Richard C. Oliphant M.D. v. Billie Jo Ries

Kentucky Supreme Court·Decided February 14, 2019·No. 2017-SC-0208·Unpublished

Opinion

RENDERED: FEBRUARY 14, 2019 TO BE PUBLISHED

2017-SC-000208-DG

RICHARD C. OLIPHANT, M.D. AND APPELLANTS LOUISVILLE PHYSICIANS FOR WOMEN, PLLC

ON REVIEW FROM COURT OF APPEALS V. CASE NO. 2011 -CA-000100-MR JEFFERSON CIRCUIT COURT NO. 05-CI-002925

BILLIE JO RIES; BILLIE JO RIES, AS APPELLEES NEXT FRIEND OF INFANT CHILD, LAUREN ELIZABETH RIES; KEVIN RIES; AND KEVIN RIES, AS NEXT FRIEND OF INFANT CHILD, LAUREN ELIZABETH RIES

OPINION OF THE COURT BY JUSTICE HUGHES REVERSING AND REINSTATING Lauren Ries was born in 1997 with multiple disabilities as a result of medical complications before and during birth. In 2010, after years of medical negligence litigation between the Ries family and Lauren’s doctors and the hospital, a Jefferson Circuit Court jury rendered a verdict in favor of the defendants and the trial court entered a judgment to that effect. The Court of Appeals initially reversed and ordered a new trial due to a Daubert issue that it concluded the trial court had decided erroneously, but this Court unanimously reversed and remanded to the appellate court for consideration of a second

issue raised by the Rieses that had not been addressed. Oliphant v. Ries, 460 S.W.3d 889 (Ky. 2015). On remand a divided appellate panel reversed again, holding that the trial court erred by limiting an expert’s testimony. The case is now before this Court a second time on discretionary review. Finding no error in the trial court’s challenged ruling, we reverse and reinstate the judgment.

FACTS AND PROCEDURAL HISTORY On January 20, 1997, Billie Jo Ries was 36-weeks pregnant with a baby girl, Lauren. At approximately 5:00 a.m., Ries discovered that she was experiencing bright red vaginal bleeding. Ries and her husband contacted the on-call obstetrician for her doctor’s office, Dr. Richard Oliphant of Louisville Physicians for Women, who instructed them to go to the hospital. Dr. Oliphant believed that Ries had suffered a partial placental abruption, which required urgent, but not emergent, attention.

The Rieses went to Baptist East Hospital (the Hospital) and the nurse called Dr. Oliphant, who was completing a delivery at another hospital. The nurse informed Dr. Oliphant that Ries and the baby were relatively stable. Soon after, the baby’s heart rate decelerated, and the nurse called to request Dr. Oliphant’s immediate presence. Dr. Oliphant arrived at the Hospital and performed an emergency C-section, delivering Lauren at 6:59 a.m.

In addition to the possible placental abruption, Ries apparently also suffered from a somewhat rare and dangerous condition known as vasa previa with velamentous insertion, which was unknown to the medical staff that

delivered Lauren.1 One of these conditions caused Lauren to bleed in utero and lose approximately one-third to one-half of her blood volume. While the parties strongly disagree as to whether Lauren’s bleeding occurred before or after the Rieses arrived at the Hospital, Lauren was injured as a result and is now severely disabled.

In 2005, the Rieses, on behalf of themselves and Lauren, sued the Hospital, Louisville Physicians for Women, Dr. Oliphant, Dr. Tonya Robinson (the neonatologist who treated Lauren at birth), and Dr. Robinson’s practice (collectively “the Defendants”) in Jefferson Circuit Court. At trial, the Rieses argued that the majority of Lauren’s blood loss occurred after she arrived at the Hospital and her injuries resulted from the delay in delivering the baby, and the inadequate care Lauren received after delivery. The Defendants argued that the majority of Lauren’s blood loss occurred before she arrived at the Hospital and therefore her injuries were not preventable. We review the pretrial proceedings relevant to the issue before us generally, with reference to additional details as necessary in our analysis.

