Complaint: Jones v. Piedmont Healthcare, Inc., et al
Original Complaint
In the State Court of Muscogee County
State of Georgia
JEREMY JONES
BETH JONES,
Plaintiffs,
— versus —
THE MEDICAL CENTER, INC.
PIEDMONT HEALTHCARE, INC.
VINCENT M. NICOLAIS, MD
SAMUEL OSEI-BONSU, MD
RADIOLOGY PARTNERS, INC.
COLUMBUS DIAGNOSTIC CENTER, INC.
JOSHUA KOERNER, DO
NOLEN MEDICAL CONSULTING LLC
CHERYL STEPHENS, MD
MANASA VALLURI, MD
TABITHA MILLER, RN
CHRISTINA ORR, RN
JOHN/JANE DOE 1-10,
Defendants
CIVIL ACTION
FILE NO. ___________
JURY TRIAL DEMANDED
Plaintiff’s Complaint for Damages
Nature of the Action
1. This medical malpractice action arises out of medical services negligently performed on Jeremy Jones on September 8-9, 2019.
2. Pursuant to OCGA § 9-11-9.1, attached to this Complaint are the Affidavits of (i) Jonathan Schwartz, MD, MBA, (ii) Paul Collier, MD, and (iii) Judith Climenson, RN, CCRN-CMC, CNRN-SCRN.
3. This Complaint incorporates the opinions and factual allegations contained in those affidavits.
4. As used in this Complaint, the phrase “standard of care” means that degree of care and skill ordinarily employed by the medical profession generally under similar conditions and like circumstances as pertained to the Defendant’s actions or omissions under discussion.
Parties, Procedure, and Roles[1]
Jeremy and Beth Jones
5. Jeremy and Beth Jones, the Plaintiffs, are residents of Alabama but submit to the personal jurisdiction and venue of this Court.
The Medical Center, Inc. (“MCI”)
6. On September 8, 2019, Jeremy Jones was admitted to Piedmont Columbus Regional Midtown Hospital at 710 Center Street, Columbus, Georgia 31901 (the “Hospital”).
7. The Hospital is owned by The Medical Center Hospital Authority.
8. The Hospital is operated by The Medical Center, Inc. (“MCI”).
9. MCI is a Georgia corporation.
10. MIC is organized pursuant to the provisions of the Georgia Nonprofit Corporation Code. MCI has no capital stock and has only one member. The sole member of MCI is Piedmont Healthcare, Inc.
11. MCI is organized to operate exclusively for public charitable, educational, and scientific uses and purposes.
12. The purpose of MCI is to serve and promote the public health of the general population and particularly to lease (from The Medical Center Hospital Authority), and operate the Hospital and its related facilities as an acute care general hospital for the benefit of the general public.
13. MCI’s power and authority thus extend to providing medical and hospital care.
14. As the operator of the Hospital, MCI is responsible for the management and supervision of medical and hospital services at the Hospital.
15. As the operator of the Hospital, MCI is directly (not vicariously) liable for any negligence in the management and supervision of medical and hospital services at the Hospital.
16. MCI directly employs multiple licensed physicians and nurses.
17. Through the physicians and nurses MCI employs, a great deal of medical knowledge is available to MCI.
18. MCI employed the nurses responsible for the nursing care of Jeremy Jones at the Hospital on September 8 & 9, 2019.
19. MCI is vicariously liable for any negligence by the nurses responsible for the nursing care of Jeremy Jones at the Hospital on September 8 & 9, 2019.
20. MCI provided liability insurance for the resident physicians responsible for the medical care of Jeremy Jones at the Hospital on September 8 & 9, 2019.
21. MCI had the right to direct and control the resident physicians responsible for the medical care of Jeremy Jones at the Hospital on September 8 & 9, 2019.
22. MCI set the work schedules for the resident physicians responsible for the medical care of Jeremy Jones at the Hospital on September 8 & 9, 2019.
23. MCI was responsible for creating and promulgating policies and protocols that had to be followed by the resident physicians responsible for the medical care of Jeremy Jones at the Hospital on September 8 & 9, 2019.
24. MCI was responsible for providing the resident physicians with supervision and assistance by a fully licensed physician to protect the safety of the Hospital’s patients.
25. MCI employed the resident physicians responsible for the medical care of Jeremy Jones at the Hospital on September 8 & 9, 2019.
26. MCI is vicariously liable for any negligence by Dr. Manasa Valluri and Dr. Cheryls Stephens in the medical care of Jeremy Jones at the Hospital on September 8 & 9, 2019.
27. If any other entity was the principal of the resident physicians responsible for the medical care of Jeremy Jones at the Hospital on September 8 & 9, 2019, then each such entity is hereby on notice that but for a mistake concerning the identity of the proper party, the action would have been brought against it.
28. MCI’s principal office is in Muscogee County at 707 Center Street, Columbus, GA 31902.
29. The cause of action originated in Muscogee County.
30. MCI has an office in Muscogee County.
31. MCI transacts business in Muscogee County.
32. MCI is subject to venue in this county.[2]
33. MCI’s registered agent is CSC of Cobb County, Inc., located at 192 Anderson Street SE, Suite 125, Marietta, GA 30060, in Cobb County.
34. MCI has been properly served with this complaint.
35. MCI is subject to the personal jurisdiction of this Court.
36. MCI is subject to the subject-matter jurisdiction of this Court.
37. MCI has no defense to this suit based on the statute of limitations, laches, or any other defense premised on delay in bringing suit.
Piedmont Healthcare, Inc. (“PHI”)
38. Piedmont Healthcare, Inc. (“PHI”) is a Georgia corporation.
39. PHI is organized pursuant to the provisions of the Georgia Nonprofit Corporation Code.
40. PHI is organized exclusively for the benefit of, to perform the functions of, and to carry out the charitable purposes within the meaning of the Internal Revenue Code of 1986 and to carry out the charitable, scientific, and educational purposes of various healthcare organizations.
41. PHI was organized “to carry out” the purposes of the hospitals within its organization, “by providing … management services … and supervision” to all of them.
42. PHI directly employs multiple licensed physicians and nurses.
43. Through the physicians and nurses PHI employs, a great deal of medical knowledge is available to PHI.
44. On March 1, 2018, PHI bought MCI, which became a wholly-owned subsidiary and supported organization of PHI.
45. MCI became a “functionally integrated” part of PHI.
46. Piedmont Healthcare, Inc. manages the functions of MCI.
47. Piedmont Healthcare, Inc. participates in managing and supervising the provision of medical and hospital services at the Hospital.
48. PHU is liable for any negligence in the management and supervision of medical and hospital services at the Hospital.
49. PHI’s principal office is in Fulton County at 1800 Howell Mill Road, Suite 850, Atlanta, Georgia, 30318.
50. PHI’s registered agent is CSC of Cobb County, Inc., at 192 Anderson Street, N.E., Suite 125, Marietta, GA, 30060.
51. PHI has been properly served with this complaint.
52. PHI is subject to the personal jurisdiction of this Court.
53. PHI is subject to the subject-matter jurisdiction of this Court.
54. PHI is subject to venue in Muscogee County because one or more of PHI’s co-defendants resides in Muscogee County.[3]
55. PHI has no defense to this suit based on the statute of limitations, laches, or any other defense premised on delay in bringing suit.
Vincent M. Nicolais, MD
56. Vincent M. Nicolais, MD, was a critical care physician who wrote the initial Critical Care Report on Jeremy on September 8, 2019, at 1552 hrs.
57. On September 8, 2019, at 1552 hrs, Dr. Nicolais wrote instructions to observe Jeremy 4-5 more hours in the ICU and then, if stable, to transfer Jeremy to the neurosciences unit.
58. Dr. Nicolais resides in Muscogee County.
59. Dr. Nicolais resides at 5110 Midland Trace, Midland, GA 31820-3426.
60. Dr. Nicolais acted as an agent of MCI in treating Jeremy Jones on September 8, 2019.
61. MCI is vicariously liable for any negligence by Dr. Nicolais in treating Jeremy on September 8, 2019.
62. If any other entity was Dr. Nicolais’ principal in September 2019 with respect to his medical treatment of Jeremy Jones, each such entity is hereby on notice that but for a mistake concerning the identity of the proper party, the action would have been brought against it.
