A married couple living in Manhattan, New York, USA. The husband Gregg owns five dry cleaning stores in NYC. The wife Sheila writes cookbooks and volunteers regularly for the Help Center, a suicide hotline. They have one son, David, who is studying engineering at NYU. You are preparing their income tax return for the current tax year. In September of the current year, you call Gregg and Sheila to find out if they have questions about year-end tax planning. The following scenarios pertain to transactions they engaged in this year:

1. Gregg is self-employed and this year he spent $1,800 on suits, shirts and shoes to wear while meeting with investors in his franchise of dry cleaners. Sheila is a writer and on her book tour the publisher requires that she wear suits, high heels and appropriate jewelry. The cost of those items for Sheila this year was $6,750. Under what circumstances may this couple deduct the cost of these work clothes?

2. Their son David is a junior at NYU. For his first two years he was eligible for scholarships which paid all of his tuition and expenses. Beginning in Fall of the current year, however, Gregg and Sheila are paying for his tuition and fees, though he will still receive a scholarship for room and board. In addition, they paid for a study abroad trip to Oxford for David in June/July of the current year, which included tuition and fees for the course he took there, as well as travel costs, room and board. They would like to know the tax treatment of these items. Also, their friend Helen told them they could have avoided this issue to begin with by saving in advance through other tax beneficial options. Gregg does not believe him and wants to know what they could have done differently.

A Sudden Pain

One Monday morning in early 2004 my husband Jerry woke me and said his back was hurting. When the pain became severe we decided to go to the emergency room. At the emergency room, they treated him for the pain with several rounds of narcotics, including injections of morphine and Dilaudid. The emergency room doctor arrived and ordered a CT scan. When the CT scan results came back, the emergency room physician said that it looked as though Jerry was passing a kidney stone. Jerry was admitted to the medical-surgical unit for observation and pain management.

The hospital suggested a urologist, who v

visited us that afternoon. The urologist confirmed that there was a kidney stone but said the CT scan also had shown a small mass within the kidney. He wanted to do an additional test, with dye, to see the mass.

Jerry was given morphine and the painkiller Toradol (ketorolac) by intravenous injection every 4 hours through the night and into the following day. They also set up IV fluids to help wash out the kidney stone.

The next morning, Tuesday, Jerry was supposed to have a CT scan with dye to get a better look at the mass in his kidney. I went to school to prepare lesson plans in anticipation of being away from class. When I returned to the hospital, Jerry told me that they had not done the test because something was wrong. So I found a nurse, who said that Jerry’s blood work had shown his serum creatinine level was rising. They did not want to perform the dye test until these kidney function test results looked better.

Jerry continued to receive Toradol throughout the day even though his pain was well controlled. I asked a nurse if this kind of high creatinine level was normal for a person with a kidney stone. She told me that it was probably caused by the Toradol and explained that nonsteroidal anti-inflammatory drugs like Toradol can cause the creatinine level to rise. She told me Jerry was getting too much Toradol.

This nurse was an RN—a registered nurse—but I did not realize this at the time. The nurses’ badges did not designate whether they were an RN or a licensed vocational nurse (LVN). The attire was the same for all nurses, so I could not distinguish between them. The hospital’s policy was to use RNs only as “resource” nurses. There were only two registered nurses on the floor, and they were not assigned to specific patients. The bedside nurses taking care of the patients were LVNs. So if an LVN needed to give a medication that she was not authorized to give, the LVN had to find a registered nurse who could administer the medication. I did not understand at the time that this was the policy.

When the doctor came to the room on Tuesday evening around 5:30, I mentioned Jerry’s creatinine level and told him what the nurse had said. While the doctor was in the room his three pagers went off at various times, all while we were trying to have a conversation about Jerry. When I brought up the creatinine a second time, he told us he would discontinue the Toradol and restart the IV fluids to get the creatinine level down.

By 7:00 that night they still had not started the IV fluids. When the night shift nurse came in, she told me there had been no order placed for this request. At my insistence, she called the doctor, and later she started the IV and discontinued the Toradol. At that time, Jerry’s pain medication was changed to a Lortab tablet every 4 hours because his pain level was now only about 2 on a scale of 1–10.

