Nina Pham - Ebola Case Assessment - 7 Hours Maximum Please. Good Work Needed

PLAINTIFF ’S ORIGINAL PETITION Page 1 of 36 C CC CAUSE N NN NO.

. _______________ _______________ _______________ _______________ N INA PHAM , Plaintiff , v. T EXAS HEALTH RESOURCES , INC ., Defendant. IN THE DISTRICT COURT OF DALLAS COUNTY , TEXAS ____ JUDICIAL DISTRICT P PP PLAINTIFF ’ ’’ ’S O OO ORIGINAL P PP PETITION “Nina, I have bad news. We’re sorry. You tested positive for Ebola.” With those words, 26 year old Nina Pham’s life was in peril and forever changed as she became the first person on United States soil to con tract the Zaire ebolavirus or, as it is now simply known, Ebola. Without wanting to or agreeing to, Nina became the face of America’s fight against this fatal and feared pathogen. What no one knew or understood was that she was also a symbol of corporate neglect–a casualty of a h ospital system’s failure to prepare for a known and impending medical crisis. PLAINTIFF ’S ORIGINAL PETITION Page 2 of 36 In the fall of 2014, Nina was a nurse in the Intensive Care Unit (“ICU”) at Texas Health Dallas Presbyterian Hospital (“Presbyterian”), a ho spital in the Texas Health Resources (“THR”) hospital system. In the ICU, Nina was the first nur se assigned to treat a patient, Thomas Eric Duncan, who had recently traveled to the United State s from Western Africa where there is a widespread outbreak of Ebola. In a cruel twist, aft er watching Mr. Duncan go through the horrific and painful course of the disease as she des perately tried to save his life, Nina herself was diagnosed with Ebola just two days after Mr. Dun can’s life was taken by it. Facing the same horrific death sentence as Mr. Duncan, Nina fought th rough and ultimately survived Ebola.

While as a survivor Nina has been applauded publicly–i ncluding being named one of TIME Magazine’s Persons of the Year and one of The Dallas Morning News’ Texans of the Year–she faces a frighteningly uncertain future medically, prof essionally, and personally. Nina has pledged to do all that she can to advance the cause of nursing and to defeat Ebola, however she will never outrun the terror of her experience and th e lasting impact of her infection.

But in many respects, Nina’s story is not a story of Ebola; rather, it is a story of our health care system’s greatest asset: compassionate and bra ve health care providers. And, sadly, it is also a story of the greatest problem facing our health ca re system and the well-being of patients and those brave workers: controlling corporations like THR that often put bottom-lines, profits and public image ahead of the safety and well-being of p atients and health care providers. Nina brings this case to hold Texas Health Resources accountable for what happened to her and to send a message to corporations like it t hat the safety of all patients and health care 1 W ORLD HEALTH ORGANIZATION , Ebola Virus Disease Fact Sheet N " 103 (September 2014 ed.), available at http://www.who.int/mediacentre/factsheets/fs103/en/ (last visited Dec. 26, 2014). 2 Id. 3 Id .

P LAINTIFF ’S ORIGINAL PETITION Page 3 of 36 providers comes first. So when the next viral outbre ak occurs–and it will occur–these hospitals will be prepared and those health care providers wi ll be protected.

I.I.

T TT T HE E EE EBOLA C CC CRISIS Ebola is not a new virus. The virus was originally i dentified in 1976 following outbreaks in Nzara, Sudan and in Yambuku, Congo. 1 The outbreak in Yambuku first appeared near the Ebola River and is the genesis of the name of the v irus. 2 Since then, the World Health Organization (“WHO”) has tracked Ebola and confirme d more than 1,700 cases.

Ebola is a particularly lethal and highly communicab le virus and causes Ebola virus disease, a hemorrhagic fever known for its very hig h mortality rate. The virus spreads by direct contact with body fluids, such as blood, of an infect ed human or other animal, and upon contact with a recently contaminated item or surface. The c linical course of the disease is horrifying:

first symptoms are the sudden onset of fever, fatigue , muscle pain, headache, and sore throat.

Violent vomiting, diarrhea, rash, and impaired kidn ey and liver function follow. In some cases, Ebola victims suffer both internal and external blee ding (e.g. oozing from the gums, blood in the stools). 3 Death is often caused by hypovolemia, or low blood pressure from fluid loss due to hemorrhaging. Death occurs in 50 percent of patient s. 4 W ORLD HEALTH ORGANIZATION , International Health Regulations , “IHR Procedures concerning Public Health Emergencies of International Concern,” available at http://www.who.int/ihr/procedures/pheic/en/ (last visited December 26, 2014). Since 2005, the International Health Regulations have been legally-binding regula tions designed to improve the capacity of all countries t o detect, assess, notify and respond to public health threats. P LAINTIFF ’S ORIGINAL PETITION Page 4 of 36 Its very high mortality rate and communicability mak e Ebola a major public health risk, and the WHO classifies it as a World Health Organiz ation Risk Group 4 Pathogen (requiring Biosafety Level 4-equivalent containment). It is al so a threat to public safety given its potential as a bioterrorism agent, and as such is classified a s a U.S. Centers for Disease Control and Prevention Category A Bioterrorism Agent and as a “ select agent” under the 2001 Patriot Act and the 2002 Public Health Security and Bioterrorism P reparedness Response Act (“PHSBPRA”).

Due to these deadly facts, hospitals in the United St ates are required to be prepared for and have policies in place to react to select agents like Eb ola as a matter of national security.

A.A.

A. The Ebola epidemic in West Africa.

The Ebola epidemic in West Africa.The Ebola epidemic in West Africa.

The Ebola epidemic in West Africa.

In December 2013, the largest Ebola outbreak ever do cumented began in Guinea in Western Africa and has reached epidemic proportions . Ebola subsequently has spread extensively from Guinea to Sierra Leone, and Liberia, and to a lesser extent, Nigeria, Mali, Senegal, United Kingdom, Spain and the United States. The WHO has reported more than 20,000 cases and 8,000 deaths from Ebola, but those numbers are believed to be understated.

By the summer of 2014, news reports began covering t he Ebola crisis in West Africa. On August 8, 2014, the WHO Director-General declared the outbreak a “Public Health Emergency of International Concern.” That official designatio n indicates that the Ebola outbreak “constitutes a pubic health risk to other States throug h the international spread of the disease.” 4 PLAINTIFF ’S ORIGINAL PETITION Page 5 of 36 As part of the August 8 meeting, the WHO issued its “Statement on the 1 st Meeting of the IHR Emergency Committee on the 2014 Ebola Outbreak in We st Africa” in which the WHO advised that “the Ebola outbreak in West Africa constitutes a n ‘extraordinary event’ and a public health risk to other States” and warned that “the possible consequences of further international spread are particularly serious in view of the virulence of t he virus, the intensive community and health facility transmission patterns, and the weak health systems in the currently affected and most at-risk countries.” The Statement concluded that “a coordinated international response is deemed essential to stop and reverse the interna tional spread of Ebola.” This designation of a “Public Health Emergency of International Concern, ” used for only the third time in WHO history, is a legal designation that imposes legal measures on disease prevention, surveillance, control, and response, by 194 signatory countries, i ncluding the United States.

