Foord v. Memorial Hospital at North Conway NH et al
ORDER granting 81 Motion for Summary Judgment. Concord Hospitals motion for summary judgment is granted as to Dr. Foords EMTALA claim. The state law claims against Concord Hospital are dismissed without prejudice. So Ordered by Magistrate Judge Andrea K. Johnstone.(kad)
UNITED STATES DISTRICT COURT
FOR THE DISTRICT OF NEW HAMPSHIRE
William D. Foord, MD, individually
and as Trustee and Executor of
the Estate of Carol C. Foord
Capital Region Health Care Corp.
d/b/a Concord Hospital et al.
Case No. 17-cv-596-AJ
Opinion No. 2020 DNH 011
The plaintiff, William Foord, M.D. (“Dr. Foord”), brings
this action alleging that his wife, decedent Carol Foord (“Ms.
Foord”), received inadequate care from several medical providers
prior to her death on November 24, 2015. 1
Doc. no. 51.
Foord seeks recovery for violations of the Emergency Medical
Treatment and Active Labor Act (“EMTALA”), 42 U.S.C. § 1395dd,
medical malpractice, and loss of consortium. 2
One of the
defendants, Capital Region Health Care Corp. d/b/a Concord
Hospital (“Concord Hospital”), moves for summary judgment.
Dr. Foord objects.
Doc. no. 90.
For the reasons that
The amended complaint alleges that Ms. Foord died on November
26, 2015, but Dr. Foord identified her actual date of death as
November 24, 2015 in his deposition. See doc. no. 81-2 at 1.
2 Dr. Foord brings the medical malpractice and loss of consortium
counts under New Hampshire law.
follow, the motion is granted as to the EMTALA claim and the
state law claims are dismissed without prejudice. 3
Summary Judgment Standard
Summary judgment is appropriate where “there is no genuine
dispute as to any material fact and the movant is entitled to
judgment as a matter of law.”
Fed. R. Civ. P. 56(a); see also
Xiaoyan Tang v. Citizens Bank, N.A., 821 F.3d 206, 215 (1st Cir.
“An issue is ‘genuine’ if it can be resolved in favor of
either party, and a fact is ‘material’ if it has the potential
of affecting the outcome of the case.”
Xiaoyan Tang, 821 F.3d
at 215 (quoting Pérez–Cordero v. Wal–Mart P.R., Inc., 656 F.3d
19, 25 (1st Cir. 2011)) (internal quotation marks omitted).
the summary judgment stage, the court “view[s] the facts in the
light most favorable to the non-moving party” and “draw[s] all
reasonable inferences in the nonmovant's favor . . . .”
v. Nat’l R.R. Passenger Corp., 844 F.3d 307, 312 (1st Cir. 2016)
(first quoting Rodriguez–Cuervos v. Wal–Mart Stores, Inc., 181
F.3d 15, 19 (1st Cir. 1999); then quoting Pina v. Children's
Place, 740 F.3d 785, 795 (1st Cir. 2014)).
The court will not,
however, credit “conclusory allegations, improbable inferences,
and unsupported speculation.”
Fanning v. Fed. Trade Comm’n, 821
As the court declines to exercise supplemental jurisdiction
over Dr. Foord’s state law claims, it need not consider Concord
Hospital’s request for summary judgment on those claims.
F.3d 164, 170 (1st Cir. 2016) (quoting Méndez–Aponte v. Bonilla,
645 F.3d 60, 64 (1st Cir. 2011)), cert. denied, 137 S. Ct. 627
“A party moving for summary judgment must identify for the
district court the portions of the record that show the absence
of any genuine issue of material fact.”
Flovac, Inc. v. Airvac,
Inc., 817 F.3d 849, 853 (1st Cir. 2016).
Once the moving party
makes the required showing, “the burden shifts to the nonmoving
party, who must, with respect to each issue on which [it] would
bear the burden of proof at trial, demonstrate that a trier of
fact could reasonably resolve that issue in [its] favor.”
(quoting Borges ex rel. S.M.B.W. v. Serrano–Isern, 605 F.3d 1, 5
(1st Cir. 2010)).
“This demonstration must be accomplished by
reference to materials of evidentiary quality, and that evidence
must be more than ‘merely colorable.’”
