RETURN DATE: SEPTEMBER 18, 2018 SUPERIOR COURT JOHN E. GAROFALO, ADMINISTRATOR OF THE ESTATE OF JESSICA R. GAROFALO AND HARRY MONTGOMERY, ADMINISTRATOR WATERBURY OF THE ESTATE OF RAYNE MONTGOMERY VS. AT WATERBURY WATERBURY AUGUST 16, 2018 LEGACY NETWORK, INC. WATERBURY JONATHAN P. LANDRY, SPECIALISTS IN WOMENS HEALTHCARE, ARTHUR B. LANDRY, JOHN KACZMAREK, ELEANOR A. BERRY, AND DENISE PRATT, APRN COMPLAINT FIRST COUNT: (As to plaintiff, John E. Garofalo, Adm. of the Estate of Jessica Garofalo and Defendant, Waterbury HOSpital and Legacy Network, Inc. d/b/a Waterbury Hospital) I . At all times mentioned herein, the defendant, Waterbury Hospital and Legacy Network, Inc. d/b/a Waterbury Hospital (hereinafter collectively referred to as Waterbury Hospital), was a corporation organized and existing under the laws of the State of Connecticut. 2. Said defendant conducted and maintained a general hospital, including emergency room services, medical and surgical facilities for treatment of patients and has a principle place of business located at 64 Robbins Street, Waterbury, Connecticut. 3. At all times relevant hereto, Jonathan P. Landry, MD. was an agent, servant and/or employee of the defendant, Waterbury Hospital, acting within the scope of his authority. 4. On or about February 22, 2017, John E. Garofalo was appointed the Administrator of the Estate of Jessica R. Garofalo, deceased by the Probate Court in the District of Waterbury and brings this action acting as such pursuant to C.G.S ?52?555. Kennedy, jolzmon, Schwab Roberge L.L.C. - ATTORNEYS A?rmw LONG MARITIME CENTER . 555 LONG EIARF DRIVE, 13m Floor - Niiw 06551 .FAX {203) 8556345 {203) 865?8430 NO. 106077 5. On September 6, 20l5, Jessica R. Garofalo, presented to the emergency department of the Defendant, Waterbury HOSpital with complaints of abdominal pain. 6. On said date, the defendant accepted Jessica R. Garofalo as a patient through the emergency department. 7. At the aforementioned time, the defendant, acting by and through Jonathan P. Landry, M.D., and its other actual and/or apparent agents, servants and/or employees, examined Jessica R. Garofalo and undertook to provide her with medical care and treatment for her complaints. 8. During said visit, Jessica R. Garofalo underwent a CT scan that revealed an indeterminate right adrenal lesion measuring 3.2 2.7 cm. which was reported to be better evaluated with MRI. 9. She was diagnosed with pelvic in?ammatory disease, an ovarian and gallbladder sludge and discharged from the emergency department with prescriptions and instructions to follow? up with her ob?gyn. 10. Thereafter, Jessica R. Garofalo, became pregnant. I 1. On August 20, 2016, she presented to the defendant, Waterbury Hospital, in connection with her pregnancy for a scheduled betamethasone injection. She became short of breath, tachycardic and was taken emergently for c-section and delivered a baby girl, Rayne Montgomery. 12. Shortly thereafter she suffered cardiac arrest and despite multiple rounds of ACLS she died. 13. On August 21, 2016, her infant baby girl, Rayne Montgomery, died as a result of respiratory failure and hypoxic ischemic encephalopathy. Kennedy, jo/mson, Schwab ea" Roberge L.L.C. 0 AT LAW LONG CliN'I?liR - 555 LONG DRIVE, 13th Floor a NEW l-IAvnN, CT 06511 FAX (203) 865-5345 0 (203) 865?8430 NO. 106077 14. The injuries, losses and damages sustained by the plaintiff decedent, Jessica R. Garofalo, were caused by the carelessness and negligence of the defendant in one or more of the following ways, in that said defendant: a. discharged Jessica R. Garofalo from the emergency department without informing her of the adrenal lesion found on CT scan imaging; b. failed to recommend follow-up for said adrenal lesion; c. failed to obtain an MRI to better evaluate the right adrenal lesion; d. failed to recognize the signi?cance of the right adrenal lesion; e. failed to recognize the risks associated with the right adrenal lesion; and f. failed to use safe and effective medical practices and procedures. 15. As a result of the carelessness and negligence of the defendant, the plaintiff? decedent, Jessica R. Garefalo, suffered maternal congestive heart failure associated with pheochromocytoma, physical and emotional pain and suffering, cardiorespiratory arrest and death. 