Court Opinion

ID: 9955770
Source: CourtListenerOpinion
Date Created: 2024-03-29 14:15:10.276854+00
Date Added: 2024-06-11T08:15:20.628981
License: Public Domain

RENDERED: MARCH 22, 2024; 10:00 A.M.
                  NOT TO BE PUBLISHED

          Commonwealth of Kentucky
                  Court of Appeals
                     NO. 2022-CA-0771-MR

CARRIE HALL, AS
ADMINISTRATOR OF THE ESTATE
OF HASSEL DARRELL HALL AND
ALICE HALL                                         APPELLANTS

           APPEAL FROM FLOYD CIRCUIT COURT
v.         HONORABLE THOMAS M. SMITH, JUDGE
                 ACTION NO. 17-CI-00215

HIGHLANDS HOSPITAL
CORPORATION                                          APPELLEE

AND

                     NO. 2022-CA-0773-MR

HIGHLANDS HOSPITAL
CORPORATION                                 CROSS-APPELLANT

         CROSS-APPEAL FROM FLOYD CIRCUIT COURT
v.         HONORABLE THOMAS M. SMITH, JUDGE
                  ACTION NO. 17-CI-00215

CARRIE HALL, AS
ADMINISTRATOR OF THE ESTATE
OF HASSEL DARRELL HALL AND
ALICE HALL                                                    CROSS-APPELLEES

                                  OPINION
                           AFFIRMING IN PART AND
                             REVERSING IN PART

                                   ** ** ** ** **

BEFORE: EASTON, JONES, AND LAMBERT, JUDGES.

JONES, JUDGE: The estate of Hassel Darrell Hall (“The Estate”) and Alice Hall,

his widow, appeal from an order of the Floyd Circuit Court which granted

summary judgment in favor of Highlands Hospital Corporation (“Highlands”),

resulting in dismissal of the estate’s claim for pain and suffering and Alice’s claim

for loss of consortium. Highlands filed a cross-appeal, arguing the trial court erred

in denying its motion for summary judgment related to the need for an expert

witness as to Hall’s medical expenses prior to his death or, alternatively, by not

granting its motion for directed verdict on the same issue at trial. We affirm the

trial court’s order granting summary judgment in favor of Highlands relating to the

claims for pain and suffering and loss of consortium. We reverse the final

judgment of the trial court because expert testimony was required with regard to

medical expenses; therefore, summary judgment should have been granted on

behalf of Highlands.

                                         -2-
                                        I. BACKGROUND

               In the days leading up to March 27, 2016, Hassel Hall was

experiencing shortness of breath, difficulty breathing, and low oxygen saturation

levels. On the evening of March 26, 2016, Hassel’s oxygen saturation levels

dropped into the mid-to-low sixties, but he refused to go to the hospital.1 Hassel

was prescribed oxygen therapy at all times due to emphysema, COPD,2 and coal

worker’s pneumoconiosis (black lung disease). He was also in consultation with a

pulmonologist specialist at the University of Kentucky for a possible lung

transplant.

               On the morning of March 27, 2016, Hassel finally agreed to go to the

emergency room at Highlands. His wife, Alice, drove him; their daughter, Carrie,

met them there. Carrie arrived first and went into the emergency department to

retrieve a wheelchair. Upon arrival, Hassel was alert and able to get himself out of

the car and into the wheelchair unassisted, while holding his portable oxygen tank.

Carrie then pushed Hassel into the emergency department.

1
  The Halls’ daughter, Carrie Hall, testified that Hassel’s oxygen saturation levels were never
above 92%. Although the medical records indicate Hassel’s wife, Alice, told medical personnel
at Highlands that Hassel’s oxygen saturation levels had dropped into the “mid-fifties” on March
26, 2016, in her testimony, Alice stated his levels only dropped as low as the mid-sixties.
“Normal oxygen saturation levels in a healthy individual are 96-99%.” Bryan v. CorrectCare-
Integrated Health, Inc., 420 S.W.3d 520, 522 n.1 (Ky. App. 2013).
2
    Chronic Obstructive Pulmonary Disease.

