Title: Ex parte Huntsville Emergency Medical Services, Inc., et al.

State: alabama

Issuer: Alabama Supreme Court

Document:

Rel: September 9, 2022 
 
 
 
 
 
 
 
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) 229-0650), 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 
 
SPECIAL TERM, 2022 
 
_________________________ 
 
1210129 
_________________________ 
 
Ex parte Huntsville Emergency Medical Services, Inc., Jacob 
Steele, Dea Calce, Calvin Hui, and Christopher Nunley 
 
  PETITION FOR WRIT OF MANDAMUS 
 
(In re: Gloria Owen, as personal representative of the Estate of 
Robert Owen, deceased  
 
v.  
 
Huntsville Emergency Medical Services, Inc., et al.)  
 
 (Limestone Circuit Court: CV-20-900156) 
 
 
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2 
 
PER CURIAM. 
 
Robert Owen died 11 days after being transferred from Huntsville 
Hospital to the University of Alabama at Birmingham Hospital ("UAB 
Hospital") for cardiac treatment.  His widow Gloria Owen, as the personal 
representative of his estate, sued the ambulance company that had 
transported him, Huntsville Emergency Medical Services, Inc. 
("HEMSI"), as well as HEMSI employees Jacob Steele, Calvin Hui, 
Christopher Nunley, and Dea Calce (HEMSI and its employees are 
collectively referred to as "the HEMSI defendants"), alleging that events 
that occurred during Robert's transport had "caused him unnecessary 
stress, worry, concern, anxiety, and/or a delay in treatment," leading to 
further heart damage and his eventual death. 
During discovery, Gloria sought information from the HEMSI 
defendants about the previous conduct and employment record of Steele, 
a licensed emergency medical technician ("EMT") and the assigned driver 
of the HEMSI ambulance that transported Robert.  The HEMSI 
defendants objected to Gloria's requests and sought a protective order, 
arguing that the Alabama Medical Liability Act ("the AMLA"), § 6-5-480 
et seq. and § 6-5-540 et seq., Ala. Code 1975, governed her claims and 
1210129 
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prohibited discovery related to any acts and omissions of a defendant that 
were not specifically described in the complaint.  The Limestone Circuit 
Court rejected the HEMSI defendants' request for a protective order and 
directed them to produce the requested discovery; they now petition this 
Court for mandamus relief, specifically a writ directing the trial court to 
amend its order to give effect to what they assert are the applicable 
privilege and discovery protections of the AMLA.  We grant the petition 
in part and deny it in part. 
Facts and Procedural History 
 
In April 2019, Robert sought treatment at Huntsville Hospital for 
chest pain and fatigue.  After preliminary tests, Robert's physicians 
concluded that he should be transferred to UAB Hospital for further 
evaluation and treatment.  Because Robert was considered a high-risk 
cardiac patient, Huntsville Hospital contacted HEMSI and ordered an 
advanced-life-support ambulance for the transfer.  In response, HEMSI 
dispatched an ambulance driven by Steele and staffed by Calvin Hui, a 
licensed paramedic tasked with monitoring Robert throughout the trip to 
Birmingham. 
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Steele began either falling asleep or passing out before the 
ambulance even left Huntsville Hospital.  Once on the road, Steele 
struggled to stay awake, and the ambulance repeatedly left its lane and 
had to swerve to avoid striking other vehicles.  Finally, after missing the 
interstate exit leading to Birmingham, Steele pulled over and informed 
Hui that he could not continue driving.  When Hui contacted his 
supervisor Christopher Nunley to apprise him of the situation, Nunley 
directed Hui and Steele to switch places.  The ambulance then proceeded 
toward Birmingham with Hui driving and Steele in the back with Robert.  
But instead of monitoring Robert, Steele put on headphones and began 
watching videos before falling asleep. 
 
At some point during the drive, Robert's chest pain increased and 
he began to call for help.  Steele did not wake up.  Eventually, Hui heard 
Robert's cries and stopped the ambulance on the side of the road.  
Although Hui had a hard time finding the nitroglycerin that Robert 
needed, he eventually located and administered the medication and 
resumed the trip.  Steele remained asleep throughout this episode. 
 
