In order to proceed with a matter in state court after a medical review panel renders an opinion in favor of a healthcare provider, a patient is required to produce an expert opinion that the healthcare provider’s conduct failed to meet the applicable standard of care. If the patient fails to produce an expert opinion to refute the panel opinion, the defendant healthcare provider will be entitled to judgment in his or her favor as a matter of law. Such expert opinions are typically provided by physicians, as the general rule is that non-physician healthcare providers are not qualified under the evidence rules to render opinions regarding medical causation. However, Indiana courts have held that in certain circumstances non-physician providers may qualify to render an expert opinion on medical causation.
In the recent decision of Nataomi Riley, et al. v. St. Mary’s Medical Center Evansville, the Court of Appeals reversed a lower court’s decision granting summary judgment in favor of the hospital finding that a radiologic technologist (“RT”) was qualified to render an expert opinion on whether the hospital’s breach in the standard of care proximately caused the plaintiff’s injuries. Nataomi Riley, et al. v. St. Mary’s Medical Center Evansville, 19A-CT-844, 2019WL5557034 (Ind. Ct. App. 2019).
In 2015, Nataomi Riley was scheduled to receive a CT scan at St. Mary’s Medical Center of Evansville, Inc. In preparation for the scan, hospital employee RT Karen Osborne injected contrast dye into Nataomi’s right arm. As the dye was going in, Nataomi began experiencing intense pain in her arm. She subsequently had to be removed from the CT machine when the pain went from her arm up into her shoulder. A different RT inserted contrast dye into Nataomi’s left arm without any problems and the CT scan was obtained. Following the exam, an egg-sized swelling was visible on Nataomi’s right arm and RT Osborne determined an infiltration had occurred. RT Osborne treated the area and wrapped a dressing around it before sending Nataomi home with instructions that she might experience some bruising and swelling. RT Osborne did not notify the hospital radiologist about the infiltration.
By the time she returned home, Nataomi’s swelling had significantly increased, and she was rushed to the emergency department for her pain. Surgery was ultimately performed on Nataomi’s right hand where the flesh had broken open. Nataomi required weeks of home health care post-operatively and now suffers from nerve damage to her dominant hand.
In 2016, the Rileys filed a proposed medical malpractice complaint with the Indiana Department of Insurance against the hospital alleging Nataomi had “developed compartment syndrome of the right arm requiring emergency surgery and prolonged wound care” and “suffered permanent neurological and muscular damage to [her] right arm,” among other injuries, as a result of the hospital’s negligence. The medical review panel disagreed finding that the evidence submitted by the parties did not support the conclusion that the hospital “failed to comply with the appropriate standard of care” and that the hospital’s conduct “was not a factor in the injuries and damages of which [the Rileys] complained.”
Despite the outcome at panel, the Rileys proceeded in state court. The hospital filed a motion for summary judgment and designated the medical review panel’s opinion. In response, the Rileys designated an affidavit from RT Barry Southers who opined that RT Osborne “did not follow the standard of care in these circumstances and that conduct was factor in the resultant injury to [Riley].” Specifically, RT Southers opined that RT Osborne should have stopped injecting the contrast dye into Nataomi’s arm as soon as she complained of pain and notified the radiologist physician about the infiltration and that RT Osborne’s failure to do so was a factor in causing the injuries suffered by Nataomi. Although the hospital conceded RT Southers’s affidavit established a genuine issue of material fact regarding a breach of the standard of care, it argued he was not qualified to render an expert opinion on causation. The hospital contended that even in the absence of negligence some contrast medium is introduced into the surrounding tissue at the time of the injection; thus, expert medical evidence was needed to demonstrate that Nataomi’s injuries were caused either entirely by the introduction of additional contrast medium after breaching the standard of care or were exacerbated by the introduction of the additional contrast medium. The hospital argued that this was a complicated medical question that was beyond the scope of a layperson’s understanding and required qualified expert medical testimony.
The Court of Appeals disagreed finding that RT Southers was indeed qualified to render an expert opinion on whether the hospital’s breach proximately caused Nataomi’s injuries. In discussing its decision, the Court stated: “It was not [RT] Southers’s task to pinpoint the precise amount of contrast medium it would have taken to cause any injury to Nataomi; it was merely his task to state, based on his expertise, whether [RT] Osbrone’s alleged breach of the standard of care was a proximate cause of the injuries that [Riley] suffered. The Riley’s point out that Nataomi ‘faced a visible collection of caustic fluid just under her skin the same size as the fluid introduced by [RT] Osborne, within seconds of the injection.’ The causation issue here was not complex, and therefore we conclude that Southers was qualified to render an expert opinion and thus establish a genuine issue of material fact on that issue.” Consequently, the Court of Appeals reversed the trial court’s grant of summary judgment for the hospital and remanded the case for further proceedings.