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FILED
DALLAS COUNTY
3 CIT ATTY MAIL 2/6/2020 3:14PM
FELICIA PITRE
DISTRICT CLERK
Kayla Buckley
CAUSE NO.: DC-20-00255
AMY WICKERSHAM AND IN THE DISTRICT COURT OF
PERRY WICKERSHAM
Plaintiffs
VS.
BENJAMIN BRASHEAR, MD,
GARRY GUCE, MD,
DANIEL SCHEURICH, MD,
GUSTAVO N. DEL TORO, DO,
PAUL A. GUTTUSO, MD, DALLAS COUNTY, TEXAS
CHRISTINA D. WRIGHT, RD,
BRASHEAR FAMILY MEDICAL, P.A., mmmmmmmwmmmmmmmmmwmmmmmm
WELLMED MEDICAL GROUP, P.A.
D/B/A WELLMED AT KAUFMAN,
SOUND INPATIENT PHYSICIANS INC.,
DR. GARRY GUCE & ASSOCIATES,
PLLC, TEXAS HEALTH PHYSICIANS
GROUP, LUMINCARE PHYSICLAN
GROUP, P.A., ARAMARK
HEALTHCARE SUPPORT SERVICES,
LLC AND TEXAS HEALTH
PRESBYTERIAN KAUFMAN
Defendants 44th JUDICIAL DISTRICT
PLAINTIFFS’ FIRST AMENDED ORIGINAL PETITION
TO THE HONORABLE JUDGE OF SAID COURT:
Plaintiffs, Amy Wickersham and Perry Wickersham, files this First Amended
Original Petition complaining 0f Defendants, Benjamin Brashear, MD, Garry Guce, MD,
Daniel Scheurich, MD, Gustavo N. Del Toro, DO, Paul A. Guttuso, MD, Christina D.
Wright, RD, Brashear Family Medical, PA, WellMed Medical Group, P.A. d/b/a WellMed
atKaufman, Sound Inpatient Physicians Inc., Dr. Garry Guce & Associates, PLLC, Texas
Health Physicians Group, Lumincare Physician Group, P.A., Aramark Healthcare Support
Services, LLC, Texas Health Presbyterian Kaufman, Erik Tijerina, FNP, Sunflower Park
Health Care and HealthTexas Provider Network d/b/a Baylor Scott & White Primary Care
Associates for their causes of action and support thereof respectfully state the following:
DISCOVERY LEVEL
1. Under Texas Rules ofCiVil Procedure, Rule 190.3, this case shall be conducted under
a Level 3 discovery control plan.
PARTIES
2. Plaintiffs Amy Wickersham and Perry Wickersham are residents of Kaufman
County, Texas.
3. Defendant Benjamin Brashear, MD, is a medical doctor providing services in
Kaufman and Dallas County, Texas. Defendant may be served With service of process at
2801 Millennium Drive, Suite, B, Kaufman Texas 75 140 0r wherever Defendant may be
found.
4. Defendant Garry Guce, MD, is medical doctor providing services in Kaufman
County, Texas. Defendant may be served with service of process at 874 ED Hall Drive,
Suite 106, Kaufman, Texas 75 142 0r Wherever Defendant may be found.
5. Defendant Daniel Scheurich, MD, is medical doctor providing services in Kaufman
and Dallas County, Texas. Defendant Daniel Scheurich, MD is a resident ofDallas County,
Texas. Defendant may be served With service ofprocess at 2000 Beechwood Lane, Copell,
Texas 75019 0r Wherever Defendant may be found.
6. Defendant, Gustavo N. Del Toro, DO, is a medical doctor providing services in
Kaufman and Collin County, Texas. Defendant may be served With service of process at
2150 S. Central Expy, Suite 200, McKinney, Texas 75070 or Wherever Defendant may be
found.
7. Defendant Paul A. Guttuso, MD, is a medical doctor providing services in
Kaufman County, 3rd
Texas. Defendant may be served with service of process at 604 S.
Street, Suite A, Mabank, Texas 75 147 0r Wherever Defendant may be found.
8. Defendant Christina D. Wright, RD, isa registered dietician providing services in
Kaufman County, Texas. Defendant may be served With service of process at 3400 W.
Interstate Highway 20 N. Access Rd. Van, Texas 75790 or Wherever Defendant may be
found.
9. Defendant Brashear Family Medical, PA. is a medical entity providing medical
services in Kaufman County, Texas. Defendant may be served With service 0f process by
serving its registered agent, Benjamin Russell Brashear at2801 Millennium Dr., Suite B
Kaufman, Texas 75142 or wherever Defendant may be found.
10. Defendant WellMed Medical Group, P.A. d/b/a WellMed at Kaufman is a
medical entity in providing medical services in Kaufman County, Texas. Defendant may
be served with service of process by serving its registered agent, CT Corporation System at
1999 Bryan St., Ste. 900, Dallas, Texas 75201 or wherever Defendant may be found.
11. Defendant Sound Inpatient Physicians, Inc., is a medical entity in Midland County,
Texas. Defendant may be served with service of process by serving its registered agent,
Corporation Service Company d/b/a CSC-Lawyers Incorporating Service Company, 211 E.
7th Street, Suite 620, Austin, Texas 78701or wherever Defendant may be found.
12. Defendant Dr. Garry Guce & Associates, PLLC, is a medical entity in Kaufman
County, Texas. Defendant may be served with service of process by serving its registered
agent, Glenda Lydia at 3721 FM 1837, Kaufman, Texas 75142or wherever Defendant may
be found.
13. Defendant Texas Health Physicians Group, is a medical entity in Kaufman and
Dallas County, Texas. Defendant may be served with service of process by serving its
registered agent, Donald B. Collins at 612 E. Lamar Blvd., Suite1400, Arlington, Texas
76011 or wherever Defendant may be found.
14. Defendant Lumincare Physician Group, PA, is a medical entity in Midland County,
Texas. Defendant may be served with service of process by serving its registered agent,
Incorp Services Inc. at 815 Brazos, Suite 500, Austin, Texas 78701 or wherever Defendant
may be found.
15. Defendant Aramark Healthcare Support Services, LLC, is a medical entity in
Texas. Defendant may be served with service of process by serving its registered agent, CT
Corporation System at 1999 Bryan St., Ste. 900, Dallas, Texas 75201 or wherever Defendant
may be found.
16. Defendant Texas Health Presbyterian Kaufman, is a medical facility in Kaufman
County, Texas. Defendant may be served with service of process by serving its registered
agent, Donald B. Collins at 612 E. Lamar Blvd., Suite1400, Arlington, Texas 76011 or
wherever Defendant may be found.
17. Defendant Erik Tijerina, FNP, is a family nurse practitioner providing services in
Kaufman County, Texas. Defendant may be served with service of process at 801 W Main
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Street, Gun Barrel City, Texas 75 1 56 0r Wherever Defendant may be found.
18. Defendant Sunflower Park Health Care, is a medical facility in Kaufman County,
Texas. Defendant may be served With service of process by serving its registered agent,
InCorp Services, Inc. at 815 Brazos St., Suite 500, Austin, Texas 787010r Wherever
Defendant may be found.
19. Defendant HealthTexas Provider Network d/b/a Baylor Scott & White Primary
Care Associates, is a medical facility in Henderson County, Texas. Defendant may be
served With service 0f process by serving its registered agent, CT Corporation System at
1999 Bryan St., Ste. 900, Dallas, Texas 75201 0r Wherever Defendant may be found.
VENUE AND JURISDICTION
’
20. Venue for Plaintiffs action against the Defendants is proper in Dallas County, Texas
because individual defendants are residents ofDallaS County, Texas, and were also residents
0f Dallas County, Texas, at the time that Plaintiffs' cause of action accrued and at all times
relevant t0 this lawsuit, in particular Daniel Scheurich, MD.
