IN THE STATE COURT OF COBB COUNTY

STATE OF GEORGIA

Tenika Storey, Individually and as Representative of the Estate of Waymon Storey (Deceased),

Plaintiff,

— versus —

Wellstar Health System, Inc,

Wellstar Medical Group, LLC,

Kennestone Hospital, Inc,

Atlanta Medical Center, Inc,

South Fulton Emergency Physicians, LLC,

Richisa Salazar, MD (f/k/a Richisa Hamilton),

Philip Ramsay, MD,

Vernon Henderson, MD,

Estate of Vernon Henderson,

Morning Strickland, RN,

Jessica Astrella, RN (f/k/a Jessica Kainer), and

John/Jane Does 1-10,

                                             Defendants.

CIVIL ACTION

FILE NO. ___________

JURY TRIAL DEMANDED

Parties, Jurisdiction, and Venue

1.          Plaintiff TENIKA STOREY is a citizen and resident of Georgia. Plaintiff submits to the personal jurisdiction and venue of this Court.

2.          Defendant WELLSTAR HEALTH SYSTEM, INC. (“Wellstar Health”) is a Georgia nonprofit corporation. Registered agent: Leo Reichert. Physical address and principal office address: 793 Sawyer Road, Marietta, GA 30062, in Cobb County.

3.          Wellstar Health is subject to the personal jurisdiction of this Court.

4.          Wellstar Health is subject to the subject-matter jurisdiction of this Court in this case.

5.          Wellstar Health is directly subject to venue in this Court, because Wellstar Health maintains its registered office in Cobb County.[1]  

6.          Pursuant to OCGA § 9-10-31, Wellstar Health is also subject to venue in this Court, because at least one of its co-defendants is directly subject to venue here.

7.          Wellstar Health has been properly served with this complaint.

8.          Wellstar Health has no defense to this lawsuit based on undue delay—whether based on the statute of limitations, the statute of repose, laches, or any other similar theory.

9.          At all times relevant to this complaint, Wellstar Health was the employer or other principal of one or more of the individual defendants in this action.

10.      At all times relevant to this complaint, Wellstar Health operated Wellstar Atlanta Medical Center (“Hospital” or “AMC”), which was located at 303 Parkway Drive NE, Atlanta, GA 30312.

11.      At all times relevant to this complaint, Wellstar Health was the parent corporation of the Hospital.

12.      Wellstar Health thus provided overall coordination (including governance) to the Hospital.

13.      Defendant WELLSTAR MEDICAL GROUP, LLC (“Wellstar Medical”) is a Georgia nonprofit corporation. Registered agent: Leo Reichert. Physical address and principal office address: 793 Sawyer Road, Marietta, GA 30062, in Cobb County.

14.      Wellstar Medical is subject to the personal jurisdiction of this Court.

15.      Wellstar Medical is subject to the subject-matter jurisdiction of this Court in this case.

16.      Wellstar Medical is directly subject to venue in this Court, because Wellstar Medical maintains its registered office in Cobb County. 

17.      Pursuant to OCGA § 9-10-31, Wellstar Medical is also subject to venue in this Court, because at least one of its co-defendants is directly subject to venue here.

18.      Wellstar Medical has been properly served with this complaint.

19.      Wellstar Medical has no defense to this lawsuit based on undue delay—whether based on the statute of limitations, the statute of repose, laches, or any other similar theory.

20.      At all times relevant to this complaint, Wellstar Medical was the employer or other principal of one or more of the individual defendants in this action.

21.      Defendant KENNESTONE HOSPITAL, INC. (“Kennestone”) is a Georgia nonprofit corporation. Registered agent: Leo Reichert. Physical address and principal office address: 793 Sawyer Road, Marietta, GA 30062, in Cobb County.[2]

22.      Kennestone is subject to the personal jurisdiction of this Court.

23.      Kennestone is subject to the subject-matter jurisdiction of this Court in this case.

24.      Kennestone is directly subject to venue in this Court, because Kennestone maintains its registered office in Cobb County. 

25.      Pursuant to OCGA § 9-10-31, Kennestone is also subject to venue in this Court, because at least one of its co-defendants is directly subject to venue here.

26.      Kennestone has been properly served with this complaint.

27.      Kennestone has no defense to this lawsuit based on undue delay—whether based on the statute of limitations, the statute of repose, laches, or any other similar theory.

28.      At all times relevant to this complaint, Kennestone was the employer or other principal of one or more of the individual defendants in this action.

29.      At all times relevant to this complaint, Kennestone operated the Hospital.

30.      At all times relevant to this complaint, Kennestone was the parent corporation of the Hospital.

31.      Kennestone thus provided overall coordination (including governance) to the Hospital.

32.      Defendant ATLANTA MEDICAL CENTER, INC. (“Atlanta Medical”) is a Georgia corporation. Registered agent: C T Corporation System. Physical address: 289 S Culver Street, Lawrenceville, GA 30046 in Gwinnett County. Principal office address: 14201 Dallas Parkway, Dallas, TX 75254.

33.      Atlanta Medical is subject to the personal jurisdiction of this Court.

34.      Atlanta Medical is subject to the subject-matter jurisdiction of this Court in this case.

35.      Pursuant to OCGA § 9-10-31, Atlanta Medical is subject to venue in this Court, because at least one of its co-defendants is directly subject to venue here.

36.      Atlanta Medical has been properly served with this complaint.

37.      Atlanta Medical has no defense to this lawsuit based on undue delay—whether based on the statute of limitations, the statute of repose, laches, or any other similar theory.

38.      At all times relevant to this complaint, Atlanta Medical was the employer or other principal of one or more of the individual defendants in this action.

39.      At all times relevant to this complaint, Atlanta Medical operated the Hospital.

40.      At all times relevant to this complaint, Atlanta Medical was the parent corporation of the Hospital.  

41.      Atlanta Medical thus provided overall coordination (including governance) to the Hospital.

42.      Defendant SOUTH FULTON EMERGENCY PHYSICIANS, LLC (“South Fulton Emergency”) is a Georgia nonprofit corporation. Registered agent: CSC of Cobb County, Inc. Physical address: 192 Anderson Street SE, Suite 125, Marietta, GA, 30060, in Cobb County. Principal office address: 5665 New Northside Drive, Suite 320, Atlanta, GA 30328, in Fulton County.

43.      South Fulton Emergency is subject to the personal jurisdiction of this Court.

44.      South Fulton Emergency is subject to the subject-matter jurisdiction of this Court in this case.

45.      South Fulton Emergency is directly subject to venue in this Court, because South Fulton Emergency maintains its registered office in Cobb County. 

46.      Pursuant to OCGA § 9-10-31, South Fulton Emergency is also subject to venue in this Court, because at least one of its co-defendants is directly subject to venue here.

