Statutory COVID-19 Immunity Requires a Causal Nexus to the Pandemic: Commentary on Jackson v. Mayfield Ky Opco, LLC

I. Introduction

The Supreme Court of Kentucky’s decision in Hollie Jackson, as Administrator of the Estate of Emma Hayes v. Mayfield KY Opco, LLC d/b/a Mayfield Health and Rehabilitation (2024-SC-0180-DG, rendered December 18, 2025) is the Court’s first comprehensive construction of Kentucky’s COVID-19 immunity statute, KRS 39A.275.

The case arose from the death of Emma Hayes, an 88‑year‑old nursing home resident with extensive comorbidities, who tested positive for COVID-19 and died on December 3, 2020, following what the estate characterizes as serious neglect—including a nearly five-hour delay between staff finding her unresponsive and obtaining meaningful medical assessment or transfer to a hospital.

The central legal issue was whether Kentucky’s COVID-19 immunity statute insulated the nursing home defendants (collectively, “Mayfield”) from all liability for Hayes’s injuries and death merely because she had COVID-19 and was treated in a COVID unit during the declared emergency, or whether the statute requires a specific causal connection between the alleged injuries and COVID-19 (or COVID-related measures).

The Supreme Court, in an opinion by Chief Justice Lambert, reverses the Court of Appeals and the Graves Circuit Court, holding that:

• KRS 39A.275 immunity applies only where the plaintiff’s injuries are caused by or result from COVID-19 or certain COVID-related conduct; mere temporal coincidence with the pandemic or the patient’s COVID-positive status is insufficient.
• There are genuine issues of material fact regarding:
  • whether Emma Hayes’s death was actually caused by COVID-19, and
  • whether Mayfield’s conduct rose to the level of gross negligence, for which the statute affords no immunity.
• Summary judgment was prematurely granted, especially in light of Mayfield’s refusal to provide most requested discovery.
• Non-COVID-related injuries and pre-March 6, 2020 conduct fall outside the statute’s scope and cannot be swept away by a blanket COVID-immunity ruling.

The decision thus establishes a significant precedent: COVID-19 immunity in Kentucky is not categorical but requires a demonstrable, fact-based causal nexus to COVID-19 or specified COVID-response activities, and it does not reach grossly negligent conduct.

II. Summary of the Opinion

A. Holdings

1. Interpretation of KRS 39A.275 (“COVID immunity statute”):
   • The statute covers only “COVID-19 claims,” defined as claims “for an act or omission arising from COVID-19.”
   • A claim “arises from COVID-19” only if the injury or harm is:
     • “caused by or resulting from”:
       1. actual, alleged, or possible exposure to, transmission of, or contraction of COVID-19; or
       2. services, treatment, or other action performed to limit or prevent the spread of COVID-19; or
       3. services performed outside the normal course of business in response to COVID-19.
   • This language imposes a causation requirement—immunity is not triggered by the mere existence of COVID-19 or by the general fact of COVID-era operations.
2. Partial scope of immunity:
   • Even if some claims related to Hayes’s death might ultimately be subject to immunity, other claims—such as alleged chronic neglect, malnutrition, record falsification, fraud, and certain regulatory violations—are not COVID-caused and therefore cannot be dismissed under KRS 39A.275.
   • Conduct and injuries occurring before March 6, 2020 (the emergency declaration date) categorically fall outside the immunity statute.
3. Cause of death as a disputed fact:
   • The death certificate listing COVID-19 as one cause of death is only prima facie evidence of cause, not conclusive proof.
   • An expert affidavit (Dr. Mansfield) opining that COVID was not a substantial factor in Hayes’s death creates a genuine factual dispute.
   • Because causation (COVID vs. other comorbidities and alleged neglect) is contested, summary judgment based on COVID immunity is improper.
4. Gross negligence exception:
   • KRS 39A.275 expressly excludes immunity for “gross negligence, or wanton, willful, malicious, or intentional misconduct.”
   • Evidence of a nearly five-hour delay in responding meaningfully after staff could not rouse Hayes, combined with expert testimony characterizing this as wanton or reckless disregard, is sufficient to create a triable question of gross negligence.
   • The circuit court misapplied the summary judgment standard by deciding, as a matter of law, that the allegations did not amount to gross negligence.
5. Discovery:
   • Mayfield produced only a floor plan and a limited subset of Hayes’s records (roughly from late October 2020 onward), while refusing most document requests and interrogatories.
   • Given material factual disputes and minimal discovery, the plaintiff is entitled to further discovery on remand, subject to CR 26.02.
6. PREP Act:
   • The Court expressly declines to decide whether the federal PREP Act affords immunity.
   • On remand, the circuit court may consider PREP Act immunity if Mayfield chooses to pursue it after discovery.

