IN THE SUPERIOR COURT OF WHITFIELD COUNTY

STATE OF GEORGIA

ANNETTE SMITH and MICHAEL SMITH, individually and as representatives of the estate of MICHAELA E. SMITH, deceased

Plaintiffs

— versus —

MICHAEL J. COONEY, MD,

VIRTUAL RADIOLOGIC CORPORATION,

KEVIN F. JOHNSON, MD,

NORTH GEORGIA RADIOLOGY, PA,

DAVID F. HAWKINS, MD,

EMERGENCY COVERAGE CORPORATION,

JEFFREY T. GLASS, MD,

HAMILTON MEDICAL CENTER, INC.,

HAMILTON HEALTH CARE SYSTEM, INC., and

JOHN/JANE DOES 1-10,

Defendants

CIVIL ACTION

FILE NO. 

PLAINTIFFS’ COMPLAINT FOR DAMAGES

Nature of This Action

1.             This medical-malpractice action arises out of medical services negligently provided to 26-year-old Michaela Elizabeth Smith at Hamilton Medical Center (“Hamilton”), on June 28 and 29, 2019, leading to her wrongful death.

2.             This action is brought by Michaela’s parents, Annette and Michael Smith, individually and on behalf of Michaela’s estate.

3.             Plaintiffs assert a wrongful-death claim pursuant to OCGA Title 51, Chapter 4, on behalf of all wrongful-death beneficiaries.

4.             As representatives of Michaela’s estate, Plaintiffs assert a claim for harm Michaela suffered as a result of the alleged negligence. 

5.             Pursuant to OCGA § 9-11-9.1, the affidavits of Radiologist Anthony Mancuso, ER Doctor Brian Stettler, Neurologist Alexander Merkler, Neurosurgeon Elad Levy, and Nurse Lynne Cesarini are attached as Exhibits 1-5, respectively. This Complaint incorporates the opinions and allegations those affidavits contain.

6.             As used here, the phrase “standard of care” means the degree of care and skill ordinarily employed by the medical profession generally under similar conditions and like circumstances as pertained to Defendants’ actions here.

7.             This Complaint relies largely on uncontroversial medical principles and facts. 

8.             This is a straightforward case: Although two radiology studies and her clinical presentation indicated that Michaela was having a catastrophic stroke, Defendants repeatedly misread the studies as normal, failed to diagnose the stroke, failed to treat her deficits as a neurological emergency, and failed to treat the stroke with a thrombectomy or otherwise, causing her death at 26.  

Parties, Jurisdiction, and Venue[1]

9.             Plaintiffs Annette Smith and Michael Smith are both citizens of Georgia.

10.          Defendant Michael Joseph Cooney, MD, is a citizen of California. He may be served with process at his residence, 116 N. Dianthus Street, Manhattan Beach, CA 90266. Dr. Cooney has been properly served with this Complaint.

11.          Dr. Cooney is subject to the personal jurisdiction of this Court.

12.          Pursuant to OCGA § 9-10-93, Dr. Cooney is subject to venue in this Court because the cause of action originated in Whitfield County and because one of his co-defendants is a Georgia resident subject to venue here.

13.          At all times relevant to this Complaint, Dr. Cooney acted as an employee or other agent of Defendant Virtual Radiologic Corporation.

14.          Defendant Virtual Radiologic Corporation (“vRAD”) is a Delaware Corporation. Registered Agent: Cogency Global Inc. Physical Address: 900 Old Roswell Lakes Parkway, Suite 310, Roswell, GA, 30076 (Fulton County). vRAD has been properly served with this Complaint.

15.          vRAD is subject to the personal jurisdiction of this Court.

16.          vRAD is subject to venue in this Court because the cause of action originated in Whitfield County, and because one of vRad’s co-defendants is subject to venue here.  

17.          At all relevant times, vRAD was the employer or other principal of Dr. Cooney’s.

18.          If another entity was Dr. Cooney’s employer or principal during those times, that entity is hereby on notice that, but for a mistake concerning the identity of the proper party, this action would have been brought against that entity.

19.          Defendant Kevin Fountain Johnson, MD, is a citizen of Georgia. He may be served with process at his residence, 1075 Buckingham Way, Rocky Face, GA 30740-9101 (Whitfield County). Dr. Johnson has been properly served with this Complaint.

20.          Dr. Johnson is subject to the personal jurisdiction of this Court.

21.          Dr. Johnson is subject to venue in this Court because he is a resident of Whitfield County, and because one of his co-defendant is subject to venue here.

22.          At all times relevant to this Complaint, Dr. Johnson acted as an employee or other agent of Defendant North Georgia Radiology, P.A.

23.          Defendant North Georgia Radiology, P.A., (“NGR”) is a Georgia Professional Corporation. Registered Agent: Brian Cate. Physical Address: 1407 North Thornton Avenue, Dalton, GA, 30720 (Whitfield County). NGR has been properly served with this Complaint.

24.          NGR is subject to the personal jurisdiction of this Court.

25.          NGR is subject to venue in this Court because NGR maintains its registered office in Whitfield County; because the cause of action originated in, and NGR has an office and transacts business in, Whitfield County; and because one of NGR’s co-defendants is subject to venue here.

26.          At all relevant times, NGR was the employer or other principal of Dr. Johnson’s.

27.          If another entity was Dr. Johnson’s employer or principal during those times, that entity is hereby on notice that, but for a mistake concerning the identity of the proper party, this action would have been brought against that entity.

28.          Defendant David Franklin Hawkins, MD, is a citizen of Georgia. He may be served with process at his residence, 421 Blue Jay Pkwy, Ringgold, GA 30736-4918 (Catoosa County). Dr. Hawkins has been properly served with this Complaint.

29.          Dr. Hawkins is subject to the personal jurisdiction of this Court.

30.          Dr. Hawkins is subject to venue in this Court because one of his co-defendants is subject to venue here.

31.          At all times relevant to this Complaint, Dr. Hawkins acted as an employee or other agent of Defendant Emergency Coverage Corporation.

32.          Defendant Emergency Coverage Corporation (“ECC”) is a Tennessee corporation with a principal place of business in Tennessee. ECC is registered in Georgia. Registered Agent: The Prentice-Hall Corporation System. Physical Address: 40 Technology Parkway South, #300, Norcross, GA 30092. ECC has been properly served with this Complaint.

33.          ECC is subject to the personal jurisdiction of this Court.

34.          ECC is subject to venue in this Court because the cause of action originated in Whitfield County and because one of ECC’s co-defendants is subject to venue here.   

35.          At all relevant times, ECC was the employer or other principal of Dr. Hawkins’s.

36.          If another entity was Dr. Hawkins’s employer or principal during those times, that entity is hereby on notice that, but for a mistake concerning the identity of the proper party, this action would have been brought against that entity.

37.          On or about December 14, 2020, in response to a letter from Plaintiffs’ counsel, counsel for Dr. Hawkins and ECC represented to Plaintiffs’ counsel that ECC was Dr. Hawkins’s employer at all times relevant to this action.

38.          If another entity was Dr. Hawkins’s employer or principal during those times, that entity is hereby on notice that, but for a mistake concerning the identity of the proper party, this action would have been brought against that entity.

39.          Defendant Jeffrey Thurman Glass, MD, is a citizen of Tennessee. He may be served with process at his residence, 200 Manufacturers Road, Apt. 308, Chattanooga, TN 37405-5001. Dr. Glass has been properly served with this Complaint.

40.          Dr. Glass is subject to the personal jurisdiction of this Court.

41.          Pursuant to OCGA § 9-10-93, Dr. Glass is subject to venue in this Court because the cause of action arose in Whitfield County and because of one his co-defendants is a Georgia resident subject to venue here.

42.          At all times relevant to this Complaint, Dr. Glass acted as an employee or other agent of Defendant Hamilton Medical Center, Inc., and/or Defendant Hamilton Health Care System, Inc. (both, “the Hamilton Defendants”).

43.          Defendant Hamilton Medical Center, Inc. (“Hamilton”) is a Georgia nonprofit Corporation. Registered Agent: Savannah B. Moore. Physical Address: 1200 Memorial Drive, Dalton, GA 30720 (Whitfield County). Hamilton has been properly served with this Complaint.

44.          Hamilton is subject to the personal jurisdiction of this Court.

45.          Hamilton is subject to venue in this Court because Hamilton maintains its registered office in Whitfield County; because the cause of action originated in, and Hamilton has an office and transacts business in, Whitfield County; and because one of Hamilton’s co-defendants is subject to venue here.

46.          At all relevant times, Hamilton was the employer or other principal of Dr. Glass, as well as Nurses Megan Martin, Victoria Brock, and Gabe Herman. 

47.          If another entity was the employer or principal of Jeffrey T. Glass, Meagan Martin, Victoria Brock, or Gabe Herman during those times, that entity is hereby on notice that, but for a mistake concerning the identity of the proper party, this action would have been brought against that entity.

48.          Defendant Hamilton Health Care System, Inc. (“Hamilton Health”) is a Georgia nonprofit Corporation. Registered Agent: Savannah B. Moore. Physical Address: P.O. Box 1900, 1200 Memorial Drive, Dalton, GA 30720 (Whitfield County). Hamilton Health has been properly served with this Complaint.