47.      South Fulton Emergency has been properly served with this complaint.

48.      South Fulton Emergency has no defense to this lawsuit based on undue delay—whether based on the statute of limitations, the statute of repose, laches, or any other similar theory.

49.      At all times relevant to this complaint, South Fulton Emergency was the employer or other principal of one or more of the individual defendants in this action.

50.      Herein, the Defendants identified in the preceding paragraphs may be referred to collectively as the “Corporate Defendants.”

51.      Herein, the Defendants identified in the following paragraphs may be referred to collectively as the “Individual Defendants.”

52.      Defendant RICHISA SALAZAR, MD (formerly known as Richisa Hamilton) is a citizen and resident of Georgia. She resides at 2178 Waldrop Road, Marietta, GA, in Cobb County.

53.      Dr. Salazar is subject to the personal jurisdiction of this Court.

54.      Dr. Salazar is subject to the subject-matter jurisdiction of this Court in this case.

55.      Dr. Salazar is directly subject to venue in this Court, because she is a resident of Cobb County.

56.      Pursuant to OCGA § 9-10-31, Dr. Salazar is also subject to venue in this Court, because at least one of her co-defendant’s is directly subject to venue here.

57.      Dr. Salazar has been properly served with this complaint.

58.      Dr. Salazar has no defense to this lawsuit based on undue delay—whether based on the statute of limitations, the statute of repose, laches, or any other similar theory.

59.      At all times relevant to this complaint, Dr. Salazar acted as an employee or other agent of one or more of the Corporate Defendants: Wellstar Health, Wellstar Medical, Kennestone, Atlanta Medical, and/or South Fulton Emergency.

60.      As Dr. Salazar’s employer(s) or other principal(s) at the time of her negligence, one or more of the Corporate Defendants is/are vicariously liable for her negligence, because she was acting within the scope of her employment or other agency at that time.

61.      If another entity was the employer or other principal of Dr. Salazar during that time, 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.

62.      Defendant PHILIP RAMSAY, MD, is a citizen and resident of Georgia. He resides at 1630 W Sussex Road NE, Atlanta, GA 30306, in Fulton County.

63.      Dr. Ramsay is subject to the personal jurisdiction of this Court.

64.      Dr. Ramsay is subject to the subject-matter jurisdiction of this Court in this case.

65.      Pursuant to OCGA § 9-10-31, Dr. Ramsay is subject to venue in this Court, because at least one of his co-defendant’s is directly subject to venue here.

66.      Dr. Ramsay has been properly served with this complaint.

67.      Dr. Ramsay has no defense to this lawsuit based on undue delay—whether based on the statute of limitations, the statute of repose, laches, or any other similar theory.

68.      At all times relevant to this complaint, Dr. Ramsay acted as an employee or other agent of one or more of the Corporate Defendants: Wellstar Health, Wellstar Medical, Kennestone, Atlanta Medical, and/or South Fulton Emergency.

69.      As Dr. Ramsay’s employer(s) or other principal(s) at the time of his negligence, one or more of the Corporate Defendants is/are vicariously liable for his negligence, because he was acting within the scope of his employment or other agency at that time.

70.      If another entity was the employer or other principal of Dr. Ramsay during that time, 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.

71.      Defendant VERNON HENDERSON, MD, is a citizen and resident of Georgia.[3] He resides at 2134 Spencers Way, Stone Mountain, GA 30306, in DeKalb County.

72.      Dr. Henderson is subject to the personal jurisdiction of this Court.

73.      Dr. Henderson is subject to the subject-matter jurisdiction of this Court in this case.

74.      Pursuant to OCGA § 9-10-31, Dr. Henderson is subject to venue in this Court, because at least one of his co-defendant’s is directly subject to venue here.

75.      Dr. Henderson has been properly served with this complaint.

76.      Dr. Henderson has no defense to this lawsuit based on undue delay—whether based on the statute of limitations, the statute of repose, laches, or any other similar theory.

77.      At all times relevant to this complaint, Dr. Henderson acted as an employee or other agent of one or more of the Corporate Defendants: Wellstar Health, Wellstar Medical, Kennestone, Atlanta Medical, and/or South Fulton Emergency.

78.      As Dr. Henderson’s employer(s) or other principal(s) at the time of his negligence, one or more of the Corporate Defendants is/are vicariously liable for his negligence, because he was acting within the scope of his employment or agency at that time.

79.      If another entity acted as the employer or other principal of Dr. Henderson during that time, 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.

80.      Defendant ESTATE OF VERNON HENDERSON is hereby named as a Defendant in the alternative to Dr. Henderson, based on the allegations herein pled against Dr. Henderson.

81.      Upon information and belief, Dr. Vernon Henderson passed away prior to the filing of this lawsuit, likely on or about February 22, 2023.

82.      Upon information and belief, Susan Henderson, Dr. Henderson’s surviving spouse, serves as the representative of the Estate of Vernon Henderson.

83.      Susan Henderson resides at 2134 Spencers Way, Stone Mountain, GA 30306, in DeKalb County.

84.      The Estate of Vernon Henderson is subject to the personal jurisdiction of this Court.

85.      The Estate of Vernon Henderson is subject to the subject-matter jurisdiction of this Court in this case.

86.      Pursuant to OCGA § 9-10-31, the Estate of Vernon Henderson is subject to venue in this Court, because at least one of its co-defendant’s is directly subject to venue here.

87.      The Estate of Vernon Henderson has been properly served with this complaint.

88.      The Estate of Vernon Henderson has no defense to this lawsuit based on undue delay—whether based on the statute of limitations, the statute of repose, laches, or any other similar theory.

89.      Defendant MORNING STRICKLAND, RN, is a citizen and resident of Georgia. She resides at 1423 Hartford Avenue SW, Atlanta, GA 30310, in Fulton County.

90.      Nurse Strickland is subject to the personal jurisdiction of this Court.

91.      Nurse Strickland is subject to the subject-matter jurisdiction of this Court in this case.

92.      Pursuant to OCGA § 9-10-31, Nurse Strickland is subject to venue in this Court, because at least one of her co-defendant’s is directly subject to venue here.

93.      Nurse Strickland has been properly served with this complaint.

94.      Nurse Strickland has no defense to this lawsuit based on undue delay—whether based on the statute of limitations, the statute of repose, laches, or any other similar theory.

95.      At all times relevant to this complaint, Nurse Strickland acted as an employee or other agent of one of more of the Corporate Defendants: Wellstar Health, Wellstar Medical, Kennestone, Atlanta Medical, and/or South Fulton Emergency.

96.      As Nurse Strickland’s employer(s) or other principal(s) at the time of her negligence, one or more of the Corporate Defendants is/are vicariously liable for her negligence, because she was acting within the scope of her employment or other agency at that time.

