Leonard Boyd v. Central Iowa Hospital Corp., d/b/a Iowa Methodist Medical Center

• Court: Court of Appeals of Iowa
• Decided: June 18, 2025
• Docket: 24-0570
• Status: Published

Opinion

IN THE COURT OF APPEALS OF IOWA

No. 24-0570 Filed June 18, 2025

LEONARD BOYD, Plaintiff-Appellant,

vs.

CENTRAL IOWA HOSPITAL CORP., d/b/a IOWA METHODIST MEDICAL CENTER, Defendant-Appellee. ________________________________________________________________

Appeal from the Iowa District Court for Polk County, Heather Lauber, Judge.

A plaintiff appeals the grant of summary judgment to medical providers.

AFFIRMED.

Matthew M. Sahag (argued) of Dickey, Campbell, & Sahag Law Firm, PLC,

Des Moines, for appellant.

Jeffrey R. Kappelman (argued), Jack D. Hilmes, Erik P. Bergeland, and

Peter R. Lapointe of Finley Law Firm, P.C., Des Moines, for appellee.

Heard at oral argument by Tabor, C.J., and Ahlers and Langholz, JJ. 2

TABOR, Chief Judge.

Leonard Boyd was treated at Iowa Methodist Medical Center (IMMC) for

gunshot wounds. Doctors prescribed hydromorphone and other narcotics, but

Boyd continued to experience pain. In the same timeframe, pharmacy technician

Victor Van Cleave was diluting vials of fentanyl and hydromorphone with sterile

water or saline. Boyd’s stay at the hospital overlapped with Van Cleave’s short

employment at the pharmacy before IMMC fired him for diverting pain medications.

Boyd sued IMMC, alleging (1) negligence and (2) negligent hiring,

supervision, and retention, as well as seeking punitive damages. The district court

granted IMMC’s motion for summary judgment. The court found that Boyd’s claims

required expert testimony, along with a certificate of merit affidavit and an expert

witness designation. Because Boyd filed neither, the court dismissed his claims.

The court also found Boyd failed to offer proof that he received tampered doses.

Or if he did receive tampered doses, that the diluted medication caused his pain.

Without evidence that Van Cleave’s actions proximately caused Boyd’s injuries,

the court found IMMC was entitled to judgment as a matter of law.

Boyd challenges the district court’s findings, urging us to reverse and

remand for trial. But because Boyd did not generate a genuine issue of material

fact that the actions of Van Cleave or IMMC caused his injuries, we affirm the grant

of summary judgment. By affirming on that ground, we need not address the

expert witness issues.

I. Facts and Prior Proceedings

On August 9, 2016, Boyd was shot several times during an attempted

robbery in Ames. An ambulance rushed him to IMMC in Des Moines, where he 3

had exploratory surgery on his stomach to remove some of the bullets. But a bullet

remained in his right hip. Boyd also developed an abdominal abscess which

required doctors to implant a drainage device to treat the infection.

For the first two weeks of his hospital stay, Boyd felt like his treatment and

medication were controlling his pain. On top of the intravenous hydromorphone

and dilaudid, Boyd received other pain relievers, including acetaminophen,

gabapentin, oxycodone, and benzodiazepines. Boyd said he noticed a change on

August 23 when the pain started to increase. The increased pain continued for

several days through August 29. After that, Boyd transferred to a rehabilitation

unit and continued to struggle “hard” with pain control until he was discharged on

September 6.

