Full Opinion

RENDERED: JUNE 25, 2026 TO BE PUBLISHED Supreme Court of Kentucky 2024-SC-0216-DG DIAGNOSTIC X-RAY PHYSICIANS, PSC APPELLANTS (DXP); CHRISTOPHER DALE HENLEY M.D.; AND DARREN CAIN M.D. ON REVIEW FROM COURT OF APPEALS V. NO. 2023-CA-0748 JEFFERSON CIRCUIT COURT NO. 20-CI-005331 DEBORAH LLOYD; NORTON APPELLEES HOSPITALS, INC. D/B/A NORTON'S WOMEN'S AND CHILDREN'S HOSPITAL; AND SHEILA SLONE KCSA AND 2024-SC-0224-DG SHEILA SLONE KCSA APPELLANT ON REVIEW FROM COURT OF APPEALS V. NO. 2023-CA-0748 JEFFERSON CIRCUIT COURT NO. 20-CI-005331 DEBORAH LLOYD; CHRISTOPHER APPELLEES DALE HENLEY M.D.; DARREN CAIN M.D.; DIAGNOSTIC X-RAY PHYSICIANS, PSC (DXP); AND NORTON HOSPITALS, INC. D/B/A NORTON'S WOMEN'S AND CHILDREN'S HOSPITAL OPINION OF THE COURT BY JUSTICE KELLER REVERSING These consolidated appeals arise from allegations of medical negligence against a surgical assistant and certain radiologists following Deborah Lloyd’s (“Lloyd”) total knee replacement surgery, during which a suturing needle was inadvertently left inside her knee after becoming dislodged from its holder during suturing. In this opinion, we revisit the requirement that expert testimony is necessary to establish the standard of care in medical negligence actions. We also address the nuances of our res ipsa loquitur doctrine as it pertains to the concept of exclusive control in cases involving foreign objects retained in a surgical patient’s body. Having granted discretionary review, heard oral arguments, and carefully examined the record, we reverse the Court of Appeals and reinstate the trial court’s grants of summary judgment in favor of the appellants. FACTUAL AND PROCEDURAL BACKGROUND On December 20, 2019, Dr. Sean Griffin (“Dr. Griffin”), an orthopedic surgeon, with surgical assistant Sheila Slone (“Slone”) assisting under Dr. Griffin’s direct supervision, performed a total knee replacement surgery on Deborah Lloyd’s right knee at Norton Hospitals, Inc. d/b/a Norton’s Women’s and Children’s Hospital (“Norton”). Slone used a suturing needle to close the incision. Shortly prior to full closure of the incision, it became apparent to Slone that a suturing needle had dislodged from its holder and was missing. Slone attempted to locate the needle through a visual search and by 2 “palpat[ating] the area” but was unsuccessful. Slone immediately reported the loss of the needle, and the entire surgical team, including Slone and Dr. Griffin, searched for the needle. When no needle was found, Dr. Griffin ordered an x- ray of Lloyd’s knee to determine whether the needle was inside her knee. Dr. Darren Cain (“Dr. Cain”), a radiologist, reviewed the x-ray. Dr. Cain noted that “[t]here is no unexpected radiopaque foreign body identified.” Dr. Griffin also reviewed the x-ray and apparently failed to observe the needle. Dr. Griffin concluded that the needle was likely lost, and he decided against re-opening the incision to continue searching for the needle. Lloyd’s surgery was allowed to conclude, and Lloyd was not advised of the possibility that a foreign object had been left inside her after the surgery. As was customary, another x-ray was taken in the recovery room to assess the outcome of the surgery. Dr. Christopher Henley (“Dr. Henley”), a radiologist, reviewed the x-ray but, like Dr. Griffin and Dr. Cain, appears to have failed to observe the needle. On January 16, 2020, Lloyd attended a post-operative follow-up visit with Dr. Griffin. Dr. Griffin ordered another x-ray of Lloyd’s right knee. Dr. Griffin charted in Lloyd’s medical record that Lloyd was overall doing well, but that she had a metallic foreign body of unknown origin in her right knee. Dr. Griffin noted that the foreign body was not palpable and did not appear to be affecting her, although he also noted that she appeared to have some delayed healing and blistering. He did not address the foreign object at that time. 3 On February 3, 2020, Lloyd returned to see Dr. Griffin for another follow- up. This time, Dr. Griffin noted that Lloyd’s knee had developed “superficial dehiscence” which may have been at least partially caused by the foreign body. On February 7, 2020, the needle was removed and the wound cleaned during a follow-up procedure. In Lloyd’s medical record, Dr. Griffin noted that Lloyd had originally done well after the initial knee replacement, but she developed central wound dehiscence that was progressive. Her wound began draining serous fluid. Postoperative x-rays revealed metallic foreign body in the anterior soft tissues of the knee. Wound revision