                                              -3-
             Testimony from hospital staff indicate Hassel was “blue,” “dusky,”

and “cyanotic” upon entering the emergency department. Upon arriving at the

triage window, Hassel became unresponsive. Carrie described it as “a seizure” and

testified he was biting his tongue and his head fell forward. Nancy Fraley, a triage

nurse at Highlands who witnessed the events, testified she knew Hassel was in

respiratory distress.

             At that point, hospital staff and Carrie began to transport Hassel

through triage for examination and treatment. Hassel was still in the wheelchair

obtained from hospital staff upon arrival, being pushed by Carrie. The wheelchair

did not have footrests and Hassel’s feet were dragging the floor. By all accounts,

Hassel was a large man and weighed approximately 250 pounds. Nurse Fraley and

a registration clerk, Jessica Scarberry, attempted to assist in the transport of Hassel

by lifting his feet off the floor. Upon doing so, the wheelchair tipped backward

and both Hassel and the wheelchair landed on Carrie, although Hassel remained in

the chair. Highlands’ staff were able to get Hassel upright in the wheelchair once

again, but upon lifting his legs, the wheelchair tipped backward for a second time,

and Hassel’s head struck the floor. Carrie described Hassel’s coloring as “black”

at that point. Hospital staff were able to get Hassel onto a gurney where they

started CPR. He was subsequently intubated. A CT scan of Hassel’s head was

                                          -4-
performed, among other testing and treatment. He also tested positive for

influenza.

                Eventually, doctors at Highlands decided to transport Hassel to

Pikeville Medical Center (“PMC”) for treatment. He was taken by ambulance to a

helipad, and from there he was airlifted to PMC. After arriving at PMC, another

CT scan of Hassel’s head was performed along with various other tests and

treatment. Hassel never regained consciousness and was removed from the

ventilator on March 29, 2016. He died approximately two minutes later. His death

certificate lists the immediate cause of death as severe anoxic brain injury due to

acute hypoxic respiratory failure due to coal worker’s pneumoconiosis and COPD.

                On March 23, 2017, the Estate filed the underlying complaint against

Highlands. The Estate maintained, and continues to maintain, that this is a general

negligence action based in premises liability. The Estate made claims for pain and

suffering, medical expenses, punitive damages, and Alice made a claim for loss of

consortium. Discovery ensued and, on March 10, 2021, the Estate filed its

preliminary witness list, which included the names of Hassel’s treating physicians

at Highlands and PMC. Although the Estate included a section entitled “Rule

26.02 disclosures,” the contents of this section failed to comply with CR3 26.02 or

3
    Kentucky Rule of Civil Procedure.

                                           -5-
the Agreed Scheduling Order of the parties. As a result, no expert witnesses were

disclosed by the Estate.

             The next day, Highlands filed a motion for summary judgment, citing

a lack of expert testimony by the Estate to prove injury, pain and suffering, and

medical expenses. At the hearing before the trial court, the Estate argued that there

was no “science” involved because this was not a medical malpractice case. The

Estate also admitted that it could not relate Hassel’s death to the wheelchair

tipping, but it could show that the wheelchair tipped twice, and Hassel hit his head

on the ground. Although the Estate argued expert medical testimony was not

necessary, it pointed to Hassel’s CT scan from Highlands to show what it

characterized as brain swelling due to the fall. The trial court entered an order

ruling that expert testimony was needed for any causal connection between the

wheelchair tipping and Hassel’s medical condition or death.

             As a result, the trial court dismissed the Estate’s wrongful death

claim, including medical expenses not caused by the wheelchair tipping event.

Alice’s loss of consortium claim was dismissed for the same reasons. The trial

court also found that expert testimony was needed to show pain and suffering

attributable to the wheelchair tipping, and therefore also dismissed that claim. The

trial court denied Highlands’ motion for summary judgment related to any medical

                                         -6-
expenses which the Estate could prove were specifically caused by the wheelchair

tipping.

             Discovery continued and, on June 23, 2021, Highlands filed a second

motion for summary judgment on all remaining medical expenses, arguing a lay

juror could not differentiate between medical expenses caused by Hassel’s

respiratory arrest and underlying conditions versus those caused by the wheelchair

tipping. It also asserted the Estate had not produced any testimony that pointed to

which expenses were specifically caused by the wheelchair tipping. Further,

Highlands argued the Estate could not establish that the wheelchair event, and not

Hassel’s other medical conditions, more likely than not caused the medical

expenses. The trial court denied the motion.

