Case Title: Chi Yun Ho, M.D. v. Loretta M. Frye

Citation: 

Docket Number: 67S01-0707-CV-291

State: indiana

Court: Indiana Supreme Court

Date: 2008-02-21T00:00:00Z

Document:
ATTORNEYS FOR APPELLANT 
 
ATTORNEYS FOR APPELLEE 
ATTORNEYS FOR AMICUS CURIAE 
Edna M. Koch 
 
 
 
Daniel M. Mills  
 
IND. STATE MEDICAL ASSOC. &  
Jennifer A. Strickland-Padgett 
 
Mills Law Office  
 
THE AMERICAN MEDICAL ASSOC.  
Zeigler Cohen & Koch 
 
 
Bloomington, Indiana 
 
Thomas J. Costakis 
Indianapolis, Indiana 
 
 
 
 
 
 
Libby Y. Mote 
 
 
 
 
 
William C. Lloyd  
 
Krieg DeVault LLP 
 
 
 
 
 
Lloyd Law Office 
 
Indianapolis, Indiana 
 
 
 
 
 
Bloomington, Indiana 
 
 
 
 
 
 
 
 
 
THE IND. TRIAL LAWYERS ASSOC. 
 
 
 
E. Paige Freitag  
 
Stephen L. Williams 
 
 
 
 
 
Bauer & Densford 
 
Mann Law Firm 
 
 
 
 
 
Bloomington, Indiana 
 
Terre Haute, Indiana 
________________________________________________________________________ 
In the 
Indiana Supreme Court  
_________________________________ 
No. 67S01-0707-CV-291 
 
CHI YUN HO, M.D.,  
 
 
 
 
 
Appellant (Defendant below) 
 
 
 
 
and Cross-Appellee, 
v. 
LORETTA M. FRYE AND  
THOMAS HOFFMANN, PERSONAL  
REPRESENTATIVE OF THE ESTATE OF  
CHARLES FRYE,  
 
 
 
 
 
Appellees (Plaintiffs below),  
 
 
 
 
 
 
 
 
and Cross-Appellants. 
 
_________________________________ 
 
Appeal from the Putnam Circuit Court, No. 67C01-0210-PL-349 
The Honorable Matthew L. Headley, Judge 
_________________________________ 
 
On Petition To Transfer from the Indiana Court of Appeals, No. 67A01-0603-CV-122 
_________________________________ 
 
February 21, 2008 
 
Dickson, Justice. 
 
 
In this medical negligence case arising from the alleged failure to remove all of the 
surgical sponges following abdominal surgery, the trial court denied the plaintiffs' motion for 
partial summary judgment, the jury returned a verdict in favor of the surgeon, and the trial court 
FILED
CLERK
of the supreme court,
court of appeals and
tax court
Feb 21 2008, 3:14 pm
thereafter granted a new trial.  The Court of Appeals reversed the denial of partial summary 
judgment, found for the plaintiffs on liability as a matter of law, and remanded for a 
determination of damages.  Ho v. Frye, 865 N.E.2d 632 (Ind. Ct. App. 2007).  We granted 
transfer, thereby automatically vacating the opinion of the Court of Appeals.  Ind. Appellate Rule 
58(A).  We affirm the denial of summary judgment, reverse the order granting a new trial, and 
reinstate the jury verdict.     
 
The defendant-appellant, Chi Yun Ho, M.D. (Dr. Ho), brings this appeal to challenge the 
trial court's order setting aside the jury verdict and granting the plaintiffs, Loretta M. Frye and 
Thomas Hoffman, personal representative of the Estate of Charles Frye, a new trial on liability 
and damages.  Dr. Ho's challenge to the order setting aside the verdict and granting a new trial 
presents two claims: (1) the trial court order failed to make specific findings as required under 
Ind. Trial Rule 59(J), and (2) the jury verdict was supported and not against the weight of the 
evidence.   
 