When the ambulance finally arrived in Birmingham, Hui could not 
find UAB Hospital.  After about 15 minutes of searching, Hui finally 
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located the hospital's entrance and completed the transport.  Once 
admitted, Robert complained to his family about the trip and the anxiety 
it had caused him.  His daughter spoke with HEMSI employee Dea Calce 
about the transport and says that he acknowledged to her that Steele had 
been involved in other problematic incidents while working for HEMSI. 
Robert died while still a patient at UAB Hospital.  Following his 
death, Gloria initiated this action alleging that Steele had been using 
drugs the night before and the morning of Robert's transport; that Hui, 
Nunley, and Calce were aware of Steele's drug use and emotional 
problems and knew that he was unfit to drive an ambulance; and that 
the events that occurred during Robert's transport had proximately 
caused his death.  Gloria specifically asserted five counts against the 
HEMSI defendants:  (1) a common-law wantonness claim, (2) a common-
law negligence claim, (3) a "common carrier" negligence claim,1 (4) a 
wantonness claim under the AMLA, and (5) a negligence claim under the 
AMLA.  In short, the first three counts ("the driving claims") made 
allegations about Steele's reckless driving and HEMSI's wrongful hiring, 
 
1See generally Connell v. Call-A-Cab, Inc., 937 So. 2d 71 (Ala. 2006) 
(recognizing the heightened duty of care that a common carrier owes its 
passengers). 
1210129 
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training, supervision, and retention of him as a driver, and its wrongful 
entrustment of the ambulance to him, while the latter two counts ("the 
medical claims") alleged that the HEMSI defendants had breached the 
relevant standard of care in providing medical services to Robert.  Gloria 
acknowledged that the medical claims were governed by the AMLA but 
took the position that the driving claims were not.  The HEMSI 
defendants argued that Gloria's claims were in substance all medical-
malpractice claims subject to the AMLA and repeatedly asked the trial 
court to dismiss the driving claims on that basis.  In April 2021, the court 
denied those requests.   
After Gloria served discovery requests seeking information about 
Steele's past conduct and employment record, the HEMSI defendants 
objected and moved for a protective order.  The HEMSI defendants again 
invoked the AMLA -- repeating their assertion that it governed all of 
Gloria's claims regardless of how she had denominated them -- and 
arguing that § 6-5-551 of the AMLA expressly bars plaintiffs in medical-
malpractice cases from conducting discovery regarding any act or 
omission "alleged … to render the health care provider liable" that is not 
specifically described in the complaint.  § 6-5-551, Ala. Code 1975 
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(explaining that a complaint alleging medical malpractice must include 
"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 plaintiff "shall be prohibited from conducting discovery with 
regard to any other act or omission").  Thus, the HEMSI defendants 
argued, Gloria was prohibited from using the discovery process to obtain 
information about Steele's past conduct and employment record that was 
unrelated to the transport of Robert.2 
 
 In October 2021, the trial court denied the HEMSI defendants' 
request for a protective order, holding that Gloria was "entitled to 
conduct discovery about prior conduct of Steele, HEMSI's knowledge of 
the same, and any reprimands, disciplinary or corrective actions 
involving Steele."  The court specifically explained that the information 
Gloria sought was relevant because she had "asserted theories of 
negligent and wanton hiring, training, supervising, retention, and 
entrustment, and she has alleged HEMSI and its employees had actual 
or constructive knowledge that Steele had an uncontrolled drug and/or 
 
2The HEMSI defendants also filed and served privilege logs 
identifying the information they had withheld as privileged. 
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alcohol abuse problem, but allowed him to drive an ambulance anyway."  
Additionally, the court again rejected the HEMSI defendants' argument 
that the driving claims were subject to the AMLA because, the court said, 
those claims "concern[ed] Steele's basic fitness as a driver of a motor 
vehicle" and did not relate to the provision of medical services.  Thus, the 
trial court concluded, "[§] 6-5-551 presents no obstacle to [the requested] 
discovery."  In the alternative, the court held that -- regardless of whether 
the driving claims were subject to the AMLA -- Gloria was entitled to the 
requested discovery based solely on the medical claims because she had 
"identifie[d] Steele as an incompetent and unfit employee, and [her] 
discovery requests for prior conduct are limited to those [acts] committed 
by him."  Finally, the court held that Gloria was entitled to the discovery 
of data on Steele's mobile phone (1) created, generated, or received the 
day before, the day of, or the day after Robert's transport; (2) pertaining 
to Robert's transport and Steele's activities the day before, the day of, or 
the day after that transport regardless of when that data was created, 
generated, or received; and (3) pertaining to Steele's fitness or ability to 
operate vehicles as of the date of Robert's transport regardless of when 
that data was created, generated, or received.   
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In November 2021, the HEMSI defendants petitioned this Court for 
mandamus review, arguing that the trial court had exceeded its 
discretion by denying their request for a protective order and by directing 
them to produce discovery that they say is privileged under § 6-5-551. 
Standard of Review 
 
