Complaint: Fey v. Piedmont Healthcare Inc. et al
STATE COURT of FULTON COUNTY
STATE of GEORGIA
Anna Fey,
Plaintiff
— versus —
Piedmont Hospital, Inc. doing business as Piedmont Atlanta Hospital
Piedmont Heart Institute Physicians, Inc.
Sarah Reedy, MD
John/Jane Doe 2-10,
Defendants
Civil Action
File No. _________
COMPLAINT
INTRODUCTION
1. This case arises from simple negligence and professional negligence affecting the care of Anna Fey at Piedmont Atlanta Hospital on the morning of September 13, 2022.[1]
2. Anna Fey was harmed because of mistakes made by an individual healthcare provider working within a flawed system. That is, negligent administration set the physician up for failure and led to patient harm.
3. As to the professional negligence claim, pursuant to OCGA 9-11-9.1, Plaintiffs attach and incorporate the affidavit of Jonathan Schwartz, MD, MBA as Exhibit 1.
DEFENDANTS, JURISDICTION & VENUE[2]
Piedmont Hospital, Inc., doing business as Piedmont Atlanta Hospital (PAH)
4. Piedmont Hospital, Inc. (PAH) owns and operates Piedmont Atlanta Hospital, under the management and supervision of PAH’s parent company, Piedmont Healthcare, Inc.
5. PAH may be served through its Registered Agent, CSC of Cobb County, Inc. at 192 Anderson Street, NE, Suite 125, Marietta, GA, 30060.
6. PAH has been properly and timely served with this Complaint.
7. PAH’s principal office address is 1968 Peachtree Road, NW, Atlanta, GA, 30309, in Fulton County.
8. PAH is subject to the personal jurisdiction of this Court.
9. PAH is subject to the subject-matter jurisdiction of this Court in this case.
10. Pursuant to OCGA 14-3-510(b)(3), PAH is directly subject to venue in this county because the cause of action originated in this county and the corporation has an office and transacts business in this county.
11. PAH has been properly served with this Complaint.
12. PAH has no defense to this lawsuit based on undue delay in suing — whether based on the statute of limitations, the statute of repose, laches, or any similar theory.
Piedmont Heart Institute Physicians, Inc. (PHIPI)
13. Piedmont Heart Institute Physicians, Inc. (PHIPI) was the employer or other principal of Sarah Reedy, MD in September 2022.[3]
14. In her care of Anna Fey on September 12-13, 2022, Dr. Reedy acted in the course and scope of her employment with PHIPI or otherwise acted as an agent of PHIPI.
15. PHIPI may be served through its Registered Agent, CSC of Cobb County, Inc. at 192 Anderson Street, NE, Suite 125, Marietta, GA, 30060.
16. PHIPI’s Principal Office Address is 95 Collier Road NW, Suite 2045, Atlanta, GA, 30309, in Fulton County.
17. PHIPI has been properly and timely served with this Complaint.
18. PHIPI is subject to the personal jurisdiction of this Court.
19. PHIPI is subject to the subject-matter jurisdiction of this Court in this case.
20. Pursuant to OCGA 9-10-31, PHIPI is subject to venue in this county because at least one of their codefendants (PHA) is subject to venue here.
21. Pursuant to OCGA 14-3-510(b)(3), PHIPI is directly subject to venue in this county because the cause of action originated in this county and the corporation has an office and transacts business in this county.
22. PHIPI has no defense to this lawsuit based on undue delay in suing — whether based on the statute of limitations, the statute of repose, laches, or any similar theory.
Sarah Reedy, MD
23. Sarah Reedy, MD may be served through her counsel.
24. Dr. Reedy has been properly and timely served with this Complaint.
25. Dr. Reedy is subject to the personal jurisdiction of this Court.
26. Dr. Reedy is subject to the subject-matter jurisdiction of this Court in this case.
27. Pursuant to OCGA 9-10-31, Dr. Reedy is subject to venue in this county — because she lives in this county and because her codefendants are subject to venue here.
28. Dr. Reedy has no defense to this lawsuit based on undue delay in suing — whether based on the statute of limitations, the statute of repose, laches, or any similar theory.
FACTS[4]
Medical Error, Patient Safety, and Healthcare Administration[5]
Overview
29. The healthcare system is complex and not widely understood.
30. People who do not work in healthcare administration can easily make assumptions that are strong but wrong — including the assumption that medical error is solely a matter of individual error by the licensed healthcare professionals directly involved in patient care.
