Amy Collignon Gunn

Crystal Jefferson was thirty-one when she delivered her first child by cesarean section at Missouri Baptist Medical Center on October 27, 2005. A CT scan during her hospital stay showed a soft-tissue mass in her abdomen and a collection of fluid in her pelvis, and the radiologist recommended a follow-up study. A second scan on December 9 showed both again, and again the radiologist recommended a follow-up. On January 19, 2006, Dr. Amy Mosher, a radiologist, read the third and told Jefferson that the fluid collection had resolved; neither Mosher’s report nor what she told Jefferson mentioned that the mass was still there. Jefferson believed the problem was gone.

In the spring of 2008 she felt pressure in her abdomen, and tests showed that the mass was inoperable stage IV colon cancer. She died in 2011. When her children sued, Missouri Baptist relied on one sentence in Missouri’s malpractice-damages statute, which barred recovery against a health care provider for the acts of a person who was not its “employee,” and on its position that Mosher was the employee of a radiology group. A St. Louis County judge agreed and entered summary judgment for the hospital, ending the family’s claim against it before trial.

On August 19, 2014, the Missouri Court of Appeals in St. Louis reversed that judgment. Amy Collignon Gunn and Anne-Marie Brockland represented Jefferson’s two children, who sued through their father, on appeal. The Eastern District held that “employee” carried its common-law meaning—a worker whose manner and means of work the principal has the right to control—and sent the case back to be decided under that test. The children’s case against the hospital settled two years later, and in 2017 the General Assembly rewrote the statute in reaction to the ruling.

Gunn has tried nearly fifty cases to verdict since she finished law school in 1996, for people hurt by medical care, defective products and negligence. In March 2025 a St. Louis County jury found for a boy injured during a labor at Mercy Hospital St. Louis in which his mother pushed for twelve and a half hours. In May 2026 a Sangamon County, Illinois, jury returned a $38.4 million verdict for a surgical technologist pinned by a Hillrom equipment boom that collapsed in an operating room. In both trials Gunn and her co-counsel built the plaintiff’s case from the defendant’s own records and witnesses: fetal heart-rate tracings the obstetrician reviewed at 8 a.m., and a Hillrom risk analysis that rated a collapse of the boom “catastrophic.”

Whose Employee Was Dr. Mosher

On December 15, 2011, Jefferson’s children, Collin and Courtney, suing through their father, Eric, brought claims against the hospital, Mosher and Mosher’s practice, Midwest Radiological Associates, alleging that her cancer would have been treated two years earlier if Mosher had not overlooked the mass. Missouri Baptist moved for summary judgment under section 538.210.2(3). That provision barred liability against any provider whose liability the chapter limited when the claim was “based on the actions or omissions of any other entity or person who is not an employee of such individual or entity.” The hospital asserted that Mosher was an employee of Midwest Radiological Associates, which contracted with her directly and paid her. In reply, the family pointed out that Missouri Baptist did not permit a radiologist to practice at the hospital unless she was also a member of Midwest.

After a hearing, Judge Gloria C. Reno of the St. Louis County Circuit Court agreed with the hospital. The court read the word “employee” through the chapter’s separate definition of a “physician employee” and entered judgment for Missouri Baptist. The family’s claims against Mosher and her group were resolved separately, and the Jeffersons appealed the judgment in the hospital’s favor.

Presiding Judge Lisa S. Van Amburg wrote for the panel, joined by Judges Patricia L. Cohen and Philip M. Hess. “Here, section 538.210.2(3)’s plain language is clear,” Van Amburg wrote. The statute used the word “employee,” and the court presumed that the legislature’s choice of a different term from “physician employee” was intentional and made for a particular purpose. The term “physician employee,” the court noted, “appears nowhere in Chapter 538 besides the definitions section.” The statute’s history pointed the same way. When the General Assembly amended section 538.210 in 2005, it deleted the term “physician employee” from that section, and an amendment is presumed to change existing law.

