Indiana: Courts May Decide COVID-19 Statutory Immunity Before MMA Panel; “Arising from COVID-19” Encompasses Ventilator-Immobilization Complications

Introduction

Estate of Waggoner v. Anonymous Health System, Inc. (Ind. Mar. 4, 2026) addresses how Indiana’s Medical Malpractice Act (MMA) interacts with COVID-era immunity statutes enacted to protect healthcare providers during the pandemic. The case arises from the hospitalization of Elmer Waggoner, who developed severe COVID-19 respiratory failure, required mechanical ventilation and immobilization, then developed a pressure wound (bed sore) that progressed to necrotizing infection and death. His Estate filed a proposed MMA complaint against over eighty providers, alleging negligent care relating to the pressure wound.

The decision presented two threshold issues with broad procedural and substantive implications:

  1. Procedural/jurisdictional: May a trial court decide statutory immunity on a preliminary determination/summary judgment motion while a proposed complaint is pending and before a medical-review panel is formed and issues an opinion?
  2. Substantive immunity: Do the state COVID immunity statutes and the federal PREP Act immunize providers where the alleged malpractice concerns wound development and treatment during (and partially after) the state emergency, and where the causal chain runs through ventilator use and immobilization?

The Indiana Supreme Court held the trial court could decide immunity without awaiting a panel opinion and that the Providers were immune under both Indiana statutes and the federal PREP Act.

Summary of the Opinion

  • Preliminary determination permitted: The Court held that immunity is a threshold legal issue the trial court may decide under the MMA when its resolution does not require expert medical opinion from the medical-review panel.
  • State immunity applies: The Providers were immune under the Healthcare Immunity Act and the Premises Immunity Act because Elmer’s injuries “arose from COVID-19”—specifically from treatment actions performed for COVID-19 (ventilation and resulting immobilization), even if the immediate cause of death was a wound complication rather than active COVID infection.
  • Federal PREP Act immunity independently applies: Providers were also immune because the claims “caused by, aris[e] out of, relat[e] to, or result[] from” the use of a covered countermeasure (a ventilator) during the declared federal emergency period.
  • Gross negligence / willful misconduct exceptions not triggered: The Estate did not designate evidence sufficient to create a fact issue on gross negligence under Indiana law; and any PREP Act “willful misconduct” claim must proceed exclusively in the U.S. District Court for the District of Columbia, after pursuing the Covered Countermeasures Process Fund.

The Court affirmed summary judgment for Providers and vacated the Court of Appeals’ published reversal.

Analysis

1) Precedents Cited

MMA procedure and the “threshold issue” doctrine

  • Gierek v. Anonymous 1, 250 N.E.3d 378 (Ind. 2025): The Court relied on Gierek for the controlling framework: while the MMA generally requires a medical-review panel opinion before court litigation, trial courts retain “limited authority” to decide certain threshold issues—particularly where expert medical opinion is not required. Waggoner uses Gierek to draw a line between (a) standard-of-care/medical causation questions reserved to the panel and (b) legal issues like statutory immunity that can be decided by statutory interpretation once the material facts relevant to immunity are undisputed for summary judgment purposes.
  • Cmty. Health Network, Inc. v. McKenzie, 185 N.E.3d 368 (Ind. 2022): Quoted through Gierek to reaffirm the MMA’s core sequencing principle—panel opinion first—while preserving the statutory exception for threshold rulings.
  • Lorenz v. Anonymous Physician #1, 51 N.E.3d 391 (Ind. Ct. App. 2016): Cited for the proposition that trial court jurisdiction during the panel process is limited, helping frame why the Court carefully situates immunity as a permissible threshold matter.
  • Haggerty v. Anonymous Party 1, 998 N.E.2d 286 (Ind. Ct. App. 2013): Used as an example where immunity could be preliminarily determined because expert opinion was unnecessary—supporting the Court’s view that immunity can be decided early when it turns on legal construction, not medical judgment.
  • Ashley v. Anonymous 1, 245 N.E.3d 658, 2024 WL 4142508 (Ind. Ct. App. Sep. 11, 2024) (mem.), trans. denied: Although a memorandum decision, it functioned as a factually parallel illustration: bed sores developed while the patient was immobilized for ventilation as part of COVID-19 treatment, and the Court of Appeals concluded no expert opinion was required to decide whether the injury was “related” to actions taken to treat COVID-19.

Summary judgment standards and legal interpretation

  • Hughley v. State, 15 N.E.3d 1000 (Ind. 2014): Cited for Indiana’s summary judgment standard and the requirement to draw reasonable inferences in favor of the nonmovant. Waggoner nonetheless finds no genuine issue of material fact because, for immunity purposes, the relevant “arising from” nexus was undisputed.
  • ESPN, Inc. v. Univ. of Notre Dame Police Dep't, 62 N.E.3d 1192 (Ind. 2016): Cited for de novo review of statutory interpretation, underscoring the Court’s posture that immunity here is fundamentally a question of law.

