Court Opinion

ID: 9396066
Source: CourtListenerOpinion
Date Created: 2023-05-19 14:06:23.318519+00
Date Added: 2024-06-11T17:19:13.779703
License: Public Domain

RENDERED: MAY 12, 2023; 10:00 A.M.
                        NOT TO BE PUBLISHED

               Commonwealth of Kentucky
                         Court of Appeals

                            NO. 2022-CA-0579-MR

JEWISH HOSPITAL, AN ASSUMED
NAME OF JEWISH HOSPITAL & ST.
MARY’S HEALTHCARE, INC.; AND
KENTUCKYONE HEALTH, INC.                                         APPELLANTS

               APPEAL FROM JEFFERSON CIRCUIT COURT
v.                HONORABLE MITCH PERRY, JUDGE
                       ACTION NO. 17-CI-000253

KAREN REDDINGTON,
INDIVIDUALLY; AND KAREN
REDDINGTON, AS EXECUTRIX OF
THE ESTATE OF DONALD PATRICK
REDDINGTON, SR.                                                    APPELLEES

                                  OPINION
                                 AFFIRMING

                                 ** ** ** ** **

BEFORE: THOMPSON, CHIEF JUDGE; CETRULO AND ECKERLE,
JUDGES.

THOMPSON, CHIEF JUDGE: Jewish Hospital, an assumed name of Jewish

Hospital & St. Mary’s Healthcare, Inc., and KentuckyOne Health, Inc.
(“Appellants”), appeal from a judgment of the Jefferson Circuit Court entered on

March 23, 2022, and from the circuit court’s order denying Appellants’ post-trial

motions entered on April 29, 2022. Appellants argue that the circuit court erred in

1) failing to grant summary judgment; 2) giving the jury improper negligence and

missing evidence instructions; 3) allowing the use of privileged documents

contrary to the law of the case; and, 4) improperly allowing the jury to hear

evidence of Appellants’ subsequent remedial policy change. Appellants seek an

opinion reversing the judgment on appeal and remanding the matter for a new trial.

Having heard the oral arguments of counsel, and after careful review, we find no

error and affirm the judgment on appeal.

                    FACTS AND PROCEDURAL HISTORY

              On April 29, 2016, Donald Reddington (“Mr. Reddington”) had

surgery at Appellants’ hospital to repair a torn rotator cuff. After surgery, Mr.

Reddington developed complications and was intubated. He was admitted to the

intensive care unit (“ICU”). On May 10, 2016, Mr. Reddington received a

tracheostomy and began to make some improvement.

              About 10 days later, and based on his improvement, Mr. Reddington’s

treating physician, Dr. John Wesley McConnell, transferred Mr. Reddington to an

intermediate care floor. Mr. Reddington’s pulse oximetry was monitored every

four hours.

                                         -2-
            On May 22, 2016, and while monitored by cardiac telemetry, Mr.

Reddington’s tracheostomy tube became dislodged and he began to asphyxiate.

Mr. Reddington’s primary room nurse, Rachel Ruppel, was in the cafeteria when

the tracheostomy tube became dislodged. Ms. Ruppel would later state that she

had previously handed off Mr. Reddington’s care to nurse Val McGee. Ms.

McGee denied that Ms. Reddington’s care was handed off to her, and testimony

was later adduced that Ms. McGee was with Ms. Ruppel in the cafeteria.

            Sometime after Mr. Reddington’s tracheostomy tube became

dislodged, a cardiac alarm sounded at the nurses’ station which was about 11 feet

from Mr. Reddington’s room. Nurse Angelique Kahn-Brown heard the alarm, and

responded to Mr. Reddington’s room. She discovered that the tracheostomy tube

was dislodged, and observed that Mr. Reddington was not breathing and his skin

was blue. Ms. Kahn-Brown called a “code blue” to summon immediate assistance

for Mr. Reddington. At about this time, Ms. Ruppel received a text that Mr.

Reddington’s cardiac leads were off.