             In August 2021, Highlands moved the trial court to clarify which

medical expenses would be admissible at trial. The trial court held a hearing and

accepted an itemization of hospital expenses that the Estate’s counsel separated

from the rest of Hassel’s medical expenses for the three days he received treatment

and testing at Highlands and PMC. Although the Estate argued it should be

allowed to seek all $127,000 in medical expenses, the trial court allowed only

those expenses that the Estate’s counsel had determined were directly related to the

wheelchair tipping, which were approximately $46,000. The Estate presented no

lay or expert testimony at the hearing, or in any deposition prior to the hearing,

                                         -7-
about which medical expenses could be tied specifically to the wheelchair tipping

event. It does not appear from the record before us that the trial court entered an

order regarding permissible medical expenses.

              A three-day trial was held in April. Redacted medical bills totaling

$46,049.47 were admitted into evidence without any accompanying testimony

from lay or expert witnesses. The jury found for the Estate and awarded $40,000

in medical expenses. All parties appealed. Further facts will be developed as

necessary.

                             II. STANDARD OF REVIEW

              We begin by noting that Highlands appeals from a denial of a motion

for summary judgment or, in the alternative, from denial of its motion for directed

verdict at trial.

              The general rule under CR 56.03 is that a denial of a
              motion for summary judgment is, first, not appealable
              because of its interlocutory nature and, second, is not
              reviewable on appeal from a final judgment where the
              question is whether there exists a genuine issue of
              material fact. Bell v. Harmon, Ky., 284 S.W.2d 812
              (1955).

              However, there is an exception to the general rule found
              in Gumm v. Combs, Ky., 302 S.W.2d 616 (1957), and
              subsequently approved in Loy v. Whitney, Ky., 339
              S.W.2d 164 (1960), and Beatty v. Root, Ky., 415 S.W.2d
              384 (1967). The exception applies where: (1) the facts
              are not in dispute, (2) the only basis of the ruling is a
              matter of law, (3) there is a denial of the motion, and (4)
              there is an entry of a final judgment with an appeal

                                          -8-
             therefrom. Then, and only then, is the motion for
             summary judgment properly reviewable on appeal, under
             Gumm.

Transportation Cabinet, Bureau of Highways, Commonwealth of Ky. v. Leneave,

751 S.W.2d 36, 37 (Ky. App. 1988).

             In the case at bar, there are no factual disputes. The trial court ruled as

a matter of law that expert testimony was not needed with regard to medical

expenses related to the wheelchair tipping, and a final judgment was entered

following the trial. Accordingly, the denial of Highlands’ motion for summary

judgment is properly before us. Also before us is the appeal of the trial court’s

order granting summary judgment in favor of Highlands due to lack of expert

testimony related to pain and suffering and loss of consortium.

             Ordinarily, we review appeals from summary judgment rulings de

novo; however, we review preceding issues such as the adequacy of discovery or

the necessity of expert testimony under the abuse of discretion standard, although

they may be addressed by the trial court in a summary judgment order. Whether

expert testimony is required is wholly within the trial court’s discretion. Green v.

Owensboro Medical Health System, Inc., 231 S.W.3d 781, 783 (Ky. App. 2007).

We will reverse only upon finding the trial court abused its discretion. Id. “In

Kentucky, the test for abuse of discretion is whether the trial court’s decision was

                                          -9-
arbitrary, unreasonable, unfair, or unsupported by sound legal principles.” Jackson

v. Ghayoumi, 419 S.W.3d 40, 43 (Ky. App. 2012) (citation omitted).

                                      III. ANALYSIS

              Highlands has maintained that this is a medical malpractice case

because the Estate has claimed negligence and the failure to provide the minimum

standard of care. See, e.g., Chamis v. Ashland Hospital Corporation, 532 S.W.3d

652 (Ky. App. 2017). Highlands also argues that expert testimony was necessary

to prove each element of the Estate’s claims regardless of what type of case it is.

