COA: Standard of care same for all doctors

The Indiana Court of Appeals ruled in a medical malpractice claim brought by a former inmate who had gender reassignment surgery that the standard of care for doctors practicing inside prisons is the same as the standard of care for those practicing outside of prison.

Christa Allen had gender reassignment surgery in January 2002, which included the construction of a vaginal vault. As part of her treatment, her doctor, Alan Neal Wilson, prescribed hormone therapy and the use of a vaginal stent, a soft plastic appliance worn internally like a tampon. The stent keeps the vaginal vault dilated and prevents atrophy.

When Allen first entered the Department of Correction in June 2006, the correction facility allowed her to use the stint. But later the superintendent determined its use was a security breach. The DOC allowed for alternatives, but they caused issues for Allen. After her release in late 2007, Wilson examined Allen and found that because of her inability to use the stent, her vaginal vault had contracted and become unusable. The doctor estimated it would cost between $60,000 and $120,000 to restore Allen’s vagina.

Allen filed her proposed medical malpractice complaint against the three doctors who treated her while in prison. A review panel ruled in favor of the doctors, as did Marion Superior Judge Health Welch. Welch determined that Allen failed to provide expert testimony to rebut the opinion of the medical review panel when she only presented testimony from Wilson. Welch also held that doctors practicing in the prison system have a different standard of care than those practicing in the general population.

In Christa Allen v. Richard Hinchman, M.D.; Richard Tanner, M.D.; and Jeffery Smith, M.D., 49A02-1311-PL-975, the appeals judges disagreed.

“[W]e recognize that medical care in the DOC involves additional considerations not present in a hospital or general care facility. However, we cannot find that physicians practicing in prisons may deviate from the standard of care without reasonable, articulable concerns. In short, we do not find that physicians practicing in prisons may determine the standard of care based on the circumstances and concerns facing them with regard to individual patients, especially when such concerns remain vague and nebulous. To do so would be to empower prison physicians to determine for themselves what standard of care should apply based on each individual case, a practice we will not endorse,” Judge John Baker wrote.

 As such, Wilson was qualified to testify as an expert. The medical review panel found the doctors did not breach their standard of care and that Allen’s damages were not causally linked to the care they provided. But Wilson’s expert testimony rebutted the medical review board, so summary judgment was inappropriate.