31. The National Institute of Medicine wrote nearly 25 years ago:
Although almost all accidents result from human error, it is now recognized that these errors are usually induced by faulty systems that “set people up” to fail. Correction of these systems failures is the key to safe performance of individuals. Systems design — how an organization works, its processes and procedures — is an institutional responsibility. Only the institution can redesign its systems for safety; the great majority of effort in improving safety should focus on safe systems, and the health care organization itself should be held responsible for safety.[6]
32. That passage expresses the consensus in the healthcare community.
33. Plaintiffs attach and incorporate into this complaint the following exhibits, which explain the role of healthcare administrators in medical error and patient safety.[7]
Exhibit 2: Affidavit of Jonathan Burroughs, MD
Exhibit 3: HHS Office of Inspector General, Report: “Adverse Events in Hospitals: A Quarter of Medicare Patients Experienced Harm in October 2018” (executive summary)
Exhibit 4: Scale of Harm from Medical Error: Summary of Studies, 2000-2022
Exhibit 5: National Institute of Medicine, To Err is Human: Building a Safer Health System (excerpts)
Exhibit 6: The Joint Commission Comprehensive Accreditation Manual for Hospitals (effective Jan. 1, 2022) (excerpt regarding hospital leadership)
Exhibit 7: Excerpt from Understanding Patient Safety, 3d Ed. By Robert Wachter and Kiran Gupta
Exhibit 8: Sentinel Event Alert: “The essential role of leadership in developing a safety culture”
Exhibit 9: Piedmont Healthcare Inc., “Time out for safety.”
The Healthcare Business
34. The healthcare industry is one of the largest industries in the United States — accounting for $4.3 trillion or nearly 20% of the economy in 2021.
35. Non-profit as well as for-profit corporations provide healthcare services in exchange for money.
36. Non-profit as well as for-profit healthcare corporations pay their officers and employees. Some CEOs of non-profit healthcare corporations make millions of dollars yearly.
37. Healthcare corporations — non-profit as well as for-profit — typically market their services to the public.
38. Healthcare corporations typically invite the public to come to the corporations’ facilities for services, many of which could be provided at other facilities.
39. Healthcare corporations typically compete with each other both for patients and for affiliations with physicians and other healthcare providers.
40. Healthcare corporations often compete by advertising the quality and safety of their services.
41. For their part, individual healthcare providers generally are paid well compared to other US workers. For example, physicians consistently rank among the highest-paid professionals in the United States, and nurses generally earn above-average salaries compared to other workers with similar education levels.
Scale of Harm from Medical Error
42. Estimates vary widely, but even at the low end, conservative estimates indicate that each year in the United States, medical error causes tens of thousands of deaths, and many more serious but non-lethal injuries.
43. By comparison, in the year 2022, commercial airline crashes worldwide accounted for approximately 19 deaths.
Flawed Systems as a Cause of Medical Error
44. The causes of medical error have been studied extensively.
45. Medical errors usually arise from a combination of two general factors: (a) systemic problems that create unreasonable potential for error, and (b) failings by individual clinicians within that system.
46. The consensus view today is that human error is inevitable and therefore we need to create patient safety systems that prevent inevitable human errors from reaching a patient and causing harm.
47. According to Matthew Schreiber, MD, vice president of safety for Piedmont Healthcare, “Errors happen because imperfect humans interact with imperfect processes,” Dr. Schreiber says. “[T]he greatest opportunity is in engineering processes which minimize the chance for error.”[8]
48. For patient safety, the healthcare industry looks now to systemic issues as the primary cause of harm to patients, because safety barriers can be created to prevent inevitable human errors from reaching the patient.
The Importance of Managers/Administrators
49. The complexity of healthcare and the danger of inadequate processes and organizational cultures creates a need for good management of healthcare facilities.
50. Physicians and nurses treating patients typically are not able to prevent or fix problems with the systems and organizational culture in a healthcare organization. In many hospitals, physicians working in the hospital are not even employed by the hospital corporation but simply have “privileges” to work at the hospital.
51. Of necessity, the clinicians providing direct patient care rely on healthcare managers/administrators to prevent or fix problems with the systems and organizational culture in a healthcare organization.
52. Managing a healthcare organization is not the same as practicing medicine or nursing. Management involves different roles and responsibilities, and it requires different knowledge and skills.
53. Administration and patient care are distinct, complementary functions. Both are critical to safe healthcare. Negligence in either function endangers patients.
The Patient-Safety Work of Managers/Administrators
54. Many healthcare managers/administrators are not licensed healthcare professionals.
55. Healthcare managers who are not licensed healthcare professionals do not provide patient care. Instead, they manage. They manage the organization’s systems, processes, and culture. They make sure tasks get done. They may not perform the tasks personally — they may not be qualified to do so — but they make sure someone qualified does perform the task. The manager’s work is critical because in a large, complex organization, if someone doesn’t manage a project, the project is apt to go undone.
56. Healthcare corporations and their managers play a critical role in protecting patients from medical error.
57. Healthcare corporations and their managers must work diligently to protect patients from medical error.
58. Protecting patients from medical error must be a top priority of any healthcare corporation — starting at the top, with the Board and the Chief Executive Officer.
59. A primary job of non-clinician administrators is to support clinicians by providing systems, resources, and training that facilitate proper medical care and actively prevent medical error — to set clinicians and patients up for success rather than failure.
60. Healthcare corporations must create an administrative structure dedicated to patient safety.
61. The leaders of healthcare corporations must manage processes to identify what needs to be done for patient safety, and to make sure it gets done.
