Lawsuit: Gerardi v. Livanova, 2018

Case 8:18-cv-01880-EAK-SPF Document 1 Filed 07/31/18 Page 1 of 28 PageID 1
UNITED STATES DISTRICT COURT

FOR THE MIDDLE DISTRICT OF FLORIDA
GARY F. GERARDI INDIVIDUALLY CIVIL ACTION

AND AS THE ANTICIPATED NO.:
PERSONAL REPRESENTATIVE OF
THE ESTATE OF LOIS J. GERARDI
Plaintiffs,
v.
JURY TRIAL DEMANDED
LIVANOVA, PLC, LIVANOVA

DEUTSCHLAND GmbH (f/k/a
SORIN GROUP DEUTSCHLAND
GmbH), AND LIVANOVA HOLDINGS
USA, INC. (f/k/a SORIN GROUP
USA, INC.)
CIVIL COMPLAINT
Plaintiffs Gary F. Gerardi individually, and as the Anticipated Personal
Representative of the Estate of Lois J. Gerardi by and through the undersigned attorneys,
alleges the following:
JURISIDCTION AND VENUE
1. This Court has subject matter jurisdiction over this action pursuant to the
diverse citizenship of the parties. 28 USCS § 1332(a)(2). Plaintiffs are citizens and
residents of Florida. Defendant, LivaNova PLC (“LivaNova”) is a foreign for-profit
corporation incorporated under the laws of England and Wales with a headquarters in
London. LivaNova Deutschland GmbH (f/k/a Sorin Group Deutschland GmbH), is a
foreign corporation headquartered in Munich, Germany. Defendant, LivaNova Holdings

