Daniel E. Holloway
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Southeast Permanente complaint alleges missed adrenal cause of resistant hypertension

The complaint alleges that a physician who provided nephrology evaluation and The Southeast Permanente Medical Group managed a patient’s resistant hypertension, hypokalemia, and chronic kidney disease from August 2021 through December 2023 as though the high blood pressure needed only lifelong medication. That combination of findings was consistent with primary hyperaldosteronism from an adrenal adenoma, a potentially curable surgical cause, but timely workup, referral, and disclosure of that possibility did not follow. An incidental CT scan during an emergency-room evaluation in October 2023 found a right adrenal nodule and the patient improved after an adrenalectomy in July 2024.

System
The Southeast Permanente Medical Group
Facility
The Southeast Permanente Medical Group, Inc.
Providers involved
The Southeast Permanente Medical Group, Inc. / Nirvan Mukerji, M.D.
Pattern
Alleged failure to work up secondary causes of resistant hypertension with hypokalemia and kidney disease
Harm
Alleged years of delayed diagnosis of an aldosterone-producing adrenal adenoma before adrenalectomy

Overview

This page concerns a public complaint alleging that providers in a nephrology treatment relationship did not investigate or disclose a potentially curable adrenal cause of a patient’s resistant hypertension. The complaint states that it refiles an earlier action dismissed without prejudice for lack of a contemporaneous expert affidavit.

Chronology

The complaint alleges as follows:

  1. The patient first saw Nirvan Mukerji, M.D. for nephrology evaluation on or about August 9, 2021 on his primary-care physician’s referral.
  2. From August 2021 through December 2023 his blood pressure frequently remained elevated on multiple medications and he continued to need potassium supplements.
  3. CT imaging during an emergency-room evaluation on October 28, 2023 identified a 3.1 cm right adrenal nodule and recommended outpatient MRI.
  4. An MRI on January 14, 2024 characterized the lesion as an adrenal adenoma.
  5. Adrenal vein sampling on May 13, 2024 was interpreted on May 17, 2024 as showing right lateralization with an index of 7.98.
  6. A right laparoscopic adrenalectomy on July 10, 2024 and later pathology confirmed an aldosterone-producing adenoma, after which blood pressure and potassium improved.

Alleged failures

The complaint alleges the following failures:

  • Secondary causes of resistant hypertension, including primary hyperaldosteronism, were not timely evaluated.
  • The patient was not referred for endocrine, adrenal, interventional radiology, or surgical consultation.
  • The significance of the October 28, 2023 CT finding and the MRI recommendation was not recognized or acted on.
  • The patient was never told his presentation suggested a potentially curable adrenal disorder rather than hypertension needing indefinite medication, and the complaint contends this silence tolled the limitations period.
  • The complaint alleges that The Southeast Permanente Medical Group is vicariously liable for its physician and independently negligent in credentialing and supervision, and the complaint pleads punitive damages with an expert affidavit under O.C.G.A. § 9-11-9.1.

Entities and tags

The Southeast Permanente Medical Group, Inc.Nirvan Mukerji, M.D.Resistant hypertensionHypokalemiaChronic kidney diseasePrimary hyperaldosteronismAdrenal adenomaAdrenal vein samplingLaparoscopic adrenalectomyDelayed or missed diagnosisDelayed treatmentInformed consentNephrologyInternal medicineEndocrinology