Ralph Gabriel v. Franciscan Alliance, Inc. d/b/a Franciscan St. Anthony Crown Point (mem. dec.)

MEMORANDUM DECISION
Pursuant to Ind. Appellate Rule 65(D),
FILED
this Memorandum Decision shall not be Jan 10 2020, 6:04 am
regarded as precedent or cited before any CLERK
Indiana Supreme Court
court except for the purpose of establishing Court of Appeals
and Tax Court
the defense of res judicata, collateral
estoppel, or the law of the case.
ATTORNEY FOR APPELLANT ATTORNEYS FOR APPELLEE
Joseph Banasiak Libby Yin Goodknight
Highland, Indiana Krieg DeVault LLP
Indianapolis, Indiana
Robert A. Anderson
Shannon L. Noder
Krieg DeVault LLP
Merrillville, Indiana
IN THE
COURT OF APPEALS OF INDIANA
Ralph Gabriel, January 10, 2020
Appellant-Plaintiff, Court of Appeals Case No.
19A-CT-1487
v. Appeal from the Lake Superior
Court
Franciscan Alliance, Inc. d/b/a The Honorable John M. Sedia,
Franciscan St. Anthony Crown Judge
Point, Trial Court Cause No.
Appellee-Defendant. 45D01-1809-CT-568
Barnes, Senior Judge.
Court of Appeals of Indiana | Memorandum Decision 19A-CT-1487 | January 10, 2020 Page 1 of 9
Statement of the Case
[1] Ralph Gabriel appeals the trial court’s grant of summary judgment in favor of
Franciscan Alliance, Inc. d/b/a Franciscan St. Anthony Crown Point
(“Franciscan”). We affirm.
Issue
[2] Gabriel raises one issue, which we restate as: whether the trial court erred in
granting Franciscan’s motion for summary judgment as to Gabriel’s claim of
medical malpractice.
Facts and Procedural History
[3] On March 21, 2011, Gabriel arrived at Franciscan’s hospital in Crown Point,
Indiana. He was diagnosed with two fractures in his right leg, one of them
severe, and a fracture to his left foot. Gabriel reportedly sustained the injuries
after jumping out of a window. Doctors at Franciscan performed two surgeries,
one on each of his legs, and they discharged him from the hospital on March
28.
[4] On June 13, 2011, a doctor removed a splint from Gabriel’s right leg, and it
“was okay then.” Appellant’s App. Vol. 2, p. 91. On June 22, Gabriel arrived
at a Veteran’s Administration hospital (“VA”) in a wheelchair, with “open,
swelling, draining wounds on right and left leg.” Id. at 88. Emergency room
staff noted that his right leg was “draining yellow fluid.” Id. at 90. Testing
revealed that Gabriel had a staph infection in his right leg, where Franciscan’s
Court of Appeals of Indiana | Memorandum Decision 19A-CT-1487 | January 10, 2020 Page 2 of 9
doctors had installed plates and screws to treat his injuries. The VA doctors
performed surgery to treat the infection.
[5] On March 20, 2013, Gabriel filed a proposed civil complaint with the Indiana
Department of Insurance. He alleged that his leg infection was caused by
Franciscan’s medical malpractice. The parties presented evidence to a medical
review panel. On June 7, 2018, the panel issued a unanimous opinion,
determining the evidence did not support a conclusion that Franciscan failed to
meet the applicable standard of care while treating Gabriel.
[6] On August 29, 2018, Gabriel filed suit against Franciscan. Franciscan filed an
answer and a motion for summary judgment. Franciscan designated the review
panel’s unanimous decision in support of its motion for summary judgment.
Gabriel responded to the motion. He did not designate any expert medical
evidence to oppose Franciscan’s motion.
[7] The trial court held oral argument on Franciscan’s motion. On June 7, 2019,
the trial court granted the motion, noting that Gabriel had not provided an
opinion from a medical expert and had thus failed to demonstrate there was a
dispute of material fact. This appeal followed.
Discussion and Decision
[8] When we review the grant of a motion for summary judgment, we apply the
same standard as the trial court. Glon v. Mem’l Hosp. of South Bend, Inc., 111
N.E.3d 232, 237 (Ind. Ct. App. 2018), trans. denied. Summary judgment is
appropriate only when the movant shows that ‘“the designated evidentiary
Court of Appeals of Indiana | Memorandum Decision 19A-CT-1487 | January 10, 2020 Page 3 of 9
matter shows that there is no genuine issue as to any material fact and that the
moving party is entitled to a judgment as a matter of law.’” Id. (quoting Ind.
