DOCUMENT 2

ELECTRONICALLY FILED
8/18/2020 9:43 AM
01-CV-2020-902915.00
CIRCUIT COURT OF
JEFFERSON COUNTY, ALABAMA
JACQUELINE ANDERSON SMITH, CLERK
IN THE CIRCUIT COURT OF JEFFERSON COUNTY, ALABAMA

HAYDEN MAC INGRAM, A MINOR, who

sues by and through his parents and next
friends, Brady and Macy Ingram; BRADY INGRAM,
individually; and MACY INGRAM, individually,
CIVIL ACTION NO.
PLAINTIFFS,
________________
V.

ST. VINCENT’S BIRMINGHAM,

There may be other entities whose true names and identities are unknown to the plaintiffs at this
time who may be legally responsible for the claim(s) set forth herein and who may be added by
amendment by the plaintiffs when their names and identities are accurately ascertained by further
discovery. Until that time, the plaintiffs will designate these parties in accordance with ARCP
9(h). The word "entity" as used herein is intended to refer and include any, and all, legal entities
including persons any, and all forms of partnership, any, and all types of corporate and
unincorporated associations. The symbol by which these party defendants are designated is
intended to include more than one entity if discovery reveals that the descriptive characterization
of the symbol applies to more than one entity. In the present action, the party defendants which
the plaintiffs must include by descriptive characterization are as follows:

DEFENDANT A, the legal entity known and doing business as St. Vincent’s Birmingham on the
occasion described herein;

DEFENDANT B, C, & D, the legal entity which employed the physicians, individual nurses and
other healthcare providers who negligently failed to confirm, document and act upon Macy
Ingram’s GBS (Group B Streptococcus) status on admission to St. Vincent’s Birmingham on
July 16, 2020;

DEFENDANTS E, F, & G, the legal entity responsible for coordination of the information
systems between the laboratory at St. Vincent’s Birmingham and the patient’s electronic health
record to accurately report GBS results as positive, negative or unknown, and assure that those
results are seen and acted upon by healthcare providers in this setting;

DEFENDANT H, I & J, the individual physicians, nurses and other healthcare providers who
negligently failed to ascertain, confirm and act upon Macy Ingram’s correct GBS status at the
time of her admission on July 16, 2020, including ordering antibiotic prophylaxis;

DEFENDANT K, the legal entity which failed to have policies, procedures, protections and
safeguards to assure that GBS culture status is accurately documented as positive, negative or
unknown at the time of a patient’s admission for labor and delivery, including a prohibition
against the use of “preliminary negative” for the reporting of GBS culture status.

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 DOCUMENT 2

DEFENDANTS.

COMPLAINT

1. Plaintiffs, Hayden Mac Ingram, (hereinafter referred to as Hayden) is a minor child born
on July 17, 2020. His parents, Brady and Macy Ingram, are adult resident citizens of
Bibb County, Alabama.

2. Defendant, St. Vincent’s Birmingham (hereinafter referred to as St. Vincent’s), is a

domestic corporation whose primary place of business is in Birmingham, Jefferson
County, Alabama.

3. On July 15, 2020, Macy Ingram was twenty-four years of age and 35+5 weeks pregnant
with her second child. She presented to her obstetrician’s office on that day and
underwent a cervical exam. She was one centimeter dilated and the decision was made to
do a GBS culture and screening for that bacteria. Macy’s first child, Jaxon, was born in
September of 2017, at thirty-five weeks gestation and her GBS status was unknown at the
time.

4. Macy’s water broke at home the next day, July 16, 2020, at around 7:30 p.m. She
telephoned the on-call nurse at the obstetrician’s office and was told to come directly to
the labor and delivery emergency department at St. Vincent’s. Brady and Macy arrived at
the hospital around 10:00 p.m., and hospital personnel met them in the parking lot. Macy
was taken by wheelchair to the labor and delivery emergency department and placed in a
small holding room. She received a COVID-19 test and the admissions process was
completed while she was awaiting the results. Registered Nurse Amber Hulsey is
believed to be the nurse who attended Macy in the emergency department, including a
discussion of her GBS status. Macy recalls telling her that she was tested in the OB’s
office the day before, but had not heard anything about her results. There was no other
discussion of her GBS status with anyone in the holding room, including Dr. Marshall
Neil White, III, who stopped by to let Macy know he was there and that they would take
good care of her at St. Vincent’s. Dr. White is Macy’s admitting physician, an OBGYN
Laborist, an OB Hospitalist and an employee of St. Vincent’s in the ED for Labor and
Delivery. When her COVID-19 test returned negative, she was sent to a labor and
delivery suite.

5. Upon admission to the labor and delivery suite, Dayna Rockford was the registered nurse
who attended Macy. Her labor progressed normally throughout the early morning hours
of July 17, 2020, and Hayden was delivered at 9:03 a.m. that morning. He was a healthy
baby weighing over 5 pounds with Apgar scores of 8 at one minute and 9 at five minutes.
For the remainder of the day and throughout the next day, the 18th of July, Hayden
remained in Macy’s room.

6. The plans were for them to be discharged on Sunday, July 19th, but, at 3:30 a.m. on that
date, Hayden began to exhibit signs of respiratory distress and was admitted to the NICU.

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Later that day, one of the neonatologists caring for Hayden informed Brady and Macy
that he was being treated for a presumed GBS infection, as blood cultures would take
some time to come back.

7. On Monday, July 20, 2020, a nurse practitioner named Sarah informed Macy that she
looked back at her medical record and found that a positive Group B strep report was
reported by the lab and entered in her chart on July 17, 2020, around 2 p.m. This
statement was shocking to Macy and Brady as no one had mentioned GBS status since
Macy’s admission on July 16th. Macy and Brady then asked why Hayden had not been
treated for GBS since 2 p.m. on Friday, and Sarah indicated that she would set up a
meeting the next day to answer their questions.

