Case Title: Marsha Ledbetter v. Robert Hunter, M.D., Lawrence Benken, M.D., and Ball Memorial Hospital

Citation: 

Docket Number: 49S02-0412-CV-501

State: indiana

Court: Indiana Supreme Court

Date: 2006-02-22T00:00:00Z

Document:
ATTORNEYS FOR APPELLANT 
 
ATTORNEYS FOR APPELLEES 
ATTORNEYS FOR AMICUS CURIAE 
Michael L. Hanley 
 
 
BALL MEMORIAL HOSPITAL 
IND. STATE MEDICAL ASSOC. 
Vernon J. Petri & Assoc.,  
 
AND ROBERT HUNTER, M.D. 
Linda J. Cooley 
Indianapolis, Indiana 
 
 
Mary K. Reeder  
 
Libby Y. Mote 
 
 
 
Pamela G. Schneeman 
 
Krieg DeVault, LLP 
 
Mary A. Findling  
 
 
Riley Bennett & Egloff, LLP 
Indianapolis, Indiana 
Findling Garau Germano  
 
Indianapolis, Indiana 
 
 
& Pennington, P.C. 
 
 
 
 
 
 
 
 
 
Indianapolis, Indiana 
 
 
ATTORNEY FOR APPELLEE 
 
 
 
 
 
LAWRENCE BENKEN, M.D. 
 
   
 
 
 
 
 
 
 
James W. Brauer 
     
 
 
 
 
Stewart & Irwin, PC 
 
 
 
 
 
Indianapolis, Indiana 
_____________________________________________________________________________ 
 
In the 
Indiana Supreme Court  
_________________________________ 
 
No. 49S02-0412-CV-501 
 
MARSHA LEDBETTER,  
 
 
 
 
Appellant (Plaintiff below), 
 
v. 
 
ROBERT HUNTER, M.D., 
LAWRENCE BENKEN, M.D., AND 
BALL MEMORIAL HOSPITAL  
 
 
 
Appellees (Defendants below). 
_________________________________ 
 
Appeal from the Marion Superior Court, No. 49D02-9409-CT-384  
The Honorable Kenneth H. Johnson, Judge 
_________________________________ 
 
On Petition To Transfer from the Indiana Court of Appeals, No. 49A02-0309-CV-770 
_________________________________ 
 
February 22, 2006 
 
Dickson, Justice. 
 
 
In this appeal following the trial court's dismissal of the plaintiff's complaint alleging 
medical negligence, the Court of Appeals concluded that the Indiana Medical Malpractice Act's 
statute of limitations regarding claims of minors violated the Privileges and Immunities Clause 
of the Indiana Constitution.  Ledbetter v. Hunter, 810 N.E.2d 1095, 1103 (Ind. Ct. App. 2004).  
We granted transfer, thereby automatically vacating the opinion of the Court of Appeals, and 
now deny the plaintiff's claim that the challenged statutory provision is unconstitutional.   
 
 
This lawsuit seeks damages for injuries to Trenda Ledbetter, who was born at defendant 
Ball Memorial Hospital on November 25, 1974, with birth complications causing serious and 
permanent physical and mental injuries.  For religious reasons, Trenda's mother did not assert a 
malpractice claim on behalf of her daughter.  On April 22, 1994, less than two years after her 
eighteenth birthday, Trenda filed a medical malpractice claim against the hospital and defendants 
Robert Hunter, M.D. and Lawrence Benken, M.D., the physicians who attended her birth.  The 
defendants moved to dismiss, contending that the action was not commenced before Trenda's 
eighth birthday pursuant to the Indiana Medical Malpractice Act limitations period for claims of 
minors.  The trial court granted the motion, but the Court of Appeals reversed and remanded to 
the trial court for consideration of the constitutionality of the statutory limitation period under the 
Privileges and Immunities Clause.  Ledbetter v. Hunter, 652 N.E.2d 543 (Ind. Ct. App. 1995), 
transfer not sought.  Trenda died shortly thereafter, and her mother, Marsha Ledbetter, was sub-
stituted as the plaintiff in this action.  After further proceedings, the trial court again dismissed 
the action, finding that the plaintiff had failed to demonstrate that the statute was unconstitu-
tional.  Appellant's App'x. at 28.   
 
