Bill of Particulars

A Death in the Hospital /Bill of Particulars


RALPH H. SPEKEN and STEPHANIE Z. SPEKEN, As co-Administrators of the Estate of SETH B. SPEKEN, deceased, and RALPH H. SPEKEN and STEPHANIE Z. SPEKEN, individually


Index: 128682/94



COLUMBIA PRESBYTERIAN MEDICAL CENTER, “JOHN DOE”, and “JANE DOE”,(true identities unknown, being doctors, nurses, residents, interns and other medical or technical personnel who rendered services to the decedent at the COLUMBIA PRESBYTERIAN MEDICAL CENTER),



PLEASE TAKE NOTICE, that the plaintiffs as and for their Amended Verified Bill of Particulars, answering the demand of the defendant, respectfully show to this Court as follows:

1. The decedent’s date of birth was July 19, 1970. At the time of his death, he resided at 2728 Henry Hudson Parkway, Bronx, New York 10463. The decedent was not married and had no children. Stephanie Speken was born January 20, 1947 Ralph Speken was born October 16, 1941 Ralph and Stephanie Speken were the parents of the decedent.

2. Plaintiff claims a delay in reaching the correct diagnoses of Xanax withdrawal.

3. No claim is made for the failure of the defendant to administer a diagnostic test.

4. The defendant failed to administer Xanax to treat the withdrawal symptoms. Defendant also failed to timely begin treatment with Ativan; failed to timely begin to administer the drug intravenously and failed to raise the dosage on a timely basis to treat decedent’s agitation, hallucinations and other withdrawal symptoms; defendant also failed to adequately sedate the decedent which would nave obviated or at least limited, the need for restraints.

5. It will be claimed that the defendant, through its agents, servants and/or employees were negligent, careless and reckless in the care and treatment rendered to the decedent while he was a psychiatric patient under their care, control and supervision; in failing to properly monitor, observe and supervise the decedent who was delusional and delirious; in causing, allowing and permitting the decedent, who was medicated, to be permitted to use the lavatory unattended; in failing to order one on one coverage for the supervision and care of the decedent; in causing,and permitting the decedent to fall and strike his head while in the lavatory; in failing to order, monitor and observe proper protective and immobilizing devices and restraints; in failing to properly monitor, observe and act upon the decedent’s reactions and experiences to his withdrawal and/or administration of medications and immobilizing devices; in causing, allowing and permitting the decedent to be injured while restrained with immobilizing and/or protective devices; in failing to properly order specific time limits for the use of protective /immobilizing devices; in failing to properly and adequately observe and re-examine the decedent in order to determine the propriety of continued the use of restraints; in failing to properly observe, chart and assess the decedent’s condition every 30 minutes; in improperly restraining the decedent ,with wrist restraints and ankle restraints; in failing to properly train, supervise and instruct the hospital staff in the use and application of restraining devices; in failing to provide for the decedent’s safety; in failing to take proper care and adequate and necessary safeguards and supervision to prevent the occurrence herein set forth; in failing to use accepted modes, practices, procedures and standards made, set and provided for the use of such restraints within the medical and hospital community; in failing to comply with the standards of medical and hospital care and treatment practiced by physicians and/or medical institutions and their personnel; in failing to use the accepted, correct and established modes and procedures in connection with the treatment of the conditions from which the decedent was suffering; in treating the decedent in a manner contrary to the accepted rules and standards of the community wherein the treatment was utilized upon decedent; in failing to use and exercise the required degree of care, skill, judgment and diligence; in failing to possess and provide the usual degree of medical and nursing care reasonably required to be possessed by doctors, nurses, therapists and other medical and/or technical personnel in the locality; in negligently causing, allowing and permitting the decedent to be fatally injured; in failing to take proper steps, timely steps and to render proper and timely examinations of the plaintiff’s intestate. In addition to the acts of negligence previously set forth, the defendant was negligent in failing to listen to the history given by Seth’s father; in failing to timely diagnose Xanax withdrawal; in failing to administer Xanax; in failing to timely begin the administration of Ativan; in failing to timely administer the Ativan intravenously; in administering the Ativan in doses that were inadequate to treat the patient’s symptoms; in failing to respond when a nurse summoned a physician in and about the evening of August 22; in failing to then begin appropriate treatment of hallucinations and other symptoms of withdrawal; in failing to then consult a psychiatrist; in subsequently failing to keep the treating resident psychiatrist aware of changes in the patient’s condition; in failing to have a psychiatric attending involved in the care of the patient; in failing to timely transfer the patient to the intensive care unit for appropriate monitoring and treatment; in failing to perform appropriate mental status examinations; in failing to reassess the need for restraints; in failing to document the patient ‘s condition and the need for restraints in the chart; in maintaining the restraints for more time than was necessary; in failing to document any need for the restraints on a periodic basis; in failing to reevaluate whether the patient needed restraints every few hours; in failing the hospitals rules and regulations regarding the frequency of reassessment for the need for restraints; in failing to follow New York State rules and regulations and practices regarding the reassessment for the need for restraints; in failing to have promulgated rules and regulations for patient’s not in a psychiatric unit regarding the use and continuance of restraints; in failing to train the interns and residents regarding the need, use, reassessment and risk of restraints; in failing to document when restraints were used and when they were removed; in failing to consult appropriate medical texts, the Physicians Desk Reference and other recognized authorities regarding the management of Xanax withdrawal; in failing to adequately sedate the patient; in continuing the need for restraints for longer period than would have been necessary if the patient had been adequately sedated and treated for his withdrawal; in failing to administer Ativan in dosages consistent with the symptoms that he was showing; in administering Haldol when said medication was contraindicated; in delaying the performance of a lumbar puncture to rule out other causes of the patient’s symptoms; in permitting pulmonary emboli to develop; in failing to timely diagnose same; and in failing to administer anticcagulants.