Trial Rule 56(C)). Upon this showing, the nonmoving party has the burden of
demonstrating that there is a genuine issue of material fact. AM Gen., LLC v.
Armour, 46 N.E.3d 436, 439 (Ind. 2015). All reasonable inferences are
construed in favor of the nonmoving party. Id. In addition, our review of
summary judgment is limited to the evidence designated by the parties to the
trial court. Laycock v. Sliwkowski, 12 N.E.3d 986, 990 (Ind. Ct. App. 2014),
trans. denied.
[9] Medical malpractice actions are similar to other negligence actions. Narducci v.
Tedrow, 736 N.E.2d 1288, 1292 (Ind. Ct. App. 2000). Summary judgment is
rarely appropriate in negligence cases because such cases are particularly fact-
sensitive and are governed by a standard of the objective reasonable person,
which is best applied by a jury after hearing all the evidence. Kramer v. Catholic
Charities of Diocese of Fort Wayne-South Bend, Inc., 32 N.E.3d 227, 231 (Ind.
2015). Nonetheless, summary judgment is appropriate when the undisputed
material evidence negates one element of a negligence claim. Id. The elements
of a medical malpractice claim are: (1) the physician owed a duty to the
plaintiff; (2) the physician breached that duty; and (3) the breach proximately
caused the plaintiff’s injuries. Mayhue v. Sparkman, 653 N.E.2d 1384, 1386 (Ind.
1995).
[10] Physicians are not held to a duty of perfect care. Slease v. Highbanks, 684
N.E.2d 496, 498 (Ind. Ct. App. 1997). Instead, a doctor must exercise the
Court of Appeals of Indiana | Memorandum Decision 19A-CT-1487 | January 10, 2020 Page 4 of 9
degree of skill and care ordinarily possessed and exercised by a reasonably
skillful and careful practitioner under same or similar circumstances. Id. at 498-
99. To establish the applicable standard of care and to show a breach of that
standard, a plaintiff generally must present expert testimony. Id. at 499. A
plaintiff’s need for expert testimony may be particularly acute in summary
judgment cases, because “a unanimous opinion of the medical review panel
that the physician did not breach the applicable standard of care is ordinarily
sufficient to establish prima facie evidence negating the existence of a genuine
issue of material fact entitling the physician to summary judgment.” Stafford v.
Szymanowski, 31 N.E.3d 959, 961 (Ind. 2015).
[11] The doctrine of res ipsa loquitur (“res ipsa”) is a limited exception to the
general rule that the mere fact of injury will not create an inference of
negligence. St. Mary’s Ohio Valley Heart Care, LLC v. Smith, 112 N.E.3d 1144,
1150 (Ind. Ct. App. 2018), trans. denied. Under res ipsa, negligence may be
inferred where: (1) the injuring instrumentality is shown to be under the
management or exclusive control of the defendant or his servants; and (2) the
accident is such that in the ordinary course of things does not happen if those
who have management of the injuring instrumentality use proper care. Vogler v.
Dominguez, 624 N.E.2d 56, 61 (Ind. Ct. App. 1993), trans. denied.
[12] In this case, we focus on the second element of res ipsa. A plaintiff relying
upon res ipsa may show that the accident was more probably the result of lack
of proper care by relying upon common sense and experience or expert
testimony. Id. In other words, the standard of care need not be established by
Court of Appeals of Indiana | Memorandum Decision 19A-CT-1487 | January 10, 2020 Page 5 of 9
expert medical evidence when the doctor’s conduct was understandable by the
jury without extensive technical input. Narducci, 736 N.E.2d at 1293.
[13] The type of situations in which a jury can judge an incident without extensive
technical input “have typically arisen from physicians leaving a foreign object in
the patient’s body; juries can understand without independent explanation that
the object should have been removed.” Syfu v. Quinn, 826 N.E.2d 699, 705
(Ind. Ct. App. 2005). Similarly, in Gold v. Ishak, 720 N.E.2d 1175, 1179 (Ind.
Ct. App. 1999), trans. denied, a patient suffered burns on her face and chest
when, during a surgery to cauterize blood vessels in her neck, an electrocautery
unit’s spark ignited the oxygen flowing from a loosely-secured oxygen mask on
the patient’s face. A panel of this Court concluded a layperson could
understand through their common knowledge that a fire occurring during
surgery where an instrument emits a spark near a supply of oxygen was the
result of negligent conduct.