97.      If another entity acted as the employer or other principal of Nurse Strickland during that time, 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.

98.      Defendant JESSICA ASTRELLA, RN (formerly known as Jessica Kainer), is a citizen and resident of Georgia. She resides 619 Stoneview Drive, Canton, GA 30115, in Cherokee County.

99.      Nurse Astrella is subject to the personal jurisdiction of this Court.

100.   Nurse Astrella is subject to the subject-matter jurisdiction of this Court in this case.

101.   Pursuant to OCGA § 9-10-31, Nurse Astrella is subject to venue in this Court, because at least one of her co-defendant’s is directly subject to venue here.

102.   Nurse Astrella has been properly served with this complaint.

103.   Nurse Astrella has no defense to this lawsuit based on undue delay—whether based on the statute of limitations, the statute of repose, laches, or any other similar theory.

104.   At all times relevant to this complaint, Nurse Astrella acted as an employee or other agent of one or more of the Corporate Defendants.

105.   As Nurse Astrella’s employer(s) or other principal(s) at the time of her negligence, one or more of the Corporate Defendants is/are vicariously liable for her negligence, because she was acting within the scope of her employment or other agency at that time.

106.   If another entity acted as the employer or other principal of Nurse Astrella during that time, 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.

107.   JOHN/JANE DOES 1-10 are those yet-unidentified natural and legal persons who may be wholly or partly liable for the damages alleged here.

108.   Once served with process, John/Jane Does 1-10 are subject to the jurisdiction and venue of this Court.

General Notice of Claims

109.   Pursuant to OCGA § 9-11-18 and OCGA § 9-11-9.1, Plaintiff hereby provides general and sufficient notice of her claims against the Defendants.

Professional Negligence: Dr. Salazar and Corporate Defendants

110.   At all times relevant hereto, Dr. Richisa Salazar (formerly known as Dr. Richisa Hamilton) was a physician engaged in the practice of medicine in the State of Georgia.

111.   On December 23, 2021, Dr. Salazar entered into a physician-patient relationship with Waymon Storey.

112.   Dr. Salazar thus had a duty to provide care to Mr. Storey within the applicable standard of care.

113.   Dr. Salazar failed to comply with the applicable standard of care in the care she provided to Mr. Storey. 

114.   At all times relevant hereto, Dr. Salazar was an employee or other agent of one or more of the Corporate Defendants, and was acting within the course and scope of her employment or other agency.

115.   One or more of the Corporate Defendants are therefore liable for Dr. Salazar’s failures to comply with the applicable standard of care.

Professional Negligence: Dr. Ramsay and Corporate Defendants

116.   At all times relevant hereto, Dr. Philip Ramsay was a physician engaged in the practice of medicine in the State of Georgia.

117.   On December 23, 2021, Dr. Ramsay entered into a physician-patient relationship with Waymon Storey.

118.   Dr. Ramsay thus had a duty to provide care to Mr. Storey within the applicable standard of care.

119.   Dr. Ramsay failed to comply with the applicable standard of care in the care he provided to Mr. Storey. 

120.   At all times relevant hereto, Dr. Ramsay was an employee or other agent of one or more of the Corporate Defendants, and was acting within the course and scope of his employment or other agency.

121.   One or more of the Corporate Defendants are therefore liable for Dr. Ramsay’s failures to comply with the applicable standard of care.

Professional Negligence: Dr. Henderson and Corporate Defendants

122.   At all times relevant hereto, Dr. Vernon Henderson was a physician engaged in the practice of medicine in the State of Georgia.

123.   On December 23, 2021, Dr. Henderson entered into a physician-patient relationship with Waymon Storey.

124.   Dr. Henderson thus had a duty to provide care to Mr. Storey within the applicable standard of care.

125.   Dr. Henderson failed to comply with the applicable standard of care in the care he provided to Mr. Storey. 

126.   At all times relevant hereto, Dr. Henderson was an employee or other agent of one or more of the Corporate Defendants, and was acting within the course and scope of his employment or other agency.

127.   One or more of the Corporate Defendants are therefore liable for Dr. Henderson’s failures to comply with the applicable standard of care.

Professional Negligence: Nurse Strickland and Corporate Defendants

128.   At all times relevant hereto, Nurse Morning Strickland was a registered nurse engaged in the practice of medicine in the State of Georgia.

129.   On December 23, 2021, Nurse Strickland entered into a nurse-patient relationship with Waymon Storey.

130.   Nurse Strickland thus had a duty to provide care to Mr. Storey within the applicable standard of care.

131.   Nurse Strickland failed to comply with the applicable standard of care in the care she provided to Mr. Storey. 

132.   At all times relevant hereto, Nurse Strickland was an employee or other agent of one or more of the Corporate Defendants, and was acting within the course and scope of her employment or other agency.

133.   One or more of the Corporate Defendants are therefore liable for Nurse Strickland’s failures to comply with the applicable standard of care.

Professional Negligence: Nurse Astrella and Corporate Defendants

134.   At all times relevant hereto, Nurse Jessica Astrella (formerly known as Jessica Kainer) was a registered nurse engaged in the practice of medicine in the State of Georgia.

135.   On December 23, 2021, Nurse Astrella entered into a nurse-patient relationship with Waymon Storey.

136.   Nurse Astrella thus had a duty to provide care to Mr. Storey within the applicable standard of care.

137.   Nurse Astrella failed to comply with the applicable standard of care in the care she provided to Mr. Storey. 

138.   At all times relevant hereto, Nurse Astrella was an employee or other agent of one or more of the Corporate Defendants, and was acting within the course and scope of her employment or other agency.

139.   One or more of the Corporate Defendants are therefore liable for Nurse Astrella’s failures to comply with the applicable standard of care.

140.   As the direct and proximate result of the negligence of the Defendants, Mr. Storey experienced pain, suffering, injury, and death. 

141.   Plaintiff is thus entitled to survival and wrongful-death damages in excess of $10,000, in an amount to be proved at trial.

OCGA § 9-11-9.1 Requirements

142.   Pursuant to OCGA § 9-11-9.1, the affidavit of Emergency Medicine Physician Keith Borg, an expert witness competent to testify as to the standard of care required of Dr. Salazar, is attached as Exhibit 1.

143.   Pursuant to OCGA § 9-11-9.1, the affidavit of Surgeon Rohit Sharma, an expert witness competent to testify as to the standard of care required of Dr. Ramsay, Dr. Henderson, and other trauma surgeons, is attached as Exhibit 2.

144.   Pursuant to OCGA § 9-11-9.1, the affidavit of Nurse Chrissy White, an expert witness competent to testify as to the standard of care required of Nurse Strickland, Nurse Astrella, and other nurses, is attached as Exhibit 3.

