Court Opinion

ID: 9897382
Source: CourtListenerOpinion
Date Created: 2023-11-14 19:10:52.702059+00
Date Added: 2024-06-11T09:15:45.047293
License: Public Domain

FILED
                                                                            Jun 02 2023, 8:55 am

                                                                                 CLERK
                                                                             Indiana Supreme Court
                                                                                Court of Appeals
                                                                                  and Tax Court

ATTORNEYS FOR APPELLANTS                                    ATTORNEYS FOR APPELLEES
A. Richard M. Blaiklock                                     JANE DOE, JOHN DOE I, AND
Wade D. Fulford                                             JOHN DOE II
Michael D. Heavilon                                         Gabriel A. Hawkins
Lewis Wagner, LLP                                           Gregory L. Laker
Indianapolis, Indiana                                       Cohen & Malad, LLP
                                                            Indianapolis, Indiana

                                                            ATTORNEYS FOR APPELLEE
                                                            BOARD OF TRUSTEES OF
                                                            ANONYMOUS HOSPITAL
                                                            Brian L. Park
                                                            Norris Cunningham
                                                            Michael J. Blinn
                                                            Stoll Keenon Ogden PLLC
                                                            Indianapolis, Indiana

                                                            ATTORNEY FOR APPELLEE
                                                                            1
                                                            JONATHAN CAVINS
                                                            Michael D. Conner
                                                            Spitzer Herriman Stephenson Holderead
                                                            Conner & Persinger, LLP
                                                            Marion, Indiana

1
 Although Appellee Jonathan Cavins has not participated in this appeal, he is nevertheless a party on appeal.
See Ind. Appellate Rule 17(A) (stating that a party of record in the trial court shall be a party on appeal).

Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023                                     Page 1 of 54
                                             IN THE
    COURT OF APPEALS OF INDIANA

Indiana Department of Insurance                            June 2, 2023
and Indiana Patient’s                                      Court of Appeals Case No.
Compensation Fund,                                         22A-CT-1276
Appellants-Defendants,
                                                           Appeal from the
                                                           Boone Circuit Court
        v.
                                                           The Honorable
Jane Doe and John Doe I,                                   Lori N. Schein, Judge
individually and as next friends                           Trial Court Case No.
and legal guardians of John Doe                            06C01-2108-CT-1016
II, an unmarried minor,
Appellees-Plaintiffs,

and

Jonathan Cavins and Board of
Trustees of Anonymous
Hospital,
Appellees-Intervenors.

                  Opinion by Senior Judge Najam
                         Judge Foley concurs.
  Judge Robb concurs in part and dissents in part with separate opinion.

Najam, Senior Judge.

Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023                       Page 2 of 54
      Statement of the Case
[1]   Appellants, the Indiana Department of Insurance and the Patient’s

      Compensation Fund, bring this interlocutory appeal from the trial court’s denial

      of their motion for summary judgment on a claim for excess damages under the

      Medical Malpractice Act (“the Act”) brought by Jane Doe and John Doe I,

      individually and as next friends and legal guardians of John Doe II, an

      unmarried minor (the “Does”). We conclude that there are no genuine issues

      of material fact and that the Fund is entitled to judgment as a matter of law.

      Accordingly, we reverse and remand with instructions.

      Issues
[2]   The ultimate question presented is whether the Does have satisfied the statutory

      prerequisites for access to the Patient’s Compensation Fund. In order to answer

      that question, we must address the following issues:

              I.       Whether a freestanding claim of negligent credentialing
                       can exist where the underlying act of negligence does not
                       constitute medical malpractice under the Act;
              II.      Whether the liability of the health care provider as
                       admitted and established under Indiana Code section 34-
                       18-15-3(5) precludes the Fund from disputing the
                       compensability of a claim for excess damages;
              III.     Whether the doctrines of laches and equitable estoppel can
                       prevent the Fund from contesting compensability of an
                       excess damages claim where the Fund did not intervene
                       before the claimant and the health care provider reached a
                       settlement agreement to which the Fund is not a party; and

      Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023             Page 3 of 54
              IV.      Whether this Court’s opinion in Martinez v. Oaklawn
                       Psychiatric Center, Inc., 128 N.E.3d 549 (Ind. Ct. App.
                       2019), clarified on reh’g, trans. denied, affects the application
                       of the Act in this case.

[3]   First, we hold that an underlying act of medical malpractice is a necessary

      predicate and condition precedent to a medical credentialing malpractice claim.

[4]   Second, we hold that, where the Fund is not a party to a settlement agreement

      between the claimant and the provider and the court must consider the liability

      of the health care provider as “admitted and established,” the Fund is not

      precluded from making an independent determination and may dispute

      whether the underlying conduct is compensable under the Act.

[5]   Third, we hold that the Fund does not have an affirmative duty to intervene in

      settlement negotiations between a claimant and a provider or to address a claim

      for excess damages until the claim has been filed in court. Before such a claim

      is filed, the doctrines of laches and estoppel, on these facts, are unavailable to

      prevent the Fund from disputing the compensability of an excess damage claim

      under the Act.

[6]   And fourth, we conclude that Martinez v. Oaklawn Psychiatric Center, Inc. does not

      affect the resolution of the Does’ claims.

      Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023                     Page 4 of 54
      Facts and Procedural History
[7]   Jonathan Cavins was a pediatrician who was convicted of two counts of felony

      child molesting, one count of felony sexual misconduct with a minor, and two

      counts of felony child seduction for his commission of sexual acts on several

      male teenage patients, including John Doe II, while he was employed at

      Anonymous Hospital. Following Cavins’ convictions, the Does filed a medical

      malpractice action against Cavins and the Hospital. The Does reached a

      confidential settlement with the Hospital in an amount sufficient to permit them

      to petition for excess damages from the Patient’s Compensation Fund. The

      settlement, however, is not final but is contingent upon whether the Does

      obtain access to the Fund.

[8]   The Does then filed this action for additional compensation from the Fund, and

      both the Hospital and Cavins intervened. The Department of Insurance and

      the Fund moved for summary judgment, asserting that the Does’ claims fall

      outside the scope of the Medical Malpractice Act. The trial court denied the
                                                                           2
      motion, and the Department of Insurance and the Fund now appeal.

      2
          We held oral argument in this case on February 8, 2023.

      Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023         Page 5 of 54
       Discussion and Decision
       Standard of Review
[9]    Summary judgment is proper if the evidence shows that there is no genuine

       issue of material fact and that the moving party is entitled to judgment as a

       matter of law. Ind. Trial Rule 56(C); Pike Twp. Educ. Found., Inc. v. Rubenstein,

       831 N.E.2d 1239, 1241 (Ind. Ct. App. 2005). Where, as here, the relevant facts

       are not in dispute, we are presented with a pure question of law for which

       summary judgment disposition is particularly appropriate. Pike Twp. Educ.

       Found., 831 N.E.2d at 1241. We review pure questions of law de novo. Id.

[10]   Indiana’s Medical Malpractice Act was enacted in 1975 and dictates the

       statutory procedures for medical malpractice actions. See Ind. Code §§ 34-18-1-

       1 to 34-18-18-2. The Act defines “malpractice” as “a tort or breach of contract

       based on health care or professional services that were provided, or that should

       have been provided, by a health care provider, to a patient.” Ind. Code § 34-18-

       2-18 (1998). “Health care” is “an act or treatment performed or furnished, or

       that should have been performed or furnished, by a health care provider for, to,

       or on behalf of a patient during the patient’s medical care, treatment, or

       confinement.” Ind. Code § 34-18-2-13 (1998).

[11]   Whether a claim is one of medical malpractice as defined by the Act is a

       question of law to be determined by the court. G.F. v. St. Catherine Hosp., Inc.,

       124 N.E.3d 76, 85 (Ind. Ct. App. 2019), trans. denied. To make that

       determination, we look to the substance of a claim. Metz as Next Friend of Metz v.

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023          Page 6 of 54
       Saint Joseph Reg’l Med. Ctr.-Plymouth Campus, Inc., 115 N.E.3d 489, 495 (Ind. Ct.

       App. 2018). The appropriate analysis involves two steps: (1) a determination

       of whether the alleged negligence involves provision of medical services and (2)

       whether the rendering of medical services was to the plaintiff for the plaintiff’s

       benefit. Doe v. Ind. Dep’t of Ins., 194 N.E.3d 1197, 1201 (Ind. Ct. App. 2022),

       trans. denied.

[12]   The touchstone of a claim of medical malpractice is the “‘curative or salutary

       conduct of a health care provider acting within his or her professional

       capacity.’” Metz, 115 N.E.3d at 495 (quoting Howard Reg’l Health Sys. v. Gordon,

       952 N.E.2d 182, 185 (Ind. 2011)). Claims that come within the purview of the

       Act must be based on “‘the provider’s behavior or practices while acting in his

       professional capacity as a provider of medical services.’” Metz, 115 N.E.3d at

       495 (quoting Robertson v. Anonymous Clinic, 63 N.E.3d 349, 358 (Ind. Ct. App.

       2016), trans. denied).

[13]   On the other hand, excluded from the Act is conduct “‘unrelated to the

       promotion of a patient’s health or the provider’s exercise of professional

       expertise, skill, or judgment.’” Metz, 115 N.E.3d at 495 (quoting Howard Reg’l

       Health Sys., 952 N.E.2d at 185). Actions of health care providers falling outside

       the scope of the Act are those that are “‘demonstrably unrelated to the

       promotion of the plaintiff’s health or an exercise of the provider’s professional

       expertise, skill, or judgment.’” Id. (quoting Howard Reg’l Health Sys., 952

       N.E.2d at 186). The Act is neither all-inclusive for claims against health care

       providers, nor is it intended to be extended to cases of ordinary negligence.

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023          Page 7 of 54
       G.F., 124 N.E.3d at 84. It was designed to curtail, not expand, liability for

       medical malpractice. Id.

       I. Freestanding Claim of Negligent Credentialing
[14]   In this appeal, neither the Does nor the Hospital contend that the negligent

       credentialing claim turns on whether a sexual assault constitutes medical
                        3
       malpractice. And the Fund argues that the Does’ negligent credentialing claim

       against the Hospital is based on a claim that is not compensable under the Act.

