IN THE CIRCUIT COURT OF SEBASTIAN COUNTY, ARKANSAS.
`
`FORT SMITH DIVISION
`CIVIL DIVISION
`
`ERIC STIPINS, in his capacity as
`Special Administrator of the Estate of
`STEPHANIE STIPINS, deceased PLAINTIFF
`
`VS. Case No. 66CV-23-281
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`MERCY HEALTH FORT SMITH COMMUNITIES d/b/a
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`MERCY CLINIC OBSTETRICS AND GYNECOLOGY;
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`MERCY HOSPITAL FORT SMITH;
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`MERCY HEALTH POOLED COMPREHENSIVE LIABILITY
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`PROGRAM;
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`JOHN D. MCCLANAHAN, M.D.;
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`BROCK DUPREE WILSON, D.O.; and
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`ZACHARY RAY, M.D. DEFENDANTS
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`PLAINTIFEF’S RESPONSE TO SEPARATE DEFENDANT MERCY HOSPITAL FORT
`SMITH AND MERCY HEALTH POOLED COMPREHENSIVE LIABILITY
`PROGRAM’S MOTION TO DISMISS
`(AND INCORPORATE BRIEF)
`
`COMES NOW the Plaintiff, by and through counsel, and for his Response to Separate
`Defendant Mercy Hospital Fort Smith and Separate Defendant Mercy Health Pooled
`Comprehensive Liability Program’s Motion to Dismiss, states:
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`INTRODUCTION AND BACKGROUND
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`On March 27, 2023, Plaintiff filed his Complaint alleging that Stephanie Stipins died as a
`result of negligent medical care she received at Mercy Hospital Fort Smith (“Mercy Hospital™)
`following her hysterectomy. The Complaint describes the timeline of her post-surgical
`hospitalization, including her worsening abdominal pain, abnormal vital signs, and deterioration,
`ultimately leading to her collapse and death on July 5, 2022. The Complaint alleged that these
`failures in care proximately caused her injuries and death and further alleged that Mercy Hospital
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`was vicariously liable for the negligence of its providers.
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`Plaintiff’s Complaint did not specifically identify by name nurses who contributed to the
`failures of care. At the time of filing, Plaintiff alleged that Mercy Hospital was vicariously liable
`for the negligence of its providers, specifically Dr. John D. McClanahan, Dr. Brock Dupree Wilson,
`and Dr. Zachary Ray. As discovery progressed, it became evident that several nurses employed by
`Mercy Hospital played direct roles in the same failures of care described in the Complaint. On
`information and belief, those nurses, including Jessica Winfrey, LPN, Christina Rogers, RN, and
`Joy Silvey, RN, are employees of Separate Defendant Mercy Hospital Fort Smith.
`
`On March 22, 2024, Plaintiff served Defendants with expert disclosures, which included
`the opinions of Stacey Shaw, RN, a licensed registered nurse. Nurse Shaw concluded that the
`identified Mercy Hospital nurses violated the applicable standards of care in connection with the
`same events described in the Complaint. She opined that these acts and omissions directly
`contributed to Mrs. Stipins’ decline and death. (Exhibit A, at 6).
`
`In May 2024, Defendants disclosed Dr. Trey Becton as their own expert to rebut Plaintift’s
`nursing expert. Dr. Becton specifically addressed the same clinical facts and testified that the
`Mercy Hospital nurses did not breach the standard of care. (Exhibit B, at 7).
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`LEGAL STANDARD
`
`In ruling on a Motion to Dismiss based upon failure to state facts upon which relief can be
`granted, the Court must treat all factual allegations in the Plaintift’s Complaint as true and view
`them in the light most favorable to the Plaintiff. Key v. Curry, 2015 Ark. 392, 473 S.W.3d 1, 3,
`citing Hanks v. Sneed, 366 Ark. 371, 235 S.W.3d 883 (2006); see also Billy/Dot, Inc. v. Fields, 322
`Ark. 272, 275, 908 S.W.2d 335 (1995). In making this determination, courts look only to the
`allegations in the complaint and not to matters outside of the complaint. Billy/Dot, Inc. v. Fields,
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`322 Ark. at 275. Furthermore, all reasonable inferences must be resolved in favor of the Plaintiff
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`and the Complaint is to be liberally construed. Perry v. Baptist Health, 358 Ark. 238, 24142, 189
`S.W.3d 54 (2004), citing Clayborn v. Bankers Standard Ins. Co., 348 Ark. 557, 75 S.W.3d 174
`(2002).