Nature of immunity defenses; negligence assumed, liability denied

  • Putnam Cnty. Sheriff v. Price, 954 N.E.2d 451 (Ind. 2011): The Court used Price to characterize immunity as an affirmative defense that “assumes negligence but denies liability.” This matters because it allows the Court to bypass panel-dependent standard-of-care disputes: assuming the Estate’s negligence narrative, the court still asks whether the statutes bar suit.

Interpreting and applying Indiana COVID immunity statutes

  • Mellowitz v. Ball State Univ., 221 N.E.3d 1214 (Ind. 2023): Cited to contextualize the legislature’s policy choice to “insulate and protect” segments of public life during COVID-19, bolstering a broad, purposive reading of COVID-era immunities.
  • Fluhr v. Anonymous Doctor 1, 234 N.E.3d 912 (Ind. Ct. App. 2024), trans. denied: Important on the “arising from” concept: immunity applied even where the patient did not have COVID-19, because treatment delays were attributable to COVID-19 isolation procedures. Waggoner uses Fluhr to reinforce that “arising from COVID-19” includes response measures and treatment actions undertaken because of the pandemic, not merely harms caused by infection itself.

Exceptions for heightened culpability (gross negligence; willful/wanton misconduct)

  • N. Ind. Pub. Serv. v. Sharp, 790 N.E.2d 462 (Ind. 2003): Supplies the definition of “gross negligence” (reckless disregard), used to reject the Estate’s attempt to avoid immunity by invoking heightened culpability without supporting evidence.
  • Hershberger v. Brooker, 421 N.E.2d 672 (Ind. Ct. App. 1981): Cited for the willful/wanton framework—intentional misconduct or conscious indifference to probable injury.
  • McGowen v. Montes, 152 N.E.3d 654 (Ind. Ct. App. 2020), trans. denied: Used to support summary judgment where the designated evidence cannot reasonably establish gross negligence or willful/wanton misconduct.

PREP Act causal breadth and “cannot be separated” reasoning

  • Cowen v. Walgreen Co., No. 22-CV-157-TCK-JFJ, 2022 WL 17640208 (N.D. Okla. Dec. 13, 2022): Cited for the idea that the causal “chain of events cannot be separated from the administration of a covered countermeasure,” supporting a broad nexus between the alleged loss and the countermeasure’s administration/use.

Non-judicial authority

  • 2017 Ind. Op. Att'y Gen. No. 8: Quoted for the proposition that disaster-emergency-related immunity can apply to services provided before or after the formal declaration, reinforcing the Court’s rejection of a rigid cut-off argument tied to March 3, 2022.

2) Legal Reasoning

A. Why the trial court could decide immunity before the medical-review panel

The Estate’s core procedural argument was that deciding immunity would require deciding medical causation—i.e., whether Elmer died from COVID-19 or from a negligently treated pressure wound— which would be reserved to the panel. The Court reframed the inquiry: the immunity statutes did not require COVID-19 to be the immediate medical cause of death; they required that the injury “arise from” COVID-19 or from services/treatment/actions performed for COVID-19. Because the Providers’ assertion of immunity assumes negligence for purposes of the defense (Putnam Cnty. Sheriff v. Price), the court can accept the Estate’s alleged causal narrative (bed sore led to death) and still decide whether the statutory “arising from” nexus is met.

The decisive move is definitional: the Court treated the immunity question as statutory interpretation applied to largely undisputed timeline and treatment facts. Under the MMA, issues not requiring expert medical opinion are not “reserved” to the panel (Gierek v. Anonymous 1), so the trial court retained jurisdiction to decide immunity as a threshold matter.

B. State immunity: “arising from COVID-19” includes downstream complications of COVID treatment

The Court applied the text of the Healthcare Immunity Act and the Premises Immunity Act, focusing on statutory definitions of “arising from COVID-19,” which expressly include harms caused by “services, treatment, or other actions performed for COVID-19.”

Even accepting the Estate’s theory that death resulted from inadequate pressure-wound treatment (rather than from active viral illness), the record—especially the Estate’s own expert— tied the wound’s development to prolonged immobilization necessary for ventilation due to COVID respiratory failure. That link satisfied the statutes’ required relationship. In short: if COVID necessitated ventilation, and ventilation/immobilization contributed to the wound, then the wound-related injury “arose from” treatment “performed for COVID-19.”

The Court rejected the Estate’s “he tested negative” argument as legally misdirected: statutory immunity is not limited to injuries caused by viral presence at the moment of death; it includes injuries stemming from the pandemic response and COVID-directed care.

C. Timing: immunity not defeated merely because death occurred after the state emergency rescinded

The Court disagreed with the Court of Appeals’ view that the Governor’s March 3, 2022 rescission categorically barred Healthcare Immunity Act protection for later care. Because the relevant services “arose” during and in response to the disaster emergency (treatment began during the emergency; the COVID-necessitated course of care continued), the Court held that the fact some care extended beyond rescission did not sever immunity. The Court also emphasized that the Premises Immunity Act remained in force for causes of action accruing after March 1, 2020, and did not expire until 2024.

