Articles Posted in Medical Malpractice

Informed Consent
The Indiana Court of Appeals recently affirmed a trial court’s denial of a defendant’s motion for judgment on the evidence and motion to correct error in a medical malpractice informed consent case in which a jury awarded significant damages to the plaintiff arising out of a nerve injury during surgery. The patient in Glock v. Kennedy underwent five surgeries to his left hand, including amputations to his left index finger, which were performed by a surgeon after the patient suffered a crush injury to his left hand. During the fourth surgery, the surgeon caused a nerve injury to the patient’s thumb.

While the medical review panel formed to review the case pursuant to the Indiana Medical Malpractice Act found that the surgeon met the applicable standard of care and his conduct was not a factor of the resultant damages, the panel found there was a material issue of fact, not requiring expert opinion, bearing on liability for consideration by the court or jury as to whether the surgeon provided appropriate informed consent before the fourth surgery.

In order to prevail on a claim asserting lack of informed consent in a medical care case, a patient must prove (1) nondisclosure of required information; (2) actual damage… (3) resulting from the risks of which the patient was not informed; (4) cause in fact, which is to say that the plaintiff would have rejected the medical treatment if he had known the risk; and (5) that reasonable persons, if properly informed, would have rejected the proposed treatment. The plaintiff in Glock presented testimony from one of the medical review panel members stating that discussion of the risks of the procedure performed should include nerve injury and reoccurrence of pain or the lack of eliminating the pain. Contrary to the surgeon’s testimony, the patient testified that he was never told the likelihood of success of the procedure in which the nerve injury occurred was only 75% and that the surgeon never explained any risk of the nerves being close together between the index finger and thumb. The patient’s stepsister also testified that the patient was not told about the risk of nerve damage.

The right to a trial by a jury is considered one of our sacred rights under the Constitution. However, this guarantee means little if the impaneled jurors profess to having an unalterable belief as to the propriety of awarding money damages even when instructed by a judge that it is their duty to do so. Indiana’s guidance to trial judges is quite general when it comes to whether a juror should be stricken, as the trial court’s literal reading of the rule in Estate of Pyle v. Mattar, M.D. illustrates.

In Estate of Pyle, the personal representative of the deceased Pyle’s estate, filed a wrongful death/medical malpractice suit against Dr. Mattar and other healthcare providers seeking money damages. During jury selection (also known as voir dire), the following exchange took place between plaintiff’s counsel and a prospective juror, Miller:

[Miller]: So, we have to determine the dollar amount?

Indiana has a rather complex and parsimonious medical malpractice statute which sometimes leads to claimants seeking creative solutions to some of the obstacles they face in pursuing justice for claims with merit.  Garau Germano, P.C. v. Robertson, 2019 WL 3886461, involved just such a creative approach.  In Garau Germano, the Indiana Court of Appeals upheld the dismissal of a complaint for declaratory judgment and mandate filed on behalf of a law firm and one of its clients against the Indiana Patient’s Compensation Fund (PCF) and related parties.  The law firm and client sought to prevent the defendants from requiring a medical malpractice claimant’s periodic payments agreement with a qualified health care provider to pay out the provider’s maximum liability under the Indiana Medical Malpractice Act (MMA) before the claimant could access the PCF. For context, the MMA provides that healthcare providers can discharge their liability to claimants by making an immediate payment of their maximum liability under the MMA, or by making an immediate payment and paying the cost of a periodic payments agreement. Ind. Code § 34-18-14-4. The plaintiffs in this case argued that the MMA does not require that a healthcare provider’s immediate payment plus the money paid out under a periodic payments agreement equal the provider’s maximum liability before a claimant can access the PCF.

The MMA provides that healthcare providers are not liable for an amount in excess of $250,000.00 for an act of malpractice that occurs after June 30, 1999 and before July 1, 2017, $400,000.00 for an act of malpractice that occurs after June 30, 2017 and before July 1, 2019, and $500,000.00 for an act of malpractice that occurs after June 30, 2019. Ind. Code § 34-18-14-3. However, if a healthcare provider’s immediate payment of money plus its expenditure for a periodic payments agreement exceeds $187,000.00 for an act of act of malpractice that occurs after June 30, 1999 and before July 1, 2017 or seventy-five percent (75%) of its maximum liability for an act of malpractice after June 30, 2017, the healthcare provider will be considered to have paid its maximum liability. Ind. Code §§ 34-18-14-4, 34-18-15-3. If a healthcare provider has agreed to settle its liability by payment of its maximum liability, either by an immediate payment or by making an immediate payment and paying for a periodic payments agreement to pay out money in the future, a claimant can thereafter file a petition to seek excess damages from the PCF. Ind. Code § 34-18-15-3.

