In the State Court of Gwinnett County

State of Georgia

GLENDA YARBROUGHIndividually and as Representative of the Estate of RONALD YARBROUGH, deceased,

                  Plaintiff,

— versus —

GWINNETT HOSPITAL SYSTEM, INC.

CARDIOVASCULAR GROUP, P.C.

LANCE B. FRIEDLAND, MD

JOHN/JANE DOE 1-10,

                  Defendants

CIVIL ACTION

FILE NO. ___________

JURY TRIAL DEMANDED

Plaintiff’s Complaint for Damages

Nature of the Action

1.             This medical malpractice, wrongful death action arises out of medical services negligently performed on Ronald Yarbrough in October 2018 and May 2019.

2.             Plaintiff Glenda Yarbrough is the wife of Ronald Yarbrough, deceased.

3.             At the time of his death, Ronald Yarbrough was 64 years old with a life expectancy of an additional 19.5 years.[1]

4.             As Adminstrator, Plaintiff Glenda Yarbrough asserts a claim on behalf of the estate of Ronald Yarbrough for harm he suffered before he died.

5.             Plaintiff also asserts a wrongful-death claim pursuant to OCGA Title 51, Chapter 4.

6.             Pursuant to OCGA § 9-11-9.1, the Affidavit of Meldon C. Levy, MD, and the Affidavit of Marcia Bell, RN,are attached hereto as Exhibits 1 and 2. This Complaint incorporates the opinions and factual allegations contained in those affidavits.

7.             As used in this Complaint, the phrase “standard of care” means that degree of care and skill ordinarily employed by the medical profession generally under similar conditions and like circumstances as pertained to the Defendant’s actions under discussion.

Parties, Jurisdiction, and Venue

8.             Glenda Yarbrough is a citizen of Georgia and the wife of Ronald Yarbrough, deceased, and the representative of his estate.

9.             Defendant Gwinnett Hospital System, Inc. (“GHS”) is a Georgia corporation with its Registered Office in Gwinnett County. GHS may be served through their Registered Agent, Peter B. Wheeler, at 100 Medical Center Boulevard, Admin., Suite 110, Lawrenceville, Georgia 30046.

10.          GHS has been properly served with this Complaint.

11.          GHS has no defense to this lawsuit based on undue delay in bringing suit — whether based on the statute of limitations, the statute of repose, laches, or any similar theory.

12.          Pursuant to OCGA §§ 14-2-510 and 14-3-510,[2] GHS is subject to venue in this Court because (a) it maintains its registered office in Gwinnett County and (b) the cause of action originated in Gwinnett County and the corporation has an office and transacts business in that county.

13.          Plaintiff believes that at all relevant times, GHS was the employer or other principal of the individuals who conducted the pre-admission, pre-surgery screening of Ronald Yarbrough in May and June 2019 for his planned colon resection surgery. However, if any other entity was a principal of those individuals, each such entity is hereby on notice that but for a mistake concerning the identity of the proper party, the action would have been brought against it.

14.          Defendant Cardiovascular Group, P.C. (“CVG”) is a Georgia professional corporation with its Registered Office in Gwinnett County. CVG may be served through their Registered Agent, Philip A. Romm, at 755 Walther Road, Lawrenceville, Georgia 30046.

15.          CVG has been properly served with this Complaint.

16.          CVG has no defense to this lawsuit based on undue delay in bringing suit — whether based on the statute of limitations, the statute of repose, laches, or any similar theory.

17.          Pursuant to OCGA 14-2-510 and OCGA 14-7-2 and -3,[3] CVG is subject to venue in this Court because (a) it maintains its registered office in Gwinnett County and (b) the cause of action originated in Gwinnett County and the corporation has an office and transacts business in that county.

18.          Plaintiff believes that at all relevant times, CVG was the employer or other principal of Dr. Lance B. Friedland and the other individuals responsible for recording the CT calcium scoring results in Ronald Yarbrough’s chart, or for reviewing those results, or for communicating the importance of those results to Mr. Yarbrough. However, if any other entity was a principal of those individuals, each such entity is hereby on notice that but for a mistake concerning the identity of the proper party, the action would have been brought against it.

19.          Defendant Lance B. Friedland, MD, is a citizen of Georgia, residing in Fulton County. He may be served with process at his residence: 1010 Chesson Court, Alpharetta, Georgia 30022. If not found there, Dr. Friedland may be served at his place of business: Cardiovascular Group, 755 Walther Road NW, Lawrenceville, Georgia, 30045.

