WA= SHINGTON, Sept. 19, 1999 = -- American Home Products has offered to pay $4 billion to settle consumer cla= ss action lawsuits involving fen-phen, the New York Times reported.

The diet pills were taken off the market in 1997 after reports that they could cause heart-valve damage. = ;

The $4 billion settlement would = be used to set up a fund that would compensate persons who had already been injured and to monitor consumers who had taken the drug but not yet develop= ed symptoms.

It's estimated that at least 6 m= illion people took diet pill combinations of fenfluramine and phentermine before the combination was withdrawn. There were about 4,100 suits pending at the time of the reported settlement.

Brief - The Fen-Phen Settlement - Brown v. American Home Products Corporation Diet Drugs, No. 99-20593 (E.D.Pa. 08/28/2000)

In March 1997, researchers at the Mayo Clinic in Rochester, Minnesota be= gan observing an association between the use of fenflurami= ne and/or dexfenfluramine and a particular type of valvul= ar heart disease. Eventually, the Mayo Clinic researchers observed this unusual form of valvular heart disease in 24 women who = had used fenfluramine in combination with phentermine. The findings of the Mayo researchers were first brought to the attention of the public in a July 8, 1997 press release and were eventually published on August 28, 1997, in the New England Journa= l of Medicine.

On July 8, 1997, the FDA issued a public health advisory, followed by letters to 700,000 physicians requesting information about similar patients. Based on information the FDA received in response, the FDA requested the withdrawal of fenfluramine and dexfenfluramine = from the U.S. market. On September 15, 1997, AHP and the FDA announced that there would be no further sales of Pondimin and Redux in the United States. Subsequently, the causal relationship between valvular heart disease and= the use of dexfenfluramine and fenfluramine was investigated and confirmed in three epidemiological studies published in the New England Journal of Medicine in September 1998. A wave of litigation followed, and eventually these claims were consolidated in federal court and became certified as a class action, with a global settlement reached and approved by the court on August 8, 2000 (see the full opinion by clicking on the link in the title).

The court summed up the medical facts of the case in this way:

"In sum, the medical situation of individuals who used AHP's products, Pondimin = and Redux, is as follows. First, because the population of individuals who took diet drugs for more than three or four months is at an increased risk of asymptomatic valvular heart disease, it is appropriate for them to have a screening echocardiogram to d= etermine if they have developed VHD as a consequence of exposure to Pondimin and Redux. Second, to the extent that diet drug recipients manifest FDA Positive levels of regurgitation, they require antibiotic prophylaxis and ongoing medical surveillance to determine if the= re is progression in their condition such that further medical treatment or intervention is appropriate. (Tr. 5/3/00 at 102-103.) Finally, if diet drug recipients have or develop serious levels of regurgitation (defined as eith= er severe regurgitation or moderate regurgitation with dilatation, hypertrophy, reduced ejection fraction, or pulmonary hypertension) then such individuals suffer disabling conditions for which substantial compensation is warranted." (The court also discussed the much lower probability of progressive pulmonary hypertension.)

The settlement divides the exposed persons into various classes, based on which drugs they took, how long they took them, and their present medical condition. It then provides four matrixes of compensa= tory payments and future medical services matched to the classification of the plaintiffs. It also establishes a tracking system and registry, and a settlement trust fund which will be funded to about $2.5 billion.

There are four matrices under the settlement. Matrix A= -1 describes the compensation available to diet drug recipients with serious V= HD who took diet drugs for 61 days or longer, who are registered as having FDA Positive levels of valvular regurgitation by Da= te 2 and who do not have any of the alternative causes of VHD that make the B matrices applicable. Matrix A-2 describes the compensation available to spouses, parents, children and significant others of diet drug recipients entitled to compensation on Matrix A-1.

Matrix B-1 describes the compensation available to cla= ss members with serious VHD who were registered as having only Mild Mitral Regurgitation by the close of the Screening Pe= riod, or who took diet drugs for 60 days or less, or who have factors that would = make it difficult for them to prove that their VHD was caused by the use of diet drugs. Id. These conditions include most conditions that are objectively identifiable as causes of VHD independent of the use of diet drugs. Matrix = B-2 describes the compensation available to the spouses, parents, children and significant others of those entitled to compensation on Matrix B-1.