On Wednesday morning I dropped by the hospital and then I went on to school. Around noon Jerry called and asked me to come back to the hospital. He said they were trying to explain something to him but he could not understand because the medication was making him feel confused. So I arranged for a substitute teacher for the afternoon and returned to the hospital.

I stayed with Jerry throughout the evening. About 7:15 that evening the bedside nurse (an LVN) came in with medication. Jerry told her he was not going to take it because it was making him feel odd and his pain level was minimal. The LVN told him that he needed to maintain his pain relief regimen, but Jerry refused the Lortab. He told her that if he needed the medication he would let her know. I left the hospital about 8:00 that evening, as our son Jordan had come to visit Jerry. They watched basketball and talked politics until around 9:00 p.m., when Jordan left the hospital.

Jerry was set to go home the next morning. We were just waiting for results of the morning blood test to confirm that his creatinine level had come down so that he could be discharged. Because the CT scan with dye had not been done, Jerry was scheduled for an MRI after discharge because the hospital did not offer open MRI services. His pain was minimal and manageable with Lortab, so the doctor had told Jerry he could leave the hospital to get the MRI and follow up after the doctor’s office had received the images.

Your Husband Is Dead

The following morning, Thursday, January 22, the phone rang at 5:50 a.m. I thought it must be Jerry because when he was away from home he would often call early in the morning to say good morning. The person on the phone told me that my husband had had an emergency and that I needed to come to the hospital immediately. When I asked what had happened, she said there had been an emergency and a urologist was in with him now. She asked how long it would take me to get to the hospital. I said about 5 minutes. I was terrified. She had given me no information about my husband’s “emergency.” I assumed because a urologist was with him that he was passing the kidney stone and that something had happened related to the kidney stone.

I dashed to the hospital and ran up to the second floor where Jerry’s room was. As I entered the waiting area I saw our son. At that moment my heart stopped. A nurse I had never seen before came walking toward me as I started down the hall to Jerry’s room; she took Jordan and me into an empty patient room. The nurse looked at me and said, “Your husband is dead.” I was absolutely stunned. This could not be true. I kept repeating, “No! No!”

A young woman who was standing with the nurse told us that pain medication had been given to Jerry sometime in the early morning hours. She was crying as she told us this. I learned later that she was the new on-call attending physician for the urology group. She had only recently finished her residency. She had never seen Jerry before but had been called to the hospital when the staff discovered that Jerry was dead.

The nurse repeated to me several times, “Your husband died peacefully in his sleep. You can take comfort in that.” At that point, I ran out of that room and into Jerry’s room, and he did look asleep, except that there were tubes inserted into his mouth and I saw a catheter hanging on his bed. The room was nice and neat, and Jerry was lying on his back with his hands on his chest. It all looked surreal.

My shock was so complete that I tried to wake Jerry—tried shaking him—finally collapsing in screams and sobs. The same nurse stood in the doorway and said again, “He looks like he is just sleeping, doesn’t he? Doesn’t he look peaceful?”

The young doctor who had told us about Jerry’s death was gone. I asked again and again what had happened, but we could not get anyone to answer any specific questions. When I asked about the tubing and the catheter, the nurse said they had called a code and that a full resuscitation with intubation was standard procedure. A nurse came into the room some time later and asked if we wanted the tubes removed. I said, “No, don’t change anything.” I did not want anything changed because I did not know what had happened.

During that morning I questioned nurses and the administrator who had come in to talk to us. I kept receiving the same news—that Jerry had died peacefully in his sleep. The administrator asked us about funeral arrangements, and a nurse brought in a release form. I asked about the county medical examiner. Had he been called? When would someone come to begin the investigation? The nurse told me that the medical examiner’s office was “not interested in investigating” Jerry’s death. I was stunned. I asked, “What did you tell them about the cause of his death?”

She replied, “Renal failure.”

