Barnett v. Vanderbilt - Tennessee Medical Malpractice Lawsuit

IN THE CIRCUIT COURT FOR DAVIDSON COUNTY, TENNESSEE
JOSHUA BARNETT, )
)
Plaintiff, )
) MEDICAL MALPRACTICE
v. ) AND PERSONAL INJURY
)
VANDERBILT UNIVERSITY )
MEDICAL CENTER, ) JURY DEMAND
)
Defendant. )
COMPLAINT
The Plaintiff, for his cause of action, respectfully states to the Court and Jury the following:
PARTIES, VENUE, AND JURISDICTION
1. Plaintiff Joshua Barnett, is an adult citizen of the State of Tennessee. The Plaintiff
resides in Nashville, Davidson County, Tennessee.
2. Defendant Vanderbilt University Medical Center (“VUMC”) is a general hospital,
licensed by the Tennessee Department of Health Board for Licensing Health Care facilities.
VUMC is a “health care provider,” as that term is defined by Tenn. Code Ann. §29-26-101(2)(B).
3. VUMC is a non-profit corporation, formed under the laws of the State of Tennessee.
VUMC’s principle place of business is 1161 21st
Ave., Nashville, Tennessee 37232.
4. VUMC may be served through its registered agent, National Registered Agents,
Inc., at 800 S. Gay, St., Suite 2021, Knoxville, Tennessee 37929.
5. The Plaintiff’s cause of action arose in Nashville, Tennessee (Davidson County).
Venue and a jury demand are proper pursuant to Tenn. Code Ann. §20-4-101(a). This Court has
jurisdiction pursuant to Tenn. Code Ann. §16-10-101.

MEDICAL MALPRACTICE LAWSUIT
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MEDICAL, LEGAL, & ECONOMIC RELATIONSHIPS
6. Rakesh Chandra, M.D. is an ENT-otolaryngologist at VUMC. Dr. Chandra
is an agent, employee and/or servant of VUMC. Alternatively, Dr. Chandra acted as an
ostensible agent/employee/servant of VUMC during the events described in this Complaint.
The Plaintiff presented to, and was admitted through, VUMC’s Emergency Department, and
he played no role in selecting Dr. Chandra to participate in the medical care and treatment he
sought from VUMC.
7. Lola Chambless, M.D. is a neurosurgeon at VUMC. Dr. Chambless is an
agent, employee and/or servant of VUMC. Alternatively, Dr. Chambless acted as an ostensible
agent/employee/servant of VUMC during the events described in this Complaint. The Plaintiff
presented to, and was admitted through, VUMC’s Emergency Department, and he played no
role in selecting Dr. Chambless to participate in the medical care and treatment he sought from
VUMC.
8. Dr. Chandra and Dr. Chambless will be collectively referred to herein as
“the VUMC surgeons.”
9. At the time of the matters contained in this Complaint, the Plaintiff and
VUMC had a healthcare provider-patient relationship. This relationship between the Plaintiff
and Defendant began no later than March 27, 2015.
STATEMENT OF FACTS
a. Plaintiff’s March 27, 2015 Exam at Vanderbilt Neuro Ophthalmology Clinic.
10. Beginning in the Fall of 2014, Mr. Barnett was experiencing vision deficits
that progressively worsened over time. He suffered occasional double vision and issues with
depth perception when catching balls.

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11. On March 27, 2015, Mr. Barnett presented to the Vanderbilt Neuro-
Ophthalmology Clinic in connection with the vision issues he had been experiencing.
12. Mr. Barnett was examined by Josh Bond, III, M.D. Dr. Bond noted that Mr.
Barnett had bitemporal hemianopic defects (a form of partial blindness), consistent with
pathology involving the optic chiasm.
13. Dr. Josh Bond sent Mr. Barnett to the Vanderbilt Emergency Department
(“ED”) to be examined further, including for an MRI and neurology evaluation.
b. Plaintiff’s March 27, 2015 Presentation to the VUMC ED.
14. On March 27, 2015, Mr. Barnett presented to the VUMC ED in connection
with the vision problems he had been experiencing and a potential pathology involving the
optic chiasm.
15. Mr. Barnett’s ED exam was notable for bitemporal hemianopsia consistent
with a concern that an intracranial mass was compressing the optic chasm.
16. The ED Diagnosis was Bitemporal Hemianopsia.
17. An MRI of the sella was performed on March 27, 2015.
18. The MRI Findings included a sellar and suprasellar pituitary macroadenoma
that measured 35 mm in height and 27 mm in AP dimension.
c. Plaintiff’s March 27, 2015 Admission to VUMC.
19. Mr. Barnett was thereafter seen by Peter Morone, M.D., a neurologist at
VUMC. Dr. Morone documented that the MRI of the brain showed a pituitary macroadenoma,
measuring approximately 2.5 x 3.5 cm.
20. After examining the Plaintiff, Dr. Morone admitted Mr. Barnett to VUMC.