With no statutory definition of “employee” to apply, the court turned to agency law. The Restatement (Third) of Agency defines an employee as “an agent whose principal controls or has the right to control the manner and means of the agent’s performance of work,” and the test asks whether the principal had the right to exercise that control, whether or not it used it. The hospital’s lawyers, Steven Wasserman, John Mahon Jr. and Lisa Larkin, argued that the court could not look to the common law of agency, because “agent” and “employee” are different words. “While it is true that these terms are not synonymous, MBMC misapprehends the import of this fact,” Van Amburg wrote. An employee, the court explained, is a kind of agent, set apart by the principal’s right to control the details of the work.

The court then took up a further objection on its own. Missouri courts have long recognized that physicians must be free to exercise independent medical judgment, and the court accepted that premise while holding that it did not settle the question. A physician does not become a non-employee agent “merely because the hospital does not have the right to stand over the [physician’s] shoulder and dictate to him or her how to diagnose and treat patients.” The court set out the Restatement’s ten factors, among them the extent of control, whether the work is part of the principal’s regular business, how the worker is paid, and whether the parties believed they were creating an employment relationship. “No single Restatement factor is dispositive,” the court wrote.

The court reversed the summary judgment and remanded with instructions to apply the term “employee” in section 538.210.2(3) “in a manner consistent with this opinion.” The Supreme Court of Missouri denied transfer on November 25, 2014, leaving the Eastern District’s reading in place. In January 2015 Nicole K. Jobe of Thompson Coburn advised hospitals to review their contracts with the physicians on their medical staffs in light of the decision. The terms she listed as pointing toward agency included a hospital’s control over medical standards and prices, a contract making one physician group the only one to provide a service at the hospital, required liability coverage at set limits, termination rights and hospital ownership of the equipment. The Jeffersons’ case returned to St. Louis County and settled on confidential terms in August 2016.

In February 2017 the Missouri Senate gave first-round approval to Senate Bill 237, sponsored by Sen. Caleb Rowden, a Columbia Republican, to change the definitions of “employee” and “physician employee” in malpractice cases. In March the House passed its own version, 101 to 50. Its sponsor, Rep. Kevin Austin, said hospitals should not be sued over doctors who do only part of their work there, and opponents warned that injured patients would find it harder to recover. Both bills grew out of the 2014 decision in favor of the two Jefferson children.

Sen. Scott Sifton, an Affton Democrat, called the measure a “hospital immunity act and a nursing home immunity act.” Rowden, who handled it in the Senate, offered his own name for it: “I’d say it’s a ‘let’s sue the right person’ act.” The Senate approved the final version of House Bill 452, 27 to 5, on May 11, 2017, and the House agreed the next day, 98 to 45, a few hours before the session ended. The governor approved it on June 30.

The new law removed the definition of “physician employee” and wrote a definition of “employee” into chapter 538. An “employee” is now “any individual who is directly compensated by a health care provider for health care services rendered by such individual,” together with nonphysician workers a staffing company supplies, and section 538.210 bars a claim against a provider based on the acts of anyone who is not its employee, with one narrow exception. Under that language, a radiologist paid by an outside group is no longer the hospital’s employee for purposes of the statute. Collin and Courtney Jefferson’s case against Missouri Baptist had settled ten months before the governor approved the bill.

Nice, Until Provoked

Gunn is from Owensboro, Kentucky. She studied political science at Transylvania University in Lexington, graduating in 1993, and earned her law degree cum laude from Saint Louis University School of Law in 1996, after a spring 1995 judicial internship with Magistrate Judge Clifford J. Proud of the Southern District of Illinois. She was managing editor of the Saint Louis University Law Journal, which published her piece on reasonable-doubt jury instructions after Victor v. Nebraska. She is admitted in Missouri and Illinois. By 2007 she was practicing at Simon Passanante in St. Louis and had tried cases in both states. She was a member of The Simon Law Firm in St. Louis until she and Erica B. Slater opened Gunn | Slater in Clayton in January 2025.