16. As a further result of the carelessness and negligence of the defendant, the plaintiff?s decedent, Jessica R. Garofalo has been permanently deprived of the enjoyment of her normal life?s activities. 17. As a further result of the carelessness and negligence of the defendant, the plaintiff?s decedent, Jessica R. Garofalo suffered permanent loss of earnings and loss of earning capacity. 18. As a further result of the carelessness and negligence of the defendant, the decedent?s estate was required to expend sums of money for funeral and estate costs. 19. On or about July 26, 2018, the plaintiff obtained a 90- day extension of the statute of limitations. Kennedy, johnson, Schwab c5? Roberge L.L.C. - A'r'ronmars ATLAW LONG I-IARF 1~1 CENTER 0 555 LONG MARY DRIVE, 1311-1 Floor - NEW HAVEN, CT 0651] FAX (203) 865?5345 (203) 86545430 EIURIS NO. 106077 SECOND COUNT: (As to plaintiff, Harry Montgomery, Adm. of the Estate of Rayne Montgomery and defendant, Waterbury Hospital and Legacy Network, Inc. d/b/a Waterbury Hospital) 1-3. Paragraphs 1 through 3 of the First Count are hereby incorporated, re-alleged and made paragraphs 1 through 3 of the Second Count. 4. On or about December 8, 2016, Harry Montgomery was appointed the Administrator of the Estate of Rayne Montgomery, deceased by the Probate Court in the District of Waterbury and brings this action acting as such pursuant to C.G.S ?52~555. 5-13. Paragraphs 5 through 13 of the First Count are hereby incorporated, re?alleged and made paragraphs 5 through 13 of the Second Count. 14. Concerning the care of Jessica R. Garofalo and the death of Rayne Montgomery, the defendant was negligent in one or more of the following ways, in that said defendant: a. discharged Jessica R. Garofalo from the emergency department without informing her of the adrenal lesion found on the CT scan imaging; b. failed to recommend follow-up for said adrenal lesion; 0. failed to obtain an MRI to better evaluate said right adrenal lesion; d. failed to recognize the signi?cance of the right adrenal lesion; e. failed to recognize the risks associated with the right adrenal lesion; and f. failed to use safe and effective medical practices and procedures. 15. As a result ofthe carelessness and negiigence ofthe defendant, the plaintiff?s decedent, Rayne Montgomery, suffered respiratory failure and hypoxic ischemic encephalopathy, physical and emotional pain and suffering, and death. 16. As a result of the carelessness and negligence of the defendant, the piaintift?s decedent, Rayne Montgomery?s capacity to carry out life?s activities was permanently destroyed. Kennedy, johnson, Schwab ct? Roberge L.L.C. - ATTORNEYS AT LAW LONG - 555 LONG WI-IARF DRIVE, 13th Floor . NEW CT 06511 FAX (203) 8655345 0 (203) 865-8430 NO. 106077 17. As a result of the carelessness and negligence of the defendant, the plaintiffs decedent, Rayne Montgomery suffered permanent loss of earnings and loss of earning capacity. 18. As a further result of the carelessness and negligence of the defendant, the decedent?s estate was required to expend sums of money for funeral and estate costs. 19. On or about July 26, 20 i 8, the plaintiff obtained a 90~day extension of the Statute of Limitations. THIRD COUNT: (As to plaintiff, John E. Garofalo, Adm. of the Estate of Jessica Garofalo and Defendant, Jonathan P. Landry, MD.) 1. At all times mentioned herein, the defendant, Jonathan P. Landry, M.D., was a physician licensed to practice medicine in the State of Connecticut. 2?4. Paragraphs 4 through 6 of the First Count are hereby incorporated and real leged and made Paragraphs 2 through 4 of the Third Count. 5. At the aforementioned time, the defendant examined Jessica R. Garofalo and undertook to provide her with medical care and treatment for her complaints. 6-17. Paragraphs 8 through 19 of the First Count are hereby incorporated and re-alleged and made Paragraphs 6 through 17 of the Third Count. FOURTH COUNT: (As to plaintiff, Harry Montgomery, Adm. of the Estate of Rayne Montgomery and defendant, Jonathan P. Landry, MD.) 1. At all times mentioned herein, the defendant, Jonathan P. Landry, M.D., was a physician licensed to practice medicine in the State of Connecticut. 