Title: Shelvia Graves v. Brookwood Health Services, Inc., d/b/a Brookwood Medical Center

State: alabama

Issuer: Alabama Supreme Court

Document:

REL: 12/18/2009 
Notice: T h i s 
o p i n i o n i s s u b j e c t t o f o r m a l 
r e v i s i o n b e f o r e 
p u b l i c a t i o n i n 
t h e advance 
s h e e t s o f 
Southern Reporter. 
R e a d e r s a r e r e q u e s t e d t o n o t i f y t h e 
Reporter of Decisions, 
Alabama A p p e l l a t e C o u r t s , 300 D e x t e r Avenue, Montgomery, Alabama 36104-3741 
((334) 229¬
0 6 4 9 ) , o f 
any 
t y p o g r a p h i c a l o r o t h e r e r r o r s , i n 
o r d e r t h a t c o r r e c t i o n s may 
be 
made b e f o r e 
t h e o p i n i o n i s 
p r i n t e d i n 
Southern Reporter. 
SUPREME COURT OF ALABAMA 
OCTOBER TERM, 2009-2010 
1071224 
S h e l v i a Graves 
v. 
Brookwood H e a l t h S e r v i c e s , Inc., 
d/b/a 
Brookwood M e d i c a l 
Center 
Appeal from J e f f e r s o n C i r c u i t 
Court 
(CV-02-4480) 
MURDOCK, 
J u s t i c e . 
S h e l v i a 
G r a v e s 
a p p e a l s 
f r o m a j u d g m e n t i n f a v o r o f 
B r o o k w o o d 
H e a l t h 
S e r v i c e s , 
I n c . , 
d/b/a B r o o k w o o d 
M e d i c a l 
C e n t e r 
( " B r o o k w o o d " ) , on G r a v e s ' s 
c l a i m 
a l l e g i n g 
m e d i c a l 
1071224 
n e g l i g e n c e 
a g a i n s t 
n u r s e s 
a t B r o o k w o o d . 
We 
r e v e r s e 
and 
remand. 
I . 
F a c t s and P r o c e d u r a l H i s t o r y 
On A u g u s t 7, 2000, G r a v e s was 
a d m i t t e d t o B r o o k w o o d ' s 
D i g e s t i v e 
D i s e a s e 
C e n t e r 
t o u n d e r g o 
an 
u p p e r 
and 
l o w e r 
g a s t r o i n t e s t i n a l exam ("GI exam") as t h e r e s u l t o f p r o b l e m s 
she 
h a d 
b e e n 
h a v i n g 
r e l a t e d 
t o 
u l c e r a t i v e 
c o l i t i s , 
an 
i n f l a m m a t o r y d i s e a s e o f t h e s m a l l i n t e s t i n e a n d c o l o n . 
G r a v e s 
had h a d s e v e r a l m e d i c a l p r o b l e m s b e f o r e t h e GI exam, i n c l u d i n g 
two p r i o r c o l o n s u r g e r i e s , s i n u s p r o b l e m s , 
m i g r a i n e h e a d a c h e s , 
and 
i r o n - d e f i c i e n c y a n e m i a - - t h e l a s t o f w h i c h 
r e q u i r e d h e r 
t o r e c e i v e f r e q u e n t v i t a m i n B-12 s h o t s and o c c a s i o n a l b l o o d 
t r a n s f u s i o n s . 
As a c o n s e q u e n c e , b y G r a v e s ' s own a d m i s s i o n i n 
h e r d e p o s i t i o n t e s t i m o n y , she h a d r e c e i v e d s e v e r a l s h o t s and 
b e e n a d m i n i s t e r e d s e v e r a l I V s i n t h e y e a r s b e f o r e t h e GI exam. 
G r a v e s ' s 
l a t e s t 
I V was 
a d m i n i s t e r e d 
a p p r o x i m a t e l y 
a week 
b e f o r e t h e GI exam. 
The n u r s i n g - a d m i s s i o n summary 
p r e p a r e d 
b e f o r e 
t h e GI exam 
i n d i c a t e d 
t h a t 
G r a v e s 
h a d edema, o r 
s w e l l i n g , i n h e r h a n d s and f i n g e r s , a s m a l l c u t on one f i n g e r 
o f h e r r i g h t h a n d , and b r u i s e s on h e r u p p e r a r m s . 
G r a v e s 
r e l a t e d t h a t she t o l d t h e n u r s e s who a d m i t t e d h e r f o r t h e GI 
2 
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exam t h a t 
t h e b r u i s e s were f r o m p r e v i o u s 
I V s , 
b u t 
she 
s t a t e d 
t h a t 
h e r 
h a n d s 
and 
f i n g e r s were 
n o t 
s w o l l e n 
b e f o r e 
t h e 
GI 
exam. 
G r a v e s t e s t i f i e d t h a t t h e n u r s e s a t t h e D i g e s t i v e 
D i s e a s e 
C e n t e r a t t e m p t e d 
t o 
s t a r t 
an 
IV 
i n h e r 
l e f t 
arm,
1 
w h i c h 
was 
u n s u c c e s s f u l , 
and 
t h e n t h e y i n s e r t e d t h e 
IV i n h e r 
l e f t h a n d , 
w h i c h r e s u l t e d i n an 
i n f i l t r a t i o n .
2 
A c c o r d i n g 
t o G r a v e s , 
t h e 
n u r s e s t h e n w i t h d r e w t h e IV f r o m h e r 
l e f t h a n d and 
i n s e r t e d i t 
i n t o 
t h e 
b a c k 
o f 
h e r 
r i g h t h a n d .
3 
G r a v e s 
a l l e g e s 
t h a t 
an 
i n f i l t r a t i o n 
o c c u r r e d 
i n 
h e r 
r i g h t 
h a n d 
and 
t h a t 
she 
i m m e d i a t e l y b e g a n e x p e r i e n c i n g 
s e v e r e p a i n i n h e r 
r i g h t h a n d , 
w h i c h c a u s e d h e r t o s t a r t c r y i n g . 
G r a v e s s t a t e d t h a t she 
t o l d 
t h e 
n u r s e s 
t h a t 
t h e 
IV was 
i n s e r t e d i n c o r r e c t l y and 
t h a t i t 
was 
c a u s i n g 
h e r p a i n , b u t t h e y d i d n o t remove t h e IV. 
A t 
t h a t 
p o i n t , Dr. G r e g o r y Champion e n t e r e d 
t h e room and 
a d m i n i s t e r e d 
1The 
p u r p o s e o f t h e IV was 
t o i n j e c t a s u c c e s s i o n 
o f d r u g s 
t h a t w o u l d i n d u c e c o n s c i o u s 
s e d a t i o n 
o f 
t h e 
p a t i e n t 
f o r 
t h e 
d u r a t i o n 
o f t h e 
GI exam. 
2An 
i n f i l t r a t i o n 
o c c u r s 
when 
an 
IV 
i s 
n o t 
p r o p e r l y 
i n s e r t e d 
i n t o t h e 
v e i n 
and 
t h e 
f l u i d 
i n t h e 
IV 
i s 
i n j e c t e d 
i n t o t i s s u e s u r r o u n d i n g 
t h e 
s i t e 
o f t h e 
IV. 
3 T h e 
p r o c e d u r e 
r e c o r d 
f o r 
G r a v e s ' s 
GI 
exam 
d o e s 
n o t 
i n d i c a t e t h a t t h e n u r s e s had 
any p r o b l e m s s t a r t i n g t h e 
I V ; i n 
a d d i t i o n , 
i t s t a t e s t h a t t h e 
IV was 
i n s e r t e d i n G r a v e s ' s 
l e f t 
h a n d and 
t h a t 
i t r e m a i n e d t h e r e 
t h r o u g h o u t t h e 
GI exam. 
3 
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t h e 
i n j e c t i o n 
o f 
t h r e e 
s u c c e s s i v e 
d r u g s 
t h r o u g h 
t h e 
IV 
f i r s t 
V e r s e d , 
t h e n D e m e r o l , 
and 
f i n a l l y 
P h e n e r g a n . 
G r a v e s 
a l l e g e s t h a t she 
t o l d D r . C h a m p i o n t h a t t h e IV was 
c a u s i n g 
h e r 
p a i n b u t 
t h a t he 
r e p l i e d t h a t t h e y were a l r e a d y b e h i n d i n 
t h e 
p r o c e d u r e and 
t h a t she w o u l d j u s t h a v e t o e n d u r e i t . 
G r a v e s c l a i m s t h a t D r . C h a m p i o n t h e n b e g a n t h e GI exam by 
p l a c i n g 
a t u b e w i t h 
a t i n y c a m e r a down h e r 
t h r o a t w h i l e 
she 
r e m a i n e d 
c o m p l e t e l y 
c o n s c i o u s .
4 
G r a v e s 
r e l a t e d 
t h a t 
she 
c o n t i n u e d 
t o c r y b e c a u s e o f t h e p a i n i n h e r h a n d c a u s e d by 
t h e 
IV and c h o k e d as t h e c a m e r a was 
f o r c e d down h e r 
t h r o a t . 
Once 
t h e 
c a m e r a 
was 
i n 
p l a c e , 
D r . 
C h a m p i o n 
p e r f o r m e d 
t h e 
e x a m i n a t i o n and 
o b t a i n e d 
b i o p s i e s o f G r a v e s ' s b o w e l . 
The 
GI 
exam t o o k 10 
t o 20 
m i n u t e s .
5 
G r a v e s 
t e s t i f i e d 
t h a t upon c o m p l e t i o n 
o f 
t h e 
p r o c e d u r e 
she 
l o o k e d 
down a t 
h e r 
r i g h t 
h a n d 
and 
n o t i c e d 
t h a t 
i t 
was 
s w o l l e n 
" l i k e a b o x i n g 
g l o v e . " 
G r a v e s was 
t r a n s p o r t e d 
t o 
t h e 
r e c o v e r y room a f t e r D r . C h a m p i o n o r d e r e d 
t h a t a warm c o m p r e s s 
4 T h e p r o c e d u r e 
r e c o r d 
i n d i c a t e s t h a t 
G r a v e s 
was 
s e d a t e 
f o l l o w i n g t h e a d m i n i s t r a t i o n o f t h e 
l a s t d r u g d o s a g e and 
t h a t 
she 
r e m a i n e d so 
u n t i l 
she awoke i n t h e 
r e c o v e r y 
room. 
5 D r . 
C h a m p i o n ' s n o t e s 
on 
t h e 
p r o c e d u r e 
do 
n o t 
i n d i c a t e 
t h a t 
t h e r e were any 
p r o b l e m s 
s e d a t i n g 
G r a v e s o r 
t h a t 
G r a v e s 
e x p r e s s e d any 
f e e l i n g o f d i s c o m f o r t 
d u r i n g 
t h e 
GI exam. 
4 
1071224 
be p l a c e d on t h e 
i n f i l t r a t i o n 
s i t e .
6 
G r a v e s 
t e s t i f i e d 
t h a t 
n e i t h e r t h e s w e l l i n g n o r t h e p a i n i n h e r r i g h t h a n d s u b s i d e d 
w h i l e 
she was 
i n t h e r e c o v e r y room. 
G r a v e s 
was d i s c h a r g e d 
f r o m B r o o k w o o d w i t h o u t r e c e i v i n g 
f u r t h e r 
t r e a t m e n t f o r h e r 
h a n d . 
G r a v e s 
s t a t e d t h a t D r . C h a m p i o n t o l d h e r h u s b a n d 
t h a t 
t h e 
s w e l l i n g i n h e r h a n d w o u l d s u b s i d e w i t h i n 10 
d a y s . 
G r a v e s 
s t a t e d 
t h a t 
she 
v i s i t e d 
an 
e m e r g e n c y 
room 
a p p r o x i m a t e l y two weeks l a t e r when t h e p a i n i n h e r r i g h t h a n d 
s t i l l 
h a d 
n o t 
s u b s i d e d . 
G r a v e s 
s u b s e q u e n t l y b e g a n 
s e e i n g 
o t h e r 
d o c t o r s when 
t h e e m e r g e n c y - r o o m 
t r e a t m e n t 
f a i l e d 
t o 
r e d u c e 
t h e 
p a i n 
i n 
h e r 
r i g h t 
h a n d 
and 
she 
e x p e r i e n c e d 
p r o g r e s s i v e 
l o s s 
o f 
r a n g e 
o f 
m o t i o n 
i n 
t h a t 
h a n d . 
She 
r e c e i v e d n e r v e b l o c k s i n h e r 
r i g h t h a n d f r o m one 
p h y s i c i a n , 
w h i c h 
d i d n o t 
r e s u l t 
i n s i g n i f i c a n t 
i m p r o v e m e n t . 
She 
was 
r e f e r r e d 
t o o r t h o p e d i c s u r g e o n D r . 
W i l l i a m 
S t a n d e f f e r , 
who 
p e r f o r m e d 
