McAbee v. Chapman

504 S.W.3d 18, 2016 Ky. LEXIS 629, 2016 WL 7655521
CourtKentucky Supreme Court
DecidedDecember 15, 2016
Docket2014-SC-000555-DG
StatusPublished
Cited by7 cases

This text of 504 S.W.3d 18 (McAbee v. Chapman) is published on Counsel Stack Legal Research, covering Kentucky Supreme Court primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
McAbee v. Chapman, 504 S.W.3d 18, 2016 Ky. LEXIS 629, 2016 WL 7655521 (Ky. 2016).

Opinion

OPINION OF THE COURT BY

JUSTICE HUGHES

Kentucky Rule of Evidence (KRE) 615 permits a party in any proceeding to which that rule applies to demand that persons who will testify during the proceeding be excluded from the courtroom “so that they cannot hear the testimony of other witnesses.” The Rule is subject to certain exceptions, including an exception for “a person whose .presence is shown by a party to be essential to the presentation of the party’s case.”1 We granted discretionary review in this medical malpractice matter to consider whether the trial court properly applied the “essential person” exception when it excepted from the Plaintiffs invocation of “the rule,” (as KRE 615 is commonly known in Kentucky courts) two of the defendant’s expert witnesses. We conclude that the trial court misapplied the rule because it did not require the defendant to make an; adequate showing that the presence in court of either expert was [20]*20“essential” to the presentation of the defendant’s case, but we further conclude upon careful review of the record that the error was harmless. We thus affirm, albeit for different reasons, the Court of Appeals’ affirmance of the trial court’s Judgment.

RELEVANT FACTS

In April 2011, Kathy McAbee, a resident of Dawson Springs, Kentucky, brought suit in the Hopkins Circuit Court against Darren Chapman, MD, a general surgeon who practices primarily in Madisonville, Kentucky. Ms. McAbee alleged that Dr. Chapman injured her and caused her financial loss and pain and suffering by negligently performing a surgical procedure known as an anastomosis, a procedure whereby separate sections of tube-like structures—in this case Ms. McAbee’s colon—are joined together. Because resolution of this case requires an understanding of the medical proof, we review that proof in considerable detail.

Beginning in about September 2009, Ms. McAbee, then sixty-five, experienced periodic bouts of abdominal pain and digestive problems which her primary care physician referred to as an “irritable bowel” condition. These episodes gradually became more frequent and more intense, until in January 2010, a particularly severe episode prompted Ms. McAbee to seek emergency room treatment at what was then known as the Madisonville Regional Medical Center. Diagnostic procedures performed there, including a CT scan, indicated a stricture, a partial closure, in Ms. McAbee’s sigmoid colon, the final, s-shaped curve of the colon just before the beginning of the rectum. Dr. Chapman was called in to consult with Ms. McAbee and her two daughters, and he explained to them that in his view Ms. McAbee’s condition was quite serious and urgent, malignancy being a possible cause of the stricture and perforation of the colon being a possible result, since the occlusion was already far along.

On January 14, 2010, Dr. Chapman performed surgery on Ms. McAbee. He removed the constricted portion of the colon (diverticulitis, an inflammatory condition, not malignancy, the apparent cause), and because Ms. McAbee’s condition had not allowed for an adequate bowel preparation, rather than reattaching the colon to the rectum, (what is referred to as an “anasto-mosis”) he set up a colostomy2 on Ms. McAbee’s abdomen and sealed off the rectum below the excision. This procedure allows the colon a chance to recover before making the reconnection.

