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Adams v. Sietsema

Supreme Court of Kentucky

November 2, 2017



          COUNSEL FOR APPELLANTS: Daniel Garland Brown Robert Joseph Shilts · Gazai Brown.

          COUNSEL FOR APPELLEE: . Gregory Allen Belzley Belzley Bathurst Attorneys Daniel Jay .Canon Clay, Daniel, Walton, Adams, PLC


         Appellee, Mark Sietsema, brought this medical malpractice action alleging Appellants John Adams, M.D., and Elizabeth Walkup, A.R.N.P., were negligent in treating, or more accurately, in failing to treat, his illness while he was an inmate in the Hardin County Detention Center (HCDC), thereby causing him to unnecessarily endure days of pain and suffering. Appellee primarily asserts that Adams, as medical director for HCDC, was inattentive to inmate medical needs, and that he failed to adequately instruct the jail's medical staff how to handle patients that refuse to take medications. Appellee also asserts that Walkup negligently failed to provide the jail nursing staff with a clear order as to when Appellee should have been taken to a hospital emergency room.

         The trial court entered a summary judgment dismissing Appellee's claims against Adams and Walkup because he had no expert evidence to establish the relevant standards of care or to show that Adams' and Walkup's breach of the standard of care caused the Appellee's damages. The Court of Appeals reversed the trial court upon its conclusion that the negligent conduct asserted by Appellee fit within the res ipsa loquitur doctrine and thus could be sustained at trial without expert testimony.[1] Upon discretionary review, we conclude that Appellee's failure to produce expert evidence is fatal to his claim, and so, we reverse the Court of Appeals and reinstate the summary judgment granted by the trial court.


         Southern Health Partners, Inc. (SHP) contracted to provide health care services to inmates of HCDC, including the services of a physician. Pursuant to its contract with HCDC, SHP employed a registered nurse and several licensed practical nurses to staff the jail's medical unit around the clock. SHP contracted with Adams to serve as the jail medical director. That contract specifically designated Adams as the primary care physician for all inmates at the jail.

         Among other duties set forth in the contract, Adams agreed to "[b]e responsible to provide 24-hour continuous on-call physician coverage when in town and available;" and to [a]ccept telephone calls from SHP personnel to evaluate medical problems and provide medical decisions, including telephone prescriptions, emergency room referrals, and such other items as are reasonably necessary." With SHP's consent, Adams employed Walkup to fulfill his duty of making weekly jail visits to monitor and evaluate the quality of patient care. Adams personally visited the jail monthly.

         To facilitate Adams' assent on various medical forms used at the jail, Adams authorized Walkup to direct nurses to use his signature stamp on the forms during his absence. Walkup testified that the signature stamp was to be used to record Dr. Adams' assent on lab requests and other documents, including inmates' refusal of treatment forms. She testified that the use of the signature stamp facilitated the medical treatment of inmates by allowing essential documents to remain with the inmate's medical record, rather than j setting them aside in a stack to be signed by Dr. Adams at his next jail visit. The stamped documents could then be tabbed within the medical record and easily located when she reviewed the records at her next weekly visit.

         Appellee claims that the nurses' improper use of the signature stamp caused him to suffer unnecessarily over the course of several days. After experiencing fever and vomiting for two days, Appellee requested medical treatment. The next morning, a staff nurse visited him and noted his complaints of abdominal pain, nausea, vomiting, and fever. Appellee reported that he had a history of diverticulitis and that a large portion of his colon had been surgically removed. The nurse initiated a course of the anti-nausea medication Phenergan and a restricted diet.

         The next day, a different nurse visited Appellee. On this occasion, he did not specifically complain of abdominal pain, but he still reported nausea, vomiting, and the fever he had had for three days. The treatment plan approved by the Medical Team Administrator, Brenda Brown, R.N., prescribed a Phenergan suppository and continuation of the special diet. It also directed that Appellee be placed in isolation until his vomiting stopped.

         Four days later, still in isolation, Appellee again filled out a written request for medical treatment. He complained of vomiting and constipation for six days. He requested an antibiotic and a stool softener. Walkup arrived at the jail the next day. She diagnosed his condition as diverticulitis and mild dehydration. She ordered a regimen of clear liquids for 48 hours, Phenergan, and antibiotics. She left a written order for Appellee to be taken to the emergency room if he was "unstable or unable to tolerate fluids."