B.B.

B. All American hospitals are warned Ebola is coming and that they must prepare.

All American hospitals are warned Ebola is coming a nd that they must prepare.

By early September, the CDC and the American Hospita l Association warned THR that Ebola was an imminent threat and that health care p rovider training and policies should be adopted for screening and diagnosing patients, as w ell as the development of safe protocols for personal protective equipment to protect health care workers. The CDC offered and produced webinars about how staff should be trained to protect themselves in treating an Ebola patient.

II.

II.II.

II.

THR THR THR THR I II IGNORES THE D DD DANGER OF E EE EBOLA THR was formed in 1997 when Presbyterian Healthcare Resources merged with the Harris Methodist System in Fort Worth. Since 1997, T HR has expanded by buying hospitals and PLAINTIFF ’S ORIGINAL PETITION Page 6 of 36 building others. It now consists of 25 hospitals, 62 outpatient facilities, and an enormous physician practice group of more than 500 physicians . THR bills itself as the largest health care system in North Texas. And, while it is nominally a non-profit organization, its growth is largely derived from an aggressive focus on increasi ng profitability. On its website, it proudly claims $3.8 billion in operating revenue in fiscal y ear 2013, and $6.1 billion in assets.

One of the primary ways in which THR increases that profitability is through control over the hospitals and physicians in its system. W hen it benefits THR, such as in avoiding liability in litigation, THR will emphasize that it s hospitals are separate legal entities. However, in practice, THR asserts an enormous amount of contro l over its hospitals and physicians. One such area involves the practice of nursing in its hos pitals. THR employs a chief nursing executive and requires the nursing departments at each of THR’s hospitals, including Presbyterian, to report to and follow the instructio n of THR’s chief nursing executive and the systemwide nursing executive team. THR has a stated goal to have uniformity in nursing throughout its system–primarily for cost/profit reaso ns–and it works aggressively to control nursing to enforce uniformity. THR additionally empl oys other systemwide clinical officers who have the responsibility and ability to direct t he establishing of policies and practices in each of the system hospitals. A.

A.A.

A. THR ignores the warnings of Ebola.

THR ignores the warnings of Ebola.THR ignores the warnings of Ebola.

THR ignores the warnings of Ebola.

In his October 16, 2014 testimony before the U.S. H ouse of Representative Subcommittee on Oversight and Investigation, Daniel Varga, M.D., the Chief Medical Officer for THR admitted that THR was made aware of the danger of E bola coming to the U.S. Dr. Varga PLAINTIFF ’S ORIGINAL PETITION Page 7 of 36 claimed that on July 28, an Infection Prevention Nurse Specialist at THR first received a CDC health advisory on Ebola virus disease and began sha ring it with other THR personnel. Dr. Varga also claimed that on August 1, THR leaders sent an em ail directing that all hospitals needed to adhere to an epidemiological emergency policy on ho w to care for patients with Ebola-like symptoms. Included in that email was the THR-drafte d epidemiologic emergency policy that specifically addressed Ebola. Dr. Varga testified that additional information was circulated on August 1 and August 13. Dr. Varga told Congress that t he Dallas County Health and Human Services Department communicated with THR about Ebola preparations in the months leading up to Mr. Duncan’s admission. It must be noted that Dr . Varga made numerous patently false statements to Congress, including falsely claiming t he hospital staff was trained to manage Ebola and misrepresenting to Congress what type of person al protective equipment, or PPE, the nurses wore at various times when caring for Mr. Duncan. Nevertheless, it is clear from THR’s testimony and the press releases it has issued that THR was directing the Ebola preparedness for its ho spitals. Despite assuming that duty, THR wholly failed to ensure that appropriate polices, pr ocedures, and equipment were in place. Thus tragically, when Ebola finally came to one of its h ospitals, the health care providers were at a high risk for exposure to the deadly virus because the y were untrained and were not provided appropriate protective equipment. 5 In reporting, Ms. Troh has been identified as Mr. Duncan’s fiancé, but in fact, the two had been marr ied under the common law in Liberia decades earlier.

6 Mr. Duncan would certainly have expressed concern about being exposed to Ebola if he knew he had been exposed when he went to the hospital to seek medical care. It defies common sense to think he would not have mentioned that extremely important bit of information to Ms. Troh or the nurses when he was seeking medical care . Given the confessed problems with THR’s electronic medica l records, it is unclear what Mr. Duncan did tell the hospital.

P LAINTIFF ’S ORIGINAL PETITION Page 8 of 36 III.

III.III.

III.

THR’ THR’ THR’ THR’ S F FF FIRST V VV VICTIM :

: T TT THOMAS E EE ERIC D DD DUNCAN Thomas Eric Duncan, 41, lived in Monrovia, Liberia, where he worked as a personal driver. In the fall of 2014, Mr. Duncan had plans i n place to come to Dallas, Texas, to reunite with his common law wife Louise Troh. 5 Prior to leaving Liberia, Mr. Duncan must have been unknowingly exposed to Ebola 6 and brought the virus to the U.S. when he arrived in Dallas on September 20, 2014. By September 24, Mr. Duncan began feeling ill, and on the evening of September 25, he went to the emergency room at nearby Presbyterian. The events that occurred in the emergency room have been publicly discussed and beca me the subject of ever-shifting explanations by THR. But what is ultimately known is that Mr. Duncan was discharged with a diagnosis of sinusitis and a prescription for anti biotics despite the fact he was exhibiting classic symptoms of Ebola and had reported he was recently in Africa. THR has publicly admitted that it made mistakes in the emergency room and that Mr. Duncan should not have been sent home.

Mr. Duncan’s condition worsened, and in the early mo rning of September 28, an ambulance brought him back to Presbyterian. He was e xamined again in the emergency room all day where it was noted that he had symptoms of fever, explosive diarrhea and projectile vomiting. By 10:20 am, it was suspected that Mr. D uncan had Ebola, and by 1:00 pm, PLAINTIFF ’S ORIGINAL PETITION Page 9 of 36 Presbyterian contacted the CDC. At 8:30 pm, an Infectious Disease specialist confirmed that Ebola was highly suspected. Mr. Duncan remained in t he ER all night and was noted to be deteriorating the next morning. Finally, at 4:40 pm, on September 29, Mr. Duncan was admitted to the hospital and transferred to a 24-bed intensive care unit from whi ch all other patients had been removed.

