,lS Jason cFarlin Esq. 62 Market St. #305 Wailuku HI 96793 Ph: 808-269?0625 Email: Jason@mcfarlinlawyer.com Attorney for Plainti?Gaylene Louise Barron aka Gaylene Louise Baker, for Herself and on Behalf of all Statutory Bene?ciaries and as Personal Representative of the Estate of Deceased Minor SPB IN THE CIRCUIT COURT OF THE SECOND CIRCUIT STATE OF HAWAII - Gaylene Louise Barron aka Gaylene CIVIL NOLouise Baker, for Herself and on Behalf (Medical Malpractice) of all Statutory Beneficiaries and as Personal Representative of the Estate of DECLARATION OF Deceased Minor SPB, EXHIBITS SUMMONS Plaintiff, VS. Dr. Gabrielle Galler-Rimm, Galler-Rimm Behavioral Health Services Inc. Defendants, 93d Rd 9- l?f?l?l COMPLAINT: Comes now Gaylene Louise Barron aka Gaylene Louise Baker (herein ?Mother?), for Herself and on Behalf of all Statutory Beneficiaries and as Personal Representative of the Estate of Deceased Minor SPB, by and through her Attorney Jason McFarlin, for her Complaint against Dr. Gabrielle Galler-Rimm, and Galler-Rimm Behavioral Health Services Inc. (herein asserts, alleges and avers as follows: I. NATURE OF THE LAWSUIT: Mother commenced this medical malpractice action on behalf of her deceased 13-year- old minor, SPB. SPB died while under the care of Dr. Gabrielle Galler-Rimm MD, a Board- Certi?ed Pediatrician. 9 Mother brings three causes of action: (1) medical battery, (2) doctrine of informed consent, and (3) medical negligence. PARTIES: 1. Plaintiff SPB (herein or ?Minor?), at all times relevant was a Minor residing in the County of Maui, State of Hawaii. SPB is now deceased. 2. Plaintiff Gaylene Louise Barron aka Gaylene Louise Baker (herein ?Mother?), at all times relevant is Personal Representative of the Estate of Deceased Minor SPB, biological mother with legal and physical custody, and resides in the County of Maui, State of Hawaii. 3. Defendant DR. GABRIELLE GALLER-RIMM MD (herein ?Galler-Rimm? or ?Dr. at all times relevant was a Board-Certified Pediatrician doing substantial business in the County of Maui, State of Hawaii. 4. Defendant GALLER-RIMM BEHAVIORAL HEALTH SERVICES INC., at all times relevant was doing substantial business in the County of Maui, State of Hawaii. JURISDICTION: 5. Plaintiff incorporates in the Complaint, by reference, paragraphs 1-4 as if fully set forth herein. 6. All incidents complained of herein occurred in the County of Maui, State of Hawaii. 7. The amount in controversy exceeds $30,000 exclusive of interest and attorney?s fees. w: 8. Plaintiff incorporates in the Complaint, by reference, paragraphs 1-7 as if fully set forth herein. 9. From 201 1-2013 both HI School (Irene Chang and Anna Dewitt utilized Conners to diagnose and treat SPB. Neither diagnosed ADHD, nor did they prescribe ADHD medication. 10. SPB committed suicide 09/03/2015 while in a physician patient relationship with Galler- Rimm. 1 1. It is common knowledge among Board Certified Pediatricians that Conners I has not been the Standard of Care used to diagnose ADHD for approximately 30 years. 12. In 2014-2015 Galler-Rimm diagnosed and treated SPB with Conners I. 13. Among Board Certi?ed Pediatricians the correct Standard of Care (SOC) to diagnose ADHD in a patient with behavioral and conditions is to refer them to a Child C) who can help with the ADHD diagnosis. At the same time, the Board-Certi?ed Pediatrician should also utilize Conners testing when diagnosing ADHD. 14. Galler-Rimm knew about Conners when diagnosing ADHD, but intentionally hid the correct SOC from Mother, and intentionally used the incorrect SOC (Conners I) to diagnose and treat minor. 15. Pediatricians Dr. Ho, Dr. Hirayama, and Dr. Clark all refer patients exhibiting multiple issues, like those exhibited by SPB, to Child to assist in the diagnosis of ADHD. 16. Dr. Galler-Rimm did not refer SPB to a Child to assist in the diagnosis of ADHD. 17. The risk factors associated with Focalin intensify (including suicide) when ADHD medication like Focalin is prescribed to children exhibiting behavioral and conditions, (2) but the child does not have ADHD. 18. When mother requested medical records, Dr. Galler-Rimm provided Mother with a partial record and removed Conners I documents. 19. The cumulative effect of Galler-Rimm?s Acts of Medical Negligence, Acts of Medical Battery, and failure to obtain Informed Consent, probably cased Minor?s suicide. 