions in this case
in this case will
will be
be based
based upon a a reasonable
reasonable degree
degree of
of medical
medical probability.
probability.

Records Reviewed:
Reviewed:

As 0f
of the
the time
time of
0f drafting
drafting this
this report,
report, II have
have reviewed the following
reviewed the following records
records related to this
related to this matter:
matter:

(1) Excel ER -A Keller


(1) Excel Keller 8/7/16
8/7/16
(2)
(2) Autopsy Report
Report (Tarrant
(Tarrant Co.
Co. Medical Examiner) 8/7/16 to 1111116
8/7/16 to 11/1l16
(3) Statement of
(3) Juli Treadwell
ofJuli

Brief
Brief Summary
Summau ofPertinent
of Pertinent Records:
Records:

Olivia
Olivia Steinborn
Steinbom was a a 4-year-old
4-yearold female
female who presented
presented to Excel ER Center
to Excel Center around 1:58 AM on
around 1:58AM on
8/7/16 with a one day history of fever, vomiting, diarrhea, decreased activity and decreased
8/7/16 with a one day history of fever, vomiting, diarrhea, decreased activity and decreased oral intake. oral intake.
Olivia
Olivia had
had a history of
a history of deafness
deafness and a a cochlear
cochlear implant.
implant. The records
records indicate
indicate that
that she
she had tachycardia
tachycardia (heart
(heart
rate of
rate of 160
EGO beats/min)
beats/min) and tachypnea
tachypnea (respiratory
(respiratory rate
rate of 52/min).
52/min). The infant
infant was given
given anan IV
[V bolus
bolus of fluid
uid
and
and aa complete
complete blood count (CBC)
blood count (CBC) and
and electrolytes
electrolytes were obtained. No blood
were obtained. bland cultures
cultures or
or IV antibiotics
antibioticg
were ordered.
were The CBC showed
ordered. The showed a a markedly
markedly abnormal
abnormal white
white count
count of 1.1
.1 and platelet
I platelet count
count of 78,000.
78,000. Her
potassium
potassium was also
also low at
at 3.0.
3.0.
tuberculosisandemployeesataChildrenshospital.InfectControlHosp
Epidemiol,2002;23:56872.

Gonzalez BE, Correa AG, Kaplan SL: Catscratch disease occurring in
threesiblingssimultaneously.PediatrInfectDisJ,2003;22:4678.

NunezGussmanJ,StarkeJ,CorreaA,GravissEA,PanX,PopeckE,Metry
D: A report of cutaneous tuberculosis in siblings. Pediatr Derm, 2003;
20:4047.

Jump SM, Sauver JL, Weaver AL, Bagniewski SM, Wilson JW, Huskins
WC,AksamitTR,BrutinelWM,ScalciniMC,SiaIG,CorreaAG,McCoyK,
BoyceTG:IncidenceoftuberculosisinOlmstedCounty,MN,19902001.
MayoClinProc,2004;79:111923.

BlockS,CorreaAG:Updateonthemanagementofpediatricacuteotitis
media and acute bacterial sinusitis. Contemporary Pediatr, 2006; 23:1
12.

AlZein N, Boyce TG, Correa AG, Rodriguez, V. Meningitis caused by
lymphocyticchoriomeningitisvirusinapatientwithleukemia.JPediatr
HematolOncol,2008;30:7814

MurrayKO,GorchakovR,CarlsonAR,BerryR,LaiL,NatrajanM,Garcia
MN,CorreaA,PatelSM,AagaardK,MuliganMJ:Prolongeddetectionof
Zikavirusinvaginalsecretionsandwholeblood.EmergInfectDis,2017;
23:99101

3.Abstractsgivenduringlastthreeyears:
CorreaA,LorinM,RainussoN,DrutzJ,andFrugE.Stretchingthe
SimulatedDollar:CombiningReflectivePracticeandTeamBased
Learning(Abstract#:751707).Posterpresentationatthe2014Pediatric
AcademicSocietiesandAsianSocietyforPediatricResearchJoint
MeetinginVancouver,BC,Canada,May36,2014.

CorreaA,RainussoN,LorinM,DrutzJ,andFrugE.Stretchingthe
SimulatedDollar:CombiningReflectivePracticeandTeamBased
Learning.2014AnnualBCMEducationalInnovationsDay.April30,2014.

CorreaA,RainussoN,LorinM,DrutzJ,andFrugE.Stretchingthe
SimulatedDollar:CombiningReflectivePracticeandTeamBased
LearningPosterpresentationattheBCM2014Academyof
DistinguishedEducators,AnnualShowcaseofEducationalScholarship.
September26,2014.