This was more than 30 hours from when Mr. Duncan was brought to the Presbyterian emergency room. Over the next 8 days, Mr. Duncan’s condition deteriorated until his body finally gave in on the morning of Wednesday, Octobe r 8, and he was pronounced dead.

We will never know whether Mr. Duncan would have been able to survive if he had been given proper treatment instead of discharged f rom the emergency room on September 25.

We do know that earlier treatment increases the lik elihood of survival, and while Mr. Duncan was not in serious condition on September 25, he was in the advanced stages of Ebola on September 28. Had THR heeded the CDC and other warn ings and ensured its hospitals were ready for Ebola, Mr. Duncan would have had the best o pportunity to possibly survive. Instead, what THR has admitted were “mistakes” robbed Mr. Dun can of that chance and placed others at great risk when his condition progressed to the most dangerous and communicable stages of Ebola. IV.

IV.IV.

IV.

N NN N INA C CC CARES FOR H HH HER P PP PATIENT Nina Pham is the oldest daughter of two Vietnamese i mmigrants, Peter and Diana Pham.

Nina grew up in a Vietnamese community in East Fort W orth, and her devoutly-Catholic family 7 Nina acquired her certificate in Critical Care Nursing on August 1, 2014, little more than a month be fore she cared for Mr. Duncan.

8 New graduate nurses are rarely hired directly into critical care units. Most hospitals require one to two years of general nursing experience prior to being considered for em ployment in intensive care.

P LAINTIFF ’S ORIGINAL PETITION Page 10 of 36 has long been active in church. Her parents instill ed in Nina a deep religious conviction and sense of duty. They taught her the primacy of helpin g others. Nina excelled in school and ultimately attended Texas Christian University in Fo rt Worth where she graduated in 2010 with a bachelor of science in Nursing. During her senior year at TCU, Nina did a clinical rotation in the intensive care unit and fell in love with helpin g ICU patients. Nina was certified by the Texas Board of Nursing in 2010, 7 and, upon graduation, she was hired by Texas Health Dallas Presbyterian Hospital as an ICU nurse. 8 As an ICU nurse, Nina treated patients in need of ad vanced life support and monitoring.

She dealt with patients who were on ventilators, in need of monitoring of vital signs, required IVs and medications, and patients who needed lifesa ving interventions such as Advanced Cardiovascular Life Support, or ACLS. However, ICU nurs es are not trained or experienced to treat biosafety level 4 pathogens like Ebola. A.

A.A.

A. Nina becomes Mr. Duncan’s first nurse.

Nina becomes Mr. Duncan’s first nurse.Nina becomes Mr. Duncan’s first nurse.

Nina becomes Mr. Duncan’s first nurse.

On the morning of September 29, Nina showed up for he r usual shift in the ICU where she had two patients. By the middle of the day, bo th of her patients were discharged from the ICU. As such, Nina was next up in the rotation to ta ke the next patient admitted to the ICU.

In the early afternoon, Nina’s unit manager and the ICU supervisor called her into an office to talk. Nina was told that the ER departme nt had a patient suspected for Ebola, and that PLAINTIFF ’S ORIGINAL PETITION Page 11 of 36 the hospital wanted to bring the patient to the ICU, even though he was not a patient that fit the ICU criteria. Nina was told the patient would b e hers. She was told Mr. Duncan was in stable condition and could use the bathroom by himsel f. She was told that she would not have to go in the patient’s room much and could just monito r him remotely, all of which turned out to be untrue. Nina was shocked. She had never been trained to han dle infectious diseases, never been told anything about Ebola, how to treat Ebola, or ho w to protect herself as a nurse treating an Ebola patient. The hospital had never given her a aa any nyny ny in-services, training or guidance about Ebola. All Nina knew about Ebola is what she had he ard on the television about the deadly outbreak in West Africa. Nina asked her manager what she should do to protect herself from the deadly disease.

Either her manager or her supervisor went to the Int ernet, searched Google, printed off information regarding what Nina was supposed to do, and handed Nina the printed paper. The ICU did not have any written polices or manuals about treating level 4 infectious disease patients generally or Ebola specifically. Even Even Even Even though thoughthough though Mr.

Mr.Mr.

Mr.

Duncan DuncanDuncan Duncan had hadhad had been beenbeen been at atat at Presbyterian PresbyterianPresbyterian Presbyterian for forfor for a aa a day dayday day and andand and a aa a half halfhalf half with withwith with a aa a differential differentialdifferential differential diagnosis diagnosisdiagnosis diagnosis of ofof of Ebola, Ebola,Ebola, Ebola, when whenwhen when it itit it came camecame came time timetime time to toto to admit admitadmit admit him himhim him to toto to the thethe the ICU and have Nina take ICU and have Nina take ICU and have Nina take ICU and have Nina take care carecare care of ofof of him, the sum total of the information Nina was pro vided to him, the sum total of the information Nina was prov ided to him, the sum total of the information Nina was prov ided to him, the sum total of the information Nina was prov ided to protect protect protect protect herself herselfherself herself before beforebefore before taking takingtaking taking on onon on her herher her patient patientpatient patient was waswas was what whatwhat what her herher her manager managermanager manager “Googled” “Googled”“Googled” “Googled” and andand and printed printedprinted printed out outout out from the Internet.

from the Internet. from the Internet.

from the Internet. Contrary to the message THR has pushed in the press, Nina was assigned Mr. Duncan as a patient. She did not volunteer to be his nurse. Ni na saw Mr. Duncan like any other patient: 9 The Galveston National Laboratory in Galveston, Texas is a biosafety level 4 (BSL-4) Biocontainment Laboratory.

It is one of only two national BSL-4 laboratories i n the United States that are the highest safety level facilities dedicated to work with the most dangerous and exoti c life-threatening infectious agents, including primarily hemorrahagic diseases such as the Ebola. In other words, one of the two places in this country and on e of the handful of places on earth with qualified and train ed experts on the containment and treatment of Ebol a was only a phone call and an hour’s flight away. P LAINTIFF ’S ORIGINAL PETITION Page 12 of 36 she was a nurse and felt it was her duty to do what s he could do to help him. But the myth perpetuated by THR that this was a “volunteer” health care team obscures the dark reality: Nina was put in the position to take care of Mr. Duncan wi thout any prior knowledge of the risks, dangers, or any training. As with any patient, a n urse can attempt to refuse an assignment, but Nina was not inclined to do that because she saw cri tical care nursing as a calling, and she had a job to do. Unfortunately, THR was sending her to do it without the necessary qualifications or protections to do it safely. B.

B.B.