 
The plaintiff contends that the medical malpractice statute of limitations for minors vio-
lates Article 1, Section 23, of the Indiana Constitution as interpreted by Collins v. Day, 644 
N.E.2d 72 (Ind. 1994).  Section 23 states:  "The General Assembly shall not grant to any citizen, 
or class of citizens, privileges or immunities, which, upon the same terms, shall not equally be-
long to all citizens."  In Collins, we analyzed the enactment of this provision and synthesized 
prior case law, concluding that: 
Article 1, Section 23 of the Indiana Constitution imposes two requirements upon statutes 
that grant unequal privileges or immunities to differing classes of persons.  First, the dis-
parate treatment accorded by the legislation must be reasonably related to inherent char-
acteristics [that] distinguish the unequally treated classes.  Second, the preferential treat-
ment must be uniformly applicable and equally available to all persons similarly situated.  
Finally, in determining whether a statute complies with or violates Section 23,  
courts must exercise substantial deference to legislative discretion. 
644 N.E.2d at 80.  The first prong itself has two necessary components:  "[a] such classification 
 
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must be based upon distinctive, inherent characteristics [that] rationally distinguish the unequally 
treated class, and [b] the disparate treatment accorded by the legislation must be reasonably re-
lated to such distinguishing characteristics."  Id. at 79.  Likewise, the second prong is described 
as comprising two elements:  "[a] any privileged classification must be open to any and all per-
sons who share the inherent characteristics [that] distinguish and justify the classification . . . , 
[and] [b] the special treatment accorded to any particular classification [must be] extended 
equally to all such persons."  Id.   
 
 
We cautioned in Collins that, in applying the two-prong standard, courts "must accord 
considerable deference to the manner in which the legislature has balanced the competing inter-
ests involved," id. at 80, that "[s]o long as the classification is based upon substantial distinctions 
with reference to the subject matter, we will not substitute our judgment for that of the legisla-
ture[,] nor will we inquire into the legislative motives prompting such classification," id. (quot-
ing Chaffin v. Nicosia, 261 Ind. 698, 701, 310 N.E.2d 867, 869 (1974)), and that a challenger 
must "negative every conceivable basis which might have supported the classification," id. (quot-
ing Johnson v. St. Vincent Hosp., Inc., 273 Ind. 374, 392, 404 N.E.2d 585, 597 (1980)).   
 
 
Nevertheless, Collins clearly emphasized our anticipation that "our independent state 
privileges and immunities jurisprudence will evolve in future cases facing Indiana courts to as-
sure and extend protection to all Indiana citizens."  Collins, 644 N.E.2d at 81.  Although we ex-
plicitly noted that preferential legislative treatment that was proper when enacted "may later 
cease to satisfy the requirements of Section 23 because of intervening changes in social or eco-
nomic conditions," a challenger must carry its burden to negate every reasonable basis for the 
classification.  Id.   
 
 
The plaintiff challenges the constitutionality of the limitation period in the Indiana Medi-
cal Malpractice Act, which states: 
A claim, whether in contract or tort, may not be brought against a health care provider 
based upon professional services or health care that was provided or that should have 
been provided unless the claim is filed within two (2) years after the date of the alleged 
act, omission, or neglect, except that a minor less than six (6) years of age has until the  
minor's eighth birthday to file.   
 
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Ind. Code § 34-18-7-1(b).1  The plaintiff points to the fact that this statute of limitations for mi-
nor victims is two years, or until age eight if injured in the first six years of life, in contrast to 
minor victims of other torts, who have until two years after the age of majority to file suit.  Ind. 
Code § 34-11-6-1.  She argues that the first prong of Collins is thereby violated because the Act, 
without a legitimate basis, creates "two unequally treated classes:  1) those children injured by 
medical malpractice; and 2) those children injured by negligence other than medical malprac-
tice."  Br. of Appellant at 10.  In addition, the plaintiff separately asserts that the second prong is 
violated because the Act's statute of limitations treats differently two subclasses of minor victims 
of medical malpractice:  "1) those with parents who seek legal advice and file a claim; and 2) 
those with parents who chose not to do the same."  Id. at 11.   
 
 
As to the first prong, we find dispositive the plaintiff's failure to negate the legislative 
basis for unequal treatment of the two identified classes.  Although acknowledging that the Act's 
statute of limitations as it applies to minors was specifically found to be constitutional in St. Vin-
cent Hosp., the plaintiff argues that minors' medical negligence claims have an insignificant im-
pact upon the availability of healthcare statewide and that a change in the statute of limitations 
does not risk the availability of health care services.  Br. of Appellant at 16-18.  Before the trial 
court, the plaintiff served nonparty requests for production upon numerous medical malpractice 
insurance carriers and upon the Indiana State Medical Association and the Indiana Hospital As-
sociation seeking information regarding "what significance, if any, the statute of limitations for 
minors had on the affordability of medical malpractice insurance and the consequent availability 
of health care services."  Br. of Appellant at 17.  The plaintiff emphasizes that "neither the insur-
ance carriers nor the health care associations could produce a single document showing that a 
change in the disability provision for minors in medical malpractice cases would have any ad-
verse effect on the cost of insurance, the availability of health care services, or the ability to de-
fend malpractice claims."  Br. of Appellant at 20.   
 