62. Healthcare corporations must create and maintain systems and processes that guard against medical error.
63. Administrators cannot write medical or nursing policies, but administrators are responsible for making sure procedures are in place to identify what policies or protocols are needed and to oversee the process for creating them.
64. Administrators are responsible for making sure policies and protocols are communicated effectively to healthcare system staff.
65. Administrators are responsible for making sure training needs are identified and that the necessary training is given.
66. Healthcare corporations (through administrators) must make sure they are actually implementing practices that protect patients — not just papering the file.
The Danger of Administrative Negligence
67. No corporation is compelled to get into the healthcare business, to offer healthcare services to the public, or to advertise and market those services and invite patients to the facility. But for a corporation to take those actions and yet fail to diligently manage patient safety processes creates unnecessary danger. It increases the danger to patients and makes it inevitable that some patients will suffer harm.
68. In their duties concerning patient safety, negligence by healthcare corporations and their administrators promotes medical error and contributes to patient harm.
69. Nonetheless, some institutions persist in attributing medical error solely to clinicians and refuse to acknowledge institutional or management responsibility. This mentality is dangerous: It perpetuates system-level problems that promote medical error and hurt patients.
70. As the National Institute of Medicine writes, “The problem is not bad people; the problem is that the system needs to be made safer.”[9]
71. It would be dangerous to exempt healthcare corporations and managers from accountability, because that would remove an important incentive for them to work diligently to protect patients.
72. Indeed, the National Institute of Medicine explicitly encourages focusing on the liability of institutions:
“A comprehensive approach to improving patient safety is needed. … The combined goal of the [Institute’s] recommendations is for the external environment to create sufficient pressure to make errors costly to health care organizations and providers, so they are compelled to take action to improve safety.”[10]
Medical Professionalism
Responsibility for Medical Errors
73. In providing healthcare, bad outcomes can happen even if the care is perfect.
74. However, there are standards that apply to healthcare, and sometimes providers fail to live up to those standards.
75. We can’t criticize anyone based only on hindsight: We have to consider what they knew or should have known at the time.
76. Even good people and good healthcare providers can be and sometimes are negligent.
77. Healthcare ethics require that when medical negligence happens, the providers responsible for it should own up to it.
78. Owning up to negligence is important because it helps to identify mistakes so they don’t happen again.
79. When medical negligence happens, the providers responsible for it should disclose it to the patient or family.
80. When medical negligence may have happened and caused serious harm, the healthcare facility should investigate.
Unconscious Bias
81. Multiple studies have found that women, racial minorities, lower-income people, and other disadvantaged groups often receive worse healthcare than others.
Vulnerability, Trust, Caring, & Diligence
82. When a sick or injured patient comes to healthcare providers, there is — or at least should be — a trust between the patient and the providers.
83. The patient puts their health and safety in the hands of the healthcare providers.
84. The healthcare providers make a commitment to take good care of the patient.
85. The healthcare providers make a commitment to do their jobs properly.
86. Doing the job properly starts with caring about the patient.
87. A healthcare provider’s job can be hard, so it can be tempting to cut corners or take shortcuts in patient care. But if a healthcare provider takes shortcuts often enough, it’s just a matter of time before someone gets hurt.
Paying Attention & Speaking Up
88. For healthcare providers, doing the job right includes simply paying attention to the patient.
89. It can be easier to breeze in and out of the patient’s room without really paying attention.
90. Providers must pay attention to anything that might indicate a problem with the patient.
91. Providers must make sure the potential problem gets investigated.
92. Each member of the team is responsible for speaking up if there’s a warning sign that a problem has developed.
93. Each member of the healthcare team is responsible for speaking up if there’s a concern that the patient is not being taken care of properly.
Safety Over Danger
94. Healthcare providers must not unnecessarily expose a patient to serious danger.
95. When a patient already faces serious danger, healthcare providers must not leave the patient exposed to it unnecessarily.
96. Healthcare providers must err on the side of greater caution, diligence, and safety for the patient.
97. Healthcare providers must never err on the side of greater danger for the patient.
All Reasonably Available Measures, Done Timely
98. If a patient is in danger of a potentially catastrophic condition, healthcare providers must take all reasonably available steps to prevent it.
99. If a potentially catastrophic condition has already begun, healthcare providers must take all reasonably available steps to prevent further harm.
100. Healthcare providers must make all reasonable efforts to act in a timely fashion.
101. If a patient faces a potentially catastrophic condition that is time-sensitive, healthcare providers must do all they reasonably can to address it promptly.
Respect for the Patient; Educating the Patient
102. Healthcare providers must respect the dignity and independence of the patient.
103. When circumstances allow it, providers must educate the patient or family about the dangers they face and the options they have.
104. Healthcare providers must make decisions about patient care based on what’s best for the patient’s well-being.
105. Healthcare providers must balance the danger from taking a reasonably available measure against the danger of not taking it.
