Case Title: Collins v. Herring Chiropractic Center, LLC

Citation: 

Docket Number: 1151173

State: alabama

Court: Alabama Supreme Court

Date: 2017-02-17T00:00:00Z

Document:
Rel:02/17/2017
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, 2016-2017
____________________
1151173
____________________
Betty Collins
v.
Herring Chiropractic Center, LLC, and Ricardo Herring, D.C.
Appeal from Jefferson Circuit Court
(CV-14-902835)
BOLIN, Justice.
Betty Collins appeals from a summary judgment in favor of
Ricardo Herring, D.C., and Herring Chiropractic Center, LLC,
the defendants in her action seeking damages for alleged
medical malpractice.
1151173
Facts and Procedural History
The evidence, viewed, as we are required to do,  in a
light most favorable to Collins as the nonmovant shows the
following. Beginning in June 2012, Collins was being treated
by Dr. Herring for injuries to her knee, shoulder, and lower
back.  The treatment for her knee injury included applying a
"cold pack"  to her knee.  Collins received treatment from Dr.
1
Herring on several occasions during June 2012. 
On July 9, 2012, Collins sought treatment from Dr.
Herring for her knee injury.  During that appointment, Dr.
Herring's 
assistant 
retrieved 
a 
cold 
pack 
from 
the
refrigerator and placed it directly on Collins's knee.  On
Collins's previous appointments, the cold pack had been
sitting out on a table when she arrived and was later placed
on her knee.  Collins noticed that the cold pack applied on
July 9  was harder than the cold packs that had been applied
to her knee during previous appointments.   Collins's
appointment that day was in the morning, and the chiropractic
center had been closed the previous seven days. Collins felt
heat when the cold pack was removed from her knee; during her
Apparently, the cold packs were filled with gel or some
1
similar material.
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previous treatments her knee felt cold when the cold pack was
removed.  A few hours later, Collins developed blisters on her
knee where the cold pack had been.  Subsequently, scars
developed on Collins's knee where the cold pack had been.  
   On July 7, 2014, Collins sued the defendants alleging
medical malpractice arising out of the application of the cold
pack to her knee.  The defendants timely filed an answer. 
Subsequently, the defendants filed a motion for a summary
judgment.  They supported their summary-judgment motion with
an affidavit from Dr. Herring.  In the affidavit, Dr. Herring
stated in pertinent part:
"At all time when I provided care and treatment
to Ms. Collins I did so in keeping with the standard
of care that applied to me and to other similarly
situated chiropractors.
"....
"As a part of the care and treatment of Ms.
Collins a cold pack was used.  There were two types
that are used in my practice. ...  The manner and
method that these types of packs are used in my
office did not cause any injury and the area claimed
to have been affected by Ms. Collins exceeds the
area over which the cold pack would have been
place[d].  The use of a cold pack in the care and
treatment of Ms. Collins's condition is a recognized
and standard treatment by chiropractors.  It was not
a deviation from the appropriate standard of care to
use a cold pack.  
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"I provided appropriate chiropractic care and
treatment when treating Ms. Collins.  I did not fall
below the standard of care in providing care or
treatment to Ms. Collins in any respect.  I did not
cause any injury to Ms. Collins."
In their summary-judgment motion, the defendants argued
that Collins had not produced any evidence demonstrating that
Dr. Herring's treatment fell below the applicable standard of
care.  The defendants argued that Collins failed to present
testimony from a similarly situated expert witness because
Collins had not designated an expert witness as required under
the Alabama Medical Liability Act ("the AMLA"), § 6-5-480 et
seq. and § 6-5-540 et seq., Ala. Code 1975, to testify that
Dr. Herring breached his duty of care in treating Collins. 
They also argued that Dr. Herring's affidavit affirmed that he
did not breach the required standard of care in treating
Collins and that his treatment was not the cause of Collins's
injuries.  
In response to their motion, Collins argued that it was
not necessary for her to present expert testimony in
opposition to the summary-judgment motion because Collins's
claims fell within an exception to the AMLA, i.e., Collins's
claims could be readily understood by a layperson. 
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1151173
Collins further argued that her deposition testimony provided
substantial evidence of her claims and that it was up to a
jury to determine whether the application of the cold pack on
July 9, 2012, was the cause of her injuries.  
On June 24, 2016, the trial court entered a summary
judgment in favor of the defendants.  Collins timely filed an
appeal.  We reverse and remand.  
Standard of Review
"We review a summary judgment de novo. Potter v.
First Real Estate Co., 844 So. 2d 540, 545 (Ala.
2002)(citing American Liberty Ins. Co. v. AmSouth
Bank, 825 So. 2d 786 (Ala. 2002)). 