 
   In St. Vincent Hosp., this Court expressly rejected a challenge to the Act's classification 
of the claimants by age, concluding that the purpose of the Act, "to protect the health of citizens 
of this State by preventing a reduction of health care services," 273 Ind. at 392, 404 N.E.2d at 
                                                 
1 Formerly Ind. Code § 27-12-7-1(b). 
 
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597, is "furthered in a rational manner by limiting the legal disability of infants to those under six 
years of age, and the classification of those entitled to legal disability by age and type of claim 
bears a fair and substantial relationship to that same end."  Id. at 405, 404 N.E.2d at 604.   We 
decline to overturn this determination based upon the defendants' failure to affirmatively provide 
documentary proof to support the rationale used in St. Vincent Hosp.  When challenging a statute 
as invalid under Section 23, it is the challenging party who has the burden to negate "every rea-
sonable basis for the classification."  Collins, 644 N.E.2d at 81.  Demonstrating a lack of sub-
stantial evidence supporting a legislative rationale does not affirmatively establish that the ra-
tionale is unreasonable.   
 
 
The inference from this lack of information, if true, may well provide powerful support 
for legislative reconsideration of the challenged minor limitation period.  But a statute is not un-
constitutional simply because we might disagree with the legislature about the wisdom of the 
statute.  State v. Rendleman, 603 N.E.2d 1333, 1334 (Ind. 1992).  
 
 
The plaintiff separately contends that the limitation period for minors violates Section 23 
because Trenda Ledbetter, a part of the class of children injured by medical malpractice, was 
also part of a subclass of minors whose parents fail or choose not to timely assert medical mal-
practice claims, in contrast to those parents who seek legal advice and timely file claims.  The 
plaintiff asserts that this constitutes a violation of the second prong of Collins, which requires 
that the unequal privileges or immunities granted by statute to differing classes of persons be of 
uniform applicability and availability to "all persons who share the inherent characteristics [that] 
distinguish and justify the classification.  Collins, 644 N.E.2d at 79.     
 
But the two subclasses alleged by the plaintiff, based upon whether a child's parents 
timely assert the child's medical malpractice claim, are not treated differently by the statute.  The 
unequal special privileges or immunities, or special treatment, accorded minor children injured 
by medical malpractice is that they are subject to specific time limitations within which to file 
claims (within two years of the occurrence or until their eighth birthday, if injured anytime be-
fore their sixth birthday).  Such special treatment, the limitation regime imposed by the Act, 
definitely is applicable equally to all who share the distinguishing inherent characteristic of being 
 
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minor victims of medical malpractice.  The children in each of the plaintiff's alleged subclasses 
share the same statute of limitations regime, with different results occurring only based upon 
whether or not the child, through her parents, elects to comply with the statutory deadlines.  
Medical malpractice claims may be equally presented on behalf of any child injured by medical 
malpractice simply upon the initiation of the claim within the statutory time limit.       
 
Under Indiana law, custodial parents are authorized to act on behalf of their minor chil-
dren for the purpose of consenting to health care.  Ind. Code §§ 16-36-1-3,-5, 29-3-3-3(8).  Par-
ents are likewise designated to maintain actions for injuries to their child caused by the wrongful 
act or omission of another.  Ind. Code § 34-23-2-1.  "The responsibility to learn of a child's inju-
ries and to recognize that they may have been caused by the tortious act of another must fall to 
parents and legal guardians."  Fager v. Hundt, 610 N.E.2d 246, 251 (Ind. 1993).  Noting the 
"natural and legal obligations of parents to protect and care for their children," this Court has im-
puted to a child, for the purpose of accrual of a cause of action, their parent's knowledge of facts 
regarding their child's injury.  Id.  While Fager involved application of the general limitation pe-
riod allowing a minor two years after reaching majority in which to commence suit, its rationale 
is equally applicable here.   
 
The plaintiff's contention regarding the second prong of Collins is thus equivalent to al-
leging that each statute of limitation violates Section 23 because, within the class of persons sub-
ject to such a statutory limitation period, there are two classes of persons unequally treated—
those who timely commence an action and those who fail or choose not to.  The second prong 
does not prohibit such a distinction.   
 
In considering challenges to the constitutionality of a statute, we accord it "with every 
reasonable presumption supporting its validity and place the burden upon the party challenging it 
to show unconstitutionality."  St. Vincent Hosp., 273 Ind. at 381, 404 N.E.2d 591.  Any claimed 
fatal constitutional defects must be "clearly apparent."  Id.  All doubts are resolved against the 
party challenging the constitutionality of a statute.  State v. Rendleman, 603 N.E.2d 1333, 1334 
(Ind. 1992).  The presumption of constitutionality continues unless "clearly overcome" by a con-
trary showing.  Id.   
 
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We conclude that the plaintiff has failed to overcome the presumption of constitutionality 
that must be accorded the Medical Malpractice Act limitation period for minors.  Transfer having 
previously been granted, we affirm the trial court judgment dismissing this action.   
 
Shepard, C.J., and Sullivan, Boehm, and Rucker, JJ., concur.   
 
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