            Medical personnel responded to the code blue and attempted to

resuscitate Mr. Reddington with CPR and ventilation. Ms. Kahn-Brown initiated

these procedures before the code blue personnel arrived. As no appropriate

tracheostomy tube was available, a new tube had to be retrieved from Appellants’

central supply. Mr. Reddington was re-intubated and resuscitated, but had suffered

                                        -3-
a hypoxic brain injury due to a lack of oxygen. He never regained consciousness,

was subsequently removed from life support, and died.

                Several months later, Karen Reddington,1 individually and as the

executrix of the estate of Mr. Reddington (“Appellee”), filed the instant medical

negligence action against Appellants in Jefferson Circuit Court. Appellee sought

damages for Mr. Reddington’s pain, suffering, and mental anguish, as well as for

medical expenses, funeral costs, and loss of consortium. Protracted litigation

followed, resulting in a jury trial conducted in February and March of 2022. The

jury returned an award in favor of Appellee in the amount of $3,913,180.55.

Appellants’ post-judgment motions were denied, and this appeal followed.

                            ARGUMENTS AND ANALYSIS

                Appellants first argue that the Jefferson Circuit Court committed

reversible error in failing to grant its motion for summary judgment. They assert

that Appellee failed to produce any expert testimony related to medical causation,

with Appellee instead arguing that its experts’ opinions on standard of care

breaches were sufficient. According to Appellants, Appellee’s experts testified

that they would not offer any opinion on causation at trial. At most, Appellants

assert that Appellee’s experts testified as to physician conduct, for which

Appellants were not responsible. Though Advance Practice Registered Nurse

1
    Karen and Donald Reddington were married.

                                                -4-
(“APRN”) Robert Rogers testified as to causation, Appellants argue that Rogers

did not offer expert testimony to a reasonable degree of medical probability, and

did not express an opinion that Appellants’ conduct was the proximate cause of

Mr. Reddington’s death. The focus of Appellants’ argument on this issue is that

without any sworn testimony on causation regarding Appellants’ conduct,

Appellee was forced to cite its expert disclosures as the sole source of expert

opinion on causation. Appellants argue that even when viewing the evidence in

Appellee’s favor, summary judgment was appropriate because Appellee did not

offer any affirmative expert evidence relating to causation and Appellants’

conduct.

               In response, Appellee argues that Appellants failed to comply with

Kentucky Rules of Civil Procedure (“CR”) 76.12(4)(c)(v),2 which requires at the

beginning of the argument a statement with reference to the record showing

whether the issue was properly preserved for review and, if so, in what manner.

Appellee notes that Appellants failed to identify in either the Notice of Appeal or

its brief any written order denying its July 21, 2021 motion for summary judgment.

Further, Appellee contends that even if Appellants identified in the record an order

2
  CR 76.12(4)(c)(v) was replaced by the Kentucky Rules of Appellate Procedure (“RAP”)
32(A)(4) effective January 1, 2023. We will refer to these rules interchangeably as the context
requires.

                                               -5-
denying summary judgment, such an order would not be appealable because it was

subsumed by the judgment.

              Appellants have not complied with the former CR 76.12(4)(c)(v),

which required,

              [a]n argument conforming to the statement of Points and
              Authorities, with ample supportive references to the
              record and citations of authority pertinent to each issue of
              law and which shall contain at the beginning of the
              argument a statement with reference to the record
              showing whether the issue was properly preserved for
              review and, if so, in what manner.

              Appellants’ argument section of the brief does not contain a statement

at the beginning with reference to the record showing whether each issue was

properly preserved for review and, if so, in what manner.

              “A brief may be stricken for failure to substantially comply with the

requirements of these rules.” RAP 31(H)(1). The rule requiring an argument

section including a statement of preservation is a substantial requirement of RAP

32 encompassed by RAP 31(H)(1).

              When a party fails to abide by the Rules of Appellate Procedure, we

may choose “(1) to ignore the deficiency and proceed with the review; (2) to strike

the brief or its offending portions . . . ; or (3) to review the issues raised in the brief

for manifest injustice only[.]” Hallis v. Hallis, 328 S.W.3d 694, 696 (Ky. App.