On cross-appeal, the plaintiffs contend that the trial court erred in (1) denying their 
motion for partial summary judgment on the issue of liability, (2) failing to grant their motion for 
judgment on the evidence on the issue of liability, and (3) permitting defense witnesses to 
present testimony seeking to shift the sponge count responsibility from Dr. Ho to the attending 
nurses.   
 
 
The principal facts are undisputed.  In October 2000, Dr. Ho performed an abdominal 
surgical procedure on Loretta Frye.  Shortly before closing the patient's abdomen, Dr. Ho was 
informed by the nursing staff that all of the sponges used during the procedure were outside of 
the patient and accounted for.  In March of 2001, however, it was discovered that a sponge from 
Dr. Ho's surgery remained inside the patient's abdomen.  As a result, Mrs. Frye suffered 
complications and required further medical care.  The plaintiffs thereupon initiated this action 
pursuant to the Indiana Medical Malpractice Act.1  The medical review panel convened 
thereunder issued its unanimous opinion that Dr. Ho failed to meet the applicable standard of 
care.    
                                             
 
1 Following mediation, the plaintiffs' action against the hospital was settled and dismissed.   
 
2
 
 
The plaintiffs filed a motion for partial summary judgment on the issue of Dr. Ho's 
negligence, asserting that the doctor had a non-delegable duty to remove every sponge used in 
the surgery and was thus responsible for such removal as a matter of law.  The trial court denied 
the motion without explanation.  The case proceeded to trial and the jury returned a verdict in 
favor of Dr. Ho.  Eleven days later, the plaintiffs filed an Ind. Trial Rule 50 motion for judgment 
on the evidence, and three days thereafter filed a supplemental motion to correct error pursuant 
to Ind. Trial Rule 59(J).  Following "consideration of the evidence and testimony at trial [and] 
argument and briefs by [c]ounsel," the trial court ordered a new trial on the issue of liability and 
damages but did not make any special findings of fact or provide any explanation for the basis of 
its order.  Appellant's App'x at 17.    
 
1.  Order for New Trial 
 
Dr. Ho challenges the order primarily on grounds that the trial court failed to make 
specific findings as required by T.R. 59(J).  The plaintiffs respond that the new trial was ordered 
in response to their T.R. 50 motion, which does not require findings.   
 
 
Rules 50 and 59(J) significantly differ as to the requirement of findings if a new trial is 
ordered.  Keith v. Mendus, 661 N.E.2d 26, 31 (Ind. Ct. App. 1996), trans. denied; Anderson v. 
Amtech Capital Corp, 600 N.E.2d 149, 150 (Ind. Ct. App. 1992).  Under T.R. 50(C), a trial court 
may grant a new trial as to part or all of the issues, and the rule imposes no explicit requirement 
for supporting findings.  A trial court is not required to enter special findings and conclusions 
when granting a new trial under T.R. 50(C).  Keith, 661 N.E.2d at 31; Anderson, 600 N.E.2d at 
150.  But under T.R. 59(J), a trial court's authority to grant a new trial on a motion to correct 
error is conditioned upon explicit prerequisites.  To the extent relevant to the asserted bases for 
the plaintiffs' T.R. 59(J) motion, the rule states that when a new trial is granted: 
if the decision is found to be against the weight of the evidence, the findings shall relate 
the supporting and opposing evidence to each issue upon which a new trial is granted; if 
the decision is found to be clearly erroneous as contrary to or not supported by the 
evidence, the findings shall show why judgment was not entered upon the evidence.   
T.R. 59(J)(7).   The different requirements for written findings in T.R. 50 and T.R. 59(J) are 
 