a s u r g e r y on 
G r a v e s ' s 
r i g h t 
h a n d 
on November 
8, 
2000. 
The s u r g e r y was 
n o t s u c c e s s f u l , and G r a v e s 
t h e r e a f t e r 
r e c e i v e d e x t e n s i v e t r e a t m e n t i n r e p e a t e d v i s i t s 
-- 
i n c l u d i n g 
a n o t h e r 
s u r g e r y 
t o 
h e r 
h a n d 
-- 
f r o m 
o r t h o p e d i c 
s u r g e o n 
6The 
p r o c e d u r e 
r e c o r d 
n o t e d 
t h a t 
an 
i n f i l t r a t i o n 
h a d 
o c c u r r e d i n G r a v e s ' s 
l e f t h a n d and 
t h a t a warm c o m p r e s s 
was 
p l a c e d on t h e 
i n f i l t r a t i o n 
s i t e . 
5 
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D r . J o h n B u c k l e y . 
G r a v e s 
has 
n o t r e g a i n e d 
f u l l 
u s e o f 
h e r 
r i g h t h a n d , and she has b e e n d i a g n o s e d w i t h p e r m a n e n t 
n e r v e 
damage t o t h e h a n d . 
On 
J u l y 29, 2002, G r a v e s 
and h e r t h e n h u s b a n d 
M i c h a e l
7 
s u e d B r o o k w o o d , 
a l l e g i n g 
t h a t 
t h e 
n u r s e s 
i n t h e 
D i g e s t i v e 
D i s e a s e C e n t e r h a d 
n e g l i g e n t l y 
i n s e r t e d 
t h e IV i n G r a v e s ' s 
r i g h t 
h a n d on A u g u s t 
7, 
2000, w h i c h 
r e s u l t e d 
i n p e r m a n e n t 
n e r v e damage t o t h a t h a n d . 
On November 14, 2003, B r o o k w o o d 
f i l e d 
i t s i n i t i a l 
m o t i o n 
f o r a summary j u d g m e n t , 
w h i c h i t 
s u p p o r t e d 
w i t h 
G r a v e s ' s 
m e d i c a l r e c o r d s f r o m B r o o k w o o d , 
an 
a f f i d a v i t f r o m n u r s e G i n g e r A z b i k ( t h e n u r s e who 
i n s e r t e d t h e 
IV 
i n t o G r a v e s ' s h a n d ) s t a t i n g t h a t she h a d n o t b r e a c h e d t h e 
s t a n d a r d 
o f 
c a r e 
i n 
i n s e r t i n g 
t h e 
I V , 
and 
a 
n a r r a t i v e 
o f 
u n d i s p u t e d 
f a c t s . 
G r a v e s 
o p p o s e d 
t h e 
m o t i o n 
t h r o u g h 
an 
a f f i d a v i t 
f r o m R e b e c c a 
L a n g e r , a n u r s e a t t h e U n i v e r s i t y 
o f 
A l a b a m a 
a t 
B i r m i n g h a m , 
who 
s t a t e d 
t h a t 
i n 
h e r 
o p i n i o n 
B r o o k w o o d ' s 
n u r s e s 
h a d 
b r e a c h e d 
t h e 
s t a n d a r d o f 
c a r e , 
and 
e x c e r p t s f r o m G r a v e s ' s d e p o s i t i o n t e s t i m o n y . 
B a s e d on t h e s e 
7 M i c h a e l G r a v e s s u b s e q u e n t l y f i l e d a m o t i o n t o d i s m i s s h i s 
l o s s - o f - c o n s o r t i u m c l a i m b e c a u s e he was 
no l o n g e r m a r r i e d t o 
S h e l v i a G r a v e s 
and no l o n g e r " w i s h e d t o p a r t i c i p a t e 
i n 
t h i s 
l a w s u i t . " 
The 
t r i a l 
c o u r t g r a n t e d t h e m o t i o n , l e a v i n g 
G r a v e s 
as t h e s o l e 
p l a i n t i f f . 
6 
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s u b m i s s i o n s , t h e 
t r i a l 
c o u r t d e n i e d B r o o k w o o d ' s m o t i o n f o r a 
summary j u d g m e n t . 
F o l l o w i n g 
t h e 
d e n i a l 
o f 
t h e 
summary-judgment 
m o t i o n , 
d i s c o v e r y 
c o n t i n u e d , 
d u r i n g 
w h i c h 
s e v e r a l 
d e p o s i t i o n s 
w e r e 
t a k e n , 
i n c l u d i n g 
t h e 
d e p o s i t i o n s 
o f 
N u r s e 
L a n g e r , 
D r . 
S t a n d e f f e r , 
and 
D r . 
B u c k l e y . 
D r . 
B u c k l e y was 
i n i t i a l l y 
d e p o s e d 
on 
November 
11, 
2004. 
I n 
F e b r u a r y 
2008, 
a 
v i d e o 
d e p o s i t i o n 
o f D r . 
B u c k l e y was 
t a k e n . 
The 
day 
a f t e r 
t h e 
t r a n s c r i p t 
o f 
D r . 
B u c k l e y ' s 
v i d e o 
d e p o s i t i o n was 
c o m p l e t e d , B r o o k w o o d f i l e d a r e n e w e d m o t i o n f o r 
a summary j u d g m e n t , w h i c h i t s u p p o r t e d w i t h e x c e r p t s 
f r o m 
t h e 
d e p o s i t i o n 
o f 
D r . 
S t a n d e f f e r 
and 
D r . 
B u c k l e y ' s 
v i d e o 
t e s t i m o n y . 
The 
m o t i o n 
n o t e d 
t h a t 
G r a v e s 
p r e v i o u s l y 
had 
i d e n t i f i e d o r t h o p e d i c 
s u r g e o n s D r . S t a n d e f f e r 
and D r . 
B u c k l e y 
as 
t h e 
p h y s i c i a n s 
q u a l i f i e d 
t o 
s p e a k 
t o 
t h e 
i s s u e 
o f 
c a u s a t i o n . 
B r o o k w o o d 
n o t e d 
t h a t 
D r . 
S t a n d e f f e r 
i n 
h i s 
d e p o s i t i o n 
t e s t i m o n y 
t e s t i f i e d 
t h a t 
he 
d i d n o t 
t h i n k 
i t 
was 
" p l a u s i b l e " o r " r e a s o n a b l e " 
t h a t 
t h e 
IV 
i n f i l t r a t i o n 
c a u s e d 
G r a v e s ' s 
i n j u r y . 
I t 
a l s o 
h i g h l i g h t e d 
t h e 
f a c t 
t h a t 
D r . 
B u c k l e y 
i n h i s v i d e o 
t e s t i m o n y 
s t a t e d 
t h a t 
i t was 
p o s s i b l e , 
b u t 
n o t 
p r o b a b l e , 
t h a t 
t h e 
IV 
i n f i l t r a t i o n 
had 
c a u s e d 
t h e 
7 
1071224 
n e r v e damage i n G r a v e s ' s r i g h t h a n d . 
B a s e d on t h i s e v i d e n c e , 
B r o o k w o o d 
c o n t e n d e d 
t h a t 
G r a v e s 
h a d 
f a i l e d 
t o 
e s t a b l i s h 
a 
p r i m a 
f a c i e c a s e o f m e d i c a l n e g l i g e n c e . 
G r a v e s r e s p o n d e d t o t h e m o t i o n by 
c i t i n g N u r s e 
L a n g e r ' s 
a f f i d a v i t 
and 
e x c e r p t s f r o m D r . 
B u c k l e y ' s 2004 
d e p o s i t i o n . 
She 
n o t e d 
t h a t D r . 
B u c k l e y h a d 
s t a t e d 
i n 2004 
t h a t 
i t was 
p r o b a b l e 
t h a t 
t h e 
IV 
i n f i l t r a t i o n 
h a d 
c a u s e d 
h e r 
i n j u r y . 
B r o o k w o o d ' s m o t i o n was 
s e t f o r a h e a r i n g on M a r c h 
7, 2008. 
B r o o k w o o d 
f i l e d 
a 
m o t i o n 
t o 
s t r i k e 
N u r s e 
L a n g e r ' s 
a f f i d a v i t 
-- t o t h e e x t e n t t h a t G r a v e s 
s o u g h t 
t o u s e 
i t t o 
e s t a b l i s h c a u s a t i o n -- on t h e g r o u n d 
t h a t a r e g i s t e r e d 
n u r s e 
was n o t q u a l i f i e d t o t e s t i f y as an e x p e r t on m e d i c a l c a u s a t i o n 
i n 
a m e d i c a l - m a l p r a c t i c e a c t i o n . 
B r o o k w o o d 
a l s o moved 
t o 
s t r i k e D r . B u c k l e y ' s 2004 d e p o s i t i o n on t h e g r o u n d t h a t i t was 
s u p p l a n t e d by t h e 2008 v i d e o 
d e p o s i t i o n . 
D u r i n g a h e a r i n g on M a r c h 
7, 2008, t h e 
t r i a l 
c o u r t d i d 
n o t r u l e on B r o o k w o o d ' s r e n e w e d m o t i o n f o r a summary 
j u d g m e n t . 
I n s t e a d , t h e 
t r i a l 
c o u r t 
i n d i c a t e d 
t h a t i t w a n t e d t o r e v i e w 
t h e 
t e s t i m o n y f r o m b o t h o f D r . B u c k l e y ' s d e p o s i t i o n s b e f o r e 
r u l i n g on t h e m o t i o n . 
On M a r c h 10, t h e d a t e t h a t h a d b e e n s e t 
f o r 
t r i a l , t h e t r i a l c o u r t i n d i c a t e d t h a t i t w a n t e d t o p r o c e e d 
8 
1071224 
t o 
t r i a l 
p r o v i d e d 
t h a t 
G r a v e s w o u l d be p r e s e n t i n g 
f u r t h e r 
e v i d e n c e o f c a u s a t i o n . 
A l s o a t t h i s 
t i m e , 
G r a v e s 
c o n c e d e d 
t h a t N u r s e L a n g e r ' s t e s t i m o n y 
c o u l d n o t be u s e d t o e s t a b l i s h 
c a u s a t i o n , and she w i t h d r e w D r . S t a n d e f f e r as a w i t n e s s f o r 
p u r p o s e s o f c a u s a t i o n . 
T h u s , 
o n l y D r . B u c k l e y ' s 
t e s t i m o n y 
r e m a i n e d as e v i d e n c e t o e s t a b l i s h c a u s a t i o n . 
The p a r t i e s t h e n 
p r o c e e d e d t o j u r y 
s e l e c t i o n . 
On 
M a r c h 
11, 2008, 
t h e 
t r i a l 
c o u r t 
h e a r d 
e x t e n s i v e 
a r g u m e n t s c o n c e r n i n g 
t h e p a r t i e s ' m o t i o n s i n l i m i n e . 
D u r i n g 
t h i s 
h e a r i n g , 
t h e 
t r i a l 
c o u r t 
r u l e d 
t h a t 
G r a v e s 
c o u l d n o t 
i n t r o d u c e c e r t a i n m e d i c a l 
l i t e r a t u r e c o n c e r n i n g t h e e f f e c t o f 
t h e d r u g P h e n e r g a n ,
8 w h i c h G r a v e s a p p a r e n t l y 
i n t e n d e d t o u s e 
as 
e v i d e n c e 
r e g a r d i n g 
c a u s a t i o n . 
B r o o k w o o d t h e n u r g e d t h e 
t r i a l c o u r t t o r e c o n s i d e r i t s a l l e g a t i o n i n i t s r e n e w e d m o t i o n 
f o r 
a summary j u d g m e n t 
t h a t t h e e v i d e n c e o f c a u s a t i o n 
was 
i n s u f f i c i e n t 
b e c a u s e 
G r a v e s h a d c o n c e d e d 
t h a t 
she h a d no 
c a u s a t i o n 
e v i d e n c e 
o t h e r 
t h a n 
t h e d e p o s i t i o n 
t e s t i m o n y 
o f 
Dr. 
B u c k l e y . 
F o l l o w i n g an i n c a m e r a m e e t i n g among t h e 
t r i a l 
8 T h e 
t r i a l 
c o u r t c o n c l u d e d 
t h a t G r a v e s was a t t e m p t i n g t o 
add a new c l a i m t o h e r c o m p l a i n t 
i n v o l v i n g t h e d r u g P h e n e r g a n 
t h o u g h she n e v e r amended h e r c o m p l a i n t t o i n c l u d e a l l e g a t i o n s 
c o n c e r n i n g 
t h e u s e o f a s p e c i f i c d r u g b y B r o o k w o o d . 
9 
1071224 
c o u r t 
and 
t h e 
p a r t i e s ' 
a t t o r n e y s , 
t h e 
t r i a l 
c o u r t 
s t a t e d 
t h e 
f o l l o w i n g 
i n open 
c o u r t : 
"The 
C o u r t 
h a v i n g 
c o n s i d e r e d 
t h e 