Id. (citation omitted)
(quoting Anderson v. Liberty Lobby, Inc., 477 U.S. 242, 249
The nonmoving party’s failure to make the requisite
showing “entitles the moving party to summary judgment.”
The relevant facts, viewed in the light most favorable to
Dr. Foord, are as follows.
On November 14, 2015, Ms. Foord
presented at Memorial Hospital’s (“Memorial”) Emergency
Department with numbness and sensory deficit on the left side of
her body, along with hemi-paralysis and deadweight on her left
Doc. no. 90 at 3.
She was examined by Dr. James
Clifford, who consulted with a radiologist.
Doc. no. 81-1 at 2. 4
Ms. Foord’s providers at Memorial reviewed her tests and
concluded that her symptoms were caused by old brain
calcifications, not a subarachnoid hemorrhage.
recommended that Ms. Foord follow up with her primary care
The next day, she called her PCP, who
advised her to go to Maine Medical Center (“MMC”).
Doc. no. 81-
2 at 2-3.
On November 16, Ms. Foord presented to MMC and was examined
by a neurologist, who recommended that she stay overnight and
undergo magnetic resonance imaging (“MRI”) and magnetic
resonance angiography (“MRA”) tests. 5
Doc. no. 81-1 at 2.
However, the Foords left MMC against medical advice.
81-2 at 4.
The next day, November 17, Ms. Foord called her PCP
to arrange for imaging studies at Memorial, but her insurer did
not approve them.
Id. at 5.
On November 18, Ms. Foord again
The court may rely on Concord Hospital’s narrative for facts
that have not been opposed by Dr. Foord. See LR 56.1(b) (“All
properly supported material facts set forth in the moving
party’s factual statement may be deemed admitted unless properly
opposed by the adverse party.”).
An MRA “is a noninvasive test that is used in evaluating the
blood vessels in a patient’s brain and neck.” Gage v. Rymes
Heating Oils, Inc., No. 14-cv-480-PB, 2016 WL 843262, at *3 n.2
(D.N.H. Mar. 1, 2016).
attempted to have the studies done at Memorial, but her insurer
had still not approved them.
her to Concord Hospital.
Ms. Foord’s PCP then referred
On November 19, 6 Ms. Foord presented at Concord Hospital’s
Doc. no. 81-4 at 5.
When the Foords
arrived, they were triaged “quite immediately.”
Doc. no. 81-2
Ms. Foord underwent an evaluation of her chief complaint,
assessment of her airway, breathing, circulation, and mental
status, and performance of her vital signs, including
temperature, blood pressure, pulse, respiratory rate, oxygen
saturation, and pain level.
See doc. nos. 81-1 at 3, 81-4 at 7.
Hospital staff also conducted an initial health screening
covering her medical history, recent travel, tobacco use, and
See doc. nos. 81-1 at 3, 81-4 at 7.
Subsequently, Ms. Foord underwent additional neurological,
respiratory, cardiovascular, extremity, Glasgow coma, abdominal,
and genito-urinary evaluations.
See doc. nos. 81-1 at 3, 81-4
Dr. Fox then saw Ms. Foord and took a chief complaint, a
history of present illness, and past medical, medication,
surgical, and social history.
Doc. nos. 81-2 at 13, 81-4 at 2.
The amended complaint alleges that Ms. Foord presented at
Concord Hospital on November 18, 2015, but Concord Hospital’s
records show that her visit occurred on November 19, 2015. See
doc. no. 81-4 at 2.
Dr. Fox also conducted a physical exam that included an overall
general assessment, vital signs, and an examination of the head,
eyes, ears, nose, throat, neck, lungs, heart, abdomen,
extremities, and neurological function.
81-4 at 2-3.
Doc. nos. 81-1 at 4,
She also performed a stroke scale.
Doc. no. 81-4
Dr. Fox consulted with a neurologist, who recommended an
MRI and an MRA of the brain.
Doc. nos. 81-2 at 13, 81-4 at 3.
Those tests were performed, though Dr. Foord points out that the
MRA was performed on the Circle of Willis, which is distinct
from the surface of the brain.
Doc. nos. 81-4 at 3, 90 at 4.
Dr. Fox discussed the results with Dr. Venus, the interpreting
radiologist, who believed the results could indicate a
subarachnoid hemorrhage and recommended a computerized
tomography (“CT”) scan.
Doc. no. 81-4 at 3.