Meanwhile, Van Cleave—a certified pharmacy technician with no criminal

history—started working at the IMMC pharmacy on August 22. Pharmacy

employees helped train and supervise Van Cleave, but he soon began working

independently. Part of his training involved learning how to access the hospital’s

tightly controlled narcotics supplies. Within a week or two, Van Cleave could open

some of the hospital’s narcotics-securing Omnicell machines.1

In those first two weeks of his employment, according to Van Cleave’s

testimony, he began diverting narcotics—primarily dilaudid, fentanyl, and

hydromorphone—for his personal use. He would open a machine using his access

1 According to the pharmacy director’s affidavit, the handling of controlled substances at the hospital is limited to licensed professionals like Van Cleave. IMMC developed a process to monitor the chain of custody for controlled substances as well as for the training and supervision of pharmacy workers like Van Cleave. 4

code, remove a narcotic vial from its “pocket” or bin, siphon some medication with

a sterile syringe, and refill the vial with sterile water or saline usually stocked at the

station using a clean syringe. Opening the vial would sometimes break the tamper

tape on top. Then, Van Cleave would enter computer codes called “null

transactions” to conceal his actions. The first such notation appeared in IMMC’s

records on August 25. Van Cleave testified that usually he diverted medication

from just one vial at a time. But his highest diversion tally was six vials in a day.

Coworkers began questioning Van Cleave for leaving his assigned posts

and eventually raised flags about the “null transactions.” Confronted by pharmacy

and human resources personnel six weeks into his employment, he confessed to

diverting the narcotics. Van Cleave later pleaded guilty to federal criminal charges.

Using its records, IMMC correlated the dates of Van Cleave’s null

transactions with patients prescribed medication from the Omnicell machines to

which he had access. That correlation identified 730 patients. IMMC reached out

to those potentially affected patients—sparking this action and a lawsuit involving

many more patients being litigated separately.2

In January 2021, Boyd sued IMMC, listing counts of (1) negligence;

(2) negligent hiring, supervision, and retention; and (3) punitive damages. IMMC

answered and raised several affirmative defenses. Eleven months after the

answer, IMMC moved to dismiss based on Boyd’s failure to file a certificate of merit

affidavit, as required under Iowa Code section 147.140 (2021), for all claims

requiring expert testimony to establish his prima facie case.

2 The caption of that case is In re Fentanyl/Hydromorphone Diversion Litigation

(medical diversion litigation), and it includes fifteen different civil case numbers. 5

Twelve months later, the district court denied the motion to dismiss, finding

that, when taking the allegations in the petition as true, Boyd had “pled claims

outside the scope of section 147.140.” It found that if Boyd received saline or

diluted pain medications instead of the medication he was prescribed, the “lack of

care is so obvious as to be within the comprehension of a layperson,” which

“require[d] only common knowledge and experience to understand.” So expert

witness testimony was unnecessary. As a second point, the court found that

Boyd’s allegations included ordinary negligence claims on the hiring, retention, and

supervision of “non-professional staff.” So it denied the motion to dismiss for

Boyd’s failure to file a certificate of merit affidavit. The court ruled on that motion

twenty-one months after Boyd’s statutory filing deadline for the certificate of merit

affidavit.

Meanwhile, the parties exchanged discovery and took depositions. Another

year passed before IMMC filed two motions for summary judgment. The first

reasserted Boyd’s failure to file the certificate of merit and added Boyd’s failure to

designate expert witnesses, under Iowa Code section 668.11. The second

asserted Boyd could not establish it was more likely than not that he received a

defective dose of pain medication or that it caused him a permanent injury.

Because Boyd could not make a prima facie showing of causation, a necessary

element of negligence, IMMC contended it was entitled to summary judgment.

In resisting summary judgment, Boyd asserted that collateral estoppel

barred IMMC from raising the lack of a certificate of merit affidavit because the

court in the medical diversion litigation found expert testimony was unnecessary. 6

The district court granted IMMC’s motions, finding collateral estoppel did

not bar IMMC from seeking dismissal based on the lack of the certificate of merit

affidavit. In relevant part, the court found that Boyd had two claims—(1) negligent

hiring and supervision and (2) negligent care and treatment—both of which

required expert medical testimony to prove causation and damages. Accordingly,

Boyd should have filed a certificate of merit affidavit and expert witness

designations; his failure to do so required dismissal of his claims. The court also

noted: “Boyd has brought forth no evidence to show that it is more likely than not

he received any tampered doses. IMMC’s experts indicate it is unlikely, and

Boyd’s only testimony was that his pain increased sometime after August 25th.”