with treatment of the surgical wound dehiscence and removal of the foreign body were indicated in order to prevent further infectious complications, including knee sepsis. Dr. Griffin also noted that the foreign object appeared to be a suture needle. Dr. Griffin did not prescribe additional antibiotics, “as this did not represent an infection.” Expert disclosures in the record indicate that Lloyd underwent a third surgery on February 28, 2020, to remedy the effects of the retained needle. Additionally, Lloyd had to undergo long term antibiotic use and chronic suppressive therapy, which caused further health complications and harm to Lloyd. Lloyd filed suit in Jefferson Circuit Court in September 2020, originally naming Slone, Dr. Griffin, Norton, and Ellis and Badenhausen Orthopaedics, P.S.C. as defendants. Lloyd later amended her complaint to add Dr. Henley, Dr. Cain, and Diagnostic X-Ray Physicians, P.S.C. (collectively, “Radiologists”) as defendants. Dr. Griffin reached a settlement with Lloyd and has been dismissed as a defendant from this case. 4 Kentucky Rules of Civil Procedure (“CR”) 26.02 states that a party may be required 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. A scheduling order directed Lloyd to identify her experts and provide disclosures by April 2022. Lloyd identified her expert witnesses as Dr. Morrison, an infectious disease expert, and Dr. Dysart, an orthopedic surgeon. Dr. Morrison’s disclosure centered around criticisms of Dr. Griffin and did not specifically criticize the Radiologists or Slone. Because Dr. Griffin is no longer a party to this action, only Dr. Dysart’s disclosures are relevant for our purposes. As it relates to Dr. Dysart’s expected testimony, Lloyd disclosed: Dr. Dysart is expected to testify that Defendants’ medical care and treatment of Ms. Lloyd was below the standard of good and proper medical care during her care and treatment at Norton Women’s and Children’s Hospital for her complex right total knee replacement procedure of December 20, 2019. Dr. Sean Griffin failed to locate, remove, and document a suture needle retained by Plaintiff during her surgery due to the actions of the surgical assistant, Sheila Slone. Dr. Griffin failed to properly notify the patient and document the retained suture needle, which had been confirmed by an incorrect instrument count. Retained foreign bodies are known to cause great risk to patients, including but not limited to infection and/or sepsis, possible re-operation, readmissions and prolonged hospital stays, severe pain, and even death. He is further expected to testify that [the Radiologists] had a duty to review, identify, and document the intra-operative and post- operative x-rays, showing the retained suture needle, and failed to do so. Failing to locate, identify, and remove the retained suture needle caused a delay in treatment and significant harm to [Lloyd], including but not limited to an infection which required two 5 subsequent surgeries on February 7, 2020 and February 28, 2020, as well as long-term antibiotic use and chronic suppressive therapy which caused further health consequences and harm to [Lloyd]. Dr. Dysart was deposed on August 16, 2022. During this deposition, Dr. Dysart went beyond the scope of his disclosures and written report in criticizing Norton, the Radiologists, and Slone. Dr. Dysart also testified that he could not opine on the standard of care applicable to radiology: Q: All right. Do you intend on testifying at trial that Dr. [Cain] failed to act as a reasonable radiologist under like or similar circumstances in the services he provided to Ms. Lloyd? A: I’m not a radiologist. Q: That’s the tenor of my question. A: So reasonable will have to go to an expert. All I can say is he missed a foreign body. I can say that. Q: All right. And I understand that. I want you to presume that the question the jury will be given in this case was whether Dr. [Cain] failed to act as a reasonable radiologist under like or similar circumstances. And from what I gather from you, you are not prepared to say that because you are not a radiologist; correct? A: So I would — I would defer to radiology. Now, from an orthopedic opinion, he missed it. Q: However, you’re not going to testify that Dr. [Cain], or Dr. Henley, for that matter, failed to act as a reasonable radiologist under like or similar circumstances; true? A: I don’t know what reasonable means in terms of the Academy of Radiology. Let them answer that question. .... Q: All right. And you understand from this case that Dr. [Cain] is