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consistent with the differing nature of trial court review of a jury verdict.  As explained in Keith: 
When a trial court grants a new trial on the basis of a motion for judgment on the 
evidence pursuant to T.R. 50(C), it must consider only the evidence most favorable to the 
nonmoving party and may grant the motion only when there is no evidence or reasonable 
inferences therefrom to support an essential element of the claim.  However, when the 
trial court grants a new trial as a "thirteenth juror" under the provisions of T.R. 59(J), it 
must sift and weigh the evidence and judge witness credibility.  "If Rule 50(C) new trial 
relief is granted, it cannot be on the basis of the '13th Juror' or a review of the evidence.  
If the trial court is going to 'weigh the evidence' then this kind of new trial must come as  
part of a motion to correct error under Trial Rule 59." 
Keith, 661 N.E.2d at 31, quoting 3 Harvey, Indiana Practice 299 (1988) (other included citations 
omitted).  A new trial under T.R. 50(C) is thus appropriate only when there is a glaring absence 
of critical evidence or reasonable inferences—a critical failure of proof,2 but to order a new trial 
under T.R. 59(J), a trial court must determine "that the verdict . . . is against the weight of the 
evidence," T.R. 59(J)(7), thus requiring the careful sifting and evaluation described in Keith.  
When a trial judge reweighs the evidence and substitutes his or her judgment for that of the jury 
under T.R. 59(J), the rule mandates special findings that "relate the supporting and opposing 
evidence to each issue upon which a new trial is granted[.]"  T.R. 59(J).  When a trial court 
orders a new trial because the verdict is against the weight of the evidence, but fails to make the 
required special findings, "the proper remedy is reinstatement of the jury verdict."  Weida v. 
Kegarise, 849 N.E.2d 1147, 1152 (Ind. 2006);  see also State v. White, 474 N.E.2d 995, 1000 
(Ind. 1985).       
 
Trial Rule 50(A)(4) expressly permits a party to move for a judgment on the evidence in 
its motion to correct error, and the plaintiffs' T.R. 59(J) motion to correct error expressly 
                                             
 
2 The structure of Trial Rule 50 treats the granting of a judgment notwithstanding a verdict separately 
from the granting of a new trial.  Section (A) authorizes a judgment notwithstanding a verdict "[w]here all 
or some of the issues in a case tried before a jury . . . are not supported by sufficient evidence or a verdict 
thereon is clearly erroneous as contrary to the evidence because the evidence is insufficient to support 
it…"  T.R. 50(A).   This standard appears only in subsection (A).  In contrast, Section (C) permits the trial 
court to grant a new trial "when entry of a judgment is impracticable or unfair to any of the parties or 
otherwise is improper, whether requested or not."  T.R. 50(C).  This analysis, however, was not raised or 
addressed by the parties, and we find no Indiana appellate decisions that make this distinction.  On the 
contrary, Indiana case law has generally followed the Keith formulation that permits a new trial under 
T.R. 50(C) if the reviewing court finds, limiting appellate consideration to "the evidence most favorable 
to the nonmoving party," that "there is no evidence or reasonable inferences therefrom to support an 
essential element of the claim."  Keith, 661 N.E.2d at 31.  
  
 
4
incorporated their pending T.R. 50 motion for judgment on the evidence.3  The plaintiffs' T.R. 
59(J) motion alternatively asserted that the jury verdict was either "clearly erroneous" (seeking 
an actual judgment in plaintiffs' favor on liability and a new trial only on damages) or "against 
the weight of the evidence" (requesting a new trial on both liability and damages).  Appellant's 
App'x at 179.  In ordering a new trial, not only did the trial court's order lack special findings or 
other explanation, but also it did not specify whether the court was granting a new trial based on 
the Trial Rule 50 motion for judgment on the evidence or the Trial Rule 59 motion to correct 
error.  Rather than grant judgment on liability and a new trial only on damages, however, the trial 
court ordered a new trial on both liability and damages, which convinces us that it was granting 
the relief requested by plaintiffs under the "against the weight of the evidence" standard for T.R. 
59(J), which standard cannot be the basis of relief under T.R. 50.  Salcedo v. Toepp, 696 N.E.2d 
426, 433 (Ind. Ct. App. 1998); Keith, 661 N.E.2d at 31-32.  The trial court's order for a new trial 
thus rested upon its determination that the verdict was against the weight of the evidence, thereby 
evidencing the court's intention to grant the T.R. 59(J) motion.4  Because the court failed, 
however, to make the special findings required by the rule, the order for new trial must be 
reversed.  Weida, 849 N.E.2d at 1152.         
 
