131 N.E.3d 640
Ind. Ct. App.2019Background
- Kimberly Snyder, a cystic fibrosis patient needing a lung transplant, was sedated and transported by Prompt Medical Transportation by ground from Indiana to UPMC in Pittsburgh after Humana (Medicare Advantage) denied air transport.
- During the trip the ambulance became lost and the drive extended from ~334 miles to 370–395 miles; evidence suggests sedation (Versed) ran out and Kimberly experienced ventilator instability en route.
- On arrival at the wrong Pittsburgh hospital she was admitted to that ICU, a clot was removed from her breathing tube, she later developed pneumonia, and died one week after transport.
- The Estate sued Prompt, St. Joseph Regional Medical Center (SJRMC), and Humana for wrongful death. A medical review panel unanimously found SJRMC and Prompt’s conduct was not a factor in the resulting damages (one panelist thought Prompt breached the standard of care but not causally).
- The trial court struck two expert affidavits disclosed after court-ordered expert-deadline, accepted only Dr. Pilewski’s deposition (in which he repeatedly stated any causal link was speculative), granted summary judgment to Prompt and SJRMC, and dismissed Humana under Medicare Part C preemption.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether trial court erred in striking untimely expert affidavits | Estate: vacatur of pretrial order vacated expert deadlines; late experts should be allowed | Prompt/SJRMC: February 2018 expert-deadline remained in effect; late disclosure prejudiced defendants | Court: No error — sanctions appropriate; affidavits struck for untimeliness and prejudice |
| Whether there is a genuine issue on causation to defeat summary judgment | Estate: Dr. Pilewski's affidavit shows Prompt/SJRMC conduct substantially contributed to death | Prompt/SJRMC: medical review panel unanimous that conduct was not a factor; Pilewski’s deposition is speculative | Court: No genuine issue — Pilewski’s deposition disclaims causation; panel opinion negates causation; summary judgment affirmed |
| Whether deposition–affidavit conflict permits treating affidavit as admissible | Estate: affidavit rebuts panel and supports causation despite deposition answers | Defendants: deposition testimony controlling; affidavit cannot create issue when inconsistent | Court: Follow deposition where affidavit conflicts absent evidence of mistake; deposition statements were clear — affidavit disregarded |
| Whether Estate’s state-law negligence claim against Humana is barred by Medicare Part C preemption | Estate: Humana’s denial of air transport was negligent under state law | Humana: Part C preempts state-law claims concerning coverage/medical necessity determinations | Court: Part C’s express preemption clause bars state negligence claims that would require applying state standards to federally governed coverage decisions; dismissal affirmed |
Key Cases Cited
- Williams v. Tharp, 914 N.E.2d 756 (Ind. 2009) (summary judgment standard and review)
- Scripture v. Roberts, 51 N.E.3d 248 (Ind. Ct. App. 2016) (unanimous medical review panel opinion shifts burden and requires expert rebuttal)
- Crawfordsville Square, LLC v. Monroe Guar. Ins. Co., 906 N.E.2d 934 (Ind. Ct. App. 2009) (affidavit conflicting with deposition is disregarded unless deposition mistake is plausible)
- Uhm v. Humana, Inc., 620 F.3d 1134 (9th Cir. 2010) (Medicare Part C preemption can extend to certain state common-law claims)
- Puerto Rico v. Franklin Cal. Tax-Free Trust, 136 S. Ct. 1938 (U.S. 2016) (when statute contains express preemption clause, courts focus on plain wording rather than presumption against preemption)