"'We apply the same standard of review the
trial court used in determining whether the
evidence presented to the trial court
created a genuine issue of material fact.
Once a party moving for a summary judgment
establishes that no genuine issue of
material fact exists, the burden shifts to
the 
nonmovant 
to 
present 
substantial
evidence creating a genuine issue of
material fact. "Substantial evidence" is
"evidence of such weight and quality that
fair-minded persons in the exercise of
impartial 
judgment 
can 
reasonably 
infer 
the
existence of the fact sought to be proved." 
844 So. 2d at 545 (quoting Nationwide Prop.
& Cas. Ins. Co. v. DPF Architects, P.C.,
792 So. 2d 369, 372 (Ala. 2000)) (citations
omitted).'
"Summary 
judgment 
is 
appropriate 
only 
when 
there
is no genuine issue of any material fact and the
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moving party is entitled to judgment as a matter of
law. Rule 56(c)(3), Ala. R. Civ. P."
Hooper v. Columbus Reg'l Healthcare Sys., Inc., 956 So. 2d
1135, 1139 (Ala. 2006).
Discussion
Collins argues that the trial court erred in entering a
summary judgment for the defendants on the basis that she had
not designated an expert witness.  Specifically, she contends
that expert testimony is not required in this case to
establish either the standard of care or the causal connection
between the defendants' acts and her injuries.  
"To maintain a medical-malpractice action, the
plaintiff ordinarily must present expert testimony
from a 'similarly situated health-care provider' as
to (1) 'the appropriate standard of care,' (2) a
'deviation from that standard [of care],' and (3) 'a
proximate 
causal 
connection 
between 
the
[defendant's] act or omission constituting the
breach and the injury sustained by the plaintiff.'
Pruitt v. Zeiger, 590 So. 2d 236, 238 (Ala.
1991)(quoting Bradford v. McGee, 534 So. 2d 1076,
1079 (Ala. 1988)). The reason for the rule that
proximate causation must be established through
expert testimony is that the issue of causation in
a medical-malpractice case is ordinarily 'beyond
"the ken of the average layman."'  Golden v. Stein,
670 So. 2d 904, 907 (Ala. 1995), quoting Charles W.
Gamble, McElroy's Alabama Evidence, § 127.01(5)(c),
p. 333 (4th ed. 1991). The plaintiff must prove
through 
expert 
testimony 
'that 
the 
alleged
negligence "probably caused the injury."'  McAfee v.
Baptist Med. Ctr., 641 So. 2d 265, 267 (Ala. 1994)."
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Lyons v. Walker Reg'l Med. Ctr., 791 So. 2d 937, 942 (Ala.
2000).  It is well settled that there is an exception to the
rule requiring expert testimony "'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.'"  Tuscaloosa Orthopedic Appliance Co. v.
Wyatt, 460 So. 2d 156, 161 (Ala. 1984)(quoting Dimoff v.
Maitre, 432 So. 2d 1225, 1226–27 (Ala. 1983)); see also
Anderson v. Alabama Reference Labs., 778 So. 2d  806 (Ala.
2000).  
The following situations have been recognized as
exceptions to the general rule that the plaintiff in a
medical-malpractice action must proffer independent expert
medical testimony:  
2
We note that it is not necessary for a plaintiff to
2
produce an independent 
expert 
to establish a requisite element
of a medical-malpractice claim where the testimony of the
defendant establishes that element. Timmerman v. Fitts, 514
So. 2d 907 (Ala. 1987); see also Ford v. Stringfellow Mem'l
Hosp., 39 So. 3d 184, 191 (Ala. Civ. App. 2009)("Even when
expert testimony is required to establish certain elements of
a plaintiff's medical-malpractice claim, the plaintiff need
not produce an independent expert witness to provide that
testimony; instead, the plaintiff may rely on the testimony of
the defendant to establish the elements of the claim for which
expert testimony is required.  See Timmerman, 514 So. 2d at
913; Wilson v. Manning, 880 So. 2d 1101, 1110-11 (Ala. 2003);
and Dansby v. Hagood, 719 So. 2d 839, 842 (Ala. Civ. App.
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"'(1) where a foreign instrumentality is found in
the plaintiff's body following surgery; 2) where the
injury complained of is in no way connected to the
condition for which the plaintiff sought treatment;
3) where the plaintiff employs a recognized standard
or authoritative medical text or treatise to prove
what is or is not proper practice; and 4) where the
plaintiff is himself or herself a medical expert
qualified 
to 
evaluate 
the 
doctor's 
allegedly
negligent conduct.'"
Allred v. Shirley, 598 So. 2d 1347, 1350  (Ala. 1992)(quoting
Holt v. Godsil, 447 So. 2d 191, 192–93 (Ala. 1984)(citations
omitted in Allred)); see also Anderson v. Alabama Reference
Labs., supra.  
