RENDERED: SEPTEMBER 5, 2025; 10:00 A.M. NOT TO BE PUBLISHED
Commonwealth of Kentucky Court of Appeals NO. 2024-CA-1395-MR
CHRISTOPHER J. BOWEN APPELLANT
APPEAL FROM FRANKLIN CIRCUIT COURT v. HONORABLE THOMAS D. WINGATE, JUDGE ACTION NO. 20-CI-00486
ALISON M. CASSELL-HARRIS, APRN APPELLEE
OPINION AFFIRMING
** ** ** ** **
BEFORE: COMBS, EASTON, AND LAMBERT, JUDGES.
EASTON, JUDGE: The Appellant, Christopher J. Bowen (“Bowen”), appeals
from the Franklin Circuit Court’s Order granting Summary Judgment to the
Appellee, Alison M. Cassell-Harris (“Cassell-Harris”), APRN.1 The circuit court
determined by summary judgment that Bowen was unable to sustain a medical
1 Advanced Practice Registered Nurse. negligence case against Cassell-Harris because Bowen’s expert did not offer
sufficient testimony that Cassell-Harris deviated from the standard of care or
caused harm to Bowen. Having reviewed the record and the applicable law, we
affirm.
FACTUAL AND PROCEDURAL HISTORY
At approximately 1:00 a.m. the morning of June 18, 2019, Bowen
presented to the Emergency Room (“ER”) at Frankfort Regional Medical Center
(“FRMC”) with shortness of breath, chest tightness, and a rapid heart rate of about
210 beats per minute. Bowen was assessed initially by Cassell-Harris.
Cassell-Harris became aware of Bowen’s diagnosis of Wolff-
Parkinson-White Syndrome (“WPW”), which means he has an extra electrical
pathway in his heart. Cassell-Harris determined Bowen was outside of her scope
of knowledge to properly treat, so she transferred care of Bowen to Dr. Joseph
Palumbo (“Dr. Palumbo”), a locum tenens2 ER physician. According to Cassell-
Harris’s uncontroverted deposition testimony, Dr. Palumbo directed her to order
several medications for Bowen. Cassell-Harris placed those medication orders,
which were later administered to Bowen by a nurse.
At 2:00 a.m., Cassell-Harris’s shift ended, and she left the hospital.
Approximately fifteen minutes later, Bowen went into cardiac arrest. He was
2 Latin for “to hold the place.” It refers to a doctor who fills in for another doctor.
-2- resuscitated within about three minutes and was stabilized. He was transferred
from FRMC to the University of Kentucky Medical Center around 2:00 p.m. the
next afternoon.
On June 16, 2020, Bowen filed a medical negligence action in the
Franklin Circuit Court, naming several defendants, including Cassell-Harris. All
other defendants were dismissed as parties prior to the summary judgment at issue.
Cassell-Harris was the last remaining defendant.
Bowen filed his expert disclosure in February 2024. Only one expert
was named, Dr. Matthew Vreeland (“Dr. Vreeland”). In June 2024, Cassell-Harris
filed a motion for summary judgment, alleging Bowen’s expert did not sufficiently
set forth opinions that she violated the standard of care or that any action she took
caused Bowen’s injuries. After reviewing the deposition of Bowen’s expert, the
circuit court agreed with Cassell-Harris, and granted her summary judgment in an
order entered on August 12, 2024. Bowen filed a motion to vacate the summary
judgment. The circuit court again considered Dr. Vreeland’s report and testimony
and denied Bowen’s motion to vacate. This appeal follows. Further facts and
testimony will be discussed as they become relevant to our analysis.
STANDARD OF REVIEW
“The standard of review of a trial court’s granting of summary
-3- judgment is whether the trial court correctly found that there were no genuine
issues as to any material fact and that the moving party was entitled to judgment as
a matter of law. Summary judgment is proper when it appears that it would be
impossible for the adverse party to produce evidence at trial warranting a judgment
in its favor.” Andrew v. Begley, 203 S.W.3d 165, 169 (Ky. App. 2006) (internal
quotation marks and citations omitted). “Because summary judgment involves
only legal questions and the existence of any disputed material issues of fact, an
appellate court need not defer to the trial court’s decision and will review the issue
de novo.” Jenkins v. Best, 250 S.W.3d 680, 688 (Ky. App. 2007).
