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08-29-1994
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E ? a::pY• ;:,;.; '•r ' E'' '• ?." .;x?: i?• r,'. ' is 1' sS "<, F:- s'i• ',I,s : , r ''? 1 : ? ?.•. : fix. {4F ? . r .. ., r - e .. .. . . _ ' ?' r?t l' " ? s`'t sion 29-m=94 i • r. ?rl l.. ,l.. '.F'` :"t[I •. • it !? ?' f , '•?:3,{py Y.i ??js'",`'.''?ra?'??r?' -q, r. '?f ?t?t?.+??}i?:. ' 'fh : X. M? ri ..?; ?. ?,•,'•f v°a is l?i' i• .?t '?'lfa2', .'iy ! , ?IOlt '`fl'E' ' ?„r: ?° ?? ? ? '? ?' ' ' c } ?'? • f ? ?, I ,cr !!: s: .r ' ` ?J) ° : > 4;? 'S,'.i.•;e °.a .!• :i>: ."f in'''; =`4.. 'iC' •. ;, x, ,?'°; ?!., 'f `hr.,:', •• i :r ' 5 ' ? y? °'•, ':'C7 i " ; ' ?r ' . , a . ? , ,. , .(.'rs`.at„ u. , .....r.'T.. .: 'r• ,,. ,,.. 1 f x,r J, , ?tl , :: h.? .. 1.1. _.._... .y :? •nsf?Jr. ..«. - h.•:, , I, r.I ?. ''t "![:?•a-.'St .. ??•? 1. , i. r,. . r . , . !' . .. .... .. .... .i , ''!' ., s r'?'' .( ACTION AGENDA ' ` Board of Trustees of the 'Employees' . Pension Fund August 29 1994 , 1 Call to order 'J. 11:45 a.m. F... 2.. ?4pproval of Minutes ? 2. .. Approved as submitted., , of 8115/94 1 3. Request for acceptance 3.'' Approved. I into membership: a) Susan'Chase' _' • " b) Vincent Mazza ' c) Liza' Beebe d) Jacqueline Hall ; e) Dimas Rivera Burgos 4. Job-Connected Disability Pension"- ' 4. Granted'- to, be granted: Van Horton 5. Other Business: 5. None: } ' 6. 'Adjournment: 6. 11:53 a.m. L TRUSTEES OF THE' EMPLOYEES' PENSION FUND !torn #f i ' Agenda-Cover Memorandum Meeting Date: 8/29/94 I Subject: Membership in Employees' Pen--don Plan Recommendation/Motion: Employee(s) listed below be accepted into the Employees' Pension Plan as recommended by the Pension Advisory Committee. and that the appropriate officials be authorized to execute same. BACKGROUND: Seniority Pension Nai[I1?. Job__Ciass Dept./Div. D- F,9=tie Date Susan Chase, City Clerk Technician City Clerk 7/25/94 7/25/94 Vincent Mazza, Equip. Operator I Pks. & Rec./Nursery 7/25/94 7/25/94 Liza Beebe, Police Service Tech. Police 7/25/94 7/25/94 Jacqueline Hall, Utilities Chemist Pub. Wks./WPC 8/8/94 8/8/94 Dimas Rivera Burgos, Solid Waste Wkr. Pub.Wk./Solid Waste 8/8/94 8/8/94 Reviewed by: Originating Dept: Casts: Commission Action: Human Re sourc Total Legal _ NA ? Approved Budget NA_ ,_? ? Approved w/conditions Purchasing NA User Dept.: Current FY ? Denied Risk Mgml. ___NA ? Continued to: CIS ACM Advertised: Funding Source: ? Capt. Imp. Other NA ro? Date: Paper: ? Operating ? Other Attachments: ® Not required Submitted by: Affected parties Appropriatlon Code: Letter(s) ? Notified Not required ? None Clly Manaver p •.?, ,rf S: S'.'4=? /ffpp C>#:: ,. .. r6'„'1fs', .,r r ! ,.f. ?, CITY OF CLEARWATER EMPLOYEES' 'PENSION PLAN ° PENSION ADVISORY COMMITTEE Ali;,. r. r r, TO: Pension Trustees FROM Pension Advisory Committee SUBJECT: Recommendation for Acceptance into Pension Plan DATE: August 3, 1994 As Trustees of the City of Clearwater Employees' Pension Fund, you are hereby notified. that the employee(s) listed below have been duly examined by a local physician and each has been ` designated . as a "first class risk", These employees are eligible for pension membership as noted in the Pension Eligibility Date column below, and it is the recommendation of the Pension Advisory. Committee that they be accepted into membership. Pension Elig., Nhm?. Job, Class. & Dept./Div. Birth Date Hire Date Date Susan' Chase, City Clerk Technician, City Clerk's Office 10/29/65 7/25194 7125194 Vincent Mazzn, Equipment Operator 1, 12/19144 7125194 7/25/94 Parks & Recreation/Nursery Liza Beebe, Police Service Technician. Police Department 5/23165 Jacqueline Hall, Utilities Chemist, Public Works/WPC 12110/64 Dimas Rivera Burgos,.Solid Waste Wkr. Public Works/S.W. 6/1/63 7125/94 818194 818/94 7125/94' 8/8194 8/8194 .tcl ' TRUSTEES OF THE EMPLOYEES' PENSION FUND Item # L` Agenda Cover Memorandum Meeting Date: ei29i94 Subject: Pension to be Granted Recommendation/Motion: Van Horton, Fire Lieutenant, Fire Department, be granted a jab-connected disability pension undrr . Section(s) 2.397 and/or 2.399. of the Employees' Pension Plan as recommended by the Pension Advisory