Court Opinion

ID: 9926751
Source: CourtListenerOpinion
Date Created: 2024-01-25 17:03:41.00847+00
Date Added: 2024-06-11T09:20:21.773326
License: Public Domain

FILED
                                                         Jan 25 2024, 9:16 am

                                                              CLERK
                                                          Indiana Supreme Court
                                                             Court of Appeals
                                                               and Tax Court

                          IN THE

  Indiana Supreme Court
             Supreme Court Case No. 23S-CT-109

                      Penny Korakis,
                       Appellant-Plaintiff,

                               –v–

Memorial Hospital of South Bend, Michael R.
Messmer, D.O., and David A. Halperin, M.D.,
                      Appellees-Defendants.

        Argued: June 23, 2023 | Decided: January 25, 2024

             Appeal from the St. Joseph Circuit Court
                     No. 71C01-2106-CT-215
               The Honorable John Broden, Judge

    On Petition to Transfer from the Indiana Court of Appeals
                         No. 22A-CT-867

                    Opinion by Justice Massa
Chief Justice Rush and Justices Slaughter, Goff, and Molter concur.
Massa, Justice.

   The core issue here is whether Indiana’s summary-judgment standard
requires a medical expert to expressly state the applicable standard of care
in his affidavit. Two of our cases offer two possible answers: Oelling v.
Rao, 593 N.E.2d 189 (Ind. 1992), says yes, but Jordan v. Deery, 609 N.E.2d
1104 (Ind. 1993), says no and suggests the standard of care may be
inferred from other content in the affidavit. For three decades, Oelling has
been cited more often, but we hold that our precedents align more closely
with Jordan. Today, we retire that part of the Oelling rule, which required
affidavits to state the standard of care expressly, and embrace Jordan
instead. Thus, the standard of care may be inferred from an affidavit.

   Plaintiff was injured in an automobile accident and treated by two
doctors at a hospital. She later sued both doctors, and the hospital, for
medical malpractice. The trial court entered summary judgment for all
three defendants, and the Court of Appeals, relying on Oelling,
unanimously affirmed. Today, we summarily affirm the Court of Appeals
opinion insofar as it concluded that Dr. Halperin and Memorial Hospital
of South Bend are each entitled to summary judgment. See Ind. Appellate
Rule 58(A)(2); see also Martin v. Amoco Oil Co., 696 N.E.2d 383, 386 n.4 (Ind.
1998) (acknowledging we can “decline to review” portions of an appellate
opinion and thus “partially deny transfer” on such issues). But applying a
more refined distillation of our precedents to Dr. Messmer, we reach a
different outcome and reverse the trial court’s decision as it relates to him.

Facts and Procedural History
   On August 3, 2017, Penny Korakis was taken to Memorial Hospital of
South Bend (“Hospital”) for medical care where she reported pain from
her left hand to her left shoulder. She received emergency care and
treatment from Dr. David A. Halperin, which included x-rays of her left
arm and hand. He also diagnosed her with an acute soft tissue injury.

   Korakis returned to the Hospital a week later, where she received
treatment from a nurse practitioner who ordered additional x-rays of her
left shoulder, elbow, and wrist. The nurse practitioner referred Korakis to

Indiana Supreme Court | Case No. 23S-CT-109 | January 25, 2024       Page 2 of 11
treatment with Dr. Michael R. Messmer, which Korakis received in August
and September. Dr. Messmer ordered more x-rays of Korakis’s wrist, but
did not order a magnetic resonance imaging (“MRI”) exam of her left
elbow. He also did not order an MRI at a subsequent appointment in
September. But he did refer Korakis to physical therapy that same day.

   Korakis began physical therapy, but returned to Dr. Messmer in
October based on lasting and worsening pain in her left elbow. The next
day, a nurse from Dr. Messmer’s office called Korakis and told her that
she could return to physical therapy, wait two weeks to schedule an MRI,
or she could see Dr. John Kelbel. She selected the last option. Dr. Kelbel
examined Korakis later in October and noted that the initial x-rays at the
Hospital revealed an occult radial fracture in Korakis’s left elbow, but the
injury had enough time to heal and had likely reached maximum medical
improvement. He ordered an MRI of her left elbow along with her right
ankle. Korakis returned to Dr. Messmer in November to discuss the
results from the MRIs. He explained the results were fine, but after
Korakis told him about the possible occult radial fracture in her left elbow,
Dr. Messmer reported in his notes that she may have suffered a fracture.