21. This Court has subject matter jurisdiction over this action because the amount of
monetary relief claimed by Plaintiffs’ isover $200,000.00 but not more than $6,000,000.00
and Plaintiff’ s action is for personal injuries resulting from medical negligence pursuant t0
TEX. CIV. PRAC. & REM. CODE § 74.001 et seq. A11 conditions precedent t0 the filing 0fthis
action, including the sending of the required notice letter pursuant t0 TEX. CIV. PRAC. &
REM. CODE
22.
§ 74.001
On July 3,
et seq., have occurred.
w
2017, Mrs. Wickersham underwent Sleeve gastrectomy performed by
Dr. Christopher Bell. At her follow-up Visit 0n July 27, 2017, Dr. Bell documented that
Mrs. Wickersham was doing well, tolerating oral liquids, and was 0n no active medications.
Instructions were "Advance diet and activities as tolerated" and follow up in one month.
23. On August 1, 2017, Mrs. Wickersham had a follow up appointment with Primary
Care Physician Dr. Garry Guce Who noted Mrs. Wickersham was having trouble swallowing
pills since her procedure and also had possible infection t0 her incision site. Dr. Guce
prescribed antibiotic Clindamycin and started her on anti—anxiety medication Xanax. The
only other active medication documented at that time was hydrochlorothiazide for high
blood pressure.
24. On August 3, 2017, Mrs. Wickersham presented to Texas Health Presbyterian
Kaufman emergency department due to fever. She was found to have an abdominal wall
abscess at her umbilical incision and was started on IV antibiotics. She was then transported
to Medical City Dallas for higher level of care "by original surgical provider" Dr. Bell.
25. On August 15, 2017, Mrs. Wickersham returned to Texas Health Presbyterian
Kaufman emergency department with persistent abdominal abscess and new complaints of
vomiting for several weeks. She was found to have signs of acute kidney injury so transfer
back to Medical City Dallas for care under Dr. Bell was initiated.
26. On September 5, 2017, Mrs. Wickersham was seen for follow up at Dr. Guce's office
by Ning Cui, NP who indicated the patient had been hospitalized for dehydration and
malnutrition, and discharged 10 days ago with instructions to follow "post-surgical
guidelines of nutrition intake." She reported taking a vitamin supplement and "B12 shot as
directed."
27. On September 25, 2017, Mrs. Wickersham was seen again by Ning Cui, NP who
noted the patient was "very emotional," and reported no strength in her legs, intractable
vomiting and only keeping chicken soup down. Ms. Wickersham's weight was down to 336
lbs., representing a 53-lb weight loss since her last recorded weight of 389 on 07/27. She
had begun seeing a psychologist for counseling the previous week. Depression Screening
was now "Moderate Depression." On October 23, 2017, Mrs. Wickersham was seen again
by Ning Cui, NP for weakness and not eating, stating she wished she had not done the
surgery, feeling nauseous and wanting to vomit all the time.
28. On November 7, 2017, Mrs. Wickersham presented to Texas Health Presbyterian
Kaufman emergency department for complaints of weakness and vomiting. Stewart Alan
Master, MD documented that the patient recently had gastric sleeve and last saw Dr. Bell
in August who reported everything was fine. Current Medications were Xanax, Symbicort
and Norco. Labs indicated a critically low potassium level of 2.6. Mrs. Wickersham was
given a one-time dose of thiamine 100 mg IV as well as potassium in the emergency
department. She was admitted by Hospitalist Dr. Stephen McMahon. The following day,
Dr. McMahon documented "Recheck at 5 p.m., if potassium reasonable, may be able to
safely discharge…" Mrs. Wickersham was subsequently discharged that evening by Feni
John, NP.
29. On December 6, 2017, Mrs. Wickersham presented to Texas Health Presbyterian
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Kaufman emergency department complaining of generalized weakness, arthralgias and
myalgias. Again, history of gastric sleeve and decreased appetite were noted. Potassium
was once again critically low. Mrs. Wickersham was re-admitted by Feni John, NP for
treatment of urinary tract infection; acute hypokalemia and neuropathy. Dr. McMahon
ordered continuous IV infusion of D5 with ½ normal saline and added potassium. Mrs.
Wickersham was discharged home on December 8, 2017.
30. On December 18, 2017, Mrs. Wickersham presented to Texas Health Presbyterian
Kaufman emergency department again due to a fall. Recent history was noted and
presenting complaints included nausea, vomiting, weakness, tingling and throbbing of
bilateral feet. Emergency department physician Kyle Vannguyen ordered a one-time dose
of oral thiamine 200 mg, given in the emergency department. Mrs. Wickersham was
discharged home with plans to follow up with a social worker.
31. On January 6, 2018, Mrs. Wickersham presented to Texas Health Presbyterian
Kaufman emergency department and was seen by Mark Maynard, DO, noting pertinent
history of bypass surgery followed by multiple hospitalizations, chronic vomiting, weakness
and hypokalemia. Mrs. Wickersham was admitted under the care of Hospitalist Dr.
Benjamin Brashear, and given IV fluids with potassium, magnesium and anti-nausea
medication. At her prior emergency department visit on December 18, 2017, the provider
had reported a history of already a 100lbs. weight loss since bariatric surgery. Mrs.
Wickersham's weight was documented as 136.1kg on that emergency department visit. Mrs.
Wickersham's weight during the January 6, 2018, admission, documented by Dr. Brashear
in his H&P, is 126.4kg, representing an additional 21.3 lbs weight loss in less than 3 weeks.
32. On January 7, 2018, in his discharge summary, Dr. Brashear acknowledged having
reviewed the records of prior visits when he writes "Please see her last few ER and hospital
admissions for similar presentation", so he is clearly aware of the dramatic and ongoing
weight loss Mrs. Wickersham has suffered. Dr. Brashear states Mrs. Wickersham "had not
been eating and drinking well at home", and that at the time of discharge, "She is still not
sure about her diet and fluid needs...". Dr. Brashear stated Mrs. Wickersham had a follow
up visit scheduled with her PCP, Dr. Guce but besides ensuring she was no longer
dehydrated and that her Potassium had normalized, Dr. Brashear does nothing to actively
address Mrs. Wickersham's malnourished state. Dr. Brashear discharges her apparently
hoping she will do better with her poor nutrition than she has done on prior presentations.
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33. On the evening of January 27, 2018, Mrs. Wickersham presented to Texas Health
Presbyterian Kaufman emergency department complaining of weakness. After evaluation
in the emergency department it was determined she was in septic shock, presumably related
to a UTI, and eventually discovered to be related to community acquired pneumonia as well.
She was admitted under the care of her PCP Dr. Garry Guce, who supervised her care from
admission January 27, 2018 thru January 31, 2018, when her care is handed off to a series
of hospitalists. As her PCP, Dr. Guce is familiar with Mrs. Wickersham's history, including
her bariatric surgery as well as her issues with nausea, vomiting, poor intake, and dramatic
weight loss. In addition, Dr. Guce comments multiple times in those days on her weakness
and her peripheral neuropathy, for which she was taking Lyrica.
34. On January 29, 2018, Dr. Guce includes "Neuropathy" and "weakness" in his
progress note assessment, but does not include any plans aimed at determining the root cause
of the those problems in this patient. In Dr. Guce's January 30, 2018 and January 31, 2018,
progress notes, he continues to include weakness in his assessment, and further qualifies the
neuropathy as "idiopathic" without indication there has been further testing or a Neurology
consultation to support the conclusion that there is no identifiable cause for the neuropathy.
Although he notes a normal B12 level, other causes of weakness and neuropathy in
malnourished patient, such as a B1 level are not obtained. Dr. Guce does mention on
January 31, 2018, "may need neuro ffup as OP for EMG-NCV", an appropriate diagnostic
step, however he fails to pursue this critically important step.
35. On February 1, 2018, Mrs. Wickersham was seen by Gustavo N. Del Toro, DO, who
notes her "Weakness" and ongoing severe pain from "Idiopathic Peripheral Neuropathy", but
no further plan for investigating these two significant problems is implemented . Mrs.
Wickersham was seen by Deborah A. Andrews, PT who states: "Pt unable to ambulate
secondary to weakness and fatigue...informed pt she was too weak to go home in this state."
