Title: Siner v. Kindred Hosp. Ltd. P’ship
Citation: N/A
Docket Number: 49S05-1604-CT-219
State: Indiana
Issuer: Indiana Supreme Court
Date: April 28, 2016

APPELLANTS PRO SE 
 
 
 
 
 
ATTORNEYS FOR APPELLEES 
Kathy L. Siner  
 
 
 
 
 
KINDRED HOSPITAL, DENNIS 
John T. Siner 
 
 
 
 
 
 
NICELY, AND DAVID UHRIN  
Indianapolis, Indiana 
 
 
 
 
 
Melinda R. Shapiro 
 
 
 
 
 
 
 
 
Libby Y. Goodknight 
 
 
 
 
 
 
 
 
Lauren C. Sorrell 
 
 
 
 
 
 
 
 
Krieg DeVault LLP 
 
 
 
 
 
 
 
 
Indianapolis, Indiana 
 
 
 
 
 
 
 
 
 
ATTORNEYS FOR APPELLEE 
 
 
 
 
 
 
 
 
MOHAMMED MAJID 
 
 
 
 
 
 
 
 
Michael Roth 
 
 
 
 
 
 
 
 
Brett T. Clayton 
 
 
 
 
 
 
 
 
Eichhorn & Eichhorn, LLP 
 
 
 
 
 
 
 
 
Indianapolis, Indiana   
______________________________________________________________________________ 
 
In the 
Indiana Supreme Court  
_________________________________ 
 
No. 49S05-1604-CT-219 
 
KATHY L. SINER, PERSONAL REPRESENTATIVE OF THE ESTATE OF 
 
 
 
 
GERALDINE A. SINER, DECEASED, AND JOHN T. SINER, PRIOR  
ENDURING POWER OF ATTORNEY AND MEDICAL  
REPRESENTATIVE OF THE DECEASED,   
 
 
 
Appellants-Plaintiffs, 
 
v. 
 
KINDRED HOSPITAL LIMITED PARTNERSHIP, D/B/A  
KINDRED HOSPITAL OF INDIANAPOLIS, ET AL.,  
MOHAMMED A. MAJID, M.D., DENNIS NICELY,  
DAVID UHRIN, R.N., 
 
 
 
 
 
 
Appellees-Defendants. 
 
 
_________________________________ 
 
Appeal from the Marion Superior Court 12, No. 49D12-1305-CT-20123 
The Honorable Heather Welch, Judge 
_________________________________ 
 
On Petition to Transfer from the Indiana Court of Appeals, No. 49A05-1404-CT-165 
_________________________________ 
 
April 28, 2016 
FILED
C L E R K
Indiana Supreme Court
Court of Appeals
and Tax Court
Apr 28 2016, 12:14 pm
 
 
2 
Rush, Chief Justice. 
 
 
 
To obtain summary judgment in Indiana, a moving party must demonstrate the absence of 
any genuine issue of material fact on at least one element of the opposing party’s claim. Conflict-
ing affidavits regarding an element of a claim cannot satisfy this burden because they create a 
disputed factual issue that must be resolved at trial. 
 
In this medical malpractice case, the defendants’ own designated evidence revealed con-
flicting medical opinions on the element of causation. Because these conflicting opinions create a 
genuine issue of material fact, summary judgment is inappropriate and would deny the plaintiffs 
their rightful day in court. Accordingly, we reverse the trial court’s grant of summary judgment 
to the defendants. 
Facts and Procedural History 
 
Eighty-three-year-old Geraldine Siner, who had advanced dementia, was admitted to 
Kindred Hospital in October 2007 for treatment of aspiration pneumonia. She was unable to 
make her own medical decisions during her stay, but her son John Siner was her designated 
health care representative and had been appointed power of attorney in 1996. 
 