   In 2019, Korakis filed a proposed complaint with the Indiana
Department of Insurance (“IDOI”) against Dr. Halperin, Dr. Messmer, and
the Hospital (collectively, “Defendants”), alleging the care and treatment
she received from them (including failures to diagnose and treat her) were
negligent and fell below the standard of care. Korakis alleged that Dr.
Halperin “failed to identify and diagnose the true extent of [her] injuries,
which included broken bones.” Appellant’s App. Vol. 2, p. 47. She claimed
that during her follow-up appointments with Dr. Messmer, he “failed to
properly examine [her] injuries and the x-rays taken thereof and failed to
determine and disclose to [Korakis] the true extent of the injuries that she
incurred on August 3, 2017, which included broken bones.” Id. at 48.

   A Medical Review Panel (“MRP”) concluded that “[t]he evidence does
not support the conclusion that [Defendants] failed to meet the applicable
standard of care as charged in the complaint.” Id. at 53, 56, 59. Later,
Korakis filed suit.

  Similar to her proposed complaint, Korakis alleged that Defendants
had failed to “proper[ly] identify, diagnose, and treat” her injuries,

Indiana Supreme Court | Case No. 23S-CT-109 | January 25, 2024     Page 3 of 11
“including broken bones,” resulting in required corrective surgery. Id. at
13–14, 20–21. She asserted negligence and negligent infliction of emotional
distress that resulted in economic and non-economic damages.

   Dr. Halperin moved for summary judgment based on the favorable
MRP opinion. Dr. Messmer and the Hospital also moved for summary
judgment on that basis.

   Korakis responded to both motions. She first argued that Dr. Halperin
failed to identify a fracture to Korakis’s elbow, “despite it being apparent
from the initial x-rays.” Id. at 117. She next argued that Dr. Messmer failed
to identify the fracture “apparent in both x-rays” on August 3 and 10, and
his “delay in identifying” her fracture and providing proper treatment
“likely worsened” her condition. Id. at 146. In each response, Korakis
argued that genuine issues of material fact precluded summary judgment.

   In support of her arguments, Korakis designated a medical expert
affidavit from Dr. James E. Kemmler. He testified to his credentials,
including that he “practiced orthopedic medicine for approximately 25
years” and had “extensive experience performing standard of care
reviews for personal injury and medical malpractice cases.” Id. at 121. He
also testified about the relevant medical records he reviewed and the
chronology of Korakis’s treatment:

        31. Upon review of the relevant x-rays and other medical records, it
        is my opinion that Ms. Korakis suffered an occult fracture of her
        left elbow.

        32. This fracture can be observed in the x-rays taken during Ms.
        Korakis’s initial visit to the emergency [room] as well as those
        taken on August 10, 2017.

        33. The records indicate that Dr. Halperin failed to identify Ms.
        Korakis’s fracture during her initial visit to the emergency room.

        34. The records also indicate that Dr. Messmer failed to order
        additional x-rays of Ms. Korakis’s left elbow when appropriate.

        35. It is my opinion that Dr. Messmer should have done more
        testing prior to placing Ms. Korakis in a sling and ordering physical
        therapy.

Indiana Supreme Court | Case No. 23S-CT-109 | January 25, 2024      Page 4 of 11
        36. The delay in identifying and providing the appropriate
        treatment for Ms. Korakis’s fracture likely worsened her condition
        and contributed to her stiffness, limited range of motion, limited
        recovery, and current condition.

        37. Accordingly, it is my opinion that Dr. Messmer [sic] treatment
        of Ms. Korakis[] fell below the standard of care.

   Id. at 124.

   At the hearing on the summary judgment motions, Dr. Messmer and
the Hospital argued that Dr. Kemmler’s affidavit could not defeat
summary judgment because “nowhere does he state what the appropriate
standard of care is[,]” Tr. at 7, and “[a]t best, his affidavit says what he
would do, what he thinks is appropriate. But his personal opinion is
irrelevant,” id. at 12. They pointed out that “never does he say that [the]
Hospital breached that standard of care.” Id. at 7.

