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Spoilers: 13.05 "Ames vs. Kovac"

Doc Sharon http://p072.ezboard.com/baeb

Just a tiny bit of info, it looks to be an eppy with lots of Luka in court scenes. Abby is working her first shift since the baby. There are flashbacks to the Ames' case told from Luka's POV as well as the patient's. Andre Braugher should be very compelling.

The case itself involves a man admitted with pneumonia. He doesn't want to go to the ER, his boss insists, he doesn't want to stay. The ER is swamped with waits up to 12 hours, the guy is less than impressed with the place.

Chuny, his nurse, has a lot of trouble starting an IV on him, tries at least 4 times without success, naturally, in retrospect, it is this sort of thing that makes Mr. Ames is suspect the quality of his care.

Mr. Ames asks to see Luka because he doesn't want stuck again and is told Luka is busy with a trauma, but Ames sees him sitting at the computer at the nurses' station, looking at photos with Frank and then eating a bagel before he returns. This is the sort of stuff that looks horrible to a jury even if it is all easily explained. Anyway, despite Ames' desire to leave with an rx, Luka places a central line.

The guy is then left in the ER for several days and can't sleep, has no privacy, has to use a bedpan because there is no one available to assist him to the rest room.

Medically, what happens is he throws a clot from his central line, and it travels through his foramen ovale (little hole between the atria in the heart which usually closes up at birth, but can remain open without symptoms) and goes to his brain. By the time this happens, Ames is so fed up with the place that he refuses TPA because he is afraid someone will screw it up and his stroke worsens.

Anyway, Luka does rather badly on cross examination, getting angry and complaining about how short staffed and busy they were. Juries are not impressed by this, believe me. In real life, the hospital would have settled this out of court for a bundle.

Mr. Ames was a very skilled carpenter pre-stroke and now cannot work, his marriage fell apart and he only sees his kids once a week. He lives alone on disability. They show home movies of him making beautiful furniture, playing with his kids, hugging his wife and contrast them with film of his current life to drive home the point.

Abby is back and is dismayed to discover that the ER apparently no longer has its own ultrasound, but has to borrow from Radiology, leading to delays. Crenshaw and Neela are consulted, but leave to await the ultrasound. Abby ends up convincing Pratt to do some sort of risky procedure on a patient, not enough info to tell what that is about, not sure it is the ultrasound patient. Abby gets a phone call during it but is too busy to take it, no other info.

At one point while discussing a patient with Pratt, Abby fires up her breast pump, startling him. Little miss classy announces her 'boobs are about to explode'. Don't know where they are when this happens. Hope they're not in the ambulance bay or the nurses' station.

Sam, Abby and Pratt end up singing a bit of 'Should I Stay or Should I Go?' together.

More info: Abby's patient, Mariko, is having life threatening GI bleeding from Crohn's disease, but doesn't want her son, away at college, notified because she has been in and out of the hospital so many times. The gastroenterologist feels her disease is too extensive for endoscopic management and she will need surgery. While Abby and the GI guy are talking to her, Timmy tells Abby that 'Big Daddy' called for her.

Luka testifies that he brought a neurologist into talk to Mr. Ames after he refused the TPA because he feared the 10% risk of death or more severe disability with its use. The neuro tried to explain that since he is younger and healthier than the usual stroke victim, his risks would be lower, but he doesn't buy it since nothing has gone right in days at County.

Abby and Gates are caring for a guy whose wife bit his tongue off. Gates tries to introduce himself to Abby, jokes lamely about the case, tries to ask about the baby. She ignores him for the most part.

The eppy ends with the case going to the jury. The jurors are 'types' more than real people. One thinks all doctors are greedy and getting kickbacks from drug companies, another talks about how the American medical system is completely messed up and that is not Luka's fault, especially at County, where 'the standard of care' is a joke. We see Ames waiting for the jury to come back and Luka wandering the streets of Chicago, worried and alone in the cold night.