a radiologist, as is Dr. Henley; correct? A: Yes, sir. 6 Q: And they would have completed different residency programs than you; correct? A: Of course, yes. Q: All right. And they would, when applying for privileges for the hospital, have applied for different privileges than you; correct? A: Sure Q: All right. A: Yeah, sure. Q: And they would be board-certified by a different specialty board than you; correct? A: Are they board-certified? Q: Yes. A: I didn’t – okay. Yes, sir. Q: Okay. And would belong to different professional societies than you; correct? A: Yes, sir. Q: All right. And you do not hold yourself out as a radiologist and never have and never will; correct? A: No, sir. Q: That is correct? A: That’s correct. Q: All right. And you do not consider yourself to be an expert in the field of radiology; correct? A: Okay. So in my experience dealing with multiple radiologists, we can often read a film better than they can about a specific issue; and the reason is we see many, many more of the same thing. So in my practice, we often didn’t have radiology review films because we considered ourselves adequate and well-enough trained to read them ourselves, which is what we do routinely. So there are certain 7 situations that we actually are more appropriate reviewing the film than they are. I will tell you that. Q: All right. Do you consider yourself to be a radiology expert? A: Oh, no, sir. Q: All right. Do you consider yourself to know what the standard of care is in the field of radiology? A: No sir. Additionally, Dr. Dysart’s deposition criticized the actions of a circulating nurse employed by Norton 1, even though such opinions were outside the scope of his disclosure. Claiming that the deposition testimony included unexpected testimony leading to unfair surprise, Norton moved to strike all testimony in Dr. Dysart’s deposition transcript between pages 169 and 235 where he was critical of the nurse. The trial court granted this motion, ordering that “the late-disclosed opinions of Dr. Stanley Dysart contained in Dr. Dysart’s deposition” be stricken from the record. Lloyd was unsuccessful in challenging the trial court’s order striking the deposition testimony, which Lloyd claimed was overbroad and struck non-surprise testimony pertaining to Dr. Dysart’s criticisms of the Radiologists. Despite Lloyd’s extensive discussion of the stricken portions of Dr. Dysart’s testimony, she neither filed a cross-motion nor asked for any relief from the trial court’s order. 1 In addition to her claims against Slone, the Radiologists, and Dr. Griffin, Lloyd also asserted claims against Norton based on the alleged actions of its employee, a circulating nurse. Aside from this brief mention, those claims are not pertinent to this appeal. 8 On November 15, 2022, Slone filed a motion for summary judgment, arguing that the deadline for disclosing experts has expired and Lloyd has not identified any expert who will testify that Slone breached the standard of care applicable to surgical assistants. In fact, the only evidence on the record on that issue came from Dr. Griffin, who testified that Slone did not deviate from the standard of care applicable to surgical assistants in Kentucky. Under Kentucky law, a plaintiff is required to submit expert testimony on the issue of professional negligence, meaning Lloyd must submit expert testimony from which a jury could reasonably conclude that Slone deviated from the applicable standard of care. There is no such expert, therefore Slone is entitled to summary judgment in her favor. Lloyd responded by acknowledging that “[i]t is accurate that both of Plaintiff’s retained expert witnesses have given deposition testimony indicating that, in regards to the factual events indicated in the medical records and deposition testimony, they had no specific criticism of [Slone] regarding a breach of the applicable standard of care,” but argued that such was not needed because the case against Slone is one of res ipsa loquitur. 