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STATE OF NORTH CAROLINA

COUNTY OF DURHAM


IN THE GENERAL COURT OF JUSTICE 
              SUPERIOR COURT DIVISION
     FILE NO. 90 CVS 3183
_______________, Individually
and as Guardian Ad Litem for
__________________, and
_______________________, Individually,
                
                 Plaintiffs,

                 v.

______________________________,
INC. d/b/a ____________________
and _____________ 

                 Defendants.
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PLAINTIFFS' FIRST
REQUEST FOR ADMISSIONS
TO DEFENDANT _______
_________________________________________________________________________

          Pursuant to Rule 36 of the North Carolina Rules of Civil Procedure, the plaintiffs herewith serve the following Request for Admissions on the defendant _______ which must be answered in writing, separately, and served upon counsel for the plaintiffs within thirty (30) days from the date of service hereof.

          1. Admit that the minor plaintiff, ___________________, arrived at the ___________________ emergency department at 8:45 p.m. on August 19, 1987.
RESPONSE:





          2. Admit that at 8:45 p.m. on August 19, 1987, defendant ___________________ undertook to provide ___________________ with medical treatment and a hospital/patient relationship was established between ___________________ and the defendant ___________________.
RESPONSE:



          3. Admit that there is no documentation in the ___________________ medical records of ___________________ of a triage assessment of ___________________ before 11:00 p.m. on August 19, 1987.
RESPONSE:



          4. Admit that a nursing triage assessment was not performed on ___________________ at the ___________________ emergency department on August 19 or 20, 1987 prior to 11:00 p.m. on August 19, 1987.
RESPONSE:



          5. Admit that the standards of practice applicable to the nursing triage assessment of ___________________ at the ___________________ emergency department on August 19, 1987 required that the triage assessment be performed within fifteen (15) minutes of Neville's arrival at the ___________________ emergency department.
RESPONSE:

          6. Admit that ___________________ had a strong palpable pulse in his left foot at approximately 11:00 p.m. on August 19, 1987.
RESPONSE:



          7. Admit that ___________________ had positive capillary refill in his left toenails at approximately 11:00 p.m. on August 19, 1987.
RESPONSE:



          8. Admit that ___________________ had swelling of his left foot and swelling above and below his left knee at approximately 11:00 p.m. on August 19, 1987.
RESPONSE:


          9. Admit that the plaintiff, __________, brought the x-rays of ___________________'s left knee and leg taken at ____________ on August 19, 1987 to the ___________________ emergency department on August 19, 1987.
RESPONSE:



          10. Admit that the x-rays taken at ____________ on August 19, 1987 of ___________________'s left knee show a dislocation of his left knee.
RESPONSE:



          11. Admit that Dr. ____________, a resident physician, was notified at 11:10 p.m. on August 19, 1987 of ___________________'s arrival in the emergency department of ___________________.
RESPONSE:



          12. Admit that on August 19 and 20, 1987 Dr. ___________________ was an agent and employee of ___________________.
RESPONSE:



          13. Admit that on August 19 and 20, 1987 Dr. ___________________ was acting within the course and scope of his agency and employment with ___________________ when he was notified of ___________________'s arrival in the ___________________ emergency department and while providing medical treatment to ___________________.
RESPONSE:

          14. Admit that there is no documentation in the ___________________ medical records of ___________________ of a physician being called or notified of ________s arrival in the ___________________ emergency department prior to 11:10 p.m. on August 19, 1987.
RESPONSE:



          15. Admit that ___________________'s left leg was swollen and tender distally from the mid-left femur to the mid-left calf at approximately 11:30 p.m. on August 19, 1987.
RESPONSE:




          16. Admit that there was a palpable dorsalis pedis pulse and posterior tibial pulse in ___________________'s left lower extremity at approximately 11:30 p.m. on August 19, 1987.
RESPONSE:




          17. Admit that the physician's assistant student's assessment of ___________________ at 11:30 p.m. on August 19, 1987 at the ___________________ emergency department included a history of how the minor plaintiff had been injured.
RESPONSE:



          18. Admit that the history of ___________________'s injury obtained by the physician's assistant student at the ___________________ emergency department on August 19, 1987 at approximately 11:30 p.m. included the following: a twelve year old black male status post three wheel RV accident today at 5:00 p.m. when his left foot went under left rear wheel after hitting a bump, RV turned right and turned over on his left knee and leg and patient felt "pop" in left knee just under the patella.
RESPONSE:




          19. Admit that there is no documentation in the ___________________ medical records of ___________________ showing examination of ___________________ by a physician prior to 1:15 a.m. on August 20, 1987.
RESPONSE:



          20. Admit that ___________________ was not examined by a physician in the ___________________ emergency department on August 19 or 20, 1987 prior to 1:15 a.m. on August 20, 1987.
RESPONSE:



          21. Admit that the standards of practice applicable to the resident physicians on call to the ___________________ emergency department on August 19 and 20, 1987 required that ___________________ be examined by a resident physician within thirty (30) minutes of receiving notice that _______ was in the ___________________ emergency department.
RESPONSE:



          22. Admit that the log book of the ___________________ emergency department on August 19, 1987 shows a left knee fracture as the admitting complaint of ___________________ at 8:45 p.m. on August 19, 1987.
RESPONSE:





          23. Admit that on August 19, 1987 ___________________ emergency department policy required a triage assessment of patients arriving in the ___________________ emergency department within fifteen (15) minutes of the time of arrival. 
RESPONSE:



          24. Admit that on August 19, 1987 ___________________'s injuries required that he be classified as an emergent patient by triage assessment at the ___________________ emergency department .
RESPONSE:




          25. Admit that on August 19, 1987 ___________________ emergency department policy required that a patient classified as emergent by triage assessment immediately be brought back to Team I, placed in the appropriate room, and attended until an experienced nurse team arrived.
RESPONSE:




          26. Admit that on August 19, 1987 after ___________________'s arrival at the ___________________ emergency department, he was not immediately taken back to Team I, placed in the appropriate room, and attended until an experienced nurse team arrived.
RESPONSE:



          27. Admit that on August 19, 1987 the ___________________ emergency department's emergent category of triage was defined as any delay in treatment that will be detrimental to life or limb.
RESPONSE:





          28. Admit that on August 19, 1987 ___________________ emergency department policy required that patients in the emergent category of triage be seen immediately or within minutes of arrival.
RESPONSE:




          29. Admit that on August 19, 1987 ___________________ was not seen immediately or within minutes of his arrival at the ___________________ emergency department as required by the ___________________ emergency department policy referred to in request #24 applicable to patients classified as emergent.
RESPONSE:




          30. Admit that Dr. ___________________, Jr. was a senior resident on duty in the ___________________ emergency department from, but not limited to, 8:45 p.m. on August 19, 1987 until 1:15 a.m. on August 20, 1987.
RESPONSE:




          31. Admit that Dr. ___________________, Jr. was an agent and employee of ___________________ on August 19 and 20, 1987.
RESPONSE:





          32. Admit that Dr. ___________________, Jr. accepted ___________________ as a transfer patient of ___________________ from ______________ on August 19, 1987 during a telephone conversation with Dr. ___________________.
RESPONSE:




          33. Admit that Dr. ___________________, Jr. was acting within the course and scope of his agency and employment with defendant ___________________ when he accepted ___________________ as a transfer patient of ___________________ from _____________________ on August 19, 1987 during a telephone conversation with Dr. ___________________.
RESPONSE:





          34. Admit that Dr. ___________________, Jr. was acting within the course and scope of his agency and employment with defendant ___________________ while he was on duty in the ___________________ emergency department on August 19 and 20, 1987.
RESPONSE:

          35. Admit that on August 19, 1987 ___________________ emergency department policy required that one of the surgical residents on duty in the emergency department be immediately notified of the patient's name, estimated time of arrival and problems, and be given instructions about the care of the patient after arrival when a patient was accepted for admission to ___________________ from another facility.
RESPONSE:



          36. Admit that on August 19, 1987 ___________________ emergency department policy required that the surgical resident on duty in the emergency department immediately give the patient's name, estimated time of arrival, problems, and instructions about the care of the patient after arrival to the charge nurse on duty in the emergency department when a patient is accepted as a transfer patient for admission to ___________________ from another facility.
RESPONSE:





          37. Admit that on August 19, 1987 ___________________ emergency department policy required that the charge nurse on duty in the emergency department record the information described in requests #31 and #32 on the arrival board behind the front desk and pass on the information to the next shift of nurses, if necessary, when a patient is accepted as a transfer patient for admission to ___________________ from another facility.
RESPONSE:




          38. Admit that the charge nurse on duty in the ___________________ emergency department on August 19, 1987 at the time ___________________ was accepted as a transfer patient of ___________________ from _________________ did not record any information regarding ___________________ on the arrival board behind the front desk and did not pass on the information regarding ___________________ to the next shift of nurses.
RESPONSE:




          39. Admit that on August 19, 1987 ___________________ emergency department policy required that when a transfer patient arrived in the emergency room, he/she was to be registered and evaluated by the surgical resident on duty in the emergency department.
RESPONSE:



          40. Admit that neither Dr. ___________________, Jr. nor any other surgical resident on duty in the ___________________ emergency department on August 19, 1987 registered or evaluated ___________________ upon his arrival at the ___________________ emergency department.
RESPONSE:



          41. Admit that on August 19, 1987 ___________________ emergency department policy required that the time interval from the phone call of the surgical resident to the surgical subspecialist until the patient is seen by the surgical subspecialist should be within ten (10) minutes for an acute problem.
RESPONSE:



          42. Admit that on August 19, 1987 ___________________ emergency department policy required that during telephone contact with a referring physician regarding a transfer patient from another facility, the surgical resident on duty in the emergency department get important information regarding the details of the accident, details of injury, and therapy instituted.
RESPONSE:



          43. Admit that during Dr. ___________________, Jr.'s telephone conversation with Dr. ___________________, the referring physician at ____________, Dr. ___________________, Jr. did not get important information regarding the details of ___________________'s accident, details of his injury, or the therapy instituted.
RESPONSE:




          44. Admit that on August 19, 1987 copies of outside records and x-rays were important in the initial evaluation and treatment of transfer patients in ___________________'s emergency department.
RESPONSE:




          45. Admit that on August 19, 1987 Dr. ___________________, Jr. did not request that the x-rays and medical records of ___________________ from ____________ be sent to the ___________________ emergency department with Neville.
RESPONSE:



          46. Admit that on August 19, 1987 ___________________ emergency department policy required that the surgical resident on duty in the emergency department call a consultant without hesitation and without delay, at an early stage of a patient's emergency room stay.
RESPONSE:



          47. Admit that on August 19, 1987 ___________________ emergency department policy required that every patient be seen first by a physician, then a medical student or physician's assistant student may be assigned.
RESPONSE:




          48. Admit that ___________________ was seen by a physician's assistant student at 11:30 p.m. on August 19, 1987 in the ___________________ emergency department, approximately one hour and forty-five minutes prior to ___________________ being seen by any physician in the ___________________ emergency department.
RESPONSE:



          49. Admit that on August 19 and 20, 1987 ___________________ emergency department policy required that the surgical resident on duty in the emergency department have primary responsibility for all surgical patients in the emergency department.
RESPONSE:




          50. Admit that ___________________ was a surgical patient in the ___________________ emergency department on August 19 and 20, 1987.
RESPONSE:




          51. Admit that on August 19 and 20, 1987 ___________________ emergency department policy required that the senior surgical resident on duty in the emergency department see and enter a note in the medical record on every patient registered to Surgery and every patient for whom surgery is consulted.
RESPONSE:




          52. Admit that Dr. ___________________, Jr. did not see or examine ___________________ on August 19 or 20, 1987 and did not enter a note in the medical records of ___________________ on August 19 or 20, 1987.
RESPONSE:




          53. Admit that on August 19 and 20, 1987 ___________________ emergency department policy required that even when a subspecialty has accepted responsibility for a patient in the emergency department, the surgical resident on duty in the emergency department is expected to know the nature of the principal problem, the plan of care, and the circumstances in any delay.
RESPONSE:




          54. Admit that Dr. ___________________, Jr. did not know the nature of ___________________'s principal problem, the plan for his care, and the circumstances in delay in the care and treatment of ___________________ on August 19 and 20, 1987.
RESPONSE:



          55. Admit that on August 19 and 20, 1987 ___________________ emergency department policy required that if the care of a patient is at a complete standstill awaiting the arrival of the physician responsible for the next step in the care, and the period of awaiting his or her arrival in the emergency department is as long as thirty (30) minutes, the delay and circumstances are to be recorded in the file maintained on such delays.
RESPONSE:




          56. Admit that Dr. ___________________, Jr. was the senior resident in the surgery department on duty in the ___________________ emergency department from, but not limited to, 8:45 p.m. on August 19 until 1:15 a.m. on August 20, 1987.
RESPONSE:




          57. Admit that the attached Exhibit A is a genuine, true, and accurate copy of Entry Number 10-1 of the Surgical Residents Manual contained in the ___________________ Emergency Department Policy Manual.
RESPONSE:




          58. Admit that the attached Exhibit B is a genuine, true, and accurate copy of Entry Number 10-2 of the Surgical Residents Manual contained in the ___________________ Emergency Department Policy Manual.
RESPONSE:




          59. Admit that the attached Exhibit C is a genuine, true, and accurate copy of Entry Number 13 of the Surgical Residents Manual contained in the ___________________ Emergency Department Policy Manual.
RESPONSE:




          60. Admit that on August 19 and 20, 1987 ___________________ emergency department policy required that primary responsibility for surgical patients in the emergency department belonged to the surgical resident on duty in the emergency department until the consultant for the appropriate subspecialty agreed to accept responsibility for the surgical patient.
RESPONSE:


          61. Admit that Dr. ___________________, Jr., the senior surgical resident on duty in the ___________________ emergency department on August 19 and 20, 1987, did not take primary responsibility for ___________________ prior to a subspecialty consultant agreeing to accept primary responsibility for ___________________.
RESPONSE:




          62. Admit that on August 19 and 20, 1987 ___________________ emergency department policy required that response times longer than thirty (30) minutes for physicians called to the emergency department be routinely questioned.
RESPONSE:




          63. Admit that Dr. ____________, then Surgical Director of the Emergency Room, was instructed on or before March 11, 1987 to maintain a record of physicians called to the emergency room whose response times were longer than thirty (30) minutes and to report repeated, unjustified delays to the chairmen of the departments.
RESPONSE:




          64. Admit that on August 19 and 20, 1987 ___________________ emergency department policy required that triage be followed promptly by examination of the patient by a resident physician within ten (10) to fifteen (15) minutes.
RESPONSE:




          65. Admit that on August 19 and 20, 1987 ___________________ emergency department policy required that the senior surgical resident on duty in the emergency department see all surgery patients in the emergency department and be responsible for their diagnosis, treatment, and disposition.
RESPONSE:




          66. Admit that on August 19 and 20, 1987 ___________________ emergency department policy required that the triage nurse resolve any doubt about urgency in the care of an emergency department patient by conferring with a physician, which carried high priority.
RESPONSE:


          67. Admit that the triage nurse who assessed ___________________ on August 19, 1987 did not confer with any physician regarding the urgency of the care of ___________________.
RESPONSE:




          68. Admit that on August 19 and 20, 1987 ___________________ emergency department policy required that if a surgical patient had been registered for more than thirty (30) minutes, and the Junior Assistant Resident and Senior Assistant Resident were both urgently occupied with other patients, that a chief resident or the surgical director be called to initiate medical evaluations.
RESPONSE:




          69. Admit that neither a chief resident nor the surgical director were called to initiate medical evaluations in the emergency department on August 19 and 20, 1987.
RESPONSE:




          70. Admit that on August 19 and 20, 1987 ___________________ emergency department policy required, as a backup procedure, that the surgical director be routinely called by the acute or non-acute receptionist whenever a patient in the emergency department had been registered for an hour, but had not yet been seen by a physician.
RESPONSE:




          71. Admit that the surgical director, Dr. ___________, was not called by the acute or non-acute receptionist regarding ___________________ between 8:45 p.m. on August 19, 1987 and 1:15 a.m. on August 20, 1987.
RESPONSE:




          72. Admit that on August 19 and 20, 1987 ___________________ emergency department policy required that two (2) surgical residents be on duty in the emergency department at all times.
RESPONSE:




          73. Admit that on August 19 and 20, 1987 ___________________ emergency department policy required that subspecialty residents be available to the emergency department twenty-four (24) hours a day.
RESPONSE:




          74. Admit that on August 19 and 20, 1987 the mission of the ___________________ Emergency Department was to provide a specialized clinical setting to support the medical, nursing, and allied health education programs at ___________________ through exemplary, emergency patient care practices and a responsive support system.
RESPONSE:




          75. Admit that on August 19 and 20, 1987 one of the goals of the ___________________ Emergency Department was to operate in a manner to develop and maintain a high level of employee competence, commitment, and job satisfaction.
RESPONSE:




          76. Admit that on August 19 and 20, 1987 ___________________ emergency department policy required that all patients under sixteen (16) years of age be seen by the pediatric resident in the emergency department.
RESPONSE:




          77. Admit that on August 19, 1987 ___________________ was twelve (12) years old.
RESPONSE:




          78. Admit that ___________________ was not seen by a pediatric resident in the ___________________ emergency department on August 19 or 20, 1987.
RESPONSE:






          79. Admit that on August 19 and 20, 1987 ___________________ emergency department policy required that if a patient had to wait after triage for any reason, the triage nurse was to check the patient every fifteen (15) minutes.
RESPONSE:



          80. Admit that the triage nurse on duty in the ___________________ emergency department on August 19, 1987 did not check on ___________________ every fifteen (15) minutes during his wait after being triaged.
RESPONSE:



          81. Admit that on August 19 and 20, 1987 ___________________ emergency department policy provided that a patient with joint dislocation was classified as emergent.
RESPONSE:





          82. Admit that on August 19 and 20, 1987 at the ___________________ emergency department, significant factors in the diagnosis and treatment of joint fractures and dislocations were the presence/absence of pulses, color, movement, mechanism of injury, and pain.
RESPONSE:




          83. Admit that on August 19 and 20, 1987 ___________________ emergency department policy required that all fractures and dislocations be splinted and iced.
RESPONSE:




          84. Admit that ___________________ had a dislocated left knee upon presentation to the ___________________ emergency department on August 19, 1987.
RESPONSE:




          85. Admit that ___________________'s left knee was not splinted and iced in the ___________________ emergency department on August 19, 1987.
RESPONSE:

          86. Admit that ___________________'s left knee was not splinted and iced in the ___________________ emergency department on August 20, 1987.
RESPONSE:



          87. Admit that on August 19 and 20, 1987 ___________________ emergency department policy required that students assigned to the emergency room see patients under the direction of the emergency room residents.
RESPONSE:



          88. Admit that Dr. ___________________, Jr. had supervisory responsibility for the physician's assistant students working in the ___________________ emergency department from, but not limited to, 8:45 p.m. on August 19, 1987 until 1:15 a.m. on August 20, 1987. 
RESPONSE:





          89. Admit that Dr. ___________________, Jr. did not supervise the physician's assistant student who examined ___________________ in the ___________________ emergency department on August 19, 1987 in connection with the physician's assistant student's examination of ___________________ on August 19, 1987.
RESPONSE:




          90. Admit that the physician's assistant student who examined ___________________ on August 19, 1987 was required to be under the direction of Dr. ___________________, Jr. on August 19, 1987.
RESPONSE:




          91. Admit that Dr. ___________________, Jr. did not direct or instruct a physician's assistant student to examine or interview ___________________ on August 19, 1987.
RESPONSE:




          92. Admit that on August 19 and 20, 1987 the data terminal operators, receptionists, admissions clerks, nurses, physician's assistant students, and resident physicians who were working in the ___________________ emergency department and who were on call to the ___________________ emergency department were acting within the course and scope of their agency and employment with ___________________ in connection with the treatment provided ___________________ in the ___________________ emergency department.
RESPONSE:




          93. Admit that neither ____________, ____________, ___________________, nor any other person having personal knowledge of the three-wheel vehicle accident involving ___________________ on August 19, 1987, has been interviewed by any person, firm, or entity on behalf of defendant ___________________ regarding the manner of ___________________'s operation of the three-wheel vehicle on August 19, 1987 and ____________and ____________'s supervision thereof.
RESPONSE:




          94. Admit that ___________________ had no dopplerable pulses in his left foot at 1:30 a.m. on August 20, 1987.
RESPONSE:

          95. Admit that there is no documentation in the ___________________ medical records of ___________________ of the presence of a pulse in ___________________'s left foot at or after 1:15 a.m. on August 20, 1987.
RESPONSE:



          96. Admit that the copies of the ___________________ medical records of ___________________ which defendant ___________________ has produced for the plaintiffs is a complete set of ___________________'s ___________________ medical records.
RESPONSE:



This _____ day of _________________, 1991.

CHARLES A. BENTLEY, JR. & ASSOCIATES




____________________________________
Charles A. Bentley, Jr./ 
Susan B. Kilzer
Post Office Box 52089
Durham, North Carolina 27717-2089
Telephone: (919) 489-1330

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