BEFORE THE HEALTH CLAIMS ARBITRATION
OFFICE OF MARYLAND


BERNADETTE M. GESSER HCA NO. 78-92
and
EDWARD L. GESSER,
Claimants,
VS.
SUVANNEE VIDHYAPUM, M.D.
 a"d
MUSTAFA ONAL, M.D.
and
SOUTH BALTIMORE GENERAL
HOSPITAL, a body corporate,
Defendants.



Chester, Pennsylvania
September 17, 1980


Deposition of DE.  MARSHALL KLAVAN, held

in the offices of Dr. Marshall Klavan, Suite 203, Crozer-

Chester Medical Center, at 11:20 a.m., on the above date,

before Sean 14.  Fallon, a Registered Professional Reporter

and an Approved Reporter of the U.S. District Court.




APPEARANCES:

JONATHAN SCHOCHOR, ESQ.
1101 St. Paul Street - Suite 201
Baltimore, Maryland 21202
Attorney for the Claimants

ROBERT H. HOUSE, JR., ESQ.
800 Fidelity Building
Charles at Lexington
Baltimore, Maryland 21201
Attorney for Defendants Vidhyapum and Onal

WHITEFORD, TAYLOR, PRESTON, TRIMBLE & JOHNSTON
BY: WILLIAM D. WHITEFORD, ESQ.
2000 First Maryland Building
25 South Charles Street
Baltimore, Maryland 21201
Attorneys for Defendant South Baltimore
General Hospital

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PAGE

I DR. MARSHALL KLAVAN, after havi@g
2 first been duly sworn, w, jarined and testified
3 as follows:
4 EXAMINATION
5 BY MR. WHITEFORD;
6 Q Doctor, your full name and your address?
7 A Marshall Klavan.  Suite 203 Crozer-Chester
S Medical Center, Professional Building, Upland, Pennsylvania.
9 0 And you are a licensed physician in the State
10 of Pennsylvania?
11 A I am.
12 0 How long have you been so licensed?
13 A Since 1964.
14 0 Doctor, your name has been supplied as an expert
15 witness by Mr. Schochor in the case of Gesser versus
16 South Baltimore General Hospital, et al.
17 When were you first contacted with regard to
18 this case?
19 A Summer of '78.
20 0 Were you sent records at that time?
21 A I was.
22 0 Were you sent anything else?
23 A Not at that time.
24 Q What have you subsequently been supplied with?

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PAGE 3
Klavan



I A Plaintiff's deposition.

2 Q Have you ever rendered a written opinion in this

3 case?

4 A No.

5 MR. SCHOCHOR: So the record is clear,

6 I also gave him the Interrogatories. He's

7 had those.

8 THE WITNESS: Well, that came with the

9 deposition.

10 MR. SCHOCHOR: Came later.

11 MR. BOUSE: Y ou mean the Plaintiff's

12 Answers?

13 MR. SCHOCHOR: The Claimant's Answers.

14 BY MR. WHITEFORD:

15 Q When did you first express an opinion with

16 regard to liability in this case, Doctor?

17 A I usually make contact by phone within a couple

18 of weeks after I receive the records.

19 I looked it up last night. My records are at

20 home. I think I was contacted in July or August.

 .21 So, at the latest, the end of the August I would

22 have spoken to Mr. Schochor.

23 MR. SCHOCHOR: He is assuming that.

24 Do you have that written down someplace?

PAGE
Klavan,



I THE WITNESS: No.

2 MR. SCHOCHOR: I don't know when the

3 telephone call came, either.

4 Q And I take it, Doctor, it is your opinion that

5 there has been a violation of accepted standards in this

6 case?

7 A Yes. it is my opinion there have been.

8 Q Would you tell me each and every violation

9 of accepted medical standard you feel took place and by

10 whom it took place?

11 A Initially, when the patient was admitted on the

12 18th of September, she was at 36 weeks of pregnancy.  Some-

13 where between 36 and 37 weeks with the usual pregnancy

14 running 40 weeks.

15 The admission diagnosis at that time was nausea

16 and vomitting of pregnancy, which is a condition peculiar

17 to pregnant women during the first three months of pregnancy

18 and occasionally presents again during the seventh month

19 of pregnancy or, if we will, between the 28th and 32nd

20 week.

21 The patient who presents with persistent nausea

22 and vomitting at that late stage in pregnancy, the diagnosis

23 of hyperemesis gravidorum, which is nausea and vomitting

24 of pregnancy, is one that's made by exclusion. more likely

5
PAGE
Klavan

I one has to consider things not peculiar to pregnancy such
2 as hepatitis, possibililty of intestinal obstruction.
3 1 feel that the diagnosis of this case as
4 hyperemesis gravidorum, was not within accepted standards
5 and that the more appropriate diagnosis would have been
6 nausea and vomitting, etiology undetermined, and if they
7 had looked into it they would have ascertained more rapidly
8 that indeed she did have hepatitis.
9 Q You are saying they.
10 A Dr. Suvannee, the attending physician, who
11 admitted the patient.
12 The second deviation was that in the face of
13 nausea, vomitting, irrespective of the fact that this
14 patient was given intravenous fluids, the urinary output
15 was of such exaggerate amount that one cannot account for
16 it on the basis of the fluid this patient was receiving,
17 even intravenous