More flashbacks to Ames stay at County: puking drug addicts, forgotten meals, nurses who don't know whether he is allowed to eat or not even though they are supposedly caring for him.

Early in the eppy, Luka is at the apartment reviewing his depo when Abby spills something on it and then tells him he's done enough reviewing anyway. She does speak to Joe as she heads to the door, it is the new nanny, Miriam, 60 ish. She is Mary Poppins essentially, all love and hugs and very assured and experienced. She is also quite affectionate with Joe who is a 'happy baby'. Abby gives her all sorts of last minute instructions as Luka hurries her out the door. She kisses the baby goodbye. In the car, Abby is afraid she has forgotten everything and will look like a med student. Luka is preoccupied with the case as he knows Ames will look very sympathetic to the jury. Abby offers to call off her shift and go to court with him since the ER has been fine without her these 'past few months'. He tells her to go to work.

Pratt goes for a haircut in the old neighborhood and is surprised to discover that most of the locals don't go to the doctor ever. He tells them they need their BP's checked, their sugars, their prostates. As he leaves, he runs into his brother Chaz who is now attending UIC (University of Illinois Chicago). Chaz later calls him at the ER.

Stormwatcher77 http://p089.ezboard.com/btheerexchange

The bulk of this episode shows us various scenes in the trial where Ames attorneys try to prove that Luka was negligent in his care of Ames. It seems that, in 2004, Ames came to the ER with what later is diagnosed as pneumonia, forced by his boss who did not want a contagious employee. Ames resists because he is afraid his boss will give the job to someone else.

It takes a while for staff to see Ames; Chuny is unsuccessful in starting an IV for antibiotics and Luka starts a central line. Ames is in the ER for 3 days because there are no beds upstairs. He cant sleep because of the noise, and must use a bedpan because nurses are too busy to help him. The ER is swamped the entire time, and the nurses had a higher than standard load, yet it seems Luka did not bring that fact to the attention of anyone.

On the third day, Ames has numbness in his arm but his symptoms go away. Because Luka did not, during the three days, listen for or appreciate Ames had a heart murmur, a clot formed and moved through the mans congenital heart defect to his brain, causing a stroke.

Even worse, however, is that after the staff realized Ames had a stroke, Luka and the neurosurgeon strongly recommend TPA therapy. But Ames, thoroughly disgusted by his 3 day experience, refuses emphatically. The stroke is serious enough that he cannot recover fully. As a result, Ames cant work, is on federal disability, lost his wife, sees his children only once a week, and lives a miserable life.

The defense attorney is quite effective, with film of Ames life before the stroke, with his wife and children, and today, alone, disabled. During closing arguments, she brings in Ames children for the effect on the jury.

The jury begins debating the outcome, some arguing about the ineffective care Ames received and condemning the entire health care system. Another argues that the judge wants them to decide based only on the evidence they saw. One accuses Luka of being part of the system and not caring, but driving his fancy car.

Luka is quite torn up about the entire event before as he has a morning with Abby, and afterwards, walking the streets. In the morning, he is distracted and upset because the baby burped over his papers. Abby and he prepare to leave as the super nanny arrives. During the trial Luka loses his even temper under questioning. And near the end, he walks the streets quite upset with the proceeding. From other spoilers, we know that Abby is concerned, phoning Lukas cell phone and leaving the message to call her.

Meanwhile, as the episode opens, Pratt is at a barber shop with some old-timers. He talks about how he has an apartment there, not up in the rich sections of the city. He notices that one of the regular customers has a tremor in his hand and asks if the man has seen a doctor. The answer is no because no one trusts the medical system. As he leaves, Pratt accidentally runs into Chaz, his half-brother. Chaz in entering college and they agree to see each other again. Pratt seems happy about that. Later, Chaz shows up to the ER asking to see Pratt.