Mandamus is an extraordinary remedy that will be granted only 
when the petitioner establishes (1) a clear legal right to the order sought; 
(2) an imperative duty upon the respondent to perform, accompanied by 
a refusal to do so; (3) the lack of another adequate remedy; and (4) the 
properly invoked jurisdiction of the court.  Ex parte Ocwen Fed. Bank, 
FSB, 872 So. 2d 810, 813 (Ala. 2003).  Here, it is undisputed that the trial 
court has refused to grant the HEMSI defendants' motion for a protective 
order based on § 6-5-551.  Moreover, this Court has explained that an 
appeal is not an adequate remedy when the § 6-5-551 privilege is not 
recognized.  See, e.g., Ex parte Gentiva Health Servs., Inc., 8 So. 3d 943, 
946-47 (Ala. 2008).  Finally, the HEMSI defendants' petition is timely 
and complies with Rule 21, Ala. R. App. P.3  Our resolution of this case 
 
3Gloria argues that the HEMSI defendants' November 2021 
petition is untimely because they failed to seek mandamus review of the 
April 2021 order in which the trial court denied their motion to dismiss 
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therefore hinges on the first inquiry -- whether the HEMSI defendants 
have a clear legal right to the relief they seek.   
Analysis 
 
The HEMSI defendants' only argument to this Court is that § 6-5-
551 authorizes them to withhold the discovery requested by Gloria; they 
do not invoke any other statute or privilege, nor do they argue that the 
requested discovery is barred under the general provisions of Rule 26, 
Ala. R. Civ. P.  Thus, if Gloria's driving claims are outside the scope of 
the AMLA, § 6-5-551 necessarily does not apply and the HEMSI 
 
the driving claims because, the court held, those claims were "not subject 
to [the AMLA]."  That order, Gloria states, sufficiently apprised the 
HEMSI defendants that § 6-5-551 would not apply and started the clock 
for seeking mandamus review of that issue.  We disagree.  Although there 
may be some overlap between the issues decided in the April 2021 and 
October 2021 orders, it is well settled that, "subject to certain narrow 
exceptions, the denial of a motion to dismiss is not reviewable by petition 
for a writ of mandamus."  Ex parte Brown, 331 So. 3d 79, 81 (Ala. 2021).  
Gloria has identified no exception that would have permitted the HEMSI 
defendants to seek mandamus relief from this Court in April 2021 (the 
exception making mandamus review appropriate now -- the disregarding 
of a discovery privilege -- had not yet occurred).  See Ex parte Vanderwall, 
201 So. 3d 525, 532 (Ala. 2015) (explaining that the petitioner could not 
use a petition for a writ of mandamus to challenge the trial court's 
decision "that general tort-law principles, rather than the AMLA," 
governed the litigation against him but could appropriately challenge a 
discovery order disregarding the § 6-5-551 privilege).  The HEMSI 
defendants' petition is therefore timely. 
1210129 
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defendants are not entitled to the relief they seek.  Accordingly, we first 
consider whether the driving claims are properly viewed as medical-
malpractice claims governed by the AMLA and subject to the § 6-5-551 
privilege. 
A.  The applicability of the AMLA to the driving claims 
 
