Ky. Guardianship Adm'rs, LLC v. Baptist Healthcare Sys., Inc.
| Decision Date | 03 May 2019 |
| Docket Number | NO. 2017-CA-000665-MR,NO. 2017-CA-000727-MR,NO. 2017-CA-000752-MR,2017-CA-000665-MR,2017-CA-000727-MR,2017-CA-000752-MR |
| Parties | KENTUCKY GUARDIANSHIP ADMINISTRATORS, LLC, AS CONSERVATOR FOR KALI CRUSENBERRY; AND LOUISE YOUNT, AS GUARDIAN OF KALI CRUSENBERRY APPELLANTS v. BAPTIST HEALTHCARE SYSTEM, INC., d/b/a BAPTIST HEALTH CORBIN; APOGEE MEDICAL GROUP, KENTUCKY, PSC; AND SUBHOSE BATHINA, M.D. APPELLEES AND BAPTIST HEALTHCARE SYSTEM, INC., d/b/a BAPTIST HEALTH CORBIN CROSS-APPELLANT v. KENTUCKY GUARDIANSHIP ADMINISTRATORS, LLC, AS CONSERVATOR FOR KALI CRUSENBERRY; AND LOUISE YOUNT, AS GUARDIAN OF KALI CRUSENBERRY CROSS-APPELLEES AND APOGEE MEDICAL GROUP, KENTUCKY, PSC; AND SUBHOSE BATHINA, M.D. CROSS-APPELLANTS v. KENTUCKY GUARDIANSHIP ADMINISTRATORS, LLC, AS CONSERVATOR FOR KALI CRUSENBERRY; AND DORA LOUISE YOUNT, AS GUARDIAN FOR KALI CRUSENBERRY CROSS-APPELLEES |
| Court | Kentucky Court of Appeals |
TO BE PUBLISHED
APPEAL FROM WHITLEY CIRCUIT COURT
Kentucky Guardianship Administrators, LLC, as conservator for Kali Crusenberry, and Louise Yount, as guardian of Kali Crusenberry (collectively "Crusenberry"), appeal, and Baptist Healthcare System, Inc., d/b/a Baptist Health Corbin ("Baptist"), as well as Apogee Medical Group, Kentucky,PSC ("Apogee") and Subhose Bathina, M.D., cross-appeal1 the Whitley Circuit Court's trial order and judgment entered March 3, 2017, and order denying Crusenberry's motion for new trial on April 5, 2017.2 After careful review of the record, briefs, and applicable law, we affirm.
On August 1, 2013, Kali—22 years old at the time—presented to Baptist's Emergency Department ("ED") with a myriad of health concerns, including fever, nausea, vomiting, urinary tract infection ("UTI"), kidney infection, gallstones, pneumonia, and critically low potassium—also referred to as hypokalemia—which can cause an abnormal heart rhythm, known as a prolonged QT interval, and lead to cardiac arrest. Kali was admitted to Baptist's Telemetry Unit and administered potassium and an antibiotic, Azithromycin—a QT-prolonging drug. Her then-treating nephrologist ordered that potassium be replaced pursuant to Baptist's standing "Potassium Replacement Order." On August 4, nurses ceased administering potassium to Kali. After making positivestrides toward recovery, including Kali's interacting with family members, eating food from McDonald's, and ambulating to smoke, Dr. Raymond Hackett—who surgically performed a stent placement to aid with Kali's kidney stone on August 4—recommended that Kali be discharged from the hospital.
On August 5, Dr. Bathina first became involved in Kali's medical treatment when he reported to work for his first shift since Kali's admission to Baptist. Having examined Kali, reviewed her records, and consulted with Dr. Hackett, Dr. Bathina discharged Kali with a prescription for Levaquin—another antibiotic which can also prolong the heart's QT interval—instead of Azithromycin to continue treatment of Kali's pneumonia, kidney infection, and UTI.
At approximately 10:00 a.m. the morning following discharge, Kali took her first dose of Levaquin. About an hour later her mother—who had been at the house helping Kali take care of her three young children—discovered Kali in cardiac arrest and called 911. Paramedics arrived and shocked Kali's heart into rhythm while in transit to Baptist's ED. An EKG performed at the ED showed that Kali had a prolonged QT interval, which is potentially fatal. Kali's potassium levels were also critically low again.
Although Kali survived this episode of cardiac arrest, her brain was deprived of oxygen for such a period that she consequently lost her ability to speak, use her upper and lower extremities, feed herself, and control her bowelsand bladder. An echocardiogram performed the day following her cardiac arrest revealed a condition known as Takotsubo Syndrome or "broken heart syndrome" which is a sudden and unforeseeable condition immediately preceded by an emotional or physical trigger that causes transient weakening of the left ventricle of the heart.
