FOR PUBLICATION
ATTORNEYS FOR APPELLANT: ATTORNEYS FOR APPELLEES:
ROBERT G. WEDDLE TIMOTHY J. KENNEDY
MATTHEW W. CONNER Indianapolis, Indiana
Indianapolis, Indiana
JON M. PINNICK
DONALD B. KITE, SR.
Carmel, Indiana
MARK A. McCANN
MARK A. SCOTT
Kokomo, Indiana
STEVEN L. LANGER
JENNIFER E. DAVIS
Valparaiso, Indiana
IN THE
COURT OF APPEALS OF INDIANA
SALLY MCCARTY, COMMISSIONER )
OF THE INDIANA DEPARTMENT OF )
INSURANCE, AS ADMINISTRATOR OF )
THE INDIANA PATIENTS )
COMPENSATION FUND, )
)
Appellant-Defendant, )
)
vs. ) No. 49A02-0304-CV-324
)
VICKI L. SANDERS AND DANIEL P. )
SANDERS, INDIVIDUALLY AND AS )
NATURAL PARENTS OF LUCAS SANDERS, )
DECEASED INFANT; MICHAEL T. THOMAS, )
ADMINISTRATOR OF THE ESTATE OF )
KERRY L. THOMAS, DECEASED, AND )
INDIVIDUALLY, AND JACOB M. THOMAS, )
DECEASED, AND INDIVIDUALLY, AND )
JACOB M. THOMAS, BY NEXT FRIEND, )
MICHAEL T. THOMAS; AND JEFFREY )
KOEHL AND CARLA S. KOEHL, )
AS PARENTS, NATURAL GUARDIANS, )
AND LEGALLY APPOINTED CO-GUARDIANS )
OF THE ESTATES OF MARIAH K. KOEHL )
AND SAMANTHA K. KOEHL, MINORS, )
)
Appellees-Plaintiffs. )
APPEAL FROM THE MARION SUPERIOR COURT
The Honorable David J. Dreyer, Judge
Cause No. 49D10-0008-CT-001135
49D10-0010-MI-001551
49D10-0101-CT-0096
APRIL 7, 2004
OPINION - FOR PUBLICATION
RATLIFF, Senior Judge
STATEMENT OF THE CASE
Appellant-Defendant Sally McCarty, Commissioner of the Indiana Department of Insurance (the Commissioner), as
administrator of the Indiana Patients Compensation Fund (the Fund) appeals the trial courts
denial of the Funds motion for partial summary judgment in actions involving Appellees-Plaintiffs
Vicki L. Sanders and Daniel P. Sanders (the Sanders), individually and as natural
parents of Lucas Sanders, deceased infant; and Michael T. Thomas (Thomas), administrator of
the Estate of Kerry L. Thomas, deceased, and individually, and Jacob M. Thomas,
by next friend, Michael T. Thomas. The Commissioner also appeals the
trial courts grant of partial summary judgment in an action involving Jeffrey Koehl
and Carla S. Koehl (the Koehls), as parents, natural guardians, and legally appointed
co-guardians of the estates of Mariah K. Koehl and Samantha K. Koehl, minors.
We affirm.
ISSUES
I. Whether the trial court erred in determining as a matter of law that
the Sanders and the Koehls may recover from the Fund for multiple injuries
under separate statutory caps after a single statutory minimum payment has been made
by the health care provider.
II. Whether the trial court erred in basing its denial of the Commissioners motion
for partial summary judgment on its conclusion that that there was only one
occurrence of malpractice by the health care provider in Thomas case.
III. Whether the language of Thomas settlement agreement precludes Jacob Thomas from recovering from
the Fund.
STATEMENT OF THE FACTS
Due to the similarity in the facts therein, the trial court consolidated three
separate cases. In each case, it was alleged that a single occurrence
of malpractice resulted in injuries to more than one victim. The health
care providers in each case paid the equivalent of the maximum amount under
the Medical Malpractice Act (the Act) of $100,000.00 for the single occurrence of
malpractice. Under the provisions of the Act, claims were then made against
the Fund for the payment of damages that exceeded the $100,000.00 statutory cap
amount paid by the health care providers. In the petitions for recovery
from the fund, each injured party made a separate claim under a separate
statutory cap.