                                            -6-
2010) (citation omitted); see also Ford v. Commonwealth, 628 S.W.3d 147, 153-55

(Ky. 2021).

              It appears that either the Jefferson Circuit Court made no ruling on

Appellants’ summary judgment motion or, if it made the ruling, it was not

designated in the appellate record. In either instance, as Appellants have not cited

the circuit court’s response, if any, to its motion for summary judgment, there is

nothing for us to review. The duty rested with Appellants to insist upon a ruling,

and the failure to do so constitutes a waiver of the motion. Transportation Cabinet

Bureau of Highways, Com. of Ky. v. Leneave, 751 S.W.2d 36, 38 (Ky. App. 1988).

              Per Hallis, supra, we have reviewed Appellants’ argument on this

issue for manifest injustice only. “Manifest injustice” requires a showing that a

different result was probable, or that the error in the proceeding was of such

magnitude as to be “shocking or jurisprudentially intolerable.” Martin v.

Commonwealth, 207 S.W.3d 1, 3-4 (Ky. 2006).

              Appellants’ motion for summary judgment centered on causation, i.e.,

its claim that even when viewed in a light most favorable to Appellee, Appellee

could not present sufficient expert testimony at trial to demonstrate that

Appellants’ negligence proximately resulted in Mr. Reddington’s death. Appellee

tendered expert witness disclosures in pre-trial proceedings, and these experts

testified at trial in a manner sufficient to persuade the jury on Appellee’s

                                          -7-
negligence claim. Further, Appellants did not move for a directed verdict on

causation at the close of Appellee’s evidence nor the close of all of the evidence.

Having closely examined the record and the law on this issue, we do not find that a

different result was probable, nor that the purported error in the proceeding was of

such magnitude as to be shocking or jurisprudentially intolerable but for the

alleged error. Martin, supra. Accordingly, we find no manifest injustice.

             Appellants next argue that the circuit court committed reversible error

in improperly submitting Instruction No. 4 to the jury. This instruction stated:

             It was the duty of Jewish Hospital, by and through its
             employees, to establish and follow procedures regulating
             the administration of care to patients, including Donald
             Reddington, and to exercise the degree of care and skill
             ordinarily expected of a reasonable prudent hospital by
             and through its employees acting under similar
             circumstances.

Appellants argue that this instruction improperly placed two duties on it – one

specific and one general; that is, 1) to create and follow procedures regulating the

administration of care to patients, and 2) to exercise ordinary care. Appellants

contend that there is no duty under Kentucky law to create and follow procedures

relating to patient care. In support of this proposition, Appellants direct our

attention to Lake Cumberland Regional Hospital, LLC v. Adams, 536 S.W.3d 683,

695 (Ky. 2017). Appellants assert that simple, “bare bones” instructions are

                                          -8-
required under Kentucky law, and that Instruction No. 4 demanded more of

Appellants than the law requires. On this basis, they request a new trial.

               As with its first argument, Appellants failed to preserve this argument

for appellate review as formerly required by CR 76.12(4)(c)(v). Again, our options

are to ignore the deficiency and proceed with the review; to strike the brief or its

offending portions; or, to review the issues raised in the brief for manifest injustice

only. Hallis, supra. As it is clear from the record that Appellants challenged

Instruction No. 4 below, and Appellee so acknowledges, sanctions for violating CR

76.12(4)(c)(v), which include striking Appellants’ brief and dismissing his appeal,

are not warranted. See Baker v. Campbell County Board of Education, 180 S.W.3d

479, 482 (Ky. App. 2005). Accordingly, we will consider this claim of error as if it

were properly preserved.

               The focus of Appellants’ argument on this issue is its contention that

the Jefferson Circuit Court erred in imposing upon Appellants a novel and

improper duty to establish and follow patient procedures. We do not read Adams,

supra, and the related case law as holding that such an instruction is improper.

Rather than holding that an instruction on hospital policy or procedures is

improper, Adams held that the plaintiff therein was not entitled to such an

instruction.

