Patricia Karsner v. Marcis A. Craig, M.D. ( 2021 )

RENDERED: JANUARY 22, 2021; 10:00 A.M.
NOT TO BE PUBLISHED
Commonwealth of Kentucky
Court of Appeals
NO. 2019-CA-1051-MR
PATRICIA KARSNER APPELLANT
APPEAL FROM HARDIN CIRCUIT COURT
v. HONORABLE KELLY MARK EASTON, JUDGE
ACTION NO. 17-CI-01861
MARCIS A. CRAIG, M.D. AND APPELLEES
HARDIN MEMORIAL
OPINION
AFFIRMING
** ** ** ** **
BEFORE: COMBS, LAMBERT, AND K. THOMPSON, JUDGES.
COMBS, JUDGE: This is a medical negligence case. Patricia Karsner appeals the
summary judgment of the Hardin Circuit Court entered in favor of Hardin
Memorial Hospital and Marcis Craig, M.D. Karsner filed the malpractice action
claiming damages arising out of complications associated with surgery performed
on her left arm. Because it was persuaded that the action had been filed out of
time, the circuit court granted summary judgment. After our review, we affirm.
The following material facts are undisputed. On September 23, 2015,
Karsner sustained a fracture of her humerus during an altercation with local police.
She was taken by ambulance to Hardin Memorial Hospital where her arm was
immobilized by a splint. Several days later, Dr. Craig, an orthopedic surgeon
employed by Hardin Memorial Hospital, performed an open reduction internal
fixation to help repair the fractured bone. He utilized a surgical locking plate and
surgical screws. No complications were noted.
At Karsner’s first follow-up appointment on October 13, 2015, Dr.
Craig noted that the incisions were healing well. He ordered physical therapy.
During follow-up visits on November 5, 2015, and December 3, 2015, neither Dr.
Craig nor his nurse practitioner noted any complications. Images indicated the
humerus was “aligned and well-fixated” and that the “[h]ardware [was] intact.”
Karsner failed to show up for appointments scheduled for January 21,
2016, and March 10, 2016. During her next visit, on March 17, 2016, Karsner
complained of pain in her forearm. An x-ray now indicated “non-union” of the
humerus. Dr. Craig ordered a bone stimulator to help in healing.
Karsner saw Dr. Craig’s nurse practitioner for another visit on April
22, 2016. Karsner complained of pain in her upper left arm. A radiology report
dated April 29, 2016, indicated that the bone was “partially ununited.” Evidence
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of hardware loosening and of a broken screw was also observed. Karsner was
advised of the hardware failure.
On May 3, 2016, Karsner returned for another follow-up visit with Dr.
Craig. She reported that she was continuing to feel pain. Dr. Craig again
described the humerus as a “non-union.” Dr. Craig referred Karsner to Dr. Craig
Roberts, a trauma specialist at the University of Louisville. Dr. Craig’s office
scheduled an appointment for May 18, 2016, but Karsner did not appear for the
appointment with Dr. Roberts.
In a telephone call to Dr. Craig’s office on June 15, 2016, Karsner
complained that she was continuing to feel significant pain in her arm and that her
prescription for narcotic pain medication had been reduced. An office note
documented that Karsner was crying and reported that she was contemplating
suicide because of the pain.
Karsner saw her primary care physician on July 8, 2016. The
physician noted in his progress report that Karsner reported that she was treating
with Dr. Roberts because a surgical plate had loosened in her upper arm just
months after her surgery.
On July 27, 2016, Karsner went to the hospital emergency room. She
complained of pain in her left arm and a rash. Images indicated “displacement of
the butterfly fragment of bone which is now no longer fixed with the screws.”
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Two days later, on July 29, 2016, Karsner saw Dr. Craig for the last
time. Dr. Craig again noted humerus “non-union.” He suggested to Karsner that
he set up another appointment for her to see Dr. Roberts in Louisville. Karsner
indicated to Dr. Craig that she might or might not be able to attend. However, she
did see Dr. Roberts, and on September 16, 2016, he performed surgery to remove
the failed surgical hardware.
On August 16, 2017, Karsner filed a proposed complaint with a
medical review panel. (The medical review panel procedure was subsequently
declared unconstitutional.) On November 8, 2017, Karsner filed a medical
malpractice action against Dr. Craig and the hospital in Hardin Circuit Court.
