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Branstetter v Christy South, MD

Bo Bolus and Mike Augustus teamed with Steve Romines in a 6 day trial in Barren Circuit Court to vindicate the wholly unnecessary passing of Anna Branstetter, then age 36 from opiate induced respiratory depression. Anna Beth worked in March of 2013 as the assistant director of HR at T.J. Samson Hospital in Glasgow. Branstetter, who was well-known in her nearby hometown of Edmonton, had a masters degree in HR from WKU. She earned $71,000 a year. Against this backdrop, Branstetter, who was single and childless, presented to the ER at T.J. Samson at 10:13 on the evening of 3-3-13. She had severe abdominal pain. Branstetter came under the care of an ER physician, Kevin Flowers. A CT scan indicated a significant ovarian cyst was the likely source of Branstetter’s pain. Flowers ordered two doses of morphine in the ED. The first was at 11:20 or so and the second was just after midnight. The third dose at 2:00 was given after Branstetter was admitted to the hospital by South. Flowers then turned over Branstetter’s care to an Ob-Gyn, Dr. Christy South. South received a call from hospital nurses that despite the morphine, Branstetter was still in pain. South ordered a 1 mg dose of Dilaudid at 4:00 a.m. and it was dutifully administered by hospital nurses. Branstetter fell asleep. A little more than three hours later Branstetter was found unresponsive in her hospital bed. A code was called but she could not be resuscitated. An autopsy was performed at Vanderbilt. Dr. Justin Cates, Pathology, ruled out a embolic death or other sudden cause. He concluded (without determining why) that Branstetter had suffered a global hypoxic event. Branstetter’s estate (representing her parents) filed this lawsuit and alleged a combination of error by Flowers, South and the hospital nurses all led to her death. The theme of the case was that Branstetter, who was opioid-naive, was over-medicated and then under-monitored. Branstetter essentially died of an overdose in her hospital bed. It was argued that she shouldn’t have been given such large doses in light of her inexperience with opiates. Moreover once the opiates were ordered and particularly the Dilaudid, her respirations should have been monitored. The key expert for the estate was Dr. Kenneth Rothfield, Anesthesia, Jacksonville, FL. He was critical of all three defendants and also provided causation proof. The estate’s other liability expert was Dr. Kelly Kasper, Ob-Gyn from IU. If the estate prevailed it sought medicals of $72,541 plus Branstetter’s funeral bill of $9,046. There was no conscious pain and suffering, the third and final element of her damages being destruction. It was limited in the instructions to $2,261,873. The vocational expert was Ralph Crystal, Lexington. In the months leading to trial, the estate settled their claims with both Flowers and the hospital. The case would proceed to trial against South alone. The duties of the settled non-parties would remain in issue for purposes of comparative fault. South defended on several fronts that were intertwined. The first was that she met the standard of care in ordering Dilaudid and that it was not necessary to monitor Branstetter’s respirations with the information she had been provided. This tied to the second part of the theory, South explaining that Branstetter’s demise was not opioid-related. A pathologist expert, Dr. Gregory Balko, Edgewood, wasn’t sure what caused Branstetter’s but noted strong evidence it wasn’t related to respiratory depression as her lungs were harvested. The defense also relied on Dr. Todd Billett, Ob-Gyn, Richmond, VA, and Dr. Kenneth Ferslew, Toxicology, Johnson City, TN. This case was tried for six days in Glasgow. The case was argued to the jury for the plaintiff by Romines who was born in the adjoining Metcalfe County and was taught 3rd grade by Anna Beth’s mother, Betty. In an emotionally charged closing Romines postured that an otherwise healthy person in their 30s should not die of a brain injury in the hospital, much less before the Ob-Gyn even saw her. Romines challenged the jury with their verdict to send a message to Kentucky doctors to be careful and ask questions before prescribing Dilaudid.The jury returned a mixed verdict. It found fault to South and the hospital, but concluded Flowers had not violated the standard of care. That fault was assessed 80% to T.J. Samson and the remaining 20% South. The jury turned to damages and the estate took the medical bills and funeral expense as claimed. Branstetter’s destruction was $500,000. The raw verdict totaled $581,587.