From 2001 to 2015 she taught pretrial litigation as an adjunct professor at Washington University School of Law. Since 2017 she has served on the Supreme Court of Missouri’s Civil Rules Committee, and in 2021 she wrote about amendments to the civil rules for The Missouri Trial Attorney under the title “Changes to Missouri Supreme Court Rules of Civil Procedure, No Longer ‘Purported’ to be Amended.” She was president of the Missouri Association of Trial Attorneys for 2023–2024 and chaired the Eastern District of Missouri’s merit selection panel for magistrate judges in 2022. She hosts two podcasts about trial work: Heels in the Courtroom, which she helped found in 2020 with the women trial lawyers at Simon, and Trial Tested, produced for the American College of Trial Lawyers.

On a February 2024 episode of Heels in the Courtroom about dressing for court, Gunn said dressing for trial is “an opportunity for women to be different, to be feminine, to be relatable to the folks on the jury.” For her own trials: “I want to wear something like white or cream at every trial because white is the color of good, right?”

In 2007, about a decade into practice, she published a piece in the St. Louis Lawyer titled “Since When Is ‘Too Nice’ A Fault?” With Elizabeth S. Lenivy she later wrote “Hospitals off the hook, Patients. . . out of luck” for the medical-malpractice edition of AIEG VOICE in 2020, and she has written for other trial lawyers on witness impeachment, Daubert, medical-device preemption and screening malpractice cases. Her motto now is “I’m nice, until I’m provoked.” Opponents who treat her, her team and her clients with respect, she has written, get the same in return, and incivility brings “measurable consequences.”

Twelve and a Half Hours at Mercy Hospital St. Louis

Sarah Anyan was a cardiac nurse at Mercy Hospital St. Louis, and her husband, Blake, was a respiratory therapist. She came to Mercy on May 3, 2020, after her water broke, with no health concerns. “We just had a very typical pregnancy,” she said later. She had an epidural at 10:42 that night, was fully dilated by 3:50 the next morning, and began to push. Dr. Daniel McNeive, a Mercy Clinic obstetrician, first came into her room at 8 a.m. He saw fetal heart-rate tracings that indicated the baby might not be getting enough oxygen, and he advised her to keep pushing. The baby was delivered without a cesarean at 4:24 p.m., about twelve and a half hours after the pushing began.

Remi, as his parents call him, was born with poor muscle tone and no cry. He had hypoxic-ischemic encephalopathy—brain damage from oxygen deprivation during birth—and began having seizures within hours. He spent forty-six days in the neonatal intensive care unit and has cerebral palsy.

Both parents worked in health care, and both had trusted the team caring for them. “We just had complete faith and trust in our team,” Blake said. The Anyans alleged that no one told them the risks of prolonged pushing, that no one offered a cesarean despite signs of fetal distress, and that Remi did not receive immediate treatment after birth. “We had two nurses at my bedside. Speaking as a nurse, I was really, really disappointed that they didn’t share that with me,” Sarah said. Blake described the injury in terms of their own training: “It’s just a major travesty. It hurts us as parents, but it also hurts us as care providers. That’s so far away from what we’ve been taught to do, and what I teach my students to do.”

The Anyans sued Mercy and McNeive in St. Louis County Circuit Court in August 2021. “I was so inspired by Sarah and Blake and wanted desperately to help them and to investigate this case,” Gunn said. She tried the case in March 2025 with Slater and with Elizabeth S. Lenivy of Simon Law. The plaintiffs’ evidence was that McNeive should have delivered the baby by C-section as early as 9:30 a.m., nearly seven hours before the birth. An expert for the family called that much pushing inexcusable, and one expert testified to never having seen that situation in a hospital setting. Other testimony addressed the hours after delivery. “There was an opportunity for intervention,” Blake said. “You couldn’t reverse the injury that happened, but he could have received therapeutic hypothermia. It would have lessened his injury by 20 to 30 percent, is what some of the different experts think.”