1 Vasa previa occurs when the fetal blood vessels cross over the cervix, underneath the baby, creating a risk that the blood vessels will rupture or compress, causing the baby to bleed out or suffer a lack of oxygen. Catherine Ebbing, et al. Prevalence, Risk Factors and Outcomes of Velamentous and Marginal Cord Insertions, PLoS One: A Peer Reviewed, Open Access Journal (July 30, 2013) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3728211/. Velamentous insertion occurs when the umbilical vessels insert into the membranes before they reach the placenta. This results in a lack of protection of the umbilical vessels, increasing the risk that the vessels will rupture. Id.

From 2005 to 2010, the parties engaged in extensive discovery. In late 2009, the parties filed their initial expert witness disclosures. The Rieses’ experts included Dr. Carolyn Crawford, a neonatologist, and Dr. Zane Brown, a maternal-fetal medicine specialist. The Defendants’ disclosure included Dr. Jay Goldsmith, a neonatologist, as one of their experts who would testify that Dr. Robinson and the Hospital nursing staff complied with the standard of care. The disclosure also indicated that Dr. Goldsmith reserved the right to form additional opinions based on other experts’ depositions.

In March 2010, the parties deposed Dr. Crawford, the Rieses’ expert, who briefly discussed equilibration — the process by which the cardio-vascular system takes fluids from other parts of the body to compensate for lost blood — and the level of hemoglobin in Lauren’s blood.2 In April 2010, the parties deposed Dr. Goldsmith. Dr. Goldsmith opined that Lauren’s blood loss occurred before she arrived at the Hospital because equilibration takes two to four hours and Lauren’s hemoglobin levels were diluted at birth. In his opinion, this suggested that her body had time to draw fluids (which do not contain hemoglobin) from her other tissues after her blood loss occurred. Dr. Goldsmith noted that if Lauren had bled at the Hospital immediately prior to

2 “Hemoglobin is the protein contained in red blood cells that is responsible for delivery of oxygen to the tissues. To ensure adequate tissue oxygenation, a sufficient hemoglobin level must be maintained.” Walker HK, et al., editors. Hemaglobin and Hematocrit, Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. (1990). https://www.ncbi.nlm.nih.gov/books/NBK201/ .

delivery, her body would not have had time to equilibrate and her hemoglobin levels would not have been diluted.

The Rieses disputed Dr. Goldsmith’s testimony from the beginning of the case. Dr. Goldsmith’s calculation, discussed in detail in the April deposition, rested on the assumption that fetuses have the same equilibration rate as adults and children, despite his inability to point to specific studies to support his theory.3 When the deposition resumed one month later, in May 2010, Dr. Goldsmith revealed that he could not find any studies proving that fetuses equilibrate at the same rate as post-birth humans. He noted that such research, which would require intentionally causing fetuses to bleed to measure their equilibration rate, would be unethical.

On July 12, 2010, the Rieses filed a supplemental expert witness disclosure stating that one of their previously disclosed experts, Dr. Brown, would testify about the equilibration rate of fetuses and his opinion that fetal equilibration rates differ from child and adult equilibration rates.4 Three days earlier, during her second deposition on July 9, 2010, Dr. Crawford had strongly disagreed with Dr. Goldsmith’s equilibration calculation and determination of when Lauren’s lowest hemoglobin levels occurred. Dr.

3 Dr. Goldsmith’s calculations involved a mathematical formula that utilized total blood volume, hematocrit level, hemoglobin level, and the rate of equilibration of a human fetus. Hematocrit is a measurement comparing the number of red blood cells to total blood volume, revealing whether a person has a normal amount of red blood cells, too many, or too few. Walker, supra note 2.

4 That disclosure is quoted verbatim and discussed infra.

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