49.          Hamilton Health is subject to the personal jurisdiction of this Court.

50.          Hamilton Health is subject to venue in this Court because it maintains its registered office in Whitfield County; because the cause of action originated in, and Hamilton Health has an office and transacts business in, Whitfield County; and because one of Hamilton Health’s co-defendants is subject to venue here.

51.          At all relevant times, Hamilton Health was the employer or other principal of Dr. Glass, as well as Nurses Megan Martin, Victoria Brock, and Gabe Herman. 

52.          If another entity was the employer or principal of Dr. Glass, Nurse Martin, Nurse Brock, or Nurse Herman during those times, that entity is hereby on notice that, but for a mistake concerning the identity of the proper party, this action would have been brought against that entity.

53.          Herein, “Hamilton Defendants” refers to both Hamilton and Hamilton Health. 

54.          Defendants John/Jane Does 1-10 are those yet-unidentified natural persons and/or entities who may be liable, in whole or in part, for the damages alleged herein. Once served with process, John/Jane Does 1-10 are subject to the jurisdiction and venue of this Court.

55.          No Defendant has a defense to this action based on undue delay, whether based on the statute of limitations, the statute of repose, laches, or any similar theory.

56.          This Court has subject-matter jurisdiction over this case.

General Medical Principles

Acute Ischemic Stroke

57.          Stroke is the sudden death of brain cells due to a lack of oxygen.

58.          A stroke may result in brain-damage, long-term disability, and death.

59.          When a stroke is caused by the rupture of an artery, it is called a hemorrhagic (bleeding) stroke.

60.          When a stroke is caused by blocked blood-flow, it is called an ischemic stroke.

61.          Ischemia is a condition in which a person does not get enough oxygen to an organ or tissue to maintain its health.

62.          If something blocks blood-flow to the brain, brain cells start to die because they cannot get oxygen. That is an acute ischemic stroke.

63.          A thrombus is a blood clot that forms within a blood vessel, reducing blood-flow.

64.          An embolus is a blood clot that breaks off and travels through the bloodstream until it lodges into a blood vessel that is too small for the clot to pass through.

Basilar Artery Occlusion - BAO

65.          The basilar artery lies at the front of the brainstem in the midline.

66.          The basilar artery is formed by the union of the two vertebral arteries.

67.          Basilar Artery Occlusion (“BAO”) is the name for an acute ischemic stroke originating in the basilar artery. 

68.          A BAO is a type of posterior-circulation stroke.

69.          A BAO occurs when a blood clot in the basilar artery impedes blood-flow, resulting in ischemia in the posterior part of the brain.   

70.          If not treated quickly, a BAO can lead to brain damage, organ malfunction, catastrophic disability, and death.

71.          A BAO occurring at the uppermost part of the basilar artery is known by two names: top-of-the-basilar syndrome and rostral brainstem infarction.

BAO Signs and Symptoms

72.          Because the cerebral vessels tend to irrigate specific territories in the brain, their occlusion results in highly stereotyped syndromes that, even prior to imaging studies, can suggest the site of the vascular lesion (occlusion).

73.          Likewise, the signs and symptoms of a BAO may vary depending on where the occlusion is located along the basilar artery.

74.          The hallmarks of a BAO include:

·      decreased or altered consciousness

·      quadriparesis (loss of voluntary movement in all four limbs)

·      various combinations of limb ataxia (impaired balance or coordination)

·      oculomotor (eye-movement) abnormalities

·      pupillary abnormalities (pupils react abnormally to light)

·      dysarthria (inability to articulate speech)

75.          Other signs and symptoms of BAO include:

·      Hyperreflexia (overactive or overresponsive reflexes)

·      Abnormal spontaneous movements such as shivering, twitching shuddering, jerking, or tremulous shaking

·      Dysphonia (loss of the ability to speak)

·      Abnormalities of alertness and behavior, including hallucinations.

·      Dizziness, vomiting.

76.          The signs and symptoms of BAO can present in various combinations.

77.          Decerebrate posturing is a sign of BAO. Also known as “extensor posturing,” decerebrate posturing involves the arms and legs being held straight out, the toes being pointed downward, and the head and neck being arched backward.

78.          In rare BAO cases, patients suffer locked-in syndrome. Patients with this syndrome are alert and conscious but lose all voluntary movement except vertical eye movement. They are aware of their “locked-in” condition.

Stroke triage

79.          When a patient arrives at a hospital’s emergency department (“ED” or “ER”) with serious neurological deficits concerning for stroke, the triage nurse must: (a) notify the attending physician immediately; (b) provide emergent care to the patient; and (c) call a code stroke or initiate a stroke protocol insofar as the nurse has the authority to do so under the hospital’s policies.

80.          Triage refers to the process of sorting and prioritizing patients for care.

81.          The triage nurse performs a brief, focused assessment and assigns the patient a triage acuity level, which is a proxy measure of how long an individual patient can safely wait for a medical-screening examination and treatment.

82.          An ER nurse must assign, document, and report an accurate acuity level (also known as “triage score”) for a patient.

83.          The Emergency Severity Index (ESI) stratifies patients into five acuity groups, from level 1 (most urgent) to level 5 (least urgent). 

84.          Level 1 (resuscitation) requires immediate, life-saving intervention. Level 1 includes patients with cardiopulmonary arrest, major trauma, severe respiratory distress, and seizures.

85.          Level 2 (emergent) requires an immediate nursing assessment and rapid treatment. Level 2 includes patients who are in a high-risk situation, are confused, lethargic, or disoriented, or have severe pain or distress, including patients with stroke, head injuries, asthma, and sexual-assault injuries.

86.          Level 3 (urgent) includes patients who need quick attention but can wait as long as 30 minutes for assessment and treatment. Level 3 includes patients with signs of infection, mild respiratory distress, or moderate pain—conditions that are a far cry from stroke. 

87.          A patient who arrives at the ED with neurological deficits concerning for an acute stroke must generally be assigned an acuity level of 2.  

88.          The accuracy of the acuity level is critical because it determines the care the patient subsequently receives and the urgency with which it is provided. 

Neurological assessments

89.          When a patient presents to the ER with significant neurological deficits concerning for stroke, an ER nurse must promptly perform, document, and report a full neurological assessment of the patient. 

90.          A full neurological assessment is important because it determines the care the patient receives downstream and the urgency with which it is provided.

91.          A full neurological assessment covers, at minimum, the patient’s mental status, motor function, sensory function, and pupillary response.

92.          The obligation to perform a comprehensive neurological assessment applies with special force at a designated stroke center.

93.          When a patient manifests neurological deficits concerning for stroke, an ER nurse caring for the patient must perform, document, and report neurological assessments of the patient on an hourly basis, if not more frequently.

94.          These obligations apply with special force if the patient deteriorates. 

Stroke diagnosis: history and presentation

95.          The most characteristic historical aspect of stroke is its abrupt onset.

96.          After onset, symptoms most often stay the same or improve over the few hours that follow. Symptoms may also worsen in a smooth or stuttering course.

97.          Ischemic strokes may rapidly resolve, but even if they resolve completely, they may recur after minutes to hours.

98.          A second characteristic historical aspect of stroke is that symptoms usually fit the distribution of a single vascular territory: the middle, anterior, or posterior cerebral arteries; a penetrating artery; or the basilar or vertebral arteries.

99.          Symptoms thus provide an important clue as to the likely location of the stroke.

Stroke diagnosis: Glasgow Coma Scale

100.       A patient’s mental status includes the patient’s level of consciousness. 

101.       The Glasgow Coma Scale (GCS) is an objective and reliable way of recording and tracking a patient’s level of consciousness.

102.       The GCS tests three categories of function: eye-opening response, verbal response, and motor response. 

103.       A GCS score ranges from 3 (totally unresponsive) to 15 (normal). A score of 9-12 means that the patient has suffered moderate brain injury. A score of 3-8 means that the patient is comatose and has suffered severe brain injury.

104.       The GCS is not a substitute for a full neurological assessment.

105.       In the GCS, motor response (including any decerebrate posturing) is the most powerful predictor of the patient’s outcome.

Stroke diagnosis: MEND exam

106.       The Miami Emergency Neurologic Deficit (“MEND”) exam is an effective screening tool for detecting stroke.

107.       The MEND exam was developed to facilitate communication among healthcare providers throughout the continuum of care.

108.       The MEND exam consists of (a) the three elements of the Cincinnati Prehospital Stroke Scale (CPSS), plus (b) six elements from the National Institute of Health Stroke Scale that account for posterior-circulation strokes. 

109.       The MEND exam is an ideal screening tool in emergency situations because it can be performed in less than two minutes, without any instruments.

Stroke diagnosis: NIHSS score

110.       The National Institute of Health Stroke Scale (NIHSS) is a common diagnostic method for quickly assessing the severity of a stroke.

111.       The NIHSS is considered the only valid tool to assess stroke-deficit severity.

112.       The NIHSS is the gold standard in clinical trials and clinical practice in the U.S. 

113.       The NIHSS looks at 11 elements that evaluate specific abilities in the patient.

114.       A patient’s score on each element can range from 0 (normal) to 2, 3, or 4. The highest total score possible is 42.

115.       A total score of 1-4 indicates a minor stroke; 5-15, a moderate stroke; 16-20, a moderate-to-severe stroke; and 21-42, a severe stroke. 

