A day at the spa.

Rymsza, Leonard ; Johnson, Gordon ; Saunders, Kurt 等

CASE DESCRIPTION

The primary subject matter of this case concerns business law and statistical analysis. Secondary issues involve negligence vs. negligence per se; duty; breach of duty; causation; contributory vs. comparative negligence; and statistical concepts involving linear regression analysis, probability and expected value. The case also presents strategic thinking and ethical issues related to business conduct and their affects on consumers. The case has a difficulty of level three, appropriate for junior level courses. The case is intended to be taught in three class hours, including a class presentation by student teams. The case is expected to require a minimum of three hours of outside preparation by student teams that present a report.

This case is designed for use in an upper division inter-disciplinary business course. The purpose of the course is to enable students to utilize the knowledge they have gained in their lower division core business courses that include one business law course and one statistics course. However, the case can be easily modified for use as an in-class or take-home assignment in an introductory business law course by eliminating the Case A Questions on statistics.

CASE SYNOPSIS

Students are faced with a factual setting that presents practical business and ethical issues. After learning from his doctor that he was a prime candidate for a heart attack, the victim in this case considers a regimen of diet and exercise. The exercise aspect of the plan involved possible membership at a local gym, of which his wife was already a member. Following a discussion with his wife, it was decided that the victim would drive his wife to the gym and return to pick her up when her exercise session was completed. When the victim returned to the gym to pick up his wife, he waited for her in the gym lobby. While waiting for his wife, the victim suffered a cardiac arrest. Although medical assistance was immediately administered by a gym employee, and later by emergency medical technicians and trauma center personnel, the victim did not survive.

Following the victim's death, it was learned that he had suffered a sudden cardiac arrest. Individuals who suffer a sudden cardiac arrest generally survive if heart rhythm is restored using a defibrillator. The gym did not have a defibrillator on the premises. Was the gym negligent in failing to have a defibrillator on the premises? If the gym had had a defibrillator on the premises would the victim have survived? Since the victim was a prime candidate for a heart attack did the victim contribute to his own death?

In answering these questions, the case is divided into three major parts. The first part of the case requires students to utilize their understanding of several statistical issues. They are required to: use linear regression to predict age at death given a specific cholesterol level; determine the expected cost of owning a defibrillator; calculate the age at which the average person will experience their first cardiac incident; and estimate the number of lives that are saved if a defibrillator is available for use.

The second part requires students to analyze a possible negligence claim against the gym with respect to its failure to have a defibrillator on the premises. Students are required to address the following negligence concepts: duty; breach of duty; negligence per se; actual (cause in fact) causation; damages; and defenses to negligence (i.e., contributory vs. comparative negligence). The last part of the case enables the students to propose strategies regarding settlement and ethical issues raised by the gym's refusal to assume responsibility for its actions.

The Case Description and Case Synopsis should be removed before assigning this case to a student or student group. This material could prejudice the minds of students.

INTRODUCTION

Dr. Vontz looked at Tommy Jetson with a scowl. "This is serious, Tommy. You are a prime candidate for a heart attack at age 48. Your blood cholesterol level is 290 mg/dL, you have high blood pressure, you're overweight, and you don't exercise." Tommy left Dr. Vontz's office feeling depressed, so he went to see a movie at the Multiplex Theatre in the Eastfield Mall. Although he was irritated by the commercials that were run prior to the showing of the movie, he thought that the movie was outstanding. After the movie Tommy dined on sprouts and seaweed at a health food restaurant. Not thrilled with the prospect of a continued health food diet of sprouts, seaweed and sawdust, Tommy resolved to exercise more. He hoped that exercise would result in his losing weight and the lowering of both his blood pressure and blood cholesterol level.

On July 4, 2007, the morning following his visit to Doctor Vontz, Tommy had an intensive discussion with his wife, Jipsy, regarding his health and lack of exercise. Jipsy had joined the local Silver's Gym the previous year with the expressed intent to "get in shape." Subsequent to her joining Silver's, Jipsy had continually encouraged Tommy to join her at the Spa telling him "since starting my workout program I feel great and I think the exercise would be good for your health." Tommy was steadfast in his refusal to join his wife at Silver's telling her that her "constant nagging about his health and exercise did nothing but cause an increase in his blood pressure." However, following this latest discussion regarding Tommy's visit to Doctor Vontz, Jipsy asked Tommy if he would at least accompany her to Silver's that morning to watch her exercise. Tommy agreed, saying "I'll just drop you off and pick you up after your session is over."