8. On Tuesday, July 21, 2020, Macy and Brady met with the obstetrician who delivered
Hayden, Dr. Cary Crowe; Allison Blackburn, the NICU nurse manager; and a lady who is
head of the Women and Children’s Center at St. Vincent’s. When asked why her GBS
culture status had not been correctly charted on the 16th of July and why no one was made
aware of the positive GBS report on the 17th of July, the St. Vincent’s representatives
indicated that an information systems failure had occurred. They confirmed to Macy and
Brady that her medical record reflected a negative GBS culture status at the time of her
admission on the 16th of July and all times thereafter. They also stated that the result
which was reported and documented on admission was a “preliminary negative result.”
Further, they informed Macy and Brady that the hospital’s information system failed to
timely and appropriately notify healthcare providers of the positive GBS result which
came in on July 17, 2020, at approximately 2 p.m. According to St. Vincent’s personnel,
this failure resulted in Hayden going for approximately 37 ½ hours without his physicians
knowing of the positive GBS culture. No antibiotics were administered to him during this
period.

Macy and Brady understood from this conversation that St. Vincent’s laboratory
generates and makes available a “preliminary negative result” for GBS culture status, and
these hospital personnel indicated that this “preliminary result” played a role in the
failure to treat Macy and Hayden for GBS. The Ingrams do not know which providers
had access to the lab results or on what basis the GBS negative documentation occurred.

9. Hayden was diagnosed with GBS meningitis, and he suffered massive damage to his
cerebral cortex. He required intubation for ventilation and IV antibiotics for treatment of
the meningitis. He came off the ventilator on July 24, 2020, though he remains critically
ill. He was under the care of neurologists for the damage to his brain which resulted in
seizures. Hayden also suffered several apneic episodes and is expected to be followed at
Children’s Hospital.

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REVIEW OF MEDICAL RECORDS

10. On August 3, 2020, Macy’s chart from St. Vincent’s was received in the mail at the
Ingram home. For the first time, the Ingrams saw the admission note done by Dr. White,
which included a statement that “Group B strep cultures are negative” in the History of
Present Illness section of that document. There is no mention by Dr. White about the
basis for this statement, nor is there any evidence in the medical record at the time of his
note that there were “preliminary” results of the GBS culture available to him or Nurse
Hulsey from the lab. If there was such a “preliminary” result available at the time, and it
was so designated or known by Dr. White or Nurse Hulsey not to be the final result,
Macy should have received antibiotic prophylaxis. If the negative GBS result was not
designated by the lab or known to be “preliminary”, then Dr. White relied upon critically
misleading data from St. Vincent’s in failing to order antibiotic prophylaxis. The
admission note was electronically signed by Dr. White at 10:51 p.m. on July 16, 2020.
From this point forward, the electronic health record for this admission reflected that
Macy was GBS negative, thus no plans were made or orders given for intrapartum
antibiotic prophylaxis by health care provider associated with her labor and delivery.

11. The chart revealed an order for Group B strep culture with sensitivity dated July 15,
2020, at 1554 CDT. The laboratory at St. Vincent’s made a Preliminary Report of this
screening on July 17, 2020, at 1411 CDT, and one minute later, a Final Report was
posted at 1412 CDT. These identical reports and findings confirmed “Streptococcus
agalactiae (Group B), NO PCN ALLERGY REPORTED, no further workup.” Statements
made by the nurse practitioner, Sarah, to the Ingrams on Monday, July 20, 2020, that
Macy’s GBS culture status had been documented as negative on admission, and the status
had not been changed following posting of the results of the GBS culture in her electronic
health record, were confirmed by the records. This Order for GBS culture and sensitivity
was available to Dr. White and Nurse Hulsey at the time of Macy’s admission. It
provided unassailable evidence that the GBS culture was performed the previous day and
would not likely have been processed or finalized at the time of Macy’s admission.

12. In addition to Dr. White’s admission note that the GBS culture was negative, page 215 of
the St. Vincent’s chart reflects that Amber Hulsey transcribed prenatal labs on July 17,
2020, at 0:08 CDT. This note includes prenatal GBS and she charted it to be negative.
On information and belief, the Prenatal labs from previous encounters were available in
the CERNER EHR and were pulled forward by Nurse Hulsey as she created Macy’s OB
Admission Form. If the GBS status was reported as negative by the lab at St. Vincent’s,
or this is the point where a preliminary report of negative was made available in the
CERNER system, this was a disastrous failure to accurately communicate for Hayden.
Nurse Hulsey and Dr. White, to the extent they reviewed this data, were misinformed,
and thus misled about Macy’s GBS status. Regardless of how this failure to ascertain her
correct GBS status occurred, no intrapartum antibiotic prophylaxis was ordered.
On page 13 of the St. Vincent’s chart, a page from the Henderson & Walton prenatal
records contains a place for the date the GBS culture was performed and the result. Both
of those data points are blank, and there is no indication that Macy was GBS negative

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 DOCUMENT 2

anywhere else in the prenatal record. The basis for Nurse Hulsey’s and Dr. White’s
documentation that Macy was GBS negative is unknown to the plaintiffs, but, as set forth
above, it is believed that the lab or EHR information system may have provided a
“preliminary” negative result which was relied upon by Macy’s providers.

Further, at the time Ms. Hulsey entered the prenatal GBS as negative, an order was
triggered in the electronic health record which is contained on page 107 of the chart. That
order is entitled: “PATIENT IS GBS NEGATIVE” and that order is timed at 01:18
EDT on July 17, 2020, the precise time of Nurse Hulsey’s transcribed prenatal records.
Literally, from this point on, Macy was GBS negative to every healthcare provider who
could have been privy to this communication order.

BACKGROUND ON GBS SCREENING AND TREATMENT

13. Group B streptococcus, also known as Group B strep infection (GBS) is a type of
bacterial infection that can be found in a pregnant woman’s vagina or rectum. It is found
in about 25% of all healthy adult women. A mother can pass GBS to her baby during
labor or after rupture of membranes. The American College of Obstetricians and
Gynecologists (ACOG) recommends that women get tested for GBS bacteria when they
are 36 through 37 weeks pregnant. All women whose cultures are positive for GBS
should receive appropriate intrapartum antibiotic prophylaxis. If the prenatal GBS culture
result is unknown when labor starts, intrapartum antibiotic prophylaxis is indicated for
women who have risk factors for GBS early onset disease (EOD). At-risk women include
those who present in labor with a substantial risk of pre-term birth, just as Macy
presented on this occasion. Though she had been tested the day before, she had not heard
back from that test at the time of her admission to St. Vincent’s. Therefore, her GBS
status was pending and unknown to her at the time. Intravenous penicillin remains the
agent of choice for intrapartum prophylaxis and Macy was not allergic to penicillin.
Under the circumstances existing on July 16, 2020, when she was admitted to St.
Vincent’s, the standard of care for Macy included intrapartum antibiotic prophylaxis
because of her unknown GBS status at the onset of labor (culture results unknown), as
well as her early onset of labor at less than 37 weeks gestation. If the lab at St. Vincent’s
reported her GBS culture status as a “preliminary negative,” and made that known to her
providers, she should have received antibiotic prophylaxis. If the lab failed to let her
providers know that the negative result was “preliminary” at the time of her admission,
this was a catastrophic failure to communicate critical information which resulted in
Hayden’s catastrophic injury. Had Macy been given antibiotics during labor, Hayden had
a 1 in 4000 chance of developing GBS disease. If Macy does not receive antibiotics
during labor, as here, Hayden had a 1 in 200 chance of developing GBS disease. He was
20 times more likely to get GBS disease because of the failure to know, confirm,
document and act upon Macy’s correct GBS status, and to therefore give prophylactic
antibiotics as required by the standard of care.