20.          Dr. Friedland has been properly served with this Complaint.

21.          Dr. Friedland has no defense to this lawsuit based on undue delay in bringing suit — whether based on the statute of limitations, the statute of repose, laches, or any similar theory.

22.          Pursuant to OCGA 9-10-31, Dr. Friedland is subject to venue in this Court because his co-defendant, CVG, is subject to venue in this Court.

23.          At all times relevant to this Complaint, Dr. Friedland acted as an employee or agent of CVG.

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

25.          This Court has subject matter jurisdiction, and venue is proper as to all Defendants in this Court.

Facts

26.          When a cardiologist has a patient undergo testing, the physician and the physician’s practice group are responsible for reviewing the results, identifying any concerning results, correctly informing the patient of any important abnormal results, arranging for any appropriate follow-up testing or counseling, and ensuring that the results are recorded in the patient’s chart and readily available to the physician.

27.          These tasks are important to patient safety. If these tasks are not performed diligently, then dangerous, treatable medical conditions may go unaddressed — with catastrophic results.

28.          The cardiologist and the practice group bear joint responsibility for the tasks described above.

29.          Generally, when a cardiologist examines a patient in advance of anticipated medical procedures, the cardiologist must consider whether the patient’s cardiovascular condition is suited for the potential procedures, and must issue any cautions or warnings that may be necessary.

30.          Where a cardiologist does not issue such cautions or warnings, a patient may be erroneously cleared for a surgery or other procedure that the patient’s heart cannot safely withstand.

31.          On March 7, 2017, upon a referral from Ronald’s primary care physician, Dr. Robert Deimler, Ronald underwent a stress test, an exercise treadmill test (ETT), at Gwinnett Medical Center.

32.          Dr. Louis Heller reviewed the ETT results. Dr. Heller noted “ST Changes: 2-3 mm inferior and anterolateral ST-T wave downsl.” Dr. Heller’s overall impression was “Abnormal ETT.”

33.          Because of the abnormal ETT, Ronald was scheduled for an exercise dual isotope myocardial perfusion scan (DIMPS).

34.          Dr. Lance Friedland reviewed the results of the DIMPS and found it to be normal, noting “There is no evidence of Ischemia or Infarction at a maximal level of exercise.”

35.          More than a year and half later, on October 15, 2018, Dr. Friedland examined Mr. Yarbrough at CardioVascular Group and ordered a CT calcium scoring examination.

36.          On October 26, 2018, Mr. Yarbrough went to the Gwinnett Hospital System for a noncontrast CT scan of his heart, which provided calcium scoring. The report for that exam noted that Mr. Yarbrough’s coronary artery calcification score in his left anterior descending artery (“LAD”) was 469.

37.          The standard of care required CardioVascular Group and Dr. Friedland to review these test results, to place them in Mr. Yarbrough’s chart, and to make sure the information was readily available to Dr. Friedland in future reviews or examinations of Mr. Yarbrough.

38.          The calcium scoring results meant Mr. Yarbrough likely had extensive atherosclerotic plaque in his LAD — that is, that Mr. Yarbrough likely had a high-grade stenosis in one of the critical arteries to the myocardium.

39.          The standard of care required Dr. Friedland to follow up with Mr. Yarbrough, for further evaluation and potential treatment of the coronary artery disease.

40.          Dr. Friedland did not follow up with Mr. Yarbrough on the calcium scoring. Dr. Friedland thereby violated the standard of care.

41.          Instead, on October 30, 2018, CardioVascular Group sent a letter to Mr. Yarbrough, telling him in essence that his calcium scoring results were unconcerning.

42.          The letter from CardioVascular Group specifically indicated that Dr. Friedland had noted Mr. Yarbrough’s elevated calcium score, but cited an old cardiac catheterization and a 2017 stress test as alleviating concerns from the calcium score. (“Your Calcium score is elevated, but your last cardiac cath showed non-obstructive disease. . . . Your stress test in 2017 was negative.”)

43.          Ronald Yarbrough reasonably relied on the letter from CardioVascular Group interpreting the CT calcium score in light of the prior stress test and cardiac catheterization.

44.          However, Dr. Friedland’s October 2018 office note referred only to a cardiac catheterization from 2006 (twelve years earlier) and a stress test from March 2017 (1-1/2 years earlier).

45.          It was grossly unreasonable to regard Mr. Yarbrough’s highly elevated calcium score as unconcerning based on a 12-year-old cardiac catheterization and a 1-1/2-year-old stress test.