Tommy did just that. He drove Jipsy to Silver's, dropped her off and returned to pick her up. Jipsy was not waiting outside of Silver's when Tommy arrived to pick her up so Tommy parked his car and entered Silver's to wait in the lobby until his wife was finished. Tommy found a seat in the lobby where he could sit and wait. While waiting for his wife, Tommy suddenly collapsed to the floor. A Silver's employee saw Tommy collapse and rushed to his side. He checked Tommy for breathing and a pulse. Determining that Tommy was not breathing, had no pulse and appeared to be unconscious and unresponsive, the employee directed that Emergency Medical Service (EMS) assistance be called. The Silver's employee then began administering cardiopulmonary resuscitation (CPR). The only medical aid that the employee was able to administer was CPR since Silver's did not have an automated external defibrillator (AED) on the premises. The employee continually administered CPR until two emergency medical technicians (EMTs) arrived 12 minutes after being summoned.

After assessing the situation and determining that Tommy was still not breathing, had no pulse and was unconscious, one EMT assumed the continued administration of CPR while the second EMT attached electrode pads from an a AED that was one item of the EMT's emergency equipment. Following proper procedures the EMT administered a first shock then a second shock and then a third shock, in accordance with appropriate guidelines. The EMT was unable to discern a pulse. CPR was resumed for one minute. There still being no pulse, an additional set of three quick shocks was administered. Again no pulse was detected. Tommy was transported to the nearest emergency trauma center. While transporting Tommy to the trauma center, the EMTs continued with CPR and defibrillation in compliance with appropriate procedures. Upon arrival at the trauma center, Tommy's care was transferred to the on-duty physician. Subsequent attempts to revive Tommy failed.

An autopsy performed following Tommy's death indicated that he did not die from a heart attack but rather from sudden cardiac arrest (SCA). According to medical experts, the only accepted treatment to restore an effective heart rhythm in victims of sudden cardiac arrest is defibrillation using an automatic external defibrillator (AED). Cardiopulmonary resuscitation (CPR) alone is not effective in treating SCA.

Tommy's wife, Jipsy, is contemplating suing Silver's Gym for negligence. The Board of Director's of Silver's Gym has asked your legal team to write a report evaluating the legal and statistical issues facing Silver's Gym.

Mission Statement

The Mission of Silver's Gym and Health Spa is to promote the health, well-being and fitness skills of its members by providing the best and most up to date fitness equipment and fitness knowledge for strength training, cardiovascular training, and health and nutrition programs. Through a passionate and first class Team, we strive to inspire our members to achieve their greatest individual potential.

Core Values

PROVIDING THE HIGHEST QUALITY FITNESS EQUIPMENT AND PROGRAMS

Passion for Fitness

We appreciate the health benefits that derive from being physically fit. We strive to improve each of our members' quality of life.

Standards of Quality

We have high standards and our goal is to provide the highest quality of fitness equipment and programs we possibly can.

SATISFYING AND DELIGHTING OUR MEMBERS

Our Members

Our members are our most important stakeholders. They are the lifeblood of our business. We can satisfy the ends of our other stakeholders only by satisfying our members first.

Extraordinary Member Service

We go the extra mile to satisfy and delight our members. We strive to meet or exceed their expectations on every visit to our facilities. We are aware that by doing so, our members will become advocates for programs. Advocates do more than just use our facilities, they talk about Silver's to their friends and others. We want to serve our members completely, effectively, warmly and with a smile.

Education

We can generate greater appreciation and loyalty from our members by providing educational programs on fitness and related issues including health, nutrition and the environment.

Meaningful Value

We offer value to our members by providing them with the highest quality of fitness equipment and health programs, caring service at competitive fees. We constantly strive to improve the value of our business to our members.

Inviting and Safe Environment

We create a fitness environment that is inviting fun and safe. We want our gym's to become meeting places where our members meet their friends and make new ones. We want our members to feel and be safe during every visit.

Silver's Corporate Vision

Our corporate vision is:

1. To develop a professional fitness Team. Each member of the Team will be well educated in health and fitness programs and issues; loyal to the team and our gym members; and oriented to achieve personal and gym members' success.