In contrast, the Estate has maintained that this is not a medical malpractice case,

but rather, that its claims lie in general negligence and expert testimony is therefore

not needed.

               KRE4 702 provides:

               If scientific, technical, or other specialized knowledge
               will assist the trier of fact to understand the evidence or
               to determine a fact in issue, a witness qualified as an
               expert by knowledge, skill, experience, training, or
               education, may testify thereto in the form of an opinion
               or otherwise, if:

                         (1) The testimony is based upon sufficient
                        facts or data;

                         (2) The testimony is the product of
                        reliable principles and methods; and

4
    Kentucky Rule of Evidence.

                                           -10-
                      (3) The witness has applied the principles
                     and methods reliably to the facts of the
                     case.

            To determine if expert testimony was necessary, we begin by looking

at each element of a negligence claim. “To demonstrate that the defendant was

negligent a plaintiff must show that (1) the defendant owed the plaintiff a duty of

care; (2) the defendant breached that duty of care; (3) a causal connection between

the defendants[’] conduct and the plaintiff’s damages; and (4) damages.” Gonzalez

v. Johnson, 581 S.W.3d 529, 532 (Ky. 2019) (footnote omitted).

             “In medical malpractice cases the plaintiff must prove that the

treatment given was below the degree of care and skill expected of a reasonably

competent practitioner and that the negligence proximately caused injury or death.

The bare possibility of causation will not suffice.” Reams v. Stutler, 642 S.W.2d

586, 588 (Ky. 1982) (citations omitted). This is ordinarily accomplished through

expert testimony that “must be that an alleged negligent act probably caused the

injury, and that a nexus between the alleged act and the injury is not merely

possible.” Jackson v. Ghayoumi, 419 S.W.3d 40, 45 (Ky. App. 2012) (citing

Jarboe v. Harting, 397 S.W.2d 775 (Ky. 1965)). Highlands’ alleged negligent

conduct would be a legal cause of harm to Hassel if: (a) Highlands’ conduct is a

substantial factor in bringing about the harm; and (b) there is no rule of law

relieving Highlands from liability because of the manner in which its negligence

                                         -11-
has resulted in the harm. See Deutsch v. Shein, 597 S.W.2d 141, 144 (Ky. 1980),

abrogated on other grounds by Osborne v. Keeney, 399 S.W.3d 1 (Ky. 2012).

              The Estate’s theory of the case throughout the proceedings, including

trial and now before this Court, is that Highlands breached the standard of care by

not providing a wheelchair with footrests to transport Hassel. The Estate maintains

that, because the wheelchair did not have footrests, Hassel’s feet dragged the floor.

This, in turn, required Highlands’ staff to lift his legs, which caused the wheelchair

to tip backwards and Hassel to hit his head on the floor. The Estate argues Hassel

had pain and suffering, related medical expenses, and Alice Hall experienced a loss

of consortium, as consequences.

              As previously stated, the Estate did not identify any expert witnesses.

Although it did identify two of Hassel’s treating physicians at Highlands and PMC

as lay witnesses, only one of those physicians, Dr. Paul Weinberger, emergency

room physician at PMC, testified at the trial. However, he was not asked to testify

to the standard of care. In contrast, Highlands offered testimony from nursing

expert Patricia Howard that the nurses at Highlands did what any reasonable and

prudent nurse would do in providing care to Hassel, including providing a

wheelchair without footrests. Ms. Howard explained that, due to the “dead

weight” of an unresponsive patient, footrests on a wheelchair can actually act as a

hinderance.

                                         -12-
             This is not a case in which hospital staff are alleged to have operated

the wheelchair negligently by pushing it into a wall. Rather, the Estate’s argument

concerns the type of wheelchair supplied by the hospital. We agree with

Highlands that whether it met the standard of care in the type of wheelchair

provided to Hassel is beyond the knowledge of a layperson and required expert

testimony. The average juror may be familiar with wheelchairs in a general sense,

but this “does not mean that a jury would necessarily understand the specifics of

[wheelchair usage] or the standard of care upon medical personnel [who provide

them to patients for use].” Baptist Healthcare Systems, Inc. v. Miller, 177 S.W.3d

676, 680 (Ky. 2005). A layperson could not possibly know what type of

wheelchair would have been appropriate to transport a patient who was alert and

ambulating on his own when the wheelchair was provided, but who suffered

respiratory arrest and became unresponsive just moments later. Stated differently,

a layperson would not know the medical reasons for transporting a patient with

certain health issues in a wheelchair with footrests versus without. A lay juror

would not know if there if there was some sort of defect in the wheelchair because

it lacked footrests or if there was an overall design defect. Accordingly, we agree

with Highlands that expert testimony was needed regarding the standard of care.

