Indiana Supreme Court Clarifies Healthcare Providers Can Be Liable for Multiple Provider Pre-Fund Caps and Prejudgment Interest Awards in Medical Malpractice Cases

On June 26, 2025, the Indiana Supreme Court issued a significant opinion in Abbas v. Neter-Nu, a medical malpractice case involving a below-the-knee amputation following allegedly negligent care at Methodist Hospital in Gary, Indiana. The decision affirms a jury verdict for the patient while clarifying important principles of Indiana medical malpractice law—including how verdicts against multiple healthcare providers can be collected against the pre-Patient Compensation Fund statutory cap under Indiana’s Medical Malpractice Act (MMA), how prejudgment interest is to be calculated under the MMA, the limits of superseding cause, and evidentiary standards at trial.

Background: Improper IV Placement Leads to Severe Injury

In July 2015, Hetep Bilal Neter-Nu, a truck driver, visited the emergency department at Methodist Hospital with complaints of nausea and vomiting. After two IV lines became dislodged from his arms, a nurse—without a physician’s order and despite lacking training—placed an IV in Neter-Nu’s foot. Although he later complained of pain in the foot, and early signs of infiltration were documented, Neter-Nu was discharged two days later.

Several days later in Iowa, Neter-Nu was hospitalized with blackened toes and no blood flow in his foot. Doctors determined the foot was unsalvageable. On August 19, 2015, he underwent a below-the-knee amputation.

Neter-Nu submitted his claim to a medical review panel as required under Indiana’s Medical Malpractice Act. The panel unanimously found that the evidence did not support a conclusion that the healthcare providers failed to meet the applicable standard of care. Undeterred, Neter-Nu filed suit in Lake Superior Court against Methodist Hospital, Nurse Morgan Mittler, and Dr. Zainab Abbas, alleging that Mittler’s negligent IV placement and Abbas’s failure to recognize and respond to signs of injury led to the amputation of his leg, and that Methodist was vicariously liable for their conduct. Despite the unfavorable panel opinion, the case proceeded to a two-week jury trial in late 2022.

A jury found Nurse Morgan Mittler, Dr. Zainab Abbas, and Methodist Hospital liable and awarded Neter-Nu $11 million. The trial court reduced the award to $1.25 million under the then-applicable statutory cap imposed by the MMA (now $1.8 million) and awarded prejudgment interest on the then-applicable single $250,000 cap (now $500,000).

The Court of Appeals Reverses Jury Verdict and Remands for New Trial

The Indiana Court of Appeals had previously reversed the jury verdict and ordered a new trial, finding that the trial court erred in denying Methodist Hospital’s motion for judgment on the evidence and in instructing the jury that it could find the hospital liable for the actions of unnamed employees beyond the nurse and physician. The Court of Appeals also concluded the trial court should have given a superseding cause instruction and committed multiple evidentiary errors in excluding impeachment and habit evidence.

Supreme Court Affirms Verdict but Orders Correction on Prejudgment Interest

The Indiana Supreme Court granted transfer and vacated the Court of Appeals opinion, holding that while the trial court erred in some respects, those errors did not warrant a new trial given the application of joint-and-several liability, the adequacy of the jury instructions as given, and the defendants’ waiver of key evidentiary arguments. The Indiana Supreme Court largely upheld the trial court’s rulings and the jury’s verdict but found one key error: the trial court miscalculated prejudgment interest.

Under Indiana’s then-applicable MMA caps, qualified healthcare providers were liable up to $250,000 individually (now increased to $500,000), with the Patient’s Compensation Fund paying amounts above the cap up to the statutory maximum (presently capped at $1.8 million). The trial court awarded prejudgment interest based on just one $250,000 cap, despite both Mittler and Abbas being separately liable.

The Supreme Court clarified that each provider’s full $250,000 liability is subject to prejudgment interest. In other words, where multiple providers are liable, prejudgment interest applies to each defendants’ pre-Fund cap individually. The Court remanded the case for the trial court to recalculate prejudgment interest accordingly.

