February 5, 2008

Re: SB 42 (2008) – Senator Tony Hill

HB 481 (2008) – Representative Dave Murzin Relief of Rhonda Hughes

SPECIAL MASTER’S FINAL REPORT

THIS IS AN UNOPPOSED EQUITABLE CLAIM FOR

$100,000 AGAINST ESCAMBIA COUNTY FOR NEGLIGENT MEDICAL CARE PROVIDED TO RHONDA HUGHES IN 2002 BY AN EMERGENCY MEDICAL TECHNICIAN EMPLOYED BY THE COUNTY.

The EMT mistakenly gave Ms. Hughes an injection of Mivacron, which is a paralytic agent. The EMT initially denied giving Ms. Hughes the wrong medication, but he later admitted his mistake. The EMT was subsequently fired by the County.

The Mivacron injection caused Ms. Hughes to go into full cardiopulmonary arrest. She was transported to the hospital emergency room, and CPR was administered. She was diagnosed with a possible anoxic or hypoxic brain injury because she apparently stopped breathing for some period of time during the incident, which deprived her brain of oxygen.

Ms. Hughes testified at the Special Master hearing that she has constant problems with her memory since the incident. She had memory and other cognitive problems prior to the incident, but her treating physicians attribute her current memory problems to the brain injury rather than her pre- existing condition of dysautonomia because cognitive problems are typically transitory, not constant, when related to dysautonomia.

Neuropsychological testing of Ms. Hughes corroborates her claims of memory problems. The tests indicate that her memory functioning is in the “mildly impaired range” and that she has other cognitive deficiencies.

The professionals who conducted the tests -- Dr. Brett Turner and Dr. Kevin Groom -- attributed Ms. Hughes’ memory and cognitive problems to her brain injury, even though they did not review Ms. Hughes’ extensive history of medical and psychological problems. By contrast, the County’s expert, Dr. Barbara Stein, reviewed Ms. Hughes’ history and was of the opinion that “numerous non-claim- related factors are contributing to [Ms. Hughes’] ongoing symptom presentation.” Dr. Stein was also of the opinion that Ms. Hughes’ “extensive medical and psychiatric history are contributing to her mild cognitive dysfunction,” although she did acknowledge that Ms. Hughes has “some claim- related permanent impairment” (emphasis supplied).

Dr. Stein did not quantify “some” or opine as to how much of Ms. Hughes’ permanent impairment is attributable to the

brain injury. Ms. Hughes’ treating psychiatrist, Dr. Michael Conrad, was of the opinion that “at least half or more” of her depression and anxiety symptoms are related to the brain injury, rather than the dysautonomia.

Ms. Hughes is on a number of daily medications for her medical and psychological problems. Most of the medications are for problems unrelated to the brain injury, such as her depression and “chronic pain.” For example, she takes 60 mg of Methadone daily for pain.

In November 2006, Ms. Hughes was referred to a specialist, Dr. Rick Beach, for recommendations regarding pain management. Dr. Beach identified a number of factors that complicate the implementation of a pain management plan that is less dependent on medications, including Ms. Hughes’ history of psychological problems.

Dr. Beach pointed out that Ms. Hughes “appears to have all the risk factors for personality or characterological disorder prior to brain injury,” and he identified several issues that warranted further examination, including the possibility that Ms. Hughes was using her condition for “avoidance (of life responsibilities and stresses)”, “attention (continued care- taking by family),” and “continued opiate doses (patient with history of opiate abuse in past).” Dr. Beach concluded that until Ms. Hughes resolved her lawsuit with the County, “there may not be much incentive for Ms. Hughes to actively participate in a program that is focuse[d] on wellness and personal responsibility and a program that is designed to reverse any rolls as a victim that a patient may have unknowingly fallen into secondary to their long-term pain condition.”

Dr. Stein expressed similar opinions. For example, she opined in her report that Ms. Hughes “is misattributing many of her symptoms to the [County]’s alleged conduct” and that “secondary gain including avoidance of responsibility and stress, attention from caretakers and potential financial remuneration is also present.” Dr. Stein also pointed out that Ms. Hughes had no problem remembering many things and that she had “selective recall.”

The assessments of Ms. Hughes by Dr. Beach and Dr. Stein are consistent with my observation of her at the Special

Master hearing. Her testimony and the testimony of her mother regarding the extent of her memory problems were generally unpersuasive. Indeed, notwithstanding the fact that the neuropsychological testing showed no signs of malingering (i.e., faking) by Ms. Hughes, I was not persuaded that Ms. Hughes’ memory problems and cognitive deficits are as severe as she says they are.

Ms. Hughes lives with her mother, who is a retired school teacher. Ms. Hughes depends upon her mother to oversee her medications, but Ms. Hughes acknowledged that she is capable of performing most activities of daily living (e.g., grooming, cooking, cleaning). Additionally, Ms. Hughes has no problems driving.

Ms. Hughes has not worked since September 2001, which is prior to the incident giving rise to this claim. She stopped working because of her dysautonomia, and she has been declared permanently and totally disabled by the U.S. Social Security Administration. She receives disability payments of approximately $700 per month, which is her only source of income other than the support that she receives from her mother.

Ms. Hughes is eligible for Medicare as a result of her permanently disabled status, and Medicare is her primary insurance. Ms. Hughes is not currently eligible for Medicaid because she lives with and receives support from her mother.

Ms. Hughes testified that she is still in therapy for her neuropsychological problems, and that she goes to therapy “every 2 or 3 weeks.” However, she has not made a serious effort to follow up with Dr. Beach regarding a pain management plan that is less dependent on Methadone.

Dr. Conrad testified in deposition that Ms. Hughes will require daily supervision and care to ensure that she is taking her medications correctly. Ms. Hughes’ mother currently performs that role, but Ms. Hughes may have to hire someone to take over that role as her mother gets older. The present value cost of the daily care that Ms. Hughes will need over the course of her life was estimated to be in excess of $300,000.

Dr. Conrad stated in an affidavit provided at the Special Master hearing that Ms. Hughes will life-long psychiatric care, medication, and counseling due to her brain injury. He also stated that the amount of care and treatment could increase as she aged. The costs of this care and treatment are not included in the $300,000 referenced above.

Payment of the claim bill will not adversely affect the County or its emergency medical services program. The County provided a letter from its Risk Manager, which states that “at least $100,000 has been set aside in reserve for payment of a claims bill in favor of Rhonda Hughes.”

the County, including opening an art studio and buying some land in Destin. In her testimony at the Special Master hearing, Ms. Hughes denied making those statements to Dr. Beach.

material contributing cause to Ms. Hughes’ current condition in light of her extensive history of medical and psychological problems or that her memory problems and cognitive deficiencies are as bad as she says they are.

Respectfully submitted,

T. Kent Wetherell Senate Special Master

cc: Senator Tony Hill Representative Dave Murzin

Faye Blanton, Secretary of the Senate

House Committee on Constitution and Civil Law Karen Camechis, House Special Master Counsel of Record

Docket for Case No: 07-004287CB

Orders for Case No: 07-004287CB