145.   Pursuant to OCGA § 9-11-9.1, the affidavit of Internist and Hospitalist Jonathan Schwartz, a witness competent to testify as to a standard of care required of the Individual Defendants and other providers, is attached as Exhibit 4.

Administrative Negligence: Corporate Defendants

146.   Plaintiff here incorporates by reference all paragraphs of this Complaint.

147.   Each of the Corporate Defendants owed ordinary duties of care to Waymon Storey.

148.   Each of the Corporate Defendants breached those duties.

149.   Each of the Corporate Defendants are directly liable for the breach of those duties.

150.   Each of the Corporate Defendants breached those duties through the acts and omissions of administrators not licensed for the professions listed in OCGA § 9-11-9.1(g).

151.    Each of the Corporate Defendants breached those duties through the acts and omissions of professional staff performing purely administrative tasks.

152.   Negligent administration by Corporate Defendants created unnecessary and unreasonable potential for medical error by providers involved in the care of Waymon Storey.

153.   Negligently administered systems and organizational cultures facilitated, rather than prevented, individual medical error.

154.   By violating its duties of ordinary care, each of the Corporate Defendants harmed Waymon Storey.

155.   The administrators directly responsible for the negligent administration were employees or servants, or actual or ostensible agents, of one or more of the Corporate Defendants.

156.   The Corporate Defendants are thus vicariously liable for the ordinary negligence of those administrators.

­­____________________

157.   Wherefore, Plaintiff respectfully demands judgments against the Defendants for money damages in an amount in excess of $10,000, together with the costs of this action and such other and further relief as is just and proper.

Note on Notice Pleading

Herein, statements not in enumerated paragraphs require no response from Defendants.

The above “General Notice” suffices to please this case. In keeping with the overriding goal of the Civil Practice Act (“to secure the just, speedy, and inexpensive determination of every action”),[4] the detailed allegations below are presented to provide further notice, narrow disputes, and simplify discovery and trial.

Nevertheless, Plaintiff does not waive Georgia’s notice-pleading requirements, or assume any obligation to provide more than the general notice required by law.[5]   

Additional Notice of Claims

Professional Negligence

Claim 1 – Failure to Recognize Significance of Trauma

158.   Under the circumstances present in this case, the standard of care requires an ED physician to recognize the severity of the patient’s chest trauma and its implications for the patient’s ability to maintain ventilation.

159.   Specifically, the standard of care requires an ED physician to recognize that the patient’s chest trauma has already impaired the patient’s ability to ventilate and may soon result in respiratory failure.

160.   On December 23, 2021, Dr. Richisa Salazar violated these requirements, by failing to recognize that Mr. Storey had suffered serious chest injuries in a rollover car accident and that the trauma had already impaired his ability to maintain ventilation and could soon result in respiratory failure.

161.   Because Dr. Salazar failed to recognize the extent and significance of Mr. Storey’s chest trauma, Dr. Salazar also failed to include chest trauma, hypoventilation, or hypoxia among her differential diagnoses.

162.   Dr. Salazar then also failed to obtain a chest x-ray, which would have assisted in identifying the extent of Mr. Storey’s chest injuries.

163.   These violations were all the more egregious for the following reasons:

a.    Mr. Storey had just survived a rollover car accident, requiring extrication from a 2-foot vehicular intrusion.

b.    Mr. Storey presented to the ED with obvious traumatic injuries, including visible bone depressions over his sternum and ribs.

c.     Mr. Storey presented to the ED with severe hypoxemia—with a critically low oxygen-saturation level.

d.    Mr. Storey’s oxygen reserves were thus likely depleted by the time he arrived.

e.     Mr. Storey had other independent and observable risk-factors for hypoventilation and hypoxia, including his weight and body-mass index.

f.      Mr. Storey had a lower tolerance for hypoxia, given such risk-factors.

g.    On route to the Hospital, Mr. Storey repeatedly asked EMS to be sat up, suggesting he had positional hypoxia. 

h.    Consistent with his worsening hypoxia and respiratory effort, Mr. Storey presented to the ED in severe pain and distress.

i.      Once at the ED, Mr. Storey’s hypoxia did not improve “despite non rebreather mask application.”

j.      Instead, as his “dyspnea progressed,” Mr. Storey’s mental status “rapidly declined,” from a GCS-score of 15 to 3.

k.    As his hypoxia worsened, the trauma team gave Mr. Storey an antipsychotic.

164.   With such evidence, an ED physician should readily recognize that the patient’s chest trauma has put him at impending risk of losing his ability to breathe.

165.   Nothing is more basic to the job of an ED physician than recognizing that a patient is losing the ability to breathe.

166.   In fact, in a healthcare provider’s encounter with a trauma patient, the provider must immediately assess the patient’s ABCs—airway, breathing, and circulation.

167.   By failing to recognize that Mr. Storey was losing his ability to breathe, Dr. Salazar deviated from the standard of care.

168.   In fact, she deviated grossly from that standard of care.

169.   By failing to recognize something as basic as a patient’s failing ability to breathe, Dr. Salazar also failed to exercise even slight diligence as an ED physician.

170.   Had she exercised even slight diligence, Dr. Salazar would have readily recognized that Mr. Storey’s chest trauma had already put him at impending risk of losing his ability to maintain ventilation. 

171.   Had Dr. Salazar met the standard of care, the trauma team likely would have provided Mr. Storey the ventilation and oxygenation he needed, well before his hypoxia could result in respiratory arrest, much less death.

172.   Had Dr. Salazar recognized the extent of Mr. Storey’s trauma and its clinical implications, she herself (or others on the trauma team) would have performed an earlier intubation, promptly after his arrival—in a more-controlled setting, with a high probability of obtaining a definitive airway.

173.   With a definitive airway in place, the trauma team then would have easily provided Mr. Storey the ventilation that was required to reverse his hypoxia.

174.   As a result, Mr. Storey likely would have returned to normoxia within minutes of his arrival— before he could experience respiratory arrest, much less death.

175.   Dr. Salazar’s failure to recognize the clinical significance of Mr. Storey’s presentation was thus a cause of his respiratory arrest, cardiac arrest, and death.

176.   Dr. Salazar’s failure was also a cause of the pain and suffering Mr. Storey likely endured as he gradually died from oxygen-deprivation—in the hands of a trauma team, at a major trauma center.  

Claim 2: Failure to Intubate Patient

177.   Under present in this case, because the patient’s ability to maintain ventilation is impaired before he arrives at the hospital, the standard of care requires an ED physician to perform an intubation on the patient promptly upon the patient’s arrival.

178.   In light of the patient’s clinical presentation, the standard of care requires an ED physician to seize upon the potentially-narrow window of time to perform the intubation.