Again, I was shocked. I knew for certain that his death was not caused by renal failure. Just a few hours ago, Jerry had been in minimal pain, talking, laughing, and watching basketball. There had never been any mention of renal failure. We later learned that the Harris County medical examiner’s office had no record of a call from the hospital about Jerry’s death. A representative from that office gave a sworn affidavit attesting to “no record of a call concerning Jerry Carswell” received from the hospital.

I told the hospital administrator that I wanted an autopsy. Jerry was supposed to come home, he had no other health problems, he was taking no other medications, and he had been active. The nurse told me that the urologist had already ordered an autopsy. I asked how that worked. Did they do them here or somewhere else? The nurse said they would do the autopsy at a hospital in downtown Houston. I told her that I did not want the hospital where Jerry had died to perform the autopsy, because I wanted an independent autopsy. The nurse replied that an autopsy could cost up to $10,000. At this point I did not care how much it might cost; I just wanted it to be complete so I could find out what had happened. Jordan and I talked this over—we wanted an autopsy that would tell us why Jerry had died.

A nurse brought me the document to request the autopsy. She assured me that the autopsy conducted by the hospital would be “just like” an autopsy I would get from an independent pathologist. There was a place to mark if I wanted a partial autopsy or anything specific. I wrote on the paper, “Complete Autopsy,” and signed it.

At one point the hospital administrator came into the room and announced that it was “time for us to go home.” I told her I wanted to be there when the funeral home transported Jerry’s body out of the hospital. I again stated that I did not want anything removed from Jerry’s body, and I specifically requested that the urine from the catheter bag go to the autopsy. Later, around noon, the administrator came back in and told us the funeral home was on their way to transport Jerry’s body for autopsy. She literally placed her hand on my back and pushed me toward the door of the room. We all then left the hospital and went home. Later, I learned that the funeral home did not arrive at the hospital until more than an hour later.

There are no adequate words to describe what I felt like leaving the hospital, the reality of the cold air when I got outside, of what had just happened inside that building. Jerry was gone. I could not absorb that fact, or that I had just signed for an autopsy when I had never before had any occasion even to think about an autopsy, or the fact that no one at the hospital would tell us anything specific about how Jerry died. There I was, going back home alone—this surely was some terrible nightmare.

Looking for Answers

When I went home, I called friends, and they called friends, and by the next day the Houston Chronicle published a story in the sports section about the loss of this man whom everyone in the area knew. There was an outpouring of response from coaches in the area and from the students Jerry had coached. His death was a great loss to many people.

While we were mourning his loss, Jerry’s body was being transferred to the pathology lab at the hospital in Houston. The autopsy was done there. But it turned out that this hospital was a sister hospital to the one where Jerry had died. It was not the independent autopsy we thought we were getting.

We later found that there are two distinct kinds of autopsy procedures. Clinical autopsies, the kind usually done in hospitals, do not include the same investigative procedures that a forensic autopsy does. Even though a large dose of narcotics had been administered to Jerry prior to his death, Jerry’s autopsy did not include toxicology screening that would have been done by the medical examiner or by an independent pathologist in what is called a forensic autopsy. Jerry’s autopsy was done by a pathologist who testified that he had never done a toxicology screen in an autopsy, not once in his 20+ years of working for that hospital pathology group. The pathologist did not test the urine that remained in the body. The urine bag that I had seen in the hospital room disappeared. A hospital pathologist said the bag was not with the body when it arrived in the lab.

Shortly after Jerry was buried, I went to the hospital and got his records. When I read the report from the emergency room doctor who had been called to the code, it said that Jerry had been found lying across the bottom of the bed as if he had been trying to get up. The urologist’s report said the same thing. This was in direct conflict with what I had been told at the hospital, that he had “died peacefully” in his sleep.

That is the point at which I decided I needed more information. The attending urologist from the hospital helped us get the autopsy report, but he never answered my questions about why there were two conflicting stories. The hospital did not return my calls.