1
USA, Inc. (f/k/a Sorin Group USA, Inc.) has a principal place of business in Houston,
Texas.
2. Personal jurisdiction exists over Defendants, LivaNova PLC, LivaNova
Deutschland GmbH (f/k/a Sorin Group Deutschland GmbH) and LivaNova Holdings
USA, Inc. (f/k/a Sorin Group USA, Inc.), in the U.S. and in Florida due to the general and
specific contacts they maintain. Defendants maintain those contacts presently and did so
at all times material to this action. The amount in controversy exceeds $75,000.
3. Venue is proper in this District pursuant to 28 U.S.C. § 1391 as a
substantial part of the events and/or omissions giving rise to the Plaintiffs’ claims
emanated from activities within this jurisdiction and Defendants conduct substantial
business within this jurisdiction.
THE PARTIES
4. The Plaintiff, Gary F. Gerardi, is the surviving spouse of Lois J. Gerardi
and is a resident of the state of Florida residing at 3918 38th Avenue, Bradenton, Florida
34208. Plaintiff, Gary F. Gerardi is the Anticipated Personal Representative for the
Estate of Lois J. Gerardi.
5. Decedent Lois J. Gerardi was at all times relevant to this action a citizen
and resident of the Florida until her death in 2016.
6. Defendant, LivaNova PLC (“LivaNova”) is a foreign for-profit
corporation headquartered in London. LivaNova is a global medical device company
specializing in, among other products, devices used in the treatment of cardiovascular
diseases. LivaNova pursuant to an October 2015 merger agreement between Sorin Group
2
S.p.A1 and non-party, Cybertronics, Inc. advised purchasers in the United States it is the
responsible party for the Sorin 3T Heater-Cooler System at issue herein. Further,
LivaNova has directly communicated with the Food and Drug Administration (“FDA”),
3T System Customers and other interested parties with respect to safety concerns about
the 3T System.
7. Defendant, LivaNova Deutschland GmbH (f/k/a Sorin Group Deutschland
GmbH) (“Sorin”) is a foreign for profit corporation headquartered in Munich, Germany.
Sorin designed, manufactured and marketed the Sorin 3T Heater-Cooler System.
8. Defendant, LivaNova Holdings USA, Inc. (f/k/a Sorin Group USA, Inc.)
(“Sorin USA”) is a U.S. designer, manufacturer, marketer and distributor of the Sorin 3T
Heater-Cooler System with a principal place of business in Houston, Texas.
GENERAL FACTUAL ALLEGATIONS
8. Tampa General Hospital is located at 1 Tampa General Circle, Tampa,
Florida 33606. On or about November 9, 2016, Tampa General notified its patients who
underwent open-heart cardiac surgery at their facility that they had been potentially
exposed to rare and potentially fatal bacteria via Sorin 3T Heater-Cooler Systems used to
regulate blood temperature.2
9. The bacterium at issue, M. Abscessus, is subspecies of nontuberculous
mycobacterium (“NTM”) that occur naturally in the environment and rarely causes
1
Upon information and belief, Sorin Group S.p.A. was the original holding company of Defendants, Sorin
Group Deutschland GMBH and Sorin Group USA, Inc.
2
November 9, 2016 Hospital Warning letter from Tampa General is attached as Exhibit A.
3
illness. However, M. Abscessus poses unique risks to patients whose organs and chest
cavities are directly exposed to the bacteria during surgery.
10. Symptoms of M. Abscessus infection and other NTM subspecies including
M. Chimaera, are non-specific and may include any of the following: persistent fever,
pain, night sweats, joint and muscle pain, unexplained weight loss and fatigue.
11. The diagnosis of an NTM infection requires targeted culturing and/or
molecular diagnostic testing, the results of which take at least 6-8 weeks.
B. Defendants’ 3T Heater-Cooler Systems as the Infection Source
12. The 3T Systems used at Tampa General were designed, manufactured,
marketed and/or sold by the Defendants.
13. The 3T regulates blood temperature by circulating water through tubes
into a heat exchanger where blood is pumped into separate chambers during surgery. The
water tanks and other areas where water pass through aerosolize a vapor containing NTM
which exits out of the device and is pushed into the ambient air of the operating room
through the System’s exhaust fan. If placed in the operating room, contaminated vapor
from the 3T directly enters the sterile surgical field and the patient’s open body.
4
(taken from Defendants’ publicly available presentation to the FDA Circulatory Devices
Panel on June 2, 2016)
14. Published studies dating back to the 1980s confirm that NTM is