Both John and his sister Kathy Siner consistently instructed the care providers, including 
the attending physician Dr. Mohammed Majid, to classify their mother as “full code” so she 
would receive all life-sustaining therapies in the event of cardiac or pulmonary arrest. But 
Kindred Hospital’s Ethics Committee reviewed the family’s decision, noting that Geraldine 
Siner’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 in mid-
November—acknowledging “[l]egal concerns with changing code status despite family 
opposition”—and changed Geraldine Siner’s classification to “no code,” so that she would not 
receive any life-sustaining therapies. 
 
After Kathy Siner was told that “she needed to find another hospital and doctor” if she 
wanted her mother to remain “full code,” John and Kathy Siner arranged for a transfer to 
Methodist Hospital. When Geraldine Siner arrived at Methodist Hospital on December 8, 2007, 
 
 
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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. 
 
In November 2009, Kathy Siner filed a medical malpractice complaint with the Indiana 
Department of Insurance against Kindred Hospital and several of its employees (collectively, 
“Kindred”) and Dr. Majid. 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.” John and Kathy Siner then filed this medical malpractice suit pro 
se, alleging that the defendants “failed to comply with the appropriate standard of care under the 
circumstances, proximately resulting in injuries and damages of a nature requiring 
compensation.” 
 
Kindred and Dr. Majid separately moved for summary judgment. Each designated as 
evidence the medical review panel’s opinion, as well as affidavits from Dr. James Krueger—one 
of the members of the panel—saying that in his opinion Kindred and Dr. Majid “did not cause 
injury to Ms. Siner” in administering her pulmonary care.1 Kindred and Dr. Majid argued that 
Dr. Krueger’s affidavits shifted the burden to the Siners to show a genuine issue of material fact 
regarding causation and that the medical review panel’s opinion could not satisfy that burden 
because it was too speculative to provide affirmative evidence of proximate cause. 
 
The Siners responded to both motions for summary judgment. They designated affidavits 
regarding Geraldine Siner’s care from two additional doctors—Dr. Lawrence Reed II and Dr. 
Timothy Pohlman—in their response to Kindred’s motion, but not to Dr. Majid’s motion. The 
trial court granted Dr. Majid’s motion for summary judgment because the Siners had not 
designated any expert testimony on the causation element. The court likewise granted Kindred’s 
motion for summary judgment, determining that because Dr. Reed’s and Dr. Pohlman’s 
affidavits did not address the issue of causation, the Siners failed to show a genuine issue of 
material fact on that element of their medical malpractice claims. The Siners appealed the grants 
of summary judgment as pro se appellants, and the Court of Appeals affirmed in part and 
                                                 
1 Kindred and Dr. Majid submitted separate affidavits from Dr. Krueger. They contain the same 
information and conclusions but are tailored for each defendant. 
 
 
4 
reversed in part in a divided opinion. Siner v. Kindred Hosp. Ltd. P’ship, 33 N.E.3d 377 (Ind. Ct. 
App. 2015).  
 
The Court of Appeals panel unanimously reversed summary judgment for Kindred after 
determining that Dr. Pohlman’s affidavit did, in fact, create a genuine issue of fact on proximate 
cause. Id. at 384 (majority opinion); Siner, 33 N.E.3d at 386 (Kirsch, J., dissenting). The 
majority, however, affirmed summary judgment for Dr. Majid because the Siners did not 
designate Dr. Pohlman’s affidavit as evidence when responding to Dr. Majid’s motion. Siner, 33 
N.E.3d at 385 (majority opinion). The majority also noted that the medical review panel’s 
opinion—that the defendants’ “conduct may have been a factor of some resultant damages”—
was too speculative regarding causation to support a verdict and thus could not create a genuine 
issue of material fact for summary judgment. Id. Judge Kirsch dissented from the majority’s 
decision regarding Dr. Majid, arguing that even if one member of a medical review panel could 
later undermine the panel’s previous unanimous opinion, the contradiction creates a genuine issue 
of material fact. Id. at 386 (Kirsch, J., dissenting). 
The Siners petitioned for transfer, which we now grant, vacating the Court of Appeals 
decision. Ind. Appellate Rule 58(A). For the reasons explained below, we reverse the trial court’s 
grants of summary judgment to Kindred and Dr. Majid.2 
Standard of Review 
 