When Dr. Fox
informed Ms. Foord of this recommendation, Foord said that she
thought the area of concern resulted from a traumatic brain
injury as a child, not from a subarachnoid hemorrhage.
also informed Dr. Fox that her providers at MMC told her she did
not have a subarachnoid hemorrhage.
Ms. Foord underwent a CT scan.
Doc. no. 81-4 at 3, 21-22.
After reviewing the results of this scan, Dr. Venus concluded
that Ms. Foord did not have a subarachnoid hemorrhage.
also recommended an MRI with gadolinium 7 and a magnetic resonance
venography (“MRV”) test. 8
Id. at 3, 18.
Dr. Fox diagnosed Ms.
Foord as follows: “Intermittent left hemiparesis, transient,
Concern for possible complex migraine versus
Id. at 3.
Ms. Foord was discharged, with an
outpatient test 9 and a follow-up neurology appointment scheduled.
Doc. nos. 81-2 at 9, 81-4 at 3.
At the time of discharge, Ms.
Foord was asymptomatic, ambulatory, walking, talking, and
Doc. no. 81-2 at 7, 14.
The next day, November 20, Ms. Foord called her PCP and
reported that “everything is fine.”
Id. at 10.
On November 23,
Ms. Foord underwent an EEG and was informed by the interpreting
physician that the results were normal.
November 24, she had “the worst headache of [her] life” and died
later that day.
Id. at 1, 16.
Gadolinium-based contrast agents may be “administered to
patients to enhance the quality of MRIs.” McGrath v. Bayer
HealthCare Pharm. Inc., 393 F. Supp. 3d 161, 164 (E.D.N.Y.
An MRV uses technology similar to an MRI but creates imaging of
the veins. See Ricciardi v. Comm'r of Soc. Sec., No. 15 Civ.
1140 (JCF), 2016 WL 6806245, at *4 n.3 (S.D.N.Y. Nov. 16, 2016).
The type of outpatient test that was scheduled is disputed by
the parties. Concord Hospital suggests it was an
electroencephalogram (EEG). Doc. no. 81-1 at 5. Dr. Foord
asserts that it was an MRA with gadolinium. Doc. no. 90 at 5.
Dr. Foord brings claims against Concord Hospital for
violations of the Emergency Medical Treatment and Active Labor
Act (EMTALA), as well as for medical malpractice and loss of
consortium under New Hampshire law.
The court first addresses
Dr. Foord’s federal EMTALA claim.
Dr. Foord’s EMTALA Claim
Concord Hospital argues that there is no genuine dispute as
to whether its treatment of Ms. Foord complied with the
requirements set out by EMTALA.
Dr. Foord contends that Concord
Hospital violated EMTALA by failing to conduct the proper
screening tests and failing to stabilize Ms. Foord before
Congress passed “EMTALA in 1996 in response to claims that
hospital emergency rooms were refusing to treat patients with
emergency conditions but no medical insurance.”
Centro Medico del Turabo, 642 F.3d 17, 18 (1st Cir. 2011)
(citing Reynolds v. MaineGeneral Health, 218 F.3d 78, 83 (1st
Thus, EMTALA “is a limited anti-dumping statute,
not a federal malpractice statute.”
Id. (quoting Reynolds, 218
F.3d at 83); see also Correa v. Hosp. San Francisco, 69 F.3d
1184, 1192 (1st Cir. 1995) (“EMTALA does not create a cause of
action for medical malpractice.”).
To make out an EMTALA claim,
a plaintiff must show (1) the hospital is a
participating hospital, covered by EMTALA, that
operates an emergency department; (2) the plaintiff
arrived at the facility seeking treatment; and (3) the
hospital either (a) did not afford the patient an
appropriate screening in order to determine if she had
an emergency medical condition, or (b) released the
patient without first stabilizing the emergency
Cruz-Vazquez v. Mennonite Gen. Hosp., Inc., 717 F.3d 63, 68-69
(1st Cir. 2013) (citing Correa, 69 F.3d at 1190).
Neither party disputes that Concord Hospital is a
Additionally, there is no dispute about
whether Ms. Foord arrived at Concord Hospital seeking treatment.
Therefore, the court must determine whether Concord Hospital
failed to appropriately screen Ms. Foord or diagnosed her with
an emergency medical condition and failed to stabilize that
condition before releasing her.
Dr. Foord argues that Concord Hospital failed to
appropriately screen Ms. Foord.
