Carey v. INDIANA PHYSICAL THERAPY, INC.
926 N.E.2d 1126, 2010 WL 2145450, 2010 Ind. App. LEXIS 912 (2010)
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Rule of Law:
In a medical malpractice claim, a plaintiff must present expert testimony that affirmatively establishes a causal link between the defendant's alleged negligence and the injury; testimony expressing uncertainty or an inability to determine causation is insufficient to create a genuine issue of material fact on proximate cause to survive summary judgment.
Facts:
- Brent Carey was injured in an automobile accident and subsequently received a settlement from the tortfeasor.
- Carey's doctor referred him to physical therapist Stephen Connelly for treatment of his injuries.
- During his third therapy session, Carey alleged that Connelly performed aggressive 'compressions' by laying his chest across Carey's arms and pushing down with his body weight.
- Carey claimed he 'felt something pop' and 'screamed out in pain', at which point Connelly stopped the maneuver.
- Connelly denied that Carey expressed any pain during the session or that the event as described by Carey occurred.
- At some point after the therapy, Carey was diagnosed with reflex sympathetic dystrophy (RSD).
- Carey's expert neurologist, Dr. Jody Neer, testified that Carey's symptoms worsened after the therapy but stated, 'I don't know with certainty whether that has caused his chronic condition.'
Procedural Posture:
- Brent Carey sued his physical therapist, Stephen Connelly, and Indiana Physical Therapy, Inc. for medical malpractice in an Indiana trial court.
- Connelly filed a motion for summary judgment, arguing that Carey had failed to designate sufficient expert testimony on the element of proximate cause.
- The trial court granted summary judgment in favor of Connelly.
- Carey, as the appellant, appealed the trial court's grant of summary judgment to the Court of Appeals of Indiana.
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Issue:
Does a medical expert's testimony that they cannot say with certainty whether a defendant's conduct caused the plaintiff's injury create a genuine issue of material fact as to proximate cause sufficient to defeat a motion for summary judgment?
Opinions:
Majority - May, J.
No. A medical expert's testimony that fails to establish a certain causal link between the alleged negligence and the plaintiff's injury is insufficient to create a genuine issue of material fact as to proximate cause. To survive summary judgment, a plaintiff must present affirmative evidence of causation. Here, Carey's expert, Dr. Neer, was unable to say with certainty that the physical therapy caused Carey's reflex sympathetic dystrophy (RSD), admitting the auto accident and the therapy were 'intertwined' causes. The court, citing Malooley v. McIntyre, found that an expert's inability to determine causation does not support an allegation of causation; instead, it supports the conclusion that the plaintiff could not find an affirmative proponent for their claim. Dr. Neer's testimony, filled with uncertainty, failed to establish the necessary 'causative nexus,' and therefore, Connelly was entitled to judgment as a matter of law because he successfully negated the proximate cause element of Carey's malpractice claim.
Analysis:
This case reinforces the stringent requirement for plaintiffs to establish proximate cause through clear and affirmative expert testimony in medical malpractice actions, particularly at the summary judgment stage. The ruling clarifies that an expert's speculation or inability to definitively link the defendant's breach to the plaintiff's injury is fatal to the claim. It makes it more difficult for plaintiffs with pre-existing or complex injuries to proceed to trial, as any ambiguity in their expert's testimony regarding causation can be grounds for dismissal. This decision empowers defendants to obtain summary judgment by highlighting weaknesses in the certainty of the plaintiff's expert opinion on causation.
