Non-Physician Healthcare Provider Allowed to Give Expert Causation Opinion in Indiana Medical Malpractice Case

The Indiana Court of Appeals recently issued a decision on whether a non-physician healthcare provider could render an expert opinion as to medical causation in an Indiana medical malpractice case. In Riley v. St. Mary’s Med. Ctr. of Evansville, Inc., the patient filed a lawsuit against a hospital arising out of an IV contrast extravasation the patient suffered during a CT scan to rule out a pulmonary embolism. The patient alleged that the hospital’s radiologic technologist (RT) was negligent in injecting contrast dye into her right arm in preparation for the CT scan, and as a result, suffered compartment syndrome necessitating surgery and causing permanent injuries.

After the medical review panel formed in the parties’ case returned a unanimous opinion in favor of the hospital, the hospital moved for summary judgment. In response, the patient designated an affidavit from another radiologic technologist, Barry Southers, RT (Southers), who opined that the hospital RT did not comply with the applicable standard of care and that the hospital RT’s conduct was a factor in the resultant injury to the patient. In reply, the hospital argued that Southers, while he could give an opinion as to breach of the standard of care, could not give an expert opinion as to causation. The trial court agreed and entered summary judgment in favor of the hospital.

Plaintiffs in medical malpractice cases in Indiana must prove that (1) the defendant owed a duty to the plaintiff, (2) the defendant breached that duty, and (3) the breach proximately caused the plaintiff’s injuries. A unanimous opinion of a medical review panel is ordinarily sufficient to support a party’s motion for summary judgment where the non-movant is then required to rebut the medical review panel opinion with expert medical testimony. The question before the Indiana Court of Appeals was whether Southers was sufficiently qualified to render an expert opinion on the element of causation to rebut the negative opinion of the medical review panel.

To qualify as an expert under Indiana Evidence Rule 702, the subject matter of the expert’s testimony must be distinctly related to some scientific field, business, or profession beyond the knowledge of an average layperson and the witness must be shown to have sufficient skill, knowledge, or experience in that area so that the witness’s opinion will aid the jury. The general rule in Indiana is that non-physician healthcare providers like Southers are not qualified to render opinions as to medical causation. However, there is no blanket rule. Non-physician healthcare providers may qualify to give expert opinions as to causation if the causation issue is not complex.

On appeal, the hospital argued that some contrast medium can be introduced into the surrounding tissue in the absence of negligence and the issue of causation, in this case, was a complicated medical question because it turned on whether the patient’s injuries were caused or exacerbated entirely by the introduction of additional contrast medium after the breach of the standard of care. The Indiana Court of Appeals disagreed. The Court first noted that the hospital cited no authority for the proposition that some contrast medium may be introduced into the surrounding tissue in the absence of negligence. The Court then noted that it was not Southers’s task to pinpoint the precise amount of contrast medium it would have taken to cause any injury to the patient, but rather whether the hospital RT’s breach in the standard of care proximately caused the patient’s injuries. As a result of the extravasation, the patient had experienced a visible collection of caustic fluid under her skin that was the same size as the fluid introduced by the hospital RT within seconds of the injection. The Court found that the issue of causation was not complex in this case, and therefore, the patient’s expert, Southers, was qualified to render an expert opinion on causation.

The Indiana Court of Appeals reversed the trial court’s entry of summary judgment in favor of the hospital and remanded the case for further proceedings in light of the genuine issues of material fact as to liability and causation. You can read the full opinion here.