Franklin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CR002735 0B649 - 036 IN THE COURT OF COMMON PLEAS, FRANKLIN COUNTY, OHIO CRIMINAL DIVISION STATE OF OHIO, Plaintiff, Case No. 19CR-2735 vs. Judge Michael J. Holbrook WILLIAM S. HUSEL, (Daubert Hearing Requested) Defendant. STATE'S MOTION IMONY OF GOURANG Now comes the State of Ohio, by and through undersigned counsel, and hereby moves to exclude the trial testimony of Defendant's expert witness, Mr. Gourang P. Patel, PharmD, M Sc., pursuant to Ohio Evid. R. 702. Asa pharmacist, Mr. Patel is not qualified to testify on the issue of causation generally, or cause of death specifically. He is also not draw life qualified to opine on dosing decisions or the deci 1g when to \n regar support. Mr. Patel has admitted these limitations under oath in prior testimony. Offering opinions outside of the area of one’s expertise is prohibited by Evid. R. 702(B). Mr. Patel’s limitations in this regard also make his opinions unreliable, in violation of Evid. R. 702(C) and Daubert v. Merrell Dow Pharma, Inc. 509 U.S. $79 (1993), as adopted by the Ohio Supreme Court. His testimony must therefore be excluded. Pursuant to Ohio Evid. R. 104(A), prior to allowing Mr. Patel to offer testimony to the jury, the Court must make a preliminary determination as to whether he is qualified to testify as an expert on this subject matter, and whether his opinions meet the requisite threshold of reliability. In Daubert, the United States Supreme Court declared that the trial court is to serve as the “gatekeeper” with regard to the admission of expert testimonyFranklin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CR002735 op649 - 037 Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579 (1993). This “gatekeeping” function is to ensure that “any scientific testimony or evidence admitted is not only relevant, but reliable.” Daubert, 509 U.S. at 589. The Ohio Supreme Court adopted this role for Ohio trial court judges in Miller v. Bike Athletic Co., 80 Ohio St. 3d 607 (1998). Trial courts do not have “discretion to abandon the gatekeeping function.” Jn re Meridia Prods. Liab. Litig., 328 F. Supp. 2d 791, 804 (ND Ohio, 2004) (quoting Kumho Tire Co., Ltd. v. Carmichael, 526 U.S. 137, 159 (1999) (Scalia, J., concurring) (emphasis added). As such, the State respectfully requests the Court conduct a Daubert hearing outside the presence of the jury prior to allowing Mr. Patel to be called as a witness in this matter. The State was unable to bring this motion in limine prior to the start of trial, as the Court permitted Defendant to provide the State with his expert witnesses’ names and reports after trial had already begun. This however, does not obviate the Court’s gatekeeping function under Evid. R. 104(A), 702(B), 702(C), and Daubert. I. Mr, Patel’s Background and Proffered Opinions Per Mr, Patel’s CV, attached as State’s Exhibit A, Mr. Patel received a B.S. in chemistry before attending pharmacy school and graduating with a Pharm. D. Mr. Patel also has a M.S. in clinical research. Since 2002, Mr. Patel has worked as a pharmacist in a clinical setting, He has also served as an associate professor. In Mr. Patel’s report, attached as State's Exhibit B, he states that he has “20 years of experience in the area of Pharmacy and Pharmacology.” Mr. Patel is not a medical doctor. His report provides no basis for what education or experiences qualify him to make cause of death determinations. It is also unclear what education and training he has in the field of pharmacology. Multiple courts have drawn aFranklin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CR002735 oB649 - 038 clear line between a pharmacist and a pharmacologist with regard to the scope of expert testimony. See, DeVito v. Smithkline Beecham Corp., (*{The expert's] insistence in holding himself out as a pharmacologist ... ignores at least one fundamental distinction between pharmacology and pharmacy ~ a distinetion which is critical here, ‘Pharmacology can be fairly described as the study of the effect of drugs on living organisms. Pharmacy, on the other hand, is the profession of preparing and dispensing drugs.” It is self-evident that there is a vast difference in the education, experience and skill necessary to obtain degrees in these two different fields.” (internal citations omitted)). See also, Dellinger v. Pfizer, Inc. W.D.N.C. No. 5:03CV95, 2006 U.S. Dist. LEXIS 96355 (July 19, 2006) (noting that the ‘expert was not a medical doctor and had a degree in pharmacy, not pharmacology, and therefore, was not qualified to render a relevant or reliable opinion on the issue of causation), In particular, the State objects to the following opinions set forth in Mr. Patel’s report (J) “It is my opinion that the withdraw (sic) of care is very time sensitive.” (2) “Unless otherwise directed by the family, the patient should be removed from life-support as soon as reasonably possible to avoid the possibility of further suffering or perishing on life-support against the wishes of the family.” (3) “The decision as to the appropriate dose of medication to be used on end-of-life care is based upon many clinical factors.” (4) “Reviewing these cases as a whole, it is clear the medication doses administered can be seen as not enough to cause death.” (5) “While each of the cases presents different medical nuances, it is apparent from an overall review of the cases that the comfort care medication did not lead to or cause the deaths of these patients.Franklin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CR002735 oB649 - 039 (6) “Thus, it is my opinion that the medications prescribed by Dr, Husel and administered by the Mount Carmel West ICU staff did not cause harm,” As a pharmacist, Mr. Patel is not qualified to opine on appropriate doses of medication for end-of-life care. He has admitted as much in a deposition in the related civil matter. Nor is Mr. Patel able to opine on the time-sensitive nature of the withdrawal of care. Because he is not a medical doctor, Mr. Patel has no say in the decision to withdraw a patient’s care Further, as a pharmacist, Mr. Patel is not qualified to opine on the issue of causation, particularly as it relates to cause of death. Again, the Court does not need to rely on the State’s word on this is sue—Mr. Patel has admitted this himself in depositions in the related civil matter.' As set forth fully below, Mr, Patel’s opinions do not satisfy the requirements found in Ohio Evid. R. 702(B) and 702(C). Law and Analysis Admissibility of expert opinion testimony is governed by Evid. R. 702. Evid. R. 702 requires that: (A) the witness's testimony relate to matters beyond the knowledge or experience of a layperson; (B) the witness have specialized knowledge, skill, experience, training, or education regarding the subject matter of the testimony; and (C) the witness’s testimony be based on reliable scientific, technical, or specialized information. Evid. R. 702. “[Thhe party offer ng a witness as an expert has the burden of establishing that the witness. is qualified to competently give such testimony.” Buroker v. Prati Indus., Inc., 10" Dist. Franklin No, 19AP-383, 2020-Ohio-2845, {] 34 (quoting Beattie v. McCoy, 10" Dist Franklin No. C-17019, 2018-Ohio-2535, $25 (citing Tully v. Mahoning Express Co., 161 The State notes that other courts have excluded Mr. Patel’s testimony where he has attempted to offer unreliable opinions on medical concepts outside the scope of his area of expertise. See, Hale v. Baver Corp., S.DIIIl No, 15-cv-00745-IPG-SCW, 2017 US, Dist. LEXIS 61077 (Apr. 20. 2017) 4Franklin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CR002735 oB649 - 040 Ohio St. 457 (1954), paragraph two of the syllabus, and Wright v. Hamilton, 141 Ohio app. 3d 296 (12 Dist. 2001))) (emphasis added) A. Mr, Patel is Not Qualified to Serve as an Expert in this Field as required by Evid. R. 702(b). As the initial part of the gatekeeper role, the Court must ensure that an expert’s testimony does not exceed the scope of the expert’s actual area of expertise. As such, Defendant must show Mr. Patel is “is qualified as an expert. .. regarding the subject matter of the testimony.” Evid, R, 702(B), Mr. Patel must be more than just “qualified in general.” He must be qualified as an expert with regard to each of the specific areas underlying the opinions he is offering, In cases dealing with medical issues, it has been made clear in Ohio courts, and courts across the country, that an expert witness’s testimony must be limited to the scope of practice and field of pra -e where that individual is actually an expert. See, e.g, RT v, Knobeloch, 10" Franklin No. 16AP-809, 2018-01 1596, {79 (trial court correctly prohibited a doctor specializing in anesthesia and pharmacology from opining on a child’s diagnosis of bipolar disorder, as the witness was “not a psychiatrist or pediatrician” and therefore “did not have the expertise required” to render an opinion on issues in that area), Hager v. Fairview Gen. Hosp., 8" Dist. Franklin No. 83266, 2004- Ohio-3959, (expert testimony on the cause of dental injuries was properly found to be “reserved to the practice of dentistry” and “outside the knowledge, skill, and expertise of a nurse”), Young v. Key Pharmaceuticals, Inc., 112 Wash.2d 216, 770 P.2d 182, 190 (1989) (a pharmacist was not qualified to testify as an expert because “[w]ith all due respect to the pharmaceutical profession, pharmacists are not doctors and are not licensed to prescribe medication because they lack the physician’s rigorous training in diagnosis and treatment”Franklin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CR002735 op649 - oat and said “lack of training might lead to error in a pharmacist’s assessment of proper treatment”). 