2?4. Paragraphs 4 through 6 of the First Count are hereby incorporated and realleged and made Paragraphs 2 through 4 of the Fourth Count. 5. At the aforementioned time, the defendant examined Jessica R. Garofalo and undertook to provide her with medical care and treatment for her complaints. Kennedy, 011mm, chwa 59? Roberge L.L.C. - ATTORNEYS AT LAW LONG WIIARF CENTER - 5355 LONG WI-IARF DRIVE, 13th Floor 0 NEW i-lAVl?N, 0651! FAX (203) 8656845 0 (203) 865-8430 - NO. 106077 6-17. Paragraphs 8 through 19 of the Second Count are hereby incorporated and re?alleged and made Paragraphs 6 through 17 of the Fourth Count. FIFTH COUNT: (As to plaintiff, John E. Garofalo, Adm. of the Estate of Jessica Garofalo and Defendant, Specialists in Women?s Healthcare, RC.) 1. At all times relevant hereto, the defendant, Specialists in Women?s Healthcare, P.C., was a professional corporation organized and existing under the laws of the State of Connecticut with a business address at 134 Grandview Ave, Waterbury, Connecticut. 2. At all times relevant hereto, the defendants, Arthur Landry, M.D., John Kaczmarek, M.D., Eleanor Berry, MD. and Denise Pratt, APRN, were agents, servants and/or employees of the defendant, Specialists in Women?s Healthcare, P.C., acting within the scope of their authority. 3. On or about February 22, 2017, John E. Garofalo was appointed the Administrator of the Estate of Jessica R. Garofalo, deceased by the Probate Court in the District of Waterbury and brings this action acting as such pursuant to C.G.S ?52-555. 4. On and before September 30, 2015, the plaintiff? decedent, Jessica R. Garofalo, came under the continuing care and treatment of the defendant for gynecological and obstetrical care. 5. On or about September 30, 2015, Jessica R. Garofalo presented to the defendant with complaints of urinary tract infection. 6. On said date, the defendant obtained the CT scan results from the Waterbury Hospital emergency department visit of September 6, 2015, which revealed an indeterminate right adrenal lesion measuring 3.2 2.7 cm. reported to be better evaluated by MRI. 7. At said visit, Jessica R. Garofalo was diagnosed with acute cystitis and prescribed -Macrobid. The right adrenal lesion was not addressed and no follow?up was undertaken at that time. Kennedy, 011mm, Schwab ea? Roberge L.L.C. - ATTORNEYS AT LAW LONG WHARF - 5535 LONG WI-IARF DRIVE. Isth Fioor - NEW 065! 1 FAX (203) 865?5345 - (203) 865-8430 - NO. 106077 8. Thereafter, Jessica R. Garofalo became pregnant and the defendant undertook to provide her medical care with respect to her pregnancy and to deliver her baby. 9. During said medical care there was no follow?up of the right adrenal lesion. 10. On August 20, 2016, the plaintiffs decedent, Jessica R. Garofalo, presented to the defendant, Waterbury Hospital in connection with her pregnancy for a scheduled betamethasone injection. She became short of breath, tachycardic and was taken emergently for c?section and delivery of a baby girl, Rayne Montgomery. 1 l. Shortly thereafter, Jessica R. Garofaio suffered cardiac arrest and deSpite multiple rounds of ACLS she died. 12. On August 21, 2016, her infant baby girl, Rayne Montgomery, died as a result of respiratory failure and hypoxic ischemic encephalopathy 13. The injuries, losses and damages sustained by the plaintiff?s decedent, Jessica R. Garofalo were caused by the carelessness and negligence of the defendant in one or more of the following ways, in that said defendant: a. failed to foliow-up on the CT scan of September 6, 20} 5; b. failed to order an MRI on or about September 30, 2015, and/or everyday thereafter; 0. failed to recognize that the lesion reported on the CT scan of September 6, 2015, required follow-up; d. failed to recognize the risks associated with the failure to follow?up on the findings of the CT scan; e. failed to make a referral and/or refer her to an endocrinologist, and/or other appropriate specialist to assess the 3.2 2.7 cm. adrenal lesion reported on the CT scan of September 6, 2015; f. failed to make a referral to address the 3.2 2.7 cm. adrenal lesion in the setting of her pregnancy; and g. failed to use safe and effective medical practices and procedures. Kennedy, 012mm, Schwab ear Roberg?e L.L.C. - ATTORNEYS AT LAW LONG I-IARF CENTER . 