106. Patients who have been educated on their risks and options are better able to protect themselves.
107. Patients who have been educated on their condition are better able to know if they should seek medical attention.
108. Patients who have been educated on their condition are better able to know if they should seek a second opinion.
Teamwork
109. In most healthcare settings, there’s a team of people responsible for caring for a patient.
110. Each member of the healthcare team shares responsibility for the patient.
111. For each member of the team, a crucial part of the job is to communicate with other team members.
112. It is essential to make sure important information gets to the people who can do something about it.
The Critical Role of Nurses
113. Nurses typically spend more time with the patient than the physicians do.
114. Nurses serve as “eyes and ears” of physicians.
115. Nurses serve as advocates for the patient.
116. If nurses have concerns about the care a patient is receiving, they must raise those concerns until the concerns are addressed properly.
Piedmont Atlanta Hospital and Anna Fey
Piedmont’s Marketing
117. PAH and its parent company advertise the Piedmont System and PAH as safe for patients.
118. For example, Piedmont’s website includes a post stating:
According to Matthew Schreiber, M.D., vice president of safety for Piedmont Healthcare, if hospitals would practice the Always Safe program that Piedmont has in place today, they could reduce preventable events of patient harm by as much as 80 percent within three years.
. . .
Safety is a part of the Piedmont culture. Every employee – physicians, nurses, techs and even those in non-clinical positions – is required to attend mandatory safety training as part of our Always Safe program. For example, routine steps are taken to ensure our staff confirms various information on patients before treating them. This includes verifying the name, date of birth, medication, dosage, procedure, etc.
Employees are also empowered to speak up or question a manager or physician if they feel something is “not quite right.” “We’ve made a promise to make safety our top priority at Piedmont,” Dr. Schreiber says. “Our patients expect the very best care when they visit one of our hospitals, clinics or doctors’ offices. We give them the same care we would our own families.”[11]
The Presenting Problem
119. On the night of September 12, 2022 — at about 10:30 PM — Anna Fey came to the Piedmont Atlanta Hospital Emergency Department by ambulance. (PHA 2, 55.)[12]
120. The Piedmont healthcare team for Anna included Sarah Reedy, MD. (PHA 6.)
121. At the time, Anna was nearly 65 years old. She reported back pain that had begun months ago, had worsened in recent weeks, and had gotten bad enough that morning (Sept. 12) that she couldn’t walk. (PHA 6.)
122. Anna told Dr. Reedy that her primary care physician, Dr. Alan Perry, had suggested Anna’s pain might be caused by arthritis in her back, which would be consistent with other musculoskeletal problems Anna had. (PHA 6.)
123. Anna told Dr. Reedy that she had come to the PHA Emergency Department the week before with similar back pain. (PHA 6.)
124. Anna told Dr. Reedy that on the prior ED visit, she had been prescribed prednisone but had stopped taking it because Anna suffers bipolar disorder and the prednisone caused her to “misbehave” with her bipolar disorder. (PHA 6.)
125. Prednisone is a corticosteroid and is known to aggravate symptoms of mania in patients with bipolar disorder.
126. Anna also told Dr. Reedy that on her prior visit to the ED, Anna had been prescribed Norco (a combination of hydrocodone and acetaminophen) but that it did not relieve the pain. (PHA 6.)
Overview of ED Visit
127. The PAH medical records provide an “ED Patient Care Timeline” that provides in part as follows:
. . .
. . .
. . .
. . .
. . .
(PHA 55-62.)
The Diagnostic Process
The Problem of Diagnostic Errors
128. The healthcare community has known for decades or longer that diagnostic errors cause death or disability for large numbers of Americans.
129. Usually, when a patient first shows up with a problem there are several potential causes of it — several potential diagnoses.
130. Clinicians must be conscious of the range of conditions that could be causing the patient’s problems.
131. The complexity of medical problems and the number of potential diagnoses create a risk of error.
132. The first diagnosis that comes to mind may be wrong.
133. The diagnosis that seems most likely may be wrong.
134. Patients can suffer catastrophic harm when clinicians consider only the diagnosis that seems most likely.
135. Clinicians must consider the worst diagnoses that are plausible and gather enough information either to confirm them or rule them out with high confidence.
Diligence & Preventing Errors
136. The diagnostic process is designed to make sure clinicians consider all the reasonably likely causes of a patient’s problems — especially those that could be catastrophic.
137. The diagnostic process is fundamental to a clinician’s work.
138. The diagnostic process is taught in school.
139. The basic diagnostic process is general and applies across healthcare specialties.
140. The diagnostic process is designed in part to counteract mental shortcuts that cause diagnostic errors.
141. Mental shortcuts can undermine the diagnostic process and contribute to diagnostic errors.
142. Mental shortcuts include things like making assumptions about patients, jumping to conclusions, focusing on information that tends to confirm your beliefs and disregarding contrary information.
143. Failing to consider reasonable alternative diagnoses (especially potentially catastrophic ones) is a mental shortcut called “premature closure.”
144. Premature closure violates the diagnostic process. It is a basic, fundamental error.
145. Clinicians must follow the diagnostic process consistently, diligently, and with speed appropriate to the potential danger to the patient.