Committee. [j and that the appropriate officials be authorized to execute same. BACKGROUND: Van Horton, Fire Lieutenant, Fire Department, was employed by the City o n August 28, 1978, and began participating in the Pension Plan on that date. On January 6, 1994, h e suffered a heart attack which is the basis for his request for this job-connected disability pension. Mr. Horton has submitted letters from Dr. Donald R. Eubanks, dated May 6, 1994, and Dr. Richard Sola, dated June 6, 1994. The letter from Dr. Eubanks states, "Mr. Horton sustained a n acute inferior wall myocardial infarction ...I consider Mr. Horton to be permanently unemployable and unable to perform rigorous and stressful functions demanded by being employed as a fire fighter." The letter from Dr. Sola states, "Mr. Horton is a 45-year old male who suffered a recent inferior myocardial infarction ...I consider Mr. Horton a good candidate for permanent disability. His current employment as a fire fighter and the physical and stressful functions demanded by this employment would most likely have a negative effect on his long term cardiovascular status." Under F.S. 112.18, there is a presumption that any heart or lung disease incurred by a firefighter is presumed to be job-connected. Mr. Horton's request for a job-connected disability pension was approved by the Pension Advisory Committee at its meeting of August 3, 1994. This pension will be effective at the expiration of h i s vacation and sick leave as prorated with Workers' Compensation. Based on an average salary of approximately $36,197 over the past five years and the formula for computing job-connected disability pensions, Mr. Horton's pension will approximate $27,148 annually. Charts from Finance which take into consideration mortality rates and age reflect t h e 11present value: cost of financing" this pension will be approximately $307,136. Reviewed by: Legal NA Budget NA Purchasing _ NA Risk Mgmt. CIS INA ACM Other NA Submitted by: Originating Dept: Human Resources User Dept.: Advertised: Date: Pa er: II Not required Affected parties ? Notified Costs: $307.736 Total Current FY Funding Source: ? Capt. Imp. ? Operating Other Eensiog Appropriation Code: Commission Action: ? Approved ? Approved w/conditions ? Denied ? Continued to: Attachments: Letter(s) ® Not required 1 646-07410-530100-SBS I El None City Manager C I T Y [ E C L E A R W A T E R POST OFFICE: BOX 4749 CLEARWATER, FLOR.10A 34 618.4746 Human Resources Deprlment 8131482.6870 TO. Honorable Mayor and Members of the City Commission as Trustees of the Employees' Pension Plan FROM: Pension Advisory Committee COPIES: ' Van ..Horton; Debbie Bailey, Payroll Services Manager; Risk Management SUBJECT: Pension for Van Horton-Job-Connected Disability Pension DATE: August 3. 1994 The Pension Advisory Committee (PAC) received an application for disability pension from Van Horton on June 20, 1994. Mr. Horton has been determined by the Pension Advisory Committee to 'meet the requirements of the Pension Plan for a job-connected disability pension. He was employed by the City on' August 23, 1978, and began participating in the Pension Plan on that date. Further, he has submitted medical documentation, copies of which are attached, relative to his disability which. has been -reviewed and approved by the PAC. By motion made and duly carried at its meeting of August 3, 1994, the Pension Advisory Committee approved/recommended , the granting of a job-connected disability pension to Mr. Horton in accordance with provisions of Section 2.397 of the City Code. This pension is to be effective on a elate to be determined. The amount of Mr. Horton's pension will be calculated by the Finance Department according to the formula' in the Pension Plan for job-connnected disability pension at such time as his last five years of service and salary can be computed. I hereby certify that the Pension Advisory Committee has approved the granting of a job- Connected disability pension for Van Horton and the above dates are correct. Cha'rian, _Pension Advisory .,Committee "Equal Employment and Affirmative Action Employer' PENSION REQUEST FORM ' II van A. Horton do hereby apply for