1, Mr, Patel is not qualified to offer an expert opinion as to the timing of palliative withdrawal or appropriate doses of medication for the victims in this matter. Mr. Patel is a pharmacist. He is not a medical doctor. R.C. 4729.01(B) provides a very specific definition of what is encompassed within a pharmacist’s scope of expertise Nowhere within that definition of the “practice of pharmacy” is there any reference to the diagnosis of a patient's medical condition. Likewise, Ohio law does not permit a pharmacist to prescribe medication, R.C. 4729.01(1). Finally, Mr. Patel is not able to change a patients’ code status or authorize a palliative withdrawal. Again, the Court does not need to rely on the State’s argument alone. Mr. Patel’s telling statements under oath set forth below support mandatory exclusion of his testimony In his deposition, when asked to opine on issues related to concomitant prescribing of fentanyl and benzodiazepines, Mr. Patel stated “I’m not going to opine on that. You can ask the prescriber.” State’s Exhibit C at 219-220, When asked whether medications should be limited to minimum dosages and durations required, Mr. Patel responded “I’m not going to be opining as a physician.” /d. at 222. When asked about prescribing benzodiazepines to comatose patients, Mr. Patel responded “I would defer to a physician, sir.” Jd. at 279. When asked how often he has been involved with palliative extubations where fentanyl is used, Mr. Patel responded “I’m not doing the extubation, sir, I couldn’t answer that question.” Jd. at 280. When asked why certain medications would be prescribed in a palliative extubation setting, Mr. Patel answered “[y]ou would need to ask the physician.” Id, at 283. When asked if he could opine on the appropriate doses of fentanyl and versed for a patient in a palliative extubation, Mr. Patel said “No, I don’t believe so.” State'sFranklin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CR002735 ope49 - 042 Exhibit D at 165. When asked if he had an opinion on the minimum dose necessary to provide comfort care for the patient, Mr. Patel answered “I don’t order drugs. I don’t believe I can opine on that.” /d. at 165-166, When asked how to anticipate pain for dosing purposes prior to a palliative extubation, Mr. Patel answered “[yJou will have to ask an ordering provider. I'm not a physician, sir.” State’s Exhibit C at 100. When asked about agonal breathing and whether it was painful, Mr. Patel stated this was outside his area of expertise. Jd. at 102. When asked if an unconscious patient with a high lactic acid level would be in pain, Mr. Patel stated this was also outside his area of expertise. Jd. at 120. When asked whether it was his opinion that the palliative extubations in this case ‘were an emergency, Mr. Patel responded “[n]o, sir. I'l let the physicians talk about that.” Id. at 153, When asked for the rationale as to why the medications in this case were prescribed, Mr. Patel answered “[y]ou would need to ask the physician.” Jd. at 283. Despite previously acknowledging all of these limitations to his qualification as an expert witness, Mr. Patel has authored another report in an attempt to offer expert testimony on these topies. Defendant bears the burden of establishing that Mr, Patel is qualified to testify as an expert with regard to these issues. Defendant cannot meet this burden, as Mr. Patel has already admitted he is not qualified to opine on these issues in his deposition testimony. As such, Mr. Patel’s testimony on these issues must be excluded as required by Evid. R. 702(B). 2. Mr. Patel is not qualified to offer an expert opinion on the issue of causation. A pharmacist is not qualified to opine on the issue of cause of death. Determining cause of death, including ruling out other potential causes of death, is a medicalFranklin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CR002735 op649 - 043 determination that needs to be made by a doctor. The Ohio legislature has recognized this is multiple sections of the Revised Code. For example, R.C. 313.02(A) requires a coroner, the individual responsible for cause of death determinations, to be a licensed physician, Like ian, ise, R.C. 3705.16 requires a death certificate to be completed by a physi Pharmacists are statutorily excluded from both of these roles where determining cause of death is the primary responsibility The 10 District Court of Appeals has recognized this qualification requirement as well, In MeMunn v. Mount Carmel Health, a case also involving opiates and respiratory depression, the trial court ruled that the chief toxicologist from the Franklin County Coroner's Office could not give opinion testimony as to the cause of death, as he was not a physician. MeMunn v. Mount Carmel Health, 10" Dist. Franklin No. 97APE0S-643, 1998 Ohio App. LEXIS 1891, *23. The 10" District affirmed this decision. Jd. Mr. Patel himself has acknowledged under oath that he is not qualified to opine on the issue of cause of death. When asked what Bonnie Austin’s cause of death was, Mr. Patel responded “I’m not opining on cause of death.” State’s Exhibit C at 284. When asked if the drugs prescribed by Defendant had an impact on cause of death, when that impact ‘would occur, Mr. Patel responded “I don’t know.” /d. at 239. When asked how quickly the drugs ordered by Defendant could cause death, Mr, Patel again answered “I don’t have an opinion on the time of death from these drugs.” /d. at 242. When asked whether the medications at issue in this case could cause someone to stop breathing within five minutes, Mr. Patel answered “I don’t know. I guess it’s possible. I don’t know.” State’s Exhibit D at 24, When asked if he could offer an opinion as to James Allen’s cause of death, Mr. Patel answered “[cJause of death, no.” Id, at 166.Franklin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CR002735 op649 - 044 Perhaps the most telling acknowledgement that Mr. Patel does not possess the qualifications necessary to opine on cause of death is his opinion that “in all of these cases you can universally put down the cause of death is withdrawal of life support.” fd, at 288 ‘As the Court is well aware from the testimony already presented in this case, “withdrawal of life support” is not a medically or legally recognized cause of death, Mr. Patel’s overly simplistic opinion on this matter highlights his deficit of knowledge, training, and experience necessary to offer a qualified opinion on causation Defendant holds the burden of establishing that Mr, Patel is qualified to offer the expert opinions contained in his report. Despite the fact that Mr. Patel has already acknowledged under oath that he is not able to opine on cause of death, he has again authored a report asserting these same positions. Setting aside the ethical concems of knowingly proffering an unqualified opinion, it is self-evident that Mr. Patel is not qualified to opine on the issues contained in this section of his report. As such, his testimony on causation must be excluded in accordance with Evid, R. 702(B), B. Mr. Patel’s opinions on causation do not meet the requisite level of reliability required by Evid. R. 702(c) and Daubert. In Daubert, the United States Supreme Court established a test to ensure that admitted expert testimony is both relevant and reliable. Daubert set forth a list of factors relating to reliability, including: (1) whether the expert's reasoning or methodology has been or could be tested; (2) whether the expert’s reasoning or methodology has been subject to peer review and publication; (3) the known potential rate of error, and (4) the level of acceptance of the expert’s reasoning or methodology by