Karsner alleged that Dr. Craig’s treatment had fallen below the standard of care
and that the hospital was vicariously liable for his negligence.
Dr. Craig and the hospital answered and denied the allegations. They
also asserted the one-year statute of limitations as a defense.
Karsner was deposed on October 10, 2018. With respect to Dr.
Craig’s treatment, Karsner testified that as early as March 10, 2016, she had
developed “an underlying concern” regarding her care. She believed that:
the surgery hadn’t been done properly. That Dr. Craig
shouldn’t have done it; he should have sent me to a
trauma surgeon that day. And that the infection and my –
my complaints of there being more pain, not less pain,
and the complaints of infection were going – going
unnoticed, untreated, and ignored.
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Karsner thought Dr. Craig should not have performed the surgery and “just felt an
underlying sense that . . . he was in over his head.” She was convinced that Dr.
Craig was not adequately qualified to perform her surgery and was out of his depth
“when he started talking about trauma surgeons, and I started looking into what
trauma surgeons do, and . . . what should have been done.”
Relying on Karsner’s deposition testimony, the hospital filed a motion
for summary judgment on February 4, 2019. It argued that Karsner had knowledge
of her alleged injury no later than July 2016 and, consequently, that she had failed
to assert a timely claim. In a supplemental memorandum, the hospital raised issues
concerning its governmental immunity.
On March 19, 2019, Dr. Craig filed a similar motion for summary
judgment. Relying on Karsner’s deposition testimony, Dr. Craig argued that the
action against him had not been timely filed.
In separate responses, Karsner argued that by the time of her
deposition, she “had participated in far too many conversations with legal counsel
and medical experts and other physicians to accurately testify as to what she knew
or thought she knew” during the period that she was being treated by Dr. Craig.
She also contended that the “continuing course of treatment doctrine” tolled the
statute of limitations until after Dr. Roberts performed the corrective surgery. She
argued that her treatment with Dr. Roberts constituted a continuing course of Dr.
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Craig’s treatment because Dr. Craig had referred her to Dr. Roberts. For these
reasons, she argued that summary judgment was not warranted.
The circuit court conducted a hearing on the motions on April 2, 2019.
At the end of the hearing, the court instructed the parties to present any caselaw
that they could find pertaining to an extension of the continuing course of
treatment doctrine as proposed by Karsner.
Several days later, the circuit court rendered summary judgment. The
court concluded that Karsner had discovered or should have discovered her injury
well before her last visit with Dr. Craig in July of 2016. The court was not
persuaded that the continuing course of treatment doctrine could be extended to
toll the statute of limitations throughout Karshner’s treatment with Dr. Roberts and
that Dr. Craig and the hospital were entitled to judgment as a matter of law.
On April 10, 2019, Karsner filed a motion to supplement the record
with a memorandum. In her memorandum, she explained that the court need not
evaluate the continuous treatment doctrine as it pertained to Dr. Craig’s referral to
Dr. Roberts after all. Instead, Karsner’s argument now focused upon an allegation
that Dr. Craig had fraudulently concealed his malpractice. She argued that Dr.
Craig failed to inform her “about some wrongdoing that may give rise to a cause of
action” and merely referred her to Dr. Roberts. Karsner surmised that “Dr. Craig
knew something was not right or he would not have referred [me] to a trauma
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surgeon – yet he said nothing.” Karsner contended that the referral was deceptive
and that Dr. Craig used it merely to “run out the statute of limitations clock.” She
described the referral as a distraction and alleged that it was made only to “eat up”
time on a “wild goose chase.”
On April 12, 2019, the clerk of the Hardin Circuit Court entered the
circuit court’s summary judgment against Karsner. The circuit court’s subsequent
order denying Karsner’s motion to alter, amend, or vacate the judgment was
entered on May 3, 2019.
Five days later, on May 8, 2019, Karsner tendered electronically her
notice of appeal. She did not pay the requisite filing fee, however. CR1
73.02(1)(b) provides mandatorily that a notice of appeal “shall not be docketed or
noted as filed until such payment is made.” CR 73.02(1)(b). The failure of a party
to file timely a notice of appeal shall result in dismissal. CR 73.02(2).
