Court Opinion

ID: 9897366
Source: CourtListenerOpinion
Date Created: 2023-11-14 19:10:41.229836+00
Date Added: 2024-06-11T09:15:44.429059
License: Public Domain

FILED
                                                                           Jun 19 2023, 9:24 am

                                                                               CLERK
                                                                           Indiana Supreme Court
                                                                              Court of Appeals
                                                                                and Tax Court

ATTORNEYS FOR APPELLANT                                    ATTORNEYS FOR APPELLEE
Rodney L. Scott                                            D. Tysen Smith, II
John R. Hofmann                                            Morgan & Morgan
Waters Tyler Hofmann & Scott, LLC                          Louisville, Kentucky
New Albany, Indiana                                        Amicus Curiae
                                                           Jerry Garau
                                                           Garau Germano, P.C.
                                                           Indiana Trial Lawyers
                                                           Indianapolis, Indiana

                                            IN THE
    COURT OF APPEALS OF INDIANA

Baptist Health Medical Group,                              June 19, 2023
Inc.,                                                      Court of Appeals Case No. 22A-
Appellant-Defendant,                                       CT-2585

        v.                                                 Appeal from the Floyd Superior
                                                           Court
Carla Wellman, Individually and                            The Honorable Maria D. Granger,
as Surviving Spouse of David                               Judge
Wellman, Deceased,                                         Trial Court Cause No.
Appellee-Plaintiff.                                        22D03-2108-CT-1055

                                 Opinion by Judge Riley
                         Chief Judge Altice and Judge Pyle concur.

Riley, Judge.

Court of Appeals of Indiana | Opinion 22A-CT-2585 | June 19, 2023                                  Page 1 of 15
      STATEMENT OF THE CASE
[1]   Appellant-Defendant, Baptist Health Medical Group, Inc. (Baptist Health),

      appeals the trial court’s partial summary judgment in favor of Appellee-

      Plaintiff, Carla Wellman, Individually and as Surviving Spouse of David

      Wellman, Deceased (Wellman), on Wellman’s Complaint of medical

      malpractice arising from medical care provided by Baptist Health to David

      Wellman (David). 1

[2]   We reverse and remand.

      ISSUE
[3]   Baptist Health presents this court with one issue on appeal, which we restate as:

      Whether the designated evidence regarding the physician’s standard of care

      provided to David created a genuine issue of material fact precluding partial

      summary judgment.

      FACTS AND PROCEDURAL HISTORY
[4]   This is a malpractice action involving the August 2017 medical treatment of

      David by multiple providers employed by Baptist Health for a complex

      presentation of health issues, including weight-related cardiac problems,

      respiratory issues, heart disease, congestive heart failure, obstructive sleep

      apnea, hyperlipidemia, hypertension, morbid obesity, COPD, and diabetes.

      1
          The Indiana Trial Lawyers Association appeared as amicus in support of Wellman.

      Court of Appeals of Indiana | Opinion 22A-CT-2585 | June 19, 2023                     Page 2 of 15
      Previously, in 2011, David had received a mitral valve replacement after

      contracting sepsis and pneumonia. Upon arrival at Baptist Health’s emergency

      room on August 22, 2017, David was lethargic and unable to communicate.

      Due to respiratory failure, he was immediately placed on a ventilator. Multiple

      specialists employed by Baptist Health consulted on his care, including the

      emergency room physician, hospitalists, cardiologists, pulmonary, and

      infectious disease doctors. Srinivas Manchikalapudi, M.D. (Dr. Manchi) 2

      consulted on David’s cardiac issues due to the risk of endocarditis from the

      mechanical mitral valve.

[5]   After David was admitted, Dr. Manchi performed a transesophageal

      echocardiogram (TEE) and noted that although it was a “technically difficult

      study,” he did not believe evidence of vegetation or endocarditis was present.

