By: Sean T. Devenney
In Martinez v. Oaklawn Psychiatric Center, Inc., 128 N.E.3d 549 (Ind. Ct. App. 2019) the Indiana Court of Appeals issued an opinion on July 12, 2019 expanding the reach of the Indiana Medical Malpractice Act (“Act”) for cases which heretofore may have been considered outside the scope of the Act. The opinion has implications for medical facilities throughout the state. It has particular impact on those facilities that encounter and treat patients suffering with mental illness. However, the application of this case could have broader implications going forward.
Background on the Indiana Medical Malpractice Act
A little history is in order to understand the importance of the decision. Whether a specific case falls within the purview of the Act cannot be overstated in as much as the Act includes significant and important protections for health care providers that take the necessary administrative steps to qualify under the Act. The Act includes caps on damages as well as a process requiring the plaintiff to pursue its case before the an independent “randomly” chosen Indiana Medical Review Panel made up of health care professionals tasked with reviewing the care in question and rendering an opinion as to whether there is evidence of malpractice before the plaintiff can actively pursue the case in Court. In short, the Act provides significant protection to medical providers and facilities that take the necessary administrative steps to qualify themselves for the protections afforded by the Act. Thus, qualified medical providers are usually well advised to assert that a specific case falls within the confines of the Act so as to garner the protections of the Act.
Facts of the Case
The relevant facts of the case are as follows.
Roy Martinez was a mentally ill patient that was admitted to a group home operated by Oaklawn Psychiatric Center. Oaklawn had taken the steps necessary to qualify under the Act. Oaklawn hires “residential assistants” that are responsible for helping the residents to become independent. Specifically, the residential assistants help manage daily activities like hygiene, medications and transportation. The residential assistants are trained in non-violent, verbal de-escalation strategies.
In the early morning hours of August 3, 2017, at approximately 12:30 AM, Roy Martinez was watching TV when the residential assistant on duty, Kennedy Kafatia (“Kafatia”), instructed Martinez that it was time to go to bed because it was past curfew. Martinez refused stating he wanted to finish his drink and show. When Kafatia approached a lamp to turn off the light, Martinez apparently took issue and an altercation ensued. Martinez attempted to charge Kafatia. Kafatia dodged the charge and kicked Martinez in the shin causing a large cut. Martinez then walked to the kitchen and called 911. Kafatia stayed in the living room and awaited the police consistent with Oaklawn training. The police arrived and found Martinez in the kitchen, breathing but unconscious. While the police waited for the medics to arrive, Martinez suddenly stopped breathing. The police began CPR. The medics arrived, continued CPR, but to no avail. Martinez was pronounced dead at approximately 1:41 AM at a local hospital. A lawsuit for wrongful death ensued against Oaklawn.
The complaint alleged Kafatia was acting in the course and scope of his employment when he negligently or recklessly injured Martinez resulting in his death. The Plaintiff further alleged that Oaklawn’s employees failed to render appropriate first aid after the altercation. Finally, the Plaintiff alleged that Oaklawn was liable for negligent supervision, failing to provide a safe living environment, failing to properly staff the facility, failing to train employees, and failing to provide safety and protection to patients living in the facility.
In response to the Complaint, Oaklawn raised the defense that the matter pending in court could not proceed because the Plaintiff had failed to follow the terms of the Act requiring the Plaintiff to pursue the matter before a Medical Review Panel prior to filing suit. Basically, Oaklawn took the position that the court did not have subject matter jurisdiction over the case because as a precondition to filing suit in court, the plaintiff had to pursue the matter under the Act. The trial court agreed with Oaklawn and dismissed the case for lack of subject matter jurisdiction. The appeal to the Indiana Court of Appeals followed.
The Court Evaluated Each Party’s Characterization of the Altercation
In evaluating the case, the Indiana Court of Appeals acknowledged and evaluated the Plaintiff’s positions. Basically, the Plaintiff took the position that Kafatia was not engaged in the administration of health care in relation to Martinez as described in the facts above, and therefore this was not a medical malpractice case but a standard tort case. The Plaintiff’s contention was: Just because Oaklawn was a mental health facility does not mean that any injury that happens is the result of medical malpractice. The facts from the Plaintiff’s perspective were as simple as Kafatia and Martinez got in a fight and that is not the provision of healthcare; and further, an expert is not necessary to evaluate whether Kafatia acted reasonably under the circumstances. Thus, the Act should not apply.
However, Oaklawn argued that the enforcement of the curfew was the provision of healthcare in the context of the case, and that the actions taken after the fight by Kafatia (i.e., removing himself from the situation presumably to allow Martinez to calm down) was a judgment call that was sufficient to trigger the application of the Act.
The Court Adopts a New Test Which Appears to Broaden the Scope of the Act
The Indiana Court of Appeals recognized that prior cases were difficult to harmonize with one another as to when the Act might apply in the more obscure cases that do not clearly fall within the confines of traditional medical malpractice. Indeed, the Court of Appeals recognized that prior precedent had resulted in hairline distinctions between those cases that sound in medical negligence versus those that sound in ordinary negligence. In an attempt to provide lower courts and litigants with clearer guidance, the Indiana Court of Appeals created a new test to determine whether the Act applies to a particular case. The Court described the test as follows:
[W]e believe that the current test . . . as to whether the Medical Malpractice Act applies to specific misconduct is to determine whether that misconduct arises naturally or predictably from the relationship between the health care provider and patient or from an opportunity provided by that relationship. It is further important to realize that . . . such conduct may include otherwise tortious or abusive conduct.
In applying the test to the facts, the Court found that the curfew Kafatia was attempting to enforce was in fact part of the health care being administered by Oaklawn, and Martinez’s aggressive behavior was a consequence of the enforcement of the administration of the health care (namely a curfew). Further, Kafatia also followed Oaklawn’s protocol by removing himself from Martinez’s presence to await the arrival of the police. Given Kafatai was working within the confines of Oaklawn’s processes, policies, and procedures, and the incident arose naturally from the dispute over curfew which the Court determined was part of the medical treatment process, the Court concluded the incident and injuries fell “squarely within the scope of the Medical Malpractice Act.”
This case has broad reaching implications for facilities in which patients are involved in altercations with staff for whatever reason. Certainly, cases that heretofore may have been considered outside the scope of the Act, could be looked at in a new light. It seems that so long as the altercation arose naturally and probably from what arguably could be seen as the administration of health care, the entire incident could be covered under the Act.