SING v. ATHLETICO LTD (2025)

MEMORANDUM DECISION

[1] Julie Sing appeals the LaPorte Superior Court's grant of summary judgment for Athletico, Ltd. (“Athletico”) on Sing's complaint alleging medical malpractice. Sing presents two issues for our review:

1. Whether the trial court abused its discretion when it struck portions of her expert witness's affidavit.

2. Whether the trial court erred when it granted Athletico's summary judgment motion.

[2] We affirm.¹

Facts and Procedural History

[3] After Sing underwent surgery to replace her left hip, she started physical therapy at Athletico. During a visit on May 6, 2021, a physical therapy assistant, Melissa Dunfee, instructed Sing to use an exercise machine called a “Nu Step.” Appellant's App. Vol. 2, p. 184. After a few minutes, Dunfee “observed [Sing's] leg still positioned in the foot pedal, but her knee adducted. And it leaned against her other leg. And she was unable to move it.” Id. at 187. Dunfee cut the session short, and Sing asked her son to drive her to a local hospital.

[4] At the hospital, Sing reported left hip pain. Sing explained that, while she was riding a bicycle during physical therapy earlier that day, “her left leg twisted and she felt her hip dislocate.” Appellant's App. Vol. 6, p. 210.

Later that day, Ms. Sing was seen by Scott Fielder, M[.]D[.], an orthopedic surgeon. He evaluated Ms. Sing, determined she had sustained a left cemented bipolar hemiarthroplasty prosthetic dislocation and subsequently performed a closed reduction of the left hip prosthesis under general anesthesia. He noted that there was no fracture or prosthesis malalignment.

Id. at 211.

[5] In November, Sing filed an amended complaint with the trial court alleging that Athletico had caused her injuries when it “negligently ․ failed to ․ exercise the proper, adequate and customary skill required of physical therapists and physical therapy facilities to treat the medical condition of [Sing]; ․ [f]ailed to properly treat [Sing]; and ․ [e]xceeded doctor's orders.” Appellant's App. Vol. 2, p. 18. Athletico filed a motion for summary judgment and, in support, designated a physician's opinion that Athletico did not violate the standard of care and did not cause Sing's injuries. In support of her memorandum in opposition to summary judgment, Sing's designated evidence included only an affidavit of a physical therapist, William Thompson, who is not a medical doctor.

[6] In response, Athletico argued that Thompson was not qualified to give an opinion on medical causation and moved the trial court to strike “all causation opinions in” Thompson's affidavit. Appellant's App. Vol. 7, p. 2. Following oral argument, the trial court granted Athletico's motion to strike and entered summary judgment for Athletico. This appeal ensued.

Discussion and Decision

Issue One: Motion to Strike

[7] Sing argues that the trial court abused its discretion when it granted Athletico's motion to strike. We review for an abuse of discretion a trial court's decision on a motion to strike. Bunger v. Brooks, 12 N.E.3d 275, 279 (Ind. Ct. App. 2014). We will reverse only when the decision is clearly against the logic and effect of the facts and circumstances. Id.

[8] In its order granting the motion to strike, the trial court concluded that “Dr. Thompson is not a medical doctor and medical testimony is required to prove causation in complex cases and with respect to pain.” Appellant's App. Vol. 2, p. 10. In support, the court cited this Court's opinion in Goodwin v. Toney, 203 N.E.3d 481 (Ind. Ct. App. 2022), trans. denied. In Goodwin, the plaintiff sought treatment for neck pain from a chiropractor. During one treatment, the plaintiff experienced a sudden onset of pain, weakness, and numbness in her left hand. A few days later, a medical doctor ordered an MRI of her spine, which showed that she had metastatic bone cancer and had sustained a compression fracture in her neck. A few months later, the plaintiff died.

[9] The plaintiff's personal representative (“PR”) filed a proposed complaint for damages with the Indiana Department of Insurance. A medical review panel found that the chiropractor had not complied with the appropriate standard of care, but the panel could not give an opinion whether that conduct was a factor in causing the claimed damages. After the PR filed a complaint with the trial court, the chiropractor moved for summary judgment. In support of that motion, the chiropractor submitted affidavits from two medical doctors.