                                          -9-
             Humana of Kentucky, Inc. v. McKee, 834 S.W.2d 711 (Ky. App.

1992), is instructive. In McKee, a teenage boy, by and through his parents, alleged

that when he was an infant, Humana was negligent in failing to diagnose the

child’s treatable metabolic disorder via a PKU test which proximately resulted in a

lifetime of disability. After the boy and his father were awarded a multimillion-

dollar judgment, Humana argued on appeal that a jury instruction improperly set

forth two duties – one to establish and follow procedures and another to exercise

ordinary care.

             In rejecting Humana’s argument, a panel of this Court determined that

the phrase “in establishing and following procedures” in the instruction did not

create an additional duty, but merely qualified Humana’s duty to exercise ordinary

care. The Court said:

             Finally, Humana argues that Instruction No. 2b had the
             effect of demanding more of it than the law requires
             because it not only imposed a duty upon the hospital to
             exercise ordinary care in administering the PKU test, but
             it also imposed a duty upon the hospital to establish and
             comply with procedures regulating the administration of
             the test. However, we agree with the trial court that the
             phrase “in establishing and following procedures” in
             Instruction No. 2b did not impose a separate legal duty
             upon Humana but, rather, merely served as qualifying
             language which the court utilized in defining Humana's
             duty to exercise ordinary care. Moreover, we reject

                                        -10-
               Humana’s argument that Instruction No. 2b violates the
               dictates of Rogers v. Kasdan, supra, in any respect.[3]

Id. at 722-23.

               McKee stands for the proposition that instructional language

addressing the duty to establish and follow procedures merely qualifies the

underlying duty of ordinary care. Such language does not create a new and

unwarranted duty contrary to established precedent. Instruction No. 4 contained

qualifying language similar to that addressed in McKee, and did not create a new

duty unsupported by the case law. We find no error.

               Appellants’ next claim of error centers on physical and electronic

records of Mr. Reddington’s cardiac function recorded in the minutes leading up to

and during the code blue event. In addition to appearing on monitors, Mr.

Reddington’s cardiac function was recorded electronically in his hospital room, at

the nurse’s station, and in a remote telemetry unit. Appellants’ code sheet also had

a space to preserve cardiac rhythm strips. Multiple lay and expert witnesses would

later testify that common practice or policy was to print and/or electronically

preserve such records after a code blue in order to memorialize the event. The

3
 Rogers v. Kasdan, 612 S.W.2d 133, 136 (Ky. 1981), stated that a jury instruction “should not
contain an abundance of detail, but should provide only the bare bones of the question for jury
determination. This skeleton may then be fleshed out by counsel on closing argument.”

                                              -11-
recordings at issue, however, were not retained by Appellants, and Appellants’

failure to retain the records became an issue at trial.

             At the close of the proceedings, the Jefferson Circuit Court gave the

jury Instruction No. 3, a spoliation instruction, which stated:

             If you find from the evidence that the cardiac rhythm
             strips or records should have been preserved for the
             period immediately prior to and during Mr. Reddington’s
             code event, and if you further find from the evidence that
             Defendant, Jewish Hospital, intentionally and in bad faith
             lost or destroyed the cardiac rhythm strips or records, you
             may, but are not required to, infer that the information
             recorded in the cardiac rhythm strips would be, if
             available, adverse to Defendants and favorable to the
             Plaintiff.

             Appellants argue that by issuing the Instruction No. 3, the circuit court

committed reversible error because, 1) no documents were missing “utterly without

explanation” as addressed in University Medical Center, Inc. v Beglin, 375 S.W.3d

783, 790 (Ky. 2011), as modified on denial of reh’g (Mar. 22, 2012); 2) Appellants

were not on notice that the documents were relevant to any litigation when the

records were not retained, which is consistent with Appellants’ customary retention

policy; and, 3) there was no evidence of bad faith.