1. PLAINTIFF MEDICAL MALPRACTICE THEORY OF LIABILITY: STATUTE OF LIMITATIONS: 20. Plaintiff incorporates in the Complaint, by reference, paragraphs 1-19 as if fully set forth herein. As a threshold issue, this court must determine whether Plaintiff? 3 claims are barred by the statute of limitations. 22. Under Hawaii Law: No action for injury or death against a chiropractor, clinical laboratory technologist or technician, dentist, naturopathic physician, nurse, nursing home administrator, dispensing optician, optometrist, osteopath, physician or surgeon, physical therapist, podiatrist, or veterinarian duly licensed or registered under the laws of the State, or a licensed hospital as the employer of any such person, based upon such person's alleged professional negligence, or for rendering professional services without consent, or for error or omission in such person's practice, shall be brought more than two years after the plaintiff discovers, or through the use of reasonable diligence should have discovered, the injury, but in any event not more than six years after the date of the alleged act or omission causing the injury or death. This six-year time limitation shall be tolled for any period during which the person has failed to disclose any act, 0 error, or omission upon which the action is based and which is known to the person. HRS 657-7.3 Medical torts; limitation of actions; time. A two-year limitation commences to run when plaintiff discovers, or through the use of reasonable diligence should have discovered, (1) the damage; (2) the violation of the duty; and (3) the causal connection between the violation of the duty and the damage. Jacoby v. Kaiser Found. Hosp, 622 P.2d 613 (Haw.Ct.App. 1981) 23. Maui Police Department Case Summary Report of Minor?s Suicide indicates that on 09/03/2015, ?Gaylene BARRON discovered her son, (13 year old male) cold to the touch, unresponsive, not breathing and without a pulse.? (Exhibit 1). Damage to Minor was discovered 09/03/2015. (Exhibit 2). 24. Thereafter, through the use of reasonable diligence, Mother began discovering numerous violations of Galler-Rimm?s duty to Minor, and the causal connection between the violations of the duty and the damage Minor suffered. Mother consulted Dr. Santo Triolo', who, after reviewing Minor?s medical records and interviewing Mother, concluded Galler-Rimm committed numerous violations of her duty to utilize the Standard of Care (SOC) Board-Certi?ed Pediatrician?s should utilize to diagnose and treat a patient with Minor?s behavioral and conditions. In Dr. Triolo?s view, the probability significantly exceeds 50%, that the cumulative effect of the numerous SOC violations caused Minor?s Suicide. (Exhibit 3). 25. Plaintiff ?led an Inquiry Regarding Rendering Professional Services with the Medical Inquiry and Conciliation Panel (MICP), MICP No. 2017-056, on July 12, 2017. 26. The Notice of Termination from MICP is dated May 8, 2018. (Exhibit 4). 27. This following is from the MICP Guide (pg. 4), provided on website at 11. What happens to the statute of limitations when an inquiry is ?led? Pursuant to HRS ?671-18, once an inquiry is filed with the MICP, the applicable statute of limitations is tolled for 60 days following the mailing of the notice of termination, or for a maximum of 12 months from the filing of the inquiry, whichever occurs first. Consequently, it is very important for the party ?ling the inquiry to keep track of how much time remains under the applicable statute of limitations as of the time the inquiry is filed with the MICP because that 1 Dr Triolo has a in Family Relations and Human Development/ Developmental (Clinical Child) $9 0 will be the amount of time remaining after the applicable statute of limitations resumes running. 28. Therefore, Plaintiff?s claims are not time barred by the statute of limitations. COUNT 1: MEDICAL BATTERY: 29. Plaintiff incorporates in the Complaint, by reference, paragraphs 1-28 as if fully set forth herein. 30. Dr. Galler-Rimm failed to disclose a material aspect of the nature and character of the treatment performed on SPB. As such, Galler-Rimm failed to obtain consent for the treatment she provided SPB and an unpermitted touching occurred. 31. Dr. Galler-Rimm performed medical treatment on Minor SPB that was substantially different in nature and character from that to which Mother consented. 