[10] In opposition to summary judgment, the PR submitted an affidavit from a physical therapist. Toney moved to strike that affidavit on the ground that the physical therapist was not qualified to render an opinion on medical causation. The trial court granted the motion to strike and entered summary judgment for the chiropractor.

[11] On appeal, we stated that,

“[i]n a medical negligence claim, the plaintiff must prove by expert testimony not only that the defendant was negligent[ ] but also that the defendant's negligence proximately caused the plaintiff's injury.” Clarian Health Partners, Inc. v. Wagler, 925 N.E.2d 388, 392 (Ind. Ct. App. 2010) (emphasis added), trans. denied, disapproved of on other grounds, Siner v. Kindred Hosp. Ltd. P'ship, 51 N.E.3d 1184, 1189 n.5 (Ind. 2016). As we have explained:

When an injury is objective in nature, the plaintiff is competent to testify as to the injury and such testimony may be sufficient for the jury to render a verdict without expert medical testimony. Ordinarily, however, the question of the causal connection between a permanent condition, an injury[,] and a pre-existing affliction or condition is a complicated medical question. When the issue of cause is not within the understanding of a lay person, testimony of an expert witness on the issue is necessary. An expert, who has the ability to apply principles of science to the facts, has the power to draw inferences from the facts which a lay witness or jury would be incompetent to draw․

Daub v. Daub, 629 N.E.2d 873, 877-78 (Ind. Ct. App. 1994) (citations omitted), trans. denied. Further:

Indiana Evidence Rule 702 requires that an expert be qualified as such by his knowledge, skill, experience, training, or education. Additionally, an expert must have sufficient skill in the particular area of expert testimony before the expert can offer opinions in that area. Therefore, before an expert may testify in an area, the proponent of the expert must show that the expert is competent in that area. Moreover, questions of medical causation of a particular injury are questions of science necessarily dependent on the testimony of physicians and surgeons learned in such matters.

Armstrong v. Cerestar USA, Inc., 775 N.E.2d 360, 366 (Ind. Ct. App. 2002) (emphasis added) (cleaned up), trans. denied.

Id. at 486.

[12] We concluded that whether the chiropractor had caused the compression fracture or had made the chance of the fracture more likely by his treatment were “complex medical questions requiring expert testimony.” Id. We affirmed the trial court's order granting the motion to strike because the physical therapist was “not qualified to render an opinion as to medical causation.” Id.

[13] Here, in an attempt to distinguish Goodwin, Sing argues that there are no complex medical questions requiring testimony by a medical doctor. Rather, Sing maintains, as she did to the trial court, that she did not have a dislocated hip before her appointment at Athletico but suffered the dislocation during that appointment. Sing describes a “ ‘temporal, easy relationship’ ” between the cause and effect of her treatment that day. Appellant's Br. at 12 (quoting Tr. p. 16). Thus, she maintains that Thompson, a physical therapist, was qualified to give an opinion on causation here.

[14] However, we agree with Athletico that the circumstances surrounding Sing's injury present a complex medical question requiring a medical doctor's opinion. In support of summary judgment, Athletico designated as evidence the affidavit of Dr. Charles Clark, M.D., an orthopedist. Dr. Clark noted that on May 5, 2021, one day before Sing suffered a dislocated hip during treatment at Athletico, Sing had fallen “ ‘onto her butt’ ” after she reached for something on the ground and “ ‘went backwards and fell.’ ” Appellant's App. Vol. 2, p. 53. Dr. Clark opined: “At that point in her recovery[ following the surgery], under no circumstances should Ms. Sing have been reaching forward towards the ground. It is my opinion that the act of reaching forward caused a significantly increased likelihood of a dislocation.” Id. at 54.