             Beglin does not support Appellants’ claim of error on this issue. In

Beglin, a jury determined that University Hospital was negligent, by and through

its employees, in causing the death of Jennifer Beglin. The jury awarded Beglin’s

estate over $9,000,000 in compensatory and punitive damages. On appeal, the

                                          -12-
hospital argued that the trial court’s spoliation instruction was erroneous. That

instruction stated:

             If you find from the evidence that an incident report was
             in fact prepared by Nurse Barbara Cantrell recording
             material information about Mrs. Beglin’s surgery, and if
             you further find from the evidence that University
             Medical Center, Inc. d/b/a University of Louisville
             Hospital, intentionally and in bad faith lost or destroyed
             the incident report, you may, but are not required to, infer
             that the information recorded in the incident report would
             be, if available, adverse to University Medical Center and
             favorable to the plaintiffs.

The Kentucky Supreme Court determined that the spoliation instruction in Beglin

was proper. The Court stated that,

             [t]his remains the approved instruction in both criminal
             and civil cases. See Monsanto Co. v. Reed, 950 S.W.2d
             811, 815 (Ky. 1997) (“Where the issue of destroyed or
             missing evidence has arisen, we have chosen to remedy
             the matter through evidentiary rules and ‘missing
             evidence’ instructions.”) All agree that the Sanborn[4]
             instruction accurately sets forth the elements necessary to
             permit a jury to draw an adverse inference from missing
             evidence.

                    The text of the instruction further demonstrates
             two important factors relevant to our review. First, the
             instruction contemplates that the jury will engage in fact-
             finding (“If you find from the evidence . . .”), thereby
             implying that, like any other issue, if there is a factual
             dispute in relation to the issue, the jury will resolve the
             disagreement. This obviously implies that, under our
             law, the trial court does not make any final and

4
 Sanborn v. Commonwealth, 754 S.W.2d 534 (Ky. 1988), addressed the form for a missing
evidence instruction.

                                          -13-
             conclusive factual determination upon the elements of a
             missing evidence instruction. Second, the adverse
             inference portion of the instruction is optional (“you may,
             but are not required, to infer . . .”). The approved
             instruction does not impose upon the jury a duty to draw
             the adverse inference even when it believes the evidence
             was intentionally disposed of.

                    As a final note, the instruction did not require the
             jury to affirmatively indicate in the jury verdict forms its
             findings or determinations in relation to the instruction.
             We therefore do not know if the jury found for or against
             University Hospital under the instruction and,
             consequently, whether it had any impact at all on the
             verdicts. It is possible that the jury concluded that the
             report was lost innocently, and did not hold the
             disappearance of the report against University Hospital.

Beglin, 375 S.W.3d at 788 (emphasis in original) (footnote omitted).

             Instruction No. 3, now before us, closely mirrors the instruction in

Beglin. Like the Beglin instruction, Instruction No. 3 contains the same or similar

“[i]f you find from the evidence” and “you may, but are not required to, infer”

language. And as with the Beglin instruction, Instruction No. 3 did not require the

jury to make a “yes” or “no” response, but allowed it to make or not make an

inference from the evidence. Per Beglin, we are not persuaded by Appellants’

argument that Instruction No. 3 was erroneous and requires a new trial.

Appellants’ assertions that they were not on notice that the documents were

relevant to any litigation when they were not retained, and that they did not act in

bad faith, do not alter that conclusion.

                                           -14-
             Appellants’ next argument is that the circuit court erred in allowing

the use of privileged documents at trial contrary to the law of the case. During the

course of litigation, Appellants sought and received a writ of prohibition barring

Appellee from entering Appellants’ root-cause analysis report (“RCA”) into

evidence. Jewish Hospital v. Perry, 626 S.W.3d 509 (Ky. 2021). The RCA

process was initiated several weeks after Mr. Reddington’s death by then interim

risk manager, Melanie Woodring, after it became apparent that Appellee might file

a lawsuit. A group of hospital personnel, including Ms. Woodring, the Chief

Medical Officer, the Director of Nursing, and the Assistant Nurse Manager –

together referred to as the “Code E Team” – evaluated the care received by Mr.

