STATE OF MINNESOTA

COUNTY OF HENNEPIN

Larry V. King,

Plaintiff,

vs.

Allina Health System, d/b/a Abbott Northwestern Hospital, and Sarah May Casareto,

Defendants.

DISTRICT COURT

FOURTH JUDICIAL DISTRICT

Court File No. Case Type: Medical Malpractice Judge:

COMPLAINT

Plaintiff, as and for his Complaint herein, states and alleges as follows:

1. On November 8, 2010, and at all times material herein, Allina Health

System d/b/a Abbott Northwestern Hospital (hereinafter "Abbott") was a non-profit

corporation duly organized and existing under the laws of the State of Minnesota with

its principal place of business in Minneapolis, Minnesota, and was engaged in the

business and profession of caring for the ill, and held itself out to the public to be well-

able to perform its functions as a health care provider and, specifically, that its

physicians, nurses, and other employees were well-able to perform their duties and

responsibilities in the care of patients entrusted to such persons.

2. On November 8, 2010, and at all times material herein, Sarah May

Casareto CCasareto") was a registered nurse duly licensed by the State of Minnesota,

and held herself out to possess that degree of skill, ability and learning common to

nurses in this community and, in addition, held herself out to possess that degree of

skill, ability and learning common to nurses practicing in a hospital interventional

radiology procedure room and administering sedatives and anesthetics to patients

undergoing surgical procedures. On November 8, 2010, Casareto was an agent and/or

employee of Abbott, and was acting within the scope of her agency and employment.

3. Defendant Abbott, and its physicians, nurses, and staff identified herein,

including defendant Casareto, undertook to care for and treat Larry V. King, and to do

all things necessary and proper for his care and treatment while at Abbott.

4. At all times material herein, Defendant Abbott was responsible for the

selection, training and supervision of its nurses and other staff, and was responsible for

the safe delivery of medical care in their facilities and by their employees and agents.

5. On or about October 6, 2010, a CT scan revealed the presence of a 1.2 em

stone just below the ureteropelvic junction of Mr. King's right kidney, and an 8 mm

stone in the lower pole of the right kidney. Mr. King underwent extracorporeal shock

wave lithotripsy without successful passage of the stones. Accordingly, a percutaneous

nephrolithotomy was scheduled to remove the stones.

6. The percutaneous nephrolithotomy typically takes place in two stages. In

the first stage, usually performed by an interventional radiologist in a procedure room

with the patient under conscious sedation, the kidney is accessed with a needle through

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the flank under fluoroscopy and a guide wire is placed through the flank into the

kidney and passed down to the ureter. A "double-J" stent is then placed over the guide

wire, and the stent curls up in the kidney at the proximal, end and curls in the bladder

distally. The stent has multiple perforations to allow the urine to drain from the kidney

down the ureter to the bladder.

7. The second stage of the percutaneous nephrolithotomy procedure takes

place ill an operating room with the patient under general anesthesia under the

supervision of an urologist. The tract from the flank to the kidney is dilated, and a scope

is inserted through the patient's side into the kidney and the kidney stone is removed.

8. On November 8, 2010, Mr. King presented to Abbott for a percutaneous

nephrolithotomy and was taken to a preparation room. As part of the preoperative

procedures, a peripheral line was inserted into Mr. King's left hand, a medical history

was taken, and interventional radiologist Subbarao Inampudi, M.D. met with Mr. King

to explain the procedure.

9. During this meeting, Dr. Inampudi explained that Mr. King would be

under "conscious sedation" during the first stage of the procedure, and that he would

not likely feel pain and would not likely even remember the procedure afterwards.

10. "Conscious sedation" induces an altered state of consciousness through

the use of a narcotic analgesic, such as Fentanyl (Sublimaze®), and a sedative, such as

Midazolam (Versed™). In addition to its sedative action, Versed™ is also an amnestic,

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which causes a period of brief amnesia in the patient and usually erases any memory of

the procedure.

11. At or about 11:15, Casareto entered Mr. King's room, placed her hand on

King's leg, said "Hi love", and explained that she would be transporting him to the

Interventional Radiology procedure room. As Casareto pushed Mr. King's gurney

down the hall, she told King "You're gonna have to man up here and take some of the

pain because we can't give you a lot of medication, you're going straight into surgery."

Casareto assured Mr. King that she would be standing by or near his head throughout

the procedure.

12. Casareto and Mr. King arrived in the procedure room at or about 11:20,

and King was rolled onto his stomach on a procedure table. The procedure team

consisted of Dr. Inampudi, surgical technologist or "scrub tech" E.P., medical technician

or "circulator" E.G., and procedure nurse Casareto.

13. Upon her arrival in the procedure room, Casareto was talking very loudly

and using animated "grand gestures". Casareto's eyes were red, and she explained to

E.G. that she had been swimming earlier that morning and her eyes had become

irritated by the chlorine. Casareto asked E.G. to wash her eyes, but E.G. refused, and so

Casareto filled a syringe with saline and irrigated her eyes in the presence of Mr. King

and the other procedure staff.