      (Appellant’s App. Vol. II, p. 65). Dr. Manchi prescribed continued medical

      therapy including antibiotics. David’s condition improved in the days

      following the TEE. The ventilator was removed and a possible discharge from

      the hospital was discussed. However, David suffered a brain bleed and his anti-

      coagulant medication had to be reversed. He was subsequently transferred to

      the University of Louisville Hospital where physicians conducted further

      testing, including an additional TEE which indicated several lesions on the

      2
          As the parties refer to Dr. Manchikalapudi by a shortened version of his name, we will do likewise.

      Court of Appeals of Indiana | Opinion 22A-CT-2585 | June 19, 2023                                  Page 3 of 15
      mitral valve and which were believed to be thrombus rather than vegetation.

      David passed away while at the University of Louisville Hospital.

[6]   On July 31, 2019, Wellman filed her second amended proposed complaint

      before the Indiana Department of Insurance, claiming that Baptist Health and

      its cardiologist, Dr. Manchi, had committed medical malpractice which

      resulted in David’s death. The proposed complaint was evaluated by the three-

      person medical review panel which consisted of an emergency medicine doctor,

      an infectious disease physician, and a cardiologist. On June 3, 2021, the

      emergency medicine doctor and the infectious disease doctor found in favor of

      Baptist Health and Dr. Manchi on the standard of care and causation but noted

      that they could not “give an opinion as to the read[ing] of the TEE.”

      (Appellant’s App. Vol. II, pp. 31, 37). However, the cardiologist panel

      member, Dr. Jarrod Frizzell (Dr. Frizzell), concluded that Baptist Health and

      Dr. Manchi had “failed to meet the applicable standard of care as to the reading

      of the TEE.” (Appellant’s App. Vol. II, p. 34).

[7]   On the basis of the medical review panel’s opinion, on August 31, 2021,

      Wellman filed a Complaint against Baptist Health sounding in negligence

      regarding Dr. Manchi’s cardiology care. On January 6, 2022, Wellman filed a

      partial motion for summary judgment with respect to the standard of care,

      along with a memorandum and designation of evidence, designating Dr.

      Frizzell’s panel opinion and affidavit. On March 7, 2022, Baptist Health filed a

      response, a memorandum in opposition to Wellman’s motion, and a

      designation of evidence. Baptist Health’s designation included a three-page,

      Court of Appeals of Indiana | Opinion 22A-CT-2585 | June 19, 2023         Page 4 of 15
      fifteen-paragraph affidavit from Dr. Manchi which detailed his treatment of

      David and his perceived compliance with the standard of care in performing

      and interpreting the TEE, deposition testimony of Dr. Frizzell, analyzing the

      basis for his opinion on the standard of care on reading a TEE, and certified

      medical records from the University of Louisville Hospital. On March 31,

      2022, Wellman replied to Baptist Health’s response.

[8]   On September 6, 2022, after a hearing, the trial court granted Wellman’s

      motion for partial summary judgment on the issue of the standard of care.

      Although the trial court in its judgment mentioned that the testimony of Dr.

      Frizzell and the University of Louisville Hospital records had been designated

      by Baptist Health, it did not further analyze this evidence. Ultimately, the trial

      court concluded that no genuine issue of material fact existed with respect to

      the reading of the TEE, and it granted partial summary judgment to Wellman

      on David’s received standard of care, ruling that Dr. Manchi’s affidavit alone

      was not sufficient to create an issue of material fact to rebut a unanimous

      medical review panel’s opinion and that an opinion from an outside expert was

      required.

[9]   On September 19, 2022, Baptist Health filed its motion to certify the

      interlocutory order for appeal, which was granted by the trial court on October

      7, 2022. This court accepted the interlocutory appeal on December 5, 2022.

      Baptist Health now appeals. Additional facts will be provided as necessary.

