Verdicts & Settlements


Representative Verdicts & Settlements
  1. Katie Hoyt v. Carl Christman, M.D. - Highest Kansas Jury Verdict $6 Million
  2. Plaintiff v. Defendant Hospital and 2 Doctors -
    $4.7 Million
  3. 14-Year Old Girl - $4.4 Million
  4. Emmanuel Zapata v. 3 Physicians and Hospital -
    $4.3 Million
  5. Minor child vs. Kansas hospital - $3.4 Million
  6. Destiny Hawley v. Mayflower Contract Services -
    $2.8 Million
  7. Shirley Keck v. Wesley Medical Center - $2.7 Million
  8. 12-Year Old Boy - $2.5 Million
  9. Alexis Rangel v. Builder's Transport Inc. - $2.25 Million
  10. Darryl McGinnes v. Estephan Zayat, M.D. - $2 Million
  11. Lori Dechant v. Dr. Bartal - $2 Million
  12. Minor Child - $1.6 Million
  13. Colorado baby boy v. Colorado physician - $1.5 Million
  14. Store Patron v. Wichita, KS Department Store -
    $1.3 Million Punitive Damages, Plus Actual Damages Awarded by Jury
  15. 68-Year Old Woman v. Neurosurgeon - $1.2 Million Workers Compensation award and $965,000 Medical Malpractice settlement


Medical Malpractice

Cancer

Edwin Main v. Parman, M.D. and Murphy, M.D. - $716,000 Verdict

Our firm represented a 62-year old man, Ed Main, who was diagnosed with late stage colon and rectal cancer. A lawsuit was filed against two physicians alleging that they were negligent in the treatment and diagnosis of the cancer. Mr. Main alleged that had the physicians properly diagnosed his cancer at an earlier time he would have had an excellent chance of survival. The case was tried and the jury found for the plaintiff in the amount of $716,000.00.

Young Man v. Rural Kansas Physician - Large Confidential Settlement

Jim Howell represented a young man who was seen by a rural Kansas family physician for treatment of a mole that he noticed was changing. The physician determined that the mole was not cancerous, and despite repeated complaints from the patient that the mole had continued to change, the physician refused to biopsy the mole to test for cancer. The young man eventually sought a second opinion from a dermatologist, who biopsied the mole and discovered that the young man had metastatic malignant melanoma. The delay in diagnosis dramatically reduced the young man's life expectancy. A large confidential settlement was reached.

Teenage boy v. Wichita Pediatric Neurologist - Large Confidential Settlement

Jim Howell represented a teenage boy whose physician failed to timely diagnose his brain tumor. The boy began seeing the pediatric neurologist after developing learning problems and a lazy eye. A CT scan was performed which recommended an MRI to evaluate possible hydrocephalus as a cause. The neurologist mistakenly believed he performed the MRI and that it was negative and continued to treat the boy for attention deficit disorder. The parents finally took their child to another doctor, who immediately ordered an MRI due to lazy eye and discovered a tumor causing hydrocephalus. The delay in diagnosing hydrocephalus resulted in permanent and severe brain injury. A lawsuit was filed, yielding a large confidential settlement.

:: back to top

Brain Injury

Minor Child - $1.6 Million

A baby began to deliver but showed signs of a prolapsed umbilical cord - a serious medical emergency. An immediate C-section was indicated, but there was no anesthesiologist or obstetrician available to perform it, resulting in a 20-minute delay. During that time, the baby was robbed of the necessary oxygen and sustained severe brain damage.

Mother was in labor at 2:00am at the hospital when the baby's head presented itself. The baby had a prolapsed umbilical cord, developed fetal distress, and needed to be delivered immediately. There was no OB present nor anesthesiologist present to perform an emergency C-section. A 20-minute delay ensued, and the baby suffered brain damage from asphyxia. The hospital claimed the brain damage was genetically caused.

The hospital had in previous months handed out brochures which said it could handle any obstetric emergency, 24 hours a day. Plaintiff claimed the hospital was misrepresenting the services it could provide. The hospital settled for $1,600,000.00.

Katie Hoyt v. Carl Christman, M.D. - Highest Kansas Jury Verdict $6 Million

Katie Hoyt, a newborn, received a severe brain injury during the birthing process. Her doctor's delayed for over 30 minutes the performance of an emergency C-section. During that delay she suffered a severe lack of oxygen, as noted on the fetal heart monitor strip. The jury awarded Katie $6,000,000.00. No Kansas jury has awarded a higher amount for a medical malpractice case since this verdict.

Shirley Keck v. Wesley Medical Center - $2.7 Million

Shirley Keck, age 61, was admitted to Wesley Medical Center. Due to understaffing of nurses in the hospital, Shirley's nurse did not assess Shirley often enough and did not monitor Shirley's oxygen level. Shirley's deteriorating condition was not noticed by the nurse because the nurse was overworked. Shirley suffered a respiratory arrest with a resulting brain injury. Shirley reached a $2.7 million settlement with Wesley Medical Center. She and her attorney agreed that they would not keep her settlement confidential so that others people might avoid injury. Her story became nationally newsworthy and was presented on CBS - 60 minutes, Reader's Digest, NBC nightly news, CNN, Chicago Tribune, Wichita Eagle and other media.

12-Year Old Boy - $2.5 Million

UB was a 12-year old boy who had a sudden onset of severe diabetes. The young doctor and the hospital had no expertise in treating severe diabetes.He should have been referred to a specialist. Instead, he did not receive the correct treatment and was given the wrong medication. This allowed his brain to swell. His swollen brain led to brain damage and permanent bodily disability. He received a settlement of $2.5 million.

38-Year old Mother v. Wichita, KS Hospital - $22 Million Life Care Plan

Jim Howell represented a 38-year old working mother of two young children who sustained brain death as the result of hospital and nursing negligence. The woman presented to the emergency room of a Wichita , KS hospital with shortness of breath. Because her oxygen saturation levels were so low, she was immediately admitted into the intensive care unit, where she was placed on a ventilator unit for total support. A respiratory therapist turned down the alarm volume on the unit to a point where it could barely be heard. Nurse understaffing resulted in inadequate monitoring of the medications used to sedate and paralyze the patient. She awoke and pulled off the ventilator tubing, causing the alarm to go off, but because of the residual paralytic medication in her body, the patient was unable to breathe on her own. The ventilator alarm was ignored by one nurse and was unable to be heard by the other nurses. The patient, whose condition was eventually discovered, coded and was resuscitated, but the delay resulted in severe brain injury.