In Ex parte HealthSouth Corp., 851 So. 2d 33 (Ala. 2002),
this Court explained that the list of exceptions in Allred to
the general rule requiring expert testimony was illustrative
and not exclusive.  The Court went on to explain that the
first two examples were related to those categories of cases
in which the lack of skill is so apparent as to be understood
by a layperson and required only common knowledge and
experience to understand it.  The Court noted that the third
and fourth examples set out in the list of exceptions had
nothing to do with evidence within the common knowledge of the
jury, because those exceptions to the rule requiring the
1998).").
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1151173
proffer of expert testimony are where an authoritative
treatise is offered or the plaintiff is a medical expert
qualified to evaluate the health-care provider's allegedly
negligent conduct.  
The HealthSouth Court went on to "reformulate" the
exceptions to the general rule requiring expert testimony in
medical-malpractice actions as follows:
"[T]o recognize first, a class of cases '"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,"'
[Tuscaloosa Orthopedic Appliance Co. v.] Wyatt, 460
So. 2d [156] at 161 [(Ala. 1984)](quoting Dimoff v.
Maitre, 432 So. 2d 1225, 1226–27 (Ala. 1983)), such
as when a sponge is left in, where, for example, the
wrong leg is operated on, or, as here, where a call
for assistance is completely ignored for an
unreasonable period of time. A second exception to
the rule requiring expert testimony applies when a
plaintiff relies on '"'a recognized standard or
authoritative medical text or treatise,'"' Anderson
[v. Alabama Reference Labs., 778 So. 2d [806] at 811
[(Ala. 2000)], or is himself or herself a qualified
medical expert."
851 So. 2d at 39.  The Court's reformulation of categories in
HealthSouth essentially clarifies the exceptions to the
general 
rule 
requiring 
expert 
testimony 
in 
medical-malpractice
actions by emphasizing in the first exception as  reformulated 
that there are situations where the lack of skill is so
9
1151173
apparent as to be understood by a layperson, thereby requiring
only common knowledge and experience to understand it, and
that further the list of examples of such situations was not
exhaustive but merely set out examples of 
possible 
situations. 
In the second exception as reformulated, the Court simply
combines the use of an authoritative treatise and the
plaintiff's own testimony as a medical expert as the second
exception to the general rule.
As stated earlier, we view the evidence at the summary-
judgment stage in a light most favorable to Collins as the
nonmovant for summary judgment.  Harris v. Health Care Auth.
of Huntsville, 6 So. 3d 468 (Ala. 2008). In the instant case,
Collins's knee was treated with a cold pack.  The evidence,
when viewed in a light most favorable to Collins, indicates
that the cold pack had been in the refrigerator for seven
days, that it had not been thawed when Collins arrived for her
appointment, and that it was hard on the day of her treatment
in contrast to her treatment on other visits.  Collins felt
heat when the cold pack was removed from her knee.  Collins
developed blisters on her knee following the treatment and
later scarring.  It was not necessary for Collins to present
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1151173
independent expert testimony where her medical-malpractice
case requires only common knowledge and experience to
understand what is akin to frostbite.  See, e.g., McGathey v.
Brookwood Health Servs., Inc., 143 So. 3d 95 (Ala.
2013)(expert 
testimony 
was 
not 
required 
in 
medical-malpractice
action to establish a breach of the standard of care by a
hospital employee in failing to ensure that a metal bar used
to keep the plaintiff's arm in place was sufficiently cool
following a 270-degree sterilization process before it was
attached to the plaintiff's arm); Walker v. Southeast Alabama
Med. Ctr., 545 So. 2d 769 (Ala. 1989)(holding that expert
testimony not necessary in medical-malpractice action where
plaintiff was injured when bed rail was left in the down
position contrary to doctor's orders); Therrell v. Fonde, 495
So. 2d 1046 (Ala. 1986)(holding that expert testimony was not
necessary 
to 
withstand 
summary 
judgment 
in 
medical-malpractice
action where the company refused to allow speedier transport
of the injured worker to the hospital and company doctor did
nothing to prevent the delay in transporting the worker and
did not look at the worker's hand, which had been crushed); 
Lloyd Noland Found., Inc. v. Harris, 295 Ala. 63, 322 So. 2d
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709 (1975)(holding that expert testimony was not necessary in
medical-malpractice action where plaintiff's leg was burned
after the application of hot plaster cast that had not been
properly cooled); and Ford v. Stringfellow Mem'l Hosp., 39 
So. 3d 184, 192-93 (Ala. Civ. App. 2009)(holding that patient
was not required to provide expert testimony on claims against
hospital because "[w]hether a hospital's employees are under
a duty to properly and sufficiently cool surgical equipment
and instruments before their use in surgery, whether the wrist
traction tower was not sufficiently cooled after it was
sterilized, and whether the heat from the wrist traction tower
caused a third-degree burn to Ford's upper arm are all matters
that can be easily understood and determined by the average
person without the aid of a medical expert. Simply put, the
present case fits within the 'class of cases "'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
at 39. See also Lloyd Noland Found., Inc. v. Harris, 295 Ala.
