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Old 03-05-2013, 00:47   #201
robrides85
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Media s**** it up again:

"The staffer was identified today as a resident services director, not a nurse as previously reported."

Given that a contract was signed where there was no expectation of CPR, seems possible that there wasn't anyone present who knew CPR - sounds like a bare minimum facility anyway - pretty much an apartment complex.

Any lawyers that understand the Good Samaritan law, speak up. Wikipedia makes it sound as if it applies only if you have no financial reward from the exchange of medical services.

If this is the case, then the facility would have to certify their employees in order to obtain decent insurance (charging their residents more) in order to "serve" CPR in their contract with residents. So the easier way out is to make it clear that they are not taking money in exchange for the possibility of future CPR from anyone employeed by the "apartment complex", freeing the facility from liability.

Therefore, the resident director probably could have given CPR without having to worry about being sued (covered by Good Samaritan because she wasn't under contract to give medical services), but the policy against it may also have had good reason to exist - the people living there may not have been able to afford to live there if the facility had to pay extra, and therefore charge extra to cover the insurance for a CPR that went bad enough that someone wanted to sue (and since a more than ample majority of CPR don't do any good, that may be an expensive insurance bill).

Anyway, not a lawyer, so if you are, cut in.

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Old 03-05-2013, 05:52   #202
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A resident services director "could" be a nurse, but I really doubt they'd pay nurse's wages when they could get a non-nurse for less.


"SURELY there is a law SOMEWHERE that says that a reasonable person is required to TRY to render medical assistance, regardless of policies."

According to ABC News the state of Vermont is the only state with a law that requires a person to help.
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Old 03-05-2013, 05:56   #203
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Originally Posted by JohnBT View Post
A resident services director "could" be a nurse, but I really doubt they'd pay nurse's wages when they could get a non-nurse for less.


"SURELY there is a law SOMEWHERE that says that a reasonable person is required to TRY to render medical assistance, regardless of policies."

According to ABC News the state of Vermont is the only state with a law that requires a person to help.
That was the first thing that came to mind, the Seinfeld finale.
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Old 03-05-2013, 05:56   #204
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"The staffer was identified today as a resident services director, not a nurse as previously reported." - ABC News

I was wrong, it appears she wasn't a certified nursing assistant with 6 weeks of training.
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Old 03-05-2013, 06:04   #205
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Welcome to the future of Obamacare, when some pencil-pushing clerk will determine the financial value of an older person's life, and the parable of the Good Samaritan is no longer taught.

Just don't call them death panels or the media will mock you.

"Follow the money."-Deep Throat, 1973
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Old 03-05-2013, 07:27   #206
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That was the first thing that came to mind, the Seinfeld finale.
Should we need a law to do what is just the right thing . The answer is No if you don't want to help me because it's the right thing to do I don't want your help any way.

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Old 03-05-2013, 07:36   #207
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Should we need a law to do what is just the right thing . The answer is No if you don't want to help me because it's the right thing to do I don't want your help any way.

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Doing the right thing involves paying for the services that one wishes to receive. The decedent did not pay for medical services, so she received none.
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Old 03-05-2013, 07:45   #208
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Doing the right thing involves paying for the services that one wishes to receive. The decedent did not pay for medical services, so she received none.
But that's not what I'm talking about.
You cannot pass a law and expect someone to be a good Samaritan if they don't have it in their DNA
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Old 03-05-2013, 07:46   #209
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Doing the right thing involves paying for the services that one wishes to receive. The decedent did not pay for medical services, so she received none.
Just like Obamacare, if she's too old to work and pay the taxes, she's too old to receive services or even food.


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Old 03-05-2013, 07:57   #210
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Just my 2 cents reading through this thread -

1) If we accept as true that she was indeed in a legally defined independent living facility and had signed contract acknowledging no available medical assistance, then those bystanders, regardless whether or not they are nurses, have no legal duty to act beyond calling 911. Do they have a moral duty to act? Probably. However, we can't legally punish someone for not following moral duty absence of legal obligations.

2) If it was indeed an independent living dining hall, those bystanders are probably not nurses to begin with.