It is Abbys first day back at work, and although she offered to come to the court room with Luka (because she could see he was stressing about the trial), he says she should go to work, and Abby agrees. She meets Gates for the first time (who calls Luka the big guy) and is not impressed. Abby also meets Crenshaw and is equally unimpressed. She handles a number of patients, including

Jenkins who has a splinted ankle and Abby shows him how to use crutches, but the crutches break and she falls down (but is alright). Jenkins in not impressed. Then, a man who whos blood pressure was normal at triage but upon examination is high. And, Mariko who has Crones Disease and is now bleeding. Her specialist doc cant scope her because of the bleeding and they prepare her for surgery. Marikos son is away at school but she wont call him despite her serious condition. (Cut to Luka in court.) Later, Abby convinces Pratt to do a risky procedure to save Marikos life and it works. Meanwhile, Luka calls her while she was upstairs with a patient. Timmy calls Luka, big daddy.

Later, Abby takes a call from the nanny: baby Joe is upset and crying even though the nanny has done everything. Abby begins singing through the phone, joined by Sam and Pratt singing, Should I Stay or Should I Go by The Clash. At the words, should I cool it or should I blow? and the scene cuts to Luka on the stand during the trial, about to lose his cool.

Very little Neela; shes down with Crenshaw on a consult, and towards the end, talks with Ray who brings up her med student, Katie. (From earlier spoilers, we learn that Ray treats Katies burns and she suggests they go out to a club.) Very little Ray (except for above) and some Sam but mostly in the nursing role. No Kerry.

Genevieve http://www.fanforum.com

During a medical scene Timmy comes in to give messages. Says there's someone on the line for Pratt who says he's his brother. And he tells Abby that "big daddy" called while she was upstairs.

Gates introduces himself to Abby sort of recognizes him. He says he used to be a paramedic, now he's an intern. Pratt: Next week he wants to be a cowboy. Gates: Astronaut

There's one little snippet with Ray and Neela. Ray approaches and asks if she has a minute. Neela says she has 12 hours, she's on all night. Ray says it's about Katey, her new med student... and that's the end of the page.

There's some talk between Pratt and Abby about patients or something and then there's a loud hum as Abby fires up her breast pump. Pratt asks what it is and she tells him she's pumping, remarking that her "boobs were about to explode". I think this is her first day back to work. There are some random mentions about it being good to be back and someone asking who's watching the baby.

In another part Timmy tells Abby that it's her baby-sitter on the phone, Anny gives a look or something, and he says it's important.

Oh, found the babysitter. Her name is Miriam. There's a scene with Abby and Kovac before her goes off to court. The baby spit up on some of his papers. Kovac says he needs to review the stuff, and Abby asks "10 times?" Abby tells him he didn't do anything wrong and to just tell the truth. Kovac looks at her, he wishes it was that easy. The doorbell rings and Abby heads for the door with Joe. It's Miriam and she takes the baby then follows Abby inside. Abby's telling her stuff she put out. Kovac says he should get going. Abby says her too and gives some last minute instructions to Miriam. Abby tells her not to worry about calling her with any questions. She's ambivalent about leaving, but she and Kovac exit. They're in the car together and Abby is talking about work, but Kovac doesn't respond and she becomes aware of his troubled state of mind about the case. He's worried. Abby asks if he wants her to come with him to court, but he says it's more important for her to be at work. She tells him good luck and gives him a kiss before getting out and heading through the arch.

speddoc http://www.tv.com/er/show/111/board

Episode 13.5: Ames v. Kovac (Broadcast Date: October 19, 2006)

The episode opens at Luka and Abbys. Luka is grim, oblivious to the morning hubbub around him, as he prepares for court by reviewing his deposition from a year earlier. Something spills on Lukas papers (we cant tell what). Abby tries to clean up, then one page is damaged, Abby apologizes for the spill and the damage. Luka insists hes got to go over the papers, for the tenth time, Abby notes, but hes afraid he might contradict himself and look bad. She gently reassures him hes done nothing wrong, to tell the truth and hell be fine, but hes clearly not convinced its that easy. Abby carries BK, chatting with him as she gets ready for the arrival of the nanny. Luka is still reading when their 60-year-old nanny, Miriam, arrives. Miriam takes the baby as Abby adds a few last reminders about clothes and feeding, a bit unsure she wants to leave him. Luka, still up in his head, says he has to leave, and Abby leaves with him.

