Case Title: Diane Bibb v. Center for Pain of Montgomery, P.C.

Citation: 

Docket Number: 1061711

State: alabama

Court: Alabama Supreme Court

Date: 2009-05-15T00:00:00Z

Document:
REL: 05/15/2009
Notice: This opinion is subject to formal revision before publication in the advance
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SUPREME COURT OF ALABAMA
OCTOBER TERM, 2008-2009
____________________
1061711
____________________
Diane Bibb
v.
Center for Pain of Montgomery, P.C.
Appeal from Montgomery Circuit Court
(CV-06-613)
MURDOCK, Justice.
Diane Bibb appeals from a summary judgment entered by the
Montgomery Circuit Court in favor of the Center for Pain of
Montgomery, P.C. ("the Center"), on Bibb's claim alleging
medical negligence.  We affirm the trial court's judgment.
1061711
Bibb amended her complaint 
on 
August 17, 2006, to include
1
an allegation that Dr. Katz performed the CESI on behalf of
the Center, but she never named Dr. Katz as an individual
defendant.
2
I.  Facts and Procedural History
Bibb alleged in her complaint that she was injured on
March 5, 2004, when Dr. Bradley Katz, a board-certified
anesthesiologist employed by the Center, administered a
cervical epidural steroid injection ("CESI") to her.  Bibb
states that the CESI, which is injected into the neck, was
intended to relieve her neck pain.  Bibb alleges that at some
point after the injection she lost the use of her left hand
and has never regained the use of that hand.  
Bibb filed an action alleging medical negligence against
the Center under the Alabama Medical Liability Act, § 6-5-480
et seq. and § 6-5-540 et seq., Ala. Code 1975 ("the AEMLD"),
on March 3, 2006.   The Center filed a motion for a summary
1
judgment on July 10, 2007.  In support of the motion, the
Center submitted an affidavit from Dr. Katz in which he
testified to his expertise in the medical specialty of
anesthesiology and explained that at all times during his
treatment of Bibb he met or exceeded the standard of care to
1061711
3
which other board-certified anesthesiologists would have been
held in a similar case.
Bibb filed a response in opposition to the Center's
summary-judgment motion on July 24, 2007.  Bibb relied solely
on the doctrine of res ipsa loquitur to establish that the
Center breached the applicable standard of care.  In support
of her response, Bibb filed her own affidavit, in which she
stated that it was "apparent" that the loss of the use of her
left hand is "in an area remote from where [she] was being
treated."  She averred that "[t]his type of injury does not
occur in the absence of someone's negligence and the injury
occurred while [Dr. Katz] was in the exclusive control of
[her] person while undergoing an injection for neck pain."  
After a hearing, the trial court granted the Center's
motion for a summary judgment; it did not provide its
rationale for doing so.  Bibb appeals.
II.  Analysis
"In order for a plaintiff alleging medical
malpractice to rebut a defendant's prima facie
showing, the plaintiff must produce substantial
evidence establishing '(1) that the defendant
breached the standard of care and (2) that this
breach proximately caused the 
plaintiff's 
injuries.'
Williams v. Spring Hill Memorial Hosp., 646 So. 2d
1373, 1375 (Ala. 1994).  'Ordinarily, the plaintiff
1061711
4
is required to prove these elements through expert
testimony.'  Levesque v. Regional Medical Center
Bd., 612 So. 2d 445, 448 (Ala. 1993)."
Golden v. Stein, 670 So. 2d 904, 906-07 (Ala. 1995) (footnote
omitted).
Bibb admits that she did not submit any expert testimony.
She argues, however, that the circumstances of her case fall
into an exception to the general requirement of expert
testimony in a medical-malpractice action, i.e., the doctrine
of res ipsa loquitur. 
In discussing the general rule that requires expert
testimony in a medical-malpractice action, this Court has
held:  "A narrow exception to this rule exists '"in a case
where want of skill or lack of care is so apparent ... as to
be understood by a layman, and requires only common knowledge
and experience to understand it."'"  Ex parte HealthSouth
Corp., 851 So. 2d 33, 38 (Ala. 2002) (quoting Tuscaloosa
Orthopedic Appliance Co. v. Wyatt, 460 So. 2d 156, 161 (Ala.
1984), quoting in turn Dimoff v. Maitre, 432 So. 2d 1225,
1226-27 (Ala. 1983), quoting in turn Lloyd Noland Found., Inc.
v. Harris, 295 Ala. 63, 66, 322 So. 2d 709, 711 (1975)).
"This exception has usually been applied under circumstances
1061711
5
where the doctrine of res ipsa loquitur is applicable, or
where the injury complained of is in no way connected to the
condition for which the plaintiff sought treatment."  Bell v.
Hart, 516 So. 2d 562, 566 (Ala. 1987) (citations omitted).  
Bibb contends that the doctrine of res ipsa loquitur
applies in her case because, she says, the loss of the use of
her left hand is allegedly "in no way connected to" the
treatment of her neck pain.  Therefore, she asserts, it
requires no special knowledge to conclude that Dr. Katz was
negligent in administering the CESI.  This argument is without
merit.  This Court has stated that the exception refers to
"such cases 'as an injury to an arm and shoulder during an
operation for appendicitis, or an injury to an eye during the
same type of operation.'"  Anderson v. Alabama Reference
Labs., 778 So. 2d 806, 811 (Ala. 2000) (quoting Powell v.
Mullins, 479 So. 2d 1119, 1121 (Ala. 1985) (citations and
quotation marks omitted in Anderson)).  Those situations do
not describe the facts in Bibb's case because it is indeed
conceivable that a person could lose feeling in an extremity
as a result of an injection near the spinal cord.  
1061711
6
Bibb's allegation plainly calls into question the manner
in which Dr. Katz performed the CESI and the effect a CESI
could have upon Bibb's neurological condition.  The need for
expert testimony "is 
dependent upon 
whether 
the 
average person
is able to decide without expert testimony whether or not the
procedure followed in any given case falls below the
acceptable standard."  Tuscaloosa Orthopedic Appliance Co.,
460 So. 2d at 161.  The standard of care for administering a
CESI and the risks, if any, associated with administering a
CESI in accordance with that standard of care are not subjects
within 
the 
knowledge 
of 
the 
average 
person. 
 
The
administration of the CESI involves "specialized training and
knowledge that puts an understanding of the acceptable
standard of care ... beyond the common knowledge of the jury.
Laymen do not have the background and knowledge without expert
testimony to understand whether or not [the CESI] has been
properly [administered]."  Tuscaloosa Orthopedic Appliance
Co., 460 So. 2d at 162.
Bibb needed to present expert testimony as substantial
evidence of the breach of the standard of care and causation
of the injury to her left hand in order to rebut the Center's
1061711
7
properly supported summary-judgment motion.  Because Bibb did
not present such evidence, the trial court correctly granted
the Center's motion for a summary judgment.
AFFIRMED.
Cobb, C.J., and Lyons, Woodall, Stuart, Smith, Bolin, and
Parker, JJ., concur.