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`Arkansas requires fact pleading, but those pleadings are to be liberally construed. Ark. R.
`Civ. P. 8(a)(1) provides that a pleading must contain “a statement in ordinary and concise language
`of facts showing that the pleader is entitled to relief.” As the Arkansas Supreme Court has
`explained, “Pleadings are to be liberally construed and are sufficient if they advise a defendant of
`his obligations and allege a breach of them.” Rabalaias v. Barnett, 284 Ark. 527, 528, 683 S.W.2d
`919, 921 (1985).
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`Further, Rule 15(b) provides that when issues not raised by the pleadings are tried by the
`express or implied consent of the parties, “they shall be treated in all respects as if they had been
`raised in the pleadings.” Ark. R. Civ. P. 15(b). Such amendment may be made ‘““at any time, even
`after judgment,” but the failure to amend “does not affect the result of the trial of these issues.” Id.
`The rule thus recognizes that pleadings conform to the evidence, and that issues actually litigated
`by the parties are part of the case even if they were not specifically pled.
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`ARGUMENT
`L The Complaint Pleads Sufficient Facts to Put Mercy Hospital on Notice.
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`The Complaint alleged that Separate Defendant Mercy Hospital was vicariously liable for
`the negligence of its providers, specifically Dr. John D. McClanahan, Dr. Brock Dupree Wilson,
`and Dr. Zachary Ray. It set forth facts describing Mrs. Stipins’ post-surgical hospitalization, her
`worsening abdominal pain, abnormal lab findings, abnormal vital signs, and her ultimate collapse
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`and death on July 5, 2022. Those allegations asserted that Mercy Hospital’s providers failed to
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`properly test, monitor, and diagnose her deteriorating condition, and that these failures proximately
`caused her death.
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`According to Mercy Hospital, Drs. McClanahan, Wilson, and Ray are not employees of
`Mercy Hospital Fort Smith. As it relates to Mercy Hospital, however, that fact does not defeat the
`sufficiency of the pleading. Plaintiff’s expert disclosures identify other employees of Mercy
`Hospital — specifically, Christina Rogers, RN, Jessica Winfrey, LPN, and Joy Silvey, RN —
`whose conduct during the same hospitalization violated applicable standards of care. Those
`failures occurred in the same course of treatment described in the Complaint and contributed
`directly to the same outcome. The Complaint therefore placed Mercy Hospital on notice of its
`potential liability, and the subsequent disclosures confirm that its nursing staff are among the
`employees through whom that liability arises.
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`Arkansas law does not require a plaintiff to name every individual employee whose
`negligence forms the basis of an employer’s vicarious liability. What Rule 8 requires is notice, and
`pleadings are sufficient if they “advise a defendant of his obligations and allege a breach of them.”
`Rabalaias v. Barnett, 284 Ark. 527, 528, 683 S.W.2d 919, 921 (1985). The Complaint provided
`that notice by alleging a failure of care by Mercy Hospital’s providers during a defined course of
`treatment, and by asserting that Mercy Hospital was vicariously liable for that negligence.
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`Plaintiff’s expert disclosure in March 2024 simply identified the Mercy nurses whose
`conduct fell below the standard of care, and Defendants themselves responded with their own
`nursing expert. Expert discovery on both sides confirms that Defendants have long been aware
`that the conduct of their nursing staff is part of the case and have defended accordingly. Because
`Defendants have long known of these allegations, prepared a rebuttal expert, and engaged in
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`discovery on these issues, there is no unfairness or prejudice in proceeding on the claims.
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`II. In the Alternative, Rule 15(b) Deems the Pleadings Amended to Conform to the
`Evidence.