63. Dr. Nicolais has been properly served with this complaint.
64. Dr. Nicolais is subject to the personal jurisdiction of this Court.
65. Dr. Nicolais is subject to the subject-matter jurisdiction of this Court.
66. Dr. Nicolais is subject to venue in this Court.
67. Dr. Nicolais has no defense to this suit based on the statute of limitations, laches, or any other defense premised on delay in bringing suit.
Joshua Koerner, DO
68. Joshua Koerner, DO, was the supervising physician for Dr. Manasa Valluri and Dr. Cheryl Stephens on September 8 & 9, 2019.
69. In September 2019, Dr. Koerner was a Family Medicine physician less than 1-1/2 years into his career as a fully licensed physician.
70. Dr. Koerner was responsible for supervising and assisting Drs. Valluri and Stephens on September 8 & 9, 2019.
71. Dr. Koerner acted as an agent of “MCI” in supervising and assisting Drs. Valluri and Stephens on September 8 & 9, 2019.
72. MCI is vicariously liable for any negligence by Dr. Koerner in supervising and assisting Drs. Valluri and Stephens on September 8 & 9, 2019.
73. Dr. Koerner also acted as an agent of Nolen Medical Consulting LLC in providing medical services in September 2019.
74. Nolen Medical Consulting LLC is vicariously liable for any negligence by Dr. Koerner in providing medical services on September 8 & 9, 2019.
75. If any other entity was Dr. Koerner’s principal in September 2019 with respect to his medical treatment of Jeremy Jones, each such entity is hereby on notice that but for a mistake concerning the identity of the proper party, the action would have been brought against it.
76. Dr. Koerner resides in Muscogee County.
77. Dr. Koerner resides at 8272 Dream Boat Drive, Unit 436, Columbus, Georgia 31909.
78. Dr. Koerner has been properly served with this complaint.
79. Dr. Koerner is subject to the personal jurisdiction of this Court.
80. Dr. Koerner is subject to the subject-matter jurisdiction of this Court.
81. Dr. Koerner is subject to venue in this Court.
82. Dr. Koerner has no defense to this suit based on the statute of limitations, laches, or any other defense premised on delay in bringing suit.
Nolen Medical Consulting LLC (“NMC”)
83. Nolen Medical Consulting LLC (“NMC”) is a Georgia limited liability company.
84. NMC’s principal office address is in Muscogee County at 272 Dream Boat Drive, APT 436, Columbus, GA, 31909.
85. NMC’s registered agent is Dr. Koerner.
86. NMC’s registered office is Dr. Koerner’s residential address, 8272 Dream Boat Drive, APT 436, Columbus, GA, 31909.
87. NMC has been properly served with this complaint.
88. NMC is subject to the personal jurisdiction of this Court.
89. NMC is subject to the subject-matter jurisdiction of this Court.
90. NMC is subject to venue in this Court.
91. NMC has no defense to this suit based on the statute of limitations, laches, or any other defense premised on delay in bringing suit.
Samuel Osei-Bonsu, MD
92. In September 2019, Dr. Osei-Bonsu was an agent of Radiology Partners.
93. In September 2019, Dr. Osei-Bonsu was an agent of Columbus Diagnostic Center, located at 2040 10th Ave, Columbus, GA 31901.
94. If any other entity was Dr. Osei-Bonsu’s principal in September 2019 with respect to his medical treatment of Jeremy Jones, each such entity is hereby on notice that but for a mistake concerning the identity of the proper party, the action would have been brought against it.
95. Dr. Osei-Bonsu resides in Muscogee County.
96. Dr. Osei-Bonsu resides at 7461 Blackmon Road, Apt 4710, Columbus, Georgia 31909.
97. Dr. Osei-Bonsu has been properly served with this complaint.
98. Dr. Osei-Bonsu is subject to the personal jurisdiction of this Court.
99. Dr. Osei-Bonsu is subject to the subject-matter jurisdiction of this Court.
100. Dr. Osei-Bonsu is subject to venue in this Court.
101. Dr. Osei-Bonsu has no defense to this suit based on the statute of limitations, laches, or any other defense premised on delay in bringing suit.
Radiology Partners, Inc. (“RPI”)
102. Radiology Partners, Inc. (“RPI”) is a Delaware corporation registered to do business in Georgia, with its principal office address in California.
103. RPI’s registered agent in Georgia is Corporation Service Company in Gwinnett County at 2 Sun Court, Suite 400, Peachtree Corners, Georgia, 30092.
104. RPI says they were founded in 2012 with a mission to transform radiology.
105. RPI says “Teamwork: The core of our Practice. We work together.”
106. RPI says, “We deliver quality care and experience to patients.”
107. RPI says, “We exist to provide the best in radiology services. We strive to understand the needs of our clients – especially patients and referring physicians – and exceed their expectations.”
108. RPI says, “We take responsibility for our actions and acknowledge that each of us has a role in the success of the Practice.”
109. Dr. Osei-Bonsu was affiliated with RPI in September 2019.
110. RPI was Dr. Osei-Bonsu’s employer or other principal in September 2019.
111. RPI is vicariously liable for any negligence by Dr. Osei-Bonsu in treating Jeremy Jones.
112. RPI has been properly served with this complaint.
113. RPI is subject to the personal jurisdiction of this Court.
114. RPI is subject to the subject-matter jurisdiction of this Court.
115. RPI is subject to venue in this Court pursuant to OCGA § 9-10-31, because various co-defendants are subject to venue here.
116. RPI has no defense to this suit based on the statute of limitations, laches, or any other defense premised on delay in bringing suit.
Columbus Diagnostic Center, Inc. (“CDI”)
117. Columbus Diagnostic Center, Inc. (“CDI”) is a healthcare provider registered with the Centers for Medicare and Medicaid Services under three National Provider Identifiers: 1700892288 and 1316108624 and 1598081093.
118. The only healthcare providers registered with NPPES as “Columbus Diagnostic Center” are providers operating in Muscogee County, Georgia, in Columbus.
119. CDI is a corporation formed in Delaware.
120. In its registration with the Georgia Secretary of State’s Corporations Division, CDI states that its principal office addres is in Jupiter, Florida.
121. CDI’s registered agent is Paul Cote in Fulton County at 69 Wood Place, Roswell, Georgia, 30075.
122. CDI has been properly served with this complaint.
123. CDI is subject to the personal jurisdiction of this Court.
124. CDI is subject to the subject-matter jurisdiction of this Court.
125. CDI is subject to venue in this county pursuant to OCGA §§ 14-2-510 and 14-3-510.
126. CDI is subject to venue in Muscogee County pursuant to OCGA § 9-10-31 because one or more of CDI’s co-defendants resides here.
127. CDI has no defense to this suit based on the statute of limitations, laches, or any other defense premised on delay in bringing suit.
Manasa Valluri, MD
128. Manasa Valluri, MD was involved in the treatment of Jeremy Jones on September 8 & 9, 2019.
129. In September 2019, Dr. Valluri was a Family Medicine resident at the Hospital. She was two or three months into the first year of her residency.
130. MCI controlled Dr. Valluri’s schedule.
131. MCI was responsible for creating and promulgating policies & protocols, which Dr. Valluri was required to comply with.
132. MCI was responsible for providing Dr. Valluri with supervision and assistance by a fully licensed physician to protect the safety of Dr. Valluri’s patients.
133. MCI was Dr. Valluri’s employer in September 2019.
134. If any other entity was Dr. Valluri’s principal in September 2019 with respect to her medical treatment of Jeremy Jones, each such entity is hereby on notice that but for a mistake concerning the identity of the proper party, the action would have been brought against it.
135. Dr. Valluri resides in Muscogee County.
136. Dr. Valluri resides at 6600 Kitten Lake Dr, Midland, Georgia 31820.
137. Dr. Valluri has been properly served with this complaint.
138. Dr. Valluri is subject to the personal jurisdiction of this Court.
139. Dr. Valluri is subject to the subject-matter jurisdiction of this Court.
140. Dr. Valluri is subject to venue in this Court.
141. Dr. Valluri has no defense to this suit based on the statute of limitations, laches, or any other defense premised on delay in bringing suit.
Cheryl Stephens, MD
142. Cheryl Stephens, MD was involved in the treatment of Jeremy Jones on September 9, 2019.
143. In September 2019, Dr. Stephens was in her second year as a Family Medicine resident at the Hospital.
144. MCI controlled Dr. Stephens’ schedule.
145. MCI was responsible for creating and promulgating policies & protocols, which Dr. Stephens was required to comply with.