the relevant professional community. Daubert, $09 U.S. at 393-94.Franklin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CR002735 op649 - 045 This list of factors is non-exhaustive, The advisory committee notes to Rule 702 of the Federal Rules of Evidence, the analogous federal rule on this issue, lists other factors courts may consider when determining whether an expert’s opinions meet the requisite threshold of liability. One of these factors is “[wJhether the expert has adequately accounted for obvious alternative explanations.” Advisory Committee Note to Fed. R Evid. 702. By Mr. Patel’s own admissions, he is unable to determine cause of death. He is not able to rule out the possible alternative causes for the victims’ deaths in this case. His inability to rule out alternative explanations for the victis s’ deaths makes any of his opinions on the topic unreliable. “If the witness is relying solely or primarily on experience, then the witness must explain how that experience leads to the conclusion reached, why that experience is a sufficient basis for the opinion, and how that experience is reliably applied to the fact.” fd. “[T]he more subjective an expert’s inquiry, the more likely the testimony should be excluded as unreliable.” Jn re Meridia Prods. Liab. Litigation, 328 F.Supp.2d 791 (N.D.Ohio 2004). An expert's qualifications, their conclusions, and their assurances of reliability are “not enough” to meet the Daubert standard for reliability, /d. Mr. Patel’s opinions that the drugs ordered by Defendant caused no harm and did not cause death are wholly unreliable, His report offers no basis for his opinions. Instead, he calls upon the Court to rely solely on his subjective judgments without any foundation for how he arrived at his conclusions In addition to the 10" District, multiple courts have recognized the unreliable nature ofa pharmacist’s opinions on causation generally, as well as on cause of death specifically 10Franklin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CR002735 oB649 - 046 In Kidd v. Dickerson, a Tennessee trial court properly excluded the causation testimony of a pharmacist expert witness. As the court noted: [the pharmacist’s] affidavit provides no information as to how his education and experience as a pharmacist makes him competent to opine a to the cause of the patient’s stroke or to rule out other possible causes for her death. In the absence of such information, we decline to assume. that a pharmacist has the education and experience to offer opinions on this particular issue. In short, this a complex case wherein [an individual was found to have a multitude of issues all bearing down on her in the weeks prior to her death, [The pharmacist], however, has not shown via. his affidavit that he is competent to express an opinion as to the cause of {the individual’ s] death in light of this complex medical situation Kidd v. Dickerson, App. No, M2018-01133-COA-R3-CV, 2020 Tenn, App. LEXIS 443 (Oct. 5, 2020) (emphasis added). In Khodes v. Bayer Healthcare Pharms., a federal district court came to the same conclusion, noting, [wJhile the Fifth Circuit has held that a medical doctor testifying, as to issues of causation may base his testimony upon a review of the medical records, the doctor’s experience, and a broad review of the literature, plaintiffs have failed to point this court to any such holding in regards to a pharmacist. Rhodes v, Bayer Healthcare Pharmaceuticals, W.D.La, No. 10-1695, 2013 U.S. Dist. LEXIS 44670 (Mar. 26, 2013). Mr. Patel’s deposition testimony reveals how unreliable his opinions are on the pertinent issues in this case. When asked whether these large doses of medicine could cause someone to stop breathing within five minutes, Mr. Patel responded “I don’t know. I guess it’s possible. I don’t know.” State’s Exhibit D at 24. When asked if he had an understanding as to why one of the victims died 22 minutes after administration of the medicine, Mr. Patel answered “I don’t know. I can’t ~ I have no opinion. Those are all factors. I don’t have a crystal ball.” /d. at 182-183, When asked if the drugs ordered by Defendant had an impact ‘on cause of death, when that impact would occur, Mr, Patel responded “I don’t know.” uFranklin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CR002735 op649 - 047 State’s Exhibit C at 239, When asked how quickly the drugs ordered by Defendant could cause death, Mr. Patel again answered “I don’t have an opinion on the time of death from these drugs.” /d, at 242. Finally, when asked if he has done any research on how a 2,000 microgram dose of fentanyl would affect an individual, Mr. Patel responded “[n]o, 1 haven’t done research on what 2,000 micrograms does on a patient.” /d. at 309. Defendant may argue that Mr. Patel is not opining on cause of death, but rather ruling out a cause of death, This argument is illogical, as itis still ultimately an opinion on causation, To rule out a cause of death is to opine on the issue of cause of death. As noted above in the advisory notes to Fed. Evid. R. 702, whether an expert has accounted for alternative explanations bears directly on the issue of reliability. Mr. Patel admits that he is not able to account for these alternative explanations, as he is not a physician, Mr. Patel does not have the medical knowledge necessary to determine how the large doses of medication at issue in this case interplayed with the complex medical conditions of each of the fourteen victims. Without this ability, any opinion from Mr. Patel on this issue is simply unreliable. This is the exact type of testimony that Daubert directs courts to exclude as part of the gatekeeper role. Further, Mr. Patel’s expert report offers no explanation for how he can reliably opine on cause of death or rule out potential causes of death with his training and experience as a pharmacist. His deposition testimony makes it clear that he recognizes he is unable to reliably do so. It is abundantly clear that Mr. Patel lacks the qualifications to reliably opine on any issues of causation in this case, Defendant cannot meet his burden of establishing that Mr. Patel’s opinions are reliable. As such, the State respectfully requests the Court to prohibit Mr. Patel’s testimony subsequent to Evid. R. 703(C).Franklin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CR002735 oB649 - 048 C. Boaston Iss In State v. Boaston, the Ohio Supreme Court set forth a bright line rule concer 1 expert testimony — “it is error to admit expert-opinion testimony when the expert’s opinion was not set forth in a written report prepared in compliance with Crim. R. 16(K).” State v. Boaston, 160 Ohio St. 3d 46, 2020-Ohio-1061, { 1. In Boaston, the expert authored a written report as required by Crim. R. 16(k). /d. at 156. However, in her trial testimony, the expert offered opinions that were not contained in her expert report. Jd. The Ohio Supreme Court ultimately held “[tJhe trial court accordingly erred in allowing the opinion testimony that went beyond the scope of the supplied expert report.” Jd. at 58. If Mr. Patel is permitted to testify, the State will object to testimony concerning any expert opinions that are not specifically set forth in his attached report. D. he exclusion of Mr, Patel’s testimony is required under Ohio Evid R. 702 and does not infringe upon Defendant's rights. While Defendant has a right to present evidenc his defense, “fiJm the exercise of this right, the accused, as is required of the State, must comply with established rules of procedure and evidence designed to assure both fairness and reliability in the ascertainment of guilt and innocence.” State v. Swann, 119 Ohio St. 3d 552, 2008-Ohio-4847, 14 (quoting Chambers v. Mississippi, 410 U.S. 284, 302 (1973)). “[T]he exclusion of unreliable evidence is a principal objective of many evidentiary rules.” /d. (quoting United States v. Scheffer, 523 U.S. 303, 309 (1998) (citing Fed, R. Evid, 702, 802, and 901, and Daubert v. Merrell Dow Pharmaceuticals, Inc., 509 U.S. 579, 89 (1993))). “Chambers therefore does not stand for the proposition that the defendant is denied a fair opportunity to defend himself whenever a state or federal rule excludes favorable evidence.”” State v. Swann, 119 Ohio St. 3d 552, 2008-Ohio-4847, {| 15 (quoting Scheffer, 523 U.S. at 316) 13,Franklin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CR002735 op649 - 049 Consequently, it is clear that Evid. R. 702 and Dauhert require the exclusion of Mr. Patel’s testimony. While Mr, Patel may be qualified as an expert in some matters, the opinions he is attempting to offer in this matter are outside the scope of his expertise, thus failing to satisfy Evid. R. 702(B). Further, Mr. Patel’s testimony