2.  Denial of Summary Judgment   
 
  
The relief sought by the plaintiffs' T.R. 50 and 59 motions was based on the same 
contention asserted by the plaintiffs in support of their motion for partial summary judgment – 
                                             
 
3 We note that T.R. 50(C) appears to explicitly authorize a motion for judgment on the evidence "after the 
jury is discharged."  Some decisions, however, state that a T.R. 50 motion "may only be made in a motion 
to correct errors."  But these appear to address T.R. 50(A) motions seeking judgment, not T.R. 50(C) 
motions seeking a new trial.  See, e.g., Huff v. Travelers Indem. Co., 266 Ind. 414, 421, 363 N.E.2d 985, 
990 (1977);  Rothbert v. Spake, 832 N.E.2d 593, 597 (Ind. Ct. App. 2005).  And although Huff opined 
that a motion to correct error was the exclusive tool to challenge a verdict after jury discharge, the 
language of T.R. 50(A) clearly makes resort to T.R. 59(J) permissive, not mandatory.  And the provision 
expressly permitting a motion for judgment on the evidence to be included in a motion to correct errors 
appears only in T.R. 50(A), relating to the entry of judgment, not in T.R. 50(C), relating to the ordering of 
a new trial.       
 
4 The plaintiffs urge that, in light of a physician's non-delegable duty to insure that all sponges have been 
removed, it is more likely that the trial court did not reweigh the evidence under T.R. 59(J) but rather 
granted a new trial under T.R. 50.  Even if this were so, such new trial order is erroneous as a matter of 
law for the reasons discussed in Part 2 of this decision.   
 
5
that the surgeon had breached, as a matter of law, his non-delegable duty to assure removal of 
sponges.  On cross-appeal, the plaintiffs contend that they were entitled to summary judgment on 
liability because the undisputed facts presented at summary judgment required application of 
Funk v. Bonham, 204 Ind. 170, 183 N.E. 312 (1932), which they assert holds that the surgeon is 
responsible, as a matter of law, for the removal of surgical sponges.  In response, Dr. Ho quarrels 
with the plaintiffs' interpretation of Funk, and argues that the designated evidence in opposition 
to partial summary judgment was sufficient to create a genuine issue of fact as to whether he met 
the standard of care.   
 
 
A party seeking appellate reversal of the denial of summary judgment must demonstrate 
that the designated evidentiary matter negates the existence of any genuine issue of material fact 
and that the moving party is entitled to judgment as a matter of law.  Ind. Trial Rule 56(C); 
Cinergy Corp. v. Assoc. Elec. & Gas, 865 N.E.2d 571, 574 (Ind. 2007).   In determining the 
appropriateness of summary judgment, the reviewing appellate court, like the trial court, must 
construe all facts in favor of the nonmoving party.  Time Warner Entertainment Co. v. 
Whiteman, 802 N.E.2d 886, 895 (Ind. 2004).   
 
 
To support their motion for partial summary judgment, the plaintiffs identified Dr. Ho's 
admissions that he performed the surgery upon Mrs. Frye; that he used several sponges during 
the surgery; that when he closed the surgical incision in her abdomen, he was unaware that a 
sponge remained inside her abdomen; that Mrs. Frye later underwent surgery to remove the 
sponge and the resulting abscess that had formed; and that the medical review panel decision 
found that Dr. Ho had failed to meet the applicable standard of care.  In response, Dr. Ho 
designated only passages from the deposition testimony of Timothy Glass, M.D., and Dr. Ho's 
own affidavit, both of which asserted that Dr. Ho's medical care for Mrs. Frye was within the 
applicable standard of care.   Appellees' App'x at 102-110.  Dr. Glass also expressed his 
disagreement with the decision of the medical review panel.  Id. at 110.   
 