[15] Dr. Clark concluded that the treatment provided to Sing at Athletico on May 6 “did not cause” the dislocation. Id. Rather, Dr. Clark concluded that, “because of her fall [at home on May 5], Ms. Sing was, more likely than not, going to experience a second hip dislocation regardless of the therapy provided on May 6, 2021.” Id. at 55. Dr. Clark opined that Sing's hip was already displaced before she arrived at Athletico on May 6 and “that any movement during the necessary physical therapy, or afterwards could have caused the hip to dislocate.” Id.

[16] With that evidence, we reject Sing's argument that the cause and effect of her dislocated hip is obvious. As Athletico acknowledges, Thompson was qualified to testify regarding the applicable standard of care. But, given Thompson's lack of medical training, we cannot say that the trial court abused its discretion when it struck portions of Thompson's affidavit relevant to medical causation.²

Issue Two: Summary Judgment

[17] Next, Sing contends that the trial court erred when it entered summary judgment for Athletico. Our standard of review is well settled.

When reviewing a summary judgment decision, our well-settled standard is the same as it is for the trial court: summary judgment is appropriate where the designated evidentiary matter shows that there is no genuine issue as to any material fact and that the moving party is entitled to a judgment as a matter of law. We construe all evidence in favor of and resolve all doubts as to the existence of a material issue in favor of the non-moving party.

Stafford v. Szymanowski, 31 N.E.3d 959, 961 (Ind. 2015) (citations and quotation marks omitted).

[18] Indiana's “distinctive summary judgment standard imposes a heavy factual burden on the movant to demonstrate the absence of any genuine issue of material fact on at least one element of the claim.” Siner v. Kindred Hosp. Ltd. P'ship, 51 N.E.3d 1184, 1187 (Ind. 2016). “For a medical malpractice claim, those elements are ‘(1) that the physician owed a duty to the plaintiff; (2) that the physician breached that duty; and (3) that the breach proximately caused the plaintiff's injuries.’ ” Id. (citation omitted). Failure to provide expert testimony will usually subject the plaintiff's medical malpractice claim to summary disposition. Speaks v. Rao, 117 N.E.3d 661, 667 (Ind. Ct. App. 2018).

[19] Here, in support of its summary judgment motion, Athletico designated Dr. Clark's affidavit, which revealed his opinion that Athletico did not breach the standard of care and did not cause Sing's injuries. The burden then shifted to Sing, who did not provide expert testimony on the issue of causation (see Issue One).

[20] On appeal, Sing maintains that she sustained an “objective injury” that does not require expert testimony, and she argues that a jury would be entitled to disregard Dr. Clark's testimony and find in her favor. Appellant's Br. at 19. We disagree. As we explained in Issue One, the circumstances surrounding Sing's injury present a complex medical question requiring a medical doctor's opinion. Given Sing's lack of evidence on the issue of causation, she did not sustain her burden in opposition to summary judgment.

[21] For all these reasons, the trial court did not err when it entered summary judgment for Athletico.

[22] Affirmed.

FOOTNOTES

1.   In her brief on appeal, Sing stated: “Since an opinion by a medical review panel was not mentioned by either side it must be concluded that the defendant was not a ‘health care provider’ under the medical malpractice act ․ and therefore the provisions of the act do not apply.” Appellant's Br. at 16. Because our jurisdiction over this appeal rests on whether Athletico is a qualified health care provider, we require more than mere speculation on the matter. Accordingly, we issued an order that Sing show cause why this appeal should not be dismissed for lack of subject matter jurisdiction. In her prompt response, Sing submitted a 2021 proposed complaint for damages that she had filed with the Indiana Department of Insurance as well as a letter from the Department indicating that Athletico is not a qualified health care provider under the Medical Malpractice Act. Accordingly, our subject matter jurisdiction over this appeal has been established.

2.   We note that Thompson holds a Doctor of Physical Therapy and a Doctor of Philosophy in Biomechanics and Movement Science. He is a professor of physical therapy at Indiana University in Indianapolis and an adjunct professor at Indiana University's School of Medicine. His high credentials notwithstanding, Thompson lacks the critical qualifications needed to opine as to complex medical causation.

Mathias, Judge.

Foley, J., and Scheele, J., concur.