2 2 According to Black’s Law Dictionary, res ipsa loquitur is Latin for the phrase, “the thing speaks for itself.” RES IPSA LOQUITUR, Black's Law Dictionary (12th ed. 2024). Res ipsa loquitur is defined as, The doctrine providing that, in some circumstances, the mere fact of an accident's occurrence raises an inference of negligence that establishes a prima facie case; specif., the doctrine whereby when something that has caused injury or damage is shown to be under the management of the party charged with negligence, and the accident is such that in the ordinary course of things it would not happen if those who have the management use proper care, the very occurrence of the accident affords reasonable evidence, in the absence of the explanation by the parties charged, that it arose from the want of proper care. Id. 9 On December 5, 2022, the Radiologists also filed a motion for summary judgment, premising their motion on the fact that neither of Plaintiff’s experts claimed that the Radiologists failed to act as a reasonable radiologist in the same or similar circumstances and that no expert testimony was presented addressing the applicable standard of care for a radiologist. In a consolidated opinion and order, the trial court addressed both motions for summary judgment. The trial court granted summary judgment in favor of Slone, finding that res ipsa loquitur did not apply: In the case sub judice and from the facts as they exist in the record, the only defendant who had control of the instrumentality [the suture needle] causing Plaintiff’s injury was the certified surgical assistant, Slone. Thus, while the doctrine of res ipsa loquitur could be invoked to create a rebuttable presumption of negligence on her part, that presumption has been rebutted by the facts in the record. Plaintiff stipulates that “[n]o witness has testified as to a specific act or lack thereof on the part of Ms. Slone that was contrary to the protocol in question,” and “[i]t is accurate that both of Plaintiff’s retained expert witnesses have given deposition testimony indicating that, in regards to the factual events indicated in the medical records and deposition testimony, they had no specific criticism of [Slone] regarding a breach of the applicable standard of care.” Indeed, there was testimony by Plaintiff’s expert, Dr. Dysart, that the suture needle could have become detached without any negligence on the part of Slone. While the Plaintiff opines that further discovery could unearth facts which could enable a jury to find Slone negligent, again, in reviewing a motion for summary judgment under CR 56.03, “the focus should be on what is of record rather than what might be presented at trial.” Welch [v. Am. Publ’g Co. of Ky., 3 S.W.3d 724, 730 (Ky. 1999)]. (emphasis removed). Notably, the trial court elaborated that because “the doctrine of res ipsa loquitur is applicable only to those who had full control of the instrumentality which caused the injury, and only Slone had such control, the doctrine is inapplicable to Norton and the [Radiologists].” (internal 10 quotation marks omitted). The trial court also granted summary judgment in favor of the Radiologists, finding that “neither expert has held themselves out as experts in the field of radiology, and the Court agrees that the standard of care and any breach thereof by radiologists is not within the common knowledge or experience of any layman.” Lloyd filed a motion to reconsider the trial court’s order granting summary judgment to Slone and the Radiologists, which the trial court denied. The Court of Appeals reversed the trial court’s grant of summary judgment to both Slone and the Radiologists. As it pertains to the Radiologists, the Court of Appeals based its reasoning on the qualifications of expert witnesses: The Radiologists assert that plaintiffs in a medical malpractice case are required to present expert testimony establishing the standard of care expected of the “class of physicians or specialists to which he belongs.” However, our caselaw indicates that once the trial court determines the expert is properly qualified, the jury is responsible for weighing the expert’s testimony. See Washington v. Goodman, 830 S.W.2d 398, 400 (Ky. App. 1992) (citations omitted) (stating factors like qualifications, experience, and training go to the weight of the testimony, not admissibility). . . . Likewise, this Court has recognized that “[t]here are numerous reported cases where a physician has been held qualified to express an opinion on medical matters outside his area of expertise.” .... [T]he trial court . . . abuse[d] its discretion in determining that there was insufficient evidence in Dr. Dysart’s . . . testimony to submit to a jury on Lloyd’s claims that the Radiologists failed to diagnose or locate the suture needle. As discussed, testimony from a medical provider who specializes in a different area of medicine or who is licensed or practices in a different medical discipline may not carry as much weight with a jury. 11 Here, the trial court based its summary judgment in favor of the Radiologists on a