146. MCI was responsible for providing Dr. Stephens with supervision and assistance by a fully licensed physician to protect the safety of Dr. Stephens’ patients.
147. MCI was Dr. Stephens’ employer in September 2019.
148. If any other entity was Dr. Stephens’ principal in September 2019 with respect to her medical treatment of Jeremy Jones, each such entity is hereby on notice that but for a mistake concerning the identity of the proper party, the action would have been brought against it.
149. Dr. Stephens resides in Muscogee County.
150. Dr. Stephens has been properly served with this complaint.
151. Dr. Stephens is subject to the personal jurisdiction of this Court.
152. Dr. Stephens is subject to the subject-matter jurisdiction of this Court.
153. Dr. Stephens is subject to venue in this Court.
154. Dr. Stephens has no defense to this suit based on the statute of limitations, laches, or any other defense premised on delay in bringing suit.
155. Dr. Stephens may be served at 233 Grandmar Chase, Canton, Georgia 30115.
Tabitha Miller, RN
156. Tabitha Miller, RN was a nurse partly responsible for the care of Jeremy Jones on September 8, 2019.
157. Nurse Miller resides in Alabama.
158. Nurse Miller resides at 2700 College Drive, Apt 2703, Phenix City, Al 36869-2032.
159. Nurse Miller has been properly served with this complaint.
160. Nurse Miller is subject to the personal jurisdiction of this Court.
161. Nurse Miller is subject to the subject-matter jurisdiction of this Court.
162. Nurse Miller is subject to venue in this Court because various of her co-defendants are subject to venue in this Court.
163. Nurse Miller has no defense to this suit based on the statute of limitations, laches, or any other defense premised on delay in bringing suit.
164. Nurse Miller was an employee of MCI in September 2019.
165. If any other entity was Nurse Miller’s principal in September 2019 with respect to her responsibility for participating in the care of Jeremy Jones, each such entity is hereby on notice that but for a mistake concerning the identity of the proper party, the action would have been brought against it.
Christina Orr, RN
166. Christina Orr, RN was a nurse partly responsible for the care of Jeremy Jones on September 8 & 9, 2019.
167. Nurse Orr resides in Muscogee County.
168. Nurse Orr resides at 2924 Hatcher Drive, Columbus, Georgia 31907-2158.
169. Nurse Orr has been properly served with this complaint.
170. Nurse Orr is subject to the personal jurisdiction of this Court.
171. Nurse Orr is subject to the subject-matter jurisdiction of this Court.
172. Nurse Orr is subject to venue in this Court.
173. Nurse Orr has no defense to this suit based on the statute of limitations, laches, or any other defense premised on delay in bringing suit.
174. Nurse Orr was an employee of MCI in September 2019.
175. If any other entity was Nurse Orr principal in September 2019 with respect to her responsibility for participating in the care of Jeremy Jones, each such entity is hereby on notice that but for a mistake concerning the identity of the proper party, the action would have been brought against it.
John/Jane Does
176. Defendants John/Jane Doe 1-10 are those yet unidentified individuals and/or entities who may be liable, in whole or part, for the damages alleged herein. Once served with process, John/Jane Doe 1-10 are subject to the jurisdiction and venue of this Court.
177. This Court has subject matter jurisdiction, and venue is proper as to all Defendants in this Court.
General Principles
Hospital Management & Patient Safety
178. In 1999, the Institute of Medicine estimated that 44,000 to 98,000 Americans died each year from medical errors.
179. Since then, the healthcare industry, academia, and federal and state policymakers have started to focus on patient safety.
180. Nevertheless, in 2016, researchers at John Hopkins Medicine concluded that over 250,000 Americans die each year from medical errors.
181. The John Hopkins study revealed that medical error ranks as the third-leading cause of death in the United States, behind only heart disease and cancer, and ahead of respiratory disease.
182. It is now generally accepted that medical errors result largely from system failures.
183. That is, medical errors are not caused solely by “bad apple” individual clinicians directly involved in patient care.
184. Instead, medical errors often result from a combination of failures by multiple persons within an organization, rather than from individual failure alone.
185. Leaders, managers, and administrators of hospitals and other healthcare organizations are responsible for acting affirmatively to (i) protect patient safety and (ii) prevent systemic failures enabling individual error.
186. Leaders, managers, and administrators owe patients an ordinary duty to safeguard their safety.
187. Leaders, managers, and administrators do not require professional licensing.
188. While leaders, managers, and administrators work with and through licensed healthcare professionals, the ultimate responsibility for patient safety rests with leaders, managers, and administrators. The buck stops with them.
189. Certain systemic sources of medical error are well recognized. They include, in no particular order:
a. The failure to implement or enforce protocols for patient care.
b. Defects in the policies and procedures for the handoff of a patient’s care.
c. Lack of teamwork and communication.
d. Flaws in procedures meant to prevent breakdowns in communication.
e. The failure to train, supervise, and support healthcare providers, especially lower-ranking and less-experienced providers.
f. Gaps in the systems for preventing medication mix-ups.
g. Inadequate staffing, particularly overnight, weekends, and holidays.
h. Absence of mechanisms to escalate patient-safety issues in real time, without fear of retaliation.
i. A culture that punishes providers who speak out on patient-safety issues.
j. A culture that discourages the recognition and remediation of errors.
k. The failure to build a culture that values and rewards patient advocacy.
l. Problems with morale — from overwork, understaffing, unfair employment practices, and poor management decisions.
m. Flaws in procedures for credentialing competent providers.
190. Safeguarding patient safety thus requires, among other things:
a. Ensuring that systems are in place to avoid known sources of medical error. Such systems include technologies (like electronic medical-record systems) as well as effective policies, protocols, and practices.
b. Ensuring that individual providers understand and are trained on policies, protocols, and practices, and are prepared to implement them.
c. Ensuring proper training, supervision, and support of individual providers, particularly nurses and residents.
d. Ensuring compliance through assessments, evaluations, and audits.
e. Ensuring competence of providers at the time of credentialing.
f. Maintaining provider morale through (among other things) institutional transparency, accountability, and responsiveness.
g. Cultivating a culture of safety that (i) vigilantly mitigates systemic sources of medical errors and (ii) acknowledges and remediates medical errors to prevent their recurrence.
Anatomy, Endovascular Procedures, & Closure
191. The various tissues of the body need blood in order to live.
192. Blood carries oxygen and other nutrients to the body.
193. Arteries consist of three “tunicae” or layers: the intima, media, and adventitia. The innermost layer of an artery is the intima.
194. Endovascular means “inside the blood vessel.” Endovascular surgery is a type of procedure that uses very small cuts and long, thin tubes called catheters, which are placed inside a blood vessel to repair it.
195. Endovascular procedures in an artery create a risk of arterial injury or occlusion (blockage) that may cause acute limb ischemia.
196. At the end of an endovascular procedure where the femoral artery was used as the access/puncture site, one option for sealing the puncture wound is an “Angio-Seal” device — a Vascular Closure Device.
197. The manufacturer of the Angio-Seal device instructs that the risks of using the device include embolism and ischemia.
198. The manufacturer of the Angio-Seal device instructs that before placing an Angio-Seal, a physician should perform an arteriogram of the site, to evaluate the femoral artery.
Limb Ischemia Generally
199. A clot or other physical obstruction in an artery may reduce or stop the blood supply to tissues downstream from the obstruction.
200. “Ischemia” refers to an inadequate blood supply to part of the body.
201. Acute limb ischemia occurs from an abrupt interruption of blood flow to an extremity.
202. “Critical limb ischemia” refers to a severe blockage of blood flow to a limb, placing the limb at risk for loss of function.
203. If treatment of a clot is delayed, the clot may get bigger, may obstruct smaller downstream arteries, and may stick more to the arterial walls and become harder to treat.
204. If blood supply to a living part of the body is halted long enough, that part of the body will die.
205. One commonly cited estimate in the medical literature is that generally a human arm or leg is at risk of irreversible injury if the arm or leg loses blood supply for more than 6 to 8 hours.
206. A limb that loses blood supply for more than 8 hours is at risk of amputation.
Acute Limb Ischemia — Presentation & Management
207. Acute limb ischemia typically causes pain and involves cool skin and abnormal skin color.
208. Generally, a potential case of acute limb ischemia requires urgent assessment, because it may require emergency treatment.
