DICKSON, J.
The defendant first challenges the trial court’s decision in allowing the plaintiff, over defendant’s objection, “to recite hearsay testimony at trial about what Dr. Saquib told her about her injuries.” . . . The defendant argues that “Dr. Saquib, Cave’s internist, was not the one receiving medical diagnosis or treatment” and that the plaintiff’s “testimony as to what Dr. Saquib allegedly told her about the results of diagnostic tests and the cause of her pain does not qualify as an exception to the hearsay rule under Evid. R. 803(4) since the statements at issue were made by Dr. Saquib to Cave and not by Cave to Dr. Saquib for purposes of receiving a diagnosis or treatment.” Id. at 19.
Indiana Evidence Rule 803(4) operates as an exception to the general rule that hearsay is inadmissible evidence at trial. The rule states:
Statements for Purpose of Medical Diagnosis or Treatment. Statements made for purposes of medical diagnosis or treatment and describing medical history, or past or present symptoms, pain, or sensations, or the inception or general character of the cause or external source thereof insofar as reasonably pertinent to diag-nosis or treatment.
The plaintiff points to Coffey v. Coffey, 649 N.E.2d 1074 (Ind. Ct. App. 1995), trans. not sought, as authority for allowing statements made by a health care provider to a patient to be ad-mitted under the 803(4) hearsay exception. Coffey involved the distribution of marital assets in a dissolution proceeding. To show available assets, the husband attempted to admit a letter from his doctor describing his medical condition and diagnosis, arguably a relevant factor when determining property division. . . . The trial court excluded the letter, and in his appeal, the husband argued the letter should have been admitted under 803(4). . . . The Court of Appeals agreed, reversed, and remanded, apparently concluding that the letter’s information regarding physical diagnosis, treatment agenda, and resulting inability to work fell within rule 803(4)’s language, which does not explicitly state whose statements fall within the exception.
We disagree with and disapprove of this holding in Coffey. The rationale for the 803(4) hearsay exception is that a declarant has a personal interest in obtaining a medical diagnosis and treatment, and this interest motivates the patient to provide truthful information. See McClain v. State, 675 N.E.2d 329, 331 (Ind. 1996). Stated another way, a patient’s personal interest in receiving medical treatment supplies significant indicia of reliability that the patient’s statements are true, thus reducing the need for exclusion of hearsay evidence not subject to cross-examination. Declarations made by a physician or other health care provider to a patient do not share this enhanced indicia of reliability. Furthermore, because of the substantial likelihood that a typical patient may fail to fully or accurately comprehend or understand the physician’s report, to admit into evidence a patient’s personal perception of the physician’s statement would not only foster the possibility of misreporting but also eliminate the opportunity for clarifying cross-examination of the physician. While Rule 803(4) does not expressly identify which declarants’ medical statements are intended to be treated as a hearsay rule exception, we hold that the Rule is intended and should apply only to statements made by persons who are seeking medical diagnosis or treatment.
For this reason, the plaintiff’s testimony reporting Dr. Saquib’s statements about the results of diagnostic tests and the cause of her pain does not qualify as an exception to the hearsay rule under Rule 803(4).
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The defendant does not challenge the reasonableness as to any of the dollar amounts incurred by the plaintiff for her medical care, but rather he asserts that he should have been permitted to present evidence to challenge the necessity of certain treatment, specifically the nerve conduction study and “passive care” treatment provided more than four weeks after the collision.
For over a century, some Indiana appellate opinions have recited that to recover damages for medical expenses, such expenses must be “reasonable and necessary.” . . . When this phrase has appeared, the issue usually addressed is the reasonableness of medical expenses, not the necessity of the medical treatment.
. . . .
While the foregoing opinions provide little clarification as to the proper application of “necessary,” it is apparent that the shorthand phrase “reasonable and necessary” embodies two aspects. First, the claimed amount of medical expenses must be reasonable. Second, the nature and extent of the claimed medical treatment must be necessary.
In the present case, the plaintiff asserts that evidence proffered by the defendant to challenge the medical necessity of some of the plaintiff’s treatment was correctly excluded pursuant to Whitaker v. Kruse, 495 N.E.2d 223 (Ind. Ct. App. 1986)].
In Whitaker, the Court of Appeals reversed a verdict for the defendants because an in-struction improperly permitted the defendants to contest the propriety of the plaintiff’s doctor’s diagnosis and treatment. It concluded:
We hold that an injured party may recover for injuries caused by the original tort-feasor’s negligent conduct and for any aggravation of those injuries caused by a physician’s improper diagnosis and unnecessary treatment or proper diagnosis and negligent treatment. In order to recover under this rule, the plaintiff need only show he exercised reasonable
care in choosing the physician.
Whitaker, 495 N.E.2d at 226. The court found that the defendants’ allegation was merely that their expert witnesses “would have elected to continue conservative treatments rather than perform surgery.” Id. at 227.5
The rationale expressed in Whitaker was that “the tort-feasor created the necessity for medical care in the first instance. So long as the individual seeking medical care makes a reasonable choice of physicians, he is entitled to recover for all damages resulting from any aggravation of his original injury caused by a physician’s misdiagnosis or mistreatment.” . . . Whitaker explained: “Liability is imposed because it is reasonably foreseeable that medical care providers are human and capable of making mistakes.” 495 N.E.2d at 226.
