Title: Wells v. Storey

State: alabama

Issuer: Alabama Supreme Court

Document:

792 So. 2d 1034 (1999)
Teresa Gail WELLS
v.
Dr. Robert STOREY et al.
1970450.

Supreme Court of Alabama.
November 24, 1999.
*1035 James C. Alison, Huntsville; and J. Allen Brinkley of Brinkley & Chesnut, Huntsville, for appellant.
Robert L. Williams of Spain & Gillon, L.L.C., Birmingham, for appellees Health Care Authority of the City of Huntsville, Alabama d/b/a Huntsville Hospital, Dr. Robert Storey, and Dr. Timothy Corbin.
James E. Davis, Jr., and Jeffrey T. Kelly of Lanier Ford Shaver & Payne, P.C., Huntsville, for appellees Huntsville Hospital, Donna Freedman Groce, and Sharon Arnold.
Michael A. Florie and Joseph S. Miller of Starnes & Atchison, L.L.P., Birmingham, for appellee Dr. Jess Power.
Dorothy A. Powell and Mark W. Lee of Parsons, Lee & Juliano, P.C., Birmingham, for amici curiae Alabama Hospital Ass'n Trust and Alabama Hospital Ass'n.
BROWN, Justice.
Teresa Gail Wells, the plaintiff in a medical-malpractice action, appeals from a summary judgment entered in favor of Drs. Robert Storey and Timothy Corbin; Huntsville Hospital; and nurses Donna Freedman Groce and Sharon Arnold; and she also appeals from a partial summary judgment entered in favor of Dr. Jess Power. We affirm.
On September 19, 1994, Wells was admitted to Huntsville Hospital. Wells contends that she was admitted for the induction of labor, while the defendants here on appeal assert that Wells was in the early stages of labor. Wells's prenatal care had been managed by the Family Practice Department of the University of Alabama in Huntsville ("UAH"). Wells was admitted by Donna Groce, a nurse employed by Huntsville Hospital. Nurse Groce obtained Wells's signature on an "Authorization for Procedure" form. At approximately 6:00 a.m. on September 20, 1994, Dr. Corbin, a resident physician employed by the UAH family-practice program, determined that Wells was in active labor, and he sent her to the delivery room. Nurse Arnold, the labor and delivery nurse who initially assisted Dr. Corbin, telephoned Dr. Power, the hospital's on-duty anesthesiologist, and reported to him that Wells was requesting an epidural anesthetic for labor pain.[1] Dr. Power then administered the epidural anesthetic to Wells. After administering the epidural, Dr. Power rotated off call and left the hospital. He did not see Wells as a patient again.
Nurse Arnold and Dr. Corbin, with the help of Dr. Storey, an attending physician employed by the UAH family-practice program, delivered Wells's child, her third, a healthy baby boy. After doing a post-delivery checkup, which included an examination *1036 of the spinal region where the epidural anesthetic had been inserted, Dr. Corbin discharged Wells from the hospital on the afternoon of September 22, 1994.
Wells returned to the hospital in an ambulance on September 23, 1994. She complained of back pain and pain in her right leg with numbness and tingling, and she had a fever of 99.8 degrees. The emergency-room physician noted that she was three days postpartum, that an epidural had been administered, and that she had a history of lumbar-disc rupture. The emergency room diagnosis was "lumbar radiculapathy; s/p epidural block; and morbid obesity." Wells was discharged without treatment. The discharge instructions were bed rest, gentle heat, and weight loss.
On September 26, 1994, Wells again returned to the hospital by ambulance, complaining of severe back pain and paralysis. Dr. Joel Pickett, a neurologist, examined Wells. He found and drained an epidural abscess from the lumbar area of the spinal cord.[2] Wells suffered irrevocable nerve damage from the abscess, and the result was permanent paralysis from the waist down.
Thereafter, Wells filed a medical-malpractice action against the aforementioned hospital, physicians, and nurses. Wells alleged that her physicians had violated the medical standard of care each owed to her as a patient. She also alleged that, aside from the physicians' duty to obtain her informed consent to the epidural procedure, the hospital and the two nurses also had had a duty to obtain her informed consent and that those defendants had breached that duty.