B. Disposition

• The Supreme Court reverses the Court of Appeals.
• It vacates the Graves Circuit Court’s summary judgment in favor of Mayfield.
• It remands for further proceedings, including additional discovery and consideration of remaining defenses (such as the PREP Act).

III. Factual and Procedural Background

A. Emma Hayes and Her Conditions

Emma Hayes was admitted to Mayfield Health and Rehabilitation, a nursing home, on February 6, 2018, at age 85. She was wheelchair-bound and required 24-hour care and assistance with all activities of daily living. Her substantial medical history included:

• Congestive heart failure (CHF)
• Non-Alzheimer’s dementia
• Epilepsy, syncope
• Chronic obstructive pulmonary disease (COPD)
• Osteoarthritis, arteriosclerotic heart disease
• Diabetes, cholelithiasis
• Peripheral vascular disease and cerebrovascular disease
• Pulmonary hypertension

The record before the Supreme Court was notably sparse regarding her overall care, largely because Mayfield refused to provide most of the requested discovery, producing only limited medical records from October 28, 2020 to December 3, 2020.

B. COVID Diagnosis and Events of December 3, 2020

• On November 26, 2020, Hayes tested positive for COVID-19 and was transferred to Mayfield’s dedicated COVID unit.
• On December 3, 2020, at approximately 8:51 a.m., staff attempted to rouse her to administer medications but were unable to do so. They abandoned the attempt and, based on the records the Court had, took no action until about 1:45 p.m.
• At 1:45 p.m., her recorded vital signs were alarming:
  • BP: 160/75
  • Pulse: 44
  • Oxygen saturation: 87%
  • Respirations: 50 per minute, labored
  • Temperature: 99.6°F
  • “Jerking/twitching” of upper extremities and head
• She was transferred by ambulance to Jackson Purchase Medical Center. EMS records described her distress as “severe,” with shortness of breath and altered mental status.
• Hospital records:
  • Arrival at 2:38 p.m. in respiratory distress.
  • Intubation at 2:58 p.m.
  • Death at 3:40 p.m.

A troubling detail: Mayfield’s own records chart “care” allegedly provided to Hayes during the night shift after her death (6 p.m. December 3 to 6 a.m. December 4), including bed mobility assistance, dressing, bowel movements, pressure device placement, repositioning, behavior observations, and refusal to eat a snack—despite her documented death at 3:40 p.m. on December 3.

C. The Lawsuit and Claims

On November 9, 2021, Emma Hayes’s son, Hollie Jackson, filed suit as administrator of her estate and on behalf of wrongful death beneficiaries. The complaint asserted nine counts, including:

• Negligence and medical negligence
• Violations of long-term care resident’s rights
• Common law fraud
• Breach of fiduciary duty
• Wrongful death
• Punitive damages
• Individual negligence claims against two administrators and a registered nurse

Substantive allegations included:

• Chronic understaffing and inadequate supervision
• Failure to comply with Cabinet for Health and Family Services (CHFS) regulations (non-COVID-related)
• Failure to maintain adequate records
• Failure to allocate sufficient resources to meet basic resident needs
• Failure to prevent, correct, and disclose deficiencies and a “culture of patient harm”
• Failure to:
  • Perform timely and accurate assessments, treatments, and medication administration
  • Respond to significant changes in condition
  • Notify physicians and family of changes
  • Transfer Hayes to a hospital when her condition exceeded the facility’s capacity
  • Prevent mental and physical abuse
• Alleged manipulation or falsification of medical records to conceal neglect

Crucially, the complaint did not plead COVID-based theories:

• It did not allege that Hayes’s exposure to or contraction of COVID-19 was itself a wrongful act.
• It did not allege injuries caused by COVID-countermeasures (e.g., isolation measures, testing protocols) or by services outside ordinary business in response to COVID.
• The word “COVID” did not appear in the complaint.

D. The Defendants’ Immunity Defenses

In their answer, Mayfield raised, among other defenses:

• KRS 39A.275 (Kentucky’s COVID immunity statute) as a bar to the complaint “in whole or in part.”
• The federal PREP Act, 42 U.S.C. § 247d‑6d, as an additional potential immunity shield.

Under KRS 39A.275:

• “Essential service providers” (which includes licensed nursing homes) are deemed agents of the Commonwealth for purposes of providing “essential services arising from COVID-19.”
• They “shall not be liable for any COVID-19 claim” during the declared emergency.
• “COVID-19 claim” means a claim “for an act or omission arising from COVID-19,” which is in turn defined through the causation language in KRS 39A.275(1)(a)1–3.
• There is an explicit exception for “gross negligence, or wanton, willful, malicious, or intentional misconduct.”