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`Even if the Court were to conclude that the Complaint was not specific as to the nurses,
`Arkansas Rule of Civil Procedure 15(b) resolves the issue. That rule provides that when issues not
`raised in the pleadings are tried by the express or implied consent of the parties, “they shall be
`treated in all respects as if they had been raised in the pleadings,” and that the failure to formally
`amend “does not affect the result of the trial of these issues.” Ark. R. Civ. P. 15(b).
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`Arkansas courts have consistently recognized that Rule 15 allows issues to be tried even if
`they were not specifically pled. As the Court of Appeals explained in Ison Properties, LLC v. Wood,
`“Rule 15 provides for liberal amendments to and supplementation of pleadings and does not
`require that the claim be pled in writing at the time the parties actually try the issues.” 85 Ark. App.
`443,449, 156 S.W.3d 742, 746 (2004). Likewise, in Hope v. Hope, the Arkansas Supreme Court
`explained: “Although pleadings are required so that each party will know the issues to be tried and
`be prepared to offer his proof, Rule 15(b) allows for the amendment of the pleadings to conform
`to the evidence introduced at trial.” 333 Ark. 324, 329, 969 S.W.2d 633, 636 (1998).
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`That principle applies here. Both parties have litigated the standard of care of Mercy
`Hospital’s nursing staff. Plaintiff disclosed Nurse Stacey Shaw in March 2024, identifying specific
`nurses and their failures to meet the applicable standard of care. Defendants responded by
`disclosing Dr. Trey Becton to rebut those opinions, and both experts have been or will be deposed.
`This record demonstrates implied consent to try the issue of nursing negligence, just as Rule 15(b)
`contemplates.
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`Finally, the Arkansas Supreme Court has made clear that amendments should be allowed
`absent prejudice. Pineview Farms, Inc. v. A.O. Smith Harvestore Prods., Inc., 298 Ark. 78, 85-87,
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`765 S.W.2d 924, 928 (1989). Defendants have known of these allegations for over a year, disclosed
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`a rebuttal expert, and engaged in discovery on these issues. They have had a full and fair
`opportunity to defend, and no prejudice can be shown. Plaintiff will promptly amend the Complaint
`to set out these allegations should the Court require it.
`III. Mercy Health Pooled Comprehensive Liability Program
`The only basis for naming Separate Defendant Mercy Health Pooled Comprehensive
`Liability Program was in connection with the Arkansas Direct Action Statute, which allows a
`Plaintiff to sue an insurer where a nonprofit asserts charitable immunity. Plaintiff pled the Pool as
`an alternate defendant in the event that Mercy Hospital Fort Smith asserted charitable immunity.
`Mercy Hospital Fort Smith has since waived charitable immunity in its Answer. Because
`the Direct Action Statute no longer applies under these circumstances, Plaintiff does not oppose
`dismissal of Mercy Health Pooled Comprehensive Liability Program from this action.
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`CONCLUSION
`
`For the reasons set forth above, the Motion to Dismiss should be denied as to Separate
`Defendant Mercy Hospital Fort Smith. The Complaint sets forth sufficient facts to place Mercy
`Hospital on notice of its vicarious liability, and both parties have fully litigated the issues of nursing
`negligence through expert disclosures and discovery. In the alternative, Arkansas Rule of Civil
`Procedure 15(b) deems the pleadings amended to conform to the evidence, and Plaintiff stands
`ready to amend if the Court so requires.
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`As to Separate Defendant Mercy Health Pooled Comprehensive Liability Program,
`Plaintiff does not oppose dismissal in light of Mercy Hospital Fort Smith’s waiver of charitable
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`immunity.
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`Respectfully Submitted,
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`oA
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`Joey McCutchen (ABA#88045)
`Stephen Napurano (ABA#2017071)
`McCutchen Napurano—The Law Firm
`P.O. Box 1971
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`Fort Smith, AR 72902
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`(479) 783-0036
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`(479) 783-5168 Facsimile
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`CERTIFICATE OF SERVICE
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`I, Joey McCutchen state that on this 22" of August, 2025 a copy of the
`foregoing pleading was served by filing with the Court's eFlex system upon all counsel
`of record.