36. On February 2, 2018, at 1326, Mrs. Wickersham was seen by Christina Dipaul
Wright, RD, who notes continued poor PO intake. She recommended sending Ensure at
mealtimes and documented, "Will monitor progress, weights, labs, oral intake and plan of
care". At 1841, Mrs. Wickersham was seen by Gustavo N. Del Toro, DO, who notes her
"Weakness" and ongoing severe pain, but adds "She states she is too weak to do PT.", but
no further plan for investigating these two significant problems is implemented.
37. On February 3, 2018, Mrs. Wickersham was seen by Paul A. Guttuso, MD, who
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notes her "Weakness" and ongoing severe pain from "Idiopathic Peripheral Neuropathy",
but no further plan for investigating these two significant problems is implemented. Dr.
Guttuso simply "Add cymbalta for pain" and "Increase Lyrica".
38. On February 4, 2018, Mrs. Wickersham was seen by Paul A. Guttuso, MD, who
notes her continued issues maintaining adequate magnesium and potassium levels. He notes
"Weakness", and ongoing severe pain from "Idiopathic peripheral neuropathy", but no
further plan for investigating these two significant problems is implemented. Dr. Guttuso
astutely comments in his plan "Needs improved nutrition", but no specific plans to
accomplish this appear to be implemented.
39. On February 5, 2018, Mrs. Wickersham was seen by Gustavo N. Del Toro, DO who
notes "...still very weak. At home she would get around with a walker...", and on exam "She
is generally weak, needing assistance to sit up in bed...". "Weakness" and "Idiopathic
Peripheral Neuropathy" remain in the assessment, but no further plan for investigating these
two significant problems is implemented. Plans are made to discharge Mrs. Wickersham to
a Skilled Nursing Facility/Rehab. Mrs. Wickersham was seen by Deborah A. Andrews, PT
who states: "Pt. lethargic with flat affect appeared dazed and had received hydrocodone
according to. Pt still rating pain7/10...in B feet and lowere legs...Pt. unsafe to return home
at this time."
40. On February 6, 2018, at 1048, Mrs. Wickersham was seen by Deborah A. Andrews,
PT who states: "Pt. difficult to arouse and unable to make sense of her speech since it was
slurred." At 1200, Mrs. Wickersham was seen by Daniel R. Scheurich, MD, who notes "Still
weak." "Weakness", "Idiopathic peripheral neuropathy" and "Debility" remain in the
assessment, but no further plan for investigating these significant problems is implemented.
Plans are made to discharge Mrs. Wickersham to a Skilled Nursing Facility/Rehab. At 1419,
Mrs. Wickersham was seen by Christina Dipaul Wright, RD who notes continued poor and
inadequate PO intake. She recommended continuing Ensure at mealtimes and documented,
"Will monitor progress, weights, labs, oral intake and plan of care".
41. On February 7, 2018, Mrs. Wickersham was seen by Daniel R. Scheurich, MD.
"Weakness", "Idiopathic Peripheral Neuropathy" and "Debility" remain in the assessment,
but no further plan for investigating these significant problems is implemented. Plans
continue to be made to discharge Mrs. Wickersham to a Skilled Nursing Facility/Rehab. At
1618, Mrs. Wickersham was seen by Deborah A. Andrews, PT who states: "Sit to stand x
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4 attempts all unsuccessful...Pt states she stood up this morning with the help of 3 persons
and showered and got off the bedside commode. Unable to verify this with nursing. They
do not recall this." At 2122, Mrs. Wickersham is assessed by Peggy D. Goodner, RN who
notes getting Mrs. Wickersham up to the bedside commode required maximum assistance
from 2 staff members. On returning patient to her bed, she notes "pt. unable to bear weight
and providing no assistance with transfer.
42. On February 8, 2018, Mrs. Wickersham was seen by Daniel R. Scheurich, MD. who
does not acknowledge the severity of weakness encountered the evening before. Dr.
Scheurich again notes "Weakness", "Debility" and "Idiopathic Peripheral Neuropathy" in his
assessment, but notes no plans for further work up, no plans for further intervention
regarding the weakness that appears to be worsening significantly, despite the care and
nutrition being offered at that facility. Dr. Scheurich appears to simply proceeded with the
plan to discharge this patient who is acutely worsening to a SNF/Rehab facility.
43. On February 8, 2018, Mrs. Wickersham was admitted to Sunflower Park Health
Care, a skilled nursing facility, for physical therapy under the care of Dr. Garry Guce and
Erik Tijerina, NP. Admission diagnoses included severe malnutrition and muscle weakness
with history of gastric sleeve surgery. Admission medications did not include thiamine or
vitamin B1. Erik Tijerina, NP documented in the Admission History and Physical that Mrs.
Wickersham was "nearly non-ambulatory" and, "was told by hospital they think loss of
ability to eat and nausea is mental and has psych visit pending…"
44. During her stay at Sunflower Park, Mrs. Wickersham continued to experience
nausea, vomiting and inability to hold down substantial amounts of food. On February 15,
2018, she was complaining of pain all over. On February16, 2018, she was sent to the ER
for complaints of numbness to her face, slurring speech and difficulty grasping objects. She
returned within 4 hours with no new medications. Tramadol and Lyrica were being given
for pain.
45. On the afternoon of February 17, 2018, Jodianne Ashley, LVN notified Erik Tijerina
NP that Mrs. Wickersham complained of not being able to feel her legs. He advised nursing
staff to monitor and report any changes to him. A little over an hour later, Nurse Ashley
documented that Mrs. Wickersham also complained of lack of control of her arms. Mrs.
Wickersham's blood sugar level was borderline low at 61. She agreed to drink a shake and
requested Zofran for nausea. Overnight, Mrs. Wickersham continued to complain that her
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arms were stillweak and numb. In addition, a large reddened area "almost burned area" 0n
her lower back, bottom and upper thighs was documented.
46. The following morning at 09:09 a.m., Nurse Ashley documented that Mrs.
Wickersham's speech was slow and slurred and that she continued t0 complain ofweakness
and numbness is all extremities. By 11:09 a new order was received from Mr. Tijerina for
referral to wound care for treatment 0f her buttocks.
47. On February 19, 2018, at approximately 1:28 p.m., Dawn Bryant, LVN documented
that Mrs. Wickersham was having trouble gripping items and continued t0 complain 0f not
having any feeling in her hands and legs. An order was finally obtained from Dr. Guce t0
transfer Mrs. Wickersham STAT t0 Rockwell Presbyterian Hospital ER for altered mental
status Where the ED physician would be awaiting her arrival.
48. Mrs. Wickersham arrived at Rockwell Presbyterian emergency department at
approximately 2:32 With complaints ofweakness With 10w blood pressure and found t0 have
bilateral pulmonary emboli. She was admitted and started 0n a blood thinner. Critical Care
consult was performed by Delano Fabro, Jr. Mrs. Wickersham continued to complain of
numbness 0f her extremities and per Occupational Therapy note on February 20, 201 8, she
had decreased coordination and required assistance With all activities. Hospitalist Usman
Chaudhry, MD documented discoordinated upper extremity movements." Teresa Ingle, RN,
documented that Mrs. Wickersham was confused and paranoid, "unrelated t0 morphine or
Norco," and described auditory and Visual hallucinations.
49. As a result of Mrs. Wichersham’s injuries, Plaintiffs bring this suit t0 recover
damages.
NEGLIGENCE AND GROSS NEGLIGENCE OF DEFENDANTS
50. A11 named Defendants and their agents, servants and/or employees are healthcare
providers Who accepted a duty t0 act as reasonably prudent healthcare providers would under
the same 0r similar circumstances When they accepted Amy Wickersham, entering into a
physician—patient relationship and/or a healthcare provider—patient relationship at all relevant
times in 2018.