Incidentally, prior to this event, the Joint Commission on Accreditation of Health Organizations issued an alert to all hospitals warning them of ventilator accidents and how to prevent them. This alert was acted upon by numerous committees, but none of the precautions in the alert were ever implemented. The Alert was hidden from plaintiff's counsel until it was discovered on the JCAHO website. In addition, key documents were destroyed and the ventilator data was erased.

The mother remains in a persistent vegetative state to this day. The lawsuit filed by Mr. Howell was settled while a motion for punitive damages was pending. The woman received a Life Care Plan in the amount of $22 million, in addition to a confidential settlement.

:: back to top

Shoulder Dystocia

Tabitha Redden v. Dr. Matthews in Garden City, KS

The largest ever settlement in Kansas for a shoulder dystocia case

At the moment of her birth, Tabitha's delivery was hindered by "shoulder dystocia," a fairly common complication of vaginal delivery. Shoulder dystocia is diagnosed when the baby's head is protruding out of the vagina, but one of the baby's shoulders is stuck behind the mother's pubic bone, preventing complete delivery. It is dangerous to the baby if the doctor attempts to dislodge the baby's shoulders by pushing or pulling on the baby's head, since doing so may tear the baby's brachial nerve plexus.

Tabitha claimed the obstetrician, Dr. George Matthews, negligently failed to perform the well-recognized McRoberts maneuver, which would have safely dislodged her shoulder and allowed delivery without tearing apart her brachial nerve plexus. Instead, Dr Matthews delivered Tabitha by forcefully pushing down on her head, which dislodged her shoulder but also tore her brachial plexus. The injury she sustained caused permanent disability of her arm, which she must live with every day of her life. The case settled for $850,000.00, the largest amount ever paid in Kansas for the settlement of a shoulder dystocia case.

:: back to top

Spine Injury

Lori Dechant v. Dr. Bartal - $2 Million

Dr. Bartal treated a child with pediatric scoliosis for a total of 25 visits over an eight year time period but failed to order the MRI necessary to diagnose her spinal tumor, despite the presence of numerous warning signs that it existed. During the years of failed diagnosis, the tumor grew the length of the child's spine. Once the tumor was discovered (by another doctor, who immediately ordered an MRI after his first consult with the child), it was resected surgically, but the surgery was so invasive that the child was left with paraperesis from the waist down and is incontinent in her bowel and bladder.

History

In the late 1990's, Mr. Prochaska filed suit against Dr. Eli Bartal, a pediatric orthopedic surgeon, on three separate cases on the same day after having received a favorable jury verdict on his first case against Dr. Bartal. His first case involved an intraoperative spinal cord injury from back surgery.

After the three cases were resolved, Dr. Bartal hired a Wichita attorney to sue Mr. Prochaska and his clients for malicious prosecution, a tort wherein a lawsuit is brought without probable cause. Even though Mr. Prochaska had reports from three expert witnesses faulting Dr. Bartal, the doctor paid counsel nearly $400,000 to countersue Mr. Prochaska in an effort to discourage him from ever suing Dr. Bartal again.

Mr. Prochaska was defended in this countersuit by a prominent Kansas attorney, Lynn Johnson, who sensed the injustice of the suit and worked the case pro bono.

A week before the trial, a district court judge dismissed the case based on Mr. Prochaska's Motion for Summary Judgment, affirming that Mr. Prochaska was able to show ample probable cause for suing Dr. Bartal. An appeal was filed by Dr. Bartal, and was immediately accepted by the Supreme Court - bypassing the Appellate Court altogether. The Supreme Court unanimously affirmed the trial court's decision that Mr. Prochaska had probable cause to sue Dr. Bartal.

Lori's Case

In 2002, Mr. Prochaska again filed suit against Dr. Bartal, this time on behalf of Lori Dechant, a minor.

When Lori was 7 years old, Dr. Bartal examined her and found her spine to be curved. He correctly diagnosed her with juvenile scoliosis, a diagnosis which requires prompt MRI studies to see if a tumor is present in the spinal cord. Dr. Bartal failed to order the MRI, and the tumor present in Lori's back continued to grow for eight more years without being discovered.

From age 7 to age 15, Lori was seen by Dr. Bartal on twenty-five office visits. During this time, her condition continued to worsen and she developed six additional warning signs that indicated the need for an MRI. Each of the warning signs Lori exhibited, including abnormal spinal cord test, chronic back pain, and atypical scoliosis curve, are widely accepted in the medical literature as reasons to take MRIs, even when they occur individually, without the presence of the other signs.

At age 15, Lori changed doctors. Her new doctor immediately ordered an MRI study and found a tumor which had grown to the length of the spinal cord. The necessary surgical resection of that tumor left Lori paraperetic from the waist down, and incontinent of bowel and bladder.

Dr. Bartal claimed that resection of the tumor would have left Lori paraperetic at any age, and that MRIs are not routinely taken. Mr. Prochaska, however, succeeded in a motion for punitive damages against Dr. Bartal the wanton conduct of missing 25 opportunities to order the MRI that was necessary to diagnose Lori's tumor. A settlement was reached, including Dr. Bartal's policy limits of $2 million, and Lori refused to sign a confidentiality agreement.

68-Year Old Woman v. Neurosurgeon - $965,000 Settlement

Brad Prochaska represented a 68-year old woman who ran a stop sign while driving. She sustained a broken neck after colliding with another car, but was not paralyzed at the scene of the accident. The woman was transported to the hospital, where she was examined by a neurosurgeon. The neurosurgeon suspected that the woman's neck was broken, but removed her neck brace anyway. In the absence of the supporting brace, her head was able to move enough to cause broken neck bones to pinch her spinal cord, thereby causing the woman to become paralyzed from the neck down.

The neurosurgeon claimed it was the woman's fault for getting in the car wreck, and that her paralysis had already occurred at the scene of the accident. Despite these defenses, the neurosurgeon settled the suit for $965,000.00.

Because the woman was on the job at the time of the automobile accident, she also received a workers compensation settlement in the amount of $1.2 Million. At the time, this was the largest ever workers compensation settlement in Kansas history.

:: back to top

Stroke

Plaintiff v. Defendant Hospital and 2 Doctors - $4.7 Million

A 35-year old mother sustained locked-in syndrome due to hospital understaffing and negligent discontinuation of heparin therapy. The case settled for $4.7 million.