On October 24, 2014, Kali's husband, Branden, initiated the instant lawsuit. However, Branden eventually moved Kali and their three children in with his mother, Louise Yount, and voluntarily dismissed his loss of spousal consortium claim just prior to the commencement of trial. As a result, Kentucky Guardianship Administrators, LLC, was appointed Kali's conservator, and Louise Yount was appointed Kali's guardian. The case was tried before a jury on February 13-27, 2017. Crusenberry's theory of liability presented at trial was that the failure of Baptist's nurses to administer potassium to Kali during the last three shifts of her hospitalization, counter to the standing replacement order, led to her low potassium levels after discharge and, combined with her prior consumption of Azithromycin and first dose of Levaquin prescribed by Dr. Bathina—both QT-prolonging medications—resulted in a cardiac arrhythmia called Torsades de Pointes, and ultimately her cardiac arrest. Crusenberry further contended that the Takotsubo Syndrome was the result rather than the cause of Kali's cardiac arrest and subsequent anoxic brain injuries. A unanimous defense verdict was renderedfinding no defendant breached the standard of care, without reaching issues of causation or damages. The judgment was entered, Crusenberry moved for a new trial, and the motion was denied. These appeals followed.
Crusenberry presents twelve arguments on appeal, which fall into the following three categories: (1) evidence Crusenberry argues was improperly excluded at trial; (2) evidence Crusenberry argues was improperly included at trial; and (3) submission of what Crusenberry asserts was a prejudicial jury instruction. Baptist presents two arguments on cross-appeal that the trial court erred in denying its motion for directed verdict on the bases of: (1) proximate cause; and (2) ostensible agency. Apogee and Dr. Bathina present two arguments on cross-appeal: (1) the trial court should have granted their motion for directed verdict on the issues of standard of care and causation; and (2) the trial court erred in denying their motion to exclude the testimony of Drs. James Tisdale, Carl Blond, and Michael J. Hiestand under KRE3 702 and Daubert v. Merrell Dow Pharm., Inc., 509 U.S. 579, 113 S.Ct. 2786, 125 L.Ed.2d 469 (1993). We will address each set of arguments, in turn.
The standard of review concerning a trial court's evidentiary rulings is abuse of discretion. Tumey v. Richardson, 437 S.W.2d 201, 205 (Ky. 1969). "The test for an abuse of discretion is whether the trial judge's decision was arbitrary, unreasonable, unfair, or unsupported by sound reasonable principles." Penner v. Penner, 411 S.W.3d 775, 779-80 (Ky. App. 2013) (citation omitted).
Issue 1: Whether Kali was unfairly prejudiced from telling the jury about her evidence in opening statements. Crusenberry withdrew her argument on this issue in her reply brief; therefore, no discussion is required.
Issue 2: Whether Kali's key expert witness was arbitrarily limited in his testimony. Crusenberry argues that the trial court improperly limited the causation testimony of James Tisdale, Pharm.D. However, it is well-settled that the "trial court is vested with wide discretion in determining [whether] to admit or exclude expert testimony." Jones v. Stern, 168 S.W.3d 419, 424 (Ky. App. 2005). It is also undisputed that Dr. Tisdale is not a medical doctor but is, instead, a Doctor of Pharmacy.
Crusenberry's arguments pertaining to Savage v. Three Rivers Med. Ctr., 390 S.W.3d 104 (Ky. 2012), are distinguishable. In that case, a nurse with specialized experience in interpreting x-rays testified regarding her interpretationof an x-ray, and no medical opinions concerning causation were elicited from the nurse. In this case, the trial court properly limited Dr. Tisdale's testimony to areas within his expertise, excluding the actual cause of Kali's cardiac event. Further, the testimony Crusenberry claims was improperly excluded pertained only to the issue of causation, one not reached by the jury. Additionally, Crusenberry presented other expert evidence on the issue of causation. Therefore, any error or potential error in excluding Dr. Tisdale's testimony was harmless.
Issue 3: Whether Kali was unfairly precluded from mentioning Baptist's incident report. Crusenberry argues that she should have been allowed to introduce a Baptist Healthcare Systems Incident Report produced at the deposition of Baptist's pharmacist, Herb Petitt.4 Defense counsel objected to introduction of the report into evidence at trial, citing Pauly v. Chang, 498 S.W.3d 394 (Ky. App. 2015). In that case, another panel of our court held that "simply because the information is discoverable does not necessarily mean that it is relevant or admissible." Id., 498 S.W.3d at 408, as modified (Dec. 23, 2015). The panel noted:
CR [Kentucky Rules of Civil Procedure] 26.02 provides that the parties may obtain discovery of any matter not privileged which is relevant to the subject matter in thepending action. Relevancy is more loosely construed for purposes of discovery than for trial. It is not necessary that the information sought be admissible as competent evidence at trial. Even though it might be otherwise incompetent and inadmissible, information may be elicited if it appears reasonably calculated to lead to the discovery of admissible evidence. It is allowable if there is a reasonable possibility that the information sought may provide a lead to other evidence that will be admissible.
Pauly, 498 S.W.3d at 408-09. KRE 401 defines relevant evidence as "evidence having any tendency to make the existence of...
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