2. To provide a health and fitness service and message to our members and the community. We will strive to provide up-to-date programs based upon the latest research in the industry; pro-active services for our members; and a message of good health and fitness to the community through a professional marketing, advertising and branding strategy.

3. To be a recognized leader in the fitness industry. Based upon sound medical information and technology, we will strive to be at the forefront in promoting health and fitness for our entire community.

4. To provide opportunities for all Team members to further individual career goals. The promotion of internal growth and development of increased responsibilities for the purpose of promoting individual Team members is desirable.

5. To provide a safe environment for Team and gym members. All Team members will be trained in the proper use of all fitness equipment. In addition, all Team members will be trained to provide assistance in the event of any medical emergency.

Case A Questions--Statistical

Q. 1. Using the data set in Table 1, use linear regression to obtain an equation to predict age at death given a specific cholesterol level. Predict the age at which Tommy will die given his cholesterol level is 290 mg/dL. Interpret the slope in the context of this problem. Interpret the coefficient of determination.

Q. 2. Suppose it costs $10,000 to buy a defibrillator. Find the expected value of owning a defibrillator if there is a .03 probability that Silver's will lose a lawsuit regarding its operation, with each lawsuit resulting in Silver's being liable in the amount of $900,000.

Q. 3. If the age of an initial cardiac incident (heart attack or sudden cardiac arrest) is normally distributed with a population standard deviation = 15 years, find the age at which the average person will experience their first cardiac incident, given that 5% of all initial cardiac incident victims are younger than 45.

Q. 4. Suppose that over the next several years, there will be 100 cardiac incidents at Silver's. Without a defibrillator, 30 victims will die before paramedics arrive. With a defibrillator, there is a .80 probability of saving a victim who would die without it. However, there is a .03 probability that improper use of the defibrillator will kill a victim who would have otherwise lived. Find the expected number of lives saved by the defibrillator.

Case B Questions--Legal Issues--Negligence

Q. 5. Was Silver's Gym negligent in failing to have an AED on the premises? (In answering this question assume that Gould Health & Safety Code [section] 204 and [section] 205 and Gould Evidence Code [section] 966 in the Case Library WERE NOT in force at the time of Tommy's death.)

Q. 6. Suppose Gould Health & Safety Code [section] 204 and [section] 205 and Gould Evidence Code [section] 966 in the Case Library WERE in force at the time of Tommy's death. Would your answer to Question

5 change? Why or why not?

Case C Question--Ethical & Strategic Issues

Q. 7. Regardless of the conclusions reached in Questions 5 and 6, would your firm recommend that Silver's have an AED on its premises in the future? Your answer should consider the statistical and legal issues involved as well as ethical and strategic issues.

LIBRARY--A DAY AT THE SPA

Article appearing in the January 5, 2007 issue of the Journal of Medicine & Science in Sports.

NCAA Committee Considers Mandatory Placement of AEDs at Division I Sporting Venues

The NCAA Committee on Competitive Safeguards and Medical Aspects of Sports is currently considering a proposal that would mandate the placement of at least one automatic external defibrillator (AED) at all Division I sporting venues.

The Committee has recently completed a survey of head athletic trainers at all 326 Division I NCAA universities. Surveys were completed and returned by 244 institutions. There were 35 cases of AED use for sudden cardiac arrest with 77% (27/35) occurring in older non-students, 14% (5/35) in intercollegiate athletes, and 3% (1/35) in a nonintercollegiate athlete. The immediate resuscitation rate was 54% (19/35). A shock was delivered in 21 cases with a resuscitation rate of 71% (15/21). None of the intercollegiate athletes were successfully resuscitated. The average cost per AED was $2460. In a ten year model (expected useful life of an AED), the cost per life immediately resuscitated was $52,400, and the estimated cost per life-year gained ranged from $10,500 to $22,500.

Every year hundreds of thousands of Americans die from cardiac incidents. Medical experts indicate that the key to survival is the timely administration of first aid including cardiopulmonary resuscitation (CPR) and, if necessary, the restoration of an effective heart rhythm using a medical devise called an automatic external defibrillator (AED).