209. Clinical assessment of a potentially ischemic limb generally involves (a) a physical examination of the affected limb, (b) taking a history that includes the duration of symptoms, and (c) a handheld Doppler pulse assessment including an ankle-brachial pressure index.
210. A handheld Doppler device is commonly available in hospitals and can help to assess blood flow by creating sound that indicates the strength of the pulse.
211. Generally, hospital nurses are taught how to use a handheld Doppler device.
212. Generally, physicians who provide clinical treatment to hospital patients are taught how to use a handheld Doppler device.
213. An ankle-brachial pressure index compares the blood pressure at the ankle and elbow, to help identify a weak pulse.
214. Generally, hospital nurses are taught how to take an ankle-brachial pressure measurement.
215. Generally, physicians who provide clinical treatment to hospital patients are taught how to take an ankle-brachial pressure measurement.
216. In cases of acute limb ischemia, generally a vascular surgeon should be consulted.
217. Acute limb ischemia is commonly categorized by degree of severity — class I (limb viable), class IIa (limb marginally threatened), class IIb (limb immediately threatened, and class III (limb non-viable).
218. The severity of limb ischemia is commonly assessed based on factors including (a) degree of pain, (b) degree of sensory deficit, (c) degree of motor deficit, (d) strength of arterial pulse, and (e) strength of venous signal.
219. Where motor and sensory deficits cannot be assessed for a potentially ischemic leg, the arterial and venous signal assessments become all the more important.
220. “Pedal pulse” refers to pulses in the foot, which are commonly assessed at the top of the foot or at the ankle.
221. Pedal pulses may be assessed by touch or by Doppler device.
222. An obese patient’s pedal pulses may be difficult to assess by touch. Doppler assessment is more reliable for such patients.
223. The absence of an audible arterial pedal pulse on Doppler assessment indicates at least class IIa ischemia (limb marginally threatened).
224. Acute limb ischemia of class IIa requires urgent treatment to restore and preserve blood flow.
225. Where an arterial pedal pulse is absent and the sensory or motor deficits cannot be assessed, caution requires treating the ischemia as class IIb (limb immediately threatened).
226. Acute limb ischemia of class IIb requires emergency treatment to restore blood flow.
227. In cases of critical or severe acute limb ischemia, diagnostic investigation generally should not delay therapeutic intervention. Where facilities allow, the patient should generally be treated by an interventionalist with access to diagnostic as well as interventional tools.
Treatment of Jeremy Jones
Note: Beneath most numbered allegations below, we include page references to evidentiary sources (mainly the Bates-stamped medical records served along with this Complaint). We also include screenshots from the evidentiary sources. We include these citations and screenshots only to make it easier for the Defense to respond to the allegations. We do not intend the citations or screenshots as part of the allegations to which the Defendants must respond.
Sunday, September 8, 2019
228. In September 2019, Jeremy Jones is 33 years old and married. His wife’s name is Beth.
229. Jeremy and Beth live in Auburn, Alabama.
230. Auburn, Alabama is on Central time.
Wake-up stroke & first response
231. The morning of Sunday, September 8, at approximately 0910 hrs, Jeremy awakes with right-sided weakness and altered mental status with difficulty speaking. Jeremy falls out of bed.
· AFD 1, 5
232. At 0913 hrs, Beth calls 911.
· AFD 1
233. An EMS crew goes to Jeremy and Beth’s house. The EMS recognize Jeremy might be having a stroke. They order a helicopter EMS to fly Jeremy to Piedmont Columbus Regional Hospital, in Columbus, Georgia.
· AFD 5
Acute treatment at Piedmont Columbus
234. Columbus, Georgia is on Eastern time.
235. At 1124 hrs, Dr. James Sirleaf orders a CT head without contrast and a CTA head and neck.
· PCe 271
· PCe 272
236. At 1145 hrs, Dr. Sirleaf consults with neurologist Dr. Nojan Valadi. Dr. Valadi recommends an Interventional Radiology consult.
· PCe 8
237. At approximately 1214 hrs, Dr. William Lewis calls Dr. Sirleaf to discuss the CTA findings. Dr. Lewis’ conclusion includes “Essentially complete occlusion/severe stenosis of involving the cervical and petrous portions of the left internal carotid artery, beginning just distal to the carotid bifurcation.”
· PCe 272-73
238. At 1217 hrs, Dr. Valadi requests that Jeremy be placed in the Neuro ICU.
· PCe 8
239. At approximately 1245 hrs, Jeremy is taken to Interventional Radiology.
· PCe 275
240. At 1308 hrs, Dr. Valadi enters a consult note. He records a physical examination showing motor strength of 0/5 for Jeremy’s right lower extremity proximally, 2/5 knee extension, and 4/5 foot dorsiflexion plantarflexion.
· PCe 21, 23
. . .
241. From 1258 hrs to 1316 hrs, Dr. Osei-Bonsu performs a thrombectomy.
· PCe 275
242. Dr. Osei-Bonsu punctures Jeremy’s right femoral artery, to perform a thrombectomy in Jeremy’s left internal carotid artery.
· PCe 274
243. At the conclusion of the procedure, Dr. Osei-Bonsu closes the femoral-artery puncture site with a 6 French Angio-Seal device.
· PCe 274
244. Dr. Osei-Bonsu does not document an arteriogram of the access site to confirm proper placement of the Angio-Seal device.
· PCe 274
. . .
245. The radiology images from Piedmont Columbus do not include an arteriogram of Jeremy’s femoral artery at the end of the stroke thrombectomy on September 8.
· DICOM metadata
246. At 1316 hrs, Dr. Valadi enters a set of orders for Jeremy’s post-thrombectomy care.
· PCe 184-192
. . .
247. At 1316 hrs, Dr. Valadi’s orders include an order for “ICU vital signs/neuro checks/MEND exam every hour for 48 hours, then per ICU routine while in ICU.”
· PCe 191
248. At 1338 hrs, Dr. Sirleaf discusses the case with Dr. Shirvanian Namagerdi, who agrees to admit Jeremy to the ICU.
· PCe 8
249. At 1354 hrs, Nurse Sarah Hartsell notes, “pt constantly moving legs, continuously reminded to keep right leg straight and down, but forgets easily. No hematoma noted at this time.”
· PCe 892
250. At 1357 hrs, Dr. Maura Gonzalez orders an inpatient neurology consult for a stroke admission.
· PCe 197
251. At 1401 hrs, Dr. Gonzalez becomes Jeremy’s attending physician.
· PCe 892
252. At 1401 hrs, Dr. Gonzalez enters a set of orders for Jeremy’s post-thrombectomy care.
· PCe 200-202
. . .
253. At 1401 hrs, Dr. Gonzalez identifies Jeremy as at low risk for a deep vein thrombosis.
· PCe 201
254. At 1401 hrs, Dr. Gonzalez enters an order for an intermittent pneumatic compression device for Jeremy.
· PCe 200
255. At 1401 hrs, Dr. Gonzalez requests a bed for Jeremy in the Neuro ICU.
· PCe 893
In the ICU after the thrombectomy
256. At 1451 hrs, Jeremy is admitted to the ICU.
· PCe 894
257. At 1500 hrs, Nurse Charles Brand notes Jeremy’s “peripheral vascular” as “WDL” — within defined limits.
· PCe 789
· PCe 825
258. At 1500 hrs, Nurse Brand notes Jeremy has no pain.
· PCe 796
259. At 1500 hrs, Nurse Brand notes Jeremy’s skin is intact.
· PCe 798
. . .
260. At 1552 hrs, Dr. Vincent Nicolais writes an Initial Critical Care Report. He documents intact distal pulses, persistent right-sided weakness, a Babinski sign on the right, and that Jeremy’s skin is warm and dry.
· PCe 42
· PCe 43-44
261. At 1552 hrs, Dr. Nicolais writes instructions to observe Jeremy 4-5 more hours in the ICU and then, if stable, to transfer Jeremy to the neurosciences unit.
· PCe 48
· PCe 204-05
262. At 1600 hrs, Jeremy is not assessed for skin, pain, or peripheral vascular status.
· PCe 798
. . .
· PCe 821
263. At 1700 hrs, Jeremy is not assessed for skin, pain, or peripheral vascular status.
· PCe 795
. . .