Recognizing the general rule in Indiana that a plaintiff’s recovery may be reduced if he fails to obey his physician’s instructions and thereby exacerbates or aggravates his injury, the Whitaker court sternly rejected the proposition that an injured party could not recover for injuries caused by misdiagnosis or performance of an arguably unnecessary procedure, declaring that such a rule would place the injured party “in the unenviable position of second-guessing his physicians in order to determine whether the doctor properly diagnosed the injury and chose the correct treatment. This court will not place innocent parties who have been injured by another’s negligence in such a position.” Id.
But we do not read Whitaker to allow an injured plaintiff to recover for medical treatment wholly unrelated to a defendant’s wrongful conduct. Whitaker does not eliminate the causation element. It specifically states: “We hold that an injured party may recover for injuries caused by the original tort-feasor’s negligent conduct . . . .” Id. (emphasis added). And although holding that a plaintiff may recover for damages from a physician’s misdiagnosis or mistreatment, the language of Whitaker is that such damages must be “resulting from any aggravation of his original injury caused by a physician’s misdiagnosis or mistreatment.” Id. (emphasis added).
“Under standard negligence doctrine, in order for a defendant to be liable for a plaintiff’s injury, the defendant’s act or omission must be deemed to be a proximate cause of that injury.” City of Gary v. Smith & Wesson Corp., 801 N.E.2d 1222, 1243 (Ind. 2003). “‘Proximate cause’ has two components: causation-in-fact and scope of liability.” Kovach v. Caligor Midwest, 913 N.E.2d 193, 197 (Ind. 2009). “The scope of liability doctrine asks whether the injury was a natural and probable consequence of the defendant’s conduct, which in the light of the circumstances should have been foreseen or anticipated.” Id. at 198. The analysis in Whitaker is helpful in understanding the contours of this foreseeability aspect when a defendant seeks to challenge the nature and extent of medical treatment selected and provided by a plaintiff’s medical care professionals. Even if their medical judgment is unsound or erroneous, such human frailties are reasonably foreseeable and do not allow a defendant to escape liability for wrongful conduct. Id. at 226.
This formulation does not have the result, as the defendant here warns, that “a defendant will never be able to refute a plaintiff’s claim that medical bills were reasonable and necessary.” Appellant’s Br. at 26. As to reasonableness, the Whitaker rule does not affect the evaluation of whether the amount claimed for a medical expense is reasonable. The rule does, however, guide application of the “scope of liability” aspect of the proximate cause element. While Whitaker restricts a defendant’s evidence as to the “scope of liability” component of proximate cause, it does not preclude challenge to the “causation-in-fact” component. A future defendant may thus present evidence to counter a plaintiff’s claim that but for the defendant’s alleged negligence, the disputed medical treatment would not have occurred. . . . Thus, for example, a plaintiff may not recover damages for dental care received following a collision in which harm to the plaintiff’s teeth was not implicated. Likewise, a defendant may properly challenge whether a plaintiff’s medical treatment was not at all necessitated by the alleged tortious conduct but by a non-aggravated, pre-existing condition.
In summary, we hold that the phrase “reasonable and necessary,” as a qualification for the damages recoverable by an injured party, means (1) that the amount of medical expense claimed must be reasonable, (2) that the nature and extent of the treatment claimed must be necessary in the sense that it proximately resulted from the wrongful conduct of another, and (3) the rule in Whitaker is a correct application of the “scope of liability” component of proximate cause. [Footnote omitted.]
Sullivan, Boehm, and Rucker, JJ., concur.
SHEPARD, C.J., concurs in result with separate opinion:
Given the regularity with which this Court expresses its faith in the judgment of juries, I am surprised that my colleagues hold today that on a crucial issue submitted for jury decision one side may provide evidence but the other side may not.
The Court’s explanation about the scope of a tortfeasor’s potential responsibility for the costs necessitated by his actions seems straightforward and correct. And, the notion that a claimant has the burden to provide proof that medical specials reflect reasonable and necessary treatment expenses is hornbook law.
What is not hornbook law is the rule announced about how this issue may be litigated before the jury. The claimant may satisfy the burden of proof simply by tendering medical bills in accordance with Evidence Rule 413. The responding party is barred from challenging whether these bills do in fact reflect reasonable and necessary treatment, the very thing the jury will be called upon to decide.
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Most of the time, when medical treatment is provided by mainstream practitioners, there will be little tussle over whether the care was reasonable and necessary and the practical effect of prohibiting a party from tendering probative evidence to the jury will not likely lead to an unjust verdict. Because I am not persuaded that the prohibition worked an injustice in this instance, I
join in affirming the outcome. But the breadth of today’s ruling will lead future judges and juries to work injustices at the very moment when judgment is most needed to hold to account providers at the edge of reasonably necessary treatment, or beyond it. Today’s “Sibbing rule” insulates sharp practices from scrutiny, which is why I decline to join in.