A Tennessee doctor has blamed first responders and hospital staff for the sudden death of his estranged wife – but her family believes that he killed her.
Sarah Shanks, a healthy, vibrant 35-year-old mother-of-two and avid runner, collapsed in her Knoxville driveway just after 2:40 a.m. on January 20, 2023. She never regained consciousness and died in the hospital nine days later.
She died just months after she hired a divorce attorney and accused her husband Ryan Shanks of controlling behavior.
Now, dueling lawsuits in Knox County Circuit Court paint two starkly different versions of what happened – as her death is still classed as ‘undetermined.’
Ryan, an emergency room doctor, filed a wrongful death lawsuit against first responders, hospital staff, and the city of Knoxville – alleging they mishandled Sarah’s emergency and failed to meet basic medical standards.
His complaint claims medics delayed intubation and CPR, misread vital signs, and were slow to transport Sarah to Fort Sanders Regional Medical Center. He insists their negligence caused her death.
But his lawsuit offers few details about what actually led to Sarah’s collapse – and makes no mention of their deteriorating marriage or her recent efforts to divorce him.
Sarah’s family tells a different story – one of escalating emotional abuse, surveillance, and fear.
A Tennessee mother of two, Sarah Shanks, died in January 2023 after collapsing in her driveway — and two years later, dueling lawsuits are painting vastly different pictures of what happened
Her estranged husband, Dr. Ryan Shanks, blames first responders and hospital staff, claiming they failed to provide adequate care and caused her death
They filed their own wrongful death suit in February 2025, accusing Ryan of causing Sarah’s death in order to prevent a divorce and retain control of their two children.
‘Sarah Shanks was trying to escape an unhappy marriage,’ the family alleged. ‘She was continuously emotionally abused and subjected to the whims of her tyrannical, controlling and manipulative husband who mistreated her, threatened her, terrorized her, and abandoned her before eventually killing her.’
The suit claimed Ryan either choked Sarah or otherwise physically deprived her of oxygen that night, causing the anoxic brain injury that ultimately killed her.
‘On January 29, 2023, the Decedent, Sarah Shanks, suffered a wrongful death as a result of the Defendant’s knowing and intentional lethal actions and conduct,’ it states.
Molly Stevens, who grew up with Sarah, said she was ‘devoted not only to her kids but also to a healthy lifestyle.’
‘The day I got the phone call that she had been brought to the hospital, I was in complete shock,’ her close friend Stevens told 13 ON YOUR SIDE. ‘She was probably one of the most healthy people I know.’
‘She was an energizer bunny!’ Stevens told 13 ON YOUR SIDE. ‘She was an avid runner… and she went for a run every day.’
According to Sarah’s family, she had borrowed money to hire a divorce attorney and had separated from Ryan.
They allege he told friends that a divorce would be ‘inconvenient’ and ‘unaffordable,’ and that he had secretly cloned Sarah’s phone to monitor her whereabouts.
The night of January 20, according to the lawsuit, Ryan called Sarah’s parents separately to say he was having ‘suicidal ideations’ and thinking about buying a gun. The couple reportedly argued afterward.
Sarah’s family believes Ryan is responsible, alleging he abused and ultimately killed her to stop her from divorcing him
Sarah had several glasses of wine and took sleeping pills, Ryan later told police — her blood alcohol level was 0.1, above the legal limit to drive.
At around 1:30 a.m., Sarah told Ryan she had fallen in the bathroom and hurt her neck.
She went back to bed but soon woke up in a panic, telling Ryan she thought she was going to die.
To avoid waking the kids, she stepped outside. That’s where paramedics found her: unresponsive, alone, and struggling to breathe.
Twelve minutes after their arrival, Sarah went into cardiac arrest. Medics began CPR and transported her to Fort Sanders, but she never regained consciousness.
‘I have a copy of the 911 call,’ said Stevens. ‘You can hear her gasping for breath in the background. It’s horrible. And just him, he’s a doctor. It’s just, I can’t believe that he didn’t try to do more or do more sooner.’
The family’s lawsuit says Sarah’s blood gas pH was critically low, a sign of oxygen deprivation.
A CT scan showed soft tissue swelling around her neck and an unusual air pocket in her chest.
An MRI later confirmed global anoxic encephalopathy — brain damage from lack of oxygen.
Still, authorities declined to press charges.
Sarah had recently hired a divorce lawyer and reportedly told friends she feared Ryan’s controlling behavior
That night, she drank wine, took sleeping pills, and later told Ryan she thought she was going to die — moments before she was found unresponsive outside
In a letter obtained by Knox News, Knox County District Attorney Charme Allen wrote that Sarah’s autopsy was inconclusive, and that the case lacked prosecutable evidence.
But she described the circumstances as ‘highly suspicious’ and emphasized that Ryan had been the only adult with Sarah in the hours leading up to her collapse. She also noted ‘evidence of instability in their marriage’ and concerns about Ryan’s mental health.
Knox County’s Chief Medical Examiner, Dr. Darinka Mileusnic-Polchan, concluded that Sarah’s prolonged hospitalization and status as an organ donor made it impossible to determine a cause of death with certainty.
‘We could neither prove nor exclude foul play,’ she wrote. The death certificate lists the cause as ‘undetermined.’
Sarah’s family later learned one of her organs was donated to a Michigan resident, and they were able to meet the recipient – a bittersweet experience covered in a local news segment.
But grief has turned to determination. The family is suing Ryan Shanks for $20 million in compensatory damages, $40 million in punitive damages, and hopes to re-establish contact with Sarah’s children, who they say they haven’t seen in over a year.
‘The main point is to establish a relationship with the kids,’ said Stevens, ‘and just make sure that they’re being well cared for and taken care of, and know who their mother was. That’s what Sarah would have wanted.’
Ryan Shanks has denied all allegations. His attorney, C. Gavin Sheppard, called the family’s suit ‘false, defamatory and malicious’ and said the doctor and his children are ‘grieving the tragic loss of Sarah.’
Medical records cited in the family’s lawsuit point to oxygen deprivation, neck swelling, and brain damage, suggesting possible strangulation
The medical examiner ruled her cause of death “undetermined,” citing complications from her hospital stay and organ donation
‘Dr. Shanks has never been charged with any crime associated with the death of his wife,’ Sheppard said. ‘He is confident that the true facts associated with her death will continue to be revealed in the pending lawsuit that he filed.’
That lawsuit — blaming American Medical Response, the Knoxville Fire Department, Covenant Health, and Fort Sanders Regional — remains pending.
So does the one filed by Sarah’s parents.
And the truth of what happened in those early hours of January 20, 2023, remains bitterly disputed.