Each defendant moved for a summary judgment. Following a hearing, the trial court entered three summary judgments: (1) for the hospital and the nurses, on the ground that they had had no independent duty to obtain informed consent from Wells before she underwent a medical procedure; (2) for Drs. Storey and Corbin on the grounds that they were immune from suit, on the basis that at the time of the actions made the basis of Wells's claims they were employees of the UAH Family Practice Residency Program and were engaging in discretionary functions; and (3) for Dr. Power on all claims other than the claim regarding his alleged failure to obtain informed consent. Each of the three summary judgments was certified as final, pursuant to Rule 54(b), Ala.R.Civ.P.
Wells contends that the trial court erred in entering the summary judgment in favor of Huntsville Hospital and nurses Groce and Arnold against her claim that they had breached the appropriate standard of care by failing to obtain her informed consent.
Our review of a summary judgment is de novo.
Hobson v. American Cast Iron Pipe Co., 690 So. 2d 341, 344 (Ala.1997).
Wells's admitting nurse was Donna Groce. As part of the admission process, Groce obtained Wells's signature on a form entitled "Huntsville Hospital Authorization for Procedure." This form stated, in pertinent part:
(Groce deposition, plaintiff's exhibit 1.)
During her deposition, Groce testified that the phrases "Vaginal Delivery" and "Epidural Anesthesia" were stamped onto the form before Wells signed it. Wells, however, disputed Groce's testimony, claiming that there was nothing stamped on the form when she signed it. Wells also testified that neither Nurse Groce nor Nurse Arnold, who assisted with the delivery, explained to Wells the risks associated with epidural anesthesia. Wells argues that this Court should create an independent duty that would require a hospital and its nurses to obtain informed consent from a patient for a medical procedure before a physician performs the procedure. We disagree.
Section 6-5-484, Ala.Code 1975, sets out the standard of care owed to a patient:
In Fain v. Smith, 479 So. 2d 1150, 1152 (Ala.1985), this Court recognized a duty on the part of a physician to inform his patient of all material risks associated with a medical procedure, noting that a physician may be held liable if he negligently performs that duty. This Court stated, "We *1038 think the legislature has adopted the traditional view that the doctor's duty to get the informed consent of the patient must be measured by a professional medical standard." Id.
Although the question whether nurses and hospitals have an independent duty to obtain the informed consent of a patient is a question of first impression in this state, approximately one-half of the states have addressed this issue. In those states, the courts have uniformly held that the duty to obtain a patient's informed consent rests solely with the patient's physician, rather than with a hospital or its nurses (unless, because of special circumstances, the physician is an agent for the hospital). Krane v. Saint Anthony Hosp. Systems, 738 P.2d 75, 77 (Colo.App.1987); Petriello v. Kalman, 215 Conn. 377, 576 A.2d 474, 477 (1990); Valcin v. Public Health Trust of Dade County, 473 So. 2d 1297, 1307 (Fla. Dist.Ct.App.1984), rev'd in part on other grounds, 507 So. 2d 596 (Fla.1987); Parr v. Palmyra Park Hosp., Inc., 139 Ga.App. 457, 228 S.E.2d 596, 598 (1976); Winters v. Podzamsky, 252 Ill.App.3d 821, 190 Ill. Dec. 203, 621 N.E.2d 72, 75 (1993); Auler v. Van Natta, 686 N.E.2d 172, 175 (Ind.Ct. App.1997); Pauscher v. Iowa Methodist Medical Center, 408 N.W.2d 355, 362 (Iowa 1987); Kelley v. Kitahama, 675 So. 2d 1181, 1183 (La.Ct.App.1996); Lincoln v. Gupta, 142 Mich.App. 615, 370 N.W.2d 312, 318 (1985); Ackerman v. Lerwick, 676 S.W.2d 318, 320-21 (Mo.Ct.App. 1984); Giese v. Stice, 252 Neb. 913, 567 N.W.2d 156, 164 (1997); Baird v. American Medical Optics, 301 N.J.Super. 7, 693 A.2d 904 (1997); Johnson v. Sears, Roebuck & Co., 113 N.M. 736, 832 P.2d 797 (1992); Nisenholtz v. Mount Sinai Hosp., 126 Misc.2d 658, 483 N.Y.S.2d 568 (Sup.Ct. 1984); Cox v. Haworth, 54 N.C.App. 328, 283 S.E.2d 392, 395-96 (1981); Kershaw v. Reichert, 445 N.W.2d 16, 17-18 (N.D.1989); Goss v. Oklahoma Blood Inst., 856 P.2d 998, 1007 (Okla.Ct.App.1990); Kelly v. Methodist Hosp., 444 Pa.Super. 427, 664 A.2d 148, 150-51 (1995); Boney v. Mother Frances Hosp., 880 S.W.2d 140, 143 (Tex. Ct.App.1994); Howell v. Spokane & Inland Empire Blood Bank, 114 Wash. 2d 42, 785 P.2d 815, 822 (1990); Cross v. Trapp, 170 W.Va. 459, 294 S.E.2d 446, 458-59 (1982); Mathias v. St. Catherine's Hosp., Inc., 212 Wis.2d 540, 569 N.W.2d 330, 333 (Ct.App.1997).