46.          The stress test was abnormal in it showed exercise-induced 2-3 mm ST segment depression consistent with ischemia.

47.          Several months after the CT calcium scoring, in 2019, Mr. Yarbrough suffered abdominal pain for which he went to a hospital Emergency Room. In response to his abdominal problems, a colonoscopy and endoscopy were planned.

48.          Before those procedures, Mr. Yarbrough returned to Dr. Friedland.

49.          On May 6, 2019, Dr. Friedland examined Mr. Yarbrough at CardioVascular Group. Dr. Friedland understood that Ronald had been to the ER for abdominal pain and that Ronald was scheduled for a colonoscopy and endoscopy.

50.           At this office visit, the standard of care required Dr. Friedland to consider whether Mr. Yarbrough could safely undergo the colonoscopy and endoscopy.

51.          Because of the high calcium score and additional risk factors, the standard of care required Dr. Friedland to do a cardiac workup before the colonscopy and endoscopy, to exclude ischemic heart disease.

52.          Dr. Friedland did not do such a workup.

53.          Dr. Friedland’s office note made no reference to Mr. Yarbrough’s CT calcium scoring from October 2018.

54.           On May 9, 2019, Mr. Yarbrough underwent a colonoscopy that revealed benign polyps in his colon, including a non-obstructive mass for which the gastroenterologist referred Mr. Yarbrough for a surgical consult.

55.           On May 15, 2019, Mr. Yarbrough saw a surgeon, Dr. Kota Venkatesh, to consider a colon resection.

56.           On May 23, 2019, Mr. Yarbrough went through a pre-admission screening at Gwinnett Hospital, by Nakia Vasey-Evans, RN.

57.          The screening included a discussion of cardiological conditions. Mr. Yarbrough told the hospital staff that he experienced tachycardia, hyperlipidemia, and difficulty with certain tasks.

58.           The preadmit testing record indicates “medical consents/clearance” by Dr. Robert Deinler (internal medicine) and by Dr. Friedland. 

59.          For a nurse conducting a pre-surgery screening, the standard of care requires the nurse to obtain direct, unambiguous medical clearance for the surgery from the patient’s treating physicians.

60.          On information and belief, the nurse did not obtain medical clearance from Dr. Friedland but erroneously recorded a clearance from him. The nurse thus violated the standard of care.

61.          On June 4, 2019, before the surgery, Mr. Yarbrough underwent a pre-anesthesia evaluation, which reviewed the same cardiological information as given in the May 23 pre-admit screening.

62.           The information obtained in the pre-admission and pre-anesthesia screenings was consistent with the October 30, 2018, letter from CardioVascular Group to Mr. Yarbrough.

63.          As of October 2018 — nearly eight months before the scheduled surgery — Mr. Yarbrough likely had a high-grade arterial stenosis that (without treatment) rendered a non-urgent surgery dangerous to Mr. Yarbrough.

64.          A non-minor surgery places physical stress on the cardiovascular system, in part because of the effects of anesthesia, which can cause cardiac depression and hemodynamic instability. The stress of surgery thus can place demands on the heart that are dangerous in a patient with untreated cardiac disease.

65.          Even as of October 2018, without further cardiological treatment, a non-urgent colectomy for Mr. Yarbrough would have posed a significant risk of inducing a heart attack. That risk would likely have increased in the nearly eight months from the October 26, 2018, calcium scoring to the June 4, 2019, colectomy.

66.          Mr. Yarbrough was not medically qualified for the June 4 surgery.

67.          If Dr. Friedland had been asked to provide written medical clearance for Mr. Yarbrough’s June 4 colectomy, then Dr. Friedland likely would have reviewed Mr. Yarbrough’s CT calcium scoring results, realized Mr. Yarbrough was not fit for surgery, and refused to clear him for the surgery.

68.          If Mr. Yarbrough’s arterial stenosis had been identified and treated appropriately beginning in October 2018, with careful evaluation before the June 2019 colectomy, Mr. Yarbrough likely could have undergone the colectomy safely.

69.          On the afternoon of Tuesday, June 4, 2019, Mr. Yarbrough underwent the colectomy. 

70.          About a day and a half after the surgery, while Mr. Yarbrough recovered, in the early morning hours of Thursday, June 6, 2019, Mr. Yarbrough showed signs of cardiac distress.

71.          At approximately 1:00 AM on June 6, cardiologist Dr. Martin B. Siegfried examined Mr. Yarbrough. Dr. Siegfried noted that Mr. Yarbrough was experiencing chest pain with elevated troponin levels. Dr. Siegfried suspected demand ischemia.