is unreliable, and thus fails to meet the burdens set forth in Evid. R. 702(C) and Daubert. Thus, the exclusion of ‘Mr. Patel’s testimony is required by law, and any such exclusion would not infringe upon Defendant's rights, CONCLUSION For the reasons stated above, the State respectfully requests this Honorable Court conduct a Daubert hearing and bar the expert testimony of Mr. Gourang P. Patel Respectfully submitted, G. GARY TYACK (0017524) Prosecuting Attorney s/ Dav even David F. Zeyen (0068069) Janet A. Grubb (0017522) Taylor M. Mick (0095926) Paula M, Sawyers (0061175) Corinne M, Buker (0095172) Assistant Prosecuting Attorneys 373 South High Street ~ 14" FL Columbus, Ohio 43215 (614) 462-3555 Counsel for Plaintiff 14Franklin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CR002735 oB649 - 050 CERTIFICATE OF SERVICE The undersigned hereby certifies that the foregoing notice was electronically filed and served via the Clerk’s electronic filing system on Jose Baez, Diane Menashe, and Jaime Lapidus, counsel for Defendant, on this day, March 24, 2022. s/ Taylor M. Mick Taylor M. Mick (0095926) Assistant Prosecuting AttorneyFranklin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CR002735 oB649 - O51 Gourang P. Patel, B.S. Chem, Pharm.D, MSc., FCCM BCPS.,BCCCP Curriculum Vitae Email Address: Gourana » patel@nish.edy Experience July 2002-Present Post-Doctoral Training July 2004-June 2002 Educational Training ‘August 1992- May 1996 ‘August 1996-May 2001 ‘August 2006-June 2008 Professional Experience August 2009-Present Pharmacy Supervisor- Aduit Critical Care and Operating Room Associate Professor Division of Pulmonary and Critical Care Medicine Department of Anesthesiology Department of Pharmacy RUSH Medical College RUSH University Medical Center Chicago, tinois, Internal Medicine Pharmacy Residency John Cochran VA Medical Center Saint Louis, Missouri Residency Director: Jennifer Kasiar, Pharm.0., BCPS ‘Truman State University B.S. Degree in Chemistry Kirksville, Missouri St. Louis College of Pharmacy Doctor of Pharmacy Saint Louis, Missouri Magna Cum Laude Rush Graduate College Master of Science Clinical Research Program Chicago, Hinois Associate Professor Department of Internal Medicine RUSH Medical College Chicago,Franklin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CR002735 oB649 - 052 July 2009-July 2014 November 2003-Present November 2003-Present August 2002-Present August, 2001- June, 2002 October, 2000-July 2011 May 2015- Present Ee rial Board January 2019 — Present Curriculum Vitae Gourang Patel Clinical Site Coordinator Critical Care Residency (PGY2) Midwestern University Chicago Colleges of Pharmacy Site: RUSH University Medical Center Chicago, IL Adjunct instructor ‘Advanced Practice Nursing Northern illinois University [NIU] Assistant Professor Department of internal Medicine RUSH Medical College Chicago, It. Adjunct Assistant Professor Division of Pharmacy Practice Chicago Colleges of Pharmacy Midwestern University Downers Grove, IL Clinical Instructor Division of Pharmacy Practice Saint Louis College of Pharmacy St. Louis, MO Pharmacist Walgreen's Pharmacy Saint Louis, Missouri Chicago, linois Associate Professor Department of Anesthesiology Crilical Care Medicine Journal/Publication Reviewer ‘August 2016 January 2014 Society of Critical Care Medicine (SCCM) ‘SCCM Annual Critical Cate Congress and Symposium January 2017 meeting Abstract Reviewer Journal of Critical Care Manuscript ReviewerFranklin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CR002735 oB649 - 053 January 2010 June 2009 July 2008-Present ‘September 2007 June 2007- Present December 2005-Present Hospital Committees Curriculum Vitae Gourang Patel Pharmacoepidemiology and Drug Safety Manuscript Reviewer American College of Chest Physicians ACCP Annual Meeting Abstract Reviewer Pharmacotherapy Manuscript Reviewer Critical Care/infectious Diseases Society of Critical Care Medicine (SCCM) ‘SCCM Annual Critical Care Congress and Symposium February 2008 meeting Abstract Reviewer University Health-System Consortium (UHC) Monograph Reviewer Drug information Annals of Pharmacotherapy Manuscript Reviewer Critical Care/infectious Disease * Critical Care Quality Committee- 2008-Present Member + Emergency Resuscitation Committee- Member 2002-2008 Co-Chair 2008-2011 * Surgical Quality Improvement Committee- 2010-present Member * Pharmacy and Therapeutics Committee- 2010-present Member Curriculum and Evaluation Committee- 2014-present RUSH Medical College Member Publications Textbook Chapter 4. 2018-2019 Critical Care Pharmacy Preparatory Review and Recertfication Course’. Chapter- Practice Administration and Development: Protocol Development and Quallty 3pea ~ offpritin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CRO02735 Curriculum Vitas Gourang Pate! ‘Assurance Reviewed by: Gourang Patel, PharmD, MSc, FCCM, BCPS, BCCCP and Russel Roberts, PharmD, FCCM 2. Anaphylaxis, Allergies, Angioedema, and Acute CNS Disorders. 2018 CCSAP Chapter Book 2 pg. 61-80. American College of Clinical Pharmacy. By Gourang Patel, PharmD. MSc and Megan Rech, PharmD, MS. 3. Acute Culmonary Embolism in Adults. 2017 PSAP Chapter Book 2 pg. 67-95. American College of Clinical Pharmacy. By Sandy Bartlett, PhD, PharmD and Gwen Bartlett, PharmD. Reviewed by: Gourang Patel, PharmD, MSc and Gina Lumbard Harper, PharmD. 4. Patel GP, O'Donnell JT. Adverse effects of diabetic drugs. Drug Injury: Liability, Analysis, and Prevention. Lawyers & Judges Publishing Company. October 2012. ‘Chapter 22; 369-380. Updated 2016 6. Patel GP. Acute adverse drug events in critical care: Emergency Department and Intensive Care Unit. Drug Injury: Liability, Analysis, and Prevention. Lawyers & Judges Publishing Company. October 2012. Chapter 28; 483-490. Updated 2016 6. Patel GP. Post-Mortem Drug Redistribution. Drug Injury: Liability, Analysis, and Prevention. Lawyers & Judges Publishing Company. October 2012. Chapter 46; 779- 781. Updated 2016 7. Patel GP and Kumar A. Antimicrobial, Antifungal, and Antiviral therapies. Society of Critical Care Medicine [SCCM] Adult Board Critical Care Review. August 2011. Chapter 26; 447-460. Updated 2017 8. Patel GP_ ICU infection i it-Resistance. Chapter 6: Is Vancomycin- Resistant Enterococcus (VRE) under control? Selected Proceedings from the 8” ‘Summer Conference in Intensive Care Medicine. Scciety of Critical Care Medicine. ‘October 2009; 61-68. Continuing Education (CE) Articles 1, Menich BE, Miano TA, Patel GP, and Hammond DH. Norepinephrine and Vasopressin compared with Norepinephrine and Epinephrine in Adults with Septic Shock. Ann Pharmacother. 2019 (Epub ahead of print] 2. Lopansri B, Miller R, Burke J, et al. Physician agreement on diagnosis of sepsis in the intensive care unit: estimation of concordance and analysis of underlying factors in a multicenter cohort. Journal of intensive Care. 2019. [Epub ahead of print} 3. Nelson K, Patel GP, Hammond DH. Effects from continuous infusions of dexmedetomidine ‘and propofol on hemodynamic stability in critically il adult patients with septic shock. J Intensive Gare Med. 2018. [Epub ahead of print] 4, Miller RR, Lopansri BK, Burke JP, Levy M, Opal S, Rothman RE, D'Alessio FR, Sidhaye VK, ‘Aggarwal NR, Balk R, Greenberg JA, Yoder M, Patel G, et al. Validation of a Host Response ‘Assay, Septicyle™ LAB, for Discriminating Sepsis from SIRS in the ICU. Am J Resp Crit Care. 2018;198:903-913.Franklin Count '- peas ~ of fprilin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CRO02735 Curriculum Vitew Gourang Patel 5, DeMott JM, Patel G, Lat |. Effects of chronic antihypertensives on vasopressor dosing in ‘septic shock. Ann Pharmacother. 2018;52:40-47 6. Caffarini E, DeMott J, Patel G, Lat | Determining the clinical utility of an absolute procaicitonin (PCT) value for predicting a positive culture result. Antimicrob Agents Chemother. 2017;61:1-6. 7.Falana O, Patel G. Efficacy and Safety of Tranexamic Acid versus Aminocaproic Acid in Cardiovascular Surgery. Ann Pharmacother 2014; 48:1563-9 8. Patel GP. The management of substance abuse in the critically il, Dis Mon. 2014; 60:428- 440, 9. Elpem E, Killeen K, Patel GP, Senecai P. The Application of Intermittent Pneumatic ‘Compression Devices for Thromboprophylaxis. Am J Nurs. 2013;113:30-36 10. Kiel PJ, Vargo CA, Patel GP, Rosenbeck LL, and Srivastava S. Possible correlation of sirolimus plasma concentrations with sinusoidal obstructive syndrome of the liver in patients, undergoing myeloablative allogeneic hematopoietic cell transplantation. Pharmacotherapy. 2012; 32:441-5, 141. Patel, GP. Postmortem Drug Levels: innocent Bystander or Guilty as Charged. J Pharm Pract, 2012; 25:41-44 12, Patel, GP and Balk RA. Systemic Steroids in Severe Sepsis and Septic Shock. Am J Respir Crit Care Med.2012; 185:133-139. 