   Dr. Halperin argued that Dr. Kemmler’s affidavit was insufficient
because Dr. Kemmler, who was an orthopedic specialist, did not state
whether he was familiar with the applicable standard of care for an
emergency medicine physician in the same or similar circumstances as Dr.
Halperin. He also argued that “there is no statement . . . that Dr. Halperin
breached the standard of care,” and “without that . . . it’s insufficient to
create a genuine issue of material fact.” Id. at 15. The trial court granted
both summary judgment motions in favor of Defendants.

   Following an unsuccessful motion to correct error, Korakis appealed.
She argued that Dr. Kemmler’s affidavit created a genuine issue of
material fact and thus the trial court erred in granting summary judgment.
A unanimous Court of Appeals panel rejected this argument and affirmed.
Korakis v. Mem’l Hosp. of S. Bend, 198 N.E.3d 415 (Ind. Ct. App. 2022), reh’g
denied. Korakis then sought transfer, which we granted, 208 N.E.3d 1256
(Ind. 2023), thus vacating the appellate opinion, App. R. 58(A).

Standard of Review
   “We review summary judgment decisions de novo,” and thus apply
“the same standard as the trial court.” Miller v. Patel, 212 N.E.3d 639, 644

Indiana Supreme Court | Case No. 23S-CT-109 | January 25, 2024       Page 5 of 11
(Ind. 2023). Summary judgment is proper 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 a judgment as a matter of
law.” Ind. Trial Rule 56(C). Here, we “draw all reasonable inferences in
the non-moving party’s favor.” Serv. Steel Warehouse Co., L.P. v. U.S. Steel
Corp., 182 N.E.3d 840, 842 (Ind. 2022).

Discussion and Decision
   Defendants, as summary judgment movants, shouldered the initial
burden of establishing the absence of any genuine issue of material fact as
to one element of Korakis’s medical malpractice claims. See Manley v.
Sherer, 992 N.E.2d 670, 673 (Ind. 2013). To set forth a prima facie medical-
malpractice claim, a plaintiff must show “(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.” Siner v. Kindred
Hosp. Ltd. P’ship, 51 N.E.3d 1184, 1187 (Ind. 2016). A “unanimous opinion
of the medical review panel” in favor of the movant is typically enough to
satisfy this threshold burden. Stafford v. Szymanowski, 31 N.E.3d 959, 961
(Ind. 2015). But the non-movant may oppose such an opinion with expert
testimony. Siner, 51 N.E.3d at 1188; see Chi Yun Ho v. Frye, 880 N.E.2d 1192,
1201 (Ind. 2008) (explaining a plaintiff cannot generally prevail without
furnishing “expert opinion that a defendant health care provider’s
conduct fell below the” standard of care). Thus, under our summary-
judgment standard, “expert opinions which conflict on ultimate issues
necessarily defeat summary judgment.” Siner, 51 N.E.3d at 1190.

I.      The applicable standard of care may be inferred.
   To begin, we state our amended rule for medical malpractice affidavits
in Indiana: the applicable standard of care may be inferred, provided the
affidavit contains substantively sufficient information. See Jordan, 609
N.E.2d at 1110. But simply inferring the applicable standard of care is not
enough under our rule: the affidavit must also include “a statement that
the treatment . . . fell below” the standard of care, Oelling, 593 N.E.2d at

Indiana Supreme Court | Case No. 23S-CT-109 | January 25, 2024       Page 6 of 11
190, to constitute an opinion that “takes on the character of an evidentiary
fact” for summary judgment, Chi Yun Ho, 880 N.E.2d at 1201; see also T.R.
56(E) (stating a non-movant must “set forth specific facts”).

   Before we analyze Dr. Kemmler’s affidavit, we recap the history of
medical malpractice expert affidavits in Indiana. The story properly
begins with Oelling, where a plurality of this Court established two
requirements for expert affidavits opposing summary judgment in
medical malpractice actions: an affidavit must (1) “set out the applicable
standard of care” and (2) include “a statement that the treatment . . . fell
below” the applicable standard. 593 N.E.2d at 190. To be sure, the Oelling
affidavit fell short of both conditions. It did not “set out any standard at
all,” nor did it include a statement that the treatment “fell below” the
standard. Id. at 191. Rather, the expert stated generally that he “would
have treated [the patient] differently.” Id. at 190–91. But that statement
was far too amorphous, and so summary judgment was proper. Id.