d e p o s i t i o n 
t e s t i m o n y 
o f 
Dr. 
S t a n d e f f e r , 
Dr. 
B u c k l e y , 
b o t h 
d e p o s i t i o n s 
o f Dr. B u c k l e y , r u l e s t h a t [ B r o o k w o o d ' s ] 
r e q u e s t 
f o r j u d g m e n t 
as 
a m a t t e r 
o f 
l a w 
s h o u l d 
be 
g r a n t e d . 
I t h i n k [ G r a v e s ] and [ B r o o k w o o d ] have b o t h 
s t i p u l a t e d as t o t h o s e d e p o s i t i o n s . 
The 
C o u r t , upon 
r e v i e w o f t h o s e , 
f i n d s [ B r o o k w o o d ' s ] m o t i o n i s g o i n g 
t o be 
g r a n t e d . " 
F o l l o w i n g 
t h i s p r o n o u n c e m e n t , 
t h e 
t r i a l 
c o u r t 
d i s m i s s e d 
t h e 
j u r y . 
On 
A p r i l 
22, 
2008, 
t h e 
t r i a l 
c o u r t 
e n t e r e d 
a 
w r i t t e n 
o r d e r , 
w h i c h p r o v i d e d , 
i n p e r t i n e n t 
p a r t : 
" [ G r a v e s ] 
f a i l e d 
t o 
meet 
t h e 
s t a n d a r d 
o f 
s u b s t a n t i a l 
e v i d e n c e 
r e q u i r e d 
by 
A l a b a m a 
Law, 
i n d i c a t i n g 
t h a t 
t h e 
a l l e g e d 
n e g l i g e n c e 
p r o b a b l y 
c a u s e d 
t h e 
i n j u r y 
c l a i m e d 
by 
t h e 
p l a i n t i f f . 
Dr. J o h n B u c k l e y and 
Dr. W i l l i a m S t a n d e f f e r were 
two 
o r t h o p e d i c 
s u r g e o n s 
who 
t r e a t e d 
[ G r a v e s ] . 
Dr. 
B u c k l e y , 
by 
way 
o f 
h i s 
t r i a l 
t e s t i m o n y , 
and 
Dr. 
S t a n d e f f e r , 
by way 
o f h i s d e p o s i t i o n , 
t e s t i f i e d 
t h a t t h e y c a n n o t s t a t e t h e 
i n f i l t r a t i o n 
a t i s s u e 
i n 
t h i s c a u s e was 
t h e p r o b a b l e c a u s e o f [ G r a v e s ' s ] h a n d 
i n j u r y , 
o n l y 
t h a t 
i t i s a p o s s i b l e c a u s e . 
( B u c k l e y 
d e p o s i t i o n 
I I I , 
p. 
4 2 ; 
S t a n d e f f e r 
d e p o s i t i o n , 
p. 
1 0 0 ) . 
" A b s e n t s u b s t a n t i a l e v i d e n c e d e m o n s t r a t i n g 
t h a t 
t h e 
a l l e g e d n e g l i g e n c e 
i s t h e p r o b a b l e c a u s e o f 
t h e 
c l a i m e d 
i n j u r y , a j u d g m e n t as a m a t t e r o f l a w 
i s 
due 
t o be 
e n t e r e d 
i n f a v o r 
o f B r o o k w o o d H o s p i t a l . " 
G r a v e s a p p e a l s f r o m t h i s j u d g m e n t o f t h e 
t r i a l 
c o u r t . 
10 
1071224 
I I . 
S t a n d a r d o f R e v i e w 
T h o u g h t h e t r i a l 
c o u r t s t y l e d i t s o r d e r as r e l i e f 
b a s e d 
on B r o o k w o o d ' s " r e n e w e d m o t i o n f o r 
j u d g m e n t as a m a t t e r o f l a w 
p u r s u a n t t o R u l e 50 o f t h e A l a b a m a R u l e s o f C i v i l 
P r o c e d u r e , " 
t h e m o t i o n 
b e f o r e t h e t r i a l 
c o u r t was, i n f a c t , 
B r o o k w o o d ' s 
"Renewed M o t i o n f o r Summary J u d g m e n t . " 
M o r e o v e r , 
t h e 
t r i a l 
c o u r t 
e n t e r e d i t s o r a l 
o r d e r 
b e f o r e 
G r a v e s 
p r e s e n t e d any 
p o r t i o n o f h e r c a s e t o t h e e m p a n e l e d 
j u r y . 
T h e r e f o r e , t h e 
t r i a l 
c o u r t a c t u a l l y e n t e r e d a summary j u d g m e n t i n f a v o r o f 
B r o o k w o o d as o p p o s e d t o a j u d g m e n t as a m a t t e r o f l a w . 
See 
R u l e 5 0 ( a ) , A l a . 
R. C i v . 
P. ( p r o v i d i n g f o r a " j u d g m e n t as a 
m a t t e r o f l a w " o n l y a f t e r "a p a r t y h a s b e e n f u l l y h e a r d on an 
i s s u e " ) . 
T h i s d i s t i n c t i o n makes no d i f f e r e n c e i n t e r m s o f o u r 
s t a n d a r d o f r e v i e w b e c a u s e " [ t ] h e s t a n d a r d by w h i c h we r e v i e w 
a r u l i n g on a m o t i o n f o r a [ j u d g m e n t 
as a m a t t e r o f l a w ] i s 
' " m a t e r i a l l y 
i n d i s t i n g u i s h a b l e f r o m t h e s t a n d a r d by w h i c h we 
r e v i e w a summary j u d g m e n t . " ' " 
B a i l e y v . F a u l k n e r , 940 So. 2d 
247, 249 ( A l a . 2006) ( q u o t i n g F l i n t C o n s t r . Co. v . H a l l , 904 
So. 2d 236, 246 ( A l a . 2 0 0 4 ) , q u o t i n g i n t u r n H a t h c o c k v . Wood, 
815 So. 2d 502, 506 ( A l a . 2 0 0 1 ) ) . 
"'We 
a p p l y t h e same s t a n d a r d o f r e v i e w [ i n 
r e v i e w i n g 
t h e 
g r a n t 
o r 
d e n i a l 
o f 
a 
11 
1071224 
summary-judgment m o t i o n ] as t h e t r i a l c o u r t 
a p p l i e d . 
S p e c i f i c a l l y , 
we must 
d e t e r m i n e 
w h e t h e r 
t h e movant has made a p r i m a 
f a c i e 
s h o w i n g 
t h a t no g e n u i n e 
i s s u e o f m a t e r i a l 
f a c t 
e x i s t s and t h a t t h e movant i s e n t i t l e d 
t o 
a j u d g m e n t as a m a t t e r o f l a w . 
R u l e 
5 6 ( c ) , 
A l a . R. C i v . P.; B l u e C r o s s & B l u e  
S h i e l d o f A l a b a m a v. H o d u r s k i , 899 So. 2d 
949, 952-53 ( A l a . 
2 0 0 4 ) . 
I n m a k i n g s u c h a 
d e t e r m i n a t i o n , we must r e v i e w t h e e v i d e n c e 
i n 
t h e 
l i g h t 
most 
f a v o r a b l e 
t o 
t h e 
n o n m o v a n t . 
W i l s o n v . B r o w n , 496 So. 2d 
756, 
758 
( A l a . 1 
98 
6) . 
Once 
t h e movant 
makes a p r i m a 
f a c i e 
s h o w i n g 
t h a t t h e r e i s 
no 
g e n u i n e 
i s s u e 
o f 
m a t e r i a l 
f a c t , 
t h e 
b u r d e n 
t h e n 
s h i f t s 
t o t h e nonmovant 
t o 
p r o d u c e 
" s u b s t a n t i a l 
e v i d e n c e " as t o t h e 
e x i s t e n c e o f a g e n u i n e 
i s s u e o f 
m a t e r i a l 
f a c t . 
B a s s v. S o u t h T r u s t Bank o f B a l d w i n  
C o u n t y , 538 So. 2d 794, 797-98 ( A l a . 1 9 8 9 ) ; 
A l a 
.Code 1975, § 1 2 - 2 1 - 1 2 . ' " 
M u t u a l A s s u r a n c e , I n c . v. S c h u l t e , 970 So. 2d 292, 295 ( A l a . 
2007) 
( q u o t i n g Dow v. A l a b a m a D e m o c r a t i c 
P a r t y , 
8 
97 So. 2d 
1035, 1038-39 ( A l a . 
2 0 0 4 ) ) . 
I I I . 
A n a l y s i s 
"To 
h a v e 
a 
v a l i d 
c l a i m 
u n d e r 
t h e 
A l a b a m a 
M e d i c a l 
L i a b i l i t y 
A c t , 
t h e 
[ p l a i n t i f f ] 
must 
p r o v i d e 
e v i d e n c e 
i n d i c a t i n g 
t h a t t h e n e g l i g e n c e a l l e g e d i s t h e p r o x i m a t e and 
p r o b a b l e c a u s e o f [ t h e p l a i n t i f f ' s ] i n j u r y ; a mere 
p o s s i b i l i t y 
o r one p o s s i b i l i t y among o t h e r s i s i n s u f f i c i e n t 
t o meet t h e 
b u r d e n o f p r o o f . " 
L y o n s v. V a u g h a n R e g ' l Med. C t r . , L L C , [Ms. 
12 
1071224 
1 0 7 1 5 0 2 , 
A p r i l 
24, 
2009] 
___ 
So. 
3d 
___ , ___ 
( A l a . 2009) 
( c i t i n g 
S o r r e l l 
v. 
K i n g , 
946 
So. 
2d 
854, 
862 
( A l a . 
2 0 0 6 ) ) . 
G r a v e s 
c o n t e n d s 
t h a t 
t e s t i m o n y 
f r o m 
Dr. 
B u c k l e y ' s 
2004 
d e p o s i t i o n 
c o n s t i t u t e s 
s u b s t a n t i a l 
e v i d e n c e 
t h a t 
t h e 
IV 
i n f i l t r a t i o n p r o b a b l y 
c a u s e d h e r 
i n j u r y . 
B r o o k w o o d 
c o u n t e r s 
t h a t , 
i n c o n t e x t , 
Dr. 
B u c k l e y ' s 2004 
d e p o s i t i o n 
t e s t i m o n y , 
when 
c o n s i d e r e d 
w i t h 
h i s 
2008 
v i d e o 
t e s t i m o n y , 
d o e s 
n o t 
e s t a b l i s h 
s u b s t a n t i a l e v i d e n c e o f 
c a u s a t i o n . 
The 
p e r t i n e n t p o r t i o n s 
o f Dr. 
B u c k l e y ' s 2004 
d e p o s i t i o n 
p r o v i d e 
as 
f o l l o w s : 
"Q. 
When d i d y ' a l l 
f i r s t 
see 
[ G r a v e s ] ? 
"A. 
W e l l , 
t h e 
f i r s t 
t i m e 
I 
saw 
h e r 
was 
on 
December 5, 
2000. 
"Q. 
A l l r i g h t s i r . And 
d i d you 
o b t a i n a h i s t o r y a t 
t h a t 
t i m e ? 
"A. 
Y e s . 
F o r 
r e a s o n s 
w h i c h 
had 
t o 
do 
w i t h 
t h e 
n a t u r e 
o f t h e c o n d i t i o n , I d i d n ' t 
s h a l l we 
s a y , 
e x p l o r e 
t o o 
d e e p l y 
t h e 
c i r c u m s t a n c e s 
s u r r o u n d i n g 
t h e 
o r i g i n a l 
i n j u r y 
b e c a u s e 
t h a t 
had h a p p e n e d a b o u t f i v e months p r e v i o u s l y . 
And 
s h e ' d 
a l s o 
a l r e a d y 
b e e n 
o p e r a t e d 
on. 
So 
I 
d i d n ' t 
t h i n k 
t h a t 
b e l a b o r i n g 
t h o s e p o i n t s 
was 
g o i n g 
t o be 
p a r t i c u l a r l y 
h e l p f u l . 
"But 
my 
u n d e r s t a n d i n g 
was 
she had 
an I.V. 
w h i c h 
i n f i l t r a t e d 
and 
w h i c h 
r e s u l t e d i n some 
d o r s a l 
f i b r o s i s and 
t h a t she had u n d e r g o n e an 
e x t e n s o r 
t e n d o n 
t e n d o l y s i s 
and 
r e l e a s e 
o f some o f 
t h e 
13 
1071224 
m e t a c a r p o p h a l a n g e a l 
j o i n t 
c a p s u l e s , 
and 
a l s o 
had 
an 
i n t r i n s i c 
r e l e a s e o f t h e 
r i g h t h a n d . 
f i 
"Q. 
The 
h i s t o r y 
o f 
t h e 
I.V. 
i n f i l t r a t i o n 
was 
t h a t 
r e f e r r i n g 
b a c k 
t o 
A u g u s t 
2000 
a t 
B r o o k w o o d 
H o s p i t a l ? 
"A. 
T h a t was 
my 
u n d e r s t a n d i n g , 
y e s . 
"Q. 
Dr. 
B u c k l e y , 
do 
you 
h a v e 
an 
o p i n i o n 
as 
t o 
w h e t h e r t h e 
I.V. 
i n f i l t r a t i o n 
i n A u g u s t o f 2000 
p r o b a b l y 
c a u s e d t h e 
i n j u r y and damage t h a t 
you 
saw 
w i t h r e g a r d 
t o h e r 
r i g h t u p p e r 
e x t r e m i t y ? 
f i 
"A. 
W e l l , 
as you 
a r e a w a r e , I have o n l y 
h i s t o r y 
t o 
 