Our summary judgment standard of review is well settled. We draw all reasonable 
inferences in favor of the non-moving party and affirm summary judgment only “if the 
designated evidentiary matter shows that there is no genuine issue as to any material fact and that 
the moving party is entitled to judgment as a matter of law.” Ind. Trial Rule 56(C); see also, e.g., 
Hughley v. State, 15 N.E.3d 1000, 1003 (Ind. 2014). And we “give careful scrutiny to assure that 
the losing party is not improperly prevented from having its day in court.” Tankersley v. 
Parkview Hosp., Inc., 791 N.E.2d 201, 203 (Ind. 2003) (citing Landmark Health Care Assocs. 
L.P. v. Bradbury, 671 N.E.2d 113, 116 (Ind. 1996)). 
                                                 
2 Dr. Majid has moved to strike portions of the Siners’ petition to transfer, arguing that it raises a res ipsa 
loquitur issue for the first time and alleges facts unsupported by the record. Because those portions of the 
petition to transfer are irrelevant to this decision, we deny the motion—and the Siners’ related motions—as 
moot. 
 
 
5 
 
To that end, Indiana’s distinctive summary judgment standard imposes a heavy factual 
burden on the movant to demonstrate the absence of any genuine issue of material fact on at least 
one element of the claim. Hughley, 15 N.E.3d at 1003. For a medical malpractice claim, those 
elements are “(1) that the physician owed a duty to the plaintiff; (2) that the physician breached 
that duty; and (3) that the breach proximately caused the plaintiff’s injuries.” Mayhue v. Sparkman, 
653 N.E.2d 1384, 1386 (Ind. 1995). A “unanimous opinion of the medical review panel” in favor 
of the movant is “ordinarily sufficient” to meet this initial burden, requiring the non-movant to 
rebut the medical panel opinion with expert medical testimony. Stafford v. Szymanowski, 31 
N.E.3d 959, 961 (Ind. 2015). But cases hinging on disputed material facts are by definition 
inappropriate for summary judgment, because weighing evidence is “a matter for trial, not 
summary judgment.” Hughley, 15 N.E.3d at 1005–06; In re Ind. State Fair Litig., No. 49S02-
1601-CT-51, 2016 WL 348155, at *2 (Ind. Jan. 28, 2016). 
Discussion and Decision 
 
Kindred and Dr. Majid, as the summary judgment movants, had the initial burden to 
demonstrate the absence of any genuine issue of material fact on at least one element of the 
Siners’ medical malpractice claims. See Manley v. Sherer, 992 N.E.2d 670, 673 (Ind. 2013). 
Establishing this prima facie case is typically “only the beginning of the story,” but here Kindred 
and Dr. Majid failed to carry even this initial burden, making summary judgment inappropriate. 
Hughley, 15 N.E.3d at 1004. 
I. Defendants Must Affirmatively Negate the Plaintiffs’ Claims in Order to Merit 
Summary Judgment. 
Because Kindred and Dr. Majid moved for summary judgment, they bear the burden of 
“affirmatively negating” at least one element of the Siners’ claims. Schmidt v. Ind. Ins. Co., 45 
N.E.3d 781, 785 (Ind. 2015). They argue that Dr. Krueger’s affidavits satisfy that burden by 
demonstrating that Kindred and Dr. Majid did not cause injury to Geraldine Siner. But Dr. 
Krueger’s affidavits do not address all of the Siners’ claims.  
In their complaint, the Siners allege malpractice “on multiple acts or occurrences,” 
resulting in “multiple injuries to [Geraldine Siner’s] nervous system, respiratory system, 
cardiovascular system, [and] musculoskeletal system”; medical bills; and several other harms 
 