When we received the death certificate, there was no cause of death listed. We still, even now, do not have an official cause of death. The death certificate listed three conditions present prior to death. These had to do with an irritation in the lining of Jerry’s stomach and in the pyloric area, both of which we believe were probably side effects of the Toradol and not underlying conditions; Jerry had no indication of any kind of medical distress other than the kidney stone until we came to the hospital. Ironically, the autopsy report showed no kidney stone on the right side where Jerry’s pain had been. It noted a small stone on the other side still in the kidney. It also noted the small mass and said it “appears confined to the kidney.”

After seeing Jerry’s medical records, I talked with a friend who encouraged me to contact an attorney to see if we could find out what had caused Jerry’s sudden and unexpected death. We then entered a long and difficult legal process that I wish we had not had to do. In that process we discovered a number of issues that were very disturbing.

One key issue was that the amount of the medication Toradol that Jerry had been given was far in excess of the strict limits recommended for this drug. This explained why the drug had such an adverse effect on his kidneys. Another was that the LVN who was administering the Toradol was not allowed by hospital policy to administer this class of drug and did not have sufficient training in the purpose of the drug or its possible side effects, which include adverse effects on the kidneys. Because the RNs were floaters and were not assigned to specific patients, there was no real monitoring or oversight of the bedside LVN nurses.

We also discovered that just before midnight on the night Jerry died, the same LVN had written details in Jerry’s chart about giving pain medication to a knee surgery patient. She had detailed the angle the knee was positioned in and things like that. By the time we saw the records, this information had been lined out. The correction was initialed and dated January 22, the morning of Jerry’s death, indicating to us that Jerry’s LVN had not noticed her mistake during the night that Jerry died. Personnel records showed that this LVN had taken many extra shifts that week—more than twice the hours of any other nurse. I am not sure what mental state she was in the night of Jerry’s death, but she definitely placed the wrong information in Jerry’s record. As part of the correction done after Jerry’s death, she reported that she had administered Lortab to Jerry about 1:00 a.m. We wondered if she could have given him the Lortab and the surgery patient’s medication, too.

Jerry’s records reflect a call to the on-call urologist saying that Jerry had been in level 9–10 pain since 1:00 a.m. At 3:15 a.m., according to the medication record, a nurse—it is unclear which nurse—administered a bolus does of 75 mg of Demerol and 25 mg of Phenergan. In trial, a laboratory technician stated she encountered two nurses coming out of Jerry’s room with a syringe at 5:00 a.m. There is no record of a 5:00 a.m. medication administration, however. When the lab tech entered the room around 5:15 a.m. to draw blood, she found Jerry’s lifeless body.

It was a year before we sought legal recourse, but in the end we felt we had no choice. The legal process was slow and stalled repeatedly for various reasons, including changes in hospital ownership. The hospital was uncooperative, and the judge sanctioned them for spoliation and destruction of evidence. The hospital mounted an unsuccessful challenge against both the sanctions and our requests for evidence. Then the hospital where the autopsy had been done filed for bankruptcy. All told, it took us 5 and a half years to get into a courtroom. When we finally got there, the hospital administrator and nurses denied under oath that they had ever spoken to Jordan and me about the funeral home or the autopsy. This was proven not true by funeral home documents and by the testimony of other people who had been present that morning.

The jury vote fell two votes short of the number required for a negligence verdict in Texas. Several jurors later stated to my attorney that because there was no official cause of death, they felt there were too many unanswered questions to make a determination, even though they felt that the hospital had caused Jerry’s unexpected death. The jury voted in our favor on the post-mortem fraud, finding that the statements hospital personnel made to me had led me to believe the autopsy would be “complete” and would be an investigation into the cause of Jerry’s death. In a unanimous vote, the jury added punitive damages as a punishment for what they considered the hospital’s egregious misconduct.

Conclusion

One of the most shocking things to come out of the lawsuit occurred during the pathologist’s deposition. He stated that he had removed Jerry’s “whole heart” and retained it in his lab. The pathologist did not request permission or inform me that he had retained Jerry’s heart and stored it in an unmarked plastic bucket in the pathology lab. We had buried Jerry without his heart, a disturbing and painful realization that haunts us still.

