The Court of Appeals of Indiana (“Indiana Appellate Court”), in its opinion dated October 29, 2019, reversed summary judgment entered in favor of the defendant hospital involving its radiologic technologist (“RT”) in an Indiana medical malpractice lawsuit that alleged that the RT was negligent in injecting contrast dye into the plaintiff’s arm in preparation for a CT scan and that the negligence proximately caused various injuries.
The Underlying Facts
The 68-year-old plaintiff arrived at the defendant hospital for a CT scan with contrast dye to rule out a pulmonary embolism. She had had the same test done before and never had any problems. The RT set up the IV and as the dye was going into the plaintiff’s arm, she repeatedly told the RT “it hurts, it hurts.” After a few seconds, the plaintiff was screaming to get her out of the machine because the pain went from her whole arm up to her shoulder. When the RT came to get the plaintiff out of the machine, the RT allegedly said, “I knew there was a problem when looking at your x-ray.” The RT stated in her affidavit that she failed to visualize the contrast in the plaintiff’s chest on the machine’s monitor within 5 to 6 seconds of the injection. The RT observed swelling that resembled a small egg on the plaintiff’s right arm and the plaintiff complained of some pain. The RT concluded an infiltration had occurred and applied compresses, massaged the area, and elevated the plaintiff’s right arm. The RT did not notify the defendant hospital’s radiologist about the infiltration.
The plaintiff subsequently had surgery for “[r]ight arm IV contrast extravasation.” The plaintiff alleged that she now experiences sharp electrical shock running from her wrist down into her fingers, that her grip is not as secure, and that she suffered other injuries as a result of the contrast extravasation and the treatment for same.
The plaintiff subsequently filed a proposed medical malpractice complaint against the hospital with the Indiana Department of Insurance, alleging that as a result of medical negligence the plaintiff developed compartment syndrome of the right arm requiring emergency surgery and prolonged wound care and suffered permanent neurological and muscular damage to her right arm, among other injuries. The Indiana medical review panel unanimously opined that the evidence submitted by the parties did not support the conclusion that the hospital failed to comply with the appropriate standard of care and that the hospital’s conduct was not a factor in the plaintiff’s injuries and damages.
The plaintiff then filed her Indiana medical malpractice lawsuit in court. The defendant hospital filed a motion for summary judgment and designated the medical review panel’s opinion. In response, the plaintiff included an affidavit from a RT who opined that the hospital’s RT “did not follow the standard of care in these circumstances and that conduct was a factor in the resultant injury to [the plaintiff].” The defendant hospital argued that the plaintiff’s RT expert was not qualified to render an expert opinion as to medical causation. At the summary judgment hearing, the defendant hospital conceded that the plaintiff’s expert RT’s affidavit established a genuine issue of material fact regarding a breach of the standard of care, but reiterated its argument that the plaintiff’s expert was not qualified to render an expert opinion on causation. The trial court issued an order summarily granting the defendant hospital’s summary judgment motion, and the plaintiff appealed.
Indiana Appellate Court Opinion
Expert testimony is governed by Indiana Evidence Rule 702, which provides,
(a) A witness who is qualified as an expert by knowledge, skill, experience, training, or education may testify in the form of an opinion or otherwise if the expert’s scientific, technical, or other specialized knowledge will help the trier of fact to understand the evidence or to determine a fact in issue.
(b) Expert scientific testimony is admissible only if the court is satisfied that the expert testimony rests upon reliable scientific principles.
The Indiana Appellate Court stated that two requirements must be met for a witness to qualify as an expert. First, the subject matter must be distinctly related to some scientific field, business, or profession beyond the knowledge of the average layperson; and second, the witness must be shown to have sufficient skill, knowledge, or experience in that area so that the opinion will aid the trier of fact.
The Indiana Appellate Court stated that the general rule is that non-physician healthcare providers are not qualified under Evidence Rule 702 to render opinions as to medical causation because there is a significant difference in the education, training, and authority to diagnose and treat diseases between physicians and non-physician healthcare providers. However, a non-physician healthcare provider may qualify under Evidence Rule 702 to render an opinion as to medical causation if the causation issue is not complex. The determinative question is whether the non-physician healthcare provider has sufficient expertise, as provided in Rule 702(a), with the factual circumstances giving rise to the claim and the patient’s injuries.
The plaintiff’s expert RT opined that the defendant hospital’s RT should have stopped injecting the contrast dye into the plaintiff’s arm as soon as the plaintiff complained of pain and notified the hospital’s radiologist about the infiltration, and that the hospital RT’s failure to do so was a factor in causing the injuries suffered by the plaintiff. The defendant hospital argued: “Because some contrast medium is introduced into the surrounding tissue in the absence of negligence, expert medical evidence must be provided to demonstrate that [Nataomi’s] injuries were either caused entirely by the introduction of additional contrast medium after breaching the standard of care or that her injuries were exacerbated by the introduction of that additional contrast medium. This is a complicated medical question that is beyond the scope of a layperson’s understanding and requires qualified expert medical testimony.”
The Indiana Appellate Court held: “The Hospital cites no authority for its assertion that some contrast medium may be introduced into the surrounding tissue in the absence of negligence; in any event, as the Rileys observe, “[s]ome contrast going in the tissue is different from a significant amount of contrast going into the tissue.” Reply Br. at 9. Even Osborne herself acknowledged that “the more contrast that infiltrates under the skin, the more damage there can be[.]” … It was not Southers’s task to pinpoint the precise amount of contrast medium it would have taken to cause any injury to Nataomi; it was merely his task to state, based on his expertise, whether Osborne’s alleged breach of the standard of care was a proximate cause of the injuries that Nataomi actually suffered. The Rileys point out that Nataomi “faced a visible collection of caustic fluid just under her skin the same size as the fluid introduced by [RT] Osborne, within seconds of the injection.” Appellants’ Br. at 31. The causation issue here was not complex, and therefore we conclude that Southers was qualified to render an expert opinion and thus establish a genuine issue of material fact on that issue. Consequently, we reverse the trial court’s grant of summary judgment for the Hospital and remand for further proceedings.” (emphasis added)
Source Nataomi Riley and Frank Riley v. St. Mary’s Medical Center of Evansville, Inc., Opinion 19A-CT-844.
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