go 
by. 
"Q. 
Y e s , s i r . 
"A. 
And 
s i n c e 
I h a d 
s e e n h e r 
a f t e r 
s e v e r a l 
t h i n g s 
had 
t a k e n p l a c e , 
I'm 
somewhat r e m o v e d f r o m 
t h e 
o r i g i n a l e v e n t . 
B u t 
t h a t was 
t h e 
o n l y 
h i s t o r y 
t h [ a t ] 
I e v e r a c h i e v e d , 
I e v e r o b t a i n e d , 
and 
I 
d i d n ' t 
e v e r 
r e c e i v e 
any 
i n f o r m a t i o n 
t o 
t h e 
c o n t r a r y . 
So 
I have 
t o assume 
t h a t 
t h a t 
was 
t h e 
s i g n a l 
e v e n t . 
"Q. 
And 
when 
you 
s a y 
' s i g n a l 
e v e n t , ' what 
do 
you 
mean by 
t h a t ? 
"A. 
T h a t 
was 
t h e 
p o i n t 
a t 
w h i c h 
h e r 
d i s c o m f o r t 
b e g a n . 
14 
1071224 
"Q. 
[ G r a v e s ' s c o u n s e l ] 
a s k e d you a b o u t w h e t h e r you 
had made a d e t e r m i n a t i o n as t o w h e t h e r t h e I.V. 
i n f i l t r a t i o n s 
a t i s s u e i n t h i s 
c a s e 
p r o b a b l y 
c a u s e d t h e i n j u r y t h a t y o u , D r . S t a n d e f f e r , and 
Dr. 
S p r u i l l
[
9
] a l l t r e a t e d . 
And f i r s t o f f 
I want 
t o 
a s k you a 
l i t t l e 
b i t a b o u t 
t h a t 
l i n e o f 
q u e s t i o n i n g . 
" E a r l y 
on you i n d i c a t e d t o us 
t h a t t h e 
i n f o r m a t i o n 
c o n t a i n e d 
i n y o u r 
c h a r t 
a b o u t t h e 
p a t i e n t ' s 
p r o b l e m 
w i t h 
w h i c h 
she 
p r e s e n t e d 
b e i n g 
r e l a t e d t o an i n f i l t r a t i o n was by way o f 
t h e p a t i e n t ' s own h i s t o r y ; i s t h a t 
c o r r e c t ? 
"A. 
C o r r e c t . 
"Q. 
Y o u r 
i n t e r e s t i s n o t i n m a k i n g some 
f o r e n s i c 
d e t e r m i n a t i o n 
a b o u t what 
c a u s e d t h e 
u l t i m a t e 
i n j u r y ? 
"A. 
C o r r e c t . 
I n s o f a r 
as 
t h e 
l a c k 
o f 
s u c h 
i n f o r m a t i o n d o e s n ' t i m p i n g e upon t h e t r e a t m e n t 
I'm d e l i v e r i n g . 
And b e c a u s e I was s e e i n g h e r 
a t 
a 
t i m e 
s e v e r a l 
months 
f r o m 
t h e 
i n c i t i n g 
e v e n t , 
and 
s i n c e 
t h e 
c h a n g e s 
t h a t 
h a d 
e s t a b l i s h e d 
-- 
h a d 
b e e n 
e s t a b l i s h e d 
was 
c h r o n i c , i t 
d i d n ' t 
r e a l l y make a g r e a t 
d e a l o f 
d i f f e r e n c e what t h e o r i g i n a l 
c i r c u m s t a n c e 
was. 
What 
I 
was 
c o n f r o n t e d 
w i t h 
was 
a 
r a t h e r 
a g g r e s s i v e 
d o r s a l 
f i b r o s i s 
t h a t 
was, as i t 
t u r n s o u t , l a r g e l y n o t a m e n a b l e t o 
t r e a t m e n t . 
"Q. 
Yes 
s i r . 
A n d 
f r o m 
y o u r 
p e r s p e c t i v e , 
y o u r 
c o n c e r n was t r e a t i n g a c o n d i t i o n t h a t showed up 
on 
y o u r 
d o o r s t e p , 
so 
t o 
s p e a k , 
and n o t 
d e t e r m i n i n g 
u l t i m a t e l y what c a u s e d i t ? 
"A. 
C o r r e c t . 
9 T h i s 
i s a 
r e f e r e n c e 
t o D r . W e s l e y 
S p r u i l l , 
a 
p a i n -
management 
s p e c i a l i s t . 
15 
1071224 
"Q. 
And 
you 
a r e 
n o t 
c o m i n g i n h e r e t o d a y t o 
o f f e r 
any 
t e s t i m o n y 
t o 
t h e 
e f f e c t 
t h a t 
you 
now 
b e l i e v e 
t h a t 
what 
o c c u r r e d 
a t 
B r o o k w o o d 
H o s p i t a l 
i n A u g u s t 2000 c a u s e d t h e 
i n j u r y 
t h a t 
you 
t r e a t e d ; i s t h a t 
c o r r e c t ? 
"A. 
C o r r e c t . 
As 
I s a i d 
e a r l i e r , 
t h a t 
was 
what 
I 
was 
t o l d , 
and 
t h a t 
was 
r e a s o n a b l e 
and 
c o n s i s t e n t 
w i t h 
t h e 
c i r c u m s t a n c e s 
as 
t h e y 
p r e s e n t e d 
t h e m s e l v e s 
t o 
me. 
And 
so 
I 
d i d n ' t 
f e e l 
i t n e c e s s a r y t o e x p l o r e 
t h a t f u r t h e r . 
"Q. 
S u r e . 
And 
l e t me 
a s k 
you 
t h i s , 
Dr. 
B u c k l e y . 
D i d M r s . 
G r a v e s g i v e t h a t h i s t o r y t o you 
a t 
t h e 
t i m e 
she 
f i r s t 
p r e s e n t e d 
a b o u t 
t h e 
I.V. 
i n f i l t r a t i o n , 
o r 
was 
i t by 
t h e 
way 
o f 
some 
o t h e r 
d o c u m e n t a t i o n ? 
"A. 
No. 
I 
b e l i e v e , 
j u d g i n g 
f r o m 
t h e 
d i c t a t i o n 
w h i c h 
I p r e p a r e d 
a t 
t h e 
t i m e 
o f 
t h e 
o r i g i n a l 
v i s i t , 
t h a t 
i n f o r m a t i o n 
came 
t o 
l i g h t 
d u r i n g 
o u r 
i n i t i a l 
c o n t a c t . 
"Q. 
And 
any 
i n d i c a t i o n i n t h e 
c h a r t 
t h a t t h e r e 
may 
be 
some 
p o t e n t i a l 
r e l a t i o n s h i p b e t w e e n 
t h e 
i n j u r y 
t h a t 
you 
were 
t r e a t i n g 
and 
t h e 
i n f i l t r a t i o n 
t h a t 
o c c u r r e d 
i s 
n o t 
meant 
t o 
r e f l e c t 
a d e t e r m i n a t i o n 
by 
you 
t h a t t h e r e 
i s a 
c a u s a l r e l a t i o n s h i p , b u t 
i n s t e a d i s i n t e n d e d 
t o 
r e f l e c t p a t i e n t - h i s t o r y 
i n f o r m a t i o n ? 
"A. 
I t h i n k I a g r e e w i t h t h a t 
s t a t e m e n t . 
"Q. 
I 
know 
t h a t 
was 
somewhat 
o f 
a 
c o n v o l u t e d 
q u e s t i o n . 
And 
t h e r e a s o n I'm 
a s k i n g 
i t i s 
-¬
"A. 
May 
I 
s a y 
t h a t 
I 
do 
n o t 
h a v e 
an 
o p i n i o n 
i n d e p e n d e n t o f t h e 
i n f o r m a t i o n 
I r e c e i v e d 
f r o m 
M r s . 
G r a v e s a b o u t t h e c a u s e o f h e r 
p r o b l e m . 
16 
1071224 
"Q. 
I s e e . So you w o u l d n o t s i t h e r e t o d a y and s a y  
t h a t 
t h e 
i n f i l t r a t i o n 
p r o b a b l y 
c a u s e d 
t h e 
 