The AMLA applies to "any action for injury, damages, or wrongful 
death, whether in contract or in tort, against a health care provider for 
breach of the standard of care."  § 6-5-551 (emphasis added).  Thus, it is 
the substance of an action -- rather than its form -- that determines 
whether the AMLA applies.  Ex parte Alabama Dep't of Mental Health & 
Mental Retardation, 723 So. 2d 11, 13 (Ala. 1998).  In Ex parte 
Vanderwall, 201 So. 3d 525, 537-38 (Ala. 2015), this Court explained that 
the relevant inquiry is not "who committed the alleged wrongful conduct 
or when and where that conduct occurred, but … whether the harm 
occurred because of the provision of medical services."  The HEMSI 
defendants argue that the driving claims are quintessential medical-
malpractice claims that "are rooted in the provision of medical services."  
Petition at 17.  In response, Gloria states that "[s]howing up to work 
drug-free, hiring and retaining workers to drive who are not drug addicts, 
1210129 
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and not entrusting vehicles to workers who show up for work on drugs 
have nothing to do with providing medical services," and, she argues, the 
AMLA therefore has no application to those claims.  Answer at 11.   
After reviewing Gloria's complaint, we agree with the HEMSI 
defendants that the driving claims stem from the provision of medical 
services.  Notable among the "factual averments common to all counts" 
set forth by Gloria in her complaint are the following facts: 
-- "[A]fter a discussion among Robert, his family and his 
physicians at Huntsville Hospital, the decision was made that 
Robert would be transferred to UAB Hospital in Birmingham 
for evaluation and consideration for surgery and/or medical 
and cardiac interventions." 
 
-- "Huntsville Hospital requested an advanced life support 
(ALS) ambulance transport from defendant HEMSI to 
transport Robert to UAB Hospital.  In response, defendant 
HEMSI sent a ground ambulance unit to Huntsville Hospital 
which was crewed by Jacob Steele, an EMT, and Calvin Hui, 
a paramedic." 
 
-- "Prior to leaving Huntsville Hospital, HEMSI, Calvin Hui 
and/or Jacob Steele were aware that Robert was a high-risk 
cardiac patient requiring an ALS/cardiac transport with 
continuous cardiac monitoring and care by a licensed 
paramedic." 
 
-- "HEMSI and its employees also agreed and undertook to 
provide continuous medical care, with the medical care being 
provided by Calvin Hui, a licensed paramedic." 
 
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These alleged facts demonstrate that the decision to transfer Robert to 
UAB Hospital was medical in nature and had to be made so that he could 
receive testing and treatment that was not available at Huntsville 
Hospital.  Additionally, his condition dictated that he not be transported 
by private vehicle or a common carrier such as a shuttle bus or taxicab; 
rather, as a high-risk cardiac patient, he required a specialized transport 
capable of providing continuous monitoring and care.  Thus, HEMSI's 
transport was a vital part of the provision of medical services to 
Robert -- not only would he receive "continuous medical care" throughout 
the transport, but the transport would make it possible for him to receive 
the medical care at UAB Hospital that his physicians had concluded was 
a necessary part of his treatment.  The driving claims are therefore 
properly viewed as medical-malpractice claims that fall within the scope 
of the AMLA. 
 
This conclusion is buttressed by Gloria's concession that at least 
some of her claims against the HEMSI defendants are subject to the 
AMLA.  By its terms, the AMLA applies only to actions "against a health 
care provider for breach of the standard of care."  §§ 6-5-548(a) and 6-5-
551, Ala. Code 1975 (emphasis added).  Ambulance companies, EMTs, 
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and paramedics are not expressly identified as "health care provider[s]" 
in the AMLA's definition of that term.  See § 6-5-542(1), Ala. Code 1975 
(defining 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").  But 
§ 6-5-481(8), Ala. Code 1975, further explains that "[a]ny professional 
corporation or any person employed by physicians, dentists, or hospitals 
who are directly involved in the delivery of health care services" are 
considered "other health care providers" for purposes of the AMLA.  In 
explaining what it means for a professional corporation or person to be 
"employed by" a health-care provider, this Court has stated that "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."  Ex parte Partners in 
Care, Inc., 986 So. 2d 1145, 1148 (Ala. 2007).   
Here, it is undisputed that Robert's physicians and Huntsville 
Hospital "made use" of HEMSI as part of their delivery of health-care 
services to Robert -- those physicians made a medical decision to transfer 
Robert to UAB Hospital for additional medical treatment, and Huntsville 
1210129 
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Hospital called HEMSI to conduct that transfer.  Thus, not only are the 
HEMSI defendants "other health care providers" under the AMLA, but, 
to the extent that the HEMSI defendants were being "used" to deliver 
health-care services to Robert, any injury Robert suffered due to actions 
or omissions of the HEMSI defendants that were reasonably related to 
that "use" was incurred during the provision of medical services.  See 
Vanderwall, 201 So. 3d at 537 ("'"[T]he AMLA applies to conduct that is, 
or that is reasonably related to, the provision of health-care services 
allegedly resulting in a medical injury."'" (citation and emphasis 
omitted)).  The AMLA therefore applies to the driving claims asserted by 
Gloria. 
B.  The  discovery parameters set out by § 6-5-551  
 