146. If a clinician does not follow the diagnostic process consistently, diligently, and with appropriate speed, then eventually some patient will suffer for it.
Summary of the Diagnostic Process
147. The diagnostic process involves the following features:
a. Pay attention to the patient.
b. Look for relevant information, including concerning signs and symptoms.
c. Take a history appropriate to the problem.
d. Perform a physical examination appropriate to the problem.
e. Think through the plausible potential causes of the problem and make a list (a “differential diagnosis”).
f. If there is anything that is both potentially catastrophic and time-sensitive, give it priority. (“Worst first.”)
g. Gather enough information about each item on the list sufficiently to either confirm it or rule it out with high confidence — through a consultation or referral if necessary.
h. Repeat this process (or parts of it) as new information comes in from tests or other sources.
148. If there is a plausible diagnosis that could be catastrophic and time-sensitive, it must be investigated quickly and sufficiently to confirm it or rule it out with high confidence.
149. A clinician must never simply disregard a potentially catastrophic and time-sensitive diagnosis, even if it seems less likely than a less serious diagnosis.
150. As new information comes in, clinicians often must revisit the differential diagnosis and perform additional investigation.
Dr. Reedy Orders a CT and Pain Relief
151. Shortly after evaluating Anna, Dr. Reedy ordered two tablets of Norco for pain, a muscle relaxer (Robaxin), and a CT without contrast of Anna’s lumbar spine. (PHA 16, 55-56.)
152. Dr. Reedy ordered the CT at 2302 hrs. (PHA 16.)
153. Transport staff came to get Anna for the CT at 0331 hrs on the morning of September 13. (PHA 60.)
154. The CT was performed at 0355 hrs. (PHA 17.)
155. A “nighthawk” radiologist from Vision Radiology provided a preliminary CT report at 0417 hrs. (VRA 1.)
The Preliminary CT Report
156. The preliminary CT report said, “IMPRESSION: No acute osseous traumatic injury. Multilevel degeneration. Consider MRI of the lumbar spine for further assessment if clinically indicated. However, there is asymmetric increased size of the right iliopsoas relative to the left side, which is nonspecific and could reflect sequelae of trauma versus infection. Consider CT of the abdomen and pelvis with intravenous contrast for further assessment.”
Potential Infection
157. The possible indication of infection reflected a significant danger to Anna.
158. The iliopsoas consists of three distinct muscles. They are usually grouped together due to their common attachment point on your femur (thigh bone): the iliacus muscle, the psoas major muscle, and the psoas minor muscle.
159. The term “iliopsoas” is often used interchangeably with the term “psoas.”
160. The psoas muscle is a big, important muscle. It helps you bend your hip and lower back. It keeps your spine stable. It’s important for walking and running.
161. The psoas muscle is deep inside your body, running from your lower back, through your pelvis, and connecting to your thigh bone. It’s surrounded by your spine, major blood vessels, kidneys, and parts of your intestines.
162. An infection in the psoas muscle that’s making one side bigger than the other raises serious concerns, because (a) the infection could spread to other important body parts nearby (including the spine), and (b) if the infection is not treated, it could lead to sepsis (a major cause of mortality).
Sepsis
163. Psoas infections have significant mortality because of sepsis, as well as long-term damage to the muscle, leading to difficulty walking or moving normally.
164. Sepsis is a life-threatening condition that occurs when the body’s response to infection causes widespread inflammation and organ dysfunction.
165. Sepsis is difficult to address, in part because it is difficult to identify early.
166. Early symptoms of sepsis can be vague and mimic other conditions, making it challenging to diagnose in its initial stages.
167. Common early signs include fever, rapid heart rate, and rapid breathing, which can be mistaken for less severe illnesses.
168. There is no single definitive test for sepsis, which complicates early diagnosis.
169. Sepsis is also difficult to address because it can progress rapidly.
170. Sepsis can evolve quickly from a localized infection to a systemic, life-threatening condition.
171. As it progresses, sepsis can lead to shock, multiple organ failure, and death.
172. Once sepsis takes hold, preventing further deterioration becomes increasingly difficult.
173. Organ dysfunction can create a cascade of problems, each compounding the others.
174. Maintaining adequate blood flow to organs while managing inflammation is a delicate balance.
175. Delays in treatment significantly increase mortality risk.
176. Any infection has the potential to lead to sepsis, especially in vulnerable populations such as seniors with preexisting health problems.
177. For these reasons, early diagnosis and treatment of serious infections are crucial for preventing sepsis.
Implications for Anna Fey
178. For Anna Fey, it was important that the possibility of a psoas infection be quickly confirmed or ruled out with high confidence.
179. That did not happen.
Dr. Reedy Does Nothing About a Potential Psoas Infection
180. At 0459 hrs (about 45 minutes after the preliminary CT report), Dr. Reedy decided to discharge Anna with no further diagnostic tests. (PHA 14, 61.)
181. In her ED note, under a section titled “Medical Decision Making,” Dr. Reedy quoted from the preliminary CT report, but omitted any reference to a potential infection. Dr. Reedy wrote, “CT lumbar spine shows psoas asymmetry, which is nonspecific and could represent spasm.” (PHA 13-14.)