       The Fund discusses our decisions in both Winona Memorial Hospital, Ltd.

       Partnership v. Kuester, 737 N.E.2d 824 (Ind. Ct. App. 2000) and Fairbanks

       Hospital v. Harrold, 895 N.E.2d 732 (Ind. Ct. App. 2008), trans. denied, and

       concludes that, without an underlying claim of medical malpractice, a claim of

       negligent credentialing cannot be brought under the Act. More particularly, a

       claim of negligent credentialing cannot proceed under the Act based on just any

       act of negligence; rather, the underlying negligence must constitute medical

       malpractice.

       3
         At oral argument, the Fund asserted that “We all seem to agree that what [Cavins] did was not [medical
       malpractice]” and that “We all agree that what he did was not patient treatment.” See
       https://mycourts.in.gov/arguments/default.aspx?&id=2717&view=detail&yr=2023&when=2&page=1&co
       urt=APP&search=Doe&direction=%20ASC&future=True&sort=&judge=&county=&admin=False&pageSi
       ze=20 [https://perma.cc/JJ79-CJ37] (beginning at 4:44 and 19:49). Neither the Does nor the Hospital
       contested those statements. Instead, the Does argued that when considering a negligent credentialing claim,
       it does not matter whether the underlying claim sounds in medical negligence, provided that the medical
       malpractice element of negligent credentialing is satisfied. Likewise, the Hospital argued that even assuming
       for argument’s sake that a sexual assault does not constitute medical malpractice, where the credentialing
       decision is the proximate cause of the underlying tort, there is a viable medical malpractice claim whether or
       not the tort sounds in medical malpractice.

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023                                  Page 8 of 54
[15]   For their part, the Does allege that the substance of their claim against the

       Hospital constitutes medical malpractice because the credentialing of a doctor,

       which is done by medical professionals, some of whom are required to be

       physicians, is directly related to the provision of health care.

[16]   The Hospital agrees with the Does and further contends that, because the act of

       medical credentialing itself is a provision of health care that comes under the

       Act, any underlying tort caused by negligent credentialing will suffice,

       regardless of whether it constitutes medical malpractice. Stated another way,

       regardless of the nature of the misconduct of the credentialed physician, the

       character and nature of the hospital’s credentialing decision remains a decision

       that required the exercise of professional medical expertise, skill, and judgment

       (i.e., an act that constitutes health care under the Act), which brings the action

       under the Act. The Hospital claims that Winona “did little more than recognize

       that a negligent credentialing claim is a claim of secondary liability” and, for

       that reason, alleges that Fairbanks misapplied Winona when it relied on Winona

       to hold that both the secondary claim of negligent credentialing and the

       underlying act of negligence that gives rise to it must constitute medical

       malpractice. Intervenor Hospital’s Br. p. 11. In addition, the Hospital

       distinguishes Fairbanks from the present case by the fact that it involved the

       negligent supervision of a hospital employee rather than the negligent

       credentialing of a doctor.

[17]   In Winona, we held that a claim for negligent credentialing of a doctor is an

       action for malpractice subject to the Act and that “[t]he credentialing process

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023           Page 9 of 54
       alleged must have resulted in a definable act of medical malpractice that

       proximately caused injury to [the plaintiff] or [the plaintiff] is without a basis to

       bring the suit for negligent credentialing.” 737 N.E.2d at 828. And we said

       that “both alleged negligent acts” are “required to recover (i.e., both the

       credentialing and the malpractice).” Id. (emphasis added).

[18]   Eight years later in Fairbanks, we were called upon to decide whether a claim of

       negligent supervision of a hospital employee fell within the Act if the

       underlying tort by the employee was unwanted sexual advances. We deemed

       Winona to be dispositive of the issue and stated:

               We thus learn from Winona that a medical malpractice action
               cannot become completely unmoored from the provision of what
               our case law has established is the very essence of health care,
               i.e., “conduct, curative or salutary in nature, by a health care
               provider acting in his or her professional capacity[.]” This is
               especially true where, as here, the patient is required to prove
               more than one layer—or multiple acts—of tortious conduct in
               order to prevail. It is for this reason that the court held in Winona
               that it availed the patient nothing to prove that Winona was
               negligent in credentialing the physician in question if the patient
               did not also prove that said physician’s negligence in rendering
               health care services was a proximate cause of the patient’s harm.
               In other words, both allegedly tortious acts that comprised the patient’s
               claim of malpractice must sound in medical malpractice and not merely
               ordinary negligence.

       Fairbanks, 895 N.E.2d at 738 (cleaned up) (emphasis added). We therefore

       concluded that both claims—sexual misconduct by Fairbanks’ employee and

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023              Page 10 of 54
       Fairbanks’ negligent supervision of the employee—must sound in medical

       malpractice in order for the action to come within the Act’s purview. Id.

[19]   While we acknowledge the distinction between the negligent hiring, training,

       and supervision of a hospital employee and the negligent credentialing of a

       doctor, we conclude that Fairbanks correctly applied Winona and, in any event,

       this distinction does not affect our analysis in this case. And we cannot agree

       with Hospital’s view that any tort will do, that a negligent credentialing claim is

       a freestanding claim, and that “it makes no difference” whether the underlying

       claim sounds in medical negligence. Intervenor Hospital’s Br. p. 15. This is an

       argument that finds no support in our case law; rather, the case law is clear that

       an underlying act of medical malpractice is the predicate and condition

       precedent for a negligent credentialing claim. Indeed, relying on Winona, in

       Martinez v. Park, we succinctly and unambiguously stated that “Without a

       showing of an underlying breach of the standard of care by Dr. Park

       proximately causing Martinez’s injuries, the Healthcare Center cannot be liable

       for the negligent credentialing of him.” 959 N.E.2d 259, 272 (Ind. Ct. App.

       2011).

[20]   Just as we did in Fairbanks, we conclude here that “a medical malpractice action

       cannot become completely unmoored from the provision of what our case law

       has established is the very essence of health care . . . .” 895 N.E.2d at 738.

       Thus, we hold once again that negligent credentialing is a secondary claim of

       liability that requires two negligent acts: (1) an underlying act of negligent

       health care by a credentialed physician and (2) negligence by the hospital in

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023         Page 11 of 54
       credentialing the physician. In order to state a claim that comes within the

       purview of the Act, and thus confer access to the Fund, both acts must

       constitute medical malpractice. A plaintiff cannot assert a claim of negligent

       credentialing to bootstrap and convert a common law negligence claim into

       statutory medical malpractice. In this case, the Does’ claim against the

       Hospital is tantamount to a common law tort of negligent hiring and retention

       akin to the claims asserted in Fairbanks. Given that this Court has consistently

       held that sexual misconduct is unrelated to the promotion of a patient’s health
                                                                     4
       and does not constitute medical malpractice, Cavins’ misconduct here

       constitutes ordinary negligence, not medical malpractice, and thus the Does’

       secondary claim of negligent credentialing cannot come within the purview of

       the Act.

[21]   The dissent advocates for a radical departure from Indiana caselaw, which

       makes clear that conduct “‘demonstrably unrelated to the promotion of the

       [patient]’s health’” falls outside the scope of the Act. Metz, 115 N.E.3d at 495

       4
         See, e.g., Doe, 194 N.E.3d 1197 (tort claim arising from sexual assault by nurse while patient was
       hospitalized did not fall within purview of the Act); Fairbanks, 895 N.E.2d 732 (claims based on hospital
       employee’s unwanted sexual advances toward patient did not to fall under the Act); Grzan v. Charter Hosp. of
       Nw. Ind., 702 N.E.2d 786 (Ind. Ct. App. 1998) (mental health counselor’s conduct of engaging in emotional
       and sexual relationship with patient did not fall within scope of the Act); Murphy v. Mortell, 684 N.E.2d 1185
       (Ind. Ct. App. 1997) (hospital employee’s act of molesting patient did not constitute rendition of health care
       or professional services, was not designed to promote patient’s health, and did not call into question
       employee’s use of skill or expertise as a health care provider; thus, patient’s claim sounded in general
       negligence and did not fall within purview of the Act), trans. denied; Doe by Roe v. Madison Ctr. Hosp., 652
       N.E.2d 101 (Ind. Ct. App. 1995) (coerced sexual intercourse between minor patient and hospital employee
       held not to fall under the Act), trans. dismissed.

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023                                 Page 12 of 54
       (quoting Howard Reg’l Health Sys., 952 N.E.2d at 186). If adopted, the dissent’s

       reasoning would vastly expand liability for statutory medical malpractice claims

       to include criminal acts—a result disavowed by our precedent and clearly not

       contemplated or intended by our legislature. See, e.g., G.F., 124 N.E.3d at 84.

       We decline to take that path.

[22]   The dissent cites our holding in Winona that “a claim for negligent credentialing

       of a physician is an action for malpractice subject to the Act” but disregards our

       declaration in the same case that “the Act applies to conduct [that is] curative

       or salutary in nature.” 737 N.E.2d at 828. Here, Cavins’ criminal conduct is

       unrelated to the promotion of the patient’s health and not curative or salutary in

       nature. A sexual assault will not support a medical malpractice claim because a

       sexual assault does not constitute the practice of medicine. Rather, a sexual

       assault is a crime that occupies a different realm than medical negligence. The

       fact that the crime occurs within the context of a doctor-patient relationship

       does not alter the essence of the crime or transform the crime into medical

       malpractice. In this case, the physician’s misconduct cannot be characterized

       as “health care or professional services that were provided, or that should have

       been provided, by a health care provider, to a patient.” See Ind. Code § 34-18-

       2-18 (defining “malpractice”). Thus, the sexual assault underlying the claim

       does not satisfy the statutory definition of medical malpractice.

       II. Effect of Indiana Code § 34-18-15-3(5)
[23]   The Does additionally argue that the Fund cannot challenge their negligent

       credentialing claim against the Hospital because it is “established” as a matter
       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023        Page 13 of 54
       of law as a result of their settlement agreement. To support this argument, the

       Does cite Indiana Code section 34-18-15-3(5) (2017), which provides: “In

       approving a settlement or determining the amount, if any, to be paid from the

       patient’s compensation fund, the court shall consider the liability of the health

       care provider as admitted and established.”

