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Major Hosp. v. Lee

Court of Appeals of Indiana
Jun 4, 2024
No. 23A-CT-2670 (Ind. App. Jun. 4, 2024)

Opinion

23A-CT-2670

06-04-2024

Major Hospital, Inc. d/b/a Harbor Health &Rehab, Appellant v. Helen Lee, as Legal Guardian of P.L., Appellee

ATTORNEYS FOR APPELLANT Janet A. McSharar Caitlin R. Jared Jessica L. Wood Drewry Simmons Vornehm, LLP Carmel, Indiana ATTORNEY FOR APPELLEE Beth Brown Nowak Kelly Law Offices LLC Schererville, Indiana


Pursuant to Ind. Appellate Rule 65(D), this Memorandum Decision is not binding precedent for any court and may be cited only for persuasive value or to establish res judicata, collateral estoppel, or law of the case.

Appeal from the Lake Superior Court The Honorable Calvin D. Hawkins, Judge Trial Court Cause No. 45D02-2306-CT-627

ATTORNEYS FOR APPELLANT

Janet A. McSharar Caitlin R. Jared Jessica L. Wood Drewry Simmons Vornehm, LLP Carmel, Indiana

ATTORNEY FOR APPELLEE

Beth Brown Nowak Kelly Law Offices LLC Schererville, Indiana

MEMORANDUM DECISION

BAILEY, JUDGE

Case Summary

[¶1] In this interlocutory appeal, Major Hospital d/b/a Harbor Health &Rehab ("Harbor Health") appeals the denial of its motion to dismiss the complaint of Helen Lee, as guardian of Harbor Health resident P.L. ("Guardian"). Harbor Health presents the sole issue of whether the trial court erred in concluding that the complaint allegations are outside the purview of the Indiana Medical Malpractice Act ("MMA") and thus it has jurisdiction over the matter without submission of a proposed complaint to a medical review panel. We affirm.

Facts and Procedural History

[¶2] On December 28, 2018, P.L. became a resident of Harbor Health, which was formerly known as Lake County Nursing and Rehabilitation Center. P.L. suffers from cognitive disabilities and has limited communication and ambulatory skills; she is considered to be a fall risk. During her residency, P.L. slept on a bed with the closest-to-the-floor setting and she had a bedside mat to cushion falls.

[¶3] On June 10, 2021, Guardian was informed that P.L. had suffered a fall. Upon seeing P.L. six days later, Guardian was persuaded that P.L.'s injuries were too extensive to be consistent with a fall from her bed. Guardian insisted that P.L. be transferred to a hospital. P.L. never returned to the care of Harbor Health.

[¶4] On June 5, 2023, Guardian filed a complaint against Harbor Health and other defendants, who have since been dismissed as parties. The complaint alleged that P.L. had, on June 8, 9, and/or 10, 2021, "sustained serious bodily injuries as a result of an incident or incidents which were not part of any treatment performed or furnished." (App. Vol. II, pg. 9.) The injuries were described as "significant swelling and bruising across her face, torso, and legs" attributable to a "physical assault." (Id. at 10.) According to the complaint, Harbor Health "breached its duty by allowing [P.L.] to suffer serious bodily injury ... as a result of a physical assault by unknown agents, employees, residents, or other patients." (Id. at 12.) Allegedly, Harbor Health did not properly report the incident to law enforcement or any health or welfare agency.

Based upon their arguments before the trial court and on appeal, the parties appear to agree that Guardian contacted the East Chicago Police and filed a report regarding P.L.'s injuries, and that Harbor Health at some point in time reported the incident to the Indiana Department of Health, which in turn reported the incident to the Indiana Attorney General Medicaid Fraud Control Unit.

[¶5] On August 2, 2023, Harbor Health filed a motion to dismiss for lack of subject matter jurisdiction, pursuant to Indiana Trial Rule 12(B)(1). Specifically, Harbor Health contended that it is a "qualified provider" under the MMA and "entitled to dismissal ... because [Guardian] failed to follow the [MMA] requirements" of filing a proposed complaint with the Indiana Department of Insurance and presenting that complaint to a medical review panel. (App. Vol. II, pg. 24.)

Harbor Health also contended that Guardian violated the MMA by using identifying information as to the medical provider and that the complaint failed to state a claim for relief and was subject to dismissal pursuant to Indiana Trial Rule 12(B)(6). These contentions are not raised as issues in this interlocutory appeal.

