Case Title: Ex parte Partners In Care, Inc. PETITION FOR WRIT OF MANDAMUS: CIVIL (In re: Sandra Sherman and Leslie Nobles v. Partners In Care, Inc. (Mobile County: CV-07-900097); Rebekah Baker v. Partners In Care, Inc. (Conecuh County: CV-06-900008); Patricia Crook v. Partners In Care, Inc. (Conecuh County: CV-06-900009); Marshelia Evans v. Partners In Care, Inc. (Conecuh County: CV-06-9000010); Mattie Jones v. Partners In Care, Inc. (Conecuh County: CV-06-9000011); Ronald Jones v. Partners In Care, Inc. (Conecuh County: CV-06-9000012); Barry Likely v. Partners In Care, Inc.

Citation: 

Docket Number: 1061261

State: alabama

Court: Alabama Supreme Court

Date: 2007-12-07T00:00:00Z

Document:
Sandra Sherman and Leslie Nobles v. Partners in Care,
1
Inc. (Mobile Circuit Court, CV-07-900097), is 1 of 18 cases,
17 of which are pending in the Conecuh Circuit Court,
involving the same defendant. The other 17 cases are: (1)
Rebekah Baker v. Partners in Care, Inc. (CV-06-900008); (2)
Patricia Crook v. Partners in Care, Inc. (CV-06-900009); (3)
Marshelia Evans v. Partners in Care, Inc. (CV-06-900010); (4)
Mattie Jones v. Partners in Care, Inc. (CV-06-900011); (5)
REL:12/07/07 
Notice: This opinion is subject to formal revision before publication in the advance
sheets of Southern Reporter.  Readers are requested to notify the Reporter of Decisions,
Alabama Appellate Courts, 300 Dexter Avenue, Montgomery, Alabama 36104-3741 ((334) 229-
0649), of any typographical or other errors, in order that corrections may be made before
the opinion is printed in Southern Reporter.
SUPREME COURT OF ALABAMA
OCTOBER TERM, 2007-2008
____________________
1061261
____________________
Ex parte Partners in Care, Inc.
PETITION FOR WRIT OF MANDAMUS
(In re: Sandra Sherman and Leslie Nobles
v.
Partners in Care, Inc.) 
(Mobile Circuit Court, CV-07-900097 )
1
1061261
Ronald Jones v. Partners in Care, Inc. (CV-06-900012); (6)
Barry Likely v. Partners in Care, Inc. (CV-07-900001); (7)
Leodus Mims v. Partners in Care, Inc. (CV-06-900013); (8)
Loretta Pugh v. Partners in Care, Inc. (CV-06-900014); (9)
Anita White v. Partners in Care, Inc. (CV-06-900015); (10)
Vincent Brundidge v. Partners in Care, Inc. (CV-06-900008);
(11) Stephen Burrell v. Partners in Care, Inc. (CV-07-900003);
(12) D.J. Frye v. Partners in Care, Inc. (CV-07-900005); (13)
Bama Lee Hendrix v. Partners in Care, Inc. (CV-06-136); (14)
Joni Lambert v. Partners in Care, Inc. (CV-06-137); (15) Tia
Logsdon v. Partners in Care, Inc. (CV-07-900002); (16) Barbara
McCreary v. Partners in Care, Inc. (CV-07-900004); and (17)
Billy J. Jackson v. Partners in Care, Inc. (CV-07-900006).
2
BOLIN, Justice.
Partners in Care, Inc. ("PIC"), the defendant in multiple
actions alleging that it produced a defective drug that
injured the recipients of the drug, petitions this Court for
a writ of mandamus directing the Mobile Circuit Court and the
Conecuh Circuit Court, in separate actions, to vacate their
orders denying PIC's motions for a change of venue, for a more
definite statement, and to enter a protective order, all made
pursuant to the Alabama Medical Liability Act, § 6-5-480 et
seq., Ala. Code 1975 ("the AMLA"), and to grant those motions.
We deny the petition.
I.
PIC, a business based in Shelby County, is licensed by
the Alabama State Board of Pharmacy as both a traditional
1061261
The actions filed in Jefferson County have been
2
transferred to Shelby County on PIC's motion.