commonly found in water and has a high propensity to become airborne (aerosolize)
through natural processes.3
3
See e.g., Wendt, et al., Epidemiology of Infection by Nontuberculous Mycobacteria, III. Isolation of
Potentially Pathogenic Mycobacteria from Aerosols, American Review of Respiratory Disease, 1980
(“Field experiments have confirmed the existence of a natural mechanism for the transfer of significant
numbers of mycobacteria from water to air.”); Falkinham, Mycobacterial Aerosols and Respiratory
Disease, Emerging Infectious Diseases, July 2003 (“Environmental opportunistic Mycobacteria are present
in drinking water, resistant to disinfection, able to provoke inflammatory reactions, and readily
aerosolized.”).
5
15. The potential for contaminated water from heater-cooler devices to infect
patients intraoperatively was recognized by the medical and scientific community as
early as November 2002.4
16. Invasive cardiovascular infections identified as NTM have been reported
in Switzerland, Germany and the Netherlands since 2011.5
17. A public health investigation in Switzerland following six patient
infections since 2011 included microbiological examinations of environmental samples
that identified NTM contamination in heater-cooler units, including water samples from
inside the units. Samples of the ambient air were positive for M. Chimaera, a species of
NTM, when the units were running, but negative when they were turned off. 6
18. In April 2011, the FDA visited Defendant, Sorin, in Munich, Germany for
a plant inspection and to discuss safety concerns with the 3T approved in 2005 through
the 510(k) process. The FDA advised the company that its 3Ts harbored dangerous
4
See The Heater-Cooler Unit—A Conceivable Source of Infection, Weitkemper, et al., The Journal of the
American Society of Extra-Corporeal Technology, 2002.
5
ECDC Rapid Risk Assessment, Invasive Cardiovascular Infection by Mycobacterium Chimaera
Potentially Associated with Heater-Cooler Units Used During Cardiac Surgery, April 30, 2015, available
online at http://ecdc.europa.eu/en/publications/Publications/mycobacterium-chimaera-infection-associated-
with-heater-cooler-units-rapid-risk-assessment-30-April-2015.pdf (last accessed on July 12, 2017).
6
Subsequent studies have further confirmed that the 3T aerosolizes M. Chimaera when powered on. See
e.g., Lyman, et al. Invasive Nontuberculous Mycobacterial Infections among Cardiothoracic Surgical
Patients Exposed to Heater-Cooler Devices, Emerging Infectious Diseases, May 2017; Gotting, et al.,
Heater-Cooler Units: Contamination of Crucial Devices in Cardiothoracic Surgery, Journal of Hospital
Infection, February 2016; Sommerstein, et al., Transmission of Mycobacterium Chimaera from Heater-
Cooler Units during Cardiac Surgery Despite an Ultraclean Air Ventilation System, Emerging Infectious
Diseases, June 2016.
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bacteria and that it had failed to make a proper risk assessment for cleaning the devices to
prevent bacterial infections in patients exposed in the operating room.
19. Defendants conceded to the FDA that this particular patient risk was “not
considered” because it was “not of concern.”
20. During this inspection, the FDA also advised the company that the
bacterial growth charts it used to justify the original instruction for device disinfection
every 14 days allowed bacterial overgrowth well in excess of safe standards in just one
and a half days. The company admitted to the FDA that its cleaning instructions did not
meet these standards and that it had no information to support the cleaning methods it
disseminated to U.S. purchasers.
21. More than four years later, on July 15, 2015, Defendants issued a Class 2
435organisms, including Mycobacteria, in Sorin Heater Cooler Devices, if proper
disinfection and maintenance is not performed per instructions for use.”
22. The recall directed customers to follow the new cleaning and disinfection
procedures outlined in a Field Safety Notice issued by Defendants on June 15, 2015.
23. According to this Field Safety Notice, the company’s hygiene concept
was “enhanced”7 by introducing the following modifications:
a) Use filtered tap water when filling the device;
7
A month prior to the recall, in May 2015, Defendants informed customers that devices that had not been
maintained according to the manufacturers’ IFUs required a mechanical deep disinfection process to
remove bacterial colonization, referred to as “biofilm”.
7
b) To make disinfection easier, switch from three different cleaning

