Rita Horn and Charles Horn v. Cesar Antonio Jara, M.D. and Northwest Indiana Cardiovascular Physicians, P.C. (mem. dec.)

Citations: 63 N.E.3d 1; 2016 Ind. App. LEXIS 377; 2016 WL 5095755Docket: 64A03-1512-CT-2251

Court: Indiana Court of Appeals; September 20, 2016; Indiana; State Appellate Court

Original Court Document: View Document

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The Memorandum Decision states that it should not be treated as precedent except for issues of res judicata, collateral estoppel, or the law of the case. The appeal involves Rita and Charles Horn against Cesar Antonio Jara, M.D., and Northwest Indiana Cardiovascular Physicians, P.C., following a jury trial concerning a medical malpractice claim. The key issue is whether the trial court abused its discretion by excluding the Horns' expert testimony and evidence related to the standard of care breach due to the angiogram being deemed unnecessary. The court affirmed the decision.

In July 2006, Rita Horn, with a history of coronary artery disease, was admitted to the hospital following chest pain complaints. Dr. Jara, her cardiologist, performed a coronary angiogram, which resulted in internal bleeding. Although Rita recovered, she continued to experience pain. In January 2008, the Horns filed a negligence complaint with the Indiana Department of Insurance regarding the July procedure but failed to submit their complete complaint to the medical review panel.

Their submission included a res ipsa loquitor argument asserting that the procedure was improperly performed, which led to complications. In June 2010, the Horns filed a negligence complaint in court and identified Dr. Stephen Joyce as an expert witness, who stated that the angiogram was unwarranted based on prior normal stress test results. The Defendants filed motions to exclude testimony concerning the angiogram's necessity, which the trial court granted.

On April 17, 2014, the trial court ruled to exclude evidence not presented to the medical review panel and limited the Horns to arguments related to that panel's findings. Following this ruling, the Horns sought an interlocutory appeal, which the trial court granted but was ultimately denied by the appellate court. During the jury trial, the Horns attempted to preserve the issue of excluded testimony but the trial court upheld its exclusion. The jury found in favor of the Defendants, prompting the Horns to appeal. 

The appellate court reviews evidence exclusion for abuse of discretion, reversing only if the decision contradicts the facts or substantially affects justice. The Horns argued that the trial court improperly excluded portions of Dr. Joyce’s testimony and evidence related to Dr. Jara’s alleged breach of standard care during the angiogram procedure, asserting that this evidence was presented to the medical review panel through their proposed complaint. 

Under Indiana's Medical Malpractice Act (MMA), malpractice claims must first go before a medical review panel, which evaluates the evidence submitted by both parties before the trial court can assume jurisdiction. The MMA prohibits introducing new allegations of breach at trial that were not addressed by the panel. The Horns claimed all relevant allegations were submitted, but the record indicates that the panel of physicians did not receive the proposed complaint, as it was only sent to the panel chairman, not the members.

The record indicates that the medical review panel did not receive or consider the proposed complaint, including the allegations it contained. The evidence presented to the panel included a Submission and attached medical exhibits. The Horns alleged that the Defendants breached the standard of care by not performing catheterization and angiogram procedures carefully. However, they did not reference cardiac stress tests conducted by Dr. Jara or his failure to consider their normal results. The Submission primarily discussed the angiogram and the complications that arose, without addressing whether the procedure was warranted. Many of the exhibits intended to support their claims were either missing from the appeal record or could not be clearly identified. The discernible exhibits discussed the angiogram's performance and outcomes but did not address whether the procedure was indicated. The Horns claimed their improper diagnosis allegation was linked to the angiogram decision-making, but the court found that the claim did not sufficiently assert a malpractice issue regarding diagnosis. Consequently, the medical review panel did not evaluate whether Dr. Jara breached the standard of care concerning the angiogram's necessity, and this issue could not be introduced at trial. The trial court was justified in excluding related expert testimony and evidence, focusing solely on the standard of care in performing the angiogram procedure itself. The decision was affirmed, with concurrence from Justices Riley and Pyle.