Karsner paid her filing fee on July 12, 2019. Nevertheless, the clerk’s
handwritten notation on the face of the notice of appeal indicates that it was filed
electronically on “5-8-19.” It also appears that she superimposed a “5” onto the
“7” or vice-versa. The clerk’s handwritten note correctly indicates that the filing
fee was received on July 12, 2019, and that copies of the notice of appeal were
1
Kentucky Rules of Civil Procedure.
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then served upon the attorneys of record and our clerk. A copy was received by
this Court on July 15, 2019.
On July 24, 2019, we ordered Karsner to show cause why her appeal
should not be dismissed for failure to file a timely notice of appeal. We have
reviewed her response to our order as well as the responses of Dr. Craig and the
hospital.
In her response to our show cause order, Karsner explained that
counsel filed the notice of appeal “with no filing fee being collected or required in
Hardin Circuit Court.” Counsel stated that he “had no notice that there was a
problem.” However, as time passed and counsel became concerned about
certification of the record, he contacted the circuit court clerk. Counsel indicated
that the clerk “admitted that it was her fault and that we should have been
contacted by Hardin County Court Clerk regarding the filing fee. . . .” He
explained that the clerk advised that she would certify the record once the filing fee
was paid. The fee was promptly forwarded to her attention. In the response filed
with this Court, counsel made no reference whatsoever to the appellate rules of
procedure.
In their responses, Dr. Craig and the hospital observed that counsel
misidentified the filing tendered electronically on May 8, 2019, as “Other
Document/Pleading” rather than as a “Notice of Appeal (Civil).” A tendered
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“Other Document/Pleading” does not require a filing fee. Consequently, the
electronic filing system would never have prompted counsel to pay a filing fee.
Dr. Craig and the hospital argued that because the notice tendered on
May 8 was unaccompanied by a filing fee until July 12, it was insufficient to
invoke our jurisdiction pursuant to the rules of civil procedure. They relied upon
the holding of the Kentucky Supreme Court in Excel Energy, Inc. v
Commonwealth Institutional Securities, Inc., 37 S.W.3d 713 (Ky. 2000) as
modified on denial of reh’g (Nov. 22, 2001), as well as our reasoning in Bruner v.
Sullivan University System, Inc., 544 S.W.3d 669 (Ky. App. 2018).
In Excel Energy, counsel tendered a notice of appeal to the Jefferson
Circuit Clerk’s office and stamped it “filed” with the file stamp located in the
clerk’s office. Counsel dropped the notice of appeal into an inbox for processing
but failed to tender the filing fee. The following day, the clerk’s office notified
counsel that the notice was inadequate without the filing fee and refused to mark
the notice as filed until the filing fee was paid. The filing fee was promptly paid
and the tendered notice was marked filed -- but only after the filing deadline. The
court concluded that Excel’s notice of appeal had not been timely filed, that
substantial compliance with the rules was not a standard applicable to the facts,
and that automatic dismissal of the appeal was required by our rules of civil
procedure.
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In Bruner, counsel attempted to file a notice of appeal with the court’s
electronic filing system on May 31, 2016 -- the date the notice was due. However,
counsel misidentified the tendered notice as “NOTICE — OTHER.”
Consequently, counsel was not prompted to pay the required filing fee. The filing
fee was not paid for another week. On that day, the clerk docketed Bruner’s notice
of appeal and marked it as filed. We ordered Bruner to show cause why his appeal
was not subject to automatic dismissal.
Bruner’s counsel explained that his failure timely to pay the filing fee
was the result of his law clerk’s difficulty navigating the Jefferson Circuit Court’s
online electronic filing system. We noted that the electronic system in question
was implemented under the authority of the Kentucky Supreme Court’s Amended
Order 2015-02. Section 15 of that order, entitled “Technical Difficulties; System
Unavailability,” provides in relevant part:
(1) Jurisdictional deadlines. Some deadlines are
jurisdictional and cannot be extended. A technical
failure, including a failure of the eFiling system, will not
excuse a failure to comply with a jurisdictional deadline.
The eFiler must ensure that a document is timely filed to
comply with jurisdictional deadlines and, where
necessary to comply with such deadlines, the eFiler must
file the document conventionally accompanied by a
certification of the necessity to do so in order to meet a
jurisdictional deadline.
We rejected counsel’s excuse.