Luka drives them both to work, still lost in his thoughts. Abby chatters a bit nervously about returning to work after being gone several months, but Luka doesnt seem to hear her. Abby realizes how worried he is, and asks if hes OK. He tells her hes concerned about how sympathetic Ames will appear, and what losing the case will do to his professional reputation and their income; he seems to expect to lose. As they arrive at the hospital, Abby offers to go to court with him, but he thinks its better she goes to work, and she agrees.

Luka meets his attorney, Walton, and Angela at the courthouse. Hes in a world he doesnt know, and is only half listening as they brief him on how to testify. He tells them hell meet them in the courtroom, and disappears into the bathroom.

The bulk of the episode is set in the courtroom. The case begins with Ames testimony; his attorney asks why he came to the ER on February 13, 2004. Ames begins then we cut to a flashback from his POV, as his boss insists he stay for treatment of a cough, despite a 12-hour wait. He recounts Chunys brusque treatment of him at Triage while hes pleasant and cooperative. During this time, he first sees Luka chatting with Chuny. We return to present-day and hear Luka questioned by his attorney about his first contact with Ames. This cuts to the same recollection of Curtis signing in, this time from Lukas POV, Chuny is now professional and kind, Ames resistant to treatment.

Testimony continues in this way as each is questioned by his own, or opposing council. We see key events from each mans POV as Luka evaluates Ames, recommends IV antibiotics when Ames wants a shot, places a central line after Chuny cant put in an IV, the first numbness that indicates the stroke followed by Lukas examination, and Luka, with the help of a neurologist, discussing TPA which Ames refuses. Other flashbacks include Chuny attempting an IV several times, and Ames experiences with what he sees as indifferent treatment while hes left alone in the ER, unable to sleep and using a bedpan. At one point, he asks to see Luka, and is told hes with a patient, but sees Luka smiling and looking at pictures with Frank, then eating a bagel.

Lukas cross-examination by Kellerman, Ames attorney, goes badly. Luka tries to calmly explain that Ames was monitored by a resident who was responsible for his care, and that his pneumonia was improving. Kellerman asks if nurses do the close monitoring, then presses him about the nursing shortage, and what he did about it, while he tries to explain how things are done. Later, she presses him regarding the medical aspects of the case, suggesting Luka missed a heart murmur that might have indicated the small hole between two chambers of the heart (patent foramen ovale) that would have allowed a blood clot to travel to Ames brain (rather than lodging in his lung, as would ordinarily happen.) Luke tries to explain the rarity of the condition as the attorney attempts to paint him as negligent. Luka is rattled by the way she cuts him off and her insistent questioning, and finally loses control, insisting he was treating a number of serious patients, that they were understaffed and overburdened, and that his actions were reasonable given Ames status. Once the judge restores order, Kellerman presses Luka, trying to get him to admit he could have prevented the stroke, over Waltons objections.

Late in the episode, around 5:00, we see Abby try to call Lukas cell phone, and leave a message. Pratt asks how hes doing but she doesnt know anything. Luka sits at the defense table, feeling guardedly hopeful. Walton sums up, portraying Luka as having exceeded the standard of care according to the experts, and the stroke as an unpredictable complication. Walton tells the jury his (Lukas) ER is the last bastion for people who have no other access to decent healthcare. During Waltons summation, a paralegal brings Ames children into the courtroom. Kellerman counters with a series of then-and-now videos showing Ames as he is now: alone, divorced, and living on disability and as he was before the stroke: a skilled furniture maker. The videos are designed to play on the jurys sympathies, as Kellerman suggests Ames was abandoned by the hospital and given substandard care by Luka.