The PREP Act, by contrast, provides broad federal immunity for “covered persons” with respect to claims for losses caused by or related to the use of “covered countermeasures” (e.g., certain drugs, devices, vaccines, respiratory devices) during a declared public health emergency, subject to a narrow willful-misconduct exception. The trial court did not reach the PREP Act issue because it found KRS 39A.275 dispositive.

E. Discovery Disputes

Jackson served discovery in December 2021, seeking a wide array of documents and information limited to the period of Hayes’s residency, including:

• All clinical records (only a partial subset was provided—October 28 to December 3, 2020)
• Pre-admission screenings, medication records, incident reports, staffing records
• Emails responsive to a keyword protocol
• Policies and procedures, staffing and disciplinary documents
• Audit trails detailing chart entries
• Depositions of key personnel

Mayfield largely objected and refused to produce anything beyond:

• A floor plan of the facility, and
• Some medical charts for Hayes (late 2020 only).

Jackson responded with a series of motions to compel, explaining at length the relevance of each request, including specific motions targeting emails, audit trails, and depositions. The circuit court did not rule on those motions before proceeding to hear and grant summary judgment.

F. Lower Court Rulings

1. Graves Circuit Court

The circuit court granted summary judgment for Mayfield, finding:

• Emma Hayes “died, at least in part, from COVID-19 as evidenced by the death certificate.”
• Therefore, Mayfield was immune from suit under KRS 39A.275 unless gross negligence or willful/malicious misconduct was shown.
• Jackson’s allegations, even if true, did not rise to gross negligence “as a matter of law.”
• Having found state-law COVID immunity dispositive, the court did not reach the PREP Act defense.
• All claims were dismissed with prejudice.

Notably, the circuit court:

• Did not meaningfully analyze or even recite the operative causation subsections—KRS 39A.275(1)(a)1–3.
• Did not differentiate COVID-related harms from non-COVID-related injuries or pre-emergency conduct.
• Did not resolve the pending motions to compel or allow significant discovery beyond limited records.

2. Court of Appeals

The Court of Appeals affirmed in an unpublished decision (Jackson v. Mayfield KY Opco, LLC, 2023‑CA‑0260‑MR, 2024 WL 1335637), holding:

• KRS 39A.275(1)(a)1 is triggered by “the actual, alleged, or possible exposure to, transmission of, or contraction of COVID-19,” and Hayes’s COVID-positive status sufficed.
• The statute does not require actual contraction of COVID (although here she had in fact tested positive); the mere fact COVID was a factor in her history the week before death justified immunity.
• The gross negligence exception did not apply because Jackson allegedly failed to offer sufficient evidence beyond a “conclusory” statement in Dr. Mansfield’s affidavit.

The Court of Appeals, like the circuit court, did not reach the PREP Act issue. The Supreme Court granted discretionary review.

IV. Precedents and Authorities Considered

A. Summary Judgment Standards: Steelvest, Hammons, and Bryant

• CR 56.03 allows summary judgment only when there is “no genuine issue as to any material fact” and the movant is “entitled to a judgment as a matter of law.”
• Steelvest, Inc. v. Scansteel Serv. Ctr., Inc., 807 S.W.2d 476 (Ky. 1991):
  • Summary judgment is to be applied “cautiously.”
  • The movant must show the adverse party “could not prevail under any circumstances.”
  • The record must be viewed in the light most favorable to the nonmovant, with all doubts resolved in that party’s favor.
• Hammons v. Hammons, 327 S.W.3d 444 (Ky. 2010):
  • Appellate review of a grant of summary judgment is de novo, as it presents a pure question of law.
• Bryant v. Louisville Metro Hous. Auth., 568 S.W.3d 839 (Ky. 2019):
  • Whether a defendant is entitled to immunity is also reviewed de novo.

B. The Key State Precedent on KRS 39A.275: LP Louisville Herr Lane, LLC v. Buckaway

The majority adopts, and builds on, the Court of Appeals’ statutory analysis in LP Louisville Herr Lane, LLC v. Buckaway, 705 S.W.3d 31 (Ky. App. 2024), the only earlier published Kentucky decision construing KRS 39A.275.