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COUNT I – ALABAMA MEDICAL LIABILITY ACT

14. The allegations set out above are hereby asserted and realleged by reference thereto as if
fully and completely set out herein. All claims against the named defendants also refer to
fictitiously described defendants A-K.

15. Plaintiffs aver that the nurses, physicians and other healthcare personnel, (and those
fictitious parties whose true names and identities are unknown at this time), acting
individually and in the line and scope of their employment and/agency relationship with
defendant St. Vincent’s, breached the minimum standard of care required of them by
failing to use that degree of care, skill and diligence which is ordinarily possessed and
used by healthcare providers practicing in the national medical community under similar
circumstances, and hence were negligent in one or more of the following respects:

a. Failing to confirm and accurately document Macy’s GBS status on admission;

b. Erroneously charting her GBS status as negative on admission;

c. Failing to conclude that Macy’s GBS status was unknown, or pending, because of
the GBS culture being performed on July 15, 2020, the day before her admission;

d. Causing or allowing a preliminary, nonfinal negative GBS status to be reported

from the lab and made available in the EHR, resulting in Macy not receiving
antibiotic prophylaxis after her admission to labor and delivery;

e. Failing to take steps which were readily available and reasonably required to
verify GBS status in a patient in pre-term labor, with premature rupture of
membranes, whose GBS culture was performed less than 36 hours before
admission;

f. Failure to appreciate Macy’s risk factors for GBS and increasing her baby’s risk
of GBS disease by failing to order and give antibiotic prophylaxis;

g. The error in documenting GBS status resulted in no antibiotic prophylaxis being

administered when Macy was admitted in labor on the 16th, but to make matters
worse, a positive GBS final report was documented in the electronic health record
at 2:12 p.m. on the 17th. Based on information and belief, not a single healthcare
provider caring for Macy or Hayden was aware of that final report. This GBS
final report simply became a part of the electronic health record and St. Vincent’s
information system failed to provide electronic alerts, notifications or prompts to
individual healthcare providers treating Macy and Hayden concerning this critical
result;

h. In a patient who is GBS positive, as Macy was at the time, this catastrophic
information systems failure in the electronic health record resulted in Hayden not
being treated with antibiotics from 2:12 p.m. on July 17, 2020, until

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approximately 3:30 a.m. on July 19, 2020. Causing Hayden to lose 37 hours,
where IV antibiotics could and should have been administered, resulted in
devastating GBS disease and permanent neurologic damage to his brain, which
would likely have been avoided with antibiotic prophylaxis at the time of
admission;

i. Failing to have policies, procedures and protocols which outline the steps
necessary to ascertain and confirm GBS status, especially in a hospital setting
where there is a dedicated OB-ER and a Board Certified OBGYN Laborist/OB
Hospitalist in charge of processing for admission;

j. Failing to have policies, procedures and protocols in place which require that the
admitting physician or nursing personnel, at a minimum, place a call to the lab
when information is available that the GBS culture was less than 36 hours old and
could not have been finally reported at that point;

k. Failing to have policies, procedures and protocols which require the admitting
physician and nursing personnel in labor and delivery to have unassailable
evidence of final GBS status when admitting a laboring patient;

l. Causing or allowing a “preliminary negative” GBS culture status to exist in the St.
Vincent’s lab data and failing to have an information system/EHR which advised
healthcare providers that the negative status was preliminary, and not a final
report.

m. Causing or allowing a catastrophic failure of communication between the lab and

providers regarding the status of Macy’s GBS culture status on admission,
resulting in a failure to accurately provide critical information to those providers
and ultimately causing Hayden’s catastrophic injuries because appropriate
antibiotics were not administered to Macy on admission.

16. Plaintiffs further aver that as a direct and proximate result of the above failures of
Defendant St. Vincent’s to meet the minimum standard of care, Hayden suffered
devastating damage to his brain and central nervous system. As well, Macy and Brady
suffered life altering harms, losses and damages as a consequence of the devastating
injuries to their child.

WHEREFORE, Plaintiffs demand general compensatory damages against Defendant St.

Vincent’s and Fictitious Defendants’ A-K, in an amount to be determined by the jury.

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COUNT II – WANTON MISCONDUCT

17. The allegations set out above are hereby asserted and realleged by reference thereto as if
fully and completely set out herein. All claims against named defendants also refer to
fictitiously described defendants A-K.

18. Plaintiffs aver that the nurses, pharmacists, pharmacy techs and other healthcare
personnel (and those fictitious parties whose true names and identities are unknown at
this time), acting individually and in the line and scope of their employment and agency
relationship with defendant St. Vincent’s, breached the minimum standard of care
required of them by wantonly failing to use that degree of care, skill and diligence which
is ordinarily possessed and used by healthcare providers practicing in the national
medical community under similar circumstances, and hence were wanton in one or more
of the following respects:

a. Wantonly failing to confirm and accurately document Macy’s GBS status on

admission;

b. Wantonly charting her GBS status as negative on admission;

c. Wantonly failing to conclude that Macy’s GBS status was unknown or pending
because of the culture being performed on July 15, 2020, the day before her
admission;

d. Wantonly causing or allowing an unverified and nonfinal negative GBS status to

be reported from the lab and made available in the EHR, resulting in Macy not
receiving antibiotic prophylaxis after her admission to labor and delivery;

e. Wantonly failing to take steps which were readily available and reasonably
required to verify GBS status in a patient in pre-term labor, with premature
rupture of membranes, whose GBS culture was performed less than 36 hours
before admission;

f. Wantonly failing to appreciate Macy’s risk factors for GBS and increasing her
baby’s risk of GBS disease by failing to order and give antibiotic prophylaxis;

g. Wantonly failing to document the error in GBS status resulted in no antibiotic

prophylaxis being administered when Macy was admitted in labor on the 16th, but
to make matters worse, a positive GBS final report was posted in the electronic
health record at 2:12 p.m. on the17th. Based on information and belief, not a
single healthcare provider caring for Macy or Hayden was aware of that final
report. This final GBS report simply became a part of the electronic health record
and St. Vincent’s information system provided no alerts, prompts or notifications
to healthcare providers about this critical result;