The rationale behind the uniformly held rule is explained by the New Mexico Court of Appeals in Johnson v. Sears, Roebuck & Co.:
113 N.M. at 738, 832 P.2d  at 799.
Further reasoning can be found in the Colorado Court of Appeals' opinion in Krane v. Saint Anthony Hospital Systems:
738 P.2d  at 77.
As this Court stated in Fain v. Smith, 479 So. 2d  at 1152, the Alabama Legislature has adopted the traditional view that it is the doctor's duty to obtain the informed consent of the patient. Thus, we decline to create an independent duty that requires hospitals and nurses to likewise obtain informed consent from a patient. Accordingly, the summary judgment in favor of Huntsville Hospital and Groce and Arnold is affirmed insofar as it relates to Wells's claim that they had a duty to obtain her informed consent.
Wells next contends that the trial court erred when it entered the partial summary judgment in favor of Dr. Jess Power. Specifically, she argues that the summary judgment was improper insofar as it related to her claim that Dr. Power breached a duty to provide follow-up care. She argues that the appropriate standard of care requires a post-anesthesia follow-up by the anesthesiologist who performed the procedure.[3]
Entering the summary judgment for Dr. Power, the trial judge stated, in pertinent part:
(C. 780-82.)
On a motion for summary judgment, the burden is on the moving party to make a prima facie showing that there is no genuine issue of material fact to be considered by the jury. When the moving party has made this prima facie showing, the burden shifts to the nonmovant to present substantial evidence creating a genuine issue of material fact. Leonard v. Providence Hosp., 590 So. 2d 906, 907 (Ala. 1991). "[S]ubstantial 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." West v. *1041 Founders Life Assurance Co. of Florida, 547 So. 2d 870, 871 (Ala.1989). See § 6-5-542(5), Ala.Code 1975; Gonzalez v. Blue Cross/Blue Shield of Alabama, 689 So. 2d 812, 816 (Ala.1997). Moreover, to defeat a properly supported motion for a summary judgment on a medical-malpractice claim, the nonmovant ordinarily must present testimony from a "similarly situated" medical expert. Levesque v. Regional Medical Ctr., 612 So. 2d 445, 449 (Ala.1993).
Dr. Power was a board-certified anesthesiologist. Wells's "similarly situated" medical expert was Dr. Peter Gloersen, also a board-certified anesthesiologist. However, Dr. Gloersen's deposition testimony supported Dr. Power's contention that he had no duty to personally perform a follow-up on Wells after administering the epidural anesthetic, so long as a follow-up was performed by someone else. Dr. Gloersen testified:
(Gloersen deposition, pp. 129-30.)
Wells offered no expert testimony indicating that Dr. Power breached the applicable standard of care regarding follow-up treatment. Such testimony was required by § 6-5-484, Ala.Code 1975. Because there was no genuine issue as to any material fact, the trial court properly entered the partial summary judgment in favor of Dr. Power on the claim that he provided negligent follow-up care.