[¶6] After some history - including a grant of the motion to dismiss, a motion to vacate the dismissal, a grant of the motion to vacate, a motion for clarification, filing of responses, and a motion to correct error - the parties appeared for a hearing on October 6, 2023. Oral argument of counsel was heard as to whether Guardian's complaint stated a claim for medical negligence or ordinary negligence. On October 10, the trial court issued an order denying Harbor Health's motion to dismiss and certifying the order for interlocutory appeal. On December 22, this Court granted a motion to accept jurisdiction of this interlocutory appeal. Discussion and Decision

[¶7] Harbor Health filed a motion to dismiss pursuant to Indiana Trial Rule 12(B)(1), which permits a defense of lack of jurisdiction over the subject matter. Harbor Health argues that, because Guardian's claim was not first adjudicated by a medical review panel, the trial court lacks subject matter jurisdiction. Subject matter jurisdiction is "the constitutional or statutory power of a court to hear and determine cases of the general class to which any particular proceeding belongs." State v. Reinhart, 112 N.E.3d 705, 711 (Ind. 2018). "In determining whether a court has subject matter jurisdiction, the only relevant inquiry is whether the petitioner's claim falls within the general scope of the authority conferred upon such court by the constitution or by statute." Id. at 12. "On appeal in Trial Rule 12(B)(1) cases of this posture, we accept the facts as alleged in the complaint as true." Putnam Cnty. Hosp. v. Sells, 619 N.E.2d 968, 970 (Ind.Ct.App. 1993).

[¶8] One of the requirements of the MMA, subject to certain limitations, is that a proposed medical malpractice complaint must first be filed with the Indiana Department of Insurance for review by a medical review panel before the complaint is filed in an Indiana court. Ellenwine v. Fairley, 846 N.E.2d 657, 660 (Ind. 2006). The MMA, thus, "grants subject matter jurisdiction over medical malpractice actions first to the medical review panel, and then to the trial court." Putnam Cnty. Hosp., 619 N.E.2d at 970.

[¶9] Harbor Health contends that Guardian's complaint alleges medical negligence, including negligence in failure to report an injury, and expert testimony is required for trial. Guardian contends that she alleges a single breach of duty, that is, the hospital did not protect P.L. from being physically attacked. According to Guardian, this did not arise from the provision of medical treatment. The propriety of the trial court's denial of the motion to dismiss ultimately turns on whether Guardian stated a claim in negligence or medical malpractice. Whether a case is one of medical malpractice as defined by the MMA is a question for the court:

The interpretation of the MMA presents a question of law subject to de novo review. . . . We note, however, that it was designed to curtail, not expand, liability for malpractice. . . . Thus, the MMA is in derogation of the common law and should be strictly construed against imposing limitations on a claimant's right to bring suit.
Cmty. Health Network, Inc. v. McKenzie, 185 N.E.3d 368, 375 (Ind. 2022) (internal citations omitted).

[¶10] A claim against a medical provider sounding in general negligence or premises liability rather than medical malpractice falls outside the procedural and substantive provisions of the MMA. Peters v. Cummins Mental Health, Inc., 790 N.E.2d 572, 576 (Ind.Ct.App. 2003), trans. denied. We look to the substance of a claim to determine the applicability of the MMA. Doe by Roe v. Madison Ctr. Hosp., 652 N.E.2d 101, 104 (Ind.Ct.App. 1995), trans. dismissed.

[¶11] The MMA provides that malpractice is "a tort or breach of contract based on health care or professional services that were provided, or that should have been provided, by a health care provider, to a patient." Ind. Code § 34-18-2-18. "To determine whether the conduct was based on 'health care' or 'professional services,' we look first to the definitions provided in the MMA." Cmty. Health, 185 N.E.3d at 376. Health care is "an act or treatment performed or furnished, or that should have been performed or furnished, by a health care provider for, to, or on behalf of a patient during the patient's medical care, treatment, or confinement." I.C. § 34-18-2-13. The statutory requirement that the alleged tortious conduct (whether by omission or commission) occur "during" a patient's care, treatment, or confinement "imposes a temporal requirement that tethers the misconduct to patient care." Cmty. Health, 185 N.E.3d at 376.