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 DOCUMENT 2

h. In a patient who is GBS positive, as Macy was at the time, this wanton systems
failure in the electronic health record resulted in Hayden not being treated with
antibiotics from 2:12 p.m. on July 17, 2020, until approximately 3:30 a.m. on July
19, 2020. Wantonly causing Hayden to lose 37 hours where IV antibiotics could
and should have been administered to him resulted in devastating GBS disease
and permanent neurologic damage to his brain which could easily have been
avoided with antibiotic prophylaxis at the time of admission;

i. Wantonly failing to have policies, procedures and protocols which outline the
steps necessary to ascertain and confirm GBS status, especially in a hospital
setting where there is a dedicated OB-ER and a Board Certified OBGYN
Laborist/OB Hospitalist in charge of processing for admission;

j. Wantonly failing to have policies, procedures and protocols in place which

require that the admitting physician or nursing personnel place a call to the lab, at
a minimum, when information is available that the GBS culture was less than 36
hours old and could not have been finally reported at that point;

k. Wantonly failing to have policies, procedures and protocols which require the
admitting physician and nursing personnel in labor and delivery to have
unassailable evidence of final GBS status when admitting a laboring patient;

l. Wantonly causing or allowing a “preliminary negative” GBS culture status to

exist in the St. Vincent’s lab data and failing to have an information system/EHR
which advised healthcare providers that the negative status was preliminary, and
not a final report.

m. Wantonly causing or allowing a catastrophic failure of communication between

the lab and providers regarding the status of Macy’s GBS culture status on
admission, resulting in a failure to accurately provide critical information to those
providers and ultimately causing Hayden’s catastrophic injuries because
appropriate antibiotics were not administered to Macy on admission.

19. Plaintiffs further aver that as a direct and proximate result of the above wanton failures of
Defendant St. Vincent’s to meet the minimum standard of care, Hayden suffered
devastating damage to his brain and central nervous system. As well, Brady and Macy
suffered life altering harms, losses and damages because of the devastating injury to their
child.

WHEREFORE, Plaintiffs demand general compensatory and punitive damages against

Defendant St. Vincent’s and Fictitious Defendant’s A-K in an amount to be determined by the
jury.

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 DOCUMENT 2

COUNT III – FICTITIOUS PARTIES

Plaintiffs adopt each and every material allegation of paragraphs 1 – 19, as if fully set out
herein.

20. Plaintiffs further aver that the breaches of the standard of care, negligence, wantonness
and other tortious conduct of the fictitious defendants, identified as Defendants A-K,
combined and concurred to proximately cause the injuries and damages suffered by the
plaintiffs. Defendants, “A-K”, whose current names and identities are unknown to the
plaintiffs, will be correctly named and identified when they are ascertained.

WHEREFORE, PREMISES CONSIDERED, plaintiffs’ claim of the defendants,

including those fictitiously described herein, compensatory and punitive damages in an amount
to be determined by the jury.

COUNT IV – PLAINTIFFS’ HARMS AND LOSSES

21. Plaintiff Hayden Ingram has struggled mightily for his life in the last few weeks. Current
imaging indicates that he has suffered devastating, permanent damage to his brain and he
will likely have significant neurologic impairments for the remainder of his life. He has
endured a painful hospital admission, which includes catheters to provide medication and
an endotracheal tube to ventilate him. Though the full extent of his harms and losses is
not yet known, it is likely he will be severely impaired and need assistance with all
activities of daily living for the remainder of his lifetime.

22. Macy and Brady Ingram will lovingly care for Hayden for the rest of his life, including
providing financial support for his medical care. Macy will have to quit her job to care
for Hayden and she will provide the nursing services necessary to maintain his quality of
life and take care of a child who has profound neurologic deficits.

WHEREFORE, PREMISES CONSIDERED, plaintiffs’ claim of the defendants,

including those fictitiously described herein, compensatory and punitive damages in an amount
to be determined by the jury.

s/D. Leon Ashford

D. Leon Ashford (ASH001)
Ralph D. Cook
Devan L. Byrd
Attorneys for Plaintiffs
HARE, WYNN, NEWELL & NEWTON,
LLP
2025 Third Avenue, North, Suite 800
Birmingham, AL 35203
Telephone: (205) 328-5330

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Fax: (205) 324-2165

E-Mail: leon@hwnn.com
devan@hwnn.com

PLAINTIFFS DEMAND TRIAL BY STRUCK JURY IN THIS CAUSE.

/s/D. Leon Ashford__________________

OF COUNSEL

Plaintiffs’ Address:

2685 Ingate Road

Centreville, Alabama 35042

Serve Defendants at:

St. Vincent’s Birmingham

C/O Corporation Service Company, Inc.
641 South Lawrence Street
Montgomery, AL 36104

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 DOCUMENT 3
ELECTRONICALLY FILED
8/18/2020 9:43 AM
01-CV-2020-902915.00
CIRCUIT COURT OF
JEFFERSON COUNTY, ALABAMA
JACQUELINE ANDERSON SMITH, CLERK
IN THE CIRCUIT COURT OF JEFFERSON COUNTY, ALABAMA

HAYDEN MAC INGRAM, A MINOR who

sues by and through his parents and next
friends, Brady and Macy Ingram; BRADY INGRAM,
individually; and MACY INGRAM, individually,
CIVIL ACTION NO.
PLAINTIFFS,
________________
V.