By late in the labor, McNeive acknowledged the heart-rate concerns, but he said that Remi was too low in the birth canal for him to feel he could deliver him safely by C-section. The jury deliberated four hours and on March 25, 2025, returned its verdict for Remi against Mercy Hospital, Mercy Clinic and McNeive.

Mercy said afterward that it and its physicians “never want patients or their families to suffer and believe in the care that was provided in this case,” and that it was considering an appeal. Blake spoke to other parents: “Nothing can reverse what happened to Remi, but we’d like mothers going into the labor and delivery room to know four hours is a long time. Going past that definitely carries risks.”

When his parents spoke publicly in April 2025, Remi was about to turn five. He uses a gait trainer to take steps and a device that tracks his eye movements to answer questions. “Our morning routine probably takes an hour,” Blake said. “He likes to try and do a lot of things himself. He wants his spoon and control of being able to give himself a drink, and rather than just try and force all that stuff on him, we try and make him an active participant in everything that he does.” Sarah said: “We have to be strong because Remi is strong, and we have to fight for him because he fights every day.”

Short Bolts in Operating Room 16

On January 31, 2022, a little before 9 p.m., Stacey Brown, a surgical technologist at HSHS St. John’s Hospital in Springfield, Illinois, was alone preparing Operating Room 16 for an early-morning surgery when a TruPort medical boom made by Hill-Rom Company, Inc., a division of Baxter Healthcare, collapsed on her without warning. The metal extension pinned her right foot to the floor. She had readied operating rooms by herself many times without trouble. “I didn’t even move that boom a half inch,” she said. Baxter had completed its purchase of Hill-Rom the month before.

She has had two major shoulder surgeries, and her dominant right arm is permanently impaired. She has continuing injuries to her neck, right leg, right foot and right wrist. Her treating physicians do not expect her right shoulder to improve meaningfully, and they expect her neck injuries to require more surgery. She uses a cane and cannot fully use her right hand. “See, my hand is just frozen,” she said, showing a reporter. “I’ve been a nurse since 1979… I loved what I did,” said Brown, who lives in Macoupin County. Of the work she can no longer do, she said: “I love taking care of people, and that’s what’s kind of hard for me now.”

Brown sued in December 2023, and Gunn and Slater tried her case against Hillrom to a Sangamon County jury. Their evidence was that the boom failed because Hillrom had installed bolts shorter than the design specifications required, a concealed defect that routine inspection and preventive maintenance could not detect. “Twenty millimeters is what they were installed with and 35 millimeters is what the design called for,” Slater said.

Hillrom had known of the risk of bolt mix-ups in its TruPort production process since at least 2018, and a similar assembly defect had been identified in 2014 at its German manufacturing plant. In 2018 the company did not inspect or retrofit the booms it had already installed. Hillrom testified under oath that the company’s policy was to wait for a complaint, which meant no action would be taken until a person was actually harmed. Hillrom’s own risk analysis rated the potential harm from a complete boom collapse as “catastrophic.” “It could have killed somebody, (if) they were unconscious and then boom,” Brown said.

On May 6, 2026, Hill-Rom admitted liability in a court filing. A manufacturing error, the company acknowledged, had left “certain load bearing bolts” too short, and the TruPort boom “was an unreasonably dangerous product.” Slater said the company had been very hesitant to concede that much—“it’s a legal admission and it’s a pretty serious one”—and that it was using the admission to split the case into compensatory and punitive phases so that the punitive evidence would not color the jury’s view of the damages. With liability conceded, the jury decided what Brown’s injuries were worth and whether Hillrom should be punished.

In May 2026 the jury awarded Brown and her husband, Roger, $4.6 million in compensatory damages and awarded Brown $33.8 million in punitive damages, a total of $38.4 million. Baxter said it strongly disagreed with the verdict and intended to appeal, and that the case “concerns an injury resulting from a product installed in 2013 and was an isolated incident.” Of the thirty-one booms at St. John’s, five had the same short bolts. The worldwide field retrofit Hillrom performed in 2022, after Brown was hurt, cost approximately $800,000.