Kellie E. Denton, as Co-Administrator of the Estate of William A. Raines, III v. Mark Nunley, M.D.

Court of Appeals of Kentucky·Decided February 14, 2025·No. 2024-CA-0093·Unpublished

Opinion

RENDERED: FEBRUARY 14, 2025; 10:00 A.M.

NOT TO BE PUBLISHED

Commonwealth of Kentucky

Court of Appeals

NO. 2024-CA-0093-MR

KELLIE E. DENTON, AS CO- ADMINISTRATOR OF THE ESTATE OF WILLIAM A. RAINES, III; JEREMY RAINES; JOLIE RAINES; AND WILLIAM A. RAINES, IV, AS CO-ADMINISTRATOR OF THE ESTATE OF WILLIAM A. RAINES, III APPELLANTS

APPEAL FROM JEFFERSON CIRCUIT COURT v. HONORABLE ANNIE O’CONNELL, JUDGE ACTION NO. 17-CI-003043

MARK NUNLEY, M.D. AND LOUISVILLE EMERGENCY MEDICINE ASSOCIATES, P.S.C. APPELLEES

OPINION

AFFIRMING

** ** ** ** **

BEFORE: THOMPSON, CHIEF JUDGE; ACREE AND CALDWELL, JUDGES. CALDWELL, JUDGE: The Estate of William A. Raines, III, appeals from a

judgment on a jury verdict in favor of Mark Nunley, M.D. in a wrongful death action alleging medical negligence in failing to diagnose and treat an aortic dissection. We affirm.

FACTUAL AND PROCEDURAL BACKGROUND Mr. Raines arrived at the emergency department of Baptist East Hospital (“Baptist”) shortly after midnight on November 28, 2016, presenting with chest pain. Upon admission, he was evaluated and treated by Dr. Nunley. Mr. Raines described the pain in his chest as being possibly indigestion with its onset occurring about an hour prior, after a long day of driving had culminated in having dinner with friends at a restaurant. An electrocardiogram (“EKG”) and chest x-ray were performed at this time, although Dr. Nunley observed all cardiovascular findings to be within normal limits. Aside from chest pain and belching, records reflect Mr. Raines denying any other symptoms. He was administered pain medication, as well as medication for treatment of nausea and acid reflux. After Mr. Raines reported a resolution to his chest pain around 4:00 am, he was discharged with instructions to see a cardiologist.

Within minutes of the discharge, Mr. Raines returned to the Baptist emergency department and reported his chest pain had returned before he could even exit the hospital’s parking lot. Mr. Raines was readmitted and again assessed by Dr. Nunley. An on-call cardiologist, Dr. Rudolph Licandro, was dispatched and, by telephone, admitted Mr. Raines to telemetry for observation. However,

Mr. Raines remained in the emergency department while waiting for a bed to open in the telemetry department.

Cardiologist Dr. Jesse Adams, a partner of Dr. Licandro, arrived at Baptist and examined Mr. Raines at around 7:30 am. Dr. Adams’ note for this time shows Mr. Raines was indicating some discomfort in his chest, but no acute distress, and having a normal heart rate and rhythm. Following the examination, Mr. Raines was transported to the telemetry floor. However, before connections to telemetry monitors were completed, he reported severe chest pain. Rapid response efforts were not successful, and Mr. Raines was pronounced deceased shortly thereafter. An autopsy determined Mr. Raines’ death was caused by an acute aortic dissection.

On June 15, 2017, the Estate for Mr. Raines filed a Complaint in Jefferson Circuit Court alleging medical negligence by Dr. Nunley, Dr. Licandro, Dr. Adams, as well as Baptist Health.

On August 30, 2019, the Estate filed a CR1 26.02 disclosure with the trial court. Three physicians were identified in the disclosure as having been retained by the Estate to render testimony at trial. Dr. Gregory J. Fermann, an emergency medicine physician, was anticipated to render an opinion that Dr. Nunley and Dr. Licandro should have suspected an aortic dissection and ordered a

1 Kentucky Rules of Civil Procedure.

computerized tomography (“CT”) scan of Mr. Raines’ chest shortly after his return to the emergency department. The disclosure indicated Dr. Robert M. Bojar, a cardiothoracic surgeon, shared the views of Dr. Fermann. The disclosure also stated Dr. Bojar opined that had a chest CT been performed after Mr. Raines’ readmission to Baptist, but prior to 7:00 am, there would have been sufficient time to discover and repair the aortic dissection and Mr. Raines’ death could have been avoided. The disclosure indicated a third proffered medical expert, vascular surgeon Dr. Benjamin Brooke, “also agrees with the opinions expressed by Drs. Fermann and Bojar.” No additional opinion regarding the case was indicated to be held by Dr. Brooke, although the disclosure indicated he would “testify regarding the medical literature on the subject matter.” A deposition of Dr. Brooke, which the Estate intended to read to the jury at trial, took place on February 9, 2023.