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21. After it became clear that Mr. Barnett had a pituitary adenoma that was at
least 2.5 x 3.5 cm, the plan became to perform an urgent endonasal resection surgery to remove
it (in its entirety). In fact, Mr. Barnett was told he would be leaving Against Medical Advice
(AMA), if he left VUMC between the time he was seen in the Vanderbilt ED and when the
surgery was performed.
22. On March 28, 2015, a CT of the sinuses was performed. The CT was
performed for surgical planning purposes.
23. The CT scan confirmed what had previously shown by the MRI. Mr. Barnett
had a pituitary adenoma that was approximately 2.7 x 3.5 cm in size.
24. Multiple specialists reviewing the imaging studies agreed on the estimated
size of the pituitary adenoma.
25. On March 28, 2015, an endocrine consult was performed. The
corresponding note documents that the MRI of the pituitary performed in the ER on March
27, 2015 demonstrated a 3.5 cm likely pituitary microadenoma abutting bilateral cavernous
sinuses and elevating the optic chiasm.
26. On March 28, 2015, an otolaryngology consult was performed. It
documents that the pituitary adenoma was 2.5 x 3.5 cm in size. More specifically, on imaging,
the pituitary adenoma was 3.5 cm in height x 2.7 cm in AP dimension.
27. A Pre-Operative Anesthesia Evaluation referenced a pituitary adenoma,
with dimensions of 2.5 x 3.5 cm.
d. Plaintiff’s March 30, 2015 Adenoma Resection Surgery.
28. On March 30, 2015, Dr. Chandra and Dr. Chambless attempted an
endoscopic endonasal resection surgery to remove to remove the pituitary adenoma.

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29. The endoscopic endonasal resection surgery was performed with the
assistance of a stereotactic image-guided surgical navigation headset, which – among other
purposes –aids the surgeon performing this procedure delineate the exact boundaries of a
tumor.
30. Dr. Chandra and Dr. Chambless each provided their own descriptions of the
surgery in separate operative reports.
31. Both operative reports state that the “tumor” was removed, as was planned
by the VUMC surgeons, and as would be expected of surgeons performing an endoscopic
endonasal surgery to resect a pituitary adenoma. Dr. Chambless’ Operative Report documents
that Dr. Chambless believes on March 30, 2015 that she had obtained a “maximal safe
resection.” Neither of the Operative Reports regarding the March 30, 2015 have ever been
amended. No amended documentation regarding the March 30, 2015 surgery was ever sent
by Vanderbilt to a health insurance company.
32. In reality, Dr. Chandra and Dr. Chambless did not appropriately identify the
boundaries of the pituitary adenoma intraoperatively, and only a small fraction of Mr.
Barnett’s pituitary adenoma was resected (~20%). Dr. Chambless does not believe, and did
not believe in 2015, that removing less than 25% of a pituitary adenoma constitutes a
“maximal” resection of that mass. Dr. Chambless does not believe, and did not believe in
2015, that removing less than 25% of a pituitary adenoma constitutes removing “the tumor.”
33. Dr. Chambless intended to remove at least 80% of the pituitary adenoma
during the March 30, 2015 surgery. When the March 30, 2015 surgery was completed, Dr.
Chambless believed that more than 80% of the pituitary adenoma had been removed.

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36. After the surgery was completed, specimens of the removed tissues were
sent to Pathology.
e. Plaintiff’s Post-Operative Care at VUMC, and Discharge on April 1, 2015.
37. A pathology report was prepared regarding the specimens sent to pathology
from the March 30, 2015 surgery.
38. One specimen was identified as Nasal and Sinus Contents, resection –
benign fibrocartilage and bone. That specimen was 3.9 x 2.7 x 1.5 cm aggregate of tan-white,
firm, cartilaginous tissue.
39. The second specimen was identified as Pituitary, Transspenoidal
Hypophysectomy – pituitary adenoma. This specimen was 2.0 x 1.2 x 0.3 cm aggregate of
soft to rubbery, tan-white tissue.
40. With regard to the specimen identified as the pituitary adenoma, the
neoplasm was strongly and diffusely immunoreactive for synaptophysin. There was no
significant expression of ACTH, HGH, or prolactin in the adenoma cells. The MIB-1
proliferation index was marginally elevated (estimated at approximately 5%). The pathology
report mentions that only rare adenoma cells are immunoreactive for p53, and that a reticulin

