Charles Aillones sued Glen Minton in Vanderburgh County, Indiana for negligently causing a car accident. Aillones wanted to elicit expert testimony from the nurse practitioner who treated him. The trial judge ruled that a nurse may not testify as a medical expert. On appeal from that ruling, the Indiana Court of Appeals decided that the nurse practitioner could give expert testimony in an ordinary case involving injuries related to a traffic accident.
Facts of the Case
Minton was driving a vehicle that collided with the rear of Aillones’ vehicle. Aillones obtained treatment from Alan Swartz, a licensed nurse practitioner, for pain in his neck and lower back.
Swartz has a master’s degree in nursing and is board certified as a nurse practitioner. His license allows him to examine and treat patients, to interpret lab results, to prescribe medications, and to refer patients for physical or occupational therapy. He has treated more than one hundred traffic accident victims.
Swartz diagnosed Aillones as having a concussion and a cervical sprain. Swartz prescribed a muscle relaxant and ibuprofen. Two weeks later, Aillones was still in pain. Swartz switched the prescription from ibuprofen to naproxen and referred him to a physical therapist.
Aillones sued Minton for negligence. He designated Swartz as his medical expert.
Swartz testified in a deposition that Aillones had sustained an injury to the soft tissues in his neck and lower back. When asked whether the injuries were caused by the collision, Swartz testified he did not see the collision but could say that the injuries were caused by trauma. He also testified that the injuries were consistent with the motor vehicle accident that had been described to him.
Prior to trial, Minton’s lawyer asked the court to preclude Swartz from testifying about the cause of Aillones’ injuries. The trial court ruled that a nurse practitioner does not qualify as an expert witness. Minton was granted the opportunity to appeal that ruling prior to trial.
Nurses as Expert Witnesses
As is true in most states, Indiana law provides that a witness is qualified to testify as an expert if the witness has “skill, knowledge, or experience” in a “scientific field, business, or profession beyond the knowledge of the average person.” Indiana courts have permitted experts to testify when they have special knowledge that would help a jury understand the facts of a case, even if they have no formal training.
The trial court relied on Indiana precedent that deemed nurses to be unqualified to give an opinion as to medical causation. The Indiana Court of Appeals noted that those cases involved allegations of medical malpractice. Despite the broad language used by the appellate courts in those cases, the holdings could properly be limited to opinions rendered by a nurse as to whether a doctor’s negligence harmed a patient.
The decisions relied on the superior medical training of doctors, and viewed a nurse’s opinion as insufficient to support a claim that medical negligence caused a patient’s injury. Ordinarily, whether if an expert is qualified to render a helpful opinion, it is up to the jury to decide whether the expert’s opinion is worthy of belief. Although the appellate court did not say so, the decisions might be seen as following the common judicial trend of extending greater protection to doctors than courts extend to other defendants in negligence cases.
The court of appeals also took note of an earlier decision that held open the door for nurses to testify about the appropriate standard of care that a nursing home should provide. The court suggested that in some contexts, a nurse would have the kind of experience and training that would allow a nurse to form expert opinions that might be helpful to a jury.
The court of appeals concluded that “no blanket rule prevents a nurse [from] acting as an expert witness.” The question is whether the nurse has enough knowledge, education, experience, or training to form an opinion and, if so, whether that opinion would be helpful to the jury.
Expert Opinions of Nurse Practitioner
The court noted that Indiana law defines a nurse practitioner as an “advanced practice nurse” who plays a specialized role in delivering advanced levels of nursing care. By regulation, nurse practitioners are entitled to diagnose conditions, assess the findings of physical examinations and lab results, make health care plans, and prescribe drugs.
The court concluded that a nurse practitioner is a highly trained and educated medical professional. While a nurse practitioner does not have the same education as a physician, that fact goes to the weight a jury might give to the expert opinion, not to its admissibility.
The court did not decide the limits of expert testimony a registered nurse who is not a nurse practitioner might be allowed to give in an ordinary negligence case. Nor did the court decide whether a nurse practitioner, unlike a registered nurse who has not been certified as a nurse practitioner, might be qualified to testify as to medical causation in a medical malpractice case.
Rather, deciding the case on the limited facts before it, the court held that a nurse practitioner may be qualified to testify as an expert that a patient’s injuries were consistent with a car accident. The court said that Swartz could not testify that the accident caused the injuries, since Swartz did not see the accident. Presumably, that same logic would prevent a doctor from testifying that an accident caused an injury. Absent evidence of any other potential cause, however, the expert’s testimony that an injury is consistent with an accident should permit a jury to infer that the injury was caused by the accident.
Significance of the Case
The Aillones decision is noteworthy for two reasons. First, the decision allows injury victims to obtain expert testimony from the medical professional who might be best suited to give it. When a patient is treated by a nurse practitioner, that witness is in the best position to explain the patient’s injuries to the jury. Given the high cost of medical experts, it benefits injury victims to call a treating nurse practitioner as an expert, rather than having the victim examined by a doctor simply to gain an admissible expert opinion.
Second, the connection between Aillones’ injuries and the car accident seems obvious. Allowing a nurse practitioner to testify that the injuries are consistent with the accident is reasonable under the facts of the case.
In other cases, where it is less obvious that the injuries were caused by the accident, or where there are grounds to contest the issue of causation, it may be necessary to obtain additional expert opinions. Causation of whiplash injuries, for instance, might best be explained by a biomechanical engineer working in conjunction with a neurologist. Understanding the nature and complexity of the facts that may be disputed will help attorneys select experts that are appropriate for each case.