Evidence Admitted - DEFT'S EX A-40 FOR ID - CV OF DEFT'S MEDICAL EXPERT Due Date: Complete Date: September 28, 2021 (2024)

Evidence Admitted - DEFT'S EX A-40 FOR ID - CV OF DEFT'S MEDICAL EXPERT Due Date: Complete Date: September 28, 2021 (1)

Evidence Admitted - DEFT'S EX A-40 FOR ID - CV OF DEFT'S MEDICAL EXPERT Due Date: Complete Date: September 28, 2021 (2)

  • Evidence Admitted - DEFT'S EX A-40 FOR ID - CV OF DEFT'S MEDICAL EXPERT Due Date: Complete Date: September 28, 2021 (3)
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Filing # 134956572 E-Filed 09/21/2021 03:42:59 AM Rafael J. Fernandez Jr. M.D., F.A.A.O.S., F.A.C.S. Fernandez Orthopedics, PA 2916 South Douglas Road Suite 1 Coral Gables, Florida 33134 Tel: (786) 837-8888 Fax: (888) 837-4974 go@gablesortho.com ! PERSONAL Place of Birth: Boston, Massachusetts Foreign Languages: Spanish CERTIFICATIONS Social Security Office - Hearings and Appeals - Medical Expert 2001 - 2010 American Board of Orthopaedic Surgery 1999 American Board of Orthopaedic Surgery - Recertification 2008, 2019 Workman’s Compensation Certification 1997 Diplomat of the National Board of Medical Examiners 1991 Defendant/Respondent 2019-003489-CA-01 MEDICAL LICENSES 9/28/2021 Alabama 1998 0021658 Florida 1997 0072583 A40 Illinois 1996 036092815 APPOINTMENTS University of Miami-School of Nursing and Health Studies Clinical Preceptor 2014 - Current Florida International University – Herbert Wertheim College of Medicine: Clinical Assistant Professor, Department of Orthopaedics Voluntary Faculty 2010 - Current Florida International University – School of Nursing Clinical Preceptor 2007 - 2008 POST DOCTORAL EDUCATION University of Illinois - Peoria Sports Medicine Fellowship University of Kansas - Wichita Orthopaedic Residency University of Kansas - Wichita Rotating Internship UNDERGRADUATE EDUCATION University of Illinois - Chicago Medical School Medical Doctorate Loyola University - Chicago Undergraduate BS - Biology D1-40 FOR ID PROFESSIONAL ACTIVITIES “America’s Top Orthopedists” 2017 THE DOCTORS COMPANY Florida Physicians’ Advisory Panel Member 2010 - 2016 “America’s Top Surgeons” 2008 First Health Insurance Consultant 2000 Team Physician Cypress Creek High School, Orlando 1998 - 2000 Volunteer Osceola County Sports Medicine Physicals 1998 - 2000 PROFESSIONAL ASSOCIATIONS Florida Medical Association Member Florida Medical Association Delegate 2018 Dade County Medical Society Member Board Member - District 3 2017 - Current American Academy of Orthopaedic Surgeons Fellow Florida Orthopaedic Society Member Miami Orthopaedic Society Member Member-at-large 2005 - 2006 Treasurer 2006 - 2007 Vice-President 2007 - 2008 President 2008 - 2009 American College of Surgeons Fellow American College of Surgeons-Florida Chapter Member HOSPITAL COMMITTEES Coral Gables Hospital Past-President, Medical Staff 2015 - 2016 President, Medical Staff 2013 - 2014 President Elect, Medical Staff 2011 - 2012 Chief, Department of Surgery 2009 - 2010 Chief, Section of Orthopaedics 2007 - 2008 Medical Executive Committee 2009 - 2018 Peer Review Committee – Member 2011 - Current Chairman, Credentials Committee 2011 - 2012 Co-Chairman Quality Improvement Committee 2011 - Current Co-Chairman Safety Committee 2011 - Current Physician Champion IMPACT 2011 – Current CIPIC – Member 2011 - Current Utilization Review Committee 2010 - 2011 Physician Reviewer, SIMS PLUS 2009 - 2014 Physician Reviewer, SCIPS 2009 – 2014 Credentials Committee - Chairman 2009 - 2010 Physician Leadership Group - Member 2008 - Current D1-40 FOR ID Doctors Hospital Medical Staff President 2019 - Current Vice-Chairman, Department of Surgery 2013 - 2014 Unit Practice Council – Champion 2011 - 2012 Medical Executive Committee 2009 - 2016, 2019 - current Chairman, Quality Improvement Committee 2009 - 2016 Co-Chairman, Performance Improvement Steering Committee 2009 - 2014 Quality Improvement Committee 2006 - 2008 Surgical Case Review Committee 2005 - 2008, 2017 - Current Mercy Hospital Section Chief, Orthopaedics 2005 - 2006 Blood Usage Committee 2004 - 2006 Infectious Disease Committee 2003 - 2004 Operating Room Committee 2003 - 2004 Orthopaedic Rehabilitation Task Force 2002 Pan American Hospital Pharmaceutical and Therapeutics Committee 2003 - 2004 Hialeah Hospital Medical Care Committee 2001 - 2003 CURRENT HOSPITAL AFFILIATIONS Coral Gables Hospital Status: Active 2000 - Current 3100 SW 37th Street Coral