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We then considered counsel’s argument that the automated response
that Bruner received after he tendered his notice of appeal brought the matter
within the purview of the court’s earlier holding in Norwest Bank Minnesota, N.A.
v. Hurley, 103 S.W.3d 21 (Ky. 2003).
In Hurley, the appellant tendered a timely notice of appeal along with
a check in the amount of the filing fee. However, when the circuit court clerk
received the notice of appeal, she noticed that the check was unsigned. The clerk
contacted Norwest’s counsel, alerted him that the check was unsigned, and
indicated that it was being returned to him for proper signature. Despite the error,
the clerk assured Norwest’s counsel that the notice of appeal would be filed. The
clerk did in fact note on the docket that the notice was filed on the day it was
received -- April 20. The circuit court clerk received the signed check on May 9
and noted on the docket that the filing fee was paid that day.
On appeal, we concluded that the clerk violated the provisions of CR
73.02(1) by filing Norwest’s notice of appeal because payment was not made
timely; i.e., the docket sheet reflected that payment was made on May 9, which
was beyond the thirty-day limit allowed in our rules of civil procedure. Relying on
the decision of the Kentucky Supreme Court in Excel Energy, 37 S.W.3d 713, we
concluded that the notice of appeal was untimely and dismissed the appeal.
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On appeal, our decision was reversed. The Kentucky Supreme Court
determined that because the clerk had docketed the notice of appeal the day it
was filed, the notice of appeal had been timely and validly filed -- despite the
clerk’s failure to collect the filing fee in violation of the provisions of CR
73.02(1)(b).
In Bruner, we determined that the facts described in Hurley were
readily distinguishable. In Bruner, the certified record indicated that the clerk
accepted Bruner’s notice of appeal on June 8, 2016 -- the date on which Bruner
paid his filing fee. Therefore, we concluded that Bruner’s notice of appeal was
untimely and dismissed the appeal.
In the case now before us, after considering the parties’ responses, a
three-judge motion panel observed that the Hardin Circuit Court Clerk did not
serve the notice of appeal as properly filed until Karsner’s filing fee was received.
Nevertheless, by order entered October 22, 2019, the divided panel passed the
matter to this merits panel for further consideration, and the parties filed their
briefs.
In her brief on appeal, Karsner argues that the circuit court erred by
failing to conclude that the statute of limitations was tolled. She cites as the basis
for tolling: (1) Dr. Craig’s alleged fraudulent concealment of his malpractice; (2)
her inability to discover the malpractice until she was examined by an expert
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retained for litigation; or (3) an extension of the continuing course of treatment
doctrine. Karsner did not address the timeliness of her notice of appeal in her
brief.
Because of her omission of the timeliness issue, the hospital argues
that she has forfeited any argument that the appeal was timely filed and encourages
the Court to dismiss the appeal on this basis. Dr. Craig and the hospital contend
that the notice of appeal was not effective until Karsner tendered the filing fee on
July 12, 2019. Since it was untimely as of that date, they argue that dismissal is
required by our rules of civil procedure. In the alternative, the hospital contends
that the Court should exercise its discretion to dismiss the appeal pursuant to the
provisions of CR 73.02(2).
CR 73.02(2) provides that a party’s failure to comply with procedural
rules relating to appeals (even where the failure does not affect the validity of the
appeal) is a ground for such action as the appellate court deems appropriate.
Pursuant to the rule, we may (among other things) dismiss the appeal, strike the
offending brief, or impose fines upon counsel.
In Clark v. Workman, 604 S.W.3d 616 (Ky. App. 2020), we observed
that appellant’s counsel had failed to make a sincere attempt to comply with our
rules governing submission of briefs. While we declined to dismiss the appeal,
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strike the brief, or fine counsel, we decided to review the matter only for manifest
injustice.
Karsner’s brief, too, fails to comply with our rules of civil procedure.
The statement of the case does not contain any “supportive references to the
record[,]” nor does the brief 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.” CR 76.12(4)(c)(iv), (v). Despite the specific
requirements of our rules, Karsner failed to satisfy perhaps the two most
substantial requirements for briefs set forth in CR 76.12(4)(c). The latter error is
magnified by the specific assertion of both Dr. Craig and the hospital that the
fraudulent concealment argument presented in Karsner’s brief is wholly
unpreserved for our review.
