Title: Jewish Hospital v. House

State: kentucky

Issuer: Kentucky Supreme Court

Document:

RENDERED: DECEMBER 13, 2018 TO BE PUBLISHED 2017-SC-000440-DG JEWISH HOSPITAL & ST. MARY’S HEALTHCARE, INC. D/B/A JEWISH HOSPITAL MEDICAL CENTER SOUTH APPELLANT V. ON REVIEW FROM COURT OF APPEALS CASE NOS. 2015-CA-001205 AND 2015-CA-001278 BULLITT CIRCUIT COURT NO. 12-CI-Ol 132 BARBARA HOUSE, ADMINISTRATRIX OF THE ESTATE OF LAURA B. ALEXANDER, DECEASED; BARBARA HOUSE, CO­ GUARDIAN OF KAYLEN ALEXANDER, A MINOR; AND DARRELL HOUSE, CO­ GUARDIAN OF KAYLEN ALEXANDER, A MINOR APPELLEES OPINION OF THE COURT BY JUSTICE KELLER REVERSING AND REINSTATING Laura Ale xande r was a patie nt at Je wish Hospital Me dical Ce nte r South (“Je wish Hospital”). She was tre ate d and re le ase d on Nov e mbe r 28, 2011. Tragically, late r that e v e ning, Laura was take n by ambulance to Je wish Hospital in downtown Louisv ille . She die d se v e ral hours late r from cardiac arre st se condary to a staph aure us infe ction in he r blood. Barbara House , Laura’s mothe r and administratrix of he r e state , brought suit in Bullitt Circuit Court, alle ging me dical malpractice against Dr. Charle s She rrard, Jr., Je wish Hospital, and Dr. She rrard’s profe ssional group. Dr. She rrard se ttle d the claims against him but the case against Je wish Hospital proce e de d to trial, afte r which a jury found in fav or of Je wish Hospital. The Court of Appe als re v e rse d and re mande d for a ne w trial. This Court grante d discre tionary re v ie w. For the following re asons, we now re v e rse and re instate the judgme nt of the Bullitt Circuit Court. I. BACKGROUND Laura, the n thirty-thre e ye ars old, came into Je wish Hospital’s Eme rge ncy Room (“ER”) e arly on the morning of Nov e mbe r 28, 2011. She complaine d of dark urine , fe e ling de hydrate d, muscular pain, and we akne ss in he r arms and le gs. Although he r blood pre ssure was in the normal range , he r he artrate was e le v ate d at 148 be ats pe r minute (bpm). Dr. She rrard e v aluate d Laura at approximate ly 6:15 a.m.; he obtaine d a me dical history, orde re d lab te sts, and orde re d two lite rs of intrav e nous fluids to be administe re d. Early during Laura’s stay, the nursing shift change d, and Nurse Charity Johnston be gan assisting in Laura’s tre atme nt. Johnston administe re d the first lite r of fluids at 6:30 a.m.; at 8:08 a.m.. Dr. She rrard re -e v aluate d Laura and note d that he r he artrate had de cre ase d to be twe e n 114 and 118 bpm. During this re -e v aluation, Laura informe d Dr. She rrard that she had e xe rcise d stre nuously a fe w days e arlie r. Due to this ne w information. Dr. She rrard suspe cte d that Laura’s symptoms we re cause d by rhabdomyolysis, muscle fibe rs bre aking down afte r physical damage . Laura’s potassium was de cre ase d in he r lab re sults so Dr. She rrard also diagnose d Laura with hypokale mia, a potassium de ficie ncy, as we ll as acute de hydration, e xe rcise d-induce d myositis (inflammation of muscle tissue ), and myofascial (muscular irritation) pain. At 8:15 a.m.. Dr. She rrard e nte re d an orde r discharging Laura, conditione d upon he r re ce iv ing a se cond lite r of fluids. Johnston administe re d the se cond lite r at 8:18 a.m. At that time , Laura’s he artrate was 124 bpm. At 9:47 a.m., Johnston discharge d Laura. At that time he r he artrate was 132 bpm. Although he r he artrate was lowe r than whe n she first pre se nte d in the ER, it was highe r than whe n Dr. She rrard had last e v aluate d Laura. Johnston did not notify Dr. She rrard of this change but, inste ad, continue d with the discharge instruction. Johnston state d that she fe lt, in he r nursing judgme nt, that Laura’s he artrate at discharge was consiste nt with what it had be e n at the time Dr. She rrard had orde re d the conditional discharge . Laura’s discharge from Je wish Hospital, while still tachycardic, was the focal point of the alle ge d malpractice of both Dr. She rrard and Nurse Johnston. During his de position te stimony. Dr. She rrard e xplaine d that the re we re se v e ral factors he fe lt contribute d to Laura’s incre ase d he artrate : she had just finishe d taking Fle xe ril (pre scribe d for muscular pain) which can cause tachycardia; tachycardia can occur with de hydration and may not comple te ly re solv e with fluids; and Laura’s he artrate at a re ce nt v isit to the ER was also abov e 100, so he r base line may be highe r than normal. Laura we nt home with he r mothe r and spe nt most of the day in be d. At about 7:00 p.m. that same e v e ning, Laura e xpe rie nce d sudde n shortne ss of bre ath and paralysis in he r arms and le gs. She was take n by ambulance to Je wish Hospital’s downtown Louisv ille facility. Afte r a thorough e xamination and aggre ssiv e care , doctors de te rmine d that Laura was in se ptic shock. Whe n Laura v isite d the e me rge ncy room e arlie r that day, she had not pre se nte d with fe v e r, chills, or any of the normal signs of infe ction, pe r Dr. She rrard. Upon admission that e v e ning, the doctors and nurse s at the downtown facility administe re d antibiotics upon de te rmining she was in se ptic shock. Sadly, the profe ssionals we re unable to sav e Laura. She