· PCe 796
. . .
· PCe 821
264. At 1800 hrs, Jeremy is not assessed for skin, pain, or peripheral vascular status.
· PCe 795
. . .
· PCe 796
. . .
· PCe 821
265. At 1900 hrs, Nurse Tabitha Miller documents an NIH Stroke Scale assessment. She notes a total score of 10, with right-side deficits. She notes a sensory deficit score of 1.
· PCe 814
. . .
· PCe 825
266. At 1900 hrs, Nurse Miller documents that Jeremy has no sensation in his right leg but that Jeremy shows a flicker of muscle on his right leg.
· PCe 793
. . .
267. At 1900 hrs, Nurse Miller documents that Jeremy’s peripheral vascular status is WDL, within defined limits, and that his right leg pedal pulse is “+2.”
· PCe 795
. . .
268. At 2000 hrs, Nurse Miller documents an NIH Stroke Scale assessment. She notes a total score of 10, with right-side deficits. She notes a sensory deficit score of 1.
· PCe 814
. . .
269. At 2000 hrs, Nurse Miller documents that Jeremy has sudden, cramping pain at a level of 6/10, that Jeremy’s right calf muscle is cramping, and that Jeremy’s skin is clammy and diaphoretic (i.e., sweating heavily). Nurse Miller documents that as a pain intervention, Jeremy received massage and emotional support.
· PCe 806
. . .
· PCe 823
· PCe 796
. . .
270. Notwithstanding Jeremy’s sudden pain, at 2000 hrs, Nurse Miller documents that Jeremy’s peripheral vascular status is Within Defined Limits, that he has no cyanosis, that his capillary refill is less than three seconds, and that his right leg pedal pulse is +2.
· PCe 795
. . .
271. At 2000 hrs, Nurse Miller documents that Jeremy has no sensation in his right leg but that Jeremy shows a flicker of muscle on his right leg.
· PCe 793
. . .
272. At approximately 2031 hrs, Nurse Miller notifies Dr. Manasa Valluri of “pt’s constant pain/knot in R calf muscle.” Nurse Miller notes that Jeremy’s pedal pulse is present and “no drainage/hematoma present on R groin incision.” Nurse Miller notes, “will closely monitor pt.”
· PCe 145
273. In September 2019, Dr. Valluri is a Family Medicine resident. She is two or three months into the first year of her residency.
· Manasa Valluri, MD, LinkedIn page
· Piedmont Columbus Resident Biographies: https://www.piedmont.org/locations/piedmont-columbus/residency/ContentPage.aspx?nd=14850
274. At 2100 hrs, Nurse Miller documents that Jeremy has no sensation in his right leg and shows a flicker of muscle in his right leg.
· PCe 793
. . .
275. At 2100 hrs, Nurse Miller does not document a peripheral vascular assessment of Jeremy. Nurse Miller does not document an assessment of cyanosis, capillary refill, pulses, or skin color and temperature.
· PCe 795
. . .
· PCe 787
276. At 2105 hrs, Dr. Manasa Valluri orders 5 mg of Flexeril (a muscle relaxer) for Jeremy.
· PCe 159
277. Dr. Valluri does not write a note concerning Jeremy’s leg pain.
· See search of records for “Author: Manasa”
· See search of records for “Author: Valluri”
· See search of records for “Note by Manasa”
· See search of records for “Note by Valluri”
278. At 2200 hrs, Nurse Miller documents that Jeremy has no sensation in his right leg and shows a flicker of muscle in his right leg.
· PCe 793
. . .
279. At 2200 hrs, Nurse Miller does not document a peripheral vascular assessment of Jeremy. Nurse Miller does not document an assessment of cyanosis, capillary refill, pulses, or skin color and temperature.
· PCe 795
. . .
· PCe 787
Transfer to Neuro floor
280. At 2240 hrs, Nurse Miller calls Nurse Christina Orr to give a report on Jeremy, in preparation for transferring Jeremy out of the ICU, to room 1001.
· PCe 145
281. At approximately 2251 hrs, Jeremy is transferred to a Neuro floor, room 1001. This transfer is contrary to the wishes of neurologist Dr. Nojan Valadi. This transfer is also contrary to the prior order of Dr. Nicolais to transfer Jeremy out of the ICU only if Jeremy remained stable.
· PCe 145
· PCe 61
282. At 2255 hrs, Matennah Muhammed records some flowsheet assessments, including vital signs.
· PCe 821
· PCe 825
283. At 2255 hrs and 2300 hrs, no assessment is documented for Jeremy’s peripheral vascular status. No assessment is documented for cyanosis, capillary refill, pulses, or skin color and temperature.
· PCe 772
. . .
· PCe 773
· Note: All Sept 8, 2300 hrs flowsheet records copied below
· PCe 767
· PCe 768
· PCe 769
· PCe 770
· PCe 805
· PCe 806
· PCe 807
284. At 2304 hrs, Nurse Christina Orr writes that Jeremy has arrived in Room 1001.
· PCe 145
285. At 2304 hrs, Nurse Christina Orr writes, “assessment complete.” But as indicated above, Nurse Orr records no assessment at or around 2300 hrs.
· PCe 145
286. At 2304 hrs, Nurse Christina Orr notes that Jeremy complains of right leg cramping despite receiving Flexeril at 2117 hrs.
· PCe 145
287. At 2304 hrs, Nurse Christina Orr writes that a physician was paged concerning Jeremy’s leg cramping.
· PCe 145
288. At 2304 hrs, Nurse Christina Orr writes that she will continue to monitor Jeremy closely.
· PCe 145
289. At 2314 hrs, Dr. Valluri orders 10 mg of Flexeril for Jeremy.
· PCe 159
290. The order for 10 mg of Flexeril states that it was authorized by Dr. Bruce Brennaman, a vascular surgeon.
· PCe 159
291. The authorization attributed to Dr. Brennaman is not specifically time-stamped.
· PCe 159
292. Apart from non-time-stamped references to Dr. Brennaman having authorized certain medication orders, the medical records contain no reference to Dr. Brennaman having been involved in Jeremy’s case until September 9 at 0852 hrs, when he enters an order for cefazolin.
· PCe 160
· See search of records for “author: Bruce”
· PCe 140 — earliest note authored by Dr. Brennaman, time-stamped Sept 9 at 1300 hrs
293. Dr. Brennaman’s own records indicate that he was not involved until after Dr. Osei-Bonsu attempted a thrombectomy in Jeremy’s leg on the morning of September 9.
· PCe 26 — consult note by Dr. Brennaman, indicating he was called on Sept 9, after CTA & thrombectomy attempt by Dr. Osei-Bonsu
. . .
· PCe 35 — amputation op note by Dr. Brannaman, saying he first saw Jeremy about 10 hours after the initial finding of limb ischemia
. . .
294. However, the records identify Dr. Brennaman as having authorized medications ordered by other physicians on September 8, at 1309 hrs, 1445 hrs, 1446 hrs, and 2314 hrs.
· PCe 157
· PCe 158
. . .
· PCe 159
295. At midnight, no assessments of Jeremy are recorded in the flowsheets.
· PCe 765 — last flowsheet times for Sept 8
· PCe 674 — first flowsheet times for Sept 9
Monday, September 9
Early morning hours: On neuro floor
296. On Sept 9 at 0036 hrs, Nurse Christina Orr calls neurologist Dr. Nojan Valadi, to inform him that Jeremy has been moved from the ICU to the Neuro floor, and to seek clarification of orders.
· PCe 145
· PCe 61
297. At 0036 hrs, Dr. Valadi orders that Jeremy be returned to the ICU or moved to the Neuro ICU.
· PCe 145
· PCe 61
298. At 0100 hrs, Nurse Christina Orr does not record assessments of Jeremy.
· PCe 765 — last flowsheet times for Sept 8
· PCe 674 — first flowsheet times for Sept 9
Transfer to Neuro ICU (presumed)
299. At 0104 hrs, Nurse Orr enters an order authorized by Dr. Valadi, to transfer Jeremy to the ICU.
· PCe 206
300. At approximately 0118 hrs, Nurse Orr transfers Jeremy to the Neuro ICU.
· PCe 145
301. At the time of the 0118 hrs handoff, Jeremy has been in the care of Nurse Christina Orr since approximately 2300 hrs — about 2 hours and 20 minutes. In that time, Nurse Orr does not record any assessment of Jeremy’s right leg.