179.   In this setting, early recognition and intervention increase the chance of success, while decreasing the risk that a crash intubation will be needed.

180.   For these reasons, upon receiving a trauma alert while the patient is on route, the standard of care also requires an ED physician to prepare the trauma team to perform an early intubation promptly upon the patient’s arrival. 

181.   On December 23, 2021, Dr. Salazar violated these requirements, by failing to intubate Mr. Storey promptly after he arrived at the Hospital ED.

182.   Instead, because Dr. Salazar failed to intubate him promptly upon arrival, Mr. Storey decompensated further, forcing Dr. Salazar to attempt an emergent intubation in the uncontrolled setting of cardiac arrest.

183.   These violations were all the more egregious for the following reasons:

a.    Mr. Storey had just survived a rollover car accident, requiring extrication from a 2-foot vehicular intrusion.

b.    Mr. Storey presented to the ED with obvious traumatic injuries, including visible bone depressions over his sternum and ribs.

c.     Mr. Storey’s prehospital oxygen-saturation level was critically low.

d.    Mr. Storey’s oxygen reserves were thus likely depleted by the time he arrived.

e.     Mr. Storey had other independent and observable risk-factors for hypoventilation and hypoxia, including his weight and body-mass index.

f.      Mr. Storey had a lower tolerance for hypoxia, given such risk-factors.

g.    Mr. Storey was in severe distress on route to the Hospital.

h.    Nevertheless, Mr. Storey had a GCS score of 15 at the time of arrival.

i.      Generally, a competent ED physician can perform an intubation rapidly, even on a difficult patient.     

184.   Nothing is more basic to the job of an ED physician than securing a patient’s airway.

185.   Because Dr. Salazar failed to intubate him promptly upon his arrival at the ED, Mr. Storey’s ability to maintain ventilation diminished and failed, resulting in respiratory arrest.

186.   By failing to intubate him promptly upon his arrival, Dr. Salazar thus deviated from the standard of care.

187.   In fact, she deviated grossly from the standard of care.

188.   By failing to intubate him promptly after his arrival, Dr. Salazar also failed to exercise even slight diligence as an ED physician.

189.   Had Dr. Salazar exercised even slight diligence, she would have prepared to intubate Mr. Storey when he was on route to the Hospital, and she would have then started intubation upon his arrival.

190.   The fact that his heart still had pulseless electrical activity (PEA) when it arrested strongly suggests that Mr. Storey had hypoxic cardiac arrest. 

191.   Had Dr. Salazar intubated Mr. Storey promptly upon his arrival, the trauma team would have quickly provided him the ventilation required to reverse his hypoxia.

192.   As a result, Mr. Storey likely would have returned to normoxia within minutes of his arrival—before he could experience respiratory failure, much less hypoxic cardiac arrest and death.

193.   Dr. Salazar’s failure to intubate Mr. Storey promptly upon his arrival was thus a cause of his respiratory arrest, cardiac arrest, and death.

194.   Dr. Salazar’s failure was also a cause of the pain and suffering Mr. Storey likely endured as he gradually died fromoxygen-deprivation—in a major trauma center, in the hands of a host of healthcare providers.

Claim 3: Failure to Use Supraglottic Device

195.   Under the circumstances present in this case, when intubation proves unsuccessful or difficult, the standard of care alternatively requires an ED physician to utilize a supraglottic device to establish an airway on the patient.

196.   This requirement is critical when the patient has coded after an extended period of hypoxia, and when every minute that passes may therefore make a difference between life and death.

197.   On December 23, 2021, Dr. Salazar violated this requirement, by failing to utilize a supraglottic device to establish an airway on Mr. Storey—even after intubation proved unsuccessful and difficult.

198.   On December 23, 2021, Dr. Salazar violated this requirement, by attempting to intubate Mr. Storey “5 or more” times—even after intubation proved unsuccessful and difficult.

199.   These violations are all the more egregious for the following reasons:

a.    A supraglottic device is a common, simple, and effective airway adjunct to establish a patient’s airway in seconds.

b.    The anatomy of an obese patient can make intubation more challenging than normal.

c.     A supraglottic device is an alternative precisely for challenging intubations.

d.    By the time of the first unsuccessful intubation, Mr. Storey was already in respiratory arrest or imminently in respiratory arrest.

e.     It was therefore essential to establish an airway as soon as possible, before the arrest could become irreversible. 

200.   Nothing is more basic to the job of an ED physician than establishing a patient’s airway.

201.   Here, because Dr. Salazar failed to utilize a supraglottic device, she failed to establish an airway during the time available to save Mr. Storey’s life.

202.   Dr. Salazar thus deviated from the standard of care.

203.   In fact, she deviated grossly from the standard of care.

204.   By failing to utilize a supraglottic device, Dr. Salazar also failed to exercise even slight diligence as an ED physician.

205.   Had she exercised even slight diligence, Dr. Salazar would have promptly used a supraglottic device—right after intubation first failed or proved difficult.

206.   Instead, Dr. Salazar attempted “5 or more” intubations over an extended period of time.

207.   Had Dr. Salazar promptly utilized a supraglottic device, the trauma team likely would have ventilated and oxygenated Mr. Storey, reversing his hypoxia.

208.   In turn, because Mr. Storey was in hypoxic arrest, the trauma team likely would have resuscitated Mr. Storey, preventing his death.

209.   Dr. Salazar’s failure to utilize a supraglottic device was thus a cause of Mr. Storey’s death.

Claim 4: Failure to Place Surgical Airway

210.   Under the circumstances present in this case, when the ED physician is otherwise unable to establish an airway, the standard of care alternatively requires the ED physician to emergently place a surgical airway on the patient by performing a cricothyrotomy.

211.   This requirement is critical when (a) the patient has received a sedative and paralytic, (b) the patient has arrested after an extended period of hypoxia, and (c) every minute may therefore represent the difference between life and death for the patient.

212.   On December 23, 2021, Dr. Salazar violated this requirement, by failing to place a surgical airway on Mr. Storey, promptly after intubation failed.

213.   Nothing is more basic to the job of an ED physician than securing a patient’s airway.

214.   Here, because Dr. Salazar failed to place a surgical airway, the trauma team failed to secure Mr. Storey’s airway during the time available to save his life.

215.   By failing to place a surgical airway, Dr. Salazar thus deviated from the standard of care.

216.   In fact, she deviated grossly from the standard of care.

217.   By failing to obtain a surgical airway, Dr. Salazar also failed to exercise even slight diligence as an ED physician.

218.   Had she exercised even slight diligence, she would have emergently placed a surgical airway on Mr. Storey—immediately after intubation failed.