[24]   The Does conflate two distinct concepts: “factual compensability” and “legal

       compensability.” In Robertson v. B.O., our Supreme Court distinguished

       between a provider’s underlying liability for negligence (“factual

       compensability”) and compensability from the Fund (“legal compensability”).

       977 N.E.2d 341, 347 (Ind. 2012). The Court explained that, under Indiana

       Code section 34-18-15-3(5), the question of factual compensability is foreclosed

       when a plaintiff settles with a health care provider. Id. at 347-48. However,

       such a settlement does not preclude the Fund from contesting the legal

       compensability of the claimed injury as one that is not compensable under the

       Act and therefore also not subject to a claim for excess damages from the Fund.

       Id.

[25]   In Cutchin v. Ind. Dep’t of Ins., 446 F. Supp. 3d 413, 420-21 (S.D. Ind. 2020),

       rev’d and remanded sub nom. on other grounds, Cutchin v. Beard, 854 F. App’x 86

       (7th Cir. 2021), we find an excellent discussion of the distinction our Supreme

       Court articulated in Robertson. Plaintiff Cutchin attempted the same argument

       as the Does proffer here. After reaching a settlement agreement with providers,

       Cutchin sought excess damages from the Fund. The Fund argued the Act did

       not apply to Cutchin’s claim. Citing the same statutory language as the Does,

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023         Page 14 of 54
       Cutchin argued the Fund was foreclosed from contesting the applicability of the

       Act and therefore the Fund’s liability for excess damages. He asserted that the

       language of Indiana Code section 34-18-15-3(5) unequivocally establishes the

       Fund’s liability when a health care provider settles a claim with a claimant.

[26]   The court rejected Cutchin’s claim and explained that his settlement with the

       provider established the liability of only the health care provider, not the

       liability of the Fund. The court pointed to the plain language of the statute that

       states: “the court shall consider the liability of the health care provider as

       admitted and established.” Ind. Code § 34-18-15-3(5) (emphasis added). The

       court thus distinguished between a challenge to the liability of a health care

       provider, which the Fund cannot do after settlement between the plaintiff and

       the provider, and a challenge to the applicability of the Act, which the Fund

       may do even when a settlement has occurred. Accordingly, the court in Cutchin

       concluded that the settlement between Cutchin and the providers did not

       foreclose the Fund from challenging the applicability of the Act and did not

       establish the Fund’s liability. Considering the Does’ argument on this issue, we

       agree with and adopt the reasoning set forth in Cutchin. We therefore conclude

       that the settlement agreement between the Does, the Hospital, and Cavins

       established only the liability of Cavins and the Hospital (per Robertson, the

       “factual compensability”) and does not preclude the Fund from challenging the

       applicability of the Act (per Robertson, the “legal compensability”) to the claims

       of the Does.

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023             Page 15 of 54
       III. Laches and Estoppel
[27]   The Hospital contends the equitable doctrines of laches and estoppel should be

       applied to preclude the Fund from challenging the applicability of the Act to the

       Does’ claim. Particularly, the Hospital alleges the Fund should have contested

       the Does’ claim to excess damages sooner than it did. We cannot agree.

[28]   The parties to a medical malpractice claim cannot bind the Fund, a non-party,

       by an adjudication or stipulation establishing the health care provider’s factual

       liability in negligence. As we discussed in Issue II, a settlement establishing a

       provider’s factual liability does not necessarily establish whether the claim is

       covered under the Act or the Fund’s liability for excess damages. Rather, the

       Fund is permitted to make an independent determination of whether a claim for

       excess damages is based upon a claim covered by the Act, and the Fund’s

       responsibility in this regard is not ripe until a claim for excess damages is made.

       See Ind. Code § 34-18-15-3(1) (if plaintiff demands damages in excess of

       provider’s policy limits, plaintiff must file petition in court demanding payment

       from the Fund); -3(2) (petition must contain sufficient information to inform

       parties about nature of claim and amount demanded, and plaintiff must serve

       petition on commissioner (administrator of Fund)); -3(3) (commissioner may

       object to demand); -3(5) (at hearing on petition and objections, court shall hear

       evidence to determine amount, if any, to be paid from the Fund). Until such

       time as a petition demanding payment of damages from the Fund is filed under

       Subsection 34-18-15-3(1), the Fund is not required to participate in settlement of

       the plaintiff’s claim or to intervene in the plaintiff’s action. Accordingly, the

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023          Page 16 of 54
       Fund cannot be faulted for not having indicated or made an excess damages

       determination before the plaintiff’s petition for excess damages has been filed

       and triggers the Fund’s statutory responsibility to weigh in. It is the plaintiff’s

       burden to show he or she has met the statutory prerequisites under Section 34-

       18-15-3 in order to petition the Fund for excess damages. McCarty v. Walsko,

       857 N.E.2d 439, 443 (Ind. Ct. App. 2006).

[29]   Although the Hospital raises the defense of laches, it fails to address any of the

       elements that would establish that defense. The Hospital also fails to establish

       its equitable estoppel claim. The Hospital contends that the parties were

       harmed by the Fund’s “after-the-fact challenge to settlement,” that the Fund

       had been on notice of the claim for years, and that the settlement agreement

       was reached in “detrimental reliance” on the Fund’s silence, where the Fund

       had the “opportunity to intervene and elected not to.” Intervenor Hospital’s Br.

       p. 16. The reliance element of estoppel has two parts: (1) reliance in fact and

       (2) right to rely. Wabash Grain, Inc. v. Smith, 700 N.E.2d 234, 237 (Ind. Ct.

       App. 1998), trans. denied. The parties’ settlement agreement is expressly

       conditioned upon whether the Fund “successfully rejects” the agreement and

       the Does’ petition for excess damages, in which event the agreement “shall be

       null and void.” See Appellants’ App. Vol. IV, p. 48, ¶ 16.1. Having anticipated

       that the Fund could well dispute an excess damages claim, the parties cannot

       now be heard to complain that they relied in fact on the Fund’s silence and

       were blindsided when the Fund did just that. And, as we have said, because the

       Fund had no duty to intervene in the parties’ settlement negotiations, the

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023           Page 17 of 54
       parties had no right to rely on the Fund’s alleged failure to participate in those

       negotiations.

[30]   We conclude, therefore, that the doctrines of laches and estoppel do not apply

       on these facts. And where the Fund is not a party to a settlement agreement

       between the claimant and the provider, the Fund has no affirmative duty to

       address a claim for excess damages until a claimant has filed a petition in court

       demanding payment of damages from the Fund.

       IV. Application of Martinez v. Oaklawn Psychiatric Center
[31]   As we have seen, the ultimate question presented here is whether the Does are

       entitled to claim excess damages from the Fund based upon their negligent

       credentialing claim against the Hospital. In considering that question, the

       parties have addressed whether this Court’s opinion in Martinez v. Oaklawn

       Psychiatric Center affects application of the Act in this case.

[32]   Martinez announced a new “current test” for evaluating medical malpractice

       claims based upon the employment law concept of scope of employment and

       the doctrine of respondeat superior. 128 N.E.3d at 558. Specifically, Martinez

       stated that the test for whether the Act applies to specific misconduct is

       “whether that misconduct arises naturally or predictably from the relationship

       between the health care provider and patient or from an opportunity provided

       by that relationship.” Id. However, as discussed below, we did not apply that

       test in Martinez, and the holding in Martinez did not deviate from established

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023         Page 18 of 54
       case law on the scope of the Act. See Doe, 194 N.E.3d at 1204 (stating that “the

       Martinez court essentially applied the accepted and longstanding standard”).

[33]   Instead, Martinez reiterated and applied the well-established standard for

       conduct covered by the Act, namely, that “The Act covers ‘curative or salutary

       conduct of a health care provider acting within his or her professional capacity,

       but not conduct unrelated to the promotion of a patient’s health or the

       provider’s exercise of professional expertise, skill, or judgment.’” Id. at 556

       (quoting Terry v. Cmty. Health Network, Inc., 17 N.E.3d 389, 393 (Ind. Ct. App.

       2014)). We also recognized the long-standing rule that “When deciding

       whether a claim falls under the provisions of the Medical Malpractice Act, we

       are guided by the substance of a claim to determine the applicability of the

       Act.” Martinez, 128 N.E.3d at 556. And we confirmed that in determining

       whether a claim sounds in medical malpractice, “we consider whether the claim

       is based on the provider’s behavior or practices while acting in his professional

       capacity as a provider of medical services.” Id.

[34]   In Martinez, the employee’s scope of employment and the employer’s vicarious

       liability were not at issue. Doe, 194 N.E.3d at 1203 n.5. We noted that “[t]he

       parties agree that [the employee] was an employee of Oaklawn, a ‘health care

       provider,’ and when the incident occurred, [the employee] was acting within

       the scope of his employment.” Martinez, 128 N.E.3d at 556. And we

       concluded, “The undisputed record establishes that Oaklawn is a healthcare

       provider and [the employee] is, and was at the time of the incident at issue in

       this case, its employee.” Id. at 562. Thus, the holding in Martinez did not turn

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023          Page 19 of 54
       on whether or not the residential assistant was employed by Oaklawn, and it

       was also undisputed that the assistant’s conduct “was a part of Oaklawn’s

       provision of healthcare to Martinez.” Id.

[35]   Here, just as in Martinez, scope of employment and vicarious liability are not at

       issue. We acknowledge, of course, that in a given case, a health care provider’s

       scope of employment may be relevant and potentially dispositive in making an

       employer liability determination under the Act, but this is not the case.