116.       The NIHSS score is generally accurate, helps determine appropriate treatment, and tends to predict outcomes.

117.       In fact, the initial severity of a stroke according the NIHSS is the most important predictor of outcome.

Stroke diagnosis: CT scan and MRI

118.       A CT scan and an MRI are noninvasive diagnostic tests.

119.       They enable doctors to view a patient’s body in cross-sectional slices, as if the body were sliced layer-by-layer and an image were taken of each slice.

120.       A non-contrast head CT scan is the standard procedure for the initial evaluation of stroke.

121.       In the emergent initial evaluation of an acute-stroke patient in the ED, a non-contrast head CT scan is the imaging test used in most hospitals worldwide.

122.       A CT scan takes less than 1 minute to complete.

123.       A CT scan can quickly differentiate between an ischemic stroke and intracranial hemorrhaging and other mass lesions—information crucial to the subsequent therapeutic decisions that will be rapidly made.

124.       A brain MRI can provide substantial information on stroke localization, age, bleeding, and tissue status. Unlike a CT or CTA, an MRI requires the patient to hold still for several minutes

125.       A brain MRI can visualize ischemic infarcts earlier than a CT scan, and can identify acute posterior-circulation strokes more accurately than a CT scan.

126.       An MRI’s diffusion-weighted imaging (“DWI sequence”) can show any restricted diffusion consistent with infarct.

127.       By showing such restriction, a DWI sequence helps exclude conditions that mimic a stroke, such as peripheral vertigo and migraine with aura.

128.       An MRI’s DWI sequence and perfusion-weighted imaging (“PWI”) allow differentiation between reversible and irreversible neuronal injury

Stroke diagnosis: vascular imaging

129.       A CTA and an MRA are vascular-imaging tests.

130.       Vascular imaging specifically focuses on the blood vessels.

131.       Vascular imaging produces images of the blood vessels that are more detailed than the images of the surrounding organs and tissues.

132.       Vascular imaging thus enables doctors to look at blood vessels more thoroughly.

133.       Vascular imaging specifically helps doctors find blood clots.

134.       Vascular imaging helps doctors diagnose and treat ischemic strokes, including BAO. 

135.       A CTA is the test most commonly used to diagnose vascular problems, including blood clots.

136.       A CTA takes minutes to complete—a few minutes to inject a contrast dye and less than a minute to run the scan. 

137.       A CTA quickly provides a snapshot of the entire cerebral arterial anatomy, and can diagnose intracranial and extracranial stenosis, aneurysms, and dissections.

138.       A CTA is the most frequently used test for detecting whether a patient is eligible for a thrombectomy.

139.       An MRA provides the same information as a CTA. Unlike a CT or CTA, an MRA requires the patient to hold still for several minutes.

140.       A doctor must promptly order vascular imaging when there is reason to suspect an occlusion in a major artery supplying the brain, like the basilar artery.

141.       When there is reason to suspect a BAO, the most rapid and cost-effective approach is to evaluate the patient’s vessels outright with a CTA or MRA.

Radiology reports

142.       Radiologists interpret imaging studies (including a CT, CTA, MRI, MRA) and communicate findings and conclusions on written radiology reports.

143.       A radiologist must interpret imaging studies reasonably and accurately. A radiologist must also provide prompt and accurate radiology reports.

144.       Critical values are results that vary so much from normal that they suggest a condition that is life-threatening unless appropriate action is taken quickly.

145.       When an imaging study suggests that a patient is at risk of stroke, or may be having a stroke, a radiologist must call critical values—that is, immediately call the attending physician to inform him or her of the study’s findings. 

Stroke treatment: medical emergency

146.       During a stroke, every minute counts. Time lost is brain lost.

147.       Because effective treatments are available that must be started within minutes, most acute neurological presentations should be assumed to be a stroke until proven otherwise by history, exam, or radiographic testing.

148.       When a patient presents with significant neurological deficits concerning for stroke, a physician must act quickly to confirm or rule out stroke.    

149.       The National Institute of Neurological Disorders recommends time-frames for completing standard procedures for evaluating potential ischemic-stroke patients. ER physicians and neurologists must generally meet these targets. 

150.       When a physician includes stroke among the differential diagnoses for a patient, the physician must act quickly to confirm or rule out stroke.   

151.       When a patient is diagnosed with stroke, medical providers must act quickly to treat the stroke. If the stroke is an ischemic stroke, providers must act quickly to clear the blood clot causing the stroke. In some cases, providers must act quickly to order and perform a thrombectomy to remove the blood clot. 

152.       The death rate and level of disability resulting from a stroke can be dramatically reduced by immediate and appropriate medical care.

Stroke treatment: thrombectomy

153.       The only FDA-approved treatments for ischemic stroke are thrombectomy and intravenous TPA.

154.       In a thrombectomy, a neurosurgeon inserts a catheter into the body through an incision in the femoral artery (which is located in the groin).  

155.       The catheter is guided through the blood system towards the blood clot.

156.       Once the catheter reaches the blood clot, the neurosurgeon attempts to suction, dissolve, or retrieve the clot. 

157.       Every hour’s delay in achieving recanalization by a thrombectomy results in 8% decrease in the probability of good outcome, on average. Every 20 minutes saved leads to an average equivalent to 3 months of disability-free life for the patient.

158.       The practitioner initially evaluating the patient is responsible for facilitating the patient’s transfer to a thrombectomy suite.  

Treatment of Michaela Smith

Prologue: Michaela Gets Kicked on the Head

159.       About June 21, 2019, during training for her job as a detention officer, Michaela was kicked on the right side of her head. HMC 30, HMC 71.

160.       At that time, Michaela experienced dizziness and headache, but these symptoms resolved on their own. HMC 30, HMC 71.

HMC 71.

June 28-29, 2019 – Michaela’s First Visit to Hamilton

Onset of Symptoms

161.       On June 28, 2019, Michaela again received job-training, which involved physical activity and tests, including being sprayed in the face with pepper spray at about 17:00. HMC 30, HMC 2, HMC 6.

HMC 2.

162.       After training, Michaela drove herself home and “felt well for a couple [of] hours.” HMC 30, HMC 2, HMC 6.

HMC 30.

163.       Between 20:30 and 21:30, Michaela developed headache, shortness of breath, swelling throat, slurred speech, facial and hand numbness, near syncope, vomiting, dizziness, face pain, and difficulty talking. HMC 71, HMC 30, HMC 2.

HMC 71.

164.       Michaela had no prior history of a similar problem. HMC 71.

HMC 71. 

Initial Examination at the Hamilton ED

165.       By 21:43, Michaela arrived at the Hamilton ED with her parents. HMC 65, HMC 72. 

HMC 65.

166.       Upon admitting Michaela, the ED identified the reasons for her visit as headache, shortness of breath, and nausea with vomiting. HMC 79.

HMC 79.

167.       Between 22:53 and 22:59, Nurse Kayla Rewis triaged Michaela. HMC 67-68.

168.       Nurse Rewis entered the history of the present illness as: “Allergic Reaction - Onset 30 mins ago. Exposed to pepper spray.” HMC 68.

169.       Michaela’s complaints included “soreness/swelling to throat, headache, vomiting, and near syncopal episode, numbness to left side of face and slurred speech after being sprayed with pepper spray.” HMC 68. 

HMC 68.

170.       Nurse Rewis assigned Michaela’s condition an acuity level of 3. HMC 68. 

HMC 68.

171.       At about 23:38, Dr. Shawn Holsonback examined Michaela. HMC 71-72. 

HMC 71. 

172.       At that time, Dr. Holsonback noted the prior kick to Michaela’s head: “Approx 1 week ago, while in jail school, was struck in the right side of the head with kick, developed dizziness, headache w/o syncope at the time, sx resolved.” HMC 71.

HMC 71. 

173.       At that time, Michaela’s neurological condition was: “motor intact, sensory intact. CN2-12 intact, grip and BLE strength symmetric. finger to nose intact, neg pronator drift. Tongue midline, no facial asymmetry. BLE slight tremor-chronic per pt and family at bedside.” HMC 72.

174.       Her mental status was: “speech clear, oriented X 3, normal affect, responds appropriately to questions.” HMC 72.

HMC 72.  

175.       Michaela’s general appearance was: “well nourished, alert, cooperative, [with] no acute distress, no obvious discomfort.” HMC 71.

HMC 71.

176.       Dr. Holsonback also obtained an NIHSS score. Michaela scored 0 on each of the 11 elements and overall. HMC 72.

HMC 72. 

Michaela Has Head CT Scan

177.       At 23:47, despite Michaela’s NIHSS score, Dr. Holsonback ordered a stat head CT scan, for “headache right side.” HMC 64.

HMC 64.

178.       The CT scan was performed by 23:54—within minutes of the order. HMC 61.

HMC 61. 

179.       The CT scan showed a brainstem or posterior-circulation stroke.

180.       Image 7 of 29 showed a white hyperdense sign of a basilar-artery thrombosis:

181.       Image 8 of 29 showed a white streak, consistent with thrombus, where the basilar artery branches into the posterior cerebral arteries at its termination:

Dr. Cooney Fails to Identify Stroke on CT

182.       At 00:18 (now June 29, 2019), acting as a vRad employee, Radiologist Michael Cooney interpreted the 32 images associated with the CT scan. HMC 61-62.

HMC 61. 

183.       Dr. Cooney found no hemorrhage, mass-effect, midline shift, abnormal ventriculomegaly, acute fracture, acute sinusitis, or mastoid effusion. HMC 61.

HMC 61.

