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`DOCKET NO. HHB-CV22-6072948-S
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`SUPERIOR COURT
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`J.D. OF NEW BRITAIN
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`AT NEW BRITAIN
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`MARCH 20, 2024
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`CAROLINE SKUDLAREK, EXECUTOR
`OF THE ESTATE OF ALFONS SKUDLAREK :
`HANNELORE SKUDLAREK
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`DR. JEFFREY GOLDBERG
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`PROHEALTH PHYSICIANS, INC.
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`NOTICE OF FILING OF SECOND AMENDED COMPLAINT
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`Pursuant to Practice Book § 10-44, the Plaintiffs in the above-captioned action hereby
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`give notice that they have filed a second amended complaint in this matter. Said second amended
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`complaint is attached hereto as Exhibit A.
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`THE PLAINTIFFS,
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`__/s/ 421138___________
`Brennen Maki
`Maki Law, LLC
`Their Attorneys
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`♦1♦
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`MAKI LAW, LLC
`467 Naubuc Ave. ♦ Glastonbury, CT 06033 ♦ 860.269.5780 ♦ Facsimile: 860.221.3947
`Juris No. 437597
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`CERTIFICATION
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`I certify that a copy of this document was or will immediately be mailed or delivered
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`electronically or non-electronically this 20th day of March, 2024, to all attorneys and self-
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`represented parties of record and to all parties who have not appeared in this matter and that
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`written consent for electronic delivery was received from all attorneys and self-represented
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`parties receiving electronic delivery.
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`Edward William Mayer Jr., Esq.
`Gfeller Laurie LLP
`977 Farmington Avenue Suite 200
`West Hartford CT 06107
`emayer@gllawgroup.com
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`/s/ 421138
`_____________________
`Brennen Maki
`Commissioner of the Superior Court
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`♦2♦
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`MAKI LAW, LLC
`467 Naubuc Ave. ♦ Glastonbury, CT 06033 ♦ 860.269.5780 ♦ Facsimile: 860.221.3947
`Juris No. 437597
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`DOCKET NO. HHB-CV22-6072948-S
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`:
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`SUPERIOR COURT
`
`DR. CAROLINE SKUDLAREK, EXECUTOR :
`OF THE ESTATE OF ALFONS SKUDLAREK :
`HANNELORE SKUDLAREK
`:
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`:
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`DR. JEFFREY GOLDBERG
`:
`PROHEALTH PHYSICIANS, INC.
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`J.D. OF NEW BRITAIN
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`AT NEW BRITAIN
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`MARCH 20, 2024
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`SECOND AMENDED COMPLAINT
`
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`Count One: (By the Plaintiff, the Estate of Alfons Skudlarek, as Against the Defendant, Dr.
`Jeffrey Goldberg)
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`At all times relevant to this complaint the Plaintiff, Dr. Caroline Skudlarek, was and
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`1.
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`is a resident of Jamestown, Rhode Island.
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`2. Dr. Caroline Skudlarek is the daughter of Alfons Skudlarek, who died on November
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`11, 2020. On December 11, 2020, Dr. Caroline Skudlarek was duly appointed the Executor of the
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`Estate of Alfons Skudlarek, and brings this action in said capacity.
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`3. At all times relevant to this complaint, Alfons Skudlarek was a resident of Bristol,
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`Connecticut.
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`4. On October 31, 2020, Mr. Skudlarek had an annual physical, including routine
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`bloodwork, with Dr. Goldberg at the Prohealth office at 25 Collins Road, Bristol, Connecticut.
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`Mr. Skudlarek’s present and past conditions along with comorbidities were noted in the note,
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`which included an incorrect measurement of the patient’s height, which affected his reported
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`BMI.
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`♦3♦
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`MAKI LAW, LLC
`467 Naubuc Ave. ♦ Glastonbury, CT 06033 ♦ 860.269.5780 ♦ Facsimile: 860.221.3947
`Juris No. 437597
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`5. On the evening of November 1, 2020, Mrs. Skudlarek contacted her husband’s
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`primary care physician, Dr. Jeffrey Goldberg of ProHealth Physicians, Inc. that he had complaints
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`of fever, chills and difficulty with walking for one day. Mr. Skudlarek was scheduled for a Covid
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`test for the next day November 2, 2020.
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`6. On November 2, a Covid test was performed on him to determine whether he had
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`contracted SARS-CoV-19. He was required to wait outside in the extreme cold for approximately
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`thirty minutes. All testing performed indicated he was positive for Covid-19.
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`7. On November 2, 2020, Mr. Skudlarek was 79 years old, and had comorbidities including
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`obesity, hypertension and cardiovascular disease.
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`8. On November 2, 2020 Mr. Skudlarek was advised that he was positive for SARS-CoV-
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`19 by personnel at ProHealth; despite this, no medication was provided to him, nor was he
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`advised as to what symptoms to watch for to indicate escalated medical care would be warranted.