A. The Sanders
In January of 1997, Stanley R. Drake, M.D. (Drake) delayed delivery of twins
carried by Vicki Sanders. After Vicki experienced severe hemorrhaging, one child (Lucas)
died, and the other child (Katie) experienced damage to her brain. Vicki
suffered various injuries.
The Sanders filed with the Department of Insurance an amended proposed complaint against
Drake and Terre Haute Regional Hospital (THR). In their amended complaint, the
Sanders alleged that Drake and THR were negligent during the treatment and hospitalization
of Vicki for labor and delivery of Lucas and Katie on January 9,
1997.
In March of 2000, the Sanders entered into a release, settlement agreement, and
confidentiality agreement with Health Care Indemnity, Inc. (HCI), THRs insurer. Pursuant to
the release, HCI agreed to pay the equivalent of the statutory health care
provider cap of $100,000.00. In exchange for the settlement payments, the Sanders
released THR and HCI from any and all claims connected with the admission
and treatment of Vicki Sanders and the delivery of Lucas and Katie.
The Sanders filed their petition for excess damages from the Fund under Ind.
Code § 34-18-15-3. In their petition, the Sanders alleged that their agreement
to settle with the health care provider for the statutory equivalent of $100,000.00
under Ind. Code § 34-18-14-4(b) entitles each of them to recover from the
Fund. The Sanders petitioned on the understanding that they were entitled to
damages from the Fund under a separate $750,000.00 statutory limit for each of
them.
B. The Koehls
In April and May of 1997, Jerry L. Kight, M.D. (Kight) administered radioactive
iodine as thyroid treatments to Carla Koehl while she was pregnant with her
twins, Mariah and Samantha. The administration of this substance resulted in injuries
to Mariah and Samantha, who now suffer from hypothyroidism.
In October of 2000, the Koehls entered into a settlement agreement with Kight.
Pursuant to the agreement, Kight agreed to pay the statutory sum of
$100,000.00 in exchange for a complete release of liability for all claims relating
to his care and treatment of Carla, Mariah, and Samantha.
In January of 2000, the Koehls filed two separate petitions against the Fund,
one on behalf of Mariah and the other on of behalf of Samantha.
Mariah and Samantha alleged that Kights payment entitles them to recover damages
from the Fund for their separate injuries.
C. Thomas
On September 24, 1998, Kerry Thomas was admitted to Caylor-Nickel Medical Center (Caylor-Nickel)
for delivery of her child, Jacob. A nurse anesthetist employed by Caylor-Nickel
administered an epidural injection to Kerry. Within a few minutes after the
epidural began, Kerry became non-responsive, her respiration ceased, and she went into cardiopulmonary
arrest. Resuscitative measures were taken, and Kerry was taken to an operating
room where Jacob was delivered by caesarian section.
Kerry did not regain consciousness, and she died on October 23, 1998.
As a result of Kerrys cardiopulmonary arrest during childbirth, Jacob suffered anoxic encephalopathy,
which resulted in permanent brain damage.
On December 11, 1998, Michael Thomas, individually, as Jacobs next friend, and in
his capacity as administrator of Kerrys estate, filed a medical malpractice proposed complaint
against Caylor-Nickel. Thomas subsequently accepted a settlement payment of $100,000.00 from Caylor-Nickel
and its insurer, Medical Assurance of Indiana. Thomas then entered into an
agreed entry of judgment with the Commissioner whereby the Fund paid Thomas $650,000.00
as a settlement to Kerrys estate.
On August 9, 2002, the Thomases filed an amended petition for payment of
damages from the Fund, alleging that Jacob is entitled to recovery under a
separate cap.
D. Consolidation
The trial court consolidated the three cases described above for purposes of ruling
on pending motions for partial summary judgment filed by the Commissioner in the
Sanders and Thomas cases and a pending motion for summary judgment filed by
the Koehls. The Commissioner contended that settlement payments of the statutory cap
amount of $100,000.00 must be made by the health care providers to each
injured party before the injured parties are entitled to excess damages from the
Fund.
