BARBARA CASTEEL, INDIVIDUALLY AND ON BEHALF OF THE ESTATE OF RICK CASTEEL V. JOHN KRIKOR GULUZIAN ET. AL. — NOT TO BE PUBLISHED - OPINION AFFIRMING

RENDERED: OCTOBER 9, 2026; 10:00 A.M. NOT TO BE PUBLISHED Commonwealth of Kentucky Court of Appeals NO. 2025-CA-1042-MR BARBARA CASTEEL, INDIVIDUALLY AND ON BEHALF OF THE ESTATE OF RICK CASTEEL APPELLANT v. APPEAL FROM KENTON CIRCUIT COURT HONORABLE KATHLEEN LAPE, JUDGE ACTION NO. 20-CI-01338 JOHN KRIKOR GULUZIAN; RADIOLOGY ASSOCIATES OF NORTHERN KENTUCKY, PLLC; AND SAINT ELIZABETH MEDICAL CENTER, INC. APPELLEES OPINION AFFIRMING ** ** ** ** ** BEFORE: ACREE, L. JONES, AND MOYNAHAN, JUDGES. MOYNAHAN, JUDGE: Appellant, Barbara Casteel, individually and on behalf of the estate of Rick Casteel, (collectively “the Estate”), challenges the July 9, 2025, judgment from the Kenton Circuit Court which memorialized the final jury verdict

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-2- in the underlying wrongful death action initiated by the Estate. In that judgment, the jury determined that the actions of Appellee, John Guluzian, M.D. (“Dr. Guluzian”), who was employed by Appellee, Radiology Associates of Northern Kentucky, PLLC (“RANK”), was not a substantial factor in causing Mr. Casteel’s death. The Estate also challenges the circuit court’s May 22, 2025, order granting the summary judgment motion of Appellee, Saint Elizabeth Medical Center, Inc. (“SEMC”), which dismissed it as a party from the underlying case. For the reasons stated herein, we affirm. BACKGROUND On October 8, 2019, Rick Casteel (“Mr. Casteel”) presented to the emergency room of SEMC with stomach pains and vomiting. Upon arriving, Mr. Casteel completed a registration process which included signing a standard Medical and Authorization Release (“the Authorization”) form utilized by SEMC. Mr. Casteel e-signed this Authorization on an electronic signature pad, though a laminated hard copy of the Authorization was available for review at the time. Pertinent to this appeal is the paragraph of the Authorization which states that the patient understands that SEMC independently contracts with some practitioners, who are not employees of SEMC, for various services, including radiology. It is uncontested that Mr. Casteel had signed several other Authorizations with similar language over the previous four years, the most recent having been in June 2019.

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-3- After the registration process, Mr. Casteel underwent an evaluation with an emergency medicine physician, who took a medical history of Mr. Casteel’s stomach pains and vomiting, performed a physical exam, and ordered some laboratory tests and an abdominal computed tomography (“CT”) scan on his abdomen. At the time, the emergency physician did not note anything remarkable during Mr. Casteel’s physical exam or laboratory work. The CT scan was interpreted by Dr. Guluzian, a radiologist employed by RANK and contracted with SEMC to provide radiology services. After examining the CT scan as well as a previous CT scan of Mr. Casteel’s from 2015, Dr. Guluzian reported no acute findings. However, both the 2015 and 2019 CT scans show that Mr. Casteel had a paraoesophageal hernia. Relying in part upon Dr. Guluzian’s findings, the emergency physician discharged Mr. Casteel early on October 9, 2019. Mr. Casteel was still vomiting at the time of discharge. The following day, Mr. Casteel passed away with the cause of death being attributed to a gastric perforation related to a volvulus.1 The Estate initiated the underlying action in September 2020, and discovery commenced. The parties deposed multiple expert witnesses, two of whom were Sean Harbison, M.D. (“Dr. Harbison”) for Dr. Guluzian and RANK, 1 A volvulus is a twisting of a portion of the digestive tract.

