Mary (Jones) Shirey v. Rex Flenar, M.D.
Mary (Jones) Shirey v. Rex Flenar, M.D.
Opinion of the Court
Case Summary
[1] After Mary Shirey was injured in a car accident, she sought treatment from Dr. Rex Flenar. A few weeks later, Shirey's lawyer asked Dr. Flenar for her medical records. Dr. Flenar failed to respond for several years before eventually indicating that the records were destroyed by his medical-records software provider. Shirey has sued Dr. Flenar, claiming that she has a private right of action under Indiana Code section 16-39-1-1, which requires a healthcare provider to supply a patient's medical records upon request by the patient. She also asserts that, to the extent Dr. Flenar lost or destroyed the records, she has a claim for third-party spoliation of evidence, because without the records she was unable to fully substantiate her personal-injury claim stemming from the accident. The trial court granted Dr. Flenar summary judgment on both claims, and Shirey appeals. She has failed to persuade us that our General Assembly intended to create a private cause of action for a violation of Section 16-39-1-1. However, we conclude that Dr. Flenar had a duty to preserve the records under the circumstances of this case and is therefore properly subject to a cause of action for spoliation. As such, we affirm in part, reverse in part, and remand this matter to the trial court for further proceedings.
Facts and Procedural History
[2] Shirey filed her complaint against Dr. Flenar in August 2016. She alleged that she began treating as a patient of Dr. Flenar on March 24, 2013; that she was injured in a car accident less than a week later, on March 30, "due to the negligence of a third party"; and that she "sought treatment thereafter" from Dr. Flenar. Appellant's App. Vol. II p. 14. She further claimed that she, "by counsel," requested her medical records and bills from Dr. Flenar on April 25, 2013; that she did not receive a response from Dr. Flenar; and that she and her lawyer made multiple follow-up requests over the next three years (the last on March 11, 2016), none of which Dr. Flenar responded to. Id. at 14-15.
[3] Shirey included two counts in her complaint. In Count I, she alleged that Dr. Flenar violated Section 16-39-1-1 (which we also call the "record-production statute"), *1104which provides, in subsection (c), "On written request and reasonable notice, a provider shall supply to a patient the health records possessed by the provider concerning the patient." In Count II, she alleged in the alternative that Dr. Flenar "may no longer be in possession of the medical records because he lost or destroyed them." Id. at 16. She claimed, generally, that she "suffered injury by being refused access and use of her medical records and bills" and, more specifically, that she "suffered damages by being rendered incapable of completely documenting her injury claim for damages from her March 30, 2013 accident due to the lack of complete medical evidence[.]" Id. at 15.
[4] Dr. Flenar filed a motion for summary judgment in which he claimed that his medical-records software provider destroyed Shirey's records without his knowledge:
In 2013, Dr. Flenar was practicing medicine as Kendallville Family Care Center, Inc., which was his private practice. Dr. Flenar maintained electronic medical records with regard to each patient. In order to maintain these medical records, Dr. Flenar utilized an electronic medical records software program called "MyWay," which was developed by AllScripts. MyWay EMR software included the patient's history, clinical charting, ePrescribing, lab orders and results, and all other records that would have been contained in a patient's chart. In early 2014, Dr. Flenar was informed by AllScripts that it would no longer support the MyWay software and that he would need to purchase a new EMR software program from AllScripts. Since he had encountered very poor service from AllScripts with the MyWay software, he decided to use a different EMR software called Practice Fusion. MyWay was incompatible with the new software so he began using two different EMR's, Practice Fusion for creating and maintaining an EMR going forward, and MyWay to access old pat[i]ent records. Dr. Flenar joined a class action lawsuit against AllScripts for its decision to no longer support MyWay. He was notified in April or May of 2015 that the class action was settled and that he could continue to access the MyWay records for another year if he agreed to pay $1,000. Dr. Flenar signed up for that option but was never billed and in June, 2015, he was cut off from his access to his patient's records in MyWay. In July, 2015, Dr. Flenar closed his practice in Kendallville. After getting cut off from his access to the MyWay records, Dr. Flenar called AllScripts, but received no [cooperation]. He found an email address on the internet that was supposed to be used if he needed to contact AllScripts to obtain [ ] copies of his patient's records, but that did not work either. After multiple unsuccessful attempts to obtain Dr. Flenar's patients' medical records, he was informed that AllScripts destroyed all of his patients' records and that he will not be able to obtain a copy of Ms. Shirey's office chart. Dr. Flenar does not recall receiving any notice that AllScripts would destroy his patients' medical records.