B. THR does not provide appropriate PPE or guidance on how to use it THR does not provide appropriate PPE or guidance on how to use it THR does not provide appropriate PPE or guidance on how to use it THR does not provide appropriate PPE or guidance on how to use it.

As noted, the nurses on the unit had no choice but to use the Internet to find out how to protect themselves. Even though Mr. Duncan had be en at Presbyterian for a day and a half, THR did not request or turn over the care to trained professionals from the CDC or another qualified health care facility that was trained and equipped to treat Mr. Duncan, nor did THR contact specialists who knew proper safety for deal ing with Ebola, such as the professionals at the nearby Galveston National Laboratory. 9 Nor did THR bring in the most experienced infectious diseases specialists and nurses from withi n its system to manage his care. Rather, THR placed untrained ICU nurses in this dangerous situation . PLAINTIFF ’S ORIGINAL PETITION Page 13 of 36 Like the others, Nina was left to determine–on her own–what personal protective equipment (PPE) to wear and how to don, doff, and we ar it. Based on what she could learn from the Internet, on the first day she cared for Mr. Dun can, Nina put on a regular isolation gown covering her front and back, double gloves, a surgica l mask with plastic shield and double booties. Importantly, Nina’s neck and hair remaine d exposed. Nina was not even provided disposable scrubs or a change of clothes. She had to wear the scrubs she wore that first day home, taking out of the hospital clothing that was p otentially carrying the virus.

That first day in the IUC, Nina was the only nurse w ho went in to care for Mr. Duncan, who was very appreciative and nice to Nina. As Nin a left for the evening, the care was turned over to the night nurses, who wore similar protectio ns.

C. Mr. Duncan is diagnosed with Ebola. Mr. Duncan is diagnosed with Ebola.Mr. Duncan is diagnosed with Ebola.

Mr. Duncan is diagnosed with Ebola.

The next day, September 30, Nina returned to the hosp ital, where the nurses expressed concerns about the adequacy of the equipment available for their personal protection. Specific representations were made to the nurses to not worry about Ebola exposure because the equipment provided to them was sufficient and in fact exceeded what the nurses needed to protect themselves from contracting Ebola–represent ations that were reckless and false. Still worried, the nurses decided on their own to switch t o N95 masks instead of a splatter masks, and they continued wearing the face shield and double glo ves, gown and booties. Still, the nurses’ neck and hair remained exposed without any options f or additional protection.

Early that afternoon, Mr. Duncan’s test results conf irmed he had Ebola. Nina’s heart sank. However, she continued to do everything she c ould for Mr. Duncan, whose situation had PLAINTIFF ’S ORIGINAL PETITION Page 14 of 36 not yet begun to seriously deteriorate. After staying longer than her shift required, Nina left for the night and turned Mr. Duncan over to the night nurs e, Amber Vinson.

That night, the news broke to the public that a pati ent at Presbyterian had Ebola. Nina’s mother, Diana, was worried about Nina and called her . When Nina let her mother know that she was, in fact, treating Mr. Duncan, her mother wa s afraid for her daughter and tried to convince her to not go into work the next day. V.

V.V.

V. “Nina, do not go back there. Just call in sick or qu it.” “Mom, I can’t abandon him. He is my patient. It’s my job.

I’m going back.” The first night after Nina began treating Mr. Duncan was a long, dark night for her. She did not know much about Ebola, but she was aware that it was a highly contagious and potentially fatal disease. And she knew that she w as not trained to care for highly contagious patients. Nina was scared. And like most people w ould, she thought about refusing to care for Mr. Duncan. But ultimately Nina’s sense of duty, compa ssion, and bravery won out. She knew Mr. Duncan needed help, and she felt it was her job to help him in his time of need. One powerful factor convinced her she would be fine: Nina believed that THR would warn her and would not put her in any situation that was as dangero us as she feared. So, Nina put her faith in THR that she would be safe. She decided she would go back and continue caring for Mr.

Duncan. PLAINTIFF ’S ORIGINAL PETITION Page 15 of 36 A.

A.A.

A. Nina continues to care for Mr. Duncan.

Nina continues to care for Mr. Duncan.Nina continues to care for Mr. Duncan.

Nina continues to care for Mr. Duncan.

Even more concerned after Mr. Duncan was definitivel y diagnosed with Ebola, the nurses located and put on Tyvek or “hazmat” suits with double gloves. They added on “chemo gloves” and taped these to the suit. The nurses also located and added a personal respirator that they covered with a blue gown. All of these decisio ns with regard to personal protective equipment were made by the nurses without any formal g uidance or training by THR supervisors as to what they were supposed to be doing . The nurses were just using their best guesses and their instincts to protect themselves. Over the course of six 12-14 hour shifts in the follo wing days, Nina worked with other nurses to do their best to help Mr. Duncan as his he alth deteriorated. In doing so, the health care providers experienced circumstances in taking c are of Mr. Duncan that were more like what one would expect in a third world country than w hat one would expect in a hospital in a nation with a highly developed health care system . The ICU was not designed or equipped to be an infectious disease isolation unit. So instea d, clear drop cloths were taped to the ceiling and walls of the hallway to create a makeshift cont ainment facility. As Mr. Duncan’s condition deteriorated and biohazardous material increased, th ere were more issues that THR was unprepared to address. Even though the nurses who car ed for Mr. Duncan were not trained in hazardous waste disposal, the hospital did not send people who were trained for such duties to the ICU. That meant these nurses had to clean up the room and the biohazardous waste and dirty sheets on their own. They tied up the sheets i n knots and placed them with contagious hazardous material in the ICU room next to Mr. Duncan where it just piled up. All of the talk PLAINTIFF ’S ORIGINAL PETITION Page 16 of 36 publicly about how our superior health care system would make fighting Ebola different in the U.S. stands in stark contrast to what actually occur red when the first patient arrived, and the situation was no better than that in Liberia. Ebola workers in Zaire . But in at least one way, Nina and the other nurses ha d it worse than those health care workers in third world countries: in West Africa, the health care providers wear full “moon suits” when they are treating Ebola patients. Here, at THR’s h ospital, the health care providers were given only basic coverings that left them exposed to the highly contagious disease. Despite the claims about our advanced health care system, ultimately none of it was brought to bear to protect the health care providers here. Nina Pham would have be en better off treating Mr. Duncan in a Liberian Ebola center than in THR’s signature hospit al.

B.B.

B. Mr. Duncan passes and Nina is told she is at no r isk.

Mr. Duncan passes and Nina is told she is at no ris k.

When Mr. Duncan finally passed away on October 8, Ni na was heartbroken. The hope that she could save her patient was the one thing th at had kept her going through the stress of the situation and fear that she had of the virus. Wh ile Mr. Duncan passed early that morning 10 THR told Nurse Amber Vinson the same thing.