ANALYSIS
Bowen argues the circuit court erred in granting summary judgment to
Cassell-Harris because the expert testimony provided was adequate to create a
genuine issue of material fact. He states Dr. Vreeland’s deposition testimony
indicated that Cassell-Harris’s actions were a deviation from the standard of care
and that they were a substantial factor in causing Bowen’s injuries.
In a medical negligence case, a plaintiff must prove the applicable
medical standard of care, a breach of that care, and an injury resulting from that
breach of care. Blankenship v. Collier, 302 S.W.3d 665, 675 (Ky. 2010). In order
to survive summary judgment, a plaintiff must present a genuine issue of material
fact for every element. See Andrew v. Begley, supra, at 170.
-4- A party’s “burden of proof at the trial is greater than merely proving a
negligent act followed by injury. There must be proof that the negligent act was
the proximate cause of the injury. Negligence in medical malpractice cases must
be established by expert testimony unless negligence and injurious results are so
apparent that a layman with general knowledge would have no difficulty
recognizing it.” Morris v. Hoffman, 551 S.W.2d 8, 9 (Ky. App. 1977) (citations
omitted). “[T]he medical testimony must be that the causation is probable and not
merely possible.” Id. Negligence cannot be assumed merely from a poor outcome
of a patient. Meador v. Arnold, 94 S.W.2d 626, 631 (Ky. 1936).
“Under Kentucky law, a plaintiff alleging medical malpractice is
generally required to put forth expert testimony to show that the defendant medical
provider failed to conform to the standard of care.” Blankenship, supra, at 670.
“[T]he lack of expert testimony is truly a failure of proof [for which] a summary
judgment is appropriate.” Adams v. Sietsema, 533 S.W.3d 172, 177 (Ky. 2017)
(internal quotation marks and citation omitted).
The circuit court determined that Dr. Vreeland’s testimony did not
satisfy the standard to get past summary judgment. The circuit court’s order stated
it “agrees with APRN Cassell-Harris that the expert testimony supplied by Mr.
Bowen does not sufficiently suggest that APRN Cassell-Harris deviated from the
-5- standard of care.”3 To analyze further, we must look at both the sequence of
events from the time Bowen came into the ER to when he was stabilized and also
what Dr. Vreeland actually stated in his deposition testimony. It is also important
to understand what injuries Bowen has claimed.
Bowen has had additional treatment and procedures performed on his
heart since this incident. But according to his own expert, this event did not cause
those to occur or be necessary; they were because of his underlying WPW. It does
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RENDERED: SEPTEMBER 5, 2025; 10:00 A.M. NOT TO BE PUBLISHED
Commonwealth of Kentucky Court of Appeals NO. 2024-CA-1395-MR
CHRISTOPHER J. BOWEN APPELLANT
APPEAL FROM FRANKLIN CIRCUIT COURT v. HONORABLE THOMAS D. WINGATE, JUDGE ACTION NO. 20-CI-00486
ALISON M. CASSELL-HARRIS, APRN APPELLEE
OPINION AFFIRMING
** ** ** ** **
BEFORE: COMBS, EASTON, AND LAMBERT, JUDGES.
EASTON, JUDGE: The Appellant, Christopher J. Bowen (“Bowen”), appeals
from the Franklin Circuit Court’s Order granting Summary Judgment to the
Appellee, Alison M. Cassell-Harris (“Cassell-Harris”), APRN.1 The circuit court
determined by summary judgment that Bowen was unable to sustain a medical
1 Advanced Practice Registered Nurse. negligence case against Cassell-Harris because Bowen’s expert did not offer
sufficient testimony that Cassell-Harris deviated from the standard of care or
caused harm to Bowen. Having reviewed the record and the applicable law, we
affirm.
FACTUAL AND PROCEDURAL HISTORY
At approximately 1:00 a.m. the morning of June 18, 2019, Bowen
presented to the Emergency Room (“ER”) at Frankfort Regional Medical Center
(“FRMC”) with shortness of breath, chest tightness, and a rapid heart rate of about
210 beats per minute. Bowen was assessed initially by Cassell-Harris.