Reddington, reviewed the professional competency of hospital staff, and

determined whether changes in care were warranted. Appellants argue that the

circuit court improperly allowed evidence to be admitted at trial in violation of the

writ.

             Again, Appellants have not preserved this matter for appellate review

in the manner required by the former CR 76.12(4)(c)(v). See Hallis, supra, for the

reasons why compliance with the briefing rules is not merely a convenience to the

Court, but is a necessity for carrying out the ends of justice. Per Hallis, we will

review this claim of error for manifest injustice.

                                         -15-
              Appellants direct our attention to Kentucky Revised Statute (“KRS”)

311.377(2), which states:

              At all times in performing a designated professional
              review function, the proceedings, records, opinions,
              conclusions, and recommendations of any committee,
              board, commission, medical staff, professional standards
              review organization, or other entity, as referred to in
              subsection (1) of this section, shall be confidential and
              privileged and shall not be subject to discovery,
              subpoena, or introduction into evidence, in any civil
              action in any court, including but not limited to medical
              malpractice actions . . . . The confidentiality and
              privilege protections of this subsection shall only be
              available to a person or entity that attests to participating
              in a patient safety and quality improvement initiative[.]

Appellants argue that per KRS 311.377(2) and the Supreme Court’s writ of

prohibition in Perry, supra, that the Jefferson Circuit Court improperly admitted

into evidence at trial information contained in the RCA report, and/or related

information from Appellants’ Incident Report and QRS Alert.5 The Incident

Report was completed by nurse McGee about one day after the code blue event

and served as a basis for the subsequent physician peer review. Appellants assert

that all information contained in or relating to the RCA report, Incident Report, and

QRS Alert, as well as any related witness testimony, was privileged and should not

have been admitted at trial. While acknowledging that none of the privileged

5
  The writ of prohibition rendered by the Kentucky Supreme Court in Perry, supra, barred only
the admission of the RCA. Appellants state that a QRS Alert is a policy change.

                                             -16-
documents were admitted into evidence, Appellants assert that the circuit court

improperly allowed into evidence certain witness testimony which paralleled the

content of the privileged documents.

             In addition to not preserving this argument for review as required by

the former CR 76.12(4)(c)(v), Appellants do not cite or otherwise quote any

specific testimony it finds objectionable. No specific rulings rendered by the

circuit court at trial, if any, are cited or preserved. Rather, Appellants provide

several footnotes in which they claim that privileged information was improperly

revealed at trial, but no specific testimony is quoted or cited therein.

             Appellants direct our attention to motions in limine filed about two

months prior to trial, but these are not preserved and not addressed in the Notice of

Appeal. Further, Appellants acknowledge that none of the purportedly privileged

documents were admitted into evidence at trial.

             As noted above, “manifest injustice” requires a showing that a

different result was probable, or that the error in the proceeding was of such

magnitude as to be “shocking or jurisprudentially intolerable.” Martin, 207

S.W.3d at 3-4. Based on the entirety of the record, including the uncontroverted

testimony regarding the events leading up to and including the code blue and Mr.

Reddington’s subsequent death, we do not conclude that the result of the

                                          -17-
proceeding would have been different but for the alleged error, nor that the error

was shocking or jurisprudentially intolerable.

             Lastly, Appellants argue that the QRS Alert was inadmissible by

operation of Kentucky Rules of Evidence (“KRE”) 407, which states:

             When, after an event, measures are taken which, if taken
             previously, would have made an injury or harm allegedly
             caused by the event less likely to occur, evidence of the
             subsequent measures is not admissible to prove
             negligence, culpable conduct, a defect in a product, a
             defect in a product’s design, or a need for a warning or
             instruction. This rule does not require the exclusion of
             evidence of subsequent measures when offered for
             another purpose, such as proving ownership, control, or
             feasibility of precautionary measures, if controverted, or
             impeachment.

             This argument parallels Appellants’ preceding argument. It was not

preserved for review, and Appellants acknowledge that the QRS Alert document

was not entered into evidence. We find no error.