72.          Several hours later, at approximately 0930 hours, another cardiologist, Dr. Salil Patel, noted that Mr. Yarbrough’s troponin levels continued to rise and noted that the EKG suggested myocardial ischemia with sinus tachycardia.

73.          On Friday, June 7, Dr. Priya Baronia noted that Mr. Yarbrough had suffered a non-ST-elevation myocardial infarction and would probably have a heart catheterization the following Monday.

74.          On Saturday, June 8, cardiologist Dr. Siegfried noted that a heart catheterization had been delayed to allow time for the healing of the surgical bed.

75.          On Sunday, June 9, Dr. Siegfried noted that Mr. Yarbrough likely suffered a focal LAD disease.

76.          On Monday, June 10, Dr. Rodica Ellis noted that Mr. Yarbrough had been referred to cardiac surgery for a coronary artery bypass evaluation, due to severe arterial disease and ischemic cardiomyopathy.

77.          On Tuesday, June 11, Dr. Lance Friedland noted that it appeared Mr. Yarbrough would receive bypass surgery the following week, because the surgeon Dr. Venkatesh recommended that bypass surgery wait until at least 10 days after the abdominal surgery.

78.          On Sunday, June 16, Mr. Yarbrough’s physicians noted that Mr. Yarbrough had a bone-healing deficiency that made a traditional open-sternum bypass surgery dangerous.

79.          On Monday, June 17, Mr. Yarbrough’s physicians planned to transfer Mr. Yarbrough to Emory St. Joseph’s Hospital, for a robot-assisted minimally invasive surgery.

80.          On Monday, June 17, Mr. Yarbrough was in fact transferred to Emory St. Joseph’s.

81.          At Emory St. Joseph’s, Mr. Yarbrough was prepared for bypass surgery to occur on Friday, June 21.

82.          From the afternoon of Friday, June 21 through the early morning of Saturday, June 22, Mr. Yarbrough underwent an approximately 10-hour cardiac surgery.

83.          The surgery encountered complications that required switching from a minimally-invasive, robot-assisted approach to a sternotomy. Mr. Yarbrough experienced ventricular arrhythmias and hypokinesis during the surgery. At the close of surgery, Mr. Yarbrough appeared reasonably stable.

84.          On Saturday, June 22, after the surgery, at about 8 AM, a hospital progress note suggests that Mr. Yarbrough remained intubated and on a ventilator but appeared stable.

85.          Twenty-four hours later, by 8 AM on Sunday, June 23, Mr. Yarbrough was showing signs of kidney failure.

86.          Another day later, by about 11 AM Monday, June 24, Mr. Yarbrough’s condition had become critically ill, with cardiogenic shock and respiratory instability as well as kidney failure.

87.          Another day later, on Tuesday, June 25, Mr. Yarbrough had deteriorated more.

88.          That day, June 25, Mr. Yarbrough was transferred to Emory University Hospital.

89.          Over the next 2-1/2 weeks, Mr. Yarbrough’s family watched him deteriorate and made the decision to let him pass away.

90.          On July 12, 2019, Mr. Yarbrough died.

91.          Mr. Yarbrough died from organ failure caused by cardiogenic shock.

92.          If Dr. Friedland, CardioVascular Group, and Gwinnett Medical Center had not violated their standards of care, Mr. Yarbrough’s LAD stenosis could have been addressed safely and timely, and the June 2019 post-surgery heart attack and premature death could have been avoided.

93.          If Mr. Yarbrough’s LAD stenosis had been identified and addressed properly in October 2018, Mr. Yarbrough likely would have lived at least another 10 years.

Count 1 – Injuries & Wrongful Death from Professional Negligence — GHS

94.          Plaintiff incorporates by reference, as if fully set forth herein, all preceding paragraphs of this Complaint.

95.          The standard of care required the hospital staff who conducted the preadmit screenings for the colectomy to obtain a medical clearance from Dr. Friedland and to bring the CT calcium scoring result to the attention of the anesthesia team.

96.          The staff violated that standard of care.

97.          That violation substantially contributed to Mr. Yarbrough suffering a heart attack induced by the surgery — leading ultimately to organ failure and death.

98.          GHS is vicariously liable for the negligence of the staff, because they acted within the scope of their agency for GHS.