EMTALA does not define
“appropriate medical screening,” but the First Circuit has
stated that a participating hospital must provide an examination
“reasonably calculated to identify critical medical conditions
that may be afflicting symptomatic patients and provides that
level of screening uniformly to all those who present
substantially similar complaints.”
69 F.3d at 1192).
Id. at 69 (quoting Correa,
A “touchstone” in determining uniform
treatment is “[w]hether a hospital’s existing screening protocol
was followed in a circumstance where triggering symptoms were
identified by hospital emergency room staff . . . .”
(citing Cruz–Queipo v. Hosp. Español Auxilio Mutuo de P.R., 417
F.3d 67, 71 (1st Cir. 2005); Battle v. Mem’l Hosp., 228 F.3d
544, 558 (5th Cir. 2000); Summers v. Baptist Medical Ctr.
Arkadelphia, 91 F.3d 1132, 1138 (8th Cir. 1996)); see also
Correa, 69 F.3d at 1192 (“The essence of this requirement is
that there be some screening procedure, and that it be
The First Circuit has provided
Circumstances where a screening protocol was not
followed when triggering symptoms were identified have
been distinguished, for the purposes of EMTALA
coverage, from situations where: (1) no screening
protocol existed; (2) standard screening procedures
existed but were not followed because no identifiable
triggering symptoms were presented; and (3) standard
screening procedures were in fact followed when
identifiable triggering symptoms were presented but an
improper diagnosis resulted.
Cruz-Vazquez, 717 F.3d at 69 (emphasis added) (citations
To establish a screening violation, however, a
plaintiff “need not prove that she actually suffered from
an emergency medical condition when she first came through
the portals of the defendant's facility; the failure
appropriately to screen, by itself, is sufficient to ground
liability as long as the other elements of the cause of
action are met.”
Id. (quoting Correa, 69 F.3d at 1190).
The record demonstrates that Concord Hospital conducted an
appropriate screening during Ms. Foord’s visit on November 19,
Concord Hospital’s Emergency Department policy requires
qualified medical personnel to screen, examine, test, and
evaluate a patient to determine whether she has an emergency
See doc. nos. 81-3 at 1, 81-7.
arriving at Concord Hospital on November 19, Ms. Foord underwent
thorough screening evaluations conducted by the nursing staff
and Dr. Fox.
Doc. no. 81-4 at 2-3, 7.
The Concord Hospital
providers performed MRI and MRA tests on Ms. Foord.
Id. at 3.
Dr. Fox discussed the results with Dr. Venus, who recommended a
CT scan to determine whether there was a subarachnoid
Ms. Foord underwent the CT scan.
Id. at 21-
After reviewing the results of this scan, Dr. Venus
concluded that Ms. Foord did not have a subarachnoid hemorrhage.
Id. at 3, 21-22.
Dr. Fox ultimately diagnosed Ms. Foord with
“[i]ntermittent left hemiparesis, transient, resolved.
for possible complex migraine versus seizure.”
Id. at 3.
Concord Hospital’s evaluation and treatment of Ms. Foord
were “reasonably calculated to identify critical medical
Moreover, based on the undisputed material facts,
no reasonable jury could find that Concord Hospital departed
from its standard procedures or applied them in an uneven
In short, even considering the record in the light most
favorable to Dr. Foord, Concord Hospital complied with its
EMTALA screening requirements.
Dr. Foord puts forward several “disputed” facts and
contends that they create a triable issue as to whether Concord
Hospital conducted appropriate screening measures.
will address the disputes that are material to the appropriate
Dr. Foord asserts that an MRA was not performed on Ms.
Foord’s brain but was instead performed on her Circle of Willis.
However, this fact – even if taken as true – is immaterial to
the EMTALA analysis.
Instead, the issue of whether Ms. Foord’s
doctors properly conducted the MRA bears on Dr. Foord’s medical
Dr. Foord also asserts that while Dr. Venus indicated that
“additional screening examinations” including an MRV and MRI
with contrast were necessary, they were never performed.
no. 90 at 5.
However, in the same paragraph, Dr. Foord concedes
that a CT scan was performed.
Ms. Foord’s medical
records show that Dr. Venus’s preliminary diagnosis of
subarachnoid hemorrhage changed based on the findings of the CT
See doc. no. 81-4 at 3, 17-18, 21-22.
that Concord Hospital conduct the screening tests necessary to
determine whether a patient is suffering from an emergency
The record shows that in Ms. Foord’s case,
it did so.
