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1:10P: Emergency Room Visit
Mathew Calbi, age 14, reports to Pascack Valley Hospital emergency room -
4:00P: Differential Diagnosis
Differential Diagnosis-(1) paratonsillar abscess;(2) posterior pharyngeal abscess; (3) vascular injury (an injury to an artery or vein); & (4) thoracic aneurysm (a ballooning of the wall of an artery or vein in the thorax) -
4:32P: Dr. Steckowych
Dr. Cartaxo called head and neck surgeon, and asked her to come in to examine Matthew. Dr. S. advised CAT Scan, and call her with results. -
5:00P: Morphine
Dr. Cartaxo administered 2 milligrams of morphine sulfate to ease Matthew's pain -
5:47P: CAT Scan Neck | 5:55P: CAT Scan of Chest
Performed -
6:16P: Dr. Steckowych
Arrives in emergency room -
6:21P: Dr. Anna Kelly-Radiologist
Read CAT Scan films of neck. Spoke briefly to Dr. Cartaxo to obtain more clinical information about Matthew. Dr. Cartaxo told her that the patient history was "somewhat unclear." -
6:30P: Morphine and Nurse Drew's Observations
Nurse Drew administered one-milligram of morphine sulfate. "Swelling in neck didn't increase beyond minimal level or change color through shift." -
6:46P: Dr. Kelly's Report
Received by telephone by Dr. Cartaxo. Finding... "Extensive soft tissue mass encasing and compressing the right jugular vein." Suspected "jugular injury with hemorrhage." -
6:50P: Dr. Cartaxo calls Dr. Roxana Klein
Dr. Cartaxo called the vascular surgeon on call, Dr. Roxana G. Kline, whom he reached at 6:50 p.m. Because the neck CAT scan results confirmed that Matthew was suffering from a vascular injury -
6:55P: Dr. Kline
Dr. Kline did not have the training to do what was required to stem the bleeding: to perform a median sternotomy, a procedure in which the surgeon opens the patient's sternum, makes an excision into the neck, and removes a part of the collarbone. Only a thoracic surgeon could perform such an operation -
7:07P: Dr. Ignatius Zairis
Dr. Cartaxo called Dr. Ignatius Zairis, the thoracic surgeon on call, but he did not come to the hospital or return several calls placed by doctors in the emergency room in the next hour. -
7:15P: Dr. Steven Schreiber
Dr. Cartaxo's shift ended at 7:00 p.m., and Dr. Steven Schreiber, who settled his liability with plaintiff before trial, began his shift as the emergency room doctor. By 7:15 p.m., Dr. Schreiber had assumed care of Matthew. -
7:50P: Dr. Kline examins Matthew
Matthew's blood pressure normal, but his heart rate "seemed on the high side." Dr. Kline found no evidence of trauma to the head, but a blood spot on the right eye and swelling at the top of the chest and bottom of the neck. -
7:50P: Dr. Kline examines Matthew
Dr. Kline considered Matthew's blood pressure normal, but his heart rate "seemed on the high side." Dr. Kline found no evidence of trauma to the head, but a blood spot on the right eye and swelling at the top of the chest and bottom of the neck. -
7:57P: Matthew's condition recognized as Life-threatening
Dr. Kelly faxed a second report to the hospital at 7:57 p.m. containing her amended findings. At that point, Dr. Kline recognized Matthew's situation as life-threatening. -
8:10P: Dr. Zairis, the thoracic surgeon calls
Dr. Zairis, the thoracic surgeon, called the emergency room at 8:10 p.m. and spoke with Dr. Kline. Dr. Kline testified that she provided Dr. Zairis with "the information [she] had gathered from the blood test, the X rays, the CAT scan, [and] Dr. Kelly's conversation about the updated CAT scan" in which she noted there was "active bleeding from [the] right subclavian artery[.]" She told him about Matthew's 11.7 hemoglobin level. Dr. Zairis's memory of that conversation differed somewhat. -
8:20P: Matthew to be transferred to another Hospital
The doctors agreed that Matthew would have a better outcome if transferred to Westchester Medical Center (Westchester), a level-one trauma center, where he could be treated by a pediatric thoracic surgeon and pediatric residents -
9:46P: Matthew's Condition Worsens
Between 9:46 p.m. to 10:01 p.m., Matthew's heart rate climbed from 135 to 176 beats per minute. He began "screaming out" in pain at roughly 10:00 p.m. and quantified his pain as fifteen out of ten at that time. By 10:02 p.m., his blood pressure had dropped to 43/28. "Total cardiovascular collapse" occurred at 10:20 p.m. -
10:48P: Dr. Zairis is called
Dr. Zairis received another call from the hospital at about 10:48 p.m.; he was told that Matthew was in shock and was de- compensating; in other words, his heart was failing to maintain adequate circulation due to loss of blood. -
11:15P: Dr. Zairis arrives at Hospital
Dr. Zairis went to the hospital and examined Matthew at 11:15 p.m. He made his first incision at 11:30 p.m. -
11:30P: Dr. Zairis observations
When Dr. Zairis opened Matthew's chest, he found "massive venous bleeding coming from the internal jugular vein as well as from the subclavian vein." Matthew's pericardium was filled with 200 cubic centimeters of venous blood, while his pleural cavity was filled with two-and-a-half liters of arterial blood. Dr. Zairis's operative report stated that he was able to control the venous bleeding by repairing the internal jugular vein and subclavian vein with sutures. Dr. Zairis also repaired the tear -
1:15P: Triage Nurse
Matthew told the nurse that he had been kicked by his mother in the face earlier that day and was experiencing sharp pain on the right side of his face and his right shoulder. He rated his pain 10-10. -
1:30P: Triage Nurse Assessment
Classified Matthew's case as "non-urgent," The lowest of three triage scores. -
2:30P: Nurse Josephine Drew | And again at 5:30P
2:30P: "No discoloration in Matthew's neck & only slight swelling. No visible pain or distress. Matthew vomited. Drew didn't report it to Dr. Cartaxo." 5:30P: "Color Good, Active and not asleep." -
3:30P: Dr. Cartaxo Examination
History was "scuffle with mother, while on floor neck turned, sudden onset of pain." Exam revealed significant swelling, only sign of trauma, small hemorrhage in eye. -
7: 48P: Dr. Kelly's amended CAT Scan report
Dr. Kelly called the emergency room at 7:48 p.m. and spoke with Dr. Kline. She told Dr. Kline that she had found another series of images that she had not considered in her initial diagnosis; the second set of images showed that an artery was bleeding in addition to the venous bleeding she observed in her first report. Dr. Kelly faxed a second report to the hospital at 7:57 p.m. containing her amended findings. At that point, Dr. Kline recognized Matthew's situation as life-threatening. -
12:50A
Matthew was pronounced dead on the operating room table at 12:50 a.m.