219.   Instead, Dr. Salazar attempted intubation “5 or more” times.

220.   Had Dr. Salazar promptly placed a surgical airway, the trauma team likely would have provided Mr. Storey the ventilation and oxygenation he needed, reversing the hypoxia that led to his cardiac arrest in the first place.

221.   In turn, the trauma team likely would have resuscitated Mr. Storey, preventing his death.

222.   Dr. Salazar’s failure to place a surgical airway was thus a cause of Mr. Storey’s death. 

Claim 5: Failure to Secure Airway

223.   Under the circumstances present in this case, when the ED physician is unable to establish an airway promptly, the standard of care requires the on-call trauma surgeon and any other trauma surgeon at bedside to secure the patient’s airway emergently, either by intubating the patient or by placing a surgical airway.

224.   On December 23, 2021, insofar as they were on-call or at bedside, Dr. Phillip Ramsay, Dr. Vernon Henderson, and possibly other trauma surgeons violated these requirements, by failing to secure Mr. Storey’s airway emergently, immediately after Dr. Richisa Salazar, the ED physician, was unable to do so.

225.   Nothing is more fundamental to the job of a trauma surgeon than securing a patient’s airway.

226.   Here, the trauma surgeons failed to secure Mr. Storey’s airway during the window of time available to save his life.

227.   By failing to secure Mr. Storey’s airway under those circumstances, these trauma surgeons deviated from the standard of care.

228.   In fact, they deviated grossly from the standard of care.

229.   By failing to secure Mr. Storey’s airway, these surgeons also failed to exercise slight diligence as trauma surgeons.

230.   Had they exercised slight diligence, these surgeons would have emergently secured Mr. Storey’s airway—as soon as it became clear that Dr. Salazar was unable to do so.

231.   Instead, Dr. Salazar attempted intubation “5 or more” times, even as and after the window to save Mr. Storey’s life closed.

232.   Had even one of these surgeons secured Mr. Storey’s airway, Mr. Storey would have received the ventilation and oxygenation he needed, likely reversing the hypoxia that led to his cardiac arrest in the first place.

233.   In turn, the trauma team likely would have resuscitated Mr. Storey, preventing his death.

234.   Each failure to secure Mr. Storey’s airway thus contributed to his death.

Claim 6: Failure to Monitor Vitals

235.   Under the circumstances present in this case, the standard of care requires a hospital nurse attending to the patient to monitor, report, and document the patient’s vital signs—at least every 5 minutes for the first 30 minutes after the patient arrives.

236.   The required vital signs include the patient’s temperature, heart rate, respiratory rate, blood pressure, and oxygen saturation (SpO2 level).

237.   The purpose of closely monitoring the patient is early detection of any clinical deterioration, to provide appropriate treatment or intervention without delay.

238.   On December 23, 2021, according to Hospital records, Nurse Morning Strickland, Nurse Jessica Kainer, and possibly other nurses at the Hospital’s ED each violated these requirements, by failing to monitor Mr. Storey’s vitals as required, from the time of his arrival until he coded. Hospital nurses thus repeatedly violated the standard of care.

239.   These violations were all the more egregious for the following reasons:

a.    Mr. Storey had just survived a rollover car accident, requiring extrication from a 2-foot vehicular intrusion.

b.    Mr. Storey presented to the ED with severe hypoxemia—with a critically low oxygen-saturation level.

c.     Mr. Storey had other independent and observable risk-factors for hypoventilation and hypoxia, including his weight and body-mass index.

d.    Mr. Storey was in severe pain and distress upon his arrival at the ED.

e.     Mr. Storey had obvious traumatic injuries, including bone depressions in his sternum and ribs.

240.   Because monitoring a patient’s vitals enables early detection of clinical deterioration, nothing is more basic to the job of a nurse than monitoring a patient’s vitals.

241.   By failing to monitor Mr. Storey’s vitals as required, Nurse Strickland, Nurse Kainer, and possibly other Hospital nurses deviated from the standard of care.

242.   In fact, they deviated grossly from the standard of care.

243.   By failing to monitor Mr. Storey’s vitals as required, these nurses also failed to exercise even slight diligence.

244.   Had they exercised even slight diligence, they would have monitored Mr. Storey’s vitals as required.

245.   Had Nurse Strickland, Nurse Kainer, or another Hospital nurse monitored, reported, and documented Mr. Storey’s vitals as required, his vitals (especially his oxygen saturation and respiratory rate) likely would have alerted the trauma team that Mr. Storey’s hypoxia was rapidly worsening.

246.   So alerted, the trauma team then likely would have recognized that Mr. Storey’s already-impaired ability to maintain ventilation was diminishing quickly.

247.   As a result, the trauma team likely would have intubated Mr. Storey without delay—before his hypoxia resulted in respiratory arrest, much less death.

248.   Each failure to monitor Mr. Storey’s vitals thus contributed to his respiratory arrest, cardiac arrest, and death.

249.   Each such failure was also a cause of the pain and suffering he likely experienced as he gradually died from oxygen-deprivation—in a major trauma center, in the hands of healthcare providers.                                  

Claim 7: Failure to Document

250.   Under the circumstances present in this case, the standard of care requires the physicians, nurses, and other providers involved in the patient’s care to enter clear, complete, and accurate records concerning the care provided to the patient.

251.   Under these circumstances, the standard of care also requires the physicians and nurses to enter such records promptly.

252.   These documentation requirements serve a clinical purpose beyond merely memorializing information.

253.   Especially here, the required documentation informs and drives clinical decision-making, in a setting where fast and accurate communications are essential for patient care and safety.

254.   These requirements, for example, help ensure that providers work in a coordinated and effective fashion.

255.   In short, these requirements help optimize outcomes, prevent adverse long-term consequences, and safeguard patient safety.

256.   In December 2023, physicians and nurses who cared for Mr. Storey at the Hospital violated these requirements, by entering records that are unclear, incomplete, and incongruent.

257.   For example, the records concerning oxygen delivery omit or confuse important facts, such as the time and the rate at which oxygen was administered.

258.   Likewise, the records of the attempted intubations document at most two of the “5 or more” intubation attempts, without noting information about the other attempts.

259.   The providers who violated these requirements include Dr. Richisa Salazar, Dr. Philip Ramsay, Nurse Morning Strickland, and Nurse Jessica Kainer, and may also include Dr. Naqeeb Faroqui, physicians identified in the records as “Dr. Henderson” and “Dr. Anderson,” Nurse Wendy Tribble, Nurse Joshua Willis, RCP Jacob Byrd, and others.

260.   The physicians and nurses also violated these documentation requirements, by failing to enter records promptly.

261.   The deficiencies in these Hospital records are far from trivial or immaterial.

262.   On the contrary, they are of a degree rarely seen in hospital records, particularly records from a major trauma center concerning a patient who died there.   