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`Instead, ProHealth personnel advised him to go home and take over-the-counter medicine to
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`relieve his fever.
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`9. [Stricken after Request to Revise.]
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`10.
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`Within hours of testing positive for SARS-CoV-19, Mr. Skudlarek began
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`exhibiting clear signs and symptoms of serious decompensation, including persistent fever of over
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`103 degrees despite medication, ataxia, neurologic difficulties, problems walking and debilitation
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`so severe he was unable to speak with ProHealth medical personnel via telephone, and instead
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`relied on his wife to relay his condition to them.
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`11.
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`Mrs. Skudlarek phoned Dr. Goldberg several times on November 2, 2020, due to
`♦4♦
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`MAKI LAW, LLC
`467 Naubuc Ave. ♦ Glastonbury, CT 06033 ♦ 860.269.5780 ♦ Facsimile: 860.221.3947
`Juris No. 437597
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`Mr. Skudlarek’s worsening symptoms without Dr Goldberg calling back. On the evening of
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`November 2, 2020 she again called Prohealth and at that time, she informed the on-call nurse that
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`Mr. Skudlarek was suffering from a persistent fever of approximately 103 degrees, was having
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`difficulty walking, and was debilitated to the point that he could not speak with the nurse by
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`phone.
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`12.
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`Mrs. Skudlarek specifically requested of the on-call nurse that Dr. Goldberg call
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`her to discuss her husband’s condition and/or that medication be provided to her husband, and
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`was promised that a phone call would be made to her by the doctor the following day. Despite
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`this promise, neither Dr. Goldberg nor anyone from ProHealth contacted her.
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`13.
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`Later in the evening on November 2, 2020 the Dr. Skudlarek phoned ProHealth
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`and spoke with the on-call nurse. As a practicing physician herself, Plaintiff noted that given Mr.
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`Skudlarek’s age and comorbidities his persistent fever of 103 degrees alone was clinically
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`significant, requested medication for her father, and further requested Dr. Goldberg contact the
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`family to discuss his care and escalation of care to an emergency room. Dr. Skudlarek was also
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`told that Dr. Goldberg would call her in the morning to address her father’s condition. Like Mrs.
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`Skudlarek, Dr. Skudlarek never received a phone call from any doctor or medical professional
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`from ProHealth as had been promised.
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` 14. On November 3, 2020, having received no callback, Mrs. Skudlarek attempted to
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`contact ProHealth again about her husband’s condition, but no one was answering the office
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`phone. At one point, she reached someone who told her that “she was on the list for a phone call,”
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`but no one called. Hours later, in desperation, Mrs. Skudlarek began trying random extensions in
`♦5♦
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`MAKI LAW, LLC
`467 Naubuc Ave. ♦ Glastonbury, CT 06033 ♦ 860.269.5780 ♦ Facsimile: 860.221.3947
`Juris No. 437597
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`the phone system, eventually reaching a bookkeeper whom she told again that her husband’s
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`condition was continuing to deteriorate. She again requested medication, to speak with Dr.
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`Goldberg, and/or for an office visit to assess his condition and treat him. ProHealth personnel
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`instructed Mrs. Skudlarek to bring her husband to their walk-in clinic for assessment.
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`15. Mrs. Skudlarek immediately contacted ProHealth’s walk-in clinic to schedule her
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`husband’s appointment, only to be told that he would not be allowed in the clinic due to his
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`infection. Mrs. Skudlarek was further told to wait until the end of the day on November 3, 2020
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`for a phone call from the on-call physician’s assistant.
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`16. At approximately 6:00 p.m. on November 3, 2020, Mrs. Skudlarek was contacted
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`by a physician’s assistant from ProHealth. She relayed that her husband continued to suffer from
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`high fevers, difficulty walking and severe debilitation, and that his condition appeared to be
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`worsening. The ProHealth physician’s assistant told her there was nothing she could do to help,
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`no medication she could prescribe, and that Mr. Skudlarek would have to remain home without
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`treatment as Mr. Skudlarek could have these symptoms for 3 weeks. No information was
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`provided to Mrs. Skudlarek in terms of what signs or symptoms to watch for that would indicate
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`hospitalization was necessary.
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`17. During the aforementioned phone call, Mrs. Skudlarek again requested the
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`opportunity to speak with Dr. Goldberg about her husband’s condition. This request was refused.
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`18. On the morning of November 4, 2020 Mrs. Skudlarek again called Prohealth to