184.       Dr. Cooney’s findings failed to include the white hyperdense sign of basilar-artery thrombosis seen in image 7/29 of the study. HMC 61.

185.       Dr. Cooney’s findings also failed to include the white streak consistent with thrombus visible in image 8/29 of the study. HMC 61.

186.       Instead, contrary to the plain images, Dr. Cooney affirmatively concluded and reported that the study showed “No acute intracranial abnormality.” HMC 61.

HMC 61.

187.       At 00:28, Dr. Holsonback documented Dr. Cooney’s reading of the CT scan as showing “no acute intracranial abnormality.” HMC 72. 

HMC 72.

Hamilton Discharges Michaela Prematurely, without Informing Her of BAO

188.       At 00:57, Dr. Holsonback rechecked Michaela. She was “resting, feeling better,” with a “headache still present” and “all numbness resolved.” HMC 72.   

189.       At 02:15, Michaela continued to feel “better,” had “No focal neuro deficits,” and was “Agreeable with discharge.” HMC 72, HMC 2.

HMC 72. 

190.       At 02:15, Michaela signed her disposition summary. HMC 65-66.

191.       The summary identified her diagnoses as “Headache” and “Exposure to pepper spray,” identified her chief complaint as a possible allergic reaction, permitted her to return to work in 1-2 days without restrictions, and instructed her to “Return to the Emergency Department sooner if worse.” HMC 65. 

HMC 65.

192.       Michaela “verbalized understanding and ability to comply” with these instructions, without any “learning/communication barriers.” HMC 70.

193.       Michaela had a “strong ambulatory gait at time of discharge.” HMC 70.

194.       Her pain was 0 of 10. HMC 70.

HMC 70. 

195.       At 02:27, Michaela went home in “stable” condition. HMC 65, HMC 70.

196.       Neither any provider nor the discharge papers informed Michaela or her parents of the occlusion in her basilar artery. See, e.g., HMC 65-66, HMC 70. 

HMC 65. 

HMC 70.

197.       Michaela “felt comfortable going home.” HMC 6.

HMC 6. 

198.       At home, she “went to bed about 3:45 a.m. doing fairly well.” HMC 4, HMC 6.

HMC 4. 

June 29, 2019 – Michaela Returns to Hamilton by Ambulance

She Wakes with Global Alteration of Consciousness

199.       Michaela awoke with severe signs and symptoms of stroke, reflecting the onset of a neurological emergency after her discharge from Hamilton. 

200.       Michaela awoke “foaming out the mouth and shaking.” HMC 26.

HMC 26.

201.       At about 07:15, Michaela’s mother “heard her moan” in her bedroom and found her “with altered mental status and poor mobility.” HMC 2, HMC 6, HMC 30. 

202.       Michaela talked “through her gritted teeth but could not really open her mouth and was having problems with moving and slurred speech.” HMC 2.

203.       Speaking “through her teeth,” Michaela told her mother “that she was unable to get out of bed and had wet on herself.” HMC 6, HMC 2.

HMC 2.

HMC 6. 

204.       Thus, “something happened between [03:45] and 7:15 when the mother heard her make a noise and she [was] definitely different both physically with her motor function and with her cognition since then.” HMC 4.

HMC 4.

205.       The paramedics were then called. HMC 2, HMC 6. Because they could not get Michaela up to walk, she was transported back to the ED by stretcher. HMC 6. 

HMC 6.

Michaela Returns to Hamilton ED with

Classic Signs of a BAO

206.       By 08:19, the ambulance arrived at the Hamilton ED. HMC 24, HMC 25.

207.       Michaela returned as a clinically different patient, whose neurological condition had deteriorated dramatically overnight.

208.       She now had, for example, “fluctuating symptoms of stiffness in her lower extremities and occasional extensor posturing type movements with tremors of her upper extremities but no definite convulsions.” HMC 2, HMC 5, HMC 7.

HMC 2.

209.       These signs alone made clear that Michaela was facing a neurological emergency requiring expedited evaluation and intervention. Her extensor posturing, moreover, suggested that the emergency involved brainstem injury.

210.       Nevertheless, the reasons for Michaela’s visit were noted as other speech disturbances, unspecified dysphagia, and generalized edema, and the principal diagnosis was noted as “altered mental status, unspecified.” HMC 48. 

HMC 48. 

211.       Between 08:14 and 08:27, Nurse Megan Martin triaged Michaela. HMC 25-27. Nurse Gabe Herman was present. HMC 24.

212.       Michaela “was squinting her eyes and looking around, while still shaking.” HMC 26.

213.       Nurse Martin gave Michaela a MEND exam. During the exam, Michaela was “holding her eyes closed, showing globalized weakness and mumbling when she spoke until told to speak more clearly.” HMC 26.

HMC 26. 

214.       Nurse Martin did not document or report the findings of the MEND exam. 

215.       In addition, despite Michaela’s dramatic new deficits, Nurse Martin assigned her condition an acuity level of 3—the same score Nurse Rewis gave to Michaela’s vastly better condition the night before. HMC 26, HMC 68.

HMC 26. 

216.       Nurse Martin also failed to perform a full neurological assessment. HMC 26-27. 

Dr. Hawkins Notes but Fails to Treat the Stroke

217.       At some point between 09:12 and 12:44, Emergency Medicine Physician David Hawkins examined Michaela. HMC 30-31. 

218.       Michaela was lethargic, in an altered mental status, unresponsive to commands and conversation, and unable to open her eyes or follow commands. HMC 30. 

HMC 30.

219.       Michaela’s general appearance was: “unresponsive, uncooperative,” with “no attempt at spon[taneous] movement, tearful, appears crying at times, some nonspecific response to room environment, urinated in bed x 2.” HMC 31.

220.       Michaela’s neurological condition was: “extremities flaccid with occ spam and extension of arms and legs . . . DTRS arms and legs. Will not follow commands.” HMC 31.

221.       Michaela’s extremities were: “flaccid” with occasional “spastic tone” as in posturing. HMC 31.

222.       Michaela’s mental status was: “unable to vocalize, confused, bizarre affect, does not respond to questions.” HMC 31.

HMC 31. 

223.       Dr. Hawkins’s differential diagnosis led with nine psychiatric conditions, including adjustment reaction, drug abuse, eating disorder, personality disorder, and schizophrenia. HMC 31.

224.       Dr. Hawkins’s differential diagnosis then identified nine neurological conditions, leading with stroke (CVA) and including TIA.[2]  HMC 31. 

HMC 31.

225.       Despite listing stroke, Dr. Hawkins did not order vascular imaging to confirm or rule out stroke, did not take action to treat the stroke, and failed even to order a new CT scan or obtain a new stroke score. 

Dr. Johnson Fails to Identify Stroke on CT

226.       At 09:15, Radiologist Kevin Johnson read, and submitted a final report on, the same CT scan misread by Dr. Cooney. HMC 60. 

HMC 60. 

227.       Dr. Johnson found no evidence of acute intracranial hemorrhage, mass-effect, midline shift, hydrocephalus, abnormal extra-axial fluid collections, paranasal sinus disease, or mastoid or middle-ear effusions. HMC 60. He also found that gray-white differentiation was “within normal limits.” HMC 60.

228.       Dr. Johnson’s findings failed to include the white hyperdense sign of basilar-artery thrombosis seen in image 7/29. HMC 60.

229.       Dr. Johnson’s findings also failed to include the white streak consistent with thrombus visible in image 8/29. HMC 60.

230.       Instead, contrary to the plain images, Dr. Johnson affirmatively concluded and reported that this was a “Normal exam.” HMC 60.

HMC 60. 

Michaela Languishes without Assessments, Diagnosis, or Treatment

231.       At 08:35, Nurse Victoria Brock performed and documented a general assessment of Michaela. HMC 27-28.

232.       At 08:57, Nurse Brock took Michaela’s vitals. Two hours passed before Nurse Brock (or anyone else) took Michaela’s vitals again, at 10:57. Nurse Brock then took Michaela’s vitals at 11:15 and 11:37. HMC 26. 

HMC 26.

233.       At about 10:00, Nurse Lindsey Andrews called the Georgia Poison Center about Michaela’s symptoms. The Center recommended a chest x-ray, and a head CT scan “to rule out something unrelated to the pepper spray incident.” HMC 28.

HMC 28.

234.       At 10:08, Dr. Hawkins ordered the recommended chest x-ray. HMC 15.

HMC 15.

235.       But Dr. Hawkins did not order the recommended CT scan.

236.       At 10:31, Dr. Johnson read the chest x-ray and concluded it was a “normal exam.” HMC 15, HMC 22. 

237.       Between 10:44 to 10:54, Nurse Brock performed a fingerstick glucose check, drew a blood culture, and gave Michaela intravenous fluids. HMC 28.

HMC 28.

238.       At 11:14, Nurse Brock used a catheter to empty Michaela’s bladder, and sent a urine specimen to the lab for a urine screen. HMC 28.

HMC 28.   

239.       At 11:22, Dr. Hawkins ordered a stat brain MRI without contrast, “for alter[ed] mental status, after heavy physical activity and heat expo[sure].” HMC 23. 

HMC 23.

240.       During the hours she cared for Michaela, Nurse Brock, like Nurse Martin, failed to perform a full neurological assessment of Michaela. Nurse Brock also failed to perform hourly neurological assessments of Michaela. SeeHMC 26-28.

241.       At 12:30, Nurse Andrews provided Michaela incontinence care. HMC 29.

HMC 29.