263.   These violations were thus a gross departure from the standard of care.

Additional Notice of Claims

Administrative Negligence

Negligence, not Professional Malpractice

264.   Georgia law recognizes that ordinary negligence in the form of negligent administration can contribute to a chain of events that includes harmful medical malpractice.[6]

265.   Georgia law recognizes that both ordinary negligence and medical malpractice can co-exist and combine to cause harm — creating liability for both ordinary negligence and medical malpractice.

266.   Any negligence by a person not licensed for a profession listed in OCGA § 9-11-9.1(g) is ordinary negligence, not professional malpractice.

267.   Georgia courts have not catalogued every purely administrative task or duty that exists in a hospital.

268.   Plaintiff’s Negligent Administration claim is not a claim for professional malpractice as defined in OCGA § 9-11-9.1. Instead, it is a claim for negligence — that is, ordinary or simple negligence.

269.   This claim is premised largely on the negligence of persons who are not licensed for professions listed in OCGA § 9-11-9.1.

270.   To the extent this claim is premised on the negligence of persons who are licensed for professions listed in OCGA § 9-11-9.1, this claim addresses only acts that could permissibly be performed by people who are not so licensed.

271.   To the extent trial and appellate courts ultimately determine that any particular act constituted professional malpractice as defined in OCGA § 9-11-9.1, Plaintiff stipulates that the act does not support a claim for ordinary negligence.

Non-Licensed Administrators

272.   At all times relevant to this action, one or more of the Corporate Defendants was responsible for managing, operating, and/or administering the Hospital.

273.   The administrators of the Hospital included persons who were not licensed healthcare professionals and were not licensed for any profession listed in OCGA § 9-11-9.1 (“Non-Licensed Administrators”).

274.   Non-Licensed Administrators at the Hospital had responsibilities that impacted the safety of patients, including Waymon Storey.

275.   Non-Licensed Administrators at the Hospital negligently failed in such duties, thereby causing harm to Waymon Storey and his family.

276.   The negligent administration by Non-Licensed Administrators likely included failures of training, monitoring, communication, supervision, staffing, and funding, and the failure to create and maintain a culture of safety.

Licensed Administrators Acting in Purely Administrative Capacity

277.   The administrators of the Hospital included persons who were licensed healthcare professionals but who at times performed purely administrative duties (“Licensed Administrators”).

278.   Licensed Administrators had purely administrative responsibilities that impacted the safety of patients, including Waymon Storey.

279.   Licensed Administrators negligently failed in such purely administrative duties, thereby causing injury to Waymon Storey and his family.

280.   The negligent administration by Licensed Administrators included failures of training, monitoring, communication, supervision, staffing, and funding, and the failure to create and maintain a culture of safety.

Healthcare Administration Generally

281.   The way healthcare facilities are managed is not obvious or intuitive.

282.   Even clinicians with years of experience in a healthcare facility may have limited knowledge of how that facility is administered.

283.   Because most adults will have significant experience with healthcare as patients or consumers, they may have “gut” or “common sense” intuitions about healthcare administration that are strong, but wrong.

Principles of Healthcare Administration

Scale of Medical Error, and System Failures as a Cause

284.   Preventable medical error is a leading cause of death in the United States.

285.   The complexity of hospital care creates potential for medical errors of various kinds—for example, lack of preparedness, inattention, failures of communication, mistaken assumptions that someone else is addressing a problem, and others.

286.   A central function of healthcare administration is to create systems and organizational cultures that facilitate detection and correction of medical errors before they cause serious harm to any patient.

287.   Medical errors usually involve (a) error by a clinician directly involved in a patient’s care, and (b) system failures that create or accept unnecessary potential for error.

Management or Administration as a Distinct Discipline

288.   Hospital administrators need education, training, and skills different from those required to be a physician or nurse. Hospital administrators must have management training, but need not have gone to medical or nursing school.

289.   OCGA § 9-11-9.1(g) does not include hospital administrators in the list of professionals to which OCGA § 9-11-9.1 applies.

290.   Non-Licensed Administrators—because they are not medical professionals—do not apply medical judgment in their work.

291.   Where licensed medical professionals occupy administrative roles, some of their duties include administrative tasks that do not require being a licensed medical professional—for example, checking to make sure a certain policy has been communicated to hospital staff, or checking to make sure hospital staff have undergone certain training.

Non-Licensed Administrators and Patient Safety

292.   Clinicians treating patients usually are not in a position to fix problems with the systems and organizational cultures in a hospital.

293.   Hundreds or thousands of providers may practice in a given hospital. The individual providers practice within the systems and organizational cultures maintained by hospital administrators. The individual providers must rely on and are constrained by the work of hospital administrators.

294.   Patient safety is not solely the responsibility of the individual providers treating a patient.

295.   Hospital administrators acting in a purely administrative capacity also have responsibilities for protecting patient safety.

296.   Negligence by Non-Licensed Administrators can and does foreseeably cause harm to patients. Within the healthcare industry, this principle is accepted and well understood, by clinicians and non-clinicians alike.

Responsibilities of Hospital Administrators for Patient Safety

297.   Federal regulations impose requirements on hospital administrators concerning patient safety.

298.   The Joint Commission’s accreditation standards impose requirements on hospital administrators concerning patient safety.

299.   Pursuant to industry standards, Non-Licensed Administrators are responsible for the systems and organizational cultures of the hospital.

300.   Non-Licensed Administrators must learn about and identify the common sources of medical error industry-wide, and must ensure that those general sources of error are addressed effectively in the administrators’ own hospital.

301.   Concerning policies or protocols for medical care, Non-Licensed Administrators have limited but important responsibilities.

302.   Concerning policies or protocols for medical care, Non-Licensed Administrators are responsible for:

a.    making sure need-assessments are performed, to identify what policies or protocols should be created,

b.    making sure policies and protocols are communicated effectively to hospital staff (instead of merely papering the file),

c.     making sure training is given so that hospital staff understand how to apply the policies and protocols in practice,

d.    making clear that the policies and protocols must be followed (that is, that they are not bureaucratic formalities that staff can disregard),

e.     monitoring and enforcing compliance, and

f.      ensuring remedial actions are taken where compliance problems arise.

303.   Non-Licensed Administrators must engage all hospital staff in actively seeking out problems in the hospital’s system and culture—and in fixing the problems before they cause further harm.

304.   Non-Licensed Administrators must ensure the hospital is actually implementing policies. Papering the file is not enough.