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`speak with Dr. Goldberg and was hung up on. She then called back and was told by a ProHealth
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`staff member, “Can you handle it? They are not going to bother with him!”
`♦6♦
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`MAKI LAW, LLC
`467 Naubuc Ave. ♦ Glastonbury, CT 06033 ♦ 860.269.5780 ♦ Facsimile: 860.221.3947
`Juris No. 437597
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`19. Mrs. Skudlarek then transferred the care of her husband to Dr. Guardino, a
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`Concierge physician in Farmington, who immediately gave him medication and shortly thereafter
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`admitted Mr. Skudlarek emergently to the University of Connecticut with a diagnosis of COVID-
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`19 pneumonia.
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`20. Mrs. Skudlarek then called and spoke with the medical director of ProHealth about
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`her husband’s condition and the Defendant’s lack of response. The medical director indicated
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`two doctors had recently quit and their office “was in turmoil and disarray”. She apologized and
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`said that now that Mr. Skudlarek had a Concierge physician, he should be fine.
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`21. On November 5, 2020, Dr. Skudlarek called the medical director as the hospital
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`was unable to get Mr Skudlarek’s records from Prohealth. The Director had the records
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`prepared by the office and they were picked up by Mrs. Skudlarek.
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`22. On November 11, 2020 and at approximately 4:04 A.M., after suffering numerous
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`COVID-related medical setbacks and complications, Mr. Skudlarek died of SARS-CoV-19.
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`23. Mr. Skudlarek’s injuries and death were proximately caused by the gross
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`negligence of Dr. Goldberg in one or more of the following ways:
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`A.
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`B.
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`C.
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`In that at the time of Mr. Skudlarek’s Covid-19 diagnosis, the standard of care for
`treatment of Covid-19 patients was risk assessment, close monitoring, supportive
`care, and immediate hospitalization if a high risk patient is decompensating, none
`of which was followed by Dr. Goldberg.
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`In that he failed to provide the decedent or his family with appropriate advice
`regarding the decedent’s infection;
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`In that he failed to provide the decedent or his family with appropriate treatment
`regarding the decedent’s infection;
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`
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`♦7♦
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`MAKI LAW, LLC
`467 Naubuc Ave. ♦ Glastonbury, CT 06033 ♦ 860.269.5780 ♦ Facsimile: 860.221.3947
`Juris No. 437597
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`D.
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`E.
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`F.
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`G.
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`H.
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`I.
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`J.
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` In that he failed to provide the decedent or his family with a single callback
`despite repeated requests;
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`In that he failed to escalate the decedent’s care despite repeated clear and obvious
`signs and symptoms of rapidly worsening infection;
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`In that he failed to provide the decedent with appropriate medication regarding the
`decedent’s infection;
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`In that he failed to properly advise the decedent and/or his family to seek a higher
`level of care for his infection despite clear and obvious signs he should do so;
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`In that he failed to properly supervise his medical staff to ensure patients suffering
`from SARS-CoV-19, such as the decedent, received appropriate attention;
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`In that he failed to properly instruct his medical staff on how to monitor, address
`and advise patients suffering from SARS-CoV-19;
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`In that he failed to identify the decedent as a high-risk patient and treat him
`accordingly.
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`24. As a further direct and proximate result of the gross negligence of Dr. Goldberg,
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`Mr. Skudlarek and/or his estate were forced to expend money on doctors, hospitals and the like,
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`up to the time of his death.
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`25. As a further direct and proximate result of the gross negligence of Dr. Goldberg,
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`Mr. Skudlarek was deprived of his ability to pursue and enjoy life’s pleasures.
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`26. As a further direct and proximate result of the gross negligence of Dr. Goldberg,
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`Mr. Skudlarek missed work and lost wages, and has suffered a complete destruction of his
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`earning capacity, all to his financial detriment.
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`♦8♦
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`MAKI LAW, LLC
`467 Naubuc Ave. ♦ Glastonbury, CT 06033 ♦ 860.269.5780 ♦ Facsimile: 860.221.3947
`Juris No. 437597
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`Count Two: (By the Plaintiff, the Estate of Alfons Skudlarek, as Against the Defendant,
`ProHealth Physicians, Inc.)
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`1-22. Paragraphs one through twenty-two (22) of Count One of this complaint are
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`hereby incorporated as paragraphs one through twenty-two (22) of this Count Two as if fully set
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`forth herein.
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`23. At all times relevant, Dr. Goldberg was acting as an agent, apparent agent, servant
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`and/or employee of the Defendant, ProHealth Physicians, Inc.
