Law360 (January 19, 2024, 6:31 PM EST) — The Kentucky Supreme Court has thrown out a man’s negligence suit against a hospital over an injury to his ankle he says stems from a staffer pushing his wheelchair into a desk, finding that an expert is needed to determine whether the injury is truly a result of that collision or the surgery he had days before.

In an opinion filed Thursday, the justices reinstated a summary judgment ending Ronald N. Arnsperger Jr.’s suit against Saint Elizabeth Medical Center Inc., saying the appeals court that ruled in Arnsperger’s favor had wrongly focused on the standard of care rather than causation in determining he didn’t need an expert to support his claims.

According to the opinion, Arnsperger has an “extensive medical history” involving his left ankle, including multiple surgeries. He went in for surgery to fix his ankle’s alignment by having two screws inserted into the bone on Dec 14, 2015. During that surgery, the drill bit broke and Dr. Bilal Shamsi was only able to put in one screw.

Shamsi then urged Arnsperger to get X-rays to determine if the ankle was in alignment, and during a hospital visit on Dec. 18, Arnsperger was being wheeled to the examination room in a wheelchair when he says the staffer rammed his ankle into a desk. X-rays taken that day showed his ankle was out of alignment, and he sued for negligence.

The trial court granted summary judgment, citing Arnsperger’s lack of a causation expert, but the appeals court reversed, finding that he didn’t need an expert because a layman could understand that the staffer breached the standard of care by not being careful about moving him in the wheelchair.

In Thursday’s opinion, however, the justices said the appeals court focused on the wrong question — the determining factor was not whether the staffer breached the standard of care but whether the injury was a result of the collision or the surgery.

Both Arnsperger and the appeals court assumed causation — that the injury could only have been caused by the collision — but the justices on Thursday said that is not clear, given Arnsperger’s long medical history involving his ankle, including the surgery on Dec. 14, and Shamsi’s deposition in which he said Arnsperger reported that he’d hit his left foot on Dec. 17, a day prior to the collision.

And while Arnsperger has argued that his case concerns ordinary, and not medical, negligence, the justices wrote that this does not get around the issue, and the hospital’s expert, Dr. Mihir Patel, said in a deposition that the injury was most likely a result of the initial surgery.

“We are content to concede that Arnsperger and the Court of Appeals are correct that the standard of care for a hospital staffer pushing a wheelchair-bound patient needs no expert testimony,” the justices wrote. “But that overlooks the fact that Arnsperger has always assumed the collision with the desk caused his injury, whereas his medical history in the days preceding the collision and the medical testimony of Dr. Shamsi and Dr. Patel call that assumption into doubt.”

A jury could not look at the facts of the case and infer that the ankle had been properly aligned immediately following surgery or that the collision must have caused the injury by the mere fact that there was a collision, the justices wrote.

“It’s a disappointing decision for Mr. Arnsperger, but I understand the court’s reasoning,” said Shane C. Sidebottom of Ziegler & Schneider PSC, representing Arnsperger, to Law360 on Friday. “I think it will be wise for lawyers representing injured clients in negligence cases going forward to be more cognizant on obtaining a hired expert on direct causation of an injury.”

Ellen M. Houston of Dressman Benzinger LaVelle PSC, representing Saint Elizabeth, said Monday that the justices got it right.

“This was a hard-fought victory for the defense and a shining example that persistence pays off,” Houston told Law360.

Saint Elizabeth is represented by Ellen M. Houston and Michael J. Enzweiler of Dressman Benzinger LaVelle PSC.

Arnsperger is represented by Shane C. Sidebottom of Ziegler & Schneider PSC and Justin A. Sanders of Rittgers Rittgers & Nakajima.

The case is Saint Elizabeth Medical Center Inc. v. Arnsperger, case number 2022-SC-0302-DG, in the Supreme Court of Kentucky.

–Editing by Andrew Cohen.

Update: This story has been updated with comment from Saint Elizabeth’s attorney.

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