P LAINTIFF ’S ORIGINAL PETITION Page 17 of 36 around 7:51 am, Nina stayed at the hospital until aro und 2:30 pm in the break room.

Shortly after Mr. Duncan passed, THR had Nina come in for a meeting with the hospital’s manager of occupational health and a representative from the CDC. Nina was told that the PPE she wore was safe and that she was at “ no nono no risk riskrisk risk ” of having contracted Ebola. Nina was surprised.

She had been assuming she was at risk but did not know if the risk was high, medium or low.

But she was now told she was at “no risk” at all and that she could freely see her friends and family. 10 Nina called her friends and family, and she tried t o cheer herself up from the loss of Mr.

Duncan by having close friends over and spending tim e with her loved ones, confident in what THR told her that she was not at any risk to them. Had she any reason to think she was, she would not have allowed her loved ones to get close t o her.

VI.

VI.VI.

VI.

N NN N INA F FF FIGHTS FOR H HH HER L LL LIFE W WW W HILE THR THR THR THR W WW W ORRIES ABOUT I II ITS R RR REPUTATION Since the time she began treating Mr. Duncan, Nina ha d been checking her temperature twice a day. Two days after Mr. Duncan passed, Nina woke up at 5:00 am feeling hot and chilly.

She checked her temperature, which previously had been hovering in the 97-98 degree range, and her temperature read 99.8. Nina called the hosp ital’s manager of occupational health and told her about the temperature, and the manager infor med Nina not to worry about it because it did not meet the 100.4 threshold for concern. 11 A “No information” patient is a way to log a patient into the system to protect a patient’s privacy so the patient’s name is not visible to others accessing the electro nic health record. The hospital failed to follow N ina’s wishes, and Nina’s record was grossly and inappropriately acces sed by dozens of people throughout the THR system.

P LAINTIFF ’S ORIGINAL PETITION Page 18 of 36 In the early hours of the next day, Nina woke up, and her temperature was 100.6. Nina decided she needed to go to the hospital. As she d rove to Presbyterian, she called ahead and told them that she was one of Mr. Duncan’s nurses, that sh e had a fever, and that she wanted to be admitted as a “No Information” patient so that her identity would be protected. 11 Nina did not want anyone to know that she might be sick with Ebo la.

When Nina arrived at the ER, she was taken back int o an isolation room where she stayed the rest of the day while they ran tests. Sh ortly before midnight, the chief nursing officer for Presbyterian came into Nina’s room wearing a ful l hazmat suit. Nina could tell from his red eyes that it was bad news. That’s when she was tol d she had tested positive for Ebola.

Nina was in shock. Having just watched a terrible a nd painful death befall Mr. Duncan, Nina knew what was in store for her. Through her sh ock, fear and panic, she only had one thought: please start aggressive treatment immediate ly.

During the course of the next several days, Nina coura geously battled Ebola. Throughout her admission at Presbyterian, her medical records indicate that Nina’s condition was life- threatening, but Nina was determined she would survive .

A.A.

A. THR was primarily concerned with itself.

THR was primarily concerned with itself.THR was primarily concerned with itself.

THR was primarily concerned with itself. Throughout this whole time, THR was worried about one thing above all: its public image. Already suffering from intense media scrutiny and criticism for how it mishandled the initial discharge of Mr. Duncan and his treatment, T HR desperately began PR damage control PLAINTIFF ’S ORIGINAL PETITION Page 19 of 36 to try to combat the growing distrust in the core competency of THR’s hospital. With patients abandoning and avoiding Presbyterian, THR’s brand a nd its revenues were tanking. So, ultimately with the guidance of an outside PR firm, TH R launched a public relations offensive designed to increase goodwill. THR quickly learned that Nina and her dog Bentley ha d enormous public support and sympathy. So THR began trying to use Nina as a PR to ol to save its plummeting image. While Nina laid in isolation, heavily medicated and facin g a potentially gruesome death, THR had its PR department calling Nina. The PR Department was trying to release information and use Nina as part of its THR-corporate-driven #PresbyPro ud campaign.

After Amber Vinson, a second nurse at Presbyterian a lso was confirmed to have Ebola, THR was in full crisis mode. Public perception was t hat the hospital was incompetent, and it was in need of good news. Desperately, THR issued a press release that announced Nina’s condition had been upgraded from stable to good in h opes that the public would think THR was doing something right. However despite publicly claiming Nina was in good c ondition, Nina’s medical records tell another story. Her records show that while THR’s PR apparatus was publically proclaiming PLAINTIFF ’S ORIGINAL PETITION Page 20 of 36 Nina’s improved condition, health care providers were at the very same time having “end of life discussions” with her in which they tried to convinc e Nina to not require lifesaving measures, and specifically documenting in Nina’s medical recor d note that she was in such critical condition that she could not make decisions for hers elf. Remarkably, on October 14 th, the same day THR was issuing press releases report ing that Nina is in “good condition,” her medical records co ntain a progress note from Nina’s pulmonologist that states:

Indeed, when Diana Pham heard from the news that he r daughter’s condition had been upgraded to good, she asked the doctors, and the doc tors told her that was not the case. The family was shocked and confused. This particular note in Nina chart encapsulates how i mproperly THR acted in trying to use Nina Pham as a public relations tool when what sh e needed was to be cared for like any other patient in a serious medical crisis. The phys ician notes her condition is “life-threatening” and that he “discussed plan of care with family as p atient unable to make their own clinical decisions.” But despite her clinical status precludin g her from making her own clinical decisions, PLAINTIFF ’S ORIGINAL PETITION Page 21 of 36 the physician– surely at the direction of THR, as no physician would do this of his own accord –is also discussing consent forms for release of informa tion so that THR can use the public’s concern for Nina to tell a different story, hoping Nina’s g oodwill will transfer to THR. Further, the note demonstrates how misaligned THR’s priorities were. Even though THR’s own records indicate Nina’s condition left he r unable to make important decisions on her own, THR had no problem asking for and relying on h er consent to release information about her to the public for its own corporate benefit. But when Nina expressed her desire to continue all levels of medical support (meaning, that she wan ted the doctors and nurses to engage in life- saving measures if necessary), then THR wanted to “d iscuss it again” later and chose instead to talk to her family about it because Nina was “unable t o make their [her] own clinical decisions....” This sort of backwards and repellan t action is emblematic of the improper motivations of THR. B.

B.B.