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`24. At all times relevant, all medical staff referenced in the aforementioned paragraphs
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`were agents, apparent agents, servants and/or employees of the Defendant, ProHealth
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`Physicians, Inc., and were acting in their capacity as such.
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`25. Mr. Skudlarek’s injuries and death were proximately caused by the gross
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`negligence of ProHealth Physicians, Inc. through its agents, apparent agents, servants and/or
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`employees in one or more of the following ways:
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`A.
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`In that they failed to provide the decedent or his family with appropriate advice
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`regarding the decedent’s infection;
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`B.
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`In that they failed to provide the decedent or his family with appropriate treatment
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`regarding the decedent’s infection;
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`C.
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`In that they failed to provide the decedent or his family with a single callback from
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`a doctor despite repeated requests;
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`D.
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`In that they failed to escalate the decedent’s care despite repeated clear and
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`obvious signs and symptoms of rapidly worsening infection;
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`♦9♦
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`MAKI LAW, LLC
`467 Naubuc Ave. ♦ Glastonbury, CT 06033 ♦ 860.269.5780 ♦ Facsimile: 860.221.3947
`Juris No. 437597
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`E.
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`In that they failed to provide the decedent with appropriate medication regarding
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`the decedent’s infection;
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`F.
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`In that they failed to properly advise the decedent and/or his family to seek a
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`higher level of care for his infection despite clear and obvious signs he should do
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`so;
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`G.
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` In that they failed to properly supervise their medical staff to ensure patients
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`suffering from SARS-CoV-19, such as the decedent, received appropriate
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`attention;
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`H.
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`In that they failed to properly instruct their medical staff on how to monitor,
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`address and advise patients suffering from SARS-CoV-19;
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`I.
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`In that they failed to identify the decedent as a high-risk patient and treat him
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`accordingly.
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`26. As a direct and proximate result of the gross negligence of ProHealth Physicians,
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`Inc., Mr. Skudlarek suffered injury and death.
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`27. As a further direct and proximate result of the gross negligence of ProHealth
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`Physicians, Inc., Mr. Skudlarek and/or his estate were forced to expend money on doctors,
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`hospitals and the like, up to the time of his death.
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`28. As a further direct and proximate result of the gross negligence of ProHealth
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`Physicians, Inc., Mr. Skudlarek was deprived of his ability to pursue and enjoy life’s pleasures.
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`♦10♦
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`MAKI LAW, LLC
`467 Naubuc Ave. ♦ Glastonbury, CT 06033 ♦ 860.269.5780 ♦ Facsimile: 860.221.3947
`Juris No. 437597
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`29. As a further direct and proximate result of the gross negligence of ProHealth
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`Physicians, Inc., Mr. Skudlarek missed work and lost wages, and has suffered a complete
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`destruction of his earning capacity, all to his financial detriment.
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`Count Three: (By the Plaintiff, Hannelore Skudlarek, as Against the Defendant, Dr. Jeffrey
`Goldberg)
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`1.-26. Paragraphs one through twenty-six (26) of Count One of this complaint are hereby
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`incorporated as paragraphs one through twenty-four (26) of this Count Three as if fully set
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`forth herein.
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`27. At all times relevant to this complaint, the Plaintiff, Hannelore Skudlarek, was and
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`remains a resident of Bristol, Connecticut.
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`28. At all times relevant to this complaint, the Plaintiff was the wife of Alfons
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`Skudlarek, and at the time of his death had been married to him for approximately fifty-eight (58)
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`years.
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`29. As a direct and proximate result of the gross negligence of the Defendant, Dr.
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`Jeffrey Goldberg, the Plaintiff has been permanently and forever deprived of the love, society and
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`companionship of her husband, Alfons Skudlarek.
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`30. The Plaintiff, Hannelore Skudlarek, brings this action pursuant to, and in
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`accordance with, Connecticut General Statutes 52-555a.
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`♦11♦
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`MAKI LAW, LLC
`467 Naubuc Ave. ♦ Glastonbury, CT 06033 ♦ 860.269.5780 ♦ Facsimile: 860.221.3947
`Juris No. 437597
`
`
`
`