procedures (every five days, every two weeks and every three
months), to just two (every seven days and every fourteen days);
c) The option to use peracetic acid instead of Clorox for disinfection;
d) Use hydrogen peroxide in low dose for device preservation;
e) Include all external tubing, bottles and buckets in the disinfection

process;
f) Change to polyethylene tubing that meets national drinking water

standards; and
g) Unused heater-coolers should be disinfected bi-weekly.
24. Upon information and belief, Defendants knew or should have known that
design and/or manufacturing defects in the 3T renders it prone to bacterial colonization
and transmission, regardless of the cleaning and disinfection procedures used.8
25. Manufacturing and User Facility Device Experience (“MAUDE”) reports,
such as one reported to the FDA on July 7, 2016, evidence that even mechanical deep
8
See e.g., Garvey, et al., Decontamination of Heater-cooler Units Associated with Contamination by
Atypical Mycobacteria, Journal of Hosp. Infection, March 2016 (finding that Defendants’ decontamination
protocol was inadequate and that removal of internal tubing was required to achieve water quality in 3Ts);
Marra, et al., Mycobacterium Chimaera Infections Associated with Contaminated Heater-Cooler Devices
for Cardiac Surgery: Outbreak Management, Clinical Infectious Diseases, April 19, 2017 (“Despite
adherence to these [manufacturer] recommendations for use of sterile or filtered water, and regular water
circuit disinfection and tubing changes, M. Chimaera contamination will persist…investigators using far
more intensive attempts at disinfection have been unable to eradicate M. Chimaera from 3T
HCDs.”)(internal citations omitted).
8
disinfection followed by the use of filtered water, new water hoses, and three cycles of
Defendants’ new cleaning procedure fail to eliminate high bacteria counts in the 3T.9
C. Additional NTM Outbreaks and Regulatory Agency Responses
26. The risk of NTM transmission with the 3T is not unique to Tampa General
Hospital. In November 2015, Penn State Milton. S. Hershey Medical Center in Hershey,
PA announced that 2300 patients had been exposed to NTM via its 3Ts and later
confirmed multiple infections and deaths linked to the devices. On September 20, 2016,
yet another Pennsylvania hospital, Penn Presbyterian Medical Center in Philadelphia,
announced patient infections linked to the 3T.
27. Hospitals throughout the U.S. states have reported patient infections
and/or device contamination with NTM. For example, the University of Iowa Hospitals
and Clinics has confirmed multiple NTM infections, including deaths, attributed to the
3T. In May 2016, Swedish Medical Center in Seattle, Washington issued letters
notifying certain cardiac bypass patients that it had tested and found NTM in several of
its 3Ts.
28. Many hospitals have either discontinued using the 3T or have moved the
3T into a separate room to prevent contaminated aerosols from reaching the surgical
field.
9
See also, ECDC Rapid Risk Assessment, supra (“In Switzerland, cleaning and decontamination of the
heater-cooler units was followed by recontamination. A new heater-cooler unit that initially tested negative
for M. Chimaera at the hospital tested positive three months after purchase and installation.”)
9
29. On October 21, 2015, the U.S. Centers for Disease Control and Prevention
(“CDC”) issued an Interim Practical Guidance communication to raise awareness among
health departments, healthcare facilities and providers of the association between NTM
infections and the use of heater-cooler devices.
30. On December 29, 2015, the FDA sent Defendants a warning letter
advising that 3Ts were subject to refusal of admission into the U.S. until they resolved
several FDA violations, including the FDA’s determination that the 3Ts were
adulterated10 and misbranded and lacked requisite safety validation for several design
changes to both the device itself as well as a series of revised disinfection instructions.
The FDA’s findings were based on its inspections of the company’s Munich, Germany
and Arvada, Colorado production facilities.
31. In the letter, the FDA identified various design change orders dating back
to December 11, 2012 which had never been documented, validated and/or submitted to
the FDA for approval.
32. The letter also identified several changes to the disinfection instructions,
dating back to December 20, 2011, which had never been reported to the FDA and which,
like the current disinfection instructions, lacked proper efficacy validation.
33. In April 2016, a Euro Surveillance study following environmental
investigations conducted between July 2014 and June 2015 determined that certain 3Ts
10
Under the Federal Food, Drug and Cosmetic Act, a medical device is “adulterated” if the methods used
in, or the facilities or controls used for their manufacture, packing, storage or installation are not in
conformity with current good manufacturing practice requirements of the Quality System regulation.
10
manufactured at Defendants’ Munich, Germany production facility were contaminated
with NTM on the production line or elsewhere at Defendants’ manufacturing facility.
34. A June 1, 2016 FDA Safety Communication following the Euro
Surveillance findings noted that “this paper suggests a direct link between the M.
Chimaera to which European patients were exposed and became infected during open-
chest cardiac surgery, and one specific heater-cooler model—the 3T.” The FDA