[36]   In sum, in Martinez we did not apply the “current test.” Doe, 194 N.E.3d at

       1204. Rather we concluded both that Oaklawn’s employee was acting within

       the scope of his employment with Oaklawn, a health care provider, and that the

       employee’s “attempt to enforce Martinez’s curfew was a part of Oaklawn’s

       provision of healthcare to Martinez.” Martinez, 128 N.E.3d at 562. In other

       words, we held that the alleged medical malpractice fell squarely within the

       well-established purview of the Act. While we stated that we would “apply [the

       current] test to the facts and circumstances of this case” and alluded to “the

       broadened scope of employment set forth in” Cox v. Evansville Police Dep’t, 107

       N.E.3d 453 (Ind. 2018), we did not apply the “current test” to any conduct not

       already within the recognized scope of the Act. Martinez, 128 N.E.3d at 558,

       562. A close reading of Martinez shows that the test was not a factor and was

       not dispositive. Instead, in Martinez we followed—and did not broaden or

       otherwise deviate from—well-established medical malpractice case law. Thus,

       we conclude that the actual holding in Martinez does not affect the application

       of the Act in this case.

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023        Page 20 of 54
       Conclusion
[37]   Based upon the foregoing, we hold that an underlying act of medical

       malpractice which is a proximate cause of the patient’s harm is a necessary

       predicate and condition precedent to a medical credentialing malpractice claim.

       We also hold that, where the Fund is not a party to a settlement agreement

       between the claimant and the provider and the court must consider the liability

       of the health care provider as “admitted and established,” the Fund is not

       precluded from making an independent determination and disputing whether

       the underlying conduct is compensable under the Act. Finally, we conclude

       that the Fund has no affirmative duty to intervene in settlement negotiations

       between the claimant and the provider or to address a claim for excess damages

       until a claimant has filed a petition in court for payment of damages from the

       Fund. Accordingly, we find there are no genuine issues of material fact, and

       the Fund is entitled to judgment as a matter of law.

[38]   Reversed and remanded with instructions for the trial court to enter summary

       judgment in favor of the Fund.

       Foley, J., concurs.

       Robb, J., concurs in part and dissents in part with separate opinion.

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023        Page 21 of 54
       Robb, J., concurring in part and dissenting in part.

[39]   I concur in Parts II, III, and IV of the majority opinion. As to Part I, I

       respectfully dissent. The Fund has asked this court to decide, first, if this act of

       sexual abuse of a minor by a doctor that occurred during an appointment with

       the victim patient sounds in medical malpractice and, second, whether a claim

       of negligent credentialing can only occur when the underlying misconduct is

       one of medical malpractice. The Fund takes the position that the Does’ claim

       for excess damages from the Fund cannot stand absent a claim of medical

       malpractice. According to the Fund, Cavins’ sexual abuse of his minor patient

       did not amount to medical malpractice and negligent credentialing is not a

       standalone claim.

[40]   The majority mischaracterizes the dissent’s position in issue one in calling it a

       “radical” departure from Indiana caselaw. --- N.E.2d ---, --- (Ind. Ct. App.

       2023). As explained and demonstrated in detail below, the dissent’s position is

       consistent with other state jurisdictions that have answered the question before

       us.

[41]   As to the second issue, I disagree with the majority’s conclusion that the

       commission of patient sexual abuse by a health care provider during treatment

       of the patient precludes a medical malpractice claim. First, as stated above, we

       believe the caselaw supports the conclusion that this molest sounds in medical

       malpractice and provides the condition precedent that even the majority seeks.

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023          Page 22 of 54
[42]   Second, the majority concedes that negligent credentialing does not require an

       underlying act of medical malpractice misconduct which is consistent with the

       law. And, a claim for negligent credentialing is an action for malpractice
                                   5
       subject to the Act. Winona Mem’l Hosp., Ltd. P’ship v. Kuester, 737 N.E.2d 824,

       828 (Ind. Ct. App. 2000). Since a negligent-credentialing claim, in and of itself,

       falls within the Act, even if the molest in the instant case is not found to fall

       within the Act, the negligent credentialing is supported by a sufficient act of

       misconduct and the medical malpractice nature of the negligent-credentialing

       claim supports the Appellees’ right to obligate the Fund.

[43]   To prevail, the Fund has to win under both issues. If the Fund loses under

       either, the Fund cannot prevail. However, under the facts and circumstances of

       this case, the Fund loses under both issues because (1) the sexual abuse Cavins

       perpetrated on his young victim was medical malpractice that falls under the

       Act; and (2) as all parties agree, a negligent-credentialing claim is a medical

       malpractice question, but it is not necessary to have an underlying medical

       malpractice claim per se to support a claim for negligent credentialing – a

       nonmedical malpractice bad act can support a negligent-credentialing claim.

       Thus, the Fund’s potential obligation to pay excess damages to the Does is

       supported by both issues. And, the trial court’s determination that the Fund’s

       5
           See ¶¶ 18-22, infra, for a discussion of the distinction between the terms “credentialing” and “privileging.”

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023                                      Page 23 of 54
       summary judgment motion on a claim for excess damages should be denied is

       supported by the law.

[44]   Because this is a case of first impression, it presents a unique circumstance

       where we are tasked with addressing a negligent-credentialing claim where a

       pediatrician administering a physical examination to a minor – that included

       discussion and instruction on the use of condoms – sexually abused the patient

       by stroking and then placing a condom on the patient’s penis. Prior Indiana

       cases have, in the medical malpractice context, addressed situations where a

       patient was sexually abused by a medical professional while healthcare or

       medical treatment was administered to the patient. However, none of those

       cases quite replicates the facts as presented in the instant case.

[45]   In reaching its determination – that the Does’ negligent-credentialing claim

       against the Hospital fails for lack of an underlying act of medical malpractice as

       a necessary predicate and condition precedent – the majority begins and ends its

       analysis with whether Cavins’ misconduct constitutes medical malpractice.

       And the majority concludes that, based on legal precedent, Cavins’ misconduct

       does not. Therefore, the majority has determined, the negligent-credentialing

       claim fails because there is no underlying medical malpractice on the part of the

       doctor; there are no genuine issues of material fact; the Fund is entitled to

       judgment as a matter of law; and, thus, summary judgment should be entered in

       favor of the Fund. However, with this holding, the majority has essentially

       foreclosed negligent-credentialing claims in every circumstance where sexual

       abuse occurs during medical treatment.

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023         Page 24 of 54
[46]   I begin with the determination that first and foremost, the sexual abuse that

       Cavins perpetrated on his young patient during the physical examination did

       constitute medical malpractice. Second, even if the bad act did not rise to the

       level of medical malpractice, the alleged negligent-credentialing claim,

       nevertheless, survives – not as a free-standing claim but based on misconduct on

       the part of the health care provider that results in underlying liability. Thus, it

       is possible that nonmedical misconduct may trigger an inquiry on the part of the

       patient into the credentialing process – in this case, an inquiry into whether the

       Hospital should have extended privileges to Cavins. And because the sexual

       abuse in question falls under the Act, under either issue, supra, the Does’

       negligent-credentialing claim stands.

[47]   If we approach such claims as the majority instructs, then we risk running afoul

       of the purpose of the Act – that is, to facilitate the adjudication and settlement

       of alleged medical malpractice claims. And we open the door to the risk that

       health care providers will wrongly prevail on summary judgment; viable claims

       of negligent credentialing will be lost; and the real issue presented will never be

       reached.

[48]   Additionally, I note that in this case, the confidential settlement reached

       between the Does and the Hospital necessarily eclipsed a summary judgment

       factfinding inquiry that could have uncovered any facts that might support

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023          Page 25 of 54
                                                                                  6
finding that Cavins did in fact commit medical malpractice. However, even

under these circumstances, the majority posits that, in cases such as this, where

sexual abuse occurs during medical treatment, there is no set of material facts

that can bring the Does’ claims under the Act. The majority has cast its net too

wide because:

1.       The majority assumes, even under circumstances where the development

         of potential material facts has not occurred, that an act of sexual abuse of

         a patient during medical treatment can never amount to medical

         malpractice – a notion which is foundationally unsound because it

         pronounces, ipso facto, that there can never be medical malpractice

         under circumstances where a health care provider commits sexual abuse

         while providing medical treatment.

2.       The majority has made a determination, as a matter of law, that

         henceforth there can be no set of circumstances where a health care

         provider who, during medical treatment, sexually abuses a patient

         commits medical malpractice, and, the majority, essentially, precludes in

         Indiana any such claim from rising to the level of medical malpractice.

6
 The Does and the Hospital are, essentially, aligned on appeal. As the majority notes, the Does reached a
confidential settlement with the Hospital in an amount sufficient to permit the Does to petition for excess
damages from the Fund. However, the settlement is not final, as it is contingent upon whether the Does
obtain access to the Fund.

Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023                                Page 26 of 54
[49]   Furthermore, according to the majority, a negligent-credentialing claim does

       not require the underlying misconduct to constitute medical malpractice. But

       even absent the majority’s concession, the appropriate conclusion in this case is

       that the trial court properly denied the Fund’s summary judgment motion, and

       the law supports this.

[50]   In sum, and as further explained below, the majority’s holding is a bridge too

       far and produces unintended and far-reaching consequences that not only

       undermine the purpose and intent of the Act but also foreclose the possibility

       that in certain circumstances sexual abuse that occurs during medical treatment

       can rise to the level of medical malpractice.

       Purpose of the Act

[51]   Since its enactment in 1975, the Act has dictated the statutory procedures

       for medical malpractice actions. See Ind. Code § 34-18-1-1 et seq. “One of the

       principal legislative purposes behind the [Act] . . . was to foster prompt

       litigation of medical malpractice claims.” Ellenwine v. Fairley, 846 N.E.2d 657,

       664 (Ind. 2006). As we reasoned in Sue Yee Lee v. Lafayette Home Hosp.,

       Inc., “Viewed from the historical perspective[,] 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 [A]ct.” 410 N.E.2d

       1319, 1324 (Ind. Ct. App. 1980). It is well-settled that a claim for negligent

       credentialing of a physician is an action for malpractice subject to the Act.

       Winona, 737 N.E.2d at 828. And with any complaint alleging medical

       malpractice, the plaintiff’s action begins under the premise that the health care
       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023         Page 27 of 54
       provider’s misconduct falls within the Act until a medical review panel or a
                                              7
       court determines otherwise.