Id. at 27-28 (citations omitted). Dr. Flenar did not explain why he failed to provide Shirey's records between April 2013 and June 2015, when he apparently still had access to them. Moreover, as the legal basis for his motion, Dr. Flenar did not disclaim responsibility for the loss of the records. Instead, he asserted that Shirey's lawsuit is one for medical malpractice and that Shirey was therefore required to present her claims to a medical review panel before taking them to court, pursuant to the Indiana Medical Malpractice Act. See
[5] In her response to Dr. Flenar's motion, Shirey argued that her suit is not governed by the Medical Malpractice Act "because she has not alleged any bodily injury arising out of malpractice and the substance of her claim is not within the scope of the Act." Appellant's App. Vol. II p. 50. She asserted that she has a private right of action for Dr. Flenar's violation of the record-production statute as well as a claim for third-party spoliation of evidence in that Dr. Flenar's actions "directly caused her to suffer damages through incomplete evidence in her principal claim."
[6] In reply, Dr. Flenar abandoned his medical-malpractice theory and addressed the record-production statute and the issue of spoliation for the first time. He argued that Section 16-39-1-1 does not confer a private right of action. Regarding spoliation, he maintained that "public policy weighs against recognizing a third-party spoliation claim in this matter" because "any alleged damages would be highly speculative" and Shirey "has not alleged bad faith by Dr. Flenar or alleged that he affirmatively acted to destroy evidence to avoid or lessen his liability."
[7] After a short hearing, the trial court issued an order granting Dr. Flenar's motion, largely incorporating his legal arguments on both issues.
[8] Shirey now appeals.
Discussion and Decision
[9] Shirey contends that the trial court should not have granted Dr. Flenar summary judgment on either the statutory claim or the spoliation claim. "When reviewing summary judgment, we apply the same standard as the trial court: summary judgment is proper only when the designated evidence shows no genuine issue of material fact and the moving party is entitled to judgment as a matter of law." Megenity v. Dunn ,
I. Private Right of Action
[10] Shirey first argues that she has a private right of action under the first sentence of Indiana Code section 16-39-1-1(c) : "On written request and reasonable notice, a provider shall supply to a patient the health records possessed by the provider concerning the patient." Whether a statute confers a private right of action is a question of law that we review de novo. Doe # 1 v. Ind. Dep't of Child Servs. ,
[11] As Shirey acknowledges, our General Assembly has not expressly created a private right of action for violations of the record-production statute. Therefore, we must examine the language of the statute to determine whether the legislature nonetheless intended to allow private actions. See
[12] First, from the outset, we must be reluctant to find an implied right of action.
[13] Second, Title 16 includes its own enforcement mechanism. Specifically, Indiana Code section 16-19-3-18(b) provides *1106that the Indiana State Department of Health "may bring an action to enforce this title[.]" We have held that this is "[t]he enforcement mechanism of [Title 16][.]" HealthPort Techs., LLC v. Garrison Law Firm, LLC ,
[14] And third, a holding that the record-production statute confers a private right of action would be seriously at odds with our Supreme Court's interpretation of the closely related record-retention statute, Indiana Code section 16-39-7-1. In Howard Regional Health System v. Gordon ,
[15] Notwithstanding all that, Shirey emphasizes the following passage from our Supreme Court's decision in LTV Steel Co. v. Griffin : "As a general rule, a private party may not enforce rights under a statute designed to protect the public in general and containing a comprehensive enforcement mechanism."
[16] However, in more recent opinions, the Supreme Court has made clear that the passage from LTV Steel should not be read literally. In Blanck v. Indiana Department of Correction , the Court held that various prison-discipline statutes do not confer a private right of action even though they appeared to be designed primarily to benefit inmates.
II. Spoliation
[17] Shirey argues that even if she does not have a private right of action under Section 16-39-1-1, she has a valid common-law claim for spoliation of evidence. The latter claim is not simply a reframing of the former. While both claims ultimately arise from Dr. Flenar's failure to provide Shirey's medical records, they are distinguishable because the spoliation claim does not depend on a violation of the record-production statute (or, for that matter, the record-retention statute, Indiana Code section 16-39-7-1 ). Rather, it is an allegation that Dr. Flenar lost or destroyed evidence that he knew or should have known was relevant to Shirey's personal-injury claim relating to the car accident.
[18] Our Supreme Court held in Gribben v. Wal-Mart Stores, Inc. that Indiana law does not recognize a claim for "first-party" spoliation-the loss or destruction of evidence by a party to the principal litigation.
[19] This Court has not recognized any third-party spoliation claims since Gribben . However, we did allow one such claim seven years before Gribben . In Thompson ex rel. Thompson v. Owensby ,
*1108Am. Nat'l Prop. & Cas. Co. v. Wilmoth ,
[20] Balancing the Webb factors in this case, we hold that the trial court erred by concluding that Dr. Flenar did not have a duty to preserve Shirey's medical records.