i n j u r y w h i c h you 
t r e a t e d ? 
"A. 
W e l l , I g u e s s t h a t ' s a c t u a l l y what I w o u l d s a y .  
B u t I w o u l d s a y i t b e c a u s e o f t h e 
i n f o r m a t i o n  
t h a t 
I 
o b t a i n e d 
f r o m my 
o n g o i n g 
d i s c u s s i o n s 
 
w i t h 
S h e l v i a G r a v e s . 
"Q. 
Okay. 
So b a s e d on p a t i e n t h i s t o r y and -¬
"A. Y e s . 
"Q. 
-- 
b a s e d 
on 
t h e 
i d e a 
t h a t 
you 
h a v e n ' t 
i n d e p e n d e n t l y i n v e s t i g a t e d -¬
"A. 
C o r r e c t . 
"Q. 
-- a n d have no o t h e r 
i n f o r m a t i o n 
w i t h w h i c h t o 
c o m p a r e ? 
"A. 
T h a t i s c o r r e c t . 
"Q. 
What i n y o u r 
o p i n i o n 
w o u l d 
c a u s e t h e t y p e o f 
s c a r 
t i s s u e and 
f i b r o s i s 
t h a t Dr. 
S t a n d e f f e r 
d e s c r i b e d 
t h a t he e n c o u n t e r e d ? 
"A. 
W e l l , 
I 
t h i n k 
I 
c o u l d 
a n s w e r 
t h a t 
more 
a c c u r a t e l y b y s a y i n g 
t h a t t h e i n f i l t r a t i o n o f 
some 
i r r i t a t i n g s u b s t a n c e c o u l d . 
I d o n ' t know 
t h a t i t n e c e s s a r i l y w o u l d , and c e r t a i n l y 
t h e r e 
a r e o t h e r p o t e n t i a l c a u s e s as w e l l . 
So I d o n ' t 
t h i n k 
t h e r e ' s 
a n y t h i n g 
t h a t 
i s 
s u f f i c i e n t l y 
s p e c i f i c 
a b o u t 
h i s o p e r a t i v e 
f i n d i n g s 
t h a t 
w o u l d a l l o w one t o s a y w i t h 
c e r t a i n t y t h a t t h e 
c o n d i t i o n 
c o u l d 
h a v e b e e n c a u s e d 
o n l y b y t h e 
e v e n t i n q u e s t i o n . 
B u t I t h i n k t o e s t a b l i s h 
s u c h a r e l a t i o n s h i p i s p r o b a b l y 
r e a s o n a b l e . 
17 
1071224 
"Q. 
A l l r i g h t s i r . 
The 
h i s t o r y t h a t S h e l v i a G r a v e s 
gave you a b o u t t h e 
i n f i l t r a t i o n 
o f t h e 
I.V., 
o r 
t h e 
e x t r a v a s a t i o n , 
was 
c o n s i s t e n t 
w i t h 
t h e 
i n j u r y Dr. 
S t a n d e f f e r 
d e s c r i b e d 
and 
t h e 
i n j u r y 
you 
a l s o 
f o u n d when 
you 
went 
i n 
t o 
do 
y o u r 
s u r g e r y ? 
"A. 
W e l l , 
i t i s c e r t a i n l y c o n s i s t e n t 
w i t h what 
Dr. 
S t a n d e f f e r 
d e s c r i b e d . 
As 
you 
p o i n t e d 
o u t , 
o r 
as 
was 
p o i n t e d 
o u t 
e a r l i e r , 
by 
t h e 
t i m e 
I 
saw 
h e r 
I 
d o n ' t 
t h i n k 
i t w o u l d 
be 
p o s s i b l e 
t o 
d i s t i n g u i s h b e t w e e n 
p o s t o p e r a t i v e 
c h a n g e s 
and 
t h e 
o r i g i n a l i n j u r y . 
"Q. 
A l l r i g h t , 
s i r . 
And 
i f we 
assume 
t h a t 
t h e r e 
was 
no 
o t h e r 
h i s t o r y 
o f 
i n j u r y , damage, 
o r 
t r a u m a t o h e r 
r i g h t h a n d o t h e r 
t h a n 
t h i s 
I.V. 
t h a t 
e x t r a v a s a t e d , 
a s s u m i n g 
t h a t 
t o 
be 
t r u e , 
I ' l l 
a s k 
you w h e t h e r o r n o t 
i t i s p r o b a b l e 
t h a t  
t h e 
I.V. 
i n f i l t r a t i o n 
c a u s e d t h e 
i n j u r y ? 
"A. 
A g a i n m a k i n g a l l o f t h e a s s u m p t i o n s t h a t we're  
aware 
o f , 
I 
t h i n k 
t h a t 
i s 
a 
r e a s o n a b l e 
s t a t e m e n t . 
"Q. 
J u s t 
b r i e f l y , 
Dr. 
B u c k l e y . 
Assume t h a t 
t h e r e 
 