[52]   However, as a prerequisite to filing suit in court, the Act generally requires

       claimants to file a proposed complaint with a medical review panel. Ind. Code

       § 34-18-8-4. The complaint is then reviewed by the panel, which provides an

       expert opinion about whether the claim involves malpractice, thus ensuring that

       in cases where a party seeks recovery from the Fund, it is only those cases that

       appropriately fall within the confines and further the purpose of the Act that
                           8
       remain viable. Ind. Code § 34-18-10-22. The Act limits recovery against

       7
         The elements of a medical malpractice claim are: (1) the medical provider owed a duty to the plaintiff; (2)
       the medical provider failed to conform his or her conduct to the requisite standard of care; and (3) an injury
       to the plaintiff resulted from that failure. Glon v. Mem’l Hosp. of S. Bend, Inc., 111 N.E.3d 232, 239 (Ind. Ct.
       App. 2018), trans. denied. The plaintiff must present expert medical testimony establishing: (1) the applicable
       standard of care required by Indiana law; (2) how the defendant medical provider breached that standard of
       care; and (3) that the medical provider’s negligence in doing so was the proximate cause of the injuries
       complained of. Id.
       8
         Although limited exceptions apply, generally speaking, an action against a health care provider may not be
       commenced in an Indiana court before (1) the complaint has been presented to a medical review panel and
       (2) an opinion is given by the panel. Ind. Code § 34-18-8-4. “‘When a medical review panel renders an
       opinion in favor of the physician, the plaintiff must come forward with expert medical testimony to rebut the
       panel’s opinion . . . .’” Overshiner v. Hendricks Reg’l Health, 119 N.E.3d 1124, 1132 (Ind. Ct. App. 2019)
       (quoting Robertson v. Bond, 779 N.E.2d 1245, 1249 (Ind. Ct. App. 2002), trans. denied), trans denied. “Because
       of the complex nature of medical diagnosis and treatment, expert testimony is generally required to establish
       the applicable standard of care.” Desai v. Croy, 805 N.E.2d 844, 850 (Ind. Ct. App. 2004) (citing Simms v.
       Schweikher, 651 N.E.2d 348, 349-50 (Ind. Ct. App. 1995)), trans denied. “If medical expert opinion is not in
       conflict regarding whether the physician’s conduct met the requisite standard of care, there are no genuine
       triable issues.” Id.
       In limited instances, however, expert opinion evidence may not be required because the doctrine of res ipsa
       loquitur applies. This doctrine recognizes that the circumstances surrounding an injury may be such as to
       raise a presumption, or at least permit an inference, of negligence on the part of the defendant, despite
       the medical review panel’s opinion to the contrary. St. Mary’s Ohio Valley Heart Care, LLC v. Smith, 112
       N.E.3d 1144, 1150 (Ind. Ct. App. 2018), trans. denied.

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023                                  Page 28 of 54
       covered medical providers and allows any excess damages to be paid out of the

       Fund. Ind. Code § 34-18-14-3.

       Duty Hospital Owes to Patients

[53]   Hospitals owe their patients a duty to exercise reasonable care in rendering

       hospital services, which includes a duty to safeguard the welfare of

       its patients from harm inflicted by third persons. See generally 41

       C.J.S. Hospitals § 35. The essence of the general duty of care owed to patients

       by a hospital is to provide patients with an environment where their health and

       safety needs can best be addressed. Id. A broad general duty of care can

       include numerous specific activities, such as compliance with applicable

       hospital administration standards, the existence of an adequate quality

       assurance program, and the proper training and supervision of hospital staff. Id.

[54]   Regarding the tort of negligent credentialing, “[a] hospital always has a duty to

       exercise reasonable care in granting privileges to physicians.” Rieder v. Segal,

       959 N.W.2d 423, 429 (Iowa 2021). As noted in Brookins v. Mote, where the

       Montana Supreme Court recognized negligent credentialing as a valid cause of

       action in Montana,

               [T]he rise of the “modern hospital” imposed a duty on hospitals
               to take steps to ensure patient safety in the process of
               accreditation and granting privileges:
                        [T]he integration of a modern hospital becomes readily
                        apparent as the various boards, reviewing committees, and
                        designation of privileges are found to rest on a structure
                        designed to control, supervise, and review the work within

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023         Page 29 of 54
                        the hospital. The standards of hospital accreditation . . .
                        demonstrate that the medical profession and other
                        responsible authorities regard it as both desirable and
                        feasible that a hospital assume certain responsibilities for
                        the care of the patient.

       2012 MT 283 at ¶ 58, 367 Mont. 193, 211, 292 P.3d 347, 360 (2012) (quoting

       Hull v. N. Val. Hosp., 159 Mont. 375, 389, 498 P.2d 136, 143 (1972)).

[55]   A hospital’s governing board “is the supreme authority in the hospital[,]” and

       that board is responsible for the management, operation, and control of

       the hospital; the appointment, reappointment, and assignment of privileges to

       members of the medical staff; and establishment of requirements for

       appointments to and continued service on the hospital’s medical staff. Ind.

       Code § 16-21-2-5. Under Indiana Code section 16-21-2-7, the medical staff of a

       hospital is responsible to the governing board for the following:

               (1) The clinical and scientific work of the hospital.

               (2) Advice regarding professional matters and policies.

               (3) Review of the professional practices in the hospital for the
               purpose of reducing morbidity and mortality and for the
               improvement of the care of patients in the hospital, including the
               following:

                        (A) The quality and necessity of care provided.

                        (B) The preventability of complications and deaths
                        occurring in the hospital.

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023                Page 30 of 54
       Credentialing and Extending Hospital Privileges to Physicians

[56]   Another way in which hospitals protect patients from harm is through the

       credentialing and privileging processes. In this case, the parties to this appeal

       use the terms “credentialing” and “privileging” interchangeably. However, our

       focus here is on privileging, not credentialing. And although the terms are

       closely related, they do refer to distinct concepts, but that distinction has not

       been used by the parties to this appeal in any of their arguments.

       “Credentialing” refers to the process of determining whether a doctor is

       qualified to be on the medical staff. See, e.g., Hall v. Jennie Edmundson Mem’l

       Hosp., 812 N.W.2d 681, 683 n.1 (Iowa 2012). “Privileging” refers to the

       determination by the hospital as to which specific procedures a doctor will be

       allowed to perform within the hospital. Id.

[57]   More specifically, credentialing is the process in which a physician’s credentials

       are verified; is a way to confirm that the physician graduated from medical

       school and received their certification; and ensures that a physician has a

       license to practice medicine in their specialty and in their state. Justin Nabity,

       Hospital Credentialing: What to Expect as a Physician (Nov. 4, 2022),

       https://physiciansthrive.com/hospital-credentialing/ [https://perma.cc/J993-

       S2BC] (last visited May 15, 2023). Credentialing is important because it is the

       healthcare industry’s best way to protect patients by ensuring that patients

       receive high-quality care from physicians who have met state licensure and

       certification requirements. Id. Credentialing is the first step in gaining

       employment as a physician and is a prerequisite for obtaining privileges. Id.

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023          Page 31 of 54
       And physicians must go through the process of credentialing before they can

       apply for hospital privileges. Id.

[58]   Privileges, on the other hand, permit physicians to treat and perform certain

       procedures on patients, and without those privileges, a physician cannot treat

       patients in a hospital setting. Id. The privileging process centers on the

       physician’s scope of practice related specifically to patient care and ensures that

       a physician has experience and competency in their specialty or area of

       medicine. Id.

[59]   Simply put, medical credentialing allows healthcare practices to confirm the

       qualifications of their healthcare professionals, while privileging ensures that

       physicians have the experience and clinical competency necessary, within their

       area of medicine, to care for patients. The Privileging Puzzle: Requirements for

       Providers and Organization (Jan. 10, 2023),

       https://www.healthstream.com/resource/blog/the-privileging-puzzle-

       requirements-for-providers-and-organizations [https://perma.cc/Q5MN-44FH]

       (last visited May 15, 2023). And to protect patients, hospitals must adhere to

       complex and lengthy credentialing and privileging processes to screen

       physicians, verify their ability to practice, and determine which procedures and

       services a physician is competent to perform and deliver. Jan Laws, Federal

       Regulations & Other Standards for Credentialing and Privileging (May 17, 2021),

       https://www.symplr.com/blog/federal-regulations-other-standards-for-

       credentialing-and-privileging [https://perma.cc/S2KT-U2UB] (last visited May

       15, 2023). Although details of the credentialing and privileging processes vary

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023          Page 32 of 54
       depending upon the hospital, location, medical specialties, and particular

       circumstances involved, the processes typically involve numerous steps, such

       as:

               Providing and keeping updated contact information for all
               providers on staff;

               Providing a checklist of credentialing information required of
               physicians applying for privileges at a facility or practice site;

               Requiring peer references and checking those references;

               Performing background checks and verifying accuracy with listed
               references, former employers, federal agencies, state licensing
               boards, medical associations, and specialty certification boards;

               Investigating details of any malpractice claims;

               Submitting the credentialing application to the facility’s
               governing body for final review and a decision on whether to
               approve the application for privileges.

       Medical Staff Credentialing, Privileges & Peer Review,

       https://www.komahonylaw.com/medical-staff-credentialing-privileges-peer-

       review/ [https://perma.cc/A3TD-5NXY] (last visited May 15, 2023).

[60]   Together, credentialing and privileging ensure patients have access to safe and

       reliable care. The Privileging Puzzle: Requirements for Providers and Organization

       (Jan. 10, 2023), https://www.healthstream.com/resource/blog/the-privileging-

       puzzle-requirements-for-providers-and-organizations

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023             Page 33 of 54
       [https://perma.cc/Q5MN-44FH] (last visited May 15, 2023). Improper

       privileging and credentialing can lead to patient harm and lawsuits. Jan Laws,

       Federal Regulations & Other Standards for Credentialing and Privileging (May 17,

       2021), https://www.symplr.com/blog/federal-regulations-other-standards-for-

       credentialing-and-privileging [https://perma.cc/S2KT-U2UB] (last visited May

       15, 2023).

