A 22-year-old woman was taken to the ER due to shortness of breath. She was examined by an osteopathic physician licensed in family practice. The physician, who was not board-certified in emergency medicine, documented a prior medical history of marijuana and crack cocaine usage. The patient was described as "dyspneic," "wheezing" and showing signs of hyperventilation. She refused a paper bag to assist in respiration and her vital signs could not be ascertained. The physician ordered a portable X-ray. The patient was then placed on a breathing mask with Albuterol. Difficulty in breathing persisted and she was moved to another room where she was given Valium and Solu/Medrol 125 mg. More Valium was administered. The patient was unable to make eye contact or respond to verbal commands. During attempted intubation the patient awoke, became combative and pulled out the ET tube. She was then intubated nasally and she again removed the tube. Valium and another muscle relaxant were administered and she was intubated with one tube into the stomach and one into the trachea. Another tube was tried, followed by digital intubation. A bag and mask were continued. The patient went into fibrillation and died, 50 minutes after admittance. The X-ray subsequently showed a 50%-60% right pneumothorax with subcutaneous emphysema overlying the entire thorax and the inferior aspect of the neck and small pneumomediastinum. A drug screen showed evidence of marijuana but no cocaine. The autopsy listed the cause of death as "myocardial bridging anomaly" and did not indicate any abnormality or injury to the heart. An independent pathologist reported that awareness of the pneumothorax would have ruled out the listed cause of death. A medQuest osteopathic ER expert opined the defendant negligently "blew off" the patient as a drug addict, causing her death. A medQuest osteopathic family practitioner independently concurred, finding total mismanagement of the patient, including a failure to diagnose the pneumothorax and perform proper defibrillation.