555 LONG WIMRF DRIVE, 13:11 Floor - New HAVEN. Cl? 065: 1 FAX (203) 865-5345 . (203) 865-8430 - NO. 1060?? 14 - 18. Paragraphs 15 through 19 of the First Count are hereby incorporated and realleged and made Paragraphs 14 through 18 of the Fifth Count. SIXTH COUNT: (As to plaintiff, Harry Montgomery, Adm. of the Estate of Rayne Montgomery and defendant, Specialists in Women?s Healthcare, P.C.) 1-2. Paragraphs 1 through 2 of the Fifth Count are hereby incorporated and realleged and made Paragraphs 1through 2 of the Sixth Count. 3. On or about December 8, 2016, Harry Montgomery was appointed the Administrator of the Estate of Rayne Montgomery, deceased by the Probate Court in the District of Waterbury and brings this action acting as such pursuant to C.G.S ?52?555. 4-12. Paragraphs 4 through 12 of the Fifth Count are hereby incorporated and realleged and made Paragraphs 4 through 12 of the Sixth Count. 13. Concerning the care of Jessica R. Garofalo and the death of Rayne Montgomery said defendant was negligent in one or more of the following ways, in that said defendant: a. failed to follow-up on the CT scan of September 6, 2015; b. failed to order an MRI on or about September 30, 2015, and/or everyday thereafter; c. failed to recognize that the lesion reported on the CT scan of September 6, 2015, required follow-up; d. failed to recognize the risks associated with the failure to follow-up on the ?ndings of the CT scan; e. failed to make a referral and/or refer her to an endocrinologist, and/or other appropriate specialist to assess the 3.2 2.7 cm. adrenal lesion reported on the CT scan of September 6, 2015; f. failed to make a referral to address the 3.2 2.7 cm. adrenal lesion in the setting of her pregnancy; and g. failed to use safe and effective medical practices and procedures. Kennedy, johnson, Schwab Roberge I..L.C. - ATTORNEYS ATLAW LONG WHARF - 555 LONG DRIVE, 13th Flotn? - NEW CT 06511 FAX (203) 865-5345 0 (203) 865-8430 I NO. 106077 14-18. Paragraphs 14 through 18 of the Fifth Count are hereby incorporated and realleged and made Paragraphs 14 through 18 of the Sixth Count. SEVENTH COUNT: (As to plaintiff, John E. Garofalo, Adm. of the Estate of Jessica Garofalo and Defendant, Arthur B. Landry, MD.) 1. At all times mentioned herein, the defendant, Arthur B. Landry, M.D., was a physician licensed to practice medicine in the State of Connecticut. 2-17. Paragraphs 3 through 18 of the Fifth Count are hereby incorporated and realleged and made Paragraphs 2 through 17 of the Seventh Count. EIGHTH COUNT: (As to plaintiff, Harry Montgomery, Adm. of the Estate of Rayne Montgomery and defendant, Arthur B. Landry, MD.) 1. At ail times mentioned herein, the defendant, Arthur B. Landry, M.D., was a physician licensed to practice medicine in the State of Connecticut. 2- l7. Paragraphs 3 through 18 of the Sixth Count are hereby incorporated, re-alleged and made paragraphs 2 through 17 of the Eighth Count. NINTH COUNT: (As to plaintiff, John E. Garofalo, Adm. 0f the Estate of Jessica Garofalo and Defendant, John Kaezmarek, MD.) 1. At all times mentioned herein, the defendant, John Kaczmarek, M.D., was a physician licensed to practice medicine in the State of Connecticut. 2- l7. Paragraphs 3 through 18 of the Fifth Count are hereby incorporated, re?alleged and made paragraphs 2 through 17 of the Ninth Count. TENTH COUNT: (As to plaintiff, Harry Montgomery, Adm. of the Estate of Rayne Montgomery and defendant, John Kaczmarek, MD.) 1. At all times mentioned herein, the defendant, John Kaczmarek, M.D., was a physician licensed to practice medicine in the State of Connecticut. Kennedy, johmon, Schwab air Robarge L.L.C. - LAW LONG WIIARF MARITIME CENTER - 555 LONG WI-IARF Dawn, 13in . New CT 06511 FAX (203) 865-5345 - (203) 865-8430 0 NO. t06077 2- 17. Paragraphs 3 through 18 of the Sixth Count are hereby incorporated, re-alleged and made paragraphs 2 through 17 of the Tenth Count. ELEVENTH COUNT: (As to plaintiff, John E. Garofalo, Adm. of the Estate of Jessica Garofalo and Defendant, Eleanor A. Berry, MD.) 1. At all times mentioned herein, the defendant, Eleanor A. Berry, M.D., was a physician licensed to practice medicine in the State of Connecticut. 2? 