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-4- and Douglas Aach, M.D. (“Dr. Aach”) for the Estate. In 2022, the parties filed their initial disclosures for expert witnesses pursuant to Kentucky Rule of Civil Procedure (“CR”) 26.02.2 Specifically, the disclosure regarding Dr. Harbison states in part: Dr. Harbison has reviewed the Hospital records from the care which precipitated this litigation[,] the autopsy report and [] the radiology images herein, as well as transcripts from the depositions of Drs. Nithianandam and Guluzian. Based on his review of these materials in conjunction with his education, training and experience, it is anticipated Dr. Harbison will testify from the perspective of a gastrointestinal surgeon in rebuttal to any criticisms of Dr. Guluzian or to any contention that Dr. Guluzian’s care was causative of any injury or harm to [Mr. Casteel]. More specifically, it is anticipated his testimony will include the following opinions: (1) There are no appreciable acute issues or pathology on the radiology images from 10/09/2019 and nothing on these images suggested the need for any consultations or urgent interventions. (2) The perforation herein occurred after the images at issue were taken and nothing appreciable on those images suggested a perforation was imminent. (Record, (“R.”) at 87-88). 2 CR 26.02(4)(a)(i) provides: “A party may through interrogatories require any other party to identify each person whom the other party expects to call as an expert witness at trial, to state the subject matter on which the expert is expected to testify, and to state the substance of the facts and opinions to which the expert is expected to testify and a summary of the grounds for each opinion.”

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-5- The following year, and before discovery was complete, SEMC moved for summary judgment on the Estate’s claim for vicarious liability against it, arguing that there was no ostensible agency between Dr. Guluzian and SEMC. The circuit court denied the motion, though provided no analysis or reason for doing so, other than noting the Estate’s assertion that SEMC was not being forthright about its presentation of Dr. Guluzian’s employment status. Discovery continued and the matter was set for a jury trial. Prior to trial, the parties filed respective motions in limine to exclude certain articles of testimony. Within the Estate’s omnibus motion, it requested the standard exclusion for undisclosed opinion testimony from experts. SEMC made the same request. The circuit court granted the request noting approval from each party. Following the close of discovery, SEMC renewed its motion for summary judgment on the vicarious liability claim. Noting its prior denial of SEMC’s motion for summary judgment, the circuit court recognized that discovery “has now been completed and the issue is ripe for the court’s reconsideration.” (R. at 770.) The circuit court considered the Kentucky Supreme Court’s ruling in Sneed v. University of Louisville Hospital, 600 S.W.3d 221 (Ky. 2020), determined that SEMC had provided sufficient notice to Mr. Casteel that Dr. Guluzian was not its employee, granted SEMC’s motion for summary judgment, and dismissed it as

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-6- a party from the action. Consequently, the Estate proceeded to trial against only Dr. Guluzian and his employer, RANK, over the course of several days in May and June 2025. At trial, the Estate’s experts testified that Dr. Guluzian deviated from the standard of care in his interpretation of Mr. Casteel’s CT scan because of his failure to report findings concerning a paraoesophageal hernia. Dr. Guluzian’s experts acknowledged that while the paraoesophageal hernia may have been present, the 2019 CT scan did not show signs of a volvulus. Exactly how and when the volvulus occurred, whether it was after or before the imaging took place, became a key issue at trial. Specifically on the Estate’s behalf, Dr. Aach, a gastrointestinal surgeon, testified that in his typical practice he would review and compare a patient’s CT scans; in this case he would have viewed both Mr. Casteel’s 2015 and 2019 CT scans. At one point during his testimony, Dr. Aach explained that it was possible for an individual to vomit through an obstructed stomach, such as one with a volvulus, with enough force generated by the compression of a hernia. (Video Record (“V.R.”), May 30, 2025, Trial at 12:30:45.) The last witness called in the trial was Dr. Harbison. Prior to his testimony, the Estate orally moved to prohibit any opinions relating to the 2015 CT scan. As part of its basis for the request, it noted that Dr. Harbison acknowledged