 
6 
and losses. Dr. Krueger’s affidavits, however, are limited to Geraldine Siner’s pulmonary care, 
so they could support summary judgment on only that aspect of her medical care. 
Specifically, in his affidavits, Dr. Krueger says that his agreement with the medical  
review panel opinion “was based solely on prolonged application of a CPAP3 mask to the 
patient.” He further notes that Indiana University’s Pulmonary and Critical Care Service directed 
the CPAP use, that its decisions were reasonable under the circumstances, and that Kindred and 
Dr. Majid appropriately consulted with and deferred to the Service. Dr. Krueger concluded his 
affidavits by emphasizing that Kindred and Dr. Majid “met the standard of care and did not 
cause any injury to Geraldine Siner in regard to the issue of CPAP application.” Throughout the 
affidavits, Dr. Krueger does not give any opinion about the remainder of Geraldine Siner’s care. 
We make summary judgment determinations “from the evidentiary matter designated to 
the court.” T.R. 56(C); see also Manley, 992 N.E.2d at 673 (“An appellate court reviewing a 
challenged trial court summary judgment ruling is limited to the designated evidence before the 
trial court . . . .”). Here, Kindred and Dr. Majid designated the medical review panel’s opinion—
which favored the Siners; affidavits from Dr. Krueger; and an additional affidavit from Kristy 
Walden, the CEO of Kindred Hospital, which likewise does not relate to any of the Siners’ non-
pulmonary claims.4 Because the evidence designated here can affirmatively negate only the 
claims related to pulmonary care, summary judgment on the Siners’ non-pulmonary claims is 
inappropriate.  
II. Conflicting Evidence on a Material Issue Precludes a Prima Facie Case for Summary 
Judgment.  
Dr. Krueger’s affidavits provide evidence on Geraldine Siner’s pulmonary care and 
would be sufficient, standing alone, to shift the burden to the Siners on those claims. The 
affidavits do not, however, stand alone—Kindred and Dr. Majid also designated as evidence the 
                                                 
3 “CPAP, or continuous positive airway pressure, is a treatment that uses mild air pressure to keep the 
airways open.” Nat’l Heart, Lung, & Blood Inst., U.S. Dep’t of Health & Human Servs., What is CPAP?, 
http://www.nhlbi.nih.gov/health/health-topics/topics/cpap (last updated December 13, 2011).  
 
4 Kristy Walden testified in her affidavit that an independently contracted pulmonology service—and not 
Kindred employees—oversaw Geraldine Siner’s pulmonary care. 
 
 
7 
medical review panel’s opinion that the defendants’ “conduct may have been a factor of some 
resultant damages, but not the death of the patient.” 
Drawing all reasonable inferences in favor of the non-moving party, as we must, we find 
that the medical review panel’s opinion conflicts with Dr. Krueger’s affidavits on the pulmonary 
claims. Kindred’s and Dr. Majid’s own designated evidence establishes a genuine issue of 
material fact on the element of causation, preventing them from affirmatively negating the 
Siners’ claims, as Indiana summary judgment practice requires. Hughley, 15 N.E.3d at 1003 
(“[W]hile federal practice permits the moving party to merely show that the party carrying the 
burden of proof lacks evidence on a necessary element, we impose a more onerous burden: to 
affirmatively ‘negate an opponent’s claim.’” (quoting Jarboe v. Landmark Cmty. Newspapers of 
Ind., Inc., 644 N.E.2d 118, 123 (Ind. 1994))). Summary judgment, then, is inappropriate on all of 
the Siners’ claims. 
 