In Buckaway:

• A post-surgical patient developed a severe E. coli wound infection in a nursing home in April–May 2020.
• Her estate alleged negligent wound care and failure to communicate with physicians.
• The nursing home argued that a telehealth follow-up (instead of in-person) was a COVID-19 countermeasure triggering immunity under KRS 39A.275 and the PREP Act.
• The Court of Appeals held:
  • The COVID immunity statute requires a causal connection between the injury and either COVID itself or COVID-related countermeasures (the same “caused by or resulting from” language).
  • Evidence showed the infection developed over days or weeks of neglect, and COVID protocols did not prevent proper wound care; thus, the telehealth conference came too late to be causally relevant.
  • Immunity was therefore not triggered.

The Supreme Court expressly endorses Buckaway’s causation-focused reading, using it as a foundation for its own statutory construction.

C. Statutory Interpretation: Shawnee Telecom

The Court invokes Shawnee Telecom Resources, Inc. v. Brown, 354 S.W.3d 542 (Ky. 2011), reaffirming that:

• If a statute’s language is clear, courts apply its plain meaning.
• Only if the statute is ambiguous or frustrates a plain reading should courts consult legislative history and other extrinsic aids.

Here, because KRS 39A.275 plainly hinges immunity on injuries “caused by or resulting from” specific COVID-related phenomena, the majority declines to rely on legislative debate transcripts, even though the dissent emphasizes that history to argue for a very broad reading.

D. Out-of-State Analogy: Waggoner v. Anonymous Healthcare Sys., Inc. (Indiana)

The Court finds non-binding support in Waggoner v. Anonymous Healthcare Sys., Inc., 250 N.E.3d 1091 (Ind. Ct. App. 2025), where:

• A decedent was initially hospitalized for severe COVID, later developed a pressure ulcer and necrotizing fasciitis, and died.
• The estate alleged negligence in preventing/treating the pressure sore.
• Indiana’s COVID-immunity statute, similar in structure, covered liability for “health care services arising from” the COVID emergency.
• Because Indiana law requires a medical review panel to address causation before trial, the appellate court held that immunity could not be decided until the panel determined whether the decedent’s pressure wound and death “arose out of” the COVID emergency.

The Kentucky Supreme Court draws a parallel: just as Indiana’s immunity statute turns on whether injury “arose from” COVID-related emergency care, Kentucky’s KRS 39A.275 requires a causation inquiry that, on these facts, cannot be decided on a thin record at summary judgment.

E. Kentucky Medical Review Panels: Claycomb Comparison

The Court briefly contrasts Indiana’s pre-suit medical review panel system with Kentucky’s, noting that:

• Kentucky’s attempt to implement medical review panels for malpractice claims was invalidated as unconstitutional in Commonwealth v. Claycomb, 566 S.W.3d 202 (Ky. 2018).
• Instead, Kentucky plaintiffs must satisfy KRS 411.167 pre-suit notice requirements, but causation issues are ordinarily decided in court, not by panels.

This comparison underscores that causation disputes in Kentucky remain squarely within the province of the trial court and jury, reinforcing why summary judgment was premature here.

V. Legal Reasoning and Analysis

A. Interpreting KRS 39A.275: Causation at the Center

1. The statutory framework

KRS 39A.275 provides that during the declared COVID-19 emergency:

• Essential service providers (including nursing homes) are immune from any “COVID-19 claim.”
• “COVID-19 claim” means a claim “for an act or omission arising from COVID-19.”
• “Arising from COVID-19” is defined in KRS 39A.275(1)(a) as involving an injury or harm that:
  • allegedly occurred on or after March 6, 2020, and
  • was “caused by or resulting from” one of three categories:
    1. Exposure to, transmission of, or contraction of COVID-19;
    2. Services, treatment, or other action performed to limit or prevent its spread; or
    3. Services performed outside the normal course of business in response to COVID-19.
• Immunity does not cover “gross negligence, or wanton, willful, malicious, or intentional misconduct.”

The majority emphasizes two textual points:

1. The phrase “caused by or resulting from” is substantive; it imposes a causal nexus requirement, not mere temporal or contextual association.
2. The statute protects only “COVID-19 claims”—not every claim that arose during the pandemic or every negligent act by an essential service provider.

2. Rejecting an “everything during COVID” reading

Mayfield argued KRS 39A.275 “applies to any injury arising after March 6, 2020, not only to COVID-19” and that:

• Since Hayes had contracted COVID and died while in the COVID unit, and
• All nursing homes were engaged in COVID-related protocols,

the statute covered the entire case.

The Court rejects this broad reading, aligning with Buckaway:

“The statute does not, as Mayfield argues, apply to any injury occurring during the declared COVID emergency. Rather, it applies to ‘any claim or cause of action for an act or omission arising from COVID-19.’… [T]he injury must be ‘caused by or [result] from’…” (emphasis in original).

Thus, immunity requires proof that the injuries alleged—here, including death, alleged neglect, malnutrition, record falsification, and fraud—were actually caused by COVID infection or qualifying COVID-related conduct.