305.   Non-Licensed Administrators have important responsibilities in a variety of specific areas. The following is a non-exhaustive list:

a.    Culture of Safety

b.    Quality Monitoring and Improvement

c.     Staffing and Training

d.    Communication, Transfers, and Hand-offs

e.     Patient Rights and Grievance Process

f.      Sentinel Events

Accountability for Hospital Administrators

306.   Purely administrative negligence can contribute substantially to medical error that hurts patients.

307.   It would be dangerous to exempt hospital administrators from accountability for their negligence.

308.   Exempting hospital administrators from accountability for their own negligence would remove an important incentive for administrators to work diligently to create systems that protect patients.

Negligent Administration Claim

309.   Through the negligent acts and omissions of administrators, one or more of the Corporate Defendants breached duties of care owed to Waymon Storey, causing him pain, suffering, injury, and death.

310.   Through the negligent acts and omissions of administrators, one or more of the Corporate Defendants breached duties of care owed to Waymon Storey’s family, causing them pain and suffering.  

311.   The negligent care Mr. Storey received gives rise to reasonable inferences of administrative negligence in the ways identified below, among others.

Example 1

312.   Administrators owe patients duties to create, implement, promulgate, and enforce protocols that are necessary to reasonably ensure patient safety, including a hospital trauma protocol. 

313.   Administrators also owe patients duties to provide education and training sufficient to ensure that members of the trauma team understand, follow, and comply with the hospital’s trauma protocol.

314.   Administrators also owe patients duties to regularly organize effective trauma simulations: mock exercises in which team members can improve their clinical skills; the team can enhance its collective ability to deliver organized, coordinated, and timely care; and administrators can identify the providers and workflows required to provide appropriate care in different scenarios. 

315.   These duties apply with special force at hospitals that are, or hold themselves out to be, major trauma centers, like the Hospital here. 

316.   These duties apply with special force to major trauma centers, which provide care, or should provide care, through a wide-ranging multi-disciplinary trauma team—like the Hospital here.

317.   Here, the trauma team’s repeated failures to secure Mr. Storey’s airway reveals that Hospital administrators either lacked, or otherwise failed to implement, promulgate, or enforce, a trauma protocol. 

318.   Here, the repeated failures to secure Mr. Storey’s airway even after several physicians were at bedside reveal that Hospital administrators also failed to organize the required team simulations. 

319.   Had Hospital administrators effectively created, implemented, promulgated, and enforced an effective trauma protocol, Dr. Salazar or others on the trauma team likely would have established an airway on Mr. Storey, promptly after he arrived at the ED—before he could suffer hypoxic cardiac arrest. 

320.   Had Hospital administrators provided the trauma team the required education and training, Dr. Salazar or another provider likely would have established an airway on Mr. Storey, promptly after he arrived at the ED—before he could suffer hypoxic cardiac arrest. 

321.   Had Hospital administrators organized effective simulations, the trauma team likely would have secured Mr. Storey’s airway, before he could suffer hypoxic cardiac arrest, and even shortly afterward. 

322.   Had Hospital administrators met the duties outlined above, the trauma team likely would have provided Mr. Storey and ventilation and oxygenation he needed, well before he could experience respiratory arrest, much less death.

323.   Each administrative failure thus permitted and likely even enabled the uncoordinated, disorganized, and ineffective care Mr. Storey received.

324.   Each administrative failure thus permitted and likely even enabled the failure to secure or even establish an airway.

325.   Each administrative failure was thus a cause of Mr. Storey’s pain, suffering, injury, and death.

Example 2

326.   As explained above, the standard of care requires healthcare providers to enter clear, complete, accurate, and timely medical records.

327.   Documentation informs and drives clinical decision-making downstream.

328.   That is, providers downstream rely upon the clarity, completeness, and accuracy of the medical records they receive.

329.   In short, appropriate documentation is essential optimize outcomes, prevent adverse long-term consequences, and safeguard patient safety.

330.   Administrators owe patients duties to create, implement, promulgate, and enforce policies that are necessary to reasonably ensure patient safety, including policies on proper documentation of cases in medical records.  

331.   Administrators also owe patients duties to provide education and training sufficient to ensure that clinicians understand, follow, and comply with the hospital’s policies and expectations on documentation.

332.   Here, as explained above, the Hospital medical records concerning Waymon Storey are unclear, incomplete, and incongruent.

333.   The deficient records, moreover, are not limited to one or two providers.

334.   Instead, the entire trauma team either entered deficient records or failed to enter records altogether.  

335.   The deficiencies in these Hospital records are far from trivial or immaterial.

336.   They are of a degree rarely seen in hospital records, particularly records from a major trauma center concerning a patient who died there.  

337.   These pervasive failures to enter records as required reveals that Hospital administrators either lacked, or otherwise failed to implement, promulgate, or enforce, any effective policy on documentation.

­­­_______________________

338.   Pursuant to OCGA Title 51, Chapter 4, Plaintiff is entitled to recover from the Corporate Defendants for the harm their negligent administration caused Mr. Storey.  

[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]  In December 2021, Wellstar Atlanta Medical Center, Inc. (“WAMC”) was a Georgia nonprofit corporation. Registered agent: Leo Reichert. Physical address and principal office address: 793 Sawyer Road, Marietta, GA 30062, in Cobb County. On October 1, 2022, WAMC merged with and into Kennestone Hospital, Inc. Kennestone was the Surviving Corporation. WAMC and Kennestone are therefore the same entity for legal purposes. Herein, all references to “Kennestone” or “WAMC” refer to both entities.

[3]  Plaintiff hereby intends to name the “Dr. Henderson” identified in Hospital records as being involved treating Waymon Storey on December 23, 2021. Upon information and belief, that physician was Dr. Vernon Henderson. If the “Dr. Henderson” identified in Hospital records was actually another person, that person is hereby on notice that, but for a mistake concerning the identity of the proper party, this action would have been brought against him. In that case, Plaintiff will also dismiss the allegations and claims herein asserted against Dr. Vernon Henderson and his Estate.

[4] See OCGA 9-11-1.

[5] See Atlanta Women’s Specialists v. Trabue, 310 Ga. 331 (2020) (“Georgia is a notice pleading jurisdiction. Generally, our Civil Practice Act (CPA) advances liberality of pleading. … [A] complaint need only provide fair notice of what the plaintiff's claim is and the grounds upon which it rests . … [The] objective of the CPA is to avoid technicalities and to require only a short and plain statement of the claim that will give the defendant fair notice of what the claim is and a general indication of the type of litigation involved; the discovery process bears the burden of filling in details.”) (cleaned up).

[6] See, e.g., Dent v. Memorial Hospital, 270 Ga. 316 (1998) (reversing judgment in favor of hospital, because jury instructions did not make clear that both ordinary negligence and professional malpractice would authorize a verdict against the hospital); Lowndes County Health v. Copeland, 352 Ga. App. 233 (2019) (affirming verdict for both ordinary negligence and professional negligence against skilled nursing facility).