99.          Mr. Yarbrough’s estate is entitled to recover from GHS for the physical, emotional, and economic injuries Mr. Yarbrough suffered before he died, including special damages such as funeral costs and other direct financial costs, as a proximate result of the Defendants’ negligence.

100.       Pursuant to OCGA Title 51, Chapter 4, Ronald Yarbrough’s wrongful death beneficiaries are entitled to recover from GHS for the value of Mr. Yarbrough’s life lost as a proximate result of the Defendants’ negligence.

Count 2 – Injuries & Wrongful Death from Professional Negligence — CardioVascular Group and Dr. Friedland

101.       Plaintiff incorporates by reference, as if fully set forth herein, all preceding paragraphs of this Complaint.

102.       The standard of care required Dr. Friedland to follow up on the CT calcium score results, correctly inform Mr. Yarbrough of the results and their significance, and to evaluate Mr. Yarbrough for further treatment of his arterial stenosis.

103.       The standard of care required CVG itself (through its staff) to ensure that the score results were recorded in Mr. Yarbrough’s chart, brought to Dr. Friedland’s attention, and correctly communicated to Mr. Yarbrough.

104.       Dr. Friedland and the CVG staff violated these standards of care.

105.       These violations substantially contributed to Mr. Yarbrough suffering a heart attack induced by the surgery — leading ultimately to organ failure and death.

106.       Dr. Friedland is directly liable for his own negligence.

107.       CVG is vicariously liable for the negligence of Dr. Friedland and of other CVG staff, because those individuals were acting within the scope of their agency for CVG.

108.       Mr. Yarbrough’s estate is entitled to recover from CardioVascular Group and Dr. Friedland for the physical, emotional, and economic injuries Mr. Yarbrough suffered before he died, including special damages such as funeral costs and other direct financial costs, as a proximate result of the Defendants’ negligence.

109.       Pursuant to OCGA Title 51, Chapter 4, Ronald Yarbrough’s wrongful death beneficiaries are entitled to recover from CardioVascular Group and Dr. Friedland for the value of Mr. Yarbrough’s life lost as a proximate result of the Defendants’ negligence.

Damages

110.       Plaintiff incorporates by reference, as if fully set forth herein, all preceding paragraphs of this Complaint.

111.       As a direct and proximate result of the Defendants’ conduct, Plaintiff is entitled to recover from Defendants reasonable compensatory damages in an amount exceeding $10,000.00 to be determined by a fair and impartial jury for all damages Plaintiff suffered, including physical, emotional, and economic injuries.

112.       WHEREFORE, Plaintiff demands 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; and

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

May 8, 2020

Respectfully submitted,

/s/ Lloyd N. Bell                             

Georgia Bar No. 048800

Daniel E. Holloway

Georgia Bar No. 658026

BELL LAW FIRM

1201 Peachtree St. N.E., Suite 2000

Atlanta, GA 30361

(404) 249-6767 (tel)

bell@BellLawFirm.com

dan@BellLawFirm.com

/s/ Lawrence B. Schlachter                      

Lawrence B. Schlachter M.D. J.D.

Georgia Bar No. 001353

Schlachter Law Firm

1201 Peachtree Street NE, Suite 2000

Atlanta, GA 30361

(770) 552-8362 (tel)

larry@schlachterlaw.com

Attorneys for Plaintiff

[1] See National Vital Statistics Reports, Vol. 68, No. 7, June 24, 2019, Table 2. Life table for males: United States, 2017, available at https://www.cdc.gov/nchs/data/nvsr/nvsr68/nvsr68_07-508.pdf.

[2] OCGA §§ 14-2-510 and 14-3-510 provide identical venue provisions for regular business corporations and for nonprofit corporations:

“Each domestic corporation and each foreign corporation authorized to transact business in this state shall be deemed to reside and to be subject to venue as follows: (1) In civil proceedings generally, in the county of this state where the corporation maintains its registered office…. (3) In actions for damages because of torts, wrong, or injury done, in the county where the cause of action originated, if the corporation has an office and transacts business in that county; (4) In actions for damages because of torts, wrong, or injury done, in the county where the cause of action originated.”

Note: These same venue provisions apply to Professional Corporations, because PCs are organized under the general “Business Corporation” provisions of the Georgia Code. See OCGA § 14-7-3. These venue provisions also apply to Limited Liability Companies, see OCGA § 14-11-1108, and to foreign limited liability partnerships, see OCGA § 14-8-46.

[3] Defining a “professional corporation” as a corporation organized under OCGA Title 14, Chapter 2 (and thus subject to OCGA 14-2-510).