      Court of Appeals of Indiana | Opinion 22A-CT-2585 | June 19, 2023         Page 5 of 15
       DISCUSSION AND DECISION
[10]   Initially, we note that the issue is not, as suggested by the parties and amicus,

       whether a defendant doctor’s own affidavit standing alone is sufficient to defeat

       summary judgment. Although Baptist Health did designate Dr. Manchi’s own

       affidavit claiming he did not violate the standard of care, this case does not

       solely rest on the adequacy of the factual content of his affidavit. Rather, in

       response to Wellman’s motion for summary judgment, Baptist Health also

       designated the medical records from the University of Louisville Hospital and

       portions of Dr. Frizzell’s deposition. Accordingly, the issue presented for our

       review is whether the totality of the designated evidence is sufficient to raise a

       genuine issue of material fact.

[11]   When reviewing the grant or denial of summary judgment, we apply the same

       test as the trial court: summary judgment is appropriate only if the designated

       evidence shows there is no genuine issue of material fact and the moving party

       is entitled to judgment as a matter of law. Ind. Trial Rule 56(C); Sedam v. 2JR

       Pizza Enters., LLC, 84 N.E.3d 1174, 1176 (Ind. 2017). “A fact is ‘material’ if its

       resolution would affect the outcome of the case, and an issue is ‘genuine’ if a

       trier of fact is required to resolve the parties’ differing accounts of the truth, or if

       the undisputed material facts support conflicting reasonable inferences.”

       Hughley v. State, 15 N.E.3d 1000, 1003 (Ind. 2014). The moving party bears the

       initial burden of showing the absence of any genuine issue of material fact as to

       a determinative issue. Id.

       Court of Appeals of Indiana | Opinion 22A-CT-2585 | June 19, 2023             Page 6 of 15
[12]   Our review is limited to those facts designated to the trial court, and we

       construe all facts and reasonable inferences drawn from those facts in favor of

       the non-moving party. T.R. 56(H); Meredith v. Pence, 984 N.E.2d 1213, 1218

       (Ind. 2013). Because we review a summary judgment ruling de novo, a trial

       court’s findings and conclusions offer insight into the rationale for the court’s

       judgment and facilitate appellate review but are not binding on this court.

       Denson v. Estate of Dillard, 116 N.E.3d 535, 539 (Ind. Ct. App. 2018).

       Additionally, we are not constrained by the claims and arguments presented to

       the trial court, and we may affirm a summary judgment ruling on any theory

       supported by the designated evidence. Id.

[13]   In support of her motion for summary judgment, Wellman submitted and

       designated the opinion of the medical review panel, in which Dr. Frizzell

       determined that Baptist Health and Dr. Manchi had failed to meet the

       applicable standard of care when reading the TEE. In addition, in his

       affidavit—which was also designated by Wellman— Dr. Frizzell criticized the

       number of images taken during the TEE and averred that had “the

       interpretation [of the TEE] met the standard of care, [it] would have likely

       changed [David’s] course in that he would have undergone timely studies and

       investigation to rule-in or rule-out infective endocarditis, more likely than not

       resulting in the diagnosis of endocarditis being ruled in and treated.”

       (Appellant’s App. Vol. II, pp. 39-40). He further specified that “the failure to

       meet the applicable standard of care [] increased the risk of [David’s] death

       from infective endocarditis and reduced his chance to survive.” (Appellant’s

       Court of Appeals of Indiana | Opinion 22A-CT-2585 | June 19, 2023         Page 7 of 15
       App. Vol. II, p. 40). This designation satisfied Wellman’s prima facie burden to

       show there was no genuine issue of material fact; it was then up to Baptist

       Health and Dr. Manchi to designate sufficient expert testimony setting forth

       specific facts showing the existence of a genuine issue for trial. See Scripture v.