 
The plaintiffs urge that under these facts partial summary judgment in their favor was 
required by Funk and Miller v. Ryan, 706 N.E.2d 244 (Ind. Ct. App. 1999), trans. denied, 726 
N.E.2d 302.  They assert that Funk and Miller stand for the proposition that "[a] surgeon is 
 
6
charged as a matter of law with the duty to remove sponges used in an operation, and ordinary 
care and caution forbid the surgeon to delegate the absolute authority and responsibility to a 
nurse or nurses to account for sponges and thus escape liability."  Appellees' Br. at 17.   
 
 
This Court's 1932 decision in Funk involved similar facts.  In the course of abdominal 
surgery, a sponge was left inside the patient.  Following a jury verdict and judgment for the 
plaintiff, the trial court denied the doctor's motion for a new trial.  He appealed, asserting that the 
verdict was not supported by sufficient evidence because of the absence of expert witness 
testimony establishing medical negligence and because the sponge was overlooked and left 
inside the patient's abdomen by "accident" rather than due to negligence.  Funk, 204 Ind. at 175, 
183 N.E. at 314.  The doctor further asserted that the nurse had reported to him that all sponges 
were accounted for, and argued that a mistake by the nurse could not be imputed to him.  Finding 
the evidence sufficient to sustain the verdict, the Funk court stated: 
A surgeon is charged, as a matter of law, with the duty to remove sponges used in the 
operation, which sponges will not be of use in the abdomen after the operation.  Ordinary 
care and caution forbids a surgeon to delegate the absolute authority and responsibility to  
a nurse or nurses to account for sponges and to thus escape responsibility himself.   
Funk, 204 Ind. at 180, 183 N.E. at 316.   
 
 
Despite the apparent breadth of this language, however, Funk was an appeal from a jury 
verdict, not from a trial court summary judgment for the plaintiff, nor from a judgment for 
plaintiff on the evidence, nor from a judgment for plaintiff notwithstanding a contrary verdict, 
nor from a judgment for the plaintiff as a matter of law in the absence of evidence from the 
defendant.  In fact, elsewhere in its discussion, Funk declares that "it is for the jury to determine 
from the evidence whether the omission of certain treatment, like the failure to remove a lap-
sponge used in the operation before the incision was closed, was or was not negligence."  Funk, 
204 Ind. at 176, 183 N.E. at 314.   The court found the rule of res ipsa loquitur applicable, 
"which put upon the [surgeon] the burden of proving to the satisfaction of the jury, in order to 
present a complete defense, that he was not negligent in leaving the sponge .…"  Funk, 204 Ind. 
at 177, 183 N.E. at 315.   The court emphasized the absence of defense evidence from the doctor 
to show that "good surgery was practiced."  Id..    
 
 
7
In light of its context, we do not understand Funk to hold that a surgeon is absolutely 
liable as a matter of law for failure to remove unnecessary sponges used in a patient during 
surgery.  Rather, Funk properly recognizes that, notwithstanding a surgeon's assignment to 
assistants the task of tracking surgical sponges, the surgeon's failure to remove a sponge is 
evidence of medical negligence and will support a jury verdict finding liability on the part of the 
surgeon.        
 
In Miller v. Ryan, the Court of Appeals affirmed a jury verdict in favor of plaintiffs in a 
medical malpractice action arising out of foot surgery performed by two podiatrists, one 
operating upon the plaintiff's left foot and the other on the right foot.  The lead surgeon 
unsuccessfully challenged a jury instruction that a podiatrist performing an operation "may not 
delegate the duty to another podiatrist or assistant and thereby avoid responsibility."  Miller, 706 
N.E.2d at 250.  Like Funk, this case did not affirm a trial court granting judgment for the plaintiff 
as a matter of law due to a surgeon's failure to remove a foreign object.  We do not find Miller to 
support the plaintiff's motion for partial summary judgment.      
 
