Nasser v. St. Vincent Hospital & Health Services
926 N.E.2d 43, 2010 Ind. App. LEXIS 622, 2010 WL 1486888 (2010)
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Rule of Law:
Under Indiana Evidence Rule 702, a registered nurse is not qualified to provide expert testimony on the issue of medical causation in a medical malpractice case, and such an opinion from a non-physician on a medical review panel is inadmissible to create a genuine issue of material fact for trial.
Facts:
- Constance Renee Nasser was admitted to St. Vincent Hospital for observation at eighteen weeks during a problematic twin pregnancy following an amniocentesis.
- On July 25, 2001, while hospitalized, Nasser began experiencing severe abdominal pain.
- When Nasser's husband requested assistance, nurses stated they could not administer pain medication until the on-call doctor finished an emergency surgery and apparently did not call Nasser's personal doctor as requested.
- After her husband left for the night, Nasser began bleeding and felt the onset of delivery.
- Nasser repeatedly pushed the nurse call button and screamed for help, but no hospital staff responded.
- Alone in her hospital bed, Nasser delivered two stillborn fetuses.
- Nasser's husband returned to find her alone with the delivered fetuses, just as doctors and nurses were first entering the room.
Procedural Posture:
- Constance Renee Nasser filed a proposed medical malpractice complaint against St. Vincent Hospital with the Indiana Department of Insurance.
- A medical review panel, comprising two physicians and one registered nurse, was formed.
- The panel issued a split opinion: the two physicians found the hospital met the standard of care and its conduct was not a factor in the damages, while the registered nurse found the hospital breached the standard of care and its conduct was a factor in the damages.
- Nasser filed a complaint in Marion Superior Court (trial court).
- St. Vincent Hospital filed a motion for summary judgment, arguing Nasser lacked physician expert testimony on causation.
- Nasser filed a cross-motion for summary judgment, relying on the opinion of the registered nurse from the review panel.
- The trial court granted summary judgment in favor of St. Vincent Hospital and denied Nasser's motion.
- Nasser's motion to correct errors was denied by the trial court.
- Nasser (appellant) appealed the trial court's grant of summary judgment to the Indiana Court of Appeals, with St. Vincent Hospital as the appellee.
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Issue:
Under Indiana Evidence Rule 702, is a registered nurse's expert opinion on medical causation admissible to create a genuine issue of material fact and defeat a motion for summary judgment in a medical malpractice action?
Opinions:
Majority - Vaidik, Judge
No. A registered nurse's expert opinion on medical causation is not admissible to create a genuine issue of material fact in a medical malpractice case. The court reasoned that there is a significant difference in the education, training, and authority to diagnose between physicians and nurses. Citing its precedent in Long v. Methodist Hospital, the court affirmed that the determination of the medical cause of injuries is a form of diagnosis that falls outside the professional scope and expertise of a registered nurse. While the Indiana Medical Malpractice Act permits non-physicians to serve on medical review panels and makes their opinions admissible, Indiana Evidence Rule 702 governs the qualification of expert witnesses. When a statute and a rule of evidence conflict, the rule of evidence prevails. Because the nurse panelist was not qualified by 'knowledge, skill, experience, training, or education' to testify on medical causation, her opinion was inadmissible. Since Nasser conceded expert testimony was required and provided no other qualified expert testimony on causation, summary judgment for the hospital was appropriate.
Analysis:
This decision reinforces a strict application of expert qualification standards under Indiana Evidence Rule 702 in medical malpractice cases. It establishes that while the Medical Malpractice Act allows non-physician experts on review panels, their opinions on medical causation are inadmissible in court, effectively requiring a plaintiff to secure a physician expert to survive summary judgment on that issue. The case solidifies the distinction between the standard of nursing care, on which a nurse can opine, and medical causation, which is reserved for physicians. This raises the evidentiary burden for plaintiffs who might otherwise rely on a favorable opinion from a non-physician panelist.