retirement from the City of Clearwater . Gen eral Employees' Pension Plan. My benefits date is August 28, 1978 (Entry date into pension plan) M y date of hire is August 28, 1978 My birthday is April 19, 1948 i My job classification is Fire Lieutenant and I work in the _ Fire Department Division. My resignation date is to be determined ' The type of pension for which I am applying is (check only one): Regular Pension based on years of . service x ,fob-connected Disability Pension Non-jab-connected Disability Pension .My spouse's name is: Marilyn K. Horton Dependent children under 'the age of 18 and residing in my household are: Jeffrey Wallace Februar•- 15, 1979 + (Print Child's Full Name) (Child's Date of Birth) I hereby certify all of the above to be true and correct: Cam- June 20, 1994 {Signature) (Date) STATE OF FLORIDA The fore of g 1 , trllment as ck owledged before me this . COUNTY OF PINELLAS ? y , who 's 'personally now, to me r who has produced as identification and who did/did not take an oath. blic r Niatar. t)u. NOTARY j (Slgnatu e) MY COMMISSIONEgX?pjRRES-, SEPT. 24, 19941 ¦ONL-^?iTi3iilJ?le11 1`1 ?.G t}IIPLRWRifCASr. (Name of Notary Printed) L._ CITY OF CLEARWATER GENERAL EMPLOYEES' PENSION PLAN , OPTIONS FIREFIGHTERS OPTION #;: Employees can receive a- lump. sup. payment for vacation' and holiday pay and 1/2 of accrued sick leave at the. time. of separation from the City. There will be no 68%a deduction -for' pension from this lump sum payment nor will this amount count' as earnings in the calculation of the pension. The last day of work will be' the termination date. and pension benefits will begin the following day. .OPTION 42: Employe:, can extend termination date by the time due (Only . available to for vacation, holiday pay, and 1/2 of accrued sick leave, employees hired Termination date %vill be the 'final clay of 'exteaded time. prior ' to 10/1/88) Pension benefits will begirt the following day. .•rx klrxs. .,xas +r xulxrx li t.4 T[xwr rw+. I. Van A. Horton an emolovee ` Of the City of Clearwater, hereby aap!y for pension benefits under the General Employees' Pension Plan. I hereby certify that I fully understand the two options offered to me. I choose to retire using Option ;t ? and wish my benefits to be calculated under this option. I understand that once this form is signed, my decision Li-revocable. EMPLOYEE'S SIGNATURE: SOCIAL SECURITY t: 364-58-5111 1917 Wood Haven Street Tarpon Springs, FL 34689 DATE: - June 20, 1994 t '- • gL61 ? ? li 1 'gAMUER -_---- --------__` DIVt510NMICAOFILM /' p FOR CARRIER'S DATE STAMP FLORIDA DEPARTMENT OF LABOR AND EMPLOYMENT SECURITY I REC'b BY CAR»IER SENT TO DIVISION DIVISION OF WORKERS' COMPENSATION 11.800-342.1741 (or) contact your local office for assistance t NOTICE OF INJURY Report all deaths within 24 hours (904) 48a-3044. RAP( nV9=0 Ik 9:nRkAATfntJ NAME (First, Middle, Last) r Social Security Number Dale and Time of Accident Vin 11ortau 346-48-5111 1/6/94 2.10111 hrs. EAALUFENS DESCRIPTION OF ACCIpt:NT 610 Franklin St. Cl earwater I'L 3616 t ...Chast pai11 (at ltaaa) , . , 462-63OU T LEPH N r 813 c AESCAISE NJURY. oA DISEASE AND INDICATE PART p AODY AF ECTEO m~ +.. oo. ht Index fin er at second loin( eic : (e Am utation of ti havturad ribs load oisonin ) OCCUPATI N 77(A Fireligltter g g .g. p , , p g, . :rhesC >ain DATE F BIFII SEX ; DID YOU REQUEST MEDICAL CARE? ? YES ? NO 4/19/48 t .UM 'OF IF YES, DID EMPLOYER PROVIDE MEDICAL? 0 YES ? Np FRAPt nYFR INFORMATION. . I FIRM'S NAME AND ADDRESS -? FEDERAL I.D. 14LIMSER DATE AND TIME FIRST REPORTED City of Clearwater, Dept. 12ZO ? ab-60ouu n} - 11 F. U. Box 4746 ?W.C.COVERAGE BY POLICVMEMBER NUMBER Clearwater, 1;L 34615 'QINSURANCECO. 0SELF•tNSURED ? NAME, ADDRESS, TELEPHONE OF OR SERVICE COMPANY INSURANCE CO WILL YOU CONTINUE TO PAY TELEPHONE }? L I =in- 75tS . SALARY? ? YES ? NO ,«,,,., N.. coo. Inc Johns Eastern Company PLACE OF ACCIDENT (Street, City, County. Staley . , Post Office Box 3318 LAST DAY PAID THROUGH Employee Is Houle Sarasota, FL 34230 1 1 I - 800 - 749-3044 _ RATE OF PAY ? HR © WK ' NAME, ADDRESS AND TELEPHONE OF PHYSICIAN OR HOSPITAL ) !49 2 • DAY ? Fd0 ? b f u N DID THE EMPLOYEE KNOWINGLY REFUSE TO USE A SAFETY I{e{ i:ll El l is ttE:'Iq. Hosp f tai um er o h oo s Number a1 hours 56 APPLIANCE PROVIDED eY YpU, THE EMPLOYER? 