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stain supported the diagnosis of adenoma, showing loss of the acinar architecture
characteristic of normal pituitary tissue, and with all controls showing appropriate reactivity.
41. The VUMC surgeons did not order, perform, or review any post-operative
imaging (CT or MRI) to confirm whether they had actually removed all of the pituitary
adenoma before discharging Mr. Barnett from VUMC. The VUMC surgeons could have
ordered post-operative imaging prior to Mr. Barnett’s discharge from VUMC to evaluate and
document how much of the pituitary adenoma was actually removed during the March 30,
2015 surgery. Hundreds of VUMC patients had imaging performed on them on March 30,
2015. Hundreds of VUMC patients had imaging performed on them on March 31, 2015.
42. Mr. Barnett was discharged from VUMC on April 1, 2015. When Mr.
Barnett was discharged from VUMC on April 1, 2015, the VUMC surgeons had not arranged
for any imaging to be performed to evaluate and document how much of the pituitary adenoma
was actually removed during the March 30, 2015 surgery.
f. Plaintiff’s May 12 MRI and May 13 Check-Up with VUMC Surgeons.
43. On May 12, 2015, an MRI of Mr. Barnett’s sella was performed, with and
without contrast. This was the first post-operative imaging arranged by anyone at Vanderbilt
that would provide any information regarding the amount of the adenoma that was removed
during the March 30, 2015 surgery. The imaging performed on May 12, 2015 could have
been performed earlier in the timeframe between March 30, 2015 and May 12, 2015. This
imaging was not performed earlier because the VUMC surgeons did not order any such
imaging during the postoperative period prior to May 12, 2015.
44. The comparison of Mr. Barnett’s March 27 and May 12 MRIs showed as
follows:

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a. March 27, 2015 (pre-operative): sellar/suprasellar mass measuring 35 mm x 27 mm
b. May 12, 2015 (post-operative): sellar/suprasellar mass measuring 28 mm x 23 mm.
45. Comparison of these MRIs demonstrated that the VUMC surgeons removed
only a small fraction of the tumor during the March 30, 2015 resection surgery. A tumor of
the size reflected in the May 12 MRI could not, and would not (re)grow that quickly in a six
week period of time.
46. The comparison of the March 27, 2015 and May 12, 2015 imaging
demonstrated that less than 25% of the pituitary adenoma was removed during the March 30,
2015 surgery.
47. More than 25% of the pituitary adenoma was supposed to be removed
during the March 30, 2015 surgery.
48. On May 13, 2015, Mr. Barnett had a post-operative office visit with Dr.
Chambless. Dr. Chambless acknowledged in her documentation that the May 12 MRI showed
“a large amount of residual disease.” She further observed: “[t]his appears to have now fallen
down into the sella where we initially did our resection.” She recommended a “redo procedure
to try to get a more complete resection.”
g. The Plaintiff Required Several Additional Corrective Surgeries and Suffered
Additional Injuries due to the failed March 30, 2015 Surgery.
49. Mr. Barnett was informed that he should see a non-VUMC neurosurgeon to
get real answers and better care.
50. On May 20, 2015, Mr. Barnett had an initial office visit with a new
neurosurgeon, Robbi Franklin, M.D., with Nashville Neurosurgery. This appointment was set
up at the request of Dr. Jerkins, Mr. Barnett’s endocrinologist, who accompanied Mr. Barnett
to this appointment.

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51. Dr. Franklin documented that the imaging performed after the March 30,
2015 resection surgery performed at Vanderbilt “revealed little to none of the pituitary tumor
was actually resected.” He also documented that the “significant residual tumor component”
was still causing “persistent optic nerve compression.”
52. Dr. Franklin further mentioned in his clinical documentation that “[i]t is
unclear what took place at the time of [the VUMC] surgery to fully explain the large residual
disease” and that he was “positive that a gross total resection and optic nerve compression
[was] achievable.”
53. On June 5, 2015, Mr. Barnett underwent an MRI of the brain at Centennial
Medical Center. The Findings included an examination that was remarkable for a large
pituitary mass that measured 2.2 x 2.2 cm in axial dimension and approximately 2.7 cm in
superior to inferior dimension. The mass extended through the diaphragm sella and was
causing significant deformity and displacement of the optic nerves optic chasm in the region
of the basal forebrain.
54. On June 8, 2015, Dr. Franklin admitted Mr. Barnett to Centennial Medical
Center for an expanded endonasal approach resection surgery (“EEEAR”) of Mr. Barnett’s
pituitary adenoma. The surgery was necessary only because the VUMC surgeons removed
only a small fraction of the tumor during the initial March 30, 2015 resection surgery.
55. During the June 8, 2015 EEEAR, Dr. Franklin encountered a large and
obvious tumor that was not removed during the March 30, 2015 surgery. There was no medical
reason why this mass could not have been safely removed during the March 30, 2015 surgery
at VUMC.