17. Paragraphs 3 through 18 of the Fifth Count are hereby incorporated, re-alleged and made paragraphs 2 through 17 of the Eleventh Count. TWELFTH COUNT: (As to plaintiff, Harry Montgomery, Adm. of the Estate of Rayne Montgomery and defendant, Eleanor A. Berry, M.D.) 1. At all times mentioned herein, the defendant, Eleanor A. Berry, M.D., was a physician licensed to practice medicine in the State of Connecticut. 2- 17. Paragraphs 3 through 18 of the Sixth Count are hereby incorporated, re?alleged and made paragraphs 2 through 17 of the Twelfth Count. THIRTEENTH COUNT: (As to plaintiff, John E. Garofalo, Adm. of the Estate of Jessica Garofalo and Defendant, Denise Pratt, APRN) 1. At all times mentioned herein, the defendant, Denise Pratt, APRN, was a licensed advanced practice nurse licensed to practice in the State of Connecticut. 2- 17. Paragraphs 3 through 18 of the Fifth Count are hereby incorporated, re?alieged and made paragraphs 2 through 17 of the Thirteenth Count. FOURTEENTH COUNT: (As to plaintiff, Harry Montgomery, Adm. of the Estate of Rayne Montgomery and defendant, Denise Pratt, APRN) 1. At all times mentioned herein, the defendant, Denise Pratt, APRN, was a licensed advanced practice nurse licensed to practice in the State of Connecticut. Kennedy, jolmson, Schwab Roberge L.L.C. - ATTORNEYS ATLAW LONG HARP - 555 LONG HARP DRIVE, 13th Floor - New CT 06511 FAX (208) 865?5845 {208) 865-8430 0 NO. 106077 2? 17. Paragraphs 3 through 18 of the Sixth Count are hereby incorporated, re-alleged and made paragraphs 2 through 17 of the Fourteenth Count. Dated at New Haven, Connecticut, this 16th day of August, 2018. THE PLAINTIFFS BY Telephone: (203) 865-8430 Kennedy, jokmo-n, Schwab Roberge L.L.C. ATTORNEYS AT LAW LONG WI--IARF CENFER - 555 LONG WIIARF DRIVE, 13th Floor 0 NEW 065! 1 FAX (203) 865-5345 0 (203) 865?8430 0 NO. 106077 RETURN DATE: SEPTEMBER 18, 2018 JOHN E. GAROFALO, ADMINISTRATOR OF THE ESTATE OF JESSICA R. GAROFALO AND HARRY MONTGOMERY, ADMINISTRATOR OF THE ESTATE OF RAYNE MONTGOMERY VS. WATERBURY LEGACY NETWORK, INC. WATERBURY JONATHAN P. LANDRY, SPECIALISTS IN WOMENS HEALTHCARE, ARTHUR B. LANDRY, JOHN KACZMAREK, ELEANOR A. BERRY, AND DENISE PRATT, APRN STATEMENT OF DEMAND SUPERIOR COURT WATERBURY AT WATERBURY AUGUST 16, 2018 The Plaintiffs in the above entitled action claim compensatory damages in excess of THOUSAND DOLLARS. THE PLAINTIF Kennedy, Johnson, of Roberge L.L.C. - ATTORNEYS AT LAW LONG WI-IARF MARITIME, CENTER . 555 LONG WI-IARF DRIVE, 13th Floor - NEW HAVEN, C'l" 065i] FAX (203) 8655345 (203} 865-8430 - NO. 106077 RETURN DATE: SEPTEMBER 18, 2018 JOHN E. GAROFALO, ADMINISTRATOR OF THE ESTATE OF JESSICA R. GAROFALO AND HARRY MONTGOMERY, ADMINISTRATOR OF THE ESTATE OF RAYNE MONTGOMERY VS. WATERBURY LEGACY NETWORK, INC. WATERBURY JONATHAN P. LANDRY, SPECIALISTS IN WOMENS HEALTHCARE, ARTHUR B. LANDRY, JOHN KACZMAREK, ELEANOR A. BERRY, AND DENISE PRATT, APRN SUPERIOR COURT WATERBURY AT WATERBURY AUGUST 16, 2018 CERTIFICATE OF REASONABLE INQUIRY I hereby certify that I have made a reasonable inquiry, as permitted by the circumstances, to determine whether there are grounds for a good faith belief that there has been negligence in the care or treatment of the claimants? decedents. Copies of written opinions of a similar health care providers as required pursuant to Connecticut General Statutes ?52-190a are attached hereto. This inquiry has given rise to a good faith belief on my part that grounds exist for an action against each named defendant. ft Stephanie?? . Commissmne it? ob/e fe? rof perior Court Kennedy, johnso-n, Schwab ab? Roberge L.L.C. - ATTORNEYS AT LAW LONG WI-IARF MARITIME . 555 LONG DRIVE. 13th Floor . NEW HAVEN, CT 065} 1 FAX (203) 865-5345 . (203) 865?8430 . NO. 106077 RETURN DATE: SUPERIOR COURT JOHN E. GAROFALO, ADMINISTRATOR OF THE ESTATE OF JESSICA R. GAROFALO AND HARRY MONTGOMERY, ADMINISTRATOR WATERBURY OF THE ESTATE OF RAYNE MONTGOMERY VS. AT WATERBURY WATERBURY HOSPITAL, ET AL OPINION PURSUANT TO C.G.S. SECTION 52-i90a SUBJECT 0 GENERAL I am board-certi?ed in emergency medicine and I am familiar with the standard of care as it relates to the practice of emergency medicine in the year 2015 and forward in the United States. I have reviewed the medical records of Waterbury Hospital for the emergency department Visit of