The matrices are composed of cells formed by the intersection of five separate matrix levels of severity and 11 separate age intervals ranging from diet drug recipients who are less than or equal to 24 years old to diet drug recipients who are 70 to 79 years of age. Generally,= the amount of compensation provided by the matrices decreases with age both bec= ause younger individuals have a longer damage period and because, as discussed above, age increasingly confounds the effects of diet drugs in producing valvular regurgitation.

The levels of VHD described on the settlement matrices correspond with the medical consensus regarding the stages of serious VHD. Level I describes those individuals who either h= ave severe regurgitation or have suffered bacterial endoca= rditis. Level II describes those individuals with moderate to severe regurgitation = who have evidence of changes in their cardiac status such as hypertrophy, dilatation, reduced ejection fraction, pulmonary hypertension and the like. Level III describes those individuals who have or need valvular repair or replacement surgery. Level IV describes those individuals who suf= fer from either complications of valvular surgery or whose disease has progressed to the point that surgery is not an effective remedy. Level V describes those individuals whose VHD is so far advanced th= at it is terminal. (Ex. P-95 ¶ 48; Ex. P-3 at 40-50 of 148.) Each cell formed by the intersection of an age interval with a severity level describes the amount of compensation to which a claimant mee= ting those criteria is entitled.

Class members do not have to demonstrate that their in= juries were caused by ingestion of Pondimin and Redux in order to recover Matrix Compensation Benefit= s. Rather, the Matrices represent an objective system of compensation whereby claimants need only prove that they meet objective criteria to determine wh= ich matrix is applicable, which matrix level they qualify for and the age at wh= ich that qualification occurred.

Under the Settlement Agreement, claims based on PPH, including claims for compensatory, punitive, exemplary or multiple damages based on PPH are not "settled claims." The settlement protects Class Memb= ers against the running of any statute of limitations with respect to such clai= ms.

In addition, the amounts specified by each cell of each matrix will be increased by 2% per year to provide protection against infla= tion for individuals who qualify for such payments in the future.

Under the Settlement Agreement, the determination of a matrix benefit is not subject to the exercise of discretion by the Administrators of the Settlement or by any court. Rather, benefits determinations are based on the sworn certification of a board certified physician--primarily a board certified cardiologist or cardiothoracic surge= on--that a class member either has or does not have each o= f the conditions applicable under the settlement matrices.

Under the Settlement Agreement, class members who took= diet drugs for 60 days or less have the right to receive reimbursement of the co= sts of purchasing Pondimin and/or Redux at the rate of $30 per month for prescriptions of Pond= imin and $60 per month for prescriptions of Redux. Eligible class members must register for this benefit by Date 1. Under the consumer protection laws= of many states, class members arguably had the right to recover the cost of echocardiograms which they incurred as a consequence of their exposure to <= span class=3DSpellE>Pondimin and Redux. Under= the Settlement Agreement, class members have the right to be reimbursed the net out-of-pocket expenses of obtaining echocardiograms outside of the medical monitoring program subject to the availability of money within Fund A after payment of all other benefits except prescript= ion reimbursement benefits for those who took diet drugs 61 days or longer. Eligible class members must register for this benefit by Date 1.

In order to prevent fraud, the settlement requires the Trustees to perform a quarterly audit of five percent of the total claims. = In addition, the settlement permits AHP to submit additional claims for quarte= rly audit. The audit procedure re= quires those responsible for administration of the settlement to gather all medical records relevant to the audited claim and forward them to a highly qualified independent board certified cardiologist who is responsible for making a determination as to whether or not there was a reasonable medical basis for= the representations made by any physician in support of the claim. If the audit= ing cardiologist makes the determination that there was a reasonable medical ba= sis to support the class member's claim and there is no substantial evidence th= at fraud was committed in connection with the claim, the claim is to be allowe= d. If not, those responsible for the administration of the settlement are requ= ired to apply to the court for relief.