3) The DA running around threatening to criminally charge everyone in the facility is just stupid. It just reminds me that many DA's are first and foremost scumbag lawyers out for fame and book deals.

To OlliesRevenge -
4) Seattles' EMS out-of-hospital witnessed VF save rates are impressive. However, "witnessed VF" is very likely a very small percentage of overall cardiac arrests. Witnessed VF implies the initial collapse was witnessed, so the "down time" is very short, and Seattle seems to have a very robust first reponders protocol. One thing you learn about interpreting data is, you need to stratify (break down) groups to minimize confounders. Age, gender, down time, underlying events (VF from choking on chicken vs VF from massive anterior wall MI are very, very different) are just some of the things you need to stratify in order to bolster credibility of your data.

5) ER calling fire department for intubation. This is a legal disaster waiting to happen. A Level 1 trauma center means they have anesthesiologist in-house 24/7. And ER doc's should really be trained in fiberoptic video-assisted intubation, and be ready to emergently surgically trach someone if necessary. A third year ER resident should be able to do these things, much less a board certified ER doc. Having medic's intubate in the ER opens up a whole bag of worms in the accreditation process. Are all fire department medics properly credentialled by the hospital's medical staff credentialling committee? Approved by the hospital's malpractice carriers? Otherwise, the Joint Commission will have a field day and may shut down the ER if they find out that fire department medics are doing intubations in the ER.

To Slathrum -
6) Out in the rural area where you are the only choice, I am sure you are a Godsend to those that need emergent medical assistance. However, to go on and say that anyone less than a trauma surgeon in a Level I trauma center is providing inferior or redundent care to you is arrogant and stupid. I can assure you that our second year ER resident can provide more and better care than you in a rudimentary ER with basic medical equipments. You simply do not have the training of an ER physician. You are limited to ACLS or PHTLS, neither of which are definitive care.
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Old 03-05-2013, 10:25   #211
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They are, however, medical professionals who denied basic lifesaving care to someone.
Either they had a duty to act or they did not have a duty to act. The duty to act for employees of a facility is spelled out in their employment contract and by their supervisors direction. They are not required to act outside of how their employers define their duties.

I am a first responder. I have training and equipment and volunteer to help people in need and once I start treating someone then I have both a legal and moral obligation to not abandon them. However my training and equipment does not make me responsible for every person I happen to come across in my daily life.

Would I have given that woman CPR, absolutely. However I would have been under no obligation to do so.

What ticks me off is that the facility didn't have an AED available. You don't have to really have any training to use one and all CPR is for is to buy time for an AED to get there.
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Old 03-05-2013, 11:16   #212
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Originally Posted by PicardMD View Post
Just my 2 cents reading through this thread -

To Slathrum -
6) Out in the rural area where you are the only choice, I am sure you are a Godsend to those that need emergent medical assistance. However, to go on and say that anyone less than a trauma surgeon in a Level I trauma center is providing inferior or redundent care to you is arrogant and stupid. I can assure you that our second year ER resident can provide more and better care than you in a rudimentary ER with basic medical equipments. You simply do not have the training of an ER physician. You are limited to ACLS or PHTLS, neither of which are definitive care.
You are taking what I've said out of context. In the case of a cardiac arrest, there really is no benefit to transporting to an ER. Dead is dead, and you and I both know that all that will continue upon arrival is a continuation of ACLS, with the exception of a very limited amount of specific situations, like drowning and hypothermia-related arrests.

The fact that in EMS we hone in on this one skill and scenario cannot be ignored. To do so based on a title, is arrogant and stupid too. You are correct, I am not a physician and do not intend to fancy myself one. For the living, the ER is without a doubt the place to be. For the dead, no. That was the context of my statement.
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Old 03-05-2013, 11:22   #213
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You are taking what I've said out of context. In the case of a cardiac arrest, there really is no benefit to transporting to an ER. Dead is dead, and you and I both know that all that will continue upon arrival is a continuation of ACLS, with the exception of a very limited amount of specific situations, like drowning and hypothermia-related arrests.