cautioned U.S. purchasers of the 3T that if they purchased their units before September
2014 they may have been shipped from Defendants’ factory contaminated with M.
Chimaera.11
35. In June 2016, a study published in the Journal of Emerging Infectious
Diseases confirmed the airborne transmission of NTM via 3Ts due to the ability of the
System’s exhaust fan to disrupt the ultraclean air ventilation systems of operating rooms.
According to the study, aerosolization from the 3T carried NTM a distance of up to 5
meters from the device.
36. On June 2-3, 2016, the FDA hosted a Circulatory System Devices Panel
for the Medical Devices Advisory Committee to address the public health risk posed by
heater-cooler devices, and in particular, the 3T.
11
June 1, 2016 FDA Safety Communication, available at
http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm504213.htm (last accessed on January
24, 2017).
11
37. During this Panel, the FDA noted that nearly 90% of the Medical Device
Reports (“MDR”) it received between January 2010 and February 2016 citing device
contamination and patient infection were attributed to the 3T.
38. During this Panel, Defendants’ representatives admitted that the company
was in the process of retrofitting existing 3Ts with new design features, including, but not
12
limited to, changing tubing materials from PVC to polyethylene to limit biofilm
formation and the introduction of plugs in the water circuit to prevent sitting water.12
39. On October 13, 2016, the CDC released the results of genome sequencing
studies confirming that patient infections in Pennsylvania and Iowa were directly linked
to Defendants’ Munich, Germany manufacturing site.13
40. That same day, the FDA issued updated Safety Communication instructing
hospitals throughout the country to discontinue using 3Ts manufactured before
September 2014 due to evidence of “point source contamination at the production site”.14
41. A later study titled “Global Outbreak of Severe Mycobacterium Chimaera
Disease after Cardiac Surgery: A Molecular Epidemiological Study” also concluded that
3Ts were most likely contaminated with M. Chimaera during manufacturing.15
12
Currently, Defendants’ website advises overseas customers (but not U.S. customers) that it has released a
“vacuum and sealing upgrade and aerosol collection kit” whereby a disposable canister is attached to the
3T and connected to a vacuum system to capture and divert NTM aerosols from the surgical field. See
http://www.livanova.sorin.com/products/cardiac-surgery/perfusion/hlm/3t-out-us (last accessed on July 12,
2017).
13
See CDC Morbidity and Mortality Weekly Report for October 14, 2016, available online at
https://www.cdc.gov/mmwr/volumes/65/wr/mm6540a6.htm?s_cid=mm6540a6_w (last accessed on June
20, 2017). Multiple studies have since linked the same strain of M. Chimaera to patient infections
following use of the 3T in geographically sequestered locations such as Australia, Canada, France,
Germany, Hong Kong, Ireland, the Netherlands, Spain and Switzerland. See e.g., Svensson, et al.,
Mycobacterium chimaera in heater–cooler units in Denmark related to isolates from the United States and
United Kingdom, Emerg Infect Dis., March 2017, available online at
https://wwwnc.cdc.gov/eid/article/23/3/16-1941_article (last accessed on June 20, 2017); see also Walker,
et al., Microbiological Problems and Biofilms Associated with Mycobacterium Chimaera in Heater-cooler
Units Used for Cardiopulmonary Bypass, Journal of Hospital Infection, April 26, 2017 (collecting data of
global M. Chimaera infections)
14
See October 13, 2016 “UPDATE: Mycobacterium Chimaera Infections Associated with LivaNova PLC
(formerly Sorin Group Deutschland GmbH) Stockert 3T Heater-Cooler System: FDA Safety
Communication”, available online at
http://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm520191.htm (last accessed on June 20,
2017)
13
42. Subsequent studies published in 2017 further confirm “an ongoing
international outbreak of M. Chimaera infection following cardiac surgery” and that “all
M. Chimaera infections have been attributed to a specific make/model of HCU (Sorin 3T,
LivaNova Deutschland GmbH, formerly Sorin Group Deutschland GmbH).16
FACTUAL ALLEGATIONS SPECIFIC TO PLAINTIFF
43. On July 22, 2015, Lois J. Gerardi was admitted for a Right Lung
Transplant at Tampa General Hospital located at 1 Tampa General Circle, Tampa, Florida
33606. Based upon information and belief, a Stockert 3T device was used during this
surgery.
44. On or about September 2, 2015, Lois J. Gerardi was admitted to Tampa
General Hospital in order to start IV tymoglobulin for an A2 transplant rejection.
45. On or about June 22, 2016, Lois J. Gerardi presented to her primary care
physician Dr. Todd Horiuchi with several days of feeling very fatigued and under the
weather. She was admitted to Sarasota Memorial Hospital due to abnormalities on CT
and labs.
46. On or about June 24, 2016, Lois J. Gerardi was transferred to Tampa
General Hospital for continued care upon admission she was found to have pulmonary
infiltrates of her transplanted lung.
15
Published online July 12, 2017 in the Lancet Infectious Diseases journal.
16
See e.g., Walker, et al., supra.
14
47. On or about July 25, 2016, a respiratory culture was taken for an Acid Fast
Bactilli test which yielded a positive result for a mycobacterium and was sent to National
Jewish Healthcare for further identification.