   Oelling instituted a two-part test for medical expert affidavits. But its
first requirement proved to be the most formative in practice. The phrase
“set out” suggested the applicable standard of care must be expressly
identified. In turn, panels latched onto this rule. See, e.g., Lusk v. Swanson,
753 N.E.2d 748, 753 (Ind. Ct. App. 2001) (finding pulmonologist’s expert
affidavit inadequate to preclude summary judgment for an orthopedic
surgeon where affiant did not “articulate the requisite standard of care”),
trans. denied; Perry v. Driehorst, 808 N.E.2d 765, 770 (Ind. Ct. App. 2004)
(concluding doctor’s deposition testimony about a discogram could not
bar summary judgment because it did not “establish what the standard of
care was”), trans. denied. Oelling thus produced its own line of cases.

   But the story doesn’t end with Oelling. Soon came a new chapter with
Jordan, which involved a medical expert’s affidavit that, along with a copy
of her curriculum vitae, revealed her medical credentials. 609 N.E.2d at
1110. The expert attended medical school in Indiana, was licensed to
practice medicine in the state, and practiced medicine in Gary. Id. She also
stated that “she was familiar with the standard of care at hospitals in
South Bend and Plymouth.” Id. That said, she did not expressly state the
applicable standard of care. Id. In reviewing the contents of the affidavit,

Indiana Supreme Court | Case No. 23S-CT-109 | January 25, 2024         Page 7 of 11
the Court “reluctantly conclude[d]” it was enough “under the facts” in
that case to establish a genuine issue of material fact to defeat summary
judgment. Id. at 1111. The central point of Jordan was that the “lack of
detail” in a medical expert affidavit went to its “weight and credibility,”
not its sufficiency for establishing a genuine issue of material fact. Id.

   Jordan stands for the general view that the opinion from a qualified
expert in a medical malpractice affidavit is enough to infer the applicable
standard of care, provided it has substantively sufficient information. Id.
at 1110. Thus, an express statement of the standard was not required to
defeat summary judgment. Rather, it could be inferred based on the
content in the affidavit. See id. Panels gravitated toward this rule. See, e.g.,
Jones v. Minick, 697 N.E.2d 496, 500 (Ind. Ct. App. 1998) (relying on Jordan
and its progeny to find a genuine issue of fact about the alleged breach in
the standard of care even though the affidavit was “not as thorough as it
could be”), trans. denied; Randolph Cnty. Hosp. v. Livingston, 650 N.E.2d
1215, 1219 (Ind. Ct. App. 1995) (applying Jordan to conclude the doctor’s
“bare assertion that he is familiar with the standard of care of physicians
engaged in abdominal surgery” was enough to bar summary judgment),
reh’g denied, trans. denied. Jordan thus generated its own line of cases.

   And this is where the rubber meets the road. No doubt, tension exists
between Oelling and Jordan. The panel here asked for guidance in
resolving that tension. Korakis, 198 N.E.3d at 422 n.3. Just look at the
intensified split from both case progenies. Compare Lusk, 753 N.E.2d at 753
(applying Oelling), with Jones, 697 N.E.2d at 500 (applying Jordan). Today,
we alleviate that mounting pressure and hold that Oelling’s mandate that
a medical expert affiant expressly “set out the applicable standard of care”
is abrogated. 593 N.E.2d at 190. At the same time, we preserve Oelling’s
directive that a medical expert affiant must include “a statement that the
treatment . . . fell below” the standard of care. Id. Thus, the applicable
standard of care may be inferred, provided the affidavit contains
substantively sufficient information. See Jordan, 609 N.E.2d at 1110. The
affidavit must also include “a statement that the treatment . . . fell below”
the standard of care, Oelling, 593 N.E.2d at 190, to reflect “an evidentiary
fact” for summary judgment, Chi Yun Ho, 880 N.E.2d at 1201.

Indiana Supreme Court | Case No. 23S-CT-109 | January 25, 2024         Page 8 of 11
II.     Dr. Kemmler’s affidavit creates a genuine issue
        of material fact about Dr. Messmer’s alleged
        breach of the applicable standard of care.
   Applying our test, we conclude that Dr. Kemmler’s affidavit creates a
genuine issue of material fact about Dr. Messmer’s alleged breach of the
standard of care. To begin, there is enough information in his affidavit to
infer the applicable standard of care. Two reasons support that conclusion.