An AED is used to deliver an electrical shock to the heart of a victim of sudden cardiac arrest (SCA). SCA is not a heart attack (medically referred to as a myocardial infarcation). A heart attack occurs when a blockage in a blood vessel interrupts the flow of oxygen-rich blood to the heart, causing heart muscle to die. However, SCA, also referred to as sudden cardiac death (SCD), occurs when the heart's electrical system malfunctions resulting in electrical impulses of the heart suddenly becoming chaotic, causing the heart to abruptly stop pumping blood effectively to the rest of the body. The victim becomes unresponsive, loses consciousness, has no pulse and stops breathing. The only accepted treatment to restore an effective heart rhythm is defibrillation. Cardiopulmonary resuscitation (CPR) alone is not effective in treating SCA.

Defibrillation is the technique involving the administration of an electric shock that can restore the heart's normal rhythm. While this procedure historically has been available only from paramedics or in hospital settings, the development of a portable computer (AED) that can analyze a person's heart rhythm has enabled lay people, coaches and sports-medicine staff members to be trained to perform this procedure. These portable devices, about the size of a lightweight laptop computer, are increasingly more practical to have available.

SCA is responsible for approximately one-half of all heart disease deaths. Every day in the United States nearly 1,000 individuals suffer a cardiac arrest, and only about 50 will survive. In many instances death results merely because lifesaving defibrillation does not reach the victim in time. Paramedic life-saving attempts in cases of cardiac arrest are rarely successful. The time it takes for the emergency squad to respond to an emergency call is usually greater than ten minutes. Those precious minutes are the critical difference between life and death. Statistics indicate that the success rate of restoring normal heart rhythm through CPR techniques is less than 5 percent. Combining CPR with defibrillation within the first minute after arrest increases the success rate to 95 percent. However, each minute of delay in administering lifesaving defibrillation decreases an SCA victim's chance of survival by 10 percent. After a delay of ten minutes, more than 90 percent of SCA victims will die if their heart has not been defibrillated. Communities that have initiated Public Access Defibrillator programs that place AEDs in ambulances, police cars, and other public locations are experiencing SCA survival as high as 43 percent, compared with large cities with no such programs where the survival rate is as low at 1 percent.

Although the value of having AEDs readily available appears obvious, concerns regarding liability, rapid availability of emergency personnel, training, cardiac risk of the population and maintenance of the defibrillators are concerns that have been raised regarding the need for having AEDs at athletic venues.

Although the cost of AEDs is declining, most still range between $2,000 and $4,000, the statistics speak for themselves and the cost of saving one life arguably justifies the purchase price of a unit.

Article appearing in the community newspaper.

HOMETOWN TRIBUNE/ February 14, 2007

ASSEMBLY CONSIDERS REQUIRING AEDS AT HEALTH CLUBS

Hometown, Gould. Last week, the Gould Legislative Assembly met to consider legislation that would require all health clubs and spas in the state to have an automatic external defibrillator (AED) on their premises. Sudden cardiac arrest is the cause of death in more that 250,000 people in the United States each year. More than 90 percent of the victims die when defibrillation is not prompt. It is estimated that as many as 50 percent of cardiac arrest victims could be saved if they were defibrillated within seven minutes or less. However, medical experts caution that any such rescue must be swift if the victim is to survive neurologically intact.

Evidence of the effectiveness of AEDs is seen from the results of placing 49 AEDs in the two international airports located in metropolitan Hometown. During the first 12 months after the 49 AEDs were placed in the two airports, 14 cardiac arrests occurred (12 going into ventricular fibrillation). Nine of the victims were revived with an AED with no neurological damage. Further, in nine of the incidents, airport travelers--not staff personnel- successfully operated the devices.

How likely is it for a member of a health club to suffer cardiac arrest in the health club facility? The answer to this question is not precisely known. However, in one database of more than 2.9 million commercial health club members, 71 deaths were reported in a two-year period or about 1 death per 2.6 million workout sessions.

In a survey of 65 randomly selected Gould health clubs, 17 percent reported a club member having a sudden cardiac death or heart attack during a five-year period. It is important to note that the demographics of health club membership are rapidly changing. More than half of all fitness centers now have a membership base of people 35 years and older. In addition, the fastest growing membership segment is in the 55 and older age group.