 
 
Burke v. Capello, 520 N.E.2d 439 (Ind. 1988), also a malpractice action, involved an 
orthopedic surgeon who performed hip replacement surgery but left a fragment of cement one 
inch in diameter inside the patient, requiring further surgery and resulting in ongoing numbness 
and pain.  This Court reversed the trial court's grant of summary judgment in favor of the doctor, 
stating:  "The inference of breach of duty confronts medical opinion of no breach of duty.  
Justice thus requires a trial."  Id. at 442.  Significantly however, the opinion added: "This is not 
to say that at this point justice requires a verdict for the plaintiff."  Id. 
 
Not unlike the present case, in Cox v. Paul, 828 N.E.2d 907 (Ind. 2005), we addressed a 
medical malpractice plaintiff's claim of liability as a matter of law based upon language included 
in Harris v. Raymond, 715 N.E.2d 388 (Ind. 1999), stating a physician's duty to warn current and 
former patients of certain facts "as a matter of law."  Id. at 394.  Faced with almost identical facts 
in Cox, we rejected the claim that such failure calls for strict liability and clarified that, while 
there was a duty to warn, the duty was not absolute but rather was a "duty to make 'reasonable 
efforts'" to contact all current and former patients.  Cox, 828 N.E.2d at 912.  Applying the rule of 
 
8
res ipsa loquitor, we recognized the rule as having the procedural effect of "shifting the burden 
of proof to the defendant or creating a presumption of negligence."  Id.  Cox found that a 
physician's undisputed failure to warn a patient about risks associated with medical treatment 
was sufficient to shift the burden to the physician to provide an explanation:   
He, therefore, is fairly charged with responsibility for explaining the steps he took to give 
notice and why they were reasonable under the circumstances.  If he shows reasonable 
steps, the trier of fact may find him not liable despite the failure of those steps to  
accomplish the goal of completing the communication to the patient.   
 
Id. at 913.  But we found the physician's evidence to be insufficient to meet his burden.  "Only 
speculation, not evidence, is offered to support any explanation for lack of notice, and that 
explanation even if it were supported by evidence is not free of the inference of negligence."  Id.   
We vacated the denial of plaintiffs' motion for partial summary judgment and remanded with 
instructions to grant the motion.   
 
 
The Court of Appeals opinion in the present case concluded that the plaintiffs had 
designated sufficient evidentiary matter in support of their motion for partial summary judgment 
for the rule of res ipsa loquitur to apply, and that this shifted the burden to Dr. Ho "to explain 
how he met the standard of care."  Ho, 865 N.E.2d at 638.  The court then concluded that Dr. 
Ho's designated matter contended in essence that "he did not breach his duty . . . because the 
nurse had the duty to count the sponges and miscounted."  Id. at 638.  Finding that the 
physician's explanation was insufficient, the court reversed the denial of plaintiffs' motion for 
partial summary judgment and remanded for a new trial on the issue of damages.   
 
 
To support their motion for partial summary judgment on liability, the plaintiffs 
designated evidence describing the physician-patient relationship between Mrs. Frye and Dr. Ho, 
providing the fact and details of the surgery and the fact that a sponge was left in her abdomen 
when Dr. Ho completed the surgery, describing the resulting injuries, and attaching the opinion 
of the medical review panel that Dr. Ho and the hospital "failed to meet the applicable standard 
of care and that such conduct was a factor of the resultant damages."  Appellees' App'x at 91.  
Because the plaintiffs' designated materials included this expert medical opinion, this case does 
not call for application of the rule of res ipsa loquitur.  The plaintiffs' designated matters 
satisfied their burden as the party moving for summary judgment. To defeat the motion, Dr. Ho, 
 
9
as non-movant, was required to designate evidence that demonstrated a genuine issue of material 
fact upon a determinative issue.       
 