Kindred and Dr. Majid argue—and the Court of Appeals majority agreed—that the 
medical review panel’s opinion is too speculative to create a genuine issue of fact. But their 
argument relies on cases where expert testimony was insufficient to support a verdict. See Palace 
Bar, Inc. v. Fearnot, 269 Ind. 405, 409, 381 N.E.2d 858, 861 (1978); Topp v. Leffers, 838 N.E.2d 
1027, 1036 (Ind. Ct. App. 2005), trans. denied; City of E. Chi. v. Litera, 692 N.E.2d 898, 901–02 
(Ind. Ct. App. 1998), trans. denied. These cases, however, are not on point: summary judgment is 
inappropriate whenever “a conflict of evidence may exist” on a material issue. Purcell v. Old Nat. 
Bank, 972 N.E.2d 835, 841 (Ind. 2012) (emphasis added). Evidence sufficient to support a verdict 
is not required.  
 
Although Dr. Krueger unequivocally stated that Kindred and Dr. Majid “did not cause 
any injury to Ms. Siner in regard to the issue of CPAP application,” the medical review panel’s 
opinion was that the defendants’ “conduct may have been a factor of some resultant damages.” 
This disagreement on the ultimate issue of causation demonstrates that a conflict of evidence 
may exist, even before “resolv[ing] all doubts against the moving party.” Estate of Mintz v. 
 
 
8 
Conn. Gen. Life Ins. Co., 905 N.E.2d 994, 998 (Ind. 2009) (citing Atl. Coast Airlines v. Cook, 
857 N.E.2d 989, 994–95 (Ind. 2009)).5  
Moreover, in medical malpractice cases, expert opinions which conflict on ultimate 
issues necessarily defeat summary judgment. Chi Yun Ho v. Frye, 880 N.E.2d 1192, 1200–01 
(Ind. 2008) (affirming a denial of summary judgment when an affidavit “challenge[d] the 
medical review panel’s finding of medical negligence” but did “not provide any facts describing 
the specific actions taken” by the defendant). While the medical review panel’s opinion here 
contains no specific facts, its medical conclusions do create a genuine issue of fact. Any lack of 
detail “goes to the weight and credibility to be assigned to [the opinion], not to whether it is 
adequate to create a question of fact.” Jordan v. Deery, 609 N.E.2d 1104, 1106, 1111 (Ind. 1993) 
(finding that a doctor’s affidavit with “no discernible facts” demonstrated “the existence of a 
material fact” when it concluded that the defendants violated the standard of care, causing 
injuries).  
 “[S]ummary judgment ‘is not a summary trial.’” Hughley, 15 N.E.3d at 1003–04 (quoting 
Ayres v. Indian Heights Volunteer Fire Dep’t, Inc., 493 N.E.2d 1229, 1234 (Ind. 1986)). And, so, 
defeating summary judgment requires only a genuine issue of material fact, not necessarily a 
persuasive issue of material fact. Id. at 1004–05. A trier of fact must decide whether the Siners’ 
evidence is persuasive, and we must leave that determination in its capable hands.  
Conclusion 
 
In this medical malpractice case, we find that Kindred and Dr. Majid did not 
affirmatively negate the Siners’ claims as required to merit summary judgment. Rather, Kindred 
and Dr. Majid themselves created a genuine issue of material fact by designating for summary 
judgment Dr. Krueger’s affidavits and the conflicting medical review panel’s opinion. Because 
their designated evidence shows that a conflict of evidence may exist on the element of causation, 
summary judgment for Kindred and Dr. Majid is inappropriate. The conflicting evidence must be 
                                                 
5 Kindred and Dr. Majid rely on two Court of Appeals cases in arguing that the medical review panel’s 
opinion is insufficient to overcome summary judgment. See Clarian Health Partners, Inc. v. Wagler, 925 
N.E.2d 388 (Ind. Ct. App. 2010), trans. denied; Malooley v. McIntyre, 597 N.E.2d 314 (Ind. Ct. App. 1992). 
We disapprove of these decisions to the extent they conflict with this opinion. 
 
 
9 
resolved by a trier of fact, and we therefore reverse the trial court’s grants of summary judgment 
to Kindred and Dr. Majid. 
Dickson, Rucker, David, and Massa, JJ., concur.