passe d away shortly afte r midnight from cardiac arre st, se condary to a staph aure us infe ction in he r blood. It was late r de te rmine d that Laura had be e n tre ate d se v e ral we e ks prior for a boil;1 it had be e n surgically lance d and was the probable cause of the se psis that le d to Laura’s de ath. Dr. She rrard se ttle d Laura’s e state ’s claims against him. The claims against Je wish Hospital proce e de d to trial. Dr. She rrard was not pre se nt at trial; his v ide o de position was playe d for the jury. He was still include d as a party to the proce e dings for apportionme nt purpose s unde r Ke ntucky Re v ise d Statute (“KRS”) 411.182.2 At the close of plaintiffs case , Je wish Hospital’s counse l mov e d for dire cte d v e rdict, claiming that the plaintiffs had faile d to prov e causation. The trial court de nie d the motion. Je wish Hospital the n 1 This fact was unknown to Dr. She rrard or Je wish Hospital pe rsonne l whe n Laura came into the ER that morning. 2 “In all tort actions ... inv olv ing fault of more than one (1) party ... including third-party de fe ndants and pe rsons who hav e be e n re le ase d ... the court ... shall instruct the jury to answe r inte rrogatorie s ... indicating: (a) The amount of damage s e ach claimant would be e ntitle d to re cov e r if contributory fault is disre garde d; and (b) The pe rce ntage of the total fault of all the partie s to e ach claim that is allocate d to e ach claimant, de fe ndant, third-party de fe ndant, and pe rson who has be e n re le ase d from liability ...” KRS 411.182(1). 4 mov e d for dire cte d v e rdict on standard of care as to Dr. She rrard; counse l argue d that it was undispute d by the partie s that Dr. She rrard’s conduct fe ll be low the standard of care . Laura’s e state ’s counse l argue d that, from Dr. She rrard’s v ide o te stimony, he te stifie d that his conduct was appropriate . Be cause Dr. She rrard was an e xpe rt witne ss, this te stimony was sufficie nt to cre ate an issue of fact for the jury. The judge grante d Je wish Hospital’s motion, stating that e ach of the e xpe rt witne sse s pre se nte d by Laura’s e state had te stifie d that Dr. She rrard’s conduct was be low the standard of care . The case was pre se nte d to the jury with an instruction that Dr. She rrard had falle n be low the standard of care . The jury re turne d a v e rdict for Je wish Hospital. The Estate appe ale d. The Court of Appe als de te rmine d that, not only was the trial court’s grant of dire cte d v e rdict in e rror, but also he ld that a trial court cannot grant a dire cte d v e rdict of ne glige nce against an e mpty-chair de fe ndant. The Court of Appe als cite d to this Court’s case in CertainTeed Corp. V. Dexter, 330 S.W.3d 64 (Ky. 2010) as the foundation of its broad holding. The Court of Appe als re v e rse d the judgme nt and re mande d the case for a ne w trial. Je wish Hospital mov e d this Court for discre tionary re v ie w, which we grante d. II. STANDARD OF REVIEW On appe al, the ce ntral issue be fore this Court is whe the r the trial court e rre d in granting a dire cte d v e rdict on the issue of Dr. She rrard’s failing to me e t the re le v ant standard of care . “[A] trial judge cannot e nte r a dire cte d v e rdict unle ss the re is a comple te abse nce of proof on a mate rial issue or if no dispute d issue s of fact e xist upon which re asonable minds could diffe r.’' Argotte v. Harrington, 521 S.W.3d 550, 554 (Ky. 2017) (quoting Bierman v. Klapheke, 967 S.W.2d 16, 18-19 (Ky. 1998)). “The trial court must draw all fair and re asonable infe re nce s from the e v ide nce in fav or of the party opposing the motion.” Argotte, 521 S.W.Sd at 554 (quoting Commonwealth v. Sawhill, 660 S.W.2d 3, 5 (Ky. 1983)). “On appe llate re v ie w of an orde r granting a dire cte d v e rdict, the te st is whe the r Tinde r the e v ide nce as a whole it would not be cle arly unre asonable for a jury to find [for the plaintiff|.’” Argotte, 521 S.W.3d at 554 (quoting Sawhill, 660 S.W.2d at 5). III. ANALYSIS A. MAY A TRIAL COURT ENTER DIRECTED VERDICT AGAINST AN EMPTY-CHAIR DEFENDANT? On dire ct appe al, the Court of Appe als discusse d the oddity of a plaintiffs case inv olv ing an e mpty-chair de fe ndant. “The plaintiffs strate gy in such case s is turne d on its he ad.” The plaintiff no longe r hope s to prov e this abse nt actor at fault, but rathe r to minimize that party’s comparativ e fault and, thus, maximize re cov e ry from the party proce e ding to trial. Noting this irre gularity, the Court of Appe als cite d to this Court’s opinion in CertainTeed v. Dexter, stating that “[e ]mpty-chair de fe ndants who hav e se ttle d are to be tre ate d no diffe re ntly than participating de fe ndants in re gard to what must be prov e d to apportion fault against the m [e v e n t]hough the e mpty-chair de fe ndant will not actually be he ld liable in the trial, since it is lite rally not on trial ...” 