242.       At 12:45, Dr. Hawkins consulted Neurologist Jeffrey Glass. Dr. Glass suggested admitting Michaela to the hospital, agreed to evaluate her in the ER, and agreed with the MRI “to distinguish function from organ cause.” HMC 32.

HMC 32.

243.       During the hours that had passed so far since Michaela’s return to Hamilton, Dr. Hawkins and Dr. Glass failed to diagnose or treat Michaela’s stroke.

The MRI Confirms a Treatable Ischemic Stroke

244.       Between 12:45 and 13:29, Michaela underwent the brain MRI, for “altered mental status after physical activity.” See HMC 16.

245.       Though the MRI’s DWI sequence showed that Michaela’s brainstem was ischemic (confirming stroke), the MRI’s FLAIR sequence remained normal.

246.       That is, Michaela’s brainstem had not yet suffered permanent stroke changes despite the basilar occlusion.

Instead of Treating the Stroke, Dr. Hawkins Admits Michaela for Observation

247.       At 12:54, Michaela continued manifesting signs and symptoms of stroke, including decreased consciousness, bizarre affect with no interactions, general weakness, lack of speech, tearfulness, spasticity to extremities, and incontinence. HMC 32. 

248.       Despite her severe deficits, Dr. Hawkins admitted Michaela for “observation,” noting that the head CT scan of “last night” was negative. HMC 32.

HMC 32.

249.       Dr. Hawkins’s reason for the admission was: “exposure to pepper spray during training course dev local inflammatory reaction.” HMC 32.

Dr. Johnson Again Fails to Identify the Stroke—in the MRI and the CT Scan

250.       At 13:29, Dr. Johnson interpreted Michaela’s MRI, and at 13:30, he discussed his findings with Dr. Hawkins. HMC 16.

HMC 16.

251.       The MRI showed “no definitive sites of diffusion restriction” and “no abnormal sites of FLAIR signal.” HMC 16.

252.       The MRI also showed: gray-white differentiation within normal limits, normal flow voids maintained within the major intracranial vascular pedicles, and no sites of pathologic contrast enhancement. HMC 16. 

HMC 16.

253.       The MRI thus showed that Michaela’s brainstem remained generally intact despite the basilar occlusion.

254.       Dr. Johnson, however, failed to identify the brainstem ischemia visible in the DWI sequence. HMC 16.

255.       Instead, contrary to the plain DWI imaging, Dr. Johnson concluded and reported that “No definitive acute abnormalities are identified on this motion-compromised examination.” HMC 16. 

HMC 16. 

256.       In addition, Dr. Johnson again reviewed Michaela’s CT scan, for “comparison” purposes. He thus had a second opportunity to interpret the CT scan. HMC 16.

257.       Dr. Johnson failed again to recognize and report the plain sign of basilar-artery thrombosis seen image 7/29, failed again to recognize and report the white streak consistent with thrombus seen in image 8/29, and thus failed to correct his conclusion that the CT scan was a “normal exam.” See HMC 16, HMC 60.

Michaela Continues to Languish without Assessments, Diagnosis, or Treatment

258.       At 12:30, Nurse Gabe Herman took Michaela’s vitals. Nurse Herman then took Michaela’s vitals at 14:04, 15:59, and 17:46. HMC 26. 

HMC 26.

259.       At 14:05, Nurse Herman performed a partial neurological assessment of Michaela—limited only to her GCS score. HMC 29. 

HMC 29. 

260.       Despite the score, Nurse Herman failed to perform hourly neurological assessments of Michaela. See HMC 27-28. 

261.       Between 14:05 and 14:18, Internist Ananka Myrie called Dr. Hawkins, to inform him she wanted neurology and psychiatry evaluations before admitting Michaela. HMC 32.

HMC 32.

262.       Between 14:17 and 14:22, Dr. Hawkins informed Dr. Glass of Dr. Johnson’s MRI findings. They discussed the facts that Michaela still appeared stuporous and interacted intermittently and primitively with her parents. HMC 32.

HMC 32. 

263.       At 14:51, while the ED continued waiting for Dr. Glass’s evaluation, Dr. Hawkins turned over Michaela’s care to Dr. Jonathan Thompson. HMC 32. 

HMC 32.

Even After Seeing Michaela, Dr. Glass Does Not Diagnose or Treat the Stroke

264.       At 15:54, Dr. Glass finally examined Michaela. HMC 1-7.

265.       Michaela continued to exhibit clear signs of stroke, including: altered mental status, hyperreflexia, extensor posturing of all four extremities, intermittent deconjugate gaze, inability to talk, inconsistent response to commands, bilateral Babinski, and bilateral Hoffmann’s in her hands. HMC 6, HMC 3.  

HMC 6.

HMC 6. 

HMC 3.

266.       Despite “having difficulty tying all of this in together and in particular tying it into the exposure to pepper spray,” despite recognizing that Michaela “came to the emergency room with more typical symptoms yesterday with the pepper spray” and went to bed “doing fairly well,” and despite Michaela’s deficits, Dr. Glass still did not turn his attention to diagnosis of stroke. HMC 4, HMC 6-7.

267.       Instead, noting that Michaela’s “MRI scan did not show a structural abnormality to account for the symptoms,” Dr. Glass focused on “a hypoxic event” and “seizures,” each of which he recognized as improbable. HMC 6-7.

268.       Dr. Glass even decided to order an EEG for the “unlikely” seizures. HMC 7. 

HMC 4.

HMC 6-7.

269.       As a result, even after seeing Michaela’s severe deficits, Dr. Glass failed to order vascular imaging, failed to diagnose stroke, and failed to treat the BAO.   

Dr. Glass Signs Off on Transfer to Erlanger

270.       At 16:28, Dr. Glass was “notified by the intensivist team and emergency room physician” that they felt Michaela needed “a higher level of care and will try and arrange transfer” to another hospital. HMC 7.

HMC 7.

271.       Dr. Glass then agreed with Michaela’s transfer to Baroness Erlanger Hospital (“Erlanger”). HMC 4, HMC 7. 

HMC 4.

272.       At 17:13, Nurse Michael Otting called “Whitfield County 911 to request a unit for code 2 transfer to Erlanger ER.” HMC 29.

HMC 29.

273.       At 17:35, Michaela was transferred to Erlanger. The reason was “altered mental status,” and the benefit of the transfer was “neuro evaluation.” HMC 45. 

HMC 45. 

274.       At 17:46, Michaela was discharged from Hamilton. HMC 48.

HMC 48. 

Epilogue: Michaela Dies at Erlanger

275.       At 18:32, Michaela arrived at the Erlanger ED by ambulance. BEH 7. 

BEH 7.

276.       At 01:10, now June 30, 2019, Michaela was transferred from the ED to the Erlanger “Neuromed/Neurosurg ICU.” BEH 22.  

BEH 22. 

277.       On June 30, 2019, Dr. Glass dictated and transcribed his consultation notes, which he signed the following day. HMC 5.

278.       Referring back to June 29, 2019, Dr. Glass noted that “something happened between [3:45] and [0]7:15 when the mother heard her make a noise and she [was] definitely different both physically with her motor function and with her cognition since then. I am not sure what happened.” HMC 4.

HMC 4.

279.       Meanwhile, Michaela’s condition “progressively worsened” at Erlanger. BEH 41. 

280.       On July 1, 2019, she was placed on a ventilator. BEH 41. 

281.       On July 2, 2019, a brain CT scan produced an “urgent critical result,” including “a diffuse hypodensity extending through the right cerebellar hemisphere and brainstem concerning for infarct with inferior tonsillar herniation.” BEH 310.

282.       The CT findings prompted Erlanger to administer three additional studies: an MRI of the brain, an MRA of the brain, and an MRA of the neck. BEH 41-44.

BEH 41.

283.       On the night of July 2, 2019, Erlanger performed the three studies. BEH 319. 

284.       The studies found “acute infarcts in the right cerebellar hemisphere and brainstem with diffuse cerebellar edema, mass-effect on the brainstem and cerebellar tonsillar herniation,” as well as “absent flow related enhancement of the intracranial vessels concerning for brain death.” BEH 41, BEH 319.

BEH 41.

BEH 319.

285.       At 09:50 on July 3, 2019, a nuclear medicine scan confirmed “brain death.” BEH 41, BEH 328-29.

286.       Michaela was pronounced dead at that time. BEH 40.

BEH 40.

287.       Michaela Elizabeth Smith was 26 years old. HMC 67, HMC 44.   

Injury and Wrongful Death from Professional Negligence

Count 1: Failure to Identify Stroke and Call Critical Values - Against Dr. Cooney and vRAD

288.       Plaintiffs incorporate by reference all paragraphs of this Complaint as though fully set forth herein.

289.       Radiologist Cooney violated the standard of care by failing to identify the abnormality in Michaela’s CT scan indicating she had a BAO when she arrived at Hamilton on June 28, 2019.

290.       Specifically, Dr. Cooney failed to identify the white hyperdense sign of basilar-artery thrombosis plainly visible in image 7/29 of the CT scan.

291.       Specifically, Dr. Cooney failed to identify the white streak consistent with thrombus plainly visible in image 8/29 of the CT scan. HMC 61.

292.       Dr. Cooney then violated the standard of care by failing to call critical values—failing immediately to call Dr. Holsonback or anyone else at the emergency department to notify them of the life-threatening abnormality. HMC 61.

