All negligence cases are not created equal. While some medical malpractice cases seem cut and dry, others can be difficult to pin down. Medically related premises liability cases are often mistaken for medical malpractice. Still, most do not meet the standard to fall within the Act (Ind. Code §34-18-et seq. referred to after as “the act”). Determining whether a case is standard negligence or medical malpractice is the first deciding factor for application under the Act. The second deciding factor is whether the defendant provides proof of financial responsibility to the Commissioner of the Indiana Department of Insurance to become a “qualified provider.” 
Whether a claim is subject to the act is important for two reasons:
- Is the plaintiff required to go through a medical review panel before filing the case in court? 
- Is the plaintiff subject to the act’s damage caps? 
Three Examples of Medically Related Premises Liability Cases
A classic example of a premises case falling outside the Act is Winona Memorial Foundation of Indianapolis v. Lomax, 465 N.E.2d 731 (Ind. Ct. App. 1984), where the plaintiff was a patient on her way to a dressing room from the pool area when she tripped and fell because she caught her foot on a floorboard that protruded above floor level. Because a protruding floorboard presented no exercise of medical or professional judgment and involved a negligent administrative act as opposed to a patient-specific care decision, it could be understood by a jury without expert testimony as to the appropriate standard of care and was not subject to the act. The court concluded that the act’s passage had nothing to do “with the sort of liability any health care provide--whether a hospital or a private practitioner—risks when a patient or anyone else is injured by the negligent maintenance of the provider’s business premises.” Lomax, 465 N.E.2d at 739. This reasoning was followed in Ray, where the court held that a plaintiff’s claim that the hospital negligently and carelessly caused and permitted its premises to become infested and infected with Legionnaire’s Disease was outside the act because it was based upon premises liability. The court especially rejected the defendant’s argument that the mere allegation of a patient-provider relationship is enough to bring the case within the act. Instead, the court found the complaint was not subject to the act because it alleged negligent maintenance rather than negligent medical care. Ray, 551 N.E.2d at 466-467. The Court of Appeals Opinion was summarily adopted by the Indiana Supreme Court on transfer. Ray, 558 N.E.2d 829 (Ind. 1990).
Another case held to be outside the act because it was framed as a premises case is Pluard ex. rel. Pluard v. Patients Compensation Fund, 705 N.E.2d 1035 (Ind. Ct. App. 1999), trans. denied. Here, an infant was injured when a surgical lamp detached from a wall and fell on him, hitting him in the head. Pluard, 705 N.E.2d at 1036. After a settlement with the hospital, the patient sought to recover excess damages from the Patients Compensation Fund (the “PCF”). The PCF argued that the claim was not compensable because the tort did not fall under the purview of the act. Id. The Court of Appeals ruled for the PCF, stating: [T]he duty to secure the light, and even the nurses’ assistant’s duty to position it, did not involve a health care decision involving the exercise of professional skill or judgment. Instead, it involved the general duty to maintain safe premises and equipment. As such, it involves issues capable of resolution without application of the standard of care prevalent in the local medical community and thus, is outside the purview of the act, which requires convening a panel of medical experts for the purposes of judging a completely different kind of question.” Pluard, 705 N.E.2d at 1038.
The premises theory was also applied to find a case that fell outside the Act in Harts v. Caylor-Nickel Hospital, Inc., 553 N.E.2d 874 (Ind. Ct. App. 1990). Here, a patient alleged that he suffered injuries when his bed rail collapsed as he attempted to roll over, causing him to fall out of bed. The plaintiff alleged that the hospital’s employees had failed to restrain or secure the side guardrail properly. The Court of Appeals held that the patient’s complaint was one of ordinary negligence and not covered under the medical practice act because the patient “did not allege any breach of duty directly associated with medical negligence that was integral to the rendering of medical treatment that would subject his claim to the Medical Malpractice Act” Id. at 879. See also, St. Mary Med. Ctr. v. Bakewell, 938 N.E.2d 820 (Ind. Ct. App. 2010) (plaintiff fell while showering and filed a claim against the hospital because it had breached its duty to make the place reasonably safe by failing to install appropriate handrails and mats, so matter was outside the act). Comparing Putnam Cty. Hosp. v. Sells, 619 N.E.2d 968 (Ind. Ct. App. 1993) with Harts demonstrates the importance of framing the case. Sells and Harts both involved a fall and alleged negligence regarding bed rails. Harts held the case was outside the act because the bedrails structurally failed. Sells, however, held the case was subject to the act because it was not an allegation of faulty premises or equipment. Instead, the plaintiff alleged that the hospital failed to train and supervise its staff properly concerning the procedures for monitoring patients after surgery and making sure the bedrails were up to protect the patient. Compare also Methodist Hospital v. Rioux, 438 N.E.2d 315, 316 (Ind. Ct. App. 1982) (slip and fall within the act because plaintiff alleged the defendant negligently and carelessly failed to provide care to prevent her fall) with Lomax (slip and fall not within act because plaintiff alleged negligent maintenance).