Before reaching the merits of the appeal, we must first decide whether
our jurisdiction has been properly invoked and, even if so, whether the deficiencies
of Karsner’s brief would nonetheless preclude our review. As we observed in
Bruner, 544 S.W.3d at 672:
if a notice of appeal is tendered to a clerk within the time
permitted by the Civil Rules, but is unaccompanied by
the requisite filing fee, there could be two very different
results:
(1) As in Hurley, the clerk might violate his or her oath
of office by accepting the notice of appeal anyway, in
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which case the ensuing appeal will not be subject to
automatic dismissal as untimely; or
(2) as in Excel, the clerk might refuse to file the notice of
appeal until the filing fee is received, in which case—
assuming the filing fee is paid on a date outside the
appellate window—the ensuing appeal will be subject to
automatic dismissal as untimely.
In this case, we believe the situation is closer to that described by the
court in Hurley. Despite counsel’s failure to pay the required filing fee, the Hardin
Circuit Court Clerk hand-wrote across the face of the notice of appeal that it was
filed on May 8, 2019, the date upon which it was electronically tendered.
Additionally, along with a notation that the filing fee was not received until July
12, 2019, the clerk again misrepresented the truth and noted on the docket that the
notice of appeal was filed on May 8, 2019. Because of the clerk’s actions, there is
no basis pursuant to Hurley upon which to conclude that the appeal is subject to
automatic dismissal.
Next, we must decide whether Karsner’s failure to comply with the
provisions of CR 73.02(2) merits dismissal of the appeal. We conclude that it does
not. However, as in Clark, supra, we are persuaded that Karsner has failed to
make a sincere attempt to comply with our rules of appellate procedure. As a
result, we elect to consider the appeal on its merits -- but to review only for
manifest injustice.
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Karsner contends that the circuit court erred by concluding that her
claims were time-barred on the basis that she failed to show the existence of any
circumstance that would make the action timely under either the discovery rule or
the continuous course of treatment doctrine. However, our review of the circuit
court’s decision does not indicate that Karsner suffered a manifest injustice as a
result of the dismissal.
In its judgment, the circuit court carefully recounted its thorough
analysis of the defenses asserted by Dr. Craig and the hospital. It noted that
ordinarily a medical negligence action must be brought within one year of the date
that the injury is, or with reasonable care, should have been discovered. KRS2
413.140. “[T]he statute begins to run on the date of the discovery of the injury, or
from the date it should, in the exercise of ordinary care and diligence, have been
discovered.” Wiseman v. Alliant Hospitals, Inc., 37 S.W.3d 709, 712 (Ky. 2000)
(quoting Hackworth v. Hart, 474 S.W.2d 377 (Ky. 1971)).
The circuit court concluded that the chronology of events was
undisputed in this case. Reviewing Karsner’s deposition testimony, it observed
that she tied her rising concerns about the adequacy of her care to Dr. Craig’s
decision to refer her to a Louisville trauma surgeon, Dr. Roberts, during her May 3,
2016, visit. “Particularly problematic for Karsner is her statement about her
2
Kentucky Revised Statutes.
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understanding the bone wasn’t healing and her knowledge of the broken screw.”
Karsner was aware of these things no later than May 3, 2016. Karsner certainly
either knew or had reason to know what was causing her pain and who had caused
it no later than her last visit with Dr. Craig in July 2016.
Finally, the circuit court noted that where the date of the discovery of
an injury does not pose a genuine factual dispute, summary judgment is
appropriate. It concluded that no genuine issue of fact remained -- that Karsner
discovered or should have discovered her injury well before her last visit with Dr.
Craig in July 2016 -- and that Dr. Craig and the hospital were entitled to judgment
as a matter of law.
The court also reviewed the potential applicability of the continuing
course of treatment doctrine. The circuit court observed that in Harrison v.
Valentini, 184 S.W.3d 521 (Ky. 2005), as modified on denial of reh’g (Mar. 23,
2006), the Kentucky Supreme Court (in a divided opinion) adopted the continuing
course of treatment doctrine to toll the statute of limitations in medical malpractice
actions. Where it applies, the continuous course of treatment doctrine provides
that “the statute of limitations is tolled as long as the patient is under the continuing
care of the physician for the injury caused by the negligent act or omission.” Id. at
524 (footnote omitted). The Harrison Court noted as follows:
the trust and confidence that marks the physician-patient
relationship puts the patient at a disadvantage to question
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the doctor’s techniques, and gives the patient the right to
rely upon the doctor’s professional skill without the
necessity of interrupting a continuing course of treatment
by instituting suit.