ST. VINCENT’S BIRMINGHAM,

There may be other entities whose true names and identities are unknown to the plaintiff at this
time who may be legally responsible for the claim(s) set forth herein and who may be added by
amendment by the plaintiff when their names and identities are accurately ascertained by further
discovery. Until that time, the plaintiff will designate these parties in accordance with ARCP
9(h). The word "entity" as used herein is intended to refer and include any and all legal entities
including persons any and all forms of partnership, any and all types of corporation and
unincorporated associations. The symbol by which these party(ies) defendants are designated is
intended to include more than one entity in the event that discovery reveals that the descriptive
characterization of the symbol applies to more than one entity. In the present action, the party
defendants which the plaintiff must include by descriptive characterization are as follows:

DEFENDANT A, the legal entity known and doing business as St. Vincent’s Birmingham, on
the occasion described herein;

DEFENDANT B, C, & D, the legal entity which employed the physicians, individual nurses and
other healthcare providers who negligently failed to confirm, document and act upon Macy
Ingram’s GBS (Group B Streptococcus) status on admission to St. Vincent’s Birmingham on
July 16, 2020;

DEFENDANTS E, F, & G, the legal entity responsible for coordination of the information
systems between the laboratory at St. Vincent’s Birmingham and the patient electronic health
record to report GBS results and assure that those results are seen and acted upon by healthcare
providers in this setting;

DEFENDANT H, I & J, the individual physicians, nurses and other healthcare providers who
negligently failed to see and act upon Macy Ingram’s GBS status as documented in the electronic
health record at the time of her admission on July 16, 2020;

DEFENDANT K, the legal entity which failed to have policies, procedures, protections and
safeguards to assure that GBS status is accurately documented at the time of a patient’s
admission for labor and delivery, including a prohibition against the use of “preliminary results”
for the reporting of GBS status.

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 DOCUMENT 3

DEFENDANTS.

PLAINTIFFS’ FIRST INTERROGATORIES

TO DEFENDANT ST. VINCENT’S BIRMINGHAM

Come now the Plaintiffs, pursuant to Rules 33 and 34 of the Alabama Rules of Civil

Procedure, and propound the following first set of interrogatories to Defendant, St. Vincent’s

Birmingham (hereinafter St. Vincent’s).

DEFINITIONS AND INSTRUCTIONS

The following definitions and instructions are to be used when answering these

interrogatories and requests for production.

1. The terms "you" and "yours", unless otherwise specified, mean and include

St. Vincent’s, its parent corporation, its subsidiaries, successors, predecessors, its present and former

officers, executives, directors, agents and employees and all other persons acting or purporting to act

on behalf of said Defendant.

2. The word "document", whether used in the singular or plural, when used

herein shall be interpreted in its broadest sense, and shall include any original, reproduction or

copy of any kind of writing or documentary material, including without limitation,

correspondence, letters, memoranda, interoffice communications, e-mail, notes, diaries, contracts,

drawings, plans, specifications, fax communications, shipping records, bills of lading, minutes of

meetings, invoices, billings, checks, reports, studies, articles, books, telegrams, notes of telephone

conversations, computer discs, computer tapes and any other physical recordation of any and all

communications and every other means of recording or preserving any tangible information, which

employs the use of letters, words, pictures, symbols or any combination thereof.

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 DOCUMENT 3

3. The words "record" or "recording" whether used as a singular or plural, shall

be used herein in its broadest sense and shall include any original, reproduction, or copy of any kind

of visual or audio information, including without limitation, audio tapes, video tapes, compact discs,

video discs, computer discs, computer tapes, motion picture film or any other means or mechanism

for the preservation of visual or audio information.

4. The term "identify" or "identified", when used with reference to a person shall mean

to state and provide said person's full name (or so much of said person's full name as is known to

you), date of birth, social security number, last known and complete residence address and

telephone number, last known and complete business address and telephone number.

5. The term "identify" or "identified", when used with reference to a partnership,

corporation, association, trade group or other legal entity, shall mean to state and provide, with

respect to such entity, its full and correct legal name (or so much of its full and correct legal name as

is known to you), its address, and the name of its President, Managing Partner or other person of

management authority for such entity, or to provide so much of said information as is known, or may

be reasonably ascertainable by you.

6. The term "identify" or "identified" when used with reference to a document shall

mean to provide so much of the following information about said document as is known to you or

reasonably ascertainable by you:

a) The date of such document.

b) The author of such document.

c) The recipient of such document.

d) All addressee(s) and the address(es) to whom the document was sent (if
any).

3
 DOCUMENT 3

e) The name of the present custodian of the document.

f) The address of the present whereabouts of the document.

g) A detailed summary of the subject matter of such document.

h) A complete listing of any document or recording which was attached to,

referred to or was the subject matter of said document.

i) A statement as to whether such document has ever been produced or

disclosed by you.
j) If you assert any privilege with respect to said document, a statement of the
factual and legal basis for said assertion of privilege, with the same clarity
and in the same detail that you would present such assertion of privilege to
the court in defense of said privilege.

7. The term "identify" or "identified" when used with reference to a recording

shall mean to provide so much of the following information about said recording as is known to

you or reasonably ascertainable by you:

a) The date of such recording.

b) The photographer, camera person, tape operator or creator of such

recording.

c) The recipient of such recording.

d) All addressee(s) and the address(es) to whom the recording was sent (if
any).

e) The name of the present custodian of the recording.

f) The address of the present whereabouts of the recording.

g) A detailed summary of the subject matter of such recording.

h) A complete listing of any document which was attached to, referred to or

was the subject matter of said recording.

i) A statement as to whether such recording has ever been produced or

disclosed by you.

j) If you assert any privilege with respect to said recording, a statement

4
 DOCUMENT 3

of the factual and legal basis for said assertion of privilege, with the same
clarity and in the same detail that you would present such assertion of
privilege to the court in defense of said privilege.

8. You are requested to furnish all information in your possession and all

information available to you, not merely such information as is of your own personal knowledge

but also all knowledge that is available to St. Vincent’s, through its employees, officers, directors,

and agents by reasonable inquiry, including inquiry of their representatives and attorneys.

9. If you are unable to answer any of the following interrogatories completely, you

should answer to the extent possible and should state, in detail, the reason that your answer is

incomplete or the reason that you are unable to answer the question(s) or produce the requested

documents or records.