6. The defendant should have begun IV administration of the Ativan sooner.

7. No claim is made for defective equipment. Plaintiff claims that the defendant through its agents, servants and/or employees improperly applied protective and restraining devices on the decedent and failed to properly monitor and examine him.

8. Plaintiff claims that all of the doctors and nurses who were responsijle for the treatment of the withdrawal and the ongoing use of restraints were negligent. These include Dr. Collins, Dr. Bongiovi, Dr. Sagman, Dr. Berkowitz, Dr. Ortiz, Dr. Mayer, Dr. Bertsch, Dr. Li, and anyone else who failed to discontinue the restraints when they were no longer necessary.

9/10. Plainiff has furnished defendants with authorizations as to any doctar, hospital, institution and facility where decedent received medical treatment with respect to psychiatric, or psychological care.

11. The negligent acts took place during the decedent’s admission to the Columbia Presbyterian Hospital between August 21, 1993 and August 27, 1993.

12. See item 11, supra.

13. It will be claimed that the decedent was admitted to the defendant hospital for panic disorder, anxiety and depression. Defendant undertook to treat Xanax withdrawal.

14. As a result of the negligent care and treatment rendered, the decedent sustained the following personal injuries: bilateral pulmonary thromboembolus; thrombosis of periprostatic veins and small veins of lower extremities including those near the achiiies tendons resulting in death. severe facial abrasions on capsular surface; The foregoing injuries and/or the aggravation, exacerbation, activation and/or precipitation of those conditions from which he suffered in and about the internal parts and organs of his body caused the decedent to die aware and conscious of impending death and during that period suffered great pain, anguish and agony. decedent suffered severe pain and suffering, emotional distress, hallucination, agitation and other symptoms of withdrawal as well as struggling the restraints.

15. Not applicable. The decedent died while in the defendant hospital.

16. Not applicable.

17. Not applicable.

18. Not applicable.

19. The decedent’s date of death: 8/27/93 Place of death: Columbia Presbyterian Hospital Cause of Death: Pulmonary Thromboembolus due to immobilization due to psychiatric disorder. Autopsy performed by New York City Medical Examiner, ME Case No: M93 6833; on August 28, 199?.

20. No claim is made for loss of present financial support from the decedent. Plaintiffs reserve the right to prove the value of lost future financial support.

21. Not applicable.

22. Not applicable.

23. Not applicable.

24. The following are the special damages approximated to date and continuing: Funeral expenses: $ 5,026.00 Park West Riverside Chapels 333 Amsterdam Avenue New York, New York 10023 Haimm Memorial Center 2 Austin Avenue Iselln, NJ 08830 595.00

25. Not applicable.

26. Not applicable.

27. Not applicable

28. Petition for Letters of Administration and Letters are annexed hereto

29. Decedent’s social security number: 092-58-4483

Dated: New York, New York
October 10, 1996

Yours, etc.,
Attorneys for Plaintiff
Office & P.O. Address
800 Third Avenue
New York, New York 10022
(212) 355-3900

Attorneys for Defendant
116 John Street New York,
New York 10038