Having concluded that the AMLA applies to the driving claims, we 
now consider the trial court's alternative holding -- that the discovery 
Gloria has requested about Steele's past conduct and employment record 
is not privileged even if the AMLA applies.  Although many of the rules 
and principles that govern the discovery process in any civil case apply 
with equal force in medical-malpractice cases, § 6-5-551 is explicit that it 
is the AMLA that ultimately "govern[s] the parameters of discovery" in 
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these cases.  Section 6-5-551 notably sets forth one important parameter 
-- the plaintiff in an AMLA action is "prohibited from conducting 
discovery with regard to any … act or omission" outside those acts and 
omissions that are specifically described in the plaintiff's complaint as 
rendering the defendant liable.   
Here, Gloria has alleged that the HEMSI defendants committed 
various acts and omissions that constitute breaches of the relevant 
standard of care.  With regard to Gloria's claims against Steele, all of her 
allegations are related to his transport of Robert.  If those claims were 
the only ones that she had asserted, under the plain language of § 6-5-
551, she would be "prohibited from conducting discovery with regard to 
any other act or omission" of Steele's that involved an individual other 
than Robert.  But those are not the only claims in this action.  Gloria has 
also asserted claims alleging that HEMSI negligently or wantonly hired, 
trained, supervised, or retained Steele as an employee.  As this Court has 
explained in a non-AMLA case, these types of claims require a plaintiff 
to establish "by affirmative proof that [the employee's] incompetency was 
actually known by the [employer] or that, had [the employer] exercised 
due and proper diligence, [it] would have learned that which would 
1210129 
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charge [it] in the law with such knowledge."  Thompson v. Havard, 285 
Ala. 718, 723, 235 So. 2d 853, 858 (1970).  A plaintiff meets this burden 
"by showing specific acts of incompetency and bringing them home to the 
knowledge of the [employer], or by showing them to be of such nature, 
character, and frequency that the [employer], in the exercise of due care 
must have had them brought to [its] notice."  Id.    
Thus, when an action against a health-care provider contains 
allegations of negligent or wanton hiring, training, supervision, or 
retention, evidence of prior acts or omissions by either the health-care 
provider or the employee -- although not directly related to the provision 
of health care to the injured party -- may otherwise be relevant to prove 
the claims.  Examples of such evidence would include evidence showing 
a health-care provider's knowledge of misconduct by an employee that 
occurred before the employee was hired or evidence of a health-care 
provider's knowledge of conduct by an employee after hiring that should 
have demonstrated to the health-care provider that the employee was 
incompetent. 
But the limitation on discovery imposed by § 6-5-551 still applies.  
In Ex parte Ridgeview Health Care Center, Inc., 786 So. 2d 1112, 1117 
1210129 
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(Ala. 2000), this Court considered the operation of § 6-5-551 in cases in 
which a health-care provider was alleged to have breached the standard 
of care by negligently hiring, training, supervising, or retaining an 
employee.  The Ridgeview Court noted that, in a case decided the 
previous year, the Court had held that a "plaintiff was entitled to discover 
information related to other acts and omissions by the defendant [health-
care provider] that were relevant to the plaintiff's allegations that the 
[defendant] had negligently hired, trained, and supervised its 
employees."  Id. at 1115 (discussing Ex parte McCollough, 747 So. 2d 887 
(Ala. 1999)).  But the legislature had responded to the McCollough 
decision by amending § 6-5-551 to expressly state that the AMLA applies 
to any action "against a health care provider for breach of the standard 
of care, whether resulting from acts or omissions in providing health care, 
or the hiring, training, supervision, retention, or termination of care 
givers."  (Emphasis added.)  Thus, the Ridgeview Court acknowledged 
that the holding in McCollough had been superseded by the amendment 
to § 6-5-551 and that, applying the amended statute to the case before it, 
the plaintiff was "not entitled to discovery regarding acts or omissions by 
[the defendant] in the hiring, training, supervising, retaining, or 
1210129 
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terminating of employees other than those employees whose acts he 