Gould Health & Safety Code Division 301--Disease Prevention & Health Promotion Part 1--Chronic Disease Chapter 12--Cardiovascular Disease

[section] 204. Each year, sudden cardiac arrest, also known as sudden cardiac death, is responsible for the death of more than 250,000 residents of the United States. Medical research indicates that the key to survival of sudden cardiac arrest is the timely implementation of a "chain of survival" including cardiopulmonary resuscitation (CPR) and the restoration of an effective heart rhythm by defibrillation. Recent technological breakthroughs have resulted in the availability of a portable lifesaving devise called an "automated external defibrillator" or "AED." In order to promote the health and safety of its citizens the following statutes are enacted.

[section] 205

(a) Commencing one year after the enactment of this section:

(1) Every health studio, as defined in subdivision (h) shall acquire an automated external defibrillator (AED).

(2) Every health studio, as defined in subdivision (h), shall maintain, and train personnel in the use of an automated external defibrillator acquired pursuant to this section, and shall not be liable for civil damages resulting from the use or attempted use of an automatic external defibrillator as provided in this section.

(b) An employee of a health studio who renders emergency care or treatment is not liable for civil damages resulting from the use or attempted use of an automatic external defibrillator, except in the case of personal injury or wrongful death that results from gross negligence or willful or wanton misconduct on the part of the person who uses, attempts to use an automatic external defibrillator to render emergency care or treatment.

(c) When an employee uses or attempts to use, an automatic external defibrillator consistent with the requirements of this section to render emergency care or treatment, the members of the board of directors of the facility shall not be liable for civil damages resulting from any act or omission in rendering the emergency care or treatment, including the use or attempted use of an automatic external defibrillator.

(d) When an employee of a health studio renders emergency care or treatment using an automatic external defibrillator, the owners, managers, employees, or otherwise responsible authorities of the facility shall not be liable for civil damages resulting from any act or omission in the course of rendering that emergency care or treatment.

(h) For purposes of this section, "health studio" means any facility permitting the use of its facilities and equipment or access to its facilities and equipment, to individuals or groups for physical exercise, body building, reducing, figure development, fitness training, or any other similar purpose, on a membership basis. "Health studio" does not include any hotel or similar business that offers fitness facilities to its registered guests for a fee or as part of the hotel charges.

Exhibit 1

(Exhibit 1 is a copy of a letter from Abbey Lounge to Beau Flex
requesting answers to several questions relating to
automatic external defibrillators.)

February 14, 2007

Silver's Gym, Inc.
Corporate Headquarters
15821 Fitness Lane
Powerlift City, Gould 00050

Mr. Beau Flex
Director of Risk Management
Silver's Gym, Inc.
1400 Treadmill Lane
Powerlift City, Gould 00049

Dear Mr. Flex:

The Board of Directors for Silver's Gym, Inc. has directed me to write
this letter to you. The purpose of this letter is to request that you
research several issues relating to Automatic External Defibrillators
(AEDs). As you know, the Board has been struggling with the issue of
whether to provide AEDs at all of Silver's Gym health facilities. Major
questions have been raised as to the costs associated with the
purchase of these machines. In order the facilitate further discussion
by the Board at its upcoming May meeting, it is interested in your
analysis of the following issues:

1. Costs associated with the AED--purchase cost, maintenance and
testing costs, education and training costs, etc.;

2. The reliability of AEDs;

3. Potential liability for coming to another's aid--the Good Samaritan
issue;

4. Who will be trained to use the AED and what is the availability of
the individual--must there be at least one employee on duty at all
times who is trained in the use of the AED;

5. How fast must the response be in order to prevent significant
neurological damage or death;

6. Is there an increased risk of liability for using an AED; (Would
providing AEDs create a higher duty on Silver's part by deciding to
make an AED available even though not required by law--is there
potentially more liability by having an AED and not being perfect
with performance and availability than there is in not having one
available at all- since currently there is no requirement to have an
AED on the premises is it therefore most likely
that no liability exists in not having one on the premises;

7. Any other issues you believe must be considered by the Board.

Your timely response to this inquiry is appreciated.

Sincerely,

Abbey Lounge
Chairman of the Board
Silver's Gym, Inc.