‘OPT = OUT’ RIGHTS

The Settlement Agreement provides multiple opportuniti= es for class members to gain information concerning the injuries they have suffere= d as a result of taking Pondimin and Redux and to opt-out of the settlement in light of the information gained through those opportunities. The Settlement Agreement actually provides for four separate opt-out opportunities. All class members who are diagnosed as having mild or greater mitral regurgitation or mild or greater aortic regurgitation by the end of the Screening Period, who reach a matrix level condition after September 30, 19= 99, but before December 31, 2015 and who have registered for settlement benefit= s by Date 2 are entitled to exercise a "back-end opt-out." Each class member who wishes to exercise a right of back-end opt-out must submit a wri= tten notice of intent to do so within the latter of 120 days of the date on which the class member first knows (or should have known in the exercise of reasonable diligence) that the Diet Drug Recipient developed a matrix level condition or by Date 2. Final= ly, the Settlement Agreement provides for a "financial insecurity opt-out right." If a condition of financial insecurity with respect to payment of AHP's<= /span> obligations under the Settlement Agreement occurs in accordance with the conditions defined in the Agreement, then all Diet Drug Recipients who were diagnosed as having FDA Positive or Mild Mitral Regurgitation by the end of the Screening Period and who have registered for settlement benefits by Date 2 have a right to opt-out of the settlement and pursue all of their settled claims against AHP and the other Released Parti= es, including claims for punitive, multiple and exemplary damages. (Additional opt-out rights are pro= vided for in the

Settlement.)

ATTORNEY= 217;S FEES

Attorneys for individual class members who recover Mat= rix Compensation Benefits are entitled to recover the total attorneys' fees due under the terms of any valid written contingent fee agreement with such cla= ss member less the percentage amount (maximum of 9%) awarded by the court to C= lass Counsel and other attorneys for their services in creating Fund B and secur= ing the benefits it provides.

Matrix A-1 - For Diet Drug Recipients

Diet Drug Recipients who ingested Pondimin a= nd/or Redux for 61 or more days, who were diagnosed as FDA Positive, whose conditions are eligible for matrix payments but who do not = have any condition or circumstance which makes Matrix B-1 applicable, receive payments on Matrix A-1.

The level field defines the level of severity for fen-phen related conditions according to the AHP Settlement Plan.

=	Age at Diagnosis/Event
Level<= o:p>	<= ; 24	25-29<= o:p>	30-34<= o:p>	35-39<= o:p>	40-44<= o:p>
I=	$123,750	$117,563	$111,685	$106,100	$100,795
II	$643,500	$611,325	$580,759	$551,721	$524,135
III	$940,500	$893,475	$848,801	$806,361	$766,043
IV	$1,336,500	$1,269,675	$1,206,191	$1,145,881	$1,088,587
V=	$1,485,000	$1,410,750	$1,340,213	$1,273,202	$1,209,542
&= nbsp;

<= /o:p>

Level	45-49	50-54	55-59	60-64	65-69	70-79
I	$95,755	$90,967	$86,419	$82,098	$73,888	$36,944
II	$497,928	$473,032	$449,381	$426,912	$384,221	$192,111
III	$727,741	$691,354	$656,786	$623,947	$561,552	$280,776
IV	$1,034,158	$982,450	$933,327	$886,661	$797,995	$398,998
V	$1,149,065	$1,091,612	$1,037,031	$985,180	$886,662	$443,331

Matrix B-1 - For Diet Drug Recipients

Diet Drug Recipients who are eligible for mat= rix payments and to whom one or more of the following conditions apply, receive payments on Matrix B-1:

Diet Drug Recipients who ingested Pondimin and/or Redux for 60 days or less, who were diagnosed as FDA Positive.
Diet Drug Recipients who ingested Pondimin and/or Redux for 61 or more days, who were diagnosed as FDA Positive with any of the following conditions:

With respect to an aortic valve claim:

The following congenital aortic valve abnormalities: unicuspid= , bicuspid or quadricuspid valves, ventricu= lar septal defect associated with aortic regurgitat= ion;
Aortic dissection involving the aortic root and/or aortic valve;
Aortic sclerosis in people who are > 60 years old as of the time they are first diagnosed as FDA Positive; Aortic root dilatation >5.0 cm;
Aortic stenosis with an aortic valve area <1.0 squa= re centimeter by the Continuity Equation.