Boyd appeals.

II. Scope and Standard of Review

We review the grant of summary judgment for correction of legal error.

Rieder v. Segal, 959 N.W.2d 423, 425–26 (Iowa 2021). Summary judgment is

proper “if the pleadings, depositions, answers to interrogatories, and admissions

on file, together with the affidavits, if any, show that there is no genuine issue as

to any material fact and that the moving party is entitled to judgment as a matter

of law.” Iowa R. Civ. P. 1.981(3). We view the summary judgment record in the

“light most favorable to the nonmoving party.” Rieder, 959 N.W.2d at 426 (citation

omitted). As the nonmoving party, Boyd is “entitled to every legitimate inference

that we may draw from the record.” Degeneffe v. Home Pride Contractors, Inc.,

16 N.W.3d 501, 505 (Iowa 2025) (citation omitted). 7

III. Discussion

Boyd first challenges the district court’s conclusion that he was required to

file a certificate of merit affidavit and reasserts his collateral estoppel claim. But

we choose to bypass those issues and instead consider the basic question

whether Boyd generated a genuine issue of material fact that Van Cleave’s actions

caused his alleged injury—a necessity for both his claims to move forward.

Causation is a common element of both medical negligence and negligent

hiring, supervision, and retention.3 If the summary judgment record lacks evidence

supporting a jury question on causation, IMMC was entitled to judgment as a

matter of law. See Uhler v. Graham Grp., Inc., 992 N.W.2d 577, 584 (Iowa 2023).

Boyd “may not rest upon the mere allegations or denials” in his pleadings. See

Iowa R. Civ. P. 1.981(5). “Summary judgment is not a dress rehearsal or practice

run; it is the put up or shut up moment in a lawsuit, when a nonmoving party must

show what evidence it has that would convince a trier of fact to accept its version

of the events.” Slaughter v. Des Moines Univ. Coll. of Osteopathic Med., 925

3 To establish medical negligence, the patient must prove by a preponderance of

the evidence (1) an applicable standard of care, (2) a violation of this standard, and (3) a causal relationship between the violation and injury sustained. Plowman v. Fort Madison Cmty. Hosp., 896 N.W.2d 393, 401 (Iowa 2017). And to establish negligent hiring, supervision, and retention, the patient must show: (1) that the employer knew, or in the exercise of ordinary care should have known, of its employee’s unfitness at the time of hiring; (2) that through the negligent hiring of the employee, the employee’s incompetence, unfitness, or dangerous characteristics proximately caused the resulting injuries; and (3) that there is some employment or agency relationship between the tortfeasor and the defendant employer. Godar v. Edwards, 588 N.W.2d 701, 708–09 (Iowa 1999). 8

N.W.2d 793, 808 (Iowa 2019) (cleaned up). “The resistance must set forth specific

facts which constitute competent evidence showing a prima facie claim.”

Id. (emphasis and citation omitted). “A genuine issue of material fact exists when

reasonable minds can differ as to how a factual question should be resolved.”

Andersen v. Khanna, 913 N.W.2d 526, 535 (Iowa 2018) (citation omitted).

As the district court found, the evidence that Boyd received one of the

tampered doses is sparse. IMMC tracked Boyd’s medication administrations and

identified two doses of hydromorphone that came from a machine that Van Cleave

accessed, coinciding with a “null transaction” notation. That bin contained ten total

vials. Boyd’s doses were administered on August 28 and 29. A professor of

statistics studied the reports detailing Van Cleave’s activities on the Omnicell

machines and determined that the likelihood that Boyd received tampered vials

was 10.8% for the first identified vial and 31.5% for the second.