0 YES C3 NO Tarpon Springs, }:L Numbeoat d DATE EMPLOYED LAST DATE EMPLOYEE WORKED ays per week 6/2p/,/8 1 / 5 /19 4 / - . PAID FOR DATE OF INJURY RETURNED TO WORK ? YES CKNO AUTHORIZED BY EMPLOYER ? YES -ONO YES I T NO 0 IF YES, GIVE DATE 1 I LOCATION ADDRESS WAS INJURY FATAL? (3 YES ? ? IF YES, GIVE DATE OF DEATH r r f=ATION M IF APPLICABLE) AGREE WITH DESCRIPTION OF ACCIDENT? NATURE OF BUSINESS ? YES Cr-NC-) IF NO ATTACH EXPLANATION Any person who, knowingly and with Intent to injure, defraud or deceive any -improyer or employee, insurance company or selr,lnsured prograrn. Illes any statement of claim containing any lalsa or misleading lnformaWn is guilty of a felony of the third degreo. I have provided tye employee their copy of this notice: r Ip Person O Hy.maq- - •. NOT AVAILABLE FOR SIGNATURE EMPLOYEE SIGNATURE tit mitable to sgni DATE i EMPLOYER StONArURE DATE ?.?+nrlt?n tlvrtilnmHtl?.1rY i Carrier Audit 4 Location # Service Co. Carrier File 0 ? 1, Controverting Case--DWC•112, NOTICE OF OENIAL•ATTACrED ? 2. Lost Time Case--Date of First Payment I 1 AWN( -- Comp Rate First day of disability --Date of First Contact with Claimant f ' ? In Person ? Telephone 0 Mail -Notice Filed Due to Multiple Periods of Oidability. Dates Covered by First Payment F d T.T.D. ? T.f? D. Date Form Rec'd. I__r __! . r ? Catastrophic ? P.T D, ? Death ? 3. Medical Only which became a Lost Time Case. (Complete all information in item 2 above) REMARKS: ' i ADJUSTER NAME: i CARRIER NAME, ADDRESS b TELEPHONE. DATE. f f ADJUSTER SIGNATURE: Form.DWC-1 111911 1-.E1??U, f 14f1Ud JNU9V•Y1J1 Jlllif: AUV ' (813) 586.0021 Palm Harbor, Florida 34684 j ° FAX 1813) 581.0386 ' (813) 789.0021 Donald R. Eubanks. M,D, Douglas' J. Spriggs, M.D. Michael D. Williamson. M.D, Vanessa J, Lucarella, M.D. Paul L. Phillips, M.D. Bernardo Stein, M,D. Jose L. Gallastegul, M.D. Jorge P. Navas, M,D. May. 6, 1994 TO WHOM IT MAY CONCERN: Re: Mr. Van A. Horton .On 1-6-9h, Mr. Horton sustained an acute inferior wall. myocardial infarction. On 1-13--94, an attempted percutaneous 'transluminal coronary angioplasty was unsuccessful because of the segment of the artery involved with the obstruction and the recurrent formation of clots at'the site of the dilatation.' He had an urgent coronary artery revascularization procedure performed with saphenous'vein 'bypass to. the right posterior descending-coronary artery and the first obtuse marginal branch. Since that time, he has completed cardiac rehabilitation. He does not have any angina. He tires somewhat easier than usual and recent exercise thallium scintigra- phy revealed evidence of previous inferior wall myocardial infarction, as evidence by scar. It also showed some area around the infarction that developed evidence of lack of blood flow-with exercise. I consider Mr. Horton to be permanently unemployable and unable to perform rigorous and stressful functions demanded by being employed as a fire fighter. Enclosed are some records for your perusal, including a resting electrocardiogram, thallium stress test report, catheterization report of 1-13-94 and the operative note. sincerely, Donald R. Eubanks, M.D. DRE/ldr Enclosures INTERVENTIONAL CARDIOVASCULAR CONSULTANTS NEW PATIENT EVALUATION NAME : r HORTON, VAN SOCIAL SECURITY NUMBER: 364-48-5111 ,DATE: June 6, 1994 REFERRING PHYSICIAN: Donald R. Eubanks, M.D. REASON FOR CONSULTATION: Second opinion regarding disability. HISTORY OF PRESENT ILLNESS:' The patient is a 45-year-old male who works as a fire fighter. He has a history of atherosclerotic cardiovascular disease. His cardiac history dates back to 1993, when he developed symptoms of probable exertional angina following his rehabilitation for knee surgery. On January 6, 1994, he was admitted to Helen Ellis Hospital with an acute inferior myocardial infarction. He was treated with TPA. He underwent cardiac catheterization on January 10th, which showed critical stenosis of the right coronary artery and approximately 85% stenosis of the circumflex coronary artery. ' He was transferred