Wells further contends that the trial court erred in holding that Drs. Corbin and Storey, as employees of the UAH Family Practice Residency Program, were immune from suit because it found that at the time of the actions Wells complains of they were engaged in discretionary functions. Specifically, Wells argues that Drs. Corbin and Storey were not entitled to "discretionary-function immunity" because, she says, they had a nondiscretionary duty *1042 to obtain her informed consent before she was administered an epidural anesthetic.
Despite this Court's well-established precedent concerning the doctrine of discretionary-function immunity, Wells asks this Court to overrule its decisions in Harper v. Gremmel, 703 So. 2d 346 (Ala.1997);[4]Smith v. King, 615 So. 2d 69 (Ala.1993); Smith v. Arnold, 564 So. 2d 873 (Ala.1990); and Barnes v. Dale, 530 So. 2d 770 (Ala. 1988), and to distinguish the discretionary-function immunity enjoyed by State-employed physicians from the immunity enjoyed by other State employees. Based on the facts of this case, Wells argues, Drs. Corbin and Storey should not have immunity from her lawsuit. She maintains that the duty owed her by Drs. Corbin and Storey was one of due care. Citing Phillips v. Thomas, 555 So. 2d 81 (Ala.1989), she argues that the duty to obtain her informed consent "was not [a duty] requiring difficult decision-making like the duty accompanying a discretionary public function." In Ex parte Cranman, [Ms. 1971903, November 24, 1999],[*] released today, this Court considered whether to abandon long-established precedent and to divest State-employed physicians of discretionary-function immunity. In Cranman, the Court traced the history of discretionary-function immunity in Alabama and analyzed the constitutional implications of our prior caselaw, before stating:
392 So. 2d  at 415. Based on these standards, this Court concluded that the defendant physicians were entitled to state-agent's immunity. Id.
In accordance with the standards announced in Ex parte Cranman, Drs. Corbin and Storey are entitled to state-agent's immunity. Drs. Corbin and Storey were treating Wells as a patient of the UAH Family Practice Clinic, the employer of both physicians. Dr. Corbin, a family-practice resident physician, was under the supervision of Dr. Storey, a UAH family-practice attending physician. Given the facts of this case, we conclude that Drs. Corbin and Storey were not servants of Huntsville Hospital, but, rather, were acting in a manner consistent with their job responsibilities as employees of the UAH Family Practice Residency Program.
Alabama has elected to educate physicians by funding state medical schools. Certainly, this State has an interest in training and educating physicians to care for its citizens. Moreover, as we noted in Cranman, "the Legislature has conferred broad powers on the University of Alabama to take steps `necessary to or promotive of the ends of its creation.' § 16-47-2, Ala.Code 1975." As employees of the UAH Family Practice Residency Program, Drs. Corbin and Storey were participating in one aspect of the State's medical-training program. Their conduct consisted of making decisions concerning the proper medical treatment for a patient in active labor who was requesting relief from the pain associated with childbirth.
In accordance with subparagraph (6) of the standards enumerated in Cranman, 792 So. 2d  at 414, we conclude that Drs. Storey and Corbin are entitled to state-agent's immunity. Our decision is in accordance with previous decisions where we have held that State-employed physicians making health-care determinations were engaged in "discretionary functions." See, e.g., Smith v. Arnold, 564 So. 2d  at 876. But, as we stated in Cranman, "that factor alone is not determinative." 392 So. 2d  at 414. Here, the balancing analysis weighs in favor of immunity by this State's decision to educate physicians and to fund medical schools and the legislative authority for the University of Alabama to engage in *1044 such activities. When State-employed physicians provide health-care services for the citizens of Alabama, they perform a public service. As we noted in Cranman:
792 So. 2d  at 416-17.
Based on the authority of Ex parte Cranman, the summary judgment in favor of Drs. Corbin and Storey is affirmed.
AFFIRMED.
HOUSTON, SEE, and LYONS, JJ., concur.
MADDOX, J., concurs specially.
JOHNSTONE, J., concurs in part and concurs in the result in part.
HOOPER, C.J., and COOK, J., concur in part and dissent in part.
MADDOX, Justice (concurring specially).