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`St
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`Stephen Napurano
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`March 22, 2024
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`L. Kyle Heffley
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`Sarah J. Heffley
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`KUTAK ROCK LLP
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`5111 W JB Hunt Drive, Suite 300
`Rogers, Arkansas 72758
`Kyle.Heffley@KutakRock.com
`Sarah.Heffley@KutakRock.com
`
`Jason B. Hendren
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`HALL BOOTH SMITH, PC
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`5001 W. Founders Way, Suite 330
`Rogers, AR 72758
`JHendren@hallboothsmith.com
`
`RE: Eric Stipins, in his capacity as Special
`Administrator of the Estate of Stephanie
`Stipins, deceased
`
`VS.
`
`Mercy Health Fort Smith Communities d/b/a
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`Mercy Clinic Obstetrics and Gynecology;
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`Mercy Hospital Fort Smith; Mercy Health Pooled
`Comprehensive Liability Program; John D. McClanahan, M.D.;
`Brock Dupree Wilson, M.D.; and Zachary Ray, M.D.
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`All,
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`This letter is intended to supplement Plaintiff’s interrogatory responses regarding expert
`witnesses. It is also intended to serve as a disclosure of Plaintiff’s expert witnesses.
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`George Kuhn, M.D.
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`Dr. Kuhn is a board-certified OBGYN with 40 years of experience performing
`gynecological surgeries, including laparoscopic hysterectomies.
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`Dr. Kuhn’s opinions are based on his review of the medical records and his education,
`training, and experience. All opinions offered by Dr. Kuhn are within a reasonable degree of
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`EXHIBIT
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`medical certainty. His opinions are set forth below, whether indicated as a specific opinion or as a
`matter to which he is testifying about. He also may testify regarding his opinions about matters
`collateral to the specific opinions provided.
`
`Dr. Kuhn will provide expert opinion and testimony regarding the medical care provided
`to Stephanie Stipins, by the attending obstetrician-gynecologist, Dr. John D. McClanahan, and the
`on-call obstetrician-gynecologist, Dr. Brock Dupree Wilson, during her hospitalization following
`the laparoscopic hysterectomy performed on June 28, 2022.
`
`Dr. Kuhn is expected to provide a detailed description of a laparoscopic hysterectomy like
`the one performed on Stephanie Stipins by Dr. Don Phillips. This will include a detailed
`explanation of the anatomy pertinent to the procedure as well as the surrounding anatomical
`structures. Dr. Kuhn is also expected to describe the typical post-operative course following a
`laparoscopic hysterectomy. This will include the typical anticipated recovery milestones and
`potential complications associated with the procedure such as an ileus.
`
`Dr. Kuhn is expected to testify that Stephanie Stipins began having severe abdominal pain
`several days after her procedure. These symptoms escalated and prompted her to visit the
`emergency room on July 1, 2022. Dr. Kuhn is expected to testify that the abdominal CT Scan
`performed in the emergency room on July 1, 2022, revealed the presence of a significant amount
`of air and fluid in the abdomen. Mrs. Stipins was discharged from the hospital and was
`subsequently readmitted on July 2, 2022, with worsening abdominal pain with associated
`vomiting, and abdominal distension. It is anticipated that Dr. Kuhn will testify that the diagnosis
`of an ileus on July 2, 2022, was inconsistent with the patient’s clinical presentation and the imaging
`findings. Dr. Kuhn is expected to testify that Mrs. Stipins’ clinical presentation, including
`leukopenia, and imaging findings should have raised immediate concerns about the possibility of
`a more serious intraabdominal problem, such as a bowel perforation and/or peritonitis.
`Furthermore, Ms. Stipins’ pain, which persisted despite the regular administration of Dilaudid and
`morphine, should have raised concerns about the underlying cause of Mrs. Stipins’ symptoms. Dr.
`Kuhn will testify that it is more probable than not that a bowel injury occurred during the surgical
`procedure, which clinically manifested on July 1, 2024. Dr. Kuhn will opine that Mrs. Stipins'
`death was most likely caused by an undiagnosed bowel perforation leading to severe peritonitis.