48. Lois J. Gerardi ultimately died from her NTM infection in 2016 while still
at Tampa General Hospital.
49. On August 7, 2016, the mycobacterium was identified as M. Abscessus.
50. As a direct and proximate result of Defendants’ negligence and liability
producing conduct as described herein, Lois J. Gerardi acquired an M. Abscessus
infection, forcing her to undergo painful medical procedures and treatment.
producing conduct as described herein, Plaintiff, Gary F. Gerardi, in his own right and as
the Anticipated Personal Representative of the Estate of Lois J. Gerardi, expended
various sums of money for medical care and treatment.
producing conduct as described herein, Decedent, Lois J. Gerardi suffered from
excruciating and agonizing physical and emotional pain and suffering.
53. As a further direct and proximate result of Defendants’ negligence and
liability producing conduct as described herein, Plaintiff Gary F. Gerardi, was deprived
of the care, comfort, companionship, services and consortium of his wife, Lois J. Gerardi.
54. Decedent, Lois J. Gerardi, was in no way responsible for her injuries.
COUNT I
Negligence - Design Defect
15
55. Plaintiffs incorporate by reference the preceding paragraphs as if fully set
forth herein.
56. The 3T is a product within the meaning of Florida products liability law.
57. The 3T was expected to reach, and did reach, users and/or consumers,
including Decedent Lois J. Gerardi without substantial change in the defective and
unreasonably dangerous condition in which it was sold or distributed.
58. Under Florida products liability law, Defendants owed Decedent, Lois J.
Gerardi a duty to exercise reasonable care in designing and testing the 3T.
59. The Defendants designed the 3T for the purpose of heating and cooling
patient blood during major heart, lung and liver surgeries.
60. At all times material, the 3T was used in a manner intended and/or
foreseeable to the Defendants.
61. A patient or consumer using the 3T would reasonably expect the device to
be free of significant defects.
62. The 3T, as designed by the Defendants, colonizes bacteria, including M.
Abscessus.
63. The 3T, as designed by the Defendants, directly transmits bacteria,
including M. Abscessus, to patients during invasive surgery.
64. The foreseeable risks of using the 3T, particularly severe bacterial
infection and/or death, significantly outweigh the benefits conferred upon patients using
the 3T.
16
65. Reasonable alternative designs existed for the 3T which would have
eliminated or reduced the risk of bacterial colonization and/or transmission of such
bacteria to patients undergoing invasive surgical procedures.
66. Reasonable and feasible alternative designs include, but are not limited to,
measures to direct airflow away from the surgical field (i.e. a housing unit for the exhaust
vent), reducing the force at which air is vented from the 3T to a rate of less than 1000
cubic feet per minute, water reservoir isolation by using closed loop fluid management,
an open water design to prevent inaccessible airspace, removable lids and parts for easy
disinfection, disposable tank liners to prevent biofilm formation, and internal
pasteurization or UV features to kill bacteria.
67. The failure to use feasible, reasonable alternative designs that eliminate
bacterial colonization and the aerosolization of bacteria into the ambient air of operating
rooms renders the 3T unreasonably unsafe.
68. Defendants knew or should have known that NTM, or other harmful
bacteria, were likely to colonize within the 3T and be spread to patients during surgery
through the 3T’s exhaust vents.
69. Decedent, Lois J. Gerardi’s M. Abscessus infection was caused by
Defendants’ conduct as follows:
a) Failing to conduct adequate safety and efficacy testing before placing
the 3T into the stream of commerce;
17
b) Failing to timely establish procedures for reviewing the design of the
3T after receiving information that patients were developing bacterial
infections as a result of surgeries using the 3T;
c) Failing to timely establish procedures for validation or, where
appropriate, review and approval of design change orders for the 3T
before their implementation as required under 21 CFR 820.30(i); and
d) Failing to design or redesign the 3T to eliminate or mitigate bacterial
colonization and/or transmission of such bacteria.
70. Decedent, Lois J. Gerardi, was proximately harmed by the design defects
in the 3T as described above.
WHEREFORE, Plaintiff Gary F. Gerardi, individually and as Anticipated
Personal Representative of the Estate of Lois J. Gerardi demands judgment against
Defendants, individually, jointly, vicariously, severally, and/or in the alternative, for such
damages as may be permitted pursuant to the laws of the State of Florida, together with
interest thereon, costs of suit and attorneys’ fees.
COUNT II
Strict Liability-Manufacturing Defect
forth herein.
18
including Decedent, Lois J. Gerardi, without substantial change in the defective and
74. Defendants manufactured the 3T for the purpose of heating and cooling
patient blood during major heart, lung and liver surgeries.
76. A reasonable patient or consumer of the 3T would expect that the device
77. The 3T System, as manufactured by the Defendants, colonizes bacteria,
including NTM. The 3T System, as manufactured by the Defendants, directly transmits
bacteria, including NTM, to patients during invasive surgery.
the 3T.
79. Decedent, Lois J. Gerardi’s M. Abscessus infections were caused by