32. Dr. Galler-Rimm intentionally diagnosed and treated SPB with the wrong SOC (Connors I) when she knew the correct SOC was Conners 33. Galler-Rimm intentionally hid Conners 111 from Mother and did not discuss Conners with Mother. 34. Galler-Rimm intentionally failed to disclose the material risks associated with utilizing the wrong SOC to diagnose and treat SPB. 35. Galler-Rimm misrepresented to Mother that Conners I was the correct SOC to use for diagnosing and treating behavioral and conditions.2 36. Galler-Rimm committed Fraud by knowingly concealing SPB should be receiving Conners testing to be diagnosed and treated. 37. Mother?s consent to Conners I was inadequately informed by Galler-Rimm, which is, as a practical matter, no consent at all. INFORMED CONSENT: 38. Plaintiff incorporates in the Complaint, by reference, paragraphs 1-37 as if fully set forth herein. 2 Fraud or misrepresentation or failure on the nart of a doctor to reasonably inform a patient vitiates the consent that he may have obtained from a patient and, therefore, whatever was done by a doctor, even with the utmost skill, is batterv and a patient would have a claim for reliji. Thus it is no defense for a doctor that the treatment or diagnostic procedure was conducted with utmost skill, because the claim for relief is not the unskillful nor negligent act of a physician, but the unconsented touching of a patient which is battery. Nishi v. Hartwell, 52 Haw. 188,473 P.2d 116 (HI, 1970). 39. In order for Plaintiff?s negligent non-disclosure informed consent claim to be submitted to the jury, the following FIVE ELEMENTS MUST BE ESTABLISHED: (1) prior to treatment, Dr. Galler-Rimm owed a duty to disclose to the patient the risk of the harm suffered by the patient; (2) Dr. Galler-Rimm negligently performed or failed to perform the duty of disclosure; (3) the patient suffered the harm; (4) Dr. Galler-Rimm?s negligent performance or nonperformance of the duty was a cause of the harm because (4a) the treatment was a substantial factor bringing about the patient?s harm and (4b) the patient, acting rationally and reasonably, would not have undergone the treatment had they been properly informed of the risk of harm that in fact occurred; and (5) no other cause is a superseding cause. Keomaka v. Zakaib, 811 P.2d 478, 8 Haw.App. 518 (Hawai'i App., 1991). 40. ELEMENT 1: Prior to Treatment, Dr. Galler-Rimm owed a duty to disclose to the patient the risk of harm suffered by the patient. 3 ,4 3 HRS 671?3 (Supp.2008) provides, in relevant part: The following information shall be supplied to the patient or the patient's guardian or legal surrogate prior to obtaining consent to a proposed medical or surgical treatment or a diagnostic or therapeutic procedure: (1) The condition to be treated; (2) A description of the proposed treatment or procedure; (3) The intended and anticipated results of the proposed treatment or procedure; (4) The recognized alternative treatments or procedures, including the option of not providing these treatments or procedures; (5) The recognized material risks of serious complications or mortality associated with: (A) The proposed treatment or procedure; (B) The recognized alternative treatments or procedures; and (C) Not undergoing any treatment or procedure; and (6) The recognized bene?ts of the recognized alternative treatments or procedures. 4 ln Ray v. Kapiolani Med. Specialists, 125 Hawai'i 253, 262, 259 P.3d 569, 578 (2011), the Hawaii Supreme Court "interpreted HRS 671-3(b) as supplying the standard for a physician's duty to disclose information to the patient.? 125 Hawai?i at 266, 259 P.3d at 582. A physician's duty to inform encompasses four separate duties: (1) the general duty to supply information about a proposed medical treatment or procedure embodied by HRS (2) the duty to inform the patient of recognized alternative treatments or 0 41. Galler-Rimm did not inform Mother of the risks and bene?ts of Recognized Alternative Treatments or Procedures. 42. Galler-Rimm violated the duty to Warn Mother of Material Risks (including Suicide) prior to Treatment. 43. ELEMENT 2: Dr. Galler-Rimm negligently performed or failed to perform the duty of disclosure. 5 44. Before consenting to Conners 1 testing for SPB, Galler-Rimm knew or should have known Mother would have wanted to be informed of the Correct SOC (Conners Ill). 