A. Relationship
[21] Regarding the first factor, Dr. Flenar's attorney conceded at oral argument that Dr. Flenar had an important relationship with Shirey. According to Shirey's complaint, she became a patient of Dr. Flenar on March 24, 2013, and she sought treatment from him after the car accident a week later. Dr. Flenar had a vital relationship with Shirey not only because he was responsible for her care but also as the presumptive safekeeper of the records generated in relation to that care. See Gordon ,
B. Foreseeability
[22] As for the second factor, the harm alleged by Shirey was reasonably foreseeable by Dr. Flenar. Recently, our Supreme Court adopted this Court's holding that the foreseeability component of the duty inquiry requires a "general analysis of the broad type of plaintiff and harm involved, without regard to the facts of the actual occurrence." Goodwin v. Yeakle's Sports Bar & Grill, Inc. ,
[23] Here, we see the issue, generally stated, as whether it is reasonably foreseeable to a healthcare provider that a patient who requests her medical records will suffer harm if she does not receive them. We conclude that it most definitely is. A patient's request for records puts a healthcare provider on notice that the patient needs the records for some reason-perhaps current or future medical care, employment, life insurance, or, as here, legal-which in turn puts the provider on notice that the patient could be worse off without them. See generally Glotzbach v. Froman ,
[24] Dr. Flenar points out that Shirey, in responding to the motion for summary judgment, did not designate any evidence that supports her allegation that she requested her records from Dr. Flenar. He asserts that a plaintiff opposing such a motion "may not rest upon his pleadings but must set forth specific facts, by affidavit *1109or otherwise, which demonstrates that there is a genuine issue for trial." Appellee's Br. p. 8. But a plaintiff's burden to designate specific evidence is triggered only after the defendant designates his own evidence to negate the allegations in question. See , e.g., McDonald v. Lattire ,
C. Public Policy
[25] Dr. Flenar begins and ends his challenge to Shirey's spoliation claim by discussing public-policy concerns. He relies heavily on Glotzbach ,
[26] In doing so, the Court placed the greatest weight on the public-policy considerations. The Court identified some characteristics that all spoliation claims have in common. First, there are options other than a tort action to deter or remedy spoliation: criminal sanctions (e.g., perjury or obstruction of justice), sanctions under the Indiana Rules of Professional Conduct "if attorneys for the third party are involved in the misconduct," and contempt sanctions against "non-parties who frustrate the discovery process by suppressing or destroying evidence."
[27] The Court also addressed several matters specific to the case before it. It noted that "the employee is entitled to worker's compensation, and permitting claims of spoliation by the employer would open the door to satellite litigation against the employer that the WCA [Worker's Compensation Act] is designed to foreclose." Id ;see also
[28] Dr. Flenar makes no argument that the alternative sanctions discussed in Glotzbach -criminal charges, professional misconduct charges against an attorney, and discovery sanctions-would be of any value in this case. It is highly unlikely that Dr. Flenar would be charged with a crime, even if it turned out that he intentionally destroyed the records. Moreover, there is no indication that any attorneys were involved in the destruction of the records. Nor is there any indication that the destruction of the records frustrated any "discovery process"-as far as we know, there was never any court case relating to the underlying personal-injury claim in which discovery could have even been conducted.
[29] Instead, Dr. Flenar focuses on the potential for speculation in the determination of damages. He asserts:
Any alleged damages in this matter would be highly speculative, just as the Court noted in Glotzbach . In order to prove damages, Shirey would have to prove that she was entitled to damages in her personal injury lawsuit, that Dr. Flenar's medical records would have increased her damages award or settlement, and the collectability of the increased amount. Determining the difference in recovery between what [Shirey] will recover in settlement and what she may have recovered if she had additional medical records is highly speculative and amounts to guesswork.
Appellee's Br. pp. 15-16. We share Dr. Flenar's concern, but only to an extent. Speculation regarding damages is a worry in every spoliation case, since every spoliation case, by definition, involves missing evidence. But if our Supreme Court found this fact dispositive, it easily could have foreclosed third-party spoliation claims entirely, in either Gribben or Glotzbach . Because it did not, we treat the difficulty of determining damages as just one relevant factor.
[30] Dr. Flenar also contends that public policy weighs against allowing Shirey's claim because she "has not alleged bad faith by Dr. Flenar or alleged that he affirmatively acted to destroy evidence to avoid or lessen his liability."