was 
no 
p r i o r i n j u r y , damage, o r t r a u m a 
t o 
t h e 
 
r i g h t h a n d ; assume t h a t when [ G r a v e s ] went i n t o  
t h e B r o o k w o o d H o s p i t a l , she 
had 
n o t 
e x p e r i e n c e d  
any 
p a i n o r d i s c o m f o r t 
w i t h r e g a r d 
t o h e r 
r i g h t  
h a n d ; 
assume 
t h a t 
t h e 
I.V. 
was 
i n s e r t e d 
and 
 
t h a t 
she 
s t a r t e d 
e x p e r i e n c i n g 
s e v e r e 
b u r n i n g 
 
p a i n 
i n h e r 
r i g h t h a n d s u b s e q u e n t 
t o 
t h e 
I.V. 
 
i n s e r t i o n , 
and 
t h a t 
t h e r e 
was 
s w e l l i n g o f 
t h e 
 
r i g h t 
h a n d 
t h a t 
was 
g r o s s l y 
a p p a r e n t ; 
and 
 
assume 
t h a t 
h e r 
symptoms 
w i t h 
r e g a r d 
t o 
h e r 
 
r i g h t h a n d p e r s i s t e d f r o m t h a t p o i n t 
f o r w a r d . 
18 
1071224 
" I f 
we make t h o s e 
a s s u m p t i o n s 
as 
b e i n g 
t r u e ,  
I ' l l 
a s k 
you 
w h e t h e r 
o r 
n o t 
t h e 
I.V. 
i s 
 
p r o b a b l y 
t h e 
s o u r c e 
o r 
e t i o l o g y 
o f h e r 
i n j u r y 
 
and damage i n h e r 
r i g h t hand? 
f i 
"A. 
Y e s . " 
( E m p h a s i s added.) 
The 
p e r t i n e n t 
p o r t i o n s 
o f 
Dr. 
B u c k l e y ' s 
2008 
v i d e o 
t e s t i m o n y p r o v i d e as 
f o l l o w s : 
"Q. 
Dr. 
B u c k l e y , 
g i v e n t h e p a t i e n t h i s t o r y i n 
t h i s 
c a s e 
as 
w e l l 
as 
y o u r 
own 
k n o w l e d g e 
and 
e x p e r t i s e 
i n h a n d 
i n j u r i e s 
and 
t h e 
c l i n i c a l 
f e a t u r e s 
t h a t 
you 
e n c o u n t e r e d 
d u r i n g 
y o u r 
s u r g e r y on 
[ G r a v e s ] , do you h a v e an o p i n i o n 
as 
t o 
w h e t h e r 
t h e 
I V 
i n f i l t r a t i o n 
i n A u g u s t 
o f 
2000 
most 
p r o b a b l y 
i s 
t h e 
s o u r c e 
o r 
s i g n a l 
e v e n t 
o f t h i s 
i n j u r y ? 
f i 
"A. 
The 
h i s t o r y 
t h a t 
I 
was 
p r o v i d e d 
c e r t a i n l y 
s u g g e s t s 
a 
r e l a t i o n s h i p 
i n 
t e r m s 
o f 
t i m e 
b e t w e e n t h e o n s e t o f t h e p r o c e s s w h i c h 
r e s u l t e d 
i n 
my 
s e e i n g 
h e r 
and 
o p e r a t i n g upon 
h e r 
and 
s u b s e q u e n t l y 
t r e a t i n g 
h e r 
and 
an 
e v e n t 
i n v o l v i n g an IV i n f i l t r a t e . 
To t h e e x t e n t t h a t 
t e m p o r a l 
c o n n e c t i o n 
i s 
a c c u r a t e 
and 
t o 
t h e 
e x t e n t 
t h a t 
n o t h i n g 
e l s e 
h a p p e n e d 
w h i c h 
r e p r e s e n t s 
a 
p l a u s i b l e 
e x p l a n a t i o n 
f o r 
t h e 
p r o c e s s , 
i t w o u l d seem r e a s o n a b l e 
t o i m p l i c a t e 
t h e 
i n f i l t r a t i o n . 
As 
I s a i d 
e a r l i e r , 
I d o n ' t 
t h i n k 
t h e r e ' s 
a n y t h i n g 
a b o u t 
t h e 
s i t u a t i o n 
I 
e n c o u n t e r e d 
t h a t 
was 
c h a r a c t e r i s t i c 
o f 
an 
I V 
i n f i l t r a t i o n . 
19 
1071224 
"Q. 
G i v e n 
e v e r y t h i n g 
t h a t 
you know 
s i t t i n g 
h e r e 
t o d a y , 
I 
t a k e 
i t t h a t 
i t i s r e a s o n a b l e t o 
c o n c l u d e 
t h a t t h e s o u r c e o f h e r i n j u r y i s 
t h e 
I V 
i n f i l t r a t i o n ? 
"A. The -- I d o n ' t 
t h i n k 
t h a t I c a n s a y a n y t h i n g 
more t h a n I j u s t s a i d . 
I t h i n k 
t h a t i t 
i s -¬
t h e 
r e l a t i o n s h i p 
c e r t a i n l y i s p o s s i b l e , b u t  
w h e t h e r 
o r n o t i t i s p r o b a b l e 
i s 
a n o t h e r  
m a t t e r , 
and 
I 
d o n ' t 
t h i n k 
I 
c a n make 
a 
 
s u p p o r t a b l e s t a t e m e n t i n t h a t 
r e g a r d . 
"Q. 
D o c t o r , l e t 
me 
j u s t -- I w a n t e d t o r e f e r 
b a c k 
t o t h e d e p o s i t i o n 
t h a t you gave i n t h i s 
c a s e 
some t i m e ago and s e e i f I c a n r e f r e s h 
y o u r 
r e c o l l e c t i o n t o some 
e x t e n t . 
"On page 32, t h e d e f e n s e l a w y e r was 
a s k i n g 
you q u e s t i o n s , 
and n e a r t h e b o t t o m o f page 32, 
he s t a t e d o r he q u e s t i o n e d y o u : 'So, you w o u l d 
n o t 
s i t h e r e 
t o d a y 
and 
s a y 
t h a t 
t h e 
i n f i l t r a t i o n 
p r o b a b l y c a u s e d t h e i n j u r y w h i c h 
you t r e a t e d ? ' 
And y o u r a n s w e r , 
' W e l l , I g u e s s 
t h a t ' s 
a c t u a l l y what I w o u l d s a y , b u t I w o u l d 
s a y 
i t b e c a u s e 
o f t h e 
i n f o r m a t i o n 
t h a t 
I 
o b t a i n e d 
f r o m 
my 
o n g o i n g 
d i s c u s s i o n s 
w i t h 
S h e l v i a G r a v e s . ' 
I s t h a t 
s t i l l 
y o u r t e s t i m o n y 
t o d a y ? 
"A. Y e s . 
I n o t h e r w o r d s , t h e r e l a t i o n s h i p upon  
w h i c h 
t h i s 
s t a t e m e n t 
i s b a s e d 
i s 
l a r g e l y  
h i s t o r i c a l , n o t b a s e d upon any s o r t o f f o r e n s i c  
a s s e s s m e n t 
o f 
t h e 
s u r g i c a l 
f i n d i n g s 
o r 
 