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14. The heart rate of patients undergoing conscious sedation must be carefully

monitored during surgery, and so Casareto was responsible for attaching EKG monitor

patches and leads to Mr. King's body. According to E.G., Casareto was shaking so

badly that she was unable to attach the EKG leads to the patches, and so E.G. did so. In

Casareto's condition, she was even unable to apply the blood pressure cuff to Mr.

King's arm.

15. The procedure began at 11:35. At 11:38, Casareto reportedly administered

1 mg of Versed™ and 50 mcg of Fentanyl. At 11:50, Dr. Inampudi punctured Mr.

King's skin and inserted a 21-gauge needle into King's posterior right flank above the

kidney. He then pushed the needle into the lower pole of Mr. King's kidney, and

injected a dye contrast material. Next, Dr. Inampudi advanced a 0.018 inch guide wire

through the needle and into the renal pelvis. An introducer sheath was then placed,

and a 5-French catheter (about the size of a 2d finishing nail) was advanced over the

guide wire and into the urinary bladder.

16. Throughout this 57-minute surgery, Larry King was in excruciating pain.

E.P. recalls that Mr. King was "writhing in pain", and characterized his pain level as

"extraordinary". E.G., who participated in many of these procedures in the past, stated

that she had never observed a patient in as much pain as Mr. King.

17. At 12:00, Dr. Inampudi ordered additional pain medication, and Casareto

purportedly administered 1 mg of Versed™ and 50 mcg of Fentanyl. According to E.G.

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and E.P., this additional medication had no effect on Mr. King's pain, and he continued

to scream and moan in agony.

18. Instead of remaining at or near Mr. King's head as a procedure nurse is

expected to do, Casareto sat down at a desk with her back toward King and the rest of

the procedure staff - a position she held throughout most of the procedure. Dr.

Inampudi commanded Casareto to get back to her patient and figure out why the pain

medication was not working. According to E.P. and E.G., Casareto approached Mr.

King and spoke loudly into his ear, "You gotta go to your happy place Larry. Go to

your beach".

19. Mr. King was in so much pain that he instinctively tried to roll away from

Dr. Inampudi's probing instruments, and E.P. had to hold him down so that he would

not roll off the table. Dr. Inampudi paused the procedure, and looked for Casareto.

Again, instead of standing at the head of her patient, Casareto was sitting with her back

toward Mr. King at a desk where medications are normally drawn-up into syringes. Dr.

Inampudi instructed Casareto to "get over to your patient" and give him some

additional medication. In response, Casareto asked, "You mean now?"

20. According to E.P. and E.G, Casareto was unable to stay awake during the

surgery and kept falling asleep. E.G. observed Casareto rocking back and forth on the

stool while sitting as the desk.

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21. At 12:15, after fumbling and then dropping a syringe on the floor,

Casareto injected something into Mr. King's IV line, which she recorded as 1 mg of

Versed™ and 50 mcg of Fentanyl. Casareto then asked Dr. Inampudi, "Can I go now?"

22. Whatever it was that Casareto injected into Mr. King's IV line, it had no

impact on King's pain level according to E.P. and E.G.

23. E.G. was so concerned about Casareto's behavior that she left the

procedure area and contacted nurse manager Patricia Bruggeman ("Bruggeman") to

observe the situation.

24. When Bruggeman arrived at the procedure room, she observed Casareto

stumbling and staggering as she moved about the room, and failing to properly attend

to Mr. King. Bruggeman heard Mr. King moaning in pain, and observed Casareto

staggering and then dropping a syringe on the floor while apparently trying to

administer medication ordered by Dr. Inampudi.

25. The procedure ended at 12:35. As Dr. Inampudi was scrubbing and

preparing to send Mr. King to the pre-operative care unit, he observed Casareto drop" a

whole drug box" containing syringes and vials on the floor.

26. "Waste" or "wastage" are terms used to describe medications that are

signed-out for a patient but are not administered. These medications must be disposed

of appropriately. Policies are supposed to be established by hospitals on how to deal

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with "wastage". In most cases, the wastage of any controlled substance must be

witnessed.

27. According to Casareto, among the drugs spilled on the floor was 250 mcg

of Fentanyl. Casareto asked E.G. to sign-off as a witness to the alleged "wastage" of the

250 mcg of Fentanyl, but E.G. refused to do so. Casareto became enraged and unleashed

a verbal tirade at E.G. which continued as E.P. wheeled Mr. King out of the procedure

room toward the pre-operative holding area.

28. E.G. discovered that Casareto was in possession of at least two unlabeled

syringes. One syringe appeared to contain approximately 5 cc, which Casareto insisted

was saline. When E.G. reminded her that the contents would need to be wasted

pursuant to hospital policy, Casareto angrily injected the contents into the trash and

tossed the empty syringe and needle into the garbage.

29. Casareto signed-out a total of 500 mcg of Fentanyl, but she has never

accounted for 50 mcg of missing Fentanyl.

