Union Hospital and Muhammad Khan, M.D., Appellants-Defendants v. Max Reagin, Jr., Appellee-Plaintiff (2025)

MEMORANDUM DECISION

Case Summary

[1] Max Reagin, Jr., filed a proposed medical malpractice complaint with the Indiana Department of Insurance (“the IDOI”), as well as a complaint for intentional infliction of emotional distress (“IIED”) with the trial court, against Union Hospital (“Union”) and Muhammad Khan, M.D. (“Dr. Khan”) (collectively, “Defendants”). Both complaints are based on Defendants’ treatment of Reagin's deceased wife, Cindy. The medical review panel that was convened to review Reagin's proposed medical malpractice complaint unanimously determined that the evidence did not support the conclusion that Defendants failed to meet the applicable standard of care. Defendants each filed a motion for summary judgment on Reagin's IIED claims, which the trial court denied. On appeal, Defendants argue that the trial court erred in denying their summary judgment motions. We agree and therefore reverse and remand with instructions to enter summary judgment in Defendants’ favor.

Issues

[2] Defendants present the following dispositive issues for review:

1. Whether Reagin's IIED claims sound in medical malpractice and are therefore subject to the Indiana Medical Malpractice Act (“the MMA”); and

2. Whether a genuine issue of material fact exists regarding Defendants’ compliance with the applicable standard of care.

Facts and Procedural History

[3] In May 2017, Cindy underwent elective surgery at Union. After the surgery, Cindy “was confused” and “having difficulty swallowing[.]” Union's App. Vol. 2 at 92. “[I]t was determined that Cindy had hyponatremia with an extremely low sodium of 112[.]” Id. She “continued to deteriorate and was discharged on June 9, 2017 but never regained her normal ambulation, ability to speak as she had, or to eat and swallow.” Id. at 92-93. She was diagnosed with central pontine myelinolysis, a “debilitating neurological condition[.]” Id.

[4] On the morning of May 26, 2018, Cindy “woke up lethargic” and was “unresponsive.” Dr. Khan's App. Vol. 2 at 76. Reagin took her to Union's emergency department, where she presented “with altered mental status.” Id. At 11:45 a.m., Cindy was evaluated by Dr. Anita Toussi, whose initial differential diagnosis was intracranial hemorrhage and hyponatremia. Blood tests, an electrocardiogram, a head CT, and a chest x-ray revealed no emergent medical condition. Dr. Toussi consulted with Dr. Khan, who admitted Cindy to the emergency department.

[5] Dr. Khan evaluated Cindy at 1:30 p.m. His impression was “Acute Encephalopathy likely neurological[.]” Id. at 86. Dr. Khan noted Cindy's history of central pontine myelinolysis and that she would be observed to see if her “mental status improve[d],” as this was “an exp[e]cted event” with her history. Id. Dr. Khan further noted, “Husband has agreed to make her DNR [do not resuscitate] and is thinking about hospice.” Id.

[6] When Dr. Khan reevaluated Cindy at 10:43 the next morning, there was “[n]o change in status[.]” Id. at 89. Dr. Khan updated Reagin and his daughter about Cindy's condition and “[s]poke in detail” with them “about hospice and they agreed.” Id. In his discharge notes, Dr. Khan wrote, “Patient has minimal chances of improvement with her deteriorating condition. Arranged charity hospice visits for family.․ Family agreed to take her home and refused ambulance ride to home which was offered two times.” Id. at 91. According to Reagin, he refused because he was not allowed to ride in the ambulance and did not want Cindy to die alone. Cindy was discharged from Union and was loaded into Reagin's truck. After Reagin drove a few blocks, Cindy “stopped breathing” and “collapsed[.]” Union's App. Vol. 2 at 95. Reagin drove back to Union, where Cindy was pronounced dead. Her family “refused CPR and any other resuscitative measures.” Dr. Khan's App. Vol. 2 at 94.