Plaintiff incurred a dissection of the vertebral artery in her neck from a chiropractic treatment. She went to the hospital where the two doctors treated her with heparin to prevent her from incurring strokes caused by blood clots formed as a result of the dissection. The two doctors eventually switched her from heparin to a low molecular weight heparin for easier administration of the medication. The patient was off heparin for approximately 20 hours, and began having a stroke. She had additional strokes in the 2 days following. This resulted in "locked in syndrome," a condition in which her mind is normal but she cannot talk or move any part of her body.

Plaintiff claimed that during the 20-hour period of no heparin, the nurse failed to properly monitor her, and the nurse failed to immediately call the doctor when stroke signs appeared. Plaintiff contended that her strokes would not have begun if heparin not been discontinued; also, if the doctor had been immediately notified by the nurse about the stroke signs, the doctor would have immediately switched back to heparin, which would have prevented any further strokes.

Plaintiff's attorney, Brad Prochaska, obtained two statements written by the nurse wherein she admitted that she did not properly monitor the patient, nor notify the doctor for stroke signs. The nurse wrote that the patient did not get the care she needed because the hospital was understaffed and the nurse was too busy with other patients. The case settled for $4.7 million.

Brad Prochaska of Prochaska, Giroux, & Howell handled the liability part of the case, and Vic Bergman of Shamberg, Johnson & Bergman handled the damages part of the case.

49-Year Old Woman v. Wichita, KS hospital and E.R. Physician - Large Confidential Settlement

Daniel Giroux and Brad Prochaska represented a 49-year old woman (client) who was employed at Boeing. She presented to a Wichita hospital emergency room with a right-sided headache and left-sided weakness, which are classic signs of a transient ischemic attack (TIA) or mini-stroke. A CAT scan was performed and was interpreted as normal. The patient was given pain medications as well as muscle relaxants and was discharged with a diagnosis of headache. Two days later, the client suffered a stroke thereby rendering her left leg useless. The lawsuit was settled for a confidential amount.

:: back to top

Surgical Complications

Novak v. Children’s Mercy Hospital and James Jaggers, M.D. - Large Confidential Settlement

Jim Howell represented Jasmine Novak, a minor child, in a lawsuit against Dr. James Jaggers and Children’s Mercy Hospital. While performing heart surgery on the child, Dr. Jaggers negligently clamped off and cut off a major pulmonary artery. The injury was discovered three days later when the child suffered acute pulmonary and cardiovascular distress. As a result of the negligence of Dr. Jaggers and the staff of Children’s Mercy Hospital, Jasmine sustained permanent damage to her cardiovascular and pulmonary systems. A settlement was reached and the defendants requested the amount remain confidential.

Darma McVey v. Michael Hotard, M.D. – Large Confidential Settlement

Jim Howell represented Darma McVey in a lawsuit against Dr. Michael Hotard. While operating on Mrs. McVey to remove a small mass behind her right ear, Dr. Hotard negligently cut her facial nerve, resulting in permanent right facial paralysis. A settlement was reached and the defendant requested the amount remain confidential.

Darryl McGinnes v. Estephan Zayat, M.D. - $2 Million

Brad Prochaska and Daniel Giroux served as local counsel in this wrongful death case brought by the family of Darryl McGinnes against Dr. Estephan Zayat. McGinnes, a 38-year old father of three, was admitted to Wesley Medical Center with an acute abdomen. Dr. Zayat suspected a gall stone and recommended a procedure known as ERCP, but failed to advise Mr. McGinnes of the risks of the procedure. During the surgery, Dr. Zayat experienced numerous complications that ultimately led to acute pancreatitis, thereby causing Mr. McGinnes' death.

Plaintiffs argued that the procedure was unnecessary and that the defendant fell below the standard of care when he justified the procedure. A Sedgwick County jury awarded the Plaintiffs $2 million.

Minor child v. Orthopaedic surgeon - $425,000 Verdict

Brad Prochaska represented a minor child in a lawsuit against a Kansas orthopaedic surgeon. While operating on the child to remove a spinal meningocele, the surgeon seriously damaged the child's spinal cord, causing permanent paraparesis and incontinence. A Sedgwick County jury awarded a $425,000 verdict.

14-Year Old Girl - $4.4 Million

We represented a 14-year old girl who had an arterio-venous malformation in her neck. The doctor who operated on her had never performed this surgery before. The hospital who employed the doctor failed to prevent the doctor from operating at its hospital when the doctor had no privileges to do this rare surgery. The girl eventually became quadriplegic. She received a settlement of $4.4 million.

:: back to top

Post-Surgical Complications

David Cook v. Brent Lancaster, M.D., Rod Buzzas, M.D. and Wesley Medical Center - $834,000 Verdict

Brad Prochaska represented the family of David Cook, a 56-year old man was admitted to Wesley Medical Center after an automobile accident that left him with a broken hip. He was discharged, but later returned with bowel difficulties. Wesley nurses negligently failed to chart a key symptom, diarrhea occurring more than once a day for a few days. That symptom, if recorded in the nurse notes, would have alerted the attending (Brent Lancaster, M.D.) and resident (Rod Buzzas, M.D.) physicians to suspect the presence of Clostridium difficile toxin, a side effect of too many days worth of antibiotics.

The doctors also negligently failed on their own to recognize Mr. Cook's diarrhea was a sign of the toxin when they knew he had been on antibiotics for several days. Both Lancaster and Buzzas negligently failed to order the simple necessary laboratory test to look for the toxin until it was to late to save Mr. Cook's life.

The jury handed down a verdict of more than $834,000, finding Wesley to be 25% at fault and the two physicians equally sharing the remaining 75% of fault. The verdict constituted the third highest medical malpractice verdict in the state during that five-year period.

Cancer Resection Patient v. Concordia, KS Surgeon - Large Confidential Settlement

Jim Howell represented the estate of a man who died as a result of surgical negligence. The patient underwent resection of colon to remover cancerous growth. Post-operatively, clear signs and symptoms developed suggesting an internal bleed. The surgeon ignored the possibility of internal hemorrhaging and continued to administer blood and fluids with no indication of associated output. Massive internal bleeding and associated systemic stress resulted in a heart attack and ultimately the patient's death. Mr. Howell filed a lawsuit on behalf of the man's estate and a large confidential settlement was reached.