             We next turn to the element of causation. The trial court found that

expert testimony was required to show the wheelchair tipping caused: (1) a

                                        -13-
worsening of Hassel’s medical condition; and (2) pain and suffering. We agree

with the trial court in this respect and summary judgment in favor of Highlands

was appropriate. However, the trial court also determined expert testimony was

not necessary to prove medical expenses attributable to the wheelchair tipping. We

disagree with the trial court in this regard.

             The Estate essentially argues it is possible for a lay juror to isolate the

wheelchair tipping and discern pain and suffering and medical expenses caused

solely by those events, and not from any other medical reason, without expert

testimony. “There may, of course, be situations in which causation is so apparent

that laymen with a general knowledge would have no difficulty in recognizing it.”

Jarboe, 397 S.W.2d at 778. “But excepting those situations we have adhered to

the rule that the causal connection between an accident and an injury must be

shown by medical testimony and the testimony must be that the causation is

probable and not merely possible.” Id. The Estate believes the case at bar falls

into the category of cases where causation is readily apparent and requires no

expert testimony. We disagree.

             Further, although the Estate does not use the term in its brief to this

Court, it is arguing that the doctrine of res ipsa loquitor (“the thing speaks for

itself”) applies with respect to negligence. However, the Estate must establish

                                          -14-
causation before any inference of negligence can be made. The Kentucky Supreme

Court has recently addressed this issue. To wit,

            Res ipsa loquitur applies in medical malpractice cases
            when “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” or
            “when ‘medical experts may provide a sufficient
            foundation for res ipsa loquitur on more complex
            matters.’” [Perkins v. Hausladen, 828 S.W.2d, 652, 655
            (Ky. 1992)] (quoting Paintsville Hosp. Co. v. Rose, 683
            S.W.2d 255, 256-57 (Ky. 1985)). The former is
            “illustrated by cases where the surgeon leaves a foreign
            object in the body or removes or injures an inappropriate
            part of the anatomy.” Id. at 654. The latter occurs when
            expert testimony establishes the “type of injury was not
            an ordinary risk of the surgery, that the method by which
            it occurred was within the exclusive control of the
            defendant, and that the injury was not due to any
            voluntary action or contribution on the part of the
            plaintiff.” Id. at 655. In other words, “when the
            circumstances and the probabilities as to the causative
            factors of an accident lie within the ken of experts, expert
            evidence is necessary to establish a foundation that gives
            rise to an inference of negligence.” 65A C.J.S.
            Negligence § 820 (emphasis added).

            Crucial to remember is res ipsa loquitur “allows an
            inference of negligence in certain cases, not causation;
            established causation is a prerequisite to the application
            of the doctrine.” Id. at § 821 (emphasis added). “A lack
            of knowledge as to the cause of the accident does not call
            for the application of the doctrine.” Cox v. Wilson, 267
            S.W.2d 83, 84 (Ky. 1954). That “[t]he plaintiff’s injury
            must have resulted from the accident[,]” is a basic
            element of res ipsa loquitur in Kentucky. Id. See also
            Quillen v. Skaggs, 233 Ky. 171, 25 S.W.2d 33, 34-35
            (1930). Res ipsa loquitur “must be linked with the injury
            suffered. There may be an inference of negligence when,

                                       -15-
              according to common knowledge and experience, the
              accident would not have happened except for the
              wrongful act of the defendant.” Jos. N. Rice Co. v.
              Grayson, 341 S.W.2d 238, 239 (Ky. 1960). The doctrine
              is therefore inapplicable where more than one cause can
              be inferred from the evidence. Schroerlucke v. McDaniel
              Funeral Home, Inc., 291 S.W.2d 6, 8 (Ky. 1956). “[T]he
              doctrine [can] be applied only when the nature of the
              accident itself not only clearly supports the inference of
              negligence on the part of the defendant but excludes all
              other inferences that it might be due to one or more
              causes of which the defendant is not responsible.” Id. at
              9.