3
retail pharmacy and as a manufacturer/wholesaler/distributor
of drugs.  In November and December 2006, PIC produced a
faulty batch of generic injectable betamethasone, a steroid
commonly used in the treatment of arthritis, sinusitis, and
other conditions.  The betamethasone was shipped to physicians
in various parts of Alabama for use in treating their
patients.  After those physicians began using the PIC-produced
betamethasone in their practice, some of the patients who
received injections of the medication had adverse reactions to
it.  It was later determined that there was a problem with the
batch of betamethasone PIC had produced, and the batch was
recalled.
Lawsuits 
were 
subsequently 
filed 
against 
PIC 
by
individuals in Jefferson County,  Mobile County, and Conecuh
2
County, who all alleged that they had been injured by the PIC-
produced betamethasone.  Those plaintiffs stated their claims
as product-liability claims made pursuant to the Alabama
Extended Manufacturer's Liability Doctrine; however, PIC
subsequently moved each of the trial courts to treat the
claims as medical-liability claims under the AMLA and to
1061261
The AMLA provides in § 6-5-546, Ala. Code 1975, that
3
actions brought thereunder "must be brought in the county
wherein the act or omission constituting the alleged breach of
the standard of care by the defendant actually occurred."
Section 6-5-551 provides that "[t]he plaintiff shall include
in the complaint filed in the action a detailed specification
and factual description of each act and omission alleged by
plaintiff to render the health care provider liable to
plaintiff" and that "[a]ny party shall be prohibited from
conducting discovery with regard to any other act or omission
or from introducing at trial evidence of any other act or
omission."  Sections 6-5-545 and -548 contain further
restrictions on the scope of discovery in AMLA actions.
 
4
transfer the cases to Shelby County, to require the plaintiffs
to file a more definite statement, and to enter a protective
order in accordance with the provisions of the AMLA.  The
3
Jefferson Circuit Court granted PIC's motion to transfer and
transferred the cases pending in its court to Shelby County,
where PIC had produced the batch of betamethasone that
allegedly caused the injuries.  However, the Mobile Circuit
Court and the Conecuh Circuit Court denied PIC's motions.  PIC
now petitions this Court to issue a writ of mandamus directing
the Mobile Circuit Court and the Conecuh Circuit Court to
vacate their orders denying PIC's motions for a change of
venue, motions for a more definite statement, and motions to
enter a protective order, and to enter orders granting those
motions. We deny PIC's petition.
1061261
5
II.
A writ of mandamus is an extraordinary remedy, and a
petitioner seeking such a writ must demonstrate a clear, legal
right to the relief sought.  Ex parte Palm Harbor Homes, Inc.,
798 So. 2d 656, 660 (Ala. 2001).  In the instant case, PIC has
a clear, legal right to have its motions granted only if it
can establish that the plaintiffs' claims are indeed subject
to the AMLA.  That inquiry in turn hinges on whether PIC is a
"health-care provider" within the meaning of the AMLA.  
The AMLA defines a "health care provider" as "[a] medical
practitioner, 
dental 
practitioner, 
medical 
institution,
physician, dentist, hospital, or other health care provider as
those terms are defined in Section 6-5-481." § 6-5-542(1),
Ala. Code 1975.  PIC does not dispute that it is not a
"medical practitioner," a "dental practitioner," a "medical
institution," a "physician," a "dentist," or a "hospital," as
those terms are defined in § 6-5-481; thus, the question
becomes whether PIC falls within the definition of "other
health care providers" in that section.  
Section 6-5-481(8) defines "other health care providers"
as "[a]ny professional corporation or any person employed by
1061261
6
physicians, dentists, or hospitals who are directly involved
in the delivery of health care services."  This Court on
multiple 
previous 
occasions has considered whether an
individual or corporation is an "other health care provider"
entitled to the protections of the AMLA; however, our
interpretation of § 6-5-481(8) has not always been uniform.
In some cases, we have considered whether the corporation or
person seeking to be considered an "other health care
provider" is itself  "directly involved in the delivery of
health care services," while in other cases we have read the
phrase "who are directly involved in the delivery of health
care services" as describing the physician, dentist, or
hospital that employs the corporation or person seeking to be
considered an "other health care provider."  Compare Wilson v.