    First, medical credentials. Like Jordan, where the expert testified that
she had attended medical school, was licensed to practice medicine, and
currently practiced medicine, 609 N.E.2d at 1110, Dr. Kemmler, a licensed
medical doctor, testified that he “practiced orthopedic medicine for
approximately 25 years,” Appellant’s App. Vol. 2, p. 121. Dr. Kemmler
also testified that he had a vast portfolio of experience where he had
performed “standard of care reviews” in medical malpractice cases. Id.
Thus, he was qualified to testify on the medical treatment here.

   Second, medical judgment. Like Jordan, where the expert stated that she
reviewed the pertinent medical records, 609 N.E.2d at 1111, Dr. Kemmler
reviewed “the relevant x-rays and other medical records,” before
concluding that “Ms. Korakis suffered an occult fracture of her left
elbow,” Appellant’s App. Vol. 2, p. 124. He added that “[t]his fracture can
be observed in the x-rays taken during [her] initial visit to the emergency
room as well as those taken on August 10, 2017.” Id. In light of these facts,
Dr. Kemmler reasoned that “[t]he records also indicate that Dr. Messmer
failed to order additional x-rays of Ms. Korakis’s left elbow when
appropriate.”1 Id. (emphasis added). And that it was his “opinion that Dr.
Messmer should have done more testing prior to placing Ms. Korakis in a
sling and ordering physical therapy.” Id. (emphasis added). Dr. Messmer’s
failure to do so resulted in a “delay in identifying and providing the
appropriate treatment,” which “likely worsened her condition and

1The words “when appropriate,” read in context with the rest of Dr. Kemmler’s affidavit,
allow us to readily infer the standard of care that he concludes was not satisfied.

Indiana Supreme Court | Case No. 23S-CT-109 | January 25, 2024                   Page 9 of 11
contributed to her stiffness, limited range of motion, limited recovery, and
current condition.” Id. In sum, Dr. Kemmler put forth a detailed qualified
judgment about the care Dr. Messmer provided to Korakis.

   For these reasons—the affidavit recites the affiant’s credentials and his
detailed judgment about this case—we are satisfied that his affidavit
contains enough information to enable the court to infer the standard of
care without resorting to “undue speculation.” Overshiner v. Hendricks
Reg’l Health, 119 N.E.3d 1124, 1133 (Ind. Ct. App. 2019), trans. denied.

   Under our test, the affidavit must still contain “a statement that the . . .
treatment fell below” the standard of care. Oelling, 593 N.E.2d at 190; see
also Jordan, 609 N.E.2d at 1111 (requiring a “conclusion” that treatment
“violated the standard of care”). This opinion functions as an “evidentiary
fact” for summary judgment. Chi Yun Ho, 880 N.E.2d at 1201. Otherwise,
courts must speculate about breach. See Oelling, 593 N.E.2d at 190–91
(finding affidavit deficient, in part, because it stated only that the expert
“would have treated” patient differently, not that the doctor’s treatment
“fell below the applicable standard”). Here, Dr. Kemmler concluded: “[I]t
is my opinion that Dr. Messmer [sic] treatment of Ms. Korakis[] fell below
the standard of care.” Appellant’s App. Vol. 2, p. 124. Thus, his affidavit
passes our test and creates a genuine issue of material fact about Dr.
Messmer’s alleged breach of the standard of care. See Jordan, 609 N.E.2d at
1110; Oelling, 593 N.E.2d at 190. Because there is a “conflict of evidence,”
this issue “must be resolved by a trier of fact.” Siner, 51 N.E.3d at 1190. We
therefore reverse summary judgment entered for Dr. Messmer.

Conclusion
   We thus affirm in part and reverse in part.

Rush, C.J., and Slaughter, Goff, and Molter, JJ., concur.

Indiana Supreme Court | Case No. 23S-CT-109 | January 25, 2024        Page 10 of 11
ATTORNEY FOR APPELLANT PENNY KORAKIS
Andrea L. Ciobanu
Ciobanu Law, P.C.
Indianapolis, Indiana

ATTORNEYS FOR APPELLEES MEMORIAL HOSPITAL OF SOUTH
BEND AND DR. MICHAEL R. MESSMER
Robert J. Palmer
David A. Spalding
May Oberfell Lorber
Mishawaka, Indiana

ATTORNEYS FOR APPELLEE DR. DAVID A. HALPERIN
Jason A. Scheele
Ashley M. Gilbert-Johnson
Rothberg Logan & Warsco LLP
Ft. Wayne, Indiana

Indiana Supreme Court | Case No. 23S-CT-109 | January 25, 2024   Page 11 of 11