Title: Bradford v. McGee

State: alabama

Issuer: Alabama Supreme Court

Document:

534 So. 2d 1076 (1988)
Dr. Charles R. BRADFORD III
v.
Bentley Alan McGEE, a minor, who sues by and through his father and next friend, Mark McGEE, et al.
Bentley Alan McGEE, a minor, who sues by and through his father and next friend, Mark McGEE, et al.
v.
Dr. Charles R. BRADFORD III.
87-137, 87-189.

Supreme Court of Alabama.
September 30, 1988.
Rehearing Denied November 18, 1988.
*1077 W. Stancil Starnes, Randal H. Sellers, and Laura Howard Peck, of Starnes & Atchison, Birmingham, for appellant/cross-appellee.
Stephen D. Heninger and S. Greg Burge, of Heninger, Burge and Vargo, Birmingham, for appellees/cross-appellants.
HOUSTON, Justice.
On July 27, 1981, Sandra McGee gave birth by cesarean section to a son, Bentley, who suffers from cerebral palsy. Thereafter, Bentley's parents, Mark and Sandra McGee, brought suit on his behalf against Dr. Charles Bradford, who performed the cesarean section, and Jackson County Hospital, alleging that they negligently departed from the appropriate standard of care and thereby proximately caused Bentley's *1078 injuries. At trial, a jury heard testimony from several witnesses, including Dr. Bradford and four experts, and returned a verdict for the McGees, awarding them $950,000 in compensatory damages. Dr. Bradford and Jackson County Hospital moved for J.N.O.V. or, in the alternative, for a new trial. The trial court granted the hospital's J.N.O.V. motion, and Dr. Bradford's new trial motion, but denied Dr. Bradford's J.N.O.V. Dr. Bradford appeals from the denial of his J.N.O.V. motion, and the McGees cross-appeal from the granting of the new trial motion.[1] For the reasons discussed below, we affirm the rulings on both motions and remand this cause for a new trial as to the claims against Dr. Bradford.
After hearing testimony from several jurors, the trial court granted Bradford's motion for new trial on the following grounds:
The trial court considered several instances of jurors' incomplete responses to voir dire questions and one instance of improper remarks during closing as grounds for granting a new trial; we find that at least two of these groundsnamely, Mr. David Woodall's and Mrs. Francis Little's failure to respond to material questions on voir direclearly support the trial court's finding of probable prejudice; and, therefore, we affirm.
During voir dire, Bradford's counsel asked the jury venire, including Mr. David Woodall, who became a juror in the case, whether any of them knew members of the Potter or McGee families. (Sandra McGee's maiden name was Potter.) No prospective juror responded to this question. During the hearing to consider the motion for new trial, Mr. Woodall testified that his sister, Alice Potter, is the aunt of Sandra McGee by marriage. He testified that Mrs. Potter had visited the trial at least twice and had had contact with him and his wife one night during the trial. Throughout the trial, Bradford's counsel was not aware of juror Woodall's relationship with Sandra McGee.
Bradford's counsel also asked the jury venire whether any of them had a family member who suffered from a disability. Francis Little, who became a juror, did not respond to this question. During the post-trial hearing, however, Mrs. Little testified that her son had been seriously injured in an automobile accident and had suffered brain damage. Her son had been convalescing at her home prior to the trial. During the trial, she had in her possession photographs of her son's accident; and, on one occasion, she approached plaintiff's counsel to discuss the possibility of filing suit against the driver who had hit her son. Plaintiff's counsel refused to discuss this matter with her during the trial. After the jury returned a verdict, she approached plaintiff's counsel again and asked him to represent her son.
The trial court was in the best possible position to determine whether there was probable prejudice. These two instances of nonresponsiveness on the part of jurors when asked extremely material questions during voir dire constitute a sufficient basis upon which the trial court could have found probable prejudice. Therefore, we hold that the trial court did not abuse its discretion in granting a new trial. Gold Kist, Inc. v. Brown, 495 So. 2d 540 (Ala. 1986); Ensor v. Wilson, 519 So. 2d 1244 *1079 (Ala.1988) (Houston, J., concurring specially).