h i s t o l o g i c f i n d i n g s , j u s t t h a t she s a i d t h i s i s 
 
what h a p p e n e d , and I assumed t h a t was c o r r e c t . 
"Q. 
I u n d e r s t a n d . 
"And 
you 
d i d n ' t 
u n d e r t a k e 
any 
f o r e n s i c 
e x a m i n a t i o n 
t o d e t e r m i n e 
t h e c a u s e 
b e c a u s e , 
20 
1071224 
q u i t e 
f r a n k l y , you were 
more 
i n t e r e s t e d i n 
c a r i n g f o r 
h e r and t r e a t i n g h e r and s e e i n g what 
you 
c o u l d do t o make h e r l i f e 
b e t t e r ; i s t h a t 
f a i r ? 
"A. 
C o r r e c t . " 
( E m p h a s i s added.) 
I t i s a p p a r e n t 
f r o m t h e d e p o s i t i o n 
t e s t i m o n y 
t h a t D r . 
B u c k l e y 
t e s t i f i e d 
i n 2004 t h a t t h e I V i n f i l t r a t i o n 
p r o b a b l y 
c a u s e d t h e i n j u r y t o G r a v e s ' s r i g h t h a n d . 
D r . B u c k l e y 
s t a t e d 
t h a t 
he 
d i d " n o t have 
an 
o p i n i o n 
i n d e p e n d e n t 
o f t h e 
i n f o r m a t i o n I r e c e i v e d f r o m M r s . G r a v e s a b o u t t h e c a u s e o f 
h e r 
p r o b l e m , " b u t t h i s i s n o t s u r p r i s i n g g i v e n 
t h a t D r . 
B u c k l e y 
was 
n o t t h e f i r s t 
p h y s i c i a n t o s e e G r a v e s 
f o l l o w i n g t h e I V 
i n f i l t r a t i o n . 
"'The 
e x p e r t 
o p i n i o n 
t e s t i m o n y 
o f a 
p h y s i c i a n - w i t n e s s 
as t o t h e 
c o n d i t i o n , 
d i a g n o s i s , 
p r o g n o s i s 
o r o t h e r w i s e 
o f 
h i s 
p a t i e n t , whom he h a s p e r s o n a l l y 
e x a m i n e d , 
may be b a s e d i n p a r t on t h e h i s t o r y o f 
t h e 
c a s e , 
i n c l u d i n g b o t h h i s p r e s e n t 
and p a s t 
c o n d i t i o n and symptoms as r e l a t e d b y t h e 
p a t i e n t 
t o 
t h e 
p h y s i c i a n - w i t n e s s 
i n 
c o n n e c t i o n 
w i t h , 
and as 
p a r t 
o f , t h e 
e x a m i n a t i o n . ' " 
Drummond Co. v. B o s h e l l , 641 So. 2d 1240 , 1243 ( A l a . 1994 
) 
( q u o t i n g 
C h a r l e s 
W. 
Gamble, 
M c E l r o y ' s 
A l a b a m a 
E v i d e n c e 
§ 1 1 0 . 0 1 ( 1 ) ( 4 t h 
e d . 
1 9 9 1 ) ) . 
21 
1071224 
Among o t h e r t h i n g s , B r o o k w o o d c o n t e n d s t h a t D r . B u c k l e y ' s 
2004 
d e p o s i t i o n 
t e s t i m o n y 
d o e s n o t c o n s t i t u t e 
s u b s t a n t i a l 
e v i d e n c e o f c a u s a t i o n b e c a u s e , i t 
a r g u e s , D r . B u c k l e y made 
i t 
c l e a r i n 
b o t h t h e 2004 d e p o s i t i o n and t h e 2008 d e p o s i t i o n t h a t 
h i s c o n c l u s i o n was b a s e d on p a t i e n t h i s t o r y and was n o t meant 
t o be a f o r e n s i c 
a s s e s s m e n t o f c a u s a t i o n . 
M e d i c a l - e x p e r t 
t e s t i m o n y i s 
n o t r e n d e r e d 
i n v a l i d , h o w e v e r , s i m p l y b e c a u s e 
i t 
i s b a s e d upon a p a t i e n t ' s h i s t o r y . 
"'The 
l a w r e c o g n i z e s t h a t , i n t h e p r a c t i c e 
o f m e d i c i n e , a d i a g n o s i s o f t h e a i l m e n t may 
i n c l u d e 
a 
p e r s o n a l 
e x a m i n a t i o n 
o f t h e 
p a t i e n t 
by 
a l l t h e methods 
known 
t o 
s c i e n c e , and a l s o t h e h i s t o r y o f t h e c a s e , 
as g i v e n by t h e p a t i e n t o r o t h e r 
e x a m i n i n g 
p h y s i c i a n . 
" ' T h i s h i s t o r y may i n c l u d e a 
s t a t e m e n t 
o f 
p r e s e n t 
a n d 
p a s t 
symptoms 
A 
p r o f e s s i o n a l 
o p i n i o n 
as t o t h e 
n a t u r e , 
c a u s e , 
and e x t e n t o f t h e a i l m e n t , 
b a s e d 
upon a l l t h e s e m a t t e r s i n c o n n e c t i o n 
w i t h 
and as p a r t o f t h e p e r s o n a l e x a m i n a t i o n o f 
t h e p a t i e n t , i s c o m p e t e n t 
e v i d e n c e . ' " 
T i d b a l l v . O r k i n E x t e r m i n a t i n g Co., 583 So. 2d 239, 241 ( A l a . 
1991) 
( q u o t i n g S t a t e R e a l t y Co. v . L i g o n , 218 A l a . 5 4 1 , 543¬
44, 119 So. 672, 674 
( 1 9 2 9 ) ) . 
I t i s t r u e t h a t t h e f a c t s u n d e r l y i n g a p a t i e n t ' s m e d i c a l 
h i s t o r y may be -- and i n t h i s c a s e a r e -- i n d i s p u t e , b u t 
t h e 
22 
1071224 
v e r a c i t y o f t h e h i s t o r y r e c o u n t e d b y a p a t i e n t i s a m a t t e r f o r 
t h e 
j u r y ' s 
d e t e r m i n a t i o n . 
Dr. B u c k l e y , 
l i k e 
any p h y s i c i a n 
b a s i n g 
an 
o p i n i o n on 
p a t i e n t 
h i s t o r y , 
was 
b e i n g 
a s k e d 
t o 
assume t h a t G r a v e s h a d a c c u r a t e l y r e l a t e d h e r m e d i c a l 
h i s t o r y 
and, 
b a s e d 
on 
t h a t 
a s s u m p t i o n , 
t o g i v e h i s o p i n i o n as t o 
w h e t h e r t h e I V i n f i l t r a t i o n p r o b a b l y c a u s e d G r a v e s ' s 
i n j u r y . 
On t h i s b a s i s , 
Dr. B u c k l e y c o n c l u d e d i n h i s 2004 d e p o s i t i o n 
t h a t i t 
was t h e p r o b a b l e 
c a u s e . 
Dr. 
B u c k l e y ' s 
t e s t i m o n y i n t h i s 
r e g a r d i s no 
d i f f e r e n t 
t h a n 
i f he 
was 
t o 
o f f e r 
h i s 
o p i n i o n 
i n 
r e s p o n s e 
t o 
h y p o t h e t i c a l q u e s t i o n s b a s e d upon e v i d e n c e i n t h e r e c o r d . 
An 
e x p e r t w i t n e s s "may 
g i v e an o p i n i o n b a s e d upon 
h y p o t h e t i c a l 
q u e s t i o n i n g as t o f a c t s a l r e a d y i n e v i d e n c e , o r e v i d e n c e t o be 
s u b s e q u e n t l y a d m i t t e d . " 
C r a w f o r d v . H a l l , 531 So. 2d 874, 875 
( A l a . 
1 9 8 8 ) . 
I n l i k e manner, Dr. B u c k l e y a c c e p t e d t h e h i s t o r y 
G r a v e s p r o v i d e d h i m and f o r m e d an o p i n i o n -- b a s e d upon t h a t 
i n f o r m a t i o n , h e r c o n d i t i o n , and h i s m e d i c a l k n o w l e d g e -- t h a t 
t h e I V i n f i l t r a t i o n p r o b a b l y c a u s e d G r a v e s ' s 
i n j u r y . 
I n 
f a c t , 
Dr. 
B u c k l e y 
o f f e r e d 
t h e same 
c o n c l u s i o n i n 
r e s p o n s e t o h y p o t h e t i c a l q u e s t i o n s a s k e d b y G r a v e s ' s 
c o u n s e l . 
B r o o k w o o d c o n t e n d s 
t h a t Dr. B u c k l e y ' s 
o p i n i o n e l i c i t e d 
as a 
23 
1071224 
r e s u l t o f t h e h y p o t h e t i c a l q u e s t i o n s i s n o t 
r e l i a b l e 
b e c a u s e 
" t h e e x p e r t may 
n o t g i v e h i s o p i n i o n u n l e s s t h o s e 
f a c t s h a v e 
b e e n 
p r o p e r l y 
h y p o t h e s i z e d 
b e f o r e 
t h e 
e x p e r t 
w i t n e s s . " 
B o s h e l l , 
641 
So. 
2d 
a t 
1243. 
B r o o k w o o d 
a r g u e s 
t h a t 
t h e 
h y p o t h e t i c a l q u e s t i o n s p o s e d t o Dr. B u c k l e y d i d n o t p r o p e r l y 
h y p o t h e s i z e 
t h e 
f a c t s b e c a u s e , 
i t s a y s , 
t h e q u e s t i o n s 
a s k e d 
h i m 
t o assume 
t h a t 
" t h e r e was 
no 
p r i o r 
i n j u r y , 
damage, 
o r 
t r a u m a 
t o 
t h e 
r i g h t 
h a n d . " 
B r o o k w o o d 
n o t e s 
t h a t t h e r e 
i s 
e v i d e n c e 
i n t h e 
r e c o r d 
i n d i c a t i n g 
t h a t G r a v e s ' s 
h a n d s were 
s w o l l e n b e f o r e t h e IV was 
i n s e r t e d . 
B r o o k w o o d ' s 
a r g u m e n t 
a g a i n 
m i s t a k e n l y 
assumes 
t h a t 
m e d i c a l - e x p e r t 
t e s t i m o n y 
does 
n o t 
e s t a b l i s h 
s u b s t a n t i a l 
e v i d e n c e o f c a u s a t i o n when i t i s b a s e d upon f a c t s t h a t a r e i n 
d i s p u t e . 
A " p r o p e r l y h y p o t h e s i z e d " q u e s t i o n n e e d n o t be b a s e d 
upon u n d i s p u t e d f a c t s ; i t i s enough t h a t i t i s b a s e d on 
" f a c t s 
a l r e a d y i n e v i d e n c e , o r e v i d e n c e t o be s u b s e q u e n t l y 
a d m i t t e d . " 
C r a w f o r d , 
531 
So. 
2d 
a t 
875. 
The 
q u e s t i o n s 
p o s e d 
t o 
Dr. 
B u c k l e y a c c u r a t e l y r e f l e c t e d e v i d e n c e i n t h e r e c o r d s u b m i t t e d 
by G r a v e s . 
The 
f a c t t h a t t h e r e i s a l s o e v i d e n c e i n t h e r e c o r d 
t h a t 
c o n f l i c t s 
w i t h G r a v e s ' s 
t e s t i m o n y 
s i m p l y 
r e f l e c t s 
t h e 
d i s p u t e t h a t must be r e s o l v e d by a j u r y . 
The manner i n w h i c h 
24 
1071224 
t h e 
j u r y 
r e s o l v e s 
t h e 
c o n f l i c t 
w i l l 
a f f e c t 
t h e 
u l t i m a t e 
v i a b i l i t y 
o f 
Dr. 
B u c k l e y ' s 
o p i n i o n , 
b u t 
t h e 
f a c t u a l 
d i s p u t e 
d o e s 
n o t 
a f f e c t w h e t h e r 
a 
c o n c l u s i o n 
drawn 
by 
Dr. 
B u c k l e y 
b a s e d 
upon 
G r a v e s ' s 
v e r s i o n 
o f 
t h e 
f a c t s 
c o n s t i t u t e s 
s u b s t a n t i a l 
e v i d e n c e 
f o r p u r p o s e s 
o f 
t h e 
summary 
j u d g m e n t 
e n t e r e d 
h e r e . 
B r o o k w o o d 
f u r t h e r 
c o n t e n d s 
t h a t 
r e g a r d l e s s 
o f 
how 
Dr. 
B u c k l e y ' s 2004 d e p o s i t i o n 
t e s t i m o n y 
i s c o n s i d e r e d , 
h i s 
2008 v i d e o 
d e p o s i t i o n s e t t l e s t h e m a t t e r b e c a u s e he 
t e s t i f i e d 
i n t h e 
l a t t e r 
d e p o s i t i o n m e r e l y t h a t i t was 
" p o s s i b l e , " r a t h e r 
t h a n 
" p r o b a b l e , " 
t h a t 
t h e 
I V 
i n f i l t r a t i o n 
c a u s e d 
G r a v e s ' s 
i n j u r y . 
Our 
c a s e s make i t a b u n d a n t l y c l e a r , h o w e v e r , t h a t 
a 
p o r t i o n o f t h e 
t e s t i m o n y 
o f t h e 
p l a i n t i f f ' s 
e x p e r t 
c a n n o t 
be 
v i e w e d 
" a b s t r a c t l y , i n d e p e n d e n t l y , 
and 
s e p a r a t e l y 
f r o m 
t h e 
b a l a n c e 
o f h i s t e s t i m o n y . " 
H i n e s v. A r m b r e s t e r , 
477 
So. 
2d 
302, 
304 
( A l a . 1 9 8 5 ) . 
See, 
e.g., 
Downey v. M o b i l e 
I n f i r m a r y 
 
