Nursing Home Industry: Can Medical Review Panel Include Nurse’s Causation Opinion?

Assisted Living Insurance


A Win for the Nursing Home Industry: Indiana Appellate Court Sides with Nursing Home Case on Whether Medical Review Panel Can Include Nurse’s Causation Opinion

In a significant case earlier this year, the Indiana Court of Appeals settled an issue on whether a medical review panel can include a nurse’s opinion on medical causation, and put to rest a much contested issue involving Indiana long-term care facilities facing medical negligence litigation. Under the Medical Malpractice Act, nurses can serve on medical review panels because they’re included in the statutory definition of “health care providers”. But in the case of Honore v Doe Corporation, the Indiana Court of Appeals found that “there is a significant difference in education, training, and authority to diagnose and treat diseases between physicians and nurses,” and that nurses do not have the requisite expertise to provide opinions on medical causation. This is the first time that the Court held that a nurse could not properly offer an opinion on medical causation. And in our opinion the right decision.

The Case Details

The case involved a woman that resided in an unnamed health care facility (Doe Corp.) in Hamilton County from December 2002 until her death in April 2004. Her estate filed a complaint with the Indiana Department of Insurance alleging a breach in the reasonable standard of medical and nursing care while the woman was there, and in 2007 that case went before a Medical Review Panel as outlined in the Medical Malpractice Act. The panelists included physicians, as is standard, whose opinions stated that the Doe Corporation had not caused the patient’s alleged injuries or death. Also included on the panel was a nurse, with the panel chairman agreeing that the nurse’s opinions regarding medical causation were not to be included in the panel findings as such opinions were, by law, reserved only for physicians to render. However in 2009 the panel chair acted in opposition to that agreement by including the nurse’s viewpoint in a written opinion about medical causation, which found that Doe Corp. failed to meet the reasonable standard of care regarding the deceased patient.

Doe Corp. then petitioned the trial court for a preliminary determination of law, questioning the validity of the review panel’s decision – citing inclusion of the nurse member’s opinion despite the panel chair’s previous agreement to specifically exclude that input. The trial court struck down Doe’s petition on the grounds that it did not have subject matter jurisdiction, as a similar case was pending in another state. Doe appealed the decision and in April 2011, the appellate court determined that subject matter jurisdiction was indeed in the hands of the trial court regarding enforcement of the requirement that the review panel chairman perform his statutory duties as agreed. Moreover, the appellate court found that the trial judge had dismissed the motion in error.


Our Support
The Midwest Insurance Group, a risk retention group for assisted living, residential communities, and nursing homes, managed by Caitlin-Morgan, supports the appellate court’s decision. The group participates in Indiana’s Patient Compensation Fund (PCF).

We believe that our support was not only good for Doe Corp., but also for the entire Indiana long-term care industry. Those facilities participating in Indiana’s PCF receive the benefit of having a medical panel of experts reviewing allegations of medical negligence during the pre-trial administrative process.

With all due respect to the hardworking professionals in the registered nursing field, a medical panel operates at its highest capability when it consists of esteemed medical doctors with pertinent areas of specialty, who bring to bear their years of advanced education and training to render medical opinions. Careful panel member selection adds weight to the panel conclusion, which can be of substantial use in the courtroom. Because long-term care can often involve multiple and complex health issues, rendering an opinion as to whether an alleged injury or death stems from a resident patient’s pre-existing condition(s) or the facility’s treatment requires the expertise of a medical doctor. More telling, doctor-sourced opinions are the law in Indiana as well as in most states. Nurses are prohibited from giving testimony at trials involving injury or death allegedly due to medical causes. Ultimately, the appellate court’s decision in this matter will serve to reaffirm the usefulness and validity of the medical panel process for the long-term care and other industries.