`
`Dr. Kuhn is further expected to testify that Mrs. Stipins’ condition required follow-up
`diagnostic testing and later surgical intervention, rather than the administration of pain medication
`and ambulation as ordered by Dr. McClanahan. Dr. Kuhn is expected to testify that the applicable
`standard of care required further evaluation and intervention, including but not limited to, further
`diagnostic testing, and an immediate consultation with a general surgeon to discuss the need for
`possible surgical intervention. Dr. Kuhn is expected to testify that Dr. McClanahan’s failure to
`take these actions was a violation of the applicable standard of care. Dr. Kuhn is further expected
`to testify that Dr. McClanahan’s failure to order a repeat CT Scan on and after July 3, 2022, as
`well as additional blood work on and after July 4, 2022, was a violation of the applicable standard
`of care. Dr. Kuhn will further testify that the overuse of narcotics, along with Zofran, masked the
`clinical signs and symptoms of a surgical abdomen, which also fell below the applicable standard
`of care.
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`Dr. Kuhn is expected to testify that Dr. Brock Dupree Wilson, as the on-call physician
`responsible for Mrs. Stipin’s care on July 4, 2022, violated the applicable standard of care by
`failing to adequately evaluate Ms. Stipins despite being made aware by nursing staff of her
`escalating pain. Specifically, Dr. Wilson failed to personally assess Mrs. Stipins, failed to modify
`the treatment plan or order additional diagnostic tests to ascertain the cause of her increased pain,
`and failed to consult with a general surgeon for further evaluation and management of Mrs. Stipins’
`condition.
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`Dr. Kuhn will testify that Dr. McClanahan and Dr. Wilson’s failure to properly test for,
`diagnose, and treat Mrs. Stipins’ bowel perforation were concurrent proximate causes of her death.
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`Dr. Kuhn reserves the right to give additional opinions if he receives additional
`information.
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`Daniel Lee Howell, Jr. M.D.
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`Dr. Daniel Howell is a board-certified general surgeon with 16 years of experience
`performing various surgical procedures, including exploratory laparotomies and bowel repairs.
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`Dr. Howell’s opinions are based on his review of the medical records and his education,
`training, and experience. All opinions offered by Dr. Howell are within a reasonable degree of
`medical certainty. His opinions are set forth below, whether indicated as a specific opinion or as a
`matter to which he is testifying about. He also may testify regarding his opinions about matters
`collateral to the specific opinions provided.
`
`Dr. Howell will provide expert opinion and testimony regarding the medical care provided
`to Stephanie Stipins by the attending obstetrician-gynecologist, Dr. John D. McClanahan, and on-
`call obstetrician-gynecologist, Dr. Brock Dupree Wilson, and other medical staff during her
`hospitalization following the laparoscopic hysterectomy performed on June 28, 2022.
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`Dr. Howell is expected to provide a detailed description of the typical course of action a
`general surgeon would undertake in evaluating and managing a patient like Stephanie Stipins. This
`will include a detailed explanation of the relevant anatomy.
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`Dr. Howell will testify that Stephanie Stipins' clinical symptoms, coupled with the findings
`of the abdominal CT Scan performed on July 1, 2022, were highly suggestive of a bowel
`perforation rather than a post-operative ileus. Dr. Howell has reviewed the abdominal CT Scan
`performed on July 1, 2022, and will opine that the findings were abnormal and should have raised
`concerns about a more serious intraabdominal problem, particularly when considered alongside
`Ms. Stipins’ clinical symptoms. Dr. Howell will testify that the abdominal CT Scan showed a
`significant amount of air and fluid in the abdomen. Dr. Howell will testify that it is more probable
`than not that a bowel injury occurred during the surgical procedure, which clinically manifested
`on July 1, 2024. Dr. Howell will opine that Mrs. Stipins' death was most likely caused by an
`undiagnosed bowel perforation leading to severe peritonitis. Furthermore, Dr. Howell will argue
`that the perforation was manageable and could have been repaired if detected early.