`

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`Count Four: (By the Plaintiff, Hannelore Skudlarek, as Against the Defendant, ProHealth
`Physicians, Inc.)
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`1.-29. Paragraphs one through twenty-nine (29) of Count Two of this complaint are
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`hereby incorporated as paragraphs one through twenty-nine (29) of this Count Four as if fully set
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`forth herein.
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`30. At all times relevant to this complaint, the Plaintiff, Hannelore Skudlarek, was and
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`remains a resident of Bristol, Connecticut.
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`31. At all times relevant to this complaint, the Plaintiff was the wife of Alfons
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`Skudlarek, and at the time of his death had been married to him for approximately fifty-eight (58)
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`years.
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`32. As a direct and proximate result of the gross negligence of the Defendant,
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`ProHealth Physicians, Inc., the Plaintiff has been permanently and forever deprived of the love,
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`society and companionship of her husband, Alfons Skudlarek.
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`33. The Plaintiff, Hannelore Skudlarek, brings this action pursuant to, and in accordance
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`with, Connecticut General Statutes 52-555a.
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`♦12♦
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`MAKI LAW, LLC
`467 Naubuc Ave. ♦ Glastonbury, CT 06033 ♦ 860.269.5780 ♦ Facsimile: 860.221.3947
`Juris No. 437597
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`WHEREFORE, the Plaintiffs claim:
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`1. Monetary damages;
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`2. Costs of suit;
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`3. Such other relief as in law or equity may appertain.
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`THE PLAINTIFFS,
`
`
`__/s/ 421138____________
`Brennen Maki
`Maki Law, LLC
`Their Attorneys
`
`
`
`
`
`
`♦13♦
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`MAKI LAW, LLC
`467 Naubuc Ave. ♦ Glastonbury, CT 06033 ♦ 860.269.5780 ♦ Facsimile: 860.221.3947
`Juris No. 437597
`
`
`
`

`

`DOCKET NO, HHB-CV22-6072948-S
`
`:
`
`SUPERIOR COURT
`
`DR. CAROLINE SKUDLAREK, EXECUTOR:
`OF THE ESTATE OF ALFONS SKUDLAREK:
`
`HANNELORE SKUDLAREK
`
`J.D. OF NEW BRITAIN
`
`AT NEW BRITAIN
`
`DR. JEFFREY GOLDBERG
`PROHEALTH PHYSICIANS, INC.
`
`;
`:
`
`JULY 20, 2022
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`STATEMENT OF AMOUNT IN DEMAND
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`The amount, legal interest or property in demand is greater than Fifteen Thousand Dollars
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`($15,000.00).
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`THE PLAINTIFFS,
`
`_/sf 421138
`Brennen Maki
`Maki Law, LLC
`Their Attorneys
`
`[4
`
`467 Naubuc Ave.
`
`MAKI LAW, tic
`+ Glastonbury, CT 06033 + 860.269.5780 + Facsimile: 860.221.3947
`Juris No. 437597
`
`