       Roberts, 51 N.E.3d 248, 252 (Ind. Ct. App. 2016) (Plaintiffs’ introduction of

       medical review panel opinion in their favor “satisfied [their] burden to show

       there was no genuine issue of material fact[.]”); T.R. 56(E) (“When a motion

       for summary judgment is made and supported as provided in this rule, an

       adverse party may not rest upon the mere allegations or denials of his pleading,

       but his response, by affidavits or as otherwise provided in this rule, must set

       forth specific facts showing that there is a genuine issue for trial”).

[14]   In response to Wellman’s motion for partial summary judgment, Baptist Health

       designated Dr. Manchi’s affidavit which included extensive facts and detailed

       medical information, explaining his treatment and his perceived adherence to

       the standard of care in performing and interpreting the TEE. In addition,

       Baptist Health designated certified medical records from the University of

       Louisville Hospital, which bolstered Dr. Manchi’s conclusions by noting that

       clots—and not vegetation—were present on the mitral valve and that

       endocarditis was never conclusively diagnosed, as well as the deposition

       testimony of Dr. Frizzell in which he conceded that the medical guidelines for

       the standard of care on which he based his opinion allow for variations in the

       ability to perform all aspects of a TEE depending on the individual patient’s

       Court of Appeals of Indiana | Opinion 22A-CT-2585 | June 19, 2023           Page 8 of 15
       characteristics, anatomic variations, pathologic features, time constraints, and

       the judgment of the treating physician.

[15]   In Chi Yun Ho v. Frye, 880 N.E.2d 1192, 1195 (Ind. 2008), Frye brought a

       medical malpractice claim against Dr. Ho, a surgeon, for failure to remove all

       of the surgical sponges following abdominal surgery. In response to Frye’s

       motion for summary judgment in which Frye designated the unanimous

       medical review panel’s conclusion in his favor, Dr. Ho designated his own

       affidavit and the deposition testimony of another treating doctor, averring that

       Dr. Ho had complied with the standard of care. Id. The trial court denied

       Frye’s summary judgment motion and both parties appealed various issues,

       including the denial of summary judgment. Id. On appeal, our supreme court

       considered “whether conflicting opinions [in medical malpractice cases]

       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.” Id. at 1201 (emphasis added). Although Dr.

       Ho’s designation was “extremely sparse in factual content,” and did not set out

       in terms what the applicable standard of care was, but affirmed that the

       defendant had met it, our supreme court held that, together, the affidavit and

       deposition extract sufficed to preclude summary judgment in Frye’s favor

       because they created a genuine issue of material fact. Id. at 1201. “Medical

       negligence is . . . not generally a conclusion that may be reached by a jury

       without . . . an expert opinion [as to the applicable standard of care] among the

       evidence presented. Such expert opinion takes on the character of an

       Court of Appeals of Indiana | Opinion 22A-CT-2585 | June 19, 2023            Page 9 of 15
       evidentiary fact in medical malpractice cases.” Id. In such cases, therefore, “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 cases where mere “speculation, not evidence” is designated by a defendant

       in an attempt to furnish nonnegligent explanations for his conduct. Id.

[16]   Indiana’s jurisprudence has further elaborated that “[o]f course, [such

       conclusory] opinions would be greatly enhanced by detailing the factual

       circumstances upon which they were based. Numerous cases, however, have

       treated such detailing as affecting the weight and credibility to be given to the

       opinion [by the trier of fact] rather than its admissibility” and sufficiency to

       defeat a motion for summary judgment. Jordan v. Deery, 609 N.E.2d 1104, 1111

       (Ind. 1993) (“reluctantly” reversing summary judgment); see also Scripture, 51

       N.E.3d 252 (Defendant-Doctors’ affidavits did not raise a genuine issue of

       material fact precluding summary judgment because the affidavits did not set

       forth specific facts regarding the patient’s care, but instead, echoed the denials

       of their pleading and consisted of conclusory statements). Our supreme court

       has emphasized that the question on summary judgment is not whether the

       evidence would support a verdict in favor of the non-moving party, but whether

       “a conflict of evidence may exist” on a material issue. Siner v. Kindred Hosp. Ltd.