13. Rech MA, Prasse MC, Patel GP. Use of Vasopressors in Septic Shock. JCOM. 2011; 18:273-277 14, Patel GP, Crank CW, Leikin JB. An evaluation of Hepatotoxicity and Nephrotoxicity of Liposomal Amphotericin B (L-AMB). J Med Tox. 2011; 7:12-15 15, Peterson SJ, Chen Y, Sullivan CA, Kinnare KF, Tupesis NC, Patel GP, Sowa DC, Lateef O, ‘Sheean PM, Assessing the influence of registered dietitian order-writing privileges on parenteral nutrition use. J Am Diet Assoc. 2010; 100:1703-11 16. Crank CW, Scheetz MH, Brielmaier B, Rose WE, Patel GP, Ritchie DJ, Segreti J. Comparison of Outcomes from Daptomycin or Linezolid Treatment for Vancomycin-Resistant Enterococeal Bloodstream infection. Cin Ther, 2010; 32:1713-1719 17. Gumani PK, Patel GP, Crank CW, Vais D, Lateef 0, Akimov S, Balk RA, and Simon D. Impact of the Implementation of a Sepsis Protocol for the Management of Fluid-Refractory Septic Shock: A Single-Center, Before-and-Afler Study. Clin Ther. 2010; 32:1285-1293 18. Patel GP, Grahe JS, Sperry M, Singla S, Elpem E, Lateef O, Balk RA. Efficacy and Safety of Dopamine versus Norepinephrine in the Management of Septic Shock. Shock. 2010 April, 33:375-380Franklin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CR002735 0B649 - 056 Curriculum Vitaw Gourang Pate! 19. Patel GP. A focus on medication safety in the intensive care unit. Curr Drug Safety. 2010 Jan; 8:1 20. Patel GP and Kane-Gill S. Medication Error Analysis: A Systematic Approach. Curr Drug Safety. 2010 Jan; 8: 2-5 21. Elpern EH, Killeen K, Ketchem A, Wiley A, Patel GP, Lateef O. Reducing use of indwelling urinary catheters and associated urinary tract infections. Am J Crit Care. 2009 Nov; 18: 535-541 2. Patel GP, Simon D, Scheetz M, Crank CW, Lodise T, Patel N. The effect of time to antifungal therapy on mortality in Candidemia associated septic shock. Am J Ther. 2009 Nov- Dec; 16:508-511 23. Kieinpell RM, Patel GP. Pneumonia in Older Adults. Adv. Nurse Prac. September 2009) AB-AT 24. Low-Molecular Weight Heparins: Update on Follow-On “Generic” Compounds (Part 2). Co- Chairs: Tapson V and Marcus P. Faculty: Patel GP and Groce J. Chest Physician August 2009: 16-17 25. Low-Molecular Weight Heparins: Update on Follow-On "Generic" Compounds (Part 1). Co- Chairs: Tapson V and Marcus P. Faculty: Patel GP and Groce J. Chest Physician July 2009: 16-17 26. Low-Molecular Weight Heparins: Patient Safety and Ciinical Data Requirements for Follow- ‘on "Generic’ Biologic Compounds. Co-Chairs: Tapson VF, Marcus P. Faculty: Fareed J, Patel GP, Talarico L, Groce JB. Chest Physician supplement. September 2008: 1-15 27. Kiel PK, Lo M, Stockwell D, Patel GP. An Evaluation of Amikacin Nephrotoxicity in the Hematology/Oncology Population. Am J Ther. 2008; 18: 131-136 28. Patel GP and Balk RA. Choice of vasopressor in septic shock: does it matter? Critical Care. 2007,11:174 29. Elpem EH, Patel GP, Balk RA. Antibiotic Therapy for Pulmonary Exacerbations in Adults vith Cystic Fibrosis. Medsurg Nurs. 2007;16: 293-298. Continuing Education (CE). 30. Gueret R, Patel GP, Simon DM, Balk RA. Invasive Aspergillosis: Case Report and Review of the Approach to Diagnosis and Treatment. Clinical Pulmonary Medicine. 2007;14: 197-205 31. Patel GP, Elpemn EH, Balk RA. A Campaign Worth Joining: Improving Outcome in Severe ‘Sepsis and Septic Shock Using the Surviving Sepsis Campaign Guidelines. South Med J. 2007;100: 567-8 32. Patel GP, Crank CW, Black S. Therapeutic Interventions for the Treatment and Control of influenza. J Pharm Technol. 2007;23:79-85 33. Patel GP, Balk RA. Recognition and Treatment of Hyponatremia in Acutely tI! Hospitalized Patients. Clin Ther. 2007;29: 211-229Franklin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CR002735 op649 - O57 Curriculum Vitae Gourang Patel 34. Patel GP, Loh-Trivedi M. Clinical Pharmacists In the Intensive Care Unit: Is there really an ‘equation? Intensive Care Med. 2006 Aug: 32(8):1275-6 36. Philbrick AH, Crank CW, Patel GP. Antiretrovirals: Pharmacotherapy and Adverse Drug Reactions. Inet Continuing Education. 2005; 9(5):1-21. inetCE 221-399-05-010-H02, Released ‘August 2005 36. Crank CW, Pate! GP. Antimicrobial Resistance in Gram-Positive and Gram-Negative Bacteria. Inet Continuing Education. 2005; 9(4):1-19. InetCE 221-999-05-009-H01. Released: uly 2005 37. Patel GP, Liberman J, Gurka D, Elpern E, Balk RA. Complications of Critical illness: Rationale for Prophylactic Strategies. Clinical Pulmonary Medicine. 2005;12(4):258-268. 38. Patel GP and Crank CW- Management of Gram-Negative Resistance in the intensive Care Unit. Journal of Pharmacy Practice. 2005;18:91-89. 39, Patel GP, Gurka D, Balk RA. Management of Sepsis and Septic Shock. Curr Opin Crit Care. 2003;9:390-396. 40. Patel GP, Balk RA. The Interaction of the Coagulation and Inflammatory Cascades in the and Management of Severe Sepsis and Septic Shock. Biomedical Progress 41, Patel GP, Kaisar JB. Syndrome of inappropriate Antidiuretic Hormone- Induced Hyponatremia Associated with Amiodarone. Pharmacotherapy 2002;22 (6): 649-651 42. Moeriein SM, Perlmutter JS, Patel GP, et al. Comparison of Carbon-11 andFluorine-18, Labeled (N-Methyl) Benperidol (NMB) in rodents Using MicroPet maging. J Lab Comp Radiopharm 2001 ;44:5455-s456. Abstract/Poster Presentation 1, Patel GP, Nelson KM, Hammond D. Effects from Propofol and Dexmedetomidine in the Critically ill adults with Septic Shock. Society of Critical Care Medicine (SCCM) meeting. San Diego, CA. February 2019 2. Menich B, Miano T, Patel GP, Hammond D. Norepinephrine and Vasopressin versus Norepinephrine and Epinephrine in Adults with Septic Shock. Society of Critical Care Medicine (SCCM) meeting. San Diego, CA. February 2019 3, Benken S, Patel GP, Hammond D. Society of Critical Care Medicine (SCCM) meeting. San Diego, CA. February 2019 4, Zouien E and Patel GP. Case presentation. Kombucha. Society of Critical Care Medicine (SCCM) meeting. San Antonio, TX. February 2018.Franklin Ci peas — offprklin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CRO02735 Curriculum Vitew Gourang Patel 5, Patel GP, Buvanendran A, Rehman S, Gaurav K, Moric M, Robinson S, Kroin J. Opioid prescription pattems in a university academic Emergency Department. American Society of Anesthesiologists (ASA). Boston, MA. October 2017 6. Caffarini E, DeMott J, Patol G, Lat | Determining the ulility of an abss value. Society of Critical Care Medicine (SCCM) meeting. Honolulu, HI. January 2017, 7. Lai Y, Seddon A, Nathan S, DiGrazia L, Patel GP, Merchant N. Evaiuation of Bortezomib with Methotrexate and Tacrolimus for Graft-Versus-Host Disease Prophylaxis in Allogenic Stem Cell Transplant Patients. Hematology Oncology Pharmacists Association (HOPA). March 2016 8, Patel GP, Berger K, O'Donnell P, DeMott J, Rechner G, Hanson A, Cooke J, Varghese M, Balk RA. Clinical pharmacist ir tions with procatcitonin whi i stewardship. Sociely of Critical Care Medicine (SCCM) meeting. Phoenix, AZ. January 2016. 9. Falana O, Patel GP. Efficacy and safety of tranexamic acid versus e-aminocaproic acid in cardiovascular surgery. Society of Critical Care Medicine (SCCM) meeting, San Francisco, CA. January 2014 10. Malik N, Patel GP, Tandon R. Clinical Outcomes in patients with Group Ili associated pulmonary hypertension on prostacyclin therapy. American Thoracic Society (ATS). Philadelphia, PA. May 2013 11. Patel GP, Vais D, Gumani P, Crank C, Kleinpell D, Simon D, Lateef O. A Multidisciplinary Improve Outcomes in Patients with Septic. American College of Chest Physicians (ACCP) Oral slide Presentation. San Diego, CA. October 2009 12, Patel GP, Crank CW, Leikin JB. tion of Hepatotoxicity ang ty of Liposomal Amphotericin B. North American Congress of Clinical Toxicology. NACCT. San Antonio, TX. September 2009 13. Patel GP and Leikin JB. Reversal of Ventricular Tachycardia (V7) from Lidocaine with Amiodarone. North American Congress of Clinical Toxicology. NACCT. San Antonio, TX. ‘September 2009 14. Vais D, Patel GP, Gurnani P, Crank C, Simon D. An Approach to Improve Outcomes in Patients with Septic Shock, intemational Congress of Chemotherapy and Infection 26” session Toronto, Canada. June 2009 18. Patel GP, Kleinpell R, Ward E, Lateef O, Altman P, and Gonzaga M. improving Sepsis Care Practices Through Muhidisciplinary initiatives. RUSH University Medical Center Research Forum. Chicago, tL. May 2009 16. Moreno-Frenco P, Mahajan N, Simon-Grahe J, Patel GP, Lee W, Tandon R. Qutcome of Pulmonary Hypertension Patients who required Endotracheal intubation with Intensive Care ‘Unit Admission, American Thoracic Society (ATS) meeting, Toronto, Canada. May 2008 17. Patel GP, Sperry M, Yoder MA, Simon-Grahe J, Balk RA, Efficacy and Safety of Dopamine versus Norepinephrine in the Management of Septic Shock. Society of Critical Care Medicine (SCCM). Oral Presentation af the Annual Meeting. Honolulu, HA. February 2008. 