51. Defendant Benjamin Brashear, MD breached the standard of care by failing t0
adequately observe, diagnose, and treat Amy Wickersham When she presented for care. Such
breaches of Defendant include but are not limited t0 failing t0 make diagnosis of
micronutrient deficiency, failing t0 recognize that the same patient struggling With nausea,
vomiting and weakness requiring hospitalization would be at even higher risk for Vitamin
and nutrient deficiencies and such were the proximate cause of Plaintiff‘s injuries. These
breaches by Defendant were negligent, willful and wanton, reckless and grossly negligent
10
and, as such, these breaches were the proximate cause of Plaintiff’s injuries claimed herein.
52. Defendant Garry Guce, MD breached the standard of care by failing to adequately
observe, diagnose, and treat Amy Wickersham when she presented for care. Such breaches
of Defendant include but are not limited to failing to make diagnosis of micronutrient
deficiency; failing to recognize that his patient following gastric sleeve surgery could suffer
from nutrient malabsorption, failing to recognize that the same patient struggling with
nausea and vomiting requiring several hospitalizations would be at even higher risk for
vitamin and nutrient deficiencies and such were the proximate cause of Plaintiff’s injuries.
These breaches by Defendant were negligent, willful and wanton, reckless and grossly
negligent and, as such, these breaches were the proximate cause of Plaintiff’s injuries
claimed herein.
53. Defendant Daniel Scheurich, MD, breached the standard of care by failing to
adequately observe, diagnose, and treat Amy Wickersham when she presented for care.
Such breaches of Defendant include but are not limited to failing to make diagnosis of
micronutrient deficiency, failing to recognize that the same patient struggling with nausea,
vomiting and weakness requiring hospitalization would be at even higher risk for vitamin
and nutrient deficiencies and such were the proximate cause of Plaintiff's injuries. These
breaches by Defendant were negligent, willful and wanton, reckless and grossly negligent
and, as such, these breaches were the proximate cause of Plaintiff’s injuries claimed herein.
54. Defendant Gustavo N. Del Toro, DO, breached the standard of care by failing to
adequately observe, diagnose, and treat Amy Wickersham when she presented for care. Such
breaches of Defendant include but are not limited to failing to make diagnosis of
micronutrient deficiency, failing to recognize that the same patient struggling with nausea,
vomiting and weakness requiring several hospitalizations would be at even higher risk for
vitamin and nutrient deficiencies, failing to diagnose and treat thiamine deficiency such
were the proximate cause of Plaintiff's injuries. These breaches by Defendant were
negligent, willful and wanton, reckless and grossly negligent and, as such, these breaches
were the proximate cause of Plaintiff’s injuries claimed herein
55. Defendant Paul A. Guttuso, MD breached the standard of care by failing to
adequately observe, diagnose, and treat Amy Wickersham when she presented for care. Such
breaches of Defendant include but are not limited to failing to make diagnosis of
micronutrient deficiency; failing to recognize that the same patient struggling with nausea,
vomiting and weakness requiring several hospitalizations would be at even higher risk for
vitamin and nutrient deficiencies, failing to diagnose and treat thiamine deficiency and such
were the proximate cause of Plaintiff's injuries. These breaches by Defendant were
11
negligent, willful and wanton, reckless and grossly negligent and, as such, these breaches
were the proximate cause of Plaintiff’s injuries claimed herein
56. Defendant Christina D. Wright, RD breached the standard of care by failing to
adequately observe, diagnose, and treat Amy Wickersham when she presented for care. Such
breaches of Defendant include but are not limited to failing to recommend micronutrients
to aid in meeting needs based on analysis of prolonged suboptimal intake and failing to
recommend investigation of nutrient statuses based on analysis of prolonged suboptimal
intake and such breaches were the proximate cause of Plaintiff's injuries. These breaches
by Defendant were negligent, willful and wanton, reckless and grossly negligent and, as
such, these breaches were the proximate cause of Plaintiff’s injuries claimed herein.
57. Defendant Erik Tijerina, FNP breached the standard of care by failing to adequately
observe, diagnose, and treat Amy Wickersham when she presented for care. Such breaches
of Defendant include but are not limited to failing to make diagnosis of micronutrient
deficiency; failing to recognize that his patient following gastric sleeve surgery could suffer
from nutrient malabsorption, failing to recognize that the same patient struggling with
nausea and vomiting requiring several hospitalizations would be at even higher risk for
vitamin and nutrient deficiencies and such were the proximate cause of Plaintiff's injuries.
These breaches by Defendant were negligent, willful and wanton, reckless and grossly
negligent and, as such, these breaches were the proximate cause of Plaintiff's injuries
claimed herein.
ACTS OF AGENTS, SERVANTS AND/OR EMPLOYEES
58. Whenever in this Petition it is alleged that the Defendant Brashear Family Medical,
PA did any act or thing, it is meant that Defendant Brashear Family Medical, PA and it’s
employees/agents/servants including but not limited to Benjamin Brashear, MD,, did such
act or thing, and that, at the time such act or thing was done, it was done in the ordinary
course and scope of employment of each Defendant's officers, agents, servants, employees
or representatives. As such Defendant Brashear Family Medical, PA is vicariously liable
under the doctrine of respondeat superior.
59. Whenever in this Petition it is alleged that the Defendant WellMed Medical Group,
P.A. d/b/a WellMed at Kaufman did any act or thing, it is meant that Defendant WellMed
Medical Group, P.A. d/b/a WellMed at Kaufman and it’s employees/agents/servants
including but not limited to Garry Guce, MD, did such act or thing, and that, at the time such
act or thing was done, it was done in the ordinary course and scope of employment of each
Defendant's officers, agents, servants, employees or representatives. As such Defendant
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WellMed Medical Group, P.A. d/b/a WellMed at Kaufman is vicariously liable under the
doctrine of respondeat superior.
60. Whenever in this Petition it is alleged that the Defendant , Sound Inpatient Physicians
Inc., did any act or thing, it is meant that Defendant Sound Inpatient Physicians Inc. and it’s
employees/agents/servants including but not limited to Garry Guce, MD, did such act or
thing, and that, at the time such act or thing was done, it was done in the ordinary course and
scope of employment of each Defendant's officers, agents, servants, employees or
representatives. As such Defendant Sound Inpatient Physicians Inc. is vicariously liable
under the doctrine of respondeat superior.
61. Whenever in this Petition it is alleged that the Defendant Dr. Garry Guce &
Associates, PLLC did any act or thing, itis meant that Defendant Dr. Garry Guce &
Associates, PLLC and it’s employees/agents/servants including but not limited to Garry
Guce, MD, did such act or thing, and that, at the time such act or thing was done, it was done
in the ordinary course and scope of employment of each Defendant's officers, agents,
servants, employees or representatives. As such Defendant Dr. Garry Guce & Associates,
PLLC is vicariously liable under the doctrine of respondeat superior.
62. Whenever in this Petition it is alleged that the Defendant Texas Health Physicians
Group did any act or thing, it is meant that Defendant Texas Health Physicians Group and
it’s employees/agents/servants including but not limited to Paul A. Guttuso, MD,, did such
act or thing, and that, at the time such act or thing was done, it was done in the ordinary
course and scope of employment of each Defendant's officers, agents, servants, employees
or representatives. As such Defendant Texas Health Physicians Group is vicariously liable
under the doctrine of respondeat superior.
63. Whenever in this Petition it is alleged that the Defendant Lumincare Physician
Group, P.A., did any act or thing, it is meant that Defendant Lumincare Physician Group,
P.A. and it’s employees/agents/servants including but not limited to, Gustavo N. Del Toro,
DO, did such act or thing, and that, at the time such act or thing was done, it was done in the
ordinary course and scope of employment of each Defendant's officers, agents, servants,
employees or representatives. As such Defendant Lumincare Physician Group, P.A. is
vicariously liable under the doctrine of respondeat superior.
64. Whenever in this Petition it is alleged that the Defendant Aramark Healthcare
Support Services, LLC did any act or thing, it is meant that Defendant Aramark Healthcare
Support Services, LLC and it’s employees/agents/servants including but not limited to
Christina D. Wright, RD, did such act or thing, and that, at the time such act or thing was
done, itwas done in the ordinary course and scope of employment of each Defendant's
13
officers, agents, servants, employees 0r representatives. As such Defendant Aramark
Healthcare Support Services, LLC is vicariously liable under the doctrine 0f respondeat
superior.
