In a decision by the Commonwealth of Kentucky Court of Appeals (“Appellate Court”) issued on August 14, 2015 in a medical malpractice case filed by a prison inmate against the medical services providers at the detention center in which he was incarcerated, the Appellate Court held, “We believe that the res ipsa loquitor exception can apply in this case and that material facts are still at issue which would preclude summary judgment.”
The Appellate Court stated that except in limited factual circumstances, the plaintiff in a medical negligence case is required to present expert testimony that establishes (1) the standard of skill expected of a reasonably competent medical practitioner and (2) that the alleged negligence proximately caused the injury. However, Kentucky recognizes two exceptions to the expert witness rule in medical malpractices cases: both exceptions involve the application of the res ipsa doctrine and permit the inference of negligence even in the absence of expert testimony.
One exception involves a situation in which any layman is competent to pass judgment and conclude from common experience that such things do not happen if there has been proper skill and care (for example, where the surgeon leaves a foreign object in the body or removes or injures an inappropriate part of the anatomy). The second occurs when medical experts may provide a sufficient foundation for res ipsa loquitor on more complex matters (for example, where the defendant doctor makes admissions of a technical character from which one could infer that he or she acted negligently).
The Underlying Facts
The plaintiff was suffering from diverticulitis and had previously had sixteen inches of his colon removed by the time he was incarcerated in 2009. In May 2010, he was experiencing abdominal pain, nausea, vomiting, constipation, and fever, and he sought medical treatment at the detention center. The plaintiff alleged that timely and proper medical care for his serious condition was not provided to him, despite repeated requests, resulting in hospitalization in the ICU of a local hospital due to severe dehydration, a bowel obstruction, and a possible ruptured esophagus. He also developed respiratory failure and had to be intubated. He underwent an exploratory laparotomy on the second day of his hospitalization that revealed multiple adhesions to his small bowel which caused an obstruction that had to be surgically repaired.
The plaintiff’s medical malpractice lawsuit named numerous defendants, including the medical director of the detention center and a nurse. All of the defendants moved for summary judgment, and the trial court granted summary judgment in favor of the medical director and the nurse because the plaintiff did not have an expert medical opinion regarding their roles in his injuries (without an expert to testify as to their roles, the trial court held that the plaintiff could not prove breach of duty and causation).
The Appellate Court stated that the defendant medical director was not only the primary medical caregiver of the detention center but also oversaw all aspects of the medical care received by the inmates. The medical director’s contract required him to visit the detention center once a week but he only visited the detention center once a month – he delegated the weekly visits to the defendant nurse.
The defendant medical director was not even aware of the plaintiff until he was transported to the hospital – the defendant nurse did not inform the medical director with regard to the inmates she saw at the detention center. The medical director and defendant nurse were the only medical providers qualified to diagnose medical conditions and prescribe at the detention center, and they were the primary medical caregivers for the plaintiff. The defendant nurse did not examine the plaintiff until he had been in the detention center’s medical observation unit for five days, and she failed to check on his progress after her initial examination of the plaintiff.
The Appellate Court held, based on these facts, coupled with the plaintiff’s testimony regarding the pain and suffering he endured until he was hospitalized, that the plaintiff met the res loquitor exception regarding the requirement for medical expert testimony: a layperson could conclude that the defendant medical director and defendant nurse did not effectively communicate with the detention center’s staff and that they did not properly oversee the plaintiff’s care, and that the plaintiff’s improvement once he was hospitalized could support a layperson concluding that the lack of communication and oversight contributed to the plaintiff’s prolonged pain and suffering.
The Appellate Court held that the trial court erred in granting summary judgment in favor of the defendant medical director and defendant nurse because whether or not they provided adequate medical care in these circumstances is something a layperson can understand, and the res ipsa loquitor exception would apply.
Source Siestma v. Adams, M.D., No. 2013-CA-001159-MR.
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