CITYWIDE FITNESS CENTER, INC. Dr. Vontz looked at Tommy Jetson with a scowl

CITYWIDE FITNESS CENTER, INC.
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 310 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.
The morning following his visit to Doctor Vontz, Tommy had an intensive discussion with his wife,
Jitsy, regarding his health and lack of exercise. Jitsy had joined the local Citywide Fitness Center
the previous year with the expressed intent to “get in shape.” Subsequent to her joining Citywide
Fitness Center, Jitsy 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 Citywide Fitness Center 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,
Jitsy asked Tommy if he would at least accompany her to Citywide Fitness Center 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 Jitsy to Citywide Fitness Center, dropped her off and returned to
pick her up. Jitsy was not waiting outside of Citywide Fitness Center when Tommy arrived to pick
her up so Tommy parked his car and entered Citywide Fitness Center 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 Citywide Fitness Center 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 Citywide Fitness Center employee then began
administering cardiopulmonary resuscitation (CPR). The only medical aid that the employee was
able to administer was CPR since Citywide Fitness Center did not have an automated external
defibrillator (AED) on the premises. The employee continually administered CPR until two
emergency medical technicians (EMT’s) 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.



Copyright 2009, Dr. Gordon Johnson, Dr. Leonard Rymsza, and Dr. Kurt Saunders

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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, Jitsy, is contemplating suing Citywide Fitness Center for negligence.
On behalf of Citywide Fitness Center, Mr. Beau Flex has hired your firm to provide an analysis of
the situation. Initially, Mr. Flex provided your firm with copies of letters exchanged between
himself and Chaise Lounge. In addition, Mr. Flex provided your firm with some data relating to
age at death and blood cholesterol levels.
After reviewing the information provided by Mr. Flex a meeting was arranged by your firm to
discuss this matter further with Mr. Flex. During that meeting Mr. Flex provided additional
information including the following: Citywide Fitness Center Mission Statement and Corporate
Vision; a magazine article from the “Journal of Medicine & Science in Sports”; a newspaper article
from the “Hometown Tribune”; a copy of a Gould Court of Appeals Case (Fogel v. Get ‘N Go
Markets); a copy of Gould Health & Safety Code, §§ 204-205; and a copy of Gould Evidence
Code, § 966.

Required
Your firm has been hired by Citywide Fitness Center to provide an analysis of the situation. Write
a report using the report writing guide from the course website. Before beginning to write the
report, what issues must be addressed in the case? Does your firm require additional
information? If so, what is the additional information needed?
Your answer should include concepts 1, 4, and 5 from statistics, concepts 2 and 5 from business
law, and material in ethics.

2

Citywide Fitness Center, Inc.
Corporate Headquarters
15821 Fitness Lane
Powerlift City, Gould 00050
October 12, 2008
Mr. Beau Flex
Director of Risk Management
Citywide Fitness Center, Inc.
1400 Treadmill Lane
Powerlift City, Gould 00049
Re: Automatic External Defibrillators
Dear Mr. Flex:
The Board of Directors for Citywide Fitness Center, 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 (AED’s).
As you know, the Board has been struggling with the issue of whether to provide AED’s at all of
Citywide Fitness Center 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, it is interested in your analysis of the following issues:
1.
2.
3.
4.

5.
6.

7.

Costs associated with the AED – purchase cost, maintenance and testing costs,
education and training costs, etc.;
The reliability of AED’s;
Potential liability for coming to another’s aid – the Good Samaritan issue;
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;
How fast must the response be in order to prevent significant neurological
damage or death;
Is there an increased risk of liability for using an AED; (Would providing AED’s
create a higher duty on Citywide Fitness Center 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;
Any other issues you believe must be considered by the Board.

Your timely response to this inquiry is appreciated.
Sincerely,

Chaise Lounge
Chaise Lounge
Chairman of the Board
Citywide Fitness Center, Inc.

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Department of Risk Management
Beau Flex, Director
Citywide Fitness Center, Inc.
1400 Treadmill Lane
Powerlift City, Gould 00049
November 1, 2008
Ms. Chaise Lounge
Chairperson of the Board
Citywide Fitness Center, Inc.
15821 Fitness Lane
Powerlift City, Gould 00050
Re: Automated External Defibrillators
Dear Chairperson 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 numerous 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 earlier 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, lightweight 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
backup. 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 pad 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

4

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 AED’s.
It is clear that AED’s are of proven clinical benefit when used to defibrillate individuals
experiencing sudden cardiac arrest. AED’s are electronic devices and as such component
failures do occur. It is estimated that in the last three years more than 100,000 AED’s have been
recalled. In 2006 there more than 30,000 AED’s were recalled. A complete list detailing the
reason for the recalls is available. In addition, data is available relating to the number of AED's
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 date, 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 AED’s 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 an 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%.

5

Is there an increased risk of liability for using an AED? (Would providing AED’s create a
higher duty on Citywide Fitness Center 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 AED’s
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 AED’s, 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 AED’s 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 AED’s 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
AED’s must also consider that a comprehensive policy must be developed to deal with all aspects
of AED’s including: annual review of records of inspection, testing and maintenance;
dissemination to employees of information about the AED policy; location and storage of AED’s;
review of requests for the purchase of AED’s, 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 AED’s. The sources of the information will be gladly furnished to the Board upon request.
Sincerely,

Beau Flex
Beau Flex
Director of Risk Management

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Citywide Fitness Center
Mission Statement
The Mission of Citywide Fitness Center 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 Citywide Fitness Center 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.

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Citywide Fitness Center 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.

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CITYWIDE FITNESS CENTER, INC. LIBRARY

Article appearing in the Journal of Medicine & Science in Sports - January 5, 2008

(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.

NCAA Committee Considers Mandatory
Placement of AED’s 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 non-intercollegiate 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.

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

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 device 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. H...