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

CourtCourt of Appeals of Kentucky
DecidedFebruary 14, 2025
Docket2024-CA-0093
StatusUnpublished

This text of 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.) is published on Counsel Stack Legal Research, covering Court of Appeals of Kentucky primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

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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).

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RENDERED: FEBRUARY 14, 2025; 10:00 A.M. NOT TO BE PUBLISHED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,

-2- 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.

-3- 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

-4- 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.

-5- 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

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