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56. Two separate times in his clinical documentation, Dr. Franklin referred to
the initial March 30, 2015 resection surgery performed by the VUMC surgeons as “really
nothing more than a biopsy.”1
57. When an endonasal resection surgery is properly performed, it creates a rent
in the dura that can cause a post-operative CSF leak. To prevent the possibility of a post-
operative CSF leak, the surgeon creates a nasal septal flap.
58. During the June 8, 2015 EEEAR, Dr. Franklin was unable to reuse the nasal
septal flap previously created by the VUMC surgeons. The previous flap was quite small and
the pedicle had retracted. Dr. Franklin had to create a second septal flap.
59. The creation of a second flap is not nearly as effective in preventing post-
operative CSF leaks as an initial flap created within a “virgin” nose.
60. The VUMC’s creation of a small nasal septal flap during the March 30,
2015 surgery, without completely resecting the tumor, presented a significant risk of CSF leak
following a redo resection surgery that could not be contained via a flap.
61. Following the June 8, 2015 endonasal resection surgery, Dr. Franklin
ordered prompt post-operative imaging to ensure that he had resected the entire tumor,
consistent with his standard practice.
62. On June 9, 2015, Mr. Barnett underwent an MRI of the brain at Centennial
Medical Center. The MRI confirmed that Dr. Franklin had resected the entire tumor. This was
the same tumor that was supposed to be resected during the March 30, 2015 surgery at VUMC.
63. On June 12, 2015, Mr. Barnett was discharged from Centennial Medical
Center.
1
A biopsy is a surgery performed to remove a very small sample of tissue for the basic purpose of lab testing.

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64. After his June 8, 2015 admission to Centennial Medical Center, Mr. Barnett
experienced a postoperative CSF leak, due to the ineffectiveness of the second flap. The
second flap was ineffective as a result of the March 30, 2015 surgery by the VUMC surgeons
making the integrity and effectiveness of a second flap in that same area less likely to prevent
a CSF leak.
65. Mr. Barnett’s CSF leak, following the June 8, 2015 redo endonasal resection
surgery, was proximately caused by the VUMC surgeon’s negligence and medical malpractice
in performing the March 30, 2015 surgery and because that negligence and medical
malpractice made an additional surgery at that same site necessary.
66. Due to the CSF leak, Mr. Barnett required continued medical care and
treatment, including additional surgical procedures on (1) June 25, 2015, (2) July 2, 2015, (3)
July 13, 2015, (4) July 16, 2015, and (5) July 24, 2015.
NEGLIGENCE AND MEDICAL MALPRACTICE OF VUMC
67. The Plaintiff incorporates the factual averments and allegations set forth
above as if fully described herein.
68. The relationship of health care provider – patient existed between the
Plaintiff and Defendant VUMC during the time in question.
69. Defendant VUMC owed the Plaintiff a duty to provide appropriate care and
treatment, including during the time in question. Tenn. Comp. R. Reg. §1200-08-01-.07,
which is applicable to VUMC, provides that “If [a] hospital provides surgical services, the
services must be … provided in accordance with acceptable standards of practice.”

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70. The Defendant, through its actual and apparent agents, failed to comply with
the standard of recognized acceptable professional practice applicable to the medical and
surgical care it provided to Mr. Barnett causing serious personal injury.
71. The ways in which the Defendant, through its actual and apparent agents,
failed to comply with the applicable standard of recognized acceptable professional practice
(“standard of care”) include, but not are not limited to:
a. Failing to properly perform the March 30, 2015 endonasal resection surgery
causing serious personal injury.
b. Failing to appropriately delineate the dimensions of the pituitary adenoma
during the March 30, 2015 surgery causing serious personal injury.
c. Failing to completely resect the pituitary adenoma during the March 30,
2015 surgery causing serious personal injury.
d. Failing to recognize, intraoperatively, that the entire the pituitary adenoma
had not been resected during the March 30, 2015 surgery causing serious
personal injury.
e. Failing to recognize, post-operatively, that the entire the pituitary adenoma
had not been resected during the March 30, 2015 surgery resulting in serious
personal injury.
CAUSATION AND DAMAGES
72. The Plaintiff incorporates the factual averments and allegations set forth
above as if fully described herein.
73. As a direct and proximate result of the Defendant’s failure to perform the
March 30, 2015 surgery in accordance with applicable standards of recognized acceptable
professional practice, Mr. Barnett sustained physical, mental, and emotional injuries, and loss
of enjoyment of life, loss of consortium between the Plaintiff and his wife, and he incurred
medical expenses he would not otherwise have incurred. These injuries and damages would
not otherwise have occurred absent the Defendant’s negligence and medical malpractice.
74. As a direct and proximate result of the Defendant’s failure to perform the
March 30, 2015 surgery in accordance with applicable standards of recognized acceptable