45. Before consenting to the treatment recommend by Galler-Rimm to diagnose and treat ADHD, Galler-Rimm knew or should have known Mother would have wanted to be informed that the correct SOC when diagnosing ADHD for children exhibiting behavioral and issues is to refer the child to a medical professional trained in Child 46. Before consenting to the ADHD stimulant Focalin, Galler-Rimm knew or should have known Mother would have wanted to be advised of the risk of suicide. 47. Before consenting to a prescription of 10mg Focalin XR, Galler-Rimm knew or should have known Mother would have wanted to be informed that the correct dosage for pediatrics is 5mg Focalin XR. 48. While SPB was being treated with the ADHD stimulant Focalin, Mother repeatedly expressed concerns about the side effects of Focalin due to changing behavior (including increased aggression, anger, depression, agitation, hallucinations, co-morbid behavior and hurting small animals). As such, Galler-Rimm knew or should have known that Mother would have wanted to know about alternative treatments and drugs available to SPB. procedures, including the option of not providing these treatments or procedures, as provided in HRS 671? (3) the duty to warn of material risks prior to treatment as provided in HRS and (4) the duty to inform patients of the recognized bene?ts of any recognized alternative treatments or procedures as provided in HRS 5 Hawaii adopted the Patient-Oriented Standard to determine whether a physician owes a duty to disclose a particular piece of information to a patient prior to treatment. Under this standard, the ?focus should be on what a reasonable person objectively needs to hear from his or her physician to allow the patient to make an informed and intelligent decisions regarding proposed medical treatment.? Carr v. Strode, 79 Hawai?i 486,, 904 P.2d 500 (1995). This standard is based upon ?whether a reasonable person would have wanted to consider the purportedly withheld information before consenting to the treatment." ld. a - 49. Galler?Rimm?s medical records fail to indicate the risk or alternative treatments available to SPB were disclosed. 50. Mother did not receive, nor sign an informed consent document. 51. ELEMENT 3: the patient SPB suffered the undisclosed harms. 52. SPB suffered the undisclosed harm associated with Focalin: Suicide. 53. SPB suffered the undisclosed harm associated with taking the high dosage of 10mg Focalin XR: Suicide. 54. SPB suffered the undisclosed harm associated with being diagnosed and treated with the wrong SOC, Conners I. 55. SPB suffered the undisclosed harms associated with being denied the correct SOC (Conners to diagnose and treat his condition. 56. SPB suffered the undisclosed harm associated with not being referred to a Child to diagnose ADHD. 5 7. ELEMENT (4) Dr. Galler-Rimm?s negligent performance or nonperformance of the duty was a cause of the harm because the treatment was a substantial factor bringing about the patient?s harm. 58. Dr. Triolo indicates Risk factors (including Suicide) associated with the ADHD stimulant Focalin are greater if the patient has NO ADHD and significant emotional problems. 59. Galler-Rimm prescribed SPB Focalin XR 10mg for the entire time leading up to his death. The dosage recommended for pediatric patients is Focalin XR 5mg. 60. The high dosage of Focalin XR 10mg was maintained despite Mother repeatedly expressing concerns about the classic risk factors of Focalin (including adverse side effects, behavioral changes) and the discovery SPB had been sexually abused; all of which occurred after Galler-Rimm began prescribing this drug. 61. Galler-Rimm?s use of the wrong SOC (Conners I) led to misdiagnosing SPB with ADHD, and negligently treating with Focalin. 62. From 2011-2013 HI DOE School (Irene Chang and Anna Dewitt utilized Conners to diagnose ADHD and treat SPB. SPB was not diagnosed with ADHD during this time, and did not take ADHD drugs. (Exhibit 5). While being diagnosed and treated with Conners SPB did not exhibit signs of hurting himself or make any Suicide attempt. 63. School Anna Dewitt recorded Minor denied homicidal and suicidal ideation and attempts. (Exhibit 5). 