Cassell-Harris became aware of Bowen’s diagnosis of Wolff-
Parkinson-White Syndrome (“WPW”), which means he has an extra electrical
pathway in his heart. Cassell-Harris determined Bowen was outside of her scope
of knowledge to properly treat, so she transferred care of Bowen to Dr. Joseph
Palumbo (“Dr. Palumbo”), a locum tenens2 ER physician. According to Cassell-
Harris’s uncontroverted deposition testimony, Dr. Palumbo directed her to order
several medications for Bowen. Cassell-Harris placed those medication orders,
which were later administered to Bowen by a nurse.
At 2:00 a.m., Cassell-Harris’s shift ended, and she left the hospital.
Approximately fifteen minutes later, Bowen went into cardiac arrest. He was
2 Latin for “to hold the place.” It refers to a doctor who fills in for another doctor.
-2- resuscitated within about three minutes and was stabilized. He was transferred
from FRMC to the University of Kentucky Medical Center around 2:00 p.m. the
next afternoon.
On June 16, 2020, Bowen filed a medical negligence action in the
Franklin Circuit Court, naming several defendants, including Cassell-Harris. All
other defendants were dismissed as parties prior to the summary judgment at issue.
Cassell-Harris was the last remaining defendant.
Bowen filed his expert disclosure in February 2024. Only one expert
was named, Dr. Matthew Vreeland (“Dr. Vreeland”). In June 2024, Cassell-Harris
filed a motion for summary judgment, alleging Bowen’s expert did not sufficiently
set forth opinions that she violated the standard of care or that any action she took
caused Bowen’s injuries. After reviewing the deposition of Bowen’s expert, the
circuit court agreed with Cassell-Harris, and granted her summary judgment in an
order entered on August 12, 2024. Bowen filed a motion to vacate the summary
judgment. The circuit court again considered Dr. Vreeland’s report and testimony
and denied Bowen’s motion to vacate. This appeal follows. Further facts and
testimony will be discussed as they become relevant to our analysis.
STANDARD OF REVIEW
“The standard of review of a trial court’s granting of summary
-3- judgment is whether the trial court correctly found that there were no genuine
issues as to any material fact and that the moving party was entitled to judgment as
a matter of law. Summary judgment is proper when it appears that it would be
impossible for the adverse party to produce evidence at trial warranting a judgment
in its favor.” Andrew v. Begley, 203 S.W.3d 165, 169 (Ky. App. 2006) (internal
quotation marks and citations omitted). “Because summary judgment involves
only legal questions and the existence of any disputed material issues of fact, an
appellate court need not defer to the trial court’s decision and will review the issue
de novo.” Jenkins v. Best, 250 S.W.3d 680, 688 (Ky. App. 2007).
ANALYSIS
Bowen argues the circuit court erred in granting summary judgment to
Cassell-Harris because the expert testimony provided was adequate to create a
genuine issue of material fact. He states Dr. Vreeland’s deposition testimony
indicated that Cassell-Harris’s actions were a deviation from the standard of care
and that they were a substantial factor in causing Bowen’s injuries.
In a medical negligence case, a plaintiff must prove the applicable
medical standard of care, a breach of that care, and an injury resulting from that
breach of care. Blankenship v. Collier, 302 S.W.3d 665, 675 (Ky. 2010). In order
to survive summary judgment, a plaintiff must present a genuine issue of material
fact for every element. See Andrew v. Begley, supra, at 170.
-4- A party’s “burden of proof at the trial is greater than merely proving a
negligent act followed by injury. There must be proof that the negligent act was
the proximate cause of the injury. Negligence in medical malpractice cases must
be established by expert testimony unless negligence and injurious results are so
apparent that a layman with general knowledge would have no difficulty
recognizing it.” Morris v. Hoffman, 551 S.W.2d 8, 9 (Ky. App. 1977) (citations
omitted). “[T]he medical testimony must be that the causation is probable and not
merely possible.” Id. Negligence cannot be assumed merely from a poor outcome
of a patient. Meador v. Arnold, 94 S.W.2d 626, 631 (Ky. 1936).
“Under Kentucky law, a plaintiff alleging medical malpractice is
generally required to put forth expert testimony to show that the defendant medical
provider failed to conform to the standard of care.” Blankenship, supra, at 670.
“[T]he lack of expert testimony is truly a failure of proof [for which] a summary
judgment is appropriate.” Adams v. Sietsema, 533 S.W.3d 172, 177 (Ky. 2017)
(internal quotation marks and citation omitted).
