An 83-year-old with advanced dementia was admitted to the hospital for treatment of aspiration pneumonia. She was unable to make her own medical decisions during her stay, but her son was her designated health care representative and had been appointed power of attorney. Both her son and daughter consistently instructed the care providers, including the attending physician, to classify their mother as “full code” so she would receive all life-sustaining therapies in the event of cardiac or pulmonary arrest.
But the hospital’s Ethics Committee reviewed the family’s decision, noting that the woman’s condition was unlikely to improve, that “[t]he greatest benefit with least burden [was] to make the patient a no code,” and that the family had “unrealistic expectations and strong religious beliefs.” The Ethics Committee ultimately overruled the “full code” decision about six weeks after the woman was admitted to the hospital—acknowledging “[l]egal concerns with changing code status despite family opposition”—and changed the woman’s classification to “no code,” so that she would not receive any life-sustaining therapies.
After the daughter was told that “she needed to find another hospital and doctor” if she wanted her mother to remain “full code,” the son and daughter arranged for a transfer to another hospital. When the woman arrived at the other hospital, about three weeks after her classification was changed to “no code,” she required immediate treatment for a collapsed lung and was suffering from wounds on her cheeks, overwhelming infection, and septic shock. She died twenty days later.
As a prerequisite to filing suit, the daughter filed a medical malpractice complaint with the Indiana Department of Insurance against the hospital, several hospital employees, and the attending physician. A medical review panel issued a unanimous opinion “that the evidence supports the conclusion that the defendants failed to comply with the appropriate standard of care, and that their conduct may have been a factor of some resultant damages, but not the death of the patient.”
The son and daughter filed a medical malpractice complaint against the hospital, several hospital employees, and the attending physician. The complaint alleged that the hospital, its employees, and the attending physician failed to comply with the appropriate standard of care under the circumstances, proximately resulting in injuries and damages of a nature requiring compensation. Specifically, the complaint alleged malpractice “on multiple acts or occurrences,” resulting in “multiple injuries to [the woman’s] nervous system, respiratory system, cardiovascular system, [and] musculoskeletal system”; medical bills; and several other harms and losses.
The hospital and attending physician separately moved for summary judgment. Each designated as evidence the medical review panel’s opinion, as well as an affidavit from one of the members of the panel. In his affidavit, the member of the medical review panel said that his agreement with the medical review panel opinion “was based solely on prolonged application of a CPAP3 mask to the patient.” He further noted that Indiana University’s Pulmonary and Critical Care Service directed the CPAP use, that its decisions were reasonable under the circumstances, and that the hospital and attending physician appropriately consulted with and deferred to the Service. The member of the medical review panel concluded his affidavits by emphasizing that the hospital and attending physician “met the standard of care and did not cause any injury to [the woman] in regard to the issue of CPAP application.”
The son and daughter responded to the motions for summary judgment. In support of their response to the hospital’s motion, they filed affidavits from two additional doctors. The Marion Superior Court granted the attending physician’s motion for summary judgment because the son and daughter had not designated any expert testimony on the causation element. The trial court then granted the hospital’s motion for summary judgment because the two additional doctors’ affidavits did not address the issue of causation.
The Indiana Court of Appeals affirmed summary judgment for the attending physician, but reversed summary judgment for the hospital after determining that the additional affidavits created a genuine issue of fact on proximate cause.
The Supreme Court of Indiana reversed the trial court’s grants of summary judgment to the hospital and the attending physician. The court held that a genuine issue of material fact revealed in conflicting medical opinions in the defendants’ own designated evidence on the element of causation precluded summary judgment.
A genuine issue of material fact revealed in conflicting medical opinions in the defendants’ own designated evidence on the element of causation precluded summary judgment. The testimony of the member of the medical review panel did not address all of the children’s claims because it was limited to the woman’s pulmonary care, not the alleged injuries to her nervous system, cardiovascular system, and musculoskeletal system. Throughout his testimony, the member of the medical review panel did not give any opinion about the remainder of her care. Because the evidence designated by the hospital and attending physician could affirmatively negate only the claims related to pulmonary care, summary judgment on the children’s non-pulmonary claims was inappropriate. Moreover, the court found that the testimony of the member of the medical review panel, that the hospital and attending physician did not cause any injury to the woman in regard to the issue of CPAP application, conflicted with the medical review panel’s opinion, that the conduct of the hospital and attending physician may have been a factor of some resultant damages. This conflict established a genuine issue of material fact on the element of causation, preventing the hospital and attending physician from affirmatively negating the children’s claims, as required for summary judgment.
The Supreme Court of Indiana reversed the trial court’s grants of summary judgment to the hospital and the attending physician.
See: Siner v. Kindred Hosp. Ltd. Partnership, 2016 WL 1704317 (Ind., April 28, 2016) (not designated for publication).
See also Medical Law Perspectives, March 2016 Report: Slumbering Concerns: Sleep Disorder Treatment Risks and Liabilities
See also Medical Law Perspectives, December 2015 Report: Pneumonia Complications, Hospitalizations, Deaths: Risks and Liabilities
See also Medical Law Perspectives, November 2015 Report: Risks in Caring for Patients with Cognitive Impairments: Alzheimer's Disease and Dementia