B. THR ambushes Nina on Video THR ambushes Nina on VideoTHR ambushes Nina on Video THR ambushes Nina on Video Perhaps the act most indicative of THR’s callousness in the pursuit of good PR happened on the day Nina finally got transferred to the Nati onal Institutes of Health (“NIH”) in Bethesda, Maryland. THR desperately wanted to claim credit f or making Nina better so that the public would not believe that Nina was being transferred be cause she was not receiving proper medical PLAINTIFF ’S ORIGINAL PETITION Page 22 of 36 care. Before she departed for NIH, one of Nina’s physicians entered her room with a tiny GoPro camera under his hood filming everything in the room . The physician tried to get Nina to say good things about Presbyterian and to get her to say that she was feeling well and wished she was not being transferred. Nina, unclear as to what was occurring, did not give the answers THR was looking for. The physician tried to tease out a ny good sound bites he could get but mostly failed. Finally at the end of the discussions, he m ade Nina tear up a little bit and then respond with optimistic statements. THR immediately edited the video to make it look as good as possible for THR. Then THR released it to the press and published it on the THR YouTube site. It had the effect THR wanted. Quickly it was rebroadcast around the world in what appeared to be a very “rah-rah” message from the beloved Nurse Pham about how good a hospital Presbyterian was and how she was “Presby Proud.” Never once did THR get Nina’s permission to be used as a PR pawn like this. Never once did THR discuss its purposes or motivations or tell N ina what it was going to do with the information it sought from her. Instead, THR went to this young lady who was not in the position to be making any such decisions, and used he r when she was in the darkest moment of her life, all for THR’s own benefit. VII.

VII. VII.

VII.

N NN N INA B BB BEATS E EE EBOLA B BB BUT F FF FACES AN U UU UNCERTAIN F FF FUTURE At the NIH, Nina was treated in a facility properly prepared and equipped for treating Ebola. The situation there was vastly different. Where the THR facility was marked by PLAINTIFF ’S ORIGINAL PETITION Page 23 of 36 confusion, unpreparedness and an overwhelming concern about public relations, the environment at the NIH exuded total confidence and p reparedness. Moreover, the NIH executives and team, led by Dr. Anthony Fauci, were s ingularly focused on making sure Nina survived and beat Ebola. Fortunately, Nina was event ually discharged from the NIH Ebola free, receiving a hug from Dr. Fauci. From NIH, she was ta ken to the White House where President Obama embraced her for the whole world to see.

Unfortunately, even cured, not everyone will embrace Nina. She faces the potentially life-long stigma of being the “Ebola nurse.” When she goes out in public, some people act afraid of her.

It is not clear what the future holds for Nina. Professionally, she doubts whether she can ever be a critical care nurse again – in part because of the emotional stress and anxiety over the trauma she experienced and in part because of the fear and stigma that follows her. So despite only just beginning to pursue her dream of a career in critical care nursing, Nina is now faced with the possibility of never returning to her passion. On a personal level, Nina has suffered through unspeak able horror. After overcoming the fear, stress and anguish of watching what happen ed to Mr. Duncan, Nina then had to face the reality that she could suffer the same fate. Th is young lady faced death and the grief of PLAINTIFF ’S ORIGINAL PETITION Page 24 of 36 parents afraid of the most painful of losses–the loss of a child. Nina was put in the position to make “end of life” decisions, underscoring the likel ihood of death.

Although Nina’s fear of dying from Ebola now exists only in her frequent nightmares, she is worried about her future as her long-term medic al prognosis remains unknown. No one knows the long-term medical impact of having Ebola. Emerging evidence shows that there are likely serious long-term effects, including potential vision loss and worse. Moreover, Nina was given large doses of experimental drugs, the long-te rm side effects of which are unknown but likely to be significant. Likewise, the potential costs of managing those long-term side effects is unknown. Of greatest concern is the question of w hether this will affect Nina’s ability to have children, something that has always been important to her. Nina must deal with what no young person of her age should have to face: a potentially bleak medical future with indeterminate costs of future needs. Beyond the professional and medical uncertainty, Nin a faces long-term effects on her enjoyment of life and personal relationships. In a ddition to the nightmares and anxiety she has, she faces isolation caused by the stigma of the dise ase that will follow her with each person she meets, as some people keep their distance and treat her as “different.” And for a young, vibrant female like Nina, one major concern is whether she will ever be looked upon as the same by friends, patients, or even a partner. These uncerta inties have changed her life. Health care providers like Nina Pham are what make our health care system great. They are the ones who step in to take care of patients w ho are in the greatest need. But to do their jobs well and safely, they need the backing of a sy stem that is willing to invest in safety and do PLAINTIFF ’S ORIGINAL PETITION Page 25 of 36 everything it can do to support these health care providers. Profit-hungry corporate systems like THR fail to do that as they lose sight of what matters most in health care and instead focus on growth, cost control, and branding a sterling im age. When Nina needed THR the most, THR failed her, desp ite the fact that THR wanted to sell her to the public as the face of the company. Nina wants to bring this to light in order to ensure that THR refocuses on what is important and do es not fail her or any other health care provider again. Since Nina does not feel she can go back to what she loved about nursing, she hopes this lawsuit is a new way to help others as an advocate for what is right.

Nina Pham files this Original Petition and respectf ully shows the following:

VIII.

VIII. VIII.

VIII.

P PP P ARTIES 1. At all relevant time periods, Nina Pham was a res ident of Dallas County, Texas.

2. Texas Health Resources, Inc. is a Texas corporatio n with a principle place of business in Tarrant County, Texas and may be served through its r egistered agent for service of process:

Donald B. Collins 612 E. Lamar Blvd., Ste. 1400 Arlington, Texas 76011 IX.

IX.IX.

IX.

D DD D ISCOVERY C CC CONTROL P PP PLAN 3. Plaintiff intends that discovery be conducted under Level III of T EXAS RULE OF CIVIL PROCEDURE 190.3. PLAINTIFF ’S ORIGINAL PETITION Page 26 of 36 X.

X.X.

J JJ J URISDICTION AND V VV VENUE 4. Venue is proper in Dallas County pursuant to T EXAS CIVIL PRACTICES & REMEDIES CODE §15.002(a)(1) because all or a substantial part of th e events or omissions giving rise to these claims occurred in Dallas County.

5. This Court has jurisdiction because the amount in co ntroversy exceeds the minimum jurisdictional amounts of the Court. XI.

XI.XI.

XI.

C CC C AUSES OF A AA ACTION Count One:

Count One: Count One:

Count One: Negligence of THR.

Negligence of THR.Negligence of THR.

Negligence of THR.

6. Plaintiff incorporates the preceding paragraphs i n this Count.

7. At all relevant times, THR controlled nursing at Presbyterian, through its corporate control of Presbyterian, and through shared decision making in each of the THR system hospitals that are required to report to THR’s Chie f Nursing Executive and THR’s Nursing Executive Team (NET). THR directs nursing through the system-wide nursing service. 8. At all relevant times, THR controlled the “Ebola response” at Presbyterian.