Mayor of Small Kansas Town v. Halstead Orthopedic Surgeon - Large Confidential Settlement

Jim Howell represented the mayor of a small Kansas town in a lawsuit against a Halstead, KS orthopedic surgeon. The orthopedic doctor performed a laminectomy/discectomy to remove a herniated disc. A drain was placed in the incision and hooked up to a Hemovac system with minimal suction. The system clogged and the patient began to experience numbness in his lower extremities and loss of bowel and bladder control. The nurses failed to note the drain output or check the suction on the drain, but did report the neurological changes to the surgeon who refused to come in until the next day. The patient was taken to surgery 24 hours after the first signs and symptoms were reported, but the large blood pool and clotting in the back from the clogged Hemovac system had caused permanent damage to the spinal cord. The patient was left with a permanent limp and loss of bowel and bladder control. A large confidential settlement was reached.

:: back to top

Heart

David Lee v. Wesley Medical Center Emergency Department - Large Confidential Settlement

Brad Prochaska represented the family of David Lee, a 55-year old man, who was improperly triaged at the Wesley Medical Center Emergency Room. The patient arrived at the E.R. with a history of smoking and complaints of chest pain. This is picture of an ongoing heart attack. Mr. Lee was forced to wait 1 hour and 38 minutes before being seen for his heart attack in progress. When he was finally seen by an emergency department doctor, he suddenly collapsed and died of his heart attack. Had he been given medication earlier while in the E.R.,he would have lived. Instead, he died before this simple treatment was given.

The case originally went to trial and the jury found no fault on the part of Wesley Medical Center . However, Mr. Prochaska's exhaustive investigation of the jury's deliberations led to findings by Judge Paul Clark of misconduct by the jury and a new trial was ordered. The hospital then settled for a confidential amount.

Shirley Keck v. Wesley Medical Center - $2.7 Million Verdict

Shirley Keck, age 61, was admitted to Wesley Medical Center . Due to understaffing of nurses in the hospital, Shirley's nurse did not assess Shirley often enough and did not monitor Shirley's oxygen level. Shirley's deteriorating condition was not noticed by the nurse because the nurse was overworked. Shirley suffered a respiratory arrest with a resulting brain injury. Shirley reached a $2.7 million settlement with Wesley Medical Center . She and her attorney agreed that they would not keep her settlement confidential so that others people might avoid injury. Her story became nationally newsworthy and was presented on CBS -- 60 minutes, Reader's Digest, NBC nightly news, CNN, Chicago Tribune, Wichita Eagle and other media.

:: back to top

Anesthesia

52-Year Old Man v. Anesthesiologist - Large Confidential Settlement

Daniel Giroux represented the estate of a 52-year old man (decedent) who was employed as an engineer at Boeing. In 2002, the decedent developed a mass in his throat which required biopsy to determine whether it was malignant. At the time of the biopsy, the decedent suffered from a litany of health problems such as obesity, high blood pressure, sleep apnea, diabetes and reflux disorder. These conditions put the decedent at a high risk for developing anesthesia complications. Despite these health problems, the biopsy was performed under general anesthesia at a one-day surgical center. In the post-operative period, the anesthesia team had to intubate the decedent several times since he could not maintain and adequate airway to supply his body with the necessary amount of oxygen. Consequently, the decedent was exposed to a lengthy period of time without oxygen and later died.

A lawsuit was filed against the anesthesia team for failing to maintain an adequate airway. The case was settled for a confidential amount against the anesthesiologist.

:: back to top

Diabetes

12-Year Old Boy - $2.5 Million

UB was a 12 year old boy who had a sudden onset of severe diabetes. The young doctor and the hospital had no expertise in treating severe diabetes. He should have been referred to a specialist. Instead, he did not receive the correct treatment and was given the wrong medication. This allowed his brain to swell. His swollen brain led to brain damage and permanent bodily disability. He received a settlement of $2.5 million.

:: back to top

Failure to Diagnose

Robert Schlagel v. Hospital, ER Doctor 1, ER Doctor 2, and Hospitalist – Large Confidential Settlement

Jim Howell represented the family of Robert Schlagel in a survival and wrongful death lawsuit against Hospital, ER Doctor 1, ER Doctor 2, and Hospitalist. Robert Schlagel, a 50-year old man, presented to Hospital with complaints of chest and back pain. Despite having CTA films showing a potentially metastatic tumor on one of Mr. Schlagel’s vertebra, ER Doctor 1, the emergency room physician, told Mr. Schlagel he had a small hemangioma, assured him it was nothing serious, and sent him home with orders to follow up with an MRI in a week.

Mr. Schlagel scheduled an MRI to be taken 4 days after his visit to the Hospital, but returned to the E.R. three days after his initial visit because his pain had worsened. On this second visit, he was seen by ER Doctor 2, and again a CTA study showed an invasive tumor on the spine, this time with swelling around the spinal cord. The radiologist again recommended an MRI, but ER Doctor 2 admitted Mr. Schlagel to the hospital noting only non-specific chest pain. He negligently failed to note the CTA findings and the recommendation for an MRI in the chart when he transferred care to the Hospitalist.

Once Mr. Schlagel was admitted, Hospital nurses noted progressive loss of sensation and weakess in Mr. Schalgel’s lower extremities, but failed to report those abnormalities to the Hospitalist. Meanwhile, the Hospitalist negligently failed to consult the emergency room records and failed to order the recommended MRI, despite signs and symptoms of spinal cord compression exhibited by Mr. Schlagel. On the morning of the fifth day after first presenting to Via Christi, Mr. Schlagel awoke in the hospital room with lower extremity paraplegia. A STAT MRI was ordered which showed that the spinal tumor had progressed to the point of compressing the blood supply to the spinal cord, causing permanent paralysis to his legs.

Mr. Schlagel remained paralyzed from the chest down and was hospitalized at various institutions for rehabilitation and care until he was sent home to die more than two years later. He died several months later, secondary to the complications of paraplegia. Medical bills and economic damages incurred by Mr. Schlagel were in excess of $8 Million. A settlement was reached and remains confidential at the defendants’ request.

Estate of Young Mother v. Physician, Physician Assistant and Rural Kansas Hospital - Large Confidential Settlement

Daniel Giroux represented the estate of a 32-year old single mother (decedent) of two young children who resided in western Kansas . In September of 2001, the decedent presented to a local hospital with complaints of severe chest pain, shortness of breath, and coughing up blood which is the classic presentation for a pulmonary embolism. The decedent was treated by a physician assistant who diagnosed her with pleurisy and discharged her without any work-up to exclude pulmonary embolism. Two days later, the decedent collapsed and died. Autopsy revealed that the decedent died of a massive saddle pulmonary embolism.