a) Failing to timely establish procedures or practices to prevent the 3T
from being contaminated with NTM on the production line or
elsewhere at Defendants’ production facilities;
19
b) Manufacturing and selling the 3T with NTM contamination that
occurred on the production line or elsewhere at Defendants’
production facilities; and
c) Failing to ensure proper workmanship, materials and labeling for the
3T.
80. Decedent, Lois J. Gerardi, was proximately harmed by the manufacturing
defects in the 3T as described above.
COUNT III
Negligence - Warnings Defects
forth herein.
including Decedent, Lois J. Gerardi, without substantial change in the defective and
84. Defendants owed Lois J. Gerardi a duty to exercise reasonable care in
marketing, advertising, promoting, distributing and/or selling the 3T.
20
85. Defendants advertised and promoted the 3T for the purpose of heating and
cooling patient blood during major heart, lung and liver surgeries.
87. A reasonable patient or consumer of the 3T would expect that the device
88. The 3T colonizes bacteria, including NTM, and directly transmits such
bacteria to patients during invasive surgery.
bacteria were likely to colonize within the 3T and could be spread to patients during
surgery through the exhaust vent.
the 3T.
91. Decedent, Lois J. Gerardi’s M. Abscessus infections were caused by
a) Failing to provide proper cleaning and disinfection procedures for the
3T;
b) Failing to conduct proper validation studies to demonstrate the safety
and efficacy of cleaning and disinfection procedures for the 3T;
21
c) Failing to warn patients like Lois J. Gerardi and/or purchasers of the
3T that the System colonized bacteria and unnecessarily transmitted it
into the ambient air of operating rooms;
d) Failing to timely notify known purchasers of the 3T that patients could
be exposed to NTM, including M. Abscessus.
e) Failing to timely alert hospitals and patients to promptly test for NTM
infection when patients present with fever, pain, night sweats, joint
and muscle pain, weight loss and fatigue after surgery using the 3T;
and
f) Failing to timely notify known purchasers of the 3T to relocate the
device to a location outside of the operating room during surgery to
prevent patient transmission of NTM.
92. Decedent, Lois J. Gerardi, was proximately harmed by the warnings
defects in the 3T as described above.
COUNT IV
Negligent Misrepresentation
22
93. Plaintiff incorporates by reference the preceding paragraphs as if fully set
forth herein.
95. Defendants designed, manufactured, marketed, advertised, promoted, and
sold the 3T which was expected to reach, and did reach, users and/or consumers,
including Lois J. Gerardi.
96. Defendants owed Lois J. Gerardi a duty to exercise reasonable care in
labeling, marketing, advertising, promoting, distributing and/or selling the 3T.
97. Based upon information and belief, the Defendants supplied information
to Lois J. Gerardi’s physicians and health-care providers including, but not limited to,
product labeling, and advertising and promotional materials.
98. The 3T colonizes bacteria, including NTM, and directly transmits such
bacteria to patients during invasive surgery.
bacteria were likely to colonize within the 3T and could be spread to patients during
surgery through the exhaust vent.
100. The information supplied by the Defendants misrepresented the safety of
the 3T unit. The Defendants represented that the 3T could be disinfected by following
the protocols established in the 3T IFUs.
101. The Defendants intended for Lois J. Gerardi’s physicians and health-care
providers to rely upon these representations in performing their maintenance and
disinfection procedures.
23
103. The Defendants failed to exercise reasonable care or competence in
communicating these risks to Lois J. Gerardi and her health-care providers.
104. Lois J. Gerardi and her health-care providers relied upon the
misrepresentations in choosing to purchase and use the 3T device.
105. Lois J. Gerardi was proximately harmed by the negligent
misrepresentations made by the Defendants as described above.
COUNT V
Loss of Spousal Consortium
forth herein.
107. Plaintiff, Gary F. Gerardi, was entitled to the care, comfort,
companionship, services and consortium of his wife, Lois J. Gerardi.
108. As a result of the aforesaid injuries, Plaintiff, Gary F. Gerardi was and will
continue to be deprived of the care, companionship, services and consortium of his wife,
Lois J. Gerardi.
24
PRAYER FOR RELIEF
Plaintiffs, Gary F. Gerardi, in his own right and as the Anticipated Personal
Representative of the Estate of Lois J. Gerardi, in his own right and as the Anticipated
Personal Representative of the Estate of Lois J. Gerardi, brought on behalf of decedent’s
estate and survivors request the Court to enter judgment against the Defendants as
follows:
A. An award to Plaintiffs of compensatory and punitive damages,
costs and reasonable attorneys’ fees, as permitted by law;
B. An award of pre-judgment and post-judgment interest, as provided
by law;
C. Leave to amend this Complaint to conform to the evidence
produced at trial; and
D. Such other relief as may be appropriate under the circumstances.
JURY TRIAL DEMANDED
Plaintiffs demand a trial by jury on all issues so triable.
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Case 8:18-cv-01880-EAK-SPF Document 1-1 Filed 07/31/18 Page 1 of 2 PageID 29
John E. Jones, III 1:18-MD-02816-JEJ