Gables, Florida 33146 (305) 445-8461 Doctors Hospital Status: Active 2000 - Current Baptist Healthcare System 5000 University Drive Coral Gables, Florida 33146 (786) 308-3000 South Miami Hospital Status: Active 2010 - Current Baptist Healthcare System 6200 SW 73rd Street Miami, Florida 33143 (305) 661-4611 PUBLICATIONS Fernandez RJ, Cahill B. “Osteochondritis Dissecans.” Orthopaedic Special Edition. Volume 4, Number 3, 1998. D1-40 FOR ID Fernandez RJ, Lucas GL. “Biodegradable Implants in Hand and Wrist Fracture Management.” Kansas Medicine. Volume 97, Number 3 & 4, Winter/Spring 1997. Fernandez RJ, Gluck J. “Clostridium Septicum Gas Gangrene of the Gluteus Maximus and an Ascending Colon Malignant Tumor.” Clin Orthop. 1994; 308:178-182. PRESENTATIONS “What’s New with Knee and Hip Replacements.” Orthopaedic Community Seminar at Doctors Hospital, Miami, Florida. 2011, 2013, 2014, 2015. “No Bones About it: Prevention and Treatment of Osteoporosis.” Orthopaedic Community Seminar at Doctors Hospital, Miami, Florida. 2006, 2007, 2008, 2009, 2010. “The Meniscus is not a Vestigial Organ.” Orthopaedic Seminar Presentation at Mercy Hospital, Miami, Florida. October 29, 2004. “Osteoarthritis and Osteoporosis: Fact and Fiction.” Orthopeadic Seminar Presentation at the Biltmore Hotel, Coral Gables Florida. June 24, 2004. “Hip Fractures: Review of Current Trends”. Presentation at the Pan American Medical Convention 2003Annual Meeting. July 5, 2003. “Current Concepts in Total Joint Arthroplasty.” Presented at the Total Joint Arthroplasty Seminar, Mercy Hospital, Miami, Florida. November 2001. Fernandez, RJ, Bartal E, Lin J. “Magnetic Resonance Imaging and Technitium Bone Scan in Experimentally Induced Osteonecrosis.” Presented at the Mid-America Orthopaedic 1996 Annual Meeting. April 24, 1996. Fernandez, RJ, Dusek JK, Lucas GL. “Preliminary Wichita Fracture Database, Via Christi Regional Medical Center-St. Francis Campus, Wichita, Kansas.” Presented at the Kansas Orthopaedic Society 1993 Annual Meeting. October 15, 1993. RESEARCH Fernandez, RJ, Bartal E, Lin J. “Magnetic Resonance Imaging and Technitium Bone Scan in Experimentally Induced Osteonecrosis.” Fernandez RJ, Dusek JK, Lucas, GL. “Preliminary Wichita Fracture Database Via Christi Regional Medical Center-St. Francis Campus, Wichita, Kansas.” CV 06.17.2019 D1-40 FOR ID

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Case Number: 23BBCV00532 Hearing Date: July 26, 2024 Dept: A LOS ANGELES SUPERIOR COURT NORTH CENTRAL DISTRICT - BURBANK DEPARTMENT A TENTATIVE RULING JULY 26, 2024 MOTION FOR SUMMARY JUDGMENT Los Angeles Superior Court Case # 23BBCV00532 MP: Arsen Hovanesyan M.D. (Defendant) RP: Natalie Gold, Inc. dba Burbank Tower Pharmacy, Karina Nazarian, Artin Aghakhani and Linda Nguyen (Co-Defendants) NOTICE: The Court is not requesting oral argument on this matter. The Court is guided by California Rules of Court, Rule 3.1308(a)(1) whereby notice of intent to appear is requested. Unless the Court directs argument in the Tentative Ruling, no argument is requested and any party seeking argument should notify all other parties and the court by 4:00 p.m. on the court day before the hearing of the partys intention to appear and argue. The tentative ruling will become the ruling of the court if no argument is received. Notice may be given either by email at BurDeptA@LACourt.org or by telephone at (818) 260-8412. ALLEGATIONS: Rima Shafrazian, Gevik Shafrazian, and Greta Shafrazian, individually and as successor in interest of the estate of Joseph Shafrazian (Decedent) (collectively Plaintiffs) bring this action against Natalie Gold, Inc. dba Burbank Tower Pharmacy, WellRx, Inc. dba Wellness Lab, Jivan Melikian, M.D., Artin Aghakhani, R.PH., Karina Nazarian, Linda Nguyen, R.PH., Aram Manoukian, and Arsen Hovanesyan, M.D. (Hovanesyan) (collectively Defendants). Plaintiffs allege Defendants negligently failed to deliver Decedents prescriptions for a heart condition, ultimately resulting in his death. Before the Court is a Motion for Summary Judgment brought by Hovanesyan. Plaintiff asserts two causes of action against Hovanesyan for (1) Wrongful Death by Medical Negligence and (2) Survival Action. Plaintiffs filed a notice of non-opposition; however, an opposition was filed by Natalie Gold, Inc. dba Burbank Tower Pharmacy, Karina Nazarian, Artin Aghakhani and Linda Nguyen (hereinafter Co-Defendants). ANALYSIS: I. LEGAL STANDARD A party may move for