Whether the trial court properly denied Dr. Bradford's J.N.O.V. motion turns on whether the McGees satisfied their burden of producing sufficient evidence setting forth the appropriate standard of care, Dr. Bradford's breach of that standard, and a proximate causal connection between Dr. Bradford's breach and Bentley's injuries. After a careful and complete review of the evidence, using the scintilla rule of evidence, we find that the McGees satisfied their burden of proof. Accordingly, we affirm the trial court's judgment denying the J.N.O.V.
Before examining the record, we delineate the standard of review and the law governing actions brought under the Medical Liability Act.
This action was pending in the courts of this state prior to June 11, 1987; therefore § 12-21-12, Code of Alabama 1975, as amended, does not apply; and the applicable standard of review is as follows:
"`A motion for directed verdict or J.N. O.V. is tested against the scintilla rule, which requires that a question go to the jury "if the evidence or any reasonable inference arising therefrom, furnishes [so much as] a mere gleam, glimmer, spark, the least particle, the smallest trace, or a scintilla in support of the theory of the complaint." Alabama Power Co. v. Taylor, 293 Ala. 484, 306 So. 2d 236 (1975). In reviewing a trial court's ruling on these motions, the appellate court, guided by the standard of the scintilla rule, determines whether there was sufficient evidence below to produce a conflict warranting jury consideration. Baker v. Chastain, 389 So. 2d 932 (Ala.1980). Like the trial court, the appellate court must view all the evidence in a light most favorable to the non-moving party. Ritch v. Waldrop, 428 So. 2d 1 (Ala.1982).'"
Peete v. Blackwell, 504 So. 2d 222, 224 (Ala. 1986) (quoting Hammond v. City of Gadsden, 493 So. 2d 1374, 1376 (Ala.1986)).
Section 6-5-484, Code of Alabama (1975), as we have construed it, imposes a legal duty upon doctors to exercise the degree of reasonable care, diligence, and skill that reasonably competent physicians in the national medical community would ordinarily exercise when acting in the same or similar circumstances. Keebler v. Winfield Carraway Hospital, 531 So. 2d 841 (Ala.1988). To recover damages for an alleged breach of this duty, a plaintiff must produce evidence that establishes 1) the appropriate standard of care, Keebler, supra; Dobbs v. Smith, 514 So. 2d 871 (Ala. 1987), 2) the doctor's deviation from that standard, Keebler; Dobbs, and 3) a proximate causal connection between the doctor's act or omission constituting the breach and the injury sustained by the plaintiff. Ensor v. Wilson, 519 So. 2d 1244 (Ala.1987); Howard v. Mitchell, 492 So. 2d 1018 (Ala.1986). To present a jury question, the plaintiff 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. Howard, supra; Williams v. Bhoopathi, 474 So. 2d 690 (Ala.1985).
"What was said in McClinton v. McClinton, 258 Ala. 542, 544-45, 63 So. 2d 594, 597 (1952), is appropriate in this case:
"`Proof which goes no further than to show an injury could have occurred in an alleged way, does not warrant the conclusion that it did so occur, where from the same proof the injury can with equal probability be attributed to some other cause.'
Howard at 1020.
Generally, a plaintiff must establish these prima facie elements by introducing expert testimony. Therrell v. Fonde, 495 So. 2d 1046 (Ala.1986); Rosemont, Inc. v. Marshall, 481 So. 2d 1126 (Ala.1985). An exception to the general rule requiring expert testimony in medical malpractice suits obtains in cases where the want of skill or lack of care is so apparent as to be within the comprehension of the average layman and thus requires only common knowledge and experience to understand it. Therrell, supra; Rosemont, supra. The medical intricacies implicated in this case required the use of expert testimony. In determining whether the McGees' medical experts provided the necessary scintilla of evidence to present a jury question as to whether Dr. Bradford departed from the applicable standard of care, and whether such a departure proximately caused Bentley's cerebral palsy, we must review the testimony as a whole and not abstractly. Hines v. Armbrester, 477 So. 2d 302 (Ala.1985). This Court has written:
Alabama Farm Bureau Ins. Co. v. Hunt, 519 So. 2d 480 (Ala.1987).