The circuit court determined that Dr. Vreeland’s testimony did not
satisfy the standard to get past summary judgment. The circuit court’s order stated
it “agrees with APRN Cassell-Harris that the expert testimony supplied by Mr.
Bowen does not sufficiently suggest that APRN Cassell-Harris deviated from the
-5- standard of care.”3 To analyze further, we must look at both the sequence of
events from the time Bowen came into the ER to when he was stabilized and also
what Dr. Vreeland actually stated in his deposition testimony. It is also important
to understand what injuries Bowen has claimed.
Bowen has had additional treatment and procedures performed on his
heart since this incident. But according to his own expert, this event did not cause
those to occur or be necessary; they were because of his underlying WPW. It does
not appear from the record that Bowen had any lasting physical injuries from the
cardiac arrest, or at least none that can be attributed to this event rather than his
WPW diagnosis. But Bowen does claim Post-Traumatic Stress Disorder (“PTSD”)
and anxiety from this event and the treatment received at FRMC.
Dr. Vreeland was critical of the medication regiment ordered for
Bowen. He stated that neither Adenosine nor beta blockers should have been
given to a patient with WPW. He further stated the dosage of procainamide given
to Bowen was insufficient. According to Bowen’s medical records, Cassell-Harris
ordered 100 mg of procainamide to be administered to Bowen. Dr. Vreeland
opined that approximately 1,050 mg should have been administered, infused at 20-
3 Circuit Court Order, August 12, 2024, Page 480 of Record.
-6- 50 mg per minute. He also stated Bowen should have been cardioverted4 upon
arrival in the ER.
Cassell-Harris testified she ordered the medications on Dr. Palumbo’s
orders. Bowen presented to the ER at approximately 1:00 a.m. Cassell-Harris did
the initial assessment and became aware of Bowen’s WPW diagnosis. She then
claims she turned Bowen’s care over to Dr. Palumbo, and Dr. Palumbo accepted
that transfer of care, because Cassell-Harris felt Bowen’s condition was outside her
scope of practice and competency. Bowen argues this creates a genuine issue of
material fact because the medical records do not illustrate that Dr. Palumbo
ordered the medications or became the primary caregiver for Bowen. Dr. Palumbo
has not been deposed in this case, so Bowen asserts it is only the testimony of
Cassell-Harris that exists to support her narrative.
“In response to a motion for summary judgment, the respondent must
present at least some affirmative evidence showing the existence of a genuine issue
of material fact[.]” Haugh v. City of Louisville, 242 S.W.3d 683, 686 (Ky. App.
2007) (internal quotation marks and citations omitted). Bowen contends that we
have only Cassell-Harris’s word that Dr. Palumbo told her to put in the order for
the medications, and that Dr. Palumbo took over Bowen’s care. Yet Bowen has
not presented any evidence in opposition to Cassell-Harris’s testimony. He has not
4 The application of electric shock to bring the heart back into a normal rhythm.
-7- shown any testimony or evidence that Dr. Palumbo did not accept responsibility
for Bowen as a patient. Bowen cannot simply say “we don’t know” to create an
issue of material fact to avoid summary judgment.
Additionally, Bowen’s medical records independently support
Cassell-Harris’s claim that Dr. Palumbo took over Bowen’s care. In his medical
records attached to Cassell-Harris’s motion for summary judgment, there are
notations that explicitly state this. For example, one notation states: “Patient
presented to ER complaining of chest pain, SOA. Well appearing patient in no
acute distress. AFebrile, VSS. Initial EKG showed Afib with RVR. No response
to adenosine. Care transferred to Dr. Palumbo.”5 Further on the same page of
records:
This patient’s care has been transferred to and accepted by [Dr. palumbo] [sic]. We discussed: the patient’s chief complaint; labs and imaging that have been completed and those that are still pending; procedures that have been completed and those remaining to be done; any treatment provided and the patient’s response to treatment; any significant change in condition; input from consultants if any; the treatment plan prior to the transfer of care. The accepting physician will follow up on all pending labs and imaging and make any necessary changes to the current impression and/or treatment plan. The accepting physician is now responsible for the patient’s care and final disposition.6
5 Medical Records of Christopher Bowen, Exhibit 1, Page 393 of Record. 6 Id.
-8- This entry was electronically signed by Jeremy P. Stich on June 18,
2019, at 13:49 (1:49 p.m.). At the end of Bowen’s records is the statement “I
reviewed the PA/NP’s chart. I agree with the assessment and care plan, and
confirm the diagnosis(es).”7 After this entry is the electronic signature of Joseph
M. Palumbo, DO, on June 18, 2019, at 23:53 (11:53 p.m.).
Dr. Palumbo was never a defendant in this case. We will not
speculate as to why he was never named as a party or deposed in this case.