330 S.W.3d 64, 74 (Ky. 2010). In an atte mpt to clarify the rule , the Court of Appe als state d: “the party who benefits by the jury’s be lie f in the fault of the e mpty-chair de fe ndant be ars the burde n of prov ing by a pre ponde rance of the e v ide nce e v e ry e le me nt of the e mpty-chair de fe ndant’s liability, just as if he or she was still e xpose d to inde te rminate liability and still had a pre se nce in the courtroom.” The “crux” of the re v e rsible e rror found by the Court of Appe als was “the trial court’s failure to conside r the e ffe ct of the shifting burde n of proof in an e mpty-chair de fe ndant tort case .” The Court of Appe als de te rmine d the dire cte d v e rdict as to Dr. She rrard’s liability was, the re fore , pre mature . “[W]e would ne v e r hav e pe rmitte d a dire cte d v e rdict at the close of the plaintiffs case against Je wish Hospital - the “participating de fe ndant[]” as CertainTeed would call it.” Applying the same rule to the sce nario be fore it, the Court of Appe als plainly he ld: “No dire cte d v e rdict may be e nte re d against an e mpty-chair de fe ndant prior to the close of all e v ide nce .” To de te rmine whe the r such a holding is corre ct, this Court must first analyze its own pre ce de nt in CertainTeed to de te rmine the true implications of that case . Additionally, we must probe the rule on dire cte d v e rdicts and the n, applying CertainTeed, de cide how the rule s and pre ce de nt must co-e xist. 1. CertainTeed v. Dexter CertainTeed v. Dexter was an asbe stos-re late d products liability case against nine te e n se parate de fe ndants. 330 S.W.3d at 68. All but two de fe ndants se ttle d or we re dismisse d from the case , le av ing only the two re maining de fe ndants to proce e d to trial. Id. The othe r se v e nte e n de fe ndants we re conside re d “e mpty-chair” de fe ndants at trial. Id. De xte r was a pipe fitte r from 1946 until 1984. Id. He was diagnose d with lung cance r and sue d the nine te e n de fe ndants for products liability and ne glige nce . Id. at 69. The nine te e n companie s e ithe r made asbe stos products, which De xte r use d in his work, or owne d buildings in which De xte r was e xpose d to asbe stos. Id. At trial, Ce rtainTe e d was one of the pre se nt de fe ndants; the proof showe d that De xte r was only e xpose d to Ce rtainTe e d’s products for one we e k out of his forty-ye ar care e r. Id. De spite a we alth of proof that much of De xte r’s e xposure was due to the e mpty-chair de fe ndants, the jury allocate d no fault to any of the abse nt de fe ndants. Id. The trial court, upon de fe nse motion, grante d a ne w trial be cause this failure to apportion fault to any e mpty-chair de fe ndant was manife stly against the e v ide nce . Id. at 69-70. On re trial, the jury did allocate fault to some of the e mpty-chair de fe ndants. Id. at 70. Plaintiffs the n appe ale d, arguing that that trial court e rre d in granting the ne w trial. Id. Proce durally, this Court addre sse d the standard of re v ie w for a trial court’s grant of ne w trial but, substantiv e ly, this Court grapple d with how to tre at e mpty-chair de fe ndants for apportionme nt purpose s. Id. at 71-74. “Ordinarily, to apportion fault among multiple tortfe asors, the plaintiff must prov e e ach tortfe asor’s liability be yond the plaintiff[’]s burde n of proof[],]” Id. at 73. But, whe n one de fe ndant se ttle s, le av ing anothe r de fe ndant at trial, “[t]he burde n of proof in such a case is e ffe ctiv e ly shifte d[.]’’ Id. Rathe r than a plaintiff atte mpting to maximize all partie s’ liability, a de fe ndant atte mpts to shift blame onto anothe r party, minimizing the re cov e ry against the m. “[I]t is the participating de fe ndant, not the plaintiff, who se e ks to show that the 8 e mpty-chair de fe ndant is re sponsible .” Id. “[T]he participating de fe ndant is me re ly se e king a re duction of its liability.” Id. To thus still re quire a plaintiff to prov e liability as to a se ttling de fe ndant would be counte r-productiv e ; it would also disince ntiv ize plaintiffs from se ttle me nt in some ways. For what is the point of se ttle me nt if a plaintiff must still carry the burde n against that de fe ndant for re cov e ry against a se parate e ntity? To simplify the proce ss and clarify the law, this Court atte mpte d to e xplain how to tre at the se abse nte e de fe ndants: Empty-chair de fe ndants who hav e se ttle d are to be tre ate d no diffe re ntly than participating de fe ndants in re gard to what must be prov e d to apportion fault against the m. Though the e mpty-chair de fe ndant will not actually be he ld liable in the trial, since it is lite rally not on trial, a participating de fe ndant must still prov e liability on the part of the tortfe asor onto whom it se e ks to shift some of the blame . Id. at 74. This principle is consiste nt with Ke ntucky’s adoption of comparativ e fault. Id. If the e v ide nce is sufficie nt to submit an e mpty-chair de fe ndant’s fault to the jury, such an allocation comports with the principle s of comparativ e ne glige nce . Id. The Court the n applie d the law to De xte r’s case . Id. at 75-83. Much of the e v ide nce pre se nte d, by both De xte r and Ce rtainTe e d, showe d that De xte r’s e xposure to asbe stos was cause d, at le ast in part, by the e mpty-chair de fe ndants. Id. Thus, the trial court did not e rr in granting a ne w trial to prov ide for apportionme nt among all pote ntially liable partie s, whe the r those partie s we re at trial or