64. While SPB was under Galler-Rimm?s care in 2014-2015 she failed to refer SPB to a Child to assist in the diagnosis of ADHD. 65. Collectively, numerous factors associated with Galler-Rimm?s failure to obtain informed consent from Mother, the failure to disclose and utilize the correct SOC, the utilization of the wrong SOC and the resulting negligent misdiagnosis and negligent treatment of SPB indicate Galler-Rimm?s negligent performance or nonperformance of the duty was probably substantial factor that brought about Minor?s harm. 66. ELEMENT (4) Dr. Galler-Rimm ?s negligent performance or nonperformance of the duty was a cause of the harm because the patient, acting rationally and reasonably, would not have undergone the treatment had he been properly informed of the risk of harm that in fact occurred.6 67. A RP in Mother?s position would not have consented to undergo treatment with the wrong SOC to diagnose and treat ADHD, had she been properly informed of the risks of diagnosing and treating ADHD with the wrong SOC (including the risk of suicide associated with the ADHD stimulant Focalin. 68. A RP in Mother?s position would not have consented to a prescription of 10mg Focalin XR, had she been properly informed that the correct dosage for pediatrics is 5mg Focalin XR. 69. The correct SOC to diagnose ADHD was the use of Conners and the referral of SPB to a Child to assist in the diagnosis. 70. Galler-Rimm utilized Conners I to diagnose and treat ADHD, and did not refer SPB to a Child 71. After disclosing intensifying behavioral and problems SPB exhibited while prescribed Focalin, and the discovery SPB was sexually abused while under Galler-Rimm?s care (all of which Mother reported to Galler-Rimm), had the risks associated with Focalin (including 6 Element (4b) causation is to be judged by an objective standard, that is, whether a reasonable person in the Mother's position would have consented to the treatment that led to Minor's injuries had Mother been properly informed of the risk of the injury that befell him or her. - - Suicide) been disclosed, a RP person in Mother?s position would have refused to allow SPB to continue taking Focalin and sought alternative treatments. 72. Prior to consenting to Minor taking Focalin, both Mother and Minor?s Father expressed concerns about the side effects of this drug and other drugs. 73. After SPB was prescribed Focalin, during subsequent appointments with Galler-Rimm, Mother continued voicing concerns about Focalin?s side effects, as well as Minor?s changing intensifying behavioral and conditions, and the discovery SPB had been sexually abused. 74. In addition, had Galler-Rimm disclosed the correct SOC to diagnose ADHD (including the risk of Suicide), Mother would have definitely refused to utilize the wrong SOC to diagnose and treat ADHD. 75. ELEMENT 5: No other cause is a superseding cause.7 76. Minor?s behavioral and conditions, as well as sexual abuse Minor suffered, occurred approximately 4 years prior to Galler-Rimm utilizing the wrong SOC to diagnose ADHD and treat with the stimulant Focalin. behavioral and conditions intensi?ed after Galler-Rimm?s diagnosis and treatment of ADHD. 77. Prior to Galler-Rimm?s diagnosis and treatment, SPB had not been diagnosed with ADHD, nor had he been prescribed an ADHD stimulant. 78. Prior to Galler-Rimm?s diagnosis and treatment, SPB had not exhibited signs of hurting himself, nor had he attempted Suicide. 79. Mother reported the following intensifying behavioral and conditions to Galler-Rimm after she diagnosed ADHD and treated with Focalin (comorbid behavior, hurting small animals, hallucinations, discovery of sexual abuse). 80. Dr. Triolo will testify that (1) Focalin?s risk factors are greater if there is NO ADI-ID and the patient has signi?cant emotional problems, and the (2) cumulative effect of using the wrong SOC probably caused Minor?s Suicide. 81. There were no other prescription drugs prescribed to SPB while under Galler-Rimm?s care. 7 A superseding cause is an act of a third person or other force which by its intervention prevents the original actor from being liable for harm to another which his antecedent negligence is a substantial factor in bringing about. superseding cause is generally one which operates, in succession to a prior wrong, as the proximate cause of an injury." 57A AmJur.2d Negligence 596, at 569 (1989). 10 MEDICAL NEGLIGENCE: 82. Plaintiff incorporates in the Complaint, by reference, paragraphs 1-81 as if fully set forth herein. 