I became convinced that Texas needed a state-promulgated consent form for autopsy so that families could be informed about their rights concerning autopsies. In addition to Jerry’s heart being removed without our knowledge, Jerry’s death met three of the six conditions that Texas law specifies as requiring a death investigation or forensic autopsy. I went to my state representative and asked him to sponsor a bill that would require hospitals to use an “informed consent” for autopsy, a document that would inform families of their legal rights. The Jerry Carswell Memorial Act passed the Texas legislature in 2011, and now every medical institution in the state must use this form when they ask for permission to do an autopsy. The form lists the conditions under which state law says there must be a death investigation and states that the patient’s family has the right to request an independent pathologist to attend or perform the autopsy (Figure 15-1).

Questions

What do you think Jerry Carswell’s nurses and doctors could have done to protect against the adverse outcome that occurred?

What steps do you think the hospital should have taken to avoid the suspicions and antagonisms that immediately arose between this family and the hospital?

Consider the legal process in this lengthy case from both the hospital’s and the family’s point of view. Is this the best way to handle this situation?

Should more autopsies be mandated? Read some of the literature on autopsy findings and discuss whether you think a high autopsy rate is a good idea.

Look up the differences between forensic and clinical autopsies. Should toxicology screening be required in hospital autopsies?

Which of the core competencies for health professions are most relevant for this case ?why?

Jessica is a 30 year old immigrant from Mexico City. She and her husband Marco have been in the U.S for the last three years and have finally earned enough money to move out of their aunt home and into an apartment of their own. They are both hard workers. Jessica works 50 hours a week at a local restaurant, and Marco has been contracting side jobs in construction. Six months before their move to an apartment, Jessica finds out she is pregnant. Four months later, Jesssica and Marco arrive at the county hospital, a large, public, nonteaching hospital. A preliminary ultrsaound indicates a pssible abnormality with the fetus. Further scans are conducted and it determind that the fetus has a rare condition in which it has not developed any arms, and will not likely develop them. There is also a 25% chance that the fetus may have down syndrome. Dr. Wilson, the primary attending physician is seeing Jessica for the first time, since she and Marco did not receive earlier prenatal care over concerns about finances. Marco insists that Dr. Wilson refrain from telling Jessica the scan results, assuring him that he will tell his wife himself when she is emotionally ready for the news. While Marco and Dr. Wilson are talking in another room, Aunt Maria walks into the room with adistressed look on her face. She can tell that something is wrong and inquires of Dr. Wilson. After hearing of the diagnosis, she walks out of the room wailing loudly and praying out loud. Marco and Dr. Wilson continues their discussion and Dr. Wilson insists that he has an obligation to Jessica his patient and that she has a right to know the diagnosis of the fetus. He furthermore is intent to discussing all relevant factors and options regrading the next step, including abortion. Marco insists on taking some time to think of how to break the news to Jessica, but Dr. Wilson, frustrated with the direction of the conversation, informs husband that such a choice is not his to make. Dr. Wilson proceeds back across the hall, where he walks in on Aunt Maria awkwardly praying with Jessica and phoning the priest. At that point, Dr. Wilson gently but briefly informs Jessica of the diagnosis, and lays out the option for abortion as a responsible medical alternative, given the quality of life such a child would have. Jessica looks at him and struggles to hold back hers tears. Jessica is torn between her hopes of a better socioeconomic position and increased independence, along with her conviction that all life is sacred. Marco will support Jessica in whatever decision she makes, but is finding it difficult to not view the pregnancy and prospects of a disabled child as aburden and a barrier to their economic security and plans. Dr. Wilson lays out all of the options but clearly makes his view known that abortion is "scientifically" and medically a wise choice is this situation. Aunt Maria pleads with Jessica to follow through with the pregnancy and allow what "God intends" to take place, and urges Jessica to think of her responsibility as a mother. Write a 500-750 word analysis of this situation be sure to address the following questions. Which theory or theories are being used by Jessica, Marco, Maria and Dr. Wilson to determine the moral status of the fetus? Explain? How does the theory determine or influence each of their recommendation for action? What theory do you agree with? How would the theory determine or influence the recommendation for action? Please cite all sources.