to Morton Plant Hospital, where'angiopl.asty of the right coronary artery was attempted, unsuccessfully. He underwent an emergency coronary artery bypass. Vein grafts were placed on the posterior descending branch of the right coronary artery and to the first obtuse marginal branch of the circumflex. Postoperatively, he has been fairly stable. He has completed a cardiac rehabilitation program. He has not experienced recurrence of angina. At the present time he is able to perform his usual, activities; however, according.to his records he is unable to perform rigorous and stressful functions. He has no history of congestive heart failure or cardiac arrhythmias. PAST MEDICAL HISTORY: Myocardial infarction in January 1994. Kidney stones since 1992, treated with l.itotripsy. He. has arthritis of the knee. CURRENT MEDICATIONS: Aspirin, Seldane, vitamins. ALLERGIES: Denied. SOCIAL HISTORY: He quit smoking 12 years ago. He drinks alcohol socially. FAMILY HISTORY: Mother is 75 and alive. Father is 80 and alive. CORONARY RISK FACTORS: Borderline hypertension, hyperlipidemia, cholesterol has been'described in the range of 260. Remote smoking history. Continued... ;, t'!':• 'y ;.'1.' '?Fa ?' ..,.. ilia'. '. .. NV•,.. .. a .v .. - .. ' • ... Page -2- I HORTON, VAN ; ' PHYSICAL'EXAMINATION: GENERAL: Pleasant male-in no acute distress. 'VITAL SIGNS: Heart rate is 74:• Blood pressure is.138/94. !:. WEIGHT: 206 pounds, HEENT: Pupils are equal, round and reactive. Neck is supple. No? jugular venous distention. No carotid bruits. LUNGS: Clear to auscultation and percussion. HEART. -EXAMINATION: PMI 5th intercostal space, midclavicular line. Normal heart sounds; no murmurs or gallops. ABDOMEN: Soft and nontender. EXTREMITIES: No edema and normal healing of the surgical' scars. IMPRESSION: 1. Coronary artery disease, severer status post myocardial, :• infarction in January 1994. 2. Status post double coronary artery bypass surgery. 3. Borderline hypertension., 4. Hyperlipidemia. RECOMMENDATIONS: Mr. Horton is a 45-year-old male who suffered a recent.inferior myocardial infarction. He underwent a successful double coronary artery bypass. He has multiple risk factors'for coronary artery disease. I consider Mr. Horton a good candidate for permanent disability. His current employment as a fire fighter and the physical and stressful functions demanded by this employment would most likely have a negative effect'on his long term cardiovascular status. RICHARD SOLA, M.D., F.A.C. . RS:DT:ec. CC,. Mr. Horton Donald R. Eubanks, M.D. 1 '?r "k 1, . : w:a:.r •.: f. ?•: 'n i., , ? ., +. v.' r51+-?, .????.?• •rti ?'S'. .4 -!f ?'',' '.? T • .. d.•'r. .?. . ., ,, •. .? V .N. •rr ..'k l::.fi d.c. .. ... '?LwA. •f ..rr it .?: ..t ! .!i%.+«. a. .a.til ?t•n,, .?.•_a„S.A.".i...:f ,...v.•.,, .. .: .: ... ... . • ... YrMTlk/ , `i. MORTON PLANT HOSPITAL ? CLEARWATER, FL Date of Admission: 01 • ? } , Cl`7 CHIEF COMPLAINT:, Chest pain. HISTORY OF PRESENT ILLNESS: Mr. Horton is.a 45 year old male, who states that for the last several years he has noticed some chest pressure with radiation to the neck that usually occurred with exertion and. was relieved promptly by rest. After a Thallium t Scintigraphy prior to knee arthroscopy two years ago was reported to be normal. After rehab from his knee operation he would intermittently notice the heaviness in the chest. This had become somewhat accentuated a month ago and on approximately the 4th of January, after working out,, basketball., and exercising with his children, he noticed severe retrosternal chest pain, associated with diaphoresis and was seen in the Emergency Room at Tarpon Springs: Hospital.. Electrocardiogram revealed acute inferior wall myocardial infarction for which he received TPA. By one our after TPA was ' started the pain was alleviated. It recurred the morning of the 7th and was relieved promptly by Nitroglycerin. He has not had any pain since. Recent cardiac catheterization 1/10/94 was performed,- which revealed a long lesion in the right coronary artery in about an 8551, circumflex vessel.. There was also inferior lateral wall- contraction... abnormality at the time of left ventricular cineangiography