American Red Cross, 600 So. 2d 216, 218 (Ala. 1992) (holding
that the Red Cross was an "other health care provider," in
part because it was "directly involved in the delivery of
health care services"), with Anderson v. Alabama Reference
Labs., 778 So. 2d 806, 810 (Ala. 2000)(holding that a medical
laboratory was an "other health care provider" because its
testing of a specimen was an integral part of the physician's
1061261
7
delivery of health-care services to the patient).  We also at
one time interpreted the term "employed" as it is used in  §
6-5-481(8) 
to 
require 
an 
employment 
or 
contractual
relationship between the corporation or person seeking to be
considered an "other health care provider" and a physician,
dentist, or hospital, while we have more recently recognized
that the physician, dentist, or hospital need only have "used"
the corporation or person seeking to be considered an "other
health care provider." Compare Ex parte Main, 658 So. 2d 384,
387 (Ala. 1995) (holding that a registered nurse was an "other
health care provider" because her contractual relationships
with a hospital and physician were "sufficiently analogous to
employment 
relationships"), 
with 
Cackowski 
v. 
Wal-Mart 
Stores,
Inc., 767 So. 2d 319, 324-35 (Ala. 2000) (construing
"employed" to apply to a person of whom the physician makes
use or whose services the physician engages).  
However, although perhaps not perfectly consistent, our
caselaw considering § 6-5-481(8), and especially our more
recent decisions such as Cackowski and Anderson, generally
stand for the following proposition:  a corporation or person
seeking to be considered an "other health care provider" under
1061261
8
the AMLA need not prove an employer/employee relationship or
a contractual relationship with a physician, dentist, or
hospital to establish that it or he is "employed" by a
physician, dentist, or hospital, although such a relationship
would certainly fall within the statute; however, at a minimum
a physician, dentist, or hospital must have made use of that
corporation or person in the physician's, dentist's, or
hospital's delivery of health-care services to the plaintiff-
patient.  Thus, our ultimate inquiry in the present case is
whether the physicians who injected their patients with the
PIC-produced and distributed betamethasone were somehow
"using" PIC to deliver health-care services to those patients.
The facts as they have been submitted to this Court confirm
that they were not using PIC in that fashion.
Because Cackowski also considered whether a pharmacist
was an "other health care provider," it is instructive to
compare the facts in that case to those here. The Court stated
in Cackowski:
"An individual goes to a physician for treatment of
a physical complaint.  Upon examining the patient,
the physician may determine that a course of
medication is necessary to treat the patient's
condition.  Accordingly, the physician writes out a
prescription, which the patient takes to the
1061261
9
pharmacy of his choice to be filled.  Although it is
the physician who prescribes the medication, it is
only a pharmacist/pharmacy that can fill the
prescription, by supplying the patient with the
called-for medication.  See § 34-23-1(17) and (18),
Ala. Code 1975.  Because a pharmacist and/or a
pharmacy is inextricably linked to a physician's
treatment of his patients, the dispensing of drugs
is an integral part of the delivery of health care
services to the public.  For this reason, we
conclude that a pharmacist is within the definition
of 'other health care provider' set out in §
6-5-481(8), Ala. Code 1975."
767 So. 2d at 325.  Thus, in Cackowski, the physician examined
a patient and decided on a course of treatment that included
a prescription for medicine that could then only be obtained
from a pharmacy.  The physician's treatment, that is, his
delivery of health-care services, could not be completed
without the intervening service (the dispensing of drugs)
offered by the pharmacy.  The physician in Cackowski was,
therefore, using the pharmacy's services to complete the
delivery of health-care services to that patient.  
In contrast, the physicians in the present case did not
rely on PIC to assist them in delivering health-care services
to their patients.  Rather, those patients sought treatment
from their physicians, and the physicians immediately treated
them in-office by administering an injection of betamethasone,
1061261
10
which the physicians had purchased beforehand.  Notably, there
was no intervening act by PIC that enabled the physician to
complete the delivery of the health-care services; the
"inextricable link[]" that was present in Cackowski is absent.
The link between the physician's treatment and the patient in
this case was a direct one, and the physician in no way used
or employed PIC to complete the delivery of health-care
services to that patient. 