       The Parties’ Arguments on Appeal

[61]   In the instant case, the Fund argues, essentially, that the act of negligently

       credentialing a doctor (read, negligently privileging a doctor) who then sexually

       assaults a minor does not transform an otherwise common-law-negligence case
                                                                 9
       into one of statutory medical malpractice. The Fund maintains that Cavins’

       misconduct did not amount to medical malpractice and negligent credentialing

       is not a standalone claim. So, according to the Fund, without an underlying

       claim of medical malpractice, the Does’ claim of negligent credentialing cannot

       stand. The Fund argues that unless the underlying misconduct is within the

       Act, the question of privileges and credentialing has no merit.

[62]   The majority states that “neither the Does nor the Hospital contend that the

       negligent-credentialing claim turns on whether a sexual assault constitutes

       medical malpractice” and that neither party contests the Fund’s statement at

       9
        Having noted the distinction between the terms “credentialing” and “privileging,” I use the term
       “credentialing” as the parties do to avoid any confusion regarding the parties’ respective arguments.

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023                                 Page 34 of 54
       oral argument that the parties all “seem to agree that what [Cavins] did was not

       [medical malpractice].” --- N.E.2d at --- n.3. I disagree with the majority’s

       characterization of the Does’ and the Hospital’s arguments. The Does argue

       their negligent-credentialing claim survives because the substance of their claim

       sounds in malpractice and is inextricably linked to medical care. According to

       the Does: (1) it was negligence on the part of the Hospital to credential Cavins;

       (2) the credentialing of Cavins was the proximate cause of the injury to John

       Doe II; and (3) in order to determine whether red flags existed that should have

       alerted the Hospital’s credentialing board to not credential Cavins, expert

       medical testimony is needed to explain Cavins’ duties and obligations and the

       intricacies of the different medical procedures Cavins was authorized to

       perform at the Hospital.

[63]   The Hospital argues that because it was required to engage in a credentialing

       process, and because the Does allege the Hospital did so negligently, then

       Cavins’ misconduct falls within the Act – even though the same misconduct, if

       perpetrated by a nonmedical person, would not fall within the Act. The

       Hospital maintains that it does not matter what kind of misconduct occurs on

       the part of the doctor, so long as some sort of underlying liability exists. And

       when a claim against the Hospital invokes a credentialing decision, any

       misconduct on the doctor’s part falls under the Act because the misconduct, no

       matter the type, does not alter a hospital’s credentialing duty. In other words,

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023        Page 35 of 54
       because the granting of hospital credentials is a decision made by doctors who
                                                                                                                     10
       are reviewing other doctors, that sort of decision falls squarely within the Act.

       Cavins’ Misconduct Constitutes Medical Malpractice

[64]   In determining whether Cavins’ misconduct – that is, his sexual abuse of John

       Doe II during the examination – amounted to medical malpractice, the facts

       and circumstances of this case lead to a positive answer. In the instant case, the

       record clearly establishes that, for purposes of the Act, John Doe II was a

       patient, and both Cavins and the Hospital were health care providers. And it is

       not disputed that Cavins committed a bad act. But as to the question of

       whether Cavins’ misconduct constitutes medical malpractice, I part ways with

       the majority and maintain that it does. Not only was Cavins treating John Doe

       II at the time the sexual abuse occurred, but the sexual abuse was so

       inextricably intertwined and so closely connected to the examination and to

       why John Doe II was being treated by Cavins such that the misconduct was

       inseparable from the medical care that was provided during the physical

       examination of John Doe II. And because of this close connection between the

       medical care administered and the underlying misconduct, that misconduct

       rises to the level of medical malpractice. I explain in greater detail below.

[65]   The Act, by its plain terms, applies only to “a patient or the representative of a

       patient who has a claim for bodily injury or death on account of malpractice.”

       10
            As we noted in footnote 2, supra, the Does and the Hospital are, essentially, aligned on appeal.

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023                                    Page 36 of 54
       Lake Imaging, LLC v. Franciscan All., Inc., 182 N.E.3d 203, 207 (Ind. 2022)

       (quoting Ind. Code § 34-18-8-1). “Malpractice” is a “tort or breach of contract

       based on health care or professional services that were provided, or that should

       have been provided, by a health care provider, to a patient.” Ind. Code § 34-18-

       2-18. As explained in B.R. ex rel. Todd v. State,

                  A “patient” is “an individual who receives or should have
                  received health care from a health care provider, under a
                  contract, express or implied, and includes a person having a
                  claim of any kind, whether derivative or otherwise, as a result of
                  alleged malpractice on the part of a health care provider.” [Ind.
                  Code] § 34-18-2-22. And “health care” is “an act or treatment
                  performed or furnished, or that should have been performed or
                  furnished, by a health care provider for, to, or on behalf of a
                  patient during the patient’s medical care, treatment, or
                  confinement.” [Ind. Code] § 34-18-2-13.

                                                                          11
       1 N.E.3d 708, 713 (Ind. Ct. App. 2013), trans. denied.                  Relevant to this case,

       Indiana Code section 34-18-2-14(1) defines “health care provider” as “[a]n

       individual, . . . a limited liability company [or a] corporation . . . licensed or

       legally authorized by this state to provide health care or professional services as

       a physician [or a ] . . . hospital[.]”

[66]   However, when deciding whether a claim falls under the provisions of the Act,

       “we are guided by the substance of a claim to determine the applicability of the

       Act.” Doe by Roe v. Madison Ctr. Hosp., 652 N.E.2d 101, 104 (Ind. Ct. App.

       11
            The Act does not define the term “professional services.”

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023                       Page 37 of 54
       1995). And the “fact that the alleged misconduct occurs in a healthcare

       facility” or that “the injured party was a patient at the facility” is not dispositive

       in determining whether the claim sounds in medical malpractice. Madison Ctr.,

       Inc. v. R.R.K., 853 N.E.2d 1286, 1288 (Ind. Ct. App. 2006), trans. denied.

       Rather, “the test is whether the claim is based on the provider’s behavior or

       practices while acting in [its] professional capacity as a provider of medical

       services.” Id. (quotation marks omitted).

[67]   As our Supreme Court noted in Howard Reg’l Health Sys. v. Gordon,

               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). . . .

               [R]egardless 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.” [Van Sice v. Sentany, 595
               N.E.2d 264, 267 (Ind. Ct. App. 1992).]

       952 N.E.2d 182, 185 (Ind. 2011).

[68]   We have also noted that:

               A case sounds in ordinary negligence [rather than medical
               malpractice] where the factual issues are capable of resolution by
               a jury without application of the standard of care prevalent in the
               local medical community. By contrast, a claim falls under the
       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023           Page 38 of 54
               Medical Malpractice Act where there is a causal connection
               between the conduct complained of and the nature of the patient-
               health care provider relationship.

       B.R. ex rel. Todd, 1 N.E.3d at 714-15 (citations omitted).

[69]   Cavins, at that time a licensed and credentialed practicing physician offering

       pediatric services, had been administering healthcare to John Doe II since John

       Doe II was an infant. Cavins had seen John Doe II in the past for yearly

       physical examinations.

[70]   The practice group to which Cavins belonged used the recommended practices

       of the American Academy of Pediatrics (“AAP”) to guide the physicians

       through the various health stages of children. One of the AAP recommended

       practices was to discuss various topics with adolescents twelve and older who

       were near to or entering puberty, including: drugs and alcohol, puberty, abuse,

       sexually-transmitted diseases, safe sex, and condoms. And it was acceptable by

       AAP standards to discuss condoms and even demonstrate the proper use of a

       condom on an object, such as a banana. See Cavins v. State, 20A-CR-1213, 2021

       WL 221156, at *1 (Ind. Ct. App. Jan. 22, 2021), trans. denied.

[71]   When the sexual abuse occurred, John Doe II, then twelve years old, was

       visiting the pediatrician’s office for a physical examination that would

       determine whether John Doe II was fit to play sports at his school. The

       physical examination included a hernia test, which necessitated Cavins to touch

       John Doe II’s testicles and penis, as well as a discharge test, where Cavins ran

       his fingers down the shaft of John Doe II’s penis. John Doe II did not know
       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023           Page 39 of 54
       the purpose of the tests, but he was not upset by the administration of the hernia

       test because Cavins had performed the test before. See Appellant’s Appendix,

       Volume II at 242-45. And there existed a legitimate medical purpose for Cavins

       to touch John Doe II’s genitalia. However, Cavins, under the guise of

       providing John Doe II with sex education and information regarding condom

       use, then proceeded to stroke John Doe II’s penis; place a condom on the boy’s

       penis; remove the condom; then, using a paper towel, wipe off the boy’s penis.

       And this underlying misconduct was at the very core of what Cavins, as John

       Doe II’s pediatrician, was supposed to do – that is, provide health care or

       professional services in the form of a routine physical examination. At just

       twelve years old, John Doe II’s ability to distinguish between when the

       legitimate part of the physical examination ended and the sexual abuse began,

       let alone prevent the abuse, was limited.

[72]   Other states have found that sexual abuse that occurs during medical treatment

       constitutes medical malpractice. For example, in Doe 56, et al. v. Mayo Clinic

       Health System – Eau Claire Clinic, Inc., 369 Wis.2d 351, 880 N.W.2d 681 (2016),

       the Wisconsin Supreme Court reasoned that, generally speaking, where minor

       patients are sexually assaulted by their doctor during a genital examination

       (that is, where the doctor physically manipulated boys’ penises), the sexual

       assault is an intentional act that should be pursued as an intentional tort in the

       civil or criminal area and not under a claim of medical malpractice. The

       Wisconsin Supreme Court added, however, that “[w]hen there exists . . . a

       legitimate medical purpose for a genital examination, a claim can fall within medical

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023              Page 40 of 54
                                                                                                                     12
       malpractice.” Doe 56, 369 Wis.2d at 357, 880 N.W.2d at 684 (emphasis added) ;

       see also J.W. v. B.B., 2005 WI App 125, ¶ 10-11, 284 Wis.2d 493, 501, 700

       N.W.2d 277, 281 (Ct. App. 2005) (finding that digital-rectal prostate

       examinations done as part of a pre-employment physical properly fell within the

       confines of medical malpractice where the physician had a legitimate medical

       purpose or reason for the alleged inappropriate touching).