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Lawsuit: Gerardi v. Livanova, 2018

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Lawsuit: Gerardi v. Livanova, 2018

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What is the civil complaint about?

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Case 8:18-cv-01880-EAK-SPF Document 1 Filed 07/31/18 Page 1 of 28 PageID 1

UNITED STATES DISTRICT COURT

GARY F. GERARDI INDIVIDUALLY CIVIL ACTION

LIVANOVA, PLC, LIVANOVA

Plaintiffs Gary F. Gerardi individually, and as the Anticipated Personal

alleges the following:

JURISIDCTION AND VENUE

residents of Florida. Defendant, LivaNova PLC (“LivaNova”) is a foreign for-profit

London. LivaNova Deutschland GmbH (f/k/a Sorin Group Deutschland GmbH), is a

foreign corporation headquartered in Munich, Germany. Defendant, LivaNova Holdings

2. Personal jurisdiction exists over Defendants, LivaNova PLC, LivaNova

3. Venue is proper in this District pursuant to 28 U.S.C. § 1391 as a

business within this jurisdiction.

4. The Plaintiff, Gary F. Gerardi, is the surviving spouse of Lois J. Gerardi

Estate of Lois J. Gerardi.

and resident of the Florida until her death in 2016.

6. Defendant, LivaNova PLC (“LivaNova”) is a foreign for-profit

corporation headquartered in London. LivaNova is a global medical device company

7. Defendant, LivaNova Deutschland GmbH (f/k/a Sorin Group Deutschland

GmbH) (“Sorin”) is a foreign for profit corporation headquartered in Munich, Germany.

Sorin designed, manufactured and marketed the Sorin 3T Heater-Cooler System.

Heater-Cooler System with a principal place of business in Houston, Texas.

GENERAL FACTUAL ALLEGATIONS

8. Tampa General Hospital is located at 1 Tampa General Circle, Tampa,

regulate blood temperature.2

9. The bacterium at issue, M. Abscessus, is subspecies of nontuberculous

cavities are directly exposed to the bacteria during surgery.

10. Symptoms of M. Abscessus infection and other NTM subspecies including

11. The diagnosis of an NTM infection requires targeted culturing and/or

B. Defendants’ 3T Heater-Cooler Systems as the Infection Source

12. The 3T Systems used at Tampa General were designed, manufactured,

marketed and/or sold by the Defendants.

13. The 3T regulates blood temperature by circulating water through tubes

through natural processes.3

patients intraoperatively was recognized by the medical and scientific community as

early as November 2002.4

16. Invasive cardiovascular infections identified as NTM have been reported

in Switzerland, Germany and the Netherlands since 2011.5

17. A public health investigation in Switzerland following six patient

infections since 2011 included microbiological examinations of environmental samples

prevent bacterial infections in patients exposed in the operating room.

considered” because it was “not of concern.”

disseminated to U.S. purchasers.

435organisms, including Mycobacteria, in Sorin Heater Cooler Devices, if proper

disinfection and maintenance is not performed per instructions for use.”

was “enhanced”7 by introducing the following modifications:

a) Use filtered tap water when filling the device;

b) To make disinfection easier, switch from three different cleaning

c) The option to use peracetic acid instead of Clorox for disinfection;

d) Use hydrogen peroxide in low dose for device preservation;

e) Include all external tubing, bottles and buckets in the disinfection

f) Change to polyethylene tubing that meets national drinking water

g) Unused heater-coolers should be disinfected bi-weekly.

design and/or manufacturing defects in the 3T renders it prone to bacterial colonization

and transmission, regardless of the cleaning and disinfection procedures used.8

25. Manufacturing and User Facility Device Experience (“MAUDE”) reports,