from the Vanderburgh Circuit Court The Honorable David D.
Kiely, Judge Trial Court Cause No. 82C01-1809-CT-4911
ATTORNEYS FOR APPELLANTS Arthur R. Baxter, Jr. Cynthia S.
Rose Baxter Rose & Schrager LLP Indianapolis, Indiana
ATTORNEYS FOR APPELLEE Michele S. Bryant Lauren E. Dimmitt
Wooden McLaughlin LLP Evansville, Indiana
Nataomi Riley and her husband, Frank Riley, filed a medical
malpractice complaint against St. Mary's Medical Center
of Evansville, Inc. ("the Hospital"), alleging that
a Hospital radiologic technologist ("RT") was
negligent in injecting contrast dye into Nataomi's arm in
preparation for a CT scan and that the negligence proximately
caused various injuries. The Hospital moved for summary
judgment. In response, the Rileys designated an affidavit
from another RT who opined that the Hospital's RT
breached the applicable standard of care and that this
negligence proximately caused Nataomi's injuries. The
Hospital conceded that the RT's affidavit established a
genuine issue of material fact regarding a breach of the
standard of care, but argued that the RT was not qualified to
render an expert opinion on proximate causation. The trial
court granted the Hospital's summary judgment motion. On
appeal, the Rileys argue that their RT is qualified to render
an expert opinion on proximate causation and that a genuine
issue of material fact exists regarding that issue. We agree
and therefore reverse and remand for further proceedings.
and Procedural History
The designated evidence most favorable to the Rileys as the
summary judgment opponents indicates that at approximately
3:00 p.m. on June 8, 2015, sixty-eight-year-old Nataomi
arrived at the Hospital for a CT scan with contrast dye to
rule out a pulmonary embolism. According to Nataomi's
affidavit, she had had "the same test done before and
never had any problems." Appellants' App. Vol. 2 at
50. When Hospital employee RT Karen Osborne "came into
the room to insert the dye [Nataomi] told her that [she had]
always been a 'hard stick', and [Osborne's] reply
was 'Don't worry this is not my first rodeo. I've
been doing this for over 25 years.'" Id.
Osborne inserted an IV into Nataomi's right forearm, went
behind a barrier to avoid radiation exposure from the CT
scan, and used a remote control to inject a thirty-milliliter
pressurized "smart prep" test dose of dye into
Nataomi's arm at four milliliters per second.
Id. at 152. "As the dye was going into
[Nataomi's] arm it was so painful [she] kept telling
[Osborne], 'it hurts, it hurts'." Id.
at 50. "With the intense pain [Nataomi] was having [she]
just knew it was going into the tissue and [she] told
[Osborne] that." Id. Once the entire test dose
was injected, Osborne put Nataomi "into the [x]-ray
machine. After a few seconds [Nataomi] was screaming to get
[her] out of the machine because the pain went from [her]
whole arm up to [her] shoulder." Id. When
Osborne came to get Nataomi out of the machine, Osborne said,
"'I knew there was a problem when looking at your
x-ray.'" Id. According to Osborne's
affidavit, she "fail[ed] to visualize the contrast in
[Nataomi's] chest [on the machine's monitor] within 5
to 6 seconds of the injection[.]" Id. at 54.
"Another technician then inserted a needle in
[Nataomi's] left arm and there was no pain when the dye
went in [her] left arm." Id. at 50. Nataomi
received a thirty-milliliter test dose and an additional
seventy milliliters of dye in her left arm, for a total of
100 milliliters. Id. at 167-69. "The
technicians put [her] back in the x-ray machine and it seemed
like just a few minutes went by and [her] x-ray was
finished." Id. at 50. Osborne "observed
swelling that resembled a small egg [on Nataomi's right
arm] and [Nataomi] complained of some pain."
Id. at 54. Osborne "concluded an infiltration
had occurred" and "applied compresses, massaged the
area, and elevated [Nataomi's] right arm."
Id.According to Nataomi, Osborne "wrapped
a dressing around [her] right arm and said, you might have a
little bruising and swelling within an hour or after coming
home and she left the room." Id. at 50. Osborne
did not notify the Hospital's radiologist, Dr. Tony
Findley, about the infiltration.
Nataomi got home between 6:30 and 7:30 p.m., and "[s]oon
after" her "arm continued to swell so bad that the
flesh broke open on [her] right hand and fluid was running
out." Id. She called the "x-ray department
and spoke to a technician and explained what was going
on." Id. The technician told Nataomi "to
apply alternating cold and hot compresses on [her] arm"
and "that if it got too bad to go to the emergency
room." Id. at 50-51. Around 10:00 p.m.,
"the pain became so unbearable and the swelling so bad
that [Frank] took [Nataomi] to the Emergency Room. The ER
doctor gave [her] morphine for the pain and ordered an
[x]-ray for [her] right arm." Id. at 51.