determination that it would be impossible for Lloyd to proceed to trial without an expert qualified in the field of radiology. However, Dr. Dysart was qualified to testify regarding the Radiologists; therefore, there was a genuine issue of material fact for the jury to review. (some internal citations omitted). As it pertains to Slone, the Court of Appeals held that expert testimony was not required based on the doctrine of res ipsa loquitur. The Court of Appeals explained that “typically, ‘the plaintiff in a medical negligence case is required to present expert testimony’ establishing both ‘the standard of skill expected of a reasonably competent . . . practitioner’ and the proximate cause of the injury.” (quoting Andrew v. Begley, 203 S.W.3d 165, 170 (Ky. App. 2006)). But there are two important exceptions, one involving a situation where any layman is competent to pass judgment and conclude from common experience that such things do not happen if there has been proper skill and care; illustrated by cases where the surgeon leaves a foreign object in the body or removes or injures an inappropriate part of the anatomy. The second occurs when medical experts may provide a sufficient foundation for res ipsa loquitur on more complex matters. Perkins v. Hausladen, 828 S.W.2d 652, 655 (Ky. 1992) (internal quotation marks and citations omitted). The Court of Appeals found that both exceptions were applicable here to prevent summary judgment in favor of Slone. Both Slone and the Radiologists appealed the Court of Appeals’ reversal of summary judgment, and their appeals were consolidated. Further facts will be developed below as necessary. ANALYSIS 12 The Radiologists ask us to answer whether Dr. Dysart’s expert testimony is sufficient to satisfy the requirement that, in a medical negligence case, a plaintiff must bring forth expert testimony as to “the applicable medical standard of care, any breach of that standard, and the resulting injury.” Blankenship v. Collier, 302 S.W.3d 665, 675 (Ky. 2010) (citing Perkins, 828 S.W.2d at 655). Slone asks us to decide whether res ipsa loquitur eliminates the need for expert testimony in a retained-foreign-object case where the evidence shows that the person who controlled the object until it was lost inside the patient was not negligent in losing it, and that a different individual exclusively controlled the subsequent decision to continue or abandon efforts to locate and retrieve it. As Slone and the Radiologists raise distinct issues, their claims of error will be addressed separately. Standard of Review Both the Radiologists and Slone appeal the Court of Appeals’ reversal of summary judgment. Summary judgment “should only be used ‘to terminate litigation when, as a matter of law, it appears that it would be impossible for the respondent to produce evidence at the trial warranting a judgment in his favor and against the movant.’” Steelvest, Inc. v. Scansteel Serv. Ctr., Inc., 807 S.W.2d 476, 483 (Ky. 1991) (quoting Paintsville Hosp. Co. v. Rose, 683 S.W.2d 255, 256 (Ky. 1985)). Furthermore, CR 56.03 states that summary judgment should be granted if the evidence shows that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a 13 matter of law. “The 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, 807 S.W.2d at 480. “Because summary judgments involve no fact finding, this Court will review the circuit court's decision de novo.” 3D Enters. Contracting Corp. v. Louisville & Jefferson Cnty. Metro. Sewer Dist., 174 S.W.3d 440, 445 (Ky. 2005). On appeal, “[t]he standard of review on appeal of a summary judgment is whether the circuit judge correctly found that there were no issues as to any material fact and that the moving party was entitled to a judgment as a matter of law. Summary judgment is appropriate where the movant shows that the adverse party could not prevail under any circumstances.” Pearson ex rel. Trent v. Nat'l Feeding Sys., Inc., 90 S.W.3d 46, 49 (Ky. 2002). To the extent that the Radiologist’s appeal concerns the trial court’s ruling on the admissibility of Dr. Dysart’s testimony, this was an evidentiary determination by the trial court and is reviewed for an abuse of discretion. “A trial court's ruling on the admission of expert testimony is reviewed under the same standard as a trial court's ruling on any other evidentiary matter.” Goodyear Tire & Rubber Co. v. Thompson, 11 S.W.3d 575, 578 (Ky. 2000). “Generally, we review a trial court's evidentiary determinations for abuse of discretion—'whether the trial judge's decision was arbitrary, unreasonable, unfair, or unsupported by sound legal principles.’” Mason v. Commonwealth, 559 S.W.3d 337, 339 (Ky. 2018) (quoting Lopez v. Commonwealth, 459 S.W.3d 867, 872–73 (Ky. 2015)). 