not. Id. at 83. Contrary to the state me nts of the Court of Appe als in this case , CertainTeed was not a broad policy de cision, dictating e v e ry proce dural ste p in a case with an e mpty-chair de fe ndant. Rathe r, the case re late d to a v e ry spe cific que stion: what must a de fe ndant pre se nt in its case to cre ate sufficie nt basis to pre se nt the jury with an e mpty-chair de fe ndant’s apportionme nt of fault? Howe v e r, as in many are as of the law, a solution to one proble m will ine v itably le ad to furthe r que stions. Case s inv olv ing e mpty-chair de fe ndants are comple x, to be sure . The imme diate case be fore us pre se nts anothe r such issue : how should trial courts tre at e mpty- chair de fe ndants in motions for dire cte d v e rdict unde r Ke ntucky Rule of Civ il Proce dure (“CR”) 50.01? 2. Kentucky Rule of Civil Procedure (“CR”) 50.01 CR 50.01, the rule on a motion for dire cte d v e rdict, state s: A party who mov e s for a dire cte d v e rdict at the close of the e v ide nce offe re d by an oppone nt may offe r e v ide nce in the e v e nt that the motion is not grante d, without hav ing re se rv e d the right so to do and to the same e xte nt as if the motion had not be e n made . A motion for a dire cte d v e rdict which is not grante d is not a waiv e r of trial by jury e v e n though all partie s to the action hav e mov e d for dire cte d v e rdicts. A motion for a dire cte d v e rdict shall state the spe cific grounds the re for. The orde r of the court granting a motion for a dire cte d v e rdict is e ffe ctiv e without any asse nt of the jury. CR 50.01. “Unde r Ke ntucky law, a motion for dire cte d v e rdict ... should be grante d only if ‘the re is a comple te abse nce of proof on a mate rial issue in the action, or if no dispute d issue of fact e xists upon which re asonable minds could diffe r.’” Morales v. American Honda Motor Co., Inc., 151 F.3d 500, 506 (6th Cir. 1998) (quoting Adam v. J.B. Hunt Transp., Inc., 130 F.3d 219, 231 (6th Cir. 1997) (quoting Washington v. Goodman, 830 S.W.2d 398, 400 (Ky. App. 1992))). “The controlling single que stion on a motion for a dire cte d v e rdict, 10 e ithe r at the close of plaintiffs e v ide nce , or at the close of all e v ide nce , is whe the r the plaintiff has sustaine d the burde n of proof by ‘more than a scintilla of e v ide nce ’[.]” James v. England, 349 S.W.2d 359, 361 (Ky. 1961) (citing Wadkins’ Adm’x v. Chesapeake & Ohio Railway Co., 298 S.W.2d 7 (Ky. 1956)). Howe v e r, the language of this pre ce de nt le ads to the ine v itable difficulty in the case be fore us. The trial court did not grant a dire cte d v e rdict in the “comple te abse nce of proof on a mate rial issue in the action.” Quite to the contrary, the trial court de te rmine d the re was nothing le ft for the jury to de te rmine against an abse nt party and e nte re d a partial dire cte d v e rdict on an issue of liability. Thus, the trial court de te rmine d the re was no dispute as to a mate rial issue in the action. The trial court did not que stion whe the r the “plaintiff has sustaine d [its] burde n.” Unde r CertainTeed, it was not the Estate ’s burde n he re to prov e Dr. She rrard’s liability or lack the re of. Inste ad, it was Je wish Hospital’s burde n to pre se nt e v ide nce shifting the apportionme nt of fault to Dr. She rrard’s bre ach of the standard of care . Pe rhaps it is this confusing jumble of que stions that pre se nts such a quandary as to the appropriate ne ss of the trial court’s actions he re . For re ally, what the court grante d was not a dire cte d v e rdict. The court’s so-calle d dire cte d v e rdict at the close of plaintiffs case was more similar, in practice , to a partial summary judgme nt as to the issue of Dr. She rrard’s bre ach of duty. “In Ke ntucky, ... a ruling on a summary judgme nt is a more de licate matte r and [] its inquiry re quire s a gre ate r judicial de te rmination and discre tion since it 11 take s the case away from the trie r of fact be fore the e v ide nce is actually he ard.” Steelvest, Inc. v. Scansteel Serv. Ctr., Inc., 807 S.W.2d 476, 482 (Ky. 1991) (citing Payne v. Chenault, 343 S.W.2d 129 (Ky. 1960) and Rowland v. Miller’s Adm’r, 307 S.W.2d 3 (Ky. 1956)). “The re is a gre at diffe re nce be twe e n discov e ring whe the r the re be an issue of fact and de ciding such an issue .” Rowland, 307 S.W.3d at 6 (citing Farrall v. Dist. of Columbia Amateur Athletic Union, 153 F.2d 647 (D.C. Cir. 1946)). He re , Je wish Hospital argue d that the re was “no dispute ” as to Dr. She rrard’s bre ach of the standard of care . In this way, the motion was more like one of a partial summary judgme nt rathe r than a dire cte d v e rdict. Howe v e r, this doe s not re solv e the issue be fore this Court be cause what the trial court grante d, and instructe d the jury on, was a partial dire cte d v e rdict. What is still pe rple xing within this case is the proce dural posture of the partie s at the time of the motion. To place this discussion in pe rspe ctiv e , le t us e xamine the ordinary issue be fore a court whe n de te rmining whe the r a dire cte d v e rdict is appropriate . In the criminal conte xt, the Commonwe alth pre se nts its case against a de fe ndant. At the close of that e v ide nce , the de fe ndant mov e s for dire cte d v e rdict, claiming that the Commonwe alth has failed to me e t its burde n in prov ing the case . The situation pre se nte d by Je wish Hospital is quite diffe re nt. In the same criminal conte xt, the analogous situation would be : the Commonwe alth proce e ds to trial against two co-de fe ndants. At the close of the Commonwe alth’s e v ide nce , one co-de fe ndant re que sts a dire cte d v e rdict against his co-de fe ndant, claiming the re is going to be no e v ide nce to disprov e that co-de fe ndant’s guilt. 