PIC's arguments that it should be considered an "other
health care provider" are not persuasive.  Citing Cackowski
and Ex parte Rite Aid of Alabama, Inc., 768 So. 2d 960 (Ala.
2000), a case similar to Cackowski in that it involved a claim
against a pharmacy, PIC argues that "[t]his Court's prior
holdings establish beyond question that a pharmacy is a
healthcare provider subject to the AMLA."  (Petition at p. 5.)
However, for the reasons explained above, it is not a person's
or corporation's occupation or type of business that
determines whether the AMLA applies, it is whether that person
or corporation was used by a physician, dentist, or hospital
in delivering health-care services to a patient.  
1061261
We note that the plaintiffs have argued that PIC was not,
4
in fact, acting as a pharmacy when it produced and distributed
the betamethasone alleged to have caused their injuries.
Rather, they argue, PIC was acting as a manufacturer,
wholesaler, or distributor pursuant to the business license it
also held authorizing it to engage in those activities.
However, we need not make a conclusive determination as to
whether 
PIC 
was 
acting 
as 
a 
pharmacy, 
manufacturer,
wholesaler, or distributor; it is sufficient to conclude that
PIC was not employed by the physicians who purchased the PCI-
11
Moreover, although PIC argues that, under Cackowski and
Rite Aid, the relationship that must be analyzed to determine
whether the AMLA applies "is that between the pharmacy and the
overall healthcare system, the 'inextricable link' to the
delivery of healthcare created by the activities of the
pharmacists, namely, dispensing medication," it fails to
recognize that, unlike the pharmacies in Cackowski and Rite
Aid, it was not merely "dispensing" medication.  (Petition at
p. 12.) The pharmacies in Cackowski and Rite Aid were
dispensing 
drugs 
to 
specific 
individuals 
after 
those
individuals presented the pharmacies with prescriptions
written by their physicians.  PIC, in contrast, was producing
its version of a generic drug and then selling and shipping
bulk orders of that drug to physicians to use in their
practice with any individuals who might appear seeking
treatment.  This distinction is an important one.   
4
1061261
produced betamethasone to deliver health-care services to
their patients.
12
PIC also argues that a decision by this Court affirming
the orders of the Mobile Circuit Court and the Conecuh Circuit
Court denying PIC's various motions would be contrary to our
previous holding in Wilson v. American Red Cross, supra.  In
Wilson, a patient sued the Red Cross after he contracted
hepatitis as a result of a blood transfusion for which the Red
Cross had supplied the blood. 600 So. 2d at 217.  The Red
Cross had collected, processed, and distributed the tainted
blood to the hospital for the hospital to use as needed before
this particular patient went to the hospital to obtain
treatment; however, this Court nevertheless held that the Red
Cross was an "other health care provider" and that the
patient's action was accordingly subject to the AMLA. 600 So.
2d at 218-19.  PIC argues that its actions in producing and
distributing the betamethasone to physicians, before the
patients who would ultimately receive the medication visited
those same physicians for treatment, are substantially similar
to the actions of the Red Cross in Wilson and that it should
be considered an "other health care provider" on that basis.
1061261
13
However, in Wilson, this Court interpreted the term
"employed" in § 6-5-481(8) in the more literal sense and
concluded that the Red Cross was "employed" by a hospital
because it "was under a contract with the University of
Alabama Hospital to supply blood to the hospital."  600 So. 2d
at 218.  PIC has not argued that there was such a contractual
or quasi-employment relationship with the physicians who
purchased its betamethasone in the present case, nor is there
evidence of such a relationship.  PIC's argument is instead
based on the "inextricable link" described by this Court in
Cackowski, which link we have already determined was not
present here. Therefore, Wilson is distinguishable.  
III.
PIC has not established that the physicians to whom it
sold betamethasone were using PIC to deliver health-care
services to their patients.  Accordingly, PIC cannot be
considered an "other health care provider" for the purposes of
these actions, and it is not entitled to the protections
afforded health-care providers by the AMLA.  Because PIC does
not have a clear, legal right to the relief it seeks –– an
order directing the Mobile Circuit Court and the Conecuh
1061261
14
Circuit Court to vacate their orders denying PIC's motions
for a change of venue, for a more definite statement, and for
a protective order, and to enter an order granting the same
motions –– the petition for the writ of mandamus is denied.
