Opinion ID: 852125
Heading Depth: 1
Heading Rank: 3

Heading: Preserving Medical Records and the Medical Malpractice Act

Text: Two threshold questions about the Gordons' claim are whether it falls within the general scope of the Medical Malpractice Act and whether Indiana's statute on maintenance of health records statute creates a private right of action. We review such questions of statutory interpretation under a de novo standard and owe no deference to a trial court's legal conclusions. South Bend Tribune v. South Bend Cmty. Sch. Corp., 740 N.E.2d 937 (Ind. 2000). Indiana courts understand the Malpractice Act to cover curative or salutary conduct of a health care provider acting within his or her professional capacity, Murphy v. Mortell, 684 N.E.2d 1185, 1188 (Ind.Ct.App.1997), but not conduct unrelated to the promotion of a patient's health or the provider's exercise of professional expertise, skill, or judgment. Collins v. Thakkar, 552 N.E.2d 507, 510 (Ind. Ct.App.1990). To determine whether the Act is applicable, the court looks to the substance of a claim. Van Sice v. Sentany, 595 N.E.2d 264 (Ind.Ct.App.1992). Thus, regardless of what label a plaintiff uses, claims that boil down to a question of whether a given course of treatment was medically proper and within the appropriate standard are the quintessence of a malpractice case. Id. at 267 (plaintiff's claims of fraud and battery fell within the Malpractice Act because the first was essentially a claim that the defendant failed to adhere to a standard of care and the second was a claim that the defendant did not obtain informed consent for a procedure); Popovich v. Danielson, 896 N.E.2d 1196, 1202-04 (Ind.Ct.App.2008) (though styled as assault and battery, fraud, breach of contract, and defamation, all plaintiff's claims involved defendant's exercise of professional judgment and involved actions taken while providing medical care and thus the requirements of the Act applied). By contrast, to fall outside the Malpractice Act a health care provider's actions must be demonstrably unrelated to the promotion of the plaintiff's health or an exercise of the provider's professional expertise, skill, or judgment. Kuester v. Inman, 758 N.E.2d 96 (Ind.Ct.App.2001); Collins, 552 N.E.2d at 510 (Ind.Ct.App. 1990) (Act held inapplicable in cases where the conduct involved was unrelated to the promotion of a patient's health or the provider's exercise of professional expertise, skill or judgment). Splitting out separate actions by a provider has usually been held contrary to the Act. In determining that both the activity of credentialing and medical malpractice should be reviewed together under the Act, the Court of Appeals explained the landscape well: Viewed from the historical perspective we believe the conclusion is inescapable that our General Assembly intended that all actions the underlying basis for which is alleged medical malpractice are subject to the act. [T]he obvious purpose of the act is to provide some measure of protection to health care providers from malpractice claims, and to preserve the availability of the professional services of physicians and other health care providers in the communities and thereby protect the public health and well-being[.] Winona Mem'l Hosp., LP v. Kuester, 737 N.E.2d 824, 828 (Ind.Ct.App.2000) (quoting Sue Yee Lee v. Lafayette Home Hosp., Inc., 410 N.E.2d 1319, 1324 (Ind.Ct.App. 1980)). [2] The Gordons' underlying claim in Count II alleges medical malpractice because the [m]aintenance of health records by providers is so closely entwined with health care and because records in general are so important to a medical review panel's assessment of whether the appropriate standard of care was met. Ind.Code §§ 16-39-7-1, 34-18-10-22(a). The Gordons rightly acknowledge how important health care records are for the nature and quality of the health care provided, for billing purposes, and peer review.  (Appellee's Br. at 16.) (emphasis added) Surely the skillful, accurate, and ongoing maintenance of test and treatment records bears strongly on subsequent treatment and diagnosis of patients. It is a part of what patients expect from health care providers. It is difficult to contemplate that such a service falls outside the Act. We thus move to the Gordons' contention that the statute on maintenance of health records creates a private right of action separate from the Medical Malpractice Act. The Gordons maintain that the enactment of new subsection (d) implicitly recognizes that there is civil liability on the part of a healthcare provider if it violates Ind.Code § 16-39-7-1. (Appellee's Br. at 20.) We have long-standing analytical tools for addressing whether a statute contains an implied private right of action. Kho v. Pennington, 875 N.E.2d 208, 218 (Ind.2007) (Sullivan, J., concurring in part and dissenting in part). Determining whether a civil cause of action exists begins with an examination of legislative intent. Estate of Cullop v. State, 821 N.E.2d 403 (Ind.Ct.App.2005). A private party may not usually enforce rights under a statute designed to protect the public in general and which contains an enforcement provision. Id. When a statute limits a thing to be done in a particular mode, it includes the negative of any other mode. Id. at 409 (quoting Nat'l R.R. Passenger Corp. v. Nat'l Ass'n of R.R. Passengers, 414 U.S. 453, 459, 94 S.Ct. 690, 38 L.Ed.2d 646 (1974)). Whether a statute creates a private right of action is a question of law for the court. See Blanck v. Ind. Dep't of Corr., 829 N.E.2d 505 (Ind.2005). As it existed in 2008 and during the earlier period of the events surrounding Jacob Gordon's birth, Chapter 16-39-7 of the Indiana Code (Maintenance of Health Records, X-Rays, and Other Tests) provided, in language that is still in the Code: Sec. 1. (a) As used in this section, provider means the following:    (13) A hospital or facility licensed under IC 16-21-2 or IC 12-25 or described in IC 12-24 or IC 12-29. (b) A provider shall maintain the original health records or microfilms of the records for at least seven (7) years. (c) A provider who violates subsection (b) commits an offense for which a board may impose disciplinary sanctions against the provider under the law that governs the provider's licensure, registration, or certification under this title or IC 25. Effective July 1, 2009, the legislature added subsection (d): (d) A provider is immune from civil liability for destroying or failing to maintain a health record in violation of this section if the destruction or failure to maintain the health record occurred in connection with a disaster emergency as declared by the governor under IC XX-XX-X-XX or other disaster, unless the destruction or failure to maintain the health record was due to negligence by the provider.
The legislative genealogy of these provisions sheds light on the issue at hand. Subsections (a) thru (c) previously appeared in Indiana Code § 16-4-8-2 (1992). In 1993, the General Assembly created Chapter 16-39-7 and placed (a) thru (c) there. At the same time, it added Section 2, addressing the Maintenance of x-rays by providers; mammograms; violations; civil liability. P.L. 2-1993, § 22; Ind. Code § 16-39-7-2 (1993). [3] The addition of subsection (d) to Section 1 in 2009 came after the Gordons filed their complaint. As the statutes existed at the time of Jacob's birth, a violator of Chapter 7, Section 1, would be subject to disciplinary sanctions under the law that governs the provider's licensure, registration, or certification under Title 16 or Title 25. By contrast, a violator of Section 2 would be exposed to the same disciplinary sanctions but would possess substantial immunity created by subsection (e). [4] The language of subsection (e) in Section 2 is similar to the language added in 2009 to subsection (d) of Section 1. Recalling that Sections 1 and 2 were crafted at the same time, the legislature could have created civil liability for a violation of Section 1 and did not do so. This differential treatment says a fair amount about legislative intent as respects the law at the time relevant to this lawsuit. Moreover, the structure of Section 1(d) reads largely as a grant of immunity to hospitals that lose records due to natural disasters. It was enacted in the wake of a storm that destroyed the medical records of a leading hospital. [5] We conclude that neither the rules of statutory construction nor the history of the enactment lead to the idea that Section 1(d) confers a private remedy for the Gordons.