`

`DOCKET NO. HHB-CV22-6072948-S
`
`;
`
`SUPERIOR COURT
`
`DR. CAROLINE SKUDLAREK, EXECUTOR :
`OF THE ESTATE OF ALFONS SKUDLAREK:
`
`HANNELORE SKUDLAREK
`
`J.D. OF NEW BRITAIN
`
`AT NEW BRITAIN
`
`DR, JEFFREY GOLDBERG
`PROHEALTH PHYSICIANS, INC.
`
`:
`:
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`JULY 20, 2022
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`CERTIFICATE OF GOOD FAITH
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`This is to certify that 1 have made reasonable inquiry as permitted by the circumstances to
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`determine that there are grounds for a good faith belief that there has been negligence in the care
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`and treatment of Alfons Skudlarek. This reasonable inquiry gives rise to a good faith belief that
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`grounds exist for an action against the named Defendants. Attached hereto is a redacted opinion
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`letter concerning the plaintiff pursuant to C.G.S. § 52-190a.
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`‘THE PLAINTIFFS,
`
`_fs/ 421138
`Brennen Maki
`Maki Law, LLC
`Their Attorneys
`
`+]5°
`
`467 Naubuc Ave.
`
`MAKILAW,Lic
`+ Glastonbury, CT 06033 + 860.269.5780 + Facsimile: 860.221.3947
`Jutis No. 437597
`
`

`

`
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`EXPERT REPORT IN THE MATTER OF ALFONS SKUDLAREK
`
`Background and Qualifications
`
`lam a medical doctor currently licensed to practice medicine in the state of California
`(California Medical License: JMB. | have been practicing medicine for 19 years in the
`hospital and outpatient setting.
`| am certified by the American Board of Family Medicine with
`no interruption In certification or licensure. | received my medical degree from George
`Washington University Medical School, Washington, D.C.
`in 2002. | have also received a Master
`of Public Health degree from Boston University. i completed a residency in Family Medicine at
`University ofME Vedical Center. | am currently a Family Physician & Chief
`Executive Officer at
`California. From August 2020 to August
`2021, | served as a Telemedicine Family Physician forP| treating over 1,000
`patients with Covid-19 and related complications. (have also served as a Family Physiclan &
`Chief Executive Officer atis 3\ifornia. Copies of
`my current curriculum vitae and fee schedules are attached hereto. All the opinions expressed
`below are based on my medical training, education, and experience.
`
`Case Summary
`
`Alfons Skudlarek was 79-year-old obese male with a history of hypertension, coronary
`artery disease, gout, predlabetes, and polymyalgla rheumatica. At baseline, he was a
`physically active and mentally astute individual leadinga full life. He was diagnosed with
`Covid-19 on November 2, 2020 at the ProHealth Physician Clinic in Bristol, Connecticut.
`At time of his diagnosis, he was discharged home without follow up or home care
`instructions or precautions. He began to decompensate that same night with neurologic
`symptoms of weakness and ataxia. Calls to ProHealth Physicians by his family on his
`behalf, were repeatedly made, requesting a physician callback which never came.
`Instead, he was told by ProHealth Physician Clinic RNs and PAs that this was normal, and
`nothing could be done. After 48 hours without appropriate clinical follow up,his
`condition had severely deteriorated warranting urgent emergency room evaluation. He
`was admitted to the hospital and due to his already decompensated state, suffered a
`cascade of further complications which ultimately resulted In his death on November
`11, 2020.
`
`[1]
`
`