In responding to the plaintiffs' motion for partial summary judgment on liability, Dr. Ho 
does not dispute any of the plaintiffs' factual assertions except the medical review panel's finding 
on medical negligence.  His response designates only his own affidavit and certain passages from 
the evidentiary deposition of Dr. Timothy Glass, M.D., who performed subsequent surgery on 
Mrs. Frye.  Dr. Ho's affidavit declares that he is a licensed Indiana physician; Board Certified in 
Obstretrics and Gynecology; is familiar with the standard of care required to be exercised by a 
reasonable, prudent, careful and skillful surgeon performing gynecological surgery; and "took all 
the necessary and reasonable steps, in accordance with the standard of care, to remove all 
sponges from Mrs. Frye's abdomen at the conclusion of the surgery."  Appellees' App'x at 106.  It 
further states that the hospital surgery record shows that final sponge counts were completed and 
correct and that no sponges were unaccounted for, and that a surgery nurse had verbally reported 
to him that the sponge counts were correct.  Dr. Ho's affidavit states his opinion that the surgical 
care he rendered was within the applicable standard of care.  In the designated passages from Dr. 
Glass's deposition, he states that during his subsequent surgical procedure on Mrs. Frye, he 
personally kept track of sponges and relied upon the nurses to count sponges, that in his opinion 
Dr. Ho's care of Mrs. Frye was not below the applicable standard of care, and that he disagreed 
with the decision of the medical review panel.  Dr. Ho contends that these designated matters 
were sufficient to show a genuine issue of material fact by "directly opposing [the] opinions" 
presented by the plaintiffs "on whether Dr. Ho's care met the standard of care."  Appellants' 
Reply Br. and Cross-Appellees' Br. at 21.          
 
 
Dr. Ho's designation of evidence in opposition to summary judgment is extremely sparse 
in factual content.  The fact that the nursing staff made and recorded sponge counts showing all 
sponges accounted for and reported that fact to Dr. Ho does not preclude Dr. Ho's liability.  As 
held in Funk, a surgeon may not escape his responsibility to remove sponges used during the 
surgery simply by delegating responsibility for tracking surgical sponges to attending nurses.  
The designated matters opposing summary judgment do not provide any facts describing the 
specific actions taken by Dr. Ho during the surgery, nor do they provide any facts that form a 
 
10
basis for any explanation for his conduct.  But Dr. Ho's designated matters do challenge the 
medical review panel's finding of medical negligence.   
 
 
The determinative question is thus whether conflicting opinions regarding whether a 
physician met the applicable standard of care, in the absence of facts supporting such opinions, 
operate to create a genuine issue of material fact precluding summary judgment.  In Cox, we held 
that "speculation, not evidence" is insufficient.  828 N.E.2d at 913.  But in a medical malpractice 
case, an opinion on the ultimate fact of whether a defendant physician's conduct fell below the 
applicable standard of care may be seen as qualitatively different from the speculation found 
insufficient in Cox.  Unless satisfied by the rule of res ipsa loquitur, a medical malpractice 
plaintiff is ordinarily required to present expert opinion that a defendant health care provider's 
conduct fell below the applicable standard of care.  Perry v. Driehorst, 808 N.E.2d 765, 768 (Ind. 
Ct. App. 2004), trans. denied.  Medical negligence is thus not generally a conclusion that may be 
reached by a jury without such an expert opinion among the evidence presented.  Such expert 
opinion takes on the character of an evidentiary fact in medical malpractice cases.   
 
 
It is well-established that in medical malpractice summary judgment proceedings, the 
non-movant "is only required to produce expert evidence refuting the panel's opinion" presented 
by the moving party regarding the standard of care.  Randolph County Hosp. v. Livingston, 650 
N.E.2d 1215, 1218 (Ind. Ct. App. 1995), trans. not sought.  See also McIntosh v. Cummins, 759 
N.E.2d 1180, 1184 (Ind. Ct. App. 2001); Jones v. Minick, 697 N.E.2d 496, 499 (Ind. Ct. App. 
1998).  In the present case, by creating a genuine issue of material fact regarding his compliance 
with the applicable standard of care, Dr. Ho's designated materials were sufficient to defeat the 
plaintiffs' motion for partial summary judgment.   
 