9. In so doing, THR was negligent in the following p articulars:

a. failing to act with ordinary care; b. failing to recognize the likelihood and appreciat e the danger of the Ebola virus coming to its hospitals; c. failing to develop and implement policies and pro cedures on how to respond to the presence of the Ebola virus in the patient popula tion; PLAINTIFF ’S ORIGINAL PETITION Page 27 of 36 d. failing to ensure that all health care providers were trained on policies and procedures on how to recognize, appreciate, contain and treat the Ebola virus in the patient population; e. failing to train nurses on proper protection, incl uding how to don and doff PPE; f. failing to ensure that the hospitals have appropri ate personal protective equipment; g. failing to notify the appropriate authorities and get qualified people to manage the Ebola patients; and h. failing to protect Nina Pham from a foreseeable h arm.

10. THR’s acts or omissions are a proximate cause of Nina’s damages resulting from these tragic events. Nina hereby prays for and seeks all available damages as set forth below.

Count Two: Negligent Undertaking under Restatement (Second) of Torts § 323.

11. Plaintiff incorporates the preceding paragraphs in this count.

12. THR undertook, for pecuniary benefit, to control t he methods, policies and procedures, and conditions of nursing care at Presbyterian and t hus assumed a duty, inter alia , to train, warn, and protect those nurses under the Restatement (Second ) of Torts § 323.

13. Further, THR undertook, for pecuniary benefit, to c ontrol the response to the Ebola virus at Presbyterian, including the development of polici es and procedures, and thus assumed a duty, inter alia , to train, warn, and protect against the dangers o f the Ebola virus under the Restatement (Second) of Torts § 323.

14. Having assumed those duties, THR was negligent as set forth in the preceding count, including in failing to adequately protect, warn, and train nurses against the dangers of the Ebola virus. PLAINTIFF ’S ORIGINAL PETITION Page 28 of 36 15. Nina suffered harm as a result of THR’s failure to exercise reasonable care in fulfilling those duties.

16. THR’s failure to exercise reasonable care in fulfi lling those duties increased the risk of harm to Nina, or in the alternative, Nina was harme d in reliance upon THR’s failure to warn her of dangers known to it.

17. THR’s acts or omissions are a proximate cause of Nina’s damages resulting from these tragic events. Nina hereby prays for and seeks all available damages as set forth below.

Count Three: Premises Liability.

Count Three: Premises Liability. Count Three: Premises Liability.

Count Three: Premises Liability.

18. Plaintiff incorporates the preceding paragraphs in this count.

19. At all times relevant hereto, THR owned, occupied , possessed, exercised control over, or had the right to control the premises at Presbyt erian at which Nina was injured. As such, THR owed the highest duties of care to Nurse Pham as an invitee to warn her and protect her from the inherently dangerous conditions at Presbyte rian that existed as a result of the presence of a highly communicable viral agent and in the inad equacy of the safety measures in place to deal with that dangerous condition. 20. THR knew or should have known of the danger of Eb ola and the inadequacy of its preparations and Presbyterian’s capability to treat patients such as Mr. Duncan, all of which resulted in a dangerous condition for Nina. THR thus should have either warned about or made safe the dangerous condition by, inter alia , a. warning Nurse Pham that the PPE provided was inade quate; b. training Nurse Pham on how to properly don and dof f PPE; PLAINTIFF ’S ORIGINAL PETITION Page 29 of 36 c. training Nurse Pham about how to treat patients with the Ebola virus and which activities increase the risk of exposure; d. assigning qualified experts to oversee the care of Mr. Duncan and actions of the nurses; e. transferring Mr. Duncan to a facility equipped to s afely treat him instead of admitting him to an ICU not used for infectious disea ses, or, in the alternative, bringing qualified experts to take over Mr. Duncan’s care and the premises thereby eliminating the dangerous condition to Nurse Pham and those similarly situated; and f. failing to provide appropriate safety equipment to protect anyone exposed to Mr.

Duncan.

21. THR negligently and grossly negligently failed t o meet those duties, and it was foreseeable that the conditions posed such an extrem e degree and unreasonable risk of harm to an untrained and unprotected nurse like Nurse Pham, tha t failing to meet those duties would proximately cause damage to nurses like Nurse Pham.

22. THR’s acts or omissions are a proximate cause of Nina’s damages resulting from these tragic events. Nina hereby prays for and seeks all available damages as set forth below.

Count Four:

Count Four: Count Four:

Count Four: Invasion of Privacy Invasion of PrivacyInvasion of Privacy Invasion of Privacy.

23. Plaintiff incorporates the preceding paragraphs in this count.

24. At all relevant times, Nina Pham had a right to privacy, seclusion and ownership over her name and likeness. Nina requested such privacy b y being asked to be a “No information” patient, and Nina had a reasonable expectation that information regarding her identity, her medical condition or her personal image would be kep t private. PLAINTIFF ’S ORIGINAL PETITION Page 30 of 36 25. THR, through its agents, intentionally intruded on Nina’s solitude, seclusion and private affairs when Nina was in a life-or-death situation. It would be highly offensive to a reasonable person that a patient, like Nina, would be in isolat ion with a highly communicable and lethal virus, and yet her THR was disclosing highly persona l medical information about her, filming her without her informed consent, and generally atte mpting to use her for purposes of THR’s public relations. 26. Further, THR, through its agents, publicized inform ation about Nina’s private life, including her identity, her personal health informat ion, and other personal facts that the public had no right to know and for which THR had no right to publicize. As set forth above, such disclosures would be highly offensive to a reasonable person.

27. Finally, THR, through its agents, appropriated Ni na’s name and likeness for the value associated with it. Through a number of press releas es, a video, and other press efforts, THR’s use of Nina can be identified, and THR did so for it s advantage. 28. THR’s invasion of Nina’s privacy rights are a pr oximate cause of Nina’s damages resulting from these tragic events. Nina hereby prays for and seeks all available damages as set forth below. Count Five:

Count Five: Count Five:

Count Five: Fraud.

Fraud.Fraud.

Fraud.

29. Plaintiff incorporates the preceding paragraphs in this count.

30. THR, through its agents, made material representa tions to Nina Pham about her privacy and THR’s need to release information. Those mater ial representations were known to be false PLAINTIFF ’S ORIGINAL PETITION Page 31 of 36 or made recklessly with the intent that Nina would rely on those representations. Nina did rely on them, to the extent she had capacity to do so.

31. THR’s fraudulent representations proximately caused damages to Nina, and Nina hereby prays for and seeks all available damages as set fo rth below.

Count Six:

Count Six: Count Six:

Count Six: Securing the Execution of Document by Dec eption.

Securing the Execution of Document by Deception. Securing the Execution of Document by Deception.

Securing the Execution of Document by Deception.

