## Facts

- Ronald Kraemer, a Navy veteran, received care for neck and back problems at a Department of Veterans Affairs hospital operated by the United States.
- In 2013, VA neurosurgeon Dr. Neal Patel performed a spinal-fusion surgery on Kraemer that involved implanted hardware, including titanium screws.
- On the morning of surgery, Patel spoke with Kraemer and Kraemer’s wife about the procedure, but the contents of the conversation were disputed.
- Patel maintained that he discussed the procedure’s scope and risks; Kraemer claimed Patel gave only basic information about the type of procedure and did not discuss specific risks, including a risk of allergic reaction to the materials used.
- Before the operation, Kraemer signed the VA’s standard consent form describing the procedure and listing multiple known risks and side effects.
- The consent form included Patel’s signature attesting that he had discussed all relevant aspects of treatment with the patient and Kraemer’s signature attesting he had been informed of benefits, risks, and alternatives.
- The surgery itself was successful, but two days later Kraemer developed hives that persisted.
- Over the following months, Kraemer sought evaluation from several physicians to determine the cause of the hives.
- A neurosurgeon later suggested that, based on the timing, Kraemer was likely allergic to the titanium screws implanted during surgery.
- Kraemer sued the United States under the Federal Tort Claims Act (FTCA), alleging Patel failed to obtain informed consent by not disclosing the risk of an allergic reaction (hives) to the implanted materials.
- The United States moved for summary judgment, arguing Kraemer had not designated the medical expert testimony Indiana law requires to prove an informed-consent claim.

## Issues

1. Under the FTCA applying Indiana law, can a plaintiff’s lack-of-informed-consent claim survive summary judgment without expert testimony establishing the professional standard of care for risk disclosure?
2. Under Indiana informed-consent law, did Kraemer present the expert evidence needed to prove causation for his nondisclosure theory?

## Decision

- The court granted the United States’ motion for summary judgment.
- Applying Indiana law through the FTCA, the court held Kraemer’s informed-consent claim failed because he did not designate expert testimony on (a) the applicable disclosure standard of care and (b) the required causal connection between the alleged nondisclosure and his claimed injury.
- The court entered judgment for the United States.

## Legal Principles

- Summary judgment is proper when the record shows no genuine dispute of material fact and the movant is entitled to judgment as a matter of law; the nonmovant must support its position with admissible evidence.
- Under the FTCA, the United States’ liability is determined by the substantive tort law of the state where the alleged act or omission occurred; here, Indiana law governed.
- Indiana informed-consent claims generally require medical expert testimony to establish what information a reasonably prudent physician would disclose in similar circumstances and whether the defendant physician’s disclosure fell below that standard.
- Indiana also generally requires medical expert testimony to establish causation when the causal connection involves medical questions outside a lay juror’s ordinary understanding, including whether a condition was caused by surgical materials and how an allergic reaction relates to implanted hardware.
- Indiana recognizes a narrow “common knowledge” exception to expert-testimony requirements, but disputes about implant-related allergy risks and medical causation are not typically resolved through common knowledge alone.
- Indiana’s informed-consent doctrine is often described through a multi-element framework (including disclosure, breach, and causation), but a court may resolve the case at summary judgment where the plaintiff’s evidentiary showing is missing on required elements.

## Conclusion

Kraemer’s FTCA suit turned on an Indiana informed-consent theory that Dr. Patel failed to warn him about a possible allergic reaction to titanium screws used in spinal-fusion surgery. At summary judgment, the court ruled for the United States because Kraemer did not provide medical expert testimony to establish the disclosure standard of care or to prove causation linking the alleged nondisclosure to his injuries.


Kraemer v. United States, 2018 WL 1811978 (2018)