65. Whenever in this Petition it isalleged that the Defendant Texas Health Presbyterian
Kaufman did any act or thing, it is meant that Defendant Texas Health Presbyterian
Kaufman and it’s employees/agents/servants including but not limited t0, Christina D.
Wright, RD, did such act or thing, and that, at the time such act 0r thing was done, it was
done in the ordina
Preview
FILED DALLAS COUNTY 3 CIT ATTY MAIL 2/6/2020 3:14PM FELICIA PITRE DISTRICT CLERK Kayla Buckley CAUSE NO.: DC-20-00255 AMY WICKERSHAM AND IN THE DISTRICT COURT OF PERRY WICKERSHAM Plaintiffs VS. BENJAMIN BRASHEAR, MD, GARRY GUCE, MD, DANIEL SCHEURICH, MD, GUSTAVO N. DEL TORO, DO, PAUL A. GUTTUSO, MD, DALLAS COUNTY, TEXAS CHRISTINA D. WRIGHT, RD, BRASHEAR FAMILY MEDICAL, P.A., mmmmmmmwmmmmmmmmmwmmmmmm WELLMED MEDICAL GROUP, P.A. D/B/A WELLMED AT KAUFMAN, SOUND INPATIENT PHYSICIANS INC., DR. GARRY GUCE & ASSOCIATES, PLLC, TEXAS HEALTH PHYSICIANS GROUP, LUMINCARE PHYSICLAN GROUP, P.A., ARAMARK HEALTHCARE SUPPORT SERVICES, LLC AND TEXAS HEALTH PRESBYTERIAN KAUFMAN Defendants 44th JUDICIAL DISTRICT PLAINTIFFS’ FIRST AMENDED ORIGINAL PETITION TO THE HONORABLE JUDGE OF SAID COURT: Plaintiffs, Amy Wickersham and Perry Wickersham, files this First Amended Original Petition complaining 0f Defendants, Benjamin Brashear, MD, Garry Guce, MD, Daniel Scheurich, MD, Gustavo N. Del Toro, DO, Paul A. Guttuso, MD, Christina D. Wright, RD, Brashear Family Medical, PA, WellMed Medical Group, P.A. d/b/a WellMed atKaufman, Sound Inpatient Physicians Inc., Dr. Garry Guce & Associates, PLLC, Texas Health Physicians Group, Lumincare Physician Group, P.A., Aramark Healthcare Support Services, LLC, Texas Health Presbyterian Kaufman, Erik Tijerina, FNP, Sunflower Park Health Care and HealthTexas Provider Network d/b/a Baylor Scott & White Primary Care Associates for their causes of action and support thereof respectfully state the following: DISCOVERY LEVEL 1. Under Texas Rules ofCiVil Procedure, Rule 190.3, this case shall be conducted under a Level 3 discovery control plan. PARTIES 2. Plaintiffs Amy Wickersham and Perry Wickersham are residents of Kaufman County, Texas. 3. Defendant Benjamin Brashear, MD, is a medical doctor providing services in Kaufman and Dallas County, Texas. Defendant may be served With service of process at 2801 Millennium Drive, Suite, B, Kaufman Texas 75 140 0r wherever Defendant may be found. 4. Defendant Garry Guce, MD, is medical doctor providing services in Kaufman County, Texas. Defendant may be served with service of process at 874 ED Hall Drive, Suite 106, Kaufman, Texas 75 142 0r Wherever Defendant may be found. 5. Defendant Daniel Scheurich, MD, is medical doctor providing services in Kaufman and Dallas County, Texas. Defendant Daniel Scheurich, MD is a resident ofDallas County, Texas. Defendant may be served With service ofprocess at 2000 Beechwood Lane, Copell, Texas 75019 0r Wherever Defendant may be found. 6. Defendant, Gustavo N. Del Toro, DO, is a medical doctor providing services in Kaufman and Collin County, Texas. Defendant may be served With service of process at 2150 S. Central Expy, Suite 200, McKinney, Texas 75070 or Wherever Defendant may be found. 7. Defendant Paul A. Guttuso, MD, is a medical doctor providing services in Kaufman County, 3rd Texas. Defendant may be served with service of process at 604 S. Street, Suite A, Mabank, Texas 75 147 0r Wherever Defendant may be found. 8. Defendant Christina D. Wright, RD, isa registered dietician providing services in Kaufman County, Texas. Defendant may be served With service of process at 3400 W. Interstate Highway 20 N. Access Rd. Van, Texas 75790 or Wherever Defendant may be found. 9. Defendant Brashear Family Medical, PA. is a medical entity providing medical services in Kaufman County, Texas. Defendant may be served With service 0f process by serving its registered agent, Benjamin Russell Brashear at2801 Millennium Dr., Suite B Kaufman, Texas 75142 or wherever Defendant may be found. 10. Defendant WellMed Medical Group, P.A. d/b/a WellMed at Kaufman is a medical entity in providing medical services in Kaufman County, Texas. Defendant may be served with service of process by serving its registered agent, CT Corporation System at 1999 Bryan St., Ste. 900, Dallas, Texas 75201 or wherever Defendant may be found. 11. Defendant Sound Inpatient Physicians, Inc., is a medical entity in Midland County, Texas. Defendant may be served with service of process by serving its registered agent, Corporation Service Company d/b/a CSC-Lawyers Incorporating Service Company, 211 E. 7th Street, Suite 620, Austin, Texas 78701or wherever Defendant may be found. 12. Defendant Dr. Garry Guce & Associates, PLLC, is a medical entity in Kaufman County, Texas. Defendant may be served with service of process by serving its registered agent, Glenda Lydia at 3721 FM 1837, Kaufman, Texas 75142or wherever Defendant may be found. 13. Defendant Texas Health Physicians Group, is a medical entity in Kaufman and Dallas County, Texas. Defendant may be served with service of process by serving its registered agent, Donald B. Collins at 612 E. Lamar Blvd., Suite1400, Arlington, Texas 76011 or wherever Defendant may be found. 14. Defendant Lumincare Physician Group, PA, is a medical entity in Midland County, Texas. Defendant may be served with service of process by serving its registered agent, Incorp Services Inc. at 815 Brazos, Suite 500, Austin, Texas 78701 or wherever Defendant may be found. 15. Defendant Aramark Healthcare Support Services, LLC, is a medical entity in Texas. Defendant may be served with service of process by serving its registered agent, CT Corporation System at 1999 Bryan St., Ste. 900, Dallas, Texas 75201 or wherever Defendant may be found. 16. Defendant Texas Health Presbyterian Kaufman, is a medical facility in Kaufman County, Texas. Defendant may be served with service of process by serving its registered agent, Donald B. Collins at 612 E. Lamar Blvd., Suite1400, Arlington, Texas 76011 or wherever Defendant may be found. 17. Defendant Erik Tijerina, FNP, is a family nurse practitioner providing services in Kaufman County, Texas. Defendant may be served with service of process at 801 W Main 3 Street, Gun Barrel City, Texas 75 1 56 0r Wherever Defendant may be found. 18. Defendant Sunflower Park Health Care, is a medical facility in Kaufman County, Texas. Defendant may be served With service of process by serving its registered agent, InCorp Services, Inc. at 815 Brazos St., Suite 500, Austin, Texas 787010r Wherever Defendant may be found. 19. Defendant HealthTexas Provider Network d/b/a Baylor Scott & White Primary Care Associates, is a medical facility in Henderson County, Texas. Defendant may be served With service 0f process by serving its registered agent, CT Corporation System at 1999 Bryan St., Ste. 900, Dallas, Texas 75201 0r Wherever Defendant may be found. VENUE AND JURISDICTION ’ 20. Venue for Plaintiffs action against the Defendants is proper in Dallas County, Texas because individual defendants are residents ofDallaS County, Texas, and were also residents 0f Dallas County, Texas, at the time that Plaintiffs' cause of action accrued and at all times relevant t0 this lawsuit, in particular Daniel Scheurich, MD. 21. This Court has subject matter jurisdiction over this action because the amount of monetary relief claimed by Plaintiffs’ isover $200,000.00 but not more than $6,000,000.00 and Plaintiff’ s action is for personal injuries resulting from medical negligence pursuant t0 TEX. CIV. PRAC. & REM. CODE § 74.001 et seq. A11 conditions precedent t0 the filing 0fthis action, including the sending of the required notice letter pursuant t0 TEX. CIV. PRAC. & REM. CODE 22. § 74.001 On July 3, et seq., have occurred. w 2017, Mrs. Wickersham underwent Sleeve gastrectomy performed by Dr. Christopher Bell. At her follow-up Visit 0n July 27, 2017, Dr. Bell documented that Mrs. Wickersham was doing well, tolerating oral liquids, and was 0n no active medications. Instructions were "Advance diet and activities as tolerated" and follow up in one month. 23. On August 1, 2017, Mrs. Wickersham had a follow up appointment with Primary Care Physician Dr. Garry Guce Who noted Mrs. Wickersham was having trouble swallowing pills since her procedure and also had possible infection t0 her incision site. Dr. Guce prescribed antibiotic Clindamycin and started her on anti—anxiety medication Xanax. The only other active medication documented at that time was hydrochlorothiazide for high blood pressure. 