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`Additionally, Dr. Howell will opine that Dr. McClanahan and Dr. Wilson’s plan of care,
`which included the regular administration of narcotic medication and encouragement of
`ambulation, was a completely inadequate means of treating Mrs. Stipins’ condition. Dr. Howell
`will testify that repeat imaging, additional blood work, broad-spectrum antibiotics, and an
`immediate consultation with a general surgeon for possible surgical intervention were necessary.
`Dr. Howell will testify that Dr. McClanahan and Dr. Wilson’s failure to properly test for, diagnose,
`and treat Mrs. Stipins’ bowel perforation were concurrent proximate causes of her death.
`Furthermore, Dr. Howell will testify that Mrs. Stipins’ death was preventable if proper medical
`treatment had been provided.
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`Dr. Howell reserves the right to give additional opinions if he receives additional
`information.
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`Barry Fox, M..D.
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`Dr. Barry Fox is board certified with the American Board of Internal Medicine—infection
`disease and internal medicine with extensive experience in the diagnosis and treatment of
`abdominal infections. Dr. Fox will provide expert testimony regarding the medical care provided
`to Stephanie Stipins, focusing on the actions of the attending obstetrician-gynecologist, Dr. John
`D. McClanahan, and the on-call obstetrician-gynecologist, Dr. Brock Dupree Wilson, and other
`hospital staff during her hospitalization following the laparoscopic hysterectomy performed on
`June 28, 2022. Dr. Fox will also explain the pathophysiology of abdominal infections.
`
`Dr. Fox will opine that Mrs. Stipins' symptoms at the emergency room on July 1, 2022,
`particularly the severe abdominal pain, tachycardia, and lab work showing leukopenia with dohle
`bodies and vacuolated neutrophils, and the results of the abdominal CT scan, were highly
`suggestive of an underlying infectious process. Dr. Fox is expected to testify that the abdominal
`CT Scan performed in the emergency room on July 1, 2022, revealed the presence of significant
`amounts of fluid and air in the abdomen. Dr. Fox will testify that Mrs. Stipins’ symptoms in the
`emergency room, and in the subsequent hospital stay, were caused by an undiagnosed bowel
`perforation. It is Dr. Fox’s opinion that Mrs. Stipins most likely sustained a bowel injury during
`the laparoscopic hysterectomy. Dr. Fox will opine that the bowel injury clinically manifested on
`July 1, 2022, and led to multiorgan system failure and death.
`
`Dr. Fox will testify that Dr. McClanahan and Dr. Wilson’s treatment plan, consisting of
`prescribing narcotic pain medication and encouraging ambulation, was completely inadequate to
`treat Mrs. Stipins’ underlying pathology. Furthermore, Dr. Fox will explain the significance of a
`low white blood cell count relative to the suspicion of underlying infection. He will assert that
`immediate intervention, including further diagnostic testing, administration of broad-spectrum
`antibiotics, and consultation with a general surgeon, was necessary to address the bowel
`perforation and prevent the progression to peritonitis.
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`It is Dr. Fox's expert opinion that Mrs. Stipins ultimately died from severe peritonitis
`caused by the undiagnosed bowel perforation and multiorgan system failure. He will explain the
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`pathophysiology of peritonitis and the importance of timely surgical intervention to repair bowels
`perforations. He will also explain the importance of the timely administration of broad-spectrum
`antibiotics to mitigate the risk of systemic infection and organ failure. Dr. Fox will also testify that
`Dr. McClanahan and Dr. Wilson exhibited cognitive bias in their medical decision making, failing
`to consider infection in the differential diagnosis of Mrs. Stipins’ symptoms.
`
`Furthermore, Dr. Fox will argue that the perforation was manageable and could have been
`repaired if detected promptly. He will provide a detailed explanation of the treatment approach for
`bowel perforations and associated infections from an infectious disease perspective. It is Dr. Fox’s
`opinion that Mrs. Stipins would have survived if early appropriate actions, such as repeat imaging,
`blood work, administration of broad-spectrum antibiotics, and surgical consultation, had been
`properly ordered. Dr. Fox will testify that Dr. McClanahan and Dr. Wilson’s failure to properly
`test for, diagnose, and treat Mrs. Stipins’ bowel perforation were concurrent proximate causes of
`her death.