This aspect of the ruling represents an important clarification for plaintiffs and trial courts alike, ensuring that interest compensation is not artificially limited when multiple defendants are involved.

Hospital Liability: No Direct Liability Without Expert Testimony

The Court agreed with the defendants that the trial court erred in instructing the jury that it could find Methodist Hospital directly liable or vicariously liable for the acts of unnamed agents. The plaintiff had not presented expert testimony showing that any Methodist employee other than Mittler or Abbas breached the standard of care.

Nevertheless, the error was found to be harmless. The hospital had conceded that it was vicariously liable for both Mittler and Abbas, and the jury was properly instructed on joint-and-several liability. Because the jury’s damages award was not apportioned among defendants and the hospital’s liability flowed through the two employees already at issue, the verdict stood.

Jury Instructions: Superseding Cause and Hindsight

The defense had also requested jury instructions on superseding cause (arguing that Neter-Nu’s delay in seeking care broke the chain of causation) and on avoiding hindsight in assessing the standard of care. The Court found no abuse of discretion in the trial court’s refusal to give these instructions.

The Court explained that the trial court’s standard instructions on proximate cause and reasonable care under the circumstances adequately covered these issues. Importantly, the Court reiterated that superseding cause requires an independent and unforeseeable intervening act—which was not established here. Neter-Nu had been discharged on narcotic medications and was not medically trained, making his delay in seeking additional care foreseeable as a matter of law.

Evidentiary Rulings: Defendants Waived Key Objections

A recurring theme in the decision was the defendants’ failure to preserve certain evidentiary arguments. The providers attempted to introduce past medical records to show that Neter-Nu had a tendency to remove IVs during prior hospitalizations, arguing this showed a habit and could be used to impeach his credibility.

However, the Court found the trial court properly excluded the records. The defendants failed to establish the frequency and consistency necessary for “habit” under Indiana Evidence Rule 406. The Court also found the records constituted inadmissible character evidence under Rule 404(b), and that their introduction posed a risk of unfair prejudice by inviting the jury to infer that Neter-Nu was responsible for the IV dislodgement based on prior conduct.

Crucially, while the defense later argued on appeal that the records could have been used to impeach Neter-Nu’s testimony that he was a “compliant patient,” they did not make that specific argument at trial. By failing to preserve this basis, the Court held the issue was waived.

The same waiver occurred in the defendants’ attempt to impeach Neter-Nu’s expert witness, Dr. Tripp, using an earlier email. The trial court excluded the email after finding the defense had not properly laid the foundation to use it to refresh the expert’s recollection. Although the defense later characterized the email as impeachment evidence, that argument, too, was not clearly raised at trial and was thus waived.

The Court’s ruling serves as a reminder that trial counsel must clearly articulate the legal grounds for evidence admission at the time of the objection or offer of proof—arguments raised for the first time on appeal will not be considered.

Takeaways for Medical Malpractice Litigants

This case provides meaningful guidance on multiple fronts:

• Prejudgment interest applies to each provider’s full statutory cap, not just one, when multiple providers are liable.
• Individual provider defendants are each responsible for a full statutory pre-Fund cap (now $500,000) even if agents or employees of the same healthcare entity.
• The doctrine of superseding cause does not apply to patient actions, but rather applies to an unforeseeable act of a third person or other force.
• A provider raising a defense of superseding cause or other causation-based defense has the burden of coming forward with expert testimony meeting the evidentiary standard for causation, not mere speculation.
• Preserving objections and evidentiary theories at trial is critical—appellate courts will not consider new arguments raised after the fact.

At Barsumian Armiger Injury Lawyers, we remain committed to monitoring and explaining key legal developments affecting personal injury and medical malpractice claims across Indiana. If you or someone you love has been harmed by negligent medical care, our attorneys are here to help you pursue the justice and compensation you deserve. You can read the Indiana Supreme Court’s full opinion here.