8Franklin Ci peas — of {pnklin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CRO02735 Curriculum Vitao Gourang Patel 18, Patel GP, Crank CW, Loh-Trivedi M, Balk RA. An Evaluation of Nephrotoxicity of Lioosomal Amphotericin B. American College of Clinical Pharmacy (ACCP). Denver, CO. October 2007 49. Brielmaier BD, Reichley R, Casabar E, Ledeboer N, Patel GP, Crank CW, Segreti J, Ritchie OU. Daptomycin for Treatment of Vancomycin-resistant Enterococcus Bloodstream Infections American College of Clinical Pharmacy (ACCP). Denver, CO. October 2007 20. Kumar A, Skrobik |, Guzman J, Lapinsky S, Laupland K, Dodek P, Zanotti S, Patel GP, Simon D, and the CATTS Investigators. The High Mortality of Candida Septic Shack is elays in Initiale jal Th Interscience Conference of Antimicrobial Agents and Chemotherapy (ICAAC). Chicago, iL. September 2007 21. Kiel PJ, Patel GP, Stockwell D. Fung H, Evaluation of Nephrotoxicity Regarding Aminoalycoside Dosing in a Hematology/Oncoloay Population, American Society of Health- ‘Systems Pharmacy (ASHP) meeting. Anaheim, CA. December 2006 22. Tverdek F, Patel GP, Crank CW. Assessment of the Treatment of Hospital and Ventilator ‘Associated Preurnonia at a University Hospital. American Society of Health-Systems Pharmacy (ASHP) meeting. Anaheim, CA. December 2006 23. Simon-Grahe J, Shashaa S, Patel GP, Elpem E, and Baik, RA. incidence end Outcome of Vasopressor Resistance in Septic Shock. American College of Chest Physicians (ACCP) meeting. Salt Lake City, Utah. October 2006 24. Patel GP, Akimov S, Santos C, Wang Y, Crank CW, Balk RA, Simon D. Assessing Antibiotic ‘Administration in Patients With Septic Shock, Infectious Disease Society of America (IDSA) meeting. Toronto, Canada. October 2006 25. Patel GP, Crank CW, Proia L, Simon-Grahe J, Simon D. Candidemia associated Septic Shock, Infectious Disease Society of America (IDSA) meeting. Toronto, Canada. October 2006 26. Patel GP, Simon-Grahe J, Balk RA. An Evaluation of Adrenal Function and Infecting Pathogen in Septic Shock American Thoracic Society (ATS) meeting. San Diego, CA. May 2006 27. Simon-Grahe J, Patel GP, Elpemn E, and Baik, RA. Physiologic stressed cortisol levels in yasopressor-dependent septic shock correlate with 26-day mortality American Thoracic Society (ATS) meeting. San Diego, CA. May 2006 28. Bell J, Simon-Grahe J, Patel GP, Balk RA, Etiotogic Cause of Septic Shock Is Not ‘Associated With Duration of Vasoptessor Therapy Or 28 Day Mortality American Thoracic Society (ATS) meeting, San Diego, CA. May 2006 29. Grimm S, Cannon J, Lee T, Crank C, Patel GP, Proia L, Labuszewski L, Mullane K, Jancel T, Clark N. Utilization of Newer Antifunaals ina Large Metropolitan Setting, FOCUS on Fungal Infections. Las Vegas, NV. March 2006 30, Reimann M, Crank C, Patel GP, Flint N Amin Therapeutic Drug Monitoring American Society of Health- Systems Pharmacists (ASHP) Wide Year meeting. Las Vegas, NV. December 2005Fi p64 ~ offpritin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CRO02735 Curriculum Vitao Gourang Pate! 31, Simon-Grahe J, Patel GP, Elpern E, Balk RA. The Safety of Dopamine versus Norepinephrine as Vasopressor Therapy in Septic Shock American College of Chest Physicians (Chest) meeting. Montreal, Canada. October 2005 32. Simon-Grahe J, Patel GP, Elpem E, Kellar D, Balk RA. Dopamine versus Norepinephrine as the Initial Vasopressor in Septic Shock American Thoracic Society (ATS) meeting. San Diego, CA: May 2005 93. Patel GP, Patel P, Gurka D, Elpem E. Economic Evaluation of Sedation and Analgesia in Medical Intensive Care Unit American Society of Health-System Pharmacists (ASHP) Mid-Year meeting. New Orieans, LA. December 2003 34. Patel P, Patol GP. Evaluation of Stress Ulcer Prophylaxis with Pantoprazole in Medically Il Patients American Society of Health-System Pharmacists (ASHP) Mid-Year meeting, New Orleans, LA. December 2003 Presentations 4. Pharmacotherapy challenges in Critically ill Patients. Society of Critical Care Medicine- ‘SCCM Multiprofessional Critical Care Adult Course. Chicago, IL. August 2019. 2, "Slow to Wake: Managing Delayed Emergence In the Postsurgical Setting”. American College of Clinical Pharmacy ACCP Giobal meeting. Perioperative PRN Focus Session. OR Blues: Management of Perioperative Emergencies. Seattle, WA. October 2018, 3, “Reducing Opioid use in Orthopedic Surgery’. American Association of Orthopedic Surgery [AOS]. New Orleans, LA. March 2018 4. “Perioperative Analgesia’. Midwest Orthopedics at Rush. Grand Rounds. April 2017. 5. ‘Life-Threatening Infections: Diagnosis and Antimicrobial Therapy Selection”. Fundamentals in Critical Care Support [FCCS] program for the Society of Critical Care Medicine [SCCM]. Chicago, IL. August 2016 6, “Technology in the ICU- an arranged marriage between Telemedicine and Telepharmacy’, Speaker. Society of Critical Care Medicine (SCCM). 45" Annual Congress. Orlando, FL. January 2016 7.* Which Box Does Your Patient Fit into to? Method behind the madness for vasopressor selection’, Speaker. Society of Critical Care Medicine (SCCM). 45” Annual Congress. Continuing Education (CE). Ortando, FL. January 2016 8. “Bleeding Jeopardy’. Speaker. Society of Critical Care Medicine (SCCM). 45" Annual Congress. Continuing Education (CE). Orlando, FL. January 2016 9. "Perioperative Medication Dosing in the Obese Patient”. Department of Anesthesiology- Grand Rounds. January 2016 10. "Perioperative Medication Safety’. Department of Anesthesiology-Grand Rounds. December 2015. 10p64 — offanklin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CRO02735 Curriculum Vitae Gourang Patel 11."Flumazenit: Then and Now’. American Academy of Clinical Toxicology/American Board of Applied Toxicology (AACT/ABAT). Journal Club presentation-Webinar. October 2015. 12. "Vasoactive therapies in the ICU’. Illinois Academy of Physician Assistants (PA). Continuing Education, Chicago, IL. October 2016. 13, “Life-Threatening infections: in Critical Care Support [FCCS} program for the Society of Critical Care Me Chicago, IL. March 2015 .gnosis and Antimicrobial Therapy Selection”. Fundamentals ine [SCCM]. 14, “Emerging Therapies for idiopathic Puimonary Fibrosis (ILD) and the Role of Specialty Pharmaceuticals”. National Association of Specialty Pharmaceuticals [NASP]. Continuing Education (CE). Orlando, FL. October 2014 16, ‘Life-Threatening Infections: Diagnosis and Antimicrobial Therapy Selection”. Fundamentals in Critical Care Support [FCCS] program for the Society of Critical Care Medicine [SCCM] Chicago, IL. August 2014 46. “Pharmagologic parameters for the Obese ICU patient’ American College of Physicians [ACP] Annual Conference. Continuing Education (CME). Orlando, FL. April 2014 17. "Pain, Agitation, and Delirium in the ICU" Speaker, American College of Physicians [ACP] Annual Conference. Continuing Education (CME). San Francisco, CA. April 2013 18, "Drug-induced Arrhythmia’s in the ICU" Speaker, Society of Critical Care Medicine (SCCM) 40" Annual Conference. Continuing Education (CE). San Diego, CA. January 2011 19, “Managing Hyponatremia: Challenges & Opportunities for the Hospital Pharmacist’Moderator and Speaker. iiinols Council of Health-System Pharmacists (ICHP). Continuing Education (CE). Oak Brook, IL. August 2011 20. "A Pharmacist approach to a patient with septic shock" 5" Annual Sino-American Hospital Pharmacy Conference. Nanjing, China. May 2010 24, 2010 JPT International intravenous Conference: Intravenous medication compounding and safety. "Aseptic technique for compounding sterile products” and USP Chapter <787>" Beling, China. May 2010 22. "An approach to the management of defirium in the ICU" liingis Council of Health-System Pharmacists (ICHP). Spring Meeting. Bioomington, iL. March 2010 23, Vancomycin resistant Enterococcus (VRE). Society of Critical Care Medicine (SCCM): ICU Infection in an Era of Multi-Resistance. 8” Summer Conference in Intensive Care Medicine Chicago, IL. June 2008 24. “One Prokinetic Agent versus Two for Gastrointestinal Motility’ Presented at the American Society of Parenteral and Enteral Nutrition (ASPEN) conference. Presenter. New Orleans, LA. February 2008 "peas ~ offpnilin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CRO002735 Curriculum Vitew Gourang Patel 25. Hyperglycemia Management in the ICU” Presented at the American Society of Parenteral and Enteral Nutrition (ASPEN) conference. Session Moderator and Presenter. New Orieans, LA. February 2009 26. “Catecholamines at the ICU Bedside: Which is the best?” Presented to the Department of Pharmacology, Seminar Series. Rush University Medical Center. Chicago, IL. November 2008. 