`
`Dr. Fox’s opinions are based on his review of the medical records and his education,
`training, and experience. All opinions offered by Dr. Fox are within a reasonable degree of medical
`certainty. His opinions are set forth below, whether indicated as a specific opinion or as a matter
`to which he is testifying about. He also may testify regarding his opinions about matters collateral
`to the specific opinions provided.
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`Dr. Fox reserves the right to give additional opinions if he receives additional information
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`Jose Spencer, M.D.
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`Dr. Jose Spencer is a board-certified radiologist based in Austin, Texas. Dr. Spencer’s
`opinions are based on his review of the abdominal CT Scan performed on Stephanie Stipins on
`July 1, 2022, and his education, training, and experience.
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`Dr. Spencer will testify that the abdominal CT Scan performed on Stephanie Stipins on
`July 1, 2022, showed the presence of a significant amount of air and fluid, bowel wall thickening,
`and mesentery edema, within the abdominal cavity. The presence of this significant volume of air
`and fluid, bowel wall thickening, and mesentery edema within the abdominal cavity, over 72 hours
`post-laparoscopic hysterectomy, raises concerns for a potential intra-abdominal complication
`including a bowel perforation. Dr. Spencer will describe the typical findings of a CT Scan
`performed during the postoperative period following a laparoscopic hysterectomy and will
`distinguish that with the findings of Mrs. Stipins’ imaging. Dr. Spencer will testify that the
`abdominal CT Scan performed on Mrs. Stipins was abnormal and suggested the possibility of a
`postoperative complication including a bowel perforation.
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`Dr. Spencer will further explain the role of a radiologist during the postoperative period
`and the relationship between radiology and clinical practitioners in the management of patients.
`Dr. Spencer reserves the right to give additional opinions if he receives additional information.
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`Edward J. Stone, M..D.
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`Dr. Edward Stone is a board-certified internist based in Chicago, Illinois that practices as
`a hospitalist. Dr. Stone will provide expert testimony regarding the medical care provided to
`Stephanie Stipins, focusing on the actions of the hospitalist, Dr. Zachary Ray, following the
`laparoscopic hysterectomy performed on June 28, 2022.
`
`Dr. Stone’s opinions are based on his review of the medical records and his education,
`training, and experience. All opinions offered by Dr. Stone are within a reasonable degree of
`medical certainty. His opinions are set forth below, whether indicated as a specific opinion or as a
`matter to which he is testifying about. He also may testify regarding his opinions about matters
`collateral to the specific opinions provided.
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`Dr. Stone will testify that Dr. Ray was consulted for assistance in fluid management due to
`an acute kidney injury and hyponatremia. On July 3, 2022 and July 4, 2022, Dr. Ray examined
`Stephanie Stipins and noted that she continued to have abdominal pain, tachycardia, and abdominal
`distention. Dr. Ray acknowledged in his progress notes that the diagnosis made by Dr.
`McClanahan was that of a post-operative ileus, which was being managed by the primary service
`and it was noted that she was on narcotic pain medication. Dr. Stone will testify that Dr. Ray
`should have recognized that treating a post-operative ileus with regular administration of narcotic
`pain medication was contraindicated. Dr. Stone will testify that the applicable standard of care
`required him to acknowledge the inadequacy of the treatment plan and advocate for a modification.
`Furthermore, Dr. Stone will assert that based on Plaintiff’s symptoms, the standard of care required
`Dr. Ray to advocate for additional imaging, such as a CT scan and consideration of a nasogastric
`tube. Furthermore, Dr. Stone will testify that the standard of care required Dr. Ray to consult with
`the gynecology department managing Mrs. Stipins’ care and advocate for a consult with a general
`surgeon, especially upon discovering Mrs. Stipins’ worsening condition on July 4, 2022. Dr. Stone
`will testify that Dr. Ray’s failure to take these actions was a violation of the applicable standard of
`care.