[73]   St. Paul Fire & Marine Ins. Co. v. Asbury, 149 Ariz. 565, 720 P.2d 540 (App.

       1986), involved a gynecologist who was accused of improperly manipulating his

       patients during gynecological examinations. See 720 P.2d at 541. In Asbury, the

       Arizona Court of Appeals addressed the question of whether a physician’s

       sexual assault of a patient was covered by malpractice insurance,

       acknowledging that, generally, sexual assault by a physician on a patient is not

       covered by malpractice insurance. However, the court adopted an exception to

       that rule for sexual assaults that are “intertwined with and inseparable from the
                                                                                              13
       services provided.” Asbury, 149 Ariz. at 567, 720 P.2d at 542.

       12
         Ultimately, the Wisconsin Supreme Court in Doe 56 determined that the minor patients and their parents
       could maintain an action for medical malpractice against the physician and the medical clinic and that a
       three-year statute of limitations period applicable to the causes of action began to run from the date the
       physician last touched the patients’ genitals during an examination. Doe 56, et al. v. Mayo Clinic Health System
       – Eau Claire Clinic, Inc., 369 Wis.2d 351, 880 N.W.2d 681 (2016).
       13
         The Asbury court found that injuries sustained in a sexual assault that took place during a gynecological
       examination were covered as injuries caused by the “providing or withholding of professional services.” St.
       Paul Fire & Marine Ins. Co. v. Asbury, 149 Ariz. 565, 566, 720 P.2d 540, 541 (App. 1986) (internal quotation
       marks omitted). The court rejected the argument that the alleged acts of improper clitoral manipulation
       during the gynecological examination were unprofessional and, therefore, not covered by malpractice
       insurance. Id.

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023                                   Page 41 of 54
[74]   In Princeton Ins. Co. v. Chunmuang, 151 N.J. 80, 698 A.2d 9 (1997), another case

       addressing whether a physician’s sexual assault of a patient was covered by

       malpractice insurance, a seventeen-year-old female was sexually assaulted

       during a gynecological examination performed by Chunmuang, the attending

       physician. Specifically, the patient had made an appointment to see

       Chunmuang because she was experiencing monthly cramping but had not yet

       menstruated. Chunmuang touched the patient inappropriately and sexually

       assaulted her during the examination. The patient did not return for a follow-

       up visit with Chunmuang because he had made her “feel dirty.” 151 N.J. at 84,

       698 A.2d at 10. And, while she continued to experience cramping and had not

       yet menstruated, she was not able to seek medical assistance from another

       gynecologist because of the emotional distress that resulted from her
                                              14
       examination by Chunmuang.

[75]   The court in Chunmuang reasoned that based on the malpractice insurance

       policy language, the court “[did] not find it necessary to rely on the reasoning in

       Asbury that a sexual assault during a gynecological examination is more

       14
          The issue addressed by the New Jersey Supreme Court in Princeton Ins. Co. v. Chunmuang, 151 N.J. 80, 698
       A.2d 9 (1997), was whether an exclusion from coverage in a medical malpractice insurance policy for “injury
       resulting from [the physician’s] performance of a criminal act” insulates the insurer from liability for
       compensatory damages awarded to the insured’s patient in an action based on a sexual assault by the insured
       physician in the course of a gynecological examination. 151 N.J. at 82, 698 A.2d at 10. The court held that
       “claims based on injuries caused by a physician’s criminal conduct are properly excluded from coverage
       under the policy at issue. [The insurance carrier] is not responsible to [the patient] for the damages she
       suffered as a result of Chunmuang’s sexual assault.” 151 N.J. at 100, 698 A.2d at 19. The court remanded
       the matter to afford the patient “the opportunity on remand to produce proof of damages caused by
       Chunmuang’s malpractice that is separable from his criminal conduct.” 151 N.J. at 101, 698 A.2d at 19.

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023                              Page 42 of 54
       intertwined with the professional services sought than a sexual assault in the

       course of another type of physical examination.” 151 N.J. at 97, 698 A.2d at

       18. The court added, “[W]e do not find it necessary to rely on Asbury to find

       that the acts that are the basis of Chunmuang’s civil liability, in addition to

       being criminal, also constituted malpractice that would be covered by the policy

       were it not for the criminal-acts exclusion.” 151 N.J. at 97, 698 A.2d at 18

       (emphasis added). The court then determined that “the important question”

       was “simply whether a substantial nexus exists between the context in which

       the acts complained of occurred and the professional services sought.” Id. And

       the court found it had “no difficulty in concluding that [Chunmuang’s bad] acts

       constituted a ‘medical incident’ as defined by Chunmuang’s malpractice policy”

       because the acts complained of by the patient “took place in Chunmuang’s office in

       the course of what he represented to be a medical examination[, and t]hose acts were

       possible only because the patient entrusted herself to the physician’s care for the

       purpose of receiving diagnosis and treatment for a medical problem.” 151 N.J.

       at 97-98, 698 A.2d at 18 (emphasis added).

[76]   In the case before us, as in Doe 56, J.W., Asbury, and Chunmuang, supra, there

       was no distinct separation between the treatment Cavins administered to John

       Doe II and the sexual abuse Cavins perpetrated on the patient. While Cavins

       had a legitimate medical purpose for touching John Doe II’s genitalia, the

       sexual abuse occurred as part and parcel of a physical examination that was

       improperly administered and departed from accepted standards of health care.

       Cavins, under the guise of a proper examination, sexually abused the patient,

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023            Page 43 of 54
       and, thus, committed malpractice. Simply put, during a legitimate

       examination, Cavins departed from medically accepted practices thereby

       injuring the patient and committing medical malpractice. What the majority, in

       our case, fails to recognize is that, essentially, John Doe II was injured by

       Cavins’ failure to administer a proper physical examination.

[77]   And to the extent that the majority argues a lay jury, without the aid of expert

       medical testimony, could determine whether Cavins’ misconduct was

       malpractice, the doctrine of res ipsa loquitur is an accepted exception to the

       need for expert testimony and that not every act that a lay jury might find

       appalling or, at first blush, tangential to medical treatment, falls outside the
                              15
       scope of the Act.           I recognize that not all claims against health care providers

       constitute medical malpractice, but we have such a case before us. Claims

       sounding in ordinary negligence attributed to misconduct on the part of the

       health care provider may not rise to the level of medical malpractice. And

       simply because a bad act occurs in a doctor’s office that, in and of itself, does

       not bring the bad act within the confines of medical malpractice. See Madison

       Ctr., Inc., 853 N.E.2d at 1288. However, the majority has eliminated from the

       confines of the Act all acts of sexual abuse that occur during medical treatment

       under every set of circumstances and in every context. I am not convinced that

       in Indiana, this is the intended purpose of the Act. See Cmty. Health Network,

       15
          Expert testimony is not required when the factfinder can understand that a health care provider’s conduct
       fell below the applicable standard of care without technical input from an expert witness. See Syfu v. Quinn,
       826 N.E.2d 699, 703 (Ind. Ct. App. 2005).

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023                                 Page 44 of 54
       Inc. v. McKenzie, 185 N.E.3d 368, 375 (Ind. 2022) (noting, “[The Act] is in

       derogation of the common law and should be strictly construed against

       imposing limitations on a claimant’s right to bring suit.”).

       A Negligent-Credentialing Claim Can Be Supported By Other Misconduct
       Committed By A Health Care Provider

[78]   As noted initially, with negligent-credentialing claims, there are two

       components, pursuant to the Act: (1) an underlying claim of misconduct within

       the physician-patient relationship that might rise to medical malpractice (as it

       does here); and (2) underlying misconduct that should have affected the

       hospital’s credentialing of the physician. Yet, regarding these components, as I

       will further explain below, there can be no free-standing, standalone negligent-

       credentialing claims.

[79]   The predicate claim for a negligent-credentialing action has an additional

       criterion: it must be based upon a bad act or misconduct that is directly related to

       the patient-physician relationship – specifically, a direct relationship between

       the patient and the doctor in light of the doctor’s capacity as a doctor – that

       results in underlying liability. For example, a negligent-credentialing claim

       would not exist if no bad act had been inflicted upon that specific patient within
                                                                16
       the relationship with that specific doctor.

       16
         This is to say, for example, a patient of a hospital cannot bring a negligent-credentialing claim against the
       hospital based upon a chance encounter with a physician who has privileges at the hospital but is not the
       patient’s treating physician.

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023                                   Page 45 of 54
[80]   To be clear, it is not necessary that two separate acts of misconduct occur.

       Instead, just one underlying bad act can trigger an inquiry into the credentialing

       of the doctor. Again, I emphasize that the conduct that gives rise to the cause

       of action must be at least tangentially related to the services the physician

       performed.

[81]   For purposes of the components as applied to the instant case, I acknowledge

       that first and foremost, there must be some relationship between the patient and

       the physician and the alleged misconduct on the physician’s part. And, I note,

       this factor further narrows the group of viable negligent-credentialing claims

       and, therefore, would not open the floodgates to baseless litigation.

[82]   Such negligent-credentialing claims will necessarily allege some misconduct on

       the part of the physician that proximately caused a patient’s alleged injury. If

       this were not so, any alleged bad act on the part of physician might lead to a

       claim of negligent credentialing. In other words, if there is no direct connection

       between the alleged misconduct and the relationship that exists, at that time,

       between the patient and the physician – in the doctor’s capacity as a doctor –

       then the alleged misconduct would not support a negligent-credentialing claim

       or trigger an inquiry into whether a hospital should have extended privileges to

       the doctor. See, e.g., Garland Cmty. Hosp. v. Rose, 156 S.W.3d 541, 546 (Tex.

       2004) (noting, without negligent treatment, a negligent credentialing claim

       could not exist) (internal citation omitted).

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023         Page 46 of 54
[83]   It is important to note there are a number of nonmedical occurrences that

       could/should cause a hospital to reconsider credentialing this doctor, such as

       touching someone inappropriately at a social gathering or committing theft.

       But because these activities do not involve a relationship to the doctor as a

       doctor performing conduct tangentially related to the services for which the

       victim interacted with the doctor, these claims are outside the instant case.