The trial court denied the Commissioners request for partial summary judgment and granted
the Koehls request, stating that a single $100,000.00 payment from the health care
provider in each case allowed each injured party to seek excess damages from
the Fund. The trial court further stated that the Act allows each
injured party to recover damages under a separate $750,000.00 cap. The Fund
now appeals.
DISCUSSION AND DECISION
STANDARD OF REVIEW
The purpose of summary judgment is to end litigation when no issue of
material fact exists and when the case may be determined as a matter
of law. LeBrun v. Conner, 702 N.E.2d 754, 756 (Ind.Ct.App.1998). We
must exercise caution to ensure a party of its right to a fair
determination of genuine issues. Art Country Squire, L.L.C. v. Inland Mortgage Corp.,
745 N.E.2d 885, 891 (Ind.App. 2001). The burden is on the movant
to negate the existence of any genuine issue of material fact, and all
doubts must be resolved against the movant. Id. It is only after
the movant makes a prima facie showing of the nonexistence of a genuine
issue of material fact that the burden shifts to the nonmovant to set
forth specific facts showing the existence of a genuine issue for trial.
Id. In reviewing the nonmovant's response, we consider as true the facts
set forth in the nonmovant's affidavits and liberally construe discovery in the nonmovant's
favor. Id. Where the material facts are undisputed, the sole task
of the court on appeal is to determine whether the trial court properly
applied the law to the facts. Laux v. Chapin Land Associates, Inc.,
615 N.E.2d 902, 905 (Ind. Ct. App. 1993), trans. denied. The interpretation
of a statute is a pure question of law for the court.
Chavis v. Patton, 683 N.E.2d 253, 257 (Ind. Ct. App. 1997).
I. THE SANDERS AND THE KOEHLS
Ind. Code § 34-18-14-3(a) provides that the total amount recoverable for an injury
or death of a patient may not exceed $750,000.00 for an act of
malpractice that occurred during the time period at issue.
See footnote During the time
period at issue, Ind. Code § 34-18-14-3(b) provided that a qualified health care
provider was not liable for an amount in excess of $100,000.00 for an
occurrence of malpractice.See footnote Ind. Code § 34-18-14-3 (c) provides that any amount
due that is in excess of the total liability of all liable health
care providers shall be paid from the Fund.
The Commissioner contends that the trial court erred in interpreting Ind. Code §
34-18-14-3 to allow each injured person to recover under separate statutory caps from
the Fund. The Commissioner argues that the trial court failed to properly
apply certain rules of construction in interpreting the statute. The Commissioner further
argues that the trial courts interpretation of the statute conflicts with prior case
law. The Commissioner asserts that the terms injury or death used in
Ind. Code § 34-18-14-3(a) are synonymous with the terms occurrence of malpractice used
in Ind. Code § 34-18-14-3(b).
The first step in statutory interpretation is to determine whether the legislature has
spoken clearly and unambiguously on the point in question.
Parkhurst v. Van
Winkle, 786 N.E.2d 1159, 1160 (Ind. Ct. App. 2003). When a statute
is clear and unambiguous, courts need not, and indeed shall not, apply any
rules of construction other than to require that words and phrases be taken
in their plain, ordinary, and usual sense. Id. (quoting Coutee v. Lafayette
Neighborhood Housing Services, Inc., 792 N.E.2d 907, 912 (Ind. Ct. App. 2003), trans.
denied). Questions of statutory interpretation are particularly amenable to resolution by summary
judgment. Chief Industries, Inc. v. Indiana Department of Revenue, 792 N.E.2d 972,
976 (Ind. Tax Ct. 2000).
In the present case, the trial court determined that Ind. Code § 34-18-14-3
is unambiguous. We agree. Subsection (a) limits recovery for an injury
or death of a patient to $750,000.00. The term patient is defined
in Ind. Code § 34-18-2-22 as 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. All the claimants in this case are patients under
Ind. Code § 34-18-2-22, a conclusion that the Commissioner does not dispute.
Subsection (b) limits the amount that a health care provider has to pay
for an occurrence of malpractice. The plain meaning of occurrence, a term
not defined by the Act, is act or instance of occurring, happening, event,
episode, or incident. The American Heritage College Dictionary at 944 (3d ed.