and the right coronary artery was felt to be the culprit artery. Less occlusive disease was noticed in the left anterior descending, clear { artery and the patient is referred for consideration of PTCA. He denies any other cardiovascular symptoms. CORONARY ARTERY DISEASE RISK FACTORS: Include borderline hypertension. Cholesterol value of 260 which has gone to 240. Remote cigarette smoking, eleven years ago. FAMILY HISTORY; Signi`icant in father who is 80 years old and had aortocoronary bypass graft at age 62 and has done well. Mother is 72 and had bypass surgery done two years ago and also has blocked carotid artery. One living brother has hypertension and diabetes. PAST MEDICAL HISTORY: Significant in the patient's past history is history of renal disease, manifested, by renal calculi, requiring lithotripsy and at that time, apparently some abnormal kidney function was noted. Prior to catheterization at Helen Ellis, the creatinine was 1.9. He is now being tested to see what influence the dye might have had on that creatinine.level, Other than the previously mentioned arthroscopy of Efier knee the patient denies any other abnormalities. The only medication prior to entering the hospital included Clinoril. CONTINUED.... HISTORY AND PHYSICAL HORTON, VAN A. 376326 1 Page 1 EUBANKS PRIuINAL ,.?f ) G1 y ra...??r.iwY:wZ1?..?sYN.:?i"?..[..a. R.:?l L•R. a.=+•_ _ ?. ?.i,.:r.?: r F.i?.::.;.ilf:J?J.ati.i•?.?•S ..?Man...?.=a..a .. ... ...... P . ..a?... ?..+....? . ' ,. • It _ Tt ' MORTON PLANT HOSPITAL CLEARWATER,. FL I' CARDIOVASCULAR PHYSICAL'EXAMINATION: BLOOD PRESSURE : . Reveals a blood pressure of 124/70 HEART RATE 70. GENERAL: Well nourished, well developed white male. HEENT: Within normal limits. LUNGS: Clear to auscultation. HEART: Unremarkable.' .-ABDOMEN: Exam does not reveal any organomegaly. RECTAL,.GENITALIA: Not done. ORTHOPAEDIC AND UROLOGICAL:' Intact. Peripheral pulses are present. Electrocardiogram reveals inferior infarction of a transmural nature.. `Chest-x-ray reported did not show any cardiomegaly or pulmonary venous hypertension. IMPRESSION: 1. Atherosclerotic coronary heart disease. Recent acute inferior wall myocardial infarction. Recent TPA administration with residual high-grade right coronary. artery and circumflex lesion. 2. History of renal lithiasis and history of renal insufficiency. .3. Hypercholesterolemia. pLA?F; 1. Re-check creatinine'and once acceptable would proceed"with PTCA of the right coronary artery and will not do circ until a few weeks later, since it is my belief the circumflex is in the artery, remote from recent necrosis. I discussed these orations with the patient, his wife, and mother and father, and he agrees to proceed. DONALD R. EUBANKS, M.D. .DRE;PI5:MTI D: 01/;1/94 T:01/11/94 2 HISTORY AND.PHYSICAL .PAGE 2 ORIGINAL 6W. HORTON, VAN A. 376326 i • [ .?y _?;??1 t', ?'??; ?.. ?,a`? .?» 1 .ii..Vr?I1':a?ia? . ?'. _. 1wf .{; .•`,.r, ..a ?: :r?7hLjf,.X +y.r...r?.J.., ...r?•,?'?S•h.r.'? .. ... ..'.??. ..'.?.. V.. '1„ ?. t':,?;.AM r.,iJwa..• . LU.w .,aw,r ?...... 1. ,.4 wJ+,..y.•L..n.•i.- i ' MORTON PLANT HOSPITAL CLEARWATER, FLORIDA Date of Admission: 01/11/94 Date of Discharge: .01/18/94 HISTORY OF PRESENT ILLNESS: This is a 45 year-old white male with a history of arteriosclerotic heart disease and who has sustained a .recent myocardial infarction approximately`five days ago. The patient was treated with tissue plasminogen activator'. He is also known to have mild renal insufficiency. He was admitted to Helen Ellis Memorial Hospital following his interior wall myocardial infarction and treated with tissue plasminogen activator. A cardiac catheterization was performed at Helen Ellis Memorial Hospital on January 10th. This revealed a long 95 percent occlusion of the right coronary artery and an 85 percent occlusion of the circumflex artery. There'was no significant disease in the left anterior descending coronary artery. After stabilization the patient was transferred to Morton Plant Hospital for repeat cardiac catheterization and possible percutaneous transluminal coronary angioplasty. HOSPITAL tOURSE: However, upon his transfer to Morton Plant Hospital it was noted that his