"When they moved [her] arm it was so painful that [she]
was screaming and thought [she] would pass out from the
pain." Id. "A short time later a trauma
surgeon [Dr. Todd Burry] came in and commented that he had
hardly ever seen a case like this and he was going to have to
do surgery." Id. Nataomi was diagnosed with
"[r]ight arm IV contrast extravasation."
Id. at 72.
Nataomi went into surgery at about 5:30 a.m. Dr. Burry's
notes indicate that Nataomi was administered general
anesthesia and preoperative antibiotics. "The
hematoma/fluid collection was then identified. A linear
incision was made approximately 2 inches in length parallel
with the radius.… Immediately the hematoma was entered
and fluid was drained. Hematoma was debrided and this
hematoma was approximately 5 inches in length overall."
Id. A "wound VAC [vacuum-assisted closure] was
cut to the appropriate size … and then covered with
appropriate dressing." Id. Nataomi was
discharged "on June 12, 2015 and then had weeks of home
health care with the wound [VAC]." Id. at 51.
According to Nataomi, who is right-handed, "[t]he skin
is tight over the healed wound and pulls. The surgeon said
that there is nothing he can do for that." Id.
"Ever since the surgery, on average of two to three
times a day, [she gets] a sharp electrical shock running from
[her] wrist down into [her] fingers." Id.
"The surgeon told [her] that [she has] nerve damage.
[Her] grip is not as secure. [She] will be holding something
in the right hand and all of a sudden it will just drop out
of [her] hand." Id. "While writing [her]
fingers will start to curl and [she has] to stop and take
[her] left hand and uncurl them." Id.
In January 2016, the Rileys filed a proposed medical
malpractice complaint against the Hospital with the Indiana
Department of Insurance, alleging that as a result of medical
negligence Nataomi "developed compartment syndrome of
the right arm requiring emergency surgery and prolonged wound
care" and "suffered permanent neurological and
muscular damage to [her] right arm[, ]" among other
injuries, and that Frank suffered a loss of consortium.
Id. at 22. In June 2018, the medical review panel
unanimously opined that the evidence submitted by the parties
did not support the conclusion that the Hospital "failed
to comply with the appropriate standard of care" and
that the Hospital's conduct "was not a factor in the
injuries and damages of which [the Rileys] complained."
Id. at 28, 31, 34.
In September 2018, the Rileys filed a medical malpractice
complaint against the Hospital in the trial court. The
Hospital filed a motion for summary judgment and designated
the medical review panel's opinion. In response, the
Rileys designated Nataomi's medical records,
Osborne's deposition, Dr. Findley's answers to
interrogatories,  and affidavits from Nataomi, Osborne, and
RT Barry Southers, who opined that Osborne "did not
follow the standard of care in these circumstances and that
conduct was a factor in the resultant injury to
[Nataomi]." Id. at 57. In its reply to the
Rileys' response, the Hospital argued that Southers was
"not qualified to render an expert opinion as to medical
causation" and cited cases to support its argument.
Appellants' App. Vol. 3 at 9. At the summary judgment
hearing, the Hospital conceded that Southers's affidavit
established a genuine issue of material fact regarding a
breach of the standard of care, but reiterated its argument
that Southers was not qualified to render an expert opinion
on causation. In March 2019, the trial court issued an order
summarily granting the Hospital's summary judgment
motion. The Rileys now appeal. Additional facts will be
The Rileys argue that the trial court erred in granting the
Hospital's summary judgment motion. "We review a
summary judgment ruling by applying the same standard as the
trial court: if the evidence shows there are no genuine
issues of material fact and the moving party is entitled to
judgment as a matter of law, summary judgment is
appropriate." Lorenz v. Anonymous Physician #1,
51 N.E.3d 391, 397 (Ind.Ct.App. 2016). Just as the trial
court does, we resolve all questions and view all evidence in
the light most favorable to the non-moving party, so as to
not improperly deny that party its day in court. Sorrells
v. Reid-Renner, 49 N.E.3d 647, 650 (Ind.Ct.App. 2016)
(quoting Alldredge v. Good Samaritan Home, Inc., 9
N.E.3d 1257, 1259 (Ind. 2014)). "Evidence sufficient to
support a verdict is not required" to establish a
genuine issue of material fact. Siner v. Kindred Hosp.
L.P., 51 N.E.3d 1184, 1189 (Ind. 2016).
"Indiana's distinctive summary judgment standard
imposes a heavy factual burden on the movant to demonstrate
the absence of any genuine issue of material fact on at least
one element of the claim." Id. at 1187. For a
medical malpractice claim, those elements are (1) that the
defendant owed a duty to the plaintiff; (2) that the
defendant breached that duty; and (3) that the breach
proximately caused the plaintiff's injuries. Id.
"A 'unanimous opinion of the medical review
panel' in favor of the movant is 'ordinarily
sufficient' to meet [the movant's] initial burden,
requiring the non-movant to rebut the medical panel opinion
with expert medical testimony." Id. (quoting