3. Subsection (1)(a)1: Injury “caused by or resulting from” contraction of COVID-19

Under KRS 39A.275(1)(a)1, immunity may be triggered if the injury was caused by the “actual, alleged, or possible exposure to, transmission of, or contraction of COVID-19.”

Mayfield’s argument was simple: Hayes had COVID; her death certificate listed COVID-19 as a cause; therefore her death was a COVID-caused injury, and all claims related to it are barred.

The Court carefully dismantles that argument.

a. Death certificates as evidence of cause of death

The Court notes:

• A death certificate is a vital record (KRS 213.011(14)).
• It is “prima facie evidence” of the fact, place, date, and time of death and the identity of the decedent (KRS 397.1005(2)).
• Statutes expressly contemplate that a coroner’s initial conclusion can be changed if an autopsy is later performed (KRS 72.465(2)).

Here:

• Coroner Jones was not a physician and admitted he was not qualified to diagnose medical conditions.
• He relied only on:
  • Emergency department documents from a single hospital visit, and
  • Conversations with ED staff and family.
• He did not review Mayfield’s records, speak to primary or specialty physicians, or order an autopsy.

The death certificate therefore could not be treated as conclusive proof that COVID-19 was the operative cause of death, especially in light of contrary expert testimony.

b. Competing medical evidence on causation

• Dr. David Mansfield, a geriatric physician practicing since 1982, reviewed available records and opined that COVID was not a substantial factor in Hayes’s death.
• He further opined that Mayfield acted with wanton or reckless disregard by failing to monitor, communicate, and transfer Hayes in a timely manner.

Given Hayes’s extensive cardiac and pulmonary comorbidities (CHF, COPD, arteriosclerotic heart disease, pulmonary hypertension, etc.), all of which can independently cause respiratory failure and death, the Court holds:

• It is at least equally plausible—viewed in the light most favorable to Jackson—that her death was caused by preexisting conditions and neglect, rather than by COVID-19.
• Thus, there is a genuine issue of material fact as to whether Hayes’s death was “caused by or resulting from” her contraction of COVID-19.

Because the COVID-immunity statute places the burden on the essential service provider asserting immunity, Mayfield failed to carry this burden for summary judgment purposes.

c. Non-death injuries and non-COVID theories

The Court also emphasizes that Jackson’s claims include other injuries unrelated to COVID contraction, such as:

• Alleged chronic neglect and insufficient medical care preceding her COVID diagnosis
• Unplanned weight loss and malnutrition
• Abuse and violations of dignity
• Fraud, record falsification, failure to maintain staffing and training

Mayfield did not even attempt to show that these injuries were caused by COVID-19 or that they arose from COVID-related services in the sense required by the statute. Immunity under subsection (1)(a)1 therefore could not justify the dismissal of these claims.

4. Subsection (1)(a)2: Services to limit or prevent spread of COVID-19

KRS 39A.275(1)(a)2 covers injuries caused by “services, treatment, or other action performed to limit or prevent the spread of COVID-19.”

Mayfield’s theory:

• It operated a dedicated COVID unit as part of its response to the pandemic.
• Because Hayes was moved to that unit and because all nursing homes were implementing COVID protocols, any injury she suffered thereafter should be treated as arising from COVID-19 mitigation efforts.

The Court finds this far too thin:

• Mayfield offered only generic CMS memoranda and waiver documents describing national COVID guidance, and a general Kentucky COVID indicator report.
• It offered no evidence of:
  • Which specific countermeasures were actually implemented at Mayfield’s facility; or
  • How those particular measures caused or contributed to Hayes’s alleged injuries or death.

Put simply, the Court holds that:

“Mayfield has provided no direct proof of any services or treatments it was providing to limit the spread of COVID, let alone any proof that Emma’s injuries or death were caused by those services.”

Absent a concrete causal link between particular mitigation measures and particular harms, subsection (1)(a)2 does not furnish immunity.

5. Subsection (1)(a)3: Services outside the normal course of business

KRS 39A.275(1)(a)3 covers injuries caused by “services performed by an entity outside the normal course of its business in response to COVID-19.”

Here again, Mayfield argued in a conclusory way that:

• Operating the COVID unit itself was outside the normal course of business, and
• Therefore, any injury suffered by Hayes while in the unit qualifies as arising from COVID-19.

The Court rejects this bootstrapping:

• Mayfield did not specify which practices or services allegedly fell “outside the normal course” of its business.
• It made no factual showing that these specific out-of-course services caused Hayes’s injuries.

Thus, subsection (1)(a)3 could not justify summary judgment either.