Jessica is a 30 year old immigrant from Mexico City. She and her husband Marco have been in the U.S for the last three years and have finally earned enough money to move out of their aunt home and into an apartment of their own. They are both hard workers. Jessica works 50 hours a week at a local restaurant, and Marco has been contracting side jobs in construction. Six months before their move to an apartment, Jessica finds out she is pregnant. Four months later, Jesssica and Marco arrive at the county hospital, a large, public, nonteaching hospital. A preliminary ultrsaound indicates a pssible abnormality with the fetus. Further scans are conducted and it determind that the fetus has a rare condition in which it has not developed any arms, and will not likely develop them. There is also a 25% chance that the fetus may have down syndrome. Dr. Wilson, the primary attending physician is seeing Jessica for the first time, since she and Marco did not receive earlier prenatal care over concerns about finances. Marco insists that Dr. Wilson refrain from telling Jessica the scan results, assuring him that he will tell his wife himself when she is emotionally ready for the news. While Marco and Dr. Wilson are talking in another room, Aunt Maria walks into the room with adistressed look on her face. She can tell that something is wrong and inquires of Dr. Wilson. After hearing of the diagnosis, she walks out of the room wailing loudly and praying out loud. Marco and Dr. Wilson continues their discussion and Dr. Wilson insists that he has an obligation to Jessica his patient and that she has a right to know the diagnosis of the fetus. He furthermore is intent to discussing all relevant factors and options regrading the next step, including abortion. Marco insists on taking some time to think of how to break the news to Jessica, but Dr. Wilson, frustrated with the direction of the conversation, informs husband that such a choice is not his to make. Dr. Wilson proceeds back across the hall, where he walks in on Aunt Maria awkwardly praying with Jessica and phoning the priest. At that point, Dr. Wilson gently but briefly informs Jessica of the diagnosis, and lays out the option for abortion as a responsible medical alternative, given the quality of life such a child would have. Jessica looks at him and struggles to hold back hers tears. Jessica is torn between her hopes of a better socioeconomic position and increased independence, along with her conviction that all life is sacred. Marco will support Jessica in whatever decision she makes, but is finding it difficult to not view the pregnancy and prospects of a disabled child as aburden and a barrier to their economic security and plans. Dr. Wilson lays out all of the options but clearly makes his view known that abortion is "scientifically" and medically a wise choice is this situation. Aunt Maria pleads with Jessica to follow through with the pregnancy and allow what "God intends" to take place, and urges Jessica to think of her responsibility as a mother. Write a 500-750 word analysis of this situation be sure to address the following questions.

1. Which theory or theories are being used by Jessica, Marco, Maria and Dr. Wilson to determine the moral status of the fetus? Explain?