32. Plaintiff incorporates the preceding paragraphs in this count.

33. THR knowingly and intentionally misrepresented f acts to Nina with the intent to defraud and induce her to agree to the release of inf ormation regarding her medical conditions and views of Presbyterian. THR knowingly made fals e representations or omitted necessary information regarding the reasons THR was seeking s uch releases and what THR would do with any such information so released. In this regard, T HR mislead Nina, as she had no intention of allowing THR to release false information about her condition or use her likeness as a public relations tool for THR’s corporate benefit. Relyin g upon THR’s deception, Nina executed written releases that adversely affected the proper ty and interests of Nina and her family.

34. THR’s conduct in that regard is a proximate cause of Nina’s damages. Nina hereby prays for and seeks all available damages as set forth be low.

E.E.

E. Count Seven: Gross Negligence of THR.

Count Seven: Gross Negligence of THR.Count Seven: Gross Negligence of THR.

Count Seven: Gross Negligence of THR.

35. Plaintiff incorporates the above paragraphs by r eference.

36. Plaintiff avers that the conduct of THR as set fo rth above constitutes gross negligence as those terms are defined by law. THR was consciousl y aware of an extreme degree of risk to the health care workers such as Nina Pham and those simi larly situated, but it nevertheless PLAINTIFF ’S ORIGINAL PETITION Page 32 of 36 proceeded in failing to act to protect them in complete disregard for the rights, safety and welfare of Nina and those similarly situated.

37. For this gross negligence, Plaintiff specificall y pleads for the recovery of exemplary damages as set forth herein. XII.

XII. XII.

XII.

A AA A GENCY 38. At all relevant times, the employees or agents o f THR whose conduct is implicated were in the course and scope of their employment or actin g as agents of THR such that THR is liable for the conduct of those employees or agents. XIII.

XIII. XIII.

XIII.

D DD D AMAGES A.

A.A.

A. Damages to Nina Pham Damages to Nina PhamDamages to Nina Pham Damages to Nina Pham 39. As a result of the negligence of THR, Nina suffere d through severe physical, emotional, and reputational injury and will likely suffer in the future such injuries. Nina therefore prays for damages, including, but not limited to the follow ing:

a. Physical pain and mental anguish sustained in the p ast; b. Physical pain and mental anguish that, in reasona ble probability, Nina will sustain in the future; c. Physical impairment sustained in the past; d. Physical impairment that, in reasonable probabili ty, Nina will sustain in the future; e. Loss of enjoyment of life sustained in the past; PLAINTIFF ’S ORIGINAL PETITION Page 33 of 36 f. Loss of enjoyment of life that, in reasonable probability, Nina will sustain in the future; g. Medical care expenses sustained in the past; h. Medical care expenses that, in reasonable probabi lity, Nina will sustain in the future; i. Loss of earning capacity that, in reasonable prob ability, Nina will sustain in the future; j. Loss of reputation sustained in the past; k. Loss of reputation that, in reasonable probability , Nina will sustain in the future; l. Restitution damages for loss of value associated wi th her name, reputation and goodwill.

40. The above damages exceed the minimal jurisdiction of this Court, and Nina prays for full recovery of such damages following a trial by jury. B.

B.B.

B. Exemplary Damages Exemplary DamagesExemplary Damages Exemplary Damages 41. Nina alleges that each and every negligent act o r omission of THR and its agents, as set forth above, when viewed objectively from the stand point of policymakers, involved an extreme degree of risk, considering the probability and mag nitude of the physical harm to others and that THR had actual subjective awareness of the risks invo lved, but nevertheless proceeded with conscious indifference to the rights, safety or welf are of Nina and other nurses and health care providers at Presbyterian, and as such, such conduct a mounts to gross negligence or malice, as those terms are defined by law, so as to give rise to an award of exemplary or punitive damages, for which Nina now pleads against THR. Additionally , by reason of such conduct, Nina is PLAINTIFF ’S ORIGINAL PETITION Page 34 of 36 entitled to and therefore asserts a claim for punitive and exemplary damages in an amount sufficient to punish and deter THR, and other corpora te owners of hospitals like them, from such conduct in the future.

42. Additionally, each of the malicious and fraudulent acts of THR independently give rise to an award of exemplary or punitive damages, for wh ich Nina now pleads against THR in an amount sufficient to punish and deter THR, and other c orporate owners of hospitals like them, from such conduct in the future. XIV.

XIV. XIV.

XIV.

P PP P RE - -- -JUDGMENT AND P PP POSTJUDGMENT I II INTEREST 43. Nina requests pre-judgment and post-judgment intere st in accordance with the maximum legal interest rates allowable as interprete d under the laws of the State of Texas.

XV.

XV. XV.

XV.

R RR R EQUEST FOR A J JJ JURY T TT TRIAL 44. Nina demands a jury trial on all issues so triable and contemporaneously with the filing of this Petition submits the applicable fee. XVI.

XVI. XVI.

XVI.

R RR R EQUEST FOR D DD DISCLOSURE 45. Pursuant to T EXAS RULE OF CIVIL PROCEDURE 194, Defendant is requested to disclose the information and material described in Rule 194.2. T he written responses to the above requests for disclosure should conform to Rule 194.3 and the ma terials, documents, and/or copies of same should be produced in compliance with Rule 194.4. Th e written responses, materials, and PLAINTIFF ’S ORIGINAL PETITION Page 35 of 36 documents are to be delivered to the A LDOUS LAW FIRM , 2311 Cedar Springs Road, Suite 200, Dallas, Texas 75201, as required following receipt o f this request.

XVII.

XVII. XVII.

XVII.

P PP P RAYER 46. Nina prays that THR be cited to appear and answe r herein, and that upon final determination of these causes of action, Nina receiv e a judgment against THR awarding Nina damages as follows: a. Actual, compensatory, consequential, exemplary, and punitive damages, in an amount in excess of the minimal limits of the Court; b. Costs of Court; c. Prejudgment interest at the highest rate allowed b y law from the earliest time allowed by law; d. Interest on judgment at the highest legal rate fro m the date of judgment until collected; and e. All such other and further relief at law and in equi ty to which Nina may show herself to be justly entitled. PLAINTIFF ’S ORIGINAL PETITION Page 36 of 36 Respectfully submitted, /s/ Charla G. Aldous C CC CHARLA G.

G.G.

G. A AA ALDOUS State Bar. No. 20545235 [email protected] B BB BRENT R.

R.R.

R. W WW W ALKER State Bar No. 24047053 [email protected] H HH H EATHER L.

L.L.

L. L LL LONG State Bar No. 24055865 [email protected] A AA ALDOUS L LL LAW F FF FIRM 2311 Cedar Springs, Suite 200 Dallas, TX 75201 214.526.5595 phone 214.526.5525 fax A TTORNEYS FOR PLAINTIFF NURSE NINA PHAM