A jury trial began on February 21, 2023. All defendants aside from Dr. Nunley had been dismissed prior to the trial.

At trial, the Estate’s experts testified consistently with the opinions recited in the CR 26.02 disclosure. Expert witnesses for Dr. Nunley expressed opinions that Dr. Nunley had not breached the standard of care and disputed many aspects of the opinions of the Estate’s expert witnesses.

Multiple witnesses were questioned regarding an article titled “Evaluation of the Adult with Chest Pain in the Emergency Department” which

had been published in 2016 by UpToDate, an online database of information for physicians. The article lists six potential causes of chest pain which present an immediate threat to a patient’s life: acute coronary syndrome, aortic dissection, pulmonary embolism, tension pneumothorax, pericardial tamponade, and mediastinitis (esophageal rupture). Differential diagnosis of the six causes is discussed extensively in the article’s body. Graphics depicting an algorithm titled “Emergency department approach to chest pain” are included and referenced in the article, as well as two tables titled “Presentations of aortic dissection based on affected structures” and “Differentiation of life-threatening causes of chest pain[.]” The introductory section of the article contains a sentence which was a particularly frequent subject of discussion and inquiry by the Estate: “[c]linicians in the ED focus on the immediate recognition and exclusion of life-threatening causes of chest pain.”

Dr. Nunley was initially called to testify during the Estate’s case. At the close of the Estate’s case, it made a motion for a directed verdict. The Estate argued Dr. Nunley had made statements during his testimony that were judicial admissions and conclusively established the standard of care and his breach thereof. The motion was denied by the trial court.

At the close of the case, following closing arguments, the jury rendered a 10-2 verdict in favor of Dr. Nunley. This appeal follows. Further facts will be provided as necessary in our analysis.

Applicable Standards of Review Motion for a Directed Verdict A motion for directed verdict “raises only questions of law as to whether there is any evidence to support a verdict.” Harris v. Cozatt, Inc., 427 S.W.2d 574, 575 (Ky. 1968) (emphasis added). Accordingly, where there is any “conflicting evidence, it is the responsibility of the jury, the trier of fact, to resolve such conflicts.” Daniels v. CDB Bell, LLC., 300 S.W.3d 204, 215 (Ky. App. 2009). The trial court should avoid consideration of the credibility or weight of proffered evidence. “[A] trial judge cannot enter a directed verdict unless there is a complete absence of proof on a material issue or if no disputed issues of fact exist upon which reasonable minds could differ.” Bierman v. Klapheke, 967 S.W.2d 16, 18-19 (Ky. 1998) (citation omitted). The moving party has a high burden to meet. Louisville Metro Gov’t v. Ward, 610 S.W.3d 295, 307 (Ky. App. 2020).

“On appellate review, we will reverse the trial court’s ruling only if we find that the jury could not have reasonably reached its verdict on the basis of the evidence before it.” Belt v. Cincinnati Ins. Co., 664 S.W.3d 524, 530 (Ky. 2022) (internal quotation marks and citation omitted). Only where the jury’s result is “palpably or flagrantly against the evidence” may we reverse the trial court’s decision to deny a motion for a directed verdict. Lewis v. Bledsoe Surface Mining

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Kellie E. Denton, as Co-Administrator of the Estate of William A. Raines, III v. Mark Nunley, M.D., (Ky. Ct. App. 2025).

Kellie E. Denton, as Co-Administrator of the Estate of William A. Raines, III v. Mark Nunley, M.D. (Kellie E. Denton, as Co-Administrator of the Estate of William A. Raines, III v. Mark Nunley, M.D.) — published by Counsel Stack Legal Research, free access to 12M+ legal documents.

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