12 To unde rstand and re solv e the issue be fore us, this Court must de lv e into the me chanics and inte nt of CR 50.01. The re are two type s of dire cte d v e rdicts; (1) “the most common type of dire cte d v e rdict, whe re the claimant lose s be cause claimant’s proof is inade quate f;]” and (2) “whe n the claimant’s e v ide nce is ov e rwhe lming, and in the analogous situations whe n the e v ide nce on a de fe nse is e ithe r inade quate or ov e rwhe lming.” Michae l J. Waggone r, New Rule 50 May End Directed Verdicts for Plaintiffs, 22 SW. U.L. Rev. 389, 391 (1993). In civ il case s, both the se type s of dire cte d v e rdicts are av ailable unde r Ke ntucky law.3 See Droppelman v. Willingham, 169 S.W.2d 811, 814 (Ky. 1943) (“Dire cte d v e rdicts for plaintiffs in ne glige nce case s are rare , but whe n the undispute d e v ide nce points une rringly to ne glige nce of the de fe ndant as the cause of the accide nt, a dire ct v e rdict for the plaintiff is prope r.”). Importantly, such a dire cte d v e rdict in favor of a plaintiff would only be pe rmissible unde r CR 50.01 at the close of the de fe ndant’s proof. A party may mov e “for a dire cte d v e rdict at the close of the evidence offered by an opponent...” CR 50.01. Thus, a plaintiff must prope rly wait until a de fe ndant has pre se nte d its proof be fore re que sting such a dire cte d v e rdict.4 What CR 50.01 inte nds is to 3 The corollary dire cte d v e rdict for the Commonwe alth, or plaintiff, in a criminal case , howe v e r, is not proce durally prope r. “It is ne v e r prope r for a trial court to dire ct a v e rdict of guilty whe re the re is a ple a of not guilty, de spite the fact that the e v ide nce of his guilt may be conv incing and wholly uncontradicte d.” Taylor v. Commonwealth, 125 S.W.3d 216, 219 (Ky. 2003) (citing Commonwealth v. Durham, 57 S.W.3d 829 (Ky. 2001)). 4 This proposition is supporte d by a case cite d by the Estate , Sherrard v. Oakley, 413 S.W.2d 78, 78 (Ky. 1967). The re , the Court de te rmine d that plaintiffs could not obtain a dire cte d v e rdict at the close of plaintiffs’ e v ide nce . Id. “Cle arly the trial court had no powe r to cut off de fe ndant’s right to pre se nt his case , if he so 13 allow the party opposing the motion for dire cte d v e rdict to hav e had an opportunity to pre se nt its proof prior to be ing fore close d from doing such. The rule cle arly e ncompasse s motions for dire cte d v e rdict by de fe ndants against plaintiffs and plaintiffs against de fe ndants in the prope r situation. But, what re mains uncle ar from the language of the rule is whe the r one de fe ndant may obtain a dire cte d v e rdict against anothe r de fe ndant, at the close of plaintiffs e v ide nce . If Dr. She rrard had be e n pre se nt at trial, we must hold that the timing of Je wish Hospital’s motion was imprope r. The motion for dire cte d v e rdict was against Dr. She rrard, not the Estate . Although the Estate had its opportunity to pre se nt proof, the party against whom the motion was made had not had an opportunity to pre se nt its case . CR 50.01 state s that the motion for dire cte d v e rdict is “at the close of the e v ide nce offe re d by an oppone nt.” The only common-se nse unde rstanding of this rule is that the oppone nt to the motion is the same “oppone nt” that must hav e close d its offe r of e v ide nce . Thus, in the ory, a co-de fe ndant may mov e for dire cte d v e rdict against anothe r co-de fe ndant but only afte r that co-de fe ndant has pre se nte d its proof or de cline d to pre se nt any proof. This Court’s pre de ce ssor addre sse d such an issue in Lyon v. Prater, 351 S.W.2d 173 (Ky. 1961). The re , the Prate rs we re passe nge rs in Lyon’s v e hicle . Id. at 174-75. The Lyon and Collie r v e hicle s collide d, and the Prate rs sought damage s against both partie s. Id. Collie r mov e d for dire cte d v e rdict at the de sire d, by sustaining a motion of the plaintiffs for a dire cte d v e rdict at the close of the ir case .” Id. 14 close of the Prate rs’ e v ide nce . Id. at 175. The Court he ld that “the prope r practice be fore dire cting a v e rdict in fav or of one of two or more de fe ndants is to allow the othe r de fe ndant to pre se nt his te stimony on the que stion of the liability of e ach and all the de fe ndants, and e v ide nce of one de fe ndant... may inculpate the othe r the same as though prov e d as a part of the plaintiffs case .” Id. at 175-76. In othe r words, the party against whom a dire cte d v e rdict motion is made must hav e an opportunity to pre se nt proof. Pursuant to Lyon, e v e n whe n a co-de fe ndant mov e s for dire cte d v e rdict against the