       P’ship, 51 N.E.3d 1184, 1189 (Ind. 2016) (original emphasis) (quoting Purcell v. Old

       Nat’l Bank, 972 N.E.2d 835, 841 (Ind. 2012)).

[17]   Chi Yun Ho is to be further distinguished from cases in which an affiant

       physician affirmed merely that “he would have treated [the patient] differently,

       Court of Appeals of Indiana | Opinion 22A-CT-2585 | June 19, 2023         Page 10 of 15
       not that [defendant physician]’s treatment fell below the applicable standard [of

       care].” Oelling v. Rao, 593 N.E.2d 189, 190-91 (Ind. 1992) (emphasis in

       original). Such a designation is insufficient as a matter of law to preclude

       summary judgment because it does not address the applicable legal standard:

       whether the patient’s treatment fell below the applicable standard of care. Id.

       Thus, “[t]o refute the defendants’ evidence, the affidavit needed to set out the

       applicable standard of care and a statement that the treatment in question fell

       below that standard.” Id. at 190.

[18]   Here, resolving, as we must, all reasonable inferences and all ambiguities in

       Baptist Health’s favor, we conclude that a fair reading of Dr. Manchi’s affidavit,

       together with the University of Louisville Hospital records and Dr. Frizzell’s

       deposition testimony, created a genuine issue of material fact that precluded the

       entry of summary judgment. Whereas Dr. Frizzell’s medical review panel’s

       conclusion of breach of standard of care and his subsequent affidavit criticizing

       Dr. Manchi’s interpretation and reading of the TEE was prima facie sufficient to

       support Wellman’s motion for summary judgment, in response thereto Dr.

       Manchi’s affidavit averred an explicit factual basis to support his standard of

       medical care provided, course of treatment, opinions, and conclusions. Dr.

       Manchi’s affidavit commenced with the introduction of his education and

       credentials, recognizing that he had “been practicing in clinical cardiology in

       Indiana for over twenty years and ha[d] performed hundreds of TEEs in [his]

       career, and perform[ed] over fifty every year.” (Appellant’s App. Vol. II, p. 64).

       Maintaining that he is “familiar with the standard of care applicable to

       Court of Appeals of Indiana | Opinion 22A-CT-2585 | June 19, 2023       Page 11 of 15
       cardiologists,” Dr. Manchi asserted that his “interpretation of and report on

       [David’s] TEE complied with the applicable standard of care.” (Appellant’s

       App. Vol. II, p. 64). In his explanation of the standard of care, Dr. Manchi

       elaborated that “the standard of care allows for variation in the number of

       images obtained and duration of the exam depending on the clinical

       circumstances with the patient.” (Appellant’s App. Vol. II, pp. 64-65). While a

       probe is inserted into the patient and a number of images are recorded during

       the procedure, Dr. Manchi asserted to be able to see more than merely those

       recorded images as the “TEE is a continuous imaging process.” (Appellant’s

       App. Vol. II, p. 64). Through this process, Dr. Manchi was able to visualize

       “the prosthetic mitral valve to determine whether there [was] evidence of

       vegetation.” (Appellant’s App. Vol. II, pp. 64-65). The affidavit explained in

       detail the difficulty of the study as David “was on a monitor” and “morbidly

       obese per BMI[,]” and as a result the “number of images [was limited] to 18[.]”

       (Appellant’s App. Vol. II, p. 65). Based on his “adequate and desirable

       visualization of the prosthetic mitral valve,” Dr. Manchi concluded there was

       an absence of vegetation or structural abnormalities. (Appellant’s App. Vol. II,

       p. 65). Dr. Manchi further noted that David’s subsequent improvement

       supported the accuracy of his reading of the TEE.