B. The Gross Negligence Exception

1. Definition and standard

The Court synthesizes Kentucky law and Black’s Law Dictionary:

• Gross negligence is a “wanton or reckless disregard for the lives, safety, or property of others.” (Gibson v. Fuel Transp., Inc., 410 S.W.3d 56 (Ky. 2013)).
• Multiple acts of negligence can collectively amount to gross negligence, even if each single act might not. (Horton v. Union Light, Heat & Power Co., 690 S.W.2d 382 (Ky. 1985)).
• “Wanton” and “reckless” conduct involve:
  • Doing an unreasonable act in disregard of a known or obvious risk so great as to make harm highly probable,
  • With conscious indifference to the consequences. (Kirschner v. Louisville Gas & Elec. Co., 743 S.W.2d 840 (Ky. 1988)).

2. Application to the five-hour delay

Jackson’s core gross-negligence argument is that:

• At 8:51 a.m., Hayes, an 88-year-old, fully dependent resident with serious cardiac and pulmonary diseases, could not be roused for her medications.
• Mayfield staff then allegedly did nothing of substance until 1:45 p.m.—nearly five hours later—at which point her vital signs were severely deranged and she was in obvious distress.
• Only then was emergency transfer arranged.

Dr. Mansfield’s affidavit supports the characterization of this inaction as “wanton or reckless disregard” for her life and safety.

The majority does not decide that this is gross negligence as a matter of law, but it holds that:

• These facts, if proven, could reasonably support a finding of gross negligence.
• Under Steelvest, that suffices to defeat summary judgment; a jury, not a judge on summary judgment, must resolve the gross negligence question.

The circuit court therefore erred by:

• Treating the gross negligence determination as a matter of law on a limited record, and
• Concluding that Jackson’s allegations “do not rise” to gross negligence without crediting the expert opinion and factual allegations in the light most favorable to the plaintiff.

C. Discovery and the Impropriety of Premature Summary Judgment

The Court’s analysis is informed by the broader context:

• Jackson issued substantial discovery requests early in the case.
• Mayfield and related entities:
  • Resisted most document production and interrogatories.
  • Withdrew a jurisdictional motion (Portopiccolo Group) after limited jurisdictional discovery was authorized.
  • Filed summary judgment before complying with broad discovery obligations.
• Jackson responded with multiple motions to compel, including audit trails and depositions, particularly relevant to:
  • The accuracy of charting (e.g., post-death entries),
  • Staffing levels and training,
  • How COVID protocols were implemented in practice.

Without ruling on these motions, the circuit court relied heavily on incomplete records, such as:

• Partial medical charts (October 28–December 3, 2020 only), and
• Disputed factual assertions (e.g., that normal vitals were recorded at 9:51 a.m. on December 3, and that an x-ray showed no acute cardiopulmonary disease) that were not actually supported by the record before the Supreme Court.

The Supreme Court concludes that:

• Given unresolved factual disputes on causation and gross negligence, and
• Given the restricted discovery record,

summary judgment was inappropriate. On remand, Jackson is entitled to further discovery under CR 26.02.

D. The PREP Act: Reserved for Remand

Although the PREP Act was pled as a defense, neither the circuit court nor the Court of Appeals decided it, and Mayfield’s briefing in the Supreme Court was limited to a request that the issue be remanded if state-law immunity failed.

The Supreme Court:

• Declines to opine on PREP Act immunity in this decision.
• Expressly leaves the issue open for the circuit court on remand, after a more complete factual record is developed.

This is significant in practice: even though KRS 39A.275 immunity has been substantially narrowed by this opinion, the federal PREP Act may yet provide a partial or complete shield in some COVID-related healthcare cases—depending on whether the defendants can establish “covered countermeasure” status and the statutory prerequisites.

VI. The Dissenting Opinion (Justice Keller, joined by Justice Bisig)

The dissent provides a starkly different view of both the statute and the record, and it is important for understanding the boundaries of the new precedent.

A. Broad Reading of KRS 39A.275

Justice Keller would uphold the trial court’s summary judgment, reasoning that:

• KRS 39A.275 is meant to provide sweeping protection to essential service providers during an unprecedented pandemic.
• Legislative debates surrounding Senate Bill 5 reveal that legislators knowingly accepted expansive immunity—even in scenarios of ordinary negligence not directly tied to COVID infection itself (e.g., car accidents by essential workers, non-COVID hospital deaths, slip-and-falls at grocery stores)—in order to keep essential services operating.
• Jackson’s claims, by his own framing, focus on alleged negligent care “over the last weeks and days of [Hayes’s] life” in a COVID unit, and thus are inherently tied to the facility’s COVID-19 response.

