Esquire, M.D.

Dr. Samuel K. Cullan hasn’t just studied medicine; he’s studied how to teach medicine to juries

Published in 2009 Missouri & Kansas Super Lawyers — November 2009

As an attorney and a doctor, Samuel K. Cullan deals with complex legal and medical issues every day—but he knows most jurors do not. So, early on in his career, he learned an important lesson: don’t just tell—show.

A few losses several decades ago—such as a case in the early 1990s in which a man died after his doctor administered an overdose of the blood thinner Coumadin—stuck in his mind and made him reconsider how he had been presenting his cases. “It was a clear-cut case. I felt horrible about losing,” says Cullan, who spent time talking to the jury, judge and opposing attorney afterward to see what he could learn. “I think I made some assumptions that people understood things that not everyone understands. Part of the problem of being a physician and a lawyer is that you speak the language of medicine, so you assume everyone else understands it as well. It is a mistake to not slow down and translate medical-speak into English.”

Now, breaking down medical issues into easily understandable language comes naturally to Cullan. Sitting in his office just north of the Missouri River in Kansas City, Mo., he talks about one of his bigger verdicts: $4.6 million in a case just across the state line in Kansas, in which nurses failed to check to see whether a baby’s head was up or down—vertex or breech, in medical jargon. “The nurse didn’t check—just documented that the baby was vertex, because 90 percent of them are, but it was breech. When the doctor came in, he was shocked when the baby came out bottom first.

“The risk is this,” Cullan continues, as he gets up, walks across the room, and grabs a baby doll and a plastic model pelvis. He puts the doll through the pelvis feet first. “The head gets stuck around the cervix—the head is stuck, and the body’s out, and the baby’s suffocating, so the doctor has to get the baby out right away. [In this case] the doctor pulled the baby out with a lot of force, which caused a thoracic spinal cord injury, and the baby’s legs were paralyzed.”

Cullan has been asked to speak to other lawyers about the case, Team Bank (as trustee for Ariana Wilburn) v. Bethany Medical Center, not just because it was one of the larger medical malpractice verdicts in Wyandotte County, Kan., but because he used an unusual tool, a live demonstration, to help the jury understand what did—and did not—happen.

“One way nurses can determine if a baby is head-up or head-down—if the nurse can’t tell by doing a vaginal exam, although they should be able to tell—one of the things our expert said, is there are ultrasound machines they can just roll into the room and look.”

To show how quick and easy that would have been, Cullan called a half dozen obstetricians to find a model patient of the same height, weight and number of weeks into pregnancy as his client had been at delivery. During the trial, the model lay down on an examination table in the courtroom, and Cullan’s expert obstetrician used a portable ultrasound machine to determine her baby’s position. The image popped up on computer screens in the jury box. “Once the machine was set up, it literally took 15 seconds,” Cullan says.

Putting together that demonstration took time. It was difficult to find the model and a company that would rent out an ultrasound machine—the cost was more than $2,000, but ultimately well worth it. “If you just say to somebody, ‘Ultrasounds are very simple and easy to do—all you have to do is just take a little lubrication and move it around and you can see the head and the buttocks.’ Well, just saying that is one thing but showing them is different. They see it, they understand it, they believe it.”

Like the Wilburn case, a full two-thirds of Cullan’s cases at the The Law Office of Samuel K. Cullan, M.D., J.D. (whose tagline is “Put a Doctor in Your Court”) involve obstetrical malpractice or brain injuries. That’s partly because Cullan fell in love with obstetrics while attending medical school at Creighton University in Omaha, Neb. He graduated from law school there in 1982 and medical school in 1987.

While doing rotations at inner-city and suburban hospitals, Cullan volunteered for extra shifts during Thanksgiving and Christmas holidays so he could get more experience assisting with deliveries. His first solo delivery was an accident: the obstetrician went to grab a cup of coffee, then forgot the code for the new hospital security system and couldn’t get back to the patient in time. “By the time he got there, I had delivered the baby. I didn’t know what I was doing, but the nurse talked me through it—she was great.” Cullan smiles: “It was a girl—8 pounds, 2 ounces.” Now he makes it a point to keep current in obstetrics by subscribing to journals, attending conferences and staying certified in fetal heart monitoring.

Cullan didn’t always plan to become a doctor-lawyer. One of 12 children born to parents who married during the Great Depression and ran a wheat farm in Nebraska, he grew up with a strong work ethic, driving tractors on the family farm from dawn to dusk every summer with his siblings. When Cullan was 22, he thought he might like to get into politics, so he ran for public office. While he was serving two terms as a senator in the Nebraska State Legislature, he became chair of the health and welfare committee. He handled issues such as indigent care, Medicaid, alcoholism and drug abuse, and developed a passion for health care.

That experience, along with the example of his older siblings, including brother Dan Cullan—who recently passed away after a brief illness and also was a medical doctor, a lawyer and a member of the Inner Circle of Advocates—helped him decide to go to law school and medical school. Samuel Cullan’s sister Virginia Cullan, who also is an attorney and manages his office, says her brother is a workaholic who cares deeply about each client. “Whether it’s a $200,000 case or a $20 million case, he wants the client to feel it’s the most important thing—that’s their case, their life, their one shot at getting their life back on track,” she says.

Of course, it’s not necessary to be a medical doctor to be a good medical malpractice attorney, but Cullan says his medical training helps him in his practice, from screening clients to understanding the ins and outs of each case. For example, Cullan once took and settled a case involving a young man who had been electrocuted that had been rejected by four other attorneys, including a well-known medical malpractice firm.

 “I looked at the ambulance records from the paramedic, including the cardiac rhythm strip, and it was absolutely clear to me that the paramedic didn’t follow standard protocol for resuscitating somebody with an abnormal heart rhythm—and I knew that because I was ACLS (Advanced Cardiac Life Support) certified. I knew exactly what a paramedic should do when they see a specific rhythm, when to use a defibrillator. Other law firms told the family that the injury was a result of electrocution, so there was nothing they could do. Being ACLS-certified was helpful in allowing me to immediately recognize that the paramedic failed to follow protocol.”

 

Teresa Guerra-York chose Cullan partly because of his double degrees, after her son was injured during birth—the fourth victim of the same obstetrician, she later found out. During a long and difficult labor, her doctor used a vacuum and then yanked on the baby’s head, which injured nerves in the spine and left the baby’s right arm limp. Guerra-York’s son, Michael, who is now 7, cannot throw a baseball, carry a school lunch tray or zip his pants.

In court, Guerra-York remembers that Cullan expertly showed the jurors exactly what her son’s disability would do to him for the rest of his life. Cullan brought Michael, then almost 3, into the courtroom so jurors could see that his walk was unstable and his arm just hung at his side. Then Cullan showed the jury how Michael’s disability would affect his life as an older child, a teenager and an adult. “It was emotional not just for me, but for the jurors,” Guerra-York says. “You could see it on their faces.” Their verdict: $1.7 million.

Thomas W. Wagstaff, one of the founding partners of Wagstaff & Cartmell in Kansas City, Mo., has known Cullan for more than 20 years. Wagstaff has worked with him on some cases and squared off against him as opposing counsel on others. “When I met him, he was a brand-new lawyer,” Wagstaff says. “He’s developed into a really terrific lawyer. The things that stand out are his preparedness and his willingness to go to the mat—he has done that, and he’s gotten some very good results. He’s one of the top attorneys around.”

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