Harlett v. St. Vincent Hospitals and Health Services
2001 Ind. App. LEXIS 796, 2001 WL 503459, 748 N.E.2d 921 (2001)
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Rule of Law:
Under the Indiana Medical Malpractice Act, registered nurses are explicitly qualified to serve as members of medical review panels, and a trial court lacks the authority to remove them based on a prior court's holding regarding a nurse's qualification to provide expert testimony on medical causation at trial.
Facts:
- Christina Harlett and John Harlett (the Harletts) filed a proposed complaint with the Indiana Department of Insurance, alleging St. Vincent Hospital nurses were negligent in failing to prevent Christina from developing a bedsore and failing to treat it once it became apparent.
- The parties began selecting a medical review panel; the Harletts nominated two registered nurses whom St. Vincent struck, and St. Vincent nominated two physicians whom the Harletts struck.
- The panel chairman then provided striking panels, from which the parties selected one nurse and one physician.
- The selected panelists twice chose a physician as the third panelist, but the Harletts objected.
- The chairman subsequently listed a striking panel of nurses, and after the parties alternately struck, one nurse was left, completing the panel with two nurses and one physician.
- The chairman certified this panel, consisting of two nurses and one physician, to the Indiana Department of Insurance.
- After the Harletts made their submission to the panel, St. Vincent requested the chairman to excuse the two nurses and replace them with physicians, which the chairman declined to do.
Procedural Posture:
- Christina Harlett and John Harlett (the Harletts) filed a proposed complaint with the Indiana Department of Insurance, alleging medical malpractice by St. Vincent Hospital and Health Services (St. Vincent) nurses.
- After the medical review panel was formed and the Harletts made their submission, St. Vincent filed a motion for a preliminary determination of law with the trial court (the court designated in the proposed complaint as having jurisdiction).
- St. Vincent's motion requested the trial court to order that the medical review panel be comprised of at least two physicians and that any nurse panelist be limited in their opinions, citing Long v. Methodist Hospital of Indiana, Inc.
- The trial court partially granted St. Vincent's motion, ordering the chairman to excuse one registered nurse panelist and tender a striking panel of three Plastic Surgeons.
- The Harletts appealed the trial court's decision to the Court of Appeals of Indiana.
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Issue:
1. Does a trial court have the authority under the Indiana Medical Malpractice Act to entertain a motion for a preliminary determination of law regarding the qualifications of a medical review panelist, particularly after the opposing party has submitted its case to the panel? 2. Did the trial court err by ordering the removal of a registered nurse from a medical review panel and her replacement with a physician, based on a previous case that addressed a nurse's qualification to offer expert testimony on medical causation in court?
Opinions:
Majority - Ratliff, Senior Judge
1. Yes, the trial court had the authority under the Indiana Medical Malpractice Act to address St. Vincent's motion for a preliminary determination of law. Indiana Code § 34-18-11-1(c) expressly grants jurisdiction to the trial court "during the time after a proposed complaint is filed ... but before the medical review panel gives the panel's written opinion." Since St. Vincent's motion was filed after the proposed complaint but before a written panel opinion, it was timely. While I.C. § 34-18-11-1, concerning preliminary determinations, is to be narrowly construed per Griffith v. Jones, I.C. § 34-18-10-14 provides an additional basis for jurisdiction. This latter statute states that a party or panelist who fails to act as required by the chapter is subject to mandate upon application to the court. St. Vincent asserted that the chairman failed to appoint a panel consisting of three qualified panelists as required by I.C. § 34-18-10-10, thus alleging a failure to carry out a statutory duty under the Medical Malpractice Act, which falls within the purview of I.C. § 34-18-10-14. 2. No, the trial court erred in ordering the medical review panel chairman to dismiss a registered nurse panelist and replace her with a plastic surgeon. The Medical Malpractice Act plainly includes "registered or licensed practical nurse[s]" within its definition of "health care provider" (Ind. Code § 34-18-2-14). Furthermore, I.C. § 34-18-10-5 states that "all health care providers in Indiana ... who hold a license to practice in their profession shall be available for selection as members of the medical review panel." The panel's role is to provide an expert opinion on whether the evidence supports a conclusion that the defendant failed to act within appropriate standards of care (I.C. § 34-18-10-22(a)). While Long v. Methodist Hospital of Indiana, Inc. held that nurses are not qualified to offer expert testimony on the medical cause of injuries or increased risk of harm in a trial, that case did not address a nurse's qualification to serve on a medical review panel. The trial court's decision to exclude the nurse by expanding the specific holding of Long directly contradicts the clear statutory authorization for nurses to serve on medical review panels. Any modification to the Act regarding panel composition is the prerogative of the legislature, not the courts.
Analysis:
This case clarifies the boundaries of judicial intervention in the medical review panel process under the Indiana Medical Malpractice Act. It establishes that while trial courts possess statutory jurisdiction to address procedural issues, such as alleged failures by a panel chairman to follow statutory duties, this authority does not extend to overriding the clear legislative intent regarding panel composition. The decision reinforces that licensed nurses are statutorily qualified to serve on medical review panels, distinguishing their role in an advisory panel from their qualifications to provide expert testimony on causation in a trial. This helps ensure the integrity and informal nature of the medical review panel process as envisioned by the legislature, preventing parties from using expert witness qualification rules to reshape the panel's membership.