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-7- that he had not seen the 2015 CT scan when he gave his first deposition. The circuit court overruled the motion. During his direct testimony, Dr. Harbison was shown the 2015 CT scan and the only question pertaining to that scan was whether Mr. Casteel’s paraoesophageal hernia was larger between the two, to which he responded affirmatively. (V.R. June 5, 2025, Trial at 11:14:10.) Dr. Harbison also responded to Dr. Aach’s testimony about whether an individual would be able to vomit through an obstructed stomach with enough force, to which he responded that it was unlikely but conceivable. Id. During his cross-examination, counsel for the Estate asked Dr. Harbison whether he had seen the 2015 CT scan prior to making his initial medical opinions, to which he responded negatively. Counsel for the Estate then continued to ask Dr. Harbison several questions about the differences between the 2015 and 2019 CT scans, to which Dr. Harbison responded that there were no significant differences from his view, the only notable difference was Mr. Casteel’s paraoesophageal hernia being slightly larger. (V.R. June 5, 2025, Trial at 11:29:40.) The jury unanimously found Dr. Guluzian failed to comply with the standard of care; however, nine jurors did not find that Dr. Guluzian’s breach of that standard of care proximately caused Mr. Casteel’s death. On appeal, the Estate seeks a new trial asserting the circuit court erred in allowing Dr. Harbison to

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-8- testify that he had seen the 2015 CT scan, and in granting SEMC’s motion for summary judgment regarding the Estate’s vicarious liability claim. STANDARD OF REVIEW For questions regarding the admissibility of witness testimony, the Court reviews the lower court’s determination for an abuse of discretion, or in other words, if the decision was arbitrary, unreasonable, unfair, or unsupported by sound legal principles. Commonwealth v. English, 993 S.W.2d 941, 945 (Ky. 1999). In ruling on summary judgment, “[t]he record must be viewed in a light most favorable to the party opposing the motion for summary judgment and all doubts are to be resolved in his favor.” Steelvest, Inc. v. Scansteel Service Center, Inc., 807 S.W.2d 476, 480 (Ky. 1991). “Appellate review of a summary judgment involves only legal questions and a determination of whether a disputed material issue of fact exists. So, we operate under a de novo standard of review with no need to defer to the trial court’s decision.” Adams v. Sietsema, 533 S.W.3d 172, 177 (Ky. 2017). ANALYSIS I. Undisclosed Expert Opinions Generally, trial courts are afforded a wide latitude of discretion in determining whether to admit or exclude expert testimony. Jones v. Stern, 168 S.W.3d 419, 424 (Ky. App. 2005). Our civil rules also provide a rather liberal

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-9- discovery process, which the courts have held “simplifies and clarifies the issues in a case; eliminates or significantly reduces the element of surprise; helps to achieve a balanced search for the truth, which in turn helps to ensure that trials are fair; and it encourages the settlement of cases.” LaFleur v. Shoney’s, Inc., 83 S.W.3d 474, 478 (Ky. 2002). Part of the pretrial discovery process includes appropriately disclosing expert witnesses pursuant to CR 26.02(4), as the “discovery of the substance of an expert witness’s expected testimony is essential to trial preparation.” Clephas v. Garlock, Inc., 168 S.W.3d 389, 394 (Ky. App. 2004). In addition to there being an abuse of discretion, “the person requesting exclusion of testimony must show prejudice. Otherwise, there is no valid basis to exclude or limit testimony.” Equitania Ins. Co. v. Slone & Garrett, P.S.C., 191 S.W.3d 552, 556 (Ky. 2006). This tenet is recognized in our civil rules, CR 61.01 stating: No error in either the admission or the exclusion of evidence . . . is ground for granting a new trial or for setting aside a verdict . . . unless refusal to take such action appears to the court inconsistent with substantial justice. The Court at every stage of the proceeding must disregard any error or defect in the proceeding which does not affect the substantial rights of the parties. Furthermore, “[w]hen considering a claim of harmless error under CR 61.01, the court determines whether the result probably would have been the same absent the error or whether the error was so prejudicial as to merit a new trial.” CSX Transp., Inc. v. Begley, 313 S.W.3d 52, 69 (Ky. 2010) (footnote omitted).