September 6, 2015 and the Autopsy Report dated August 21, 2016. Based upon my review, Jessica Garofalo, a 33 year old female presented to the emergency department at Waterbury Hospital on September 6, 2015, at approximately 11:00 p.311. with chief complaint of abdominal pain. The pain was reported as beginning a day prior and her were constant. The pain was reported as 8 out of 10 and the character of the pain was reported as achy, dull and diffuse. Lab studies were obtained that showed an elevated white blood cell count with a left shift. In addition, a CT scan of the abdomen was performed which reported a possible left ovarian for which clinical correlation was recommended; and an indeterminate right adrenal lesion measuring 3.2 2.7 cm. Kennedy, johmon, Schwal: or Roberge L.L.C. - ar?r?orwm?mrmw LONG mm 5513 LONG um? DRIVE, 13m Flour . New 065! FAX (203} 865-5345 . (203} 865?8430 - NC). 1060?? which may be better evaluated with MRI. She was diagnosed with pelvic in?ammatory disease, an ovarian and gallbladder sludge. She was discharged from the emergency department with prescriptions for Percocet 1 tablet every 6 hours as needed for pain, Flagyl 1 tablet 2 times a day for 14 days and 100 mg 2 times a day for 14 days. She was instructed to follow up with her ob-gyn, Eleanor Berry, MI). Thereafter, on August 20, 2016, Jessica Garofalo presented to Waterbury Hospital for a scheduled betamethasone injection in connection with her pregnancy. She became short of breath, tachycardic, developed ARF, was intubated and an emergency c-section was performed. Shorty thereafter she suffered cardiac arrest and despite multiple rounds of ACLS she died. On Autopsy, the right adrenal gland was nearly completely replaced by a circumscribed 9x6x5 cm. mass. The cause of death was reported as ?peripartum demise following emergency cesarean section for management of maternal congestive heart failure associated with pheochromocytoma following betamethasone administration.? It is my opinion that there appears to be evidence of medical negligence on the part of the emergency department, emergency department staff and the physicians of Waterbury Hospital. The basis of this opinion includes discharging the patient without informing her of the adrenal lesion found on CT scan imaging; the failure to recommend follow-up for said adrenal lesion; the failure to obtain an MRI to better evaluate the right adrenal lesion; the failure to recognize the signi?cance of the right adrenal lesion; the failure to recognize the Kennedy, fohmn-n, Sahara!) etrRoberge - Lowe Wimar MARITIME CENTER - 555 LONG Witt-xx]: DRIVE, 13m rum - New CT 0651.: FAX (203) 8656345 . (203) 865-8430 - NO. 106077 risks associated with the right adrenal lesion; and the failure to use safe and effective medical practices and procedures. The opinions stated herein are based upon the information available to me at this time. Should other infomation and evidence become available, I reserve the right to supplement and or amend this opinion. Kennedy, Johnson, Schwab ca? Roberge L.L.C. .- AT LAW LONG WHARF - 555 LONG WIIARF DRIVE, 13:11 Floor - New 9651] FAX (203] Rosa?ds (203) 865-8430 . NO- 106077 RETURN DATE: . SUPERIOR COURT JOHN E. GAROFALO, ADMINISTRATOR OF THE ESTATE OF JESSICA R. GAROFALO AND HARRY MONTGOMERY, ADMINISTRATOR WATERBURY OF THE ESTATE OF RAYNE MONTGOMERY VS. AT WATERBURY WATERBURY HOSPITAL, ET AL OPINION PURSUANT TO C.G.S. SECTION 52?l90a SUBJECT TO GENERAL I am board-certi?ed in obstetrics and gynecology and I am familiar vvith the standard of care as it relates to the practice of obstetrics and gynecology in the year 2015 and forward in the United States. I have reviewed the medical records of Waterbury Hospital, Specialists in Women?s Healthcare, RC, and Autopsy Reports. Based upon my review, Jessica Garofalo presented to Specialists in Women?s Healthcare, PC. on September 30, 2015, for complaints of urinary pain and vaginal discharge. She provided a history of being evaluated in the Waterbury Hospital emergency department. A report of CT scan performed at Waterbury Hospital was provided to Specialists in Women?s Healthcare, PC via facsimile on that day. Pursuant to the CT scan performed at Waterbury Hospital a possible left ovarian and an indeterminate right