14 Radiologists Lloyd’s case against the Radiologists hinges on whether she can proceed with only Dr. Dysart’s expert testimony in her medical negligence case against the Radiologists. 3 “As explained previously, a plaintiff bringing a typical medical malpractice case is required by law to put forth expert testimony to inform the jury of the applicable medical standard of care, any breach of that standard and the resulting injury.” Blankenship, 302 S.W.3d at 675 (citing Perkins, 828 S.W.2d at 655). No party disputes that, while Dr. Dysart’s testimony does critique the Radiologists and allege that they have fallen short of their standard of care, his testimony does not name what that standard of care for radiologists is. On the contrary, Dr. Dysart admitted under oath that he does not know the standard of care for radiologists. The Court of Appeals held that Dr. Dysart was qualified to testify despite specializing in a different area of medicine, and that after passing the initial threshold for qualifying as an expert, the question of credibility was left to the jury. The Court of Appeals explained that, while Dr. Dysart is an orthopedic surgeon and not a radiologist, “[t]here are numerous reported cases where a physician has been held qualified to express an opinion on medical matters outside of his area of expertise.” (quoting Owensboro Mercy Health Sys. v. Payne, 24 S.W.3d 675, 677–78 (Ky. App. 1999)). The Court of Appeals 3 Per CR 26.02 and the trial court’s scheduling order which set a deadline for expert disclosures which has now passed, Dr. Dysart’s testimony will be limited in scope to that which was disclosed in Lloyd’s expert disclosure. 15 explained that “testimony from a medical provider who specializes in a different area of medicine or who is licensed or practices in a different medical discipline may not carry as much weight with a jury.” (citing Payne, 24 S.W.3d at 677– 78). Nevertheless, the Court of Appeals concluded that, the trial court based its summary judgment in favor of the Radiologists on a determination that it would be impossible for Lloyd to proceed to trial without an expert qualified in the field of radiology. However, Dr. Dysart was qualified to testify regarding the Radiologists; therefore, there was a genuine issue of material fact for the jury to review. See Goodman, 830 S.W.2d at 400. Thus, as to the Radiologists, we reverse the summary judgment in their favor. None of this is untrue — it just misapprehends the actual issue at hand. The Court of Appeals incorrectly framed the issue as “whether it would be impossible for Lloyd to proceed against the Radiologists without expert testimony from a physician in the same specialty.” Whether Dr. Dysart meets the baseline qualification to testify against Radiologists is not the present controversy. Indeed, as the Court of Appeals points out, “[a] physician or other medical provider is not automatically disqualified from testifying against a defendant who specializes in a different area of medicine or who is licensed or practices in a different medical discipline.” Tapp v. Owensboro Med. Health Sys., Inc., 282 S.W.3d 336, 341 (Ky. App. 2009). Dr. Dysart could testify, and his “special knowledge skill, experience, training, or education” would likely “assist the trier of fact to understand the evidence or to determine a fact in issue.” See Kentucky Rule of Evidence (“KRE”) 702. However, even if this case goes to trial and Dr. Dysart testifies, one vital piece will still be lacking – Lloyd still has no expert to testify as to the standard 16 of care for the Radiologists. Dr. Dysart can assist with testifying as to varying aspects of a radiologists’ duties and how he has typically seen them performed, but one thing he has specifically said he cannot do is recite the standard of care for radiologists. The time afforded to Lloyd to identify her experts has passed, and unfortunately for her, the aggregate of her two experts still leaves her coming up short as to the standard of care for radiologists. Expert testimony as to the applicable standard of care is a requirement in medical negligence cases: [A] plaintiff bringing a typical medical malpractice case is required by law to put forth expert testimony to inform the jury of the applicable medical standard of care, any breach of that standard and the resulting injury. Perkins[], 828 