`

`Timeline of Events
`
`1. October 27, 2020 - Mr. Skudlarek completed a routine annual physical exam with Or.
`Jeffery Goldberg at the ProHealth Physicians Clinic. He was noted to be obese with
`previously diagnosed prediabetes, gout, hypertension, and coronary artery disease. He
`was taking Allopurinol, Tenormin, and a baby aspirin. His only complaint at this visit was
`of allergic rhinitis for which he was prescribed Ipratropium nasal spray.
`2. November 1, 2020- Mr. Skudlarek began experiencing shaking chills and developed a
`fever of 103 degrees, His wife called the ProHeaith Physicians Clinic and scheduled a
`Covid test for him the following day. This encounter is documented by PA, Brooke
`Kokus,
`3. November 2, 2020- Mr. Skudlarek presented to the ProHealth Physicians Clinic for an
`ID NOW rapid antigen Covid test and was noted to be positive, A PCR test was also done
`at this time. It is unclear from the ProHealth Physician Clinic records who communicated
`these positive test results to him. The note from that visit was unsigned and showed an
`incompletelist of Mr. Skudlarek’s comorbidities. He was only noted to have
`hypertension, His history of cardiovascular disease and obesity were omitted. No home
`care instructions or precautions are documented as being given to the patient.
`
`10:38pm — Mr. Skudlarek began having difficulty walking and continued to have
`a high fever. His wife called the ProHealth Physictans Clinic to ask for advice. She
`spoke with Catherine O'Neill, RN. Ms, O'Neill documented that Mr. Skudlarek
`was too sick to come to the phone and she could not speak with him directly.
`The patient’s wife explained that he was off balance, febrile and experiencing
`shaking chills as well as congestion. She asked about a 2-pak and was told to take
`Tylenol and that the on-call MD would call back, Also advised to call the clinic for
`an in-person appointment the next day.
`
`10:55pm — Mr, Skudlarek’s daughter called ProHealth Physician Clinic and spoke
`with Erica Baisvert, RN. She was concerned that her father was off balance when
`walking after being diagnosed with Covid earller that day. She asked about
`possibility of prescribing 2-pak as he may have had sinus symptoms prior to
`diagnosis. The patient’s daughter also reminded the nurse of Mr. Skudlarek’s
`history of polymyalgia rheumatica. The patient’s daughter was told that the on-
`call MD would call back with further advice. According to the nursing notes, the
`on-call MD wascalled but there is no documentation of a conversation with the
`MD, The note was electronically signed by Dr, Munish Shasirl at 7:56am the
`follawing morning. However, Dr. Shasiri did not return a call to the family or
`patient that evening or the following morning. No physician from ProHealth
`Physicians Clinic called the Mr. Skudlarek or his family after his Covid diagnosis
`despite multiple requests.
`
`[2)
`
`

`

`November 3, 2020 —Mr. Skudlarek’s wife called ProHealth Physicians Clinic to speak with
`Dr. Goldberg, his PCP, multiple times with no call back. She then called to schedule an
`appointment as had been recommended the previous evening. She was told he needed
`to be seen in the walk-in clinic but was later told he could not comeinto the clinic with
`Covid and a PA would call at 6pm that evening.
`6:03pm -- Katherine Voss, PA-C called and only spoke with Mr. Skudlarek’s wife
`because he wastooill to come to the phone, She described his continued high
`fever, shaking chills, and walking off balance. There was discussion of 2-pak for
`sinus infection, but she was told by Ms. Vossthatit was not indicated. The
`patient’s wife was told there was no treatment and thatit could take weeksto
`recover. Ms, Voss documentedif pulse oximeter 94% for 30 minutes, patient
`should go to hospital. Mr. Skudlarek’s
`
`November4, 2020 ~ Mr. Skudlarek’s condition continued to decompensate,
`characterized by sustained fever, chills, and difficulty walking. His wife called the
`ProHealth Physicians Clinic multiple times request a physician call back and did not
`receive one. Mrs. Skudlarek spoke withclinic director, Tracy Weber, who told her the
`office was in turmoil.
`
`Mr, Skudlarek’s daughtervisited him at his home and determined he should be
`taken to the emergency room, He was brought to the University of Connecticut
`Medical Center that evening and admitted. On admission, he was observed as
`being weak and ataxic and noted to have bilaterally ng infiltrates consisted with
`Covid-related pneumenia as well as new thrombocytopenia.
`November5, 2020 - Mr. Skudlarek suffered a series of complications and rapid
`decompensation while at UCONN hospital ultimately requiring intubation and maximal
`pressor support.
`November 10, 2020 — Due to the severity of his condition, Mr, Skudlarek was
`transferred to St. Francis hospital for consideration of extracorporeal membrane
`oxygenation.
`November11, 2020 - Mr. Skudlarek failed to respondto treatment. While undergoing
`dialysis catheter placementfor continuous renal replacement therapy, Mr. Skudiarek
`experienced an unrecoverable cardiac asystole and died.
`
`Failure to Meet Standard of Care
`
`ProHealth PhysiciansClinic failed to meet the standard of care in the treatment and
`management of Mr. Skudlarek beginning with his diagnosis of Covid-19 on the morning
`November2, 2021 and every subsequentinteraction until his delayed hospitalization on
`evening of November 4, 2020.
`
`(3]
`
`