The McGees attributed the cause of Bentley's cerebral palsy to acute and chronic hypoxia, which, according to them, Dr. Bradford negligently failed to discover and to treat until it was too late. The McGees adduced expert evidence showing that hypoxia is a cause of cerebral palsy; that gestation periods exceeding 42 weeks can result in hypoxia, depriving the fetus of essential oxygen; that Mrs. McGee had completed her 42d week of pregnancy when she entered Jackson County Hospital; that after 42 weeks of gestation, proper medical treatment requires prenatal fetal monitoring, which Dr. Bradford failed to perform; and that once labor began, Dr. Bradford, knowing that Bentley was in fetal distress, performed a late cesarean section. Essentially, the McGees allege that Dr. Bradford proximately caused Bentley's affliction by negligently allowing Bentley to remain in his mother's womb for a dangerously protracted time, resulting in a long and short term deprivation of oxygen.
After a careful review of the whole record, resolving all doubts in favor of the McGees, we find that the McGees did present, through expert testimony, a scintilla of evidence indicating that Dr. Bradford breached the appropriate standard of care and that this breach probably caused Bentley's cerebral palsy.
Drs. Huddleston, Faustin, and Davis testified that prenatal fetal testing should be performed beginning at the 42d week of pregnancy. Dr. Faustin's testimony as to the appropriate standard of care is as follows:
*1081 "A. Probably true.
". . . .
Mrs. McGee was admitted to the hospital at midnight on the morning of July 27. It is undisputed that Dr. Bradford did not perform fetal testing prior to admission. Bentley was born at 10:30 a.m. on July 27. Thus, the critical questions in determining a breach are 1) whether Bentley had reached a gestational age of 42 weeks prior to admission and 2) whether Dr. Bradford should have known this and, in accordance with accepted medical practice, should have performed fetal testing to discover and then to prevent health problems associated with post-term infants.
Fetal gestational age is derived by counting the weeks between the last menstrual period (LMP) and the delivery date. It was uncontradicted at trial that, due to the increased risk of fetal harm caused by prematurity or post-maturity, setting an accurate due date is extremely important. It was also uncontradicted that the patient's LMP determines when the due date should be set. Mrs. McGee testified that she told Dr. Bradford that her LMP occurred on September 8, 1980. Dr. Bradford testified that on one visit Mrs. McGee informed him of a September 8 LMP but that on another visit she told him it had occurred on October 8. In his efforts to determine Mrs. McGee's LMP, Dr. Bradford performed a pelvic examination and consulted with a radiologist, who conducted two ultrasound tests. An ultrasound is a technique used to estimate fetal age. The first ultrasound test, which was performed on January 22, 1981, indicated a fetal age of 14 weeks and confirmed an October 8 LMP. The second ultrasound test, which was performed later in the pregnancy, in April, indicated a fetal age of 28 weeks and confirmed a September 8 LMP. Based on the results of the pelvic examination and the first ultrasound test, Dr. Bradford estimated an October 8 LMP and upon that estimation calculated the due date for July 14. Dr. Huddleston, an obstetrician who testified on behalf of Dr. Bradford, stated that the appropriate standard of care requires a doctor to perform fetal testing once the fetus reaches an age of 42 weeks. He also testified that the procedure Dr. Bradford employed to estimate a due date was appropriate and that calculating the due date for July 14 was within the standard of care. Even upon consideration of the second ultrasound test, which indicated an older fetal age, and Mrs. McGee's belief that her LMP had occurred in September, Dr. Huddleston testified that Dr. Bradford's actions were "entirely appropriate."
Dr. Davis, another obstetrician who testified for Dr. Bradford, agreed that fetal testing should be performed at 42 weeks. But, he also agreed that Dr. Bradford did not breach the appropriate standard of care in his calculation of fetal age and in setting the due date. Dr. Davis testified that an estimated due date is a clinical judgment based on three factors: 1) menstrual history, 2) the size of the uterus calculated by performing a pelvic examination, and 3) results from ultrasound tests. He testified that Dr. Bradford properly considered all three factors. The following hypothetical *1082 questions posed by defense counsel and Dr. Davis's responses thereto are instructive:
The McGees introduced into evidence testimony from two medical experts, Dr. Daniel Faustin, an obstetrician from New York, and Dr. Gary Meyers, a specialist in pediatric neurology and neonatology. Dr. Faustin testified that at the time of admission Mrs. McGee had completed her 42d week of pregnancy:
*1083 "A. (Deponent nodding head affirmatively.)