24. On August 3, 2017, Mrs. Wickersham presented to Texas Health Presbyterian Kaufman emergency department due to fever. She was found to have an abdominal wall abscess at her umbilical incision and was started on IV antibiotics. She was then transported to Medical City Dallas for higher level of care "by original surgical provider" Dr. Bell. 25. On August 15, 2017, Mrs. Wickersham returned to Texas Health Presbyterian Kaufman emergency department with persistent abdominal abscess and new complaints of vomiting for several weeks. She was found to have signs of acute kidney injury so transfer back to Medical City Dallas for care under Dr. Bell was initiated. 26. On September 5, 2017, Mrs. Wickersham was seen for follow up at Dr. Guce's office by Ning Cui, NP who indicated the patient had been hospitalized for dehydration and malnutrition, and discharged 10 days ago with instructions to follow "post-surgical guidelines of nutrition intake." She reported taking a vitamin supplement and "B12 shot as directed." 27. On September 25, 2017, Mrs. Wickersham was seen again by Ning Cui, NP who noted the patient was "very emotional," and reported no strength in her legs, intractable vomiting and only keeping chicken soup down. Ms. Wickersham's weight was down to 336 lbs., representing a 53-lb weight loss since her last recorded weight of 389 on 07/27. She had begun seeing a psychologist for counseling the previous week. Depression Screening was now "Moderate Depression." On October 23, 2017, Mrs. Wickersham was seen again by Ning Cui, NP for weakness and not eating, stating she wished she had not done the surgery, feeling nauseous and wanting to vomit all the time. 28. On November 7, 2017, Mrs. Wickersham presented to Texas Health Presbyterian Kaufman emergency department for complaints of weakness and vomiting. Stewart Alan Master, MD documented that the patient recently had gastric sleeve and last saw Dr. Bell in August who reported everything was fine. Current Medications were Xanax, Symbicort and Norco. Labs indicated a critically low potassium level of 2.6. Mrs. Wickersham was given a one-time dose of thiamine 100 mg IV as well as potassium in the emergency department. She was admitted by Hospitalist Dr. Stephen McMahon. The following day, Dr. McMahon documented "Recheck at 5 p.m., if potassium reasonable, may be able to safely discharge…" Mrs. Wickersham was subsequently discharged that evening by Feni John, NP. 29. On December 6, 2017, Mrs. Wickersham presented to Texas Health Presbyterian 5 Kaufman emergency department complaining of generalized weakness, arthralgias and myalgias. Again, history of gastric sleeve and decreased appetite were noted. Potassium was once again critically low. Mrs. Wickersham was re-admitted by Feni John, NP for treatment of urinary tract infection; acute hypokalemia and neuropathy. Dr. McMahon ordered continuous IV infusion of D5 with ½ normal saline and added potassium. Mrs. Wickersham was discharged home on December 8, 2017. 30. On December 18, 2017, Mrs. Wickersham presented to Texas Health Presbyterian Kaufman emergency department again due to a fall. Recent history was noted and presenting complaints included nausea, vomiting, weakness, tingling and throbbing of bilateral feet. Emergency department physician Kyle Vannguyen ordered a one-time dose of oral thiamine 200 mg, given in the emergency department. Mrs. Wickersham was discharged home with plans to follow up with a social worker. 31. On January 6, 2018, Mrs. Wickersham presented to Texas Health Presbyterian Kaufman emergency department and was seen by Mark Maynard, DO, noting pertinent history of bypass surgery followed by multiple hospitalizations, chronic vomiting, weakness and hypokalemia. Mrs. Wickersham was admitted under the care of Hospitalist Dr. Benjamin Brashear, and given IV fluids with potassium, magnesium and anti-nausea medication. At her prior emergency department visit on December 18, 2017, the provider had reported a history of already a 100lbs. weight loss since bariatric surgery. Mrs. Wickersham's weight was documented as 136.1kg on that emergency department visit. Mrs. Wickersham's weight during the January 6, 2018, admission, documented by Dr. Brashear in his H&P, is 126.4kg, representing an additional 21.3 lbs weight loss in less than 3 weeks. 32. On January 7, 2018, in his discharge summary, Dr. Brashear acknowledged having reviewed the records of prior visits when he writes "Please see her last few ER and hospital admissions for similar presentation", so he is clearly aware of the dramatic and ongoing weight loss Mrs. Wickersham has suffered. Dr. Brashear states Mrs. Wickersham "had not been eating and drinking well at home", and that at the time of discharge, "She is still not sure about her diet and fluid needs...". Dr. Brashear stated Mrs. Wickersham had a follow up visit scheduled with her PCP, Dr. Guce but besides ensuring she was no longer dehydrated and that her Potassium had normalized, Dr. Brashear does nothing to actively address Mrs. Wickersham's malnourished state. Dr. Brashear discharges her apparently hoping she will do better with her poor nutrition than she has done on prior presentations. 6 33. On the evening of January 27, 2018, Mrs. Wickersham presented to Texas Health Presbyterian Kaufman emergency department complaining of weakness. After evaluation in the emergency department it was determined she was in septic shock, presumably related to a UTI, and eventually discovered to be related to community acquired pneumonia as well. She was admitted under the care of her PCP Dr. Garry Guce, who supervised her care from admission January 27, 2018 thru January 31, 2018, when her care is handed off to a series of hospitalists. As her PCP, Dr. Guce is familiar with Mrs. Wickersham's history, including her bariatric surgery as well as her issues with nausea, vomiting, poor intake, and dramatic weight loss. In addition, Dr. Guce comments multiple times in those days on her weakness and her peripheral neuropathy, for which she was taking Lyrica. 34. On January 29, 2018, Dr. Guce includes "Neuropathy" and "weakness" in his progress note assessment, but does not include any plans aimed at determining the root cause of the those problems in this patient. In Dr. Guce's January 30, 2018 and January 31, 2018, progress notes, he continues to include weakness in his assessment, and further qualifies the neuropathy as "idiopathic" without indication there has been further testing or a Neurology consultation to support the conclusion that there is no identifiable cause for the neuropathy. Although he notes a normal B12 level, other causes of weakness and neuropathy in malnourished patient, such as a B1 level are not obtained. Dr. Guce does mention on January 31, 2018, "may need neuro ffup as OP for EMG-NCV", an appropriate diagnostic step, however he fails to pursue this critically important step. 35. On February 1, 2018, Mrs. Wickersham was seen by Gustavo N. Del Toro, DO, who notes her "Weakness" and ongoing severe pain from "Idiopathic Peripheral Neuropathy", but no further plan for investigating these two significant problems is implemented . Mrs. Wickersham was seen by Deborah A. Andrews, PT who states: "Pt unable to ambulate secondary to weakness and fatigue...informed pt she was too weak to go home in this state." 36. On February 2, 2018, at 1326, Mrs. Wickersham was seen by Christina Dipaul Wright, RD, who notes continued poor PO intake. She recommended sending Ensure at mealtimes and documented, "Will monitor progress, weights, labs, oral intake and plan of care". At 1841, Mrs. Wickersham was seen by Gustavo N. Del Toro, DO, who notes her "Weakness" and ongoing severe pain, but adds "She states she is too weak to do PT.", but no further plan for investigating these two significant problems is implemented. 37. On February 3, 2018, Mrs. Wickersham was seen by Paul A. Guttuso, MD, who 7 notes her "Weakness" and ongoing severe pain from "Idiopathic Peripheral Neuropathy", but no further plan for investigating these two significant problems is implemented. Dr. Guttuso simply "Add cymbalta for pain" and "Increase Lyrica". 