Saint Elizabeth Medical Center, Inc. v. Arnsperger, No. 2022-SC-0302-DG, ---

S.W.3d ---, 2024 WL 316434, at *4 (Ky. Jan. 18, 2024) (internal footnote

omitted).5

              We now address the question of whether expert testimony was needed

to establish that the wheelchair tipping event alone caused pain and suffering to

Hassel. To receive an award for pain and suffering, there must be substantial

evidence to establish that pain and suffering actually occurred. Worldwide

Equipment, Inc. v. Mullins, 11 S.W.3d 50, 61 (Ky. App. 1999) (emphasis added).

Importantly, the Estate never established that Hassel sustained an injury from the

wheelchair tipping event. External physical examinations of his head at PMC

revealed no injury, including bumps or bruising. Although the CT scan performed

5
  On February 8, 2024, the Kentucky Supreme Court issued a finality letter indicating that the
case is now final and that it has been designated as published.

                                              -16-
at Highlands showed “some posterior swelling,” the record also indicates his

treating physician “could not rule out stroke” in addition to the possibility it was

caused by the wheelchair tipping. Testimony from expert witness Owen Samuels,

M.D., produced by Highlands, indicated there was no sign of trauma to the brain

either externally or from the two CT scans. Rather, he attributed the brain swelling

to lack of oxygen due to respiratory arrest. Defense expert John E. Parker, M.D.,

also provided an affidavit stating that Hassel’s brain swelling was unrelated to

trauma from the wheelchair tipping. The Estate notably acknowledged at the

hearing on the motion for summary judgment that it was seeking damages for pain

and suffering only for the time between the first and second wheelchair tipping,

which it admitted was a very small period of time, “seconds to a minute or two.”

This is because the Estate contends Hassel was conscious and capable of

experiencing pain until he hit his head on the floor during the second tipping

event.6

              By all accounts, Hassel went into respiratory arrest and became

unresponsive prior to the wheelchair tipping. He had severe, chronic, and complex

underlying health issues and presented to Highlands extremely ill, including with

undiagnosed influenza. The Estate argues because Carrie testified Hassel looked

6
 “[D]amages for pain and suffering are not allowed to an unconscious person.” Vitale v.
Henchey, 24 S.W.3d 651, 659 (Ky. 2000).

                                            -17-
her in the eye for a brief moment when he was on the floor after the first

wheelchair tipping, that necessarily means he was at least partially conscious.

“Damages for pain and suffering may be awarded, however, if the injured person

was partly conscious, had intervals of consciousness, or was conscious for a short

time before death.” Vitale, 24 S.W.3d at 659 (internal quotation marks and

footnote omitted). However, a layperson would not be qualified to say if, given

Hassel’s medical conditions, he was conscious or partially conscious between

wheelchair tipping events, regardless of whether his eyes were open.7

              Whether an individual experiencing Hassel’s medical conditions was

conscious and able to experience pain is a question based on scientific, technical,

or specialized knowledge. Accordingly, whether the wheelchair tipping event

alone caused pain and suffering for Hassel required expert testimony. We

therefore affirm the trial court’s order dismissing the Estate’s claim for pain and

suffering as well as Alice Hall’s corresponding claim for loss of consortium.8

7
  Although all witness testimony indicated Hassel became “unresponsive” prior to the
wheelchair tipping, whether “unresponsive” is medically the same as “unconscious” and unable
to experience pain is also outside the knowledge of a lay juror.

8
  “Loss of consortium damages can be obtained whenever a spouse is wrongfully incapacitated
by a third party to the extent that the marital relationship has been damaged due to that harm.”
Martin v. Ohio Cnty. Hosp. Corp., 295 S.W.3d 104, 109 (Ky. 2009). Here, due to his underlying
medical conditions – both past and present on the morning of March 27, 2016 – neither the
Estate nor Alice Hall can prove without expert testimony that Highlands wrongfully
incapacitated Hassel. See also Kentucky Revised Statute (KRS) 411.145.