`

`Provider Responsibility When Ordering Diagnostic Tests
`
`Physicians and clinical providers have a wide range of available diagnostic tests are their
`disposal when trying to evaluate patients. When ordering diagnostic tests, the standard of care
`requires physicians and clinical providers to know how to manage the abnormal results of those
`tests. This may include treatment or referral, In the case of Mr. Skudtarek, ProHealth Physicians
`Clinic demonstrateda clear lack of knowledge in managing high-risk Covid-19 patients by not
`adequately treating Mr. Skudlarek,
`
`Disseminating Results and Instructions for Covid-19 Care
`
`Whenever a clinician provides results to a patient, the standard of care requires a documented
`explanation of what the results mean, the expected length and course of treatment as well as
`passible complications and how to best manage them. This is especially true of Covid-19 cases
`where thereis a high degree of patient anxiety due to knownrisks of the disease. No such
`information was provided to Mr. Skudlarek or his family members at the time of his diagnosis.
`He did not know how to managehis condition at home and he was notgiven information on
`what to do if his condition worsened.
`
`Risk Stratification
`
`By the time Mr. Skudlarek was diagnosed with Covid-19 in November 2020, there was clearly
`established criteria for risk stratification regarding Cavid-19 disease severity. Besides advancing
`age, numerous comorbidities have been proven to increase the risk severe Covid-19 with
`complications as seen in the table on the next page.
`
`Severeillness can occur in otherwise healthy individuals of any age, but it predominantly occurs
`in adults with advanced age or certain underlying medical comorbidities. Specific demographic
`features and laboratory abnormalities have also been associated with severe disease.
`
`The standard of care requires the treating provider to assessthe risks to the patient and
`determine appropriate and timely follow-up. In this case, Mr, Skudlarek would have metcriteria
`as a high-risk patient warranting closer follow up and a lower threshold for referral to a higher
`level of care in a hospital setting. Had Mr. Skudlarek been admitted to the hospital 48 hours
`earlier, more likely not he would have received lifesaving antibiotics, steroids and Remdesivir
`and his untimely death could have been prevented.
`
`Mortality in COVID-19 patients has been linked to the presence of the so-called “cytokine
`storm” induced by the virus usually occurring about 7-10 days after exposure. Excessive
`production of proinflammatory cytokines leads to ARDS aggravation and widespreadtissue
`damage resulting in multi-organ failure and death, Targeting cytokines early during the
`management of COVID-19 patients improves survival rates and reduces mortality. The key to
`survival is rapid Identification of high-risk patients in order to treat this process early before the
`body is overwhelmed,
`
`[4]
`
`

`

`Comorbidities the COC classifies as risk facters for severe COVID- 19"[1,2]
` PETE PLANEPSLSTRaeaearlroetaLePdED
`
`1, Established and probable risk factors (comorbidities that have heen aassociated with severe COVID-19
`in at least 1 meta-analysis or systematic review (starred conditions], or in observational studies)
`
`
`= Cancer*
`
`
`Cerebrovascular disaase™
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`
`a Children with certain underlying conditions*
`« Chroni¢ kidney disease™
`wn COPD* and other lung disease (including interstitial king disease, pulmonary fibrosis, pulmonary
`hyperterision)
`« Diabetes mellitus, type 1" and type 2"
`a Down syndrome
`= Heart conditions (such as heart failure, coronary artery disease, or cardiomyopathies)*
`e HIV
`
`® Neurologic conditions, including dementia
`» Obesity™ (8MI 230 kg/m?) and overweight (OM] 25 to 29 kg/m?)
`= Pregnancy"
`# Smoking” (current and former)
`s Sickle cell disease
`
`
`
`
`
`» Solid organ or bload stemcell transplantation
`® Substance use disorders
`
`
`
`Use of corticosteroids or ather immunosuppressive medications
`
`
`Possible risk factors (supported by mostly case series, case reports, or, if other study design, the
`sample size is small)
`
`
`e Cystic fibrosis
`« Thalassemia
`
`
`
`Possible risk factors but evidence is mixed (comorbidities have been associated with severe COVID-19
`in at least 1 meta-analysis or systematic review, but other studies had reached different conclusions)
`
`» Asthma
`
`
`
`
`
`
`
`® Hypertension
`»
`Jmmune deficiencies
`« Liver disease
`
`COVIO-19: coronavirus disease 2019; CDC: Centers for Disease Control and Pravention; COPD: chronic
`obstructive pulmonary disaase; 8MI: body mass index.
`* These comorbidities are associated with severe COVID-19 in adults of all ages, Risk of severe disease also
`rises steadily with age, with more than 60% of deaths occurring in adults older than age 65, People of color
`are also at incr