Finally, Dr. Foord asserts that Concord Hospital
inaccurately set forth the opinions of his experts, Dr.
Stanhiser and Dr. Jensen.
He points out Dr. Stanhiser’s opinion
that Dr. Fox failed to order a CT of Ms. Foord upon her arrival
and to admit her based on her findings.
Doc. no. 90 at 6.
Foord also highlights Dr. Jensen’s statement that Concord
Hospital staff should have treated Ms. Foord as a “subarachnoid
patient” and that “further screening examinations” including
computed tomography angiography (CTA) and computed tomography
venography (CTV) tests should have been ordered.
criticism advanced by Dr. Stanhiser and Dr. Jensen is not that
Concord Hospital failed to screen Ms. Foord; it is that Concord
Hospital screened Ms. Foord incorrectly.
Therefore, while these
allegations are germane to Dr. Foord’s malpractice claim, they
are not material to the EMTALA claim.
Throughout his opposition memorandum, Dr. Foord argues that
Concord Hospital was required to conduct a battery of imaging
tests – including an MRA of the brain (instead of the Circle of
Willis), an MRV, an MRI with contrast, a CTA, and a CTV – for a
variety of reasons.
However, that reading of the statute is
EMTALA requires only that a hospital screen in a
manner reasonably calculated to identify critical medical
conditions and provide that level of screening uniformly.
Cruz-Vazquez v. Mennonite Gen. Hosp., Inc., 717 F.3d at 69.
Foord’s relentless entreaties do not reflect the actual
requirements of EMTALA.
Taking the existing record into
account, there is no genuine dispute regarding whether Concord
Hospital followed proper screening procedures.
Thus, to survive
summary judgment on his EMTALA claim, Dr. Foord must show that
there is a genuine dispute regarding whether Concord Hospital
failed to stabilize Ms. Foord before discharging her on November
Duty to Stabilize
Dr. Foord argues that Ms. Foord was suffering from an
emergency medical condition, which Concord Hospital failed to
stabilize before discharge.
EMTALA defines “emergency medical
condition” as “a medical condition manifesting itself by acute
symptoms of sufficient severity (including severe pain) such
that the absence of immediate medical attention could reasonably
be expected to result in . . . placing the health of the
individual . . . in serious jeopardy,” “serious impairment to
bodily functions,” or “serious dysfunction of any bodily organ
or part . . . .”
42 U.S.C. § 1395dd(e)(1)(A).
The statute goes
on to define “to stabilize” as providing “such medical treatment
of the condition as may be necessary to assure, within
reasonable medical probability, that no material deterioration
of the condition is likely to result from or occur during the
transfer of the individual from a facility . . . .”
42 U.S.C. §
EMTALA’s duty to stabilize “does not impose a standard of
care prescribing how physicians must treat a critical patient's
condition while he remains in the hospital, but merely
prescribes a precondition the hospital must satisfy before it
may undertake to transfer the patient.”
Alvarez-Torres v. Ryder
Mem'l Hosp., Inc., 582 F.3d 47, 51 (1st Cir. 2009) (quoting
Fraticelli–Torres v. Hosp. Hermanos, 300 F. Appx. 1, 4 (1st Cir.
In short, “[t]he stabilization provision requires a
covered hospital, within its staff and facilities, to provide an
individual it determines has an emergency medical condition with
‘such further medical examination and such treatment as may be
required to stabilize the medical condition.’”
Id. at 52
(quoting 42 U.S.C. § 1395dd(b)(1)(A)).
The undisputed material facts show that Concord Hospital
stabilized Ms. Foord before discharging her on November 19.
Following a variety of tests and consultations, Ms. Foord
discussed a discharge plan with her doctors, which included
Doc. nos. 81-2 at 14-15, 81-4 at 3.
Foord admits that upon discharge, Ms. Foord was asymptomatic and
Doc. no. 81-2 at 7, 14.
Dr. Foord now insists that
because Ms. Foord still had abnormal findings at the time of
discharge and was actually suffering from a subarachnoid
hemorrhage, she had an emergency medical condition and by
definition could not be stabilized.