The fact that in EMS we hone in on this one skill and scenario cannot be ignored. To do so based on a title, is arrogant and stupid too. You are correct, I am not a physician and do not intend to fancy myself one. For the living, the ER is without a doubt the place to be. For the dead, no. That was the context of my statement.
Been in the business for 30 years as a Cop we call it the PR run.
I remember the days when resuce would roll to the scene and if it was a "found dead"would run a strip and call it, NOW everyone seems to get worked, hell even some that are a little stiff take the ride.
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Old 03-05-2013, 11:48   #214
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You are taking what I've said out of context. In the case of a cardiac arrest, there really is no benefit to transporting to an ER. Dead is dead, and you and I both know that all that will continue upon arrival is a continuation of ACLS, with the exception of a very limited amount of specific situations, like drowning and hypothermia-related arrests.

The fact that in EMS we hone in on this one skill and scenario cannot be ignored. To do so based on a title, is arrogant and stupid too. You are correct, I am not a physician and do not intend to fancy myself one. For the living, the ER is without a doubt the place to be. For the dead, no. That was the context of my statement.
If I have taken your statement out of context, then my bad.

However, my statement is not based on a title. It's based on training and education. Yes, some EMS is very good at following protocols. With enough practice, a high school graduate can be taught proficiency in ACLS. I can assure you an ER physician can do much more in cardiac arrests beyond ACLS.

You are right that EMS shouldn't transport the obviously dead - your decapitation, rigor, decomposed corpse you find in the back alley dumpster. However, in your fresh cardiac arrests, many jurisdictions have protocols to load and run and transport while you do CPR/ACLS in the bus. Why? Getting them to definitive care as quickly as possible improves survival. Plenty of patients arrive in our ER with CPR in progress, and some of them do survive -- not just your drowning or hypothermia. Last I looked, EMS cannot decompress a cardiac tamponade or flow a transvenous pacer in the field. And no, I don't need a trauma surgeon or Level I Trauma Center to do these. I expect a PGY-2 or PGY-3 EM resident in a typical ER to be able to do these.
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Old 03-05-2013, 12:49   #215
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If I have taken your statement out of context, then my bad.

However, my statement is not based on a title. It's based on training and education. Yes, some EMS is very good at following protocols. With enough practice, a high school graduate can be taught proficiency in ACLS. I can assure you an ER physician can do much more in cardiac arrests beyond ACLS.

You are right that EMS shouldn't transport the obviously dead - your decapitation, rigor, decomposed corpse you find in the back alley dumpster. However, in your fresh cardiac arrests, many jurisdictions have protocols to load and run and transport while you do CPR/ACLS in the bus. Why? Getting them to definitive care as quickly as possible improves survival. Plenty of patients arrive in our ER with CPR in progress, and some of them do survive -- not just your drowning or hypothermia. Last I looked, EMS cannot decompress a cardiac tamponade or flow a transvenous pacer in the field. And no, I don't need a trauma surgeon or Level I Trauma Center to do these. I expect a PGY-2 or PGY-3 EM resident in a typical ER to be able to do these.
I don't think I was as specific as I should have been in the first place, so that's on me too. Anyway, I agree with you for the most part. In reality though, you have to be very close to an ER for these interventions to be of any realized benefit.

Honestly, when was the last time you decompressed a cardiac tamponade that was a trauma code that EMS brought in while in arrest and the patient survived? Have you ever? I don't doubt that some codes do survive that are transported. I'm pretty sure the numbers don't support the theory that taking the time to load a patient and go instead of continuing the code in place is beneficial.
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Old 03-05-2013, 13:11   #216
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"The duty to act for employees of a facility is spelled out in their employment contract and by their supervisors direction. They are not required to act outside of how their employers define their duties."

I just read another report on CNN that says the "nurse" really was a nurse (or had been at some point), but wasn't hired to be a nurse. She was employed as a residential services director.

I wonder if she'd even worked as a nurse in the past 10 or 20 years or had any recent training.
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Old 03-05-2013, 13:21   #217
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"The duty to act for employees of a facility is spelled out in their employment contract and by their supervisors direction. They are not required to act outside of how their employers define their duties."

I just read another report on CNN that says the "nurse" really was a nurse (or had been at some point), but wasn't hired to be a nurse. She was employed as a residential services director.