summary judgment if it is contended that the action has no merit or that there is no defense to the action or proceeding. (C.C.P. § 437c(a).) [I]f all the evidence submitted, and all inferences reasonably deducible from the evidence and uncontradicted by other inferences or evidence, show that there is no triable issue as to any material fact and that the moving party is entitled to judgment as a matter of law, the moving party will be entitled to summary judgment. (Adler v. Manor Healthcare Corp. (1992) 7 Cal.App.4th 1110, 1119.) The moving party bears an initial burden of production to make a prima facie showing of the nonexistence of any triable issue of material fact, and if he does so, the burden shifts to the opposing party to make a prima facie showing of the existence of a triable issue of material fact. (Aguilar v. Atlantic Richfield Co. (2001) 25 Cal.4th 826, 850; accord C.C.P. § 437c(p)(2).) To establish a triable issue of material fact, the party opposing the motion must produce substantial responsive evidence. (Sangsterv. Paetkau (1998) 68 Cal.App.4th 151, 166.) II. MERITS Co-Defendants Opposition The Court notes that neither it, nor the parties, have located any California state court authority directly addressing whether a co-defendant can oppose another co-defendants motion for summary judgment. However, in Aguilar v. Atlantic Richfield Co. (2001) 25 Cal.4th 826, the California Supreme Court held that "any adverse party" may oppose a summary judgment motion. A real party in interest has standing to prosecute an action, except as otherwise provided by statute. (C.C.P. §367.) A real party in interest must have an actual, substantial interest in the subject matter of the action. (County of Alameda v. State Board of Control (1993) 14 Cal.App.4th 1096, 1103.) A person who has an actual interest in the subject matter of an action, and therefore a right to relief, has standing. (Parker v. Bowron (1953) 40 Cal.2d 344, 351.) A party to whom indemnity might be owed or who would owe indemnity is a real party in such an action. (Time for Living, Inc. v. Guy Hatfield Homes/All American Development Co. (1991) 230 Cal.App.3d 30, 40.). However, that is not the case here. On May 16, 2023, Co-Defendants filed their Cross-Complaint stating causes of action for (1) Equitable Indemnity, (2) Contribution, and (3) Declaratory Relief. The adverse parties in Co-Defendants Cross-Complaint are the fictious entities/persons identified as Roes 1-50. A review of the Courts records reveals that Co-Defendants have never amended their Cross-Complaint to identify the parties unknown to them at the time of filing. Nor have Co-Defendants ever independently filed a Cross-Complaint against Hovanesyan. As such, it would appear to the Court that Co-Defendants lack standing to oppose this motion. In reaching this conclusion, in addition to Aguilar as noted above, the court finds the United States District Court case of Eckert v. City of Sacramento (E.D. Cal. 2009) 2009 WL 3211278, helpful. In Eckert, the Court stated: Union Pacific raises a procedural question that has been infrequently addressed: [i]n the absence of cross-claims, may one co-defendant be the sole & opposition to another co-defendants motion for summary judgment? The Blonder Court answered the question in the negative, concluding that in the absence of a crossclaim, a co-defendant lacks standing to oppose his co-defendants motion for summary judgment. Under the rationale of Blonder, since there is no crossclaim between the Defendants, Union Pacific and the City are not adverse parties and the City therefore does not have standing to oppose Union Pacifics motion for summary judgment. The Citys arguments opposing Union Pacifics motion will therefore not be considered. (Id. at 3, citing to Blonder v. Casco Inn Residential Care, Inc. (D.Me. May 4, 2000) 2000 WL 761895, at *1 [internal citations omitted].) The Court finds the rationale set forth, and referred to in Eckert is persuasive. (See also Fraioli v. Lemcke, 328 F.Supp.2d 250 (D.R.I.2004) 263 n. 4 [[S]ince none of the defendants in this case have filed cross claims against each other, the defendants are not adverse parties who are entitled to object to each others motions for summary judgment.]; Dixon v. County of Alameda (N.D.Cal. Apr.18, 1997) 1997 WL 220311, at *6 n. 8 [noting that co-defendant did not have standing to oppose co-defendants motion for summary judgment]; C.F. Bean