A lawsuit was filed against the physician assistant, his employer hospital, and his supervising physician for misdiagnosing the pulmonary embolism. The lawsuit was settled for a confidential amount.

46-Year Old Woman v. Western Kansas Physician - Confidential Settlement

Our firm represented a 46-year old female who resides in Western Kansas . In December of 1999, our client was attending a family picnic at a farm when she was kicked in the abdomen by a horse. The client was taken to a local hospital where diagnostic test were performed to determine whether any internal injury had occurred. A CAT scan revealed free air in the abdomen and her lab results were abnormal, both of which are consistent with a perforated bowel. Immediate surgery was required to repair the injured bowel and prevent a massive infection or peritonitis. Despite findings confirming a perforated bowel, the treating surgeon opted not to perform surgery. Two weeks later, the client developed a massive infection which required numerous surgeries, drain placements, colostomy and other interventions. The client's convalescence which lasted a couple of years. A lawsuit was filed against the surgeon for not promptly operating on the client, and a confidential settlement was reached.

Quadriplegic Man v. Wichita ER Doctor and Family Physician - Large Confidential Settlement

Jim Howell represented a man who sustained head trauma during a fall. The man presented to the emergency department of a Wichita , KS hospital with clear signs of a brain bleed which were noted but not treated by the emergency department physician. The man was discharged with instructions to follow-up with his family physician. The family practice doctor examined the man but failed to diagnose the progressing hemorrhage in the man's brain until he suffered irreversible brain damage and quadriplegia. A lawsuit was filed, yielding a large confidential settlement.

Kidney Patient v. Hutchinson Family Practice Doctor - $10 Million Life Care Plan

Jim Howell represented a young man who lost both of his kidneys due to the negligence of his Family Practice doctor. The patient presented to the physician on three separate occasions with symptoms of a rapidly progressing kidney disease, but the physician ignored the red flags and misdiagnosed his condition as kidney stones. The young man then visited a urologist, who immediately recognized the need for emergent care and admitted him to the hospital. The delay in diagnosis of the kidney disease resulted in the loss of both kidneys, and the young man suffered through two years of dialysis before receiving a transplant. The lawsuit filed against he Hutchinson physician yielded a Life Care Plan in excess of $10 million and a confidential settlement.

Estate of Young Mother and Unborn Child v. Garden City Family Practice Doctor - Large Confidential Settlement

Jim Howell represented the estate of a young mother and her unborn child against a Garden City family practice doctor. The pregnant mother underwent gall bladder surgery (cholescystectomy) because of a gall bladder infection. Despite the mother's classic signs of blood clots in the lungs, the surgeon refused to administer heparin post-operatively under the mistaken belief that the anticoagulant would pass the placental barrier and injure the baby. The surgeon suspected blood clots and sent a letter to the family practice doctor, who saw the mother on two post-surgical follow-up visits. Clear signs of blood clots were present on both visits, but the family practice doctor ignored them and the letter and instead prescribed antibiotics to the pregnant woman. She and the baby both died from a massive pulmonary embolism (blood clot in the lungs). A lawsuit was filed and resulted in a large confidential settlement.

Abdominal Aortic Aneurysm Patient v. Lyons, KS Radiologist, P.A. and Family Practice Physician - Large Confidential Settlement

Jim Howell represented the estate of a Lyons, KS man whose aortic aneurysm was missed by three healthcare providers. The man experienced back pain and presented to his family physician. The physician ordered an x-ray which was interpreted by the radiologist as normal, but in actuality showed signs of a dissecting abdominal aortic aneurysm. The man's pain increased and he went to the emergency room where he was seen by a physician assistant. His presentation clearly exhibited classic signs and symptoms of an abdominal aortic aneurysm, but he was sent home with a diagnosis of muscle pain. While at home, he collapsed and was taken back to the emergency room where his was seen by his family physician. The FP suspected an abdominal aortic aneurysm, but sent the man to Great Bend, KS for a CT scan, where there was not a surgeon who could repair the aneurysm. Meanwhile, the man suffered a complete dissection of the aorta and began hemorrhaging while in CT. The emergency room doctor stabilized the man and had him rushed to Hutchinson, KS, where there was a surgeon who could perform the repair, but the man died postoperatively from complications of the aneurysm. A lawsuit was filed, yielding a large confidential settlement.

:: back to top

Medication Error

Family of Newborn Twin v. Wichita, KS hospital - $20 Million Life Care Plan

Jim Howell represented a twin baby boy who sustained severe brain damage due to nursing negligence. Due to fluid deficit, the baby had low blood pressure at the time of delivery. The baby's doctor ordered normal saline to be given intravenously over time to stabilize the baby's blood pressure. The nurse misread the label on the saline solution and administered a solution which as 50 times stronger than it should have been, causing the newborn's brain to swell to the point of tissue destruction. The nurse then attempted to cover up her error. The hospital was also found negligent for storing the two types of saline side-by-side, despite warnings issued by the manufacturer stating that the two types should no be stored together because of the risk of medication error. Mr. Howell sued the hospital on behalf of the baby and obtained a Life Care Plan in excess of $20 million, as well as a confidential settlement.

Estate of Deceased Heart Patient v. Rural Pharmacist - Large Confidential Settlement

Jim Howell represented the estate of a man who was prescribed heart medication by his doctor. The man took his prescription to a rural pharmacy, where the pharmacist misread the prescription and filled it with the wrong medication at a potent dose. The man took the medication and suffered toxic overdose, brain damage, and death. A lawsuit was filed, yielding a large confidential settlement.

:: back to top

Obstetric Negligence

Colorado baby boy v. Colorado physician - $1.5 Million

Brad Prochaska represented a baby boy in a Colorado medical malpractice case against a Colorado physician. The infant's mother died of a heart attack during labor due to an amniotic fluid embolism, and the doctor failed to deliver the baby promptly. Because of the delay, the infant suffered severe hypoxic brain injury and is a quadriplegic. The case was settled for $1.5 million.