Med. 
C t r . , 
662 
So. 
2d 
1152, 
1154 
( A l a . 
1 
995) 
( n o t i n g 
t h a t 
" [ t ] h i s 
C o u r t has 
c o n s i s t e n t l y h e l d t h a t t h e 
t e s t i m o n y 
o f 
an 
e x p e r t w i t n e s s 
i n a m e d i c a l 
m a l p r a c t i c e c a s e must be v i e w e d 
as 
a 
w h o l e , 
and 
t h a t 
a 
p o r t i o n 
o f 
i t 
s h o u l d 
n o t 
be 
v i e w e d 
a b s t r a c t l y , 
i n d e p e n d e n t l y , 
o r s e p a r a t e l y f r o m t h e b a l a n c e 
o f 
25 
1071224 
t h e e x p e r t ' s 
t e s t i m o n y " ) . 
I n o t h e r w o r d s , Dr. B u c k l e y ' s 2008 
v i d e o 
d e p o s i t i o n t e s t i m o n y must be v i e w e d i n i t s e n t i r e t y , as 
w e l l as i n c o n t e x t 
w i t h t h e t e s t i m o n y he p r o v i d e d 
i n h i s 2004 
d e p o s i t i o n . 
I t 
i s t r u e 
t h a t 
Dr. B u c k l e y 
s t a t e d 
i n h i s 2008 
v i d e o 
d e p o s i t i o n t h a t " t h e r e l a t i o n s h i p [ b e t w e e n t h e I V i n f i l t r a t i o n 
and G r a v e s ' s i n j u r y ] c e r t a i n l y i s p o s s i b l e , b u t w h e t h e r o r n o t 
i t i s p r o b a b l e i s a n o t h e r m a t t e r , and I d o n ' t t h i n k I c a n make 
a s u p p o r t a b l e 
s t a t e m e n t i n t h a t r e g a r d . " 
When c o n f r o n t e d 
w i t h 
h i s 
s t a t e m e n t 
o f 
p r o b a b i l i t y 
f r o m 
h i s 2004 
d e p o s i t i o n , 
h o w e v e r , Dr. B u c k l e y d e f e n d e d h i s 2004 t e s t i m o n y , 
e x p l a i n i n g 
t h a t " t h e r e l a t i o n s h i p upon w h i c h t h i s s t a t e m e n t 
[ t h a t t h e I V 
i n f i l t r a t i o n p r o b a b l y c a u s e d t h e i n j u r y ] i s b a s e d i s l a r g e l y 
h i s t o r i c a l , n o t b a s e d upon any s o r t o f f o r e n s i c a s s e s s m e n t o f 
t h e 
s u r g i c a l f i n d i n g s o r h i s t o l o g i c f i n d i n g s , j u s t t h a t she 
s a i d 
t h i s i s what h a p p e n e d , and I assumed t h a t was 
c o r r e c t . " 
Thus, Dr. B u c k l e y s t a t e d i n 2008 -- as he d i d i n 2004 -- 
t h a t 
a s s u m i n g 
G r a v e s ' s 
p a t i e n t 
h i s t o r y was 
a c c u r a t e , 
he 
s t i l l 
b e l i e v e d t h a t t h e I V i n f i l t r a t i o n p r o b a b l y c a u s e d h e r i n j u r y . 
I n o t h e r w o r d s , Dr. B u c k l e y ' s 2008 v i d e o 
d e p o s i t i o n 
t e s t i m o n y 
26 
1071224 
d o e s n o t 
c o n t r a d i c t t h e 
d e p o s i t i o n t e s t i m o n y 
he 
p r o v i d e d 
i n 
2004. 
"'We 
a r e t o v i e w t h e 
[ e x p e r t ] t e s t i m o n y 
as a w h o l e , 
and, 
so 
v i e w i n g 
i t , d e t e r m i n e 
i f t h e 
t e s t i m o n y 
i s 
s u f f i c i e n t 
t o 
c r e a t e a r e a s o n a b l e 
i n f e r e n c e o f t h e 
f a c t t h e p l a i n t i f f 
s e e k s 
t o 
p r o v e . ' " 
G i l e s v. B r o o k w o o d H e a l t h S e r v s . , 
I n c . , 5 So. 
3d 
533, 
550 
( A l a . 2008) 
( q u o t i n g H i n e s , 
477 
So. 
2d 
a t 
3 0 4 - 0 5 ) . 
V i e w i n g 
Dr. 
B u c k l e y ' s 
t e s t i m o n y 
as 
a w h o l e 
and 
v i e w i n g 
t h e 
e v i d e n c e 
i n t h e 
l i g h t most f a v o r a b l e 
t o G r a v e s , we 
c o n c l u d e 
t h a t G r a v e s d e m o n s t r a t e d t h e e x i s t e n c e 
o f a g e n u i n e i s s u e 
as 
t o 
m e d i c a l 
c a u s a t i o n 
and 
t h a t 
t h e 
t r i a l 
c o u r t ' s 
summary 
j u d g m e n t a g a i n s t h e r 
on 
t h i s b a s i s t h e r e f o r e was 
i n e r r o r . 
I V . 
C o n c l u s i o n 
We 
r e v e r s e t h e j u d g m e n t o f t h e 
t r i a l c o u r t , and we remand 
t h e c a u s e f o r f u r t h e r 
p r o c e e d i n g s . 
We 
a l s o n o t e 
t h a t G r a v e s 
has 
f i l e d 
a m o t i o n 
t o 
s t r i k e 
what she 
c a l l s B r o o k w o o d ' s " S u r - R e p l y B r i e f . " 
G r a v e s r e f e r s 
t o 
a l e t t e r B r o o k w o o d s e n t t o t h e 
o f f i c e o f t h e c l e r k o f 
t h i s 
C o u r t a f t e r b r i e f i n g 
c l o s e d i n t h i s c a s e i n w h i c h i t a l e r t e d 
t h e C o u r t t o a c a s e t h e C o u r t r e l e a s e d a f t e r b r i e f i n g 
c l o s e d , 
w h i c h B r o o k w o o d c l a i m e d 
" d e a l [ t ] d i r e c t l y 
w i t h 
t h e 
i s s u e 
o f 
27 
1071224 
s u f f i c i e n c y o f c a u s a t i o n t e s t i m o n y i n a m e d i c a l m a l p r a c t i c e 
a c t i o n a n d i s d i r e c t l y on p o i n t w i t h B r o o k w o o d ' s p o s i t i o n i n 
t h i s a p p e a l . "
1 0 
G r a v e s ' s p r i m a r y o b j e c t i o n t o t h e s u b m i s s i o n 
by 
B r o o k w o o d 
a p p e a r s 
t o be t h e i n c l u s i o n 
o f r e s p o n s e s t o 
a r g u m e n t s a n d s t a t e m e n t s G r a v e s made i n 
h e r r e p l y b r i e f . 
We 
f i n d G r a v e s ' s m o t i o n t o s t r i k e 
w e l l t a k e n , a n d we 
t h e r e f o r e 
g r a n t i t . 
MOTION TO STRIKE GRANTED; REVERSED AND REMANDED. 
Cobb, C . J . , 
a n d L y o n s , 
S t u a r t , a n d B o l i n , J J . , c o n c u r . 
1 0The c a s e 
n o t e d by B r o o k w o o d i s Thompson v . P a t t o n , 6 
So. 3d 1129 ( A l a . 
2 0 0 8 ) , a n d a l t h o u g h i t 
a d d r e s s e s t h e i s s u e 
o f 
c a u s a t i o n t e s t i m o n y , i t p r o v i d e s no more 
a s s i s t a n c e i n 
d e c i d i n g 
t h i s c a s e t h a n s e v e r a l o t h e r c a s e s t h a t h a d a l r e a d y 
b e e n c i t e d by t h e p a r t i e s i n t h e i r 
b r i e f s . 
28