293.       Instead, Dr. Cooney also violated the standard of care by notifying Dr. Holsonback and by reporting, contrary to the images, that Michaela’s CT scan showed “no acute intracranial abnormality.” HMC 61.

294.       As a direct result of Dr. Cooney’s violations of the standard of care, the Hamilton ED failed to call a code stroke, and failed to diagnose and treat Michaela’s stroke.

295.       Instead, based on Dr. Cooney’s misreading of the CT scan, Dr. Holsonback prematurely closed Michaela’s case and discharged her, noting that the CT scan showed “no acute intracranial abnormality.” HMC 72.

296.       At the time of her CT scan, Michaela’s stroke score was 0 (normal).

297.       At the time of her discharge and even later when she went to bed that early morning, Michaela was doing “fairly well.”

298.       But-for Dr. Cooney’s violations, therefore, Michaela likely would have undergone a thrombectomy, intravenous TPA, or other effective therapy, before the BAO caused permanent damage to her brain, much less her death.  

299.       Dr. Cooney’s violations thus caused Michaela pain and suffering, injury, and death.

300.       As Dr. Cooney’s employer or other principal at the time of his negligence, vRAD is vicariously liable for Dr. Cooney’s negligence, because he was acting within the scope of his employment or agency with vRAD at that time.

Count 2: Failure to Identify Stroke and Call Critical Values - Against Dr. Johnson and NGR

301.       Plaintiffs incorporate by reference all paragraphs of this Complaint as though fully set forth herein.

302.       The morning of June 29, 2019, Radiologist Johnson violated the standard of care by failing to identify the abnormality in Michaela’s CT scan indicating she had a BAO when she was discharged from Hamilton a few hours earlier.   

303.       Specifically, Dr. Johnson failed to identify the white hyperdense sign of basilar-artery thrombosis seen in image 7/29 of Michaela’s CT scan. HMC 60.

304.       Specifically, Dr. Johnson failed to identify the white streak consistent with thrombus plainly visible in image 8/29 of Michaela’s CT scan. HMC 60.

305.       At that time, Dr. Johnson also violated the standard of care by failing immediately to call Dr. Hawkins or anyone else at the emergency department to notify them of the life-threatening abnormality. HMC 60.

306.       Instead, Dr. Johnson affirmatively violated the standard of care by reporting, contrary to the images, that the CT scan was a “normal exam.” HMC 60.

307.       As a direct result of these violations by Dr. Johnson, on the morning of June 29, 2019, the Hamilton ED failed to call a code stroke, and failed to diagnose and treat Michaela’s stroke, including by a thrombectomy.

308.       Dr. Johnson’s own MRI findings demonstrated that Michaela’s brainstem was ischemic but had not yet suffered permanent stroke changes even later that day.

309.       But-for Dr. Johnson’s violations, therefore, Michaela likely would have undergone an effective thrombectomy or other intervention.      

310.       These violations by Dr. Johnson thus caused Michaela pain and suffering, injury, and death.

311.       As Dr. Johnson’s employer or other principal at the time of his negligence, NGR is vicariously liable for Dr. Johnson’s negligence, because he was acting within the scope of his employment or agency with NGR at that time.

Count 3: Failure to Identify Stroke and Call Critical Values - Against Dr. Johnson and NGR

312.       Plaintiffs incorporate by reference all paragraphs of this Complaint as though fully set forth herein.

313.       The afternoon of June 29, 2019, Dr. Johnson reviewed Michaela’s brain MRI, comparing it to her CT scan. Dr. Johnson thus had a second chance to identify the stroke—in both the MRI and the same CT scan.

314.       Dr. Johnson again violated the standard of care by again failing to identify the signs of the BAO plainly visible in the CT imaging.

315.       At the same time, Dr. Johnson failed to identify that Michaela’s MRI confirmed that Michaela was likely having an ischemic stroke.

316.       Specifically, Dr. Johnson failed to identify the brainstem ischemia visible in the DWI sequence of the MRI. In fact, because Dr. Johnson did not even hint at the ischemia in his report, it appears that he did not view the DWI.

317.       After reading the MRI and reviewing the CT scan, Dr. Johnson again violated the standard of care by again failing to call critical values—failing immediately to call Dr. Hawkins or anyone else at the emergency department to notify them of the life-threatening abnormalities.

318.       Instead, Dr. Johnson also violated the standard of care by reporting, contrary to the imaging, that “No definitive acute abnormalities are identified on this motion-compromised examination.” HMC 16.

319.       As a direct result of these additional violations by Dr. Johnson, the Hamilton ED again failed to diagnose and treat Michaela’s stroke, including by a thrombectomy, on the afternoon of June 29, 2019.

320.       Instead, relying on Dr. Johnson’s misreading of the CT scan and the MRI, after hours of additional delay, the Hamilton ED transferred Michaela to Erlanger, without taking any steps to treat her stroke.

321.       But-for these violations by Dr. Johnson, Michaela’s stroke would have been diagnosed and she would have undergone a thrombectomy or other intervention.

322.       The FLAIR sequence in Michaela’s MRI showed that her brainstem had not yet suffered permanent stroke changes on the afternoon of June 29, 2019.

323.       Dr. Johnson himself found no definite sites of diffusion restriction and no abnormal sites of FLAIR signal. He also found that the “gray-white differentiation appears within normal limits” and that “normal flow voids are maintained within the major intracranial vascular pedicles.” HMC 16.

324.       Dr. Johnson’s own findings thus confirmed that Michaela’s brainstem had not yet suffered permanent stroke changes.

325.       The MRI thus showed that Michaela likely would have recovered had Dr. Johnson identified the BAO, in either her CT scan or her MRI, even on the afternoon of June 29, 2019. A thrombectomy, therefore, likely would have been effective, even at that time.   

326.       These additional violations by Dr. Johnson thus caused Michaela pain and suffering, injury, and death.

327.       As Dr. Johnson’s employer or other principal at the time of his negligence, NGR is vicariously liable for Dr. Johnson’s negligence, because he was acting within the scope of his employment or agency with NGR at that time.

Count 4: Failure to Provide Emergent Care – Against the Hamilton Defendants

328.       Plaintiffs incorporate by reference all paragraphs of this Complaint as though fully set forth herein.

329.       When a patient arrives at an emergency room with serious neurological deficits concerning for stroke, the standard of care requires the triage nurse to notify the attending ER physician immediately; provide emergent care to the patient; and call a code stroke or initiate a stroke protocol insofar as the nurse has the authority to do so under the hospital’s policies.

330.       On June 29, 2019, Michaela returned to the Hamilton ER with serious neurological deficits concerning for stroke. In addition, Nurse Martin suspected a stroke.

331.       Nurse Martin nevertheless failed immediately to notify Dr. Hawkins (or another physician) of Michaela’s condition, failed to provide emergent care to Michaela, and failed to exercise whatever authority she had to call a code stroke or initiate a stroke protocol.

332.       Nurse Martin’s failure to provide Michaela emergent care fell grossly short of the standard of care.

333.       As a result of these failures by Nurse Martin, Michaela did not undergo rapid evaluation, expedited radiology-imaging, or emergent treatment for her stroke.

334.       Because time is brain, a delay in the recognition, diagnosis, or treatment of a stroke causes harm to the patient.

335.       Nurse Martin’s failures thus caused harm to Michaela.

336.       Nurse Martin’s violations of the standard of care thus caused Michaela pain, suffering, and brain-injury, and likely contributed to her death. 

337.       As Nurse Martin’s employer or other principal at the time of her negligence, one or both of the Hamilton Defendants are vicariously liable for her negligence, because she was acting within the scope of her employment or agency with one or both of the Hamilton Defendants at that time.

Count 5: Failure to Triage and Assess –

Against the Hamilton Defendants

338.       Plaintiffs incorporate by reference all paragraphs of this Complaint as though fully set forth herein.

339.       The standard of care requires an emergency-room nurse to assign, document, and report an accurate acuity level (also known as “triage score”).

340.       When Michaela returned to the Hamilton ER, Nurse Megan Martin violated these requirements by assigning and documenting an acuity level of 3 for Michaela, where her neurological deficits indicated a level 2. 

341.       The standard of care also requires an emergency-room nurse to perform, document, and report a full neurological assessment when a patient arrives with significant neurological deficits.

342.       When Michaela returned to the Hamilton ER, Nurse Martin violated these requirements by failing to perform, document, and report a full neurological assessment of Michaela.

343.       A patient’s acuity level and initial assessment are critical because they determine the level and urgency of care the patient receives downstream.  

344.       Nurse Martin’s failures to triage and assess Michaela fell grossly short of the standard of care.

345.       Nurse Martin’s failures to triage and assess Michaela delayed the recognition, diagnosis, and treatment of Michaela’s stroke, by setting a baseline for Michaela’s condition that did not reflect its true urgency and severity.

346.       As a result of these violations, Michaela was not evaluated by a physician for about an hour at minimum, did not undergo rapid radiology-imaging to confirm or rule out stroke, and did not receive a neurological assessment for hours.  

347.       Because time is brain, a delay in the recognition, diagnosis, or treatment of a stroke causes harm to the patient.

348.       These additional violations of the standard of care by Nurse Martin thus caused Michaela pain, suffering, and brain-injury, and likely contributed to her death. 