IT IS HEREBY REQUESTED THAT ALL DOCUMENTS PRODUCED IN

RESPONSE TO THE FOLLOWING INTERROGATORIES BE BATES
STAMPED; AND, FOR EACH INTERROGATORY ELICITING A
RESPONSE WHICH REFERS TO ANY DOCUMENT THAT THE
RESPONSIVE DOCUMENTS BE IDENTIFIED BY REFERRING TO THEIR
RESPECTIVE BATES STAMP NUMBERS.

INTERROGATORIES

1. Provide a detailed and chronological description of everything done by Amber Hulsey,

R.N., for Macy Ingram in the emergency department on July 16, 2020, including how she
determined Macy’s GBS status.

ANSWER:

2. Provide a detailed and chronological description of everything done by Dr. Marshall

White, III, for Macy Ingram in the emergency department and thereafter on July 16,
2020, including how he determined that Macy’s GBS cultures were negative.

ANSWER:

3. Were Dr. White and Amber Hulsey each acting in the line and scope of their employment
with St. Vincent’s on July 16, 2020?

ANSWER:

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 DOCUMENT 3

4. Is there any other legal entity responsible for their conduct as employer or master?

ANSWER:

5. Do you claim that any device, computer, software, information system (EHR or LIS), or
other piece of equipment played any part or role in causing or contributing to the
conclusion that Macy Ingram’s GBS status was negative on July 16, 2020? If so, fully
explain your contention and provide the name of any third party responsible therefor.

ANSWER:

6. Do you admit that Macy’s GBS status was unknown or pending on July 16, 2020, when
she was admitted to St. Vincent’s?

ANSWER:

7. Do you agree that the standard of care required, under the circumstances, that she be
given intrapartum antibiotic prophylaxis for prevention of GBS early-onset disease in her
baby?

ANSWER:

8. Is there any other legal entity or person responsible for the failure of Macy Ingram to
receive intrapartum antibiotic prophylaxis? If so, please identify that entity or those
persons.

ANSWER:

9. Have there been any changes to the CERNER EHR, Laboratory LIS or in the clinical
practice of ascertaining GBS status on admission at St. Vincent’s as a result of this
incident?

ANSWER:

10. Do you contend that a failure in communication caused or played a role in Macy Ingram
not receiving intrapartum antibiotic prophylaxis? If so, fully explain how this failure
occurred and why.

ANSWER:

11. State the basis for Dr. White’s comment in his admission note that “Group B strep
cultures are negative.”

ANSWER:

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 DOCUMENT 3

12. Where did Nurse Hulsey obtain the prenatal lab values she charted on Page 215,
including specifically the GBS: Negative data?

ANSWER:

13. What failures, factors, or actions caused or contributed to Macy Ingram not receiving
intrapartum antibiotic prophylaxis on this occasion?

ANSWER:

14. The bacteriology report, dated July 17, 2020, contains a preliminary and final report. Was
the preliminary report at 1411 CDT on July 17, 2020, the only preliminary report
provided by the lab at St. Vincent’s?

ANSWER:

15. Was the final bacteriology report timed at 1412 CDT and dated July 17, 2020, the actual
date and time the document was entered into Macy’s electronic health record for her
Reference Lab encounter? (FIN:7000575691)

ANSWER:

16. Was the final bacteriology report dated July 17, 2020, ever entered into Macy’s EHR for
her admission for labor on July 16th, 2020? (FIN:7000576542) If not, why not?

ANSWER:

17. Did any prompts, alerts or notices of this bacteriology report go to any specific healthcare
provider involved in the care and treatment of Macy Ingram or Hayden Ingram on that
day or at any time thereafter?

ANSWER:

18. Is there a third-party consultant or other legal entity responsible for the method and
manner of reporting GBS culture results to the ordering physician, posting them to the
patient’s hospital chart if they are admitted at the time or providing healthcare providers
with GBS results when involved in that patient’s care at the time they are finalized?
Please provide the names of all such entities.

ANSWER:

19. Were the prenatal records from Henderson & Walton made a part of Macy’s OB
admission chart of July 16, 2020? (FIN:7000576542) If so, when and how was that done?

ANSWER:

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 DOCUMENT 3

20. How long has the practice of providing preliminary GBS negative test results from the St.
Vincent’s lab existed at St. Vincent’s?

ANSWER:

21. Have other babies been harmed by St. Vincent’s erroneously providing these preliminary
negative GBS test results?

ANSWER:

22. Provide a detailed explanation of how and why the CERNER EHR interface with the
prenatal lab values allowed a preliminary GBS negative test result to be posted.

ANSWER:

23. Do you admit that causing or allowing this erroneous, preliminary negative GBS test
result to be made a part of Macy’s EHR violated the standard of care for hospitals like St.
Vincent’s in July of 2020?

ANSWER:

24. Do you admit that this violation of the standard of care directly and proximately caused
harms and losses to be suffered by Hayden and his parents, including Hayden’s
devastating brain damage and resulting neurologic deficits?

ANSWER:

/s/D. Leon Ashford

D. Leon Ashford ASH001
Ralph D. Cook
Devan L. Byrd
Attorneys for Plaintiffs
HARE, WYNN, NEWELL & NEWTON,
LLP
2025 Third Avenue, North, Suite 800
Birmingham, AL 35203
Telephone: (205) 328-5330
Fax: (205) 324-2165
E-Mail: leon@hwnn.com
devan@hwnn.com

PLEASE SERVE AT THE SAME TIME THE SUMMONS AND COMPLAINT

ARE SERVED.

8
 DOCUMENT 4
ELECTRONICALLY FILED
8/18/2020 9:43 AM
01-CV-2020-902915.00
CIRCUIT COURT OF
JEFFERSON COUNTY, ALABAMA
JACQUELINE ANDERSON SMITH, CLERK
IN THE CIRCUIT COURT OF JEFFERSON COUNTY, ALABAMA

HAYDEN MAC INGRAM, A MINOR who

sues by and through his parents and next
friends, Brady and Macy Ingram; BRADY INGRAM,
individually; and MACY INGRAM, individually,
CIVIL ACTION NO.
PLAINTIFFS,
________________
V.