[7] In April 2019, Reagin filed a proposed complaint with the IDOI, asserting claims of medical malpractice against Defendants and four physicians who were involved in Cindy's 2017 surgery and postoperative care. As relevant here, Reagin alleged that Defendants were negligent in “failing to stabilize Cindy” and in discharging her, which proximately caused her death and proximately caused injuries and damages to Reagin. Id. at 21. On the same day, Reagin also filed a complaint with the trial court, asserting IIED claims against Defendants.¹ Reagin alleged that Defendants’ actions “were reckless, willful, intentional and calculated to cause [him] to have severe emotional distress by forcing him to witness Cindy's death[.]” Id. at 16.²

[8] In June 2019, Defendants each filed a motion to dismiss Reagin's IIED complaint, which the trial court denied. In June 2022, the medical review panel that was convened to review Reagin's proposed medical malpractice complaint unanimously determined with respect to all six defendants that the evidence did not support the conclusion that they “failed to meet the applicable standard of care and the conduct complained of was not a factor of the resultant damages.” Id. at 27.

[9] In May 2023, Defendants each filed a motion for summary judgment on Reagin's IIED claims. Reagin filed a consolidated response, and Defendants each filed a reply. After a hearing, the trial court summarily denied Defendants’ motions. This discretionary interlocutory appeal ensued.

Discussion and Decision

[10] Defendants’ argument is twofold: (1) Reagin's IIED claims sound in medical malpractice and are therefore subject to the MMA; and (2) Defendants are entitled to summary judgment on those claims because there is no genuine issue of material fact that they met the applicable standard of care.

Issue One: Applicability of the MMA to Reagin's IIED Claims

[11] The MMA “governs medical malpractice claims against health care providers, with malpractice defined as ‘a tort or breach of contract based on health care or professional services that were provided, or that should have been provided, by a health care provider, to a patient.’ ” Strickholm v. Anonymous Nurse Prac., 136 N.E.3d 264, 267 (Ind. Ct. App. 2019) (quoting Ind. Code § 34-18-2-18). For purposes of the MMA, “tort” is defined as “a legal wrong, breach of duty, or negligent or unlawful act or omission proximately causing injury or damage to another.” I.C. § 34-18-2-28. “ ‘Health care’ means an act or treatment performed or furnished, or that should have been performed or furnished, by a health care provider for, to, or on behalf of a patient during the patient's medical care, treatment, or confinement.” I.C. § 34-18-2-13.

[12] It is undisputed that Union and Dr. Khan, as a facility and a physician licensed and legally authorized to provide health care services, are both “health care providers” as defined by the MMA. I.C. § 34-18-2-14(1). And the MMA defines “patient” as follows:

an individual who receives or should have received health care from a health care provider, under a contract, express or implied, and includes a person having a claim of any kind, whether derivative or otherwise, as a result of alleged malpractice on the part of a health care provider. Derivative claims include the claim of a parent or parents, guardian, trustee, child, relative, attorney, or any other representative of the patient including claims for loss of services, loss of consortium, expenses, and other similar claims.

I.C. § 34-18-2-22 (emphasis added). Thus, if Reagin's IIED claims are a result of alleged malpractice on the part of a health care provider, he would be considered a patient under the MMA. See Cutchin v. Beard, 171 N.E.3d 991, 997 (Ind. 2021) (“Section 34-18-2-22 says that a third party who did not receive medical care from a provider but who has a claim due to the provider's medical malpractice to a traditional patient also is a ‘patient’ under the [MMA].”); see also Gierek v. Anonymous 1, 250 N.E.3d 378, 387 (Ind. 2025) (“In sum, the MMA covers all claims for ‘malpractice’ by a ‘patient’ against a ‘health care provider,’ as those terms are defined in the Act. And nothing in the Complaint Statute[³ ] limits the MMA's application to claims involving only bodily injury or death.”).