plaintiff, the othe r co-de fe ndant should hav e an opportunity to pre se nt proof. See id. This implication is se nsible ; for one co-de fe ndant’s the ory of the case may be to shift blame to the othe r co-de fe ndant, just as was the case in the trial be low. Thus, be fore dire cting a v e rdict, it is practical to allow all the pote ntial proof against the party making the motion to be e nte re d and conside re d by the trial court. Ye t, Dr. She rrard was not at trial. If he had be e n, his attorne y would hav e like ly made this argume nt upon Je wish Hospital’s motion for dire cte d v e rdict. Dr. She rrard had no opportunity to pre se nt proof and any such dire cte d v e rdict must wait until afte r such opportunity has be e n prov ide d. But Dr. She rrard, as state d, was not pre se nt at trial. He was not going to pre se nt any proof in re sponse to the Estate ’s case . So what e ffe ct doe s it cre ate whe n one of the se co-de fe ndants is not a pre se nt, physical party at trial? To unde rstand the inte rplay be twe e n CR 50.01 and this Court’s case law on e mpty-chair de fe ndants, we must apply the law of CertainTeed to CR 50.01. 15 3. Applying CertainTeed to CR 50.01 “Empty-chair de fe ndants who hav e se ttle d are to be tre ate d no diffe re ntly than participating de fe ndants in re gard to what must be prov e d to apportion fault against the m.” CertainTeed, 330 S.W.3d at 74. The Court of Appe als de te rmine d that this rule should be e xte nde d to me an that e mpty-chair de fe ndants who hav e se ttle d should be tre ate d no diffe re ntly than participating de fe ndants. The Court of Appe als, in e sse nce , re mov e d the piv otal cav e at to the CertainTeed rule : e mpty-chair de fe ndants must be tre ate d the same as participating de fe ndants whe n determining apportionment of fault. The rule was crafte d to comport with comparativ e fault principle s to addre ss a spe cific issue : how to de al with apportionme nt afte r one de fe ndant, but not all de fe ndants, has se ttle d. In such a situation, “it is the participating de fe ndant, not the plaintiff, who se e ks to show that the e mpty-chair de fe ndant is re sponsible .” Id. at 73. “[T]he participating de fe ndant is me re ly se e king a re duction of its liability.” Id. The CertainTeed rule is not automatic; e mpty- chair de fe ndants should not, unde r any and all possible circumstance s, be conside re d e xactly the same as participating de fe ndants. Such a bright-line rule would ine v itably cre ate confusion. Howe v e r, if allocation of fault is concomitant to the issue be fore the court, the n the courts must e nde av or to apply the CertainTeed rule and tre at e mpty-chair de fe ndants the same as pre se nt de fe ndants to prote ct the rights of all the partie s inv olv e d. The que stion the n be come s whe the r this proce dural oddity—a pre se nt de fe ndant se e king a dire cte d v e rdict against an e mpty-chair de fe ndant—is also 16 so inte rtwine d with the apportionme nt of fault issue as to apply the CertainTeed rule and re quire us to tre at the e mpty-chair de fe ndant the same as the pre se nt de fe ndant. This Court holds that Je wish Hospital’s motion for dire cte d v e rdict against Dr. She rrard cle arly implicate s apportionme nt of fault. Je wish Hospital’s e ntire motiv ation in showing Dr. She rrard had, in fact, bre ache d his standard of care , was to minimize or e liminate its own liability for Laura’s de ath. As such, the apportionme nt of fault be come s an issue and we must apply the CertainTeed rule . We must tre at the motion as though Dr. She rrard was pre se nt at trial, just as any othe r participating de fe ndant. If Je wish Hospital had mov e d for dire cte d v e rdict at the close of the Estate ’s e v ide nce , and Dr. She rrard had be e n pre se nt, the trial court’s grant would cle arly be in e rror. Dr. She rrard had no opportunity to pre se nt e v ide nce and de fe nd himse lf. Unde r Lyon, the court should hav e pe rmitte d e ach co­ de fe ndant to pre se nt its case be fore e nte rtaining any dire cte d v e rdict motions against any of those partie s. See 351 S.W.2d at 175-176. Ev e n unde r the cle ar language of CR 50.01, the motion was not made at the close of the e v ide nce of the party against whom the motion was made . Granting this proce durally de funct dire cte d v e rdict was cle arly in e rror. We de cline to hold as broadly as the Court of Appe als and say that such a dire cte d v e rdict is always in e rror. Howe v e r, in applying the CertainTeed rule and CR 50.01, we hold that the dire cte d v e rdict at issue here was in e rror. As such, instructing the jury as to Dr. She rrard’s bre ach of duty, re fle cting the e rrone ous dire cte d 17 v e rdict, was also in e rror. But, we must de te rmine whe the r, as Je wish Hospital argue s, that e rror was me re ly harmle ss and doe s not re quire re v e rsal. B. WAS THE ERROR IN GRANTING DIRECTED VERDICT HARMLESS? It is a “se ttle d maxim that ‘e rrone ous jury instructions are pre sume d to be pre judicial.]” Commonwealth v. Caudill, 540 S.W.3d 364, 367 (Ky. 2018) (quoting Mason v. Commonwealth, 331 S.W.3d 610, 623 (Ky. 2011) (citing Harp V. Commonwealth, 266 S.W.3d 813, 818 (Ky. 2008))). Howe v