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-10- The Estate argues that the circuit court erred in overruling its motion in limine to exclude testimony from Dr. Harbison regarding Mr. Casteel’s 2015 CT scan. It contends that any opinions offered by Dr. Harbison relating to the 2015 CT scan were undisclosed, as Appellees’ CR 26.02 disclosure did not specifically state that Dr. Harbison would be offering opinions relating to the 2015 CT scan, and because Dr. Harbison explicitly stated during his previous deposition that he had not viewed the 2015 CT scan. Notably, as Dr. Guluzian and RANK point out, the Estate does not clearly explain what this testimony is or provide adequate citations to the video record on appeal.3 Regardless, the Court has reviewed Dr. Harbison’s testimony in its entirety and can only surmise that the specific testimony that the Estate refers to concerns his indication that he had seen the 2015 CT scan and his view that it would have been difficult for Mr. Casteel to vomit through an obstructed stomach. The Court has also reviewed Dr. Harbison’s prior deposition and observes that this specific point is not mentioned. However, we fail to see how the admission of this 3 The Estate cites to the circuit court’s consideration of its motion in limine made before Dr. Harbison’s testimony but fails to indicate any specific portion of Dr. Harbison’s testimony. Pursuant to Kentucky Rules of Appellate Procedure (“RAP”) 32(A)(4) an appellant’s brief shall provide “ample references to the specific location in the record and citations of authority pertinent to each issue of law. . .” Additionally, “[i]t is well-settled that an appellate court will not sift through a voluminous record to try to ascertain facts when a party has failed to comply with its obligation under” applicable briefing rules. Parker v. Commonwealth, 291 S.W.3d 647, 676 (Ky. 2009). The Court reminds counsel of the importance to provide adequate citations to the record on appeal in the future.

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-11- testimony is prejudicial, or that it would have altered the jury’s ultimate determination for a number of different reasons. Firstly, we agree with Dr. Guluzian and RANK that Dr. Harbison’s testimony concerning the difficulty in vomiting through an obstructed stomach appears to have been directly elicited to rebut Dr. Aach’s testimony on that subject. Whether Dr. Aach’s testimony on this subject amounted to undisclosed opinion testimony is not an issue before this Court,4 but assuming arguendo that it was, the Estate “opened the door” to this testimony and Dr. Harbison’s testimony may serve as “curative admissibility.” Purcell v. Commonwealth, 149 S.W.3d 382, 399 (Ky. 2004), overruled on other grounds by Commonwealth v. Prater, 324 S.W.3d 393 (Ky. 2010); see also Miller v. Eldridge, 146 S.W.3d 909, 914 (Ky. 2004). Furthermore, to the extent that Dr. Harbison did testify about the 2015 CT scan, we note that he was presented a screenshot of the 2015 CT scan during his testimony, and the majority of that testimony was elicited on cross-examination by the Estate’s counsel, which included the fact that Dr. Harbison had not reviewed the 2015 CT scan before sitting for his deposition.5 4 We note that Dr. Guluzian and RANK have also failed to provide adequate citations to the precise testimony by Dr. Aach which it asserts was an undisclosed opinion and remind counsel of the importance of doing so in the future. 5 The Court also notes that Dr. Harbison was also shown the 2015 CT scan during the previous deposition, was questioned about the scan, and it was included as an exhibit to that deposition.