[19]   In addition to Dr. Manchi’s affidavit, Baptist Health designated the University

       of Louisville Hospital’s medical records for David. While further testing and an

       additional TEE were conducted, these results indicated that “given the

       sequence of events, the mitral valve lesions are most likely thrombotic.”

       Court of Appeals of Indiana | Opinion 22A-CT-2585 | June 19, 2023      Page 12 of 15
       (Appellant’s App. Vol. II, p. 68). The University of Louisville Hospital’s

       physicians noted that “[w]hile off anticoagulation, the [mitral valve

       replacement] thrombosis rate/risk will continue to grow and causing [sic] flash

       pulmonary edema;” there was no diagnosis of endocarditis. (Appellant’s App.

       Vol. II, p. 75). Also, Dr. Frizzell’s deposition, which was designated in support

       of Baptist Health’s position, appeared to signal Dr. Frizzell’s concession that

       the standard of care allowed for certain variations depending on individual

       patient characteristics, anatomic variations, pathologic features, time

       constraints, and the judgment of the treating physician.

[20]   In sum, Dr. Manchi’s affidavit, which detailed the standard of care, the

       procedure and its difficulties, and the resulting conclusion drawn from the

       procedure, together with the testing results at the University of Louisville

       Hospital and Dr. Frizzell’s deposition, were sufficient to create a genuine fact

       issue requiring resolution by the trier of fact.

[21]   Nevertheless, in an effort to encourage this court to disregard Dr. Manchi’s

       affidavit, Wellman characterizes the affidavit as “self-serving.” (Appellant’s Br.

       p. 21). Despite this characterization, we find that Dr. Manchi’s affidavit

       comports with the Indiana Supreme Court’s Hughley standard. Hughley

       involved a civil proceeding initiated by the State seeking forfeiture of the

       defendant’s cash and car, which the State alleged were proceeds of, or meant to

       be used to facilitate, the defendant’s drug dealing. See Hughley, 15 N.E.3d at

       1002. The defendant’s affidavit recited his competence to testify and then

       stated in full that the currency seized during this arrest was not the proceeds of

       Court of Appeals of Indiana | Opinion 22A-CT-2585 | June 19, 2023         Page 13 of 15
       criminal activity nor was it intended to be used for anything other than legal

       activities, and the car was never used to transport controlled substances and was

       not the proceeds from any unlawful activity. See id. Our supreme court found

       that Hughley had designated facts with specificity sufficient to defeat summary

       judgment:

               [H]ere, Defendant did not merely rest on his “pleadings”—that
               is, the complaint, answer, or counter-, cross-, and third-party
               claims with answers or replies thereto. T.R. 7(A). Rather, he
               designated an affidavit—albeit a perfunctory and self-serving
               one—that specifically controverted the State’s prima facie case,
               denying under oath that the cash or car were proceeds of or used
               in furtherance of drug crimes.

       Id. at 1004. Likewise, here, Dr. Manchi submitted a three-page, fifteen

       paragraph affidavit, in which he detailed, under oath, the extensive facts and

       medical information, explained the treatment and procedure, and his method in

       interpreting the TEE. Accordingly, Dr. Manchi’s affidavit, combined with the

       University of Louisville Hospital’s medical records and Dr. Frizzell’s

       deposition, included sufficient specificity to controvert Wellman’s prima facie

       case and precluded the entry of summary judgment.

       CONCLUSION
[22]   Based on the foregoing, we conclude that Baptist Health’s designated evidence

       created a genuine issue of material fact as to whether Dr. Manchi’s treatment of

       David complied with the standard of care to preclude the entry of summary

       judgment in favor of Wellman.

       Court of Appeals of Indiana | Opinion 22A-CT-2585 | June 19, 2023        Page 14 of 15
[23]   Reversed and remanded for further proceedings.

       Altice, C. J. and Pyle, J. concur

       Court of Appeals of Indiana | Opinion 22A-CT-2585 | June 19, 2023   Page 15 of 15