The question raised by the plaintiffs was whether the present payment of money by a healthcare provider plus the future payments under a periodic payments agreement must equal a healthcare provider’s maximum liability. For an act of medical malpractice that occurred after June 30, 1999 and before July 1, 2017, could a claimant access the PCF if a healthcare provider makes an immediate payment of $150,000.00 and pays $37,001.00 for a periodic payments agreement that only pays out $50,000.00 in the future (a total of $200,000.00 in payments), as opposed to paying out $100,00.00 (a total of $250,000.00 in payments)? The answer to this question is important as it relates to elderly claimants, for instance, as any future payments under a periodic payments agreement may not pay out during their lifetime.

We previously wrote about a split between two panels of the Indiana Court of Appeals on what constitutes preferred venue under Indiana Trial Rule 75 in medical malpractice cases in Indiana. Indiana Trial Rule 75 provides for preferred venue in “the county where… the principal office of a defendant organization is located…,” and the Indiana Supreme Court has previously interpreted the term “principal office” as “the place in Indiana where one serves the corporate registered agent.” Ind. R. Trial P. 75(A)(4); Am. Family Ins. Co. v. Ford Motor Co., 857 N.E.2d 971, 975 (Ind. 2006) (American Family).

Plaintiffs in both medical malpractice cases argued preferred venue existed in Marion County, Indiana because one or more of the defendants had registered agents with office addresses in Marion County. However, the healthcare Defendants in these cases argued that preferred venue did not lie in Marion County because a new Indiana statute provides that “[t]he address of [an entity’s registered] agent does not determine venue in an action or a proceeding involving the entity.” Ind. Code § 23-0.5-4-12.

The Indiana Court of Appeals in Morrison v. Vasquez, 107 N.E.3d 1103 (Ind. Ct. App. 2018) held that Marion County, Indiana was not a preferred venue based upon the address of the defendant’s registered agent, whereas the Court in Indiana Univ. Health S. Indiana Physicians, Inc. v. Noel, 114 N.E.3d 479 (Ind. Ct. App. 2018) held that preferred venue lied in Marion County.

Not all claims against healthcare providers in Indiana constitute medical malpractice and fall within the scope of the Medical Malpractice Act. A slip-and-fall on untreated ice in a parking lot at a hospital, for instance, is a claim of ordinary negligence, as opposed to medical malpractice. The Medical Malpractice Act does not apply to claims of ordinary negligence.

Whether a claim constitutes medical malpractice or ordinary negligence is a question of law and often turns on hairline distinctions with courts looking to the substance of a claim. The test is whether the claim is based on the provider’s behavior or practices while acting in a professional capacity as a provider of medical services. The Medical Malpractice Act applies to curative or salutary conduct undertaken for the benefit of a patient’s health. The Medical Malpractice Act does not apply to conduct unrelated to the promotion of a patient’s health or the provider’s exercise of professional expertise, skill, or judgment. Courts also ask whether the issues are capable of resolution by a jury without application of the standard of care and whether there is a causal connection between the conduct complained of and the patient-healthcare provider relationship.

The Indiana Court of Appeals recently held that the Medical Malpractice Act was not applicable to a claim of negligent dissemination of protected health information.

In finding in favor of several healthcare providers in a medical malpractice case in Indiana, the Indiana Court of Appeals in Speaks v. Vishnuvardhan Rao reviewed numerous concepts applicable to medical malpractice claims in Indiana.

Medical malpractice claimants in Indiana must prove that a healthcare provider owed the patient a duty, the healthcare provider breached that duty, and the breach proximately caused injury to the patient. Healthcare providers are not obligated to provide perfect care, but they must exercise the degree of skill and care ordinarily possessed and exercised by a reasonably skillful and careful healthcare provider under the same or similar circumstances.

The patient in this case filed a lawsuit against several healthcare providers claiming her healthcare providers committed malpractice by administering the wrong medication, failing to correctly complete a DVT risk form, and failing to properly monitor and flush her IV.

There currently exists a split between two panels of the Indiana Court of Appeals on what constitutes preferred venue under Indiana Trial Rule 75. Indiana Trial Rule 75 is a rule adopted by the Indiana Supreme Court that sets forth venue requirements for cases filed in Indiana state courts. While the rule provides that “[a]ny case may be venued, commenced and decided in any court in any county,” Ind. R. Trial P. 75, it allows for parties to have cases transferred to other courts or counties that have preferred venue, based upon criteria set forth in ten (10) separate subsections.