63, 66, 322 So. 2d 709, 711-12 (1975)(expert medical testimony
12
1151173
not necessary in case involving burn to leg of patient caused
by application of cast that had not been properly cooled).").
Collins further argues that it was also not necessary for
her to present expert testimony establishing the additional
issue of causation.  In Sorrell v. King, 946 So. 2d 854,
862–63 (Ala. 2006), this Court stated: 
"A plaintiff in a medical-malpractice action
must also present expert testimony establishing a
causal connection between the defendant's act or
omission constituting the alleged breach and the
injury suffered by the plaintiff. Pruitt v. Zeiger,
590 So. 2d 236, 238 (Ala. 1991). See also Bradley v.
Miller, 878 So. 2d 262, 266 (Ala. 2003); University
of Alabama Health Servs. Found., P.C. v. Bush, 638
So. 2d 794, 802 (Ala. 1994); and Bradford v. McGee,
534 So. 2d 1076, 1079 (Ala. 1988). To prove
causation 
in 
a 
medical-malpractice 
case, 
the
plaintiff must demonstrate '"that the alleged
negligence 
probably 
caused, 
rather 
than 
only
possibly caused, the plaintiff's injury."' Bradley,
878 So. 2d at 266 (quoting University of Alabama
Health Servs., 638 So. 2d at 802). See also DCH
Healthcare Auth. v. Duckworth, 883 So. 2d 1214, 1217
(Ala. 2003)('"There must be more than the mere
possibility that the negligence complained of caused
the injury; rather, there must be evidence that the
negligence 
complained 
of 
probably 
caused 
the
injury."' (quoting Parker v. Collins, 605 So. 2d
824, 826 (Ala. 1992))); and Pendarvis v. Pennington,
521 So. 2d 969, 970 (Ala. 1988)('"The rule in
medical malpractice cases is that to find liability,
there must be more than a mere possibility or one
possibility 
among 
others 
that 
the 
negligence
complained of caused the injury; there must be
evidence that the negligence probably caused the
injury."' (quoting Williams v. Bhoopathi, 474 So. 2d
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690, 691 (Ala. 1985), and citing Baker v. Chastain,
389 So. 2d 932 (Ala. 1980))). In Cain v. Howorth,
877 So. 2d 566 (Ala. 2003), this Court stated:
"'"'To present a jury question, the
plaintiff 
[in 
a 
medical-malpractice 
action]
must adduce some evidence indicating that
the alleged negligence (the breach of the
appropriate standard of care) probably
caused the injury. A mere possibility is
insufficient. The evidence produced by the
plaintiff 
must 
have 
"selective 
application"
to one theory of causation.'"'
"877 So. 2d at 576 (quoting Rivard v. University of
Alabama Health Servs. Found., P.C., 835 So. 2d 987,
988 (Ala. 2002)). However, the plaintiff in a
medical-malpractice case is not required to present
expert testimony to establish the element of
proximate causation in cases where 'the issue of
proximate cause is not ... "beyond the ken of the
average layman."' Golden v. Stein, 670 So. 2d 904,
908 (Ala. 1995). Therefore, '[u]nless "the cause and
effect relationship between the breach of the
standard of care and the subsequent complication or
injury is so readily understood that a layperson can
reliably 
determine 
the 
issue 
of 
causation,"
causation in a medical-malpractice case must be
established 
through 
expert 
testimony.' 
DCH
Healthcare Auth., 883 So. 2d at 1217–18 (quoting
Cain, 877 So. 2d at 576)."
In the instant case, the procuring and application of the
cold pack was within the exclusive control of the defendants,
and no evidence was presented indicating that Collins
contributed to her injuries.  Blistering and subsequent
scarring does not ordinarily occur following the application
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of a cold pack, absent negligence. The causative relationship
between Collins's injury and the defendants' acts are such
that it can be readily understood, to the extent that a
layperson can reliably determine the issue of causation
without independent expert testimony to assist in that
determination.  
Based on the foregoing, we reverse the summary judgment
in favor of the defendants, and we remand the case for further
proceedings consistent with this opinion.  
REVERSED AND REMANDED.
Stuart, Parker, Murdock, Shaw, Main, and Wise, JJ.,
concur.
Bryan, J., concurs in the result.
15