creatinine was beginning to elevate. He was followed over the next 48 hours until. his creat-_i.nine returned to baselin: . Consultation from Cardiac Surgical Associates was obtained for purpose of back-up for possible angioplasty. The patient ac-'reed to this and was subsequently prepped and taken to the cardiac catheterization lab on January 13th where an attempted angioplast f of the right coronary artery was performed. Initially, the artery dilated;" however, it pre-occluded, and repeat attempts at 'an angioplasty were unsuccessful... He was tlier_efore transferred to the operating room where an emergency coronary artery bypass k2 was performed by J. Crayton Pruitt Jr., M.D.. At the time of surgery the heart and aorta appeared co be normal and the vessels that were bypassed were the right posterior descending coronary artery and first obtuse marginal circumflex artery. Both bypasses were performed with single reverse saphenous vein grafts. The total cardiopulmonary bypass time was,40 minutes and the aortas cross clamp time was 28 minutes. The systemic temperature was cooled to 35 degrees Centigrade. Cardiac arrest: was obtained with the use of Plegisol. The patient tolerated the procedure well and was released from the operating room. Postoperatively, he was awake, alert-and extubated by the first postoperative day and transferred to-the telemetry floor. An CONTINUED... DISCHARGE SUMMARY HORTON, VAN 376326 Page 1 ORIGINAL L. ' `_ i.l,:. i':.?°.; 4:,. ,.? < X1.3 I:'1 ., ?'i?r 3.r i?•. ?: o ' ? '? I?`a•.?,1 ,.??i?."?..:?;c.iMti.L•?Y'.????,L..::`:1.rur5.?.x?..u.:-:?.e?:::....MC,..?a'.'i.."r:','vs:? .`."?`'?"+ t%5}71F.???1 :Y.:tiw2t?.A.Sth`.TJr??:.'';?'fr?ler?.".?:. -;7::x5a ?i'.:+'+ t!'te?z ?XlctiyYt?' 7,:'111 ?[eirlill 24ORTON PLANT CLEARWATER, -HOSPITAL FLORIDA electrocardiogram on the 'first postoperative day revealed changes consistent with an inferior wall. myocardial infarction, and evidence of pericarditis. The creatinine was followed closely and peaked at 3.0..'He had no arrhythmias. The creatinine gradually returned to baseline and he was subsequently able to be discharged to his home on the Sth postoperative day. At the time ofdischarge the pulse was 92, blood pressure was-I20/76. Lungs:clear to percussion and auscultation. The heart revealed a regular rate and rhythm with no gallops, rubs or murmurs noted. The peripheral pulses were 2 plus bilaterally. The abdominal examination was negative. His incisions 'were healing well. LABORATORY DATA: The preoperative electrocardiogram revealed •a ` normal sinus rhythm with rate of-61, changes consistent with an ,inferior infarction with posterior distention of-indeterminate age. The postoperative electrocardiogram revealed a ,normal sinus rhythm with rate of 85 and changes consistent with an inferior in and T-wave changes consistent with a lateral wall ischemia. 'At the time.o,f discharge' the hematocrit was 29.8; hemoglobin 9.9; potassium CONSULTATIONS:. Cardiac, Surgical Associates COMPLICATIONS: Failed angioplasty. PROCEDURES PERFORMED: 1. Cardiac catheterization and attempted but failed percutaneous transluminal. coronary angioplasty of the right coronary artery. 2. Emergency coronary artery bypass X2. DIET: Regular diet with no added salt. ACTIVITIES: Up ad-lib with no lifting and no driving. DISCHARGE MEDICATIONS: Aspirin grains 5 qd; Nu-Iron 150mg qd; Clinoril 1 bid; and Lortab 5mg 1-2 tabs q4-6 hours prn for pain. FOLLOWUP: In followup, this patient will be seen by Cardiac 'Surgical Associates in approximately nine days for skin clip removal, and by Donald R. Eubanks,,M.D'. or Vanessa J. Lucarell.a, M.D. in approximately two weeks. CONDITION ON DISCHARGE: The prognosis is good for full and Lrr CONTINUED... DISCHARGE SUMMARY Page 2 ORIGINAL HORTON, VAN 376326 r0..?.r- JCP,: P23 : MTI D': 01/18/94 T:01/18/94- 1 DISCHARGE SUMMARY Page 3 ORIGINAL HORTON, VAN 37.632& _;Yii?t..;?`1y''. f'. , :?t?.1 ? , ? ?` i"'4.•9?? ;`iF r?'