Drutz,JE,CorreaA,LorinM,RainussoN,andFrugE.Stretchingthe
SimulatedDollar:UsingTeamBasedReflectivePractice.(abstractID:
IPSSW20151231)Posterpresentationatthe7thInternational
PediatricSimulationSymposiaandWorkshops.Vancouver,Canada.May
46,2015.
4. Books:
a.Textbooks

FisherRG,BoyceTG,CorreaAG:MoffetsPediatricInfectiousDiseases:
AProblemOrientedApproach.WoltersKluwer.,FifthEdition,2017.

b.BookChapterswritten:
Correa AG: Acinetobacter Infections. In: Feigin RD, Cherry JD (eds):
Textbook of Pediatric Infectious Diseases. W. B. Saunders Co., Fourth
Edition,1998:13904.

CorreaCaldern A: Tratamiento Coadyuvante en Sepsis Neonatal. In:
GonzalezSaldaaN,SaltigeralP,MacasM(eds):InfectologaNeonatal.
EditorialTrillas,Mxico.Firstedition,1997:3945.

Correa AG, Starke JR: Bacterial pneumonias. In: Chernick V, Boat TF
(eds): Kendings Disorders of the Respiratory Tract in Children. W.B.
SaundersCo.,SixthEdition,1998:485503.

Correa AG, Starke JR: Tuberculosis. In: Green M, Haggerty RJ,
Weitzman M (eds): Ambulatory Pediatrics. W.B. Saunders Co., Fifth
Edition,1999:31019.

Correa AG: Infectious Diseases. In: McLaurin J (ed): Manual for the
Care of the Migrant Farmworkers Children. American Academy of
Pediatrics,FirstEdition,2001:108138.

Correa AG, Starke JR. Infections of the lower respiratory tract in
children. In: Niederman MS, Sarosi GA, Glassroth J (eds): Respiratory
Infections.W.B.SaundersCo,SecondEdition,2001:155169.

CorreaCaldern A: Tratamiento Coadyuvante en Sepsis Neonatal. In:
GonzalezSaldaaN,SaltigeralP,MacasM(eds):InfectologaNeonatal.
EditorialTrillas,Mxico.Secondedition,2006.

CorreaAG:AcinetobacterInfections.In:FeiginRD,CherryJD,Demmler
GJ, Kaplan SL (eds): Textbook of Pediatric Infectious Diseases. W. B.
SaundersCo.,FifthEdition,2004:15441548.

Sattler C, Correa AG: Coagulasepositive Staphylococcal Infections
(Staphylococcusaureus).In:FeiginRD,CherryJD,DemmlerGJ,Kaplan
By
By 4:43 AM that
4:43AM that same day, Olivia remained
day, Olivia remained tachycardic
tachycardia and
and tachypneic
lachypneic despite
despite fluid
uid bolus
bolus and
and non0
further
further vomiting.
vomiting. Even in
in the
the presence
presence of these abnormal
ofthese abnormai fmdings,
ndings. Olivia
Olivia was discharged
discharged home and and arrived
arrived
there
there around
around 55 AM, at
at which time
time all
a1] the
the family
family went toto sleep.
sleep. The father
father woke up around
around 9:45
9:45 Am, to to find
nd
her "cold and
her cold and blue" with
blue with emesis
emesis around
around her
her face.
face. They transported
transported her
her in
in their
their vehicle
vehicle back
back toto Excel
Excel ER-
Keller where she
Kcller where she arrived around 10
arrived around 10 AM in in full
full cardiovascular
cardiovascular arrest.
arrest. Despite
Despite resuscitation
resuscitation efforts,
efforts, she was
she was
pronounced dead
pronuunced dead at
a1 10:28
10:28 AM on 0n 8/7/16.
8/7/1 6.

An autopsy done by
autopsy done the Tarrant
by the County Medical
Tarl'aut County Medical Examiner confirmed
conrmed the
the presence
presence of
of
pneumococcal
pneumococca] meningitis
meningitis as the cause
as the cause of
0f her
her demise.
demise.

Standard of Care and Actions


Standard of Actions Required
Reouired to
to Meet the
the Standard of
of Care Dr.
-Dr. Brandon Morshedi

1.
I. The standard
standard of of care
care required
required Dr.
Dr. Brandon
Brandon Morshedi
Morshedi to
lo be
be able
able to
to identify
identify when patients
patients are
are
appropriate
appropriate candidates
candidates forfor discharge
discharge from
from the
the Emergency Center.
Center. The standard
standard of
0f care
care required
required
Dr.
Dr. Morshedi
Morshedi to to only
only discharge
discharge aa pediatric
pediatric patient
patient when appropriate
appropriate and
and safe to do so,
safe to so, when that
that
pediatric
pediatric patient
patient has
has appropriate
appropriate vital
vital signs
signs and
and bloodwork. standard of
bloodwork. The standard of care
care required
required Dr.
Dr.
Morshedi,
Morshedi, asas aa physician
physician ordering
ordering lab
lab tests such as
tests such as CBC, to
to identify
identify abnormalities
abnormalities suggestive
suggestive of aa
serious
serious bacterial
bacterial infection,
infection. such
such as
as marked leukopenia
leukopenia (low
(low white
white count)
count) and
and thrombocytopenia
thrombocytopenia
(low
(low platelet
platelet count).
count).