I wonder if she'd even worked as a nurse in the past 10 or 20 years or had any recent training.
Regardless of whether she was a nurse or not, the 911 Operator made it clear several times on the call that ANYONE could help and that she could walk them through what to do over the phone.

Not only did the Glenwood employee refuse to perform CPR herself, she refused to even hand the phone to anyone nearby that might have been willing to help. If you listen to the 911 call, there are a few minutes where the Operator is literally begging this woman to ask ANYONE to help, even a gardener or passerby outside.

The woman refuses to do so and when challenged on her lack of action by the 911 Operator she even states flat out that she intends to just watch the woman die.

I would challenge anyone on this thread who wishes to argue the morality of the Glenwood employee's actions to listen to the 911 tape first.
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Old 03-05-2013, 13:26   #218
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Regardless of whether she was a nurse or not, the 911 Operator made it clear several times on the call that ANYONE could help and that she could walk them through what to do over the phone.

Not only did the Glenwood employee refuse to perform CPR herself, she refused to even hand the phone to anyone nearby that might have been willing to help. If you listen to the 911 call, there are a few minutes where the Operator is literally begging this woman to ask ANYONE to help, even a gardener or passerby outside.

The woman refuses to do so and flat-out states that she intends to watch the patient die.
And I attribute this to she was more than likely told she would lose her job if she deviated from the plan, and she valued her job more than that ladies life.
A sad but true comment on the world we live in that has been ruined by attorneys and horrible court decisions.
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Old 03-05-2013, 13:32   #219
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And I attribute this to she was more than likely told she would lose her job if she deviated from the plan, and she valued her job more than that ladies life.
A sad but true comment on the world we live in that has been ruined by attorneys and horrible court decisions.
I can pretty well guarantee that Glenwood's contract contains no language stating that in addition to not offering medical assistance, their employees are required to actively block assistance from third parties by refusing to communicate the 911 Operators requests to anyone nearby.
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Old 03-05-2013, 13:34   #220
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"the 911 Operator made it clear several times on the call that ANYONE could help "

Could. The idea of teaching CPR over the phone during an undiagnosed emergency is exciting, but has its drawbacks. But like you said, could, not must.

A CA Supreme Court ruling in 2008 has opened a lot of eyes. Pull somebody from a car wreck and get sued by them even though there's a good samaritan law.

http://articles.latimes.com/2008/dec...od-samaritan19

"The divided high court appeared to signal that rescue efforts are the responsibility of trained professionals. It was also thought to be the first ruling by the court that someone who intervened in an accident in good faith could be sued."
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Old 03-05-2013, 13:39   #221
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"the 911 Operator made it clear several times on the call that ANYONE could help "

Could. The idea of teaching CPR over the phone during an undiagnosed emergency is exciting, but has its drawbacks. But like you said, could, not must.

A CA Supreme Court ruling in 2008 has opened a lot of eyes. Pull somebody from a car wreck and get sued by them even though there's a good samaritan law.

http://articles.latimes.com/2008/dec...od-samaritan19

"The divided high court appeared to signal that rescue efforts are the responsibility of trained professionals. It was also thought to be the first ruling by the court that someone who intervened in an accident in good faith could be sued."
I agree, but what irks me here is that the Glenwood employee took it upon herself to deny anyone nearby the opportunity to make a decision for themselves on whether they could try to help this woman. By refusing to pass on the 911 Operator's repeated requests to call out to anyone in the area so she could speak with them, this lady did much more than merely refuse to perform CPR.
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Old 03-05-2013, 13:55   #222
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I can pretty well guarantee that Glenwood's contract contains no language stating that in addition to not offering medical assistance, their employees are required to actively block assistance from third parties by refusing to communicate the 911 Operators requests to anyone nearby.
I stick by my observations.

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Old 03-05-2013, 15:35   #223
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I don't think I was as specific as I should have been in the first place, so that's on me too. Anyway, I agree with you for the most part. In reality though, you have to be very close to an ER for these interventions to be of any realized benefit.