detailed specifically and factually described in his complaint as rendering 
[the defendant] liable."  786 So. 2d at 1117.  Gloria thus concedes that 
under § 6-5-551 she cannot discover information about HEMSI's 
management of other employees, but she argues that the trial court 
correctly applied Ridgeview when it held that she was entitled to discover 
information about Steele's past conduct and employment record. 
The HEMSI defendants counter by emphasizing that Ridgeview is 
not the last time this Court spoke to this issue.  In fact, just four weeks 
after Ridgeview was decided, this Court revisited the issue in Ex parte 
Coosa Valley Health Care, Inc., 789 So. 2d 208 (Ala. 2000).  Citing the 
amendment to § 6-5-551 and Ridgeview, the Court again held that the 
plaintiff was not entitled to conduct broad discovery into the employment 
records of the defendant's employees but was instead only "entitled to 
discovery of information involving the provision of care and/or services to 
[the decedent], … not to other persons."  789 So. 2d at 218.   The HEMSI 
defendants seize on this language and argue that Gloria is entitled to 
discover only that information in Steele's employment record related to 
the care and services he provided to Robert -- not information related to 
1210129 
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the care or services he provided to other individuals.  Gloria, meanwhile, 
argues that Coosa Valley was not intended to limit Ridgeview in this 
manner and that any difference in the holdings of those cases is simply 
attributable to the fact that specific employees had been identified in 
Ridgeview but no specific employees had been named in Coosa Valley. 
Neither side has it exactly right.  Section 6-5-551 permits discovery 
related to acts or omissions specifically alleged in the complaint, but it 
prohibits discovery "with regard to any other act or omission" not 
properly alleged.  Thus, in an action involving negligent or wanton hiring, 
training, supervision, or retention, § 6-5-551 does not permit discovery of 
any acts or omissions of employees who are identified in the complaint.  
Rather, discovery is permissible as to only those acts or omissions that 
(1) are specifically and factually described in the plaintiff's complaint and 
(2) are relevant to the plaintiff's claim.  See Ridgeway, 786 So. 2d at 1117 
(explaining that, when a plaintiff has alleged that a health-care provider 
breached the standard of care by negligently hiring, training, 
supervising, or retaining an employee, "then the plaintiff may discover 
information only concerning those acts or omissions by those employees 
1210129 
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whose conduct is detailed specifically and factually described in the 
complaint as rendering the health-care provider liable"). 
Here, Gloria's complaint contains specific and detailed allegations 
about previous acts and omissions attributable to Steele -- and about 
HEMSI's knowledge of the same -- that are relevant to her claims that 
HEMSI negligently or wantonly hired, trained, supervised, and retained 
Steele.  First, it is alleged that Calce told Robert's daughter the day after 
his transport that "HEMSI had received other complaints about Jacob 
Steele from other transportees and/or their families, that Mr. Steele had 
emotional/mental problems, and … that Mr. Steele had long been a 
problem at HEMSI before Robert's transport."  Second, Gloria alleged 
that Steele had been involved in previous on-the-job incidents 
demonstrating that he was unfit for his job on specific dates -- March 4, 
2016; March 1, 2017; August 12, 2017; August 4, 2018; September 24, 
2018; December 20, 2018; January 8, 2019; February 27, 2019; March 6, 
2019; March 29, 2019; and April 14, 2019 -- and that HEMSI had 
knowledge of all of these incidents but continued to employ Steele and 
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allowed him to operate HEMSI ambulances and transport patients in 
spite of that knowledge.4 
To be sure, general allegations about an employee's misconduct, 
drug use, or mental and emotional problems do not meet the level of 
specificity required by § 6-5-551 to open the door to discovery about that 
employee's record.  But the details in Gloria's complaint go beyond 
general allegations.  She lists specific dates on which Steele is alleged to 
have had "incidents" that occurred in the line and scope of his 
employment and that allegedly demonstrated that he was unfit for his 
job.  And she has also alleged specific facts indicating that HEMSI had 
knowledge of his problematic record.  These are sufficiently pleaded 
allegations of "acts or omissions" relevant to Gloria's claims of negligent 
 