Emmanuel Zapata v. 3 Physicians and Hospital - $4.3 Million

Brad Prochaska represented a severely injured child in a lawsuit against Lihn Tran, M.D., Wesley Williams, M.D., and Via Christi Health Systems d/b/a Via Christi Medical Center - St. Francis Campus. Prior to his delivery, Emmanuel's mother, Angela, was given too much pitocin, causing hyperstimulation of labor. The physicians and nurses failed to correct this hyperstimulation by stopping the pitocin, and the condition lasted for 14 hours, with late decelerations for 5 hours.

Manny, born in February 2000, is now incapable of social interaction, bladder control, and language development due to the hypoxic brain injury he sustained during labor and delivery. Drs. Tran and Williams each settled for $1 Million, Dr. Greer settled for $800,000, and Via Christi settled for $1.5 Million.

Vacuum Extraction and Delayed Delivery - $12 Million Life Care Plan

Jim Howell represented a severely injured newborn in a lawsuit against the obstetrician. When labor failed to progress, the obstetrician ignored signs of fetal distress and elected to use vacuum extraction, despite the mother's protests. Repeated attempts at vacuum extraction resulted in further delay of the delivery, causing the baby to suffer severe hypoxic (lack of oxygen) brain damage. The lawsuit yielded a Life Care Plan for the baby in excess of $12 million, in addition to a confidential settlement.

Delayed C-Section of Breech Baby - $20 Million Life Care Plan

Jim Howell represented a severely injured newborn in a lawsuit against the obstetrician. At 38 weeks gestation, the baby was in breech position. The obstetrician recommended external cephalic version rotation to correct the baby's position for vaginal delivery, but failed to inform the mother of the risks of the procedure. During the procedure, the baby's umbilical cord became entangled, cutting off all blood flow from the placenta to the baby. Despite signs of fetal distress, the obstetrician delayed performing a C-section for 30 minutes, causing the baby to sustain profound hypoxic brain injury. The lawsuit yielded a Life Care Plan in excess of $20 million for the baby, as well as a confidential settlement.

Delayed C-Section After Placental Abruption - $20 Million Life Care Plan

Jim Howell represented a severely injured newborn in a lawsuit against the obstetrician and family practice faculty supervisor. The mother was admitted for labor and delivery by a family practice resident, under the supervision of a family practice faculty supervisor. As labor progressed, the fetal heart monitor strips showed clear signs of fetal distress secondary to progressing placental abruption. The obstetrician-on-call was contacted for consult and told of the findings, as was the family practice faculty supervisor, but neither would see the patient. Fetal distress continued, prompting an emergency C-section, which was performed by a resident who did not have C-section privileges. The delay coupled with placental abruption caused severe hypoxic brain damage to the baby. The lawsuit yielded a Life Care Plan of $20 million for the baby, as well as a confidential settlement.

Un-Equipped Operating Room at Morton Co. Hospital - $22 Million Life Care Plan

Jim Howell represented a young mother who was admitted to Morton County Hospital (KS) for a routine labor and delivery. During labor, a prolapsed cord occurred, calling for emergent C-section. The mother was transported to the operating room, but the room was found to be empty of necessary equipment, instruments and supplies. The room had been cleared completely prior to the woman's admission in order to strip and re-wax the floors, but notice was not given to staff physicians and the O.R. director who knew about it was on vacation. The staff searched for equipment and supplies in hallways and closets in order to perform the C-section, but the 30-minute delay caused profound hypoxic brain injury to the baby. prior to the instigation of the lawsuit, key documents were destroyed. The lawsuit yielded a Life Care Plan of $22 million for the baby, as well as a confidential settlement.

:: back to top

Chiropractic Negligence

Augusta Chiropractor Sued for Causing Herniated Disk - Large Confidential Settlement

Jim Howell represented a woman in a lawsuit against an Augusta , KS chiropractor. The woman was told that her lumbar vertebra were out of alignment. The chiropractor proceeded to perform the "million dollar roll" as opposed to sending her to an orthopedic doctor for manipulation under anesthesia. The procedure caused severe lumbar disk herniation and permanent injury to the woman's back. A large confidential settlement was obtained.

:: back to top

Radiologist Negligence

Grandmother v. Wichita Radiologist - Large Confidential Settlement

Jim Howell represented the estate of an elderly woman who suffered paralysis and death due to the negligence of a Wichita radiologist. The woman was staying at her daughter's home while in town shopping for the Christmas holiday. She passed out while getting out of shower, causing back and lower extremity pain. She was taken to the emergency room where x-rays were taken. The radiologist read the x-rays as normal when in fact they showed a subluxation of one vertebrae over another and possible spinal cord impingement. The grandmother was admitted to the hospital to investigate the source of the vertigo which caused the initial collapse. By the second day in the hospital, she began experiencing numbness and lower extremity weakness. She awoke on the third day with lower leg paralysis and was rushed to CT, where the subluxation was discovered together with damage to her spinal cord. She was rushed to surgery, but never recovered the use of her legs. She was placed in a care home and subsequently died. A lawsuit was filed against the radiologist, yielding a large confidential settlement.

:: back to top

Psychiatric Negligence

Therapy Patient v. Wichita Psychiatrist - Large Confidential Settlement

Jim Howell represented a woman who had suffered physical and sexual abuse at the hands of her ex-husband. The woman saw a psychiatrist, who engaged in sexual activity with the woman under the guise of therapy. He convinced her that sexual escapades and "playing house" with him were appropriate treatment regimens. Mr. Howell filed a lawsuit on the patient's behalf and a large confidential settlement was reached.

Estate of Pharmacist v. Mental Hospital - Large Confidential Settlement

Jim Howell represented the estate of a pharmacist in a lawsuit against the mental hospital where the man committed suicide. The man was admitted to the Wichita, KS facility of a nationwide mental care organization due to an attempted suicide. He was evaluated by an untrained social worker and put on a 15-minute interval suicide watch. The facility was understaffed and the worker in charge of performing the 15-minute checks was on lunch break for over an hour with no one assigned to perform her checks. While the worker was absent, the pharmacist made a noose out of his t-shirt and hung himself. The worker altered the records to show that she had performed all checks and the staffing sheets were altered to indicate that the facility was properly staffed. An in-house peer review and risk management investigation was performed and statements of witnesses were taken. The statements were ordered produced after a heated discovery battle. The statements were in conflict with the altered records. A large confidential settlement was obtained on behalf of the deceased man's estate.