Id. (citation omitted). By tolling the statute of limitations for medical malpractice
actions, the continuous course of treatment doctrine “gives the physician a
reasonable chance to identify and correct errors made at an earlier stage of
treatment.” Id. at 525 (citation omitted).
In the case before us, the circuit court declined to apply the doctrine.
It reasoned that the purpose of the doctrine -- “to support the relationship between
doctor and patient to address complications, which, if properly treated, may avoid a
bad result” -- was not implicated because Karsner had filed her action more than a
year after she last saw Dr. Craig. Furthermore, it observed that no appellate
court in Kentucky had considered an expansion of the doctrine to encompass not
only the original doctor’s treatment of the patient, but also his subsequent referral
of the patient to another doctor.
After the circuit court granted summary judgment, the Kentucky
Supreme Court published its Opinion in Sneed v. University of Louisville Hospital,
600 S.W.3d 221 (Ky. 2020). The Sneed Court rejected the patient’s contention that
the continuous course of treatment doctrine could be expanded to include
subsequent treatment by another physician who worked at the same hospital
where she received her initial care. It was not convinced that an extension of the
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doctrine would serve to “bolster the relationship of trust and confidence” that a
patient has with a particular treating physician. “The type of relationship between
a patient and the Hospital, or all physicians at the Hospital, is different in kind and
degree than the relationship between a patient and a single treating physician.”
Sneed, 600 S.W.3d at 227. “A patient’s ‘ability to make an informed judgment as
to the negligent treatment’ is not so impaired by her relationship with the Hospital
itself to prevent her from discovering her injury.” Id. (citation omitted).
Therefore, the Supreme Court rejected an extension of the doctrine.
The evidence in this case indicates that Dr. Roberts and Dr. Craig
were involved in entirely separate practices in different cities. Furthermore, no
evidence was presented to show that Dr. Roberts collaborated with Dr. Craig or
that he even discussed Karsner’s care with Dr. Craig. There is no evidence to
indicate that Dr. Roberts did anything more than rely upon Karsner’s medical
records for information concerning Dr. Craig’s surgery and subsequent care.
Finally, it bears noting that Karsner’s bold suggestion that she was “a victim of an
ongoing cover-up” is absolutely unsupported by anything appearing of record.
Under the circumstances, we are not persuaded that manifest injustice resulted
from the trial court’s decision not to extend the continuous course of treatment
doctrine beyond Dr. Craig, Karsner’s original physician.
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Finally, we address Karsner’s contention that the circuit court erred by
failing to conclude that Dr. Craig’s decision to refer her to Dr. Roberts constituted
fraudulent concealment of her injury (and of his malpractice) sufficient to extend
the statute of limitations under principles of equitable estoppel. Dr. Craig and the
hospital argue that the issue is unpreserved for review. Karsner contends that the
issue is preserved because the circuit court merely failed to appreciate the nuances
of her original argument concerning the accrual of her cause of action.
The rule is firmly established that the trial court should first be given
the opportunity to rule on questions before they are available for appellate review.
See Curty v. Norton Healthcare, Inc., 561 S.W.3d 374 (citing Elwell v. Stone, 799
S.W.2d 46, 48 (Ky. App. 1990)). This Court will entertain an argument not
presented to the trial court only to avert a manifest injustice. Id. This argument
was not previously presented to the circuit court prior to its decision to render
summary judgment. And it does not appear that our review is necessary to avert a
manifest injustice. Therefore, we decline to address it except to note again that the
allegation is unsupported by anything appearing of record.
We AFFIRM the judgment of the Hardin Circuit Court.
ALL CONCUR.
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BRIEF FOR APPELLANT: BRIEF FOR APPELLEE HARDIN
MEMORIAL HOSPITAL:
Jeffrey A. Sexton
Louisville, Kentucky Jennifer B. Oldham
Elizabethtown, Kentucky
Thomas N. Kerrick
Shawn Rosso Alcott
Bowling Green, Kentucky
BRIEF FOR APPELLEE MARCIS A.
CRAIG, M.D.:
Craig L. Johnson
Timothy B. George, Jr.
Louisville, Kentucky
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