ST. VINCENT’S BIRMINGHAM,

There may be other entities whose true names and identities are unknown to the plaintiff at this
time who may be legally responsible for the claim(s) set forth herein and who may be added by
amendment by the plaintiff when their names and identities are accurately ascertained by further
discovery. Until that time, the plaintiff will designate these parties in accordance with ARCP
9(h). The word "entity" as used herein is intended to refer and include any and all legal entities
including persons any and all forms of partnership, any and all types of corporation and
unincorporated associations. The symbol by which these party(ies) defendants are designated is
intended to include more than one entity in the event that discovery reveals that the descriptive
characterization of the symbol applies to more than one entity. In the present action, the party
defendants which the plaintiff must include by descriptive characterization are as follows:

DEFENDANT A, the legal entity known and doing business as St. Vincent’s Birmingham, on
the occasion described herein;

DEFENDANT B, C, & D, the legal entity which employed the physicians, individual nurses and
other healthcare providers who negligently failed to confirm, document and act upon Macy
Ingram’s GBS (Group B Streptococcus) status on admission to St. Vincent’s Birmingham on
July 16, 2020;

DEFENDANTS E, F, & G, the legal entity responsible for coordination of the information
systems between the laboratory at St. Vincent’s Birmingham and the patient electronic health
record to report GBS results and assure that those results are seen and acted upon by healthcare
providers in this setting;

DEFENDANT H, I & J, the individual physicians, nurses and other healthcare providers who
negligently failed to see and act upon Macy Ingram’s GBS status as documented in the electronic
health record at the time of her admission on July 16, 2020;

DEFENDANT K, the legal entity which failed to have policies, procedures, protections and
safeguards to assure that GBS status is accurately documented at the time of a patient’s
admission for labor and delivery, including a prohibition against the use of “preliminary results”
for the reporting of GBS status.

1
 DOCUMENT 4

DEFENDANTS.

PLAINTIFFS’ FIRST REQUEST FOR PRODUCTION OF DOCUMENTS

TO DEFENDANT ST. VINCENT’S BIRMINGHAM

Come now the Plaintiffs, pursuant to Rules 33 and 34 of the Alabama Rules of Civil

Procedure, and propound the following first set of requests for production of documents to

Defendant, St. Vincent’s Birmingham (hereinafter referred to as St. Vincent’s).

DEFINITIONS AND INSTRUCTIONS

The following definitions and instructions are to be used when answering these requests

for production.

1. The terms "you" and "yours", unless otherwise specified, mean and include

St. Vincent’s, its parent corporation, its subsidiaries, successors, predecessors, its present and former

officers, executives, directors, agents and employees and all other persons acting or purporting to act

on behalf of said Defendant.

2. The word "document", whether used in the singular or plural, when used herein

shall be interpreted in its broadest sense, and shall include any original, reproduction or copy of

any kind of writing or documentary material, including without limitation, correspondence, letters,

memoranda, interoffice communications, e-mail, notes, diaries, contracts, drawings, plans,

specifications, fax communications, shipping records, bills of lading, minutes of meetings,

invoices, billings, checks, reports, studies, articles, books, telegrams, notes of telephone

conversations, computer discs, computer tapes and any other physical recordation of any and all

communications and every other means of recording or preserving any tangible information, which

employs the use of letters, words, pictures, symbols or any combination thereof.

2
 DOCUMENT 4

3. The words “record” or “recording” whether used as a singular or plural, shall

be used herein in its broadest sense and shall include any original, reproduction, or copy of any kind

of visual or audio information, including without limitation, audio tapes, video tapes, compact discs,

video discs, computer discs, computer tapes, motion picture film or any other means or mechanism

for the preservation of visual or audio information.

4. The term “identify” or “identified”, when used with reference to a person shall

mean to state and provide said person’s full name (or so much of said person’s full name as is

known to you), date of birth, social security number, last known and complete residence address

and telephone number, last known and complete business address and telephone number.

5. The term “identify” or “identified”, when used with reference to a partnership,

corporation, association, trade group or other legal entity, shall mean to state and provide, with

respect to such entity, its full and correct legal name (or so much of its full and correct legal name as

is known to you), its address, and the name of its President, Managing Partner or other person of

management authority for such entity, or to provide so much of said information as is known, or may

be reasonably ascertainable by you.

6. The term “identify” or “identified” when used with reference to a document shall

mean to provide so much of the following information about said document as is known to you or

reasonably ascertainable by you:

a) The date of such document.

b) The author of such document.

c) The recipient of such document.

d) All addressee(s) and the address(es) to whom the document was sent (if
any).

3
 DOCUMENT 4

e) The name of the present custodian of the document.

f) The address of the present whereabouts of the document.

g) A detailed summary of the subject matter of such document.

h) A complete listing of any document which was attached to, referred to or

was the subject matter of said recording.

i) A statement as to whether such document has ever been produced or

disclosed by you.

j) If you assert any privilege with respect to said document, a statement of the
factual and legal basis for said assertion of privilege, with the same clarity
and in the same detail that you would present such assertion of privilege to
the court in defense of said privilege.

7. The term “identify” or “identified” when used with reference to a recording

shall mean to provide so much of the following information about said recording as is known to

you or reasonably ascertainable by you:

a) The date of such recording.

b) The photographer, camera person, tape operator or creator of such

recording.

c) The recipient of such recording.

d) All addressee(s) and the address(es) to whom the recording was sent (if
any).

e) The name of the present custodian of the recording.

f) The address of the present whereabouts of the recording.

g) A detailed summary of the subject matter of such recording.

h) A complete listing of any document which was attached to, referred to or

was the subject matter of said recording.

i) A statement as to whether such recording has ever been produced or

disclosed by you.

4
 DOCUMENT 4

j) If you assert any privilege with respect to said recording, a statement

of the factual and legal basis for said assertion of privilege, with the same
clarity and in the same detail that you would present such assertion of
privilege to the court in defense of said privilege.

8. You are requested to furnish all information in your possession and all

information available to you, not merely such information as is of your own personal knowledge

but also all knowledge that is available to St. Vincent’s, through its employees, officers,

directors, and agents by reasonable inquiry, including inquiry of their representatives and

attorneys.

9. If you are unable to answer any of the following interrogatories or requests for

production completely, you should answer to the extent possible and should state, in detail, the

reason that your answer is incomplete or the reason that you are unable to answer the question(s)

or produce the requested documents or records.

10. Electronic Files. You have an obligation to preserve all digital or analog

electronic files in electronic format, regardless of whether hard copies of the information exist.