349.       As Nurse Martin’s employer or other principal at the time of her negligence, one or both of the Hamilton Defendants are vicariously liable for her negligence, because she was acting within the scope of her employment or agency with one or both of the Hamilton Defendants at that time.

Count 6: Failure to Diagnose Stroke - Against Dr. Hawkins and ECC, and Dr. Glass and the Hamilton Defendants

350.       Plaintiffs incorporate by reference all paragraphs of this Complaint as though fully set forth herein.

351.       In stark contrast to her presentation as an ambulatory patient a few hours earlier, Michaela returned to the Hamilton ED on a stretcher, with altered mental status, decerebrate posturing, and other serious neurological deficits.

352.       On June 29, 2019, Dr. Hawkins and Dr. Glass each violated the standard of care by failing to diagnose Michaela’s stroke.   

353.       First, even though they extensively documented Michaela’s signs and symptoms, Dr. Hawkins and Dr. Glass failed to recognize the clinical significance of those signs and symptoms, namely, that they pointed to a neurological emergency.

354.       For example, Michaela’s extensor posturing by itself suggested she was suffering massive brain injury, likely from a brainstem stroke.

355.       Dr. Hawkins and Dr. Glass thus failed to make an accurate clinical diagnosis.

356.       Second, Dr. Hawkins and Dr. Glass failed to order stat vascular imaging—a timely and definitive diagnostic study capable of identifying the source of Michaela’s neurological deficits. That study would have investigated blood-flow in Michaela’s brain and would have definitively confirmed the BAO.   

357.       Third, Dr. Hawkins failed to perform even basic screening tests to confirm or rule out stroke, including a new CT scan and stroke score, each of which would have taken at most a few minutes to complete.

358.       Dr. Hawkins’s failure to use vascular imaging and other tools to investigate and diagnose Michaela’s condition is all the more confounding because he documented stroke as a lead differential diagnosis.

359.       Dr. Hawkins’s failure to diagnose fell grossly short of the standard of care.

360.       But-for these violations of the standard of care by each Dr. Hawkins and Dr. Glass, Michaela would have undergone a thrombectomy or other effective treatment.  

361.       Michaela’s MRI demonstrated that her brainstem had not yet suffered permanent stroke changes, even on the afternoon of June 29, 2019.

362.       A thrombectomy, therefore, likely would have been effective even at that time.     

363.       These violations by Dr. Hawkins and Dr. Glass thus caused Michaela pain and suffering, injury, and death.  

364.       As Dr. Hawkins’s employer or other principal at the time of his negligence, ECC is vicariously liable for Dr. Hawkins’s negligence, because he was acting within the scope of his employment or agency with ECC at that time.

365.       As Dr. Glass’s employer or other principal at the time of his negligence, one or both of the Hamilton Defendants are vicariously liable for Dr. Glass’s negligence, because he was acting within the scope of his employment or agency with one or both of the Hamilton Defendants at that time.

Count 7: Failure to Provide Emergent Care - Against Dr. Hawkins and ECC, and Dr. Glass and the Hamilton Defendants

366.       Plaintiffs incorporate by reference all paragraphs of this Complaint as though fully set forth herein.

367.       The standard of care requires an emergency-medicine physician to initiate a stroke protocol or otherwise provide emergent care when a patient presents with significant neurological deficits concerning for stroke.

368.       The standard of care also requires a consulting neurologist to provide emergent care to such a patient.   

369.       Insofar as they focused on a possible stroke at all, Dr. Hawkins and Dr. Glass failed to provide Michaela emergent care and instead wasted precious time, in violation of the standard of care.  

370.       Even though Michaela arrived by ambulance on a stretcher no later than 08:19, Dr. Hawkins failed to examine her until 9:12, at the very earliest.

371.       Dr. Hawkins then failed to order a brain MRI until 11:22—over three hours after her arrival. The MRI was administered at 12:45, and was read at 13:29—over five hours after her arrival. 

372.       Dr. Hawkins then failed to consult with Dr. Glass until 12:45—nearly four-and-a-half hours after Michaela’s arrival.

373.       Dr. Glass did not examine Michaela until 15:54—nearly eight hours after her arrival.

374.       In fact, Dr. Hawkins apparently did not admit Michaela to the hospital floor until 12:54, and then only for observation. 

375.       Moreover, while precious minutes and hours ticked away, Dr. Hawkins wasted time attempting to rule out allergies, poisoning, and dystonia.

376.       Dr. Hawkins also wasted valuable time trying to rule out unfounded psychiatric issues, including drug abuse, eating disorder, and schizophrenia.

377.       In light of her deficits, the standard of care required Dr. Hawkins, as attending ER physician, to examine Michaela, order vascular imaging, consult with Dr. Glass, and otherwise investigate and treat her deficits—all emergently.

378.       Dr. Hawkins thus violated the standard of care by repeatedly failing to provide Michaela emergent care. 

379.       These violations by Dr. Hawkins are all the more egregious and inexplicable because he himself twice identified stroke in his differential diagnosis. 

380.       Dr. Hawkins’s failure to provide Michaela emergent care fell grossly short of the standard of care. 

381.       Likewise, Dr. Glass failed to provide emergent care and wasted precious time.  

382.       Dr. Hawkins consulted with Dr. Glass at 12:45—nearly four-and-a-half hours after Michaela’s arrival.

383.       Instead of examining Michaela without further delay, Dr. Glass merely agreed to see Michaela in the ER for evaluation—at an unspecified time.

384.       Dr. Glass did not examine Michaela until 15:54—over three hours after his consultation with Dr. Hawkins and nearly eight hours after her arrival.

385.       Although Dr. Glass then saw for himself that Michaela had a constellation of classic stroke symptoms, he still did not order vascular imaging at all, much less on an expedited basis.

386.       Instead, acknowledging he was having difficulty tying the patient’s symptoms together, Dr. Glass focused on conditions he deemed improbable, including hypoxia and seizures.  

387.       All this while precious minutes and then hours ticked away. 

388.       Dr. Glass then signed off on transferring Michaela to Erlanger, still without diagnosing and treating her stroke.

389.       In light of her presentation, the standard of care required Dr. Glass to examine Michaela, order vascular imaging, and otherwise investigate and treat her deficits—all on an emergent basis. This was especially the case because Dr. Hawkins had already identified stroke as a leading differential diagnosis. 

390.       Dr. Glass thus violated the standard of care by repeatedly failing to provide Michaela emergent care.   

391.       But-for these violations by each Dr. Hawkins and Dr. Glass, Michaela would have undergone a thrombectomy or other effective treatment.  

392.       Michaela’s MRI demonstrated that her brainstem had not yet suffered permanent stroke changes, even on the afternoon of June 29, 2019.  

393.       A thrombectomy, therefore, likely would have been effective even at that time.   

394.       These additional violations by Dr. Hawkins and Dr. Glass thus caused Michaela pain and suffering, injury, and death.   

395.       As Dr. Hawkins’s employer or other principal at the time of his negligence, ECC is vicariously liable for Dr. Hawkins’s negligence, because he was acting within the scope of his employment or agency with ECC at that time.

396.       As Dr. Glass’s employer or other principal at the time of his negligence, one or both of the Hamilton Defendants are vicariously liable for Dr. Glass’s negligence, because he was acting within the scope of his employment or agency with one or both of the Hamilton Defendants at that time.

Count 8: Failure to Perform Neuro Checks - Against the Hamilton Defendants

397.       Plaintiffs incorporate by reference all paragraphs of this Complaint as though fully set forth herein.

398.       The standard of care requires an emergency-room nurse to perform, document, and report, at minimum, hourly neurological assessments of a patient with significant neurological deficits.

399.       On June 29, 2019, Nurse Victoria Brock and Nurse Gabe Herman each violated these requirements.

400.       During the hours she cared for Michaela, Nurse Brock did not perform any neurological assessments of Michaela.

401.       During the hours he cared for Michaela, Nurse Herman performed one, incomplete neurological assessment of Michaela, limited to her level of consciousness.

402.       Nurse Brock’s and Nurse Herman’s failure to perform assessments of a deteriorating patient with severe neurological deficits fell grossly short of the standard of care.

403.       Because time is brain, a failure to recognize, diagnose, and treat a stroke causes harm to the patient.

404.       Especially because Michaela deteriorated under the care of Nurse Brock and Nurse Herman, each assessment they failed to perform was yet another wasted opportunity to recognize Michaela’s actual acuity level, to recognize the need for and order vascular imaging, and to diagnose and treat Michaela’s stroke.

405.       Each missed assessment thus caused harm to Michaela.    

406.       These violations by each Nurse Brock and Nurse Herman thus caused Michaela pain, suffering, and brain-injury, and likely contributed to her death. 

407.       As Nurse Brock’s and Nurse Herman’s employer or other principal at the time of their negligence, one or both of the Hamilton Defendants are vicariously liable for their negligence, because Nurse Brock and Nurse Herman were acting within the scope of their employment or agency with one or both of the Hamilton Defendants at that time.

Count 9: Failure to Treat Stroke –

Against Dr. Hawkins and ECC, and Dr. Glass and the Hamilton Defendants

408.       Plaintiffs incorporate by reference all paragraphs of this Complaint as though fully set forth herein.

409.       Dr. Hawkins and Dr. Glass failed to take the steps necessary for Michaela to undergo a thrombectomy or other effective intervention. Dr. Hawkins and Dr. Glass did not even order a neurology consult for a thrombectomy. 

