1. Jeff Vaughn v. Kentuckiana Colon & Rectal Surgery and Dr. Wayne Tuckson

2. Dr. Tuckson cut out Jeff’s “Benign”46 year old colon Jeff’s rectal bleeding in September 01 had been caused by hemorrhoids PROVEN FACTS FAP = death from cancer unless colon is cut out Jeff did not have FAP and Dr. Tuckson’s documents did not support FAP Jan 30, 2002 = sole office visit with Dr. Tuckson before surgery March 19, 2002 = Dr. Tuckson cut out colon with “presumed” diagnosis -Discharge Summary (Ex. 28) -Dr. Tuckson’s April 17, 2002 letter (Ex. 29)

3. Credibility 3 Key Facts the Defense Fought with Fiction ●FAP Misdiagnosis – was Jeff misdiagnosed with FAP? ●Hemorrhoids – did they cause Jeff’s rectal bleeding? ●Litigation Fear – is this why Jeff not told he had AFAP?

4. Dr. Tuckson cut based on hearsay from patient Jeff Dr. Tuckson cut with Jeff’s statement and 4 documents Dr. Tuckson had 4 reports - that identified a total of 2 polyps: Standard of Care: Jeff’s statement alone is NOT an acceptable way for Dr. Tuckson to confirm FAP diagnosis. 1. EGD Path Report – not consistent with FAP 2. EGD Report – not consistent with FAP 3. Colonoscopy Path Report – unclear at best 4. Colonoscopy Report – not consistent with FAP January 31, 2002 Office Visit: - Jeff said Dr. Haider said Jeff had: “familial polyposis” more than 100 polyps

5. Sept 21, 2001 to Jan 30, 2002 March 19, 2002 to Jan 20, 2004 ______________ ______________     (45 + Days) Dr. Tuckson Chart 4 reports, 1 letter, and Jeff says FP ____ 0 Dr. Tuckson ●Scopes, ●DNA Tests, ●  to collect documents diagnosing FAP HealthSouth Surgery Chart  ☻ Photos b4 litigation? Dr. Kashif Haider Chart  ☻ Includes Dr. Lee’s Path ☻ Includes Hardin CT Scan Hardin Hospital Chart  ☻ Includes Dr. Lee’s UK Path Dr. Tuckson Chart  Surgery Report  2 Office Visits ●No mention of AFAP Jewish Hospital Chart ●No mention of AFAP Mayo Clinic – 1/20/04 ●Jeff’s lawyer gets DNA tested Documents - FAP Misdiagnosis/Surgery (4 + months) (1 year and 10 months)

6. 1. EGD Path = Inconsistent with FAP 1/22/02 Pathology Report faxed to Dr. Tuckson on Jan 30 th  Infectious Organisms Not Seen  Stain for Bacteria Negative  Heartburn Fax received at 10:01p.m. 

7. 2. EGD = Heartburn, not FAP 1/22/02 Operative Report faxed to Dr. Tuckson on Jan 30 th Before Scope Diagnosis 1. Persistent heartburn 2. Possible familial polyposis  After Scope Diagnosis 1.Heartburn  not familial polyposis  Fax received at 1:23p.m. 

8. 3. Colonoscopy Path = Unclear at Best 10/12/01 Pathology Report faxed to Dr. Tuckson on Jan 30 th Low to High Grade Dysplasia? Either low or high not both Moderate to Severe Dysplasia? no more “moderate” Either low or high  Fax received at 1:23p.m.   1 documented polyp

9. 4. Colonoscopy Report = Inconsistent with FAP 10/11/01 Report faxed to Dr. Tuckson on Jan 30 th Before Scope Diagnosis 1. Rectal Bleeding  After Scope Diagnosis 1. Hemorrhoids 2. Colon Polyp x 2  Fax received at 1:23p.m. 

10. Dr. Tuckson never told Dr. Haider the surgery date Red Flags Index Case = no family History Polyps Not Evenly Distributed Low to High = Severe?