[31] As for the other policy considerations identified in Glotzbach , we agree with Shirey that none of them are relevant here. This case does not involve worker's compensation, so the exclusivity and subrogation provisions of the Worker's Compensation Act are not implicated. See Glotzbach ,
[32] In sum, we conclude that all three Webb factors favor Shirey. We therefore hold that Dr. Flenar had an enforceable duty to preserve Shirey's medical records once she requested them from him and that the trial court erred by granting Dr. Flenar summary judgment on Shirey's spoliation claim. As with any negligence case, there are other elements beyond duty-namely, breach, proximate cause, and damages. But those issues are beyond the scope of Dr. Flenar's motion for summary judgment. In the trial court, Dr. Flenar did not address spoliation until his reply brief, and even then his argument was limited to three paragraphs. He said little about the particulars of Shirey's claim, focusing instead on general public-policy arguments. And the only evidence he designated-his own affidavit about his struggles with his software provider-is insufficient to negate a spoliation claim as a matter of law. Given the narrow scope of Dr. Flenar's argument, as well as our general preference for letting even marginal cases proceed to trial, see Hughley ,
[33] Affirmed in part, reversed in part, and remanded.
Baker, J., concurs with opinion.
Crone, J., concurs with opinion.
Shirey asserts that Section 16-39-1-1"is specifically titled, 'Right of Access , written requests; effective duration,' " Appellant's Reply Br. p. 8 (emphasis in original), and that this "title" signals not only a right of access to medical records but the existence of a private cause of action to enforce that right of access. Shirey does not tell us what version of the Indiana Code she is referencing, but the legislature did not include this purported title in the public law that created Section 16-39-1-1, see P.L. 2-1993, § 22, or in any of the public laws that have amended the statute, see P.L. 40-1994, § 66; P.L. 102-1994, § 1; P.L. 2-1995, § 72; P.L. 108-1996, § 4; P.L. 157-2006, § 4. The heading appears to have been added by publishers after the legislature enacted the statutes. In any event, the legislature has declared that any headings it includes in a law "are not part of the law," "are intended for organizational purposes only," and "are not intended to affect the meaning, application or construction of the statute they precede."
Notably, Shirey does not argue that Indiana Code section 16-39-7-1, the record-retention statute we addressed earlier, establishes the duty required for a spoliation claim, even though it specifically requires providers to maintain records for seven years. In Glotzbach v. Froman , our Supreme Court hinted that such a statute might be sufficient to create a duty to preserve.
Concurring Opinion
[1] I am compelled to concur, though I do so with great dissatisfaction. While I acknowledge that we are bound to abide by our Supreme Court's ruling in Gordon , I take the opportunity to respectfully disagree with the holding in that case.
[2] In my view, the doctor-patient relationship has always borne a common law duty in the doctor to retain her patients' medical records and, concomitantly, to produce them when asked. While the doctor maintains, updates, and stores those records, it cannot be denied that, at the end of the day, they belong-or at least partially belong-to the patient.
[3] Indeed, our General Assembly has acknowledged and codified this duty by enacting Indiana Code section 16-39-1-1(c). In so doing, the legislature confirmed that the public policy of this State is to protect the right of patients to have access to their medical records. It defies logic to conclude that by giving the Department of Health the power to enforce this right, the legislature also extinguished our common law power, as citizens, to enforce it for ourselves. To conclude on the one hand that the General Assembly acknowledged and protected this right and, on the other, that it dramatically curtailed it, is to ascribe a lack of reason to our legislators that I believe is unwarranted.
[4] If a doctor decided to have a bonfire with her patients' medical records-or, in this day and age, if she decided to terminate her relationship with the company responsible for online maintenance of those records, knowing that such termination would lead to the deletion of the records-public policy would surely dictate that her patients would have a right to recover for those actions. While there is no evidence of knowing malfeasance in the case at hand, under Gordon , the result would be the same in either situation.
[5] And that result, as acknowledged by Judge Crone, is no result at all. Because if the Department of Health is the only entity with the right to enforce Title 16, to the exclusion of individual citizens, and the *1112right that the Department would be enforcing in this case is the right to have one's health records supplied upon request, if those records are simply gone, then there is nothing to be done. Under Gordon , there is simply no consequence whatsoever if a doctor loses her patients' medical records, whether by carelessness, malfeasance, or circumstance. I simply cannot countenance such a result. I do not believe that this furthers the public policy of Indiana, either from the perspective of the citizens or the General Assembly.
[6] To tell the citizens of this State that their physicians are required to maintain their medical records, but that there is no consequence for a failure to do so-even when that failure results in financial or health-related consequences to patients-is to make the requirement wholly meaningless. I encourage our Supreme Court to reconsider the Gordon holding. But in the meantime, as I am bound to abide by it, I reluctantly concur with the majority.
Concurring Opinion
[1] I fully concur as to issue II. I also concur as to issue I, but only reluctantly, and only because we are bound by our supreme court's restrictive approach to recognizing statutorily created private rights of action. See Gordon ,
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