[84]   However, there is conduct that would not fall within the medical malpractice

       statute, yet it causes injury to a person and is so related to the doctor-patient

       relationship that it supports a claim of negligent credentialing, such as:

       • Spreading malicious gossip about a patient to people without a medical
         need to know;
       • Revealing personal and private information to people without a medical
         need to know;
       • Failing to follow basic hospital safety protocols such as securing bed rails
         after an examination;
       • Embracing unsupported medical treatment theories that delay a person’s
         appropriate and proper treatment.

[85]   As such, it is imperative that we examine the physician’s misconduct from a

       global perspective and in the complete context of the circumstances that gave

       rise to the misconduct. We should examine together the relationship between

       the misconduct that occurred and the result of that misconduct in light of

       whether the misconduct should have affected the hospital’s credentialing of the

       physician.

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023          Page 47 of 54
[86]   If, as the majority instructs, we limit our approach in determining negligent-

       credentialing claims to whether the underlying misconduct must constitute

       medical malpractice, we examine the misconduct through too narrow a lens,

       which can result in circumstances where potentially successful negligent-

       credentialing claims may be improvidently denied.

[87]   Therefore, when presented with a negligent-credentialing claim, instead of

       merely focusing on the underlying misconduct to determine whether the

       misconduct constitutes medical malpractice per se, the proper approach is to first

       determine whether there is any underlying alleged misconduct which should

       bear on the hospital’s decision whether to extend hospital privileges to the

       physician.

[88]   So, in sum, there can be no free-standing, standalone claim for negligent

       credentialing. However, I reiterate that there are two components to determine

       negligent-credentialing claims, pursuant to the Act: (1) an underlying claim of

       misconduct that might rise to medical malpractice; and (2) underlying

       misconduct that should have affected the hospital’s credentialing of the

       physician. Thus, in the case before us, even if Cavins’ misconduct does not rise

       to the level of medical malpractice, it is clear that the conduct arose due to the

       patient’s direct relationship with the physician; and, therefore, it is possible that

       the misconduct may trigger on the patient’s part an inquiry into whether the

       Hospital should have extended privileges to Cavins.

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023           Page 48 of 54
       Floodgates to Litigation

[89]   Approaching negligent-credentialing claims by first examining the underlying

       alleged misconduct, notwithstanding whether or not the conduct amounts to

       medical malpractice per se, does not expand the Act’s application and does not

       create a separate, standalone cause of action that would increase the number of

       such claims. See, e.g., G.F. v. St. Catherine Hosp., Inc., 124 N.E.3d 76, 84-85 (Ind.

       Ct. App. 2019), trans. denied.

[90]   Without question, for a negligent-credentialing claim to survive, there still must

       be underlying misconduct and proximate causation between the negligent

       credentialing and the underlying conduct. Furthermore, this approach does not

       conflict with the purpose of the Act or that of a medical review panel – that is,

       to “encourage the mediation and settlement of claims and [to] discourage the

       filing of unreasonably speculative lawsuits.” Johnson v. St. Vincent Hosp.,

       Inc., 273 Ind. 374, 388-89, 404 N.E.2d 585, 595 (1980), overruled on other grounds

       by In re Stephens, 867 N.E.2d 148 (Ind. 2007). It is this approach that remains

       faithful to the Act’s purpose.

[91]   Importantly, this approach limits rather than opens the floodgates to or

       encourages a plethora of baseless, speculative negligent-credentialing claims or

       claims that attempt to bootstrap and convert common-law-negligence claims

       into statutory medical malpractice, as the majority asserts has occurred in the

       case before us. On the contrary, adopting this approach facilitates expediency

       in adjudicating negligent-credentialing claims and encourages mediation and

       settlement by involving a medical review panel early in the matter and
       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023          Page 49 of 54
       requiring, when appropriate, expert medical testimony to prove or disprove the

       negligent-credentialing claims. It is clear that medical credentialing requires

       consideration of the multi-faceted factors that trained medical professionals

       have based on their training and education that lay people do not possess.

       Expert Medical Testimony is Necessary in Deciding Negligent-Credentialing
       Claims

[92]   Additionally, I note that the credentialing process is a medical decision that

       commonly requires explanation by a medical expert. Generally, the process is

       beyond the scope of the common knowledge of ordinary laypersons. And it is

       not reasonable to believe that a layperson would be familiar with a hospital’s

       credentialing process – a complex process involving numerous steps such as

       screening physicians, verifying physicians’ ability to practice, and determining

       which procedures and services a physician is competent to perform and deliver.
                                                                                                           17
       After all, it is medical experts who make the credentialing decisions.                                   See Ind.

       Code §§ 16-21-2-5, -7. And, consequently, in the larger context of negligent-

       credentialing claims, expert testimony is required to establish the standard of

       17
          But cf. Martinez v. Oaklawn Psychiatric Ctr., Inc., 128 N.E.3d 549 (Ind. Ct. App. 2019), clarified on reh’g, 131
       N.E.3d 777, trans. denied, 140 N.E.3d 286 (Ind. 2020) (David, J., dissenting) (concluding, where residential
       assistant in group home caused injury to plaintiff’s leg that resulted in plaintiff’s death, “I believe a lay jury
       could assess whether [the residential assistant’s] actions were tortious or not without applying a medical
       standard of care. Whether [the residential assistant] was negligent is not something beyond the knowledge of
       the jury and I’m not sure what a panel of healthcare providers could make clear here.”). However, I note
       that the facts and circumstances in the case before us differ significantly from those in Martinez.

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023                                         Page 50 of 54
       care the hospital owed the patient and how the hospital breached the standard

       of care.

[93]   Regarding the necessity of expert testimony in negligent-credentialing cases, the

       Montana Supreme Court observed in Brookins, the following:

               It has been noted that “[a]ll courts that have looked at the
               question have concluded that expert testimony is necessary to
               establish the standard of care owed by a hospital, or whether the
               hospital has been negligent.” Benjamin J. Vernia, Tort Claim for
               Negligent Credentialing of Physician, 98 A.L.R. 5th 533, 553 (2002)
               (internal citation omitted). The courts that have already
               addressed this question have reasoned that the process through
               which a hospital credentials a doctor to use its facilities is outside
               the knowledge of a common person. See e.g. Johnson v.
               Misericordia Cmty. Hosp., 99 Wis.2d 708, 301 N.W.2d 156, 172
               (1981) (“[S]ince the procedures ordinarily employed by hospitals
               in evaluating applications for staff privileges are not within the
               realm of the ordinary experience of mankind . . . expert
               testimony was required to prove the same.”); Neff v. Johnson
               Meml. Hosp., 93 Conn.App. 534, 889 A.2d 921, 928 (2006) (“we
               hold that the parameters of a hospital’s judgment in credentialing
               its medical staff is not within the grasp of ordinary jurors.”).

               ***

               We agree with other courts that the process of physician
               credentialing can be complicated and that the reasonable care a
               hospital must undertake in credentialing a doctor is not readily
               ascertainable by a layman.

       2012 MT at ¶ 62, 367 Mont. at 213, 292 P.3d at 361-62 (internal quotation

       marks and citation omitted.)

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023            Page 51 of 54
[94]   Simply put, the knowledge of the credentialing process necessary to determine

       negligent-credentialing claims is outside of the purview of non-doctors and

       nonmedical professionals. And I proffer that if we present negligent-

       credentialing claims to a jury absent expert testimony, we potentially open the

       door to visceral reactions by the jury to conduct on the part of the doctor that

       may have no effect on the hospital’s decision to credential the doctor, e.g.,

       seemingly innocuous gossip about someone not associated with the doctor’s

       office or regarding a patient.

[95]   If we follow the majority’s approach in determining negligent-credentialing

       claims, we thwart the Act’s broader purpose of fostering the prompt litigation

       of medical malpractice claims. See, e.g., Ellenwine, 846 N.E.2d at 666. By not

       requiring expert testimony regarding the credentialing decision – that is,

       testimony provided by the medical professionals who made the credentialing

       decision in the first place – we run the risk of opening the floodgates to

       litigation. The lack of expert testimony essentially sets the bar for negligent-

       credentialing claims too low, leading to drawn out litigation and a reduction in

       settlements. See, e.g., Lake Imaging, LLC, 182 N.E.3d at 210. And, above all, we

       risk inviting outcomes where health care providers wrongly prevail on summary

       judgment, resulting in the loss of a plaintiff’s viable claim of negligent

       credentialing.

       Conclusion

[96]   In conclusion, Cavins’ sexual abuse of John Doe II constitutes medical

       malpractice because the misconduct was at the very core of what Cavins, as
       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023             Page 52 of 54
       John Doe II’s attending physician, was supposed to do – that is, perform a

       physical examination on John Doe II. Finding this conduct falls within the Act

       defeats the Fund’s objection. However, whether or not Cavins’ misconduct, or

       any alleged misconduct, constitutes medical malpractice is irrelevant to

       accessing the Act under a negligent-credentialing claim. While any number of

       bad acts on a doctor’s part can affect credentialing, a negligent-credentialing

       claim falls under the Act, ordinarily requiring an opinion by a medical review

       panel and, ultimately, expert testimony to decide the claim. And, at the end of

       the day, there still must be proximate causation between the negligent

       credentialing and the underlying misconduct. So, even if the majority is correct

       (and even if the trial court had determined) that, in the instant case, the sexual

       abuse does not constitute medical malpractice, that conclusion is not dispositive

       of the Does’ negligent-credentialing claim against the Hospital and does not

       remove the claim from the scope of the Act.

[97]   Furthermore, I caution that following the majority’s approach invites the risk

       that some legitimate negligent-credentialing claims will be prematurely disposed

       of on summary judgment. I believe we have been presented with just such a

       case.

[98]   And, finally, I posit that had the matter before us been addressed as I suggest,

       this litigation might have been resolved by a full and final settlement of the

       matter.

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023         Page 53 of 54
[99]   Therefore, I would affirm the trial court’s denial of summary judgment. In all

       other respects, I concur with the majority opinion.

       Court of Appeals of Indiana | Opinion 22A-CT-1276 | June 2, 2023      Page 54 of 54