2.
2. The standard
standard ofof care
care required
required Dr.
Dr. Brandon Morshedi to Io appropriately
appropriately evaluate,
evaluate, treat
treat and refer
refer for
for
hospitalization
hospiialization a a pediatric
pediatric patient
patient who meet
meet the
the criteria
criteria for
for Systemic
Systemic Inflammatory
Inammatory Response
Response
Syndrome
Syndrome (SIRS),
(SIRS), hashas signs
signs and symptoms of
and symptoms of aa bacterial
bacterial infection,
infection. grossly
grossly abnormal
abnormal bloodwork
bloodwork
and
and a history of
a history cochlear implant.
ofcochlear implant. Specifically,
Specically, the
the standard
standard of care
care required
required Dr.
Dr. Brandon Morshedi
to perform aa diagnostic
to perform diagnostic evaluation
evaluation (including
(including blood
blood culture
culture and
and lumbar puncture),
puncture). toto transfer
transfer the
the
patient
patient for
f'or admission
admission to to the
the hospital
hospital and
and to
to treat the patient
treat the patient with
with IV antibiotics
antibiotics until
until aa serious
serious
bacterial
bacterial infection
infection cancan be
be excluded.
excluded.

Failure
Failure to
t0 Meet the Care Dr.
the Standard of Care- Dr. Brandon Morshedi

1.
l. Dr.
Dr. Brandon
Brandon Morshedi
Morshedi failed to meet
failed to meet the
the standard
standard of care
care by
by inappropriately
inappropriately discharging
discharging Olivia
Olivia
Steinborn
Steinbom when it it was
was unsafe
unsafe toto do
do so.
so. Dr.
Dr. Brandon
Brandon Morshedi failedfailed to
to meet the
[he standard
standard of 0f care
care
by
by failing
Failing to
to appreciate
appreciate the
the significance
signicance of
of a
a grossly
grossly abnormal
abnormal white
while count
count and
and platelet
platelet count
count in
in

Olivias's
Olivias's labwork, particularly in
labwork. particularly in the
the setting of a patient
setting ofa patient with
with a cochlear implant
a coohlear implant which significantly
signicantly
increased
increased the
the risk
risk for
for bacterial
bacterial meningitis.
meningitis. Dr.
Dr. Morshedi
Morshedi failed
failed to
to order
order IV antibiotics,
antibiotics. to
to transfer
transfer
her
her for
for hospitalization,
hospitalization, and
and toIo perform
perform a a blood
blood culture
culture and
and lumbar
lumbar puncture,
puncture, which
which were
were all
all required
required
in
in order
order toto meet
meet the standard of
the standard of care.
care. Instead,
Instead, hehe discharged
discharged Olivia,
Olivia, and
and ordered
ordered only
only aa topical
topical
antibiotic (Ciprodex)
antibiotic (Ciprodex) for for otitis
otilis media.
media.

With
With regard
regard to
to the
the nurses
nurses at
at Excel
Excel ER,
ER I incorporate
incorporate the
l opinions of
the opinions 0f Dr.
Dr. Kenneth
Kenneih Corre
Corre related
related to
to
the standard of
1he standard of care
care and violations
violations of the
ofthe standard
standard of
of care
care of those
oftllose nurses
nurses at
a1 Excel
Excel ER.
ER.
LostPines,Texas

2.Collegeadministrative,committee,etc.:
19941999 ContinuingEducationCommittee
BaylorCollegeofMedicine
Houston,Texas

20012002 InternationalActivitiesCommittee
BaylorCollegeofMedicine
Houston,TX


B.Otheradministrativeassignments
1.Administrative,committee,etc.:
19932002 AntimicrobialSubcommittee
HarrisCountyHospitalDistrict
Houston,Texas

19952002 AntibioticSubcommittee,
TexasChildren'sHospital
Houston,Texas

19962002 Consultant,PediatricTuberculosis
TuberculosisEliminationDivision
TexasDepartmentofHealth
Austin,Texas

19992002 NationalHispanicAdvisoryBoard
PfizerPharmaceutical
NewYork,NewYork

19962002 CommitteeonInfectiousDiseasesand
Immunizations,TexasPediatricSociety
Austin,Texas

20002002 InfectionsCommittee,
TexasChildren'sHospital
Houston,Texas

20012002 CoChair,CommitteeonInfectious
DiseasesandImmunizations,
TexasPediatricSociety
Austin,Texas

2001 Consultant,CommitteeonAntibiotic
UsageGuidelinesforLatinAmerica,
PanamericanHealthOrganization/
WorldHealthOrganization
Washington,DC