38. On February 4, 2018, Mrs. Wickersham was seen by Paul A. Guttuso, MD, who notes her continued issues maintaining adequate magnesium and potassium levels. He notes "Weakness", and ongoing severe pain from "Idiopathic peripheral neuropathy", but no further plan for investigating these two significant problems is implemented. Dr. Guttuso astutely comments in his plan "Needs improved nutrition", but no specific plans to accomplish this appear to be implemented. 39. On February 5, 2018, Mrs. Wickersham was seen by Gustavo N. Del Toro, DO who notes "...still very weak. At home she would get around with a walker...", and on exam "She is generally weak, needing assistance to sit up in bed...". "Weakness" and "Idiopathic Peripheral Neuropathy" remain in the assessment, but no further plan for investigating these two significant problems is implemented. Plans are made to discharge Mrs. Wickersham to a Skilled Nursing Facility/Rehab. Mrs. Wickersham was seen by Deborah A. Andrews, PT who states: "Pt. lethargic with flat affect appeared dazed and had received hydrocodone according to. Pt still rating pain7/10...in B feet and lowere legs...Pt. unsafe to return home at this time." 40. On February 6, 2018, at 1048, Mrs. Wickersham was seen by Deborah A. Andrews, PT who states: "Pt. difficult to arouse and unable to make sense of her speech since it was slurred." At 1200, Mrs. Wickersham was seen by Daniel R. Scheurich, MD, who notes "Still weak." "Weakness", "Idiopathic peripheral neuropathy" and "Debility" remain in the assessment, but no further plan for investigating these significant problems is implemented. Plans are made to discharge Mrs. Wickersham to a Skilled Nursing Facility/Rehab. At 1419, Mrs. Wickersham was seen by Christina Dipaul Wright, RD who notes continued poor and inadequate PO intake. She recommended continuing Ensure at mealtimes and documented, "Will monitor progress, weights, labs, oral intake and plan of care". 41. On February 7, 2018, Mrs. Wickersham was seen by Daniel R. Scheurich, MD. "Weakness", "Idiopathic Peripheral Neuropathy" and "Debility" remain in the assessment, but no further plan for investigating these significant problems is implemented. Plans continue to be made to discharge Mrs. Wickersham to a Skilled Nursing Facility/Rehab. At 1618, Mrs. Wickersham was seen by Deborah A. Andrews, PT who states: "Sit to stand x 8 4 attempts all unsuccessful...Pt states she stood up this morning with the help of 3 persons and showered and got off the bedside commode. Unable to verify this with nursing. They do not recall this." At 2122, Mrs. Wickersham is assessed by Peggy D. Goodner, RN who notes getting Mrs. Wickersham up to the bedside commode required maximum assistance from 2 staff members. On returning patient to her bed, she notes "pt. unable to bear weight and providing no assistance with transfer. 42. On February 8, 2018, Mrs. Wickersham was seen by Daniel R. Scheurich, MD. who does not acknowledge the severity of weakness encountered the evening before. Dr. Scheurich again notes "Weakness", "Debility" and "Idiopathic Peripheral Neuropathy" in his assessment, but notes no plans for further work up, no plans for further intervention regarding the weakness that appears to be worsening significantly, despite the care and nutrition being offered at that facility. Dr. Scheurich appears to simply proceeded with the plan to discharge this patient who is acutely worsening to a SNF/Rehab facility. 43. On February 8, 2018, Mrs. Wickersham was admitted to Sunflower Park Health Care, a skilled nursing facility, for physical therapy under the care of Dr. Garry Guce and Erik Tijerina, NP. Admission diagnoses included severe malnutrition and muscle weakness with history of gastric sleeve surgery. Admission medications did not include thiamine or vitamin B1. Erik Tijerina, NP documented in the Admission History and Physical that Mrs. Wickersham was "nearly non-ambulatory" and, "was told by hospital they think loss of ability to eat and nausea is mental and has psych visit pending…" 44. During her stay at Sunflower Park, Mrs. Wickersham continued to experience nausea, vomiting and inability to hold down substantial amounts of food. On February 15, 2018, she was complaining of pain all over. On February16, 2018, she was sent to the ER for complaints of numbness to her face, slurring speech and difficulty grasping objects. She returned within 4 hours with no new medications. Tramadol and Lyrica were being given for pain. 45. On the afternoon of February 17, 2018, Jodianne Ashley, LVN notified Erik Tijerina NP that Mrs. Wickersham complained of not being able to feel her legs. He advised nursing staff to monitor and report any changes to him. A little over an hour later, Nurse Ashley documented that Mrs. Wickersham also complained of lack of control of her arms. Mrs. Wickersham's blood sugar level was borderline low at 61. She agreed to drink a shake and requested Zofran for nausea. Overnight, Mrs. Wickersham continued to complain that her 9 arms were stillweak and numb. In addition, a large reddened area "almost burned area" 0n her lower back, bottom and upper thighs was documented. 46. The following morning at 09:09 a.m., Nurse Ashley documented that Mrs. Wickersham's speech was slow and slurred and that she continued t0 complain ofweakness and numbness is all extremities. By 11:09 a new order was received from Mr. Tijerina for referral to wound care for treatment 0f her buttocks. 47. On February 19, 2018, at approximately 1:28 p.m., Dawn Bryant, LVN documented that Mrs. Wickersham was having trouble gripping items and continued t0 complain 0f not having any feeling in her hands and legs. An order was finally obtained from Dr. Guce t0 transfer Mrs. Wickersham STAT t0 Rockwell Presbyterian Hospital ER for altered mental status Where the ED physician would be awaiting her arrival. 48. Mrs. Wickersham arrived at Rockwell Presbyterian emergency department at approximately 2:32 With complaints ofweakness With 10w blood pressure and found t0 have bilateral pulmonary emboli. She was admitted and started 0n a blood thinner. Critical Care consult was performed by Delano Fabro, Jr. Mrs. Wickersham continued to complain of numbness 0f her extremities and per Occupational Therapy note on February 20, 201 8, she had decreased coordination and required assistance With all activities. Hospitalist Usman Chaudhry, MD documented discoordinated upper extremity movements." Teresa Ingle, RN, documented that Mrs. Wickersham was confused and paranoid, "unrelated t0 morphine or Norco," and described auditory and Visual hallucinations. 49. As a result of Mrs. Wichersham’s injuries, Plaintiffs bring this suit t0 recover damages. NEGLIGENCE AND GROSS NEGLIGENCE OF DEFENDANTS 50. A11 named Defendants and their agents, servants and/or employees are healthcare providers Who accepted a duty t0 act as reasonably prudent healthcare providers would under the same 0r similar circumstances When they accepted Amy Wickersham, entering into a physician—patient relationship and/or a healthcare provider—patient relationship at all relevant times in 2018. 51. Defendant Benjamin Brashear, MD breached the standard of care by failing t0 adequately observe, diagnose, and treat Amy Wickersham When she presented for care. Such breaches of Defendant include but are not limited t0 failing t0 make diagnosis of micronutrient deficiency, failing t0 recognize that the same patient struggling With nausea, vomiting and weakness requiring hospitalization would be at even higher risk for Vitamin and nutrient deficiencies and such were the proximate cause of Plaintiff‘s injuries. These breaches by Defendant were negligent, willful and wanton, reckless and grossly negligent 10 and, as such, these breaches were the proximate cause of Plaintiff’s injuries claimed herein. 52. Defendant Garry Guce, MD breached the standard of care by failing to adequately observe, diagnose, and treat Amy Wickersham when she presented for care. Such breaches of Defendant include but are not limited to failing to make diagnosis of micronutrient deficiency; failing to recognize that his patient following gastric sleeve surgery could suffer from nutrient malabsorption, failing to recognize that the same patient struggling with nausea and vomiting requiring several hospitalizations would be at even higher risk for vitamin and nutrient deficiencies and such were the proximate cause of Plaintiff’s injuries. These breaches by Defendant were negligent, willful and wanton, reckless and grossly negligent and, as such, these breaches were the proximate cause of Plaintiff’s injuries claimed herein. 