However, this argument is
tautological; under that reasoning, any medical malpractice case
in which the doctors failed to correctly diagnose an emergency
condition and thereafter released the patient would trigger
This does not accurately reflect the legal requirements
See Correa, 69 F.3d at 1192 (“EMTALA does not
create a cause of action for medical malpractice.”).
doctors at Concord Hospital did not diagnose a subarachnoid
hemorrhage and therefore acted reasonably based on their
Thus, there is no genuine dispute that Ms. Foord’s
Dr. Foord asserts that “cases in the First Circuit impose a
duty on the hospital to stabilize the patient based on the
question of whether deterioration of the patient’s condition is
likely to occur within reasonable medical probability,” citing
to Correa, 69 F.3d. Doc. no. 90 at 13-14. However, the issue
in Correa related to the appropriate screening requirement, not
the duty to stabilize, and did not set out the standard advanced
by Dr. Foord. See Correa, 69 F.3d at 1192 n.7 (“Because we
uphold the jury's finding that HSF violated EMTALA when it
failed to afford Ms. Gonzalez an appropriate screening, we need
not comment upon the jury's finding that HSF also violated
EMTALA by improperly transferring Ms. Gonzalez before her
condition had stabilized.”). While Dr. Foord critiques the
authority offered by Concord Hospital on this point, it appears
that the First Circuit has adopted this interpretation. See
Reynolds, 218 F.3d at 85 (“It is doubtful that the text of the
statute would support liability under the stabilization
provision for a patient who had DVT, absent evidence sufficient
to support a finding that the hospital knew of his DVT.”); see
also Kenyon v. Hosp. San Antonio, Inc., 951 F. Supp. 2d 255, 264
doctors at Concord Hospital stabilized her before discharge.
Concord Hospital’s motion is granted on the EMTALA claim.
At oral argument, Dr. Foord urged the court to exercise its
supplemental jurisdiction over his state claims if summary
judgment was granted on the EMTALA claim.
Concord Hospital takes the converse position.
A district court
has “considerable authority whether to exercise [supplemental
jurisdiction], considering factors such as judicial economy,
convenience, fairness to litigants, and comity.”
Echevarria v. Pichis, Inc., 659 F.3d 182, 191 (1st Cir. 2011)
(citing Newman v. Burgin, 930 F.2d 955, 963 (1st Cir. 1991)).
The court “may decline to exercise supplemental jurisdiction
over a claim . . . if . . . the district court has dismissed all
claims over which it has original jurisdiction . . . .”
U.S.C. § 1367 (emphasis added).
Moreover, “[w]hen a plaintiff's
anchor claim is a federal cause of action and the court
(D.P.R. 2013) (“Thus, by its plain language, the statute does
not provide a cause of action when a hospital does not stabilize
an emergency medical condition that it negligently failed to
diagnose.”). While EMTALA does include the “reasonable medical
probability” language that Dr. Foord emphasizes, it is limited
to situations where the deterioration would “result from or
occur during the transfer . . . .” 42 U.S.C. § 1395dd(e)(3)(A);
see also Fraticelli-Torres, 300 F. App'x at 4. Dr. Foord’s
argument on this point essentially disputes the accuracy of the
diagnosis, which bears on the malpractice claim but does not
affect the EMTALA analysis.
unfavorably disposes of the plaintiff's federal claim at the
early stages of a suit, well before trial, the court generally
dismisses any supplemental state-law claims without prejudice.”
Ramos-Echevarria, 659 F.3d at 191 (citing Rodriguez v. Doral
Mortg. Corp., 57 F.3d 1168, 1177 (1st Cir. 1995)).
As the court now grants Concord Hospital’s motion for
summary judgment on Dr. Foord’s EMTALA claim, only his state law
claims for medical malpractice and loss of consortium would
The court declines to exercise supplemental
jurisdiction and dismisses Dr. Foord’s state claims without
prejudice to refiling in state court.
For the reasons above, Concord Hospital’s motion for
summary judgment is granted as to Dr. Foord’s EMTALA claim.
state law claims against Concord Hospital are dismissed without
January 27, 2020
Andrea K. Johnstone
United States Magistrate Judge
Paul M. Monzione, Esq.
Todd J. Hathaway, Esq.
Abby Tucker, Esq.
William N. Smart, Esq.
Nicholas D. Meunier, Esq.
Christopher M. Bracci, Esq.
John D. Cassidy, Esq.
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