Corp. v. Clayton Indus. Ltd. (E.D.La. Aug.19, 1996) 1996 WL 470644, at *1 [same].) Further, that language of C.C.P. § 437c indicates there is no standing for a co-defendant to oppose a motion for summary judgment that does not seek relief against it. (See C.C.P. § 437c(p)(2) [If the defendant meets its burden to show that a cause of action has no merit by showing that an element of the cause of action cannot be established, the burden shifts to the plaintiff or cross-complainant to show that a triable issue of one or more material facts exists as to the cause of action or a defense thereto.].) Request for a Continuance Although the Court finds that the Co-Defendants do not have standing, it will further note that a request for continuance is denied for the reasons stated in Hovanesyans Repy to Co-Defendants Opposition. Facts In order to determine whether Hovanesyan has produced unrefuted evidence that he adhered to the standard of care, the Court finds it useful to provide a brief summary of the general facts of the case. On February 2, 2022, Decedent presented to his cardiologist, Hovanesyan, for a history and physical. (Exh. G. pp. 1997.) Decedents history and physical revealed that he suffered from a small to medium anterior perfusion defect consistent with ischemia. (Id.) On March 1, 2022, Decedent presented to Adventist Health Glendale wherein Hovanesyan performed a coronary angiography. (Id. at pp. 1982-1987.) The Court notes that Plaintiffs claims for medical negligence against Hovanesyan are purely in reference to his alleged failure to ensure Decedents receipt of the medication Plavix. Plaintiff makes no allegations as to whether Hovanesyan negligently performed the coronary angiography. (See FAC ¶ 24 [Defendants Dr. Hovanesyan and Dr. Melikian and DOES 1 through 10 were responsible for prescribing the Clopidogrel/Plavix, following up, and making sure that Mr. Shafrazian was taking Clopidogrel/Plavix after his procedure.].) Hovanesyans post-procedure Progress Notes for Decedent show that Dr. Melikian prescribed Plavix, Nitroglycerin, and Aspirin on March 1, 2022 on an inpatient basis. (See Exh. G, p. 1989-1993 & 2090.) Decedents records also indicate that, on March 2, 2022 at 9:41 a.m., Hovanesyan ordered outpatient prescriptions for Plavix, Nitroglycerin, and Aspirin. (Id. at 2091.) These prescriptions appear to have been ordered to Burbank Tower Pharmacy. (Id.) Further, the discharge paperwork issued to and signed by Decedent included a Home Medications list which instructed Decedent to take a daily dose of Plavix. (Id. at 2045, 2067.) Records reflect that on March 2, 2022 at 9:42 a.m., Burbank Tower Pharmacy received Hovanesyans prescription order. (Aghakhani Depo. p. 89, ¶¶ 19-25; Abramian Depo. p. 73, ¶¶ 8-25; Koroglu Depo. p., 53, ¶¶ 2-5.) Though the parties disagree as to why, it is clear that the Plavix and Aspirin prescriptions were placed on hold by Burbank Tower Pharmacy. Hovanesyan is of the opinion that the medications were placed on hold as the result of Decedents not having been given the medication. (See Aghakhani Depo. p. 26, ¶¶ 8-15 [She told me the patient never picked up the medication&thats why they put it on hold.].) On March 14, 2022, Decedent suffered a heart attack and died. (Exh. I.) An autopsy report revealed that Decedents cause of death was a myocardial infarction in the left ventricular free wall. (Exh. J.) Medical Negligence As concerns the action for Medical Negligence, Hovanesyan argues that summary judgment must be granted because there is no triable issue of fact as to whether his actions adhered to the standard of care in treating Decedent. The elements of a cause of action for medical malpractice are: (1) a duty to use such skill, prudence, and diligence as other members of the profession commonly possess and exercise; (2) a breach of the duty; (3) a proximate causal connection between the negligent conduct and the injury; and (4) resulting loss or damage. (Chakalis v. Elevator Solutions, Inc. (2012) 205 Cal.App.4th 1557, 1571.) The standard of care against which the acts of a physician are to be measured is a matter peculiarly within the knowledge of experts; it presents the basic issue in a malpractice action and can only be proved by their testimony. (Hanson v. Grode (1999) 76 Cal.App.4th 601.) When a defendant moves for summary judgment and supports his motion with expert declarations that his conduct fell within the community standard of