Jessica is a 30 year old immigrant from Mexico City. She and her husband Marco have been in the U.S for the last three years and have finally earned enough money to move out of their aunt home and into an apartment of their own. They are both hard workers. Jessica works 50 hours a week at a local restaurant, and Marco has been contracting side jobs in construction. Six months before their move to an apartment, Jessica finds out she is pregnant. Four months later, Jesssica and Marco arrive at the county hospital, a large, public, nonteaching hospital. A preliminary ultrsaound indicates a pssible abnormality with the fetus. Further scans are conducted and it determind that the fetus has a rare condition in which it has not developed any arms, and will not likely develop them. There is also a 25% chance that the fetus may have down syndrome. Dr. Wilson, the primary attending physician is seeing Jessica for the first time, since she and Marco did not receive earlier prenatal care over concerns about finances. Marco insists that Dr. Wilson refrain from telling Jessica the scan results, assuring him that he will tell his wife himself when she is emotionally ready for the news. While Marco and Dr. Wilson are talking in another room, Aunt Maria walks into the room with adistressed look on her face. She can tell that something is wrong and inquires of Dr. Wilson. After hearing of the diagnosis, she walks out of the room wailing loudly and praying out loud. Marco and Dr. Wilson continues their discussion and Dr. Wilson insists that he has an obligation to Jessica his patient and that she has a right to know the diagnosis of the fetus. He furthermore is intent to discussing all relevant factors and options regrading the next step, including abortion. Marco insists on taking some time to think of how to break the news to Jessica, but Dr. Wilson, frustrated with the direction of the conversation, informs husband that such a choice is not his to make. Dr. Wilson proceeds back across the hall, where he walks in on Aunt Maria awkwardly praying with Jessica and phoning the priest. At that point, Dr. Wilson gently but briefly informs Jessica of the diagnosis, and lays out the option for abortion as a responsible medical alternative, given the quality of life such a child would have. Jessica looks at him and struggles to hold back hers tears. Jessica is torn between her hopes of a better socioeconomic position and increased independence, along with her conviction that all life is sacred. Marco will support Jessica in whatever decision she makes, but is finding it difficult to not view the pregnancy and prospects of a disabled child as aburden and a barrier to their economic security and plans. Dr. Wilson lays out all of the options but clearly makes his view known that abortion is "scientifically" and medically a wise choice is this situation. Aunt Maria pleads with Jessica to follow through with the pregnancy and allow what "God intends" to take place, and urges Jessica to think of her responsibility as a mother. Write a 500-750 word analysis of this situation be sure to address the following questions.

2. How does the theory determine or influence each of their recommendation for action? What theory do you agree with?

1.  Kerry’s vehicle was struck by a drunk driver who ran a stop sign.  Kerry’s husband, who was a passenger in Kerry’s car, was killed in the accident.  Kerry was hospitalized after the accident and her medical bills totaled $22,600.  Due to the injuries Kerry suffered in the accident, she was unable to work for two months.  She lost $10,000 in work earnings.  Six months after the accident, Kerry was still experiencing severe pain in her lower back.  Kerry sued the driver of the other vehicle.  The other driver did not have a driver’s license or auto insurance because he had been arrested previously for driving while intoxicated three times.       

   a.  Kerry won the lawsuit because the other driver was determined to have been negligent.  Explain how the four-part test of whether an act is negligent was satisfied in this case.  (2 points)    

   b.  What type of damages:  general damages, special damages, or punitive damages   do each of the following represent?  (half-point each, provide one answer for each part – general damages, special damages, or punitive damages)

      1.  The judge ordered the drunk driver to pay Kerry $100,000 for the loss of her spouse / life partner.   

     2.  The judge was so angry at the repeat-offender drunk driver that he ordered him to pay Kerry an additional $100,000 to “make an example out of his egregious behavior.”

   3.  The judge ordered the drunk driver to pay Kerry $22,600 for her medical expenses.  

Case: Rollie Hendrix is a 35-year-old husband and father of three children. Over the past six months he has experienced headaches and palpitations of increasing frequency and severity. In addition, he has periods of intense anxiety and panic attacks. His wife Arlene has noticed that Rollie’s face is often pale and that he sweats more. Upon examination by his physician, Rollie was found to be severely hypertensive and in atrial fibrillation. Rollie’s physician suspected that he might have a Pheochromocytoma and ordered a battery of tests, which confirmed his diagnosis.

What is a Pheochromocytoma? Explain the cardiovascular effects of epinephrine and norepinephrine when they bind to adrenergic receptor types. Why are patients with a pheochromocytoma often hyperglycemic, sweat excessively, and be constipated? How should Rollie be treated (Do not put the obvious answer to remove tumor)?

CASE 4.1

Manchester United Soccer Club

Nicolette Larson was loading the dishwasher with her husband, Kevin, and telling him about the first meeting of the Manchester United Tournament Organizing Committee. Nicolette, a self-confessed “soccer mom,” had been elected tournament director and was responsible for organizing the club’s first summer tournament.