Exhibit 2

(This is a copy of a letter from Beau Flex to Abbey Lounge responding
to the questions in Exhibit 1)

April 1, 2007

Department of Risk Management
Beau Flex, Director
Silver's Gym, Inc.
1400 Treadmill Lane
Powerlift City, Gould 00049

Ms. Abbey Lounge
Chairman of the Board
Silver's Gym, Inc.
15821 Fitness Lane
Powerlift City, Gould 00050

Dear Chairman Lounge:

In an effort to assist the Board of Directors in deciding whether or
not to provide Automated External Defibrillators at all of its health
facilities, an analysis of the questions raised by the Board is hereby
provided. I apologize for the length of this letter. However, the
issues presented are complex and require, at times, lengthy analysis.
The seven questions raised in your letter are specifically addressed
below.

Costs associated with the Automated External Defibrillator
(AED)--purchase cost, maintenance and testing costs, education and
training costs.

AED Cost--Originally, when AED units first became available the cost
was approximately $10,000 per unit. However, today, small, light-weight
units cost less than $3500. The units range in cost from between $1500
to $3500 per unit. The average cost of an AED unit is
approximately $2500.

Maintenance/Testing Costs--AEDs are complicated electronic devices and
require regular maintenance and testing. AEDs are powered by batteries
that have an approximate life span of two to five years depending on
the type and capacity of the battery and patterns of usage of the AED.
Batteries range in price with an average cost of approximately $150 per
battery. In light of the concerns of AED reliability, it is recommended
that each AED unit have a spare battery back-up. AED's also require use
of disposable pads that deliver the electric shock to the victim.
Generally, disposable pads have a shelf life of approximately 18
months. Each AED unit also requires at least one additional back-up
set of pads. The pads must be replaced by the expiration date whether
or not used. The cost of a single set of disposable pads is, on
average, approximately $65.

Some AED units can perform self-testing functions. Each AED has a
maintenance and testing schedule recommended by its manufacturer. It
is important that the Board understands that AEDs cannot just be
purchased and hung on a wall and be forgotten until the need for the
AED's use arises. The cost of routine testing of an AED unit would be
negligible and can be included in an employee's daily responsibilities.

Education and Training Costs--Training classes are available from
various organizations. Courses generally include cardiopulmonary
resuscitation (CPR) and AED training. Courses differ in length from
four to six hours. The cost of a training course ranges from $40 to
$60 per participant. The American Heart Association recommends that
those trained in the use of AEDs receive a refresher course every 6
months and complete retraining every two years.

Currently all employees are CPR certified and are retrained every two
years. The additional cost of including initial AED training along with
CPR certification is approximately $5 per employee. The cost of a
refresher course every six months for every employee would be
approximately $15 per employee. These costs, although approximate, are
believed to be reliable estimates.

The reliability of AEDs.

It is clear that AEDs are of proven clinical benefit when used to
defibrillate individuals experiencing sudden cardiac arrest. AEDs are
electronic devices and as such component failures do occur. It is
estimated that in the last three years more than 100,000 AEDs have been
recalled. In 2006 there more than 30,000 AEDs were recalled. A complete
list detailing the reason for the recalls is available. In addition,
data is available relating to the number of AEDs subject to FDA
recalls; annual AED advisory notices issued by the FDA; the number of
AED malfunctions reported to the FDA; and a detailed listing of the
specific AED models that have been the subject of recalls and the
purpose for the recalls. If the Board desires a thorough analysis of
the available data, it is recommended that the
Board contact the renowned statistical consulting firm of Tontz De Leon
and Associates.

Although AEDs have a distressing failure rate, the medical community
stresses that the number of lives that are saved by having AEDs readily
available clearly outweigh the risks associated with the number of
observed malfunctions.

Potential liability for coming to another's aid--the Good Samaritan
issue.

The Good Samaritan statute is a statute which exempts from liability a
person who voluntarily renders aid to an injured person but who
negligently causes injury while rendering the aid. The Gould state
legislature is currently considering adopting a statute that
specifically exempts owners of health studios and their boards of
directors, managers and employees from civil damages resulting from
any act or omission in rendering emergency care using or attempting
to use and AED. It is important to note, however, that one is not
exempt from liability for civil damages when the actions of the one
rendering aid are deemed to be grossly negligent or willful or wanton
misconduct.

Who will be trained to use the AED and what is the availability of
the individual--must there be at least one employee on duty at all
times who is trained in the use of the AED.