83. In order for a medical negligence claim to be submitted to the jury, the following elements must be established: (1) a physician-patient relationship existed between Dr. Galler- Rimm and Minor; (2) the SOC Dr. Galler-Rimm had a duty to utilize; (3) Dr. Galler-Rimm breached the applicable (4) the breach was the legal cause of Minor?s injury; and (5) Minor suffered a compensable injury. 84. Physician-Patient Relationship: Medical records completed by Dr. Galler-Rimm indicate she began treating Minor 01/14/2014 and continued until Minor?s Suicide 09/03/2015. Mother first took Minor to Dr. Galler-Rimm for treatment due to concerns about Minor?s behavioral and conditions. At least fourteen appointments are documented between 1/ 14/2014 ?08/2l/2015. 85. Dr. Galler-Rimm Breached her Duty to Treat Minor with the Appropriate Standard of Care (SOC). Dr. Galler-Rimm is a Board-Certified Pediatrician and is required to possess the same knowledge and skill and use the same care as other physicians in the same medical specialty use in the same or similar circumstances. As such, when Dr. Galler-Rimm treated behavioral and condition, Dr. Galler-Rimm had a duty to use the same SOC that other Board-Certi?ed Pediatricians would have used in the same or similar circumstances. 86. Breach #1 Galler-Rimm failed to utilize the appropriate SOC to Diagnosis ADHD in a child exhibiting the behavioral and conditions which SPB exhibited. The correct SOC was to refer SPB to a Child to assist in the diagnosis of ADHD. Galler-Rimm failed to make this referral. 87. Breach #2 Dr. Galler-Rimm utilized an outdated SOC (Conners I) when treating SPB. Conners is the appropriate testing a Board-Certi?ed Pediatrician should use when assisting a Child in diagnosing ADHD. Galler-Rimm used Conners 1 in 2014-2015, which has been ?out of date for approximately 30 years and [was] replaced because of multiple diagnostic problems.? Further, Dr. Triolo states that medical records provided to Mother indicate Galler-Rimm failed to perform Conners I correctly. (Exhibit 3). 11 0 Moreover, Conners was performed from 201 1-2013 by HI DOE School Anna Dewitt and Irene Chang (Exhibit 5). None of these tests diagnosed ADHD, nor did they result in the prescription of ADHD stimulants like ocalin. 88. Breach After Diagnosing ADHD and prescribing ocalin, Galler-Rimm Failed to Recommend or Perform Alternative Testing or Treatments after Mother REPEA EDL reported to Galler-Rimm concerns about Minors intensifying Behavioral and problems, and the discovery of Minor ?s Sexual Abuse. 89. Many of the behavioral changes, risk factors, and side effects Mother reported are classic Risk Factors associated with Focalin (including increased aggression, anger, depression, agitation, hallucinations, co?morbid behavior and hurting small animals). 90. Many of the behavioral changes, risk factors, and side effects Mother reported are Standardized Measures which clearly indicate NO ADHD (including increased aggression, anger, depression, agitation, hallucinations, co-morbid behavior and hurting small animals). 91. The appropriate SOC is to recognize these Risk Factors and Standardized Measures and stop prescribing Focalin, and rely on alternative treatments. 92. Galler-Rimm failed to recommend or consider STOPPING the prescription of Focalin or REDUCE the dosage of Focalin. 93. Focalin probably intensi?ed and behavior problems. 94. The adverse Side effects of stimulant medications are reversible, after the medication is stopped, subside, and the patient goes back to baseline. 95. Breach Dr. Galler-Rimm Breached the SOC by prescribing 10mg ocalin XR. 96. The appropriate SOC for pediatrics is 5mg ocalin XR. 97. Breach #5 Dr. Galler-Rimm failed to perform New Testing or Provide Information Requested by State of Hawaii Department of Health, Maui Family Guidance Center ?s Mental Health Supervisor, Leo Asuncion MA MF T. Galler-Rimm has a track record of failing to follow through with health care providers, patients, and health care organizations. 98. The correct SOC was for Galler-Rimm to provide the information to other healthcare professionals, and conduct the testing requested. 99. Between 06/10/2015 06/ 15/2015, Leo Asuncion MA MF contacted Dr. Galler-Rimm twice, informing her the following information was needed to complete Minor?s Intake: (1) 12 or history, (2) past and current medication, (3) 5 Axis Diagnosis, (4) Mental Health Exam, (5) developmental history with medical history and current issues. (Exhibit 6). 