. S! •'>; `' 1. .,. , . , - .. . .... • MORTON PLANT' HOSPITAL t CLEARWATER,. FLORIDA DATE OF OPEIkATION : 01/14/9.4 PREOPERATIVE DIAGNOSIS: Failed percutaneous transluminal coronary angioplasty. POSTOPERATIVE DIAGNOSIS: Failed percutaneous transluminal coronary angioplasty. OPERATIVE PROCEDURE:' Emergency.coronary artery bypass,, rafts times two placing saphenous vein from the aorta to the posterior' descending coronary artery and saphenous vein from the aorta to the obtuse marginal branch of the circumflex. SURGEON: J. Crayton Pruitt, Jr, M.D. ASSISTANT: Brian Whittie, P.A. ANESTHESIA: General. OPERATIVE FINDINGS: Fair to good quality saphenous vein. The posterior-descending coronary artery had moderate distal disease. The obtuse marginal branch of-the circumflex had mild distal disease., The patient came off cardiopulmonary bypass with ease using low dose LevoPhed and Regitine., CLINICAL-PROFILE: Mr. Horton is a 45--year-old gentleman who recently suffered an inferior wall myocardial infarction which was.treated with tissue•plasminogen activator approximately five days ago. He also has a history cif mild renal insufficiency prior to a catheterization at Helen Ellis Memorial Hospital.' He was transferred here after catheterization for percutaneous transluminal coronary angioplasty of his right coronary artery but also was noted to have a high grade stenosis of an obtuse marginal branch. Catheterization had demonstrated inferior posterolateral hypokinesis. During attempted percutaneous transluminal coronary angioplasty, the right coronary artery could be opened but would close within ten minutes after each inflation. Therefore, because of the fact that he ,was developing pain with the artery closed and because of the fact that they.were unable to keep the vessel open, he was recommended to undergo urgent coronary artery bypass graft. CONTINUED... OPERATIVE REPORT HORTON, VAN 376326• Page 1• EUBANKS COPY 1 . M ,, MORTON PLANT 'HOSPITAL CLEARWATER, FLORIDA' DESCRIPTION OF OPERATION': The patient-was taken to the Operating Room and placed supine open the operating table. A radial 'artery line, Swan-Ganz catheter, and-Foley catheter were placed. The patient was given a general anesthetic. He remained reasonably hemodynamically stable with a blood pressure'of approximately 90 systolic although right before draping, he developed a nodal-rhythm and pressure dropped-into the low 80Is. Median sternotomy was performed and.saphenous vein was harvested from the lower extremities. He was systemically Heparinized. He was placed on cardiopulmonary bypass with an ascending aortic and right atrial cannul•a and systemically cooled to approximately 32 degrees. 'When the heart fibrillated, a left ventricular vent was introduced through the right superior pulmonary vein. A Gundry retrograde coronary sinus catheter was introduced for cardioplegia administration. With the vented fibrillating heart, we dissected out our grafting sites noted above. We then cross clamped the aorta and administered antegrade followed by retrograde crystalloid cardioplegia, A phrenic nerve protection pad was placed beneath the heart and topical ice cold solution applied to the surface of the heart. Diastolic arrest was obtained. We then proceeded to.sew the end of the saphenous vein to'the side of the posterior descending coronary artery and then began rewarming as we started the saphenous vein anastomosis to the obtuse marginal branch of the circumflex. Running 7-0 Prolene was used for each'and each was marked with a small metal ring marker at the proximal site of the ascending aorta. Once rewarming was complete and the cross clamp was released, we established flow through the vein grafts. The patient was then weaned from cardiopulmonary bypass after resumption of ventilation and removal of the vent and Gundry. He came off bypass reasonably well using low dose bevoPhed and Regitine. Protamine was administered. Temporary pacing wires were left in the right atrium and right ventricle and sternum was closed over two chest tubes using eight sternal wires followed by closure of the presternal fascia, subcutaneous tissue, and skin with absorbable suture. Sterile dressing was applied and the patient was taken from the Operating Room having tolerated the procedure well. J. CRAYTON PRUITT JR., M.D. CC: DR. EUBANKS JCP:P12:MTI' D: 01/14/94 T:01/14/94 2 OPERATIVE REPORT Page 2 COPY HORTON, VAN 376326 EUBANKS