PETITION DENIED.
Cobb, C.J., and Stuart, J., concur.
Lyons and Murdock, JJ., concur specially.
1061261
15
LYONS, Justice (concurring specially).
Section 6-5-481(8), Ala. Code 1975, defines "other health
care providers" as "[a]ny professional corporation or any
person employed by physicians, dentists, or hospitals who are
directly involved in the delivery of health care services."
(Emphasis added.)  In the absence of employment in the context
of a contract for the rendition of services, we have found the
status of a health-care provider to exist under the
alternative definition of "employ" as "to make use of."  In
that class of cases we have found direct, as opposed to
indirect, involvement by reason of the presence of an ensuing
chain of events set in motion by the physician and involving
the subsequent conduct of the entity seeking status as an
"other health care provider."  Thus, the pharmacist was both
used and directly involved in Cackowski v. Wal-Mart Stores,
Inc., 767 So. 2d 319, 325 (Ala. 2000) ("Accordingly, the
physician writes out a prescription, which the patient takes
to the pharmacy of his choice to be filled. Although it is the
physician who prescribes the medication, it is only a
pharmacist/pharmacy that can fill the prescription, by
supplying the patient with the called-for medication.").  The
1061261
16
testing laboratory was both used and directly involved in
Anderson v. Alabama Reference Laboratories, 778 So. 2d 806,
810 (Ala. 2000) ("Similarly, in this case, Dr. Fuller
employed, or engaged the services of, ARL to test a sputum
specimen of his patient, Mr. Anderson.  The purpose of having
ARL test Anderson's specimen was directly linked to Dr.
Fuller's diagnosis and treatment of Anderson. Thus, ARL's
testing of Anderson's specimen was an integral part of Dr.
Fuller's delivery of health-care services to Anderson.
Therefore, we hold that ARL falls within the AMLA's definition
of 'other health-care provider.'").  In each instance, the
physician using the entity found to be within the definition
of "other health care provider" set in motion a chain of
events involving the direct participation of the other entity.
PIC argues that the role of the blood supplier recognized
as being within the definition of "other health care provider"
in Wilson v. American Red Cross, 600 So. 2d 216 (Ala. 1992),
is indistinguishable from the role PIC played.  PIC
distributed 
betamethasone; 
the 
blood 
supplier 
furnished 
blood.
No ensuing chain of events involving the subsequent conduct of
another 
entity 
was 
set 
in 
motion 
by 
the 
physician
1061261
17
administering betamethasone or giving a blood transfusion.
But, as the main opinion points out, there existed in Wilson
a contract of employment for the rendition of services between
the blood supplier and the hospital.   See Wilson, 600 So. 2d
at 218 ("The record in the instant case reveals that when
Wilson received the allegedly defective blood, the Red Cross
was under a contract with the University of Alabama Hospital
to supply blood to the hospital.  The record further reveals
that the activities of the Red Cross are highly technical and
require supervision and participation by a physician and other
trained technical personnel.  Based on this evidence, we
conclude that the Red Cross is employed by the hospital and
that the Red Cross is directly involved in the delivery of
health care services.").  Distribution of blood for the
purpose of transfusions is "declared not to be a sale of such
whole blood, plasma, blood products, blood derivatives, or
other human tissues."  Ala. Code 1975, § 7-2-314(4).   As this
Court held in American National Red Cross v. ASD Specialty
Healthcare, Inc., 888 So. 2d 464, 466 (Ala. 2003):  "Thus,
those 'furnishing,' 'distributing,' or 'procuring' blood
products provide a service, and that service does not
1061261
18
constitute a sale."  (Footnote omitted.)  Providing such a
service under a contract of employment supplies the requisite
direct involvement.  Here, PIC manufactures a product; it is
not employed to render a service.  As a manufacturer, it must
stand or fall on those cases applying the alternative
definition of "employ" as "to make use of" and the concomitant
requirement of establishing itself as an actor in an ensuing
chain of events set in motion by the physician.  Because it
has not offered such evidence, it cannot be deemed to fall
within the definition of "other health care provider" set
forth in § 6-5-481(8).  
Murdock, J., concurs.