[¶12] Neither the occurrence of an injury at a place that can generally be described as a healthcare facility nor the plaintiff's status as a patient are dispositive in determining whether the claim sounds in medical malpractice. Estate of O'Neal ex rel. Newkirk v. Bethlehem Woods Nursing &Rehab. Ctr., 878 N.E.2d 303, 311 (Ind.Ct.App. 2007). A contrary rule would result in an unreasonably broad inclusion of claims that were not intended to fall within the scope of the MMA. Id. Accordingly, the MMA "concerns itself with" the provider's "behavior or practices while acting in [a] professional capacity as a provider of medical services." Collins v. Thakkar, 552 N.E.2d 507, 510 (Ind.Ct.App. 1990), trans. denied. "Applying this test has resulted in hairline distinctions between claims that sound in medical negligence and those that sound in ordinary negligence." Estate of O'Neal, 878 N.E.2d at 311.

[¶13] A case sounds in ordinary negligence where the factual issues are capable of resolution by a jury without application of the standard of care prevalent in the local medical community. See Murphy v. Mortell, 684 N.E.2d 1185, 1188 (Ind.Ct.App. 1997) (alleging sexual battery during hospitalization outside the MMA), trans. denied; Doe by Roe, 652 N.E.2d at 103 (claim of sexual assault causing patient to contract chlamydia outside the MMA); Winona Mem'l Found. of Indianapolis v. Lomax, 465 N.E.2d 731, 732 (Ind.Ct.App. 1984) (complaint for negligence arising from fall of patient on loose floorboard as she prepared to receive physical therapy stated a claim for premises liability not within the scope of the MMA); Harts v. Caylor-Nickel Hosp., Inc., 553 N.E.2d 874, 879 (Ind.Ct.App. 1990), (the tenor of a complaint for injury upon fall from hospital bed after the bedrail collapsed sounded in ordinary negligence), trans. denied.

[¶14] Similarly, in Pluard v. Patients Comp. Fund, 705 N.E.2d 1035, (Ind.Ct.App. 1999), trans. denied, a negligence claim was presented by allegations arising after a surgical lamp became detached from the wall and fell on a newborn's head. Although a nurse had positioned the light at the direction of a doctor, it was not the positioning of the light - but its detachment - that caused the injury. Id. at 1038. A juror's common knowledge and experience would enable them to understand these circumstances; accordingly, the case did not sound in medical malpractice. Id. By contrast, the MMA applies where there is a causal connection between the conduct complained of and the nature of the patienthealth care provider relationship. See Putnam, 619 N.E.2d at 971 (a complaint for injury to a plaintiff who fell following surgery and was still under the effects of anesthesia fell "squarely within the scope of the [MMA]"). Moreover, a physician-patient relationship is necessary to bring claims under the procedures of the MMA. See Weldon, 714 N.E.2d at 1110 (a participant in a red blood cell donor program was not a patient for purposes of the MMA when the procedure performed on her body, the injection of antigens to produce antibodies for manufacture of RhoGam for pregnant women, was not performed for the participant's benefit).

[¶15] The MMA covers only "curative or salutary conduct of a health care provider acting within his or her professional capacity" and "not conduct unrelated to the promotion of a patient's health or the provider's exercise of professional expertise, skill, or judgment." Howard Reg'l Health Sys. v. Gordon, 952 N.E.2d 182, 185 (Ind. 2011); see also Collins, 552 N.E.2d at 510-11 ("The legislature's establishment of a medical review panel, the sole purpose of which is to provide an expert determination on the question of whether a provider complied with the appropriate standard of care, suggests that the scope of the Act is [ ] confined to actions premised upon the exercise of professional judgment."), trans. denied. Thus, if the alleged harm would have occurred independent of medical services provided to the plaintiff, it sounds in common law negligence.

[¶16] We now turn to the specific allegations of Guardian's complaint to determine whether she states a common law negligence claim or alleges that the defendant committed medical malpractice as to P.L. To recover for negligence, the plaintiff must prove that: (1) the defendant owed the plaintiff a "duty"; (2) the defendant "breach[ed]" that duty; and (3) the plaintiff suffered "compensable damages proximately caused by the breach." Cmty. Health Network, 185 N.E.3d at 379. Medical malpractice involves a medical provider who is "acting in his professional capacity as a provider of medical services." Collins, 552 N.E.2d at 511.