S.W.2d at 655. A jury trial without the requisite proof is a futile exercise, wasteful of judicial time, jurors' time and the litigants' time and resources. CR 56 is intended to avoid such unnecessary proceedings. Neal v. Welker, 426 S.W.2d 476, 479-80 (Ky. 1968) “the curtain must fall at some time upon the right of a litigant” to put forth the most basic level of proof and the plaintiff's bare assertion “that something will turn up' cannot be made basis for showing that a genuine issue as to a material fact exists”; Green v. Owensboro Medical Health System, Inc., 231 S.W.3d 781, 784 (Ky. App. 2007) (the trial court properly granted summary judgment for the defendant doctor because the plaintiff, by not identifying any expert witnesses, “failed to introduce evidence sufficient to establish the respective applicable standard of care”). Blankenship, 302 S.W.3d at 675 (emphasis added). While Lloyd contends that Dr. Dysart “has performed hundreds of knee replacements and knows the standard of care for the procedure and role of the radiologist,” this is in direct contradiction to Dr. Dysart’s own admissions that he does not know the standard of care for radiologists. In his deposition, he was directly asked, “[d]o you consider yourself to know what the standard of 17 care is in the field of radiology?” to which Dr. Dysart clearly and plainly responded, “[n]o sir.” While Dr. Dysart might assist the jury in other aspects of the case, he, by his own admission, is unable to assist the jury with determining the standard of care for radiologists, an essential element for a medical negligence case. Lloyd contends that Dr. Dysart “admitted during his deposition that he is not a radiologist [he is an orthopedic surgeon] but he has knowledge of the role of the Radiologist and what is expected of one doing the imaging for this operation which he has done hundreds of times.” Lloyd also cites Dr. Dysart for his assertion that the Radiologists’ oversight was a “stunning miss” as evidence that the standard of care was breached, even though Dr. Dysart declined, in the first place, to define the standard of care. Different medical specialties have different standards of care, and one will only be held to the standard of care in the specialty in which they are trained. “In the arena of medical negligence, controlling Kentucky authority imposes upon a physician the duty to ‘use that degree of care and skill which is expected of a reasonably competent practitioner in the same class to which [the physician] belongs acting in the same or similar circumstances.’” Mitchell v. Hadl, 816 S.W.2d 183, 185 (Ky. 1991) (quoting Blair v. Eblen, Ky., 461 S.W.2d 370, 373 (Ky. 1970)). While Lloyd implicitly argues that Dr. Dysart’s assertion that the Radiologists made a “stunning miss” is sufficient to imply that the standard of care was breached, it is impossible to know that a standard was not met without first defining the standard. We are unwilling to extend the 18 requirement that an expert specify the relevant standard of care to include testimony that does not define the standard of care but instead invites the finder of fact to construct the standard of care through a series of inferences. We are also unwilling to substitute the requirement that a medical negligence plaintiff present proof of the standard of care with the requirement that the plaintiff present proof of breach of the standard of care. Our jurisprudence in this area has always treated the two as distinct requirements, both of which the plaintiff must prove through expert testimony. See Blankenship, 302 S.W.3d at 667 (“Pursuant to Kentucky law, in most medical malpractice cases, a plaintiff is required to put forth expert medical testimony to establish the applicable standard of care, any breach that occurred and any resulting injury to the plaintiff.” (emphasis added)); Savage v. Three Rivers Med. Ctr., 390 S.W.3d 104 (Ky. 2012) (“Upon examination of the testimony, it is apparent that it does not identify with specificity the relevant standard of care applicable to a surgeon in a retained object case, nor does it examine [medical defendant]'s specific conduct during the surgery so as to demonstrate how he breached the relevant standard of care. . . . Because [Plaintiff] failed to meet its burden of establishing by expert testimony the standard of care imposed upon [medical defendant] in a surgery such as this, and that he breached that standard of care by his specific actions or failure to act, the trial court properly denied [plaintiff]'s request for an