Honestly, when was the last time you decompressed a cardiac tamponade that was a trauma code that EMS brought in while in arrest and the patient survived? Have you ever? I don't doubt that some codes do survive that are transported. I'm pretty sure the numbers don't support the theory that taking the time to load a patient and go instead of continuing the code in place is beneficial.
Yes, I agree that if you are out in the middle of nowhere and all you have is whatever you have in your bus, then there is probably not a whole lot of differences between a very well trained paramedic and an MD, with the advantage of MD not having to call medical control.

This is why I say the faster you can get someone into an ER, the better off it may be.

As for cardiac tamponade - it dependes. Blunt chest trauma with cardiac tamponade, they are good as dead. Thoracotomy in a blunt chest trauma that has arrested is almost always useless.

Penetrating trauma, on the other hand, is survivable. I've personally done it in residency while moonlighting in the ER (don't do ER work nowadays) - did a thoracotomy, decompressed a tamponde, while the thoracic surgeon was gowning up. Guy brought in by EMS in full arrest - walked out of the hospital a month later.

Non-traumatic cardiac tamponade in full arrest - usually in PEA - saved quite a few of those through the years by doing bedside pericardiocentesis. No, they are not common, but they are survivable.
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Old 03-05-2013, 15:49   #224
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I would challenge anyone on this thread who wishes to argue the morality of the Glenwood employee's actions to listen to the 911 tape first.
I don't think anyone will argue the morality of the situation. However, we live in a legal world.

Something that haven't been brought up -

CPR, like it or not, is a medical procedure. In a medical facility, it requires a physician's order. This is usually done by a "standing order" in the facility by the medical director.

Healthcare workers employed by a medical facility - such as a nursing home like this one, cannot perform medical procedures without a physicians order. I am sure a standing order exists for their patients in their skilled and assisted living facilities. I am further confident that their senior residents (they are NOT patients) living in their independent living facility are NOT covered by their nursing home MD's standing order, because these residents are NOT patients of the nursing home's MD. They are simply living in an apartment attached to the nursing home. They do not have a "physician of record" in that facility. So, a healthcare worker cannot legally perform a medical procedure without a physician's order while on duty. They may risk their own license if they do.

Furthermore, I assume that the nursing home portion of this facility has a crash cart, and the standing order for cardiopulmonary arrest in their nursing facility go far beyond CPR. So, if the independent living area is to be covered by the nursing home's standing order, does it mean that they need to bring the crash cart to this lady and do the full ACLS resuscitation? There are also a whole bunch of other standing orders for other emergency situations for the nursing home portion of the facility - where do you draw the line as to what the independent living part should enjoy? It's a slippery slope for the facility to agree to ANY medical interventions for the independent living residents. Once you agree to ONE medical intervention such as CPR, you go down the slope of having to provide EVERY medical intervention available to the nursing home patients. Last I look, the independent living residents do not pay for any of these services. If they want these services, they should have signed up for the assisted living or skilled nursing part of the facility. This was made clear to them.

So while I agree that the morally decent thing to do is to attempt CPR. However, we cannot expect the workers to put their livelihood on the line when they have no legal duty to act. For the same reason, I will not touch a patient in an out-of-state hospital where I am not licensed to practice medicine or credentialled as a medical staff. My first duty is my livelihood to my family.
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Old 03-05-2013, 16:05   #225
PicardMD
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Join Date: Feb 2002
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Quote:
Originally Posted by tsmo1066 View Post
I agree, but what irks me here is that the Glenwood employee took it upon herself to deny anyone nearby the opportunity to make a decision for themselves on whether they could try to help this woman. By refusing to pass on the 911 Operator's repeated requests to call out to anyone in the area so she could speak with them, this lady did much more than merely refuse to perform CPR.
Problem is, we don't know the facility layout.
If they are deep inside the compound in their dining hall, I doubt they could find a "bystander" not working for them to help. Can't expect them to leave her and go out into the streets (and out of their compound) to yell for help. If this really happened in the dining hall, there are other senior residents around and the staff's responsibility to these residents well being (ie crowd control) must come first. Furthermore, their policy is to stay with the victim until help arrives.
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* Beverly Picard, MD * The SECOND sexiest lady doc I know... (my wife is THE sexiest lady doc I know :cool:, but she wouldn't let me use her name as my handle on a gun board... :supergrin: )
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Nov 11, 2013 at 11:42