Testimony based on medical journals allowed

A physician testifying at a medical malpractice case should have been allowed to offer testimony based on her reading of medical journals, and a Marion County judge erred when he excluded part of her statements, the Indiana Court of Appeals decided.

The error, however, was harmless and didn't affect the overall outcome in a medical negligence case against a Wishard Memorial Hospital doctor stemming from a relative's death following post-operative treatment.

The court issued its unanimous ruling today in Linda Spaulding, et al. v. Erinn R. Harris, M.D. and Health and Hospital Corp. of Marion County d/b/a Wishard Memorial Hospital, No. 49A02-0810-CV-954. The case involves the medical treatment and subsequent death of Mattie Spaulding, a morbidly obese 58-year-old woman who underwent emergency aortic valve replacement surgery for congestive heart failure. A couple months after the procedure in March 2002, she consulted with Harris at Wishard's Blackburn Community Health Center for post-operative blood monitoring for possible clots. She had blood tests to monitor her coagulation factor because of being on a blood thinner. On June 20, 2002, an ambulance was called to her house; however, she refused three times to be transported. Three days later, she was taken to Community Hospital and diagnosed with a subdural hematoma for which she underwent a craniotomy. She was later transferred to a rehabilitation facility, where she suffered acute respiratory failure and died. The cause of death was a blood clot traveling to the lungs and preventing oxygenation.

After her death, the Spaulding family filed a complaint with the Indiana Department of Insurance against Dr. Erinn Harris and Wishard Memorial Hospital, alleging the doctor failed to adequately monitor Mattie's coagulation and that she developed her injuries because of negligence. Two members of a medical review panel found in May 2006 that a material issue of fact existed and should be heard by a jury, while a third panelist determined the defendants had failed to provide the appropriate standard of care. The Spauldings then filed suit in Marion Superior Court.

An issue arose when one of the medical review panelists, a primary care doctor, testified based on her experience in administering blood thinners and monitoring coagulation like Mattie's. She testified in a video deposition that a medical article she'd consulted showed higher blood levels could present a greater danger for spontaneous bleeds, and that her belief was that Harris should have tested Mattie more often; she had no tests between June 4 and 23. Judge Gerald Zore redacted portions of the expert's causation testimony that was based on medical literature, but the Spauldings argued that testimony was improperly excluded.

The Court of Appeals agreed, citing caselaw from the 1980s to show expert witnesses can draw upon all sources of information and consult authoritative sources to reach a conclusion. Finding that Indiana Code Section 34-18-10-23 does not give review panel members a "free pass to testify on any matters they so choose," the court acknowledged that she could consult medical periodicals during the deposition under Rule 702. However, the exclusion was harmless because at least three others statements from that doctor were admitted and other testimony showed a similar connection about the medical issue.

The court also determined that the trial court didn't abuse its discretion by excluding the words "Department of Insurance" on the medical review panel opinion and that admitting a redacted copy of that certified opinion was allowed.