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professional practice, Mr. Barnett was forced to endure additional operations and medical
treatment, incur additional medical expenses, and experience extended pain and suffering.
These injuries and damages would not otherwise have occurred absent the Defendant’s
negligence and medical malpractice.
COMPLIANCE WITH STATUTORY NOTICE / GOOD FAITH REQUIREMENTS
75. The Plaintiff, through counsel, has complied with the provisions of Tenn.
Code Ann. §29-26-121 requiring individuals asserting a potential health care liability claim to
give written notice of such potential claim to each health care provider that will be a named
Defendant at least 60 days prior to filing a complaint. On or by March 19, 2015, notice was
given to the Defendant in accordance with Tenn. Code Ann. §29-26-121. The Affidavit of
Brian Manookian and supporting documentation demonstrating compliance are attached to
this Complaint as Exhibit 1. The Complaint was filed more than 60 days after notice was
given. The Complaint was filed more than 60 days after Defendant received Pre-Suit Notice.
76. Defendants had the opportunity to review the facts of this matter between
the time of receipt of Pre-Suit Notice by March 19, 2015 and the filing of this Complaint. No
agent or representative for the Defendant ever communicated to counsel for the Plaintiff any
inability or problem with obtaining or reviewing the pertinent medical records, which counsel
for the Plaintiff provided access to via an appropriate, HIPAA-compliant release for
Defendant to obtain.2
77. The Notice described in this section was provided within the applicable
period of time. More than 60 days have passed since the notice was given. This suit is timely
2
Since VUMC was the only anticipated Defendant, it was already authorized to review its own records per 45
C.F.R. §164.506 (allowing use for “health care operations”) and 45 C.F.R. §164.501 (defining “health care
operations” to include “conducting or arranging for medical review, legal services...”).

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filed before the applicable statute of limitations (as extended by Tenn. Code Ann. §29-26-121)
expired.
78. In accordance with Tenn. Code Ann. §29-26-122, the Plaintiff’s counsel has
consulted with one or more experts who provided a signed written statement confirming that
upon information and belief they are competent under Tenn. Code Ann. §29-26-115 to express
opinions in this case and believe, based on the information available from medical records
concerning the care and treatment of the Plaintiff, that there is a good faith basis to maintain
this action consistent with the requirements of Tenn. Code Ann. §29-26-115. The Certificate
of Good Faith demonstrating the same is attached to this Complaint as Exhibit 2.
PRAYER FOR RELIEF
WHEREFORE, the Plaintiff prays for the following relief:
1. That proper process be issued and be served upon the Defendant, and the
Defendant or Defendants’ lawyer or attorney be required to appear and
answer this Complaint within the time required by law;
2. That the Plaintiff be awarded fair and reasonable damages, including
compensatory damages up to $850,000.00;
3. That the Plaintiff be awarded the costs of trying this action including costs of trial
lawyer;
4. That this action be heard by a jury;
5. That costs of this action be taxed to the Defendant including fees of trial attorney;
6. That prejudgment interest be awarded to the Plaintiff;
7. That the Plaintiff be awarded all and any such other and further relief as the
Court deems proper; and,

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8. That Plaintiffs’ right to amend this Complaint to conform to the evidence
be reserved.
Respectfully submitted,
Brian Cummings, #19354
Brian Manookian, #26455
Cummings Manookian PLC
45 Music Square West
Nashville, Tennessee 37203
(T) 615-266-3333
(F) 615-266-0250
bcummings@cummingsmanookian.com
bmanookian@cummingsmanookian.com
www.cmtrialattorneys.com
Attorneys for the Plaintiffs

Barnett v. Vanderbilt - Tennessee Medical Malpractice Lawsuit

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