Under this view:

• Even if subsection (1)(a)1’s causation requirement were construed narrowly, subsection (1)(a)2 independently bars the claims because:
  • Care in a COVID unit is by definition a “service” and an “action performed to limit or prevent the spread of COVID-19.”
  • Jackson’s claims “pertain to the alleged negligent care (service) in a COVID-19 unit,” squarely within (1)(a)2.
• Thus, whether Hayes literally “died from COVID” is not a material dispute; her injury still “arises from” COVID-19 services under the statute.

B. Disagreement on Gross Negligence

On gross negligence, the dissent:

• Accepts the circuit court’s finding that Mayfield checked Hayes’s vitals at 9:51 a.m. and found them normal (even though the majority notes no record support for this).
• Emphasizes the context of the early pandemic:
  • Hospitals were overwhelmed.
  • Patients faced risks simply by entering hospitals.
  • Guidance discouraged hospital visits unless critically ill.
• Characterizes Mayfield’s decision to monitor and then transfer Hayes as an exercise of clinical discretion, not gross negligence.

Regarding alleged false charting after death, the dissent notes:

• These entries occurred after Hayes’s death.
• Jackson has not connected any alleged false charting before death causally to her injuries.
• Absent causation, even fraudulent records about post-death care cannot sustain a gross negligence claim about her treatment prior to death.

C. Preservation and Discovery

The dissent also addresses procedural issues:

• It criticizes Jackson’s failure to comply with RAP 32(A)(4) by not expressly stating how issues were preserved in his opening brief.
• It notes that, while Jackson raised discovery issues below, he waited nearly six months after Mayfield’s production and until after the summary judgment motion was filed to move to compel.
• Given the timeline (over a year from filing to summary judgment) and Jackson’s delayed efforts, the dissent sees no abuse of discretion in the trial court’s decision to proceed to summary judgment without further discovery orders.

On non-negligence claims (fraud, breach of fiduciary duty, pre-emergency conduct), the dissent argues:

• Those theories were not distinctly argued to the trial court as surviving COVID immunity.
• Under preservation doctrine, appellate courts will not search the record to resurrect unargued theories.
• Therefore, the global summary judgment should stand.

VII. Complex Concepts Simplified

A. “COVID-19 claim” and “arising from COVID-19”

In plain terms:

• A “COVID-19 claim” under KRS 39A.275 is not simply any lawsuit filed during the pandemic.
• It is a lawsuit where:
  • The injury happened during the declared emergency, and
  • The injury was caused by:
    • Getting or being exposed to COVID-19, or
    • The facility’s efforts to prevent COVID’s spread (like isolation protocols or testing), or
    • New or unusual services the facility took on because of COVID (things they wouldn’t normally do).

If an injury has nothing to do with COVID itself or the facility’s COVID-response actions—such as longstanding neglect, understaffing, or pre-pandemic misconduct—then it is not a “COVID-19 claim” and the immunity statute does not apply.

B. Summary Judgment and “Material Fact”

Summary judgment is a way to end a case early, but only when:

• There is no real dispute about the important facts (material facts), and
• Based on those undisputed facts, the moving party is entitled to win as a matter of law.

A “material” fact is one that could affect the outcome of the case. If reasonable people could disagree about an essential fact—like whether COVID-19, neglect, or both caused death—summary judgment is improper, and the case should go to trial (or at least further factual development).

C. Death Certificates as Evidence

A death certificate is strong but not ironclad evidence:

• It shows when and where a person died and who they were.
• It also lists causes of death, but that part can be challenged.
• If new medical information comes to light, especially from autopsies or expert doctors, a court can decide that the death certificate does not tell the whole story about what really caused death.

In this case, the coroner was not a doctor and did not review all relevant records, while a physician expert offered a different causation opinion. That disagreement alone prevents summary judgment on cause of death.

D. Gross Negligence vs. Ordinary Negligence

• Ordinary negligence is simply failing to act as a reasonably careful person (or professional) would—a mistake, oversight, or lapse in judgment.
• Gross negligence is much more serious:
  • It involves acting (or failing to act) in the face of a known, obvious, significant risk that makes harm very likely.
  • The person essentially doesn’t care about the risk—showing a “wanton” or “reckless” disregard for others’ safety.

The COVID immunity statute protects essential providers from lawsuits for ordinary negligence tied to COVID, but not from claims of gross negligence or intentional/willful misconduct.