With respect to a mitra= l valve claim:

The following congenital mitral valve abnormalities: parachute valve, cleft of the mitral valve associated with atrial septal defect;
Mitral Valve Prolapse as determined by Echocardi= ogram. "Mitral Valve P= rolapse" refers to a condition where (a) the echoardiogra= m video tape or disk includes the parasternal long axis view and (b) that echocardiographic view shows displacement of one or both mitral leaflets >2mm above the atrial-ventric= ular border during systole, and >5mm leaflet thickening during diastole= , as determined by a Board-Certified Cardiologist.
Chordae tendineae rupture or papillary muscle rup= ture; or acute myocardial infarction associated with acute mitral regurgitation;
Mitral annular calcification;
M-Mode and 2-D Echocardiographic evidence of rheumatic mitral valves (doming of the anterior leaflet a= nd/or anterior motion of the posterior leaflet and/or commissural fusion), except where there is no evidence of rheumatic valve disease upon pathological examination of mitral valve tissue.

With respect to claims for the aortic and/or= mitral valve(s):

Heart valve surgery prior to Pondimin and/or Redux use on the valve that is the basis of claim;
Bacterial endocarditis prior to Pond= imin and/or Redux use;
FDA Positive regurgitation (confirmed by Echocardiogram) prior to Pondimin and/or Redux use for the valve that is the basis of claim;
Systemic Lupus Erythernatosus or Rheumatoid Arthritis^{1
and valvular regurgitation and/or valvular abnormalities of a type associated with
those conditions² ;}
Carcinoid tumor of a type associated with aortic and/or mi= tral valve lesions;
History of daily u= se of methysergide or e= rgotamines for a continuous period of longer than 120 days.

=	Age at Diagnosis/Event
Level<= o:p>	<= ; 24	25-29<= o:p>	30-34<= o:p>	35-39<= o:p>	40-44<= o:p>
I=	$24,750	$23,513	$22,337	$21,221	$20,159
II	$128,700	$122,265	$116,152	$110,344	$104,827
III	$188,100	$178,695	$169,760	$161,272	$153,208
IV	$267,300	$253,935	$241,238	$229,176	$217,717
V=	$297,000	$282,150	$268,043	$254,641	$241,908
&= nbsp;

<= /o:p>

Level	45-49	50-54	55-59	60-64	65-69	70-79
I	$19,152	$18,194	$17,284	$16,420	$14,778	$7,389
II	$99,586	$94,606	$89,876	$85,383	$76,844	$38,422
III	$145,548	$138,270	$131,357	$124,790	$112,310	$56,155
IV	$206,831	$196,489	$186,665	$177,332	$159,599	$79,800
V	$229,813	$218,322	$207,406	$197,036	$177,332	$88,666

Matrix Level I:

Matrix Level I is severe left sided valvular heart disease without complicating factors, = and is defined as one of the following:

(a) Severe aortic regurgitation (AR) > 5O% jet height/left ventricular outflow tract height (JH/LVOTH)³ and/or severe mitral regurgitation (MR) > 40% regurgitant jet area/left atrial= area (RJA/LAA)^4,5; and = no complicating factors as defined below;

(b) FDA Positive valvular regurgitation⁶ with bacterial endocarditis contracted after commencement Pondimin and/or Redux use.

Matrix Level II:

Matrix Level II is left sided valvular heart disease with complicating factors, and is defined as:

(a) Moderate AR (25% - 49% JH/LVOTH= )⁷ or Sev= ere AR (> 50% JH/LVOTH)⁸ with o= ne or more of the following:

Pulmonary hypertension secondary to severe aortic regurgitation with a peak systolic pulmonary artery pressure > 40 mm Hg measured by cardiac catheterization or w= ith a peak systolic pulmonary artery pressure > 45 mm Hg⁹ measured by Doppler Echocardiography, at rest, utilizing standard procedures^10,11 assuming a right atrial pressure of 10 mm = Hg;
Abnormal left ventricular end-systolic dimension > 50 mm¹²= by M-mode or 2-D Echocardiography or abnormal left ventricular end-diasto= lic dimension > 70 mm¹³= as measured by M-mode or 2-D Echocardiography;
Ejection fraction of <= 5O%¹⁴; and/or

(b) Moderate MR (20% - 40% RJA/LAA)= ¹⁵ or S= evere MR (> 40% RJA/LAA)¹⁶ with= one or more of the following:

Pulmonary hypertension secondary to valvular heart disease with p= eak systolic pulmonary artery pressure > 40 mm Hg measured by cardiac catheterization or with a peak systolic pulmonary artery pressure >= 45 mm Hg¹⁷ measured by Doppler Echocardiography, at rest, utilizing the procedures described in Section F.2.(a)(i);
Abnormal left atrial supero-inferi= or systolic dimension > 5.3 cm¹⁸ (apical four chamber view) or abnormal left atria= l antero-posterior systolic dimension > 4= .0 cm (parasternal long axis view) measured by 2= -D directed M-mode or 2-D echocardiography with normal sinus rhythm using sites of measurement recommended by the American Society of Echocardio= graphy¹⁹= ;
Abnormal left ventricular end-systolic dimension > 45 mm²⁰= by M-mode or 2-D Echocardiogram;
Ejection fraction of &= lt; 60%^2=
1.
Arrhythmias, defined as chronic atrial fibrillation/flutter that c= annot be converted to normal sinus rhythm, or atrial fibrillation/flutter requiring ongoing medical therapy, either of which are associated with left atrial enlargemen= t; as defined in Section F.2.(b)(ii).

Matrix Level III

Matrix Level III is left sided valvular heart disease requiring surgery or conditions of equal severity, and is defined a= s:

(a) Surgery to repair or replace the aortic and/or mitral valve (s) following the use of Pondimin and/or Redux or<= /p>

(b) Severe regurgitation and the presence of ACC/AHA Cl= ass I indications for surgery to repair or replace the aortic²² and/= or mitra1^23<=
/a> valve(s) and a statement from the attending Board Certified Cardiothoracic Surgeon or Board Certified Cardiologist supported by medical records regard= ing the recommendations made to the patient concerning val= vular surgery, with the reason why the surgery is not being performed; or

(c) Qualification for payment at Matrix Level l(b) (as described in Section F.1.b. above) or Matrix Level II and, in addition, a stroke due to bacterial endocarditis contracted= after use of Pondimin and/or Red= ux or as a consequence of chronic atrial fibrillat= ion with left atrial enlargement as defined in Sect= ion F.2.(b)(ii) which results in a permanent condition which meets the criteria= of AHA Stroke Outcome Classification 24 Func= tional Level II, determined six months after the event.

Matrix Level IV:

Matrix Level IV is defined as follows:

(a) Qualification for payment at Matrix Level l (b) (as described in Section F.1.b. above), II or III and, in addition, a stroke du= e to bacterial endocarditis contracted after use of = Pondimin and/or Redux- or= as a consequence of chronic atrial fibrillation with= left atrial enlargement as defined in Section F.2.(b)(ii) = which results in a permanent condition which meets the criteria of AHA Stroke Out= come Classification²⁵ Functional Level III, determined six months after the event; or

(b) Qualification for payment at Matrix Level l(b), II, or III and, in addition, a peripheral embolu= s due to Bacterial Endocarditis contracted after use = of Pondimin' and/or Redux or= as a consequence of atrial fibrillation with left atrial enlargement as defined in Section F.2.(b)(ii) = which results in severe permanent impairment to the kidneys, abdominal organs, or extremities, where severe permanent impairment means:

for the kidneys, chronic severe renal failure requiring hemodialysis or Continuous Abdominal Peritoneal Dialysis for more than six months;
for the abdominal organs, impairment requiring intra-abdominal surgery; iii) for the extremities, impairment requiring amputation of a major limb; or

(c) The individual has the following:

Qualification for payment= at Matrix Level III; and
New York Heart Association Functional Class I or Class II symptoms as documented by the attending Board Certified Cardiothoracic Surgeon or Board Certified Cardiologist; and
Valv= ular repair and replacement surgery or ineligibility for surgery due to med= ical reasons as documented by the attending Board Certified Cardiothoracic Surgeon or BoardCertified Cardiologist; an= d
Significant damage to the heart muscle, defined as: (a) a left ventricular ejection fraction <= ;30% with aortic regurgitation or a left ventricular ejection fraction <= 35% with mitral regurgitation in patients who = have not had surgery and meet the criteria of Section F.3.(b) or (b) a left ventricular ejection fraction <40% six months after valvular repair or replacement surgery in patients who have had such surgery; o= r

(d) The individual has had valvula= r repair or replacement surgery and has one or more of the following complications which occur either during surgery, within 30 days after surge= ry, or during the same hospital stay as the surgery:=

Renal failure, defined as chronic, severe renal failure requiring regular h= emodialysis or Continuous Abdominal Peritoneal Dialysis for greater than six months following aortic and/or mitral valve repla= cement surgery;
Peripheral embolus follow= ing surgery resulting in severe permanent impairment to the kidneys, abdom= inal organs, or extremities;
Quadriplegia or paraplegia resulting from cervical spine injury during valvu= lar heart surgery; or