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`Dr. Stone will further explain the role and responsibilities of a hospitalist in this setting.
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`Dr. Stone reserves the right to give additional opinions if he receives additional
`information.
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`Stacy Shaw, RN
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`Stacy Shaw is a licensed registered nurse with thirty-six years of experience. Nurse Shaw
`is familiar with the care, degree, skill, and learning ordinarily possessed and used by nurses, in
`good standing, engaged in the practice of nursing at Mercy Hospital Fort Smith, or in a similar
`locality, and specifically with regard to the care required of nurses responsible for post-surgical
`care and treatment.
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`Nurse Shaw’s opinions are based on her review of the medical records and her education,
`training, and experience. All opinions offered by Nurse Shaw are within a reasonable degree of
`nursing certainty. Her opinions are set forth below, whether indicated as a specific opinion or as a
`matter to which she is testifying about. She also may testify regarding her opinions about matters
`collateral to the specific opinions provided.
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`It is Nurse Shaw’s opinion to a reasonable degree of nursing probability, based on her years
`of nursing education, training, and experience, that Cristina Rogers, RN, Joy Silvey, RN, and
`Jessica Winfrey, LPN, violated the applicable nursing standards of care in this case.
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`On July 3, 2022, Dr. John McClanahan noted that neither IV fluids nor labs had been
`initiated despite being ordered the previous night. Nurse Shaw will testify that Christina Rogers,
`RN, was responsible for administering IV fluids and drawing labs as per Dr. McClanahan’s order.
`Nurse Shaw will testify that Nurse Rogers’ failure to initiate IV fluids and draw labs was a
`violation of the applicable standard of care, especially considering Mrs. Stipins’ decreased urine
`output, elevated creatinine, tachycardia, and low sodium levels noted in prior lab work. Nurse
`Shaw will further testify that this delay in treatment directly contributed to Mrs. Stipins’ acute
`kidney injury.
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`On the morning and afternoon of July 3, 2022, Mrs. Stipins continued to have severe
`abdominal pain, nausea, abdominal distention, tachycardia, and a low urine output. Nurse Shaw
`will testify that the applicable standard of care for nurses required Nurse Rogers to notify a
`physician of these concerning signs and symptoms. Nurse Rogers should have taken further steps,
`including advocating for additional assessments or interventions, potentially escalating the matter
`to hospital administration if necessary to ensure that Mrs. Stipins received the appropriate level of
`care and consideration of a second medical opinion. Nurse Roger’s failure to take additional steps
`as a patient advocate for Stephanie Stipins was a violation of the applicable standard of care.
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`On the evening of July 3™, Mrs. Stipins continued to have intense abdominal pain,
`tachycardia, abdominal distention, and low urine output. Nurse Shaw will testify that the
`applicable standard of care for nurses required Nurse Jessica Winfrey to notify a physician of these
`concerning signs and symptoms. Nurse Winfrey should have taken further steps, including
`advocating for additional assessments or interventions, potentially escalating the matter to hospital
`administration if necessary to ensure that Mrs. Stipins received the appropriate level of care and
`consideration of a second medical opinion. Nurse Winfrey’s failure to take additional steps as a
`patient advocate for Stephanie Stipins was a violation of the applicable standard of care.
`
`On July 4™ Mrs. Stipins continued to have intense abdominal pain, tachycardia, and
`abdominal distention. According to Nurse Joy Silvey’s progress note, she initiated contact with
`the on-call obstetrician-gynecologist (OBGYN), Dr. Brock Dupree Wilson, due to Mrs. Stipins'
`worsening pain. Following her conversation with Dr. Wilson, the treatment plan in place was
`continued, which consisted of ambulation and the administration of pain medication. Nurse Silvey
`should have recognized that the existing treatment plan was inadequate for addressing Mrs. Stipins'
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`deteriorating condition. Nurse Silvey should have taken further steps, including advocating for
`additional assessments or interventions, potentially escalating the matter to hospital administration
`if necessary to ensure that Mrs. Stipins received the appropriate level of care and consider