182. Dr. Reedy left out the part about a possible infection in the iliopsoas. She also left out the radiologist’s recommendation of a follow-up CT with contrast.
183. Nothing in Dr. Reedy’s notes provided a reasonable basis for discharging Anna without following up on the suggestion of an iliopsoas infection.
184. Dr. Reedy noted, “Pt is well-appearing with reassuring VS, exam, and imaging.” This did not justify a discharge without a follow-up CT. While vital signs and general appearance are important, they can be misleading in cases of deep-seated infections or early sepsis. The imaging showed a concerning finding that warranted further investigation. Furthermore, while Anna did not show a fever, a fever could be masked or prevented by the Norco she was given.
185. Dr. Reedy noted, “CT lumbar spine shows psoas asymmetry, which is nonspecific and could represent spasm.” This did not justify a discharge without a follow-up CT. While psoas asymmetry can be due to spasm, the radiologist specifically recommended further imaging to rule out more serious conditions like infection or trauma. Dismissing this recommendation without further investigation was dangerous.
186. Dr. Reedy noted, “There is no acute neurological deficit.” This did not justify a discharge without a follow-up CT. The absence of neurological deficits is reassuring, but it doesn’t rule out all serious conditions that could cause psoas asymmetry. To the contrary, the absence of deficits could reflect that the infection was still early enough in its evolution that long-term harm could still be prevented by prompt diagnosis and treatment.
187. Dr. Reedy noted, “The patient has multiple prescribers of opioid pain medication.” This did not justify a discharge without a follow-up CT. It was irrelevant to the decision not to pursue further imaging. While this may be a concern for pain management, and while it is proper for a physician to consider the possibility that a patient is exaggerating in order to get drugs, this concern only made it more important to address the possibility of infection revealed by the CT.
188. Dr. Reedy noted, “She request to be admitted for ‘meniscus repair’ of her right knee because ‘that started everything.’” This did not justify a discharge without a follow-up CT. It was irrelevant to the decision about follow-up imaging for the psoas finding. The patient’s request for admission for an unrelated issue doesn’t negate the need to investigate the CT findings.
189. Dr. Reedy noted, “I have explained to her repeatedly that sometimes are chronic in nature and cannot be treated emergently.” This did not justify a discharge without a follow-up CT. It doesn’t address the specific concern raised by the CT findings.
190. Dr. Reedy noted, “She has follow-up with orthopedics arranged.” This did not justify a discharge without a follow-up CT. Follow-up is important, but an outpatient visit to an orthopedist at some unspecified future time would be too little, too late if Anna did have a serious infection.
191. Dr. Reedy noted, “Exam is not concerning for cauda equina syndrome/epidural hematoma or abscess.” This did not justify a discharge without a follow-up CT. While ruling out these conditions is important, it doesn’t address the specific psoas finding on CT.
192. Dr. Reedy noted, “No rf for diskitis. No signs of serious bacterial infection or acute surgical emergency.” This did not justify a discharge without a follow-up CT. The absence of obvious signs of infection doesn’t rule out a deep-seated infection like a psoas abscess, which can have subtle presentations.
193. Dr. Reedy noted, “Precautions for return to the ER discussed in detail.” This did not justify a discharge without a follow-up CT. The advice was sound, but it did not address the need for follow-up imaging.
194. Dr. Reedy noted, “Patient is aware that radiology studies may be over-read by the radiologist with new or different findings.” This did not justify a discharge without a follow-up CT. This seems to downplay the importance of the first radiologist’s concern and recommendation for further imaging.
195. In short, none of Dr. Reedy’s comments, singly or in combination, justify the decision to discharge Anna without the recommended follow-up CT.
After Discharge
196. Around 0615 hrs on September 13, Dr. Reedy and the PHA staff discharged Anna over her objections — forcibly putting her into a wheelchair to roll her out of the hospital. (PHA 62.)
197. Nearly two hours later, at 0802 hrs, a local radiologist “over-read” the CT, to produce a final report. The final report wrote in part, “Impression: Asymmetric right iliopsoas muscle enlargement with amorphous internal hypodensity and muscular fat stranding. Findings concerning for myositis with possible intramuscular phlegmon versus abscess. Traumatic myositis is also in the differential diagnosis. . . . RECOMMENDATION: Contrast-enhanced CT of the abdomen and pelvis for better evaluation of the iliopsoas abnormality.” (PHA 18.)
198. The “over-read” radiologist also issued an “orange alert.” (PHA 18.)
199. By the time the orange alert was issued, Anna was no longer in the hospital. She was in severe pain on the way home.
200. Anna or her husband, Tony, received a phone call from Anna’s primary care physician, Dr. Alan Perry, with Piedmont. Dr. Perry said she would need a follow-up CT and that his office (an outpatient clinic) would contact her to schedule one.