Manchester United Soccer Club (MUSC), located in Manchester, New Hampshire, was formed in 1992 as a way of bringing recreational players to a higher level of competition and preparing them for the State Olympic Development Program and/or high school teams. The club currently has 24 boys and girls (ranging in age from under 9 to 16) on teams affiliated with the New Hampshire Soccer Association and the Granite State Girls Soccer League. The club’s board of directors decided in the fall to sponsor a summer invitational soccer tournament to generate revenue. Given the boom in youth soccer, hosting summer tournaments has become a popular method for raising funds. MUSC teams regularly compete in three to four tournaments each summer at different locales in New England. These tournaments have been reported to generate between $50,000 and $70,000 for the host club.

MUSC needs additional revenue to refurbish and expand the number of soccer fields at the Rock Rimmon soccer complex. Funds would also be used to augment the club’s scholarship program, which provides financial aid to players who cannot afford the $450 annual club dues.

Nicolette gave her husband a blow-by-blow account of what transpired during the first tournament committee meeting that night. She started the meeting by having everyone introduce themselves and by proclaiming how excited she was that the club was going to sponsor its own tournament. She then suggested that the committee brainstorm what needed to be done to pull off the event; she would record their ideas on a flipchart.

What emerged was a free-for-all of ideas and suggestions. One member immediately stressed the importance of having qualified referees and spent several minutes describing in detail how his son’s team was robbed in a poorly officiated championship game. This was followed by other stories of injustice on the soccer field. Another member suggested that they needed to quickly contact the local colleges to see if they could use their fields. The committee spent more than 30 minutes talking about how they should screen teams and how much they should charge as an entry fee. An argument broke out over whether they should reward the winning teams in each age bracket with medals or trophies. Many members felt that medals were too cheap, while others thought the trophies would be too expensive. Someone suggested that they seek local Page 126corporate sponsors to help fund the tournament. The proposed sale of tournament T-shirts and sweatshirts was followed by a general critique of the different shirts parents had acquired at different tournaments. One member advocated that they recruit an artist he knew to develop a unique silk-screen design for the tournament. The meeting adjourned 30 minutes late with only half of the members remaining until the end. Nicolette drove home with seven sheets of ideas and a headache.

As Kevin poured a glass of water for the two aspirin Nicolette was about to take, he tried to comfort her by saying that organizing this tournament would be a big project not unlike the projects he worked on at his engineering and design firm. He offered to sit down with her the next night and help her plan the project. He suggested that the first thing they needed to do was to develop a WBS for the project.

Questions:

1. Make a list of the major deliverables for the project and use them to develop a draft of the work breakdown structure for the tournament that contains at least three levels of detail. What are the major deliverables associated with hosting an event such as a soccer tournament?

2. How would developing a WBS alleviate some of the problems that occurred during the first meeting and help Nicolette organize and plan the project?

3. Where can Nicolette find additional information to help her develop a WBS for the tournament?

4. How could Nicolette and her task force use the WBS to generate cost estimates for the tournament? Why would this be useful information?

I and my husband Jatin have total amount of $150,000 in our savings account. We have 3 school going kids. We want to buy a new home, a new car and keep funds for children higher education.

We finalized to buy a home for $760,000. We may use $120,000 of our savings as a down payment on it. For balance financing the mortgage specialist/agent gave us the following options:

1. Option 1: a 25-year mortgage/loan, with semi-monthly payments (at the end of each period). The interest rate on the mortgage is 3.26% APR (annual percentage rate) compounded semi-annually.

Ques 1. What will the semi-monthly payment be on the Option 1 mortgage?

Please use (display + name) the excel function/ formula used for each yellow cell.

2. Option 2: a monthly payment of $2,900 to be made at the end of each period. The interest rate with this option would be 3.60% APR (annual percentage rate) compounded semi-annually.

Ques 2. How many years will Option 2 mortgage be amortized over? Please use (display + name) the available excel function/ formula in each yellow cell .

Ques 3. To buy a new car of $45,000 (including taxes). In exchange of our old car for $10,000 and $10,000 from our savings as a down payment, the car dealer would provide the $25,000 balance as a 5-year loan paid semi-monthly at 4.8% ANNUAL RATE compounded semi-monthly. What will the payment be on the loan for the car as per below information? Please use (display + name) the excel function/ formula used for each yellow cell.