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-12- Finally, we are not convinced that any of Dr. Harbison’s testimony concerning the 2015 CT scan would have been necessarily barred because it was not explicitly mentioned in the disclosure or “failed to comply with both the letter and the spirit of CR 26.02.” Meade v. Dvorak, 571 S.W.3d 585, 588 (Ky. App. 2018). As seen in the language of the disclosure listed, supra, Dr. Harbison was expected to testify as a gastrointestinal surgeon in rebuttal to Dr. Guluzian’s expert witnesses concerning the issue of causation. Though the disclosure noted his testimony would apply specifically to the 2019 CT scan, it is not unreasonable to assume that his testimony may extend to touch on issues concerning the 2015 CT scan, especially after he was presented with a copy of that scan and questioned about it in both his second deposition and during his testimony at trial. Cf. Clephas, 168 S.W.3d at 393-94. In Clephas, this Court held that a portion of an expert’s testimony was significantly prejudicial and constituted an inadmissible undisclosed opinion based upon its determination that the disclosure statement in question was overly broad and did not sufficiently apprise the parties that the expert would be testifying about the plaintiff’s specific medical condition; the fact that the defendant’s counsel had engaged in shoddy trial tactics and had a pattern of noncompliance with discovery requests; and the fact that the expert had not formulated his opinion, or was

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-13- provided with the materials necessary for him to do so, until a few hours before his testimony. Id. Ultimately, we cannot say the circuit court abused its discretion in denying the Estate’s motion in limine to exclude Dr. Harbison’s testimony, nor has the Estate provided sufficient reasoning to conclude that Dr. Harbison’s testimony relating to the 2015 CT scan prejudiced its position. II. SEMC Summary Judgment As SEMC maintains in its brief, the only claim the Estate has asserted against it is vicarious liability through Dr. Guluzian and RANK, based on the theory that Dr. Guluzian was an ostensible agent of SEMC. However, because we have held that the judgment against Dr. Guluzian should be affirmed, the issues of vicarious liability and ostensible agency are effectively rendered moot. See Branham v. Rock, 449 S.W.3d 741, 752 (Ky. 2014); see also Floyd v. Humana of Virginia, Inc., 787 S.W.2d 267, 269-70 (Ky. App. 1989). The Estate also argues that SEMC’s dismissal from the case on the eve of trial prejudiced its case against Dr. Guluzian and RANK because juries are more critical of corporate entities like hospitals rather than individuals; however, we observe that the Estate has cited no legal authority to support this point, nor are we aware of any. To the extent that the circuit court’s determination that Dr. Guluzian was not an ostensible agent of SEMC may have affected the proceedings,

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-14- we find no error in the circuit court’s determination. There was no evidence presented that SEMC intended to deceive or induce Mr. Casteel into believing Dr. Guluzian was its employee, or that Mr. Casteel’s decision to seek treatment from SEMC was in any way predicated upon Dr. Guluzian’s employment.6 Considering the clear language of the Authorization, which was signed, albeit electronically, by Mr. Casteel on several occasions including the night he sought treatment at SEMC, we cannot agree with the Estate that SEMC’s steps to inform Mr. Casteel were by any means unreasonable. Sneed, 600 S.W.3d 221; see also Floyd, 787 S.W.2d 267 (citing Williams v. St. Claire Medical Center, 657 S.W.2d 590 (Ky. App. 1983)). CONCLUSION Accordingly, we discern no abuse of discretion or reversible error in the circuit court’s decisions and affirm the July 9, 2025, judgment and May 22, 2025, order of the Kenton Circuit Court. ALL CONCUR. 6 Ms. Casteel indicated that she and Mr. Casteel sought medical treatment at SEMC because it was “the only hospital in the area,” had never met or seen Dr. Guluzian, and had no knowledge of who Dr. Guluzian was other than that he was the radiologist who examined Mr. Casteel’s CT scan after the fact.

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-15- BRIEFS FOR APPELLANT: Patrick J. Beirne Logan E. English Covington, Kentucky BRIEF FOR APPELLEES JOHN GULUZIAN AND RADIOLOGY ASSOCIATES OF NORTHERN KENTUCKY, PLLC: Benny C. Epling, II Lexington, Kentucky BRIEF FOR APPELLEE SAINT ELIZABETH MEDICAL CENTER, INC.: Ellen M. Houston Covington, Kentucky

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