201. Dr. Perry apparently did not recognize the potential danger of a psoas infection, or the urgency of a prompt follow-up CT. In any event, neither then nor later did he ever tell Anna that she might have a potentially catastrophic infection and that she needed to return to the emergency department for a follow-up CT as soon as possible. Dr. Perry did eventually tell Anna she would have to go to the ED in order to get a follow-up CT without a substantial delay, but he did not explain the danger and the urgency of the situation.
202. Anna remained in severe pain such that even being moved in a stretcher was painful. After a series of efforts to arrange a repeat CT, Anna finally was returned to the emergency department by ambulance on September 15.
203. Anna was seen in the ED at around 1445 hrs on Sept. 15. (MCA 54.)
204. A lumbar CT with contrast was ordered. The report said, “Peripherally enhancing pockets of fluid are present within the right psoas muscle, most likely representing areas of abscess. Small amount of fluid appears to be at the right lateral L3-L4 disc space, which raises suspicion for discitis/osteomyelitis as the probable source of abscess. Advise further evaluation with contrast-enhanced lumbar spine MRI.” (MCA 79.)
205. Anna was admitted to PHA for treatment and remained in the hospital for about three weeks while the infection was treated. (MCA 54, 123.)
206. On September 17, Dr. Reedy added a comment to her ED note from September 12-13. She wrote as follows: “At the time of returning to the chart to sign it, I have reviewed the final imaging results and it appears there was concern for myositis or psoas abscess by the radiologist after over reading the initial study. I was not made aware of these findings by radiology and upon checking on the patient, I see that she is currently hospitalized and receiving appropriate care.” (PHA 15.)
207. Dr. Reedy’s September 17 addendum was misleading. The preliminary and final CT reports were similar in identifying the possibility of a psoas infection. An abscess is a result of infection.
CAUSES OF ACTION
208. Plaintiffs’ causes of action are based on the averments stated above as well as the additional averments stated below.
209. Discovery may produce new information that changes the basis of Plaintiffs’ claims.
210. The averments below seek to give the Defendants detailed notice of the legal principles on which Plaintiffs’ claims are based. However, the legal bases may change as additional information emerges.
Negligence (PAH)
211. This “simple” or “ordinary” negligence claim is not a claim for professional malpractice subject to OCGA 9-11-9.1.[13]
212. This claim addresses the role of purely managerial or administrative negligence in the breakdown of the Hospital’s patient-safety systems and processes.
213. A hospital’s patient-safety systems and processes include purely managerial work as well as professional healthcare work. Negligent management can (and did here) contribute to harm to patients.
214. PAH was negligent in various purely administrative functions, in ways that contributed to the erroneous discharge of Anna Fey on the morning of September 13, 2022.
215. Anna suffered harm because of the erroneous discharge.[14]
Professional Malpractice (Dr. Reedy and PHIPI)
216. Dr. Reedy violated the standard of care by discharging Anna instead of ordering the follow-up CT with contrast that was suggested in the preliminary CT report.
217. Dr. Reedy’s poor record-keeping on September 13 — including a misleading characterization of the preliminary CT report, omitting any reference to possible infection or the recommendation for a follow-up CT — contributed to her improper discharge of Anna.
218. Dr. Reedy’s negligence caused harm to Anna.
219. PHIPI is vicariously liable for Dr. Reedy’s negligence.[15]
CONCLUSION
220. Plaintiff demands judgment in excess of $10,000[16] for general damages, for special damages consisting of medical bills and related expenses, and such other and further relief as the Court deems just and proper.
September 9, 2024
Respectfully submitted,
/s/ Daniel E. Holloway
Georgia Bar No. 658026
DEH Law
2062 Promise Road, Unit 1305
Rapid City, SD 57701
404-670-6227
Attorney for Plaintiff
[1] Plaintiffs rely on all averments stated in numbered paragraphs in the main text, but not on statements in footnotes. The Defendants need not respond to footnoted statements. The footnotes are offered largely to avoid unnecessary motion practice by stating the relevant law, some parts of which are less familiar than others.
This complaint provides more than the general notice of claims required by the notice-pleading standard of Georgia law. The law permits does not require the additional detail provided here, but neither does the law forbid it. See OCGA 9-11-8(a) (a complaint “shall contain” a short and plain statement — not “shall contain only”). The additional detail provides additional notice of the basis of the claims and is offered in the hope of narrowing the disputes and promoting efficiency in the litigation. (Note OCGA 9-11-1 (“This chapter shall be construed to secure the just, speedy, and inexpensivedetermination of every action.”).)
Plaintiffs do not waive the protections of Georgia’s notice-pleading standard. See Atlanta Women’s Specialists v. Trabue, 310 Ga. 331 (2020) (“[A] complaint need only provide fair notice of what the plaintiff’s claim is and the grounds upon which it rests. … [T]he objective of the CPA is to avoid technicalities and to require only a short and plain statement of the claim that will give the defendant fair notice of what the claim is and a general indication of the type of litigation involved; the discovery process bears the burden of filling in details.”).
Because this complaint provides extensive detail, Plaintiffs will agree to extend the Defendants’ time to answer the complaint.