                                             -18-
             We now turn to whether expert testimony was needed to prove

medical causation related to the medical expenses the Estate attributed to the

wheelchair tipping. Prior to trial, the Estate presented medical bills totaling

approximately $127,000. Upon motion from Highlands to clarify which expenses

would be admissible at trial, the trial court conducted a hearing and concluded the

admissible medical expenses to be approximately $46,000, based solely on

determinations made by the Estate’s counsel without reference to any lay or expert

witness testimony. The bills making up the $46,000 that were submitted to the

jury were for the following: (1) the CT scan at Highlands; (2) radiology services at

Highlands; (3) ambulance services to the helipad; (4) airlift services to PMC; and

(4) the CT scan at PMC. Of the approximately $46,000 in medical bills, the bill

for airlift services comprised roughly $38,000 of that total.

             The question before us is not whether those amounts were reasonable,

but whether the wheelchair tipping was a substantial factor in the resulting medical

expenses presented to the jury. Gonzalez, 581 S.W.3d at 534. Dr. Paul

Weinberger, Hassel’s treating physician at PMC, testified he did not analyze the

medical records for which tests and treatment were necessary for the head trauma

versus respiratory arrest. He also testified that he could not say whether Hassel

would have required transfer to PMC for respiratory failure regardless of any

possible head trauma, or if he needed to be transferred to PMC due to both

                                         -19-
respiratory failure and possible head trauma. However, Highlands presented

expert testimony that all medical tests and treatment received by Hassel would

have been necessary regardless of the wheelchair tipping due to the lack of oxygen

to his brain during respiratory arrest. Further, the medical records present in the

record before us vary as far as indicating whether Hassel’s primary medical issue

at the time was respiratory arrest or head trauma with most, including the record

for air transport services, indicating respiratory arrest was the primary medical

issue.

             To recover damages for medical expenses, the Estate must show with

reasonable certainty that said expenses “are the direct, natural, and proximate

consequences of the defendant’s wrongful act.” Western Union Telegraph Co. v.

Guard, 139 S.W.2d 722, 727 (Ky. 1940). Although it was never shown that Hassel

sustained an injury from the wheelchair tipping, Highlands and PMC may have

needed to investigate the possibility of an injury from the events. However, in a

lengthy list of medical bills, it was an abuse of discretion for the trial court to allow

the Estate’s counsel to cherry-pick expenses he believed derived solely from the

wheelchair tipping without the benefit of expert testimony.

             The absence of proof on any one of the required elements of a

negligence claim (i.e., duty, breach, causation, and damages) is fatal to the claim.

M & T Chemicals, Inc. v. Westrick, 525 S.W.2d 740, 741 (Ky. 1974). A medical

                                          -20-
malpractice case may only proceed to trial without expert testimony when “duty,

breach, causation, and injury are readily apparent within the common knowledge

of a jury[.]” Arnsperger, 2024 WL 316434, at *4. Here, due to Hassel’s severe

underlying health issues and the complications that arose when he arrived at

Highlands, none of the elements are readily apparent to a lay juror without expert

testimony to isolate and differentiate the wheelchair tipping event. In other words,

Hassel’s past and present medical conditions meant that more than one cause could

be inferred from the evidence. Id.

                                 IV. CONCLUSION

            For the foregoing reasons, we affirm the Floyd Circuit Court’s order

granting summary judgment to Highlands with regard to the Estate’s claims for

pain and suffering and loss of consortium. We reverse the trial court’s final order

awarding medical expenses totaling $40,000 to the Estate for medical expenses due

to lack of expert testimony.

             ALL CONCUR.

                                        -21-
BRIEF FOR APPELLANTS/CROSS-     BRIEF FOR APPELLEE/CROSS-
APPELLEES CARRIE HALL AS        APPELLANT HIGHLANDS
ADMINISTRATOR OF THE            HOSPITAL CORPORATION:
ESTATE OF HASSEL DARRELL
HALL AND ALICE HALL:            Clay M. Stevens
                                Kristen H. Fowler
Jarrod Bentley                  Rachel A. Stratton
Prestonsburg, Kentucky          Louisville, Kentucky

                              -22-