:: back to top

Psychologist Negligence

Therapy Patient vs. Montgomery County Psychologist - Large Confidential Settlement

Jim Howell represented a patient who had suffered sexual abuse as a child. The doctor convinced the patient that having sex with him while undergoing biofeedback in his office was an appropriate treatment regimen. The sexual abuse was discovered and the patient-therapist relationship was abruptly terminated, leading to further mental distress and injury. A lawsuit was filed on the patient's behalf, yielding a large confidential settlement.

:: back to top

Nursing Home Negligence

Estate of 89-Year Old Woman v. Nursing Home - Large Confidential Settlement

Jim Howell represented the estate of an 89-year old woman who was fatally injured at the nursing home where she lived. While being transferred by lift from her wheelchair to a whirlpool tub, the nursing aide lowered the lift with the woman's legs folded under it, causing bilateral hip fractures. In an attempt to cover up the incident, the aide placed the resident back into bed. The nursing home knew that the aide was a drug abuser and was under the influence of drugs at the time of the incident. The nursing home knowingly attempted to cover up the incident by documenting that the resident fell on her own while getting out of bed. The fractures were discovered days later and the resident was taken to the hospital for surgery, but died a week later. Jim Howell filed a lawsuit on behalf of the injured resident's estate, and a large confidential settlement was reached while a motion for punitive damages was pending before the court.

:: back to top


Auto, Truck, Train, Construction and Motorcycle Accidents

Automobile Accidents

Destiny Hawley v. Mayflower Contract Services - $2.8 Million

Destiny Hawley was an 8 month old girl involved in a car accident with a bus. She suffered a closed head injury (concussion) which caused an unpleasant change in her personality and her ability to learn.The jury awarded Destiny $2.8 million against the Mayflower Contract Services, Inc., the bus company.

Injured Motorist v. Wichita Police Officer - $250,000 Settlement

Jim Howell represented a man who was injured in a motor vehicle accident with an undercover Wichita police officer. The officer was driving an unmarked vehicle, allegedly trying to follow and arrest a prostitute who was on foot, when he ran a stop sign and t-boned the vehicle driven by a young man who had the right of way. The man sustained a herniated disk as a result of the collision. A lawsuit was filed, yielding a settlement of $250,000.00.

Injured Motorist v. Off-Duty Police Officer - $350,000 Settlement

Jim Howell represented a woman who was injured in an automobile accident with a police cruiser who struck her as she was turning left onto a county road. The impact sent the woman's car into a ditch, where it rolled three times. The woman was hospitalized with fractures for a month. The officer claimed he had lights and siren on and was in pursuit of a speeder that had been called in as leaving the scene of an accident. Discovery revealed that the police officer was off-duty, there was no call to 911 about a speeder and no report to dispatch that the officer was in pursuit. A lawsuit was filed and the case settled for $350,000.00.

Injured Motorist v. Arkansas City Fire Department - $175,000 Settlement

Jim Howell represented a woman motorist who was injured after her vehicle was t-boned by an Arkansas City fire truck. The woman and her daughter were traveling through a green light when the fire truck blew through the intersection and struck her vehicle. An eye witness, who was employed by the city at the time as a dispatcher, testified that the truck had lights and siren on and had slowed at the intersection to check for traffic. An ad was run in the local paper in an attempt to locate other witnesses. Three witnesses responded, stating that the truck did not have its siren on and never slowed at the intersection. The driver suffered minor injuries and the passenger did not suffer any injuries. The case settled for $175,000.00.

:: back to top

Trucking Accidents

Alexis Rangel v. Builder's Transport Inc. - $2.25 Million

Our firm represented Alexis Rangel, a 9-year old girl, who suffered a leg injury when a semi-trailer ran into the automobile in which she was traveling. She sued the trucking company, Builder's Transport, Inc. The jury awarded her $1.1 million.

Estate of Automobile Driver v. Wheat Truck Operator - $400,000 Settlement

Jim Howell represented the estate of a woman who was killed on her way to the local animal clinic to get medication for a pet. She suddenly hit her brakes and made a sharp right turn. Evidence showed that the signals on her vehicle were not on at the time. The driver of a wheat truck following her locked up his brakes and tried to avoid hitting her vehicle but could not. A lawsuit was filed, yielding a settlement of $400,000 00.

:: back to top

Train Accidents

Jeremy Honeycutt v. Union Pacific Railroad - Large Confidential Settlement

Brad Prochaska represented Jeremy Honeycutt, a 6-year old boy, who was injured while playing by railroad tracks. Jeremy fell and both of his legs were severed by the train's wheels. He received a large confidential settlement from Union Pacific Railroad, whose attorney stated the settlement would provide Jeremy with the "best possible medical and orthopedic care now and in the future."

:: back to top

Construction Accidents

Crane Operator Error Causes Injury - $800,000 Settlement

Jim Howell represented the employee of a soy bean processing plant who sustained permanent injury to his foot. The plant had hired a crane operator to remove a 10-ton grain auger for repair. Because of the size of the auger, chains were required to hoist it. Though the chains were available a mile from the plant, the crane operator chose instead to use nylon straps and in the wrong configuration to hoist the auger. The straps sheared and the auger dropped and bounced, striking a workman's leg and causing injury to his leg and foot. In addition to workers compensation benefits, the workman received a settlement from the crane operator of $800,000.

:: back to top

Motorcycle Accidents

Motorcyclist v. Sedgwick County - $272,000 Verdict

Brad Prochaska represented Jon Mayo, who sustained a broken leg in a motorcycle accident on a Sedgwick County road. The injury required three operations and left Mr. Mayo with a permanent limp. A lawsuit was filed, alleging that the county created a dangerous condition by failing to warn motorists that the road was barricaded ahead. At trial, a jury awarded Mr. Mayo $272,000.

Workman v. Unsafe Forklift Operator - $500,000 Settlement

Jim Howell represented an injured workman whose foot was permanently injured as a result of unsafe operation of a forklift. The man was hired to assist in loading oil rigging pipe onto a flatbed trailer for transport. While he was securing the load, a forklift operator bumped into the trailer, causing the load to shift, fall, and strike the workman's foot. The workman sustained permanent injury to his foot. A lawsuit was filed on the workman's behalf, yielding a $500,000 settlement.