[13] Pursuant to the MMA, “an action against a health care provider may not be commenced in a court in Indiana before: (1) the claimant's proposed complaint has been presented to a medical review panel ․; and (2) an opinion is given by the panel.” I.C. § 34-18-8-4. The MMA “neither specifically includes nor excludes intentional torts from the definition of malpractice.” Van Sice v. Sentany, 595 N.E.2d 264, 266 (Ind. Ct. App. 1992). “It is therefore the substance of a claim, not its caption, which determines whether compliance with the [MMA] is necessary.” Id.⁴

[14] Essentially, Defendants contend that Reagin's IIED claims are merely a repackaging of his medical malpractice claims. We agree. Both sets of claims are based on Defendants’ allegedly tortious failure to stabilize and allegedly tortious discharge of Cindy. “[W]hether a given course of treatment was medically proper and within the appropriate standard of care is the quintessence of a malpractice case.” Id. at 267. Reagin's allegations of intentionality and claim for emotional distress damages on his own behalf are insufficient to remove his IIED claims from the purview of the MMA.

Issue Two: Summary Judgment

[15] Defendants observe that the health care at issue was submitted to the medical review panel as required by Indiana Code Section 34-18-8-4 and that the panel unanimously determined that they did not breach the applicable standard of care. “In medical malpractice cases, a unanimous opinion of the medical review panel that [the] health care provider did not breach the applicable standard of care is ordinarily sufficient to establish prima facie evidence negating the existence of a genuine issue of material fact entitling the health care provider to summary judgment.” Ford v. Jawaid, 52 N.E.3d 874, 878 (Ind. Ct. App. 2016). “Consequently, in such situations, the burden shifts to the plaintiff, who may rebut with expert medical testimony.” Id. “Failure to provide expert testimony will usually subject the plaintiff's claim to summary disposition.” Bhatia v. Kollipara, 916 N.E.2d 242, 246 (Ind. Ct. App. 2009).⁵

[16] Here, Reagin failed to designate any expert medical testimony in response to Defendants’ motions for summary judgment, so he failed to meet his burden to show that a genuine issue of material fact existed regarding whether Defendants breached the applicable standard of care. As such, the trial court should have ruled in Defendants’ favor. Therefore, we reverse and remand with instructions to enter judgment accordingly.⁶

[17] Reversed and remanded.

FOOTNOTES

1.   “[T]he elements of IIED require proof that the defendant: (1) engaged in extreme and outrageous conduct (2) which intentionally or recklessly (3) caused (4) severe emotional distress to another.” Jaffri v. JPMorgan Chase Bank, N.A., 26 N.E.3d 635, 639 (Ind. Ct. App. 2015).

2.   Reagin further alleged that Defendants violated the federal Emergency Treatment and Labor Act (“EMTALA”), 42 U.S.C. § 1395dd. Defendants convincingly argue that EMTALA is inapplicable here and thus they should have been granted summary judgment on that claim. In response, Reagin says only that he cited EMTALA in his IIED complaint to show that Defendants had “ulterior motives” for discharging Cindy. Appellee's Br. at 5. In his reply brief, Dr. Khan suggests that Reagin has effectively abandoned his EMTALA claim, and we agree.

3.   See I.C. § 34-18-8-1 (“Subject to IC 34-18-10 and sections 4 through 6 of this chapter, a patient or the representative of a patient who has a claim under this article for bodily injury or death on account of malpractice may do the following: (1) File a complaint in any court of law having requisite jurisdiction. (2) By demand, exercise the right to a trial by jury.”).

4.   Union notes that Reagin “ignores” Van Sice, Cutchin, and Gierek, the last of which involved claims for negligent infliction of emotional distress that the Supreme Court held were subject to the MMA. Union's Reply Br. at 4-5.

5.   “The exception to this rule is that a plaintiff is not required to present expert testimony in those cases where deviation from the standard of care is a matter commonly known to lay persons.” Bhatia, 916 N.E.2d at 246 n.1. Reagin “makes no argument that the applicable standard of care in this case is a matter commonly known to lay persons.” Id.

6.   Reagin contends that Defendants are attempting to relitigate their motions to dismiss. Defendants observe that the medical review panel had not yet issued its opinion in the medical malpractice proceeding and that the Supreme Court had not yet issued its opinions in Cutchin and Gierek when the trial court denied their motions to dismiss.

Bailey, Judge.

Judges Brown and Weissmann concur. Brown, J., and Weissmann, J., concur.