         The following afternoon Appellee rejected the prescribed medications. The attending nurse had him sign a "Refusal of Medical Treatment and Release of Responsibility" form and advised him to inform the medical staff if his vomiting continued. Instead of notifying Adams and securing his direct acknowledgment of Appellee's refusal of treatment, the nurse stamped his signature to the form. No one at the jail contacted Walkup during this time concerning Appellee's medical status.

         For the next two days, Appellee continued to refuse his medication. At each refusal, the nurse completed the standard refusal of treatment form, stamping it with Adams' signature without contacting him or Walkup. On the third morning, Appellee was discovered collapsed on the floor of his cell. He again refused medication, and again, the treatment refusal form was completed and stamped with Adams' signature, and no contact was made with Adams or Walkup. After further assessment, Nurse Brown ordered that Appellee be taken to the emergency room of the local hospital. At that point, Brown informed Walkup that Appellee had been taken to the hospital, and Walkup informed Adams. Until then, Adams was never made aware of Appellee's condition, or even that Appellee was an inmate/patient at HCDC. Later, Appellee was transferred to intensive care at the University of Louisville Hospital where he underwent surgery for a bowel obstruction.

         Based upon the foregoing events, Appellee brought medical negligence claims against Adams, Walkup, and the SHP nursing staff at the jail. He specifically claim that he suffered unnecessary mental and physical pain due to the three-day delay in his hospitalization, which he further claims was caused by: 1) the nurses' use of Adams' signature stamp which made it unnecessary for them to inform Adams of Appellee's condition when Appellee refused his medication; and 2) Walkup's inadequate instructions to the jail nurses about the circumstances which would compel Appellee's immediate transport to a hospital.

         During pre-trial discovery, Appellee identified only one potential expert witness, Nurse Susan Turner. Although Turner's opinion found fault in the care provided for Appellee by the jail nursing staff, she expressed no opinion critical of Adams or Walkup. Adams and Walkup moved for summary judgment based upon the lack of evidence critical of their conduct.

         The trial court concluded that Appellee could not prove liability on the part of Adams or Walkup without an expert opinion to identify how Adams' and Walkup's conduct breached the standard of care and caused injury to Appellee. The Court of Appeals reversed the trial court's decision based upon its conclusion that whether Adams or Walkup, or both of them, rendered deficient care to Appellee under the factual circumstances of this case could be determined without expert opinion.

         II. ANALYSIS

         A. A trial court's decision to grant summary judgment is subject to de novo appellate review.

         The first point of contention addressed by the parties to this appeal concerns the standard of review by which we should judge a trial court's decision to grant summary judgment when a medical malpractice claimant fails to support his claim with expert testimony. Appellants Adams and Walkup insist that appellate review must grant substantial deference to the trial court. They argue that "abuse of discretion" is the applicable standard of review. Citing Baptist Healthcare System, Inc. v. Miller, 177 S.W.3d 676, 680-681 (Ky. 2005), and Miller v. Eldrldge, 146 S.W.3d 909, 917 (Ky. 2004), they contend that the Court of Appeals gave insufficient deference to the trial court's opinion, which they characterize as an evidentiary ruling traditionally left to the discretion of the trial court. Appellee argues that the issue upon which the trial court granted summary judgment is a question of law to be reviewed by an appellate court de novo.

         To keep this threshold issue in its proper perspective, we should note the comment of the United States Supreme Court in Koon v. United States, 518 U.S. 81, 100 (1996):

Little turns, however, on whether we label review of this particular question abuse of discretion or de novo, for ari abuse-of-discretion standard does not mean a mistake of law is beyond appellate correction. A [trial] court by definition abuses its discretion when it makes an error of law. . . . The abuse-of-discretion standard includes review to determine that the discretion was not guided by erroneous legal conclusions.

We made a similar observation in Sargent v. Shaffer.

When it is argued that a trial court abused its discretion because its decision was "unsupported by sound legal principles, "[2] we must examine the application of those legal principles, and that is inherently a matter of law. We generally accord no deference to a trial court's view of the law. Thus, as a practical matter, in that limited instance ...

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