Workman v. Crane Operator for Failure to Inspect - Wrongful Death - Large Confidential Settlement

Jim Howell represented the estate of a workman who was fatally injured in a construction accident. The contractor responsible for building a bridge brought a 100-foot boom crane from another job to the bridge job-site to lift and set bridge pylons. The crane operator failed to inspect the crane's cable reaving. The boom dropped when reaving suddenly mis-spooled, severing the arm of a workman on the site. The workman's arm was reattached at a local hospital but post-operative infections lead to his eventual death. Mr. Howell filed a lawsuit on behalf of the workman's estate. A large confidential settlement was reached while a motion for punitive damages was pending before the court.

:: back to top


Workers Compensation

Auto Accident while on the job - Record-breaking $1.2 Million Settlement

Brad Prochaska represented a 68-year old woman who ran a stop sign while driving. She sustained a broken neck after colliding with another car, but was not paralyzed at the scene of the accident. The woman was transported to the hospital, where she was examined by a neurosurgeon. The neurosurgeon suspected that the woman's neck was broken, but removed her neck brace anyway. In the absence of the supporting brace, her head was able to move enough to cause broken neck bones to pinch her spinal cord, thereby causing the woman to become paralyzed from the neck down.

The neurosurgeon claimed it was the woman's fault for getting in the car wreck, and that her paralysis had already occurred at the scene of the accident. Despite these defenses, the neurosurgeon settled the suit for $965,000.00.

Because the woman was on the job at the time of the automobile accident, she also received a workers compensation settlement in the amount of $1.2 Million. At the time, this was the largest ever workers compensation settlement in Kansas history.

:: back to top


Other Personal Injury

Slip and Fall

Carol Frame v. Wal-Mart Stores, Inc. - Confidential Settlement

Daniel Giroux represented Carol Frame, a 76-year old woman who works for a local fitness club. On an early Sunday morning in August of 2004, Mrs. Frame was grocery shopping along with her husband at a local Wal-Mart store. On the way to the checkout counter, she slipped and fell on a grape and consequently fractured her shoulder. The grapes had fallen from the stand onto the floor while a Wal-Mart employee was stocking the stand about twenty minutes prior to Mrs. Frame's fall. Unfortunately, the grapes were not cleaned up, thereby creating a fall hazard. A claim was filed on the client's behalf for medical expenses, lost wages, and pain and suffering. Wal-Mart settled for $50,000.00.

Elderly Grocery Shopper v. Dillons Stores - $120,000 Settlement

Jim Howell represented an elderly lady who was injured while shopping at a Wichita, KS Dillons grocery store. A produce employee of the grocery store stocked grapes in the morning. While doing so, grapes spilled onto the floor and remained there for the rest of the morning, contrary to the store's inspection policy. An elderly lady was shopping in the produce department when she slipped on one of the spilled grapes and fractured her hip. The store contended it followed its inspection policy. Discovery proved that the person in charge of inspection was on vacation at the time and no one was told to assume his duties. A lawsuit was filed, yielding a $120,000.00 settlement.

:: back to top

Firearm Accidents

Family of 16-Year Old Boy v. Homeowner's insurance company

Daniel Giroux represented the estate of a 16-year old boy (decedent) who was hunting with his 16-year old friend. While trying to navigate some terrain, the friend accidentally discharged his shotgun thereby shooting the decedent in the abdomen. The decedent was immediately taken to a hospital where he was pronounced dead. A claim was brought against the friend's parents under their homeowner's policy. The claim was settled for the full amount of the homeowner's policy limits.

:: back to top

Fraud

Minor child vs. Kansas hospital - $3.4 Million

Brad Prochaska represented a child in a suit against a surgeon whose negligence during a spinal meningocele surgery left the child paralyzed and incontinent. During the trial of that matter, plaintiff's attorneys noted discrepancies in the medical records and filed a separate suit alleging that the hospital (where the surgery was performed) fraudulently altered the child's medical records to cover up evidence of malpractice. Hospital lawyers claimed changes in the records occurred unintentionally as a result of a filing error. The hospital was sued for fraud and the case settled for $3.4 Million.

:: back to top

Dental Malpractice

Dental Patient v. Haysville, KS dentist - Confidential Settlement

Walter Craig represented a Derby, KS woman who suffered severe infection as a result of the negligence of a Haysville, KS dentist. The patient was seen by the Haysville dentist for placement of prosthodontics. Several teeth were pulled and impressions of her gums were made to assist with the creation of false teeth. During the process, however, some of the plastic impression material was left behind in the woman's oral cavities, and the cavities were stitched closed. The pieces of plastic became lodged in the floor of her sinuses, causing chronic severe sinus infections. Eventually, the woman saw an oral surgeon who discovered the impacted particles and removed them. A confidential settlement was reached with the dentist.

:: back to top

Premises Liability

Store Patron v. Wichita, KS Department Store - $1.3 Million Punitive Damages, Plus Actual Damages Awarded by Jury

Jim Howell represented a store patron who was injured while shopping at a Wichita department store. Inappropriate merchandising, use of glass shelves in the infant clothing department and failures in inspection policy resulted in a shelf falling and striking the shopper's foot, causing tarsal tunnel injury. The shelves were not secured by fasteners and the person in charge of inspection was laid off prior to incident. The policy of the department store encouraged under-reporting of defects that could injure patrons. Mr. Howell filed a lawsuit on the patron's behalf and the case was taken to trial. A Sedgwick County jury awarded actual damages and the court awarded punitive damages in the amount of $1.3 million.

:: back to top

Prochaska | Giroux | Howell
7701 E. Kellogg Suite 415 Wichita, KS 67207-1709
Please fill out and submit the information below and we will contact you shortly.
name:

phone:

e-mail:

case comments:


Anti-spam question:



   
Please be aware that the transmission of an e-mail inquiry itself does not create an attorney-client relationship.

Kansas Personal Injury Attorney Disclaimer: The accident, injury, personal injury, medical malpractice, wrongful death, and/or other Kansas legal information offered herein by Prochaska, Giroux & Howell, is not formal legal advice, nor is it the formation of an attorney client relationship. In order for our firm to be considered your attorney there must be a signed agreement between the client and the firm. Any case results set forth herein are based solely upon that particular case and offer no promise or guarantee on the outcome of any other matter. Please contact a Kansas personal injury lawyer for a consultation. This site is not intended to solicit clients outside the State of Kansas.

© 2009 Prochaska, Giroux & Howell – Wichita Personal Injury Attorneys and Kansas Medical Malpractice Lawyers

Website Design, SEO and Legal Internet Marketing by: SLS Consulting l Sitemap