1993). An occurrence of malpractice is the actual act itself, not the
resulting injury. The legislature could have chosen to require a health care
provider to pay up to $100,000.00 for each injury or death of a
patient resulting from an occurrence of malpractice, but it clearly did not do
so.
In Johnson v. St. Vincent Hospital, Inc., 273 Ind. 374, 404 N.E.2d 585,
589-90 (1980), abrogated on other grounds by Collins v. Day, 644 N.E.2d 72
(Ind. 1994), our supreme court stated the conditions which led to the passage
of the Act:
Immediately prior to its enactment seven of the ten insurance companies writing the
majority of medical malpractice insurance policies in the State ceased or limited writing
such insurance because of unprofitability or an inability to calculate an adequate premium.
Premiums had already increased as much as 1200 percent over a period
of fifteen years because of the increase in the number and size of
claims. Physicians practicing high risk specialties such as anesthesiology were hard pressed
or totally unable to purchase insurance coverage. In some rural areas surgery
was reported cancelled. Emergency services were discontinued at some hospitals. Health
care providers had become fearful of the exposure to malpractice claims and at
the same time were unable to obtain adequate malpractice insurance coverage at reasonable
prices.
Thus, the primary purpose of the Act was to limit the financial exposure
of healthcare providers, thereby allowing them to acquire affordable malpractice insurance. To
effectuate this purpose, the Act apportions financial responsibility between health care providers and
the Fund. Eakin v. Reed, 567 N.E.2d 148, 149-50 (Ind. Ct. App.
1991), trans. denied. The statutory scheme attempts to balance the escalating costs
of malpractice insurance with the realization that some incidents of malpractice produce devastating
results, including astronomical medical bills. Id.
The plain, unambiguous language of Ind. Code § 34-18-14-3 is consistent with the
purposes of the Act. Ind. Code § 34-18-14-3(a) allows each injured person
to obtain excess damages to cover the costs of his or her injury.
On the other hand, Ind. Code § 34-18-14-3(b) limits the amount of
damages that a health care provider may have to pay because of a
single occurrence to the set amount of $100,000.00. Thus, Subsection (b) does
not compel malpractice carriers to factor in additional, unpredictable costs that would be
incurred if the statutory cap were tied to the possible multiple injuries resulting
from an occurrence of malpractice. Accordingly, as interpreted by the trial court
upon its plain meaning, the statute achieves the twin goals of compensating those
injured by malpractice and at the same time assuring that malpractice insurance will
be available to health care providers.
Furthermore, we do not find St. Anthony Medical Center, Inc. v. Smith, 592
N.E.2d 732 (Ind. Ct. App. 1992) or Bova v. Roig, 604 N.E.2d 1
(Ind. Ct. App. 1992) to be controlling. The facts of these cases,
which pertained to the rare instance where two occurrences of malpractice resulted in
a single injury, are significantly different from the facts in the present case.
With regard to any language in St. Anthony that appears to conflict
with our holding here, we note that under the facts of St. Anthony
the occurrences and the injury were, as a practical matter, the same.
Here, there is more than one injury.
The trial court did not err in denying the Commissioners motion for partial
summary judgment as it pertains to the Sanders and Thomas or in granting
the Koehls motion for summary judgment.
II. FACTUAL QUESTION PERTAINING TO JACOB THOMAS CLAIM
One of the reasons given by the trial court for the denial of
the Commissioners motion for partial summary judgment was that [t]he Act allows only
one Provider limit in each case here because there is only one act
of malpractice in each case. Holding otherwise contravenes the clear meaning of
occurrence and the consistent logic of Indiana cases interpreting the Act. Appellants
App. at 43. In its subsequent supplemental order, the trial court noted
that Caylor-Nickels insurer, Medical Assurance, had filed a motion for summary judgment seeking
a determination that there is one occurrence of malpractice, therefore one liability limit
for its physician under the [Act]. Appellants App. at 45. In
granting Medical Assurances motion, the trial court concluded that it had previously concluded
that there is one occurrence in the consolidated cases, including [Thomas]. Id.
The practical effect of the trial courts orders is a grant
of summary judgment in favor of Thomas on the issue of whether there
was only one occurrence of malpractice.
