## Facts

- John A. Hill III was admitted to an Indiana hospital in December 1999 for severe coronary artery disease and underwent coronary artery bypass graft surgery.
- He received heparin during the surgery as part of the standard anticoagulation used with bypass procedures.
- Post-operatively, Hill’s physicians later ordered that Hill not receive heparin because they suspected heparin-induced thrombocytopenia (HIT), a rare immune-mediated reaction that can lead to clotting (including HIT with thrombosis, sometimes called HITT).
- Despite the stop orders, Hill continued to receive heparin in the form of “heparin flushes” through IV lines under hospital protocol, and the treating physicians did not immediately realize the flushes were continuing.
- Hill’s condition worsened, he developed serious thrombotic complications, and ultimately underwent amputations of three limbs.
- Hill and his wife sued four physicians involved in Hill’s care—Drs. Lloyd, Csicsko, Ryan, and Rhinehart—alleging negligent diagnosis and treatment related to anticoagulation management and the failure to prevent continued exposure to heparin.
- Before trial, Hill settled claims with the hospital and the Indiana Patient’s Compensation Fund for a total of $1.25 million, then proceeded to trial against the physicians, contending their acts caused additional, compensable harm.
- At trial, after Hill’s case-in-chief, the court entered judgment on the evidence (directed verdict) for Drs. Lloyd and Csicsko; the case went to the jury on the claims against Drs. Ryan and Rhinehart, and the jury returned a defense verdict.

## Issues

1. Whether the trial court erred by granting judgment on the evidence for Drs. Lloyd and Csicsko, where Hill argued the jury needed to assess joint and several liability among all four physicians.
2. Whether the trial court abused its discretion by instructing the jury that a physician is not liable for an error in diagnosis or treatment if the physician used reasonable care and skill.

## Decision

- The Indiana Court of Appeals affirmed the judgment on the evidence in favor of Drs. Lloyd and Csicsko.
- The court held that, given Hill’s prior settlement for the catastrophic injuries, Hill failed to present sufficient evidence that Lloyd or Csicsko caused separate and distinct injuries for which Hill had not already been compensated.
- The court rejected Hill’s argument that removing Lloyd and Csicsko from the case improperly prevented the jury from considering joint and several liability, because joint and several liability cannot apply absent proof that each alleged tortfeasor is liable.
- The court affirmed the jury’s defense verdict for Drs. Ryan and Rhinehart.
- The court upheld the challenged jury instruction as a correct statement of Indiana law when read with the instructions as a whole.

## Legal Principles

- Judgment on the evidence is proper only when there is a total absence of evidence on an essential element, or where the evidence supports only one reasonable conclusion for the moving party.
- In a medical malpractice action, a plaintiff generally must present medical testimony to connect the defendant’s breach of the standard of care to the plaintiff’s injury and damages.
- When a plaintiff has already settled for the primary injuries arising from a course of medical care, the plaintiff must produce evidence tying a remaining defendant’s alleged malpractice to separate and distinct injuries (or otherwise avoid duplicative recovery) to recover additional damages from that defendant.
- Joint and several liability does not allow a jury to impose liability on a party against whom the plaintiff has not presented legally sufficient evidence of negligence and causation.
- A physician is not an insurer of a successful result and is not liable for an error in diagnosis or treatment if the physician exercised the reasonable care and skill ordinarily used by similarly situated physicians; a jury instruction conveying this rule is permissible when the full set of instructions also explains negligence and the plaintiff’s burden of proof.

## Conclusion

The Court of Appeals affirmed: (1) the directed verdict for Drs. Lloyd and Csicsko because Hill did not present sufficient proof that they caused compensable harm separate from injuries already covered by Hill’s settlement, and (2) the defense verdicts for Drs. Ryan and Rhinehart, concluding the jury was properly instructed that physicians are not liable for diagnostic or treatment errors absent a failure to use reasonable care and skill.


Hill v. Rhinehart, 45 N.E.3d 427 (2015)