John Adams M.D. v. Mark Sietsema
2015 SC 000483
| Ky. | Nov 29, 2017Background
- Mark Sietsema (plaintiff) was an inmate at Hardin County Detention Center (HCDC) who experienced fever, vomiting and abdominal symptoms culminating in collapse and emergency surgery for bowel obstruction.
- Southern Health Partners (SHP) provided jail medical services; Dr. John Adams was contracted as medical director/primary care physician and authorized NP Elizabeth Walkup to perform weekly jail visits and use his signature stamp on medical documents, including "refusal of treatment" forms.
- Nurses repeatedly documented Sietsema's refusals of prescribed medications; they stamped Adams' signature on refusal forms instead of contacting Adams or Walkup. After days of refusals and worsening symptoms, nurses finally sent Sietsema to the ER.
- Sietsema sued Adams and Walkup for medical negligence, alleging (1) Adams negligently permitted or created a system (use of stamp) that kept him unaware of serious refusals and (2) Walkup negligently drafted an ambiguous order re: when to send the patient to the hospital.
- At summary judgment the trial court dismissed claims against Adams and Walkup for lack of expert proof on standard of care and causation; the Court of Appeals reversed, applying res ipsa loquitur. The Kentucky Supreme Court granted discretionary review.
- The Kentucky Supreme Court reversed the Court of Appeals and reinstated summary judgment, holding plaintiff failed to produce necessary expert evidence to establish breach/causation for the claims against Adams and Walkup.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether summary judgment for lack of expert proof is reviewed de novo or for abuse of discretion | Sietsema: legal question; review de novo | Adams/Walkup: trial court evidentiary discretion; abuse of discretion | De novo review; whether lack of expert testimony is a failure of proof is legal and reviewed de novo |
| Whether res ipsa loquitur excuses need for expert testimony regarding Adams' alleged negligence (signature stamp/oversight) | Sietsema: stamp practice and Adams' admitted response (would have sent to ER if informed) permit lay inference of negligence and causation without expert | Adams/Walkup: nursing practices, stamp use, and training/communication issues involve medical judgment and standard of care requiring expert proof | Majority: res ipsa inapplicable; expert testimony required to show duty/breach re: training/use of stamp; summary judgment proper (dissent would have allowed res ipsa/admissions exception for Adams) |
| Whether Walkup's order ("unstable or unable to tolerate fluids") was so ambiguous that expert proof is unnecessary | Sietsema: order ambiguous, led to delay—lay jurors can infer fault | Walkup: order was clinically adequate; nurses should have called for clarification if needed; clinical meaning requires medical context | Expert testimony required to establish that the order breached standard of care; res ipsa inapplicable; summary judgment proper |
Key Cases Cited
- Koon v. United States, 518 U.S. 81 (discussing interplay of standards of appellate review)
- Blankenship v. Collier, 302 S.W.3d 665 (Ky. 2010) (lack of expert testimony is a failure of proof warranting summary judgment except in limited circumstances)
- Baptist Healthcare Sys., Inc. v. Miller, 177 S.W.3d 676 (Ky. 2005) (trial-court discretion to grant continuance to secure expert; admissibility vs. sufficiency distinction)
- Miller v. Eldridge, 146 S.W.3d 909 (Ky. 2004) (standards for appellate review of evidentiary rulings)
- Perkins v. Hausladen, 828 S.W.2d 652 (Ky. 1992) (medical malpractice generally requires expert testimony)
- Jarboe v. Harting, 397 S.W.2d 775 (Ky. 1965) (res ipsa loquitur exception where lay experience suffices to infer negligence)