This includes preserving:

A. Active data (i.e., data immediately and easily accessible on the client’s systems

today);

B. Archived data (i.e., data residing on backup tapes or other storage media);

C. Deleted data (i.e., data that has been deleted from a computer hard drive but is

recoverable through computer forensic techniques); and

D. Legacy data (i.e., data created on old or obsolete hardware or software).

E. Defendants must preserve active, archived and legacy data including but not limited

to:

5
 DOCUMENT 4

1. Word-processed files, including drafts and revisions;

2. Spreadsheets, including drafts and revisions;

3. Databases;

4. CAD (computer-aided design) files, including drafts and revisions;

5. Presentation data or slide shows produced by presentation software (such as

Microsoft PowerPoint);

6. Graphs, charts and other data produced by project management software (such as

Microsoft Project);

7. Animations, images, audio, video and audiovisual recordings, MP3 players, and

voicemail files;

8. Data generated by calendaring, task management and personal information

management (PIM) software (such as Microsoft Outlook or Lotus Notes);

9. Data created with the use of personal data assistants (PDAs), such as PalmPilot,

HP, Jornada, Cassiopeia or other Windows CE-based or Pocket PC devices or

Smart Phones;

10. Data created with the use of document management software; and

11. Data created with the use of paper and electronic mail logging and routing

software.

F. Defendants must preserve media used by Defendants’ computers including but not

limited to:

1. Magnetic, optical or other storage media, including the hard drives or floppy disks

used by [Corporation] computers;

2. Backup media (i.e., other hard drives, backup tapes, floppies, Jaz cartridges, CD-

6
 DOCUMENT 4

ROMs and the other software necessary to reconstruct the data contained on the

media and;

3. Archived media (you should retain a mirror imaged copy of any media no longer

in service but used during the following time periods.

July 16, 2020 and July 19, 2020

11. Hardware. You have an obligation to preserve all electronic systems even if they are

replaced. This includes computer servers, stand-alone personal computers, hard drives, laptops,

PDAs, smart phones and other electronic processing devices. Defendants should retain copies of

any hardware no longer in service but used during the following time periods.

July 15, 2020 and July 19, 2020

IT IS HEREBY REQUESTED THAT ALL DOCUMENTS PRODUCED IN

RESPONSE TO THE FOLLOWING REQUESTS FOR PRODUCTION OF DOCUMENTS
BE BATES STAMPED; AND, IDENTIFIED BY REFERRING TO THEIR RESPECTIVE
BATES STAMP NUMBERS.

REQUESTS FOR PRODUCTION OF DOCUMENTS

1. All St. Vincent’s policies, procedures, by-laws, standards, guidelines or other position

statements which are relevant in any respect to Macy Ingram’s admission on this

occasion, including ascertaining, confirming and documenting her GBS status, GBS lab

values (preliminary and final), and their accession or reporting.

RESPONSE:

2. The personnel files for Marshall Neil White, III, M.D., and Amber Hulsey, R.N.

RESPONSE:

3. All records, including paper and electronic documents, data, correspondence, files and

information related in any way to Macy or Hayden Ingram, including evidence of phone

7
 DOCUMENT 4

calls, instant messages, SMS usage or text messages among Dr. Marshall White; Amber

Hulsey; Allison Blackburn; nurse practitioner, Sarah; and any other St. Vincent’s

personnel with knowledge of the underlying facts in this case. This request includes the

period from July 15 through July 24, 2020.

RESPONSE:

4. Any documents or records which provide the basis for Amber Hulsey’s charting that

Macy’s Prenatal GBS was negative on page 215 of the chart.

RESPONSE:

5. Any documents or records which provide the basis for Dr. Marshall White’s admission

note that includes, “Group B strep cultures are negative.”

RESPONSE:

6. All policies, procedures and protocols for collection, analysis and reporting of GBS

cultures by the St. Vincent’s lab in July of 2020.

RESPONSE:

7. Any policy, procedure or protocol applicable in July of 2020, for targeted intravenous

intrapartum antibiotic prophylaxis for prevention of GBS EOD in babies born to women

with positive antepartum GBS cultures.

RESPONSE:

8. With respect to the “patient is GBS negative” order of July 17, 2020, at 01:18 EDT,

please state the meaning of “Communication order entered secondary to documentation.

WH_GBS_NEGATIVE.”

RESPONSE:

8
 DOCUMENT 4

9. Please provide all documentation which is the basis for the entry of “This patient is GBS

negative” order.

RESPONSE:

10. Produce a full and complete color copy of any and all records, reports, logs, data, and/or
other materials of any description whatsoever documenting each and every entry, the
time each entry was made, who made the entry and any subsequent changes to the entry,
for any information entered into the electronic health record system, whether entered
manually by a user or automatically electronically captured, relating in any way to Macy
Ingram’s Lab Encounter (FIN:7000575691) of July 15 (GBS Screening) and July 16,
2020, (FIN:7000576542) (Rule Out Labor), admission to St. Vincent’s. This request
specifically includes, but is not limited to the following:

a. Audit trails;

b. Access logs;

c. Work station logs (including work station ID keys);

d. Cerner Audit logs;

e. Cerner Prenatal Labs and Tests.

RESPONSE:

11. Screenshots of all available menu options for medical staff to choose from when charting

the following activities in St. Vincent’s electronic health record system in July of 2020:

o Ob/Gyn Admit

o Ob/Gyn Powerplans

o Prenatal Labs and Test Results

o Order: Patient is GBS Negative

o Order: Patient is GBS Positive

o Prenatal Visit diagnosis

o Prenatal Visits and Encounters

o Encounter for antenatal screening for Streptococcus B (CD-10-CM-Z36.85)

9
 DOCUMENT 4

o Prenatal Transcribed Labs (GBS)

o WH_GBS_Negative Communication Order

o WH_GBS_Positive Communication Order

o OB Admission Assessment

o Antepartum Risk Factors

RESPONSE:

/s/D. Leon Ashford

D. Leon Ashford ASH001
Ralph D. Cook
Devan L. Byrd
Attorneys for Plaintiffs
HARE, WYNN, NEWELL & NEWTON, LLP
2025 Third Avenue, North, Suite 800
Birmingham, AL 35203
Telephone: (205) 328-5330
Fax: (205) 324-2165
E-Mail: leon@hwnn.com
devan@hwnn.com

PLEASE SERVE AT THE SAME TIME THE SUMMONS AND COMPLAINT

ARE SERVED.

10