E. State COVID Immunity vs. the Federal PREP Act

• KRS 39A.275 is a state statute:
  • It covers “essential service providers” broadly (e.g., nursing homes, hospitals).
  • It focuses on whether an injury “arose from” COVID-19 or COVID-response services.
• The PREP Act is a federal law:
  • It applies only to “covered persons” using “covered countermeasures” (specific drugs, devices, vaccines, etc.).
  • It offers immunity for losses related to those countermeasures during a declared emergency.

A defendant can potentially invoke both, but each has its own technical requirements and exceptions.

VIII. Impact and Future Significance

A. Narrowing the Practical Reach of COVID Immunity

The most important doctrinal contribution of Jackson is that it decisively narrows the practical reach of KRS 39A.275:

• Immunity is not automatic for all injuries occurring during the pandemic or in a COVID-designated unit.
• Defendants must:
  • Identify the specific COVID-related category (infection, mitigation service, or out-of-course service) they rely on; and
  • Produce evidence that the plaintiff’s injury was actually “caused by or resulting from” that category.
• Non-COVID injuries—such as longstanding understaffing, malnutrition, abuse, or regulatory violations—remain fully actionable.

B. Litigation Strategy in Healthcare and Long-Term Care Cases

For plaintiffs:

• Careful pleading should distinguish:
  • COVID-independent negligence (e.g., routine care failures that would have been negligent before COVID), from
  • Conduct arguably tied to COVID-related protocols.
• Early and robust discovery targeting:
  • How the facility actually implemented COVID protocols;
  • Staffing logs, policy manuals, audit trails; and
  • Internal communications about care and standards of practice,
  can demonstrate that alleged harm arose from basic care failures, not from pandemic response measures.
• Expert testimony on both causation and the standard of care (ordinary vs gross negligence) will often be indispensable.

For defendants:

• It is no longer sufficient to point to the existence of COVID or a facility’s COVID unit; detailed, facility-specific, and patient-specific evidence will be necessary.
• Resistance to discovery may undermine an immunity motion, as in Jackson, where thin records and unexplained chart anomalies (post-death care entries) were viewed unfavorably.
• Where PREP Act immunity is asserted, defendants should develop a factual record tying alleged injuries to specific covered countermeasures and compliance with federal declarations.

C. Guidance for Trial Courts

Trial courts applying KRS 39A.275 should:

• Treat immunity questions as fact-intensive, particularly when causation is disputed and medical evidence is contested.
• Avoid resolving immunity on summary judgment where:
  • Discovery is incomplete, especially when the defendant resists relevant discovery, or
  • Conflicting expert opinions or records create genuine issues of material fact.
• Disaggregate claims:
  • Some claims may be barred as “COVID-19 claims,” while other claims in the same lawsuit may proceed.

D. Influence Beyond KRS 39A.275

Although KRS 39A.275 was subsequently repealed, the General Assembly preserved the bar on causes of action that were prohibited under it, and the Court’s interpretive approach has broader implications:

• Future emergency-immunity statutes are likely to be read with similar insistence on actual causation and careful attention to statutory text.
• Legislatures may, in light of this case, draft clearer definitions of the scope and limits of emergency immunities.
• Other jurisdictions facing similar statutes might look to Jackson and Buckaway, alongside cases like Waggoner, for persuasive guidance on balancing emergency protections with accountability for non-pandemic-related negligence.

IX. Conclusion: Key Takeaways

• Causation is essential: KRS 39A.275 immunity applies only where injuries are “caused by or resulting from” COVID-19 infection, COVID-mitigation services, or out-of-course services taken in response to COVID.
• COVID status alone is not enough: The mere fact that a plaintiff had COVID-19, or was treated in a COVID unit, does not automatically transform all subsequent injuries into “COVID-19 claims.”
• Non-COVID and pre-emergency claims survive: Alleged harms unrelated to COVID or occurring before March 6, 2020, fall outside the statute and must be adjudicated on their merits.
• Gross negligence remains actionable: Even within the statute’s scope, gross negligence—or wanton, willful, malicious, or intentional misconduct—is not immunized. The threshold is high, but factual allegations like prolonged non-response to an unresponsive, fragile patient can be sufficient to reach a jury.
• Discovery matters: Courts should be wary of granting summary judgment on immunity where discovery is incomplete, especially when the defendant controls most of the relevant evidence.
• PREP Act issues remain open: On remand, federal immunity under the PREP Act may still be litigated, but it will require its own causation-specific, countermeasure-specific factual showing.

Ultimately, Jackson v. Mayfield Ky Opco, LLC stands as a major Kentucky precedent on pandemic-era liability: it preserves the General Assembly’s intent to protect essential services from opportunistic or marginal COVID lawsuits, while ensuring that the shield does not become a blanket amnesty for unrelated neglect or reckless disregard of vulnerable residents’ lives.