Boyd testified about the timing of those doses. He said that on August 21,

providers implanted a device to drain fluid from his abdomen infection, and he felt

his pain was well-controlled. But from August 23 to August 29, he felt his pain was

not well-controlled. He testified he didn’t know then that the medication could be

at fault; he just thought his injuries were getting worse. And he perceived that

medical providers did not believe him. Boyd urges us to view this evidence in the

light most favorable to his claims and accept the inference that his self-reports of

pain increasing—coinciding with Van Cleave’s tenure—shows that he received the

defective doses and suffered injury. He argues the jury could combine the

statistical probabilities with his testimony to reach a more than fifty percent chance

that defective doses caused his injury. 9

But—for several reasons—that link is too tenuous, even when we view the

evidence in the best light for his case. First, other evidence in the record muddies

the causal connection. The medical records show Boyd refused to allow the

nurses to change the dressings on his wounds on August 28 and 29—dates he

reported increased pain. Then, on August 29, Boyd complained that he wasn’t

given the correct medication for pain before the drain dressing was changed, which

he believed was deliberate and in retaliation for an argument he had with his

treating physician.

Second, Boyd’s ongoing pain reports fail to align with the inference that he

received tampered doses on August 28 and 29. On August 30, he transferred to

a rehabilitation unit outside the hospital but continued to struggle with pain control

until he was discharged on September 6. During that period, there was no chance

that he received a diluted dose. That timing undermines the legitimacy of any

inference that a jury could make from the overlap of Boyd’s stay in the hospital with

Van Cleave’s employment.

Third, even if Boyd could show by a preponderance of the evidence that he

received tampered vials, the summary judgment record lacks proof that those

diluted doses caused his increased pain. IMMC’s medical experts highlighted a

complex set of interactions affecting his treatment. A board-certified

anesthesiologist and pain management specialist reviewed Boyd’s medical

records. In a letter, the expert explained that pain-relief response to

hydromorphone depends on many factors including the dose, “the emotional state

of the patient, the addition of [other] non-opioid pain medications, and the use of

non-medication pain treatments such as reassurance, massage, heat, and ice.” 10

Regarding hydromorphone, he wrote, “The goal is generally not to eliminate pain

entirely but to reduce pain to tolerable levels.” The expert noted that Boyd also

received acetaminophen, gabapentin, oxycodone, and benzodiazepines. And his

review showed nurses “attentively monitored” Boyd’s pain complaints and

responded with various treatments. The expert saw no compelling evidence that

Boyd received tampered or diluted medications. In his view, the pain Boyd

experienced would be expected under the circumstances. Finally, he believed the

non-opioid pain medications could be sufficient pain control by themselves.

IMMC also offered evidence from an internal medicine doctor who reported

that Boyd’s abscessed abdomen would have contributed to his pain. Plus, oral

opioids were being administered alongside the intravenous medications, so in this

expert’s opinion, any medication diversion was unlikely to contribute to a change

in Boyd’s pain reports on August 23. According to this expert, it was more likely

related to “infectious complications from his trauma.”

Boyd criticizes the district court for considering his other injuries, his refusal

of recommended treatment, and the other pain interventions he received—

suggesting it inappropriately weighed his credibility. True, “[w]hether a plaintiff has

proved causation is generally a jury question.” Uhler, 992 N.W.2d at 584. But our

supreme court cautions that “a jury should not be asked to speculate on the issue

of causation” where “the analytical gap between the evidence presented and the

inferences to be drawn is too wide.” Id. (citation omitted). This is such a case.

Neither Boyd’s testimony nor any other evidence in the record can establish

a prima facie case that Van Cleave’s conduct or IMMC’s employment practices

caused an injury. What’s more, IMMC’s medical evidence is unchallenged. A 11

reasonable factfinder could not reach a conclusion on causation from the record

presented. Because Boyd cannot prove that element of his claims, IMMC is

entitled to summary judgment.