53. Defendant Daniel Scheurich, MD, breached the standard of care by failing to adequately observe, diagnose, and treat Amy Wickersham when she presented for care. Such breaches of Defendant include but are not limited to failing to make diagnosis of micronutrient deficiency, failing to recognize that the same patient struggling with nausea, vomiting and weakness requiring hospitalization would be at even higher risk for vitamin and nutrient deficiencies and such were the proximate cause of Plaintiff's injuries. These breaches by Defendant were negligent, willful and wanton, reckless and grossly negligent and, as such, these breaches were the proximate cause of Plaintiff’s injuries claimed herein. 54. Defendant Gustavo N. Del Toro, DO, breached the standard of care by failing to adequately observe, diagnose, and treat Amy Wickersham when she presented for care. Such breaches of Defendant include but are not limited to failing to make diagnosis of micronutrient deficiency, failing to recognize that the same patient struggling with nausea, vomiting and weakness requiring several hospitalizations would be at even higher risk for vitamin and nutrient deficiencies, failing to diagnose and treat thiamine deficiency such were the proximate cause of Plaintiff's injuries. These breaches by Defendant were negligent, willful and wanton, reckless and grossly negligent and, as such, these breaches were the proximate cause of Plaintiff’s injuries claimed herein 55. Defendant Paul A. Guttuso, MD breached the standard of care by failing to adequately observe, diagnose, and treat Amy Wickersham when she presented for care. Such breaches of Defendant include but are not limited to failing to make diagnosis of micronutrient deficiency; failing to recognize that the same patient struggling with nausea, vomiting and weakness requiring several hospitalizations would be at even higher risk for vitamin and nutrient deficiencies, failing to diagnose and treat thiamine deficiency and such were the proximate cause of Plaintiff's injuries. These breaches by Defendant were 11 negligent, willful and wanton, reckless and grossly negligent and, as such, these breaches were the proximate cause of Plaintiff’s injuries claimed herein 56. Defendant Christina D. Wright, RD breached the standard of care by failing to adequately observe, diagnose, and treat Amy Wickersham when she presented for care. Such breaches of Defendant include but are not limited to failing to recommend micronutrients to aid in meeting needs based on analysis of prolonged suboptimal intake and failing to recommend investigation of nutrient statuses based on analysis of prolonged suboptimal intake and such breaches were the proximate cause of Plaintiff's injuries. These breaches by Defendant were negligent, willful and wanton, reckless and grossly negligent and, as such, these breaches were the proximate cause of Plaintiff’s injuries claimed herein. 57. Defendant Erik Tijerina, FNP breached the standard of care by failing to adequately observe, diagnose, and treat Amy Wickersham when she presented for care. Such breaches of Defendant include but are not limited to failing to make diagnosis of micronutrient deficiency; failing to recognize that his patient following gastric sleeve surgery could suffer from nutrient malabsorption, failing to recognize that the same patient struggling with nausea and vomiting requiring several hospitalizations would be at even higher risk for vitamin and nutrient deficiencies and such were the proximate cause of Plaintiff's injuries. These breaches by Defendant were negligent, willful and wanton, reckless and grossly negligent and, as such, these breaches were the proximate cause of Plaintiff's injuries claimed herein. ACTS OF AGENTS, SERVANTS AND/OR EMPLOYEES 58. Whenever in this Petition it is alleged that the Defendant Brashear Family Medical, PA did any act or thing, it is meant that Defendant Brashear Family Medical, PA and it’s employees/agents/servants including but not limited to Benjamin Brashear, MD,, did such act or thing, and that, at the time such act or thing was done, it was done in the ordinary course and scope of employment of each Defendant's officers, agents, servants, employees or representatives. As such Defendant Brashear Family Medical, PA is vicariously liable under the doctrine of respondeat superior. 59. Whenever in this Petition it is alleged that the Defendant WellMed Medical Group, P.A. d/b/a WellMed at Kaufman did any act or thing, it is meant that Defendant WellMed Medical Group, P.A. d/b/a WellMed at Kaufman and it’s employees/agents/servants including but not limited to Garry Guce, MD, did such act or thing, and that, at the time such act or thing was done, it was done in the ordinary course and scope of employment of each Defendant's officers, agents, servants, employees or representatives. As such Defendant 12 WellMed Medical Group, P.A. d/b/a WellMed at Kaufman is vicariously liable under the doctrine of respondeat superior. 60. Whenever in this Petition it is alleged that the Defendant , Sound Inpatient Physicians Inc., did any act or thing, it is meant that Defendant Sound Inpatient Physicians Inc. and it’s employees/agents/servants including but not limited to Garry Guce, MD, did such act or thing, and that, at the time such act or thing was done, it was done in the ordinary course and scope of employment of each Defendant's officers, agents, servants, employees or representatives. As such Defendant Sound Inpatient Physicians Inc. is vicariously liable under the doctrine of respondeat superior. 61. Whenever in this Petition it is alleged that the Defendant Dr. Garry Guce & Associates, PLLC did any act or thing, itis meant that Defendant Dr. Garry Guce & Associates, PLLC and it’s employees/agents/servants including but not limited to Garry Guce, MD, did such act or thing, and that, at the time such act or thing was done, it was done in the ordinary course and scope of employment of each Defendant's officers, agents, servants, employees or representatives. As such Defendant Dr. Garry Guce & Associates, PLLC is vicariously liable under the doctrine of respondeat superior. 62. Whenever in this Petition it is alleged that the Defendant Texas Health Physicians Group did any act or thing, it is meant that Defendant Texas Health Physicians Group and it’s employees/agents/servants including but not limited to Paul A. Guttuso, MD,, did such act or thing, and that, at the time such act or thing was done, it was done in the ordinary course and scope of employment of each Defendant's officers, agents, servants, employees or representatives. As such Defendant Texas Health Physicians Group is vicariously liable under the doctrine of respondeat superior. 63. Whenever in this Petition it is alleged that the Defendant Lumincare Physician Group, P.A., did any act or thing, it is meant that Defendant Lumincare Physician Group, P.A. and it’s employees/agents/servants including but not limited to, Gustavo N. Del Toro, DO, did such act or thing, and that, at the time such act or thing was done, it was done in the ordinary course and scope of employment of each Defendant's officers, agents, servants, employees or representatives. As such Defendant Lumincare Physician Group, P.A. is vicariously liable under the doctrine of respondeat superior. 64. Whenever in this Petition it is alleged that the Defendant Aramark Healthcare Support Services, LLC did any act or thing, it is meant that Defendant Aramark Healthcare Support Services, LLC and it’s employees/agents/servants including but not limited to Christina D. Wright, RD, did such act or thing, and that, at the time such act or thing was done, itwas done in the ordinary course and scope of employment of each Defendant's 13 officers, agents, servants, employees 0r representatives. As such Defendant Aramark Healthcare Support Services, LLC is vicariously liable under the doctrine 0f respondeat superior. 65. Whenever in this Petition it isalleged that the Defendant Texas Health Presbyterian Kaufman did any act or thing, it is meant that Defendant Texas Health Presbyterian Kaufman and it’s employees/agents/servants including but not limited t0, Christina D. Wright, RD, did such act or thing, and that, at the time such act 0r thing was done, it was done in the ordina