11. Jeff’s did not have a deadly disease, he had Hemmorhoids _________________________________

12. Dr. Tuckson’s Fault Dr. Tuckson failed to exercise reasonable care in treating Jeff because he failed to confirm the diagnosis before cutting. Dr. Tuckson was required by standard of care to confirm diagnosis: (1) Contact Dr. Haider (2) Order DNA testing (3) Take a look himself Dr. Rex. GI IU Dr. Sussman Surgical Oncologist UC

13. (1) Contact Dr. Haider - what would a  have revealed?  Dr. Lee had argued “no way” Jeff had FAP in early Jan 02 – p. 21  Dr. Haider said Jeff had less than 100 polyps and no history – p. 39 _______________________ ___________________________ _________________  Polyposis not on Lee’s mind  p. 45

14. (2) DNA Testing - what would a “Mayo” test have shown?  A mutation was NOT detected ________________________________________ ________________

15. (3) Look Inside Colon First – what would Dr. T have seen?  No adenoma or carcinoma  Benign segment of colon

16. Dr. Haider’s Fault What have the Defendants proven as to Dr. Haider’s fault?

17. Apportionment of Fault and Jeff’s Damages Example of effect of “apportionment” on damages awarded Defendants Pay Total Damages $1,000,000 Dr. T Fault x 50% Dr. T Owes Jeff $500,000   Verdict Reduced $1,000,000 total damages award reduced by $500,000 for Dr. H 50% share of fault Jeff collects $500,000 from $1,000,000 awarded in this 50/50 example.

18. THIS CASE IS ABOUT AFAP About Defendants A = F = A = P = Faulting Another Person = Dr. Haider

19. THIS CASE IS ABOUT AFAP About Defendants A = F = A = P = Fabricating A Polyposis = AFAP

20. Attenuated FAP = Defense born by law suit Dr. Tuckson never mentioned it but now says Jeff had “A”FAP Time Line - Jeff not told he had “A”FAP at: Jan 30, 2002 - Office Visit with Dr. Tuckson March 19, 2002 - Surgery with Dr. Tuckson April 17, 2002 - Office Visit with Dr. Tuckson July 3, 2002 Office - Visit with Dr. Tuckson No mention of “A”FAP in medical records July 15, 2003 Dr. Tuckson Deposition Jeff hears “A”FAP a year after his last Office Visit

21. FAP and AFAP – very rare and even rarer Entire Population = 100%    Colon cancer = 5%   FAP = < 1% of 5%   AFAP = 2% of < 1% of 5%   AFAP with Desmoids = 3% of 2% of < 1% of 5% . _________________

22. What does the Mayo Clinic say about AFAP?  None of the listed mutations were detected ________________________________________________ _____

23. Fundic Gland polyps are nearly always associated with AFAP and may precede the development of colorectal polyps. AFAP article, p. 130, January 2002 Dr. Church did not mention of “controversy” in commentary Jeff did NOT have Fundic Gland Polyps Undisputed Fact per EGD What does Dr. Church’s article say about AFAP?

24. In addition, screening with flexible sigmoidoscopy the recommended modality for FAP, is inadequate, because the majority of colonic lesions in patients with AFAP are right sided. AFAP article, p. 130 January 2002 Left sided Polyps and AFAP not discussed in Dr. Church’s commentary What else does the article say about AFAP? Jeff had left sided polyps

25. Jeff had 3 Small Low Grade Adenomas 3 ant size adenomas do not equal AFAP 1. Colonoscopy – 2 polyps 10/11/01 Dr. H rectum scope Dr. Fenoglio-Preiser 2 low grade ant-size adenomas Specimen to Pathology 1 piece of tan tissue (.6 x.02 x.02 cm) Specimen to Pathology 6 tan fragments (2.0 mm each) _________________________________________________________  Dr. Fenoglio-Preiser 1 low grade ant-size adenoma   2. Flex Sig - 4 polyps 11/5/01 Dr. H rectum scope 3. Colon Removal 3/19/02 Dr. T surgery Specimen to Pathology Jeff’s Colon 3 feet approximately  Dr. Fenoglio-Preiser 0 adenomas Jewish Pathology Benign Colon No adenomas No carcinomas _________________________________________________________ = COMMON

26. _____________________ ______________________________ _____________________________________________________________________ _________________________________________________ DNA testing is powerful tool to be used to confirm diagnosis in an atypical patient like Jeff __________ Hardin Memorial Request for 2 nd Pathology Opinion from Dr. Lee Dr. Church Primer, Chapter 9, Page 71

27. Jeff’s damages – the unnecessary surgery

28. Jeff’s pain and suffering since surgery 10 Bowel Movements a Day X 365 Days in a Year X 28Years of Life Expectancy 102,200 Bowel Movements Left Jeff Can Not Eat Normally Jeff Wakes Up In Pain Every Day Jeff Can Not Control His Gas Jeff Has “Accidents” Jeff Carries A Diaper Bag Jeff Defecates Over A Dozen Times Per Day Jeff Has To Work More Hours To Do His Job

29. Dr. Lynch says a “gross” deviation from a minimally acceptable standard of care has turned Jeff into a bowel cripple

30. Dr. Tuckson operated the scapel which, according to him, was the “Truck In This Case”