· See above.
302. At 0118 hrs, Nurse Latonya Warren notes that Jeremy is complaining of being hot, and that his temperature is 99.6.
· PCe 145
303. At 0120 hrs, within minutes of Jeremy being transferred to her care, Nurse Warren performs an assessment of Jeremy — including the vascular status of Jeremy’s right leg.
· PCe 729
· PCe 825
Recognition of Right Leg Ischemia
304. At 0120 hrs, Nurse Warren notes that Jeremy’s right leg has no pedal pulses, and that his skin is cool and cyanotic.
· PCe 731
. . .
305. At 0138 hrs, Nurse Warren pages Dr. Valluri to notify her that Jeremy has no pedal pulse in his right leg.
· PCe 144
306. At 0142 hrs, Dr. Valluri is at Jeremy’s bedside.
· PCe 144
307. At 0152 hrs Dr. Cheryl Stephens is at Jeremy’s bedside.
· PCe 144
· PCe 49
· PCe 206
308. At 0150 hours, it has been almost six hours since Jeremy was found (at 2000 hrs) with sudden pain in his right leg.
309. In September 2019, Dr. Cheryl Stephens is in her second year as a Family Medicine resident.
· Cheryl Stephens, MD, LinkedIn page
· Piedmont Columbus Resident Biographies: https://www.piedmont.org/locations/piedmont-columbus/residency/resident-profiles
310. On the morning of September 9, Dr. Stephens is supervised by Joshua Koerner, DO.
· PCe 49
311. In September 2019, Dr. Koerner is a Family Medicine physician less than 1-1/2 years into his career as a licensed physician.
· Georgia Composite Medical Board licensee information
· US News biography page for Dr. Koerner (accessed 7/1/2021): https://health.usnews.com/doctors/joshua-koerner-1157346
Diagnostic CTA
312. At approximately 0152 hrs, a plan is made to order a CT angiogram of Jeremy’s right leg.
· PCe 144
313. Dr. Stephens speaks to neurologist Dr. Valadi and interventional radiologist Dr. Osei-Bonsu.
· PCe 49
314. Dr. Valadi advises “CT angiography, notification of Dr.Osui-Bensu, and consideration for vascular surgery consultation.”
· PCe 61
315. Dr. Valadi then calls Dr. Koerner and makes the same recommendations.
· PCe 61
316. At 0220 hrs, Dr. Stephens enters an order for a CT angiogram — ordering it stat, and adding comments, “Post op day 1, thrombectomy, right groin insertion surgical site, absent RLE DP pulse.”
· PCe 206
317. At 0233 hrs, Nurse Warren calls neurologist Dr. Valadi. She writes that Dr. Valadi agrees with the plan for an angiogram.
· PCe 144
318. At 0243 hrs, Nurse Warren calls Jeremy’s wife, Beth, to gain consent for a diagnostic CT angiogram.
· PCe 144
319. At 0311 hrs, the diagnostic CT angiogram of Jeremy’s right leg is performed.
· PCe 277
320. At 0425 hrs Eastern (0325 hrs Central), radiologist Dr. Erik Richter calls Nurse Warren to report his interpretation of the CTA — an “extensive nearly completely occlusive thrombus throughout the right leg arterial vasculature.”
· PCe 277
· PCe 278
321. Dr. Richter finds, “Right common femoral, femoral, popliteal artery as well as runoff vessels are essentially nearly completely occluded with trace peripheral flow. The profunda branch of the femoral artery is patent.”
· PCe 278
322. The common femoral artery runs through the upper leg, from the groin to the knee.
323. The popliteal artery runs behind the knee.
324. The downstream arteries include the anterior and posterior tibial arteries.
325. At 0425 hrs, Nurse Warren writes a note to record her conversation with Dr. Richter.
· PCe 144
326. At 0428 hrs, Nurse Warren calls Dr. Stephens to convey what Dr. Richter reported.
· PCe 144
327. By 0428 hrs, it has been almost 8-1/2 hours since Jeremy was found with sudden pain in his right leg (at 2000 hrs), and over three hours since Jeremy was found (at 0120 hrs) to have no pedal pulse in his right leg.
Thrombectomy Attempt
328. At 0428 hrs, Nurse Warren and Dr. Stephens discuss a plan for a therapeutic interventional radiology procedure.
· PCe 144
329. After learning of the CTA findings, Dr. Stephens calls neurologist Dr. Osei-Bonsu to reevaluate.
· PCe 49
330. At 0438 hrs, Nurse Warren calls Jeremy’s wife, Beth, to obtain consent for an interventional radiology procedure. Beth consents.
· PCe 144
331. At 0455 hrs, interventional radiologist Dr. Samuel Osei-Bonsu is at Jeremy’s bedside.
· PCe 144
332. At 0500 hrs, Nurse Warren calls Beth to notify her of the planned procedure.
· PCe 145
333. At 0512 hrs, Nurse Warren takes Jeremy to the interventional radiology suite.
· PCe 145
334. Dr. Osei-Bonsu writes that “Written and oral informed consent [for an IR angiogram of Jeremy’s leg] was obtained after discussing the risks, benefits, and alternatives.”
· PCe 278
335. At 0530 hrs, Dr. Osei-Bonsu begins an IR angiogram of Jeremy’s right leg.
· IR angiogram Exam Protocol summary (from DICOM image files)
336. Dr. Osei-Bonsu finds intimal injury of the right common femoral artery with thrombosis of the superficial femoral artery. The intima is the innermost part of the artery.
· PCe 278
337. Dr. Osei-Bonsu performs a partial thrombectomy using an AngioJet device.
· PCe 278
338. An AngioJet is a catheter-based device to break up a blood clot using high pressure liquid and pulsing action to break apart and remove the clot.
339. In the upper part of the femoral artery, Dr. Osei-Bonsu performs an angioplasty — using a catheter and balloon to widen the area of the artery in which blood can flow.
· PCe 278
340. Dr. Osei-Bonsu places a 38-centimeter (15 inch) long stent in the upper part of the femoral artery.
· PCe 278
341. These procedures improve blood flow in the upper femoral artery, where the stent was placed.
· PCe 278
342. Despite the procedure, the clot remains in the lower femoral artery and popliteal artery.
· PCe 278
343. Despite multiple attempts to remove the clot in the lower femoral artery and popliteal artery, the clot remains.
· PCe 278
344. Dr. Osei-Bonsu finally aborts the thrombectomy and consults a vascular surgeon.
· PCe 278
345. At the end of the procedure, Jeremy has no discernible blood flow below his right knee.
· PCe 278
346. The IR angiogram procedure lasts through 0816 hrs. The procedure takes approximately 2 hours and 45 minutes (having begun at 0530 hrs).
· Exam Protocol summary (from DICOM file)
· Radiology image metadata (from DICOM file)
347. Around 0816 hrs, Dr. Osei-Bonsu seeks a vascular surgery consultation from Dr. Bruce Brennaman — more than 12 hours after Jeremy’s sudden pain in his right leg (at 2000 hrs), and approximately seven hours after Jeremy was found with no pedal pulse in his right foot (at 0120 hours).
· PCe 278
. . .
· PCe 26
348. At some point after the IR procedure, Jeremy is taken to the operating room.
· PCe 278-79
Vascular Surgery Consult & Amputation
349. After the IR procedure, vascular surgeon Bruce H. Brennaman, MD comes to examine Jeremy.
· PCe 26
350. Dr. Brennaman concludes that Jeremy’s leg symptoms began between 2030 hrs and 2230 hrs — between approximately 10 and 12 hours before Dr. Brennaman was consulted.
· PCe 26
351. When Dr. Brennaman examines him, Jeremy’s foot is cold and pulseless, and Jeremy’s symptoms are worsening.
· PCe 26
· PCe 28
352. On Dr. Brennaman’s examination, Jeremy has no movement or sensation in his right foot.
· PCe 26
353. Earlier, neurologist Dr. Valadi’s examination showed Jeremy had 4/5 motor strength in his right foot.
· PCe 26
· PCe 23
354. On examining Jeremy, Dr. Brennaman concludes that Jeremy’s lower right leg is probably not viable.
· PCe 26
· PCe 29
355. Dr. Brennaman proceeds to the operating room for an emergency exploratory surgery with the hope of saving Jeremy’s leg, but anticipating that amputation is likely necessary.