Thus, the appropriate standard of care required Dr. Bradford to perform fetal testing beginning at 42 weeks, which, he failed to do until July 27, when Bentley's gestational age had completed the 42d week. There is expert medical testimony that this constituted negligence. But, the plaintiffs' case does not end here. To recover damages, they must have established a causal connection between Dr. Bradford's negligence and Bentley's cerebral palsy. Specifically, did the delay in performing fetal testing, possibly by as much as six days, proximately cause Bentley's cerebral palsy?
At the outset, we note that our discussion is limited to the evidence indicating that chronic hypoxia proximately caused Bentley's cerebral palsy. The McGees premised their causation theory on the existence of acute and chronic hypoxia, but succeeded in establishing a causal connection only with respect to the chronic hypoxia. Dr. Faustin testified that Dr. Bradford committed "malpractice" by failing to perform a cesarean section sooner than July 27th. Allegedly, Dr. Bradford's late cesarean section during labor subjected Bentley to acute hypoxia and that acute hypoxia constituted a substantial factor in causing the cerebral palsy. Dr. Faustin did not testify, however, that Dr. Bradford's breach of the appropriate standard of care occurring during labor on the 27th caused the cerebral palsy. Moreover, Dr. Meyers testified that the "acute lack of oxygen occurred after [Bentley] was born," and that there was "no way to be certain" whether Bentley suffered acute hypoxia during the labor process. The record does not indicate, and the McGees do not argue, that Dr. Bradford breached the appropriate standard of care after Bentley's birth. With regard to their causation theory premised on acute hypoxia, the McGees failed to establish a scintilla of sufficient evidencethat is, evidence by expert testimonyshowing that the negligence complained of probably caused the acute hypoxia, and that it, in turn, caused the cerebral palsy. Accordingly, we focus on the sufficiency of the evidence introduced at trial indicating a causal connection between Dr. Bradford's allegedly negligent pre-natal care and the chronic hypoxia.
Dr. Faustin testified that at the time of admission Mrs. McGee had completed her 42d week of pregnancy. With regard to the correlation between an overdue pregnancy and the risk of hypoxia, Dr. Faustin testified:
Dr. Meyers diagnosed Bentley's illness as cerebral palsy and attributed its cause to hypoxia. Pertinent portions of Dr. Meyers's testimony that support the McGees' theory of causation are as follows:
*1084 ". . . .
". . . .
". . . .
". . . .
". . . .
". . . .
". . . .
The McGees' explanation for the cause of Bentley's cerebral palsy can be summarized as follows: Bentley was a post-term baby who had completed 42 weeks of gestation at birth; Dr. Bradford should have performed fetal testing prior to the end of the 42d week of pregnancy to detect signs of fetal oxygen depletion; the prolonged pregnancy resulted in uteroplacental insufficiency, or, in layman's terms, a poor exchange of oxygen between the mother and the fetus; the uteroplacental insufficiency led to chronic hypoxia and, consequently, the oxygen-starved Bentley suffers cerebral palsy today. This explanation is more than a mere conjecture. The evidence established through Drs. Faustin, Huddleston, Meyers, and Davis has selective application to this one theory. Their testimony constituted a scintilla of evidence that Dr. Bradford's alleged negligence probably caused Bentley's cerebral palsy.
For the foregoing reasons, the rulings of the trial court are affirmed, and this cause is remanded for a new trial as to the claims against Dr. Bradford.
AFFIRMED AND REMANDED.
TORBERT, C.J., and MADDOX, ALMON, SHORES, BEATTY, ADAMS and STEAGALL, JJ., concur.
[1]  See John Crane-Houdaille, Inc. v. Lucas, 534 So. 2d 1070 (Ala. 1988), for a discussion concerning the appealability of an order denying a J.N.O.V. but also granting a new trial.