My views regarding this case are fully expressed in my special concurrence in Ex parte Cranman, [Ms. 1971903, November 24, 1999].[**]
JOHNSTONE, Justice (concurring in part and concurring in the result in part).
I concur in Part I (duty to obtain informed consent) and in Part II (anesthesiologist's duty of follow-up care). I concur in the result in Part III (qualified immunity), in accordance with my analysis in the main opinion in Ex parte Rizk, [Ms. 1970493, November 24, 1999].[***]
COOK, Justice (concurring in part and dissenting in part).
I concur as to Parts I and II. However, as to Part III, which discusses discretionary-function immunity, I respectfully dissent, for the same reasons I expressed in Ex parte Cranman, [Ms. 1971903, November 24, 1999](Cook, J., dissenting).[****]
HOOPER, C.J., concurs.
[1]  Wells denied making such a request, and disputed the content and circumstances surrounding her conversation with Arnold and Dr. Power. Wells alleged that Dr. Power failed to obtain her informed consent to the epidural procedure, and she sought damages for that alleged failure. The fact that Wells denies requesting the epidural is related to that claim. That claim is the only one of the plaintiff's claims not disposed of by the summary judgment here on appeal.
[2]  Dr. Pickett testified that hemorrhage from placement of the catheter for the epidural anesthetic was the most likely cause of the abscess.
[3]  Although Dr. Power's summary judgment related to all of Wells's claims against Dr. Power except her claim that he failed to obtain her informed consent, the only contention Wells makes on appeal, as to Dr. Power, is that the trial court erred in entering the summary judgment against her claim that he breached the standard of care with respect to a follow-up visit. Thus, it is unnecessary to discuss the remaining claims on which the summary judgment was entered.
[4]  In Harper, the majority affirmed the judgment of the trial court, without an opinion; however, in dissent, Justice Cook addressed the issue whether the defendant, a State-employed physician, was entitled to a summary judgment under the doctrine of discretionary-function immunity. Although the decision in Harper has no precedential value, see Rule 53(d), Ala.R.App.P., we note it because of Justice Cook's dissent in that case. In that dissent, he stated that the defendant Dr. Gremmel was not entitled to a summary judgment because, Justice Cook said, he was a "loaned servant" of the private hospital where he treated the plaintiff Harper. 703 So. 2d  at 347.
[*]  Note from the reporter of decisions: Wells v. Storey and Ex parte Cranman were both decided by opinions issued on November 24, 1999. The main opinion in Wells v. Storey and the special writings cite Cranman several times. Rehearing applications were filed in both cases. The rehearing application in Wells was withdrawn on January 15, 2000; the rehearing application in Cranman remained pending until June 16, 2000. On that date, the Supreme Court granted the application, withdrew the November 24, 1999, opinion, and substituted a new opinion. The November 24, 1999, opinion carried the judgment line "AFFIRMED." The opinion substituted on June 16, 2000, was very different; it carried the judgment line "[REHEARING] APPLICATION GRANTED; OPINION OF NOVEMBER 24, 1999, WITHDRAWN; OPINION SUBSTITUTED; REVERSED AND REMANDED."

The quotation from Cranman that appears later in this paragraph beginning "We today review, refine, and restate ..." does not appear in the June 16, 2000, Cranman opinion. Likewise, other statements quoted in Wells from Cranman may not appear in the substituted Cranman opinion of June 16, 2000.
A second application for rehearing in Cranman was denied on November 22, 2000. The opinion in Ex parte Cranman is published at 792 So. 2d 392.
[**]  Note from the reporter of decisions: The Supreme Court, on June 16, 2000, on application for rehearing, withdrew the November 24, 1999, opinion in Cranman and substituted another opinion, with a different result.
[***]  Note from the reporter of decisions: The Supreme Court, on June 30, 2000, on application for rehearing, withdrew the November 24, 1999, opinion in Rizk and substituted a new opinion, with a different result.
[****]  Note from the reporter of decisions: The Supreme Court, on June 16, 2000, withdrew the November 24, 1999, opinion in Cranman and substituted another opinion, with a different result. As to the opinion of June 16, 2000, Justice Cook concurred in the judgment and concurred in part in the opinion.