4We note that Gloria's original complaint did not refer to these 
specifically dated incidents, and it is not clear from the materials before 
us exactly how she learned of them.  But the materials submitted by the 
HEMSI defendants contain a privilege log regarding Steele's employee 
file that refers to records of "events" that occurred on those same dates; 
Gloria amended her complaint to include the dates after receiving this 
privilege log.  It thus seems probable that the privilege log was the source 
for the allegations that Steele was involved in incidents on the dates 
listed in Gloria's amended complaint.  The parties have not addressed 
whether it is appropriate for a privilege log to be used in this manner, 
but, because no challenge to the practice was made in the trial court or 
to us, it is unnecessary for us to decide that issue here.   
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or wanton hiring, training, supervision, and retention to satisfy § 6-5-551 
and to permit discovery into the specifically alleged incidents.  We 
recognize that those incidents may relate to the provision of care to other 
patients and that the discovery and admissibility of evidence of acts or 
omissions related to the care of other patients is generally disallowed 
under § 6-5-551.  See Ex parte Tombigbee Healthcare Auth., 260 So. 3d 
1, 16 (Ala. 2017) (Shaw, J., dissenting).  But they could also be evidence 
of Steele's alleged "incompetency," and HEMSI's knowledge of them, see 
Thompson, supra, could be the proof necessary "to render the health care 
provider liable," § 6-5-551, for the negligent or wanton hiring, training, 
supervision, or retention of Steele.  Thus, Gloria is not restricted from 
discovering HEMSI records about these incidents.  But to the extent that 
the trial court's October 2021 order permits discovery of other 
information in Steele's employee file regarding acts or omissions that are 
not specifically described in Gloria's complaint -- or of information on 
Steele's mobile phone unrelated to Robert's transport or the other 
specifically described acts and omissions -- that order is too broad and the 
HEMSI defendants are entitled to an order limiting the scope of discovery 
to comply with § 6-5-551. 
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Conclusion 
 