                                 CONCLUSION

             Appellants were not entitled to summary judgment, and the circuit

court did not err in its negligence and missing evidence instructions. We find no

basis for concluding that the circuit court improperly admitted privileged

documents into evidence, nor that any testimony was violative of the writ of

prohibition. For these reasons, we affirm the March 23, 2022 judgment of the

Jefferson Circuit Court, and April 29, 2022 order denying post-judgment relief.

                                        -18-
             ECKERLE, JUDGE, CONCURS.

        CENTRULO, JUDGE, CONCURS IN RESULT ONLY AND FILES
SEPARATE OPINION.

             CENTRULO, JUDGE, CONCURRING IN RESULT: Respectfully, I

concur in result only. I believe that the alleged errors were sufficiently referenced

for our appellate review. Our appellate court rules require a reference to the

location in the record at the beginning of each argument. The references herein

were largely in footnotes and/or the appendix, but I believe that was sufficient to

allow our full review.

             However, I agree with the majority that the summary judgment denial

was not properly preserved below as there was no ruling ever entered on that

motion. Moreover, as to the other alleged errors, those are all matters that rest

within the discretion of the trial judge. Appellant claims the trial court erred in

placing two duties on the hospital with the wording of Instruction No 4. However,

the trial court considered arguments on the instructions by both parties, reviewed

case law and pattern instructions, and clearly considered the evidence presented

over nine days of trial. The trial court then instructed the jury in keeping with the

standard jury instruction manuals and with medical malpractice case law. I agree

with appellant that the better language would have been “that the hospital has a

duty IN establishing and following procedures” rather than the use of AND in

                                         -19-
setting forth the duty of ordinary care. However, it did not rise to the level of an

abuse of discretion.

             Similarly, regarding the spoliation instruction given to the jury, we are

limited in our review on appeal. Trial courts are vested with wide discretion in

deciding what admonitions and instructions to the jury are appropriate under the

evidence and attendant circumstances. Our standard of appellate review is for

abuse of discretion. As the majority noted, University Medical Center v Beglin,

375 S.W.3d 783 (Ky. 2011), is dispositive on this issue, and the Beglin court opted

for a flexible standard that grants wide discretion to the trial court . Norton

Healthcare, Inc. v. Disselkamp, 600 S.W.3d 696, 730 (Ky. 2020). Similarly, the

appellant cannot prevail on its argument as to improper references to subsequent

remedial measures as the trial court gave the proper admonition to the jury

consistent with Davenport By & Through Davenport v. Ephraim McDowell

Memorial Hospital, Inc., 769 S.W.2d 56 (Ky. App. 1988).

             I turn now to the argument on admissibility of privileged information

(as determined by the Supreme Court earlier in Jewish Hospital v. Perry, 626

S.W.3d 509 (Ky. 2021)). On this point, Jewish Hospital again did not obtain a

ruling on its motion in limine pertaining to two documents, the Incident Report and

the QRS Alert. Instead, the trial court passed consideration of admissibility of

those items until trial. At trial, the trial court did not allow the documents to be

                                          -20-
admitted at trial, but did allow testimony from several witnesses regarding facts

contained in those two documents. That testimony was without any

contemporaneous objection, and that testimony did not violate the Supreme

Court’s ruling in Perry. The text of that opinion makes it clear that their review

was limited to the admissibility of a root cause analysis report only.

             For the foregoing reasons, I concur with the Opinion affirming the

judgment which upholds the jury verdict herein.

BRIEFS FOR APPELLANTS:                     BRIEF FOR APPELLEE:

B. Todd Thompson                           Jack Conway
Eleanor M. B. Davis                        Louisville, Kentucky
Joseph A. Wright
Louisville, Kentucky                       Kevin C. Burke
                                           Jamie K. Neal
ORAL ARGUMENTS FOR                         Louisville, Kentucky
APPELLANTS:
                                           ORAL ARGUMENTS FOR
Joseph A. Wright                           APPELLEE:
Louisville, Kentucky
                                           Jack Conway
                                           Louisville, Kentucky

                                         -21-