30. Dr. Inampudi came to Bruggeman's office "very upset" about CasaretD's

"unusual", "distracted", "odd" and "bizarre" behavior during surgery. He told

Bruggeman it was obvious to him that Mr. King did not receive enough pain

medication, and that a patient should never be in such pain. Dr. Inampudi also told

Bruggeman that Casareto kept telling Mr. King to "go to his happy place".

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31. Based upon the concerns expressed by E.G. and Dr. Inampudi, as well as

her own observations in the procedure room, Bruggeman contacted Human Resources

Senior Generalist Bob Doyle ("Doyle"), and then paged Casareto to her office. When

Casareto arrived, Bruggeman and Doyle found her speech to be incoherent and slurred.

Casareto was rocking back and forth, was off-balance, and her demeanor was

belligerent. At that time, four labeled empty syringes were found in Casareto's scrub

pocket.

32. Bruggeman and Doyle suspected Casareto to be under the influence of

drugs or alcohol, and Casareto was asked to submit to a drug screen test.

33. Casareto refused to submit to the drug screen test and so, upon

information and belief, Casareto's employment at Abbott was immediately terminated.

34. Defendant Casareto was negligent and careless in her care and treatment

of Plaintiff Larry King by, among other acts and omissions: assuming responsibility for

the care to Plaintiff King during surgery while under the influence of controlled

substances; failing to advise Dr. Inampudi and/or other hospital personnel of her

impaired condition; diverting Fentanyl and/or Versed™ intended for Mr. King for her

own use and enjoyment; failing to properly monitor Mr. King's pain during surgery;

failing to administer Fentanyl and/or Versed™ to Mr. King as ordered by Dr. Inampudi;

and by failing to otherwise adhere to the prevailing standards of care in the field of

nursing and, specifically, for the care of patients undergoing surgery in a hospital

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interventional radiology procedure room; the negligence and carelessness of which

violated the existing standard of care in this community at the time Plaintiff King was

under her care.

35. Defendant Abbott held itself out as a medical health care center practicing

to the standards of care required of such facilities, and providing the skilled medical

and nursing care necessary for a patient's proper care and treatment during surgical

procedures. At all times material herein, Abbott was responsible for the adequate

training, supervision, and staffing of its nurses and other staff.

36. Abbott knew or should have known prior to November 8, 2010 that

Casareto was exhibiting drug seeking behavior and that she had become dependant

upon narcotic pain medications. Abbott knew that during a three-month period prior

to November 8, 2010, Casareto had failed to properly document, waste, and/or account

for oral narcotic pain medication on at least six different occasions that she had obtained

from the Abbott pharmacy for administration to patients.

37. Abbott was careless and negligent in its care and treatment of Larry King

as follows: negligently hiring, training, and employing Casareto; failing to properly

supervise Casareto; failing to timely recognize CasaretD's drug dependence and/or drug

seeking behavior; failing to monitor Casareto so as to prevent her diversion of patient

narcotics for her own use; failing to properly discipline Casareto when she was unable

to account for oral pain medications she obtained from the hospital pharmacy during

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2010; allowing Casareto to serve as a procedure nurse responsible for the administration

of anesthesia during Plaintiff's surgery; failing to develop and implement adequate

policies and procedures related to drug testing and suspicious behavior by nursing

staff; failing to timely and fully report Casareto's impaired conduct of November 8,

2010 to appropriate licensing agencies; failing to immediately remove Casareto from the

procedure room and replace her with an unimpaired procedure nurse when

Bruggeman observed Casareto staggering and stumbling in the procedure room and

acting in a manner consistent with impairment by drugs or alcohol; and by failing to

otherwise adhere to the prevailing standards of care for patients. The negligent acts

and omissions of defendant Abbott and its staff as alleged violated the existing

standards of care in this community at the time Mr. King was under its care.

38. The acts and omissions of Casareto and other staff and personnel at

Abbott were within the course and scope of their employment and agency, and Abbott

is vicariously liable for their negligence.

39. As a direct and proximate result of the professional negligence and

carelessness of defendants Abbott and Casareto as alleged herein, Plaintiff Larry King

was subjected to excruciating and sustained physical pain for nearly one hour, which

has caused, and will in the future continue to cause, Plaintiff King to suffer emotional

pain and distress, all to Plaintiffs damage in a reasonable amount in excess of Fifty

Thousand and no/100 Dollars ($50,000.00).

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WHEREFORE, Plaintiff prays for judgment against defendants Abbott and

Casareto, and each of them, in an amount in excess of $50,000.00, together with costs,

disbursements, prejudgment interest and such other and further relief as is just and

equitable.

Dated: /0 - / zr-I) MESHBESHER & SPENCE, LTD.

Qsl/\ By: r .~ \ Anthony Nemo, #221351

1616 Park Avenue Minneapolis, MN 55404 (612) 339-9121

Attorneys for Plaintiff Larry V. King

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