The Commissioner contends that there is a material issue of fact which precludes
the trial court from granting summary judgment to Thomas on the question of
whether the tragic circumstances that resulted in Kerrys death and Jacobs injuries constitute
a single occurrence of malpractice under the Act. The Commissioner points to
designated evidence, in the form of designated portions of a deposition by its
expert, Edwin Campbell, M.D. (Campbell). In response, Thomas points to designated portions
of the same deposition.
Campbell stated in his deposition that a nurse anesthesiologist administered an epidural to
Kerry, and that even though Kerry expressed discomfort, the nurse proceeded to inject
the epidural in the wrong location. Kerry went into pulmonary arrest and
Jacobs brain began to be deprived of oxygen. The room did not
have the proper equipment to aid in Kerrys resuscitation, so the nurse anesthesiologist
sent Jerry Thomas to find another nurse to secure the equipment. By
the time the obstetrician arrived, Kerry was intubated. The obstetrician then realized
that a caeserian section was needed. However, the obstetrician took an inordinate
amount of time in performing the procedure.
Campbell further stated that Jacob was deprived of oxygen from the onset of
his mothers cardio-pulmonary arrest and continued to be in distress until his delivery.
Campbell also stated that it is difficult to quantify the amount of
brain damage experienced by Jacob at any certain point, but he opined that
the damage increases with every minute that goes by without oxygen. Campbell
concluded that even though the hospitals delay in performing the caesarian was a
separate act, both Kerrys and Jacobs injuries were caused by the nurse anesthetists
negligence.
Our review of Campbells deposition leads us to the conclusion that there was
one continuous sequence of events that led to two separate injuries. This
continuous sequence, beginning with the misplaced epidural and concluding with the delinquent caesarian
section, was precipitated by Caylor-Nickels failure to provide necessary personnel to cover the
contingencies occasioned by the negligent administration of the epidural to Kerry. The
trial court was correct in determining that there was no material issue of
fact in this matter.
III. THE SETTLEMENT AGREEMENT
The Commissioner contends that because Jacob was not made a party to the
settlement agreement between Kerry and Caylor-Nickel, he had no standing to demand payment
from the Fund. In support of her contention, the Commissioner cites Ind.
Code § 34-18-15-3, which delineates the procedure for demanding payment from the Fund.
Included in the statute is the requirement that claimants file a petition
demanding payment of damages from the Fund after a health care provider or
its insurer has agreed to settle its liability on a claim. Ind.
Code § 34-18-15-3(1)(B). The crux of the Commissioners contention is that Jacob
was not the claimant who settled with Caylor-Nickel, and he thus cannot be
the claimant who makes a demand of payment from the Fund.
Because there was one occurrence of malpractice that resulted in two injuries, Caylor-Nickel
was required to settle its liability by making a single payment of its
policy limits. Caylor-Nickel, through its insurer, has agreed to settle its liability
to Kerry on the occurrence of malpractice that resulted in injuries to both
Kerry and Jacob. When that settlement of liability was made, the injured
parties then became eligible to make a demand for damages from the Fund.
We do not believe that the statute should be read to require
that Jacob do the useless act of making a claim to Caylor-Nickel when
it has already agreed to settle its liability. See Apple v. Apple,
157 Ind.App. 68, 299 N.E.2d 239, 242 (1973) (holding that equity does not
require the doing of a useless thing). Jacobs filing of a
petition demanding payment of damages from the Fund is sufficient to establish his
standing as a claimant under the statute.
CONCLUSION
The trial court did not err in denying the Commissioners motion for partial
summary judgment as it pertained to the Sanders and Thomas. Furthermore, the
trial court did not err in granting the Koehls motion for partial summary
judgment.
Affirmed.
RILEY, J., and SHARPNACK, J., concur.
Footnote:
Ind. Code § 34-18-14-3(a) also provides a cap of $500,000.00 for injury
or death from an act of malpractice that occurred before January 1, 1990
and a cap of $1,250,00.00 for injury or death from an act of
malpractice that occurred after June 30, 1999. These caps are not applicable
to this case.
Footnote: The statutory limit is now $250,000.00.