3.  Denial of Judgment for Plaintiff on Liability 
 
 
The plaintiffs also assert on cross-appeal that the trial court erred in failing to enter 
judgment on the evidence directing a verdict or entering judgment against Dr. Ho on the issue of 
liability.  In Part 1 above, we addressed Dr. Ho's claim of trial court error in ordering a new trial 
on both liability and damages, vacating it because of the absence of special findings. The 
 
11
plaintiffs' separately contend, however, that the trial court was required, as a matter of law, to 
grant their T.R. 50(C) motion for judgment on the evidence and to enter judgment finding Dr. Ho 
liable as a matter of law.   Citing Funk, they argue that a surgeon is required as a matter of law to 
remove all surgical sponges and may not escape liability by relying on nurses to count the 
sponges.   
 
We disagree with the plaintiffs' understanding of Funk.  As discussed in Part 2 above, 
Funk stands for the proposition that, notwithstanding a surgeon's assignment to surgical 
assistants the task of tracking surgical sponges, a surgeon's failure to remove a surgical sponge is 
evidence of medical negligence and will support a jury verdict finding liability on the part of the 
surgeon.  Funk did not consider whether the failure to remove a sponge required judgment to be 
entered against a surgeon as a matter of law without a jury determination that the surgeon's 
conduct fell below the applicable standard of care.        
 
 
In the appellate review of the denial of a T.R. 50(A) motion for judgment on the 
evidence, the reviewing court assesses whether granting the motion would have been proper.  
This requires that, considering only the evidence and reasonable inferences drawn most 
favorable to the non-moving party, there is no substantial evidence supporting an essential issue 
in the case.  Smith v. Baxter, 796 N.E.2d 242, 243 (Ind. 2003).  We find that Dr. Ho's expert 
medical evidence that his performance of the surgery on Mrs. Frye satisfied the applicable 
standard of care constituted evidence sufficient to support Dr. Ho's claim of non-liability.  The 
trial court did not err in denying the plaintiffs' request for judgment on liability as a matter of 
law.   
 
4.  Permitting Defense Witnesses Testimony 
 
 
The plaintiffs contend that Dr. Ho and his expert witnesses should not have been 
permitted to testify "that the standard of care is met when the surgeon relies upon nurses to count 
sponges."  Appellees' Br. at 23.  The plaintiffs argue that permitting such testimony was (1) 
irrelevant because under Funk, Dr. Ho is ultimately accountable as a matter of law for the 
surgical sponge error, and (2) confusing "to have other doctors testify that they rely on their 
 
12
 
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nurses for the sponge count and that Dr. Ho did no wrong," contrary to Miller.  Id.   
 
 
The plaintiffs have misread the holding in Funk.  The challenged evidence was directly 
relevant to whether Dr. Ho's conduct during surgery fell below the applicable standard of care.   
As to the claim that the evidence was confusing, we understand this assertion to be based on the 
language used by the Court of Appeals in Miller that a doctor "may not delegate to another . . . 
assistant and thereby avoid responsibility."  Miller, 706 N.E.2d at 250 (emphasis added).  As 
noted in Part 2 above, however, Miller affirmed a medical malpractice verdict for the plaintiff 
and the above language, in effect, explained that evidence of assignment of responsibility to 
another surgical team member would not avoid liability as a matter of law so as to require 
reversal of the verdict.  The Miller language does not establish that a physician may not seek the 
assistance of other medical professionals in the course of surgery, nor not does it preclude 
evidence of such "delegation" of function as evidence to be considered in the overall 
determination of whether a defendant medical provider fell below the applicable standard of 
care.   
 
 
In the present case, the testimony offered by Dr. Ho's witnesses was neither irrelevant nor 
confusing.  The trial court did not err in overruling the plaintiffs' objections thereto.   
 
Conclusion 
 
 
The order of the trial court denying the plaintiffs' motion for partial summary judgment 
is affirmed. The trial court's rulings on admissibility of testimony is affirmed.  The trial court 
did not err in failing to order judgment on liability in response to the plaintiffs' motion for 
judgment on the evidence.  The order granting a new trial, however, is reversed.  This case is 
remanded with instructions to enter judgment on the jury's verdict.   
 
Shepard, C.J., and Sullivan, Boehm, and Rucker, JJ., concur.