adrenal lesion measuring 3.2 2.7 cm. was reported. According to the radiology report, the indeterminate adrenal lesion may be better evaluated with MRI. A Kennedy, johnmn, Schwab 59' Robergs L.L.C. - armw LONG WI-IARF CENTER - 555 LONG DRIVE, Floor - NEW CT {36511 FAX (203) 865-5345 (203) 865-8430 0 JURIS NO. 106077 urine dipstick, STD check and vaginal culture were done. She was discharged with diagnosis of acute cystitis and prescribed Macrobid. Thereafter on March 11, 2016, she presented to Specialists in Women?s Healthcare, PC. for continuation of pregnancy. Pregnancy was con?rmed and she continued her prenatal care through August 20, 2016. On August 19th, at 31 weeks she received betamethasone injection for cervical funneling. She presented to Waterbury Hospital for her second scheduled betamethasone injection but was short of breath, tachycardic to 160?s and desaturating to the 80?s. A chest x~ray initially read as normal was later addended to ?scattered, mostly ground glass in?ltrates throughout both lungs.? Her labs showed leukocytosis of 30.1 with bandemia, high anion gap metabolic acidosis. She was taken emergently for c~section. Shortly thereafter, she suffered cardiac arrest and despite multiple rounds of ACLS she died. On Autopsy, the right adrenal gland was nearly completely replaced by a 9 6 5 cm. mass. The cause of death was reported as ?peripartum demise following emergency cesarean section for management of maternal congestive heart failure associated with pheochromocytoma and following betamethasone administration for fetal risk reduction due to maternal cervical insuf?ciency after surgical treatment of It is my Opinion that there appears to be evidence of medical negligence on the part of physicians, Arthur Landry, John Kaczmarek, and Eleanor Berry, MD. of Specialists in Women?s Health, RC, and their staff. Kennedy, Schwab er Roberge - ATLAW LONG WI-IARF - 55:3 DRIVE. 1311-1 Flour - NEW l-lawzn, 065: I FAX {203) 865-5345 0 (203) 865-8430 NO. 1136077 The basis for this Opinion includes failing to follow-up on the CT scan of September 20, 2015; the failure to order an MRI on or about September 20, 2015 and/or everyday thereafter; the failure to recognize that the lesion reported on the CT scan of September 20, 2015 required follow-up; the failure to recognize the risks associated with the failure to follow~up on the ?ndings of the CT scan; the failure to make a referral and/or refer her to an endocrinologist to access the 3.2 2.7 cm. adrenal lesion reported on the CT scan of September 20, 2015; the failure to make a referral to address the 3.2 2.7 cm. adrenal lesion especially in the setting of pregnancy; and the failure to use safe and effective medical practices and procedures. The opinions stated herein are based upon the information available to me at this time. Should other information and evidence become available, 1 reserve the right to supplement and or amend this opinion. Kennedy, johnson, Sch-wall ab? Roberge L.L.C. ATLAW LONG WI-MRF CENTER . 1355 LONG HARF DRIVE. 13th Floor . New HAVEN, 0651] FAX {203) 86543345 - (203) 865-8430 0 NO. I06077 RETURN DATE: SUPERIOR COURT JOHN E. GAROFALO, ADMINISTRATOR OF THE ESTATE OF JESSICA R. GAROFALO AND HARRY MONTGOMERY, ADMINISTRATOR WATERBURY OF THE ESTATE OF RAYNE MONTGOMERY VS. AT WATERBURY WATERBURY HOSPITAL, ET AL OPINION PURSUANT TO C.G.S. SECTION 52-1903 SUBJECT TO GENERAL I am a licensed Advanced Practice Nurse with a Post Master's Advanced Practice Nursing Degree in Women?s Health and a Post Master?s Advanced Practice Nursing Degree in Family Healthcare. I am familiar with the standard of care for advanced practice nursing in the year 2015 and forward in the United States. I have been a Registered and Advanced Practice Nurse in active professional nursing practice in excess of 20 years. 1 have extensive experience in women?s health nursing and obstetrics. I have extensive experience in teaching at the university level for both didactic and clinical components to undergraduate nursing students, graduate nursing students, and nursing practitioner students. I am duly licensed and have veri?ed that the licensure quali?cations in my state of licensure are the same as the qualifications in the State of Connecticut. 