Nevertheless, from our review of Dr. Vreeland’s deposition, it is Dr. Palumbo and
his actions that Dr. Vreeland most strongly criticized. In addition to the
medication critique and the failure to cardiovert Bowen upon arrival, Dr. Vreeland
discussed Dr. Palumbo’s excited statements immediately after resuscitating
Bowen, which were remembered by Bowen and are a source of Bowen’s claimed
and continuing anxiety.
We have no doubt this entire situation was incredibly stressful for
Bowen, and it would not be surprising for a patient to have anxiety after such an
incident. But to assess what part Cassell-Harris played in this, we must again look
at the timeline. Bowen went into cardiac arrest at approximately 2:17 a.m.
Cassell-Harris’s shift ended at 2:00 a.m., and she had already left the hospital.
Anything that occurred immediately prior to or subsequent to the cardiac arrest
7 Id. Page 399 of Record.
-9- cannot be attributed to Cassell-Harris or any action she took or failed to take,
especially considering the uncontroverted evidence that Dr. Palumbo was in
charge.
Ultimately, Bowen is unable to show that Cassell-Harris breached any
duty or that any breach caused his injuries. Dr. Vreeland specifically stated in his
deposition that it was reasonable for an APRN to rely on the attending physician’s
instructions in these circumstances. Regardless of who ordered the medications,
Bowen cannot meet the burden to survive summary judgment. While Dr. Vreeland
had criticisms of the care Bowen received, when taken as a whole, Dr. Vreeland’s
testimony did not affirmatively state that any care—or lack of care—was the cause
of Bowen’s cardiac arrest:
Q: Okay. Then, based on your opinions, can we agree that none of the medications that were given caused or contributed to cause Mr. Bowen’s code event?
A: Other than our discussion about the procainamide not being delivered in a reasonable dose, yes.
Q: Okay. Right. It didn’t—
A: But other than that . . .
Q: It didn’t cause it?
A: No.
Q: That’s right?
A: Correct.
-10- Q: Okay. So neither the procainamide, the adenosine, or the beta blockers caused Mr. Bowen’s code event, correct?
A: That’s correct.
Q: Okay. I think your sort of asterisks on the procainamide there was that perhaps it could have prevented it if he had been given more, but we don’t know that as we sit here today?
A: We don’t know that.
Q: Because you also agreed with me that the event—or maybe—is it your opinion that the event that he sustained was a result of the continuation of his underlying condition?
A: Yes.8
Dr. Vreeland could not state with any degree of even probability that
Bowen would not have suffered his cardiac arrest even if he had been given an
appropriate dose of procainamide. “[P]roximate causation must be shown by a
reasonable degree of medical probability, rather than mere possibility or
speculation.” Ashland Hosp. Corp. v. Lewis, 581 S.W.3d 572, 577-78 (Ky. 2019).
If Dr. Vreeland cannot show that Cassell-Harris’s actions were the cause of
Bowen’s cardiac arrest, he certainly cannot make the leap that Cassell-Harris’s
actions were the cause of Bowen’ anxiety and even PTSD that arose due to the
cardiac arrest. The cardiac arrest occurred after Cassell-Harris ceased participating
8 Deposition of Dr. Matthew Vreeland, Pages 44-45.
-11- in Bowen’s care and after Cassell-Harris properly followed the treating doctor’s
orders.
CONCLUSION
Because Bowen was unable to provide expert testimony that Cassell-
Harris’s actions constituted a deviation from the standard of care or that they
caused Bowen’s injuries, summary judgment was appropriate. We AFFIRM the
Franklin Circuit Court.
ALL CONCUR.
BRIEFS FOR APPELLANT: BRIEF FOR APPELLEE:
Escum L. Moore, III Joseph A. Wright Lexington, Kentucky Eleanor M.B. Davis Elizabeth F. Ousley Haylee M. Deutsch Louisville, Kentucky
-12-