The case goes to the jury near the episodes end. Angela reassures Luka she can tell when a jury likes a doctor, and by implication, that this one likes Luka. The early jury deliberations spin off into a discussion of common ideas about rich doctors, kickbacks, and lack of concern. The episode ends with Ames sitting in the darkened courtroom, contemplating the day. It cuts back the jury briefly as theyre airing their attitudes about the health care system in light of the case, as the foreperson tries to get them to consider the evidence it doesnt look good for Luka. We hear their deliberations continue in voice over and see Luka walking the Chicago streets clearly worried, branded by them as a part of a failed health care system.

Abby returns to the ER, and works with Gates; we learn shes back after several months. She and Gates treat a frail older man as Gates tries to charm her, which she ignores. When Abby asks for an ultrasound, she learns they no longer have a machine, but must order one from radiology. Crenshaw and Neela come down from surgery before ultrasound arrives. Abby introduces herself, Crenshaw is typically rude, and they take the patient to surgery. Later, Abby and Gates chat a bit about the baby, and Abby tells Gates she doesnt want to be one of those crazy Moms who calls the babysitter once an hour. At the end of her shift, she takes a tumble while trying to show a patient how to use some rickety crutches, and jokes with Neela about it.

Pratt makes a morning visit to the barber shop, and chats with a group of older men who tease him about his uptown lifestyle. He notices one seems to have a tremor, and asks about their access to heath care; it appears none of them has seen a doctor in some time. He meets up with Chaz, whos started at the University of Illinois, Chicago. They decide to see one another more often. At the hospital, Pratt runs the board for the day. He and Ray treat a man whos bitten off part of his tongue. Later, Chaz comes to the hospital looking for Pratt, wanting to go out after Pratts shift. Theres also a short scene where Katey thanks Ray for treating a burn she receives while on duty, and Ray tries to talk to Neela about Katey.

Pratt, Abby and Sam treat a woman named Mariko, who is vomiting blood. Consultation with her doctor indicates she need surgery for an upper GI bleed. Shes alone, but doesnt want them to bother her son, who is away at school in Oregon. Abby gently tries to persuade her to call him. At some point, Abby and Pratt talk while Abby is using her breast pump, which unnerves Pratt. Later, it appears Mariko starts bleeding badly, and Pratt reluctantly agrees to let Abby place a balloon of some sort in her thoracic aorta that gets her bleeding under control long enough to get her to surgery. As Crenshaw and Neela arrive to take the patient up, Miriam calls and Abby sings to the baby over the phone; Sam and Pratt join her.

Timmys also around again. He tells Abby big daddy has called while she was out, and calls her Doc Lock; later he carries a similar message from Chaz for Pratt, and comes to get Abby when Miriam calls.


08/31 - Episode 13.0? - Ames v. Kovac: Kovac is in court over a medical case that occurred in 2004 where a man, Ames, was brought to the ER because of a cough. During testimonies, we will see flashbacks from the point of view of people on the stand. In Ames' version, he is polite and reasonable throughout his stay in the hospital, but the medical staff is not. In Kovac's version, the staff is polite but Ames is not. It's clear that it is Ames versus Kovac, who will win? Neela, Crenshaw, Sam, Gates, Abby, Marquez, and Pratt, also appear.


ER --(10:01PM-11:00PM) --(TV-14)

. "Ames V. Kovac"
KOVAC TAKES THE STAND-- FOREST WHITAKER ("The Shield") GUEST STARS- Fresh off of her maternity leave, Abby (Maura Tierney) prepares to return to work but worries that she may not remember how to be a doctor. Kovac (Goran Visnjic) tries to recall his treatment of stroke patient, Curtis Ames (guest star Forest Whitaker) as he prepares for his day in court. Abby and Pratt (Mekhi Phifer) try an unconventional method for treating a heart patient in hopes of avoiding a more invasive procedure. Meanwhile, Dr. Kovac defends his actions in court while Mr. Ames tries to prove he was neglected at County General. Parminder Nagra, Linda Cardellini, Shane West, and John Stamos also star.