Preferred venue for cases can exist in more than one court or county in Indiana. One of the ten (10) subsections of Indiana Trial Rule 75 provides for preferred venue in “the county where… the principal office of a defendant organization is located…” Ind. R. Trial P. 75(A)(4).

The Indiana Court of Appeals’ split decisions arise from medical malpractice cases filed in Marion County, Indiana. The defendants sought to have the cases transferred to other counties, namely Monroe County, Indiana and Lawrence County, Indiana. Although Indiana procedural law enacted by Indiana’s legislature provides that “[t]he address of [an entity’s registered] agent does not determine venue in an action or a proceeding involving the entity,” Ind. Code § 23-0.5-4-12, the Indiana Supreme Court has interpreted the term “principal office” as used in Indiana Trial Rule 75(A)(4) and (10) as “the place in Indiana where one serves the corporate registered agent.” Am. Family Ins. Co. v. Ford Motor Co., 857 N.E.2d 971, 975 (Ind. 2006) (American Family).

Legislators in Indiana and Kentucky have enacted laws mandating medical review panels in cases where individuals allege they have been harmed by a healthcare provider’s negligence, commonly known as medical malpractice.  Under legal challenge, Indiana found the legislation constitutional, whereas Kentucky did not.

Long ago, prior to enacting this legislation, Indiana’s and Kentucky’s founders provided as part of their Constitutions that their courts should be “open” and justice administered freely and “without delay.”

Article I, Section 12 of the Indiana Constitution provides:

The Indiana Court of Appeals recently issued an opinion in Biedron v. Anonymous Physician 1 addressing the applicable statute of limitations in medical malpractice lawsuits in Indiana.

Biedron involved three related medical malpractice claims, which were consolidated for the purposes of the appeal. Proposed complaints for medical malpractice were filed by the plaintiffs with the Indiana Department of Insurance more than two (2) years after the alleged malpractice occurred in each of the cases. The plaintiffs in each of the cases argued that the 2-year occurrence-based statute of limitations, as set forth in the Indiana Medical Malpractice Act, should be tolled under the doctrine of fraudulent concealment. With differing trial court orders on the defendant healthcare providers’ motions for summary judgment on the statute of limitations issue, the Indiana Court of Appeals affirmed in part and reversed in part, finding in favor of the Indiana healthcare providers.

Under the Indiana Medical Malpractice Act, a medical malpractice claim, whether in contract or tort, may not be brought against a healthcare provider based upon professional services or healthcare that was provided, or that should have been provided, unless the claim is filed within two (2) yeas after the date of the alleged act, omission, or neglect, except that a minor less than six (6) years of age has until the minor’s eighth birthday to file. Ind. Code § 34-18-7-1.

Our lawyers are currently investigating the FDA’s recall of Valsartan in an effort to determine whether a sufficient medico-legal basis will exist to file Valsartan lawsuits for those impacted.  At this point, it is difficult to ascertain whether those who have taken Valsartan products contaminated with NDMA may have been adversely affected by taking the contaminated drug.  The viability of such claims will depend in large part on how long the medication was taken, from whom the medication was sourced, who manufactured the medication, what dose of the medication was taken, and the amount of contaminant contained in the medication.  A Valsartan lawsuit attorney can investigate the facts necessary to form a basis for possible Valsartan litigation.  First and foremost, though, is the need for those taking a contaminated Valsartan medication to consult their physician to determine if they have been taking a contaminated Valsartan product to determine whether a different medication may be indicated.  According to the FDA, Valsartan users should not stop taking the medication until completing a physician consultation.

The biggest concern for Valsartan users appears to be an elevated risk of cancer, although other concerns are possible organ damage or tumors.  Nonetheless, and importantly, at this time, the FDA is warning those taking Valsartan do not stop taking the medication unless and until you have consulted with your prescribing physician.  It is also important to note that not all Valsartan medication was contaminated with NDMA. The FDA has published a list of the recalled and non-recalled medications, which can be found here.  Valsartan lawsuit lawyers will continue to monitor the information being developed by the FDA and companies participating in Valsartan recalls.

According to the FDA, taking the highest Valsartan does (320 mg) from the recalled batches daily for the full four years may increase the risk of cancer to the point one additional case of cancer occurs in the lifetimes of a hypothetical group of 8000 such Valsartan takers.  This may seem like a relatively insignificant risk compared to the risks of developing cancer published by the American Cancer Society.  However, this is additional risk and one additional case of this terrible disease is one too many and may very well warrant a Valsartan law firm to file a product liability or failure to warn lawsuit supported by admissible scientific and epidemiological evidence.

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