e r, this Court has, on occasion, de te rmine d such e rror doe s not re quire re v e rsal if the “pre sumption [of pre judice ] can be succe ssfully re butte d upon a showing that the e rror was harmle ss.” Caudill, 540 S.W.3d at 367 (quoting Commonwealth V. McCombs, 304 S.W.3d 676, 680 (Ky. 2009) (citing Harp, 266 S.W.3d at 818)); see also Weaver v. Brooks, 350 S.W.2d 639, 640 (Ky. 1961) (citing Miller v. Miller, 296 S.W.2d 684 (Ky. 1956)) (Stating that “te chnically incorre ct instructions are not grounds for re v e rsal whe re the rights of the losing party are not pre judice d.”). “[T]he party de fe nding the e rrone ous instruction be ars the burde n of showing that no pre judice re sulte d.” Sargent v. Shaffer, 467 S.W.3d 198, 212 (Ky. 2015) (citing McKinney v. Heisel, 947 S.W.2d 32, 35 (Ky. 1997)). The burde n is upon Je wish Hospital to show that the Estate was not pre judice d by the e rrone ous instruction he re and that re v e rsal is, thus, not re quire d. The Estate asse rts that the jury could hav e e asily be e n imprope rly swaye d by the instruction as to Dr. She rrard’s bre ach of duty, le ading to the pre judicial v e rdict against the Estate . To me e t its burde n, Je wish Hospital 18 state s that, at trial, it ne v e r argue d that Dr. She rrard’s ne glige nce caused Laura’s de ath. Inste ad, its argume nt was that any failure in Dr. She rrard’s care did not le ad to Laura’s de ath. Its argume nt in closing re fute d any ne glige nce on Je wish Hospital’s part but, alte rnativ e ly, any ne glige nce in e ithe r Nurse Johnston or Dr. She rrard’s conduct was not the le gal cause of Laura’s untime ly de ath. Howe v e r, the core of Je wish Hospital’s harmle ss e rror argume nt is that, be cause the instruction as to Dr. She rrard’s bre ach of care (Instruction No. 2) was afte r Je wish Hospital’s liability instruction (Instruction No. 1), and the jury stoppe d with Instruction No. 1, the n the jury never reached Instruction No. 2 re garding Dr. She rrard. Ironically, he re , we hav e a war be twe e n two pre sumptions. It is a “se ttle d maxim that ‘e rrone ous jury instructions are pre sume d to be pre judicial!.]” Caudill, 540 S.W.3d at 367 (quoting Mason, 331 S.W.3d at 623 (citing Harp, 266 S.W.3d at 818)). Howe v e r, “[i]t is [also] pre sume d that the jury will follow instructions issue d to it by the trial court.” Morgan v. Scott, 291 S.W.3d 622, 643 (Ky. 2009) (citing Johnson v. Commonwealth, 105 S.W.3d 430, 436 (Ky. 2003) (quoting Scobee v. Donahue, 164 S.W.2d 947, 949 (Ky. 1942))). We pre sume instructions to be pre judicial, but we also pre sume that the jury followe d the instructions be fore it. If the jury did so he re , the n it did not utilize Instruction No. 2 in de ciding that Je wish Hospital had no liability in Laura’s de ath. The jury instructions, at issue he re , state d: 19 INSTRUCTION NO. 1 NEGLIGENCE OF JEWISH HOSPITAL SOUTH It was the duty of Je wish Hospital & St. Mary’s He althcare , Inc. d/b/a Je wish Hospital Me dical Ce nte r South (re fe rre d to he re afte r in the se instructions as “Je wish Hospital South”) and its e mploye e s to e xe rcise toward Laura Ale xande r that de gre e of care of and skill ordinarily e xpe cte d of re asonable and prude nt hospitals unde r similar circumstance s. If you are satisfie d from the e v ide nce that the y faile d to comply with that duty and that such failure on the ir part was a substantial factor in causing the de ath of Laura Ale xande r, you will find for the plaintiffs; othe rwise you will find for the hospital. Please Proceed to Interrogatory No. 1 INTERROGATORY NO. 1 NEGLIGENCE OF JEWISH HOSPITAL SOUTH Do you be lie v e from the e v ide nce that Je wish Hospital South and its e mploye e s faile d to e xe rcise the de gre e of care and skill ordinarily e xpe cte d of re asonable and prude nt hospitals unde r similar circumstance s and that such failure on the ir part was a substantial factor in causing the de ath of Laura Ale xande r? [Ye s/No and signature line s] If you answered “no” to Interrogatory No. 1 you have completed your deliberations and you should inform the Bailiff. If you have answered “yes” to Interrogatory No. 1 you shall proceed to Instruction No. 2. INSTRUCTION NO. 2 It was the duty of Dr. Charle s D. She rrard, Jr. in tre ating and atte nding Laura Ale xande r to e xe rcise the de gre e of care and skill e xpe cte d of a re asonably compe te nt physician acting unde r similar circumstance s. Dr. Charle s D. She rrard faile d to comply with that duty. If you are satisfie d from the e v ide nce that such failure was a substantial factor in causing Laura Ale xande r’s de ath, you will find for the Plaintiffs. Othe rwise you will find for Dr. She rrard. Proceed to Interrogatory No.2. INTERROGATORY NO. 2 NEGLIGENCE OF Dr. CHARLES D. SHERRARD,[] JR. Do you be lie v e from the e v ide nce that Dr. Charle s D. She rrard, Jr.’s failure to comply with his duty to e xe rcise the de gre e of care and skill e xpe cte d of a re asonably compe te nt physician acting unde r similar circumstance s was a substantial factor in causing Laura Ale xande r’s de ath? [Ye s/No and signature line s] Proceed to Instruction No. 3. The jurors che cke d “No” afte r Inte rrogatory No. 1, nine jurors