The American Heart Association notes that Emergency Medical Response
is more effective if multiple certified personnel are present during
an incident. Ambulances and paramedics can have variable response
times. Conducting CPR as part of the initial response is very rigorous
and can cause significant fatigue with just one rescuer. In addition,
should there be a need to use an AED at least two certified personnel
should be available to render aid, one individual administering CPA
and the other individual operating the AED.

How fast must the response be in order to prevent significant
neurological damage or death.

According to the American Heart Association, defibrillation within the
first minute of sudden cardiac arrest can save the lives of up to 90%
of its victims. The sooner the shock is delivered, the better. With
each minute of delay until defibrillation, the survival rate drops by
10%. If a sudden cardiac arrest victim is not defibrillated within 10
minutes, his or her chance of survival is less than 2%.

Is there an increased risk of liability for using an AED. (Would
providing AEDs create a higher duty on Silver's part by deciding to
make an AED available even though not required by law--is there
potentially more liability by having an AED and not being perfect
with performance and availability than there is in not having one
available at all- since currently there is no requirement to have
an AED on the premises is it therefore most likely that no
liability exists in not having one on the premises.)

In deciding whether to implement or not to implement a program that
affects our members it is certainly appropriate for the Board of
Directors to consider and evaluate the relative risks and benefits
that flow from the decision. Presently, there are no know court cases
where judgments have been rendered against the user of an AED based
upon negligent or improper use of the AED. The few cases that have
been filed based upon liability for the negligent operation of AEDs
have apparently been difficult to win because it was not easy to
establish that the operator caused harm to the victim in attempting to
resuscitate the victim who, absent the use of the AED, was dead
or close to death when the AED was used.

However, the lifesaving benefits of AEDs, the cost of the units and
program implementation and the lack of treatment alternatives provide
strong arguments for concluding that a duty may be owed to members,
guests, etc. who may suffer sudden cardiac arrest while present at
one of our facilities. It may very well be that the failure to
purchase and or use AEDs might subject the Corporation to an increased
risk of liability in this rapidly evolving
area.

For further clarification of the issues relating to legal liability
and the decision to provide or not provide AEDs at the Corporation's
health facilities, it is recommended that the Board contact Ms. Elle
Woods, in-house counsel.

Other issues.

There are several other issues that the Board may wish to consider. The
decision to purchase AEDs must also consider that a comprehensive
policy must be developed to deal with all aspects of AEDs including:
annual review of records of inspection, testing and maintenance;
dissemination to employees of information about the AED policy;
location and storage of AEDs; review of requests for the purchase of
AEDs, replacement batteries, pads and other supplies; etc. The Board
should also consider the probability that a member will suffer sudden
cardiac death in light of the population age group of our members.
Employee receptivity to AED training must also be considered. Lastly,
the Board must consider the extent of exposure to liability on the
part of the Corporation if AED's are not provided in each of its
facilities.

The information provided herein is based upon extensive research of
available materials that deal with AEDs. The sources of the information
will be gladly furnished to the Board upon request.

Sincerely,

Beau Flex
Director of Risk Management
Silver's Gym

Leonard Rymsza, California State University, Northridge

Gordon Johnson, California State University Northridge

Kurt Saunders, California State University Northridge

Table 1--Data Set--Cholesterol Level and Age at Death

               age at
cholesterol    death

137                63
162                85
270                59
210                73
233                79
90                 91
252                47
156                72
127                97
194                49
205                51
266                59
216                51
167                62
230                78
171                72
155                93
128                91
274                72
198                63
268                35
206                76
204                74
177                78
337                58
222                69
180                71
174                67
274                47
211                70
149                83
224                47
190                52
158                58
161                56
126                77
159                59
201                77
134                71
129                90
193                60
95                104
156                60
220                67
211                70
206                58
153                61
247                72
212                75
189                54
160                86
245                57
49                 75
203                81
159                79
210                83
198                63
181                60
127                63
186                55
186                68
183                72
233                43
163                54
263                67
195                66
218                68
232                50
184                55
253                73
158                90
60                 79
191                64
210                77
118                70
174                53
233                49
285                56
290                45
217                47
183                73
217                53
250                41
80                 93
141                71
246                41
136                85
162                72
219                45
135                86
261                64
221                68
182                88
233                41
206                51
191                72
220                80
252                53
213                76
167                64