[¶17] Guardian's complaint acknowledges that P.L. was a patient of Harbor Health but alleges that the harm to P.L. did not arise from the provision of medical treatment. The import of the complaint is that P.L. was physically assaulted under Harbor Health's watch. The complaint includes factual averments that a Harbor Health representative falsely reported the incident as a fall, and that Harbor Health failed to report the incident as required by State and federal law. But the underlying claim - the sole specifically alleged breach of duty for which damages are sought - is failure to prevent the physical assault on P.L. Such is within the understanding of a lay person serving on a jury. No medical expertise is required to prove that a person having a duty toward P.L. failed to prevent a physical attack and the incident was falsely described as a fall. No medical concept needs to be explained to the jury to defend against those allegations.

[¶18] Harbor Health points out that its nursing staff engaged in fall prevention strategies. According to Harbor Health, "the decision as to the appropriate fall prevention strategies for a resident is for the promotion of their health and is an intrinsic aspect of the delivery of nursing care and services in a long-term care nursing facility." Appellant's Brief at 22. As such, Harbor Health urges that a medical review panel must "review and opine on the degree of care used [by nursing staff] fall risk assessments and interventions." Id. at 23. However, Guardian does not allege that P.L. fell; rather, she asserts that P.L. was attacked. If, as Guardian asserts, P.L. was physically attacked, this has no connection to the provision of medical care.

[¶19] Harbor Health points to the complaint's assertion that Harbor Health failed to properly report an attack upon P.L. and argues that failure to report is an appropriate and necessary issue for a medical review panel. Harbor Health directs our attention to Terry v. Cmty. Health Network, 17 N.E.3d 389 (Ind.Ct.App. 2014). In Terry, an unconscious patient was examined and found to be under the influence of a drug and having possible vaginal trauma. Nonetheless, the attending physician did not complete a rape kit or report a possible rape to authorities. See id. at 391. Terry filed a complaint against the hospital, without first proceeding through a medical panel review, and the complaint was dismissed. On appeal, the dismissal was affirmed as to a breach of duty claim but reversed as to the intentional infliction of emotional distress claim. Id. at 395-96.

[¶20] As to the breach of duty claim, the Court stated in relevant part:

Terry's medical evaluation consisted of a full body exam and a toxicology screening. While performing that evaluation, the doctor completed a diagnostic report. These services were provided so the physician could properly diagnose Terry and to promote Terry's health. These services were curative and salutary. . . . In deciding what tests to run, what symptoms to look for, and how to treat Terry, the physician relied on his professional expertise, judgment, and skill. . . . He used his years of training to determine what steps to take. These decisions- along with the decision not to complete a rape kit, the failure to conclude that Terry was raped, and the failure to report a rape- were made by the physician while acting in his professional capacity as a provider of medical services. . . . Any dispute about the physician's judgment in treating Terry is an appropriate issue for the medical review panel to decide; in this instance, a jury may well need to apply the standard of care that is appropriate for treating similar patients in the local medical community. . . . The relationship between the healthcare provider and patient on these facts was for the purpose of emergency medical treatment; this relationship is the direct cause of Terry's claim.
Id. at 394. (internal citations omitted.) Here, by contrast, the complaint does not challenge the exercise of professional judgment during the provision of medical services. The "direct cause," see id., of Guardian's claim is an alleged physical attack. This is not an instance in which a jury needs to apply a medical standard of care.

Conclusion

[¶21] The trial court has subject matter jurisdiction over Guardian's claim that a physical attack was perpetrated upon P.L. Accordingly, the trial court did not err in denying Harbor Health's motion to dismiss.

[¶22] Affirmed.

Crone, J., and Pyle, J., concur.


Summaries of

Major Hosp. v. Lee

Court of Appeals of Indiana
Jun 4, 2024
No. 23A-CT-2670 (Ind. App. Jun. 4, 2024)
Case details for

Major Hosp. v. Lee

Case Details

Full title:Major Hospital, Inc. d/b/a Harbor Health &Rehab, Appellant v. Helen Lee…

Court:Court of Appeals of Indiana

Date published: Jun 4, 2024

Citations

No. 23A-CT-2670 (Ind. App. Jun. 4, 2024)