410.       Dr. Hawkins’s failure even to order a neurology consult for a thrombectomy fell grossly short of the standard of care.  

411.       But-for these additional violations by each Dr. Hawkins and Dr. Glass, Michaela would have undergone a thrombectomy or other effective treatment.   

412.       Michaela’s MRI demonstrated that her brainstem had not yet suffered permanent stroke changes, even on the afternoon of June 29, 2019.

413.       A thrombectomy, therefore, likely would have been effective even at that time.   

414.       These additional violations by each Dr. Hawkins and Dr. Glass thus caused Michaela pain and suffering, injury, and death.

415.       As Dr. Hawkins’s employer or other principal at the time of his negligence, ECC is vicariously liable for Dr. Hawkins’s negligence, because he was acting within the scope of his employment or agency with ECC at that time.

416.       As Dr. Glass’s employer or other principal at the time of his negligence, one or both of the Hamilton Defendants are vicariously liable for Dr. Glass’s negligence, because he was acting within the scope of his employment or agency with one or both of the Hamilton Defendants at that time.

Causation – As to All Counts

417.       Plaintiffs incorporate by reference all paragraphs of this Complaint as though fully set forth herein.

418.       At 23:54 on June 28, 2019, during her first visit to Hamilton, Michaela underwent a non-contrast head CT scan. At 0:18 on June 29, 2019, Radiologist Michael Cooney read and reported on the CT scan.

419.       Dr. Cooney did not identify or report the hyperdensity of Michaela’s thrombosed basilar artery visible in the CT scan imaging.

420.       At 2:27, Michaela was discharged from Hamilton looking neurologically normal.

421.       In light of those facts and of her age and medical history, Michaela was a candidate for mechanical thrombectomy, should her condition have worsened at that point in time.

422.       At that time, moreover, mechanical thrombectomy likely would have led to a full and normal recovery. 

423.       At 9:15 on June 29, 2019, during Michaela’s second visit to Hamilton, Radiologist Kevin Johnson reviewed and submitted a final report on the same CT scan.

424.       Dr. Johnson also did not identify or report the hyperdensity of Michaela’s thrombosed basilar artery.

425.       At that time, in light of her age and medical history, Michaela remained a candidate for mechanical thrombectomy.

426.       At that time, moreover, mechanical thrombectomy likely would have led to a functional recovery. 

427.       At 12:45 on June 29, 2019, Michaela’s brain MRI showed that her brainstem, although ischemic, had not yet suffered permanent stroke changes.

428.       Specifically, the FLAIR sequence of the MRI demonstrated that Michaela’s brainstem had not yet suffered permanent stroke changes and generally remained normal, despite the occlusion in her basilar artery.

429.       In light of those findings and of Michaela’s age and medical history, she remained at that time a candidate for mechanical thrombectomy.              

430.       At that time, moreover, mechanical thrombectomy likely would have led to a functional recovery.                                                                            

431.       In addition, in light of those findings and of Michaela’s age and medical history, mechanical thrombectomy likely would have led to a functional recovery had it been performed that day, before or upon Michaela’s transfer to Erlanger.

432.       Thus, each failure promptly to diagnose and treat Michaela’s stroke while she was at Hamilton caused Michaela Smith pain and suffering, injury, and death. 

OCGA § 13-6-11 Claims -

Against All Defendants

433.       Plaintiffs incorporate by reference all paragraphs of this Complaint as though fully set forth herein.

434.       Plaintiffs show that Defendants have acted in bad faith, have been stubbornly litigious, and have caused Plaintiffs unnecessary trouble and expense.

435.       Plaintiffs are thus entitled to their expenses of litigation pursuant to OCGA § 13-16-11, including reasonable attorneys’ fees. 

______________________

436.       Pursuant to OCGA Title 51, Chapter 4, Plaintiffs are entitled to recover from all Defendants for all damages causedby the Defendants’ professional negligence.

Damages

Survival Action – Estate Claim

437.       Plaintiffs incorporate by reference all paragraphs of this Complaint as though fully set forth herein.

438.       Plaintiffs Annette and Michael Smith are entitled to damages for their daughter Michaela’s conscious pain and suffering over the hours and days she endured—and gradually perished from—an untreated stroke.

439.       After she returned to Hamilton on June 29, 2019, although she was unable to speak, Michaela reacted with “whining or crying” depending on what her parents said or who was in the room. HMC 6. 

HMC 6. 

440.       On that day, Michaela was “tearful” and “crying at times.” HMC 31.

HMC. 31. 

441.       Michaela responded “when family members would come in” and her parents believed she heard them. HMC 2.

442.       Indeed: “She would sometimes seem to open her eyes and close her eyes to command and she would cry appropriately at times.” HMC 2. At times, Michaela seemed to cry and moan appropriately. HMC 3. 

HMC 2.

HMC 3.

Wrongful Death Claim

443.       Plaintiffs incorporates by reference all paragraphs of this Complaint, as though fully set forth herein.

444.       Plaintiffs are also entitled to damages for Michaela’s wrongful death.

445.       Michaela was a normal, active, well-adjusted 26-year-old, who had a promising future and was “just getting started.”

446.       Michaela graduated from Dalton State College (of the University of Georgia system), with a major in criminal justice and a minor in psychology.

447.       She previously worked at the District Attorney’s Office for Whitfield and Murray Counties, helping attorneys prepare for trial. Michaela planned to return to work for the D.A. later in her career.

448.       In early 2019, Michaela became a sworn deputy for the Murray County Sheriff’s Department, serving as a detention officer in a facility for female inmates. She secured that position after a lengthy job search, thanks in part to a recommendation from the D.A.

449.       Michaela often voiced gratitude for her job, reflecting that it was where God wanted her to be.

450.       Michaela treated the inmates she served with dignity and respect. Because prison garments were at different stages of fading, Michaela would take time to pair up tops and bottoms, so that they matched. Each day, before her shift ended, Michaela asked the inmates if they had what they needed for the night. The inmates often said that Michaela was “a jailer who gets it.”

451.       Michaela had a huge heart. She believed deeply in treating people with decency and had an unshakable faith that they would respond in kind.

452.       Going back to her college days, Michaela was involved in efforts to combat domestic violence and human trafficking.

453.       Michaela had strong, loving, and productive relationships with family, friends, neighbors, and others.

454.       She was a huge University of Alabama football fan. She would not miss watching a game with her family and friends. Before her death, Michael and Annette were thinking of surprising her with tickets to a game.

455.       Michaela had a close-knit group of friends at church. See Appendix.

456.       She always made room for others in her life. In college, for example, she would often come home with a classmate who had nowhere to go for a break or holiday.

457.       At church, she served as nursery teacher for pre-school children. She loved singing hymns and gospel songs—at church, in the car, in the shower. 

458.       Michaela dated a young man starting at the age 18, but that relationship ended two years before her death. By 2019, Michaela had moved on and was actively dating again. She had plans and hopes to marry and have children in due time.    

459.       Michaela was an only child. Annette and Michael adopted her as a baby, after they had been married, and had tried to have or adopt a child, for 16 years.

460.       At that time, Annette was systematically contacting lawyers, to see if they knew anyone who was looking to place a baby. She crossed paths with a former classmate, who connected her with a young mother.

461.       Michaela would constantly express gratitude to her parents for adopting her. She felt she had “gained” rather than “lost” something by being adopted.

462.       This is the last Father’s Day card Michael received from Michaela.  

463.       Annette and Michael considered Michaela “a gift from God” for the 26 years of her abridged life. They still think of her that way.

464.       Annette and Michael say that were “committed to Michaela before she was even born,” and once she came into their lives, they “never yearned for another child.” 

465.       According to them, “Michaela was a better person than her parents.” 

466.       Michaela enjoyed watching television series with her parents. She could recite dialogue from Gray’s Anatomy by memory. 

467.       Michaela and her parents took regular vacations to Florida. At the time of her death, she was starting to plan the next family vacation. 

468.       Unbeknownst to her parents, Michaela had signed up to be an organ donor. They learned of that fact after she died. Annette and Michael were asked to write a letter to the doctors and nurses harvesting Michaela’s organs in the operating room. This is what they wrote. 

469.       Michaela’s organs were donated to five recipients, whose lives were likely saved.

470.       Michaela’s heart went to a 14-year-old girl, who lived.

471.       In February 2020, the Murray County Sheriff’s Department announced the creation of the Michaela Smith Scholarship Fund, which will provide an annual college scholarship to a student from each of the two high schools in Murray County who plans to pursue a career in criminal law or law enforcement. 

___________________

472.       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 Plaintiffs suffered, including physical, emotional, and economic injuries.

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, including attorneys’ fees;

d.             Punitive damages; and

e.             Such other and further relief as the Court deems just and proper.

April ___, 2021                                                    Respectfully submitted,

/s/ Lloyd N. Bell                                           

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

/s/ Lawrence B Schlachter­­

Lawrence B Schlacter, MD, JD

Georgia Bar No. 001353

SCHLACHTER LAW FIRM

88 West Paces Ferry Rd

Atlanta GA 30305

Telephone: (770) 552-8362

larry@schlachterlaw.com

Attorneys for Plaintiffs

APPENDIX

[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 differentcounties, 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] “CVA” stands for cerebrovascular accident, another name for stroke. “TIA” stands for transient ischemic attack, a brief stroke-like attack, or mini-stroke, which often precedes a full-blown stroke.