D. Exceptions: gross negligence and willful/wanton misconduct require designated evidence, not labels

The Court treated the Estate’s invocation of “gross negligence” as insufficient because it was unsupported by designated evidence showing reckless disregard or intentional/conscious wrongdoing as described in N. Ind. Pub. Serv. v. Sharp and Hershberger v. Brooker. An expert’s criticism that care was “inadequate,” without more, did not create a triable issue of heightened culpability (consistent with McGowen v. Montes).

E. PREP Act: ventilator use triggers broad federal immunity and preemption

Independently, the Court held the PREP Act barred the claims. The statutory language is expansive: immunity covers claims “caused by, arising out of, relating to, or resulting from” the administration or use of a covered countermeasure. The Court identified the ventilator as a covered countermeasure and found the Estate’s own expert linked the pressure wound to immobilization for ventilator support. Citing Cowen v. Walgreen Co., the Court concluded the causal chain could not be separated.

The Court also emphasized the PREP Act’s channeling function: the exclusive remedy is the Covered Countermeasures Process Fund, and the only immunity exception—willful misconduct— must be brought as an exclusive federal cause of action in the U.S. District Court for the District of Columbia, after pursuing the Fund. Because the Estate did not proceed that way, the exception did not apply.

3) Impact

A. Procedural impact: earlier dispositive motions in MMA cases involving immunity

The most immediate doctrinal impact is procedural. Waggoner clarifies that Indiana trial courts may decide statutory immunity as a preliminary determination/summary judgment issue without waiting for a medical-review panel, so long as the immunity question does not require expert opinion. Practically, this invites earlier motions and earlier resolution in cases where immunity turns on statutory scope and undisputed treatment context.

B. Substantive impact: “arising from COVID-19” is broader than “caused by COVID-19”

Substantively, the Court adopts (and reinforces via Ashley v. Anonymous 1 and Fluhr v. Anonymous Doctor 1) a broad reading of COVID immunity: harms tied to COVID-directed treatment decisions (ventilation, immobilization, isolation protocols, resource constraints) can qualify even when the immediate injury is non-viral (pressure wounds, delayed stroke treatment).

This interpretation will likely shape the “nexus” analysis in future cases: litigants should expect courts to examine whether the injury is downstream of COVID-related treatment actions, not solely whether the patient had COVID at injury/death or whether COVID is the proximate medical cause.

C. Federal overlay: PREP Act as a backstop immunity and preemption tool

The decision underscores that in COVID-era care involving “covered countermeasures,” the PREP Act may independently preempt state-law negligence claims, functioning as a potent backstop even if state immunity arguments are contested. It also highlights the stringent procedural channeling of willful misconduct claims to federal court in the District of Columbia, which can be outcome-determinative.

D. Litigation strategy and pleading proof burdens

Finally, Waggoner signals that merely pleading “gross negligence” (or raising it late in summary judgment briefing) will not avoid immunity absent designated evidence consistent with Indiana’s heightened culpability standards. This places greater emphasis on early evidentiary development and on distinguishing negligence from reckless/intentional misconduct.

Complex Concepts Simplified

Medical-review panel (MMA)
A screening mechanism: before most malpractice suits proceed in court, a panel of medical professionals issues an opinion on whether the provider met the standard of care and whether the conduct contributed to damages. But courts can still decide certain “threshold” legal issues that don’t require medical expertise.
Preliminary determination jurisdiction
Limited authority for trial courts to decide some issues while the proposed complaint is pending before the panel—especially purely legal questions like statutory interpretation, provided they do not require expert medical opinion.
Immunity as an affirmative defense
A defense that (for purposes of the defense) can assume the plaintiff’s negligence allegations are true but argues the law bars liability anyway (e.g., due to statutory immunity).
“Arising from COVID-19”
In these statutes, it is not limited to harm directly caused by the virus. It can include harm resulting from “services, treatment, or other actions performed for COVID-19,” such as ventilation-related immobilization leading to bed sores.
Gross negligence / willful or wanton misconduct
More blameworthy than ordinary negligence. Gross negligence involves reckless disregard; willful/wanton implies conscious or intentional wrongdoing. Labeling conduct as “gross” is not enough—evidence must support that heightened state of mind.
PREP Act preemption and “covered countermeasures”
The PREP Act can block state-law suits related to administering/using certain emergency medical products/devices (covered countermeasures) during a declared emergency. It channels compensation to a federal fund and permits only narrow, specially filed federal “willful misconduct” claims.

Conclusion

Estate of Waggoner v. Anonymous Health System, Inc. establishes two key takeaways in Indiana COVID-era malpractice litigation. First, trial courts may decide statutory immunity as a threshold matter without waiting for a medical-review panel when the issue is resolvable by statutory interpretation and undisputed context facts. Second, “arising from COVID-19” is construed broadly to include injuries stemming from COVID-directed treatment actions—here, ventilator use and immobilization leading to a pressure wound and fatal complications— even where COVID is not the immediate cause of death at the end of the clinical course.

The opinion thus strengthens immunity defenses for pandemic-related care and clarifies procedural sequencing under the MMA, while also emphasizing the PREP Act’s sweeping preemptive force in covered-countermeasure cases.