Dr. Chapman performed the reconnection, or anastomosis—referred to by the parties and in the record as the colostomy “take down” four months later—on May 14, 2010. While an anastomosis used to be routinely, and is still sometimes, established by means of sutures—stitches sewn in by the surgeon—Dr. Chapman employed a newer surgical instrument, a sort of stapler that is referred to as such in the record. This stapling instrument brings together the two parts of the tract to be connected by means of an anvil and a base. The anvil is anchored to the tissue on one side of the desired connection, and the sides are brought together when the anvil is screwed onto a central post projected from the base which has been anchored to the tissue on the other side. The tract can be connected end-to-end, like two sections of a garden hose; end-to-wall, like a T-joint between drain pipes; or even wall-to-wall. Once the two sides have been brought together, the instrument connects them by forcibly inserting a double ring of staples—with a selected diameter—thus [21]*21effecting a seam around the inside of the tract. In the process a doughnut-shaped circle of tissue inside the ring of staples is cut away, thereby opening the tract. It is Dr. Chapman’s performance of this stapling anastomosis procedure that Ms. McAbee alleges fell below the standard of care.

On May 26, 2010, not quite two weeks after the take-down procedure, Ms. McA-be'e returned to the emergency room because she noticed feces in her urine. She was referred to an urologist, Dr. James Fellows, who, on about June 1, 2010, performed a cystoscopy, ie., he inserted a viewing instrument, a cystoscope, inside Ms. McAbee’s bladder and examined the bladder wall. The examination revealed a fingertip-sized hole, or fistula, through the wall of the bladder, through the conjoined wall of the rectum,3 into the rectum itself. The fistula allowed feces to pass from rectum to bladder and urine to pass from bladder to rectum. To her immense distress, physical and psychological, in the days that followed Ms. McAbee experienced both.

During that initial exam, Dr. Fellows also found in the fistulous tract three staples such as-those employed in the anasto-mosis, all of them closed into figure eights. According to Dr. Fellows, the staples were not connected to any tissue, but appeared merely to have floated along the- fistulous tract and were lying loosely on the wall of the bladder. He picked them up with a “grabber,” an extension of the cystoscope, and removed them.

Drs. Fellows and Chapman conferred, and they agreed that Ms. McAbee would require several weeks, even months, of recovery before she could possibly tolerate a corrective surgery. In the meantime, on June 3, 2010 Dr. Chapman set up a second colostomy, this one at a different, and according to Ms. McAbee a far less convenient, place on Ms. McAbee’s abdomen. The second colostomy, according to Dr. Chapman, was intended not only to alleviate the problem of colon contents passing into the bladder, but was also meant to move the colon as far from the fistula as possible. This colostomy did prevent the movement of material from colon to bladder, but it did not prevent the movement in the opposite direction of urine into the rectum, a problem that plagued Ms. McA-bee for the next several months.

Making attempts to address that problem, Dr. Fellows on three occasions, on about June 19, 2010, July 13, 2010, and July 27, 2010, cauterized near the fistula the tissue that had formed connecting the bladder and the rectum, in hopes that separated from the rectum the bladder might spontaneously heal the hole that had formed in it.4' During the first of those procedures, Dr. Fellows found two more staples scattered along the fistulous tract and removed them with the “grabber.”

By the end of July, it was apparent that the conservative approach, cautery, had failed to induce Ms. McAbee’s bladder to heal itself, and Ms. McAbee testified that at that point she felt abandoned by both Dr. Chapman and Dr. Fellows.

Free access — add to your briefcase to read the full text and ask questions with AI

Related

John Joseph Hart v. Commonwealth of Kentucky
Court of Appeals of Kentucky, 2024
Blaine Van Gansbeke v. Bridget F. Van Gansbeke
Court of Appeals of Kentucky, 2024
James Gentry v. Commonwealth of Kentucky
Kentucky Supreme Court, 2024
Feodis Beal v. Commonwealth of Kentucky
Court of Appeals of Kentucky, 2023
Conley v. Commonwealth
576 S.W.3d 570 (Missouri Court of Appeals, 2019)

Cite This Page — Counsel Stack

Bluebook (online)
504 S.W.3d 18, 2016 Ky. LEXIS 629, 2016 WL 7655521, Counsel Stack Legal Research, https://law.counselstack.com/opinion/mcabee-v-chapman-ky-2016.