100. Failure to respond to this request was especially egregious as it was recently revealed Minor had been sexually abused and experiencing intensifying behavioral and problems. Leo Asuncion?s request to Galler-Rimm was based on concerns about the problems Mother communicated to him. 101. At least seven additional visits with Dr. Galler-Rimm occurred 06/19/2015, 06/26/2015, 07/13/2015, 08/01/2015, 08/04/15, 08/13/2015, 08/21/2015; yet Leo Asuncion?s requests were ignored. 102. Galler-Rimm?s lack of follow through is also evidenced by Social Security Administration Disability Claims Examiner J. Okinishi?s request for Minor?s records. (Exhibit 7). 103. Dr. Triolo will testify Galler-Rimm has a reputation and long track record of failing to follow through with health care providers, patients, and health care organizations. 104. Breach #6 Galler-Rimm Disregarded Minor?s Medical History when diagnosing and treating Minor. 105. The correct SOC is to review Minor?s Medical History when determining how to diagnose and treat them. 106. Galler-Rimm consistently disregarded Mother?s concerns about intensifying behavioral and risk factors exhibited after being prescribed Focalin. 107. Galler-Rimm also disregarded the diagnosis and treatment from 201 1-2013 by HI DOE School Anna Dewitt and Irene Change who both determined Minor did not have ADHD and did not require a prescribed stimulant. 108. By 201 l, SPB had developed the cerebral connections to rule out ADHD. 109. A Reasonable Juror could conclude that Dr. Galler-Rimm ?s numerous SOC Breaches is the Legal Cause of -S uicide:8 8 It is well recognized that the rule that a verdict in a malpractice case cannot be based on speculation or conjecture as to cause does not necessarily require that the plaintiff prove causation by direct and positive evidence which excludes every other possible hypothesis as to the cause of the injuries. Generally, it is held that, after a fair preponderance of evidence discloses facts and circumstances proving a reasonable probability that the defendant?s negligence or want of skill was the proximate cause of the injury, the plaintiff has supported his burden of proof suf?ciently to justify a 13 1 10. In order to establish the causation element of a medical negligence claim, plaintiff must demonstrate that the treatment Dr. Galler-Rimm provided to Minor was a legal cause of the injuries sustained by Minor. A legal cause is de?ned as a cause that was a substantial factor in bringing about the patient?s injury. 11 1. Failure to follow a recognized SOC removes the possibility of a iurv decision being based on speculation or conjecture. When a physician utilizes a treatment that is not an accepted SOC, this is suf?cient to show that a probable risk of iniurv to the patient has occurred. 1 12. For plaintiff to satisfy this element, it be established that it is more probable than not that the Minor?s suicide resulted from Dr. Galler-Rimm?s malpractice. But-for causation not only requires that defendant increased the risk of death, but also that their negligence was the most probable cause. 1 13. The probability is well over 50%, that the cumulative impact of all of Galler-Rimm?s SOC breaches caused Minor?s Suicide. 114. Minor Suffered a Compensable Injury: Minor died after committing suicide. He had his entire life, including his working life ahead of him. Therefore, this element of the negligent treatment claim is established. is prayed for, providing that each Defendant,joint1y and severally, pay the following, in amounts subject to proof at trial: 1 15. Medical treatment costs, treatment costs, and other treatment costs previously incurred. 116. Loss of income expected to be incurred until the time of trial and in the future. 117. General damages for pain, suffering, physical disfigurement and other intangible losses sustained. 1 18. Loss of future earning capacity. 119. Medical treatment costs, treatment costs, and other treatment costs expected to be incurred in the future. 120. Loss of income incurred in the past. 121. General damages sustained. verdict in his behalf. Schulz v. Feigal, 142 84, 89 (Minn. 1966). 14 CD 122. Costs of suit herein. 123. Prejudgment and postjudgment interest allowed by law. 124. Such other and further relief as the Court may deem proper. DATED: Wailuku, Hawaii 7 [4 444? Jason McFarlin, Attorney for Plaintiffs 15