and the fore man signe d the signature line s, and the jury the n re turne d to the courtroom. He re , 20 although the instructions are pre sume d to be pre judicial, we hold that the e v ide nce from the re cord prov e s that any e rror he re was harmle ss. Admitte dly, the trial judge re ad through the e ntire ty of the jury instructions be fore closing argume nts. Thus, although the jury may not hav e re ache d Instruction No. 2 in its de libe rations, it he ard the conte nt of that instruction prior to the close of the case . The jury he ard that the re had alre ady be e n a finding that Dr. She rrard’s conduct fe ll be low the standard of care . Je wish Hospital did re ite rate this fact, re fe re ncing that the judge had made this finding, during its closing argume nt. Howe v e r, the se pote ntial pre judice s are outwe ighe d by the proof in the re cord that this instruction was harmle ss. The implication of Instruction No. 2 is that Dr. She rrard was at fault, at le ast in part, for Laura’s de ath. In the Estate ’s ope ning state me nt, it blatantly state d that “Dr. She rrard has some blame in this case . His care was not e xe mplary ...” The Estate was also cle arly on notice that Je wish Hospital inte nde d to pursue this line of de fe nse . During Je wish Hospital’s ope ning state me nt, it said that Dr. She rrard’s inv olv e me nt was important. Je wish Hospital told the jury that the plaintiffs e v ide nce would show Dr. She rrard fe ll be low the standard of care , that he should not hav e discharge d Laura, and that he had a duty inde pe nde nt from Nurse Johnston. During closing argume nts, Je wish Hospital re ite rate d Dr. She rrard’s fault. It did state that the judge had found that his conduct fe ll be low the standard of care . Howe v e r, counse l told the jury it must de te rmine whe the r this conduct cause d Laura’s de ath and counse l argue d that it had not cause d 21 he r tragic de ath. Importantly, the Estate did not obje ct to any of the se state me nts as to Dr. She rrard’s inv olv e me nt. The Estate made similar state me nts in its closing as it did in ope ning. Counse l re ite rate d that Dr. She rrard “made a mistake ” and “made an incorre ct diagnosis.” He state d once again that the y all know Dr. She rrard did not me e t the standard of care ; he state d the ir e xpe rts had always maintaine d that. But, the Estate ’s counse l argue d, that failure had not be e n a substantial factor in Laura’s de ath. The Estate argue s the instruction on Dr. She rrard’s fault cloude d the jury’s v e rdict. Ye t, the jury was also re ad the instruction that allowe d it to find fault against both Dr. She rrard and Je wish Hospital. During closing argume nts, both Je wish Hospital and the Estate discusse d this apportionme nt and e xplaine d how the jury could div ide fault among the partie s. If we follow the Estate ’s logic, the n the jury would hav e unde rstood from all the se instructions that finding fault as to Dr. She rrard did not fore close the option of finding Je wish Hospital liable . The Estate cannot claim pre judice from a state me nt that Dr. She rrard had some fault in Laura’s de ath whe n it re pe ate dly made that same argume nt throughout trial proce e dings. We find it pe rsuasiv e that the jury re turne d to the courtroom afte r answe ring Inte rrogatory No. 1. Be cause it is pre sume d to follow instructions, that ne ce ssarily me ans that it did not re v ie w Instruction No. 2 whe n making its final de cision. Additionally, if the court had not grante d a dire cte d v e rdict as to Dr. She rrard’s liability, Je wish Hospital could still hav e made the same argume nts, subje ct to any re le v ant rule s of e v ide nce . The 22 de fe nse would hav e be e n practically ide ntical, e xce pt it would hav e had a pre se nt de fe ndant fighting against its liability argume nt. This Court is satisfie d from a thorough re v ie w of the re cord that the pre se nce of this e rrone ous instruction had no e ffe ct on the jury’s v e rdict. IV. CONCLUSION For the fore going re asons, we re v e rse the Court of Appe als and re instate the judgme nt of the Bullitt Circuit Court. Although we agre e with some of the Court of Appe als’ re asoning, we take this opportunity to re fine and e xplain our prior ruling in CertainTeed. Base d on that ruling, we hold that a dire cte d v e rdict by a pre se nt de fe ndant against an e mpty-chair de fe ndant falls unde r the CertainTeed rule . The re fore , the e mpty-chair de fe ndant must be tre ate d the same as any othe r de fe ndant in the case within this sce nario. Je wish Hospital’s motion for dire cte d v e rdict was proce durally infirm and the trial court’s granting of the dire cte d v e rdict was in e rror. Howe v e r, afte r thoroughly re v ie wing the re cord, we find such e rror was harmle ss. We thus re instate the judgme nt of the Bullitt Circuit Court. All sitting. Minton, C.J., Cunningham, Hughe s, Ke lle r, VanMe te r and Ve nte rs, JJ., concur. Wright, J., concurs in re sult only. 23 COUNSEL FOR APPELLANT: William Ke nne dy Simpson Jose ph Wright Thompson, Mille r & Simpson, PLC COUNSEL FOR APPELLEES: Ronald Wilt Ste phe n Klausing Jr. Wilt & Klausing, PLLC Jame s Dav id Ballinge r Ballinge r Law, PLLC 24