apportionment instruction.” (emphasis added)); Baptist Healthcare Sys., Inc. v. Miller, 177 S.W.3d 676, 680–81 (Ky. 2005) (“As the standard of care is not within the scope of common experience of 19 jurors, requiring expert testimony as to the standard of care of a phlebotomist was a proper exercise of trial court discretion.”); Lloyd v. Norton Hosps., Inc., No. 2023-CA-0748-MR, 2024 WL 1685440 (Ky. App. Apr. 19, 2024), review granted (Oct. 16, 2024), not to be published (“typically, ‘the plaintiff in a medical negligence case is required to present expert testimony’ establishing both ‘the standard of skill expected of a reasonably competent . . . practitioner’ and the proximate cause of the injury”) (quoting Andrew, 203 S.W.3d at 170). Further, what may be a “stunning miss” to one specialty is not necessarily to another specialty. Dr. Dysart testified that in the context of orthopedic radiology, he thinks he is more qualified to render an opinion in this case than a radiologist. If we accept this as true, what might be a “stunning miss” to him still might not fall below the standard of care for radiologists in general. Dr. Dysart testified that he is unable to testify as to what the American College of Radiology standards are. Without a specific standard of care, the rest is pure speculation. We can only hold a professional to the standards relevant to their level of training and credentialing. To analogize simply, we cannot hold a paramedic to the same standards as we hold a cardiologist, although both are trained to recognize and respond to cardiac emergencies. The same is true here — although both radiologists and orthopedic surgeons share some competencies, each specialty undergoes a distinct level of education and training. It would be unfair to hold one specialty to the standards of another when one receives vastly greater or different training. 20 “In a medical malpractice action, where a sufficient amount of time has expired and the plaintiff has still ‘failed to introduce evidence sufficient to establish the respective applicable standard of care,’ then the defendants are entitled to summary judgment as a matter of law.” Blankenship, 302 S.W.3d at 668. While the Court of Appeals focused on answering whether Dr. Dysart was qualified to opine as an expert witness, this was a distinct issue from whether Lloyd presented expert testimony regarding the relevant standard of care of the Radiologists. Perhaps Dr. Dysart was qualified to testify about the standard of care of the Radiologists — he just did not. Because of this glaring omission, summary judgment was appropriate, and we reverse the Court of Appeals’ reversal of the trial court’s grant of summary judgment in favor of the Radiologists. Slone As discussed above, expert testimony is typically required to prove medical negligence. However, expert testimony may not be required when negligence can be presumed, such as through the doctrine of res ipsa loquitur. As applied to this case [res ipsa loquitur] means nothing more than whether the facts and circumstances are such that negligence can be inferred, even in the absence of expert testimony. As Prosser explains, res ipsa loquitur is a “Latin phrase, which means nothing more than the thing speaks for itself,” and is simply “[o]ne type of circumstantial evidence.” Prosser and Keeton on Torts, Sec. 39 (5th ed. 1984). Perkins, 828 S.W.2d at 654–55. The primary question in Slone’s appeal is whether res ipsa loquitur applies in a retained‑foreign‑object medical negligence case where the 21 defendant had exclusive control over the instrument immediately before it became lost inside the patient, but the evidence shows that the loss occurred without any negligence by the defendant and that the defendant had no actual or constructive control of the instrument after it became lost. As discussed above, the trial court found that res ipsa loquitur “could be invoked to create a rebuttable presumption of negligence on [Slone’s] part” but “that presumption has been rebutted by the facts in the record” — i.e., the evidence that Slone was not negligent in her actions when the needle became separated from the holder and became lost inside Lloyd. Consequently, the trial court granted summary judgment in favor of Slone based upon Lloyd’s lack of expert witness testimony proving that Slone was negligent. The Court of Appeals reversed the trial court’s grant of summary judgment in favor of Slone. The Court of Appeals held that, while normally most medical malpractice claims cannot be proven without expert t