(e) A stroke caused by aortic and/or mitral valve surgery and the stroke has produced a permanent condition which meets= the criteria of the AHA Stroke Outcome Functional Levels II or III determined s= ix months after the event.²⁶

(f) The individual has had valvula= r repair or replacement surgery and suffers from post operative endocarditis, mediastinitis or sternal osteomyelitis, ei= ther of which requires reopening the median sternotomy = for treatment, or a post-operative serious infection defined as HIV or Hepatiti= s C within six months of surgery as a result of blood transfusion associated wi= th the heart valve surgery.

(g) The individual has had valvula= r repair or replacement surgery and requires a second surgery through the ste= rnum within 18 months of the initial surgery due to prosthetic valve malfunction, poor fit, or complications reasonably related to the initial surgery.

Matrix Level V:

Matrix Level V is defined as:

(a) Endocardial Fibrosis (A) diagnosed by (1) endomyocardial biopsy that demonstrates fibrosis and cardiac catheterization that demonstrates restric= tive cardiomyopathy or (2) autopsy that demonstrates= endocardial fibrosis and (B) other causes, including dilated cardiomyopathy, myocardial infarction, = amyloid, Loeffler's endocarditis, endomyocardial fibrosis as defined in Braunwald (involving one= or both ventricles, located in the inflow tracts of the ventricles, commonly involving the chordae tend= ineae, with partial obliteration of either ventricle commonly present)²⁷ focal fibrosis secondary to valvular regurgitation (e= .g., "jet lesions"), focal fibrosis secondary to catheter instrumentat= ion, and hypertrophic cardiomyo= pathy with septal fibrosis, have been excluded; or

(b) Left sided valvular hea= rt disease with severe complications, defined as Matrix Levels I(b) (as described in Section F.1.b. above), III or IV above with one or more of= the following:

A severe stroke following aortic and/or mitral valve surgery or due = to bacterial endocarditis contracted after us= e of Pondimin and/or Redux or as a consequence of chronic atrial fibrillati= on with left atrial enlargement as defined in Section F.2.b.(ii) and the severe stroke has resulted in a permanent condition which meets the criteria of AHA Stroke Outcome Classificatio= n²⁸ Functional Levels IV or V, determined six months after the event; or <= /li>
The individual has the following:

Qualification for payment at Matrix Levels III or IV; and
New York Heart Association Functional Class III or Class IV symptoms as documented by the attending Board-Certified Cardiothoracic Surgeon or Board-Certifi= ed Cardiologist; and
Valvular repair or replacement surgery or ineligibility for surgery due to med= ical reasons as documented by the attending Board-Certified Cardiothoracic Surgeon or Board-Certified Cardiologist; and
Significant damage= to the heart muscle, defined as:

a left ventricular ejection fraction < 30% with aortic regurgitation or a left ventricular ejection fraction < 35% with mit= ral regurgitation, in patients who have not had surgery and meet the criteria of Section F.3.b.or
a left ventricular ejection fraction < 40% six months after val= vular repair or replacement surgery in patients who have had such surgery;= or
Heart transplant;=
Irreversible pulmonary hypertension (PH) secondary to valvul= ar heart disease defined as peak?systolic p= ulmonary artery pressure >50 mm Hg^{29 (by
cardiac catheterization) at rest following repair or replacement sur=
gery
of the aortic and/or mitral valve(s);}
Persistent non-cognitive state^{30
caused by a complication of valvular hea=
rt
disease (e.g., cardiac arrest) or valvular
repair/replacement surgery supported by a statement from the attendi=
ng
Board Certified Cardiothoracic Surgeon or Board Certified Cardiologi=
st,
supported by medical records; or}

(c) Death resulting from a condition caused by valvular heart disease or valvul= ar repair/replacement surgery which occurred post?Pondimi= n and/or Redux use supported by a statement from = the attending Board Certified Cardiothoracic Surgeon or Board Certified Cardiologist, supported by medical records; or

(d) The individual otherwise qualifies for payment at Matrix Level II, III, or IV and suffers from ventricular fibrillation or su= stained ventricular tachycardia which results in hemodynamic compromise.

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