27. “Safety and Therapeutic interchange of Generic Low-Molecular Weight Heparins” Presented at American College of Chest Physicians ACCP Roundtable meeting. Philadelphia, PA. October 2008. 28. “Therapeutic interchange and Generic Low-Moleculer Weight Heperins” Presented at the North American Thrombosis Forum (NATF) meeting at Brigham’s and Women’s Hospital, Boston, MA. September 2008. 29. “Safety of Follow-on Biologic Medications: Implications for Anticoagulants” Continuing Education Program. Presented at the American College of Chest Physicians ACCP meeting, Huntington Beach, CA, March 2008. 30. “Balancing Propofol and Nutrition in the intensive Care Unit" Pragmatic Approach to Nutrition in the Intensive Care Unit. Continuing Education Program. Presented at RUSH University Medical Center. Chicago, IL. November 2007, 31_Advanced Critical Care & Trauma Symposium. Program Consultant and Speaker. Continuing Education (American Association of Critical Care Nurses AACN, Accreditation Council for Continuing Education AMA, American Academy of Physician Assistants ACCME, and Accreditation Council for Pharmacy Education ACPE) “Adverse Effects of Sedation and Analgesia in the ICU” “Evaluation and Treatment of Delirium in the ICU” “An Approach to Bleeding in the ICU: A Focus on Pharmacotherapy” Chicago, IL. November 2007 32, An Evaluation and Treatment Approach to Hyponatremia in the Hospitalized Patient” ‘Alabama Society of Health System Pharmacists (AISHP) Annual Meeting. Continuing Education (ACPE) Birmingham, AL. October 2007 33. “A Evaluation of Treatment Strategies for the Treatment of Hyponatremia in Acutely i Patients" Presented to Mayo Clinic Nephrology Fellows. Rochester, MI. April 2007 34. "Pharmacologic Considerations in the Intensive Care Unit: Nutrition” Pragmatic Approach to Nutrition in the Intensive Care Unit. Continuing Education Program. Presented at RUSH University Medical Center. Chicago, IL. November 2008. 36. “Management of Sedation and Analgesia in the Intensive Care Unit’ ilinois Council of Health-System of Pharmacists (ICHP) Annual Meeting. Continued Medical Education (ACPE). ‘Oak Brook, IL. September 2005. 36. “Therapeutic Management of Gram-Positive and Gram-Negative Resistance” Medicine Grand Rounds, Continuing Medical Education (CME). Presented at St. Joseph Hospital Chicago, IL. April 2005 12Franklin Count : p64 ~ of!prklin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CRO02735 Curriculum Vitae Gourang Pate! 37. “Update on the ACCP-Chest Guidelines for Prevention of Venous Thromboembolism” Presented to RUSH University Medical Center Pulmonary and Critical Care Fellows. Chicago, IL. March 2005 38. “Approaches to Resistance in Community Acquired Pneumonia” Medicine Grand Rounds, Continuing Medical Education (CME). Presented at Oak Park Hospital. Oak Park, IL. February 2005 39. "Management of COPD Exacerbation in the Intensive Care Unit" Presented to University of Chicago and Michael Weiss Memorial Hospital Residents/Intems. Chicago, IL. February 2005 40. “Acute Coronary Syndromes-Nursing Approach to Intravenous Treatment Strategies" Presented at Centegra’s Fall Nursing Symposium-Continuing Education (CE). Woodstock, IL. September 2004 41. “Acute Coronary Syndromes-A Focus on Reperfusion Therapies” Presented to RUSH University Medical Center Cardiology and Critical Care Fellows. Chicago, IL. August 2004 42. “Approach to Invasive Fungal Infections in Critically tll Oncology Patients" Presented to Northwestern Memorial Hospital Hematology and Oncology Fellows. Chicago, IL. July 2004 43. “Advances in Antifungal Pharmacology and Update in Candida Guidelines” Pulmonary and Critical Care and Infectious Disease Fellows, Moderator/Presenter Presented to UIC, RUSH, ‘and Loyola Medical Center Chicago, !L. March/April 2004 44, “Strategies for Venous Thromboembolism and Stress Ulcer Prophylaxis in Medically i Patients” Medicine Grand Rounds Presented to RUSH Medical Center Residents/interns, Continuing Medical Education (CME), RUSH University Medical Center, Chicago, IL. November 2003 48. “Critical Appraisal of Surveillance Data for Community Acquired Respiratory Pathogens” Presented to Attending Physicians in Chicagoland Area, Four Seasons Hotel, Chicago, IL November 2003 46. “Application of Evidence Based Medicine in the Treatment of Community Acquired Pneumonia’ Presented to St. Mary's Internal Medicine Residents, St. Mary's Hospital, Chicago, IL, October 2003, 47. “Application of Community Acquired Pneumonia Guidelines in an Urgent Care Center” Presented to Attending House Staff, Sherman Medical Center, Algonquin, IL. September 2003 48. “Treatment Approach to Resistant Gram-Posttive Infections” Presented to Northwest ‘Community Hospital Pharmacy Staff, Arlington Heights, IL. July 2003, 49. “Cardiovascular Pharmacology- RUSH Cardiology Review’ Continuing Education Program Presented to RUSH-SLMC Cardiology Fellows, RUSH-Presbyterian St. Luke's Medical Center, Chicago, IL. August 2002 50. “Bioterrorism” Continuing Education Program Presented to Saint Louis Area Pharmacists, Saint Louis College of Pharmacy, St. Louis, MO. February 2002 43Franklin County Oh '- p64 ~ offpitin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CRO002735 Curriculum Vitaw Gourang Pate! 51. “Sepsis: A New Treatment Approach with Activated Protein C” Continuing Education Program Presented to Saint Louis Area Pharmacists, Saint Louis College of Pharmacy Saint Louis, MO. October 2001 82. “Sepsis: A New Treatment Approach with Activated Protein C" Medicine Grand Rounds Presented to Washington University and Saint Louis University Residents, John Cochran VA Medical Center, Saint Louis, MO. October 2001 53. “The Prevention and Treatment of Postmenopausal Osteoporosis” Presented to Indian Society of Physicians of Saint Louis, Ghandi Cultural Center, Saint Louis, MO. October 2001 54, “Clopidogrel vs. Ticlopidine after Coronary Artery Stent Placement” Doctor of Pharmacy ‘Seminar, Presented to Saint Louis College of Pharmacy Faculty, Saint Louis, MO. January 2001 ‘88. “The Role of Cofactors in Metabolism” inorganic Chemistry Research Thesis Presented t0 ‘Chemistry Faculty, Truman State University, Kirksville, MO. May 1996 ‘Teaching Experience Spring, 2001 PP 2100: Introduction to Pharmaceutical Care and Non- Prescription Drugs Weekly Group Discussion Leader August, 2001-June2002 Clinical Instructor Division of Pharmacy Practice Saint Louis College of Pharmacy Fall, 2001 ‘TH 4001: Therapeutics | Weekly Group Discussion Leader Fall, 2001 Resident Teaching Workshops Saint Louis College of Pharmacy ‘An 48-hour workshop series designed to develop an understanding of knowledge, skilis, and attitudes necessary to achieve student-centered, assessment driven learning. Spring, 2002 CP 5700 Antimicrobial Pharmacotherapy (2 hours) Lecturer/discussion facilitator (Chloramphenicol, Quinupristin/Datfopristin, Linezolid, and Vancomycin) Spring, 2002 PP 2100 Introduction to Pharmaceutical Care and OTC Drugs ‘Weekly discussion section leader Spring, 2002 Preceptor for Pharm.D. Clinical Clerkships Chicago Colleges of Pharmacy 14Franklin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CR002735 0B649 - 065 Curriculum Vitae Gourang Patel Midwestern University Fall, 2002-Present Preceptor for Pharm.D. PGY1 Residents Medical intensive Care Unit rotation RUSH University Medical Center August 2002-2010 Adjunct Assistant Professor Division of Pharmacy Practice Chicago Colleges of Pharmacy Midwestern University Therapeutic Issues in Critical Care-PPRA 0650 Course Director: Tudy Hodgman Pharm.0., BCPS, FCCM November 2003-2010 Assistant Professor Introduction to Pharmacology-Fluids and Electrolytes ‘Acid-Base in the Intensive Care Unit PRF 333 Department of intemal Medicine RUSH Medical College Chicago, IL August 2005-August 2010 Assistant Professor ‘Advanced Therapeutics Course 530D Pharmacotherapeutics - Vasoactive Therapy in the Intensive Care Unit - Acute Coronary Syndromes: Focus on Reperfusion Therapies College of Nursing RUSH Medical Center Chicago, IL ‘August 2009-August 2011. Assistant Professor Course: Medical Pharmacology RUSH Medical College Chicago, IL Eall Quarter: 20 contact hours = Pharmacokinetics | and if - Autonomic Nervous System Winter Quarter: 14 contact hours > Cardiovascular Pharmacology ‘August 2009-2014 Assistant Professor Course: Physiology and Pharmacology RUSH Graduate College 15Franklin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CR002735 0B649 - 066 July 201 1-Present July 2011-Present May 2014-Present January 2016-present November 2018 ‘Simulation/Education Tr Curriculum Vitae Gourang Patel Chicago, IL Eall Quarter: 25 contact hours = Autonomic Nervous System Cardiovascular Pharmacology ‘Spring Quarter: 3 contact hours "Anticoagulant and antiplatelet therapies - Toxicology Assistant Professor Course Director Course: CDS 608 Pharmacology RUSH College of Health Sciences ‘Audiology Pharmacology Curriculum- 30 contact hours Assistant Professor Department of Anesthesiology Resident lectures: Pharmacology curriculum Topics: - Pharmacokinetics [PK] - Pharmacodynamics [PD] - Protein binding/Drug dissociation ~ Drug dosing in obese patients Assistant Professor Nurse Anesthesia Program [CRNA] Course: NSG 542 Pharmacology Cutriculum- 8 contact hours Topics: = Pharmacokinetics/Pharmacodynamics - Anaphylaxis = Drug-Drug Interactions Assistant Professor Perfusion Pharmacology PRF 523 ‘Course Director and lecturer- 9 contact hours Roosevelt College of Pharmacy Pharmacology- PHAR 632 Antiemetic therapies-1 hour Antiulcer therapies-1 hour 16Franklin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CR002735 oB649 - o6f Curriculun Vitaw Gourang Patel 1. Loh-Trivedi M and Patel GP “Surviving Sepsis Campaign 2008: A Focus on Pharmacotherapy’ Critical Care Simulation. Presented at the American College of Chest Physicians ACCP meeting, Philadelphia, PA. October 2008 2. Patel GP “Acute Management of Asthma” Critical Care Presentation. Presented at ‘American College of Chest Physicians (ACCP) meeting. Austin, TX. March 2008 3. Patel GP. “Optimizing Sedation and Analgesia in the ICU" Critical Care Bundle Course. Presented at American College of Chest Physicians (ACCP). Dundee, IL. June 2008 4, Sung A and Patel GP. “Treatment Approaches for Pulmonary Hypertension in the ICU" Critical Care Bundle Course. Presented at American College of Chest Physicians (ACCP). Dundee, IL. June 2009 6. Loh-Trivedi M and Patel GP “Alternatives to Propofol sedation in the ICU: A review of current sedation and analgesia” Presented at the American College of Chest Physicians (ACCP) meeting. San Diego, CA. October 2009 6. Patel GP. “Life-Threatening Infections: Diagnosis and Antimicrobial Therapy". Fundamentals in Critical Care Support (FCCS) sponsored by the SCCM. August 2013 — August 2017 Community Service Ronald McDonald House January 2015 Chicago Food Depository April 2016 Honors and Awards Society of Critical Care Medicine (SCCM) Presidential Citation: Contribution to Critical Care January 2018 Society of Critical Care Medicine (SCCM) Presidential Citation: Contribution to Critical Care January 2016 Member Spotlight December 2012 ical Pharmacy and Pharmacology Section Newsletter Society of Critical Care Medicine (SCCM) Society of Critical Care Medicine (SCCM) Presidential Citation: Contribution to Critical Care January 2014 GlaxoSmithkline Pharmaceutical Award in Patient Care May 2001 Recipient of Mark A. Gasaway Scholarship 2000-2001 7Franklin County Ohio Clerk of Co - pea ~ offpritin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CRO002735 Curriculum Vitaw Gourang Pate! Recipient of Wemer Scholarship 1999-2000 Saint Louis College of Pharmacy High Proficiency Scholarship 1997-2001 Saint Louis College of Pharmacy Dean's List 1996-2000 Clinical Research/Grants 41. March 2003-Auqust 2008 Trial: Randomized Trial of Norepinephrine versus Dopamine for Septic Shock Site: RUSH University Medical Center, Medical intensive Care Unit Role: Primary investigator Funding: None ‘january 2005- June 2008 Tfial: Prospective Review of Antibiotic Administration in Medical-Surgical Intensive Care Unis for Sepfic Shock. Medical Intensive Care Unit and Emergency Department. Site: RUSH University Medical Center Role: Co-Investigator Funding: Center for Clinical Research, RUSH Medical Center, amount of $1,000 3. January 2006-March 2008 ‘Tal: Retrospective Review of Candidemia Associated Septic Shock Site: RUSH University Medical Center Role: Primary investigator Funding: None 4, June 2009-July 2010 Trial: The Role of Simulation training with Pharmacy Practice Residents (PGY1/PGY2) in order to reduce adverse events with intravenous medications Site: RUSH University Medical Center Simulation Lab Role: Primary investigator Funding: Center for Teaching Excellence/Midwestern University and Chicago Colleges of Pharmacy for $2,500 5. April 2015. April 2016 Trial: Validation of septic gene ExpressioN Using Septicyte (VENUS) Site: Rush University Medical Center- Medical Intensive Care Unit Role: Co- Investigator 6. June 2016- present Trial: Safety of Oliceridine (TRV130) in patients with acute pain for which parenteral opioid therapy is warranted Site: Rush University Medical Center Primary Investigator: Adam Young, MD-Anesthesiology Role: Data Safety Monitoring Board (OSMB} 7, danuary 2017 ~ December 2019 18Franklin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CR002735 0B649 - 069 Curriculum Vitaw Gourang Patel ‘Trial: implementation of Pharmacy services in an out-patient CF clinic Site: Rush University Medical Center Role: Primary Investigator Funding: Cystic Fibrosis Foundation (CFF) Grant for $87,480 over 3 years 8, June 2017 — July 2018 ‘Trial: An evaluation of focal anesthetic efficacy and safety Evaluation of Patient Safety Based on Cumulative Local Anesthetic Exposure in the Perioperative Area Site: Rush University Medical Center Role: Primary Investigator Funding: Center for Clinical Research, RUSH University Medical Center, amount $2,000 Professional Affiliations/Leadership ‘American Academy of Clinical Toxicology (ACT) ‘Member American College of Chest Physicians (ACCP) Member Society of Critical Care Medicine (SCCM) Member ‘American College of Clinical Pharmacy (ACCP) Member Perioperative PRN Treasurer Gateway College of Clinical Pharmacy Member Rho Chi National Honor Society Beta-Kappa Chapter/ Member Saint Louis College of Pharmacy Fellowships The institute of Medicine of Chicago (IOMC) ‘American College of Critical Care Medicine (FCCM) Current Licensure and Certification Board Certified Critical Care Pharmacist (BCCCP) 19 2009-Present 2008-Present 2002-Present 2002-Present 2018-2019 2000-2002 1999- Present December 2015 January 2017 November 2015Franklin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CR002735 oB649 - 076 Basic Disaster Life Support (BDLS) Board Certified Pharmacotherapy Specialist (BCPS) Advanced Cardiac Life Support (ACLS) Registered Pharmacist by examination, Ilinois Registered Pharmacist by examination, Missouri Basic Cardiac Life Support (BLS) Revised 11/2018 Curriculum Vitao Gourang Patel July 2008, December 2002 November 2002 June 2002 October 2000 April 2000Franklin County Ohio Clerk of Courts of the Common Pleas- 2022 Mar 24 10:13 AM-19CR002735 oB649 - O71 Gourang P. Patel, PharmD Chicago, IL February 25", 2022 Jose Baez, Esq The Baez Law Firm 1200 Brickell Avenue Suite 620 Miami, FL 33131 Diane Menashe, Esq. Ice Miller LLP 250 West Street Suite 700 Columbus, OH 43215 Re: State of Ohio v. William S. Husel, 19-CR-02735 Dear Mr. Baez and Ms. Menashe, Ihave reviewed medical records which you provided in multiple cases over the last several months. Based upon my review of those medical records | have formed opinions on the effect of the medications given to patients during palliative withdrawals performed at Mount Carmel Hospital. The charts | have reviewed include the records of James Timmons, Bonnie Austin, Sandra Castle, Jeremia Hodge, Thomas Mathews, Beverly Schirtzinger, Troy Alison, Janet Kavanaugh, Danny Mollette, Michael Walters, Norma Welch, C.B. (redacted), Melissa Penix, R.H. (redacted), Jan Thomas, Sanders Young, James Allen, Joanne Bellisari, Larry Brigner, Timothy Fitzpatrick, and Brandy McDonald Itis my opinion that the withdraw of care is very time sensitive. When families decide to remove medical support, in many instances, it has been a difficult decision. The patient is in the ICU and many times unstable, and the family has made a decision to have their loved one pass off support. As such, time is of the essence. Unless otherwise directed by the family, the patient should be removed from life-support as soon as reasonably possible to avoid the possibility of further suffering or perishing on life-support against the wishes of the family. The decision as to the appropriate dose of medication to be used on end-of-life care is based upon many clinical factors. Because the goal is to relieve pain associated with dying, and itis a unique clinical situation and dosing guidelines are inapplicable. In the practice of palliative withdraw of life support, there are no maximum dosages. In fact, the Center for Disease Control and Prevention (CDC) in the proposed 2022 guidelines for prescribing opioids on the management of end-of-life care by physicians outline those maximum doses are not applicable in this particular setting. (Federal Registry 2/10/22)