[2] OCGA §§ 14-2-510 and 14-3-510 provide identical venue provisions for regular business corporations and for nonprofit corporations:
“Each domestic corporation and each foreign corporation authorized to transact business in this state shall be deemed to reside and to be subject to venue as follows: (1) In civil proceedings generally, in the county of this state where the corporation maintains its registered office…. (3) In actions for damages because of torts, wrong, or injury done, in the county where the cause of action originated, if the corporation has an office and transacts business in that county; (4) In actions for damages because of torts, wrong, or injury done, in the county where the cause of action originated.”
These same venue provisions apply to Professional Corporations, because PCs are organized under the general “Business Corporation” provisions of the Georgia Code. See OCGA § 14-7-3. These venue provisions also apply to Limited Liability Companies, see OCGA § 14-11-1108, and to foreign limited liability partnerships, see OCGA § 14-8-46.
Furthermore, OCGA 9-10-31 provides that, “joint tort-feasors, obligors, or promisors, or joint contractors or copartners, residing in different counties, may be subject to an action as such in the same action in any county in which one or more of the defendants reside.”
[3] Plaintiff is delivering a copy of this complaint to the following physician practice groups associated with Piedmont Healthcare, Inc. Within the period provided by law for commencing the action, each of those entities (1) will have received such notice of the institution of the action that they will not be prejudiced in maintaining their defense on the merits, and (2) will know or should know that, but for a mistake concerning the identity of the proper party, the action would have been brought against them. All of these entities have the same Registered Agent: CSC of Cobb County, Inc. at 192 Anderson Street, NE, Suite 125, Marietta, GA, 30060. Plaintiff is delivering a copy of this complaint to each of the following entities via their Registered Agent:
· Piedmont ED Professional, LLC
· The Piedmont Clinic, Inc.
· Piedmont Medical Care Corporation
· Athens Regional Physician Services, Inc.
· Athens Regional Specialty Services Inc.
· Regional FirstCare, Inc.
· University Health Care Physicians, LLC.
[4] This section recites the principal facts of the case, but additional material facts are stated in other sections below.
[5] Duties depend on facts. Here, important background facts are not widely understood, so we provide a short primer on healthcare administration and its relation to medical error and patient safety.
[6] Exhibit 8, exhibit page 69. Unless otherwise noted, all emphasis in quotations is added.
[7] Plaintiffs stipulate that the Defendants are not required to admit or deny the statements in the exhibits.
[8] Exhibit 6. Also available at https://www.piedmont.org/living-real-change/time-out-for-safety#.
[9] Exhibit 5, page 27.
[10] Exhibit 5, pages 12-13.
[11] Exhibit 9; also available at: https://www.piedmont.org/living-real-change/time-out-for-safety#.
[12] With this complaint, we are serving on the Defendants a Bates-stamped set of Anna Fey’s medical records. The record citations here are to that set of records.
[13] Section 9.1 lists the professionals it applies to. The statute does not apply to anyone not on the list. See, e.g., Upson County Hospital v. Head, 246 Ga. App. 386 (2000) (“To the extent that the hospital agents or employees are not “professionals,” … the affidavit requirements of OCGA 9-11-9.1 do not apply.”). Even for professionals listed in Section 9.1, the affidavit requirement applies only if professional judgment is involved. See, e.g., Lutz v. Foran, 262 Ga. 819 (1993) (“In malpractice actions, a plaintiff must present expert testimony to establish the parameters of acceptable professional conduct. Not every act that a professional performs, however, is a professional act that requires expert testimony. If the professional’s alleged negligence does not require the exercise of professional judgment and skill, the cause of action is based on a simple negligence theory.”). Just because negligence happened at a hospital doesn’t mean it was professional malpractice. Ordinary negligence can happen in hospitals, too. See, e.g., Lamb v. Candler General Hospital, 262 Ga. 70 (1992) (“[S]imply because an alleged injury occurs in a hospital setting, a suit to recover for that injury is not necessarily a medical malpractice action.”). A claim for medical malpractice does not exclude a separate claim for ordinary negligence. See, e.g. Upson County Hospital v. Head, 246 Ga. App. 386 (2000) (“Clearly, Head’s claim that the hospital is liable for any and all acts of negligence on behalf of its employees and agents can be construed as a claim for both simple negligence and professional negligence.”).
[14] Because the medical records contain far less information clearly relating to managerial/administrative actions, as to this claim, Plaintiffs hew more closely to the bare requirements of the notice-pleading standard.
[15] Discovery may reveal nursing malpractice in the course of Anna’s September 12-13 ED visit. PAH would be vicariously liable for any such malpractice. And any such malpractice would arise out of the conduct, transaction, or occurrence set forth or attempted to be set forth in this original pleading. Therefore an amendment adding such a claim would relate back to the date of this original pleading. See OCGA 9-11-15(c). See also Jensen v. Engler, 317 Ga. App. 879 (2013).
[16] This language is required by OCGA 9-11-8(2)(B), which also provides that “no further monetary amount shall be stated.”