· PCe 29
356. At 0916 hrs, Jeremy is taken to a holding room from interventional radiology.
· PCe 144
357. In preparation for the surgery, hospital staff places a Foley catheter in Jeremy’s bladder. Dr. Brennaman notes that Jeremy’s urine had a dark color similar to Coca-Cola. The color indicates myoglobinuria (an excess amount of myoglobin in the urine, mostly caused by muscle breakdown).
· PCe 36
358. At 0953 hrs, the anesthesia pre-procedure is complete.
· PCe 149
359. During the exploratory surgery, Dr. Brennaman finds that the right lower leg has no viable muscle. “The entire 4 compartments of the right lower extremity showed no viable muscle whatsoever. There was no movement to electric current. The muscle was dark red and all 4 compartments were tightly encumbered resulting in a dead leg.”
· PCe 35
. . .
360. During the surgery, Dr. Brennaman finds the muscle very dark, cold, and unresponsive to stimulation.
· PCe 36
361. Dr. Brennaman then amputates Jeremy’s right leg above the knee.
· PCe 36
Causes of Action
Count 1 – Ordinary Negligence (The Medical Center, Inc. Piedmont Healthcare, Inc., Radiology Partners, Inc., and Columbus Diagnostic Center, Inc.)[4]
362. Plaintiff incorporates by reference, as if fully set forth herein, all preceding paragraphs of this Complaint.
363. The Medical Center, Inc. and Piedmont Healthcare, Inc. each participate in managing Piedmont Columbus Regional Hospital, in Columbus, Georgia.
364. The leadership, management, and administrative roles for the hospital do not require professional licensure by the State of Georgia.
365. Multiple members of the Board of Directors of MCI have no professional license.
366. Multiple members of the Board of Directors of PHI have no professional license.
367. Multiple members of the senior management/administration of MCI have no professional license.
368. Multiple members of the senior management/administration of PHI have no professional license.
369. The Medical Center, Inc. Piedmont Healthcare, Inc., Radiology Partners, Inc., and Columbus Diagnostic Center, Inc. (collectively, the “Corporate Defendants”) each owed the patients of the Hospital an ordinary duty to manage the healthcare services at the Hospital in a manner designed to safeguard patients against medical error.
370. Each of the Corporate Defendants, through its respective leaders, managers, and administrators, breached that duty, by failing to implement policies, procedures, and practices sufficient to safeguard patients against medical error.
371. The repeated confounding failures by the individual Defendants reveal and exemplify those systemic failures.
372. The systemic breaches by the Corporate Defendants were thus causes of Jeremy Jones’ injuries and Beth Jones’ loss of consortium.
373. The systemic breaches by the Corporate Defendants include but are not limited to the following:
i. Task: Institute supervision and support for residents
Requirement
374. Hospital management and attending physicians are responsible for ensuring that residents are properly supervised and supported. Failure to do so endangers patients.
375. The overall responsibility lies with hospital management, who need not be licensed physicians or nurses. The managers must recruit the efforts of the hospital’s medical and nursing staff.
Violation
376. The clinical failings in this Complaint indicate that the hospital management and supervising physicians likely failed to act reasonably to ensure proper supervision and support for the resident physicians involved in the treatment of Jeremy Jones.
Causation & Damages
377. This violation caused harm to Jeremy, by contributing to the delay in treating Jeremy’s leg ischemia.
378. This violation contributed to Jeremy’s suffering an unnecessary leg above-the-knee amputation.
ii. Task: Institute patient safety systems
Requirement
379. Hospital management, working through clinical staff, is responsible for developing and implementing patient safety systems. This includes, among other things, leading efforts to create protocols to avoid or mitigate known risks, efforts to promulgate and train staff concerning such protocols, efforts to monitor compliance, and efforts to remediate deficiencies.
Violation
380. The clinical failings discussed below indicate that the hospital management likely failed to act reasonably to develop and implement patient safety systems pertaining to risks of acute limb ischemia in patients who have recently undergone endovascular procedures.
Causation & Damages
381. This violation caused harm to Jeremy, by contributing to the delay in treating Jeremy’s leg ischemia.
382. This violation contributed to Jeremy’s suffering an unnecessary leg above-the-knee amputation.
Count 2 – Professional Negligence (all Defendants)
383. Plaintiffs incorporate by reference, as if fully set forth herein, all preceding paragraphs of this Complaint.
384. The Defendants and their agents violated their standards of care and caused harm in at least the following respects:
iii. Task: Sept 8, approx. 1400 hrs — Provide for peripheral vascular monitoring for patients who have recently undergone an endovascular procedure (such as a stroke thrombectomy).
Requirement
385. Provision must be made for frequent (e.g., hourly) monitoring of the peripheral vascular status of patients in the 12-24 hours after undergoing an endovascular procedure such as a thrombectomy for stroke.
386. This responsibility ultimately lies with hospital management. Additionally, the interventionalist bears responsibility for ensuring adequate post-procedure assessment. Depending on the structure of responsibility at the hospital, responsibility may also lie with the ICU or other unit management, with the ICU physicians responsible for the patient, and with the nursing management.
Violation
387. No orders were entered for routine peripheral vascular checks. And as shown by the pattern of infrequent checks, the hospital and ICU effectively had no policies or protocols requiring frequent peripheral vascular checks.
388. In this respect, MCI, PHI, and the interventionalist who performed the thrombectomy (Dr. Samuel Osei-Bonsu) violated their standards of care. Depending on the division of responsibility at the hospital, the ICU management, the responsible ICU physicians, and/or the nursing leadership may have violated their standards of care.
Causation & Damages
389. This violation caused harm to Jeremy, by contributing to the delay in treating Jeremy’s leg ischemia. The thrombosis ultimately identified in Jeremy’s right leg was the cause of Jeremy’s leg pain identified — despite sensory deficits in that leg — at 2000 hrs on Sept 8. If MCI, PHI, or Dr. Osei-Bonsu had performed their duties in this respect, the thrombus likely would have been identified and treated before the thrombus caused any long-term harm to Jeremy.
390. This violation contributed to Jeremy’s suffering an unnecessary above-the-knee amputation.
iv. Task: Sept 8, 1552 hrs — Order and provide ICU care for a post-stroke-thrombectomy patient.
Requirement
391. A physician admitting a patient to an ICU after thrombectomy for a stroke should admit the patient for 24 hours, unless exigent circumstances require a shorter time. Twenty-four hour observation is routinely ordered for post-stroke thrombectomy patients, and 24-hour observation facilitates close monitoring and prompt response to complications.
392. A physician and nurse providing ICU care pursuant to an order to discharge the patient after remaining stable for 4-5 more hours must keep the patient in the ICU until a physician’s examination finds the patient stable.
Violation
393. Dr. Nicolais violated the standard of care by ordering that Jeremy be discharged from the ICU without an adequate period for monitoring.
394. Dr. Valluri, Dr. Stephens, and Nurse Tabitha Miller violated the standard of care by discharging Jeremy from the ICU at around 2250 hrs on September 8. Jeremy was not stable, and no physician examined Jeremy at that time to determine whether he was stable.
Causation & Damages
395. These violations caused harm to Jeremy, by contributing to the delay in treating Jeremy’s leg ischemia. The premature transfer of Jeremy from one nurse (Tabitha Miller) to another (Christina Orr) likely contributed to the failure of hourly monitoring of Jeremy’s vascular status — and thus in turn to the delayed diagnosis and treatment of Jeremy’s right leg acute ischemia.
396. These violations contributed to Jeremy’s suffering an unnecessary leg above-the-knee amputation.
v. Task: Sept 8, 2000 hrs — Manage a post-thrombectomy patient with sudden, serious pain in the leg used for the puncture/access site for the thrombectomy.
Requirement
397. On being informed of this situation, the responsible physician must perform a physical examination of the leg and, unless vascular injury can be ruled out, order stat diagnostic imaging and/or consult vascular surgery.
Violation
398. Dr. Valluri did not document and did not perform any bedside physical examination of Jeremy’s leg. Nor did Dr. Valluri consult vascular surgery. Dr. Valluri violated the standard of care in this respect.