care, he is entitled to summary judgment unless the plaintiff comes forward with conflicting expert evidence. (Munro v. Regents of University of California (1989) 215 Cal.App.3d 977, 984985 [citations omitted].) Hovanesyan submits the declaration of Michael L. Chaikin, M.D. (Chaikin), in support of his motion. Chaikin states that he is a board-certified cardiologist and has been practicing cardiology since 1980. (Chaikin Decl. ¶ 2.) Chaikin bases his declaration on his review of Decedents medical records as well as the depositions of Greta Shafrazian, Givek Shafrazian, Rima Shafrazian, Artin Aghakhani, Linda Nguyen, Sarineh Abramian, and Yolanda Siraki. (Chaikin Decl. ¶ 5.) Chaikin states that, in his medical opinion, Hovanesyan appropriately documented that Decedent was receiving Plavix on an inpatient basis after the procedure. (Chaikin Decl. ¶ 9.) Chaikin further states that Hovanesyans ordering of Plavix to Burbank Tower Pharmacy was within the standard of care. (Id.) Chaikin states that the records for Burbank Tower Pharmacy indicate they received the prescription order on March 2, 2022. (Id.) Chaikin states that, from the review of the deposition testimony in this matter, it is unclear why the Plavix prescription was placed on hold. (Id.) Regardless, Chaikin states that, from his review of the records and testimony, it is clear that Hovanesyan did not place any prescriptions on hold. (Id.) Chaikin concludes that, in his medical opinion, no act or omission of Hovanesyan caused or contributed to Decedents passing. (Chaikin Decl. ¶ 10.) The Court is satisfied from the testimony of Chaikin that Hovanesyans actions were within the applicable standard of care. The Court notes that Plaintiffs have produced no expert testimony in contravention of Chaikins statements. It follows that Hovanesyan has demonstrated by unrefuted evidence that no triable issue of fact exists as to his breach of the standard of care in prescribing Plavix to Decedent. The holding in Munro makes abundantly clear that summary judgment must therefore be granted in favor of Hovanesyan. Survival Action A cause of action that survives the death of the person entitled to commence an action or proceeding passes to the decedents successor in interest, subject to Chapter 1 (commencing with Section 7000) of Part 1 of Division 7 of the Probate Code, and an action may be commenced by the decedents personal representative or, if none, by the decedents successor in interest. (C.C.P. § 377.30.) A survivor claim is also a statutory cause of action; however, unlike a wrongful death claim, the survival statutes do not create a cause of action but merely prevent the abatement of the decedents cause of action and provide for its enforcement by the decedents personal representative or successor in interest. (San Diego Gas & Elec. Co. v. Superior Ct. (2007) 146 Cal. App. 4th 1545, 1553.) Here the Court finds Plaintiffs survival action must also fail as they are unable to establish any triable issues of material fact regarding the breach element of the wrongful death cause of action above. Conclusion Hovanesyan has adequately demonstrated that his behavior was within the standard of care by virtue of his experts testimony. Plaintiffs have produced no evidence to the contrary and a non-opposition was filed. As Plaintiffs survival action assumes the medical negligence of Hovanesyan, it too presents no triable issue of fact. Co-Defendants do not have standing to contest the summary judgment and have not justified a continuance. Accordingly, Hovanesyans unopposed motion for summary judgment is GRANTED. --- RULING: In the event the parties submit on this tentative ruling, or a party requests a signed order or the court in its discretion elects to sign a formal order, the following form will be either electronically signed or signed in hard copy and entered into the courts records. ORDER Arsen Hovanesyan M.D.s Motion for Summary Judgment came on regularly for hearing on June 26, 2024, with appearances/submissions as noted in the minute order for said hearing, and the court, being fully advised in the premises, did then and there rule as follows: THE MOTION FOR SUMMARY JUDGMENT IS GRANTED. UNLESS ALL PARTIES WAIVE NOTICE, HOVANESYAN TO GIVE NOTICE. IT IS SO ORDERED. DATE: July 26, 2024 _______________________________ F.M. TAVELMAN, Judge Superior Court of California County of Los Angeles

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