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Younes v. Nolan1/19/2005
member whether he palpated Patient A's neck on the visit of April 16, 1999, the day that the nurse noted cervical pain. On June 9, 1999, Dr. Younes' explanation for the lump was that after stopping the Prednisone Patient A had a flare-up of the lymph nodes. (Tr. 6/29/04 at 45.)
The third person to testify, on September 11, 2002, was Dr. Stephen John D'Amato ("Dr. D'Amato), a Board certified emergency medical physician who saw Patient A at his North Providence medical services facility on June 9, 1999, six days after her last visit to Dr. Younes. Dr. D'Amato's medical record of Patient A was introduced as Exhibit 6. There was a notation in the record about a "lump behind the right ear" that was typed by the receptionist. (Tr. 9/11/02 at 81.) The nurse's note in the record, after the signature R.N., said in part, "c/o nausea, lump behind right ear, no appetite, no taste, increased mucous.." (Tr. 9/11/02 at 82.) Dr. D'Amato noted a firm mass on the right angle of the mandible and sternocleidal mastoid muscle. (Tr. 9/11/02 at 86.) The record also noted a "large hard matted area right neck." (Tr. 9/11/02 at 87.) Dr. D'Amato stated that the mass was like a hard congealed type. (Tr. 9/11/02 at 90.) Dr. D'Amato further described the mass as being found right at the point where the jaw makes the curve. In describing painful glands in the neck, Dr. D'Amato testified as follows:
"The nurse's note, it says, 'lump behind the right ear'; and then my note below it says, 'painful glands in the neck.' It's very common for patients to come in when they have got a lump, they call this behind the ear. You see that all the time."
The fourth person to testify was Dr. Paul J. Agatiello (Dr. Agatiello). Dr. Agatiello, whose curriculum vitae was admitted as Exhibit 9, was Board certified in internal medicine and testified as an expert on July 23, 2003. Before testifying, Dr. Agatiello reviewed the specification of charges, the testimony of John Doe and the direct examination of Dr. Younes, up to the point where he left off on September 11, 2002. Dr. Agatiello also reviewed the testimony and medical records of Dr. D'Amato. In addition to the above, he reviewed the office and progress notes of Dr. Younes, the pathology reports and other medical data.
A page from Harrison's Principles of Internal Medicine 10th Edition was made Exhibit 11 in the case. Dr. Agatiello went into detail in describing inadequate documentation on the part of Dr. Younes with respect to the treatment of June 3, 1999. (Tr. 7/23/03 at 23-28.) With respect to documentation, he stated that students are taught that if it's not written, it's not done. In support of this, he referred to the page in Harrison's Principles of Internal Medicine pertaining to the "history" and "physical" parts of the text. (Tr. 7/23/03 at 29.) Those sections clearly provide that the written history of an illness should embody all the facts of medical significance in the life of the patient. The results of the physical examination, like the details of the history, should be recorded at the time they are elicited rather than hours later when they are subject to the distortions of memory. Dr. Agatiello based his testimony upon his education, training and experience, and cited the medical text as additional support.
Dr. Agatiello testified that based on a review of Appellant's records, Appellant did not examine the head, face or neck of the patient on June 3, 1999, and if he did, then it was not documented in the record. Dr. Agatiello noted numerous instances where Appellant failed to use the degree of skill and care expected of a reasonably competent practitioner in the same class in which he belonged, acting in the same or similar circumstan
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