1 have reviewed the medical records of Waterbury Hospital, Specialists in Women?s Healthcare, RC, and Autopsy Report. Kennedy, johmon, Scizweb df Roberge L.L.C. . sr'mw Lom; WIIARF MARITIME . 555 LONG DRIVE. [Bth Flour 0 New CT 0651! Faxaoma?s?sarls . (203) 865-8430 - Based upon my review of the records, Jessica Garofalo was seen on September 30, 2015, by Denise Pratt, APRN of Specialists in Women?s Healthcare, P.C. Ms. Garofalo?s chief complaint was noted to be UTI. According to the history, Ms. Garofalo complained of urinary as well as pain and vaginal discharge. She reported being evaluated . in the Waterbury Hospital emergency department as well. A urinalysis without microscopy was taken which revealed several positive ?ndings. A report of a CT scan performed at Waterbury Hospital dated September 6, 2015, was sent to Specialists in Women?s Healthcare, P.C. by facsimile on the day of her evaluation. The results of her CT scan included a possible left ovarian and an indeterminate right adrenal lesion measuring 3.2 2.7 cm. Pursuant to the report, the adrenal lesion would be better evaluated with MRI. At the end of the evaluation performed by Ms. Pratt, she was diagnosed with acute cystitis, prescribed Macrobid and instructed to notify the of?ce if no improvement in 3 days. Her next visit wason March 11, 2016 for con?rmation of pregnancy and prenatal care. She was seen by Denise Pratt, APRN at this visit. Her pregnancy was con?rmed. She was instructed to avoid alcoholic beverages, prenatal education was provided regarding nutrition and exercise, ?rst trimester screenings, and cystic fibrosis testing. She was given prenatal vitamins and follow-up appointment for her first prenatal visit and ultrasound. She continued to receive her prenatal care at Specialists in Women?s Healthcare. Kennedy, johmon, Schwab at? Haber-gs L.L.C. - ATMRNEYS AT LAW LONG Wnaar . 555 Lone WHARF Dawn. 13m - New HAVEN, Ct? 0135}! FAX {205} 865-5345 (203) 865-8430 . JURIS NO. room? On August 19, 2016, at 31 weeks she received betamethasone injection for cervical furmeiing. On August she presented to Waterbury Hospital for her second scheduled betamethasone injection. At presentation she was short of breath and tachycardia. She was taken emergently for e-section and shortly thereafter suffered cardiac arrest and death. Pursuant to the Autopsy Report, her right adrenal gland was nearly completely replaced by a 9 6 5 cm. mass. The cause of death was reported as ?peripartum demise following emergency cesarean section for management of maternal congestive heart failure associated with pheochromocytoma and following betamethasone administration for fetal risk reduction due to maternal cervical insufficiency after surgical treatment of It is my opinion that there appears to be evidence of medical negligence. on the part of Denise Pratt, APRN of Specialists in Women?s Health, P.C. The basis for this opinion includes failure to follow?up on lab studies; the failure to follow?up on the CT scan of September 6, 2015', the failure to follow-up with one of the physicians in the practice regarding the CT results; the failure to order an MR1 on or about September 30, 2015, and/or everyday thereafter; the failure to recognize that the lesion reported on the CT scan of September 6, 2015, required followup; the failure to recognize the risks associated with the failure to follow-up on the ?ndings of the CT scan; the failure to make a referral and/or refer her to an appropriate specialist to assess the 3.2 2.7 cm. adrenal lesion reported on the CT scan of September 6, 2015; the failure to make a referral to address the 3.2 2.7 cm. adrenal lesion especially in the setting of pregnancy; and the failure to use safe and effective medical practices and procedures. Kennedy, johnson, Schwab a? Roberge L.L.C. . ar'mw LONG WHARF CENTER 555 LONG WHARF DRIVE, 13m Floor - New i?lrWliN, CT 0651: FAX {203) 865-5345 (205} 865-8430 I NO. 106077 The opinions stated herein are based upon the informatio time. Should other information and evidence become available, 11 available to me at this I reserve the right to supplement and or amend this opinion. Kennedy, johnsa?, LONG WHARF MARITIME. CENTER 555 . Schwab car Roberge - AT LAW LONG WIMRF 13 . . Pic . ?New Ilmm. CI 06511 (203) sea-84303315 ..