[14] By contrast, in Carpenter v. Campbell, 149 Ind. App. 189, 191, 271 N.E.2d 163,
165 (1971), a patient underwent a Caesarian section in June 1964. Almost a
month later, she arrived at an emergency room, where she was diagnosed with
a bowel obstruction and required extensive treatment. The patient later sued
the doctors who performed the Caesarian section, claiming their malpractice
had caused the bowel obstruction and a subsequent severe infection. She
further argued the doctors were liable under the doctrine of res ipsa. A panel of
this Court concluded res ipsa was inapplicable because the evidence showed the
obstruction could have been caused by a variety of complications, some of
Court of Appeals of Indiana | Memorandum Decision 19A-CT-1487 | January 10, 2020 Page 6 of 9
which might not have been the result of negligence by the defendants. As a
result, negligence could not be inferred.
[15] Further, in Methodist Hosps., Inc. v. Johnson, 856 N.E.2d 718, 719-20 (Ind. Ct.
App. 2006), Johnson gave birth to a child in a hospital. In the following days,
hospital personnel noted that the infant’s skin reacted poorly to intravenous
needles (“IVs”). Despite the personnel’s attempts to move the IVs to different
locations on the infant’s body and provide other treatments, the infant
developed burns at the locations where IVs had been inserted.
[16] Johnson filed a proposed complaint, but a medical malpractice review board
unanimously determined the hospital did not breach the standard of care.
Next, Johnson sued, claiming negligence. The hospital moved for summary
judgment but did not prevail. On appeal, the question was whether res ipsa
applied, thereby establishing an inference of negligence, despite Johnson’s
failure to provide expert medical evidence to oppose summary judgment. A
panel of this Court determined the complications arising from the placements of
the IV were “not within the realm of a layperson’s knowledge.” Id. at 722. As
a result, common knowledge was insufficient to establish the second element of
res ipsa, and Johnson should have submitted expert medical evidence to
establish a dispute of material fact. In the absence of such evidence, the Court
concluded the hospital was entitled to summary judgment.
[17] Turning to the facts of Gabriel’s case, we conclude they more closely resemble
the circumstances of Carpenter and Methodist Hospitals than the circumstances in
Court of Appeals of Indiana | Memorandum Decision 19A-CT-1487 | January 10, 2020 Page 7 of 9
Gold. Gabriel, like the plaintiff in Carpenter, developed an infection after
surgery, but there were numerous possible causes for the infections, only some
of which could have involved negligence by hospital staff. Gabriel’s situation is
even less clear than Carpenter’s because Carpenter reported her bowel
obstruction one month after surgery, while Gabriel did not report his infection
until almost three months after surgery, during which time he was not under the
hospital’s care. As the Carpenter Court stated, “‘courts reject the notion that
because infection follows a treatment an inference of negligence is to be made.’”
149 Ind. App. at 196, 271 N.E.2d at 168 (quoting Quick v. Thurston, 290 F.2d
360, 363-64 (D.C. Cir. 1961)).
[18] Similarly, in Methodist Hospitals the hospital submitted expert evidence that the
complications resulting from the placement of the IVs could have occurred
despite due care being taken by the doctors and hospital employees. Gabriel’s
infection, like the infant’s complications in Methodist Hospitals, are beyond a
layperson’s common knowledge. Gabriel should have provided expert medical
evidence to determine whether the standard of care was met. See Methodist
Hosps., 856 N.E.2d at 722; see also Narducci, 736 N.E.2d at 1293-94 (reversing
denial of summary judgment on medical malpractice claim arising from
surgical complications; cause and nature of complications deemed beyond
common knowledge of laypersons, and expert medical evidence was required).
In the absence of expert medical evidence establishing a dispute of material fact,
the trial court did not err in granting summary judgment in favor of Franciscan.
Court of Appeals of Indiana | Memorandum Decision 19A-CT-1487 | January 10, 2020 Page 8 of 9
Conclusion
[19] For the reasons stated above, we affirm the judgment of the trial court.
[20] Affirmed.
Bradford, C.J., and Tavitas, J., concur.
Court of Appeals of Indiana | Memorandum Decision 19A-CT-1487 | January 10, 2020 Page 9 of 9