All the claims asserted by Gloria in this action are governed by the 
AMLA and subject to the limitations on discovery imposed by § 6-5-551.  
To the extent that the trial court's October 2021 order did not give effect 
to the § 6-5-551 privilege, the HEMSI defendants' petition is granted and 
the trial court is directed to modify that order as discussed herein.  But 
to the extent the HEMSI defendants seek to prevent Gloria from 
discovering information regarding acts or omissions that are specifically 
alleged and described in her complaint, their petition is denied. 
 
PETITION GRANTED IN PART AND DENIED IN PART; WRIT 
ISSUED. 
 
Parker, C.J., and Bolin, Shaw, Wise, Bryan, Mendheim, Stewart, 
and Mitchell, JJ., concur. 
Sellers, J., dissents, with opinion. 
 
 
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SELLERS, Justice (dissenting).   
The main opinion holds in part that the plaintiff's first three claims 
("the driving claims") fall under the Alabama Medical Liability Act ("the 
AMLA"), § 6-5-480 et seq. and § 6-5-540 et seq., Ala. Code 1975. Section 
6-5-551, Ala. Code 1975, applies to "any action for injury, damages, or 
wrongful death, whether in contract or in tort, against a health care 
provider for breach of the standard of care." The AMLA does not expressly 
identify ambulance companies, emergency medical technicians ("EMTs"), 
or paramedics as "health care provider[s]." See § 6-5-542(1), Ala. Code 
1975. However, it does identify as "other health care providers" 
professional corporations or persons employed by hospitals and "directly 
involved in the delivery of health care services." § 6-5-481(8), Ala. Code 
1975; this definition could include ambulance drivers, EMTs, and 
paramedics. Finally, to be "employed by" a health-care provider, the 
health-care provider 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."  Ex parte Partners in Care, Inc., 986 So. 2d 1145, 
1148 (Ala. 2007). The main opinion correctly notes that Robert Owens's 
physicians and Huntsville Hospital undisputedly "made use" of 
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Huntsville Emergency Medical Services, Inc. ("HEMSI"), to deliver 
health-care services to Robert.  
However, this Court has clarified that the relevant inquiry is not 
just "who committed the alleged wrongful conduct or when and where 
that conduct occurred, but … whether the harm occurred because of the 
provision of medical services." Ex parte Vanderwall, 201 So. 3d 525, 537-
38 (Ala. 2015). I do not believe that merely driving an ambulance and 
breaching duties common to every driver on the road can be properly 
classified as a medical service under the AMLA. Accordingly, I dissent.  
Actions that are not medical services can occur in the same room, 
and in the same window of time, and can be committed by the same actor, 
as actions that are medical services as contemplated by the AMLA. This 
Court held in Vanderwall that a claim arising from a sexual assault, 
committed by a health-care worker during a medical examination within 
a medical setting, was not governed by the AMLA. The Court noted that 
the alleged injury did not stem from the provision of medical services, 
because there was no "therapeutic or medical reason" for the defendant's 
actions. Ex parte Vanderwall, 201 So. 3d at 538. The question then is not 
just whether the action occurs in an ambulance or a hospital room, during 
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27 
 
transport or examination. Rather, the inquiry is whether the specific 
action can be fairly characterized as a medical service. 
 
The main opinion cites several facts from the complaint concerning 
actions underlying the driving claims, which it says stem from the 
provision of medical services. Granted, the decision to transfer Robert to 
another hospital, the request for an advanced-life-support ambulance, 
and the agreement to undertake continuous medical care may all be 
medical services under the AMLA. However, under Vanderwall, an act 
may be committed in an ambulance, no matter how advanced its life-
support features are, and still not be subject to the AMLA. Thus, 
although the transport may have been a vital part of the provision of 
medical services, Steele's reckless driving and alleged drug use had no 
medical or therapeutic value for Robert and Steele's actions cannot be 
characterized as the provision of "medical services." 
 
Other states with similar laws have focused on the nature of the 
action in question. The Texas Medical Liability Act ("TMLA") applies to 
causes 
of 
action 
against 
health-care 
providers 
under 
similar 
circumstances to those contemplated by § 6-5-551 of the AMLA. See Tex. 
Civ. Prac. & Rem. Code Ann. § 74.001(a)(13). Echoing Ex parte Alabama 
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Department of Mental Health and Mental Retardation, 723 So. 2d 11,13 
(Ala. 1998), a Texas Court of Appeals held that review of whether a claim 
falls under the TMLA focuses on the "underlying nature of the cause of 
the action, not the label given to the claim in the pleadings." Coci v. 
Dower, 585 S.W.3d 652, 655 (Tex. App. 2019). In Coci, the court held that 
a claim based upon an ambulance operator's driving was not related to 
the provision of medical services. Id. at 657. Rather, the court held, it 
stemmed from a legal duty common to every driver on the road. Id.5 
Similarly, in cases in which an ambulance driver's liability stems only 
from an action related to his or her duty as a driver, and not from his or 
her position as a health-care provider, I am persuaded that such action 
is not a "medical service" under the AMLA. 
In conclusion, although HEMSI's transport of Robert may have 
been a vital part of the medical services provided to him, that does not 
 
5Other Texas cases considering injuries involving gurneys and 
wheelchairs have been decided using similar logic. The application of 
Vanderwall would result in similar outcomes under the AMLA. See Faber 
v. Collin Creek Assisted Living Center, Inc., 629 S.W.3d 630 (Tex. App. 
2021) (holding that TMLA did not govern when rolling walker tipped over 
due to sidewalk crack, causing injury); and City of Houston v. Houston, 
608 S.W.3d 519, 529-531 (Tex. App. 2020) (holding that TMLA governed 
when injuries stemmed from EMTs' failure to secure patient in accord 
with established protocols).  
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29 
 
mean that every action taken during the transport was as well. To the 
extent that Jacob Steele's actions related to his duties as a driver, and 
not his duties as a health-care provider, I would hold that those actions 
are not medical services under the AMLA.