Causation & Damages
399. This violation caused harm to Jeremy, by contributing to the delay in treating Jeremy’s leg ischemia and contributed to Jeremy’s suffering an unnecessary leg above-the-knee amputation.
vi. Task: Sept 8, 2300 hrs — Again, manage a post-thrombectomy patient with sudden, serious pain in the leg used for the puncture/access site for the thrombectomy.
Requirement
400. A nurse identifying the patient in this situation must perform and document a physical assessment of the leg and request the responsible physician to examine the leg.
401. On being informed of this situation, the responsible physician must perform a physical examination of the leg and, unless vascular injury can be ruled out, order stat diagnostic imaging and/or consult vascular surgery.
Violation
402. Nurse Christina Orr failed to perform and document an assessment of Jeremy’s leg. And again Dr. Valluri failed to examine Jeremy’s leg and order proper followup. Dr. Valluri and Nurse Orr violated the standard of care in this respect.
Causation & Damages
403. These violations caused harm to Jeremy, by contributing to the delay in treating Jeremy’s leg ischemia and contributing to Jeremy’s suffering an unnecessary leg above-the-knee amputation.
vii. Task: After Sept 8, 2000 hrs until Sept 9, 0120 hrs — Ongoing monitoring to assess the leg of a post-thrombectomy patient with sudden, serious pain in the leg used for the puncture/access site for the thrombectomy.
Requirement
404. In addition to notifying the responsible physician(s), a nurse responsible for a patient in this circumstance must perform frequent (at least hourly) assessments of the vascular status of the patient’s leg.
Violation
405. Despite Jeremy’s post-thrombectomy risk for leg ischemia, despite significant pain being noted both at 2000 hrs and 2304 hrs, and despite recognizing that they must “closely monitor” Jeremy’s leg, the nursing staff failed to perform even hourly assessments of Jeremy’s leg. In this respect, the nursing staff (Nurse Miller and Nurse Orr) violated the standard of care.
Causation & Damages
406. These violations caused harm to Jeremy, by contributing to the delay in treating Jeremy’s leg ischemia and contributing to an unnecessary above-the-knee amputation.
viii. Task: Sept 9, 0130 hrs — Manage (or supervise residents managing) the leg of the same patient hours later, when the leg is found without pedal pulses, and where evaluation of sensory and motor function is limited by deficits from a stroke.
Requirement
407. Physicians assessing a patient in these circumstances must inform themselves of the relevant medical history — including the leg pain beginning hours earlier. The physicians must act on the possibility that acute limb ischemia had begun 5-1/2 hours earlier, meaning that the time window for saving the leg might be quickly closing.
408. Accordingly, the physicians must treat the case as a limb-threatening emergency, requiring emergent diagnosis and treatment by a vascular surgeon.
Violation
409. The residents did not treat Jeremy’s pulseless leg as an emergency. They did not document (and likely did not perform) a bedside diagnostic examination by Doppler device, to assess the degree of weakness of arterial and venous flow in the leg — which was important to understand the severity of ischemia. Nor did the residents consult vascular surgery (the most important action) despite being advised to do so by Dr. Valadi. The residents did order stat diagnostic imaging (though it was not performed quickly). The residents did not, however, order any treatment for Jeremy’s ischemic leg. In these respects, the residents — Dr. Valluri and Dr. Cheryl Stephens — violated the standard of care.
410. Additionally, the supervising physician, Dr. Koerner, failed to provide the residents any supervision or support as they dealt with a surgical emergency — despite being alerted and advised by Dr. Valadi. In this respect Dr. Koerner violated the standard of care.
Causation & Damages
411. These violations caused harm to Jeremy. They further delayed the treatment of Jeremy’s ischemic leg and contributed to the painful death of Jeremy’s lower right leg.
412. These violations caused Jeremy to undergo an otherwise unnecessary above-the-knee leg amputation.
ix. Task: Sept 9, 0200 hrs — Consult on the same patient shortly after the leg was found to be pulseless.
Requirement
413. Any physician consulting on a patient in Jeremy’s condition as of 0130 hours on Sept 9 was required to ask about the history of the patient’s leg issues — which in this case went back to the sudden pain noted at 2000 hrs the night before. Accordingly, the consulting physician must advise or provide emergent diagnosis and treatment — preferably by a vascular surgeon (if available) but at least by an interventional radiologist with a vascular surgeon standing by.
414. The requirement to act to ensure emergent treatment applies to any physician involved, regardless of specialty. While the physician’s particular practice area dictate the specific assistance the physician can offer (e.g., recommendations vs. hands-on treatment), the general duty to ensure emergent treatment applies across specialties.
Violation
415. The interventional radiologist, Dr. Samuel Osei-Bonsu, did not recommend an immediate vascular surgery consult when first notified of Jeremy’s pulseless leg. Nor did Dr. Osei-Bonsu immediately come in to treat Jeremy. Instead, Dr. Osei-Bonsu advised purely diagnostic imaging that caused a delay of approximately three hours (from approximately 0200 hrs when Dr. Osei-Bonsu was consulted until approximately 0500 hrs when Dr. Osei-Bonsu was bedside.) In failing to act to ensure emergent treatment, Dr. Osei-Bonsu violated the standard of care.
Causation & Damages
416. This violation further delayed treatment of Jeremy’s ischemic leg and contributed to the death of Jeremy’s lower right leg.
417. This violation caused Jeremy to undergo an otherwise unnecessary above-the-knee leg amputation.
418. This list of negligent acts is not exhaustive.
419. The corporate Defendants are vicariously liable for the negligence of their employees or other agents, because the agents acted within the scope of their agency for the corporate Defendants.
420. Pursuant to OCGA Title 51, Chapter 4, Jeremy Jones is entitled to recover from all Defendants for all damages caused by the Defendants’ professional negligence.
Count 3 – Loss of Consortium (all Defendants)
421. Plaintiffs incorporate by reference, as if fully set forth herein, all preceding paragraphs of this Complaint.
422. As a result of the standard-of-care violations discussed above, Beth Jones has suffered a loss of consortium.
423. Mrs. Jones is entitled to recover from all Defendants for the loss of consortium she has suffered.
Damages & Jury Demand
424. Plaintiffs incorporate by reference, as if fully set forth herein, all preceding paragraphs of this Complaint.
425. As a direct and proximate result of the Defendants’ conduct, Plaintiffs are entitled to recover from Defendants reasonable compensatory damages in an amount exceeding $10,000.00 to be determined by a fair and impartial jury for all damages Plaintiff suffered, including physical, emotional, and economic injuries.
426. WHEREFORE, Plaintiffs demand a trial by jury and judgment against the Defendants as follows:
a. Compensatory damages in an amount exceeding $10,000.00 to be determined by a fair and impartial jury;
b. All costs of this action;
c. Expenses of litigation pursuant to OCGA 13-6-11;
d. Punitive damages; and
e. Such other and further relief as the Court deems just and proper.
August 30, 2020
Respectfully submitted,
/s/ Lloyd N. Bell
Georgia Bar No. 048800
Daniel E. Holloway
Georgia Bar No. 658026
BELL LAW FIRM
1201 Peachtree St. N.E., Suite 2000
Atlanta, GA 30361
(404) 249-6767 (tel)
bell@BellLawFirm.com
dan@BellLawFirm.com
Attorneys for Plaintiff
[1] 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.
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.”
[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. If venue is based solely on this paragraph, the defendant shall have the right to remove the action to the county in Georgia where the defendant maintains its principal place of business.”
Note: 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.
[3] OCGA § 9-10-31: Subject to the provisions of Code Section 9-10-31.1 [regarding forum non conveniens], joint tort-feasors … 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.
[4] A claim of negligence against hospital managers is not a claim of professional negligence against a licensed professional (or based on negligence by a licensed professional). Therefore such a claim is not subject to OCGA 9-11-9.1 or 24-7-702(c). Rather, such a claim is for ordinary negligence subject to ordinary notice pleading.
OCGA 9-11-9.1 governs claims for professional negligence:
(i) against “A professional licensed by the State of Georgia and listed in subsection (g) of this Code section,”
(ii) against a business entity “based upon the action or inaction of a professional licensed by the State of Georgia and listed in subsection (g) of this Code section,” and
(iii) against a health care facility “based upon the action or inaction of a health care professional licensed by the State of Georgia and listed in subsection (g) of this Code section.”
Hospital management and administrative staff are not required to be licensed and are not listed in OCGA 9-11-9.1(g).